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Giustina A, di Filippo L, Allora A, Bikle DD, Cavestro GM, Feldman D, Latella G, Minisola S, Napoli N, Trasciatti S, Uygur M, Bilezikian JP. Vitamin D and malabsorptive gastrointestinal conditions: A bidirectional relationship? Rev Endocr Metab Disord 2023; 24:121-138. [PMID: 36813995 PMCID: PMC9946876 DOI: 10.1007/s11154-023-09792-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
This paper is one of the outcomes of the 5th International Conference "Controversies in Vitamin D" held in Stresa, Italy from 15 to 18 September 2021 as part of a series of annual meetings which was started in 2017. The scope of these meetings is to discuss controversial issues about vitamin D. Publication of the outcomes of the meeting in international journals allows a wide sharing of the most recent data with the medical and academic community. Vitamin D and malabsorptive gastrointestinal conditions was one of the topics discussed at the meeting and focus of this paper. Participants to the meeting were invited to review available literature on selected issues related to vitamin D and gastrointestinal system and to present their topic to all participants with the aim to initiate a discussion on the main outcomes of which are reported in this document. The presentations were focused on the possible bidirectional relationship between vitamin D and gastrointestinal malabsorptive conditions such as celiac disease, inflammatory bowel diseases (IBDs) and bariatric surgery. In fact, on one hand the impact of these conditions on vitamin D status was examined and on the other hand the possible role of hypovitaminosis D on pathophysiology and clinical course of these conditions was also evaluated. All examined malabsorptive conditions severely impair vitamin D status. Since vitamin D has known positive effects on bone this in turn may contribute to negative skeletal outcomes including reduced bone mineral density, and increased risk of fracture which may be mitigated by vitamin D supplementation. Due to the immune and metabolic extra-skeletal effects there is the possibility that low levels of vitamin D may negatively impact on the underlying gastrointestinal conditions worsening its clinical course or counteracting the effect of treatment. Therefore, vitamin D status assessment and supplementation should be routinely considered in all patients affected by these conditions. This concept is strengthened by the existence of a possible bidirectional relationship through which poor vitamin D status may negatively impact on clinical course of underlying disease. Sufficient elements are available to estimate the desired threshold vitamin D level above which a favourable impact on the skeleton in these conditions may be obtained. On the other hand, ad hoc controlled clinical trials are needed to better define this threshold for obtaining a positive effect of vitamin D supplementation on occurrence and clinical course of malabsorptive gastrointestinal diseases.
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Affiliation(s)
- Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
- Division of Endocrinology, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
| | - Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Agnese Allora
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniel D Bikle
- Veterans Affairs Medical Center, University of California San Francisco, 1700 Owens St, San Francisco, CA, 94158, USA
| | - Giulia Martina Cavestro
- Gastroenterology and Gastrointestinal Endoscopy Unit, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - David Feldman
- Stanford University School of Medicine, Stanford, CA, USA
| | - Giovanni Latella
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Salvatore Minisola
- Department of Clinical, Internal, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicola Napoli
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico Di Roma, Rome, Italy
| | | | - Melin Uygur
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Endocrinology and Metabolism Disease, RTE University School of Medicine, Rize, Turkey
| | - John P Bilezikian
- Department of Medicine, Vagelos College of Physicians and Surgeons, New York City, NY, USA
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Borba AC, Terra NL, Areosa SVC. RELATIONSHIP BETWEEN TBS SCORE, BONE DENSITY AND FRACTURES IN OLDER MEN: INTEGRATIVE REVIEW. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e253507. [PMID: 36092170 PMCID: PMC9425967 DOI: 10.1590/1413-785220223004e253507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/16/2021] [Indexed: 11/22/2022]
Abstract
Population ageing is an inexorable truth. This is the reason for an increase in the number of studies analyzing common pathologies, such as osteoporosis, in older people. Osteoporosis is a disease resulting from bone fragility, thus increasing the risk of fracture. Although the occurrence is predominant in women, studies analyzing the male population have raised interest among the scientific community. Nevertheless, there is no consensus regarding the best way to estimate the risk of fracture. Bone density testing and TBS (trabecular bone score) assessments are alternatives available for diagnosing. To assess the relationship between bone mineral density, the changes in TBS and fractures in older men. We conducted an integrative review of the literature in the LILACS, Scopus and PubMed databases, searching for studies in the last five years. We found 97 studies, and five of these matched our guiding question. We found five articles that matched our selecting criteria. All five presented the importance of using TBS for a better accuracy in improving the estimate of risk of fracture in older men. The association of TBS with bone density is important to best estimate the risk of fracture in elder men. Level of Evidence II, Diagnostic Studies.
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Affiliation(s)
- Alexandre Coutinho Borba
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto de Geriatria e Gerontologia, Porto Alegre, RS, Brasil
| | - Newton Luiz Terra
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto de Geriatria e Gerontologia, Porto Alegre, RS, Brasil
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Assessment of bone quality with trabecular bone score in patients with inflammatory bowel disease. Sci Rep 2021; 11:20345. [PMID: 34645875 PMCID: PMC8514496 DOI: 10.1038/s41598-021-99669-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/27/2021] [Indexed: 01/20/2023] Open
Abstract
Inflammatory bowel disease (IBD) patients have a significant risk of developing bone loss. The trabecular bone score (TBS) is a relatively new parameter used to provide information on bone quality. The study cohort included 81 patients with IBD and 81 healthy controls. Blood tests, dual-energy x-ray absorptiometry (DXA), including TBS, were assessed. Harvey–Bradshaw Index (HBI) for Crohn's disease (CD) and the Partial Mayo Score for ulcerative colitis (UC) were used for evaluation of clinical disease activity. Compared with the healthy controls, the IBD patients had lower lumbar spine (LS) bone mineral density (BMD) (1.06 ± 0.18 vs. 1.16 ± 0.15 g/cm2, p < 0.005), hip BMD (0.88 ± 0.13 vs. 0.97 ± 0.13 g/cm2, p < 0.005) and TBS (1.38 ± 0.1 vs. 1.43 ± 0.1, p < 0.005) values. The patients with stricturing CD had lower TBS (1.32 ± 0.13 vs. 1.40 ± 0.9, p = 0.03) and LS BMD (0.92 ± 0.19 vs. 1.07 ± 0.1, p = 0.01) values compared with those with non-stricturing CD. Multivariate regression model analysis identified HBI as independent factor associated with TBS. Our results support that all DXA parameters are lower in patients with IBD than in healthy patients. Moreover, TBS is a valuable tool for assessment of bone impairment in active CD.
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Levy-Shraga Y, Megnazi O, Modan-Moses D, Tripto-Shkolnik L, Gruber N, Haberman Y, Shouval DS, Weiss B. Trabecular Bone Score in Children and Adolescents With Inflammatory Bowel Diseases. J Clin Densitom 2021; 24:243-251. [PMID: 33189561 DOI: 10.1016/j.jocd.2020.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Trabecular bone score (TBS) is a textural index that evaluates bone microarchitecture of the lumbar spine. Our aim was to assess TBS in children with inflammatory bowel diseases and to evaluate correlations with clinical, laboratory and densitometric variables. METHODS A retrospective study of TBS and areal bone mineral density measurements by dual-energy X-ray absorptiometry (DXA) of children with either Crohn's disease (CD) or ulcerative colitis (UC). Bone mineral apparent density was calculated for size adjustment. TBS Z-score for each child were calculated based on data from a healthy population of similar age and gender distribution. Variables significantly associated with TBS were included in stepwise linear regression models to examine independent predictors of TBS. RESULTS Fifty patients (age at DXA scan 13.8 ± 3.0 years, 29 males) were included. No significant differences were observed between the patients with CD and UC, in age at diagnosis, age at DXA scan and disease duration. The mean TBS of patients with CD (n = 35) was lower than of patients with UC (n = 15): 1.340 ± 0.080 vs 1.395 ± 0.092, p = 0.040. The mean TBS Z-score of patients with CD, -0.443 ± 0.788, was significantly lower than expected in healthy children (p = 0.002), while the mean TBS Z-score of patients with UC, 0.231 ± 0.685, was similar to that of healthy children (p = 0.212). In the stepwise linear regression analysis, BMI Z-score at diagnosis, phosphorus level at diagnosis and age at the time of the DXA scan were significant independent predictors of TBS (r² = 0.604; β = 0.037, 95% confidence interval (CI) for β 0.022-0.051, p < 0.001; β = 0.045, 95% CI: 0.017-0.073, p = 0.002; and β = 0.031, 95% CI: 0.005-0.021, p < 0.002, respectively). CONCLUSIONS TBS is significantly reduced in pediatric patients with CD but not in patients with UC. This finding likely reflects the effect of CD on bone microarchitecture.
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Affiliation(s)
- Yael Levy-Shraga
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Ophir Megnazi
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dalit Modan-Moses
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Liana Tripto-Shkolnik
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Noah Gruber
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Haberman
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Pediatric Gastroenterology and Nutrition, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Dror S Shouval
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Pediatric Gastroenterology and Nutrition, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Batia Weiss
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Pediatric Gastroenterology and Nutrition, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
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Haschka J, Kraus DA, Behanova M, Huber S, Bartko J, Schanda JE, Meier P, Bahrami A, Zandieh S, Zwerina J, Kocijan R. Fractal-Based Analysis of Bone Microstructure in Crohn's Disease: A Pilot Study. J Clin Med 2020; 9:jcm9124116. [PMID: 33419268 PMCID: PMC7766043 DOI: 10.3390/jcm9124116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/07/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022] Open
Abstract
Crohn's disease (CD) is associated with bone loss and increased fracture risk. TX-Analyzer™ is a new fractal-based technique to evaluate bone microarchitecture based on conventional radiographs. The aim of the present study was to evaluate the TX-Analyzer™ of the thoracic and lumbar spine in CD patients and healthy controls (CO) and to correlate the parameters to standard imaging techniques. 39 CD patients and 39 age- and sex-matched CO were analyzed. Demographic parameters were comparable between CD and CO. Bone structure value (BSV), bone variance value (BVV) and bone entropy value (BEV) were measured at the vertebral bodies of T7 to L4 out of lateral radiographs. Bone mineral density (BMD) and trabecular bone score (TBS) by dual energy X-ray absorptiometry (DXA) were compared to TX parameters. BSV and BVV of the thoracic spine of CD were higher compared to controls, with no difference in BEV. Patients were further divided into subgroups according to the presence of a history of glucocorticoid treatment, disease duration > 15 years and bowel resection. BEV was significantly lower in CD patients with these prevalent risk factors, with no differences in BMD at all sites. Additionally, TBS was reduced in patients with a history of glucocorticoid treatment. Despite a not severely pronounced bone loss in this population, impaired bone quality in CD patients with well-known risk factors for systemic bone loss was assessed by TX-Analyzer™.
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Affiliation(s)
- Judith Haschka
- 1st Medical Department, Hanusch Hospital, 1140 Vienna, Austria; (J.H.); (D.A.K.); (S.H.); (J.B.); (J.Z.)
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of OEGK, AUVA Trauma Center Vienna-Meidling, 1140 Vienna, Austria;
| | - Daniel Arian Kraus
- 1st Medical Department, Hanusch Hospital, 1140 Vienna, Austria; (J.H.); (D.A.K.); (S.H.); (J.B.); (J.Z.)
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of OEGK, AUVA Trauma Center Vienna-Meidling, 1140 Vienna, Austria;
| | - Martina Behanova
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of OEGK, AUVA Trauma Center Vienna-Meidling, 1140 Vienna, Austria;
| | - Stephanie Huber
- 1st Medical Department, Hanusch Hospital, 1140 Vienna, Austria; (J.H.); (D.A.K.); (S.H.); (J.B.); (J.Z.)
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of OEGK, AUVA Trauma Center Vienna-Meidling, 1140 Vienna, Austria;
| | - Johann Bartko
- 1st Medical Department, Hanusch Hospital, 1140 Vienna, Austria; (J.H.); (D.A.K.); (S.H.); (J.B.); (J.Z.)
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of OEGK, AUVA Trauma Center Vienna-Meidling, 1140 Vienna, Austria;
| | - Jakob E. Schanda
- Department of Trauma Surgery, AUVA Trauma Center Vienna-Meidling, 1120 Vienna, Austria;
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria
| | | | - Arian Bahrami
- Department of Radiology and Nucelar Medicine, Hanusch Hospital Vienna, 1140 Vienna, Austria; (A.B.); (S.Z.)
| | - Shahin Zandieh
- Department of Radiology and Nucelar Medicine, Hanusch Hospital Vienna, 1140 Vienna, Austria; (A.B.); (S.Z.)
| | - Jochen Zwerina
- 1st Medical Department, Hanusch Hospital, 1140 Vienna, Austria; (J.H.); (D.A.K.); (S.H.); (J.B.); (J.Z.)
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of OEGK, AUVA Trauma Center Vienna-Meidling, 1140 Vienna, Austria;
| | - Roland Kocijan
- 1st Medical Department, Hanusch Hospital, 1140 Vienna, Austria; (J.H.); (D.A.K.); (S.H.); (J.B.); (J.Z.)
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of OEGK, AUVA Trauma Center Vienna-Meidling, 1140 Vienna, Austria;
- Medical Faculty of Bone Diseases, Sigmund Freud University, 1020 Vienna, Austria
- Correspondence: ; Tel.: +43-191-021-57368
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