The Role of Biochemical Tests in the Screening and Monitoring of Osteoporosis

Lindsay R Cosman F. Primary osteoporosis. In: Coe FL Favus MJ , eds. Disorders of Bone and Mineral Metabolism. New York: Raven Press, 1992: 831–88.

Melton LJ Wahner HW Richelson LS O'Fallon WM Riggs BL . Osteoporosis and the risk of hip fractures. Am J Epidemiol 1986; 124: 254–61.

Ross PD Rasnich RD Vogel JM . Detection of pre-fracture spinal osteoporosis using bone mineral absorptiometry. J Bone Miner Res 1988; 3: 1–11.

Eastell R Riggs BL Wahner HW O'Fallon WM Amadio PC Melton LJ . Colles’ fracture and bone density of the ultradistal radius. J Bone Miner Res 1989; 4: 607–13.

Cooper C. Review of UK data on the rheumatic diseases—6: Osteoporosis. Br J Rheumatol 1991; 30: 135–7.

Boyce WJ Vessey MP . Rising incidence of fracture of the proximal femur. Lancet 1985; i: 150–1.

Melton LJ O'Fallon WM Riggs BL . Secular trends in the incidence of hip fractures. Calcif Tissue Int 1987; 41: 57–64.

Hoffenberg R James OFW Brocklehurst JC Green ID Horrocks P Kanis JA Fractured neck of femur: Prevention and management. Summary and recommendations of a report of the Royal College of Physicians. J R Coll Physicians Land 1989; 23: 8–12.

Avioli LV . Significance of osteoporosis: A growing international healthcare problem. Calcif Tissue Int 1991; 49 (suppl): S5–S7.

Cummings SR Kelsey JL Nevitt MC O'Dowd KJ . Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985; 7: 178–208.

Melton LJ Kan SH Frye MA Wahner HW O'Fallon WM Riggs BL . Epidemiology of vertebral fractures in women. Am J Epidemiol 1989; 129: 1000–11.

Jensen GF Christiansen C Boesen J Hegedins V Transbol I. Epidemiology of postmenopausal and long bone fractures. Clin Orthop 1982; 166: 75–81.

Winner SJ Morgan CA Evans JG . Perimenopausal risk of falling and incidence of distal forearm fracture. BMJ 1989; 298: 1486–8.

Melton LJ . Epidemiology of osteoporosis. In: Christiansen C , ed. Hormone replacement and its impact on osteoporosis. Clin Obstet Gynaecol 1991; 5: 785–805.

Parfitt AM . Bone remodelling: Relationship to the amount and structure of bone and the pathogenesis and prevention of fracture. In: Riggs BL Melton LJ , eds. Osteoporosis: Etiology, Diagnosis and Management. New York: Raven Press, 1988: 45–93.

Dempster DW Lindsay R. Pathogenesis of osteoporosis. Lancet 1993; 341: 797–801.

Reeve J Meunier PJ Parsons JA Bernat M Bijvoet OLM Courpon P Anabolic effect of human parathyroid hormone fragment on trabecular bone in conventional osteoporosis: A multicentre trial. BMJ 1980; 280: 1340–4.

Lindsay R. Why do oestrogens prevent bone loss? In: Christiansen C , ed. Hormone replacement and its impact on osteoporosis. Clin Obstet Gynaecol 1991; 5: 837–52.

Austin LA Heath H. Calcitonin: Physiology and pathophysiology. N Engl J Med 1981; 304: 269–78.

Fujita T. Vitamin D in the treatment of osteoporosis. Proc Soc Exp Biol Med 1992; 199: 394–9.

Hansen MA Overgaard K Riis BJ Christiansen C. Role of peak bone mass and bone loss in postmenopausal osteoporosis: 12 year study. BMJ 1991; 303: 961–4.

Väänänen HK . Pathogenesis of osteoporosis. Calcif Tissue Int 1991; 49: S11–14.

Morrison NA Qi JC Tokita A Kelly PJ Crofts L Nguyen TV Prediction of bone density from vitamin D receptor alleles. Nature 1994; 367: 284–7.

Eriksen EF Mosekilde L Melsen F. Trabecular bone remodelling and bone balance in hyperthyroidism. Bone 1985; 6: 421–8.

Silverberg SJ Shane E de la Cruz L Dempster DW Feldman F Seldin D Skeletal disease in primary hyperparathyroidism. J Bone Miner Res 1989; 4: 283–91.

Price CP . Multiple forms of human serum alkaline phosphatase: Detection and quantitation. Ann Clin Biochem 1993; 30: 355–72.

Weiss MJ Henthorn PS Lafferty MA Slaughter C Raducha M Harris H. Isolation and characterisation of a cDNA encoding a human liver/bone/kidney-type alkaline phosphatase. Proc Natl Acad Sci USA 1986; 83: 7182–6.

Schoneau E Herzog KH Boehles HJ . Liquid chromatographic determination of isoenzymes of alkaline phosphatase in serum and tissue homogenates. Clin Chem 1986; 32: 816–18.

Rosalki SB Foo YA . Two new methods for separating and quantifying bone and liver alkaline phosphatase isoenzymes in plasma. Clin Chem 1984; 30: 1182–6.

Moss DW Edwards RK . Improved electrophoretic resolution of bone and liver alkaline phosphatases resulting from partial digestion with neuraminidase. Clin Chim Acta 1984; 143: 177–82.

Hill CS Wolfert RL . The preparation of monoclonal antibodies which react preferentially with human bone alkaline phosphatase and not with liver alkaline phosphatase. Clin Chim Acta 1989; 186: 315–20.

Price PA . Vitamin K-dependent bone proteins. In: Cohn DV Martin TJ Meunier PJ , eds. Calcium Regulation and Bone Metabolism: Basic and Clinical Aspects, Vol 9. Amsterdam: Elsevier, 1987: 419–26.

Power MJ Fottrell PF . Osteocalcin: Diagnostic methods and clinical applications. Crit Rev Clin Lab Sci 1991; 28: 287–335.

Manduca P Sanguineti C Pistone M Boccignone E Sanguineti F Santolini F Differential expression of alkaline phosphatase in clones of human osteoblast-like cells. J Bone Miner Res 1993; 8: 291–300.

Delmas PD Christiansen C Marin KG Price PA . Bone Gla protein (osteocalcin) assay standardization report. J Bone Miner Res 1990; 5: 5–11.

Gundberg CM Weinstein RS . Multiple immunoreactive forms of osteocalcin in uremic serum. J Clin Invest 1986; 77: 1762–7.

Tracy RP Andrianorivo A Riggs BL Mann KG . Comparison of monoclonal and polyclonal antibody-based immunoassays for osteocalcin—a study of sources of variation in assay results. J Bone Miner Res 1990; 5: 451–61.

Deftos LJ . Bone protein and peptide assays in the diagnosis and management of skeletal disease. Clin Chem 1991; 37: 1143–8.

Delmas PD Wilson DM Mann KG Riggs BL . Effect of renal function on plasma levels of bone Gla-protein. J Clin Endocrinol Metab 1983; 57: 1028–30.

Simon LS Krane SM . Procollagen extension peptides as markers of collagen synthesis. In: Frame B Potts JT , eds. Clinical Disorders of Bone and Mineral Metabolism. Amsterdam: Excerpta Medica, 1983: 108–11.

Smedsrod B Melkko J Risteli L Risteli J. Circulating C-terminal propeptide of type I procollagen is cleared mainly via the mannose receptor in liver endothelial cells. Biochem J 1990; 271: 345–50.

Parfitt AM Simon LS Villanueva AR Krane SM . Procollagen type I carboxy terminal extension peptide in serum as a marker of collagen biosynthesis in bone. Correlation with iliac bone formation rate and comparison with total alkaline phosphatase. J Bone Miner Res 1987; 2: 427–36.

Eriksen EF Charles P Melsen F Mosekilde L Risteli L Risteli J. Serum markers of type I collagen formation and degradation in metabolic bone disease: Correlation with bone histomorphometry. J Bone Miner Res 1993; 8: 127–32.

Risteli L Risteli J. Biochemical markers of bone metabolism. Ann Med 1993; 25: 385–93.

Kivirikko KI . Urinary excretion of hydroxyproline in health and disease. Int Rev Connect Tissue Res 1970; 5: 93–163.

Teerlink T Tavernier P Netelenbos JC . Selective determination of hydroxyproline in urine by high performance liquid chromatography using precolumn derivatisation. Clin Chim Acta 1989; 183: 309–16.

Delmas PD . Clinical use of biochemical markers of bone remodeling in osteoporosis. Bone 1992; 13: S17–21.

Krane SM Kantrowitz FG Byrne M Pinnell SR Singer FR . Urinary excretion of hydroxylysine and its glycosides as an index of collagen degradation. J Clin Invest 1977; 59: 819–27.

Moro L Modricky D Rovis L de Bernard B. Determination of galactosyl hydroxylysine in urine as a means for the identification of osteoporotic women. Bone Miner 1988; 3: 271–6.

Robins SP . Functional properties of collagen and elastin. Clin Rheumatol 1988; 2: 1–36.

Black D Duncan A Robins SP . Quantitative analysis of the pyridinium crosslinks in urine using ion-paired reversed-phase high-performance liquid chromatography. Anal Biochem 1988; 169: 197–203.

James IT Perrett D Thompson PW . Rapid assay for hard tissue collagen cross-links using isocratic ion-pair reversed-phase liquid chromatography. J Chromatogr 1990; 525: 43–57.

Robins SP . An enzyme linked immunoassay for the collagen cross-link pyridinoline. Biochem J 1982; 207: 617–20.

Seyedin SM Kung VT Daniloff YN Hesley RP Gomez B Nielsen LA Immunoassay for urinary pyridinoline: The new marker of bone resorption. J Bone Miner Res 1993; 8: 635–41.

Van Hoek MJC Martens MFWC Wälchli R Ganse R Rosmalen FMA . A novel polyclonal antibody against deoxypyridinoline to be used in radioimmunoassay. Osteoporos Int 1994 (in press).

Chen S-Y Sunshine EM Blustein BI Zuk RF . An automated chemiluminescent assay for pyridinoline—a urinary marker for bone resorption [Abstract]. Clin Chem 1994; 40: 1021.

Seibel MJ Robins SP Bilezikian JP . Urinary pyridinium crosslinks of collagen: Specific markers of bone resorption in metabolic bone disease. Trends Endocrin Metab 1992; 3: 263–70.

Uebelhardt D Gineyts EC Chapuy MC Delmas PD . Urinary excretion of pyridinium crosslinks: A new marker of bone resorption in metabolic bone disease. Bone Miner 1990; 8: 87–96.

Eastell R Hampton L Colwell A Green JR . Urinary collagen crosslinks are highly correlated with radioisotopic measurements of bone resorption. In: Christiansen C Overgaard K , eds. Osteoporosis. Copenhagen: Osteopress, 1990: 469–77.

Delmas PD Schlemmer A Gineyts E Riis B Christiansen C. Urinary excretion of pyridinoline correlates with bone turnover measured in iliac crest biopsy in patients with vertebral osteoporosis. J Bone Miner Res 1991; 6: 639–44.

Risteli J Elomaa I Niemi S Novamo A Risteli L. Radioimmunoassay for the pyridinoline cross-linked carboxy terminal telopeptide of type I collagen: A new serum marker of bone collagen degradation. Clin Chem 1993; 39: 635–40.

Hassager C Jensen LT Pødenphant J Thomsen K Christiansen C. The carboxyterminal pyridinoline cross-linked telopeptide of type I collagen in serum as a marker of bone resorption: The effect of nandrolone decanoate and hormone replacement therapy. Calcif Tissue Int 1994; 54: 30–3.

Hanson DA Weis ME Bollen A-M Maslan SL Singer FR Eyre DR . A specific immunoassay for monitoring human bone resorption: Quantitation of type 1 collagen crosslinked N-telopeptides in urine. J Bone Miner Res 1992; 7: 1251–8.

Moss DW . Multiple forms of acid and alkaline phosphatases: Genetics, expression and tissue specific modification. Clin Chim Acta 1986; 161: 123–35.

Minkin C. Bone acid phosphatase: Tartrate resistant acid phosphatase as a marker of osteoclast function. Calcif Tissue Int 1982; 34: 285–90.

Miller SC . The rapid appearance of acid phosphatase at the developing ruffled border of parathyroid hormone activated medullary bone osteoclasts. Calcif Tissue Int 1985; 37: 526–9.

Chambers TJ Fuller K Darby JA . Hormonal regulation of acid phosphatase release by osteoclasts disaggregated from neonatal rat bone. J Cell Physiol 1987; 132: 90–6.

Moonga BS Moss DW Patchell A Zaidi M. Intracellular regulation of enzyme secretion from rat osteoclasts and evidence for a functional role in bone resorption. J Physiol 1990; 429: 29–45.

Raisz LG . Mechanisms and regulation of bone resorption of osteoclastic cells. In: Coe FL Favus MJ , eds. Disorders of Bone and Mineral Metabolism. New York: Raven Press, 1992: 287–311.

Allen SH Nuttleman PR Ketcham CM Roberts RM . Purification and characterisation of human bone tartrate-resistant acid phosphatase. J Bone Miner Res 1989; 4: 47–55.

Kraenzlin ME Lau KHW Liang L Freeman TK Singer FR Stepan J Development of an immunoassay for serum osteoclastic tartrate-resistant acid phosphatase. J Clin Endocrinol Metab 1990; 71: 442–51.

Stepan JJ Silinkova-Malkova E Havranek T Formánková J Zichová M Lachmanova J Relationship of plasma tartrate resistant acid phosphatase to the bone isoenzyme of serum alkaline phosphatase in hyperparathyroidism. Clin Chim Acta 1983; 133: 189–200.

Tavassoli M Rizo M Yam LT . Elevation of serum acid phosphatase in cancers with bone metastases. Cancer 1980; 45: 2400–3.

Stepan JJ Pospichal J Presl J Pacovsky V. Plasma tartrate resistant acid phosphatase, bone isoenzyme of serum alkaline phosphatase and urinary hydroxyproline for early identification of the patients at risk for developing osteoporosis. In: Christiansen C Arnaud CD Norden BEC Parfitt AM Peck WA Riggs BL , eds. Osteoporosis Vol 1. Copenhagen: Aalborg Stiftsrbogtrykkeri, 1984: 139–43.

Eastell R Heath H Kumar R Riggs BL . Hormonal factors: PTH, vitamin D and calcitonin. In: Riggs BL Melton LJ , eds. Osteoporosis: Etiology, Diagnosis and Management. New York: Raven Press, 1988: 373–88.

Reeve J. The use of biochemical and isotopic studies in the investigation of bone disorders. In: Stevenson JC , ed. New Techniques in Metabolic Bone Disease. London: Wright, 1990: 92–109.

Nilas L Borg L Gotfredsen A Christiansen C. Comparison of single- and dual-photon absorptiometry in postmenopausal bone mineral loss. J Nucl Med 1985; 26: 1257–62.

Gotfredsen A Podenphant M Norgaard H Nilas L Nielsen VH Christiansen C. Accuracy of lumbar spine bone mineral content by dual photon absorptiometry. J Nucl Med 1988; 29: 248–54.

Ho CP Kim RW Schaffer MB Sartoris DJ , Accuracy of dual energy radiographic absorptiometry of the lumbar spine: Cadaver study. Radiology 1990; 176: 171–3.

Genant HK Ettinger B Harris ST Block JE Steiger P. Quantitative computed tomography in assessment of osteoporosis. In: Riggs BL Melton LJ , eds. Osteoporosis: Etiology, Diagnosis and Management. New York: Raven Press, 1988: 221–49.

Stewart A Reid DM Porter RW . Broadband ultrasound attenuation and dual energy X-ray absorptiometry in patients with hip fractures: Which technique discriminates fracture risk? Calcif Tissue Int 1994; 54: 466–9.

Hassager C Christiansen C. Current techniques for bone mass measurement. In: Christiansen C , ed. Hormone replacement and its impact on osteoporosis. Clin Obstet Gynaecol 1991; 5: 807–15.

Cumming RG . Calcium intake and bone mass: A quantitative review of the evidence. Calcif Tissue Int 1990; 47: 194–201.

Wolman RL Faulmann L Clark P Hesp R Harries MG . Different training patterns and bone mineral density of the femoral shaft in elite, female athletes. Ann Rheum Dis 1991; 50: 487–9.

Duda RJ O Brien JF Katzmann JA Peterson JM Mann KG Riggs BL . Concurrent assays of bone Gla-protein and bone alkaline phosphatase: Effects of sex, age and metabolic bone disease. J Clin Endocrinol Metab 1988; 66: 951–7.

Garnero P Delmas PD . Assessment of the serum levels of bone alkaline phosphatase with a new immunoradiometric assay in patients with metabolic bone disease. J Clin Endocrinol Metab 1993; 77: 1046–53.

Seibel MJ Cosman F Shen V Gordon S Dempster DW Ratcliffe A Urinary hydroxypyridinium crosslinks of collagen as markers of bone resorption and estrogen efficacy in postmenopausal osteoporosis. J Bone Miner Res 1993; 8: 881–9.

Eastell R Delmas PD Hodgson SF Eriksen EF Mann KG Riggs BL . Bone formation rate in older normal women: Concurrent assessment with bone histomorphometry, calcium kinetics and biochemical markers. J Clin Endocrinol Metab 1988; 67: 741–8.

Eastell R Simmons PS Colwell A Assiri AMA Burritt MF Russell RGG Nyctohemeral changes in bone turnover assessed by serum Gla-protein concentration and urinary deoxypyridinoline excretion: Effects of growth and aging. Clin Sci 1992; 83: 375–82.

Eastell R Calvo MS Burritt MF Offord KP Russell RGG Riggs BL . Abnormalities in circadian patterns of bone resorption and renal calcium conservation in type I osteoporosis. J Clin Endocrinol Metab 1992; 74: 487–94.

Parfitt AM . The contribution of bone histology to understanding the pathogenesis and improving the management of osteoporosis. Clin Invest Med 1982; 5: 163–7.

Stepan J Pacovsky V Horn V Silinkova-Malkova E Vokrouhlicka O Konopasek B Relationship of the activity of the bone isoenzyme of serum alkaline phosphatase to urinary hydroxyproline excretion in metabolic and neoplastic bone diseases. Eur J Clin Invest 1978; 8: 373–7.

Hodsman AB Fraher LJ Ostbye T Adachi JD Steer BM . An evaluation of several biochemical markers for bone formation and resorption in a protocol utilizing cyclical parathyroid hormone and calcitonin therapy for osteoporosis. J Clin Invest 1993; 91: 1138–48.

Riis BJ . Biochemical markers of bone turnover in diagnosis and assessment of therapy. Am J Med 1991; 55 (B): 64S–68S.

Hasling C Eriksen EF Melkko J Risteli L Charles P Mosekilde L Effects of a combined estrogen-gestagen regimen on serum levels of the carboxy-terminal propeptide of human type I procollagen in osteoporosis. J Bone Miner Res 1991; 6: 1295–300.

Ebeling PR Jones JD O'Fallon WM Jones CH Riggs BL . Short term effects of recombinant human insulin-like growth factor I on bone turnover in normal women. J Clin Endocrinol Metab 1993; 77: 1384–7.

Bettica P Moro L Robins SP Taylor AK Talbot J Singer FR Bone resorption markers galactosyl hydroxylysine, pyridinium crosslinks and hydroxyproline compared. Clin Chem 1992; 38: 2313–18.

Uebelhart D Schlemmer A Johansen JS Gineyts E Christiansen C Delmas PD . Effect of menopause and hormone replacement therapy on the urinary excretion of pyridinium cross links. J Clin Endocrinol Metab 1991; 72: 367–73.

Beardsworth LJ Eyre DR Dickson IR . Changes with age in the urinary excretion of lysyl- and hydroxylysylpyridinoline, two new markers of bone collagen turnover. J Bone Miner Res 1990; 5: 671–6.

Hamdy NAT Papapoulos SE Colwell A Eastell R Russell RGG . Urinary collagen crosslink excretion: A better index of bone resorption than hydroxyproline in Paget's disease of bone? Bone Miner 1993; 22: 1–8.

Stepan JJ Limova Z. Biochemical assessment of bone loss in patients on long term thyroid hormone treatment. Bone Miner 1992; 17: 377–88.

Robins SP Duncan A Riggs BL . Direct measurement of free hydroxy-pyridinium crosslinks of collagen in urine as new markers of bone resorption in osteoporosis. In: Christiansen C Overgaard K , eds. Osteoporosis 1990: Proceedings of the Third International Symposium on Osteoporosis, Copenhagen, Denmark, 14–20 October. Copenhagen: Osteopress, 1990: 465–8.

Thompson PW Spector TD Edwards AC James IT . Urinary deoxypyridinoline and serum osteocalcin as measures of bone metabolism in early postmenopausal women: Distribution and comparison with other measures. In: Christiansen C Overgaard K , eds. Osteoporosis 1990: Proceedings of the Third International Symposium on Osteoporosis, Copenhagen, Denmark, 14–20 October. Copenhagen: Osteopress, 1990: 493–5.

Fledelius F Riis BJ Overgaard K Christiansen C. The diagnostic validity of urinary free pyridinolines to identify women at risk of osteoporosis. Calcif Tissue Int 1994; 54: 381–4.

Rosen HN Pollack R Dresner Moses AC Rosenblatt M Zeind AJ Clemens JD Specificity of urinary excretion of crosslinked N-telopeptides of type I collagen as a marker of bone turnover. Calcif Tissue Int 1994; 54: 26–39.

Scarnecchia L Minisola S Pacitti MT Carnevale V Romagnoli E Rosso R Clinical usefulness of serum tartrate-resistant acid phosphatase activity determination to evaluate bone turnover. Scand J Clin Lab Invest 1991; 51: 517–24.

de la Piedra C Torres R Rapado A Curiel MD Castro N. Serum tartrate-resistant acid phosphatase and bone mineral content in postmenopausal osteoporosis. Calcif Tissue Int 1989; 45: 58–60.

Charles P Hasling C Risteli L Risteli J Mosekilde L Ericksen EF . Assessment of bone formation by biochemical markers in metabolic bone disease: Separation between osteoblastic activity at the cell and tissue level. Calcif Tissue Int 1992; 51: 406–11.

Farley J Chesnut CJ Baylink DJ . Improved method for quantitative determination in serum alkaline phosphatase of skeletal origin. Clin Chem 1981; 27: 2002–7.

Hassager C Jensen LT Johansen JS Riis BJ Melkko J Pødenphant J The carboxy-terminal propeptide of type I procollagen in serum as a marker of bone formation: The effect of nandrolone decanoate and female sex hormones. Metabolism 1991; 40: 205–8.

Melton LJ Eddy DM Johnston CC . Screening for osteoporosis. Ann Int Med 1990; 112: 516–28.

Torgerson DJ Reid DM . Osteoporosis prevention through screening: Will it be cost effective? In: Reid D , ed. Osteoporosis. Baillière's Clinical Rheumatology , Vol 7. London: Baillière Tindall, 1993: 603–22.

Nordin BEC Need AG . How can we prevent osteoporosis? In Christiansen C Johansen JS Riis BJ , eds. Osteoporosis. Denmark: Norhaven A/S, 1987: 1205–10.

Anon. Expensive news for osteoporotics. Lancet 1988; ii: 754.

Wosnich RD Ross PD Maclean CJ Davis JW Vogel JM . A prospective study of bone mass measurements and spine fracture incidence. In: Christiansen C Johansen JS Riis BJ , eds. Osteoporosis. Denmark: Norhaven A/S, 1987: 377–8.

Jensen GF Christiansen C Transbol I. Fracture frequency and bone preservation in postmenopausal women treated with estrogen. Obstet Gynecol 1982; 69: 493–6.

Nilsson BE Westlin NE . Bone mineral content and fragility fractures. Clin Orthop 1977; 125: 196–9.

Eltinger G Genant HK Cann CE . Long term estrogen replacement prevents bone loss and fractures. Ann Int Med 1985; 102: 319–24.

Brown JP Delmas PD Malaval L Edouard C Chapuy MC Meunier PJ . Serum bone Gla protein: A specific marker for bone formation in postmenopausal osteoporosis. Lancet 1984; i: 1091–3.

Christiansen C Riis BJ Rodbro P. Prediction of rapid bone loss in postmenopausal women. Lancet 1987; i: 1105–8.

Christiansen C Riis BJ Rodbro P. Screening procedure for women at risk of osteoporosis. Osteoporos Int 1990; 1: 35–40.

Consensus Development Conference. Prophylaxis and Treatment of Osteoporosis. Am J Med 1991; 90: 107–10.

Mundy GR . Boning up on genes. Nature 1994; 367: 216–17.

Christiansen C , ed. Hormone replacement and its impact on osteoporosis. Clin Obstet Gynaecol 1991; 5: 785–963.

Heaney RP . Effect of calcium on skeletal development, bone loss and risk of fractures. Am J Med 1991; 91 (suppl 5B): 23S–28S.

Tilyard MW Spears GFS Thomson J Dovey S. Treatment of postmenopausal osteoporosis with calcitriol or calcium. N Engl J Med 1992; 326: 357–62.

Harris ST Gertz BJ Genant HK Eyre DR Survill TT Ventura JN The effect of short term treatment with alendronate on vertebral density and biochemical markers of bone remodelling in early postmenopausal women. J Clin Endocrinol Metab 1993; 76: 1399–406.

Chestnut CH . Drug therapy: Calcitonin, bisphosphonates, anabolic steroids and hPTH (1–34). In: Riggs BL Melton LJ , eds. Osteoporosis: Etiology, Diagnosis and Management. New York: Raven Press, 1988: 403–14.

Hodsman AB Steer BM Fraher LJ Drost DJ . Bone densitometric and histomorphometric responses to sequential human parathyroid hormone (1–38) and salmon calcitonin in osteoporotic patients. Bone Miner 1991; 14: 67–83.

Dure-Smith BA Kraenzlin ME Farley SM Libonati CR Schulz EE Baylink DJ . Fluoride therapy for osteoporosis: A review of dose response, duration of treatment and skeletal sites of action. Calcif Tissue Int 1991; 49 (suppl): S64–72.