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Osteoporosis

Adapted from: "The Parkinson's Disease Treatment Book Partnering with Your Doctor to Get the Most from Your Medications" by J. Eric Ahlskog

Preventing Osteoporotic Fractures among those with Imbalance

The density of our bones decreases as we age, sometimes sufficient to cause osteoporosis. When this occurs, our bones are more susceptible to fracture. The risk of fractures from osteoporosis can be substantially reduced by early and appropriate interventions.

Calcium is a major component of our bones, necessary for their density and strength. However, calcium is also required by our bodies for a variety of important metabolic processes; our body regulates blood levels of calcium, keeping them relatively constant. If our blood levels of calcium decline, then calcium is pulled from bones to keep the blood levels stable. Thus, if we do not consume sufficient quantities of calcium from our diet, it is reabsorbed from our bones. This can lead to osteoporosis.

Inactivity also promotes calcium reabsorption from bone. This renders bone less dense and therefore more prone to fracture.

The absorption of calcium from food takes place in the gut and is made significantly more efficient by vitamin D. Sunlight exposure is vital for the normal production of vitamin D. Those with limited sunlight exposure need to be careful to get adequate vitamin D in their diet.

Studies indicate that most Americans over the age of 50 do not receive adequate amounts of dietary calcium or vitamin D. It has been shown that this is particularly problematic among some seniors, where diet, decreased mobility and decreased sunlight exposure may all play a role.

Calculating calcium content: “Elemental” calcium

How much calcium do I need? Calcium in nature is attached to some other compound such as carbonate, chloride, gluconate, etc. This can make the calculation of the calcium content a little confusing when we are determining the daily requirement.

Calcium may be calculated as calcium alone (elemental calcium) or as calcium plus whatever is attached to it (e.g. calcium carbonate). In other words, the amount in milligrams (mg) may be shown as only the calcium, or the combination of calcium plus carbonate, chloride, gluconate, etc. Below, we specify the daily calcium requirement in terms of “elemental calcium”. This is calcium alone. Look for the term, “elemental” on the label of calcium supplements when calculating how much you will derive from that source. Otherwise, the daily requirements shown below will not apply.

In order to prevent osteoporotic fractures in middle-aged or senior adults with imbalance, we recommend the following:

For Premenopausal Women and All Men (without osteoporosis)

  • Vitamin D: 800 units daily. Note that one multivitamin usually contains 400 units of vitamin D, as does drinking a quart of milk.
  • Calcium: 1200 mg of elemental calcium daily (This may derive from a combination of milk, other dairy products and supplements, such as TumsTM.

For Postmenopausal Women (or men with osteoporosis)

  • Vitamin D: 800 units daily.
  • Calcium: 1500 mg of elemental calcium daily.

The vitamin D and calcium may come from a variety of sources, including diet, vitamin pills or supplements.

We also recommend a bone density study to assess whether additional measures are necessary to strengthen bones. If this study demonstrates that your bones are sufficiently weak (osteoporosis), your internist will then consider adding a medication to your vitamin D and calcium supplements. Your family physician or internist can order this test.

If you have already been diagnosed as having osteoporosis, you may have been prescribed a medication such as alendronate (Fosamax), risedronate (Actonel) or ibandronate (Boniva). Note that these medications do not contain calcium or vitamin D; you must still take adequate calcium and vitamin D in addition.

One caveat: if you have a history of calcium-containing kidney stones, calcium and vitamin D supplementation may not be advisable. In that case, consult your internist or family physician.

Section of Movement Disorders, 2006 Mayo Clinic, Rochester, MN