Role of Calcium in Bone metabolism & pathologies SEMINAR 2.pptx

Role of Calcium in Bone
metabolism & pathologies
associated with it's
disorders.
PRESENTED BY: DR. MANSI DHIRAN (MDS I).
DEPT. OF PROSTHODONTICS.

IMPORTANCE.
• As dentists, it is vital for us to have a complete understanding of the
general metabolism of calcium as it helps in the formation and
maintenance of the teeth and their supporting bony structure.
• For Example: Oral health maintenance for adults with osteoporosis is
important. Bone weakness and loss usually affects the ridges that
hold dentures resulting in ill-fitting dentures. These patients require
new dentures more often than those who have strong, healthy bones.
Dr. Kamalakanth Shenoy, Dr. Rajesh Shetty, Dr. Savita Dandakeri and Dr. Tehseen Zakir 2018 International journal of current research.

INTRODUCTION.
-Approximately 99% of the total body weight of calcium is present in the
skeleton.
-The remaining 1% is found in the cell membranes and extracellular fluid.
-It is this small percentage of calcium that is vital to all life processes. Most
of the body calcium is found in the osseous tissue in the form of
hydroxyapatite, an inorganic crystal made up of calcium and phosphorus.
Only minimal amount of calcium is present in the teeth.

DAILY REQUIREMENTS OF
CALCIUM.
Harinarayan, C & Joshi, Shashank. (2009). Vitamin D status in India-Its implications and Remedial Measures. The Journal of the Association
of Physicians of India. 57. 40-8.

DISTRIBUTION OF BODY
CALCIUM.
• Calcium is the most abundant mineral in the human
body.
• Normal Level of Plasma Calcium is 9-11 gm/dl.
• The average adult body contains in total approximately
1-1.5 kg, 99% in the skeleton in the form of calcium
phosphate salts, the remaining 1% is in the blood, body
fluids and soft tissues

FACTORS AFFECTING
ABSORBTION OF CALCIUM.
• Vitamin D: Calcitriol induces the synthesis of the
carrier protein (Calbindin) in the intestinal epithelial
cells.
• Parathyroid hormone: It increases calcium transport
from the intestinal cells.
• Acidity: It favours calcium absorption
• Phytic acid: It is present in cereals. It reduces uptake
of Calcium.
• Oxalates: Forms insoluble calcium oxalates; so
absorption is reduced.
• Phosphate: High phosphate content will cause
precipitation as calcium phosphate.

CALCIUM BALANCE.
• Dietary absorption is the only means of obtaining
calcium.

• The normal daily turnover of calcium is maintained by an
interplay of the following processes:
1) Absorption of ingested calcium.
2) Exchange of calcium between bone and ECF.
3) Secretion of calcium from ECF.
4) Excretion of calcium in the fecal matter and urine.
Calcium in the context of dietary sources and metabolism – Royal Society of
Chemistry, 2015, pp.3-20 DOI

1) ABSORPTION OF CALCIUM.
• Calcium absorption in the small intestine occurs by both
active & passive diffusion.
• Uptake of calcium by active transport predominates in:
Duodenum & Jejunum;
• Simple diffusion predominates in: Ileum.
• Most of the ingested calcium is normally eliminated in the
feces, although the kidneys have the capacity to excrete
large amounts by reducing tubular reabsorption of
calcium.

2) EXCHANGE OF CALCIUM BETWEEN
THE BONE AND ECF.
• The ECF contains 1000mg of calcium which is in dynamic
equilibrium with the calcium present in the bones.
• Two types of exchange occurs between ECF and bone:
• Rapid Exchange : occurs between the ECF and the smaller
1% of readily exchangeable pool of bone calcium. A large
amount of calcium (around 20,000mg) per day moves in
and out of this pool.
• Slow Exchange : occurs between the ECF and the larger
(99% of total bone content) pool of stable calcium. This
exchange is the one concerned with bone remodeling by
constant interplay of bone resorption and
deposition(around 50mg/day).

3) EXCRETION OF CALCIUM.
• The same amount of calcium as absorbed from the gut i.e.
about 350mg, must ultimately be excreted to maintain
balance.
• The Major site of Calcium excretion are Kidneys.
• Excretion of calcium occurs in fecal matter as well as urine.

Calcium in the context of dietary sources and metabolism – Royal Society of Chemistry, 2015, pp.3-20 DOI

FACTORS REGULATING SERUM
CALCIUM LEVEL.
1) Vitamin D:
• The active form of Vit D is
Dihydroxycholecalciferol or
Calcitriol.
• The Calcitriol includes a
carrier protein in the
intestinal mucosa which
increases the absorption of
calcium. Hence blood calcium
level tends to be elevated.

ACTIONS OF CALCITRIOL.
1. Action on Intestine : Helps in
calcium absorption.
2. Action on bone : Increases bone
mineralization.
3. Action on Kidney : Increases renal
absorption of calcium and
phosphate.
4. Other actions of Calcitriol :
Calcium transport into skeletal and
cardiac muscles.
• Stimulates differentiation of
keratinocytes and inhibits their
proliferation.
• Stimulates differentiation of
immune cells.
• Involved in regulation of
growth and production of
growth factors.

2) CALCITROPIC HORMONES-
PARATHYROID HORMONE(PTH).
Functional Anatomy of Parathyroid glands:
Two pairs of small endocrine glands attached to the
back of the thyroid gland measuring 6x4x2mm and
weighing about 140mg.
Histological structure : Two main types of cell are seen
a) Chief/Principle cells: secrete parathyroid
hormone/parathormone.
b) Oxyphilic cells: first appear at puberty and their
function is still not clear.
Parathormone(PTH):
Structure: Single chain polypeptide containing 84
amino acids
Synthesis: Synthesized from pre-cursor prepro-PTH
which has 115 amino acids
Secretion: Released from chief cells by exocytosis in
response to decreased plasma ionized calcium
concentration

REGULATION OF PTH SECRETION.
• ROLE OF PLASMA IONIZED
CALCIUM : PTH is inversely
related to Plasma ionized
Calcium.
• ROLE OF PLASMA
PHOSPHATE : Plasma
phosphate increase
causes decrease in
serum calcium which
in turn increases PTH
secretion
• ROLE OF VITAMIN D :
Decreases PTH secretion.
• ROLE OF SERUM MAGNESIUM
: High serum Mg acts on
CaR, VDR, FGF23 receptors
and causes decrease in PTH
production
• Phosphate metabolism is also
regulated by the Calcitropic hormones
to maintain it within a narrow range.
Phosphate has an inverse relationship
with calcium – with increased
excretion seen under the influence of

• Plasma Levels: of PTH is about 130pg/ml.
• Half life of PTH in plasma is 5 to 8 minutes.
• Degradation of PTH occurs rapidly in the peripheral
tissues.

ACTIONS OF PTH.
1) Action on bone : Stimulates calcium
and phosphorus resorption from bones
i.e. causes demineralization.
2) Action on Kidney : Increases calcium
reabsorption.
• Inhibits phosphate reabsorption in
the proximal tubule.
• Inhibits reabsorption of Na+ and
HCO3- thereby causing acidification.
• Stimulates reabsorption of Mg 2+ by
the renal tubules.
• Stimulates synthesis of 1,25-
dihydroxycholecalciferol.
3) Action on Intestine : Enhances both
calcium and phosphate absorption from
intestine by increasing synthesis of 1,25-
dihydroxycholecalciferol.

3) Calcitonin:
• It is secreted by the thyroid
parafollicular or clear cells ,
stimulated by serum
calcium.
• Calcitonin decreases serum
calcium level. It inhibits
Resorption of bone.
• It decreases the activity of
osteoclasts and increases
that of osteoblasts.
• Calcitonin and PTH are
directly antagonistic. The
PTH and calcitonin
together promote the bone
growth and remodeling.
https://healthjade.net/calcitonin/

THYROID AND PARATHYROID GLANDS FUNCTION
IN MAINTAINING CALCIUM BALANCE:

4) Cortisol:
• In adrenal insufficiency, there is volume depletion
and reduced cardiac contractility, resulting in
decreased glomerular filtration rate and reduction in
the amount of calcium filtered.
• Coupled with increased calcium and sodium
reabsorption at the proximal tubules, this results in
decrease in calcium clearance.
• In adrenal insufficiency, loss of inhibition of pituitary
TSH secretion by glucocorticoid may increase bone
Resorption and mobilize calcium from bone.

5) Estrogen:
Plays an important role in
helping increasing Calcium
Absorption.
• After Menopause,
Estrogen Level may Drop
And so does Calcium
Adsorption.
• Hormone Replacement
Therapy has been Shown
to increase the Production
of Vitamin D thus
increasing Calcium
Absorption.

Factors regulating serum calcium level.

CONDITIONS ARISING FROM
IRREGULARITIES IN CALCIUM
METABOLISM.
1) Hypercalcemia:
• The term denotes that the blood calcium level is
more than 12mg/dl.
• The major cause is hyperparathyroidism.
• There is osteoporosis and bone Resorption.
Pathological fracture of bones may result.

• Symptoms-
1) Tiredness.
2) Polyuria.
3) Loss of appetite.
4) Nausea, vomiting.
5) Constipation.-
6) Dehydration.
7) Loss of muscle tone. Decreased
excitability of muscles and
nerves.
• Conditions in which it
occurs-
- Hyperparathyroidism.
- Acute osteoporosis.
- Vit. D intoxication.
- Thyrotoxicosis.

• Evaluation:
Hypercalcemia can be classified into
1) Mild Hypercalcemia: 10.5 to 11.9 mg/dL .
2) Moderate Hypercalcemia: 12.0 to 13.9 mg/dL.
3) Hypercalecemic crisis: 14.0 to 16.0 mg/dL
Most cases of Hypercalcemia are detected on routine testing.
Work up for etiology includes obtaining serum PTH, calcitonin,
Vitamin D, ionized calcium, phosphorus, magnesium, alkaline
phosphatase levels, renal functions, and urinary calcium-
creatinine ratio.
Hyperparathyroidism is characterized by high calcium, high i-
PTH levels with low phosphorous levels.
Hypercalcemia ; Nazia M. Sadiq; Srividya Naganathan; Madhu Badireddy.
https://www.ncbi.nlm.nih.gov/books/NBK430714/

• Treatment:
• Required if the patient is symptomatic or if the calcium level is
more than 15 mg/dL, even in asymptomatic patients.
• Immediate therapy is w an infusion of 0.9% saline (restores
intravascular volume & promotes calcium excretion in the
urine)
• Hemodialysis is the treatment of choice to rapidly decrease
serum calcium in patients with heart failure or renal
insufficiency.
• Patients with hyperparathyroidism require surgical exploration
and removal of the source of increased PTH secretion.
• Bisphosphonates such as etidronate are the drugs of choice for
Hypercalcemia of malignancy as they inhibit osteoclastic
activity.
• Hypercalcemia associated with excess vitamin D can be
treated with steroids as they inhibit one alpha-hydroxylase
activity.

2) Hypocalcemia.
• When serum calcium level is
< 8.8 mg/dl, it is
Hypocalcemia.
• If it is < 7.5mg/dl, Tetany, a
life-threatening condition
will result causing
Carpopedal Spasm.
• This occurs in cases of :
• -Insufficient Ca in the diet.
• - Hypoparathyroidism.
• - Insufficient Vit. D in the
diet.
• -Increase in calcitonin levels.

• CLINICAL FEATURES:
• Short stature.
• Shortened metacarpal or metatarsal bones.
• Mental retardation.
• RADIOGRAPHIC FEATURES:
• Enamel hypoplasia
• External root resorption
• Delayed eruption
• Root dilacerations

Trousseau sign in Hypocalcemia:
Neurons are less Stable and more likely to Fire
Spontaneously leading to Tetany.

Chvostek-Weiss sign in Hypocalcemia.
• Abnormal Twitching of Facial
Muscles innervated by Facial
Nerve.
• When the facial nerve is
tapped in front of the ear, the
facial muscles on the same
side of the face will contract
sporadically.

ORAL MANIFESTATIONS.
• Delayed eruption,
• There may be multiple
unerupted teeth.
• Enamel hypoplasia & Dentin
dysplasia.
• Dryness of mucous membrane.
• Angular chelitis.
• Circumoral paresthesia.
• Root defects.
• Hypodontia and impacted teeth.
• Large pulp chambers in
deciduous and permanent
teeth.
• Thickening of lamina dura in
permanent teeth.

TREATMENT.
An intravenous injection of 20ml of 10% Calcium gluconate is
given to correct Hypocalcemia and relieve tetany.

• The Dental management :
• Prevention of caries with periodic check-up,
as pulp chambers are large, caries easily
involve the pulp causing pulpitis, requiring
endodontic treatment.
• Delayed eruption and hypodontia cause
malposition and has to be treated by
orthodontics.

RICKETS.
• Occurs in children between 6
months to 2 years of age.
• Affects long bones.
• Lack of calcium causes failure
of mineralization resulting into
formation of cartilaginous form
of bone.
• Most critical areas affected are
the centers of endochondral
ossification at epiphyseal
plates.
• TYPES OF RICKETS: 1) Nutritional
2) Vitamin D resistant.
3) Vitamin D dependent.
4) Oncogenous.
Rathee, Manu & Singla, Shefali & Tamrakar, Amit. (2013). Calcium and Oral Health: A Review. International Journal of Scientific
Research. 2. 10.15373/22778179/SEP2013/116.

• ORAL MANIFESTATIONS: 1) Developmental
anomalies of enamel and dentin.
2) Delayed eruption.
3) Malalignment of teeth.
4) High caries index.
5) Enamel hypoplasia.
• Hypocalcification of teeth and presence of large pulp
chambers.
• Loss of alveolar bone.
• Metaphyseal widening.

• MANAGEMENT: 1) Vitamin D : 0.5 to 1g/day for
children 2-4years.
• 1 to 4g/day for children >4years
2) Parenteral administration of Phosphate : 0.08mmol/kg body
weight over 6 hours
3) Early diagnosis and treatment prevents limb deformities
4) Corrective osteotomies for deformed limbs deferred until
radiologically healed rickets is noted and serum alkaline
phosphatase levels are normal.
• Dental management is by full mouth pulpectomies,
placement of posterior stainless steel crowns, and anterior
composite resin restorations.

OSTEOMALACIA.
• Adult counterpart of Rickets.
• Characterized by defective
mineralization of adult bones in
which epiphyseal growth plates
are already closed.
• These softer bones have a
normal amount of collagen
that gives the bones its
structure, but they are lacking
in calcium.
• The common oral
manifestation is in the form of
severe periodontitis.

• SYMPTOMS: Pain and chronic
fatigue.
• Muscle weakness.
• Waddling gait.
• Bones become soft, especially
involved are pelvic girdle, ribs
and femur.
• Pseudo fractures seen in flat
bones(ribs , scapula) and ends
of long bones(femur).
Pseudo fractures.
• Biconcave vertebral bodies.
• Femoral neck fractures.
• MANAGEMENT: Similar to that
of rickets.

• 3rd most common endocrinal
disease after diabetes and
thyroid disease.
• TYPES:
1) PRIMARY:
• Parathyroid adenoma.
• Parathyroid hyperplasia.
• Parathyroid carcinoma.
2) SECONDARY:
• Kidney Disease or Low
calcium Level.
• Vitamin D Deficiency.
3) TERTIARY:
• Autonomous nodule
hyperplasia.

• Oral manifestations: loss of bone
density, mobile teeth, drifting of teeth,
complaint of vague jaw bone pain,
sensitive teeth, soft tissue calcifications
and dental abnormalities such as
development defects, alterations in dental
eruption.
• Increased incidence of tori.
• According to Schour and Massler,
malocclusion caused by sudden drifting
with definite spacing may be one of the
first signs of the disease.
• BROWN TUMOR von Recklinghausen :
Diffuse and focal lesions in multiple
bones. These lesions are termed brown
tumors due to the presence of old
hemorrhage within the lesion giving it a
distinct brown color.
Vestergaard P, Thomsen Sv. Medical treatment of primary, secondary, and tertiary hyperparathyroidism. Curr Drug Saf. 2011 Apr;6(2):108-13. doi:
10.2174/157488611795684703. PMID: 21524244.

RADIOGRAPHIC FEATURES OF PRIMARY
HYPERPARATHYROIDISM
• Normal trabecular pattern is lost and replaced by granular
or ground glass appearance.
• Moth eaten appearance of jaw bone.
• Lamina Dura is diminished or completely absent in 10% of
cases.
Phore, Swati & Panchal, RahulSingh & Baghla, Pallavi & Nabi, Nuzhat. (2015). Dental radiographic signs. Indian
Journal of Health Sciences. 8. 85. 10.4103/2349-5006.174234.

TREATMENT OF HYPERPARATHYROIDISM.
• Watchful waiting : In case calcium levels are only
slightly elevated, kidneys are functioning normally
and bone density is normal.
• Surgery : Surgical removal of the problematic gland.
• Medications : These include Calcimimetics (tricks
parathyroid gland into thinking there is sufficient
amount of Calcium), Hormone replacement
therapy(post-menopausal women), Bisphosphonates.

OSTEOPOROSIS.
• Osteoporosis has been defined by WHO in 1994 as “a
disease characterized by low bone mass and
microarchitectural deterioration of bone tissue leading to
enlarged bone fragility and a consequent increase in fracture
risk”.
• It’s a disorder where the bone mineral density is 2.5
standard deviation below the mean peak value in young
adults.
Rani, Seema & Bandyopadhyay-Ghosh, Sanchita & Ghosh, Subrata & Liu, Guozhen. (2020). Advances in Sensing Technologies for Monitoring of Bone
Health. Biosensors. 10. 42. 10.3390/bios10040042.

OSTEOPOROSIS.
• Osteoporosis refers to lack of
bone density or poverty of bone
tissue.
• After the age of 40-45, calcium
absorption is reduced and
calcium excretion is increased,
so, there is a net negative
balance for calcium. This is
reflected in demineralization.
• After the age of 60, osteoporosis
is seen.
• Most prevalent metabolic bone
disease that is associated with
an increased risk for fractures.

OSTEOPOROSIS.
• Women above 50 years of age
have a 40% risk for these
fractures.
• Decreased absorption of
vitamin D and reduced levels of
androgens/ estrogens in old
age are the causative factors.
• Can be present without any
Symptoms for Decades
because it Doesn’t cause
symptoms until Bone
Fractures.

TYPES OF OSTEOPOROSIS.
Chitra, Vellapandian & Sukumaran, Evelyn. (2021). Diagnosis, Screening and Treatment of Osteoporosis –A Review. Biomedical and Pharmacology
Journal. 14. 567-575. 10.13005/bpj/2159.

OSTEOPOROSIS AND RESIDUAL
RIDGE RESORPTION.
• RRR after tooth loss is a well described biological reaction.
• A decrease in biomechanical loading on bone reduces the
stresses within the bone and results in Resorption within
the bone and its periosteal surface.
• The single case control study seems to indicate that the
bone mineral content status in the jaws is lower in patients
with symptomatic osteoporosis than in healthy age and
menopausal age-matched females and that osteoporosis
may produce a risk factor for severe resorption of the
maxillary residual ridge, while this relationship is not clear
cut in the mandible. (Habets LLMH et al., 1998).

BONE DENSITOMETRY TEST.
• A Bone Densitometry Test (DXA or DEXA scan) measures your
bone mineral density (BMD). Your bone density is then compared
to the average BMD of an adult of your sex and race at the age of
peak bone mass (approximately age 25 to 30). The result is your T
score.
• A T score of -1 to +1 is considered normal bone density.
• A T score of -1 to -2.5 indicates osteopenia (low bone density).
• A T score of -2.5 or lower is bone density low enough to be
categorized as osteoporosis.
opkinsmedicine.org/health/conditions-and-diseases/osteoporosis/osteoporosis-what-you-need-to-know-as-you-age#:~

TREATMENT:
• Increasing calcium intake by means of dairy foods &
supplementation is the most practiced method to optimize
calcium balance. . A supplementation of 750 to 1,000 mg per
day calcium and 375 IU vitamin D is suggested.
• Vit D is another widely used therapeutic adjunct because of
its important role in bone metabolism.
• The most widely prescribed osteoporosis medications are
bisphosphonates. Eg: Alendronate & Risedronate.
• Bone-building medicines like Teriparatide, Romosozumab
(Parathyroid Hormone Substitute).
• Estrogen therapy remains controversial because of
uncertainty about long-term benefits.

RECOMMENDATIONS RELEVANT TO THE
PREVENTION
& MANAGEMENT OF OSTEOPOROSIS.
• Maintain daily protein intake
levels of 50-60 grams to promote
a positive calcium balance.
• Maintain the RDA of 800mg of
calcium for men & non-
pregnant women.
• Participate in regular exercise
programs appropriate to age &
health status.
• Avoid risk factors related to
osteoporosis such as smoking,
excessive alcohol, & the generous
use of caffeine- containing
beverages.

Calcium/Phosphorus ratio of the
diet.
• Among the many recognized systemic influences calcium-phosphorus
imbalances have been specifically implicated as contributing factors in
the pathogenesis of alveolar bone destruction and osteoporosis.
• This ratio should be approximately 1: 1, but it is usually found to be
much greater. Excess intake of phosphorus in the diet causes secondary
hyperparathyroidism which in turn leads to more bone resorption.
• Wical and Swoope studied a group of edentulous patients and related
bone loss to calcium phosphorus ratios which showed that patients with
low calcium intake and calcium-phosphorus imbalances had severe
mandibular bone resorption.
Rathee, Manu & Singla, Shefali & Tamrakar, Amit.
(2013). Calcium and Oral Health: A Review.
International Journal of Scientific Research. 2.
10.15373/22778179/SEP2013/116.

Prosthodontic management of the
osteoporotic patient.
• Preservation of underlying tissue
structure should be attained with
proper design of complete
denture.
• While fabricating removable
dentures reduction of the forces
on residual ridge. Mucostatic or
open mouth impression. techniques,
selective pressure impression
technique reduce mechanical
forces while impression Making.
• Semi anatomic or non-anatomic
teeth with narrow buccolingual
width should be selected.
Bandela V, Munagapati B, Karnati RK, Venkata GR, Nidudhur SR. Osteoporosis: Its Prosthodontic Considerations - A Review. J Clin
Diagn Res. 2015 Dec;9(12):ZE01-4. doi: 10.7860/JCDR/2015/14275.6874. Epub 2015 Dec 1. PMID: 26816999; PMCID: PMC4717718.

• Optimal use of soft liners,
extended tissue intervals by
keeping the dentures out of
mouth for 10 hours a day
can be advised.
• While fabricating Fixed
partial denture in
periodontally compromised
abutments it may
accelerate the bone loss in
osteoporotic patients. So,
the fabrication of FPD
should follow treatment of
osteoporosis rather than
preceding it.
Bandela V, Munagapati B, Karnati RK, Venkata GR, Nidudhur SR. Osteoporosis: Its Prosthodontic Considerations - A Review. J Clin Diagn Res. 2015
Dec;9(12):ZE01-4. doi: 10.7860/JCDR/2015/14275.6874. Epub 2015 Dec 1. PMID: 26816999; PMCID: PMC4717718.

Implants:
• Implants placed in patients with
systemic osteoporosis did not
present higher failure rates than
those placed in patients without
osteoporosis. However there was
increased marginal bone loss than
those in control groups.
• Compromised bone strength affects
anchorage of implants and impaired
bone growth and late remodeling
could impair strength. Antiresorptive
agents(Bisphosphonates), Bone
forming agents(PTH Peptides), Dual
effect agents(Strontium ranelate),
Future anabolic agents present as
therapeutic options.

• Established systemic osteoporosis does not imply that a jaw
bone is unsuitable for osseous integration nor is it an
absolute contraindication to implant therapy.
• Dao et al., and Becker et al., in studying the association
between pre-menopausal and postmenopausal women and
implant failure, did not find a higher failure rate for implants
placed in women older than 50 as compared with women
younger than 50 or between women and men older than 50.
• Augat P et al., found more number of maxillary implant
failures than mandibular implants in post menopausal
women.
• Reduced bone density does effect the treatment planning
surgical approach, length of healing, necessitates need of
progressive bone loading and hydroxyapatite coating on
implants.
• Daily calcium uptake should be up to 1500 mg/day pre and
post surgically.

OSTEOPOROSIS AND IMPLANT
SUPPORTED OVERDENTURES:
• Over dentures supported by implants improve the
masticatory force, and thus the loading on the mandibular
bone compared to that of conventional full dentures.
• The mandibular osteoporosis prior to implant treatment
may present a risk for minor accentuation of Peri-implant
marginal bone loss but not implant failure within 5 years.
• The implant supported overdentures are the treatment of
choice after total tooth loss because of their bone sparing
effect and may also be recommended to persons with
osteoporosis.

ROLE OF CALCIUM IN THE ORAL
HEALTH OF GERIATRIC PATIENT.
• The calcium needs for older patients are less as than they
were in young age.
• For the individual geriatric new denture wearer each diet
prescription should be based on an analysis and evaluation
of his individual food habits and actual food intake.
• Also, the physical nature of the diet should be consistent
with the patient’s ability and experience to swallow, chew,
and bite with the dental prosthesis.

CALCIUM TOXICITY.
• If the calcium in diet and from supplements exceeds
the tolerable upper limit, you could increase your risk
of health problems, such as:
• Kidney stones.
• Prostate cancer.
• Constipation.
• Calcium buildup in your blood vessels.
• Impaired absorption of iron and zinc.

CONCLUSION.
• As a result of the essential role
played by calcium in intracellular
and extracellular metabolism, the
clinical manifestations of related
disease states are extensive.
• Thus an understanding of the
basic mechanism of calcium,
phosphate metabolism and
pathophysiology of various
related disorders is helpful in
guiding therapeutic decisions.
• The Prosthodontist, by identifying
the features would be at an
advantage enabling to refer
patient for bone density screenings
for early diagnosis and
subsequent treatment of disease.

REFERENCES.
• Essentials of human anatomy and physiology –Cummings.
• Textbook of Human Physiology – Indu Khurana.
• Bandela V, Munagapati B, Karnati RK, Venkata GR, Nidudhur SR. Osteoporosis: Its
Prosthodontic Considerations - A Review. J Clin Diagn Res. 2015 Dec;9(12):ZE01-4. doi:
10.7860/JCDR/2015/14275.6874. Epub 2015 Dec 1. PMID: 26816999; PMCID: PMC4717718
• Harinarayan, C & Joshi, Shashank. (2009). Vitamin D status in India-Its implications and
Remedial Measures. The Journal of the Association of Physicians of India. 57. 40-8.
• Dr. Kamalakanth Shenoy, Dr. Rajesh Shetty, Dr. Savita Dandakeri and Dr. Tehseen Zakir
2018 International journal of current research.
• Calcium in the context of dietary sources and metabolism – Royal Society of Chemistry,
2015, pp.3-20 DOI
• Hypercalcemia ; Nazia M. Sadiq; Srividya Naganathan; Madhu Badireddy.
ncbi.nlm.nih.gov/books/NBK430714/
• Rathee, Manu & Singla, Shefali & Tamrakar, Amit. (2013). Calcium and Oral Health: A
Review. International Journal of Scientific Research. 2. 10.15373/22778179/SEP2013/116.
• Vestergaard P, Thomsen Sv. Medical treatment of primary, secondary, and tertiary
hyperparathyroidism. Curr Drug Saf. 2011 Apr;6(2):108-13. doi:
10.2174/157488611795684703. PMID: 21524244.
• Phore, Swati & Panchal, RahulSingh & Baghla, Pallavi & Nabi, Nuzhat. (2015). Dental
radiographic signs. Indian Journal of Health Sciences. 8. 85. 10.4103/2349-5006.174234.
• Rani, Seema & Bandyopadhyay-Ghosh, Sanchita & Ghosh, Subrata & Liu, Guozhen. (2020).
Advances in Sensing Technologies for Monitoring of Bone Health. Biosensors. 10. 42.
10.3390/bios10040042.

Role of Calcium in Bone metabolism & pathologies SEMINAR 2.pptx

Role of Calcium in Bone metabolism & pathologies SEMINAR 2.pptx

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Role of Calcium in Bone metabolism & pathologies SEMINAR 2.pptx