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Sandra Drummond looks at the role of calcium in preventing osteoporosis

A dialysate containing a calcium concentration of 1.75 mmol/L has been the standard in CAPD for a long time. This concentration was chosen to achieve a positive calcium balance to suppress hyperparathyroidism. In the measurement of peritoneal calcium mass transfer, conflicting results have been published, with positive and negative calcium balances reported. These differences have been explained by differences in the filtration rate, and a negative correlation between the filtration rate and the peritoneal calcium mass transfer can be found. Whereas nearly all patients in this study had a negative calcium balance using a glucose solution of 3.86%, a wide variation was found for the 1.36% glucose solution. There were several patients who had a positive calcium balance despite a positive filtration rate. The explanation for this finding lay in differences in serum concentrations of calcium, and especially differences in the size of the total exchangeable calcium pool that contains the plasma calcium compartment. A negative correlation between peritoneal calcium balance and the size of the total exchangeable calcium pool could be demonstrated. This finding may explain the differences in the peritoneal calcium flux reported in the literature. As an enlargement of the exchangeable calcium pool correlates with the progression of vascular calcification, therapeutic efforts should be directed toward prevention of an enlargement of this pool.

Calcium is an important nutrient but also contributes to the texture, taste and functionality of most dairy products. The balance between micellar and free calcium in curd and serum phase during direct acidification of bovine milk was studied by changing organic acid type, pH and acidification temperature. Concentration of free calcium increased with decreasing pH and increasing temperature. Citric acid was more efficient than lactic acid at lowering free calcium concentration, while temperature effect was larger for acidification with lactic acid. These findings are rationalized by the stronger binding of calcium to citrate compared to lactate with an almost athermal binding for citrate and an endothermal binding for lactate. Curd yield decreased by decreasing pH as solubilization of colloidal calcium phosphate causes loss of minerals into the serum phase decreasing the concentration of both calcium and phosphate left in the curd, while acidification temperature had little effect on curd yield. These results are important to improve yield and tailor the properties and functionality of dairy products, such as for example Mozzarella cheese.

Crustaceans have been extensively used as models to study Ca balance because of their exoskeletons, which undergo Ca dynamics associated with the molting cycle. This article discusses major findings during the past 10 yr. Discussion of intermolt Ca regulation focuses on two areas: (1) mechanisms that enable extracellular (EC) Ca levels to be maintained irrespective of environmental levels and (2) evidence for acidosis-induced exoskeletal CaCO₃ mobilization. Marine crustaceans routinely maintain EC Ca levels above ambient Ca levels by protein binding and in dilute seawater (SW) by active uptake; urine is isoionic with respect to Ca. Extracellular Ca rises when subtidal species are aerially exposed. Freshwater (FW) crayfish tolerate passive branchial Ca eflux while influx mechanisms are inoperative. Filtered Ca is extensively reabsorbed in the antennal gland so that renal loss is minimal. Circulating Ca can be altered by exposure to low-Ca water or hypersaline media. Acid-intolerant species may experience a...

BACKGROUND Low intakes of calcium are associated with an increased risk of both osteoporosis and cardiovascular disease. OBJECTIVE To provide new estimates of the average calcium requirement for men and women, we determined the dietary calcium intake required to maintain neutral calcium balance. DESIGN Calcium balance data [calcium intake -(fecal calcium + urinary calcium)] were collected from 155 subjects [women: n = 73; weight: 77.1 +/- 18.5 kg; age: 47.0 +/- 18.5 y (range: 20-75 y); men: n = 82; weight: 76.6 +/- 12.5 kg; age: 28.2 +/- 7.7 y (range: 19-64 y)] who participated in 19 feeding studies conducted in a metabolic unit. Balance data from the final 6-12 d of each dietary period (minimum length:18 d) of each study (1-9 observations per subject) were analyzed. Data were excluded if individual intakes of magnesium, copper, iron, phosphorus, or zinc fell below the estimated average requirements or exceeded the 99 th percentile of usual intakes from the 1994 Continuing Survey of Food Intakes by Individuals (for iron, above the upper limit). Daily intakes of calcium ranged between 415 and 1740 mg. The relation between intake and output was examined by fitting random coefficient models. Coefficients were included to test for sex and age differences. RESULTS The models predicted a neutral calcium balance [defined as calcium output (Y) equal to calcium intake (C)] at intakes of 741 mg/d [95% prediction interval (PI): 507, 1035; Y = 148.29 + 0.80C], 9.4 mg kg body wt(-1) d(-1) [95% PI: 6.4, 12.9; Y = 1.44 + 0.85C], or 0.28 mg kcal(-1) d(-1) [95% PI: 0.19, 0.38; Y = 0.051 + 0.816C]. Neither age nor sex affected the estimates when calcium intakes were expressed as mg/d or as mg kg body wt(-1) d(-1). CONCLUSION The findings suggest that the calcium requirement for men and women is lower than previously estimated.

P(論文), The calcium (Ca) balance was studies in four strains of rat (Wistar, Fischer, Sprague-Dawley and Donryu), maintained on either a diet, supplemented with Harper mineral mixture or a diet supplemented AIN-76 mineral mixture. Six rats from each experimental group were killed after 21 days of diet feeding. During 16 to 21 days excreta were collected separately from each rat. The measurement of Ca were performed by the method of atomic absorption spectrometry. The amounts of food intake were significantly increased or decreased according to strain difference, but not affected by the rats of mineral mixture supplemented to diet. The major cause for the variation of Ca balance was due to the change of food intake according to strain difference. The effect of mineral mixture on Ca balance might be dependent on dietary content of Ca, but not on urinary Ca excretion.

Backgrounds. Calcium (Ca) and bone metabolism in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) patients show a remarkable difference depending on dialysis modalities. The levels of serum Ca and phosphate (P) in HD patients fluctuate contributing to the intermittent and rapid removal of plasma solute unlike in CAPD. Characteristics of plasma solute transport in automated peritoneal dialysis (APD) patients are resembled with that in HD. The purpose of the present study was to examine the difference of transperitoneal Ca removal between APD and CAPD anuric patients.Subjects and Methods. Twenty-three APD anuric patients were enrolled in this study. Biochemical parameters responsible for transperitoneal Ca removal in 24-hour and 4-hour peritoneal effluents were analyzed on CAPD and APD.Results. Transperitoneal Ca removal on APD was smaller compared with that on CAPD. The Ca removal was related to the ultrafiltration during short-time dwell. Decrease of the Ca removal during NPD induced by short-time dialysate dwell caused negative or small Ca removal in APD patients. The levels of intact PTH were increased at the end of PET.Conclusion. It appears that short-time dwell and frequent dialysate exchanging might suppress the transperitoneal Ca removal in anuric APD patients.

25 Pag., 5 Tabl. The definitive version is available at: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1522-2624, Experiments to evaluate the effect of in-season calcium (Ca) sprays on late-season peach (Prunus persica L. Batsch cv. Calrico) were carried out for a 2-year period. Calcium formulations (0.5% and 1.0% in 2008 and only 0.5% tested in 2009) supplied either as CaCl2 or Ca propionate in combination with two or three adjuvants (0.05% of the nonionic surfactants Tween 20 and Break Thru, and 0.5% carboxymethylcellulose, CMC) were sprayed four to five times over the growing season. Peach mesocarp and endocarp Ca concentrations were determined on a 15-day basis from the beginning of May until the end of June. Further tissue analyses were performed at harvest. A decreasing trend in fruit Ca concentrations over the growing season was always observed regardless of the Ca treatments. Both in 2008 and 2009, significant tissue Ca increments associated with the application of Ca-containing sprays in combination with adjuvants were only observed in June, which may be coincident with the period of pit hardening. In 2008, both at harvest and after cold storage, the total soluble-solids concentration (° Brix) of fruits supplied with Ca propionate (0.5% and 1.0% Ca) was always lower as compared to the rest of treatments. The application of multiple Ca-containing sprays increased firmness at harvest and after cold storage, especially when CaCl2 was the active ingredient used. Supplying the adjuvants Tween 20 and CMC increased fruit acidity both at harvest and after cold storage. Evaluation of the development of physiological disorders after cold storage (2 weeks at 0°C) indicated a lower susceptibility of Ca-treated fruits to internal browning. Fruits treated with multiple CaCl2-, CMC-, and Break Thru®-containing sprays during the growing season were significantly less prone to the development of chilling injuries as compared to untreated peaches., Dr. V. Fernández is supported by a “Torres Quevedo contract” (MICINN-PTQ) co-financed by the European Social Fund. Work was financed by AGL2009-08501/AGR (Programa Nacional de Proyectos de Investigación Fundamental), and INIA (PET2007-09-C5), cofinanced by the European Social Fund.

Stanniocalcin-1 (STC-1) was first identified to involve in Ca(2+) homeostasis in teleosts, and was thought to act as a hypocalcemic hormone in vertebrate. Recent studies suggested that STC-1 exhibits broad effects on ion balance, not confines to Ca(2+), but the mechanism of this regulation process remains largely unknown. Here, we used zebrafish embryos as an alternative in vivo model to investigate how STC-1 regulates transepithelial ion transport function in ion-transporting epithelium. Expression of stc-1 mRNA in zebrafish embryos was increased in high-Ca(2+) environments but decreased by acidic and ion-deficient treatments while overexpression of stc-1 impaired the hypotonic acclimation by decreasing whole body Ca(2+), Na(+), and Cl(-) contents and H(+) secretion ability. Injection of STC-1 mRNA also down-regulated mRNA expressions of epithelial Ca(2+) channel, H(+)-ATPase, and Na(+)-Cl(-) cotransporter, suggesting the roles of STC-1 in regulation of ions other than Ca(2+). Knockdown of STC-1 caused an increase in ionocyte progenitors (foxi3a as the marker) and mature ionocytes (ion transporters as the markers), but did not affect epithelium stem cells (p63 as the marker) in the embryonic skin. Overexpression of STC-1 had the corresponding opposite effect on ionocyte progenitors, mature ionocytes in the embryonic skin. Taken together, STC-1 negatively regulates the number of ionocytes to reduce ionocyte functions. This process is important for body fluid ionic homeostasis, which is achieved by the regulation of ion transport functions in ionocytes. The present findings provide new insights into the broader functions of STC-1, a hypocalcemic hormone.

The response of calciotropic hormones and bone turnover to exercise and immobilization was examined by the measurement of calcium balance, bone turnover indexes, levels of parathyroid hormone, nephrogenous adenosine 3',5'-cyclic monophosphate (cAMP), and 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] weekly for 6 wk in three groups of rats: control, exercise trained, and immobilized. Early in the experiment, increases were observed in excretion of urinary calcium, hydroxyproline, and in serum alkaline phosphatase after both exercise and immobilization. It was not until the latter part of the experimental period that changes were observed in nephrogenous cAMP and intestinal absorption efficiency of calcium. In the fasting state, the exercise group had a drop in serum calcium and phosphate and a rise in nephrogenous cAMP and serum 1,25(OH)2D3 compared with the control group. The exercised animals experienced an increase in bone mass, whereas the immobilized animals had a decline in bone mass. Thus exercise stimulates bone growth, resulting in an increased demand for minerals that is satisfied by an increase in serum 1,25(OH)2D3 levels and increased intestinal absorption of calcium. The increase in calcium absorption suppresses parathyroid hormone production (nephrogenous cAMP) in the exercised animal. Immobilization resulted in increased bone resorption that suppressed parathyroid hormone, nephrogenous cAMP, and the intestinal absorption of calcium.

Calcium balances performed on 519 individuals from birth to 30 years of age, derived from 34 published reports, were pooled by age group and the relationship between intake and balance for each group was compared at both extremes of the intake range. At all ages, from infancy through the young adult years, balance values tended to flatten and become constant at higher intakes, while at lower intakes balance was invariably highly correlated with intake. Threshold intakes and balances were estimated by fitting the data to a two-component, split, linear-regression model. The threshold values at which balance no longer rose with intake exceeded the US recommended dietary allowances for calcium for all the age groups concerned.

Calcium flux and mode of uptake were investigated in an underground dwelling mole-rat, Cryptomys damarensis, fed diets of varying Ca content. The amount of dietary Ca positively influenced the amounts ingested, absorbed and retained. The linear relationship between ingested and absorbed Ca was significantly (P less than 0.001) correlated, implying that this process is nonsaturable. When mole-rats were fed a diet low in Ca, apparent fractional absorption of Ca was high (85.88%). This increased still further when the diet was changed to a food of greater Ca content (96.13%, carrots; 96.97%, gemsbok cucumber). Mineral homeostasis is regulated at the intestinal level in most mammals. Regardless of dietary Ca content, uptake of 45Ca (examined via the everted gut sac technique) was passive, confirming that absorption is via a nonsaturable process. Plasma Ca concentrations were not tightly regulated, yet when fed the diet with the highest Ca content, mole-rats were not hypercalcemic. Regardless of diets, Ca apparent fractional retention was positive, and approached physiological maxima (greater than 97%). Cryptomys damarensis, in using highly efficient modes of mineral uptake and retention, is therefore capable of fully exploiting the limited food resources of their arid ecotope.

To assess the efficacy, safety and calcium balance of a membrane based regional citrate anticoagulation plasma exchange protocol.This was an observational, prospective, single centre study of membrane separation plasma exchange using regional citrate anticoagulation. It was performed using a fixed dose pre-filter citrate infusion that was based on the plasma flow rate. Patients received a post filter calcium infusion that was modified during treatment based on systemic ionized calcium monitoring. Post filter ionized calcium was not assessed. Safety and efficacy were assessed by extraction of clinical events and laboratory data contemporaneously recorded in electronic health records.Thirty-six sessions in five patients were performed. No patients developed symptomatic hypocalcaemia, and no patient had a recorded ionized calcium below 0.81 mmol/L. Filter clotting occurred in two sessions. The mean net calcium gained was 9.6 ± 1.8 mmol per session.Regional citrate anticoagulated membrane separation plasma exchange can be performed safely and effectively without the need for post filter ionized calcium monitoring. The algorithm employed resulted in a net calcium gain.

Contains fulltext : 35554.pdf ( ) (Open Access) Juvenile gilthead sea bream were exposed to diluted seawater (2.5 per thousand salinity; DSW) for 3 h or, in a second experiment, acclimated to DSW and fed a control or calcium-deficient diet for 30 days. Branchial Ca(2+) influx, drinking rate and plasma calcium levels were assessed. Sea bream plasma parathyroid hormone related protein (sPTHrP) was measured, and mRNAs of pthrp, its main receptor, pth1r, and the calcium-sensing receptor (casr) were quantified in osmoregulatory tissues and the pituitary gland. When calcium is limited in water or diet, sea bream maintain calcium balance; however, both plasma Ca(2+) and plasma sPTHrP concentrations were lower when calcium was restricted in both water and diet. Positive correlations between plasma sPTHrP and plasma Ca(2+) (R(2)=0.30, N=39, P

The nature and mechanism of calcium complexation with human serum components in the presence of silicone rubber were assessed in in vitro model experiments. Silicone rubber samples were incubated for 67 h in serum of both physiologic calcium concentrations and induced hypercalcemic levels. Physiologic calcium incubation decreased the intrinsic and nth binding site association constants by factors of 2 and 4, respectively, from initial serum values. Incubation with silicone rubber did not change the association constants. Hypercalcemia incubation lowered the intrinsic and nth binding site association constants by 39 and 61%, respectively. Polymer incubation increased the intrinsic association constant and decreased the number of binding sites by a factor of 2. With initial binding site association constants unperturbed by incubation and Hill coefficients equivalent to 1, complexation was non-cooperative and binding sites were considered to be identical and independent. Both Scatchard and Hill plots show nonlinearity for the polymer incubation case giving two distinct linear regions. This is indicative of cooperative binding for incubation with polymer; the Hill coefficient for the physiologic calcium concentration range was 0.97, while the coefficient for the hypercalcemic calcium range was 6.

To determine whether during hypokinesia (diminished movement) periodic physical exercise affects calcium (Ca(2+)) balance and Ca(2+) loss.Studies were conducted on 30 physically healthy male volunteers during the preexperimental period of 30 days and the experimental period of 364 days. They were equally divided into three groups: active control subjects (ACS), hypokinetic subjects (HKS), and periodic training subjects (PTS). The ACS group ran an average distance of 9.3+/-1.2 km/d; the HKS group walked an average distance of 1.3+/-0.2 km/d; and PTS group walked and ran average distances of 1.3+/-0.2 km/d and 9.2+/-1.2 km/d for 5 and 2 days per week, respectively.Serum Ca(2+) level, fecal and urine Ca(2+) loss, and Ca(2+) imbalance increased (P0.05) in the PTS and HKS groups compared with their preexperimental levels and the values in their respective ACS group. The serum Ca(2+) concentration, urine and fecal Ca(2+) loss, and Ca(2+) imbalance increased more (P0.05) in the PTS group than in the HKS group.During hypokinesia, Ca(2+) imbalance is more evident with than without physical exercise and Ca(2+) loss is exacerbated more with higher than lower Ca(2+) imbalance.

Background: Additional calcium is required during lactation, and several calcium regulatory factors are involved in calcium balance. In lactating rural women who have marginal nutrition and consume a high-fiber diet, negative calcium balance may be expected. Objective: We evaluated calcium balance and its association with potential calcium regulatory factors in lactating, rural Mexican women who had marginal nutrition and consumed a high-fiber diet. Design: This cross-sectional study included women at 1, 3, 6, and 12 mo of lactation (L1, L3, L6, and L12 groups) and women who had weaned their infants (W group). Age-matched, nonlactating women (NL group) were also included. Calcium balance and concentrations of calcium regulatory factors were determined. Correlation analysis was performed by using data from all of the lactating women. Results: Calcium balance in the L1, L3, and L6 groups was negative and was significantly different (P < 0.05) from that in the W and NL groups. Serum parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D [1,25-(OH) 2 D] concentrations were significantly higher (P < 0.05) in the W group than in the L and NL groups. Calcium balance was positively associated with serum estradiol concentrations (r = 0.58, P < 0.05) and negatively associated with serum 1,25-(OH) 2 D concentrations (r = -0.52, P < 0.05). Breast-milk calcium concentrations correlated positively with serum PTH-related peptide (PTHrP) concentrations (r = 0.51, P < 0.05) and negatively with serum estradiol concentrations (r = -0.57, P < 0.05). Conclusions: Negative calcium balance was observed during lactation in rural Mexican women who consumed a high-fiber diet. Furthermore, the data suggest that the hormones estradiol and PTHrP are involved in the regulation of calcium balance and of the calcium content of milk during lactation.

The dietary acid load created by the typical Western diet may adversely impact the skeleton by disrupting calcium metabolism. Whether neutralizing dietary acid with alkaline potassium salts results in sustained improvements in calcium balance remains controversial. In this randomized, double-blind, placebo-controlled study, 52 men and women (mean age 65.2 ± 6.2 years) were randomly assigned to potassium citrate 60 mmol/d, 90 mmol/d, or placebo daily with measurements of bone turnover markers, net acid excretion, and calcium metabolism, including intestinal fractional calcium absorption and calcium balance, obtained at baseline and at 6 months. At 6 months, net acid excretion was significantly lower in both treatment groups compared to placebo and it was negative, meaning subjects' dietary acid was completely neutralized (-11.3 mmol/d on 60 mmol/d; -29.5 mmol/d on 90 mmol/d, p < 0.001 compared to placebo). At 6 months, 24-hour urine calcium was significantly reduced in persons taking potassium citrate 60 mmol/d (-46 ± 15.9 mg/d) and 90 mmol/d (-59 ± 31.6 mg/d) compared with placebo (p < 0.01). Fractional calcium absorption was not changed by potassium citrate supplementation. Net calcium balance was significantly improved in participants taking potassium citrate 90 mmol/d compared to placebo (142 ± 80 mg/d on 90 mmol/d versus -80 ± 54 mg/d on placebo; p = 0.02). Calcium balance was also improved on potassium citrate 60 mmol/d, but this did not reach statistical significance (p = 0.18). Serum C-telopeptide decreased significantly in both potassium citrate groups compared to placebo (-34.6 ± 39.1 ng/L on 90 mmol/d, p = 0.05; -71.6 ± 40.7 ng/L on 60 mmol/d, p = 0.02) whereas bone-specific alkaline phosphatase did not change. Intact parathyroid hormone was significantly decreased in the 90 mmol/d group (p = 0.01). Readily available, safe, and easily administered in an oral form, potassium citrate has the potential to improve skeletal health. Longer-term trials with definitive outcomes such as bone density and fracture are needed.

Osteoblast function was investigated in 27 patients with idiopathic osteoporosis. Transiliac bone biopsy specimens were taken after double labelling with tetracycline, and metabolic calcium balance was studied almost simultaneously. Many of the patients showed poor double labelling of their otherwise unremarkable trabecular osteoid, suggesting impaired formation of bone at many of these surfaces. This phenomenon was not accompanied by increased width of osteoid seams (as seen in osteomalacia), indicating that formation of the matrix and its mineralisation were in equilibrium. For the first time, highly significant positive correlations (p less than 0.01) were found between indices of bone formation, determined by labelling with tetracycline, and calcium balance. Thus some patients with osteoporosis who are rapidly losing bone have low rates of formation of trabecular bone both by individual osteoblasts and in relation to available bone surfaces. As histological indices of bone resorption also independently correlated strongly and inversely (p less than 0.01) with calcium balance the rate of initiation of new basic multicellular units by osteoclastic resorption of trabecular surfaces (or the depth of resorption at these surfaces) also appears to be an important determinant of mineral balance. The mechanisms that regulate the effective life span of mature osteoblasts require further investigation, particularly as some promising treatments that can increase trabecular bone volume in osteoporosis, such as parathyroid peptide hPTH (1-34) and sodium fluoride, must work through a reversal of osteoblastic depression.

P(論文), http://www.tsc-05.ac.jp/pdf_library/2014.pdf

This chapter discusses the role of calcium balance in aging. Calcium balance is the resultant of several interacting forces, including nutrition, hormonal status, disuse, and general involution. Minimization of the structural impact of a negative calcium balance (that is, a depleted skeleton) requires a multifaceted approach, including, but not limited to, an adequate calcium intake. Because calcium utilization is inefficient even during growth; and becomes more so with age; calcium intake requirements are high, and rise with age. Intakes of calcium for healthy elderly persons should be in the range of 1400–1600 mg/day, and patients with osteoporosis being treated with bone active agents may need substantially more to realize the full benefit of their antiosteoporosis therapies. The goal of a high calcium intake in the elderly is both to make certain that inadequate calcium is not compounding the other negative factors influencing the aging skeleton. and to support any bone-building potential that may reside in current and future antiosteoporosis therapies.

Calcium balance in chronic kidney disease is poorly understood as calcium deficiency is a stimulus for secondary hyperparathyroidism and consequent bone loss while calcium excess promotes extraosseous calcifications. To help resolve this, we evaluated calcium balance in normal individuals and in patients with chronic kidney disease (CKD) on daily diets containing 800 and 2000 mg elemental calcium. Both normal individuals and patients with late stage 3 and stage 4 CKD were in slightly negative to neutral calcium balance on the 800-mg calcium diet. Normal individuals were in modest positive calcium balance on the 2000-mg diet, while patients with CKD on the same diet were in marked positive calcium balance at least over the 9 days of study; and significantly greater than the normal individuals. Increased calcium intake significantly decreased 1,25-dihydroxy-vitamin D and intact parathyroid hormone levels but did not alter the serum calcium concentration. Thus, our findings have important implications for both preventing calcium deficiency and loading in individuals with late stage 3 and stage 4 CKD.