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47 Cards in this Set

  • Front
  • Back

risk factors for fracture (age < 50)

-fragility fractures

-use of high-risk medications


-malabsorption syndromes

-chronic inflammatory conditions

-perimary hyperparathyroidism

-other disorders strongly associated w rapid bone loss or fractures

risk factors for fracture (age 50-64)

-fragility fx after age 40

-prolonged use of glucocorticoids or other high risk medications

-parental hip fx

-vertebral fx or osteopenia identified on radiography

-high alcohol intake or current smoking

-low body weight (<60kg) or major weight loss (>10% of body weight at age 25)

-other disorders strongly associated w osteoporosis

dietary sources of calcium




ice cream

tofu with calcium sulphate

white beans




rice or soy beverage

fortified orange juice



calcium in 1 cup milk


calcium in 50g hard cheese


calcium in 1/4 cup almond


calcium in 1 med orange


calcium in 1/2 cup fortified orange juice


how much calcium in Tums regular

200mg elemental per

how much calcium in caltrate

600mg elemental

how much calcium in citracal

200mg elemental

how much calcium in citracal + D

315mg elemental

how much vit D in caltrate600 + D

800 IU

how much vit D in caltrate plus

800 IU

how much vit D in citracal + D

200 IU

health canada calcium requirements:

51-70 y/o

males: 1000mg

females: 1200mg

health canada calcium requirements:

> 70 y/o


health canada calcium requirements


14-18 y/o: 1300mg

16-50 y/o: 1000mg

health canada vit D requirements:

9-70 y/o

600 IU

health canada vit D requirements

> 70 y/o

800 IU

health canada vit D requirements


600 IU

vit D: canadian pediatric recommendations

premature infants:

-200 IU/kg/d

-max 400 IU/d

infants first year:

-400 IU/d

-increase to 800IU/d from oct-april for those living north of 55th parallel (edmonton)

infants and children should be exposed to sunlight for short periods (15min/d)

suggest considering 2000IU daily to pregnant and lactating women

dietary sources of vit D


rice or soy beverage

fortified orange juice

egg yolk

sockeye salmon, canned

atlantic sardines

pacific sardines


vit D in 1 cup milk

100 IU

vit D in 1/2 cup fortified orange juice

50 IU

vit D in 75g sockeye salmone


vit D in 1 egg yolk

25 IU

calcium carbonate % elemental calcium


calcium citrate % elemental calcium


calcium gluconate % elemental calcium


calcium carbonate pros


contains highest amount of elemental calcium

well absorbed by most of the popn

to enhance abs:

-take w food (comparable abs to calcium citrate)

-take in divided doses (can only abs 500mg/dose)

calcium carbonate cons


-flatulence, bloating, constipation

calcium citrate pros

-pH independent

-less carbon dioxide production

recommended for pts w:


-kidney stones

-intolerable gas w carbonate

calcium citrate cons

more expensive than carbonate in general

avoid in chronic renal failure

-binds albumin in dialysis soln

coral calcium

contains: calcium carbonate, magnesium, trace amounts of other minerals

-claimed to be from coral reefs

marketed as:

-a calcium w superior absorption

-a panacea for Alzehimer's, cancer, diabetes, fibromyalgia

-claimed that low body pH causes these conditions and that coral calcium increases pH

no benefit

milk-alkali syndrome

-historically occurred w ingestion of large amounts of calcium and an absorbable alkali (eg sodium bicarbonate) leading to hypercalcemia

today more likely w inappropriate high doses of calcium carbonate

- >4000mg elemental calcium/d

-cases have occured w 1000-1500mg elemental calcium/d

-recent resurgence in geriatric popn

usual presentation: hypercalcemia, metabolic alkalosis, imparied renal fxn

-sn/sx hypercalcemia: fatigue, depression, mental status changes, N/V/C, urinary frequency, ECG changes, arrhythmias

large amounts of milk or dairy products are not necessary for this condition to develop

kidney stones

4 types: calcium, uric acid, struvite, cysteine

most kidney stones made of caclium oxalate

-precipitation of calcium oxalate crystals in the urine

-increased oxalate likely cause of kidney stones

dietary calcium binds oxalates in the GIT

-limits their abs and prevents their precipitation in the kidney

low calcium diet increases oxalate in the urine

advise kidney stone pts to:

-limit sources of oxalate (beet greens, rhubarb, sorrel, nuts, berries, spinach, chocolate)

-continue w calcium intake (dietary more protective?)

-calcium citrate may have protective effect

pts who may be at risk for lead toxicity

renal failure pts using large amounts of calcium acetate

lead contamination

lead is a natural component in many foods and supplements

a serving of raisins, grapes, berries, wine, or leafy greens contains more lead than a typical calcium supplement

lead content in calcium supplements

per 1500mg elemental calcium/d:

-caltrate > 3mcg

-nature made (oyster shell) 1.95mcg

-oscal 1.74mcg

-Tums below level of detection

sx of calcium toxicity

-increased thirst

-urinary frequency





-mental confusion

foods/medications that may interact w calcium

-Phytates (bran, metamucil, soybeans, seeds)

-some Abx (quinolones, tetracyclines)

-thiazide diuretics




magnesium benefit

has a role in bone and teeth formation

possible benefits of concurrent use w calcium

-laxative effect > 350mg

-concurrent ingestion w calcium does not seem to affect abs or either mineral

sources of magnesium

-whole grains

-green leafy vegetables



magnesium DRI


vit K recommendations

-not recommended for prevention of post-menopausal osteoporosis

-not recommended for tx of postmenopausal osteoporosis

-not recommended for use in men or premenopausal women