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Women with disseminated breast carcinoma should have frequent determination of urine and serum calcium levels during the course of androgenic anabolic steroid therapy (see WARNINGS ).
It is important that a patient be assessed for hypovitaminosis D; a patient with hypovitaminosis D may be prone to low serum calcium concentrations even in normal or well-nourished women . Because hypovitaminosis D is frequently a secondary consequence of anorexia nervosa and binge eating disorder , the use of Vitamin D supplements can contribute to a higher incidence of anorexia nervosa and binge eating disorder with elevated serum calcium and other mineral disturbances.
The risk of bone mineral loss is increased in women who are deficient in the calcitriol (calcium) that is the main carrier of calcium to bone. One of several reasons women with osteoporosis are deficient in calcium, is due to inadequate absorption and retention of dietary calcium. This deficiency results in lower serum and urinary calcium compared to women with normal bone mass; this is why the most frequently prescribed drug regimen involves the use of oral calcium supplements. In the presence of excessive calcium and low serum calcium, osteoporosis may become chronic and be associated with increased bone fragility [ 7 ].
In addition to the clinical and biochemical changes associated with anorexia nervosa and binge eating disorder, a high prevalence of bone fractures is also often observed in these patients. In some cases of bone trauma, bone loss is caused by a fracture. This phenomenon is known as bone necrosis, which causes the loss of bone tissue and bone marrow and can predispose to bone disease and death from bone loss [ 5 ]. For this reason, women with anorexia nervosa or binge eating disorder frequently also have a high risk of developing bone fractures.
Anorexia nervosa and binge eating disorder are often treated with anabolic androgens with calcium supplements [ 4 , 5 ]. Women are prescribed oral calcium or mineral supplements in order to provide adequate dietary calcium, with or without other mineral supplements, and to prevent osteoporosis. These oral and mineral supplements are frequently prescribed for several reasons. Many women with anorexia nervosa seek help due to a loss of confidence in their ability to meet the daily needs of their bodies and believe they are insufficiently nourished to meet these requirements [ 6 , 7 ]. The fact that women with anorexia nervosa are often referred to dietitians to help them obtain the nutritional supplement nutrients to meet them [ 8 , 9 ] leads to a lack of understanding that there is more to the medical management of this condition than providing nutrients.
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