I'm new to this hub and this is my first post. I have recently been waking during the night with pain under ribs at right side, and often extending around the back. I have to sit straight up for an hour or more until it subsides, as lying down makes it worse. I am guessing maybe Biliary Colic. I take Presnisolone for PMR (since March 2020) and my GP prescribed 4 tabs per day of AdCal about 7 weeks ago - with the first episodes of night pain starting about a week later. The results of a recent Dexa scan shows I have osteoporosis (T score on spine -3.9). I took my first Alendronic Acid tab 5 days ago and that caused no problems. I have no wish to stop the calcium if I need it too, but at the moment it is my prime suspect. My diet is low fat and really healthy, as is my lifestyle. I do lots of fast walking and exercise. So my questions are:
1. Could the calcium be causing the pain?
2. Do I really need the calcium if I am now taking Alendronic Acid?
Any comments would be much appreciated.
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clover-4
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Calcium supplement does cause digestive issues for some people, so it might be worth stopping it for a while and see whether the problem clears up. For most people, it's recommended, if possible, to get your calcium from diet (NICE guidelines), although many GPs appear unaware of this and routinely prescribe a combined calcium/vit D supplement. Here's a calcium calculator, which I find very easy to use and fairly accurate: cgem.ed.ac.uk/research/rheu.... It's usually recommended in the UK that we need a minimum of 700mg calcium daily, though you may need a little more while taking AA. If you find it is the calcium that's the problem, ask your GP to prescribe Vitamin D alone; although failing that, it's quite cheap to buy over the counter.
Thank you for your reply. I did the calcium calculation via your link and was surprised to arrive at a score of 867mg daily. I will stop the Adcal for 2 or 3 weeks and see what happens. I have never before suffered from digestive problems - well except for the odd bit of heartburn if I eat sugary rubbish!
I suggest you buy some vitamin D (eg from a pharmacy) in the same quantity that's contained in your Adcal, as but D plays an essential role in calcium absorption. Have you had your bit D, calcium and parathyroid blood level tested? Many if if take more but D than is routinely prescribed, because our blood levels wouldn't be high enough on 800 IU daily. I was advised by a consultant to raise my blood level to at least 75nmol/litre, preferably 100.
I was sure I had replied to you but I can’t see it so I’ll start again.
Calcium could indeed be causing you problems. I didn’t do at all well with my first prescribed calcium - felt awful right from the minute I started it. Think it was called Acrette ( I called it concrete).
My GP changed me to Ad-Cal, that was more pleasant to take but my gut still didn’t feel good. Eventually it was decided in discussion with my fracture liaison nurse that I was probably taking enough dietary calcium to give up the calcium tablets which I did.
I did a bit more research and decided to buy my own calcium citrate and now I take one of them a day to give me a little boost. I was going to try a plant based calcium and then on the morning it was due to be delivered I got a text from Amazon telling me it was undeliverable- I’m assuming someone drove a fork lift truck over it or something like that - I just reordered the calcium citrate I had before but my aim is to try out a plant based calcium.
I also like the ROS leaflet that lists calcium and vitamin D containing foods. I discovered there are a lot of foods that contain calcium that I hadn’t thought of - dried figs / oranges / almonds etc so I can boost my intake throughout the day.
Thanks for replying. Your use of the word 'concrete' rang bells right away. I've felt for some weeks now that I have indeed ingested concrete. Tummy always feels heavy but not painful. The ony pain is during the night under ribs on right side. After doing the calcium intake calculation (as suggested by Met00 above) and coming up with a score of 867, I will ditch the calcium meantime and see what happens.
I suffer from a similar rib pain and have put it down to a kidney problem. The endocrinologist I consulted said that kidney stones can be caused by calcium supplements. Mine is definitely exacerbated if I take calcium citrate and does flare up soon after.
Have you estimated your Total Ca intake per day, from both diet and your Ca supplement? I did, when I was having gut ache from Ca supplement and was shocked to find it above 2000 mg per day. I was taking far too much!
I eventually saw a consultant who agreed I was taking too much Ca. She told me to stop the supplement, buy a separate D3 and monitor my Ca intake from my diet and only take enough Ca supplement to keep within the Total Ca RDA.
The RDA for Ca is usually stated as 1000 to 1200 mg per day. The NOS stated years ago the 700 mg is actually sufficient for most folk. I personally aim for the RDA, as I take prescription Strontium Ranelate as my OP medication.
I was a vegetarian for 40 + yrs until I started breaking bones. I then realised my Ca, essential protein and fat intakes were all lower than the RDAs.
I then started including organic dairy, especially full fat Goat yogurt, some cheese, 1 egg most days and occasional organically raised chicken and lamb.
Fat is essential in your diet, as it aids the absorption of the essential fat soluble vitamins needed for bone health, especially D3, vit A retinol and Vit K2.
Have you had your Vit D level checked?
The optimal blood level is often stated as around 120 to 170 nmol/L. This isn’t just for bone health but also for the health of your immune and other body functions. The dosage contained in prescription D supplements is often too low to ever reach, even the lower range of thIs optimal level.
I personally took 5000 IU a day for months before I saw any improvement.
I presently maintain a level of around 130 nmol/L by taking 4000 IU a day.
I get my level checked twice a year and alter my D3 intake accordingly.
You MUST get your Vit D level checked!
I also found the book ‘Vitamin K2 and the Ca Paradox’ by Kate Rheaume Bleue helpful. It explains how Magnesium, D3, Vit A retinol and Vit K2, all work together to aid the absorption and utilisation of Ca.
Thanks for that reply. This hub is giving me plenty of informative replies and food for thought. I'm so glad I joined it - it certainly beats worrying in the middle of the night!
I haven’t much to add at all other than that 4 AdCal seemed excessive to me. I take 2 a day and my scores are very similar to yours. It now sounds as though I should be re-evaluating taking AdCal in combination after all...!
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