Synosteo®

A unique combination of calcium, vitamin D3 and vitamin K2 in the form of effervescent powder for the health of bones

SYNOSTEO is a unique combination in the form of effervescent powder which contains:

  • 500mg calcium citrate
  • 300mg calcium lactate
  • 800 IU of vitamin D3
  • 45μg of vitamin K2-7

Its usage combines several benefits:

  • SYNOSTEO is a unique combination in the form of effervescent powder
  • The chewable supplements or liquid supplements are usually absorbed more easily because their salts are already broken down before they reach the stomach
  •  SYNOSTEO contains calcium citrate and calcium lactate

SYNOSTEO is a fixed combination of vitamin D3, calcium and vitamin K – vitamin D3 ensures a better absorption of calcium and the combined usage provides a better compliance.

SYNOSTEO has a pleasant orange flavour – a lot of existing formulation do not have a pleasant taste and cannot be tolerated by the patients.

SYNOSTEO contains vitamin Κ2-7 – vitamin K2 prevents the formation of arteric calcification and improves the health of bones by increasing the bone mass and decreasing the loss of bones (through carboxylation of osteocalcin).

SYNOSTEO is made without gluten or lactose.

Synosteo is a unique combination that can be used as monotherapy in osteopenia or osteoporosis or as the combined therapy in the treatment of osteoporosis with other medicines.

The majority of calcium supplements contain calcium carbonate. This form of calcium is not convenient for digestion and it has to be taken with food.

Calcium citrate and lactate are digested more easily and can be taken independently of meals.

Contrary to citrate and lactate, calcium carbonate is base and it requires acidic environment in order to dissolve and be absorbed:

  • Thus, it is recommended to be taken immediately after a meal or with a glass of orange juice
  • Then, it is not recommended to be used by people who take medicines which raise the pH in the stomach (protonic pump inhibitors, H2 antagonists).

Calcium citrate does not require acidic environment to dissolve, and as such it can be taken at any time of the day, even with empty stomach.

Calcium citrate is also useful in people with achlorhydria, inflammatory diseases of the intestines or with the absorption disorders.

Calcium citrate has fewer undesired effects on the gastrointestinal tract.

One more potential concern for chronic usage of calcium supplements is nephrolithiasis:

  • Calcium citrates prevent the formation of a new stone and reduce further growth of a stone in patients with residual stones and they are very useful in the prevention and treatment of stones that contain calcium in adults.

Calcium lactate is the salt of calcium and lactic acid. Even though its name points to milk, it was made by the controlled fermentation of glucose and other sugars by various microorganisms, and as such, it is also very convenient for people allergic to milk or intolerant to lactose.

It maintains the health of bones.

The maintenance of the health of bones is a very complicated process. In adult people, the daily removal of a small quantity of minerals (the process called resorption) has to be balanced by the equal depositing of new minerals so that the bone mass and strength could be preserved. When this balance is disturbed and directed to excessive resorption, the bones first become weaker (osteopenia) and in time they become more and more brittle and prone to fractures (osteoporosis).

The balance between resorption and depositing is enabled by two types of cells – osteoclast (responsible for the resorption of mineral tissue) and osteoblast (responsible for the synthesis of bone matrix and its additional mineralization).

Because of the large number of patients worldwide, osteoporosis is considered a serious health problem. About 30% of all women in Europe and in the USA in the period of menopause are suffering from this disease.  At least 40% of these women and 15-30% of men will have one or more fractures till the end of their lives. It turned out that the initial fracture is a great risk for the occurrence of the new ones.  It has been proved that there is an 86% increase of risk for a new fracture in people who have already had one fracture.

It maintains the health of bones.

The maintenance of the health of bones is a very complicated process. In adult people, the daily removal of a small quantity of minerals (the process called resorption) has to be balanced by the equal depositing of new minerals so that the bone mass and strength could be preserved. When this balance is disturbed and directed to excessive resorption, the bones first become weaker (osteopenia) and in time they become more and more brittle and prone to fractures (osteoporosis).

The balance between resorption and depositing is enabled by two types of cells – osteoclast (responsible for the resorption of mineral tissue) and osteoblast (responsible for the synthesis of bone matrix and its additional mineralization).

Because of the large number of patients worldwide, osteoporosis is considered a serious health problem. About 30% of all women in Europe and in the USA in the period of menopause are suffering from this disease.  At least 40% of these women and 15-30% of men will have one or more fractures till the end of their lives. It turned out that the initial fracture is a great risk for the occurrence of the new ones.  It has been proved that there is an 86% increase of risk for a new fracture in people who have already had one fracture.

Osteoporosis – loss of bone tissue

The loss of bone tissue is gradual and painless and there are usually no symptoms which could point to the fact that a person is suffering from osteoporosis. That is why osteoporosis is often described as a “silent“ disease.

The first symptom of osteoporosis is usually a fracture, most commonly located on the spine or in the area of a hip, but it is also possible on other bones as well.

Fractures caused by osteoporosis can lead to chronic pain, disability or psychological symptoms, including depression.

Calcium, vitamin D3 and vitamin K2 have been recognized as important and essential nutrients for the preservation of the health of bones and their homeostasis.

At the age from 35 to 45 the bone density is stable under normal circumstances, with small fluctuations. After the age of 40-45 (depending on an individual), in both genders, a gradual loss of bone tissue begins at the rate of 0.5 to 1.0% per year.

In men, this annual loss rate remains stable until old age, while in women this rate rises 2-5% due to the period of menopause.

The aim of the treatment of osteoporosis is to keep the bone density above the threshold of a spontaneous bone fracture.

Calcium

Calcium is an essential microelement for human body.
More than 99% of it is contained in bones and teeth as the main material element, and about 1% is found in extracellular space.

The calcium in bones also acts like a reserve for maintaining the level of calcium in blood which is necessary for normal functioning of nerves and muscles.
The absorption in the intestines is the only way of natural intake of calcium, and vitamin D3 is the only hormone which controls that process.

Calcium absorption

The absorption of calcium is reduced with age (in children, it is about 70%, and about 30% in adults), especially in women with osteoporosis.

If the needs for calcium are higher, it can be taken from the bones so that the normal values can be preserved.

However, the adding of the “borrowed“ calcium does not always lead to the quality of bone tissue. Namely, if the deficiency of calcium lasts longer, the homeostasis is disturbed and osteolysis stimulated in bones overcomes the formation of a bone and leads to a gradual decrease in bone density resulting in osteoporosis.

In perimenopause and in the early years after the menopause, the loss of oestrogen has disastrous effects on bones, and the disturbances of the level of calcium are of great importance on the occurrence of postmenopausal osteoporosis.

The deficiency of oestrogen also leads to the decrease in the production and activity of vitamin D in the intestines. This state leads to the decrease in calcium absorption in the intestines and to hypocalcemia.

So, the usage of vitamin D3 and calcium is useful during the period of postmenopause.

After the age of 40, a gradual decrease in bone density is noticeable in both genders for several reasons:

  • the osteolysis phase is normal, while the phase of bone formation is a bit slower, which results in slow, but continuous decrease in bone density, which, after several years, leads to osteoporosis.
  • ageing of intestinal epithelial cells results in the reduction of calcium absorption
  • in older people, the kidneys do not work properly, so the reabsorption of calcium from urine is not regular and there is additional production of vitamin D which results in the reduced calcium absorption

Groups with the higher risk of inadequate homeostasis of calcium:

  • women with amenorrhoea or menopause
  • persons allergic to milk or lactose
  • older people due to special dietary habits
  • weight-losing diets and treatments for chronic obstipation contain larger quantities of fibers which can create complexes with calcium in the intestines and thus prevent its absorption
  • prolonged and chronic vegetarian diet, consumption of chocolate (contains oxalate), carbonated juices, resulting in the reduced absorption of calcium from food
  • people who consume larger quantities of proteins and coffee which can lead to polyuria with the increased excretion of calcium.
  • increased quantities of salt in a diet lead to the elimination of calcium with urine
  • excessive consumption of alcoholic drinks reduces calcium absorption
Vitamin D

Vitamin D is a fat-soluble vitamin that regulates the absorption of calcium in the intestines and maintains the adequate serum calcium, and the concentrations of phosphorus as well, in order to ensure the normal mineralization of bones and prevent hypocalcemic tetany.

Vitamin D is considered a steroid hormone which is created in the kidneys and the role of which is the regulation of cellular growth, neuromuscular and muscular function and the reduction of inflammation.

Very little food in the nature contains vitamin D (fish, fish oil, meat, egg yolk…)
Vitamin D is also produced endogenously, under the influence of UV sun rays on the skin, as much as up to 50%.

During perimenopause and menopause, due to the deficiency of oestrogen, the production and activity of vitamin D is also reduced in the intestines, which leads to the reduced calcium absorption in the intestines and to hypocalcemia.

In older people, the production and activity of vitamin D is also reduced due to ageing of intestinal cells, the cells of skin and kidneys and due to a smaller exposing to sun. Also, the reduction of muscular mass in older people causes additional increase of risk of bone fractures.

Thus, the exogenous usage of vitamin D3 and calcium in persons in menopause and in later years is the first line of therapy.

According to scientific international guidelines, to the women after the menopause and men older than 50 who have a higher risk of fractures, the following is advised:

  • daily dosage of 800 IU of vitamin D3 and
  • calcium between 700 and 1200 mg a day
Vitamin K

Vitamin K is a fat-soluble vitamin which can be in the form of K1 (phylloquinone) and K2 (menaquinone).
Vitamin K is an essential cofactor in numerous biochemical processes:

  • While the role of vitamin K1 is important in the process of blood coagulation, the research has confirmed the clear role of vitamin K2 in the process of:
  • deposition of calcium in the bones
  • prevention of deposition of calcium in arteries

Thus it becomes clear how the two totally different diseases – osteoporosis and atherosclerosis are connected.

Another important fact was published in 2007, when it was concluded that contrary to vitamin K1, the deficiency of vitamin K2 is widely spread.

Vitamin K2-7 has a double role in the maintenance of the bone homeostasis:

  • stimulates the synthesis of osteoblast and the deposition of calcium in the bones
  • Reduces the resorption of bones by inhibiting the formation of osteoclast

Active osteocalcin (OC) is an essential protein for the bone formation induced by vitamin K2.

Without vitamin K2, the osteocalcin is not carboxylated and, as such, it is inactive, so it cannot connect to hydroxyapatite in the bone matrix.

The deficiency of vitamin K causes an inadequate metabolism of calcium and its usage. It is called “calcium paradox”.

This paradox suggests that the necessary calcium is not effectively used for the bone formation and other health function, simultaneously increasing its harmful levels in the vascular system and finally leading to cardiovascular diseases.  Vitamin K2 is necessary for avoiding the complications of the calcium paradox.

Among various forms of vitamin K, the length of the side chain plays an important role in the biousability:

  • Menaquinone (vitamin K2) with the medium length of the side chain (MK-7) is better absorbed compared to the short (MK-4) or longer (MK-8 and MK-9) side chains
  • Vitamin K2-MK7, due to its longer half-life (72 h) has more stable concentrations in the serum and tissues contrary to other forms of vitamin K (1-1.5 h)

The recommended daily dosage of vitamin K2-MK7, according to clinical studies, is 45 mcg and that dosage can be achieved exclusively by supplementation.

The latest research has concluded that the main point in the metabolism of calcium is actually the need for extra supplementation with vitamin K2-MK7 together with calcium and vitamin D3, especially in women in menopause and older people.

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