Calcium Citrate and Vitamin D in the Treatment of Osteoporosis

BackgroundCalcium and vitamin D play an essential role in bone metabolism but deficiency and/or inadequate intake are common.ObjectivesTo describe a practical approach based on the literature regarding clinically important aspects of calcium and vitamin D supplementation.MethodsA 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.ResultsAn 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.ConclusionDaily 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.

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“…When the calcium salts are ingested and enter the acidic environment of the stomach, dissolved calcium ions become available (30). …”

Section: Mechanism and Functional Aspects Of Intestinal Absorption Ofmentioning

confidence: 99%

Calcium and vitamin D supplementation: state of the art for daily practice

Velde

Brouwers²,

Geusens³

et al. 2014

Food & Nutrition Research

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“…Vitamin D plays a vital role in calcium absorption in the gastrointestinal tract. Vitamin D levels have been shown to be inadequate in over half of the women treated for osteoporosis in the USA and Europe (183). 7‐Dehydrocholesterol is absorbed into the systemic circulation via the skin or from the diet.…”

Section: Current Clinical Therapiesmentioning

confidence: 99%

Osteoporosis and osteopenia: implications for periodontal and implant therapy

Otomo‐Corgel¹

2012

Periodontology 2000

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How does low bone mineral density alter treatment decisions? Osteoporosis and osteopenia are major health care issues that may impact on periodontal and implant therapy. Because of the prevalence of osteoporosis, understanding its etiology and the current treatment regimens for patients with low bone mineral density is essential for dental professionals. Millions of patients are now taking medications for the treatment of osteoporosis, and periodontists should be aware of the many medication options that are prescribed. The most frequently prescribed drugs are the bisphosphonates. It is important to be aware that bisphosphonates are not all the same, and patient responses to treatment may vary depending on which bisphosphonates they are taking. Due to recent concerns about bisphosphonate-induced osteonecrosis of the jaw, this paper provides guidance to help the clinician regarding decision-making about preventive and interventional dental treatment when their patient has been prescribed a bisphosphonate. An understanding of current bisphosphonates, their uses, their structural differences and their intended actions helps to improve clinical decision-making. Current knowledge regarding the effects of osteoporosis/osteopenia on periodontal diseases and alveolar bone loss is inconclusive. It is certainly clear that bisphosphonates are not indicated as an adjunctive treatment as part of periodontal therapy because of the risk of osteonecrosis. Regarding implant placement, there are no convincing data that dental implant placement is contraindicated in the osteoporotic patient. However, patients should understand the small risk of compromised bone healing following implant placement if the patient has been taking bisphosphonates. Due to the risks of osteonecrosis, dental clinicians should work closely with their medical colleagues prior to the physician prescribing oral bisphosphonates. Ideally, optimal periodontal and dental health should be established before the patient commences bisphosphonate therapy.

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“…These reactions are commercially employed today as a significant commercial source of vanillin, with typical yields of 5-15%. [312,313] A wide range of oxidants have been employed, including nitric acid [314], metal oxides [315,316], nitrobenzene [317], molecular oxygen [318], hydrogen peroxide [319], and ozone [320].…”

Section: Oxidationmentioning

confidence: 99%

“…It is a relatively harsh means of depolymerisation, with high ozone feed rates giving significant oxidation of the phenolic methoxy groups untouched by most depolymerisation methods [335], and destruction of the aromatic component to generate carboxyl and carbonyl species reported by UV/vis spectroscopy [336]. Model compound studies have found depolymerisation to be most effective at low ozone feed rates, with cleavage of ethers and carbon-carbon double bonds, while with higher ozone feed rates, significant indiscriminate oxidation to aliphatic carbonyl compounds was observed [320]. Depolymerisation with ozone has been found to proceed more rapidly under basic conditions than acidic conditions [337] and has also been found to be strongly pH dependent in model compound studies, with ionised model species reacting orders of magnitude more rapidly than unionised ones [338].…”

Section: Oxidationmentioning

confidence: 99%