The combination of
calcium with
vitamin D (
vitamin D(3) [colecalciferol]) forms the basis of preventive and therapeutic regimens for
osteoporosis. A number of studies have suggested that the combination of
calcium and
vitamin D is effective when administered at respective dosages of at least 1200 mg and 800 IU per day, although efficacy is, as expected, affected by patient compliance. Overall, treatment with this combination appears to be effective in reducing the incidence of non-vertebral and
hip fractures. Also, in all
drug studies (of antiresorptive and
anabolic agents and
strontium ranelate) that demonstrated a reduction in risk of
osteoporotic fractures, patients also took
calcium and
vitamin D supplements. An important finding in this regard is that
vitamin D levels have been demonstrated to be inadequate in more than half of women treated for
osteoporosis in the US and Europe. The capacity of the small intestine to absorb
calcium salts depends on the solubility and ionization of the
salts. These properties vary for different
salts, with fasting
calcium citrate absorption being greater than that of
calcium lactogluconate and
calcium carbonate.
Calcium citrate formulations taken between meals may help to prevent abdominal distension and
flatulence, as well as minimize the risk of
renal calculus formation, thus helping to optimize patient compliance. Therefore,
calcium citrate combined with
vitamin D is the combination of choice for the prevention or treatment of
osteoporosis.