Metastatic Calcification and Dystrophic Calcification

By Dr Arun Pal Singh

Metastatic calcification and dystrophic calcification are pathological calcification which means abnormal calcium deposits at the places where these are normally not found.

Heterotopic ossification is another name for pathologic calcification and both metastatic and dystrophic calcification constitute heterotopic calcification.

Normally, inorganic calcium salts are found in bones and teeth.

Pathologic or heterotopic calcification is the deposition of calcium salts in tissue other than osteoid [bone] and enamel [teeth]

Here are the details of these types of calcification

Metastatic Calcification

In this type of calcification, the tissue being affected is normal but the main defect is an elevated blood calcium level. Elevated calcium causes deposition of the calcium in tissues and results in the removal of calcium from the bones.

This type of calcium deposition occurs in a variety of sites like kidneys, lungs, stomach, blood vessels, cornea.

Causes of Metastatic Calcification

Chronic Renal Failure [causes secondary hyperparathryoidism]
Hyperparathyroidism
- Primary Hyperparathyroidism
- Secondary Hyperparathyroidism
Excessive absorption of calcium from the bowel
- Hypervitaminosis D
- Idiopathic hypercalcemia of infancy
Hypophosphatasia
Malignancies
- Parathyroid adenoma [causes primary hyperparathyroidism]
- Multiple myeloma
- Lymphoma
- Leukemia
- Hypopharyngeal squamous cell carcinoma
- Synovial sarcoma
- Breast carcinoma
- Choriocarcinoma
Destructive bone lesions
Renal tubular acidosis
Mechanism of metastatic calcification

The mechanism of metastatic calcification is not clear.

Metastatic calcification can be influenced by the release of excess calcium salts from the bone. Phosphate concentration, alkaline phosphatase activity, and alkaline environment may contribute.

This leads to precipitation of The calcium phosphate and calcium carbonate salts in tissues.

Metastatic calcification occurs when there is hypercalcemia but it doesn’t happen in all cases of hypercalcemia.

Dystrophic Calcification

In dystrophic calcification, serum calcium levels are normal and the calcium salts are deposited in dead or degenerate tissues.

Mechanism of Dystrophic Calcification

The process of dystrophic calcification starts in membrane-bound vesicles within cells. When the membrane gets damaged, calcium binds to the phospholipid in the membrane. Phosphatases within the membrane add phosphate groups to the calcium, forming calcium phosphate which is the hydroxyapatite crystals in the regular bone.

Examples of Dystrophic Calcification

Following are examples of dystrophic calcification

Calcification of caseous tissue in tuberculosis
After fat necrosis in the breast or pancreatitis
Calcification in thrombus such as left ventricular thrombus, coronary artery calcification, inferior vena cava, superior vena cava
Hemorrhagic infarction in the spleen
Calcified hematoma
Myositis ossificans
Atherosclerotic plaques
Granulation tissue in chronic inflammation like constrictive pericarditis
Monckeberg’s sclerosis – A form of arteriosclerosis
Infection as in Schistosomiasis [Leads to calcification of the ureters, bladder, and seminal vesicles
Degenerate colloid goiter
Calcification in various types of cyst
Calcinosis Cutis
Degenerate tumor-like uterine leiomyoma

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About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

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