The role of calcium & vitamin D
Calcium & Vitamin D
Calcium is the most abundant mineral in the body, it is stored in the bones, supporting structure and function1
Food remains the best source of calcium but supplements should be considered if dietary calcium intake is insufficient 2
Vitamin D is a fat-soluble vitamin that can be:
- found in limited dietary sources (margarine, eggs, oily fish, green peas);
- produced in the skin via the action of sunlight3. (Approx. 10-15 min of sunlight a day without sun screen)4
Vitamin D helps to build strong bones and is essential for everyone throughout life. Vitamin D3 is very important to help protect our bones, your body to absorb calcium and supporting your muscles to help decrease falls, as well as helping your immune system.5
How does it work?
Ultraviolet B sun rays interact with 7-dehydrocholesterol in the skin which is converted to vitamin D₃.6,7
Vitamin D from either the sun or food binds to the Vitamin D binding protein and travels in the bloodstream to the liver.7
In the liver it is converted to 25-hydroxyvitamin D3 or (25(OH)D) (calcidiol)and in the kidneys to 1,25(OH)D (calcitriol) the biologically active circulating hormone.7
Calcitriol travels to the small intestine where it enables the increase of calcium absorption ultimately affecting bone health.7,8
Calcium and Vitamin D Deficiency
Clinical features of calcium and vitamin D deficiency include:
Osteopenia / Osteoporosis
Osteoporosis is characterised by low bone mass and micro-architectural deterioration in bone tissue, leading to enhanced bone fragility and increased fracture risk10,11. Osteopenia is a precursor of osteoporosis11.
Types. There are 2 main types of osteoporosis12:
1. Primary. Caused by postmenopausal/age-related (senile) bone loss
2. Secondary. As result of nutrition, endocrine, drug, malignancy, chronic disease or idiopathic bone loss.
Some interesting facts about Osteoporosis
- 1 in 3 women, and 1 in 5 men will experience a fracture after the age of 501,3.
- 33% women aged 60-70 & 66% aged 80 or older have osteoporosis1,4.
- Calcium and vitamin D play an essential role in reducing hip fractures1,5
- Patients who continue to take their calcium and vitamin D medication can reduce their risk of hip fracture by 29%1,
Guidelines and recommendations
How much Calcium & Vitamin D do we need?
Vitamin D is measured by serum levels of 25-hydroxyvitamin D (25-(OH)D) which has a half-life or 3-6 weeks. 7,14,16
The Royal Osteoporosis Society (UK) reference levels to be adopted by healthcare professionals. 17
Vitamin D deficiency is common among older Irish adults. Results from the 2017 TILDA study show that the prevalence of Vitamin D deficiency in this age group was 13.1% (1 in 8). 18
Calcium is maintained in the range from 8.5 to 10.5 mg/dL. Normal values and reference ranges may vary among laboratories as much as 0.5 mg/dl. 19
Calcium and Vitamin D supplements are recommended for anyone who is unable to get the daily recommend amounts through food4.
Calcium is maintained in the range from 8.5 to 10.5 mg/dL. Normal values and reference ranges may vary among laboratories as much as 0.5 mg/dl. 19
Calcium and Vitamin D supplements are recommended for anyone who is unable to get the daily recommend amounts through food4.
Uk National Osteoporosis Guidelines Group
If you’re taking an osteoporosis medication you may benefit from increasing your daily calcium intake to around 1,000mg.2
References for this section are as follows
- https://theros.org.uk/information-and-support/bone-health/nutrition-for-bones/calcium/ The Royal Osteoporosis Society, Information and support – Nutrition for bones – Calcium. Accessed February 2024.
- The Royal Osteoporosis Society. What are the Pharmacological Treatment Options? Available in the public domain: https://theros.org.uk/healthcare-professionals/courses-and-cpd/osteoporosis-resources-for-primary-care/initiation/, accessed February 2024
- Nair R, Maseeh A. Vitamin D: The “sunshine” vitamin. Journal of Pharmacology & Pharmacotherapeutics. 2012;3(2):118-126.
- Osteoporosis Guidelines For health professionals. Irish Osteoporosis Society. 2012. Available in public domain: https://www.icgp.ie/speck/properties/asset/asset.cfm?type=LibraryAsset&id=658D8B2D%2D9409%2D98E3%2D2
E7EC84B8CAC3A35&property=asset&revision=tip&disposition=
inline&app=icgp&filename=IOS%5FGuidelines%5FSept%5F2012%5F1%5F%2Epdf [Accessed February 2024] - https://www.irishosteoporosis.ie/information-support/vitamin-d-osteoporosis/ The Irish Osteoporosis Society, Vitamin D and Osteoporosis, Accessed February 2024
- Hirsch, A. L. 2000. Vitamin D. Kirk-Othmer Encyclopedia of Chemical Technology.
- Holick MF. VITAMIN D: A D-LIGHTFUL SOLUTION FOR HEALTH. Journal of investigative medicine: the official publication of the American Federation for Clinical Research. 2011;59(6):872-880.
- Christakos S, Dhawan P, Porta A, Mady LJ, Seth T. Vitamin D and Intestinal Calcium Absorption. Molecular and Cellular Endocrinology. 2011;347(1-2):25-29.
- Vaishya et al. Resurgence of vitamin D: Old wine in new bottle. J Clin Orthop Trauma. 2015;6(3):173-83
- Ensrud KE, Crandall CJ. Osteoporosis. Ann Intern Med. 2017;167:ITC17–ITC32.
- Karaguzel G1, Holick MF. Diagnosis and treatment of osteopenia. Rev Endocr Metab Disord. 2010;11(4):237-51.
- Usha Kini, B. N. Nandeesh. Physiology of Bone Formation, Remodeling, and Metabolism. Radionuclide and Hybrid Bone Imaging pp 29-57.
- International Osteoporosis Foundation. Osteoporosis Facts and Stats. Available in public domain at: https://www.iofbonehealth.org/facts-statistics [Accessed February 2024]
- Brouwer-Brolsma, E. M. et al Vitamin D: Do we get enough?: A discussion between vitamin D experts in order to make a step towards the harmonisation of dietary reference intakes for vitamin D across Europe. Osteoporosis International, (2013). 24(5), 1567-1577
- Sunyecz et a, 2008, The use of calcium and vitamin D in the management of Osteoporosis in Therapeutics and Clinical Risk Management.
- Holick, M.F. Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol. 2009;19(2):73-8.
- The Royal Osteoporosis Society Guidelines: Vitamin D and Bone Health: A practical clinical guideline for patient management. December 2018
- Laird E et al. The prevalence of vitamin D deficiency and the determinants of 25(OH)D concentration in older Irish adults: Data from The Irish Longitudinal Study on Ageing (TILDA). J Gerontol A Biol Sci Med Sci. 2017 Sep 2.
- Goldstein DA. Serum Calcium. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990
Deficit of Calcium in the Irish diet
The Irish Longitudinal Study on Ageing (TILDA) found that older adults in Ireland consume an average of 2.1 daily servings of calcium (560mg) compared to the recommended 3 servings. 1, 2
Overall, 17% of older adults in Ireland comply with the recommended 3 daily servings of Milk, yogurt and cheese, with 70% consuming less than this.
In osteoporosis a daily intake of 1000 mg of calcium is recommended. 3
Cadelius 600mg can make up this deficit. 4
References
- , Irish longitudinal study of the ageing, consumption patterns and adherence to the food pyramid. Page 98. https://tilda.tcd.ie/publications/reports/pdf/w3-key-findings-report/TILDA%20Wave%203%20Key%20Findings%20report.pdf Accessed February 2024
- The Irish Osteoporosis Society, Nutrition and Bone Health. https://www.irishosteoporosis.ie/information-support/nutrition-bone-health/ Accessed February 2024
- The Royal Osteoporosis Society, Information and support – Nutrition for bones – Calcium. https://theros.org.uk/information-and-support/bone-health/nutrition-for-bones/calcium/ Accessed February 2024
- Consilient Health Cadelius 600mg / 1000 IU Summary of Product Characteristics available on www.medicines.ie Accessed February 2024
The information on this website is intended for Republic of Ireland residents only.
Date of Preparation: February 2024
Job bag code: IE-CH-1518
