Summary.It is unknown whether bone changes which can occur in multiple myeloma (MM) are due to cytokineinduced osteoclastic bone resorption from a clone of abnormal plasma cells or high-dose glucocorticoid therapy.We studied 25 MM patients treated for 1-12 years with combination chemotherapy, subdivided into two groups. Group 1 consisted of 12 patients with stage I and II myeloma and group 2 consisted of 13 patients with stage III MM. Their serum biochemistry, tetracycline-labelled bone histomorphometry and bone densitometry were compared to age-and sex-matched controls.Patients with MM demonstrated increased indices of bone resorption (P < 0 : 001 versus controls) and, to a lesser extent, increased indices of bone formation (P < 0 : 01 versus controls). No patient had evidence of a mineralization defect.Lumbar spine, femoral neck and total body bone mineral density measurements (BMD) were significantly lower in group 2 compared with group 1 (P < 0 : 05). Following 12 months of therapy, lumbar spine BMD decreased by 6 : 6% (95% CI, 2 : 7% to ¹9 : 3%) and femoral neck BMD decreased by 9 : 5% (95% CI, ¹3 : 2% to ¹15 : 9%). In a stepwise regression analysis, cumulative prednisolone dosage (B Coef: ¼ ¹0 : 39; P ¼ 0 : 03) and plasma cell infiltrate (B Coef: ¼ ¹0 : 08; P ¼ 0 : 05) were the most important predictors of lumbar spine bone loss, whereas serum paraprotein (B Coef: ¼ ¹0 : 35; P ¼ 0 : 02) and plasma cell infiltrate (B Coef: ¼ ¹0 : 20; P ¼ 0 : 04) were the most important predictors of femoral neck bone loss.We conclude that MM is characterized by high bone turnover with osteoblast-osteoclast uncoupling. Both disease activity and high-dose glucocorticoid therapy may be responsible for the ongoing bone loss seen with MM.

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Oral colon transit scintigraphy using indium-111 diethylene-triamine-pentaacetic acid was performed in 41 healthy subjects (22 females, 19 males) to determine variability with age and sex and to define normal ranges. Repeat studies were performed in 10 females and 9 males to assess intra-subject variability. Females showed slightly but significantly slower colonic transit than men and slightly greater intra-subject variability. There was no correlation between age and colonic transit. The results have implications for the definition of normal ranges.

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Colon transit scintigraphy (CTS) was performed in 100 consecutive patients with idiopathic constipation using oral indium-111-labeled DTPA. Criteria were defined to allow classification of studies as normal, slow transit constipation (STC), or obstructed defecation (OD). Results were compared with final clinical diagnosis in 100 and findings of defecating proctography in 70. Of those with a scintigraphic diagnosis of STC, this was also the final diagnosis in 75% (33 of 44), and the scintigraphic diagnosis of OD was confirmed in 61% (17 of 28). Of 28 normal or equivocal scans, the final diagnosis was STC in only two (4%) but OD in 10 (21%). Fifty-four percent of patients with STC and 71% with OD had abnormal proctograms. The correlation between CTS and proctography was mediocre, occurring in 54% of patients. CTS has a valuable role in the diagnostic work-up of patients with idiopathic constipation.