General pathology · Cell injury, adaptation and death
Pathologic calcification: dystrophic vs metastatic !
- Lesion
Calcium can deposit in damaged tissue even when blood calcium is normal, or in healthy tissue when blood calcium or phosphate is high.
Updated 2026-11-01
What it is
Pathologic calcification is abnormal deposition of calcium salts in tissue. Dystrophic calcification occurs in dead or damaged tissue with normal serum calcium and is very common (atheromas, damaged valves, old tuberculosis). Metastatic calcification occurs in normal tissue when serum calcium or phosphate is high, typically in kidney failure, hyperparathyroidism, bone destruction or vitamin D excess.
Step by step
- Dystrophic: cell membranes of dead cells offer phospholipids that bind calcium.
- Membrane-bound phosphatases generate phosphate next to the bound calcium.
- Calcium phosphate crystals nucleate in membrane-bound vesicles and mitochondria.
- Crystals grow and spread, forming hard deposits that may become bone-like.
- Metastatic: when the calcium-phosphate product rises, crystals form in normal tissues with a relatively alkaline compartment.
Dystrophic vs metastatic
| Feature | Dystrophic | Metastatic |
|---|---|---|
| Serum calcium | Normal | High (or high phosphate) |
| Tissue | Dead or damaged | Normal |
| Frequency | Very common | Less common |
| Examples | Atheromas, damaged valves, old tuberculosis, fat necrosis, psammoma bodies | Nephrocalcinosis, lung and gastric calcification, calciphylaxis |
| Clinical meaning | Marks old injury; can stiffen valves and arteries | Signals a calcium-phosphate disorder |
Clinical notes
- Calcific aortic valve stenosis is a dystrophic process of aging valves and the most common valve lesion needing surgery in older adults.
- In chronic kidney disease, phosphate retention and secondary hyperparathyroidism cause vascular calcification and, rarely, calciphylaxis with painful skin necrosis.
Test yourself
Think of the answer, then tap the question to see it.
In which type of calcification is serum calcium normal?
Dystrophic calcification, which occurs in dead or damaged tissue.
Which tissues are most affected by metastatic calcification?
Tissues that excrete acid and have an alkaline compartment: lung interstitium, kidney, gastric mucosa, and systemic arteries and pulmonary veins.
In which tumours are psammoma bodies typical?
Papillary thyroid carcinoma, serous ovarian tumours, meningioma and mesothelioma.
Related
- Patterns of necrosis: coagulative, liquefactive, caseous, fat, fibrinoid, gangrenous
- Intracellular accumulations: cholesterol, proteins, hyaline, glycogen
- How organs age: normal changes vs disease
- Naming tumours: -oma, carcinoma, sarcoma, and the misleading names
Related conditions
- Hypercalcaemia
- Chronic kidney disease
- CKD-mineral and bone disorder (renal osteodystrophy)
- Calciphylaxis (calcific uremic arteriolopathy)
- Aortic Valve Stenosis
- Atherosclerosis and dyslipidaemia
- Tuberculosis
- Primary hyperparathyroidism
- Hypercalcaemia of malignancy
- Multiple myeloma
- Sarcoidosis
- Thyroid cancer (papillary)
- Meningioma
Elsewhere in DurgiPedia
- Calcium and phosphate
- Vitamin D (calcitriol)
- Calcium regulation: PTH, vitamin D and calcitonin
- Phosphate and FGF-23
- Renal handling of calcium, phosphate and magnesium
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Hypercalcemia: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2024); Chronic Kidney Disease (StatPearls (NCBI Bookshelf), 2024).
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Representative model, for educational purposes only.