Osteocalcin(OC) is a specific serum p arameter of bone formation. Since bone metabolism disturbances, including osteoporosis, are seen in paraplegia, the serum levels of OC, midregional parathyroid hormone(mPTH), intact para thyroid hormone (iPTH) and calcitonin (CT) serum levels were determined in 13 patients with paraplegia or tetraplegia and 15 control subjects by radioimmuno assay in a cross sectional study. In addition, the urinary hydroxyproline/creatine and the urinary calcium/creatinine ratio was determined. Serum OC levels were significantly increased in the patients with spinal cord injury (p < 0.02), whereas serum levels of mPTH, iPTH and CT were not statistically different.The urinary hydroxproline/creatinine ratio was significantly higher in the patients than in the controls (p < 0.02), and the urinary calcium/creatinine ratio also tended to be higher in the patients. In a follow up study over 6 months after spinal cord injury, serum OC, serum iPTH, urinary hydroxyproline/creati nine ratio and the calcium/creatinine ratio were determined in 6 patients at monthly intervals. Hyperhydroxyprolinuria preceded the gradual increase of serum OC from normal to clearly elevated levels. Our data suggest that increased bone resorption in paraplegia is linked to an enhanced osteoblastic activity.

Effective and intensive communication between the individual patient and the rehabilitation team is essential for the outcome of rehabilitation, as patients must undertake their own rehabilitation and the rehabilitation team must be able to investigate the objectives, views and dreams of the individual patient to establish rehabilitation objectives in keeping with the patient's wishes.

Our findings suggest that a less effective repair of 8-OHdG is associated with a higher degree of pulmonary airway obstruction in patients with silicosis.

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