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However, the calcium status of a population is challenging to measure, and there are no standard methods to identify high\u2010risk communities even in settings with an elevated prevalence of a disease caused or exacerbated by low calcium intake (e.g., rickets). The calcium status of a population depends on numerous factors, including intake of calcium\u2010rich foods; the bioavailability of the types of calcium consumed in foods and supplements; and population characteristics, including age, sex, vitamin D status, and genetic attributes that influence calcium retention and absorption. The aim of this narrative review was to assess candidate indicators of population\u2010level calcium status based on a range of biomarkers and measurement methods, including dietary assessment, calcium balance studies, hormonal factors related to calcium, and health outcomes associated with low calcium status. Several promising approaches were identified, but there was insufficient evidence of the suitability of any single indicator to assess population calcium status. Further research is required to develop and validate specific indicators of calcium status that could be derived from the analysis of data or samples that are feasibly collected in population\u2010based surveys.<\/jats:p>","DOI":"10.1111\/nyas.14886","type":"journal-article","created":{"date-parts":[[2022,8,31]],"date-time":"2022-08-31T12:44:15Z","timestamp":1661949855000},"page":"93-106","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Calcium status assessment at the population level: Candidate approaches and challenges"],"prefix":"10.1111","volume":"1517","author":[{"given":"Ziaul H.","family":"Rana","sequence":"first","affiliation":[{"name":"The New York Academy of Sciences  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1201-3397","authenticated-orcid":false,"given":"Megan W.","family":"Bourassa","sequence":"additional","affiliation":[{"name":"The New York Academy of Sciences  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1702-1433","authenticated-orcid":false,"given":"Filomena","family":"Gomes","sequence":"additional","affiliation":[{"name":"The New York Academy of Sciences  New York New York USA"},{"name":"NOVA Medical School Universidade NOVA de Lisboa  Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuradha","family":"Khadilkar","sequence":"additional","affiliation":[{"name":"Hirabai Cowasji Jehangir Medical Research Institute  Pune India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubina","family":"Mandlik","sequence":"additional","affiliation":[{"name":"Hirabai Cowasji Jehangir Medical Research Institute  Pune India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Owino","sequence":"additional","affiliation":[{"name":"Division of Human Health International Atomic Energy Agency  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Pettifor","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences University of Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7742-0925","authenticated-orcid":false,"given":"Daniel E.","family":"Roth","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children\/University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Shlisky","sequence":"additional","affiliation":[{"name":"The New York Academy of Sciences  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashanth","family":"Thankachan","sequence":"additional","affiliation":[{"name":"Saint John's Research Institute  Bangalore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connie M.","family":"Weaver","sequence":"additional","affiliation":[{"name":"San Diego State University  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,8,31]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-017-4230-x"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/advances\/nmy086"},{"key":"e_1_2_15_4_1","volume-title":"Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium","author":"Ross A. 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