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Calcium supplements: Practical considerations

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Abstract

The preferable source of calcium is a balanced diet, but medicinal supplements are sometimes necessary if patients are to reach desired intakes. A divided dose regimen (4×/d; i.e., with meals and at bedtime) results in substantially greater absorption of a supplement than does l×/d dosing. However, differences in chemical solubility between supplement preparations are of little importance, with calcium carbonate preparations, for example, being absorbed as well or better than some much more highly soluble salts. Gastric acid is not necessary for absorption of even poorly soluble preparations, so long as they are taken with meals. Because typical patients exhibit a wide range of absorption efficiencies, it is desirable to assess absorption fraction before beginning a supplement regimen. (Some patients will need three times as large a dose as others to absorb the same amount of calcium.) Calcium intakes up to at least 62.5 mmol (2500 mg) are safe for virtually all patients.

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References

  1. Delmi M, Rapin C-H, Bengoa J-M, Delmas PD, Vasey H, Bonjour J-P. Dietary supplementation in elderly patients with fractured neck of the femur. Lancet 1990; 335:1013–16.

    PubMed  Google Scholar 

  2. Heaney RP, Recker RR, Stegman MR, Moy AJ. Calcium absorption in women: relationships to calcium intake, estrogen status, and age. J Bone Min Res 1989; 4:469–75.

    Google Scholar 

  3. Heaney RP, Smith KT, Recker RR, Hinders SM. Meal effects on calcium absorption. Am J Clin Nutr 1989; 49:372–6.

    PubMed  Google Scholar 

  4. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985; 313:70–3.

    PubMed  Google Scholar 

  5. Heaney RP, Recker RR, Weaver CM. Absorbability of calcium sources: the limited role of solubility. Calcif Tissue Int 1990; 46:300–4.

    PubMed  Google Scholar 

  6. Carr CJ, Shangraw RF. Nutritional and pharmaceutical aspects of calcium supplementation. Am Pharmacy 1987; NS27:49–57.

    Google Scholar 

  7. Shangraw R. Factors to consider in the selection of a calcium supplement. Public Health Reports 1989; Sept–Oct: S46–50.

    Google Scholar 

  8. Heaney RP, Weaver CM, Fitzsimmons ML. The influence of calcium load on absorption fraction. J Bone Min Res 1990; 11:1135–8.

    Google Scholar 

  9. Deehr MS, Dallal GE, Smith KT, Taulbee JD, Dawson-Hughes B. Effects of different calcium sources on iron absorption in postmenopausal women. Am J Clin Nutr 1990; 51:95–9.

    PubMed  Google Scholar 

  10. Smith KT, Heaney RP, Flora L, Hinders SM. Calcium absorption from a new calcium delivery system. Calcif Tissue Int 1987; 41:351–2.

    PubMed  Google Scholar 

  11. Horowitz M, Need AG, Philcox JC, Nordin BEC. Biochemical effects of a calcium supplement in osteoporotic postmenopausal women with normal absorption and malabsorption of calcium. Min Electrolye Metab 1987; 13:112–16.

    Google Scholar 

  12. Pak CYC, Avioli LV. Factors affecting absorbability of calcium from calcium salts and food. Calcif Tissue Int 1988; 43:55–60.

    PubMed  Google Scholar 

  13. Haynes RJ Jr, Murad F. Agents affecting calcification: calcium, parathyroid hormone, calcitonin, vitamin D, and other compounds. In: Gilman AG, Goodman LS, Rall TW, Murad F (eds) The pharmacological basis of therapeutics, 7th edn. New York: Macmillan, 1985:1517–22.

    Google Scholar 

  14. Bo-Linn GW, Davis GR, Buddrus DJ, Morawski SG, Santa Ana C, Fordtran JS. An evaluation of the importance of gastric acid secretion in the absorption of dietary calcium. J Clin Invest 1984; 73:640–7.

    PubMed  Google Scholar 

  15. Heaney RP. Fecal calcium density: a measure of calcium compliance. J Bone Min Res 1990; (submitted for publication).

  16. Heaney RP, Weaver CM, Fitzsimmons ML, Recker RR. Calcium absorptive consistency. J Bone Min Res 1990; 11:1139–42.

    Google Scholar 

  17. Heaney RP, Recker RR. Estimation of true calcium absorption. Ann Intern Med 1985; 103:516–21.

    PubMed  Google Scholar 

  18. Heaney RP, Recker RR. Estimating true fractional calcium absorption. ‘Letter to the Editor’. Ann Intern Med 1988; 108:905–6.

    Google Scholar 

  19. Marshall DH, Nordin BEC. A comparison of radioactive calcium absorption tests with net calcium absorption. Clin Sci 1981; 61:477–81.

    PubMed  Google Scholar 

  20. Heaney RP, Gallagher JC, Johnston CC, Neer R, Parfitt AM, Whedon GD. Calcium nutrition and bone health in the elderly. Am J Clin Nutr 1982; 36:986–1013.

    PubMed  Google Scholar 

  21. Shipp CC, Maletskos CJ, Dawson-Hughes B. Measurement of47Calcium retention with a whole-body counter. Calcif Tissue Int 1987; 41:307–12.

    PubMed  Google Scholar 

  22. Lentner C, Lauffenburger T, Guncaga J, Dambacher MA, Haas HG. The metabolic balance technique: a critical reappraisal. Metabolism 1975; 24:461–71.

    PubMed  Google Scholar 

  23. Heaney RP. En recherche de la différence (P<.05). Bone Min 1986; 1:99–114.

    Google Scholar 

  24. Heaney RP, Skillman TG. Secretion and excretion of calcium by the human gastrointestinal tract. J Lab Clin Med 1964; 64:29–41.

    PubMed  Google Scholar 

  25. DeGrazia JA, Ivanovich P, Fellows P, Rich C. A double isotope method for measurement of intestinal absorption of calcium in man. J Lab Clin Med 1965; 66:822–9.

    PubMed  Google Scholar 

  26. Martin BR, Weaver CM, Smith DL. Calcium absorption from milk versus calcium carbonate in college-age women using stable isotopes. Fed Proc 1989; 3:A771 (abstract no. 3160).

  27. Eastell R, Vieira NE, Yergey AL, Riggs BL. One-day test using stable isotopes to measure true fractional calcium absorption. J Bone Min Res 1989; 4:463–8.

    Google Scholar 

  28. Nicar MJ, Pak CYC. Calcium bioavailability from calcium carbonate and calcium citrate. J Clin Endocrinol Metab 1985; 61:391–3.

    PubMed  Google Scholar 

  29. Broadus AE, Dominguez M, Bartter FC. Pathophysiological studies in idiopathic hypercalciuria: use of oral calcium tolerance test to characterize distinctive hypercalciuric subgroups. J Clin Endocrinol Metab 1978; 47:751.

    PubMed  Google Scholar 

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Heaney, R.P. Calcium supplements: Practical considerations. Osteoporosis Int 1, 65–71 (1991). https://doi.org/10.1007/BF01880445

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  • DOI: https://doi.org/10.1007/BF01880445

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