G

Adequate calcium and vitamin D intake are essential for preventing and treating osteoporosis. Calcium and vitamin D supplements to meet requirements should be ad ded to all drug therapy regimens for osteoporosis. Calcium and vitamin D supplementation increases bone mineral density, and the combination decreases the risk of hip and vertebral fractures. Additionally, vitamin D supplementation decreases non-vertebral fractures in older men and women living independently.15

Calcium plays an important role in maximizing peak bone mass and decreasing bone turnover, thereby slowing bone loss. When the calcium supply is insufficient, calcium is taken from bone stores to maintain the serum calcium level. Adequate calcium consumption is essential to prevent this from occurring. Calcium supplementation may also correct hyperparathyroidism in elderly patients.

The highest daily elemental calcium requirements of 1,500 mg are recommended for postmenopausal women and elderly men over age 65. When these requirements cannot be achieved by diet alone, appropriate calcium supplementation is recommended.

Calcium supplements are available in a variety of calcium salts and dosage forms. Calcium requirements are listed in terms of elemental calcium. However, many product labels list calcium content in the salt form, so the percentage of elemental calcium must be known to calculate the elemental calcium content per tablet.

Some calcium products contain lead.16 While the clinical significance and long-term risks are unknown, it is best to use supplements without a high lead content. Due to the number of calcium supplements available, patients may find it overwhelming to choose a supplement. Health care providers can help patients find a suitable and tolerable supplement with good absorption and high elemental calcium content, necessitating fewer tablets per day. Table 56-6 lists widely available supplements with elemental calcium and vitamin D content.

A number of factors can limit calcium absorption, and special consideration must be given to calcium dosing to maximize absorption. Large amounts of calcium taken at once cannot be absorbed. Supplement doses should be limited to 500 to 600 mg of elemental calcium per dose. Calcium intake greater than 2,500 mg/day should be avoided due to increased risk of toxicity, including hypercalciuria and hypercalcemia.6

Calcium carbonate should be taken with food to maximize absorption. Elderly patients or patients receiving proton pump inhibitors or H2-receptor antagonists may have added difficulty absorbing calcium supplements due to reduced stomach acidity.

Better absorption may occur in this setting with calcium citrate because an acid environment is not needed for absorption; it may be taken with or without food.

Table 56-6 Calcium and Vitamin D Content of Common Supplements"

Product

(% Elemental Calcium)

Eiem entai

Calcium per Vitamin D per Tablet (mg) Ta biet (IU)

Calcium Carbonate (40%)

Turns 500 mg Turns E-X 750 mg rums ULI RA 1,000 mg OCa! 500 Os-CaiSOO+D Os-Cai Ultra ¿altrate 600 Caltiate 6G0 + D Ca It rate 600 + Soy One-A-Day Women's

Multivitamin Rolaids SSO mg Viactiv

200

300

400

500

500

200

600

200

600

600

200

600

200

450

400

220

500

100

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