[Evolution of lung cancer in the North of the province of Castellón, Spain, 1993-2002]

OBJECTIVE

To investigate the changes in lung cancer incidence, histological type, and survival in patients in the north of the province of Castellón, Spain, during a follow-up period of 10 years, and to compare the findings with other national and international studies.

PATIENTS AND METHOD

All patients diagnosed with lung cancer between January 1, 1993 and December 31, 2002 were included in this prospective, observational study. Disease was confirmed by biopsy or suspected from clinical, radiological, and/or bronchoscopic findings.

RESULTS

In the study period, 271 patients were diagnosed with lung cancer (239 men and 32 women), with a mean (SD) age of 66.8 (11.8) years. The age-adjusted incidence rate standardized to the world population was 20.42 cases per 100,000 population. Smokers or ex-smokers comprised 88.1% of the study population, and 72.6% of patients were over 60 years old. Biopsy confirmation was obtained in 262 cases (96.7%). Squamous cell carcinoma predominated (46.5%) but the proportion of adenocarcinoma increased (23.6%). Surgery was possible in only 22% of the patients. Mean overall 5-year survival was 15.7 months.

CONCLUSIONS

In the north of the province of Castellón, the incidence of lung cancer continues to increase in men but has decreased slightly in women. Squamous cell carcinoma is the most common type, but the incidence of adenocarcinoma has clearly increased. Overall, survival did not improve during the 10 years of follow up despite advances in treatment.

[Epidemiological study of lung cancer in the northern part of the province of Castellón]

OBJECTIVES

To estimate the incidence and survival of bronchopulmonary carcinoma in the northern part of the Spanish province of Castellón while collecting other epidemiologic data.

PATIENTS AND METHODS

This prospective, observational study enrolled all patients residing habitually in northern Castellón with diagnoses of bronchopulmonary carcinoma recorded from 1 January 1993 until 31 December 1997. Enrollment criteria were cytohistologic confirmation of diagnosis or suspicion based on clinical, radiologic and/or bronchoscopic data.

RESULTS

One hundred eighteen patients (100 men, 18 women) were so diagnosed, giving a world population-adjusted incidence of 17.4 cases per 100,000 inhabitants (men: 31.2; women: 4.5). Smokers or ex-smokers accounted for 84.7% and 74.5% were over 60 years of age. Cytohistologic confirmation was obtained for 117 patients (99%). Epidermoid carcinoma predominated (58%) and surgery was performed in only 23% of the cases. Only one patient was lost to follow-up during the study period. Mean 5-year survival was 7.6%.

CONCLUSIONS

The standardized incidence of bronchopulmonary carcinoma in 1993-1997 in the northern part of Castellón was 17.4 cases per 100,000 inhabitants (women: 31.2; women: 4.5), with epidermoid carcinoma predominating and a five-year survival rate of 7.6%.

Static lung volumes: reference values from a Latin population of Spanish descent

BACKGROUND AND OBJECTIVES

The aim of this study was to develop a set of prediction equations and 90% confidence intervals for static lung volumes using the multibreath helium equilibration method from a sample of asymptomatic Caucasian subjects of Spanish descent. Moreover, these equations were compared with those of previous studies.

METHODS

Measurements of static lung volumes using techniques recommended by the American Thoracic Society and the European Community for Steel and Coal were carried out on a selected sample of 591 healthy nonsmoking volunteers (305 men and 286 women) aged 18-88 years, living in the metropolitan area of Valencia, on the east coast of Spain. Multiple regression analysis using height, age and weight as independent variables were used to provide predicted values for both sexes. These reference values were compared with other sets of prediction equations reported in the literature using an independent sample of 69 subjects (32 men and 37 women).

RESULTS

Simple linear regression equations using age, height and body weight predicted all the subdivisions of lung volumes (vital capacity, expiratory reserve volume (ERV), inspiratory capacity, functional residual capacity (FRC), residual volume (RV), total lung capacity (TLC), FRC/TLC and RV/TLC) as well as more complex equational models. The distribution of residuals fulfilled the assumptions of multiple regression analysis (independence, homoscedasticity and Gaussian distribution of residuals), except for ERV, using simple linear models. The derived equations did not differ significantly from most of the previously reported equations and were usually superior in their ability to predict the lung volumes.

CONCLUSIONS

The use of the present prediction equations is recommended in the Latin population of Spanish descent and in populations with similar Caucasian characteristics.

Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study

The aims of this study were to identify risk factors for hip fracture in men aged 50 years or more. We identified 730 men with hip fracture from 14 centers from Portugal, Spain, France, Italy, Greece and Turkey during the course of a prospective study of hip fracture incidence and 1132 age-stratified controls selected from the neighborhood or population registers. The questionnaire examined aspects of work, physical activity past and present, diseases and drugs, height, weight, indices of co-morbidity and consumption of tobacco, alcohol, calcium, coffee and tea. Significant risk factors identified by univariate analysis included low body mass index (BMI), low sunlight exposure, a low degree of recreational physical activity, low consumption of milk and cheese, and a poor mental score. Co-morbidity including sleep disturbances, loss of weight, impaired mental status and poor appetite were also significant risk factors. Previous stroke with hemiplegia, prior fragility fractures, senile dementia, alcoholism and gastrectomy were associated with significant risk, whereas osteoarthrosis, nephrolithiasis and myocardial infarction were associated with lower risks. Taking medications was not associated with a difference in risk apart from a protective effect with the use of analgesics independent of co-existing osteoarthrosis and an increased risk with the use of anti-epileptic agents. Of the potentially 'reversible' risk factors, BMI, leisure exercise, exposure to sunlight and consumption of tea and alcohol and tobacco remained independent risk factors after multivariate analysis, accounting for 54% of hip fractures. Excluding BMI, 46% of fractures could be explained on the basis of the risk factors sought. Of the remaining factors low exposure to sunlight and decreased physical activity accounted for the highest attributable risks (14% and 9% respectively). The use of risk factors to predict hip fractures had relatively low sensitivity and specificity (59.6% and 61.0% respectively). We conclude that lifestyle factors are associated with significant differences in the risk of hip fracture. Potentially remediable factors including a low degree of physical exercise and a low BMI account for a large component of the total risk.

Increased proliferation of osteoblast precursor cells in estrogen-deficient rats

We have evaluated the in vivo and in vitro changes in osteoblast characteristics induced by estrogen deficiency and 17 beta-estradiol (E2) treatment in ovariectomized (OVX) rats. Estrogen deficiency induced osteopenia and increased bone turnover, as evidenced by bone histomorphometry at 1, 3, and 6 mo postovariectomy. Bone surface osteoblastic cells (OB) isolated from tibias of OVX rats, OVX rats treated with E2 (10 micrograms/kg body wt), and sham rats showed no difference in alkaline phosphatase activity and osteocalcin production in vitro. In contrast the proliferation rate of OB cells was higher in OVX rats compared with sham rats at all time points post-surgery, as shown by [3H]thymidine incorporation and cell number. The proliferation rate of alkaline phosphatase-positive marrow cells was also higher in OVX rats compared with sham rats. E2 treatment of OVX rats corrected histologic indexes of bone resorption and formation and normalized OB cell proliferation. induced by estrogen deficiency in OVX rats is related to an increased proliferation of osteoblast precursor cells present in the marrow stroma and along the endosteal bone surface.

Residential care and risk of proximal femur fracture

The risk of hip fracture is higher among persons living in long-term care than among persons living at home. The aim of this study was to explain the difference in risk between the two types of residence by identifying differences in the respective risk factor profiles. Information from the Mediterranean osteoporosis (MEDOS) study questionnaire was used for statistical analyses of 107 non-demented female cases and 225 neighbourhood controls matched for age, sex, and residential area. The statistical analyses incorporated adjustments of the risk estimates by unconditional multivariate logistic regression. Urban background, activity, and morbidity were found to differ between the two types of residence. The detected differences in risk factor profiles were, however, not considered to be sufficient as an explanation for the difference in risk of fracture.

[Vitamin-resistant hypophosphatemic rickets and spinal cord compression. Apropos of 2 cases]

Adults with X-linked vitamin-resistant hypophosphatemic rickets can develop spinal cord compression as a result of spinal canal stenosis due to involvement of the spine with the increased periosteal and ligamentary calcification which is typical of the disease. Two cases are reported. In both patients, spinal cord compression manifested as rapidly progressive spastic paraplegia due to compression at T9 and T5, respectively. Decompressive laminectomy ensured full recovery in one case but was ineffective in the other. In both cases, paraplegia developed approximately one year after initiation of therapy combining a metabolite of vitamin D and phosphorus in high doses. Current imaging techniques (CT scan, magnetic resonance imaging) provide highly accurate information on the anatomic mechanism of the stenosis, its often multiple locations, and its course. Three factors are involved in the stenosis, in variable degrees: thickening of the laminae, hypertrophy of the facet joints, thickening and calcification of the yellow ligament. Magnetic resonance imaging is the investigation of choice in these patients. A deleterious effect vitamin D-phosphorus treatment cannot be outruled. The appropriateness of initiating this treatment should be prudently discussed and treated patients should be closely monitored.

Evidence for efficacy of drugs affecting bone metabolism in preventing hip fracture

OBJECTIVE

To examine the effects of taking drugs affecting bone metabolism on the risk of hip fracture in women aged over 50 years.

DESIGN

Retrospective, population based, case-control study by questionnaire.

SETTING

14 centres in six countries in southern Europe.

SUBJECTS

2086 women with hip fracture and 3532 control women matched for age.

MAIN OUTCOME MEASURES

Number of drugs affecting bone metabolism taken and length taken for.

RESULTS

Women taking drugs affecting bone metabolism had a significantly decreased risk of hip fracture. After adjustment for differences in other risk factors, the relative risk of hip fractures was 0.55 (95% confidence interval 0.31 to 0.85) in women taking oestrogens, 0.75 (0.60 to 0.94) in those taking calcium, and 0.69 (0.51 to 0.92) in those taking calcitonin. The fall in risk was not significant for anabolic steroids (0.6 (0.29 to 1.22)). Neither vitamin D nor fluorides were associated with a significant decrease in the risk of hip fracture. The effect on hip fracture risk increased significantly with increasing duration of exposure (risk ratio 0.8 (0.61 to 1.05) for less than median exposure v 0.66 (0.5 to 0.88) for greater than median exposure). Drugs were equally effective in older and younger women, with the exception of oestrogen.

CONCLUSIONS

Oestrogen, calcium, and calcitonins significantly decrease the risk of hip fracture. Short term intervention late in the natural course of osteoporosis may have significant effects on the incidence of hip fracture.

Dynamics of circulating osteocalcin in rats during growth and under experimental conditions

Osteocalcin is the most abundant non-collagenous protein produced in the process of bone formation. A specific radioimmunoassay has been developed using a rabbit antiserum raised against osteocalcin extracted from rat bone. The sensitivity of the assay was tested in male and female rats under different experimental conditions: ovariectomy led to a mild increase in circulating osteocalcin (70.6 +/- 6.9 vs 51.6 +/- 6.3 ng/ml; p < 0.05) and deprivation of dietary calcium elevated plasma levels further (119 +/- 6.3 ng/ml; p < 0.01). As expected, pharmacological enhancement of bone turnover with calcitriol produced a significant increase in plasma osteocalcin (296 +/- 24.1 vs 89.5 +/- 5.1 ng/ml; p < 0.01), whereas prednisolone, a steroidal compound known to inhibit osteoid mineralization, significantly reduced circulating concentrations of this protein (70 +/- 7.4 vs 100 +/- 6.3 ng/ml; p < 0.05). Plasma kinetics recorded in female rats between birth and the 100th week revealed a highly significant (p < 0.001) elevation peaking at the third week (231 +/- 70.6 ng/ml) and slowly declining to reach values measured at birth (41.3 +/- 9.2 ng/ml) at the 16th week (47 +/- 4.6 ng/ml). Subsequently, a small but significant (p < 0.05) decline towards senescence was recorded. The osteocalcin surge preceded the period of rapid growth (weeks 3 to 11) estimated by vertebral length progression, showing a tendency to stabilize as growth spurt slowed down. A moderate but significant (p < 0.01) increment was observed after mating (87.8 +/- 5.1 vs 69.5 +/- 4.0 ng/ml). Although plasma osteocalcin remained stable during lactation, average levels were elevated in comparison with age-matched non-pregnant controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of fluoride on bone and bone cells in ovariectomized rats

To evaluate whether treatment with a mitogenic agent may increase bone formation and bone mass in osteopenia induced by estrogen deficiency, we determined the effect of oral fluoride treatment on bone and bone cells in ovariectomized rats. Sodium fluoride (NaF) was administered to 3-month-old ovariectomized rats 1 day after ovariectomy (OVX) for 1, 3, and 6 months. NaF was given in drinking water at the dose of 1 mg/kg body weight per day. Fluoride administration led to a partial prevention of the bone loss induced by OVX as shown by histologic analysis of tibial metaphysis and by evaluation of femoral calcium content. These beneficial effects of fluoride were more striking at early time points (1 and 3 months postovariectomy) than after 6 months of treatment. The increase in trabecular bone volume in OVX rats treated with fluoride was associated with a rise in the osteoblast surface, which was increased by 60, 72, and 235% at 1, 3, and 6 months postovariectomy compared to untreated OVX rats. In OVX rats and in sham-operated rats plasma osteocalcin was increased in correlation with the osteoblast surface. However, these two parameters were not correlated in OVX rats treated with fluoride. The heat-labile bone-specific alkaline phosphatase in plasma was decreased in OVX rats treated with fluoride compared to OVX rats, suggesting that both the number and the activity of osteoblasts were affected by NaF treatment. To examine the effect of fluoride on the osteocalcin production and the proliferative capacity of bone cells, osteoblastic cells were isolated by collagenase digestion from the bone surface of tibia in treated and untreated OVX rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Agenesis of the right pulmonary artery in a young asymptomatic girl

We report the case of a 13 yr old, asymptomatic girl with agenesis of the right pulmonary artery. In the context of a tuberculosis survey in her school, an X-ray examination disclosed a decreased volume of the right lung. Ventilation and perfusion scans and digital substraction angiography established the diagnosis.

Agenesis of the right pulmonary artery in a young asymptomatic girl

We report the case of a 13 yr old, asymptomatic girl with agenesis of the right pulmonary artery. In the context of a tuberculosis survey in her school, an X-ray examination disclosed a decreased volume of the right lung. Ventilation and perfusion scans and digital substraction angiography established the diagnosis.

Stress fractures of the lower limbs in osteoporotic patients treated with fluoride

We report clinical and bone morphometric findings in 18 osteoporotic patients who experienced stress fractures during fluoride therapy. Patients were treated with either sodium fluoride (n = 15), or sodium monofluorophosphate (n = 3). Oral calcium supplementation was given in 11 patients, and vitamin D in 13. Stress fractures occurred after 17.1 +/- 10.3 months of therapy (range: 5-41 months). Atraumatic sudden pain in a lower limb bone extremity, normal initial roentgenogram, high 99technetium uptake on early bone scan, and a 3 to 4 week delay in linear bone condensation area at the same site were characteristics of stress fracture. The most frequent sites were the tibial metaphysis (n = 13), femoral neck (n = 10), and calcaneus (n = 4). Biochemical data showed increased plasma alkaline phosphatase levels in 11 patients, and mild renal failure in 2. Bone histomorphometry was performed on an iliac crest specimen in 10 patients at the time of the stress fracture. Trabecular bone volume was normal, and formation parameters were increased. Features of osteomalacia were encountered in only 2 patients with decreased renal function. Trabecular resorption was increased, as assessed by the osteoclastic surface (1.01 +/- 1.15% bone surface), and the number of osteoclasts (0.44 +/- 0.49 per mm2 bone section). The clinical course was favorable in all patients who stopped fluoride, although 5 patients who continued the treatment had either completion of femoral neck stress fractures to hip fractures (n = 2), or recurrent stress fractures (n = 2), or both (n = 1). Fluoride appears to be a key factor in the pathogenesis of stress fractures, and may be associated with increased trabecular resorption in some treated patients.

Comparative effects of a novel vitamin D analogue MC-903 and 1,25-dihydroxyvitamin D3 on alkaline phosphatase activity, osteocalcin and DNA synthesis by human osteoblastic cells in culture

MC-903 is a novel vitamin D analogue which has been shown to promote epidermal cell differentiation but is 100 times less active than 1,25 dihydroxyvitamin D3 (1,25(OH)2D) in causing hypercalcemia. In order to determine the activity of this compound on bone cells, we have compared the effects of MC-903 and 1,25 dihydroxyvitamin D3 (1,25(OH)2D) on parameters of cell proliferation and differentiation in cultured normal human osteoblastic cells derived by migration from trabecular bone fragments. Dose response curves showed that MC-903 was 10 to 100 times less effective than 1,25(OH)2D in stimulating the synthesis of the osteoblast specific protein osteocalcin by human bone cells depending on the basal osteocalcin production. In cells showing high basal osteocalcin synthesis, 1,25(OH)2D (10(-8) M) was 2- to 3-fold more potent than MC-903 (10(-8) M) in inducing osteocalcin from 48 to 96 h of treatment. The greater activity of 1,25(OH)2D over MC-903 was observed in human bone cell cultures with elevated basal osteocalcin levels, indicating that the response to 1,25(OH)2D but not to MC-903 was amplified in cells with the higher osteoblastic characteristics. The effects of MC-903 and 1,25(OH)2D on alkaline phosphatase activity were not markedly different. Transforming Growth Factor-beta (TGF beta) (0.5 ng/mL, 48 h) was found to completely suppress the osteocalcin synthesis induced by 1,25(OH)2D (10(-8) and 10(-9) M), whereas the MC-903-induced osteocalcin synthesis was not affected, suggesting a negative interaction between TGF beta and 1,25(OH)2D but not MC-903 on osteocalcin synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of calcitonin administration on young pig trabecular bone remodeling

Ten-week-old pigs were treated with 4 different treatment schedules of porcine calcitonin for 2 months. Groups C1 and C4 received continuous treatment: C1 had daily IM injections (4 IU/kg/BW (body weight) each injection), and C4 was infused with a minipump implanted subcutaneously delivering 4 IU/kg/BW/day. Groups C2 and C3 received intermittent calcitonin treatment (each injection 4 IU/kg/BW): C2 was given 1 out of every four days, C3 was injected 5 consecutive days out of 20 days. The total dosage received in C1 versus C4 and C2 versus C3 were the same. Results were evaluated by histomorphometry after double tetracycline labeling on iliac trabecular bone. Resorption surfaces were decreased in groups C2, C3 and C4, but bone volume, osteoclast surfaces, and interstitial bone thickness were not modified in any group receiving calcitonin. Osteoblast and mineralizing surfaces were increased in group C2, C3 and C4. Plasma 1,25-dihydroxyvitamin D concentration and bone formation rate were increased in groups C2 and C4. Plasma immunoreactive parathyroid hormone levels and parathyroid weights were not increased in any treated groups. In conclusion, 2-month calcitonin treatment did not decrease the amount of bone resorbed in growing pigs. Continuous calcitonin infusion and intermittent calcitonin administration induced an increase in the extent of active bone formation which might be in part dependent on an increased production of 1,25 dihydroxyvitamin D.

Cyclosporin A induces in vivo inhibition of resorption and stimulation of formation in rat bone

We investigated a possible "in vivo" effect of cyclosporin A, an immunosuppressive agent, on normal rat bone remodeling. At an oral daily dose of 7 mg/kg for 14 days, the blood level of cyclosporin A was in the usual effective range and no change in renal function or magnesium metabolism was observed. Treated rats had decreased bone resorption: urinary hydroxyproline, plasma acid phosphatase, and the number of osteoclasts in caudal vertebrae were significantly reduced. By contrast, bone formation assessed by dynamic histomorphometry after double tetracycline labeling was increased. No modification of calciotropic hormones (vitamin D metabolites and parathyroid hormone as assessed by urinary cyclic AMP) was observed at the end of the treatment. These results suggest that in vivo cyclosporin A treatment induces bone remodeling modifications related to either a direct or a lymphokine-mediated effect on bone cells.

[Value of bone fluoride determination in osteoporotic patients treated with sodium fluoride]

In order to find out whether the response of osteoporosis to sodium fluoride treatment or complications arising from this treatment are related to the retention of fluoride in bones, we measured bone fluoride concentrations in 30 patients with primary osteoporosis who had been treated with sodium fluoride for 1 to 8 years. We found a significant correlation (r = 0.74, P less than 0.001) between bone fluoride concentration and total amount of fluoride ingested. However, with any given amount of sodium fluoride, the bone fluoride concentration could vary by up to three times from a patient to another. There was a significant correlation between bone fluoride concentration and trabecular bone volume on the hand (r = 0.54, P less than 0.001) and thickness of osteoid borders measured on the same biopsy specimen on the other hand (r = 0.45, P less than 0.001). Five patients developed lower limb bone fissures after 11 to 18 months of sodium fluoride treatment, but their bone fluoride concentration was not significantly different from that of the 25 patients who had no fracture. These data suggest a relationship between the degree of stimulation of bone formation by fluoride and the bone concentration of that substance; however, peripheral fractures are not dependent on bone fluoride concentration.

[Amino-hydroxy-propylidene biphosphonate in the treatment of Paget's disease resistant to calcitonin and/or etidronate]

18 patients with Paget's disease resistant to calcitonin and/or to EHDP (ethane-hydroxy bisphosphonate) were treated with APD (disodium amino-hydroxypropylidene-bisphosphonate). The efficacy of the product was judged by the decrease in serum alkaline phosphatases and of hydroxyproline in the 24-hour urine specimen. The treatment lasted for a maximum of 6 months. Administration of APD was stopped before six months if he hydroxyproline content in the urine returned to normal (except in the case of four patients where the early interruption of treatment was due to lack of supplies). Of the 14 patients who followed the regular course of treatment, the urine hydroxyproline became normal between the first and the sixth month of treatment in 11 patients: at the start, all had a 24-hour urine hydroxyproline content equal to or less than 2.1 mmol/l 24 h (275 mg/24 h). The baseline 24-hour urine hydroxyproline in the remaining three patients was higher (3.55; 2.30; 3.28 mmol/24 h), but the level was reduced by 50% after 6 months of treatment. Alkaline phosphatases were reduced in the same proportions but the decrease occurred at a slightly later date. The residual activity was evaluated in 9 subjects who had not received any treatment for one year: in 8 out of the 9 patients the parameters used for measuring bone activity had not appreciably altered. Treatment with APD was restarted in 4 patients after a period of 12 to 36 months without therapy, and its efficacy was found to be comparable to that of the drug's first use. In all, APD demonstrated remarkable efficacy in pagetic patients resistant to both calcitonin and/or EHDP.

Decreased bone formation in osteoporotic patients compared with age-matched controls

In order to study trabecular bone remodeling in postmenopausal osteoporosis we compared bone biopsies of 44 osteoporotic women aged 50-70 to those of 23 nonosteoporotic women, matched for age, who had a bone biopsy during anesthesia for knee arthritis. Trabecular bone volume, mean wall thickness, osteoblastic surfaces, labeled surfaces, and bone formation rate were decreased in osteoporotic women compared with control women. The osteoclast number and the osteoclastic surfaces were the same in the two groups. The normal distribution of the histomorphometric static parameters in osteoporotic patients did not allow the separation of subgroups. These data indicate that decreased bone formations is a major contributing factor leading to trabecular bone loss in postmenopausal osteoporosis.

[Primary hyperparathyroidism seen in rheumatology. Clinical symptoms and the relation between bone histologic signs and biological parameters]

We report the clinical and biological picture of 34 primary hyperparathyroidism (PHT) cases, diagnosed in rheumatology. It concerned 25 women and 9 men, aged 61 + 11 years. The PHT was often asymptomatic (47 p. cent of cases) at the time of diagnosis. The clinical manifestations were dominated by asthenia (50 p. cent) and renal lithiasis (47 p. cent). We found a chondrocalcinosis in 29 p. cent of patients. No patient presented any bony manifestations of cystic osteitis; 7 out of 34 patients (including 6 women between 57 and 74 years) presented vertebral compression. The mean calcemia was 117 +/- 9 mg/l. There were no hypercalcemic attack. The dosage of PTH and cyclic AMP were elevated in 29 out of 32 and 28 out of 31 patients respectively. In all patients, the level of either of these two tests was increased. The chloremia/phosphoremia ratio was also extremely predictive of HBP, since it was increased, exceeding 3.3 in 33 out of 34 patients. The 25-hydroxyvitamin D levels (25 (OH) D) were normal. The levels of 1,25 (OH) 2D were markedly spread (37 +/- 16 pg/ml) and not significantly different from the reference group. Patients with lithiasis did not present a higher level of 1,25 (OH) 2D. A bone histomorphometry carried out in 15 patients showed a bone trabecular volume similar to that of the reference with the same age. The osteoclastic resorption was increased in all cases and was not correlated with the PTH level, but was significantly correlated with the level of 1,25 (OH) 2D (r = 0.79 p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

The prevalence of chondrocalcinosis in the human knee joint. An autopsy survey

The prevalence of pathological calcifications in the menisci and articular cartilage of both knees was investigated macroscopically and radiologically in 130 consecutive autopsies. The mean age of the subjects was 72 +/- 13 years. Only 8 subjects were less than 50 years old. All had been admitted to hospital and no patient had a history of joint disorders. Half of the patients were male. Calcifications were found in 27 (20.7%) cases, all over 60 years of age. There were 15.4% males and 26.1% females affected. The incidence of intraarticular calcifications in females increased from 11.1-37.5% and in males from 20-29.4% for the 60-69 year age group and the over 80-year age group, respectively. One third of affected cases had only meniscal and 2/3 had both meniscal and chondral calcifications. Isolated meniscal calcifications were found more often in 1 and mixed meniscal and chondral calcifications were found in both knees. Severe destructive articular cartilage lesions were observed significantly more often in joints with intraarticular calcifications than in joints of age matched subjects without calcifications. Joints with calcifications showed little evidence of synovial inflammation. Similarly, no specific relationship was found between the presence of crystal and amyloid deposits in the knees examined.

Osteocalcin and bone morphometric parameters in adults without bone disease

Serum bone Gla-protein (s-BGP or osteocalcin) and other serum biochemical parameters were measured in 19 subjects (8 women and 11 men, aged 20-82 years) without any bone disease. Each subject simultaneously underwent an iliac crest biopsy; tetracycline double-labeling was performed in 11 subjects, allowing correlations between s-BGP and bone histomorphometric parameters. s-BGP was significantly correlated with static bone parameters: trabecular bone volume (r = 0.74; P less than 0.001), osteoid surfaces (r = 0.69; P less than 0.001), osteoblastic surfaces (r = 0.68; P less than 0.002); dynamic bone formation parameters: total labeled surfaces (r = 0.72; P less than 0.01); and the bone formation rate (r = 0.69; P less than 0.01). We conclude that s-BGP is a valuable marker for evaluating bone formation in healthy adult subjects.

Different schedules of administration of (3 amino-1-hydroxypropylidene)-1, 1 bisphosphonate induce different changes in pig bone remodeling

Intermittent administration of antiosteoclastic agents has been proposed in order to increase trabecular bone volume (TBV). We evaluated the effect of two different intermittent schedules of administration of (3 amino-1-hydroxypropylidene)-1, 1 bisphosphonate (AHPrBP) on pig bone remodeling for a period of 60 days. AHPrBP (1.6 mumol/kg/injection) was given subcutaneously daily (group A1), or 5 consecutive days out of 21 days (group A2), or 1 out of every fourth day (group A3). Compared to control animals, group A1 significantly increased trabecular bone volume (TBV) (+62%) with a marked decrease in bone resorption assessed by interstitial bone thickness. Bone formation assessed by mean wall thickness (MWT) was also decreased due to a decrease in the number and activity of osteoblasts. There was not a delay in the coupling mechanism as assessed by the reversal surfaces. The two groups receiving intermittent schedules had markedly different results. Group A2 had very similar changes to group A1 despite receiving four time less drug. Compared to group A1 and A2, group A3 had smaller decrease in resorption and higher bone formation rate with identical MWT. These differences between group A2 and A3 were associated with similar levels of parathyroid hormone and vitamin D metabolites. Different bone concentrations induced by the two different schedules of AHPrBP may explain the greater effect on bone resorption and osteoblast recruitment in group A2 and thus a milder effect of the AHPrBP administration once every fourth day.

Lack of biological activity of vitamin D3-3 beta sulfate during lactation in vitamin D-deficient rats

Sulfoconjugated vitamin D has been claimed to have an important antirachitic activity and to be present at higher amounts than free vitamin D in maternal milk. We have previously shown that vitamin D3-3 beta sulfate (SD3) administration has little effect on calcium and bone metabolism during pregnancy in rats. In the present work, we have compared the biological activity of free vitamin D3 (D3) and SD3 during the lactation period. After delivery, D-depleted (-D) female rats were orally treated with D3 or SD3 (1,300 pmoles/every two days) during 20 days of lactation. Vitamin D status was determined before, during and at the end of the treatment for mother rats and at days 1 and 20 of life in suckling pups. Both mothers and pups were sacrificed at day 20 of lactation and subjected to hormonal and mineral determinations and to histomorphometric analysis of bone metabolism. After 12 days of SD3 treatment, mother rats showed a slight but significant elevation in plasma concentrations of calcium phosphorus and vitamin D metabolites. This effect was reversed at the end of lactation; at this time most maternal plasma parameters did not differ from those observed in -D non-treated mothers. By contrast, 20 days of D3 administration in mothers normalized plasma biochemical parameters. These results were confirmed by analysis of both static and dynamic parameters of bone formation. Maternal SD3 treatment did not improve either plasma biochemical or histological parameters of bone formation and resorption in suckling pups which remained comparable to that of D-deficient pups; by contrast, pups from D3-treated mothers normalized most biochemical plasma parameters although bone metabolism remained abnormal. In conclusion, the biological activity of SD3 on bone and mineral metabolism during lactation in rats is as low as in the nonreproductive stages.

Bone histological heterogeneity in postmenopausal osteoporosis: a sequential histomorphometric study

We studied sequential bone biopsies performed at 6 to 24 month intervals from 14 untreated osteoporotic women (64 +/- 7). Subgroups were defined, respectively, by increased osteoclastic resorption surfaces and decreased osteoblastic surfaces +/- 2 S.D. Normal values were obtained from bone biopsy of 23 normal women (61 +/- 8). When patients were divided into subgroups according to the above criteria the first biopsy showed that 3 out of the 14 patients had high resorption surfaces and 6 had low osteoblastic surfaces. Eight patients spontaneously changed during the study. In 2 patients there was a change in resorption surfaces, in 3 in osteoblastic surfaces and in 3 a change in both osteoblastic and resorption surfaces was observed. Considering the first or second bone biopsy results the patient variance was higher than the control subject's variance; however the variance between the first and second bone biopsy of one patient was not different from the variance inside the group of patients. The average intraindividual variation of the parameters on sequential biopsies was of the same order as the one we previously observed on simultaneous bone biopsies of normal and hemodialyzed patients. We concluded that if osteoporosis is a heterogeneous disorder, subgroups cannot be definitively defined on the basis of cellular parameters of bone remodelling assessed on bone biopsies.

Bone changes due to pregnancy and lactation: influence of vitamin D status

The effects of pregnancy and lactation on endosteal bone formation and resorption were evaluated in vitamin D-depleted (-D) and vitamin D-repleted (+D) rats. Pregnancy induced a marked stimulation of osteoclastic bone resorption and of static and dynamic parameters of bone formation and mineralization. Bone resorption increased independently of vitamin D status and did not correlate with plasma 1,25-dihydroxyvitamin D3 [1,25(OH)2D] levels, but it was associated with increased plasma immunoreactive parathyroid hormone (iPTH) concentrations. Stimulation of the endosteal bone formation rate was mainly impaired in D-depleted rats, resulting in trabecular bone loss, which, in -D mother rats, was associated with decreased bone ash and total bone calcium. Lactation further stimulated bone resorption and reduced the trabecular bone volume; ash weight and bone calcium content were also decreased independently of the vitamin D status and changes in plasma iPTH levels. In presence of vitamin D, the bone formation rate increased fourfold during lactation but was unchanged in -D lactating rats. During lactation, vitamin D-depleted rats lost twofold more calcified bone than +D rats because of impaired mineralization. Thus, the present study shows that both the endosteal bone resorption and formation are stimulated by pregnancy and lactation and that vitamin D is required for normal bone mineralization during the reproductive period.

Reference intervals for vitamins B1, B2, E, D, retinol, beta-carotene, and folate in blood: usefulness of dietary selection criteria

Reference intervals for normal concentrations in blood of vitamins B1, B2, E, D, retinol, beta-carotene, and folic acid were determined from a selected sample of people attending a Health Examination Center or being examined in occupational health services in France. This reference sample consisted of 362 men and women, ages 18 to 44 years, selected according to the main variation factors known for the vitamins studied: consumption of tobacco and alcohol, ponderal index (relating height and weight), use of drugs and oral contraceptives, and past history of surgical or medical treatment. Reference intervals were determined for each sex. Vitamin B1 (erythrocyte transketolase activity), plasma retinol, and folic acid values in whole blood are significantly higher in men than in women (p less than 0.001), but vitamin B2 (activation of erythrocyte glutathione reductase) and plasma beta-carotene values are significantly higher in women (p less than 0.001 and less than 0.01 respectively). Dietary intake of vitamins produced no significant displacement of the reference values. For each vitamin we discuss the other major sources of variation factors and the usual values reported in the literature.

Reference intervals for vitamins B1, B2, E, D, retinol, beta-carotene, and folate in blood: usefulness of dietary selection criteria

Reference intervals for normal concentrations in blood of vitamins B1, B2, E, D, retinol, beta-carotene, and folic acid were determined from a selected sample of people attending a Health Examination Center or being examined in occupational health services in France. This reference sample consisted of 362 men and women, ages 18 to 44 years, selected according to the main variation factors known for the vitamins studied: consumption of tobacco and alcohol, ponderal index (relating height and weight), use of drugs and oral contraceptives, and past history of surgical or medical treatment. Reference intervals were determined for each sex. Vitamin B1 (erythrocyte transketolase activity), plasma retinol, and folic acid values in whole blood are significantly higher in men than in women (p less than 0.001), but vitamin B2 (activation of erythrocyte glutathione reductase) and plasma beta-carotene values are significantly higher in women (p less than 0.001 and less than 0.01 respectively). Dietary intake of vitamins produced no significant displacement of the reference values. For each vitamin we discuss the other major sources of variation factors and the usual values reported in the literature.

Calcidiol in human milk. The effect of prohormone on vitamin D status of breast fed unsupplemented infants

Vitamin D, free or sulfoconjugated, and calcidiol (25(OH)vitamin D) levels were measured by competitive binding assay in breast milk samples of nursing mothers. Vitamin D status of their unsupplemented breast fed infants was determined. A strong correlation was established during the first month of the infant life only between calcidiol mother milk content and breast-fed infant serum. Calcidiol seems to be the vitamin D derivative mainly responsible for the maintainance of the vitamin D status of the newborn infant.

Relationship between bone GLA-protein (BGP) and calcidiol (25-hydroxycalciferol) in serum of breast-fed infants

The aim of this investigation was to study the bone metabolism in early infancy by establishing the relationship between serum osteocalcin levels and the hormonal vitamin D status of exclusively breast-fed infants during their first month of life. Calcium, phosphorus, alkaline phosphatase, 25-hydroxycalciferol (calcidiol), 1,25-dihydroxycalciferol (calcitriol) and osteocalcin (BGP or GLA-protein) were measured in 22 healthy lactating women and their paired breast-fed infants before and after supplementation (400 IU vitamin D per day). Prior to supplementation calcidiol, calcitriol and osteocalcin remained unchanged. Following supplementation there was an increase in all the parameters with the exception of calcitriol. The administration of vitamin D to breast-fed infants should in fact have an effect on bone activity as reflected by the increase in osteocalcin levels.

Relationship between the vitamin D content of maternal milk and the vitamin D status of nursing women and breast-fed infants

This work was designed to study the effect of the vitamin D content of human milk on the vitamin D status of exclusively breast-fed infants, and the relation between milk and maternal serum concentrations of vitamin D during the first month of lactation. Serum levels of calcium (Ca), phosphorus (P), magnesium (Mg) and 25-hydroxyvitamin D (25-OH-D) were determined in a racially heterogeneous population of nursing women, between days 3 and 5 (L3), 15 and 18 (L15) and 30 and 45 (L30) post partum. The same parameters were determined in the serum of 1-month-old breast-fed infants. Maternal milk samples were obtained at L3, L15 and L30 and analysed for Ca, P, Mg, vitamin D and 25-OH-D content. Milk levels of Ca, P and Mg were found to be within the range previously described by other authors. No correlation was found between serum and milk levels of vitamin D and 25-OH-D in nursing mothers. The 25-OH-D concentration in milk was related to its vitamin D content and strongly correlated (P less than 0.001) with the 25-OH-D levels in the serum of exclusively breast-fed infants. No significant changes were observed in maternal serum levels of 1,25-dihydroxyvitamin D (1,25-(OH)2D3) measured at L3 and L30, or between maternal and infant levels of 1,25-(OH)2D3 at L30. This study emphasizes the importance of the 25-OH-D content of maternal milk, in being primarily responsible for the vitamin D concentrations found in the serum of exclusively breast-fed infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of vitamin D sulphate in human milk using desorption chemical ionization mass spectrometry

Vitamin D3 sulphate (SD3) identification in human milk was obtained using Desorption Chemical Ionization (DCI). The chemical ionization reagent gas used was nitrogen, molecules were ionized when the emitter was heated. SD3 was obtained from lactarium human milk and purified by high-performance liquid chromatography (HPLC). A selected ion monitoring (SIM) measurement was carried out with typical ions, m/z 366 for SD3 and m/z 384 for parent vitamin D3, the intensity ratio (I366/I384) greater than 1 being related to the presence of the sulphoconjugated form of vitamin D3 in the sample analysed. The detection of small quantities of SD3 in human milk is possible using this technique.

Influence of vitamin D on mineral metabolism, hormonal status and bone histology in lactating rats and their pups

Mineral, hormonal and skeletal changes were determined in vitamin D-deficient (-D) and vitamin D-replete (+D) mother rats and in their litters on day 20 of lactation. These results were compared with those obtained in -D mothers and pups, after giving the mothers an oral supplement (10 i.u. vitamin D3/day) during the period of lactation (20 days). Compared to +D animals, both -D lactating mothers and their pups exhibited extremely low plasma levels of 25-hydroxyvitamin D3 (25-OH-D3), diminished 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) and increased levels of immunoreactive parathyroid hormone (iPTH). Vitamin D-deficient mothers also had higher levels of calcitonin and lower levels of prolactin than +D mothers. All -D animals (mothers and pups) showed increased osteoclastic bone resorption and severe osteomalacia as shown by decreased bone ash, decreased calcification rate and increased endosteal osteoid surface, volume and thickness. In mothers treated with vitamin D3 during lactation, nearly all the plasma variables measured, as well as bone histomorphometric features, were normal. In contrast, their pups still showed rickets and osteomalacia, despite normal levels of 25-OH-D3 and calcium in the plasma. These pups had raised plasma levels of 1,25(OH)2D3 and iPTH associated with persistent stimulation of bone resorption. This study showed that (1) severe vitamin D deficiency in lactating rats produced marked osteomalacia and secondary hyperparathyroidism in both mothers and pups, and (2) vitamin D treatment of -D mother rats during lactation (10 i.u. vitamin D3/day) reversed the mineral, hormonal and skeletal abnormalities in mothers but not in pups.

Increased bone aluminum deposition after subtotal parathyroidectomy in dialyzed patients

Ten dialyzed patients underwent a systematic bone biopsy before and 19 +/- 9 months after subtotal parathyroidectomy (PTX). At the end of the follow-up period all the patients, except two, who complained of proximal myalgia, were asymptomatic. Compared to the bone biopsy specimen obtained prior surgery, decreased bone formation without mineralization impairment was observed after PTX. Despite an average decrease in aluminum gels intake after PTX, an increase in stained aluminum was observed (0.69 +/- 0.79 versus 1.20 +/- 0.95 mm/mm2, P less than 0.050). Aluminum accumulation depended on the pre-PTX bone aluminum load: pre- and post-PTX bone aluminum loads were correlated (r = 0.78, P less than 0.01). Bone aluminum accumulation was not related to the amount of aluminum gel intake after PTX; however, only two patients free of both bone aluminum deposit prior to PTX and aluminum gel intake after PTX had no stainable aluminum on the second bone biopsy after PTX. The only patient who had no decrease in bone formation after PTX had no increase in bone aluminum. Assuming that the patients had no aluminum deposit prior to dialysis, we measured the rate of bone aluminum accumulation. It rose from 0.11 +/- 0.09 mm/mm2/year prior to PTX to 0.40 +/- 0.25 mm/mm2/year after PTX (P less than 0.05) in the six patients who were maintained on phosphate binders and who had a decrease in bone formation after PTX. These six patients had unchanged aluminum gel intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of the calcium antagonist, diltiazem on in vitro and in vivo/in vitro bone resorption

The effect of the calcium antagonist diltiazem on bone resorption in organ culture has been investigated. It was found that diltiazem was ineffective alone but that in concentrations above 5 mumol/l it reduced mineral and organic resorption induced in vitro by 1.25 dihydroxycholecalciferol (1.25 (OH)2D3). No additivity with calcitonin effects was observed. Diltiazem did not significantly affect bone resorbing activity stimulated by 24,25(OH)2D3. Bone resorption was measured by an in vivo/in vitro technique using 45Ca prelabelled mice. Compared with 1.25(OH)2D3 alone treated group (0.480 pmol/g), it was found that diltiazem (100 nmol/g) reduced bone resorption without effect on calcium and phosphorus plasmatic concentrations at death. These data suggest that such a calcium antagonist is able to inhibit 1.25-(OH)2D3-increased-bone resorption either in vitro or in vivo/in vitro.

Osteoclast abnormalities in idiopathic osteopetrosis. Reference to the ultrastructural histochemistry study

In order to investigate skeletal abnormalities in a case of idiopathic osteopetrosis, a bone biopsy was taken from the anterior iliac crest and prepared for ultrastructural and histochemical study. There was a drastic reduction in osteoclastic bone resorption. The ruffle border and sealing zone, which are the osteoclast cell surface markers of bone resorption, were absent. The cells were highly vacuolated, and the vacuoles contained large amounts of a residual organic material which reacted strongly with acid phosphatase. Acid phosphatase activity was never found outside the cell, and in particular, not at the bone-cell interface. This suggests that the defect in bone resorption is caused by cell membrane abnormalities and the lack of ruffle border formation, rather than the inability of the lysosomal enzymes to digest the bone matrix.

Effect of 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 maternal loads on maternal and fetal vitamin D metabolite levels in the rat

Two groups of female rats were used to investigate vitamin D metabolism in the pregnant animals and in their fetuses. In the first group, 3 micrograms of 25-hydroxyvitamin D3 (25-OH-D3) per kg of body weight were injected into intact or nephrectomized (NX) pregnant rats 3 h before sacrifice on day 21 of pregnancy; in the second group, 2 and 6 ng, respectively, of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) per day were infused continuously into pregnant rats between days 17 and 21 of pregnancy. The findings in the fetuses were obtained by quantitative analysis of extracts (Extrelut) of total fetal body lipids; the extracts were purified on Sep Pak and vitamin D sterols were further separated by high-pressure liquid chromatography. Three hours after the dams were injected with 25-OH-D3, the maternal plasma concentration (mean +/- SD) of 1,25(OH)2D3 was 221 +/- 84 pg/ml. In NX pregnant rats, the 1,25(OH)2D3 levels were still elevated: 95.6 +/- 49.0 pg/ml vs 45 +/- 22 pg/ml in control rats. In fetuses from intact or NX dams, the levels of 25-OH-D3 and 1,25(OH)2D3 were not different from the results obtained in the control fetuses but 24,25(OH)2D3 concentrations were increased (6.7 +/- 1.2 ng vs 2.2 +/- 0.7 ng/g body weight). After maternal infusion of 2 or 6 ng/day of 1,25(OH)2D3 (n = 8), plasma concentrations (mean +/- SD) of the metabolite were 64 +/- 31 and 517 +/- 356 pg/ml, respectively, the second being significantly higher than that of the control rats; 25-OH-D3 and 24,25(OH)2D3 levels did not change. 1,25(OH)2D3 contents (mean +/- SD) in fetuses from the treated dams were not different from those of control fetuses (10 +/- 2 pg/g body weight). Our results suggest that pregnant rats and their fetuses were protected against an excessive increase of 1,25(OH)2D3 concentrations in the maternal plasma; although there was some individual hypercalcemia, no significant increase in mean calcemia was detected in the dams, and 1,25(OH)2D3 either did not cross the placental barrier or was rapidly metabolized because we did not find any changes in the fetal content. As in intact or NX pregnant rats, 25-OH-D3 was metabolized into 1,25(OH)2D3, the increase of 24,25(OH)2D3 in the fetuses might be associated with a protective mechanism.

Histomorphometric evidence of deleterious effect of aluminum on osteoblasts

Bone histomorphometry was performed in 26 hemodialyzed patients to study the relation between the dynamic parameters of bone formation and aluminum deposition. Patients were divided into two groups according to whether bone formation rate at tissue level (Svft) was above or below normal: 0.089 mu 3/mu 2 per day. The 12 patients who constituted group II, defined by a Svft less than 0.089 mu 3/mu 2 per day, had markedly decreased extent of double-labeled surfaces (m = 1.3 +/- 6.5%), and these were absent in 8 of 12 patients. Osteomalacia, defined by decreased formation with increased mean osteoid thickness (greater than 15 micron), was present in only 3 of 12 patients in group II. The 14 patients who constituted group I, defined by a Svft greater than 0.089 mu 3/mu 2 per day, had both increased total labeled surfaces and mineralization rate. Osteomalacia was present in none of the group I patients. In trabecular bone, group II patients had increased stainable aluminum deposition, compared to group I patients, whether estimated as total stainable aluminum (2.16 +/- 1.34 vs 0.17 +/- 0.28 mm/mm2) or stainable percent of trabecular surfaces (42 +/- 19 vs 4 +/- 5%). This last parameter was inversely related to osteoblastic surfaces (r = -0.49, n = 26, P less than 0.01) and total labeled surfaces (r = -0.72, n = 26, P less than 0.01). Therefore, massive aluminum deposition was not invariably associated with impaired mineralization but with decreased formation due to decreased extent of active formation surfaces. In the group I patients, moderate aluminum deposition was not associated with the mineralization arrest observed in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Vitamin D3 3 beta sulfate has less biological activity than free vitamin D3 during pregnancy in rats

The biological activities of free (D3) and sulfoconjugated (SD3) vitamin D3 were compared after 6 weeks of oral administration to D-deficient (-D) female rats which were mated in the meantime. Mothers and pups were sacrificed 1-2 days following parturition and mineral and hormonal plasma status was determined in mothers and bone mineral determinations and bone histomorphometric studies performed. In newborns, plasma levels of Ca, P and 25-hydroxyvitamin D (25(OH)D) were measured. After parturition, -D mothers had decreased body weight (BW) as well as decreased plasma levels of Ca, P and 1,25-dihydroxyvitamin D (1,25(OH)2D) associated with undetectable levels of 25(OH)D. Plasma levels of immunoreactive calcitonin and parathormone, by contrast, were higher than in vitamin D-replete (+D) control mothers. Bone histomorphometric analysis showed osteomalacia and secondary hyperparathyroidism in -D mothers. After parturition, -D +SD mothers had reduced BW compared to D-treated mothers and the plasma parameters measured were abnormal. Almost all bone histomorphometric parameters were found to be intermediate between +D and -D groups without reaching values of +D mothers. By contrast, -D +D mothers had most of the bone formation parameters identical to those of +D mothers. However, bone resorption was still higher while plasma levels of P and 25(OH)D remained slightly, but significantly lower than in +D mothers. In pups, plasma Ca in both D3- and SD3-treated groups was similar to values in +D-treated rats. However, pups from SD3-treated mothers still showed plasma levels of P and 25(OH)D lower than in +D pups. In conclusion, treatment with SD3 in -D mother rats significantly improves the biochemical plasma parameters of pups, but complete normalization can be achieved only in the D3-treated group. Our results show that when administered at equal amounts, SD3 has a much lower biological activity than D3 in -D female rats and cannot therefore replace vitamin D3 particularly during pregnancy.

Multifactorial low remodeling bone disease during cyclic total parenteral nutrition

The physiopathology of metabolic bone disease described during long term total parenteral nutrition is poorly understood. We therefore prospectively assessed bone status of seven adult patients [mean age, 42 +/- 16 (SD) yr] treated with cyclic total parenteral nutrition for a period of 7 +/- 2 (SD) months. All patients had hypercalciuria (381 +/- 96 mg/day) associated with negative calcium balance in six of seven patients (-49 +/- 120 mg/day). A correlation was found (r = +0.74, P less than 0.01) between protein intake and calciuria. Two patients developed slight transient hypercalcemia. Serum magnesium and phosphate levels remained within the normal range. A high aluminum load due to the added phosphate solution (253 +/- 84 micrograms/day) was associated with increased serum aluminum levels (52 +/- 38 micrograms/liter). Normal serum levels of 25 hydroxyvitamin D (12 +/- 7 ng/ml) and low normal 1,25 dihydroxyvitamin D levels (21 +/- 8 pg/ml) were found. Serum PTH was normal in five and increased in two of the seven patients. However, in these two patients skeletal unresponsiveness to the action of PTH was found. A new histomorphometric picture of bone was observed; it consisted of a markedly reduced bone formation with subnormal osteoclastic activity leading to a low trabecular bone volume. No osteomalacia was found. The aluminum load may have played a role in these bone defects. The hypercalciuria with negative calcium balance was attributed to the cyclic amino-acid delivery during TPN.

[Cellular aspects of the aging of the articular cartilage. II. Condylar cartilage with fissured surface taken from normal and arthritic knees]

The authors studied the cellular density (number of cells per mm2) of cartilage taken from the femoral condyles of 46 cadavers (73 knees). In each case, the cartilage was taken from the summit of the condyle and, in 46 joints (27 subjects), a sample was also taken from the posterior surface (non weight-bearing zones). The fragments of non-calcified cartilage were sectioned with a cryostat and the sections (10 micrometers) were stained with hematein-eosin and solid red-Alcian blue. This study demonstrates: 1) a decrease in the cellular density of fissured cartilage compared to normal cartilage; this decrease appears to be proportional to the degree of fibrillation; 2) a decrease in the cellular density of apparently normal cartilage from arthrotic joints compared with normal cartilage from healthy joints; 3) with the age of the subjects, an increase in the density of the clones (number of clones per mm2) and the density of clonal cells (number of clonal cells per mm2) together with a decrease in the mean number of chondrocytes per clone. In fissured cartilage, the density of the clones, the density of the clonal cells and the number of chondrocytes per clone are slightly higher on the posterior surface of the condyles than on the summit of the condyles. These results emphasise the importance of the role that might be played by cellular phenomena in the mechanisms of deterioration of cartilage with aging and with arthrosis.

Effects of iron overload on bone remodeling in pigs

For study of the effects of an iron overload on bone remodeling, 5 control pigs were compared with 5 pigs given a total dose of 10.8 g of parenteral iron in 36 days. Treated pigs developed an iron tissue overload demonstrated by a marked increase in bone and liver iron. Except for a modest increase in SGOT, there was no biochemical or histologic sign of liver damage. Serum levels of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were unchanged in the treated pigs. There was no accumulation of iron in the parathyroid glands and the serum immunoreactive parathyroid hormone level was unchanged in the treated animals. Bone histomorphometry after double tetracycline labeling showed that in the treated pigs osteoblast cell surfaces, double and total labeled surfaces, appositional rate, and formation at tissue level were significantly decreased, and reversal surfaces were increased. Mineralization was not impaired because the osteoid thickness was unchanged. From the morphometric measurements it was concluded that osteoblast recruitment and the collagen synthesis rate were decreased. Mean wall thickness, which indicates the amount of bone synthesized, was also lowered. In contrast, the osteoclastic resorption surfaces and the depth of lacunae resulting from osteoclast resorption were unchanged by treatment. Despite this imbalance between formation and resorption, trabecular bone mass estimated on trabecular bone volume and bone ash was unchanged after 36 days' treatment. Perls' stain revealed that iron deposits were present in osteoblast and osteoclast cells and also inside the bone matrix, because there was a linear deposit along the trabecular surfaces, cement line, and osteoid-mineralized bone interface. Therefore, because treatment induced no modification of the major humoral regulators of bone metabolism, it is suggested that iron, which was present in bone cells and matrix, could play a role in bone remodeling.