Both fat and lean tissue mass are related to total and regional bone mass in post-menopausal women, the relationship being strongest for fat mass. Body weight shows stronger correlations with bone mass than either height or body mass index. In view of the direction and magnitude of changes in fat, lean tissue and bone mineral after the menopause, adiposity and muscularity are more likely to be determinants of peak bone mass than of the rate of post-menopausal bone loss.

Objectives-To assess the efficacy of a single intravenous infusion of pamidronate in Paget's disease ofbone. Methods-Fourteen patients with active Paget's disease (raised serum alkaline phosphatase, bone pain or neurological involvement) were treated with a single intravenous infusion of 105 mg pamidronate. Patients were assessed for biochemical and clinical improvement for up to two years following treatment. A further infusion was given following symptomatic relapse (pain at a known site of pagetic involvement). Results-Serum alkaline phosphatase fell following treatment, with a nadir 5 9 months after treatment. Bone pain was improved in nine of 12 patients after six months. Retreatment of four patients resulted in a similar response. Conclusion-Single dose intravenouspamidronate (105 mg) is a convenient and effective treatment for Paget's disease.(Ann Rheum Dis 1993; 52: 616-618) assessment included: clinical examination, radionuclide scintigraphy (99mTc methylene bisphosphonate) with measurement of 24 hour whole body retention of bisphosphonate (normal value less than 40%) and radiography of affected bones, full blood count, serum calcium (corrected for serum albumin; 2-0-2-4 mmol/l), phosphate (0-8-1 4 mmol/l), alanine transaminase (7-40 U/1), alkaline phosphatase (30-135 U/1), and albumin. A 24 hour urine collection was obtained to assess the hydroxyproline/creatinine ratio (0 006-0-030).Pamidronate was given as a single infusion of 105 mg in 1 litre of 5% dextrose over 24 hours. Four patients received a second infusion and a single patient a third infusion because of symptomatic relapse, defined as pain at a previously documented site of pagetic involvement. Similar assessments excluding bone scintigraphy were performed at one, two, and three months after treatment, and at threemonthly intervals thereafter. Pain was assessed subjectively as either worse, unchanged, or better.Statistical analysis was performed using Wilcoxon's rank sum test to compare values before and after treatment.

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The presence of normal bone density values in the lumbar spine is often assumed to exclude osteoporosis. Eleven cases are reported in which normal lumbar spine bone density and radiology were associated with one or more dorsal spine fractures; the diagnosis was postmenopausal osteoporosis in eight patients and corticosteroid induced osteoporosis in three. These findings suggest that spinal osteoporosis may sometimes be a focal disorder and emphasise the need for dorsal spine radiology in addition to bone densitometry in patients with strong risk factors for osteoporosis or with clinical evidence of the dorsal spine being affected.

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