Drug Topics - December 10, 2007 - (Page 32)

32 DRUG TOPICS DECEMBER 10, 2007 www.drugtopics.com CONTINUING EDUCATION GOAL To provide pharmacists and technicians with an understanding of nonprescription medications used in the prevention and treatment of arthritis and other bone disorders cium product should be used. The daily upper limit intake for oral calcium is 2.5 gm. Calcium has been shown to significantly reduce bone loss in premenopausal women. Additional studies show that taking 1,000 to 1,600 mg of calcium a day in divided doses can lead to a decrease of bone loss by 0.25% to 1.0% in women who have been in menopause for more than five years. This delayed effect is believed to be due to the initial rapid loss of estrogen at the beginning of menopause followed by a slower decline of estrogen that is believed to have less of an effect. A decreased level of estrogen in the body causes a subsequent decrease in intestinal absorption of calcium. The beneficial effects of calcium supplementation are seen within the first two years of treatment due to the ability of calcium to decrease bone remodeling. A high rate of bone remodeling is an important risk factor for fracture, and it is believed to be as important as bone mass. Even with concerns of this “first-year effect,” continuous administration of calcium after menopause appears to have additional benefits. One study by Chiu found a 50% reduction in overall bone fracture rates as well as a 10% increase in bone mineral density after years of continuous administration. The study also found a decrease of 30% to 35% of fractures for the vertebral bone as well as a decrease of 25% of fractures for the hip bone. An important aspect of the study was documentation that a continuous regimen of calcium supplementation was reported for the maximum effect to occur. Skeletal health benefits were lost within two years after discontinuation of a calcium supplement. Clinical studies and meta-analyses show calcium plus vitamin D may show a greater efficacy in osteoporosis patients. One large study by Jackson focused on women aged 50 to 79. These patients were given 1,000 mg of calcium plus 400 IU of vitamin D for seven years. Results showed an improvement in bone mineral density and an insignificant reduction in fracture risk. A limitation of the study was a poor compliance rate in the administration of the supplement. A subgroup of women in this study who were at least 80% compliant for the seven years appeared to have a significant reduction in hip fracture risk of approximately 29%. Calcium use in male patients has not been well studied. A study by Ebeling et al. suggested the administration of 1,000 mg of calcium a day in divided doses for two years led to a positive outcome. An increase of 2% to 4% in cortical or trabecular bone mass was reported. Furthermore, the study found that calcium is likely to be effective in osteoporosis when patients are compliant and using the most effective dose of calcium and vitamin D. Calcium supplementation is well tolerated; however, adverse reactions such as belching, flatulence, nausea, and constipation may be experienced at doses between 1 and 2 gm. At doses greater than 4 to 5 gm, headache, muscle weakness, apathy, fatigue, hypertension, nervousness, and insomnia may be seen. Chronic large intake of calcium may lead to hypercalcemia and renal insufficiency. The symptoms of hypercalcemia include fatigue, weakness, headache, loss of ap- CREDIT This lesson provides two hours of CE credit and requires a passing grade of 70%.* OBJECTIVES Upon completion of this article, the pharmacist and technician should be able to: Review common natural medicines used for bone health List dosages used for natural medicines to manage bone health Discuss safety and effectiveness of specific agents Discuss relevant patient information to allow safe use of supplements Discuss common adverse effects seen with the use of supplements *To receive credit you must score 70% or higher on the quiz and complete the evaluation. Upon successful completion, the University of Florida College of Pharmacy will mail Statements of Credit for written quizzes within 10 working days. Participants completing the program on-line may print a Statement of Credit after successfully completing the program. hormone will lead to the release of calcium from the bone by osteoclasts. Consequently, bone calcium stores are decreased further. Bone loss results when resorption exceeds formation. As a patient grows older, low calcium levels remain a problem due to decreased calcium absorption from the gastrointestinal (GI) tract, poor excretory conservation, and a decrease in estrogen concentrations in women. Systemic estrogen also regulates calcitonin secretion in the body. As estrogen levels in women decrease, calcitonin is secreted, leading to an increase in bone resorption. Near age 40, there is an estimated bone loss of 2%. Bone loss appears in men years later because of their large bone mass as well as having no effect from estrogen loss. Bone loss is more significant in patients who do not meet the recommended daily requirement. Calcium supplementation is believed to increase bone mineral density, decrease risk of fracture, decrease bone loss, and decrease bone remodeling in patients with osteoporosis. A normal therapeutic dose of calcium for adults up to the age of 50 is 1,000 mg daily; for women 51 years of age and over the dose is 1,200 to 1,500 mg of calcium daily in divided doses. The addition of 800 IU of vitamin D to at least 1,000 mg of calcium daily may increase calcium absorption. An adequate dietary intake of calcium should be maintained on a daily basis, or, if necessary, supplementation with a cal- http://www.drugtopics.com

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Drug Topics - December 10, 2007 Latebreakers Latebreakers in Depth Letters Health-System Edition - Cover Story Clinical Practice Professional Practice Special Report Technology Community Practice Unraveling Medicare 150 Years of American Pharmacy Rx Care In the Pipeline Cover Story: Fair or foul? Self-Care Chains and Business Government and Law Continuing Education: Natural Medicines for Bone Health New Products Advertisers Index Classified Viewpoint

Drug Topics - December 10, 2007

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