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Full length article| Volume 22, ISSUE 2, P275-285, February 01, 1957

Calcium and phosphorus metabolism

DOI:https://doi.org/10.1016/0002-9343(57)90011-6
Calcium and phosphorus metabolism
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      Abstract

      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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      References

        • Armstrong W.D.
        Phosphorus metabolism in the skeleton.
        Phosphorus Metabolism. 1952; 2: 698
        • Bergstrom W.H.
        The skeleton as an electrolyte reservoir.
        Metabolism. 1956; 5: 433
        • Howard J.E.
        The metabolism of calcium and phosphorus in bone.
        Bull. New York Acad. Med. 1951; 27: 24
        • Howard J.E.
        • Connor T.B.
        A discussion of calcium homeostasis: the role of the skeleton and some speculations on the part played by the parathyroid hormone.
        Bibliot. Paediat. 1954; 58 (Suppl.): 230
        • Neuman W.F.
        • Neuman M.W.
        The nature of the mineral phase of bone.
        Chem. Rev. 1953; 53: 1
        • Nicolaysen R.
        • Eeg-Larsen N.
        • Malm O.J.
        Physiology of calcium metabolism.
        Physiol. Rev. 1953; 33: 424
        • Owen E.C.
        Bone as a mineral reserve.
        Brit. J. Nutrition. 1952; 6: 415
      8. 1st ed. Transactions of the Macy Conference on Metabolic Interrelations. vol. 1–5. 1949–1953
      9. Ciba Foundation Symposium on Bone Structure and Metabolism. J. & A. Churchill Co, London1956
      10. Ann. New York Acad. Sc. 1955; 60: 541
      11. Ann. New York Acad. Sc. 1956; 64: 279
        • Bourne G.H.
        The Biochemistry and Physiology of Bone.
        Academic Press, New York1956
        • McLean F.C.
        • Urist M.R.
        Bone: An Introduction to the Physiology of Skeletal Tissue.
        University of Chicago Press, Chicago1955
        • Stein I.
        • Stein R.O.
        • Beller M.L.
        Living Bone in Health and Disease.
        J. B. Lippincott Co, Philadelphia, Montreal1955
        • Mitchell H.H.
        • Hamilton T.S.
        • Steggerda F.R.
        • Bean H.W.
        The chemical composition of the adult human body and its bearing on the biochemistry of growth.
        J. Biol. Chem. 1945; 158: 625
        • Armstrong W.D.
        • Johnson J.A.
        • Singer L.
        • Lienke R.I.
        • Premer M.L.
        Rates of transcapillary movement of calcium and sodium and of calcium exchange by the skeleton.
        Am. J. Physiol. 1952; 171: 641
        • Thomas R.O.
        • Litovitz T.A.
        • Rubin M.I.
        • Geschickter C.F.
        Dynamics of calcium metabolism. I. Time distribution of intravenously administered radiocalcium.
        Am. J. Physiol. 1952; 169: 568
        • Hansard S.L.
        • Comar C.L.
        • Davis G.K.
        Effects of age upon the physiological behaviour of calcium in cattle.
        Am. J. Physiol. 1954; 177: 383
        • Bronner F.
        • Harris R.S.
        • Maletskos C.J.
        • Benda C.E.
        Studies in calcium metabolism. Effect of food phytates on calcium45 uptake in children on low-calcium breakfasts.
        J. Nutrition. 1954; 54: 523
        • Frederickson J.M.
        • Honour A.J.
        • Copp D.H.
        Measurement of initial bone clearance of Ca45 from blood in the rat.
        in: 1st ed. Federation Proc.14. 1955: 49

      21. DeJong, B. P., Tanaka, G. and Copp, D. H. Unpublished data.

        • Bauer G.C.H.
        • Carlsson A.
        • Lindquist B.
        Evaluation of accretion, resorption and exchange reactions in the skeleton.
        Kgl. Fysiograf. Sällskap. Lund Förh. 1955; 25: 1
        • Bauer G.C.H.
        • Carlsson A.
        Metabolism of bone salt investigated by simultaneous administration of Ca32 and P32 to rats.
        J. Bone & Joint Surg. 1955; 37B: 658
        • Bauer G.C.H.
        • Carlsson A.
        • Lindquist B.
        Bone salt metabolism in human rickets studied with radioactive phosphorus.
        Metabolism. 1956; 5: 573
        • Singer L.
        • Armstrong W.D.
        Retention and turnover of radiocalcium by the skeleton of large rats.
        in: 1st ed. Proc. Soc. Exper. Biol. & Med.76. 1951: 229
        • Norris W.P.
        • Kisieleski W.
        Comparative metabolism of radium, strontium and calcium.
        in: 1st ed. Cold Spring Harbor Symposium Quant. Biol.13. 1948: 164
        • Amprino R.
        • Engström A.
        Autoradiographic analysis of the distribution of labelled Ca and P in bones.
        Sep. Experientia. 1952; 8: 20
        • Sherman H.C.
        Chemistry of Food and Nutrition.
        Macmillan Co, New York1952
        • Howard J.E.
        Normal calcium and phosphorus transport and body fluid homeostasis.
        in: 1st ed. Tr. Macy Conf. Metab. Interrelations. 5. 1953: 11
        • Bronner F.
        • Harris R.S.
        Absorption and metabolism of calcium in human beings, studied with calcium45.
        Ann. New York Acad. Sc. 1956; 64: 314
        • Howard J.E.
        • Parson W.
        • Bigham Jr., R.S.
        Studies on patients convalescent from fracture, III. The urinary excretion of calcium and phosphorus.
        Bull. Johns Hopkins Hosp. 1945; 77: 291
        • McCance R.A.
        • Widdowson E.M.
        • Lehmann H.
        The effect of protein intake on the absorption of calcium and magnesium.
        Biochem. J. 1942; 36: 686
        • Johnston F.A.
        • Tredwell C.
        • Diao E.
        Effect of previous calcium intake of four young men on amount retained from a low calcium diet.
        in: 1st ed. Federation Proc.15. 1956: 559
        • Leichsenring J.M.
        • Norris L.M.
        • Lamison S.A.
        • Wilson E.D.
        • Patton M.B.
        The effect of level of intake on calcium and phosphorus metabolism in college women.
        J. Nutrition. 1951; 45: 407
        • McCance R.A.
        • Widdowson E.M.
        Mineral metabolism of healthy adults on white and brown bread dietaries.
        J. Physiol. 1942; 101: 44
        • Nicolaysen R.
        • Njaa L.R.
        Investigations on the effect of phytic acid on the absorption of calcium in rats, pigs and men.
        Acta physiol. Scandinav. 1951; 22: 246
        • Chen P.S.
        • Neuman W.F.
        Renal excretion of calcium by the dog.
        Am. J. Physiol. 1955; 180: 623
        • Aub J.C.
        • Bauer W.
        • Heath C.
        • Ropes M.
        Studies of calcium and phosphorus metabolism, III. The effects of thyroid hormone and thyroid disease.
        J. Clin. Investigation. 1929; 7: 97
        • Copp D.H.
        Studies on the plasma clearance values of calcium.
        in: 1st ed. Tr. Macy Conf. Metab. Interrelations. 5. 1953: 147
        • McLean F.C.
        • Hastings A.B.
        Clinical estimation and significance of calcium-ion concentration in the blood.
        Am. J. M. Sc. 1935; 189: 601
        • Hopkins T.
        • Howard J.E.
        • Eisenberg H.
        Ultrafiltration studies on calcium and phosphorus in human serum.
        Bull. Johns Hopkins Hosp. 1952; 91: 1
        • Dent C.E.
        Discussion on the physiology and clinical disorders of the parathyroid glands.
        in: 1st ed. Proc. Roy. Soc. Med.46. 1953: 291
        • Hastings A.B.
        • Huggins C.B.
        Experimental hypocalcemia.
        in: 1st ed. Proc. Soc. Exper. Biol. & Med.30. 1933: 458
        • Patt H.M.
        • Luckhardt A.B.
        Relationship of a low blood calcium to parathyroid secretion.
        Endocrinology. 1942; 31: 384
        • Saffran M.
        • Denstedt O.F.
        The effect of intravenously injected citrate on the serum ionized calcium in the rabbit.
        Canad. J. M. Sc. 1951; 29: 245
        • Spencer H.
        • Greenberg J.
        • Berger E.
        • Perrone M.
        • Laszlo D.
        Studies on the effect of ethylenediaminetetraacetic acid in hypercalcemia.
        J. Lab. Clin. Med. 1956; 47: 29
        • Copp D.H.
        • Frederickson J.M.
        • DeJong B.
        Measurement of calcium mobilization in the dog.
        Rev. Canad. Biol. 1955; 14: 244
        • Lehmann J.
        A photoelectric micro method for the direct titration of calcium in serum with ethylenediaminetetraacetate.
        Scandinav. J. Clin. & Lab. Investigation. 1953; 5: 203
        • Albright F.
        • Reifenstein Jr., E.C.
        Parathyroid Glands and Metabolic Bone Disease: Selected Studies.
        Williams & Wilkins Co, Baltimore1948
        • Gilmour J.R.
        The Parathyroid Glands and Skeleton in Renal Disease.
        Oxford University Press, London, New York1947
        • Snapper I.
        Parathyroid hormone and mineral metabolism.
        Bull. New York Acad. Med. 1953; 29: 612
        • Bartter F.C.
        The parathyroids.
        Ann. Rev. Physiol. 1954; 16: 429
        • Albright F.
        • Ellsworth R.
        Studies on the physiology of the parathyroid glands. I. Calcium and phosphorus studies on a case of idiopathic hypoparathyroidism.
        J. Clin. Investigation. 1929; 7: 183
        • Thomson D.L.
        • Pugsley L.I.
        On the mechanism of parathyroid hormone action.
        Am. J. Physiol. 1932; 102: 350
        • Collip J.B.
        • Pugsley L.I.
        • Selye H.
        • Thomson D.L.
        Observations concerning the mechanism of parathyroid hormone action.
        Brit. J. Exper. Path. 1934; 15: 335
        • Stewart G.S.
        • Bowen H.F.
        The parathyroid control of serum calcium independent of renal mediation.
        Endocrinology. 1951; 48: 568
        • Selye H.
        Mechanism of parathyroid hormone action.
        Arch. Path. 1942; 34: 625
        • Barnicot N.A.
        The local action of the parathyroid and other tissues on bone in intracerebral grafts.
        J. Anat. 1948; 82: 233
        • Chang H.
        Localized resorption of bone adjacent to parathyroid grafts.
        Anat. Rec. 1950; 106: 266
        • Talmage R.V.
        • Elliott J.R.
        Changes in extracellular fluid levels of calcium, phosphate and citrate ions in nephrectomized rats following parathyroidectomy.
        Endocrinology. 1956; 59: 27

      61. Frederickson, J. M., Thomas, W. D. S. and Copp, D. H. To be published.

      62. Copp, D. H. and Moghadam, H. To be published.

        • Bloom W.
        • Bloom M.A.
        • McLean F.C.
        Calcification and ossification. Medullary bone changes in the reproductive cycle of female pigeons.
        Anat. Rec. 1941; 81: 443
        • Urist M.R.
        • Budy A.M.
        • McLean F.C.
        Endosteal-bone formation in estrogen-treated mice.
        J. Bone & Joint Surg. 1950; 32A: 143
        • Budy A.M.
        • Urist M.R.
        • McLean F.C.
        The effect of estrogens on the growth apparatus of the bones of immature rats.
        Am. J. Path. 1952; 28: 1143
        • Ackerman P.G.
        • Toro G.
        • Kountz W.B.
        • Kheim T.
        The effect of sex hormone administration on the calcium and nitrogen balance in elderly women.
        J. Geront. 1954; 9: 450
        • Reifenstein Jr., E.C.
        • Albright F.
        The metabolic effects of steroid hormones in osteoporosis.
        J. Clin. Investigation. 1947; 26: 24
        • Walker D.G.
        • Simpson M.E.
        • Asling C.W.
        • Evans H.M.
        Growth and differentiation in the rat following hypophysectomy at 6 days of age.
        Anat. Rec. 1950; 106: 539
        • Asling C.W.
        • Simpson M.E.
        • Evans H.M.
        Effects of pituitary factors and of thyroxin on skeletal morphogenesis in the rat.
        in: 1st ed. Tr. Macy Conf. Metab. Interrelations. 3. 1951: 125
        • Becks H.
        • Simpson M.E.
        • Evans H.M.
        • Ray R.D.
        • Li C.H.
        • Asling C.W.
        Response to pituitary growth hormone and thyroxin of the tibias of hypophysectomized rats after long postoperative intervals.
        Anat. Rec. 1946; 94: 631
        • Talmage R.V.
        • Dodds B.F.
        Comparative study of some effects of administration of dihydrotachysterol and calciferol to rats.
        Endocrinology. 1955; 57: 236
        • Zetterstrom R.
        • Winberg J.
        Primary vitamin D refractory rickets. II. Metabolic studies during treatment with massive doses of vitamin D.
        Acta paediat. 1955; 44: 45
        • Cohn W.E.
        • Greenberg D.M.
        Studies in mineral metabolism with the aid of artificial radioactive isotopes, I. Absorption, distribution and excretion of phosphorus.
        J. Biol. Client. 1938; 123: 185
        • Feaster J.P.
        • Shirley R.L.
        • McCall J.T.
        • Davis G.K.
        P32 distribution and excretion in rats fed vitamin D free and low phosphorus diets.
        J. Nutrition. 1953; 51: 381
        • Carlsson A.
        The effect of vitamin D on the absorption of inorganic phosphate.
        Acta physiol. Scandinav. 1954; 31: 301
        • Rehm P.
        • Winters J.C.
        The effect of ferric chloride on the utilization of calcium and phosphorus in the animal body.
        J. Nutrition. 1940; 19: 213
        • Street H.R.
        Influence of aluminum sulfate and aluminum hydroxide upon the absorption of dietary phosphorus by the rat.
        J. Nutrition. 1942; 24: 111
        • Harrison H.E.
        • Harrison H.C.
        Renal excretion of inorganic phosphate in relation to the action of vitamin D and parathyroid hormone.
        J. Clin. Investigation. 1941; 20: 47

      79. Copp, D. H. Unpublished data.

        • Crawford J.D.
        • Osborne Jr., M.M.
        • Talbot N.B.
        • Terry M.L.
        • Morrill M.F.
        The parathyroid glands and phosphorus homeostasis.
        J. Clin. Investigation. 1950; 29: 1448
        • Talmage R.V.
        • Kraintz F.W.
        • Frost R.C.
        • Kraintz L.
        Evidence for a dual action of parathyroid extract in maintaining serum calcium and phosphate levels.
        Endocrinology. 1953; 52: 318
        • Stoerk R.C.
        • Silber R.H.
        Parathormone in renal reabsorption of phosphate.
        Lab. Investigation. 1956; 5: 213
        • Rubin B.L.
        • Dorfman R.I.
        Bioassay of parathyroid hormone.
        in: 1st ed. Proc. Soc. Exper. Biol. & Med.83. 1953: 223
        • Reifenstein Jr., E.C.
        • Kinsell L.W.
        • Albright F.
        Observations on the use of the serum phosphorus level as an index of pituitary growth hormone activity; the effect of estrogen therapy in acromegaly.
        Endocrinology. 1946; 39: 71
        • Handler P.
        • Cohn D.V.
        The question of two or more forms of phosphate in plasma.
        in: 1st ed. Tr. Macy Conf. Metab. Interrelations. 5. 1953: 339
        • Zucker T.F.
        • Hall L.
        • Young M.
        Growth and calcification on a diet deficient in phosphate but otherwise adequate.
        J. Nutrition. 1941; 22: 139
        • Day H.G.
        • McCollum E.V.
        Mineral metabolism, growth and symptomatology of rats on a diet extremely deficient in phosphorus.
        J. Biol. Chem. 1939; 130: 269
        • Coleman R.D.
        • Becks H.
        • Kohl F.Van N.
        • Copp D.H.
        Skeletal changes in severe phosphorus deficiency of the rat. I. Tibia, metacarpal bone, costochondral junction, caudal vertebra.
        Arch. Path. 1950; 50: 209
        • Copp D.H.
        • Hamilton J.G.
        • Jones D.C.
        • Thomson D.M.
        • Cramer C.F.
        The effect of age and low phosphorus rickets on calcification and the deposition of certain radioactive metals in bone.
        in: 1st ed. Tr. Macy Conf. Metab. Interrelations. 3. 1951: 226

      90. Copp, D. H. To be published.

      Article Info

      Footnotes

      ☆Supported in part by grants from the Division of Medical Research, and the Associate Committee on Dental Research of the National Research Council. Canada.

      Identification

      DOI: https://doi.org/10.1016/0002-9343(57)90011-6

      Copyright

      © 1957 Published by Elsevier Inc.

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