Applied aspect of Ca metabolism and bone

Physiology
A. Hyperparathyroidism: Hypercalcemia
B. Hypoparathyroidism: Hypocalcemia, Tetany
C. Diseases of bone:
i. Rickets
ii. Osteoporosis
iii. Osteomalacia

Dr. Dnyanesh Gagare 1

 A. Hyperparathyroidism:
 Hyper secretion of PTH
 Three types:
a. Primary H: Due to tumor in parathyroid glands
b. Secondary H: Due to Hypocalcemia such as in-
i. Chronic renal failure
ii. Vit D deficiency
iii. Rickets
c. Tertiary H: Due to hyperplasia of parathyroid
glands in chronic secondary hyperthyroidism.
Dr. Dnyanesh Gagare 2
❖Hypercalcemia
 Plasma Ca level above the normal (9–11 mg/dl)
 Occurs in hyperparathyroidism
➢ Common signs & symptoms:
i. Depression of nervous system
ii. Sluggishness of reflex activities
iii. Lack of appetite
iv. Constipation
v. Reduced ST segment & QT interval in ECG
➢ These effects are noticed when-
o Ca level ↑ed to 12 mg/dl,

o Becomes severe with 15 mg/dl &

o Lethal at 17 mg/dl.
Dr. Dnyanesh Gagare 3
B. Hypoparathyroidism
 Hyposecretion of PTH → leads in hypocalcemia
 Causes:
i. Surgical removal of parathyroid gland
ii. Surgical removal during thyroid gland
iii. Autoimmune disease
iv. ↓ PTH receptors on target cells

Dr. Dnyanesh Gagare 4

❖Hypocalcemia
 Ca level ↓ below the normal (9-11 mg/dl)

 Occurs in hypoparathyroidism

 Due to ↓ resorption of Ca from bone

➢ Signs & Symptoms:

 Neuromuscular hyper excitability- hypocalcemic
tetany
 ↓ threshold of activation of neuron→ unstable
neuron → fire spontaneous AP → ↑ NM activity →
involuntary contraction → tetany
 Occurs when plasma Ca-level ↓ below 6 mg/dl.

Dr. Dnyanesh Gagare 5

❖Tetany:
 Involuntary contractions of muscles called
muscular spasm.
 Shows muscle twitching, crams & convulsion.
 Painful contractions seen in feet & hand.
 Ex. Carpopedal spasm- Sharp flexion of the
wrist & ankle joints
 Fig. Flexion at wrist joint & adduction of the thumb
➢ Cause:
 Hyper excitability of nerves & skeletal muscles due
to ↓ Ca level in plasma.
Dr. Dnyanesh Gagare 6
 Carpopedal spasm

Dr. Dnyanesh Gagare 7

❖Other causes of spasm
 Muscle fatigue
 Exercising in heat
 Dehydration
 Depletion of electrolytes
 Involuntary nerve discharge
 Restriction in blood flow
 Stress

Dr. Dnyanesh Gagare 8

C. Diseases of Bone
i. Rickets :
 Bone disease in children.
 Due to lack of Vit-D or calcium or phosphate.
 Important for development of strong, healthy bones.
 Vit-D helps to absorb Ca & phosphate from intestine.
 Source of Vit-D is food- like milk, eggs, and fish.
 Body also produces Vit-D when exposed to sunlight.
 Rickets is common in children between 6 and 36
months old.
 At the highest risk because they’re still growing.
Dr. Dnyanesh Gagare 9
 Not get enough Vit-D if they live in a region with little
sunlight, follow a vegetarian diet, or don’t drink milk
products.
 In some cases, the condition is hereditary.
➢ Manifestation (Clinical features)
 Boney defects- weak and soft bones
 Skeletal deformities in severe cases
 Widening of wrist
 Stunted growth
 Flattening of skull
 Bowing of legs and hands
Dr. Dnyanesh Gagare 10
  Kyphosis: Forward curvature of upper spine
 Scoliosis: Lateral curvature of the spin
 Pigeon shape chest: Collapse of chest wall
 More prone to respiratory & GIT infections.
 Enlargement of liver and spleen.
 Low plasma Ca & phosphate level.

➢ Management & Treatment

 Supply of calcium & Vit-D should be ensured.

Dr. Dnyanesh Gagare 11

 Rickets
Dr. Dnyanesh Gagare 12
ii. Osteomalacia: “Adult Rickets”
 In adults due to- Vit-D deficiency, damage of kidney,
 Poor Ca level & defective mineralization of bones.
❑Clinical features:
 Almost similar to rickets
 Diffuse skeletal pain & bony tenderness
 Muscle weakness
 Softening of bones lead to bowing of bones.
 Pseudo fractures are seen in flat bones.
 Tetany may occur in few cases with carpopedal spasm.
Dr. Dnyanesh Gagare 13
Osteomalacia: “Adult Rickets”
Dr. Dnyanesh Gagare 14
iii. Osteoporosis (Porous bones)
 Bones: Porous, fragile with high risk of fracture
 Cause: excessive bone resorption & ↓ed bone formation
 Loss of bone matrix & minerals
 Commonly affected bones: Vertebrae & Hip bone
 Osteoporosis is common in women after 60 years
➢ Causes or Risk factors for osteoporosis:
1. Sedentary life style
2. Genetic factor
3. Early menopause or ovariectomy
4. Excessive smoking
Dr. Dnyanesh Gagare 15
 5. Excessive alcohol or caffeine intake
6. Prolonged high intake of protein
7. Prolonged medication with drugs like corticosteroids
8. Endocrine disorders like hypothyroidism, Cushing’s
syndrome, Acromegaly & Hypogonadism.
9. In old age due to ↓ed GH
10. Lack of Vit-C
➢ Treatment
 ↑ Ca intake from natural sources like milk
 Moderate exercise
 Estrogen treatment in women after menopause
Dr. Dnyanesh Gagare 16