This ppt is to explain Calcium-d deficiency and one of my products that provides a unique solution

1. CALCIMA
Marketing Department

2. After this course you will be able to:-
Know role of calcium in body
Know development of fetal bone
Know calcium deficiency related disorders.
Know Calcima product knowledge.
Know market positioning of Calcima.
Know market competitors and competitive advantages.

3. MEDICAL BACKGROUND
(Calcium deficiency )

4. Calcium
 Calcium is a mineral contribute about 1.5-2 % of human body which is
considered the largest amount of mineral in the body.
 The distribution of calcium in the body mostly concentrated in bone 98% and
2% are distributed in other body tissues and fluids.
.

5. Distribution of Calcium in Body
99% in bone 1% in blood and body fluids
Blood Calcium (10mg/dl)
Non diffusible 35 %
Albumin bound
80 %
Globulin bound
20 %
Diffusible 65 %
Ionized 80 % Complexed 20 %
Bicarbonate
Citrate
Phosphate
Total body calcium- 1kg

6. Functions of Calcium
1. Growth
2. Maintenance of bones and teeth.
3. Muscle contraction
4. Heart contraction and regulation of blood pressure
5. Nerve transmission
6. Oocyte activation
7. Number of other cell processes

7. Calcium functions (Bone)
• Osteoclasts (bone cells) remodel the
bone by dissolving or resorbing bone
• Osteoblasts (bone forming cells)
synthesize new bone to replace the
resorbed bone
- Found on the outer surfaces of the
bones and in the bone cavities

8. Calcium Compounds Absorption
Concentrations of elemental
calcium absorption
Type of calcium
35-40%Calcium carbonate
20%Calcium citrate
3-9%Calcium gluconate
13-18%Calcium lactate
30%Calcium phosphate
27%Calcium citrate malate
19%Calcium orotate

9. Calcium Absorption
Factors increase calcium
absorption
Factors decrease calcium
absorption
• Vitamin D
• Gastric HCL
• Dietary intake of certain types of
proteins (MBP)
• Age
• Increase in dietary animal
proteins (High phosphorous
content)
• Increase in dietary fat intake
Calcium is absorbed from the upper part of small intestine (duodenum).

11. Calcium Homeostasis
• The bone is considered the store of calcium in the body
• When calcium level in body fluids decreases the body react by withdrawing
the calcium from bones to compensate the decreased amount
• Prolonged calcium deficiency result in resorption of high amount of calcium
from bones which lead to Osteoporosis

12. Calcium Homeostasis

14. Hormonal Regulators
• Calcitonin (CT)
• Lowers Ca++ in the blood
• Inhibits osteoclasts
• Parathormone (PTH)
• Increases Ca++ in the blood
• Stimulates osteoclasts
• 1,25 Vitamin D3
• Increases Ca++ in the blood
• Increase Ca++ uptake from the gut
• Stimulates osteoclasts

15. CHECK POINT #1

16. Calcium deficiency
Types of calcium deficiency
1-Dietary calcium deficiency is a condition in which there is an inadequate
calcium intake, which can lead to depleted calcium stores in the bones,
thinning and weakening of the bones, and osteoporosis.
2-Hypocalcemia is a low level of calcium in the blood. It can occur from taking
medications, such as diuretics; medical treatments; or disease processes, such
as renal failure or hypo-parathyroidism

17. Vitamin D
• Vitamin D is a fat-soluble vitamin that is found in food
• Sunshine is very important for usage of vitamin D because UV rays from
sunlight trigger vitamin D synthesis in the skin .
• Vitamin D exists in several forms, each with a different level of activity.
• Colecalciferol (D3) is the most active form of vitamin D. and other forms are
relatively of low activity or inactive in the body.
• The liver and kidney help convert vitamin D to its active hormone form .

18. Vitamin D
• Stimulates GI calcium and phosphate absorption
• Promotes renal calcium and phosphate re-absorption
• Calcium homeostasis: together with PTH it mobilizes calcium from skeletal stores.
• Mineralization of the growth plate & osteoid

19. Signs of Calcium Deficiency
• Impaired bone growth
• Numbness of the arms and or
legs
• Joint pains
• Muscle cramping.
• Dry skin and brittle nails
• Bone fractures or breakage
• Increased Premenstrual
syndrome symptoms
• Eczema
• Heart palpitations &
Hypertension
• Insomnia

23. Calcium & Pregnancy
• The requirements are greatest during the periods of growth such as
during pregnancy, when breast feeding and childhood.
• During Pregnancy the average foetus requires about 30 gm of calcium to
mineralize its skeleton and maintain normal physiological processes.

24. CHECK POINT #2

25. Calcium &
Fetal Skeleton
Development

26. Fetal Skeleton development
• MONTH 4: MOM’S SUPPLYING BABY PLENTY OF CALCIUM
Via the placenta, fetus delivering calcium to help her bones harden, strengthen
and lengthen. This calcium transfer continues up until birth
• MONTHS 7 AND 8: TRANSFORMING CARTILAGE TO BONE
the majority of the calcium baby gets from mother is transferred during the
third trimester – about 250 milligrams a day the baby is busy transforming
cartilage to bone as well as developing muscle

27. • MONTH 9: BABY’S BONES REMAIN SOFT
At week 36, mother-baby calcium transfer peaks, with you passing along as
many as 350 milligrams of the mineral every day. That’s the case even
though your baby’s bones are still softer than an adult’s.
They have to be, so they can fit through the birth canal around week 40 and
allow room for growth once baby is born.
Fetal Skeleton development

28. Calcium deficiency related pregnancy
complications
Pre Eclampsia
Gestational hypertension
Preterm Labor

29. Hypertension in Pregnancy
Hypertension in
Pregnancy
>140 or 90 mmHg
2 consecutive times 6 hours apart Pregnant patient
Pregnancy Induced
Hypertension
Gestational Hypertension
-ve proteinuria
Preeclampsia
+ proteinuria (≥300mg/24 or 1+)
+/- nondependent edema (face &
hands)
Eclampsia
+ unexplained grand mal
seizures
Chronic Hypertension

30. Preeclampsia
• Preeclampsia is a pregnancy complication characterized by :-
high blood pressure and signs of damage to another organ system, often the kidneys.
• Preeclampsia usually begins after 20 weeks of pregnancy in a woman whose
blood pressure had been normal.
• Even a slight rise in blood pressure may be a sign of preeclampsia.
• The main cause of preeclampsia is unknown but experts thought that it’s
related to abnormal development of placental blood vessels

31. Preeclampsia - Definition
•Presence of
Hypertension
•>140/90
•2 readings 6 hours apart
•Elevated Fasting blood glucose (FPG)
Proteinuria
• ≥ 1+ Urine dipstick (not sensitive)
• ≥ 300 mg / 24
Nondependent Edema
•Hand
•Face
•Not sensitive or specific

32. Preeclampsia - Complications
Maternal
CNS
• Seizures
• Strokes (thrombosis)
Hepatic
•Hepatic Failure
Renal
•Renal Failure
•Proteinuria
Lungs
•Pulmonary Edema
Fetal
Preterm Delivery
Stillbirth (IUFD)
Intrapartum Fetal Distress

33. • Severe headaches.
• Shortness of breath
• Changes in vision(temporary loss of vision, blurred vision or light sensitivity).
• Nausea or vomiting
• Upper abdominal pain, (under your ribs on the right side
• Decreased urine output.(Oliguria)
• Decreased levels of platelets in blood (thrombocytopenia)
• Impaired liver function
Preeclampsia symptoms (Cont.)

34. Preeclampsia
Prevention
• Low-dose aspirin a daily low-dose aspirin — between 60 and 81 milligrams
— beginning late in the first trimester.
• Calcium-Vit D
Consumption of Calcium-Vitamin D supplements were containing 500 mg Calcium plus 200 IU vitamin D3 for 9
weeks during pregnancy among pregnant women at risk for pre-eclampsia resulted in decreased FPG and serum
triglycerides levels *
* Pak J Biol Sci. Effect of calcium-vitamin D supplementation on metabolic profiles in pregnant women at risk for pre-eclampsia: a randomized placebo-controlled trial. 2012 Apr 1;15(7):316-24

35. Gestational hypertension
• Gestational hypertension is usually defined as having a blood
pressure higher than 140/90 without the presence of protein in
the urine and diagnosed after 20 weeks of gestation
Calcium supplementation in the range of 375–2000 mg resulted in a significant reduction in systolic blood
pressure of 5.40 mm Hg (95% CI: −7.81, −3.00 mm Hg) and in diastolic blood pressure of 3.44 mm Hg*
* Bucher HC, Guyatt GH, Cook RJ, et al. Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia: a meta-analysis of randomized controlled trials. JAMA 1996;275:1113–7.

36. Preterm Labor
• Preterm labor occurs when regular contractions begin to open cervix
before 37 weeks of pregnancy. A full-term pregnancy should last about 40
weeks.
• Many premature babies (preemies) need special care in the neonatal
intensive care unit. Preemies can also have long-term mental and physical
disabilities.
New studies have provided more evidence on the effects of supplementing pregnant women with vitamin D
alone or with calcium on pregnancy outcomes shown that it may reduce the risk of pre-eclampsia, low birthweight and
preterm birth.*
* De-Regil LM1, Palacios C, Lombardo LK, Peña-Rosas JP. Vitamin D supplementation for women during pregnancy Cochrane Database Syst Rev. 2016 Jan 14;1:CD008873. doi: 10.1002/14651858.CD008873.pub3.

37. Osteoporosis
• Osteoporosis is a condition that causes bones to become weak and brittle
that a fall or even mild stresses like bending over or coughing can cause a
fracture.
• Osteoporosis-related fractures most commonly occur in the hip, wrist or
spine.
• Older women who are past menopause are at highest risk. Medications,
healthy diet and weight-bearing exercise can help prevent bone loss or
strengthen already weak bones

38. Osteoporosis
Causes :
• Calcium Deficiency
• Hormonal changes (Specially female sex hormones)
• Long periods of inactivity
• Long-term use of high-dose oral corticosteroids
• Family history
• Heavy drinking and smoking

40. Ricketts
• Rickets is defective calcification of bones before epiphyseal closure in
young children due to deficiency or impaired metabolism of Vitamin D,
Calcium or Phosphorus
• If this case is developed after epiphyseal closure in adults its called
Osteomalacia.
Vitamin D Supplementation (200-400 IU daily) is recommended for prevention of rickets but the treatment require
very high doses of Vit D may reach to 5000-1000 IU daily

41. Symptoms Of Rickets
• Bone tenderness and dental problems.
• Muscle Weakness (rickets myopathy)
• increased tendency for fracture
• Skeletal deformity

42. Pharmacology
• As dietary supplement, used to treat hyperphosphatemia in patients with
chronic kidney disease by combining with dietary phosphate to form
insoluble calcium phosphate, which is excreted in feces. Calcium salts as
antacids neutralize gastric acidity resulting in increased gastric and
duodenal bulb pH; they additionally inhibit proteolytic activity of pepsin if
the pH is increased >4 and increase lower esophageal sphincter tone (IOM,
2011).

43. Pharmacology
• Absorption
Minimal unless chronic, high doses; absorption predominantly in the
duodenum and dependent on calcitriol and vitamin D; mean absorption of
calcium intake varies with age (infants 60%, prepubertal children 28%,
pubertal children 34%, adults 25%); during pregnancy, calcium absorption
doubles; calcium is absorbed in soluble, ionized form; solubility of calcium is
increased in an acid environment (IOM 2011).

44. Pharmacology
• Distribution
Primarily in bones, teeth (IOM, 2011).
• Excretion
Primarily feces (75%; as unabsorbed calcium); urine (22%) (IOM, 2011).
• Protein Binding
~40%, primarily to albumin (Wills 1971)

45. Major Drug Interactions
• Decreases absorption of quinolones, tetracyclines, iron, magnesium,
and zinc
• Corticosteroids decrease calcium status
• Loop diuretics increase urinary calcium loss
• Thiazide diuretics increase renal calcium reabsorption

46. CHECK POINT #3

47. Calcima.... chewable pieces
PRODUCT KNOWLEDGE

48. Main Composition
1-Calcium carbonate 1530 mg (500 mg elemental)
2-Vitamin D (200 I.U)
3-Milk Basic Protein (MBP)

49. Calcima.... chewable pieces
Calcium Carbonate 1530 mg (elemental 500 mg).
Reduce the risks of:-
Gestational hypertension
Preeclampsia
Preterm birth

50. Calcima.... chewable pieces

51. Calcima.... chewable pieces
Calcium Carbonate 1530 mg (elemental 500 mg).
Osteoporosis
Osteomalacia
Improves BMD
Reduce the Risk of

52. Calcima.... chewable pieces
Milk Basic Protein MBP (whey protein)
Improves:-
Bone mineral density
Bone Remodeling Process
Fetal skeletal growth

53. Calcima.... chewable pieces
0.00%
0.20%
0.40%
0.60%
0.80%
1.00%
1.20%
1.40%
1.60%
1.80%
Placebo MBP
GainoflumbarBMD%
Gain of bone mineral density in healthy adult women given placebo or MBP supplementation (40 mg) for six months.

54. Calcima.... chewable pieces
Vitamin D
Improves:-
Minerals absorption (Ca, Phosphorus)
Fetus birth weigh growth
Bone mineralization.

55. Calcima… An innovated formula with calcium – MBP combination with
delicious chocolate taste which improves calcium absorption.
Calcima… Contains vitamin D that maintain proper levels of calcium and
phosphorus.
Calcima… the ideal combination that decrease preeclampsia risks.
Calcima… Ideal standard recommended concentrations with high safety profile
to ensures proper bone mineralization.
Calcima… Aspartame free, Sorbitol free. with no heart burn.
Calcima… Small pieces with no chalky taste unlike other traditional calcium
supplements.

56.  The only product in Egyptian market that contains Calcium, Vit D in
combination with MBP that increase BMD and improve the absorption of
calcium supplement.
 Chewable chocolate pieces of Calcima has delicious taste.
 Calcima is safe, sorbitol free and aspartame free with no chalky taste .
 30 chocolate pcs easily monthly control
Why Calcima…

61. 0

66. Target Audience
 Gynecology (PM only)
 Selected Orthopedics (Starting from 2nd Qtr)
 Selected Pediatrics (Starting from 2nd Qtr)
Application:-
• 1-3 daily chewable
piece or as prescribed
by physician.
Packaging:-
• 30 chewable piece…. 44.95 LE

67. Positioning:
 For patients and pregnant who
suffer from calcium deficiency ,
Calcima is a unique formula of ideal
recommended concentrations of
Calcium , Vitamin D in combination
with MBP with delicious chewable
chocolate taste that provides high
patient compliance and safety.
Indications:
For prevention and treatment of
Calcium and vitamin D deficiency
• Increased Calcium demand in
pregnancy, children and adults
• osteoporosis.
• Prophylaxis against rickets

68. CHECK POINT #4

69. MARKET COMPETITORS

70. Extreme
Calcima competitive advantages:-
• Combination of Ca & Vit D with MBP that
enhance BMD
• No Chalky taste
• No Vit K (vit K may enhance postnatal
jaundice)
• Package (30 pcs) more suitable for monthly
control
• Price

71. Calcitron
Calcima competitive advantages:-
• Combination of Ca & Vit D with MBP that
enhance BMD
• Chewable chocolate pieces with high
bioavailability
• Not cause gastric irritation or heart burn
• Calcium and Vit D content with ideal
concentration according to
recommendations

72. CHECK POINT #5