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Transcript 
Agents That Affect Bone
Mineral Homeostasis
BY
S. Bohlooli, PhD
School of Medicine, Ardabil University of Medical Sciences
Hormonal regulators of bone
mineral homestasis
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PTH
Vitamin D
Calicitonin
Estrogens
Glucocorticoids
Bone mineral homeostasis
The hormonal interactions controlling
bone mineral homeostasis
The hormonal interactions controlling
bone mineral homeostasis
Vitamin D and its major metabolites and
analogs
Chemical and Generic Names
Abbreviation
Vitamin D3; cholecalciferol
D3
Vitamin D2; ergocalciferol
D2
25-Hydroxyvitamin D3; calcifediol
25(OH)D3
1,25-Dihydroxyvitamin D3; calcitriol
1,25(OH)2D3
24,25-Dihydroxyvitamin D3; secalcifediol
24,25(OH)2D3
Dihydrotachysterol
DHT
Calcipotriene (calcipotriol)
None
1a-Hydroxyvitamin D2; doxercalciferol
1a(OH)D2
19-nor-1,25-Dihydroxyvitamin D2; paricalcitol
19-nor-
Conversion of 7-dehydrocholesterol to vitamin D3 and
metabolism
Actions of Parathyroid Hormone (PTH), Vitamin D, and
FGF23 on Gut, Bone, and Kidney
PTH
Increased calcium and phosphate
absorption (by increased
1,25[OH]2D production)
Vitamin D
Increased calcium and
phosphate absorption by
1,25 (OH)2D
FGF23
Decreased calcium and
phosphate absorption by
decreased 1,25(OH)2
production
Kidney
Decreased calcium excretion,
increased phosphate excretion
Calcium and phosphate
excretion may be
decreased by 25(OH)D
and 1,25(OH)2D1
Increased phosphate
excretion
Bone
Calcium and phosphate resorption
increased by high doses. Low
doses may increase bone
formation.
Increased calcium and
Decreased mineralization
phosphate resorption by due to hypophosphatemia
1,25(OH)2D; bone
formation may be
increased by 1,25(OH)2D
and 24,25(OH)2D
Net effect on serum levels
Serum calcium increased, serum
phosphate decreased
Serum calcium and
Decreased serum
phosphate both increased phosphate
Intestine
Secondary Hormonal Regulators of Bone
Mineral Homeostasis
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Calcitonin
Glucocorticoids
Estrogens
Nonhormonal agents
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Bisphosphonates
Calcimimetics
Thiazides
Fluoride
Other drugs
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Gallium nitrate
Plicamycin
Strontium Ranelate
The structure of
pyrophosphate
Typical changes in bone mineral density
with time after the onset of menopause
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