How do you manage calcium and vitamin D replacement in scleroderma and myositis patients with dysphagia and malabsorption?

Dietary calcium is a good choice. I recommended that my patients with dysphasia caused by scleroderma drink 2-3 glasses of skim milk daily. 8 ounces contain 300 mg of calcium which is highly bioavailable. It also provides a good source of whey protein that contains all the essential amino acids. Another option is orange juice fortified with calcium and vitamin D. This product contains calcium in the form of calcium citrate maleate which is one of the most bioavailable forms of calcium. The vitamin D is also highly bioavailable as we have previously published. Regarding malabsorption of vitamin D, I recommended sensible sun exposure. Patients can use the app dminder.info that I helped develop and is free. It provides information for when you...