Submitted to: Current Opinions in Orthopedics
Publication Type: Review Article
Publication Acceptance Date: September 1, 1998
Publication Date: N/A
Interpretive Summary: Boron and copper are examples of elements that are present in man in small or "trace", but important amounts. When there is not enough copper in the diet, the long bones, like the femur, develop abnormally and they become thin and fracture easily. In babies, it is obviously important to know how these bone fractures are different from those caused by child abuse. Copper deficiency is not known to occur in babies unless they have another problem like prematurity, low birth weight, or poor food. In older people, extra copper in the diet helps keep the bones from getting thin but scientists need to fine tune the amount of copper that is needed to keep bones healthy because too much copper in the diet is also harmful. When people receive too much zinc in the diet, they can become copper deficient because the extra zinc crowds out the copper while it is being absorbed in the intestines. Regular amounts of boron in the diet also helps bones develop and grow normally, especially when there is not enough vitamin D in the diet. Boron may keep some older people from having severe arthritis in their joints. Scientists do not know all the causes of bone diseases and it is reasonable to assume that boron, copper, and other trace elements may be important in keeping bones healthy. The information in this review may stimulate further research on the importance of trace elements in bone health.
Technical Abstract: The review discusses boron and copper as examples of elements that are present in man in small or "trace", but important amounts. Copper deficiency is indicated by the presence of long bone abnormalities, psychomotor retardation, hypotonia, hypopigmentation, prominent scalp veins in palpable periosteal depressions, pallor, sideroblastic anemia resistant to iron treatment, vacuolated erythroid and myeloid cells in bone marrow, hepatosplenomegaly, neutropenia, and serum copper and ceruloplasmin concentrations below 6.28 mmol/L and 0.13 g/L, respectively. Unintentional copper depletion by over-zealous zinc therapy or chelation therapy as treatment for heavy metal poisoning or vascular disease is of obvious importance. Intentional copper chelation with drugs including penicillamine for treatment of abnormalities including Wilson's disease may over deplete copper stores. Signs of copper deficiency associated with perinatal stress are sometimes confused with unexplained fractures in infant non-accidental injury that are sometimes manifest in the battered child syndrome. Boron is beneficial for mineral, vitamin D, insulin, and energy substrate metabolism and immune function in animals and humans. In particular, dietary boron has physiological effects beneficial to bone growth and maintenance. Further characterization of the metabolic roles of these and other trace elements related to bone metabolism seems an extremely prudent endeavor because of the probable association of several refractory bone diseases with trace and ultratrace elements nutriture.