Use of oral calcium to treat hypocalcaemia

doi:10.1136/bmj.a355

BMJ 2008;336:1392 (21 June), doi:10.1136/bmj.a355

Letters

Hypocalcaemia

Use of oral calcium to treat hypocalcaemia

The first 150 words of the full text of this article appear below.

Cooper and Gittoes hardly mention the therapeutic use of oralcalcium.¹ At least two points should be considered. Firstly,hypoparathyroidism with mild and chronic hypocalcaemia can betreated with oral calcium alone.² Secondly, different calciumsalts do not have the same bioavailability.

Calcium carbonate is the cheapest and most frequently suppliedoral calcium salt. It is used in most calcium plus vitamin Dsupplements. However, its absorption is greatly reduced in patientswith achlorhydria, unless taken with meals.³ Achlorhydric andolder patients, who often have hypochlorhydria, should be advisedto take calcium carbonate with meals or to take calcium citrate(at any time of the day). The second option , however, costsabout 50% more.

The absorption of calcium carbonate is also impaired in fastingpatients taking proton pump inhibitors.⁴ To my knowledge, itsabsorption with meals has not been studied in these patients.Most experts therefore recommend that patients . . . [Full text of this article]

Olivier Steichen, fellow

¹ AP-HP, Hôpital Tenon, Internal Medicine Department, 75020 Paris, France

olivier.steichen@tnn.aphp.fr