Calcium Supplements

Dietary calcium supplementation reduces, but does not stop bone loss at any age. Thus a high calcium intake of 800 - 1000 mg per day of elemental calcium is appropriate in children and adolescence when bone is developing, a daily intake of 800 mg per day is recommended in adult women and this should be increased to 1200 mg per day after the menopause and in old age.

Calcium in the form of dietary products, in particularly dairy products, is appropriate, but for those who cannot or will not consume calcium in the normal diet, calcium supplementation would be appropriate.

There are a wide variety of calcium supplements available. In general any calcium salt is appropriate providing that it delivers the required amount of elemental calcium. The three commonest salts are Calcium Carbonate, Calcium Gluconate and Calcium Citrate. Calcium Carbonate salts should be taken after a meal to maximize absorption. Differences in bioavailability of calcium salts are small and not clinically significant. The yield of elemental calcium varies with the calcium salt (Calcium Carbonate 40-50%, Dolomite 22%, Calcium Citrate 21% and Calcium Gluconate 10%). A total intake of 1000-1500 mg elemental calcium is recommended. Calcium carbonate is inexpensive and provides the most elemental calcium per tablet, but it requires gastric acid for absorption so people with low gastric acid (the elderly or people taking acid blocking drugs for ulcer treatment) should take another form such as calcium citrate. Taking calcium supplements with food, especially acidic foods such as citrus, increases calcium absorption.

Forms of calcium to be avoided include oyster shell and bone meal. Studies have indicated that these supplements may contain substantial amounts of lead. One popular calcium supplement is calcium hydroxypapatite, which is basically purified bone meal. This type of calcium actually has lower absorption then either calcium carbonate or citrate.

Vitamin D

Vitamin D is actually a hormone, which assists in the absorption of calcium from the gut and the reabsorption of calcium from the renal tubules. Minor deficiency of vitamin D have been demonstrated in a high percentage of institutionalized and community living elderly. Whenever a Vitamin D deficiency is suspected we suggest that the best measure is the serum blood level of 25-hydroxycholecaliferol(25-OH). We recommend replacement of 800iu/day of vitamin daily in individuals not exposed to direct sunlight for 15 minutes a day and higher amounts are use for short periods if 25OH levels are low.

Magnesium

Magnesium supplementation may turn out to be a important supplement in the treatment of osteoporosis. Currently there are only a few studies, which supports it use. Since magnesium is such a important mineral will feel that the supplementation with magnesium in a 2:1 ratio with calcium could only be beneficial.

Boron

Boron may play a role in bone metabolism, but its role is most likely to be associated with its interactions with other minerals and vitamins such as calcium, magnesium and vitamin D. Because boron and/or magnesium deprivation causes changes similar to those seen in women with postmenopausal osteoporosis, these elements are apparently needed for optimal calcium metabolism and are thus needed to prevent the excessive bone loss which often occurs in postmenopausal women and older men.

Phytoestrogens

The use of phytoestrogens (e.g. soy) for treatment of osteoporosis especially the semi-synthetic isoflavonoid called "ipriflavone" have had conflicting study results thus at this time we can only suggest the use of these supplement as an adjunct and not as sole treatment. More double blinded placebo controlled studies are needed.

Omega 3 Fatty acids

The use of omega 3's fatty acids has been shown in some studies to significantly reduce cytokine production while concomitantly increasing calcium absorption, bone calcium, and improving bone density.

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