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Bone collagen and calcium metabolism in normocalcemic and hypercalcemic patients with breast cancer

Urine total hydroxyproline (THP), urine calcium, and serum alkaline phosphatase (SAP) were estimated in normocalcemic and hypercalcemic patients with breast cancer and bone metastases. The normocalcemic group showed a wide range for the three variables, of which THP and SAP were closely correlated (r=0.63 P < 0.001). In the hypercalcemic patients, SAP tended to fall as the serum calcium rose, and then to rise during recovery from the hypercalcemia. THP rose with the serum calcium and also showed a later rise accompanying the rise in SAP as the serum calcium fell. The results suggest that metabolism of bone collagen and mineral is rapidly altered during hypercalcemic episodes in a manner indicative of imbalance between bone destruction and formation. Osteoblastic activity may undergo wide fluctuations which appear to be relatively independent of the rate of osteolysis.