Calcium

Hertanto W Subagio

Overview
The most abundant mineral in the body The fifth most abundant elemen in the body 99% in the bones and teeth - as an integral part of bone structure - as a Ca bank

Physiological function
Structural component of bones and teeth - hydroxyapatite - will maintain calcemia at bones expense Role in biochemical reactions - muscle contraction - blood clotting - enzymes and hormones activation - transmission of nerve impulses

Sources
Milk and milk product Sardines Oysters Cauliflowers Brocolli Legumes Dried fruits Ca carbonate (40%) Ca citrate ( 21%) Ca phosphate (8%)

Bioavailability of Ca from selected foods

> 50% absorbed
cauliflower, broccoli, ca-fortified foods and beverages

30% absorbed
milk, Ca-fortified soy milk, cheese, yogurt

20% absorbed
almonds, sesame seeds, beans

< 5 % absorbed
spinach

Also depends on the mixture of the foods

Absorption
Occurs primarily in the upper part of the small intestine because Ca requires a pH < 6 to stay in solution in an ionic state. Depends on the active vit D. Human absorb about 25% ca in the food, however, when the body needs extra Ca absorption might reach as high as 60%. Older people < young people

Ca absorption
Enhancer - Stomach acid - Vit D (helps to make Ca binding protein) - Lactose - Growth hormones Inhibitor - high P intakes - high fiber diet ( phytate, oxalate)

Transport, Storage, and Excretion

Each cell has a critical need for calcium, obtaining it from the blood stream. This critical need is probably the reason humans have such excellent hormonal systems to control blood calcium. Normal blood Ca can be maintained despite an inadequate Ca intake, as much is stored in in bones. Blood Ca is a poor measure in Ca status.

Ca Homeostatis

Ca Homeostasis

Functions of Calcium
Bone development and maintenance Blood clotting Transmission of nerve impulses Muscle contraction Cell metabolism

Bone development and maintenance

Bone contain osteoblasts and osteoclasts Osteoblast secrete a collagen matrix, which form the support structures of the bone. They mature osteocytes and then secrete bone mineral, which cause bone mineralization. Osteoclast continually break down bone in areas where bone is not needed. Bone turnover (bone remodelling) represent a cycle of bone breadown by osteoclasts, followed by bone rebuilding by osteoblasts. More bone being build in areas put under high stress. Most bone is built from infancy through the late adolescent Bone loss begins in mid adulthood and increases significantly at menopause in women. In men bone loss is slow and steady from around age 30.

Promotion and Prevention of bone resorption

Ca in bones
Ca salts form crystals (hydroxyapatite) on a matrix of the collagen During mineralization give strength and rigidity to the maturing bones Types : cortical and trabecular (spongy) bones Bones are gaining and losing minerals continuously in an ongoing process of remodelling. Turnover in teeth is not as rapid as in bone

Cortical and trabecular bone

Blood clotting
Ca ions participate in in several reactions in the cascade that leads to the formation of fibrin, the main protein component of blood clot. For example in the conversion of prothrombin to thrombin.

Mechanism of Blood clotting

Transmission of nerve impulse

When a nerve impulse reaches its target site , the impulse is transmitted across the junction between the nerve and its target cell, called synapse The arrival of the impulse at the target site stimulates an influx of Ca ions into the nerve from the extracellular medium. The rise in intracellular Ca ions then triggers the release of neurotransmitters from synaptic vesicles, which are responsible for storing the neurotransmitter until needed. The released neurotransmitter then carries the impulse across the synapse to the target cells.

The release of a neurotransmitter

Nerve impulses, by opening Ca 2+ channels Stimulate the fusion of synaptic vesicles containing neurotransmitters with the cell membrane of the nerve terminals This leads to exocytosis and the release of a neurotransmitter that will bind to and stimulates the postsynaptic membrane of nearby cells

Muscle contraction
When a skeletal muscle is stimulated by a nerve impulse from the brain, Ca ions are released from intracellular stores within the muscle cells. The increased Ca ions permits the contractile proteins to slide along each other, leads to muscle contraction. To allow for subsequent relaxation, Ca ions are returned to intracellular stores, and the contractile proteins slide appart.

Mechanism of muscle contraction

Ca in cell metabolism
Ca ions help regulate metabolism in the cell by participating in the calmodulin system. When Ca enters a cell and binds to the protein calmodulin, the resulting protein-calcium complex can regulate the activity of various enzymes, including one that breaks down glycogen to many units of glucose 1-phosphate.

Hypercalcemia
Hypertension Anemia Neurological disturbance Urolithiasis Calcification of other tissues Increased HCl secretion peptic ulcer

Hypocalcemia
Increased in membrane excitability ( hypocalcemic tetany). Cardiac depression - hypototension - bradycardia - heart block

osteoporosis

Ca loss is the effect, not the cause

Osteoporosis: Definition
A skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture.
Normal Bone Osteoporotic Bone

Osteoporosis Prevention, Diagnosis, and Therapy. NIH Consensus Statement 2000 March 27-29; 17(1): 1-36. Dempster, DW, et al., JBMR 2000; 15 (1): 20.

World Health Organization (WHO) Osteoporosis Guidelines

T-Score
WHO, Guidelines for Preclinical Evaluation and Clinical Trials in Osteoporosis, 1998.

Established Risk Factors for Osteoporosis

Genetic
Female White or Asian races Thin or low peak bone mass Family history of fractures

Lifestyle
Smoking Excessive alcohol use Lack of exercise

Medical
Menopause Menstrual dysfunction or early menopause Glucocorticoid, thyroid use

Nutritional
Low calcium Vitamin D deficiency Vitamin A excess