To the content
5 . 2020

The effect of administration of dietary supplement with calcium and vitamins D3 and B6 on calcium homeostasis and falls incidence in patients with high fracture risk undergoing medical rehabilitation

Abstract

Elimination of vitamin D and calcium deficiencies is of particular importance in older patients undergoing medical rehabilitation after a serious illness, surgery or injury and having a high risk of fractures. Preventing falls and fractures, including during the course of rehabilitation, is an important challenge that can be addressed in these patients, in particular through improved nutrition and vitamin D and calcium supplementation.

The aim of the study was to evaluate the effect of long-term intake of a complex dietary supplement with calcium and vitamins D3 and B6 on calcium homeostasis and the frequency of falls in patients with high fracture risk undergoing medical rehabilitation. Material and methods. The study enrolled 109 women and 10 men (mean age 65.5±7.9 years) with high fracture risk who were undergoing medical rehabilitation. After baseline examination, 41 patients have been receiving antiresorptive therapy already comprised group 1, and patients who didn’t receive osteoporotic therapy were randomized into groups 2 (n=39) and3 (control, n=39). Patients in groups 1 and 2 for 12 months were prescribed a dietary supplement containing calcium in a daily dose of 200 mg (in the form of citrate 1000 mg), 600IU of vitamin D3 and 2 mg of vitamin B6. Allpatients underwent assessment of bone mineral density (BMD), calculation of absolute 10-year fracture risk according to FRAX, assessment of food calcium intake, etermination of biochemical parameters of calcium-phosphorus metabolism and bone remodeling (total calcium, inorganic phosphorus, alkaline phosphatase activity - by colorimetric method in blood serum; immunoreactive parathyroid hormone (PTH) and osteocalcin - by electrochemiluminescence immunoassay in blood serum; β-isomer of C-terminal telopeptide of type I collagen (CTx) and 25(OH)D in blood plasma - by immu-nochemiluminescence analysis), cases of falls and fractures were fixed.

Results. Average daily intake of calcium in the studied sample (n=119) was 782.9±243.4 mg, and 67.2% of patients consumed less than 800 mg of calcium daily. Vitamin D deficit was detected in 38.4% of the examined, its insufficiency - in 32.8%. An increase in 25(OH)D concentration was noted in groups 1 and 2 after 6 and 12 months (p<0.01), while in group 3 there was no dynamics of 25(OH)D (p>0.05). Patients in group 1 showed an increase in the level of osteocalcin and total calcium after 6 and 12 months, as well as alkaline phosphatase activity after 6 months (p<0.05). In group 3, there was an increase of PTH levels after 6 (p<0.05) and 12 months (p<0.01), CTx and alkaline phosphatase activity after 12 months (p<0.05). In group 1, there was an increase in BMD in the spine (+4.2%, p=0.024), femoral neck (+3.0%, p=0.041), and total femur (+2.7%, p=0.045), in patients of group 2 -an increase in BMD in the spine (+1.8%, p=0.048). In group 1, there was also a decrease in proportion of patients who fell after 6 months (x2=4.97, p=0.026) and a decrease in the total number of falls after 12 months (x2=4.89, p=0.027). Group 2 showed a decrease in the number of patients who fell after 6 and 12 months (x2=48.58, p=0.0034 at both stages of the study) and the number of falls in general after 6 months (x2=6.02, p=0.0142).

Conclusion. The obtained data allow us to recommend prescription of dietary supplements containing calcium and vitamin D3 as a part of complex rehabilitation of patients with high fracture risk.

Keywords:calcium intake, vitamin D, fracture risk, rehabilitation, fall risk

Funding. The study was carried out at the authors' personal funds.

Conflict of interest. The authors declare that they have no conflict of interest.

For citation: Marchenkova L.A., Fesyun A.D., Gerasimenko M.Yu., Makarova E.V. The effect of administration of dietary supplement with calcium and vitamins D3 and B6 on calcium homeostasis and falls incidence in patients with high fracture risk undergoing medical rehabilitation. Voprosy pitaniia [Problems of Nutrition]. 2020; 89 (5): 89-100. DOI: https://www.doi.org/10.24411/0042-8833-2020-10069 (in Russian)

References

1. Zhao J.G., Zeng X.T., Wang J., Liu L. Association between calcium or vitamin D supplementation and fracture incidence in community-dwelling older adults: a systematic review and meta-analysis. JAMA. 2017; 318 (24): 2466–82. DOI: https://doi.org/10.1001/jama.2017.19344

2. Wang Y., Wactawski-Wende J., Sucheston-Campbell L.E., Preus L., Hovey K.M., Nie J., et al. The influence of genetic susceptibility and calcium plus vitamin D supplementation on fracture risk. Am J Clin Nutr. 2017; 105 (4): 970–9. DOI: https://doi.org/10.3945/ajcn.116.144550

3. Lötters F.J.B., Lenoir-Wijnkoop I., Fardellone P., et al. Dairy foods and osteoporosis: an example of assessing the health-economic impact of food products. Osteoporos Int. 2013; 24 (1): 139–50. DOI:https://doi.org/10.1007/s00198-012-1998-6

4. Camacho P.M., Petak S.M., Binkley N., Diab D.L., Eldeiry L.S., Farooki A., et al. American association of clinical endocrinologists/american college of endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis. 2020 Update executive summary. Endocr Pract. 2020; 26 (5): 564–70. DOI: https://doi.org/10.4158/GL-2020-0524

5. Hill K.D., Suttanon P., Lin S.I., Tsang W.W.N., Ashari A., Hamid T.A.A., et al. What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials. BMC Geriatr. 2018; 18 (1): 3. DOI:https://doi.org/10.1186/s12877-017-0683-1

6. Wu H., Pang Q. The effect of vitamin D and calcium supplementation on falls in older adults: a systematic review and meta-analysis. Orthopade. 2017; 46 (9): 729–36. DOI: https://doi.org/10.1007/s00132-017-3446-y

7. Bolland M.J., Grey A., Avenell A. Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis. Lancet Diabetes Endocrinol. 2018; 6 (11): 847–58. DOI: https://doi.org/10.1016/S2213-8587(18)30265-1

8. Pilz S., Zittermann A., Trummer C., et al. Vitamin D testing and treatment: a narrative review of current evidence. Endocr Connect. 2019; 8 (2): R27–43. DOI:https://doi.org/10.1530/EC-18-0432

9. Papaioannou A., Kennedy C.C., Giangregorio L., Ioannidis G., Pritchard J., Hanley D.A., et al. A randomized controlled trial of vitamin D dosing strategies after acute hip fracture: no advantage of loading doses over daily supplementation. BMC Musculoskelet Disord. 2011; 12: 135. DOI: https://doi.org/101186/1471-2474-12-135

10. Marchenkova L.A., Makarova E.V. Benefits of combined calcium and vitamin D in the prevention and treatment of osteoporosis: renaissance of the paradigm. Profilakticheskaya meditsina [Preventive Medicine]. 2017; 20 (4): 57–62. DOI: https://doi.org/10.17116/profmed201720457-62 (in Russian)

11. Morris M.E. Preventing falls in older people. BMJ. 2012; 345: e4919. DOI: https://doi.org/10.1136/bmj.e4919

12. Oliver D., Daly F., Martin F.C., et al. Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age Ageing. 2004; 33: 122–30. DOI: https://doi.org/10.1093/ageing/afh017

13. Burton E., Lewin G., O’Connell H., Hill K.D. Falls prevention in community care: 10 years on. Clin Interv Aging. 2018; 13: 261–69. DOI: https://doi.org/10.2147/CIA

14. Sherrington C., Fairhall N.J., Wallbank G.K., Tiedemann A., Michaleff Z.A., Howard K., et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019; 1: CD012424. DOI: https://doi.org/10.1002/14651858.CD012424.pub2

15. Mazurov V.I., Lesnyak O.M., Belova K.Yu., Ershova O.B., Zotkin E.G., Marchenkova L.A., et al. Algorithms for choosing the treatment of osteoporosis in the provision of primary health care and the organization of preferential drug provision for certain categories of citizens who are entitled to receive state social assistance. System review and resolution of the expert Council of the Russian Association for osteoporosis. Profilakticheskaya meditsina [Preventive Medicine]. 2019; 22 (1): 57–65. DOI: https://doi.org/10.17116/profmed20192201157 (in Russian)

16. Mel’nichenko G.A., Belaya Zh.E., Rozhinskaya L.Ya., Toroptsova N.V., Alekseeva L.I., Biryukova E.V., et al. Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis. Problemy endokrinologii [Problems of Endocrinology]. 2017; 63 (6): 392–426 (in Russian)

17. Belaya Zh.E., Rozhinskaya L.Ya., Grebennikova T.A., Kanis J.A., Pigarova E.A., Rodionova S.S., et al. Summary of the draft federal clinical guidelines for osteoporosis. Osteoporoz i osteopatii [Osteoporosis and Osteopathy]. 2020; 23 (2): 4–21. DOI: https://doi.org/10.14341/osteo12373 (in Russian)

18. Pigarova E.A., Rozhinskaya L.Ya., Belaya Zh.E., Dzeranova L.K., Karonova T.L., Ilin A.V., et al. Clinical guidelines of the Russian Association of Endocrinologists for the diagnosis, treatment and prevention of vitamin D deficiency in adults. Problemy endokrinologii [Problems ofEndocrinology]. 2016; 62 (4): 60–84. (in Russian)

19. Lesnyak O.M., Nikitinskaya O.A., Toroptsova N.V.,Belaya Zh.E., Belova K.Yu., Bordakova E.V., et al. The prevention, diagnosis, and treatment of vitamin D and calcium deficiencies in the adult population of Russia and in patients with osteoporosis (according to the materials of prepared clinical recommendations). Nauchno-prakticheskaya revmatologiya [Rheumatology Science and Practice]. 2015; 53 (4): 403–8. DOI: https://doi.org/10.14412/1995-4484-2015-403-408 (in Russian)

20. Barilko M., Tsurtsumiya D., Seliverstov P., Radchenko V. Osteomed in the practice of a general practitioner. Vrach [Physician]. 2017; (3): 37–40. (in Russian)

21. Marchenkova L.A., Dreval’ A.V., Dobritsyna M.A. The structure of clinical risk factors for osteoporosis and the level of calcium intake with food in the female population of the Moscow Region. Lechashchiy vrach [Attending Physician]. 2014; (5): 89–95. (in Russian)

22. Nikitinskaya O.A., Toroptsova N.V. The social program «Osteoskrining Russia» in action. Farmateka [Pharmateca]. 2012; (6): 90–3 (in Russian)

23. Shilin D.E., Shilin A.D., Adamyan L.V. Does the Russian population have a relationship between the risk of fractures on the FRAX scale (WHO 2008) and calcium intake? Collection of theses of the IV Russian Congress on osteoporosis. Osteoporoz i osteopatii [Osteoporosis and Osteopathy]. 2010; (1): 53–4. (in Russian)

24. Markova T.N., Markov D.S., Markelova T.N., et al. The prevalence of vitamin D deficiency and risk factors for osteoporosis in young people. Vestnik Chuvashskogo universiteta [Bulletin of the Chuvash University]. 2012; (3): 441–5 (in Russian)

25. Avdeeva V.A., Suplotova L.A., Rozhinskaya L.Ya. On the question of the prevalence of vitamin D deficiency and insufficiency. Osteoporoz i osteopatii [Osteoporosis and Osteopathy]. 2020; 23 (1): 20–1. (in Russian)

26. Karonova T.L., Grineva E.N., Nikitina I.L., et al. The prevalence of vitamin D deficiency in the Northwest region of the Russian Federation among the residents of St. Petersburg and Petrozavodsk. Osteoporoz i osteopatii [Osteoporosis and Osteopathy]. 2013; (3): 3–7. (inRussian)

27. Bergmann P., Body J., Boonen S., et al. Evidence-based guidelines for the use of biochemical markers of bone turnover in the selection and monitoring of bisphosphonate treatment in osteoporosis: a consensus document of the Belgian Bone Club. Int J Clin Pract. 2009; 63 (1): 19–26. DOI: https://doi.org/10.1111/j.1742-1241.2008.01911.x

28. Naylor K.E., Jacques R.M., Paggiosi M., Gossiel F., Peel N.F., McCloskey E.V., et al. Response of bone turnover markers to three oral bisphosphonate therapies in postmenopausal osteoporosis: the TRIO study. Osteoporos Int. 2016; 27 (1): 21–31. DOI: https://doi.org/10.1007/s00198-015-3145-7

29. Chapuy M.C., Chapuy P. Biochemical effects of calcium and vitamin D supplementation in elderly institutionalized, vitamin D-deficient patients. Rev Rhum Engl Ed. 1996; 63 (2): 135–40.

30. Scopacasa F., Horowitz M., et al. Calcium supplementation suppresses bone resorption in early postmenopausal women. Calcif Tissue Int. 1998; 68: 8–12. DOI: https://doi.org/10.1007/s002239900385

31. Scragg R.K.R. Overview of results from the Vitamin D Assessment (ViDA) study. J Endocrinol Invest. 2019; 42 (12): 1391–9. DOI: https://doi.org/10.1007/s40618-019-01056-z

32. Marchenkova L.A., Makarova E.V., Vasileva V.A., Eremushkin M.A., Styazhkina E.M., Razvalyaeva D.V., etal. The effect of basic therapy with calcium and vitamins D3 and В6 on muscle strength, movement and balance functions at patients with osteoporosis undergoing medical rehabilitation. Voprosy kurortologii, fizioterapii i lechebnoy fizicheskoy kul’tury [Problems of Balneology, Physiotherapy and Therapeutic Physical Culture]. 2020; 97 (1): 25–34. DOI: https://doi.org/10.17116/kurort20209701125 (in Russian)

33. Wimalawansa S.J. Non-musculoskeletal benefits of vitamin D. J Steroid Biochem Mol Biol. 2018; 175: 60–81.DOI: https://doi.org/10.1016/j.jsbmb.2016.09.016

34. Bruyère O., Cavalier E., Reginster J.Y. Vitamin D and osteosarcopenia: an update from epidemiological studies. Curr Opin Clin Nutr Metab Care. 2017; 20 (6): 498–503. DOI:https://doi.org/10.1097/MCO.0000000000000411

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

SCImago Journal & Country Rank
Scopus CiteScore
CHIEF EDITOR
CHIEF EDITOR
Viktor A. Tutelyan
Full Member of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Scientific Director of the Federal Research Centre of Nutrition, Biotechnology and Food Safety (Moscow, Russia)

Journals of «GEOTAR-Media»