Bone-Sparing by Ca Salts With & Without Extra Phosphorus

描述：(申请人提供)骨矿物质基本上是磷酸钙，骨获取需要两种元素(钙和磷)。美国典型的钙摄入量低于当前的推荐摄入量，而典型的磷摄入量高于当前的推荐值。因此，人们的注意力主要集中在通过补充和食物强化来增加钙的摄入量上。最常用于这些目的的盐是碳酸钙。但是，尽管平均磷摄入量往往是充足或充足的，但仍有相当大比例的老年女性在任何一天摄入的磷都不到RDA的70%，因此可以说有患上磷缺乏的风险。当这些妇女接受合成代谢疗法和补充钙(作为碳酸盐)的组合时，增加的钙可能会暴露并加剧潜在的磷缺乏。这既是因为钙结合了肠道中的磷酸盐并减少了其吸收(从而有效地进一步降低了磷的摄入量)，也是因为诱导的骨合成代谢本身会消耗磷，因此吸收的磷可能不足以支持这种疗法可能增加的骨矿物质质量。 为了测试补充两种骨矿成分以支持骨质疏松症合成代谢治疗的可能的重要性和价值，我们提出了一项为期一年的随机试验，在两组接受特瑞帕特治疗的绝经后骨质疏松症妇女中，比较了添加和不添加额外磷(即磷酸钙和碳酸钙)的钙补充剂。主要的结果衡量标准将是在试验的一年中骨矿含量的变化。第二个结果是测量骨吸收生物标记物，以评估与碳酸盐盐相比，磷酸盐是否提高了重塑。发现含磷钙补充剂的优越性将提供证据，导致钙来源的成本中性变化和骨质疏松症联合治疗(以及可能的骨质疏松症预防)的相应改善。

DESCRIPTION: (provided by applicant) Bone mineral is basically calcium phosphate, and both elements (Ca and P) are required for bone acquisition. Typical Ca intakes in the U.S. are lower than current recommendations, and typical P intakes, higher. Thus attention has been focused mainly on increasing Ca intake, by supplementation and food fortification. The salt most commonly used for these purposes is calcium carbonate. But while the average P intake tends to be adequate or generous, nevertheless substantial proportions of older women ingest less than 70 percent of the RDA for phosphorus on any given day, and hence may be said to be at risk for P deficiency. When these women are given a combination of anabolic therapy and supplemental Ca (as the carbonate), the added Ca may uncover and aggravate the latent P deficiency. This is both because Ca binds phosphate in the gut and reduces its absorption (thereby effectively lowering the P intake still further) and because the induced bone anabolism will itself consume phosphorus, as a result of which absorbed phosphorus may not be sufficient to support the increase in bone mineral mass made possible by this therapy. To test the possible importance and value of supplementing both of the components of bone mineral in support of anabolic therapy of osteoporosis, we propose a 1-year randomized trial, comparing, in two groups of teriparatide-treated postmenopausal osteoporotic women, calcium supplements with and without extra phosphorus (i.e., Ca phosphate vs. Ca carbonate). The principal outcome measure will be change in bone mineral content over the one year of the trial. A secondary outcome is measurement of bone resorption biomarkers so as to assess whether the phosphate salt elevates remodeling relative to the carbonate salt. A finding of superiority of the phosphate-containing Ca supplement would provide evidence leading to a cost-neutral change in Ca sources and a corresponding improvement in osteoporosis co-therapy (and possibly osteoporosis prophylaxis as well).