Calcium supplementation adverse effects

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. 

High levels of dietary zinc were associated with marked decreases in bone calcium deposition and in the apparent retention of calcium in male weanling albino rats. Marked increases in fecal calcium levels were also observed in the zinc-fed rats. Excessive dietary zinc was associated with a shifting of phosphorus excretion from the urine to the feces. This resulted in an increase in fecal phosphorus and provided an environmental condition which would increase the possibility of the formation of insoluble calcium phosphate salts and a subsequent decrease in calcium bioavailability. The adverse effect of high dietary zinc on calcium status in young rats could be alleviated and/or reversed with calcium supplements. 

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. 

Calcium has long been implicated as a dietary factor which inhibits the absorption of manganese. Since manganese is better absorbed in the oxidized (+2) than in the reduced state (+3 or +4), any factor which increases gastrointestinal tract pH (increases alkalinity) would be expected to inhibit manganese utilization. Calcium carbonate, a commonly used antacid by humans as well as a calcium nutrient supplement, has been found to have a greater adverse effect on apparent manganese absorption in humans than does milk. 

Comparative effects of calcium lactate and milk on apparent manganese utilization by humans are shown on Table II (7). In this study, 10 adult human subjects were fed 900 mg calcium from milk or 916 mg of calcium from calcium lactate/subject/day. Calcium provided by the basal diet was maintained constant. The increase in fecal manganese excretion with the calcium lactate supplemented diet in comparison to values when milk was the supplemental manganese source suggests that calcium supplied by milk had a lesser adverse effect on manganese absorption than did that from calcium lactate (Table II). 

Polystyrene sulfonic acid has been used as sodium, potassium, and calcium salts. Sodium polystyrene sulfonate has been used to treat hyperkalemia in patients with renal insufficiency and as an adjuvant during hemodialysis. It can be given orally or rectally in all age groups (1). It has also been added to feeding formulae and nutritional supplements to reduce their potassium contents and so prevent hyperkalemia however, the reduction in potassium content was more than balanced by a concomitant increase in sodium content, presumably because of exchange of the sodium with calcium and magnesium (2,3). The uses and adverse effects of sodium polystyrene sulfonate have been reviewed (4,5). 

Adverse effects of oral calcium and vitamin D supplementation include hypercalcemia and hypercalciuria, especially in the hy-poparathyroid patient, in whom the renal calcium-sparing effect of parathyroid hormone is absent. Hypercalciuria may increase the risk of calcium stone formation and nephrolithiasis in susceptible patients. One maneuver to help prevent calcium stones is to maintain the calcinm at a low normal concentration. Monitoring 24-hour urine collections for total calcium concentrations (goal <300 mg/24 h) may also minimize the occurrence of hypercalciuria. The addition of thiazide dinretics for patients at risk for stone formation may result in a reduc-tionof both urinary calcium excretion and vitamin D requirements." ... 

Calcium is the most abundant essential mineral in the human body, 99% being located in the bones and teeth. Caldum salts have been used therapeutically in many conditions, such as lactose intolerance, osteoporosis, premenstrual syndrome, colorectal cancer, kidney stones, and multiple sclerosis. Calcium supplementation has long been regarded as a fimdamental part of the prevention and treatment of postmenopausal bone loss. Several other health benefits have also been suggested, including improvements in blood pressure and serum cholesterol. Its adverse effects include constipation, bloating, and gas [Ifi ], as well as interference with the absorption of phosphate [17. ... 

I Administration. Even under optimal conditions, all bisphosphonates are poorly absorbed (bioavailabihty = 1% to 5%). Bisphosphonates must be administered carefully to optimize the chnical benefit and minimize the risk of adverse G1 effects. Each oral tablet should be taken with at least 4 ounces of plain tap water (not coffee, juice, mineral water, or milk) at least 30 minutes before consuming any food or any other supplement or medication. The weekly oral solution needs to be taken with only 2 ounces of water. The patient should remain upright (either sitting or standing) for at least 30 minutes after bisphosphonate administration. When calcium and vitamin D dietary consumption are insufficient, supplementation is needed to ensme the beneficial effects of bisphosphonates. 

Administered as a once-daily, 20-pg SC injection in the thigh or abdominal wall, teriparatide is a clear, colorless liquid that is available as a 750 pg/3 ml, prefilled, disposable pen that requires refrigeration. Concurrent calcium (1,000 mg) and vitamin D (400 lU) supplementation is recommended. Treatment for longer than 2 years is not recommended. Teriparatide is rapidly absorbed, demonstrates 95% bioavailability, and is quickly eliminated via both hepatic and extrahepatic routes. The half life is 1 hour when administered SC. Metabolic studies have not been performed on teriparatide however, the entire PTH preprohormone has been shown to undergo enzyme-mediated transformations in the liver. Dizziness and leg cramps are the most commonly reported adverse side effects. 

Sources Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Huoride (1997) Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin 85, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998) EHetary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000) Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001) Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005) and EHetary Reference Intakes for Calcium and Vitamin D (2011). These reports may be accessed via www.nap.edu A Tolerable Upper Intake Level (UL) is the highest level of daily nutrient intake that is likely to pose no risk of adverse health effects to almost all individuals in the general population. Unless otherwise specified, the UL represents total intake from food, water, and supplements. Due to a lack of suitable data, ULs could not be established for vitamin K, thiamin, riboflavin, vitamin B12, pantothenic acid, biotin, and carotenoids. In the absence of a UL, extra caution may be warranted in consuming levels above recommended intakes. Members of the general population should be advised not to routinely exceed the UL. The UL is not meant to ply to individuals who are treated with the nutrient under medical supervision or to individuals with predisposing conditions that modify their sensitivity to the nutrient... 

Certain foods such as unrefined cereals and sugar cane juice contain organic phosphates, e.g. phytate (inositol hexaphosphate), which reduce enamel solubility, apparently by reacting with calcium phosphate salts on the enamel surface. The view that this type of compound has a caries-inhibiting effect is supported by observations that dietary supplements of calcium glycerophosphate reduce caries in rats and monkeys. At the same time, the calcium-binding properties of phytate may adversely affect the absorption of calcium from the intestine (page 143). 

In a 6-week study to evaluate the effectiveness of Vitamin D supplementation (vitamin D2 or D3 2000lU, or vitamin D2 50,000 lU weekly) compared with calcium for treatment of vitamin D sufficiency in children with inflammatory bowel disease was examined [49 ]. The most commonly reported events were nausea (n=6) increased thirst and loss of appetite (n=5 each) pruritus (n=4) drowsiness and increased urinary frequency (n=3 each) abdomirwl pain, hone pain, headache and constipation (n=2 each) rash, sensitive eyes, vomiting, irregular heartbeat, dry mouth and muscle pain (n=1 each). There were no significant differences in the frequency of adverse events between groups, and no serious adverse events were observed. 

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