Supplements calcium

One method of treatment is to inject calcitonin, which decreases blood Ca " concentration and increases bone calcification (33). Another is to increase the release of calcitonin into the blood by increasing the blood level of Ca " ( 4). This latter treatment is accompHshed by increasing Ca " absorption from the intestine requiring dietary calcium supplements and avoidance of high phosphate diets. The latter decrease Ca " absorption by precipitation of the insoluble calcium phosphate. 

Calcium carbonate is used in food and pharmaceutical appHcations for both its chemical and physical properties. It is used as an antacid, as a calcium supplement in foods, as a mild abrasive in toothpaste, and in chewing gum to name only a few (see EoOD ADDITIVES). 

When administered with ranitidine, alendronate bioavailability is increased. When calcium supplements or antacids are administered with risedronate or alendronate, absorption of the bisphosphonates is decreased, hi addition, risedronate absorption is inhibited when the drug is administered with magnesium and aluminum. There is an increased risk of gastrointestinal... 

Calcium is contraindicated in patients with hypercalcemia or ventricular fibrillation and in patients taking digitalis. Calcium is used cautiously in patients with cardiac disease. Hypercalcemia may occur when calcium is administered with the thiazide diuretics. When calcium is administered with atenolol there is a decrease in Hie effect of atenolol, possibly resulting in decreased beta blockade. There is an increased risk of digitalis toxicity when digitalis preparations are administered with calcium. The clinical effect of verapamil may be decreased when the drug is administered with calcium. Concurrent ingestion of spinach or cereal may decrease file absorption of calcium supplements. 

Patients with IBD, particularly those with CD, are also at risk for bone loss. This may be a function of malabsorption or an effect of repeated courses of corticosteroids. Patients with IBD should receive a baseline bone density measurement prior to receiving corticosteroids. Vitamin D and calcium supplementation should be used in all patients receiving long-term corticosteroids. Oral bisphosphonate therapy may also be considered in patients receiving prolonged courses of corticosteroids or in those with osteopenia or osteoporosis. 

Parathyroidectomy is a treatment of last resort for sHPT, but should be considered in patients with persistently elevated iPTH levels above 800 pg/mL (800 ng/L) that is refractory to medical therapy to lower serum calcium and/or phosphorus levels.39 A portion or all of the parathyroid tissue may be removed, and in some cases a portion of the parathyroid tissue may be transplanted into another site, usually the forearm. Bone turnover can be disrupted in patients undergoing parathyroidectomy whereby bone production outweighs bone resorption. The syndrome, known as hungry bone syndrome, is characterized by excessive uptake of calcium, phosphorus, and magnesium for bone production, leading to hypocalcemia, hypophosphatemia, and hypomagnesemia. Serum ionized calcium levels should be monitored frequently (every 4 to 6 hours for the first 48 to 72 hours) in patients receiving a parathyroidectomy. Calcium supplementation is usually necessary, administered IV initially, then orally (with vitamin D supplementation) once normal calcium levels are attained for several weeks to months after the procedure. 

Calcium gluconate is the preferred peripherally infused calcium supplement because it is less irritating to the veins. Calcium chloride must be infused via a central line. 

For acute symptomatic hypocalcemia, 200 to 300 mg of elemental calcium is administered IV and repeated until symptoms are fully controlled. This is achieved by infusing 1 g of calcium chloride or 2 to 3 grams of calcium at a rate no faster than 30 to 60 mg of elemental calcium per minute. More rapid administration is associated with hypotension, bradycardia, or cardiac asystole. Total calcium concentration is commonly monitored in critically ill patients. Under normal circumstances, about half of calcium is loosely bound to serum proteins while the other half is free. Total calcium concentration measures bound and free calcium. Ionized calcium measures free calcium only. Under usual circumstances, a normal calcium level implies a normal free ionized calcium level. Ionized calcium should be obtained in patients with comorbid conditions that would lead to inconsistency between total calcium and free serum calcium (abnormal albumin, protein, or immunoglobulin concentrations). For chronic asymptomatic hypocalcemia, oral calcium supplements are given at doses of 2 to 4 g/day of elemental calcium. Many patients with calcium deficiency have concurrent vitamin D deficiency that must also be corrected in order to restore calcium homeostasis.2,37,38... 

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... 

What type of calcium supplement would you recommend for this patient Why ... 

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 percent of elemental calcium must be known to calculate the elemental calcium content per tablet. 

Some calcium products contain lead.12 While the clinical significance and long-term risks are unknown, it is best to use supplements without a high lead content. Because of the number of calcium supplements available, patients may find it overwhelming to choose a supplement. Health care providers can help... 

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 because of 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. 

Oral bisphosphonates are poorly absorbed (less than 5%). Taking them in the presence of food or calcium supplementation further reduces absorption. After absorption, bisphosphonate uptake to the primary site of action is rapid and sustained. Once attached to bone tissue, bisphosphonates are released very slowly. These drugs are not metabolized and are excreted renally. They are not recommended for use in patients with renal insufficiency. 

Dietary and pharmacologic agents influence the risk of colon cancer. Diets high in fat and low in fiber are associated with increased colon cancer risk, whereas the regular use of aspirin (and other NSAIDs) and calcium supplementation may decrease the risk of colon cancer. 

Calcium supplementation appears to be associated with a moderate reduction in risk of recurrent colorectal adenomas, with prospective studies demonstrating a nonstatistical decrease in adenoma recurrence, and the role of calcium as a chemoprevention agent remains under investigation.47... 

Letrozole 2.5 mg once daily 15% Headache, nausea, dyspepsia, skin rash 1. No protective effect on bone recommend calcium supplementation. 

Bourgoin BP, Evans DR, Cornett JR, et al. 1993. Lead content in 70 brands of dietary calcium supplements. Am J Pub Health 83(8) 1155-1160. 

Calcium carbonate is the primary component of seashells, antacids, marble and limestone (e.g. stalactites and stalagmites in caves), blackboard chalk, scale in water pipes, and calcium supplements for people and animals. It is also used to capture S02 gas in fossil fuel burning boilers, thereby helping to prevent acid rain, and as a soil additive to provide pH adjustment and calcium to farmers soil. 

All individuals should have a balanced diet with adequate intake of calcium and vitamin D (Table 3-1). Table 3-2 lists dietary sources of calcium and vitamin D. If adequate dietary intake cannot be achieved, calcium supplements are necessary. 

Oral calcium supplementation (e.g., 1 to 3 g/day of elemental calcium) is indicated for chronic hypocalcemia due to hypoparathyroidism and vitamin D deficiency. If serum calcium does not normalize, a vitamin D preparation should be added. 

Approximately, 46 percent of all calcium consumed by Americans is from dairy products (17). Scythes et al. (18) found that dairy products contributed 66.7 percent of the calcium consumed by Canadian pre-menopausal women. Others suggest that dairy products contribute approximately 75 percent of the calcium consumed (19). Neither data set includes calcium taken as supplements. About nine percent of the population consume calcium supplements (20). 

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. 

Table IV shows data from another experiment in which the levels of calcium and phosphorus supplements were 0.4%, 0.8%, and 1.2%. Supplements of calcium resulted in significant Improvements in bone calcium levels of zinc-fed rats, whereas phosphorus supplements had little effect on bone calcium levels in zinc-fed rats. Increasing the calcium supplement from 0.4% to 0.8% resulted in additional increases in bone calcium deposition, and a level of 1.2% added calcium resulted in the same increase in bone calcium levels of rats fed 0.75% zinc as did the 0.8% calcium supplement. Mean bone calcium values of zinc-fed rats supplemented with either 0.4% calcium and phosphorus or 0.8% calcium and phosphorus were essentially the same as mean bone calcium values of zinc-fed rats supplemented with either 0.8% or 1.2% calcium. A combination supplement of 1.2% calcium and phosphorus was found to completely alleviate the decrease in bone calcium deposition associated with the feeding of a 0.75% level of zinc. Calcium supplements partially alleviated the decrease in bone phosphorus level associated with the feeding of the...

Table VII shows the calcium balance of zinc-fed and non-zinc-fed rats supplemented with 0.8% calcium and/or phosphorus. Marked increases in fecal calcium and corresponding decreases in apparent calcium retentions in the zinc-fed rats could be reversed with calcium supplementation. Phosphorus supplements appeared to be associated with increases in calcium retention in the absence of zinc, but decreases in calcium retention in the presence of zinc without calcium supplementation. Decreases in fecal calcium were noted in animals fed calcium supplements in the presence of phosphorus or zinc. High levels of zinc were associated with increases in fecal calcium excretion in the absence of extra calcium or in the presence of extra phosphorus. Calcium supplementation was generally associated with a decrease in the urinary excretion of calcium, while zinc and phosphorus supplements were generally associated with an increase in urinary calcium excretion.

Table VIII shows the phosphorus balance of zinc-fed and non-zinc-fed rats supplemented with 0.8% calcium and/or phosphorus. A dietary level of 0.75% zinc was associated with decreases in the apparent retention of phosphorus, and these data support the findings of Sadasivan (2-4). Calcium supplements were associated with slight increases in the retention of phosphorus, while phos-...

An assay is an analysis in which a named material is analyzed for that named material. For example, the assay of a tablet of ibuprofen is an analysis of the tablet for ibuprofen content. An analysis is not an assay when the analyte is some material other than the named material. An analysis of a calcium supplement for a color additive is not an assay. 

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