In order to investigate the effect of a supplementation of vitamin D in the prophylaxis of fractures of the bones of aged people, an annual intramuscular injection of ergocalciferol (150,000-300,000 IU) was given to two series of aged subjects: first to 199 (45 male) of 479 subjects (110 male) aged more than 85 years who were living in their own home, and second to 142 (29 male) of 320 (58 male) subjects aged 75-84 and living in a home for aged people. This prospective series was divided into treatment groups according to month of birth. These injections were given annually from September to December in the years 1985-1989, two to five times to each participant. The fracture rates, laboratory values, vitamin D levels, possible side effects, and mortality were followed until October 1990. A total of 56 fractures occurred in the 341 vitamin D recipients (16.4%) and 100 in 458 controls (21.8%) (P = 0.034). The fracture rate was about the same in both outpatient and municipal home series. Fractures of the upper limb were fewer in the vitamin D recipients, 10/341 = 2.9% (P = 0.025), than in the controls, 28/458 = 6.1%, during the follow-up. A similar result was obtained in fractures of ribs, 3/341 = 0.9% and 12/458 = 2.6%, respectively. Fractures of the lower limbs occurred almost as frequently, 31/341 = 9.1%, among the vitamin D recipients as among the controls, 49/458 = 10.7%. The fracture rate was higher in females (22.2%) than in males (9.5%). The fractures were fewer in the vitamin D recipients only in females.(ABSTRACT TRUNCATED AT 250 WORDS)

In a double-blind trial, 327 patients (57 men) over 65 (mean age 79.5) years received all possible combinations of calcium carbonate 3 g, vitamin D3 1000 iu, methandienone 2.5 mg and/or placebos daily for 9 months. The higher incidence of bone fractures in the placebo group was not significant. Serum calcium, phosphorus, creatinine, aspartate aminotransferase and alkaline phosphatase were followed: the greatest changes occurred with methandienone, which thus reduced osteoporotic activity and increased the muscular mass most effectively; calcium carbonate had the poorest effect. Surprisingly, coronary mortality was higher among those taking all three active substances. With two treatments the increase was not significant, but when both the groups receiving a combination of any two of the treatments were compared with those taking only one or neither of these two treatments, a significant increase in coronary deaths was seen, most significant (P less than 0.001) in those receiving vitamin D3 and methandienone.

BRITISH MEDICAL JOURNAL12 JULY 1975 7. that CO could be implicated in any of the health improvements attributable to smoking cigarettes with unventilated filter-tips. Unfortunately, hopes that tobacco subsitutes may be safer to smoke have not as yet been supported, at least so far as CO production is concerned. Planet cigarettes, which were hastily withdrawn just over a year ago, had a CO yield well above the other brands used in this study. It was also higher than has ever been reported for cigarettes. Cigarette X, which contains a mixture of tobacco (70°,) and tobacco-substitute (30%O), gave a CO yield which was about average for the group of medium and high nicotine brands. The very high CO yield of the cigar tested agrees with previous work6 and also with the evidence that cigarette smokers who switch to smoking cigars often have high COHb levels.14 15Our smoking machine "smoked" with a square-waved rather than bell-shaped puff,16 and the mean duration of each puff was 1-82 instead of 2-0 s. This is unlikely to have affected the absolute values more than negligibly, and would not affect the comparisons between brands. Our aim was to draw attention to the considerable differences between brands rather than to construct a CO yield Medical3Journal, 1975, 3, 73-74 Summary In a double-blind trial with monofluorophosphate (25 mg fluoride per day) given to 460 aged persons (237 treated, 233 control) for eight months no difference was observed in height, admission to hospital, or mortality.Fractures and exacerbation of arthrosis were more frequent in the fluoride group. Vertebral x-ray films showed no difference. The free ionized fluoride levels in the plasma of the fluoride-treated group were still twice as high two months after treatment ended. Fluoride treatment in the prophylaxis of osteoporosis is not recommended unless there is simultaneous measurement of plasma ionized fluoride levels.

A two-year randomized, double-blind, placebo-controlled clinical trial used paired serum samples from 122 patients with primary biliary cirrhosis to compare the effect of ursodeoxycholic acid and colchicine on their immune parameters. IgG antibodies to pyruvate dehydrogenase, the major autoantigen in primary biliary cirrhosis, were determined by enzyme-linked immunosorbent assay and immunoblot; enzyme inhibition assay against pyruvate dehydrogenase was used to test the changes of the functional reactivity of the serum autoantibodies. Treatment with ursodeoxycholic acid decreased both the level of IgG antibodies to pyruvate dehydrogenase (P < 0.01) and the inihibitory titer of the sera for pyruvate dehydrogenase (P < 0.01). Treatment with colchicine or placebo showed no statistically significant changes in either the antibody levels or the inhibitory titers. Ursodeoxycholic acid thus alters the immune parameters of patients with primary biliary cirrhosis. The mechanism of these changes needs further investigation.

The relationship of thyroid autoantibodies and elevated TSH level to indices of cardiovascular diseases was studied in two population series monitored for 5 years and in a cross-sectional hospital series. In a cohort of 1105 males, initially 55-74 years of age, deaths due to cardiovascular causes occurred in 19% of subjects with thyroid autoantibodies and in 11% of controls matched for age (P less than 0.05). In another cohort of 1045 males and 1223 females, initially 40-64 years of age, no difference emerged in males, while 6 out of 20 females who died of cardiovascular causes had thyroid autoantibodies, compared with 18% in the whole series. In a series of 97 hospital patients with myocardial infarction, 7 patients had thyroid autoantibodies as opposed to 12 antibody-positive subjects among controls matched for age and sex. Elevated TSH level appeared to be no better an indicator of cardiovascular morbidity or mortality than thyroid autoantibodies. It is concluded that thyroid autoimmunity may act as a cardiovascular risk factor under certain circumstances, but it does not have any general significance and the mechanism of action remains unclear.