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*It is only for medical professionals to read for reference.
The important relationship between vitamin D and calcium and phosphorus metabolism and bone health has been continuously discovered.
Damage and bone fragility increase, bone strength decreases, bone formation and bone resorption are in a negative balance, and bone loss is obvious [1]
.
Calcium is an essential element during the bone formation and reconstruction process during the whole life cycle, and supports the development and formation of bone organs [2]
.
At the same time, important associations of vitamin D with calcium and phosphorus metabolism and bone health have been continuously discovered
.
Therefore, the use of calcium and vitamin D is an important means to prevent and treat osteoporosis
.
So, what is the relationship between vitamin D and calcium metabolism and maintaining bone health? Do calcium and vitamin D have to be used in combination in clinical practice? Recently, Professor Zeng Yuhong from Xi’an Honghui Hospital accepted the invitation of the “medical community” to elaborate on the above questions
.
Prevention and treatment of osteoporosis: Let doctors "love and hate" calcium in adults, the total amount of calcium in the body is generally about 700~1500g, accounting for about 2% of body weight, of which 99% of calcium is distributed in bones and teeth, which is bone plastic Elements necessary for bone formation in the process of reconstruction and reconstruction [2]
.
Outside the bones, calcium is distributed in the blood or cells in the form of soluble calcium
.
Ionized calcium in the blood is widely involved in a variety of physiological functions in the human body, such as blood coagulation, maintaining the normal excitability of the heart, muscles, and nervous system
.
As a key signal molecule and ion, intracellular calcium participates in gene expression, synaptic transmission and synaptic plasticity [3]
.
Professor Zeng Yuhong pointed out that calcium is of great significance to many organ systems such as human bones, which makes people prefer it
.
Unfortunately, calcium alone has limited effects in increasing bone density and reducing the risk of fractures.
Therefore, it cannot be used as a treatment for osteoporosis and is only a nutritional supplement for bone health
.
Active Vitamin D: Two-pronged approach to promote intestinal calcium absorption.
Calcium is obtained through food intake.
Intestinal calcium absorption is the main way for calcium to enter the human body.
The layer of epithelial cells absorb into the blood[3], and then reach the bones to form hydroxyapatite crystals, completing bone mineralization
.
Active vitamin D is one of the most important factors to promote the absorption of calcium in the intestines, and can regulate the above two transport pathways
.
Through the combination with vitamin D receptor (VDR), active vitamin D enters the nucleus, accelerates the transcription of DNA into mRNA, and promotes the biosynthesis of Ca2+ transport related proteins (TRPV6, calcium binding protein, PMCA1b, etc.
); active vitamin D also stimulates basement membrane The activation of adenylate cyclase, under the combined action of PMCA1b and Ca2+-ATPase, transports Ca2+ to the blood through active energy consumption.
In addition, studies have shown that active vitamin D and VDR also have a regulatory effect on the paracellular passive transport of calcium.
Active vitamin D also up-regulates the expression of tight junction protein-2/12/15, thereby promoting the passive transport of calcium (Figure 1) [4, 5]
.
Figure 1 Both pathways of intestinal calcium absorption are regulated by active vitamin D.
Professor Zeng Yuhong further pointed out that the absorption of intestinal calcium is affected by many factors
.
For example, for people on a low-calcium diet (calcium intake <400 mg/d), intestinal calcium absorption is based on active transcellular transport, and the intestinal calcium absorption rate (FCA) can be as high as 70%; for people on a high-calcium diet (calcium intake 800~ 1000mg/d) mainly passive transportation, FCA is only 20%
.
The drug glucocorticoid inhibits the production of active vitamin D and reduces intestinal calcium absorption
.
Innovative breakthrough, intestinal calcium absorption and adding new power.
The elderly are prone to vitamin D deficiency, their kidneys' ability to hydroxylate 25OHD 1α is weakened, and the synthesis of active vitamin D in the body is insufficient; at the same time, the expression of calcium ion channels TRPV6 and VDR also declines[6] Therefore, the intestinal calcium absorption rate decreases, bone absorption increases, bone density decreases, osteoporosis and fracture risk increase, and bone health is seriously affected
.
Professor Zeng Yuhong emphasized that clinically, ordinary vitamin D cannot be equated with active vitamin D.
The former is a nutritional supplement for bone health, and the latter is an anti-osteoporosis drug
.
After ordinary vitamin D enters the body, it needs to be hydroxylated into active vitamin D through the liver and kidney to promote intestinal calcium absorption; active vitamin D does not require kidney hydroxylation, which is suitable for elderly patients with osteoporosis or osteoporosis patients with nephropathy The role of calcium carbonate is particularly prominent, such as calcitriol, alfacalcidol, idecalcidol and so on
.
Professor Zeng Yuhong pointed out that, unlike other active vitamin D, the new active vitamin D analogue idecalcidol uses microbial hydroxylation technology to introduce 3-hydroxypropionic acid at the 2β position, which is more stable in the blood and cell levels and binds to VDR.
Stable, longer half-life, increased biological activity in target cells, and not easily inactivated by metabolism [7, 8]; at the same time, it increases the duodenal mRNA expression of TRPV6 and calcium-binding protein Calbindin-D9k, which is more effective in promoting calcium Active transportation increases FCA (Figure 2) [5]
.
Figure 2 Mechanism of idecalcidol to promote intestinal calcium absorption A randomized controlled study provided clinical evidence support for idecalcidol to significantly improve FCA in patients with osteoporosis
.
The study included 40 patients with postmenopausal osteoporosis, randomly divided into four groups, receiving idecalcidol 0.
75μg/d, alfacalcidol 1μg/d, ordinary vitamin D3 800IU/day, no drug control , Continued treatment for 4 weeks, the results showed that: compared with the control group, after 4 weeks of treatment, the FCA of the idecalcidol group increased more than that of the alfacalcidol group (59.
5% vs 45.
9%) [9]
.
Figure 3 The treatment of idcalcidol significantly improves the FCA of patients with osteoporosis.
Summary Calcium is an essential element in the bone formation phase during the process of bone reconstruction and reconstruction
.
Intestinal calcium absorption is the main way for calcium to enter the human body.
Active vitamin D is one of the most important factors to promote intestinal calcium absorption.
It can regulate the two pathways of active transport and passive transport
.
As we age, FCA decreases, and the risk of osteoporosis and fractures increases
.
The new active vitamin D analog idecalcidol is more effective in promoting the active transport of calcium, significantly increasing FCA, thereby increasing bone density and reducing the risk of fractures
.
Expert profile Zeng Yuhong, Chief Physician, Executive Director of the Osteoporosis Department of Xi’an Honghui Hospital, Chief Physician, Member of the Osteoporosis and Bone Mineral Disease Branch of the Chinese Medical Association Member of the Osteoporosis Group of the Chinese Medical Association Orthopedic Branch Shaanxi Provincial Physician Association Chairman of the Branch of Osteoporosis and Bone Mineral Salt Physicians, Vice Chairman of the Osteoporosis and Bone Mineral Diseases Branch of the Shaanxi Medical Association, Vice Chairman of the Orthopedics Professional Committee of the Physician Education and Training Professional Committee of the Osteoporosis Branch of the Chinese Society of Gerontology and Geriatrics Member of the Standing Committee of the Chinese Medical Education Association Bone Disease Professional Committee Vice Chairman, Xi’an Medical Association Osteoporosis and Bone Mineral Salt Diseases Branch Chairman, etc.
References: [1] Osteoporosis and Bone Mineral Salt Disease Branch of Chinese Medical Association.
China Bone Journal of Porosity and Bone Mineral Diseases, 2017, 10(5): 413-443.
[2] Zhu Hanmin.
Calcium, Vitamin D and Osteoporosis Prevention and Treatment.
Drug Evaluation, 2012, 9(7): 21-27 .
[3]Child Health Care Branch of Chinese Preventive Medicine Association.
China Maternal and Child Health Research, 2019, 167(3):7-14.
[4]Wang Jianzhi, et al.
Pathophysiology (Ninth Edition).
People's Medical Publishing House.
2018 :67.
[5]Christakos S, et al.
Bonekey Rep, 2014, 3:496.
[6]Walters JR, et al.
J Bone Miner Res, 2006, 21(11):1770-1777.
[7]Sasaki H, et al.
Heterocycles, 2011, 83(6):1385.
[8] Liu Zhaopeng et al.
Synthesis of active vitamin D3 drugs, Masacalcitol and Alcalcidol and their derivatives.
[9] Uenishi K , et al.
Osteoporos Int, 2018, 29(3):723-732.
- End-"This article is only used to provide scientific information to medical and health professionals and does not represent the platform's position.
" For submission/reprint/business cooperation, please contact : Pengsanmei@yxj.
org.
cn
The important relationship between vitamin D and calcium and phosphorus metabolism and bone health has been continuously discovered.
Damage and bone fragility increase, bone strength decreases, bone formation and bone resorption are in a negative balance, and bone loss is obvious [1]
.
Calcium is an essential element during the bone formation and reconstruction process during the whole life cycle, and supports the development and formation of bone organs [2]
.
At the same time, important associations of vitamin D with calcium and phosphorus metabolism and bone health have been continuously discovered
.
Therefore, the use of calcium and vitamin D is an important means to prevent and treat osteoporosis
.
So, what is the relationship between vitamin D and calcium metabolism and maintaining bone health? Do calcium and vitamin D have to be used in combination in clinical practice? Recently, Professor Zeng Yuhong from Xi’an Honghui Hospital accepted the invitation of the “medical community” to elaborate on the above questions
.
Prevention and treatment of osteoporosis: Let doctors "love and hate" calcium in adults, the total amount of calcium in the body is generally about 700~1500g, accounting for about 2% of body weight, of which 99% of calcium is distributed in bones and teeth, which is bone plastic Elements necessary for bone formation in the process of reconstruction and reconstruction [2]
.
Outside the bones, calcium is distributed in the blood or cells in the form of soluble calcium
.
Ionized calcium in the blood is widely involved in a variety of physiological functions in the human body, such as blood coagulation, maintaining the normal excitability of the heart, muscles, and nervous system
.
As a key signal molecule and ion, intracellular calcium participates in gene expression, synaptic transmission and synaptic plasticity [3]
.
Professor Zeng Yuhong pointed out that calcium is of great significance to many organ systems such as human bones, which makes people prefer it
.
Unfortunately, calcium alone has limited effects in increasing bone density and reducing the risk of fractures.
Therefore, it cannot be used as a treatment for osteoporosis and is only a nutritional supplement for bone health
.
Active Vitamin D: Two-pronged approach to promote intestinal calcium absorption.
Calcium is obtained through food intake.
Intestinal calcium absorption is the main way for calcium to enter the human body.
The layer of epithelial cells absorb into the blood[3], and then reach the bones to form hydroxyapatite crystals, completing bone mineralization
.
Active vitamin D is one of the most important factors to promote the absorption of calcium in the intestines, and can regulate the above two transport pathways
.
Through the combination with vitamin D receptor (VDR), active vitamin D enters the nucleus, accelerates the transcription of DNA into mRNA, and promotes the biosynthesis of Ca2+ transport related proteins (TRPV6, calcium binding protein, PMCA1b, etc.
); active vitamin D also stimulates basement membrane The activation of adenylate cyclase, under the combined action of PMCA1b and Ca2+-ATPase, transports Ca2+ to the blood through active energy consumption.
In addition, studies have shown that active vitamin D and VDR also have a regulatory effect on the paracellular passive transport of calcium.
Active vitamin D also up-regulates the expression of tight junction protein-2/12/15, thereby promoting the passive transport of calcium (Figure 1) [4, 5]
.
Figure 1 Both pathways of intestinal calcium absorption are regulated by active vitamin D.
Professor Zeng Yuhong further pointed out that the absorption of intestinal calcium is affected by many factors
.
For example, for people on a low-calcium diet (calcium intake <400 mg/d), intestinal calcium absorption is based on active transcellular transport, and the intestinal calcium absorption rate (FCA) can be as high as 70%; for people on a high-calcium diet (calcium intake 800~ 1000mg/d) mainly passive transportation, FCA is only 20%
.
The drug glucocorticoid inhibits the production of active vitamin D and reduces intestinal calcium absorption
.
Innovative breakthrough, intestinal calcium absorption and adding new power.
The elderly are prone to vitamin D deficiency, their kidneys' ability to hydroxylate 25OHD 1α is weakened, and the synthesis of active vitamin D in the body is insufficient; at the same time, the expression of calcium ion channels TRPV6 and VDR also declines[6] Therefore, the intestinal calcium absorption rate decreases, bone absorption increases, bone density decreases, osteoporosis and fracture risk increase, and bone health is seriously affected
.
Professor Zeng Yuhong emphasized that clinically, ordinary vitamin D cannot be equated with active vitamin D.
The former is a nutritional supplement for bone health, and the latter is an anti-osteoporosis drug
.
After ordinary vitamin D enters the body, it needs to be hydroxylated into active vitamin D through the liver and kidney to promote intestinal calcium absorption; active vitamin D does not require kidney hydroxylation, which is suitable for elderly patients with osteoporosis or osteoporosis patients with nephropathy The role of calcium carbonate is particularly prominent, such as calcitriol, alfacalcidol, idecalcidol and so on
.
Professor Zeng Yuhong pointed out that, unlike other active vitamin D, the new active vitamin D analogue idecalcidol uses microbial hydroxylation technology to introduce 3-hydroxypropionic acid at the 2β position, which is more stable in the blood and cell levels and binds to VDR.
Stable, longer half-life, increased biological activity in target cells, and not easily inactivated by metabolism [7, 8]; at the same time, it increases the duodenal mRNA expression of TRPV6 and calcium-binding protein Calbindin-D9k, which is more effective in promoting calcium Active transportation increases FCA (Figure 2) [5]
.
Figure 2 Mechanism of idecalcidol to promote intestinal calcium absorption A randomized controlled study provided clinical evidence support for idecalcidol to significantly improve FCA in patients with osteoporosis
.
The study included 40 patients with postmenopausal osteoporosis, randomly divided into four groups, receiving idecalcidol 0.
75μg/d, alfacalcidol 1μg/d, ordinary vitamin D3 800IU/day, no drug control , Continued treatment for 4 weeks, the results showed that: compared with the control group, after 4 weeks of treatment, the FCA of the idecalcidol group increased more than that of the alfacalcidol group (59.
5% vs 45.
9%) [9]
.
Figure 3 The treatment of idcalcidol significantly improves the FCA of patients with osteoporosis.
Summary Calcium is an essential element in the bone formation phase during the process of bone reconstruction and reconstruction
.
Intestinal calcium absorption is the main way for calcium to enter the human body.
Active vitamin D is one of the most important factors to promote intestinal calcium absorption.
It can regulate the two pathways of active transport and passive transport
.
As we age, FCA decreases, and the risk of osteoporosis and fractures increases
.
The new active vitamin D analog idecalcidol is more effective in promoting the active transport of calcium, significantly increasing FCA, thereby increasing bone density and reducing the risk of fractures
.
Expert profile Zeng Yuhong, Chief Physician, Executive Director of the Osteoporosis Department of Xi’an Honghui Hospital, Chief Physician, Member of the Osteoporosis and Bone Mineral Disease Branch of the Chinese Medical Association Member of the Osteoporosis Group of the Chinese Medical Association Orthopedic Branch Shaanxi Provincial Physician Association Chairman of the Branch of Osteoporosis and Bone Mineral Salt Physicians, Vice Chairman of the Osteoporosis and Bone Mineral Diseases Branch of the Shaanxi Medical Association, Vice Chairman of the Orthopedics Professional Committee of the Physician Education and Training Professional Committee of the Osteoporosis Branch of the Chinese Society of Gerontology and Geriatrics Member of the Standing Committee of the Chinese Medical Education Association Bone Disease Professional Committee Vice Chairman, Xi’an Medical Association Osteoporosis and Bone Mineral Salt Diseases Branch Chairman, etc.
References: [1] Osteoporosis and Bone Mineral Salt Disease Branch of Chinese Medical Association.
China Bone Journal of Porosity and Bone Mineral Diseases, 2017, 10(5): 413-443.
[2] Zhu Hanmin.
Calcium, Vitamin D and Osteoporosis Prevention and Treatment.
Drug Evaluation, 2012, 9(7): 21-27 .
[3]Child Health Care Branch of Chinese Preventive Medicine Association.
China Maternal and Child Health Research, 2019, 167(3):7-14.
[4]Wang Jianzhi, et al.
Pathophysiology (Ninth Edition).
People's Medical Publishing House.
2018 :67.
[5]Christakos S, et al.
Bonekey Rep, 2014, 3:496.
[6]Walters JR, et al.
J Bone Miner Res, 2006, 21(11):1770-1777.
[7]Sasaki H, et al.
Heterocycles, 2011, 83(6):1385.
[8] Liu Zhaopeng et al.
Synthesis of active vitamin D3 drugs, Masacalcitol and Alcalcidol and their derivatives.
[9] Uenishi K , et al.
Osteoporos Int, 2018, 29(3):723-732.
- End-"This article is only used to provide scientific information to medical and health professionals and does not represent the platform's position.
" For submission/reprint/business cooperation, please contact : Pengsanmei@yxj.
org.
cn
