Calcium D3 Nycomed: how to take

A person, regardless of gender and age, constantly contains 1100-1200 mg of calcium in the body. It is present in teeth and bones. Very little of the mineral is found in urine, blood and saliva. With constant physical activity and while carrying a child, the body needs more calcium. If there is a lack of it, bone problems and diseases can begin. In this case, Calcium d3 Nycomed will help.

Signs of mineral deficiency in the body

The role of calcium in the human body is obvious: it is an integral element of bone tissue, nails and hair. Nutritionists, depending on weight, set the daily requirement at 500-1100 mg of the mineral. It promotes beautiful hair and strong nails.

Reviews of the drug indicate that it is popular among patients experiencing calcium deficiency.

Signs of a mineral deficiency include:

pain in the bones, which is associated with bone loss;
brittle and dry hair, its frequent loss;
problematic skin;
slow weight gain in children;
toxicosis in pregnant women;
miscarriages;
deterioration of the condition of teeth, the appearance of dental diseases;
nail fungus.

Osteoporosis

Report from the symposium “Osteoporosis today: the place of calcium and vitamin D in prevention and treatment”

The significance of the problem of osteoporosis in modern medicine is steadily increasing every year. Paradoxically, one of the main reasons that increases the risk of developing osteoporosis is an increase in human life expectancy. What are the current views on the prevention and treatment of this disease? Which drugs and treatment methods should you prefer? “Osteoporosis today: the place of calcium and vitamin D3 in prevention and treatment ,” which was held as part of the regular XIV Russian National Congress “Man and Medicine” on April 16, 2007, was devoted to these issues

The first message of the symposium, “Calcium and vitamin D3 in the prevention and treatment of osteoporosis from the point of view of evidence-based medicine,” was made by Doctor of Medical Sciences, Professor O.B. Ershova . Already at the very beginning of the speech, attention was focused on the great medical and social significance of the problem. “Osteoporosis is a very common skeletal disease: more than 30% of women over 60 years of age suffer from osteoporosis, and 70% of women over 80 years of age,” recalled Professor O.B. Ershova.

The most important direction in the fight against osteoporosis is to prevent the development of the disease. In the presence of a deficiency of vitamin D3, calcium absorption in the intestine is impaired, which leads to disruption of its deposition in bone tissue, the development of osteoporosis and bone fractures. Vitamin D is of great importance in maintaining muscle strength and balancing ability through its effect on highly specific muscle tissue receptors, which is important in the prevention of falls, and therefore fractures. The norms for calcium and vitamin D3 intake are known. They are recommended by the Ministry of Health of the Russian Federation and determined by the European Osteoporosis Association.

Recently, experts have identified 5 main issues regarding taking calcium supplements:

Should I take calcium and D3 in postmenopause?
Should doses and dosage regimens differ by age?
What is the relationship between the effectiveness of calcium and/or D3?
What are the levels and safety criteria for taking calcium and/or D3?
Should specific osteoporosis treatment be combined with calcium and/or D3 supplementation?

The answer to the first question can be given in the form of the following list of facts:

Adequate dietary calcium intake throughout life should ensure normal bone density
A lack of calcium during growth leads to a decrease in peak bone mass, which increases the risk of fractures in the elderly.
Calcium is less easily absorbed from foods rich in oxalic acid.
As D3 levels decrease, the secretion of PTH (parathyroid hormone, PTH) increases, inducing resorption.
Experts consider a D3 content of at least 50 nmol/l sufficient.

Speaking about the situation in Russia, Professor O.B. Ershova noted that the prevalence of calcium deficiency in children is estimated at 75%, and the average calcium intake from dairy products in women does not exceed 350 mg/day. The prevalence of D3 deficiency is also high: 44.6% of boys and 28.5% of girls are deficient. Only 3.5% of women have normal D3 levels and 23% of women over 50 years of age have a deficiency. Additionally, in patients with femoral neck fractures, 22% had severe D3 deficiency and 43% had moderate deficiency.

Answering the second question, Professor O.B. Ershova noted that the effectiveness of taking calcium and vitamin D3 is high only if there is high adherence to treatment. The failures in the above studies can be explained precisely by the fact of 50% adherence to treatment, as well as by some other study parameters that do not allow them to be considered proven. Calcium intake should increase with age for a number of reasons: a decrease in endogenous calcitriol production, a decrease in intestinal absorption and reabsorption of calcium in the kidneys, and an age-related increase in the risk of osteoporosis. In this regard, taking calcium and vitamin D3 is indicated for all persons over 65 years of age, and for those under 65 years of age, treatment is indicated for calcium and vitamin D deficiency. The most effective dose is 1000 mg of calcium and 800 IU D3 per os daily. When assessing the effectiveness of using calcium and/or D3, it was noted that only the combination of calcium and D3 significantly reduces the risk of fractures.

The WHI study (more than 36,000 patients) showed that taking 1000 mg of calcium and 400 IU D3 increased hip mineral density. A detailed analysis revealed a subgroup in which the risk of hip fractures decreased by 29% when taking calcium and vitamin D3. This subgroup included participants who followed recommendations for taking calcium and vitamin D3. One of the study's findings: participants did not consistently follow prescribed preventive measures; Only 59% of participants in this study took more than 80% of doses during the trial.

Speaking about the safety of treatment, it was noted that the main side effects of using calcium and D3 are gastrointestinal disorders (constipation, nausea, flatulence, diarrhea, abdominal pain). But such reactions are rare and are observed extremely rarely when taking calcium supplements with meals and not more than 600 mg at a time. Adequate hydration also helps. Summing up the speech, Professor O.B. Ershova presented the following conclusions:

Adequate calcium intake is necessary throughout life
The effectiveness of taking calcium and D3 in postmenopause is guaranteed with a level of treatment adherence of at least 75%.
Taking calcium and D3 should be recommended for people with osteoporosis and osteopenia.
Serum 25(OH)D levels should be at least 50 nmol/L.
Persons over 65 years of age should be required to receive constant treatment, and those over 50 and younger - if indicated, for calcium deficiency
The most effective combination is 1000-1200 mg of calcium (500-600 mg 2 times a day) and vitamin D (700-800 IU / day)

Drugs ideal for such treatment are Calcium-D3 Nycomed and Calcium-D3 Nycomed Forte . It is known that Calcium-D3 Nycomed is recommended by the Russian Osteoporosis Association as the least expensive drug for long-term prevention and as a drug with an effective combination of calcium and vitamin D 3. This is what makes it ideal from the point of view of the prevention and treatment of osteoporosis. At the end of the speech, attention was drawn to the presence of Russian recommendations “Osteoporosis. Diagnostics, prevention, treatment”, which any doctor who is faced with the problem of osteoporosis in practice should have.

A logical continuation of the theme of the symposium was the speech of Doctor of Medical Sciences N.V. Toroptsova: “Calcium-D3 Nycomed in the prevention of postmenopausal osteoporosis. Results of a 3-year multicenter study . The report reported that osteopenia is a common occurrence in women over 50 years of age (occurs in 46% of cases), and severe vitamin D3 deficiency occurs in every third postmenopausal patient. And only 23% of women have mineralization levels within the normal range. The incidence of osteoporosis increases with age. At 45-49 years old, osteoporosis almost never occurs, but 32% of such women already have signs of osteopenia. It follows that they are prime candidates for developing osteoporosis in subsequent years. Therefore, special attention should be paid to the quality of life of patients with reduced bone mineral density (BMD). Russian studies show that postmenopausal women have insufficient calcium intake from food. Thus, in women with normal BMD, the average calcium intake was approximately 800 mg, while in osteopenia this intake was 693 mg. Only 6% of postmenopausal women consume calcium in recommended amounts (1000 mg/day), while 74% have intakes below 800 mg.

The status of vitamin D3 in postmenopause was separately noted. The best laboratory method for diagnosing D3 sufficiency is to determine the concentration of 25(OH)D. Thus, the speaker’s research shows that in postmenopausal women the norm occurs only in 3.2% of cases, and a pronounced deficiency in 33% of cases. The distribution of the deficit by season is also interesting. Thus, in September-October there is a peak in D3 concentration, and in January-February it decreases by almost 1.5 times. The relationship between BMD indicators (g/cm2) and D3 concentration is also interesting. It has been shown that BMD is higher where the D3 concentration is higher, and normal BMD values are typical for D3 concentrations above 50 nmol/l. Physical activity also affects BMD. Thus, in the group of women who regularly engage in physical activity, osteopenia occurs in 13% of cases, while in the absence of regular exercise, osteopenia (OP) occurs in 29% of cases. In general, screening of postmenopausal women showed the following:

There is insufficient dietary calcium intake. At the same time, women with normal BMD values receive significantly more calcium from food than women with osteopenia.
An assessment of the level of D3 in the blood showed that in 96.8% of postmenopausal women its concentration is reduced.
There is low physical activity in postmenopausal women, which increases the risk of osteopenia.

Prevention of osteoporosis in postmenopausal women is aimed at reducing the risk of fractures. Activities include: weight loss, smoking cessation, active lifestyle, adequate calcium and D3 intake. To evaluate the effectiveness of the prevention of primary osteoporosis in Russia, an open multicenter study was conducted, in which Moscow, Yaroslavl, and Irkutsk took part. The study was conducted on 970 women (240 normal, 730 with osteopenia) using a questionnaire, densitometry of the spine and femur, X-ray morphometry, and laboratory examination (including urine calcium/creatinine index). The women were divided into 3 groups. of Calcium-D3 Nycomed for 3 years , the second group received 2.5 grams of calcium carbonate, the third group did exercise therapy and used a balanced diet.

The dynamics of BMD showed a reliable and significant (approximately 2.3 times) improvement in the mineralization of the lumbar spine when taking Calcium-D3 Nycomed in comparison with all other groups. BMD of the femoral neck showed the lowest values of demineralization when taking Calcium-D3 Nycomed (-1.42 g/cm2) in comparison with other groups (-3.2 when taking calcium carbonate, -3.9 in the rational nutrition group and -4.8 in control). An assessment of vertebral deformation showed that the minimum values (0.9 per 100 person-years) were typical for the group taking Calcium-D3 Nycomed , and the maximum (4.3 per 100 person-years) for the exercise therapy group. In general, the study allowed us to formulate the following conclusions:

Taking the drug Calcium-D3 Nycomed significantly increases BMD in the lumbar spine and reduces calcium loss in the femoral neck
Calcium-D3 Nycomed reduces the number of cases of vertebral deformity
The incidence of hypercalcemia and hypercalciuria when taking Calcium-D3 Nycomed does not exceed similar figures in the group without drug treatment
Good tolerability of the drug Calcium-D3 Nycomed .
Calcium-D3 Nycomed can be prescribed to all postmenopausal women with severe deficiency.

The topic of the next report, “Osteoporosis as a consequence of endocrinopathies: pathogenesis, diagnosis and treatment,” was presented by Professor L.Ya. Rozhinskaya . At the beginning of the speech, attention is drawn to the factors that control the processes of bone remodeling:

Calcium-regulating hormones – parathyroid hormone, calcitonin, calcitriol
Other hormones – glucocorticoids, sex hormones, thyroid hormones, growth hormone, insulin
Systemic growth factors – IGF-1, IGF-2, platelet-derived growth factor, fibroblast growth factor
Local factors - prostaglandins, TNF (TNF-alpha), TFGb, interleukins 1-6, osteocalcin, osteopantin.

Professor L.Ya. Rozhinskaya recalled that some endocrine diseases lead to osteopenia. These include hypercortisolism, hyperparathyroidism (ranked 3rd in the prevalence of endocrinopathies), thyrotoxicosis, hypogonadism, type 1 diabetes, and hypopituitarism. Thus, with hypercortisolism, up to 70% of patients have osteoporosis. In this case, there is a decrease in calcium absorption, an increase in calcium secretion, an increase in osteoblast apoptosis, an increase in osteoclast activity, an increase in PTH synthesis, a decrease in sex hormones, a decrease in calcitonin, and a decrease in the number of receptors for 1,25(OH)D (VDR). All this leads to a decrease in bone mass. Taking glucocorticoids in an amount of 5 mg/day increases the risk of hip fractures by 1.8 times and spine fractures by 2.6 times. Therefore, during treatment with steroids, it is necessary to teach the patient how to live in conditions of increased bone fragility, recommend adequate physical activity, and also take Calcium-D3 Nycomed 2 tablets per day. It is also recommended to take bisphosphonates and calcitonin.

Even subclinical hyperthyroidism is important for the development of osteoporosis. Treatment of such patients with Calcium-D3 Nycomed showed a significant decrease in the level of bone metabolism markers after 12 months.

The problem of osteoporosis in men deserves special mention. Speaking about the factors contributing to the development of osteoporosis, the speaker noted the great importance of secondary causes. But in any case, the development of osteoporosis manifests itself through a decrease in the level of free testosterone. The development of hypogonadism is associated with Klinefelter syndrome, hypogonadotropic hypogonadism, liperprolactinemia, primary testicular failure, and age-related androgen deficiency syndrome.

The only drug for which evidence of effectiveness has been obtained is alendronate. Calcium-D3 Nycomed is also indicated .

Speaking about hyperparathyroidism, it was noted that hyperproduction of PTH leads to osteoporosis, osteodystrophy, calcemia, and hypercalciuria. Professor L.Ya. Rozhinskaya recalled that the disease is often disguised as systemic osteoporosis, diabetes, nephrolithiasis, peptic ulcer, and myopathy. The main laboratory signs of the disease include: an increase in total and ionized calcium in the blood, an increase in PTH more than 76 pg/ml, hypophosphatemia below 0.7 mmol/l, increased alkaline phosphatase activity, calciuria more than 400 mg/day, increased excretion of hydroxyproline and cAMP in the urine , increased osteocalcin levels. If laboratory and clinical data are severe, treatment can be surgical in patients under 50 years of age. Postoperative treatment involves taking Calcium-D3 Nycomed (up to 6 tablets), AT-10 (5-10 drops), alfacalcidol ( Etalfa ). Treatment is carried out against the background of regular monitoring of biochemical parameters and osteodensitometry. Mild forms of the disease are treated therapeutically with HRT, bisphosphonates, and the drug Miacalcic 200 IU.

The final report of the symposium was presented by Doctor of Medical Sciences, Professor G.V. Volgina : “The importance of the drug Etalfa in the treatment of renal osteodystrophy . The report noted that the prevalence of chronic kidney disease (CKD) is quite high. So, in the USA alone there are about 20 million patients. There is an increase in the number of patients who need replacement therapy. For example, if in 1990 approximately 400,000 patients were treated with hemodialysis, in 2000 - more than a million. Complications of CKD are a decrease in the level of calcitriol and vitamin D. This leads to impaired calcium metabolism, both in the kidneys and in the body as a whole, starting from the level of absorption. Due to increased PTH levels, symptoms of bone tissue pathology (fractures, bone pain, bone marrow fibrosis) and systemic toxicity appear. As CKD develops, PTH levels gradually increase. There is a lack of vitamin D concentration and a decrease in calcitriol levels. Vitamin D deficiency occurs at stages that do not require serious intervention by a nephrologist, so the deficiency only worsens over the course of CKD. When patients receive active long-term therapy for CKD, such as steroids, the risk of osteoporosis increases significantly. The bone response in CKD includes: changes in metabolic processes in the bone (skeletal remodeling, bone resorption); changes in bone volume (loss or growth); violation of bone mineralization. Bone remodeling is influenced by hormones, cytokines, growth factors, and physical activity. All this is reflected in the activity of osteoblasts and osteoclasts. A change in balance (bone volume) can be expressed in the formation of low-turnover or high-turnover osteoporosis or osteosclerosis. A defect in bone tissue mineralization can go in one of the following directions: hyperparathyroid bone disease, uremic osteodystrophy (local mineralization defect), adynamic bone disease, generalized osteomalacia. A pronounced relationship has been established between metabolic disorders (mineralization) of bone and calcification of the cardiovascular system. The effect of CKD on increased PTH is explained through phosphate retention and low calcitriol levels, which leads to hypocalcemia and the development of hyperparathyroidism.

The main objectives of the treatment of mineral metabolism disorders and hyperparathyroidism in patients with chronic renal failure include: compensation for the lack of vitamin D2 - 1.25(OH)D, restriction of phosphorus in the diet, additional intake of calcium and active metabolites of vitamin D, and, if necessary, parathyroidectomy. Taking active vitamin D metabolites is crucial in maintaining the health of patients with CKD. Thus, a decrease in glomerular filtration rate to 60 is a signal to begin therapy with Etalfa , provided that the PTH level does not meet the target values: 3.85-7.7 pmol/L with a moderate decrease in GFR (30-60 ml/min); 7.7 – 12.1 pmol/L with a severe decrease in GFR; 15-30 pmol/L with the development of renal failure. Etalfa has a normalizing effect regardless of kidney function. Peak levels of the drug are achieved in plasma 7-12 hours after administration and further activate VDR levels in other organs and tissues. Treatment with Etalfa is indicated when serum 25(OH)D levels are less than 30 ng/mL (75 nmol/L) and plasma intact PTH levels are above target values for that stage of CKD. Treatment with active forms of vitamin D should only begin in patients with corrected levels of total calcium (less than 2.37 mmol/L) and phosphorus (less than 1.49 mmol/L). The standard starting dose is 0.25 mcg/day orally. More effective for reducing iPTH is intermittent administration: 0.5-1 mcg 2-3 times a week (preferably intraperitoneally). It is undesirable to prescribe Etalfa to patients with low adherence to treatment, those who avoid medical supervision, and those with rapid deterioration of renal function. At the end of the speech, Professor G.V. Volgina once again noted the importance of the problem of osteoporosis in CKD: in the early stages of CKD, hyperparathyroidism develops; bone loss in CKD is associated with low vitamin D levels and increased PTH; In the later stages of CKD, bone loss leads to increased mortality, including due to vascular calcification. Against this background, active vitamin D - Etalfa - can be used for early control of PTH and termination of thyroid hyperplasia. In addition, treatment with Etalfa prevents bone loss and associated complications in chronic kidney disease.

The symposium ended with the speakers' answers to incoming questions and a lively discussion on the prevention of treatment of mineral metabolism disorders with the help of
Calcium-D3 Nycomed and Etalfa. The activity of doctors from various specialties present at the symposium became another evidence of not only the relevance, but also the high practical significance of the problem of osteoporosis in medicine at the beginning of the 21st century.
Internet project "RMS-Expo" E-mail Web: Expo.rusmedserv.com

Contraindications and adverse reactions

You can read the instructions for side effects. These include:

from the metabolic side: hypercalciuria and hypercalcemia - expressed by decreased performance, lethargy, unclear thinking, problems with the heart and blood vessels;
from the gastrointestinal tract: intestinal upset, nausea, vomiting, attacks, abdominal pain;
from the central nervous system: excessive excitability, emotionality;
on the skin: itching, rash, urticaria (can be confused with any other condition, since these symptoms are characteristic of many diseases).

The drug is contraindicated in the following cases:

excess zinc in the blood;
individual intolerance to at least one component;
renal failure;
tuberculosis.

Interaction with other drugs

If the drug is taken together with other medications to treat heart and vascular diseases, toxic effects on the liver, heart and blood vessels often occur. If you still can’t stop taking them in parallel, then you should regularly monitor the level of minerals in the blood.

If you take the drug with antibiotics of the tetracycline group, the latter will be poorly absorbed. You should wait at least 3-4 hours between doses.

According to doctors, when taken together with multivitamin supplements, there may be an excess of zinc in the blood and problems in the functioning of the cardiovascular system. You should take vitamins and minerals with caution so as not to lead to an overabundance of the latter.

special instructions

Based on reviews of the drug, we can conclude that after taking it in the morning on an empty stomach, nausea and sometimes pain in the stomach may appear. This effect occurs due to the presence of cholecalciferol in the composition. This component provokes pain and cramps in patients prone to gastrointestinal diseases. Therefore, it is best to take the tablets after meals.

You should not take Calcium D3 Nycomed in parallel with alcohol, black tea and coffee drinks. The most harmless thing that can happen is that the substances are not absorbed; in the worst case, intoxication will occur.

When taken with alcohol, nausea and vomiting often occur. This is the body's reaction to the presence of incompatible substances.

The drug can be taken during pregnancy and lactation. If a pregnant woman takes Calcium, her baby will be born strong and healthy. The active substances are also able to pass into breast milk.

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.