Bone mineral density and parameters of bone metabolism in patients with acromegaly.

To assess the effect of chronically elevated plasma growth hormone (GH) levels on bone metabolism and bone mineral density (BMD), 16 patients (10 females and 6 males) with a mean age of 49.1 +/- 13.2 years (range 33-68) with active acromegaly were studied and compared to a control group of 16 sex- and age-matched subjects. BMD of the lumbar spine and two different sites of the proximal femur were measured by dual-energy x-ray absorptiometry (Norland XR-26). In the acromegalic patients the mean plasma GH concentration was 30.1 +/- 11.1 micrograms/liter, and the mean plasma somatomedin C (SMC) concentration was 6.5 +/- 1.5 U/liter. Mean serum osteocalcin (OC) levels (14.3 +/- 1.1 versus 7.2 +/- 0.4 ng/ml, p < 0.001) as well as the urinary hydroxyproline excretion (OHP; 8.8 +/- 1.4 versus 2.7 +/- 0.3 mg, p < 0.0001) were significantly higher in the acromegalic patients than in the control subjects. In the acromegalic patients BMD was significantly elevated in the two examined regions of the proximal femur, that is, the femoral neck (1.06 +/- 0.05 versus 0.86 +/- 0.03 g/cm2, p < 0.05) and Ward's triangle (0.92 +/- 0.06 versus 0.76 +/- 0.03 g/cm2, p < 0.02), whereas the BMD of the lumbar spine was not significantly different from that of control subjects. Among the patients with acromegaly a significant positive correlation between serum OC concentrations, on the one hand, and urinary OHP excretion (r = 0.7, p < 0.004) as well as BMD in the proximal femur (r = 0.64, p < 0.007), on the other hand, could be observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Basic fibroblast growth factor induces osteoclast formation in murine bone marrow cultures.

We determined the effect of basic fibroblast growth factor (bFGF) on osteoclast-like cell (OCL) formation in bone marrow cultures using C57BL/6 mice. Cells were cultured for 7 days with or without bFGF at various concentrations or 10(-8) mol/L 1,25(OH)2 vitamin D3 [1,25(OH)2D3]. bFGF dose-dependently increased OCL formation per well (10(-10) mol/ L = 40 +/- 2; 10(-9) mol/L = 146 +/- 13; 10(-8) mol/L = 156 +/- 12) compared with control (< 7 per well). The effects of bFGF at 10(-9) and 10(-8) mol/L were similar to that of 10(-8) mol/L 1,25(OH)2D3 (154 +/- 11 per well). OCLs formed by bFGF were multinuclear, tartrate-resistant acid phosphatase (TRAP)-positive, expressed calcitonin receptors, and formed characteristic resorption pits. We also determined whether bFGF enhanced OCL formation during the early proliferative or late differentiating phases of the cultures. When bFGF (10(-8) mol/L) was added only on days 1-2 or days 3-4 of 6 day cultures, there was a significant increase in OCL formation. In contrast, when bFGF was added only on days 5-6 few OCLs formed. Addition of bFGF at days 1-6 or days 1-2 and days 5-6 caused similar increases in OCL formation, which were greater than OCL formation induced by treatment for days 1-2 or days 1-4. We examined the production of prostaglandin E2 (PGE2) in the cultures because bFGF is a potent stimulator of PGE2 synthesis in bone, and PGE2 stimulates OCL formation. bFGF treatment significantly increased PGE2 levels in 7 day cultures (controls = 1.4 +/- 0.1 nmol/L, 10(-8) mol/L bFGF = 132.5 +/- 0.7 nmol/L). In addition, treatment of marrow cultures with the prostaglandin synthesis inhibitors, indomethacin or NS-398 (both at 10(-6) mol/L), completely blocked bFGF-induced OCL formation. We conclude that bFGF stimulates OCL formation in C57BL/6 bone marrow cultures by mechanisms that require prostaglandin synthesis. This pathway is likely to be one mechanism by which bFGF stimulates resorption.

High turnover bone disease following lung transplantation.

Recipients of lung transplants are at very high risk for significant bone loss. Nevertheless, data on bone disease after lung transplantation are still limited. We, therefore, retrospectively evaluated the data of 33 patients surviving at least 1 year after lung transplantation (LTx) who were seen in our outpatient clinic for osteologic evaluation. Results of clinical evaluations, radiographs, and dual-energy X-ray absorptiometry (DXA) were related to each other, to clinical variables, and to serum levels of osteocalcin, parathyroid hormone (PTH), and 25-hydroxyvitamin D: 14 of 33 patients (42%) had vertebral fractures, 9 of whom were diagnosed within 2 years after transplantation. Bone mineral density values (DXA) were markedly decreased and predictive of compression fractures. 25-Hydroxyvitamin D levels were low in 13 patients (39%) and PTH was elevated in 7 (21%). Despite corticosteroids and low 25-hydroxyvitamin D, serum osteocalcin was elevated in 12 patients (36%). This was only partially explained by hyperparathyroidism, low sex hormones, and impaired renal function, and may partly be caused by cyclosporin A. We thus conclude that severe symptomatic bone disease is common in lung transplant recipients and due to a complex situation including high turnover bone loss and hypovitaminosis D. DXA can be used to estimate fracture risk for individual patients.

Influence of radiation synovectomy on articular cartilage, synovial thickness and enhancement as evidenced by MRI in patients with chronic synovitis.

UNLABELLED: Radiation synovectomy is a safe and effective treatment for chronic synovitis that is refractory to the repetitive, intra-articular application of glucocorticosteroids in patients with rheumatoid or seronegative arthritis. Short-term and long-term effects of radiation synovectomy on articular cartilage, synovial enhancement and thickness were assessed in a prospective, clinical trial by MRI. METHODS: Thirteen patients (mean age 39+/-13 y) were treated with a median activity of 8.4 GBq 165Dy ferric hydroxide, a radionuclide with favorable physical properties and a well-documented clinical safety and efficacy profile. MRI was performed on a 1.5-T MR unit using a circular polarized knee coil. RESULTS: After a mean observation period of 13 mo, a marked reduction in synovial enhancement was observed in 10 patients. The mean reduction in baseline synovial thickness (mean 7.6+/-3.0 mm) was 24% (P = 0.03) at 1 wk and 42% (P = 0.01) about 1 y after treatment, respectively. Clinically, 9 of 13 patients (69%) exhibited persistent response to radiation synovectomy. The local clinical score, as defined by the reduction in pain, pannus, joint effusion and by the increase in the range of motion, improved significantly (P = 0.01), from a median of 7 (range 4-10) to a median of 2 (range 0-9). One year after treatment, changes in the local clinical score were related to the decrease in synovial enhancement in MRI (r = 0.7, P = 0.008, n = 12). There were no persistent adverse effects, nor was there evidence for any severe radiation-induced damage to the articular cartilage. On later follow-up images, the structure of the articular cartilage remained unaltered in all but 3 patients, who had new, superficial erosions most likely attributed to an active disease with persistence of inflammation. CONCLUSION: This study suggests that radiation synovectomy with 165Dy-ferric hydroxide is effective in terms of reducing chronic synovitis without causing detectable harm to the articular cartilage, as shown by MRI.

The spine deformity index in osteoporosis is not related to bone mineral and ultrasound measurements.

In 34 female patients suffering from osteoporotic vertebral compression fractures, the spine deformity index (SDIM) was determined, according to the method of Minne et al (1988), to reflect the radiological severity of established osteoporosis. Peripheral (single-photon absorptiometry (SPA) of the non-dominant distal forearm) and axial (quantitative computed tomography (QCT) of the lumbar spine) bone mineral measurements, as well as the broadband ultrasound attenuation of the os calcis, were performed in the osteoporotic patients and in a control group of 20 age-matched women. No correlation could be found between bone mineral measurements and radiological severity of osteoporosis, expressed as SDIM. All three densitometry methods showed clearly reduced values in patients with vertebral crush fractures. Correlations established in the control group between peripheral and axial bone mass (SPA versus QCT) could no longer be found in the osteoporotic group, thus indicating changes in bone mineral density of the spine after the occurrence of osteoporotic fractures. Our data show that SDIM is an additional parameter of osteoporotic change in the spine, independent from bone mass measurements. In the management of osteoporotic patients, quantitative radiological methods (i.e. SDIM) in addition to densitometry might be of value for grading and monitoring the progress of disease.

[Evidence of fluoride-induced effects on the calcaneus by measurements of broadband ultrasound attenuation (BUA)]. / Hinweis auf fluoridinduzierte Effekte am Kalkaneus durch Messungen der Breitband-Ultraschallabschwächung (BUA).

We measured broadband ultrasound attenuation (BUA) of the calcaneus as well as radial (RBD) and spinal bone density (SBD) in normal and osteoporotic females (n = 188) both before treatment and after long-term fluoride therapy. RBD was measured using single photon absorptiometry of the non-dominant distal forearm (SPA) and spinal bone density (SBD) was assessed using quantitative CT (QCT). In untreated osteoporotic patients (n = 62), BUA as well as the other densitometric methods showed significantly lower values (p < 0.05) when compared to age matched controls (n = 75). Females with osteoporosis and long-term treatment with fluoride (n = 51) had both significantly higher BUA values and higher spinal bone density when compared to women with untreated osteoporosis. BUA and SBD were correlated in the entire group (r = 0.5, r < 0.0001) as well as in the subgroups of untreated (r = 0.48, p < 0.001) and fluoride-treated patients with osteoporosis (r = 0.4, p < 0.05). These results suggest that BUA provides further evidence of an osteogenic response to fluoride at peripheral weight-bearing skeletal sites such as the calcaneus.

Successful treatment of high turnover osteoporosis in a patient with adrenocortical insufficiency.

We present a case of high-turnover osteoporosis associated with substituted adrenocortical insufficiency (Addison's disease) and its successful treatment with calcitonin and calcitriol. A 43-year-old man presented with markedly reduced bone mineral density (BMD) (lumbar spine BMD -3.46 SD below healthy young adults) after thirteen years of glucocorticoid substitution. Interestingly, his osteocalcin levels indicated an unusually high bone turnover and his alkaline phosphatase levels were also increased. Combination treatment with calcitriol and calcitonin was started. Re-evaluation after twelve months revealed a substantial increase in BMD (+6.8% for the lumbar spine, +15% for the left hip). Alkaline phosphatase levels had normalised and osteocalcin was nearly down to normal. In spite of a thorough evaluation, no other cause of osteoporosis was detected. We discuss these findings in view of the existing literature.

[Disodium pamidronate (APD) in therapy of hypercalcemia in primary hyperparathyroidism]. / Dinatriumpamidronat (APD) als Therapie der Hyperkalzämie bei primärem Hyperparathyreoidismus.

The established pre-operative therapy for severe hypercalcemia caused by primary hyperparathyroidism (pHPT), i.e., rehydration with saline in combination with furosemide, calcitonin and hydrocortisone, rarely leads to satisfactory results. We examined the effect of pamidronate (APD, 45-60 mg), a diphosphonate of the 2nd generation in 6 patients (4 female, 2 male) with severe hypercalcemia caused by pHPT. Prior administration of saline, furosemide, calcitonin and oral diphosphonates of the 1st and 2nd generation had failed and the patients still suffered from symptoms of hypercalcemia. APD reduced serum calcium levels in all patients: values reached the normal range (2.1-2.6 mmol/l) in 3 patients, the upper normal range in 2 patients and fell transiently into the subnormal range in 1 patient. In parallel to the decreasing calcium levels a marked increase in PTH was registered in 4 out of 6 patients. One patient with an adenoma showed no change in PTH levels, whereas one patient with hyperplasia of 5 parathyroid glands showed a significant decrease in PTH. These results confirm the potent hypocalcemic effect of pamidronate even in patients whose serum calcium could not be reduced by other conservative therapeutic strategies. Thus, pamidronate is an effective drug in the treatment of the pre-operative phase of hypercalcemia caused by pHPT.

The impact of a senior dancing program on spinal and peripheral bone mass.

Because activity and regular exercise are important factors to maintain general good health in senior citizens, we investigated whether senior dancing has any effect on peripheral or lumbar bone density. We performed a prospective study over a12-mo period on bone density at a spinal and peripheral measuring site in 28 female senior members (mean age: 67 +/- 2 yr) of a dancing group in Vienna. Lumbar bone mineral density was assessed by quantitative computed tomography (qCT) and radial bone density by single photon absorptiometry of the distal forearm. The mean training time per week was 3.2 +/- 0.8 h. In the entire group of female dancers, no significant effects of dancing on radial or lumbar bone density could be observed. Linear regression analysis showed that the lower the qCT at the beginning of the observation period, the higher was the percentage increase of spinal qCT in the entire group during 12 mo of dancing (r = 0.52, P < 0.0001). For additional evaluation, females were divided into two subgroups, osteoporotic or nonosteoporotic, based on x-rays and lumbar bone mineral density (BMD) as measured by qCT. The group classified as dancers with osteoporosis (group I) showed a significant increase in lumbar bone density, whereas in the group of dancers without signs of osteoporosis (group II), BMD remained unchanged. Additionally, radial bone density did not show any changes in either group. Group I showed a significant correlation between basal spinal BMD and the percentage change of BMD during the observation period (r = 0.7, P < 0.001). Changes of the biochemical parameters were observed in the bone-specific isoenzyme of alkaline phosphatase, a marker of osteoblastic activity, in group I giving additional evidence of increased bone formation.

Bone mass and biochemical parameters of bone metabolism in men with spinal osteoporosis.

With advancing age both sexes have an increased incidence of osteoporotic fractures, although fractures are more common in women than in men. Whereas in women several potential risk factors have been identified, less is known about osteoporosis in men. A total of 27 Austrian men (mean age: 65 +/- 2 years) with atraumatic spine fractures were studied. In all patients, medical history gave no evidence of disease or medications causing osteoporosis. Peripheral bone mass was determined by single-photonabsorptiometry on the distal non-dominant forearm; lumbal bone density was measured by quantitative computed tomography. Serum levels of calcium, phosphate, alkaline phosphatase, osteocalcin, testosterone, estrogen, parathyroid hormone and 25-hydroxy-vitamin D as well as 2-h-urinary-OH proline and calcium excretion were measured. All data were compared with those of an age and sex matched control group consisting of 19 healthy males. A significant difference in mean peripheral and axial bone mass (SPA: P less than 0.004; QCT: P less than 0.0001) was observed between osteoporotic men and controls. When compared to controls, serum levels of alkaline phosphatase (P less than 0.012), urinary OH proline (P less than 0.05) and urinary calcium excretion (P less than 0.003) were significantly higher in the osteoporotic males. Additionally, there was a significant positive correlation between serum alkaline phosphatase and urinary OH proline excretion (r = 0.32; P less than 0.04) in the osteoporotics. All other biochemical parameters showed no significant differences. Our results may lead to the assumption that osteopenia in men is related to increased bone turnover.

Risk of vertebral fractures in men: relationship to mineral density of the vertebral body.

OBJECTIVE: Vertebral fracture is the most frequent manifestation of osteoporosis in women. Because there is a lack of information about bone density and the occurrence of fractures in men with osteoporosis, we evaluated the relationship between vertebral fractures and spinal bone mineral density (BMD) to determine if there is a threshold of BMD below which fractures are likely to occur. SUBJECTS AND METHODS: Radiographs of the spine and BMD measurements of the lumbar spine as measured by quantitative CT were obtained in 201 men 21-86 years old (mean age, 68 +/- 4 years) who were referred consecutively for osteoporosis screening. Radiographs were interpreted for the presence or absence of vertebral fractures. The probability of fractures was determined after classifying the patients into subgroups according to their quantitative CT values. The relationship of spinal bone mass to spinal fracture was examined by both logistic regression and receiver operating characteristic (ROC) analysis. RESULTS: Seventy-one patients were classified as having definite vertebral compression fractures. Spinal BMD was 132 +/- 34 mg/ml for the 130 men without vertebral fractures and 75 +/- 22 mg/ml for the 71 men with vertebral fractures (p < .001). The number of fractures per patient and the BMD were negatively correlated (r = -0.71, p < 0.0001). When a BMD of 100 mg/ml was given as a fracture threshold, 15% of the patients without fractures were below this value and 14% of the patients with fractures were above this threshold. Quantifying the overlap between values from patients with and without fractures by ROC analysis, the value of 100 mg/ml gave a sensitivity of 86%. Logistic regression showed 105 mg/ml as the most discriminate value, resulting in a sensitivity of 90%. Logistic regression analysis of the predicted fracture probability also indicated that age does not significantly influence the regression curve. CONCLUSION: We found that direct quantitative CT measurement of the BMD of the vertebral body is a highly efficient approach to distinguish men without vertebral fractures from those with fractures. Thus, a fracture-threshold concept could provide a quantitative criterion to identify men at high risk for vertebral fractures.

Bone mass and bone diminution of the axial and peripheral skeleton in normal and osteoporotic Austrian females.

Measurements of bone mass were performed in 133 healthy Austrian women using the quantitative computed tomography technique of the lumbar spine and single photon absorptiometry of the distal forearm. The data were compared with those of 110 Austrian females with osteoporotic spine fractures. A significant difference in mean bone density of the lumbar spine was observed between normal and osteoporotic patients in every decade, whereas forearm measurements showed statistical differences in the seventh and eighth decade but not in the sixth decade. Compared to age matched controls, bone mass of osteoporotic women showed the following diminution: sixth decade: distal forearm: -12.7%, spine: -46.8%; seventh decade: distal forearm: -19.0%, spine: -36.7%, eighth decade: distal forearm: -15.4%, spine: -33.7%. It appears that postmenopausal osteoporosis involves greater loss of bone in the spine in the first decade after menopause and slows down after this period, whereas loss of forearm bone mineral density (BMD) increases with advancing age.

Peripheral and axial bone mass in Austrian free climbers.

The present investigation was carried out in healthy white adult males to determine the effects of exercise, in the form of free climbing, on peripheral and axial bone mass. 13 men who have been regularly engaging in alpine free climbing for a mean period of nine years and, for training purposes, have been performing additional muscle building exercises (4.5 h +/- 1 SEM per week) and 12 age matched controls were included in the study. Bone mineral content of the non-dominant distal forearm was measured by single-photon absorptiometry, and bone mineral density of the lumbar spine was determined by quantitative computed tomography. It was found that consistent exercise in the form of alpine free climbing was associated with increased bone mass of the lumbar spine (162.4 +/- 4.4 vs 184.8 +/- 7.9 mg/ml, p less than 0.025). Peripheral bone mineral content of the distal forearm was slightly but not significantly increased in the free climbers (55.4 +/- 9.0 vs 61.1 +/- 7.4 Units, p less than 0.09 N.S.). The study provides additional evidence that exercise in the form of alpine climbing, is associated with increased lumbar bone mass.

Influence of sex and age on biochemical bone metabolism parameters.

Age-related changes in bone metabolism are of interest in the pathogenesis of postmenopausal and senile osteoporosis; however, data in the literature give conflicting results. Thus, the aim of our study was to measure serum levels of osteocalcin, a specific biochemical parameter of bone formation, as well as serum levels of midregional parathyroid hormone (PTH) and alkaline phosphatase in healthy males and females of various age groups. We studied 155 healthy subjects (91 females, 64 males, mean age: 43 years, age range: 20-81 years). Serum levels of osteocalcin, alkaline phosphatase and PTH increased with age and were significantly higher in the postmenopausal than in the premenopausal females (osteocalcin: 8.7 +/- 0.4 vs. 6.5 +/- 0.3 ng/ml, p < 0.0001; alkaline phosphatase: 126 +/- 7 vs. 89 +/- 5 U/l, p < 0.0003; PTH: 111 +/- 10 vs. 61 +/- 9 pmol/l, p < 0.0001). In contrast, serum levels of osteocalcin, alkaline phosphatase and PTH were similar in the male subjects above or below the age of 50 years (osteocalcin: 6.5 +/- 0.5 vs. 7.2 +/- 0.4 ng/ml, non significant; alkaline phosphatase: 104 +/- 8 vs. 105 +/- 5 U/l, non significant; PTH: 59.6 +/- 6 vs. 61 +/- 5 pmol/l, non significant. Serum calcitonin levels were significantly lower in postmenopausal women and men above 50 years of age. Our data suggest different age-related alterations in bone metabolism in males and females. The increased levels of osteocalcin, alkaline phosphatase and PTH in postmenopausal females give evidence of increased bone turnover in these subjects. In healthy men bone-specific markers remained unchanged, indicating no relationship between bone turnover and age.

Decrease of serum calcium concentration and lost influence of calcium on parathyroid hormone release in a patient with primary hyperparathyroidism after treatment with diphosphonates.

Prolonged decrease of elevated serum calcium levels after treatment with diphosphonates in patients with primary hyperparathyroidism (pHPT) is very rare. A patient with water clear cell hyperplasia and five enlarged glands is presented who received diphosphonates (day 1 through day 8 dichloromethylene diphosphonate orally and a single dose of 60 mg pamidronate on day 8 intravenously) leading to a significant fall in serum calcium levels. Surprisingly, there was no reactive increase in intact parathyroid hormone (PTH) in the following 18 days. Patients with missing PTH regulation to hypocalcemia after diphosphonates who need a period of stabilization prior to parathyroid surgery might benefit most from this therapy.

Comparison of serum fluoride levels after administration of monofluorophosphate-calcium carbonate or sodium fluoride: differences in peak serum concentrations.

Fluoride salts are widely used in Europe in the treatment of established osteoporosis with crush fractures for their ability to increase trabecular bone mass. However, in the United States fluorides are still regarded as an experimental drug. In a prospective, randomized study we compared the fluoride pharmacokinetics of enteric-coated sodium fluoride and disodium monofluorophosphate calcium carbonate (MFP-Ca) over the period of 76 h. Twenty subjects (12 females, 8 males), aged 35-80 years, free of gastrointestinal disorders, renal impairment, and liver disease and without prior fluoride intake entered the study. Ten subjects received NaF (11.3 mg fluoride) twice a day and the other ten MFP-Ca (13.2 mg fluoride) twice a day. During the study period of 76 h the patient's usual food intake was not changed. Serum fluoride levels were determined using an ion sensitive electrode. After intake of a single drug preparation of MFP-Ca or NaF, MFP-Ca showed a significantly shorter lag time of absorption and a significantly higher maximal serum fluoride concentration than NaF (P < 0.01). A comparison of fluoride cumulative characteristics of both drugs showed virtually identical serum fluoride levels before intake of the morning dose on all 4 study days, whereas serum fluoride concentrations measured 4 h afterwards were significantly higher for MFP-Ca than for NaF. These data provide evidence of high "peak" serum fluoride levels for MFP-Ca, whereas only small peak-to-trough fluctuations are seen for NaF.

Expression and regulation of prostaglandin F receptor mRNA in rodent osteoblastic cells.

The ability of prostaglandins to inhibit collagen synthesis and induce prostaglandin G/H synthase in bone cells appears to be mediated by the prostaglandin F2 alpha receptor (FPR). We have identified FPR mRNA in the osteoblastic cell lines, Py1a from rats and MC3T3-E1 from mice, as well as in the stem cell cultures, MN-7 and mouse marrow, using reverse transcriptase-polymerase chain reaction technology (RT-PCR). Expression of FPR mRNA was increased in Pyla, MN-7 and marrow cells with prolonged culture or dexamethasone treatment and decreased after treatment with fluprostenol, a selective FPR agonist.

The non ergot D2-dopamine agonist CV 205-502 decreases growth hormone concentrations in acromegalic patients.

It was the aim of this study to test for a possible effect of the new non ergot dopamine agonist CV 205-502 on plasma growth hormone (GH) concentrations in acromegaly. 10 acromegalic patients received a single oral dose of 150 micrograms CV 205-502 after an overnight fast. As a control group 7 acromegalic patients undertook the same procedure without receiving any drug. Blood samples were drawn hourly up to 7 hours thereafter for determination of GH. Plasma growth hormone concentrations decreased by 48.8 +/- 8.7%. The nadir was observed 3 hours after CV 205-502 was administered and GH concentrations remained suppressed throughout the 7 hours of the test period. In contrast GH plasma concentrations in the control group remained stable. We conclude that acute administration of CV 205-502 suppresses GH secretion in acromegalic patients and thus could serve as an alternative therapy in acromegaly.

Broadband ultrasound attenuation: a new diagnostic method in osteoporosis.

Broadband ultrasound attenuation (BUA) measurements of the calcaneus, single-photon absorptiometry (SPA) of the nondominant distal forearm, and quantitative CT (QCT) of the lumbar spine were performed in 37 women with osteoporotic vertebral fractures and 23 female control subjects of similar age distribution to assess the usefulness of sonography in detecting axial osteopenia. In the women with osteoporotic vertebral fractures, all three measuring methods showed significantly reduced values (SPA: p less than .05; QCT: p less than .0001; BUA: p less than .05) compared with those in the control subjects. In addition, for all subjects, a significant positive correlation was found between BUA and QCT (tau = 0.25, p less than .005) and between SPA and QCT (tau = 0.34, p less than .0001). These results suggest that BUA, a simple method that is radiation-free, is a valuable tool in the management of osteoporosis.

Effect of long-term growth-hormone substitution therapy on bone mineral density and parameters of bone metabolism in adult patients with growth hormone deficiency.

Reduced bone mineral density (BMD) and the prevalence for osteoporotic vertebral fractures are symptoms of growth hormone deficiency (GHD) syndrome, and GH replacement therapy is now available for GH-deficient adults. We investigated the long-term effects of GH replacement therapy on bone mineral density (BMD) and bone metabolism in 19 adult patients with GHD over a period of 18 months. In response to GH treatment, the initially decreased IGF-I concentrations rose significantly during 18 months of therapy to levels within the normal range (matched for sex and age) (mean change 158.1 +/- 50.8 ng/ml, P < 0.001). Parameters of bone formation such as osteocalcin (OC) and procollagen I-C-Peptide (PICP) showed a significant increase in the first 6 months of therapy, followed by a slight decrease in the next months. Markers of bone resorption (CrosslapsR and deoxypyridinoline (D-Pyr) also increased significantly with a peak value after 6 months and all parameters except PICP remained above baseline values after 18 months. BMD of the femoral neck (FN) showed an increase after 18 months of therapy (mean change 0.01 +/- 0.03 g/cm2 after 18 months, n.s.). However, the increase in BMD was significant only in the lumbar spine (LS) (mean change 0.03 +/- 0.04 g/cm2, P < 0.05 after 18 months). We conclude that GH replacement therapy in adult patients with GHD over a period of 18 months causes a pronounced increase in bone turnover mainly during the first 12 months of therapy and increases BMD of the lumbar spine and the femoral neck after 18 months.