At what age should ladies start taking daily calcium tablet? And must it be accompanied by Iron/ Vitamin D tablets?

Calcium supplements are not really required as we get enough calcium through our food, but it is not absorbed properly. It is important is to have enough Vitamin D, which helps in absorbing calcium in the body. We should start taking VitaminD supplements from the age of 30 onwards.

Can one’s body derive enough calcium from the common calcium rich foods? Or is it mandatory to take supplements for healthy bones?

Yes, milk products / protein rich Non-veg foods/Veg foods like soybean, green leafy vegetables have a lot of calcium but the body is unable to absorb it properly due to deficiency of Vitamin D and the only natural source of Vitamin D is sunlight.

Other than dairy products which are the calcium rich foods ?

Green leafy vegetables, sprouts, all sorts of pulses, soybean, tofu etc.

Calcium rich sources for vegetarians? Also B12 deficiency and hypo thyroid have any linkages with each other?

Vitamin D andB12 deficiency are interlinked. Foods rich in calcium are green leafy vegetables, sprouts, all sorts of pulses, soybean, tofu etc. Vitamin B12 dietary sources are only non-veg foods like fish, mutton & chicken. Vegans can either opt for supplements, beetroot and a few probiotics like Yakult, which are also a good source of B12.

Is it true , if the vitamins B12 & D are very low(much below the accepted minimum) in our body medicine in form of tablets do not help to cover the deficiency and the only thing is to go for vitamin shots which are again painful!  Also for how long these shots will help to sustain the required levels?

Yes, if the levels of B12 and Vitamin D are very low and the patient is symptomatic, like lethargic or suffer from any muscle or joints pain, then just tablets will not help. We should ideally check the levels of Vitamin B12 & D and give supplements accordingly. Initially, if shots have been taken, supplements have to be taken to sustain the deficiency.

Is osteoporosis a genetic condition? How does someone with a history of multiple bone and ligament injuries and a low Vitamin D + B12 level (despite a healthy diet and supplements) stay healthy?

Osteoporosis is genetic only in some cases but in most cases it is not genetic. This is because of poor intake of Vitamin D. The most common cause of osteoporosis is ignorance. After pregnancy specially if the pregnancy is in a later age (30-40years) women don’t take enough care and have deficiency of vitamin D & Calcium.Regular intake of vitamin D will increase calcium and Intake of high protein diets will change the bone matrix. Osteoporosis can be prevented if levels of Vitamin D and B 12 are maintained right from the beginning (in yours 30s). 

When somebody has a ligament injury or bone injury, their levels of Vitamin D and B12 should be higher than of the normal range. This will result in faster recovery.  

Is the normal calcium test sufficient to know the calcium deficiency
Or there is some specific calcium deficiency test for bones?

Calcium deficiency is never in the blood. If calcium is deficient, then it causes heart attack or serious conditions. Normally when calcium is less in the blood, our body takes it from the bones. Calcium test is not the right test. Let your doctor evaluate and if required, the doctor will advise Dexa Scan. Dexa Scan is aright way to understanding the bone density.

I’m down with frequent and severe bursitis (I had multiple injuries before), will this issue lead to osteoporosis? I’m on and off on Bio vitamin D3

Bursitis& osteoporosis are different. Bursitis will not (in most cases) lead to osteoporosis. It can only happen if you have stopped using your joints for some reason.  If bursitis is related to multiple joint problems like rheumatoid arthritis, then it might lead to osteoporosis.

Does taking calcium on regular basis for women over 45 years lead to stone formation in kidneys? If we’re onVitamin d3 once a month 60k..should we take calcium tablets fortified with d3 which is available as a combination in most calcium tablets?

Calcium doesn’t get absorbed by the body easily even if we keep taking supplements. As already discussed, Vitamin D helps in absorbing calcium.  If calcium is absorbed by the body, then it can travel to the kidneys and lead to stone formation. Vitamin D can prevent stone formation and calcium deposits in the heart plaques. Therefore, Vitamin D is cardio protective as well as nephron protective. The amount of Vitamin D intake will depend on patient to patient. Somewhere between once in week to once in a month, 60k ideally. I will not suggest anyone above 45 years of age, who has not been diagnosed with osteoporosis, to take calcium tablets.

What are the early signs for Osteoporosis?

Early signs are – Multiple joint pains,lethargy, deep pain in bones, frequent fractures.  

Can calcium supplements betaken continuously for a long period?

Calcium should not be taken for a long period. If necessary, it can be taken along with Vitamin D supplements, only if you are osteoporotic. It also depends on the Dexa scan.

Is osteoporosis curable ?

Osteoporosis is 100%curable. It only takes time. Most important is medication and regular exercise.

Does Vitamin D deficiency lead to osteoporosis?

Yes

What are the dietary sources for Vitamin D ?

There are no dietary sources for Vitamin D.  We can obtain Vitamin D only from Sunlight (Ultra violet rays). In India the weather is such, we only get UV rays a few hours in the morning and due to pollution, the UV rays gets filtered and only infra red rays reach us. Further, dark colour clothes and sunscreens lead to lesser absorption of UV rays which causes deficiency of Vitamin D. Easiest way is to take supplements.

What is the best time of the day to sit under the sun for Vitamin D absorption ?

Between 9.00 am to 10.30am.

The questions have been answered by Dr. Debashish Chanda-MBBS, MS – Orthopaedics, Fellowship in Joint Replacement, Fellowship in Arthroplasty & Arthroscopy, Fellowship in computer navigation- C K BIRLA HOSPITAL for WOMEN

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