Cellular and Extracellular

Calcium Metabolism
 Calcium
Calcium is the most abundant mineral in the body:

about 1 kg in a 70 kg man

~ 99% of the body’s calcium is present in the bone

where it is combined with phosphate
 Dietary Sources of Calcium

Rich:
Milk, milk products as cheese & yoghurt

Fair
Legumes, vegetables
 Biological Functions of Calcium
Bone
Formation

99 % Reservoir for

ECF [Ca2+]
in bone
Total
Calcium Blood
Clotting
Of the ECF
Body Excitability of
Nerve & Muscle

1%
Metabolic
Regulation for
Action of
ICF Hormones &
Enzyme Activation
Calcium in Blood
Organ Calcium Homeostasis
 Organ Calcium Homeostasis cont.

The concentration of calcium, phosphorous &

magnesium in the plasma depends on
ORGAN PHYSIOLOGY:

Net effect of bone mineral deposition & resorption

Intestinal absorption
Renal excretion
 Endocrinal Calcium Homeostasis

 Parathyroid Hormone (PTH)

Blood
[Ca2+]  Active Vitamin D (Calcitriol or 1,25 DHCC)
is Regulated By:
 Calcitonin Hormone
Parathyroid hormone (PTH)
 Functions of Parathyroid Hormone (PTH)

The active hormone is secreted in response to al fall in plasma Ca2+

resulting in in Ca2+ increase in blood.

On bone:
PTH stimulates bone resorption by osteoclasts resulting in release of
calcium ions from bones to blood in cases of hypocalcemia

On kidney:
1- PTH increases reabsorption of calcium from kidney tubules.
2- PTH promotes activity of 1a hydroxylase of the kidney (with more
hydroxylation of 25 hydroxycholecalciferol (25 HCC) to 1,25 DHCC
(activation of vitamin D) which increases intestinal absorption of
calcium
So, action of PTH on intestine is indirect (via Vitamin D)
 Role of Parathyroid Hormone (PTH) in
Hypocalcemia

PTH
is the principal
acute regulator of
blood [Ca2+]

PTH
is a hypercalcemic
hormone in case of
hypocalcemia
Vitamin D
 Vitamin D
A group of sterols with a hormone-like function.
Sources of Vitamin D
1- Skin synthesis (On Exposure to Sun Lights):
In the skin, 7 dehydrocholesterol is converted to vitamin D3 by exposure to
sunlight
2- Diet:
- Animal Source Cholecalciferol (Vitamins D3)
- Plant Source: Ergocalciferol (Vitamin D2)
Vitamin D2 & D3 are NOT biologically active

Activation of cholecalciferol (vitamin D3)

Cholecalciferol (Vitamin D3) is activated in the body to the biologically active
form by two hydroxylations: first in the liver (at position 25) by 25 hydroxylase
& then in the kidney at positions 1 by 1 α hydroxylase
Active Vitamin D
1, 25 dihydroxycholecalciferol (Calcitriol or DHCC)
SOURCES OF VITAMIN D
Vitamin D2
plant source

DIET VITAMINs D

Vitamin D3
animal source
fatty fish
Liver
egg yolk

Sun
Rays

7-dehydrocholesterol
In the skin
 Vitamin D metabolism
Cholecalciferol (Vitamin D3) is derived from 7-dehydrocholesterol in
the skin by sunlight or supplied in the diet

In liver:
Cholecalciferol is converted to 25-hydroxycholecalciferol (25-HCC)
by the enzyme 25 hydroxylase

25-hydroxycholecalciferol is the predominant form of vitamin D

in blood
25-hydroxycholecalciferol is the main storage form of vitamin
in the body

In kidneys:
The 1 α hydroxylase enzyme converts 25 hydroxycholecalciferol to
1,25-dihydroxycholecalciferol (1, 25 DHCC or Calcitriol)
which is the biologically active form of vitamin D
A simplified schema for the regulation of serum phosphate by PTH, 1,25
(0H)2D and fibroblast growth factor 23 (FGF23)
 Functions of Vitamin D

Active vitamin D (1, 25 DHCC or Calcitriol) regulates calcium levels in the

body (calcium homeostasis)
Through:
Increasing absorption of calcium by the intestine
Minimizing loss of calcium by kidney
Stimulating resorption of bone (when necessary)
Mechanism of Action of Vitamin D
 Calcitonin Hormone

Calcitonin hormone is :
Secreted by the parafollicular or “C” cells of the thyroid gland
Released in response to high blood calcium (hypercalcemia)

In cases of hypercalcemia,
Calcitonin Hormone   blood [Ca2+] by:
 Osteoclast activity (preventing release of calcium to blood)
 Renal reabsorption of calcium
Net result of its action   blood calcium

CALCITONIN IS THE ONLY HYPOCALCEMIC HORMONE

Calcium Regulation