Doses Of Calcium Research Articles

Abstract #1186058: Two Pregnancies in A Known Case of Autosomal Dominant Hypocalcemia Type 1 (ADH1) and Hypoparathyroidism (HypoPT): A Case Report

Background: During pregnancy calcium homeostasis is altered1. Adjustment may need to be made for the doses of calcium and calcitriol to optimize fetal and maternal outcomes(1). Current recommendations advise maintaining a serum corrected calcium within the low normal reference range2,3.

The monocyte cell surface as a novel site of autoantigen generation in Rheumatoid Arthritis

Abstract Citrullination is recognized as a key pathogenic process in rheumatoid arthritis (RA), as evidenced by the formation of anti-citrullinated protein antibodies (APCAs) in the majority of patients; however, the mechanisms that result in citrullinated autoantigen generation are not fully understood. Although the citrullinating enzyme peptidylarginine deiminase IV (PAD4) is predominantly expressed by neutrophils and monocytes, the contribution of monocytes to the citrullinated autoantigen pool has been underexplored. In this study, we utilized multiple complementary methods including flow cytometry, immunofluorescence, and transmission electron microscopy, which revealed a predominantly extranuclear localization of PAD4 in monocytes with a fraction present on the cell surface. Surface PAD4 was enzymatically active and citrullinated both extracellular fibrinogen and endogenous surface proteins in a calcium dose–dependent manner. In addition, human monoclonal ACPAs cloned from patients with RA recognized fibrinogen citrullinated by monocyte-surface PAD4. Mass spectrometry analysis of citrullinated proteins from the cell surface fraction revealed CD11b to be a novel PAD4 substrate. Citrullinated CD11b was recognized by autoantibodies in 60% of ACPA+ RA patients compared to 6% of healthy controls (p=0.0021) and 0% of ACPA− RA patients (p≤0.001). Taken together, our study demonstrates that PAD4 is expressed on the surface of monocytes in an enzymatically active state that renders the monocyte surface a novel site of citrullinated autoantigen generation in RA. Supported by funds received from Bristol-Myers Squibb.

Estimation of nitrogen use efficiency by mango seedlings under nano and convention calcium fertilization using the enriched stable isotope (N-15)

This study aimed to investigate the effect of nano-Ca fertilizer on nitrogen uptake, nitrogen use efficiency and determine the best calcium form and dose for mango. A pot experiment was conducted using two year old mango seedlings (cv. Zebda). The pots were filled with sandy soil (8 kg per pot) and one seedling was transplanted into each pot. Four treatments including nano-Ca, convention Ca, soil application and foliar application have been formulated. Calcium was applied as CaO for both the convention and nanoforms. The enriched (15NH4)2SO4 was applied at a rate of (5g per pot). Plants were harvested at the end of the fall, spring, and summer growth cycles and dried at 70 oC. The dried plant is used for making fine powder and to determine total nitrogen, calcium, and %15N atom excess. Results of the study revealed that in all growth cycles, the 15N translocation was higher under foliar nano-Ca treatment than under convention Ca at a 100% rate. The highest uptake, translocation, and nitrogen use efficiency were observed at 50% (250 mg. L-1) foliar nano-Ca treatment in all cycles. In the Fall growth cycle, the values for nitrogen fertilizer use efficiency at 50% nano-Ca rate was 81.8%, while it recorded 64.9% for 25% rate and 51.2% for 100% rate. Calcium concentration, in shoot and roots, was also higher under nano-calcium (for fall cycle = 3.0 for the shoot and 2.8 for root) than the convention calcium (for fall cycle = 2.7% for the shoot and 2.2 for root) for all cycles. The summer growth cycle recorded the highest total biomass under all treatments compared with the fall or spring growth cycles. Allocation of biomass to the shoot was also reported higher under nano-Ca foliar application than that of soil application in all cycles. The best treatment is 50% (250 mg.L-1) foliar nano-Ca as it resulted in the highest N-15 uptake, translocation, and nitrogen use efficiency. Nano calcium proves to be more efficient as fertilizer than conventional calcium.

Tertiary hyperparathyroidism in patients with pseudohypoparathyroidism type 1a

Pseudohypoparathyroidism type 1a (PHP1a) is a genetic disorder caused by heterozygous loss-of-function mutations on the maternal allele of the GNAS gene. Patients with PHP1a predominantly exhibit parathyroid hormone (PTH) resistance and physical features of Albright's hereditary osteodystrophy. We report two unrelated cases with PHP1a who developed tertiary hyperparathyroidism (HPT). Molecular analyses of the GNAS gene identified a previously known heterozygous 4-bp deletion (c. 565_568delGACT) in exon 7 in case 1 and a novel heterozygous missense mutation (p.Lys233Glu) in exon 9 in case 2. Both patients developed tertiary HPT associated with hyperfunctioning parathyroid glands during long-term treatment of hypocalcemia. Case 1 had severe osteoporosis and underwent parathyroidectomy. Case 2 was asymptomatic with no evidence of bone diseases associated with tertiary HPT. PHP1a patients are at risk of developing tertiary HPT and should be treated with sufficient doses of calcium and vitamin D to achieve serum PTH levels within the mid - normal to double the upper limit of the normal range, regardless of serum calcium levels.

Mechanical property and microstructure development in alkali activated fly ash slag blends due to efflorescence

Efflorescence of alkali activated materials (AAMs) is caused by alkali leaching and precipitation of carbonated salts, which occurs concurrently with leaching and natural carbonation. Efflorescence is specifically driven by precursor and activator variability in AAMs vis-à-vis phase changes, microstructure, and mechanical properties are not well understood. To that end, this study analyses the effects of long-term (90 days) efflorescence on AAMs with eight varied calcium and activator contents and correlated with compressive and splitting tensile strengths. Microstructural features including N-A-S-H/C, N-A-S-H gel change are analysed using Fourier-transform infrared spectroscopy (FTIR), magic-angle spinning nuclear magnetic resonance (MAS-NMR) and thermogravimetric analysis (TGA). AAMs with 9 wt% Na2O and Ca/(Si + Al) ratio of 0.0 to 0.25 exhibit enhanced efflorescence and dealumination of Al[IV] in N-A-S-H/C,N-A-S-H gels, higher mobility of Na+ ions, and natural carbonation. AAMs with 5 wt% Na2O and Ca/(Si + Al) ratio of 0.0 to 0.25 exhibit lower efflorescence and higher stability, in contrast. Under efflorescence, the binder with 5 wt% Na2O and Ca/(Si + Al) ratio of 0.25 exhibited dealumination and carbonation, and the binders with 5 wt% Na2O and Ca/(Si + Al) of 0.0 to 0.10 showed less dealumination and higher concentration of Al[IV] in aluminosilicate gel, indicative of greater phase stability. This study highlights the criticality of calcium and activator doses in controlling the stability of phase composition and mechanical property, which is essential for the industrial application of AAMs.

Deciphering the short-term deactivation mechanism of the anammox performance under calcium stress

High-concentration calcium was contained in some wastewater, e.g., leachate. In this study, the response of the anammox performance to calcium (∼2000 mg/L) and the potential mechanisms were investigated in the serum bottles. 5 runs were conducted and 12 bottles were operated in each run, i.e., B1-3 (control), B4-6 (100 mg/L Ca2+), B7-9 (500 mg/L Ca2+) and B10-12 (2000 mg/L Ca2+). The dominant genus Ca. Kuenenia decreased from 19.3% to 3.8% with the increase of the calcium concentration in the bulk according to the taxonomy analysis. However, the specific anammox activity (SAA) only decreased from 5.8 ± 0.1 to 0.9 ± 0.02 mgN/(gVSS·h) in Run 1 when the calcium dosage was 2000 mg/L. Specifically, the SAA was only 16.1% that of the control in Run 1, however, the inhibition was reversible and the SAA regained to 73.2% that of the control in Run 5. Meanwhile, the porosity decreased from 82.4% to 69.9% at 2000 mg/L Ca2+. Calcium content in the granules with 2000 mg/L Ca2+was 7.8 times that of the control after Run 5. Therefore, the calcium precipitates blocking the granular pores was deduced to be responsible for the decline of the SAA.

Aspirin and calcium as a preventive therapy of early and late preeclampsia

Annotation. Preeclampsia and fetal growth restriction are major causes of perinatal death and handicap in survivors. Indications for aspirin during pregnancy are a matter of debate. The optimum dosage, from 75mg/day to 150mg/day, needs to be determined. The aim of the research was to estimate the impact of low-dose aspirin and calcium on prevention of preeclampsia. During the research there was conducted a prospective analysis of the effectiveness of aspirin and calcium in pregnant women with preeclampsia from VMCM hospital №1, in a period from 2016 till 2018. 88 women participated, they were divided into two investigated groups: I – 36 women with early preeclampsia (EP), and II group – 52 women with late preeclampsia (LP). In EP group 28 women were taking aspirin in dose of 75 mg, in LP – 36. Also, in EP group 12 women were taking low doses of calcium (˂1g/day), and 26 in LP group (tab. 1). Main diagnostically significant indexes were determined, which later underwent comparative analysis for all groups. Statistical processing of the obtained results was performed by odds ratio, its standard error and 95% confidence interval were calculated according to Altman, 1991. We didn’t define significant preventive differences in preeclampsia phenotype compared subgroups. Aspirin in dose of 75 mg/day and Calcium ˂1g/day is ineffective, also taking to account irregular intake – for 4-5-6 times per week. Preventive therapy requires definite period of beginning – 12 weeks of gestation and systemic everyday intake of drugs. In future, we need to explore a perfect dose of aspirin and calcium supplementation to prevent preeclampsia and hypertensive disorders in pregnancy.

Abstract 155: Vitamin D dependent rickets type II: Our experience and systematic review

Background: Hereditary vitamin D resistant rickets, is a rare autosomal recessive disease caused by variants affecting VDR gene. We aimed to describe our experience and systematically review the world literature.Objective: To evaluate the phenotypic and genotypic spectrum of VDDR2.Methods: The clinical and genetic spectrum of VDDR2 were analyzed.Results: Six patients of VDDR 2 were included. The mean age at the development of rachitic changes was 12±3.79 months. Baseline biochemistry revealed hypocalcemia (6.67±1.5 mg/dl), hypophosphatemia (3±1.5 mg/dl) with elevated serum alkaline phosphatase (3579±845 IU/ml) and PTH (372±183 pg/ml). Three novels variants in VDR gene were detected (p.N444D=1, p.I268T=1, p.H85R=1, p.H355TfsTer7=1). A systematic review (probands 112) revealed alopecia in majority of patients (81.2%). Complete response to oral therapy with supra-physiological dose of calcitriol and high dose of oral calcium was observed in 32.5% of cases. Recurrent variants specific to geographical locations were p.Lys45Glu (Africa); p.Cys41Tyr, p.Gln152Ter (Asia); p.Gln356Ter (Europe); p.Gln259Glu (Latino). Patients with variants in ligand binding domain (LBD) had better response to oral therapy compared to cases with DBD variants.Conclusion: Patients with VDDR2 presents in infancy with alopecia. Higher complete response rate to oral therapy can be anticipated in cases with variants affecting LBD.

Multiple brown tumor revealing primary hyperparathyroidism associated with Behçet’s disease: A case report

BackgroundPrimary hyperparathyroidism (PHP) is defined as hypercalcemia that may remain asymptomatic for years and cause lesion in skeletal system such as brown tumor (BT). Endocrine involvement in Behçet’s Disease (BD) regarding various systems can be seen. Case reportWe report an association between BD and PHP in a 45-year-old female. She had complained of inflammatory pain in the lower limb. Plain x-ray showed a lytic lesion on the upper tibia. Laboratory investigations revealed hypercalcemia (3.32 mmol/L), hypophosphatemia (0.48 mmol/L), a high parathyroid hormone (PTH) level (2278 pg/L) and a low vitamin D level (8.1 μg/L). An adenoma in the right lower parathyroid has been shown on scintigraphy, a vertebral fracture was present on lumbar spine X-ray and salt and pepper skull was shown on the lateral skull X-ray. Severe osteoporosis was present on the lumbar bone mineral density (t score −3.3), and multiple BT were revealed on bone scan. The patient was operated on and developed Hungry Bone Syndrome (HBS) following surgery. Therefore, she received high doses of calcium with favorable outcome. ConclusionThis case is a leading report for the coexistence of BD with PHP. This case provides further evidence that BD should be considered as an autoimmune process, which may be associated with endocrine involvement including PHP. On the other hand, musculoskeletal manifestations of PHP including BT still seen in daily practice require continued vigilance on the part of the physician.

Calcium Deficiency Diagnosis in Maize Leaves Using Imaging Methods Based on Texture Analysis

The artificial vision system (AVS) uses image analysis methods that can interpret images and identify nutritional deficiency symptoms in plant, even in the early stages of development. The objective of this study was to propose methods of image processing using analysis by texture to identify the deficiency of calcium (Ca) in maize (Zea mays L.) plants grown in nutrient solution. Plants were grown in nutrient solution in a greenhouse. Calcium doses were 0.0; 1.7; 3.3 and 5.0 mM of Ca, with four replications. Plant and leaf images were sampled at three main stages of maize development: V4 (plants with four leaves fully developed), V6 (plants with six leaves fully developed) and V8 (plants with eight leaves fully developed). Sampled material was split into (i) index leaf (IL) of the growing stage (V4 = leaf 4, V6 = leaf 6, and V8 = leaf 8), and (ii) new leaf (OL), both to image capture and chemical analysis. Such leaves were scanned, processed by the AVS and chemically analyzed. The texture methods used by the AVS to extract deficiency characteristics in the leaf images were: Volumetric Fractal Dimension (VFD), Gabor Wavelet Energy (GWE) and VFD with canonical analysis (VFDCA). The amount of Ca in the solution resulted in variation in the concentration of Ca in NL and IL, allowing the observation of typical symptoms of Ca deficiency. The AVS method was able to identify all Ca levels in leaves, being the GWE the best indicator using color images, scoring 80% of rights in images of the middle section of new leaves in V4.

Association of the Serum Folate and Total Calcium and Magnesium Levels Before Ovarian Stimulation With Outcomes of Fresh In Vitro Fertilization Cycles in Normogonadotropic Women.

BackgroundWomen of reproductive age are recommended to consume folic acid and other supplements before conception and during pregnancy. We aimed to investigate the association of the serum folate and total magnesium (Mg) and calcium (Ca) levels before ovarian stimulation with the outcomes of assisted reproductive technology (ART) in normogonadotropic women.MethodsWe used a subanalysis of data obtained from a multicentre, randomized prospective study (NCT03088137). A total of 110 normogonadotropic, non-advanced aged, non-obese women with tubal and/or male infertility factors were enrolled for the single fresh ovarian stimulation GnRH antagonist cycle. The main outcome measures were the total oocyte yield, mature oocytes, fertilization rate, biochemical, clinical pregnancy, and live birth. Multivariable generalized linear models adjusted for covariates were used with a Poisson distribution and the log link function for adjusted oocyte counts, and a binomial distribution and the log link function were used for adjusted clinical ART outcomes.ResultsThe medians (interquartile range (IQR)) were as follows: baseline serum folate, 20.55 ng/ml (10.8, 32.9); Mg, 19.4 mg/L (18.7, 20.7); Ca, 94 mg/L (91.2, 96.4); and Ca/Mg ratio, 4.78 (4.55, 5.02). Women with higher serum folate concentrations (Q4≥33.0 ng/ml) had significantly lower total numbers of oocytes retrieved (adjusted mean (95% CI) 9.2 (7.6-11.3) vs 12.9 (10.9-15.4, p-trend=0.006)) and lower odds ratios (ORs) (95% CI) of 0.12 (0.02, 0.79) for clinical pregnancy and 0.10 (0.01, 0.70) for live birth compared with women in the lowest quartile (<10.8 ng/ml), all p-trend<0.001. Women in the highest Ca/Mg ratio quartile (≥5.02) had ORs (95% CI) of 6.58 (1.31, 33.04) for biochemical pregnancy, 4.85 (1.02, 23.08) for clinical pregnancy and 4.07 (0.83, 19.9) for the live birth rate compared with women in the lowest quartile (<4.55), all p-trend<0.001.ConclusionsUsing multivariable models, we suggested that a baseline elevated serum folate level (≥33.0 ng/ml) and a lower Ca/Mg ratio were associated with worse ART outcomes in normogonadotropic women. Our findings might be useful for choosing safe dosages of folate, calcium, magnesium and complex supplementation for both fertile women and women undergoing infertility treatment. Further preconception large-scale studies with known micro- and macronutrient statuses of both parents and serum folate, Ca, Mg, and hormone levels, are needed.

Production and quality of Sweet Grape tomato in response to foliar calcium fertilization

In tomato, foliar application of calcium-based nutrient solutions is used to complement soil fertilization. However, knowledge regarding the factors that influence the effectiveness of foliar fertilizer applications remains incomplete. The objective of this study was to evaluate the efficiency foliar fertilization with calcium for improving production and quality of hydroponic Sweet Grape tomatoes. An experiment was conducted in a commercial hydroponic system in a split-plit-plot scheme, with two calcium doses: 1,5 and 3 mmol L-1 of Ca. The solutions were sprayed on the leaves at intervals of 7 and 14 days, using commercial foliar fertilizers containing 0.3 g L-1 of calcium chloride or calcium acetate. The results indicate that the foliar application of calcium fertilizers, regardless of the amount of calcium provided in the nutrient solution and the frequency of applications, positively affects fruit production and quality. No difference was found between the effects of application of the two calcium sources, as well as the frequency of application.

Calcium and vitamin D supplementation in pre-eclampsia: Analysis of effectiveness and safety

&#x0D; &#x0D; &#x0D; &#x0D; Purpose: To evaluate the impact of calcium and vitamin D (vit D) supplementation initiated at early pregnancy in high-risk women on reduction of preeclampsia risk.&#x0D; Methods: This prospective cohort study involved 492 pregnant women who had experienced pre-eclampsia or eclampsia in their current pregnancy (high risk) and were either on calcium (1000 mg/day) as well as vit D (400 IU/day) supplementation at early pregnancy or none. All the included pregnant women received standard doses of calcium (1500 mg/day) and vit D (600 IU/day) supplementation post 20 gestation weeks till childbirth. The primary outcome was pre-eclampsia characterized by hypertension as well as proteinuria.&#x0D; Results: From March 10, 2015 to February 24, 2018, each of the 246 pregnant women were assigned to the calcium/vit D group versus control group with no calcium/vit D. In the calcium/vit D group, 26.45 % developed preeclampsia compared to 32.11 % in control group with a Risk ratio [RR] of 0.82 (95 % confidence interval [CI], 0.62-1.08; p 0.167). No serious adverse events were related to calcium or vit D.&#x0D; Conclusion: Calcium/vit D supplementation during early pregnancy did not demonstrate any significant reduction in pre-eclampsia. Large, high-quality studies with higher patient numbers are needed for adequate testing of impact of calcium/vit D on pre-eclampsia.&#x0D; &#x0D; &#x0D; &#x0D;

Correlation between serum dosage of Calcium, Phosphorus, Alkaline Phosphatase and epifisary closing age in foals of low genetic grouping / Correlação entre as dosagens séricas de Cálcio, Fósforo, fosfatase Alcalina e idade de fechamento epifisário em potros do grupamento genético baixadeiro

The subsided region of Maranhão is characterized by its peculiar ecosystem, flooded fields in rainy seasons and an arid environment in the dry season. In this region, there is a remarkable record of the presence of a genetic group called by the local population, of horse "baixadeiro". The study aimed to determine, through radiographic evaluation, the age of closure of the radio growth plate of these animals, correlating radiographic findings with gender and serum dosages of calcium, phosphorus and alkaline phosphatase. In the study, 60 horses were used, with ages ranging from 18 to 30 months, divided into two equal groups according to gender. A portable X-ray device was used to obtain the images. The radiographic technique used was 53 kVp and 5 mAs, with a film focus distance of 70 cm in craniocaudal projection. Blood samples were performed by puncture of the external jugular vein and stored in Ependorff tubes, frozen until processing. Biochemical analyses were performed using specific kits to measure calcium, phosphorus, and alkaline phosphatase. According to the results obtained, the average age of closure of the growth plate was 26.7 months for the male and 24.5 in females. As for serum dosages, we observed that the average values found in calcium were higher in males, while the average values found for both phosphorus and alkaline phosphatase were higher in females.

Characterization of cape gooseberry (Physalis peruviana L.) fruits from plants irrigated with different regimens and calcium doses

Cape gooseberry fruits have positioned in the world market due to their excellent nutritional characteristics, because they are an ideal food that contributes to raising the defenses of the human body and helps it to face diseases such as COVID-19, they are also a natural source of antioxidants and anticancer agents. In order to avoid the physiopathy of cracking in cape gooseberry fruits, these were characterized at harvest time, coming from greenhouse plants irrigated with different applications of water levels and irrigation frequencies, as well as different calcium doses, in a design of randomized complete blocks with 12 treatments. The blocks were the irrigation frequencies (4, 9 and 14 days), while the treatments were the combination of four irrigation coefficients (0.7, 0.9, 1.1 and 1.3 of the evaporation of the tank class A) and three doses of calcium (0, 50 and 100 kg ha-1). The plants were sown in 20 L pots with peat moss substrate. Fruits were harvested at the color stage 5 and 6 of the calyx, from 19 weeks after transplanting. The different water levels and irrigation frequencies did not significantly affect the firmness of the cape gooseberry fruits, but there was a strong tendency that cracked gooseberry fruits are less firm than healthy fruits. As the irrigation coefficient increased, the total soluble solids (TSS) increased while the total titratable acids (TTA) decreased. Irrigation frequency of 14 days generated fruits with higher TSS and pH values. The calcium doses did not affect the calcium concentration in the fruits or the TSS, TTA and pH values. Therefore, it can be concluded that incremented irrigation coefficients (up to 1.3) increase the quality of cape gooseberry fruits.

Coagulation performance evaluation of alginate as a natural coagulant for the treatment of turbid water

Abstract Alginates are quite abundant in nature as they occur both as a structural component in marine brown algae (Phaeophyceae) comprising up to 40% of dry matter and as capsular polysaccharides in soil bacteria. Alginic acid is the only polysaccharide, which naturally contains carboxyl groups in each constituent residue, and possesses various abilities for functional materials. Experiments were carried out for water of turbidity 300 NTU. Alginate as such doesn't act as a coagulant, instead it should be converted to calcium alginate by adding calcium ions. Calcium chloride was used for imparting calcium ions necessary for the reaction. The dosage of calcium was fixed as 50 mg/L, 75 mg/L, 100 mg/L, 150 mg/L, 200 mg/L, and alginate doses between 2 to 10 mg/L. Calcium dosage below 50 mg/L was not sufficient for the formation of the egg-box structure which is responsible for the coagulation and flocculation process. For the mechanism of charge neutralization to take place effectively, calcium should be added first followed by alginate. pH and conductivity of the sample remain constant before and after the treatment. The dosage of alginate required for the treatment is less, so the cost of treatment also will be much less, thus alginate can replace the usage of chemical coagulants like alum.

Gerbera leaf nutritional status as a cut flower cultivated with different doses of nitrogen and calcium

Abstract Vegetative tissue analyses might help to diagnose nutritional status of a crop. Foliage diagnosis is an effective method to set up balanced fertilization procedures. The current work aims to evaluate nutrient contents of two gerbera leaf sampling periods as a cut flower cultivated in pots with different doses of nitrogen (N) and calcium (Ca) under greenhouse conditions. The experiment was carried out in a protected environment, shelter type, in a container containing substrate in a 3x3+1 factorial scheme. Three doses of N (0.07, 0.15 or 0.2 g L-1) or three doses of Ca (0.02, 0.03 or 0.04 g L-1) were applied every 15 days. Control plants did receive neither N nor Ca. The substrate was analyzed before and after cultivation, and at the end of production years, as well as completely expanded leaves were collected for nutrient analyses. There was not significant interaction between N and Ca doses. Regarding the sampling period or doses of N and Ca, the determined macronutrient concentrations were in the following order of N&gt;K&gt;Ca&gt;P&gt;S&gt;Mg. The micronutrient concentrations were in the following order of Fe&gt;Mn&gt;B&gt;Zn&gt;Cu. Except for K, all the other nutrient concentrations were in the recommended range for gerberas production.

Effect of Calcium and Vitamin D Supplementation With and Without Collagen Peptides on Volumetric and Areal Bone Mineral Density, Bone Geometry and Bone Turnover in Postmenopausal Women With Osteopenia

Collagen peptides (CPs) have been shown to potentially have a role as a treatment option in osteopenia. In the present randomized prospective study, we examined the effect of calcium, vitamin D with and without CPs supplementation on changes in volumetric bone mineral density (vBMD) and bone geometry assessed by peripheral quantitative computed tomography at the tibia, areal bone mineral density (aBMD) assessed by dual-energy X-ray absorptiometry at the lumbar spine and the hip and bone turnover markers over 12-mo. Fifty-one postmenopausal women with osteopenia were allocated to Group A who received orally 5 g CPs, 500 mg calcium and 400 IU vitamin D3 and Group B who received the same dose of calcium and vitamin D3 per day. The primary endpoint was the change of trabecular bone mineral content (BMC) and vBMD after 12-mo supplementation in Groups A and B. At the trabecular site (4% of the tibia length), Group A had a significant increase of total BMC by 1.96 ± 2.41% and cross-sectional area by 2.58 ± 3.91%, trabecular BMC by 5.24 ± 6.48%, cross-sectional area by 2.58 ± 3.91% and vBMD by 2.54 ± 3.43% and a higher % change of these parameters at 12 mo in comparison to Group B (p < 0.01, p = 0.04, p < 0.01, p = 0.04, p = 0.02, respectively). At the cortical site (38% of the tibia length), total and cortical vBMD increased by 1.01 ± 2.57% and 0.67 ± 1.71%. Furthermore, the mean aBMD at the spine was higher (p = 0.01), while bone markers decreased in Group A compared to Group B. The present study shows improvement of trabecular and cortical parameters as assessed by peripheral quantitative computed tomography at the tibia, prevention of aBMD decline and decrease of bone turnover after 12-mo supplementation with calcium, vitamin D with CPs.

Unusual hypocalcaemia in breast cancer relapse with multiple bone metastasis

Severe hypocalcaemia in breast cancer with bone metastasis is a rare finding usually associated with an advanced stage of the disease. We report a case of a 45-year-old woman with a history of local ductal carcinoma in situ (DCIS) of the breast, who presented with muscle tremors and general weakness. Hypocalcaemia was evident, with a positive Chvostek sign and a serum calcium level of 5.9 mg/dL (1.47 mmol/L), phosphorus 5.9 mg/dL (normal range: 2.3–4.7 mg/dL) with normal levels of albumin, magnesium and parathyroid hormone. High oral doses of alpha calcitriol and calcium with i.v. infusion of high calcium doses were instituted, altogether sufficient to maintain only mild hypocalcaemia. A whole-body CT revealed bone lesions along the axial skeleton. A biopsy from a bone lesion revealed a metastasis of breast carcinoma. With this pathological finding, leuprolide (GNRH analogue) and chlorambucil (alkylating agent) were initiated, followed by prompt tapering of infused calcium down to full discontinuation. Serum calcium was kept stable close to the low normal range by high doses of oral alpha calcitriol and calcium. This course raises suspicion that breast metastases to the skeleton caused tumour-induced hypocalcaemia by a unique mechanism. We assume that hypocalcaemia in this case was promoted by a combination of hypoparathyroidism and bone metastasis.Learning pointsSevere hypocalcaemia can a presenting symptom for breast cancer relapse.

Calcium supplementation during pregnancy and maternal and offspring bone health: a systematic review and meta-analysis.

Insufficient calcium intake during pregnancy may lead to maternal bone resorption and lower bone density of offspring. We evaluated the impact of supplementary calcium with or without vitamin D during pregnancy on maternal and offspring bone mineral density (BMD) and teeth firmness of the offspring. Randomized controlled trials (RCTs) were searched systematically in 11 databases. Two researchers independently screened the titles and abstracts of 3555 records and the full texts of 31 records to examine eligibility. The search yielded seven RCTs (11 reports, n = 1566). No advantage of calcium supplementation was found on maternal BMD after delivery or during breastfeeding, or on offspring BMD, even when dietary calcium intake was low. The results were neither modified by the dose of calcium nor concomitant vitamin D administration. A suspicion of some long‐term harm of the intervention on maternal BMD and growth of female offspring was raised based on the data. One study suggested some benefit of high‐dose calcium supplementation on offspring teeth firmness at 12 years old. A low number of the studies and abundant missing data reduced the quality of the findings. The impact of calcium supplementation on maternal and offspring bone health was deemed unknown because of inconclusive research results.