Calcium Rich Mineral Waters and Osteoporosis

1. Calcium Rich Mineral Waters and Osteoporosis Mine Karagülle, MD Istanbul University Istanbul Medical Faculty Department of Medical Ecology & Hydroclimatology

2. A tiny reminder! • Osteoporosis is a bone disease characterized by a reduction in bone tissue relative to the volume of anatomical bone that increases susceptibility to fracture, particularly in menopausal women

3. A tiny reminder! • With the increase in life expectancy and in the number of elderly people, osteoporotic fractures are becaming a major public health problem in industrialized countries

4. Calcium Requirement • Among dietary factors implicated as risk factors for the development of osteoporosis, calcium intake is considered one of the major determinants of bone health

5. Calcium Requirement • It is generally agreed that an adequate calcium intake(1200-1500mg/d) is necessary for the acquisition of an ideal peak bone mass and for the maintenance of the bone mineral density in adults, in postmenopausal women, and in the elderly.

6. Calcium supplementation with calcium-rich mineral waters: A systematic review and meta-analysis Böhmer et al. Osteoporosis Int 2000;11:938-943 • First all publications on calcium absorbtion from mineral waters were identified • In a second step, studies comparing calcium absorption from mineral waters with that fom dairy products • Six publications were assessed in this meta-analysis • Four studies fulfilled all inclusion criteria

7. Halpern et al.Am J Prew Med1991;7:379-83 • N=15 lactose-intolerant adults • Calcium bioavailability from mineral water at least comperable to dairy products. • Mineral water is a useful calcium source for lactose-intolerant adults

8. Heaney and Dowell .Osteoporosis Int 1994;231-44 • N=18 Healthy women • Calcium bioavailability from mineral water at least comperable to dairy products

9. Couzy et al Am J Clin Nutr 1995;62:1239-44 • N=9 Healthy women • Calcium bioavailability from mineral water comperable to dairy products

10. Van Dokkum et al Br J Nutr 1996;75: 893-903 • N=12 Healthy young adult women • Calcium bioavailability from mineral water(37.0%) comperable with dairy products(37.7-42.2%). • Combined with a spaghetti meal, calcium bioavailability from mineral water increases significantly (46.1%)

11. Guillemant et al Osteoporosis Int 1997 ;7:85-6 • N=12 Healthy young adult men • Inhibition of PTH-secretion induced by mineral water rich in calcium

12. Wynckell et al Miner Electrolyte Metab 1997;23:88-92 • N=12 Students(8 men, 4women) • The intestinal calcium absorption from mineral waters with three different concentrations (10.4,78 and 467mg/L) is comperable. • Calcium- rich mineral water is auseful calcium source for the elderly and patients with lactose intolerance

13. Calcium absorption from mineral water

14. Ion concentration of tested mineral waters(mg/L)

15. Effect of high-calcium mineral water on bone loss Copellero et al. Calcif Tissue Int 1996;59:238-239 • Randomized Controlled Trial • (n:45 postmenopausal women) • study period (13±1 months)

16. Effect of high-calcium mineral water on bone loss Copellero et al. Calcif Tissue Int 1996;59:238-239 • Gr.I: 1L/day calcium mineral water (Ferrarella; 408 mg/L Ca++) • Gr.II:1L/day low calcium mineral water: 80 mg/L

17. Effect of high-calcium mineral water on bone loss Copellero et al. Calcif Tissue Int 1996;59:238-239 • Gr.I (high calcium MW): significant reduction in osteocalcin levels • Gr.II (low calcium MW):significant decrease in bone mineral density • High calcium mineral water as an effective prophylaxis in postmenopausal bone loss

18. Importance of bioavailable calcium drinking water on bone mass Costi etal. J Endocrinol Invest 1999;22:852-856 • Case report N:255 women (30-70 years of age) in a small community area

19. Importance of bioavailable calcium drinking water on bone mass Costi etal. J Endocrinol Invest 1999;22:852-856 • Gr.A: drinking regularly a high Ca mineral water:318mg/L (Sangemini) • Gr.B: drinking different type of water with a lower Ca content: 83mg/L

20. Importance of bioavailable calcium drinking water on bone mass Costi etal. J Endocrinol Invest 1999;22:852-856 • Gr.A women ingested a significanthy higher quantity of calcium than Gr.B • Gr.A average bone density values were slightly but significanty higher than Gr. B

21. EPIDOS Cohort Study Aptel,I et al.J Bone Miner Res 1999;14:829-833 • The study included 4434 women over 75 years of age • A significant correlation was found between total calcium intake and bone density at the femoral neck

22. EPIDOS Cohort Study Aptel,I et al.J Bone Miner Res 1999;14:829-833 • An increase of 100 mg/day in calcium from drinking water was associated to a 0.5% increase in femoral bone density • Dietary calcium from other sources only led to a 0.2% increase

23. Meunier et al Osteoporosis Int Published online: 3 March 2005 • Consumption of high calcium mineral water lowers biochemical indices of bone remodeling in postmenopausal women with low calcium intake • Significant decrease of PTH, osteocalcin,bone alkaline phosphatase serum and urine type-1 collagen C telopeptide in the HCaMW group compared to placebo group

24. mineral waters rich in calcium

25. mineral waters rich in calcium

26. Conclusion • Although data are available from only a few studies with relatively small number of subjects; • calcium-rich mineral waters seem to offer an effective alternative to calcium supplementation from milk and diary products

27. Conclusion • Some mineral waters with high calcium levels, might be significant sources of calcium • And they are calorie free

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