Calcium prevents osteoporosis: The use of calcium and vitamin D in the management of osteoporosis

21.10.197224.08.2021 by alexxlab

Содержание

The use of calcium and vitamin D in the management of osteoporosis

Abstract

Osteoporosis poses a significant public health issue, causing significant morbidity and mortality. Calcium and vitamin D utilization in the optimization of bone health is often overlooked by patients and health care providers. In addition, the optimal standard of care for osteoporosis should encompass adequate calcium and vitamin D intake. Dietary intake or supplementation with calcium and vitamin D will be reviewed, including recent recommendations for increased vitamin D intake. Compliance to calcium and vitamin D therapy is paramount for effective prevention of osteoporotic fractures. A recently released algorithm (FRAX) estimating absolute fracture risk allows the health care provider to decide when pharmacologic therapy is warranted in addition to calcium and vitamin D. When pharmacologic therapy is advised, continued use of calcium and vitamin D is recommended for optimal fracture risk reduction. A ‘bricks and mortar’ analogy is often helpful when counseling patients and this analogy will be explained. This manuscript reviews relevant data related to calcium and vitamin D use for patients at risk for fracture due to bone loss.

Keywords: osteoporosis, calcium, vitamin D, osteopenia, hip fracture, bone

Osteoporosis overview

The skeletal disease of bone thinning and compromised bone strength, osteoporosis, continues to be a major public health issue as the population ages. This disease is characterized by bone fragility and an increased susceptibility to fractures, especially of the spine and hip, although any bone can be affected. It is estimated that over 10 million Americans over the age of 50 have osteoporosis. Risk for osteoporosis has been reported in people of all ethnic backgrounds. An additional 34 million have reduced bone mass, called osteopenia, which puts them at higher risk for fractures later in life (USDH 2004). The risk of fracture from osteoporosis increases with age. There are approximately 1.5 million osteoporotic fractures per year reported in women and men in the US, including over 300,000 hip fractures. As the population ages, this number will probably increase. The US Surgeon General estimates that one out of every two women over the age of 50 will have an osteoporosis-related fracture in their lifetime. In addition, 20% of those affected by osteoporosis are men with 6% of white males over the age of 50 suffering a hip fracture. It is estimated that the national direct care costs for osteoporotic fractures is US$12.2 to 17.9 billion per year in 2002 dollars, with costs rising. This cost is comparable to the Medicare expense for coronary heart disease ($11.6 billion) (Thom et al 2006).

Since bone loss occurs without symptoms, osteoporosis is often considered a ‘silent disease’. As deterioration of bone tissue mounts and disruption of bone architecture occurs, the bone becomes so weak that a relatively minor bump or fall causes a fracture or vertebrae to collapse. The resulting fracture may lead to loss of mobility and independence, with 25% requiring long term care (NAMS 2006). Fractures caused by either osteoporosis or low bone mass can lead to chronic pain, disability, as well as psychological symptoms, including depression. A woman’s risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer). Unfortunately, approximately 24% of patients with hip fractures over the age of 50 will die in the year following the fracture (NOF 2008).

Fortunately, the importance of this debilitating bone disease is being recognized. President Bush has declared 2002–2011 as the Decade of the Bone and Joint. Important advances have been made to understand the disease process and help create therapies to treat the condition. Bone health is optimized by creating an environment to achieve peak bone mass during adolescence, maintenance of healthy bone throughout life and prevention of bone loss with aging. Health care providers are vital to identify patients at risk for bone loss and diagnose bone thinning so that prevention and treatment strategies are effective.

The US Surgeon General has outlined a ‘pyramid approach’ to treating bone diseases. Prevention of falls with maintenance of bone health through adequate calcium, vitamin D, and physical activity represent the base of the pyramid for all individuals, including those with bone disease. The second tier of this pyramid relates to identifying and treating secondary causes of osteoporosis. Lastly, the third tier revolves around pharmacotherapy (USDH 2004).

Calcium and vitamin D have long been recognized as important and required nutrients for bone health and maintenance. The continuation of calcium and vitamin D in a patient with bone loss is critical for optimal care. Unfortunately, 90% of women may not be getting enough calcium and over 50% of women treated for bone loss have inadequate vitamin D levels (NDC 2004; Holick et al 2005). Currently, there are a number of pharmacologic treatments for osteoporosis which provide improvements in bone mass and reduction in fracture risk. These treatments have been studied where adequate calcium and vitamin D supplementation had been achieved. Therefore, their use is predicated on proper calcium and vitamin D therapy. The goal of this manuscript is to review data related to calcium and vitamin D in the management of osteoporosis.

Calcium

Nutrition

Peak bone mass is usually achieved by age 30; therefore, physical activity and obtaining the recommended doses of calcium and vitamin D in adolescence and young adulthood will ensure peak bone mass development () (IOM 1997). Calcium is an essential element in the human body and is necessary to many cell functions. Calcium is not only important to bone health, but it is also essential for neuromuscular activity, blood coagulation, and normal cardiac function. It is a vital component of bone architecture and is required for deposition of bone mineral throughout life. Although the body stores more than 99% of its calcium in the bones and teeth, it is also found in the extracellular fluid (ECF) or plasma. It is the levels of plasma calcium that dictate calcium balance. If the plasma level decreases, bone resorption increases to restore plasma levels. Adequate intake of calcium is necessary to maintain this balance. Calcium is absorbed in the small intestines with the aid of vitamin D (Bringhurst et al 2005). Excretion of calcium is primarily through the kidneys, although there is minor fecal loss.

Table 1

Recommended dietary intake of calcium and vitamin D. Adapted with permission from Institute of Medicine, Food and Nutrition Board (1997)

Age (years)	Calcium (mg/day)	Vitamin D (IU/day)
4–8	800	200
9–13	1300	200
14–18	1300	200
19–30	1000	200
31–50	1000	200
51–70	1200	400
≥70	1200	600

The best way to meet the daily dietary requirement is through the intake of high calcium containing foods. Dairy products are the best sources of calcium due to their high elemental calcium content, high absorptive rate, and relative low cost. Dietary sources of calcium include dairy products (milk, cheese, yogurt) and some green vegetables. Each daily dairy serving consumed contains approximately 300 milligrams. A serving size of dairy equals one cup (8 ounces) of milk, one cup of yogurt or one to 1.5 ounces of cheese. Therefore, each daily dairy serving multiplied by 300 mg would provide an estimated total elemental calcium consumption (IOM 1997). Mineral waters enriched with calcium are another source of dietary calcium. A recent study showed that high-calcium mineral waters had absorbabilities equal to milk calcium or slightly better and may provide useful quantities of bio-available calcium (Heaney 2006).

The individuals who do not obtain enough calcium from foods should take a supplement to meet these guidelines. Evidence suggests that the average American does not meet the lower end of the recommended daily calcium intake. The average women over the age of 40 has a calcium intake of less than half the amount recommended for postmenopausal women. In one study, 82% of patients with osteoporosis were taking less than the recommended 1000 mg daily (Black et al 1996). This highlights the need for calcium supplementation in all patient populations. In fact, patients with osteoporosis are more likely to have a history of inadequate dietary calcium intake (NIH 1994).

Supplements

In order to assure adequate calcium intake, a number of calcium supplements are readily available. The two most common and well-studied calcium supplements are calcium carbonate and calcium citrate. Both supplements have been shown to be equally well absorbed when taken with food (Heaney et al 2001). In the past, it was assumed that gastric acid secretion and gastric acidity played a critical role in the intestinal absorption of calcium. A randomized crossover trial demonstrated that the proton pump inhibitor, omeprazole, markedly decreased fractional calcium absorption from calcium carbonate when ingested by elderly women after an overnight fast on an empty stomach (O’Connell et al 2005). In addition, a case control study reported that long-term proton pump inhibitor therapy, particularly at high doses, was associated with an increased risk of hip fracture (Yang et al 2006). Research appears to support that calcium absorption can be ensured by ingestion with food. Recker (1985) reported normal absorption of calcium carbonate supplements when taken with a meal, even in achlorhydric patients. A study to evaluate the role of gastric acid on calcium absorption reported that a large does of cimetidine, which reduced gastric acid secretion, had no effect on calcium absorption from carbonate or citrate sources. In addition, calcium carbonate absorption was the same whether gastric contents were maintained at a pH of 7.4 or 3.0 (Bo-Linn et al 1984).

Calcium carbonate supplements have the highest percentage of elemental calcium among the calcium salts (). Calcium carbonate contains 40% elemental calcium compared to 21% found in calcium citrate, 13% found in calcium lactate, and 9% found in calcium gluconate (Weisman 2005). From a patient perspective, this translates into fewer calcium carbonate tablets required to achieve optimal intake on a daily basis. Quality calcium products should come from a reputable manufacturer who can provide adequate absorbability and bioavailability data. Given equivalent bioavailability of carbonate and citrate supplements, the cost benefit analysis favors the less expensive carbonate products. In fact, a leading calcium citrate product (Citracal) was reported to cost 1.5–1.8 times a leading calcium carbonate (OsCal) product when comparing grams of elemental calcium (Heaney et al 2001).

Table 2

Percentage of elemental calcium in common calcium salts. Adapted with permission from Weisman (2005)

Calcium salt	Elemental calcium (%)
Carbonate	40
Tricalcium phosphate	38
Citrate	21
Lactate	13
Gluconate	9

To ensure optimal absorption, patients should be counseled to take their calcium supplements with meals in divided doses. Since the GI tract can only absorb 500 to 600 mg of calcium at one time, supplements should be spaced by at least four to five hours to achieve the recommended intake (Heaney et al 1975).

Side effects from calcium supplements are few. Although GI side effects are often mentioned, the recently reported Women’s Health Initiative (WHI) did not reveal any difference between the calcium/vitamin D group and placebo group in the rate of adverse GI events, such as gas, bloating, or constipation (Jackson et al 2006). Clinically, it is worthwhile to recommend initiating a calcium/vitamin D supplement at a lower dose with gradual titration to the target intake amount over 1–2 months in patients that describe GI symptoms.

Drug interactions

Calcium supplements have the potential to interact with several prescription and over the counter medications. Calcium supplements may decrease levels of the drug digoxin. The interaction between calcium and vitamin D supplements and digoxin may also increase the risk of hypercalcemia. Calcium supplements also interact with fluoroquinolones, levothyroxine, antibiotics in the tetracycline family, and phenytoin. In all of these cases, calcium supplements decrease the absorption of these drugs when the two are taken at the same time (Jellin et al 2000; Shannon et al 2000).

Thiazide, and diuretics similar to thiazide, can interact with calcium and vitamin D supplements to increase the chances of developing hypercalcemia and hypercalciuria (Jellin et al 2000). Aluminum and magnesium antacids can both increase urinary calcium excretion. Mineral oil and stimulant laxatives can both decrease dietary calcium absorption (Jellin et al 2000).

In general, bisphosphonate drugs are poorly absorbed from the GI tract and can bind calcium. Therefore, bisphosphonate drugs should be taken on an empty stomach with a 30–60 minute post-dose fast. To ensure adequate absorption, it is prudent to avoid taking calcium supplements around the dose of oral bisphosphonates.

Often, the physician identifying and treating the patient for bone loss is not the same health care provider treating other acute and chronic medical conditions. Therefore, it is imperative to understand the pharmacology of the medications prescribed to patients and the potential interactions with calcium and vitamin D supplements.

Food interactions

Achieving optimal calcium intake requirements through diet alone can prove even more difficult in certain populations, such as vegetarians, those who are lactose intolerant and those with calorie-restriced diets. In addition, there are several substances that can interfere with the body’s ability to use calcium, including oxalate, protein, phytate, and caffeine.

Foods with high amounts of oxalate and phytate reduce the absorption of calcium contained in those foods. Spinach, rhubarb and beet greens are examples of foods that are high in oxalate. While these foods can be an important part of a healthy diet, they are not good sources of calcium.

Legumes, such as pinto beans, navy beans, and peas, are high in phytate. Wheat bran is also high in phytate. Therefore, it is recommended to avoid taking calcium supplements with oxalate- or phytate-rich foods to ensure adequate absorption.

Kidney stones

Kidney stones are crystallized deposits of calcium and other minerals in the urinary tract. Calcium oxalate stones are the most common form of kidney stones in the US. High calcium intakes or high calcium absorption were previously thought to contribute to the development of kidney stones. Other factors such as high oxalate intake and reduced fluid consumption appear to be more of a risk factor in the formation of kidney stones than calcium in most individuals.

A 17% increase in kidney stone formation was seen in the WHI study. However, this increase in kidney stone formation is contrary to a number of prior studies that showed no increased risk or a decreased risk of kidney stone formation; further study is warranted. Borghi and colleagues (2002) reported a 50% reduction in stone recurrence in men with a history of kidney stones who were assigned a calcium diet of 1200 mg/day compared to a low calcium group. Data from the Nurses Health Study who were followed for 12 years revealed that women with greater than 1000 mg/day calcium had lower risks of kidney stones compared to women with daily intake of less than 500 mg/day (Curhan et al 1997).

Vitamin D

Nutrition

Vitamin D is an important nutrient in the maintenance of bone health. The primary functions of vitamin D are the regulation of intestinal calcium absorption and the stimulation of bone resorption leading to the maintenance of serum calcium concentration (Reid et al 2003). Sources of vitamin D include sunlight, diet, and supplements. The majority of Americans do not achieve adequate vitamin D levels. In fact, it is estimated that 90% of adults between 51 and 70 years of age do not get enough vitamin D from their diet (Moore et al 2004).

Sunlight exposure, or ultraviolet B (UVB) radiation, is absorbed by the 7- dehydrocholesterol that resides in the skin to form previtamin D3. Previtamin D3, an unstable compound, is quickly converted to vitamin D3 via heat (MacLaughlin et al 1982). Vitamin D3 moves out into the extracellular space and is drawn into the capillaries by vitamin D-binding protein (DBP) (Holick 2005a). Once in the capillaries, the vitamin D is transported to the liver where it undergoes hydroxylation to form 25-hydroxyvitamin D [25(OH)D]. 25-hydroxyvitamin D is again bound by DBP and taken to the kidney where it is transported and released into the renal tubule cell and hydroxylated to form 1,25-dihydroxyvitamin D [1,25(OH)2D] (DeLuca 2004). This is the biologically active form of vitamin D, which is responsible for calcium homeostasis.

Dietary sources of vitamin D are absorbed into the lymphatic system via chylomicrons, where they enter the circulation and are bound by DBP (Bouillon 2001). From here, they are taken to the liver and kidneys, as explained above, for the formation of the active form of vitamin D [1,25(OH)2D].

Vitamin D deficiency

In vitamin D deficiency states, decreased calcium absorption occurs from the intestines, causing increased osteoclast production, which enhances the mobilization of calcium from the bone. During periods of decreased dietary intake, 1,25(OH)2D interacts with receptors in osteoblasts, ultimately leading to increased formation of osteoclasts (Holick 2004a). The mature osteoclast then releases enzymes to breakdown bone matrix ultimately releasing calcium and other minerals into the circulation (Holick 2005b). If the serum free calcium level remains low, the parathyroid gland is stimulated (Holick 2005a). Release of parathyroid hormone (PTH) causes increased renal reabsorption of calcium and also stimulates osteoclast production, leading to increased serum levels of calcium. If vitamin D deficiency is not corrected, calcium continues to be pulled from the bone and rickets can occur in children, while osteomalacia and osteoporosis can occur in adults.

Vitamin D sources

Sunlight is the most common source of vitamin D. Serum 25(OH)D levels are lower in individuals who use sunscreens and in those with pigmented skin. A practical and common recommendation for adequate vitamin D from sunlight is five to 15 minutes of sun exposure from the hours of 10 AM to 3 PM in the spring, summer, and autumn at least two times per week to the face, arms, hands, or back. This is usually enough for people with most skin types to maintain adequate vitamin D levels (Holick 2004b). After this exposure, sun-screen could be applied to limit solar skin damage. Therefore, it is important to remember that while harmful UV rays from sunlight can increase skin cancer risks, blocking these UV rays can predispose individuals to vitamin D deficiency.

If sufficient sunlight is not obtained, dietary sources of vitamin D can be utilized. Dietary sources of vitamin D include fatty fish such as salmon, mackerel, and sardines which provide 300 to 600 units/3.5 ounces, egg yolks which provide 20 units/yolk, and cod liver oil which provides 400 units/teaspoonful. The most common dietary source of vitamin D is found in fortified foods such as milk, orange juice, and some cereals which provide about 100 units per serving (Tangpricha et al 2003; Holick 2004a).

Due to the relative lack of vitamin D-containing foods, supplements of vitamin D are often necessary to achieve an adequate intake. The National Osteoporosis Foundation (NOF) recommends an intake of 800 to 1000 international units (IU) of vitamin D3 per day for adults over age 50 (NOF 2008). The safe upper limit for vitamin D intake for the general adult population was set at 2,000 IU per day in 1997 (SCSEDR 1997). Recent evidence indicates that higher intakes are safe and that some elderly patients will need at least this amount to maintain optimal 25(OH)D levels (NOF 2008).

Dietary sources of vitamin D can come from plants (ergocalciferol or vitamin D2) or animals (cholecalciferol or vitamin D3). Supplements can come from either source. A review of the medical and lay press appears to conclude that vitamin D2 is less effective than vitamin D3 in maintaining vitamin D status. A recent placebo controlled study compared intakes of 1000 units of D2 and 1000 units of D3 for 11 weeks at the end of winter. Interestingly, 67% of participants were vitamin D deficient at the start of the study. The authors concluded that 1000 units of vitamin D2 daily was as effective as 1000 units of vitamin D3 in maintaining serum 25-hydroxyvitamin D levels (Holick et al 2008). Therefore, vitamin D2 and D3 supplements should be considered comparable and of equal potency.

Since higher intakes of vitamin D can reduce bone resorption and subsequent bone loss, it appears that the recommended intake of vitamin D is in need of revised requirements, especially in older individuals. In an extensive review of the vitamin D literature, Vieth (1999) states that the daily reference intake should be 800–1000 units per day based upon bone density measurements and fracture prevention in the elderly. A recent report found that levels of 25(OH)D less than 10 ng/ml was linked to a 78% increase risk of falling in men and women over the age of 65 (Snijder et al 2006).

Fifty-two percent of North American women receiving therapy to prevent or treat osteoporosis were found to be vitamin D deficient after measuring serum 25(OH)D levels (Holick et al 2005). Furthermore, a survey of childbearing women in the US found 41% of African American women between 15 and 49 years of age to be vitamin D deficient at the end of winter (Nesby-O’Dell et al 2002). Lastly, 4% of Caucasian women were found to be vitamin D deficient at the end of summer.

Vitamin D serum levels can be measured to determine vitamin D stores. The value that is measured is 25(OH)D because this compound has the longest half life (two weeks) and it correlates with secondary hyperparathyroidism, rickets, and osteomalacia (unmineralized bone) (Holick 2006). The normal range of vitamin D (25(OH)D) is 10–55 ng/ml (25–137.5 nmol/L) (Weaver and Fleet 2004). The desired adult level of vitamin D (25(OH)D) is 30 ng/ml (75 nmol/L) or higher (NOF 2008).

Osteoporosis

Diagnosis

Recently, the NOF released its new Clinician’s Guide to Prevention and Treatment of Osteoporosis (NOF 2008). These guidelines are described as a major breakthrough in the way health care providers evaluate and treat patients with low bone mass or osteoporosis and the risk of fractures. The guidelines allow specific recommendations to many races, including Caucasian postmenopausal women, as well as African-American, Asian, Latina, and other postmenopausal women. It also addresses men aged 50 and older for the first time.

The most common clinical tool to diagnose osteoporosis and predict fracture risk is a bone mineral density (BMD) test. A measurement of bone density is often considered when it will help guide decisions regarding treatment to prevent osteoporotic fractures. The NOF recommends testing all women age 65 and older and men age 70 and older, regardless of clinical risk factors. Other indications for BMD testing include: (NOF 2008)

Younger postmenopausal women and men aged 50–70 about whom you have concern based on their clinical risk factor profile.
Women in the menopausal transition if there if a specific risk factor associated with increased fracture risk such as low body weight, prior low-trauma fracture, or high risk medication.
Adults who have a fracture after age 50.
Adults with a condition (eg, rheumatoid arthritis) or taking a medication (eg, glucocorticoids, ≥5 mg/day for ≥ 3 months) associated with low bone mass or bone loss.
Anyone being considered for pharmacologic therapy for osteoporosis.
Anyone being treated for osteoporosis, to monitor treatment effect.
Anyone not receiving therapy in whom evidence of bone loss would lead to treatment.
Postmenopausal women discontinuing estrogen therapy should be considered for bone density testing.

The updated NOF guidelines include the use of a new algorithm on absolute fracture risk, called FRAX by the World Health Organization (WHO). The FRAX algorithm takes into account not only BMD at the hip but also nine specific clinical risk factors for osteoporosis and related fractures. This algorithm estimates the 10-year hip fracture probability and 10-year all major osteoporosis-related fracture probability. Treatment is recommended for patients with hip or vertebral (clinical or morphometric) fractures, as well as those with BMD T-scores ≤ −2.5 at the femoral neck, total hip, or spine by DXA, after appropriate evaluation.

Treatment guidelines help the clinician decide which patients with osteopenia warrant pharmacologic treatment. Treatment is recommended for postmenopausal women and in men age 50 and older with low bone mass (T-score −1 to −2.5, osteopenia) at the femoral neck, total hip, or spine and 10-year hip fracture probability ≥3% or a 10-year all major osteoporosis-related fracture probability of ≥20% based on the US-adapted WHO absolute fracture risk model.

Menopause often leads to increases in bone loss with the most rapid rates of bone loss occurring during the first five years after menopause (Gallagher et al 1987). A drop in estrogen production after menopause results in increased bone resorption, and decreased calcium absorption (Gallagher et al 1980; Breslau 1994). Annual decreases in bone mass of 3%–5% per year are often seen during the years immediately following menopause, with decreases less than 1% per year seen after age 65 (Daniels 2001). Post-menopausal hormone therapy can decrease the incidence of osteoporosis and reduce fracture risk. However, since many women have elected to discontinue or avoid hormone therapy after menopause, it is imperative for health care providers to actively identify those women at risk for bone thinning and fracture. Counseling is especially prudent regarding weight bearing exercise and calcium/vitamin D intake during the perimenopause transition.

Treatment considerations

Calcium studies

Calcium supplementation has shown effectiveness for preventing osteoporotic fractures in postmenopausal women. A meta-analysis reviewed the literature from 1966 to 1997 assessing the effectiveness of calcium supplementation for the prevention of osteoporotic fractures in postmenopausal women. Only studies with fracture outcomes were eligible. This analysis revealed relative risk reductions between 25% to 70% for osteoporotic fractures. Most trials reported an approximate 30% fracture risk reduction with an intake of approximately 1000 mg/day of elemental calcium (Cummings and Nevitt 1997).

Over 18 months, a trial of elderly French women found that the number of hip fractures was reduced by 43% and nonvertebral fractures was reduced by 32% among women treated with calcium (1200 mg/day) and vitamin D (800 units/day) than among those who received placebo (Chapuy et al 1992).

Dawson-Hughes and colleagues (1990) reported that bone loss is reduced in healthy, older postmenopausal women by increasing calcium intake from 400 mg/day to 800 mg/day. In addition, postmenopausal women (within three to six years of menopause) supplemented with 1700 mg/day of calcium had reduced bone loss from the femoral neck and improved calcium balance in a study of 118 healthy white women (Aloia et al 1994). Another study revealed that dietary supplementation of calcium and vitamin D in men and women over 65 years of age could reduce bone loss in the femoral neck and spine while reducing the incidence of nonvertebral fractures over three years (Dawson-Hughes et al 1997).

A meta-analysis of 15 trials with 1806 study participants found that calcium alone caused a positive mean percentage BMD change from baseline of 2.05% for total body bone density, 1.66% at the lumbar spine, 1.6% at the hip, and 1.9% at the distal radius. The data also showed a trend toward reduction in vertebral fractures, with relative risk reduction of 0.79 (95% CI 0.54 to 1.09). However, the risk reduction for nonvertebral fractures was unclear (RR = 0.86 (95% CI 0.43 to 1.72) (Shea et al 2004).

The recent RECORD trial studied 5292 people over 70 years of age to evaluate the effectiveness of calcium and/or vitamin D supplements for the secondary prevention of fractures. Follow-up was between 24 and 62 months. The groups studied did not reveal significant reductions in future fractures. However, compliance with the supplements was a significant problem with this study. At 24 months, only 54.5% of subjects were still taking the supplement (Grant et al 2005).

A more recent meta-analysis of 29 studies, with over 63,000 individuals analyzed, looked at calcium and calcium in combination with vitamin D trials for use in prevention of fracture and bone loss was recently reported. The authors concluded that treatment was associated with a 12% risk reduction in fractures of all types. Trials with higher compliance revealed significant risk reduction compared to studies with lower compliance. In the 8 studies with greater than 80% compliance, a 24% risk reduction for all fractures was identified. The author’s conclusions were that calcium, or calcium in combination with vitamin D supplementation, was effective in the preventive treatment of osteoporosis in people aged 50 years or older. It appeared that the best effect was seen with minimum doses of 1200 mg of calcium and 800 units of vitamin D daily (Tang et al 2007).

Supplementation with vitamin D in individuals with severe calcium deficiency did not lead to bone sparing. However, calcium repletion in study subjects with marginal vitamin D levels resulted in bone sparing. Therefore, optimal intake of vitamin D is influenced by calcium intake. Optimal bone health requires both a high dietary calcium intake and high vitamin D intake (Weaver and Fleet 2004). Counseling patients that many calcium supplements also contain vitamin D is one convenient mechanism by which adequate supplementation can be achieved.

A recent study from the WHI reported results regarding calcium and vitamin D supplementation and the risk of fractures. This study randomly assigned over 36,000 healthy postmenopausal women to receive daily doses of 1000 mg calcium carbonate and 400 units of vitamin D or placebo, with a seven-year follow up with respect to fractures and BMD. The conclusions drawn from the study revealed a small but significant improvement in hip bone density, but no significant reduction in hip fracture. This trial was well conducted but left many questions unanswered. Pertinent findings within this study were that women who were adherent to their study regimen (those who took over 80% of their study calcium/vitamin D) had a significant 29% reduction in hip fracture. Women aged 60 and over (those at highest risk of fracture) had a significant 21% reduction in hip fracture risk.

Sixty-four percent of women in the placebo group had a daily calcium intake from diet and supplements of at least 800 mg and 42% had a daily vitamin D intake of at least 400 units. In addition, the study participants had average daily calcium intakes of 1150 mg before the study began, which is nearly double the national average. Therefore, this intake may certainly reduce the chances of detecting a benefit of additional calcium and vitamin D therapy in this study (Jackson et al 2006).

The data from these studies indicate a vital role for calcium and vitamin D related to optimal bone health. It is imperative that calcium and vitamin D counseling be conducted throughout life. Ensuring peak bone development via adequate nutritional intake during adolescence along with continued repeated discussions throughout a person’s life can significantly limit morbidity and mortality from osteoporosis. Poor compliance is a major obstacle in many medical regimens. Based on evidence presented, calcium and vitamin D supplementation compliance is vital to ensuring optimal risk reduction and fracture prevention.

Vitamin D studies

Vitamin D has been extensively studied regarding its impact on fracture risk reduction. In fact, vitamin D deficiency has been associated with greater incidence of hip fracture in many populations, including postmenopausal women (Chapuy et al 1992; Dawson-Hughes et al 1995). In a detailed review by LeBoff and colleagues (1999) of women with osteoporosis who were hospitalized due to hip fractures, 50% were found to have signs of vitamin D deficiency.

Reasons for an increased risk of fracture associated with vitamin D deficiency are numerous. Inability to absorb adequate amounts of calcium for optimal bone health, as well as an increased susceptibility of falling, impaired muscle strength, and increased rates of bone loss can increase the risk of fracture (Lips 2001). It has been reported that lower levels of vitamin D are independently associated with an increased risk of falling in the elderly. In fact, supplementation with vitamin D has been shown to improve musculoskeletal function and reduce the risk of falling in elderly women (Bischoff et al 2003). Human muscle contains vitamin D receptors that may lead to increasing muscle strength and improving stability (Snijder et al 2006). The combination of 700 units/day of vitamin D and 500 mg of calcium (obtained through supplementation in addition to diet) was shown to reduce falls by as much as 65% over three years in less active women over the age of 65 (Bischoff-Ferrari et al 2006).

It appears that vitamin D supplementation may prove more beneficial in reducing falls and increasing bone density in elderly women who have suffered a hip fracture when given with calcium (Harwood et al 2004). The Decalyos II study examined the effect of calcium and vitamin D supplementation over two years in a group of elderly women who were able to walk indoors with a cane or walker. Results suggested that such supplementation could reduce the risk of hip fractures in this population (Chapuy et al 2002).

All vitamin D trials from 1966 to 1999 for postmenopausal osteoporosis were evaluated in a meta-analysis to review the effect of vitamin D on bone density and fractures. Twenty-five trials that randomized women to vitamin D with or without calcium and measured bone density or fracture for at least one year were chosen. The results revealed a 37% reduction in vertebral fractures (Papadimitropoulos et al 2002).

A Cochrane Database review reported that vitamin D alone showed no statistically significant effect on hip fracture, vertebral fracture, or any new fracture. Vitamin D with calcium marginally reduced hip fractures and nonvertebral fractures, but there was no evidence of effect of vitamin D with calcium on vertebral fractures. Compliance to the supplements was not reported. The effect appeared to be restricted to those living in institutional care. There was no evidence that vitamin D increased gastrointestinal symptoms or renal disease. The conclusion was that frail older people confined to institutions may sustain fewer hip and other nonvertebral fractures if given vitamin D with calcium supplements. Further investigation regarding dose, frequency, and route of administration of vitamin D in older people was recommended (Avenell et al 2005).

Another meta-analysis of randomized, controlled fracture prevention trials with vitamin D reported that oral vitamin D supplementation between 700 to 800 units per day appeared to reduce the risk of hip and any nonvertebral fractures in ambulatory or institutionalized elderly persons. An oral vitamin D dose of 400 IU/d was not sufficient for fracture prevention. A vitamin D dose of 700 to 800 units per day reduced the relative risk of hip fracture by 26% and any nonvertebral fracture by 23% (Bischoff-Ferrari et al 2005). Subsequently, an enhanced meta-analysis was done to define the need for additional calcium supplementation in individuals receiving vitamin D for the prevention of hip fractures. Findings suggested that oral vitamin D appears to reduce the risk of hip fractures only when calcium supplementation is added (Boonen et al 2007).

Pharmacological treatment

Currently, there are a number of prescription therapeutic options for the prevention and treatment of osteoporosis. The antiresorptive medications are the largest group and include bisphosphonates (Actonel, Boniva, Fosamax, Reclast), selective estrogen receptor modulators (Evista), hormone therapy and calcitonin (Miacalcin). Teriparatide is a parathyroid hormone derivative that acts as an anabolic agent on bone and is indicated for post-menopausal women with osteoporosis who are at high risk of fracture (Eli Lilly 2008). A review of studies that led to the FDA approval of prescription medications used for the treatment of osteoporosis found that 80% of studies had been performed under conditions where a certain minimum calcium and vitamin D intake was ensured (Sunyecz and Weisman 2005). Therefore, one cannot conclude that these prescription medications would be as effective in calcium and vitamin D deficient patients. Unfortunately, calcium use during osteoporosis therapy is often under-utilized by patients and not appropriately counseled by physicians. In 1994, 43% of osteoporosis visits had some form of counseling for calcium. By 2000, this proportion had declined to 29% and fell to 23% by 2004 (Stafford et al 2005).

An effective tool that can be used to help patients understand the importance of calcium and vitamin D when using prescription medications for bone loss is the ‘brick and mortar’ analogy. In the analogy, reference is made to building a strong structural foundation. The antiresorptive medication serves as the ‘bricks’, while adequate calcium and vitamin D serve as the ‘mortar’. Without both ‘brick’ and ‘mortar’, the structure (healthy bone) could not be achieved.

Oral bisphosphonate medications must be taken on an empty stomach. Package inserts for oral bisphosphonate caution that calcium supplements may interfere with bisphos-phonate absorption and should be taken at a different time of day. Calcium citrate products can be taken on an empty stomach or with food, while calcium carbonate products should be taken with meals. Therefore, patients (especially calcium citrate users) need to be counseled to avoid taking their calcium supplements with bisphosphonates.

It is imperative for the health care provider to be aware that adequate calcium and vitamin D stores must be present to allow pharmacologic treatments for osteoporosis to be effective.

Summary

Bone loss and osteoporosis with the resultant increase in fracture risk should be major concerns for patients and health care providers. As the population ages, the long term effects of osteoporosis including pain, loss of independence and institutionalized care will become more prevalent. Efforts to prevent bone loss and osteoporosis should start with proper education about a healthy lifestyle, including optimal calcium and vitamin D and exercise in adolescence. This education should continue throughout life, with emphasis during times of increased bone loss such as the menopause transition.

This paper reviews the cornerstone of bone health; calcium and vitamin D. Although dietary sources of both nutrients are available, most people do not receive adequate amounts for proper bone health. In addition, the heightened awareness of damaging effects of sunlight has limited vitamin D synthesis from the skin. Fortunately, supplements are available that can supply the body with amounts necessary for bone health. As reviewed, there is ample evidence that calcium and vitamin D alone have the ability to prevent bone loss and reduce fracture. The one caveat is that compliance must be emphasized. Clearly, with diminished compliance the protective effects of calcium and vitamin D are lost. Continued discussions with patients to promote awareness of bone health and enhance compliance with calcium and vitamin D supplements, as well as prescription drugs, should be completed. Utilizing the entire health care team can be beneficial in this quest. Office staff should understand and remind patients about bone health at key times, such as during scheduling of bone density testing. The health care provider should highlight proper nutrition and supplementation at pertinent times. For example, annual examinations are excellent times to review calcium and vitamin D intake with recommendations for supplementation reviewed. The pharmacist has a vital role in making patients aware of the need for calcium and vitamin D with prescription osteoporosis therapies, including proper administration to ensure absorption of bisphosphonate medications.

The use of calcium and vitamin D in the management of osteoporosis

Abstract

Keywords: osteoporosis, calcium, vitamin D, osteopenia, hip fracture, bone

Osteoporosis overview

Calcium

Nutrition

Table 1

Recommended dietary intake of calcium and vitamin D. Adapted with permission from Institute of Medicine, Food and Nutrition Board (1997)

Age (years)	Calcium (mg/day)	Vitamin D (IU/day)
4–8	800	200
9–13	1300	200
14–18	1300	200
19–30	1000	200
31–50	1000	200
51–70	1200	400
≥70	1200	600

Supplements

Table 2

Percentage of elemental calcium in common calcium salts. Adapted with permission from Weisman (2005)

Calcium salt	Elemental calcium (%)
Carbonate	40
Tricalcium phosphate	38
Citrate	21
Lactate	13
Gluconate	9

Drug interactions

Food interactions

Kidney stones

Vitamin D

Nutrition

Vitamin D deficiency

Vitamin D sources

Osteoporosis

Diagnosis

Younger postmenopausal women and men aged 50–70 about whom you have concern based on their clinical risk factor profile.
Women in the menopausal transition if there if a specific risk factor associated with increased fracture risk such as low body weight, prior low-trauma fracture, or high risk medication.
Adults who have a fracture after age 50.
Adults with a condition (eg, rheumatoid arthritis) or taking a medication (eg, glucocorticoids, ≥5 mg/day for ≥ 3 months) associated with low bone mass or bone loss.
Anyone being considered for pharmacologic therapy for osteoporosis.
Anyone being treated for osteoporosis, to monitor treatment effect.
Anyone not receiving therapy in whom evidence of bone loss would lead to treatment.
Postmenopausal women discontinuing estrogen therapy should be considered for bone density testing.

Treatment considerations

Calcium studies

Vitamin D studies

Pharmacological treatment

It is imperative for the health care provider to be aware that adequate calcium and vitamin D stores must be present to allow pharmacologic treatments for osteoporosis to be effective.

Summary

The use of calcium and vitamin D in the management of osteoporosis

Abstract

Keywords: osteoporosis, calcium, vitamin D, osteopenia, hip fracture, bone

Osteoporosis overview

Calcium

Nutrition

Table 1

Recommended dietary intake of calcium and vitamin D. Adapted with permission from Institute of Medicine, Food and Nutrition Board (1997)

Age (years)	Calcium (mg/day)	Vitamin D (IU/day)
4–8	800	200
9–13	1300	200
14–18	1300	200
19–30	1000	200
31–50	1000	200
51–70	1200	400
≥70	1200	600

Supplements

Table 2

Percentage of elemental calcium in common calcium salts. Adapted with permission from Weisman (2005)

Calcium salt	Elemental calcium (%)
Carbonate	40
Tricalcium phosphate	38
Citrate	21
Lactate	13
Gluconate	9

Drug interactions

Food interactions

Kidney stones

Vitamin D

Nutrition

Vitamin D deficiency

Vitamin D sources

Osteoporosis

Diagnosis

Younger postmenopausal women and men aged 50–70 about whom you have concern based on their clinical risk factor profile.
Women in the menopausal transition if there if a specific risk factor associated with increased fracture risk such as low body weight, prior low-trauma fracture, or high risk medication.
Adults who have a fracture after age 50.
Adults with a condition (eg, rheumatoid arthritis) or taking a medication (eg, glucocorticoids, ≥5 mg/day for ≥ 3 months) associated with low bone mass or bone loss.
Anyone being considered for pharmacologic therapy for osteoporosis.
Anyone being treated for osteoporosis, to monitor treatment effect.
Anyone not receiving therapy in whom evidence of bone loss would lead to treatment.
Postmenopausal women discontinuing estrogen therapy should be considered for bone density testing.

Treatment considerations

Calcium studies

Vitamin D studies

Pharmacological treatment

It is imperative for the health care provider to be aware that adequate calcium and vitamin D stores must be present to allow pharmacologic treatments for osteoporosis to be effective.

Summary

The use of calcium and vitamin D in the management of osteoporosis

Abstract

Keywords: osteoporosis, calcium, vitamin D, osteopenia, hip fracture, bone

Osteoporosis overview

Calcium

Nutrition

Table 1

Recommended dietary intake of calcium and vitamin D. Adapted with permission from Institute of Medicine, Food and Nutrition Board (1997)

Age (years)	Calcium (mg/day)	Vitamin D (IU/day)
4–8	800	200
9–13	1300	200
14–18	1300	200
19–30	1000	200
31–50	1000	200
51–70	1200	400
≥70	1200	600

Supplements

Table 2

Percentage of elemental calcium in common calcium salts. Adapted with permission from Weisman (2005)

Calcium salt	Elemental calcium (%)
Carbonate	40
Tricalcium phosphate	38
Citrate	21
Lactate	13
Gluconate	9

Drug interactions

Food interactions

Kidney stones

Vitamin D

Nutrition

Vitamin D deficiency

Vitamin D sources

Osteoporosis

Diagnosis

Younger postmenopausal women and men aged 50–70 about whom you have concern based on their clinical risk factor profile.
Women in the menopausal transition if there if a specific risk factor associated with increased fracture risk such as low body weight, prior low-trauma fracture, or high risk medication.
Adults who have a fracture after age 50.
Adults with a condition (eg, rheumatoid arthritis) or taking a medication (eg, glucocorticoids, ≥5 mg/day for ≥ 3 months) associated with low bone mass or bone loss.
Anyone being considered for pharmacologic therapy for osteoporosis.
Anyone being treated for osteoporosis, to monitor treatment effect.
Anyone not receiving therapy in whom evidence of bone loss would lead to treatment.
Postmenopausal women discontinuing estrogen therapy should be considered for bone density testing.

Treatment considerations

Calcium studies

Vitamin D studies

Pharmacological treatment

It is imperative for the health care provider to be aware that adequate calcium and vitamin D stores must be present to allow pharmacologic treatments for osteoporosis to be effective.

Summary

Calcium and calcium supplements: Achieving the right balance

Calcium is important for bone health. See how much you need and how to get it.

By Mayo Clinic Staff

Calcium is important for bone health throughout your life. Although diet is the best way to get calcium, calcium supplements may be an option if your diet falls short.

Before you consider calcium supplements, be sure you understand how much calcium you need, the pros and cons of calcium supplements, and which type of supplement to choose.

The benefits of calcium

Your body needs calcium to build and maintain strong bones. Your heart, muscles and nerves also need calcium to function properly.

Some studies suggest that calcium, along with vitamin D, may have benefits beyond bone health: perhaps protecting against cancer, diabetes and high blood pressure. But evidence about such health benefits is not definitive.

The risks of too little calcium

If you don’t get enough calcium, you could face health problems related to weak bones:

Children may not reach their full potential adult height.
Adults may have low bone mass, which is a risk factor for osteoporosis.

Many Americans don’t get enough calcium in their diets. Children and adolescents are at risk, but so are adults age 50 and older.

Calcium requirements

How much calcium you need depends on your age and sex.

Calcium: Recommended daily amount
Men
19-50 years	1,000 mg
51-70 years	1,000 mg
71 and older	1,200 mg
Women
19-50 years	1,000 mg
51 and older	1,200 mg

The recommended upper limit for calcium is 2,500 mg a day for adults 19 to 50. For those 51 and older, the limit is 2,000 mg a day.

Calcium and diet

Your body doesn’t produce calcium, so you must get it through other sources. Calcium can be found in a variety of foods, including:

Dairy products, such as cheese, milk and yogurt
Dark green leafy vegetables, such as broccoli and kale
Fish with edible soft bones, such as sardines and canned salmon
Calcium-fortified foods and beverages, such as soy products, cereal and fruit juices, and milk substitutes

To absorb calcium, your body also needs vitamin D. A few foods naturally contain small amounts of vitamin D, such as canned salmon with bones and egg yolks. You can also get vitamin D from fortified foods and sun exposure. The RDA for vitamin D is 600 international units (15 micrograms) a day for most adults.

Who should consider calcium supplements?

Even if you eat a healthy, balanced diet, you may find it difficult to get enough calcium if you:

Follow a vegan diet
Have lactose intolerance and limit dairy products
Consume large amounts of protein or sodium, which can cause your body to excrete more calcium
Are receiving long-term treatment with corticosteroids
Have certain bowel or digestive diseases that decrease your ability to absorb calcium, such as inflammatory bowel disease or celiac disease

In these situations, calcium supplements may help you meet your calcium requirements. Talk with your doctor or dietitian about whether calcium supplements are right for you.

Do calcium supplements have risks?

Calcium supplements aren’t for everyone. For instance, if you have a health condition that causes excess calcium in your bloodstream (hypercalcemia), you should avoid calcium supplements.

It’s not definitive, but there may be a link between high-dose calcium supplements and heart disease. The evidence is mixed and more research is needed before doctors know the effect calcium supplements may have on heart attack risk.

A similar controversy surrounds calcium and prostate cancer. Some studies have shown that high calcium intake from dairy products and supplements may increase risk, whereas another more recent study showed no increased risk of prostate cancer associated with total calcium, dietary calcium or supplemental calcium intakes.

Until more is known about these possible risks, it’s important to be careful to avoid excessive amounts of calcium. As with any health issue, it’s important to talk to your doctor to determine what’s right for you.

Types of calcium supplements

Several different kinds of calcium compounds are used in calcium supplements. Each compound contains varying amounts of the mineral calcium — referred to as elemental calcium. Common calcium supplements may be labeled as:

Calcium carbonate (40% elemental calcium)
Calcium citrate (21% elemental calcium)
Calcium gluconate (9% elemental calcium)
Calcium lactate (13% elemental calcium)

The two main forms of calcium supplements are carbonate and citrate. Calcium carbonate is cheapest and therefore often a good first choice. Other forms of calcium in supplements include gluconate and lactate.

In addition, some calcium supplements are combined with vitamins and other minerals. For instance, some calcium supplements may also contain vitamin D or magnesium. Check the ingredient list to see which form of calcium your calcium supplement is and what other nutrients it may contain. This information is important if you have any health or dietary concerns.

Choosing calcium supplements

When looking at calcium supplements, consider these factors:

Amount of calcium

Elemental calcium is important because it’s the actual amount of calcium in the supplement. It’s what your body absorbs for bone growth and other health benefits. The Supplement Facts label on calcium supplements is helpful in determining how much calcium is in one serving. As an example, calcium carbonate is 40% elemental calcium, so 1,250 milligrams (mg) of calcium carbonate contains 500 mg of elemental calcium. Be sure to note the serving size (number of tablets) when determining how much calcium is in one serving.

Tolerability

Calcium supplements cause few, if any, side effects. But side effects can sometimes occur, including gas, constipation and bloating. In general, calcium carbonate is the most constipating. You may need to try a few different brands or types of calcium supplements to find one that you tolerate the best.

What prescriptions you take

Calcium supplements can interact with many different prescription medications, including blood pressure medications, synthetic thyroid hormones, bisphosphonates, antibiotics and calcium channel blockers. Depending on your medications, you may need to take the supplement with your meals or between meals. Ask your doctor or pharmacist about possible interactions and which type of calcium supplement would work for you.

Quality and cost

Manufacturers are responsible for ensuring that supplements are safe and claims are truthful. Some companies have their products independently tested by U.S. Pharmacopeial Convention (USP), ConsumerLab.com (CL) or NSF International. Supplements that bear the USP, CL or NSF abbreviation meet voluntary industry standards for quality, purity, potency, and tablet disintegration or dissolution. Different types of calcium supplements have different costs. Comparison shop if cost is a factor for you.

Supplement form

Calcium supplements are available in a variety of forms, including tablets, capsules, chews, liquids and powders. If you have trouble swallowing pills, you may want a chewable or liquid calcium supplement.

Absorbability

Your body must be able to absorb the calcium for it to be effective. All varieties of calcium supplements are better absorbed when taken in small doses (500 mg or less) at mealtimes. Calcium citrate is absorbed equally well when taken with or without food and is a form recommended for individuals with low stomach acid (more common in people over 50 or taking acid blockers), inflammatory bowel disease or absorption disorders.

More isn’t always better: Too much calcium has risks

Dietary calcium is generally safe, but more isn’t necessarily better, and excessive calcium doesn’t provide extra bone protection.

If you take calcium supplements and eat calcium-fortified foods, you may be getting more calcium than you realize. Check food and supplement labels to monitor how much total calcium you’re getting a day and whether you’re achieving the RDA but not exceeding the recommended upper limit. Be sure to tell your doctor if you’re taking calcium supplements.

Nov. 14, 2020

Show references

Calcium and vitamin D: Important at every age. National Institutes of Health. https://www.bones.nih.gov/health-info/bone/bone-health/nutrition/calcium-and-vitamin-d-important-every-age. Accessed Oct. 18, 2020.
Calcium. Natural Medicines. http://naturalmedicines.therapeuticresearch.com. Accessed Oct. 18, 2020.
Calcium fact sheet for professionals. Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/. Accessed Oct. 18, 2020.
Rosen HN. Calcium and vitamin D supplementation in osteoporosis. https://www.uptodate.com/contents/search. Accessed Oct. 18, 2020.
2015-2020 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/introduction/dietary-guidelines-for-americans/. Accessed Oct. 18, 2020.
Dietary Guidelines Advisory Committee. Scientific report of the 2020 Dietary Guidelines Advisory Committee: Advisory report to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture, Agricultural Research Service. https://www.dietaryguidelines.gov/2020-advisory-committee-report. Accessed Oct. 18, 2020.
What people with celiac disease need to know about osteoporosis. NIH Osteoporosis and Related Bone Diseases National Resource Center. https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/celiac. Accessed Oct. 18, 2020.
Dietary supplements verification program. U.S. Pharmacopeial Convention. https://www.usp.org/verification-services/dietary-supplements-verification-program. Accessed Oct. 18, 2020.
About ConsumerLab.com. ConsumerLab.com. https://www.consumerlab.com/aboutcl.asp. Accessed Oct. 18, 2020.
What is third-party certification? NSF International. https://www.nsf.org/about-nsf/what-is-third-party-certification. Accessed Oct. 18, 2020.

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Vitamin D and Calcium Supplements for Preventing Fractures | Guidelines | JAMA

The US Preventive Services Task Force (USPSTF) has recently published recommendations on vitamin D and calcium supplements for preventing bone fractures in adults.

The Role of Vitamin D and Calcium in Bone Health

Calcium is an essential mineral for many body functions, including building and maintaining healthy bones. Human bodies do not make calcium; they get it from food or supplements. Because bones are constantly being broken down and rebuilt, calcium is needed throughout life. Vitamin D also is essential for bone health, mostly because it helps ingested calcium be absorbed from the intestine. Most vitamin D in the body is made by the skin in response to sunlight, but it can also be absorbed from food and supplements.

Bone Density and Fracture Risk

As people age, the rate of bone breakdown starts to overtake the rate of bone building. In women, a major reason is a decrease in estrogen levels during menopause. Over time, this can lead to low bone density (weak bones). Eventually, it can cause osteoporosis (porous bones). People with osteoporosis are more likely to have bone fractures, especially after trauma such as a fall. Getting enough vitamin D and calcium through food earlier in life can decrease the risk of developing osteoporosis later in life. However, the role of taking vitamin D and calcium supplements is less clear.

What Is the Population Under Consideration for Taking Vitamin D and Calcium Supplements to Prevent Fractures?

This recommendation applies to adults with no known osteoporosis or vitamin D deficiency, no history of osteoporotic bone fractures, and no increased risk of falls and who live in the community (not in a nursing home or other institutional care setting).

What Are the Potential Benefits and Harms of Taking Vitamin D and Calcium Supplements to Prevent Fractures?

The possible benefit of taking vitamin D and calcium supplements is that it helps prevent osteoporosis, thereby decreasing bone fractures. However, there is currently not enough evidence to say that this is the case for most older adults. Evidence does show that taking lower doses of vitamin D and calcium (≤400 IU of vitamin D and ≤1000 mg of calcium daily) does not prevent fractures in postmenopausal women. Potential harms of taking combined vitamin D and calcium supplements include a small increased risk of kidney stones. The possible link between vitamin D and calcium supplementation and cardiovascular disease outcomes is controversial, but no studies have shown a direct link between them.

How Strong Is the Recommendation to Take Vitamin D and Calcium Supplements to Prevent Fractures?

For men and women who have not gone through menopause, there is not enough evidence to weigh the benefits and harms of taking vitamin D and calcium supplements for preventing fractures. For postmenopausal women, there is not enough evidence to weigh the benefits and harms of taking >400 IU of vitamin D and >1000 mg of calcium daily, but there is some evidence that taking ≤400 IU of vitamin D and ≤1000 mg of calcium daily has no net benefit for preventing fractures.

Bottom Line: Current Recommendation for Taking Vitamin D and Calcium Supplements to Prevent Fractures

The USPSTF concludes that for community-dwelling men and premenopausal women, there is insufficient evidence to assess the balance of benefits and harms of vitamin D and calcium supplementation, alone or combined, for the prevention of fractures (“I” statement). For postmenopausal women, the USPSTF recommends against taking ≤400 IU of vitamin D and ≤1000 mg of calcium daily for preventing fractures (“D” statement). For postmenopausal women, there is insufficient evidence for taking >400 IU of vitamin D and >1000 mg of calcium daily for preventing fractures (“I” statement).

Source: US Preventive Services Task Force. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults [published online April 17, 2018]. JAMA. doi:10.1001/jama.2018.3185

Topic: Preventive Medicine

Osteoporosis: The Role of Calcium in Osteoporosis.

The bones of the human skeleton contain 99.5% of the total calcium in the body. The calcium within bones is available to the body should the body need it for other purposes. It is the activity of bone osteoclasts which absorb the calcium in the bone and release it into the blood stream (more about this on our parathyroid and osteoporosis page). Remember, it is the calcium within the bones which makes them strong.

The daily recommended dietary calcium intake varies by age, sex, and menopausal status. Recent studies have shown that many American girls do not get enough calcium in their diet after the age of 11. Much of this is blamed upon the substitution of sodas in the diet for milk, yet the problem does not seem to be the same for males (for a number of subtle reasons). It is important to know that many women of all ages in the US do not get enough calcium in their diet either. The vast majority of endocrinologists encourage their female patients to take supplemental calcium daily. One of the easiest and most effective methods of increasing your calcium intake is to take an oral calcium supplement daily. There are several forms of oral calcium readily available over the counter (without a perscription) such as Citracal which can help maintain healthy bones and prevent osteoporosis. The following list shows the recommended calcium intake according to age, sex and hormone status.

Age	Amount of Daily Calcium
Birth to 6 months	400mg
Six months to 1 year	600mg
One to 10 years	800 – 1,200 mg
11 to 24 years	1,200 – 1,500 mg
Pregnant or Lactating	1,200 – 1,500 mg
25 to 49 years (premenopausal)	1,000 mg
50 to 64 years (postmenopausal taking estrogen or similar hormone)	1,000 mg
50 to 64 years (postmenopausal not taking estrogen or similar hormone)	1,500 mg
Over 65 years old	1,500 mg
25 to 64 years old	1,000 mg
Over 65 years old	1,500 mg

Source: National Institutes of Health Consensus Panel, Optimal Calcium Intake, 1994.

Updated on: 04/18/16

90,000 Calcium preparations for osteoporosis in women, men and the elderly.

If fractures occur with minimal impact on the bone, osteoporosis may be one of the reasons. ¹. In this chronic progressive disease, the mineral composition of the bone tissue changes, its density decreases and the internal structure of the bone is disturbed. Osteoporosis affects the mechanical and biological factors of bone repair, so the healing process can be slowed down ².With a hip fracture, osteoporosis is of critical importance – mortality from complications among older people during the first year ranges from 12 to 40% ³.

The main diagnostic method for early detection of osteoporosis is densitometry, which determines bone mineral density ³. A direct indication for research is the age of 65 years for women and 70 years for men. However, in the presence of clinical risk factors, it is recommended to undergo densitometry for people 50 years and older ³.

Prerequisites for the development of osteoporosis arise if calcium and phosphorus are not supplied enough and are poorly absorbed. In such cases, they are washed out of the bone. A sufficient level of calcium in bones also depends on how well it is absorbed in the gastrointestinal tract, how it is metabolized. And vitamin D is already responsible for this, a deficiency of which can lead to a lack of calcium and – as a result, affect the health of bone tissue ³.

According to statistics, approximately 34 million people in Russia suffer from osteoporosis to one degree or another. ¹.Long-term use of calcium supplements prevents bone loss, reducing the risk of osteoporosis and fractures in menopausal women ⁴.

Calcium preparations for the prevention of osteoporosis

Consider which calcium supplements are best for the prevention of osteoporosis. All medicines containing this element are divided into three large groups:

– monopreparations – contain only calcium salt;

– preparations containing calcium and vitamin D;

– products containing calcium, other minerals and vitamin D ⁵.

Monopreparations

Monopreparations are calcium carbonate, gluconate, lactate and chloride. But calcium itself, even in the form of organic compounds, is not well absorbed by the body, which stimulated the emergence of combined drugs.

Preparations containing Ca and vitamin D

The daily intake of vitamin D for adults is 10 mcg. It can be slightly increased during pregnancy (12.5 mg), during menopause and in old age (15 μg) ⁶.

Preparations containing Ca, vitamin D and minerals

For maintaining the structure of bone tissue, maintaining its flexibility and strength, not only calcium, but also other osteogenic minerals is very important. ⁵: magnesium, copper, manganese, zinc, boron, as well as iron, silicon and strontium. Magnesium regulates the mineralization of bone tissue and ensures its uniform growth, zinc and copper are involved in the creation of a collagen matrix, which is a kind of reinforcement for bone tissue.

Effective drugs for the treatment and prevention of osteoporosis in women and men are Calcemin® and Calcemin® Advance. With prolonged use, they stabilize bone tissue and even contribute to an increase in its density. Calcemin® helps to replenish the deficiency of calcium and vitamin D, provides the intake of trace elements important for building bone tissue ⁶. The drug is suitable for the complex treatment and prevention of osteoporosis caused by various causes, both in women and in men ⁷.

How to take calcium for osteoporosis: food

For an adult, the required daily dose of a macronutrient is from 1000 to 1200 mg, depending on age. In pregnant and lactating women, it increases to 1300-1400 mg ⁸.

In addition to taking calcium in the composition of drugs for osteoporosis, it is necessary to normalize the diet. The source of important Ca compounds are milk and lactic acid products, cottage cheese, cheese, fatty fish (sardines, mackerel) ⁹.A large amount of the mineral (1100-1400 mg) is found in sesame, a lot of it in cabbage (200-250 mg). 100 g of hard cheese contains a daily dose of calcium – 900-1100 mg ⁹.

However, even good nutrition cannot be a guarantee of a sufficient level of calcium, since its entry into the bone tissue depends on various factors (absorption, regulation of metabolism, the level of vitamin D, minerals, hormones). Therefore, for the prevention of osteoporosis, experts recommend taking special calcium preparations.

L.RU.MKT.CC.04.2019.2709

Prevention of osteoporosis: recommendations for the prevention of the disease

Contents of the article:

Risk groups: who is at risk of osteoporosis

Practically everyone needs to take measures to prevent osteoporosis. We all experience the influence of at least several predisposing factors: a sedentary lifestyle, a poor diet, poor heredity, pregnancy and childbirth, breastfeeding, various systemic diseases, the most common of which are thyroid disorders.

Briefly about groups and risk factors:

Female With the onset of menopause, women rapidly lose bone density. It is believed that women with low weight, blond hair, blue eyes and small stature are especially susceptible to osteoporosis.
Age. The older the person is, the higher the risk of getting sick. According to recent studies, bone loss begins as early as 30 years of age.
Low body weight. Scientists have shown that a decrease in the volume of adipose tissue in women leads to a loss of bone mass.This is because fat contains aromatases, enzymes that are needed for androgens to convert to estrogens. Deficiency of the latter leads to osteoporosis.
Sedentary lifestyle. A study was conducted in which young people participated. They were in the supine position for a week. And this led to a 0.9% decrease in bone density.
Lack of the required level of insolation, which is typical for our latitudes.
People who sweat frequently and a lot during sports, work or due to illness.Calcium comes out with sweat.
Negative inheritance. Prevention of osteoporosis should be especially carefully done by those women whose mothers have had frequent fractures after 50 years.
Heavy smoking and even passive smoking in large quantities.
Alcohol abuse, which removes potassium and magnesium and affects gastrointestinal enzymes, which makes it difficult to digest food and absorb nutrients from it.

Prevention: exercise to prevent osteoporosis, pills, diet

Physical activity

Let’s start with the recommendations on gymnastics to prevent osteoporosis, here are the basic exercises.

Important! All training should be started with a low load, gradually increasing it, but not bringing it to excessive.

Exercise with stress strengthens bones because it stimulates the cells responsible for the mineralization and production of bone tissue. They are called osteoblasts. There are a lot of load options – these are playing sports, running, walking, aerobics, swimming, exercise equipment, cycling, exercises with elastic bands and dumbbells, Nordic walking, swimming.If these types of activities do not suit you, you can do gymnastics at home by choosing several exercises from the ones described below. The most important thing is regularity, you need to do the exercises every day.

Initial position	Description of exercise	Number of repetitions
Lying on your back	One leg is on the floor, extended. Bend the second and pull it to the chest.Hold for 5-10 seconds, then repeat with the other leg.	2-10
Lying on your stomach, arms parallel to the floor, bent at the elbows	Tighten with your whole body, slightly raise the upper torso and arms, slowly move your body to the left and right, relax.	2-10
Sitting on your knees	Bend your chest to the floor as low as possible, arms outstretched, hold this position for 5-10 seconds.	2-10
Lying on your back, lower back pressed to the floor, legs straight	Raise one leg 15 cm from the floor, pulling the toe towards you, hold the position for 10-15 seconds.	2-5 each leg
Lying on your back with bent legs shoulder width apart	Slowly raise the pelvis and hips, tighten the buttocks and abdomen.	5-10
Lying on your back	Raise the shoulder blades while inhaling, hold for 5-7 seconds, while exhaling – return to the starting position.	3-8 with a break of 10 seconds
Standing with the left side to the back of the chair, the left hand lies on the back, the right hand is extended forward, the right leg is laid back and put on a toe	Swing free leg.	3-8 for each side
Lying on your back	Pull your knees to your stomach, press and clasp your hands, maintain this position for 10-15 seconds.	2-5 times with an interval of 10 seconds
Standing on all fours	Raise your head, bend your back, hold for up to 10 seconds, then arch your back and lower your head, holding the same time.	2-10
Standing	Walking lunges.	5-10 each leg
Lying on stomach	Raise your legs alternately, then both legs and hold for 5 seconds.	2-10
Lying on its side	Circular swings with the leg bent at the knee.	5-10 for each leg
Sitting	On inhalation, take your arms back, bend, connecting the shoulder blades, on exhalation, return to a sitting position.	5-10
Sitting	While inhaling, stretch your arms upward, while exhaling, lower your arms.	5-10

Foods and vitamins for the prevention of osteoporosis and general principles of nutrition

You need to consume enough calcium and vitamin D, which allows it to be better absorbed.Phosphorus, magnesium, copper, boron are also important for bones.

The most useful products are pork, beef, cod liver, dairy and sour milk products, homemade cheeses, fatty fish, any greens, sprouted cereals. Soy is important for women because it contains phytoestrogen, a plant analogue of estrogen.

The main sources of calcium are salmon, green vegetables and fruits, cabbage, skim milk and yogurt. Calcium-fortified orange juice, which is also rich in vitamin C, is doubly beneficial.

Important! Salt, alcohol and caffeine leach out calcium and a number of other important substances. They need to be kept to an absolute minimum.

Vitamin D levels can be maintained by walking for 30 minutes every day in the dim sun. However, in our latitudes this is not always possible. Therefore, you need to consume foods rich in this vitamin and / or include supplements in pill form. It can be Calcium D ₃ Nycomed, Ultra-D, etc. Food sources of vitamin D are egg yolks, cod liver, fatty fish, fortified milk.

It is necessary to include in the diet sources of vitamins A, C, K, as well as group B, and folic acid.

Protein should not be abused, because it disrupts the function of absorption in the gastrointestinal tract, provokes fermentation processes. Daily rate – 100-150 g.

Avoid or minimize sugary and / or carbonated drinks, packaged juices, vinegar, sour vegetables, fruits, berries, sorrel, rhubarb, spinach, sugar and salt, whole grains and instant coffee. It’s important to keep your vitamin C in balance because too much vitamin C is harmful.

Preparations and vitamins for prophylaxis

Preparations and vitamin complexes should be prescribed by a doctor. Self-prophylaxis can even hurt, because taking one can upset the balance of the other.

For prophylaxis, vitamin D is prescribed (the recommended daily dose is 400 IU), calcium preparations, thiazides, bisphosphonates, HRT. When prescribing any drug, dosage is important, because an excess of something is just as harmful as a deficiency.

If there was a long course of glucocorticosteroids, Risedronate can be prescribed, which is also indicated for women in menopause.It is a bisphosphonate that slows or completely stops bone loss by increasing bone density. In the postmenopausal period, your doctor may prescribe Raloxifene. It is a new generation prophylactic drug that has a beneficial effect on calcium metabolism and bone mass.

Preventive medical examinations

It is necessary to do ultrasound or X-ray densitometry on a regular basis, once a year. This is the most informative, fast and comfortable study. The X-ray technique is indicated for examining the femoral neck, spine, and radius.It detects hidden fractures in full body scan mode.

It is necessary to donate blood for calcium once a year, especially during therapy with hormones and glucocorticosteroids.

General recommendations for a healthy lifestyle

It is necessary to maintain an adequate level of physical activity, do gymnastics, walk more. Scandinavian walking is very helpful. The best form of prevention is swimming.

Smoking should be stopped or the number of cigarettes smoked at least halved.Alcohol can be consumed, but not enough. Maximum – a glass of wine a day or 50 ml of strong drink. Coffee is also limited to 1 or 2 cups a day. At the same time, against the background of other caffeinated drinks, including black tea, coffee should be completely abandoned.

It is important to maintain a normal weight, eat at least 500 g of fresh vegetables and fruits per day, focusing on those rich in calcium, vitamin D, A, C, K.

Elderly people must be prevented from falling. To this end, it is even worth discussing with your doctor the possibility of discontinuing drugs that cause dizziness.

Conclusion

It’s never too late to think about prevention. Especially considering the serious consequences of osteoporosis. He is able to significantly reduce the quality of life, change the social role and nullify the attitude of life. If prevention is started on time, the risk of fractures will decrease by more than 50%. And the main rule of prevention is constancy. Even 5 minutes of exercise daily, for example, will be more beneficial than one hour at the gym once a week. Moderate physical activity and a healthy lifestyle in general will not only have a positive effect on the condition of the skeleton, but also strengthen the body as a whole, increase vitality and even life expectancy.

Prevention and treatment of osteoporosis – Federal State Budgetary Institution “NMITs TPM” of the Ministry of Health of Russia

Osteoporosis: the concept and causes of the disease

Osteoporosis is a disease associated with the loss of calcium in the bones. Most often it appears in women, which is explained, first of all, by the onset of menopause. During this period, there is a decrease in the calcium content and the strength of the bone tissue, as a result of which the bones become more fragile and easily damaged.Elderly people aged 60-70, including men, also suffer from this ailment.

Due to osteoporosis, fractures of the bones of the thigh, forearm, and vertebrae in the back are possible. Often a person is not even aware of the development of a similar disease in him. But osteoporosis has its own symptoms. For example, it can be suspected in case of pain in the lumbar and thoracic regions of the back, stoop, pain in the spine and its deformities. Also, osteoporosis, the symptoms of which cannot be started, can be expressed by increased fatigue.

The causes of the disease are a decrease in the calcium content in the bones, as well as a decrease in the amount of vitamin D. In addition, its appearance is associated with a decrease in physical activity, excessive alcohol consumption, smoking, and also taking certain medications.

Diagnosis of osteoporosis

Clinical diagnosis of osteoporosis includes various studies. It allows you to detect the presence of a disease and prevent adverse consequences in the future.One of the easiest ways to determine the condition of bone tissue is X-ray. But this method is most effective for detecting late symptoms of the disease, for example, deformities of the vertebrae or bone fractures.

Also in medicine, densitometry is used to diagnose osteoporosis, which measures the amount of a mineral component in the bones, that is, calcium. It can be ultrasound or radiological. The latter type of this procedure allows you to determine the density of bone tissue and the amount of hydroxyapatite contained in it.With it, doctors can find out which area is at the greatest risk of fractures, as well as determine the amount of bone loss and the effectiveness of treatment. Ultrasonic densitometry makes it possible to obtain data on the mechanical state of bones.

In order to diagnose osteoporosis, laboratory tests using biochemical markers may be prescribed. They make it possible to determine the intensity of bone metabolism. For the diagnosis of osteoporosis, indicators of calcium, phosphorus, parathyroid hormone, deoxypyridonoline and osteocalcin are important.For 12 hours before the procedure, you should refrain from eating.
Our osteoporosis treatment center conducts comprehensive diagnostics for the detection of the disease and offers a wide range of other medical services using modern equipment.

Prevention and treatment of osteoporosis

To avoid the appearance of a disease or prevent its development, you need to monitor your body. Therefore, timely prevention and treatment of osteoporosis is needed.

First of all, you should lead a healthy lifestyle, that is, give up addictions and eat the right food with sufficient calcium and other minerals.In addition, sunbathing is useful for saturating the body with vitamin D and moderate physical activity, without which it will not be possible to do. Osteoporosis treatment also involves adhering to a special diet, taking medication, and performing a special set of exercises. All this will stop the development of a destructive disease.

Prevention of osteoporosis | Symptoms and Risk Factors

By: Female staff

Osteoporosis, or bone loss, affects nearly half of all women over 50.In most cases, women do not know they have osteoporosis until a bone is broken or fractured. Left untreated, osteoporosis can cause severe pain and difficulty in performing daily tasks. Assignments include bending, sitting, and lifting. Learn more about preventing osteoporosis and ways to reduce your risk of the disease.

Make an appointment with your OBGYN for a bone density screening to learn about the risks of osteoporosis. Don’t let it go unnoticed until you fall or get fractured.Here’s how to prevent osteoporosis even before it starts.

Know the risk factors for osteoporosis

Osteoporosis usually affects women over 50, who are generally small in size. However, older women can develop osteoporosis regardless of size and build. Common risk factors for osteoporosis include the following:

Lack of calcium and vitamin D. These nutrients support the growth and development of strong and healthy bones.
Lack of exercise. Strength training and resistance training are most effective in keeping your bones healthy and strong.
Smoking. Nicotine and cigarettes increase the rate of bone loss.
High alcohol consumption. Drinking more than two alcoholic beverages a day inhibits bone growth and formation.

Prevention of osteoporosis with early detection

Bone density screening is the only way to detect and diagnose osteoporosis before symptoms appear.A bone density test can determine if you have weak bones and determine your current bone density status. Talk to your obstetrician / gynecologist about getting a bone density screening so you can take immediate steps to improve bone health and prevent osteoporosis.

Get treatment for osteoporosis

When detected early, osteoporosis can be effectively treated with healthy lifestyle changes. For example, calcium and vitamin D supplements can help develop stronger, healthier bones.Plus, regular exercise can strengthen your bones and overall immune system function. Your obstetrician / gynecologist may also prescribe medications that can help restore bones or prevent further bone loss.

Your obstetrician / gynecologist will also discuss how to reduce the risk of falling, which increases the risk of fractures. For example, start wearing shoes with good grip, install handrails in the shower, or start using a cane or walker.

Certified Physicians at Women’s Care are committed to providing the gold standard in women’s health.Each of our healthcare teams has a distinct style and practice that can be tailored to your individual needs. For more information on how WCF can help you take care of you, please contact us to make an appointment.

Osteoporosis

Osteoporosis is a disease in which bones lose their strength – often causes disability and even death.It is impossible to cure osteoporosis, therefore it is necessary to prevent its development from childhood.

History

Osteoporosis is a disease characterized by a decrease in bone density due to loss of calcium. As a result, bones become too thin and fragile, which leads to a weakening of the skeleton, increasing the risk of fractures, especially of the spine, forearm, hip and shoulder joints.Osteoporosis and associated fractures can have serious consequences and are an important cause of limited movement, pain, long-term disability, loss of independence, and mortality.

By the decision of the World Health Organization, since 1997, October 20 has been declared World Osteoporosis Day. In Russia, this day has been celebrated since 2005.

The word “osteoporosis” comes from the Greek language: “ostoun” – bone and “poros” – loose, porous. At first, it was thought that osteoporosis was not a disease, but changes in bones caused by age.In the 18th century, surgeon John Hunter drew attention to the fact that bones change during a person’s life – in youth they are strong and strong, and with age they become more fragile.

But only in the 19th century, the French surgeon Jacob Lobstein gave these bone changes the name – osteoporosis. In the middle of the 20th century, attention was paid to osteoporosis as a widespread problem, scientific research began, and factors that increase the risk of osteoporosis were discovered, and the possibilities of diagnosis and treatment expanded.

Osteoporosis: Risk Factors

Risk factors for the development of osteoporosis are divided into uncontrollable and manageable. The first are those that cannot be changed. These are age over 65, female sex, early menopause – up to 45 years, hereditary predisposition, taking glucocorticoids for more than 3 months, prolonged immobilization (immobility) of the limb – more than 2 months, as well as some endocrine diseases.

Controllable risk factors that a person can change include: unbalanced diet, insufficient intake of calcium and vitamin D from food, insufficient physical activity, low body weight.

Signs of osteoporosis

There are indirect signs indicating osteoporosis. First of all, this is a decrease in height by more than 2 cm per year or more than 4 cm during life, as a result of which there is a clear change in posture.

In addition, a symptom of the disease may be recurrent pain, aching, which occurs more often in the lumbar or thoracic spine, aggravated by walking, decreasing in a horizontal position.

Impossible to cure – just warn!

It is important to remember that it is impossible to cure osteoporosis, therefore it is necessary to prevent its occurrence, starting from early childhood.

The main directions of disease prevention include proper nutrition, adequate physical activity, rejection of bad habits (smoking, alcohol abuse).

The goal of osteoporosis prevention is to form a strong skeleton, prevent or slow down bone loss, and prevent bone fractures.

Formation of the skeleton, development of bone tissue lasts up to 25 years. During this period, systematic exercise and sports are necessary.“Life requires movement” – this is what Aristotle said back in the 4th century BC.

Training leads not only to an increase in muscle tissue, but also to a significant build-up of the cortical layer of bones, their strengthening. Physical activity strengthens bone and muscle tissue at any age.

With regular exercise, bones become stronger – the dependence of the amount of calcium and bone density on the quality of the surrounding muscle tissue has been proven.

Correctly dosed physical activity is an effective way to combat calcium leaching from bones in the postmenopausal period of a woman’s life.

It should be remembered that such pleasant pastime as walking and cycling, jogging, tennis and jumping rope, aerobics and dancing, swimming is an excellent way to preserve and strengthen bone tissue.

In addition, the development of osteoporosis is largely dependent on nutrition. To prevent, it is necessary to include in the diet foods containing calcium and vitamin D.

Recommended daily intake of calcium: from 11 to 24 years for all – 1200 mg, from 25 to 60 years for men and from 25 years before menopause in women – 1000 mg, after 60 years in men and women in menopause – 1200 mg, after 65 years in men and in postmenopausal women – 1500 mg, for pregnant and breastfeeding women – about 1500 mg.

Advice on nutrition for osteoporosis

To prevent osteoporosis, it is necessary to abandon foods that remove calcium from the body (tea, coffee, cocoa), as well as foods containing large amounts of fat (butter, margarine and mayonnaise).

Limit the consumption of red meat (beef, veal, lamb) to 1-2 times a week, since the phosphorus contained in meat interferes with the absorption of calcium.

Milk and its derivatives, cheeses, almonds, cabbage should be in excess in the diet.With osteoporosis, the body needs a double dose of zinc, which means that it is necessary to master the preparation of dishes with legumes, liver, seafood and celery.

Don’t forget to increase your vitamin D intake, which can be obtained from sesame seeds, cheese, sour cream and eggs. Vitamin B6 and folic acid also help in the treatment of osteoporosis.

Bone tissue regains its density faster thanks to magnesium and the products that contain it. These are bananas, leafy vegetables, walnuts and legumes, dairy products.

In addition, experts advise to give up alcohol and carbonated drinks.

It is better to stick to fractional meals, that is, eat small meals 5-6 times a day.

Record-breaking products for calcium content (mg per 100 g of product): Parmesan cheese – 1300, hard cheeses – 1000, sesame – 780, Atlantic sardines – 380, basil – 370, almonds – 250, parsley – 245, soy beans and milk chocolate – 245, hazelnuts – 225, savoy cabbage – 212, white cabbage – 210, beans – 194.

Diagnosis and treatment of osteoporosis

Modern medicine has a fairly effective method for recognizing osteoporosis at its very initial stages, when the decrease in bone density does not exceed 3-5%. This method is called densitometry – it is based on determining the density of the skeleton and reveals the mineral and other active components of bone tissue.

Radiography makes it possible to detect bone depletion with more than 30% bone loss.Additionally, a study of phosphorus-calcium metabolism in the body is being carried out. The scope of the examination is determined by a specialist.

Treatment of osteoporosis is a complex problem that endocrinologists, neurologists, immunologists and rheumatologists deal with. Although there are currently no drugs that completely cure osteoporosis, there are drugs that can increase bone density and reduce the risk of fractures. First of all, the treatment of diseases and correction of the conditions that caused osteoporosis are carried out.Treatment should only be prescribed by a doctor!

Advice if there is a risk of osteoporosis

If you are at risk for osteoporosis, you must be careful with any movement and physical effort.

Try to reduce the likelihood of falls: do not wear unstable shoes or shoes with slippery soles (especially in winter), lay special rugs in the bathroom to prevent slipping on the wet floor. Always hold onto handrails and railings.It is especially important to be vigilant on stairs and escalators, when bending and lifting weights. Use a cane if necessary.

If you do fall, make sure you are not injured before getting up. Even if you feel well after an injury, see a doctor: fractures may initially be painless and unnoticeable.

Take care of the health of your musculoskeletal system, and it will serve you for a long time!

Osteoporosis treatment

What causes osteoporosis? Who is affected by this disease?

Osteoporosis is a disease in which bone density decreases, the strength of the bone structure is lost, which provokes the development of fractures.Most often, such fractures develop with a minor injury, and sometimes even during normal loads (lifting a heavy bag, doing housework, etc.). The reason for the development of osteoporosis always lies in the disruption of the process of bone tissue repair. The metabolic processes in the bone after 40 years significantly shift towards a decrease in the rate of its formation, and during menopause in women, the protective effect of female sex hormones weakens, which leads to an intense loss of bone strength.Men also suffer from osteoporosis, but bone loss occurs more slowly than women.

The risk group primarily includes women over 60 and men over 70. However, according to recent studies, osteoporosis has become significantly “younger”, and now every third woman and every fifth man over 50 years old (and this is the age of the working-age population!) Have osteoporosis.

Lyubov Vasilievna, are there any risk factors for the development of osteoporosis? What measures can be taken to reduce them?

There are a lot of risk factors, and some of them cannot be influenced – these are age over 65, female sex, menopause, especially before 45 years of age (incl.and postoperative), fractures in the patient in the past and fractures of the femoral neck in close relatives (mother, father, sisters, brothers), long-term (more than 3 months) glucocorticoid intake and immobilization for more than 2 months. Diseases of the intestine, liver, chronic renal failure, Graves’ disease, Cushing’s disease or syndrome, parathyroid disease, and condition after organ transplantation also affect the risk of developing osteoporosis.

Quitting smoking and excessive intake of alcohol and coffee, maintaining normal body weight and physical activity, adequate calcium intake and prevention of vitamin D3 deficiency help significantly reduce the risks of osteoporosis.However, these measures cannot be called effective in preventing fractures when osteoporosis already exists.

How do you know if a person has osteoporosis?

A feature of the disease is that pain in bones and joints is uncharacteristic for it, it is practically asymptomatic, and therefore a visit to a doctor often occurs only after the development of a fracture of the vertebra, femoral neck, forearm. With one of the most frequent and severe types of fracture – a hip fracture – the patient becomes bedridden for a long time.And such an event is a test for the patient and his loved ones. Hip replacement surgery (endoprosthetics) cannot be performed for all patients in a short time for various reasons: medical contraindications, lack of opportunity, high cost, etc. Therefore, I recommend all women over 60-65 years old and men over 70 years old, as well as persons over 50 years of age of both sexes with risk factors must undergo regular examinations to diagnose osteoporosis, without waiting for the development of complex fractures.

Which specialist can I contact to diagnose osteoporosis?

Rheumatologists and endocrinologists are well aware of the problem of osteoporosis, in general, they are the ones who work in osteoporosis centers. At the same time, other specialists – general practitioners, general practitioners, family doctors, orthopedic traumatologists – can also advise on this disease. At the same time, a traumatologist may be the only doctor to whom a patient with osteoporosis will turn, so it is extremely important that he receives comprehensive information from a specialist, in particular, that the fracture that has arisen (in the presence of risk factors) is not an accident in his life.If the patient is diagnosed with osteoporosis on time and is informed about the potential danger of various fractures, then intervention at this early stage can prevent their development in the future.

How is osteoporosis diagnosed?

The study is carried out on a special X-ray apparatus – a densitometer, where the bone mineral density is measured. At the same time, radiation exposure during densitometry is minimal and safe for the patient. Control studies should be carried out no more than once a year.If necessary and if there is a suspicion of an existing compression fracture (spinal fracture), an X-ray of the spine may be additionally prescribed.

Lyubov Vasilievna, let’s say osteoporosis was detected during the examination. What should you do next? Taking calcium supplements, drinking vitamin D, eating more dairy products?

If osteoporosis is diagnosed, the first thing to do is contact a specialist who will advise on non-pharmacological and pharmacological treatments for this disease.Unfortunately, neither the widely advertised calcium supplements, the dairy-rich diet, or vitamin D alone are effective treatments for osteoporosis. Currently, doctors have modern medications in their arsenal, the effectiveness of which in preventing fractures of various localization has been proven in international clinical trials involving hundreds of thousands of patients.

Are these drugs probably expensive?

Cost varies.But, in any case, the cost of a total hip replacement surgery or treatment of a vertebral fracture is several times more expensive, and the procedure itself is incomparably more painful and dangerous than the planned therapy of osteoporosis.

We always try to select a drug taking into account individual characteristics, concomitant diseases and even the wishes of the patient.

To our delight, a large number of drugs have now been developed, thanks to which the treatment of osteoporosis can be made as convenient as possible for the patient – from tablets taken once a week to highly effective injectable forms used once a year.

Osteoporosis Treatment | Dobromed

Osteoporosis treatment

Posted at 19: 20h
in Services
by doctor

Osteoporosis is a systemic disease in which the processes of destruction of bone tissue prevail over its ability to regenerate and strengthen. In this case, calcium salts are washed out from the bones, since they become unable to keep them inside.As a result, increased fragility of bones, a high tendency to fractures, which occur even with a slight external influence. It can be an ordinary bruise, careless movement, a fall.

Osteoporosis is a dangerous disease that can cause death. More often than not, the death and disability of people occurs only due to cardiovascular pathologies, diabetes mellitus and cancer.

The insidiousness of the disease lies in the fact that osteoporosis develops with a minimal set of symptoms.The patient begins to feel them when the treatment becomes ineffective – this is the stage during which fractures often occur.

Factors influencing the development of osteoporosis

Lack of calcium in the body due to inaccuracies in nutrition. It can be an unbalanced diet, adherence to a variety of diets, fasting, etc. Lack of calcium in the body often provokes disruptions in the absorption of vitamins and minerals.

Hypodynamics. Prolonged stay in a supine, immobilized position leads to the fact that osteoclasts are activated in the body.They destroy bone tissue, disrupt its mineralization. It is dangerous in this regard to stay in a state of weightlessness for a long time. Therefore, people who are diagnosed with osteoporosis must maintain constant physical activity.

Hormonal disorders. The disease can develop due to any hormonal imbalance – these are disruptions in the production of thyroid hormones, parathyroid glands, sex hormones and pituitary hormones.

Secondary osteoporosis can develop with excessive consumption of alcoholic beverages, coffee, in the presence of such a bad habit as smoking, as well as against the background of blood diseases, against the background of rheumatism, renal failure, diabetes mellitus.

If a person consumes too much carbonated water, then bone disease can develop in him even at a young age. Most carbonated drinks have been shown to contain substances that help flush calcium out of the bones.

Another reason for the development of osteoporosis is disturbances in the functioning of the digestive system, in the functioning of the cardiovascular system.

Diseases of the spine develop mainly in old age, after 60 years.Women suffer more often than men, the disease is detected in them after the onset of menopause. In the male population, calcium in the bones remains longer, its age-related loss occurs somewhat later.

Disorders of joint mobility, both large and small. Habitual physical activity leads to rapid fatigue.

At night, the patient may be disturbed by cramps arising in the lower leg. Dull aching pains are possible, or acute pains in the spinal column and in the joints.The painful sensations become especially intense during a change of weather.

It is impossible to stop the development of osteoporosis, it is an obligatory companion of the aging of the whole organism. It is possible to prevent the leaching of calcium from the bones only when it is caused by another pathology. However, this does not mean that it is impossible to slow down the rate of development of the disease. A well-designed treatment regimen eliminates the development of complications.

Diagnostic methods

X-ray examination is the most common method for diagnosing a disease.However, it is informative only when more than 30% of bone mass has been lost. It takes a long time to treat such a patient, and the effect is not always achieved.

Computed tomography. With the help of a tomograph, a disease can be detected at an early stage of its development. For this, the devices are equipped with a special attachment. An ultrasound apparatus also helps to identify the disease. But at the same time it is possible with the help of these devices to study the state of only one part of the body.While to assess the extent of the spread of the pathological process, it is necessary to examine several departments.

Osteodystrophy. Modern medicine has X-ray densimeters, thanks to which it is possible to assess the mineral density of bone tissue in several parts of the body at once. Moreover, the accuracy of such a study is high. It is possible to track even 2% bone loss, as well as to reveal the level of muscle mass and body fat, calcium content in bones.These data correlate with the age and gender of the patient. Densitometric examination is safe for health, it is carried out quickly and does not cause painful sensations. There are no side effects after the diagnosis, so you can do it as many times as necessary.

However, the reason for the loss of bone mass cannot be established using these techniques. This can only be done by the attending physician.

In addition to interviewing and examining the patient, he will send him to the delivery of the following tests:

These studies, carried out in combination, make it possible to draw up the most complete picture of the disease and prescribe the appropriate treatment.

Osteoporosis treatment

Methods of osteoporosis treatment directly depend on the nature of the disease. If it occurs as a secondary pathology, then it will be necessary to eliminate the root cause of the disease – this can be the correction of immune disorders, diseases of the cardiovascular and digestive systems, etc.

Primary osteoporosis forms due to aging of the body and most often occurs in women. Treatment requires a special approach, since most often the disease is diagnosed in the period after menopause.It is necessary to slow down as much as possible the leaching of calcium from the bones and increase its build-up. In this case, it is necessary to take into account what changes have occurred in the synthesis of sex hormones.

Basic treatment with medication. Its purpose is to correct metabolic processes in the bones. Treatment is long-term, continuous, step-by-step.

The operation is performed for osteoporosis of the hip and knee joints. If conservative therapy is ineffective, then replacement of the worn out joint with an artificial one is indicated.This contributes to the improvement of the quality of life of patients, its extension, since it eliminates the risk of spontaneous fracture of the femoral neck.

Basic treatment of osteoporosis

Calcitonins (Miacalcic). The hormone calcitonin prevents the loss of calcium from the bones, it also takes part in the process of their formation, and has an analgesic effect. The drug is made from salmon calcitonin and acts similarly to a human’s own hormone. For this purpose, drugs such as: Osteover, Alostin, Veprena can be used.

Bisphosphonate preparations are aimed at inhibiting the process of bone loss, normalizing bone mineralization. Perhaps the appointment of the following funds: Risedronate, Alendronate, Ibandronate, Zoledronic acid (Xidiphon, Etidronate, Bonefos, Fosamax).

The complex preparation Osteogenon prevents the destruction of bone tissue (suppresses the synthesis of osteoclasts and stimulates the work of osteoblasts), promotes the process of bone formation.

Fluorine derivatives are aimed at stimulating the formation of bone tissue – these are Kaltsik, Fluocalcic, Osin, Koreberon.

The parathyroid hormone teriparatide – Forsteo is used to stimulate osteoblasts. It must be injected.

All these drugs can be prescribed only by a doctor who will control blood and urine using laboratory diagnostic methods. This will assess the effectiveness of the treatment.

The level of deoxypyridinoline in urine ranges from 3.0 to 7.4 in women. Men have from 2.3 to 5.4.

The level of osteocalcin in the blood at the age of 50 years is from 11 to 23 ng / ml.After the age of 50 – from 15 to 46 ng / ml.

Phosphorus in the blood of men over 60 years old from 0.9 to 1.32. For women over 60 years old, from 0.74 to 1.2.

Hormone replacement therapy

Therapy with hormonal drugs is used very often. It is prescribed for people with severe osteoporosis, with the disease in the early stages of its development, and even for those patients who have only the prerequisites for the development of pathology. For women who have entered the menopausal period, certain estrogen receptor modulators are prescribed.These are drugs such as Raloxifene, Keoxifen, Evista, Droloxifen. Their reception helps to stop the process of bone destruction, or significantly slow it down. In this case, the risk of fractures is reduced by exactly half.

It is possible to prescribe the estrogens themselves, for example, the drugs Femoston, Kliogest, in combination with calcium preparations. But it should be remembered that taking estrogen-containing drugs affects the risk of developing gynecological oncological diseases. To achieve the effect, you will need to take estrogens for at least 5 years.In parallel, the level of hormones in the blood is monitored. Cancellation of drugs is carried out in stages, reducing the dose slowly.

Do not take estrogens to those patients who are at risk of cancer, as well as those patients who have a tendency to thrombotic complications. In addition, estrogen hormone therapy is a maintenance therapy and is not able to replenish the calcium level in the bones.

Calcium preparations for osteoporosis

To stop the development of the disease, you need to use calcium supplements.They work much better than including foods rich in this micronutrient on the menu, or using traditional therapies.

To increase the effectiveness of therapy, calcium preparations are prescribed in combination with calcium metabolism regulators:

The reception of multivitamins is shown – it can be Elevit, Kaltsinova, Komplevit, Nutrimaks. But since there are a lot of components in these funds, they are absorbed worse than mono-drugs. Therefore, they are used as a prophylactic and not as a remedy.

Taking monovitamins with calcium salts. Calcium gluconate itself is poorly absorbed, so it is best to take drugs such as calcium glycerophosphate, calcium lactate, calcium chloride.

Perhaps the appointment of combination drugs in which calcium is combined with vitamin D – it can be Calcium D3 nycomed, Orthocalcium in combination with calcium citrate, Vitamin D3 in combination with Vitrum calcium.

Only a doctor can pick up the remedy. If you take calcium preparations without medical supervision, it threatens the deposition of salts of the trace element in soft tissues, which will lead to damage to the kidneys, heart, and blood vessels.The independent use of vitamin D for the treatment of children is especially dangerous. Incorrect dosages can lead to future health problems. The same applies to the irrational use of hormonal drugs.

Modern method of osteoporosis treatment

Doctors use a qualitatively new approach in the treatment of osteoporosis, it boils down to the following points:

The next stage is the introduction of the animal tissue extract and ionized calcium under the periosteum.

At the University of Auckland in New Zealand, research is underway on a novel drug that should be a breakthrough treatment for osteoporosis.This is the drug Zometa, which is produced by Novartis AG (Switzerland) and is zoledronic acid. It is enough to enter it once a year, no more therapy is required. Based on the study, it was found that the breakdown of bone tissue after injection slows down by a year, and the bone itself becomes denser during this time. However, there is no data yet regarding the prevention of bone fractures, but trials are ongoing.

Symptomatic treatment of osteoporosis

Taking analgesics and muscle relaxants for pain and muscle spasms, taking NSAIDs for arthritis.This allows the patient to avoid the progression of the disease due to physical inactivity.

Physiotherapy treatment, exercise therapy complexes.

Compliance with the diet with the inclusion in the menu of foods rich in magnesium, phosphorus, calcium.

Home treatment of osteoporosis

Be sure to adjust your menu. To slow the progression of osteoporosis, you should include foods with vitamin D, calcium, phosphorus.These are not only dairy products, but also seaweed, spinach, broccoli, fatty fish, legumes, eggplants.

From the table it becomes clear how much calcium is contained in various foods. The calculation is based on 100 g of product.

Calcium salts are absorbed by the body in youth only by 30-35%, and in old age by 10-15%. Additionally, this process is interfered with by chocolate, tea, coffee and alcohol.

If treatment with calcium preparations is carried out, then vitamin D should be taken in parallel.If this is not done, then calcium will simply be excreted from the body by the kidneys. Being in the sun, you can enrich your body with this essential vitamin.

At home, you can do physical exercises prescribed by your doctor, do an independent massage.

Traditional medicine recommends using eggshells infused with lemon juice. Nevertheless, any pharmacy preparations that are available on the market will be much more effective than the shell of a chicken egg.

Preventive measures

The mother must take care of the child’s skeletal system while he is in her womb.To do this, she needs to take vitamins that the doctor recommends. During childhood, attention should be paid to the accumulation of bone mass, for which the child should be properly fed, make sure that he is engaged in physical education, dancing, gymnastics, etc.

In adolescence and adulthood, inhalation of tobacco smoke, alcohol, and soda should be avoided. Sex life should be regular.