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Involutional Osteopenia: Current Concepts

1976; American College of Physicians; Volume: 85; Issue: 6 Linguagem: Inglês

10.7326/0003-4819-85-6-789

1539-3704

D. L. Thomson,

Bone fractures and treatments

Clinical Review1 December 1976Involutional Osteopenia: Current ConceptsDAVID L. THOMSON, M.D., BOY FRAME, M.D., F.A.C.P.DAVID L. THOMSON, M.D.Search for more papers by this author, BOY FRAME, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-85-6-789 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptInvolutional osteopenia is the most common metabolic bone disorder affecting the elderly population. Improved diagnostic techniques now allow for earlier detection of a decrease in bone mass than is possible with routine skeletal roentgenograms. Methods developed for quantitating bone remodeling have given new insight to the mechanisms involved in age-related skeletal loss. Theories of pathogenesis include [1] inadequate skeletal acquisition during youth, [2] dietary deficiencies of calcium and vitamin D, [3] hormonal imbalance, and [4] local factors influencing skeletal remodeling, particularly at the endosteal envelope. Numerous agents affecting bone remodeling have been used to treat involutional osteopenia, but none has been proved to restore bone mass. New programs involving combinations of agents give promise for increasing bone mineral content and, it is hoped, reducing fracture rate....References1. FROST H: Bone Remodeling Dynamics. Springfield, Charles C Thomas, 1963 Google Scholar2. ISKRANT A and SMITH R: Osteoporosis in women 45 years and over related to subsequent fractures. Public Health Rep 84:33-38, 1969 CrossrefMedlineGoogle Scholar3. ALFFRAM P: An epidemiologic study of cervical and trochanteric fractures of the femur in an urban population. Acta Orthop Scand [Suppl] 65:1-109, 1964 CrossrefGoogle Scholar4. SAVILLE P: Osteoporosis: an overview, in Clinical Aspects of Metabolic Bone Disease, edited by FRAME B, PARFITT AM, DUNCAN H. Amsterdam, Excerpta Medica, 1973, pp. 293-302 Google Scholar5. RASMUSSEN H and BORDIER P: The cellular basis of metabolic bone disease. N Engl J Med 289:25-32, 1973 CrossrefMedlineGoogle Scholar6. FROST H: Bone Dynamics in Osteoporosis and Osteomalacia. Springfield, Charles C Thomas, 1966 Google Scholar7. URIST M, GURVEY M, and FAREED D: Long-term observations on aged women with pathologic osteoporosis, in Osteoporosis, edited by BARZEL US. New York, Grune & Stratton, 1970, pp. 3-37 Google Scholar8. MCCONKEY B, FRASER G, and BLIGH A: Transparent skin and osteoporosis. Lancet 1:693-695, 1963 CrossrefGoogle Scholar9. MEEMA H and REID D: The relationship between skin and cortical bone thickness in old age with special reference to osteoporosis and diabetes mellitus: a roentgenographic study. J Gerontol 24:28-32, 1969 CrossrefMedlineGoogle Scholar10. DOYLE F, GUTTERIDGE D, and JOPLIN G: An assessment of radiological criteria used in the study of spinal osteoporosis. Br J Radiol 40:241-250, 1967 CrossrefMedlineGoogle Scholar11. BLAND J, SOULE A, and VANBUSKIRK F: A study of inter- and intra-observer error in reading plain roentgenograms of the hands. Am J Roentgenol Radium Ther Nucl Med 105:853-859, 1969 CrossrefGoogle Scholar12. LACHMAN E: Osteoporosis: the potentialities and limitations of its roentgenologic diagnosis (editorial). Am J Roentgenol Radium Ther Nucl Med 74:712-715, 1955 Google Scholar13. SINGH M, NAGRATH A, and MAINI P: Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg [Am] 52A:457-467, 1970 CrossrefGoogle Scholar14. SINGH M, RIGGS B, and BEABOUT J: Femoral trabecular-pattern index for evaluation of spinal osteoporosis. Ann Intern Med 77:63-67, 1972 LinkGoogle Scholar15. SINGH M, RIGGS B, and BEABOUT J: Femoral trabecular index for evaluation of spinal osteoporosis. A detailed methodologic description. Mayo Clin Proc 48:184-189, 1973 MedlineGoogle Scholar16. WAHNER H, RIGGS B, and BEAUBOUT J: Photon absorption method and Singh index in detection of osteoporosis—a comparative study, in International Conference on Bone Mineral Measurement. United States Department of Health, Education and Welfare, (DHEW Publication no. 75-683), 1973, pp. 225-227 Google Scholar17. KHAIRI M, CRONIN J, and ROBB J: Femoral trabecular-pattern index and bone mineral content measurement by photon absorption in senile osteoporosis. J Bone Joint Surg [Am] 58A: 221-226, 1976 CrossrefGoogle Scholar18. MEEMA H and MEEMA S: Microradioscopic bone structure of the hand in thyrotoxicosis, renal osteodystrophy and acromegaly, in Clinical Aspects of Metabolic Bone Disease, edited by FRAME B, PARFITT AM, DUNCAN H. Amsterdam, Excerpta Medica, 1973, pp. 10-19 Google Scholar19. GARN S, POZNANSKI A, and NAGY J: Bone measurement in differential diagnosis of osteopenia and osteoporosis. Radiology 100:509-518, 1971 CrossrefMedlineGoogle Scholar20. MEEMA H and MEEMA S: Cortical bone mineral density versus cortical thickness in diagnosis of osteoporosis: a roentgenologic-densitometric study. J Am Geriatr Soc 17:120-141, 1969 CrossrefMedlineGoogle Scholar21. MACK P, BROWN W, and TRAPP H: The quantitative evaluation of bone density. Am J Roentgenol Radium Ther Nucl Med 61:808-825, 1949 Google Scholar22. NORDIN B, BARNETT E, and MACGREGOR J: Lumbar spine densitometry. Br Med J 1:1793-1796, 1962 CrossrefMedlineGoogle Scholar23. GRIFFITH E, STONEBRIDGE J, and LEHMANN J: Current methods of in-vivo measurement of osteoporosis. Am J Phys Med 52: 75-91, 1973 MedlineGoogle Scholar24. CAMERON J and SORENSON J: Measurement of bone mineral in-vivo: an improved method. Science 142:230-232, 1963 CrossrefMedlineGoogle Scholar25. JOHNSTON C, SMITH D, and NANCE W: Evaluation of radial bone mass by the photon absorption technique, in Clinical Aspects of Metabolic Bone Disease, edited by FRAME B, PARFITT AM, DUNCAN H. Amsterdam Excerpta Medica, 1973, pp. 28-36 Google Scholar26. MAZESS R, JUDY P, and WILSON C: Progress in clinical use of photon absorptiometry, in Clinical Aspects of Metabolic Bone Disease, edited by FRAME B, PARFITT AM, DUNCAN H. Amsterdam, Excerpta Medica, 1973, p. 37-43 Google Scholar27. DALEN N: Bone mineral assays—choice of measuring sites in International Conference on Bone Mineral Measurement. United States Department of Health, Education and Welfare, (DHEW Publication no. 75-683), 1973, pp. 60-65 Google Scholar28. SHAPIRO J, MOORE W, and JORGENSEN H: Osteoporosis. Evaluation of diagnosis and therapy. Arch Intern Med 135: 563-567, 1975 CrossrefMedlineGoogle Scholar29. Management of osteoporosis (editorial). Br Med J 4:307-308, 1975 CrossrefMedlineGoogle Scholar30. MAZESS R: Estimation of bone and skeletal weight by direct photon absorptiometry. Invest Radiol 6:52-60, 1971 CrossrefMedlineGoogle Scholar31. MANZKE E, CHESTNUT C, and WERGEDAL J: Relationship between local and total bone mass in osteoporosis. Metabolism 24:605-615, 1975 CrossrefMedlineGoogle Scholar32. SMITH D, NORTON J, and KHAIRI R: The measurement of rates of mineral loss with ageing. J Lab Clin Med 87:882-892, 1976 MedlineGoogle Scholar33. GARNETT E: An absolute measurement of in-vivo bone density, in Clinical Aspects of Metabolic Bone Disease, edited by FRAME B, PARFITT AM, DUNCAN H. Amsterdam, Excerpta Medica, 1973, pp. 44-47 Google Scholar34. COHN S, ELLIS K, and WALLACH S: In-vivo neutron activation analysis. Am J Med 57:683-686, 1974 CrossrefMedlineGoogle Scholar35. CHESTNUT C, NELP W, and DENNEY J: Measurement of total body calcium (bone mass) by neutron activation analysis: applicability to bone-wasting disease, in Clinical Aspects of Metabolic Bone Disease, edited by FRAME B, PARFITT AM, DUNCAN H. Amsterdam, Excerpta Medica, 1973, pp. 50-54 Google Scholar36. FROST H: Tetracycline-based histological analysis of bone remodeling. Calcif Tissue Res 3:211-237, 1969 CrossrefMedlineGoogle Scholar37. WU K and FROST H: Bone formation in osteoporosis. Arch Pathol 88:508-510, 1969 MedlineGoogle Scholar38. JOWSEY J, KELLY P, and RIGGS B: Quantitative microradiographic studies of normal and osteoporotic bone. J Bone Joint Surg [Am] 47A:785-806, 1965 CrossrefGoogle Scholar39. JOWSEY J: Quantitative microradiography (editorial). Am J Med 40:485-491, 1966 CrossrefGoogle Scholar40. JOWSEY J: Microradiography. A morphologic approach to quantitating bone turnover, in Clinical Aspects of Metabolic Bone Disease, edited by FRAME B, PARFITT AM, DUNCAN H. Amsterdam, Excerpta Medica, 1973, pp. 114-123 Google Scholar41. RASMUSSEN H and BORDIER P: The Physiological and Cellular Basis of Metabolic Bone Disease. Baltimore, Williams and Wilkins Co., 1974, pp. 66-67, 280-281 Google Scholar42. HARRIS W and HEANEY R: Skeletal renewal and metabolic bone disease. N Engl J Med 280:193-202, 253-259, 303-311, 1969 CrossrefMedlineGoogle Scholar43. LENTNER C, LAUFFENBURGER T, and GUNCAGA J: The metabolic balance technique: a critical reappraisal. Metabolism 24:461-471, 1975 CrossrefMedlineGoogle Scholar44. ROSE G: A critique of modern methods of diagnosis and treatment of osteoporosis. Clin Orthop 55:17-41, 1967 MedlineGoogle Scholar45. ARNAUD C: Parathyroid hormone: coming of age in clinical medicine. Am J Med 55:577-581, 1973 CrossrefMedlineGoogle Scholar46. COPP D, CAMERON E, and CHENEY B: Evidence for calcitonin—a new hormone from the parathyroid that lowers blood calcium. Endocrinology 70:638-649, 1962 CrossrefMedlineGoogle Scholar47. SILVA O, SNIDER R, and BECKER K: Radioimmunoassay of calcitonin in human plasma. Clin Chem 20:337-339, 1974 CrossrefMedlineGoogle Scholar48. DEFTOS L, ROOS B, and BRONZERT D: Immunochemical heterogeneity of calcitonin in plasma. J Clin Endocrinol Metab 40:409-412, 1975 CrossrefMedlineGoogle Scholar49. SIZEMORE G and HEATH H: Immunochemical heterogeneity of calcitonin in plasma of patients with medullary thyroid carcinoma. J Clin Invest 55:1111-1118, 1975 CrossrefMedlineGoogle Scholar50. HENNESSY J, WELLS S, and ONTJES D: A comparison of pentagastrin injection and calcium infusion as provocative agents for the detection of medullary carcinoma of the thyroid. J Clin Endocrinol Metab 39:487-495, 1974 CrossrefMedlineGoogle Scholar51. SCHNEIDER A and SHERWOOD L: Calcium homeostasis and the pathogenesis and management of hypercalcemic disorders. Metabolism 23:975-1007, 1974 CrossrefMedlineGoogle Scholar52. QUEENER S and BELL N: Calcitonin: a general survey. Metabolism 24:555-567, 1975 CrossrefMedlineGoogle Scholar53. OMDAHL J and DELUCA H: Regulation of vitamin D metabolism and function. Physiol Rev 53:327-372, 1973 CrossrefMedlineGoogle Scholar54. DELUCA H: Vitamin D: the vitamin and the hormone. Fed Proc 33:2211-2219, 1974 MedlineGoogle Scholar55. DELUCA H: Recent advances in our understanding of the vitamin D endocrine system. J Lab Clin Med 87:7-26, 1976 MedlineGoogle Scholar56. HADDAD J and CHYU K: Competitive protein-binding radioassay for 25-hydroxycholecalciferol. J Clin Endocrinol Metab 33: 992-995, 1971 CrossrefMedlineGoogle Scholar57. BRUMBAUGH P, HAUSSLER D, and BRESSLER R: Radio-receptor assay for 1α, 25-dihydroxyvitamin D3. Science 183: 1089-1091, 1974 CrossrefMedlineGoogle Scholar58. POMMER G: Untersuchungen Uber Osteomalacie Rachitis und. Leipzig, F.C.W. Vogel, 1885 Google Scholar59. PERZIGIAN A: The antiquity of age-associated bone demineralization in man. J Am Geriatr Soc 21:100-105, 1973 CrossrefMedlineGoogle Scholar60. ALBRIGHT F, BLOOMBERG E, and SMITH P: Post-menopausal osteoporosis. Trans Assoc Am Physicians 55:298-305, 1940 Google Scholar61. ALBRIGHT F, SMITH P, and RICHARDSON A: Postmenopausal osteoporosis. JAMA 116:2465-2474, 1941 CrossrefGoogle Scholar62. MEEMA H and MEEMA S: Involutional (physiologic) bone loss in women and the possibility of preventing structural failure. J Am Geriatr Soc 22:443-452, 1974 CrossrefMedlineGoogle Scholar63. SMITH R and RIZEK J: Epidemiologic studies of osteoporosis in women of Puerto Rico and southwestern Michigan with special reference to age, race, national origin and to other related or associated findings. Clin Orthop 45:31-48, 1966 CrossrefMedlineGoogle Scholar64. SMITH R, EYLER W, and MELLINGER R: On the incidence of senile osteoporosis. Ann Intern Med 52:773-781, 1960 LinkGoogle Scholar65. NORDIN B, MACGREGOR J, and SMITH D: The incidence of osteoporosis in normal women: its relation to age and the menopause. Q J Med 35:25-38, 1966 MedlineGoogle Scholar66. NEWTON-JOHN H and MORGAN D: Osteoporosis: disease or senescence? Lancet 1:232-233, 1968 CrossrefGoogle Scholar67. NEWTON-JOHN H and MORGAN D: The loss of bone with age, osteoporosis, and fractures. Clin Orthop 71:229-252, 1970 CrossrefMedlineGoogle Scholar68. MORGAN D: Osteomalacia, Renal Osteodystrophy, and Osteoporosis. Springfield, Charles C Thomas, 1973, pp. 248-257 Google Scholar69. SMITH D, KHAIRI M, and JOHNSTON C: The loss of bone mineral with ageing and its relationship to risk of fracture. J Clin Invest 56:311-318, 1975 CrossrefMedlineGoogle Scholar70. DOYLE F: Involutional osteoporosis. Clin Endocrinol Metabol 2:187-201, 1973 MedlineGoogle Scholar71. ADAMS P, DAVIES G, and SWEETNAM P: Osteoporosis and the effects of ageing on bone mass in elderly men and women. Q J Med 39:601-615, 1970 MedlineGoogle Scholar72. MORGAN B: Ageing ond osteoporosis, in particular spinal osteoporosis. Clin Endocrinol Metabol 2:187-201, 1973 CrossrefMedlineGoogle Scholar73. GARN S, ROHMANN C, and WAGNER B: Bone loss as a general phenomenon in man. Fed Proc 26:1729-1736, 1967 MedlineGoogle Scholar74. SMITH D, KHAIRI M, and JOHNSTON C: The rate of bone mineral loss with ageing (abstract). Clin Res 23:538A, 1975 Google Scholar75. MEEMA S, BUNKER M, and MEEMA H: Preventive effect of estrogen on postmenopausal bone loss. Arch Intern Med 135:1436-1440, 1975 CrossrefMedlineGoogle Scholar76. GARN S: The Earlier Gain and the Later Loss of Cortical Bone. Springfield, Charles C Thomas, 1970 Google Scholar77. SAVILLE P: The syndrome of spinal osteoporosis. Clin Endocrinol Metabol 2:177-185, 1973 CrossrefMedlineGoogle Scholar78. DOYLE F, BROWN J, and LACHANCE C: Relationship between bone mass and muscle weight. Lancet 1:391-393, 1970 CrossrefMedlineGoogle Scholar79. NORDIN B: The pathogenesis of osteoporosis. Lancet 1:1011-1014, 1961 CrossrefMedlineGoogle Scholar80. BHANDARKAR S and NORDIN B: Effect of low-calcium diet on urinary calcium in osteoporosis. Br Med J 1:145-147, 1962 CrossrefMedlineGoogle Scholar81. NORDIN B: Osteomalacia, osteoporosis and calcium deficiency. Clin Orthop 17:235-257, 1960 Google Scholar82. LUTWAK L, SINGER F, and URIST M: Current concepts of bone metabolism. Ann Intern Med 80:630-644, 1974 LinkGoogle Scholar83. LUTWAK L: Osteoporosis—a mineral deficiency disease? J Am Diet Assoc 44:173-175, 1964 CrossrefMedlineGoogle Scholar84. BASSAN J, FRAME B, and FROST H: Osteoporosis: a review of pathogenesis and treatment. Ann Intern Med 58:539-550, 1960 LinkGoogle Scholar85. RIGGS B, KELLY P, and KINNEY V: Calcium deficiency and osteoporosis. J Bone Joint Surg 49A:915-924, 1967 CrossrefGoogle Scholar86. BULLAMORE J, GALLAGHER J, and WILKINSON R: Effect of age on calcium absorption. Lancet 2:535-537, 1970 CrossrefMedlineGoogle Scholar87. SPENCER H, MENCZEL J, and LEWIN I: Absorption of calcium in osteoporosis. Am J Med 37:223-234, 1964 CrossrefMedlineGoogle Scholar88. Osteoporosis and primary intestinal lactase deficiency. Nutr Rev 25:274-276,1967 CrossrefMedlineGoogle Scholar89. JOWSEY J and RAISZ L: Experimental osteoporosis and parathyroid activity. Endocrinology 82:384-396, 1968 CrossrefMedlineGoogle Scholar90. JOWSEY J and GERSHON-COHEN J: Effect of dietary calcium levels on production and reversal of experimental osteoporosis in cats. Proc Soc Exp Biol Med 116:437-441, 1964 CrossrefMedlineGoogle Scholar91. ALBANESE A, EDELSON A, and LORENZE E: Problems of bone health in elderly. NY State J Med 75:326-336, 1975 MedlineGoogle Scholar92. SMITH R and FRAME B: Concurrent axial and appendicular osteoporosis. N Engl J Med 273:73-78, 1965 CrossrefMedlineGoogle Scholar93. SMITH R: Dietary and hormonal factors in bone loss. Fed Proc 26:1737-1746, 1967 MedlineGoogle Scholar94. CHALMERS J and HO K: Geographical variations in senile osteoporosis. J Bone Joint Surg 52B:667-675, 1970 CrossrefGoogle Scholar95. GARN S: Calcium requirements for bone building and skeletal maintenance (letter). Am J Clin Nutr 23:1149-1150, 1970 CrossrefMedlineGoogle Scholar96. RIGGS B, ARNAUD C, and JOWSEY J: Parathyroid function in primary osteoporosis. J Clin Invest 52:181-184, 1973 CrossrefMedlineGoogle Scholar97. SMITH R, RIZEK J, and FRAME B: Determinants of serum antirachitic activity. Special reference to involutional osteoporosis. Am J Clin Nutr 14:98-108, 1964 CrossrefMedlineGoogle Scholar98. LUND B, SORENSEN O, and CHRISTENSEN A: 25-Hydroxycholecalciferol and fractures of the proximal femur. Lancet 2:300-302, 1975 CrossrefMedlineGoogle Scholar99. FACCINI J, EXTON-SMITH A, and BOYDE A: Disorders of bone and fracture of proximal femur. Lancet 1:1089-1092, 1976 CrossrefMedlineGoogle Scholar100. GALLAGHER J, RIGGS L, and EISMAN J: Impaired intestinal calcium absorption in postmenopausal osteoporosis: possible role of vitamin D metabolites and PTH. Clin Res 24:360A, 1976 Google Scholar101. BERLYNE G, BEN-ARI J, and KUSHELEVSKY A: The aetiology of senile osteoporosis: secondary hyperparathyroidism due to renal failure. Q J Med 44:505-521, 1975 MedlineGoogle Scholar102. LUND B, HJARTH L, and KJAER I: Treatment of osteoporosis of ageing with 1-α hydroxycholecalciferol. Lancet 3:1168-1171, 1975 CrossrefGoogle Scholar103. AARON J, GALLAGHER J, and ANDERSON J: Frequency of osteomalacia and osteoporosis in fractures of the proximal femur. Lancet 1:229-233, 1974 CrossrefMedlineGoogle Scholar104. NORDIN B: Metabolic Bone and Stone Disease. Baltimore, Williams and Wilkens Company, 1973, p. 24 Google Scholar105. GALLAGHER J, AARON J, and HORSMAN A: The crush fracture syndrome in postmenopausal women. Clin Endocrinol Metabol 2:293-315, 1973 CrossrefMedlineGoogle Scholar106. WACHMAN A and BERNSTEIN D: Diet and osteoporosis. Lancet 1:958-959, 1968 CrossrefMedlineGoogle Scholar107. BARZEL U: The role of bone in acid-base metabolism, in Osteoporosis, edited by BARZEL US. New York, Grune and Stratton, 1970, pp. 199-206 Google Scholar108. BARZEL U: Studies in osteoporosis: the long-term effect of oophorectomy and of ammonium chloride ingestion on the bone of mature rats. Endocrinology 96:1304-1306, 1975 CrossrefMedlineGoogle Scholar109. PARFITT A and DUNCAN H: Metabolic bone disease affecting the spine, in The Spine, edited by ROTHMAN RH, SIMEONE FA. Philadelphia, W.B. Saunders Co., 1975. pp. 599-720 Google Scholar110. JOWSEY J, REISS E, and CANTERBURY J: Long-term effects of high phosphate intake on parathyroid hormone levels and bone metabolism. Acta Orthop Scand 45:801-808, 1974 CrossrefMedlineGoogle Scholar111. LICATA A and BARTTER F: Effects of dietary protein on calcium balance in normal volunteers and in patients with osteoporosis, presented at the Fifty-seventh Annual Session, American College of Physicians, 5-8 April 1976, Philadelphia Google Scholar112. RIGGS B, RYAN R, and WAHNER H: Serum concentrations of estrogen, testosterone, and gonadotropins in osteoporotic and nonosteoporotic postmenopausal women. J Clin Endocrinol Metab 36:1097-1099, 1973 CrossrefMedlineGoogle Scholar113. NORDIN B, GALLAGHER J, and AARON J: Postmenopausal osteopenia and osteoporosis. Front Hormone Res 3:131-149, 1975 CrossrefMedlineGoogle Scholar114. BARTIZAL F, COULAM C, and GAFFEY T: Impaired binding of estradiol to target tissue in postmenopausal osteoporosis (PMO): a possible molecular basis for the disease (abstract). Clin Res 23:534A, 1975 Google Scholar115. HEANEY R: A unified concept of osteoporosis (editorial). Am J Med 39:877-880, 1965 CrossrefMedlineGoogle Scholar116. HEANEY R: A unified concept of osteoporosis. A second look, in Osteoporosis, edited by BARZEL US. New York, Grune and Stratton, 1970, pp. 257-265 Google Scholar117. HEANEY R: Pathophysiology of osteoporosis: implications for treatment. Tex Med 70 (December):37-45, 1974 MedlineGoogle Scholar118. JASANI C, NORDIN B, and SMITH D: Spinal osteoporosis and the menopause. Proc R Soc Med 58:441-444, 1965 MedlineGoogle Scholar119. RIGGS B, JOWSEY J, and KELLY P: Studies of pathogenesis and treatment in postmenopausal and senile osteoporosis. Clin Endocrinol Metabol 2:317-332, 1973 CrossrefMedlineGoogle Scholar120. NORDIN B: Clinical significance and pathogenesis of osteoporosis. Br Med J 1:571-576, 1971 CrossrefMedlineGoogle Scholar121. GALLAGHER J, HARAMON A, and NORDIN B: Osteoporosis and the menopause, in Menopausal Syndrome, edited by GREENBLATT RB, MAHESH VB, MCDONAUGH PG. New York, Medcom Press, 1974, pp. 38-48 Google Scholar122. DEQUEKER J: Bone and ageing. Ann Rheum Dis 34:100-115, 1975 CrossrefMedlineGoogle Scholar123. PAK C, STEWART A, and KAPLAN R: Photon absorptio-metric analysis of bone density in primary hyperparathyroidism. Lancet 2:7-8, 1975 CrossrefMedlineGoogle Scholar124. HOSSAIN M, SMITH D, and NORDIN B: Parathyroid activity and postmenopausal osteoporosis. Lancet 1:809-811, 1970 CrossrefMedlineGoogle Scholar125. LIFSCHITZ M, PAK C, and HENNEMAN D: Treatment of osteoporosis with calcium infusions. Trans Assoc Am Physicians 83:254-266, 1970 MedlineGoogle Scholar126. FLANAGAN B and NICHOLS G: Metabolic studies of human bone in-vitro. I. Changes in hyperparathyroidism. J Clin Invest 44: 1795-1804, 1965 CrossrefMedlineGoogle Scholar127. ALBRIGHT F: Osteoporosis. Ann Intern Med 27:861-882, 1947 LinkGoogle Scholar128. REIFENSTEIN E: The rationale for use of anabolic steroids in controlling the adverse effects of corticoid hormones upon protein and osseous tissue. South Med J 49:933-960, 1956 CrossrefMedlineGoogle Scholar129. HEATH H and SIZEMORE G: Women have lower basal and stimulated plasma calcitonin levels than men, in Program Fifty-seventh Annual Meeting of Endocrine Society. Bethesda, Endocrine Society, 1975, p. 77 Google Scholar130. AITKEN J, ARMSTRONG E, and ANDERSON J: Osteoporosis after oophorectomy in the mature female rat and the effect of oestrogen and/or progesterone replacement therapy in its prevention. J Endocrinol 55:79-87, 1972 CrossrefMedlineGoogle Scholar131. FRANTZ A and RABKIN M: Effects of estrogen and sex difference on secretion of human growth hormone. J Clin Endocrinol Metab 25:1470-1480, 1965 CrossrefMedlineGoogle Scholar132. FRAME B and NIXON R: Bone marrow factors in osteoporosis, in Osteoporosis, edited by BARZEL US. New York, Grune and Stratton, 1970. pp. 238-250 Google Scholar133. Mast cells, heparin, and osteoporosis. Nutr Rev 27:43-46, 1969 CrossrefMedlineGoogle Scholar134. KELLY P, JOWSEY J, and RIGGS B: Relationship between serum phosphate concentration and bone resorption in osteoporosis. J Lab Clin Med 69:110-115, 1967 MedlineGoogle Scholar135. SMITH D and NORDIN B: The relationship between calcium balance and hydroxyproline excretion in osteoporosis. Proc R Soc Med 57:868-870, 1964 MedlineGoogle Scholar136. JOHNSON K, RIGGS B, and KELLY P: Osteoid tissue in normal and osteoporotic individuals. J Clin Endocrinol Metab 33:745-751, 1971 CrossrefMedlineGoogle Scholar137. WU K, JETT S, and FROST H: Bone resorption rates in rib in physiological, senile, and postmenopausal osteoporoses. J Lab Clin Med 69:810-818, 1967 MedlineGoogle Scholar138. SCHENK R, OLAH A, and MERZ W: Bone cell counts, in Clinical Aspects of Metabolic Bone Disease, edited by FRAME B, PARFITT AM, DUNCAN H. Amsterdam, Excerpta Medica, 1973, pp. 103-113 Google Scholar139. TEITELBAUM S, ROSENBERG E, and RICHARDSON C: Histologic studies of bone from normocalcemic postmenopausal osteoporotic patients with increased circulating parathyroid hormone. J Clin Endocrinol Metab 42:537-543, 1976 CrossrefMedlineGoogle Scholar140. VILLANUEVA A, ILNICKI L, and DUNCAN H: Bone and cell dynamics in the osteoporoses: a review of measurements by tetracycline bone labeling. Clin Orthop 49:135-150, 1966 CrossrefMedlineGoogle Scholar141. RICH C, BERNSTEIN D, and GATES S: Factors involved in an objective study of the efficacy of treatment of osteoporosis. Clin Orthop 45:63-66, 1966 CrossrefMedlineGoogle Scholar142. WALLACH S and HENNEMAN P: Prolonged estrogen therapy in postmenopausal women. JAMA 171:1637-1642, 1959 CrossrefGoogle Scholar143. HENNEMAN P: Treatment of postmenopausal osteoporosis with gonadal steroids. Semin Drug Treat 2:15-19, 1972 MedlineGoogle Scholar144. GORDAN G, PICCHI J, and ROOF B: Antifracture efficacy of long-term estrogens for osteoporosis. Trans Assoc Am Physicians 86:326-332, 1973 MedlineGoogle Scholar145. JOWSEY J and GORDAN G: Bone turnover and osteoporosis, in The Biochemistry and Physiology of Bone, vol. 3, 2nd ed., edited by BOURNE GH. New York, Academic Press, 1971, pp. 224-227 Google Scholar146. WEISS N, SZEKELY D, and AUSTIN D: Increasing incidence of endometrial cancer in the United States. N Engl J Med 294: 1259-1262, 1976 CrossrefMedlineGoogle Scholar147. SMITH D, PRENTICE R, and THOMPSON D: Association of exogenous estrogen and endometrial carcinoma. N Engl J Med 293:1164-1167, 1975 CrossrefMedlineGoogle Scholar148. ZIEL H and FINKLE W: Increased risk of endometrial carcinoma among users of conjugated estrogens. N Engl J Med 293:1167-1170, 1975 CrossrefMedlineGoogle Scholar149. MACK T, PIKE M, and HENDERSON B: Estrogens and endometrial cancer in a retirement community. N Engl J Med 294:1262-1267, 1976 CrossrefMedlineGoogle Scholar150. GORDAN G and GREENBERG B: Exogenous estrogens and endometrial cancer. Postgrad Med 59(6):66-77, 1976 CrossrefMedlineGoogle Scholar151. WEISS N: Risks and benefits of estrogen use (editorial). N Engl J Med 293:1200-1202, 1975 CrossrefMedlineGoogle Scholar152. RIGGS B, JOWSEY J, and KELLY P: Effects of sex hormones on bone in primary osteoporosis. J Clin Invest 48:1065-1072, 1969 CrossrefMedlineGoogle Scholar153. YOUNG M, JASANI C, and SMITH D: Some effects of ethinyl oestradiol on calcium and phosphorus metabolism in osteoporosis. Clin Sci 34:411-417, 1968 MedlineGoogle Scholar154. RIGGS B, JOWSEY J, and GOLDSMITH R: Short- and long-term effects of estrogen and synthetic anabolic hormone in postmenopausal osteoporosis. J Clin Invest 51:1659-1663, 1972 CrossrefMedlineGoogle Scholar155. AITKEN J, HART D, and LINDSAY R: Oestrogen replacement therapy for prevention of osteoporosis after oophorectomy. Br Med J 3:515-518, 1973 CrossrefMedlineGoogle Scholar156. LINDSAY R, HART D, and AITKEN J: Long-term prevention of postmenopausal osteoporosis by oestrogen. Lancet 2: 1038-1040, 1976 CrossrefGoogle Scholar157. GOLDSMITH N and JOHNSTON J: Bone mineral: effects of oral contraceptives, pregnancy, and lactation. J Bone Joint Surg 57A:657-668, 1975 CrossrefGoogle Scholar158. AITKEN J, HALL P, and RAO L: Hypercortisolaemia and lack of skeletal response to oestrogen in postmenopausal women. Clin Endocrinol 3:167-174, 1974 CrossrefMedlineGoogle Scholar159. PAK C, ZISMAN E, and EVENS R: The treatment of osteoporosis with calcium infusions. Clinical studies. Am J Med 47: 7-16, 1969 CrossrefMedlineGoogle Scholar160. JOWSEY J, HOYE R, and PAK C: The treatment of osteoporosis with calcium infusions. Evaluation of bone biopsies. Am J Med 47:17-22, 1969 CrossrefMedlineGoogle Scholar161. PAK C and BARTTER F: Treatment of osteoporosis with calcium infusions. Semin Drug Treat 2:39-46, 1972 MedlineGoogle Scholar162. DUDL R, ENSINCK J, and BAYLINK D: Evaluation of intravenous calcium as therapy for osteoporosis. Am J Med 55: 631-637, 1973 CrossrefMedlineGoogle Scholar163. WALTON J, DOMINGUEZ M, and BARTTER F: Effect of calcium infusions in patients with postmenopausal osteoporosis. Metabolism 24:849-854, 1975 CrossrefMedlineGoogle Scholar164. RIGGS B, JOWSEY J, and KELLY P: Effect of oral therapy with calcium and vitamin D in primary osteoporosis. J Clin Endocrinol Metab 42:1139-1144, 1976 CrossrefMedlineGoogle Scholar165. RIGGS B and JOWSEY J: Treatment of osteoporosis with fluoride. Semin Drug Treat 2:27-33, 1972 MedlineGoogle Scholar166. BURKHART J and JOWSEY J: Effects of variations in calcium intake on the skeleton of fluoride-fed kittens. J Lab Clin Med 72:943-950, 1968 MedlineGoogle Scholar167. RIGGINS R, ZEMAN F, and MOON D: The effects of sodium fluoride on bone breaking strength. Calcif Tissue Res 14:283-289, 1974 CrossrefMedlineGoogle Scholar168. GOLDSMITH R: Treatment of osteoporosis with phosphate. Semin Drug Treat 2:35-37, 1972 MedlineGoogle Scholar169. WALLACH S, ALOIA J, and COHN S: Treatment of osteoporosis with calcitonin. Semin Drug Treat 2:21-25, 1972 MedlineGoogle Scholar170. COHN S, DOMBROWSKI C, and HAUSER W: Effect of porcine calcitonin on calcium metabolism in osteoporosis. J Clin Endocrinol Metab 33:719-728, 1971 CrossrefMedlineGoogle Scholar171. SAVILLE P and HEANEY R: Treatment of osteoporosis with diphosphonates. Semin Drug Treat 2:47-50, 1972 MedlineGoogle Scholar172. REEVE J, HESP R, and WILLIAMS D: Anabolic effect of low doses of a fragment of human parathyroid hormone on the skeleton in postmenopausal osteoporosis. Lancet 1:1035-1038, 1976 CrossrefMedlineGoogle Scholar173. HARRIS W, HEANEY R, and JOWSEY J: Growth hormone: the effect on skeletal renewal in the adult dog. Calcif Tissue Res 10:1-13, 1972 CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: DAVID L. THOMSON, M.D.; BOY FRAME, M.D., F.A.C.P.Affiliations: Detroit, Michigan▸From the Department of Medicine, Henry Ford Hospital; Detroit, Michigan. 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