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Calcium and vitamin D supplementation: state of the art for daily practice.

van der Velde RY, Brouwers JR, Geusens PP, Lems WF, van den Bergh JP - Food Nutr Res (2014)

Bottom Line: Data on difference between calcium absorption with calcium carbonate compared to calcium citrate with simultaneous use of proton pump inhibitors are lacking.In most patients 500 mg per day is required to achieve a total intake of 1,200 mg, or in some 1,000 mg per day.More calcium is absorbed from calcium citrate compared to calcium carbonate.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, VieCuri Medical Centre for North Limburg, Venlo, The Netherlands.

ABSTRACT

Background: Calcium and vitamin D play an essential role in bone metabolism but deficiency and/or inadequate intake are common.

Objectives: To describe a practical approach based on the literature regarding clinically important aspects of calcium and vitamin D supplementation.

Methods: A systematic evaluation of relevant literature in Medline was conducted. We included physiological studies, publications on relevant guidelines, meta-analysis, randomized clinical trials, and cohort studies.

Results: An adequate calcium intake and vitamin D supplementation is recommended in most guidelines xon fracture prevention. Daily supplementation with 800 IU is advocated in most guidelines, appears to be safe, and with this approach it is generally not necessary to determine vitamin D levels. There are no data on additional effects of loading doses of vitamin D on fracture or fall prevention. Calcium supplementation should be tailored to the patient's need: usually 500 mg per day is required. The intestinal absorption of calcium citrate is approximately 24% better than that of calcium carbonate independent of intake with meals. Data on difference between calcium absorption with calcium carbonate compared to calcium citrate with simultaneous use of proton pump inhibitors are lacking. Concern has arisen about a possible link between calcium supplementation and an increased risk of myocardial infarction. Probably only well-designed prospective randomized controlled trials will be able to allow definite conclusions on this subject.

Conclusion: Daily supplementation with 800 IU vitamin D is a practical and safe strategy without the need for prior determination of vitamin D levels. Calcium supplementation should be tailored to the patient's need based on total daily dietary calcium intake. In most patients 500 mg per day is required to achieve a total intake of 1,200 mg, or in some 1,000 mg per day. More calcium is absorbed from calcium citrate compared to calcium carbonate.

No MeSH data available.


Related in: MedlinePlus

Relationship between serum 25(OH)D level and fractional calcium absorption (20).
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Figure 0001: Relationship between serum 25(OH)D level and fractional calcium absorption (20).

Mentions: The intestinal calcium absorption has been studied extensively in balance studies in patients with chronic renal insufficiency, revealing that a dietary intake of 1,000 mg calcium results in approximately 400 mg being absorbed in the digestive tract, whilst 200 mg of calcium is added to the intestinal lumen via excretion. The total amount of calcium that passes the digestive tract is therefore 1,200 mg, of which 800 mg is excreted via the feces. This means that the average fractional calcium absorption is 400/1,200=0.33 (16, 17). The serum calcium level and the 24-h calcium excretion can be measured accurately in clinical practice, but the actual quantity of calcium that is absorbed by the bones is much more difficult to measure. This requires the use of ‘bio-markers’, absorption of calcium isotopes, or – after extended treatment – bone densitometry. The absorption of calcium occurs primarily in the small intestine via an active trans-cellular process on the one hand, regulated by active vitamin D (1.25 (OH)2D3), and via para-cellular diffusion on the other hand (18, 19), the latter being largely vitamin D independent. The active transport is a process that can become saturated and is particularly important in the event of limited calcium intake. This results in an upregulation of the production of active vitamin D. As the fractional calcium absorption is significantly determined by active vitamin D, vitamin D deficiency will also result in decreased calcium absorption. Heaney et al. demonstrated that the calcium absorption increases up to a serum 25(OH)D level of 80 nmol/L and reaches a plateau at >80 nmol/L (Fig. 1) (20). Assuming the fact that approximately 35% of the available calcium is absorbed in the gastrointestinal system, the question is how significant the contributions of the active and passive transport systems are and in which parts of the gastrointestinal system this absorption occurs.


Calcium and vitamin D supplementation: state of the art for daily practice.

van der Velde RY, Brouwers JR, Geusens PP, Lems WF, van den Bergh JP - Food Nutr Res (2014)

Relationship between serum 25(OH)D level and fractional calcium absorption (20).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4126954&req=5

Figure 0001: Relationship between serum 25(OH)D level and fractional calcium absorption (20).
Mentions: The intestinal calcium absorption has been studied extensively in balance studies in patients with chronic renal insufficiency, revealing that a dietary intake of 1,000 mg calcium results in approximately 400 mg being absorbed in the digestive tract, whilst 200 mg of calcium is added to the intestinal lumen via excretion. The total amount of calcium that passes the digestive tract is therefore 1,200 mg, of which 800 mg is excreted via the feces. This means that the average fractional calcium absorption is 400/1,200=0.33 (16, 17). The serum calcium level and the 24-h calcium excretion can be measured accurately in clinical practice, but the actual quantity of calcium that is absorbed by the bones is much more difficult to measure. This requires the use of ‘bio-markers’, absorption of calcium isotopes, or – after extended treatment – bone densitometry. The absorption of calcium occurs primarily in the small intestine via an active trans-cellular process on the one hand, regulated by active vitamin D (1.25 (OH)2D3), and via para-cellular diffusion on the other hand (18, 19), the latter being largely vitamin D independent. The active transport is a process that can become saturated and is particularly important in the event of limited calcium intake. This results in an upregulation of the production of active vitamin D. As the fractional calcium absorption is significantly determined by active vitamin D, vitamin D deficiency will also result in decreased calcium absorption. Heaney et al. demonstrated that the calcium absorption increases up to a serum 25(OH)D level of 80 nmol/L and reaches a plateau at >80 nmol/L (Fig. 1) (20). Assuming the fact that approximately 35% of the available calcium is absorbed in the gastrointestinal system, the question is how significant the contributions of the active and passive transport systems are and in which parts of the gastrointestinal system this absorption occurs.

Bottom Line: Data on difference between calcium absorption with calcium carbonate compared to calcium citrate with simultaneous use of proton pump inhibitors are lacking.In most patients 500 mg per day is required to achieve a total intake of 1,200 mg, or in some 1,000 mg per day.More calcium is absorbed from calcium citrate compared to calcium carbonate.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, VieCuri Medical Centre for North Limburg, Venlo, The Netherlands.

ABSTRACT

Background: Calcium and vitamin D play an essential role in bone metabolism but deficiency and/or inadequate intake are common.

Objectives: To describe a practical approach based on the literature regarding clinically important aspects of calcium and vitamin D supplementation.

Methods: A systematic evaluation of relevant literature in Medline was conducted. We included physiological studies, publications on relevant guidelines, meta-analysis, randomized clinical trials, and cohort studies.

Results: An adequate calcium intake and vitamin D supplementation is recommended in most guidelines xon fracture prevention. Daily supplementation with 800 IU is advocated in most guidelines, appears to be safe, and with this approach it is generally not necessary to determine vitamin D levels. There are no data on additional effects of loading doses of vitamin D on fracture or fall prevention. Calcium supplementation should be tailored to the patient's need: usually 500 mg per day is required. The intestinal absorption of calcium citrate is approximately 24% better than that of calcium carbonate independent of intake with meals. Data on difference between calcium absorption with calcium carbonate compared to calcium citrate with simultaneous use of proton pump inhibitors are lacking. Concern has arisen about a possible link between calcium supplementation and an increased risk of myocardial infarction. Probably only well-designed prospective randomized controlled trials will be able to allow definite conclusions on this subject.

Conclusion: Daily supplementation with 800 IU vitamin D is a practical and safe strategy without the need for prior determination of vitamin D levels. Calcium supplementation should be tailored to the patient's need based on total daily dietary calcium intake. In most patients 500 mg per day is required to achieve a total intake of 1,200 mg, or in some 1,000 mg per day. More calcium is absorbed from calcium citrate compared to calcium carbonate.

No MeSH data available.


Related in: MedlinePlus