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    Home > Active Ingredient News > Endocrine System > Increased blood calcium is often not a sign of adequate calcium supplementation, but a signal that bone is rapidly losing!

    Increased blood calcium is often not a sign of adequate calcium supplementation, but a signal that bone is rapidly losing!

    • Last Update: 2022-01-09
    • Source: Internet
    • Author: User
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    *Only for medical professionals to read and refer to the 44th article related to the prevention and treatment of osteoporosis published by the director of Zhejiang Provincial People's Hospital Bian Pingda in the medical field
    .

    Some elderly patients often see the increase in blood calcium in their blood biochemical reports, and they happily think that they have enough calcium.
    In fact, the increase in blood calcium is often not caused by calcium supplementation.
    The most likely reason is that bone is rapidly losing.
    .
    .
    Generally, calcium is not easily increased.
    Calcium is the most abundant metal macro element in the human body.
    The total amount of calcium in an adult's body is about 1000 to 1300 grams, of which 99% is in the form of bone salt in bones and teeth, and the rest is in various soft tissues.
    Serum calcium only accounts for 0.
    1% of total calcium
    .

    Blood calcium mainly exists in two forms, except for free calcium (about 50%), the rest is protein-bound calcium
    .

    Protein-bound calcium is mainly combined with albumin and is affected by serum albumin.
    Therefore, elderly patients who usually take high-quality protein and higher serum albumin levels have higher blood calcium levels [1]
    .

    Calcium plays a very important physiological role inside and outside the cell, and maintaining body calcium reserves and blood calcium concentration depends on the calcium content in the diet, intestinal calcium absorption and renal calcium excretion
    .

    The body’s parathyroid cells, thyroid C cells and renal tubular cells can feel the subtle fluctuations in blood calcium, and secrete hormones such as parathyroid hormone (increases blood calcium) and calcitonin (decreases blood calcium) to make blood calcium tend to Yu normal
    .

    The normal range of blood calcium is 2.
    2~2.
    6mmol/L.
    When the serum albumin concentration is normal, if the blood calcium is higher than 2.
    6mmol/L, it is called hypercalcemia [1]
    .

     Increased blood calcium is related to rapid bone loss.
    Recently, we investigated 260 cases of rapid bone loss [serum type I collagen carboxy-terminal peptide cross-linked (CTX) ≥430pg/ml] elderly women’s blood calcium situation, and found that blood calcium is related to Serum CTX is positively correlated, that is, the faster the bone loss, the higher the blood calcium (see Figure 1)
    .

    Figure 1 The correlation between carboxy-terminal peptide cross-linking (CTX) of serum type I collagen and serum calcium in elderly women.
    Due to low levels of estrogen in the body and other reasons, the activity of osteoclasts in elderly women is enhanced, the type I collagen in the bones is rapidly destroyed, and serum CTX Obviously increased, and at the same time calcium is released from the bones into the blood quickly, resulting in increased blood calcium [2]
    .

    These elderly women with rapid bone loss, such as timely use of anti-bone resorption drugs such as bisphosphonates or RANKL inhibitors, as the serum CTX level drops, their blood calcium will gradually return to normal [3-4]
    .

     Common causes of increased blood calcium in elderly women Among the 260 elderly women who did not receive anti-osteoporosis treatment, the average blood calcium was 2.
    34 mmol/L, and only 7 (2.
    7%) cases had blood calcium exceeding 2.
    6 mmol/L, with the highest being 2.
    89 mmol/L
    .

    In these 7 elderly women, the serum CTX was 744~2107pg/ml, with an average of 1251pg/ml.
    Among them, 3 cases were patients who were paralyzed in bed after stroke for more than half a year, and 1 case was primary hyperparathyroidism.
    Patient
    .

    Reduction of mechanical stress stimulation is the main mechanism of rapid bone loss after stroke.
    Due to limb paralysis and walking inconvenience, bone weight is reduced, which leads to rapid increase in osteoclast activity, rapid bone loss, and increased serum CTX and blood calcium
    .

    In patients with primary hyperparathyroidism, due to the excessive secretion of parathyroid hormone, the number and activity of osteoclasts increase, leading to increased serum CTX and blood calcium [5]
    .

    In addition, patients who overdose calcitriol capsules for a long time may also experience increased blood calcium
    .

    When blood calcium is significantly increased, patients may have abnormal manifestations such as fatigue, decreased appetite, and increased blood creatinine.
    Therefore, elderly patients with increased blood calcium must seek medical treatment in time to find the cause and deal with it accordingly [5]
    .

    Tips: Stroke and osteoporotic stroke (commonly known as stroke) are the second leading cause of death in urban and rural residents in China (second only to malignant tumors)
    .

    Osteoporosis after stroke is a kind of disuse osteoporosis, belonging to the category of secondary osteoporosis
    .

    Studies have shown that the prevalence of osteoporosis is as high as 80% in the state of disuse of the body.
    Patients may experience pain in the lower back, ischial tuberosity, heel, etc.
    , which are often aggravated when turning over, sitting or standing weight-bearing
    .

    In addition, due to the decline in body balance and coordination of stroke patients, they are prone to falls, leading to fractures of the vertebral body and hips, which further increases the disability and mortality rate
    .

    Therefore, middle-aged and elderly people must resume exercise as soon as possible after stroke, and regularly check blood calcium, bone turnover markers and bone density and other indicators, and receive corresponding anti-osteoporosis treatment in time [6]
    .

     References: [1] You Huaizhou, Gu Yong, Lin Shanxiong.
    Calcium metabolism disorders [M].
    Chen Haozhu, Lin Guowei, Wang Jiyao editor.
    Practical internal medicine.
    14 edition.
    Beijing: People's Medical Publishing House, 2013: 952-957.
    [ 2]Shou Z, Jin X, Bian P, et al.
    Reference intervals of β-C-terminal telopeptide of type Ⅰcollagen, procollagen type ⅠN-terminal propeptide and osteocalcin for very elderly Chinese women[J].
    Geriatr Gerontol Int, 2017, 17(5):773-778.
    DOI:10.
    1111/ggi.
    12785.
    [3] Shou Zhangxuan, Bian Pingda, Jin Xue, et al.
    Effects of zoledronic acid on bone mineral density and serum bone in elderly women with osteoporosis The influence of switch markers[J].
    Chinese Journal of New Drugs and Clinical Medicine, 2017, 36(8): 497-500.
    [4]Tsourdi E, Langdahl B, Cohen-Solal M, et al.
    Discontinuation of denosumab therapy for osteoporosis: a systematic review and position statement by ECTS[J].
    Bone,2017,105(1):11-17.
    [5],.
    Progress in diagnosis and treatment of disuse osteoporosis[J].
    Chinese Osteoporosis He Bone Mineral Diseases, 2015, 8 (1): 69-72.
    [6] Zhang Chenyang, Bian Pingda, Shou Zhangxuan, et al.
    Status and countermeasures of vitamin D deficiency in the elderly[J].
    Chinese New Drugs and Clinics Magazine, 2019, 38(6): 328-332.
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