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Hypoparathyroidism treated with vitamin D: A histomorphometric study
Al9
Abstracts from Bone Morphology 1992, Lexington, Kentucky
73 COMP*##)N OF NOMNVASfVE *ND INVASNE -ATBNSOFMAGEANDSEX DERIIDENrTR8aEcUf.ARBOlYLOsSONARcHEolDGfcALuAlERlAL
PERIPHERAL
AND
SPONGIOSA METRY IN 150
M.KtwSSEL1.2,G.KMCHHUISEA2 M.WHN 3,A.BOYOE ’ H.RENKJr.1,
Zepemicker Str. 1, Berlin O-1115,Germany. It wars the awns of this study, 1.Tc correlate the results of different methods of quanbfication and +mlifiibon of tmbwuler bone rtructum, using identical bctw samples. 2. To correlate the results of the sdocted skeletal r&ons in each individual. 3. To find Uw most suitable method for Investigations on anhwlcgical material. 4. To get an lmpnssion how tmbecular bone loss is related to age end sex in a 4ooo yew dd pcpubbcn The matenal con&ad of left femurs and fwm lumbd vertebrae of 38 in&duals of both sexas and different age grcups (ff120-3Oyean. y2:30-4Oyears. #3:40BOyean). dertvmg frcm the big early bmnw-aga necmpclls Franzhaussn I in Lower AustrmAcccrding to he areas of mtenst in osteopcrcsis research, 5mm thick planparatlel sections of the femoral neck and the lumbal veltabml b&y wwre cut, embedded in methylmethacrylato, and surf&x polished. FM dfferent modes of evaluation were applied: A. Density meaunmenN (MD) of the embedded secticns m water by DEXA LUNAR). 8. Three~mensmnal analysis of U-mbkxks in a stenoscope (HILGEAS&WAlTS) fcr qualitalh!s dascdpticn and deteninaticn of the number of trabecuteo (TN). C. Standatissd X-rays won tranrfewed intc en image analydng computer (TRACOR) Md a bone density parameter was datermined. D. After cahonzoating of he block surface. a bcw volume (BVrrv) d&rminabbn was made by BSE imsgs ndydng (CAMBRIDGE STEREOSCAN). E. 50-70 pm thick gmund sections of tJw blocks were mad9 and by silverstammg a 3um thick swfacetaysr the trabewbe were stained btack. By pmducinp e binary imag+ of this layer in another image atiring system (IBAS), a bone volume (BVrm) measurement and a measurement of the trabecular connectivity by determing the trabecular bane pattern factor (TBPF) wonamade. bone vclume measunmsnt (ESE. IEAS) mwlts correlated very good (vertobnl bcdy :R-2IO.34Q,femoml neck: RL4.980), while tie msutts of all the other methods correlated wim Revalues ranging betwen 0.4 end-0.7. 2. The correlation between skeletal regions (lumbal verrebral body and femoral neck) dffsred considerably fmm m&cd tc method. For example. the male intildualr showed a much higher ccnebtion m donsity measunments (DEXA TAACOR) than the fern&s, while the ccrmlatiins of tie bans volume and tmbecular connectivity measurements (IBAS) showed just the opposite results. 3. For archwloglcal materisIs. agam tfm bon@vcluma and tmbecular connectivity &termina(ions (IBAS) pmved the best. because they are not influenced by pcstmortd changss, like mcrystallisaticn and mineral replacement. which can affect the X-my-based density measurements. 4. All methods showed. however, mat Uw most dramabcsl loss of tmbscular quMity and quafky occurs ln ais bronze age pcpulakcn in wcmen alremiy in the Bird gmup (40+0 yeara. no d&r indiidualr worn fwnd). On the cne hand. the vatwuf methcds used in tiis study and partflyin clinical uan (BMD. BVTTV), em all meant tc detect the same pathological wndition, &though employing different parameters. on tie other hand they dd not mimbta very well when th9y were used on tfm same bone samplo.Howvsr. it would b9 advisable to confirm this ctiticim by a similar investtgdfon on recant skdetal material. me ma.son for testing these memods on archedogicd mstsnd ws the planning of a mullicentemd sk~dy on vancu* akdetd material originating from different mgicnr. cuiiurer and pedods. in order tc investigate. whether genetic, envircmrntal or cultural mfluences play the main role I” the pathcgenesis of osteoporosis.
Comparison of peripheral and central spongiosa density in over 150 patients with suspected osteoporosis of a clinic for rheumatic diseases. means of osteo
(
1.Thetm)~nve&e
75
fracture rate o the groups and of the steroid dosis. analysis. Exclusion of osteoporosis in 20% of the patients after densitometry. Steroid osteoporosis shows a tendency to lower s ongiosa readings peripherally. The peripheral spongiosa Bensity of the postmenopausal osteoporosis is predominantly Pattents wtth centr~~~~~ti~~~~~i~~~~w~~ lower. however, observed, too. decreased spongiosa density predommantly central y. - The strict classification of osteoporos$s in types I and II is to be reconsidered due to densitometry. - An ideal site of measurement cannot be postulated at present.
76
CALCIUM KINETICS STUDIES IN PATIENTS WITH RENAL OSTEODYSTROPHY P. Kurz, M.-C. Faugere, P. Roth, E. Werner, J. Vlachojannis, P. Griltzmacher and H.H. Malluche. St Markus Hospital and GSF, Frankfurt M, Germany; Rion University, Patras, Greece; University of k entucky, Lexington, Kentucky, USA
intravenously) and whole measured over 28 days;
body and plasma
activities
were
Aarhus C, Denmark. Hypoparathyroidism is a diiase of missing eff 8 of the parathyrofd hormone., The disease demands lifelong treat nt of the resulting hypocaloemia. The treatment has until now been%PP ismsntatfon with vitamin D. Bone biopsies were obtained from 12 pat hypoparathyroldiim, all treated with vitamin D, 1Ma-hydroxylated vitamin D, all had nom-ralval serun calcium. We performed histomorfometric examinati found that the
hormonal indices of calcium metabolism. Sixteen patients had low turnover bone disease (LT-BD), 7 predominant hyperparathyroidism (HPT) and 21 mixed uremic osteodystrophy (MUO). Serum parathyroid hormone and alkaline phosphatase were significant1 lower in patients with LTBD. Serum calcium, phosphorus, 25 TOH) D and 1,25 (OH)2 D levels did not differ between the below the normal range (42.621. all groups. Ca-Ret was hi h in patients with 4326%). normal in MU0 6 723%) and low in LT-BD (1922). Ca-Eff was elevated in HPT (5.4a0.4 vs. 2.62 0.15) normal in MU0 (2.7 2 0.09) and low normal in LT-BD (2.3 2 0.05). These findings lend support to the notion that both patients with HPT and those with LT-BD might be prone to develop hypercalcemia and more importantly extra-osseous calcifications through different mechanisms when their calcium homeostasis is challenged by high calcium intake or administration of Vitamin D.
4.3(3.1-5.5) pm*/prn%, p~O.001. Final erosion depth was reduced to 41.7(39.443.9) vs. 53.2(47.2-59.2) pm. pcQ.001.~ The formative parameters were not signlfkantly n9ed from normal values except for fractional formation surfaoe i$ t was reduced to 5.2(2.5-7.9) vs. l&0(1 l-20) pm*/pm*%%.peO.001,iand completed wall thickness that was reduced to 42.3(34.5-50.0) vs. !54.0(50.6-57.4) Pm, pcO.01 The balance was negative -2.91(-14-8) vs. -1 .lO[-2.6-0.5) pm, which is not significantly different from mrmals. Bone structural analysis dii a bw mean va ue of marrow space star volwie of 7.6 mm3, indicatii a tight ccnnact strucWe. -conclusion: In hypoparathyroid-patients treat with vitamin D, the nuclear cells are resorptiie functions of the osteoclasts and the impaired. The formative function of the osteoblaf s is not significantly different from normals.
Abstracts from Bone Morphology 1992, Lexington, Kentucky
73 COMP*##)N OF NOMNVASfVE *ND INVASNE -ATBNSOFMAGEANDSEX DERIIDENrTR8aEcUf.ARBOlYLOsSONARcHEolDGfcALuAlERlAL
PERIPHERAL
AND
SPONGIOSA METRY IN 150
M.KtwSSEL1.2,G.KMCHHUISEA2 M.WHN 3,A.BOYOE ’ H.RENKJr.1,
Zepemicker Str. 1, Berlin O-1115,Germany. It wars the awns of this study, 1.Tc correlate the results of different methods of quanbfication and +mlifiibon of tmbwuler bone rtructum, using identical bctw samples. 2. To correlate the results of the sdocted skeletal r&ons in each individual. 3. To find Uw most suitable method for Investigations on anhwlcgical material. 4. To get an lmpnssion how tmbecular bone loss is related to age end sex in a 4ooo yew dd pcpubbcn The matenal con&ad of left femurs and fwm lumbd vertebrae of 38 in&duals of both sexas and different age grcups (ff120-3Oyean. y2:30-4Oyears. #3:40BOyean). dertvmg frcm the big early bmnw-aga necmpclls Franzhaussn I in Lower AustrmAcccrding to he areas of mtenst in osteopcrcsis research, 5mm thick planparatlel sections of the femoral neck and the lumbal veltabml b&y wwre cut, embedded in methylmethacrylato, and surf&x polished. FM dfferent modes of evaluation were applied: A. Density meaunmenN (MD) of the embedded secticns m water by DEXA LUNAR). 8. Three~mensmnal analysis of U-mbkxks in a stenoscope (HILGEAS&WAlTS) fcr qualitalh!s dascdpticn and deteninaticn of the number of trabecuteo (TN). C. Standatissd X-rays won tranrfewed intc en image analydng computer (TRACOR) Md a bone density parameter was datermined. D. After cahonzoating of he block surface. a bcw volume (BVrrv) d&rminabbn was made by BSE imsgs ndydng (CAMBRIDGE STEREOSCAN). E. 50-70 pm thick gmund sections of tJw blocks were mad9 and by silverstammg a 3um thick swfacetaysr the trabewbe were stained btack. By pmducinp e binary imag+ of this layer in another image atiring system (IBAS), a bone volume (BVrm) measurement and a measurement of the trabecular connectivity by determing the trabecular bane pattern factor (TBPF) wonamade. bone vclume measunmsnt (ESE. IEAS) mwlts correlated very good (vertobnl bcdy :R-2IO.34Q,femoml neck: RL4.980), while tie msutts of all the other methods correlated wim Revalues ranging betwen 0.4 end-0.7. 2. The correlation between skeletal regions (lumbal verrebral body and femoral neck) dffsred considerably fmm m&cd tc method. For example. the male intildualr showed a much higher ccnebtion m donsity measunments (DEXA TAACOR) than the fern&s, while the ccrmlatiins of tie bans volume and tmbecular connectivity measurements (IBAS) showed just the opposite results. 3. For archwloglcal materisIs. agam tfm bon@vcluma and tmbecular connectivity &termina(ions (IBAS) pmved the best. because they are not influenced by pcstmortd changss, like mcrystallisaticn and mineral replacement. which can affect the X-my-based density measurements. 4. All methods showed. however, mat Uw most dramabcsl loss of tmbscular quMity and quafky occurs ln ais bronze age pcpulakcn in wcmen alremiy in the Bird gmup (40+0 yeara. no d&r indiidualr worn fwnd). On the cne hand. the vatwuf methcds used in tiis study and partflyin clinical uan (BMD. BVTTV), em all meant tc detect the same pathological wndition, &though employing different parameters. on tie other hand they dd not mimbta very well when th9y were used on tfm same bone samplo.Howvsr. it would b9 advisable to confirm this ctiticim by a similar investtgdfon on recant skdetal material. me ma.son for testing these memods on archedogicd mstsnd ws the planning of a mullicentemd sk~dy on vancu* akdetd material originating from different mgicnr. cuiiurer and pedods. in order tc investigate. whether genetic, envircmrntal or cultural mfluences play the main role I” the pathcgenesis of osteoporosis.
Comparison of peripheral and central spongiosa density in over 150 patients with suspected osteoporosis of a clinic for rheumatic diseases. means of osteo
(
1.Thetm)~nve&e
75
fracture rate o the groups and of the steroid dosis. analysis. Exclusion of osteoporosis in 20% of the patients after densitometry. Steroid osteoporosis shows a tendency to lower s ongiosa readings peripherally. The peripheral spongiosa Bensity of the postmenopausal osteoporosis is predominantly Pattents wtth centr~~~~~ti~~~~~i~~~~w~~ lower. however, observed, too. decreased spongiosa density predommantly central y. - The strict classification of osteoporos$s in types I and II is to be reconsidered due to densitometry. - An ideal site of measurement cannot be postulated at present.
76
CALCIUM KINETICS STUDIES IN PATIENTS WITH RENAL OSTEODYSTROPHY P. Kurz, M.-C. Faugere, P. Roth, E. Werner, J. Vlachojannis, P. Griltzmacher and H.H. Malluche. St Markus Hospital and GSF, Frankfurt M, Germany; Rion University, Patras, Greece; University of k entucky, Lexington, Kentucky, USA
intravenously) and whole measured over 28 days;
body and plasma
activities
were
Aarhus C, Denmark. Hypoparathyroidism is a diiase of missing eff 8 of the parathyrofd hormone., The disease demands lifelong treat nt of the resulting hypocaloemia. The treatment has until now been%PP ismsntatfon with vitamin D. Bone biopsies were obtained from 12 pat hypoparathyroldiim, all treated with vitamin D, 1Ma-hydroxylated vitamin D, all had nom-ralval serun calcium. We performed histomorfometric examinati found that the
hormonal indices of calcium metabolism. Sixteen patients had low turnover bone disease (LT-BD), 7 predominant hyperparathyroidism (HPT) and 21 mixed uremic osteodystrophy (MUO). Serum parathyroid hormone and alkaline phosphatase were significant1 lower in patients with LTBD. Serum calcium, phosphorus, 25 TOH) D and 1,25 (OH)2 D levels did not differ between the below the normal range (42.621. all groups. Ca-Ret was hi h in patients with 4326%). normal in MU0 6 723%) and low in LT-BD (1922). Ca-Eff was elevated in HPT (5.4a0.4 vs. 2.62 0.15) normal in MU0 (2.7 2 0.09) and low normal in LT-BD (2.3 2 0.05). These findings lend support to the notion that both patients with HPT and those with LT-BD might be prone to develop hypercalcemia and more importantly extra-osseous calcifications through different mechanisms when their calcium homeostasis is challenged by high calcium intake or administration of Vitamin D.
4.3(3.1-5.5) pm*/prn%, p~O.001. Final erosion depth was reduced to 41.7(39.443.9) vs. 53.2(47.2-59.2) pm. pcQ.001.~ The formative parameters were not signlfkantly n9ed from normal values except for fractional formation surfaoe i$ t was reduced to 5.2(2.5-7.9) vs. l&0(1 l-20) pm*/pm*%%.peO.001,iand completed wall thickness that was reduced to 42.3(34.5-50.0) vs. !54.0(50.6-57.4) Pm, pcO.01 The balance was negative -2.91(-14-8) vs. -1 .lO[-2.6-0.5) pm, which is not significantly different from mrmals. Bone structural analysis dii a bw mean va ue of marrow space star volwie of 7.6 mm3, indicatii a tight ccnnact strucWe. -conclusion: In hypoparathyroid-patients treat with vitamin D, the nuclear cells are resorptiie functions of the osteoclasts and the impaired. The formative function of the osteoblaf s is not significantly different from normals.