Calcium and vitamin D metabolism in guamanian chamorros with amyotrophic lateral sclerosis and parkinsonism–dementia

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Abstract
Guamanian Chamorros patients (16) with amyotrophic lateral sclerosis [ALS] and 33 patients with parkinsonism-dementia [PD] for disturbances of Ca and vitamin D metabolism. The serum immunoreactive parathyroid hormone level was mildly elevated in 6 patients with ALS and in 5 patients with PD. There were significant positive correlations between serum immunoreactive parathyroid levels and duration of illness on male patients with motor neuron disease, but not in female patients or in patients with PD. Intestinal absorption of Ca, as assessed by serum and urinary activity of Ca following oral administration, was decreased in 2 patients with ALS and in 4 patients with PD, all of whom had low levels of serum 1,25-dihydroxyvitamin D. Reductions in cortical bone mass were striking in patients with motor neuron disease. A significant negative correlation was found between the percentage of cortical area of the 2nd metacarpal bone and muscle atrophy and weakness, and significant positive correlations were found between degree of immobility and ratio of urinary hydroxyproline to creatinine in patients with ALS and PD. Abnormalities in Ca metabolism were subtle. If the demonstrated deposition of metals, particularly Ca and Al, in CNS tissues of Guamanians with these 2 conditions is a cause of the diseases and of the early appearance of neurofibrillary tangles in neurons, the accumulation has apparently occurred long before onset of symptoms, and detectable abnormalities of Ca and vitamin D metabolism may already have been corrected.