Calcium supplement

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Calcium supplement
500 mg calcium supplements with vitamin D.jpg
500 milligram calcium supplements made from calcium carbonate
Clinical data
Trade names Alka-Mints, Calcet, Tums, others
AHFS/Drugs.com Monograph
License data
Routes of
administration 		By mouth, intravenous
ATC code
Identifiers
CAS Number
ChemSpider
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UNII

Calcium supplements are salts of calcium used in a number of conditions. [1] Supplementation is generally only required when there is not enough calcium in the diet. [2] [3] By mouth they are used to treat and prevent low blood calcium, osteoporosis, and rickets. [1] By injection into a vein they are used for low blood calcium that is resulting in muscle spasms and for high blood potassium or magnesium toxicity. [2] [4]

Contents

Common side effects include constipation and nausea. [1] When taken by mouth high blood calcium is uncommon. [1] Calcium supplements, unlike calcium from dietary sources, appear to increase the risk of kidney stones. [1] Adults generally require about a gram of calcium a day. [1] Calcium is particularly important for bones, muscles, and nerves. [1]

The medical use of calcium supplements began in the 19th century. [5] It is on the World Health Organization's List of Essential Medicines. [6] It is available as a generic medication. [3] In 2021, it was the 235th most commonly prescribed medication in the United States, with more than 1 million prescriptions. [7] [8] Versions are also sold together with vitamin D. [3] In 2020, the combination, calcium/vitamin D was the 215th most commonly prescribed medication in the United States, with more than 2 million prescriptions. [9] [10]

Health effects

Bone health

In healthy people, calcium supplementation is not necessary for maintaining bone mineral density, and carries risks that outweigh any benefits. [11] Calcium intake is not significantly associated with hip fracture risk in either men or women. [12] The US Preventive Service Task Force recommends against a daily supplement of calcium or vitamin D. [13] [14] Although a slight increase in bone mineral density occurred in healthy children from calcium supplementation, using additional dietary calcium is not justified, according to a 2006 review. [15]

Cardiovascular impact

There is good evidence that 1,000 mg to 1,500 mg of daily calcium supplementation can effect a modest reduction in blood pressure in adults who do not have a blood pressure condition, suggesting that achieving adequate calcium levels may have role in preventing high blood pressure. [16]

Cancer

The US National Cancer Institute does not recommend the use of calcium supplements for lowering the risk of cancer. [17] There is weak evidence calcium supplementation might have a preventative effect against developing colorectal adenomatous polyps, but the evidence is not sufficient to recommend such supplementation. [18]

Side effects

Excessive consumption of calcium carbonate antacids/dietary supplements (such as Tums) over a period of weeks or months can cause milk-alkali syndrome, with symptoms ranging from hypercalcemia to potentially fatal kidney failure. What constitutes "excessive" consumption is not well known and, it is presumed, varies a great deal from person to person. Persons consuming more than 10 grams/day of calcium carbonate (4 grams of elemental calcium) are at risk of developing milk-alkali syndrome, [19] but the condition has been reported in at least one person consuming only 2.5 grams/day of calcium carbonate (1 gram of elemental calcium), an amount usually considered moderate and safe. [20]

A 2023 systematic review found that calcium supplementation is not associated with myocardial infarction, stroke, heart failure admission, and cardiovascular/all-cause mortality. [21]

Calcium supplements may contribute to the development of kidney stones. [1]

Acute calcium poisoning is rare, and difficult to achieve without administering calcium intravenously. For example, the oral median lethal dose (LD50) for rats for calcium carbonate and calcium chloride are 6.45 [22] and 1.4 g/kg, [23] respectively.

Interactions

Calcium supplements by mouth diminish the absorption of thyroxine when taken within four to six hours of each other. [24] Thus, people taking both calcium and thyroxine run the risk of inadequate thyroid hormone replacement and thence hypothyroidism if they take them simultaneously or near-simultaneously, because significant amount of T4 is adsorbed to calcium carbonate depending on gastric pH levels, preventing absorption of T4 at the intestinal level. [25] [24]

Absorption

Calcium absorption in the gut is influenced by factors such as vitamin D levels, gut acidity, age, estrogen levels, and dietary fiber intake. It decreases with age, low vitamin D levels, hypochlorhydria, low estrogen levels, and a high-fiber diet. Calcium is absorbed both actively and passively in the small intestines, with low vitamin D levels impairing active absorption. Calcium absorption varies with serum 25-hydroxyvitamin D [25(OH)D] levels and is also influenced by dietary factors and genetics. Individuals vary in their ability to absorb calcium, with absorption inversely related to total dietary calcium intake, dietary fiber, alcohol intake, and physical activity, and positively associated with body mass index, dietary fat intake, and serum 1,25(OH2)D and parathyroid hormone levels. [26]

Excretion

Calcium is excreted from the human body primarily through urine and feces. Several factors can influence the rate of urinary calcium loss, including the intake of caffeine, protein, and sodium and low estrogen levels. Caffeine intake has been associated with bone loss, particularly in women aged 66-77 years. Women consuming more than 300 mg of caffeine per day usually experience greater bone loss in the spine than those consuming less than or equal to 300 mg per day. Genetic variants of the Vitamin D Receptor (VDR) also play a role. [26]

Types

The intravenous formulations of calcium include calcium chloride and calcium gluconate. [1] The forms that are taken by mouth include calcium acetate, calcium carbonate, calcium citrate, calcium gluconate, calcium lactate, and calcium phosphate. [1]


Vitamin D is added to some calcium supplements. Proper vitamin D status is important because vitamin D is converted to a hormone in the body, which then induces the synthesis of intestinal proteins responsible for calcium absorption. [49]

Labeling

For US dietary supplement and food labeling purposes, the amount in a serving is expressed in milligrams and as a percent of Daily Value (%DV). The labels indicate the weight of the elemental calcium in the supplement, not the total weight of the compound. For instance, in the case of calcium citrate, the label specifies the weight of the elemental calcium, not the entire calcium citrate compound. For calcium labeling purposes 100% of the Daily Value was 1000 mg, but in May 2016 it was revised to 1000–1300 mg. [50] A table of the pre-change adult Daily Values and references for the revision are provided at Reference Daily Intake. Food and supplement companies had until July 2018 to comply with the labeling change. [50]

Related Research Articles

<span class="mw-page-title-main">Calcium</span> Chemical element with atomic number 20 (Ca)

Calcium is a chemical element; it has symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar to its heavier homologues strontium and barium. It is the fifth most abundant element in Earth's crust, and the third most abundant metal, after iron and aluminium. The most common calcium compound on Earth is calcium carbonate, found in limestone and the fossilised remnants of early sea life; gypsum, anhydrite, fluorite, and apatite are also sources of calcium. The name derives from Latin calx "lime", which was obtained from heating limestone.

<span class="mw-page-title-main">Riboflavin</span> Vitamin, dietary supplement, and yellow food dye

Riboflavin, also known as vitamin B2, is a vitamin found in food and sold as a dietary supplement. It is essential to the formation of two major coenzymes, flavin mononucleotide and flavin adenine dinucleotide. These coenzymes are involved in energy metabolism, cellular respiration, and antibody production, as well as normal growth and development. The coenzymes are also required for the metabolism of niacin, vitamin B6, and folate. Riboflavin is prescribed to treat corneal thinning, and taken orally, may reduce the incidence of migraine headaches in adults.

<span class="mw-page-title-main">Thiamine</span> Chemical compound

Thiamine, also known as thiamin and vitamin B1, is a vitamin, an essential micronutrient for humans and animals. It is found in food and commercially synthesized to be a dietary supplement or medication. Phosphorylated forms of thiamine are required for some metabolic reactions, including the breakdown of glucose and amino acids.

<span class="mw-page-title-main">Kidney stone disease</span> Formation of mineral stones in the urinary tract

Kidney stone disease, also known as renal calculus disease, nephrolithiasis or urolithiasis, is a crystallopathy where a solid piece of material develops in the urinary tract. Renal calculi typically form in the kidney and leave the body in the urine stream. A small calculus may pass without causing symptoms. If a stone grows to more than 5 millimeters, it can cause blockage of the ureter, resulting in sharp and severe pain in the lower back that often radiates downward to the groin. A calculus may also result in blood in the urine, vomiting, or painful urination. About half of people who have had a renal calculus are likely to have another within ten years.

A nutrient is a substance used by an organism to survive, grow and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi and protists. Nutrients can be incorporated into cells for metabolic purposes or excreted by cells to create non-cellular structures such as hair, scales, feathers, or exoskeletons. Some nutrients can be metabolically converted into smaller molecules in the process of releasing energy such as for carbohydrates, lipids, proteins and fermentation products leading to end-products of water and carbon dioxide. All organisms require water. Essential nutrients for animals are the energy sources, some of the amino acids that are combined to create proteins, a subset of fatty acids, vitamins and certain minerals. Plants require more diverse minerals absorbed through roots, plus carbon dioxide and oxygen absorbed through leaves. Fungi live on dead or living organic matter and meet nutrient needs from their host.

Fluoride is an inorganic, monatomic anion of fluorine, with the chemical formula F−
, whose salts are typically white or colorless. Fluoride salts typically have distinctive bitter tastes, and are odorless. Its salts and minerals are important chemical reagents and industrial chemicals, mainly used in the production of hydrogen fluoride for fluorocarbons. Fluoride is classified as a weak base since it only partially associates in solution, but concentrated fluoride is corrosive and can attack the skin.

<span class="mw-page-title-main">Mineral (nutrient)</span> Chemical element required as an essential nutrient by organisms to perform life functions

In the context of nutrition, a mineral is a chemical element. Some "minerals" are essential for life, but most are not. Minerals are one of the four groups of essential nutrients; the others are vitamins, essential fatty acids, and essential amino acids. The five major minerals in the human body are calcium, phosphorus, potassium, sodium, and magnesium. The remaining minerals are called "trace elements". The generally accepted trace elements are iron, chlorine, cobalt, copper, zinc, manganese, molybdenum, iodine, selenium, and bromine; there is some evidence that there may be more.

<span class="mw-page-title-main">Calcium in biology</span> Use of calcium by organisms

Calcium ions (Ca2+) contribute to the physiology and biochemistry of organisms' cells. They play an important role in signal transduction pathways, where they act as a second messenger, in neurotransmitter release from neurons, in contraction of all muscle cell types, and in fertilization. Many enzymes require calcium ions as a cofactor, including several of the coagulation factors. Extracellular calcium is also important for maintaining the potential difference across excitable cell membranes, as well as proper bone formation.

The Dietary Reference Intake (DRI) is a system of nutrition recommendations from the National Academy of Medicine (NAM) of the National Academies. It was introduced in 1997 in order to broaden the existing guidelines known as Recommended Dietary Allowances. The DRI values differ from those used in nutrition labeling on food and dietary supplement products in the U.S. and Canada, which uses Reference Daily Intakes (RDIs) and Daily Values (%DV) which were based on outdated RDAs from 1968 but were updated as of 2016.

<span class="mw-page-title-main">Calcium citrate</span> Chemical compound

Calcium citrate is the calcium salt of citric acid. It is commonly used as a food additive (E333), usually as a preservative, but sometimes for flavor. In this sense, it is similar to sodium citrate. Calcium citrate is also found in some dietary calcium supplements. Calcium makes up 24.1% of calcium citrate (anhydrous) and 21.1% of calcium citrate (tetrahydrate) by mass. The tetrahydrate occurs in nature as the mineral Earlandite.

ATC code A12Mineral supplements is a therapeutic subgroup of the Anatomical Therapeutic Chemical Classification System, a system of alphanumeric codes developed by the World Health Organization (WHO) for the classification of drugs and other medical products. Subgroup A12 is part of the anatomical group A Alimentary tract and metabolism.

<span class="mw-page-title-main">Vegetarian nutrition</span> Nutritional and human health aspects of vegetarian diets

Vegetarian nutrition is the set of health-related challenges and advantages of vegetarian diets.

<span class="mw-page-title-main">Calcium lactate</span> Chemical compound

Calcium lactate is a white crystalline salt with formula C
6H
10CaO
6, consisting of two lactate anions H
3C(CHOH)CO−
2 for each calcium cation Ca2+
. It forms several hydrates, the most common being the pentahydrate C
6H
10CaO
6·5H
2O.

<span class="mw-page-title-main">Tricalcium phosphate</span> Chemical compound

Tricalcium phosphate (sometimes abbreviated TCP), more commonly known as Calcium phosphate, is a calcium salt of phosphoric acid with the chemical formula Ca3(PO4)2. It is also known as tribasic calcium phosphate and bone phosphate of lime (BPL). It is a white solid of low solubility. Most commercial samples of "tricalcium phosphate" are in fact hydroxyapatite.

<span class="mw-page-title-main">Calcium gluconate</span> Chemical compound

Calcium gluconate is the calcium salt of gluconic acid and is used as a mineral supplement and medication. As a medication it is used by injection into a vein to treat low blood calcium, high blood potassium, and magnesium toxicity. Supplementation is generally only required when there is not enough calcium in the diet. Supplementation may be done to treat or prevent osteoporosis or rickets. It can also be taken by mouth but is not recommended for injection into a muscle.

<span class="mw-page-title-main">Magnesium citrate</span> Chemical compound

Magnesium citrates are metal-organic compounds formed from citrate and magnesium ions. They are salts. One form is the 1:1 magnesium preparation in salt form with citric acid in a 1:1 ratio. It contains 11.33% magnesium by weight. Magnesium citrate is used medicinally as a saline laxative and to completely empty the bowel prior to a major surgery or colonoscopy. It is available without a prescription, both as a generic and under various brand names. It is also used in the pill form as a magnesium dietary supplement. As a food additive, magnesium citrate is used to regulate acidity and is known as E number E345.

Isostar is a sports drink sold in Europe. It is similar to Gatorade and Powerade in that it hydrates and provides energy through glucose. Isostar was first created in Switzerland in 1977.

<span class="mw-page-title-main">Vegan nutrition</span> Nutritional and human health aspects of vegan diets

Vegan nutrition refers to the nutritional and human health aspects of vegan diets. A well-planned vegan diet is suitable to meet all recommendations for nutrients in every stage of human life. Vegan diets tend to be higher in dietary fiber, magnesium, folic acid, vitamin C, vitamin E, and phytochemicals; and lower in calories, saturated fat, iron, cholesterol, long-chain omega-3 fatty acids, vitamin D, calcium, zinc, and vitamin B12.

Magnesium salts are available as a medication in a number of formulations. They are used to treat magnesium deficiency, low blood magnesium, eclampsia, and several other conditions. Magnesium is an essential nutrient.

References

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