Calcium:Functions

Excitation – Intracellular
contraction messengers for
-in muscles hormones,
autacoids &
Excitation –
transmitters.
secretion -in Impulse
glands generation in
Release of heart-
transmitters automaticity, A-
from nerve V conduction.
ending. Coagulation of
blood.
 •Healthy Ca++ stores, Homeostasis
adult men
8.5 to 10.4
and mg/dl
women –
1300 and
1000
99% is g
inof
bone
calcium
nd teeth
•Normal
•The extracellular
serum Ca2+ concentration
calcium tightly controlled by
hormones.
concentratio Entry at the intestine
•Ionized (50%), and\
n
protein-bound its exit at the
8.5 to 10.4 kidney;
(40%),
mg/dl These same
and complexed hormones regulate
(10%). withdrawal from the
large
Hormonal control of plasma concentration
 Remodelling
Bone[Ca++] turn
over:
• Constant and
continuous
• Osteoclastic activity
followed by
osteoblastic-
Remodelling
Remodelling deficits Remodelling
accumulate over life •Resorption
tome •New bone formation
Diet, Ex., hormones, •Closely coupled
drugs etc •Directionally opposite
Remodelling
 Calcium Absorption and
Excretion
Excretion
Ionized Ca++ is
Absorption filtered
Facilitated diffusion- Reabsorbed
All intestine Influenced by
Carrier-Duodenum Hormones
Influenced by ‘D’ Thiazide ↓excretion
Phytate, oxalate,
phosphate, TC Ca++ requirement
chelate Ca++ 300mg/d is lost
 Phenytoin & Same amount has
Glucocorticoids ↓ to be
supplememted

 Preparations and uses
Oral Uses
Calcium chloride, Ca gluconate slow
lactate, carbonate i.v. followed by
etc. infusion
Parenteral Dietary
Ca gluconate-i.v. supplement in
Produces warmth on growing children,
injection pregnancy and
lactating mothers.
As adjuants in
osteoporosis
Antacids
 Parathyroid
hormone[PTH][Parathormone]
Actions: Uses
Not used in
Increases plasma
hypoparathyroidis
Ca++ m-Expensive,
Bone Parenteral route of
resorption.[Followed delivery, Vit D can
by new bone produce
formation] comparable resuts.
Kidney:Increases Teriparatide-
reabsorption Recombinant
Intestine: Indirectly Sometimes used in
by increasing the osteoporosis
formation of Calcitrol Diagnostic; Pseudo
and true
 Calcitonin
Calcitonin Uses
Calcitonin is a Calcitonin useful in
HYPOCALCEMIC managing
hormone – actions hypercalcemia[Malig
-oppose those of PTH. nancy]
Secreted by thyroid Paget’s disease to
parafollicular C cells reduce bone pain
Preperations Osteoporosis
Porcine Not routinely used
Synthetic
Route
S.C, i.m., Nasal spray.
 Vit D

Alfacalcidol
[1OHD3

•Prohormone
•Converted in
body
to active
hormone
[Calcitriol]
 Cutaneou
s Dietary
[Under [Animal D3-
UV] Dairy, Fish,
egg yolk]
[Plant-D2]

Liver
25-OH
[25
VitD
Hydroxylation]
Kidney
[1
Kidney Hydroxylation]
[1 -25
(OH)2VitD]
Calcitriol Vitamin D synthesis
and activation
 Vit: D: Actions

[2]

[3]
[1]

] ↑ synthesis of Ca++ binding proteins

Result= ↑ Plasma
[2]↑ bone resorption concentration
3]↑ Increases tubular reabsorptionOf Ca++
 Vit D: Actions
 ↑ synthesis of Ca++ binding proteins
↑ Plasma
↑ bone resorption concn.
Of Ca++
↑ Increases tubular reabsorption

Other actions
 On Immunological cells
 On Lymphikine production
 Neuronal, skeletal muscle function
 Vit D Defeciency
Nutrional
def.
Rickets
↓
[Children
Ca++Plasma
]
concn
↑ PTH Osteomalaci
secretion a
[Adults]
Ca++
Mobilized
From bones
Hypervitaminosis??
↓Bone PK??
mineralization
Preparations Uses
 1μg of Prophylaxis-Dose??
cholecalciferol=40i.u D Resistant rickets
 Calciferol [Hereditary]
 Cholecalciferol D
 Calcitriol Dependent[heredit
 Alfacalidol- ary]
 Does not require Calcitriol/alfacalcidol
renal hydroxylation Renal rickets
 Can be used in renal Calcitriol/alfacalcid
impairment ol
 Calcipotriol[Analogue Osteoporosis
]
Hypoparathyroidis
psoriasis
m
 Osteoporosis
Characterized by decreased bone strength
Common among postmenopausal women
Defective organic matrix
Pathological factors
Multifactorial-Etiology
Management
Lifestyle
HRT, SERM,BISPHOSPHONATES, Ca++, VitD
 Bisphosphonates
CLASSIFICATION USES
 I Generation 1-
10 Ostoporosis
Etidronate Paget’s disease
 II Generation 100-
Hypercalcemia of
1000 malignancy
Palmidrnate, Bone pain in
Alendronate metastasis
 III generation 1000-
5000
ADE
Risedronate,
 Gastric irritants
Zoledronate
 Severe esophagitis
 To be swaalowed
ACTIONS
 Prevent osteoporosis
with a glass of
water in sitting
 Prevent bone