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`
`.Ju5 /BJ
`
`1988
`
`,--------s~o= suoos5B51
`JOURNAL u~ tONE_AND
`!1lNERAL hl::SBARCH
`
`. - .~ · ... · ..... ·.··.··. · .... ···· .. ·.· ... ·.·o:
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`00001
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`00001
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`

`

`1988
`Program & Abstracts
`Tenth Annual Scientific Meeting
`American Society for Bone and Mineral Research
`June 4-7, 1988
`
`New Orleans Marriott Hotel
`New Orleans, Louisiana
`
`Tri::: :-nar·_:cri31 \\i:~ ;:~.Jiie::l
`at the i~L\i! 31'1j r·1:r11 b,te
`~ttj"=·::.· :_1.:: CD-p\Ti:;:h:.· L3·,s-::
`
`00002
`
`00002
`
`

`

`JOURNAL OF
`BONE AND MINERAL RESEARCH
`The Official Journal of the American Society for Bone and Mineral Research
`
`Editor
`
`Lawrence G. Raisz
`Division of Endocrinology and Metabolism
`University of Connecticut Health Center
`Farmington, CT 06032-9984
`(203) 679-2129
`
`Associate Editors
`
`Murray J. Favus
`University qf Chicago
`5841 S. Mmyland
`P.O. Box 28
`Chicago, IL 60637
`
`Barbara E. Kream
`Division of Endocrinology and Metabolism
`University of Connecticut
`Health Center
`Farmington, CT 06032
`
`Etsuro Ogata
`University qf Tokyo
`School of 1v!edicine
`3-28-6 1v!ejirodai, Bunkyo
`Tokyo, Japan 112
`
`Herbert f'lcisch
`University of Bern
`Murtens/rasse 35
`CH-3010 Bern, Sll'ilzerland
`
`Henry M. Kronenberg
`Endocrine Unit
`Massachusells General Hospital
`Boston, MA 02114
`
`Gideon A. Rodan
`Department ql Bone Biology and Osteoporosis
`Merck, Sharp, and Doh111e
`Research Laboratories
`West Point, PA 19486
`
`John G. Haddad, Jr.
`University of Penmylvania
`531 Johnson Pavilion/G2
`36th and Hamilton Walk
`Philadelphia, PA 19104
`
`Frederick R. Singer
`USC School of Medicine
`2025 Zonal A venue
`Los Angeles, CA 90033
`
`Editorial Secretary: Linda 13. Graver
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`Constantine Anast
`Boston, MA
`Claude D. Arnaud
`San fi·ancisco, CA
`Gerald D. Aurbach
`Bethesda, MD
`Louis V. Avioli
`St, Louis, MO
`Sonia Balsan
`Paris, h·ance
`Roland Baron
`New Haven, CT
`Adele L. lloskey
`Nell' York, NY
`William T. Butler
`Birmingham, AL
`Sylvia Christakos
`Nell'ark, NJ
`Leonard J. Deftos
`San Diego, CA
`Hector F. Deluca
`1'vfadison, WI
`Marc K. Drewer
`Durham, NC
`
`T. John Martin
`Victoria, 11 ustralia
`Stephen J. Marx
`Bethesda, MD
`Pierre J. Meunier
`Lyon, fiw1ce
`Anthony W. Norman
`Riversid!!, CA
`Maureen E. Owen
`0.\/ord, 1-;ngland
`William A. Peck
`St. J,ouis, 1'v!O
`John T. Potts
`Boston, 1vl1l
`Howard Rasmussen
`New Haven, CT
`R.G.C,. Russell
`She.Ifie/cl, England
`Eduardo Slatopolsky
`St. Lo11i1·, MO
`Tatsuo Suda
`Shi11agall'a, Tokyo, Japan
`Glenda Wong,
`Colorado Springs, CO
`
`Editorial Board
`
`Takuo Fujita
`Kobe, Japan
`Julie Glowacki
`Boston, MA
`David Goltzman
`Mon/real, Quebec, Canada
`Hunter Heath Ill
`Rochester, MN
`Johan N.M. Heersche
`Toronto, Ontario, Canada
`C. Conrad Johnston, Jr.
`Indianapolis, IN
`Stephen M. Krane
`Boston, MA
`Joseph M. Lane
`New York, NY
`Jacob Lemann, Jr.
`Milll'aukee, WI
`Uri /\. Liberman
`Pelah-Tiqva, Israel
`Robert Lindsay
`West Haverstraw, NY
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`SUNDAY, JUNE 5, 1988
`
`213
`INTRACTABLE REFLEX SYMPATHETIC
`IMPROVEMENT OF
`DRAMATIC
`INTRAVENOUS
`INFUSIONS OF THE
`SYNDROME
`BY
`DYSTROPHY
`SECOND GENERATION BISPHOSPHONATE APD.
`J • P • Devogelaer'
`S. Dall'Armellina*,
`J.P. Huaux*,
`C.
`Nagant
`de
`Deuxchaisnes,
`St-Luc University Hospital, Louvain
`University in Brussels, Brussels, Belgium.
`)
`.
`15
`(RSDS
`Reflex sympathetic dystrophy
`syndrome
`a common condition, which at
`times can be ~everely
`disabling. Radiologically,
`is characterized by
`it
`areas of patchy bone atrophy which
`correspo~<l
`to
`.
`.
`Th'
`is the rationale
`19
`prom1.ntnt osteoclast activity.
`(J-
`t
`•
`for using
`second generation b1.sphosphona e
`the
`amino-l-hydroxypropylidene)-1, 1-diphosphonate
`.
`(APD~;
`We have
`treated 22 patients
`(16 F, 6 M) with RS
`resistant
`to all
`therapies.
`Average duration was
`5.7 months (range , 2.5-12.0). RSDS cases were related
`to various conditions : post-traumatic 18; neurological
`3; phenobarbital 1. The
`involved sites wen:. the foot
`(n=ll),
`the shoulder (n=6),
`the hand (n=S),
`t_he kne~
`(n=4),
`some patients having more
`than_ ~ne 1.~volv~f
`site.
`Treatment consisted of
`IV adrn1.n1.strat1.on
`15 mg APD
`in 500 ml saline over 4 h daily for 10
`consecutive days.
`17 / 18 with past-traumatic RSDS
`improved dramatically within 3-10 days after
`the
`first infusion, with complete relief of pain. Recovery
`of full motion occurred within 10 d.
`to 2 mo.
`The
`4 cases with RSDS not related to trauma also recovered,
`but with some delay
`Treatment was well tolerated,
`except
`for
`the cla;sical
`transient
`fever
`()37 · 2°C)
`in 7 /22 patients, lasting for an average 2.4 d. During
`therapy,
`a
`transient significant decrease of
`serum
`calcium and phosphorus was observed, while
`iPTH and
`levels
`increased.
`In
`conclusion, APD
`l,2S(OH)zD
`induced
`a
`dramatic
`improvement
`of
`symptoms
`in
`intractable RSDS,
`allowing
`incapacitated patients
`to resume their professional activities.
`
`215
`RADIUS DISTAL AND MIDDLE BONE DEN~ITY kATIU
`AS AN
`INDICATOR OF SPINAL OSTEOPOHOSIS.
`M. Singh, C. Lin and I(. L~ Michael Reese
`Hospital and Medical Center, Chicago, IL.
`Using single photon absorptiometry, dis(cid:173)
`tal bone density (DBD) was measured at
`the
`5 mm
`site and middle bone density (MBD)
`in
`the shaft of the radius, in 50 white females
`with osteoporosis. The results were expres(cid:173)
`sed as % of adult mean values reported by
`Awbrey et al (J Orthop Res 2:314,
`1984).
`The patients also had:
`(a) X-rays of spine,
`pelvis and hands;
`ib) 24-Hour urine studies
`for creat, Ca, Na, Mg,
`P0 4 and hydroxy(cid:173)
`proline; (c) Fasting serum values for creat,
`Ca, Na, Mg, PO', alk phos; BGP, PTH and vit(cid:173)
`D metabolites;
`and (d) Oral calcium absorp(cid:173)
`tion test using 1000 mg elemental calcium.
`Patients were divided into
`two groups
`using
`the
`relation between MDD
`and DBD.
`Group l
`(n=25) had accelerated= Tvpe A loss
`of
`trabecular
`bone
`so
`that
`MBD
`was
`greater than DBD by 10% or more. Group G
`ln=25) had balanced= Tvpe H
`loss of both
`trabecular and cortical bone so that MBD was
`DBD
`to within ±9%.
`Comparing
`the
`two
`groups:
`Ii) Total vertebral fractures were
`40
`in type A and 6 in type B
`loss, p<.01;
`(ii) Average Singh index value was 4.6
`in
`type A and 5.3 in type B bone
`loss, p<.05;
`(iii) Serum l,25(01l)zD levels were 22.7±2.2
`pg/ml in type A and 16.8±1.5 pg/ml in type B
`loss, p<.05; and (iv) Fasting urine Ca/Creat
`ratio was .174±.05 in type A and .146±.03 in
`type Bloss, p<.10.
`It is concluded
`that
`type A bone loss identifies patients at risk
`for spinal fractures while type B bone loss
`shows generalized osteoporosis.
`
`214
`INCREASED INTERLEUKIN-1 ACTIVITY AND DECREASED BONE
`DENSITY IN PATIENTS WITH "RESORPTIVE" IDIOPATHIC
`HYPERCALCIURIA. R. Paciflci, M. Rothstein,* L. Rifas,
`R. McCracken,* G. Wilkerson,* S. Luekin,* W. Lau,
`D.J. Baylink, L.V. Avloll W.A. Peck and K. Hruska.
`Division of Metabolism and Nephrology and Department of
`Medicine, The Jewish Hospital of St. Louis, St. Louis,
`MO and Department of Medicine, Loma Linda Univ. and
`Pettis VA Hospital, Loma Linda, CA
`Since increased bone resorption and fasting
`hypercalciuria ( FH) underlie some forms of idiopathic
`hypercalcuria (Ill), we have measured lnterleukin-1
`activity (IL-1) in the culture media of peripheral
`blood monocytes (PBM), blood BGP, urinary
`hydroxyprollne (OHP) and vertebral bone density by QCT
`in 8 Fil subjects and in 13 control, non-hypercalciuric
`stone formers.
`IL-1 was measured with the D 10 G.4.1 T
`cell system and results expressed in units. QCT was
`expressed as z-score relative to the predicted value
`for age and sex. Blood PT!! and l,25(01!)2D3 were
`also measured and found to be within normal limits in
`all subjects and similar in the two groups.
`BGP
`IL-1
`QCT
`Ol!P
`="""'--:-;--:-,-'(7uc,n.::i'a't7s .,.) ;,-;c;--'(";Z"'s'ac;i,o-=r""e.:..) .,..,,---'(;-';m;!:g",/-=2,;4.:.:h.;,.) _,( ng /ml)
`FH Patients 45.7+15.9 -l.35+0.15
`65.1+8.0 11:0+D
`Controls
`6.0+2.l
`-0.37+0.29
`37.3+6.l 6.l+0.8
`P<O-:-OOl
`P<0.001
`P<0.05
`P<0.07
`
`Conclusion: l) these preliminary data indicate that a
`disturbance in the bone remodeling process which
`involves locally elaborated factors rather than a PTH
`or l,25(0H)2D3 dependent mechanism, may account for
`the pathogenesis of "resporptl ve"" IH and suggest that a
`clinically significant bone loss may complicate this
`condition; 2) Although our data do not reveal the role
`of IL-1 in bone remodeling, they indicate that IL-1 ls
`elevated not only in idiopathic osteoporosis, but also
`in other states of increased bone resorption.
`
`216
`PROBLEMS IN GENERATING UNBIASED REFERENCE
`NORMAL VALUES OF LUMBAR SPINE AND FEMORAL
`NECK BONE DENSITIES. Michael Anbar State
`Univ. of New York at Buffalo, Buffalo, NY.
`Bone mineral densities (DMD) of the lumbar
`spine (LS) and the femoral neck (FN), usually
`measured by ~u~l photon absorptiometry (DPA),
`are used clinically to predict symptomatic
`osteoporosis by comparing BMD of patients to
`reference "normal" BMD values
`(RNBD). It is
`also assumed that LS BMD
`is a
`reliable
`predictor of FN BMD and vice versa. RNBD are
`usually obtained from a racially matched
`group of subjects of the same sex and used
`after normalizing for age, height and weight.
`The quality of RNBD depends on the definition
`of "normals". Clearly, any subpopulation with
`some common attribute whose average BMD
`differs
`from
`that of
`the rest of
`the
`population must be excluded. We
`identified
`several such subpopulations,
`some of which
`have not been reported. These include women
`w~th a history of traumatic fractures of any
`kind (LS), of hysterectomy without bilateral
`oophorectomy
`(LS & FN), and of cancer (LS),
`and FN of those who show abnormal features on
`their LS DPA scans. These subpopulations show
`distinctive behavior, such as response to
`treatment with estrogen or supplemental
`c~lcium, or to bilateral oophorectomy, or
`different LS/FN relationships. Including of
`subjects of such subpopulations among the
`"normals" biases RNBD, whereas using RNBD to
`evaluate members of such subpopulations might
`result in erroneous risk assessment. Also,
`physical activity, which we
`found
`to
`gradually affect DMD in normal women, must be
`considered
`in generating RNBD
`and
`in
`evaluating individual patients.
`
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