Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
Calcium seems to be in the news all the time. Yes, women
after menopause have lower levels of calcium in their bones.
True, your intake must be adequate. But this isn't the whole
story. You need vitamin D to absorb calcium. After that, you
need adequate levels in the blood which is governed by the
glands in neck called the parathyroids and by the kidneys.
Cancer and medications may also affect the level in the
blood. Hormone levels must be adequate to cause the bones to
uptake the calcium. This depends on various hormones.
So we see that just taking calcium pills is not enough. All
the other systems must be working as well. Since females have
low levels of estrogen after change-of- life, the disease
affecting calcium levels in the bones -- called osteoporosis
-- is less common in males. It would seem to make sense
therefore, that one of the interventions to help this problem
would be to give estrogens to mature females. This indeed was
the treatment for many years and it did work -- but there are
other problems with this that have made it fall from favor.
Today, the treatment is exercise and new drugs called
biphosponates. They are expensive and the kuppah does
not like to pay for them, but they work well. One drug called
Fosalan is taken only once a week.
Osteoporosis can be suggested by X-ray but a test called bone
densiometry establishes the diagnosis. Best way to prevent
this disease is to exercise when a person is still a young
girl. The disease can cause fractures of the spine with
minimal or even no trauma and this is extremely painful. It
is also disfiguring as it causes the stooped appearance.
Treatment for fracture pain is another novel drug: the nasal
spray calcitonin, one of the parathyroid hormones.
You need phosphorus to build strong bones, and vitamin D is
involved in the absorption of this as well. Deficiencies are
rare. We see low levels in sick diabetics and high levels in
cancer and kidney disease.
Magnesium is in every cell in the body and exerts many
actions. Its actions in the heart and its ability to relax
muscles have had doctors using it for rhythm problems in the
heart and for asthma, with moderate success. Hard to say who
needs this mineral, as blood tests are unreliable as
indicators of how much is in the body.
We'll finish up with minerals next week. But before, I will
tell you an interesting story. In the USA there are two
breakfast cereals: one called Wheaties and the other called
Total. They are exactly the same except that Total is vitamin
fortified. This is something that costs very little to do,
but allows the manufacturer to profit handsomely.
Supplementation costs about 1-2 cents a box. Let the buyer
beware. Write me in care of the Yated.
A message from Glaxo, sponsor of this column. If your
child needed antibiotics on Pesach, you may have noticed that
Glaxo's products, Augmentin and Zinnat, were the only
children's syrups that were kosher for Pesach. Say what you
will, but I would conclude that this is a company that cares
about its consumers. Think about that the next time the need
arises.
