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Fitzpatrick D, Laird E, Ward M, Hoey L, Hughes CF, Strain JJ, Cunningham C, Healy M, Molloy AM, McNulty H, Lannon R, McCarroll K. Secondary hyperparathyroidism: Predictors and relationship with vitamin D status, bone turnover markers and bone mineral density. Bone 2024; 184:117108. [PMID: 38642819 DOI: 10.1016/j.bone.2024.117108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Secondary hyperparathyroidism (SHPT) has adverse implications for bone health but is relatively understudied. In this study we examine the prevalence and determinants of SHPT and describe the relationship of SHPT with bone turnover markers and bone mineral density (BMD) in older Irish adults. METHOD Eligible participants (n = 4139) were identified from the Trinity-Ulster-Department of Agriculture (TUDA) study, a cohort of Irish adults aged ≥60 years. Exclusion criteria included an estimated glomerular filtration rate (eGFR) <30 ml/min and serum calcium >2.5 mmol/l to remove hyperparathyroidism due to advanced chronic kidney disease (CKD) and primary hyperparathyroidism respectively. The relationship between SHPT and bone turnover markers and BMD (measured by densitometry) was examined in a subsample (n = 1488). Vitamin D deficiency was defined as 25-hydroxyvitamin D [25 (OH)D] <30 nmol/l. RESULTS Participants had a mean age of 73.6 ± 7.9 years, 65.1 % were female and 19.4 % were found to be vitamin D deficient. The prevalence of SHPT decreased as vitamin D increased, from 30.6 % in those deficient to 9.8 % in those with 25(OH)D ≥ 50 nmol/l and increased with declining kidney function. In non‑calcium supplement users, principal determinants of SHPT were vitamin D deficiency (OR 4.18, CI 3.05-5.73, p < 0.001), eGFR 30-44 ml/min (OR 3.69, CI 2.44-5.57, p < 0.001), loop diuretic use (OR 3.52, CI 2.59-4.79, p < 0.001) and to a lesser extent body mass index (p = 0.001), eGFR 45-59 ml/min (p < 0.001) and 25(OH)D level 30-49 nmol/l (p = 0.002). Similar findings were observed in calcium supplement users, though proton pump inhibitors were also associated with SHPT (OR 1.55, CI 1.08-2.22, p = 0.018) while vitamin D 30-49 nmol/l was not. In participants with SHPT versus those without, bone turnover markers were higher: bone alkaline phosphatase (p = 0.017) and tartrate-resistant acid phosphatase (p = 0.033), whilst there was lower BMD at the neck of femur (0.880 vs. 0.903 g/cm2, p = 0.033) and total hip (0.968 vs. 0.995 g/cm2, P = 0.017). DISCUSSION The results show that up to one in six older Irish adults had SHPT and this was associated with lower BMD and higher concentrations of bone turnover markers. Both vitamin D deficiency and 25(OH)D level 30-49 nmol/l were important predictors of SHPT. Loop diuretics and PPIs may also increase the risk of SHPT, and their use may need to be carefully considered in this population. Further studies examining the potential impact of these factors on bone health in similar populations to our study sample are warranted.
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Affiliation(s)
- Donal Fitzpatrick
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland.
| | - Eamon Laird
- Department of Health & Nutritional Sciences, Atlantic Technological University Sligo, Ireland
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - J J Strain
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Conal Cunningham
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Martin Healy
- Department of Biochemistry, St James's Hospital, Dublin, Ireland
| | - Anne M Molloy
- School of Medicine, Trinity College, Dublin, Ireland
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Rosaleen Lannon
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - Kevin McCarroll
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
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Kanno A, Aizawa T, Mori Y, Aizawa T. Different types of hip fragility fractures have different values of 25-hydroxyvitamin D and parathyroid hormone. J Orthop Sci 2024; 29:256-261. [PMID: 36435724 DOI: 10.1016/j.jos.2022.11.003] [Citation(s) in RCA: 1] [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: 04/09/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vitamin D insufficiency/deficiency is related to fragility fracture. In most previous studies, there was no assessment of vitamin D deficiency status separately for hip fracture types. The first aim is to evaluate vitamin D and parathyroid hormone (PTH) status in patients with hip fracture. The second objective is to determine whether there are differences in vitamin D and PTH between the femoral neck fracture and the femoral metaphyseal fracture group. METHODS 62 men and 248 women with fragility hip fractures were enrolled. 25-hydroxyviamin D [25(OH)D] and intact PTH (iPTH) values were evaluated, and femoral neck bone mineral density (BMD) was measured on the uninjured side. Vertebral fractures (VFs) were assessed using radiographs of the thoracic and lumbar spine. We examined the relationships of 25(OH)D value with the number of prevalent VFs, T-score of femoral neck, and iPTH level. These analyses were also performed, neck fracture and trochanteric fracture separately. RESULTS Mean age was 85 years. The mean 25(OH)D was 11.2 (range, 4.0-26.1) ng/ml, whereas the mean iPTH value was 48.9 pg/ml (range, 9-429 pg/ml). The mean number of VFs was 1.5 (range, 0-11), and the mean T-score was -3.3 (range, -5.2 to -0.5). There was a weak correlation between the 25(OH)D value and the number of VFs. There was a weak but significant correlation between 25(OH)D and iPTH values. In the patients with trochanteric fractures, 25(OH)D value was significantly lower and iPTH value was significantly higher than those with neck fractures. There was a significant correlation between the 25(OH)D value and number of the VFs, 25(OH)D, and iPTH values only in trochanteric fractures. CONCLUSIONS Vitamin D deficiency was severe and PTH levels were higher in the trochanteric fractures. Both vitamin D deficiency and high PTH levels were suggested to have association with bone fragility.
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Affiliation(s)
- Atsuko Kanno
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Sendai South Hospital, Japan; Department of Orthopaedic Surgery, Iwaki City Medical Center, Japan.
| | - Toshitake Aizawa
- Department of Orthopaedic Surgery, Iwaki City Medical Center, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Japan
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Watts NB, Bilezikian JP, Bone HG, Clarke BL, Denham D, Levine MA, Mannstadt M, Peacock M, Rothman JG, Vokes TJ, Warren ML, Yin S, Sherry N, Shoback DM. Long-Term Safety and Efficacy of Recombinant Human Parathyroid Hormone (1-84) in Adults With Chronic Hypoparathyroidism. J Endocr Soc 2023; 7:bvad043. [PMID: 37091306 PMCID: PMC10119703 DOI: 10.1210/jendso/bvad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Indexed: 04/07/2023] Open
Abstract
Context Chronic hypoparathyroidism is conventionally treated with oral calcium and active vitamin D to reach and maintain targeted serum calcium and phosphorus levels, but some patients remain inadequately controlled. Objective To assess long-term safety and efficacy of recombinant human parathyroid hormone (1-84) (rhPTH(1-84)) treatment. Methods This was an open-label extension study at 12 US centers. Adults (n = 49) with chronic hypoparathyroidism were included. The intervention was rhPTH(1-84) for 6 years. The main outcome measures were safety, biochemical measures, oral supplement doses, bone indices. Results Thirty-eight patients (77.6%) completed the study. Throughout 72 months, mean albumin-adjusted serum calcium was within 2.00 to 2.25 mmol/L (8.0-9.0 mg/dL). At baseline, 65% of patients with measurements (n = 24/37) were hypercalciuric; of these, 54% (n = 13/24) were normocalciuric at month 72. Mean serum phosphorus declined from 1.6 ± 0.19 mmol/L at baseline (n = 49) to 1.3 ± 0.20 mmol/L at month 72 (n = 36). Mean estimated glomerular filtration rate was stable. rhPTH(1-84)-related adverse events were reported in 51.0% of patients (n = 25/49); all but 1 event were mild/moderate in severity. Mean oral calcium supplementation reduced by 45% ± 113.6% and calcitriol by 74% ± 39.3%. Bone turnover markers declined by month 32 to a plateau above pretreatment values; only aminoterminal propeptide of type 1 collagen remained outside the reference range. Mean bone mineral density z score fell at one-third radius and was stable at other sites. Conclusion 6 years of rhPTH(1-84) treatment was associated with sustained improvements in biochemical parameters, a reduction in the percentage of patients with hypercalciuria, stable renal function, and decreased supplement requirements. rhPTH(1-84) was well tolerated; no new safety signals were identified.
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Affiliation(s)
- Nelson B Watts
- Osteoporosis and Bone Health Services, Mercy Health, Cincinnati, OH 45236, USA
| | - John P Bilezikian
- Division of Endocrinology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Henry G Bone
- Michigan Bone and Mineral Clinic, PC, Detroit, MI 48236, USA
| | - Bart L Clarke
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
| | - Douglas Denham
- Clinical Trials of Texas, Inc., San Antonio, TX 78229, USA
| | - Michael A Levine
- Division of Endocrinology and Diabetes and Center for Bone Health, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Munro Peacock
- Department of Medicine, Division of Endocrinology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Tamara J Vokes
- Section of Endocrinology, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Mark L Warren
- Endocrinology and Metabolism, Physicians East, PA, Greenville, NC 27834, USA
| | - Shaoming Yin
- Takeda Pharmaceuticals USA, Inc., Lexington, MA 02421, USA
| | - Nicole Sherry
- Takeda Pharmaceuticals USA, Inc., Lexington, MA 02421, USA
| | - Dolores M Shoback
- Endocrine Research Unit, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
- Department of Medicine, University of California, San Francisco, CA 94143, USA
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Welsh H, Brickley MB. Pathology or expected morphology? Investigating patterns of cortical porosity and trabecularization during infancy and early childhood. Anat Rec (Hoboken) 2023; 306:354-365. [PMID: 36116138 DOI: 10.1002/ar.25081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/15/2022] [Accepted: 09/08/2022] [Indexed: 01/25/2023]
Abstract
Increased cortical porosity is associated with a heightened risk of skeletal fragility due to bone loss and structural decay in adults. However, few studies have examined the etiology of cortical porosity in infants and children. This study examines whether age-related changes in femoral growth and locomotor development influence femoral midshaft cortical porosity in a sample of 48 individuals (fetal to 3.99 years) from the 10th-13th century cemetery of St. Étienne de Toulouse, France. Histological sections were prepared and imaged using light microscopy. Midshaft geometric variables such as total area, cortical area, and pore area were calculated using BoneJ. Increased porosity and cortical trabecularization were found to be significantly associated with age, being almost exclusively present in individuals aged 0.5-1.99 years. At approximately 6 months of age infants typically begin engaging in regular femoral loading and experience an acceleration in growth. The observed increase in midshaft porosity and trabecularization, therefore, likely results from the reorganization and redistribution of cortical bone, stimulated by increased growth velocity and the onset of weight-bearing activities. The reduction in cortical porosity and trabecularization in individuals aged 2.0-3.99 years indicates that children are approaching some sort of homeostasis as growth velocity slows and their femora adapt to consistent loading. Understanding what expected skeletal development looks like is necessary when conducting bioarcheological studies and this study provides evidence for a pattern of transient midshaft porosity during infancy and early childhood.
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Affiliation(s)
- Hayley Welsh
- Department of Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - Megan B Brickley
- Department of Anthropology, McMaster University, Hamilton, Ontario, Canada
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Evaluation of factors related to the occurrence of new fragility fractures: A case-control study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:12-20. [PMID: 35973553 DOI: 10.1016/j.recot.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Fragility fractures (FF) are frequent in osteoporotic patients. There are a series of risk factors and clinical variables that could predict their appearance. MATERIAL AND METHOD A retrospective observational study of cases and controls was carried out. Cases were defined by the presence of FF (326 participants) and controls by patients with similar characteristics without FF (629 participants). RESULTS Certain factors increase the risk of FF, such as a previous diagnosis of type 2 DM (OR: 2.001), 1ng/mL elevations of CTX (OR: 1.88), having a parental history of hip fracture (OR: 1.667), 5-year increase in age (OR: 1.39), and 1kg/m2 increases in BMI (OR: 1.041). In contrast, other factors evaluated decreased this risk, such as maintaining 25(OH)D levels≥30ng/mL (OR: 0.686) and a T-score≥-2.5 (OR: 0.642). CONCLUSIONS Levels of 25(OH)D≥30ng/mL and a T-score at the femoral neck≥-2.5 are protective factors for FF, while a previous diagnosis of type 2 DM, an elevated CTX, a parental history of hip fracture, an increase of 1kg/m2 in BMI and an increase in age by 5 years would be predisposing to FF.
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Oteo-Álvaro Á, Marín Becerra MT, Fernández-Fernández T, Arrieta-Bartolomé G. [Translated article] Evaluation of factors related to the occurrence of new fragility fractures: A case-control study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T12-T20. [PMID: 36244607 DOI: 10.1016/j.recot.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Fragility fractures (FF) are frequent in osteoporotic patients. There are a series of risk factors and clinical variables that could predict their appearance. MATERIAL AND METHOD A retrospective observational study of cases and controls was carried out. Cases were defined by the presence of FF (326 participants) and controls by patients with similar characteristics without FF (629 participants). RESULTS Certain factors increase the risk of FF, such as a previous diagnosis of type 2 DM (OR: 2.001), 1ng/mL elevations of CTX (OR: 1.88), having a parental history of hip fracture (OR: 1.667), 5-year increase in age (OR: 1.39), and 1kg/m2 increases in BMI (OR: 1.041). In contrast, other factors evaluated decreased this risk, such as maintaining 25(OH)D levels≥30ng/mL (OR: 0.686) and a T-score≥-2.5 (OR: 0.642). CONCLUSIONS Levels of 25(OH)D≥30ng/mL and a T-score at the femoral neck≥-2.5 are protective factors for FF, while a previous diagnosis of type 2 DM, an elevated CTX, a parental history of hip fracture, an increase of 1kg/m2 in BMI and an increase in age by 5 years would be predisposing to FF.
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Affiliation(s)
- Á Oteo-Álvaro
- Hospital Universitario HM Madrid, HM Hospitales, Madrid, Spain.
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7
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Treyball A, Bergeron AC, Brooks DJ, Langlais AL, Hashmi H, Nagano K, Barlow D, Neilson RJ, Roy TA, Nevola KT, Houseknecht KL, Baron R, Bouxsein ML, Guntur AR, Motyl KJ. Propranolol Promotes Bone Formation and Limits Resorption Through Novel Mechanisms During Anabolic Parathyroid Hormone Treatment in Female C57BL/6J Mice. J Bone Miner Res 2022; 37:954-971. [PMID: 35122666 PMCID: PMC9098680 DOI: 10.1002/jbmr.4523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/15/2022] [Accepted: 01/30/2022] [Indexed: 11/09/2022]
Abstract
Although the nonselective β-blocker, propranolol, improves bone density with parathyroid hormone (PTH) treatment in mice, the mechanism of this effect is unclear. To address this, we used a combination of in vitro and in vivo approaches to address how propranolol influences bone remodeling in the context of PTH treatment. In female C57BL/6J mice, intermittent PTH and propranolol administration had complementary effects in the trabecular bone of the distal femur and fifth lumbar vertebra (L5 ), with combination treatment achieving microarchitectural parameters beyond that of PTH alone. Combined treatment improved the serum bone formation marker, procollagen type 1 N propeptide (P1NP), but did not impact other histomorphometric parameters relating to osteoblast function at the L5 . In vitro, propranolol amplified the acute, PTH-induced, intracellular calcium signal in osteoblast-like cells. The most striking finding, however, was suppression of PTH-induced bone resorption. Despite this, PTH-induced receptor activator of nuclear factor κ-B ligand (RANKL) mRNA and protein levels were unaltered by propranolol, which led us to hypothesize that propranolol could act directly on osteoclasts. Using in situ methods, we found Adrb2 expression in osteoclasts in vivo, suggesting β-blockers may directly impact osteoclasts. Consistent with this, we found propranolol directly suppresses osteoclast differentiation in vitro. Taken together, this work suggests a strong anti-osteoclastic effect of nonselective β-blockers in vivo, indicating that combining propranolol with PTH could be beneficial to patients with extremely low bone density. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Annika Treyball
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, USA
| | - Audrey C Bergeron
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, USA
| | - Daniel J Brooks
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Audrie L Langlais
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, USA.,Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, ME, USA
| | - Hina Hashmi
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, USA
| | - Kenichi Nagano
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Deborah Barlow
- Department of Biomedical Sciences, University of New England, Biddeford, ME, USA
| | - Ryan J Neilson
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, USA
| | - Tyler A Roy
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, USA
| | - Kathleen T Nevola
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, USA.,Tufts Graduate School of Biomedical Sciences, Tufts University, Boston, MA, USA
| | - Karen L Houseknecht
- Department of Biomedical Sciences, University of New England, Biddeford, ME, USA
| | - Roland Baron
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Anyonya R Guntur
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, USA.,Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, ME, USA.,Tufts University School of Medicine, Tufts University, Boston, MA, USA
| | - Katherine J Motyl
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, USA.,Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, ME, USA.,Tufts University School of Medicine, Tufts University, Boston, MA, USA
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Ruderman I, Rajapakse CS, Xu W, Tang S, Robertson PL, Toussaint ND. Changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism. Bone Rep 2021; 15:101120. [PMID: 34485631 PMCID: PMC8406147 DOI: 10.1016/j.bonr.2021.101120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background Secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) has a significant effect on bone, affecting both trabecular and cortical compartments. Although parathyroidectomy results in biochemical improvement in mineral metabolism, changes in bone microarchitecture as evaluated by high-resolution imaging modalities are not known. Magnetic resonance imaging (MRI) provides in-depth three-dimensional assessment of bone microarchitecture, as well as determination of mechanical bone strength determined by finite element analysis (FEA). Methods We conducted a single-centre longitudinal study to evaluate changes in bone microarchitecture with MRI in patients with SHPT undergoing parathyroidectomy. MRI was performed at the distal tibia at baseline (time of parathyroidectomy) and at least 12 months following surgery. Trabecular and cortical topological parameters as well as bone mechanical competence using FEA were assessed. Results Fifteen patients with CKD (12 male, 3 female) underwent both MRI scans at the time of surgery and at least 12 months post-surgery. At baseline, 13 patients were on dialysis, one had a functioning kidney transplant, and one was pre-dialysis with stage 5 CKD. Seven patients received a kidney transplant following parathyroidectomy prior to follow-up MRI. MRI parameters in patients at follow up were consistent with loss in trabecular and cortical bone thickness (p = 0.006 and 0.03 respectively). Patients who underwent a kidney transplant in the follow-up period had reduction in trabecular thickness (p = 0.05), whereas those who continued on dialysis had reduction in cortical thickness (p = 0.04) and mechanical bone strength on FEA (p = 0.03). Conclusion Patients with severe SHPT requiring parathyroidectomy have persistent changes in bone microarchitecture at least 12 months following surgery with evidence of ongoing decline in trabecular and cortical thickness.
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Affiliation(s)
- Irene Ruderman
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| | - Chamith S Rajapakse
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Winnie Xu
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Sisi Tang
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Patricia L Robertson
- Department of Radiology, The Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
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Sieklucka B, Pawlak D, Domaniewski T, Hermanowicz J, Lipowicz P, Doroszko M, Pawlak K. Serum PTH, PTH1R/ATF4 pathway, and the sRANKL/OPG system in bone as a new link between bone growth, cross-sectional geometry, and strength in young rats with experimental chronic kidney disease. Cytokine 2021; 148:155685. [PMID: 34411988 DOI: 10.1016/j.cyto.2021.155685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022]
Abstract
The progression of chronic kidney disease (CKD) in children is associated with deregulated parathyroid hormone (PTH), growth retardation, and low bone accrual. PTH can cause both catabolic and anabolic impact on bone, and the activating transcription factor 4 (ATF4), a downstream target gene of PTH, is related to its anabolic effect. Osteoprotegerin (OPG) and receptor activator of NF-κB ligand (RANKL) are PTH-dependent cytokines, which may play an important role in the regulation of bone remodeling. This study aimed to evaluate the impact of endogenous PTH and the bone RANKL/OPG system on bone growth, cross-sectional geometry and strength utilizing young, nephrectomized rats. The parameters of cross-sectional geometry were significantly elevated in rats with CKD during the three-month experimental period compared with the controls, and they were strongly associated with serum PTH levels and the expression of parathyroid hormone 1 receptor (PTH1R)/ATF4 genes in bone. Low bone soluble RANKL (sRANKL) levels and sRANKL/OPG ratios were also positively correlated with cross-sectional bone geometry and femoral length. Moreover, the analyzed geometric parameters were strongly related to the biomechanical properties of femoral diaphysis. In summary, the mild increase in endogenous PTH, its anabolic PTH1R/ATF4 axis and PTH-dependent alterations in the bone RANKL/OPG system may be one of the possible mechanisms responsible for the favorable impact on bone growth, cross-sectional geometry and strength in young rats with experimental CKD.
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Affiliation(s)
- Beata Sieklucka
- Department of Pharmacodynamics, Medical University of Bialystok, Mickiewicza 2C, 15-222 Bialystok, Poland
| | - Dariusz Pawlak
- Department of Pharmacodynamics, Medical University of Bialystok, Mickiewicza 2C, 15-222 Bialystok, Poland
| | - Tomasz Domaniewski
- Department of Monitored Pharmacotherapy, Medical University of Bialystok, Mickiewicza 2C, 15-222 Bialystok, Poland
| | - Justyna Hermanowicz
- Department of Pharmacodynamics, Medical University of Bialystok, Mickiewicza 2C, 15-222 Bialystok, Poland
| | - Paweł Lipowicz
- Institute of Biocybernetics and Biomedical Engineering, Bialystok University of Technology, Wiejska 45C, 15-351 Bialystok, Poland
| | - Michał Doroszko
- Department of Mechanics and Applied Computer Science, Bialystok University of Technology, Wiejska 45C, 15-351 Bialystok, Poland
| | - Krystyna Pawlak
- Department of Monitored Pharmacotherapy, Medical University of Bialystok, Mickiewicza 2C, 15-222 Bialystok, Poland.
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Kim K, Won YY, Lee SW, Seo KD. The Effect of Teriparatide on the Hip: A Literature Review. Hip Pelvis 2021; 33:45-52. [PMID: 34141690 PMCID: PMC8190496 DOI: 10.5371/hp.2021.33.2.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 12/04/2022] Open
Abstract
Teriparatide (TPTD) is a bone-forming agent used to treat postmenopausal osteoporosis. Since hip fractures are related to higher morbidity and mortality rates than other fractures, efficacious osteoporosis drugs for the hip are critical. We reviewed research articles reporting the efficacy of TPTD in terms of bone mineral density (BMD), fractures prevention, changes in the outer diameter, cortical thickness and porosity, post-operative periprosthetic BMD loss, and healing of typical and atypical fractures of the hip. Data meta-analyses indicated that TPTD not only increased the BMD of the proximal femur but also decreased the risk of hip fractures. Even though TPTD increases the cortical bone porosity of the proximal femur, the bone strength does not decrease as the majority of the porosity is located at the endocortex; further, it increases the outer diameter and thickens the cortical bone. TPTD stimulates bone remodeling and facilitates callus maturity and fracture healing. There have been many reports on improving the effect of TPTD on the healing of atypical fractures; therefore it is advisable to use TPTD considering the increase benefit compared to the risk.
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Affiliation(s)
- Kwangkyoun Kim
- Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Ye-Yeon Won
- Department of Orthopedic Surgery, Ajou University College of Medicine, Suwon, Korea
| | - Seok-Won Lee
- Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Kyung-Deok Seo
- Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea
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11
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Life course socioeconomic position and body composition in adulthood: a systematic review and narrative synthesis. Int J Obes (Lond) 2021; 45:2300-2315. [PMID: 34316000 PMCID: PMC8528709 DOI: 10.1038/s41366-021-00898-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 05/24/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Multiple systematic reviews have investigated the relation between socioeconomic position (SEP) and body mass index (BMI) throughout the life course. However, BMI does not capture quantity and distribution of fat and muscle, which are better indicators of obesity than BMI, and have been independently linked to adverse health outcomes. Less is known about the relation between SEP and body composition, and the literature has not been reviewed. We therefore systematically reviewed the literature on the association between life course SEP and body composition in adulthood. METHODS A protocol was registered on PROSPERO (CRD42019119937), and the review followed PRISMA guidelines. An electronic search of three databases (MEDLINE, Embase Classic + Embase and SPORTDiscus) was conducted. Original studies in the English language were included that examine the association between any recognised measure of SEP at any age and body composition (fat mass, fat-free mass, ratio and distribution) in adulthood, measured using a direct technique, i.e., not an anthropometric measure. A narrative synthesis was conducted. RESULTS A total of 47 papers were included in the final review, none were from low-income countries (LICs). Greater advantage in childhood and adulthood was associated with lower fat levels in high-income countries (HICs). Associations in the opposite direction were found exclusively in middle-income countries (MICs). No studies in MICs reported associations for childhood SEP. For measures of lean mass, the majority of papers reported no association, or greater advantage in adulthood associated with higher lean mass, with little variation between HICs and MICs. Associations in HICs are more often observed in women than men. CONCLUSION The results indicate that fat measures follow similar patterns to those seen for BMI, and that women in HICs are more likely to experience inequalities in both fat and lean measures. Further research in LICs and MICs is needed.
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12
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Mason RS, Rybchyn MS, Brennan-Speranza TC, Fraser DR. Is it reasonable to ignore vitamin D status for musculoskeletal health? Fac Rev 2020; 9:19. [PMID: 33659951 PMCID: PMC7886074 DOI: 10.12703/r/9-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Severe vitamin D deficiency—25-hydroxyvitamin D (25OHD) concentrations below around 25–30 nmol/L—may lead to growth plate disorganization and mineralization abnormalities in children (rickets) and mineralization defects throughout the skeleton (osteomalacia) and proximal muscle weakness. Both problems are reversed with vitamin D treatment. Apart from this musculoskeletal dysfunction at very low vitamin D levels, there is apparent inconsistency in the available data about whether concentrations of 25OHD below around 50 nmol/L cause muscle function impairment and increase the risk of fracture. This narrative review provides evidence to support the contention that improving vitamin D status, up to around 50 nmol/L, plays a small causal role in optimizing bone and muscle function as well as reducing overall mortality.
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Affiliation(s)
- Rebecca S Mason
- Physiology, Bosch Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Mark S Rybchyn
- Physiology, Bosch Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Tara C Brennan-Speranza
- Physiology, Bosch Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - David R Fraser
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, NSW 2006, Australia
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13
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Cellini M, Piccini S, Ferrante G, Carrone F, Olivetti R, Cicorella N, Aroldi M, Pini D, Centanni M, Lania AG, Mazziotti G. Secondary hyperparathyroidism and thoracic vertebral fractures in heart failure middle-aged patients: a 3-year prospective study. J Endocrinol Invest 2020; 43:1561-1569. [PMID: 32240522 DOI: 10.1007/s40618-020-01237-1] [Citation(s) in RCA: 4] [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: 01/03/2020] [Accepted: 03/23/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Vertebral fractures (VFs) were described in elderly patients with heart failure (HF) whereas their prevalence and determinants in younger HF patients are still unknown. This study aimed at assessing whether secondary hyperparathyroidism (SHPT) may influence the risk of VFs in middle-aged patients with HF. METHODS 84 patients (44 males, median age 48.5 years, range 43-65) with HF were prospectively evaluated at the baseline and after 36-month follow-up for bone mineral density (BMD) and VFs by quantitative morphometry on chest X-rays. Serum PTH, calcium, 25-hydroxyvitamin D and 24-h-urinary calcium were evaluated at the baseline and every 6-12 months during the study period. RESULTS At baseline, SHPT, hypovitaminosis D and VFs were found in 43 patients (51.2%), 73 patients (86.9%) and 29 patients (34.5%), respectively. SHPT was associated with VFs at baseline [inverse probability-weighted (ipw) odds ratio (OR) 12.2, p < 0.001]. Patients were treated with vitamin D3 alone (56%), vitamin D3 plus calcium carbonate (21.4%), calcitriol alone (4.8%), bisphosphonates plus vitamin D3 (8.3%) or a combination of bisphosphonates, vitamin D3 and calcium carbonate (9.5%). At the end of follow-up, hypovitaminosis D was corrected in all patients, whereas 19/84 patients (22.6%) had persistent SHPT. During the follow-up, 16 patients developed incident VFs which resulted to be associated with baseline SHPT (ipw OR 55.7, p < 0.001), even after adjusting from BMD change from baseline to follow-up (ipw OR 46.4, p < 0.001). CONCLUSIONS This study provides a first evidence that SHPT may be a risk factor for VFs in middle-aged patients with HF.
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Affiliation(s)
- M Cellini
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - S Piccini
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - G Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - F Carrone
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - R Olivetti
- Endocrinology Unit, ASST Carlo Poma, Mantova, Italy
| | - N Cicorella
- Cardiology Unit, ASST Carlo Poma, Mantova, Italy
| | - M Aroldi
- Cardiology Unit, ASST Carlo Poma, Mantova, Italy
| | - D Pini
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - M Centanni
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - A G Lania
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - G Mazziotti
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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14
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Moreira CA, Ferreira CEDS, Madeira M, Silva BCC, Maeda SS, Batista MC, Bandeira F, Borba VZC, Lazaretti-Castro M. Reference values of 25-hydroxyvitamin D revisited: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society of Clinical Pathology/Laboratory Medicine (SBPC). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:462-478. [PMID: 32813765 PMCID: PMC10522078 DOI: 10.20945/2359-3997000000258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 03/01/2020] [Indexed: 11/23/2022]
Abstract
Hypovitaminosis D is a common condition with a negative impact on health. This statement, prepared by experts from the Brazilian Society of Endocrinology and Metabolism and the Brazilian Society of Clinical Pathology/Laboratory Medicine, includes methodological aspects and limitations of the measurement of 25-hydroxyvitamin D [25(OH)D] for identification of vitamin D status, and identifies individuals at increased risk for deficiency of this vitamin in whom 25(OH)D measurement is recommended. For the general population, 25(OH)D levels between 20 and 60 ng/mL are considered normal, while individuals with levels below 20 ng/mL are considered to be vitamin D deficient. This statement identifies potential benefits of maintaining 25(OH)D levels > 30 ng/mL in specific conditions, including patients aged > 65 years or pregnant, those with recurrent falls, fragility fractures, osteoporosis, secondary hyperparathyroidism, chronic kidney disease, or cancer, and individuals using drugs with the potential to affect the vitamin D metabolism. This statement also calls attention to the risk of vitamin D intoxication, a life-threatening condition that occurs at 25(OH)D levels above 100 ng/mL.
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Affiliation(s)
- Carolina Aguiar Moreira
- Departamento de Metabolismo Ósseo, Sociedade Brasileira de Endocrinologia e Metabologia, Brasil
| | | | - Miguel Madeira
- Departamento de Metabolismo Ósseo, Sociedade Brasileira de Endocrinologia e Metabologia, Brasil
| | | | - Sergio Setsuo Maeda
- Departamento de Metabolismo Ósseo, Sociedade Brasileira de Endocrinologia e Metabologia, Brasil
| | | | - Francisco Bandeira
- Departamento de Metabolismo Ósseo, Sociedade Brasileira de Endocrinologia e Metabologia, Brasil
| | | | - Marise Lazaretti-Castro
- Departamento de Metabolismo Ósseo, Sociedade Brasileira de Endocrinologia e Metabologia, Brasil
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15
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Ruderman I, Rajapakse CS, Opperman A, Robertson PL, Masterson R, Tiong MK, Toussaint ND. Bone microarchitecture in patients undergoing parathyroidectomy for management of secondary hyperparathyroidism. Bone Rep 2020; 13:100297. [PMID: 32760761 PMCID: PMC7393533 DOI: 10.1016/j.bonr.2020.100297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background Secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) leads to complex bone disease, affecting both trabecular and cortical bone, and increased fracture risk. Optimal assessment of bone in patients with CKD is yet to be determined. High-resolution magnetic resonance imaging (MRI) can provide three-dimensional assessment of bone microarchitecture, as well as determination of mechanical strength with finite element analysis (FEA). Methods We conducted a single-centre, cross-sectional study to determine bone microarchitecture with MRI in CKD patients with SHPT undergoing parathyroidectomy. Within two weeks of surgery, MRI was performed at the distal tibia and biochemical markers of SHPT (parathyroid hormone [PTH] and alkaline phosphatase [ALP]) were collected. Trabecular and cortical topological parameters as well as bone mechanical competence using FEA were assessed. Correlation of MRI findings of bone was made with biochemical markers. Results Twenty patients with CKD (15 male, 5 female) underwent MRI at the time of parathyroidectomy (16 on dialysis, 3 with functioning kidney transplant, one pre-dialysis with CKD stage 5). Median PTH at the time of surgery was 138.5 pmol/L [39.6–186.7 pmol/L]. MRI parameters in patients were consistent with trabecular deterioration, with erosion index (EI) 1.01 ± 0.3, and trabecular bone volume (BV/TV) 10.8 ± 2.9%, as well as poor trabecular network integrity with surface-to-curve ratio (S/C) 5.4 ± 2.3. There was also evidence of reduced cortical thickness, with CTh 2.698 ± 0.630 mm, and FEA demonstrated overall poor bone mechanical strength with mean elastic modulus of 2.07 ± 0.44. Conclusion Patients with severe SHPT requiring parathyroidectomy have evidence of significant changes in bone microarchitecture with trabecular deterioration, low trabecular and cortical bone volume, and reduced mechanical competence of bone.
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Affiliation(s)
- Irene Ruderman
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| | - Chamith S Rajapakse
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Angelica Opperman
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Patricia L Robertson
- Department of Radiology, The Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
| | - Rosemary Masterson
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| | - Mark K Tiong
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
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16
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Pérez-López FR, Chedraui P, Pilz S. Vitamin D supplementation after the menopause. Ther Adv Endocrinol Metab 2020; 11:2042018820931291. [PMID: 32551035 PMCID: PMC7278294 DOI: 10.1177/2042018820931291] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022] Open
Abstract
The purpose of this review was to assess recent evidence regarding the effects of low vitamin D levels on some highly prevalent clinical conditions of postmenopausal women. We reviewed and selected recent literature regarding menopause-related conditions associated with vitamin D deficiency and interventions to manage them. Low circulating 25-hydroxyvitamin D (25(OH)D) levels related to menopause are linked to diet, lifestyle, changes in body composition, insulin sensitivity, and reduced physical activity. Vitamin D supplementation increases serum 25(OH)D levels while normalizing parathyroid hormone and bone markers, and in women with serum 25(OH)D levels below 10 ng/ml supplementation may improve bone mineral density. Low vitamin D status has been associated with the metabolic syndrome, high triglyceride levels, and low high-density lipoprotein cholesterol levels. When compared with placebo, vitamin D supplementation may lower the risk of the metabolic syndrome, hypertriglyceridemia, and hyperglycemia. There is an inverse relationship between fat mass and serum 25(OH)D levels and, therefore, the dosage of supplementation should be adjusted according to the body mass index. Although vitamin D supplementation may improve glucose metabolism in prediabetic subjects, data regarding muscle strength are conflictive. There is evidence that vitamin D over-treatment, to reach extremely high circulating 25(OH)D levels, does not result in better clinical outcomes. The identification and treatment of vitamin D deficiency in postmenopausal women may improve their general health and health outcomes. Vitamin D supplementation should preferably be based on the use of either cholecalciferol or calcifediol.
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Affiliation(s)
| | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador, and Facultad de Ciencias de la Salud, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
| | - Stefan Pilz
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
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17
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Gracia-Marco L, García-Fontana B, Ubago-Guisado E, Vlachopoulos D, García-Martín A, Muñoz-Torres M. Analysis of Bone Impairment by 3D DXA Hip Measures in Patients With Primary Hyperparathyroidism: A Pilot Study. J Clin Endocrinol Metab 2020; 105:5582038. [PMID: 31588503 DOI: 10.1210/clinem/dgz060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/07/2019] [Accepted: 09/27/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) has been related to bone loss. Dual-energy x-ray absorptiometry (DXA) cannot distinguish between trabecular and cortical bone compartments but the recently developed three-dimensional (3D)-DXA software might overcome this issue. OBJECTIVE To examine the differences in DXA-derived areal bone mineral density (aBMD) and 3D-DXA parameters at the hip site between patients with PHPT and a healthy control group. DESIGN Cross-sectional pilot study. SETTING Hospital. PATIENTS 80 adults (59.5 ± 9.1 yrs), 40 with PHPT and 40 age- and sex-matched healthy controls. MEASURES aBMD (g/cm2) of the femoral neck, trochanter, shaft, and total hip was assessed using DXA. Cortical surface (sBMD, mg/cm2), cortical volumetric BMD (vBMD, mg/cm3), trabecular vBMD (mg/cm3), integral vBMD (mg/cm3) and cortical thickness (mm) was assessed using 3D-DXA software. RESULTS Mean-adjusted values showed lower aBMD (7.5%-12.2%, effect size: 0.51-1.01) in the PHPT group compared with the control group (all P < 0.05). 3D-DXA revealed bone impairment (3.7%-8.5%, effect size: 0.47-0.65) in patients with PHPT, mainly in cortical parameters (all P < 0.05). However, differences in trabecular vBMD were not statistically significant (P = 0.055). The 3D mapping showed lower cortical sBMD, cortical vBMD, and cortical thickness at the trochanter and diaphysis in the PHPT group (P < 0.05) compared with the control group. In both groups, the presence of osteopenia or osteoporosis is related to lower cortical bone. CONCLUSIONS aBMD and cortical 3D parameters are impaired in patients with PHPT versus healthy controls. The vBMD of the trabecular compartment seems to be affected, although to a lesser extent.
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Affiliation(s)
- Luis Gracia-Marco
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Growth, Exercise, Nutrition and Development Research Group, Universidad de Zaragoza, Zaragoza, Spain
| | - Beatriz García-Fontana
- Bone Metabolic Unit, Endocrinology and Nutrition Division. Hospital Universitario San Cecilio. Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA). Granada, Spain
- CIBERFES, Instituto de Salud Carlos III. Madrid, Spain
| | - Esther Ubago-Guisado
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Dimitris Vlachopoulos
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Antonia García-Martín
- Bone Metabolic Unit, Endocrinology and Nutrition Division. Hospital Universitario San Cecilio. Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA). Granada, Spain
- CIBERFES, Instituto de Salud Carlos III. Madrid, Spain
| | - Manuel Muñoz-Torres
- Bone Metabolic Unit, Endocrinology and Nutrition Division. Hospital Universitario San Cecilio. Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA). Granada, Spain
- CIBERFES, Instituto de Salud Carlos III. Madrid, Spain
- Department of Medicine. Universidad de Granada, Granada, Spain
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18
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Ramalho J, Martins CSW, Galvão J, Furukawa LN, Domingues WV, Oliveira IB, Dos Reis LM, Pereira RM, Nickolas TL, Yin MT, Eira M, Jorgetti V, Moyses RM. Treatment of Human Immunodeficiency Virus Infection With Tenofovir Disoproxil Fumarate-Containing Antiretrovirals Maintains Low Bone Formation Rate, But Increases Osteoid Volume on Bone Histomorphometry. J Bone Miner Res 2019; 34:1574-1584. [PMID: 31269294 PMCID: PMC9428864 DOI: 10.1002/jbmr.3751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/03/2019] [Accepted: 04/14/2019] [Indexed: 02/02/2023]
Abstract
Bone mineral density (BMD) loss is a known complication of human immunodeficiency virus (HIV) infection and its treatment, particularly with tenofovir disoproxil fumarate (TDF)-containing antiretroviral regimens. Although renal proximal tubular dysfunction and phosphaturia is common with TDF, it is unknown whether BMD loss results from inadequate mineralization. We evaluated change in BMD by dual-energy X-ray absorptiometry (DXA) and bone histomorphometry by tetracycline double-labeled transiliac crest biopsies in young men living with HIV before (n = 20) and 12 months after (n = 16) initiating TDF/lamivudine/efavirenz. We examined relationships between calciotropic hormones, urinary phosphate excretion, pro-inflammatory and pro-resorptive cytokines, and bone remodeling-related proteins with changes in BMD and histomorphometry. Mean age was 29.6 ± 5.5 years, with mean CD4 + T cell count of 473 ± 196 cells/mm3 . At baseline, decreased bone formation rate and increased mineralization lag time were identified in 16 (80%) and 12 (60%) patients, respectively. After 12 months, we detected a 2% to 3% decrease in lumbar spine and hip BMD by DXA. By histomorphometry, we observed no change in bone volume/total volume (BV/TV) and trabecular parameters, but rather, increases in cortical thickness, osteoid volume, and osteoblast and osteoclast surfaces. We did not observe significant worsening of renal phosphate excretion or mineralization parameters. Increases in PTH correlated with decreased BMD but not histomorphometric parameters. Overall, these data suggest abnormalities in bone formation and mineralization occur with HIV infection and are evident at early stages. With TDF-containing antiretroviral therapy (ART), there is an increase in bone remodeling, reflected by increased osteoblast and osteoclast surfaces, but a persistence in mineralization defect, resulting in increased osteoid volume. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Janaina Ramalho
- Department of Nephrology, Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil
| | - Carolina Steller Wagner Martins
- Department of Nephrology, Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil
| | - Juliana Galvão
- Post-Graduation in Medicine Department, Universidade Nove de Julho, Sao Paulo, SP, Brazil
| | - Luzia N Furukawa
- Department of Nephrology, Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil
| | - Wagner V Domingues
- Department of Nephrology, Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil
| | - Ivone B Oliveira
- Department of Nephrology, Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil
| | - Luciene M Dos Reis
- Department of Nephrology, Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil
| | - Rosa Mr Pereira
- Bone Laboratory Metabolism, Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Thomas L Nickolas
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael T Yin
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Margareth Eira
- Ambulatory Division, Instituto de Infectologia Emílio Ribas, Sao Paulo, SP, Brazil.,Medicine Department, Universidade Cidade de São Paulo-UNICID, Sao Paulo, SP, Brazil
| | - Vanda Jorgetti
- Department of Nephrology, Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil.,Dialysis Division, Hospital Samaritano Americas Serviços Médicos, Sao Paulo, SP, Brazil
| | - Rosa Ma Moyses
- Department of Nephrology, Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil.,Post-Graduation in Medicine Department, Universidade Nove de Julho, Sao Paulo, SP, Brazil
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19
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Jiajue R, Jiang Y, Qi X, Wang Q, Wang W, Pei Y, Wang X, Huang W, Zheng X, Ning Z, Wang O, Li M, Xing X, Yu W, Xu L, Xia W. Calciotropic Hormones and the Prevalence of Vertebral Fractures in Chinese Postmenopausal Women with Vitamin D Insufficiency: Peking Vertebral Fracture Study. Calcif Tissue Int 2019; 104:622-630. [PMID: 30737534 DOI: 10.1007/s00223-019-00531-2] [Citation(s) in RCA: 5] [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: 12/02/2018] [Accepted: 01/28/2019] [Indexed: 01/27/2023]
Abstract
This case-control study aimed to examine the effect of high serum parathyroid hormone (PTH) level, especially the effect of secondary hyperparathyroidism (SHPT) related to hypovitaminosis D, on bone metabolism and bone phenotypes. We included a total of 830 Chinese postmenopausal women aged ≥ 50 years with serum 25-hydroxyvitamin D (25(OH)D) level < 30 ng/ml, among whom 415 women had prevalent vertebral fractures (VFs) and others were age-matched controls. We measured serum levels of 25(OH)D, PTH and bone turnover markers (BTMs), which included C-terminal telopeptide of type I collagen (β-CTX), N-aminoterminal prepeptide of type I procollagen (P1NP) and osteocalcin (OC). Bone mineral densities (BMDs) at lumbar spine and femoral neck were quantified by dual-energy X-ray absorptiometry. Morphometric VFs were validated by lateral radiograph of thoracolumbar spine. Compared to fracture-free controls, women with VFs exhibited a higher serum level of PTH and a higher percentage of SHPT (both p < 0.05), but had a similar serum level of 25(OH)D (p = 0.166). Positive correlations were depicted between PTH and BTMs (all p < 0.01), and between 25(OH)D and bone formation markers (p = 0.013 for OC, p = 0.068 for P1NP), whereas no significant correlation was identified between both calciotropic hormones and BMDs or between 25(OH)D and β-CTX (all p > 0.05). Increasing PTH was associated with an increased risk of VFs independent of 25(OH)D and BMD [odds ratio (OR) per SD increase in PTH 1.016, 95% confidence interval (95% CI) 1.006-1.027]. Moreover, women with SHPT (i.e., > 68 pg/ml) had about three times odds for VF compared to women with normal PTH levels (OR 3.270, 95% CI 1.581-6.760). These data suggest that evaluated serum PTH level might promote the bone remodeling and then lead to increased risks of VFs among Chinese postmenopausal women with vitamin D insufficiency.
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Affiliation(s)
- Ruizhi Jiajue
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Xuan Qi
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Qiuping Wang
- Department of Endocrinology, Beijing Liangxiang Hospital, Beijing, 102401, China
| | - Wenbo Wang
- Department of Endocrinology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Yu Pei
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiran Wang
- Department of Cadre Unit, General Hospital of the Rocket Force, Beijing, 100088, China
| | - Wei Huang
- Department of Endocrinology, Beijing Haidian Hospital, Beijing, 100080, China
| | - Xin Zheng
- Department of Endocrinology, China Rehabilitation Research Center, Beijing, 100068, China
| | - Zhiwei Ning
- Department of Endocrinology, Beijing Chaoyang Hospital, Beijing, 100020, China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Xiaoping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Ling Xu
- Department of Gynaecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Weibo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
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