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History: An 82-year-old woman was admitted with bilateral clavicular fractures after falling out of bed. She complained of pain in all her bones. She reported having undergone a partial gastrectomy (Billroth II) 40 years ago with subsequent milk intolerance and a dislike of direct sun light., Investigations: Scintigraphy revealed multiple areas of abnormal uptake. Conventional radiography showed in both ulnae transverse zones of increased density with a central translucent band. Laboratory tests demonstrated the constellation of increased bone turnover in secondary hyperparathyroidism with hypocalcaemia (1.49 mmol/l) and hypophyosphataemia (0.62 mmol/l). The 25-hydroxyvitamin D-level was too low to be measured. Ileal crest biopsy indicated osteomalacia., Treatment and Course: Serum levels of calcium, alkaline phosphatase and vitamin D became normal after 7 weeks of daily administration of 10,000 IU vitamin D and 1000 mg calcium. The severe pains had subsided after two weeks and no longer required analgesics., Conclusion: Multiple areas of increased uptake on skeletal scintigraphy, combined with diffuse bone pain and increased alkaline phosphatase, were at first misinterpreted as extensive skeletal metastases. But the history, at first seemingly of little significance, contained three long-term risk factors for the development of vitamin D and calcium deficiency and thus of osteomalacia, namely partial gastrectomy, milk intolerance and inadequate exposure to sun light. Early recognition of risk factors for bone changes will rapidly lead to the correct diagnosis and immediate treatment of the treatable underlying disease.

The Ehlers-Danlos syndrome (EDS) comprises a heterogenous group of nine hereditary connective tissue disorders, characterized by hyperelasticity of skin and hypermobility of joints to differing extents. The skin is easily injured and wound healing is delayed. The majority of EDS patients belong to EDS-types I-III. The pathogenesis in these cases is not known, although recent data suggest a role for collagen V. In contrast, the etiology of EDS-types IV, VI and VII has been found. While EDS IV is caused by a mutation in the collagen III gene, in EDS VI a mutation in the lysyl hydroxylase gene is present. In EDS VII, the underlying defect is a mutation in the collagen I gene. The EDS-types V, VII and X are very rare; their symptoms resemble those of EDS-type II.

Synthesis of collagenous and noncollagenous proteins by cells originating from the alveolar bone (AB-cells) and from the periodontal ligament (PDL-cells) of 8 minipigs was analyzed in primary cell cultures. Incorporation of 3H-proline into proteins recovered from cell extracts showed, that 13.7% of protein synthesized by AB-cells and 8.0% of protein synthesized by PDL-cells were collagens. In both cell lines relative amounts of collagens synthesized decreased significantly on subculturing (AB-cells: 9.3%, PDL-cells: 6.0%). Preincubation of 2nd subculture AB-cells with beta-glycerophosphate had no significant effect on collagen synthesis. Considering the fact that relative amounts of collagen recovered from cell extracts represent only 10-20% of collagen recovered from whole culture (i.e. cells and culture medium), we suggest that collagen synthesis is an important component of in vitro-protein synthesis of cells originating from the alveolar bone and the periodontal ligament.