METABOLISME CALCIUM

KASUS
Seorang anak laki laki umur 10 tahun mengalami gangguan berjalan karena kaki berbentuk o Seorang wanita umur 70 tahun kalau beerdiri membongkok, sudah beberapa kali minum susu taetapi tidak bisa pulih Seorang pembalap motor terjatuh dan mengalami patah tulang tibia, setelah sembuh kaki yang patah menjadi lebih pendek

OSTEOPOROSIS ?

PARATIROID [PTH]

CALCITONIN &
VITAMIN D

Parathyroids Gland

Peran PTH
Hemostasis Stabilisasi membran sel Ekskresi, sekresi/release neurotransmiter Kontraksi otot Formation of bone & teeth

DISTRIBUTION
Sceletal storage [90%] Plasma [1%] : 45% free, 55% bounded Free plasma Ca PTH, CALCITONIN, VIT D Ca pools stable [mature] bone & -labile [young] bone Labile bone : mudah dibongkar/resorbsi

BONE CHEMISTRY
HYDROXYAPATITE

FLUOROAPATITE

Ca. REGULATION
Three tissues : bone, intestine, kidney Three hormons : PTH, calcitonin, vit. D Three cells : osteocytes, osteoblasts, osteoclasts

Hormons Controle of Ca Metabolism

PTH : amino acid [by Chief cells] : hypercalcemic hormone Calcitonin : amono acid [by parafollicular cells/C cells]: hypocalcemic hormone

Vit D/cholecalciferol : steroid hormone; absorbtion Ca & Po4 increased

CELLULARE ASPECTS of BONE METABOLISM

OSTEOCLAST - bone resorbtion - contain acid phosphatase - stimulated by PTH - derived from circulating monocytes OSTEOCYTES : bone matric OSTEOBLAST - bone formating cells - synthesize & secrete collagene - contain allanine phosphatase

PHYSIOLOGIC ACTIONS of PTH [LOW LEVEL of PLASMA Ca]

INCREASED:
- BONE RESORBTION - ABSORBTION Ca & PO4 [GUT] - Ca REABSORBTION [KIDNEY] - PO4 EXCRETION [KIDNEY]

Physiolocic action of PTH

Bone : osteolytic activity Gut : PTH & Calcitriol sinergistically abs. Ca and Po4 Kidney : Ca reabs & PO4 excretion

Struktur dan Sintesis Vit D (Cholecalciferol)

Penyakit Akibat kekurangan & kehilangan Vit D

Rakitis (Rickets) terjadi pada anak def vit D, Kurang sinar matahari, obat antikonvulsi Osteomalasia : usia dewasa Juga pada perokok, alkoholik, PPOM Osteoporosis

Rickets and osteomalacia

Abnormalitas in the metabolism of bone Mineralisazion of bone matrix is deficient The bone to be soft and easily fractured A major of cause is deficienci of 1,25 (OH) D3

osteoporosis
Both bone matrix and minerals are lost Imbalnce between resorption and formation Decrease in bone mass and strength Incidence of fracture is increased Disuse osteoporosis (immobilized) Incresed bone resorbtion Decresed bone formation Relted agging Prevention with estrogen replecement therapy

Summary effects of PTH

Hypercalcemia hypophosphatemia Hypocalciuria Hyperphosphaturia

FUNGSI TULANG
Menjaga badan tetap tegak Sebagai alat gerak (bersama dg otot) Melindungi organ2(visceral) Tempat penyimpanan mineral tubuh : kalsium, fospat, dll Produksi sel sel darah

Hormon2 yang mengatur pembentukan tulang

Formation and incieased bone mass 1. Insulin 2. Growth hormone 3. IGF-1 4. Estrogen 5. 1,25 dihydroxyvitamin D3 6. Calcitonin Resorbtion and decreased bone mass 1. PTH 2. Cortisol 3. Thyroid hormone