Archive for the ‘Calcium’ Category
Tertiary HyperParaThyroidism is becoming common among older individuals. Or maybe we are just beginning to notice what it really is. The blood tests are the same as Primary HyperParaThyroidism – high Calcium and high PTH. But the cause and treatment are very different.
Tertiary HyperParaThyroidism happens when Secondary HyperParaThyroidism has been going on for so long that the “thermostat is reset too high”. The ParaThyroid Glands have been maintaining a high PTH level for so long that they forget to shut off when Calcium levels are high enough.
Again we have a patient whose Spine BMD has dropped despite good osteoporosis medication. She takes 500 mg Calcium at breakfast and at supper. She remembers that you can only absorb 5-600 mg Calcium at a meal. But what about lunch? She needs at least 200 mg more calcium in her day.
She plans to eat a yogurt for lunch. This would get her to her minimum of 1200 mg Calcium daily – if only she remembered more than once a week. We need to entice her with a “nooner”. We need her to crave her calcium. Adora Premium Chocolates could do it.
We have “known” for years that 25-hydroxy Vitamin D levels over 50ng/ml are “too high” (hypervitaminosis D) and often cause high Calcium levels (hypercalcemia). The Mayo Clinic designed a 10 year study to confirm that causal relationship. It was presented at ASBMR.
NOF and others have called for higher Vitamin D supplementation and higher blood levels. Mayo researchers expected to find many more cases of hypercalcemia related to many more cases of hypervitaminosis D. The numbers of Vitamin D levels above 50ng/ml have doubled during the 10 years. Levels above 80 and 100ng/ml have not increased. The numbers of high calcium levels have not increased. Those patients with the highest Vitamin D levels were not the patients with the highest Calcium levels.
The question whether calcium supplements are good or bad for you, and how much you should take, is very controversial. That is because it is the wrong question. The answer is “it depends”. We spent an hour at ASBMR going over many studies and analyses.
Total calcium intake is what matters. That means that how much calcium supplement you need today depends on how much calcium is in your diet. Unless you eat the same thing every day (boring!), your need for calcium supplement at each meal will vary. And it is more tricky than that.