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Calcium and vitamin D – Role in Musculoskeletal Health

Calcium and vitamin D – Role in Musculoskeletal Health. Bess Dawson-Hughes, M.D. How to understand the absorption of calcium correctly ？.  Calcium  Ca intake  absorption   Vitamin D   Ca ++  Muscle str.   PTH  Falls   Bone remodeling  

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Calcium and vitamin D – Role in Musculoskeletal Health

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  1. Calcium and vitamin D– Role in Musculoskeletal Health Bess Dawson-Hughes, M.D.

  2. How to understand the absorption of calcium correctly？

  3.  Calcium Ca intake  absorption   Vitamin D   Ca++ Muscle str.   PTH  Falls  Bone remodeling  Bone loss  Fracture risk

  4. Mechanisms of Intestinal Calcium Absorption Hoenderop J, et al. Physiol Rev. 2005;85:373-422.

  5. Bullamore R. Lancet 1970; 2: 535-7.

  6. What is the calcium intake that leads to maximal calcium retention in bone?

  7. Forbes, 1979

  8. 300 200 100 0 -100 -200 0 500 1000 1500 2000 2500 300 200 100 % Maximal retention 0 -100 Intake (mg/day) Linda and George McCabe, Purdue University, with permission

  9. Intestinal Absorption of Calcium from Different Calcium Salts • Calcium absorption from different calcium salts were similar to whole milk Net Calcium absorption（%） Sheikh MS, et al. N Eng J Med,1987,317(9):532-6

  10. Calcium Absorption in Relation to Dose Harvey JA, et al. J Bone Miner Res 1988; 3: 253-8.

  11. Calcium Absorption in Relation to Gastric Acid Secretion Bo-Linn GW, et al. J Clin Invest,1984,73:640-7.

  12. Calcium Absorption in Relation to Meal Heaney RP, et al. Am J Clin Nutr 1989; 49: 372-6.

  13. Effect of Oral Amino Acids on Absorption of Calcium Civitelli R et al. Nutrition 1992; 8(6):400-405

  14. Amino acid chelated calcium & Carbonate calcium • Search: MEDLINE 1999-2003 • #1 0 Osteoform • #2 147398 amino • #3 288313 acid • #4 345 chelated • #5 64534 calcium • #6 0 amino acid chelated calcium • #7 2473 carbonate • #8 64534 calcium • #9 855 carbonate calcium Search: MEDLINE 2004-2006 • #1 0 osteoform • #2 30345 calcium • #3 0 osteoform and calcium • #4 64802 amino • #5 136334 acid • #6 172 chelated • #7 30345 calcium • #8 0 amino acid chelated calcium • #9 1531 carbonate • #10 30345 calcium • #11 583 carbonate calcium

  15. Lead Content of Calcium Supplements Borgoin BP, et al. Am J Pub Health 1993.

  16. Effect of Increasing Calcium Intake on PTH and Bone Turnover in Women a Differs from other groups, p < 0.001 b Differs from other groups, p < 0.05 McKane WR et al. J Clin Endocrinol Metab 1996; 81(5):1699-1703.

  17. Calcium Supplementation for the Prevention of Postmenopausal Osteoporosis：a meta-analysis Weighted mean difference for lumbar spine after treatment with calcium at 2 yr. Calcium supplementation in women older than 45 yr with absence of menses for a minimum of 6 months; Treatment with doses of calcium at least 400 mg/d. Themaintenance dose of vitamin D was no more than 400 IU/d Shea B, et al. Endocrine Rev . 2002,23(4):552-559.

  18. 1 * Risk Ratio 0.5 0.78 0.82 0.63 0 Calcitonin Calcium Ca + Calcitonin *P=0.01 Calcitonin, Calcium and Vertebral Fracture Risk – MEDOS Study Kanis JA. Br Med J 1992; 305; 1124-28.

  19. Fracture Prevention Trials: Calcium and Vitamin D Use and Results * If dietary calcium < 1,000 mg † If 25(OH)D level < 40 nmol/L

  20. Calcium Intake in Elderly Chinese Women Woo J et al. Age and Ageing 1998; 27:455-461.

  21. Magnesium – Research Progress • Mg depletion studies have been done in rats. • Several epidemiologic studies have found positive associations between magnesium intake and bone mass and negative associations with diabetes and stroke.

  22. Magnesium Depletion and the Skeleton in Rats a Rude R. OI 2006; on-line. b Rude, R. Bone 2005; 37:211-219. c Rude R. J Nutr 2004; 134:79-85.

  23. Magnesium Intake – Associations with Diabetes and Stroke Diabetesa In >100,000 subjects followed for 12 to 18 yrs: High vs. low quintile RR 0.66 [0.60 – 0.73] Strokeb In 43,738 men followed for 8 yrs: High vs. low quintile RR 0.62 [0.43, 0.88] aLopez-Ridaura R et al. Diabetes Care 2004; 27(1):134-140. b Ascherio A et al. Circulation 1998; 98(12):1198-204.

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