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Approximately 50% of plasma calcium is free and 40-45% is bound to protein, most of which is aluminum and 5-10% is combined. Blood calcium is measured as total, but only free calcium has biological activity. Calcium plays an important physiologic role in bone mineral accumulation, muscle nerve stimulation, muscle contraction, and blood coagulation.
For proper interpretation of serum total calcium level, serum protein level should also be considered. A decrease in blood calcium can be caused by chronic kidney disease with increased levels of creatinine and phosphorus in the blood, hypothyroidism, or vitamin D deficiency (softness of bones).
The most common cases are increased blood calcium levels due to overactive parathyroid gland, tumor and bone metastasis, overactive thyroid gland and excessive consumption of vitamin D. The presence of calcium in urine does not have much diagnostic value, except in cases of kidney and bladder stones and urinary tract disorders.
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