Calcium and phosphorus metabolism

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      The skeleton, which contains over 99 per cent of the body calcium and 90 per cent of the phosphorus, provides a reserve for the maintenance and regulation of these elements. Both have important functions in cells and body fluids.
      Calcium balance depends on intake from the diet, loss in urine and feces and a balance between bone formation and bone resorption. Intake is regulated by intestinal absorption; excretion of excess calcium liberated by bone resorption occurs chiefly in urine.
      The very precise homeostatic control of the serum calcium level depends on bone, parathyroids and kidneys. Mobilization of calcium from bone during hypocalcemia was found to depend on the extent to which the serum calcium was lowered, and on the bone blood flow. The latter has been estimated at 3 to 7 per cent of the resting cardiac output in the dog. There appears to be an equilibrium between a mobilizable calcium pool in bone and the serum calcium. This equilibrium level is 5 to 7 mg. per cent in the parathyroidectomized animal and 10 to 11 mg. per cent in the normal animal. It is probable that a “feedback” mechanism regulates the output of parathyroid hormone; the hormone in turn determines the equilibrium level between mobilizable bone calcium and blood. A large part of the dietary phosphorus is absorbed and subsequently excreted by the kidney. The latter appears to be the main organ for regulation of phosphorus balance. In severe phosphorus deficiency, the requirements of the cellular soft tissues are met at the expense of the skeleton and severe osteoporosis develops. The bones, and particularly the ribs and vertebrae, become very thin and low in mineral, while the teeth are relatively unaffected.
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