Calcium: Important mineral in management of Osteoporosis

The skeletal disease of bone thinning and compromised bone strength, osteoporosis, continues to be a major public health issue as the population ages. This disease is characterized by bone fragility and an increased susceptibility to fractures, especially of the spine and hip, although any bone can be affected.

Risk for osteoporosis has been reported in people of all ethnic backgrounds. The risk of fracture from osteoporosis increases with age.¹

Calcium have long been recognized as important and required nutrients for bone health and maintenance. The continuation of calcium in a patient with bone loss is critical for optimal care. Unfortunately, 90% of women may not be getting enough calcium and over 50% of women treated for bone loss have inadequate vitamin D levels.²

Currently, there are a number of pharmacologic treatments for osteoporosis, which provide improvements in bone mass and reduction in fracture risk. These treatments have been studied where adequate calcium supplementation had been achieved. Therefore, their use is predicated on proper calcium therapy.¹

Peak bone mass is usually achieved by age 30; therefore, physical activity and obtaining the recommended doses of calcium in adolescence and young adulthood will ensure peak bone mass development (Table 1).

Table 1 Recommended dietary intake of calcium. Adapted with permission from Institute of Medicine, Food and Nutrition Board (1997)³

 In order to assure adequate calcium intake, a number of calcium supplements are readily available. The two most common and well-studied calcium supplements are calcium carbonate and calcium citrate. Both supplements have been shown to be equally well absorbed when taken with food.⁴

Calcium carbonate supplements have the highest percentage of elemental calcium among the calcium salts (Table 2). Calcium carbonate contains 40% elemental calcium compared to 21% found in calcium citrate, 13% found in calcium lactate, and 9% found in calcium gluconate.⁵

Table 2 Percentage of elemental calcium in common calcium salts.⁵

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References

1. Sunyecz JA. The use of calcium and vitamin D in the management of osteoporosis. Ther Clin Risk Manag. 2008;4(4):827-836. doi:10.2147/tcrm.s3552.
2. Holick MF, Siris ES, Binkley N, et al. Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab. 2005; 90:3215–24.
3. [IOM] Institute of Medicine, Food and Nutrition Board. 1997. Dietary reference intakes: calcium, phosphorus, magnesium, vitamin D and fl uoride. Washington DC: National Academy Press, p 432.
4. Heaney RP, Dowell SD, Bierman J, et al. Absorbability and cost effectiveness in calcium supplementation. J Am Coll Nutr 2001; 20:239–46.
5. Weisman SM. Calcium connection to bone health across a woman’s lifespan – A roundtable. J Reprod Med 2005; 50(11 Suppl):879–84.