Assoc. Prof. Irfan Esen

Calcium is the cornerstone not only of bone structure, but also of muscle contraction and nerve conduction. The calcium level in the blood is kept within a narrow range. This balance is largely provided by parathormone secreted by the parathyroid glands and vitamin D.

In vitamin D deficiency, calcium absorption from the intestine decreases and the body increases parathormone secretion to compensate for this. If this condition persists for a long time, it may lead to calcium withdrawal from the bone and decreased bone density.

In the evaluation, calcium, phosphorus, parathormone and vitamin D levels are interpreted together. Kidney functions are also taken into consideration. Treatment is planned according to the cause and continued by monitoring the levels.

The decrease in estrogen levels with menopause may cause bone destruction to progress faster than bone formation. Since the loss of bone density progresses without any symptoms during this period, it may not be noticed until a fracture occurs.

Bone density measurement, calcium and vitamin D levels, and parathormone examination are used in the evaluation. Thyroid functions and kidney status are also reviewed together, as they may affect the picture.

Preventive approach includes adequate calcium intake, correcting vitamin D deficiency, regular weight-bearing exercise and quitting smoking. Drug treatment, fracture risk and measurement results are taken into consideration together.

Hormone levels may vary depending on the time of day, fasting state, medications used and accompanying diseases. Therefore, a single measurement is often not enough. The result is interpreted together with the conditions under which the measurement was made.

Requesting interrelated hormones together clarifies the picture. For example, measuring parathormone when calcium is high helps to distinguish whether the problem is caused by the parathyroid glands or another cause.

In case of borderline results, the measurement is repeated under appropriate conditions. Imaging or stimulation tests are planned when deemed necessary. The treatment decision is based on the clinical picture, not a single number.