[Pathological restructuring of compact bone tissue as evidenced by detailed x-rays of hands]

The author analyzes precise roentgenograms of the hands in more than 250 patients with diseases of the skeleton, resultant from dysmetabolism. He emphasizes the similarity between juxta-endosteal and intracortical resorption of compact bone tissue at some sites of the compact matter. Three degrees of intracortical resorption are distinguished and its relationship to the blood parathyroid hormone level revealed. Both the intracortical and the juxta-endosteal resorption reflect the accelerated rate of bone tissue restructuring along the Haversian surfaces. The markedness of these resorption types depends on the specific features of the productive phase of restructuring as well. Intracortical resorption reflects the reversible and the juxta-endosteal resorption the irreversible bone tissue loss. The latter resorption type is associated with accelerated loss of compact matter. Laminar stratification and spongious degeneration of the compact matter in the juxta-endosteal zone is the most marked not in osteoporosis, but in osteomalacia and hyperparathyroid osteodystrophy. Intracortical resorption is valuable for the differential diagnosis of osteomalacia and hyperparathyroid osteodystrophy with osteoporosis in subjects aged under 50; in older persons irreversible loss of compact matter predominates and osteoporosis of the peripheral skeleton is therefore particularly marked.