Rapid Hypercalciuria Induction With Bone Formation Marker Reduction During Immobilization in Children

ObjectiveTo prospectively examine the occurrence of hypercalciuria and changes in bone metabolite markers in pediatric patients during immobilization.MethodsIn total, 13 children with an orthopedic disease requiring immobilization longer than 2 weeks were enrolled. Blood samples were collected after breakfast. Urine samples were collected at the second voiding after waking. The urine calcium/creatinine (Ca/Cr) ratio and various bone metabolite parameters were measured before and every 1 to 4 weeks after the start of immobilization.ResultsThe median patient age was 7 years with a range of 2 to 13 years. Orthopedic diseases in the patients were dislocated hip joint (N = 7), slipped capital femoral epiphysis (N = 2), etc. The urine Ca/Cr ratio increased significantly within a week after immobilization (P < .01) and continued to increase for 2 more weeks. Once immobilization ended, the urine Ca/Cr ratio gradually decreased and returned to the normal range approximately 6 weeks after mobility was achieved (P < .01). Serum alkaline phosphatase (ALP) and bone-specific ALP significantly decreased after immobilization began (P < .01). After immobilization ended, the serum ALP returned to preimmobilization levels in 2 to 4 weeks (P < .01). Serum N-terminal telopeptides did not change significantly during immobilization.ConclusionThe urine Ca/Cr ratio immediately increased after immobilization. In contrast to adults, bone formation markers in children decreased during immobilization, whereas bone resorption markers did not increase. To our knowledge, this study is the first to examine bone metabolism markers in children during immobilization.     

Mechanisms of hypocalcemia and markers of bone turnover in alcohol-intoxicated drinkers

Studies of hypocalcemia and osteoporosis frequently encountered in heavy users of alcohol have previously been performed on alcoholic people who have already recovered from alcohol intoxication. Bone and mineral metabolism during and after the intoxication may be different. We measured serum parameters of bone and mineral metabolism in 26 alcohol-intoxicated men and in 19 healthy control men. Although serum ionized calcium was 12% (P < 0.0001) lower in the patients than in the controls, serum intact parathyroid hormone was similar in the study groups. As reflected by decreased serum levels of osteocalcin (−43%; P < 0.001), bone formation was depressed in the patients. Serum cross-linked carboxyterminal telopeptide of human type I collagen (ICTP), a novel parameter of bone matrix degradation, was 9% higher in the patients (P = 0.03) than controls. The positive correlation between serum osteocalcin and ICTP in the controls (r = 0.59, P < 0.01) was absent in the patients (r = 0.05, P = 0.8). We conclude that in alcohol-intoxicated alcohol users, the parathyroid glands do not respond normally to a hypocalcemic stimulus, and that depressed bone formation is uncoupled from accelerated bone resorption.     

The effect of orchidectomy on thyroid C cells and bone histomorphometry in middle-aged rats

This study was to evaluate the effect of androgen deficiency on thyroid immunoreactive C-cells and bone structure and function in a male orchidectomized middle-aged rat model. Fifteen-month-old male Wistar rats were divided into orchidectomized (Orx) and the sham-operated control (Sham) group. In the Orx group significant decreases (P < 0.05) were found in the volume of C cells (by 14%), their relative volume density (by 13%) and serum calcitonin concentration (by 54%) compared to the controls. Analyses of trabecular microarchitecture of the proximal tibia metaphysis showed that Orx induced marked decreases of cancellous bone area, trabecular thickness and trabecular number (by 52, 20 and 19% respectively; P < 0.05), whereas trabecular separation was increased by 27% (P < 0.05). In Orx rats, serum osteocalcin concentration was increased by 119% (P < 0.05), while serum calcium and phosphorus were 6 and 14% (P < 0.05) lower, respectively, compared to the levels in the Sham. In addition, urine calcium content was considerably higher (by 129%; P < 0.05) in Orx animals. These findings indicate that the androgen deficiency caused by Orx in middle-aged rats modulated the structure of C cells and diminished secretion of calcitonin. Histomorphometrical and biochemical analyses demonstrated a decrease of cancellous bone mass and increased bone turnover.     

Assessment of bone remodeling using biochemical indicators of type I collagen synthesis and degradation: relation to calcium kinetics

In this study, we investigated the relation between calcium kinetic indices of bone remodeling (resorption rate, r; and formation rate, m, respectively) and two serum markers of type I collagen turnover: the pyridinoline cross-linked carboxyterminal telopeptide domains of type I collagen (S-ICTP a marker of bone matrix degradation) and the carboxyterminal propeptide of human type I procollagen (S-PICP, a marker of bone matrix formation). We studied three groups: (i) healthy controls (n = 19), (ii) a mixed group of high and low-turnover bone diseases without mineralization defects (myxedema, thyrotoxicosis and primary hyperparathyroidism n = 38), and (iii) osteoporosis (n = 52). In healthy controls, a significant regression of S-PICP on m was obtained (R = 0.53, SEE/Y = 0.44, P < 0.02). Significant regressions were also demonstrable in high- and low-turnover bone disease (R = 0.50, P < 0.001), SEE/Y = 61%) and osteoporosis (R = 0.49, P < 0.001, SEE/Y = 50%). In controls the regression coefficient for the regression of S-ICTP on r was 0.19 (NS), in high and low turnover bone disease 0.66, (SEE/Y = 59%, P < 0.001) and in the osteoporotic group 0.40 (SEE/Y = 61%, P < 0.01). We conclude that S-PICP and S-ICTP reflect whole skeletal bone formation and resorption rates in a variety of metabolic bone diseases including osteoporosis.     

Minocycline impairment of both osteoid tissue removal and osteoclastic resorption in a synchronized model of remodeling in the rat

In addition to their antibacterial effects, tetracyclines may inhibit interstitial collagenase activity and bone resorption. These properties were assessed morphometrically using minocycline (25 and 50 mg/kg/day given by the IM route) in a rat model of synchronized remodeling in which osteoclastic resorption peaks 4 days after the activating event (the extractions of the upper molars) along the antagonist mandibular cortex, a zone undergoing physiologically active formation. During the first 2 days of activation, minocycline at the two doses impaired very significantly the disorganization of both the osteoid seam and the layer of osteoblasts, a prerequisite to give osteoclasts access to the mineralized bone surface. The number of readily identifiable osteoblasts decreased slightly during this period, suggesting that minocycline prevented their transformation into lining cells. Their synthetic activity, as estimated by the size of the cells and their nucleus, appeared relatively preserved too, mostly with the higher dose. At the peak of osteoclascia, the bone surfaces undergoing remodeling were significantly decreased in the minocycline-treated groups. The resorption surface was reduced (P < 0.0003) as well as the number of osteoclasts (P < 0.0007), which were also significantly smaller. Their resorbing activity was dramatically affected as well: they excavated lacunae whose area was significantly reduced by over 70%. In addition, formation was still a prominent activity in the treated animals. These data are compatible with the inhibition at the early stages of activation of an osteoblast-secreted collagenase whose action may be the elimination of the osteoid seam. The inhibition of an osteoclast collagenase and/or of a bone matrix bound-collagenase may be responsible for the reduction in lacunar size. A direct effect of minocycline on osteoclast resorptive activity may also participate in the low resorption profile, as tetracyclines are known to interfere with the intracellular [Ca²⁺]. © 1996 Wiley-Liss, Inc.     

La radio-immunothérapie préciblée des tumeurs solides : une démarche pluridisciplinaire

No effective therapy is currently available for the management of patients with metastases of most solid tumors. Thus, pretargeted radioimmunotherapy approaches have been developed that have shown promises. One of these techniques uses bispecific monoclonal antibody and radiolabeled bivalent haptens injected sequentially. In two clinical trials, 29 patients with advanced, progressive medullary thyroid carcinoma, as documented by short serum calcitonin doubling times, received an anti-carcinoembryonic antigen x anti-diethylenetriamine pentaacetic acid (DTPA)–indium) bispecific monoclonal antibody, followed four to five days later by an ¹³¹I-labeled bivalent hapten. Overall survival was significantly longer in high-risk, treated patients than in high-risk, untreated patients (110 versus 61 months; P < 0.030). Forty-seven percent of patients, defined as biologic responders by a more than 100% increase in calcitonin doubling time, experienced significantly longer survival than non-responders (159 versus 109 months; P < 0.035) and untreated patients (159 versus 61 months; P < 0.010). Toxicity was mainly hematologic and related to bone/bone-marrow tumor spread. Various multidisciplinary aspects of this long-term endeavor that resulted in long-term disease stabilization and a significantly longer survival in high-risk patients are described and discussed with respect to future directions of research on pretargeted radioimmunotherapy.     

Calcitonin test in patients with bone changes during the course of myeloma]

Hypocalcemic response following the administration of 160 units of porcine calcitonin was investigated in 14 patients with bone lesions caused by myeloma and in 9 control subjects. Significant decrease in blood serum calcium level was found in 85 per cent of myeloma patients, both in those with osteolytic bone lesions and those with generalized osteoporosis. Moreover, in all the patients a significant positive correlation was found between hypocalcemic response and the initial blood serum calcium concentration. Calcitonin administration did not cause any changes in blood serum phosphate level in myeloma patients.     

Geranylgeranyl transferase type II inhibition prevents myeloma bone disease

Geranylgeranyl transferase II (GGTase II) is an enzyme that plays a key role in the isoprenylation of proteins. 3-PEHPC, a novel GGTase II inhibitor, blocks bone resorption and induces myeloma cell apoptosis in vitro. Its effect on bone resorption and tumor growth in vivo is unknown. We investigated the effect of 3-PEHPC on tumor burden and bone disease in the 5T2MM model of multiple myeloma in vivo. 3-PEHPC significantly reduced osteoclast numbers and osteoclast surface. 3-PEHPC prevented the bone loss and the development of osteolytic bone lesions induced by 5T2MM myeloma cells. Treatment with 3-PEHPC also significantly reduced myeloma burden in bone. The magnitude of response was similar to that seen with the bisphosphonate, risedronate. These data show that targeting GGTase II with 3-PEHPC can prevent osteolytic bone disease and reduce tumor burden in vivo, and represents a novel approach to treating tumors that grow in bone.     

Bone loss in response to long-term glucocorticoid therapy

A number of studies have shown that an excess of glucocorticoids induces osteoporosis, but the mechanism(s) and the time course of the reduction of bone mass remain uncertain. In order to clarify this issue we carried out a longitudinal clinical and histomorphometric study of patients requiring long-term glucocorticoid treatment.In 23 patients (9 men, 10 post- and 4 premenopausal women) biochemical and bone histomorphometric investigations were carried out before and during treatment with 10–25 mg/day of prednisone. Histomorphometric analysis of bone biopsies of the iliac crest showed that the decrease of TBV (up to −27%, P < 0.001) occurs predominantly within the first 5–7 months of treatment; during the subsequent stages, which include observations after 12 months of treatment, only minor changes were observed. Therefore trabecular bone loss can be satisfactorily described by a negative exponential function. None of the other histomorphometric parameters (osteoid surfaces, resorption surfaces, etc.) showed significant changes. However, the histological features of the bone biopsies during steroid therapy, showing a virtual lack of osteoblastic activity, ruled out an increase of bone resorption. Moreover, the dynamic study of the bone formation by double tetracycline labelling showed, in a small subgroup of patients, a decrease of the apposition rates (from 0.763 ± 0.053 to 0.305 ± 0.074 μ/day (mean ± SE) after treatment).No significant changes, at any time during steroid treatment, were observed in serum alkaline phosphatase, 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D, 1,25-dihydroxyvitamin D, parathyroid hormone or urinary calcium excretion. Serum calcium increased significantly within the first 1–2 months of therapy and then it returned to baseline. Urinary hydroxyproline excretion decreased significantly within the first 1–2 months and continued to fall throughout the treatment.Thus, both biochemical and histological findings suggest that long-term glucocorticoid therapy causes a reduction of bone turnover, that the bone loss occurs predominantly within the first 6 months of treatment and that patients with lower bone mass have a lower rate of bone loss.     

Correlation of Body Mass Index and Age with Osteoporosis Probability in Patients with Primary Hyperparathyroidism

ObjectiveCurrently, there are limited markers to predict the osteoporosis probability in patients with primary hyperparathyroidism. We studied the relationship between various parameters and results of DXAs at various skeletal sites.MethodsRetrospective review of data for 218 patients with primary hyperparathyroidism was performed. Age, BMI, bone mineral density, serum total calcium, ionized calcium, intact parathyroid hormone, albumin, alkaline phosphatase, phosphate, 25-hydroxy vitamin D, 1,25-dihydroxy vitamin D, 24-hour urinary calcium levels and parathyroid tumor weight were analyzed. Two different statistical models- linear regression and multivariate logistic regression were performed.ResultsAt the lumbar spine, with the linear model, BMI (P < .001), alkaline phosphatase (P < .001), and ionized calcium (P < .001) significantly correlated with T scores; whereas with the logistic model, BMI was the only variable predicting osteoporosis probability.At the femoral neck, BMI (P < .022), 25-hydroxy vitamin D (P < .001), 1,25-dihydroxy vitamin D (P < .034) correlated with T scores; whereas both BMI (P < .029) and age (P < .051) were the significant variables that predicted osteoporosis.At the total hip, BMI (P < .001) and age (P < .001) correlated with T scores; whereas with the logistic model, only BMI (P < .016) predicted osteoporosis. At the forearm, a model could not be generated due to limited number.ConclusionIn patients with primary hyperparathyroidism, BMI strongly correlated with T scores and probability of osteoporosis.     

The effect of calcitonin treatment on plasma nitric oxide levels in post-menopausal osteoporotic patients

Several recent studies have revealed a wide role for nitric oxide (NO) in bone metabolism. Low doses of NO cause bone resorption, but higher doses of NO inhibit bone resorbing activity. Cytokines are potent stimulators of NO production. NO is a very short-lived molecules. It exists for only 6-10 s only before it is converted by oxygen and water into the end-products nitrates and nitrites. Osteoporosis is a metabolic bone disease, characterized by a decreased amount of bone and increased susceptibility to fracture. NO may be involved as a mediator of bone disease such as post-menopausal osteoporosis. Calcitonin is a peptide hormone that inhibits bone resorption. The function of calcitonin in some cells is often unclear. In this study 30 post-menopausal osteoporotic women of ages ranging between 55 and 59 years without systemic diseases and free of any drug therapy were included. Twenty of them, randomly chosen, were treated with calcium (500 mg day(-1))+calcitonin (nasal spray 100 U day(-1)) and the other 10 women (control group) were treated with calcium only. This treatment was applied for 6 months and NO values were measured in each of the two groups before and after treatment. Our findings demonstrate that NO regulates osteoclastic bone resorption activity in association with calcitonin.     

Citrus bioactive compounds improve bone quality and plasma antioxidant activity in orchidectomized rats

BackgroundsWe reported that citrus consumption improves bone quality in orchidectomized male rats. In the present study, effects of feeding citrus bioactive compounds and crude extract on bone quality in orchidectomized rats were evaluated.MethodsSeventy 90-days-old male rats were randomly assigned to five groups for 60 days of feeding study. The treatment groups were SHAM-control, orchidectomy (ORX), ORX+crude extract, ORX+limonin, and ORX+naringin. At termination, animals were euthanized, blood was collected for the plasma antioxidant status. Bone resorption and bone formation markers in the blood and urine were evaluated. Bone quality in the femur and the 5th lumbar and the total calcium concentration in the bones and excreta were evaluated.ResultsOrchidectomy lowered (p<0.05) plasma antioxidant capacity, bone quality, and bone calcium; elevated (p<0.05) TRAP, deoxypyridinoline (DPD), and calcium excretion; and did not change the plasma IGF-I in comparison to the SHAM group. The citrus crude extract or the purified bioactive compounds increased (p<0.05) the plasma antioxidant status, plasma IGF-I, and bone density, preserved (p<0.05) the concentration of calcium in the femur and in the 5th lumbar, and numerically improved bone strength. The crude extract and the bioactive compounds decreased (p<0.05) fecal excretion of calcium, numerically lowered the urinary excretion of calcium, and suppressed (p<0.05) the plasma TRAP activity without affecting (p>0.1) urinary excretion of DPD in comparison to the ORX group.ConclusionsPotential benefit of the citrus crude extract and its bioactive compounds on bone quality appears to preserve bone calcium concentration and increase antioxidant status.     

Androstenedione and progesterone production in vitro by the inner or the outer theca cells in preovulatory follicles of gonadotropin stimulated calves

This study reports some of the steroidogenic characteristics of the interna and externa theca cells taken from young and eCG primed calves. These cells were isolated from large healthy follicles. They were separately cultured for 3 days in absence or in presence of steroid substrates. Androstenedione (A4) and progesterone (P4) were measured by radioimmunoassay (RIA). In control conditions, A4 levels, higher in interna than in externa cells (**P<0.01), decreased during cultures (**P<0.01). In both cell types, A4 increased in presence of 17α-hydroxypregnenolone (17OHP5), pregnenolone (P5) and 22R-hydroxycholesterol (22R-chol) (*P<0.05) but not with P4 or 17α-hydroxyprogesterone (17OHP4) (P>0.05). The most efficient substrate was dehydroepiandrosterone (DHEA) (*P<0.05). In control conditions, P4 levels increased in both cell types. They were higher in externa than in interna cells on day 1, the reverse was observed on day 3. P4 levels increased after addition of 22R-chol and P5 (*P<0.05) but not with 17OHP5, 17OHP4 and DHEA (P>0.05) from day 1 in externa cells and only on day 3 in interna cells. P4 levels measured on day 1 were lower than the quantity of P4 added as a substrate. These results, obtained with theca cells from young calf follicles, indicate: 1/A4 is synthesized by the Δ5 pathway and 17α-hydroxylase activity decreases in vitro, 2/externa and interna cells differ by the quantities of A4 and P4 produced, 3/both lack precursors to produce A4 and P4 but their 3β-hydroxysteroid dehydrogenase activity subsists, 4/P4 could be metabolized during the first 2 days in both cell cultures.     

Bone mineral density of the spine and radius shaft in children with X-linked hypophosphatemic rickets (XLH)

X-linked hypophosphatemic rickets (XLH) is characterized by inadequate skeletal mineralization. The bone mineral density (BMD) of the radius shaft and the lumbar spine was determined in 13 children with XLH. Ten patients were on treatment, whereas three patients had discontinued treatment 20–32 months prior to this study. Two of them had radiological evidence of rickets.The radius shaft BMD was significantly diminished: Z score was −1.33 ± 0.89 (P < 0.001), while the BMD of lumbar spine was significantly augmented (Z score + 1.95 ± 1.17, P < 0.001). A positive correlation was found between the Z scores for the BMD of the radius shaft and spine. The two patients with overt rickets had lower radius shaft BMD values and a lesser increment of BMD of the spine. The BMD deficit of cortical bone may be related to the lack of efficacy of the treatment and/or to an intrinsic defect of the bone on this disease. On the other hand, the augmented BMD of the lumbar spine might reflect the overabundance of partially mineralized osteoid.The determination of the BMD of the radius shaft by SPA was a sensitive method for detecting abnormalities of the bone mass in XLH patients under treatment without radiological signs of rickets.     

Effect of estrogen on egg production,shell quality and calcium metabolism in molted hens

Force-molted White Leghorn laying hens were implanted with 0.25, 0.5, 1 and 3 Compudose 200 pellets (24 mg 17β estradiol/pellet). Plasma estradiol increased with increasing E₂ dosages in a linear manner and decreased over time in a quadratic manner (P < 0.01). E₂ treatment had a nonlinear effect on total plasma calcium. Oviduct weight, shell thickness and egg weight were not significantly affected by exogenous estradiol whereas tibial bone ash percentage was increased at only one dose (P < 0.05:0.5 pellet group). Physiological supplementation with estradiol does not improve shell quality.     

Protective Effects of Gallium, Germanium, and Strontium Against Ovariectomized Osteoporosis in Rats

The effects of trace elements of gallium (Ga), germanium (Ge), and strontium (Sr) on ovariectomized (OVX) osteopenic rats were studied in this paper. The urine calcium content, serum calcium, and phosphorus contents, bone mineral content, mineral dissolution, and mechanical strength of the osteopenic rats were analyzed respectively. After the rats were fed with Ga, Ge, and Sr diet for 8 weeks, respectively, the urine calcium content decreased (P?<?0.01). Plasma calcium and phosphate concentrations decreased in the order of OVX group?>?Ge group?>?Sr group?>?Ga group?>?Sham group. Mineral content increased in the order of OVX group?<?Ge group?<?Sr group?<?Ga group?<?Sham group. A dramatic decrease in calcium solubility was found both in the gallium and strontium treated animals (P?<?0.05). However, the same result did not occur in germanium treated groups. The data provide an important proof of concept that gallium and strontium might be a new potential therapy for the management of postmenopausal osteoporosis in humans.     

Effects of Bisphosphonates on Osteoporosis Induced by Duchenne Muscular Dystrophy: A Prospective Study

Objective: Duchenne muscular dystrophy (DMD) is a severe X-linked progressive neuromuscular disease that brings a significantly increased risk of osteoporosis and bone fractures. We prospectively evaluated the effects of oral and intravenous bisphosphonates on the bones of children with DMD.Methods: This study included a total of 52 children with DMD. They were divided into zoledronic acid (ZOL), alendronate (ALN), and control groups according to bone mineral density (BMD) and history of fragility fractures. For 2 years, all patients took calcium, vitamin D, and calcitriol. Meanwhile, 17 patients received infusions of ZOL, and 18 patients received ALN. BMD, serum levels of alkaline phosphatase (ALP) and the cross-linked C-telopeptide of type I collagen (β-CTX) were evaluated.Results: After 24 months of treatment, the percentage changes in lumbar spine BMD were 23.2 ± 9.7% and 23.6 ± 8.8% in the ZOL and ALN groups (all P<.01 vs. baseline). The increases did not differ between the ZOL and ALN groups, but were significantly larger than those of the control group (P<.01). Serum β-CTX and ALP levels, respectively, were decreased by 44.4 ± 18.0% and 31.9 ± 26.7% in the ZOL group and by 36.0 ± 20.3% and 25.8 ± 14.4% in the ALN group (all P<.01 vs. baseline).Conclusion: Zoledronic acid and alendronate had similar protective effects to increase bone mineral density and reduce bone resorption in children with DMD, which were superior to treatment of calcium, vitamin D, and calcitriol.Abbreviations: 25OHD = 25 hydroxyvitamin D; ALN = alendro-nate; ALP = alkaline phosphatase; ALT = alanine aminotransferase; BMD = bone mineral density; BP = bisphosphonate; Ca = calcium; β-CTX = cross-linked C-telopeptide of type I collagen; DMD = Duchenne muscular dystrophy; FN = femoral neck; GC = glucocorticoid; LS = lumbar spine; ZOL = zoledronic acid     

Effects of cyclical therapy for osteoporosis using an oral regimen of inorganic phosphate and sodium etidronate: a clinical and bone histomorphometric study

Cyclical therapy for osteoporosis has been proposed as a means to induce a coherently structured improvement in bone remodelling dynamics. This pilot study involved 37 osteoporotic patients with symptomatic vertebral compression fractures, treated with an oral protocol designed to activate endogenous bone turnover and selectively depress osteoclastic bone resorption, utilizing inorganic phosphate and sodium etidronate respectively in sequential 3 monthly cycles. Biochemical parameters were recorded during the first cycle, and quantitative bone histomorphometry was obtained from iliac crest biopsies before and after 23.4 ± 8.5 (SEM) months of treatment. In addition, fracture rates (expressed as new vertebral fractures/1000 patient years) were studied by sequential lateral spinal radiographs. Lumbar bone mineral density (BMD) was assessed by sequential dual-beam photon densitometry. The results demonstrated equivocal biochemical evidence of 2 ° hyperparathyroidism during the initial cycle of therapy with inorganic phosphate. However, fracture rates declined significantly from 640/1000 patient years during the first 15 months therapy to 242/1000 patient years during a further 20 months follow-up (P < 0.01). Lumbar BMD increased over baseline by 8.38 ± 2.87% after 12 months treatmen (P < 0.01). Bone histomorphometric analysis disclosed a modest increment in bone volume from 16.0 to 17.4% tissue volume, and a significant increase in eroded surface from 4.2 ± 0.6 to 6.0 ± 0.9% cancellous surface (P < 0.05). However, histomorphometric parameters of bone formation deteriorated. It is concluded that this cyclical protocol resulted in short-term improvement in trabecular bone mass, but there is no evidence at a cellular level that long-term improvements in bone remodelling occurred.     

Renal Effects of Calcitonin

Porcine calcitonin in a slow-release gelatin vehicle was given by intramuscular injection to 10 patients—four with primary hyperparathyroidism, four with Paget''s disease, and two with carcinoma of the breast and hypercalcaemia. All cases showed a fall in serum calcium with an immediate rise in urine calcium. All except three patients with primary hyperparathyroidism showed a fall in serum phosphorus, but an immediate rise in urine phosphorus occurred in all cases. Urine hydroxyproline output fell in three patients with severe Paget''s disease. Urine sodium rose in all cases, but the effects on potassium, magnesium, water, and pH were not appreciably different from results obtained in four control subjects who were given the gelatin vehicle alone.The data suggest that calcitonin caused a decrease in the tubular resorption of calcium and phosphorus. The hypocalcaemic effect appeared to be due to a decrease in bone resorption in the patients with Paget''s disease but in the remaining cases could be accounted for in part or entirely by the rise in urine calcium.     

Association of a synthetic bone graft and bone marrow cells as a composite biomaterial

Porous calcium phosphates have osteoconductive properties. The aim of this study was to obtain synthetic calcium phosphate bone graft substitute. X-ray diffraction was employed to investigate the formation of the beta-tricalcium phosphate (β-TCP) phase. We evaluated the effects of bone marrow on the osteoconductivity and mechanical properties of synthetic bone graft (SG). SG cylinders loaded with bone marrow (SGBM) and SG alone were implanted into rabbits femoral condyle bone defects. Histological examinations revealed the resorption of the SG, trabecular bone with osteoblasts and osteoid substance around the implants, and colonization inside the porous β-TCP by newly formed bone. Histomorphometry conducted after three months revealed the osteoid surface to be higher in SGBM than SG (p < 0.05). The compressive strengths of SG and SGBM were significantly higher than the anatomic control at all time periods. The elastic modulus of SBG and SGBM became weaker after implantation. The present results indicate that gB-TCP is a good matrix for bone marrow, which contributes osteoinductive properties in an orthotopic. The composite biomaterial may be useful in reconstructive bone surgery.