Twelve patients with malignancy-associated hypercalcemia (MAH) were examined in order to clarify whether or not 1) treatment with salmon calcitonin (sCT) in combination with prednisolone (PSL) has any beneficial effects over sCT alone, and 2) there is any difference in the effect of sCT treatment among different subtypes of MAH. Of these patients, three had multiple myeloma, four had solid tumors with bone metastases and five had solid tumors without bone metastases. When sCT was given with PSL, all the patients showed a sustained reduction in serum Ca level. Among four patients who received sCT alone, however, only two exhibited a significant reduction in serum Ca level. There was no apparent difference in the hypocalcemic effect of sCT and PSL among the three subgroups of patients. In addition, a significant positive correlation was found between the hypocalcemic effect and pre-treatment serum P level (r=0.605, p<0.05) a These results demonstrate that hypocalcemic effect of sCT can be obtained when sCT is administered in combination with PSL to any subtypes of patients with MAH. The higher the serum P, the more pronounced did the hypocalcemic effect of sCT appear.

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Using an electrode-type apparatus (Horiba Seisakusho), serum ionized calcium (Ca_??_) was measured in patients with various kinds of abnormal calcium metabolism. Patients with hypercalcemia included 8 patients with primary hyperarathyroidism, 6 patients with breast cancer with bone metastases and 18 patients with untreated Graves' disease. Those with hypocalcemia included 54 patients after total thyroidectomy for thyroid cancer, divided into 3 groups, a tetany group, vitamin-D-administration group and autograft group. In order to compare the Ca_??_, total calcium (CaT) and corrected Ca(CaC) with the corresponding values in the control group, Standard Deviation Index (SDI) was used. Ca_??_ was significantly higher than the control group in each disease with hypercalceia, whereas it was lower than the control group in the group with hypocalcemia. A significant correlation of r=0.910, P<0.01 was found between Ca_??_ and CaT. With SDI, however, Ca_??_ showed more a distinct variation than CaT or CaC. Ca_??_ thus appear to be more useful as an index of abnormal calcium metabolism than CaT or CaC.

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To investigate the C-cell function (parafollicular cells of the thyroids) in chronic hyperglucocorticoid subjects, calcium infusion test was performed to six hyerglucocorticoid subjects and eleven age-and-sex matched normal controls. The secondary hyerparathyroidism developed in the chronic hyperglucocorticoid subjects. Basal levels of serum calcitonin and the maximum increments in serum calcitonin levels after the intravenous infusion of 3mg of calcium/kg of body weight over 10 minutes were not significantly different between these two groups. Our results indicate that the C-cell function, as estimated by the calcitonin response to calcium infusion, was not impaired in the chronic hyerlucocorticoid subjects. Therefore, calcitonin may not play a critical role in the pathogenesis of glucocorticoid-induced bone loss.

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A family of autosomal dominant osteosclerosis is presented. The propositus, a 44-year-old woman, had 9-month history of occipitalgia and left tinnitus, along with 2-month history of pain and numbness of the right upper limb. Physical examination failed to reveal any abnormal neurological findings except for paresthesia over C₅ and C₆ dermatomes. Radiographic skeletal survey showed diffuse osteosclerosis of the entire skeleton including the small peripheral bones. Histological findings of bone obtained by iliac biopsy showed markedly reduced medullary space due to thick trabecula with lamellar structure. Morphological measurement in the trabecular bone areas revealed decreased bone resorption as well as bone formation. Relatives under bloodrelationship are also surveyed roentogenographically. Her son, daughter, nephew, one of her sisters and three of her brothers showed diffuse osteosclerosis. Thus, the disease obviously ran is this family under an autosomal dominant type inheritance.

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Ethane-1-Hydroxy-1, 1-Diphosphonate (EHDP) suppresses bone turnover by inhibiting both the mineralization and resorption of the bone. Six patients with ossification of posterior longitudinal ligament (OPLL) of cervical spine were treated with this compound at a daily dosage of twenty milligrams per kilogram of body weight for one month and then ten milligrams per kilogram for the following five months. The efficacy of the compound was evaluated by clinical, laboratory and radiographic parameters before and after the administration.
All patients improved in clinical symptoms after the initial month of administration, and in half of them clinical parameters improved after six months of treatment. The clinical symptoms were also improved after six months of administration in the three patients who were younger, had the disease for shorter periods, had experienced surgical treatment and had a higher level of serum alkaline phosphatase. Serum phosphorous level was significantly elevated after one month of taking 20mg/kg/day of EHDP. No significant changes were found in radiological parameters concerning ligamentous ossification and osteoporosis, nor were any obviously adverse side-effects noted.
This short-term study suggested that a relatively high dosage of EHDP was clinically effective in the patients of OPLL with active bone turnover.

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The effects of insulin and parathyroid hormone (PTH) on glycosaminoglycan (GAG) synthesis in developing bovine dental pulp were investigated. Dental pulps from calves of 1 day to 6 months old were divided into three groups according to the growth period and were cultured as explants. GAG sunthesis was evaluated with [³⁵S] sulfate uptake as an index. On culture in chemically defined synthetic medium, active GAG synthesis was observed in the radicular pulp at the beginning of root formation. Insulin enhanced GAG synthesis in most pulp samples. PTH alone was ineffective. However, when PTH was added with insulin, GAG synthesis strikingly increased in the radicular pulp of incompletely-formed root. After completion of root formation, GAG synthesis in the pulp was not affected by PTH. These results suggest that the extent of GAG synthesis and hormonal responses remarkably advance in young pulps and higher in radicular portion than in corronal portion during the active dentinogenesis.

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Membranous lipodystrophy (Nasu) is known to be accompanied by a tendency of fracture. We have studied a brother and sister with this disease by histological methods for hard tissue. Atrophy of the metacarpal was mild, exhibiting pattern B by microdensitometry. Histomorphometry on the biopsy specimen from the iliac bone revealed mild osteoporosis with normal bone formation, exhibiting normal tetracycline labelling. The membranous structure, which is said to be characteristic to this disease, compresses the bone to cause bone tissue disturbance with defective calcification. According to these findings, the tendency to fracture is probably not due to progress of osteoporotic changes, but the physical or mechanical influence of the membranous structure is apparently responsible.

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Four diabetic patients with diabetic complications were examined to elucidate what kinds of bone changes were related to diabetes mellitus by radiological, biochemical and bone histomorphometric study.
They were all male; one osteoporosis with pathological fracture and two osteopenia. Low radial bone mineral content was demonstrated in all cases, more evidently at the distal 1/6 part. Plasma 1, 25(OH)₂D level was low in two and 24, 25(OH)₂D level was low in all cases.
Histomorphometric study of the iliac bone demonstrated osteoporotic value below 10% in bone area in two cases and normal in the other. The total resorption surface was almost normal in all the cases but did not provide any evidence of active bone resorption. The total osteoid surface was within normal in cases with decreased bone area, yet both single and double labeling of tetracycline were few and poorly calcified trabecular unit was frequently seen, suggesting disturbed calcification in these cases. In cases with normal bone area, the total osteoid surface remarkably decreased but the calcification rate was within or above the normal value, and the calcification appeared not disordered, though a bone remodelling area was reduced.
It seems that apparent osteoporosis is likely to develop as diabetes mellitus is aggravating to accompany its complications.

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