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Jiang H, Robinson DL, Lee PVS, Krejany EO, Yates CJ, Hickey M, Wark JD. Loss of bone density and bone strength following premenopausal risk-reducing bilateral salpingo-oophorectomy: a prospective controlled study (WHAM Study). Osteoporos Int 2021; 32:101-112. [PMID: 32856124 DOI: 10.1007/s00198-020-05608-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
UNLABELLED Prophylactic oophorectomy is recommended for women at high risk for ovarian cancer, but the associated impact on bone health is of clinical concern. This prospective, controlled study demonstrated substantial loss of bone density and bone strength following surgical menopause. Postoperative hormone therapy alleviated, but not fully prevented, spinal bone loss. INTRODUCTION This prospective study investigated bone health in women following premenopausal oophorectomy. METHODS Dual-energy x-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT), and pQCT-based finite element analysis (pQCT-FEA) were used to assess bone health between systemic hormone therapy (HT) users and non-users after premenopausal risk-reducing bilateral salpingo-oophorectomy (RRBSO) compared with premenopausal controls over 24-month follow-up. RESULTS Mean age was 42.4 ± 2.6 years (n = 30) for the surgery group and 40.2 ± 6.3 years for controls (n = 42), and baseline bone measures were similar between groups. Compromised bone variables were observed at 24 months after RRBSO, among which areal bone mineral density (aBMD) at the lumbar spine, tibial volumetric cortical density (Crt vBMD), and tibial bending stiffness (kbend) had decreased by 4.7%, 1.0%, and 12.1%, respectively (all p < 0.01). In non-HT users, significant losses in lumbar spine (5.8%), total hip (5.2%), femoral neck (6.0%) aBMD, tibial Crt vBMD (2.3%), and kbend (14.8%) were observed at 24 months (all p < 0.01). HT prevented losses in kbend, tibial Crt vBMD, and aBMD, except for modest 2.3% loss at the lumbar spine (p = 0.01). CONCLUSION This prospective, controlled study of bone health following RRBSO or premenopausal oophorectomy demonstrated substantial loss of bone density and bone strength following RRBSO. HT prevented loss of bone density and bone stiffness, although there was still a modest decrease in lumbar spine aBMD in HT users. These findings may inform decision-making about RRBSO and clinical management following premenopausal oophorectomy.
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Affiliation(s)
- H Jiang
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, 3050, Australia
| | - D L Robinson
- Department of Biomedical Engineering, University of Melbourne, Parkville, Australia
| | - P V S Lee
- Department of Biomedical Engineering, University of Melbourne, Parkville, Australia
| | - E O Krejany
- Department of Obstetrics and Gynaecology, University of Melbourne and Royal Women's Hospital, Parkville, Australia
| | - C J Yates
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, 3050, Australia
- Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Australia
| | - M Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and Royal Women's Hospital, Parkville, Australia
| | - J D Wark
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, 3050, Australia.
- Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Australia.
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Australia.
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Segheto KJ, Pereira M, Silva DCGD, Carvalho CJD, Massardi FR, Kakehasi AM, Juvanhol LL, Longo GZ. Vitamin D and bone health in adults: a systematic review and meta-analysis. CIENCIA & SAUDE COLETIVA 2020; 26:3221-3244. [PMID: 34378711 DOI: 10.1590/1413-81232021268.15012020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/26/2020] [Indexed: 11/22/2022] Open
Abstract
Low bone health is associated with vitamin D deficiency in older individuals; however, this association is not well established in adults. The aim of the study was to analyze the association between serum concentrations of 25-hydroxyvitamin D and bone health in adults by systematic review and meta-analysis. The search was carried out in the LILACS, PubMed, Scopus, Web of Science, ScienceDirect databases from March 2017 to October 2018 with adult individuals (20-59 years). Bone health was evaluation performed through dual X-ray absorptiometry and serum concentrations of 25(OH)D. The random effect model was used to analyze data from bone mineral content and bone mineral. Random effects models were used and the sources of heterogeneity were explored by means of meta-regression. Thirty-five articles were selected. There was positive correlation between vitamin D and bone health in most of the evaluated sites. Correlation was observed in the analysis of subgroups for lumbar spine among men. When stratified, the studies presented high heterogeneity, which was explained by the sample size, mean serum vitamin D levels and risk of bias. Vitamin D is positively correlated to bone health in adult individuals.
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Affiliation(s)
- Kátia Josiany Segheto
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV). Ed. Centro de Ciências Biológicas II s/n, Campus Universitário. 36570-900 Viçosa MG Brasil.
| | - Marcos Pereira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | | | | | | | | | - Leidjaira Lopes Juvanhol
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV). Ed. Centro de Ciências Biológicas II s/n, Campus Universitário. 36570-900 Viçosa MG Brasil.
| | - Giana Zarbato Longo
- Departamento de Nutrição, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
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3
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LeBoff MS, Chou SH, Murata EM, Donlon CM, Cook NR, Mora S, Lee IM, Kotler G, Bubes V, Buring JE, Manson JE. Effects of Supplemental Vitamin D on Bone Health Outcomes in Women and Men in the VITamin D and OmegA-3 TriaL (VITAL). J Bone Miner Res 2020; 35:883-893. [PMID: 31923341 PMCID: PMC7217747 DOI: 10.1002/jbmr.3958] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/13/2019] [Accepted: 11/29/2019] [Indexed: 12/14/2022]
Abstract
Although supplemental vitamin D is used to promote bone health in the general population, data from randomized controlled trials (RCTs) have been inconsistent. We determined whether daily, vitamin D3 supplementation improves bone mineral density (BMD) and/or structure. VITamin D and OmegA-3 TriaL (VITAL) is a double-blind, placebo-controlled RCT of supplemental vitamin D3 (2000 IU/d) and/or omega-3 fatty acids (1 g/d) in 25,871 adults nationwide. This ancillary study included a subcohort of 771 participants (men ≥50 and women ≥55 years; not taking bone active medications) evaluated at baseline and at 2-year follow-up (89% retention). Total 25(OH)D levels were measured by liquid chromatography tandem mass spectrometry (Quest Diagnostics, San Juan Capistrano, CA, USA). Free 25(OH)D (FVD) levels were measured using the ELISA assay by Future Diagnostics Solutions BV (Wijchen, Netherlands). Primary endpoints were 2-year changes in areal (a) BMD at the spine, hip, and whole body determined by dual-energy X-ray absorptiometry (DXA). Secondary endpoints were 2-year changes in volumetric (v) BMD and cortical thickness at the radius and tibia assessed by peripheral quantitative computed tomography. Supplemental vitamin D3 versus placebo had no effect on 2-year changes in aBMD at the spine (0.33% versus 0.17%; p = 0.55), femoral neck (-0.27% versus -0.68%; p = 0.16), total hip (-0.76% versus -0.95%; p = 0.23), or whole body (-0.22% versus -0.15%; p = 0.60), or on measures of bone structure. Effects did not vary by sex, race/ethnicity, body mass index, or 25(OH)D levels. Among participants with baseline FVD levels below the median (<14.2 pmol/L), there was a slight increase in spine aBMD (0.75% versus 0%; p = 0.043) and attenuation in loss of total hip aBMD (-0.42% versus -0.98%; p = 0.044) with vitamin D3 . Whether baseline FVD levels help to identify those more likely to benefit from supplementation warrants further study. Supplemental vitamin D3 versus placebo for 2 years in general healthy adults not selected for vitamin D insufficiency did not improve BMD or structure. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
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Affiliation(s)
- Meryl S LeBoff
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital Boston, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sharon H Chou
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital Boston, Boston, MA, USA
| | - Elle M Murata
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital Boston, Boston, MA, USA
| | - Catherine M Donlon
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital Boston, Boston, MA, USA
| | - Nancy R Cook
- Harvard Medical School, Boston, MA, USA.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samia Mora
- Harvard Medical School, Boston, MA, USA.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - I-Min Lee
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gregory Kotler
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vadim Bubes
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie E Buring
- Harvard Medical School, Boston, MA, USA.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - JoAnn E Manson
- Harvard Medical School, Boston, MA, USA.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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4
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25-Hydroxyvitamin D, 1,25-Dihydroxyvitamin D, and Peripheral Bone Densitometry in Adults with Celiac Disease. Nutrients 2020. [PMID: 32230847 DOI: 10.3390/nu12040929.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Adults with celiac disease (CeD) show low bone mineral density (BMD) and high fracture risk. CeD guidelines suggest measurements of serum minerals and vitamin D. However, studies on vitamin levels in CeD patients are contradictory. Aim: To investigate in CeD, 25-hydroxy-vitamin D [25(OH)D], 1,25-dihydroxy-vitamin D [1,25(OH)2D], and related analytes and to evaluate their relationships to peripheral BMD as assessed by peripheral quantitative computed tomography (pQCT). Methods: Gluten-free diet (GFD)-treated, and untreated adult CeD patients naïve to vitamin D and calcium supplementation underwent measurements of serum 25(OH)D, 1,25(OH)2D, parathyroid hormone (PTH), total calcium, phosphate, and of radius BMD by pQCT. Results: Complete data were collected in 105 patients for lab tests and 87 patients for BMD. For lab tests, untreated CeD differed from treated CeD for 22.0% lower serum 25(OH)D (p = 0.023), 42.5% higher serum PTH (p < 0.001), and 13.0% higher serum 1,25(OH)2D (p = 0.029) in the presence of similar serum calcium and phosphorus (p > 0.35). For BMD, untreated CeD differed from treated CeD for lower diaphyseal cortical BMD (1133 and 1157 mg/cm3, p = 0.004) but not for distal BMD (total, trabecular, and subcortical, p > 0.13). Independent correlates of diaphyseal cortical BMD were GFD treatment and body mass index (p < 0.05). Conclusions: Data indicated that, compared to CeD patients on a gluten-free diet, untreated adult CeD patients at diagnosis had lower 25(OH)D, higher PTH, and higher 1,25(OH)2D in the absence of difference in serum calcium and phosphorus. 25(OH)D and 1,25(OH)2D, even below the normal range, were not associated with BMD. Our findings do not support the use of vitamin D supplementation for all CeD adults.
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Ciacci C, Bilancio G, Russo I, Iovino P, Cavallo P, Santonicola A, Bucci C, Cirillo M, Zingone F. 25-Hydroxyvitamin D, 1,25-Dihydroxyvitamin D, and Peripheral Bone Densitometry in Adults with Celiac Disease. Nutrients 2020; 12:nu12040929. [PMID: 32230847 PMCID: PMC7231255 DOI: 10.3390/nu12040929] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Adults with celiac disease (CeD) show low bone mineral density (BMD) and high fracture risk. CeD guidelines suggest measurements of serum minerals and vitamin D. However, studies on vitamin levels in CeD patients are contradictory. Aim: To investigate in CeD, 25-hydroxy-vitamin D [25(OH)D], 1,25-dihydroxy-vitamin D [1,25(OH)2D], and related analytes and to evaluate their relationships to peripheral BMD as assessed by peripheral quantitative computed tomography (pQCT). Methods: Gluten-free diet (GFD)-treated, and untreated adult CeD patients naïve to vitamin D and calcium supplementation underwent measurements of serum 25(OH)D, 1,25(OH)2D, parathyroid hormone (PTH), total calcium, phosphate, and of radius BMD by pQCT. Results: Complete data were collected in 105 patients for lab tests and 87 patients for BMD. For lab tests, untreated CeD differed from treated CeD for 22.0% lower serum 25(OH)D (p = 0.023), 42.5% higher serum PTH (p < 0.001), and 13.0% higher serum 1,25(OH)2D (p = 0.029) in the presence of similar serum calcium and phosphorus (p > 0.35). For BMD, untreated CeD differed from treated CeD for lower diaphyseal cortical BMD (1133 and 1157 mg/cm3, p = 0.004) but not for distal BMD (total, trabecular, and subcortical, p > 0.13). Independent correlates of diaphyseal cortical BMD were GFD treatment and body mass index (p < 0.05). Conclusions: Data indicated that, compared to CeD patients on a gluten-free diet, untreated adult CeD patients at diagnosis had lower 25(OH)D, higher PTH, and higher 1,25(OH)2D in the absence of difference in serum calcium and phosphorus. 25(OH)D and 1,25(OH)2D, even below the normal range, were not associated with BMD. Our findings do not support the use of vitamin D supplementation for all CeD adults.
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Affiliation(s)
- Carolina Ciacci
- Celiac Center at Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, 84126 Salerno, Italy; (I.R.); (P.I.); (A.S.); (C.B.)
- Correspondence: (C.C.); (F.Z.); Fax: +0039-089968807 (C.C.)
| | - Giancarlo Bilancio
- Nephrology Unit, AOU San Giovanni di Dio e Ruggi d’Aragona, 84126 Salerno, Italy;
| | - Ilaria Russo
- Celiac Center at Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, 84126 Salerno, Italy; (I.R.); (P.I.); (A.S.); (C.B.)
| | - Paola Iovino
- Celiac Center at Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, 84126 Salerno, Italy; (I.R.); (P.I.); (A.S.); (C.B.)
| | - Pierpaolo Cavallo
- Department of Physics, University of Salerno, 84126 Salerno, Italy;
- ISC-CNR, Istituto Sistemi Complessi del CNR, 00185 Rome, Italy
| | - Antonella Santonicola
- Celiac Center at Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, 84126 Salerno, Italy; (I.R.); (P.I.); (A.S.); (C.B.)
| | - Cristina Bucci
- Celiac Center at Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, 84126 Salerno, Italy; (I.R.); (P.I.); (A.S.); (C.B.)
| | - Massimo Cirillo
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy;
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy
- Correspondence: (C.C.); (F.Z.); Fax: +0039-089968807 (C.C.)
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6
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Ersoy B, Kizilay DÖ, Yilmaz SK, Taneli F, Gümüşer G. Bone mineral density, vitamin D status, and calcium intake in healthy female university students from different socioeconomic groups in Turkey. Arch Osteoporos 2018; 13:135. [PMID: 30515581 DOI: 10.1007/s11657-018-0482-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/31/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Peak bone mass is reached in late adolescence. Low peak bone mass is a well recognized risk factor for osteoporosis later in life. Our data do not support a link between vitamin D status, bone mineral density (BMD), and socioeconomic status (SES). However, there was a marked inadequacy of daily calcium intake and a high presence of osteopenia in females with low SES. PURPOSE Our aims were to (1) examine the effects of different SES on BMD, vitamin D status, and daily calcium intake and (2) investigate any association between vitamin D status and BMD in female university students. SUBJECTS AND METHODS A questionnaire was used to obtain information about SES, daily calcium intake, and physical activity in 138 healthy, female university students (age range 18-22 years). Subjects were stratified into lower, middle, and higher SES according to the educational and occupational levels of their parents. All serum samples were collected in spring for 25-hydroxyvitamin D concentration (25OHD). Lumbar spine and total body BMD was obtained by dual-energy X-ray absorptiometry (DXA) scan (Lunar DPX series). Osteopenia was defined as a BMD between - 1.0 and - 2.5 standard deviations (SDs) below the mean for healthy young adults on lumbar spine DXA. RESULTS No significant difference was found between the three socioeconomic groups in terms of serum 25OHD concentration, BMD levels, or BMD Z scores (p > 0.05). Both the daily intake of calcium was significantly lower (p = 0.02), and the frequency of osteopenia was significantly higher in girls with low SES (p = 0.02). There was no correlation between serum 25OHD concentration and calcium intake and BMD values and BMD Z scores (p > 0.05). The most important factor affecting BMD was weight (β = 0.38, p < 0.001). CONCLUSIONS Low SES may be associated with sub-optimal bone health and predispose to osteopenia in later life, even in female university students.
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Affiliation(s)
- Betül Ersoy
- Division of Pediatric Endocrinology and Metabolism, School of Medicine, Celal Bayar University, Manisa, Turkey.
| | - Deniz Özalp Kizilay
- Division of Pediatric Endocrinology and Metabolism, School of Medicine, Celal Bayar University, Manisa, Turkey
| | - Seniha Kiremitci Yilmaz
- Division of Pediatric Endocrinology and Metabolism, School of Medicine, Celal Bayar University, Manisa, Turkey
| | - Fatma Taneli
- Department of Clinical Biochemistry, School of Medicine, Celal Bayar University, Manisa, Turkey
| | - Gül Gümüşer
- Department of Nuclear Medicine, School of Medicine, Celal Bayar University, Manisa, Turkey
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Zingone F, Ciacci C. The value and significance of 25(OH) and 1,25(OH) vitamin D serum levels in adult coeliac patients: A review of the literature. Dig Liver Dis 2018; 50:757-760. [PMID: 29773507 DOI: 10.1016/j.dld.2018.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 12/11/2022]
Abstract
Within the wide spectrum of symptoms and alteration of systems that characterizes CeD, several studies indicate a low-level of vitamin D, therefore recent guidelines suggest its evaluation at the time of diagnosis. This review examines the data from existing studies in which vitamin D has been assessed in CeD patients. Our review indicates that most of the studies on vitamin D in adult CeD report a 25 (OH) vitamin D deficiency at diagnosis that disappears when the patient goes on a gluten-free diet, independently of any supplementation. Instead, when the calcitriol, the active 1,25 (OH) vitamin D form, was evaluated, it resulted in the normal range at the time of CeD diagnosis. A strict and lifelong gluten-free diet can help recover vitamin D level without any supplementation.
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Affiliation(s)
- Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Carolina Ciacci
- Celiac Center, AOU San Giovanni di Dio e Ruggi di Aragona, University of Salerno, Department of Medicine and Surgery, Salerno, Italy.
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