Gerontology 23: 31-36 (1977)
Intestinal Absorption of 47Ca in Elderly Patients with Osteoporosis, Paget’s Disease and Osteomalacia. Effects of Calcitonin, Oestrogen and Vitamin D2 M. L en d er , E. V erner , H. Stankiew icz and J. M enczel 1 Departments of Medicine and Geriatrics, Shaare Zedek Hospital, Brookdale Institute of Gerontology and Human Development, and Hebrew University, Hadassah Medical School. Jerusalem
Key Words. Calcium absorption • Calcitonin • Oestrogens • Vitamin D2 • Osteo porosis Abstract. The intestinal absorption of 47Ca was studied in elderly patients. A standard dose of 10 uCi of 47Ca was given orally. The radioactivity was measured in the plasma, and expressed as percentage of the administered dose per litre plasma. As a control group served 12 patients aged 60-80 years, hospitalized for observa tion for various reasons, receiving no medical treatment and not suffering from any known metabolic bone diseases or other metabolic pathological conditions. Results of kinetic curves demonstrate in elderly patients a decreased absorption with maxi mum specific activity in plasma reached at 120 min, when compared to data from the literature referring to a group of young people with a mean age of 35 years. Oestrogen treatment, given as ethinyl oestradiol 10 //g once daily per os for 10 days proved to increase 47Ca absorption as was demonstrated in 2 patients with osteopo rosis. The effect of calcitonin (160 MRC units given 45 min before the test) on cal cium absorption, in 5 patients with Paget’s disease or osteoporosis appears as biphasic: in the first hour depressing calcium absorption and then in the second and third hours increasing the absorption, suggesting a hyperparathyroid state secondary to the calcitonin effect. The vitamin Da treatment proved to increase calcium ab sorption.
The availability of 47Ca for use for clinical purposes, made possible the investigation of the fate of orally given doses of radio-calcium, their pas sage to blood across the intestine and thence to other compartments such
Received: September 5, 1975.
Downloaded by: East Carolina University - Laupus Library 150.216.68.200 - 1/13/2019 11:00:46 AM
1 The authors are indebted to Mrs. M. D ickstein for secretarial help. This study was supported by a grant from Mifal Hapayis (Dr. L ender ).
32
L ender /V erner/S tankiewicz /M enczel
as the bone or excretion by the kidneys. Early investigations were pub lished by Avion et al. [1] and K inney et al. [2], using one isotope and D e G arzia et al. [3], who used a double isotope method. Later on many modifications were published [4, 5] following in essence the same basic principles. We have investigated plasma profiles of 47Ca specific activity after a dose of 47Ca was given orally. The effects of vitamin D2, ethinyl oestradiol and calcitonin on those profiles were studied on elderly patients where clinical indications existed for the use of those hormones. The pur pose of the present communication is to report our experience with one isotope method of investigation.
Methods and Patients
Downloaded by: East Carolina University - Laupus Library 150.216.68.200 - 1/13/2019 11:00:46 AM
The method of investigation was that reported by A violi et al. [1], The standard test consists of an oral dose of 10 liC'i of 47Ca given after an overnight fast. The dose is given with 90 ug of Ca ion as cold carrier (CaCl2) diluted in 300 ml of wa ter. Venous blood samples were obtained at 30, 60, 120 and 180 min and the ra dioactivity was determined in the plasma by means of a Packard gamma counter and was expressed as percent of administered dose per litre plasma. The test was carried out on four groups of patients. The first group served as a control group and consisted of 12 elderly patients, their mean age being 72 years, ranging from 60 to 82 years. These patients suffered no metabolic bone disease, renal or hepatic disorders and were usually under observation for a transient is chemic attack or a cardiac arrhythmia, and did not receive any medication what soever. The second group consisted of only one patient, a female, aged 56 years, who was admitted because of osteomalacia secondary to nutritional deprivation of vitamin D following deprivation of sunlight. No disturbances in intestinal absorp tion could be demonstrated in this patient and a peroral duodenal biopsy was inter preted as normal. The patient was examined for 47Ca absorption before and after treatment for 10 days with vitamin D2 ,600,000 U twice daily added to the diet. The third group consisted of five elderly patients, three males and two females, their mean age was 69 years (ranging from 56 to 85 years). Three patients (two males, one female) suffered from osteoporosis, and two patients from Paget’s dis ease of the bone. The patients received an ordinary diet. Calcitonin treatment was tried on all five patients and its effect on 4,Ca intestinal absorption was studied be fore and after treatment, the patients being given no other medication than de scribed. As in the previous case the patients served as their own controls. Before the second examination the patients were injected twice, i.m., 160 U (commercially ob tained) Calcitar Armour. The first injection was given the day before the test. The second injection was given 45 min before the test. In one patient the test was carried out a third time after 12 days of calcitonin teratment, only that, on the day before the third test the patient was given with the diet, orally, two doses of vitamin D2 600,000 U each dose.
Effects of Calcitonin, Oestrogen and Vitamin D2
33
Fig. 1. Plasma radioactivity profile after ingestion of 10 /
Intestinal Absorption of 47Ca in Elderly Patients with Osteoporosis, Paget’s Disease and Osteomalacia. Effects of Calcitonin, Oestrogen and Vitamin D2 M. L en d er , E. V erner , H. Stankiew icz and J. M enczel 1 Departments of Medicine and Geriatrics, Shaare Zedek Hospital, Brookdale Institute of Gerontology and Human Development, and Hebrew University, Hadassah Medical School. Jerusalem
Key Words. Calcium absorption • Calcitonin • Oestrogens • Vitamin D2 • Osteo porosis Abstract. The intestinal absorption of 47Ca was studied in elderly patients. A standard dose of 10 uCi of 47Ca was given orally. The radioactivity was measured in the plasma, and expressed as percentage of the administered dose per litre plasma. As a control group served 12 patients aged 60-80 years, hospitalized for observa tion for various reasons, receiving no medical treatment and not suffering from any known metabolic bone diseases or other metabolic pathological conditions. Results of kinetic curves demonstrate in elderly patients a decreased absorption with maxi mum specific activity in plasma reached at 120 min, when compared to data from the literature referring to a group of young people with a mean age of 35 years. Oestrogen treatment, given as ethinyl oestradiol 10 //g once daily per os for 10 days proved to increase 47Ca absorption as was demonstrated in 2 patients with osteopo rosis. The effect of calcitonin (160 MRC units given 45 min before the test) on cal cium absorption, in 5 patients with Paget’s disease or osteoporosis appears as biphasic: in the first hour depressing calcium absorption and then in the second and third hours increasing the absorption, suggesting a hyperparathyroid state secondary to the calcitonin effect. The vitamin Da treatment proved to increase calcium ab sorption.
The availability of 47Ca for use for clinical purposes, made possible the investigation of the fate of orally given doses of radio-calcium, their pas sage to blood across the intestine and thence to other compartments such
Received: September 5, 1975.
Downloaded by: East Carolina University - Laupus Library 150.216.68.200 - 1/13/2019 11:00:46 AM
1 The authors are indebted to Mrs. M. D ickstein for secretarial help. This study was supported by a grant from Mifal Hapayis (Dr. L ender ).
32
L ender /V erner/S tankiewicz /M enczel
as the bone or excretion by the kidneys. Early investigations were pub lished by Avion et al. [1] and K inney et al. [2], using one isotope and D e G arzia et al. [3], who used a double isotope method. Later on many modifications were published [4, 5] following in essence the same basic principles. We have investigated plasma profiles of 47Ca specific activity after a dose of 47Ca was given orally. The effects of vitamin D2, ethinyl oestradiol and calcitonin on those profiles were studied on elderly patients where clinical indications existed for the use of those hormones. The pur pose of the present communication is to report our experience with one isotope method of investigation.
Methods and Patients
Downloaded by: East Carolina University - Laupus Library 150.216.68.200 - 1/13/2019 11:00:46 AM
The method of investigation was that reported by A violi et al. [1], The standard test consists of an oral dose of 10 liC'i of 47Ca given after an overnight fast. The dose is given with 90 ug of Ca ion as cold carrier (CaCl2) diluted in 300 ml of wa ter. Venous blood samples were obtained at 30, 60, 120 and 180 min and the ra dioactivity was determined in the plasma by means of a Packard gamma counter and was expressed as percent of administered dose per litre plasma. The test was carried out on four groups of patients. The first group served as a control group and consisted of 12 elderly patients, their mean age being 72 years, ranging from 60 to 82 years. These patients suffered no metabolic bone disease, renal or hepatic disorders and were usually under observation for a transient is chemic attack or a cardiac arrhythmia, and did not receive any medication what soever. The second group consisted of only one patient, a female, aged 56 years, who was admitted because of osteomalacia secondary to nutritional deprivation of vitamin D following deprivation of sunlight. No disturbances in intestinal absorp tion could be demonstrated in this patient and a peroral duodenal biopsy was inter preted as normal. The patient was examined for 47Ca absorption before and after treatment for 10 days with vitamin D2 ,600,000 U twice daily added to the diet. The third group consisted of five elderly patients, three males and two females, their mean age was 69 years (ranging from 56 to 85 years). Three patients (two males, one female) suffered from osteoporosis, and two patients from Paget’s dis ease of the bone. The patients received an ordinary diet. Calcitonin treatment was tried on all five patients and its effect on 4,Ca intestinal absorption was studied be fore and after treatment, the patients being given no other medication than de scribed. As in the previous case the patients served as their own controls. Before the second examination the patients were injected twice, i.m., 160 U (commercially ob tained) Calcitar Armour. The first injection was given the day before the test. The second injection was given 45 min before the test. In one patient the test was carried out a third time after 12 days of calcitonin teratment, only that, on the day before the third test the patient was given with the diet, orally, two doses of vitamin D2 600,000 U each dose.
Effects of Calcitonin, Oestrogen and Vitamin D2
33
Fig. 1. Plasma radioactivity profile after ingestion of 10 /
