title: The effects of calcium supplementation to patients with primary hyperparathyroidism and a low calcium intake.
abstract: BACKGROUND
  In patients with primary hyperparathyroidism (PHPT) a low calcium intake might cause increased bone loss and thus aggravate osteoporosis, and a high intake might increase serum calcium level and the risk of nephrolithiasis.
  
  
  OBJECTIVE
  Generally, guidelines recommend a normal calcium intake, and accordingly, those with a low intake might benefit from a modest calcium supplementation. This hypothesis was tested in the present study.
  
  
  METHODS
  Thirty-one patients with asymptomatic PHPT were recruited from an epidemiological study (The Tromsø study 1994/95). Those with a daily calcium intake below 450 mg were given calcium supplementation (500 mg Ca(2+)), and those with an intake above 450 mg were followed without supplementation. The study was open and lasted 1 year. Serum levels of calcium, PTH, 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D, urinary calcium excretion, blood pressure, and bone mineral density (BMD) were measured.
  
  
  RESULTS
  Three subjects dropped out without reason, 1 developed abdominal discomfort from the calcium supplementation, and 3 had an increase in serum calcium of more than 0.2 mmol/L and were therefore excluded. The latter three did not differ from the rest of the group at baseline. Of the remaining 24 that completed the study, 17 were given calcium. In this group there was a non-significant increase in serum calcium and urinary calcium excretion, a significant decrease in PTH after 4 weeks (13.2 (6.0) vs 9.4 (3.0) pmol/L, P < 0.05), and a significant increase in BMD at the femoral neck at the end of the study (0.849 (0.139) vs 0.870 (0.153) g/cm(2), P < 0.05). The blood pressure was not significantly affected.
  
  
  CONCLUSIONS
  Most patients with mild PHPT and a low calcium intake tolerate a moderate calcium supplement. This may have beneficial effects on the bones, but the patients must be followed carefully.
authors.affiliation: Department of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway.
authors.forename: Rolf
authors.initials: R
authors.lastname: Jorde
authors.forename: Kasia
authors.initials: K
authors.lastname: Szumlas
authors.forename: Egil
authors.initials: E
authors.lastname: Haug
authors.forename: Johan
authors.initials: J
authors.lastname: Sundsfjord
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D015519:Bone Density / Q000187:drug effects*; D002118:Calcium / Q000097:blood* / Q000652:urine; D002136:Calcium, Dietary / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000188:drug therapy*; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood*
chemical_list: D002136:Calcium, Dietary; D010281:Parathyroid Hormone; D002118:Calcium