KULLIYYAH OF MEDICINE & HEALTH SCIENCES

Department of Biochemistry
Lecturer : Dr.B.Raghu

I MBBS Sem II

Bone

metabolism
Objective : by the end of the lecture,student should be
able to:
Describe the factors involved in calcium homeostasis
Describe the causes , symptoms of hypo and
hypercalcemia
Describe the metabolic bone diseases.

Both BONE FORMATION( by osteoblasts) AND

BONE RESORPTION (by osteoclasts) collectively
known as Bone metabolism helps in the
replacement of bone during fracture.
REGULATION OF BONE METABOLISM

Calcium is the main component of our

Actively absorbed from the upper small

intestines.
Vitamin D 1.enhances the absorption of
calcium from intestines ,2. calcium
reabsorption from kidney and 3.
stimulating resorption of bone when
necessary.
Plasma contains 9 11 mg/100ml .
Parathyroid hormone (PTH) regulates the
blood Calcium level by dual action
- mobilises calcium from bones
- simultaneously,it lowers the plasma
phosphate
concentration by decreasing the

Growth Hormone: GH directly and through

IGF-I (insulin like growth Factor) stimulates
osteoblast proliferation and activity,
promoting bone formation.
Thyroid hormone: necessary for bone growth
and maintenance of bone mass.
Hypothyroidism in children causes dwarfism
and hyperthyroidism causes secondary
osteoporosis in adults.
Sex hormones: lack of these hormones in
hypogonadism causes osteoporosis.
Postmenopausal osteoporosis starts with a
decrease in estrogen concentrations.

Response to
low plasma
calcium.

Actions of vitamin D on calcium metabolism(Calcitonin, a

thyroid hormone, decreases blood calcium by inhibiting mobilization from

Hyperparathyroidism: increased PTH caused by

tumours of parathyroids. This is accompanied
by
- hypercalcemia(12 24 mg/100ml).
- corresponding decrease in serum
phosphate level.
- increased urinary excretion of calcium
and
phosphorus.
Hypoparathyroidism: caused by surgical
removal of parathyroids. This is accompanied
by
- hypocalcemia( < 7 mg/100ml).
- corresponding increase in serum

DISORDERS OF BONE METABOLISM

Osteoporosis (porous bones)
Primary osteoporosis characterized by low bone
mass leading to enhanced bone fragility and
increase in fracture risk. Due to:
Decrease in estrogen and androgen
concentrations
Reduced physical activity
Insufficient vitamin D and calcium intake
Reduced UV exposure
Reduced renal function
Secondary osteoporosis may be caused by a
number of diseases, for example:
Hypercortisolism
Hyperparathyreoidism
Hyperthyrodism

Rickets:deficiency of Vitamin D in children

causes impairement of intestinal absorption of
calcium and phosphorus leading to defective
calcification of bones. The following changes are
noted.
- normal or slightly lower serum calcium
- low serum phosphate level
- increased serum alkaline phosphatase
Osteomalacia:Vitamin D deficiency in adults
causes demineralization of bone results in loss of
bone mass.
Paget's diesease of bone: genetic or viral
infection(measles) leads to disorganized bone
turnover results in structurally disorganized bone