Faculty Bibliography

The effect of therapy that simultaneously stimulates bone formation and inhibits bone resporption was evaluated in five patients with primary osteoporosis. The technique of in vivo neutron activation analysis was used to measure total body calcium (TB-Ca). The patients were treated with calcium supplements and salmon calcitonin combined with either a low or a high dose of growth hormond (hGH). There was no significant increase in skeletal mass (TB-Ca) during the low-dose hGH regimen. An increase in skeletal mass was observed in all patients following the high-dose regimen, except for one patient who developed secondary hyperparathyroidism. Although this study must be considered to be of a preliminary nature, the magnitude of the response in calcium balance suggests that skeletal mass can be increased in osteoporosis if combination therapy is employed.

Measurements of bone mineral content and total-body calcium, normalized and expressed as ratios, were compared with radiographic morphometry in 45 women who had spinal osteoporosis. The radiographic indices examined included the femoral score, the femoral trabecular pattern, the biconcavity and metacarpal indices, and the total peripheral score. Both ratios and all the radiographic indices except the femoral trabecular pattern were found to be related to the number of dorsal spine fractures. The relationships observed support the following conclusions: (A) the femoral score and the metacarpal index are related to the degree of osteopenia; (B) the biconcavity index reflects the extraskeletal factors that are pathogenic in spinal osteoporosis; (C) a reduced femoral trabecular pattern index is associated with spinal osteoporosis, although this measurement is not related to the degree of osteopenia; and (D) it may be imprudent to diagnose osteoporosis from the presence of lumbar compression fractures.

The age-related changes in body chemical composition were measured in a normal black population ranging in age from 30 to 80 yr. The levels of total-body calcium, phosphorus, sodium, and chlorine were measured by in vivo neutron activation. In addition, the lean body mass (total-body potassium) was measured by whole-body counting of 40K. These data were compared with the same data obtained on a normal white population in a previous study. Although there were no significant differences in the height of the two groups, black men and women had significantly higher total-body calcium, phosphorus, sodium, chlorine, and potassium than the sex-and age-matched white population. The increased levels of total-body calcium and potassium when normalized for the weight and height of the subjects were reduced but still remained significantly higher than those of the white population. Clearly specific reference standards for skeletal and muscle mass as well as for sodium and chlorine need to be established for black populations.

The age-related changes in both skeletal mass and muscle mass were directly measured in normal black women ages 30-80 yr. The levels of total-body calcium (TBCa) were determined with the use of in vivo neutron activation. The muscle mass was measured by wholebody counting of 40K. In the same population, the bone mineral content of the radius was measured using a photon absorptiometric technique. Although there was no significant difference in stature, black women had a greater skeletal mass and bone mineral content of the radius than age-matched white female subjects. When the TBCa values were normalized for body size (i.e., corrected for height and lean body mass), the TBCa was still higher for the black women but not as high as the absolute TBCa values. Clearly, it is the larger muscle mass (as reflected by the 40K measure) in relation to weight and height that accounts for this difference. The lower prevalence of fracture and osteoporosis observed in black women relative to white women is due in part to this greater quantity of skeleton. American black women with a higher bone density (i.e., skeletal mass) maintain mechanical integrity of the skeleton longer than individuals with a lower bone density. It is suggested that the larger muscle mass in black women is, in part, a determinant of their increased skeletal mass and is partly responsible for their apparent resistance to osteoporosis and fracture of the skeleton.