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Wakeman M. A Literature Review of the Potential Impact of Medication on Vitamin D Status. Risk Manag Healthc Policy 2021; 14:3357-3381. [PMID: 34421316 PMCID: PMC8373308 DOI: 10.2147/rmhp.s316897] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/12/2021] [Indexed: 12/23/2022] Open
Abstract
In recent years, there has been a significant increase in media coverage of the putative actions of vitamin D as well as the possible health benefits that supplementation might deliver. However, the potential effect that medications may have on the vitamin D status is rarely taken into consideration. This literature review was undertaken to assess the degree to which vitamin D status may be affected by medication. Electronic databases were searched to identify literature relating to this subject, and study characteristics and conclusions were scrutinized for evidence of potential associations. The following groups of drugs were identified in one or more studies to affect vitamin D status in some way: anti-epileptics, laxatives, metformin, loop diuretics, angiotensin-converting enzyme inhibitors, thiazide diuretics, statins, calcium channel blockers, antagonists of vitamin K, platelet aggregation inhibitors, digoxin, potassium-sparing diuretics, benzodiazepines, antidepressants, proton pump inhibitors, histamine H2-receptor antagonists, bile acid sequestrants, corticosteroids, antimicrobials, sulphonamides and urea derivatives, lipase inhibitors, hydroxychloroquine, highly active antiretroviral agents, and certain chemotherapeutic agents. Given that the quality of the data is heterogeneous, newer, more robustly designed studies are required to better define likely interactions between vitamin D and medications. This is especially so for cytochrome P450 3A4 enzyme (CYP3A4)-metabolized medications. Nevertheless, this review suggests that providers of health care ought to be alert to the potential of vitamin D depletions induced by medications, especially in elderly people exposed to multiple-drug therapy, and to provide supplementation if required.
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Affiliation(s)
- Michael Wakeman
- Faculty of Health and Wellbeing, University of Sunderland, Sunderland, SR1 3SD, UK
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Lancioni GE, Gigante A, O'Reilly MF, Oliva D. Evaluating Mild Physical Exercise with Two Persons with Profound Multiple Disabilities. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2019. [DOI: 10.1177/0145482x0009400707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giulio E. Lancioni
- Department of Psychology, University of Leiden, Wassenaarseweg 52, 2333 AK Leiden, the Netherlands
| | - Antonio Gigante
- Orthopedic surgeon and research associate, Department of Orthopedics, University of Ancona, Largo Cappelli 1, 60100 Ancona, Italy
| | - Mark F. O'Reilly
- Intellectual Disability Training Research Unit, Department of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Doretta Oliva
- Lega F. D'oro Research Center, 60027 Osimo (AN), Italy
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Bartlett RS, Gaston JD, Ye S, Kendziorski C, Thibeault SL. Mechanotransduction of vocal fold fibroblasts and mesenchymal stromal cells in the context of the vocal fold mechanome. J Biomech 2018; 83:227-234. [PMID: 30553439 DOI: 10.1016/j.jbiomech.2018.11.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 10/03/2018] [Accepted: 11/30/2018] [Indexed: 01/20/2023]
Abstract
The design of cell-based therapies for vocal fold tissue engineering requires an understanding of how cells adapt to the dynamic mechanical forces found in the larynx. Our objective was to compare mechanotransductive processes in therapeutic cell candidates (mesenchymal stromal cells from adipose tissue and bone marrow, AT-MSC and BM-MSC) to native cells (vocal fold fibroblasts-VFF) in the context of vibratory strain. A bioreactor was used to expose VFF, AT-MSC, and BM-MSC to axial tensile strain and vibration at human physiological levels. Microarray, an empirical Bayes statistical approach, and geneset enrichment analysis were used to identify significant mechanotransductive pathways associated with the three cell types and three mechanical conditions. Two databases (Gene Ontology, Kyoto Encyclopedia of Genes and Genomes) were used for enrichment analyses. VFF shared more mechanotransductive pathways with BM-MSC than with AT-MSC. Gene expression that appeared to distinguish the vibratory strain condition from polystyrene condition for these two cells types related to integrin activation, focal adhesions, and lamellipodia activity, suggesting that vibratory strain may be associated with cytoarchitectural rearrangement, cell reorientation, and extracellular matrix remodeling. In response to vibration and tensile stress, BM-MSC better mimicked VFF mechanotransduction than AT-MSC, providing support for the consideration of BM-MSC as a cell therapy for vocal fold tissue engineering. Future research is needed to better understand the sorts of physical adaptations that are afforded to vocal fold tissue as a result of focal adhesions, integrins, and lamellipodia, and how these adaptations could be exploited for tissue engineering.
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Affiliation(s)
- Rebecca S Bartlett
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, WI, United States
| | - Joel D Gaston
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, WI, United States
| | - Shuyun Ye
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, United States
| | - Christina Kendziorski
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, United States
| | - Susan L Thibeault
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, WI, United States.
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Walsh D, Belton S, Meegan S, Bowers K, Corby D, Staines A, McVeigh T, McKeon M, Hoey E, Trépel D, Griffin P, Sweeney MR. A comparison of physical activity, physical fitness levels, BMI and blood pressure of adults with intellectual disability, who do and do not take part in Special Olympics Ireland programmes: Results from the SOPHIE study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2018; 22:154-170. [PMID: 28125943 DOI: 10.1177/1744629516688773] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
People with an intellectual disability are less physically active, live more sedentary lives, have lower fitness levels and are more likely to be overweight or obese than the general population. No evidence exists on the impact of participation in Special Olympics Ireland (SOI) on physical activity and physical fitness levels. Adults with intellectual disabilities (16-64 years) were recruited from services and SOI clubs. Physical measures included waist circumference, height, weight, blood pressure, heart rate and 6-min walking test. Self-report questionnaires gathered data on physical activity levels. Actigraph (GT3X) accelerometers were used to gain an objective measure of physical activity. SOI participants accumulated more moderate to vigorous physical activity per day, had higher fitness levels and more positive health profile scores than those not taking part in SOI. SOI has the potential to make a positive difference to people's physical health and subsequently their overall health and well-being.
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Disrupted Bone Metabolism in Long-Term Bedridden Patients. PLoS One 2016; 11:e0156991. [PMID: 27275738 PMCID: PMC4898699 DOI: 10.1371/journal.pone.0156991] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/23/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Bedridden patients are at risk of osteoporosis and fractures, although the long-term bone metabolic processes in these patients are poorly understood. Therefore, we aimed to determine how long-term bed confinement affects bone metabolism. METHODS This study included 36 patients who had been bedridden from birth due to severe immobility. Bone mineral density and bone metabolism markers were compared to the bedridden period in all study patients. Changes in the bone metabolism markers during a follow-up of 12 years were studied in 17 patients aged <30 years at baseline. RESULTS The bone mineral density was reduced (0.58±0.19 g/cm3), and the osteocalcin (13.9±12.4 ng/mL) and urine N-terminal telopeptide (NTX) levels (146.9±134.0 mM BCE/mM creatinine) were greater than the cutoff value for predicting fracture. Among the bone metabolism markers studied, osteocalcin and NTX were negatively associated with the bedridden period. During the follow-up, osteocalcin and parathyroid hormone were decreased, and the 25(OH) vitamin D was increased. NTX at baseline was negatively associated with bone mineral density after 12 years. CONCLUSIONS Unique bone metabolic abnormalities were found in patients who had been bedridden for long periods, and these metabolic abnormalities were altered by further bed confinement. Appropriate treatment based on the unique bone metabolic changes may be important in long-term bedridden patients.
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Serin HM, Koç ZP, Temelli B, Esen İ. The bone mineral content alterations in pediatric patients medicated with levetiracetam, valproic acid, and carbamazepine. Epilepsy Behav 2015; 51:221-4. [PMID: 26298867 DOI: 10.1016/j.yebeh.2015.06.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/11/2015] [Accepted: 06/13/2015] [Indexed: 11/08/2022]
Abstract
AIM The negative effect of antiepileptic drugs on bone health has been previously documented. However, which antiepileptic drug is safer in regard to bone health is still questionable. Our aims were to investigate the bone mineral density alterations in pediatric patients who receive antiepileptic medication for a minimum of two years and to compare the results of these drugs. MATERIALS AND METHODS Fifty-nine patients (32 males, 27 females; mean age: 8.6±4.6years) and a control group (13 males, 7 females; mean age: 7.6±3.3years) were included in the study. The patients were receiving necessarily the same antiepileptic drugs (AEDs) for at least two years, and none of the patients had mental retardation or cerebral palsy. The patients were divided into three groups: group 1 (patients receiving levetiracetam (LEV), n=20), group 2 (patients receiving carbamazepine (CBZ), n=11), and group 3 (patients receiving valproic acid (VPA), n=28). Plasma calcium (Ca), phosphorus (P), parathyroid hormone (PTH), alkaline phosphatase (ALP), vitamin D levels, and bone mineral density (BMD) values of femur and vertebras (L1-4) and z-scores (comparative results of BMD values of the patients with the age- and gender-matched controls in device database) of the groups were compared. RESULTS The differences between P, PTH, ALP and age, Ca and BMD results, and vitamin D levels of the patients in all four groups was not statistically significant according to Kruskal-Wallis test (p>0.05). The z-score levels of all the patient and control groups were also not statistically significantly different compared with each other. CONCLUSION In contrast to previous reports in pediatric patients, our study has documented that there is not a considerable bone loss in patients receiving long-term AED medication. Although levetiracetam has been proposed as bone-protecting medication, we did not observe any difference between AEDs regarding bone mineral density after two years of treatment.
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Affiliation(s)
| | - Zehra Pınar Koç
- Nuclear Medicine Department, Firat University Hospital, Turkey.
| | - Berfin Temelli
- Nuclear Medicine Department, Firat University Hospital, Turkey.
| | - İhsan Esen
- Pediatric Endocrinology Department, Firat University Hospital, Turkey.
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Robien K, Oppeneer SJ, Kelly JA, Hamilton-Reeves JM. Drug-vitamin D interactions: a systematic review of the literature. Nutr Clin Pract 2013; 28:194-208. [PMID: 23307906 DOI: 10.1177/0884533612467824] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Extensive media coverage of the potential health benefits of vitamin D supplementation has translated into substantial increases in supplement sales over recent years. Yet, the potential for drug-vitamin D interactions is rarely considered. This systematic review of the literature was conducted to evaluate the extent to which drugs affect vitamin D status or supplementation alters drug effectiveness or toxicity in humans. Electronic databases were used to identify eligible peer-reviewed studies published through September 1, 2010. Study characteristics and findings were abstracted, and quality was assessed for each study. A total of 109 unique reports met the inclusion criteria. The majority of eligible studies were classified as class C (nonrandomized trials, case-control studies, or time series) or D (cross-sectional, trend, case report/series, or before-and-after studies). Only 2 class C and 3 class D studies were of positive quality. Insufficient evidence was available to determine whether lipase inhibitors, antimicrobial agents, antiepileptic drugs, highly active antiretroviral agents, or H2 receptor antagonists alter serum 25(OH)D concentrations. Atorvastatin appears to increase 25(OH)D concentrations, whereas concurrent vitamin D supplementation decreases concentrations of atorvastatin. Use of thiazide diuretics in combination with calcium and vitamin D supplements may cause hypercalcemia in the elderly or those with compromised renal function or hyperparathyroidism. Larger studies with stronger study designs are needed to clarify potential drug-vitamin D interactions, especially for drugs metabolized by cytochrome P450 3A4 (CYP3A4). Healthcare providers should be aware of the potential for drug-vitamin D interactions.
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Affiliation(s)
- Kim Robien
- Department of Epidemiology and Biostatistics, George Washington University School of Public Health and Health Services, Washington, DC 20037, USA.
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Mergler S, Evenhuis HM, Boot AM, De Man SA, Bindels-De Heus KGCB, Huijbers WAR, Penning C. Epidemiology of low bone mineral density and fractures in children with severe cerebral palsy: a systematic review. Dev Med Child Neurol 2009; 51:773-8. [PMID: 19614941 DOI: 10.1111/j.1469-8749.2009.03384.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Children with severe cerebral palsy (CP) are at risk for developing low bone mineral density (BMD) and low-impact fractures. The aim of this study was to provide a systematic literature review of the epidemiology of fractures and low BMD in children with severe CP, with an emphasis on risk factors. Gross Motor Function Classification System (GMFCS) levels IV and V were criteria for severe cerebral palsy. METHOD The literature (PubMed) was searched and eligible studies were given a level of evidence score using the Scottish Intercollegiate Guidelines Network criteria. RESULTS Seven studies were found concerning epidemiology of fractures, 11 studies described epidemiology of low BMD, and 14 studies concerned risk factors. The methodological quality of most of these studies was poor. Five studies were considered well-conducted with low risk of confounding and bias. In these studies, the incidence of fractures in children with moderate to severe CP approached 4% per year, whereas the prevalence of low BMD in the femur was 77%. Limited ambulation, feeding difficulties, previous fractures, anticonvulsant use, and lower body fat mass were associated with low BMD z-scores. INTERPRETATION There is only a limited amount of high-quality evidence on low BMD and fractures in children with severe CP.
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Affiliation(s)
- Sandra Mergler
- Medical Department ASVZ, Care and Service Centre for People with Intellectual Disabilities, Sliedrecht, the Netherlands.
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Affiliation(s)
- J. Jancar
- Honorary Consultant Psychiatrist, Stoke Park Hospital, Stapleton, Bristol, BS16 1QU, United Kingdom
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Kannus R, Jòzsa L, Renström R, Järvtoen M, Kvist M, Lento M, Oja P, Vuorl I. The effects of training, immobilization and remobilization on musculoskeletal tissue. Scand J Med Sci Sports 2007. [DOI: 10.1111/j.1600-0838.1992.tb00330.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Tekgul H, Serdaroglu G, Huseyinov A, Gökben S. Bone mineral status in pediatric outpatients on antiepileptic drug monotherapy. J Child Neurol 2006; 21:411-4. [PMID: 16901447 DOI: 10.1177/08830738060210050101] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drug-induced osteopenia has been reported in institutionalized children on chronic antiepileptic drug therapy. The aim of this study was to assess longitudinally bone mineral status in pediatric outpatients on antiepileptic drug monotherapy. The study group consisted of 30 ambulatory children on a normal diet: 15 on valproic acid, 11 on carbamazepine, and 4 on phenobarbital monotherapy. Bone mineral density, serum active vitamin D (1,25-dihydroxyvitamin D), and certain biochemical markers of bone formation (calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone, osteocalcin, calcitonin, and urinary calcium to serum creatinine and urinary phosphorus to serum creatinine ratios) were studied at the beginning of antiepileptic drug monotherapy and at the end of 2 years of treatment. Age- and sex-specific Z-scores of bone mineral density were measured at anterior-posterior L2-L4 by dual-energy x-ray absorptiometry. Drug-induced osteopenia was defined in only two patients (one on carbamazepine and the other on phenobarbital monotherapy), with Z-scores of bone mineral density less than -1.5. Serum levels of active vitamin D and biochemical markers were not significantly correlated with the Z-scores of bone mineral density. We detected a frequency of antiepileptic drug-induced osteopenia of 6.7% in pediatric outpatients after 2 years of monotherapy. However, osteopenia was not attributed to a defect in serum active vitamin D production owing to hyperparathyroidism in children on antiepileptic drug monotherapy.
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Affiliation(s)
- Hasan Tekgul
- Department of Pediatrics, Division of Pediatric Neurology, Ege University Medical Faculty, Izmer, Turkey.
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Abstract
Bone mass increases progressively during childhood, but mainly during adolescence when approximately 40% of total bone mass is accumulated. Peak bone mass is reached in late adolescence, and is a well recognised risk factor for osteoporosis later in life. Thus, increasing peak bone mass can prevent osteoporosis. The critical interpretation of bone mass measurements is a crucial factor for the diagnosis of osteopenia/osteoporosis in children and adolescents. To date, there are insufficient data to formally define osteopenia/osteoporosis in this patient group, and the guidelines used for adult patients are not applicable. In males and females aged <20 years the terminology 'low bone density for chronologic age' may be used if the Z-score is less than -2. For children and adolescents, this terminology is more appropriate than osteopenia/osteoporosis. Moreover, the T-score should not be used in children and adolescents. Many disorders, by various mechanisms, may affect the acquisition of bone mass during childhood and adolescence. Indeed, the number of disorders that have been identified as affecting bone mass in this age group is increasing as a consequence of the wide use of bone mass measurements. The increased survival of children and adolescents with chronic diseases or malignancies, as well as the use of some treatment regimens has resulted in an increase in the incidence of reduced bone mass in this age group. Experience in treating the various disorders associated with osteoporosis in childhood is limited at present. The first approach to osteoporosis management in children and adolescents should be aimed at treating the underlying disease. The use of bisphosphonates in children and adolescents with osteoporosis is increasing and their positive effect in improving bone mineral density is encouraging. Osteoporosis prevention is a key factor and it should begin in childhood. Pediatricians should have a fundamental role in the prevention of osteoporosis, suggesting strategies to achieve an optimal peak bone mass.
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Identification of Low Bone Mass in a Developmental Center: Finger Bone Mineral Density Measurement in 562 Residents. J Am Med Dir Assoc 2004. [DOI: 10.1016/s1525-8610(04)70004-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tsukahara H, Kimura K, Todoroki Y, Ohshima Y, Hiraoka M, Shigematsu Y, Tsukahara Y, Miura M, Mayumi M. Bone mineral status in ambulatory pediatric patients on long-term anti-epileptic drug therapy. Pediatr Int 2002; 44:247-53. [PMID: 11982890 DOI: 10.1046/j.1442-200x.2002.01561.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND For ambulatory pediatric outpatients,reports of abnormalities of bone metabolism associated with anti-epileptic drugs are inconsistent and may be difficult to interpret. METHODS The effects of long-term anti-epileptic therapy (mainly valproic acid and/or carbamazepine) on bone mineral status were evaluated in ambulatory epileptic patients(seven males and 11 females) aged 5.5-15.9 years. Bone mineral density (BMD) at the lumbar spine was measured by dual-energy X-ray absorptiometry and markers of bone and mineral metabolism were determined. RESULTS The mean BMD was decreased by 9% in our patients relative to the control, and five patients (all males)showed osteopenia, defined as BMD SD scores less than - 1.5. Serum levels of minerals, intact parathyroid hormone and 1alpha,25(OH)2 vitamin D were within the normal ranges. In most patients, serum levels of intact osteocalcin, carboxyterminal propeptide of type I procollagen and pyridinoline cross-linked telopeptide of type I collagen were reduced relative to the corresponding mean control values. The BB genotype by BsmI restriction fragment length polymorphism, associated with low BMD, was not found in our patients. The dietary calcium intake in the osteopenic patients was significantly lower than that of the non-osteopenic patients. CONCLUSIONS Our results indicate that long-term anti-epileptic treatment induces a state of decreased bone turnover in children, resulting in osteopenia preferentially in males. The alterations may be due, at least in part, to direct effects of the drugs on bone cells; and that low calcium intake could be an aggravating factor for anti-epileptic-associated osteopenia.
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Guo CY, Ronen GM, Atkinson SA. Long-term valproate and lamotrigine treatment may be a marker for reduced growth and bone mass in children with epilepsy. Epilepsia 2001; 42:1141-7. [PMID: 11580761 DOI: 10.1046/j.1528-1157.2001.416800.x] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine whether long-term treatment with valproate (VPA) and/or lamotrigine (LTG) in children with epilepsy is associated with altered growth and/or bone metabolism. METHODS Twenty-seven boys and 26 girls, aged 3 to 17 years (9.2 +/- 3.9, mean +/- SD), with epilepsy treated with VPA and/or LTG for > or =2 years were evaluated for growth, nutrient intakes, physical activity, bone mineral density (BMD), and blood biochemical indices of mineral and bone metabolism. RESULTS Twenty-three (43.4%) of the children had a body height below the 10th percentile. Z-scores for BMD below -1.5 occurred in 24.4% of the children. When patients were divided into two groups according to daily activity score, a significantly lower Z-score for total body BMD (p = 0.007), percentile for body height (p = 0.05), and plasma parathyroid hormone (PTH; p = 0.04), osteocalcin (p = 0.04) and 25-hydroxyvitamin D (25OHD) (p = 0.01) were found in the inactive compared with the active group. Z-score for total body BMD was correlated with daily activity score (r = 0.43, p = 0.008). Plasma intact osteocalcin and intact PTH values correlated significantly (r = 0.36, p = 0.02). Plasma 1,25-dihydroxyvitamin D was within normal range for all subjects. When patients were divided into LTG-alone, VPA-alone, and LTG-plus-VPA treatment groups, significantly lower (p < 0.05) plasma osteocalcin and percentile for body height were found in the VPA-plus-LTG treatment group. CONCLUSIONS Long-term VPA and LTG therapy, particularly when combined, is associated with short stature, low BMD, and reduced bone formation. These alterations may be mediated primarily through reduced physical activity rather than through a direct link to the VPA and/or LTG therapy.
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Affiliation(s)
- C Y Guo
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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van der Sluis IM, de Muinck Keizer-Schrama SM. Osteoporosis in childhood: bone density of children in health and disease. J Pediatr Endocrinol Metab 2001; 14:817-32. [PMID: 11515724 DOI: 10.1515/jpem.2001.14.7.817] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Bone mineral density in later life largely depends on the peak bone mass achieved in adolescence or young adulthood. A reduced bone density is associated with increased fracture risk in adults as well as in children. Pediatricians should therefore play an important role in the early recognition and treatment of childhood osteoporosis. Juvenile idiopathic osteoporosis and osteogenesis imperfecta are examples of primary osteoporosis in childhood. However, osteoporosis is more frequently a complication of a chronic disease or its treatment. This paper provides an overview of bone and bone metabolism in healthy children and the use of diagnostic tools, such as biochemical markers of bone turnover and several bone densitometry techniques. Furthermore, a number of diseases associated with osteoporosis in childhood and possible treatment strategies are discussed.
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Affiliation(s)
- I M van der Sluis
- Department of Pediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands.
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Saggese G, Baroncelli GI, Bertelloni S. Osteoporosis in children and adolescents: diagnosis, risk factors, and prevention. J Pediatr Endocrinol Metab 2001; 14:833-59. [PMID: 11515725 DOI: 10.1515/jpem.2001.14.7.833] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Bone mass acquired during childhood and adolescence is a key determinant of adult bone health. Peak bone mass, which is achieved in late adolescence, is a main determinant of osteoporosis in adulthood. Therefore, any factor adversely impacting on bone acquisition during childhood or adolescence can potentially have long-standing detrimental effects on bone health predisposing to osteoporosis and fracture risk. Thus, osteoporosis can well have its origin in childhood and adolescence. Pediatricians should be playing an active role in osteoporosis diagnosis and prevention. It is increasingly recognized that osteoporosis may occur in some disorders of children and adolescents. In this paper we review the diagnostic criteria of osteopenia/osteoporosis by densitometric assessment of bone mineral density, the contributing factors, and the mechanisms whereby several disorders may affect the acquisition of bone mass in children and adolescents. Finally, some recommendations to optimize peak bone mass in order to prevent osteopenia/osteoporosis are suggested.
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Affiliation(s)
- G Saggese
- Department of Reproductive Medicine, University of Pisa, Italy
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Morimoto Y, Tanaka T, Kito S, Morimoto A, Haneji T, Kimura M, Ohba T. Quantitative radiographic changes in the mandible and the tibia in systemically loaded rats fed a low-calcium diet. Oral Dis 2000; 6:310-7. [PMID: 11002414 DOI: 10.1111/j.1601-0825.2000.tb00144.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The combined effect of the duration of loaded physical exercise and the percentage of calcium intake on the mandible and tibia were studied in developing male rats. For the loaded exercise, rats ran on a treadmill at a rate of 12 m per min for either 1 or 2 h per day. A total of 54 4-week-old male Wistar rats were randomly assigned to one of six groups. After 4 weeks of the diet and loaded exercise, the rats were killed and their mandibles and tibia were removed. Each individual bone was assessed by radiography and the radiographs were then used for measurements of cortical thickness, bone length and bone width. All radiographic images were analyzed using a computer-based scanner image analysis system. In addition, we measured the dry weight both of the tibia and mandible. The results demonstrated that significant differences in cortical thickness, bone length, bone width, and bone weight, both of the tibia and the mandible, were detectable between the normal diet group and the low-calcium diet group. Among the normal diet groups, significant differences were found in cortical thickness, bone length, bone width, and bone weight of the tibia, whereas no significant differences in either cortical bone thickness, bone length or bone weight of the mandible were detected. In contrast, among the low-calcium diet groups, no significant differences were detected in cortical thickness, bone length, bone width or bone weight for either the tibia or the mandible. Our results suggested that systemic exercise, such as running, promote the linear dimensions and the cortical thickness of the tibia in response to local stimuli. Furthermore, sufficient calcium intake appears to be necessary to allow the effect of systemic exercise on tibial bone growth to occur. In contrast, systemic loaded exercise does not promote either bone growth or development of the mandible even under conditions of sufficient calcium intake.
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Affiliation(s)
- Y Morimoto
- Department of Dental Radiology, Kyushu Dental College, Kokurakita-ku, Kitakyushu 803-8580, Japan.
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Lancioni GE, Gigante A, O'Reilly MF, Oliva D, Montironi L. Indoor travel and simple tasks as physical exercise for people with profound multiple disabilities. Percept Mot Skills 2000; 91:211-6. [PMID: 11011890 DOI: 10.2466/pms.2000.91.1.211] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
2 to 4 30-min. periods of indoor travel and simple tasks were arranged daily as physical exercise for two women with profound mental retardation, deafness, and profound visual impairment. The questions were whether (a) the women could manage this fairly extensive exercise regimen (over about 9 and 4.5 mo.) with support technology and only minimal staff supervision and (b) the exercise could affect aspects of the women's physical condition. Data indicated that both women could successfully manage the exercise regimen with support technology, and the exercise seemed to have some beneficial effects on physical aspects such as bone metabolism and step width.
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Affiliation(s)
- G E Lancioni
- Department of Psychology, University of Leiden, The Netherlands.
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20
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Lahat E, Weiss M, Ben-Shlomo A, Evans S, Bistritzer T. Bone mineral density and turnover in children with attention-deficit hyperactivity disorder receiving methylphenidate. J Child Neurol 2000; 15:436-9. [PMID: 10921512 DOI: 10.1177/088307380001500702] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is the most common behavior disorder among children; methylphenidate is a drug frequently prescribed for the control of its symptoms. One of the potential side effects of methylphenidate that concerns parents is its impact on the growth of children, since the mechanism by which methylphenidate might influence growth is not known. As linear growth is associated with an increase in bone mineral density and turnover, this study was undertaken to evaluate bone mineral density by dual photon absorptiometry and bone turnover by measuring serum bone-specific alkaline phosphatase and the urinary deoxypyridinoline excretion rate in children treated with methylphenidate for 1 to 2 years as compared to a control group. There were no significant differences in bone mineral density at either the lumbar spine or femoral neck in the study group (0.662 +/- 0.04 and 0.735 +/- 0.07 g/cm2, respectively) as compared to the controls (0.675 +/- 0.05 g/cm2 and 0.734 +/- 0.07 g/cm2, respectively). Furthermore, there were no significant differences in serum bone-specific alkaline phosphatase in the study group (58 +/- 22 U/L) as compared to the control children (71 +/- 34 U/L) or in urinary deoxypyridinoline in the study group (34 +/- 38 nM/mM), as compared to the control group (27 +/- 12 nM/mM). In conclusion, our data do not support a significant effect of methylphenidate on bone mineral density turnover in children when used for 1 to 2 years.
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Affiliation(s)
- E Lahat
- Pediatric Neurology Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
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21
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LANCION GE. INDOOR TRAVEL AND SIMPLE TASKS AS PHYSICAL EXERCISE FOR PEOPLE WITH PROFOUND MULTIPLE DISABILITIES. Percept Mot Skills 2000. [DOI: 10.2466/pms.91.5.211-216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Lancioni GE, Campodonico F, Mantini M. Promoting Mild Physical Exercise in a Person with Profound Multiple Disabilities. ACTA ACUST UNITED AC 1999. [DOI: 10.1080/028457199439964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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23
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Akin R, Okutan V, Sarici U, Altunbas A, Gökçay E. Evaluation of bone mineral density in children receiving antiepileptic drugs. Pediatr Neurol 1998; 19:129-31. [PMID: 9744632 DOI: 10.1016/s0887-8994(98)00039-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effects of the valproic acid and carbamazepine monotherapies on bone mineral density were evaluated. Bone mineral density was measured in 53 children with primary epilepsy taking either valproic acid (n = 25) or carbamazepine (n = 28) for longer than 1 year and in a healthy control group (n = 26) by the dual-energy x-ray absorptiometry method at L2-L4 levels of lumbar vertebrae. The mean serum levels of valproic acid and carbamazepine were 66 +/- 2.2 microg/mL and 7.0 +/- 9.3 microg/mL, respectively, and the mean duration of treatment for each drug was 2.4 +/- 0.2 years and 2.6 +/- 0.5 years, respectively. Calcium intakes in diet were similar in both the control and study groups. The serum levels of calcium and phosphorus in all groups were normal. Bone mineral density values of both valproic acid and carbamazepine groups were not statistically different from that of the control group (P > 0.05).
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Affiliation(s)
- R Akin
- Department of Pediatrics, Gülhane Military Medical Academy, Ankara, Turkey
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24
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Lancioni GE, Oliva D, Ten Hoopen G. Spoken messages as auditory cues for orientation in promoting indoor travel and activity by persons with multiple disabilities. Percept Mot Skills 1997; 85:403-10. [PMID: 9347521 DOI: 10.2466/pms.1997.85.2.403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Spoken messages lasting about 2 sec. and occurring every 8 or 9 sec. were used as auditory cues for orientation to guide two persons with multiple disabilities to destinations for indoor activities. The use of spoken messages was alternated with buzzer-like sounds of the same duration and frequency of occurrence. The preliminary data indicated that both the spoken messages and the buzzer-like sounds were very effective as orientation cues. Staff found no difference in disturbance between them, yet, both were considered less disturbing than buzzer-like sounds of previous studies which had a higher frequency of occurrence.
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Affiliation(s)
- G E Lancioni
- Department of Psychology, University of Leiden, The Netherlands.
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25
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Abstract
Hypercalcemia occurs in children of all ages. A serum calcium level over 15 mg/dL can be life-threatening. The association between familial hypocalciuric hypercalcemia (FHH) and neonatal severe hyperparathyroidism (NHPT) has been discussed. FHH is characterized by a high serum calcium concentration, relatively low urine calcium excretion, and an inappropriately normal parathyroid hormone (PTH) concentration. On the other hand, NHPT is a rare disease characterized by markedly increased serum calcium (15 mg/dL) and PTH concentrations, and is fatal without parathyroidectomy early in life. Recently, a complementary DNA encoding an extracellular calcium-sensing receptor has been isolated. Furthermore, three mutations in the receptor gene in FHH and NHPT individuals have been described. Thus, heterozygotes and homozygotes of FHH may have an intermittent hypercalcemia and NHPT, respectively. Vitamin D-related hypercalcemia, and vitamin D intoxication and immobilization are also discussed.
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Affiliation(s)
- S Nishiyama
- Department of Pediatrics, School of Medicine, Kumamoto University, Japan
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26
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LANCION GE. SPOKEN MESSAGES AS AUDITORY CUES FOR ORIENTATION IN PROMOTING INDOOR TRAVEL AND ACTIVITY BY PERSONS WITH MULTIPLE DISABILITIES. Percept Mot Skills 1997. [DOI: 10.2466/pms.85.6.403-410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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27
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Chappard D, Minaire P, Privat C, Berard E, Mendoza-Sarmiento J, Tournebise H, Basle MF, Audran M, Rebel A, Picot C. Effects of tiludronate on bone loss in paraplegic patients. J Bone Miner Res 1995; 10:112-8. [PMID: 7747617 DOI: 10.1002/jbmr.5650100116] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Immobilization secondary to spinal cord injury is associated with a marked and rapid atrophy of trabecular bone (disuse osteoporosis). This is due to an early increase of osteoclastic bone resorption associated with a pronounced decreased osteoblastic bone formation. Bisphosphonates are antiosteoclastic compounds and they have been effective in preventing disuse osteoporosis. However, some of them also depress osteoblastic activity and may impair the mineralization process. Tiludronate was shown effective in reducing bone resorption in several metabolic bone diseases without inducing mineralization defects. Twenty paraplegic patients (6 females and 14 males) were randomly assigned to three groups: 6 patients entered the placebo group; 7 patients received tiludronate 200 mg/day; and 7 received 400 mg/day. Histomorphometric analysis was performed on transiliac bone biopsies before and after 3 months treatment. An insignificant decrease of bone volume was observed in the placebo group and the 200 mg group. In patients receiving 400 mg/day, a slight increase was noted. Osteoid parameters changed nonsignificantly in three groups although the 400 mg group exhibited a slight tendency to decrease osteoid volume and thickness. Eroded surfaces increased in all groups. The number of osteoclasts (identified histochemically by TRAP staining) increased in the placebo group but decreased in groups receiving tiludronate. Tiludronate appears effective in reducing bone resorption without impairing bone formation in a manner that preserved bone mass and bone cell coupling.
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Affiliation(s)
- D Chappard
- Laboratoire d'Histologie Embryologie, Faculté de Médecine, Angers, France
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28
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Simultaneous measurement of hair and bone mineral content in severely handicapped children. PATHOPHYSIOLOGY 1994. [DOI: 10.1016/0928-4680(94)90035-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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29
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Lalli JS, Mauk JE, Goh H, Merlino J. Successful behavioral intervention to treat children who are reluctant to ambulate. Dev Med Child Neurol 1994; 36:625-9. [PMID: 8034125 DOI: 10.1111/j.1469-8749.1994.tb11900.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The authors report two patients with marginal ambulation skills whose severe behavioral problems prevented participation in physical therapy. The problem behavior also limited the patients' participation in activities of daily living and social interaction. Because of the risks of loss of ambulation to overall health, an aggressive behavioral intervention was implemented to decrease problem behavior and to increase participation in physical therapy. With the use of the behavioral interventions, the authors demonstrated concomitant increases in compliance to requests to ambulate, distances ambulated, and decreases in the rates of self-injury and aggression.
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Affiliation(s)
- J S Lalli
- Division of Child Development and Rehabilitation Medicine, University of Pennsylvania School of Medicine, Children's Seashore House, Philadelphia 19104-4388
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30
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Välimäki MJ, Tiihonen M, Laitinen K, Tähtelä R, Kärkkäinen M, Lamberg-Allardt C, Mäkelä P, Tunninen R. Bone mineral density measured by dual-energy x-ray absorptiometry and novel markers of bone formation and resorption in patients on antiepileptic drugs. J Bone Miner Res 1994; 9:631-7. [PMID: 8053391 DOI: 10.1002/jbmr.5650090507] [Citation(s) in RCA: 129] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In patients on antiepileptic drugs, bone loss has been mainly demonstrated at radial sites using old technology and has been ascribed to drug-induced vitamin D deficiency rather than to any direct effects of the treatment on bone cells. We examined 38 epileptic patients (24 women and 14 men) aged 20-49 years who were using either carbamazepine or phenytoin or both. Bone mineral density (BMD) at the lumbar spine and three femoral sites was measured by dual-energy x-ray absorptiometry (DXA) and serum and urine markers of bone and mineral metabolism were determined. The latter included the C-terminal extension peptide of type I procollagen (PICP), a putative serum marker of bone formation, and the cross-linked carboxyl-terminal telopeptide of human type I collagen (ICTP), a novel serum marker of bone matrix degradation. In female patients on phenytoin, weight- and height-adjusted BMD was reduced at the femoral neck and the Ward's triangle (p < 0.05) but was at the control level in the other patient groups at all four measurement sites. Compared with controls, the serum concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were reduced by 26% (p < 0.01) and by 27% (p < 0.001) in female patients. These changes were independent of the therapy used. They were not present in male patients. For both genders the serum levels of vitamin D binding protein were normal. Both female and male patients had hypocalcemia, but women only showed hypocalciuria.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M J Välimäki
- Third Department of Medicine, University of Helsinki, Finland
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31
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Higashi A, Nakamura T, Nishiyama S, Matsukura M, Tomoeda S, Futagoishi Y, Shinohara M, Matsuda I. Zinc kinetics in patients with bone demineralization due to physical immobilization. J Am Coll Nutr 1993; 12:61-5. [PMID: 8440820 DOI: 10.1080/07315724.1993.10718284] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
To examine the relationship between zinc (Zn) status and bone demineralization, a body Zn kinetics study was performed with 74 (37 male, 37 female) disabled persons ranging in age from 16 to 45 years. Three groups were classified according to degree of limited mobility: group 1 (n = 23), capable of walking; group 2 (n = 20), capable of crawling; group 3 (n = 31), bed-ridden, Serum Zn levels were similar in the three groups, whereas body Zn clearance and the distribution of Zn showed a pattern [group 1 < group 2 < group 3 (p < 0.01, p < 0.05)], with the reverse in cases of bone mineral density (BMD) [group 1 > group 2 > group 3 (p < 0.01)]. Renal handling of Zn did not different among the three groups. There was a negative correlation between Zn distribution volume and values of BMD (p < 0.005, gamma = 0.387). Thus, various organs, as well as the skeleton, are Zn deficient in immobilized patients.
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Affiliation(s)
- A Higashi
- Department of Pediatrics, Kumamoto University Medical School, Japan
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32
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Elias AN, Gwinup G. Immobilization osteoporosis in paraplegia. THE JOURNAL OF THE AMERICAN PARAPLEGIA SOCIETY 1992; 15:163-70. [PMID: 1500942 DOI: 10.1080/01952307.1992.11735870] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The pathophysiology of osteoporosis as it relates to immobilization or disuse osteoporosis in paraplegics is briefly reviewed. The physiology of bone formation and resorption is discussed, and the influence of piezoelectric forces on bone integrity and the consequences of the loss of this effect in paraplegics is addressed. When bone is stressed, negative charges accumulate on the side from which the stress is applied and positive charges accumulate on the opposite side. Presumably the collagenous component of bone plays the major role in the generation of electrical potentials. Another mechanism important in the generation of electrical potentials is created by liquid planes streaming past solid planes. Diminished forces acting on bone, as in paraplegia, are translated into changes in the activity of bone remodeling units which can be assessed by histomorphic and histoenzymatic techniques. Other biochemical and endocrine consequences of immobilization involve increased serum calcium, decreased serum parathyroid hormone (PTH), and decreased dihydroxy-vitamin D synthesis. Urinary hydroxyproline and calcium excretion are increased, as is stool calcium. The bone loss that follows immobilization may produce an increased susceptibility to fractures involving long bones more than the spinal column, and is due more to decreased bone formation than to accelerated bone resorption. The treatment of immobilization osteoporosis primarily involves early remobilization, but other treatments, including the use of electrical fields and the administration of bisphosphonates, calcitonin, and a growth hormone are being actively investigated.
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Affiliation(s)
- A N Elias
- Department of Medicine, Endocrinology & Metabolism, University of California, Irvine
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33
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Abstract
A great number of anticonvulsants are available for treating these different types of epilepsy. Therapeutic drug monitoring has been favored as the method for controlling drug concentrations in the plasma and preventing untoward effects. When these anticonvulsants are prescribed to treat epilepsy in children, careful monitoring is most important because drug metabolism varies depending on maturation and development of body functions. Molecular approaches are also important to elucidate the effectiveness of the drugs for treatment of different seizure disorders and should contribute to a better understanding of body functions.
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Affiliation(s)
- I Matsuda
- Kumamoto University Medical School, Japan
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34
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Abstract
Bone mass is not only subject to systemic hormonal homeostatic mechanisms, but also to local mechanical influences. The importance of the mechanical balance of bone has been more recently stressed by the research on the effect of weightlessness on bone, and by the introduction of the concept of "mechanostat" in the pathogenesis of osteoporotic conditions. Immobilization osteoporosis has clinical (fractures, sometimes hypercalcemia, urinary lithiasis) and radiological features. Immobilization has an effect on bone modeling and remodeling, through an increased activation of remodeling loci, and a decrease of the osteoblastic stimulus. This leads directly to a local reduction in bone mass, the increased activation multiplying the effect of the deficit in bone formation. The prevention is based on exercise if the load is applied intermittently for a daily period. It seems also that muscle weight is an important determinant of bone mass. There is a potential for recovery during the active early phase of immobilization osteoporosis that may disappear in the subsequent late (about six months) inactive phase. Permanent losses could be prevented by appropriate measures, pharmacology or exercises, applied during the first months of immobilization. No recovery has been demonstrated after the inactive phase has been reached, whatever the treatment. The cumulative effect of repeated periods of immobilization remains hypothetical.
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Affiliation(s)
- P Minaire
- Department of Rehabilitation Medicine, C.H.R.U. Hôpital Bellevue, Saint-Etienne, France
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35
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Takei S, Hiwatari M, Imanaka H, Hokonohara M, Miyata K. Bone evaluation by microdensitometry in patients with juvenile rheumatoid arthritis. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1988; 30:671-9. [PMID: 3149127 DOI: 10.1111/j.1442-200x.1988.tb02552.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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36
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Fischer MH, Adkins WN, Liebl BH, VanCalcar SC, Marlett JA. Bone status in nonambulant, epileptic, institutionalized youth. Improvement with vitamin D therapy. Clin Pediatr (Phila) 1988; 27:499-505. [PMID: 2844466 DOI: 10.1177/000992288802701007] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study was conducted to determine if the adverse effects of anticonvulsant drug therapy and nonambulancy on bone status could be overcome with vitamin D therapy in severely handicapped individuals. Six male and five female gastrostomy fed, nonambulant, epileptic, profoundly mentally retarded individuals ranging in age from 7 to 17 years were given vitamin D therapy at a dosage of 4,000 IU/m2 body surface area/day for 6 months. Photon absorptiometry and biochemical indices of bone status were measured to follow the effects of therapy. Bone mineral content expressed as a percentage of normal improved by 11 percent (p less than 0.01), from 59.6 to 66.1 percent. Tartrate-resistant acid phosphatase, total alkaline phosphatase, and the bone isoenzyme activities declined 11 percent, 18 percent, and 11 percent respectively. These reductions were not statistically significant but they were consistent with the improvements observed by photon absorptiometry. The results of our study suggest that a conservative supplement of vitamin D will improve the bone status of severely disabled youths.
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Affiliation(s)
- M H Fischer
- Central Wisconsin Center for the Developmentally Disabled, Madison 53704
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37
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Biering-Sørensen F, Bohr H, Schaadt O. Bone mineral content of the lumbar spine and lower extremities years after spinal cord lesion. PARAPLEGIA 1988; 26:293-301. [PMID: 3205570 DOI: 10.1038/sc.1988.44] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Bone mineral content (BMC) was measured by dual photon absorptiometry in the lumbar spine, femoral neck and shaft, and proximal tibia in 26 individuals with spinal cord lesions sustained 2 to 25 years previously. In average BMC of the lumbar spine was within the range of normal values. BMC of the femoral neck and shaft was in average 25% lower than the normal values, and for the proximal tibia more than 50% lower than the normal value. Participants with cervical lesions had lower BMC values in the femoral bones than those with thoracic lesions. Neither presence of spasticity nor daily use of long leg braces influenced the BMC significantly. Participants with previous lower extremity fractures had lower BMC values in the long bones compared with participants without fractures. The preservation of the BMC of the lumbar spine may be due to maintenance of load on the spine while sitting in a wheelchair.
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Affiliation(s)
- F Biering-Sørensen
- Centre for Spinal Cord Injured, Department TH, University of Copenhagen, Denmark
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