Certainly the meds are a problem, especially pred. But Crohn's can cause problems all by itself. Absorption problems often follow inflammation and D also makes it hard to absorb nutrients. Building bone requires more than just calcium and vitamin D. Magnesium is another necessity and so is vitamin K. A lesser known need is sodium. Normally it is oversupplied in our diet, but in severe D, your electrolyte balance is deranged and you may not have enough. A deficiency in the blood results in sodium being taken from the bones.
Calcium should not be taken in the carbonate form. First, it is very poorly absorbed - you only get about
12% of the calcium taken in that form - even without other absorption problems. Second, it neutralizes your stomach acid and prevents your digestive enzymes from working properly - this causes bacterial overgrowth in the SI and a number of other problems. Third, if taken alone, calcium carbonate causes constipation. The form of calcium should be a salt of an organic acid like citrate, fumarate, maleate, succinate or a combination of those. Some calcium is in the form of "HVP chelate" which stands for "hydrolysed vegetable protein chelate" - probably OK.
Magnesium is needed for proper utilization of calcium and can be taken in combination with calcium. It is best to get twice the amount of calcium as magnesium in a combo - that is, 400 mg of magnesium and 800 mg of calcium for example. Magnesium has the opposite effect of calcium and can cause D if taken by itself - that is why a combination of the two in the proper ratio is best.
Sodium is often provided in gatorade or an oral rehydration drink. These often have too much sugar and sugar can cause its own problems. In theory, drinks that are sweetened with glucose or dextrose would be all right, since those sugars are quickly absorbed and do not enter the gut where they feed bacterial growth. However, those sweeteners usually include other sugars and consuming them can cause the same problems. Plain soda water is probably better.
Vitamin D is getting to be better known, although it is another supplement that can be a problem to absorb as a supplement. Since it is oil soluble, it is taken up in the small intestine and if the SI is inflamed or diarrhea is active, you might not get much via that route.
Vitamin K is another oil soluble vitamin and has similar absorption risks as vitamin D. In addition, a large part of your vitamin K is provided by friendly gut bacteria which are eliminated by prolonged D or by antibiotics. A prolonged vitamin K deficiency is associated with kidney stones.
Fosamax is of questionable use. It works by preventing the breakdown of bone cells. This stops the normal process of bone formation which starts with the breaking down of old bone and then growing new. The problem does not get worse, but it doesn't get better either.
Post Edited (Keeper) : 10/6/2009 10:55:40 PM (GMT-6)