Serum cystatin C as an endogenous parameter of the renal function in patients with normal to moderately impaired kidney function.

Background: Cystatin C is a proteinase inhibitor with a low molecular weight. The serum levels of cystatin C are mainly dependent on glomerular filtration rate (GFR) making cystatin C an endogenous parameter of GFR. The aim of the study was to elucidate the applicability of serum cystatin C as a parameter of GFR in patients with normal to moderately impaired kidney function and to estimate a reference interval for serum cystatin C.

Metabolic acidosis: an emerging problem in patients with intestinal segments as part of urinary diversion. A report of two cases.

Two cases of severe metabolic acidosis are reported, one of which led to severe disablement of the patient due to osteomalacia. Both patients had a urinary diversion performed years beforehand, one consisting of a continent ileal Kock reservoir and the other of a urethral Kock pouch. The mechanisms of these complications and their treatment are discussed.

Spine deformity index in osteoporotic women: relations to forearm and vertebral bone mineral measurements and to iliac crest ash density.

Bone densitometric measurements are widely used for monitoring therapeutic regimens for osteoporosis. However, it is a matter of debate which measurement site is most appropriate for prediction of individual fracture risk. The aim of this cross-sectional study was to investigate the relationship between bone mineral measurements at various sites and spine deformity index (SDI) in osteoporotic women.

A comparison of the effects of oestrogen/progestogen, high-dose oral calcium, intermittent cyclic etidronate and an ADFR regime on calcium kinetics and bone mass in postmenopausal women with spinal osteoporosis.

The effects of four different treatments for osteoporosis were compared in a prospective, randomized, 3-year study in 74 postmenopausal women with spinal crush fracture osteoporosis. Patients were randomly assigned to cyclic oestrogen/progestogen therapy (group 1, n = 20), a daily oral calcium dose of 2 g (group 2, n = 17), intermittent cyclic etidronate therapy (group 3, n = 19), or an ADFR treatment with triiodothyronine as activator and etidronate as depressor (group 4, n = 18). Spine and forearm bone mineral content was measured before entry and every 30 weeks.

Marked changes in iliac crest bone structure in postmenopausal osteoporotic patients without any signs of disturbed bone remodeling or balance.

Successful iliac crest bone biopsies were obtained from 63 women with postmenopausal vertebral crush fracture osteoporosis. Structural and static histomorphometric parameters were compared with 25 age-matched normal females, who had suffered an unexpected and sudden death. The control group for dynamic parameters comprised 13 younger normal females.

Estimation of vertebral body strength by dual photon absorptiometry in elderly individuals: comparison between measurements of total vertebral and vertebral body bone mineral.

The aim of the present study was to investigate the predictive value of bone mineral measurements by dual photon absorptiometry (DPA) in vitro for strength and ash weight of lumbar vertebral bodies in elderly, otherwise nonselected individuals. The material comprised 46 individuals: 26 males (43-95 years) and 20 females (63-95 years) without malignant diseases. Spinal segments, including L2, L3, and L4, were removed en bloc at autopsy.

Assessment of bone formation by biochemical markers in metabolic bone disease: separation between osteoblastic activity at the cell and tissue level.

In this study , serum levels of classical serum markers of bone formation [carboxyterminal propeptide of procollagen type I (S-PICP), bone Gla protein (S-BGP)], and total alkaline phosphatase (S-AP)) were related to the calcium kinetic index of whole skeletal mineralization rate (m) by regression analysis in a variety of metabolic bone diseases. For each disease, the regression coefficient (r) as well as the fraction: standard error of estimate/mean dependent variable (SEE/Y) were determined. In a group of 19 normals, only the regression of S-PICP on m reached significance (r = 0.

Calcium metabolism in postmenopausal osteoporotic women is determined by dietary calcium and coffee intake.

Eighty-five patients, age 48 to 77 y with postmenopausal crush fracture osteoporosis, were investigated using a 7-d combined calcium balance and 47Ca tracer-kinetic turnover method taking the dermal calcium loss into account. Individual dietary records were obtained based on a 4-d registration at home before hospital admission and on questioning by a dietitian. The following dietary constituents were estimated: energy content, protein, methionine, cysteine, calcium, phosphate, magnesium, coffee, fiber and vitamin C.

Effects of a combined estrogen-gestagen regimen on serum levels of the carboxy-terminal propeptide of human type I procollagen in osteoporosis.

Estrogen stimulates osteoblastic collagen production in vitro, but whether the same stimulation takes place in vivo is still unknown. To test the stimulatory effects of a combined estrogen-gestagen regimen in vivo we monitored serum levels of the carboxy-terminal propeptide of human type I procollagen (S-PICP) in a group of 12 osteoporotic women over a 150 week treatment period. Spinal bone mineral content (BMC) increased to a maximum of 5% over pretreatment values around week 90.

Skeletal size and bone mineral content in Turner's syndrome: relation to karyotype, estrogen treatment, physical fitness, and bone turnover.

Bone mineral content (BMC), bone mineral density, and metacarpal dimensions were studied in 50 women with Turner's syndrome aged 21-45 years in relation to karyotype, estrogen treatment, physical fitness, and biochemical markers of bone turnover. No differences were found between the 25 women with karyotype 45.X and women with other karyotypes.

Dermal, intestinal, and renal obligatory losses of calcium: relation to skeletal calcium loss.

Calcium balance is the difference between dietary calcium intake on the one hand and dermal, fecal, and urinary losses on the other. Bone is lost throughout adult life by at least three different mechanisms. Whether all these processes are affected by dietary calcium is at present unknown.

The effects of etidronate on trabecular bone remodeling in postmenopausal spinal osteoporosis: a randomized study comparing intermittent treatment and an ADFR regime.

Thirty-seven patients were randomized to receive intermittent cyclic etidronate (400 mg/day oral for 2 weeks, followed by 13 weeks off treatment) or an ADFR treatment (100 micrograms/day oral triiodothyronine for 7 days, followed by 400 mg/day etidronate for 2 weeks and 12 weeks off treatment). Supplemental calcium (120 mg/day) and vitamin D3 (400 IU/day) were given throughout the study period to all patients. Biochemical analyses, iliac-crest bone biopsies, and lumbar bone mineral content (BMC) measurements were performed before and during 60 weeks of treatment.

Calcium metabolism in postmenopausal osteoporosis: the influence of dietary calcium and net absorbed calcium.

A group of 85 females aged 48-77 years with postmenopausal crush fracture osteoporosis were investigated using a 7 day combined calcium balance and calcium tracer kinetic turnover study to assess the influence of dietary calcium and net absorbed calcium on bone metabolism. During the study, patients were on their habitual diet, as determined by a prestudy registration. Dietary calcium was measured after double serving of all the meals.

A randomized study on the effects of estrogen/gestagen or high dose oral calcium on trabecular bone remodeling in postmenopausal osteoporosis.

Thirty-seven patients with postmenopausal crush fracture osteoporosis were randomized to oral cyclic estrogen/gestagen (n = 20) or oral calcium (2000 mg elemental calcium per day) (n = 17). Fourteen in each group completed 1 year of treatment. Iliac crest bone biopsies were obtained after intravital double labeling with tetracycline before and after treatment in 10 patients on estrogen/gestagen and 11 patients on calcium.

Bisphosphonate whole body retention test: relations to bone mineralization rate, renal function and bone mineral content in osteoporosis and metabolic bone disorders.

The bisphosphonate whole body retention test (WBR) has been used to estimate bone mineralization rate (bone turnover). Bisphosphonates given i.v.

Etidronate disodium in the management of malignancy-related hypercalcemia.

To evaluate the efficacy of intravenous etidronate disodium (etidronate) in controlling hypercalcemia of malignancy, 20 patients with known malignant disease and hypercalcemia were randomly assigned on a two-to-one basis to receive etidronate, 7.5 mg/kg of body weight, or placebo for three to five days. All patients received 3,000 ml of saline and 40 mg of furosemide per day.

Safety of osteoporosis treatment with sodium fluoride, calcium phosphate and vitamin D.

During an 8-year period, 163 consecutive patients with spinal crush fracture osteoporosis started a 5-year treatment with a combination of sodium fluoride (60 mg/day), calcium phosphate (45 mmol/day) and vitamin D2 (18,000 IU/day), and were followed in the outpatient clinic every 3 months. Fourty-three patients completed the 5-year treatment. Mean observation time was 2.

Dual-photon absorptiometry of the proximal tibia.

Dual-photon absorptiometric bone-mineral assay, penetration tests, and axial compression tests of the proximal tibial epiphyses were carried out in 18 human cadaver knees. The reproducibility of bone mineral assay was within +/- 12% (95% tolerance limits). Linear regression analysis with bone-mineral content as the independent variable showed a good correlation to the ultimate force obtained from the compression tests on the medial (r = 0.

Exogenous triiodothyronine activates bone remodeling.

The effect of exogenous triiodothyronine (T3) as an activator of bone remodeling was investigated by measuring biochemical marker levels. Fourteen people received 100-160 micrograms of T3 for 1 week and were followed for a total of 10 weeks. Serum T3 increased markedly during the first week, whereas serum TSH and serum thyroxine (T4) decreased.

Etidronate disodium for treating hypercalcaemia of malignancy: a double blind, placebo-controlled study.

The efficacy of intravenous etidronate disodium in controlling hypercalcaemia of malignancy was evaluated in a double blind, placebo-controlled study. Twenty patients with known malignant disease and hypercalcaemia were randomly assigned on a 2:1 basis to etidronate 7.5 mg kg-1 body weight or placebo for 3-5 days.

Aspects of glucose homeostasis in uremia as assessed by the hyperinsulinemic euglycemic clamp technique.

A three-step hyperinsulinemic euglycemic clamp was performed in 14 nondialyzed uremic and ten age-matched healthy subjects. Nine of the uremics were restudied for a mean of 42 days (range, 21 to 88 days) after initiation of dialysis therapy. Insulin was infused at the following three rates: 0.

Improved in vivo insulin effect during continuous subcutaneous insulin infusion in patients with IDDM.

It has recently been shown that conventionally treated IDDMs are insulin resistant. Using the insulin clamp technique, we studied the influence of metabolic status on the in vivo insulin effect in these patients. Eleven IDDMs, treated conventionally with diet and insulin for 10.