Calcium physiology, metabolism and supplementation: a glance at patients with ankylosing spondylitis

Abstract

The aim of this review is to describe the metabolism of calcium in ankylosing spondylitis compared to physiologic conditions, and to present the current evidence on the benefits and disadvantages of calcium supplementation in these patients. A narrative review of the literature was conducted using the PubMed database and a total of 65 articles were selected. Calcium is involved in many physiopatholo­gical processes, including inflammation, bone loss and bone formation, all of which occur in ankylosing spondylitis. Many ankylosing spondylitis patients suffer from concomitant osteopenia or osteoporosis, which represent indications for calcium supplementation. Conversely, there are still concerns about the use of calcium salts for the prevention of bone fragility in non-osteoporotic or non-osteopenic patients. <br /> In these cases, biologic agents may indirectly normalize calcium dysmetabolism by rebalancing the cyto­kine milieu, in turn associated with bone remodeling. Calcium supplements may be disadvantageous for entheseal calcifications, but so far there are no clear data confirming that such an association exists.

Common mineral nutrients in ankylosing spondylitis: A 2‐sample Mendelian randomization study

“…Despite the tendency toward osteophytes, the increased risk of osteoporosis in AS may be based on chronic inflammation, lack of exercise, and malabsorption, and therefore calcium and vitamin D supplementation are often required. 5 the onset of AS. It is not the cause of AS.…”

“…3 It has been found that minerals may be involved in the pathology of AS. [4][5][6][7][8] A previous study has found that metal triggers conformational reorientation of a self-peptide bound to a disease-associated human leukocyte antigen-B27 (HLA-B27) subtype and suggests that metals may have a role in triggering rheumatic diseases such as AS. 4 Inflammation and the progressive fusion calcification of axial joints are typical features of AS.…”

“…In addition, unbalanced calcium homeostasis may lead to inflammation, formation of new bone tissue, and bone loss in the progress of AS. 5 However, it is unknown whether calcium level is a protective factor or a risk factor for AS. Trace elements are a key factor in maintaining a healthy immune system.…”

“…Minerals are nutrients that are essential for the composition of human tissues and for the maintenance of normal physiological functions, and are the general term for inorganic substances in the body that play a vital role in metabolism 3 . It has been found that minerals may be involved in the pathology of AS 4–8 …”

“…Patients with AS often have symptoms of low bone mass, which is related to the level of calcium. In addition, unbalanced calcium homeostasis may lead to inflammation, formation of new bone tissue, and bone loss in the progress of AS 5 . However, it is unknown whether calcium level is a protective factor or a risk factor for AS.…”