Associations between dietary calcium and bone status were investigated in 843 Chinese women aged 35-75 y who were selected from five rural counties where dietary calcium varied considerably. Bone mineral content (BMC) and bone mineral density (BMD) at the radius were significantly higher in one of the pastoral counties with higher calcium intake than in the nonpastoral counties. Analysis by individual for all counties combined showed that BMC and BMD were correlated positively with total calcium (r = 0.27-0.38, P < 0.0001), dairy calcium (r = 0.34-0.40, P < 0.0001), and to a lesser extent with nondairy calcium (r = 0.06-0.12, P = 0.001-0.100), even after age and/or body weight were adjusted for. The results strongly indicated that dietary calcium, especially from dairy sources, increased bone mass in middle-aged and elderly women by facilitating optimal peak bone mass earlier in life.

The relationship between dietary intakes and urinary calcium was examined in a cross-sectional survey of 764 middle-aged and elderly women with markedly different dietary patterns and lifestyles. Urinary calcium was correlated positively with urinary acids, including titratable acid (r = 0.46, P < 0.0001), ammonia (r = 0.42, P < 0.0001), and sulfate (r = 0.52, P < 0.0001). Urinary excretions of calcium and acids were correlated positively with intakes of animal and nondairy animal protein but were correlated negatively with plant-protein intake, possibly because of the alkaline nature of plant foods. Further analyses showed that urinary calcium and acids were associated positively with acid-forming foods and were associated negatively with plant foods. These results indicate that under free-living conditions urinary calcium excretion is likely determined by the acid-base status of the total diet, including among other factors the contribution of sulfur amino acids to urinary acid production.

Diet, lifestyle, and BMD differed greatly between young women from Hong Kong and Beijing. Body mass index was the most important determinant of BMD in young Chinese women, whereas age, use of oral contraceptives, and diet had less pronounced effects.

Age-related bone metabolism and lack of compliance most likely explain the lack of consistent changes in BMD or bone biochemical measures in response to milk supplementation for 2 years in Chinese women aged 20-35 years.

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