CALCIUM METABOLISM

CONTENTS
INTRODUCTION
ROLE OF CALCIUM

- HEMOSTASIS

- IN DIGESTION
- IN NEUROLOGIC AND MUSCULAR
FUNCTION
ABSORPTION, DISTRIBUTION AND EXCRETION

METABOLISM

-INTRODUCTION
-HORMONES REGULATING
--PARATHYROID
--VITAMIN D
--CALCITONIN

-CALCIUM IN OSSIFICATION
-CALCIUM FOR GROWTH
-CALCIUM LOSS
--AGE AND GENDER RELATED CHANGES

-CALCIUM DURING PREGNANCY AND LACTATION

CALCIUM AND DENTAL HEALTH

CALCIUM RELATED DISORDER

- OSTEOPOROSIS
-HYPERCALCEMIA AND HYPOCALCEMIA
-RICKETS
-STONE FORMATION
DIAGNOSTICS FOR DEFICIENCY
CALCIUM IN DIET

-DIETORY FACTORS AFFECTING

-SOURCES
-PATIENTS AND CALCIUM

SUMMARY
CONCLUSION
BIBLIOGRAPHY
4

INTRODUCTION
Calcium is an important component of a healthy diet and

a mineral necessary for life. The national osteoporosis

foundation says, "Calcium plays an important role in
building stronger, denser bones early in life and keeping
bones strong and healthy later in life."
It is an important element given atomic number 20 and
symbol Ca.
Approximately 99 percent of the body's calcium is stored
in the bones and teeth. The rest of the calcium in the body
has other important uses.
5

Calcium deposition varies according to age, diet ,according to

different gender(male and female), and according ethnicity and

racial differences.

Black adolescents have higher calcium retention than white

adolescents across a wide range of calcium intakes, which
contributes to their higher peak bone mass. Both black and
white adolescents retain less calcium on high-salt diets, but the
effect is more detrimental to bone in white adolescents

ROLE OF CALCIUM IN PHYSIOLOGICAL

PROCESSES
1. Hemostasis Ca is necessary for the activation of

2.
3.
4.
5.

clotting enzyme in the plasma as well as the enzymes

involved in producing inflammatory response.
Ca controls membranes excitation and Ca influx occurs
during the excitatory process of nerve and muscle.
Ca is bound to cell surface and has a role in stabilization
of the membrane and the intercellular adhesion.
Ca is necessary for muscular contraction.
Ca is essential in all excitation secretion processes, also
important for neurotransmitter release.
7

HEMOSTATSIS
Calcium is essential for blood coagulation (clotting), a process

that involves two pathways: the intrinsic pathway and the

extrinsic pathway.
Calcium plays a role in both pathways. The process of clot
formation involves a
cascade of proteolytic reactions, whereby inactive enzymes or
clotting factors are activated.
Calcium is required for the activation of factor X within the
intrinsic pathway .

ROLE IN DIGESTION
Calcium is required for the optimal activity of several

extracellular digestive enzymes, including proteases,

phospholipases and nucleases.
Along the length of the gastrointestinal tract a calcium ion
sensing receptor is expressed, and it is thought that the
expression of this receptor plays a role in gastric acid
secretion.

ROLE IN NEUROLOGIC AND MUSCULAR

FUNCTION.
Calcium plays an important role in provoking

neurotransmitter release from nerve cells and in muscle

contraction.
Both nerve and muscle cells are electrically excitable and
their cell membranes contain calcium selective ion
channels.
Calcium plays an integral role in skeletal, heart and
smooth muscle contraction, controlling the interaction of
thick and thin filaments in muscle fibres.
10

DISTRIBUTION , ABSORPTION, AND EXCRETION

1. Total body calcium is approx 1100-1200 gms-

More than 99 percent is in the skeleton

4-5gms in soft tissues, 1 gm in ecf.
2. Normal serum Ca is 9-11 mg%.
3. Plasma calcium is diffusible and non diffusible.
It is absorbed largely in the duodenum, jejenum, and
also from ileum.
In the intestine daily dietry Ca intake of 1000mg is
supplemented by 600 mg of Ca which enters the gut.
11

ABSORPTIONUsually between 20 and 30% of calcium consumed in the diet is

absorbed in the gastrointestinal tract (individual variability

ranges between 10 and 50%), although fractional absorption
increases during growth, pregnancy and lactation. Calcium that
is not absorbed is excreted in faeces.
Calcium is absorbed predominantly in the small intestine where
conditions are acidic, and to a lesser extent in the colon.
Calcium must be present in a suitable form before it can be
taken up by the intestinal mucosal cells. Most calcium present in
foods is in the form of complexes with other dietary
constituents.

12

13

EXCRETIONMost calcium is excreted in urine and faeces, although

small losses do occur through hair, skin and sweat.

Calcium, previously absorbed from the diet re-enters
the gastrointestinal tract via secretions from the
pancreas, bile and saliva.
Sodium intake is positively associated with urinary
calcium excretion

14

15

16

CALCIUM METABOLISM
Plasma concentrations of ionised calcium are tightly regulated between 1.1 and 1.3

mmol/L.
Calcium homeostasis occurs at three main sites: the kidneys, bone and
gastrointestinal tract.
Calcium homeostasis at these three sites is controlled, directly or indirectly by PTH,
which is secreted by the parathyroid gland. PTH is one of three major calciotropic
hormones involved in calcium homeostasis.
There are four major ways in which PTH regulates plasma calcium concentration.
Within the kidney, PTH acts to increase calcium reabsorption and,
therefore,decrease urinary excretion.

17

18

HORMONES REGULATING CALCIUM

METABOLISM
Calcium concentration in the body fluids and in cells is
maintained within narrow limits by the activity of 3
hormones- vitamin D, parathyroid hormone and
calcitonin.

19

Parathyroid hormone

(PTH), or

parathormone, is secreted by the

parathyroid glands as a polypeptide
containing 84 amino acids. It acts to
increase the concentration of calcium
(Ca2+) in the blood.
When large quantites of PTH are injected,
the calcium ion concentration in the blood
begins to rise within minutes.

20

Calcitonin (a hormone produced by the

parafollicular cells (C cells) of the thyroid
gland) acts to decrease calcium
concentration.
In many ways, calcitonin has the counter effects of
parathyroid hormone (PTH), to be specific, calcitonin
reduces blood Ca2+ levels in three ways:
Decreasing Ca2+ absorption by the intestines
Decreasing osteoclast activity in bones
Decreasing Ca2+ and phosphate reabsorption by the
kidney tubules
21

VITAMIN DIt helps intestinal absorption of calcium.

It does this by increasing calcium binding

protein in the intestinal protein in the

intestinal epithelial cells.
The rate of calcium absorption is directly
propotional to the quantity of this calcium
binding protein.
This protein remain in cells for several weeks
causing a prolonged effect on calcium
absorption.

22

BONE FORMATION Ossification (or osteogenesis) is the process of formation of new bone by

cells called osteoblasts. These cells and the bone matrix are the two most
crucial elements involved in the formation of bone. This process of
formation of normal healthy bone is carried out by two important processes,
namely:
1. Intramembranous ossification
2.Endochondral ossification

23

INTRAMEMBRANOUS OSSIFICATION The steps in intramembranous ossification

1. Formation of ossification center
2. Calcification
3. Formation of trabeculae.
4. Development of periosteum.

24

ENDOCHONDRAL OSSIFICATIONThe steps in endochondral ossification

1. Development of cartilage model
2. Growth of cartilage model
3. Development of the primary ossification center
4. Development of the secondary ossification center
5. Formation of articular cartilage and epiphyseal plate.

25

CALCIUM ROLE IN OSSIFICATIONSecretion of collagen and ground substance by

osteoblast.
Collagen monomers polymerize rapidly to
form collagen fibers , the resultant is osteoid.
Calcium salts begin to precipitate on the
surface of collagen fibers.
The initial calcium salts to be deposited are
not hydroxypatite but amorphous compounds.
Then by substitution ,addition and
reabsorption these salts get converted to into
hydroxpatite crystals.
26

CALCIUM FOR GROWTH AND AGE RELATED

CHANGES
During infancy and childhood, physical growth
occurs stature is progressively and permanently
increased at varying rates until the adult state is
achieved.
The maximal growth rate for length is encountered
soon after birth, when body mass is least.

27

 Between birth and maturity, the total calcium in the body of

a well-nourished individual increases from 2030 g (Koo.

1999; Abrams 2001) to about 1200g.
During periods of rapid growth in stature, the calcium
deposited in the skeleton is greater than when growth
proceeds more slowly.
Approximately 80% of the calcium present in bone at birth is
deposited within the bone matrix during the third trimester
of pregnancy. Calcium transfer across the placenta requires
adequate maternal calcitriol.
It is estimated that calcium accretion averages 200 mg/day
during the the last trimester of gestation. Catch-up
mineralisation occurs up until 2550 weeks after full-term.

28

LOSS OF CALCIUM
Even in healthy young adults, net loss of calcium from bone

will eventually arise if the output from the body regularly

exceeds the net absorption from the intestine.
The main routes of loss of calcium from the body are via the
faeces and urine and, in a pregnant or lactating woman, the
developing fetus and breast milk, respectively.
Calcium is lost from bones when there is complete physical
inactivity; bone mass is rapidly reduced.
Similar calcium losses occur in those who are immobilised
because of denervation.

29

Calcium loss from bone may also occur as a result

of extreme exercise.
In some female athletes, intensive exercise may
result in oestrogen deficiency and amenorrhoea
(absence of menstruation), which has been shown
to be associated with osteopenia (reduced bone
mass, reduced calcification and/or reduced bone
density).
Oestrogen inhibits bone resorption, although it is
believed that this is not the primary reason for the
osteopenia observed in some female athletes.
Poor nutritional status and low energy intakes
have also been implicated
30

PREGNANCY AND LACTATION

Calcium demands on the mother are high during the latter stages of

pregnancy and during lactation. The skeleton of full-term infants contains

2030 g of calcium, most of which is accrued during the last trimester of
gestation.
In order to meet the calcium requirements of the developing fetus,
physiological adaptations occur in the mother. Fractional calcium
absorption is increased from 2030% to up to 60% during the last trimester;
this increase is associated with an increased plasma concentration of
calcitriol, suggesting vitamin D plays a role.
The measurement of markers of bone resorption and formation during
pregnancy suggests that maternal bone turnover is increased during
pregnancy.

31

FACTORS AFFECTING AGE REALTED LOSS

A large number of factors influence age-related loss.
Gender is one such factor; women lose more bone than

men, especially around the time of the menopause, when

loss of both trabecular and compact bone is accelerated due
to a reduction in oestrogen production. Losses can be
prevented or modified by oestrogen replacement therapy if
given at the appropriate time.
In men, the loss of bone mineral is associated with an agerelated decline in gonadal function.
Genetic factors influence too.

32

33

Absorption of calcium is greater during

adolescence than in childhood and adulthood, due

to hormonal changes
The amount of bone accumulated by the time of
bone maturity varies among individuals and is
governed by genetic and environmental forces.
Bone and calcium losses occur at a steady rate
until the onset of the menopause in women, when
loss is accelerated for a period of approximately
510 years.

34

CALCIUM AND DENTAL HEALTH

Teeth consist of three types of hard tissue: enamel, dentine

and cementum. As with bone, dentine and enamel are

composed of calcium and phosphate in the form of
hydroxypatite.
Calcium helps to maintain the mineral composition of teeth,
which are subject to both demineralisation and
remineralisation dependent on a number of dietary factors
and the pH of the oral environment.
The concentration of calcium in plaque influence
demineralisation of tooth enamel. Also, the greater the
concentration of calcium in plaque, the greater the fall in pH
that can be tolerated before demineralisation occurs.

35

36

OSTEOPOROSIS
Defined it as a systemic skeletal disease characterized by low bone mass

and microarchitectural deterioration of bone tissue leading to increased

bone fragility and a consequent increase in risk fracture.
Post menopausal and women with menstrual irregularity are most
commonly affected.
Excessive bone loss occurs with women who have insufficient levels of
oestrogen.
Patients with oesteoporosis present history of aches and pains.
Women are more susceptible than men and have accelerated bone loss
spread over a number of years after menopause.

37

 Osteoporosis affects millions of people around the world; the WHO cites

osteoporosis as the second leading healthcare problem (after cardiovascular

disease) in the world .
The incidence of fracture increases with age; nearly 50% of hip fractures
occur in individuals over the age of 80 years.
The incidence also varies with ethnicity, being much less
common amongst African-Caribbean populations.
BMD in older adults predicts future risk of fracture. The risk
of fracture is significantly lower in men than women at any
given age, with fracture risk in men lagging 5 years behind
women .

38

 Primary osteoporosis includes postmenopausal and age-related

forms and so-called idiopathic osteoporosis of premenopausal

women and young or middle-aged men.
Secondary osteoporosis arises in response to an identifiable
catalyst, i.e. it is secondary to an underlying condition or
therapeutic treatment .
PRIMARY In primary osteoporosis, when the amount of bone falls below a
critical level (the fracture threshold), bones become vulnerable
to fracture and break in the face of forces they would normally
withstand.
Primary osteoporosis can be classified as type I (early onset or
postmenopausal osteoporosis) or type II (senile osteoporosis).
Individuals with type I osteoporosis have less trabecular bone
than is normal for their age, and appear to lose bone at an
accelerated rate. Individuals with type II osteoporosis are
generally older and experience reductions in the amounts of
trabecular and compact
39

40

Vertebral fractures occur in both type I and type II

osteoporosis: typically crush fractures are

associated with type I osteoporosis and wedge
deformities of the vertebrae with type II
osteoporosis.
Both type I and type II osteoporosis occur through
an imbalance between total skeletal bone
formation and bone resorption which is sustained
over many years.

41

Bone loss and calcium supplementation

in postmenopausal womenBone loss is most rapid during the first 510 years

following the menopause as a result of reduced

circulating oestrogen concentrations..
It appears that calcium supplementation may slow
cortical bone loss at this life stage rather than
trabecular bone loss.

42

OSTEOPOROSIS IN MEN Osteoporosis is called a silent disease because it

progresses without symptoms until a fracture occurs.

It develops less often in men than in women because men
have larger skeletons, their bone loss starts later and
progresses more slowly, and they have no period of rapid
hormonal change and bone loss.
CAUSES Men in their fifties do not experience the rapid loss of bone
mass that women do in the years following menopause. By
age 65 or 70, however, men and women are losing bone
mass at the same rate, and the absorption of calcium, an
essential nutrient for bone health throughout life, decreases
in both sexes.
43

Causes of Osteoporosis in Men

glucocorticoid medications
other immunosuppressive drugs
hypogonadism
excessive alcohol consumption
smoking
chronic obstructive pulmonary disease and asthma
cystic fibrosis
gastrointestinal disease
hypercalciuria
anticonvulsant medications

44

HOW IS OSTEOPOROSIS DIAGNOSED Osteoporosis can be effectively treated if it is

detected before significant bone loss has
occurred. A medical workup to diagnose
osteoporosis will include a complete medical
history, x-rays, and urine and blood tests. The
doctor may also order a bone mineral density test.
This test can identify osteoporosis, determine risk
for fractures (broken bones), and measure
response to osteoporosis treatment. The most
widely recognized BMD test is called a dualenergy x-ray absorptiometry, or DXA test.

45

EFFECTS OF OSTEOPOROSIS ON
OSSEOINTEGRATION OF IMPLANTS
Osseointegration, which is measured by the percentage of contact between

the surface of the implant and the bone, can be affected not only by the
characteristic the implant and surgical procedure, but also by patientdependent variables that can affect the quantity and quality of bone.
To achieve the osseointegration of implants is necessary to secure their
adequate primary stability. Thus, osteoporosis, characterized by bone loss,
alteration of the microstructure and the reduction in the regenerative
capacity of bone, has been considered a possible contraindication or a risk
factor for dental implant placement.

46

The reduction of bone density and of mineral

content of peripheral bones has been associated

with high resorption and atrophy of edentulous
jaws, but no relationship was found with greater
loss of implants.
The results of the reviewed studies show that it is

feasible to place implants in subjects with

osteoporosis, with success rates similar to those
obtained in healthy subjects, even in cases in
which there was poor quality of bone during or
placement.

47

It is stated by Holahan and colleagues that

osteoporosis is not a contraindication for dental

implant placement, and this is further confirmed by
slatger and colleagues .
August et al (2001) suggests that osteoporosis
negatively affects osteointegration by directly
affecting bone quality in the maxilla.

48

Koka et al also conclude that osteoporosis and bisphosphonate

use have no effect on implant success and mention that this is

logical since the space between the implant and the intact bone
which should be filled with new bone is so small, it does not
get affected by an osteoporotic condition.
It is noteworthy that age itself is not a contributing factor to
dental implant failure; however, concomitant factors together
with aging like uncontrolled metabolic diseases (osteoporosis,
diabetes, etc.) might affect the outcome of implant therapy in
both surgical and healing stages
Ana Mellado-Valero 1, Juan Carlos Ferrer-Garca 2, Javier Calvo-Catal 3, Carlos Labaig-Rueda
Med Oral Patol Oral Cir Bucal. 2010 Jan 1;15 (1):e52-7.

49

DENTIST APPROACH TO OSTEOPOROSIS

Dentist may be able to detect the first stages of osteoporosis based on a

review of medical history and the results of a comprehensive clinical and

x-ray examination. Medical history will provide information about risk
factors such as heredity (genetics), calcium deficiency, smoking,
menopause, excessive caffeine or alcohol intake and an inactive lifestyle.
Dental x-rays may indicate a decrease in the density of the jawbone and the
bone around the teeth from year to year and show advancing stages of the
disease.

50

. Osteoporosis Cropped panoramics images shows a relative radiolucency

of
jaws with reduced definition and mandibular inferior cortex moderately
eroded, evidence

51

 In addition, there are several signs that alert dentists to the possibility of

osteoporosis:
Bone loss in the jaw and around teeth. This may be a sign of bone loss in
other parts of the body.
Tooth loss. Studies support the hypothesis that people with low bone
mineral density tend to lose more teeth.
Loose or ill-fitting dentures. Bone loss may become so severe that it may be
impossible to create functional dentures. Without the aid of dentures to
chew many types of food, older patients may suffer severe nutritional
deficiencies. In addition, ill-fitting dentures can lead to mouth sores and
difficulty speaking.
Gum disease. Gum disease contributes to bone loss and may provide a clue
to the diagnosis of an underlying disease such as osteoporosis .

52

HYPERCALCEIMIA
Body calcium is under such close homeostatic control that

an excessive accumulation in blood or tissues from overconsumption is virtually unknown. There are a number of
conditions, however, that result from failure of the calcium
control mechanisms either generally or locally.
General failure of one or more control mechanisms results
in hypercalcaemia (high blood calcium concentrations).
Local disturbances, usually related to impaired arterial
supply and consequent tissue necrosis, result in the
deposition of calcium salts.

53

 Hypercalcaemia is characterised by anorexia, nausea and,

sometimes,vomiting, muscle weakness, generalised

itchiness and excessive thirst and urination. If onset is
acute, confusion or stupor may result. Kidney failure usually
occurs unless treatment is given. Hypercalcaemia occurs as
a result of either increased mobilisation of calcium from
bone or increased tubular reabsorption or decreased
glomerular filtration in the kidneys.

54

HYPOCALCEMIA
Negative calcium balance can lead to hypocalcemia.
Can be due to number of fcators, like hypoparathyroidism, chronic renal

failure,vitamin d deficiency, and hypomagnesemia.

It may idiopathic or following surgical trauma over that region and
occurrence due to failure of homeostatic mechanisim of parathyroid
hormone resulting in loss of calcium from the extracellular compartment at
a rate faster than it can be replaced.
Clinically cases of hypocalcemia have a picture of tetany due to increased
neuromuscular irritability.
Patient is often irritable complaining of tingling or parasthesia,in
limbs,cramps, and in calf muscles ,muscular twichings and carpopedal
spasm.
55

 Spasm of larynx and bronchial musculature may be seen and this often

stimulates bronchial asthma like picture.

There may be impaired memory ,anxiety,and halluciantions.
Hair may be thinned,and dental caries is often seen
LATENT TETANY
Chowsteks sign-contraction of facial muscles
Trousseaus sign-corpopedal spasm
Erbs sign-muscular contraction to normal electrical stimuli.
Serum calcium levels are low generally below 8gm/dl while phosphorus
levels are normal.

56

CHOVESTESK AND TROUSSEAU SIGN

57

CALCIUM STONE FORMATION

Calcium salt deposition most commonly occurs in the

kidneys.
Kidney stones are most common in men, with occurrence
being 50% greater than in women.
Risk factors for calcium stone formation can be divided into
urinary and pre-urinary risk factors. Urinary risk factors
include a low urine volume the most important risk factor,
excess urinary excretion of oxalate, increased urinary pH,
increased uric acid excretion, and hypercalciuria.
Hypercalciuria more than200 mg of calcium .

58

TREATMENT
HYPOCALCEMIA.

HYPERCALCEMIA

In case of acute tetany 10 or 20cc of ten

First is to restore hydration since most of

percent calcium gluconate is to be given

intravenously.
Supplements of calcium and vitamin D can
be given.
In addition diet must be rich in calcium and
low in phosphate content.

patients have been vomiting with drop in

glomerular filtration.
Drugs useful in lowering calcium levels
include glucocorticoids(prednisolone 4060mg/day), diphosphhonates(7.5mg/kg
perday intravenously).
For patients with very high levels of
calcium and renal failure, peritoneal
dialysis is the treatment of choice.

59

RICKETS
Rickets is a softening of the bones in
children potentially leading to fractures
and deformity.. The predominant cause is a
vitamin D deficiency, but lack of adequate
calcium in the diet may also lead to rickets.
Osteomalacia is the term used to describe
a similar condition occurring in adults,
generally due to a deficiency of vitamin D.

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Etiology
Vitamin D is required for proper calcium absorption

from the gut. In the absence of vitamin D, dietary

calcium is not properly absorbed, resulting in
hypocalcemia, leading to skeletal and dental
deformities and neuromuscular symptoms, e.g.
hyperexcitability.

61

 Signs and symptoms of rickets include:

1) Bone pain or tenderness
2) dental problems
3) muscle weakness
4) increased tendency for fractures (easily broken bones),
5) Growth disturbance
6) Hypocalcemia (low level of calcium in the blood), and
7) Tetany (uncontrolled muscle spasms all over the body).

62

DIAGNOSTIC TOOLS FOR CALCIUM

DEFICIENCY
To determine calcium levels in body, that is in

serum and bone, several test may be advised

by the doctor concerned.
An ionized calcium test may be ordered when
someone has numbness around the mouth
and in the hands and feet and muscle spasms
in the same areas.

63

A urine calcium test may be ordered when

someone has symptoms ofkidney stones, such

as a sharp pain in the person's side or back
around the kidneys, pain that may progress to
lower in the abdomen, and/or blood in the
urine.
Dexa scan may help in detecting further
disorder of bone , it is a kind of xray.

64

CALCIUM IN DIET
Dietary calcium intake is critical maintaining the

body skeleton. To prevent metabolic bone disease

,acquiring a dense skeleton by time of bone
maturation occurs between 30-35 years of age.
Calcium intake of postmenopausal women should be
adequate.
Patient with dentures who have excessive ridge
resorption report lower calcium intakes.

65

DIETORY FACTORS AFFECTING CALCIUM

ABSORPTIONThe physical form of dietary calcium
influences its absorption and
bioavailability.
A number of nutrients and other
compounds present in foods have the
ability to form complexes with calcium in
the intestine, which can influence its
absorption.

66

VITAMIN D

Vitamin D, as calcitriol (the active form of

vitamin D)influences calcium absorption

across the intestine.
Intestinal calcium absorption decreases
with age. It is thought that this relates to a
reduced sensitivity of the vitamin D
receptor .

67

FAT
Fat is known to influence calcium

absorption. A high excretion of fat in the

faeces is associated with increased loss of
calcium.
PROTEIN
Diets low in protein may increase
concentrations of PTH and calcitriol in the
short-term suggesting that low protein
diets may induce changes in calcium
handling in the intestine and/or skeleton..
68

Recommended adequate intake by the IOM for calcium: [28][29]

Age

Calcium (mg/day)

06 months

200

712 months

260

13 years

700

48 years

1000

918 years

1300

1950 years

1000

5170 years (male)

1000

5170 years (female)

1200

71+ years

1200

69

SOURCES OF DIETARY CALCIUM MILK AND DAIRY PRODUCTS The calcium content of milk is fairly constant and is virtually

unaffected by the cows diet, lactation stage or the climate.

The calcium in milk and milk products has a high
bioavailability.
Skimmed milks, dried skimmed milk powder and yoghurts
retain essentially all the original calcium present in the milk
prior to processing.
PLANT FOOD-. The calcium content of vegetables is little
affected by methods of cultivation.
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Fortified soya products are often marketed

as alternatives to dairy products, and they

form an important part of the diets of
many vegetarians and vegans. The calcium
content of unfortified soya products is
relatively low compared to milk , but
fortified products typically contain similar
levels.

71

72

For those who consume minimal amount of

dairy products, have lactose intolerance, have

allergies

to

dairy

foods,

calcium

supplementation can be given.

Supplements

are

well

tolerated

,are

inexpensive and have few side effects.

73

ADVERSE EFFECTSFew adverse affects of calcium supplementation have

been observed.
Some older women have reported nausea, bloating, or
constipation.
Increasing calcium intake results in higher urinary
levels of calcium.
A small percentage was observed specially men
showed susceptibility to forming kidney stones.

74

DIETARY COUNSELING FOR PATIENTS

UNDERGOING PROSTHODONTIC TREATMENTThe quality of a denture wearing patients diet can be
improved with nutrition counseling.
Patients receiving dentures should be carefully
screened for nutritional risk factors.
Dietary counseling should be included if patient is
older than 75 years, low income, weight loss, in use of
multiple drugs..

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PROVIDING NUTRITION CARE FOR

DENTURE WEARING PATIENTObtain a nutrition history and an accurate record of

food intake over a 3 to 5 day period or complete a
food frequency form.
Evaluate the diet, assess nutritional risk.
Teaching about components of a diet that will support
oral mucosa, bone health, and total body health.

77

SUMMARY
Calcium is present in body in bones and teeth.
Its homeostasis is regulated by parathyroid

,calcitonin, and vitamin d hormone.

Homeostasis takes place at kidney
,gastrointestinal tract and intestines.
Excretion takes place from kidney in form
urine and feaces.
Very essential to maintain various functions of
body.
78

CONCLUSION
Calcium plays an essential and varied role in

the body
and is vital for health.
An increase and decrease in calcium levels of
the body can lead to severe conditions like
osteoporosis ,hypercalcemia etc.
A proper intake of calcium is required for overall
development of body and is especially essential
mineral for females, due to the different
hormonal stages at various stages of life.
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