Bone mineral homeostasis

Mr. Ujjal Bose

Lecturer
KMCIC
Calcium : 1-2kg
Phosphate: 1kg
Calcium: plasma Ca is regulated by PTH, Vit D,&
calcitonin
Uses: tetany
Osteoporosis
Dietary supplement
Parathyroid hormone:
Secretion regulated by plasma Ca levels
Regulates Ca and phosphate influx across cellular
membranes in bone & kidney
Actions:
Bone: increases bone resorption by increasing the no. &
activity of osteoclasts
Kidney: increases the reabsortion of Ca & reduces that of
phosphate
Stimulates the production of 1,25-dihydroxyvitamin D
Intestines: indirectly increases absorption of ca
Teriparatide: recombinant PTH
Clinical features of acute
Hypoparathyroidism
• Hypocalcemia
• Tetany
• Carpopedal spasm
• Laryngospasm
• Tingling of lips, hands,
muscles
• Convulsions
 Clinical features of chronic
Hypoparathyroidism
• Loss of hair
• Brittle finger nails
• Caries teeth
• Cataract
• Anxiety & Depression
Vitamin D
D3 - cholecalciferol
D2 – ergocalciferaol
Activation of Vit D: hydroxylated in the liver to 25-
hydroxyvitamin D → 1,25-dihydroxyvitamin D (calcitriol)
Actions:
Intestine: increases the absorption of Ca and PO4
Bone: increases Ca & PO4 resorption
Kidney: excretion of Ca & PO4 is decreased
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 Preparations of Vitamin D
• Ergocalciferol (Vit. D2):Oral capsules- 400 IU/day
for prevention of rickets in children and
osteomalacia in adults.
• Cholecalciferol (Vit D3): oral and IM injection
Prodrugs, orally effective and are rapidly
biotransformed into calcitriol in the liver.
They are effective in renal bone disease and
hypoparathyroidism
• Calcitriol: oral capsules and solution Alfacalcidol
Dihydrotachysterol
• Calcipotriol: Vit D analogue used topically in
psoriasis.
Uses:
Prophylaxis & treatment of Vit D deficiency
Rickets:
Vit D resistant rickets
Vit D dependent rickets
Renal rickets
hypoparathyroidism
Calcitonin:
Secreted by parafollicular ‘C’ cells of thyroid
Regulated by plasma Ca levels
Actions:
bone: inhibits osteoclastic bone resorption
Kidney: Inhibits reabsortion of Ca & PO4
Bisphosphonates: etidronate, pamidronate, alendronate,
risendronate
Mechanism: retard formation and dissolution of
hydroxyapatite crystals
Localize to regions of osteoclasts
block farnesyl pyroposphate
Use: osteoporosis
Paget’s disease
Hypercalcemia of malignancy
Osteoclastic bone metastasis
Adverse effects: gastric irritation
Calcimimetics:
Cinacalcet: activates calcium sensing
receptor on parathyroid gland
Blocks PTH secretion
Use: secondary hyperparathyroidism in
chronic kidney disease
Parathyroid carcinoma
Plicamycin: cytotoxic antibiotic
Use: hypercalcemia
Paget’s disease