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CHAPTER 18
conjecture whether the osteoporosis is primarily due to diminution or inhibition of bone
formation (osteoblast-osteoporosis). X-rays do not give any information about the degree
of the osteoporosis in the early stage of cord lesions. However, changes of protein,
especially loss of albumin, demonstrating the disturbance of the nitrogen balance, and
increased calcium and hydroxyproline excretion in the urine as well as the increased
serum alkaline phosphatase, indicate the processes of decomposition in bone and
muscles. The increased calcium excretion is independent of the diet of the patients.
In recent years, attention has been paid to hydroxyproline excretion in transverse
lesions of the cord (Klein, Van den Noort & De Jak, 1966), following introduction
of hydroxyproline-estimation in the urine, as an index of the collagen metabolism by
Ziffet al.
(1956) and Dull & Hinnemann (1963). Our own results (Guttmann, Edwards &
Mehra, in press) from series investigations on spinal paralysed patients in the immediate
and early stages following spinal injuries at various levels are in accordance with those
of Klein
el al.
in so far as they show close correlation between calcium and hydroxypro
line excretion, but our total values of these two parameters were higher as compared with
FIG. icia.
