OSTEOPENIA = Person with slightly low bone mass ( T-scores of 1.

0 or higher)

Calcium Intake

Calcium Deficiency
Symptoms of hypocalcemia including numbness and tingling in the fingers, muscle cramps, convulsion, lethargy,
poor appetite, and abnormal heart rythms.
Over long term, inadequate calcium intake cause OSTEOPENIA, which if left untreated can lead to
OSTEOPOROSIS.
In individual with either oteopenia or osteoporosis, the risk of bone fractures are increases, especially in older
individuals.
Groups at Risk of Calcium Inadequancy
o Postmenopausal women
- Menopause lead to bone loss, because decrease in estrogen production both increase bone resorption and
decrease calcium absorption.
- Annual decrease of bone mass 3% - 5% per year (1st year of menopause)
then 1% per year after age 65.
- Estrogen therapy restore postmenopausal bone remodeling to the same level as at premenopause, leading to
lower rates of bone loss, but there are potential risk in HRT, so most professionals recommend that
postmenopausal women using medication, such as bisphosphonates instead of HRT.
o

Amenorrheic women and the Female athlete triad

- Amenorrhea results from reduced circulating estrogen levels in turn harve negative effect on calcium balance.
- Exercise induced amenorrhea generally decreased bone mass.
- In Female athletes and active military women, low bone-mineral density, menstrual irregularities, certain
dietary patterns and history of prior stress fractures are asscociated with increased risk of future stress fractures.
- Female athlete triad refers to the combination of disordered eating, amenorrhea, and osteoporosis.

Individuals with lactose intolerance or cow milk allergy

- Because lactose intolerant individuals usually avoid dairy products

Vegetarians
- Vegetarians might absorb less calcium than omnivores.
- Vegans who eat no animal prodicts and ovo-vegetarians (who eat eggs but not dairy products) might not get
sufficient calcium because of their avoidance of dairy products.

Risk from Excessive Calcium

o Excessively high levels of calcium in the blood, known as hypercalcemia.
o Hypercalcemia can cause :
- renal insufficiency,
- vascular and soft tissue calcification,
- hypercalciuria, and kidney stone.
- constipation and might also interfere with the absorption of iron and zinc
o Hypercalcemia, mostly occur because hgh intake of calcium from supplement, or medical condition, such as
primary hyperparathyroidism or malignancy.

Intercactions with Medicine

o Calcium supplements have the potential to interact with several types of medications.
o Calcium can decrease absoption of the ollowing drugs when taken together:
- Biphosphonates (to treat osteoporosis)
- Fluoroquinolone and Tetracycline classes of antibiotics
- Phenytoin (anticonvulsant) and Tiludronate ( to treat Pagets disease)

Calcium Dietary allowances and Sources

Calcium Metabolism

Vitamin D Intake
The recommended amounts of vitamin D for adults are as follows:
25 50 years old (and premenopausal women): 400 i.u. of vitamin D per day.
>50 (and menopausal women): 400-800 i.u. of vitamin D per day.
>65 / 70 : at least 600 i.u. is usually recommended.

Correcting a vitamin D deficiency has several components:

Eating a diet rich in vitamin D. This is more challenging than calcium as vitamin D is found naturally in only a few
foods, like fatty fish (e.g., salmon), liver and cod liver oil, and egg yolks. However, vitamin D fortified foods, such as
many types of milk, cereal, bread, and orange juice, are widely available.

Exposing the body, primarily the face, hands and arms, to sunshine.
With direct exposure to sunlight, vitamin D is manufactured in the skin.
Ten to fifteen minutes of sunshine two to three times per week will be enough.
However, as people age they are less able to make vitamin D through the skin. Additionally, sunscreen reduces the
bodys ability to absorb sunlight needed to manufacture vitamin D.

If necessary, taking a vitamin D supplement.

Calcium supplements and multivitamins also can contain vitamin D, so patients are advised to read all labels carefully,
and if necessary, to discuss intake with their physician or pharmacist.
The Institute of Medicine recommends no more than 2,000 i.u. per day.

Biphosphonates
The bisphosphonates are a class of chemicals that share a basic phosphate-carbonphosphate core and bind strongly to calcium. Over the past two decades, these drugs have
assumed a significant role in the treatment of osteoporosis because of their strong avidity for the
skeleton and their relative ease of use. Although the precise mechanism of action is not
completely understood, these agents strongly inhibit osteoclast-mediated bone resorption. As
the bone remodeling cycle is slowed, formation and resorption are decreased, although
resorption is inhibited more than formation. This process leads to a modest increase in bone
mineral density (BMD). The osteogenic action of bisphosphonates and their relative lack of
activity outside the skeleton have led to the increased use of these agents in treating
osteoporosis. This article reviews the
safety and efficacy of
bisphosphonates in the prevention
of bone loss and the treatment of
established osteoporosis.

Referensi:

http://ods.od.nih.gov/pdf/factsheets/Calcium-HealthProfessional.pdf#h4

http://www.spine-health.com/conditions/osteoporosis/calcium-and-vitamin-d-requirements
http://www.aafp.org/afp/2000/0501/p2731.html