RAREFYING DISEASE OF THE SKELETON 435 



Marmorston ( 1958 ) , and Sobel ( 1960 ) observed tliat the hexos- 

 amine/collagen ratio decreased in the femora of rats with aging. 

 In view of recent reports of decrease in galactosamine-rich muco- 

 proteins of bone matrix of patients with osteoporosis (Casuccio, 

 1962), it is now necessary to assume that quahtative, as well as 

 quantitative, changes occur in the skeleton in aged and osteoporotic 

 bones. The nature of the relation between the time-dependent proc- 

 ess of aging and osteoporosis has not been defined in meaningful 

 terms. 



Treatment 



A record of the progress of a control series of cases of osteoporosis 

 over a long period of time is essential for evaluation of any one, or 

 any combination, of the man\' forms of treatment that have been 

 prescribed for the disorder. It was possible that in manv patients the 

 skeleton was reduced within a few years to 70 or 50 per cent of 

 normal bone mass, and there was no further progress of the disorder 

 over a period of 5 to 20 years. This possibilitv created uncertainty 

 about whether therapv had had even a preventive effect either on 

 further loss of bone or on the occurrence of spontaneous fractures 

 (Urist, 1962). Though sex hormones (Gordan, 1961; Vincent and 

 Urist, 1961), anabolic steroids (Kuzell et ah, 1962), fluoride (Rich 

 and Ensinck, 1961), calcium supplements (Nordin, 1962a, 1962i>), 

 or combinations of these agents (Lichtowitz et al., 1962; Riccitelli, 

 1962) produced svmptomatic improvement, it was reasonable to 

 assume that placebo effects were responsible in many cases. By means 

 of Ca^'' kinetic studies, Bhandarkar et al. ( 1961 ) claimed to produce 

 an increase in rate of bone formation from calcium supplements, 

 and Bronner et al. ( 1962 ) measured acceleration of rate of bone 

 uptake following estrogen therapy. Improvement in radiographic 

 density or increase in the mass of bone tissue in biopsies in series of 

 cases of osteoporosis is essential for proof of a curative effect, but 

 this has not been accomplished (Fig. 14). 



Discussion 



Present knowledge of osteoporosis consists of a collection of a 

 large quantitv of negative and a small quantity of positive informa- 



