Calcium Supplementation After Fracture: Is Procal Right for You?

Issues with taking Procal after a fracture?

Director Chen: I suffered a proximal humeral fracture in a car accident last year, and five months later, the bone has not healed properly.
The doctor prescribed one Prolia injection in the morning and one in the evening, and I underwent a bone density test with a T-score of -2.8.

Question 1: Is it suitable for me to take this medication? It seems to be intended for patients with kidney disease.
Can I also supplement with calcium tablets on my own? Will that lead to an overdose since I noticed that the calcium content in Prolia is 169 mg?
Question 2: Due to my osteoporosis, the orthopedic doctor prescribed Fosamax.
Since my bones are currently healing, is it appropriate for me to take this medication? My concern is that while Fosamax may slow down the destruction of osteoclasts, could it also slow down the activity of osteoblasts?
Thank you, Director Chen, for your response.
This website is excellent and has greatly increased my knowledge.

Zhang Ziyun, 70~79 year old female. Ask Date: 2021/04/29

Dr. Chen Bochen reply Orthopedics

1.
Calcium propionate is calcium acetate, which has poor absorption and a strong odor.
It is generally used for patients with kidney issues to help eliminate phosphate ions (as calcium binds with phosphate to precipitate and subsequently excrete it).
It is usually recommended to obtain calcium from natural food sources.
If there is a deficiency, a small amount of calcium supplements can be taken.
2.
Fosamax (alendronate) is a bisphosphonate and is the most cost-effective medication for treating osteoporosis; however, it can indeed slow down bone growth.
Typically, I would allow patients to start taking it 1 to 1.5 months after a fracture.
If you wish to treat osteoporosis while also promoting fracture healing, you may ask your physician to evaluate the suitability of using Forteo (teriparatide, daily subcutaneous injection) or Evenity (romosozumab, monthly subcutaneous injection).
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Reply Date: 2021/04/29

More Info

When it comes to calcium supplementation after a fracture, particularly in the context of your recent humeral fracture and the subsequent diagnosis of osteoporosis (with a T-score of -2.8), it is essential to approach this matter with careful consideration of your overall health, dietary intake, and any medications you may be taking.

Understanding Calcium Supplementation
1. Calcium Needs Post-Fracture: After a fracture, especially in the case of osteoporosis, adequate calcium intake is crucial for bone healing and density maintenance. The recommended daily intake of calcium for adults is typically around 1000-1200 mg, depending on age and gender. Given your diagnosis, ensuring you meet this requirement is vital.

2. Procal and Its Suitability: Procal is often prescribed for patients with specific needs, including those with renal issues. If your doctor has prescribed it, it indicates that they believe it is appropriate for your situation. However, if you have concerns about its suitability, particularly regarding its use in patients with kidney disease, it is essential to discuss this with your healthcare provider. They can clarify whether Procal is indeed the right choice for you, considering your overall health status.

3. Supplementing with Additional Calcium: If Procal contains 169 mg of calcium per tablet, taking two tablets daily would provide you with 338 mg of calcium. If your dietary intake is low, you may need to supplement further. However, it is crucial to avoid exceeding the upper limit of calcium intake (typically around 2000-2500 mg per day for adults) to prevent potential adverse effects, such as kidney stones or cardiovascular issues. Therefore, tracking your total daily calcium intake from both food and supplements is essential.

Concerns Regarding Other Medications
1. Fosamax (Alendronate): This medication is commonly prescribed to help prevent bone loss and is particularly effective in reducing the risk of fractures in individuals with osteoporosis. Your concern about whether Fosamax might slow down bone growth is valid. While it works by inhibiting osteoclasts (the cells that break down bone), it does not directly inhibit osteoblasts (the cells that build bone). In fact, it can help improve bone density over time, which is crucial for healing fractures. However, it is essential to follow your doctor's instructions regarding its use, as they will tailor the treatment to your specific needs.

2. Timing and Interaction: When taking multiple medications, timing can be crucial. Fosamax should be taken on an empty stomach, and you should wait at least 30 minutes before eating or taking other medications. This ensures optimal absorption and effectiveness.

Dietary Considerations
In addition to supplements, focusing on a calcium-rich diet is vital. Foods high in calcium include dairy products (milk, cheese, yogurt), leafy green vegetables (kale, broccoli), and fortified foods (certain cereals and plant-based milk). Vitamin D is also essential for calcium absorption, so ensure you are getting adequate sunlight exposure or consider a vitamin D supplement if necessary.

Conclusion
In summary, it is crucial to have an open dialogue with your healthcare provider regarding your calcium supplementation and any medications you are taking. They can provide personalized recommendations based on your medical history, current health status, and dietary habits. Monitoring your total calcium intake and ensuring you are not exceeding recommended levels is essential for your health. With the right approach, you can support your bone healing and overall health effectively.

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