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Adequate calcium intake from dietary sources or supplements is essential for nutrition across all age groups. Dietary sources rich in calcium lead to recommendations such as the recommended dietary allowances; types of calcium supplements; preventive measures; health benefits, including bone health and cardiovascular support; and risks associated with excessive intake. Dietary calcium is crucial in bone health and metabolism. In young patients, adequate vitamin D and calcium intake are critical for bone growth, established around age 30. Adequate bone health reduces the risk of developing osteoporosis and subsequent pathological fractures in adulthood. This activity equips interprofessional healthcare teams to ensure patients receive appropriate dietary calcium for optimal growth, nutrition, and disease prevention. The effects of calcium absorption, high calcium levels, contraindications such as hypercalcemia or conditions affecting calcium metabolism, and the importance of monitoring calcium levels are highlighted. By addressing these topics in depth, healthcare professionals can enhance their understanding and practice in promoting balanced calcium intake among patients and supporting overall wellness. Objectives: Identify the recommendations for healthy calcium intake based on the indications and formulations of calcium supplementation. Evaluate calcium absorption, metabolism, and regulation steps, and summarize the physiological functions of ionized calcium. Assess adverse events with excessive calcium intake, including considerations on calcium intake in high-risk populations with chronic kidney disease. Implement effective communication among interprofessional team members to ensure adequate calcium supplementation, improving bone health and nutrition in general and high-risk populations. Access free multiple choice questions on this topic.

According to the CDC, hypercalcemia (serum levels >10.5 mg/dL [2.63 mmol/L]) and hypercalciuria (>250 mg/d in women, >275 mg/d in men) are rare in healthy individuals, typically associated with conditions such as cancer and hyperparathyroidism. Symptoms may include muscle weakness, renal insufficiency, constipation, nausea, fatigue, and an increased risk of cardiovascular mortality. High calcium intake may also elevate the risk of cardiovascular disease and prostate cancer, although findings across studies are inconsistent. Signs and Symptoms of Overdose Hypercalcaemia may present with polyuria, anorexia, nausea, constipation, mood disturbances, cognitive dysfunction, coma, shortened QT interval, dysrhythmias, nephrolithiasis, pancreatitis, peptic ulceration, hypertension, cardiomyopathy, muscle weakness, and band keratopathy. Management of Overdose There is no specific antidote or treatment available for excessive supplemental calcium intake. Initial management involves rehydration with IV 0.9% saline at 4 to 6 L/d, with careful monitoring for fluid overload in patients with renal impairment or of older age. Loop diuretics should be used cautiously and only if fluid overload is evident, as they are ineffective for lowering serum calcium levels. Dialysis may be considered for severe renal failure. Further treatment options include IV bisphosphonates, such as zoledronic acid, pamidronate, and ibandronic acid, administered cautiously with dose adjustments in renal impairment. Glucocorticoids, such as prednisolone, inhibit 1,25-dihydroxyvitamin D production, particularly effective in lymphoma or granulomatous diseases. If initial therapies are ineffective, calcimimetics, denosumab, or calcitonin are recommended under specialist supervision. Parathyroidectomy may be considered for acute severe hypercalcemia due to primary hyperparathyroidism resistant to other treatments.[45]

There is no specific antidote or treatment available for excessive supplemental calcium intake. Initial management involves rehydration with IV 0.9% saline at 4 to 6 L/d, with careful monitoring for fluid overload in patients with renal impairment or of older age. Loop diuretics should be used cautiously and only if fluid overload is evident, as they are ineffective for lowering serum calcium levels. Dialysis may be considered for severe renal failure. Further treatment options include IV bisphosphonates, such as zoledronic acid, pamidronate, and ibandronic acid, administered cautiously with dose adjustments in renal impairment. Glucocorticoids, such as prednisolone, inhibit 1,25-dihydroxyvitamin D production, particularly effective in lymphoma or granulomatous diseases. If initial therapies are ineffective, calcimimetics, denosumab, or calcitonin are recommended under specialist supervision. Parathyroidectomy may be considered for acute severe hypercalcemia due to primary hyperparathyroidism resistant to other treatments.[45] According to the Endocrine Society guidelines for hypercalcemia of malignancy, treatment options vary based on specific conditions. Treatment includes IV bisphosphonate or denosumab as primary management options. For severe hypercalcemia of malignancy (Ca2+ >14 mg/dL), calcitonin may be added initially. Denosumab is preferred in refractory or recurrent cases. For tumors with high calcitriol levels, IV bisphosphonate or denosumab is recommended. Treatment options for hypercalcemia from parathyroid carcinoma include calcimimetic, IV bisphosphonate, or denosumab.[46]

Ensuring that individual patients and the larger population understand bone health and the benefits of proper calcium intake and nutrition requires interprofessional collaboration. At the clinical level, clinicians must collaborate to accurately identify patients with varying risks of poor bone health and to focus on high-risk patients. Clinicians must also collaborate to ensure that healthy and young patients receive education on the importance of adequate calcium intake and long-term health benefits. Interprofessional collaboration also allows clinicians to educate one another, ensuring adherence to the best evidence-based practice guidelines. A recent randomized prospective trial assessed the efficacy of an interprofessional educational intervention to improve the management of osteoporosis.[47] Specifically, several long-term care homes participated in 3 educational meetings over 1 year, emphasizing quality improvement, expert opinions, and clinician audit and feedback. A control group of facilities that received no such intervention served as a comparison. This trial demonstrated a significant increase in the prescription of vitamin D and calcium in the intervention group versus the control group. A recent cohort study assessed the efficacy of a drug use evaluation program in improving the management of osteoporosis.[48] Pharmacists led the program and were involved in group education conferences, prescriber feedback, and patient education. The program yielded a statistically significant increase in vitamin D and calcium supplementation in patients when supplementation was indicated. Similar studies demonstrate the importance of continuing education and interprofessional teamwork to ensure patients receive appropriate bone health care and nutrition.

A recent randomized prospective trial assessed the efficacy of an interprofessional educational intervention to improve the management of osteoporosis.[47] Specifically, several long-term care homes participated in 3 educational meetings over 1 year, emphasizing quality improvement, expert opinions, and clinician audit and feedback. A control group of facilities that received no such intervention served as a comparison. This trial demonstrated a significant increase in the prescription of vitamin D and calcium in the intervention group versus the control group. A recent cohort study assessed the efficacy of a drug use evaluation program in improving the management of osteoporosis.[48] Pharmacists led the program and were involved in group education conferences, prescriber feedback, and patient education. The program yielded a statistically significant increase in vitamin D and calcium supplementation in patients when supplementation was indicated. Similar studies demonstrate the importance of continuing education and interprofessional teamwork to ensure patients receive appropriate bone health care and nutrition. At the public health level, interprofessional collaboration is essential for promoting population health and nutrition. A prime example is the continuing effort to fortify various fruit juices and grains with calcium and vitamin D, targeting young patients who have not reached peak bone mass. Today, various national organizations collaborate across professions to advance bone health and nutrition at the population level, including the National Osteoporosis Foundation, the National Academy of Sciences, and the National Bone Health Alliance. The interprofessional team comprises clinicians, pharmacists, nursing staff, and dieticians. These professionals should share their expertise among team members, monitor patient compliance, answer questions, and work collaboratively to guide patient outcomes. An interprofessional team approach and communication among clinicians, pharmacists, and nurses are crucial for decreasing potential adverse effects and improving patient outcomes associated with dietary or supplemental calcium.[49][50]