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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

Calcium intake and serum 25(OH)D in 50+ patients with a recent fracture.
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Figure 0004: Calcium intake and serum 25(OH)D in 50+ patients with a recent fracture.

Mentions: The average calcium intake in Great Britain for post-menopausal women is 645–705 mg calcium per day (44). This figure is 720–820 mg calcium per day in Germany (45) and in France (46). The calcium intake was also studied in the Netherlands: one-third of the women in a study performed in Amsterdam consumed less than 950 mg calcium per day (47); 18% of the women of approximately the same age in a more rural area (Ede, the Netherlands) consumed less than 800 mg per day (48). In a population with an average age of 80 years, living independently or in care homes, 25% consumed less than 938 mg per day (49). This shows that there is a large variation in the average calcium intake between the different countries. In addition, there is a large variation between individuals. It is particularly important to know what the calcium intake is of those individuals who are most in need of supplementation, for example, the patients with a recent fracture. This was demonstrated recently in a study in 502 patients over the age of 50 years with a recent fracture: only 11% had a calcium intake >1,000 mg per day in combination with serum 25(OH)D levels >50 nmol/L (Fig. 4) (50). An excessively low serum vitamin D level in combination with inadequate calcium intake occurred in 43% (50).


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)

Calcium intake and serum 25(OH)D in 50+ patients with a recent fracture.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0004: Calcium intake and serum 25(OH)D in 50+ patients with a recent fracture.
Mentions: The average calcium intake in Great Britain for post-menopausal women is 645–705 mg calcium per day (44). This figure is 720–820 mg calcium per day in Germany (45) and in France (46). The calcium intake was also studied in the Netherlands: one-third of the women in a study performed in Amsterdam consumed less than 950 mg calcium per day (47); 18% of the women of approximately the same age in a more rural area (Ede, the Netherlands) consumed less than 800 mg per day (48). In a population with an average age of 80 years, living independently or in care homes, 25% consumed less than 938 mg per day (49). This shows that there is a large variation in the average calcium intake between the different countries. In addition, there is a large variation between individuals. It is particularly important to know what the calcium intake is of those individuals who are most in need of supplementation, for example, the patients with a recent fracture. This was demonstrated recently in a study in 502 patients over the age of 50 years with a recent fracture: only 11% had a calcium intake >1,000 mg per day in combination with serum 25(OH)D levels >50 nmol/L (Fig. 4) (50). An excessively low serum vitamin D level in combination with inadequate calcium intake occurred in 43% (50).

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