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1.  An unusual case of hypercortisolism with multiple weight-bearing bone fractures 
Summary
Glucocorticoid excess, either from exogenous exposure or through endogenous overproduction, is a common cause of secondary osteoporosis. We report a 52-year-old woman presenting with multiple stress fractures of the lower extremities, despite various osteoporosis therapeutic regimens. Investigations led to the diagnosis of hypercortisolism of pituitary origin. Pituitary surgery was unsuccessful, justifying a treatment of ketoconazole. In the absence of densitometric osteoporosis, assessment of bone microstructure using high resolution peripheral quantitative computed tomography revealed alterations of both the cortical and trabecular compartments. This case illustrates that hypercortisolism may cause bone fragility in the absence of marked changes in areal bone mineral density.
PMCID: PMC3917588  PMID: 24554936
fractures; secondary osteoporosis; Cushing’s syndrome; glucocorticoids; bone mineral density
3.  Effects of the SERM raloxifene on calcium and phosphate metabolism in healthy middle-aged men 
Background. Sex hormones are important regulators of calcium and phosphate homeostasis. Estradiol appears to be a major determinant of bone health in the male gender. However, physiological effects of estrogens on calcium and phosphate homeostatic fluxes in men are still poorly understood.
Objective. We investigated the influence of 6 weeks of the SERM raloxifene, an estrogen agonist in bone, but devoid of feminizing actions, on calcium and phosphate metabolism in healthy middle-aged men.
Design. In a double-blind, randomized, placebo-controled, cross-over study, we evaluated the influence of 120 mg/day of raloxifene on calciotropic hormones levels, renal tubular reabsorption of calcium and phosphate, and intestinal calcium absorption, as assessed by the calciuric response to an oral calcium load.
Results. As compared to the placebo period, raloxifene treatment decreased the response to an oral calcium load, together with a decrease in 1,25(OH)2D3 and in IGF-I serum levels. Maximal renal tubular phosphate reabsorption was decreased in raloxifene-treated men following the calcium load. The renal handling of calcium was not changed.
Conclusion. These results are compatible with the hypothesis that raloxifene is associated with lower IGF-I and 1,25(OH)2D3 levels, with consequently reduced intestinal calcium absorption capacity.
PMCID: PMC2781229  PMID: 22461168
renal handling, intestinal calcium absorption, calciotropic hormones, males, bone.
4.  A randomized double-blind placebo-controlled trial to investigate the effects of nasal calcitonin on bone microarchitecture measured by high-resolution peripheral quantitative computerized tomography in postmenopausal women — Study protocol 
Trials  2008;9:19.
Background
Bone microarchitecture is a significant determinant of bone strength. So far, the assessment of bone microarchitecture has required bone biopsies, limiting its utilization in clinical practice to one single skeletal site. With the advance of high-resolution imaging techniques, non-invasive in vivo measurement of bone microarchitecture has recently become possible. This provides an opportunity to efficiently assess the effects of anti-osteoporotic therapies on bone microarchitecture. We therefore designed a protocol to investigate the effects of nasal salmon calcitonin, an inhibitor of osteoclast activity, on bone microarchitecture in postmenopausal women, comparing weight bearing and non-weight bearing skeletal sites.
Methods
One hundred postmenopausal women will be included in a randomized, placebo-controlled, double-blind trial comparing the effect of nasal salmon calcitonin (200 UI/day) to placebo over two years. Bone microarchitecture at the distal radius and distal tibia will be determined yearly by high-resolution peripheral quantitative computerized tomography (p-QCT) with a voxel size of 82 μm and an irradiation of less than 5 μSv. Serum markers of bone resorption and bone formation will be measured every 6 months. Safety and compliance will be assessed. Primary endpoint is the change in bone microarchitecture; secondary endpoint is the change in markers of bone turnover.
Hypothesis
The present study should provide new information on the mode of action of nasal calcitonin. We hypothezise that - compared to placebo - calcitonin impacts on microstructural parameters, with a possible difference between weight bearing and non-weight bearing bones.
Trial Registration
ClinicalTrials.gov NCT00372099
doi:10.1186/1745-6215-9-19
PMCID: PMC2373283  PMID: 18405390

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