Diet with calcium supplement osteoporosis

The primary roles and the recommended daily intake of major and trace minerals are listed in Table 38-3. Similar to vitamins, these minerals are typically obtained from dietary sources. Specific minerals may likewise be included in various multivitamins and other dietary supplements, with the intent that these minerals will promote good health and prevent disease. Again, there is generally no need for mineral supplements for most people eating a reasonably balanced diet. On the other hand, mineral supplements can be helpful in specific situations where the body s need for a mineral may exceed dietary supply. Some examples of appropriate supplementation include calcium supplements for people with osteoporosis (see Chapter 31), potassium supplements for people on diuretics (see Chapter 21), and iron supplements for people with certain anemias. Hence, mineral supplements may be helpful in certain individuals, but the dose and type of supplement should be adjusted carefully. 

Treatment of secondary osteoporosis varies depending on the actual disease process which has produced the osteoporosis, and may include adjustments to thyroid medication, dietary supplementation with calcium or vitamin D (which is involved in the ability of the intestine to absorb calcium in the diet), or other treatment of the primary disease. 

Calcium supplements, along with estrogen and calcitonin therapy, are commonly used in the prevention and treatment of osteoporosis. Bone loss dearly occurs with diets supplying under 400 mg Ca/day, Bone loss can be mirvimized with the consumpbon of the RDA for calcium. There is some thought that all postmenopausal women should consume lOOO to 1500 mg of calcium per day, an amount higher than the RDA, There is some evidence that such supplementation can reduce bone losses of the ulna but have no effect on spinal bone losses Smith and GiUigan, 1990),... 

Adequate calcium nutrition during childhood and adolescence is thought to be an important deterrent to osteoporosis in later life. A one-year study of 149 girls (8 years old) revealed the effects of consuming a typical diet (900 mg Ca/day) or a diet supplemented with an additional 850 mg Ca/day (Bonjour et ah, 1997). The Ca supplement was supplied by specially prepared biscuits, juices, and candy bars (rather than piUs) to assure compliance. To view some of the data, the density at the femoral diaphysis increased by 5% (unsupplemented) and by 6% (plus calcium) during the 1-year period. The density at the lumbar spine increased by 4% (unsupplemented) and by 4% (plus calcium). The data demonstrated a clear and definite increase in bone density at some sites, but not at others. This study, as well as others 0ohnston et ah, 1992), tend to show that calcium supplements to children can benefit bones of the appendicular skeleton, but not the axial skeleton. The appendicular skeleton includes the pelvis, arm bones, and leg bones. The axial skeleton includes the skull, vertebra, ribs, and sternum. 

The preceding statement is part of a growing calcium deficiency problem, evidenced as osteoporosis, especially among the elderly, and is apparently reason enough to take calcium supplements along with vitamin D, which is supposed to aid in the body s calcium fixation. Not only do the elderly have a problem with calcium requirements, but also with the absorption of other nutrients, even if sufficiently abundant in the total diet this is one of the many reasons geriatrics is such... 

Even though osteoporosis may not be preventable by increasing calcium intake, there are reports that calcium supplements have induced calcium retention and relieved symptoms. This may reflect the fact that, although the efficiency of absorption decreases with the amount of calcium in the diet, the total amount of calcium actually retained increases. 

With the news that calcium deficiencies in many women s diets may contribute to the development of osteoporosis (bone weakening), the use of dietary calcium supplements has become increasingly common. Many of these calcium supplements consist of nothing more than calcium carbonate, CaCOs. When a calcium carbonate tablet is ingested, it dissolves by reaction with stomach acid, which contains hydrochloric acid, HCl. The unbalanced equation is... 

Calcium Adequate calcium intake is required to maintain bone mineral density and reduce the risk of osteoporosis in the elderly. In addition to the reduced absorption of calcium by elderly people that results from age-related changes in vitamin D metabolism, the elderly also show a reduced ability to increase the efficiency of calcium absorption as an adaptive response to low-calcium diets. Also, as noted earlier, the low-acid conditions resulting from atrophic gastritis can reduce calcium absorption. Dietary calcium reacts with hydrochloric acid in the stomach to form soluble calcium chloride, which is absorbed in the small intestine. In the United States, the recommended calcium intake is 1200mg/day for men and women older than age 70. Many elderly people may benefit from calcium supplements. 

Epidemiologic studies have consistently documented that increased potassium intake is associated with greater bone mineral density. In trials, supplemental potassium bicarbonate reduced bone turnover as manifest by less urinary calcium excretion and by biochemical evidence of greater bone formation and reduced bone resorption. However, no trial has tested the effect of increased potassium or diets rich in potassium on bone mineral density or clinical outcomes related to osteoporosis. 

Vitamin D Vitamin D is important in the elderly for enhancing calcium absorption, inhibiting cellular growth, and activating lymphocyte function. Vitamin D deficiency may lead to osteoporosis and osteomalacia and possibly increase the risk for some cancers it has been associated with increased incidence of hip fractures. More than 50% of elderly people have been reported to be vitamin D deficient in some studies. In addition to the skin s decreased ability to synthesize vitamin D as people age, the kidneys, which help to convert vitamin D to its active form, sometimes do not function as well when people age. All elderly people, particularly people with limited sun exposure, such as those who are either homebound or live in northern latitudes, should include vitamin D-fortified foods and fish in their diets. If elderly people are unable to meet their vitamin D needs using dietary sources, they may require a supplement. Evidence suggests that vitamin D supplementation may reduce the risk of osteoporotic fractures in elderly people with low serum levels of vitamin D. 

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