cholecalciferol and Osteolysis

A 93 year-old woman with Paget's disease of bone had been treated with etidronate without interruption during 20 years. The daily dose was usual (5mg/kg/day) but this prescription had never been stopped by her physicians. Two fractures had already occurred in pagetic (right tibia) and non pagetic bones (right fibula) within the last 2 years, and she presented rib fractures, another right tibia fracture and right femur fracture during hospitalization time. X-rays films showed major osteolysis of left ulna and right tibia. Blood samples and technetium bone scan brought no evidence for sarcoma or lytic evolution of the disease. A transiliac bone biopsy on non pagetic bone site confirmed the diagnosis of osteomalacia (increased osteoid parameters), with secondary hyperparathyroidism (hook resorption). In Paget's disease of bone, continuous treatment by etidronate may induce generalized osteomalacia, and increase the risk of fracture in both pagetic and non-pagetic bones. Whereas physicians and pharmaceutical industry try to improve the observance of those drugs, this striking observation also points out that a prescription always needs to be updated.

Topics: Aged, 80 and over; Alkaline Phosphatase; Biopsy; Bone Density Conservation Agents; Calcification, Physiologic; Calcium Carbonate; Cholecalciferol; Etidronic Acid; Female; Femoral Fractures; Fibula; Fractures, Spontaneous; Humans; Hyperparathyroidism, Secondary; Iatrogenic Disease; Osteitis Deformans; Osteolysis; Osteomalacia; Parathyroid Hormone; Radionuclide Imaging; Rib Fractures; Tibial Fractures; Ulna; Vitamin D

In 70 patients with stage III multiple myeloma (MM) the authors studied spontaneous and lipopolysaccharide-induced production of interleukin-1 (IL-1) and interleukin-6 (IL-6) by blood and bone marrow mononuclear cells, concentration of parathyroid hormone and vitamin D3 in the serum. Bone marrow density was measured at photon absorption (Gambro), in patients treated with osteoprotectors bonefos and oxidevit before and after therapy (3.5-6 month course). It is shown that in MM there is a pathogenetic association between production of osteotropic IL-1, IL-6 and bone demineralization. The cases with reduced concentration of Ca and P ions in the serum (4 and 5.7% of patients, respectively) and increased PTH concentration (7%) suggest the existence of new, extratumor mechanisms of osteolysis. It is found that biphosphonates are optimal osteoprotectors. Bonefos (chlodronat, Lieras, Finland) arrests osteolysis proved by a significant increase of bone marrow density and clinical effect.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bone Density; Bone Marrow; Cholecalciferol; Female; Humans; Hydroxyproline; Interleukin-1; Interleukin-6; Male; Middle Aged; Multiple Myeloma; Osteolysis; Parathyroid Hormone

Chicks fed a rachitogenic diet for five weeks after hatching were then treated with a daily oral dose of 1,000 I.U. Vitamin D3 or a 1% addition to the feed of powdered leaves of Cestrum diurnum for periods of 1, 2, 4, 8, 16 and 30 days. Comparative studies were made on stained sections, microradiographs of undermineralized sections and alpharadiographs of demineralized sections. The present dose of Cestrum diurnum caused at first, a rapid maturation and mineralization of the epiphyseal cartilage and an intense growth and osteocytic osteolysis in the diaphysis of the tibia and femur. After 8 days however, growth decreased and the diaphysis gradually became petrotic. Under these conditions, the osteocytes degenerated and died. The areas of polysaccharide-rich, low density matrix which surrounded them, decreased gradually to become cementing lines, persistent after 30 days.

Topics: Animal Feed; Animals; Bone Development; Cartilage; Chickens; Cholecalciferol; Epiphyses; Osteoclasts; Osteocytes; Osteolysis; Plants; Rickets; Tibia