1
|
Polyzos SA, Kountouras J, Anastasilakis AD, Terpos E. Wnt/beta-catenin signaling inhibitors and nonalcoholic fatty liver disease: Potential therapeutic implications. Hepatobiliary Pancreat Dis Int 2023; 22:437-438. [PMID: 36858892 DOI: 10.1016/j.hbpd.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Stergios A Polyzos
- First Laboratory of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece.
| | - Jannis Kountouras
- Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece
| | | | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodestrian University of Athens, Athens, Greece
| |
Collapse
|
2
|
Walowski CO, Herpich C, Enderle J, Braun W, Both M, Hasler M, Müller MJ, Norman K, Bosy-Westphal A. Determinants of bone mass in older adults with normal- and overweight derived from the crosstalk with muscle and adipose tissue. Sci Rep 2023; 13:5030. [PMID: 36977715 PMCID: PMC10050471 DOI: 10.1038/s41598-023-31642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Lower bone mass in older adults may be mediated by the endocrine crosstalk between muscle, adipose tissue and bone. In 150 community-dwelling adults (59-86 years, BMI 17-37 kg/m2; 58.7% female), skeletal muscle mass index, adipose tissue and fat mass index (FMI) were determined. Levels of myokines, adipokines, osteokines, inflammation markers and insulin were measured as potential determinants of bone mineral content (BMC) and density (BMD). FMI was negatively associated with BMC and BMD after adjustment for mechanical loading effects of body weight (r-values between -0.37 and -0.71, all p < 0.05). Higher FMI was associated with higher leptin levels in both sexes, with higher hsCRP in women and with lower adiponectin levels in men. In addition to weight and FMI, sclerostin, osteocalcin, leptin × sex and adiponectin were independent predictors of BMC in a stepwise multiple regression analysis. Muscle mass, but not myokines, showed positive correlations with bone parameters that were weakened after adjusting for body weight (r-values between 0.27 and 0.58, all p < 0.01). Whereas the anabolic effect of muscle mass on bone in older adults may be partly explained by mechanical loading, the adverse effect of obesity on bone is possibly mediated by low-grade inflammation, higher leptin and lower adiponectin levels.
Collapse
Affiliation(s)
- Carina O Walowski
- Institute for Human Nutrition and Food Science, Christian-Albrechts-University, Düsternbrooker Weg 17, 24105, Kiel, Germany
| | - Catrin Herpich
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
- Department of Geriatrics and Medical Gerontology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Nutrition and Gerontology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Nuthetal, Germany
| | - Janna Enderle
- Institute for Human Nutrition and Food Science, Christian-Albrechts-University, Düsternbrooker Weg 17, 24105, Kiel, Germany
| | - Wiebke Braun
- Institute for Human Nutrition and Food Science, Christian-Albrechts-University, Düsternbrooker Weg 17, 24105, Kiel, Germany
| | - Marcus Both
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Mario Hasler
- Applied Statistics, Faculty of Agricultural and Nutritional Sciences, Christian-Albrechts-University, Kiel, Germany
| | - Manfred J Müller
- Institute for Human Nutrition and Food Science, Christian-Albrechts-University, Düsternbrooker Weg 17, 24105, Kiel, Germany
| | - Kristina Norman
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
- Department of Geriatrics and Medical Gerontology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Nutrition and Gerontology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Nuthetal, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Anja Bosy-Westphal
- Institute for Human Nutrition and Food Science, Christian-Albrechts-University, Düsternbrooker Weg 17, 24105, Kiel, Germany.
| |
Collapse
|
3
|
Lee HH, Choi EY, Jun HS, Kim YY. Osteoclast and Sclerostin Expression in Osteocytes in the Femoral Head with Risedronate Therapy in Patients with Hip Fractures: A Retrospective Comparative Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111566. [PMID: 36363523 PMCID: PMC9695260 DOI: 10.3390/medicina58111566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Background and Objectives: The majority of research on the effects of osteoporosis drugs has measured the bone mineral density (BMD) of the spine and femur through dual-energy X-ray absorptiometry (DEXA) and compared and analyzed the effects of the drugs through changes in the BMD values. This study aims to compare osteoclast and sclerostin expression in osteocytes after risedronate therapy by obtaining femoral heads from patients with hip fractures. Materials and Methods: We obtained the femoral heads of 10 female patients (age: ≥65 years) who received risedronate therapy for at least 1 year through hip arthroplasty during 2019−2021 (risedronate group). Meanwhile, 10 patients who had never received osteoporosis treatment were selected as controls using propensity scores with age, body mass index, and bone density as covariates (control group). While the osteoclast count was evaluated using tartrate-resistant acid phosphatase (TRAP) staining, the sclerostin expression in osteocytes was assessed using immunohistochemistry. Moreover, Western blotting and polymerase chain reaction (PCR) were performed for receptor activation of nuclear factor kappa-Β ligand (RANKL), RANK, osteoprotegerin (OPG), sclerostin, and bone morphogenetic protein-2 (BMP2). Results: TRAP staining revealed significantly more TRAP-positive cells in the control group (131.75 ± 27.16/mm2) than in the risedronate group (28.00 ± 8.12/mm2). Moreover, sclerostin-positive osteocytes were expressed more in the control group (364.12 ± 28.12/mm2) than in the risedronate group (106.93 ± 12.85/mm2). Western blotting revealed that the expressions of RANKL, RANK, sclerostin, and BMP2 were higher in the control group than in the risedronate group (p < 0.05). Furthermore, RANK, sclerostin, and OPG protein levels were higher in the control group than in the risedronate group. Conclusions: In this study, the risedronate group demonstrated lower osteoclast activity and sclerostin expression in osteocytes in the femoral head than the control group.
Collapse
|
4
|
Ivanova MM, Dao J, Kasaci N, Friedman A, Noll L, Goker-Alpan O. Wnt signaling pathway inhibitors, sclerostin and DKK-1, correlate with pain and bone pathology in patients with Gaucher disease. Front Endocrinol (Lausanne) 2022; 13:1029130. [PMID: 36506070 PMCID: PMC9730525 DOI: 10.3389/fendo.2022.1029130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
Patients with Gaucher disease (GD) have progressive bone involvement that clinically presents with debilitating bone pain, structural bone changes, bone marrow infiltration (BMI), Erlenmeyer (EM) flask deformity, and osteoporosis. Pain is referred by the majority of GD patients and continues to persist despite the type of therapy. The pain in GD is described as chronic deep penetrating pain; however, sometimes, patients experience severe acute pain. The source of bone pain is mainly debated as nociceptive pain secondary to bone pathology or neuropathic or inflammatory origins. Osteocytes constitute a significant source of secreted molecules that coordinate bone remodeling. Osteocyte markers, sclerostin (SOST) and Dickkopf-1 (DKK-1), inactivate the canonical Wnt signaling pathway and lead to the inhibition of bone formation. Thus, circulated sclerostin and DKK-1 are potential biomarkers of skeletal abnormalities. This study aimed to assess the circulating levels of sclerostin and DKK-1 in patients with GD and their correlation with clinical bone pathology parameters: pain, bone mineral density (BMD), and EM deformity. Thirty-nine patients with GD were classified into cohorts based on the presence and severity of bone manifestations. The serum levels of sclerostin and DKK-1 were quantified by enzyme-linked immunosorbent assays. The highest level of sclerostin was measured in GD patients with pain, BMI, and EM deformity. The multiparameter analysis demonstrated that 95% of GD patients with pain, BMI, and EM deformity had increased levels of sclerostin. The majority of patients with elevated sclerostin also have osteopenia or osteoporosis. Moreover, circulating sclerostin level increase with age, and GD patients have elevated sclerostin levels when compared with healthy control from the same age group. Pearson's linear correlation analysis showed a positive correlation between serum DKK-1 and sclerostin in healthy controls and GD patients with normal bone mineral density. However, the balance between sclerostin and DKK-1 waned in GD patients with osteopenia or osteoporosis. In conclusion, the osteocyte marker, sclerostin, when elevated, is associated with bone pain, BMI, and EM flask deformity in GD patients. The altered sclerostin/DKK-1 ratio correlates with the reduction of bone mineral density. These data confirm that the Wnt signaling pathway plays a role in GD-associated bone disease. Sclerostin and bone pain could be used as biomarkers to assess patients with a high risk of BMI and EM flask deformities.
Collapse
|
5
|
Ni X, Zhang Q, Li X, Pang Q, Gong Y, Wang O, Li M, Xing X, Jiang Y, Xia W. Low Levels of Serum Sclerostin in Adult Patients With Tumor-Induced Osteomalacia Compared With X-linked Hypophosphatemia. J Clin Endocrinol Metab 2022; 107:e361-e371. [PMID: 34363479 DOI: 10.1210/clinem/dgab579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Indexed: 12/24/2022]
Abstract
CONTEXT Sclerostin inhibits Wnt-β-catenin signaling, regulating bone formation. Circulating sclerostin was reported to be elevated in X-linked hypophosphatemia (XLH) patients, and sclerostin antibody (Scl-Ab) increased bone mass and normalized circulating phosphate in Hyp mice. However, circulating sclerostin levels in patients with acquired hypophosphatemia due to tumor-induced osteomalacia (TIO) are rarely reported. OBJECTIVE This study was designed to evaluate serum sclerostin levels in TIO patients compared with age- and sex-matched healthy controls and XLH patients to analyze correlations with bone mineral density (BMD) and laboratory parameters. METHODS This cross-sectional study determined serum sclerostin levels in 190 individuals, comprising 83 adult TIO patients, 83 adult healthy controls and 24 adult XLH patients. RESULTS TIO patients (43 male, 40 female) aged 44.3 ± 8.7 (mean ± SD) years had lower levels of circulating sclerostin than controls (94.2 ± 45.8 vs 108.4 ± 42.3 pg/mL, P = 0.01), adjusted for age, gender, BMI, and diabetes rate. Sclerostin levels were positively associated with age (r = 0.238, P = 0.030). Male patients had higher sclerostin than female patients (104.7 ± 47.3 vs 83.0 ± 41.8 pg/mL, P = 0.014). Sclerostin levels were positively associated with L1-4 BMD (r = 0.255, P = 0.028), femoral neck BMD (r = 0.242, P = 0.039), and serum calcium (r = 0.231, P = 0.043). Comparison of sclerostin levels in TIO patients (n = 24, age 35.9 ± 7.3 years) vs XLH patients vs healthy controls revealed significant differences (respectively, 68.4 ± 31.3, 132.0 ± 68.8, and 98.6 ± 41.1 pg/mL, P < 0.001). CONCLUSION Circulating sclerostin was decreased in TIO patients but increased in XLH patients, possibly due to histological abnormality and bone mass.
Collapse
Affiliation(s)
- Xiaolin Ni
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Qi Zhang
- Laboratory Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiang Li
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Qianqian Pang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yiyi Gong
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiaoping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Weibo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| |
Collapse
|
6
|
Nakagawa Y, Komaba H, Hamano N, Tanaka H, Wada T, Ishida H, Nakamura M, Takahashi H, Takahashi Y, Hyodo T, Hida M, Suga T, Kakuta T, Fukagawa M. Interrelationships Between Sclerostin, Secondary Hyperparathyroidism, and Bone Metabolism in Patients on Hemodialysis. J Clin Endocrinol Metab 2022; 107:e95-e105. [PMID: 34423837 DOI: 10.1210/clinem/dgab623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Indexed: 01/02/2023]
Abstract
CONTEXT Sclerostin is an osteocyte-derived inhibitor of bone formation and is increased in kidney failure, but its role in the pathogenesis of renal bone disease remains unknown. OBJECTIVE We aimed to explore the association of serum sclerostin with bone metabolism in patients undergoing hemodialysis, with a particular focus on parathyroid hormone (PTH)-dependent and PTH-independent pathways. METHODS This cross-sectional and prospective cohort study included 654 patients undergoing hemodialysis at 10 facilities in Japan. We employed multivariable linear regression to explore whether sclerostin levels were associated with metacarpal bone mineral density (BMD), intact PTH, bone alkaline phosphatase (BAP), and tartrate-resistant acid phosphatase-5b (TRACP-5b). We employed mediation analyses to explore whether and to what extent the association of PTH with bone turnover markers is mediated by sclerostin. We also compared sclerostin levels between patients with and without previous or incident fractures. RESULTS The median sclerostin level in hemodialysis patients was 3- to 4-fold higher than that in healthy individuals. Higher sclerostin levels were associated with higher metacarpal BMD and lower levels of intact PTH, BAP, and TRACP-5b. However, the relationships of sclerostin with bone turnover markers were substantially attenuated after adjustment for PTH. Mediation analysis suggested that the effects of PTH on bone turnover markers were mainly direct rather than mediated by sclerostin. Sclerostin levels were not associated with previous or incident fractures. CONCLUSION These findings suggest that in patients undergoing dialysis, sclerostin has only a limited role in bone metabolism and may not mediate the effect of PTH on bone turnover.
Collapse
Affiliation(s)
- Yosuke Nakagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, 259-1193, Japan
| | - Hirotaka Komaba
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, 259-1193, Japan
- The Institute of Medical Sciences, Tokai University, Isehara, 259-1193, Japan
| | - Naoto Hamano
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, 259-1193, Japan
| | - Hisae Tanaka
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, 259-1193, Japan
| | - Takehiko Wada
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, 259-1193, Japan
| | - Hiroaki Ishida
- Department of Transplant Surgery, Tokai University School of Medicine, Isehara, 259-1193, Japan
| | - Michio Nakamura
- Department of Transplant Surgery, Tokai University School of Medicine, Isehara, 259-1193, Japan
| | - Hiroo Takahashi
- Division of Nephrology and Diabetes, Tokai University Oiso Hospital, Oiso, 259-0198, Japan
| | | | - Toru Hyodo
- Medical Corporation Kuratakai, Hiratsuka, 254-0018, Japan
| | - Miho Hida
- Medical Corporation Kuratakai, Hiratsuka, 254-0018, Japan
| | - Takao Suga
- Medical Corporation Showakai, Tokyo, 160-0023, Japan
| | - Takatoshi Kakuta
- Division of Nephrology, Endocrinology and Metabolism, Tokai University Hachioji Hospital, Hachioji, 192-0032, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, 259-1193, Japan
| |
Collapse
|
7
|
Hanusch B, Prediger M, Tuck SP, Walker J, McNally R, Datta HK. Bone turnover markers as determinants of bone density and fracture in men with distal forearm fractures: the pathogenesis examined in the Mr F study. Osteoporos Int 2021; 32:2267-2277. [PMID: 33990874 DOI: 10.1007/s00198-021-06001-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED The pathogenesis for low-trauma wrist fractures in men is not fully understood. This study found that these men had evidence of significantly higher bone turnover compared with control subjects. Bone turnover markers were negative predictors of bone mineral density and were a predictor of fracture. INTRODUCTION Men with distal forearm fractures have reduced bone density, an increased risk of osteoporosis and of further fractures. The aim of this study was to investigate whether or not men with distal forearm fractures had evidence of altered bone turnover activity. METHODS Fifty eight men with low-trauma distal forearm fracture and 58 age-matched healthy control subjects were recruited. All subjects underwent a DXA scan of the forearm, both hips, and lumbar spine, biochemical investigations, and health questionnaires. Measurements of beta crosslaps (βCTX), procollagen type I N-terminal propeptide (PINP), sclerostin, Dickkopf-1 (Dkk1), and fibroblast growth factor 23 (FGF 23) were made. RESULTS Men with fracture had significantly higher PINP than controls at 39.2 ng/ml (SD 19.5) versus 33.4 ng/ml (SD13.1) (p<0.001). They also had significantly higher βCTX at 0.45 ng/ml (SD 0.21) versus 0.37 ng/ml (SD 0.17) (p= 0.037). Fracture subjects had significantly lower aBMD and PINP was a negative predictor of aBMD at the total hip and βCTX a negative predictor of forearm aBMD. Sclerostin was a positive predictor of aBMD at the lumbar spine and hip sites. Sex hormone binding globulin (SHBG) at 37nmol/L (SD 15.0) was lower in fracture cohort compared to 47.9 nmol/L (SD 19.2) (p=0.001) in control. Multiple regression revealed that the best model for prediction of fracture included SHBG, P1NP, and ultra-distal forearm aBMD. The likelihood of distal forearm fracture was decreased by 5.1% for each nmol/L increase in SHBH and by 1.4% for every mg/cm2 increase in ultra-distal forearm aBMD, but increased by 6.1 % for every ng/ml increase in P1NP. Men in the highest quartile of PINP had a significantly greater likelihood of distal forearm fracture than those in the lowest quartile. CONCLUSION The fracture group had significantly higher PINP and βCTX compared with the control group, and these markers were negative predictors of aBMD at the total hip and forearm sites, respectively. Sclerostin was a positive predictor of the variance of spinal and hip aBMD. Likelihood of forearm fracture was best predicted by a combination of SHBG, PINP, and ultra-distal forearm aBMD. Findings of such cross-sectional data should be treated with caution, as longitudinal studies would be required to confirm or refute them.
Collapse
Affiliation(s)
- B Hanusch
- Institute of Cellular Medicine, Newcastle University, Newcastle, Upon Tyne, UK
- James Cook University Hospital, Middlesbrough, UK
| | - M Prediger
- Institute of Cellular Medicine, Newcastle University, Newcastle, Upon Tyne, UK
- Blood Sciences, Royal Victoria Infirmary, Newcastle, Upon Tyne, UK
| | - S P Tuck
- Institute of Cellular Medicine, Newcastle University, Newcastle, Upon Tyne, UK.
- James Cook University Hospital, Middlesbrough, UK.
| | - J Walker
- James Cook University Hospital, Middlesbrough, UK
| | - R McNally
- Institute of Health and Society, Newcastle University, Newcastle, Upon Tyne, UK
| | - H K Datta
- Institute of Cellular Medicine, Newcastle University, Newcastle, Upon Tyne, UK
- James Cook University Hospital, Middlesbrough, UK
| |
Collapse
|
8
|
Zhou F, Wang Y, Li Y, Tang M, Wan S, Tian H, Chen X. Decreased Sclerostin Secretion in Humans and Mice With Nonalcoholic Fatty Liver Disease. Front Endocrinol (Lausanne) 2021; 12:707505. [PMID: 34421825 PMCID: PMC8374147 DOI: 10.3389/fendo.2021.707505] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/23/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives Growing evidence argues for a relationship between liver and bone metabolisms. Sclerostin is a secreted glycoprotein and could antagonize osteoblast-mediated bone formation. Previous studies indicated that circulating sclerostin levels may be associated with metabolic parameters with inconsistent results. This study was designed to evaluate serum sclerostin in patients with or without nonalcoholic fatty liver disease (NAFLD) and to analyze its relationship with metabolic parameters in different populations. Methods A cross-sectional study was designed and 168 NAFLD subjects and 85 control subjects were included in this study. Serum sclerostin and metabolic parameters were measured. Mouse models of NAFLD were also induced by high-fat diet. Bone structural parameters were determined using microCT and mRNA expression levels of sclerostin in bone and liver tissues were measured. Results Our study suggested that circulating sclerostin levels were significantly lower in NAFLD subjects compared with normal controls. In NAFLD subjects, sclerostin was negatively correlated with multiple metabolic parameters, including waist circumference, urea, hepatic enzyme, gamma-glutamyl transpeptidase, and triglyceride, while such correlation was not significant in control subjects. Circulating sclerostin was also negatively correlated with fatty liver index in NAFLD subjects but not in control subjects. Mice fed on a high-fat diet had reduced bone mass and lower sclerostin expression levels in both the bone and liver tissues. Conclusions Our study suggested that the liver-lipid-bone interactions may play a key role in the abnormal bone metabolism in NAFLD, and circulating sclerostin may be a surrogate marker to reflect bone metabolism status in NAFLD subjects.
Collapse
Affiliation(s)
- Fangli Zhou
- Department of Endocrinology, Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Department of Endocrinology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Wang
- Department of Endocrinology, Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Yujue Li
- Department of Endocrinology, Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Mengjia Tang
- Department of Endocrinology, Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Shan Wan
- Department of Endocrinology, Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Haoming Tian
- Department of Endocrinology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Chen
- Department of Endocrinology, Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
9
|
Xu Z, Fan F, Chen H, Shi P, Zhu D, Yang M, Wang Z, Ei-Seedi HR, Du M. Absorption and transport of a Mytilus edulis-derived peptide with the function of preventing osteoporosis. Food Funct 2021; 12:2102-2111. [PMID: 33564802 DOI: 10.1039/d0fo02353a] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The YPRKDETGAERT peptide (PME-1) identified from the Mytilus edulis proteins has been shown to promote the proliferation and differentiation of osteoblasts and it has good bone-forming activity in vitro. Further, PME-1 has been shown to prevent osteoporosis in vivo. PME-1 can be absorbed through the gastrointestinal tract, and the passing rate in monolayer Caco-2 cells was 6.57%. PME-1 can also enter the blood circulation and the concentration of PME-1 in serum reached the maximum, 61.06 ± 26.32 ng mL-1, 20 min after feeding. The multifunctional in vivo imager was used to further determine the distribution of the 5-FITC-(Acp)-YPRKDETGAERT peptide (PME-1-FITC) 2 h after feeding the peptide, and the result confirmed the above results and showed that a part of PME-1-FITC can affect bone in vivo. Therefore, PME-1 not only was easily absorbed in the gastrointestinal tract, but also has the potential beneficial effect on preventing osteoporosis.
Collapse
Affiliation(s)
- Zhe Xu
- School of Food Science and Technology, National Engineering Research Center of Seafood, Collaborative Innovation Center of Seafood Deep Processing, Dalian Polytechnic University, Dalian 116034, China. and College of Life Sciences, Key Laboratory of Biotechnology and Bioresources Utilization, Dalian Minzu University, Ministry of Education, Dalian 116029, China
| | - Fengjiao Fan
- College of Food Science and Engineering, Nanjing University of Finance and Economics, Nanjing 210046, China
| | - Hui Chen
- College of Food Science and Technology, Zhejiang University of Technology, Hangzhou 310014, China
| | - Pujie Shi
- School of Food Science and Technology, National Engineering Research Center of Seafood, Collaborative Innovation Center of Seafood Deep Processing, Dalian Polytechnic University, Dalian 116034, China.
| | - Dongyang Zhu
- School of Food Science and Technology, National Engineering Research Center of Seafood, Collaborative Innovation Center of Seafood Deep Processing, Dalian Polytechnic University, Dalian 116034, China.
| | - Meilian Yang
- School of Food Science and Technology, National Engineering Research Center of Seafood, Collaborative Innovation Center of Seafood Deep Processing, Dalian Polytechnic University, Dalian 116034, China.
| | - Zhenyu Wang
- School of Food Science and Technology, National Engineering Research Center of Seafood, Collaborative Innovation Center of Seafood Deep Processing, Dalian Polytechnic University, Dalian 116034, China.
| | - Hesham R Ei-Seedi
- Pharmacognosy Group, Department of Medicinal Chemistry, Uppsala University, Biomedical Centre, Uppsala 75123, Sweden
| | - Ming Du
- School of Food Science and Technology, National Engineering Research Center of Seafood, Collaborative Innovation Center of Seafood Deep Processing, Dalian Polytechnic University, Dalian 116034, China.
| |
Collapse
|
10
|
Peng J, Dong Z, Hui Z, Aifei W, Lianfu D, Youjia X. Bone Sclerostin and Dickkopf-related protein-1 are positively correlated with bone mineral density, bone microarchitecture, and bone strength in postmenopausal osteoporosis. BMC Musculoskelet Disord 2021; 22:480. [PMID: 34034718 PMCID: PMC8152077 DOI: 10.1186/s12891-021-04365-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/13/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Wnt-catenin signaling antagonists sclerostin and dickkopf-related protein-1 (Dkk-1) inhibit bone formation and are involved in the pathogenesis of postmenopausal osteoporosis (PO). However, the association between sclerostin and Dkk-1 and bone mineral density (BMD) in women with PO remains unclear. OBJECTIVE This study aimed to determine the association between sclerostin and Dkk-1 and BMD, bone microarchitecture, and bone strength in PO. METHODS Trabecular bone specimens were obtained from the femoral heads of 76 Chinese women with PO who underwent hip arthroplasty for femoral neck fractures. Micro-computed tomography (Micro-CT) was used to assess the BMD and bone microarchitecture of the trabecular bone. Subsequently, a mechanical test was performed. Finally, sclerostin and Dkk-1 in the bone were measured by enzyme-linked immunosorbent (Elisa) assay. Serum ionized serum ionised calcium, propeptide of type 1 collagen, C-terminal β-telopeptide of type-1 collagen, sclerostin, and Dkk-1 were also detected. RESULTS Bone sclerostin was positively correlated with serum ionised calcium, serum sclerostin, BMD, bone volume/tissue volume (BV/TV), trabecular number (Tb.N), maximum compressive force, and yield strength (r = 0.32, 0.906, 0.355, 0.401, 0.329, 0.355, and 0.293, respectively, P < 0.05) and negatively correlated with age and trabecular separation (Tb.Sp) (r = - 0.755 and - 0.503, respectively, P < 0.05). Bone Dkk-1 was positively correlated with serum ionised calcium, serum Dkk-1, BMD, BV/TV, trabecular thickness, Tb.N, maximum compressive force, yield strength, and Young's modulus (r = 0.38, 0.809, 0.293, 0.293, 0.228, 0.318, 0.352, 0.315, and 0.266, respectively, P < 0.05) and negatively correlated with age and Tb.Sp (r = - 0.56 and - 0.38, respectively, P < 0.05). Serum levels of sclerostin and Dkk-1 reflected the levels of sclerostin and Dkk-1 in the bone. CONCLUSION Bone sclerostin and Dkk-1 were positively correlated with BMD in women with PO, and higher levels of bone sclerostin and Dkk-1 might predict better BMD, bone microarchitecture, and bone strength. The potential molecular mechanisms still require further study.
Collapse
Affiliation(s)
- Jia Peng
- Orthopedic Department, Second Affiliated Hospital of Soochow University, Suzhou, China.,Second Affiliated Hospital of Soochow University, Osteoporosis Research Institute of Soochow University, Suzhou, China
| | - Zhang Dong
- Second Affiliated Hospital of Soochow University, Osteoporosis Research Institute of Soochow University, Suzhou, China
| | - Zhang Hui
- Orthopedic Department, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wang Aifei
- Orthopedic Department, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Deng Lianfu
- Shanghai Institute of Traumatology and Orthopedics, Shanghai, China. .,Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai, China. .,Ruijin Hospital, Jiao Tong University School of Medicine, Shanghai, China.
| | - Xu Youjia
- Orthopedic Department, Second Affiliated Hospital of Soochow University, Suzhou, China. .,Second Affiliated Hospital of Soochow University, Osteoporosis Research Institute of Soochow University, Suzhou, China.
| |
Collapse
|
11
|
Gharbia O, Hegazy A, Elhelaly R, ElGhaweet A. Serum sclerostin in rheumatoid-induced osteoporosis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2020. [DOI: 10.1186/s43166-020-00015-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Rheumatoid arthritis (RA) is characterized by presence of localized and generalized osteoporosis. The mechanism of decreased bone mass is complex and multifactorial, a possible mechanism behind increased bone loss in RA is upregulation of sclerostin. The aim of this work was to evaluate serum sclerostin level in RA patients and its relation with bone mineral density (BMD) and disease activity.
Results
Serum sclerostin level in RA patients was significantly higher than the controls (p < 0.001). Osteopenia and osteoporosis were more prevalent in RA patients (22.5% and 7.5% respectively) compared to controls (15% and 2.5% respectively) (p = 0.006). Serum sclerostin level was significantly correlated with tender joint count (p = 0.014), swollen joint count (p = 0.036), erythrocytes sedimentation rate (p = 0.010), C reactive protein serum level (p = 0.025), disease activity score (DAS) 28-ESR (p = 0.018), DAS28-CRP (p = 0.005), and radiological modified Sharp erosion score (p = 0.049). The correlation of serum sclerostin level in RA patients with BMD and with T-score in all sites revealed an inverse relationship with p values insignificant.
Conclusion
Serum sclerostin is a major player in bone metabolism as a negative regulator of bone growth through inhibition of Wnt signaling that is largely influenced by the disease activity. Controlling the disease activity is a major factor for prevention of local as well as generalized osteoporosis and is essential for the reparative local and systemic bone health.
Collapse
|
12
|
Jacobsson M, van Raalte DH, Heijboer AC, den Heijer M, de Jongh RT. Short-Term Glucocorticoid Treatment Reduces Circulating Sclerostin Concentrations in Healthy Young Men: A Randomized, Placebo-Controlled, Double-Blind Study. JBMR Plus 2020; 4:e10341. [PMID: 32803106 PMCID: PMC7422706 DOI: 10.1002/jbm4.10341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/09/2019] [Accepted: 12/25/2019] [Indexed: 11/08/2022] Open
Abstract
Glucocorticoid use is the most common cause of osteoporosis in young individuals. In the current study, we investigated the effects of glucocorticoid treatment on circulating sclerostin concentrations and serum bone turnover markers in healthy young men. We performed additional measurements in two combined randomized, placebo‐controlled, double‐blind, dose–response intervention studies: 64 healthy men (age: 22 ± 2 years; BMI: 22.1 ± 1.7 kg/m2) were allocated to receive placebo (n = 16), prednisolone 7.5 mg once daily (n = 24), or prednisolone 30 mg once daily (n = 24) for 2 weeks using block randomization. Primary outcome variables were serum sclerostin and serum bone turnover markers (CTx and P1NP), before and after the intervention. Baseline characteristics and variables did not differ between intervention groups. Compared with placebo, prednisolone high‐dose decreased serum sclerostin concentrations (−8.5 [−28.0 to 7.3] versus 1.5 [−6.5 to 20.0] pg/mL, p = 0.048), decreased P1NP concentrations (−28.0 [−39.3 to −18.3] versus –1.5 [−15.3 to 11.3] μg/L, p < 0.001) and increased CTx concentrations (108.0 [55.0 to 177.0] versus 64.0 [−24.3 to 120.0] ng/L, p = 0.038). Compared with placebo, prednisolone low‐dose did not alter sclerostin concentrations (p = 0.5) or CTx concentrations (p = 0.7), but tended to decrease P1NP concentrations (−9.0 [−24.0 to −1.3] versus –1.5 [−15.3 to 11.3] μg/L, p = 0.095). At baseline concentrations of sclerostin were positively correlated with concentrations of CTx (Spearman's rank correlation coefficient ρ = +0.409, p = 0.001), but not with P1NP. No significant correlations were observed between changes in outcome variables during the interventions. Short‐term high‐dose, but not low‐dose, prednisolone treatment reduces serum sclerostin concentrations in healthy young men. Whether this reflects a counter regulatory mechanism to compensate glucocorticoid‐induced negative effects through other mechanisms remains to be elucidated. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Merel Jacobsson
- Department of Internal Medicine, Division of Endocrinology, Amsterdam UMC Amsterdam The Netherlands
| | - Daniël H van Raalte
- Department of Internal Medicine, Division of Endocrinology, Amsterdam UMC Amsterdam The Netherlands
| | - Annemieke C Heijboer
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Martin den Heijer
- Department of Internal Medicine, Division of Endocrinology, Amsterdam UMC Amsterdam The Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine, Division of Endocrinology, Amsterdam UMC Amsterdam The Netherlands
| |
Collapse
|
13
|
Bovijn J, Krebs K, Chen CY, Boxall R, Censin JC, Ferreira T, Pulit SL, Glastonbury CA, Laber S, Millwood IY, Lin K, Li L, Chen Z, Milani L, Smith GD, Walters RG, Mägi R, Neale BM, Lindgren CM, Holmes MV. Evaluating the cardiovascular safety of sclerostin inhibition using evidence from meta-analysis of clinical trials and human genetics. Sci Transl Med 2020; 12:eaay6570. [PMID: 32581134 PMCID: PMC7116615 DOI: 10.1126/scitranslmed.aay6570] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/26/2019] [Accepted: 05/26/2020] [Indexed: 12/23/2022]
Abstract
Inhibition of sclerostin is a therapeutic approach to lowering fracture risk in patients with osteoporosis. However, data from phase 3 randomized controlled trials (RCTs) of romosozumab, a first-in-class monoclonal antibody that inhibits sclerostin, suggest an imbalance of serious cardiovascular events, and regulatory agencies have issued marketing authorizations with warnings of cardiovascular disease. Here, we meta-analyze published and unpublished cardiovascular outcome trial data of romosozumab and investigate whether genetic variants that mimic therapeutic inhibition of sclerostin are associated with higher risk of cardiovascular disease. Meta-analysis of up to three RCTs indicated a probable higher risk of cardiovascular events with romosozumab. Scaled to the equivalent dose of romosozumab (210 milligrams per month; 0.09 grams per square centimeter of higher bone mineral density), the SOST genetic variants were associated with lower risk of fracture and osteoporosis (commensurate with the therapeutic effect of romosozumab) and with a higher risk of myocardial infarction and/or coronary revascularization and major adverse cardiovascular events. The same variants were also associated with increased risk of type 2 diabetes mellitus and higher systolic blood pressure and central adiposity. Together, our findings indicate that inhibition of sclerostin may elevate cardiovascular risk, warranting a rigorous evaluation of the cardiovascular safety of romosozumab and other sclerostin inhibitors.
Collapse
Affiliation(s)
- Jonas Bovijn
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7FZ, UK.
- Wellcome Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Kristi Krebs
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu 51010, Estonia
| | - Chia-Yen Chen
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Ruth Boxall
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Jenny C Censin
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7FZ, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Teresa Ferreira
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7FZ, UK
| | - Sara L Pulit
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7FZ, UK
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142, USA
- Department of Genetics, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
| | - Craig A Glastonbury
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7FZ, UK
| | - Samantha Laber
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7FZ, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Iona Y Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Kuang Lin
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, Peking University Health Science Centre, Peking University, Beijing 100191, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Lili Milani
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu 51010, Estonia
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Robin G Walters
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Reedik Mägi
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu 51010, Estonia
| | - Benjamin M Neale
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Cecilia M Lindgren
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7FZ, UK.
- Wellcome Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142, USA
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Michael V Holmes
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7FZ, UK.
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| |
Collapse
|
14
|
A Review of the Potential Application of Osteocyte-Related Biomarkers, Fibroblast Growth Factor-23, Sclerostin, and Dickkopf-1 in Predicting Osteoporosis and Fractures. Diagnostics (Basel) 2020; 10:diagnostics10030145. [PMID: 32155909 PMCID: PMC7151094 DOI: 10.3390/diagnostics10030145] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/15/2023] Open
Abstract
Bone turnover markers (BTMs) derived from the secretory activities of osteoblasts and the matrix-degrading activities of osteoclasts are useful in monitoring the progression of osteoporosis and the efficacy of anti-osteoporotic treatment. However, the usefulness of BTMs in predicting osteoporosis remains elusive. Osteocytes play a central role in regulating bone formation and resorption. The proteins secreted by osteocytes, such as fibroblast growth factor-23 (FGF23), sclerostin (SOST), and dickkopf-1 (DKK1), could be candidates for osteoporosis screening and fracture prediction. This review summarizes the current evidence on the potential of osteocyte-related proteins as biomarkers for osteoporosis and fracture prediction. The literature reports that SOST may be a potential marker for osteoporosis screening but not for fracture prediction. FGF23 is a potential marker for increased fracture risk, but more studies are needed to confirm its usefulness. The role of DKK1 as a marker to predict osteoporosis and fracture risk cannot be confirmed due to a lack of consistent evidence. In conclusion, circulating osteocyte markers are potential osteoporosis biomarkers, but more studies are warranted to validate their clinical use.
Collapse
|
15
|
Yang C, Le G, Lu C, Wei R, Lan W, Tang J, Zhan X. Effects of teriparatide compared with risedronate in the treatment of osteoporosis: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e19042. [PMID: 32049802 PMCID: PMC7035098 DOI: 10.1097/md.0000000000019042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This meta-analysis was conducted to compare the effects and safety of teriparatide with risedronate in the treatment of osteoporosis. MATERIAL AND METHODS PubMed, Embase, Web of Science and Cochrane library database were systematically reviewed for studies published up to February 24, 2019. Eligible studies that compared the effects of teriparatide with risedronate in osteoporosis were included in this meta-analysis. The outcomes included percentage change in bone mineral density (BMD) of lumbar spine, femoral neck, and total hip, the incidence of clinical fractures, serum bone markers, and adverse events. A random-effects or fixed-effects model was used to pool the estimate, according to the heterogeneity among the included studies. RESULTS Seven studies were included in this meta-analysis. Compared with risedronate, teriparatide was associated with a significant increase in lumbar spine BMD [weight mean difference (WMD)=4.24, 95%CI: 3.11, 5.36; P < .001], femoral neck BMD (WMD=2.28, 95%CI: 1.39, 3.18; P < .001), and total hip BMD (WMD = 1.19, 95%CI: 0.47, 1.91; P = .001). Moreover, patients in teriparatide group had significantly lower incidences of clinical fracture (risk ratio [RR] = 0.48, 95%CI: 0.32, 0.72; P < .001), new vertebral fracture (RR = 0.45, 95%CI: 0.32, 0.63; P < .001), and non-vertebral fracture (RR = 0.63, 95%CI: 0.40, 0.98; P = .042) than those in risedronate group. There were significant differences between the 2 groups in serum change, including P1NP (WMD = 122.34, 95%CI: 68.89, 175.99; P < .001), CTx (WMD = 0.62, 95%CI: 0.29, 0.96; P < .001), and iPTH (WMD = -13.18, 95%CI: -15.04, -11.33; P < .001). The incidence of adverse events was similar between the 2 groups (RR = 0.93, 95%CI: 0.69, 1.25; P = .610). CONCLUSION This study suggested that teriparatide was more effective than risedronate for increasing the BMD in lumbar spine, femoral neck, and total hip, as well as reducing the incidences of clinical fracture, new vertebral fracture and non-vertebral fracture. There was no significant difference in incidence of adverse events between the 2 drugs. Considering the potential limitations in the present study, further large-scale, well-performed randomized trials are needed to verify our findings.
Collapse
Affiliation(s)
- Chengzhi Yang
- Department of spine osteopathic surgery, the first affiliated hospital of Guangxi medical University
- Trauma centers
| | - Guoping Le
- Department of arthropathy, the fourth affiliated hospital of Guangxi medical University
- Department of arthropathy, Guangxi liuzhou workers hospital
| | | | - Renjie Wei
- Department of orthopedic trauma, People's hospital of Hechi, Guangxi province, China
| | - Wanjie Lan
- Department of orthopedic trauma, People's hospital of Hechi, Guangxi province, China
| | | | - Xinli Zhan
- Department of spine osteopathic surgery, the first affiliated hospital of Guangxi medical University
| |
Collapse
|
16
|
Kim JA, Roh E, Hong SH, Lee YB, Kim NH, Yoo HJ, Seo JA, Kim NH, Kim SG, Baik SH, Choi KM. Association of serum sclerostin levels with low skeletal muscle mass: The Korean Sarcopenic Obesity Study (KSOS). Bone 2019; 128:115053. [PMID: 31473261 DOI: 10.1016/j.bone.2019.115053] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sclerostin is an osteocyte-derived circulating protein that inhibits the Wnt/β-catenin signaling pathway. The Wnt signaling pathway plays an important role in bone and dysregulation of the Wnt signaling pathway results in insulin resistance, inflammation, and metabolic disturbance. The aim of our study was to investigate the implication of sclerostin in low muscle mass in healthy subjects. METHODS The cross-sectional study analyzed 240 healthy non-diabetic subjects from the Korean Sarcopenic Obesity Study (KSOS). Low muscle mass was defined as the sum of the appendicular skeletal muscle mass divided by the square of height (ASM/height2) as proposed by the Asian Working Group for Sarcopenia. RESULTS Serum sclerostin was significantly higher in the low muscle mass group than the normal muscle mass group (151.3 [79.2-187.9] vs. 74.8 [47.6-119.6] pg/mL, p = 0.001). In the partial correlation analyses adjusted for age, sex, and body mass index, ASM/height2 was negatively associated with sclerostin levels (r = -0.245, p < 0.001). Furthermore, sclerostin levels decreased linearly according to the first, second, and third tertiles of ASM/height2 even after adjusting for sex, age, body mass index, life style parameters, fasting plasma glucose, bone mineral content (BMC), and total body fat mass. CONCLUSIONS Serum sclerostin levels were negatively correlated to skeletal muscle mass independent of confounding factors including BMC and total body fat mass.
Collapse
Affiliation(s)
- Jung A Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - So-Hyeon Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
| |
Collapse
|
17
|
Parveen B, Parveen A, Vohora D. Biomarkers of Osteoporosis: An Update. Endocr Metab Immune Disord Drug Targets 2019; 19:895-912. [DOI: 10.2174/1871530319666190204165207] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/16/2018] [Accepted: 01/19/2019] [Indexed: 02/06/2023]
Abstract
Background:
Osteoporosis, characterized by compromised bone quality and strength is
associated with bone fragility and fracture risk. Biomarkers are crucial for the diagnosis or prognosis
of a disease as well as elucidating the mechanism of drug action and improve decision making.
Objective:
An exhaustive description of traditional markers including bone mineral density, vitamin D,
alkaline phosphatase, along with potential markers such as microarchitectural determination, trabecular
bone score, osteocalcin, etc. is provided in the current piece of work. This review provides insight into
novel pathways such as the Wnt signaling pathway, neuro-osseous control, adipogenic hormonal imbalance,
gut-bone axis, genetic markers and the role of inflammation that has been recently implicated
in osteoporosis.
Methods:
We extensively reviewed articles from the following databases: PubMed, Medline and Science
direct. The primary search was conducted using a combination of the following keywords: osteoporosis,
bone, biomarkers, bone turnover markers, diagnosis, density, architecture, genetics, inflammation.
Conclusion:
Early diagnosis and intervention delay the development of disease and improve treatment
outcome. Therefore, probing for novel biomarkers that are able to recognize people at high risk for
developing osteoporosis is an effective way to improve the quality of life of patients and to understand
the pathomechanism of the disease in a better way.
Collapse
Affiliation(s)
- Bushra Parveen
- Department of Pharmacology, Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Jamia Hamdard, New-Delhi-10062, India
| | - Abida Parveen
- Department of Clinical Research, School of Interdisciplinary Sciences, Jamia Hamdard, New-Delhi-10062, India
| | - Divya Vohora
- Department of Pharmacology, Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Jamia Hamdard, New-Delhi-10062, India
| |
Collapse
|
18
|
Basir H, Altunoren O, Erken E, Kilinc M, Sarisik FN, Isiktas S, Gungor O. Relationship Between Osteoporosis and Serum Sclerostin Levels in Kidney Transplant Recipients. EXP CLIN TRANSPLANT 2019. [PMID: 31526333 DOI: 10.6002/ect.2019.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Sclerostin, a peptide secreted primarily by osteocytes, suppresses osteoblast maturation, thus reducing bone formation. Here, we evaluated the relationship between sclerostin levels and osteoporosis in kidney transplant recipients. MATERIALS AND METHODS This cross-sectional study included 78 kidney transplantrecipients > 18 years old and at least 6 months posttransplant. In our center, unrelated living-donor kidney transplants are not performed. Patients with parathyroid adenoma or parathyroidectomy history were excluded. Lumbar and femoral neck bone mineral densities andT and Z scores were obtained by dual-energy X-ray absorptiometry; results were used to divide patients into osteoporotic and nonosteoporotic groups. Serum sclerostin was measured by enzyme-linked immunosorbent assay. RESULTS : Of total patients, 43% had osteoporosis, mean age was 40.8 years, and 70% were male. Groups had similar ages, male-female distribution, time posttransplant, cumulative corticosteroid dose, estimated glomerular filtration rates, and 25-hydroxyvitamin D2 levels (P > .05). The osteoporotic group had lower sclerostin (405.9 ± 234.9 vs 521.7 ± 233.5 ng/dL; P = .035) and higherintact parathyroid hormone levels (110.9 ± 68.0 vs 84.8 ± 41.4 pg/mL; P = .04) than the nonosteoporotic group. Sclerostin levels were not correlated with cumulative corticosteroid dose, intact parathyroid hormone, bone mineral density, and T scores at any site but were weakly negatively correlated with age (P = .04, r = -0.25). In multiple regression analyses, only intact parathyroid hormone had negative effects on lumbar bone mineral density (P = .02) andT scores (P = .036). Serum sclerostin levels, age, and cumulative corticosteroid dose did not affect lumbar or hip bone mineral density and T scores (P > .05). CONCLUSIONS Sclerostin levels were low in our osteoporotic patients;therefore, sclerostin may not be a contributing factor to osteoporosis development. Because sclerostin is an osteocyte-derived peptide, its serum levels only reflect total osteocyte number and bone mass.
Collapse
Affiliation(s)
- Hasan Basir
- From the Internal Medicine Department, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | | | | | | | | | | | | |
Collapse
|
19
|
Jepsen DB, Ryg J, Hansen S, Jørgensen NR, Gram J, Masud T. The combined effect of Parathyroid hormone (1-34) and whole-body Vibration exercise in the treatment of postmenopausal OSteoporosis (PaVOS study): a randomized controlled trial. Osteoporos Int 2019; 30:1827-1836. [PMID: 31309239 PMCID: PMC6717187 DOI: 10.1007/s00198-019-05029-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022]
Abstract
UNLABELLED Treatment effects of combining teriparatide and whole-body vibration exercise (WBV) vs teriparatide alone in twelve months were compared using bone mineral density (BMD), bone microarchitecture, and bone turnover markers. We found an increased effect in lumbar spine BMD by adding WBV to teriparatide in postmenopausal osteoporotic women. INTRODUCTION The parathyroid hormone (PTH) analogue teriparatide is an effective but expensive anabolic treatment for osteoporosis. Whole-body vibration exercise (WBV) has been found to stimulate muscle and bone strength in some studies. Animal data demonstrate a beneficial effect on bone when combining PTH with mechanical loading. The aim of this study was to investigate if combining WBV exercise and teriparatide treatment gives additional beneficial effects on bone compared to teriparatide alone in postmenopausal women with osteoporosis. METHODS The PaVOS study is a randomized controlled trial where postmenopausal osteoporotic women starting teriparatide 20 μg/day were randomized to WBV + teriparatide or teriparatide alone. WBV consisted of three sessions a week (12 min, including 1:1 ratio of exercise:rest). Bone mineral density (BMD) and bone microarchitecture, bone turnover markers, and sclerostin measurements were obtained. Data were analyzed using a linear mixed regression model with adjustment for baseline values or robust cluster regression in an intention-to-treat (ITT) analysis. RESULTS Thirty-five women were randomized (17 in teriparatide + WBV group and 18 in teriparatide group). At 12 months, both groups increased significantly in BMD at the lumbar spine. The teriparatide + WBV group increased by (mean ± SD) 8.90% ± 5.47 and the teriparatide group by 6.65% ± 5.51. The adjusted treatment effect of adding WBV to teriparatide was statistically significant at 2.95% [95% CI = 0.14-5.77; P = 0.040]. Markers of bone turnover increased significantly in both groups at three and six months with no significant difference between groups. No other treatment effects were observed in hip BMD, bone microarchitecture parameters, or sclerostin levels in either group. CONCLUSION Twelve months of WBV and teriparatide had a significant clinically relevant treatment effect in lumbar spine BMD compared to teriparatide alone in postmenopausal osteoporotic women. ClinicalTrials.gov :(NCT02563353).
Collapse
Affiliation(s)
- D. B. Jepsen
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J. Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S. Hansen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - N. R. Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
- OPEN—Odense Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J. Gram
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - T. Masud
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Nottingham University Hospitals Trust NHS, Nottingham, UK
| |
Collapse
|
20
|
Rodrigues AM, Eusébio M, Rodrigues AB, Caetano-Lopes J, Lopes IP, Lopes A, Mendes JM, Coelho PS, Fonseca JE, Branco JC, Canhão H. Low Serum Levels of DKK2 Predict Incident Low-Impact Fracture in Older Women. JBMR Plus 2019; 3:e10179. [PMID: 31372588 PMCID: PMC6659448 DOI: 10.1002/jbm4.10179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 11/26/2022] Open
Abstract
There are currently no robust noninvasive markers of fragility fractures. Secreted frizzled related protein‐1 (sFRP‐1), dickkopf‐related protein 1 (DKK1) and DKK2, and sclerostin (SOST) inhibit Wnt signaling and interfere with osteoblast‐mediated bone formation. We evaluated associations of serum levels of sFRP‐1, DKK1, DKK2, and SOST with incident low‐impact fracture and BMD in 828 women aged ≥65 years from EpiDoC, a longitudinal population‐based cohort. A structured questionnaire during a baseline clinical appointment assessed prevalent fragility fractures and clinical risk factors (CRFs) for fracture. Blood was collected to measure serum levels of bone turnover markers and Wnt regulators. Lumbar spine and hip BMD were determined by DXA scanning. Follow‐up assessment was performed through a phone interview; incident fragility fracture was defined by any new self‐reported low‐impact fracture. Multivariate Cox proportional hazard models were used to analyze fracture risk adjusted for CRFs and BMD. During a mean follow‐up of 2.3 ± 1.0 years, 62 low‐impact fractures were sustained in 58 women. A low serum DKK2 level (per 1 SD decrease) was associated with a 1.5‐fold increase in fracture risk independently of BMD and CRFs. Women in the two lowest DKK2 quartiles had a fracture incidence rate of 32 per 1000 person‐years, whereas women in the two highest quartiles had 14 fragility fractures per 1000 person‐years. A high serum sFRP1 level was associated with a 1.6‐fold increase in fracture risk adjusted for CRFs, but not independently of BMD. Serum levels of SOST (r = 0.191; p = 0.0025) and DKK1(r = −0.1725; p = 0.011) were correlated with hip BMD, but not with incident fragility fracture. These results indicate that serum DKK2 and sFRP1 may predict low‐impact fracture. The low number of incident fractures recorded is a limitation and serum levels of Wnt regulators should be further studied in other populations as potential noninvasive markers of fragility fractures. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Ana M Rodrigues
- CEDOC EpiDoc Unit-Epidemiology of Chronic Diseases Nova Medical School Universidade Nova de Lisboa Lisboa Portugal.,Faculdade de Medicina da Universidade de Lisboa Lisboa Portugal.,Associação EpiSaúde Évora Portugal
| | | | - Ana B Rodrigues
- Faculdade de Medicina da Universidade de Lisboa Lisboa Portugal
| | - Joana Caetano-Lopes
- Department of Orthopaedic Research Boston Children's Hospital, Boston, MA, USA; Department of Genetics Harvard Medical School Boston MA USA
| | - Inês P Lopes
- Unidade de Investigação em Reumatologia Instituto de Medicina Molecular Faculdade de Medicina Universidade de Lisboa Centro Académico de Medicina de Lisboa Lisboa Portugal
| | - Ana Lopes
- Unidade de Investigação em Reumatologia Instituto de Medicina Molecular Faculdade de Medicina Universidade de Lisboa Centro Académico de Medicina de Lisboa Lisboa Portugal
| | | | | | - João Eurico Fonseca
- Unidade de Investigação em Reumatologia Instituto de Medicina Molecular Faculdade de Medicina Universidade de Lisboa Centro Académico de Medicina de Lisboa Lisboa Portugal.,Serviço de Reumatologia e Doença Ósseas Metabólicas Hospital de Santa Maria CHLN Centro Académico de Medicina de Lisboa Lisboa Portugal
| | - Jaime C Branco
- CEDOC EpiDoc Unit-Epidemiology of Chronic Diseases Nova Medical School Universidade Nova de Lisboa Lisboa Portugal.,Centro de Estudos de Doenças Crónicas (CEDOC) da NOVA Medical School Universidade Nova de Lisboa (NMS/UNL) Lisboa Portugal.,Serviço de Reumatologia do Hospital Egas Moniz-Centro Hospitalar Lisboa Ocidental (CHLO- E.P.E.) Lisboa Portugal
| | - Helena Canhão
- CEDOC EpiDoc Unit-Epidemiology of Chronic Diseases Nova Medical School Universidade Nova de Lisboa Lisboa Portugal.,Associação EpiSaúde Évora Portugal.,Escola Nacional de Saúde Pública Universidade Nova de Lisboa Lisboa Portugal
| |
Collapse
|
21
|
Kuo TH, Lin WH, Chao JY, Wu AB, Tseng CC, Chang YT, Liou HH, Wang MC. Serum sclerostin levels are positively related to bone mineral density in peritoneal dialysis patients: a cross-sectional study. BMC Nephrol 2019; 20:266. [PMID: 31315601 PMCID: PMC6637583 DOI: 10.1186/s12882-019-1452-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/03/2019] [Indexed: 02/07/2023] Open
Abstract
Background Sclerostin, an antagonist of the Wingless-type mouse mammary tumor virus integration site (Wnt) pathway that regulates bone metabolism, is a potential contributor of chronic kidney disease (CKD)–mineral and bone disorder (MBD), which has various forms of presentation, from osteoporosis to vascular calcification. The positive association of sclerostin with bone mineral density (BMD) has been demonstrated in CKD and hemodialysis (HD) patients but not in peritoneal dialysis (PD) patients. This study assessed the association between sclerostin and BMD in PD patients. Methods Eighty-nine PD patients were enrolled; their sera were collected for measurement of sclerostin and other CKD–MBD-related markers. BMD was also assessed simultaneously. We examined the relationship between sclerostin and each parameter through Spearman correlation analysis and by comparing group data between patients with above- and below-median sclerostin levels. Univariate and multiple logistic regression models were employed to define the most predictive of sclerostin levels in the above-median category. Results Bivariate analysis revealed that sclerostin was correlated with spine BMD (r = 0.271, P = 0.011), spine BMD T-score (r = 0.274, P = 0.010), spine BMD Z-score (r = 0.237, P = 0.027), and intact parathyroid hormone (PTH; r = − 0.357, P < 0.001) after adjustments for age and sex. High BMD, old age, male sex, increased weight and height, diabetes, and high osteocalcin and uric acid levels were observed in patients with high serum sclerostin levels and an inverse relation was noticed between PTH and sclerostin. Univariate logistic regression analysis demonstrated that BMD is positively correlated with above-median sclerostin levels (odds ratio [OR] = 65.61, P = 0.002); the correlation was retained even after multivariate adjustment (OR = 121.5, P = 0.007). Conclusions For the first time, this study demonstrated a positive association between serum sclerostin levels and BMD in the PD population.
Collapse
Affiliation(s)
- Te-Hui Kuo
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Shengli Rd., North Dist, Tainan, 704, Taiwan.,Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Hung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jo-Yen Chao
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Shengli Rd., North Dist, Tainan, 704, Taiwan.,Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - An-Bang Wu
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Shengli Rd., North Dist, Tainan, 704, Taiwan.,Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Chung Tseng
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Shengli Rd., North Dist, Tainan, 704, Taiwan
| | - Yu-Tzu Chang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Shengli Rd., North Dist, Tainan, 704, Taiwan
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, 395 Zhongzheng Rd., Xinzhuang Dist, New Taipei City, 242, Taiwan.
| | - Ming-Cheng Wang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Shengli Rd., North Dist, Tainan, 704, Taiwan. .,Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
22
|
Assessment of the Concentration of Bone Metabolism Markers: Sclerostin and FGF-23 in Children with Idiopathic Nephrotic Syndrome Treated with Glucocorticosteroids. DISEASE MARKERS 2019; 2019:9698367. [PMID: 31354894 PMCID: PMC6636590 DOI: 10.1155/2019/9698367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/18/2019] [Accepted: 03/18/2019] [Indexed: 11/17/2022]
Abstract
Recurring nature of idiopathic nephrotic syndrome (INS) and steroid dependence imply a long-term treatment with glucocorticosteroids (GCSs), which increases the risk of bone metabolism disorders. The search for new markers of that process is essential. The aims of this study were to assess the concentrations of sclerostin (Scl) and fibroblast growth factor-23 (FGF-23) in the plasma of children with INS and compare Scl and FGF-23 to existing markers of bone metabolism, mainly parathyroid hormone (PTH). The study involved 70 children, 50 with INS and 20 healthy children. Patients with INS were divided into 4 groups depending on the number of relapses and applied therapy. Significantly higher concentrations of FGF-23 and Scl were found in all patient groups with INS compared to the control group, and increase in the concentrations of examined parameters depending on the number of NS relapses was showed. In patients from the group with numerous relapses, higher concentrations of FGF-23 and Scl in the relapse phase than those in the remission phase were found. We observed positive correlation in these proteins with parathyroid hormone. Positive correlation of FGF-23 and Scl in the examined group was noted. Children having relapsing INS treated with steroids have higher levels of Scl and FGF-23 that can indicate the bone metabolism disorders. The significance of these observations requires further research.
Collapse
|
23
|
Ikeda T, Kaji H, Tamura Y, Akagi M. Once-weekly teriparatide reduces serum sclerostin levels in postmenopausal women with osteoprosis. J Orthop Sci 2019; 24:532-538. [PMID: 30573396 DOI: 10.1016/j.jos.2018.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 10/24/2018] [Accepted: 10/28/2018] [Indexed: 11/17/2022]
Abstract
UNLABELLED Once-weekly teriparatide treatment is widely used in the treatment of osteoporosis in Japan but the mechanisms causing the increase in bone mineral density (BMD) of the lumbar spine remain unknown. METHODS This prospective study examined the effects of once-weekly teriparatide treatment on the serum levels of sclerostin, osteocalcin, and bone formation markers as well as BMD of the lumbar spine and femoral neck in 32 postmenopausal women with osteoporosis. RESULTS The mean age of subjects was 76.3 ± 7.0 years old. Teriparatide significantly reduced serum sclerostin levels at 12 and 18 months in postmenopausal women with osteoporosis, and significantly increased serum osteocalcin levels at 3,12 and 18 months and PINP levels at 1 and 3 months, respectively. Teriparatide treatment significantly increased BMD of the lumbar spine at 6, 12, and 18 months, but did not affect BMD of the femoral neck. Examination of the relationships between percent changes in bone metabolic indices and BMD of the lumbar spine during the teriparatide treatment showed serum sclerostin changes at 3 months were negatively correlated with BMD changes of the lumbar spine at 6, 12, and 18 months. Serum osteocalcin changes were not correlated with BMD changes in the lumbar spine at 12 months. CONCLUSIONS The present study showed that once-weekly teriparatide treatment reduced serum sclerostin levels in postmenopausal women with osteoporosis. The effects of teriparatide on sclerostin may be associated with the response of the BMD of the lumbar spine.
Collapse
Affiliation(s)
- Terumasa Ikeda
- Division of Orthopedic Surgery, Kindai University Faculty of Medicine, Ohnohigashi, Osakasayama 589-8511, Japan.
| | - Hiroshi Kaji
- Department of Physiology and Regenerative Medicine, Kindai University Faculty of Medicine
| | - Yukinori Tamura
- Department of Physiology and Regenerative Medicine, Kindai University Faculty of Medicine
| | - Masao Akagi
- Division of Orthopedic Surgery, Kindai University Faculty of Medicine, Ohnohigashi, Osakasayama 589-8511, Japan
| |
Collapse
|
24
|
Tsourdi E, Makras P, Rachner TD, Polyzos S, Rauner M, Mandanas S, Hofbauer LC, Anastasilakis AD. Denosumab effects on bone density and turnover in postmenopausal women with low bone mass with or without previous treatment. Bone 2019; 120:44-49. [PMID: 30292818 DOI: 10.1016/j.bone.2018.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/29/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Prior osteoporosis therapies may affect the skeletal response to denosumab. We compared the effect of denosumab (60 mg every 6 months for 12 months) on bone mineral density and bone metabolism parameters in postmenopausal women with low bone mass who were either treatment-naïve (n = 30), or previously treated either with zoledronic acid (n = 30), or teriparatide (n = 22). METHODS We assessed lumbar spine bone mineral density (BMD) and measured serum concentrations of the bone turnover markers pro-collagen type 1 N-terminal propeptide (PINP) and C-terminal-cross-linking telopeptide of type 1 collagen (CTX), as well as sclerostin, dickkopf-1 (Dkk-1), and myostatin. RESULTS Lumbar spine BMD increased equivalently in all three groups after 12 months of denosumab compared to baseline (p < 0.001). Serum PINP and CTX decreased significantly with denosumab in pre-treated women reaching the same nadir levels as in treatment-naïve patients (p < 0.001). Women pre-treated with teriparatide displayed lower baseline myostatin concentrations as compared to the other two groups (p < 0.001). Changes in lumbar spine BMD in teriparatide pre-treated women correlated with changes in bone turnover markers and myostatin. CONCLUSIONS Denosumab induced similar increases in lumbar spine BMD in treatment-naïve and pre-treated patients and suppressed serum PINP and CTX to the same levels regardless of prior treatments. In teriparatide pre-treated patients the magnitude of change in bone turnover markers is associated with BMD response.
Collapse
Affiliation(s)
- Elena Tsourdi
- Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Force & VA General Hospital, Athens, Greece
| | - Tilman D Rachner
- Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Stergios Polyzos
- First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Martina Rauner
- Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Stylianos Mandanas
- Department of Endocrinology, 424 General Military Hospital, 54638 Thessaloniki, Greece
| | - Lorenz C Hofbauer
- Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany; Center for Regenerative Therapies Dresden, Technische Universität Dresden, Germany
| | | |
Collapse
|
25
|
Bojanić K, Bilić Ćurčić I, Kuna L, Kizivat T, Smolic R, Raguž Lučić N, Kralik K, Šerić V, Ivanac G, Tucak-Zorić S, Včev A, Smolić M. Association of Wnt Inhibitors, Bone Mineral Density and Lifestyle Parameters in Women with Breast Cancer Treated with Anastrozole Therapy. J Clin Med 2018; 7:jcm7090287. [PMID: 30227689 PMCID: PMC6162798 DOI: 10.3390/jcm7090287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/03/2018] [Accepted: 09/11/2018] [Indexed: 01/08/2023] Open
Abstract
Aim: To determine the levels of Wnt inhibitors in patients treated with aromatase inhibitors (AIs) prior to therapy and to investigate their association with bone mineral density (BMD) and lifestyle parameters. Methods: 137 breast cancer patients were divided into a group treated with 1 mg of anastrozole and a group w/o anastrozole therapy. Serum concentrations of sclerostin and dickkopf1 (DKK1) were measured by ELISA. BMD was measured by dual-energy X-ray absorptiometry (DXA). Lifestyle factors were investigated by a self-reported questionnaire. Results: Sclerostin was significantly higher in the AI-treated group (31.8 pmol/L vs. 24.1 pmol/L; p < 0.001), whereas DKK1 was significantly lower in the AI-treated group (24.3 pmol/L vs. 26.02 pmol/L; p < 0.001). Total hip and femoral neck BMD were significantly lower in the AI-treated group. Conclusion: AI treatment was associated with increased levels of sclerostin and decreased levels of DKK1.
Collapse
Affiliation(s)
- Kristina Bojanić
- Department of Mineral Metabolism, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
- Department of Radiology, Health Center Osijek, Osijek31000, Croatia.
| | - Ines Bilić Ćurčić
- Department of Mineral Metabolism, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
- Department of Medicine, University Hospital Osijek, Osijek 31000, Croatia.
| | - Lucija Kuna
- Department of Biology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
- Department of Chemistry, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
| | - Tomislav Kizivat
- Department of Mineral Metabolism, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
- Clinical Institute for Nuclear Medicine and Radiation Safety, University Hospital Osijek, Osijek 31000, Croatia.
| | - Robert Smolic
- Department of Mineral Metabolism, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
- Department of Medicine, University Hospital Osijek, Osijek 31000, Croatia.
| | - Nikola Raguž Lučić
- Department of Mineral Metabolism, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
- Department of Pharmacology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
| | - Kristina Kralik
- Department of Medical Statistics and Medical Informatics, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
| | - Vatroslav Šerić
- Department of Mineral Metabolism, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
| | - Gordana Ivanac
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, Zagreb 10000, Croatia.
| | - Sandra Tucak-Zorić
- Department of Mineral Metabolism, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
| | - Aleksandar Včev
- Department of Mineral Metabolism, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
- Department of Medicine, University Hospital Osijek, Osijek 31000, Croatia.
- Department of Pathophysiology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
| | - Martina Smolić
- Department of Mineral Metabolism, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
- Department of Pharmacology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.
| |
Collapse
|
26
|
Parveen B, Tiwari AK, Jain M, Pal S, Chattopadhyay N, Tripathi M, Vohora D. The anti-epileptic drugs valproate, carbamazepine and levetiracetam cause bone loss and modulate Wnt inhibitors in normal and ovariectomised rats. Bone 2018; 113:57-67. [PMID: 29758362 DOI: 10.1016/j.bone.2018.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 01/21/2023]
Abstract
Secondary osteoporosis is the major concern associated with long term intake of antiepileptic drugs (AEDs). Women are the vulnerable targets owing to post-menopausal bone loss. In the present work, we evaluated the effect of 10 weeks of treatment with AED therapy (carbamazepine, CBZ, 75 mg/kg; sodium valproate, SVP, 300 mg/kg; levetiracetam, LTM, 150 mg/kg) on bone mineral density and microarchitecture at femoral epiphysis, lumbar vertebrae and proximal tibia of normal and ovariectomised Wistar rats. In addition, we measured serum levels of vitamin D, receptor activator of nuclear factor kappa β-ligand (RANKL), procollagen type 1 amino-terminal propeptide (P1NP) and wnt inhibitors (sclerostin and DKK-1) following AED therapy. Micro-computed tomography analysis of bones revealed significant reduction in BMD at femur epiphysis and lumbar vertebrae with all the three AEDs evaluated. At proximal tibia, only CBZ showed a significant decline. The reduction in BMD was more pronounced in ovariectomised rats. AEDs also resulted in alteration of micro-CT parameters. These changes were accompanied by an increased serum RANKL with all AEDs while vitamin D levels were reduced only with CBZ treatment and P1NP levels were reduced with SVP and CBZ. Serum sclerostin levels were elevated following all AEDs in normal and ovariectomised rats except with CBZ in normal rats. However, increase in DKK-1 levels was observed with only LTM. Ovariectomy itself resulted in increased RANKL, sclerostin and DKK-1 and reduced vitamin D and P1NP levels. Significant differences were discernible between normal and ovariectomised rats treated with AEDs in all the parameters. However, while sclerostin increased further upon AEDs treatment, P1NP decreased with SVP and CBZ and serum DKK-1 levels showed a declining trend with all the three AEDs studied. We confirm adverse effects on bone following AEDs in female rats. Further, our results demonstrate for the first time that these effects are more pronounced in ovariectomised rats as compared to normal rats and that this could be related to estrogen deficiency which in turn enhances bone resorption via increased RANKL and reduces bone formation via increased sclerostin and reduced P1NP. Finally, our study demonstrated for the first time that AED treatment displayed changes in the serum levels of wnt inhibitors and hence modulation of wnt inhibitors might be partly involved in their adverse effects on bone.
Collapse
Affiliation(s)
- Bushra Parveen
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | | | - Moon Jain
- Central Drug Research Institute, Division of Pharmacology, Lucknow 226031, Uttar Pradesh, India
| | - Subhashis Pal
- Central Drug Research Institute, Division of Endocrinology, Lucknow 226031, Uttar Pradesh, India
| | - Naibedya Chattopadhyay
- Central Drug Research Institute, Division of Endocrinology, Lucknow 226031, Uttar Pradesh, India
| | - Manjari Tripathi
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Divya Vohora
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India.
| |
Collapse
|
27
|
Parveen B, Tripathi M, Vohora D. A Cross-Sectional Study to Assess the Modulation of Wnt Inhibitors following Anti-Epileptic Drug Therapy and their Correlation with Vitamin D and Receptor Activator of Nuclear Factor κ B Ligand in Indian Women with Epilepsy. Basic Clin Pharmacol Toxicol 2018; 123:271-276. [DOI: 10.1111/bcpt.12996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Bushra Parveen
- Pharmaceutical Medicine; Department of Pharmacology; School of Pharmaceutical Education and Research; Jamia Hamdard; New Delhi India
| | - Manjari Tripathi
- Department of Neurology; Neurosciences Centre; All India Institute of Medical Sciences; New Delhi India
| | - Divya Vohora
- Pharmaceutical Medicine; Department of Pharmacology; School of Pharmaceutical Education and Research; Jamia Hamdard; New Delhi India
| |
Collapse
|
28
|
Gossiel F, Scott JR, Paggiosi MA, Naylor KE, McCloskey EV, Peel NFA, Walsh JS, Eastell R. Effect of Teriparatide Treatment on Circulating Periostin and Its Relationship to Regulators of Bone Formation and BMD in Postmenopausal Women With Osteoporosis. J Clin Endocrinol Metab 2018; 103:1302-1309. [PMID: 29365099 PMCID: PMC6457025 DOI: 10.1210/jc.2017-00283] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 01/17/2018] [Indexed: 12/19/2022]
Abstract
CONTEXT Treatment of postmenopausal osteoporosis with teriparatide parathyroid hormone amino terminal 1-34 increases bone formation and improves bone microarchitecture. A possible modulator of action is periostin. In vitro experiments have shown that periostin might regulate osteoblast differentiation and bone formation through Wnt signaling. The effect of teriparatide on periostin is not currently known. OBJECTIVES To determine the effect of teriparatide treatment on circulating levels of periostin and other regulators of bone formation and investigate how changes in periostin relate to changes in bone turnover markers, regulators of bone formation, and bone mineral density (BMD). PARTICIPANTS AND DESIGN Twenty women with osteoporosis; a 2-year open-label single-arm study. INTERVENTION Teriparatide 20 µg was administered by subcutaneous injection daily for 104 weeks. Periostin, sclerostin, and Dickkopf-related protein 1, procollagen type I N-terminal propeptide (PINP), and C-telopeptide of type I collagen were measured in fasting serum collected at baseline (two visits) and then at weeks 1, 2, 4, 12, 26, 52, 78, and 104. BMD was measured at the lumbar spine, total hip, and femoral neck using dual energy x-ray absorptiometry. RESULTS Periostin levels increased by 6.6% [95% confidence interval (CI), -0.4 to 13.5] after 26 weeks of teriparatide treatment and significantly by 12.5% (95% CI, 3.3 to 21.0; P < 0.01) after 52 weeks. The change in periostin correlated positively with the change in the lumbar spine BMD at week 52 (r = 0.567; 95% CI, 0.137 to 0.817; P < 0.05) and femoral neck BMD at week 104 (r = 0.682; 95% CI, 0.261 to 0.885; P < 0.01). CONCLUSIONS Teriparatide therapy increases periostin secretion; it is unclear whether this increase mediates the effect of the drug on bone.
Collapse
Affiliation(s)
- Fatma Gossiel
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
- Correspondence and Reprint Requests: Fatma Gossiel, BSc, The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Beech Hill Road, Sheffield S10 2RX, United Kingdom. E-mail:
| | - Jessica R Scott
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
| | - Margaret A Paggiosi
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
| | - Kim E Naylor
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
| | - Eugene V McCloskey
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
| | - Nicola F A Peel
- Metabolic Bone Centre, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Jennifer S Walsh
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
| | - Richard Eastell
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
29
|
Polyzos SA, Makras P, Anastasilakis AD, Mintziori G, Kita M, Papatheodorou A, Kokkoris P, Terpos E. Periostin and sclerostin levels in juvenile Paget's disease. ACTA ACUST UNITED AC 2017; 14:269-271. [PMID: 29263750 DOI: 10.11138/ccmbm/2017.14.2.269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Juvenile Paget's disease (JPD) is a rare, autosomal recessive disorder featuring markedly increased serum alkaline phosphatase activity, indicative of greatly accelerated bone turnover throughout the skeleton. The main aim of this study was to evaluate circulating periostin and sclerostin levels in two adult patients with mild JPD (due to "Balkan" mutation). We measured periostin and sclerostin levels in a previously described woman and a newly diagnosed man with JPD, and 10 apparently healthy individuals, matched (1:5) to JPD patients for gender, age and body mass index. Sclerostin levels were similar between JPD patients and controls. Periostin levels were about 2.5 times higher in JPD patients. Periostin and sclerostin levels were negatively correlated (rs= -0.63; p=0.03). In conclusion, a trend towards higher periostin levels was observed in JPD patients, whereas sclerostin levels were similar to controls.
Collapse
Affiliation(s)
- Stergios A Polyzos
- Department of Endocrinology, Ippokration General Hospital, Thessaloniki, Greece
| | - Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | | | | | - Marina Kita
- Department of Endocrinology, Ippokration General Hospital, Thessaloniki, Greece
| | | | - Panagiotis Kokkoris
- Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece
| |
Collapse
|
30
|
Coulson J, Bagley L, Barnouin Y, Bradburn S, Butler-Browne G, Gapeyeva H, Hogrel JY, Maden-Wilkinson T, Maier AB, Meskers C, Murgatroyd C, Narici M, Pääsuke M, Sassano L, Sipilä S, Al-Shanti N, Stenroth L, Jones DA, McPhee JS. Circulating levels of dickkopf-1, osteoprotegerin and sclerostin are higher in old compared with young men and women and positively associated with whole-body bone mineral density in older adults. Osteoporos Int 2017; 28:2683-2689. [PMID: 28585053 DOI: 10.1007/s00198-017-4104-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/23/2017] [Indexed: 12/31/2022]
Abstract
UNLABELLED Bone mineral density declines with increasing older age. We examined the levels of circulating factors known to regulate bone metabolism in healthy young and older adults. The circulating levels of dickkopf-1, osteocalcin, osteoprotegerin and sclerostin were positively associated with whole-body bone mineral density (WBMD) in older adults, despite the average WBMD being lower and circulating dickkopf-1, osteoprotegerin and sclerostin being higher in old than young. INTRODUCTION This study aims to investigate the relationship between whole-body bone mineral density (WBMD) and levels of circulating factors with known roles in bone remodelling during 'healthy' ageing. METHODS WBMD and fasting plasma concentrations of dickkopf-1, fibroblast growth factor-23, osteocalcin, osteoprotegerin, osteopontin and sclerostin were measured in 272 older subjects (69 to 81 years; 52% female) and 171 younger subjects (18-30 years; 53% female). RESULTS WBMD was lower in old than young. Circulating osteocalcin was lower in old compared with young, while dickkopf-1, osteoprotegerin and sclerostin were higher in old compared with young. These circulating factors were each positively associated with WBMD in the older adults and the relationships remained after adjustment for covariates (r values ranging from 0.174 to 0.254, all p < 0.01). In multivariate regression, the body mass index, circulating sclerostin and whole-body lean mass together accounted for 13.8% of the variation with WBMD in the older adults. In young adults, dickkopf-1 and body mass index together accounted for 7.7% of variation in WBMD. CONCLUSION Circulating levels of dickkopf-1, osteocalcin, osteoprotegerin and sclerostin are positively associated with WBMD in community-dwelling older adults, despite the average WBMD being lower and circulating dickkopf-1, osteoprotegerin and sclerostin being higher in old than young.
Collapse
Affiliation(s)
- J Coulson
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M15GD, UK
| | - L Bagley
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M15GD, UK
| | - Y Barnouin
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M15GD, UK
- Baylor College of Medicine, Houston, TX, USA
| | - S Bradburn
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M15GD, UK
| | | | - H Gapeyeva
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia
| | - J-Y Hogrel
- Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - T Maden-Wilkinson
- School of Physical Activity and Health, Sheffield Hallam University, Sheffield, UK
| | - A B Maier
- Department of Human Movement Sciences, MOVE Research Institute, Vrij University, Amsterdam, The Netherlands
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - C Meskers
- Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - C Murgatroyd
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M15GD, UK
| | - M Narici
- Graduate Entry Medicine and Health, University of Nottingham, Nottingham, UK
| | - M Pääsuke
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia
| | - L Sassano
- Unilever Discover, Colworth Park, Sharnbrook, Bedford, UK
| | - S Sipilä
- Gerontology Research Center, Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - N Al-Shanti
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M15GD, UK
| | - L Stenroth
- Gerontology Research Center, Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - D A Jones
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M15GD, UK
| | - J S McPhee
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M15GD, UK.
| |
Collapse
|
31
|
Strollo R, Soare A, Manon Khazrai Y, Di Mauro A, Palermo A, Del Toro R, Fallucca S, Giovanna Belluomo M, Dugo L, Pianesi M, Pozzilli P, Napoli N. Increased sclerostin and bone turnover after diet-induced weight loss in type 2 diabetes: a post hoc analysis of the MADIAB trial. Endocrine 2017; 56:667-674. [PMID: 27888435 DOI: 10.1007/s12020-016-1171-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/03/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Sclerostin has been directly related to bone turnover increase in dietary-induced weight loss in non-diabetics. This has not been studied in type 2 diabetes, a condition characterized by increased circulating sclerostin and impaired bone turnover. PURPOSE To study the effect of dietary weight loss and quality of the dietary intervention on changes of sclerostin and bone turnover markers in type 2 diabetes. METHODS This was a post-hoc analysis of the MADIAB trial, a 21-day randomized controlled trial on overweight/obese type 2 diabetes patients. Patients were randomly assigned 1:1 to the Ma-Pi2 macrobiotic diet or a control diet based on dietary guidelines for type 2 diabetes. Serum sclerostin and circulating markers of bone resorption and formation (P1NP) were measured by enzyme linked immunosorbent assay in 40 subjects (1:1) at baseline and after 21 days treatment. RESULTS Both Ma-Pi2 and the control diet groups had significant decreases in body weight (6.0 ± 0.2 vs. 3.2 ± 0.1 %, p < 0.001). Sclerostin increased significantly in the two groups (all p < 0.001) but Ma-Pi2 diet group experienced a greater increase in sclerostin (34.5 vs. 15 %; p = 0.024). Serum circulating markers of bone resorption increased in the two groups (all p < 0.001); circulating markers of bone resorption at the end of the treatment tended to be higher in Ma-Pi2 diet than the control diet group (p = 0.06). P1NP did not change significantly in the two group compared to baseline. Sclerostin changes were related to body mass index reduction (r = -0.37; p = 0.02). CONCLUSIONS Diet-induced weight loss may induce significant and rapid changes in bone turnover and sclerostin levels. These changes may further impair bone health in subjects with type 2 diabetes.
Collapse
Affiliation(s)
- Rocky Strollo
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Andreea Soare
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Yeganeh Manon Khazrai
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Antonio Di Mauro
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Andrea Palermo
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rossella Del Toro
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sara Fallucca
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Maria Giovanna Belluomo
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Laura Dugo
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Mario Pianesi
- International Study Center for Environment, Agriculture, Food, Health and Economics, Tolentino, Italy
| | - Paolo Pozzilli
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
- Centre for Immunobiology, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Nicola Napoli
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
- Department of Medicine, Division of Bone and Mineral Diseases, Washington University in St. Louis, St. Louis, MO, USA.
| |
Collapse
|
32
|
Atteritano M, Di Mauro E, Canale V, Bruzzese AM, Ricciardi CA, Cernaro V, Lacquaniti A, Buemi M, Santoro D. Higher serum sclerostin levels and insufficiency of vitamin D are strongly associated with vertebral fractures in hemodialysis patients: a case control study. Osteoporos Int 2017; 28:577-584. [PMID: 27682249 DOI: 10.1007/s00198-016-3770-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022]
Abstract
UNLABELLED In hemodialysis patients, vertebral fractures were associated with elevated sclerostin levels, suggesting that sclerostin could reflect bone fragility in these patients. INTRODUCTION Fragility fractures are common in hemodialysis patients. The aims of our study were to determine the prevalence of vertebral fracture and analyze associations between sclerostin serum levels and vertebral fractures in hemodialysis patients. METHODS Ninety-two hemodialysis patients and 100 controls matched for age and sex were studied. Bone mineral density was measured by ultrasonography at non-dominant heel. The markers of bone turnover included serum osteocalcin, C-terminal telopeptide, and sclerostin. All participants underwent radiography of the thoracic and lumbar spine to ascertain the presence of vertebral fractures. RESULTS Bone ultrasound parameters at calcaneus were significantly lower in hemodialysis patients compared with controls; bone turnover markers and parathyroid hormone level were significantly higher, while serum of 25-OH-D3 was significantly lower in hemodialysis group. One or more moderate or severe vertebral fractures were found in 38 hemodialysis patients, whereas in control group, 10 patients had a vertebral fracture. In hemodialysis group, the comparison between patients with and without vertebral fractures showed that the patients with vertebral fractures had the serum sclerostin levels statistically higher than patients without vertebral, while serum levels of 25-OH-D3 was significantly lower in patients with vertebral fractures compared to the patients without vertebral fractures. Multivariate analysis disclosed that sclerostin levels were associated with an increased risk of vertebral fractures in hemodialysis patients after adjusting for multiple variables. CONCLUSIONS Our data shows high prevalence of vertebral fractures in hemodialysis patients and that it is associated with elevated sclerostin levels, reflecting bone fragility in these patients.
Collapse
Affiliation(s)
- M Atteritano
- Department of Clinical and Experimental Medicine, University of Messina, Pad. B, 2nd floor, A.O.U. Policlinico "G. Martino" Via C. Valeria, 98125, Messina, Italy.
| | - E Di Mauro
- Department of Clinical and Experimental Medicine, University of Messina, Pad. B, 2nd floor, A.O.U. Policlinico "G. Martino" Via C. Valeria, 98125, Messina, Italy
| | - V Canale
- Department of Clinical and Experimental Medicine, University of Messina, Pad. B, 2nd floor, A.O.U. Policlinico "G. Martino" Via C. Valeria, 98125, Messina, Italy
| | - A M Bruzzese
- Department of Clinical and Experimental Medicine, University of Messina, Pad. B, 2nd floor, A.O.U. Policlinico "G. Martino" Via C. Valeria, 98125, Messina, Italy
| | - C A Ricciardi
- Department of Clinical and Experimental Medicine, University of Messina, Pad. B, 2nd floor, A.O.U. Policlinico "G. Martino" Via C. Valeria, 98125, Messina, Italy
| | - V Cernaro
- Department of Clinical and Experimental Medicine, University of Messina, Pad. B, 2nd floor, A.O.U. Policlinico "G. Martino" Via C. Valeria, 98125, Messina, Italy
| | - A Lacquaniti
- Department of Clinical and Experimental Medicine, University of Messina, Pad. B, 2nd floor, A.O.U. Policlinico "G. Martino" Via C. Valeria, 98125, Messina, Italy
| | - M Buemi
- Department of Clinical and Experimental Medicine, University of Messina, Pad. B, 2nd floor, A.O.U. Policlinico "G. Martino" Via C. Valeria, 98125, Messina, Italy
| | - D Santoro
- Department of Clinical and Experimental Medicine, University of Messina, Pad. B, 2nd floor, A.O.U. Policlinico "G. Martino" Via C. Valeria, 98125, Messina, Italy
| |
Collapse
|
33
|
Tsai JN, Burnett-Bowie SM, Lee H, Leder BZ. Relationship between bone turnover and density with teriparatide, denosumab or both in women in the DATA study. Bone 2017; 95:20-25. [PMID: 27840301 PMCID: PMC6941193 DOI: 10.1016/j.bone.2016.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND While changes in biochemical markers of bone turnover (BTM) have been reported to predict changes in bone mineral density (BMD), the relationship between changes in BMD and BTMs with combined antiresorptive/anabolic therapy is unknown. METHODS In the DATA study, 94 postmenopausal osteoporotic women (ages 51-91) received either teriparatide 20-mcg SC daily, denosumab 60-mg SC every 6months, or both for 2years. Pearson's correlation coefficients (R) were calculated to determine the relationship between baseline and early changes in BTMs (as well as serum sclerostin) and 2-year changes in BMD. RESULTS In women receiving teriparatide, baseline BTMs did not correlate with 2-year BMD changes though 12-month increases in osteocalcin and P1NP were associated with 2-year increases in spine BMD. In women receiving denosumab, spine and hip BMD gains correlated with both baseline and changes in P1NP and C-telopeptide. In women receiving combined teriparatide/denosumab, while both baseline and decreases in P1NP were associated with spine BMD gains, distal radius increases were associated with less CTX suppression. Neither baseline nor changes in serum sclerostin correlated with BMD in any treatment group. SUMMARY AND CONCLUSIONS In women treated with teriparatide or denosumab, early BTM changes (increases and decreases, respectively) predict 2-year BMD gains, especially at the spine. In women treated with combined teriparatide/denosumab therapy, BMD increases at the distal radius were associated with less suppression of bone turnover. These results suggest that efficacy of combination therapy at cortical sites such as the radius may depend on residual bone remodeling despite RANKL inhibition.
Collapse
Affiliation(s)
- J N Tsai
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, United States.
| | - S M Burnett-Bowie
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, United States
| | - H Lee
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
| | - B Z Leder
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, United States
| |
Collapse
|
34
|
Varela A, Chouinard L, Lesage E, Smith SY, Hattersley G. One Year of Abaloparatide, a Selective Activator of the PTH1 Receptor, Increased Bone Formation and Bone Mass in Osteopenic Ovariectomized Rats Without Increasing Bone Resorption. J Bone Miner Res 2017; 32:24-33. [PMID: 27748532 DOI: 10.1002/jbmr.3003] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/13/2016] [Accepted: 09/18/2016] [Indexed: 01/20/2023]
Abstract
Abaloparatide is a novel 34-amino acid peptide selected to be a potent and selective activator of the parathyroid hormone receptor (PTH1R) signaling pathway with 41% homology to PTH(1-34) and 76% homology to PTHrP(1-34). A 12-month treatment study was conducted in osteopenic ovariectomized (OVX) rats to characterize the mechanisms by which abaloparatide increases bone mass. Sprague-Dawley (SD) rats were subjected to OVX or sham surgery at age 6 months and left untreated for 3 months to allow OVX-induced bone loss. Ten OVX rats were euthanized after this bone depletion period, and the remaining OVX rats received daily subcutaneous injections of vehicle (n = 18) or abaloparatide at 1, 5, or 25 μg/kg/d (n = 18/dose level) for 12 months. Sham controls (n = 18) received vehicle daily. Bone densitometry and biochemical markers of bone formation and resorption were assessed longitudinally, and L3 vertebra and tibia were collected at necropsy for histomorphometry. Abaloparatide increased biochemical bone formation markers without increasing bone resorption markers or causing hypercalcemia. Abaloparatide increased histomorphometric indices of bone formation on trabecular, endocortical, and periosteal surfaces without increasing osteoclasts or eroded surfaces. Abaloparatide induced substantial increases in trabecular bone volume and density and improvements in trabecular microarchitecture. Abaloparatide stimulated periosteal expansion and endocortical bone apposition at the tibial diaphysis, leading to marked increases in cortical bone volume and density. Whole-body bone mineral density (BMD) remained stable in OVX-Vehicle controls while increasing 25% after 12 months of abaloparatide (25 μg/kg). Histomorphometry and biomarker data suggest that gains in cortical and trabecular bone mass were attributable to selective anabolic effects of abaloparatide, without evidence for stimulated bone resorption. © 2016 American Society for Bone and Mineral Research.
Collapse
|
35
|
Dede AD, Trovas G, Chronopoulos E, Triantafyllopoulos IK, Dontas I, Papaioannou N, Tournis S. Thalassemia-associated osteoporosis: a systematic review on treatment and brief overview of the disease. Osteoporos Int 2016; 27:3409-3425. [PMID: 27503175 DOI: 10.1007/s00198-016-3719-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/20/2016] [Indexed: 01/19/2023]
Abstract
Thalassemia-associated osteoporosis constitutes a major complication in patients with thalassemia. This review presents the existing studies on the treatment of thalassemia-associated osteoporosis and discusses the management of this debilitating complication. A brief presentation of the disease characteristics and pathogenetic mechanisms is also provided. The life expectancy of patients with thalassemia has increased markedly in recent years resulting in the aging of the population and the emergence of new comorbidities. The majority of patients with thalassemia have low bone mineral density and experience lifelong fracture rates as high as 71 %. The pathogenesis of thalassemia-associated osteoporosis (TAO) is multifactorial with anemia and iron overload playing crucial role in its development. Data concerning the prevention and treatment of TAO are extremely limited. We performed a literature research in Pubmed and Scopus to identify interventional studies evaluating the effects of various agents on TAO. Seventeen studies were retrieved. We present the results of these studies as well as a brief overview of TAO including presentation, pathogenesis, and management. Most of the studies identified are of poor quality, are not randomized controlled, and include small number of participants. There are no data concerning effects on fracture rates. Bisphosphonates are the most widely studied agents and among them zoledronic acid is the most well studied. Hormone replacement treatment (HRT) shows beneficial but small effects. Denosumab and strontium ranelate have each been evaluated in only a single study, while there are no data about the effects of anabolic agents. Given the increased life expectancy and the increase in fracture rates with age, more data about the management of TAO are warranted. Moreover, due to the need for lifelong management starting at young age, careful treatment plans which may include sequential treatment may often be required. However, currently, there are no relevant data available.
Collapse
Affiliation(s)
- A D Dede
- Laboratory for Research of Musculoskeletal System "Theodoros Garofalidis", KAT Hospital, University of Athens, 10 Athinas Str., Kifissia, 145 61, Athens, Greece.
| | - G Trovas
- Laboratory for Research of Musculoskeletal System "Theodoros Garofalidis", KAT Hospital, University of Athens, 10 Athinas Str., Kifissia, 145 61, Athens, Greece
| | - E Chronopoulos
- Orthopedic Department, Konstantopoulion Hospital, University of Athens, Nea Ionia, Greece
| | - I K Triantafyllopoulos
- Laboratory for Research of Musculoskeletal System "Theodoros Garofalidis", KAT Hospital, University of Athens, 10 Athinas Str., Kifissia, 145 61, Athens, Greece
| | - I Dontas
- Laboratory for Research of Musculoskeletal System "Theodoros Garofalidis", KAT Hospital, University of Athens, 10 Athinas Str., Kifissia, 145 61, Athens, Greece
| | - N Papaioannou
- Laboratory for Research of Musculoskeletal System "Theodoros Garofalidis", KAT Hospital, University of Athens, 10 Athinas Str., Kifissia, 145 61, Athens, Greece
| | - S Tournis
- Laboratory for Research of Musculoskeletal System "Theodoros Garofalidis", KAT Hospital, University of Athens, 10 Athinas Str., Kifissia, 145 61, Athens, Greece
| |
Collapse
|
36
|
Huovinen V, Ivaska KK, Kiviranta R, Bucci M, Lipponen H, Sandboge S, Raiko J, Eriksson JG, Parkkola R, Iozzo P, Nuutila P. Bone mineral density is increased after a 16-week resistance training intervention in elderly women with decreased muscle strength. Eur J Endocrinol 2016; 175:571-582. [PMID: 27634943 DOI: 10.1530/eje-16-0521] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/26/2016] [Accepted: 09/15/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Non-pharmacological interventions are important in reducing risk for osteoporotic fractures. We investigated the effects of a 16-week individualized resistance training intervention on bone mineral density (BMD), bone turnover markers and 10-year relative risk (RR) for osteoporotic fracture. DESIGN Interventional study with a follow-up. METHODS In total, 37 elderly women (mean age 71.9 ± 3.1 years) with decreased muscle strength participated in the resistance training intervention three times per week with 60 min per session for 16 weeks under the supervision of a licensed physiotherapist. Total hip BMD with quantitative CT, bone markers (sclerostin, osteocalcin, CTX, PINP, IGF-1, 25(OH)-D) and 10-year RR for osteoporotic fracture were measured at baseline, post-intervention and at 1-year follow-up after the end of the intervention. Eleven age- and sex-matched controls did not participate in the intervention but were studied at baseline and at 1-year follow-up. RESULTS Resistance training seemed to increase total hip BMD by 6% (P = 0.005). Sclerostin (P < 0.001) and total osteocalcin (P = 0.04) increased while other bone markers remained unchanged. A 10-year RR for major osteoporotic and hip fracture remained unchanged. At follow-up total hip BMD (P < 0.001) decreased back to the baseline level with a simultaneous decrease in serum sclerostin (P = 0.045), CTX (P < 0.001) and an increase in 25(OH)-D (P < 0.001), 10-year RR for major osteoporotic (P = 0.002) and hip fracture (P = 0.01). CONCLUSIONS Our findings suggest an important role of continuous supervised resistance training for the prevention of osteoporotic fractures in elderly women with decreased muscle strength.
Collapse
Affiliation(s)
- Ville Huovinen
- Turku PET CentreUniversity of Turku, Turku, Finland
- Department of RadiologyUniversity of Turku and Turku University Hospital, Turku, Finland
| | - Kaisa K Ivaska
- Department of Cell Biology and AnatomyInstitute of Biomedicine, University of Turku, Turku, Finland
| | - Riku Kiviranta
- Department of EndocrinologyTurku University Hospital, Turku, Finland
- Departments of Medicine and Medical Biochemistry and GeneticsUniversity of Turku, Turku, Finland
| | - Marco Bucci
- Turku PET CentreUniversity of Turku, Turku, Finland
| | | | - Samuel Sandboge
- Folkhälsan Research CentreHelsinki, Finland
- Department of Chronic Disease PreventionNational Institute for Health and Welfare, Helsinki, Finland
| | - Juho Raiko
- Turku PET CentreUniversity of Turku, Turku, Finland
| | - Johan G Eriksson
- Folkhälsan Research CentreHelsinki, Finland
- Department of Chronic Disease PreventionNational Institute for Health and Welfare, Helsinki, Finland
- Department of General Practice and Primary Health CareUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riitta Parkkola
- Turku PET CentreUniversity of Turku, Turku, Finland
- Department of RadiologyUniversity of Turku and Turku University Hospital, Turku, Finland
| | - Patricia Iozzo
- Turku PET CentreUniversity of Turku, Turku, Finland
- Institute of Clinical PhysiologyNational Research Council (CNR), Pisa, Italy
| | - Pirjo Nuutila
- Turku PET CentreUniversity of Turku, Turku, Finland
- Department of EndocrinologyTurku University Hospital, Turku, Finland
| |
Collapse
|
37
|
Guañabens N, Ruiz-Gaspà S, Gifre L, Miquel R, Peris P, Monegal A, Dubrueil M, Arias A, Parés A. Sclerostin Expression in Bile Ducts of Patients With Chronic Cholestasis May Influence the Bone Disease in Primary Biliary Cirrhosis. J Bone Miner Res 2016; 31:1725-33. [PMID: 27019303 DOI: 10.1002/jbmr.2845] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/12/2016] [Accepted: 03/23/2016] [Indexed: 02/06/2023]
Abstract
Sclerostin is involved in the regulation of osteoblastogenesis and little is known about its role in the development of bone disease in primary biliary cirrhosis (PBC), characterized by low bone formation. Therefore, we have assessed the circulating levels and the liver expression of sclerostin in this cholestatic disease. Serum sclerostin levels were measured in 79 women with PBC (mean age 60.6 ± 1.2 years) and in 80 control women. Lumbar and femoral bone mineral density (BMD), as well as parameters of mineral metabolism and bone remodeling, were measured. Moreover, sclerostin gene (SOST) expression in the liver was assessed by real-time PCR in samples of liver tissue taken by biopsy in 11 PBC patients and in 5 normal liver specimens. Presence and distribution of sclerostin was evaluated in liver slices from 11 patients by immunohistochemistry. The severity of histologic lesions was assessed semiquantitatively in the same liver samples. PBC patients had higher sclerostin levels than controls (75.6 ± 3.9 versus 31.7 ± 1.6 pmol/L, p < 0.001). Serum sclerostin correlated inversely with markers of bone formation and resorption. Sclerostin mRNA in the liver was overexpressed compared with control samples (2.7-fold versus healthy liver). Sclerostin was detected by immunohistochemistry in 7 of the 11 liver samples, mainly located in the bile ducts. Liver sclerostin was associated with the severity of cholangitis (p = 0.02) and indirectly with the degree of lobular inflammation (p = 0.03). Sclerostin mRNA expression was higher in samples that tested positive by immunohistochemistry and particularly in those with lobular granuloma (p = 0.02). The increased expression of sclerostin in the liver and the association with histologic cholangitis may explain the high serum levels of this protein in patients with PBC, thus suggesting that sclerostin may influence the decreased bone formation in this cholestatic disease. © 2016 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Núria Guañabens
- Department of Rheumatology, Metabolic Bone Diseases Unit, Hospital Clínic, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
- Center for Biomedical Research Network in Hepatic and Digestive Diseases (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Silvia Ruiz-Gaspà
- Center for Biomedical Research Network in Hepatic and Digestive Diseases (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Laia Gifre
- Department of Rheumatology, Metabolic Bone Diseases Unit, Hospital Clínic, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Rosa Miquel
- Pathology Department, Hospital Clínic, Barcelona, Spain
| | - Pilar Peris
- Department of Rheumatology, Metabolic Bone Diseases Unit, Hospital Clínic, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
- Center for Biomedical Research Network in Hepatic and Digestive Diseases (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Ana Monegal
- Department of Rheumatology, Metabolic Bone Diseases Unit, Hospital Clínic, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marta Dubrueil
- Center for Biomedical Research Network in Hepatic and Digestive Diseases (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Ana Arias
- Department of Rheumatology, Metabolic Bone Diseases Unit, Hospital Clínic, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Albert Parés
- Center for Biomedical Research Network in Hepatic and Digestive Diseases (CIBERehd), Hospital Clínic, Barcelona, Spain
- Liver Unit, Hospital Clínic, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| |
Collapse
|
38
|
Polyzos SA, Anastasilakis AD, Kountouras J, Makras P, Papatheodorou A, Kokkoris P, Sakellariou GT, Terpos E. Circulating sclerostin and Dickkopf-1 levels in patients with nonalcoholic fatty liver disease. J Bone Miner Metab 2016; 34:447-56. [PMID: 26056025 DOI: 10.1007/s00774-015-0687-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/09/2015] [Indexed: 12/12/2022]
Abstract
There is increasing evidence for bone-liver interplay. The main aim of this study was to determine serum sclerostin and Dickkopf (DKK)-1 levels in patients with nonalcoholic fatty liver disease (NAFLD) and their association with the disease severity. Patients with biopsy-proven NAFLD, 13 with nonalcoholic simple steatosis (SS) and 14 with steatohepatitis (NASH), and 20 gender-, age-, body mass index- and waist circumference-matched controls were enrolled. Serum sclerostin, DKK-1, bone turnover markers, vitamin D, insulin and standard biochemical and hematologic parameters were measured; lumbar spinal dual-energy X-ray absorptiometry was performed. We observed that there was a progressive decline in serum sclerostin levels from the controls (76.1 ± 6.8) to SS (53.5 ± 6.4) and NASH (46.0 ± 8.1 pmol/l) patients (p = 0.009); in adjusted pairwise comparisons, sclerostin was significantly higher in the controls than in NASH patients (p = 0.012). Although serum DKK-1 did not differ between groups (p = 0.135), there was a trend toward U-shaped distribution (controls 35.8 ± 2.8; SS 27.3 ± 2.9; NASH 36.8 ± 4.4 pmol/l). Higher DKK-1 levels were independently associated with NASH. Regarding specific histological lesions, DKK-1 levels were marginally lower in NAFLD patients with lower (≤33 %) than higher (>33 %) steatosis grade (27.7 ± 3.1 and 38.8 ± 4.7 pmol/l, respectively; p = 0.049). No other significant difference was observed within histological lesions. In conclusion, serum sclerostin levels were lower in NASH patients than in controls. DKK-1 levels were independently associated with NASH in NAFLD patients. The potential importance of these findings indicates a possible bone-liver interaction and warrants further investigation.
Collapse
Affiliation(s)
- Stergios A Polyzos
- Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, 13 Simou Lianidi, 551 34, Thessaloniki, Macedonia, Greece.
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | | | - Jannis Kountouras
- Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, 13 Simou Lianidi, 551 34, Thessaloniki, Macedonia, Greece
| | - Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
| | | | - Panagiotis Kokkoris
- Department of Medical Research, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
| | | | - Evangelos Terpos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece
| |
Collapse
|
39
|
Prakash J, Williams FMK, Trofimov S, Surdulescu G, Spector T, Livshits G. Quantitative genetics of circulating Dickkopf-related protein 1 (DKK1) in community-based sample of UK twins. Osteoporos Int 2016; 27:2065-75. [PMID: 26762129 DOI: 10.1007/s00198-016-3486-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/05/2016] [Indexed: 12/19/2022]
Abstract
UNLABELLED Dickkopf-related protein 1 (DKK1) is a major inhibitor of Wnt signalling pathway but also plays an important role in bone formation. Its circulating levels appear to correlate significantly with plasma levels of inflammatory factors, fractalkine and IL-6. This study, using a large sample of UK twins, showed that the variation of each of these factors and correlation between them was explained by the genetic factors, and indicated possible association with DKK1 gene variants. INTRODUCTION DKK1 is involved in the development of several inflammatory conditions related to bone and joint degradation. Our objectives were to explore the genetic contribution (heritability) to circulating DKK1 variation and its correlation with other inflammatory cytokines, interleukin 6 (IL-6) and fractalkine, and to test whether the DKK1 heritability could be attributable to single nucleotide polymorphisms (SNPs) mapped to DKK1, IL-6 and FRCT genes. METHODS The study included a large community-based sample of 4939 women drawn from the general UK population. Plasma samples were analysed for circulating levels of DKK1, IL-6 and fractalkine (FRCT); 65 SNPs of DKK1, IL-6 and FRCT candidate genes, with MAF >0.1, were examined. We applied variance component analysis to evaluate contribution of putative genetic (including above SNPs) and environmental factors to variation of DKK1, and its correlation with IL-6 and FRCT. RESULTS Putative genetic factors explained 42.2 ± 2 % of the total variation of circulating DKK1 levels, and were also significant for fractalkine and IL-6 variations. Most importantly, we report significant phenotypic (0.208 ± 0.006-0.459 ± 0.007) and genetic (0.338 ± 0.069-0.617 ± 0.033) correlations between these molecules. We found evidence suggestive of association between the DKK1 and its structural genes variants. CONCLUSIONS Circulating DKK1 levels correlated significantly with levels of IL-6 and FRCT, known risk factors for several inflammatory processes suggesting a potential role of DKK1 in inflammation and tissue injury. Our results suggest the contribution of genetic factors in inter-individual variation of DKK1 levels in human population. However, further studies are required to determine genetic polymorphisms affecting DKK1 variation and its correlation with IL-6 and FRCT.
Collapse
Affiliation(s)
- J Prakash
- Human Population Biology Research Unit, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - F M K Williams
- Department of Twin Research and Genetic Epidemiology, King's College London, Strand, London, UK
| | - S Trofimov
- Human Population Biology Research Unit, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - G Surdulescu
- Department of Twin Research and Genetic Epidemiology, King's College London, Strand, London, UK
| | - T Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, Strand, London, UK
| | - G Livshits
- Human Population Biology Research Unit, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel.
- Department of Twin Research and Genetic Epidemiology, King's College London, Strand, London, UK.
- Lilian and Marcel Pollak Chair of Biological Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
40
|
Hay E, Bouaziz W, Funck-Brentano T, Cohen-Solal M. Sclerostin and Bone Aging: A Mini-Review. Gerontology 2016; 62:618-623. [DOI: 10.1159/000446278] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/19/2016] [Indexed: 11/19/2022] Open
Abstract
Sclerostin, mainly produced by osteocytes, is now considered a major regulator of bone formation. Identified from patients with a low bone mass, sclerostin inhibits the Wnt pathway by binding to LRP5/6 and subsequently increases bone formation. Sclerostin may also play a role in the mediation of systemic and local factors such as calcitriol, PTH, glucocorticoids and tumor necrosis factor-alpha. Circulating sclerostin levels increase with age and with the decline of kidney function. However, they are surprisingly higher in patients with a high bone mineral density, suggesting that sclerostin may be a relevant marker of the pool of mature osteocytes. The anti-anabolic properties lead to the development of anti-sclerostin biotherapies that are under current evaluation. The results of these clinical trials will open new promising opportunities for the treatment of osteoporosis and bone fragility fractures.
Collapse
|
41
|
Sclerostin serum levels in patients with systemic autoimmune diseases. BONEKEY REPORTS 2016; 5:775. [PMID: 26909149 DOI: 10.1038/bonekey.2016.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/16/2015] [Indexed: 12/19/2022]
Abstract
Systemic autoimmune diseases (SADs) are associated with lower bone mass and an increased risk of fractures. Sclerostin has a pivotal role in bone metabolism. Available data on circulating sclerostin levels in healthy subjects are limited, whereas those in SAD patients are absent. Our objective was to determine circulating sclerostin concentrations in systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and Crohn's disease (CD) patients, and to analyze the factors associated with sclerostin concentrations. In this cross-sectional case-control study, serum sclerostin levels were measured in 38 SLE patients, 20 CD patients, 8 SSc patients and 20 healthy controls using a sclerostin ELISA. The mean values of the sclerostin (95% confidence interval) were 35.36 pmol l(-1) (12-101) in patients and 33.92 pmol l(-1) (2.31-100) in control subjects. The mean sclerostin value was 36.4 pmol l(-1) (22.1-48.5) in SLE patients, 26.7 pmol l(-1) (17.3-36.3) in CD patients and 51.8 pmol l(-1) (26.5-77.1) in SSc patients (P=0.001). Serum sclerostin levels were positively correlated with age (P<0.001), body mass index (BMI) (P=0.01) and lumbar spine Z-score (P=0.001) and negatively with creatinine clearance (P=0.001). Glucocorticoid treatment did not affect sclerostin levels. Sclerostin levels seem to have a heterogeneous pattern in different autoimmune diseases. SLE and SSc patients did not differ from healthy controls regarding sclerostin levels. The CD group had significantly lower values compared with SSc patients. Factors associated with sclerostin levels in autoimmune diseases seem to be the same than in the general population.
Collapse
|
42
|
Cheng Q, Tang W, Sheu TJ, Du Y, Gan J, Li H, Hong W, Zhu X, Xue S, Zhang X. Circulating TGF-β1 levels are negatively correlated with sclerostin levels in early postmenopausal women. Clin Chim Acta 2016; 455:87-92. [PMID: 26826396 DOI: 10.1016/j.cca.2016.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/10/2015] [Accepted: 01/25/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND TGF-β1 regulates bone metabolism and mediates bone turnover during postmenopause. Sclerostin negatively regulates Wnt signaling pathway and also has an important role in postmenopausal bone loss. Little is known about the relationship between serum TGF-β1 and sclerostin during menopause. METHODS We compared serum levels of TGF-β1 and sclerostin in pre- and postmenopausal women and assessed the potential correlations of these levels with each other and with serum levels of bone turnover markers and bone mineral density. RESULTS A total of 176 women (58 premenopausal, 62 early postmenopausal, and 56 late postmenopausal) were included in this study. Serum TGF-β1 level was significantly higher in early postmenopausal women compared with premenopausal (32.0±7.19 vs. 26.55±6.67 ng/ml, p=0.01) and late postmenopausal (32.0±7.19 vs. 28.65±7.70 pg/ml, p=0.031) women, and no significant differences in serum sclerostin levels were observed among the 3 groups. There was a significant negative correlation between TGF-β1 and sclerostin in early postmenopausal women, but not in other groups of women. Based on multiple regression analysis, only TGF-β1 (β=-0.362; p=0.007) was an independent predictor of sclerostin during early postmenopause. CONCLUSIONS Our findings suggest that serum TGF-β1 level increases during postmenopause and declines in old age. Sclerostin production is inhibited by TGF-β1 during early postmenopause.
Collapse
Affiliation(s)
- Qun Cheng
- Research Section of Geriatric Metabolic Bone Disease, Shanghai Geriatric Institute, Department of Osteoporosis and Bone Disease, Huadong Hospital affiliated to Fudan University, China; Research Center on Aging and Medicine, Fudan University, China.
| | - Wenjing Tang
- Research Section of Geriatric Metabolic Bone Disease, Shanghai Geriatric Institute, Department of Osteoporosis and Bone Disease, Huadong Hospital affiliated to Fudan University, China; Research Center on Aging and Medicine, Fudan University, China
| | | | - Yanping Du
- Research Section of Geriatric Metabolic Bone Disease, Shanghai Geriatric Institute, Department of Osteoporosis and Bone Disease, Huadong Hospital affiliated to Fudan University, China; Research Center on Aging and Medicine, Fudan University, China
| | - Jiemin Gan
- Research Center on Aging and Medicine, Fudan University, China; Central Laboratory, Huadong Hospital affiliated to Fudan University, China
| | - Huilin Li
- Research Section of Geriatric Metabolic Bone Disease, Shanghai Geriatric Institute, Department of Osteoporosis and Bone Disease, Huadong Hospital affiliated to Fudan University, China; Research Center on Aging and Medicine, Fudan University, China
| | - Wei Hong
- Research Section of Geriatric Metabolic Bone Disease, Shanghai Geriatric Institute, Department of Osteoporosis and Bone Disease, Huadong Hospital affiliated to Fudan University, China; Research Center on Aging and Medicine, Fudan University, China
| | - Xiaoying Zhu
- Research Section of Geriatric Metabolic Bone Disease, Shanghai Geriatric Institute, Department of Osteoporosis and Bone Disease, Huadong Hospital affiliated to Fudan University, China; Research Center on Aging and Medicine, Fudan University, China
| | - Sihong Xue
- Research Section of Geriatric Metabolic Bone Disease, Shanghai Geriatric Institute, Department of Osteoporosis and Bone Disease, Huadong Hospital affiliated to Fudan University, China; Research Center on Aging and Medicine, Fudan University, China
| | - Xuemei Zhang
- Research Section of Geriatric Metabolic Bone Disease, Shanghai Geriatric Institute, Department of Osteoporosis and Bone Disease, Huadong Hospital affiliated to Fudan University, China; Research Center on Aging and Medicine, Fudan University, China
| |
Collapse
|
43
|
Sato H, Kazama JJ, Murasawa A, Otani H, Abe A, Ito S, Ishikawa H, Nakazono K, Kuroda T, Nakano M, Narita I. Serum Fibroblast Growth Factor 23 (FGF23) in Patients with Rheumatoid Arthritis. Intern Med 2016; 55:121-6. [PMID: 26781009 DOI: 10.2169/internalmedicine.55.5507] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Rheumatoid arthritis (RA) is a chronic inflammatory disease accompanied by periarticular and systemic osteoporosis. Fibroblast growth factor 23 (FGF23), which is mainly produced by osteocytes, circulates to the kidneys and regulates bone metabolism. We herein assessed serum FGF23 and its relationship to inflammation and osteoporosis in patients with RA. Methods Sixty-one patients with RA were included. Serum concentrations of FGF23 were determined using a sandwich enzyme-linked immunosorbent assay. Results The mean (± standard deviation) serum FGF23 concentration was 34.9±9.2 (range, 21.0-61.0) pg/mL. The serum FGF23 level was significantly and positively correlated with the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, disease activity score-28 based on the ESR (DAS-28 ESR) and DAS-28 CRP (r=0.261, p=0.044, r=0.280, p=0.029, r=0.409, p=0.001 and r=0.421, p=0.001, respectively). The serum matrix metalloproteinase-3 level was also significantly and positively correlated with the serum FGF23 level (r=0.331, p=0.015). Concentrations of type I collagen cross-linked N-telopeptide in the serum was significantly correlated with the serum FGF23 level (r=0.272, p=0.034). Neither the bone mineral density in the femoral neck nor lumbar was significantly correlated with the serum FGF23 level. Serum phosphate, calcium, 25-hydroxy vitamin D, and intact parathyroid hormone were not related to the serum FGF23 level. Conclusion In patients with RA, serum FGF23 is correlated with inflammation, the disease activity of RA, and bone absorption markers. Serum FGF23 may be associated with abnormal bone absorption related to RA inflammation. Further studies are necessary to clarify the mechanism underlying this association.
Collapse
Affiliation(s)
- Hiroe Sato
- Department of Rheumatology, Niigata Rheumatic Center, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Morales-Santana S, Díez-Pérez A, Olmos JM, Nogués X, Sosa M, Díaz-Curiel M, Pérez-Castrillón JL, Pérez-Cano R, Torrijos A, Jodar E, Rio LD, Caeiro-Rey JR, Reyes-García R, García-Fontana B, González-Macías J, Muñoz-Torres M. Circulating sclerostin and estradiol levels are associated with inadequate response to bisphosphonates in postmenopausal women with osteoporosis. Maturitas 2015; 82:402-10. [PMID: 26358930 DOI: 10.1016/j.maturitas.2015.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 07/24/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The biological mechanisms associated with an inadequate response to treatment with bisphosphonates are not well known. This study investigates the association between circulating levels of sclerostin and estradiol with an inadequate clinical outcome to bisphosphonate therapy in women with postmenopausal osteoporosis. METHODS This case-control study is based on 120 Spanish women with postmenopausal osteoporosis being treated with oral bisphosphonates. Patients were classified as adequate responders (ARs, n=66, mean age 68.2±8 years) without incident fractures during 5 years of treatment, or inadequate responders (IRs, n=54, mean age 67±9 years), with incident fractures between 1 and 5 years of treatment. Bone mineral density (DXA), structural analysis of the proximal femur and structural/fractal analysis of the distal radius were assessed. Sclerostin concentrations were measured by ELISA and 17β-estradiol levels by radioimmunoassay based on ultrasensitive methods. RESULTS In the ARs group, sclerostin serum levels were significantly lower (p=0.02) and estradiol concentrations significantly higher (p=0.023) than in the IRs group. A logistic regression analysis was performed, including as independent variables in the original model femoral fracture load, 25 hydroxyvitamin D, previus history of fragility fracture, sclerostin and estradiol. Only previous history of fragility fracture (OR 14.04, 95% CI 2.38-82.79, p=0.004) and sclerostin levels (OR 1.11, 95% CI 1.02-1.20, p=0.011), both adjusted by estradiol levels remained associated with IRs. Also, sclerostin concentrations were associated with the index of resistance to compression (IRC) in the fractal analysis of the distal radius, a parameter on bone microstructure. CONCLUSIONS Sclerostin and estradiol levels are associated with the response to bisphosphonate therapy in women with postmenopausal osteoporosis.
Collapse
Affiliation(s)
- Sonia Morales-Santana
- Metabolic Bone Unit, Endocrinology Division (RETICEF), Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain; RETICEF, Instituto de Salud Carlos III, Spain; Proteomic Research Service, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | - Adolfo Díez-Pérez
- RETICEF, Instituto de Salud Carlos III, Spain; Hospital del Mar-IMIM-UAB, Department of Internal Medicine, Barcelona, Spain
| | - José M Olmos
- RETICEF, Instituto de Salud Carlos III, Spain; Hospital Universitario Marqués Valdecilla, Department of Internal Medicine, Santander, Spain
| | - Xavier Nogués
- RETICEF, Instituto de Salud Carlos III, Spain; Hospital del Mar-IMIM-UAB, Department of Internal Medicine, Barcelona, Spain
| | - Manuel Sosa
- Osteoporosis Research Group. Universidad de Las Palmas de Gran Canaria. Las Palmas de Gran Canaria, Spain
| | - Manuel Díaz-Curiel
- RETICEF, Instituto de Salud Carlos III, Spain; Fundación Jiménez Díaz, Department of Internal Medicine, Madrid, Spain
| | - José L Pérez-Castrillón
- RETICEF, Instituto de Salud Carlos III, Spain; Hospital Universitario Río Ortega, Department of Internal Medicine, Valladolid, Spain
| | - Ramón Pérez-Cano
- RETICEF, Instituto de Salud Carlos III, Spain; Hospital Virgen Macarena. Department of Internal Medicine, Sevilla, Spain
| | - Antonio Torrijos
- RETICEF, Instituto de Salud Carlos III, Spain; Hospital La Paz, Department of Rheumatology, Madrid, Spain
| | - Esteban Jodar
- RETICEF, Instituto de Salud Carlos III, Spain; Hospital Universitario Quirón, Department of Endocrinology, Madrid, Spain
| | - Luis Del Rio
- RETICEF, Instituto de Salud Carlos III, Spain; CETIR Medical Centre, Barcelona, Spain
| | - José R Caeiro-Rey
- RETICEF, Instituto de Salud Carlos III, Spain; Trabeculae, Ourense, Spain
| | - Rebeca Reyes-García
- Metabolic Bone Unit, Endocrinology Division (RETICEF), Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain; RETICEF, Instituto de Salud Carlos III, Spain
| | - Beatriz García-Fontana
- Metabolic Bone Unit, Endocrinology Division (RETICEF), Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain; RETICEF, Instituto de Salud Carlos III, Spain
| | - Jesús González-Macías
- RETICEF, Instituto de Salud Carlos III, Spain; Hospital Universitario Marqués Valdecilla, Department of Internal Medicine, Santander, Spain
| | - Manuel Muñoz-Torres
- Metabolic Bone Unit, Endocrinology Division (RETICEF), Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain; RETICEF, Instituto de Salud Carlos III, Spain.
| |
Collapse
|
45
|
Erlandson KM, O'Riordan M, Hileman CO, Rapaport E, Labbato D, Campbell TB, McComsey GA. Plasma Sclerostin in HIV-Infected Adults on Effective Antiretroviral Therapy. AIDS Res Hum Retroviruses 2015; 31:731-8. [PMID: 25919636 DOI: 10.1089/aid.2015.0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Sclerostin is linked to bone physiology and cardiovascular disease through the Wnt/β-catenin signaling pathway. The goal of this study was to determine if sclerostin is related to bone physiology and cardiovascular disease during antiretroviral treatment in HIV-infected persons. This was a cross-sectional analysis from study entry into the Stopping Atherosclerosis and Treating Unhealthy bone with RosuvastatiN in HIV (SATURN) trial, an ongoing randomized trial comparing rosuvastatin to placebo in HIV-infected adults on antiretroviral therapy. Plasma sclerostin was measured at study entry by ELISA from participants with available samples. Spearman correlation and multivariable linear regression were used to test relationships between sclerostin and bone density or bone turnover and cardiovascular disease. Among 139 HIV-infected participants (median age 46 years, CD4 lymphocyte count 614 cells/μl), the median plasma sclerostin level was 444.1 (IQR 330.3, 570.1) pg/ml. Correlations were detected between sclerostin and age (r=0.26), lumbar spine Z-score (r=0.31), RANKL (r=-0.21), carotid intima-media thickness (CIMT, r=0.19), and sVCAM-1 (r=0.27), p<0.05. No significant correlations were detected between sclerostin and current (r=0.006) or nadir CD4 count (r=0.11). While associations between sclerostin, lumbar spine Z-score, and sVCAM-1 were robust to covariate adjustment (p<0.01), association with CIMT was no longer significant (p=0.08). Our findings provide preliminary support for a relationship between sclerostin and bone mineral density in HIV-infected persons. The Wnt/β-catenin pathway should be investigated as a potential mechanism for loss of bone mineral density in treated HIV infection.
Collapse
|
46
|
Muschitz C, Kocijan R, Pahr D, Patsch JM, Amrein K, Misof BM, Kaider A, Resch H, Pietschmann P. Ibandronate increases sclerostin levels and bone strength in male patients with idiopathic osteoporosis. Calcif Tissue Int 2015; 96:477-89. [PMID: 25911186 DOI: 10.1007/s00223-015-0003-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/11/2015] [Indexed: 01/24/2023]
Abstract
The pathomechanism of male idiopathic osteoporosis (MIO) differs from postmenopausal osteoporosis with regard to alterations in osteoblast activity. We evaluated intravenous ibandronate (IBN) in 25 MIO patients with fragility fractures in a prospective, monocentric, single-arm, and open-label study for 24 months. The impact and changes of sclerostin (Scl), Dickkopf-1 (DKK-1), CTX, and PINP were examined. Additionally, volumetric cortical, trabecular and areal bone mineral density (BMD), trabecular bone score (TBS), and finite element analyses (FEA) were evaluated. Compared to baseline, median Scl levels were increased after 1 month (Δ 121%, p < 0.0001) and remained elevated for 12 months. DKK-1 decreased (p < 0.001) to a lesser extent until month 9 with values comparable to baseline at study endpoint. Early changes (baseline-month 1) of Scl negatively correlated with early changes of DKK-1 (-0.72), CTX (-0.82), and PINP (-0.55; p < 0.005 for all). The overall changes over the 24 months study period of Scl negatively correlated with decreased CTX (-0.32) and DKK-1 levels (-0.57, p < 0.0001 for both); CTX and PINP changes positively correlated at each time point (p < 0.001). Volumetric hip BMD increased by 12 and 18%, respectively (p < 0.0001 for both). Cross-sectional moment of inertia and section modulus for total hip significantly improved (p < 0.05 for all). Areal BMD at total hip, spine, and TBS increased. FEA displayed an increase in bone strength both in the hip (17%) and vertebrae (13%, all p < 0.0001) at anatomical sites susceptible for fragility fracture. IBN increases Scl and improves cortical and trabecular bone strength with early and ongoing vigorous suppression of bone resorption.
Collapse
Affiliation(s)
- Christian Muschitz
- Medical Department II, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria,
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Kim W, Chung Y, Kim SH, Park S, Bae JH, Kim G, Lee SJ, Kim JE, Park BW, Lim SK, Rhee Y. Increased sclerostin levels after further ablation of remnant estrogen by aromatase inhibitors. Endocrinol Metab (Seoul) 2015; 30:58-64. [PMID: 25827459 PMCID: PMC4384667 DOI: 10.3803/enm.2015.30.1.58] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/05/2014] [Accepted: 06/18/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sclerostin is a secreted Wnt inhibitor produced almost exclusively by osteocytes, which inhibits bone formation. Aromatase inhibitors (AIs), which reduce the conversion of steroids to estrogen, are used to treat endocrine-responsive breast cancer. As AIs lower estrogen levels, they increase bone turnover and lower bone mass. We analyzed changes in serum sclerostin levels in Korean women with breast cancer who were treated with an AI. METHODS We included postmenopausal women with endocrine-responsive breast cancer (n=90; mean age, 57.7 years) treated with an AI, and compared them to healthy premenopausal women (n=36; mean age, 28.0 years). The subjects were randomly assigned to take either 5 mg alendronate with 0.5 μg calcitriol (n=46), or placebo (n=44) for 6 months. RESULTS Postmenopausal women with breast cancer had significantly higher sclerostin levels compared to those in premenopausal women (27.8±13.6 pmol/L vs. 23.1±4.8 pmol/L, P<0.05). Baseline sclerostin levels positively correlated with either lumbar spine or total hip bone mineral density only in postmenopausal women (r=0.218 and r=0.233; P<0.05, respectively). Serum sclerostin levels increased by 39.9%±10.2% 6 months after AI use in postmenopausal women; however, no difference was observed between the alendronate and placebo groups (39.9%±10.2% vs. 55.9%±9.13%, P>0.05). CONCLUSION Serum sclerostin levels increased with absolute deficiency of residual estrogens in postmenopausal women with endocrine-responsive breast cancer who underwent AI therapy with concurrent bone loss.
Collapse
Affiliation(s)
- Wonjin Kim
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Se Hwa Kim
- Department of Internal Medicine, Kwandong University College of Medicine, Incheon, Korea
| | - Sehee Park
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hyun Bae
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Gyuri Kim
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Lee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jo Eun Kim
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong Woo Park
- Department of General Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kil Lim
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
48
|
Elam ML, Johnson SA, Hooshmand S, Feresin RG, Payton ME, Gu J, Arjmandi BH. A Calcium-Collagen Chelate Dietary Supplement Attenuates Bone Loss in Postmenopausal Women with Osteopenia: A Randomized Controlled Trial. J Med Food 2015; 18:324-31. [DOI: 10.1089/jmf.2014.0100] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Marcus L. Elam
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, Florida, USA
- The Center for Advancing Exercise and Nutrition Research on Aging, Florida State University, Tallahassee, Florida, USA
| | - Sarah A. Johnson
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, Florida, USA
- The Center for Advancing Exercise and Nutrition Research on Aging, Florida State University, Tallahassee, Florida, USA
| | - Shirin Hooshmand
- The Center for Advancing Exercise and Nutrition Research on Aging, Florida State University, Tallahassee, Florida, USA
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Rafaela G. Feresin
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, Florida, USA
- The Center for Advancing Exercise and Nutrition Research on Aging, Florida State University, Tallahassee, Florida, USA
| | - Mark E. Payton
- Department of Statistics, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Jennifer Gu
- AIDP, Inc., City of Industry, California, USA
| | - Bahram H. Arjmandi
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, Florida, USA
- The Center for Advancing Exercise and Nutrition Research on Aging, Florida State University, Tallahassee, Florida, USA
| |
Collapse
|
49
|
Asamiya Y, Yajima A, Shimizu S, Otsubo S, Tsuchiya K, Nitta K. Associations between the levels of sclerostin, phosphate, and fibroblast growth factor-23 and treatment with vitamin D in hemodialysis patients with low intact PTH level. Osteoporos Int 2015; 26:1017-28. [PMID: 25366373 DOI: 10.1007/s00198-014-2934-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 09/15/2014] [Indexed: 12/30/2022]
Abstract
UNLABELLED Serum sclerostin levels could be closely associated with serum phosphate and fibroblast growth factor-23 levels in hemodialysis patients with low intact parathyroid hormone (PTH) levels. Further study is required to indicate whether these close associations are present in patients with spontaneously low PTH levels without any vitamin D treatment. INTRODUCTION Intact parathyroid hormone (iPTH) is involved in the interaction between sclerostin and phosphate/fibroblast growth factor-23 (FGF23) in animal models. However, their relationship in patients on hemodialysis (HD) is unclear. METHODS Data of 102 HD patients were collected regarding clinical and laboratory parameters and mineral bone disorder medications. The patients were divided into subgroups according to the iPTH level (A, <70 pg/mL; B, 70-150 pg/mL; C, 150-300 pg/mL; and D, ≥ 300 pg/mL). RESULTS The sclerostin level was significantly and positively correlated with phosphate and log of FGF23 levels in subgroups A, B, and combined A and B. Multiple linear regression analysis in the combined A and B subgroup revealed that male sex (t = 3.24, P = 0.01; 95% confidence interval [CI] 11.78 to 50.43) and phosphate level (t = 2.13, P = 0.04; 95% CI, 1.08 to 36.91) were independent factors for serum sclerostin level. The log of serum FGF23 level (t = 1.90, P = 0.06, 95% CI -1.85 to 63.50) appeared to be an important factor for serum sclerostin level. The frequency of patients using vitamin D treatment was not significantly different among subgroups A (93.1%), B (88.0%), C (85.2%), and D (90.5%). CONCLUSION Serum sclerostin levels were associated with serum phosphate and FGF23 levels in patients with low iPTH levels. Further study is required to indicate whether these close associations are present in patients with spontaneously low iPTH levels without vitamin D treatment.
Collapse
Affiliation(s)
- Y Asamiya
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-chou, Shinjuku-ku, Tokyo, 162-8666, Japan,
| | | | | | | | | | | |
Collapse
|
50
|
Reppe S, Noer A, Grimholt RM, Halldórsson BV, Medina-Gomez C, Gautvik VT, Olstad OK, Berg JP, Datta H, Estrada K, Hofman A, Uitterlinden AG, Rivadeneira F, Lyle R, Collas P, Gautvik KM. Methylation of bone SOST, its mRNA, and serum sclerostin levels correlate strongly with fracture risk in postmenopausal women. J Bone Miner Res 2015; 30:249-56. [PMID: 25155887 DOI: 10.1002/jbmr.2342] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/27/2014] [Accepted: 08/12/2014] [Indexed: 12/31/2022]
Abstract
Inhibition of sclerostin, a glycoprotein secreted by osteocytes, offers a new therapeutic paradigm for treatment of osteoporosis (OP) through its critical role as Wnt/catenin signaling regulator. This study describes the epigenetic regulation of SOST expression in bone biopsies of postmenopausal women. We correlated serum sclerostin to bone mineral density (BMD), fractures, and bone remodeling parameters, and related these findings to epigenetic and genetic disease mechanisms. Serum sclerostin and bone remodeling biomarkers were measured in two postmenopausal groups: healthy (BMD T-score > -1) and established OP (BMD T-score < -2.5, with at least one low-energy fracture). Bone specimens were used to analyze SOST mRNAs, single nucleotide polymorphisms (SNPs), and DNA methylation changes. The SOST gene promoter region showed increased CpG methylation in OP patients (n = 4) compared to age and body mass index (BMI) balanced controls (n = 4) (80.5% versus 63.2%, p = 0.0001) with replication in independent cohorts (n = 27 and n = 36, respectively). Serum sclerostin and bone SOST mRNA expression correlated positively with age-adjusted and BMI-adjusted total hip BMD (r = 0.47 and r = 0.43, respectively; both p < 0.0005), and inversely to serum bone turnover markers. Five SNPs, one of which replicates in an independent population-based genomewide association study (GWAS), showed association with serum sclerostin or SOST mRNA levels under an additive model (p = 0.0016 to 0.0079). Genetic and epigenetic changes in SOST influence its bone mRNA expression and serum sclerostin levels in postmenopausal women. The observations suggest that increased SOST promoter methylation seen in OP is a compensatory counteracting mechanism, which lowers serum sclerostin concentrations and reduces inhibition of Wnt signaling in an attempt to promote bone formation.
Collapse
Affiliation(s)
- Sjur Reppe
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; Lovisenberg Diakonale Hospital, Oslo, Norway; Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|