Phosphorus is an essential mineral that is usually found in nature combined with oxygen as phosphate. Most of the phosphate in the human body is in bone, but phosphate-containing molecules (phospholipids) are also important components of cell membranes and lipoprotein particles, such as HDL and LDL (“good” and “bad” cholesterols, respectively). Small amounts of phosphate play important roles in numerous biochemical reactions throughout the body.
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Osteoporosis and Elderly People Taking Calcium Supplements
Refer to label instructions
Taking calcium can interfere with phosphorus absorption. Seniors with low phosphorus levels in their diet may want to take supplemental calcium in a phosphorus-containing preparation.
While phosphorus is essential for bone formation, most people do not require phosphorus supplementation, because the typical western diet provides ample or even excessive amounts of phosphorus. One study, however, has shown that taking calcium can interfere with the absorption of phosphorus, potentially leading to phosphorus deficiency in elderly people, whose diets may contain less phosphorus.1 The authors of this study recommend that, for elderly people, at least some of the supplemental calcium be taken in the form of tricalcium phosphate or some other phosphorus-containing preparation.
Phosphorus supplements are unnecessary. Most multiple vitamin-mineral supplements do not contain phosphorus for this reason.
Phosphorus is highest in protein-rich foods and cereal grains. In addition, phosphorus additives are used in many soft drinks and packaged foods. Phosphorus is not often present in supplements except for certain calcium supplements, such as bone meal.
Phosphorus deficiency is uncommon, because dietary intake is usually adequate.2 Chronic alcoholics may become deficient in phosphorus.3 and people taking large amounts of aluminum-containing antacids4
One study has shown that taking calcium can interfere with the absorption of phosphorus, which, like calcium, is important for bone health.5. Although most western diets contain ample or even excessive amounts of phosphorus, older people who supplement with large amounts of calcium may be at risk of developing phosphorus deficiency. For this reason, the authors of this study recommend that, for elderly people, at least some of the supplemental calcium be taken in the form of tricalcium phosphate or some other phosphorus-containing preparation.
Certain medicines interact with this supplement.
Depletion of phosphorus may occur as a result of taking aluminum hydroxide. For those with kidney failure, reducing phosphorus absorption is the purpose of taking the drug, as excessive phosphorus levels can result from kidney failure. However, when people with normal kidney function take aluminum hydroxide for extended periods of time, it is possible to deplete phosphorus to unnaturally low levels.
Mineral oil has interfered with the absorption of many nutrients, including beta-carotene, calcium, phosphorus, potassium, and vitamins A, D, K, and E in some,7 but not all,8 research. Taking mineral oil on an empty stomach may reduce this interference. It makes sense to take a daily multivitamin-mineral supplement two hours before or after mineral oil. It is important to read labels, because many multivitamins do not contain vitamin K or contain inadequate (less than 100 mcg per day) amounts.
People taking sucralfate may develop lower than normal blood levels of phosphorus.9 A 42-year-old woman who took sucralfate for two weeks experienced bone pain that was caused by low phosphorus levels. The bone pain disappeared after she stopped taking the drug and began supplementing with phosphorus.10 Individuals taking sucralfate should have their blood phosphorus levels monitored regularly by their healthcare practitioner and may need to take supplemental phosphorus.
People with severe kidney disease must avoid excessive phosphorus. Based primarily on animal studies, some authorities have suggested that excess intake of phosphate is hazardous to normal calcium and bone metabolism,11 but this idea has been challenged.12 Phosphoric acid–containing soft drinks have been implicated in elevated kidney stone risk,13 , 14 but not all studies have found this relationship.15
Ingestion of excessive amounts of aluminum-containing antacids (such as Di-Gel®, Riopan®, Maalox®, or Mylanta®) can cause phosphorus deficiency.
1. Heaney RP, Nordin BEC. Calcium effects on phosphorus absorption: implications for the prevention and co-therapy of osteoporosis.J Am Coll Nutr 2002;21:239-44.
2. Pennington JA, Schoen SA. Total diet study: estimated dietary intakes of nutritional elements, 1982-1991. Int J Vitam Nutr Res 1996;66:350-62.
3. Knochel JP, Agarwal R. Hypophosphatemia and hyperphosphatemia. In Brenner B, ed. The Kidney, 5th ed. Philadelphia: WB Saunders, 1996, 1086-133 [review].
4. Lotz M, Zisman E, Bartter FC. Evidence for a phosphorus-depletion syndrome in man. N Engl J Med 1968;278:409-15.
5. Heaney RP, Nordin BEC. Calcium effects on phosphorus absorption: implications for the prevention and co-therapy of osteoporosis.J Am Coll Nutr 2002;21:239-44.
6. Bour NJS, Soullier BA, Zemel MB. Effect of level and form of phosphorus and level of calcium intake on zinc, iron, and copper bioavailability in man. Nutr Res 1984;4:371-9.
7. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 176.
8. Clark JH, Russell GJ, Fitzgerald JF, Nagamori KE. Serum beta-carotene, retinol, and alpha-tocopherol levels during mineral oil therapy for constipation. Am J Dis Child 1987;141:1210-2.
9. Vucelic B, Hadzic N, Gragas J, Puretic Z. Changes in serum phosphorus, calcium, and alkaline phosphatase due to sucralfate. Int J Clin Pharmacol Ther Toxicol 1986;24:93-6.
10. Chines A, Pacifici R. Antacid and sucralfate-induced hypophosphatemic osteomalacia: a case report and review of the literature. Calcif Tissue Int 1990;47:291-5.
11. Calvo MS, Park YK. Changing phosphorus content of the U.S. diet: potential for adverse effects on bone. J Nutr 1996;126:1168S-80S [review].
12. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D and fluoride. Washington, DC: National Academy Press, 1997, 181-6 [review].
13. Shuster J, Jenkins A, Logan C, et al. Soft drink consumption and urinary stone recurrence: a randomized prevention trial. J Clin Epidemiol 1992;45:911-6.
14. Rodgers A. Effect of cola consumption on urinary biochemical and physicochemical risk factors associated with calcium oxalate urolithiasis. Urol Res 1999;27:77-81.
15. Curhan GC, Willett WC, Rimm EB, et al. Prospective study of beverage use and the risk of kidney stones. Am J Epidemiol 1996;143:240-7.
Last Review: 07-22-2014
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