Gastrointestinal Absorption of Calcium from Milk and Calcium Salts

Sheikh, M S; Ana, Carol A. Santa; Nicar, Michael J.; Schiller, Lawrence R.; Fordtran, John S.

doi:10.1056/nejm198708273170903

Cited by 226 publications

(103 citation statements)

References 30 publications

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“…21 Calcium carbonate, which is the most common calcium salt found in dietary supplements, is relatively insoluble at high pH levels, which could potentially hinder its absorption. 22 Conversely, in vitro, proton pump inhibitors inhibit bone resorption, and in vivo, proton pump inhibitors decrease urinary excretion of calcium, likely because of inhibition of vacuolar H + /ATPases found on osteoclast cell membranes. 23 Therefore, further research is required to determine the precise effect of long-term use of proton pump inhibitors on bone mineral metabolism.…”

Section: Discussionmentioning

confidence: 99%

Use of proton pump inhibitors and risk of osteoporosis-related fractures

Targownik¹,

Lix²,

Metge³

et al. 2008

Canadian Medical Association Journal

366

219

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O steoporosis is a common condition throughout the developed world, affecting up to 16% of women and 7% of men aged 50 years and older. 1 The presence of underlying osteoporosis is a major risk factor for the development of fractures of the hip, proximal femur, spinal vertebra and forearm. In 2000, the estimated number of people with fractures worldwide was 56 million, and about 9 million new osteoporotic fractures occur each year.2 In 1993/94, the number of hip fractures in Canada was 23 375.3 This number is predicted to increase to 88 124 by the year 2041, with a parallel increase in the number of days in hospital (465 000 patientdays in 1993/94 to 1.8 million in 2041).3 Moreover, the casefatality rate for hip fractures can exceed 20%, 4 and all osteoporosis-related fractures can lead to substantial long-term disability and decreased quality of life. 5Many risk factors for the development of osteoporosis-related fracture have been identified, including white ethnic background, low body mass index, physical inactivity and female sex. [6][7][8] There are also a number of medication classes, including corticosteroids and serotonin selective reuptake inhibitors, whose use has been linked to higher rates of osteoporosis.9-11 Furthermore, any condition or drug that increases the risk of falls and injury also increases the risk of an osteoporosis-related fracture. 12,13One medication class that may affect bone mineral metabolism is proton pump inhibitors. This class of drugs inhibits the production and intragastric secretion of hydrochloric acid, which is believed to be an important mediator of calcium absorption in the small intestine.14 Recent studies have suggested that the use of proton pump inhibitors for 1 or more years is associated with hip fracture and other osteoporotic fractures; however, there is limited data on additional risk beyond 4 years exposure. 15,16 Because proton pump inhibitors are commonly prescribed to control and prevent symptoms of chronic unrelenting conditions, it is likely that many patients will use these medications for more than 4 years. Therefore, we used an adminstrative database to examine the effects of longer durations of proton pump inhibitor use on the development of osteoporosis-related fractures. Methods Data sourcesWe performed a retrospective, matched cohort study using the Population Health Research Data Repository, which contains comprehensive health care utilization data for nearly all CMAJ ResearchBackground: The use of proton pump inhibitors has been associated with an increased risk of hip fracture. We sought to further explore the relation between duration of exposure to proton pump inhibitors and osteoporosis-related fractures. Methods:We used administrative claims data to identify patients with a fracture of the hip, vertebra or wrist between April 1996 and March 2004. Cases were each matched with 3 controls based on age, sex and comorbidities. We calculated adjusted odds ratios (OR) for the risk of hip fracture and all osteoporosis-related fractures for durations...

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Section: Discussionmentioning

confidence: 99%

Use of proton pump inhibitors and risk of osteoporosis-related fractures

Targownik¹,

Lix²,

Metge³

et al. 2008

Canadian Medical Association Journal

366

219

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“…Thus TBE mainly consists of hydroxyapatite, lactic acid, and citric acid and contains some minerals and proteins originally present in bone. In this study we compared the Ca absorbability of TBE with that of Ca carbonate and of Ca lactate, the solubility of which in water is respectively very low and relatively high (6) . TBE was extrinsically labeled with 45CaC12, and Ca carbonate and Ca lactate were intrinsically labeled with the same radioisotope.…”

Section: Discussionmentioning

confidence: 99%

Absorbability of Calcium from a New Calcium Supplement Prepared from Bovine Marrow-Free Bone in Rats.

Ohtani

Tsugawa

Kamao

et al. 1998

Journal of Nutritional Science and Vitaminology, J Nutr Sci Vit

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SummaryPowdered bovine marrow-free bone was completely sol ubilized with lactic and citric acids under reduced pressure. The resulting solution was lyophilized to obtain a stable powder form (total bone extract, TBE), and the calcium (Ca) absorbability of TBE from intestine was investigated in normal rats. Each animal perorally received 10mg of Ca in 1mL of distilled water as extrinsic 45Ca-labeled TBE, intrinsic 45Ca -labeled Ca lactate , or intrinsic 45Ca-labeled Ca carbonate. The amount of radioactivity in plasma was measured periodically up to 34 h after dosing, and pharmacokinetic parameters were calculated from the radioactivity in plasma. The time taken to reach the maximal 45Ca level (Tmax) did not differ among the three groups. The area under the plasma 45Ca level/time curve (AUCoo) and the radioactivity at Tmax (Cmax) values for the TBE group were significantly higher than those of the Ca carbonate group. Similar results were observed between the Ca lactate and the Ca carbonate groups. No significant difference was observed in the AUC co and the Cmax values between the TBE and the Ca lactate groups. Radioactivity in a femur 34h after dosing was highest in the Ca lactate group and lowest in the Ca carbonate group among the three groups. Both the TBE and the Ca lactate groups showed significant higher whole-body 45Ca retention than the Ca carbonate group did, although no significant difference was found between the TBE and the Ca lactate groups. These findings indicate that the Ca absorbability of TBE is almost comparable with that of Ca lactate and higher than that of Ca carbonate. Therefore TBE would be useful as a Ca supplement with relatively high absorbability from intestine.

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“…The studies carried out to date in humans have failed to demonstrate that milk calcium is more efficiently absorbed than calcium from carbonate [17,27,30,42,48,49], or calcium from mineral waters, bicarbonate or sulfate [5,7,56]. Similarly, longterm studies in growing pigs [36][37][38] have provided no evidence that the calcium in milk and milk products (casein phosphopeptides, skim milk or yogurt) is better absorbed than is calcium from mineral salts.…”

Section: Discussionmentioning

confidence: 99%

Availability of calcium from skim milk, calcium sulfate and calcium carbonate for bone mineralization in pigs

Pointillart¹,

Coxam²,

Sève

et al. 2000

Reprod. Nutr. Dev.

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-Dairy products provide abundant, accessible calcium for humans, while some calcium sulfate-rich mineral waters could provide appreciable amounts of calcium. But there is little evidence that this calcium is as available as milk calcium for making bone. The availability of calcium was studied by monitoring bone parameters in 2-month-old pigs fed restricted amounts of calcium (70% RDA) for 2.5 months. The 3 main (≥ 50% Ca intake) Ca sources were either CaCO 3 or CaSO 4 or skim milk powder (29% of the diet). The bones of the pigs fed the "milk" diet had higher (P < 0.01) ash contents, breaking strength and density (DEXA) than those of the two others groups, in which the bone values were similar. Thus, the calcium provided by a diet containing milk appears to ensure better bone mineralization than do calcium salts included in a non-milk diet. The calcium restriction may have enhanced some milk properties to stimulate calcium absorption in these young, rapidly growing pigs.calcium availability / calcium sulfate / milk calcium / bones / pigs Résumé -Biodisponibilité comparée du calcium du lait, du sulfate et du carbonate de calcium pour la minéralisation osseuse: étude chez le porc. Le sulfate de calcium, dont certaines eaux minérales sont riches, est-il aussi bien utilisé pour la minéralisation osseuse que le calcium des produits laitiers ? Trois lots de 8 porcs, de 2 mois, recevaient pendant 2,5 mois, trois régimes dont au moins 50 % de l'apport calcique était fourni par CaSO 4 , CaCO 3 ou la poudre de lait. Bien que différents dans leur composition, les trois régimes étaient formulés pour avoir la même valeur nutritionnelle et leur teneur en Ca était restreinte (70 % des recommandations). Avec le régime « lait », les cendres, la résistance à la rupture et la densité minérale des os étaient supérieures à celles des deux autres groupes, non différents l'un de l'autre. L'analyse des paramètres circulants liés au métabolisme osseux (en particulier au collagène), des 3 groupes, exclut l'hypothèse d'un effet direct de la source Reprod. Nutr. Dev. 40 (2000) 49-61 49

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Gastrointestinal Absorption of Calcium from Milk and Calcium Salts

Cited by 226 publications

References 30 publications

Use of proton pump inhibitors and risk of osteoporosis-related fractures

Use of proton pump inhibitors and risk of osteoporosis-related fractures

Absorbability of Calcium from a New Calcium Supplement Prepared from Bovine Marrow-Free Bone in Rats.

Availability of calcium from skim milk, calcium sulfate and calcium carbonate for bone mineralization in pigs

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