A. J. W. Hitchman

Calcium Kinetic Studies in Patients with Malabsorption Syndrome

In a group of 12 patients with steatorrhea secondary to various etiologies, defective calcium absorption and negative calcium balance occurred in all patients with biochemical osteomalacia. Losses of body calcium resulted from obligatory endogenous fecal losses. High endogenous fecal calcium values appeared to be due to increased digestive juice secretions as well as defective reabsorption. Bone calcium turnover in osteomalacia varied from below to well above the normal range in agreement with reported data on bone biopsy studies. Markedly elevated bone calcium accretion rates were found in idiopathic steatorrhea alone and were associated with advanced bone disease.

Plasma vitamin D metabolite levels in phosphorus deficient rats during the development of vitamin D deficient rickets

Plasma levels of the vitamin D metabolites were related to changes in bone morphology during the development of rickets in rats deprived of phosphorus and vitamin D. Weanling rats were studied at 1, 3, and 5 wk after onset of diets deficient in phosphorus or in both phosphorus and vitamin D. Bone histology and morphometry were carried out and measurements were made of 45Ca and 32P absorption, serum Ca and P, and plasma 25(OH)D3, 24,25(OH)2D3 and 1,25(OH)2D3. After 1 wk of vitamin D restriction, the plasma levels of 25(OH)D3 and 24,25(OH)2D3 were non-detectable (less than 0.5 and less than 0.8 ng/ml). The plasma 1,25(OH)2D3 level was elevated at 1 wk (105.5 pg/ml) and fell to 19 pg/ml by 5 wk. At 1 wk mild rachitic lesions in epiphyseal cartilage were observed despite the elevated 1,25(Oh)D3 level. Serum Ca and P levels and values for 45CA and 32P absorption decreased and the severity of the rickets increased with the fall in plasma levels of 1,25(OH)2D3. In Vitamin D replete, phosphate deficient rats the epiphyseal cartilage was normal throughout the 5 wk study period. Our results provide further evidence that physiological levels of 1,25 (OH)2 D3 will not prevent rickets without adequate plasma concentrations of either 25(OH)D3 or 24,25(OH)2D3.

Differences between the effects of phosphate deficiency and vitamin D deficiency on bone metabolism

It has been widely believed that phosphate deficiency causes osteomalacia. Based on this belief, the rickets of familial hypophosphatemia has been attributed to phosphate deficiency associated with the hypophosphatemia. The present studies on rats have, however, demonstrated significant differences between the effects of phosphate deficiency on bone metabolism and the characteristic features of rickets. Weanling rats, maintained on a mildly phosphate deficient diet, had hypercalcemia and hypophosphatemia, and impairment of body growth, bone growth, and bone mineralization. The maximum effect was observed at 5 wk; between 5 and 20 wk the rats improved despite persistent hypophosphatemia. Histologically, at 5 wk the bone showed thick unmineralized osteoid seams covering most bone surfaces, but the epiphyseal cartilage was normal. In addition, the excess osteoid readily incorporated tetracycline indicating normal mineralization and, based on a new sequential pulse labeling technique, the linear bone apposition rate (LBA) was significantly (p < 0.001) increased above control values. This increase was observed within the initial 4 days of phosphate (P) deficiency and persisted up to 15 wk. This effect of P deficiency on LBA was dependent on vitamin D activity. At 4 wk, the mean LBA was 0.106 +/- 0.003 (1 SE) in control rats, 0.149 +/- 0.008 microns/hr in P deficient rats, 0.083 +/- 0.004 microns/hr in vitamin D deficient rats and 0.086 +/- 0.006 microns/hr in rats deficient in both P and vitamin D. We have reported a similar increase in LBA with parathyroid hormone activity. With vitamin D deficiency, phosphate deficient rats showed all the characteristic features of rickets; disorganization of epiphyseal cartilage, excessive unmineralized osteoid, and reduced mineralization based on the incorporation of tetracycline. We conclude that the effects of phosphate deficiency on bone metabolism more closely resembles the effects of PTH activity than the characteristic effects of osteomalacia and rickets.

Effect of treatment of calcium kinetics in metabolic bone disease

Abstract The effect of treatment on calcium kinetic and balance studies was investigated on six patients with osteoporosis (group A). The results were compared with data obtained from similar studies on four patients with calcium abnormalities secondary to steatorrhea and on one infant with vitamin D-dependent rickets (group B). The studies were carried out before treatment and subsequently at various periods up to 2 yr after the onset of treatment. The effect of treatment on bone calcium kinetics differed significantly between the two groups. In osteoporosis (group A), accretion rates of calcium to bone were lower as compared to pretreatment values. In contrast, in four of the five subjects of group B, accretion rates increased from pretreatment values. The results show that in osteoporosis changes in bone calcium metabolism were observed for as long as 2 yr on treatment, despite the fact that the balance data were normal at this time.

A radioimmunoassay for a porcine intestinal calcium-binding protein

Abstract A radioimmunoassay for porcine intestinal calcium-binding protein (CaBP) has been developed. 125 I-labeled CaBP was prepared using chloramine-T. Antisera to porcine CaBP were raised in guinea pigs and rabbits. Antibody-bound CaBP was separated from free CaBP using talc. The immunoassay was highly sensitive, measuring concentrations of CaBP in duodenal extracts as low as 1 ng/ml with good reproducibility. This is sufficiently sensitive to measure CaBP in small amounts of duodenal tissue obtained by peroral capsule biopsy. The method was specific for CaBP, showing no reactivity toward other duodenal proteins or several peptide hormones. Measurements of CaBP by immunoassay showed a good correlation with measurements of CaBP-specific calcium-binding. The immunodilution curves obtained when assaying pig renal cortical extracts against pure duodenal CaBP were parallel when tested with six different antisera, demonstrating a high degree of immunochemical similarity between kidney and duodenal CaBP. Clearly, the radioimmunoassay possesses distinct advantages for the study of the biologic role of CaBP.

Protective effect on vitamin D2 on bone apposition from the inhibitory action of hydrocortisone in rats.

SummaryUsing the technique of short interval sequential tetracycline labeling, it was documented that the apposition of mineralized bone matrix in adult male Sprague-Dawley rats was inhibited by hydrocortisone. The inhibition occurred as early as six days after the onset of the treatment and was dose dependent over a dose range of 0.62 to 20 mg per kg body weight per day. Vitamin D2 supplements by injection protected bone from this hydrocortisone action. 64 I. U. of vitamin D2 injected daily was able to prevent the inhibition of bone apposition by 20 mg per kg body weight per day of hydrocortisone. The results imply that vitamin D or its metabolites may compete with hydrocortisone in some cellular mechanisms and support the usefulness of vitamin D supplements in the treatment and the prevention of steroid-induced osteoporosis.

Measurements of fluoride in bone biopsies by neutron activation analysis for the clinical study of osteoporosis

A procedure has been developed to measure fluoride concentration in bone biopsies by neutron activation analysis /NAA/. The NAA procedure is non-destructive so that the bone biopsies can be used subsequently for histological evaluation. The fluoride content is expressed as F/Ca ratio in the bone samples. The fluoride and calcium are measured using the reactions:19F/n, γ/20F /t=11.2 s/ and48Ca/n,γ/49Ca/t=8.8 m/, respectively. The F/Ca ratio normalizes the fluoride to bone mineral avoiding the use of bone weight which is unreliable with fresh biopsy samples. This ratio also corrects for variations in neutron flux and gamma counting efficiencies. Results by this procedure were compared to biochemical determinations using an ion-selective electrode for fluoride and atomic absorption for calcium. The two methods gave results which agreed within ±5% which is the precision of the NNA procedure. The NAA method provides a simple and non-destructive procedure for fluoride measurement in bone biopsies for clinical studies. The method is now routinely used in our clinical studies for the fluoride measurements on biopsies from osteoporotic patients treated with fluoride therapy for nearly four years.

The effect of fluoride on nephrocalcinosis in rats

To investigate the effects of fluoride on soft tissue calcification, female weanling rats were fed a nephrocalcinogenic diet and NaF in drinking water over a 4 week period. The diet contained adequate Ca (0.5%) and high phosphorus (1.0%, P). The nephrocalcinosis is attributed to the relatively low dietary Ca/P ratio since addition of Ca to provide a Ca/P ratio of 2.0 prevents kidney calcification. With NaF in drinking water at levels of 1.19 to 4.76 mmol/L kidney calcification was decreased from 127 +/- 24 to 17.3 +/- 1.7 mumol/g wet weight, with no significant differences over this dose range. With the increasing NaF doses, serum F, at 4 weeks, increased from 4.4 +/- 0.8 to 36.5 +/- 6.0 mumol/L compared to untreated F levels of 1.2 +/- 0.1 mumol/L. Bone histology showed no evidence of F stimulation with any of these NaF doses. Previously reported work has shown that, for weanling rats on this diet, greater than 4.8 mumol/L NaF in drinking water is required to produce histological fluorosis within 5 weeks. To inhibit kidney calcification, NaF treatment must be maintained throughout the 4-week study period since calcification occurred if NaF was withheld over either the initial or final 2-week period. These findings indicate a possible therapeutic value of NaF, clinically, in the prevention of soft tissue calcification.

Studies of skeletal cadmium assay and toxicity

Flameless Atomic Absorption Spectrophotometry was found to be a sensitive (2·10−12 g detection limit), accurate but destructive method for cadmium assay in bone biopsy samples (about 30 mg dry weight). The inductively coupled plasma emission technique was poorer in sensitivity (1.2·10−9 g) and is also a destructive method. Activation Analysis is still less sensitive (2·10−8 g detection limit) but a nondestructive one. Cadmium was found to accumulate in bone of rats fed, for 5 weeks, 0, 50, and 100 mg Cd/l in drinking water and the bone concentrations were 0.16, 1.09, and 2.6 mg Cd/kg bone (dry wt). Histological examination of the bones showed that cadmium induced increased osteoid surface in the bone with no evidence of accompanying kidney damage. This suggests a primary effect of cadmium on bone rather than secondary effect due to kidney damage.

The relationship between bone apposition rate and vitamin D activity in phosphate-deficient rats.

In rats, phosphorus deficiency (P-) has been shown previously to stimulate the linear bone apposition rate (BAR) and this P- effect is dependent on adequate intake of vitamin D. To investigate further the relative importance of the vitamin D3 metabolites, 1,25(OH)2D3, 24,25(OH)2D3, and 25(OH)D3, in BAR stimulation, we studied, in P- rats, the relationships between BAR and plasma levels of these three vitamin D3 metabolites following vitamin D3 deprivation. Three groups of rats were placed on diets differing only in phosphorus (P) and vitamin D3(D3) content, with one group diet deficient in both P and D3, one diet, P-, D3 replete, and one diet both P and D3 replete. Plasma levels of the three vitamin D3 metabolites, plasma Ca and P, isotopic Ca absorption and BAR measurements were carried out at 1, 3, and 5 weeks after onset of the test diets. In P-, D3 replete rats, both plasma levels of 1,25(OH)2D3 and BAR were increased throughout the 1 to 5 week study period, while 25(OH)D3 and 24,25(OH)2D3 levels were not significantly different from P and D3 replete controls. In P-, D3 restricted rats, BAR was decreased by one week, prior to any reduction in plasma levels of 25(OH)D3 and 24,25(OH)2D3 and while plasma 1,25(OH)2D3 levels were still well above control values. In this P- rat model, the vitamin D dependent BAR stimulation does not appear to be directly related to alterations in the plasma levels of 1,25(OH)2D3, 24,25(OH)2D3, or 25(OH)D3.