A quantitative study of iliac bone histopathology on 62 cases with itai-itai disease

Sixty-two autopsy cases with "itai-itai" or "ouch-ouch" (in English) disease and 50 control subjects were examined by static quantitative bone histopathology. Decalcified sections after cyanuric chloride treatment (Yoshiki's method) were used. The small observer variances of the decalcified sections guaranteed the accuracy and precision of this method. In the static measurement analyses, significant increases in formation parameters and decreases in structural parameters were observed (P less than 0.05-0.000001), suggesting the presence of a marked osteoid accumulation accompanied by a bone mass reduction. Discriminant analysis clearly separated the patients from the control subjects. Two-thirds of the patients showed an increase in resorption surface prior to osteoid deposition and a decrease in osteoblast surface. Double tetracycline labeling in 4 patients showed an impaired osteoid maturation and mineralization. An impaired osteoblastic function was suggested by the results of the static and dynamic histomorphometry. The bone cadmium contents were measured in 46 patients by an atomic absorption spectrophotometer and found to be increased significantly (P less than 0.01). In Aluminon (an ammonium salt of aurine tricarboxytic acid) staining, a clear, reddish line was located in an osteoid-bone interface, suggesting a reaction of Aluminon with tissue aluminium and/or cadmium. These results suggested that an impairment of osteoblastic function and mineralization occurred in itai-itai disease and that cadmium is a possible etiological factor.