Dietary supplement is defined as any product containing a “dietary ingredient” (vitamins, minerals, herbs, amino acids, enzymes, etc.) that is intended to supplement one’s diet. Their main purpose is to provide the required nutrients and to fulfill the daily nutritional needs.[1,2]Osteoporosis is a progressive disease that affects bone density and quality, leading to an increased risk of bone fractures and reductions in quality of life. According to the International Osteoporosis Foundation (IOF), over 200 million women suffer from osteoporosis today. In fact, in women aged over 45, osteoporosis accounts for more days spent in hospital than diabetes, heart attacks and breast cancer combined.[3,4]

Bone is constantly in a cycle of being broken down and reformed. This process is known as bone remodeling and requires an adequate supply of certain nutrients. Supplementing with calcium, vitamin D and glucosamine may be the key to good bone health. It was found that when people stopped supplementing, the increased bone density they had acquired via supplementation was lost. As the demographic panorama shifts to an older generation that is more interested in disease prevention and wellness, calcium, vitamin D and glucosamine supplements will experience strong growth in demand. Various options are available to meet the new supplementation demands, but most of the women, who are more vulnerable because of the bone loss that occurs in menopause were unaware  about the importance of supplementation.[5,6]

Vitamin D is essential for bone health. Low levels of vitamin D have been associated with low bone density and risk of fractures. Vitamin D supplements may be beneficial for people who are low or deficient in this vitamin. While experts recommend getting as much calcium and other nutrients as possible from foods instead of from supplements, it may be difficult to get all the calcium needed from diet alone. A calcium supplement may be taken to help make up the difference. Calcium supplements may be appropriate for individuals who are at an increased risk of deficiency, Glucosamine is a compound that’s naturally produced by your body. Most commonly, it exists in your cartilage and helps create the proteins and fats that repair your cartilage when it’s damaged. Glucosamine isn’t commonly found in foods, but it is often sold as a supplement in drops, capsules, or topical forms. Supplements can be made from the shells of shellfish or be produced artificially. Taking glucosamine supplements may offer health benefits, particularly for joint pain such as arthritis.[7,8]

There aren't many researches in Himachal Pradesh that examine people's general understanding about Dietary supplement. Therefore, the purpose of this study is to ascertain the Perception regarding Calcium, Vitamin D and Glucosamine supplementation for Healthy Bones and Joints among females of Himachal Pradesh

Objectives of the Study

To evaluate the Perception regarding Calcium , Vitamin D and Glucosamine supplementation for Healthy Bones and Joints among females of Himachal Pradesh 

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area: Himachal Pradesh

• Study duration- between January 2022- March 2022 

• Study population-   Female population aged between 18-60 years

• Sample size- 400  females assuming 50%  adults have adequate knowledge regarding Calcium , Vitamin D and Glucosamine supplementation, 5% absolute error, 95% confidence level, and 5% non response rate.

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and Perception regarding Calcium, Vitamin D and Glucosamine supplementation was created. 

• Inclusive Criteria- who were willing to participate in the study.

• Exclusion Criteria: who were not willing to participate in the study

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin. Responses were then recorded in a Google Excel spreadsheet, the information from which was used to generate graphical display.

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analysed with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage, mean standard deviation etc.

Ethical Considerations- Participants confidentiality and anonymity was maintained. 

The goal of the current study was to evaluate the Perception regarding Calcium, Vitamin D and Glucosamine supplementation for Healthy Bones and Joints among females of Himachal Pradesh. In the present study 37% (148) of the females fall were below 40 years of age while 63% (252) were above 40 years.

Table-1: Perception of participants regarding Calcium, Vitamin D and Glucosamine supplementation

The purpose of the current study was to assess females in Himachal Pradesh's perceptions of calcium, vitamin D, and glucosamine supplementation for healthy bones and joints. We found that almost half of the participated female had insufficient knowledge regarding the need, usefulness, dose , adverse effects of these nutritional supplements.Vitamin D is essential for bone health and it plays a key role in calcium absorption and helps regulate bone turnover. Given the limited number of food sources of this vitamin, which includes fatty fish and fortified dairy products and cereals, most people obtain vitamin D through sunlight exposure. However, getting adequate amounts of vitamin D through sunlight exposure can be difficult during the winter and for those who spend the majority of their time indoors. Furthermore, people who live far north or south of the equator are at an even greater risk of vitamin D deficiency due to limited sun exposure for up to 2–5 months per year.[1,9,10]

Many studies found that people with osteoporosis were more likely to be deficient in vitamin D. Of those deficient in vitamin D, daily intake of a vitamin D supplement was also linked to a lower incidence of osteoporosis over 8 weeks .While vitamin D supplements may be beneficial for people with vitamin D deficiency, research has not observed benefits of vitamin D supplements once blood levels are at or above sufficiency levels. The current Reference Daily Intake (RDI) for vitamin D is 600 IU for children and adults ages 1–70 and 800 IU for pregnant or breastfeeding adults and those 71 years or older . To reduce the risk of bone fractures and ensure sufficient blood levels, research suggests that a dose of 400–800 IU of vitamin D per day may be sufficient. Interestingly, one study including 311 healthy adults found high doses of 4,000 and 10,000 IU of vitamin D per day resulted in a greater loss of bone mass density over 3 years than taking a smaller 400 IU daily dose . Still, while research suggests smaller doses may be better in the long term for bone density, higher doses may be needed temporarily in more severe vitamin D deficiency cases. Given that it’s estimated that 50% of the population has low levels of vitamin D, it’s worth talking to a healthcare provider if you’re concerned about not getting adequate vitamin D throughout the year.[5,8]

Calcium is a major component of bone tissue and essential for bone strength and structure. In fact, approximately 99% of your body’s calcium is stored in your skeleton. The current RDI for calcium ranges from 700–1200 mg per day, with increased needs during certain life stages, including childhood and adolescence, pregnancy and lactation, women over the age of 50, and all adults 70 years or older. While adequate calcium intake throughout your life is important for bone health, research on the potential benefits of taking calcium supplements for the prevention and management of osteoporosis is mixed . One review of 8 studies found calcium plus vitamin D supplements were linked to a 15–30% reduced risk of fractures in both community-dwelling and institutionalized middle-age and older adults. However, another review of 33 studies found that calcium supplements — either on their own or in combination with vitamin D — weren’t associated with a reduced risk of fractures in older adults living at home, compared with a placebo.Similarly, a review of 59 studies found that increasing calcium intake through either supplements or food sources resulted in small but not clinically meaningful improvements in bone mass density .Overall, while calcium supplements may be appropriate for individuals who are at an increased risk of deficiency, there’s currently insufficient evidence to recommend calcium supplements to prevent or manage osteoporosis in the general population.[6,11,12]

While experts recommend getting as much calcium and other nutrients as possible from foods instead of from supplements, it may be difficult to get all the calcium needed from diet alone. A calcium supplement may be taken to help make up the difference. Calcium supplements come in a variety of different forms, including compounds such as calcium citrate (Citracal or Solgar), calcium lactate, and calcium gluconate. The actual amount of calcium, called elemental calcium, varies in each supplement. Chelated forms of calcium, such as in the compounds just listed, are more easily absorbed by the body than other forms of calcium. However, calcium carbonate , while not as easily absorbed, contains the highest amount of elemental calcium.[13-15]

Be sure to examine the labels of supplements to see how much elemental calcium they have and what the serving sizes are. In some cases, the serving size is more than one tablet. Calcium carbonate and calcium citrate are the most commonly used calcium supplements, particularly because they contain more calcium per tablet and are less expensive per milligram of calcium than other supplements. Calcium carbonate supplies more elemental calcium per tablet than other forms and is therefore usually the best value; however, it is best to take this kind of calcium compound with food because stomach acid is needed to dissolve it. Calcium citrate has less elemental calcium in it, so more of it will need to be taken, but it is absorbed more easily than calcium carbonate. When taking a supplement, a few other things should be considered. More isn't always better; the recommended daily dose should not be exceeded because exceeding the dose increases the risk of side effects. [11,16]

Glucosamine is a compound that’s naturally produced by your body. Most commonly, it exists in your cartilage and helps create the proteins and fats that repair your cartilage when it’s damaged.Glucosamine isn’t commonly found in foods, but it is often sold as a supplement in drops, capsules, or topical forms. Supplements can be made from the shells of shellfish or be produced artificially. Taking glucosamine supplements may offer health benefits, particularly for joint pain such as arthritis. Glucosamine supplements can provide some important health benefits. glucosamine can provide benefits like: Reduced Joint Pain & Inflammation and  Improve Bone Health.[17,18]

Studies around the world have shown that glucosamine appears to reduce joint pain, especially among people with osteoarthritis. In fact, the scientific support for glucosamine is so strong that the compound is available as a medicinal substance not just as a supplement .Supplements of combined glucosamine and chondroitin — a related compound also found in cartilage — have been shown to be as effective as osteoarthritis medications such as celecoxib . For people who do not react well to non-steroidal anti-inflammatory drugs like celecoxib, glucosamine supplements may be a safe and effective way to reduce symptoms of arthritis.[19,20]

Glucosamine and chondroitin supplements may also help reduce chronic inflammation, which is linked to a number of potential health problems like  arthritis. This may be part of the reason why glucosamine reduces arthritis pain. Studies have linked regular consumption of glucosamine supplements with lower levels of inflammation. Regularly taking the supplements can help lower your risk of a number of chronic conditions.[18-20]

While more research needs to be done, early studies suggest that glucosamine supplements may help prevent the progression of osteoporosis post-menopause. Glucosamine appears to help reduce the weakening of bones by supporting healthy bone growth. This makes the supplements especially helpful for people who are at risk of developing osteoporosis as they age.[17,19]

The results of the study showed that the female participants' understanding of calcium, vitamin D, and glucosamine supplementation for healthy bones and joints was either insufficient or unsatisfactory. While some nutrients, such as vitamin D, calcium, and glucosamine, are crucial for bone health, more research is still needed to determine how helpful it is to take these supplements. The current study supports educational initiatives and public awareness campaigns about nutritional supplements for bone and joint health, particularly among women.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the IGMC,Shimla.

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