Since the problem of bone fragility is predominantly female (men's bones are usually stronger), the main consumers of calcium and vitamin D products are women. And now it turns out that while strengthening the bones, they harm their blood vessels. American scientists from West Virginia University came to this conclusion. They conducted a large study in which they assessed how different vitamins, macro- and microelements affect health. Calcium and Vitamin D were of concern to them.
Article on the topic Calcium: absorb and not lose
Pharmacological properties
Pharmacodynamics.
Vitamin D3 increases calcium absorption in the intestines. The use of calcium and vitamin D3 prevents the increase in parathyroid hormone (PTH) levels, which is caused by calcium deficiency and leads to increased/increased bone resorption (leaching of calcium from the bones). A clinical study in hospitalized patients with vitamin D deficiency showed that daily intake of 2 tablets of calcium 500 mg and vitamin D 400 IU for 6 months normalized the level of the 25-hydroxylated metabolite of vitamin D3 and reduced the manifestations of secondary hyperparathyroidism and ALP levels.
Pharmacokinetics. Calcium. Suction. About 30% of the calcium dose taken is absorbed into the gastrointestinal tract.
Distribution and biotransformation. 99% of calcium is concentrated in solid structures of the body (bones, teeth); 1% remains in the internal and extracellular environment. Approximately 50% of calcium in the blood is in the physiologically active ionized form. Almost 10% is in complex with citrates, phosphates and other anions, the remaining 40% is part of proteins, mainly albumins.
Excretion. Calcium is excreted in feces, urine and sweat. Renal excretion depends on glomerular filtration and tubular reabsorption of calcium.
Cholecalciferol. Suction. Vitamin D3 is easily absorbed in the small intestine.
Distribution and biotransformation. Cholecalciferol and its metabolites circulate in the blood bound to a specific globulin. Cholecalciferol in the liver is converted by hydroxylation into 25-hydroxycholecalciferol, then in the kidneys into the active form 1,25-dihydroxycholecalciferol, which is a metabolite responsible for enhanced absorption of calcium. Vitamin D3, which has not been metabolized, is stored in muscle and fat tissues.
Excretion. Vitamin D3 is excreted in feces and urine.
Additional Arguments
Over the years, there have been several studies confirming the negative effects of calcium and vitamin D. For example, in 2021, two studies were published at once: one tried to rehabilitate drugs with calcium, and the other confirmed their ability to increase the risk of heart disease. This study, published in the Journal of the American Heart Association and conducted by American scientists from several universities, found that calcium supplement users had a 22% increased risk of calcium plaque in the heart vessels. This was proven using computed tomography. The first time it was done at the beginning of the study, selecting volunteers without plaques in the vessels of the heart, and the second time after 10 years. And tomography revealed the negative effect of calcium supplements.
Question answer
Does calcium intake affect the development of heart disease?
The Council for Responsible Nutrition, which represents manufacturers of dietary supplements (including calcium), did not agree with the doctors' conclusions - and stated that there are studies showing the opposite.
Indications
Calcium-d3 nycomed with orange/mint flavor
Prevention and treatment of calcium and vitamin D deficiency.
Supplemental use of vitamin D and calcium as an adjunct to specific therapy for osteoporosis in patients at risk of developing calcium and vitamin D deficiency.
Calcium-D3 Nycomed Forte.
Prevention and treatment of calcium and vitamin D deficiency in elderly patients.
Supplemental use of vitamin D and calcium as an adjunct to specific therapy for osteoporosis in patients at risk of developing calcium and vitamin D deficiency.
Calcium-D3 Nycomed Osteoforte
Prevention and treatment of calcium and vitamin D deficiency in elderly patients.
Supplemental use of vitamin D and calcium as an adjunct to specific therapy for osteoporosis in patients at risk of developing calcium and vitamin D deficiency.
Why vitamin D is also dangerous
Vitamin D can also play a significant role in this. It increases the absorption of calcium from the digestive tract, and thereby ensures that its concentration in the blood will be higher. And this means that it enhances all the effects of the drug described above.
Question answer
Which vitamins are compatible with each other and which are not?
The negative role of vitamin D was confirmed a year later. In 2011, again in the same British Medical Journal, an article was published describing how two types of drugs (with calcium alone and with calcium and vitamin D in combination) increase the risk of cardiovascular diseases, and especially myocardial infarction.
That is, the current study of an increase in strokes in those who took calcium and vitamin D at the same time echoes scientific papers published in 2010 and 2011. But that's not all.
Application
The drug is intended for oral use. The tablet should be chewed or dissolved.
Calcium-D3 Nycomed with orange/mint flavor
Calcium and vitamin D deficiency
Adults: 1 tablet 1–3 times a day.
Children over 5 years of age: 1 tablet 1-2 times a day as recommended by a doctor.
Supplement to osteoporosis therapy
Adults: 1 tablet 2-3 times a day.
For patients with liver failure, no dose adjustment is required.
The drug should not be used in patients with severe renal failure (see CONTRAINDICATIONS).
Elderly patients. It is recommended to use the same doses as in adults.
Calcium-D3 Nycomed Forte. Adults and elderly patients: 1 tablet 2 times a day.
Calcium-D3 Nycomed Osteoforte. Adults and elderly patients: 1 tablet 1 time per day.
Patients with liver failure: no dose adjustment required.
Patients with severe renal failure should not use the drug (see CONTRAINDICATIONS).
Calcium-D3 Nycomed Forte
Calcium-D3 Nycomed forte is a combination drug that contains calcium and cholecalciferol (vitamin D3). This drug belongs to the group of correctors of metabolic processes of bone and cartilage tissue and is used mainly for the prevention and complex treatment of osteoporosis and its complications (increased bone fragility). Recently, the prevalence of osteoporosis has taken on more and more threatening forms: for example, among women over 60 years of age, 30% suffer from this disease, and among women over 80 years of age - 70%. In solving this problem, great importance is attached to disease prevention. A lack of vitamin D in the human body causes a malabsorption of calcium in the intestines, which leads to a violation of its accumulation in the bones, the development of osteoporosis, and, as a result, bone fractures. Vitamin D plays an important role in maintaining skeletal muscle strength and spatial balancing ability, which helps prevent falls and bone fractures. However, it is not always possible to ensure sufficient intake of calcium and vitamin D into the body from natural sources. In such cases, a reasonable way out of the current situation seems to be taking combination drugs containing both of these, which are so important for maintaining the density and integrity of the bone tissue structure. A drug ideal for this is Calcium-D3 Nycomed forte, recommended by the Russian Osteoporosis Association as a drug with the most effective qualitative and quantitative combination of calcium and vitamin D 3. In addition, from the point of view of pharmacoeconomics, Calcium-D3 Nycomed forte is the least expensive drug for long-term prevention of osteoporosis. This drug controls calcium-phosphorus metabolism (primarily in bones, nails, hair, teeth, muscles), suppresses the processes of destruction of bone tissue, increases its density, replenishing the deficiency of calcium and vitamin D3, and plays an important role in the mineralization of teeth. In addition, calcium takes part in the regulation of neuromuscular conduction, initiates muscle contractions, and is an integral part of the blood coagulation system.
Vitamin D3, for its part, promotes the absorption of calcium in the intestines. The use of a combination of calcium + vitamin D3 inhibits the production of parathyroid hormone, produced by the parathyroid glands and stimulating the resorption of bone tissue (leaching of calcium from it). Clinical trials have shown that daily use of 1 tablet of calcium-D3 Nycomed Forte for 3 months in adolescents with osteopenia helps to increase bone mineral density and significantly increase body height and weight. When using the drug by pregnant women, there is a decrease in the symptoms of calcium deficiency. It is important that the drug has virtually no clinically significant side effects, which allows its use during pregnancy and lactation. Calcium-D3 Nycomed forte has a positive effect on calcium-phosphorus metabolism in mother and fetus. It is important to note that the use of the drug in pregnant women in therapeutic doses does not cause premature overgrowth of the fontanel in newborns, because doses of calcium-D3 components Nycomed forte are physiologically justified. In addition to this, taking vitamin D3 helps prevent rickets in children in the first year of life.
Calcium-D3 Nycomed forte is available in the form of chewable tablets with lemon flavor. Vitamin D3 is absorbed in the intestines. Calcium, after getting rid of the “embrace” of the carbonate ion (initially contained in the tablet in the form of calcium carbonate), is absorbed in the proximal part of the small intestine using an active vitamin D-dependent transport mechanism. The tablets are chewed or dissolved, optimally during meals. To prevent osteoporosis, you need to take 1 tablet 2 times a day, as part of the complex treatment of osteoporosis - 1 tablet 2-3 times a day. For deficiency conditions associated with a lack of calcium and vitamin D, adults and children over 12 years old are recommended to take 2 tablets per day, children from 3 to 12 years old - 1 tablet per day.
Side effects
Adverse effects according to the frequency of occurrence are classified as follows: uncommon (≥1/1000, 1/100), rare (≥1/10,000, 1/1000), very rare (1/10,000), unknown (frequency not determined based on available data). data).
From the immune system: unknown - hypersensitivity reactions, including angioedema, laryngeal edema.
From the side of metabolism: infrequently - hypercalcemia, hypercalciuria.
Very rare: milk-alkali syndrome (frequent urge to urinate, persistent headache, persistent lack of appetite, nausea or vomiting, unusual fatigue or weakness, hypercalcemia, alkalosis, renal failure). Occur only in case of overdose (see OVERDOSE).
From the digestive system: rarely - constipation, dyspepsia, flatulence, nausea, abdominal pain, diarrhea.
From the skin and subcutaneous tissue: very rarely - itching, rash, urticaria.
Special groups of patients. Patients with renal failure. Hyperphosphatemia, nephrolithiasis and nephrocalcinosis may develop (see SPECIAL INSTRUCTIONS).
special instructions
During long-term treatment with the drug, it is necessary to monitor the level of calcium, creatinine in the blood serum and renal function, especially in the elderly during combined therapy with cardiac glycosides or diuretics (see interactions) and in patients with a high tendency to form dental stones. If signs of hypercalcemia or renal dysfunction occur, reduce the dose or stop taking the drug.
The drug should be used with caution in patients with hypercalcemia or signs of renal impairment and monitor calcium and phosphate levels. The risk of soft tissue calcification should be taken into account. In patients with severe renal failure, vitamin D in the form of cholecalciferol cannot be metabolized normally, so other forms of vitamin D should be used (see CONTRAINDICATIONS).
Concomitant intake of vitamin D from other sources, in particular from drugs or foods containing calcium (eg milk), can lead to hypercalcemia and milk-alkali syndrome with subsequent renal impairment. To avoid overdose when simultaneously prescribing other drugs containing vitamin D, it is necessary to take into account the vitamin D content in the drug Calcium-D3 Nycomed Osteoforte (800 IU). Supplemental doses of calcium or vitamin D should be taken under medical supervision. In such patients, it is necessary to regularly monitor plasma calcium levels and renal function.
Calcium-D3 Nycomed with orange/mint flavor is contraindicated for use in patients with sarcoidosis and hypoparathyroidism due to the risk of increasing the metabolism of vitamin D3 to its active form. It is necessary to monitor calcium levels in serum and urine in such patients.
Calcium-D3 Nycomed Forte and Calcium-D3 Nycomed Osteoforte should be used with caution in patients with sarcoidosis due to the risk of increasing the metabolism of vitamin D3 into its active form. It is necessary to monitor the level of calcium in the blood serum and urine.
Calcium-D3 Nycomed is used with caution in immobilized patients with osteoporosis due to the risk of developing hypercalcemia.
Patients with rare hereditary fructose intolerance, sucrase-isomaltase deficiency or glucose-galactose malabsorption should not use the drug as it contains isomalt and sucrose.
During pregnancy and breastfeeding. Pregnancy. The drug Calcium-D3 Nycomed can be used during pregnancy with a deficiency of calcium and vitamin D. The daily dose should not exceed 2500 mg of calcium and 4000 IU of vitamin D. Animal studies have shown that vitamin D in high doses has reproductive toxicity. Pregnant women should avoid overdose of Calcium-D3 Nycomed, since prolonged hypercalcemia causes adverse effects on the fetus. There is no evidence that vitamin D at recommended doses has a teratogenic effect in humans.
Lactation. The drug Calcium-D3 Nycomed can be used during breastfeeding. Calcium, vitamin D3 and its metabolites can pass into breast milk, so it is necessary to consider the intake of calcium and vitamin D from other sources into the baby's body.
Children. The drug is used to treat calcium and vitamin D3 deficiency in children over 5 years of age on the recommendation of a doctor. Calcium-D3 Nycomed Forte and Calcium-D3 Nycomed Osteoforte are not intended for use in children and adolescents.
The ability to influence reaction speed when driving vehicles and working with other mechanisms. There is no data regarding the effect of the drug on the reaction rate when driving vehicles or other mechanisms.
Calcium and vitamin D3: from osteoporosis to multimorbidity of cardiovascular diseases
Osteoporosis (OP) is one of the “young” diseases in modern clinical practice. However, a “young” disease only means that we began to think about the presence of this disease in patients only in the last decade. However, in the medical literature of the early and mid-20th century, we come across the term “widow’s hump,” which suggests the formation of kyphoscoliotic deformity of the thoracic spine in elderly women due to compression fractures. And the study of this problem began in the 19th century, when Charcot and Vulpian presented a description of this disease, and Alwens W. presented a clinical picture of senile osteoporosis in a textbook of internal medicine.
For more than 120 years, scientists and experts have been studying the problem of involutive and metabolic changes in bone tissue, but the scale of the epidemic of this disease is growing exponentially.
Osteoporosis is one of the most common components of multimorbidity in modern patients. As a result, every local or practicing doctor observing a somatic patient must actively search for risk factors and symptoms of osteoporosis, as well as prescribe prevention and treatment.
There is no doubt that the prevailing number of cases of this disease is the prerogative of patients over 50 years of age, when other socially significant diseases (cardiovascular pathology, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), etc.) become an integral part of patients’ lives .
Our studies on the structure of multimorbid pathology in patients with loss of bone mineral density (BMD) demonstrate that the highest prevalence of AP and osteopenia is observed in patients with a combination of diseases.
Thus, the prevalence of AP in patients with a combination of coronary heart disease (CHD), angina pectoris, arterial hypertension (AH) and type 2 diabetes was 39.5%; with ischemic heart disease, post-infarction cardiosclerosis, hypertension and type 2 diabetes - 41.2%; and in the presence of this combination also of a previous acute cerebrovascular accident (ACVA) - 46.8%.
The highest prevalence of osteopenia was observed in patients with a history of stroke - 56.9%, as well as in patients with alcoholic polyvisceropathy - 48.8%.
Consequently, osteoporosis often occurs in patients with chronic somatic diseases. At the same time, there are a number of pathogenetic relationships (Table 1), in particular with cardiovascular diseases (CVD) - the most common somatic diseases, where endothelial dysfunction plays an important role. The latter is associated with nitric oxide deficiency, the role of which is beyond doubt in the pathogenesis of cardiovascular diseases, and in the development of osteoporosis is associated with a decrease in the synthesis and differentiation of osteoblasts.
Over the past 2–3 years, the attention of the professional medical community has been focused on the role of calcium and vitamin D3 in clinical practice. From concerns about the occurrence of urolithiasis and calcification of atherosclerotic plaques and blood vessels to evidence of reduced mortality in patients receiving calcium and vitamin D3 supplements, here is a three-year debate between international experts.
Over the past two years, the role of vitamin D3 deficiency in the development and progression of cardiovascular pathology has been widely discussed, which, from the perspective of multimorbidity in patients with a high risk of osteoporotic fractures, requires a separate discussion of the role of these drugs in the treatment of multimorbid patients.
As evidence for the effectiveness of combination therapy with calcium and vitamin D3, one should cite data from meta-analyses of randomized clinical trials (RCTs), which combined information on the effectiveness of calcium and vitamin D3 in 369,968 patients [9, 12].
The general conclusions of these meta-analyses: the use of calcium and vitamin D3 compared with placebo reduced bone loss in patients - the relative risk (RR) was 0.76 (95% confidence interval (CI): 0.62–0.91).
All endpoints (BMD loss, hip fractures, non-vertebral fractures) of the RCT in 369,968 patients showed a benefit from calcium and vitamin D3 supplementation.
One of the key issues remains the dosage of calcium and vitamin D3. Particular attention should be paid to the fact that most recommendations (USA, UK, Scotland, France, Italy, etc.) indicate combination preparations that include calcium and vitamin D3 [1–6].
Thus, the recommended and proven doses of calcium by most professional associations are 1000 mg per day, vitamin D3 - 800 IU per day.
Considering the multimorbidity of modern patients, it should be noted that calcium is a “universal” microelement that plays a key role in most biochemical and physiological reactions.
Significant processes and effects on the development of some pathophysiological mechanisms are presented in Table. 2.
As can be seen from the above facts, calcium deficiency increases the risk of diseases associated with atherosclerosis and insulin resistance, which has a certain clinical meaning in planning a pharmacotherapy strategy in these cases.
In recent years, the issue of increasing the risk of cardiovascular accidents and associated death in patients taking calcium supplements has been discussed in European medical communities.
The most significant evidence may be a meta-analysis published by MJ Bolland in 2010 [7]. The meta-analysis included 26 studies, with a total of 20,072 patients.
From the presented data, the practitioner concludes that there is a slight increase in cardiovascular mortality in patients receiving calcium supplements. However, it should be mentioned that we are only talking about studies in which patients did not receive vitamin D3. Only one study was included in this meta-analysis [13], in which calcium was administered with vitamin D3. This study did not demonstrate an increase in the risks of cardiovascular events and death. In this study, the risk of major cardiovascular events and death did not differ from the placebo group.
The authors place special emphasis in their final conclusions: a slight increase in cardiovascular mortality when taking calcium supplements without vitamin D3.
In another analysis, the same professor [8] demonstrates that calcium doses of 1000 mg/day in the WHI study (total number of patients - 36,282) did not demonstrate a significant effect on cardiovascular events - the risk of major cardiovascular events and death was lower compared with placebo group.
Another study by Professor V. M. Tang [9] especially emphasizes the role of prescribing a combined calcium and vitamin D3 preparation for the prevention and treatment of osteoporosis, since monotherapy with one or the other in most analyzed RCTs is always worse than the combination.
Thus, when deciding to prescribe calcium supplements, it is necessary to choose combination preparations containing calcium and vitamin D3, where the daily dose of calcium will be at least 1000 mg (maximum of two tablets).
The most interesting topic for discussion is the role of vitamin D3 in the development of a number of socially significant diseases.
Summarizing the known literature and our own data, we should highlight priority pathologies associated with vitamin D3 deficiency:
- muscle weakness (sarcopenia);
- falls;
- diabetes;
- oncological diseases;
- immune system disorders;
- arterial hypertension and other CVDs;
- high mortality rate.
A significant number of studies by foreign authors show the relationship between vitamin D3 deficiency and diseases not directly related to bone tissue.
There is no doubt that there is a connection between vitamin D3 deficiency and cardiovascular diseases and arterial hypertension. Decreased vitamin D3 concentrations are associated with an increased risk of metabolic syndrome, including hypertension. Normalizing vitamin D3 levels can reduce systolic blood pressure and thus reduce the risk of cardiovascular disease.
Studies have also demonstrated that correction of vitamin D3 deficiency prevents further hypertrophy of cardiomyocytes in patients with arterial hypertension.
Because vitamin D3 deficiency affects cardiotonic properties and vascular modulation, hypertension possibly increases the negative effects of vitamin D3 deficiency on the cardiovascular system. In addition, experimental and clinical data suggest that vitamin D3 deficiency directly causes the development of hypertension.
What is the prevalence of vitamin D3 deficiency in domestic patients with somatic pathology? To answer this question, we undertook a study of the prevalence of vitamin D3 deficiency in patients in a therapeutic hospital.
We examined 134 patients, of which 44 (32.8%) were men, average age 51.6 ± 15.2. The average body mass index in patients was 28.2 kg/m2.
Among somatic diseases, cardiovascular diseases were found in most cases - 126 (94.02%). All patients had arterial hypertension, and 24 (17.9%) also had coronary artery disease, post-infarction cardiosclerosis, and chronic heart failure of functional classes II–III.
18 (13.4%) patients had type 2 diabetes as a background pathology. Among other diseases, diseases of the gastrointestinal tract were noted (chronic gastritis, peptic ulcer of the stomach or duodenum, less often in combination with chronic cholecystitis) in 16.4% of cases and COPD in 14.2% of patients.
When analyzing the daily calcium intake of the subjects, it was found that all patients received an extremely low amount of it - the average intake was 278.4 ± 117.4 mg per day (recommended calcium intake is 1000–1500 mg per day).
It should be noted that calcium intake varied between men and women:
- men - 196.3 ± 148.4 mg/day;
- women - 360.5 ± 86.7 mg/day.
There were several objective reasons for such a low calcium intake:
- 47 (35.1%) patients do not consume dairy products (including cheeses);
- 56 (41.8%) - consume greens only in the summer;
- 73 (54.5%) - consume sea fish less than once a week;
- 68 (50.7%) - rarely consume nuts, dried fruits, etc.
However, it should be recognized that low calcium intake undeniably requires additional daily calcium supplementation.
Among all those examined, only 4 patients had vitamin D3 levels that corresponded to the reference values, in accordance with the recommendations of the International Osteoporosis Foundation (2010) - more than 75 nmol/l, averaging 86.7 nmol/l. In general, more than 97% of patients with chronic somatic diseases have low vitamin D3 concentrations.
The average level of 25-hydroxyvitamin D (25 (OH)D) in the blood serum was 43.4 ± 7.6 nmol/L, with 47.8 ± 9.2 nmol/L among patients under 50 years of age.
Among our patients, 56 people were under the age of 50 years, the average age was 43.7 ± 4.5 years. Here, 3 (5.4%) patients did not have vitamin D3 deficiency, while in the group over 50 years old (here the average age was 63.2 ± 5.7 years) only 1 (1.3%) patient did not have a deficiency vitamin D3.
A number of patients (n = 34) had hypercholesterolemia; the average value of total blood cholesterol was 7.1 ± 0.9 mmol/l. We found a significant (r = -0.23, p = 0.04) negative correlation between the level of total cholesterol and the level of vitamin D3.
Among patients with type 2 diabetes (n = 18), we also obtained a significant (r = -0.34, p = 0.043) negative correlation between blood glucose levels and vitamin D3 levels.
When analyzing densitometry (central densitometry, Lunar DPX BRAVO device), patients were diagnosed with osteoporosis in 51 (38.1%) cases, and osteopenia in 62 (46.3%) cases (here the average value for the general T-criterion in the spine was - 1.9 SD).
All patients diagnosed with loss of bone mineral density were found to be vitamin D3 deficient.
Thus, almost all patients with chronic somatic diseases have a deficiency of vitamin D3. At the same time, a significant deficiency of vitamin D3 was noted: the average value was 43.4 nmol/l, with a norm of at least 75 nmol/l.
We found negative correlations between vitamin D3 levels and total blood cholesterol and blood glucose. Most patients showed loss of bone mineral density.
Consequently, our data indicate the need to correct vitamin D3 deficiency in patients with somatic pathology.
It should be assumed that the administration of vitamin D3 will lead to a reduction in mortality in patients with somatic multimorbidity. This is evidenced by one of the latest meta-analyses [10], which included more than 50 RCTs, with a total number of patients - 94,148 people, mostly elderly women.
Cholecalciferol (vitamin D3) supplementation was shown to indeed reduce mortality (RR = 0.94, 95% CI 0.91 to 0.98; 74,789 participants, 32 trials). This fact has not been confirmed for alfacalcidol, calcitriol and vitamin D2.
Thus, to create an effective concentration of vitamin D3 in a patient and achieve pharmacological effects (including reducing mortality), it is necessary to prescribe drugs containing cholecalciferol.
However, it must be clarified that most controlled studies show significantly greater evidence of a reduction in mortality with the use of combination calcium and vitamin D3 supplements.
The most important issue for a practicing physician is the specific choice of a calcium and vitamin D3 drug from a huge number of similar drugs offered on the pharmaceutical market.
The first criterion is the analysis of RCTs regarding the composition and doses of calcium and vitamin D3:
- The above material demonstrated that the most proven are combination preparations of calcium and vitamin D3.
- The most proven doses of calcium and vitamin D3 are 1000 mg/800 IU per day, respectively.
The second criterion is the prescription of medications. Unfortunately, most forums on the Internet are full of recommendations for prescribing drugs containing oyster calcium, etc. Most of these drugs contain no more than 100 mg of calcium, with the recommended dose being 3-4 tablets per day. Considering the extremely low bioavailability of calcium from the proposed form, it should be assumed that its content will still not be sufficient.
The third criterion is the analysis of the pharmacokinetic and structural characteristics of the drug. When choosing this drug, you must clearly understand that vitamin D3 is not resistant to light and is easily oxidized. Therefore, vitamin D3 must be stabilized by fatty ingredients (vegetable oils) or antioxidants. The drug Calcium-D3 Nycomed Forte meets these criteria:
- combination drug;
- 2 tablets of the drug per day - calcium/vitamin D3 - 1000 mg/800 IU;
- Vitamin D3 is in solid encapsulated form, which protects from interaction with other components of the drug, and is stabilized by several fatty ingredients and antioxidants.
An analysis of RCTs [12] demonstrates that to date, evidence has been accumulated from studies of combined calcium and vitamin D3 preparations in 356,724 (!) patients. It should be noted that approximately a third of patients were prescribed Calcium-D3 Nycomed Forte.
One of the latest studies published by Karkkainen et al. (Osteoporos Int. 2010; 21: 2047–2055), with a three-year follow-up of the effectiveness of the drug Calcium-D3 Nycomed Forte (there were 267 patients in the study group and 306 in the control group), demonstrated a 30% reduction in the risk of all fractures (p = 0.034) .
Regarding the pharmacological correction of vitamin D3 deficiency, from a practical point of view it is necessary to comply with the main criterion for choosing a drug - a high content of D3 in the drug (at least 400 IU). Because, according to the position of the International Osteoporosis Foundation, which published an expert consensus in May 2010, the daily requirement for vitamin D3 is 800–1000 IU.
In summary, studies and meta-analyses published over the past year demonstrate growing interest in combination calcium and vitamin D3 supplements. Meta-analyses including more than 360,000 patients confirm the effectiveness of the drugs in the prevention of osteoporotic fractures and a satisfactory safety profile. However, calcium monotherapy may slightly increase cardiovascular risk, but in combination with vitamin D3 this fact is not confirmed.
Considering the pathophysiological role of vitamin D3 deficiency in the development of other somatic pathologies, as well as the high prevalence of vitamin D3 deficiency among patients with cardiovascular diseases, it should be assumed that the administration of combined preparations of calcium (in a daily dose of 1000 mg) and vitamin D3 (in a daily dose of at least 800 IU) will be useful not only in the prevention of osteoporotic fractures, but also in the strategic management of patients with somatic multimorbidity.
Literature
- National Institute for Health and Clinical Excellence // Technology Appraisal 160. 2008, October (amended January 2010).
- National Institute for Health and Clinical Excellence // Technology Appraisal 161. 2008. October (amended January 2010).
- IMS BPI Data. 2010, September.
- National Osteoporosis Guideline Group. Osteoporosis: clinical guideline for prevention and treatment // Executive Summary. Updated July 2010.
- Scottish Intercollegiate Guidelines Network. Management of Osteoporosis. A National Clinical Guideline. SIGN 71. June 2003.
- National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2010.
- Bolland MJ, Avenell A., Baron JA, Gray A., MacLennan GS, Gamble GD, Reid IR Effect of calcium supplements on the risk of myocardial infarction and cardiovascular events: meta-analysis // BMJ. 2010; 341: c. 3691.
- Bolland MJ, Gray A., Avenell A., Gamble GD, Reid IR Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis // BMJ. 2011; 342 (apr19): d2040.
For the rest of the bibliography, please contact the editor.
A. V. Naumov, Doctor of Medical Sciences, Professor
GBOU VPO MGMSU Ministry of Health and Social Development of Russia, Moscow
Contact information about the author for correspondence
Interactions
The activity of vitamin D3 may be decreased when used concomitantly with rifampicin.
Thiazide diuretics reduce calcium excretion in urine. When combined therapy, it is necessary to monitor the level of calcium in the blood serum, since the risk of hypercalcemia increases.
Calcium carbonate may interfere with the absorption of tetracycline drugs. Tetracycline drugs should be taken 2 hours before or 4–6 hours after taking Calcium-D3 Nycomed.
Hypercalcemia can potentiate the toxicity of cardiac glycosides (possible arrhythmias, etc.) when using calcium and vitamin D supplements.
Calcium-D3 Nycomed with orange/mint flavor. Concomitant use in patients taking cardiac glycosides and high doses of calcium is not recommended. If combined therapy with cardiac glycosides is necessary, it is necessary to use the drug in low doses, monitor ECG and calcium levels in the blood plasma.
Calcium-D3 Nycomed Forte and Calcium-D3 Nycomed Osteoforte. It is necessary to monitor heart function using an ECG, serum calcium levels and the patient’s clinical condition.
To prevent decreased absorption of bisphosphonates, it is recommended to take Calcium-D3 Nycomed no earlier than 1 hour after taking them.
With simultaneous use of calcium, the effectiveness of levothyroxine may be reduced due to reduced absorption. Levothyroxine must be taken 4 hours after taking Calcium-D3 Nycomed.
Concomitant use of calcium may interfere with the absorption of quinolone antibiotics. Quinolone antibiotics must be taken 2 hours before or 6 hours after taking Calcium-D3 Nycomed.
Calcium salts may reduce the absorption of iron, zinc and strontium ranelate. Therefore, iron, zinc and strontium ranelate preparations must be taken 2 hours before or after taking Calcium-D3 Nycomed.
Treatment with orlistat may potentially interfere with the absorption of fat-soluble vitamins (eg vitamin D3).
Smoke is not without fire
What can you say about this? There is no smoke without fire. Back in 2008, a study by Australian scientists was published in the influential British Medical Journal (BMJ). They found that in women who took one gram of calcium citrate daily to prevent osteoporosis for many years, the risk of heart attacks doubled.
In 2010, the same journal published a meta-analysis (combining a number of studies and re-evaluating them), which assessed the use of calcium supplements (without vitamin D) used to prevent osteoporosis. As a result, it turned out that calcium increases the likelihood of developing myocardial infarction by 31%. At the same time, it was noted that the risk of strokes was still increasing, but not statistically significant.
Scientists then stated that the indications for the use of calcium supplements to prevent osteoporosis should be reconsidered. Moreover, many experts then began to speak out not only against drugs with calcium, but also against complex products containing vitamin D. Although, strictly speaking, such drugs were not included in this meta-analysis. But they had a reason to say so. And that's why.
Article on the topic
Test yourself. Are you getting enough calcium?
Overdose
Symptoms. overdose can lead to hypercalcemia and hypervitaminosis d. symptoms of hypercalcemia are anorexia, thirst, nausea, vomiting, constipation, abdominal pain, muscle weakness, fatigue, mental disorders, polydipsia, polyuria, bone pain, nephrocalcinosis, nephrolithiasis, heart rhythm disturbances in severe cases. Severe hypercalcemia can lead to coma and death. Long-term overdose of high doses of the drug can lead to irreversible kidney damage and tissue calcification.
Milk-alkali syndrome can develop when using calcium in high doses and easily digestible alkaline substances. For symptoms of milk alkaline syndrome, see SIDE EFFECTS section.
Treatment. Symptomatic and supportive therapy. You should stop using the drug. In case of previous therapy with thiazide diuretics and cardiac glycosides, they should also be discontinued.
It is necessary to rinse the stomach of patients with impaired consciousness and introduce a large amount of fluid into the body. Depending on the severity of the overdose, it may be necessary to use loop diuretics, bisphosphonates, calcitonin, and corticosteroids individually or in combination. It is necessary to monitor serum electrolyte levels, renal function and diuresis. In severe cases, ECG and central venous pressure should be monitored.
Note!
Description of the drug Calcium-D3 Nycomed forte table. chewing No. 60 on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use.
Before purchasing or using the drug, you should consult your doctor and read the manufacturer's original instructions (attached to each package of the drug). Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide to prescribe the drug, as well as determine the dose and methods of its use.
