Henry Ford Hospital Medical Journal


A. M. Parfitt


This paper discusses Richmond Smith's contributions to the field of metabolic bone disease from 1949 to 1969 in light of current concepts. He was the first to demonstrate continuing periosteal bone expansion in adults, a phenomenon of great biologic interest which is best explained if adult bone remodelling is qualitatively similar on all surfaces. He was the first to show that persons with less bone than normal have an increased risk of subsequent fracture, and so are more likely to benefit from preventive treatment. He found that blood vitamin D levels were lower in osteoporotic subjects than in controls, but he concluded that this was more likely the result than the cause of the disease. If more people had remembered this conclusion, less harm would have been done by the ill-advised administration of vitamin D and its metabolites to patients with osteoporosis. Smith was the first to provide evidence for Albright's concept that osteoporosis followed a shift in endocrine balance after menopause. This topic is still being vigorously investigated, but it seems that symptomatic osteoporosis occurs not so much in women with the more severe endocrine changes, but rather in those who had less bone at skeletal maturity.