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Evolution of the Calcium Paradigm: The Relation between Vitamin D, Serum Calcium and Calcium Absorption

Osteoporosis is the index disease for calcium deficiency, just as rickets/osteomalacia is the index disease for vitamin D deficiency, but there is considerable overlap between them. The common explanation for this overlap is that hypovitaminosis D causes malabsorption of calcium which then causes se...

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Autor principal: Nordin, Borje E. Christopher
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257716/
https://www.ncbi.nlm.nih.gov/pubmed/22254068
http://dx.doi.org/10.3390/nu2090997
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author Nordin, Borje E. Christopher
author_facet Nordin, Borje E. Christopher
author_sort Nordin, Borje E. Christopher
collection PubMed
description Osteoporosis is the index disease for calcium deficiency, just as rickets/osteomalacia is the index disease for vitamin D deficiency, but there is considerable overlap between them. The common explanation for this overlap is that hypovitaminosis D causes malabsorption of calcium which then causes secondary hyperparathyroidism and is effectively the same thing as calcium deficiency. This paradigm is incorrect. Hypovitaminosis D causes secondary hyperparathyroidism at serum calcidiol levels lower than 60 nmol/L long before it causes malabsorption of calcium because serum calcitriol (which controls calcium absorption) is maintained until serum calcidiol falls below 20 nmol/L. This secondary hyperparathyroidism, probably due to loss of a “calcaemic” action of vitamin D on bone first described in 1957, destroys bone and explains why vitamin D insufficiency is a risk factor for osteoporosis. Vitamin D thus plays a central role in the maintenance of the serum (ionised) calcium, which is more important to the organism than the preservation of the skeleton. Bone is sacrificed when absorbed dietary calcium does not match excretion through the skin, kidneys and bowel which is why calcium deficiency causes osteoporosis in experimental animals and, by implication, in humans.
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spelling pubmed-32577162012-01-17 Evolution of the Calcium Paradigm: The Relation between Vitamin D, Serum Calcium and Calcium Absorption Nordin, Borje E. Christopher Nutrients Review Osteoporosis is the index disease for calcium deficiency, just as rickets/osteomalacia is the index disease for vitamin D deficiency, but there is considerable overlap between them. The common explanation for this overlap is that hypovitaminosis D causes malabsorption of calcium which then causes secondary hyperparathyroidism and is effectively the same thing as calcium deficiency. This paradigm is incorrect. Hypovitaminosis D causes secondary hyperparathyroidism at serum calcidiol levels lower than 60 nmol/L long before it causes malabsorption of calcium because serum calcitriol (which controls calcium absorption) is maintained until serum calcidiol falls below 20 nmol/L. This secondary hyperparathyroidism, probably due to loss of a “calcaemic” action of vitamin D on bone first described in 1957, destroys bone and explains why vitamin D insufficiency is a risk factor for osteoporosis. Vitamin D thus plays a central role in the maintenance of the serum (ionised) calcium, which is more important to the organism than the preservation of the skeleton. Bone is sacrificed when absorbed dietary calcium does not match excretion through the skin, kidneys and bowel which is why calcium deficiency causes osteoporosis in experimental animals and, by implication, in humans. MDPI 2010-09-16 /pmc/articles/PMC3257716/ /pubmed/22254068 http://dx.doi.org/10.3390/nu2090997 Text en © 2010 by the authors; licensee MDPI, Basel, Switzerland http://creativecommons.org/licenses/by/3.0/ This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).
spellingShingle Review
Nordin, Borje E. Christopher
Evolution of the Calcium Paradigm: The Relation between Vitamin D, Serum Calcium and Calcium Absorption
title Evolution of the Calcium Paradigm: The Relation between Vitamin D, Serum Calcium and Calcium Absorption
title_full Evolution of the Calcium Paradigm: The Relation between Vitamin D, Serum Calcium and Calcium Absorption
title_fullStr Evolution of the Calcium Paradigm: The Relation between Vitamin D, Serum Calcium and Calcium Absorption
title_full_unstemmed Evolution of the Calcium Paradigm: The Relation between Vitamin D, Serum Calcium and Calcium Absorption
title_short Evolution of the Calcium Paradigm: The Relation between Vitamin D, Serum Calcium and Calcium Absorption
title_sort evolution of the calcium paradigm: the relation between vitamin d, serum calcium and calcium absorption
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257716/
https://www.ncbi.nlm.nih.gov/pubmed/22254068
http://dx.doi.org/10.3390/nu2090997
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