Calcification

{{Short description|Accumulation of calcium salts in bodily tissue, usually bone}}

{{about|the calcification of body tissue|calcification of water pipes|Hard water}}

File:Cardiovascular calcification - Sergio Bertazzo.tif

Calcification is the accumulation of calcium salts in a body tissue. It normally occurs in the formation of bone, but calcium can be deposited abnormally in soft tissue,{{cite journal|last1=Bertazzo|first1=Sergio|last2=Gentleman|first2=Eileen|last3=Cloyd|first3=Kristy L.|last4=Chester|first4=Adrian H.|last5=Yacoub|first5=Magdi H.|last6=Stevens|first6=Molly M.|title=Nano-analytical electron microscopy reveals fundamental insights into human cardiovascular tissue calcification|journal=Nature Materials|volume=12|issue=6|year=2013|pages=576–583|issn=1476-1122|doi=10.1038/nmat3627|pmid=23603848|pmc=5833942|bibcode=2013NatMa..12..576B }}Miller, J. D. Cardiovascular calcification: Orbicular origins. Nature Materials 12, 476-478 (2013). causing it to harden. Calcifications may be classified on whether there is mineral balance or not, and the location of the calcification.[http://www.ahdictionary.com/word/search.html?q=Calcification Calcification] The American Heritage Science Dictionary. Retrieved 2013-03-23. Calcification may also refer to the processes of normal mineral deposition in biological systems, such as the formation of stromatolites or mollusc shells (see Biomineralization).

Signs and symptoms

Calcification can manifest itself in many ways in the body depending on the location.

In the pulpal structure of a tooth, calcification often presents asymptomatically, and is diagnosed as an incidental finding during radiographic interpretation. Individual teeth with calcified pulp will typically respond negatively to vitality testing; teeth with calcified pulp often lack sensation of pain, pressure, and temperature.{{citation needed|date=May 2018}}

Causes of soft tissue calcification

Calcification of soft tissue (arteries, cartilage, heart valves, etc.) can be caused by vitamin K₂ deficiency or by poor calcium absorption due to a high calcium/vitamin D ratio. This can occur with or without a mineral imbalance.

A common misconception is that calcification is caused by excess amount of calcium in diet. Dietary calcium intake is not associated with accumulation of calcium in soft tissue, and calcification occurs irrespective of the amount of calcium intake.{{cite web|url=https://www.health.harvard.edu/womens-health/calcium-beyond-the-bones|title=Calcium beyond the bones|date = March 1, 2010|work= Harvard health Publishing}}

Intake of excessive vitamin D can cause vitamin D poisoning and excessive intake of calcium from the intestine which, when accompanied by a deficiency of vitamin K (perhaps induced by an anticoagulant), can result in calcification of arteries and other soft tissue.Paul Price, et al., [http://atvb.ahajournals.org/content/20/2/317.short "Warfarin-Induced Artery Calcification Is Accelerated by Growth and Vitamin D"], Arteriosclerosis, Thrombosis, and Vascular Biology, 2000, Vol. 20, pp. 317-327. Such metastatic soft tissue calcification is mainly in tissues containing "calcium catchers" such as elastic fibres or mucopolysaccharides. These tissues especially include the lungs (pumice lung) and the aorta.McGavin, Zachary. Pathologic basis of veterinary disease, fourth edition; Elsevier 2007.

= Mineral balance =

Dystrophic calcification, without a systemic mineral imbalance.
Metastatic calcification, a systemic elevation of calcium levels in the blood and all tissues.

Forms

Calcification can be pathological or a standard part of the aging process. Nearly all adults show calcification of the pineal gland.{{cite journal|last=Zimmerman|first=Robert A|title=Age-Related Incidence of Pineal Calcification Detected by Computed Tomography|journal=Radiology|volume=142|issue=3|pages=659–62|url=http://radiology.rsna.org/content/142/3/659.full.pdf|publisher=Radiological Society of North America|access-date=21 June 2012|url-status=dead|archive-url=https://web.archive.org/web/20120324050246/http://radiology.rsna.org/content/142/3/659.full.pdf|archive-date=2012-03-24|pmid=7063680|year=1982|doi=10.1148/radiology.142.3.7063680}}

=Location=

Extraskeletal calcification, e.g. calciphylaxis
Brain, e.g. primary familial brain calcification (Fahr's syndrome)
Choroid plexus usually in the lateral ventricles{{cite web |last1=Muzio |first1=Bruno Di |title=Normal intracranial calcifications {{!}} Radiology Reference Article {{!}} Radiopaedia.org |url=https://radiopaedia.org/articles/normal-intracranial-calcifications?lang=gb |website=Radiopaedia}}
Tumor calcification{{cite journal | url=https://link.springer.com/article/10.1007/s00710-014-0342-6 | doi=10.1007/s00710-014-0342-6 | title=Psammoma bodies in two types of human ovarian tumours: A mineralogical study | date=2015 | last1=Fanlu | first1=Meng | last2=Changqiu | first2=Wang | last3=Yan | first3=Li | last4=Anhuai | first4=Lu | last5=Fang | first5=Mei | last6=Jianying | first6=Liu | last7=Jingyun | first7=Du | last8=Yan | first8=Zhang | journal=Mineralogy and Petrology | volume=109 | issue=3 | pages=357–365 | bibcode=2015MinPe.109..357F }}
Arthritic bone spurs
Kidney stones
Gall stones
Heterotopic bone
Tonsil stones
Pulp stone

=Breast disease=

In a number of breast pathologies, calcium is often deposited at sites of cell death or in association secretions or hyalinized stroma, resulting in pathologic calcification. For example, small, irregular, linear calcifications may be seen, via mammography, in a ductal carcinoma-in-situ to produce visible radio-opacities.

Robbins and Cotran (2009), Pathologic Basis of Disease,

8th edition, Elsevier.

=Arteriosclerotic calcification=

One of the principal causes of arterial stiffening with age is vascular calcification. Vascular calcification is the deposition of mineral in the form of calcium phosphate salts in the smooth muscle-rich medial layer of large arteries including the aorta. DNA damage, especially oxidative DNA damage, causes accelerated vascular calcification.{{cite journal|pmid=32404005 |date=2020 |last1=Duer |first1=M. |last2=Cobb |first2=A. M. |last3=Shanahan |first3=C. M. |title=DNA Damage Response: A Molecular Lynchpin in the Pathobiology of Arteriosclerotic Calcification |journal=Arteriosclerosis, Thrombosis, and Vascular Biology |volume=40 |issue=7 |pages=e193–e202 |doi=10.1161/ATVBAHA.120.313792 |s2cid=218634735 |doi-access=free }} Vascular calcification could also be linked to the chronic leakage of blood lysates into the vessel wall since red blood cells have been shown to contain a high concentration of calcium.{{Cite journal |last1=Fu |first1=Hualin |last2=Li |first2=Jilong |last3=Du |first3=Peng |last4=Jin |first4=Weilin |last5=Gao |first5=Guo |last6=Cui |first6=Daxiang |date=2022-11-30 |title=Senile plaques in Alzheimer's disease arise from Aβ- and Cathepsin D-enriched mixtures leaking out during intravascular haemolysis and microaneurysm rupture |url=https://pubmed.ncbi.nlm.nih.gov/36448495 |journal=FEBS Letters |volume=597 |issue=7 |pages=1007–1040 |doi=10.1002/1873-3468.14549 |issn=1873-3468 |pmid=36448495|s2cid=254095098 }}

Diagnosis

In terms of diagnosis, in this case vascular calcification, an ultrasound and radiography of said area is sufficient.{{cite journal|last1=Raggi|first1=Paolo|last2=Bellasi|first2=Antonio|title=Clinical assessment of vascular calcification|journal=Advances in Chronic Kidney Disease|volume=14|issue=1|pages=37–43|doi=10.1053/j.ackd.2006.10.006|pmid=17200042|issn=1548-5595|year=2007}}

Treatment

Treatment of high calcium/vitamin D ratio may most easily be accomplished by intake of more vitamin D if vitamin K is normal.{{Citation needed|date=June 2021}} Intake of too much vitamin D would be evident by anorexia, loss of appetite, or soft tissue calcification.{{Citation needed|date=June 2021}}