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A recent large study has shown that calcium supplementation, with or without added vitamin D, shows no significant increase in the risk of any cardiovascular events.

Previously it was thought that calcium supplementation increased the incidence of cardiovascular events such as heart attacks and strokes in persons using these supplements. The evidence to confirm or negate these finding were inconclusive, until recently. 

A large study, conducted on data obtained from U.K. Biobank of over 500,000 men and women between the ages of 40-69, was presented by the MRC Lifecourse Epidemiology Unit at the University of Southampton. It was noted that calcium supplementation - with or without added or combined vitamin D - doesn't cause any increase in the mortality risk associated with any cardiovascular events such as hearts attacks and strokes. This was true regardless of age, medication use or whether the patients had pre-exisitng cardiovascular issues or not.

This is especially significant since management of osteoporosis includes the use of calcium and vitamin D supplementation to help improve patients' bone densities. Since osteoporosis can increase the incidence of cardiovascular complications, especially in women, it would be very important to determine whether medications used to manage this problem increase the development of unwanted complications or not.

The clinical implication of this study would then suggest that prescribing calcium supplements, with or without vitamin D added, would be safe in patients and would not be associated with the development or increased risk of cardiovascular complications.

Calcium and vitamin D supplementation

The body needs calcium and vitamin D in order to build and maintain healthy bones. Bone material gets broken down, absorbed by the body and new bone material is produced to serve as a replacement, a process known as bone turnover. As humans get older, bone turnover tends to decrease which means that more bone gets broken down than what gets replaced. This can then lead to conditions such as osteoporosis.

The other essential benefits of calcium include assisting with and improving the function of the muscles, the heart and the nervous system. There is some evidence that calcium helps to protect against issues such as diabetes, cancers and high blood pressure, but it isn't definitive.

Calcium isn't produced by the human body and therefore needs to be taking in via other sources. These can include the following:

  • Most commonly, calcium is found in dairy products such as cheese, yogurt and milk.
  • Fish with soft, edible bones such as canned salmon and sardines.
  • Dark, leafy vegetables such as kale and broccoli.
  • Calcium-fortified drinks and foods such as certain cereals and fruit juices, milk substitutes and soy products.
Vitamin D is important in the bone turnover process as its function is to act like the "cement" which bonds calcium in order to produce an adequate bone matrix.

Vitamin D is produced by the body with adequate skin exposure to the sun. It can also be found in dietary sources such as egg yolks and bones from canned salmon. 

Calcium supplements can interact with certain medications, the most important of which is thyroxine which is used to treat an underactive thyroid (hypothyroidism). In order to avoid interaction between these medications, it's usually suggested to take these supplements at least 4 hours apart.

Osteoporosis: Signs, Risk Factors, Prevention

Definition

Since osteoporosis occurs due to decreased bone production together with increased bone resorption, it results in brittle bones and an increased incidence of sustaining pathological fractures.

The most high risk patients to develop osteoporosis are Asian or Caucasian women, especially those who are post-menopausal.   

Signs and symptoms

There's typically no signs and symptoms associated with the early stages of osteoporosis, but once the bones are weakened and brittle, then patients do start to develop the following issues:

  • Pain in the back which may be caused by a fracture of the vertebra(e).
  • A hunched-over posture.
  • Loss of height over a relatively short period of time.
  • Fracturing of a bone which happens more easily than expected. The most affected bones include the spinal vertebrae, the wrists and the hips.

Associated risk factors

Many risk factors for osteoporosis exist and these can be divided into reversible and irreversible factors, hormonal factors, dietary factors and the use of certain medications.

Reversible factors

  • Using tobacco products.
  • Excessive use of alcohol, which is defined as regular consumption of more than 2 drinks a day.
  • A sedentary lifestyle.

Irreversible factors

  • As mentioned, being an Asian or Caucasian female.
  • Elderly.
  • Having a family history of first-degree relatives (mother, father or sibling) who were or are diagnosed with osteoporosis,especially if a pathological fracture had occurred.
  • Small body frame due to there being less bone mass present.

Hormonal factors

  • Situations where oestrogen and testosterone levels are decreased in women and men, respectively.
  • Hyperthyroidism causes an excess of thyroxine which may result in increased bone loss due to the metabolic rate being increased.
  • Overactive parathyroid and/or adrenal glands.

Dietary factors

  • A lifelong lack of calcium intake.
  • Eating disorders such as anorexia, which can reduce sex hormone levels and thus result in bone mass loss.
  • Gastrointestinal surgery, where a decrease in the size of the stomach or removal of part of the small intestine can result in decreased absorption of nutrients.

Medications

  • Long-term use of steroids interferes with the bone turnover process.
  • Other medications linked with osteoporosis may include those needed to manage convulsions, cancer, gastric reflux and organ transplant rejection.

Prevention

The best way to prevent the development of osteoporosis is to focus on the reversible factors associated with osteoporosis, especially if patients belong to the high risk group. This means that patients should refrain from smoking and using alcohol excessively, as well as increase their dietary intake of calcium and increase physical activity by performing aerobic exercises.

 Patients who are osteoporotic should try and prevent falls by following these suggestions:

  • Wearing low-healed shoes with non-slip soles.
  • Remove any loose rugs and electrical cords which may cause one to slip on or trip over. Slippery surfaces should also be dealt with appropriately by placing non-slip mats.
  • Make sure rooms are lit well so that any obstacles can be well visualized and avoided in order to prevent falls. 
  • Install garb bars on the inside and outside of baths and showers.
  • Make sure that the bed is placed appropriately in order to be able to get in and out of it without any difficulty.
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