Calcium Carbonate and vitamin D

Indication: This combination medication is used to prevent or treat low blood calcium levels in
people who do not get enough calcium from their diets. It may be used to treat conditions caused by
low calcium levels such as bone loss (osteoporosis), weak bones (osteomalacia/rickets), decreased
activity of the parathyroid gland (hypoparathyroidism), and a certain muscle disease (latent tetany). It
may also be used in certain patients to make sure they are getting enough calcium (e.g., women who
are pregnant, nursing, or postmenopausal, people taking certain medications such as
phenytoin, phenobarbital, or prednisone).Calcium plays a very important role in the body. It is
necessary for normal functioning of nerves, cells, muscle, and bone. If there is not enough calcium in
the blood, then the body will take calcium from bones, thereby weakening bones. Vitamin D helps
your body absorb calcium and phosphorus. Having the right amounts of vitamin D, calcium, and
phosphorus is important for building and keeping strong bones.

Side effect: Even though it may be rare, some people may have very bad and sometimes
deadly side effects when taking a drug. Signs of an allergic reaction, like rash; hives; itching;
red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or
throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth,
face, lips, tongue, or throat. Very hard stools (constipation). Upset stomach or throwing up.

Contraindication: Hypersensitivity to any of the components, hypocalcaemia resulting from

overdose of Vitamin D, hyperparathyroidism, bone metastases, severe renal insufficiency, severe
hypercalciuria, renal calculi etc.
Dosage and administration: One tablet once or twice daily with plenty of water or as
directed by the physician. Taking in full stomach ensures better absorption.
Interactions: Some products that may interact with this drug include: digoxin, phosphate
binders.Calcium can decrease the absorption of other drugs such as tetracycline antibiotics
(e.g.doxycycline, minocycline), bisphosphonates (e.g., alendronate), estramustine, levothyroxine,
and quinolone antibiotics (e.g., ciprofloxacin, levofloxacin). Also, certain medications can
decrease the absorption of vitamin D (bile acid sequestrants such as cholestyramine/colestipol,
mineral oil, orlistat). Therefore, separate your doses of these medications as far as possible from your
doses of calcium/vitamin D. Ask your doctor or pharmacist about how long you should wait between
doses and for help finding a dosing schedule that will work with all your medications.Vitamin D is
very similar to calcitriol. Do not use medications containing calcitriol while using vitamin
D.This medication may interfere with certain laboratory tests (including cholesterol tests), possibly
causing false test results. Make sure laboratory personnel and all your doctors know you use this
drug.

Overdose: At high doses it may result in nausea, vomiting, dizziness, anorexia, abdominal
cramps, headache, constipation, irritability etc. Treatment includes cessation of therapy and
adequate rehydration.
Four types of cells in bone
Microscopically, bone consists of hard, apparently homogeneous intercellular material within or
upon which can be found four characteristic cell types: osteoblasts, osteocytes, osteoclasts, and
undifferentiated bone mesenchymal stem cells. Osteoblasts are responsible for the synthesis
and deposition on bone surfaces of the protein matrix of new intercellular
material. Osteocytes are osteoblasts that have been trapped within intercellular material, residing
in a cavity (lacuna) and communicating with other osteocytes as well as with free bone surfaces
by means of extensive filamentous protoplasmic extensions that occupy long, meandering
channels (canaliculi) through the bone substance. With the exception of certain higher orders of
modern fish, all bone, including primitive vertebrate fossil bone, exhibits an osteocytic
structure. Osteoclastsare usually large multinucleated cells that, working from bone surfaces,
resorb bone by direct chemical and enzymatic attack. Undifferentiated mesenchymal stem cells
of the bone reside in the loose connective tissue between trabeculae, along vascular channels,
and in the condensed fibrous tissue covering the outside of the bone (periosteum); they give rise
under appropriate stimuli to osteoblasts.Depending on how the protein fibrils and osteocytes of
bone are arranged, bone is of two major types: woven, in which collagenbundles and the long
axes of the osteocytes are randomly oriented, and lamellar, in which both the fibrils and
osteocytes are aligned in clear layers. In lamellar bone the layers alternate every few
micrometres (millionths of a metre), and the primary direction of the fibrils shifts approximately
90°. In compact, or cortical, bone of many mammalian species, lamellar bone is further
organized into units known as osteons, which consist of concentric cylindrical lamellar elements
several millimetres long and 0.2–0.3 mm (0.008–0.012 inch) in diameter. These
cylinders comprise the haversian systems. Osteons exhibit a gently spiral course oriented along
the axis of the bone. In their centre is a canal (haversian canal) containing one or more small
blood vessels, and at their outer margins is a boundary layer known as a “cement line,” which
serves both as a means of fixation for new bone deposited on an old surface and as
a diffusion barrier. Osteocytic processes do not penetrate the cement line, and therefore these
barriers constitute the outer envelope of a nutritional unit; osteocytes on opposite sides of a
cement line derive their nutrition from different vascular channels. Cement lines are found in all
types of bone, as well as in osteons, and in general they indicate lines at which new bone was
deposited on an old surface

Bone reabsorption is resorption of bone tissue, that is, the process by which osteoclasts break
down the tissue in bones and release the minerals, resulting in a transfer of calcium
from bone tissue to the blood. The osteoclasts are multi-nucleated cells that contain numerous
mitochondria and lysosomes.
What is osteoporosis? Osteoporosis is a disease that weakens bones, increasing the risk of
sudden and unexpected fractures. Literally meaning "porous bone," it results in an increased loss
of bone mass and strength. The disease often progresses without any symptoms or pain.
Generally, osteoporosis is not discovered until weakened bones cause painful fractures (bone
breakage), often in the back (causing chronic back pain) or hips. Unfortunately, once you have
an osteoporotic fracture, you are at high risk of having another. These fractures can be
debilitating. Fortunately, there are steps you can take to prevent osteoporosis from ever
occurring. Treatments can also slow the rate of bone loss if you have osteoporosis.

How is osteoporosis related to menopause? There is a direct relationship between the lack of
estrogen after menopause and the development of osteoporosis. After menopause, bone
resorption (breakdown) overtakes the building of new bone. Early menopause (before age 45)
and any long phases in which the woman has low hormone levels and no or infrequent menstrual
periods can cause loss of bone mass. Estrogen, a hormone produced by the ovaries, helps protect
against bone loss. Replacing estrogen that is lost after menopause (when the ovaries stop most of
their estrogen production) slows bone loss and improves the body's absorption and retention of
calcium. But because estrogen therapy carries risks, it is only recommended for women at high
risk for osteoporosis who have other reasons for using it, such as menopausal symptoms. To
learn more, talk to your doctor about the pros and cons of estrogen therapy.

When Do Women Have Low Estrogen Levels? Women usually have low estrogen levels when
transitioning through menopause. During menopause, estrogen becomes imbalanced, causing
symptoms such as hot flashes, irregular periods, and vaginal dryness.

How Are Low Estrogen Levels and Osteoporosis Linked? Low estrogen levels can lead to
increased bone decay and osteoporosis. Estrogen helps to regulate bone cells called
osteoblasts, which are responsible for building new bone. When estrogen levels drop, fewer cells
are produced and bone is lost, but not replaced. Bone turnover refers to the total volume
of bone that is both resorbed and formed over a period of time

What’s the Link Between Osteoporosis and Menopause?Though the actual cause of
osteoporosis is still not completely clear, experts know that there's a distinct connection between
osteoporosis and menopause — a period when women stop ovulating, monthly menstruation
stops, and estrogen levels dramatically decrease. As much as half of a woman’s total bone loss
occurs within the first 10 years following menopause.The lack of estrogen, a natural
consequence of menopause, is directly related to a decrease in bone density. The longer a woman
experiences lower estrogen levels, the lower her bone density is likely to be. Women who are at
greater risk for osteoporosis are those who:

 Experience early menopause, before age 45

 Go a long time without having a menstrual period
 Have very irregular periods, indicating that they are not ovulating regularly
Parathyroid hormone (PTH), also called parathormone or parathyrin, is a hormone secreted by
the parathyroid glands that is important in bone remodeling, which is an ongoing process in
which bone tissue is alternately resorbed and rebuilt over time.
Bone remodeling (or bone metabolism) is a lifelong process where mature bone tissue is
removed from the skeleton (a process called bone resorption) and new bone tissue is formed (a
process called ossificationor new bone formation). These processes also control the reshaping or
replacement of bone following injuries like fractures but also micro-damage, which occurs
during normal activity. Remodeling responds also to functional demands of the mechanical
loading.

What Is Preeclampsia?
Formerly called toxemia, preeclampsia is a condition that pregnant women develop. It is marked
by high blood pressure in women who have previously not experienced high blood pressure
before. Preeclamptic women will have a high level of protein in their urine and often also have
swelling in the feet, legs, and hands. This condition usually appears late in pregnancy although it
can occur earlier.If undiagnosed, preeclampsia can lead to eclampsia, a serious condition that can
put you and your baby at risk, and in rare cases, cause death. Women with preeclampsia who
have seizures are considered to have eclampsia.There's no way to cure preeclampsia except for
delivery, and that can be a scary prospect for moms-to-be. But you can help protect yourself by
learning the symptoms of preeclampsia and by seeing your doctor for regular prenatal care.
Catching preeclampsia early may lessedn potential long-term effects for both mom and baby,

What Causes Preeclampsia? The exact causes of preeclampsia and eclampsia -- a result of a
placenta that doesn't function properly -- are not known, although some researchers suspect
poor nutrition or high body fat can be potential contributors. Insufficient blood flow to the uterus
could be associated. Genetics plays a role, as well.

Who Is at Risk for Preeclampsia?

Preeclampsia is most often seen in first-time pregnancies, in pregnant teens, and in women over 40.
While it is defined as occurring in women have never had high blood pressure before, other risk
factors include: A history of high blood pressureprior to pregnancy.A history of preeclampsiaHaving
a mother or sister who had preeclampsia. A history of obesity. Carrying more than one baby. History
of diabetes, kidney disease, lupus, or rheumatoid arthritis.
Parathyroid and Thyroid problems: Hyperparathyroidism, which is caused by too
much parathyroid hormone, can cause osteoporosis because the excess hormone extracts
calcium from your bones. On that same note, hyperthyroidism, or an overproduction of thyroid
hormone, may also lead to bone loss.