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Lundy B, Suni V, Drew M, Trease L, Burke LM. Nutrition factors associated with rib stress injury history in elite rowers. J Sci Med Sport 2022; 25:979-985. [DOI: 10.1016/j.jsams.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
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2
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Grzejszczak P, Kurnatowska I. Role of Vitamin K in CKD: Is Its Supplementation Advisable in CKD Patients? Kidney Blood Press Res 2021; 46:523-530. [PMID: 34247173 DOI: 10.1159/000516611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with CKD are at an increased risk of developing vascular calcification (VC) and bone complications which translate into a higher morbidity and mortality. The dephosphorylated and uncarboxylated matrix Gla protein (dp-ucMGP) is considered to be an indicator of vitamin K2 status and correlates with markers of VC. It is activated by γ-glutamyl carboxylase that converts inactive MGP into an active form, and vitamin K2 is a cofactor of this reaction. The active form of MGP is a known inhibitor of arterial wall calcification and plays an important role in bone turnover. Recent studies show poor vitamin K2 status in CKD patients. We aimed to review the literature for the association between vitamin K2 status and calcification and bone disease risk and the efficacy of vitamin K2 supplementation in CKD population. SUMMARY Most CKD patients, including those on renal replacement therapy, have vitamin K2 deficiency. The dp-ucMGP level, a marker of vitamin K2 status, is decreased by vitamin K2 supplementation in CKD patients, but there is no unequivocal proof that it influences arterial calcification progression and bone complications. Key Messages: CKD population are at risk of vitamin K deficiency. Supplementation of vitamin K2 is safe and improves the serum markers of its deficiency. There is lack of strong evidence that vitamin K2 supplementation slows progression of calcification or reduces the frequency of bone complications. More prospective studies are needed.
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Affiliation(s)
- Patrycja Grzejszczak
- Department of Internal Medicine and Nephrology Transplantation, 1st Chair of Internal Medicine, Medical University of Lodz, Lodz, Poland
| | - Ilona Kurnatowska
- Department of Internal Medicine and Nephrology Transplantation, 1st Chair of Internal Medicine, Medical University of Lodz, Lodz, Poland
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3
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Dipla K, Kraemer RR, Constantini NW, Hackney AC. Relative energy deficiency in sports (RED-S): elucidation of endocrine changes affecting the health of males and females. Hormones (Athens) 2021; 20:35-47. [PMID: 32557402 DOI: 10.1007/s42000-020-00214-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/20/2020] [Indexed: 12/26/2022]
Abstract
The purpose of this review is to present a different perspective of the relative energy deficiency syndrome, to improve understanding of associated endocrine alterations, and to highlight the need for further research in this area. The term "female athlete triad" was coined over 25 years ago to describe three interrelated components: disordered eating, menstrual dysfunction, and low bone mass. The syndrome's etiology is attributed to energy intake deficiency relative to energy expenditure required for health, function, and daily living. Recently, it became clear that there was a need to broaden the term, as the disorder is not an issue of only three interrelated problems but of a whole spectrum of insults resulting from low energy availability (LEA; i.e., insufficient energy availability to cover basic physiological demands) that can potentially affect any exerciser, irrespective of gender. The new model, termed relative energy deficiency in sport (RED-S), has received greater scrutiny in sports medicine due to its effects on both health and performance in athletes of both sexes. RED-S results from low-energy diets (intentional or unintentional) and/or excessive exercise. Energy deficiency reduces hypothalamic pulsatile release of gonadotropin-releasing hormone, this impairing anterior pituitary release of gonadotropins. In women, reduced FSH and LH pulsatility produces hypoestrogenism, causing functional hypothalamic amenorrhea and decreased bone mass. In men, it reduces testosterone and negatively affects bone health. Moreover, LEA alters other hormonal pathways, causing physiological consequences, such as alteration of the thyroid hormone signaling pathways, leptin levels, carbohydrate metabolism, the growth hormone/insulin-like growth factor-1 axis, and sympathetic/parasympathetic tone. This review explains and clarifies the effects of RED-S in both sexes.
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Affiliation(s)
- Konstantina Dipla
- Department of Sports Science, Exercise Physiology and Biochemistry Laboratory, Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert R Kraemer
- Department of Kinesiology and Health Studies, Exercise Physiology Laboratory, Southeastern Louisiana University, Hammond, LA, USA.
| | - Naama W Constantini
- Heidi Rotberg Sport Medicine Center, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anthony C Hackney
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, USA
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4
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Caluwé R, Verbeke F, De Vriese AS. Evaluation of vitamin K status and rationale for vitamin K supplementation in dialysis patients. Nephrol Dial Transplant 2020; 35:23-33. [PMID: 30590803 DOI: 10.1093/ndt/gfy373] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 11/09/2018] [Indexed: 01/07/2023] Open
Abstract
The cardinal biological role of vitamin K is to act as cofactor for the carboxylation of a number of vitamin K-dependent proteins, some of which are essential for coagulation, bone formation and prevention of vascular calcification. Functional vitamin K deficiency is common and severe among dialysis patients and has garnered attention as a modifiable risk factor in this population. However, no single biochemical parameter can adequately assess vitamin K status. For each biological function of vitamin K, the degree of carboxylation of the relevant vitamin K-dependent protein most accurately reflects vitamin K status. Dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) is the best biomarker for vascular vitamin K status when cardiovascular endpoints are studied. Dp-ucMGP levels are severely elevated in haemodialysis patients and correlate with markers of vascular calcification and mortality in some but not all studies. The aetiology of vitamin K deficiency in haemodialysis is multifactorial, including deficient intake, uraemic inhibition of the vitamin K cycle and possibly interference of vitamin K absorption by phosphate binders. The optimal vitamin K species, dose and duration of supplementation to correct vitamin K status in dialysis patients are unknown. Dp-ucMGP levels dose-proportionally decrease with supraphysiological vitamin K2 supplementation, but do not normalize even with the highest doses. In the general population, long-term vitamin K1 or K2 supplementation has beneficial effects on cardiovascular disease, bone density and fracture risk, and insulin resistance, although some studies reported negative results. In haemodialysis patients, several trials on the effects of vitamin K on surrogate markers of vascular calcification are currently ongoing.
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Affiliation(s)
- Rogier Caluwé
- Division of Nephrology, Department of Internal Medicine, OLVZ Aalst, Belgium
| | - Francis Verbeke
- Division of Nephrology, Department of Internal Medicine, University Hospital, Ghent, Belgium
| | - An S De Vriese
- Division of Nephrology and Infectious Diseases, Department of Internal Medicine, AZ Sint-Jan Brugge, Brugge, and Ghent University, Ghent, Belgium
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5
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Mott A, Bradley T, Wright K, Cockayne ES, Shearer MJ, Adamson J, Lanham-New SA, Torgerson DJ. Effect of vitamin K on bone mineral density and fractures in adults: an updated systematic review and meta-analysis of randomised controlled trials. Osteoporos Int 2019; 30:1543-1559. [PMID: 31076817 DOI: 10.1007/s00198-019-04949-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/19/2019] [Indexed: 11/24/2022]
Abstract
UNLABELLED Vitamin K may affect bone mineral density and fracture incidence. Since publication of a previous systematic review the integrity of some of the previous evidence has been questioned and further trials have been published. Therefore an update to the systematic review was required. INTRODUCTION This systematic review was designed to assess the effectiveness of oral vitamin K supplementation for increasing bone mineral density and reducing fractures in adults. METHODS MEDLINE, EMBASE, CENTRAL, CINAHL, clinicaltrials.gov, and WHO-ICTRP were searched for eligible trials. Randomised controlled trials assessing oral vitamin K supplementation that assessed bone mineral density or fractures in adult populations were included. A total of 36 studies were identified. Two independent reviewers extracted data using a piloted extraction form. RESULTS For post-menopausal or osteoporotic patients, meta-analysis showed that the odds of any clinical fracture were lower for vitamin K compared to controls (OR, 0.72, 95%CI 0.55 to 0.95). Restricting the analysis to low risk of bias trials reduced the OR to 0.76 (95%CI, 0.58 to 1.01). There was no difference in vertebral fractures between the groups (OR 0.96, 95%CI 0.83 to 1.11). In the bone mineral density meta-analysis, percentage change from baseline at the lumbar spine was higher at 1 year (MD 0.93, 95%, CI - 0.02 to 1.89) and 2 years (MD 1.63%, 95%CI 0.10 to 3.16) for vitamin K compared to controls; however, removing trials at high risk of bias tended to result in smaller differences that were not statistically significant. At 6 months, it was higher in the hip (MD 0.42%, 95%CI 0.01 to 0.83) and femur (MD 0.29%, 95%CI 0.17 to 0.42). There was no significant difference at other anatomical sites. CONCLUSIONS For post-menopausal or osteoporotic patients, there is no evidence that vitamin K affects bone mineral density or vertebral fractures; it may reduce clinical fractures; however, the evidence is insufficient to confirm this. There are too few trials to draw conclusions for other patient groups.
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Affiliation(s)
- A Mott
- York Trials Unit, Department of Health Sciences, University of York, ARRC Building, York, YO10 5DD, UK.
| | - T Bradley
- Chesterfield Hospital, Chesterfield Road, Calow, S44 5BL, UK
| | - K Wright
- Centre for Reviews & Dissemination, University of York, York, YO10 5DD, UK
| | - E S Cockayne
- York Trials Unit, Department of Health Sciences, University of York, ARRC Building, York, YO10 5DD, UK
| | - M J Shearer
- Centre for Haemostasis and Thrombosis, Guy's and St Thomas' NHS Trust, London, SE1 7EH, UK
| | - J Adamson
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - S A Lanham-New
- Nutritional Sciences Department, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - D J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, ARRC Building, York, YO10 5DD, UK
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Shishavan NG, Gargari BP, Jafarabadi MA, Kolahi S, Haggifar S, Noroozi S. Vitamin K 1 Supplementation Did Not Alter Inflammatory Markers and Clinical Status in Patients with Rheumatoid Arthritis. INT J VITAM NUTR RES 2019; 88:251-257. [PMID: 30786829 DOI: 10.1024/0300-9831/a000276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Rheumatoid arthritis (RA) is an inflammatory disorder in which the disease severity might be decreased by anti-inflammatory agents. There are several lines of evidence which support anti-inflammatory effects of vitamin K. The aim of this study was to examine whether vitamin K is a useful strategy for reducing inflammation in RA subjects. Materials and methods: In this double-blind placebo controlled trial, 58 patients with definitive RA were randomly allocated into two groups to receive vitamin K1 as phylloquinone [10 mg/day] or placebo pills for 8 weeks. Clinical status using disease activity score-28 (DAS-28) and serum concentrations of some inflammatory markers (IL-6, hs-CRP, TNFα) were assessed at baseline and at the end of intervention. Results: There were no significant differences between the two groups regarding any of the baseline characteristics. In the vitamin K1 group, a 27 % decrease in serum levels of IL-6 (P = 0.006) and a 13 % decrease in DAS-28 (P = 0.041) were observed. However, after adjusting for relevant confounders, i. e.; duration of RA, intake of folic acid supplements, energy intake, weight and baseline values of each variable, by comparing the two groups, we found no significant reduction in these markers. Conclusion: Vitamin K1 supplementation at 10 mg/day for 8 weeks had no significant effects on blood biomarkers of inflammation and disease severity of patients with rheumatoid arthritis compared with the placebo group.
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Affiliation(s)
- Neda Ghamarzad Shishavan
- 1 Department of Biochemistry and Diet Therapy, Student Research Committee, Nutrition Research Center, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bahram Pourghassem Gargari
- 2 Nutrition Research Center, Department of Biochemistry and Diet Therapy, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- 3 Department of Statistics and Epidemiology, Road Traffic Injury Prevention Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sousan Kolahi
- 4 Department of Rheumatology, Connective Tissue Diseases Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sepideh Haggifar
- 1 Department of Biochemistry and Diet Therapy, Student Research Committee, Nutrition Research Center, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soheila Noroozi
- 1 Department of Biochemistry and Diet Therapy, Student Research Committee, Nutrition Research Center, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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7
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Kim H, Wrann CD, Jedrychowski M, Vidoni S, Kitase Y, Nagano K, Zhou C, Chou J, Parkman VJA, Novick SJ, Strutzenberg TS, Pascal BD, Le PT, Brooks DJ, Roche AM, Gerber KK, Mattheis L, Chen W, Tu H, Bouxsein ML, Griffin PR, Baron R, Rosen CJ, Bonewald LF, Spiegelman BM. Irisin Mediates Effects on Bone and Fat via αV Integrin Receptors. Cell 2018; 175:1756-1768.e17. [PMID: 30550785 PMCID: PMC6298040 DOI: 10.1016/j.cell.2018.10.025] [Citation(s) in RCA: 350] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/27/2018] [Accepted: 10/07/2018] [Indexed: 01/08/2023]
Abstract
Irisin is secreted by muscle, increases with exercise, and mediates certain favorable effects of physical activity. In particular, irisin has been shown to have beneficial effects in adipose tissues, brain, and bone. However, the skeletal response to exercise is less clear, and the receptor for irisin has not been identified. Here we show that irisin binds to proteins of the αV class of integrins, and biophysical studies identify interacting surfaces between irisin and αV/β5 integrin. Chemical inhibition of the αV integrins blocks signaling and function by irisin in osteocytes and fat cells. Irisin increases both osteocytic survival and production of sclerostin, a local modulator of bone remodeling. Genetic ablation of FNDC5 (or irisin) completely blocks osteocytic osteolysis induced by ovariectomy, preventing bone loss and supporting an important role of irisin in skeletal remodeling. Identification of the irisin receptor should greatly facilitate our understanding of irisin's function in exercise and human health.
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Affiliation(s)
- Hyeonwoo Kim
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Department of Cell Biology, Harvard University Medical School, Boston, MA 02115, USA
| | - Christiane D Wrann
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Department of Cell Biology, Harvard University Medical School, Boston, MA 02115, USA; Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02219, USA; Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Mark Jedrychowski
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Department of Cell Biology, Harvard University Medical School, Boston, MA 02115, USA
| | - Sara Vidoni
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Department of Cell Biology, Harvard University Medical School, Boston, MA 02115, USA
| | - Yukiko Kitase
- Department of Anatomy and Cell Biology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Kenichi Nagano
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Chenhe Zhou
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Joshua Chou
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Virginia-Jeni A Parkman
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Scott J Novick
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL 33458, USA
| | - Timothy S Strutzenberg
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL 33458, USA
| | - Bruce D Pascal
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL 33458, USA
| | - Phuong T Le
- Maine Medical Center Research Institute, Scarborough, ME 04074, USA
| | - Daniel J Brooks
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Alexander M Roche
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Department of Cell Biology, Harvard University Medical School, Boston, MA 02115, USA
| | - Kaitlyn K Gerber
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Department of Cell Biology, Harvard University Medical School, Boston, MA 02115, USA
| | - Laura Mattheis
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Department of Cell Biology, Harvard University Medical School, Boston, MA 02115, USA
| | | | - Hua Tu
- LakePharma, Inc., San Carlos, CA 94070, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA 02215, USA
| | - Patrick R Griffin
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL 33458, USA
| | - Roland Baron
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Clifford J Rosen
- Maine Medical Center Research Institute, Scarborough, ME 04074, USA
| | - Lynda F Bonewald
- Department of Anatomy and Cell Biology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA; Department of Orthopedic Surgery, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Bruce M Spiegelman
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Department of Cell Biology, Harvard University Medical School, Boston, MA 02115, USA.
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8
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Pearson DA. Bone Health and Osteoporosis: The Role of Vitamin K and Potential Antagonism by Anticoagulants. Nutr Clin Pract 2017; 22:517-44. [PMID: 17906277 DOI: 10.1177/0115426507022005517] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Vitamin K's effects extend beyond blood clotting to include a role in bone metabolism and potential protection against osteoporosis. Vitamin K is required for the gamma-carboxylation of osteocalcin. Likewise, this gamma-carboxylation also occurs in the liver for several coagulation proteins. This mechanism is interrupted by coumarin-based anticoagulants in both the liver and bone. METHODS A thorough review of the literature on vitamin K, osteocalcin and their role in bone metabolism and osteoporosis, as well as the potential bone effects of anticoagulant therapy was conducted. CONCLUSIONS Epidemiological studies and clinical trials consistently indicate that vitamin K has a positive effect on bone mineral density and decreases fracture risk. Typical dietary intakes of vitamin K are below the levels associated with better BMD and reduced fracture risk; thus issues of increasing dietary intakes, supplementation, and/or fortification arise. To effectively address these issues, large-scale, intervention trials of vitamin K are needed. The effects of coumarin-based anticoagulants on bone health are more ambiguous, with retrospective studies suggesting that long-term therapy adversely affects vertebral BMD and fracture risk. Anticoagulants that do not affect vitamin K metabolism are now available and make clinical trials feasible to answer the question of whether coumarins adversely affect bone. The research suggests that at a minimum, clinicians should carefully assess anticoagulated patients for osteoporosis risk, monitor BMD, and refer them to dietitians for dietary and supplement advice on bone health. Further research is needed to make more efficacious decisions about vitamin K intake, anticoagulant therapy, and bone health.
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Affiliation(s)
- Debra A Pearson
- University of Wisconsin-Green Bay, Department of Human Biology, Nutritional Sciences, 2420 Nicolet Drive, Green Bay, WI 54311, USA.
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9
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Shishavan NG, Gargari BP, Kolahi S, Hajialilo M, Jafarabadi MA, Javadzadeh Y. Effects of Vitamin K on Matrix Metalloproteinase-3 and Rheumatoid Factor in Women with Rheumatoid Arthritis: A Randomized, Double-Blind, Placebo-Controlled Trial. J Am Coll Nutr 2015; 35:392-8. [DOI: 10.1080/07315724.2015.1026004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Kolahi S, Pourghassem Gargari B, Mesgari Abbasi M, Asghari Jafarabadi M, Ghamarzad Shishavan N. Effects of phylloquinone supplementation on lipid profile in women with rheumatoid arthritis: a double blind placebo controlled study. Nutr Res Pract 2015; 9:186-91. [PMID: 25861426 PMCID: PMC4388951 DOI: 10.4162/nrp.2015.9.2.186] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/02/2014] [Accepted: 06/03/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/OBJECTIVES Rheumatoid arthritis (RA) is associated with an excess mortality from cardiovascular disease which is likely attributed to an atherogenic lipid profile. Among nutritional factors vitamin K has been recently focused as a pivotal nutrient in improvement of lipid related markers. Thus, this study was designed to determine the effects of vitamin K on lipid profile in this disease. SUBJECTS/METHODS Fifty eight patients with definitive RA were participated in the present double blind placebo controlled study. They were randomly allocated into two groups to receive vitamin K1 as phylloquinone [10 mg/day] (n = 30) or placebo pills (n = 28), for eight weeks. In order to control the effects of probable confounders dietary intakes, anthropometric measurements including weight and height, clinical status using disease activity score-28 (DAS-28), physical activity and anxiety status were evaluated at baseline. Moreover, serum levels of lipid related markers including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were measured at baseline and at the end of intervention. RESULTS There were no significant differences between the two groups regarding any of the baseline characteristics. After adjusting for some relevant confounders, in comparison between two groups, we observed no significant changes in lipid related markers at the end of intervention. Also, there was no significant difference between before and after intervention values within groups (P > 0.05). CONCLUSIONS Function of vitamin K1 in lipid profile modification remains still controversial. This study showed that vitamin K1 has no effect on lipid profile in women with rheumatoid arthritis. Further studies with a longer follow-up are required to determine the effects of vitamin K on atherogenic lipid profile.
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Affiliation(s)
- Sousan Kolahi
- Connective Tissue Diseases Research Center, Rheumatology Section, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bahram Pourghassem Gargari
- Nutrition Research Center, Department of Biochemistry and Diet Therapy, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Ghamarzad Shishavan
- Department of Biochemistry and Diet Therapy, Student Research Committee, Nutrition Research Center, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz 5157974141, Iran
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The Prevalence of and Attitudes Toward Oligomenorrhea and Amenorrhea in Division I Female Athletes. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY & TRAINING 2014. [DOI: 10.1123/ijatt.2014-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Hamidi MS, Cheung AM. Vitamin K and musculoskeletal health in postmenopausal women. Mol Nutr Food Res 2014; 58:1647-57. [DOI: 10.1002/mnfr.201300950] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/23/2014] [Accepted: 05/01/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Maryam S. Hamidi
- Osteoporosis and Women's Health Programs; University Health Network; Toronto Ontario Canada
| | - Angela M. Cheung
- Osteoporosis and Women's Health Programs; University Health Network; Toronto Ontario Canada
- Faculty of Medicine; University of Toronto; Toronto Ontario Canada
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13
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de Paiva Luciano A, Filho NF, Adami F, de Abreu LC. Segmental Stress Fracture of Tibia in Recreational Running: A Case Report. Rev Bras Ortop 2013; 48:574-577. [PMID: 31304171 PMCID: PMC6565969 DOI: 10.1016/j.rboe.2013.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/19/2012] [Indexed: 11/21/2022] Open
Abstract
One of the first steps to be taken in order to reduce lesions in sports, such as stress fractures, is to know the nature and extension of this pathology. What follows is a case report of segmental stress fracture of the tibia in recreational athletes, which is considered somewhat rare in the literature. Case report: a 40-year-old female patient who started to have follow-up medical checks due to unusual pain in her right leg, concentrated mainly on the proximal region of the knee and ankle, after a 10-km run for a period of one month. Segmental stress fracture of the tibia was diagnosed after clinical research and further examinations.
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Affiliation(s)
- Alexandre de Paiva Luciano
- Department of Medicine, University of Taubaté, Taubaté, SP, Brazil.,Study Group on Sports Arthroscopy and Traumatology, University Hospital of Taubaté, Taubaté, SP, Brazil
| | - Nelson Franco Filho
- Orthopedics and Traumatology Service, University Hospital of Taubaté, Taubaté, SP, Brazil
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14
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Fratura por estresse segmentária na tíbia em corredora recreacional. Rev Bras Ortop 2013. [DOI: 10.1016/j.rbo.2012.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Mays S. The Effects of Infant Feeding Practices on Infant and Maternal Health in a Medieval Community. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/cip.2010.3.1.63] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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16
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Chen YT, Tenforde AS, Fredericson M. Update on stress fractures in female athletes: epidemiology, treatment, and prevention. Curr Rev Musculoskelet Med 2013; 6:173-81. [PMID: 23536179 PMCID: PMC3702771 DOI: 10.1007/s12178-013-9167-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Stress fractures are a common type of overuse injury in athletes. Females have unique risk factors such as the female athlete triad that contribute to stress fracture injuries. We review the current literature on risk factors for stress fractures, including the role of sports participation and nutrition factors. Discussion of the management of stress fractures is focused on radiographic criteria and anatomic location and how these contribute to return to play guidelines. We outline the current recommendations for evaluating and treatment of female athlete triad. Technologies that may aid in recovery from a stress fracture including use of anti-gravity treadmills are discussed. Prevention strategies may include early screening of female athlete triad, promoting early participation in activities that improve bone health, nutritional strategies, gait modification, and orthotics.
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Affiliation(s)
- Yin-Ting Chen
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University, 450 Broadway Street, Pavilion A, 2nd Floor MC 6120, Redwood City, CA 94063 USA
| | - Adam S. Tenforde
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University, 450 Broadway Street, Pavilion A, 2nd Floor MC 6120, Redwood City, CA 94063 USA
| | - Michael Fredericson
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University, 450 Broadway Street, Pavilion A, 2nd Floor MC 6120, Redwood City, CA 94063 USA
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Abstract
The passage of Title IX in 1972 resulted in a tremendous increase in the number of females participating in high school and collegiate athletics. This rise in female athletes sparked new focus areas of research in sports medicine related to woman with an important area emerging in 1980, the female athlete triad. This triad consisting of low energy availability, menstrual irregularities, and bone health disruption spans a spectrum of severity and has evolved both in diagnosis and in management throughout the years. Many health questions arise for female athletes and their health care providers, often concerning the most effective management and treatment strategies for this triad. This review examines the research and latest advancements in recognizing and understanding the female athlete triad and explores the most current recommendations for treatment and prevention.
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Metz LN, Wustrack R, Lovell AF, Sawyer AJ. Infectious, inflammatory, and metabolic diseases affecting the athlete's spine. Clin Sports Med 2012; 31:535-67. [PMID: 22658001 DOI: 10.1016/j.csm.2012.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sports and weight-bearing activities can have a positive effect on bone health in the growing, mature, or aging athlete. However, certain athletic activities and training regimens may place the athlete at increased risk for stress fractures in the spine. In addition, some athletes have an underlying susceptibility to fracture due to either systemic or focal abnormalities. It is important to identify and treat these athletes in order to prevent stress fractures and reduce the risk of osteoporosis in late adulthood. Therefore, the pre-participation physical examination offers a unique opportunity to screen athletes for metabolic bone disease through the history and physical examination. Positive findings warrant a thorough workup including a metabolic bone laboratory panel, and possibly a DEXA scan, which includes a lateral spine view.
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Affiliation(s)
- Lionel N Metz
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA 94143-0728, USA
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19
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Swift SN, Baek K, Swift JM, Bloomfield SA. Restriction of dietary energy intake has a greater impact on bone integrity than does restriction of calcium in exercising female rats. J Nutr 2012; 142:1038-45. [PMID: 22513985 DOI: 10.3945/jn.111.153361] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We sought to elucidate the effects of restricting calcium, energy, or food on the skeletal integrity of exercising female rats. Female Sprague-Dawley rats (4 mo old) were randomly assigned to 5 groups (n = 10/group): ad libitum intake of an AIN-93M diet (Research Diets D10012M, Research Diets, Inc.) with no exercise (AL-S) or with exercise (AL-EX) or to 1 of 3 exercising restriction groups [40% restriction of calcium only (CAR-EX), energy only (ER-EX), or food (FR-EX)]. All EX rats were treadmill trained 3 d/wk, 45 min/d for 12 wk at ~60% maximal oxygen consumption. After 12 wk, total body bone mineral content (by DXA) and body mass, but not lean mass, were lower in ER-EX (-17%) and FR-EX rats (-13%) compared with the AL-EX group. CAR-EX had few negative effects on bone geometry (by peripheral quantitative computed tomography) or histomorphometry. However, declines in total volumetric bone mineral density at the proximal tibia metaphysic (PTM) were observed in ER-EX (-6%) and FR-EX (-8%) groups; only FR-EX rats exhibited increased osteoclast surface and decreased mineral apposition rate in PTM cancellous bone. Decrements in serum estradiol, uterine weights, or both in these 2 groups implicate altered estrogen status as contributory. Urine pH declined significantly by 12 wk in all restricted groups, but net acid excretion increased only in CAR-EX rats. These findings, when compared with published data on sedentary rats, suggest that treadmill running exercise may mitigate some, but not all, deleterious effects on bone after chronic energy or food restriction but is more protective during calcium restriction.
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Affiliation(s)
- Sibyl N Swift
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
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20
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Abstract
1. Masters athletes may experience low back pain from multiple sources. Masters athletes with discogenic back pain should avoid or modify sports with combined rotational and compressive forces; individuals with facet-mediated pain should avoid or modify sports with excessive extension and rotation. 2. Optimization of flexibility, strength, endurance, and core control is critical. Sports specific training, realistic goal setting, and counseling are of maximal importance. 3. Overall, the health benefits of continued sports and athletic participation outweigh the potential risks of spinal degeneration in middle-aged athletes. There is little correlation between radiographic appearance of the spine and symptoms; therefore, symptoms should serve as the primary guide when determining activity modifications. Overall, masters athletes should be encouraged to remain active and fit to enhance their quality of life and reduce the risk of cardiovascular disease.
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Affiliation(s)
- Joanne Borg-Stein
- Department of PM&R, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02114, USA.
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21
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Fang Y, Hu C, Tao X, Wan Y, Tao F. Effect of vitamin K on bone mineral density: a meta-analysis of randomized controlled trials. J Bone Miner Metab 2012; 30:60-8. [PMID: 21674202 DOI: 10.1007/s00774-011-0287-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 05/16/2011] [Indexed: 11/26/2022]
Abstract
A number of randomized controlled trials (RCTs) examining the role of vitamin K on bone mineral density (BMD) have yielded inconsistent results. We performed a meta-analysis of these trials to assess the effect of vitamin K on BMD. We searched MEDLINE, EMBASE and CENTRAL for relevant studies of RCTs examining the role of vitamin K on BMD. Data on participants, interventions, and outcomes were extracted and the quality of all included trials assessed. Primary outcomes for analysis were absolute changes in BMD (mg/cm(2)) at the lumbar spine and femoral neck. Relative changes (percentage change) in BMD at the lumbar spine were also assessed. Vitamin K supplementation was shown to be efficacious in increasing BMD at the lumbar spine but not the femoral neck. The weighted mean difference (WMD) in BMD absolute change was 21.60 mg/cm(2) [95% confidence interval (CI) 3.63, 39.56] at the lumbar spine and 0.25 mg/cm(2) (95% CI -2.64, 3.14) at the femoral neck. The WMD in BMD relative change was 1.27% (95% CI 0.47, 2.06) at the lumbar spine and 0.17 (95% CI -0.21, 0.54) at the femoral neck. Subgroup analysis revealed that ethnic difference, gender, and vitamin K type were associated with variable effects on BMD at the lumbar spine. The modest overall treatment effects for vitamin K on BMD observed in this review may be biased and should be interpreted with caution. Further studies are required to address factors relating to the observed effects of vitamin K on BMD.
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Affiliation(s)
- Yanfu Fang
- School of Public Health, Anhui Medical University, 81 Mei Shan Road, Hefei 230032, Anhui, China
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22
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Ducher G, Turner AI, Kukuljan S, Pantano KJ, Carlson JL, Williams NI, De Souza MJ. Obstacles in the optimization of bone health outcomes in the female athlete triad. Sports Med 2011; 41:587-607. [PMID: 21688870 DOI: 10.2165/11588770-000000000-00000] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Maintaining low body weight for the sake of performance and aesthetic purposes is a common feature among young girls and women who exercise on a regular basis, including elite, college and high-school athletes, members of fitness centres, and recreational exercisers. High energy expenditure without adequate compensation in energy intake leads to an energy deficiency, which may ultimately affect reproductive function and bone health. The combination of low energy availability, menstrual disturbances and low bone mineral density is referred to as the 'female athlete triad'. Not all athletes seek medical assistance in response to the absence of menstruation for 3 or more months as some believe that long-term amenorrhoea is not harmful. Indeed, many women may not seek medical attention until they sustain a stress fracture. This review investigates current issues, controversies and strategies in the clinical management of bone health concerns related to the female athlete triad. Current recommendations focus on either increasing energy intake or decreasing energy expenditure, as this approach remains the most efficient strategy to prevent further bone health complications. However, convincing the athlete to increase energy availability can be extremely challenging. Oral contraceptive therapy seems to be a common strategy chosen by many physicians to address bone health issues in young women with amenorrhoea, although there is little evidence that this strategy improves bone mineral density in this population. Assessment of bone health itself is difficult due to the limitations of dual-energy X-ray absorptiometry (DXA) to estimate bone strength. Understanding how bone strength is affected by low energy availability, weight gain and resumption of menses requires further investigations using 3-dimensional bone imaging techniques in order to improve the clinical management of the female athlete triad.
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Affiliation(s)
- Gaele Ducher
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia.
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Abstract
Recent interest in vitamin K has been motivated by evidence of physiological roles beyond that of coagulation. Vitamin K and vitamin K-dependent (VKD) proteins may be involved in regulation of calcification, energy metabolism, and inflammation. However, the evidence for many of these proposed roles in the maintenance of health is equivocal. There is also an emerging viewpoint that the biochemical function of vitamin K may extend beyond that of a cofactor for the VKD carboxylation of glutamyl residues (Glus) to carboxylated Glus in VKD proteins.
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Affiliation(s)
- Sarah L Booth
- Vitamin K Laboratory, Jean Mayer USDA Human Nutrition Research Center at Tufts University, Boston, MA 02111, USA.
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Abstract
UNLABELLED Female monozygotic twins, both international endurance athletes aged 18 years, presented for a dual energy x-ray absorptiometry (DXA) scan as part of a university clinical trial. Twin 1 had only menstruated twice since menarche; Twin 2 had not yet started menstruating. Both twins acknowledged suffering from disordered eating for approximately 3 years. Both twins presented with low lumbar spine bone mineral density (BMD) and normal total body, total hip, and femoral neck BMD. DIAGNOSIS Female athlete triad comprising disordered eating with insufficient energy availability, amenorrhea, and low age-related BMD. MANAGEMENT Despite some weight gain and reduction of athletic training and competition over a 5-year period, lumbar BMD remained low in both twins and was complicated by a rapid decline in BMD at the hips. Twin 2 remained amenorrheic. The oral contraceptive pill was not effective in maintaining BMD in the other twin. Contraindicated treatment with bisphosphonates was not tolerated and promptly ceased. This case seminar emphasizes the absence of a clear physician-coordinated multi-disciplinary treatment approach and the complexity in treating all the components of the triad in young athletes. KEYWORDS female athlete triad; monozygotic; amenorrhea; bone mineral density.
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Affiliation(s)
- Karen Hind
- Carnegie Research Institute, Leeds Metropolitan University, Leeds, LS6 2QS, UK
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25
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Cheung AM, Tile L, Lee Y, Tomlinson G, Hawker G, Scher J, Hu H, Vieth R, Thompson L, Jamal S, Josse R. Vitamin K supplementation in postmenopausal women with osteopenia (ECKO trial): a randomized controlled trial. PLoS Med 2008; 5:e196. [PMID: 18922041 PMCID: PMC2566998 DOI: 10.1371/journal.pmed.0050196] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 08/13/2008] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Vitamin K has been widely promoted as a supplement for decreasing bone loss in postmenopausal women, but the long-term benefits and potential harms are unknown. This study was conducted to determine whether daily high-dose vitamin K1 supplementation safely reduces bone loss, bone turnover, and fractures. METHODS AND FINDINGS This single-center study was designed as a 2-y randomized, placebo-controlled, double-blind trial, extended for earlier participants for up to an additional 2 y because of interest in long-term safety and fractures. A total of 440 postmenopausal women with osteopenia were randomized to either 5 mg of vitamin K1 or placebo daily. Primary outcomes were changes in BMD at the lumbar spine and total hip at 2 y. Secondary outcomes included changes in BMD at other sites and other time points, bone turnover markers, height, fractures, adverse effects, and health-related quality of life. This study has a power of 90% to detect 3% differences in BMD between the two groups. The women in this study were vitamin D replete, with a mean serum 25-hydroxyvitamin D level of 77 nmol/l at baseline. Over 2 y, BMD decreased by -1.28% and -1.22% (p = 0.84) (difference of -0.06%; 95% confidence interval [CI] -0.67% to 0.54%) at the lumbar spine and -0.69% and -0.88% (p = 0.51) (difference of 0.19%; 95% CI -0.37% to 0.75%) at the total hip in the vitamin K and placebo groups, respectively. There were no significant differences in changes in BMD at any site between the two groups over the 2- to 4-y period. Daily vitamin K1 supplementation increased serum vitamin K1 levels by 10-fold, and decreased the percentage of undercarboxylated osteocalcin and total osteocalcin levels (bone formation marker). However, C-telopeptide levels (bone resorption marker) were not significantly different between the two groups. Fewer women in the vitamin K group had clinical fractures (nine versus 20, p = 0.04) and fewer had cancers (three versus 12, p = 0.02). Vitamin K supplements were well-tolerated over the 4-y period. There were no significant differences in adverse effects or health-related quality of life between the two groups. The study was not powered to examine fractures or cancers, and their numbers were small. CONCLUSIONS Daily 5 mg of vitamin K1 supplementation for 2 to 4 y does not protect against age-related decline in BMD, but may protect against fractures and cancers in postmenopausal women with osteopenia. More studies are needed to further examine the effect of vitamin K on fractures and cancers. TRIAL REGISTRATION ClinicalTrials.gov (#NCT00150969) and Current Controlled Trials (#ISRCTN61708241).
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Affiliation(s)
- Angela M Cheung
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Clinical Epidemiology Program, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Osteoporosis and Women's Health Programs, University Health Network, Toronto, Ontario, Canada
| | - Lianne Tile
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Osteoporosis and Women's Health Programs, University Health Network, Toronto, Ontario, Canada
| | - Yuna Lee
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Clinical Epidemiology Program, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Hawker
- Clinical Epidemiology Program, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Judy Scher
- Osteoporosis and Women's Health Programs, University Health Network, Toronto, Ontario, Canada
| | - Hanxian Hu
- Osteoporosis and Women's Health Programs, University Health Network, Toronto, Ontario, Canada
| | - Reinhold Vieth
- Department of Pathology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lilian Thompson
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sophie Jamal
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Clinical Epidemiology Program, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Robert Josse
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Cobb KL, Bachrach LK, Sowers M, Nieves J, Greendale GA, Kent KK, Brown BW, Pettit K, Harper DM, Kelsey JL. The effect of oral contraceptives on bone mass and stress fractures in female runners. Med Sci Sports Exerc 2007; 39:1464-73. [PMID: 17805075 DOI: 10.1249/mss.0b013e318074e532] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine the effect of oral contraceptives (OC) on bone mass and stress fracture incidence in young female distance runners. METHODS One hundred fifty competitive female runners ages 18-26 yr were randomly assigned to OC (30 microg of ethinyl estradiol and 0.3 mg of norgestrel) or control (no intervention) for 2 yr. Bone mineral density (BMD) and content (BMC) were measured yearly by dual x-ray absorptiometry. Stress fractures were confirmed by x-ray, magnetic resonance imaging, or bone scan. RESULTS Randomization to OC was unrelated to changes in BMD or BMC in oligo/amenorrheic (N=50) or eumenorrheic runners (N=100). However, treatment-received analyses (which considered actual OC use) showed that oligo/amenorrheic runners who used OC gained about 1% per year in spine BMD (P<0.005) and whole-body BMC (P<0.005), amounts similar to those for runners who regained periods spontaneously and significantly greater than those for runners who remained oligo/amenorrheic (P<0.05). Dietary calcium intake and weight gain independently predicted bone mass gains in oligo/amenorrheic runners. Randomization to OC was not significantly related to stress fracture incidence, but the direction of the effect was protective in both menstrual groups (hazard ratio [95% CI]: 0.57 [0.18, 1.83]), and the effect became stronger in treatment-received analyses. The trial's statistical power was reduced by higher-than-anticipated noncompliance. CONCLUSION OC may reduce the risk for stress fractures in female runners, but our data are inconclusive. Oligo/amenorrheic athletes with low bone mass should be advised to increase dietary calcium and take steps to resume normal menses, including weight gain; they may benefit from OC, but the evidence is inconclusive.
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Affiliation(s)
- Kristin L Cobb
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA 94305, and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA.
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Knapen MHJ, Schurgers LJ, Vermeer C. Vitamin K2 supplementation improves hip bone geometry and bone strength indices in postmenopausal women. Osteoporos Int 2007; 18:963-72. [PMID: 17287908 PMCID: PMC1915640 DOI: 10.1007/s00198-007-0337-9] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Accepted: 12/18/2006] [Indexed: 12/15/2022]
Abstract
UNLABELLED Vitamin K mediates the synthesis of proteins regulating bone metabolism. We have tested whether high vitamin K(2) intake promotes bone mineral density and bone strength. Results showed that K(2) improved BMC and femoral neck width, but not DXA-BMD. Hence high vitamin K(2) intake may contribute to preventing postmenopausal bone loss. INTRODUCTION Vitamin K is involved in the synthesis of several proteins in bone. The importance of K vitamins for optimal bone health has been suggested by population-based studies, but intervention studies with DXA-BMD as a clinical endpoint have shown contradicting results. Unlike BMC, DXA-BMD does not take into account the geometry (size, thickness) of bone, which has an independent contribution to bone strength and fracture risk. Here we have tested whether BMC and femoral neck width are affected by high vitamin K intake. METHODS A randomized clinical intervention study among 325 postmenopausal women receiving either placebo or 45 mg/day of vitamin K(2) (MK-4, menatetrenone) during three years. BMC and hip geometry were assessed by DXA. Bone strength indices were calculated from DXA-BMD, femoral neck width (FNW) and hip axis length (HAL). RESULTS K(2) did not affect the DXA-BMD, but BMC and the FNW had increased relative to placebo. In the K(2)-treated group hip bone strength remained unchanged during the 3-year intervention period, whereas in the placebo group bone strength decreased significantly. CONCLUSIONS Vitamin K(2) helps maintaining bone strength at the site of the femoral neck in postmenopausal women by improving BMC and FNW, whereas it has little effect on DXA-BMD.
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Affiliation(s)
- M. H. J. Knapen
- CARIM, University of Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - L. J. Schurgers
- VitaK, University of Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - C. Vermeer
- VitaK, University of Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- CARIM, University of Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Biochemistry, University of Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Schurgers L, Knapen M, Vermeer C. Vitamin K2 improves bone strength in postmenopausal women. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.ics.2006.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Herrmann M, Müller M, Scharhag J, Sand-Hill M, Kindermann W, Herrmann W. The effect of endurance exercise-induced lactacidosis on biochemical markers of bone turnover. ACTA ACUST UNITED AC 2007; 45:1381-9. [PMID: 17727311 DOI: 10.1515/cclm.2007.282] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AbstractClin Chem Lab Med 2007;45:1381–9.
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Affiliation(s)
- Markus Herrmann
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital of Saarland, Homburg/Saar, Germany.
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Affiliation(s)
- Joel S Newman
- Department of Radiology, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA.
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Bolin D, Kemper A, Brolinson PG. Current concepts in the evaluation and management of stress fractures. Curr Sports Med Rep 2006; 4:295-300. [PMID: 16282029 DOI: 10.1097/01.csmr.0000306289.98127.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although new technologies aid in making a rapid diagnosis and help predict clinical course of treatment, the diagnosis of stress fractures remains dependent on a high index of suspicion. Management of stress fractures involves clinical knowledge of those stress fractures that are prone to complication. The identification of predisposing factors to stress injury should be addressed. These include proper nutrition, hormonal balance, and correcting biomechanical deficits and training errors. Comprehensive evaluation and treatment is essential in facilitating recovery from stress fracture. Several new and more aggressive prevention and treatment strategies have been reported. The maintenance of cardiovascular fitness throughout the recovery process remains a key to the fastest return to full participation.
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Affiliation(s)
- Delmas Bolin
- Division of Sports Medicine, 112 Merryman Center, Virginia College of Osteopathic Medicine, Blacksburg, VA, 24061, USA
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Kainberger F, Weidekamm C, Matzner M, Trieb K. Sportschaden und Sporttrauma der Wirbelsäule: bildgebende Diagnostik. ACTA ACUST UNITED AC 2006; 56:47-57. [PMID: 16733996 DOI: 10.1016/j.rontge.2005.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sports injuries, especially those due to trend sports, and overuse resulting from monotonous repetitive movement patterns may cause various spinal abnormalities. Indications for diagnostic imaging should be established more readily in this group of young patients than in adults, as there is a higher probability to find morphologic abnormalities. This diagnostic strategy should also be applied for MRI and CT investigations. Image findings should be interpreted with view on kinetic chains related to distinct sporting activities.
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Affiliation(s)
- Franz Kainberger
- Universitätsklinik für Radiodiagnostik, Medizinische Universität Wien, AHK.
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Abstract
Although eating disorders have received much attention over the last few years in athletics, its prevalence was not always well appreciated. Over the years, professional organizations began to pay close attention to the effects of eating disorders, and with this heightened awareness, professionals as well as the general public began to recognize eating disorders as a major problem in our society. In the early 1990s, the American College of Sports Medicine (ACSM) convened the Task Force on Women's Issues in Seattle, Washington . During this conference, members of the ACSM discussed issues related to females and athletics with specific attention to eating disorders, amenorrhea, and osteoporosis. They collectively called these pathologies the Female Athlete Triad (Triad) and hence coined the phrase in 1993. Since the publication, much time and effort has been devoted towards research and understanding of the Triad. In trying to understand this complicated problem, one must grasp the concept that the three pathologies are interrelated and difficult to explain without the influence of any of the other components.
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Affiliation(s)
- Michael Brunet
- Athletic Training Educational Program, Louisiana College, 1140 College Drive, PO Box 563, Pineville, LA 71359, USA
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36
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DeFranco MJ, Recht M, Schils J, Parker RD. Stress fractures of the femur in athletes. Clin Sports Med 2006; 25:89-103, ix. [PMID: 16324976 DOI: 10.1016/j.csm.2005.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Femoral stress fractures represent an uncommon but important lower-extremity injury in athletes and soldiers. Careful assessment of the involved and contralateral lower extremity and the spine is required to make the diagnosis. Based on a review of the literature, specific treatment is based on individual patient assessment. In most cases, nonoperative management results in an excellent outcome. Certain fractures will require operative intervention to prevent displacement or to reduce a displaced fracture and return stability to the lower extremity. Complications in athletes with femoral stress fractures are rare. Most athletes can expect to return to their preinjury level of competition, if they are compliant with the treatment plan.
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Affiliation(s)
- Michael J DeFranco
- Department of Orthopaedic Surgery, A-41, The Cleveland Clinic, Cleveland, OH 44195, USA
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Firth EC, Rogers CW. Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. Conclusions. N Z Vet J 2005; 53:377-83. [PMID: 16317437 DOI: 10.1080/00480169.2005.36581] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper summarises and presents in context the main findings of an extensive series of studies of early training lasting 13 weeks in which the tissue responses of 2-year-old Thoroughbred horses were assessed using a combination of methods. Negligible clinical injury was detected and thus the study fulfilled the intention of investigating adaptive change rather than injury. Cancellous and cortical bone, some digital tendons, and articular cartilage responded to early training exercise to a greater or lesser degree. Clinical examination and ancillary diagnostic aids currently in veterinary clinical use are not sufficient to detect early abnormalities in metacarpo-phalangeal joint (MCPJ) cartilage found in both trained and untrained horses. Future work should centre on detection of such changes, on the precise registration of training workload, and on the manipulation of the responses of musculoskeletal tissues by careful investigation of the effects of introducing conditioning exercise at a young age.
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Affiliation(s)
- E C Firth
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Private Bag 11222, Palmerston North, New Zealand.
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