calcitonin and Multiple-Myeloma

Serum bone Gla protein (BGP) and alkaline phosphatase (AP) activity were compared for the assessment of skeletal status in 11 normal pregnant women, 12 normal women on days 3 and 13 of the menstrual cycle, five postmenopausal women before and after 1 month of treatment with ethinyl estradiol (20 micrograms/day), five patients with cancer and hypercalcemia during treatment with calcitonin, and one patient with Paget disease during treatment with Plicamycin. BGP and AP correlated with each other only in the pregnant women. In all other circumstances, there was no correlation between these two serum osteoblast products. Furthermore, there were conditions in which the two measurements became discordant. These studies demonstrate that BGP and AP commonly are dissociated when used as measurements of skeletal status. Although both are osteoblast products, BGP and AP probably reflect different aspects of osteoblast differentiation and function.

Topics: Adult; Alkaline Phosphatase; Calcitonin; Carcinoma, Squamous Cell; Ethinyl Estradiol; Female; Humans; Hypercalcemia; Lung Neoplasms; Middle Aged; Multiple Myeloma; Osteocalcin; Postmenopause; Pregnancy

Hypocalcemia induced by salmon calcitonin (SCT) was evaluated in 125 patients with multiple myeloma (MM) and compared with 20 normal individuals (NCs) and 20 individuals with monoclonal gammopathy of undetermined significance (MGUS). It is now well documented that the maximum hypocalcemia (M delta CA) induced in man by SCT is related to the prevailing rate of osteoclastic resorption. In patients with MGUS, the level of M delta CA was normal. Conversely, the M delta CA was significantly abnormal in patients with MM (P less than .0001 for differences between NC/MGUS patients) and was correlated with (1) initial calcium levels (P less than .001), (2) the extent of lytic bone lesions (LBLs) (P less than .01), and (3) the myeloma cell mass (P less than .001) plus disease activity. The M delta CA was found to be of predictive value for new LBLs with or without hypercalcemia and to have dramatic influence on the survival of patients with MM. We conclude that the SCT-induced hypocalcemia test is of significant importance in the evaluation of the instantaneous rate of bone resorption and in the prognosis of patients with MM.

Topics: Adult; Aged; Bone Diseases; Calcitonin; Calcium; Female; Humans; Hypercalcemia; Hypocalcemia; Male; Middle Aged; Multiple Myeloma; Neoplasm Staging; Osteoclasts; Prognosis; Radiography; Radionuclide Imaging

Clinical details are given of 8 patients who complained of severe pain from metastatic bone disease or from multiple myeloma. Four of the patients were included in a double-blind pilot trial designed to compare the effectiveness of salmon calcitonin (200 i.u. intramuscularly) and placebo given twice daily for 4 days. Two of these patients experienced pain relief and were found to have been given salmon calcitonin; the other 2 had no pain relief and had been given placebo. The other 4 of the 8 patients were treated with salmon calcitonin and also had relief of their pain. It would appear, therefore, that salmon calcitonin may be dramatically effective in the treatment of intractable pain from advanced malignancy and its use warrants further study.

Topics: Bone Neoplasms; Calcitonin; Double-Blind Method; Female; Humans; Male; Multiple Myeloma; Pain, Intractable; Pilot Projects