Hahn, Reddmann, McNutt 1

Calcium
By: Laura Hahn, Beth McNutt, Kayla Reddmann
Introduction
Calcium, an essential mineral to human nutrition, is listed on the Periodic Table of
Elements as Ca. Calcium has five stable isotopes. The most abundant isotope accounts for over
97% of the calcium that occurs naturally, and that is the form that is represented on the Periodic
Table [1]. It has an atomic number of 20, showing that every calcium atom (neutrally charged)
has twenty protons, neutrons and electrons. Since calcium is an alkaline earth metal, ions have
the ability to lose two electrons to form covalent bonds with other ions, giving each Ca ion a (+2)
charge. The atomic mass of calcium is 40.08 grams per mole.
Calcium is extremely prevalent on the planet. It is the fifth most abundant element in the
earths crust, and its ionic form is also the fifth most abundant element dissolved in the bodies of
water [1]. In most animals, calcium is the most abundant metal by mass and makes up for about
2% of a persons total body weight [1]. However, free calcium atoms are very reactive and do
not occur naturally [1].
At room temperature calcium is a solid. It appears to be gray or silver in color, with a
small tint of yellow, and very dull. Although it is harder than lead, calcium is soft and is possible
to be cut with a knife [1].
Chief Functions
Calcium is necessary for life in many living organisms and is involved in many processes
in the human body. Without calcium, life would not be able to be sustained, as the body is unable
to generate this essential nutrient [2]. It is commonly known that calcium is essential for building
strong and dense bones and teeth; however, calcium takes several additional roles in maintaining
a healthy working body.
Bone Health
Approximately 99% of the calcium consumed in a healthy individual goes to developing,
growing, and maintaining bones and teeth [2]. Calcium is an essential nutrient to the skeletal
structure and its functions, providing it with its density and strength [2]. Calcium is responsible

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for aiding in the buildup of new bone and for providing bone with its strong structure [2]. Bone
cells uptake calcium ions from the blood in order to mineralize the buildup of new bone,
providing it with its strength [2].
Humans are immediately exposed to calcium while developing in the womb. Calcium, as
well as other nutrients and molecules, travel from the mother through the placenta to the fetus
[3]. It is critical that pregnant women consume enough calcium to meet the fetal bone
requirements to support development and growth. After birth, infants are fed calcium through
means of breastmilk or formula. Consuming sufficient calcium throughout childhood can allow
the potential to achieve optimal peak bone mass [3].
Although bone growth ceases around an individuals late teens and early twenties, it is
still necessary to continue consuming adequate calcium through the lifespan [3]. Consuming
enough calcium in adulthood can reduce the risk of fractures and slow bone loss, lowering the
risk of developing osteoporosis. Osteoporosis is a condition that occurs when the buildup of new
bone in the body cannot keep up the breakdown of old bone [4]. This process causes the bones to
become very weak and brittle, so brittle that it is not uncommon for a mild fall or normal
movement to fracture bone [5]. Osteoporosis fractures occur most commonly in the hip, wrist
and spine. Post-menopausal women are at the greatest risk for developing osteoporosis; however,
it can occur in all people. Adequate calcium intakes during youth will allow the body to reach
optimal bone mass, giving the skeletal system a good foundation for when the breakdown of old
bone begins to happen quicker than the building of new bone [3].
Nerve Function
The peripheral nervous system acts as the communicator between the central nervous
system and the rest of the body. The communication is referred to as nerve cell signaling [6].
Proper nerve cell signaling requires calcium. Neurons located in different body regions have
specialized ion channels to support the function that they need to serve. Voltage gated channels
open and close in response to changes in the membrane potential [6]. Calcium channels are
found in axon terminals and open to the arrival of an action potential. Calcium enters the cytosol
after the gates open and triggers the release of a neurotransmitter [6]. Also, it can determine the
rate of these nervous system processes based on the amount of calcium in the ion channels [6].
Without calcium, the nervous system would not be able to function properly, as calcium is a

Hahn, Reddmann, McNutt 3

necessary element for allowing the neurotransmitters to send nerve messages throughout the
body.
Visceral Fat Regulation
Studies show that calcium works in conjunction with vitamin D to help regulate body
weight in humans [7, 8]. As intakes of calcium increase, the loss of body fat increases because
calcium aids in the metabolism of calories [7]. Also, calcium in the body favors visceral fat
redistribution away from the abdomen [7]. Abdominal obesity causes many health issues,
including increased risk for cardiovascular disease, type 2 diabetes, and high blood lipid levels
[8]. Adequate calcium intake can help lower the risk of those chronic diseases by the regulation
and storage sites of body fat.
Cell Signaling
There are proteins in the body that bind to calcium ions in order to participate in calcium
cell signaling pathways. These proteins are referred to as calcium-binding proteins, and there are
many different types of these proteins, depending on the role that they need to take on in the
body [9]. Calcium-binding proteins are also found in organisms as small as yeast cells [10]. The
role and function of the calcium-binding proteins often depends on the region where they are
located [10]. For example, each part of the body serves a different function to maintain
homeostasis. Calcium aids in different parts of the body to help with the designated function
[10]. However, calcium-binding proteins are involved in almost every cell process, including
learning, memory, neuron transport, and homeostasis [10].
Muscle Contractions
Calcium plays a large role in the contractions and relaxations of muscles [11]. The
sarcoplasmic reticulum is a tube-like network that surrounds each myofilament in the muscles,
responsible for instructing the myofilaments to relax or contract. When the central nervous
system sends the impulse through the peripheral nervous system to make the muscles contract,
calcium channels in the muscle cells open [11]. The myofilaments become flooded with calcium
causing the myofilaments to change shape and shorten. The change of shape contracts the
muscles [11]. When the nervous system sends the impulse to relax the muscles, the calcium gates
close, and the calcium leaves the myofilaments and returns to the sarcoplasmic reticulum. As the

Hahn, Reddmann, McNutt 4

myofilaments lose the high levels of calcium, the muscle shape goes back to the relaxed state.
This process is called the calcium cycle [11]. Without proper amounts of calcium in the body, the
calcium cycle would not be able to contract and relax muscles normally.
Cardiovascular Health
Calcium is essential in heart health. Calcium and blood pressure have a negative inverse
relationship [12]. As calcium intake declines, blood pressure will raise. As calcium intake
increases, blood pressure will decrease. High blood pressure is very dangerous to the body and
considered to be stage 1 heart failure [12]. Prolonged high blood pressure can result in heart
attacks and aneurisms, a bulge in the wall of blood supply vessels [12].
Blood Clotting
The blood clotting process, known as the clotting cascade, begins when the skin becomes
broken [13]. In the clotting cascade, calcium and vitamin K work together with a protein,
fibrinogen. When a cut is exposed to air, the calcium, vitamin K, and fibrinogen mixture reacts
with the sticky platelets in the blood to form a clot, called fibrin. The fibrin builds upon itself and
hardens around the wound to form a scab and stop bleeding. Fibrin hardens extremely quickly in
an attempt to stop the bleeding as soon as possible [13]. Inadequate calcium levels in the blood
will make breaks in the skin take longer to clot and heal, possibly resulting in infection,
excessive blood loss, and even death.
Metabolic Pathways
The body is unable to synthesize calcium and needs to receive it through the diet [2].
Proper digestion, absorption and transportation of calcium is crucial to ensure that the nutrient
goes to every body process that it is needed in [14]. Every step of calcium digestion, absorption,
and transportation is necessary to maintaining body functions because the inability for the body
to make the calcium that it needs [2].
Digestion
The digestive process of calcium takes place in the stomach and is not especially
complex. When calcium is consumed from dietary supplementation or food, it is primarily in the
form of relatively insoluble salts [14]. In acidic conditions that are found in the stomach, calcium

Hahn, Reddmann, McNutt 5

from most calcium salts can be solubilized in approximately one hour [14]. Once calcium is
solubilized, it is present in the form of free calcium ions that are transferred to the small intestine
to be absorbed by the body [14].
Absorption
The process of the absorption of calcium by the body is rather complex and involves
many factors, such as Vitamin D and parathyroid hormone, that affect absorption [14]. Calcium
absorption occurs in the small intestine either by diffusion or active transport mediated by carrier
proteins [14]. The duodenum and proximal jejunum are the two sections of the small intestine
where the main transport system for calcium functions, a process that is regulated by the active
form of Vitamin D (calcitriol) [15]. The mechanism of the main transport system involves
transferring calcium to plasma by the lumen in the gastrointestinal tract, absorbing the calcium
and then transferring it across the brush border membrane and cytosol of the enterocyte to the
plasma [15]. The main transport system requires: a membrane channel protein called calcium
transporter 1(CaT1), an ATPase pump located on the luminal side of the enterocyte, and a
cytosolic binding protein called calbindin D9k, all of which are dependent on vitamin D [14].
The function of the calbindin D9k is to carry calcium across the cytosol of the cell [15].
The second transport system for the absorption of calcium, called paracellular diffusion,
occurs primarily in the jejunum and ileum of the small intestine, is passive, takes place between
cells instead of through them, and does not require carrier proteins [14]. The paracellular
diffusion process is mostly used when a gradient of calcium concentrations occurs between the
lumen and the luminal of the enterocyte due to elevated concentrations of calcium found in the
lumen [15]. Calcium absorption can then be facilitated using the junctions between cells created
by the reactions produced by increased intracellular concentrations of calcium ions [14].
Three relatively minor contributors to calcium absorption are transcaltachia, vesicular
transport, and the release of bound calcium from fermentable fibers by bacteria located in the
large intestine. The transcaltachia system is not well understood but is known to occur after the
active form of vitamin D binds to the luminal membrane of an enterocyte [14]. The vesicular
transport system consists of the transport of calcium across the brush border membranes of
intestinal cells where the calcium is then held in vesicles [14]. The release of calcium into the

Hahn, Reddmann, McNutt 6

cytosol of the cell is then facilitated by the combination of lysosomes with the vesicles where the
calcium is held [14].
When calcium is consumed through food, calcium ions are transferred across the brush
border membrane of the enterocyte using the channel TRPV6, transferred across the cytosol of
the enterocyte by binding to the carrier protein calbindin D, and then pumped across the luminal
membrane and into the blood by ATP-dependent pumps [14]. Using a form of passive diffusion,
some calcium ions are absorbed intracellularly when high calcium ion concentrations are present
in the lumen of the intestine [15]. Calcium can also bind to proteins or form complexes with
phosphate, citrate, or sulfate when it is pumped into organelles by calcium ATPases for later use
[14].
Many factors can affect the absorption of calcium by the body including sufficient
vitamin D, parathyroid hormone, phytic acid, oxalic acid, and medications that reduce the
production of acid in the stomach [16]. Vitamin D helps to increase calcium absorption because
many of the necessary components of carrier mediated active transport are dependent on
calcitriol, the active form of vitamin D [15]. Parathyroid hormone helps to increase calcium
absorption by promoting the production of calcitriol [14]. Both phytic and oxalic acid can inhibit
calcium absorption by binding to calcium and preventing it from being absorbed by the body
[16]. Medications that reduce the production of stomach acid can result in reduced calcium
absorption due to a lack of acid to solubilize the calcium during the digestion phase [16].
Transportation
The main mechanism by which calcium is transported throughout the body is in the
bloodstream [14]. When calcium is transported in the blood, it can be present in three ways,
including: free calcium ions; calcium bound to proteins, such as albumin; and lastly, calcium
combined with citrate, phosphate, or sulfate [14]. The main destination of calcium being
transported through the blood is bone matter, where the calcium can be stored if or until the
concentration of calcium in the blood becomes too low [17]. Calcium is able to enter the
bloodstream after release of calcium from the bones or kidneys and after absorption of calcium
from food by the cells of the intestine [17].
Excretion

Hahn, Reddmann, McNutt 7

The loss of calcium from the body mainly occurs in three ways: excretion through urine,
excretion through feces, and loss through sweat [14]. The amount of calcium excreted by the
body depends on calcium balance which includes the levels of calcium found in various parts of
the body, such as the intestines and kidneys [17]. The amount of calcium that is excreted through
the urine can be affected by many factors, such as caffeine and sodium, which cause an increase
in urinary calcium excretion [17]. The body is able to filter out calcium and use the kidneys to
reabsorb the recovered calcium passively through the proximal tube [17]. Once the calcium is
absorbed by the kidneys, it can be reintroduced into the blood stream and reused by the body
[14].
Daily Recommended Intake
The amount of calcium needed by the body varies with different stages of life [18]. In
order to help prevent calcium deficiency and therefore, improper functions in the body due to a
lack of the mineral, guidelines for daily calcium intake have been established. In older years of
life, it is important that women consume more calcium than men because women are postmenopausal. Women after menopause are at the greatest risk for developing osteoporosis and
loosing bone mass [4].
As shown in Table 1, the RDA ranges from 700-1300 mg/day [14]. Table 2 shows the UL
ranges from 1000-3000 mg/day [14].
Table 1. The recommended intake levels of calcium for different genders and ages.
Age (years)

Men

Women

1-8

700-1000 mg/day

700-1000 mg/day

9-50

1000-1300 mg/day

1000-1300 mg/day

51-70+

1000-1200 mg/day

1200 mg/day

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Table 2. The upper limit intake levels of calcium for different ages of both genders.
Age (years)

Men and Women

Infant, <1

1000-1500 mg/day

1-8

2500 mg/day

9-18

3000 mg/day

19-50

2500 mg/day

51+

2000 mg/day

Deficiencies
Hypocalcemia is the lack of sufficient calcium in the bloodstream to maintain all
processes [7]. Without appropriate levels of calcium, the body is unable to maintain strong bones
and teeth, contract and relax muscles, send impulses throughout the body via the nervous system,
and clot blood quickly enough. Not having enough calcium in the body is extremely dangerous
and can result in the destruction of many different systems.
However, the most widely known calcium malnourishment is osteoporosis. This is when
the bones of an older human start to soften and lose density due to decreased creation of new
bone while maintaining destruction of older bone, causing holes and breaks [19]. Bones affected
by osteoporosis are much more brittle and likely to be fractured by even simple and small
everyday movement. While this used to be a major concern only for women, more men are
affected by osteoporosis as they age, creating concern for elderly populations in general [19].
Scientific research links numerous vitamins and minerals to osteoporosis in addition to
calcium, including vitamin A, magnesium, and vitamin D [19]. In addition to all of these
vitamins and minerals, there is new evidence that suggests phosphorus is positively correlated to
bone mass when it is linked to calcium, however, not when phosphorus is taken on its own [19].
A study, by Lee et al [19], found that when only phosphorus was added to the diet of young
women and men, it decreased the bone density of the subjects; however, when calcium and
phosphorus were added together in one supplement, the bone density increased, resulting in a
decreased risk of osteoporosis in both men and women as the subjects grew older [19]. The

Hahn, Reddmann, McNutt 9

results were only positively correlated when the subjects were premenopausal women and men
under the age of fifty [19].
Another concern with the malnourishment of calcium is in newborns and fetuses. New
research suggests that when a pregnant woman does not receive adequate calcium throughout
their pregnancy, the child is born with higher risks of insulin resistance and higher chance of
developing cardiovascular diseases later in life [12]. This study also suggests that calcium must
be paired with magnesium during intake to increase calcium uptake by both the mother and the
fetus to help the childs cells become more metabolically active and reduce insulin resistant
tendencies by stimulating glucose intake of the developing cells in a fetus. While the reasons
behind this have yet to be discovered, and the severity of the increased risk is still unknown,
there has been a link established between the two diseases and the health of the mother during
pregnancy. This means that for pregnant women, it is important to maintain a balanced, healthy
diet in order to help their children as much as possible from in the womb, so they can be
healthier when they grow to be adults [20].
Toxicities
Although it is vital that there are adequate amounts of calcium in the blood to promote
the calcium cascade, too much calcium in the blood can be harmful and symptomatic of
something wrong in the body. When excessive calcium is in the body, it must be filtered out
through the urine [21]. Hypercalcemia results in kidney damage due to the kidneys having to
work more than usual to remove excess calcium, causing them to shut down [21]. This can also
cause the free calcium in the blood to enter soft tissues and form protective barriers around
bacteria in the body, causing irritation and plaque formation [21]. Barriers around bacteria in the
body is a main concern when too much calcium is taken in from calcium supplements with
calcium citrate and calcium [21]. It is important to note hypercalcemia is too much calcium
levels in the blood, or free calcium, not too much calcium in the body as a whole. Symptoms of
hypercalcemia include abdominal pain, vomiting, and constipation [21].
There are several reasons why a person may develop hypercalcemia. The most common
reason why calcium may build up in the blood is from hyperparathyroidism [22]. The role of the
parathyroid hormone is to increase the concentration of ionic calcium in the blood [22]. The
hormone triggers the release of calcium from the kidneys and the bones. An individual with

Hahn, Reddmann, McNutt 10

hyperparathyroidism may develop very brittle and frail bones, as it is continuously leached of its
calcium stores [22]. Additional reasons for hypercalcemia include dehydration, cancer, excessive
intake of calcium or vitamin D supplements, and it may be a side effect of certain medical
conditions [21]. Increased levels of calcium in the blood cause the kidneys to work harder to
filter out the calcium causing an individual with hypercalcemia to feel unquenchable thirst and
have frequent urination [21].
Inappropriately high levels of calcium in the blood interferes with every body system that
requires the presence of calcium [22]. People with hypercalcemia may feel muscle weakness
because of the disruption in the calcium cycle and muscle contractions [11]. Fatigue and
confusion are also a symptom because it interferes with the sending and receiving of
neurotransmitters. Lastly, stomach upset, constipation, nausea and vomiting are common in
individuals that have too much calcium in their blood [7].
Hypercalcemia can be caused by an intake of too much calcium through supplements and
medications, resulting in too much overall available calcium [21]. It can also be caused by
advanced cancer, resulting in bone wasting, allowing too much calcium to enter the blood from
the bones [2]. It usually occurs in end stage cancer patients, resulting in emergencies and can
lead to death in the patient. This can be difficult to identify because the symptoms of vomiting
and discomfort are also common due to chemotherapy, leaving it to be unnoticed until it is too
late to reverse the process. While these causes are significant and dangerous, the most common
way for hypercalcemia to occur is through thyroid malfunction, causing calcium to not be sent to
pathways, creating a calcium buildup in the blood that must be removed [21].
Food Sources
In the United States and other developed countries throughout the world, the majority of
daily calcium intake comes from milk and dairy products [23]. Dairy is a good source of
calcium because the caseins in milk work with other agents, such as citrate and polyphosphates,
to carry calcium into the products they make, allowing for increased calcium content [23]. Dairy
products include all cheeses, milks, yogurts, and ice creams, making the availability to the
general public in the United States vast. A breakdown of the specific calcium-carrying
capacities of different components of dairy products shows that pyrophosphates are capable of
carrying the most calcium [23]. The calcium-carrying capacity of phosphoserine and

Hahn, Reddmann, McNutt 11

caseinophosphopeptides is as much as 5700 times lower, making the pyrophosphate and similar
substances in dairy products, such as citrate and -casein, much higher in calcium content [23].
Plant sources for calcium include collard greens, broccoli, kale, and soy beans [24].
Vegetables are believed by some to be better sources of calcium because they are easier to digest
in human bodies, making it easier to get nutrients out of than dairy products [24]. These sources
are especially important for vegans because they do not consume dairy products, making it
difficult for them to ensure adequate intake of calcium and other essential nutrients for the diet.
Some types of fish are another great source of calcium. Fish that are consumed whole,
such as anchovies and sardines, and fish that have too many bones to completely remove before
consumption, such as salmon, are high in calcium due to the bones that are consumed [24].
These bones contain not only calcium, but many other minerals that are good for a healthy diet,
as well as oils and other nutrients [25].
Table 3. Calcium content of food sources [23, 24]
Food Source

Calcium Content

Milk, skim (1 cup)

302 mg

Cheese (1 oz.)

204 mg

Yogurt, non-fat (1 cup)

314 mg

Ice cream ( cup)

85 mg

Collard greens (1 cup)

83 mg

Broccoli (1 cup)

31 mg

Kale (1 cup)

101 mg

Cabbage (1 cup)

36 mg

Soy beans (1 cup)

140 mg

Salmon (3 oz.)

10 mg

While calcium can be taken into the body by food, there are also medications that can
help increase bone density in patients and maintain bone health in the younger population. One
medication currently being tested for such capabilities is Fingilmod (also known as FTY720), a
multiple sclerosis medication [26]. Doctors have discovered an increased bone density in

Hahn, Reddmann, McNutt 12

patients taking this medication, and it is currently being tested for possible use in increasing bone
density in younger populations by adding phosphorus to the current medication. If this
medication does what it is hoped to do by increasing bone densities, it will go a long way
towards preventing diseases, such as osteoporosis as the population ages into their sixties and
older [26].
Another source of calcium is calcium supplements. Many are made from calcium
carbonate and calcium citrate sources, such as seashells and chalk [26]. While these can be
useful for populations having difficulty obtaining enough calcium in their diet, such as those
with diseases and chronic deficiencies, they should not be taken if the person already receives
adequate calcium through daily intake because it can result in hypercalcemia and possible kidney
stones or damage [26].
Conclusion
Calcium is an extremely important nutrient in human bodies. It takes many roles in
ensuring that all body functions are properly working. It is involved in bone health, and
approximately 1% of calcium intake goes to maintaining cardiovascular health, nerve function,
cell signaling, blood clotting, and body fat distribution [2]. Without calcium, life would not be
able to be sustained, as the body cannot synthesize this mineral.
Proper intake of calcium is critical to avoid any deficiencies or toxicities. Guidelines of
how much calcium is appropriate for each age group and gender have been set in place to ensure
that all individuals are consuming the right amount to supply the body systems. Fortunately, in
the United States there are many sources of calcium that people have to choose from.

Hahn, Reddmann, McNutt 13

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