Hospital based preliminary study on osteoporosis in postmenopausal women

Risk factors for osteoporosis among postmenopausal women in a Nigerian teaching hospital

Background

Osteoporosis is a progressive bone disease characterized by a reduction in bone mass and density, leading to bone fragility and an increased risk of sustaining fractures. Several studies have shown that the risk for osteoporosis increases with age and after menopause.

Methods

A cross-sectional study was undertaken of 422 postmenopausal women at the Family Medicine Clinic of the Lagos State University Teaching Hospital (LASUTH). Variables such as socio-demographic characteristics, anthropometric indices, and lifestyle habits of participants were assessed. In addition, bone mineral density was measured using a validated portable dual-energy X-ray absorptiometry scanner. The results of the bone mineral density were analyzed based on T-scores.

Results

The mean age of the study subjects was 59.8± ±6.4 years, while the mean age at menopause was 50.15 ± 4.1 years. The majority of the subjects were obese (41.5%), while the prevalence of osteoporosis and osteopenia was 15.1% and 30.6%, respectively. The use of oral steroids was associated with osteoporosis (P < 0.05).

Conclusion

We recommend regular bone mineral density screening of postmenopausal women at the primary care level for early diagnosis and treatment of osteoporosis to prevent fragility fractures.

Microbial Composition of a Traditional Fermented Wheat Preparation—Nishasta and Its Role in the Amelioration of Retinoic Acid-Induced Osteoporosis in Rats

Fermented foods have a long history of human use. The purpose of this study was to characterize the microbial composition of a traditional fermented wheat preparation—Nishasta— and to explore its effect in retinoic acid-induced osteoporosis in Wistar rats. The sample was suspended in sterile water (10% w/v), mixed thoroughly, filtered, and gradually diluted. Aliquots of dilutions were cultured in MRS (DeMan–Rogosa–Sharpe) medium, and colonies with similar morphologies were subjected to DNA extraction. The 16S rRNA gene of the isolates was amplified by polymerase chain reaction, checked by agarose gel electrophoresis, and finally identified by sequencing. Anti-osteoporosis screening of Nishasta was carried out in female Wistar rats using retinoic acid as an inducer (70 mg/kg, p.o. once a day for 14 days). Its effect on bone health parameters was determined. The bone metabolism markers such as hydroxyproline (HOP), tartrate-resistant acid phosphatase (TRACP), and alkaline phosphatase (ALP) were evaluated. The results of microbial characterization revealed the presence of ten clones of Lactobacillus plantarum in the fermented preparation with L. plantarum NF3 as the predominant strain. The average microbial count was 2.4 × 103 CFU/g. Retinoic acid administration led to a marked disorder of various bone health markers in rats. It also increased the levels of urine calcium and phosphorus, indicating increased bone destruction. Treatment with fermented wheat (at 200, 100, and 50 mg/kg doses, p.o. daily for 42 days after the induction of osteoporosis) improved bone mineral density in a dose-dependent manner. It also improved the bone microstructure and reduced the levels of ALP, TRACP, and HOP. Micro-CT revealed that it reduced trabecular separation and increased the percent bone volume, trabecular numbers, trabecular thickness, and bone mineral density in the rats. The results showed that the fermented wheat promoted bone formation and prevented bone resorption. Our findings clearly established the effectiveness of Nishasta against osteoporosis in Wistar rats that can be partly attributed to the improved gut calcium absorption and microbiota composition.

Serum levels of proinflammatory cytokines and selected bioelements in perimenopausal women with regard to body mass index

During the menopause, decreased estrogen levels may be accompanied by increased levels of inflammatory mediators. Many studies also show significant relationships between the levels of bioelements and proinflammatory cytokines. The aim of this study was to assess the levels of proinflammatory cytokines, C-reactive protein (CRP), and selected bioelements in perimenopausal women with regard to BMI. Methods: The study of 217 perimenopausal women involved the completion of questionnaires concerning sociodemographic and medical data, anthropometric measurements, and blood collection. Results: In all studied women, the levels of IL-1β significantly positively correlated with Ca, Mg, and Sr; IFNγ significantly negatively correlated with Sr, and IL-6 with Mg. In women with a normal BMI, the levels of IL-1β significantly positively correlated with Ca and Sr, and CRP positively correlated with Zn. In overweight women, the levels of IL-1β positively correlated with Ca, IL-6 with Na, and IFNγ negatively correlated with Sr. In obese women, the levels of CRP positively correlated with Zn, TNFα with Mg, IFNγ with Cu and P. The levels of IL-6 negatively correlated with Ca and Mg. Conclusions: BMI may be one of the factors that affect the relationship between serum bioelement levels and the levels of proinflammatory cytokines and CRP in women, especially during the menopausal period.

Evaluation of urinary hydroxyproline and creatinine level in patients with benign mandibular odontogenic tumor

Background

Odontogenic tumors are relatively common oro‐facial tumors seen in our environment with challenges encountered with management in terms of inadequate infrastructure and high cost of treatment. They are often associated with bone resorption with concomitant collagen degradation and excretion of their by‐products in serum or urine. The aim of this present study was to evaluate urinary hydroxyproline level in patients with benign mandibular odontogenic tumors.

Materials and methods

Twenty‐two consecutive patients with histologically diagnosed mandibular odontogenic tumors were recruited. Twenty‐two controls who matched the study group for sex and age were also recruited. The study group had CT‐Scan of their lesions done. All participants were required to fast 12 hours overnight and their early morning second void urine collected between 7 a.m and 8 a.m. The collected urine samples were stored frozen at −20°C until analysis. Colorimetric method of analysis of urinary hydroxyproline and creatinine were done using Biovision hydroxyproline kit and Randox creatinine kit, respectively. The results were recorded as urinary hydroxyproline alone (μg/μl) and as urinary hydroxyproline/creatinine ratio.

Results

The mean age of the participants was 28.45 ± 6.8 years. The mean duration of the tumors in the study group was 5.9 ± 4.4 years. A mean urinary hydroxyproline/ creatinine ratio of 0.081 ± 0.129 was noted in the study group as compared to 0.016 ± 0.006 that was noted among healthy Nigerian who served as controls in the study.

Conclusion

There was a significant increase in urinary hydroxyproline level in patients with odontogenic tumors when compared with healthy Nigerians.

Insight into the possible role of miR-214 in primary osteoporosis via osterix

Osteoporosis is a bone disease characterized by chronic pain and recurrent fractures. Osterix is a transcription factor regulating bone formation. miR-214 was found to have a role in skeletogenesis. Our goal was to investigate the possible role of miR-214 in primary osteoporosis through osterix. Their expression was determined in bone samples obtained from primary osteoporotic patients (n = 26) and age- and sex-matched controls (n = 14). Additionally, their expression was correlated to the laboratory and clinical parameters of the study participants. Differential expression of osterix and miR-214 was detected in the osteoporotic group compared to controls. While miR-214 was significantly higher, osterix was significantly lower. In primary osteoporotic patients, relative quantification value of osterix was positively correlated with sex, body mass index, and ionized calcium and negatively correlated with miR-214 and C-reactive protein. Thus, the role of miR-214 in primary osteoporosis could be through inhibiting osterix expression in bones and therefore both miR-214 and osterix could be targets for future therapeutic intervention.

Effect of age and estrogen on biochemical markers of bone turnover in postmenopausal women: a population-based study from Nepal

BACKGROUND

Osteoporosis, a common disease worldwide, is characterized by low bone mass and architectural deterioration of bone tissue, leading to enhanced bone fragility and increase in fracture risks. Both menopause and aging are related factors leading to greater risk of bone disease, particularly among postmenopausal women. Hence, the main purpose of this study was to investigate the differences in biochemical markers of bone turnover and to evaluate the association of hormones and age-related factors with biochemical markers between pre- and postmenopausal women.

METHODS

A descriptive cross-sectional study was conducted over a period of 6 months among the female population of Dholahity community, Lalitpur, Nepal. A total of 496 healthy women were selected based on the questionnaire strategy. Among them, 244 were premenopausal and 252 were postmenopausal women. Different bone markers were evaluated as per the guideline provided by the reagent manufacturer, and hormonal assay, particularly estradiol level assessment, was performed by chemiluminescence immunoassay-based technique.

RESULTS

A significant decrease in serum calcium level and estradiol level was observed in postmenopausal women as compared to premenopausal women, whereas a significant increase in serum phosphorus and alkaline phosphatase (ALP) levels was seen among postmenopausal (p<0.001). Age was significantly correlated with bone markers (ALP and calcium) in postmenopausal group (p<0.005), while there was no significant correlation in premenopausal group. In addition, there was significant positive correlation between calcium and estradiol in postmenopausal women, while ALP was negatively correlated with estradiol in that group. Further, no significant correlation was demonstrated between estradiol and bone markers in postmenopausal women in body mass index and age-adjusted partial correlation analysis.

CONCLUSION

Timely diagnosis of osteoporosis in women would be of significant benefit for effective care for required populations and help to minimize mortality rate and financial burden of our country.

Serum Osteocalcin as a Diagnostic Biomarker for Primary Osteoporosis in Women

INTRODUCTION

Osteoporosis, a major health problem in elderly population, especially in post-menopausal females, is diagnosed basically on clinical suspicion and bone mineral density measurement. Dual energy x-ray absorptiometry (DEXA) scan though a gold standard of diagnosis becomes unfit for screening purpose due to its prohibitive cost, unportability and lack of availability of machine.

AIM

To assess the diagnostic potential of serum osteocalcin levels in primary osteoporosis.

MATERIALS AND METHODS

In a case-control study, 82 post-menopausal females, between 40-70 years, were subjected to measurements of bone mineral density and serum osteocalcin levels. Based on the results of DEXA scan they were divided into two: a) Control group and B) Case group. Case group was further subdivided as Osteopenia and Osteoporosis depending on their t-scores. Correlation between different BMD grades and the levels of serum osteocalcin were analysed statistically.

RESULTS

A negative correlation was found between serum osteocalcin levels and BMD grading. Significant association of age and years since menopause (YSM) was found with serum osteocalcin levels and BMD. No association of BMI and serum osteocalcin was observed with BMD. Statistically significant difference between values of serum osteocalcin in postmenopausal non-osteoporotic women, post-menopausal women with low bone mass (osteopenia) and post-menopausal women with osteoporosis were seen.

CONCLUSION

Serum osteocalcin level measurement can be used for screening purpose in post-menopausal patients. Subjects can be further assessed by DEXA scan to, if indicated.

Effect of antiresorptive therapy on urinary hydroxyproline in postmenopausal osteoporosis

Osteoporosis becomes a serious health threat for older postmenopausal women by predisposing them to an increased risk of fracture. Osteoporosis and associated fractures are an important cause of morbidity and mortality. Special attention is being paid to early detection, management, and treatment of postmenopausal osteoporosis in women. Biochemical markers can enable dynamic and rapid measurement of total body skeletal metabolism and will be clinically useful in the management of postmenopausal osteoporosis women (PMO) and also for assessing the effects of antiresorptive therapy. With this view, we planned to assess osteoclastic activity by determining urinary hydroxyproline in osteoporotic women. The aim of this study is to measure urinary hydroxyproline (expressed as mg of hydroxyproline/g of creatinine) and serum ascorbic acid in postmenopausal women with osteoporosis and without osteoporosis. These biochemical parameters were determined 3 months post antiresorptive therapy (alendronate + calcium + vitamin D) in postmenopausal osteoporosis patients. 60 postmenopausal women with osteoporosis in the age group 45-60 years and 60 healthy postmenopausal women (normal bone mineral density) in the same age group were included in the study. Urinary hydroxyproline levels were significantly increased (P < 0.001) in PMO at baseline level as compared to control group. These levels were decreased significantly (P < 0.001) post therapy in PMO patients. Serum vitamin C levels were significantly decreased (P < 0.001) in PMO patients at baseline level as compared to controls. No significant change occurred of serum vitamin C level post therapy. Raised excretion of hydroxyproline at the baseline level might be due to increased degradation of collagen type I from the bone matrix in osteoporosis. Breakdown of collagen seems to be lowered as reflected by lowering of hydroxyproline excretion post antiresorptive therapy. Alteration in the concentration of this marker can be very well utilized to monitor the effectiveness of therapy. Thus simple, direct urinary assay to measure bone resorption is very useful in monitoring the therapy in PMO and may become an integral part of the management of osteoporosis.