Developments in Rheumatology

Calcium & Vitamin D in Bone Health summit

Calcium & Vitamin D in Bone Health summit
Leading authorities and researchers met in Melbourne in July to develop a position paper on the importance of Calcium & Vitamin D in maintaining good bone health. Individuals with low intakes of dairy or calcium in their diet are likely to have sub-optimal calcium intake. Most people over 50yrs are unlikely to meet current recommendations of 1300mgs calcium/day. Those at highest risk of low calcium intake are also those at highest risk of osteoporotic fracture including the elderly, socially disadvantaged, those with gastrointestinal disease, corticosteroid use, sex hormone deficiency and during rapid skeletal growth. Calcium supplementation effects are modest. Thus it would seem prudent to encourage a higher calcium intake in the general population through dietary sources.
Nutritional sources, eg. dairy, tin salmon with bones, and other sources of calcium may have advantage of protein and other micronutrients that may be important for general health particularly in the frail elderly. Calcium carbonate supplement may lead to constipation and bloating. Calcium citrical is more easily absorbed. This year's Healthy Bones Week theme was "Kids Love Dairy". So natural nourishing healthy eating for young and old should include high calcium foods, eg. dairy, salmon, low fact milk and yoghurts. Vitamin D is the essential precursor of 1,25-dihydroxyvitamin D which plays a central role in calcium and phosphate homeostatis. There are two forms of Vitamin D: Vitamin D3 which is mainly derived from synthesis in the skin following exposure to the sun's ultraviolet rays; and Vitamin D2 which is derived from plants and obtained from dietary intake. Dietary intake makes up only a small percentage of a person's Vitamin D. Thus it is recommended that a person get 15-30 minutes of exposure of face, hands and arms to sunlight morning or afternoon. Even in Australia Vitamin D deficiency is now common but under recognised and is increasing in certain ethnic groups, eg. Muslim women. Evidence is accumulating that Vitamin D and calcium supplementation reduces falls and fragility fractures especially in house bound frail aged. Vitamin D deficiency and hypocalcaemia should be corrected before treatment with bisphosphonates.