Adherence and barriers to the vitamin D and calcium supplement recommendation at Danish nursing homes: a cross-sectional study

Background Nursing home residents are in high risk of vitamin D deficiency, which negatively affects bone health. Vitamin D and calcium supplements haves shown to increase bone density and reduce fracture risk. Therefore, The Danish Health Authority recommends all nursing home residents a daily supplement of 20 μg vitamin D and 800–1000 mg calcium. However, adherence to the recommendation and knowledge of it is unknown. The aims of this study were to investigate adherence, knowledge, and potential barriers to this recommendation in Denmark. Methods A cross-sectional electronic survey was conducted in May–June 2020 among 50 randomly selected nursing homes widely distributed in Denmark. Questions included degree of adherence to the recommendation at each nursing home as well as respondent’s knowledge and attitudes towards it, and experienced barriers in relation to adherence. Results Respondents from 41 nursing homes answered the questionnaire, and these were mainly nurses (63%) or nursing home leaders (20%). Low adherence (≤ 40% of residents receiving both supplements) was reported at 35% of nursing homes, and only 8% of the nursing homes had a high adherence (> 80% of residents receiving both supplements). Most respondents (88%) had knowledge of the recommendation and 62% rated importance of increased implementation as high. Common explanations of low implementation were a lack of prescription by the general practitioner in the central electronic database (60%), resident-refusal to eat tablets (43%), chewing-swallowing difficulties (40%), and a high number of tablets given to the residents daily (34%). Conclusions The recommendation of daily vitamin D and calcium supplements to Danish nursing home residents is poorly implemented even though knowledge of the recommendation is relatively high. Barriers relate to an ambiguity of responsibility between the general practitioners and the nursing home staff, as well as the high number of tablets to be consumed in total by the residents. These barriers must be targeted to improve adherence in this vulnerable group of institutionalized older adults.

Inappropriate Use of Calcium Supplements among Patients with Low Risk for Osteoporosis and its Association with Knowledge on Calcium Supplements

Calcium supplement use without medical indications may be considered inappropriate as it could cause harms. This study aimed to determine the proportion of individuals with low risk for osteoporosis who used calcium supplements inappropriately. Their practice and factors influencing the use were also examined. This cross-sectional study was conducted at a university-based primary care clinic involving 125 patients, aged 18 to 64 years with low risk for osteoporosis (based on the Osteoporosis Self-assessment Tool for Asians, personal or family history of osteoporosis or hip fracture and diseases of secondary osteoporosis). A validated self-administered questionnaire was used to assess participants’ characteristics, knowledge on calcium supplements (KnowCas-12) and its practice. About 46.4% took calcium supplements within the past one year, whereby many had never discussed the use with doctors (46.6%). However, only 25.9% were compliant and almost all (95%) with incorrect consumption. The two commonest reasons for its use were “to prevent from fracture” (70.7%) and “not enough calcium through my diet” (56.9%). The median (inter quartile range) KnowCas-12 score was 6.0 (3.0) (the possible range: 0-12; the mid-point: 6). Multiple logistic regression showed only KnowCas-12 score had a significant independent association with the use (adjusted odds ratio: 0.79; 95% confidence interval: 0.64-0.98; p=0.031). In conclusion, the inappropriate use of calcium supplements was common among the low-risk individuals, but most were non-compliant with incorrect consumption. Their knowledge of calcium supplements was still lacking. As it could influence the use, educational interventions should be imparted to ensure correct osteoprotective behaviour.

A Review on The Complications and Management of Osteoporosis

Osteoporosis is a skeletal disease that is characterized by low bone mineral density. It also disrupts the microarchitectural of the bone. In leads to increased bone fragility and risk of fractures. Even while it occurs in persons of various ages and ethnicities (including Caucasians and whites), it is more common among Caucasians (whites), elderly people, and women. Osteoporosis is becoming a global epidemic as the world's population ages and lives longer. Osteoporosis affects an estimated 200 million individuals worldwide. It affects a 3rd of women and one in every 12 men. This increases morbidity as well as mortality due to several complications. Moreover, It also reduces the patient's quality of life, lengthens their life expectancy when they are disabled, and places a heavy financial load on the health insurance systems of countries that are responsible for their care. Thus, it is essential to improve diagnostic methods and to introduce early intervention to prevent this disease. Lifestyle modification is an important recommendation for the population at risk. There are several pharmacological interventions that could be taken to prevent osteoporosis as vitamin D and calcium supplements and to treat osteoporosis as bisphosphonates and anabolic drugs. The most important step in the treatment is tailored to the individual patients and to optimize the treatment according to each case individually. Therefore, increasing doctor awareness, which promotes improved awareness among the general public, will be useful in averting this epidemic.

A Neglected Case of Wilson’s Disease Presenting as Symptomatic Urolithiasis and Proteinuria

We report a short-statured, 39-year-old male presenting with recurrent kidney stones, history of refractory rickets, and bone deformity. He had been consuming multiple doses of calcium supplements and multiple courses of vitamin D over past 30 years beforeprior to reporting in our clinic without any significant laboratory or clinical improvement. The patient was diagnosed as having Fanconi’s syndrome attributable to Wilson’s disease. This patient highlighted that in case of resistant rickets, a high index of uncertainty must be invoked for Wilson’s disease. Appropriate timely recognition of this entity results in prompt ministrations and prevention of disability. We also presented and discussed reviews on Wilson’s disease from literature.

STUDY OF IMPAIRED GLUCOSE TOLERANCE AND HBA1C IN ACUTE PANCREATITIS ON THE BASIS OF SEVERITY

Aim:The study was planned to evaluate the association of Impaired Glucose Tolerance and HbA1c with severity of acute pancreatitis. Material and methods: In present study Out of 133 patients diagnosed for Acute Pancreatitis; total 115 patients (n=115), of either gender of 18 to 65 years age groups were enrolled for the study. Patients with history of any acute or chronic illness like:-Diabetes Mellitus Impaired renal function, Hyperparathyroidism, Malnourished, Pregnant and lactating women and patients on calcium supplements were excluded. Result: The % of patients with impaired glucose tolerance was higher in patients suffering from severe pancreatitis. A signicant association was observed between impaired glucose tolerance and severity of pancreatitis (p ≤ 0.0001).Also signicant difference was observed in the HbA1c levels among three groups [mild, moderate and severe AP (p≤0.0001)]. Conclusion: The study concluded that a higher % of patients of severe pancreatitis group were diabetic or at risk of developing diabetes as compared to mild pancreatitis group.

397A Meta-Analysis of Randomized Clinical Trials on Calcium Intake for Obesity Indices

Background There was no consistent finding of changes of obesity indices including fat mass by calcium supplements and dairy products intervention. Therefore, we conducted the meta-analysis of evidence on calcium supplements and dairy products (≥ 12 weeks) on changes in the obesity index (fat mass, as well as weight, body mass index, waist circumference) from randomized controlled trials (RCTs). Methods We searched for original articles during the last 10 years until August 19, 2019, using PubMed and EMBASE. The extracted data were analysed with random effects, inverse variance model using Review Manager 5.3 ver. Results Finally, ten RCTs with calcium supplements and fourteen RCTs with dairy products among adults aged 18 years old or over were selected. The intervention with calcium supplements showed significant change of fat mass (SMD, 95% CI; -0.21 [-0.37, -0.04], p = 0.02), but not in changes in body weight (p = 0.45), BMI (p = 0.14) and WC (p = 0.88). Dairy products also showed significant results in changes of fat mass (SMD, 95% CI; -0.51 [-0.90, -0.11], p = 0.01) as well as BMI (WMD, 95% CI; -0.46 [-0.67, -0.26], p < 0.00001), but not in changes of body weight (p = 0.70) and WC (p = 0.27). Conclusions The fat mass may be reduced by both calcium supplements and dairy products intervention over 12 weeks among adults 18 years old or over. Dairy products may be beneficial for BMI reduction. Key messages Dietary calcium intake might reduce fat mass in adults (≥ 18 years).

920 Improving the Management of Post-Operative Hypocalcaemia In Thyroid Surgery

Aim Hypocalcaemia is a frequent, and potentially dangerous, complication of total thyroidectomy [1, 2] due to the removal of the parathyroid glands. This quality improvement (QI) project was undertaken in a large Ear, Nose and Throat department in the East of England over a year. The project improved postoperative guideline compliance by optimising the recognition and management of patients at risk of hypocalcaemia. This process focussed on improving parathyroid hormone (PTH) and calcium blood testing, appropriate prescribing and the monitoring and management of hypocalcaemia. Method A baseline audit was conducted to determine initial guideline compliance. The QI process subsequently involved the introduction of a new intraoperative PTH pathway and the amendment of trust guidelines. In addition, there was a focus on improving clinician awareness of guidelines, junior doctor education, communication between operating surgeons and junior doctors and the optimisation of patient handover. Results The measurement of PTH at four hours improved from 42.5% to 52.2%. The project saw a significant improvement in the monitoring of hypocalcaemia (from 22.2% to 83.3% for patients with an intermediate risk of hypocalcaemia) and in the prescribing of prophylactic calcium supplements from 7.5% to 43.5%. Conclusions By optimising postoperative care this QI project improved patient safety as well as impacting on the duration, and overall cost, of inpatient stay.

Review on the extraction of calcium supplements from eggshells to combat waste generation and chronic calcium deficiency

When faced with a plethora of issues, the possibility of one problem becoming the solution of another is a rare, yet beneficial scenario. This report explores the prospect of viewing the accumulation of organic waste matter in India as a potential calcium reservoir to relieve the issue of calcium deficiency in the population. Waste generation has seen gradual growth, and it has created a problem of waste disposal. A large segment of the generated waste primarily consists of food waste which contains significant amounts of nutrients. Food waste such as eggshells, waste from shellfish, bones, and fish scales contain good amounts of bioavailable calcium, and large quantities of this discarded bioavailable calcium remain unused. Global studies show India to have significantly lower levels of calcium intake than the global average, thus increasing the risk of calcium deficiency-related diseases. Furthermore, research shows that for over the past half of the century, the intake of dietary calcium has declined drastically throughout India. This has led to chronic calcium deficiency-related diseases throughout most of the Indian population. Hence, development of calcium supplements from calcium-rich waste material has the potential to not only reduce the strain on waste management, but also to provide the calcium-deficient population with a cheaper alternative to traditional supplements. Owing to the abundance and ease of separation, eggshells have been chosen as the focus of the review. This review highlights and compares their extraction methods of providing cheap calcium supplements while reducing the amount of eggshell waste.

Effects of Adolescents’ Lifestyle Habits and Body Composition on Bone Mineral Density

The incidence of osteoporosis is increasing as the population ages, as is the need to manage and prevent it. Adolescence is the period when the fastest development of bone mass takes place. Increasing adolescents’ maximum bone mass and avoiding the risk factors for its loss are effective for preventing osteoporosis. This study investigated the factors influencing adolescents’ bone mineral density (BMD). The participants were 126 middle- and high-school students from Gangwon-do; 47.6% (n = 60) were male, with an average age of 15 (range 12–18) years of age. It was found that age, carbonated beverages, snacks, and calcium supplements were variables that showed significant differences in adolescents’ BMD. Additionally, through correlation analysis, it was found that height, weight, body mass index (BMI), body water, protein, minerals, body fat mass, and skeletal muscle mass were correlated with BMD. Multiple regression analysis identified age, calcium supplements, BMI, body fat mass, and skeletal muscle mass as BMD-associated factors. These results show that adolescents’ BMD is higher with lower body fat mass, higher BMI and skeletal muscle mass, and a higher intake of calcium supplements.