WikiDoc Resources for Calcium
Evidence Based Medicine
Guidelines / Policies / Govt
Patient Resources / Community
Healthcare Provider Resources
Continuing Medical Education (CME)
Experimental / Informatics
Calcium (Template:PronEng) is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078. Calcium is a soft grey alkaline earth metal, and is the fifth most abundant element in the Earth's crust. It is essential for living organisms, particularly in cell physiology, and is the most common metal in many animals.
The most abundant isotope, 40Ca, has a nucleus of 20 protons and 20 neutrons. This is the heaviest stable isotope of any element which has equal numbers of protons and neutrons. In supernova explosions, calcium is formed from the reaction of carbon with various numbers of alpha particles (helium nuclei), until the most common calcium isotope (containing 10 helium nuclei) has been synthesized. Calcium is the seventh most common element, by mass, in Earth's oceans.
Chemically calcium is reactive and moderately soft for a metal (though harder than lead, it can be cut with a knife with difficulty). It is a silvery metallic element that must be extracted by electrolysis from a fused salt like calcium chloride. Once produced, it rapidly forms a grey-white oxide and nitride coating when exposed to air. It is somewhat difficult to ignite, in character rather like magnesium, but when lit, the metal burns in air with a brilliant high-intensity red light. Calcium metal reacts with water, evolving hydrogen gas at a rate rapid enough to be noticeable (unlike its sister magnesium) but not fast enough at room temperature to generate much heat. Part of the slowness of the calcium-water reaction results from the metal being partly protected by insoluble white calcium hydroxide. In water solutions of acids where the salt is water soluble, calcium reacts vigorously.
Calcium salts are colorless from any contribution of the calcium, and ionic solutions of calcium (Ca2+) are colorless as well. Many calcium salts are not soluble in water. When in solution, the calcium ion to the human taste varies remarkably, being reported as mildly salty, sour, "mineral like" or even "soothing." It is apparent that many animals can taste, or develop a taste, for calcium, and use this sense to detect the mineral in salt licks or other sources. . In human nutrition, soluble calcium salts may be added to tart juices without much effect to the average palate.
Calcium is the fifth most abundant element by mass in the human body, where it is a common cellular ionic messenger with many functions, and serves also as a structural element in bone. It is the relatively high atomic-numbered calcium in the skeleton which causes bone to be radio-opaque. Of the human body's solid components after drying (as for example, after cremation), about a third of the total mass is the approximately one kilogram of calcium which composes the average skeleton (the remainder being mostly phosphorus and oxygen).
- Calcium cyclamate (Ca(C6H11NHSO4)2) was used as a sweetening agent but is no longer permitted for use because of suspected cancer-causing properties.
- Calcium gluconate (Ca(C6H11O7)2) is used as a food additive and in vitamin pills.
- Calcium permanganate (Ca(MnO4)2) is used in liquid rocket propellant, textile production, as a water sterilizing agent and in dental procedures.
- Calcium phosphate (Ca3(PO4)2) is used as a supplement for animal feed, fertilizer, in commercial production for dough and yeast products, in the manufacture of glass, and in dental products.
- Calcium tungstate (CaWO4) is used in luminous paints, fluorescent lights and in X-ray studies.
Calcium is an important component of a healthy diet. Calcium is essential for the normal growth and maintenance of bones and teeth, and calcium requirements must be met throughout life. Long-term calcium deficiency can lead to osteoporosis, in which the bone deteriorates and there is an increased risk of fractures. While a lifelong deficit can affect bone and tooth formation, over-retention can cause hypercalcemia (elevated levels of calcium in the blood), impaired kidney function and decreased absorption of other minerals.
High calcium intakes or high calcium absorption were previously thought to contribute to the development of kidney stones. However, more recent studies show that high dietary calcium intakes actually decrease the risk for kidney stones. Vitamin D is needed to absorb calcium. Dairy products, such as milk and cheese, are a well-known source of calcium. However, some individuals are allergic to dairy products and even more people, particularly those of non Indo-European descent, are lactose-intolerant, leaving them unable to consume non-fermented dairy products in quantities larger than about half a liter per serving. Others, such as vegans, avoid dairy products for ethical and health reasons. Fortunately, many good sources of calcium exist. These include seaweeds such as kelp, wakame and hijiki; nuts and seeds (like almonds and sesame); blackstrap molasses; beans; oranges; amaranth; collard greens; okra; rutabaga; broccoli; dandelion leaves; kale; sardines; and fortified products such as orange juice and soy milk. An overlooked source of calcium is eggshell, which can be ground into a powder and mixed into food or a glass of water.
The calcium content of most foods can be found in the USDA National Nutrient Database.
Dietary calcium supplements
Calcium supplements are used to prevent and to treat calcium deficiencies. There are conflicting recommendations about when to take calcium supplements. However, most experts agree that no more than 500 mg should be taken at a time because the percent of calcium absorbed decreases as the amount of calcium in the supplement increases. It is recommended to spread doses throughout the day, with the last dose near bedtime. Recommended daily calcium intake varies from 1000 to 1500 mg, depending upon the stage of life.
In July 2006, a report citing research from Fred Hutchinson Cancer Research Center in Seattle, Washington claimed that women in their 50s gained 5 pounds less in a period of 10 years by taking more than 500 mg of calcium supplements than those who did not. However, the doctor in charge of the study, Dr. Alejandro J. Gonzalez also noted it would be "going out on a limb" to suggest calcium supplements as a weight-limiting aid.
- Calcium carbonate is the most common and least expensive calcium supplement. It can be difficult to digest and causes gas in some people. Taking magnesium with it can help to prevent constipation. Calcium carbonate is 40% elemental calcium. 1000 mg will provide 400 mg of calcium. It is recommended to take this supplement with food to aid in absorption. In some calcium supplements based on calcium carbonate, vitamin D is added to aid in absorption. Vitamin D is needed for the absorption of calcium from the stomach and for the functioning of calcium in the body.
- Coral Calcium is a salt of calcium derived from fossilized coral reefs. Coral calcium is comprised of calcium carbonate and trace minerals.
- Calcium citrate is more easily absorbed (bioavailability is 2.5 times higher than calcium carbonate), easier to digest and less likely to cause constipation and gas than calcium carbonate. It also has a lower risk of contributing to the formation of kidney stones. Calcium citrate is about 21% elemental calcium. 1000 mg will provide 210 mg of calcium. It is more expensive than calcium carbonate and more of it must be taken to get the same amount of calcium.
- Calcium phosphate costs more than calcium carbonate, but less than calcium citrate. It is easily absorbed and is less likely to cause constipation and gas than either.
- Calcium lactate and calcium aspartate are both more difficult to digest and are more expensive than calcium carbonate
- Calcium chelates have been chemically bonded with an agent that the body recognizes as food. This form is generally known to be better absorbed by the human body than all other forms of calcium due to the bond.
The National Nutritional Food Association — NNFA (Newport Beach, Calif.) defines a chelate very specifically, and several criteria must be met in order for chelation to actually occur. Some of the claimed "chelates" on the market are the various Krebs (Citric Acid) Cycle chelates, such as citrate, malate, and aspartate. Dicalcium malate (chelated with malic acid) is a newer form of a true calcium chelate. It contains a high amount of elemental calcium (30%).
Prevention of fractures due to osteoporosis
Such studies often do not test calcium alone, but rather combinations of calcium and vitamin D. Randomized controlled trials found both positive and negative benefit. The different results may be explained by doses of calcium and underlying rates of calcium supplementation in the control groups. However, it is clear that increasing the intake of calcium promotes deposition of calcium in the bones, where it is of more benefit in preventing the compression fractures resulting from the osteoporotic thinning of the dendritic web of the bodies of the vertebrae, than it is at preventing the more serious cortical bone fractures which happen at hip and wrist.
A meta-analysis by the international Cochrane Collaboration of two randomized controlled trialsfound that calcium "might contribute to a moderate degree to the prevention of adenomatous colonic polyps".
More recent studies were conflicting, and one which was positive for effect (Lappe, et al.) did control for a possible anti-carcinogenic effect of vitamin D, which was found to be an independent positive influence from calcium-alone on cancer risk (see second study below) .
- A randomized controlled trial found that 1000 mg of elemental calcium and 400 IU of vitamin D3 had no effect on colorectal cancer
- A randomized controlled trial found that 1400–1500 mg supplemental calcium and 1100 IU vitamin D3 reduced aggregated cancers with a relative risk of 0.402.
- An observational cohort study found that high calcium and vitamin D intake was associated with "lower risk of developing premenopausal breast cancer"
- Electrolyte replenisher
- Nutritional supplement, mineral
- Pauling, Linus General Chemistry p. 627, 1970 ed. Dover Publications
- Dietary Supplement Fact Sheet: Calcium
- Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D and fluoride. Washington DC: The National Academies Press, 1997
- Curhan G, Willett WC, Rimm E, Stampher MJ. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 1993;328:833-8
- Anne Schaafsma, Gerard M Beelen (1999). "Eggshell powder, a comparable or better source of calcium than purified calcium carbonate: piglet studies". Journal of the Science of Food and Agriculture. 79 (12): 1596–1600.
- USDA National Nutrient Database
- Anne Harding. "Calcium May Help With Weight Loss". Retrieved 2007-07-10.
- "drugs.com article about Calcium with Vitamin D". Retrieved 2006-08-23.
- "Caltro". Retrieved 2006-08-23.
- Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997). "Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older". N. Engl. J. Med. 337 (10): 670–6. PMID 9278463.
- Weingarten MA, Zalmanovici A, Yaphe J (2005). "Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps". Cochrane database of systematic reviews (Online) (3): CD003548. doi:10.1002/14651858.CD003548.pub3. PMID 16034903.
- Jackson RD, LaCroix AZ, Gass M; et al. (2006). "Calcium plus vitamin D supplementation and the risk of fractures". N. Engl. J. Med. 354 (7): 669–83. doi:10.1056/NEJMoa055218. PMID 16481635.
- Grant AM, Avenell A, Campbell MK; et al. (2005). "Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial". Lancet. 365 (9471): 1621–8. doi:10.1016/S0140-6736(05)63013-9. PMID 15885294.
- Porthouse J, Cockayne S, King C; et al. (2005). "Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care". BMJ. 330 (7498): 1003. doi:10.1136/bmj.330.7498.1003. PMID 15860827.
- Prince RL, Devine A, Dhaliwal SS, Dick IM (2006). "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. 166 (8): 869–75. doi:10.1001/archinte.166.8.869. PMID 16636212.
- Fletcher RH (2006). "Calcium plus vitamin D did not prevent hip fracture or colorectal cancer in postmenopausal women". ACP J. Club. 145 (1): 4–5. PMID 16813354.
- Baron JA, Beach M, Mandel JS; et al. (1999). "Calcium supplements for the prevention of colorectal adenomas. Calcium Polyp Prevention Study Group". N. Engl. J. Med. 340 (2): 101–7. PMID 9887161.
- Bonithon-Kopp C, Kronborg O, Giacosa A, Räth U, Faivre J (2000). "Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. European Cancer Prevention Organisation Study Group". Lancet. 356 (9238): 1300–6. PMID 11073017.
- for abstract see PMID 17556697
- Wactawski-Wende J, Kotchen JM, Anderson GL; et al. (2006). "Calcium plus vitamin D supplementation and the risk of colorectal cancer". N. Engl. J. Med. 354 (7): 684–96. doi:10.1056/NEJMoa055222. PMID 16481636.
- Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP (2007). "Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial". Am. J. Clin. Nutr. 85 (6): 1586–91. PMID 17556697.
- Lin J, Manson JE, Lee IM, Cook NR, Buring JE, Zhang SM (2007). "Intakes of calcium and vitamin d and breast cancer risk in women". Arch. Intern. Med. 167 (10): 1050–9. doi:10.1001/archinte.167.10.1050. PMID 17533208.
- Rebecca J. Donatelle. Health, The Basics. 6th ed. San Francisco: Pearson Education, Inc. 2005.
af:Kalsium ar:كالسيوم ast:Calciu bn:ক্যালসিয়াম zh-min-nan:Ca (goân-sò͘) bs:Kalcijum bg:Калций ca:Calci cs:Vápník co:Calciu cy:Calsiwm da:Calcium de:Calcium et:Kaltsium el:Ασβέστιο eo:Kalcio eu:Kaltzio fa:کلسیم fur:Calci gl:Calcio (elemento) ko:칼슘 hy:Կալցիում hi:काल्सियम hr:Kalcij io:Kalcio id:Kalsium is:Kalsín it:Calcio (metallo) he:סידן sw:Kalisi ht:Kalsyòm ku:Kalsiyûm la:Calcium lv:Kalcijs lb:Kalzium lt:Kalcis jbo:bogjinme hu:Kalcium mk:Калциум ml:കാത്സ്യം mi:Konupūmā ms:Kalsium nah:Tenextepoztli nl:Calcium no:Kalsium nn:Kalsium oc:Calci uz:Kalsiy nds:Calcium qu:Isku q'illay sq:Kalciumi scn:Calciu (mitallu) simple:Calcium sk:Vápnik sl:Kalcij sr:Калцијум sh:Kalcij su:Kalsium fi:Kalsium sv:Kalcium ta:கல்சியம் te:కాల్షియమ్ th:แคลเซียม tg:Калсий uk:Кальцій zh-yue:鈣