Calcium is the most abundant mineral element in the body with about 99 percent in the bones primarily as hydroxyapatite. The remaining calcium is distributed between the various tissues and the extracellular fluids where it performs a vital role for many life sustaining processes. Among the extra skeletal functions of calcium are involvement in blood coagulation, neuromuscular conduction, excitability of skeletal and cardiac muscle, enzyme activation, and the preservation of cell membrane integrity and permeability.
Serum calcium levels and hence the body content are controlled by parathyroid hormone (PTH), calcitonin, and vitamin D. An imbalance in any of these modulators leads to alterations of the body and serum calcium levels. Increases in serum PTH or vitamin D are usually associated with hypercalcemia. Increased serum calcium levels may also be observed in multiple myeloma and other neoplastic diseases. Hypocalcemia may be observed e.g. in hypoparathyroidism, nephrosis, and pancreatitis.