Calcium Rich Mineral Waters and Osteoporosis

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Calcium Rich Mineral Waters and Osteoporosis

• Mine Karagülle, MD
• Istanbul University
• Istanbul Medical Faculty Department of Medical
  Ecology Hydroclimatology

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A tiny reminder!

• Osteoporosis is a bone disease characterized by a
  reduction in bone tissue relative to the volume
  of anatomical bone that increases susceptibility
  to fracture, particularly in menopausal women

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A tiny reminder!

• With the increase in life expectancy and in the
  number of elderly people, osteoporotic fractures
  are becaming a major public health problem in
  industrialized countries

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Calcium Requirement

• Among dietary factors implicated as risk factors
  for the development of osteoporosis, calcium
  intake is considered one of the major
  determinants of bone health

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Calcium Requirement

• It is generally agreed that an adequate calcium
  intake(1200-1500mg/d) is necessary for the
  acquisition of an ideal peak bone mass and for
  the maintenance of the bone mineral density in
  adults, in postmenopausal women, and in the
  elderly.

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Calcium supplementation with calcium-rich mineral
waters A systematic review and meta-analysis
Böhmer et al. Osteoporosis Int 200011938-943

• First all publications on calcium absorbtion from
  mineral waters were identified
• In a second step, studies comparing calcium
  absorption from mineral waters with that fom
  dairy products
• Six publications were assessed in this
  meta-analysis
• Four studies fulfilled all inclusion criteria

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Halpern et al.Am J Prew Med19917379-83

• N15 lactose-intolerant adults
• Calcium bioavailability from mineral water at
  least comperable to dairy products.
• Mineral water is a useful calcium source for
  lactose-intolerant adults

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Heaney and Dowell .Osteoporosis Int 1994231-44

• N18 Healthy women
• Calcium bioavailability from mineral water at
  least comperable to dairy products

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Couzy et al Am J Clin Nutr 1995621239-44

• N9 Healthy women
• Calcium bioavailability from mineral water
  comperable to dairy products

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Van Dokkum et al Br J Nutr 199675 893-903

• N12 Healthy young adult women
• Calcium bioavailability from mineral water(37.0)
  comperable with dairy products(37.7-42.2).
• Combined with a spaghetti meal, calcium
  bioavailability from mineral water increases
  significantly (46.1)

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Guillemant et al Osteoporosis Int 1997 785-6

• N12 Healthy young adult men
• Inhibition of PTH-secretion induced by mineral
  water rich in calcium

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Wynckell et al Miner Electrolyte Metab
19972388-92

• N12 Students(8 men, 4women)
• The intestinal calcium absorption from mineral
  waters with three different concentrations
  (10.4,78 and 467mg/L) is comperable.
• Calcium- rich mineral water is a useful calcium
  source for the elderly and patients with lactose
  intolerance

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Calcium absorption from mineral water
Mineral waters Subjects(n) Ca2 (mg/L) Absorption Mean()
Sangemini women (18) 318 47,5
Contrex women (9) 466 23,8
Ferrarella women(12) 368 37,0
Mineral water I students male (8) female (4) 10.4 34,1
Mineral water II students male (8) female (4) 78 37,0
Mineral water III students male (8) female (4) 467 36,1
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Ion concentration of tested mineral waters(mg/L)
Brand name Na Ca2 Mg2 Cl- SO42- HCO32-
Sangemini 16.5 318 14.6 15 42 1000
Ferrarelle 47 368 17 22 5 1385
VittelGrande 3.8 202 36 7.2 306 402
Contrex 10 466 83 8 1160 403
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Effect of high-calcium mineral water on bone loss

• Copellero et al. Calcif Tissue Int
  199659238-239
• Randomized Controlled Trial
• (n45 postmenopausal women)
• study period (131 months)

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Effect of high-calcium mineral water on bone loss

• Copellero et al. Calcif Tissue Int
  199659238-239
• Gr.I 1L/day calcium mineral water
• (Ferrarella 408 mg/L Ca)
• Gr.II1L/day low calcium mineral water 80 mg/L

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Effect of high-calcium mineral water on bone loss

• Copellero et al. Calcif Tissue Int
  199659238-239
• Gr.I (high calcium MW) significant reduction in
  osteocalcin levels
• Gr.II (low calcium MW)significant decrease in
  bone mineral density
• High calcium mineral water as an effective
  prophylaxis in postmenopausal bone loss

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Importance of bioavailable calcium drinking water
on bone mass

• Costi et al. J Endocrinol Invest 199922852-856
• Case report N255 women (30-70 years of age) in a
  small community area

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Importance of bioavailable calcium drinking water
on bone mass

• Costi et al. J Endocrinol Invest 199922852-856
• Gr.A drinking regularly a high Ca mineral
  water318mg/L (Sangemini)
• Gr.B drinking different type of water with a
  lower Ca content 83mg/L

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Importance of bioavailable calcium drinking water
on bone mass

• Costi et al. J Endocrinol Invest 199922852-856
• Gr.A women ingested a significanthy higher
  quantity of calcium than Gr.B
• Gr.A average bone density values were slightly
  but significanty higher than Gr. B

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EPIDOS Cohort Study

• Aptel,I et al.J Bone Miner Res 199914829-833
• The study included 4434 women over 75 years of
  age
• A significant correlation was found between total
  calcium intake and bone density at the femoral
  neck

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EPIDOS Cohort Study

• Aptel,I et al.J Bone Miner Res 199914829-833
• An increase of 100 mg/day in calcium from
  drinking water was associated to a 0.5 increase
  in femoral bone density
• Dietary calcium from other sources only led to a
  0.2 increase

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Meunier et al Osteoporosis Int Published online
3 March 2005

• Consumption of high calcium mineral water lowers
  biochemical indices of bone remodeling in
  postmenopausal women with low calcium intake
• Significant decrease of PTH, osteocalcin,bone
  alkaline phosphatase serum and urine type-1
  collagen C telopeptide in the HCaMW group
  compared to placebo group

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mineral waters rich in calcium
Brand name Ca2 mg/L Country
Adelborner 569 Switzerland
Eptinger 555 Switzerland
St. Augustinus 585 Germany
St. Margareten 566 Germany
Schillerquelle Ensingen 585 Germany
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mineral waters rich in calcium
Brand name Ca2 mg/L Country
Akmina 428 Turkey
Hunyadi Janos 483 Hungary
Sirma 304 Turkey
Borsec 310 Hungary
Anatolya 249 Turkey
Kekkuti 242 Hungary
Kula 236 Turkey
Mira 230 Hungary
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Conclusion

• Although data are available from only a few
  studies with relatively small number of subjects
• calcium-rich mineral waters seem to offer an
  effective alternative to calcium supplementation
  from milk and diary products

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Conclusion

• Some mineral waters with high calcium levels,
  might be significant sources of calcium
• And they are calorie free

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THANK YOU