The effects on general and bone metabolism of femoral neck fracture patients of 0.25 μg α-calcoid given orally twice daily (n=9) and 25 μg calcitonin given subcutaneously 30 times (n=10) in 10 weeks were studied against a control (n=ll). Bone histology and histomorphometry showed non-age related osteoporosis in 30% and osteomalacia in 22% of the patients studied. Impaired serum vitamin D status was found in 47 – 88% of patients, secondary hyperparathyroidism and increased serum parathyroid hormone in 59% and decreased serum calcitonin levels in 69%. On histology, normal findings and non-age related osteoporosis on histology were associated with low serum levels of 25-hydroxyvitamin D3,1,25- and 24,25-dihydroxy vitamin D3. Very high serum levels of 1,25-dihydroxyvitamin D3 and low levels of 25-hydroxyvitamin D3 occurred in fracture patients with osteomalacia. Calcitonin improved calcium balance, reduced osteoporosis and increased the serum 1,25- and 24,25-dihydroxyvitamin D3 levels but had no effect on osteomalacia. Vitamin D reduced osteomalacia, slightly increased the serum 1,25-dihydroxyvitamin D3 concentration and decreased serum levels of parathyroid hormone. Both treatments gave a similar slight decrease in serum calcitonin concentrations. A mechanism of action for the treatments is suggested.
LewinnekGEKelseyJWhiteAA: The significance and a comparative analysis of the epidemiology of hip fractures. Clin Orthop1980; 152: 35–43.
2.
BolletAJEnghGParsonW: Epidemiology of osteoporosis. Arch Intern Med1965; 116: 119–194.
3.
EnghGBolletAJHardinG: Epidemiology of osteoporosis. II. Incidence of hip fracture in mental institutions. J Bone Joint Surg (Am)1968; 50: 557–562.
4.
NiemannKMMankinHJ: Fractures about the hip in an institutionalized patient population. J Bone Joint Surg (Am)1968; 50: 1327–1340.
5.
AlfframP-A: An epidemiologic study of cervical and trochanteric fractures of the femur in an urban population. Acta Orthop Scand1964; 35 (suppl 65): 1–109.
6.
LevineSMakinMMenczelJ: Incidence of fractures of the proximal end of the femur in Jerusalem. J Bone Joint Surg (Am)1970; 52: 1193–1201.
7.
AlhavaEMPuittinenJ: Fractures of the upper end of the femur as an index of senile osteoporosis in Finland. Ann Clin Res1973; 5: 398–403.
8.
KnoweldenJBuhrAJDunbarO: Incidence of fractures in persons over 35 years of age. Br J Prev Soc Med1964; 18: 130–141.
9.
ChalmersJHoKC: Geographical variations in senile osteoporosis. J Bone Joint Surg (Br)1970; 52: 667–675.
10.
WongPCN: Fracture epidemiology in a mixed Southeastern Asian community (Singapore). Clin Orthop1966; 45: 55–61.
11.
SolomonL: Osteoporosis and fracture of the femoral neck in the South African Bantu. J Bone Joint Surg (Br)1968; 50: 2–13.
12.
StevensJFreemanPANordinBEC: The incidence of osteoporosis in patients with femoral neck fracture. J Bone Joint Surg (Br)1962; 44: 520–527.
13.
Newton-JohnHFMorganDB: The loss of bone with age, osteoporosis, and fractures. Clin Orthop1970; 71: 229–252.
14.
BrownLRFBakowskaAMillardPH: Vitamin D status of patients with femoral neck fractures. Age Ageing1976; 5: 127–131.
15.
WeismanYSalamaRHarellA: Serum 24,25-dihydroxyvitamin D and 25-hydroxyvitamin D concentrations in femoral neck fracture. Br Med J1978; 2: 1196–1197.
16.
BakerMRMcDonnellHPeacockM: Plasma 25-hydroxyvitamin D concentration in patients with fractures of the femoral neck. Br Med J1979; 1: 589–590.
17.
DawCJGrayDHHardyAE.: Osteomalacia and femoral neck fractures. J Bone Joint Surg (Br)1979; 61: 385–386.
18.
HoikkaVAlhavaEMSavolainenK: Osteomalacia in fractures of the proximal femur. Acta Orthop Scand1982; 53: 255–260.
19.
LundBSorensenOHLundB: Vitamin D, metabolism and osteomalacia in patients with fractures of the proximal femur. Acta Orthop Scand1982; 53: 251–254.
20.
HarjuESotaniemiEPuranenJ: High incidence of low serum vitamin D concentration in patients with hip fracture. Arch Orthop Trauma Surg1985; 103: 408–416.
21.
ParviainenMT: The fat-soluble vitamins A, D and E – their metabolism, binding-proteins and determination from human serum. Acta Univ Tamperensis Ser A1983; 159: 1–78.
22.
Ala-HouhalaMKoskinenTTerhoA: Maternal compared with infant vitamin D supplementation. Arch Dis Child1986; 61: 1159–1163.
23.
ReinhardtTAHorstRLOrfJW: A microassay for 1,25-dihydroxyvitamin D not requiring high performance liquid chromatography: application to clinical studies. J Clin Endocrinol Metab1984; 58: 91–98.
24.
DeLucaHFSchnoesHK: Metabolism and mechanism of action of vitamin D. Annu Rev Biochem1976; 45: 631–653.
25.
HolickMF: The cutaneous photosynthesis of previtamin D3: a unique photoendocrine system. J Invest Dermatol1981; 76: 51–58.
26.
FraserDR: Regulation of vitamin D metobolism. Physiol Rev1980; 60: 551–613.
27.
NormanAWRothJOrciL: The vitamin D endocrine system: steroid metabolism, hormone receptors and biological responses. Endocrinol Rev1982; 3: 331–366.
28.
Exton-SmithAN: Osteomalacia. In: Practical Geriatric Medicine (Exton-SmithANWekslerME, eds). New York: Churchill Livingstone, 1985; pp 344–349.
29.
AaronJEGallagherJCAndersonJ: Frequency of osteomalacia and osteoporosis in fractures of the proximal femur. Lancet1975; i: 229–233.
30.
DeLucaHF: Metabolism and molecular mechanism of action of vitamin D. Biochem Soc Trans1982; 10: 147–158.
31.
ShultzTDFoxJHeathH: Do other tissues than the kidney produce 1,25-dihydroxyvitamin D in vivo? A reexamination. Proc Natl Acad Sci USA1983; 80: 1746–1750.
32.
DeLucaHF: The vitamin D system in the regulation of calcium and phosphorus metabolism. Nutr Rev1979; 37: 161–193.
33.
OhnumaNNormanAW: Identification of a new C-23 oxidation pathway of metabolism for 1,25-dihydroxyvitamin D3 present in the intestine and kidney. J Biol Chem1982; 257: 8261–8271.
34.
OhnumaNKruseJRPopjakG: Isolation and identification of two new vitamin D metabolites produced by the intestine, 1,25-dihydroxy-23-oxo-vitamin D3 and 1,25,26-trihydroxy-23-oxovitamin D3J Biol Chem1982; 257: 5097–5102.
35.
NapoliJLHorstRL: 1,23,25-Trihydroxycholecalciferol, an intestinal metabolite of 1,25-dihydroxycholecalciferol. Biochem J1983; 214: 261–264.
36.
MayerEBishopJEOhnumaN: Biological activity assessment of the vitamin D3 metabolites 1,25-dihydroxy-24-oxo-vitamin D3 and 1,23,25-trihydroxy-24-oxo-vitamin D3. Arch Biochem Biophys1983; 224: 671–676.
37.
LundBSorensenOHChristensenAB: 25-Hydroxycholecalciferol and fractures of the proximal femur. Lancet1975; ii: 300–302.
38.
WoottonRBreretonPJClarkMB: Fractured neck of femur in the elderly: an attempt to identify patients at risk. Clin Sci1979; 57: 93–101.
39.
RapinCHJungALagierR: Y a-t-il une composante Qstelmalacique dans les fractures du col du femur?Schweiz Med Wochenschr1979; 109: 1894–1895.
40.
PettiforJMRossFPSolomonL: Seasonal variation in serum 25-hydroxycholecalciferol concentrations in elderly South African patients with fractures of femoral neck. Br Med J1978; 1: 826–827.
41.
SolomonL: Fracture of the femoral neck in the elderly: bone ageing or disease?S Afr J Surg1973; 11: 269–279.
42.
NiemannKMWMankinHJ: Fractures about the hip in the elderly indigent patient. I. Epidemiology. Geriatrics1968; 23: 150–158.
43.
ParfittAMKleerekoperM: Clinical disorders of calcium phosphorus and magnesium metabolism. In: Clinical Disorders of Fluid and Electrolyte Metabolism, 3rd edn (MaxwellMKleemanCR, eds). New York: McGraw-Hill, 1980; pp 947–1152.
44.
FrameBParfittAM: Osteomalacia: current concepts. Ann Intern Med1978; 89: 966–982.
45.
PointonJJFrancisMJOSmithR: Effect of vitamin D deficiency on sarcoplasmic reticulum function and troponin C concentration of rabbit skeletal muscle. Clin Sci1979; 57: 257–263.
46.
SorensenOHLundBISaltinB: Myopathy in bone loss of ageing: improvement by treatment with 1-hydroxycholecalciferol and calcium. Clin Sci1979; 56: 157–161.
47.
LeitchIHKnoweldenJSeddonHJ: Incidence of the fractures, particularly of the neck of the femur, in patients in mental hospitals. Br J Prev Soc Med1964; 18: 142–145.
48.
WicksMGarrettRVernon-RobertsB: Absence of metabolic bone disease in the proximal femur in patients with fracture of the femoral neck. J Bone Joint Surg (Br)1982; 64: 319–322.
49.
PiatkowskiSModrzewskiKSkwarczA: Pathological and traumatic fractures of the femoral neck in the course of osteomalacia (Looser – Milkmann syndrome). Pol Med Sci Histol Bull1966; 9: 193–196.
50.
O'DriscollM: Subcapital fracture types and osteomalacia and vitamin D deficiency. J Bone Joint Surg (Br)1973; 55B: 882.
51.
FreemanMARToddRCPirieCJ: The role of fatigue in the pathogenesis of senile femoral neck fractures. J Bone Joint Surg (Br)1974; 56B: 698–702.
52.
HorsmanANordinBECAaronJ: Cortical and trabecular osteoporosis and their relation to fractures in the elderly. In: Osteoporosis. Recent Advances in Pathogenesis and Treatment (DeLucaHFFrostHMJeeWSS, eds). Baltimore: University Park Press, 1981; pp 175–184.
53.
ParfittAMGallagherJCHeaneyRP: Vitamin D and bone health in the elderly. Am J Clin Nutr1982; 36: 1014–1031.
54.
ElsasserUHespRKlinermanL: Deficit of trabecular and cortical bone in elderly women with fracture of the femoral neck. Clin Sci1980; 59: 393–395.
55.
CorlessDBeerMBocherBJ: Vitamin D status in long-stay geriatric patients. Lancet1975; i: 404–406.
56.
MathewsMCMatkovicVWalczakN: Bone mineral density and 25-hydroxy D measurements in elderly nursing home residents. Abstracts of Fifth Workshop on Vitamin D1982; 327.
57.
Exton-SmithANHodkinsonHMStantonBR: Nutrition and metabolic bone disease in old age. Lancet1966; ii: 999–1001.
58.
McLennanWJCairdFIMacLeodCC: Diet and bone rarefaction in old age. Age Ageing1972; 1: 131–140.
59.
TsaiK-SHeathHIIIKumarR: Impaired vitamin D metabolism with aging in women. J Clin Invest1984; 73: 1668–1672.
60.
SteenbockH: The induction of growth promoting and calcifying properties in a rat by exposure to light. Science1984; 60: 224–225.
61.
SteenbockHBlackA: Fat-soluble vitamins. XVII. The induction of growth-promoting and calcifying properties in a rat by exposure to ultraviolet light. J Biol Chem1924; 61: 405–422.
62.
BurnsJPatersonCR: Single dose vitamin D treatment for osteomalacia in the elderly. Br Med J1985; 290: 281–282.
63.
DaviesMMawerEBHannJT: Vitamin D prophylaxis in the elderly: a simple effective method suitable for large populations. Age Ageing1985; 14: 349–354.
64.
StanburySW: Vitamin D and hyperparathyroidism. J R Coll Physicians Lond1981; 15: 205–217.
65.
DattaniJTExton-SmithANStephenML: Vitamin D status of the elderly in relation to age and exposure to sunlight. Hum Nutr Clin Nutr1984; 38C: 131–137.
66.
ReidIRGallagherDJABosworthJ: Prophylaxis against vitamin D deficiency in the elderly by regular sunlight exposure. Age Ageing1986; 15: 35–40.
67.
ParfittAMKleerekoperM: The divalent ion homeostatic system: physiology and metabolism of calcium, phosphorus, magnesium and bone. In: Clinical Disorders of Fluid and Electrolyte Metabolism, 3rd edn (MaxwellMKleemanCR, eds). New York: McGraw-Hill, 1980; pp 269–398.
68.
ParfittAMMathewsCRaoD: Impaired osetoblast function in metabolic bone disease. In: Osteoporosis, Recent Advances in Pathogenesis and Treatment (DeLucaHFFrostHMJeeWSS, eds). Baltimore: University Park Press, 1981; pp 321–330.
69.
ParfittAM: Metacarpal cortical dimensions in hypoparathyroidism, primary hyperparathyroidism and chronic renal failure. Calcif Tiss Res1977; 22 (suppl): 329–331.
70.
MorganDBHuntGPatersonCR: The osteomalacia syndrome after stomach operations. Q J Med1970; 39: 395–410.
71.
NordinBECSmithDA: Pathogenesis and treatment of osteomalacia. In: L'Osteomalacie (HiocoDJ, ed). Paris: Masson et Cie, 1967; pp 379–399.
72.
HodkinsonHMBrysonEKlenermanL: Sex, sunlight, season, diet and the vitamin D status of elderly patients. J Clin Exp Gerontol1979; 1: 13–15.
73.
BaylinkDMaloneyNMoreyE: Mild vitamin D deficiency (-D): a cause of osteoporosis in the elderly. Gerontologist1977; 17: 39.
74.
AvioliLV: Osteoporosis and calcitonin therapy: a new horizon. In: Proceedings of the International Symposium on Calcitonin 1984 (PecileA, ed). Amsterdam: Elsevier, 1985; pp 137–143.
75.
RasmussenH: Effect of combined therapy with phosphatase and calcitonin on bone volume in osteoporosis. Metab Bone Dis Rel Res1980; 2: 107–111.
76.
ChesnutCHNelpWBDenneyJB: Measurement of total body calcium (bone mass) by neutron activation analysis; applicability to bone-wasting disease. In: Clinical Aspects of Metabolic Bone Disease (FrameBParfittAMDuncanH, eds). Amsterdam: Elsevier, 1973; pp 50–54.
77.
WallachSAgrawalRCohnS: Les cahiers du Collège européen de therapeutique. Lyon Mediterranee Med – Med Sud-est1981; 7 (suppl 1): 28–32.
78.
BannagiaALoreF: The rationale of calcitonin treatment in postmenopausal osteoporosis. In: Calcitonin (PecileA, ed). Amsterdam: Excerpta Medica, 1980; pp 225–236.
79.
ChesnutCHSisomKNelpWB: In: Osteoporosis, a Multidisciplinary Problem (Dixon SJ, ed). R Soc Med Int Congr Symp Ser1983; 55: 239–244.
80.
MazzuoliGFPasseriMGennariC: Calcitonin 1984. Excerpta Med Int Congr Ser1985; 663: 129–136.
81.
TaylorWH: In: Osteoporosis – Its Management and Role of Calcitonin in Bone Disease and Calcitonin (NamesJARaithbyL, eds). London: De Montfort Press, 1977; p 149.
82.
LenderMVernerE: Intestinal absorption of 47Ca in elderly patients with osteoporosis, Paget's disease and osteomalacia. Effects of calcitonin oestrogen and vitamin D2. Gerontology1977; 23: 31–36.
83.
AndersonICampbellAERDunnA: Osteomalacia in elderly women. Scott Med J1966; 11: 429–435.
84.
ChalmersJConacberWDHGardnerDL: Osteomalacia a common disease in elderly women. J Bone Joint Surg (Br)1967; 49: 403–423.
85.
JenkinsDHRRobertsJGWebsterD: Osteomalacia in elderly patients with fracture of the femoral neck: a clinico-pathological study. J Bone Joint Surg (Br)1973; 55: 575–580.
86.
EidAMOrthMC: Osteomalacia as a contributing factor in fracture of the femoral neck in the elderly in Qatar. Clin Orthop1978; 132: 129–135.
87.
HoskingDJ: Changes in serum alkaline phosphatase after femoral fractures. J Bone Joint Surg (Br)1978; 60: 61–65.
88.
NilssonBEWestlinNE: The plasma concentration of alkaline phosphatase, phosphorus and calcium following femoral neck fracture. Acta Orthop Scand1972; 43: 504–510.
89.
SotaniemiEAHakkarainenHKPuranenJA: Radiologic bone changes and hypocalcemia with anticonvulsant therapy in epilepsy. Ann Intern Med1972; 77: 389–394.
