A Seminar on Calcium Metabolism

contents
Introduction Role of calcium Normal values,Types,Sources,Daily requirements Absorption,Distribution,Excretion Regulation of blood calcium levels Applied physiology Importance of calcium in Prosthodontics Conclusion References

Introduction

Most abundant mineral in the body

Calcium interacts with phosphorous forming Calcium phosphate

Role of Calcium
1. Neuronal Activity
Calcium is necessary -- For transmission of impulses from pre synaptic to post synaptic region -- For the release of neurotransmitter from synaptic vescicle

2 Muscular Activity
Calcium mediates excitation-contraction coupling of muscle fibers Skeletal Muscle Calcium binds with Troponin c and Tropomyosin Smooth Muscle in place of Troponin Calcium binds with Calmodulin

3. Hemostasis Necessary for activation of clotting factors in blood coagulation

4. Formation of bone and teeth

5. Membrane stabilization
6. Secretary activity of glands 7. Activation of enzymes

Normal Values Total body Calcium 1100g(1.5 % of total body weight) Out of this - 99% in bone - 4-5 g in soft tissues - approx 1g in extra cellular fluid Normal Serum Calcium - 9-11 mg%

Types 1. Diffusible Ionised calcium- physiologically active form (50%) Non Ionised Calcium- Calcium complexed with anions (9%) 2. Non Diffusible (41%) Calcium bound to albumin Physiologically inactive Sources Milk, Egg, Fish ,Leafy Vegetables, Cereals

Daily Requirement Adult - 500 -800mg per day Children - 1200mg per day Pregnancy and Lactation -1500mg per day After age of 50 tendency for osteoporosis may be prevented byCalcium (1500mg/day)+ Vitamin D (20mg/day)

Absorption of Calcium
Mainly from 1st and 2nd part of Duodenum Absorbed against a concentration gradient Requires a carrier protein- Calbindin helped by calcium dependent ATPase

Factors affecting Absorption

Factors Increasing Vitamin D Calcitriol Parathyroid Hormone Amino Acids..lysine,Arginine

Factors Decreasing Phytates Oxalates Malabsorption Syndrome High Phosphate content

Regulation of Blood Calcium Levels Three hormones that regulates blood calcium levels 1. Parathyroid hormone 2. 1,25-dihydroxycholecalciferol 3. Calcitonin

1. Parathyroid Hormone(PTH)
A polypeptide secreted by chief cells of parathyroid gland Synthesised from a precursor Prepro-PTH Acts via activation of adenylyl cyclase Actions a. Action on Bones Increases plasma calcium concentration by promoting bone resorption Occurs in 2 Phases Rapid Phase (Early Phase)-Osteolysis Slow Phase- Activation of Osteoclasts

b. Action on Kidneys Increases renal tubular reabsorption of calcium Occurs mainly in the distal tubules, collecting tubules, collecting duct and to a lesser extent in ascending loop of Henle c. Action on GIT Increases calcium absorption from intestine-by increasing the formation of 1,25 dihydroxycholecalciferol

2. 1,25 dihydroxycholecalciferol Activated form of Vitamin D Increases calcium absorption from intestine

3. Calcitonin A peptide hormone secreted by C cells of thyroid gland Reduces Blood calcium level by acting onBone-deposition of calcium Kidney-Increases calcium Excretion Intestine-Prevents Calcium Absorption

Applied Physiology
1.Hypoparathyroidism Decreased secretion of PTH- Hypocalcemia (calcium <8.5mg/dl) Hypocalcemic tetany neuromuscular hyper excitability - Occurs if the plasma calcium level falls below 6mg%

Signs and symptoms Carpopedal Spasm -Trousseaus Sign(Figure)

Laryngeal Stridor ECG Changes Can be detected by 1, Trousseaus Sign 2, Chvosteks Sign 3. Erb Sign

2. Hyperparathyroidism Increased secretion of PTH-Hyper calcemia

Radiology of hyperparathyroidism

Osteoporosis
Bone disease characterised by loss of bone matrix and minerals Due to excessive bone resorption and decreased bone deposition. Risk factors 1.sedentary life 2.genetic factors 3.early menopause/ ovariectomy 4.excessive alcohol intake 5.prolonged medication with corticosteroids. 6.hypothyroidism,cushings syndrome, acromegaly, hypogonadism.

3. Rickets
Bone disease occurring in children due to vitamin D deficiency

4.Osteomalacia(Adult Rickets)

5.Renal Osteodystrophy
A consequence of chronic renal failure related to calcium metabolism

Importance of calcium in Prosthodontics

Necessary for the normal growth of bone and teeth. In osteoporosis, - RRR will be more- affect denture retention frequent relining is needed Amount and density of available bone in edentulos site is the primary determining factor in predicting the success of an implant.