Mineralization, bone supplements

Minerals. Supplementation of macrominerals to mminants is sometimes necessary. Calcium and phosphoms are the minerals most often supplemented in mminant diets. One or both may be deficient, and the level of one affects the utilization of the other. Limestone, 36% calcium, is commonly used as a source of supplemental calcium. Dolomite, 22% calcium oyster sheUs, 35% calcium and gypsum, 29% calcium, are sources of calcium. Bone meal, 29% calcium, 14% phosphoms dicalcium phosphate, 25—28% calcium, 18—21% phosphoms and defluorinated rock phosphate, 32% calcium, 18% phosphoms, are sources of both calcium and phosphoms. Diammonium phosphate, 25% phosphoms phosphoric acid, 32% phosphoms sodium phosphate, 22% phosphoms and sodium tripolyphosphate, 31% phosphoms, are additional sources of phosphoms (5). 

Baud, C.A., Bang, S., Lee, H.S. and Baud, J.P 1968 X-ray studies of strontium incorporation into bone mineral in vivo. Calcified Tissue Research Supplement 2 6. 

CF patients with low bone mineral density and low serum vitamin D levels may improve bone health through supplemental vitamin D analogs beyond those found in standard CF vitamins. The optimal dose and analog have not been determined. For ergocalciferol, a minimum of 400 IU and 800 IU... 

One chronic adverse effect that is of concern is osteoporosis.32,33 Carbamazepine, phenytoin, phenobarbital, oxcarbazepine, and valproate have all been shown to decrease bone mineral density, even after only 6 months of treatment. Data on the relationship between other AEDs and osteoporosis are not currently available. Multiple studies have shown the risk of osteoporosis due to chronic AED use to be similar to the risk with chronic use of corticosteroids. Patients taking carbamazepine, phenytoin, phenobarbital, or valproate for longer than 6 months should take supplemental calcium and vitamin D. Additionally routine monitoring for osteoporosis should be performed every 2 years, and patients should be instructed on ways to protect themselves from fractures. 

Osteoporosis Oral calcium supplementation (1000-5000 mg/day) Oral vitamin D Calcifediol (1000 lU/day) Calcitriol (0.5 mcg/day) Hormone-replacement therapy Calcitonin or oral bisphosphonates If daily intake less than 1000 mg elemental calcium Documented deficiency If kidney functioning If kidney not functioning Post-menopausal women without contraindications Documented loss in bone mineral density greater than 3% Data lacking for bisphosphonates in patients with Rl... 

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 nonvertebral fractures in older men and women living independently.11 Because of the effects of calcium on... 

Several studies have evaluated dietary supplements such as isoflavones, which are found in soy products and red clover. A well-controlled trial in more than 400 postmenopausal women evaluating a specific isoflavone, ipriflavone, found no benefits on bone mineral density or fracture rates after 3 years.47 Nevertheless, because these therapies are available without prescription and are not regulated by the FDA, patients may choose to self-medicate with isoflavones. Lymphocytopenia appeared in several patients treated with ipriflavone in clinical trials. Additionally, ipriflavone should be used with caution in immunocompromised patients or those with renal disease. It may inhibit CYP1A2 and CYP2C9 and may interact with drugs metabolized by those pathways, such as warfarin. 

Table III. Effects of Calcium, Phosphorus, and Zinc Supplements on Growth and Bone Mineralization of Young Rats...

The data presented in this paper indicate that excess levels (0.75%) of dietary zinc result in decreases in the bioavailability of calcium and phosphorus in rats and interfere with normal bone mineralization. High dietary levels of calcium or zinc appeared to cause a shift in the excretion of phosphorus from the urine to the feces, while the presence of extra phosphorus tended to keep the pathway of phosphorus excretion via the urine. The presence of large amounts of phosphorus in the Intestinal tract due to high intakes of zinc would increase the possibility of the formation of insoluble phosphate salts with various cations, including calcium, which may be present. A shift in phosphorus excretion from the feces to the urine, however, could result in an environmental condition within the system which would tend to increase the bioavailability of cations to the animal. The adverse effect of zinc toxicity on calcium and phosphorus status of young rats could be alleviated with calcium and/or phosphorus supplements. 

Sales of Ca supplements alone were 875 million in the United States in 2002, and comprised 60% of all mineral supplement sales (Anonymous, 2004). In 2004, sales of Ca supplements increased by 9.3% (Uhland et ah, 2004), possibly to some extent in response to the Surgeon General s report on bone health that was issued that year. More recently in 2006, it was projected that dietary supplement sales in the United States would approach 5 billion (Anonymous, 2006). While Ca derived from a balanced diet is preferable, Ca supplements are a popular noncaloric alternative for increasing daily Ca intake. There are a vast number of oral Ca supplements available in the market place in the form of capsules, tablets, chewable tablets, effervescent tablets, liquids, powders, suspensions, wafers, and granules. However, not all Ca salts are equally soluble or bioavailable and the dose of Ca on the label of a supplement may not necessarily be reflective of the relative amount of available Ca once consumed. Furthermore, the same Ca salt may be more or less bioavailable depending on the production process and materials used to manufacture the supplement. 

In the same study by Lloyd et al. (1996), but after 2 years of CCM supplementation, the Ca group versus the placebo group demonstrated significantly higher BMD (12.2% vs 10.1% p =. 005) and bone mineral content increases (BMC 39.9% vs 35.7% p =. 01) for total body, while bone area remained similar between groups (p =. 15). At the lumbar spine and pelvis, supplemental Ca improved bone accretion compared to placebo by as much as 12-24%. Annualized bone acquisition rate was highest in Ca supplemented subjects with above-median values for... 

Dibba, B., Prentice, A., Ceesay, M., Stirling, D. M., Cole, T. J., and Poskitt, E. M. E. (2000). Effect of calcium supplementation on bone mineral accretion in Gambian children accustomed to a low-calcium diet. Am. J. Clin. Nutr. 71, 544-549. 

Jensen, L. B., Kollerup, G., Quaade, F., and Sorensen, O. H. (2001). Bone mineral changes in obese women during a moderate weight loss with and without calcium supplementation. JBMR 16,141-147. 

Matkovic, V., Landoll, J. D., Goel, P., Badenhop-Stevens, N., Ha, E. J., Li, B., and Crncevic-Orlic, Z. (2004b). Bone mineral density of skull and lower extremities during growth and calcium supplementation. In "Nutritional Aspects of Osteoporosis," (P. Burckhardt, B. Dawson-Hughes, and R. P. Heaney, eds.), pp. 3-15. Elsevier Academic Press, Burlington, MA. 

Geriatric Considerations - Summary Primidone is poorly tolerated in older adults avoid use if possible. Dosage adjustments are required in renal impairment. Numerous drug interactions with primidone exist. Primidone may reduce bone mineral den-sitybyinterferingwith vitamin D catabolism. Calcium and vitamin D supplementation and monitoring of bone mineral density are recommended for older adults taking this drug. 

Fujita, T., Fukase, M., Miyamoto, H., Matasumoto, T., and Ohue, T. (1990). Increase of bone mineral density by calcium supplement with oyster shell electrolysate. Bone Miner. 11, 85-91. 

In addition, gelatin peptides have shown to accelerate absorption of dietary calcium in animal models increasing calcium bioavailability (Kim et al., 1998). Jung et al. (2006) reported that fish bone peptides (FBP) could inhibit the formation of insoluble Ca salts in neutral pFI. During the experimental period, Ca retention was increased and loss of bone mineral was decreased by FBP II supplementation in ovariectomized rats. The levels of femoral total Ca, bone mineral density, and strength were also significantly increased by the FBP diet to levels similar to those of the casein phosphopeptide diet group. 

Warady BD, Lindsley CB, Robinson FG, Lukert BP. Effects of nutritional supplementation on bone mineral status of children with rheumatic diseases receiving corticosteroid therapy. J Rheumatol 1994 21(3) 530-5. 

Aromatase inhibitors increase bone turnover by near complete estrogen depletion, leading to reduced bone mineral density and an increased risk of fractures. Bisphosphonates plus calcium and vitamin D supplementation mitigate this (26). In an open, multicenter, randomized study in 602 women with early-stage breast cancer taking letrozole 2.5 mg/day, zoledronic acid 4 mg every 6 months prevented bone loss (27). 

Salmon calcitonin nasal spray prevented bone loss in the lumbar spine of 31 patients treated with prednisone for polymyalgia rheumatica (SEDA-22, 448) (9). They were randomized to salmon calcitonin nasal spray 200 IU/day or matched placebo for 1 year. Both groups were treated with calcium supplements if their dietary intake was below 800 mg/day. With calcitonin the mean bone mineral density in the lumbar spine fell by 1.3% and with placebo by 5% after 1 year. There were no differences in the hip, including the femoral neck and trochanter, or in total body bone density. 

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