Vitamin d and calcium in patients with osteoporosis following the
Calcium is a mineral that the body needs for good health. Calcium is found naturally in some foods and is added to others. It also is available as a nutrition supplement and is contained in some medicines like Tums. Calcium is the healthy bone mineral. About 99 percent of the calcium in the body is stored in the bones and teeth. It is the mineral that makes them hard and strong. The remaining 1 percent is needed for many activities that help keep the body functioning normally.
Calcium helps blood vessels contract narrow and expand, makes muscles contract, helps send messages through the nervous system and helps glands secrete hormones.
Bones are constantly being remodeled every day, and calcium is moving in and out of them. In children and adolescents, the body builds new bone faster than it breaks down old bone so total bone mass increases. This continues until about age 30, when new bone formation and old bone breakdown start occurring at about the same rate. In older adults, especially in post-menopausal women, bone is broken down at a faster rate than it is built. If calcium intake is too low, this can contribute to osteoporosis.
The amount of calcium needed for healthy bones and teeth is different by age. The National Institutes of Health suggests these levels of daily intake for adults:. Office of Dietary Supplements.
#18: Osteoporosis, bone health and the calcium, vitamin D controversy.
The best way to get enough calcium every day is to eat a variety of healthy foods from all the different food groups. Getting enough vitamin D every day from foods like enriched milk or from natural sunlight is important to help the body absorb and use calcium from food.
At the end of this document, there is a more detailed table of calcium content in various foods. The U. Department of Agriculture recommends that everyone aged 9 years and older eat three servings of foods from the dairy group per day.
Calcium is best absorbed through the foods we eat and the beverages we drink. For most healthy patients, it is important to eat a well-balanced diet instead of relying on supplements alone.
For individuals who cannot get enough calcium from food and beverages each day, taking a calcium supplement may be necessary. People who have lactose intolerance might have difficulty getting enough calcium through their diet alone. In addition, those with absorption problems due to gastrointestinal illness may not absorb enough calcium. Those who follow a vegan diet, or consume large amounts of protein and sodium might also not get enough calcium.
The amount of calcium the body will absorb from supplements depends on the form of calcium in the supplement, how well the calcium dissolves in the intestines, and the amount of calcium in the body. The two most commonly used calcium products are calcium carbonate and calcium citrate.
Calcium carbonate supplements dissolve better in an acid environment, so they should be taken with a meal. Calcium citrate supplements can be taken any time because they do not need acid to dissolve. For this reason, individuals who might have problems absorbing medications could consider using calcium citrate instead of calcium carbonate.Have a question?
This is a fact sheet intended for health professionals. For a reader-friendly overview of Vitamin D, see our consumer fact sheet on Vitamin D. Vitamin D also referred to as "calciferol" is a fat-soluble vitamin that is naturally present in a few foods, added to others, and available as a dietary supplement. It is also produced endogenously when ultraviolet UV rays from sunlight strike the skin and trigger vitamin D synthesis.
Vitamin D obtained from sun exposure, foods, and supplements is biologically inert and must undergo two hydroxylations in the body for activation.
The first hydroxylation, which occurs in the liver, converts vitamin D to hydroxyvitamin D [25 OH D], also known as "calcidiol. Vitamin D promotes calcium absorption in the gut and maintains adequate serum calcium and phosphate concentrations to enable normal bone mineralization and to prevent hypocalcemic tetany involuntary contraction of muscles, leading to cramps and spasms.
It is also needed for bone growth and bone remodeling by osteoblasts and osteoclasts [ ]. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. Together with calcium, vitamin D also helps protect older adults from osteoporosis. Vitamin D has other roles in the body, including reduction of inflammation as well as modulation of such processes as cell growth, neuromuscular and immune function, and glucose metabolism [ ].
Many genes encoding proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by vitamin D. In foods and dietary supplements, vitamin D has two main forms, D 2 ergocalciferol and D 3 cholecalciferolthat differ chemically only in their side-chain structures. Both forms are well absorbed in the small intestine. Absorption occurs by simple passive diffusion and by a mechanism that involves intestinal membrane carrier proteins [ 4 ].
The concurrent presence of fat in the gut enhances vitamin D absorption, but some vitamin D is absorbed even without dietary fat. Neither aging nor obesity alters vitamin D absorption from the gut [ 4 ]. Serum concentration of 25 OH D is currently the main indicator of vitamin D status.
It reflects vitamin D produced endogenously and that obtained from foods and supplements [ 1 ].For your patient with osteoporosis a higher target is more appropriate because:.
There is no evidence that this level is dangerous. The Institute of Medicine stated that the general population needs units daily in diet plus supplements. They also stated that up to units daily was probably safe. Thus, patients should know that more is not necessarily better. Cholecalciferol Vitamin D3 is readily available over the counter in international unit, international unit, and international unit tablets or capsules.
It is inexpensive and can be taken daily. An alternative is to use ergocalciferol Vitamin D2which is available by prescription as a 50, international unit capsule. To increase the vitamin D level quickly, the patient can take 50, units weekly for 4 to 12 weeks and then maintain the level with a monthly capsule.
Do not give larger doses of vitamin D at one time. There are studies showing thatunits once yearly actually increases risks for falling. Some granulomatous diseases, such as sarcoidosis, can produce hypercalciuria and hypercalcemia because the granulomas may contain the 1-alpha hydroxylase that activates hydroxyvitamin D.
This unregulated production of calcitriol leads to increased gut absorption of calcium, hypercalciuria and even hypercalcemia. Thus, the patient with active granulomatous disease must be monitored more carefully than the typical patient with osteoporosis. In addition to the hydroxyvitamin D level, a hour urine for calcium and creatinine and serum calcium must be followed as you carefully increase the hydroxyvitamin D level.
Other granulomatous disorders that can lead to hypercalcemia include lymphoma and tuberculosis. In some cases it is helpful to measure 1,dihydroxyvitamin D, especially in the evaluation of hypercalcemia of unknown etiology with low serum PTH. In a meta-analysis, vitamin D with calcium had a modest effect in reducing fracture risk. For most patients with osteoporosis, further pharmacologic therapy is necessary. A very recent analysis concluded that at least international units daily were necessary to prevent fractures.
A recent study found a correlation between vitamin D levels and strength of the femoral neck. Nonetheless, there is still controversy about the efficacy of vitamin D to prevent or treat fractures; most studies are of vitamin D plus calcium.Additionally, only 14 percent of osteoporosis patients with a previous hip fracture are receiving proper supplementation of calcium and vitamin D.
According to several studies, osteoporosis is expected to increase as our population lives longer. Osteoporosis-related fragility fractures can lead to increased morbidity, mortality and healthcare expenses. Calcium and vitamin D supplementation have been demonstrated to be effective in maintaining bone health and reducing subsequent related fractures.
Additionally, this supplementation correlates with improved clinical and functional outcomes in postoperative hip fracture patients. The team reviewed the records of 1, patients with osteoporosis to determine calcium and vitamin D supplement intake, femoral neck bone mineral density a strong predictor of hip fracture susceptibility and prior incidence of hip fracture. They found that patients Among the patients studied, patients 87 percent were female with a mean age of 67 years old.
The research findings also showed that, Caucasian females have increased odds of receiving adequate supplementation, while non-Caucasian minorities have decreased odds. Specifically, among Mexican-Americans, there was an independent risk factor for decreased odds for receiving adequate treatment. Conway, an Associate Professor of Orthopaedic Surgery. However, the compliance rates among this subset of osteoporosis patients was surprisingly low.
Given the high morbidity and mortality rates in elderly patients with hip fractures,  and that calcium and vitamin D are inexpensive and readily available to help manage osteoporosis, the authors hope that continued patient education, especially among the underserved, and an increased role by orthopaedic surgeons to assist with intervention, can help close the gap and increase awareness and compliance.
Download print friendly PDF. About the AAOS. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level best treat patients in their daily practices. The AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal health care issues and it leads the health care discussion on advancing quality.
Contact Us. Study shows prevalence of back pain in children and adolescents. Research finds stopping opioid use prior to surgery lowers risk of chronic postoperative use.
Underweight patients at greatest risk of complications following total shoulder arthroplasty. Study determines average number of days students need before returning to school after sports-related surgery. Tele-rehabilitation leads to high utilization rates and patient satisfaction. Calcium and vitamin D supplementation are essential to help manage osteoporosis, especially following a hip fracture. Study shows weight loss prior to knee surgery improved outcomes for morbidly-obese patients.
Gestational carpal tunnel syndrome found to be persistent in women post pregnancy.
Research News. Embargoed: am PT March 12, March 8, Riley pearson aaos. News Releases Study shows prevalence of back pain in children and adolescents Research finds stopping opioid use prior to surgery lowers risk of chronic postoperative use Underweight patients at greatest risk of complications following total shoulder arthroplasty Study determines average number of days students need before returning to school after sports-related surgery Tele-rehabilitation leads to high utilization rates and patient satisfaction Calcium and vitamin D supplementation are essential to help manage osteoporosis, especially following a hip fracture Study shows weight loss prior to knee surgery improved outcomes for morbidly-obese patients Gestational carpal tunnel syndrome found to be persistent in women post pregnancy.BOSTON -- Anatomical changes due to bariatric surgery can put patients at risk for mineral deficiencies and subsequent osteoporosis, and managing this risk can pose a challenge for healthcare providers.
However, the degree of fracture risk following bariatric surgery varies based on the specific procedure. Schafer said that "the literature is largest and strongest for RYGB" mostly because it was the reigning bariatric procedure in popularity until recently.
Postmenopausal women seem to be particularly affected," she noted. It could also be considered postoperatively, perhaps after 2 years, in select patients. In addition to screening bariatric surgery patients for bone changes, clinicians must also closely monitor calcium and vitamin D levels before and after surgery. Postoperatively, routine monitoring of serum 25OHD, calcium, albumin, and parathyroid hormone PTH levels is indicated.
The recommended frequency of these measurements varies between guidelines, but one reasonable approach is to do routine biochemical screening every 6 months for the first 2 years and then annually," Schafer said. She recommended that providers refer to the guidelines of the ASMBS when considering calcium and vitamin D supplementation for these patients. Patients who underwent BPD should aim to achieve a total intake of 1, to 2, mg daily, she added.
Lifestyle modification after bariatric surgery is important for these patients in order to mitigate the adverse impact on their bones. Other recommendations include a diet sufficient in protein and regular physical activity. In some bariatric surgery patients at a moderate to high fracture risk, antiresorptive osteoporosis therapies may also be appropriate.
However, in order to minimize the risk of hypocalcemia, "an antiresorptive should be used only after vitamin D and calcium supplementation is deemed sufficient based on measurement of serum 25OHD, corrected calcium, PTH, and potentially 24h urinary calcium," Schafer said, explaining that the parenteral route is preferred over oral treatment. This recommendation was reinforced by Yu, who suggested that providers "avoid oral bisphosphonates due to theoretical problems with absorption and potential for increased risk of GI adverse effects.
She also said that healthcare providers must emphasize to patients prior to bariatric surgery that calcium and vitamin D supplements are "lifelong requirements" following surgery.Proper nutrition is crucial for healthy spinal joints, discs, vertebral bodies, and other parts of your spine.
Daily soft tissue wear and tear or trauma may affect ligaments, tendons and muscles and cause neck or back pain—depending on which level of the spine is injured. Osteoporosis is an example of a disease that may worsen when nutrition is poor. Like other parts of your body, the spine needs high-quality fuel eg, well-balanced diet for cell renewal, which is essential to healing and may help prevent a spine-related problem in the future. To repair bone and connective tissue damage, your body requires adequate amounts of certain vitamins and nutrients.
Minerals, such as calcium and magnesium and other nutrients, such as vitamin D, are especially important for bone and connective tissue health. The spine needs high-quality fuel eg, well-balanced diet for cell renewal, which is essential to healing and may help prevent a spine-related problem in the future.
Calcium and Vitamin D
What affects calcium in the body? Calcium plays an essential role in the building of strong bones.Chronic Pain \u0026 Weak Bones? (Vit D/Calcium) You Can't Afford to Miss This! --- Dr Mandell
Eating calcium-rich foods and avoiding those that cause calcium loss can help you achieve and maintain healthy calcium levels. However, several factors influence calcium metabolism in the body. Your doctor may recommend a calcium supplement. How Magnesium Works Magnesium is another mineral that is as important as calcium for strong bones. Magnesium is required for calcium to get into the bones. Magnesium also is needed to make vitamin D active.
If you have concerns about factors that might lower your magnesium level or increase your need for magnesium, ask your doctor if a magnesium supplement could be beneficial for you.
Not only does Vitamin D help prevent bone loss; it plays an important role in rebuilding new bone. Plus, it strengthens collagen—a protein found in bones, tendons, and muscles.
Clinical Challenges: Osteoporosis Risk After Bariatric Surgery
How to Increase Vitamin D There are several ways to get the vitamin D your body needs to ensure good bone health. If you are not exposed to enough sunshine, do not eat enough foods fortified with vitamin D, or your diet is very low in fat, which makes it harder for you to absorb vitamin D from your food.
You may need to take a vitamin D supplement. Your doctor may measure the levels of vitamin D in your blood to help you decide what supplement might be best for you, considering your age and risk factors for osteopenia and osteoporosis. Fuel Up with Good, Nutritious Foods When you have a back or neck pain from an injury or disease, good nutrition can aid healing, and may help control your pain and ability to function.
Different spinal conditions have some different nutritional requirements.The foods we eat contain a variety of vitamins, minerals, and other important nutrients that help keep our bodies healthy.
Two nutrients in particular, calcium and vitamin D, are needed for strong bones. Calcium is needed for our heart, muscles, and nerves to function properly and for blood to clot. Inadequate calcium significantly contributes to the development of osteoporosis. Many published studies show that low calcium intake throughout life is associated with low bone mass and high fracture rates. National nutrition surveys have shown that most people are not getting the calcium they need to grow and maintain healthy bones.
To find out how much calcium you need, see the "Recommended calcium intakes" chart below. To learn how easily you can include more calcium in your diet without adding much fat, see the "Selected calcium-rich foods" list below.
Although a balanced diet aids calcium absorption, high levels of protein and sodium salt in the diet are thought to increase calcium excretion through the kidneys. Excessive amounts of these substances should be avoided, especially in those with low calcium intake. Lactose intolerance also can lead to inadequate calcium intake. Those who are lactose intolerant have insufficient amounts of the enzyme lactase, which is needed to break down the lactose found in dairy products.
To include dairy products in the diet, dairy foods can be taken in small quantities or treated with lactase drops, or lactase can be taken as a pill. Some milk products on the market already have been treated with lactase. If you have trouble getting enough calcium in your diet, you may need to take a calcium supplement.
The amount of calcium you will need from a supplement depends on how much calcium you obtain from food sources. There are several different calcium compounds from which to choose, such as calcium carbonate and calcium citrate, among others.
Except in people with gastrointestinal disease, all major forms of calcium supplements are absorbed equally well when taken with food. Calcium supplements are better absorbed when taken in small doses mg or less several times throughout the day. In many individuals, calcium supplements are better absorbed when taken with food. The body needs vitamin D to absorb calcium. This in turn leads to insufficient calcium absorption from the diet.
In this situation, the body must take calcium from its stores in the skeleton, which weakens existing bone and prevents the formation of strong, new bone. You can get vitamin D in three ways: through the skin from sunlight, from the diet, and from supplements. Men and women over age 70 should increase their uptake to IU daily, which also can be obtained from supplements or vitamin D-rich foods such as egg yolks, saltwater fish, liver, and fortified milk.
The Institute of Medicine recommends no more than 4, IU per day for adults.
However, sometimes doctors prescribe higher doses for people who are deficient in vitamin D. Remember, a balanced diet rich in calcium and vitamin D is only one part of an osteoporosis prevention or treatment program.
Like exercise, getting enough calcium is a strategy that helps strengthen bones at any age. But these strategies may not be enough to stop bone loss caused by lifestyle, medications, or menopause. Your doctor can determine the need for an osteoporosis medication in addition to diet and exercise. This publication contains information about medications used to treat the health condition discussed here.
When this publication was developed, we included the most up-to-date accurate information available. Occasionally, new information on medication is released. Would you like to order publications on bone disorders to be mailed to you? Visit our online order form.