Lutwak L
Ann Clin Lab Sci. 1975 May-Jun;5(3):185-94.
Recognition of the dynamic aspects of bone metabolism can lead to a unified concept involving endocrine and nutritional influences. Although most hormones can influence bone metabolism directly or indirectly, the principal ones involved in skeletal metabolism are parathyroid hormone, calcitonin and 1,25-dihydroxy-vitamin D. The actions of parathyroid hormone and 1,25-dihydroxy-vitamin D result in elevations of circulating extracellular fluid calcium concentration through actions directly on bone, intestine, and kidney. Calcitonin leads to decreases in calcium concentration, primarily by action on bone and kidney. The absorption and retention of calcium by the organism is further influenced by the dietary content of calcium, phosphorus, protein, and fluoride. Chronic dietary deficiencies of calcium and excesses of phosphorus may lead to chronic nutritional secondary hyperparathyroidism with resulting skeletal demineralization. In both experimental animals and in man, the earliest manifestation of this condition may be demineralization of the jaw with resultant paradentosis. Experimental studies in animals and in man have shown that this form of demineralization may be completely reversed by increasing dietary calcium and decreasing dietary phosphrous.
认识到骨代谢的动态方面可形成一个涉及内分泌和营养影响的统一概念。虽然大多数激素可直接或间接影响骨代谢，但参与骨骼代谢的主要激素是甲状旁腺激素、降钙素和1,25 - 二羟维生素D。甲状旁腺激素和1,25 - 二羟维生素D的作用通过直接作用于骨、肠道和肾脏，导致循环细胞外液钙浓度升高。降钙素主要通过作用于骨和肾脏导致钙浓度降低。机体对钙的吸收和潴留还受饮食中钙、磷、蛋白质和氟含量的影响。长期饮食中钙缺乏和磷过量可能导致慢性营养性继发性甲状旁腺功能亢进，从而导致骨骼脱矿质。在实验动物和人类中，这种情况最早的表现可能是颌骨脱矿质并导致牙周病。动物和人类的实验研究表明，通过增加饮食中的钙和减少饮食中的磷，这种脱矿质形式可能完全逆转。
