We have reviewed our ten year's experiences with 1αOHD₃ treatment in 25 cases of rickets and osteomalacia to estimate the requirements or doses for maintaining the healing. The value is large in vitamin D resistant rickets. It is small in Fanceni syndrome, vitamin D dependency, and anticonvulsant osteomalacia. Adult onset hyohoshatemic osteomalacia has the medium value.
In thirteen cases in which vitamin D treatment has been done before the 1αOHD₃ treatment, the potency ratio of 1αOHD₃ to vitamin D was calculated. It was low in vitamin D resistant rickets, and adult onset hyophospatemic osteomalacia, and high in Fanconi syndrome and vitamin D dependency. In anticonvulsant osteomalacia it falls between these two groups.
These results are considered to be the reflection of different pathogenetic mechanisms, especially various contribution of disturbed vitamin D metabolism in the various types of rickets and osteomalacia.

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A 72-year-old diabetic woman taking 1.8 of Al(OH)₃ daily for 3 months was evaluated for bone pain, anorexia, and weakness. Laboratory studies disclosed hyohosatemia, hypophosphaturia, hypercalciuria, high % tubular reabsorption of phosphate, suppressed immunoloical parathyroid hormone, and high alkaline phospatase levels. Radiological examinations demonstrated generalized osteoenia and multiple compression fractures. Biochemical abnormalities and clinical symptoms disappeared soon after discontinuing the antacid. Phosphate tolerance test performed 8 months later disclosed normal renal phosphate handling but the impaired intestinal phosphate absorption with low plasma 1, 25(OH)₂D₃ level. Physicians should be cautious for hypopspatemia when prescribing even the usual dose of antacid to patients who might have low serum 1, 25(OH)₂D₃ level.

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Vitamin D binding protein (DBP) was isolated and purified from the plasma of rabbits given large doses of vitamin D₂ (500, 000 IU par a rabbit) intravenously. The plasma was successively subjected to gel filtration on Sepadex G-200 and G-100 columns, affinity chromatography on a Blue Separose CL-6B column, ion exchange chromatography on a DEAE Sepharose CL-6B column and the same affinity chromatography and partially purified rabbit plasma DBP was obtained. The DBP fraction was applied to chromatofocusing using a Mono P HR 5/20 column and the purified DBP was obtained.
When polyacrylamide disc gel electrophoresis was performed on the purified rabbit, rat and human plasma DBPs, they gave each single band at the same position. Therefore, the three DBPs were confirmed to have a similar molecular size. However, since they showed different positions on isoelectric focusing, the three DBPs were confirmed to be different proteins on their acidity with each other. The order of strength of acidity was rabbit, rat and human plasma DBPs.

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The skeletal type of primary hyperparathyroidism is a severe form of the disease characterized by active bone resorption. It has been mainly diagnosed by x-ray dings of the bone. In the present study, the usefulness of serum acid phosphatase activity to differentiate the skeletal type from the non-skeletal type was studied retrospectively in 43 patients of operatively proved primary hyperparathyroidism. Serum acid phosphatase activity was significantly higher (p<0.001) in the skeletal type [range: 0.9-2.1, mean±SD: 1.3±0.49 Bessey-Lowry units (BLU), n=16] than in the non-skeletal type (0.3-0.9, 0.6±0.16 BLU, n=27), and revealed significantly positive correlations with serum alkaline phosphatase activity (n=43, r=0.71 and p<0.001), urinary excretion of hydroxyproline (n=8, r=0.88 and p<0.001) and circulating immunoreactive parathyroid hormone (n=8, r=0.90 and p<0.001). From these results, serum acid phosphatase activity is useful for the distinction between the skeletal type and the nonskeletal type of primary hyperparathyroidism. It is concluded that the skeletal type of primary hyperparathyroidism may be differentiated from the non-skeletal type when the level of serum acid phosphatase activity is over 1.0 BLU.

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Plasma human parathyroid hormone (hPTH) levels are usually determined by radioimmunoassay (RIA) using commercially available hPTH-RIA kits in Japan. However, current hPTH-RIA kits were found to have serious shortcomings in estimating plasma hPTH levels because the kits have no PTH-free plasma for the preparation of the standard curve. By adding PTH-free plasma from surgically hypoparathyroid patients into tubes for the standard curve, the problems were completely overcome.
Because the availability of PTH-free plasma from surgically hypoparathyroid patients is limited, a new method to obtain PTH-free plasma has been developed. This involves passing plasma from healthy adults through octadecylsilylsilica (ODS) cartridge (Sep-Pak C₁₈); the cartridge removed 70% of hPTH (1-84), 89% of hPTH (39-84) and 87% of hPTH (46-84). The ODS-treated plasma from healthy adults further proved to be usable as PTH-free plasma in hPTH-RIA. The procedure to obtain the PTH-free plasma is very simple, rapid and easy. Furthermore, most of the hPTH (1-84) and its C-terminal fragments which had been trapped by ODS cartridge were extractable by 3ml of an acetonitrile: 0.1% trifluoroacetic acid (9:1) mixture. The recovery rates against the initial amounts applied on the cartridges were about 50% for hPTH (1-84), 90% for hPTH (39-84) and 75% for hPTH (46-84).

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Microensitometry system (MD system) is recently used as a popular method to evaluate the degree of bone atrophy in the metabolic bone diseases because of its expediency. Study about the reproducibility of MD system has already been described, but a detailed study on the analytical reproducibility of new measuring system (MD-Online-Computer system) was performed in this report. A plain X-ray examination of the second metacarpal bone with aluminum slope was performed on 10 normal subjects and 30 patients with osteoporosis. The latter was diagnosed by Itami Index et al.
The precision and deviation among days, analysts and microdensitometers were studied by the analyses of those X-ray films. The range of coefficient of variation of precision for each MD parameter was from 0.2 to 9.6 percent and those mean values was within a few percent. The deviation among days, analysts and microdensitometers were not larger than the one for precision. In the comparison of analytical reproducibility of normal subjects to patients with osteoporosis, no significant difference was seen. However, analytical reproducibility was bad in the case of a bone pattern which could not be easily estimated GS₁ or GS₂ by naked eye and it was also observed that the accurate set of a scan line was most important to reduce the errors. This study indicated that the mean value of coefficient of variation were within 2 or 3 percent with respect the whole reproducibility of MD parameters of our measurement system.

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It was demonstrated that 25.9% of 58 uremic patients under regular hemodialysis showed thorax cage deformity. Patients with thorax cage deformity showed decrease of height, higher degree of kyphosis of thoracic spines, high prevalence of radiological abnormalities of bone, high serum level of alkaline phosphatase and c-terminal parathyroid hormone (PTH) and low level of percent vital capacity.
Serum PTH and osteocalcin in patients without thorax cage deformity were not increased after active vitamin D₃ (VD) treatment in spite of larger dose of VD.
It was concluded that the thorax cage eformty in patients under regular hemodialysis may be induced by secondary hyperparathyroiism and that such bone changes lead to respiratory dysfunction and should be regarded as one of signs of renal osteodystrophy.

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For the investigation of bone, muscle and nerve tissue interaction during skeletal growth, attempts were made to discover whether cultured cells isolated from calvaria, muscle and spinal cord interact with each other during their growth in vitro. The conditioned medium from myogenic cells markedly stimulated the incorporation of ³H-tymiine in calvaria cells (osteolasts). In contrast, ³H-tymiine uptake in myogenic cells was inhibited by the conditioned medium from calvaria cells. DNA synthesis in myogenic cells and calvaria cells was increased by the addition of the conditioned medium from cultured spinal cord cells. Partial purification of the myogenic cell-derived growth activity by Sephaedx G-75 gel filtration disclosed the major peak of activity at a molecular of 70, 000 or more. On the other hand, the calvaria cell-derived growth inhibition activities elute in two peaks, at approximately 12, 000 and 7, 000. These results may suggest that bone growth in regulated by factors produced by muscle and nerve tissues, and bone tissue in turn produces a factor regulating the growth of muscle.

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