Ninety-five percent of your body’s calcium is present in your bones. However, calcium is critical not only for healthy bones but also for every system and process in the body, including muscle contraction, blood clotting, brain function, heart rhythm, and kidney function. Because calcium is so important, the body has developed an elaborate system of hormones to keep the calcium level constant in the blood.
The most important of these substances are parathyroid hormone, vitamin D, and calcitonin.
Parathyroid hormone is made in the four tiny parathyroid glands
tucked in behind the neck and attached to the thyroid gland. Parathyroid
hormone controls the calcium level in the blood. If this level falls
below a certain point, this hormone is released into the bloodstream
and increases the calcium level in the blood in a number of ways.
Since calcium is critical to brain and cell health, bone mass may be
sacrificed to ensure that an adequate level of calcium is maintained
in the bloodstream.
Vitamin D is obtained primarily from the sun, where it is produced
by the ultraviolet irradiation of an inactive form of the vitamin in the
skin. It is also found in small amounts in eggs, milk, and fish. Vitamin
D is stored in the liver in a partially activated form and is transported
to the kidney, where it is converted into its final, active form. Once
activated, vitamin D increases the absorption of calcium from the
intestines and stimulates the kidney to reabsorb calcium from the
urine back into the bloodstream. Vitamin D, like parathyroid hormone,
is responsible for maintaining a specified level of calcium in
the blood. So, the correct amount of vitamin D is important to maintain calcium balance.
Several substances can affect vitamin D levels in the body. Anticonvulsant drugs stimulate the production of liver enzymes that break down vitamin D, which can lead to a vitamin deficiency. Patients on anticonvulsants can develop osteomalacia from the vitamin D deficiency and osteoporosis from the resulting calcium deficiency. This
bone loss can be avoided if the doctor regularly monitors the calcium
and vitamin D levels in these patients.
Calcitonin, another hormone, is made in the thyroid gland. It appears
to protect bone from the resorption effects of parathyroid hormone.
As we will discuss in later chapters, calcitonin is used for
treatment of osteoporosis.

