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Klinische Wochenschrift

, Volume 52, Issue 2, pp 64–73 | Cite as

Die intestinale Calcium-Resorption und ihre Störungen

II. Teil. Klinische Manifestationen gestörter Calcium-Resorption
Übersichten

Zusammenfassung

Von den Syndromen mit gesteigerter Ca-Resorption führt lediglich das alimentäre Milch-Alkali-Syndrom mit ezzessiver Ca-Zufuhr zu ernsten Komplikationen. Die Ca-Resorption steigernde Wirkung von Sexual- und Wachstumshormon ist gering, der Hyperparathyreoidismus wirkt sich vorwiegend an Niere und Knochen aus. Die gesteigerte Ca-Resorption bei Sarcoidose, die auf eine Vitamin D-Überempfindlichkeit zurückgeführt wird, wird in neueren Untersuchungen angezweifelt. Der idiopathischen Hypercalciurie mit Nephrocalcinose scheint eine pathogenetisch nicht geklärte Ca-Resorptionserhöhung zu Grunde zu liegen.

Bei den Syndromen mit erniedrigter Ca-Resorption bei Malabsorption oder Maldigestion addiert sich der Effekt einer gestörten Vitamin D-Resorption zu der einer Ca-Malabsorption. wie z. B. bei der einheimischen Sprue und anderen Dünndarmerkrankungen, bei Krankheiten von Leber-Galle-Pankreas und nach Magenresektion. Bei den verschiedenen Rachitisformen fehlt das Vitamin D für eine normale Ca-Resorption. Dabei ist das Defizit bei der gewöhnlichen Vitamin D-Mangelrachitits exogen, bei der hereditären Pseudomangelrachitis liegt eine endogene Störung des Vitamin D-Metabolismus vor, während bei der Vitamin D-resistenten Rachitis nach neueren Untersuchungen eine Phosphatmalabsorption zu Grunde liegt, während die Ca-Resorption normal ist. Bei der Entstehung der „idiopathischen“ Osteoporose spielt eine über Jahre laufende, unterschwellige alimentäre oder endogene Ca-Malabsorption durch Erzeugung eines subklinischen, sekundären Hyperparathyreoidismus offenbar eine wesentliche Rolle. Die Resorptionshemmung von Ca durch Calcitonin und Schilddrüsenhormonen ist klinisch von untergeordneter Bedeutung während ein Hypercorticismus — iatrogen oder endogen — durch eine dem Vitamin D-entgegengesetzte Wirkung zur Ca-Malabsorption und den bekannten Knochenkomplikationen führt. Die neuen Einblicke in den Vitamin D-Stoffwechsel brachten die Erklärung für die Ca-Malabsorption und Vitamin D-Resistenz bei chronischer Niereninsuffizienz: der für die Ca-Resorption wesentliche Metabolit, das 1,25 Dihydroxy-cholecalciferol, kann in der erkrankten Niere nicht mehr ausreichend gebildet werden.

Schlüsselwörter

Calciumresorption Milch-Alkali-Syndrom Sarkoidose Parathormon idiopathische Hypercalciurie Malabsorption Maldigestion Rachitis idiopathische Osteopororose Corticosteroide Calcitonin Niereninsuffizienz 

Calcium absorption in health and disease part II. Syndromes of impaired calcium absorption

Summary

Clinical manifestations of syndromes of increased Ca absorption are usually less relevant than those of impaired Ca absorption. Only the milk-alcali syndrome due to excessive Ca intake causes significant clinical complications. Sex and growth hormone increase Ca absorption only slightly while in hyperparathyroidism the more important effect is seen on kidney and bone than on Ca absorption. The vitamin D hypersensitivity in sarcoidosis is doubted in recent studies. Increased Ca absorption though poorly understood pathogenetically seems to be the cause of idiopathic hypercalciuria and nephrocalcinosis.

Vitamin D malabsorption adds to Ca malabsorption in syndromes of intestinal malabsorption and/or maldigestion such as non tropical sprue and other diseases of the small intestine, diseases of liver-bile-pancreas and gastric resection. In rickets, vitamin D is missing for normal Ca absorption due to a lack of exogenous vitamin D in the common type of rickets while in vitamin D dependent rickets vitamin D metabolism is disturbed genetically. Recently, impaired phosphate absorption was discussed to be the cause of vitamin D resistant rickets while Ca absorption is normal. An important factor in the development of “idiopathic” osteoporosis appears to be a long standing borderline alimentary or endogenous Ca malabsorption causing a subclinical secondary hyperparathyroidism. The impairment of Ca absorption by calcitonin and thyroid hormone has little clinical importance, whereas hypercorticism-iatrogenic or endogenous- leads to significant Ca malabsorption and the well known bone complications by antagonizing the vitamin D effect. The recent discoveries in vitamin D metabolism contribute to explain the Ca malabsorption and the vitamin D resistance in chronic renal failure: a polar metabolite, the 1,25 dihydroxy-cholecalciferol, cannot be formed sufficiently by the diseased kidney.

Key words

Calcium absorption milk-alkali syndrome sarcoidosis parathormone idiopathic hypercalcaemia malabsorption maldigestion rickets idopathic osteoporosis corticosteroids calcitonin renal insufficiency 

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Literatur

  1. Albright, F., Bauer, W., Ropes, M., Aub, J.C.: Studies of calcium and phosphorus metabolism. IV. The effect of the parathormone. J. clin. Invest.7, 139–181 (1929)Google Scholar
  2. Albright, F., Bloomberg, E., Smith, P.H.: Postmenopausal osteoporosis. Trans. Ass. Amer. Phycns55, 289–305 (1940)Google Scholar
  3. Albright, F., Henneman, P., Benedict, P.H., Forbes, A.P.: Idiopathic hypercalciuria. J. clin. Endocr.13, 860–880 (1953)Google Scholar
  4. Anderson, J., Dent, C.E., Harper, C., Philpot, G.R.: Effect of cortisone on calcium metabolism in sarcoidosis with hypercalcemia: possibly antagonistic actions of cortisone and vitamin D. Lancet1954II, 720–724Google Scholar
  5. Arman, E., Reizenstein, P.: Studies in the dumping syndrome. IV. Effect of calcium therapy on calcium metabolism and osteopenia in gastrectomized patients. Amer. J. dig. Dis.14, 153–162 (1969)PubMedGoogle Scholar
  6. Arnaud, C., Maijer, R., Reade, T., Scriver, C.R., Whelanl D.T.: Vitamin D dependency: an inherited postnata, syndrome with secondary hyperparathyroidism. Pediatrics46, 871–880 (1970)PubMedGoogle Scholar
  7. Avioli, L.V., Birge, S.J., Lee, S.W.: Effects of prednisone on vitamin D metabolism in man. J. clin. Endocr.28, 1341–1346 (1968)PubMedGoogle Scholar
  8. Avioli, L.V., McDonald, J.E., Lee, S.W.: The influence of age on the intestinal absorption of47Ca in women and its relation to47Ca absorption in postmenopausal osteoporosis. J. clin. Invest.44, 1960–1967 (1965)PubMedGoogle Scholar
  9. Avioli, L.V., Scott, S., Lee, S.W.: Intestinal calcium absorption: nature of defect in chronic renal disease. Science166, 1154–1156 (1969)PubMedGoogle Scholar
  10. Badenoch, J., Fourman, P.: Osteomalacia in steatorrhea. Quart. J. Med.23, 165–176 (1954)PubMedGoogle Scholar
  11. Baerg, R.D., Kimberg, D.V., Gershon, E.: Effect of renal insufficiency on the active transport of calcium by the small intestine. J. clin. Invest.49, 1288–1300 (1970)PubMedGoogle Scholar
  12. Balsan, S.: 25-hydroxycholecalciferol: effects in idiopathic vitamin D-resistant rickets. Calcif. Tiss. Res., Suppl.4, 45–46 (1970)Google Scholar
  13. Bell, N.H., Gill, J.R., Bartter, F.C.: On the abnormal calcium absorption in sarcoidosis: evidence for increased sensitivity to vitamin D. Amer. J. Med.36, 500–513 (1964)CrossRefPubMedGoogle Scholar
  14. Bogdonoff, M.D., Shock, N.W., Nichols, M.P.: Calcium, phosphorus, nitrogen and potassium balance studies in aged male. J. Geront.8, 272–288 (1953)PubMedGoogle Scholar
  15. Booth, C.C., Babouris, N., Hanna, S., McIntyre, J.: Incidence of hypomagnesaemia in intestinal malabsorption. Brit. med. J.1963 II, 141–144Google Scholar
  16. Bronner, F., Richelle, L.J., Saville, P.D., Nicholas, J.A., Corb, J.R.: Quantitation of calcium metabolism in postmenopausal osteoporosis and in scoliosis. J. clin. Invest.42, 898–905 (1963)PubMedGoogle Scholar
  17. Burnett, C.H., Commons, R.R., Albright, F., Howard, I.E.: Hypercalcemia without hypercalciuria or hyperphosphatemia, calcinosis and renal insufficiency—a syndrome following prolonged intake of milk and alkali. New Engl. J. Med.240, 787–794 (1948)Google Scholar
  18. Caniggia, A., Gennari, C., Bencini, M., Cesari, L., Borello, G.: Calcium metabolism and47calcium kinetics before and after long term thyreocalcitonin treatment in senile osteoporosis. Clin. Sci.38, 397–407 (1970a)Google Scholar
  19. Caniggia, A., Gennari, C., Borello, G., Bencini, M., Cesari, L., Escobar, S.: Intestinal absorption of calcium-47 after treatment with oral oestrogen-gestagens in senile osteoporosis. Preliminary communication. Brit. med. J.1970 I, 30–32Google Scholar
  20. Clarkson, E.M., McDonald, S.J., DeWardener, H.E.: The effect of high intake of calcium carbonate in normal subjects and patients with renal failure. Clin. Sci.30, 425–438 (1966)PubMedGoogle Scholar
  21. Cohn, S.H., Dombrowski, C.S., Hauser, W., Klopper, J., Atkins, H.L.: Effects of porcine calcitonin on calcium metabolism in osteoporosis. J. clin. Endocr.33, 719–728 (1971)PubMedGoogle Scholar
  22. Comfort, M.W., Wollaeger, E.E., Taylor, A.B., Power, M.H.: Nontropical sprue: observations on absorption and metabolism. Gastroenterology23, 155–178 (1953)PubMedGoogle Scholar
  23. Condon, J.R., Nassim, J.R., Rutter, A.: Defective intestinal phosphate absorption in familial and nonfamilial hypophosphatemia. Brit. med. J.1970 I, 138–141Google Scholar
  24. Condon, J.R., Nassim, J.R., Rutter, A.: Pathogenesis of rickets and osteomalacia in familial hypophosphatemia. Arch. Dis. Childh.46, 269–272 (1971)PubMedGoogle Scholar
  25. Cook, P.B., Nassim, J.R., Collins, J.: The effect of thyreotoxicosis upon metabolism of calcium, phosphorus and nitrogen. Quart. J. Med.28, 505–529 (1959)PubMedGoogle Scholar
  26. Cramer, C.F., Parkes, C.O., Copp, D.H.: The effect of chicken and hog calcitonin on some parameters of calcium, phosphorus and magnesium metabolism in dogs. Canad. J. Physiol. Pharmacol.47, 181–184 (1969)Google Scholar
  27. Dallas, I., Nordin, B.E.C.: The relation between calcium intake and roentgenologic osteoporosis. Amer. J. clin. Nutr.11, 263–269 (1962)PubMedGoogle Scholar
  28. Deller, D.J.: Radiocalcium absorption after partial gastrectomy. Amer. J. dig. Dis.11, 10–19 (1966)PubMedGoogle Scholar
  29. Deller, D.J., Edwards, R.G., Addison, M.: Calcium metabolism and the bones after partial gastrectomy. II. The nature and cause of the bone disorder. Aust. Ann. Med.12, 295–309 (1963)PubMedGoogle Scholar
  30. Dent, C.E., Harper, C.M., Philpot, G.R.: The treatment of renal-glomerular osteodystrophy. Quart. J. Med.30, 1–32 (1961)PubMedGoogle Scholar
  31. Dent, C.E., Watson, L.: Metabolic studies in patients with idiopathic hypercalciuria. Brit. med. J.1965 II, 449–452Google Scholar
  32. Drube, H.C., Büttner, H., Über die Wirkung oraler Kalziumgaben auf die Stuhlfettausscheidung bei Gesunden und Kranken mit Steatorrhoe. Med. Klin.59, 1234–1236 (1964)PubMedGoogle Scholar
  33. Earp, H.S., Ney, R.L., Gitelman, H.J., Richman, R., DeLuca, H.F.: Effects of 25-hydroxycholecalciferol in patients with familial hypophosphatemia and vitamin D-resistant rickets. New Engl. J. Med.283, 627–630 (1970)PubMedGoogle Scholar
  34. Edwards, N.A., Hodgkinson, A.: Metabolic studies in patients with idiopathic hypercalciuria. Clin. Sci.29, 143–157 (1965)PubMedGoogle Scholar
  35. Ewe, K.: Intestinale Calcium-Resorption und ihre Störungen bei Osteoporose, M. Cushing und Hypoparathyreoidismus; klinische und tierexperimentelle Untersuchungen. Habilitationsschrift Mainz 1969Google Scholar
  36. Ewe, K.: Calciumtransport in rat small intestine in vitro and in vivo. Naunyn-Schmiedeberg's Arch. Pharmacol.273, 352–365 (1972)CrossRefGoogle Scholar
  37. Ewe, K.: Calciumtransport in the human jejunum. II. Absorption in idiopathic osteoporosis, M. Cushing and hypoparathyreoidism. Im DruckGoogle Scholar
  38. Ewe, K., Heucher, K.: Calciumtransport in the human jejunum. I. Effect of calcium concentration, strontium and net water movement. Im DruckGoogle Scholar
  39. Fanconi, G., Girardet, P.: Familiärer persistierender Phosphatdiabetes mit Vitamin D-resistener Rachitis. Helv. paediat. Acta7, 14–41 (1952)PubMedGoogle Scholar
  40. Fanconi, G., Prader, A.: Die hereditäre Pseudomangelrachitis. Helv. paediat. Acta24, 432–447 (1969)Google Scholar
  41. Fischermann, K., Mouridsen, H., Neesgaard, I., Worning, H., Zacko, A.: Gastric and pancreatic function and the absorption of iron, vitamin B12 and calcium after proximal gastric resection for cancer in the upper part of the stomach. Scand. J. Gastroent.4, 697–703 (1969)PubMedGoogle Scholar
  42. Fletcher, E.F., Jones, J.H., Morgan, D.B.: Bone disease in chronic renal failure. Quart. J. Med.32, 321–339 (1963)PubMedGoogle Scholar
  43. Flocks, R.H.: Calcium and phosphorus excretion in the urine of patients with renal or ureteral calculi. J. Amer. med. Ass.113, 1466–1471 (1939)Google Scholar
  44. Fraser, D., Koch, S.W., Scriver, C.R.: Hyperparathyreoidism as the cause of hyperaciduria and phosphaturia in human vitamin D-deficiency. Pediat. Res.1, 425–435 (1967)PubMedGoogle Scholar
  45. Fraser, D., Salter, R.B.: The diagnosis and management of the various types of rickets. Pediat. Clin. N. Amer. p, 417–441 (1958)Google Scholar
  46. Friedland, J.A., Williams, G.A., Bowser, E.N.: Effect of hyperthyreoidism on intestinal absorption of calcium in the rat. Proc. Soc. exper. Biol. (N.Y.)120, 20–23 (1965)Google Scholar
  47. Frost, H.M.: Postmenopausal osteoporosis. A disturbance in osteoclasia. J. Amer. Geriat. Soc.9, 1078–1085 (1961)PubMedGoogle Scholar
  48. Garner, A., Ball, J.: Quantitative observations on mineralized and unmineralized bone in chronic renal azotaemia and intestinal malabsorption syndrome. J. Path. Bact.91, 545–561 (1966)PubMedGoogle Scholar
  49. Gershon-Cohen, J., Jowsey, J.: The relationship of dietary calcium to osteoporosis. Metabolism13, 221–226 (1964)CrossRefPubMedGoogle Scholar
  50. Gill, J.R., Bartter, F.C.: On the impairment of renal concentrating ability in prolonged hypercalciuria in man. J. clin. Invest.40, 716–722 (1961)PubMedGoogle Scholar
  51. Goldstein, R.A., Israel, H.L., Becker, K.L., Moore, C.F.: The infrequency of hypercalcemia in sarcoidosis. Amer. J. Med.51, 21–30 (1971)CrossRefPubMedGoogle Scholar
  52. Gordon, G.S., Eisenberg, E.: The effect of oestrogens, androgens and corticosteroid on skeletal kinetics in man. Proc. roy. Soc. Med.56, 1027–1030 (1963)PubMedGoogle Scholar
  53. Gossman, H., Helms, H.: Knochenveränderungen bei intestinalen Resorptionsstörungen. Dtsch. med. Wschr.93, 1219–1223 (1968)PubMedGoogle Scholar
  54. Gruson, M., Cerland, M., Miravet, L., Paul, J., Hioco, D.: Action de la calcitonine de pore sur le transfer in vitro du calcium 45 au niveau du duodénum de rat normal et thyreoparathyreoidectomisé. C.R. Acad. Sci. (Paris)270, 1014–1017 (1970)Google Scholar
  55. Harrell, G.T., Fisher, S.: Blood chemical changes in Boeck's sarcoid with particular reference to protein, calcium and phosphatase values. J. clin. Invest.18, 687–693 (1939)Google Scholar
  56. Harrison, A.R.: Some results of metabolic investigation in cases of renal stone. Brit. J. Urol.31, 398–403 (1959)PubMedGoogle Scholar
  57. Harrison, M., Fraser, R.: Bone structure and metabolism in calcium-deficient rats. J. Endocr.21, 197 (1960)PubMedGoogle Scholar
  58. Harrison, M., Fraser, R., Mullan, B.: Calcium metabolism in osteoporosis. Acute and long term responses to increased calcium intake. Lancet1961 I, 1015–1019CrossRefGoogle Scholar
  59. Hass, G.M.: In: The biochemistry and physiology of bone (G.H. Bourne, ed.), p. 775. New York: Academic Press 1956Google Scholar
  60. Heaney, R.P.: Radiocalcium metabolism in human dissue osteoporosis. Amer. J. Med.33, 188–200 (1962)PubMedGoogle Scholar
  61. Heaney, R.P.: A unified concept of osteoporosis. Amer. J. Med.39, 877–880 (1965)CrossRefPubMedGoogle Scholar
  62. Heaney, R.P., Whedon, G.D.: Radiocalcium studies of bone formation rate in human metabolic bone disease. J. clin. Endocr.18, 1246–1267 (1958)PubMedGoogle Scholar
  63. Hegstedt, D.M.: Symposion on human calcium requirements. J. Amer. med. Ass.185, 588–593 (1963)Google Scholar
  64. Henneman, P.H., Benedict, P.H., Forbes, A.P., Dudley, H.R.: Idiopathic hypercalciuria. New Engl. J. Med.259, 802–807 (1958)PubMedGoogle Scholar
  65. Henneman, P.H., Dempsey, E.F., Carroll, E.L., Albright, F.: The cause of hypercalciuria in sarcoidosis and its treatment with cortisone and sodium phytate. J. clin. Invest.35, 1229–1242 (1956)PubMedGoogle Scholar
  66. Herrath, D.v., Opitz, A., Koch, H.U., Knoop, H., Schäfer, K.: Effect of cortisone on vitamin D metabolism in rat plasma. Klin. Wschr.49, 48–49 (1971)PubMedGoogle Scholar
  67. Hesch, D.D., Henning, H.V., Gerlach, W., Scheler, F.: Früherkennung von Störungen der intestinalen Calciumabsorption bei Niereninsuffizienz. Klin. Wschr.49, 115–116 (1971)PubMedGoogle Scholar
  68. Higgins, P.McR., Pridie, P.B.: Postgastrectomy osteomalacia: incidence after the no-loop and other types of gastrectomy. Brit. J. Surg.53, 881–885 (1966)PubMedGoogle Scholar
  69. Hill, L.F., Berg, C.J. van den, Mawer, E.B.: Vitamin D metabolism in experimental uraemia: effects on intestinal transport45Ca and on formation of 1,25-dihydroxy-cholecalciferol in the rat. Nature (Lond.)232, 189–191 (1971)PubMedGoogle Scholar
  70. Hillemand, P., Mialaret, J., Boutelier, D.: A propos d'une ostéomalacie après gastrectomie partielle avec anastomose gastro-jéjunale. Transformation par rétablissement du circuit duodénal. Arch. Mal. Appar. dig.49, 489–500 (1960)PubMedGoogle Scholar
  71. Hodkinson, A.: Biochemical aspects of primary hyperparathyreoidism: An analysis of 50 cases. Clin. Sci.25, 231–242 (1963)PubMedGoogle Scholar
  72. Hofmann, A.F.: Clinical implication of physiochemical studies on bile salts. Gastroenterology48, 484–494 (1965)PubMedGoogle Scholar
  73. Hurxthal, L.M., Vose, G.P.: The relationship of dietary calcium intake to radiographic bone density in normal and osteoporotic patients. Calcif. Tiss. Res.4, 245–256 (1969)Google Scholar
  74. Jackson, W.P.U., Dancaster, C.: A consideration of the hypercalciuria in sarcoidosis, idiopathic hypercalciuria and that produced by vitamin D. A new suggestion regarding calcium metabolism. J. clin. Endocr.19, 658–680 (1959)PubMedGoogle Scholar
  75. Joplin, G.F., Melvin, K.E.W., Hepner, G.W., Neale, G., Bordier, P.: Calcium metabolism and bone histology in adult celiac disease. Calcif. Tiss. Res. 2 Suppl. 62 (1968)Google Scholar
  76. Jowsey, J.: Age changes in human bone. Clin. Orthop.17, 210–212 (1960)Google Scholar
  77. Jowsey, J., Kelly, P.J., Riggs, B.L., Bianco, A.J., Scholz, D.A., Gershon-Cohen, L.: Quantitative microradiographic studies of normal and osteoporotic bone. J. Bone J. Surg. A47, 785 (1965)Google Scholar
  78. Juergens, J.S., Scholz, D.A., Wollaeger, E.E.: Severe osteomalacia associated with occult steatorrhea due to nontropical sprue: report of 5 cases. Arch. intern. Med.98, 774–782 (1956)Google Scholar
  79. Kaye, M., Silverman, M.: Calcium metabolism in nephritis. J. Lab. clin. Med.66, 535–548 (1965)PubMedGoogle Scholar
  80. Kehayoglou, A.K., Holdsworth, C.D., Agnew, J.E., Whelton, M.J., Sherlock, S.: Bone disease and calcium absorption in primary biliary cirrhosis with special reference to vitamin D therapy. Lancet1968aI, 715–719CrossRefGoogle Scholar
  81. Kehayoglou, A.K., Williams, H.S., Whimster, W.F., Holdsworth, C.D.: Calcium absorption in the normal, bile-duct ligated and cirrhotic rat, with observations on the effect of long- and medium-chain triglycerides. Gut9, 597–603 (1968b)PubMedGoogle Scholar
  82. Kierkens, R., Lundh, G.: Intestinal digestion and absorption after Billroth II gastrectomy. Acta chir. scand.113, 349–356 (1957)PubMedGoogle Scholar
  83. Kimberg, D.V.: Effects of vitamin D and steroid hormones on the active transport of calcium by the intestine. New Engl. J. Med.280, 1396–1405 (1969)PubMedGoogle Scholar
  84. Kimberg, D.V., Baerg, R.D., Gershon, E., Grandusius, R.T.: Effect of cortisone treatment on the active transport of calcium by the small intestine. J. clin. Invest.50, 1309–1321 (1971)PubMedGoogle Scholar
  85. Kinney, U.R., Tauxe, W.N., Dearing, W.H.: Isotopic tracer studies of intestinal calcium absorption. J. Lab. clin. Med.66, 187–203 (1965)PubMedGoogle Scholar
  86. Kleeman, C.R. (ed.): Divalent ion metabolis and osteodystrophy in chronic renal failure. Arch. int. Med. Symp. 3,124, 670–682 (1969)Google Scholar
  87. Kocian, J.: Kalziumresorption bei Dünndarmerkrankungen. Z. Gastroent.8, 480–488 (1970)Google Scholar
  88. Krawitt, E.L.: Effect of thyreocalcitonin on duodenal calcium transport. Proc. Soc. exper. Biol. (N.Y.)125, 1084–1086 (1967)Google Scholar
  89. Lafferty, F.W., Pearson, O.H.: Skeletal, intestinal and renal calcium dynamics in hyperparathyreoidism. J. clin. Endocr.23, 891–902 (1963)PubMedGoogle Scholar
  90. Larsson, S.E.: On the development of osteoporosis. Acta orthop. scand. Suppl. 120 (1969)Google Scholar
  91. Lichtwitz, A., DeSèze, S., Cachin, M., Guillamat, M., Hioco, D., Pergola, F.: Les troubles du métabolisme phosphocalcique chez les gastrectomisés. Sem. Hôp. Paris37, 3391–3400 (1961a)Google Scholar
  92. Lichtwitz, A., De Seze, S., Cachin, M., Guillamat, M., Hioco, D., Pergola, F.: Physiopathologie des modifications du métabolisme phosphocalcique chez les gastrectomisés avec exclusion du duodénum. Sem. Hôp. Paris37, 3401–3411 (1961b)Google Scholar
  93. Lichtwitz, A., Parlier, R.: Les parathyroides et le métabolisme phosphocalcique. II. Rôle du rein et de l'intestin. Presse méd.67, 134–137 (1959)Google Scholar
  94. Liu, S.H., Chu, H.I.: Studies of calcium and phosphorus metabolism with special reference to pathogenesis and effect of dihydrotachysterol (A.T.10) and iron. Medicine (Baltimore)22, 103–161 (1943)Google Scholar
  95. Maher, J.F., Freeman, R.B., Schreiner, G.E.: Hemodialysis for chronic renal failure. II. Biochemical and clinical aspects. Ann. intern. Med.62, 535–550 (1965)PubMedGoogle Scholar
  96. Malm, O.J.: Calcium requirements and adaptation in adult men. Scand. J. clin. Lab. Invest.10, Suppl. 36 (1958)Google Scholar
  97. Mawer, E.B., Lumb, G.A., Schäfer, K., Stanbury, S.W.: The metabolism of isotopically labelled vitamin D3 in man: the influence of the state of vitamin D nutrition. Clin. Sci.40, 39–53 (1971)PubMedGoogle Scholar
  98. Mazzuoli, G.F., Terrenato, L.: Intestinal absorption and skeletal dynamics of calcium in acromegaly. Calc. Tiss. Proc. 3rd Europ. Symposion Davos 1965. p. 254–258. Berlin-Heidelberg-New York: Springer 1966Google Scholar
  99. McMillan, D.E., Freeman, R.B.: The milk alkali syndrome: a study of the acute disorder with comments on the development of the chronic condition. Medicine (Baltimore)44, 485–501 (1965)PubMedGoogle Scholar
  100. Meulengracht, E., Meyer, A.R.: Osteomalacia of the spinal column. Acta med. scand.92, 584–602 (1937)Google Scholar
  101. Milhaud, G., Vesin, P.: Hypocalciuria and calcium absorption (Letter to the editor). Lancet1963 II, 40CrossRefGoogle Scholar
  102. Moss, A.J., Waterhouse, C., Terry, R.: Gluten-sensitive enteropathy with osteomalacia but without steatorrhea. New Engl. J. Med.272, 825–830 (1965)PubMedGoogle Scholar
  103. Muldowney, F.P.: Metabolic bone disease secondary to renal and intestinal disorders. Calif. Med.110, 397–409 (1969)PubMedGoogle Scholar
  104. Munck, O.: Osteoporosis due to malabsorption of calcium responding favourably to large doses of vitamin D. Quart. J. Med.33, 209–221 (1964)PubMedGoogle Scholar
  105. Nassim, J.R., Saville, P.D., Cook, P.B., Mulligan, L.: The effect of vitamin D and glutenfree diet in idiopathic steatorrhea. Quart. J. Med.28, 141–162 (1959)PubMedGoogle Scholar
  106. Nordin, B.E.C.: Osteomalacia, osteoporosis and calcium deficiency. Clin. Orthop.17, 235–237 (1960)Google Scholar
  107. Nordin, B.E.C.: The pathogenesis of osteoporosis. Lancet1961aI, 1011–1014CrossRefGoogle Scholar
  108. Nordin, B.E.C.: Effect of malabsorption syndrome on calcium metabolism. Proc. roy. Soc. Med.54, 497–500 (1961b)PubMedGoogle Scholar
  109. Ogg, C.S.: The intestinal absorption of 47 calcium by patients in chronic renal failure. Clin. Sci.34, 467–471 (1968)Google Scholar
  110. Olson, E.B., DeLuca, H.F., Potts, J.T.: Calcitonin inhibition of vitamin D-induced intestinal calcium absorption. Endocrinology90, 151–157 (1972)PubMedGoogle Scholar
  111. Owen, E.C., Irving, J.T., Lyall, A.: The calcium requirement of older male subjects with special reference to the genesis of sensile osteoporosis. Acta med. scand.103, 235–250 (1940)Google Scholar
  112. Parfitt, A.M., Higgins, B.A., Nassim, J.R., Collins, J.A., Hilb, A.: Metabolic studies in patients with hypercalciuria. Clin. Sci.27, 463–482 (1964)PubMedGoogle Scholar
  113. Peacock, M., Hodgkinson, A., Nordin, B.E.C.: Importance of dietary calcium in the definition of hypercalciuria. Brit. med. J.1967 I 469–471Google Scholar
  114. Peacock, M., Nordin, B.E.C.: Tubular reabsorption of calcium in normal and hypercalciuric subjects. J. clin. Path.21, 353–358 (1968)PubMedGoogle Scholar
  115. Pendras, J.P., Erickson, R.V.: Hemodialysis: a successful therapy for chronic uremia. Ann. intern. Med.64, 292–311 (1966)Google Scholar
  116. Phillips, M.J., Cooke, J.N.C.: Relation between urinary calcium and sodium in patients with idiopathic hypercalciuria. Lancet1967 I, 1354–1357CrossRefGoogle Scholar
  117. Powell, R.C., Deiss, W.P.: Symtomatic osteomalacia secondary to clinically occult causes. Ann. intern. Med.54, 1280–1289 (1961)PubMedGoogle Scholar
  118. Prader, A., Illig, R., Heierli, E.: Eine besondere Form der primären Vitamin D-resistenten Rachitis mit Hypocalciämie und autosomal-dominatem Erbgang: die hereditäre Pseudomangelrachitis. Helv. paediat. Acta16, 452–468 (1961)Google Scholar
  119. Riggs, B.L., Kelly, P.J., Kinney, V.R., Scholz, D.A., Bianco, A.J.: Calcium deficiency and osteoporosis. Observations in one hundred and sixty-six patients and critical review of the literature. J. Bone Jt Surg. A49, 915–924 (1967)Google Scholar
  120. Ritz, E.: Experimentelle Untersuchungen zum intestinalen Calciumtransport bei Urämie. Z. ges. exp. Med.152, 313–324 (1970)Google Scholar
  121. Sadowski, P., Klaus, D.: Die enterale Calcium-Resorption bei Störungen des Calcium-Stoffwechsels. Med. Welt19, NF 2284–2250 (1968)Google Scholar
  122. Salomon, C.D.: Osteoporosis following calcium deficiency in rats. Calcif. Tiss. Res.8, 320–333 (1972)Google Scholar
  123. Schachter, D., Finkelstein, J.D., Kowarski, S.: Metabolism of vitamin D. I. Preparation of radioactive vitamin D and its intestinal absorption in the rat. J. clin. Invest.43, 787–796 (1964)PubMedGoogle Scholar
  124. Schäfer, K., Opitz, A.: Aktuelle Probleme azotämischer Knochenerkrankungen. Dtsch. med. Wschr.95, 84–88 (1970)PubMedGoogle Scholar
  125. Schäfer, K., Schäfer, P., Koeppe, P., Opitz, A., Höffler, D.: Untersuchungen zur Frage der urämischen Osteopathie: Störungen der intestinalen Calcium-Resorption in Abhängigkeit von der Nierenfunktion. Dtsch. med. Wschr.93, 1018–1022 (1968)PubMedGoogle Scholar
  126. Schäfer, K., Schäfer, P., Koeppe, P., Opitz, A., Höffler, D.: Untersuchungen zur Therapoie der urämischen Osteopathie. Dtsch. med. Wschr.94, 70–72 (1969)PubMedGoogle Scholar
  127. Schwarz, G.: Grundlagen der alimentären Kalziummangel-Therapie und der oralen Kalzium-Therapie der Osteoporose. Fortschr. Med.82, 853–856 (1964)Google Scholar
  128. Scriver, C.R.: Vitamin D dependency. Pediatrics45, 361–363 (1970)PubMedGoogle Scholar
  129. Scudamore, H.N., Green, P.A., Hoffman, H.N., Rosevear, J.W., Tauxe, W.N.: Scleroderma (progressive systemic sclerosis) of the small intestine with malabsorption. Amer. J. Gastroent.49, 193–208 (1968)PubMedGoogle Scholar
  130. Shafer, R.B., Gregory, D.H.: Calcium malabsorption in hyperthyreoidism. Gastroenterology63, 235–239 (1972)PubMedGoogle Scholar
  131. Sharma, O., Trowell, J., Cohen, N., Bird, R., James, D.G.: Abnormal calcium metabolism in sarcoidosis. La Sarcoidose. IVe Conférence internationale p. 627–632, Paris 1966Google Scholar
  132. Sjöberg, H.E., Nilson, L.H.: Retention of oral47Ca in patients with intestinal malabsorption: regional enteritis and pancreatic insufficiency. Scand. J. Gastroent.5, 265–272 (1970)PubMedGoogle Scholar
  133. Sjöberg, H.E., Reizenstein, P.: Nutritional studies in the dumping syndrome. III. Retention of orally administered47Ca in patients with gastrectomy. Amer. dig. Dis.12, 1156–1159 (1967)Google Scholar
  134. Smith, R.W., Frame, B.: Concurrent axial and appendicular osteoporosis: its relation to calcium consumption. New Engl. J. Med.273, 73–78 (1965)PubMedGoogle Scholar
  135. Spencer, H., Lewin, I., Somachson, J.: Influence of dietary and hormonal factors in radium-strontium metabolism in man. In: Lenihan, J.M.A., Loutit, J.F., Martin, J.H. (eds) Strontium metabolism. New York-London: Academic Press 1967Google Scholar
  136. Spencer, H., Menczel, J., Lewin, I., Somachson, J.: Absorption of calcium in osteoporosis. Amer. J. Med.37, 223–234 (1964)CrossRefPubMedGoogle Scholar
  137. Stanbury, S.W.: The treatment of renal osteodystrophy. Ann. intern. Med.65, 1133–1138 (1966)PubMedGoogle Scholar
  138. Stanbury, S.W.: Bone disease in uremia. Amer. J. Med.44, 714–724 (1968)CrossRefPubMedGoogle Scholar
  139. Stanbury, S.W., Lumb, G.A.: Parathyroid function in chronic renal failure. Quart. J. Med.35, 1–23 (1966)PubMedGoogle Scholar
  140. Stauffer, M., Rich, C.: Direct action of vitamin and lactose on bone in osteomalacia. J. clin. Invest.46, 1119 (1967)Google Scholar
  141. Stickler, G.B.: Familial hypophosphatemic vitamin D resistant rickets. Acta paediat. scand.58, 213–219 (1969)PubMedGoogle Scholar
  142. Stickler, G.B.: Persönliche Mitteilung. 1971Google Scholar
  143. Stickler, G.B., Beabont, J.W., Riggs, B.L.: Vitamin D-resistant rickets: clinical experiences with 41 typical familial hypophosphatemic patients and 2 atypical non-familial cases. Mayo Clin. Proc.45, 197–218 (1970)PubMedGoogle Scholar
  144. Thompson, G.R., Lewis, B., Booth, C.C.: Vitamin D absorption after partial gastrectomy. Lancet1966aI, 457–458CrossRefGoogle Scholar
  145. Thompson, G.R., Lewis, B., Booth, C.C.: Absorption of vitamin D3-3H in control subjects and patients with intestinal malabsorption. J. clin. Invest.45, 94–102 (1966c)PubMedGoogle Scholar
  146. Thompson, G.R., Neale, G., Watts, J.M., Booth, C.C.: Detection of vitamin D deficiency after gastrectomy: a response to very small doses of vitamin D. Lancet1965 II, 1089–1091Google Scholar
  147. Uehlinger, E.: Knochen bei gastrointestinalen Erkrankungen. In: Aktuelle Gastroenterologie, S. 149. Stuttgart: Thieme 1968Google Scholar
  148. Verner, J.V., Engel, F.L., McPherson, H.T.: Vitamin D intoxication: report of two cases treated with cortisone. Ann. intern. Med.48, 765–773 (1938)Google Scholar
  149. Vinther-Paulsen, N.: Calcium and phosphate intake in senile osteoporosis. Geriatrics8, 76–79 (1953)PubMedGoogle Scholar
  150. Webling, D.D.A., Holdsworth, E.S.: The effect of bile, bile acids and detergents on calcium absorption in the chick. Biochem. J.97, 408–421 (1965)Google Scholar
  151. Webling, D.D.A., Holdsworth, E.S.: Bile salts and calcium absorption. Biochem. J.100, 652–660 (1966)PubMedGoogle Scholar
  152. Whedon, G.D.: Effects of high calcium intakes on bones, blood and soft tissues; relationship of calcium intakes to balance in osteoporosis. Fed. Proc.18, 1112–1118 (1959)PubMedGoogle Scholar
  153. Whelton, M.J., Kehayoglou, A.K., Agnew, J.E., Turnberg, L.A., Sherlock, S.:47Calcium absorption in parenchymatous and biliary liver disease. Gut12, 978–983 (1971)PubMedGoogle Scholar
  154. Williams, G.A., Bowser, E.N., Henderson, W.J.: Calcium47 absorption in rats with induced hyperthyreoidism. J. med. Sci.3, 639–642 (1967)Google Scholar
  155. Williams, T.F., Winter, R.W., Burnett, C.H.: Familial (hereditary) vitamin D-resistant rickets with hypophosphatemia. In: Stanbury, J.B., J.B. Wyngaarden, D.S. Fredrichson (eds.) The metabolic basis of inherited disease, 2nd ed., p. 1179–1204. New York: McGraw-Hill Book Co. 1966Google Scholar
  156. Wills, M.R., Wortman, J., Pak. C.Y.C., Bartter, F.C.: The role of parathormone in the gastro-intestinal absorption of calcium. Clin. Sci.39, 89–94 (1970a)PubMedGoogle Scholar
  157. Wills, M.R., Zisman, E., Wortman, J., Evens, R.G., Pak, C.Y.C., Bartter, F.C.: The measurement of intestinal calcium absorption by external radioisotope counting: application to study of nephrolithiasis. Clin. Sci.39, 95–106 (1970b)PubMedGoogle Scholar

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© Springer-Verlag 1974

Authors and Affiliations

  • K. Ewe
    • 1
  1. 1.I. Med. Klinik und Poliklinik der Johannes Gutenberg-Universität MainzGermany

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