When to think about calcium deficiency
If you have a lack or deficiency of vitamin D, if you don’t get enough sun exposure, drink little or no milk and dairy products, for example due to an allergy or lactose intolerance, follow special types of diet (high protein diet, veganism, etc.) .), if you are addicted to caffeine (coffee, strong tea, chocolate), then you should think about the lack of calcium intake from food. By the way, foods such as spinach, greens, rhubarb, and beans, although rich in calcium, also contain oxalic and phytic acids. As a result, insoluble calcium-oxalate and calcium-phytate complexes are formed, which does not allow calcium to be absorbed.
Diseases of the kidneys, parathyroid glands and inflammatory bowel diseases also disrupt the calcium balance in the body.
Vitamin D promotes calcium absorption
Vitamin D preparations (cholecalciferol, calcitriol or alfacalcidol) promote better absorption of calcium salts. In their absence, only 10% of the calcium entering the body can be absorbed. Calcium absorption, along with estrogens, increases under the influence of growth hormone, insulin-like growth factor I, and parathyroid hormone.
An analytical review devoted to the absorption of calcium under conditions of different acidity in the stomach shows that in various groups of patients (old people, patients receiving high doses of antiulcer drugs, patients with achlorhydria), the most effective absorption of calcium carbonate occurs when it is taken with food , even in the absence of basal secretion of hydrochloric acid in the stomach.
What tests to take
It is difficult to detect calcium deficiency using a blood test, because the body does everything possible to maintain a constant level of ionized calcium in the blood. But it’s easy to be deficient or deficient in vitamin D by taking a blood test for 25-OH vitamin D.
To identify contraindications and evaluate the effectiveness of treatment with calcium preparations, you should take tests:
- Calcium and phosphorus in the blood
- Calcium in daily urine
- Blood creatinine
- 25-OH vitamin D
In the Lab4U laboratory this can be done with a discount of up to 50%.
TREATMENT AND PREVENTION OF OSTEOPOROSIS: DRUGS OF CHOICE (Part 4)
Preferanskaya Nina Germanovna
Associate Professor, Department of Pharmacology, Faculty of Pharmacy, First Moscow State Medical University named after. THEM. Sechenova, Ph.D.
COMBINED CALCIUM PREPARATIONS
Calcium carbonate + Calcium lactogluconate is produced under the trademark “Calcium-Sandoz Forte”
, effervescent tablets contain Calcium carbonate 875 mg (1750 mg) + Calcium lactogluconate 1132 mg (2263 mg), equivalent to 12.5 (25) mmol ionized calcium.
Calcium carbonate + Cholecalciferol is produced under the TN "Calcium-D3 Nycomed"
, chewable tablets with orange (mint) flavor or aroma. In 1 TB. contains Calcium carbonate 1250 mg + Vitamin D3 200 IU;
"Calcium-D3 Nycomed forte"
, chewable lemon tablets. In 1 TB. contains Calcium carbonate 1250 mg + Vitamin D3 400 IU, which is equivalent to elemental calcium 500 mg;
1 TB. drug under the technical specification "Natekal D3"
» contains calcium carbonate 1500 mg and vitamin D3 400 IU;
"CalciumOsteon" -
lozenges with orange flavor or aroma. 1 TB. contains Calcium carbonate 1250 mg and colecalciferol (vitamin D3) 200 (400) IU;
"Complivit Calcium-D3»
and
“Complivit Calcium-D3 forte ”
- combined preparations, the effect of which is due to the components included in its composition, calcium phosphate 217 mg. Regulates the exchange of calcium and phosphates, reduces resorption and increases bone density, replenishes the lack of calcium and vitamin D3 in the body, enhances the absorption of calcium in the intestines and the reabsorption of phosphates in the kidneys, promotes bone mineralization.
Calcium and vitamin D preparations are mainly used for the prevention and complex therapy of osteoporosis (menopausal, senile, “steroidal”, idiopathic) and for complications (any bone fractures).
"Kalcemin", "Kalcemin Advance" and "Kalcemin Silver"
have a number of advantages. The presence of calcium citrate in their composition reduces the dependence of the bioavailability of drugs on the state of the digestive tract, and the presence of calcium carbonate makes it possible to take drugs regardless of food intake. Calcium citrate inhibits the secretion of parathyroid hormone and thereby increases the antiresorptive effect of Calcemin, Calcemin Advance and Calcemin Silver. The presence of calcium citrate in the preparations reduces the risk of developing urolithiasis during long-term use. Vitamin D3 contained in the preparations increases the absorption of calcium in the intestine. The advantage of the drugs is the presence in their composition of microelements necessary for the metabolism of bone tissue - copper, zinc, manganese, magnesium, boron. “Kalcemin”, “Kalcemin Advance” and “Kalcemin Silver” have an osteochondroprotective effect, stimulate the synthesis of collagen and glycosaminoglycans in cartilage and bones, and increase the rate of calcium accumulation in the bones. Due to the positive effect on the formation of organic bone matrix and bone tissue mineralization, these combination drugs can be used to prevent osteopenic syndrome, scoliotic spinal deformities, osteochondrosis, osteoarthrosis, and other diseases of the musculoskeletal system. Taking “Calcemin” at a dose of 2 TB. per day for 6 months. significantly reduces the intensity of vertebral pain syndrome in women with postmenopausal osteoporosis and deformities of the vertebral bodies. A more pronounced effect is observed in the same category of patients when taking 2 TB of Calcemin Advance. per day for 6 months. Long-term use of such drugs by patients with osteoporosis prevents the development of femoral neck fractures.
"Vitrum Calcium + Vitamin D3"
– 1 TB. contains calcium carbonate from oyster shells 1458 mg and vitamin D3 200 IU.
"Marine calcium with vitamin C"
0.5 g – a bioavailable form of marine calcium from mollusk shells of the White Sea with the addition of 30 micro- and macroelements in microdoses (dietary supplement recommended by the Institute of Nutrition of the Russian Academy of Medical Sciences).
Eggshell preparations, for example, Calcid
, which contains vitamins D and C for better absorption of calcium, as well as preparations containing coral and oyster calcium, since eggshells, coral and oyster calcium are essentially the same calcium carbonate plus a complex of trace elements.
It would seem that choosing drugs with calcium carbonate is the most correct decision. Moreover, currently the share of these additives in the total volume of calcium-containing preparations produced is about 85%, due to the fact that calcium carbonate from natural sources is 8–10 times cheaper than calcium citrate. However, taking calcium carbonate has a number of disadvantages.
.
It turned out that it works well only for people with a healthy gastrointestinal tract, since with low acidity it is poorly absorbed. Taking large amounts of calcium carbonate significantly reduces stomach acidity, which is especially unpleasant if it is already low. The fact is that, when it enters the stomach, calcium carbonate reacts with hydrochloric acid contained in the gastric juice. This releases carbon dioxide, which causes flatulence, constipation, increases the formation of hydrochloric acid and causes other problems. It is appropriate to note here that drugs containing calcium carbonate are not recommended to be taken on an empty stomach. It is in this case that the decrease in acidity will be especially noticeable. Important!
For better absorption, it is best not to combine other calcium supplements with food.
So, it is obvious that the most optimal is to take combined calcium preparations, among which preference should be given to those that contain not only vitamin D3, but also microelements such as phosphorus and magnesium. It is not rational to use multivitamin preparations for calcideficiency, in which the Ca + 2 content is insufficient not only for treatment, but also for prevention.
Vitamin
D , its active metabolites and derivatives
A special place in the pathogenesis, prevention and therapy of osteoporosis is given to vitamin D and its active metabolites. Vitamin D is considered a steroid that is converted into an active metabolite in the body. The term “vitamin D” combines a group of two forms of the vitamin that are similar in chemical structure – ergocalciferol (D2) and cholecalciferol (D3). The main source of vitamin D is its endogenous formation in the skin, more than 80% (D3) and only a small part (up to 20%) comes exogenously from food or when using dietary supplements. Normally, vitamin D3 (cholecalciferol) is synthesized from the precursor of provitamin D3, 7 dihydrocholesterol, found in the skin under the influence of ultraviolet B-range light and heat. There are various factors on which the level of vitamin D3 synthesis depends: skin pigmentation, latitude of the region, daylight hours, season of the year, weather conditions, area of skin not covered by clothing. In winter, in countries located at northern latitudes, most of the ultraviolet radiation is absorbed by the atmosphere, and between October and March there is practically no synthesis of vitamin D3. With age, the skin's ability to produce vitamin D3 decreases; after 65 years, it can decrease by more than 4 times.
D-hormone deficiency causes calcium absorption impairment. A decrease in the level of calcium in the blood plasma and a decrease in the level of the active metabolite of vitamin D in turn causes the proliferation of parathyroid cells and an increase in the secretion of PTH. This secondary hyperparathyroidism causes osteoclastic bone resorption, disruption of the processes of remodeling and mineralization of bone tissue, a decrease in its density and changes in bone architecture, which in turn leads to osteoporosis and an increased risk of fractures. International studies have shown that most patients with osteoporosis are diagnosed with vitamin D deficiency. The following vitamin D3 preparations are produced - the active metabolite of vitamin D3 Calcitriol
(Rocaltrol, Osteotriol)
and its synthetic analogue
Alfacalcidol (Alpha-D3-Teva, Van-Alpha, Oksidevit, Etalfa).
OTHER DRUGS
Osseinohydroxyapatite complex
(Osteogenon)
, on the one hand, due to the presence of organic substances in the complex (osteocalcin, type II collagen, etc.), helps restore and support normal bone tissue formation. On the other hand, due to the mineral component - hydroapatite (a complex of calcium and phosphorus in a ratio of 2:1), Osteogenon inhibits the resorption process. The bioavailability of calcium in Osteogenon is higher compared to other drugs containing this macroelement. Reception 2–4 TB. One dose of the drug per day significantly reduces back pain and increases physical activity. The drug is well tolerated.
The use of drugs that have the ability to regulate calcium balance and reduce calcium excretion in urine, for example, thiazide
and
thiazide-like diuretics,
can prevent osteoporotic bone fractures, because. they have certain antiosteoporotic activity. Thiazide diuretics are widely used by elderly people to treat arterial hypertension, heart failure and eliminate various edema.
The mechanism that determines the beneficial effect of thiazides on bone mass is not yet fully understood. Thiazides may decrease calcium excretion and thus increase plasma levels. Their action is associated primarily with an increase in renal tubular reabsorption of calcium, which, in turn, can lead to an increase in serum calcium levels, a decrease in the concentration of parathyroid hormone and the active form of vitamin D. Another potential mechanism of action of thiazides is associated with a slight inhibition of carbonic anhydrase, an enzyme involved in osteoclast-mediated bone resorption. The effect on carbonic anhydrase, although carried out by some thiazides, is not considered to be the main mechanism of action, whereas sodium, which is not transported proximally, is reabsorbed in the nephron.
It is important to understand that osteoporosis can and must be treated. However, anti-osteoporotic therapy is a long process, the main thing is to be patient. If your 50th birthday is ahead, then you can no longer hesitate; you need to start preventative replenishment of calcium and vitamin D and start the process of bone rejuvenation today, so as not to regret this omission tomorrow.
The use of drugs for the treatment of osteoporosis allows
:
- normalize bone remodeling processes;
- slow down bone loss;
- reduce the severity of pain;
- prevent the occurrence of new fractures;
- improve the quality of life of patients.
Who are calcium supplements indicated for?
- In the treatment of pathological fractures due to osteoporosis
- Women over 50 years of age with vitamin D deficiency or deficiency
- If you have osteoporosis
- For women who have reached menopause to prevent osteoporosis
- If you have insufficient calcium intake from food:
The daily requirement for calcium in children under 3 years of age is 700 mg, for children 4-10 years of age and adults 1000 mg. An increased requirement of up to 1200 mg is observed in women in menopause or over 50 years of age and in men over 70 years of age. Adolescents during the growing period (10-16 years), pregnant and breastfeeding women should receive up to 1300 mg of calcium.
How much calcium should be added
Remember that you usually only need 1000-1200 mg of calcium each day. There is no point in getting more calcium. It might even be dangerous. There are recommendations that the maximum daily calcium intake should not be more than 2000-2500 mg per day. To avoid the danger of getting too much calcium and causing constipation, hypercalcemia, calcium accumulation in soft tissues, problems with the absorption of iron and zinc, it is not recommended to receive more than 1400 mg of calcium per day for a long time.
If you cannot supplement your diet with foods high in calcium (dairy products, leafy greens, nuts, beans and tofu), you can take up to 500-1000 mg of elemental calcium from supplements.