I. Holló

Three-year calcitonin combination therapy for postmenopausal osteoporosis with crush fractures of the spine

SummaryForty-five postmenopausal osteoporotic women with at least one osteoporotic vertebral crush fracture were randomized into three treatment groups. Each patient was on calcitonin, 50 U, on alternate days for 2 weeks monthly (350 U/month), and 500 mg/day oral calcium supplementation. In group II, this therapy was supplemented with phosphate (750 mg/day), and in group III, norandrostenolone decanoate (50 mg/month) was added to the calcitonin + calcium therapy. Bone mineral content, by single photon absorptiometry, of the radius midshaft and distal site (3 cm), as well as the lumbar and metacarpal radiomorphometrical indices were estimated semiannually. The therapeutic trial lasted 36 months except in the phosphate supplementation group, where, due to unfavorable results, treatment was discontinued after 24 months. Calcitonin practically prevented further bone loss for 24 months even in this relatively small and intermittent dosage. Phosphate supplementation was without benefit; however, according to the majority of the examined parameters, combination of calcitonin with the anabolic steroid norandrostenolone decanoate extended efficacy up to 36 months. This latter combination seems to be a promising, relatively inexpensive therapeutic regimen in the treatment of established postmenopausal osteoporosis.

Calcitonin secretion in streak gonad syndrome (Turner's syndrome)

SummaryOsteoporosis in one of the most common complications of streak gonad syndrome (SGS), however, its pathogenesis is still unclear. To test whether SGS is associated with calcitonin (CT) deficiency, 11 affected individuals and 8 age-matched healthy women were studied. Calcium, 3.6 mg/kg b.w. as a 10% solution of calcium chloride, was given intravenously for 3 minutes. Serum levels of CT and calcium were measured before and at 5, 30, 60, and 120 minutes after the injection. There was a statistically significant rise in serum calcium levels both in the control subjects and patients with SGS, with significantly lower levels prior to and at 30, 60, and 120 minutes following calcium load in the control group. The CT rise following calcium load was also significant at 5, 30, and 60 minutes in the controls and at 5 and 30 minutes in patients with SGS, with a significantly lower baseline and 30, 60, and 120 minutes levels in the latter group. Maximum levels of calcium and CT occurred 5 minutes after the calcium load and were statistically indistinguishable. There were no significant differences in either the calcium or the CT incremental changes between the two groups. These findings are consistent with decreased basal (and 30–120 minute) CT levels in SGS and suggest that CT deficiency may be involved in the development of osteoporosis in patients with SGS. The possible causal relationship of estrogen deficiency to the reduced CT levels in SGS is discussed.

Serum bone GLA protein in streak gonad syndrome

SummaryOsteoporosis is one of the most common complications of streak gonad syndrome (SGS), however its pathogenesis is still unclear. Bone Gla protein (BGP) has been found to be a serum marker of bone turnover in various metabolic disease states. In the present study serum BGP and alkaline phosphatase (AP) were measured in 13 osteoporotic patients with SGS and in 56 healthy women. Mean (±SD) serum BGP levels were normal (7.5±2.0 ng/ml) in seven patients who had been on estrogen-progestin replacement therapy and became significantly elevated (P<0.001) 2 and 3 months after discontinuation of the treatment (15.3±2.3 and 13.2±1.0 ng/ml, respectively). Mean (±SD) serum AP (207±65 U/l) showed significant increases (P<0.05) 2 months after withdrawal of hormonal substitution (287±74 U/l). Mean (±SD) serum BGP (15.4±3.5) and AP (287±49) levels were significantly higher (P<0.001 and <0.05, respectively) in six patients with SGS who had not been on hormonal substitution. These findings are consistent with those obtained in postmenopausal women suffering from “high remodelling osteoporosis” and suggest that bone turnover in osteoporotic patients with SGS is increased and the skeletal loss is a consequence of accelerated bone loss rather than decreased bone formation.

Impaired Calcitonin Response to Intravenous Calcium Load in Primary Biliary Cirrhosis

The pathomechanism of the process leading to osteopenia in primary biliary cirrhosis (PBC) seems to be complex. Osteomalacia heals completely in response to adequate vitamin D therapy, while osteoporotic bone disease continues despite such treatment [1]. Both the pathomechanism and the treatment of osteoporosis in PBC are controversial. Calcitonin (CT) inhibits osteoclastic activity and has been considered to have a bone protective effect [2]. This is the first report on altered CT secretion in PBC.

Effet prophylactique bénéfique de l’injection de calcitonine sur les altérations pancréatiques consécutives à la cholangiowirsungographie rétrograde

RésuméL’étude concerne l’évaluation d’un effet de la calcitonine sur les altérations biochimiques induites par la cholangiowirsungographie rétrograde endoscopique. Préalablement à l’opacification canalaire, 20 patients ont reçu 100 U.I de calcitonine synthétique de saumon et ont été comparés à 20 sujets témoins soumis à une pancréatographie classique. Les élévations des taux sériques de lipase et d’insuline furent significativement moindres chez les patients soumis à la calcitonine que chez les sujets du groupe témoin. L’analyse des accroissements supérieurs des niveaux plasmatiques d’alpha amylase et de glucagon dans le groupe traité révèle que le nombre de patients témoignant de valeurs pathologiques après pancréatographie est, significativement inférieur à celui observé dans le groupe témoin. Les valeurs de la calcémie et les taux de cortisol plasmatique ne sont pas significativement différents dans les deux groupes. Les résultats de l’étude indiquent qu’une prémédication par la calcitonine peut être utile en améliorant les paramètres biologiques habituellement altérés après pancréatographie endoscopique.SummaryThe effet of calcitonin was studied on the biochemical alterations following endoscopic retrograde pancreatography. Prior to ductography, 20 patients were given 100 IU of synthetic salmon calcitonin, and the results were compared to data obtained in 20 control patients who had been subjected to pancreatogrphy as usual. The increase in serum lipase and insulin levels was significantly less in the patients receiving calcitonin compared to the controls. When analysing maximum increments in serum alpha amylase and glucagon levels it could be established that, in the treated group the number of patients exhibiting pathological values following pancreatography was significantly less than in the controls. Changes in calcium and cortisol levels were not significantly different in the two groups. The observed results indicate that calcitonin pretreatment might be helpful in ameliorating the laboratory changes following endoscopic pancreatography.