1
|
Pepe J, Della Grotta G, Santori R, De Martino V, Occhiuto M, Cilli M, Minisola S, Cipriani C. Lumbar spine bone mineral density and trabecular bone score-adjusted FRAX, but not FRAX without bone mineral density, identify subclinical carotid atherosclerosis. J Endocrinol Invest 2021; 44:1989-1995. [PMID: 33576953 PMCID: PMC8357690 DOI: 10.1007/s40618-021-01517-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/20/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Osteoporosis and atherosclerosis share common risk factors. Aim of this study was to test if FRAX (which is an algorithm that can identify subjects at risk of fracture), without or with BMD values, also adjusted for trabecular bone score (TBS) was able to identify subclinical atherosclerosis, evaluated by measurement of carotid intima media thickness (cIMT ≥ 0.9 mm) as compared to DXA values. METHODS Ninety postmenopausal women underwent DXA measurement and cIMT evaluation. For each patient, the FRAX algorithm for major osteoporotic fracture (M) and for hip fracture (H) without BMD was computed, together with FRAX with BMD and TBS-adjusted FRAX. Serum levels of osteoprotegerin, sRANKL, and interleukin-6 were also measured. RESULTS There were no differences in anthropometric parameters and cardiovascular risk factors between subjects with cIMT ≥ 0.9 mm (35% of subjects, group A) compared to those with cIMT < 0.9 mm (group B). The prevalence of osteoporosis and FRAX BMD, TBS-adjusted FRAX both for M and H were higher in group A compared to group B. The best ROC curves to identify subjects with a cIMT ≥ 0.9 mm were: lumbar spine T-score, with a threshold of - 2.5 SD (area under the curve, AUC 0.64; p = 0.02) with a sensibility of 50% and a specificity of 76%; TBS-adjusted FRAX H with a sensibility of 50% and a specificity of 72% (AUC 0.64; p = 0.01 with a threshold of 3%). Interleukin-6 positively correlated with FRAX BMD H and M. CONCLUSIONS FRAX without BMD does not identify subclinical carotid atherosclerosis, while lumbar spine T-score and TBS-adjusted FRAX H similarly detected it with higher specificity for T-score.
Collapse
Affiliation(s)
- J Pepe
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, (SCIAC), "Sapienza" University of Rome, Rome, Italy.
| | - G Della Grotta
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, (SCIAC), "Sapienza" University of Rome, Rome, Italy
| | - R Santori
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, (SCIAC), "Sapienza" University of Rome, Rome, Italy
| | - V De Martino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, (SCIAC), "Sapienza" University of Rome, Rome, Italy
| | - M Occhiuto
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, (SCIAC), "Sapienza" University of Rome, Rome, Italy
| | - M Cilli
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, (SCIAC), "Sapienza" University of Rome, Rome, Italy
| | - S Minisola
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, (SCIAC), "Sapienza" University of Rome, Rome, Italy
| | - C Cipriani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, (SCIAC), "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
2
|
Minisola S, Colangelo L, Pepe J, Occhiuto M, Piazzolla V, Renella M, Biamonte F, Sonato C, Cilli M, Cipriani C. Vitamin D screening. J Endocrinol Invest 2020; 43:1047-1051. [PMID: 32189163 DOI: 10.1007/s40618-020-01220-w] [Citation(s) in RCA: 6] [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: 02/15/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023]
Abstract
At present, there is no need and no sufficient evidence to support universal screening for vitamin D status. There are four categories of subjects in whom there is no requirement for screening, since a number of studies indicate beneficial effects of vitamin D supplementation; these are represented by children and adolescents, pregnant women, patients taking bone active drugs and subjects with documented hypovitaminosis D. In the remaining subjects, the utilization of adequate questionnaires will target with sufficient sensitivity and specificity those with hypovitaminosis D. These must be first supplemented and, at a later time, serum 25(OH)D assay should be requested to confirm attainment of sufficiency, independently of the threshold chosen. This strategy will cut costs deriving from both widespread use of vitamin D assays and vitamin D supplementation.
Collapse
Affiliation(s)
- S Minisola
- Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza", Rome University, Viale del Policlinico 155, 00161, Rome, Italy.
| | - L Colangelo
- Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza", Rome University, Viale del Policlinico 155, 00161, Rome, Italy
| | - J Pepe
- Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza", Rome University, Viale del Policlinico 155, 00161, Rome, Italy
| | - M Occhiuto
- Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza", Rome University, Viale del Policlinico 155, 00161, Rome, Italy
| | - V Piazzolla
- Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza", Rome University, Viale del Policlinico 155, 00161, Rome, Italy
| | - M Renella
- Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza", Rome University, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Biamonte
- Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza", Rome University, Viale del Policlinico 155, 00161, Rome, Italy
| | - C Sonato
- Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza", Rome University, Viale del Policlinico 155, 00161, Rome, Italy
| | - M Cilli
- Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza", Rome University, Viale del Policlinico 155, 00161, Rome, Italy
| | - C Cipriani
- Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza", Rome University, Viale del Policlinico 155, 00161, Rome, Italy
| |
Collapse
|
3
|
Biondi P, Pepe J, Biamonte F, Occhiuto M, Parisi M, Demofonti C, Baffa V, Minisola S, Cipriani C. Oral calcidiol is a good form of vitamin D supplementation. ACTA ACUST UNITED AC 2017; 14:207-208. [PMID: 29263735 DOI: 10.11138/ccmbm/2017.14.1.207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vitamin D supplementation represents an important topic in the field of metabolic bone disease. Calcidiol, the 25-hydroxy-vitamin D [25(OH)D], is the form of vitamin D most recently introduced in clinical practice. Advantages of the use of calcidiol derive from the pharmacokinetic properties and are related to the possibility of use in patients with liver disease, obese patients, patients with intestinal malabsorption, secondary hyperparathyroidism associated with chronic kidney disease as well as to avoid any possible toxic effect when high doses are used. The ADDI-D study demonstrated the efficacy and safety of calcidiol at the daily dose of 20 or 40 μg and 125 μg/week. In particular, the daily dose of 40 μg can be suggested as an alternative in severely deficient patients, as it has demonstrated to ensure higher vitamin D levels, compared to the 20 μg/day and the weekly 125 μg dose. The last can be an option when issues with compliance to the supplementation are present.
Collapse
Affiliation(s)
- Piergianni Biondi
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University of Rome, Rome, Italy
| | - Jessica Pepe
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University of Rome, Rome, Italy
| | - Federica Biamonte
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University of Rome, Rome, Italy
| | - Marco Occhiuto
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University of Rome, Rome, Italy
| | - Martina Parisi
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University of Rome, Rome, Italy
| | - Chiara Demofonti
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University of Rome, Rome, Italy
| | - Valeria Baffa
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University of Rome, Rome, Italy
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University of Rome, Rome, Italy
| | - Cristiana Cipriani
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|