This document discusses two types of pathologic calcification: dystrophic calcification and metastatic calcification. Dystrophic calcification occurs in areas of dead or damaged tissue and is characterized by the deposition of calcium salts in necrotic areas. It occurs at normal calcium levels. Metastatic calcification occurs in normal living tissues and is associated with abnormal calcium metabolism and hypercalcemia. Common sites of metastatic calcification include the kidneys, lungs, blood vessels, and cornea. The key difference between the two is that dystrophic calcification occurs locally in damaged tissues, while metastatic calcification is driven by systemic issues with calcium regulation.

1. Dystrophic & Metastatic Calcification
Pathologic Calcification
Pathophysiology
ROHIT KUMAR TRIVEDI
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3. ▪ It is the Deposition/Accumulation of Calcium phosphate and other
calcific salts in tissue other than osteoid* or enamel.
▪ The deposition may be intracellular, extracellular or at both the
locations.
▪ There are two types of pathologic calcification:
1. Dystrophic Calcification 2. Metastatic Calcification
* Osteoid is a protein mixture secreted by osteoblasts that forms the organic matrix of bone. Bone is
formed when osteoid mineralizes. osteoid is the unmineralized, organic portion of the bone matrix that
forms prior to the maturation of bone tissue.
Pathologic Calcification

4. 1. Dystrophic calcification
▪ Encountered in areas of necrosis.
▪ It is the deposition of calcium salts in dead or degenerated tissues
▪ Occurs at normal Calcium metabolism and normal serum calcium level.
2. Metastatic Calcification
▪ Occurs in normal tissues.
▪ Associated with deranged calcium metabolism and hypercalcaemia.
Pathologic Calcification: Types

5. ▪ It is encountered in areas of necrosis, whether they are of
coagulative, caseous, or liquefactive type, and in foci (place)
of enzymatic necrosis of fat.
▪ Calcification is almost always present in the atheromas* of
advanced atherosclerosis**.
▪ It also commonly develops in aging or damaged heart
valves, further hampering their function.
❖ *Atheroma, or atheromatous plaque ("plaque"), is an abnormal accumulation
of material in the inner layer of the wall of an artery
❖ **Atherosclerosis is a disease in which plaque builds up inside arteries.
Pathologic Calcification: Types
1. Dystrophic Calcification

6. ▪ The calcium salts appear macroscopically as
fine, white granules or clumps, often felt as
gritty deposits.
▪ Dystrophic calcification may simply be a
telltale sign of previous cell injury, it is often
a cause of organ dysfunction.
Dystrophic calcification of the aortic valve
Pathologic Calcification: Types
1. Dystrophic Calcification

7. May occur in normal tissues whenever there is hypercalcaemia would include one of the
following two conditions:
1. Excessive mobilization of calcium from the bone.
2. Excessive absorption of calcium from the gut.
These causes are more common and include the following :
1. Hyperparathyroidism
2. Bony destructive lesions
3. Prolonged immobilization of a patient results in disuse atrophy of the bones and
hypercalcaemia
Pathologic Calcification: Types
2. Metastatic calcification

8. Less often, excess calcium may be absorbed from the gut causing hypercalcaemia and
metastatic calcification. These causes are as under:
1. Hypervitaminosis-D results in increased calcium absorption.
2. Milk-alkali syndrome caused by excessive oral intake of calcium in the form of milk
and administration of calcium carbonate in the treatment of peptic ulcer.
3. Hypercalcaemia of infancy is another condition in which metastatic calcification
may occur.
Sites of Metastatic Calcification
▪ Metastatic calcification can occur in any normal tissue of the body but affects the
following organs more commonly
- Kidney - Lungs, especially in the alveolar walls
- Stomach - Blood Vessels
- Cornea - Synovium
Pathologic Calcification: Types
2. Metastatic calcification

9. Difference Between Dystrophic & Metastatic Calcification
Pathologic Calcification
Feature Dystrophic Calcification Metastatic Calcification
Definition Deposition of calcium salts in dead and degenerated
tissues.
Deposits of calcium salts in normal tissues.
Calcium Metabolism Normal Deranged
Serum calcium level Normal Hypercalcaemia
Reversibility Generally irreversible Reversible upon correction of metabolic
disorder.
Causes Necrosis (caseous, liquefactive, fat), old scars,
atheromas,
Hyperparathyroidism, prolonged
immobilization, hypervitaminosis-D, milk-
alkali syndrome, hypercalcaemia of infancy
Pathogenesis Increased binding of phosphates with increased
necrotic and degenerative tissue, which in turn binds
to calcium forming calcium phosphates.
Precipitation of calcium phosphate due to
hypercalceamia at certain sites e.g. in
lungs, stomach, cornea,

10. - References -
Dystrophic & Metastatic Calcification
Pathologic Calcification

11. Dystrophic & Metastatic Calcification
Pathologic Calcification
Practice Questions
1. What do you mean by pathologic calcification? Discuss.
2. Classify pathologic calcification with suitable examples.
3. Discuss the pathogenesis of dystrophic calcification.
4. What are the major sites of metastatic calcification?
5. What is the Difference Between Dystrophic & Metastatic Calcification.
6. Define following terms:
▪ Osteoid
▪ Osteoblasts
▪ Hypercalcaemia
▪ Coagulative, caseous and liquefactive Necrosis
▪ Atheromas
▪ Atherosclerosis
▪ Hypervitaminosis-D

12. Rohit Kumar Trivedi
Assistant Professor, Pharmacy