Treating the Dysmetabolism Underlying Osteoporosis
Kohlstadt Ingrid, Cintron Kenneth in Metabolic Therapies in Orthopedics, Second Edition, 2018
The Institute of Medicine recommends as the recommended dietary allowances for calcium; 1300 mg daily for children ages 9–18 years old; 1,000 mg for men ages 19–70 years old and women ages 19–50 years old; and 1,200 mg for men ages >70 years old and women ages >50 years old [10]. Dietary sources are still considered the best, though the standard diet of western commerce generally falls far short of supplying adequate calcium. In comparing the amount of elementary calcium in the most common calcium preparations, calcium carbonate (40%) and calcium phosphate (21%) have the highest amounts. Calcium citrate has been reported to have slightly higher absorption than calcium carbonate, especially when taken on an empty stomach [130], although other studies have shown that they are of equal bioavailability [131]. The literature supports up to 1800 mg daily for patients who are actively losing weight and for patients who have undergone bariatric surgery [132, 133]. However, there have been recent concerns about possible over supplementation of calcium with an increased risk of cardiovascular disease, therefore, emphasizing the importance of dietary calcium intake and evidence-based use of calcium supplements in the appropriate patients [134].
Calcium
Linda M. Castell, Samantha J. Stear (Nottingham), Louise M. Burke in Nutritional Supplements in Sport, Exercise and Health, 2015
If necessary, calcium supplements can be taken to supplement dietary calcium. Several different kinds of calcium salts are used in calcium supplements, such as carbonate, citrate, gluconate and lactate, with calcium salt preparations being found to have at least as good calcium bioavailability as milk (Mortenson and Charles, 1996). The various calcium salts differ in amounts of mineral calcium, referred to as elemental calcium, with calcium carbonate being the highest (~40%) followed by calcium citrate (~20%). Although calcium citrate malate is considered slightly more soluble for some individuals (e.g. those with impaired HCl production), calcium carbonate supplements are inexpensive, commonly available and available in higher concentrations of elemental calcium. Absorption of calcium reaches a plateau at doses of about 500mg, therefore it is recommended that calcium tablets are better absorbed if provided in divided doses of not more than 400–500mg (Levenson and Brockman, 1994). It is also recommended that calcium supplements should be taken with meals in order to improve the reliability of absorption (Levenson and Brockman, 1994), but this does not take into account the adverse effects of extra calcium on the absorption of other minerals, especially iron, as discussed above. Potential side effects from calcium supplements include gastrointestinal bloating, constipation or gas, and are most commonly caused by calcium carbonate (NIH, 2014). However, rather confusingly, calcium carbonate is the active ingredient of indigestion medications.
Metabolic Bone Disease in Adults with Short Bowel Syndrome
John K. DiBaise, Carol Rees Parrish, Jon S. Thompson in Short Bowel Syndrome Practical Approach to Management, 2017
There are no guidelines on the replacement of calcium in SBS. Guidelines from the National Osteoporosis Foundation (NOF.org) and Institute of Medicine (iom.edu) suggest that individuals in the general population under the age of 50 take 1000 mg/day of calcium and those over the age of 50 take 1200 mg/day, with most of this from dietary sources (e.g., milk, cheese, yogurt). In SBS patients with unreliable absorption of nutrients, calcium supplements will generally be necessary. Calcium carbonate comes in a form that may be chewed or swallowed. Calcium citrate is preferred in those who also take acid blocking medication since the citrate form does not require acid to be present for absorption, while the carbonate form does require acid for absorption.
Protective potential of Angelica sinensis polysaccharide extract against ethylene glycol-induced calcium oxalate urolithiasis
Published in Renal Failure, 2018
Shengbao Wang, Xiaoran Li, Junsheng Bao, Siyu Chen
Citrate is a potent inhibitor of stone formation—by complexing with calcium, citrate prevents crystallization by inhibiting the crystal growth of calcium phosphate and calcium oxalate, retarding the agglomeration of preformed calcium oxalate crystal and preventing the heterogeneous nucleation of calcium oxalate; monosodium citrate also restores the inhibitory properties of Tamm–Horsfall protein [25,26]. To inhibit stone formation, potassium citrate and other forms of alkaline citrate have been prescribed to stone-formers; when ingested orally, alkaline citrate has been shown in multiple studies to increase the urinary pH, increase urinary citrate, and significantly reduce the recurrence of calcium stones [27]. In our experiments, we found that urinary citrate levels were significantly increased in group 3 compared with group 1, which is consistent with previous study results. Moreover, we found that KCit inhibited ethylene glycol-induced urolithiasis-related P-JNK and KIM-1 expression, crystal deposition, and pathological changes and that it improved the renal functions in ethylene glycol-induced rats.
Fracture recurrence in hip fracture with menopausal hormone therapy versus risedronate: a clinical trial
Published in Climacteric, 2021
C.-W. Park, S.-J. Lim, Y.-W. Moon, S.-H. Choi, M.-H. Shin, Y.-K. Min, B.-K. Yoon, Y.-S. Park
We conducted a prospective, open-label, randomized trial involving postmenopausal women sustaining a recent, acute hip fracture. Participants were recruited at a single institution from April 2005 to March 2015. Eligible participants were randomly assigned, in a 1:1 ratio using block randomization, to receive oral risedronate (35 mg; Sanofi-Aventis Korea, Seoul, Korea) weekly or percutaneous E2 gel (0.1%, 1.5 g; Samil Pharm. Co., Seoul, Korea) plus oral MP4 (100 mg; Han Wha Pharma Co., Seoul, Korea) daily (Figure 1). Women assigned to receive risedronate were instructed to take the drug with 200 ml of water on an empty stomach and to remain upright for at least 30 min. Women assigned to the MHT group were instructed to apply three pumps of E2 gel on their forearm and to take one capsule of progesterone daily before bedtime. All participants were additionally prescribed a daily supplemental oral calcium citrate (950 mg, twice daily; Aju Pharm, Seoul, Korea). The study drugs were planned to be administered 6 weeks after the surgical repair of a hip fracture. Participants were monitored for 4 years by clinical visits scheduled every 3 months. The study protocol was approved by the local ethics committees (SMC IRB No. 2005-01-003) and registered online (www.who.int/ictrp) (identifier: KCT0005513).
Leukocytapheresis for patients with acute myeloid leukemia presenting with hyperleukocytosis and leukostasis: a contemporary appraisal of outcomes and benefits
Published in Expert Review of Hematology, 2020
Rory M. Shallis, Maximilian Stahl, Jan Philipp Bewersdorf, Jeanne E. Hendrickson, Amer M. Zeidan
A small proportion (approximately 10%) of patients treated with leukocytapheresis will experience an apheresis-specific adverse event; however 90% and 50% of these will be mild and related to access problems (e.g. puncture needle reinsertion, local hematoma), respectively [85]. Other adverse events reported include hypotension, paresthesia, urticaria, chills, fever, nausea/vomiting, and arrhythmias, which each occur in <1% of procedures [85]. Approximately 2% of procedures, however, are complicated by serious adverse events requiring procedure interruption with the main contributor being hypotension or syncope [85]. If plasma is used as a replacement fluid, the risk of anaphylaxis exists but is still estimated to complicate only 2 per 100,000 procedures [85,86]. Citrate use as an intra-procedural anticoagulant for the closed apheresis circuit leads to a decrease in patient serum ionized calcium; citrate toxicity during the procedure can evoke hypocalcemic sequelae such as QTc prolongation, tetany, and seizure and may occur even despite supplemental calcium administration [16,83,87]. Further, prior data have associated leukocyte removal filters and the generation of the vasoactive nanopeptide bradykinin, which can lead to hypotension [88–90]. Because angiotensin-converting enzyme (ACE) normally inactivates up to 75% of circulating bradykinin, patients taking ACE inhibitors and undergoing leukocytapheresis are found to have higher levels of bradykinin; this may increase the risk of hypotension [89].
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