The purpose of this study is to determine if there is any association of paravertebral ligamentous ossification (PVLO) with hypoparathyroidism (HP), and if there are any precipitating factors which cause PVLO in patients with HP.
Thirty consecutive patients with HP, consisting of 14 idiopathic HP, 5 pseudo-HP and 11 postsurgical HP were studied. Fifty five injured patients by accidents were used as controls.
No association of the incidence of PVLO with subtypes of HP was found.
The development of PVLO appeared to get increasingly higher with age both in patients with HP and in controls, However, PVLO was significantly higher in HP (qui-square test: p<0.001).
The incidence of PVLO did not correlate with length of time before treatment of HP, the maintenance dose of vitamin D derivatives and serum levels of Ca, P, Ca×P ion product.
On the other hand, the calcification of the basal ganglia developed much earlier than PVLO and was more closely related to Ca×P ion product.
It is likely, therefore, that PVLO is caused not only by the local conditions caused by aging but also by abnormalities of calcium metabolism in HP, either as an aggravating or a causative factor.

View full abstract

Primary hyperparathyroidism as a part of multiple endocrine neoplasia, type 1 (MEN-1) is characterized by a diffuse hyperplastic change in all the parathyroid glands and because of this pathologic property the surgical treatment should be either subtotal removal leaving a wellvascularized tissue approximately 30mg in weight or total parathyroidectomy and autotransplantation to the forearm. Two cases of different MEN-1 families are reported, in which family history of the disease was obtained prior to surgery. Case 1 was a 73-year-old woman, showed chemical hyperparatyroidism, and underwent subtotal parathyroidectomy. The resected three whole glands weighed 500, 300 and 250mg, and the smallest one was partially resected. Case 2 was a 48-year-old male patient, had suffered from peptic ulcer and passed urinary stone twice. Since bone change caused by hyperparathyroidism was manifest, a total parathyroidectomy and autografting was attempted including the paratracheal dissection and thymectomy. Actually 3 parathyroid glands were pathologically confirmed, 10.6g, 350mg and 350mg in weight. Postoperative hypocalcemia continued for 8 months, which required 1α-OH-D₃ and calcium lactate administration. Long-lasted peptic ulcer healed following parathyroidectomy.

View full abstract

Two patients with osteomalacia were treated by intravenous phosphate infusion. A 35 years old male was diagnosed Primary Hypophosphateic Osteoalacia and a 28 years old female was diagnosed Osteomalacia due to Fanconi's syndrome. They had been treated with 1α(OH)D₃ and phosphate for about 10 years, but no improvement had been made.
After we started the oral administration of 1α(OH)D₃ 8 to 12μg per day and the intravenous infusion of phosphate 1.0g per day for 4 to 14 weeks, their serum P concentrations were increased and their symptoms were improved. But their radiographical findings showed no remarkable changes. During this treatment there were no side effects.
While we infused phosphate to them, we investigated diurnal variation of the serum Ca, P, parathyroid hormone, calcitonin levels and the urinary Ca/creatinin retio, P/creatinin retio.
We also infused same dosage of phosphate to the healthy man, and we investigated same factors. There were several differences of iurnals variation between osteomalacic patients and healthy man.

View full abstract

The effect of a novel anti-osteopenic compound, ipriflavone (7-isopropoxy-isoflavone, TC-80), on mineral homeostasis and morphometry of the femora on soft X-ray was studied in streptozotocin (STZ)-induced diabetic rats, STZ-diabetic rats showed typical symptoms and laboratory findings of diabetes such as severe hyperglycemia, glucosuria, hypoinsulinemia, and hyperphagia, associated with hypercalciuria, and hyperproteinuria; circulating 1, 25(OH)₂D₃ was markedly decreased. Urinary hydroxyproline excretion was increased, but cyclic AMP excretion, partially reflecting endogenous parathyroid hormone (PTH) activity, was markedly decreased. Microdensitometric analysis of the femora revealed decreases in femoral length, cortical width, and bone density; bone mineral content was also reduced These findings indicate that suppression of bone growth in diabetic rats may be related to reduced circulating 1, 25(OH)₂D₃ and presumably low plasma PTH levels. Furthermore, insulin deficiency may directly induce osteopenia in diabetic rats. Ipriflavone (300mg/kg, given as a dietary admixture for 6 wk) suppressed the reduction of bone density and decrease of calcium and phosphate contents per dried femur without affecting the diabetic state. These results indicate that the mode of action of ipriflavone differs from that of insulin, and seems to be specific for mineral metabolism.

View full abstract

Calcitonin may be usefully employed in renal osteodystrophy on some occasions. However, the fate of exogenously adminstered calcitonin during hemodialysis were not clearly understood.
This study was desinged to measure the changes of plasma concentration of synthetic eel calcitonin analog, [Asu^{1, 7}] eel calcitonin (ECT), “trapping” by dialyzer membrane and its half life (T1/2) during hemodialysis.
Plasma concentration of ECT administered into dialysis circuit fell linearly to approximately zero level within 60min. (92% reduction at 60 min). There was no evidence of membrane trapping of this analog during hemodialysis. The half life was calculated as 15.0±1.8 min, which was slightly longer than that of healthy subject (10.8±0.1 min.)

View full abstract

A 57-year-old man with post-gastrectomy osteomalacia is presented.
He had undergone total gastrectomy for gastric cancer 10 years before the admission. For the past three years he had been complaining of bone pains.
Serum calcium was 7.6mg/dl, phosphate 2.6mg/dl, alkaline-phosphatase 16.5 K. A. U., PTH 0.4ng/ml, 25-(OH)D₃ 16.5ng/ml and 1, 25-(OH)₂D₃ 72.4 pg/ml, respectively.
Bone scan with ^99mTc-MDP showed multiple hot spots in the ribs, pelvic bones and tibias. X-ray study revealed Looser's zones in the pubic bone.
A diagnosis of osteomalacia was made with histological examination of the bone tissue obtained from the right iliac crest.
The bone pains improved gradually and biochemical findings returned to normal after 11 months' treatment with 1α-hydroxyvitamin D₃ (1α-(OH)D₃, Alfarol, Chugai Co.) and calcium lactate. Looser's zones on X-ray film disappeared after 3 months, the multiple hot spots on bone image was decreased after 15 months, and histological findings were significantly improved 20 months after the treatment.
These findings indicate that the prolonged malabsorption and inadequate dietary intake after gastrectomy may have caused an osteomalacia and that oral administration of 1α-(OH)D₃ and calcium lactate is very effective way of treatment for such an osteomalacia case.

View full abstract

It is well known that the incidence of femoral neck fracture in diabetic patients is higher than that in non-diabetic patients. To confirm the difference of diabetic osteopathy from the postmenopausal osteoporosis in human bone, broken femoral heads of patients with diabetes mellitus were compared to those with postmenoausal osteoporotic patients by the quantitative analyses raiogrammetry, contact microraiograph and histomorpometry. In roentenoraphic examination of proximal femoral bone, Singh index of patients with diabetes mellitus was lower than one of osteoporotic patients. Nevertheless no difference was seen between trabecular bone volume, osteoid volume, relative osteoid volume, osteoid surface and scalloped surface of patients with diabetes mellitus, and those of osteoporotic patients. Mean diameter of osteocytic lacunæ in diabetic patients was smaller than that in osteoporotic patients.

View full abstract

The bone density of the distal metaphysis of the femur and the basal serum calcitonin level, as well as uterine weight, were significantly reduced in rats after ovariectomy. Ipriflavone, 7-isopropoxy-3-phenyl-4H-1-benzopyran-4-one, administered orally in daily doses of 25 and 100mg/kg body weihgt for 3 weeks did not change these variables. Estrone administered subcutaneously in a daily dose of 7.5μg/kg body weight suppressed the reduction of these variables and ipriflavone administered simultaneously with estrone exerted a more marked suppression. These results indicate that ipriflavone could suppress bone resorption by augmenting the action of estrogen directly on bone sites and indirectly on calcitonin secretion.

View full abstract

A 31-year-old male sustained compression fracture of the cervical spine at the age of 16 years, followed by 7 fractures of the tibial metaphysis, 3 fractures of the humeral metaphysis and 1 abrasion fracture of the calcaneus. X-ray pictures revealed marked generalized osteoporosis. In view of the absence of hereditary predisposition, complete absence of background disease and presence of normal skin collagen, this was thought to represent an extremely rare case of idiopathic juvenile osteoporosis left untreated until adulthood. Parathyroid hypofunction and low turnover osteoporosis with marked osteopenia, insufficient calfication and fibrosis were noted, providing an insight into the complex nature of bone changes of this disease.

View full abstract

The renal handling of phosphate was evaluated in eleven kidney transplant recipients.
All cases showed sustained hypophosphatemia after the transplant surgery. This hypophosphatemia might be due to an isolated defect of tubular phosphate reabsorption, because of low% TRP and TmPO₄/GFR independent of normal levels of serum iPTH, vitamin D metabolites and creatinine.
The effects of persistent hypophoshatemia on skeleton were assessed by clinical symptoms, radiography, bone mineral content and bone resonantmetry every six month. The skeletal symptoms related to hypophosphatemic state were present in six of all patients. The radiographic changes were noted in six patients. The bone mineral content measured by Norland apparatus showed remarkably low value compared with that of healthy control. The bone resonance was normal or slightly high in all patients, suggesting the presence of osteomalacic change.
Although the mechanism of this tubular leak of phosphate is not clear, adequate supplement of neutral phosphate is effective clue to prevention and treatment of this pathological states.

View full abstract

The effect of Sex steroid-thyroid hormone mixture (pregnenolone 1.0mg, androstenedione 1.0mg, androstendiol 0.5mg, testosterone 0.1mg, estrone 5μg, thyroid gland 7.5mg) on the bone mass were studied in the osteoporotic model rats.
A hundred-twenty rats were fed on low a calcium (0.1%)-low protein (5%) diet and divided into 5 groups. Group A was sham-operated and Group B was oophorectomized. Group C, D and E were experimental groups administrated 0.6, 3 and 6mg/kg/day MTH after ovariectomy respectively. In the experimental group, histological bone area of the tibia were increased 3 weeks later and percent resorption surface were significantly decreased. No difference were noted in the percent osteoid surface. Ca content of the lumbar spine were significantly increased 6 weeks later and the breaking force were also increased on 9 weeks.
These results suggest that sex steroid-thyroid hormone mixture may improve bone change in postmenopausal osteoporosis by preventing bone resorption.

View full abstract

Efficacy of therapeutic agents for osteoporosis was evaluated by the use of clinical parameters consisting of bone density in X-ray films and fracture incidence of the spine and proximal femur. Over a period of 2-4 years, 58 patients with osteoporosis were treated with drugs specifically designed for osteoporosis, calcium, alphacalcidol or estriol, and 32 patients received only analgesics served as the control.
Itami's index, indication of bone atrophy of vertebral body, showed statistical improvement in the groups treated with specific drugs, especially in the group treated with alphacalcidol or estrogen compared to non-treated group or group treated with calcium (p<0.05). Singh's index showed a tendency similar to that of Itami's index. Incidence of fractures was lowest in the group treated with estriol, but not low in the group treated with alphacalcidol.
Although some discrepancy was found between bone density and fracture rate in the group treated with alphacalcidol, overall results indicated positive effects of these drugs on osteoporosis by increasing bone density and reducing the risk of facture.

View full abstract