Osteoporosis, PTH elevada y calcio iónico inadecuadamente "normal" / Osteoporosis, elevated PTH and inadequately "Normal" Ionic Calcium

La medición de las hormonas calciotrópicas y el calcio sérico de forma rutinariaen pacientes evaluados por osteoporosis lleva a la identificación de sujetos normocalcémicoscon niveles elevados de hormona paratiroidea. Se describe el casode una mujer de 53 años con osteoporosis, en la cual se encuentra un nivel séricoelevado de hormona paratiroidea con niveles inadecuadamente “normales”de calcio iónico. En la resonancia magnética nuclear del cuello aparece una tumoraciónquística compatible con adenoma paratiroideo. Se realizó una cervicotomíadebido a la disminución severa de la masa ósea y el hallazgo en la RMN.La descripción anatomopatológica del tejido resecado confirma el diagnóstico dehiperparatiroidismo primario normocalcémico. Se revisa la posible etiología ydiscutimos la presentación de esta forma inusual de hiperparatiroidismo primariocomo una causa no sospechada de osteoporosis

The measurements of calciotropic hormones and serum calcium routinely inevaluation of patients for osteoporosis, carries to identify normocalcemic subjetswith elevated parathyroid hormone. We describe a case of a 53 year-oldwoman with osteoporosis who has high level of parathyroid hormone with inapropiatelynormal levels of ionized calcium. In the nuclear magnetic resonanceof the neck appears a cystic tumor compatible with parathyroid adenoma.Cervicotomy was done due to the severe bone mass decrease and the discoveryin the MRI. Pathological description of chirurgic piece confirms the diagnosisof normocalcemic primary hyperparathyroidism. We revise the possible ethiologyand discuss this unusual way of presentation of primary hyperparathyroidism

Bone mineral density and androgen levels in elderly males.

To clarify the relationship of sex male hormones and bone in men, we studied in 140 healthy elderly men (aged 55-90 years) the relation between serum levels of androgens and related sex hormones, bone mineral density (BMD) at different sites, and other parameters related to bone metabolism. Our results show a slight decrease of serum-free testosterone with age, with an increase of follicle stimulating hormone (FSH) and luteinizing hormone (LH) in a third of the elderly subjects studied. BMD decreased significantly with age in all regions studied, except in the lumbar spine. We found a positive correlation between body mass index (BMI) and BMD at the lumbar spine and femoral neck (P < 0.001). No relationship was found (uni- and multivariate regression analysis) between serum androgens or sex hormone-binding globulin (SHBG) and BMD. We found a positive correlation of vitamin D binding protein (DBP) and osteocalcin with lumbar spine BMD and with BMI, DBP, IGF-1, and PTH with femoral neck BMD. In conclusion, there is a slight decline in free testosterone and BMD in the healthy elderly males. However, sex male hormones are not correlated to the decrease in hip BMD. Other age-related factors must be associated with bone loss in elderly males.

Variable efficacy of bone remodeling biochemical markers in the management of patients with Paget's disease of bone treated with tiludronate.

The aim of this work was to evaluate the response of different biochemical bone markers to tiludronate administration in Paget's disease of bone. Ten patients (five men and five women), 56-77 years old (67 +/- 6.5), were treated for 3 months with tiludronate tablets (400 mg/day). Bone formation markers: alkaline phosphatase (AP), bone alkaline phosphatase (bAP), osteocalcin (BGP), and procollagen I carboxyterminal propeptide (PICP) in serum; and bone resorption markers: serum cross-linked carboxyterminal telopeptides of type I collagen (ICTP), urinary hydroxyproline/creatinine (Hyp/Cr), pyridinoline/Cr (Pyr/Cr), and alpha-1 collagen chain products degradation (CrossLaps) were assessed. Samples were taken before and at monthly intervals for 3 months after treatment began. The results of the present work show that serum AP and bAP are sensitive and reliable biochemical markers of bone formation in the follow-up of tiludronate in this disease. Serum PICP shows less sensitivity than serum AP, and serum BGP is not indicated as biochemical marker in these types of studies. Urinary hydroxyproline seems to be the most reliable biochemical marker of bone resorption. More studies should be performed with urinary Pyr and CrossLaps determinations. Serum ICTP is not adequate for the follow-up of tiludronate treatment in Paget's disease of bone.

[Differences in the cellular response of the immune system in patients with Paget's disease of bone after elcatonin and etidronate administration]. / Diferencias en la respuesta celular del sistema inmune en pacientes con la enfermedad ósea de Paget tras la administración de elcatonina y etidronato.

A cellular immunological defect is present in patients with Paget's disease of the bone. Low counts of CD4, high counts of CD8, and a low CD4/CD8 ratio were observed in 58 patients compared with controls. These findings were not correlated with the metabolic activity of the disease. After therapy with Elcatonine an improvement in the cellular immunological defect was observed in 15 patients. Etidronate improved the biochemical bone patterns but no changes were observed in the number of lymphocytic subpopulations. These changes can be related to the improvement in the bone metabolic disorder or be the result of an effect on the altered immunity in this disease.

Serum concentrations of carboxyterminal cross-linked telopeptide of type I collagen (ICTP), serum tartrate resistant acid phosphatase, and serum levels of intact parathyroid hormone in parathyroid hyperfunction.

We have studied the levels of a new biochemical marker of bone resorption, carboxyterminal cross-linked telopeptide of type I collagen (ICTP), in 26 healthy control subjects, 15 patients with primary hyperparathyroidism (PHPT) and 17 patients with secondary hyperparathyroidism (secondary HPT). Levels of ICTP in PHPT and secondary HPT have been correlated with those of serum tartrate resistant acid phosphatase (TRAP), another biochemical marker of bone turnover, and with serum levels of intact parathyroid hormone (iPTH). The ICTP levels of the control group were 2.07 +/- 0.58 micrograms l-1, n = 26, range 1.3-3.2. They were independent of sex and age in the studied age range (30-62 years). The ICTP levels of PHPT patients were 3.5 +/- 3.5 micrograms l-1, mean +/- SD, range 0.5-12.2 micrograms l-1, significantly higher than those of control subjects (p < 0.05). We found a significant linear correlation between values of ICTP and iPTH levels (p < 0.01), between values of ICTP and serum activity of TRAP (p < 0.01) and between iPTH and TRAP levels (p < 0.01) in patients with PHPT. The ICTP levels in patients with secondary HPT were higher than those of patients with PHPT, 46 +/- 37 micrograms l-1, range 12-167 micrograms l-1 (p < 0.001) due to the impaired renal clearance of this peptide. We did not find a significant linear correlation between values of ICTP and iPTH levels in the serum of patients with secondary HPT, although we found a significant correlation between levels of ICTP and levels of TRAP, both biochemical markers of bone turnover.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical usefulness of serum carboxyterminal propeptide of procollagen I and tartrate-resistant acid phosphatase determinations to evaluate bone turnover in patients with chronic renal failure.

We have studied the levels of the biochemical markers of bone formation total serum alkaline phosphatase, osteocalcin (BGP) and carboxyterminal propeptide of type I procollagen (PICP), the levels of the biochemical marker of bone resorption serum tartrate-resistant acid phosphatase (TRAP) and those of intact immunoreactive PTH (iPTH) in 30 patients at different stages of chronic renal failure (CRF), all of them without verifiable hepatopathy, and in 9 patients in hemodialysis with hepatopathy measured by the Knodell index. Sixteen control subjects were also studied. In the group of patients with CRF with or without hepatopathy, the levels of biochemical markers of bone turnover were significantly elevated with respect to those of control patients. We did not find any significant difference in the levels of these parameters between the groups with and without liver damage, in spite of the fact that TRAP and PICP are cleared mainly by the liver. Levels of TRAP and PICP correlated significantly with the other biochemical markers of bone turnover studied. The good relation observed between PICP, TRAP and the biochemical indexes of bone activity and iPTH levels suggests the clinical value of these markers in the follow-up of bone involvement in patients with CRF. On the other hand, the frequent hepatopathy found in patients with CRF does not seem to affect to a significant extent the diagnostic value of PICP and TRAP in this pathology.

Cellular immunodeficiency in Paget's disease of bone: changes induced by treatment with elcatonin.

We have found a cellular immune defect (low CD4 T lymphocyte count, high CD8 T lymphocyte count and a low CD4/CD8 ratio) in 39 PDB patients. This finding is not correlated with the bone metabolic activity of the disease. There was an improvement in the cellular immune defect in fifteen patients after treatment with elcatonin. These changes could be related to the improvement in the metabolic derangement or else could be the consequence of an effect on altered immunity.