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1. We have examined the relation between the rate of cortical bone loss and other measured variables in 108 women, untreated and on various therapies, observed for nearly 300 patient years. The majority of the subjects were postmenopausal women with various degrees of simple osteoporosis, but a few cases of hyperparathyroidism and other calcium disorders were included. 2. Calcium balance, bone resorption rats, urinary hydroxyproline and plasma alkaline phosphatase were shown to be related to the rate of bone loss; patients with the more negative balance or the higher values of the other variables had significantly higher rates of loss. The rate of bone loss was independent of the rate of bone formation.

Bone mass and related metabolic variables were studied in 50 males known to be, or to have been, regular alcohol abusers. Subjects were divided into those who were still drinking and those who had abstained for at least 3 months, and the former further subdivided into moderate and heavy drinkers. Twenty-five had at least two atraumatic spinal crush fractures. In 25 cases, bone histomorphometry was carried out. Lumbar bone mineral density and iliac crest bone volume were significantly lower in spinal crush fracture cases. Parathyroid hormone, testosterone, and urinary cortisol measurements showed no difference between groups. Alkaline phosphatase and 24-hour urine hydroxyproline were higher in osteoporotics than in nonosteoporotics. On bone histomorphometry, there were essentially no differences between those with and those without fractures in terms of bone formation and resorption parameters. Drinkers showed lower osteoid seam width and fraction of osteoid covered by osteoblasts, as well as fewer osteoblasts per 10 cm of bone surface than abstainers. Mineralization lag time was prolonged, and mineralization rate per day was lower in the drinkers. Osteon formation time was prolonged in the drinkers. On the resorption side, only the osteon resorption time was significantly different in the drinkers, being prolonged. The heavy drinkers, but not the moderate drinkers, had a significantly reduced surface extent of lacunae. We conclude that alcohol consumption has clear detrimental effects on bone formation with less pronounced suppressive effects on bone resorption. In no biochemical or hormonal measurement, however, with the exception of hydroxyproline excretion and plasma alkaline phosphatase, could those who had osteoporosis be distinguished from those who did not.