55 year old Caucasian woman not obese has the symptoms of osteoporosis. Her doctor prescribed a large dose of ca with different formulas and vitamen D3 . Weeks after starting the medicines fasciculation appeared . My advice as pharmacist was to make ca serum analysis the serum analysis was normal . fasciculation decreased with kcl syrup .question here what is the relationship between k and ca and fasciculation .second question in postmenopausal woman should I give ca supplement although ca serum level is normal .third question what is the reason of fasciculation ?
Calcium with Vitamina D-3 and Sun for Osporosis syndrom, wich is always associated in postmenopausal period with the Cramp-fasciculation syndrom and the therapy are beta-blocker, anticonvulsa and salts mineral
Yes, Postmenopausal Osteoporosis is a big problem in almost all community, there may be some variation. The present treatment is as stated Calcium preparation with Vitamin D-3. The causes are mostly Hormonal imbalance and Hypocalcemia. In my view Organic Calcium preparations are better along with Cissus Quandrangularis extract 500 mg daily and daily regular Coconut oil gentle massage.
Instead of the regular calcium carbonate, the patient can opt for mineral transporters like calcium aspartate and calcium orotate. Additionally, post menopausal osteoporosis involves the increased urinary calcium excretion due to hormonal changes. To take care of it, intake of soya isoflavones (phyto-estrogen) can be beneficial.
Additionally, Ibandronate can be prescribed to reduce the osteoclastic activity. Magnesium is also essential for maintenance of proper bone health and regulating the size of hydroxylapatite crystals.
I hope it helps.
Calcium with Vitamina D-3 and Sun for Osporosis syndrom, wich is always associated in postmenopausal period with the Cramp-fasciculation syndrom and the therapy are beta-blocker, anticonvulsa and salts mineral
Thanks alot that is tge first time I heard about CFS may be it is the reason and may be neuropathy because when I searched about CFS I found it doesn't affect sensation but my patiend suffered numbness in limbs
Firstly, treating postmenopausal osteoporosis with calcium and vitamin D supplements is a common but totally unacceptable practice. One needs to understand the cause and then treat accordingly. Bisphosphonates, HRT, PTH analogues are various modalities for treatment depending on severity of osteoporosis. Calcium and vitamin D supplementation are in addition to these modalities and not a primary modality of treatment. High protein diet also helps.
As regards the questions posted,
1. What is the relationship between k and ca and fasciculation?
Relationship of potassium with calcium may be better understood from this article https://www.ncbi.nlm.nih.gov/pubmed/26512962
and these ones too:
https://www.ncbi.nlm.nih.gov/pubmed/18759636
https://www.ncbi.nlm.nih.gov/pubmed/25990255
As these publications explain, potassium efflux and calcium influx are closely related in cellular homeostasis. That's how Potassium administration probably helped in your case.
2. In postmenopausal woman should I give ca supplement although ca serum level is normal?
Calcium levels remain normal till late as calcium is being mobilized from bone reservoir to keep normal calcium levels. In fact, calcium levels are usually normal in most cases of osteoporosis till very advanced stage. One must understand the essential and important role of calcium in cellular homeostasis.
3. What is the reason of fasciculation ?
Electrolyte imbalance which was corrected by potassium administration. Detailed mechanism of same can be understood from publication links provided above.
I agree with Dr Kumar that treating osteoporosis with calcium and vitamin D supplements alone is inadequate. Firstly, how was the diagnosis of osteoporosis made? Was there a bone density scan done? There are no symptoms until the patient fractures. If the patient has had a fracture, then active osteoporosis treatment is required, such as bisphosphonates, not just calcium and vitamin D.
Next is the puzzling appearance of muscle fasciculations in the patient. Usually, true fasciculations are due to low magnesium or low calcium levels, not high levels. More common causes of fasciculations are muscle or neurological diseases. If the fasciculations are persistent, the patient needs to see a neurologist for further tests.
Lastly, serum calcium levels are usually normal in osteoporosis and are not useful in the diagnosis of the condition.
Cannot agree more with Dr. Kumar and Dr. Yeap. The history should be properly taken to explore the exact cause of fasciculations.
Mr Hamada
I wonder what you mean when you spoke of "osteoporosis symptoms": Did the patient have any fractures?
With regard to calcium supplementation: yes, we often need to supplement even with normal serum levels depending on the daily intake (if it is insufficient, we need to supplement it).
With regard to fasciculations, I believe that more thorough etiological investigation should be done. The initiation of the same after use of the medications may not have been the cause, just a coincidence.
Finally, I would like to add that, since the diagnosis of osteoporosis, the use of anti-resorptive and / or anabolic medication should be initiated (does this patient have a clinical or densitometric diagnosis?)
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