230 



B. E. C. NORDIN 



Dk Oestrodiol 0.1 Tuj/day 



8 9 10 



mg. daily 

 a 57 yeai- 



The evidence regarding the effect of the androgens on calcium balance is rather 

 scanty. Albright and Reifenstein (1948) were able to demonstrate the good effects 

 of testosterone on several cases of osteoporosis but Ackerman et al. (1954) could find 



no effect at all. Henneman and Wallach 

 (1957) considered that testosterone had 

 some effect in senile men but no effect in 

 women. Bartter (1957) reported an im- 

 provement in calcium balance in one case of 

 1'' [ \^ osteoporosis on testosterone. Lafferty et al. 



(1964) reported that androgens and oestro- 

 gens both reduced bone resorption in osteo- 

 porosis but that after long administration 

 a secondary decline in bone formation oc- 

 curred. This is an interesting suggestion but 

 unfortunately their method of calculating 

 bone resorption rate is open to question. 



As far as the anabolic steroids are con- 

 cerned the effect of these compounds on 

 nitrogen balance is well established though 

 it is not certain that the same effect could 

 not be achieved in some instances at least 

 by increased nitrogen intake. The effect on 

 calcium balance is less consistent (Everse 

 and Keep, 1961). There appears to be a fall 

 in faecal calcium and sometimes a fall in 

 urinary calcium but the overall effect on calcium balance is rather small and hardly 

 comparable with that which can be achieved by high calcium feeding (Whedon, 

 1964). Dymling (1962) found no effect with an anabolic steroid on bone excretion 

 rate and Gordan and Eisenberg (1963) had the same experience. Lund (1963) found 

 at least as many cases of osteoporosis among steroid treated patients given an anabolic 

 compound simultaneously as among those not given such supplementary therapy. 



Thus it would appear that reduction of oestrogenic activity (particularly when 

 acute) may precipitate the reduction in bone volume which we call osteoporosis and 

 that administration of oestrogenic hormones reduces urinary calcium, raises urinary 

 citrate and promotes a positive calcium balance. The nature of these actions cannot 

 be explained at present, but they are unlikely to be connected with nitrogen balance 

 on which oestrogens have little if any effect (Albright and Reifenstein, 1948). It is, 

 therefore, probable that oestrogens influence bone in Man through an action on 

 mineral metabolism. This has been suggested by Ranney (1959) who found that 

 oestrone neutralised the effects of parathyroid extracts on bone turnover in mice. An 

 alternative explanation may be found in the work of Cushman et al. (1965) who 

 made the interesting observation that 17/?-oestradiol perfused into the isolated dog 

 adrenal inhibited corticosteroid secretion. This reminds one that the effects of 

 oestrogens on urinary calcium and citrate excretion are the reverse of those of the 

 adrenocortical steroids. 



Another little known eft'ect of oestrogens was reported by Nassim et al. (1956) 

 who found that administration of stilboestrol to 5 patients lowered the tubular 



^ J f 7 

 Days 



Fig. 4. Effect of ethinyl oestradiol 0, 

 on urinary pH, citrate and calcium i 

 old women 



