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Index was associated with an unduly high incidence of arcus seilis. Again no such association was shown.In common with other workers (Lindholm, 1960; Rodstein and Zeman, 1963) we have failed to show any close correlation between the presence of an arcus senilis and serum-cholesterol levels. However, all the subjects with a serum-cholesterol level of over 350 mg./100 ml. were noted to have an arcus senilis. It would seem that a substantially elevated serum-cholesterol level contributes to the development of an arcus senilis, but that hypercholesterolaemia is not necessary for its development.The main conclusion from this study must be that the presence or absence of an arcus senilis in middle-aged men gives no useful clinical guide to the presence of atherosclerosis. SummaryA comparison of the incidence of arcus senilis was made between middle-aged male post-cardiac-infarction patients and age-matched male patients without clinical or electrocardiographic evidence of occlusive vascular disease. No statistically significant difference in incidence was found. In agreement with previously published observations there was a progressive rise in incidence with advancing age.Post-cardiac-infection patients with an arcus senilis did not differ from those without an arcus in respect of serum cholesterol, blood-pressure, or body build, except that all patients with a serum cholesterol of over 350 mg./100 ml. had an arcus senilis.

Summary.The blood clearance and the urinary excretion of the bone scanning complex technetiumtin-methylene-diphosphonate (99mTc-Sn-MDP) administered intravenously have been measured in 27 normal subjects and 104 patients with postmenopausal osteoporosis, osteomalacia, primary hyperparathyroidism, Paget's disease, pagetoid metastases of prostatic cancer, osteolyses, chronic renal failure, and liver cirrhosis to quantitate the skeletal uptake of the radiopharmaceutical.Kinetic analysis of the data was performed in terms of a four-compartment model; correspondent rate constants and fitted values were estimated.In normal subjects the whole-body retention (WBR) up to 24 h was 33.3% _+ 7.4 SD, whereas significantly more elevated values were observed in several pathological conditions, the highest vahles being ascertained in patients with pagetoid metastases, primary hyperparathyroidism, and chronic renal failure and whenever large osteoid seams were present.Differences were found between osteoporosis and osteomalacia, monostotic and polyostotic Paget's, pagetoid and osteolytic metastases of bone.In Paget's disease significant correlations have been observed between WBR and the exchangeable calcium pool, WBR and the serum alkaline phosphatase, and WBR and the urinary excretion of hydroxyproline.Kinetic analysis demonstrated that WBR provided overestimate of the skeletal retention by an average of 16,%, the retention in the "'extravascular space" being greater in patients with chronic renal failure.This simple method shows significant promise for a quantitative approach to the skeletal turnover in metabolic bone disease.Send ~ffprints requests to Prof. A. Caniggia at the above address.

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1. Four women suffering from senile osteoporosis have been treated for 55-60 days with 25 MRC Units per day of porcine thyrocalcitonin with the following metabolic results : (a) slight diminution of plasma, urinary and endogenous faecal calcium levels ; (b) slight diminution of plasma phosphate level and urinary phosphate clearance ; (c) lowering of serum alkaline phosphatase values ; (d) diminution of urinary hydroxyproline excretion ; (e) modification of calcium balance toward positive, due to decreased urinary 2. 47Calcium kinetic studies demonstrated: (a) a slower decline in the specific activity curve after thyrocalcitonin treatment; (b) a slower decline in bone uptake values; (c) a decrease of 'calcium miscible pool', 'calcium turnover rate', 'accretion rate' 3. Differences in radiological bone patterns were not observed despite an improve-and faecal calcium and to an improvement in intestinal absorption. and 'resorption rate' calculated by the method of Aubert & Milhaud (1960). ment in the pain after treatment.The possibility that thyrocalcitonin may be of clinical value in senile osteoporosis is of great interest, but its use in this condition has been studied only for short periods in a limited number of subjects (Foster et al., 1968). More recently Baud et al. (1969) reported histological changes after 4 weeks treatment of three osteoporotic patients : diminution of enlarged osteocytes, increase of small osteocytes and of highly mineralized areas of bone. This paper reports the result of metabolic studies in four women suffering from senile osteoporosis who were treated with thyrocalcitonin for 55-60 days.

Serum concentrations of 25-hydroxy-vitamin D were measured in a group of women with symptomatic postmenopausal osteoporosis, assessed by bone biopsy. A competitive protein binding assay was used, which included a chromatographic step. Accurate surveys of dietary or therapeutic vitamin D intake and light environment were obtained in each patient. Women with severe postmenopausal osteoporosis were found to have significantly (P less than 0.001) higher serum levels of 25-hydroxyvitamin D than age-matched normal women, the mean values being 27.5 ng/ml (+/- 13.6 SD) and 9.2 ng/ml (+/-5.7), respectively. The authors hypothesize that the reduction in 1,25-dihydroxyvitamin D, recently reported in postmenopausal osteoporotic women, might be responsible for the increased serum levels of 25-hydroxyvitamin D through an inadequate product inhibition of liver vitamin D 25-hydroxylase.

Serum bone Gla-protein (BGP or osteocalcin) was measured in 25 women with histologically confirmed postmenopausal osteoporosis before and during long-term treatment with 1 microgram/day of 1,25-dihydroxyvitamin D3(1,25(OH)2D3). Basal serum BGP was significantly lower in osteoporotic women (3.8 +/- 1.4 ng/ml) than in age-matched controls (6.8 +/- 2.0 ng/ml). During 1,25(OH)2D3 therapy serum BGP increased so that the mean of the values observed on treatment (4.8 +/- 1.5) was significantly higher than the mean basal value. It is known that BGP synthesis is stimulated by 1,25(OH)2D3 and that serum BGP is a specific marker of bone formation; therefore, it is possible that the low basal levels of osteocalcin we observed were related to the low serum 1,25(OH)2D concentrations reported in osteoporotic women and that the increase in BGP levels observed under 1,25(OH)2D3 treatment was a consequence of osteoblast stimulation.

Serum concentrations of 25-hydroxyvitamin D were measured in a group of women with symptomatic postmenopausal osteoporosis, before and after long-term treatment with physiological doses of 1,25-dihydroxyvitamin D3. A competitive protein binding assay was used, which included a chromatographic step. The treatment resulted in a significant decrease in serum 25-hydroxyvitamin D levels that were higher than normal in basal conditions, the mean values before and after therapy being 27.7 ng/ml (+/- 17.1 SD) and 19.7 ng/ml (+/- 12.7), respectively. These findings seem to confirm the hypothesis that an inadequate product-inhibition of liver 25-hydroxylase is responsible for the increased basal levels of 25-hydroxyvitamin D found in postmenopausal osteoporosis.