Management of Type 1 Diabetes in Older Adults

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Am J Physiol Endocrinol Metab For convenience, references have been sorted by health issue: Zinc deficiency affects the skin and gastrointestinal tract; brain and central nervous system, immune, skeletal, and reproductive systems. Association between dietary conjugated linoleic acid and bone mineral density in postmenopausal women. Carla task force on sarcopenia: For example, I am a Type Lā€¦.. If the net result of the traumae is biochemical or neurotransmitter differences, then biochemical therapy aimed at normalizing brain chemistry would be indicated.

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11. Older Adults

World-renowned faculty at a 3. Beyond full-time faculty, students have unparalleled access to more than 3, other Mayo Clinic clinicians and researchers across all three campuses. Mayo Clinic School of Medicine all campuses is ranked No. This content does not have an English version. This content does not have an Arabic version. Sections Programs Overview M. Endothelial dysfunction occurs in children with two genetic hyperlipidemias: J Pediatr 1: Morris, CD, Carson, S.

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Combined calcium and vitamin D3 supplementation in elderly women: Osteoporos Int 13 3: Effects of calcium, dairy product, and vitamin D supplementation on bone mass accrual and body composition in year old girls: Skeletal site selectivity in the effects of calcium supplementation on areal bone mineral density gain: J Clin Endocrinol Metab 90 6: Vitamin D supplementation and bone mineral density in early postmenopausal women.

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Ann Intern Med 7: A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. Association between serum concentrations of hydroxyvitamin D3 and periodontal disease in the US population. Sustained effect of short-term calcium supplementation on bone mass in adolescent girls with low calcium intake. Fang Fang Zhang and Sarah Booth. Low Vitamin D Linked to Osteoarthritis.

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Osteoporos Int 14 8: Calcium and vitamin-D supplementation on bone structural properties in peripubertal female identical twins: Osteoporos Int [Epub ahead of print]. Vitamin D supplementation in older women. Longitudinal follow-up of bone mineral density in children with nephritic syndrome and the role of calcium and vitamin D supplements. Nephrol Dial Transplant 20 8: Vitamin D insufficiency in internal medicine residents. Calcif Tissue Int 76 1: Vitamin D in adult health and disease: Harris S, Dawson-Hughes B.

Rates of change in bone mineral density of the spine, heel, femoral, neck and radius in healthy postmenopausal women. Bone Miner 17 1: A randomized, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: Age Ageing 33 1: Am J Clin Nutr 85 suppl: Nutritional factors in osteoporosis.

A randomized controlled trial of vitamin D supplementation on preventing postmenopausal bone loss and modifying bone metabolism using identical twin pairs. J Bone Miner Res 15 Zinc intakes and plasma concentrations in men with osteoporosis: Nutrition in Bone Health Revisited: A Story Beyond Calcium. Calcium plus vitamin D supplementation and the risk of fractures.

N Engl J Med 7: Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: Calcium supplementation and increases in bone mineral density in children. N Engl J Med 2: Dietary silicon intake is positively associated with bone mineral density in men and premenopausal women of the Framingham Offspring Cohort. Journal of Bone and Mineral Research 19 2: Calcium supplementation and bone mineral accretion in adolescent girls: Am J Clin Nutr 87 2: Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: J Bone Miner Res 19 3: A follow-up study on the effects of calcium-supplement withdrawal and puberty on bone acquisition of children.

A randomized double-blind controlled calcium supplementation trial, and bone and height acquisition in children.

Br J Nutr Bone mineral acquisition in low calcium intake children following the withdrawal of calcium supplement. Double-blind, controlled calcium supplementation and bone mineral accretion in children accustomed to a low-calcium diet. Vitamin D supplementation and fracture incidence in elderly persons: Ann Intern Med 4: Calcium supplementation and bone mineral density in adolescent girls. Effect of boron supplementation on blood and urinary calcium, magnesium, and phosphorus, and urinary boron in athletic and sedentary women.

Effects of boron supplementation on bone mineral density and dietary, blood, and urinary calcium, phosphorus, magnesium, and boron in female athletes. Environ Health Perspect Suppl 7: Supplementation with oral vitamin D3 and calcium during winter prevents seasonal bone loss: J Bone Miner Res 19 8: Prevention of hip fractures by correcting calcium and vitamin D insufficiencies in elderly people.

Scand J Rheumatol Suppl Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomized controlled trial. J Bone Miner Res 17 4: Serum retinol levels and the risk of fracture. Efficacy of a progressive walking program and glucosamine sulphate supplementation on osteoarthritic symptoms of the hip and knee: Arthrit Res Ther 12 1: A co-twin study of the effect of calcium supplementation on bone density during adolescence.

Osteoporos Int 7 3: Meta-analyses of therapies for postmenopausal osteoporosis. Meta-analysis of the efficacy of vitamin D treatment in preventing osteoporosis in postmenopausal women. Endocr Rev 23 4: Effect of calcium or 25OH vitamin D3 dietary supplementation on bone loss at the hip in men and women over the age of J Clin Endocrinol Metab 85 9: Randomised controlled trial of calcium and supplementation with cholecalciferol vitamin D3 for prevention of fractures in primary care.

Soy protein and isoflavones: Am J Clin Nutr 68 6 Suppl: Vitamin D and health in the 21st century: Am J Clin Nutr 80 suppl: Correcting calcium nutritional deficiency prevents spine fractures in elderly women.

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Proc Nutr Soc 56 3: Chemistry, nutritional sources, tissue distribution and metabolism of vitamin K with special reference to bone health. J Nutr 4 Suppl: Effect of a calcium and exercise intervention on the bone mineral status of y-old adolescent girls. Spinal bone loss in postmenopausal women supplemented with calcium and trace minerals. Evaluation of glucosamine sulfate compared to ibuprofen for the treatment of temporomandibular joint osteoarthritis: J Rheumatol 28 6: Hypovitaminosis D in medical inpatients.

Effect of four monthly oral vitamin D3 cholecalciferol supplementation on fractures and mortality in men and women living in the community; randomized double blind controlled trial.

The need for more vitamin D. Vitamin D supplementation suppresses age-induced bone turnover in older women who are vitamin D deficient. One year of oral calcium supplementation maintains cortical bone density in young adult female distance runners.

Effect of vitamin K2 treatment on carboxylation of osteocalcin in early postmenopausal women. Gynecological Endocrinology 22 8: Vitamin D supplementation during infancy is associated with higher bone mineral mass in prepubertal girls. J Clin Endocrinol Metab Am J Clin Nutr 85 2: Current maternal-infant micronutrient status and the effects on birth weight in the United Arab Emirates. East Mediterr Health J 15 6: Growth and development in term infants fed long-chain polyunsaturated fatty acids: Visual, cognitive, and language assessments at 39 months: Pediatrics 3 Pt 1: Folic acid supplementation and the occurrence of congenital heart defects, orofacial clefts, multiple births, and miscarriage.

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Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica. Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia: Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age.

Am J Clin Nutr 85 3: Visual-acuity development in healthy preterm infants: Am J Clin Nutr 58 1: Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: Vitamin C and E supplementation in women at risk of preeclampsia is associated with changes in indices of oxidative stress and placental function.

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The following groups are among those most likely to need extra calcium. Menopause leads to bone loss because decreases in estrogen production both increase bone resorption and decrease calcium absorption [ 10 , 24 , 25 ]. Increased calcium intakes during menopause do not completely offset this bone loss [ 27 , 28 ].

Hormone replacement therapy HRT with estrogen and progesterone helps increase calcium levels and prevent osteoporosis and fractures. Estrogen therapy restores postmenopausal bone remodeling to the same levels as at premenopause, leading to lower rates of bone loss [ 24 ], perhaps in part by increasing calcium absorption in the gut. Several medical groups and professional societies support the use of HRT as an option for women who are at increased risk of osteoporosis or fractures [ ].

Such women should discuss this matter with their healthcare providers. In addition, consuming adequate amounts of calcium in the diet might help slow the rate of bone loss in all women.

Amenorrhea, the condition in which menstrual periods stop or fail to initiate in women of childbearing age, results from reduced circulating estrogen levels that, in turn, have a negative effect on calcium balance. Amenorrheic women with anorexia nervosa have decreased calcium absorption and higher urinary calcium excretion rates, as well as a lower rate of bone formation than healthy women [ 32 ]. The "female athlete triad" refers to the combination of disordered eating, amenorrhea, and osteoporosis.

Exercise-induced amenorrhea generally results in decreased bone mass [ 33 , 34 ]. In female athletes and active women in the military, low bone-mineral density, menstrual irregularities, certain dietary patterns, and a history of prior stress fractures are associated with an increased risk of future stress fractures [ 35 ].

Such women should be advised to consume adequate amounts of calcium and vitamin D. Supplements of these nutrients have been shown to reduce the risk of stress fractures in female Navy recruits during basic training [ 36 ].

Lactose intolerance refers to symptoms such as bloating, flatulence, and diarrhea that occur when one consumes more lactose, the naturally occurring sugar in milk, than the enzyme lactase produced by the small intestine can hydrolyze into its component monosaccharides, glucose and galactose [ 37 ].

The symptoms vary, depending on the amount of lactose consumed, history of consumption of lactose-containing foods, and type of meal. Lactose-intolerant individuals are at risk of calcium inadequacy if they avoid dairy products [ 1 , 38 , 39 ]. Research suggests that most people with lactose intolerance can consume up to 12 grams of lactose, such as that present in 8 ounces of milk, with minimal or no symptoms, especially if consumed with other foods; larger amounts can frequently be consumed if spread over the day and eaten with other foods [ 1 , 38 , 39 ].

Other options to reduce symptoms include eating low-lactose dairy products including aged cheeses such as Cheddar and Swiss , yogurt, or lactose-reduced or lactose-free milk [ 1 , 38 , 39 ]. Some studies have examined whether it is possible to induce adaptation by consuming incremental lactose loads over a period of time [ 42 , 43 ], but the evidence in support of this strategy is inconsistent [ 38 ]. Cow's milk allergy is less common than lactose intolerance, affecting 0.

People with this condition are unable to consume any products containing cow's milk proteins and are therefore at higher risk of obtaining insufficient calcium. To ensure adequate calcium intakes, lactose-intolerant individuals and those with cow's milk allergy can choose nondairy food sources of the nutrient such as kale, bok choy, Chinese cabbage, broccoli, collards and fortified foods or take a calcium supplement.

Vegetarians might absorb less calcium than omnivores because they consume more plant products containing oxalic and phytic acids [ 1 ]. Lacto-ovo vegetarians who consume eggs and dairy and nonvegetarians have similar calcium intakes [ 45 , 46 ].

However, vegans, who eat no animal products and ovo-vegetarians who eat eggs but no dairy products , might not obtain sufficient calcium because of their avoidance of dairy foods [ 47 , 48 ]. In the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition, bone fracture risk was similar in meat eaters, fish eaters and vegetarians, but higher in vegans, likely due to their lower mean calcium intake [ 49 ].

It is difficult to assess the impact of vegetarian diets on calcium status because of the wide variety of eating practices and thus should be considered on a case by case basis. Many claims are made about calcium's potential benefits in health promotion and disease prevention and treatment. This section focuses on several areas in which calcium is or might be involved: Bones increase in size and mass during periods of growth in childhood and adolescence, reaching peak bone mass around age The greater the peak bone mass, the longer one can delay serious bone loss with increasing age.

Everyone should therefore consume adequate amounts of calcium and vitamin D throughout childhood, adolescence, and early adulthood. Osteoporosis, a disorder characterized by porous and fragile bones, is a serious public health problem for more than 10 million U.

Another 34 million have osteopenia, or low bone mass, which precedes osteoporosis. Osteoporosis is most associated with fractures of the hip, vertebrae, wrist, pelvis, ribs, and other bones [ 50 ]. When calcium intake is low or ingested calcium is poorly absorbed, bone breakdown occurs as the body uses its stored calcium to maintain normal biological functions. Bone loss also occurs as part of the normal aging process, particularly in postmenopausal women due to decreased amounts of estrogen.

Many factors increase the risk of developing osteoporosis, including being female, thin, inactive, or of advanced age; smoking cigarettes; drinking excessive amounts of alcohol; and having a family history of osteoporosis [ 52 ]. Various bone mineral density BMD tests are available. A T-score of Although osteoporosis affects individuals of all races, ethnicities, and both genders, women are at highest risk because their skeletons are smaller than those of men and because of the accelerated bone loss that accompanies menopause.

Regular exercise and adequate intakes of calcium and vitamin D are critical to the development and maintenance of healthy bones throughout the life cycle. Both weight-bearing exercises such as walking, running, and activities where one's feet leave and hit the ground and work against gravity and resistance exercises such as calisthenics and that involve weights support bone health.

Supplementation with calcium plus vitamin D has been shown to be effective in reducing fractures and falls which can cause fractures in institutionalized older adults [ 54 ]. However, among community-dwelling older adults over age 50, the benefits of supplementation with these nutrients on fracture resistance are much less clear.

A recent systematic review of 26 randomized controlled trials found that calcium supplements, with or without vitamin D, modestly but significantly reduced the risk of total and vertebral fractures, but not fractures of the hip or forearm [ 55 ].

But the four trials with the lowest risk of bias, involving a total of 44, individuals, showed no effect of supplementation on risk of fracture at any site.

A related meta-analysis of calcium intake on bone mineral density found that calcium supplementation produced only a small, initial, and non-progressive increase in bone mineral density that was unlikely to result in a clinically significant reduction in the risk of bone fractures [ 56 ].

Preventive Services Task Force USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of combined vitamin D and calcium supplementation to prevent bone fractures in premenopausal women or in men [ 57 ]. In , the U. Food and Drug Administration authorized a health claim related to calcium and osteoporosis for foods and supplements [ 58 ].

In January , this health claim was expanded to include vitamin D. Model health claims include the following: Data from observational and experimental studies on the potential role of calcium in preventing colorectal cancer, though somewhat inconsistent, are highly suggestive of a protective effect [ 1 ]. In a follow-up study to the Calcium Polyp Prevention Study, supplementation with calcium carbonate led to reductions in the risk of adenoma a nonmalignant tumor in the colon, a precursor to cancer [ 63 , 64 ], even as long as 5 years after the subjects stopped taking the supplement [ 65 ].

But other observational studies have found the associations to be inconclusive [ 62 , 67 , 68 ]. In the Women's Health Initiative, a clinical trial involving 36, postmenopausal women, daily supplementation with 1, mg of calcium and International Units IU of vitamin D 3 for 7 years produced no significant differences in the risk of invasive colorectal cancer compared to placebo [ 69 ]. The authors of a Cochrane systematic review concluded that calcium supplementation might moderately help prevent colorectal adenomas, but there is not enough evidence to recommend routine use of calcium supplements to prevent colorectal cancer [ 70 ].

Given the long latency period for colon cancer development, long-term studies are needed to fully understand whether calcium intakes affect colorectal cancer risk. Several epidemiological studies have found an association between high intakes of calcium, dairy foods or both and an increased risk of developing prostate cancer [ ].

However, others have found only a weak relationship, no relationship, or a negative association between calcium intake and prostate cancer risk [ ]. The authors of a meta-analysis of prospective studies concluded that high intakes of dairy products and calcium might slightly increase prostate cancer risk [ 82 ]. Interpretation of the available evidence is complicated by the difficulty in separating the effects of dairy products from that of calcium. Calcium has been proposed to help reduce cardiovascular disease CVD risk by decreasing intestinal absorption of lipids, increasing lipid excretion, lowering cholesterol levels in the blood, and promoting calcium influx into cells [ 1 ].

However, data from prospective studies of calcium's effects on CVD risk are inconsistent, and whether dietary calcium has different effects on the cardiovascular system than supplemental calcium is not clear. Other prospective studies have shown no significant associations between calcium intake and cardiac events or cardiovascular mortality [ 83 ]. Data for stroke are mixed, with some studies linking higher calcium intakes to lower risk of stroke, and others finding no associations or trends in the opposite direction [ 83 , 85 ].

Several studies have raised concerns that calcium from supplements might increase the risk of CVD, including myocardial infarction and coronary heart disease [ ]. While there is no established biological mechanism to support an association between calcium and CVD, some scientists hypothesize that excessively high calcium intakes from supplements might override normal homeostatic controls of serum calcium levels and produce a temporary hypercalcemia [ 85 , 91 , 92 ].

Hypercalcemia is associated with increased blood coagulation, vascular calcification, and arterial stiffness, all of which raise CVD risk [ 90 , 91 , 93 , 94 ]. Many scientists question the strength of the available evidence linking supplemental calcium intake with CVD risk, noting that no clinical trials were designed primarily to evaluate this potential relationship, so researchers have only considered CVD outcomes in secondary analyses of trial data [ 93 , 95 , 96 ].

Based on a systematic review and meta-analysis of 4 randomized trials and 27 observational studies [ 97 ], the American Society for Preventive Cardiology and the National Osteoporosis Foundation concluded that there is "moderate-quality evidence" that calcium with or without vitamin D from supplements or foods "has no relationship beneficial or harmful with the risk for cardiovascular and cerebrovascular disease, mortality, or all-cause mortality in generally healthy adults" [ 92 ].

They added that based on the evidence to date, "calcium intake from food and supplements that does not exceed the [UL] should be considered safe from a cardiovascular standpoint. Several clinical trials have demonstrated a relationship between increased calcium intakes and both lower blood pressure and risk of hypertension [ ], although the reductions are inconsistent.

In the Women's Health Study, calcium intake was inversely associated with risk of hypertension in middle-aged and older women [ ]. However, other studies have found no association between calcium intake and incidence of hypertension [ 83 ].

The authors of a systematic review of the effects of calcium supplements for hypertension found any link to be weak at best, largely due to the poor quality of most studies and differences in methodologies [ ]. Calcium's effects on blood pressure might depend upon the population being studied. In hypertensive subjects, calcium supplementation appears to lower systolic blood pressure by 2ā€”4 mmHg, whereas in normotensive subjects, calcium appears to have no significant effect on systolic or diastolic blood pressure [ 83 ].

Other observational and experimental studies suggest that individuals who eat a vegetarian diet high in minerals such as calcium, magnesium, and potassium and fiber and low in fat tend to have lower blood pressure [ 48 , ].

The diet containing dairy products resulted in the greatest decrease in blood pressure [ ], although the contribution of calcium to this effect was not evaluated. Studies suggest that calcium supplementation during pregnancy reduces the risk of preeclampsia, but the benefits may apply only to populations with inadequate calcium intakes [ , ].

For women with higher dietary calcium intakes, however, the reduction in preeclampsia risk was not statistically significant. Several professional organizations recommend calcium supplements during pregnancy for women with low calcium intakes to reduce the risk of preeclampsia.

Similarly, the World Health Organization WHO recommends 1,ā€”2, mg calcium for pregnant women with low dietary calcium intakes, particularly those at higher risk of gestational hypertension [ ]. The WHO also recommends separating calcium and prenatal iron supplements by several hours to minimize the inhibitory effects of calcium on iron absorption. But some researchers argue that this interaction has minimal clinical significance and suggest that providers not counsel patients to separate the supplements to simplify the supplement regimen and facilitate adherence [ ].

Kidney stones in the urinary tract are most commonly composed of calcium oxalate. Some, but not all, studies suggest a positive association between supplemental calcium intake and the risk of kidney stones, and these findings were used as the basis for setting the calcium UL in adults [ 1 ].

The Nurses' Health Study also showed a positive association between supplemental calcium intake and kidney stone formation [ ]. High intakes of dietary calcium, on the other hand, do not appear to cause kidney stones and may actually protect against developing them [ 1 , ]. For most individuals, other risk factors for kidney stones, such as high intakes of oxalates from food and low intakes of fluid, probably play a bigger role than calcium intake [ ].

Several studies have linked higher calcium intakes to lower body weight or less weight gain over time [ ]. Two explanations have been proposed. First, high calcium intakes might reduce calcium concentrations in fat cells by decreasing the production of parathyroid hormone and the active form of vitamin D.

Decreased intracellular calcium concentrations in turn increase fat breakdown and discourage fat accumulation in these cells [ ]. Secondly, calcium from food or supplements might bind to small amounts of dietary fat in the digestive tract and prevent its absorption [ , , ]. Dairy products, in particular, might contain additional components that have even greater effects on body weight than their calcium content alone would suggest [ , ].

Despite these findings, the results from clinical trials have been largely negative. Three reviews of published studies on calcium from supplements or dairy products on weight management came to similar conclusions [ 83 , , ]. A meta-analysis of 13 randomized controlled trials published in concluded that neither calcium supplementation nor increased dairy product consumption had a statistically significant effect on weight reduction [ ].

More recently, a evidence report from the Agency for Healthcare Research and Quality concluded that, overall, clinical trial results do not support an effect of calcium supplementation on weight loss [ 83 ]. Also, a meta-analysis of 29 randomized controlled trials found no benefit of an increased consumption of dairy products on body weight and fat loss in long-term studies [ ]. Overall, the results from clinical trials do not support a link between higher calcium intakes and lower body weight or weight loss.

For additional information on calcium and weight management, see our health professional fact sheet on Weight Loss. Excessively high levels of calcium in the blood known as hypercalcemia can cause renal insufficiency, vascular and soft tissue calcification, hypercalciuria high levels of calcium in the urine and kidney stones [ 1 ].

Although very high calcium intakes have the potential to cause hypercalcemia [ 85 ], it is most commonly associated with primary hyperparathyroidism or malignancy [ 1 ]. High calcium intake can cause constipation. It might also interfere with the absorption of iron and zinc, though this effect is not well established [ 1 ].

High intake of calcium from supplements, but not foods, has been associated with increased risk of kidney stones [ 1 , , ]. Some evidence links higher calcium intake with increased risk of prostate cancer, but this effect is not well understood, in part because it is challenging to separate the potential effect of dairy products from that of calcium [ 1 ]. Some studies also link high calcium intake, particularly from supplements, with increased risk of cardiovascular disease [ , 90 , 91 ].

Getting too much calcium from foods is rare; excess intakes are more likely to be caused by the use of calcium supplements. Calcium supplements have the potential to interact with several types of medications. This section provides a few examples. Individuals taking these medications on a regular basis should discuss their calcium intake with their healthcare providers.

Calcium can decrease absorption of the following drugs when taken together: Thiazide-type diuretics can interact with calcium carbonate and vitamin D supplements, increasing the risks of hypercalcemia and hypercalciuria [ ]. Both aluminum- and magnesium-containing antacids increase urinary calcium excretion. Mineral oil and stimulant laxatives decrease calcium absorption. Glucocorticoids, such as prednisone, can cause calcium depletion and eventually osteoporosis when they are used for months [ ].

The federal government's Dietary Guidelines for Americans notes that "Nutritional needs should be met primarily from foods. Foods in nutrient-dense forms contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive health effects.