Musculoskeletal system - Calcium and vitamin D: calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol

Question 1

Musculoskeletal system

Calcium and vitamin D: calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol

Common indications

Answer 1

• Calcium and vitamin D are used in osteoporosis to ensure positive calcium balance
• Other treatments, such as bisphosphonates, may be given to reduce the risk of fragility fractures.
• Calcium and vitamin D are used in chronic kidney disease to treat and prevent secondary hyperparathyroidism and renal osteodystrophy.
• Calcium (as calcium gluconate) is used in severe hyperkalaemia to prevent life-threatening arrhythmias
• Other treatments, e.g. insulin with glucose, are given to lower the potassium concentration
• Calcium is used in hypocalcaemia that is symptomatic (e.g. paraesthesia, tetany, seizures) or severe (<1.9 mmol/L)
• Vitamin D is used in the prevention and treatment of vitamin D deficiency, including for rickets (in children) and osteomalacia (adults)

Question 2

Musculoskeletal system

Calcium and vitamin D: calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol

MOA

Answer 2

• In osteoporosis there is a loss of bone mass which increases the risk of fracture.
• In severe chronic kidney disease, impaired phosphate excretion and reduced activation of vitamin D cause hyperphosphataemia and hypocalcaemia
• hyperkalaemia, calcium raises the myocardial threshold potential, reducing excitability and the risk of arrhythmias.

Question 3

Musculoskeletal system

Calcium and vitamin D: calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol

Important adverse effects

Answer 3

• may cause dyspepsia and constipation
• When administered IV for the treatment of hyperkalaemia, calcium gluconate can cause cardiovascular collapse if administered too fast
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