The role of Calcemin Advance in the prevention of postmenopausal osteoporosis (results of a 12-month clinical trial)

Joint pain that is harmless at first can cause disability without proper treatment. This happens not only with arthrosis, when articular cartilage gradually degrades. Ankylosing spondylitis, or ankylosing spondylitis, or ankylosing spondylitis, also leads to sad consequences - this diagnosis can be heard at an appointment with a rheumatologist. The symptoms of the disease are very similar to osteoarthritis, but the principles of treatment differ. What do doctors advise in such cases?

In men, ankylosing spondylitis is diagnosed 2-3 times more often than in women

What is ankylosing spondylitis

This term refers to chronic progressive joint disease. In 80% of cases it begins with back pain (intervertebral joints are damaged), much less often with peripheral arthritis in the joints. The inflammation begins where tendons and ligaments attach to bone and spreads to the small joints between the vertebrae. Gradually the bones fuse and the spine slowly turns into one solid bone.

Since even the ligaments ossify, the person completely loses flexibility and cannot move. The inflammatory process spreads to the peripheral joints, which may already be affected by arthrosis, as well as to the eyes, lungs, kidneys and heart. Without timely treatment, the prospects are very sad.

Why does ankylosing spondylitis develop?

No one knows the exact cause, but it is assumed that the disease develops due to malfunctions of the immune system, especially in the presence of provoking factors:

• too low birth weight;
• infectious disease at the age of 5-12 years (infections of the genitourinary system and intestines are of particular danger);
• hypothermia;
• spinal and pelvic injuries;
• the presence in the body of enterobacteria that cause arthritis, etc.

The HLA-B27 gene is present in almost everyone who has been diagnosed with ankylosing spondylitis

Kalcemin

Calcemin is a regulator of phosphorus-calcium metabolism from the German pharmaceutical company. Preparations based on this mineral have been used in medicine since the time of Hippocrates. This macronutrient supports a number of important functions of the body: structural, neuromuscular, enzymatic, signaling. The problem of combating osteoporosis is no less age-related. This systemic bone disease, characterized by a decrease in bone mineral density (BMD) and damage to tissue structures at the micro level, leads to increased bone fragility and an increased risk of fractures. According to statistics, more than 30% of women aged 65 years and older have had a fracture. According to experts, prevention of this disease with calcium supplements is advisable even for women whose BMD values ​​are normal. With the use of drug therapy, the risk of bone fractures is reduced by 10% or more, and in patients with vitamin D deficiency - by 30%. Calcemin is a third-generation drug, one tablet of which contains 250 mg of elemental calcium (in the form of calcium citrate and calcium carbonate), as well as vitamin D, zinc, manganese, copper and boron. Due to such a significant concentration of calcium, the drug can be taken at any time, without being tied to meals. Calcium citrate ensures high bioavailability of the drug for diseases of the gastrointestinal tract that impair absorption, and also significantly reduces the risk of urolithiasis during long-term pharmacotherapy.

Even if you use Calcemin alone, this will be enough to reduce pain in the spine and normalize bone mineral density in patients with postmenopausal osteoporosis. The drug is well tolerated and practically does not cause any unwanted side reactions. The microelements included in its composition have the most positive effect on cartilage tissue, which makes it possible to use Calcemin for osteochondrosis, osteoarthrosis, traumatic injuries of individual parts of the musculoskeletal system, as well as for the normalization of phosphorus-calcium metabolism in older people (mainly in women in period of menopause). The drug is also in demand during pregnancy, as an adjuvant in the treatment of periodontal diseases, and in childhood and adolescence during active growth. When using Calcemin, you should not go beyond the doses specified by the manufacturer, because otherwise, excess calcium may inhibit the absorption of other essential macro- and micronutrients in the digestive tract. The drug is taken one tablet twice a day (persons under 12 years old - once a day). The optimal time of administration is before meals or during meals, although this, as noted above, is not of fundamental importance. It is best to take the tablet with water or juice. Duration of treatment - up to 1 month with the possibility of extending the course in consultation with the doctor.

Forms of ankylosing spondylitis

Depending on the location, the disease has the following forms:

• central – only the spine is affected (accounts for about half of all cases);
• rhizomelic - the shoulders and hip joints are also affected;
• peripheral – affects, in addition to the spine, the knee, elbow and ankle joints (diagnosed mainly at the age of 10-16 years);
• Scandinavian - similar in symptoms to rheumatoid arthritis, affects all joints, including small ones;
• visceral - inflammation also extends to blood vessels, kidneys, eyes and other organs.

The earlier ankylosing spondylitis is detected, the better it is treated

Features of symptoms

The most common symptom is back pain, which worsens during sleep and improves with exercise. In addition, a person may feel:

• moderate pain in the groin, sacrum;
• stiffness of movements;
• curvature of the spine and stoop;
• feeling of chest tightness;
• dizziness and tinnitus;
• swelling of the joints.

With ankylosing spondylitis, the temperature may also rise at the end of the day, weight may decrease, and the person will quickly get tired. The eyes may become inflamed, sometimes heart valve failure develops and difficulty breathing occurs. Complications in the functioning of the nervous system are not uncommon. Similar symptoms occur with arthrosis, osteochondrosis, spondylosis, rheumatoid arthritis, so it is very important to make a correct diagnosis.

Ankylosing spondylitis has symptoms similar to arthrosis

Experience with the use of the drug Calcemin Advance in postmenopausal women with osteopenia

One of the achievements of our time is the increase in life expectancy. But longevity is inevitably associated with an increase in the number of diseases. Among the pathologies whose frequency increases with age are diseases of the cardiovascular system, lungs, and oncology. An important place is occupied by osteoporosis (OP), a systemic skeletal disease characterized by a decrease in bone density, a violation of its structural and qualitative characteristics, accompanied by an increased risk of fractures. A fracture of the proximal femur occurs in 1-2 out of 1000 Russian residents aged 50 years and older, and fractures of the forearm are recorded even more often - in every 100 women of the same age group. A year after suffering a hip fracture, only 15% of patients consider themselves to have fully recovered their health.

Considering the above, it becomes clear that there is a need for the prevention and treatment of AP, an important part of which is adequate intake of calcium and vitamin D, which are necessary to maintain a healthy balance in the bones and prevent fractures. Calcium is one of the main components of bone and cartilage tissue, as well as an element necessary to maintain the osmotic and oncotic pressure of blood plasma. The total calcium content in the human body is approximately 1.9% of the total weight of a person, with 99% of all calcium occurring in the skeleton in the composition of microcrystals of carbonate apatite and hydroxyapatite, and only 1% is found in other organs and tissues. Calcium affects the permeability of biological membranes, participates in the regulation of metabolism in cells, and is an important factor in blood clotting.

In addition, calcium is an important cofactor for a number of cytoplasmic, tissue and organ-specific enzymes (for example, for all isoforms of alpha-amylase, pancreatic lipase and other enzymes), and in this role it takes an active part in metabolic processes, regulation of neuromuscular conduction and secretory activity of the stomach, and can also have a significant impact on the functional activity of most organs and systems.

Calcium intake rates vary at different periods of a person's life. Calcium intake in children should continually increase with age, since increased calcium intake during adolescence is associated with increased peak bone mass. A 10% increase in peak bone mass reduces the lifetime risk of osteoporotic fractures in adults by 50%.

The next important stages, when an increase in calcium intake to 1200-1500 mg per day is again required, are periods of pregnancy, lactation, and the onset of menopause in women. However, as previous studies have shown, calcium intake from food among women aged 50 years and older is insufficient, so additional medications are required to ensure adequate levels of calcium intake.

The main regulator of the active absorption of calcium in the body is the active metabolite of vitamin D - calcitriol. Under physiological conditions, the level of intestinal absorption of calcium does not exceed 20-30%, the use of vitamin D increases it to 60-80%. After being absorbed into the blood, calcium is distributed among systems and organs, primarily entering the bones, where it participates in the mineralization process, as well as the kidneys. Under physiological conditions, calcium excretion from the body is approximately 250-300 mg/day. In children and adolescents, the transport and utilization of calcium in the bones is 2-3 times higher than in adults, which is due to the active formation of the skeleton and bone growth. In healthy adults, the process of bone formation and resorption is balanced. In old age, due to increased resorption processes against the background of the development of vitamin D deficiency, this balance is disturbed and the removal of calcium from the bone often exceeds its entry into the skeleton. It is known that a lack of vitamin D can lead to secondary hyperparathyroidism, which, in turn, increases bone turnover, which entails increased bone loss. The concentration of 25(OH)D in the blood, which is one of the best clinical indicators of sufficient intake of vitamin D in the body, should ideally be at least 50 nmol/l, but, as research results show, vitamin D insufficiency and deficiency occur in almost all populations regardless of the time of year.

Numerous studies have shown that calcium and/or vitamin D supplementation reduces bone loss and fracture rates among postmenopausal women. In studies aimed at studying the effect of calcium and vitamin D therapy on reducing the incidence of fractures, a significant reduction in the risk of hip fracture was found by 18% [(RR 0.82 (95% CI 0.71-0.94), p = 0, 0005] and the risk of non-vertebral fractures by 12% [(RR 0.88 (95% CI 0.78-0.99), p=0.036] in groups receiving combination therapy compared with groups without treatment. In studies where Vitamin D supplementation of 700-800 IU per day had a greater effect on hip fracture risk than 400 IU (21% and 18%, respectively).In studies in which patients received vitamin D alone or placebo (4 RCTs with a total of of 9083 patients), there was no reduction in the risk of non-vertebral fractures: both when using a dose of 400 IU (RR 1.14 [95% CI 0.87-1.49]) and when using 700-800 IU (RR 1. 04 [95% CI 0.75-1.46]), which confirms previously reported data that vitamin D without added calcium does not reduce the risk of fractures. Combining calcium with vitamin D reduces the risk of fractures only in the case of 75-80% compliance patients.

Currently, calcium preparations are widely used for the prevention of AP - single preparations or combined with vitamin D. However, in Russia, doctors also have at their disposal complex calcium preparations, which are a combination of calcium and vitamin D with individual microelements. One of these drugs is Calcemin Advance, which, in addition to calcium (in the form of carbonate and citrate), includes magnesium, zinc, copper, manganese and boron.

An open clinical trial was conducted at the Research Institute of Rheumatology of the Russian Academy of Medical Sciences to evaluate the effectiveness and tolerability of the complex drug Calcemin Advance for osteopenia in postmenopausal women. 100 women aged 45-65 years with osteopenia in the spine and/or femoral neck were examined. The patients were randomly divided into 2 groups: Group I - 50 people received Calcemin Advance (1 tablet 2 times a day, which amounted to 1000 mg of calcium per day, 400 IU of cholecalciferol, 80 mg of magnesium, 15 mg of zinc, 2 mg of copper, 3 .6 mg manganese and 500 µg boron); Group II (control) – 50 women who did not receive drug treatment, who were given nutritional recommendations.

Patients of the 2 groups were comparable in age, height, weight, body mass index, duration of the reproductive period, age at menopause and duration of the postmenopausal period, BMD indicators in the lumbar spine and proximal femur. There were significant differences in the intensity of pain in the lumbar spine. Thus, in the group that subsequently received the drug, more pronounced pain syndromes were noted. In both groups, there was an insufficient daily intake of calcium from food, the deficiency of which reached 65% of the recommended standards for postmenopausal women, while no differences were found between the groups in this indicator. There were no significant differences in the state of calcium-phosphorus metabolism in both groups and in the indicators of markers of bone resorption and formation. The duration of the study was 12 months.

The main end point of the study was the dynamics of BMD during densitometric examination: analysis of BMD after 12 months of observation showed that in the group receiving Calcemin Advance therapy, a stable state of BMD was noted, while in the control group, mineral density decreased in all assessed areas, which is especially was expressed in the lumbar spine (0.865±0.06 g/cm compared with 0.853±0.067 g/cm), and this decrease was significant p<0.013.

When comparing both groups in terms of BMD dynamics (as a percentage of the initial data), a significant difference was revealed between the increase in BMD in the lumbar vertebrae in the drug intervention group and the decrease in BMD in this area in the control group, while in both areas of measurement of the proximal femur there were significant differences between groups were not obtained (Fig. 1).

Analysis of the dynamics of pain in the thoracic and lumbar spine showed a significant decrease in the severity of pain after 3, 6 and 12 months in both parts of the spine in women receiving therapy, compared with its severity at the study inclusion visit and compared with the control. The control group also showed a slight decrease in pain, but it was not statistically significant.

The quality of life of patients was assessed using a visual analogue scale (VAS) before the start of the study and after 12 months. To study the indicators of daily physical activity and limitation of movements, a questionnaire was filled out, which recorded the ability of women to perform various activities and the physical activity performed. During the study, on average across groups, we did not obtain changes in quality of life indicators, as well as range of motion and functional activity in patients, as in the comparison between groups (Table 1). However, among patients in the treatment group, there were significantly more patients who significantly improved their quality of life than in the control group (32 and 14%, respectively, p = 0.032).

Evaluating the results of biochemical studies over time, we identified an average increase in the calcium/creatinine index in the urine of patients receiving Calcemin Advance, but these indicators did not go beyond the reference values, i.e. were within normal limits and did not require discontinuation of the drug in any of the patients. Other indicators of calcium homeostasis remained within normal limits in both groups during observation.

The study of the dynamics of bone turnover markers showed similar changes in both groups: a statistically insignificant decrease in the level of osteocalcin and a significant decrease in bone alkaline phosphatase (markers of bone formation), a significant increase in type I collagen c-telopeptide (CTX - a marker of bone resorption). However, a comparative analysis between the groups revealed that in the drug intervention group the decrease in bone alkaline phosphatase levels after 3 months was on average 5% less compared to the group without treatment, and after 12 months the difference between the groups was already 26.7% (p <0.001). The average increase in serum CTX levels in patients receiving the drug after 3 months was 21% lower than in the control group, and after 12 months the differences between the groups were 26.1% and were significant (p = 0.03) ( Fig. 2).

98 people completed the study, 2 people dropped out from the control group. Adverse events associated with taking the drug occurred in 10% of people and were as follows: nausea (4%), flatulence (2%), constipation (2%), cramps in the calf muscles (2%).

Thus, the use of the drug Calcemin Advance for a year in postmenopausal women with osteopenia has a stabilizing effect on the mineral density of the skeleton and reduces pain in the spine. Its long-term use does not cause hypercalcemia and increased urinary calcium excretion. The drug is well tolerated. Due to the fact that about 80% of postmenopausal women do not take enough calcium from food, an assessment of its intake should be carried out in all postmenopausal women, and if a deficiency is detected, preventive medication in the form of pharmacological drugs in combination with vitamin D, which increases its absorption, should be prescribed. Gastrointestinal tract. The study allows us to recommend Calcemin Advance for the prevention of postmenopausal osteoporosis.

Figure and table are in the appendix

How is ankylosing spondylitis diagnosed?

As with arthrosis of the knee, shoulder or hip, this disease involves changes in the articular cartilage. The pathology takes many years to develop, and the first symptoms appear when the joints have already significantly degraded. To clarify the diagnosis, a rheumatologist may prescribe the following examinations:

• X-ray;
• MRI;
• test for histocompatibility antigen, which is responsible for predisposition to this disease;
• Ultrasound of hands and feet;
• laboratory tests - ESR, C-reactive protein (the most informative in determining the current stage of the inflammatory process);
• examinations of other systems (fluorography, electrocardiography, consultation with an ophthalmologist, etc.).

Diagnosing ankylosing spondylitis is very difficult

Glass fragility, part 3. Treatment in detail.

Murzaeva Irina Yurievna

Endocrinologist, Preventive Medicine Doctor

October 10, 2017

This article was supposed to precede the second one... Well, oh well, how inspiration came :)

According to the modern classification, we have a lot of drugs for the treatment of osteoporosis. But, as in any business, details matter. So...

1. BISPHOSPHONATES A group of synthetic selective drugs that have the ability to block the activity of osteoclasts, cells that destroy bone tissue, in the body, and restore bone structure. Indications for their use: Osteoporosis. Myeloma. Paget's disease (osteodystrophy deformans). Primary hyperparathyroidism. Tumors and metastases in bone tissue, especially those combined with hypercalcemia. The most valuable property of bisphosphonates is that they can be used in oncological diseases characterized by the formation of tumors in bone tissue. Bisphosphanates are divided into subgroups:• alendronate; • ibandronate; • zoledronic acid, • risendronate, pamidronate. The most studied of them is Bonviva (ibandronate), which can be taken once a month or intravenously once every 3 months, as a stream. In addition, the following are actively used: Tevabon 70 mg once a week - a combination of alendronate and alfacalcidol (bisphosphanate + active form of vitamin D:!:). Forosa 70 mg (alendronate) - once a week, one of the cheapest:!:. Aclasta (zoledronate) 5.33 mg, IV, including against the background of chemo-radiation therapy:!: once a year (before the drug is administered, 250 ml of saline solution is injected, the drug itself is injected in 100 ml of saline solution, after another minimum 150 ml of saline solution, for the prevention of influenza-like syndrome). Rezoklastin FS - 5 mg, IV drip, once a year (more affordable than Aclasta). Fosovanse (alendronate and colecalciferol) once a week, very convenient, another drug with an active form of vitamin D.
2. Parathyroid hormone (Teriparatide) or Forsteo, subcutaneously once a day. This is human recombinant parathyroid hormone. Indications for its use: - osteoporosis in postmenopausal women; - primary osteoporosis or osteoporosis caused by hypogonadism in men; - osteoporosis with an increased risk of fractures caused by long-term systemic therapy with corticosteroids in men and women. The drug is good, but is not used often due to the high cost and daily injections.
3. RANKL inhibitors - Denosumab or Prolia, use 60 mg once every 6 months subcutaneously! It is an inhibitor of bone tissue resorption (destruction). Monoclonal antibody. Indications for use: - treatment of postmenopausal osteoporosis; - treatment of bone loss in women receiving aromatase inhibitor therapy for breast cancer and in men with prostate cancer receiving hormone deprivation therapy. The good thing is that it can be used in the reproductive period before planning a pregnancy; bisphosphanates are prohibited in this regard (this indication is under discussion) Perhaps the most powerful and effective drug for osteoporosis: idea:
4. Strontium ranelate or BIVALOS . 1 powder per day. The mechanism of action is complex. Indications for use: - treatment of severe osteoporosis in postmenopausal women with a high risk of fractures in order to reduce the risk of vertebral and femoral fractures (including femoral neck fractures) in case of intolerance or contraindications to the use of other drugs for the treatment of osteoporosis ;:!: - main point: treatment of severe osteoporosis in men with an increased risk of fractures in order to reduce it in case of intolerance or contraindications to the use of other drugs for the treatment of osteoporosis; — treatment of osteoarthritis of the knee and hip joints in order to slow the progression of cartilage destruction? (not used at all in this indication).
5. Menopausal hormonal (hormone replacement) therapy (according to indications). - Estrogens (if the uterus is removed) or Etrogen-Progesterone (if the uterus is intact). They support bone tissue well:!: Efficiency has been proven. Estrogen is the main regulator of bone formation in both women and men. Therefore, hormone replacement therapy in men (testosterone) is also indicated. Some of this testosterone is metabolized into estrogen and will stimulate bone building.
6. Selective estrogen receptor modulators - Raloxifene. The drug Raloxifene is intended for the prevention of osteoporosis in postmenopausal women and after hysterectomy. Application: tablets 60 mg, 1 pc. daily.
7. Calcitonin - MIACALCIK , unfortunately, has been discontinued and is produced in small quantities. An analogue of the hormone produced by the C-cells of the thyroid gland is an antagonist of parathyroid hormone and, together with it, participates in the regulation of calcium metabolism in the body. Spray and intravenous injections effectively relieved the painful form of osteoporosis and hypercalcemia. Indications: - treatment of postmenopausal osteoporosis; - bone pain associated with osteolysis and/or osteopenia; - Paget's disease of bone (osteitis deformans);
8. Anabolic steroids and androgens , for the treatment of hypogonadism in men. Anatomical steroids were previously used in women after major operations, weight loss, and the indications include the treatment of osteoporosis. Among the drugs, for example, Retabolil 1 ml, intramuscularly once every 3-4 weeks.
9. Vitamin D preparations and its active metabolites (Vigantol, Aquadetrim, Divisol, Minisan, etc.), alfacaldol, etc. Need no introduction. Especially when treating osteomalacia, the dose must be selected correctly.
10. Calcium supplements (Calcemin is allowed during pregnancy). Outside of pregnancy - Calcemin Advance, Natekal, etc. It is the main building material. I repeat - in case of severe hypocalcemia, the calcium deficiency must be compensated for the first 1-2 months, and then osteoporosis must be treated.
11. Ossein is a hydroxyapatite compound (OHC) - Osteogenon. An alternative to calcium medications, which are not indicated for cholelithiasis, urolithiasis. Allowed during pregnancy. Phosphorus, which participates in the crystallization of hydroxyapatite, promotes the fixation of calcium in the bone and inhibits its excretion by the kidneys. Ossein is an organic component of the drug that contains local regulators of bone tissue remodeling (β-transforming growth factor, insulin-like growth factors I and II, osteocalcin, collagen type 1), which activate the process of bone formation and inhibit bone resorption. Indications: - prevention and treatment of primary osteoporosis of various etiologies (premenopausal, menopausal, senile); - prevention and treatment of secondary osteoporosis of various etiologies (caused by rheumatoid arthritis, liver and kidney diseases, hyperthyroidism, hyperparathyroidism, imperfect bone formation, use of corticosteroids, heparin, immobilization); — correction of osteopenia and disorders of phosphorus-calcium metabolism (including during pregnancy and during breastfeeding); - acceleration of healing of bone fractures.
12. Fluorides. The main dosage forms of sodium fluoride used in Russia are Coreberon, Ossin and Tridin. Of this group of medicines, Ossin is the most accessible. Almost never used, given the availability of more effective drugs. Indications: Primary osteoporosis (postmenopausal, presenile, senile, idiopathic), steroid osteoporosis (prevention and treatment); special forms of local osteopathy. For example, Austin 40 mg tablets 2 times a day for a year.
13. Growth hormone (Norditropin, Rastan, etc.), use is advisable for a proven diagnosis of GH deficiency (primary or age-related). In addition to osteoporosis, there must be other indications for its use.

The choice of drug will depend on: the cause of osteoporosis, the patient’s age, the presence of concomitant pathology of cholelithiasis, urolithiasis, coronary artery disease, etc., pregnancy planning, the concentration of calcium, vitamin D, parathyroid hormone and alkaline phosphatase in the blood, side effects and the price of the drug.

How is ankylosing spondylitis treated?

As in the treatment of osteoarthritis, a rheumatologist selects an individual treatment regimen - combines medicinal and non-medicinal methods. The goal of treatment is to eliminate pain and inflammation and slow down the progression of the disease. For this purpose, they resort to medications, physical therapy, recommend special exercises, and in severe cases, surgical intervention (joint replacement, fixation of vertebrae or straightening of a deformed spine).

The best physiotherapy for this diagnosis is UV irradiation, UHF therapy of joints, electrophoresis of novocaine or Parfenov's liquid. You can also get a certain improvement after a course of ultraphonophoresis with hydrocortisone, after taking salt and hydrogen sulfide baths. In the inactive stage of the disease, balneotherapy is indicated.

In case of ankylosing spondylitis, the patient is given an individual exercise therapy program. It includes exercises for stretching the spine, bending, Nordic walking and swimming, yoga or complexes with a gymnastic stick. The main thing is not to experience discomfort, otherwise you can harm the affected joints.

In case of ankylosing spondylitis, you can perform the following complex of exercise therapy, which over time will alleviate the general condition:

Instructions for use CALCEMIN® ADVANCE

Phenytoin, barbiturates, carbamazepine, rifampicin:

may reduce the effect of vitamin D3 by increasing its metabolism to inactive metabolites.

Bisphosphonates, fluorides:

it is possible to reduce the absorption of bisphosphonates and sodium fluoride in the gastrointestinal tract. It is recommended to take at least 1-2 hours before or after taking Calcemin® Advance. It is preferable to use bisphosphonates and calcium supplements at different times of the day.

Tetracycline:

the absorption of tetracycline in the gastrointestinal tract may be reduced. It is recommended to take at least 2-3 hours before or 4-6 hours after taking Calcemin® Advance.

Cardiac glycosides, calcium channel blockers:

possible increase in the toxicity of cardiac glycosides (danger of lethal arrhythmia). Monitoring of ECG and blood calcium concentration is recommended. The effectiveness of calcium channel blockers, such as verapamil, in atrial fibrillation is reduced. Combined use is not recommended.

Levothyroxine:

Possible impairment of absorption of levothyroxine. It is recommended to take at least 2-4 hours before or 4-6 hours after taking this drug.

Quinolones, antivirals:

the absorption of antibacterial agents from the quinolone group (for example, ciprofloxacin, levofloxacin, norfloxacin, ofloxacin, nalidixic acid) and antiviral agents (protease inhibitors) may be impaired. It is recommended to take at least 2-4 hours before or 4-6 hours after taking this drug.

Thiazide diuretics:

Thiazide diuretics reduce urinary calcium excretion. Due to the increased risk of hypercalcemia with concomitant use of thiazide diuretics and calcium supplements, it is recommended to regularly monitor serum calcium levels during long-term treatment.

Glucocorticoids, hormonal contraceptives:

reduce calcium absorption, possibly reducing the effect of vitamin D3. A dose adjustment of Calcemin® Advance may be required.

Ion exchange resins such as cholestyramine, laxatives, orlistat:

simultaneous use with this drug may reduce the absorption of vitamin D3 in the gastrointestinal tract. It is recommended to take 2 hours before or 4-6 hours after taking vitamin D.

Iron, zinc, magnesium, strontium ranelate:

calcium may reduce the absorption of iron, magnesium, zinc and strontium ranelate. If joint use is necessary, it is recommended to maintain an interval of at least 2 hours before or 4-6 hours after taking calcium supplements.

Food:
Possible interaction with certain foods (eg, those containing oxalic acid, phosphates, phytic acids, or foods high in fiber). Due to the risk of decreased calcium absorption, it is recommended to maintain an interval of at least 2 hours between taking calcium supplements and these foods.

What medications can be prescribed

Depending on the manifestations, the rheumatologist may include the following drugs in the treatment regimen:

• nonsteroidal anti-inflammatory drugs, such as indomethacin and diclofenac, for pain relief;
• hormonal;
• immunosuppressants (if the cause is immune in nature);
• inhibitors of TNF-alpha and B-cell activation;
• chondroprotectors (in the early stages they stop the degradation of joints, accelerate the restoration of cartilage and reduce pain).

As with other joint diseases, ankylosing spondylitis can have different development scenarios. If it is detected too late and left untreated, it can result in disability. In the early stages, a person has every chance to take control of the disease and continue to lead a full life.