Understanding Osteoporosis Medications (cont.)
Calcium and Vitamin D Supplements
Calcium is widely available without a prescription. Some examples of calcium-containing tablets or capsules include Os-Cal, Citracal, and Cal-Citrate. Some antacids (for example, TUMS) contain calcium carbonate and are often used as a calcium supplement. New forms of calcium include Viactiv, a chewable candy-like supplement containing calcium carbonate, vitamin D, and vitamin K.
- How calcium and vitamin D work: Adequate calcium and vitamin D are essential for reducing bone loss. Also, in order for other prevention and treatment medications to be effective, adequate calcium and vitamin D levels are essential.
- Who should not use these medications: Persons with any of the following conditions should not use calcium or vitamin D supplements:
- Allergy to any content of the supplements
- Vitamin D toxicity
- Elevated calcium concentration in blood
- Use: These supplements should be used as follows:
- Calcium: Daily oral intake of 1000-1200 mg of calcium is recommended to decrease osteoporosis risk. This can be accomplished by a diet rich in calcium and calcium supplements. Adults typically do not meet daily calcium dietary requirements and may require calcium supplements in order to do so. Your doctor may recommend up to 1500 mg per day if you already have osteoporosis or are at high risk for it. For maximum absorption of calcium from the stomach, the daily requirement should be divided into 2-3 doses per day that do not exceed 600 mg per dose.
- Vitamin D: Daily intake of 600-800 units of vitamin D is needed to increase bone mass for treatment. Diet, sun exposure, or vitamin D supplements can provide the necessary requirement. Prevention of osteoporosis can be achieved with lower doses of 200-400 units per day. Many multivitamins or calcium supplements also contain vitamin D.
- Drug or food interactions: Ask your doctor or pharmacist if certain foods affect your particular calcium supplement. Some calcium supplements are better absorbed from the stomach after a meal, while others are not. Some food (for example, spinach, rhubarb, whole-grain bran cereals) may bind with calcium and decrease calcium absorption. Calcium may bind to some oral medications, making them unable to be absorbed by the stomach. This is usually easy to avoid by not taking calcium within 1-2 hours before or 2-4 hours after taking medications such as sucralfate (Carafate), tetracycline (Sumycin), ciprofloxacin (Cipro), and moxifloxacin (Avelox). Thiazide diuretics, such as hydrochlorothiazide (HydroDIURIL), may increase calcium levels and cause toxicity.
- Side effects: Calcium may cause constipation, nausea, or vomiting. Individuals who have had kidney stones should have the calcium level in their urine checked to see if the increased calcium ingestion will contribute to kidney stones. Vitamin D doses recommended by your doctor should not be exceeded. Taking high-dose vitamin D for a long time can lead to toxicity and cause symptoms such as weakness, headache, drowsiness, muscle pain, bone pain, and elevated liver enzyme levels.
Francisco Talavera, PharmD, PhD
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