Aluminium deposition in bone after contamination of drinking water supply.

Two healthy individuals who drank water accidentally contaminated at source with aluminium sulphate solution were investigated 6-7 months later. Bone biopsy specimens showed discrete lines of positive staining for aluminium, the distribution being compatible with acute exposure some months previously. These findings show that under certain conditions normal individuals can absorb aluminium via the gut, and that such aluminium can be deposited in bone.

A quantitative study of iliac bone histopathology on 62 cases with itai-itai disease.

Sixty-two autopsy cases with "itai-itai" or "ouch-ouch" (in English) disease and 50 control subjects were examined by static quantitative bone histopathology. Decalcified sections after cyanuric chloride treatment (Yoshiki's method) were used. The small observer variances of the decalcified sections guaranteed the accuracy and precision of this method. In the static measurement analyses, significant increases in formation parameters and decreases in structural parameters were observed (P less than 0.05-0.000001), suggesting the presence of a marked osteoid accumulation accompanied by a bone mass reduction. Discriminant analysis clearly separated the patients from the control subjects. Two-thirds of the patients showed an increase in resorption surface prior to osteoid deposition and a decrease in osteoblast surface. Double tetracycline labeling in 4 patients showed an impaired osteoid maturation and mineralization. An impaired osteoblastic function was suggested by the results of the static and dynamic histomorphometry. The bone cadmium contents were measured in 46 patients by an atomic absorption spectrophotometer and found to be increased significantly (P less than 0.01). In Aluminon (an ammonium salt of aurine tricarboxytic acid) staining, a clear, reddish line was located in an osteoid-bone interface, suggesting a reaction of Aluminon with tissue aluminium and/or cadmium. These results suggested that an impairment of osteoblastic function and mineralization occurred in itai-itai disease and that cadmium is a possible etiological factor.

Sex- and age-related changes in bone and serum osteocalcin.

We measured bone osteocalcin concentrations in EDTA extracts from iliac crest cortical bone specimens obtained postmortem from 63 men and 71 women (age range 19-90 years), and serum osteocalcin levels in healthy blood donors, 49 men and 49 women (age range 21-65 years). Bone and serum osteocalcin concentrations were higher in men than in women, and an age-related decline was observed in both sexes. In women, however, a temporary increase in serum (P less than 0.05) osteocalcin was seen in the sixth decade. This study shows sex- and age-related changes in bone osteocalcin consistent with changes in serum osteocalcin, confirming that serum measurement of osteocalcin reflects bone levels. As osteocalcin reflects osteoblastic activity and thus bone formation, the overall decline in bone and serum osteocalcin in men and women, and the increase in serum osteocalcin in the sixth decade in women, indicate that aging is associated with a decrease in bone formation and turnover and that osteoblastic activity and bone turnover are stimulated at the menopause.

Iliac crest needle biopsy as a method for determining estrogen receptors in bone metastases from breast cancer.

The purpose of our study was to clarify whether the amount of tissue extracted by means of iliac crest needle biopsy (ICNB) would suffice for a quantitative determination of estrogen receptors (ER) in bone metastases, and to see if the method currently used for determining ER in primary tumors could also be successfully utilized in ICNB. 22 of 31 breast cancer patients examined could be evaluated. ER was positive in 7 (31.8%). Reasonable data are to be expected when the biopsy weight exceeds 0.1 g. Our study confirms that the necessary amount of tissue for ER analysis can indeed be extracted by ICNB. Our results justify further studies on a larger group of patients, since we cannot make conclusive statements concerning the value of this method for predicting the ultimate success of an endocrine treatment.

Physical and histomorphological characteristics of iliac crest bone differ according to the grade of osteoarthritis at the hand.

The amount of cortical and trabecular bone was studied in 32 iliac crest necropsy specimens from women 60-75 years of age and examined according to the grade of osteoarthritis. Three different methods to evaluate bone mass were used: dual photon absorptiometry, physical assessment according to Archimedes' principle, and histomorphometry. Patients were divided into groups--with or without osteoarthritis--according to the presence of osteoarthritis on hand x rays. A significantly increased amount of cortical and trabecular bone mass was found in those who had osteoarthritis at the hands. Percent pure/crude bone volume and trabecular width were found to be increased with osteoarthritic grade, indicating that primary osteoarthritis is probably part of a generalized bone disease.

[A histomorphometric study of normal iliac trabecular bones. Part I: Age related changes and the values of tissue-leveled static parameters].

Trans-iliac bone biopsies were performed on 142 normal Japanese subjects (55 males, 87 females, mean age: 44.8 years) and were evaluated particularly for the indices of tissue-leveled static parameters: volume and thickness of bone/osteoid, and surface measurement of formation, resorption and inert surface. The results were in general agreement with previous studies, but some discrepancies were found regarding osteoid indices: 1) The osteoid (formation) surface, especially osteoblastic osteoid surfaces, increased significantly at the ages from 50 to 60 years in females, 2) osteoid volume and relative osteoid volume were also found to have increased at this age range in females, 3) osteoid thickness decreased or had a rather constant value in females, and 4) the values of these 3 parameters decreased in males with the advance of age after young adulthood. From these results, at least at tissue level, the bone formation rate seemed to increase from the 6th to the 7th decade of life in women making a clear contrast to men in whom the formation rate appeared to decrease within the same age range.

Demonstration of aluminium in iliac bone: correlation between aluminon and solochrome azurine staining techniques with data on flameless absorption spectrophotometry.

The presence of excess aluminium was investigated in 204 samples of iliac bone from 197 patients with chronic renal failure by using the aluminon and solochrome azurine staining techniques. The results were compared with values obtained by atomic absorption spectrophotometry (AAS). Overall, the staining reactions correlated with the AAS data, but the solochrome azurine stain was positive more often than was the aluminon stain (in 90.6% and 62.3%, respectively, of bone samples with greater than the control group mean +3SD (that is, in the range 17.8 to 113.4 micrograms aluminium/g Solochrome azurine staining was consistently positive in all cases, with greater than 23.1 micrograms aluminium/g bone but the corresponding aluminon stain was occasionally inexplicably negative in this range. In some samples solochrome azurine was positive in parts of old unresorbed cement lines when the aluminon stain was negative and the bone aluminium concentration was within the normal range or slightly increased. The stains, particularly solochrome azurine, have the advantage over AAS in that they indicate the location as well as the presence of excess bone aluminium.

Fluoride content in human iliac bone: results in controls, patients with fluorosis, and osteoporotic patients treated with fluoride.

The major part of fluoride ingested is fixed on calcified tissues, mainly in bone tissue, and then is progressively but slowly recycled during bone remodeling. Thus, the measurement of bone fluoride content allows the determination of the extent of bone fluoride retention, and this parameter constitutes a useful complement to bone histology for the diagnosis of skeletal fluorosis and could also be used for the management of fluoride treatment of osteoporosis. A simple method is described to measure the fluoride content in calcined human iliac bone samples. Bone ashes were diluted in perchloric acid, and the measurement of the bone fluoride content was performed using a specific ion electrode combined with a reference electrode. Reference values are given for bone tissue from 76 control subjects (0.08 +/- 0.05% of bone ash), from two groups of 117 and 102 untreated osteoporotic patients (0.05 +/- 0.03% and 0.08 +/- 0.05%, respectively), from 166 sodium fluoride-treated osteoporotic patients (mean bone fluoride content varying from 0.24 to 0.67%, depending on the duration of therapy), and from 96 patients showing typical skeletal fluorosis (mean bone fluoride content varying from 0.56 to 1.33%, depending on the etiology of fluorosis and the relationship with the amount of fluoride ingested as well as with the duration of fluoride exposure). During a prolonged exposure of adult bone tissue to fluoride, the early bone fluoride uptake is variable and depends on the remodeling activity; then it increases rapidly before becoming more or less stable at a maximum level.

Bone lead in dialysis patients.

We measured lead and calcium in multiple bone biopsies from 11 cadavers without known excessive past exposure to lead. Paired iliac crest, transiliac and tibial bone biopsies from these cadavers indicated that in bone biopsy specimens the lead/calcium ratio is more reproducible than the absolute lead concentration. There were no significant differences between the lead/calcium ratios from the iliac crest, transiliac, or tibial specimens. Transiliac bone biopsies from 35 patients (13 patients showing symptoms of slight or moderate degree of renal failure, medical history of gout and/or arterial hypertension and 22 lead workers with chelatable lead in excess of 1000 micrograms) indicated that the lead and the lead/calcium ratio in bone biopsies reflect body lead stores as estimated by the EDT A test (r = 0.87 and 0.83, respectively). Chemical and histological studies of transiliac biopsies previously obtained from 153 dialysis patients (from 8 dialysis centers from Belgium, France and Germany) for studies of aluminum-induced bone disease showed that chronic renal failure and dialysis do not cause accumulation of lead in bone and elevated bone lead does not appear to alter trabecular bone histomorphometry. We found that in 5% of the hemodialysis population studied, bone lead concentrations approximated levels found in active lead workers.

Iliac crest biopsy: an investigation on certain aspects of precision and accuracy.

We investigated the intraobserver and section to section variation in static and dynamic histomorphometric variables in ten iliac crest biopsies. We also did a comparative study of iliac crest and lumbar spine specimens from 14 cadavers. The ten patients had osteoporosis (spinal crush fractures) and the 14 specimens taken at the necropsies were either normal or osteopenic, without malignant bone disease, bone metastases or metabolic bone disease. The majority of the coefficients of variation (CV%) were between 5 and 15% in the intraobserver analysis and 10 and 30% in the section to section analysis. These results suggest that more sections from each biopsy should be investigated to increase the precision. The correlation of variables from the iliac crest and spine showed poor agreement between resorption and osteoid variables. This fact, combined with a rather low precision of bone dynamic variables in the section to section investigation, raises the question of whether iliac crest biopsy is representative for trabecular bone turnover in the skeleton.

Comparison of histomorphometry and computerized tomography of the spine in quantitating trabecular bone in renal osteodystrophy.

Computerized tomography (CT) has the advantage of allowing the isolation of trabecular bone of the axial skeleton, which is the more sensitive to metabolic changes. By means of single-energy X-ray CT we have devised a method for assessing trabecular bone mass (TBM) at L-4 vertebral body, which has an acceptable reproducibility (CV = 2.76%). Normal values where obtained after studying 29 normal individuals from both sexes and different ages. In order to know if the method is accurate, TBM was assessed in 17 patients (6 with creatinine clearance less than 6 ml/min and 11 on chronic hemodialysis), and in all of them the results were compared with the histomorphometry of the iliac crest bone biopsy. TBM assessed by CT correlated with trabecular bone volume (TBV; mineralized bone + osteoid) (r = 0.82; p less than 0.001) and this correlation was not improved after adding the volume of marrow fibrosis to TBV. TBM assessed by CT also correlated with mineralized bone volume but at a lower level of significance (r = 0.72; p = 0.001), and no correlation was found with relative osteoid volume alone. These findings suggest that final CT value is an integral of mineralized bone and osteoid but with a higher influence of mineralized bone. Osteomalacia and osteitis fibrosa were seen in situations of normal, decreased, or increased TBM assessed by CT, although the 2 patients with severe osteosclerosis suffered osteomalacia. We conclude that the assessment of TBM by CT at the axial skeleton of uremic patients has an acceptable reproducibility and accuracy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Roentgenological and quantitative microradiographic study on ossification of posterior longitudinal ligament].

The purpose of this study was to reveal whether patients with OPLL had increased tendency of ossification in other tissues as well. Firstly patients with OPLL were classified according to radiological characteristics of ossification. Secondly transilial bone biopsy to iliac bone followed by Jowsey's microradiological analysis was performed in each patient with OPLL, patients with osteoporosis and normal individuals. The result is summarized as follows: OPLL is classified radiologically into three groups. Patients with OPLL tend to have ossification of other organs. The trabecular bone area in OPLL is significantly higher than normal and osteoporotic group. The resting surface of OPLL group is lower than normal and the turnover in OPLL is higher than normal group. The bone mineral content is more increased in OPLL group.

Bone mineral content of transilial biopsies in patients with hip fracture.

In a survey of 125 patients with hip fracture vitamin D deficiency was frequently observed, but overt osteomalacia was not found in the bone biopsies (Lips et al., 1982). In order to detect a possible hypomineralization in these vitamin D-deficient patients, we measured the bone mineral content in 64 transilial biopsies, embedded in methylmethacrylate for histomorphometric evaluation. The results were compared with those of 18 bone samples obtained at autopsy from subjects who did not suffer from metabolic bone disease. The calcium:hydroxyproline ratio, the phosphorus:hydroxyproline ratio, and the calcium:phosphorus ratio were similar in the two groups. The magnesium:hydroxyproline ratio was higher in the hip fracture group than in the controls. The ratios did not correlate with serum concentrations of the vitamin D metabolites. The results are not consistent with a decreased bone mineralization in patients with hip fracture.

Histomorphometric analysis of dynamic parameters of trabecular bone formation in the iliac crest of normal British subjects.

Some dynamic parameters of bone formation in trabecular iliac crest bone have been measured in a group of normal British subjects of both sexes over a wide age range. There was a significant age-related decrease in mean wall thickness. When either double plus single or double only tetracycline-labeled surfaces were used to represent actively mineralizing surfaces, there was a significant age-related decrease in the bone formation rate at the basic multicellular unit level. Osteoid maturation period showed a significant age-related increase when calculated using double plus single labeled surfaces. There was no significant change with age in fractional labeled surfaces, mean osteoid seam width, bone formation rate at tissue level, or bone formation period. The mean osteoid seam width and osteoid maturation period were significantly higher in males than in females.

The suitability of the iliac crest biopsy in the element analysis of bone and marrow.

Bone samples from the iliac crest were taken from 20 subjects and the content of some trace elements (iron, zinc, selenium, cobalt, strontium, aluminium, scandium, rubidium and fluorine) and of the matrix elements calcium, phosphorus and sodium was determined. The samples were taken in accordance with Burkhardt's method, which is often used in hospital for bone biopsies. The sources of errors occurring during the analysis of trace elements using this clinical procedure and the contamination of the samples by blood and the surrounding tissue are discussed. In-vivo activation analysis is also discussed as an alternative method of element analysis of the skeleton.