Abstract
Calcium supplements are broadly prescribed to treat osteoporosis either as monotherapy or together with vitamin D to enhance calcium absorption. It is still unclear whether calcium supplementation significantly contributes to the reduction of bone fragility and fracture risk. Data suggest that supplementing post-menopausal women with high doses of calcium has a detrimental impact on cardiovascular morbidity and mortality. Chronic kidney disease (CKD) patients are prone to vascular calcification in part due to impaired phosphate excretion. Calcium-based phosphate binders further increase risk of vascular calcification progression. In both bone and vascular tissue, vitamin K-dependent processes play an important role in calcium homeostasis and it is tempting to speculate that vitamin K supplementation might protect from the potentially untoward effects of calcium supplementation. This review provides an update on current literature on calcium supplementation among post-menopausal women and CKD patients and discusses underlying molecular mechanisms of vascular calcification. We propose therapeutic strategies with vitamin K2 treatment to prevent or hold progression of vascular calcification as a consequence of excessive calcium intake.
Highlights
Calcium is an abundant element in nature and is a major component of sedimentary rock that covers 75 to 80% of the Earth’s surface
In this review we provide the latest insights of the calcium paradox and the potential of using vitamin K to support both bone and vascular health
Uncarboxylated matrix Gla-protein (MGP) is associated with increased risk of vascular calcification, and some researchers advocate that vitamin K status in Chronic kidney disease (CKD) patients should be carefully monitored [182]
Summary
Calcium is an abundant element in nature and is a major component of sedimentary rock that covers 75 to 80% of the Earth’s surface. Osteocalcin (OC) is produced exclusively by osteoblasts and supports the binding of calcium to the bone mineral matrix, whereas matrix Gla-protein (MGP) is synthesized by vascular smooth muscle cells and chondrocytes to prevent ectopic calcification. In CKD patients, vitamin K deficiency is prevalent, so K2 supplementation has been suggested as treatment option to attenuate vascular calcification [23, 24].
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