Calcium Market in Mumbai

Category: Breastfeeding, Calcium, Market, Pregnancy

Last Updated: 29 Jul 2021

Pages: 27 Views: 77

Table of contents

Executive summary

This project focuses on the growth of Calcium supplement segment over two decades. This project gives us an insight into the dietary segment of pharmaceutical industry particularly the calcium supplement segment. The project is started with the introduction of Indian pharmaceutical industry and it‘s growth from three decades. Moreover in this project, the rising importance of patents & its effects (advantages & disadvantages) on the pharmaceutical industry has been discussed.

Entering further in this project, we get an idea about the brand performance of the products of calcium supplements, future market size of calcium supplement market size and then perception of doctor‘s (Orthopaedic & Gynaecologist) about the calcium supplement products. At the end of the project, data analysis has been done with graphical charts so that any person related or unrelated to this industry gets a clear idea about the project.

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We have always seen that when the need arises for anything we humans then start the search for that thing and pharma companies focusing more on cardiac & oncology segment it is most important to understand the importance of calcium supplements before the market has been taken over by foreign multinationals. Usually, the emphasis on product development is the key to commercial success. However, in the market like India and also other competitive markets like all emerging markets where high competitiveness exists, speed to market with newness either for patented or generic products can bear rewards.

It's also equally true that in markets like India where 2 more generics and competitive brands are available, it is difficult to reward investment. As a result, it is really important to develop a strategic balance between older brands might not have even matured at all and new products in such a way that a strong brand portfolio is built up and strategic assets are created. You can see this happening in stock markets for Coke, Nokia, General Electricals, Intel, Ford and McDonald.

Each brand almost becomes synonymous to the organisation and hence, we as pharma industry need to look at brands with that perspective and also think of corporate branding along with branding for new products or existing products.

Introduction

Overview of the Indian Pharmaceutical Industry

The Pharmaceutical Industry develops, produces, and markets drugs licensed for use as medications. Pharmaceutical companies can deal in generic and/or brand medications. They are subject to a variety of laws and regulations regarding the patenting, testing and marketing of drugs.

History

The earliest drugstores date back to the Middle Ages. The first known drugstore was opened by Arabian pharmacists in Baghdad in 754, and many more soon began operating throughout the medieval Islamic world and eventually medieval Europe. By the 19th century, many of the drug stores in Europe and North America had eventually developed into larger pharmaceutical companies. Most of today's major pharmaceutical companies were founded in the late 19th and early 20th centuries. Key discoveries of the 1920s and 1930s, such as insulin and penicillin, became mass-manufactured and distributed.

Switzerland, Germany and Italy had particularly strong industries, with the UK, US, Belgium and the Netherlands following suit. General Chain for Pharmaceutical Industry. Figure 1 depicts the basic components of the pharmaceutical global value chain. All of these functions can be carried out by a large, vertically integrated pharmaceutical firm, or certain segments (typically with the lesser value-add) can be contracted out to other firms. The trend of contracting other, lower-cost firms for certain segments of production has grown recently over the past decade.

Location

The major firms that pioneered the industry back in the early 20th century were located in Switzerland, Germany, UK, and the US. Today, these countries are still the location of the major firms. Since the industry requires sophisticated manufacturing techniques and intensive, highcost R&D, the most profitable firms are in predominantly advanced, developed economies. Even with a growth in the industry, and changing trends in international trade, the early pioneers are still in the lead.

The Indian pharmaceutical Industry is a success story providing employment for millions and ensuring that essential drugs at affordable prices are available to the vast population of this sub-continent. The Indian Pharmaceutical Industry today is in the front rank of India‘s science-based industries with wide ranging capabilities in the complex field of drug manufacture and technology. A highly organized sector, the Indian Pharma Industry is estimated to be worth $ 4. 5 billion, growing at about 8 to 9 percent annually.

It ranks very high in the third world, in terms of technology, quality and range of medicines manufactured. From simple headache pills to sophisticated antibiotics and complex cardiac compounds, almost every type of medicine is now made indigenously. The pharmaceutical industry in India is one of the largest & most 10 advanced among the developing countries. The Indian pharmaceutical industry is estimated to be $6 billion in size, projected to grow to $25 billion by 2010. The Indian pharmaceutical industry is now valued at USD 30 million, compared to USD 2. 3 million in 1901. There are 24,000 licensed pharmaceutical companies.

Of the 465 bulk drugs in India, approximately 425 manufactured here. Indian pharmaceutical industry occupies third position in the world from the production angle. The industry has wide range of over 100,000 drugs which include vitamins, antibiotics; antibacterial, cardiovascular drugs etc. and nearly 80% of manufacturers have sales less than Rs. 1 billion. The top 10 companies control of about 31% of the market. The industry is highly fragmented, with largest formulation players having a market share of less than 6%. India‘s healthcare spending is roughly 6% of GDP of almost three – fourths is spent from private resources.

By comparison the healthcare spending in the USA is about 11% of GDP, majority of which is from the government or third party funds. The expenditure of medicines is roughly 16% of all healthcare spending. The size of Indian Pharmaceutical industry has increased from Rs. 4 billion in the year 1971 to Rs. 250 billion in the year 2005. The Indian Pharmaceutical sector has been meeting almost 95% of the country‘s pharmaceutical needs. The key categories that have driven growth are the large segment like anti – infectives & gastrointestinal segments.

The per capita consumption in India, stands at US $3, is among amongst the lowest in the world, as compares to Japan – US $412, Germany – US $222 in 2002. In 2002 the Indian Pharmaceutical industry was valued at over $4 billion and grew by 8 – 9 percent. Generic means off – patent. Generic drugs are capturing the volumes of branded drugs in the pharma sector. A generic medicine is the one that is manufactured using a slightly different chemical composition of the original patented drug & it costs fraction of the price of its patented equivalent.

The low cost is due to the minimal expense incurred in developing a copy of original drug & a generic drug maker can come out with his drug by just proving that its therapeutic effect on the human body is same as that of the patented drug. The international market for generics valued at $23 billion accounts for 11% of the total market for pharmaceuticals. With products worth $82 billion going off – patent by 2008, US is an attractive market for generic companies. The fact that generics business has been booming on the back of increasing demand for cheaper drugs had been giving tough competition to the pharma majors.

Now in generics, delivery is all more important, as the first company to introduce a generic substitute can corner 60 – 80 percent of the market.

Competent workforce

India has a pool of personnel with high managerial and technical competence as also skilled workforce. It has an educated work force and English is commonly used. Professional services are easily available. Cost-effective chemical synthesis: Its track record of development, particularly in the area of improved cost-beneficial chemical synthesis for various drug molecules is excellent.

It provides a wide variety of bulk drugs and exports sophisticated bulk drugs. Legal & Financial Framework: India has a 53 year old democracy and hence has a solid legal framework and strong financial markets. There is already an established international industry and business community. Information & Technology: It has a good network of world-class educational institutions and established strengths in Information Technology. Globalization: The country is committed to a free market economy and globalization. Above all, it has a 70 million middle class market, which is continuously growing.

Consolidation

For the first time in many years, the international pharmaceutical industry is finding great opportunities in India. The process of consolidation, which has become a generalized phenomenon in the world pharmaceutical industry, has started taking place in India.

Investment of Indian Pharmaceutical Industry for 2009-10:

Domestic investment in the Pharmaceuticals sector is estimated at Rs. 31. 43 thousand crores which is equivalent to US $ 7. 14 billions.
The Pharmaceuticals sector has been able to attract FDI amounting to US $ 1401. 60 million in the sector during 2000-01 to 2008-09 (upto September), of which, there has been an inflow of US $ 125. 30 million during the first half of 2008-09.
There has been an upward trend in FDI inflows in the sector.
In 2007-08, the FDI inflow at US $ 334. 09 million (Rs. 13264. 28 million) has been the highest.
In so far as domestic industrial proposals between August 1991March 2008 are concerned, total IEMs filed including LOI & DIL add upto Rs. 31257 crores in Drugs & Pharmaceutical Sector.
The Pharmaceutical sector is estimated to have created 2. 20 lakh employment opportunities.
The aggregate sectoral income grew by 18. % during the quarter ending June 2008 while the growth in net profits during 2007-08 was 8. 2%.

Current scenario

Indian pharma market zooms to US 21. 83 billion (Rs 1,00,611 cr. ) in 2009-10 (February 25th, 2010) The Indian pharmaceutical industry currently values about Rs 1,00,611 crore, as the industry sector growth is back in track following revival of the economy, according to the latest Economic Survey 2009-10 report. The pharmaceutical industry in India has leap-frogged from Rs. 1500 crore in 1980 to approximately Rs. 1,00,611 crore in 2009-10, thanks to the revival of overall industrial growth to 7. 7% during April November 2009-10.

India‘s pharma sector now ranks 3rd in terms of volume of production with 10% share of the global pharmaceutical market and occupies 14th position by value, says a news release issued by Press Information Bureau from the Ministry of Finance, government of India. The Indian pharma industry growth has been fuelled by exports which registered a growth of 25% in 2008-09. Retails sales in the Indian pharmaceutical market grew by 18% in the month of March 2009, despite fears of stalling industrial growth following the slowdown across economies. The value growth of Indian pharma market as per secondary ales for the month of Mar 2009 was higher at 18. 4%, as compared to 13. 3% growth in the month of Feb 2009, according the latest data from ORG IMS, a business intelligence firm. 18 The value growth as per Mar 2009 MAT once again touched the doubledigit mark of 10. 1%, with marginally higher growth, as compared to 9. 8% as per Feb 2009 MAT.

The value growth in the month of Mar 2009 was higher at 16. 8%, as compared to 12. 5% in the month of Feb 2009. The value growth as per Mar 2009 MAT (14. 1%) was marginally higher as compared to Feb 2009 MAT (13. 6%). In October 2008, sales in the Rs 35,000-crore drug retail market had dipped by 1. %, the first time in many years, due to consumers shifting to cheaper brands and stockists facing a financial crunch. However, retail sales has gradually strengthened and in February, it rose 13. 3%. Despite the brief slowdown in growth in 2008, ORG had projected the Indian pharmaceutical industry to grow at 15-20% over the next few years. The industry has been growing at 14-15% over the last few years. Due to economic prosperity, a lot more customers are entering organised healthcare, antibiotics and acute therapies are normally the first line of defence, say analysts.

While India‘s metros and class I cities drive the growth tier II cities and rural market add to the growth momentum. Rising disposable income, improving health infrastructure such as the government‘s incentives to set up 100-bed hospitals in non-metro towns, and the general increase in health awareness due to deep penetration of the electronic media are the corner stones of sales expansion. To promote excellence in pharmaceutical education and research, 6 new National Institute of Pharmaceutical Education & Research (NIPERs) have been set up, in addition to the existing one at Mohali.

Sector structure/Market size

India's pharmaceutical industry is now the third largest in the world in terms of volume and accounts for 10 per cent of the world‘s production. According to the Mr Srikant Kumar Jena, Minister of State for Chemicals and Fertilisers, the Indian pharmaceutical industry is now over US$ 20 billion. India ranks fourteenth in terms of value. The country ranks fourth in terms of generic production and seventeenth in terms of export value of bulk actives and dosage forms, according to Mr Jena. According to a detailed research by Angel Broking, by 2015, India is expected to rank among the top 10 global pharmaceutical markets.

The industry is typically growing at around 1. 5-1. 6 times the country‘s gross domestic product (GDP) growth. Moreover, according to a FICCI-Ernst & Young study, the increasing population of the higher-income group in the country will, by 2015, open a potential US$ 8 billion market for multinational companies selling costly drugs. Besides, the report said the domestic pharma market is likely to touch US$ 20 billion by 2015, making India a lucrative destination for clinical trials for global giants. The Indian pharmaceutical offshoring industry is slated to become a US$ 2. billion opportunity by 2012, thanks to lower R&D costs and a hightalent pool in India.

Exports

India's exports of drugs, pharmaceuticals and fine chemicals grew by 29 per cent in 2008-09 to US$ 8. 25 billion compared to 2007-08. According to Mr Anand Sharma, Union Minister of Commerce and Industry, the Indian pharmaceutical sector has emerged as one of the major contributors to Indian exports with export earnings rising from a negligible amount in the early 1990s to US$ 6. 08 billion by 2007-08. A report by industry research firm, RNCOS, forecasts that pharmaceutical exports will grow at a compound annual growth rate (CAGR) of 18. per cent between 2007-08 and 2011-12. This growth will be fuelled by multi-billion dollar patent expirations and growth in the global generics market. Growth The domestic pharma market will outshine the global market, growing at a compounded annual rate of 12-15 per cent as against a global average of 4-7 per cent during 2008-2013, according to a study by market research firm IMS. According to detailed research by Angel Broking, socio-economic factors such as rising income levels, increasing affordability, gradual penetration of health insurance and the rise in chronic diseases would see the Indian formulation market touch US$ 13. billion by 2013, at a CAGR of 12. 2 per cent over the period from fiscal year 2008 to 2013 (estimated). Denmark-based world leader in diabetes care, Novo Nordisk, is looking at making India the hub for manufacturing insulin for the sub-continent. The company has set up a dedicated facility with a capacity of 26 million vials per annum in partnership with Ahmedabad-based Torrent Pharmaceuticals Ltd.

Rural Market

According to estimates, rural areas account for 21 per cent of the country's pharmaceuticals market. In 2006-07, the rural Indian pharmaceuticals market was estimated at around US$ 1. billion, having grown at about 40 per cent in 2006-07 against 21 per cent in the previous year. French company Aventis Pharma has launched a rural market division with 10 products and a sales team of 300 people as it eyes a bigger share of the fast growing Indian rural market. Pharmaceutical Retail The Indian drug retail market grew by a 29. 24 per cent in value terms in October 2009 over the same period a year ago. This is more than double the average monthly revenue growth rate of 13-14 per cent posted in the recent past, as per market research firm ORG IMS.

Generics According to a report by IMS Health, the Indian generic manufacturers will grow to more than US$ 70 billion as drugs worth approximately US$ 20 billion in annual sales faced patent expiry in 2008. With nearly US$ 80 billion worth of patent-protected drugs to go off patent by 2012, Indian generic manufacturers are positioning themselves to offer generic versions of these drugs. 22 Indian generic drug makers received half a dozen more approvals from the US Food and Drug Administration (FDA) in 2009, over the previous year. Dr Reddy's Laboratories received the highest number of tentative and final approvals in 2009 at 32, followed by Aurobindo at 26 and Wockhardt at 23.

Diagnostics Outsourcing/Clinical Trials

The Indian diagnostics and pathology laboratory business is presently around US$ 864 million and is growing at a rate of 20 per cent annually, according to industry experts. Moreover, the US$ 200 million Indian clinical research outsourcing market is estimated to reach up to US$ 600 million by 2010, according to a joint study done by KPMG and the Confederation of Indian Industry (CII).

Research & Development

The search for innovative drug molecules and better technologies by pharmaceutical MNCs is expected to offer a windfall for the smaller research-oriented Indian firms. With their drug pipelines drying up and more blockbuster drugs going off-patent, MNCs are looking at alliances for drug co-development, buying or licensing out innovative molecules which can further be developed into finished drugs. Moreover, in a bid to boost R in the pharmaceutical sector, the government will provide US$ 422. 96 million for establishing six National Institutes of Pharmaceutical Education and Research over the next five years.

Government Initiative

The government has taken various policy initiatives for the pharmaceutical sector:

The government has offered tax breaks to the pharmaceutical sector. Units are eligible for weighted tax deduction at 150 per cent for the research and development (R) expenditure incurred
Steps have been taken to streamline procedures covering development of new drug molecules and clinical research
The government has launched two new schemes—New Millennium Indian Technology Leadership Initiative and the Drugs and Pharmaceuticals Research Programme—especially targetted at drugs and pharmaceutical research.
According to Mr Ashok Kumar, Pharmaceuticals Secretary, the government is planning to set up a US$ 439. 94 million corpus fund for the pharma industry soon. The fund would be set up with the help of the government and the industry and will be used for helping the pharma industry in R.

Investment

According to the Ministry of Commerce, domestic investment in the pharmaceutical sector is estimated at US$ 6. 31 billion.

The drugs and pharmaceuticals sector has attracted foreign direct investment (FDI) worth US$ 1. 43 billion between April 2000 and December 2008.

Road Ahead

The Indian pharmaceutical industry will see tremendous growth in the coming years as consumer spending on healthcare increases in India. Consumer spending on healthcare is expected to increase to 13 per cent of GDP by 2015, up from 7 per cent in 2007. ORG IMS Indian Pharmaceutical Audit helps to identify potential therapeutic categories, monitoring performance of specific brands in relation to competing brands, segmenting the market by 4 zones, 18 states, 30 metros and all town classes.

IMS Indian Pharmaceutical Audit tracks the primary sales of harmaceutical companies on monthly basis through stockists purchase. The value growth of Indian pharma market as per secondary sales for the month of Dec‘09 was recorded higher at 27. 6% as compared to Nov‘09 month (20. 4%). The value growth for Dec‘09 MAT was also recorded higher at 17. 0%, as compared to 15. 7% as per Nov‘09 MAT. The value growth recorded in the month of Dec‘09 MAT (13%) was higher at 17%, as compared to 9. 1& in the month of Nov‘09. The value growth as per Dec‘09 MAT (13%) was comparable to Nov‘09 MAT (13. 1%). Cipla has maintained its top position and market share of 5. 8%, as per Dec‘09 MAT. Among the top 25 companies, Mankind has 25 jumped one rank to move upto rank 8. Wockhardt Merind has jumped to 14th rank. Elders surpassed the other fast-growing players including Mankind (27. 9%), Wanbury (25. 2%), Micro Labs and Alembic (24. 7%).

Drug company Cipla maintained its top position in the domestic market for the 12 months ended December, 2009, with a market share of 5. 38 per cent — up 18 per cent over the year and ahead of Ranbaxy Laboratories and GlaxoSmithKline (GSK). The total domestic drug market is valued at Rs 40,051. 4 crore, an increase of 17 per cent over the previous year, according to data from drug sales tracking agency, ORG-IMS. The agency tracks drug sales among more than 500,000 traders in the country, through stockist data. Cipla‘s domestic market share grew 18 per cent during the year, thanks to its product basket of 924 products, which is way ahead of Ranbaxy‘s 565 and GSK‘s 177 products.

Ranbaxy got a market share of 4. 91 per cent and GSK had a market share of 4. 35 per cent, with a growth of 13. 7 per cent and 18 per cent, respectively, in 2009. During the period, Cipla had sales of Rs 2,155. 9 crore in the domestic market, ahead of Ranbaxy‘s Rs 1,968. 24 crore and GSK‘s Rs 1,743. 15 crore. Cipla had overtaken Ranbaxy and GSK India to become the largest pharmaceutical company in the domestic market for the first time in May,2007, according to sources.

Calcium & Its sources

A balanced diet provides the body with all the necessary nutrients, minerals and vitamins. But, in case of malnutrition, pregnancy, post-operative care, prescription of liquid diet etc. , external supplements of calcium, protein and vitamins become necessary. Calcium (primarily found in milk & milk products) is a mineral required for bones and teeth. A certain amount of calcium is also present in an ionised form in the blood and it acts as a catalyst for many vital functions like muscle contraction and blood coagulation.

Deficiency during childhood causes rickets and in adults it causes osteoporosis. Severe deficiency can be fatal due to spasm of muscles in the respiratory system. Proteins (found in meat, pulses, egg, etc. ) are composed of amino acids. They are essential for tissue repair including skin and hair care. Deficiency leads to stunted growth and loss of muscle strength. In case of calcium deficiency, calcium and its compounds are prescribed. The domestic market size for calcium supplements is estimated to be over Rs 100 crore and is growing at 15 per cent per annum.

The domestic market size for protein supplements is estimated to be close to Rs 130 crore and is growing at about 13 per cent per annum. 40 With increasing awareness of the need to have a balanced diet, the market for calcium / protein supplements will have average growth prospects. However, with assured prescriptions during pregnancy, post operative care etc. , the market for ethical products is expected to notch 15-20% year-to-year growth. The average adult‘s weight is made up of about two per cent calcium. Most of this is found in the skeleton and teeth; the rest is stored in the tissues or blood.

Calcium is vital for healthy teeth and bones. It also plays a crucial role in other systems of the body, such as the health and functioning of nerves and muscle tissue. Good sources of calcium include dairy foods and calcium fortified products such as soymilk and breakfast cereals. People at different life stages need different amounts of calcium – young children, teenagers and older women all have greater than average requirements. According to the Australian Nutrition Survey, about 90 per cent of women and 70 per cent of children do not achieve the recommended dietary intake (RDI) for calcium. 41 The role of calcium Calcium plays a role in:

Strengthening bones and teeth
Regulating muscle functioning, such as contraction and relaxation
Regulating heart functioning
Blood clotting
Transmission of nervous system messages
Enzyme function.

Calcium and dairy food

Australians receive most of their calcium from dairy foods. If milk is removed from the diet, it can lead to an inadequate intake of calcium. This is of particular concern for children and adolescents, who have high calcium needs. Calcium deficiency may lead to disorders like osteoporosis (a disease of both men and women in which bones become fragile and brittle later in life).

Too little calcium can weaken bones If the body notices that not enough calcium is circulating in the blood, it will use hormones to reduce the amount put out by the kidneys in the urine. If not enough calcium is absorbed through the gastrointestinal tract, calcium will be taken from the bones. 42 If your dietary intake of calcium is constantly low, your body will eventually remove so much calcium from the skeleton that your bones will become weak and brittle. Calcium needs vary throughout life The recommended dietary intake of calcium is different for people of different ages and life stages:

Babies – from 7–12 months, babies are estimated to need 270mg per day if breastfed and 350mg per day if bottle fed. The calcium in infant formula may not be absorbed as efficiently as that found in breast milk. For children aged 1–3 years, the amount needed rises to 500mg per day.
Young children – skeletal tissue is constantly growing, so young children have high calcium needs. Children aged 4–8 years need around 700mg per day. This rises to 1,000mg per day for those aged 9–11 years.
Pre-teens and teenagers – puberty prompts a growth spurt. This group needs more calcium, with a ecommended dietary intake of 1,300mg per day for both boys and girls between the ages of 12 and 18 years.
Peak bone mass years – from before the onset of puberty to around the mid-20s, the skeleton increases its bone mass. If the skeleton is strengthened with enough calcium during these years, diseases like osteoporosis in the later years are thought to be less likely. During mid-life, women and men both need around 1,000mg per day.
Pregnant women – although a developing baby needs a lot of calcium and this is taken from the mother‘s bones, most women rapidly replace this bone loss once the baby has stopped breastfeeding.
There is no additional dietary calcium requirement for pregnancy, except for the pregnant adolescent, who requires an additional 1,300mg per day of calcium to meet the requirements of both her own growth and the foetus.
Breastfeeding women – there is no increased requirement for calcium during breastfeeding, except for the breastfeeding adolescent, who needs an additional 1,300mg per day.
Elderly people – as we age, the skeleton loses calcium. Women lose more calcium from their bones in the five years around the age of menopause.

However, both men and women lose bone mass as they grow older and need to ensure an adequate amount of calcium in their diet to offset these losses. While a diet high in calcium cannot reverse age-related bone loss, it can slow down the process. The recommended dietary intake for calcium is 1,300mg per day for women over the age of 50 years and men over the age of 70 years.

Non-Caucasian populations – populations with smaller frame sizes may need less calcium than Caucasian populations, who have larger frame sizes and higher intakes of animal foods, caffeine and salt.

Good sources of calcium

Good dietary sources of calcium include:

Milk and milk products – milk, yoghurt, cheese and buttermilk. One cup of milk, a 200g tub of yoghurt or 200ml of calcium fortified soymilk provides around 300mg calcium. Calcium fortified milks can provide larger amounts of calcium in a smaller volume of milk – ranging from 280mg to 400mg per 200ml milk.
Leafy green vegetables – broccoli, collards, bok choy, Chinese cabbage and spinach. One cup of cooked spinach contains 100mg, although only five per cent of this may be absorbed. This is due to the high concentration of oxalate, a compound in spinach that reduces calcium absorption. By contrast, one cup of cooked broccoli contains about 45mg of calcium, but the absorption from broccoli is much higher at around 50–60 per cent.
Soy and tofu – tofu (depending on type) or tempeh and calcium fortified soy drinks.
Fish – sardines and salmon (with bones). Half a cup of canned salmon contains 402mg of calcium.
Nuts and seeds – brazil nuts, almonds and sesame seed paste (tahini). Fifteen almonds contain about 40mg of calcium.

Calcium fortified foods – including breakfast cereals, fruit juices and bread:

1 cup of calcium fortified breakfast cereal (40g) contains up to 200mg of calcium
cup of calcium fortified orange juice (100ml) contains up to 80mg of calcium
2 slices of bread (30g) provides 200mg of calcium.

Calcium supplements It is much better to get calcium from foods (which also provide other nutrients) than from calcium supplements. If you have difficulty eating enough foods rich in calcium, you might consider a calcium supplement, especially if you are at risk of developing osteoporosis.

It‘s a good idea to discuss this with your health care professional. If you do take calcium supplements, make sure you don‘t take more than the amount recommended on the bottle (usually 600–1,500mg per day). Too much calcium may cause gastrointestinal upsets, such as bloating and constipation. Lifestyle can affect bone strength.

Some of the factors that can reduce calcium in your bones and lower bone density (weaken bones) include:

High salt diet
More than six drinks per day of caffeine-containing drinks – for example coffee, cola and tea (although tea has less caffeine)
Excessive alcohol intake
Very low body weight
Very high intakes of fibre (more than 50g per day, from wheat bran)
Low levels of physical activity
Low levels of vitamin D – this may be an issue for people who are housebound or for women who cover their bodies completely when they are outside, as they do not get enough sunlight on their skin.

Where to get help?

Your doctor
An accredited practising dietitian, contact the Dietitians Association of Australia
Nutrition Australia www. nutritionaustralia. org

Things to remember

The average adult‘s weight is made up of about two per cent calcium.
Good sources of calcium include dairy foods, calcium fortified foods (such as soy products) and, to a lesser degree, some leafy green vegetables. If you don‘t have enough calcium in your diet, you may be at increased risk of developing osteoporosis.
Absorption of Calcium Vitamin D - a steroid vitamin, which promotes absorption and metabolism of calcium and phosphorus. Under normal conditions of sunlight exposure, no dietary supplementation is necessary because sunlight promotes adequate itamin D synthesis in the skin. Deficiency can lead to osteomalacia in adults and bone deformity (rickets) in children.
Dietary sources of Vitamin D are: fish liver oils, fatty fish (herring, mackerel, salmon, sardines, pilchards, tuna), fortified margarine, infant milk formulae and eggs. Vitamin D Vitamin D plays an important role in helping the body to absorb calcium through the small intestine. Our bodies need calcium to help them develop and maintain healthy bones, muscles and teeth.
Ultraviolet (UV) radiation from the sun is the best natural source of vitamin D. Most people get enough vitamin D through exposure to sunlight during normal day-to-day outdoor activities. However, some people have very low levels of daily sun exposure. This can lead to low vitamin D and, in some cases, longer term deficiency. It is important to remember that too much sun exposure can increase the risk of skin cancer. You need to find a sensible balance between sun exposure and protection. There are very small amounts of vitamin D in some foods and drinks, but it is difficult to get enough vitamin D from diet alone.
Only a few foods (such as fish and eggs) naturally contain vitamin D. Margarine and some types of milk have added vitamin D, but most people only get 10–25 per cent of their vitamin D from food. Health effects of low vitamin D Low vitamin D and vitamin D deficiency may have no obvious symptoms but, without treatment, they can have significant health effects. They can increase a person‘s risk of musculoskeletal conditions such as:
Bone and muscle pain Rickets (soft, weakened bones) in children Osteomalacia (weak, fragile bones) in older adults. Low vitamin D also contributes to osteoporosis.

Vitamin D deficiency has recently been linked to various types of cancers (particularly colon cancer), heart disease, stroke, altered immunity and autoimmune diseases; however, more research is needed 50 to confirm this link. At-risk groups People who are at risk of low vitamin D and deficiency include:

People with naturally very dark skin. The pigment in skin (melanin) acts as a filter to UVB (Ultraviolet B) radiation and reduces the amount of vitamin D the body makes (synthesises).
People with little or no sun exposure.

This group includes:

Older adults – people who are frail, in medium to long-term residential or aged care and housebound people
People who wear concealing clothing for religious and cultural purposes
People who deliberately avoid sun exposure for cosmetic or health reasons
People at high risk of skin cancers
People who are in hospital for long periods
People with a disability or chronic disease
People in occupations with little sun exposure such as taxi drivers, factory workers or night-shift workers.
Breast-fed babies with other low vitamin D risk factors.

Breast milk is the best type of feed for babies, but it does not contain much vitamin D. Babies get their initial store of vitamin D from their mothers, so they are at risk of low vitamin D if their mother has low vitamin D. See your doctor See your doctor if you think you may be at risk of vitamin D deficiency. A simple blood test can assess your risk. If you are at risk, make sure you 51 have regular medical check-ups to monitor your levels. The doctor may recommend that you take vitamin D supplements. If so, take the supplements strictly as directed.

They are used to prevent or treat several conditions that may cause hypocalcemia (not enough calcium in the blood). The body needs calcium to make strong bones. Calcium is also needed for the heart, muscles, and nervous system to work properly. The bones serve as a storage site for the body's calcium. They are continuously giving up calcium to the bloodstream and then replacing it as the body's need for calcium changes from day to day. When there is not enough calcium in the blood to be used by the heart and other organs, your body will take the needed calcium from the bones.

When you eat foods rich in calcium, the calcium will be restored to the bones and the balance between your blood and bones will be maintained. Pregnant women, nursing mothers, children, and adolescents may need more calcium than they normally get from eating calcium-rich foods. Adult women may take calcium supplements to help prevent a bone disease called osteoporosis. Osteoporosis, which causes thin, porous, easily broken bones, may occur in women after menopause, but may sometimes occur in elderly men also. Osteoporosis in women past menopause is thought to be caused by a reduced amount of ovarian estrogen (a female hormone).

However, a diet low in calcium for many years, especially in the younger adult years, may add to the risk of developing it. Other bone diseases in children and adults are also treated with calcium supplements. Calcium supplements may also be used for other conditions as determined by your health care professional. A calcium "salt" contains calcium along with another substance, such as carbonate or gluconate. Some calcium salts have more calcium (elemental calcium) than others. For example, the amount of calcium in calcium carbonate is greater than that in calcium gluconate.

To give you an idea of how different calcium supplements vary in calcium content, the following chart explains how many tablets of each type of supplement will provide 1000 milligrams of elemental calcium. When you look for a calcium supplement, be sure the number of milligrams on the label refers to the amount of elemental calcium, and not to the strength of each tablet. Injectable calcium is administered only by or under the supervision of your health care professional. Other forms of calcium are available without a prescription.

Once a medicine or dietary supplement has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, calcium supplements are used in certain patients with the following medical condition: For good health, it is important that you eat a balanced and varied diet. Follow carefully any diet program your health care professional may recommend. For your specific dietary vitamin and/or mineral needs, ask your health care professional for a list of appropriate foods.

If you think that you are not getting enough vitamins and/or minerals in your diet, you may choose to take a dietary supplement. The daily amount of calcium needed is defined in several different ways.

For U. S. — vitamins and minerals needed to provide for adequate nutrition in most healthy persons. RDAs for a given nutrient may vary depending on a person's age, sex, and physical condition (e. g. , pregnancy). indicate the percent of the recommended daily amount of each nutrient that a serving provides. DV replaces the previous designation of United States Recommended Daily Allowances (USRDAs).

It is sometimes called "the sunshine vitamin" because it is made in your skin when you are exposed to sunlight. If you get outside in the sunlight every day for 15 to 30 minutes, you should get all the vitamin D you need. However, in northern locations in winter, the sunlight may be too weak to make vitamin D in the skin. Vitamin D may also be obtained from your diet or from multivitamin preparations. Most milk is fortified with vitamin D. Do not use bonemeal or dolomite as a source of calcium. The Food and Drug Administration has issued warnings that bonemeal and dolomite could be dangerous because these products may contain lead.

Pediatric Problems in children have not been reported with intake of normal daily recommended amounts. Injectable forms of calcium should not be given to children because of the risk of irritating the injection site. Geriatric Problems in older adults have not been reported with intake of normal daily recommended amounts. It is important that older people continue to receive enough calcium in their daily diets. However, some older people may need to take extra calcium or larger doses because they do not absorb calcium as well as younger people.

Check with your health care professional if you have any questions about the amount of calcium you should be taking in each day.

Pregnancy

It is especially important that you are receiving enough calcium when you become pregnant and that you continue to receive the right amount of calcium throughout your pregnancy. The healthy growth and 60 development of the fetus depend on a steady supply of nutrients from the mother. However, taking large amounts of a dietary supplement during pregnancy may be harmful to the mother and/or fetus and should be avoided.

Breastfeeding It is especially important that you receive the right amount of calcium so that your baby will also get the calcium needed to grow properly. However, taking large amounts of a dietary supplement while breastfeeding may be harmful to the mother and/or baby and should be avoided.

Drug Interactions

Using dietary supplements in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.