METABOLISME

CALCIUM
CALCIUM
PARATIROID [PTH]

CALCITONIN &

VITAMIN D
Parathyroids Gland
Peran PTH
Hemostasis
Stabilisasi membran sel
Ekskresi, sekresi/release neurotransmiter
Kontraksi otot
Formation of bone & teeth
FUNCTIONS OF BONE
Supports the body against gravity
Provids the rigidity that permits
locomotions
Protections the internal organs
Serves as a reservoir for calcium,
inorganic phosphate and ather mineral
elements
Products blood cells in the bone marrow
DISTRIBUTION
Sceletal storage [90%]
Plasma [1%] : 45% free, 55% bounded
Free plasma Ca PTH, CALCITONIN,
VIT D
Ca pools stable [mature] bone & -labile
[young] bone
Labile bone : mudah dibongkar/resorbsi
BONE CHEMISTRY
HYDROXYAPATITE

FLUOROAPATITE
Ca. REGULATION
Three tissues : bone, intestine, kidney

Three hormons : PTH, calcitonin, vit. D

Three cells : osteocytes, osteoblasts,

osteoclasts
Hormons Controle of Ca
Metabolism
PTH : amino acid [by Chief cells] :
hypercalcemic hormone

Calcitonin : amono acid [by parafollicular

cells/C cells]: hypocalcemic hormone

Vit D/cholecalciferol : steroid hormone;

absorbtion Ca & Po4 increased
CELLULARE ASPECTS of BONE
METABOLISM
OSTEOCLAST
- bone resorbtion
- contain acid phosphatase
- stimulated by PTH
- derived from circulating monocytes
OSTEOCYTES : bone matric
OSTEOBLAST
- bone formating cells
- synthesize & secrete collagene
- contain allanine phosphatase
PHYSIOLOGIC ACTIONS of PTH
[LOW LEVEL of PLASMA Ca]

INCREASED:

- BONE RESORBTION
- ABSORBTION Ca & PO4 [GUT]
- Ca REABSORBTION [KIDNEY]
- PO4 EXCRETION [KIDNEY]
Physiolocic action of PTH
Bone : osteolytic activity

Gut : PTH & Calcitriol sinergistically abs.

Ca and Po4

Kidney : Ca reabs & PO4 excretion

Reflexes a reductions in plasma calcium concentrations
and the actions of parathiroid hormone
Struktur dan Sintesis Vit D (Cholecalciferol)
Metabolism of Vit D to the active form
Penyakit Akibat kekurangan & kehilangan
Vit D
Rakitis (Rickets) terjadi pada anak
def vit D, Kurang sinar matahari, obat
antikonvulsi

Osteomalasia : usia dewasa

Juga pada perokok, alkoholik, PPOM

Osteoporosis
Rickets and osteomalacia
Abnormalitas in the metabolism of bone
Mineralisazion of bone matrix is deficient
The bone to be soft and easily fractured
A major of cause is deficienci of 1,25 (OH)
D3
osteoporosis
Both bone matrix and minerals are lost
Imbalnce between resorption and formation
Decrease in bone mass and strength
Incidence of fracture is increased
Disuse osteoporosis (immobilized)
Incresed bone resorbtion
Decresed bone formation
Relted agging
Prevention with estrogen replecement therapy
Bone matrix
Summary effects of PTH
Hypercalcemia

hypophosphatemia

Hypocalciuria

Hyperphosphaturia
Hormon2 yang mengatur
pembentukan tulang
Formation and incieased bone mass
1. Insulin
2. Growth hormone
3. IGF-1
4. Estrogen
5. 1,25 dihydroxyvitamin D3
6. Calcitonin
Resorbtion and decreased bone mass
1. PTH
2. Cortisol
3. Thyroid hormone
SUMMARY OF MAJOR HORMONAL
INFLUENCES BONE MASS
Multiple biological functions
of calcium
Cell signalling
Neural transmission
Muscle function
Blood coagulation
Enzymatic co-factor
Membrane and cytoskeletal functions
Secretion
Biomineralization
Effects of Parathyroid Hormone on
Calcium and Skeletal Metabolism
Bone
Increases resorption
Increases formation, especially at low and intermittent
concentrations
Kidney
Decreases calcium excretion (clearance)
Increases phosphorus excretion
Gastrointestinal Tract
Increases calcium and phosphorus absorption
Indirect effect via 1,25?D production
Blood
Increases calcium
Decreases phosphorus
Effects of Calcitonin on Mineral
Metabolism
Bone
Inhibits resorption
? Promotes formation
Kidney
Increases calcium excretion
Increases phosphorus excretion
Gastrointestinal Tract
? Inhibitory effect on calcium/phosphorus
absorption
Blood
Decreases calcium
Decreases phosphorus
Effects of 1,25?D (1,25?dihydroxyvitamin
D) on Mineral Metabolism
Bone
Promotes mineralization of osteoid
Increases resorption at high doses
Kidney
Decreases calcium excretion
Decreases phosphorus excretion
Gastrointestinal Tract
Increases calcium absorption
Increases phosphorus absorption
Blood
Increases calcium
Increases phosphorus
WASSALAM