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Kalcium a vitam n D proti osteopor ze

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Kalcium a vitam n D proti osteopor ze

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    1. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 1 Kalcium a vitamn D proti osteoporze J. Wendl NZZ FIDELITAS, s.r.o. Bratislava

    2. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 2

    3. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 3 Preitie po zlomenine femuru

    4. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 4 Nsledky OP zlomenn

    5. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 5 Ako to zacna?

    6. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 6 Kostn metabolizmus

    7. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 7 Kalcium a kost Nzky prjem kalcia = zven vdaj PTH: kles BMD stpa remodelcia (OR) dsledok kost slabne, zvyuje sa jej lomivost Vysok prjem kalcia = pokles vdaja PTH: rast BMD (mlad), spomalenie strt (star) tlm remodelcie (OR) dsledok kost silnie kles jej lomivost

    8. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 8 Kalcium pri OP odporcaj Dietary Reference Intakes for Calcium & Related Nutritiens, 1997 NIH Consensus Development Conferences, 1994, 2000 Surgeon Generals Report Report on Bone Health and Osteoporosis, 2004 NIH News (WHI), 2006 Dietary Guidelines for Americans, 2006

    9. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 9 Skutocnost a monosti ... Scasn prjem kalcia: v USA: 550 - 650 mg/d v SR: 300 - 500 mg/d (Chapuy 1992, Dawson-Hughes 1997, Chevalley 1994, Recker 1996 - tdie v populcich starch ien)

    10. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 10 Poznatky a ich aplikcia... USA r. 1994 (tesne pred zavedenm BF do liecby OP) 43% lekrskych odporcan pri OP obsahovalo radu zvit prjem kalcia USA od 9 rokov neskr len 23% lekrskych odporcan pri OP obsahovalo tto radu (Stafford 2004) USA v scasnosti 40% pac. s BF neuva kalcium vbec, 33% pac. berie menej ako 1 tbl/den (Heaney 2006)

    11. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 11 Ak mnostvo kalcia? vo veku do 50 rokov: 1 000 mg/den vo veku nad 50 rokov: 1 200 1 500 mg/den

    12. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 12 Metabolizmus vitamnu D potrava Cholesterol koa + UV iarenie (zloka B) Colecalciferol pecen (25 hydroxylcia) 25 OH colecalciferol oblicky (1alfa hydroxylcia) 1,25 (OH)2 colecalciferol - kost: mineralizcia ?OR ?OF - crevo: zvenie Ab Ca - prittne telieska: ?PTH

    13. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 13 Suplementcia kalcia Potraviny Vhodn mlieko 1 liter =1200 mg tvrd syr 10 dkg = 700 - 1200 mg jogurt 150 g = 315 mg MINERLKY Menej vhodn: Tvaroh 10 dkg = 100 mg Taven syry = vela fosftov Sjov mlieko = E2, mlo Ca Nesolit! Produkty Liekov forma tbl, eff tbl, eff granult, plv cinn ltka kalcium karbont, citrt Compliance chut, pohodlie prpravy Kombincie vitamn D, multikomponenty

    14. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 14 Suplementcia vitamnu D DOSPEL Mobiln mj september: 30 45 min UV iarenie oktber aprl: suplementcia 800 1500 IU/den Nevychdzajci z bytu alebo vo veku > 65 r. po cel rok: suplementcia 800 1500 IU/den

    15. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 15 Minerlky I: Preco? Kalciov prpravky nevhody jednorazov vysok dvka (hyperkalcimia) urolitiza niia biodostupnost neobsahuj magnzium iadny alebo mlo vitamnu D v jednej dvke

    16. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 16 Riziko nefrolitizy I Prjem kalcia a nefrolitiza: potrava vs. suplementcia 12 rocn sledovanie 91 731 ien 34-59r. (Curhan, G.C. et al., Ann Int. Med. 1997) vysok prjem Ca: ni risk nefrolitizy ne nzky prjem kalcia vysok prjem Ca z dity: znien risk (znenm absorpcie oxaltov v potrave?) vysok prvod Ca suplementciou: zven risk riziko nefrolitizy zniuje aj Mg, K, tekutiny riziko nefrolitizy zvyuje aj Na

    17. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 17 Riziko nefrolitizy II Prjem kalcia a nefrolitiza: minerlna voda s vysokm obsahom kalcia a magnzia vs. stolov voda Rizikov faktory nefrolitizy mnostvo prijatch tekutn zloenie vylcenej tekutiny tdia: 20 pac., kalciria/24hod. (Rodgers AI: Urol Int, 1997): Dokzal sa priazniv vplyv minerlky na zloenie vylcenej tekutiny (moca): exkrcia oxaltov, exkrcia magnzia saturcia kalcium oxaltom, mnostvo odlcench epitli

    18. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 18 Minerlky II: Preco? Mlieko a mliecne produkty nevhody obsahuj bielkoviny a tuky (CKD, hypercholesterolmia) obsahuj laktzu (deficit laktzy, celiakia) iadne magnzium iadny vitamn D cena

    19. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 19 Kolko stoj 600mg kalcia? pol litra mlieka = 0,23 EUR 5 dkg ementlu = 0,30 EUR 8,5 dkg eidamu = 0,59 EUR 4 nzkotucn jogurty = 1,44 EUR 5 jogurtov Activia = 2,20 EUR Aqua Os 1 liter = 0,58 EUR

    20. 13. kongres slovenskch a ceskch osteolgov, Bratislava 2010 20 Ktor minerlky? Aqua Os: 600mg Ca + 160mg Mg + 6,2 mg Na + 400 IU vit.D3 - Korytnica: 600 mg Ca + 160mg Mg + 6,2 mg Na Salvator: 450 mg Ca + 170 mg Mg + 248 mg Na Gemerka: 440 mg Ca + 140 mg Mg + 100 mg Na Baldovsk:360 mg Ca + 80 mg Mg + 20 mg Na Kltorn: 290 mg Ca + 70 mg Mg + 64 mg Na Mitick: 270 mg Ca + 105 mg Mg + 28 mg Na Magnesia: 35 mg Ca + 180 mg Mg + 5 mg Na

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