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Byline: S. Minisola (1), R. Rosso (2), E. Romagnoli (3), J. Pepe (1), S. De Geronimo (1), S. Dionisi (1), F. Paglia (1), N. Raejntroph (1), G. Aliberti (1), G. F. Mazzuoli (1) Keywords: Key words:Bone loss -- Lateral bone densitometry -- Posterior--anterior bone densitometry -- Primary hyperparathyroidism Abstract: This investigation was undertaken to determine whether the preservation of bone mass in patients with mild primary hyperparathyroidism (PHPT) could be detected when measuring spine density in the lateral projection. We compared the bone mineral density (BMD) of L2--L4 utilizing the posterior--anterior (PA) and lateral projections in postmenopausal patients with PHPT and in a group of 27 postmenopausal normal women. Thirty-three consecutive postmenopausal patients with PHPT were studied 25 were asymptomatic whereas the remaining 8 suffered complications related to the disease. Based upon the criteria established by the Consensus Conference on the Management of Asymptomatic PHPT, only 10 of the 25 asymptomatic patients could be considered affected by mild disease the remaining patients were classified as having moderate disease. Patients with mild disease had mean lateral total BMD values (0.682 +- 0.113 g/cm.sup.2) significantly higher than normal women (0.588 +- 0.076, p&lt 0.02) and patients with moderate disease (0.599 +- 0.077, p&lt 0.05). There were significant differences among the three groups in both PA L2--L4 and L1--L4 levels: patients with mild disease had significantly higher mean BMD values than patients with moderate disease and normal women, when either three or four vertebrae were considered. Interestingly, at this latter site, patients with moderate disease had significantly (p&lt 0.05) lower values than normal women. Our results indicate that patients with mild PHPT have a preservation of vertebral mass when compared with the other hyperparathyroid patients and normal women, when taking into account both the mainly trabecular portion and the whole vertebra. The finding that when the PA projection was assessed, BMD values of patients with moderate disease were significantly lower than those of normal women, might be attributed to the detrimental effect of raised parathyroid hormone levels on the cortical component of the vertebral body. Author Affiliation: (1) Dipartimento di Scienze Cliniche, Universita'La Sapienza', Rome, IT (2) Ospedale San Giovanni Evangelista, Tivoli , IT (3) Ospedale San Giovanni Battista, Rome, Italy, IT Article note: Received: 20 October 2001 / Accepted: 26 February 2002

Byline: S. Minisola (1), S. Dionisi (1), M. T. Pacitti (1), F. Paglia (1), V. Carnevale (2), A. Scillitani (3), S. Mazzaferro (1), S. De Geronimo (1), J. Pepe (1), E. D'Erasmo (1), E. Romagnoli (4) Keywords: Key words:Aging -- Bone disease -- Bone resorption -- Gender differences -- Serum markers Abstract: To assess how two different serum markers of bone resorption may reflect changes in bone turnover, we compared age- and sex-related changes in serum C-terminal telopeptide of type I collagen ([beta]CTx) and tartrate-resistant acid phosphatase activity (TRAP) in 136 healthy men and 184 normal women. Serum levels of the two markers were also assessed in several groups of patients of both sexes presenting with the most common metabolic and endocrine bone diseases: established osteoporosis (n= 77), primary hyperparathyroidism (n= 44), glucocorticoid excess (n= 17), chronic renal failure (n= 39), active Paget's disease of bone (n= 5), humoral hypercalcemia of malignancy (na=a3), osteomalacia (n= 3), hyperthyroidism (n= 10), post-surgical hypoparathyroidism (n= 10), acromegaly (active disease, n= 8) and Cushing's syndrome (n= 10). In men the regression of [beta]CTx with age showed an initial decrease in bone resorption followed by an increase thereafter, starting from the sixth decade of life. No age-related change in serum TRAP activity was observed. In women, by contrast, a slight but significant linear correlation of both serum [beta]CTx and TRAP with age (r= 0.223, p&lt 0.003 and r= 0.333, p&lt 0.0001, respectively) was found, the two markers being positively correlated (r= 0.238, p&lt 0.002). In each class of patients the mean Z-scores of [beta]CTx were significantly higher than those of TRAP activity. Moreover, compared with normal subjects, serum [beta]CTx seems to be characterized by a superior sensitivity relative to TRAP measurement, at least in the disorders studied. Author Affiliation: (1) Department of Clinical Sciences, University of Rome 'La Sapienza', IT (2) Department of Internal Medicine, IT (3) Department of Endocrinology, 'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo , IT (4) San Giovanni Battista Hospital, Rome, Italy, IT Article note: Received: 14 February 2001 / Accepted: 3 September 2001

Sex steroid hormones contribute to the physiological regulation of bone turnover in males. To address this issue, we investigated serum estradiol (E2), total testosterone (T), and DHEAS concentrations, along with serum levels of carboxy-terminal telopeptide of type I collagen (sCTx), in a sample of 76 healthy men aged 23 to 87. The concentration of sCTx declined with age. Both T and DHEAS, at variance with E2, showed a significant age-related decline. T, DHEAS and sCTx significantly (p<0.01) correlated with each other. DHEAS and T were significantly associated after correcting for age (r=0.35, p=0.002) or body mass index (r=0.65, p<0.0001). DHEAS, but not T, significantly correlated with sCTx after correcting for age (r=0.26, p=0.026, and r=0.20, p=0.08, respectively). Stepwise multiple regression analysis showed that only DHEAS (but not T or E2) was a significant independent predictor of sCTx (p=0.0001). Our results show that adrenal androgens play a crucial role in regulating bone resorption in aging men.

Background and Aims: The aim of the study was to investigate the impact of fractures (i.e., hip, Colles, humeral and vertebral fractures), compared with that of other common diseases requiring hospitalization, on health care in the main hospital in Rome (Italy)., Methods: Hospital discharge forms, filled in according to the 9th International Classification of Diseases, were examined from 1996 to 1999. Data on fractures were compared with those related to other diseases which occupy a considerable proportion of hospital operating time in Italy: coronary heart disease (CHD), cerebrovascular disorders (CVD), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD) and breast cancer (BC)., Results: In all groups of patients, the mean age of females was significantly higher (p<0.0001) than that of males. Male patients with hip fractures had hospital stays significantly longer than females (p<0.0001), whereas women with Colles fractures had significantly (p<0.02) longer stays. When patients were divided according to age (i.e., over or under 60 years), mean hospital stays did not differ between younger and older patients in all groups except Colles fractures (p<0.001). Hip fractures in older patients showed striking in-hospital mortality. Throughout the study period, hip fractures accounted for the highest overall and per-patient costs. The number of female patients with fractures (and, obviously, breast cancer) was higher, while the opposite applied to the other disorders. Male patients with fractures, CHD and CVD were significantly younger than females (p<0.0001). When the percentage of deaths was added to that of patients discharged to other institutions, fractures showed the poorest outcome of any hospitalization event. Per-patient costs were remarkably higher for CHD, followed by fractures., Conclusions: Fractures represent a growing but often underestimated burden for hospital care in Italy; further studies are needed on this issue.