Calcium Supplements Tips and Answers

In a perfect world, we’d get all the calcium we need from the foods we eat. Not just the usual suspects like yogurt, milk, and cheese, but also canned salmon and sardines, broccoli, kale and collard greens, and fortified cereals and juices. But we live in an imperfect world.

Research suggests that more than a third of us aren’t getting enough of the mineral that’s essential for building and maintaining strong bones. It helps muscles work and nerves carry messages between the brain and other parts of the body, too.

Is a calcium supplement right for you?

How Much Should You Take?

It depends on how much you’re already getting in your diet. Adults need 1,000 milligrams of calcium (from all sources) every day, and that amount goes up with age. Women over 50 and men over 70 need 1,200 milligrams per day. If you think you need a supplement to boost your number, check with your doctor.

The more calcium you take at one time, the harder it is for your body to process it. Aim for 500 milligrams or less. You may want to take a smaller amount at each meal throughout the day to add up to your total.

More than the recommended daily amount isn’t good for you. It may even be harmful, according to a 2011 study in The Journal of Clinical Endocrinology and Metabolism.

Your body gets rid of extra calcium through your kidneys, and it goes into your urine, raising the risk of kidney stones for some people. High levels of the mineral in your blood can lead to kidney problems, as well as hardened blood vessels and tissue. Some studies also link high calcium intake, particularly from supplements, with a greater risk of heart disease, though the results aren’t settled.

Calcium Carbonate or Calcium Citrate?

Calcium carbonate is the more common of the two main types of calcium supplements. You should also eat something when you take it to help your body use it best. It doesn’t matter if you take calcium citrate with or without food.

A supplement may have more calcium carbonate as an ingredient than one with calcium citrate, but they could be equally effective. When you compare products, check the labels to find out how much actual calcium you’ll be getting in a dose.

Side Effects and Interactions

Gas, bloating, and constipation are more common with calcium carbonate. That’s another reason to divvy your dose up into servings and to take them with food. Drinking more fluids may help you avoid these symptoms, too.

Trying a new type of calcium supplement? Start with a small dose, like 200-300 milligrams daily for a week, and build up gradually.

Calcium can make certain drugs less effective, so talk to your doctor if you’re taking a prescription medicine for osteoporosis or Paget’s disease, seizures, or thyroid problems, or an antibiotic.

Some antacids, laxatives, and steroids can pull calcium out of your body or keep you from using it well.

The Vitamin D Connection

Your body needs vitamin D in order to take in and use calcium. And if you’re like almost 3/4 of Americans, you aren’t getting the recommended amount: 400-800 international units daily for adults under 50, and 800-1,000 if you’re older. So, many calcium supplements also include vitamin D.

Seniors Don’t Need Calcium, Vitamin D Supplements

By Dennis Thompson

HealthDay Reporter

TUESDAY, Dec. 26, 2017 (HealthDay News) — Seniors are wasting their time and money taking calcium and vitamin D supplements to ward off the brittle bones of old age, a new review concludes.

It turns out there’s little evidence supplements protect against hip fractures and other broken bones in older folks, according to data gathered from dozens of clinical trials.

“The routine use of these supplements is unnecessary in community-dwelling older people,” said lead researcher Dr. Jia-Guo Zhao, an orthopedic surgeon with Tianjin Hospital in China. “I think that it is time to stop taking calcium and vitamin D supplements.”

Not all experts agreed with this conclusion, however. Orthopedic surgeon Dr. Daniel Smith says the study makes a “bold leap” by arguing that these supplements do no good at all.

“The big picture, which seems to be lost in this study, is that the personal health cost of a hip fracture can be catastrophic,” said Smith, an assistant professor of orthopedics at the Icahn School of Medicine at Mount Sinai in New York City.

“The potential benefit of calcium and vitamin D supplementation in preventing even a small number of hip fractures far outweighs the otherwise minimum risks associated with routine calcium and vitamin D supplementation in at-risk populations,” Smith added.

It’s been longstanding medical advice that aging people focus on getting enough calcium and vitamin D to preserve their bone health as they age.

About 99 percent of the calcium in the human body is stored in the bones and teeth, and the body cannot produce the mineral on its own, according to the U.S. National Institutes of Health. Too little calcium can lead to osteoporosis. The body also requires vitamin D to absorb calcium.

The National Osteoporosis Foundation recommends that women aged 50 or younger and men 70 or younger should get 1,000 milligrams (mg) of calcium per day. Men and women older than that should get 1,200 mg daily.

For their analysis, Zhao and his colleagues combed through medical literature to find clinical trials that previously tested the usefulness of calcium and Vitamin D supplements. They wound up with data from 33 different clinical trials involving more than 51,000 participants, all of whom were older than 50 and living independently.

Most of the clinical trials took place in the United States, the United Kingdom, New Zealand and Australia, Zhao said. The dosage of the supplements varied between the clinical trials, as did the frequency at which they were taken.

The pooled data revealed no significant association between calcium or vitamin D supplements and a person’s risk of hip fracture or other broken bones, compared with people who received placebos or no treatment at all.

Calcium and vitamin D are still essential to bone health, but these results indicate you should get them through your diet and lifestyle rather than from supplements, Zhao explained.

“Dietary calcium is irreplaceable for skeletal health,” Zhao said. “Milk, vegetable, fruit and bean products are the most important food sources of calcium.”

“Vitamin D is synthesized in the skin in response to ultraviolet-B radiation in sunlight, and dietary sources of vitamin D are limited,” Zhao continued. Exercising out in the sunshine should provide a person with all the vitamin D they need.

Potential dietary sources of these nutrients prove one of the weaknesses of the evidence review, Smith argued.

“While this study addresses concerns regarding calcium and vitamin D supplementation, it fails to address or even consider whether the patients in question are obtaining either adequate calcium and vitamin D intake in their diets or sunlight exposure, obviating the need for supplementation,” Smith said.

The evidence review also included a large amount of data from the Women’s Health Initiative, a federally funded study of aging U.S. women, said Andrea Wong, vice president of scientific and regulatory affairs with the Council for Responsible Nutrition, a trade association representing dietary supplement manufacturers.

“Unfortunately, the WHI data has been widely acknowledged as having limitations of its own having to do with subjects not taking the supplements as directed by the protocol, as well as those who took calcium and vitamin D supplements on their own, outside the protocol, before and during the study,” Wong said.

Inclusion of the WHI might have skewed the overall results of the review, Wong argued.

In addition, later reviews of the WHI data indicated that people who started taking calcium and vitamin D supplements had a reduced risk of hip fractures and other broken bones, Wong said.

“CRN recommends that people discuss their individual needs for calcium and vitamin D with their health care practitioners,” she said.

“If there is the possibility of reducing the risk of a devastating fracture by supplementing with calcium and vitamin D, as some research has found, people should not be dissuaded from supplementation by a meta-analysis that is meant as a general recommendation and may not apply to each individual,” Wong added.

The new analysis was published Dec. 26 in the Journal of the American Medical Association.

Calcium/Vitamin D Requirements, Recommended Foods & Supplements

Calcium and vitamin D are essential to building strong, dense bones when you’re young and to keeping them strong and healthy as you age. The information included here will help you learn all about calcium and vitamin D – the two most important nutrients for bone health.

What is Calcium and What Does it Do?

A calcium-rich diet (including dairy, nuts, leafy greens and fish) helps to build and protect your bones.

Calcium is a mineral that is necessary for life. In addition to building bones and keeping them healthy, calcium enables our blood to clot, our muscles to contract, and our heart to beat. About 99% of the calcium in our bodies is in our bones and teeth.

Every day, we lose calcium through our skin, nails, hair, sweat, urine and feces. Our bodies cannot produce its own calcium. That’s why it’s important to get enough calcium from the food we eat. When we don’t get the calcium our body needs, it is taken from our bones. This is fine once in a while, but if it happens too often, bones get weak and easier to break.

Too many Americans fall short of getting the amount of calcium they need every day and that can lead to bone loss, low bone density and even broken bones.

How Much Calcium Do You Need?

The amount of calcium you need every day depends on your age and sex.

*This includes the total amount of calcium you get from food and supplements.

How Much Calcium Do You Eat?

Use the International Osteoporosis Foundation’s Calcium Calculator to find out.

Sources of Calcium

Calcium-Rich Food Sources

Food is the best source of calcium. Dairy products, such as milk, yogurt, and cheese are high in calcium. Certain green vegetables and other foods contain calcium in smaller amounts. Some juices, breakfast foods, soymilk, cereals, snacks, breads and bottled water have added calcium. If you drink soymilk or another liquid that is fortified with calcium, be sure to shake the container well as calcium can settle to the bottom.

A simple way to add calcium to many foods is to add a single tablespoon of nonfat powdered milk, which contains about 50 mg of calcium. It is easy to add a few tablespoons to almost any recipe.

Reading Food Labels – How Much Calcium Am I Getting?

To determine how much calcium is in a particular food, check the nutrition facts panel for the daily value (DV). Food labels list calcium as a percentage of the DV. This amount is based on 1,000 mg of calcium per day. For example:

• 30% DV of calcium equals 300 mg of calcium.
• 20% DV of calcium equals 200 mg of calcium.
• 15% DV of calcium equals 150 mg of calcium.

Calcium Supplements

The amount of calcium you need from a supplement depends on how much you get from food. Try to get the daily amount recommended from food and only supplement as needed to make up any shortfall. In general, you shouldn’t take supplements that you don’t need. If you get enough calcium from foods, don’t take a supplement. There is no added benefit to taking more calcium than you need. Doing so may even carry some risks.

Calcium supplements are available without a prescription in a wide range of preparations (including chewable and liquid) and in different amounts. The best supplement is the one that meets your needs for convenience, cost, and availability. When choosing a supplement, keep the following in mind:

• Choose brand-name supplements with proven reliability. Look for labels that state “purified” or have the USP (United States Pharmacopeia) symbol. The “USP Verified Mark” on the supplement label means that the USP has tested and found the calcium supplement to meet its standards for purity and quality.
• Read the product label carefully to determine the amount of elemental calcium, which is the actual amount of calcium in the supplement, as well as how many doses or pills you have to take. When reading the label, pay close attention to the “amount per serving” and “serving size.”
• Calcium is absorbed best when taken in amounts of 500 – 600 mg or less. This is the case for both foods and supplements. Try to get your calcium-rich foods and/or supplements in small amounts throughout the day, preferably with a meal. While it’s not recommended, taking your calcium all at once is better than not taking it at all.
• Take (most) calcium supplements with food. Eating food produces stomach acid that helps your body absorb most calcium supplements. The one exception to the rule is calcium citrate, which can absorb well when taken with or without food.
• When starting a new calcium supplement, start with a smaller amount to better tolerate it. When switching supplements, try starting with 200-300 mg every day for a week, and drink an extra 6-8 ounces of water with it. Then gradually add more calcium each week.
• Side effects from calcium supplements, such as gas or constipation may occur. If increasing fluids in your diet does not solve the problem, try another type or brand of calcium. It may require trial and error to find the right supplement for you, but fortunately there are many choices.
• Talk with your healthcare provider or pharmacist about possible interactions between prescription or over-the-counter medications and calcium supplements.

What is Vitamin D and What Does it Do?

Vitamin D plays an important role in protecting your bones, both by helping your body absorb calcium and by supporting muscles needed to avoid falls. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you’re more likely to break bones as you age.

How Much Vitamin D Do You Need?

**Some people need more vitamin D. According to the Institute of Medicine (IOM), the safe upper limit of vitamin D is 4,000 IU per day for most adults.

Sources of Vitamin D

There are three ways to get vitamin D:

• Sunlight
• Food
• Supplements

Sunlight

Your skin makes vitamin D in reaction to sunlight and stores it in fat for later use. How much vitamin D your skin can produce depends on time of day, season, latitude, skin pigmentation, age, and other factors.

There are many reasons people do not have enough vitamin D. As we age, our skin loses its ability to generate vitamin D. People who live in cities or in institutional settings like nursing homes spend too little time outdoors. Even people who spend time outdoors often use sunscreen to prevent skin cancer. Sunscreen with an SPF as low as 8 reduces vitamin D production by 95 percent.

Vitamin D in Food

Vitamin D is found in very few foods. Sources include fatty fish like wild-caught mackerel, salmon, and tuna. Vitamin D is added to milk and other dairy products, orange juice, soymilk, and fortified cereals.

Check the food label to see if vitamin D has been added to a particular product. One eight-ounce serving of milk usually has 25% of the daily value (DV) of vitamin D. The DV is based on a total daily intake of 400 IU of vitamin D. So, a serving of milk with 25% of the DV of vitamin D contains 100 IU.

It is very difficult to get all the vitamin D you need from food alone. Most people must take vitamin D supplements to get enough to support bone health.

Vitamin D Supplements

If you aren’t getting enough vitamin D from sunlight and food, consider taking a supplement. Before adding a vitamin D supplement, check to see if any of the other supplements, multivitamins, or medications you take contain vitamin D. Many calcium supplements also contain vitamin D.

There are two types of vitamin D supplements. They are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Both types are good for bone health.

Vitamin D supplements can be taken with or without food and the full amount can be taken at one time. While your body needs vitamin D to absorb calcium, you do not need to take vitamin D at the same time as a calcium supplement. If you need help choosing a vitamin D supplement, ask your healthcare provider or pharmacist to recommend one.

How Much Vitamin D Should You Supplement?

To figure out how much vitamin D you need from a supplement, subtract the total amount of vitamin D you get each day from the recommended total daily amount for your age. For example, a 55-year-old woman who gets 400 IU of vitamin D from her calcium supplement should take between 400 and 600 additional IU of vitamin D to meet the 800 – 1,000 IU recommended for her age.

Vitamin D Deficiency: Are You at Risk?

Vitamin D deficiency occurs when you are not getting the recommended level of vitamin D over time. Certain people are at higher risk for vitamin D deficiency, including:

• People who spend little time in the sun or those who regularly cover up when outdoors;
• People living in nursing homes or other institutions or who are homebound;
• People with certain medical conditions such as Celiac disease and inflammatory bowel disease;
• People taking medicines that affect vitamin D levels such as certain anti-seizure medicines;
• People with very dark skin;
• Obese or very overweight people; and
• Older adults with certain risk factors.

Talk to your healthcare provider if you have any of these risk factors. If you have osteoporosis and also have a vitamin D deficiency, your healthcare provider may temporarily prescribe a high dose of vitamin D to bring you up to a healthy level.

A Guide to Calcium-Rich Foods

We all know that milk is a great source of calcium, but you may be surprised by all the different foods you can work into your diet to reach your daily recommended amount of calcium. Use the guide below to get ideas of additional calcium-rich foods to add to your weekly shopping list.

*The calcium content listed for most foods is estimated and can vary due to multiple factors. Check the food label to determine how much calcium is in a particular product.

Last Reviewed 02/26/2018

Calcium Supplements | Memorial Sloan Kettering Cancer Center

This information explains calcium supplements and how to take them.

Calcium is a mineral that you need to build and maintain healthy bones. If you don’t get enough calcium from your diet, your body will take it from your bones. This can cause osteoporosis.

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Osteoporosis

Osteoporosis develops when you lose bone tissue, which makes your bones more likely to fracture (break). Osteoporosis is most common in females who have gone through menopause (a permanent end of your monthly periods). It can develop in anyone, including males, due to medication or illness. Some risk factors for osteoporosis include:

• Having a thin build
• Being of Northern European or Asian descent
• Having fair skin
• Going through menopause early (before the age of 45)
• Taking certain steroid medications for longer than 3 months
• Not getting enough physical activity
• Not getting enough calcium in your diet (or from dietary supplements)
• Smoking
• Drinking too much alcohol (more than 2 drinks per day for females or 3 drinks per day for males)
• Taking aromatase inhibitors (medications that stop the production of estrogen and are used to treat breast cancer)

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Vitamin D

Vitamin D is a vitamin that helps your body absorb calcium. Your body makes vitamin D after being exposed to the sun. Vitamin D is also found in some foods.

It can be hard to get enough vitamin D from just sunlight and foods. Your doctor or clinical dietitian nutritionist might tell you to take vitamin D supplements. These can be prescription or over-the-counter vitamin D supplement pills or calcium supplements with vitamin D added.

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Recommended Daily Intakes of Calcium and Vitamin D

Getting enough calcium in your diet helps prevent osteoporosis. Calcium is measured in milligrams (mg) that you need per day.

• If you’re between the ages of 19 and 50, you need 1,000 mg of calcium every day.
• If you’re female and are age 51 or older, you need 1,200 mg of calcium every day.
• If you’re male and are between the ages of 51 and 70, you need 1,000 mg of calcium every day.
• If you’re male and are age 70 or older, you need 1,200 mg of calcium every day.

Vitamin D is measured in international units (IU) that you need per day.

• If you’re between the ages of 19 and 70, you need 600 IU of vitamin D every day.
• If you’re over 70 years of age, you need at least 800 IU of vitamin D every day.

If you have osteoporosis, you might need more calcium, vitamin D, or both. Talk with your doctor or clinical dietitian nutritionist about how much you need per day. Don’t take more than your daily recommended amount of calcium. Taking too much can be harmful to your health.

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Sources of Calcium

Food

The best way to get calcium is through the food you eat. Dairy products are a good source of calcium. If you’re lactose intolerant, try lactose-free dairy products or Lactaid^® pills. You can also try calcium-fortified orange juice and other foods. Check food labels to see the amount of calcium in foods.

The table at the end of this resource lists some foods and drinks that are high in calcium.

Calcium supplements

You may find it hard to get enough calcium from your diet alone. Your doctor or clinical dietitian nutritionist may suggest that you take a calcium supplement. You don’t need a prescription for this. Your doctor or clinical dietitian nutritionist will tell you how much you should take.

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Types of Calcium Supplements

There are several types of over-the-counter calcium supplements, including calcium carbonate and calcium citrate. These supplements are taken orally (swallowed). All calcium should be taken with food.

Don’t buy calcium tablets that are made from bone or dolomite. These may contain lead or other harmful metals. Certain health-food store preparations have this problem. Most calcium supplements that you buy in a pharmacy have been tested for this.

Calcium carbonate

Calcium carbonate is absorbed best if you take it with meals. OsCal^® and Caltrate^® are 2 brands of calcium carbonate supplements. Other forms of calcium carbonate include:

• Some antacids, such as Tums^®. If you take Tums, you don’t need to take it with a meal.
• Viactiv^®, which is a flavored soft chew.
• A liquid form that you can usually get from a pharmacy, but you may need to order it in advance.

Calcium citrate

Calcium citrate is another type of calcium supplement. Some people may absorb calcium citrate better than calcium carbonate. This is true for older people and people with low stomach acid (for example, people who have pernicious anemia).

Calcium citrate absorbs best if you take it 30 minutes before a meal. One brand of calcium citrate is Citracal^®, which is available in most pharmacies.

If you have any of the following side effects with calcium carbonate, take calcium citrate instead:

• Abdominal (belly) pain
• Gas
• Constipation (having fewer bowel movements than usual)

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Taking Calcium Supplements

• If you’re taking more than 500 mg of calcium supplements per day, take it in divided doses. This will help your body absorb it better.  For example, if you take 1,000 mg of calcium each day, take 500 mg in the morning and 500 mg in the evening.
• Talk with your doctor or clinical dietitian nutritionist before taking calcium supplements if you:
  • Have a history of hypercalcemia (too much calcium in your blood)
  • Take diuretics (water pills) or antacids for indigestion
  • Have ever had kidney stones
  • Have had problems with your parathyroid glands
  • Have a history of heart disease, including heart attack or stroke
• If you’re taking a bisphosphonate medication for osteoporosis (or for other reasons), take your calcium supplement at least 30 minutes after you take it. If you’re not sure if the medication that you’re taking is a bisphosphonate, talk with your doctor.
  • Some examples of bisphosphonate medications are alendronate (Fosamax^®) and risedronate (Actonel^®). Remember, calcium supplements don’t replace other medications you take to treat osteoporosis.
• Calcium supplements can cause constipation. If you have this side effect, increase the amount of liquids and fiber in your diet. If that doesn’t work, talk with your healthcare provider about taking a stool softener or laxative. You can also try to get more calcium from foods instead of taking supplements.

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Calcium-Rich Foods and Drinks

The following table includes some foods and drinks that are rich in calcium.

For more information on foods that are rich in calcium, talk with your clinical dietitian nutritionist.

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Additional Resources

National Institutes of Health (NIH) Osteoporosis and Related Bone Diseases National Resource Center
800-624-BONE (800-624-2663)
www.bones.nih.gov/health-info/bone/osteoporosis

National Osteoporosis Foundation
202-223-2226
www.nof.org

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Calcium supplements: MedlinePlus Medical Encyclopedia

WHO SHOULD TAKE CALCIUM SUPPLEMENTS?

Calcium is an important mineral for the human body. It helps build and protect your teeth and bones. Getting enough calcium over your lifetime can help prevent osteoporosis, which is sometimes called “thin bones.”.

Most people get enough calcium in their normal diet. Dairy foods, leafy green vegetables, and calcium fortified foods have high levels of calcium. For example, 1 cup (237 ml) of milk or yogurt has 300 mg of calcium. Older women and men may need extra calcium to prevent them from getting (osteoporosis).

Your health care provider will tell you if you need to take extra calcium. The decision to take extra calcium should be based on balancing the benefits and risks of doing so.

TYPES OF CALCIUM SUPPLEMENTS

Forms of calcium include:

• Calcium carbonate. Over-the-counter (OTC) antacid products contain calcium carbonate. These sources of calcium do not cost much. Each pill or chew provides 200 mg or more of calcium. This form of calcium should be taken with meals.
• Calcium citrate. This is a more expensive form of calcium. It is absorbed well on an empty or full stomach. People with low levels of stomach acid (a condition that is more common in people over age 50) absorb calcium citrate better than calcium carbonate.
• Other forms, such as calcium gluconate, calcium lactate, calcium phosphate: Most have less calcium than the carbonate and citrate forms and do not offer any advantages.

When choosing a calcium supplement:

• Look the word “purified” or the United States Pharmacopeia (USP) symbol on the label.
• Avoid products made from unrefined oyster shell, bone meal, or dolomite that do not have the USP symbol. They may have high levels of lead or other toxic metals.

HOW TO TAKE EXTRA CALCIUM

Follow your provider’s advice on how much extra calcium you need.

Increase the dose of your calcium supplement slowly. Your provider may suggest that you start with 500 mg a day for a week, and then add more over time.

Try to spread the extra calcium you take over the day. DO NOT take more than 500 mg at a time. Taking calcium throughout the day will:

• Allow more calcium to be absorbed
• Cut down on side effects such as gas, bloating, and constipation

The total amount of calcium adults need every day from food and calcium supplements:

• 19 to 50 years: 1,000 mg/day
• 51 to 70 years: Men – 1,000 mg/day; Women – 1,200 mg/day
• 71 years and over: 1,200 mg/day

The body needs vitamin D to help absorb calcium. You can get vitamin D from sunlight exposure to your skin and from your diet. Ask your provider whether you need to take a vitamin D supplement. Some forms of calcium supplements also contain vitamin D.

SIDE EFFECTS AND SAFETY

DO NOT take more than the recommended amount of calcium without your provider’s approval.

Try the following if you have side effects from taking extra calcium:

• Drink more fluids.
• Eat high-fiber foods.
• Switch to another form of calcium if the diet changes do not help.

Always tell your provider and pharmacist if you are taking extra calcium. Calcium supplements may change the way your body absorbs some medicines. These include certain types of antibiotics and iron pills.

Be aware of the following:

• Taking extra calcium over a long period of time raises the risk of kidney stones in some people.
• Too much calcium can prevent the body from absorbing iron, zinc, magnesium, and phosphorus.
• Antacids have other ingredients such as sodium, aluminum, and sugar. Ask your provider if antacids are OK for you to use as a calcium supplement.

The Role of Calcium and Vitamin D in Bone Health

You probably already understand that calcium is good for your bones and helps ward off osteoporosis. The nutrient is essentially a building block of bone, and it helps maintain bone strength throughout your lifetime. But calcium can only reach its full bone-building potential if your body has enough vitamin D.

Calcium and vitamin D work together to protect your bones—calcium helps build and maintain bones, while vitamin D helps your body effectively absorb calcium. So even if you’re taking in enough calcium, it could be going to waste if you’re deficient in vitamin D.

Calcium

Your bones contain 99.5% of the total calcium in your body. Many people take in enough calcium from the foods they eat.

Good sources of calcium include:

• Reduced-fat or skim milk
• Low-fat plain or fruit yogurt
• Swiss cheese
• Calcium-fortified juice
• Calcium-fortified cereal
• Tofu

The daily recommended dietary calcium intake varies by age, sex, and hormone status. Recent studies have shown that many American girls do not get enough calcium in their diet after the age of 11. Many blame this on the substitution of soda for milk, yet the problem does not seem to be the same for males (1).

It is important to note that many women of all ages in the US do not get enough calcium in their diet. 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. There are several over-the-counter forms of oral calcium that can help maintain healthy bones and prevent osteoporosis. Talk to your doctor about what option is best for you.

Vitamin D

Vitamin D helps your body absorb calcium. Sunlight is actually the main source of vitamin D for many people. However, staying in the sun without proper skin protection puts you at risk for skin cancer. If you’re worried about this risk, or live in a northern climate where sun exposure isn’t a year-long guarantee, many foods will provide you with your daily intake of vitamin D.

Good sources of vitamin D include:

• Vitamin D-fortified milk
• Egg yolks
• Fatty fish

You may want to take a daily multi-vitamin or vitamin D supplements. There are also calcium supplements available that also contain vitamin D.

The following chart shows the National Osteoporosis Foundation’s (NOF) recommended calcium and vitamin D intake according to age, sex and hormone status:

**NOF does not have specific vitamin D recommendations for these age groups. These are the recommendations of the American Academy of Pediatrics (2).

Getting enough calcium and vitamin D—either through your diet or a supplement—is an essential part of any osteoporosis prevention plan. Talk to your doctor about how best to include these nutrients into your daily routine.

Updated on: 04/24/17

Osteoporosis Drugs and Medications

Beyond calcium, vitamin D, supplements may do more harm than good for bones

April 25, 2019

5 min read

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LOS ANGELES — When it comes to optimal bone health and fracture prevention, there is scant evidence for recommending supplementation with vitamins and minerals other than calcium and vitamin D, according to a speaker at the AACE Annual Scientific and Clinical Congress.

Daniel L. Hurley

Despite a lack of empirical evidence that suggests any benefits, consumer surveys show that many people report taking various over-the-counter supplements for bone health, from phosphorus and magnesium to vitamins A, K or C, Daniel L. Hurley, MD, FACE, professor in the division of endocrinology, diabetes, metabolism and nutrition at the Mayo Clinic in Rochester, Minnesota, said during a presentation.

“For all of these vitamins and minerals and trace elements and their use in skeletal health, the first motto is do no harm,” Hurley said. “There is little data to recommend supplementation for any of these, except for calcium and vitamin D.”

The second motto, Hurley said, is to “try and do good.” Calcium and vitamin D, he noted, are safe and effective to help prevent bone loss and fracture.

“They should never be used alone in the treatment of bone loss and prevention of osteoporosis, because they are ineffective in that regard,” Hurley said. “But they are very helpful together, especially for those patients not taking calcium and likely deficient in vitamin D.”

Even early on in the perimenopausal period and in the immediate postmenopausal period, fracture risk increases, Hurley said.

“So it is understandable that if there is something that is available to us as a supplement, as a mineral, that we could take to help decrease fracture risk, that that would be very important indeed,” he said.

Some of the popular OTC supplements include the following:

Phosphorus — Phosphorus is plentiful in the diet, especially in processed foods and soda, is readily absorbed in the gut, is enhanced by vitamin D and does not interfere with calcium absorption, Hurley said. However, because the mineral is so ubiquitous, it is rare to be deficient, and there is no evidence linking phosphorus supplementation with a reduction in fracture risk, he said.

Magnesium — Magnesium is found widely in foods; however, about 48% of U.S. residents do not meet the recommended daily allowance for the mineral, which is an intracellular cation necessary for calcium and potassium homeostasis. Effects on magnesium and bone mineral density have been reported to be variable, Hurley said. In an analysis of the Women’s Health Initiative, researchers observed a higher hip BMD in women in the highest quintile of magnesium intake; however, there was no observed effect on fractures.

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Fluoride — Fluoride, which is naturally present in soil and water, has a variable effect on skeletal health depending on dose, Hurley said. At a low dose of 25 mg twice daily, fluoride can stimulate bone osteoblastic growth, although the mechanism is unclear. However, at a higher dose of 75 mg three times daily, patients may be susceptible to nonvertebral fracture, and fluoride may cause abnormal mineralization, Hurley said. Gastrointestinal side effects with the mineral have also been observed.

Strontium — Found primarily on the surface of the bone apatite crystal, strontium has a chemical similarity to calcium, Hurley said, and it is rapidly incorporated into the bone. “When strontium gets incorporated, it reduces resorption, stimulates formation, increases bone density but may not improve bone strength,” Hurley said. The supplement is not recommended, Hurley said, because the data on bone health are limited, whereas researchers have noted a signal for increased cardiovascular events with strontium use, as well as drug-like rash effects. It is not FDA-approved in the United States, and in Europe, the indication for strontium was recently restricted to severe osteoporosis only, Hurley said.

When it comes to optimal bone health and fracture prevention, there is scant evidence for recommending supplementation with vitamins and minerals other than calcium and vitamin D.

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Vitamins — Evidence is conflicting and studies are small with respect to vitamins A, K (vitamins K1 and K2), E and C as supplements for bone health, Hurley said. Observational studies suggest that vitamin E is generally positive; however, very high levels of vitamin E may interfere with vitamin K, he said.

Trace elements — There are no long-term studies that show fracture risk reduction when supplementing with trace elements, such as zinc, copper, iron and selenium. “We cannot support any trace elements for skeletal health,” Hurley said. “There is data out there … but there are just no long-term studies. Although there is suggestion that these could be helpful, these are just hypothesis generating.”

Hurley noted that current AACE clinical practice guideline for the diagnosis and treatment of postmenopausal osteoporosis recommend sufficiency of both calcium and vitamin D as part of the treatment regimen. A patient’s total calcium intake should be assessed from both diet and any supplement use, and the total daily amount of calcium should not exceed 1,200 to 1,500. A reasonable clinical approach for vitamin D is an intake of at least 1,000 IU per day for adults aged at least 50 years, as vitamin D inadequacy is common in those with a low BMD or prior fragility fracture, according to the guideline.

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“We have no idea what we should give for a supplement dose, unless it comes to calcium and vitamin D, so even if we wanted to recommend a supplement, I would have no idea how to advise you, other than to make sure your patients are meeting the [Dietary Reference Intake],” Hurley said. “A multivitamin is probably not a bad idea if someone is not eating a healthy diet.” – by Regina Schaffer

Reference:

Hurley DL. Calcium, vitamin D and other nutrients for bone health. Presented at: AACE Annual Scientific and Clinical Congress; April 24-28, 2019; Los Angeles.

Disclosure: Hurley reports no relevant financial disclosures.

Perspective

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Meghan Jardine, MS, MBA, RDN, LD, CDE

Supplements should be used to treat a deficiency, and we should try to get most of our nutrients from food. You don’t eat calcium. You don’t eat magnesium. You eat dark green leafy vegetables that contain calcium and magnesium, working together in the right proportions to promote bone health. Additionally, studies on calcium supplementation are mixed. Some studies show that calcium supplementation increases risk for fracture and cardiovascular disease, whereas other studies suggest it decreases CV risk. It can all be very confusing for patients. The take home is that the clinician or nutritionist must assess the patient in front of them, individualize their care and not make blanket recommendations. At the Physicians Committee for Responsible Medicine, we do not recommend dairy. We found that people can get all of the nutrition they need from plant-based foods. Foods that are high in calcium include tofu, calcium-fortified orange juice (for those without diabetes), commercial soy yogurt, collard greens, mustard greens, kale. Beans and legumes are high in amino acids that promote bone mineral density. However, supplementation of calcium and vitamin D may be warranted if a patient is not getting the recommended amounts of calcium and vitamin D in the diet. It is also important to consider what medications a patient is taking and whether any of those medications are known for reducing bone mass. Other important components are exercise, smoking cessation, sodium reduction and stress management.

Meghan Jardine, MS, MBA, RDN, LD, CDE

Associate Director of Diabetes Nutrition Education

The Physicians Committee for Responsible Medicine

Disclosures: Jardine reports no relevant financial disclosures.

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American Association of Clinical Endocrinology Annual Meeting

90,000 Silent epidemic. / state budgetary institution of health care of the Yamal-Nenets Autonomous Okrug “Muravlenkovskaya City Hospital”

Osteoporosis is a systemic disease that leads to increased fragility of bones and the risk of fractures from minimal trauma or even without it. According to WHO, this is one of the main diseases caused, apart from other factors, by lifestyle, along with myocardial infarction, malignant tumors, etc. It is generally accepted that women aged 50 and older most often suffer from osteoporosis.

Professor of the Department of Gerontology and Geriatrics of the Russian Medical Academy of Postgraduate Education, Doctor of Medical Sciences Malichenko Svetlana Borisovna

among the population, especially among women, the proportion of elderly people has increased. This has led to a significant increase in the number of patients with osteoporosis, making it one of the most important public health problems of the 21st century.Currently, 95% of women reach the age of menopause, whereas at the beginning of the last century they were only 60%, that is, over a century there has been a significant increase in the period of life proceeding against the background of estrogen deficiency.

Research in recent years has shown that a decrease in bone density increases the risk of premature death not associated with fractures. Impaired calcium metabolism in osteoporosis is a trigger for the development of many diseases that accompany old age, in particular, arterial hypertension, atherosclerosis, diabetes mellitus.

Osteoporosis is called a silent epidemic, because this disease develops asymptomatically, within 5-10 years. It is diagnosed even when pain appears due to a decrease in bone density in various parts of the skeleton. The most reliable method of early diagnosis is the method of quantitative assessment of bone mass – bone densitometry, which allows fixing bone loss in the early stages with an accuracy of 2-6%. Bone loss primarily occurs in the spinal column, in those sections that experience maximum stress – the thoracic and lumbar.The main complaint of patients with osteoporosis is pain in the sacrum and lumbar region, aggravated by exertion and walking, sensitivity to the slightest shock. Patients often indicate a feeling of heaviness between the shoulder blades, fatigue, the need for repeated rest during the day in the supine position. Less common complaints of joint pain, gait disturbance, lameness.

Prevention of osteoporosis should be started already in adolescence, since the formation of a skeleton with maximum strength and bone mass occurs by the age of 12.In women of childbearing age, it is very important to maintain a regular menstrual cycle. Infertility is an unfavorable factor, like early menopause, causing early estrogen deficiency. Particular attention should be paid to the diet. The diet should include foods rich in calcium salts. But by themselves, calcium salts are unlikely to help with osteoporosis. Their intake into the body should be combined with the intake of special medications. The fact is that high levels of calcium in blood and bone tissue are not the same thing.It is necessary for the trace element to get from the blood into the bones. And for this, the body must have enough vitamin D. Without it, calcium supplied with food is absorbed only by 10-15%. Therefore, for the prevention of osteoporosis, combination preparations containing both calcium and vitamin D are best suited. For calcium to be well absorbed, it is better to take the preparations with meals, after meals, or at least after having a light snack. Do not swallow them late at night on an empty stomach. For those who have poor gastric juice production, it is better to drink the tablets with sour juice, for example, orange juice, which facilitates the absorption of calcium.

Caffeine promotes the rapid elimination of calcium from the body. But this effect is not very noticeable. Of course, if you drink coffee all your life and in large quantities, your bone density may decrease slightly. But people drink coffee differently. Some people prefer, for example, coffee with milk.

And as recent studies have shown, just a glass of milk per day stops bone loss. But milk is also not a panacea for osteoporosis. It can even increase the risk of fractures.It contains not only a lot of calcium, but also protein, the excess of which in the body can lead to the loss of calcium. If proteins make up more than 35% of the diet, then, most likely, you should not rely only on milk.

Tea also contains a lot of caffeine. But, unlike coffee, it does not provoke osteoporosis, but, on the contrary, protects against it.

Several studies point out directly that carbonated drink addiction is one of the risk factors for osteoporosis. The matter is in the phosphorus contained in them, it washes calcium from teeth and bones.But most carbonated soft drinks, thankfully, don’t have enough phosphorus to be detrimental to your health. Alcohol also damages bones. Those who abuse alcohol run the risk of early osteoporosis. The reason is the same: alcohol accelerates the elimination of calcium from the body.

Many plant products contain specific acids – phytic, oxalic, which interfere with the absorption of calcium. But there are many herbal foods that are very rich in this micronutrient.Among them are nuts, seeds, green onions, spinach, parsley, dill, horseradish. There is as much calcium in beans and peas as in dairy products. And the leader in terms of its content is soy. 0.5 l of milk or kefir contains about 800 mg of pure calcium.

What rules should be followed by patients with osteoporosis at home

You need to organize your life so as to eliminate as much as possible those risk factors that lead to falls, because falls in women with reduced bone mass are fraught with fractures.If necessary, you need to rearrange the furniture, remove unnecessary items, rugs from the floor. Correction of vision in such patients should be carried out in a timely manner. Uncontrolled intake of sedatives and sleeping pills can also cause poor coordination and fall, so they should not be abused. It is better for such people to move along the streets, ride in public transport, accompanied by loved ones. It is not out of place to protect yourself from falling and some kind of auxiliary means, for example, a cane.

Medicines that interfere with the action of calcium preparations

First of all, these are drugs that regulate blood cholesterol, antibiotics of the tetracycline group, some anti-inflammatory, anticonvulsant, antidiabetic and laxatives. But only a doctor can give qualified advice on their use.

It is known that the greater the body mass, the stronger the bones.So is it true that overweight people are insured against osteoporosis

There is some truth in this. Obese women have stronger bones. This is partly due to the fact that a certain amount of female sex hormones – estrogens, which protect bone tissue from destruction, are produced in fat cells. As a rule, the greater the body fat, the more estrogen is formed in the body after the onset of menopause. In addition, excess body weight puts additional stress on the bones, which helps to strengthen them.

Smoking harms almost all organs and tissues, including bones

A woman who smokes a pack of cigarettes a day has 5-10% less bones than they could be. The harmful substances contained in tobacco smoke deprive them of minerals, slow down the production of estrogen.

Exercise is good for strengthening bones

Bones are like muscles – when used they become thicker and stronger.

For the prevention of osteoporosis, it is best to walk, jog, do aerobics, swim, ride a bicycle, play tennis or badminton, dance, jump.

Sports also develop coordination of movements, balance and strength, and reduce the likelihood that a fall will result in a fracture. Lifting weights is especially beneficial for bones. So, if your elevator constantly breaks down and you have to go up with bags at least to the fifth floor, consider it a gift of fate. But you should not overdo it in sports. A measure is needed in everything.

What’s new for the treatment of osteoporosis?

Medicines for the treatment and prevention of osteoporosis work in approximately the same way. They either interfere with the leaching of calcium from the bones, or they accelerate the growth of bone tissue. Coming up with something new is quite difficult. Nevertheless, every year new drugs appear, which, as a rule, differ from the old ones in greater efficiency, fewer side effects.There are, for example, drugs that regulate the work of special scavenger cells – osteoclasts, which “dismantle” obsolete bone tissue, or drugs based on the protein osteoprotegerin, which protects bones from destruction. There are drugs that prevent calcium from leaving the bone tissue, they also prevent the deposition of salts in soft tissues and joints. So patients with osteoporosis get real opportunities to alleviate their condition.

● How to be sure of a true calcium preparation?

Put one tablet of purchased calcium into a jar, fill it with ordinary vinegar and shake occasionally for 3-5 minutes.After 20-30 minutes, a tablet of real calcium should dissolve or crumble. If after half an hour it still remains intact, then it is worth looking for another remedy.

● Daily intake of calcium

Children under 6 months – 400 mg, from 6 months to 1 year – 600 mg, from 1 to 10 years – 800 mg.

Boys and girls 11-25 years old – 1200 mg.

Men 25-50 years old – 800-1000 mg, over 50 years old – 1200-1500 mg.

For women before menopause – 800-1000 mg, during pregnancy and lactation – 1200 mg, after menopause – 1200-1500 mg.

● Calcium content in some products

A glass of milk – 300 mg

A portion of yogurt – 300-400 mg

A portion of cheese (20g) – 200 mg

Turnip (100g) – 75 mg

Broccoli (100 g) – 50 mg

● Old recipes

Eggshell is an ideal source of calcium.It is 90% calcium and is very easily absorbed by the body. The method of using eggshells is very simple. Raw eggs are pre-singed with warm water and soap, rinsed well. Then, in a mortar, the shell is ground into powder. Dose – from 1.5 to 3 g daily, depending on age. Reception in the morning with cottage cheese or porridge. The shells from boiled eggs are slightly less active, but they are completely ready for use, having undergone sterilization during the cooking process. 90,007 90,000 COVID-19 and osteoporosis. Ask your questions to an osteoporosis specialist remotely!

Dear patients!

Today, amid the COVID-19 pandemic, we hope that you and your families are self-isolating to minimize the risk of contracting coronavirus infection.

Be at home, be safe!

We would also like to reassure people with osteoporosis and those on medication to treat osteoporosis that having osteoporosis does not increase your risk of contracting coronavirus or serious complications. However, now more than ever, staying fracture-free is extremely important for everyone with osteoporosis. This disease is chronic and does not require frequent visits to medical institutions, except in cases when fractures have occurred and a visit to a trauma center is necessary.

At a time when there is a threat of infection and the health care system is overwhelmed, general guidelines urge people to avoid hospitals and doctors’ offices unless absolutely necessary.

Please note : If you have other chronic diseases in addition to osteoporosis, such as diabetes or lung, heart or kidney disease, you are at high risk of serious complications of COVID-19 disease. We urge you to stay at home, taking the necessary precautions in accordance with the recommendations of the Russian Ministry of Health and the Russian Government.

The International Osteoporosis Foundation and the Russian Osteoporosis Association have developed recommendations for the treatment of osteoporosis and the prevention of its complications in the context of the COVID-19 epidemic and living in isolation. First of all, it is important to understand that physical isolation does not have to be social isolation. Therefore, keep in touch with family and friends by phone or email. Patients who are observed in the osteoporosis clinic and receive aniosteoporotic drugs can ask questions to the doctors of the Federal State Budgetary Institution “NMITs TPM” of the Ministry of Health of Russia by e-mail, indicated below, and receive more detailed information.Densitometry for the purpose of monitoring therapy can be postponed for 3-6 months.

Preventing falls is a vital concern in isolation. To do this, you need to make sure that there are no obstacles and factors in your home environment that make it difficult to move around the house. It is important to maintain physical activity and not forget about the set of exercises recommended by your doctor. Adhere to a proper diet, eat daily foods with a high content of calcium and vitamin D (mainly dairy).

As with other chronic diseases, patients with osteoporosis require continuous therapy with drugs that support bone metabolism. Do not stop any osteoporosis medication (including calcium and vitamin D supplements) that you have been prescribed and consult your doctor if you have any concerns. If you have been unable to follow your doctor’s prescriptions (pills, injections, or infusions) for osteoporosis because you feel unwell, a temporary delay in taking your medication will not have a long-term negative effect on bone health.This is more true for bisphosphonates, which accumulate in the bone tissue and can protect bones for a long time after they are discontinued. However, it is recommended to resume taking the drug as soon as possible. If treatment is carried out with zoledronic acid, the reduction in the risk of fractures after the next infusion persists for more than 12 months, so it is possible to delay the next infusion for several months without much damage to the bone tissue.

Denosumab deserves special attention in the current pandemic situation.Like many drugs for the treatment of chronic diseases, it has a reversible effect on bone tissue, which lasts for 6 months, as long as the concentration of the substance in the blood is maintained. Therefore, the drug should be administered subcutaneously strictly once every 6 months. Patients lose the protection of the drug after discontinuation, therefore, treatment should be continued continuously for at least three years with good tolerance and under the supervision of the attending physician. In the period of the fight against the spread of coronavirus infection, many patients, especially the elderly, are faced with the problems of leaving home and visiting medical institutions.In this regard, we recommend that you independently inject denosumab or use the help of relatives.

Let’s all be safe and fracture-free by following essential guidelines to help protect all seniors and those more vulnerable to this common virus.

The doctors of the Osteoporosis Clinic can advise you:

• Skripnikova Irina Anatolyevna, Head of the Osteoporosis Clinic, Doctor of Medicine, Osteoporosis Specialist
• Kosmatova Olga Vladimirovna, specialist in osteoporosis, candidate of medical sciences, senior researcher
• Myagkova Margarita Anatolyevna, specialist in osteoporosis, researcher

You can ask your questions to specialists by e-mail: osteoporos @ gnicpm.ru

Prevention of osteoporosis

pH balance – the best way to detoxify the body

Very often we come across the phrase “acid-base balance” and it is not always clear why it is needed.Let’s try to figure out what it is and how important the acid-base balance is for the body.

The human body is 70-80% water, and has a certain acid-base ratio, characterized by the pH. All biochemical processes in the body depend on the level of acidity, which means that any collection and deviation from the norm will cause this or that disease.

To understand what indicators should be normal, let’s analyze the acidity of the blood.

Acid-base balance in human blood is one of the most stable parameters, maintaining acid and alkaline components in a certain equilibrium within very narrow boundaries.

The acidity of fluids inside the human body normally coincides with the acidity of the blood and ranges from 7.35 to 7.45 pH.

Even a small shift from these limits can lead to severe pathology. With a shift to the acidic side, a condition occurs called acidosis, to the alkaline side, alcolosis.A change in blood acidity above 7.8 pH or below 6.8 pH is incompatible with life. The acidity of erythrocytes is 7.28–7.29 pH.

The body constantly strives to balance this ratio by maintaining a strictly defined pH level.

What causes acid-base imbalance?

The main reason for acidification of the body is unhealthy diet. We are used to evaluating food in terms of calorie content, protein content, carbohydrates, fats, vitamins and other substances.But any product has another fundamental indicator – the acid load of food.

Acid load is measured on the acid minus alkali principle.

When the food is dominated by components that form sulfuric acid (sulfur-containing amino acids in proteins) or organic acids (fats, carbohydrates), then the acid load has a positive value.

If the food contains more alkali-forming components (organic salts of magnesium, calcium, potassium), then the acid load is negative.

Most of the food we eat contains many acids, which leads to low pH levels.Fast food, coffee, tea, sugar, medications, and alcohol are major contributors to lowering pH.

When the body’s pH level drops, it begins to use a backup compensation system with the help of the kidneys and lungs. To compensate for the low pH, the body begins to absorb calcium from the bones, leading to osteoporosis.

Violation of the acid-base balance can also cause:

– Psychosomatic problems such as agitation, anxiety and stress .Muscle tension and shortness of breath lead to poor gas exchange and oxygen uptake by the alveoli / lungs. As a result, cells throughout the body receive less energy and nutrients. The more nutrients you receive as a result of good gas exchange in the lungs, the better the functioning and nutrition of all cells in the body will be. In this way, organs and cells will more easily get rid of toxins, reducing the likelihood of suboptimal pH.

– Frequent use of drugs and alcohol can cause oxidation in an unbalanced pH .
Drinking alcohol and taking multiple medications at the same time can damage the kidneys and liver. The alcohol components are converted to acid. Alcohol is absorbed in the stomach and small intestine, resulting in an immediate enzymatic degradation phase (ADH) in the stomach. The main phase of degradation occurs after alcohol is absorbed into plasma and enzyme breakdown begins in the liver. Oxidation is mainly due to the enzyme ADH (alcohol dehydrogenase), which converts ethanol to acetaldehyde.Acetaldehyde is then converted to acetic acid by the enzyme ALDH (acetaldehyde dehydrogenase). 95% of the alcohol that enters the body is broken down in the liver. Of the remaining amount of alcohol, about 2% is excreted in urine, about 2% – with exhaled air, and about 1% – with sweat.

At this stage, the body weakens and oxidizes to such an extent that the natural cleansing process can be disrupted. Therefore, the accumulation of contaminated body fluids can be a factor and then the cause of too high acidity and imbalance in alkalinity (pH).

Low pH levels cause serious illness. Therefore, taking a pH balancing drug is essential as a supplement to our daily diet.

How to regulate the acid-base balance?

The main property of products that regulate acid-base balance should be their ability to activate the electrolyte phase (biological fluids) and osmotic pressure, which is naturally present in the cell membrane.The body depends on the presence of osmotic pressure in water exchange, which ensures the ability to separate toxins without losing fluid. An example of an imbalance in electrolyte balance and osmotic pressure are processes in the small intestine. If you have diarrhea for no particular reason and are unable to retain fluids, this means that you have an imbalance in osmotic pressure in your gut. This process is regulated by the addition of sodium, which restores pressure in the cell membrane.

NFO pH-Balance has been added to the Norwegian Fish Oil product line to help regulate acidity. NFO pH-Balance is a powder containing substances valuable for the body – calcium, magnesium, zinc and vitamin C.

Due to its positive effect, NFO pH-Balance is suitable for absolutely all people. This is what makes the product so unique.

With NFO, the pH Balance can restore and activate the alkaline and osmotic balance in the body to initiate detoxification processes.By using NFO pH Balance during and after alcohol consumption, you reduce the risk of acid-base balance shifting towards oxidation. Therefore, the product helps the body to recover from the use of drugs and alcohol.

We recommend taking pH-Balance as a hangover agent, as it combines all the ingredients you need in the best possible way. Even a large amount of alcohol drunk can “smooth out” the pH-Balance, acting correctly on the body and reducing the high acidity after drinking.

As a result of the reception, the symptoms characteristic of withdrawal symptoms are eliminated: headache, irritating sensations in the epigastric region, dizziness, chills, thirst, dry mouth, unpleasant odor when talking and breathing. pH-Balance is not only an anti-hangover agent, it also has antihypoxic and antioxidant effects, activates the work of organs and tissues, normalizes metabolism, and has a positive effect on cognitive and muscle activity.

To prevent alcohol poisoning, you need to take 1 dose 1 hour before drinking alcohol, 1 dose during and 1 dose after drinking.

NFO pH-Balance contains ascorbic acid. This component is used in order to create a balance between acid and alkali. This combination of acidic and alkaline components in one product provides direct control of electrolytes (fluid balance).

Taking NFO pH Balance daily prevents symptoms such as swelling, joint stiffness, general edema, high uric acid, gas problems and back pain.

NFO pH-Balance is a complete detoxifying product for the body. It also has a controlling effect on histamine.

When is NFO pH-Balance needed:

– for complete cleansing of the body
– to ensure the maximum effect of all other additives
– when eating unhealthy food
– when using drugs
– when drinking alcohol
– to eliminate all problems with the stomach and colon
– for the treatment of allergies
– for excretion of uric acid
– to remove fluid from joints
– to remove excess fluid
– for additional energy, cleansing the liver and kidneys
– for the prevention of diarrhea
– to remove fungus, including after taking antibiotics
– to strengthen the immune system
– for cleaning the skin
– to intensify oxygen supply to cells
– for the treatment of all diseases caused by Candida
– to reduce acidity and stabilize alkalinity

How to take pH correctly Balance:

– for prophylaxis – 2 doses per day
– for therapeutic purposes – 4-5 doses per day
– in the case of alcohol consumption – before, during and after consumption (in addition to prophylactic use)
– to detoxify the body – 4–5 doses daily for 2 months, break for 2 weeks, then start prophylactic use again
– to ensure the maximum effect of other additives, pH Balance should be taken in the minimum prophylactic dose.

IMPORTANT: DO NOT stir product with any metal.

Preparations for fractures: how to accelerate bone healing

Author Yulia Vladimirovna Dmitruk Read 8 min Views 2k. Posted on 17.05.2018
Updated 11/21/2018

Therapy of fractures involves reduction, immobilization and the use of agents that have regenerative properties.To restore the integrity of the bone, medications with calcium are recommended; chondroitin and glucosamine will benefit the joints. Drugs for fractures are selected individually. In some cases, doctors use pain relievers and anti-inflammatory drugs, in others – decongestants and immunostimulating. Medicines for tissue regeneration are always appropriate, regardless of the severity and location of the damage.

What is

prescribed for

In the presence of various concomitant diseases of the musculoskeletal system, complications of the injury and a slowdown in recovery occur.In this case, patients are prescribed multicomponent preparations containing ingredients aimed at reducing the time of the rehabilitation process and preventing recurrence of the underlying ailment.

In traumatology and surgery, complexes for fast bone fusion are in demand. They include calcium and also vitamin D – a lot of it is needed by children and the elderly. Lack of vitamins is observed in women during menopause and in childbearing age after pregnancy and lactation. The same dietary supplements are used for diseases that cause the fragility of solid structures: osteoporosis, osteomyelitis.

As such, there are no drugs for bone fractures, but there are drugs that improve the formation of callus, pain relievers and decongestants. In older people, fractures are treated with drugs to quickly adhere and thin the blood so that there are no clots. According to the rules of medicine, expectorant drugs are recommended in case of rib injury. Severe injuries may require the use of anabolic steroids. They are appointed only by a specialist and only for specific indications.

In case of severe pain syndrome, anesthetics, pain relievers and anti-shock medications are used. With a fracture, non-narcotic analgesics and NSAIDs are effective.

Preparations based on chondroitin

Cartilage tissue consists of chondroitin and glucosamine, and the use of drugs with these components accelerates bone fusion. It is recommended to drink chondroitin immediately after injury.

Effective drugs of this group include:

• “ Teraflex ” – one of the best preparations for rapid bone healing in case of fractures and cracks.”Teraflex” contains chondroitin sodium sulfate, which strengthens the cartilage tissue, protects it from splitting, maintains the viscosity of the synovial fluid. Not indicated for chronic renal failure;
• “ Kondronova ” – produced in the form of capsules, improves the healing of bone structures, stimulates the formation of hyaluron, reduces the need for NSAIDs. Take 2 capsules 20 minutes before meals;
• “ Artra ” – tablets for accelerated repair of cartilage tissue.With them, the bones grow together better, the likelihood of contractures is reduced. The tool is used in the treatment of fractures of the ankle, hand bones and even the spine. “Artra” improves the biosynthesis of connective tissue, has a slight anti-inflammatory effect. It is prescribed for adults and children from 15 years of age;
• “ Inoltra ” – an American preparation in the form of capsules contains glucosamine and chondroitin, which are fortified with vitamins E, C and manganese. With this tool, bones grow together more actively, the production of synovial fluid improves, and cartilage tissue is strengthened.Due to the content of docosahexaenoic acid, soft tissues heal better, edema goes away. For the fastest healing of fractures, capsules are taken 3 times in knocks, 1-3 pcs., Depending on body weight;
• glucosamine-chondroitin complex – a domestic preparation in the form of capsules. Not a drug, but improves healing after injury. Contains important compounds for bone fusion in fractures: chondroitin sulfate, ascorbic acid, glucosamine hydrochloride, methylsulfonylmethane.Differs in an affordable price and good portability. Take 1 pc twice a day.

Calcium preparations

In case of a tendency to fractures, calcium preparations are indispensable. They also need to be taken for diseases of the skeletal system of various etiologies. In case of fractures, calcium supplements provide the body with the necessary building materials. Complexes containing vitamin D will bring benefits.

The older the person, the higher the need for calcium: for the elderly and women during pregnancy and menopause, vitamins with calcium are prescribed without fail.They counteract wear and tear on joints and strengthen bone tissue.

Inexpensive calcium preparations for bone fractures include:

• “ Calcemin ” – recommended for the prevention of calcium deficiency in the body and for recovery after fractures. Suitable for children. It is not used for urolithiasis and a tendency to allergies;
• “ Calcium D ₃ Nycomed ” – useful for women over 50 years old and the elderly.It is also prescribed to strengthen bones after fracture. The complex is suitable for long-term therapy and prevents the complication of fractures;
• calcium gluconate is a tablet preparation that accelerates the formation of primary callus and shortens the recovery period in case of uncomplicated fractures. Suitable for treating children in a dosage according to age;
• “ Osteogenon ” is a prescription drug recommended for fractures of the femoral neck, spinal injuries.Contains calcium in a 2: 1 ratio with phosphorus. Enhances crystallization and promotes bone healing. Tablets should be taken in 1-2 pcs. per day. The agent is also prescribed in the case of osteoporosis in an elderly person and a violation of calcium-phosphorus metabolism during pregnancy and hepatitis B;
• “ Vitrum Osteomag ” – promotes the fastest rehabilitation after a fracture. Contains calcium in the form of calcium carbonate, since other forms of calcium are poorly utilized. Fortified with Vitamin D, Magnesium, Copper, Zinc.The intake of calcium carbonate helps to restore the destroyed part of the bone tissue, improve collagen production, and prevent osteoporosis.

The doctor will tell you which vitamin complex is best to take in a particular case. Calcium is available to the patient, not only in the form of tablets. It can be obtained from food: cheese, cottage cheese, fish. During the rehabilitation period, you should drink milk and fermented milk products. Calcium is involved in the formation of bone tissue, but it is poorly absorbed without components such as cholecalciferol, zinc and magnesium oxides.

Painkillers

Many groups of drugs contain an anesthetic component, but if this is not enough, painkillers are additionally used for fractures. A rib fracture is considered extremely painful. To prevent painful shock, analgesics are taken.

Available pain relievers include:

• “ Ketanov ” – produces an anti-inflammatory effect. It is used for pain relief in fractures of varying degrees of complexity and localization;
• “ Ketorol ” – an analogue of the previous agent, has a pronounced analgesic effect.Recommended for various injuries: ligament ruptures, fractures, dislocations;
• “ Sedalgin ” is a tablet preparation with caffeine and sodium metamizole. Helps with acute pain syndrome and discomfort caused by long-term fixation of the fracture, is used from the age of 12;
• “ Caffetin ” is a combined pain reliever that will help with a fracture. It is a prescription drug prescribed for back injuries, muscle pains, and joint damage.Suitable for pain relief in case of hip fracture.

The duration of taking painkillers largely depends on the pain threshold. For children, sparing drugs are shown: Nurofen, Paracetamol. They are both pain relievers and NSAIDs.

Sometimes the usual analgesics for a fracture of the arm or lower extremities are not enough. If surgical intervention is required, local anesthesia is required – Novocain is administered before the operation.

Nonsteroidal anti-inflammatory drugs

It is recommended to take NSAIDs until complete fusion at the fracture site.They remove edema, prevent dangerous conditions, relieve pain, block inflammatory reactions, and prevent disturbances in the functioning of the damaged bone structure.

The list of NSAIDs includes simple aspirin-based drugs and combined complexes. The active ingredients are often arylacetic, acetylsalicylic, arylpropionic acids. They soothe inflamed tissues and are quickly eliminated from the patient’s blood.

Medicines should be used in accordance with the instructions.If the doctor has prescribed NSAIDs for a period of several weeks, they promise attention to the dosage. It usually shrinks by the end of treatment.

What drugs should be taken in case of injury (forearm):

• “ Diclofenac ” – appoint 30 minutes before meals. The drug relieves pain and improves repair. Suitable for treating children weighing over 20 kg;
• “ Meloxicam ” – well absorbed, completely degraded. Not used until 15 years of age.The tablets must be taken once a day;
• “ Movalis ” – so that the fracture heals quickly and there are no complications, “Movalis” is prescribed in the form of a solution for intramuscular injections.

The list of effective NSAIDs with pronounced anti-inflammatory properties includes Ibuprofen and its analogues, which are used in the treatment of a bruised finger to a fracture of the lower jaw.

Immunomodulators

In case of open fractures due to the high risk of wound infection, it is advisable to take immunomodulators.Preparations of natural origin are especially useful, and anabolic hormones are used to treat injuries requiring surgery and endoprosthetics.

The following immunomodulators are recommended after fractures:

• “ Pyrogenal ” – means in the form of rectal suppositories or solution for injection. Forces healing and stops the inflammatory process. Traditional drugs for the treatment of fractures are compatible with Pyrogenal, and it is the complex therapy that gives positive changes even with complicated injuries;
• “ Timalin ” – increases the activity of immune cells.Thymus extract is the basis of the healing powder. Thanks to this element, metabolic processes are improved. The drug is administered parenterally. Before surgical treatment two and three days after surgery;
• “ Likopid ” – exhibits bactericidal activity. It is used strictly according to the doctor’s prescription. The preparation contains glucosaminyl muramyldipeptide. This component increases the activity of natural killer cells. It is used in the form of tablets of 1 mg for children and 10 mg for adults.

Immunomodulators are not drugs for bone fusion, but they prevent complications after fracture. If the bone structures grow together poorly and inflammation develops, one cannot do without funds that boost immunity.

Dietary supplements and homeopathy

Homeopathic remedies are used to accelerate the repair. They help reduce inflammation and speed up bone healing. Medicines with calendula, arnica and rue will help out. In case of bone fractures, drugs with mummy have proven effective.

According to homeopaths, hypericum and eupatorium have proven healing capabilities. Dietary supplements from “Tyansha” with an important component – biocalcium will bring health benefits. It is possible to use supplements with collagen, for example, “Collagen Ultra”.

Dear readers of the 1MedHelp website, if you have any questions on this topic, we will be happy to answer them. Leave your feedback, comments, share stories with what drugs you treated such an injury! Your life experience may be useful to other readers.

90,000 Youth for a long time: how vitamin D can help prevent premature aging

The risk of heart problems and the development of Alzheimer’s disease. The lack of vitamin D also affects our appearance: the skin begins to age, losing freshness and elasticity.

To the topic Men’s health: what is vitamin D for and how it affects the ability to have children

How vitamin D affects the aging process

When it is optimal in the blood, vitamin D stimulates collagen production and helps to resist the appearance of wrinkles.

Vitamin D also stimulates factors of the immune system to suppress inflammatory processes in tissues, including skin. That is why vitamin D is so needed to combat acne and other inflammatory manifestations and chronic conditions.

As shown by clinical studies, vitamin D inhibits the transcription of anti-apoptotic proteins, and therefore prevents premature cell death.

Another function of vitamin D, which explains its role in the processes of cellular aging, is the effect on the regulators of phosphorus-calcium metabolism , the defects of which cause premature individual, genetically determined aging.

With sufficient concentration in the blood, vitamin D destroys these harmful substances and removes them from the body, thus contributing to an increase in life expectancy.

Finally, vitamin D indirectly slows down the depletion of telomeres, and therefore the aging of the body, which modern science considers to be the direct cause of the development of oncological diseases, as well as Alzheimer’s and Parkinson’s diseases.

Let us examine in more detail how vitamin D affects the length of telomeres.

Most people lack the “solar vitamin” during the cloudy season.

What are telomeres and why aging of the organism depends on them

Telomeres are repeating DNA ends. With each division, the telomere cells contract, and in the end the cell loses its ability to divide, physiologically aging and dying.

As a result of clinical studies, a relationship was found between the length of telomeres and the risk of developing with age such diseases and pathological conditions as:

• arterial hypertension,
• chronic heart failure,
• atherosclerosis,
• myocardial infarction,
• ,
• obesity,
• stroke,
• cancer.

It has also been found that the use of strategies that slow the contraction of telomeres while protecting them and repairing damage can slow the aging of the body.

Stress and chronic inflammation

Oxidative stress and chronic inflammation significantly reduce telomere activity and accelerate telomere contractions. So, these are fatal factors of rapid biological aging.

While looking for ways to maintain telomere quality longer, scientists have found and a number of clinical studies have confirmed that vitamin D reduces the concentration of mediators of systemic inflammation, such as interleukin-2, and therefore indirectly slows down telomere depletion.

The relationship between vitamin D concentration and telomere length was confirmed by a study involving 1424 women in the Nurses’ Health StuDy (NHS) program. Thus, in patients with high levels of vitamin D in blood plasma, a significant length of telomeres was recorded.

Thus, there is good reason to consider vitamin D as a potential remedy for the fight against premature aging and age-related diseases.

The danger of vitamin D deficiency for older people

While investigating how vitamin D affects the health of older age groups, scientists have established a link between vitamin D and one of the main markers of biological age – the length of leukocyte telomeres.

However, it is worth remembering about other, more obvious, risks. For example, it has been proven that 87.5% of people with a lack of vitamin D have bone loss (40.1% – osteoporosis, 47.4% – osteopenia).

In patients of older age groups with primary systemic osteoporosis and osteoarthritis, vitamin D deficiency is recorded in 80.3% of cases.

The frequency of vitamin D deficiency increases with age and reaches a maximum by the age of 80–89.

How to prevent vitamin D deficiency

The content of vitamin D in the blood should be at least 75 nmol / l (30 ng / ml).For risk groups (the elderly, obese or chronic diseases), the norm is 100 – 150 nmol / l (40 – 60 ng / ml). You can find out if this indicator is normal by doing a blood test for the level of the metabolite 25 (OH) D (25-hydroxyvitamin D).

If a laboratory test has confirmed a deficiency of vitamin D, it is necessary to restore its level in the body as soon as possible. A sufficient daily intake of vitamin D is difficult to obtain from food. Vitamin D is rich in fatty fish, liver, beef.Consuming them constantly and in large quantities is quite problematic.

The most effective and safest way to replenish the “sunshine vitamin”, especially in the cold season, is to take quality dietary supplements.

Vitamin D is recommended by the international medical community at a dosage of 2000 to 4000 IU per day.