Relevance of Calcium and Vitamin D in Supporting Bone Health: An Expert Panel Recommendation in Indonesia
International Journal of Nutrition and Food Sciences
Volume 9, Issue 2, March 2020, Pages: 54-62
Received: Aug. 22, 2019;
Accepted: Apr. 23, 2020;
Published: May 14, 2020
Views 265 Downloads 215
Saptawati Bardosono, Department of Nutrition, Faculty of Medicine, University of Indonesia/ Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Andon Hestiantoro, Department of Obstetrics & Gynecology, University of Indonesia/ Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Andri Maruli Tua Lubis, Department of Orthopaedic Faculty of Medicine, Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Siti Setiati, Department of Internal Medicine Faculty of Medicine, Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Ani Retno Prijanti, Department Biochemistry and Molecular Biology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Purwantyastuti, Department of Pharmacology, Faculty of Medicine, Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Luciana Sutanto, Department of Nutrition, Universitas Kristen Kr, Jakarta, Indonesia
Maria Regina Rachmawati, Faculty of Medicine, Universitas Gunadarma / Pasar Minggu Municipal Hospital, Jakarta, Indonesia
Sheryl Tan, Medical & Clinical Development, Bayer Consumer Care, Singapore
Osteoporosis is a bone health related condition that weakens the bones, making individuals fragile and prone to breaks. Nutrients such as calcium and vitamin D are essential for bone health. Calcium helps in building and maintaining bone mass while vitamin D aids in the absorption and utilization of calcium. According to WHO, 28.8% men and 32.3% women in Indonesia have osteoporosis, and this is inspite of the international recommendations for the daily intake of calcium and vitamin D intake. This could be attributed to low community awareness on how to prevent and care for osteoporosis. Several high-risk population groups have been identified such as those with osteopenia, undergoing rehabilitation and pregnancy/lactation periods. Therefore, in this review, an expert panel comprising of specialties of dietetics, rehabilitation medicine, orthopaedic, obstetrics & gynaecology, pharmacology, and geriatrics, convened to provide an evidence-based guidance on the prevention and care for osteoporosis. The recommendations are as follows: (i) It is important to know that calcium and vitamin D work synergistically to maintain bone health. (ii) The intake of calcium and vitamin D must start early. (iii) We should be aware that our diet and lifestyle today does not allow us to meet the recommended daily intake of calcium and vitamin D required for optimal bone health. (iv) Supplementation can compensate for the deficits in both calcium and vitamin D intake, thereby strengthening bone health. This study could guide the primary health care team, who plays a critical role in community care, to encourage early bone health awareness and care in Indonesia.
Andri Maruli Tua Lubis,
Ani Retno Prijanti,
Maria Regina Rachmawati,
Relevance of Calcium and Vitamin D in Supporting Bone Health: An Expert Panel Recommendation in Indonesia, International Journal of Nutrition and Food Sciences.
Vol. 9, No. 2,
2020, pp. 54-62.
B. campus Open text, “6.1 The Functions of the Skeletal System – Anatomy and Physiology.” [Online]. Available: https://opentextbc.ca/anatomyandphysiology/chapter/6-1-the-functions-of-the-skeletal-system/. [Accessed: 07-May-2019].
“Johns Hopkins Bayview News - The Importance of Bone Health.” [Online]. Available: https://www.hopkinsmedicine.org/news/publications/jh_bayview_news/summer_2013/the_importance_of_bone_health. [Accessed: 07-May-2019].
“Osteoporosis,” nhs.uk, 03-Oct-2018. [Online]. Available: https://www.nhs.uk/conditions/osteoporosis/. [Accessed: 07-May-2019].
“Pregnancy, Breastfeeding and Bone Health | NIH Osteoporosis and Related Bone Diseases National Resource Center.” [Online]. Available: https://www.bones.nih.gov/health-info/bone/bone-health/pregnancy. [Accessed: 07-May-2019].
“Osteoporosis in Rehabilitation.” [Online]. Available: https://www.aapmr.org/about-physiatry/conditions-treatments/musculoskeletal-medicine/osteoporosis-in-rehabilitation. [Accessed: 07-May-2019].
Y. Dionyssiotis, G. Skarantavos, and P. Papagelopoulos, “Modern Rehabilitation in Osteoporosis, Falls, and Fractures,” Clin. Med. Insights Arthritis Musculoskelet. Disord., vol. 7, pp. 33–40, Jun. 2014.
E. M. C. Lau, “Osteoporosis–a worldwide problem and the implications in Asia.,” Ann. Acad. Med. Singapore, vol. 31, no. 1, pp. 67–68, 2002.
“Vitamin D, calcium homeostasis and aging.” [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5068478/. [Accessed: 22-Apr-2019].
“Office of Dietary Supplements - Calcium.” [Online]. Available: https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/. [Accessed: 16-Apr-2019].
M. Brini, T. Calì, D. Ottolini, and E. Carafoli, “Intracellular calcium homeostasis and signaling,” Met. Ions Life Sci., vol. 12, pp. 119–168, 2013.
E. Carafoli and J. Krebs, “Why Calcium? How Calcium Became the Best Communicator,” J. Biol. Chem., vol. 291, no. 40, pp. 20849–20857, Sep. 2016.
M. P. Blaustein, “Intracellular Calcium as a Second Messenger,” in Calcium in Biological Systems, R. P. Rubin, G. B. Weiss, and J. W. Putney, Eds. Boston, MA: Springer US, 1985, pp. 23–33.
S. Mohammad-Alizadeh-Charandabi, M. Mirghafourvand, A. Mansouri, M. Najafi, and F. Khodabande, “The Effect of Vitamin D and Calcium plus Vitamin D during Pregnancy on Pregnancy and Birth Outcomes: a Randomized Controlled Trial,” J. Caring Sci., vol. 4, no. 1, pp. 35–44, Mar. 2015.
E. M. Curtis, R. J. Moon, E. M. Dennison, and N. C. Harvey, “Prenatal Calcium and Vitamin D Intake, and Bone Mass in Later Life,” Curr. Osteoporos. Rep., vol. 12, no. 2, pp. 194–204, Jun. 2014.
A. J. Phillips, S. J. Ostlere, and R. Smith, “Pregnancy-associated osteoporosis: does the skeleton recover?,” Osteoporos. Int. J. Establ. Result Coop. Eur. Found. Osteoporos. Natl. Osteoporos. Found. USA, vol. 11, no. 5, pp. 449–454, 2000.
F. Dunne, B. Walters, T. Marshall, and D. A. Heath, “Pregnancy associated osteoporosis,” Clin. Endocrinol. (Oxf.), vol. 39, no. 4, pp. 487–490, Oct. 1993.
“Calcium and Vitamin D: Skeletal and Extraskeletal Health.” [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669834/. [Accessed: 22-Apr-2019].
R. Boland, “Role of Vitamin D in Skeletal Muscle Function,” Endocr. Rev., vol. 7, no. 4, pp. 434–448, Nov. 1986.
W. B. Grant and M. F. Holick, “Benefits and Requirements of Vitamin D for Optimal Health: A Review,” Vitam. D, vol. 10, no. 2, p. 18, 2005.
K. M. Kim et al., “Interactions Between Dietary Calcium Intake and Bone Mineral Density or Bone Geometry in a Low Calcium Intake Population (KNHANES IV 2008–2010),” J. Clin. Endocrinol. Metab., vol. 99, no. 7, pp. 2409–2417, Jul. 2014.
O. Bruyère et al., “Effects of vitamin D in the elderly population: current status and perspectives,” Arch. Public Health, vol. 72, Sep. 2014.
“Bone and nutrition in elderly women: protein, energy, and calcium as main determinants of bone mineral density. - PubMed - NCBI.” [Online]. Available: https://www.ncbi.nlm.nih.gov/pubmed/12700617. [Accessed: 22-Apr-2019].
R. Rizzoli et al., “The role of dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women: A consensus statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO),” Maturitas, vol. 79, no. 1, pp. 122–132, Sep. 2014.
J. A. Sunyecz, “The use of calcium and vitamin D in the management of osteoporosis,” Ther. Clin. Risk Manag., vol. 4, no. 4, pp. 827–836, Aug. 2008.
“Office of Dietary Supplements - Vitamin D.” [Online]. Available: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. [Accessed: 17-Apr-2019].
“Nutrition Improvement.” [Online]. Available: http://www.perwatusi.or.id/index.php/id/kenali-keropos-tulang/pencegahan/perbaikan-gizi. [Accessed: 14-Jun-2019].
“Calcium | International Osteoporosis Foundation.” [Online]. Available: https://www.iofbonehealth.org/osteoporosis-musculoskeletal-disorders/osteoporosis/prevention/calcium. [Accessed: 13-May-2019].
“Vitamin D | International Osteoporosis Foundation.” [Online]. Available: https://www.iofbonehealth.org/osteoporosis-musculoskeletal-disorders/osteoporosis/prevention/vitamin-d. [Accessed: 13-May-2019].
T. O. Carpenter, N. J. Shaw, A. A. Portale, L. M. Ward, S. A. Abrams, and J. M. Pettifor, “Rickets,” Nat. Rev. Dis. Primer, vol. 3, p. 17101, Dec. 2017.
C. F. Munns et al., “Global Consensus Recommendations on Prevention and Management of Nutritional Rickets,” J. Clin. Endocrinol. Metab., vol. 101, no. 2, pp. 394–415, Feb. 2016.
S. Uday and W. Högler, “Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies,” Curr. Osteoporos. Rep., vol. 15, no. 4, pp. 293–302, 2017.
A. L. Bueno and M. A. Czepielewski, “The importance for growth of dietary intake of calcium and vitamin D,” J. Pediatr. (Rio J.), vol. 84, no. 5, pp. 386–394, Oct. 2008.
“Healthy Bones at Every Age - OrthoInfo - AAOS.” [Online]. Available: https://www.orthoinfo.org/en/staying-healthy/healthy-bones-at-every-age/. [Accessed: 13-May-2019].
R. Sugianto, J. Titus, and M. Siagian, “Risk factors of low peak bone mass in Indonesian women,” J. Gizi Klin. Indones., vol. 11, no. 2, pp. 78–84, Oct. 2014.
S. Sandjaja et al., “Food consumption and nutritional and biochemical status of 0•5-12-year-old Indonesian children: the SEANUTS study,” Br. J. Nutr., vol. 110 Suppl 3, pp. S11-20, Sep. 2013.
F. Soesanti, A. Pulungan, B. Tridjaja, and J. R. Batubara, “Vitamin D profile in healthy children aged 7-12 years old in Indonesia,” Int. J. Pediatr. Endocrinol., vol. 2013, no. Suppl 1, p. P167, 2013.
“Universitas Gadjah Mada: Indonesian Children Susceptible to Vitamin D Deficiency.” [Online]. Available: http://ugm.ac.id/en/news/16274-indonesian.children.susceptible.to.vitamin.d.deficiency. [Accessed: 23-Apr-2019].
Y. Hartriyanti, P. S. T. Suyoto, H. F. L. Muhammad, and I. R. Palupi, “Nutrient intake of pregnant women in Indonesia: a review,” Malays. J. Nutr., vol. 18, no. 1, pp. 113–124, Apr. 2012.
For the International Osteoporosis Foundation Calcium Steering Committee et al., “Global dietary calcium intake among adults: a systematic review,” Osteoporos. Int., vol. 28, no. 12, pp. 3315–3324, Dec. 2017.
“(PDF) Bone Density Status and Vitamin D and Calcium Concentrations in Pregnant and Non-Pregnant Women.” [Online]. Available: https://www.researchgate.net/publication/311630339_Bone_Density_Status_and_Vitamin_D_and_Calcium_Concentrations_in_Pregnant_and_Non-Pregnant_Women. [Accessed: 22-Apr-2019].
M. C. Kruger and F. M. Wolber, “Osteoporosis: Modern Paradigms for Last Century’s Bones,” Nutrients, vol. 8, no. 6, Jun. 2016.
N. E. Koundourakis and A. N. Margioris, “Vitamin D and Physical Activity,” Crit. Eval. Vitam. - Basic Overv., Apr. 2017.
“THE GLOBAL EPIDEMIOLOGY OF VITAMIN D STATUS • JARCP The Journal of Aging Research & Clinical Practice.” [Online]. Available: http://www.jarcp.com/703-the-global-epidemiology-of-vitamin-d-status.html. [Accessed: 13-May-2019].
K. R. Dewi, E. M. Hidayat, and A. Rachmawati, “Knowledge, Attitude, and Behavior Level of Women of Reproductive Age toward Calcium Intake,” Althea Med. J., p. 5.
C. Wariyah, M. Astuti, S. Supriyadi, and C. Anwar, “CALCIUM ABSORPTION KINETIC ON INDONESIAN RICE,” Indones. J. Chem., vol. 8, no. 2, pp. 252–257, Jun. 2010.
“Indonesian women – 95 percent do not have sufficient Vitamin D – Nov 2017 |.” [Online]. Available: https://vitamindwiki.com/Indonesian+women+%E2%80%93+95+percent+do+not+have+sufficient+Vitamin+D+%E2%80%93+Nov+2017. [Accessed: 17-Apr-2019].
D. Sari, D. Harun Alrasyid, L. Nurlndrawaty, and L. Zulkif Ii, “Occurrence of vitamin D deficiency among women in North Sumatera, Indonesia,” Malays. J. Nutr., vol. 20, pp. 63–70, Jan. 2014.
“(PDF) Is vitamin D defiiency associated with using veil in female garment workers?” [Online]. Available: https://www.researchgate.net/publication/304671112_Is_vitamin_D_defiiency_associated_with_using_veil_in_female_garment_workers. [Accessed: 22-Apr-2019].
M. Wanner, A. Richard, B. Martin, J. Linseisen, and S. Rohrmann, “Associations between objective and self-reported physical activity and vitamin D serum levels in the US population,” Cancer Causes Control CCC, vol. 26, no. 6, pp. 881–891, Jun. 2015.
M. R. Fernandes, “Association between physical activity and vitamin D: A narrative literature review,” Rev Assoc Med Bras, p. 7.
J. Valtueña, D. Dominguez, L. Til, M. González-Gross, and F. Drobnic, “High prevalence of vitamin D insufficiency among elite Spanish athletes the importance of outdoor training adaptation,” Nutr. Hosp., vol. 30, no. 1, pp. 124–131, Jul. 2014.
R. Scragg and C. A. Camargo, “Frequency of leisure-time physical activity and serum 25-hydroxyvitamin D levels in the US population: results from the Third National Health and Nutrition Examination Survey,” Am. J. Epidemiol., vol. 168, no. 6, pp. 577–586; discussion 587-591, Sep. 2008.
I. S. Wicherts et al., “Vitamin D status predicts physical performance and its decline in older persons,” J. Clin. Endocrinol. Metab., vol. 92, no. 6, pp. 2058–2065, Jun. 2007.
Y. Dionyssiotis, I. Paspati, G. Trovas, A. Galanos, and G. P. Lyritis, “Association of physical exercise and calcium intake with bone mass measured by quantitative ultrasound,” BMC Womens Health, vol. 10, p. 12, Apr. 2010.
T. E. Howe et al., “Exercise for preventing and treating osteoporosis in postmenopausal women,” Cochrane Database Syst. Rev., no. 7, p. CD000333, Jul. 2011.
J. M. Muir, C. Ye, M. Bhandari, J. D. Adachi, and L. Thabane, “The effect of regular physical activity on bone mineral density in post-menopausal women aged 75 and over: a retrospective analysis from the Canadian multicentre osteoporosis study,” BMC Musculoskelet. Disord., vol. 14, p. 253, Aug. 2013.
B. K. Poh et al., “25-hydroxy-vitamin D demography and the risk of vitamin D insufficiency in the South East Asian Nutrition Surveys (SEANUTS).,” Asia Pac. J. Clin. Nutr., vol. 25, no. 3, pp. 538–548, 2015.
H. A. Bischoff-Ferrari, J. R. Rees, M. V. Grau, E. Barry, J. Gui, and J. A. Baron, “Effect of calcium supplementation on fracture risk: a double-blind randomized controlled trial,” Am. J. Clin. Nutr., vol. 87, no. 6, pp. 1945–1951, Jun. 2008.
I. R. Reid, “Should We Prescribe Calcium Supplements For Osteoporosis Prevention?,” J. Bone Metab., vol. 21, no. 1, pp. 21–28, Feb. 2014.
R. Rajatanavin, L. Chailurkit, S. Saetung, A. Thakkinstian, and H. Nimitphong, “The efficacy of calcium supplementation alone in elderly Thai women over a 2-year period: a randomized controlled trial,” Osteoporos. Int. J. Establ. Result Coop. Eur. Found. Osteoporos. Natl. Osteoporos. Found. USA, vol. 24, no. 11, pp. 2871–2877, Nov. 2013.
R. L. Prince, A. Devine, S. S. Dhaliwal, and I. M. Dick, “Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women,” Arch. Intern. Med., vol. 166, no. 8, pp. 869–875, Apr. 2006.
V. Janakiraman, A. Ettinger, A. Mercado-Garcia, H. Hu, and M. Hernandez-Avila, “Calcium supplements and bone resorption in pregnancy: A randomized crossover trial,” Am. J. Prev. Med., vol. 24, no. 3, pp. 260–264, Apr. 2003.
A. N. Hacker, E. B. Fung, and J. C. King, “Role of calcium during pregnancy: maternal and fetal needs,” Nutr. Rev., vol. 70, no. 7, pp. 397–409, Jul. 2012.
H. A. Bischoff-Ferrari et al., “A pooled analysis of vitamin D dose requirements for fracture prevention,” N. Engl. J. Med., vol. 367, no. 1, pp. 40–49, Jul. 2012.
H. A. Bischoff-Ferrari, W. C. Willett, J. B. Wong, E. Giovannucci, T. Dietrich, and B. Dawson-Hughes, “Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials,” JAMA, vol. 293, no. 18, pp. 2257–2264, May 2005.
R. H. Harwood, O. Sahota, K. Gaynor, T. Masud, D. J. Hosking, and Nottingham Neck of Femur (NONOF) Study, “A randomised, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: The Nottingham Neck of Femur (NONOF) Study,” Age Ageing, vol. 33, no. 1, pp. 45–51, Jan. 2004.
P. Dewansingh, A. Melse-Boonstra, W. P. Krijnen, C. P. van der Schans, H. Jager-Wittenaar, and E. G. H. M. van den Heuvel, “Supplemental protein from dairy products increases body weight and vitamin D improves physical performance in older adults: a systematic review and meta-analysis,” Nutr. Res. N. Y. N, vol. 49, pp. 1–22, 2018.
A. A. Ginde, A. F. Sullivan, J. M. Mansbach, and C. A. Camargo, “Vitamin D insufficiency in pregnant and nonpregnant women of childbearing age in the United States,” Am. J. Obstet. Gynecol., vol. 202, no. 5, pp. 436. e1-436. e8, May 2010.
A. Avenell, J. C. Mak, and D. O’Connell, “Vitamin D and vitamin D analogues for preventing fractures in post‐menopausal women and older men,” Cochrane Database Syst. Rev., no. 4, 2014.
C. M. Weaver et al., “Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation,” Osteoporos. Int., vol. 27, pp. 367–376, 2016.
H. A. Bischoff-Ferrari, S. Bhasin, and J. E. Manson, “Preventing Fractures and Falls: A Limited Role for Calcium and Vitamin D Supplements?,” JAMA, vol. 319, no. 15, pp. 1552–1553, Apr. 2018.
R. D. Jackson et al., “Calcium plus vitamin D supplementation and the risk of fractures,” N. Engl. J. Med., vol. 354, no. 7, pp. 669–683, Feb. 2006.
B. M. P. Tang, G. D. Eslick, C. Nowson, C. Smith, and A. Bensoussan, “Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis,” Lancet Lond. Engl., vol. 370, no. 9588, pp. 657–666, Aug. 2007.
M. Kärkkäinen et al., “Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65–71 years: a 3-year randomized population-based trial (OSTPRE-FPS),” Osteoporos. Int., vol. 21, no. 12, pp. 2047–2055, Dec. 2010.
M. C. Chapuy et al., “Vitamin D3 and Calcium to Prevent Hip Fractures in Elderly Women,” N. Engl. J. Med., vol. 327, no. 23, pp. 1637–1642, Dec. 1992.
M. C. Chapuy et al., “Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study,” Osteoporos. Int. J. Establ. Result Coop. Eur. Found. Osteoporos. Natl. Osteoporos. Found. USA, vol. 13, no. 3, pp. 257–264, Mar. 2002.
“Prostate Cancer & Calcium Concerns.” [Online]. Available: https://www.oncologynutrition.org/erfc/eating-well-when-unwell/prostate-cancer-calcium-concerns. [Accessed: 24-Apr-2019].
“Calcium and Vitamin D Supplements May Increase Stone Risk,” Renal and Urology News, 29-Jun-2012. [Online]. Available: https://www.renalandurologynews.com/home/news/urology/kidney-stones/calcium-and-vitamin-d-supplements-may-increase-stone-risk/. [Accessed: 24-Apr-2019].
K. M. Sanders et al., “Annual High-Dose Oral Vitamin D and Falls and Fractures in Older Women: A Randomized Controlled Trial,” JAMA, vol. 303, no. 18, pp. 1815–1822, May 2010.