Calcium and vitamin D are fundamental to bone health, and they work through a synergistic mechanism that, from a young age, supports proper skeletal development. While calcium is the main component of bone, vitamin D ensures that the mineral is properly absorbed by the body where needed, preventing accumulations that could lead to unwanted effects.
To keep bones healthy, it’s advisable to follow a calcium-rich diet for life. Calcium is found in many foods, such as spinach and legumes, and in some waters, but the richest sources are milk and dairy products. «However– notes Cesare Liberali, – lactose tolerance can decline with age, making it difficult to meet daily requirements through diet alone. In this case, as with patients at risk of bone fragility, supplementation may be necessary. Calcium, in addition to supporting the action of vitamin D and osteoporosis medications, is important for muscle function».
Conversely, vitamin D depends only minimally on diet; with diet alone you can intake only about 20% of the requirement. The remaining 80% is produced by the body through sun exposure.
Osteoporosis: a silent yet widespread disease
Osteoporosis is characterized by progressive loss of bone density; it often remains asymptomatic until fragility fractures occur, which can happen even after minor trauma.
The condition represents the most advanced stage of a process that begins with osteopenia, a less severe reduction in bone mineral density but already indicative of an increased risk. Postmenopausal women are the most at risk, due to the drop in estrogen protection that accelerates demineralization.
Explains Orazio Falla, head of the osteoporosis clinic at ASL Roma 5: «Alongside primary forms linked to age and estrogen deficiency, there are secondary forms of osteoporosis associated with preexisting conditions, which can affect even younger individuals. These include malabsorption diseases, such as celiac disease, endocrine disorders like hyperthyroidism, rheumatologic diseases (systemic lupus erythematosus, rheumatoid arthritis), and hematologic conditions (multiple myeloma, monoclonal gammopathies). A fundamental premise of treatment is correcting calcium and vitamin D deficiencies, to be paired, when necessary, with specific pharmacological therapies».
When to consider supplementation?
Individuals predisposed to bone fragility should follow a calcium-rich diet, ensure adequate sun exposure, and engage in regular physical activity. The average intake is about 1 gram per day, a quantity that increases in particular life stages, such as pregnancy and lactation.
«In Italy, calcium intake is among the lowest in Europe, and vitamin D levels are often insufficient. Modern lifestyle leads to reduced sun exposure, limiting endogenous vitamin D production; in addition, diets are often low in fatty fish, the main dietary source of this nutrient. Calcium and vitamin D supplementation should be tailored to the patient’s actual needs and based on a nutritional history that considers age, sex, lifestyle, and preexisting clinical conditions, factors that influence individual requirements» continues Falla.
Also important is the choice of the type of supplementation to ensure better adherence. «Calcium citrate offers a greater tolerability profile compared with calcium carbonate, which, while having good bioavailability, is often associated with a perception of poorer digestibility. These characteristics contribute to higher patient compliance» explains Falla.
The role of the physician in proper patient management
The general practitioner should be the first reference for the patient, identifying potential nutritional deficiencies, inadequate lifestyle factors, and overlooked risk determinants.
According to Liberali, it is essential to have dialogue between the primary care physician and the specialist «to ensure appropriate management that matches the complexity of the condition and the individual patient’s needs. In general, the GP can independently manage milder cases, such as patients who need calcium and vitamin D supplementation; and also those with altered parathyroid hormone levels, an indicator that often reflects insufficient vitamin D, and people with osteopenia or early osteoporosis. When fractures occur, vertebral collapses or other significant complications arise, involvement of the specialist becomes necessary, often an endocrinologist or a clinician in the osteometabolic field».
Abbonati a Karla Miller
