Bone remodeling and calcium metabolism: A correlated histomorphometric, calcium kinetic, and biochemical study in patients with osteoporosis and Paget's disease

doi:10.1016/0026-0495(77)90081-6

Metabolism

Volume 26, Issue 6, June 1977, Pages 589-606

https://doi.org/10.1016/0026-0495(77)90081-6 Get rights and content

Abstract

The extent to which histomorphometric analysis of bone biopsies correlates with Ca kinetic and biochemical parameters to reflect true bone formation and resorption in adult man remains an unsolved issue. Two groups of patients with either low (osteoporosis), (n = 15) or high (Paget's disease, n = 6) bone turnover were studied before and after sodium fluoride (NaF) and diphosphonate (EHDP) treatment, respectively. Histomorphometry of iliac crest biopsies permitted precise quantitation of the osteoblast layers (S_Vob), osteoid seams (S_Vos), the number of osteoclasts (N_Aocl) and the Howship's lacunae (S_Vhl). These determinations were correlated with serum alkaline phosphatase (aPh), urinary hydroxyproline (HyPro), Ca accretion rate (Vo⁺), and Ca mobilization rate (Vo⁻). In both patient groups bone formation indices were significantly correlated: $S_{Vob} Vo^{+}$ , r = 0.85; $S_{Vos} Vo^{+}$ , r = 0.83; and $aPh Vo^{+}$ , r = 0.97. Provided that bone matrix formation and mineralization progress at the same rate, bone formation may be assessed by measuring either aPh, Vo⁺, S_Vob, or S_Vos. From these correlations it is not possible to draw any conclusions regarding the absolute “true” value of bone formation, be it in terms of Ca kinetics, alkaline phosphatase, or histomorphometry. However, since Vo⁺ retains its proportionality to all the other bone formation parameters tested, the so-called “slow exchange”, which refers to pure physicochemical Ca exchange processes in the bone mineral, does not perturb Vo⁺ in an unsystematic way. Vo⁺ as well as aPh and histomorphometric indices are thus reliable, though not absolute indices of bone formation. Bone resorption indices correlated less well than bone formation indices: $N_{Aocl} Vo^{−}$ , r = 0.68 and $S_{Vhl} Vo^{−}$ , r = 0.63 with both groups. In the osteoporotic group, a negative correlation existed between the empty Howship's lacunae S_Vhe and Vo⁺, r = −0.62. Consequently, the overall extent of Howship's lacunae S_Vhl is influenced both by bone resorption and bone formation. On the other hand, the best correlation of HyPro was with the sum of Vo⁺ and Vo⁻, r = 0.97, confirming that HyPro is a sensitive index for the change of bone turnover.

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^☆: Supported by Grants 3.104.69, 3.804.72, and 3.8710.72 from the Schweiz. Nationalfonds zur Förderung der wissenschaftlichen Forschung.

^☆☆: This study is part of the doctoral dissertation of Th. Lauffenburger at the University of Basle.

^★: Presented in part at the Xth European Symposium on Calcified Tissues, Hamburg, Germany, September 1973, and in part at the 58th Tagung der Deutschen Gesellschaft für Pathologie, Interlaken, Switzerland, May 1974.

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Bone remodeling and calcium metabolism: A correlated histomorphometric, calcium kinetic, and biochemical study in patients with osteoporosis and Paget's disease☆,☆☆,★

Abstract

J Clin Endocrinol Metab

Biochim Biophys Acta

Metabolism

Clin Chim Acta

Arch Biochem Biophys

Am J Med

Kidney Int

Metabolism

A quantitative histological study on bone resorption in human cancellous bone

Acta Anat

Quantitative histological study on bone formation in human cancellous bone

Acta Anat

Bone cell counts

Histomorphometrie des Knochens

Verh Dtsch Ges Pathol

Méthodes histologiques quantitatives en pathologie osseuse

Rev Lyon Med

The rate of osteoclastic bone erosion in Haversian remodeling sites of adult dog's rib

Calcif Tissue Res

Altersabhängige Skelettveränderunge. Histomorphometrische Untersuchungen an der menschlichen Beckenkammspongiosa

Klin Wochenschr

Quantitative histological studies on age changes in bone

J Pathol Bacteriol

Calcium accretion and bone formation in dogs: An experimental comparison between the results of Ca-45 kinetic analysis and tetracycline labelling

J Bone Joint Surg

Calcium kinetic techniques 10 years later: A critical appraisal

The effects of fluoride therapy on metabolic bone disease

Clin Orthop

Fluoride in osteoporosis. Quantitative histological studies on bone structure and bone remodeling in serial biopsies of the iliac crest

Histological bone changes after long-term treatment with sodium fluoride

The effects of sodium fluoride on calcium metabolism of subjects with metabolic bone diseases

J Clin Invest

Use of sodium fluoride in the treatment of osteoporosis

J Clin Endocrinol

Diphosphonate treatment of Paget's disease of bone

Horm Metab Res