Calcium Intake In Patients Research Articles

Nutrition, Vitamin D, and Calcium in Elderly Patients before and after a Hip Fracture and Their Impact on the Musculoskeletal System: A Narrative Review.

Hip fractures are a major health issue considerably impacting patients' quality of life and well-being. This is particularly evident in elderly subjects, in which the decline in bone and muscle mass coexists and predisposes individuals to fall and fracture. Among interventions to be implemented in hip fractured patients, the assessment and management of nutritional status is pivotal, particularly in subjects older than 65. Nutrition plays a central role in both primary and secondary preventions of fracture. An adequate protein intake improves muscle mass and strength and the intestinal absorption of calcium. Other nutrients with recognized beneficial effects on bone health are calcium, vitamins D, K, and C, potassium, magnesium, folate, and carotenoids. With reference to calcium, results from longitudinal studies showed that the consumption of dairy foods has a protective role against fractures. Moreover, the most recent systematic reviews and meta-analyses and one umbrella review demonstrated that the combination of calcium and vitamin D supplementation significantly reduces hip fracture risk, with presumed higher efficacy in older and institutionalized subjects. Owing to these reasons, the adequate intake of calcium, vitamin D, protein, and other macro and micronutrients has been successfully implemented in the Fracture Liaison Services (FLSs) that represent the most reliable model of management for hip fracture patients. In this narrative review, papers (randomized controlled trials, prospective and intervention studies, and systematic reviews) retrieved by records from three different databases (PubMed, Embase, and Medline) have been analyzed, and the available information on the screening, assessment, and management of nutritional and vitamin D status and calcium intake in patients with hip fractures is presented along with specific prevention and treatment measures.

Alternate-day calcium dosing may be an effective treatment option for chronic hypoparathyroidism.

Conventional treatment of chronic hypoparathyroidism consists of oral calcium supplements and active vitamin D analogs; however, some patients are unable to meet treatment goals despite the high dosage of oral calcium supplementation. We aimed to investigate the effectiveness of alternate-day oral calcium intake in patients with uncontrolled chronic hypoparathyroidism. In this retrospective cohort study, we evaluated 66 patients with chronic hypoparathyroidism who were admitted to our hospital between January 2017 and January 2019. Fourteen patients receiving ≥ 2000mg/day oral elemental calcium and who were admitted to emergency department or our outpatient clinic at least once in the last 3months for hypocalcemia requiring intravenous calcium replacement were switched to the alternate-day dosing regimen in which patients took calcium orally every other day. We collected and analyzed patients' medical history information, serum and urinary parameters over a 3-month period prior to and following the treatment. Before alternate-day dosing regimen, median oral calcium intake was 3750mg/day, oral calcitriol intake was 0.88mcg/day, serum calcium levels were 7.71mg/dL, serum phosphate levels were 5.35mg/dL, and 24-h urine calcium levels were 165mg/day. Following alternate-day dosing regimen, median oral calcium intake was 1500mg/day, oral calcitriol intake was 0.88mcg/day, serum calcium levels were 8.25mg/dL, serum phosphate levels were 5mg/dL, and 24-h urine calcium levels were 210.5mg/day. After alternate-day dosing regimen, oral calcium intake decreased and serum calcium levels increased. The number of emergency visits dropped from 21 to 3 after alternate-day dosing regimen. Patients with uncontrolled chronic hypoparathyroidism could be controlled more effectively with alternate-day dosing regimen.

Calcium intake improvement after nutritional intervention in paediatric patients with osteogenesis imperfecta

In several bone disorders, adequate calcium intake is a coadjuvant intervention to regular treatment. Osteogenesis imperfecta (OI) is a collagen disorder with a range of symptoms, ranging from fractures to minimum trauma, and it is typically treated with bisphosphonates. In the present study, we evaluate the impact of a nutritional intervention (NI) on dietary calcium intake and bone mineral density (BMD) in paediatric patients with OI. A nonrandomised clinical trial was designed with a NI. Dietary calcium intake, anthropometry and clinical features were assessed at baseline, including anthropometry, basal metabolic rate (BMR), BMD. In addition, a food guidance form was developed and sent to patients by mail. After 12months, clinical features of patients were reassessed and compared with the baseline data. Fifty-two children and adolescents were enrolled. Significant increases in total calcium intake (mg day-1 ), percentage of adequate calcium intake (%) and number of cups of milk ingested were observed after NI. We detected a positive correlation between the variation of BMD and milk consumption in patients treated with bisphosphonate. We observed an increase in calcium intake in patients with OI. This finding demonstrates the importance of nutrition therapy as part of a multidisciplinary treatment approach for bone health.

Assessment of nutritional status and calcium intake in patients with chronic obstructive pulmonary disease

Assessment of nutritional status and calcium intake in patients with chronic obstructive pulmonary disease

Patients With Mitochondrial Disease Have an Inadequate Nutritional Intake.

Mitochondrial disease (MD) is a group of disorders caused by dysfunctional mitochondria, the organelles that generate energy for the cell. Malnutrition in patients with MD may lead to increased mitochondrial dysfunction, which may enhance already existing symptoms. The aim of this study was to investigate whether patients with MD have an insufficient or unbalanced food intake and to establish which nutrients and product groups are particularly compromised in this patient group. In this observational, cross-sectional, retrospective study, sixty 3-day nutrition diaries of adult patients with MD were analyzed and compared with the Dutch recommended daily allowance and the Dutch National Food Consumption Survey (DNFCS). The intake of all macronutrients and micronutrients of patients with MD was significantly different from Dutch recommended daily allowance values with the exception of fat and iron. In particular, protein and calcium intake in patients with MD was significantly lower when compared with the DNFCS. Interindividual differences were high. Also, intake of fiber, sugars, saturated fat, and vitamin D differed from recommendations for the overall population. In comparison with DNFCS, the intake of dairy products and drinks was significant lower in patients. Our study demonstrates that many patients with MD have an inadequate diet. Specifically, intake of protein, calcium, dairy products, and fluids were low. Overall, eating a healthy diet seems as difficult for patients with MD as for the general population. Since interindividual differences are high, individual diet counseling is recommended for all adult patients with MD.

Dietary calcium intake in patients with inflammatory bowel disease

Background & aimsOsteopenia and increased risk for fractures in IBD result from several factors. Aim of the studyTo investigate the dietary intake of calcium in IBD patients. MethodsA 22-item quantitative validated frequency food questionnaire was used for quantifying dietary calcium in relation to gender and age, in 187 IBD patients, 420 normal- and 276 diseased controls. Statistical analysisMann–Whitney, chi-square- and T-tests. ResultsThe mean calcium intake was 991.0±536.0 (105.8% Recommended Daily Allowances) and 867.6±562.7SDmg/day (93.8% RDA) in healthy and diseased controls, and 837.8±482.0SDmg/day (92.7% RDA) in IBD, P<0.001. Calcium intake was high in celiac disease (1165.7±798.8SDmg/day, 120% RDA), and non-significantly lower in ulcerative colitis than in Crohn's disease (798.7±544.1SDmg/day vs 881.9±433.0). CD and UC females, but not males, had a mean calcium intake well under RDA. In all study groups the intake was lower in patients believing that consumption of lactose-containing food induced symptoms, versus those who did not (105.8% vs 114.3% RDA in normal controls; 100.4% vs 87.6% RDA in IBD). ConclusionsDiet in IBD patients contained significantly less calcium than in healthy controls. Gender and age, more than diagnosis, are central in determining inadequate calcium intake, more so in IBD. Self-reported lactose intolerance, leading to dietary restrictions, is the single major determinant of low calcium intake. Inadequate calcium intake is present in one third of IBD patients and represents a reversible risk factor for osteoporosis, suggesting the need for tailored nutritional advice in IBD.

SAT0359 Rheumatologists underestimate daily calcium intake in patients with osteoporosis

BackgroundCalcium supplements are widely used for the prevention and treatment of osteoporosis. However, in recent literature there is a controversy whether or not excessive calcium supplementation may be associated with...

P576 Calcium intake in patients with IBD

P576 Calcium intake in patients with IBD

Prevalence of low dietary calcium intake in patients with epilepsy: A study from South India

The effects of antiepileptic drugs (AED) on bone health are well documented. Inadequate dietary intake of calcium and vitamin D plays a vital role and further compromises the bone health. To assess the dietary pattern with special reference to calcium and related minerals in people with epilepsy (PWE) on AED. The dietary assessment in PWE was documented by dietary recall method. Patients were categorized according to age: group I: <14 years; group II: between 15-20 years; group III: between 21-45 years; group IV: >46 years. From the raw weights, total energy, dietary calcium, dietary phosphorous intake and phytate calcium ratio was calculated using a food composition table by Indian Council of Medical Research (ICMR) and analyzed statistically. A total of 362 patients with mean age of 29 + 15 years were studied. There were 190 women. The mean duration of AED treatment was 4 + 3 yrs, 64% on monotherapy 64% and 36% on polytherapy. The mean dietary intake of the total chohort was 2,007 + 211 Kcal/day, carbohydrate 335 + 33 gm/day; protein 31 + 7 gm/day; fat 18+2 gm/day; calcium 294 + 40 mg/day; phosphorus 557 + 102; phytates 179 + 30 mg/day; and phytate/calcium ratio 0.56+0.2. Milk and milk products were consumed by 42% of the total cohort. The daily dietary calcium (301 + 40 mg/day) intake of men was significantly higher than women (287 + 39 mg/day) (P < 0.001). This was more evident in group II (P < 0.01) and group III (P < 0.03). There was a positive correlation between dietary calcium and dietary phytates (P < 0.001), dietary proteins (P < 0.001), dietary fat (P < 0.001), and total energy (P < 0.001). The dietary consumption of calcium of all the patients was far below the recommended daily dietary allowance (RDA) by Indian Council of Medical Research (ICMR). Low dietary calcium could have a confounding effect on PWE on AED in all age groups. There is a need to formulate consensus guidelines to supplement dietary calcium to PWE.

Calcium intake in elderly patients with hip fractures

Background: Dietary calcium intake is assumed important in the prevention and treatment of osteoporosis. However, people in countries with a high calcium intake from commodities such as milk and milk products have a high incidence of hip fracture. The effect and influence of calcium intake in the prevention of osteoporotic fracture vary from different studies.Objective: To investigate premorbid daily calcium intake in patients with low energy hip fractures during four consecutive years.Design: In total 120 patients (mean age 78±8.5 (SD) years) were included between 2002 and 2005. The patients answered a structured food frequency questionnaire (FFQ) and interviews on patients’ daily calcium intake from food and supplements took place during a 6-month period before the fracture. Dual energy X-ray absorptiometry (DEXA) was performed in a subgroup of 15 patients.Results: The mean daily calcium intake from food and supplementation was 970±500 mg. However, 38% of patients had an intake below the recommended 800 mg/day. There was no significant relationship between calcium intake and age, gender, bone mineral density, serum calcium or albumin, type of fracture or body mass index. The mean free plasma calcium concentration was 2.3±0.1, i.e. within the reference limit. In 2005, 80% of the patients who underwent DEXA had manifest osteoporosis. There was a trend towards decreased calcium intake over the observation period, with a mean calcium intake below 800 mg/day in 2005.Conclusion: Hip fracture patients had a mean calcium intake above the recommended daily intake, as assessed by a FFQ. However, more than one-third of patients had an intake below the recommended 800 mg/day. The intake appeared to decrease over the investigated years. The relationship between calcium intake and fracture susceptibility is complex.

Generalized Osteopenia in Adolescent Idiopathic Scoliosis–Association With Abnormal Pubertal Growth, Bone Turnover, and Calcium Intake?

A cross-sectional study in girls with adolescent idiopathic scoliosis (AIS) and healthy counterparts of similar age. To study the association of bone mass with anthropometric parameters, bone turnover, and calcium intake in 621 girls with AIS, aged 11-6-years, and compare the results with 300 healthy girls of similar age. Generalized low bone mass has been documented in AIS, yet the cause of low bone mineral density in AIS is unknown. Corrected height and arm span, bone mineral density and bone mineral content of proximal femur, lumbar spine, and distal tibia, and bone turnover markers (bone alkaline phosphatase [bALP] and deoxypyridinoline) were evaluated. From age 13 years and older, the AIS group had longer anthropometric parameters (P < 0.05), generalized lower bone mass (P < 0.035), and 38.6% higher in bALP (P < 0.004) when compared with controls. A stronger inverse correlation between bALP and bone mass was noted in the AIS group. The bALP was positively correlated with bone area of tibia (P = 0.013) in the AIS group only. Deoxypyridonine of the AIS group was not different from the controls until age 15 years. The mean calcium intake of the AIS group was very low (only 361 mg/day), and calcium intake was significantly associated with bone mass in the AIS group. Low bone mass in AIS could be explained by faster anthropometric bone growth, higher bone turnover, and lower calcium intake in multiple regression analysis. Results from the current study showed that an abnormally faster growth rate and higher bone turnover in the patient with AIS might lead to increased bone dimensions. Calcium intake in patients with AIS was very low and likely to be insufficient for normal bone mineralization. Therefore, low bone mass in AIS may result from abnormal bone mineralization qualitatively and quantitatively and, thus, fails to catch up with increased bone growth during the peripubertal period.

Bone mineral density 6 years after a hip fracture: a prospective, longitudinal study

The purpose of this prospective study was to extend the results of previous studies to determine if an accelerated rate of loss of bone mineral density (BMD) continues for 6 years after a hip fracture. Eighty-five elderly patients who had sustained a hip fracture had determinations of BMD made at the time of fracture; 55 of these patients were available for reassessment of BMD 1 year later, and 21 were available for reassessment of BMD 6 to 7 years later. The change in BMD from injury to 1 year and from 1 to 6 years was determined and correlated with pre- and postinjury variables, such as ambulatory ability, dietary intake of calcium, serum vitamin D levels, and mental status. There was a marked decrease in BMD in the in the first year after fracture, with the mean change in BMD being −4.3% at the femoral neck and −1.8% at the lumbar spine. Between 1 and 6 years after fracture, however, there was a dramatic increase in the BMD at both the femoral neck and lumbar spine measurement sites. Relative to 1 year after fracture, the mean increases were 7.7% at the femoral neck and 4.5% at the lumbar spine. In many cases, the loss of bone mineral that occurred in the first year after fracture was completely recouped in the subsequent 5 years. Five of the 21 patients (24%) sustained a contralateral hip fracture in the 6 years after the index fracture. Lumbar spine BMD was lower at baseline ( p = 0.02), 1 year after fracture ( p = 0.007), and 6 years after fracture ( p = 0.003) in patients who sustained a second hip fracture than in those who did not. There was a general decrease in the functional activity level of patients in the 6 years after a hip fracture, but there were no statistically significant relationships between changes in BMD and the functional mobility of patients. The mean calcium intake in patients improved remarkably in the 6 years after fracture, but there was no correlation between daily calcium intake and changes in BMD. During the first year after a hip fracture, there is a rapid loss of bone mineral from the lumbar spine and contralateral femoral neck. Between 1 and 6 years after fracture, however, BMD is likely to increase, perhaps to levels greater than those at baseline. Although this investigation is small, the findings of this study point to the importance of further larger studies to further clarify the natural history of BMD after a hip fracture and the potential impact of pharmacological intervention on that natural history.

Calcium requirement—a reappraisal of the methods used in its determination and their application to patients with osteoporosis

The accepted practice of calculating the dietary calcium requirement from the relationship between calcium balance and intake was recently criticized on mathematical grounds. To try to determine the appropriate calcium intake in patients with osteoporosis, I examined the relationships between calcium intake, output, and balance in a group of such patients. Calcium-balance studies were performed on 25 patients with untreated osteoporosis: intake (x +/- SEM) was 30.34 +/- 3.02 mmol/d, output was 30.59 +/- 2.69 mmol/d, and calcium balance was -0.25 +/- 0.64 mmol/d. There was a significant correlation between intake and both output and balance (r = 0.98, P < 0.001 and r = 0.61, P < 0.01, respectively). Intake and output became equal at 31.7 (95% CI 27.9, 35.5) mmol/d. This value is the same as that obtained when the conventional method of calculation is used. Furthermore, if random values for calcium output are assigned to the observed values of intake it can be demonstrated that the same values will always be obtained by both methods The only difference is that the calculation based on balance and intake results in a narrower confidence interval.

Epidemiological aspects of Paget's disease: Family history and relationship to other medical conditions

Some epidemiological aspects of Paget's disease were examined using questionnaires completed by 864 patients with physician-diagnosed Paget's disease and 500 controls of similar ages. Specifically studied were issues of familial aggregation of the disorder, history of exposure to certain infectious diseases, other medical disorders, and calcium intake (as assessed by milk consumption) in childhood. A history of Paget's disease in a first-degree relative was noted in 12% of patients and 2% of controls. Among patients, those with a positive family history had an earlier mean age at diagnosis and a greater prevalence of bone deformity than patients with a negative family history. The risk of a first-degree relative of a pagetic patient developing Paget's disease was 7 times greater than the risk of an individual without such a relative, and the cumulative risk to age 90 for a first-degree relative of a patient was 9%, compared with a 2% risk in a person without affected relatives. The risk to the relative was greatest if the patient had an age at diagnosis of less than 55 years and had deforming bone disease. There was no difference between patients and controls for a variety of viral infections, including measles, and no difference in ownership of dogs and possible exposure to canine viruses. Diabetes was more common in controls than in patients, but arthritis, skeletal fractures, primary hyperparathyroidism, osteoporosis, and thyroid disease (in women) and renal stones (in men) were reported more commonly by patients. Milk consumption during childhood and adolescence was lower in patients than in controls. These data suggest that inherited factors play a role in predisposition to Paget's disease and fail to define a difference in the history of common viruses. The association of other medical disorders and decreased calcium intake in patients requires further study.

Monitoring calcium intake in osteoporosis by assay of nephrogenous cyclic AMP

We studied the relationship between urinary and nephrogenous cyclic adenosine monophosphate (CAMP) and intake of calcium in patients with clinical osteoporosis. Serum and urinary Ca, alkaline phosphatase, and CAMP were measured by standard techniques. Lumbar mineral density was assessed by dual photon absorptiometry. Mean (+/- SD) urinary and nephrogenous CAMP was 4.6 +/- 1.4 mumol/g creatinine (0.52 +/- 0.16 mumol/mmol creatinine) and 15 +/- 8.0 nmol/L GF in patients using an extra gram of Ca carbonate daily and 6.5 +/- 2.6 mumol/g creatinine and 32 +/- 18 nmol/L GF in patients consuming dietary Ca (p less than 0.05). Serum Ca was increased (p less than 0.05) in the supplemented group (9.8 +/- 0.4 vs 9.3 +/- 0.6 mg/dL [2.4 +/- 0.099 vs 2.32 +/- 0.14 mmol/L]) but urinary Ca and serum alkaline phosphatase were similar. Bone mineral density was the same in both (0.88 +/- 0.19 vs 0.87 +/- 0.08 g/cm2). We concluded that CAMP is greater in patients with no supplemental Ca in the diet. This test may be useful to assess patient compliance and biological availability of dietary or supplemental Ca.

Monitoring calcium intake in osteoporosis by assay of nephrogenous cyclic AMP

We studied the relationship between urinary and nephrogenous cyclic adenosine monophosphate (CAMP) and intake of calcium in patients with clinical osteoporosis. Serum and urinary Ca, alkaline phosphatase, and CAMP were measured by standard techniques. Lumbar mineral density was assessed by dual photon absorptiometry. Mean (+/- SD) urinary and nephrogenous CAMP was 4.6 +/- 1.4 mumol/g creatinine (0.52 +/- 0.16 mumol/mmol creatinine) and 15 +/- 8.0 nmol/L GF in patients using an extra gram of Ca carbonate daily and 6.5 +/- 2.6 mumol/g creatinine and 32 +/- 18 nmol/L GF in patients consuming dietary Ca (p less than 0.05). Serum Ca was increased (p less than 0.05) in the supplemented group (9.8 +/- 0.4 vs 9.3 +/- 0.6 mg/dL [2.4 +/- 0.099 vs 2.32 +/- 0.14 mmol/L]) but urinary Ca and serum alkaline phosphatase were similar. Bone mineral density was the same in both (0.88 +/- 0.19 vs 0.87 +/- 0.08 g/cm2). We concluded that CAMP is greater in patients with no supplemental Ca in the diet. This test may be useful to assess patient compliance and biological availability of dietary or supplemental Ca.

Sensitivity of the parathyroid hormone-1,25-dihydroxyvitamin D axis to variations in calcium intake in patients with primary hyperparathyroidism.

Previous studies have demonstrated a spectrum of parathyroid responsivity to alterations in the extracellular calcium concentration in patients with primary hyperparathyroidism, but studies employing physiologic amounts of calcium have not, to our knowledge, been reported. We studied 18 unselected patients with primary hyperparathyroidism at the lower (400 mg) and upper (1000 mg) limits of a normal dietary intake of calcium. The diet containing high-normal amounts of calcium induced only a slight increase in 24-hour calcium excretion (from 281 to 337 mg per day) yet was associated with significant reductions in fasting serum levels of immunoreactive parathyroid hormone (from 60 to 50 nleq per milliliter; P less than 0.001), nephrogenous cyclic AMP (from 3.52 to 2.63 nmol per deciliter of glomerular filtrate; P less than 0.001), and plasma levels of 1,25-dihydroxyvitamin D (from 74 to 58 pg per milliliter; P less than 0.001). A wide spectrum of responses was observed, with some patients appearing to have essentially autonomous parathyroid function and others having marked suppressibility (up to 50 per cent) of the parathyroid hormone-vitamin D axis. We conclude that parathyroid function may be suppressed by dietary calcium in some patients with primary hyperparathyroidism.

RADIOACTIVE CALCIUM KINETICS DURING HIGH CALCIUM INTAKE IN OSTEOPOROSIS.

tory. In patients J.B. and C.M., there was no significant antecedent medical history. All patients had normal serum calcium, phosphorus, alkaline phosphatase, phosphorus clearance, tubular reabsorption of phosphorus, peripheral hematologic examination, and bone marrow morphology. Urinary excretion of calcium was at high normal levels in patients H.S., P.F., and C.M., and below 100 mg per day in patients B.B. and J.B. Tests of intestinal absorption, including D-xylose excretion, triolein-I'3' absorption, and total fecal fat excretion, were normal in patients B.B. and J.B. Previously reported studies (2) of high calcium intake in patients B.B. and H.S. had shown sustained positive calcium balances during periods of observation as long as 3 months. Each of the five patients in the present series underwent a radiocalcium kinetic study during the control dietary periods and a repeat study at 4 to 7 weeks after the addition of approximately 4 g of calcium to the daily intake in the form of dicalcium phosphate (CaHPO4). After an initial 2-month interval of high calcium intake, patient B.B. was given normal calcium intake for approximately 4 months, and then was placed on prolonged

CALCIUM INTAKE IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM

CALCIUM INTAKE IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM