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We prepared aqueous extracts of whole femorae and tibiae of embryonic chicks. An amount of extract containing 25 microgram of protein resulted in a 500% increase in DNA synthesis in calvarial cell culture, and significant effects were detected with 5 microgram (55%). The time course for stimulation of DNA synthesis showed a peak occurring 16-20 h after addition of the extract. This matrix factor is nondialyzable, and fractionation on a column of Sephadex G-100 indicated a molecular weight of 60-80,000. At the maximum dose used, [3H]proline incorporation into total protein of calvarial cells was increased by 55%, and thus far, all fractions active in promoting DNA synthesis have been found to increase collagen synthesis in cultured chick tibiae. These data are consistent with an effect on osteoblasts as well as bone precursor cells. Extracts prepared from tibiae of 2-day-old chicks, from which the marrow had been removed, also stimulated DNA synthesis (280% increase), thus ruling out the possibility that the factor is a relatively nonspecific nitrogen from the hematopoietic cell line. We conclude that bone matrix contains a substance which could regulate bone formation in vitro by control of mitosis in osteogenic precursors and/or stimulation of osteoblast activity.

Culture medium which was conditioned by tissue of a CE mouse breast tumor in vitro contained dose-dependent osteolytic activity. The osteolytic activity was not soluble in dichloromethane and ethylacetate, indicating that it was not attributable to vitamin D metabolites or prostaglandins. However, breast tumor-conditioned medium stimulated production and release of prostaglandin E2 from mouse calvaria in vitro, and the stimulation of bone resorption in vitro by breast tumor-conditioned medium was blocked by a dose of indomethacin that prevented stimulation of mouse calvarial prostaglandin E2 production and release. The resorptive activity of parathyroid hormone (PTH) was not affected by the same dose of indomethacin, suggesting that the osteolytic factor was not PTH. This was further supported by observation that mouse kidney cell cAMP production was stimulated by PTH, but not by the aqueous phase of ethylacetate-extracted breast tumor-conditioned medium. In addition to osteolytic activity, breast tumor-conditioned medium contained a dose-dependent bone cell mitogenic activity, demonstrated by the stimulation of [3H]thymidine incorporation into trichloroacetic acid-insoluble macromolecules and a corresponding increase in bone cell number in monolayer cultures of bone cells. Breast tumor-conditioned medium also contained a dose-dependent transforming growth factor-(TGF-) like activity as defined by its ability to transform anchorage-dependent growth of nontransformed cells to anchorage-independent growth. The TGF in breast tumor-conditioned medium did not compete with epidermal growth factor (EGF) for EGF receptor binding, but its transforming activity was greatly enhanced by EGF, indicating that it was a beta-type TGF. Both the osteolytic and mitogenic activities were nondialyzable, sensitive to reducing agent, and not removable by dichloromethane and ethylacetate extractions. Furthermore, the TGF activity was not removed by ethylacetate extraction. Thus, the possibility that these activities in breast tumor-conditioned medium might be mediated by the same molecule must be considered. In summary, our data suggest that the CE mouse mammary carcinoma cells produce and secrete into the culture medium an osteolytic factor which is neither PTH nor prostaglandin and which stimulates local synthesis in bone of prostaglandin E2 which in turn increases bone resorption in vitro.

1,25-Dihydroxyvitamin D3 (1,25(OH)2D3) significantly stimulated cellular alkaline phosphatase activity in a human osteoblastic osteosarcoma cell line (TE-85 cells) in serum-free medium with 0.1% bovine serum albumin as the hormone carrier in a dose- and a time-dependent manner. The extent of the maximal stimulation was greater and the minimal dose that was required for stimulation was lower than those previously reported for TE-85 cells in the presence of serum. The magnitude of the stimulation of alkaline phosphatase activity by 1,25(OH)2D3 varied with the cell density. Daily changes of conditioned medium, as compared with no medium changes, significantly reduced the magnitude of the stimulation, suggesting that endogenous factors secreted into culture medium could play an enhancing role. Finally, application of Northern blot analysis using an oligodeoxynucleotide probe corresponding to a unique sequence of the human bone/liver/kidney alkaline phosphatase cDNA coding region revealed that 1,25(OH)2D3 increased the alkaline phosphatase mRNA level, suggesting that the increase in alkaline phosphatase activity was a result of either an increase in the rate of transcription or an increase in message stability.

Although the biologically active metabolite of vitamin D, 1,25-dihydroxycholecalciferol, is synthesized exclusively by kidney tissue, severe hypercalcemia developed in an anephric child treated with large doses of vitamin D. Treatment by calcium-free peritoneal dialysis acutely reduced serum calcium from 17.2 to 14.2 mg/100 ml. This decrement was effected by removal of three times the total calcium in extracellular fluid, suggesting enhanced bone resorption. Oral prednisolone for 7 days reduced serum calcium to 13 mg/100 ml, but hypercalcemia recurred rapidly after prednisolone was stopped. Calcitonin, given for only 4 one-half days, produced normocalcemia. Maximum serum 25-hydroxyvitamin D (25-OHD), observed immediately after vitamin D was stopped, was 635 ng/ml (normal range 23-32 ng/ml) and subsequently decreased with an initial half-time of 10 days. Losses in peritoneal dialysate may have contributed to disappearance of serum 25-OHD. Because of the high serum levels of 25-OHD and absence of renal tissue, 25-OHD was the likely metabolite that caused hypercalcemia, probably by stimulation of bone resorption, though contribution to hypercalcemia by another vitamin D metabolite cannot be absolutely excluded.

UMR106 cells, a rat osteosarcoma derived clonal line, secreted insulin-like growth factors (IGF) in vitro. The IGF-II levels corrected for the cell numbers were 7-8 times higher than the IGF-I levels in the medium. Both growth factors were higher by 4-5 fold in medium conditioned by rapidly growing cells than in medium conditioned by confluent cells. The addition of 17-beta-estradiol (E) to the culture medium was associated with a statistically significant increase in the IGF concentrations. This increment was metabolite specific, not occurring with 17-alpha-E, the inactive epimer of E. 1,25(OH)2D3 also increased the IGF-I concentration but prior treatment with E blocked the response to 1,25(OH)2D3, demonstrating antagonistic actions of these two hormones on IGF secretion by osteoblast-like cells.

Using a histochemical method for demonstrating acid phosphatase activity, we have studied osteoclasts residing at two different bone sites in rat incisor alveolar bone, one at the endosteum and the other at the tooth socket, and compared the response of these osteoclasts to systemic changes. After 12 days of calcium (0%) or phosphorus (0.2%) deprivation, the number of osteoclasts/cross section at the endosteum increased 463% (P less than 0.001) and 103% (P less than 0.002), respectively. After 10 days of calcium or phosphorus replenishment, the number of osteoclasts at this bone site decreased to levels not significantly different from those in the control. In contrast, the number of osteoclasts at the incisor socket remained insignificantly changed throughout the experimental period. A similar osteoclast differential response was also observed in the alveolar bone surrounding the first molar tooth. After 12 days of calcium deprivation, the number of osteoclasts/mm bone surface increased 371% (P less than 0.001) at the endosteum but remained insignificantly changed at the first molar socket. These results suggest that an osteoclast differential response exists in alveolar bone and that the response may be of significance inasmuch as the major function of alveolar bone is to support the teeth. The work described here supports the concept of local as well as systemic regulation of bone metabolism to simultaneously perform the dual functions of mineral homeostasis and mechanical support.

Twelve male patients surviving uremia of 9-15 years duration were studied sequentially over a mean period of 9.2 years. Radiographs, bone biopsies, bone mineral mass (BMM) measured by photon absorptiometry, and total body calcium (TBC) determined by in vivo neutron activation analysis (NAA) were used. Pathologic fractures correlated with TBC corrected for height: 4 of 5 patients without fractures had TBC above 80% predicted, whereas 5 of 7 patients with fractures fell below this value. Unlike previous studies, negative calcium balance was seen in 3 patients with prolonged hyperparathyroidism. Though soft tissue calcification occurred in 6 patients, only 1 with massive shoulder calcification had an increase in TBC; this drawback of NAA has been previously overemphasized. Moreover, radial BMM also increased in 2 patients due to soft tissue calcification. When viewed at a single point in time, nearly all patients fell within the wide normal limits of BMM vs TBC. However, 6 patients with variable bone histology studied sequentially over a mean of 8.5 years showed significant preferential loss of radial bone mass compared to TBC. Aluminium retention did not influence calcium balance in these subjects.

Fluoride is one of the most potent but least well understood stimulators of bone formation in vivo. Bone formation was shown to arise from direct effects on bone cells. Treatment with sodium fluoride increased proliferation and alkaline phosphatase activity of bone cells in vitro and increased bone formation in embryonic calvaria at concentrations that stimulate bone formation in vivo.

We have demonstrated a method for autoradiography of cell and tissue preparations which is both rapid and safe. The method utilizes only the primary scintillator, PPO, placed under the final emulsion to facilitate activation of the silver grains in the emulsion. Exposure of the autoradiographs is complete under the conditions described within 4 h at ambient temperature. The method is sensitive to exposure time and to the concentration of added radioisotope. The exclusion of volatile, toxic chemicals from the preparations allows the experiments to be performed without any health hazard to the investigator.

Results are presented from a 2-year controlled study evaluating the efficacy of 100 units synthetic salmon calcitonin/d in the treatment of postmenopausal osteoporosis. All patients received 400 units D2 po qd and 1200 mg CaCO3 po qd. The 21 control and 24 treated patients (mean age 65) were not statistically different at baseline. Although mean total body calcium (TBCa) was not significantly different between treated and control patients throughout the study, mean differences in the change in TBCa from baseline (treated minus control) were significant at 12, 18, and 26 months. The mean slope of TBCa for treated patients, but not for controls, was significantly positive through 18 months. Iliac crest bone biopsies showed (1) a significantly greater percent total bone area in treated compared to control patients at 2 years, and (2) a significantly decreased percent resorbing surface in treated patients when evaluated by paired difference from baseline. At 4 months, serum calcium values were significantly lower in treated patients than in controls (mean difference, treated minus controls), but were not statistically different from controls at study completion. Urine calcium increased significantly for the first 4 months in treated subjects and then declined to baseline levels. Since urinary calcium increased, the increase in TBCa was probably associated with an increase in net intestinal calcium absorption.

Using absorptiometry, the bone calcium mass (BCM) at two different sites of the radius was measured in 12 male patients referred for vestibuloplasty of the mandible. The most distal site contained both cortical and cancellous bone while the other site contained cortical bone only. The BCM values were compared with those for normal patients of the same age. The patients with mandibular atrophy all had less bone in the radius than their age-matched controls (p less than 0.01). This is indicative of a systemic factor or factors operating both in the mandible and in the radius. The examination prior to oral surgery should therefore include an evaluation for diseases causing general bone loss.

Osteocalcin is a vitamin K-dependent bone-specific protein that can be found circulating in the serum. The circulating levels of osteocalcin have been shown to be an index of bone turnover. Existing radioimmunoassays for osteocalcin have been shown to be specific for C-terminal epitopes, a region that is identical in the human and bovine osteocalcin. There are, however, five amino acids different in the N-terminal region of the molecule. We describe here an immunoassay for a midmolecule epitope of osteocalcin using osteocalcin purified from human femoral head bone powder. Antibody specificity was determined using tryptic digests and a synthetic fragment of human osteocalcin. This assay has only a partial crossreactivity with bovine osteocalcin. This is the first report of an assay against a midmolecular epitope of osteocalcin involving a region in which the human and bovine osteocalcins differ. Osteocalcin levels determined by this assay have a significant correlation with both the total serum alkaline phosphatase and the serum skeletal alkaline phosphatase levels in normal adult human serum and, to a greater degree, in sera of patients with conditions associated with increased bone turnover (Paget's disease, hyperparathyroidism, and newborn sera). These correlations are greater than those previously reported for C-terminal assays, suggesting the possibility that different regions of the molecule may elicit different information concerning bone turnover.

A previous study of iliac crest composition identified skeletal calcium deficiency in 25% of 56 postmenopausal osteoporotic patients evaluated prior to the use of stanozolol or calcitonin. This report is a follow-up of biopsy data after 2 years of treatment with drug or placebo in 31 patients, 11 of whom had skeletal calcium deficiency. The study diet, consisting of 1 g elemental calcium plus 400 U Vitamin D, repaired the skeletal calcium deficiency in all patients, treated and untreated alike. Total body calcium (TBC) results were influenced by separation into calcium deficient and normal mineral groups, apparent treatment response being observed largely in patients with calcium deficiency. It is suggested that if all postmenopausal women ingested 1 g elemental calcium plus 400 U Vitamin D daily, skeletal calcium deficiency in osteoporosis would disappear as a problem. Meanwhile, it is important to recognize that repair of calcium deficiency is an important variable capable of influencing bone response to therapy and the evaluation thereof.

A patient with renal cell carcinoma and hypercalcemia was found to have suppressed serum parathyroid hormone levels but striking elevations of immunoreactive prostaglandins in plasma and metastatic tissue. It was hypothesized that prostaglandins may have either played a role in the hypercalcemia or were part of a counterregulatory event.

The SK-Luci-6 cell line, established from a large-cell anaplastic lung tumor of a patient with humoral hypercalcemia of malignancy (HHM), was investigated to identify osteolytic factors produced that might mediate HHM. Most HHM-associated tumors are thought to produce parathyroid hormone-related proteins or transforming growth factor (TGF) alpha. SK-Luci-6 cells formed s.c. tumors and induced hypercalcemia in athymic nude mice. Serum-free conditioned medium from SK-Luci-6 cultures induced bone resorption in neonatal mouse calvariae in vitro, and also contained TGF-beta activity and mitogenic activity. SK-Luci-6 cell conditioned medium did not displace [125I]epidermal growth factor binding to cell receptors or stimulate cyclic AMP formation in rat osteosarcoma cells, suggesting that the conditioned medium did not contain TGF-alpha or parathyroid hormone-related proteins. The osteolytic, TGF-beta, and mitogenic activities copurified in several chromatographic separations: gel filtration in acid and then in guanidine HCl; ion exchange; and reverse phase. The results suggest that in the HHM-associated SK-Luci-6 tumor, the causative osteolytic factor produced by the tumor cells is not a parathyroid hormone-related protein or TGF-alpha but, rather, may be a TGF-beta.

To examine the long-term effects of fluoride therapy in osteoporosis, we obtained iliac crest biopsies from 11 osteoporotic patients 6 to 12 years after they had started fluoride therapy. Although basal biopsies were not obtained, nine subjects had been biopsied 4 years prior to the second biopsy. In addition, 4 subjects had stopped fluoride therapy prior to the second biopsy. Biopsy samples were divided and analyzed: (a) histomorphometrically for bone formation and mineralization; and (b) for mineral content. Parameters of bone formation were increased in the first biopsy of all patients; they remained elevated in the second biopsy of subjects still receiving fluoride, but decreased to normal values in subjects who stopped fluoride therapy. Parameters of mineralization (i.e., osteoid width and osteocytic osteoid) were elevated in the first biopsy, but had decreased in the second biopsy whether fluoride was stopped or not. There was no woven bone in these biopsies. Bone mineral content, whether measured as density or by summation of the individual ions (% mineral), was higher than normal in all subjects, whether or not they were still receiving fluoride. These results suggest that prolonged fluoride therapy of osteoporosis continues to stimulate bone formation, but does not cause a progressive mineralization defect. Mineral content is acutely increased following fluoride therapy, and persists after therapy is discontinued.

We tested the best anatomic site, reliability, and reproducibility of single-photon absorptiometric bone density measurements in premature and term newborns. Humerus and radius measurements were compared using a commercially available densitometer. The humerus was a more reliable site of measurement, particularly in the very-low-birth-weight infant. Normal ranges of humerus bone mineral content (BMC) were defined for infants of 24 to 42 weeks' gestational age at birth. Humerus BMC correlated with gestational age and birth weight of patients. We conclude that bone densitometer measurements can be successfully performed, even in very-low-birth-weight infants, when the humerus is used as the measurements site. We define normal humerus BMC values for use in diagnosis and evaluation of efficacy of treatment in infants who are at higher risk for osteopenia of prematurity.