Chapter 27. Ca2<sup>±</sup>Sensing Receptor

Brown, Edward M.

doi:10.1002/9780470623992.ch27

Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism 2008

DOI: 10.1002/9780470623992.ch27

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Chapter 27. Ca2^±Sensing Receptor

Edward M. Brown¹

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Effects of Strontium Ranelate Administration on Calcium Metabolism in Female Patients with Postmenopausal Osteoporosis and Primary Hyperparathyroidism

et al. 2012

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We investigated possible changes of parameters of calcium metabolism induced by strontium ranelate (SR). Twenty-three patients with postmenopausal osteoporosis (PO) and 14 with primary hyperparathyroidism (PHPT) were studied while taking 2 g/day of SR. Women with PO and 10 healthy age-matched control women were also daily supplemented with 1,000 mg calcium and 800 IU vitamin D. All subjects were studied at baseline and after 7 and 30 days; PO women and controls were also investigated at 180 and 360 days of treatment. Serum ionized calcium (iCa), phosphate (sP), magnesium, creatinine, 25-hydroxycholecalciferol (25[OH]D), 1,25-dihydroxycholecalciferol (1,25[OH](2)D), serum parathyroid hormone (PTH) were measured. In spot urine, we assessed calcium and phosphate over creatinine ratios (uCa/Cr, uP/Cr), calcium excretion (Ca ex) and renal phosphate threshold (TmP/GFR); in 24-h urine, calcium and magnesium over creatinine clearance ratios (CaCl/CrCl and MgCl/CrCl). In PO, SR administration was associated with a significant decrease of PTH and 1,25(OH)(2)D levels but an increase of sP (p < 0.001). SR also significantly increased Ca/Cr, Ca ex, and TmP/GFR in spot urine and CaCl/CrCl in both spot and 24-h urine (p = 0.004 to <0.001). In PHPT, SR significantly decreased iCa and increased sP, slightly modifying PTH, 25(OH)D, and 1,25(OH)(2)D values. Also in PHPT, Ca ex and CaCl/CrCl of spot and 24-h urine, as TmP/GFR, significantly increased (all p < 0.02). SR influenced the main parameters of calcium homeostasis, probably through the calcium-sensing receptor.

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Effects of Strontium Ranelate Administration on Calcium Metabolism in Female Patients with Postmenopausal Osteoporosis and Primary Hyperparathyroidism

et al. 2012

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Contribution of Intestine, Bone, Kidney, and Dialysis to Extracellular Fluid Calcium Content

Bushinsky

2010

Clinical Journal of the American Society of Nephrology

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Calcium (Ca) balance is the net of Ca intake and output from the body over a period of time. The concept of Ca balance does not consider the redistribution of Ca that often occurs in patients with chronic kidney disease (CKD), especially those who are on dialysis, which is often in the form of soft tissue and/or vascular calcification. In this article, we consider movement of Ca with respect to the extracellular fluid (ECF) and develop a mathematical formulation for Ca homeostasis with respect to the ECF that includes input and output from the diet, the bone, the kidney, and dialysis. We consider calcium homeostasis in healthy individuals and in patients with excess parathyroid hormone, excess 1,25-dihydroxyvitamin D 3 , and metabolic acidosis; patients who have CKD and are not on dialysis; and, finally, patients who have CKD and are on dialysis. On the basis of a number of assumptions, dialysis patients with a daily intake of >37.5 mmol of elemental Ca (1.5 g) have movement of Ca into the ECF even without supplemental activated vitamin D. Addition of activated vitamin D, which increases intestinal Ca absorption and can increase resorption of Ca from bone, leads to the movement of Ca into the ECF at virtually all levels of intake; however, there are numerous unanswered questions regarding Ca homeostasis in patients with CKD, including how much of the Ca, administered as a phosphate binder, is absorbed and what is the fate of this absorbed Ca. Until these pressing questions are answered with well-designed experiments, we do not know whether we are doing more harm than good for our dialysis patients by administering additional Ca as a phosphate binder, especially when they also receive activated vitamin D.

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Chapter 27. Ca2^±Sensing Receptor

Cited by 2 publications

References 68 publications

Effects of Strontium Ranelate Administration on Calcium Metabolism in Female Patients with Postmenopausal Osteoporosis and Primary Hyperparathyroidism

Effects of Strontium Ranelate Administration on Calcium Metabolism in Female Patients with Postmenopausal Osteoporosis and Primary Hyperparathyroidism

Contribution of Intestine, Bone, Kidney, and Dialysis to Extracellular Fluid Calcium Content

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Chapter 27. Ca2±Sensing Receptor

Cited by 2 publications

References 68 publications

Effects of Strontium Ranelate Administration on Calcium Metabolism in Female Patients with Postmenopausal Osteoporosis and Primary Hyperparathyroidism

Effects of Strontium Ranelate Administration on Calcium Metabolism in Female Patients with Postmenopausal Osteoporosis and Primary Hyperparathyroidism

Contribution of Intestine, Bone, Kidney, and Dialysis to Extracellular Fluid Calcium Content

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Product

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Chapter 27. Ca2^±Sensing Receptor