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Arquivos Brasileiros de Endocrinologia & Metabologia

On-line version ISSN 1677-9487

Arq Bras Endocrinol Metab vol.50 no.4 São Paulo Aug. 2006 



C'est si bone



Claudio E. Kater

Associate Professor of Medicine, Division of Endocrinology and Metabolism, Federal University of São Paulo, SP. Editor-in-chief, Brazilian Archives of Endocrinology and Metabolism



UNFORTUNATELY, IDIOMATIC EXPRESSIONS in one language may not have a precise counterpart in another language. In Portuguese (the language spoken in Brazil, for those who may not know it) there are several commonly used expressions that include "the bone" to strengthen its meaning. For instance, "osso duro de roer" ("a hard bone to nibble") and "estou no osso" ("I'm busted" or "got to the bones"), both free author's translation, may not have an apparent direct translation into English, but are quite easy to understand.

In English, "bone idle" ("bastante preguiçoso" or "ocioso"), "a bone of contention" ("um motivo de disputa entre pessoas ou partidos"), which is similar to "the apple of discord" ("o pomo da discórdia"), and "bone up on something" ("estudar com profundidade alguma coisa") relies on the hardness of the bone to put emphasis on the expression.

Now, if we move to a third language, as in the case of the French, "le os" ­ the bone - may also have equivalent meanings as in English and Portuguese. But "c'est si bon" ("it's so good" or "isto é tão bom"), as sung by many good old French, American-English and Brazilian singers (let me remind you of just a few ones: Yves Montand, Mireille Mathieu, Charles Trenet, Louis Armstrong, Eartha Kitt, Cauby Peixoto, etc) there's nothing to do with what we are talking about.

But, this does not stop me to do a little play on words. In French-Anglais, naturally.

With a little twist, "C'est si bone" may be freely understood here both as "it's so hard" and "that's the bone".

For decades, the skeleton was thought to serve only the purpose of body-bearing, and as a by-product, to frighten distracted young kids on Fridays, the 13th.

Bones used to be a stiff calcified and inert material used, at best, to calm down your dog or to be launched in the space by Stanley Kubrick's 2001 monkey-men.

If one is interested in food and cooking, as I am, one must recall that the bone and "its circumstances" are integral part of any respectable dinner's "menu", as the chicken bones soup, the "ossobucco", and the famous T-bone steak (although the bone here functions mainly as a fancy framing for the meat).

My brother and I used to dispute and choose the "better" or "bigger" half of our after meal ice cream dessert by using the chicken's remaining wishbone.

For a long time none besides the orthopedics were interested in bones, especially if they were broken. Not long ago, so-called "weak bones" (what was a weak bone at that time anyway?) were treated simply with calcium supplements. And every mother's hidden desire was to bear children with "strong bones". Even nowadays, "big bones" are also a motif for excuses. Many of the obese patients I've seen, defend their rather heavy phenotypes by saying they have "large bones"! They'd better watch out on fatty foods, too. On the other hand, many of the famous models seen swaying around in magazines and TV shows are just "skin and bones" people! "Sorry the skinny, but a little chubby in the belly is fundamental", used to sing the poet (Vinicius de Morais, the famous brazilian writer who wrote "Girl of Ipanema", together with Tom Jobim).

All of a sudden, however, the bones have grown up and come to age; bones are now everywhere. From the orthopedists it moved around to the rheumatologist, the gynecologist and the endocrinologist. Even the dermatologist may soon join the club, who knows?

Our good old guest editors hang the bone to their names and contacts: Francisco Bandeira, instead of Francis Flag, is now nicknamed "fbone", as per his e.mail address, whereas Joao Lindolfo signs up occasionally and modestly as "Johnny, the Bonny". And last but not the least, our dear John Bilezikian rules the realm unquestionably as BoneBoss!

Moving to the scientific scenario, one of the endocrinology and metabolism's subspecialty areas that experienced a sharp and vivid advancement within the last 2 or 3 decades was the calcium and bone metabolism. With the development of accurate and precise equipment to measure bone mineral content (densitometers), for the first time the bone could be correctly evaluated and the actual "bone strength" measured in a serious and truly dependable fashion.

With numbers and values one could now rely on, endocrinology and metabolism branched out to encompass yet a new or rather revitalized subspecialty, calcium and bone metabolism.

All sorts of investigations followed and new and instigating data began to flood the medical literature.

A natural follow up was the investigations into the therapeutics and genetics of the diseases associated with bone abnormalities. From regular calcium supplements, daily walking and sunlight exposure, which still are obligatory and robust recommendations for those with or prone to osteopenia and osteoporosis, the endocrinologist and all those involved with the topic, are offered frequent new medications that not only prevent the progression of osteopenia to osteoporosis but also stimulate the formation of new bone, recovering patients from the fracture-risk status.

The relatively new class of therapeutic drugs, bisphosphonates, which is still growing to incorporate more potent once a month (from once a day) medications, and the recombinant human parathyroid hormone, have provided relief for once hopeless situations as menopause, hypogonadism, and chronic glucocorticoid users.

The present special edition of the Brazilian Archives of E&M (our ABE&M) contemplates a wide variety of topics in the area, bringing together national and international experts that produced a fresh and critical issue for all those interested in bone and calcium metabolism, as well as for the general endocrinologist and clinical practitioner who will certainly benefit from the information provided herein, assembled by our superb guest editors, "The 3Bs" (B for Bone, of course), Bandeira, Borges and Bilezikian. On behalf of the Editorial Committee of the Brazilian Archives of E&M and the Brazilian Society of E&M we salute you for your efforts and thank you for you time and dedication.


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