CALCIUM METABOLISM

Sources:
Milk, cheese, dark‑green leaves, fishes, carrot

Daily requirements:
• Adults ‑ 800 mg
• Pregnant and lactating women
‑ 1200 mg
• Children ‑ 1200 mg
 Absorption
• Calcium is actively absorbed mainly from the
duodenum and the first half of jejunum
 Factors favouring calcium absorption
• Ca: P ratio ‑ Absorption is maximal when food
contains almost equal amounts of readily
available calcium and phosphorus.
• Dietary lactose and amino acids (mainly basic):
increase solubility of calcium salts
• Vitamin D
• Low pH
 Factors hindering calcium absorption
• Dietary fatty acids: Failure of fat absorption
decreases absorption of calcium and
phosphorus because fatty acids form insoluble
soaps with calcium
• Oxalates(found in spinach), phytates (from
cereal fibers) and high amount of phosphate:
By forming insoluble salts with calcium
• Coeliac disease (intestinal disorder)
• High pH
Functions of calcium:
• Constituent of bones and teeth
• Blood coagulation
• Regulates action of some enzymes‑ Examples:
Phospholipase A2, cAMP phosphodiesterase,
glycogen synthase, adenylate cyclase
• Synaptic transmission: Helps in the release of
neurotransmitters
• Muscle contraction
• Regulates permeability of gap junctions
• Reduces neuromuscular excitability
• Role in hormone action ‑ Acts as second
messenger
• Role in milk secretion
 Normal plasma calcium concentration
9‑11 mg/dL

Hormones/vitamins that regulate plasma calcium level:

1. Calcitriol
• The physiologically active form of Vitamin D is termed as
Calcitriol.
• Enhances the absorption of calcium from intestine.
• Enhances the reabsorption of calcium from the kidney tubules.
• Promotes calcification of bone (favors formation of bone).
• Overall, the plasma calcium level is increased by calcitriol.
2. Parathyroid hormone (PTH)
• It is secreted by two pairs of parathyroid glands.
• It causes decalcification of bone.
• Increases the calcium reabsorption from the
kidney tubules.
• It increases the absorption of calcium from
intestine by promoting the synthesis of calcitriol
(indirect effect).
• Overall, PTH elevates the calcium level in the
plasma.
3. Calcitonin
• It is a hormone secreted by parafollicular cells
of thyroid gland. It promotes calcification of
bone thus it lowers plasma calcium level.
Hence its action is antagonistic to that of PTH.
 Intestine Calcium
PTH

Calcitriol Vitamin D
Plasma Calcium
(9-11 mg/dL)

Calcitriol, Calcitonin PTH PTH, Calcitriol

Bone Calcium Kidney tubule calcium

 PHOSPHORUS METABOLISM

Sources:
– Wheat, maize, egg, milk, cheese, fish, meat.

Daily requirements:
• Adults ‑ 800 mg
• Pregnant and lactating women ‑ 1200 mg
• Children ‑ 1200 mg
Factors favouring phosphorus absorption

• 1. Ca:P ratio
• 2. Vitamin D
Factors hindering phosphorous absorption

• 1. Dietary fatty acids

• 2. Oxalates, phytates and iron (iron forms
insoluble ferric phosphates
Functions of phosphorus:
1. Constituent of bones and teeth
2. Energy transfer: High energy phosphates (ATP,
creatine phosphate)
3. Acid base buffer: Phosphate buffer system
4. Phosphorylation : Essential in many metabolic
pathways and in reversible covalent modification
of some enzymes. Eg. Pyruvate dehydrogenase,
glycogen synthase and phosphorylase
5. Component of some coenzymes: Examples ‑
TPP, PLP, NADP
6. Constituent of phosphoproteins, nucleic acids
and phospholipids

Plasma inorganic phosphorus level

3.0 to 4.5 mg/dL
Hormones/vitamins that regulate plasma phosphate
level:
1. Calcitriol
• Enhances the intestinal absorption of phosphate.
• Promotes bone formation by depositing phosphate
along with calcium.
• Enhances the reabsorption of phosphate from the
kidney tubules.
• Overall, plasma phosphate levels are elevated by
calcitriol.
2. Parathyroid hormone (PTH)
• PTH diminishes the reabsorption of phosphate
from the kidney tubules. Hence it lowers the
phosphate levels in the plasma.
 Disorders of phosphorus metabolism
• Hyperphosphatemia: Increased plasma
inorganic phosphorus level
• Causes:
• 1. Hypoparathyroidism
• 2. Excesive phosphate intake
• 3. Chronic renal disease
• Hypophosphatemia: Decreased plasma
inorganic phosphorus level
• Causes:
• 1. Hyperparathyroidism
• 2. Vitamin D deficiency (rickets in children,
osteomalacia in adults)