Calcium homeostasis vitamin d-parathyroid-calcitonin role (rickets,hypercalcemia,hyperparathyroidism,osteoporosis,renal osteodystrophy) prevention dr.sandeep c agrawal agrasen hospital gondia india
CALCIUM METABOLISM:
VITAMIN D-PARATHYROID-CALCITONIN ROLE
(Rickets,Osteoporosis,Renal Osteodystrophy)
Prevention Dr.Sandeep C Agrawal Agrasen Hospital Gondia India
Metabolic Bone Diseases:phosphorus,magnesium and other minerals ,Calcium and vitamin D rich diets,Sunlight exposure,vitamin D synthesis,Osteoporosis prevention and diet
This is a PPT of calcium and phosphate metabolism. Clinical correlation are not included. Hope it is useful to you all. Please Like and Share it with your friends
This is a PPT of calcium and phosphate metabolism. Clinical correlation are not included. Hope it is useful to you all. Please Like and Share it with your friends
Biochemistry of Calcium metabolism covering the source, factors effecting absorption, normal level of calcium, regulation of the calcium, hypercalcemia, hypocalcemia, disorders related to calcium and bone markers.
Useful for students of MBBS, BDS, BSc, MSc, MLT, Physiotherapy (BPT), Nursing etc.
Calcium metabolism disorders
1. CALCIUM METABOLISM DISORDERS
2. OVERVIEW: Calcium definition and requirement . Calcium metabolism regulators : VD , PTH and calcitonin. Functions of calcium. Calcium metabolic bone diseases. Calcium metabolism disorders. CASE !!
3. WHAT IS CALCIUM? Calcium is a mineral that is essential to bone health, cardiovascular health, muscle maintenance, circulatory health, and blood clotting. Calcium also acts as an enzyme activator. While calcium is found in milk and dairy products, it is also available from other food sources, such as green leafy vegetables, seafood (eating salmon with the bones provides an even greater dose), almonds, blackstrap molasses, broccoli, enriched soy and rice milk products, figs, soybeans and tofu.
A 33-year old man with polyuria and polydipsiaUsama Ragab
Clinical case uncovered (CCU) series
Endocrinology and diabetes
Case number 11: A 33-year old man with polyuria and polydipsia
Medical case presentation of polyuria
Biochemistry of Calcium metabolism covering the source, factors effecting absorption, normal level of calcium, regulation of the calcium, hypercalcemia, hypocalcemia, disorders related to calcium and bone markers.
Useful for students of MBBS, BDS, BSc, MSc, MLT, Physiotherapy (BPT), Nursing etc.
Calcium metabolism disorders
1. CALCIUM METABOLISM DISORDERS
2. OVERVIEW: Calcium definition and requirement . Calcium metabolism regulators : VD , PTH and calcitonin. Functions of calcium. Calcium metabolic bone diseases. Calcium metabolism disorders. CASE !!
3. WHAT IS CALCIUM? Calcium is a mineral that is essential to bone health, cardiovascular health, muscle maintenance, circulatory health, and blood clotting. Calcium also acts as an enzyme activator. While calcium is found in milk and dairy products, it is also available from other food sources, such as green leafy vegetables, seafood (eating salmon with the bones provides an even greater dose), almonds, blackstrap molasses, broccoli, enriched soy and rice milk products, figs, soybeans and tofu.
A 33-year old man with polyuria and polydipsiaUsama Ragab
Clinical case uncovered (CCU) series
Endocrinology and diabetes
Case number 11: A 33-year old man with polyuria and polydipsia
Medical case presentation of polyuria
Hypercalcaemia certainly possesses some diagnostic challenges
Cases are too different in ways of presentation and management do need a lot of things to be checked out. This is merely an approach for such patients.
Similar to Calcium homeostasis vitamin d-parathyroid-calcitonin role (rickets,hypercalcemia,hyperparathyroidism,osteoporosis,renal osteodystrophy) prevention dr.sandeep c agrawal agrasen hospital gondia india
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
metabolism is the sum total of tissue activity as considered in terms of physicochemical changes associated with and regulated by the availability, utilization and disposal of protein, fat, carbohydrate, vitamins, minerals, water and the influences which the endocrines exert on these processes”
The mineral elements constitutes only small proportion of body weight.
Minerals perform several vital functions which are absolutely essential for the existance of the organism.
These include calcification of bone, blood coagulation, neuromuscular irritability, acid-base equilibrium, fluid balance and osmotic regulation.
calcium , phosphorous metabolism and its regulation based on Tietz textbook of clinical chemistry and molecular diagnostics-6th edition
Similar to Calcium homeostasis vitamin d-parathyroid-calcitonin role (rickets,hypercalcemia,hyperparathyroidism,osteoporosis,renal osteodystrophy) prevention dr.sandeep c agrawal agrasen hospital gondia india (20)
http://www.drsandeepagrawal.com/spine.php
There are many different types of conditions that cause back pain. Like most medical conditions, back pain is treatable through several methodologies. Determining what condition you have is the key to determining the right treatment option for you. Back pain comes in many forms, lower back pain, middle back pain, and upper back pain are just a few of the symptoms associated with spinalconditions. You may also have pain or tingling in your extremities that may be indications of spinal conditions. Feel free to browse through our articles about conditions. Contact your doctor to set up an appointment to start your road to recovery.
Every person is different, so symptoms of conditions may present
differently for different people. Symptoms also vary depending on the
condition, its severity, location, and other factors.
Failed Back and Neck Surgery Syndromes happen when a surgery to correct pain completely fails to alleviate the pain and in some cases makes the pain worse.
There are many reasons why a surgery could fail to provide results, both related to the patient and the surgeon.
How is it that a patient could cause a surgery to fail. A great example of this would be that a patient has undergone a spinal fusion to correct spinal instability in the lower back. The surgeon has advised the patient that smoking cigarettes which could severely reduce the healing chances and effect the fusion process. The patient ignores the doctor and continues to smoke and the fusion doesn’t heal. This is an example of the patient being at fault.
In what ways could a surgeon be at fault? There are many times that there is fault before the surgery is even performed. If there is an inaccurate diagnoses the surgery will be performed in the wrong area, and possibly the wrong surgery will be done. It is important to seek a second opinion of a specialist before proceeding with surgery of any kind. If two heads can agree on what and where the problem is, it is likely that there will be an accurate diagnosis.
One of the most common reasons for Failed Back and Neck Surgery Syndrome is that the surgeon is just not experienced enough in the technique being performed and he/she doesn’t perform it properly. This is why it is important to ask the right questions to the surgeon before moving forward with the surgery. How long have you been performing back surgeries? How long have you been performing this specific surgical procedure? and how many times a year do you perform this surgery.
Back and neck surgeries are procedures meant to be a permanent fix for a specific problem and correcting failed back or neck surgery is difficult.
Human spine is a complex structure that provides both mobility (so to bend and twist) and stability (so to remain upright). The normal curvature of spine has an “s”- like curve when looked at from the side. This curvature allows even distribution of weight and with stand stress.
Herniated Disk in the Lower Back
Sometimes called a slipped disc, a herniated disk most often occurs in your lower back. It is one of the most common causes of low back pain, as well as leg pain (sciatica).
Herniated Disc symptoms: sharp, burning or stabbing pain in back, may also run down leg; onset is often sudden.
Condition and Causes
Between 60% and 80% of people will experience low back pain at some point in their lives. A high percentage of people will have low back and leg pain caused by a herniated disk.
Although a herniated disk can sometimes be very painful, most people feel much better with just a few weeks or months of nonsurgical treatment.
Diagnosis of discogenic back pain can be difficult. There are characteristic findings on physical examination, but these same findings are seen in patients with other types of back pain as well. Imaging studies can be performed, such as MRI.
Discogenic pain is pain originating from a damaged vertebral disc, particularly due to denenegrative disc disease
. However, not all degenerated discs cause pain. Disc degeneration occurs naturally with age.
Once a fully degenerated disc no longer has any inflammatory proteins that can cause pain, the disc enters into a stable position. Hence, discogenic pain rarely occurs after 60 years of age.
Discogenic pain can usually be successfully treated with non-surgical treatments, such as pain medication and physical therapy and exercise, but chronic discogenic pain that is severe and limits the individual's ability to function may need to be treated with surgery.
Damage to the disc occurs naturally or through a twisting injury where the inner and/or outer portions of the disc may tear, exposing or irritating the nerves on the outer edge of the annulus.
The injury can also create excessive micro-motion instability at the adjacent vertebrae because the disc cannot hold the vertebral segment together as well as it used to.
The disc itself has very few nerve endings and no blood supply. Without a blood supply the disc does not have a way to repair itself, and pain created by the damaged disc can last for years, either as a chronic condition or with periodic painful flare ups. The symptoms are most common in individuals age 30 to 60 years old.
What is Spondylolisthesis?
Spondylolisthesis is a condition that affects the spine as we age. The condition occurs when one of the vertebras in the spine slips forward onto the one below it. Spondylolisthesis usually develops as we age and is a result of bones, joints, and ligaments in the spine weakening and being less able to hold the structure of the spinal column in proper alignment. Degenerative spondylolisthesis begins to show itself in patients over 50 years of age and becomes much more common in after the age of 65.
Spondylolisthesis can sometimes be treated non-surgically using block or steroid injections. In some cases it is necessary to perform a minimally invasive spinal fusion procedure, and prevent further deterioration.
Treatment
Treatment varies, depending on if the type of slip, the patient's age and symptoms, and whether pressure is being put on nerves. For those whose nerves are not affected by the vertebral slippage, treatment starts with non-surgical treatments like medication and physical therapy. Bracing may also be recommended. If symptoms are manageable and the slip is small, the treatment will likely be observation. Activity restrictions may be necessary for children, like abstaining from certain sports.
If the slip is more severe or symptoms of nerve compression are present, surgery may be recommended. Surgeries for this condition include spinal decompression, where bone is removed to make room for the nerve being compressed, or spinal fusion. These surgeries are often done at the same time.
Orthobiologics is a current terminology for the application of various cells, cytokines, growth factors.Tissue Engineering,Gene Therapy,Osteoarthritis,Avascular Necrosis,Sickle Cell Disease,Disc Regeneration,PRP,Autologous Chondrocyte Transplantation,BMAC,Spinal cord Injury paraplegia,Autoimmnune disorders,Diabetic foot,Tendinopathies,Wound Healing,,SCAFFOLDS IN STEM CELL THERAPY.Regenerative medicine is now an recognized specialty which has evolved from degerative diseases of Orthopaedic Surgery.Articular Cartilage : Repair To Regenerate To Replace Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com
Magical Facts About Patients Satisfaction and Pearls of Medical Practise:Doctor-Patient Relationship & Medical Professionalism Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com
Patient Listening, Patient guide,Genuine Practise,Patient Satisfaction
Stem Cells,BMAC,PRP,Scaffold,Regenerative Medicine,Chondrocytes,Mesenchymal cells,FUTURE ORTHOPEDICS BASICS OF STEM CELLS AND TISSUE ENGINEERING Dr.Sandeep C Agrawal Gondia Maharashtra India
Knee Osteoarthritis, a common cause of knee pain and treatment ranges from exercises,tablets,arthroscopy,deformity correction to total knee replacement (TKR).
Complications after surgery can even be corrected if occurs by proper evaluation,planning and execution of the Revision Surgery.
Knee osteoarthritis basics to reconstruction to replacement dr.sandeep c agrawal agraesn hospital gondia india
Time is previous so one should utilise it to the best of it.
Self management and time management of happy meaningful life,dr.sandeep agrawal,agrasen hospital,gondia maharashtra india
New Drug Discovery and Development .....NEHA GUPTA
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Light House Retreats: Plant Medicine Retreat Europe
Calcium homeostasis vitamin d-parathyroid-calcitonin role (rickets,hypercalcemia,hyperparathyroidism,osteoporosis,renal osteodystrophy) prevention dr.sandeep c agrawal agrasen hospital gondia india
6. 1. Rapid phase – osteolysis by
osteocytes
2. Slow phase – by osteoclasts
7. CALCIUM PHYSIOLOGY:
BLOOD CALCIUM
CALCIUM FLUX INTO AND OUT OF
BLOOD:
“IN” FACTORS: INTESTINAL
ABSORPTION, BONE RESORPTION
“OUT” FACTORS: RENAL EXCRETION,
BONE FORMATION (Ca INCORPATION INTO
BONE)
BALANCE BETWEEN “IN” AND “OUT”
FACTORS
ORGAN PHYSIOLOGY OF GUT, BONE,
AND KIDNEY
HORMONE FUNCTION OF PTH AND
VITMAMIN D
1. Neutral
– normal healthy adults
– daily intake & excretion same
– bone entry & exit same
2. Positive
– growing children
– intestinal absorption > excretion
– bone entry > bone exit
3. Negative
– pregnant & lactating women
- intestinal absorption < excretion
– bone entry < bone exit
“CALCIUM
BALANCE”
11. CALCIUM, PTH, AND VITAMIN D
FEEDBACK LOOPS
NORMAL BLOOD Ca
RISING BLOOD Ca
FALLING BLOOD Ca
SUPPRESS
PTH
STIMULATE
PTH
BONE RESORPTION
URINARY LOSS
1,25(OH)2 D
PRODUCTION
BONE RESORPTION
URINARY LOSS
1,25(OH)2 D
PRODUCTION
12. FUNCTIONS OF CALCIUM
Blood coagulation
Muscle contraction
Transmission of nerve impulses
Formation of skeleton ,etc.
FREE IONIZED CALCIUM
13. CALCIUM IN GIT
• 30 – 80 % of ingested calcium is absorbed
• Actively transported out of the intestinal cells with
the help of
Ca 2+ dependent ATPase
• Increased plasma calcium – decreased absorption
from the gut
• Decreased by phosphates and oxalates and alkalis
• Increased by high protein diet
1,25 Vitamin D3
14.
15. CALCIUM IN KIDNEYS
• 98 % - 99 % is reabsorbed
60 % in PCT
40 % in Ascending limb of LOH
Distal tubule
PARATHYROID HORMONE
23. NORMAL VALUES
• Total body phosphate – 500 to 800 g.
• 85 – 90 % in skeleton
• Plasma phosphate – 12 mg / dL
2/3rd – organic
1/3rd – inorganic {Pi}
ex. PO4
3- , HPO4
2-, H2PO4
2-
FUNCTIONS
ATPase , c AMP , 2-3, DPG
Phosphorylation and Dephosphorylation
PHOSPHATE METABOLISM
24. Phosphate is found in ATP, DNA, RNA, cAMP, 2,3-DPG,
many proteins. Phosphorylation and
dephosphorylation of proteins are involved in the
regulation of cell function – bone - buffer
Inorganic phosphate in the plasma is mainly in two
forms: HPO4- (1.05 mmol/L) and H2PO4- (0.26
mmol/L)
pH of the ECF becomes more acidic, Relative increase
in H2PO4- and a decrease in HPO4- and viceversa.
Decreasing level of phosphate in ECF from far below
normal does not cause major immediate effects on the
body. In contrast, even slight increases or decreases of
calcium ion in ECF can cause extreme immediate
physiologic effects.
chronic hypocalcemia or hypophosphatemia greatly
decreases bone mineralization
25. BONE SALTS
• Salts of calcium and phosphate.
HYDROXYAPATITE
Ca10(PO4)6. (OH)2
400 Å long
10 – 30 Å thick
100 Å wide
Ca / P ratio – 1.3 to 2.0
Other salts:
Mg2+, Na+ , K+ ions conjugated
to bone crystals.
26. BONE:
3 mg of PO4 enters and is again
reabsorbed.
KIDNEYS:
85 % - 90 % of filtered Pi is reabsorbed by
Active Transport in PCT
PTH
Overflow
mechanism
Phosphorus
27. G I T
• Absorbed in duodenum and small intestine by Active transport and passive
diffusion.
• Absorption is linear to dietary intake.
29. – 25-HYDROXYLASE
FUNCTIONS
CONSTITUTIVELY
WITHOUT INPUT FROM
BLOOD CALCIUM
STATUS OR PTH
– 25(OH)VITAMIN D IS THE
BEST SCREENING TEST
FOR VITAMIN D
ADEQUACY
VITAMIN D RESISTANT RICKETS:
mutations in the gene coding for the
enzyme
1 α HYDROXYLASE
30. calcium homeostasis
absorption of Ca and P
in the small intestine
Role of vitamin D
normal mineralization of
bone
reabsorption Ca and P
in the renal tubule
31.
32.
33. • THE COUPLED PROCESS OF BONE
TURNOVER CAN BE MEASURED BY:
– MARKERS OF OSTEOBLAST METABOLISM
• SERUM BONE-SPECIFIC ALKALINE PHOSPHATASE
• SERUM OSTEOCALCIN
– MARKERS OF OSTEOCLAST METABOLISM
• URINE PRODUCTS OF BONE COLLAGEN BREAKDOWN
– HYDROXYPROLINE
– N-TELOPEPTIDES
– PYRIDINIUM CROSSLINKS
MEASUREMENT OF BONE
TURNOVER
34. Vitamin D
Intake of vitamin D3 can increase many times and
yet the concentration of 25-
hydroxycholecalciferol remains nearly normal -
prevents excessive action of vitamin D
conserves the vitamin D stored in the liver for
future use. Once it is converted, it persists in the
body for only a few weeks, whereas in the
vitamin D form, it can be stored in the liver for
many months.
35. When the plasma calcium concentration is too high, the
formation of 1,25-dihydroxycholecalciferol is greatly depressed
– decreases the absorption of calcium from the intestines, the
bones, and the renal tubules.
z
37. • EXCESSIVE INTAKE OF VITAMIN D
– RELATIVELY HARD TO DO IF ALL RELEVANT ORGAN
SYSTEMS ARE FUNCTIONING PROPERLY; GENERALLY
REQUIRES PRESCRIPTION STRENGTH VITAMIN D,
PARTICULARLY 1,25(OH)2D (CALCITRIOL)
• EXCESSIVE PRODUCTION OF 1,25(OH)2D
– EXTRA-RENAL 1-HYDROXYLATION OF 25(OH)VITAMIN
D BY AN ENZYME WITH 1-HYDROXYLASE ACTIVITY,
WHICH IS DISTINCT FROM RENAL ENZYME
• USUALLY ASSOCIATED WITH GRANULOMAS (MACROPHAGES)
OR ABNORMAL LYMPHOID TISSUE (B CELL LYMPHOMA)
• NOT REGULATED BY PTH OR CALCIUM
HYPERVITAMINOSIS D
39. ACTIONS OF PTH
I. Increases calcium and phosphate
absorption from the bones
II. Decreases excretion of calcium by the
kidneys
III. Increases the excretion of phosphate by
the kidneys
IV. Increases intestinal absorption of calcium
and phosphate.
INCREASED PLASMA CALCIUM
42. PTH - Kidneys
1. PTH causes rapid loss of phosphate in urine owing to
the effect of the hormone to diminish proximal tubular
reabsorption of phosphate ions.
PHOSPHATURIC ACTION
2.PTH increases renal tubular reabsorption of Ca.
3. increases reabsorption of Mg ions and H ions
4.decreases reabsorption of Na, K and amino acid
No PTH - continual loss of Ca into the urine would
eventually deplete both the ECF and the bones
43.
44.
45.
46.
47. • STIMULUS : Increased plasma calcium
Others: β adrenergic agonists, dopamine
and estrogen, GASTRIN, CCK, glucagon..
• ACTIONS:
Decreases absorptive action of osteoclasts
Deposits exchangeable Ca in bone salts
Decreases the formation of osteoclasts
• CLINICAL USE:
Used in the treatment of
PAGET’S DISEASE.
CALCITONIN
50. Rickets leads to
cupping and to a
brush−like
appearance of the
epiphyseal ends on
radiograms.
Radiographs of the
knee of a 3.6-year-
old girl with
hypophosphatemia
depict severe
fraying of the
metaphysis.
N Active Rickets recovery
54. • SKELETAL MASS IN
HUMAN REACHES A
PEAK AT ABOUT
AGE 30
– BEFORE 30 :
– SKELETAL MASS
INCREASING..
– BONE FORMATION
EXCEEDS BONE
RESORPTION.
– AT 30:
– TWO PROCESSES ARE
EXACTLY MATCHED
– AFTER 30:
– SKELETAL MASS IS
LOST FOR THE REST
OF LIFE
55. Normal bone has the appearance of a honeycomb
matrix (left). Under a microscope, osteoporotic
bone (right) looks more porous.
56.
57. • Bone mineral density (BMD) is the current measure
(major determinant) of fracture risk. (Not DEXA)
WHO criteria
• Mean for age
– T score: 0
• Osteopenia
– T score: -1.0~-
2.5
• Osteoporosis
– T score < -2.5
Incidence of Fem neck fx (A) and
Intertrochanteric fx (B) by BMD
Osteoporosis
58. What keeps bones healthy
Regular exercise
Adequate amounts of calcium
Adequate amounts of vitamin D, which is very essential for
absorbing calcium
63. TESTS AND DIAGNOSIS
Osteopenia refers to mild bone loss that isn't severe enough to be called
osteoporosis, but that increases the risk of osteoporosis.
The best screening test is dual energy X-ray absorptiometry (DEXA) –
measures the density of bones in the spine, hip and wrist and it's used to
accurately follow changes in these bones over time.
Ultrasound
Quantitative CT scanning
Dual energy X-ray absorptiometry
64.
65.
66. ThanksPersistence in your presentations, this is one secret to success. After my first
presentation, I got up
and did it again. Even though I was scared to death, I did it again. So
preparation in all areas of life
is so vital to your success. Don’t be lazy in preparing; don’t be lazy in
laying the groundwork that
will make all of the difference in how your life turns out.
What you may be lacking in are the strong feelings
about what you want and what you want to do.
Let these strong feelings help you take a second
look at your life. After all, you’ve only got one life,
at least on this planet. So why not make it an
adventure in achievement? Why not discover what
all
you can do and what all you can have? Why not
now take the Challenge to Succeed!
First you need to succeed to survive. We must take the seasons and learn how to
use them with
the seed, the soil and the rain of opportunity to learn how to sustain ourselves and
our family.
But then second is to then succeed to flourish in every part of your life today than
yesterday, in
our speech, our language, our health, everything we can possibility think of.
67. This presentation is for doctors and students in general.
. Graphics,Images and jpeg files are taken from Google and yahoo Image to
heighten the specific points in this presentation.
• If there is any objection/or copyright violation, please inform
drsandeep123@gmail.com for prompt deletion.
• It is intended for use only by the doctors of orthopaedic surgery.
. Views expressed in this presentation are personal. • .For any confusion please
contact the sole author for clarification.
• Every body is allowed to copy or download and use the material best suited to
him.
There is no financial involvement.
• For any correction or suggestion please contact drsandeep123@gmail.com.