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Deng AF, Wang FX, Wang SC, Zhang YZ, Bai L, Su JC. Bone-organ axes: bidirectional crosstalk. Mil Med Res 2024; 11:37. [PMID: 38867330 PMCID: PMC11167910 DOI: 10.1186/s40779-024-00540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/31/2024] [Indexed: 06/14/2024] Open
Abstract
In addition to its recognized role in providing structural support, bone plays a crucial role in maintaining the functionality and balance of various organs by secreting specific cytokines (also known as osteokines). This reciprocal influence extends to these organs modulating bone homeostasis and development, although this aspect has yet to be systematically reviewed. This review aims to elucidate this bidirectional crosstalk, with a particular focus on the role of osteokines. Additionally, it presents a unique compilation of evidence highlighting the critical function of extracellular vesicles (EVs) within bone-organ axes for the first time. Moreover, it explores the implications of this crosstalk for designing and implementing bone-on-chips and assembloids, underscoring the importance of comprehending these interactions for advancing physiologically relevant in vitro models. Consequently, this review establishes a robust theoretical foundation for preventing, diagnosing, and treating diseases related to the bone-organ axis from the perspective of cytokines, EVs, hormones, and metabolites.
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Affiliation(s)
- An-Fu Deng
- Institute of Translational Medicine, Organoid Research Center, Shanghai University, Shanghai, 200444, China
- National Center for Translational Medicine (Shanghai) SHU Branch, Shanghai University, Shanghai, 200444, China
| | - Fu-Xiao Wang
- Institute of Translational Medicine, Organoid Research Center, Shanghai University, Shanghai, 200444, China
- National Center for Translational Medicine (Shanghai) SHU Branch, Shanghai University, Shanghai, 200444, China
| | - Si-Cheng Wang
- Institute of Translational Medicine, Organoid Research Center, Shanghai University, Shanghai, 200444, China
- National Center for Translational Medicine (Shanghai) SHU Branch, Shanghai University, Shanghai, 200444, China
- Department of Orthopedics, Shanghai Zhongye Hospital, Shanghai, 200444, China
| | - Ying-Ze Zhang
- Department of Orthopaedics, the Third Hospital of Hebei Medical University, Orthopaedic Research Institution of Hebei Province, NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, 050051, China.
| | - Long Bai
- Institute of Translational Medicine, Organoid Research Center, Shanghai University, Shanghai, 200444, China.
- National Center for Translational Medicine (Shanghai) SHU Branch, Shanghai University, Shanghai, 200444, China.
- School of Medicine, Shanghai University, Shanghai, 200444, China.
- Wenzhou Institute of Shanghai University, Wenzhou, 325000, Zhejiang, China.
| | - Jia-Can Su
- Institute of Translational Medicine, Organoid Research Center, Shanghai University, Shanghai, 200444, China.
- National Center for Translational Medicine (Shanghai) SHU Branch, Shanghai University, Shanghai, 200444, China.
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
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Li Y, Liu B, Li X. High C-reactive protein-to-albumin ratio levels are associated with osteoporosis in patients with primary biliary cholangitis. Front Endocrinol (Lausanne) 2024; 15:1415488. [PMID: 38872964 PMCID: PMC11169652 DOI: 10.3389/fendo.2024.1415488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024] Open
Abstract
Objective Inflammation contributes to the development of metabolic bone diseases. The C-reactive protein-to-albumin ratio (CAR) is an inflammation-based marker with a prognostic value for several metabolic diseases. This study investigated the relationship between the CAR and osteoporosis (OP) in patients with primary biliary cholangitis (PBC). Methods Patients with PBC treated at Beijing Ditan Hospital between January 2018 and June 2023 were enrolled. Logistic regression analysis was performed to investigate the factors influencing OP. The predictive value of CAR for OP was evaluated using receiver operating characteristic (ROC) curves. Moreover, a restricted cubic spline (RCS) fitted with a logistic regression model was used to analyze the relationship between CAR and OP. Results The prevalence of OP among the patients with PBC was 26.9% (n = 82). CAR levels were higher in the OP group than in the non-OP group (0.33 (0.09, 0.61) vs. 0.08 (0.04, 0.18), P < 0.001). Logistic regression analysis showed that CAR was an independent predictor of OP in patients with PBC (odds ratio = 2.642, 95% confidence interval = 1.537-4.540, P < 0.001). CAR exhibited a good predictive ability for OP, with an areas under the curve (AUC) of 0.741. We found that individuals with CAR values > 0.1 have higher odds of OP. In addition, high CAR levels were associated with an increased prevalence of fragility fractures and high 10-year fracture risk. Conclusion High CAR levels were associated with greater odds of developing OP, and the CAR could serve as an independent predictor of OP in patients with PBC.
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Affiliation(s)
- Yanyan Li
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Bo Liu
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xin Li
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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3
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Reincke M, Seufert J, Laubner K, Meyer-Steenbuck M, Dammer A, Sturm L, Thimme R, Bettinger D, Schultheiss M. Reduced bone mineral density is associated to post-TIPS survival of female patients with decompensated cirrhosis. Dig Liver Dis 2024:S1590-8658(24)00710-2. [PMID: 38679509 DOI: 10.1016/j.dld.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Malnutrition is common in patients with cirrhosis, eventually leading to sarcopenia and loss of bone mass. AIMS The aims of this study was the assessment of body composition (BC) and bone mineral density (BMD) in patients with decompensated cirrhosis and the prognostic impact on survival after transjugular intrahepatic portosystemic shunt (TIPS) implantation. METHODS BMD and BC of 107 patients with cirrhosis undergoing TIPS implantation were prospectively analyzed by dual-energy X-ray absorptiometry. The prevalence and predisposing risk factors for reduced BMD and sarcopenia were assessed. Impact on 12-month survival after TIPS implantation was evaluated. RESULTS Sarcopenia was diagnosed in 48.6 % of the patients with a predominance of male patients (58.7% vs. 25.0 %, p = 0.001). 67.2 % had reduced BMD. Low BMI was independently associated with sarcopenia (OR 0.751 (95 % CI: 0.662;0.852), p < 0.001) and reduced BMD (OR 0.851 (0.773;0.937), p = 0.001). Patients with reduced BMD, but not sarcopenia, had impaired 12-month survival after TIPS-implantation (61.2% vs. 82.9 %, p = 0.030). Subgroup analysis showed that this was especially valid for female patients. CONCLUSIONS Sarcopenia and reduced BMD are frequently observed in patients with decompensated cirrhosis. Reduced BMD negatively affects post-TIPS survival. Since malnutrition is a leading cause, assessment of nutritional status and specific treatment should be included in clinical practice.
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Affiliation(s)
- Marlene Reincke
- Department of Medicine II, Division of Gastroenterology and Hepatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Jochen Seufert
- Department of Medicine II, Division of Endocrinology and Diabetology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Katharina Laubner
- Department of Medicine II, Division of Endocrinology and Diabetology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany
| | - Maximilian Meyer-Steenbuck
- Department of Medicine II, Division of Gastroenterology and Hepatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Anna Dammer
- Department of Medicine II, Division of Gastroenterology and Hepatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Lukas Sturm
- Department of Medicine II, Division of Gastroenterology and Hepatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II, Division of Gastroenterology and Hepatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Division of Gastroenterology and Hepatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Michael Schultheiss
- Department of Medicine II, Division of Gastroenterology and Hepatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany.
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Quiroz-Aldave JE, Gamarra-Osorio ER, Durand-Vásquez MDC, Rafael-Robles LDP, Gonzáles-Yovera JG, Quispe-Flores MA, Concepción-Urteaga LA, Román-González A, Paz-Ibarra J, Concepción-Zavaleta MJ. From liver to hormones: The endocrine consequences of cirrhosis. World J Gastroenterol 2024; 30:1073-1095. [PMID: 38577191 PMCID: PMC10989500 DOI: 10.3748/wjg.v30.i9.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
Hepatocrinology explores the intricate relationship between liver function and the endocrine system. Chronic liver diseases such as liver cirrhosis can cause endocrine disorders due to toxin accumulation and protein synthesis disruption. Despite its importance, assessing endocrine issues in cirrhotic patients is frequently neglected. This article provides a comprehensive review of the epidemiology, pathophysiology, diagnosis, and treatment of endocrine disturbances in liver cirrhosis. The review was conducted using the PubMed/Medline, EMBASE, and Scielo databases, encompassing 172 articles. Liver cirrhosis is associated with endocrine disturbances, including diabetes, hypoglycemia, sarcopenia, thyroid dysfunction, hypogonadotropic hypogonadism, bone disease, adrenal insufficiency, growth hormone dysfunction, and secondary hyperaldosteronism. The optimal tools for diagnosing diabetes and detecting hypoglycemia are the oral glucose tolerance test and continuous glucose monitoring system, respectively. Sarcopenia can be assessed through imaging and functional tests, while other endocrine disorders are evaluated using hormonal assays and imaging studies. Treatment options include metformin, glucagon-like peptide-1 analogs, sodium-glucose co-transporter-2 inhibitors, and insulin, which are effective and safe for diabetes control. Established standards are followed for managing hypoglycemia, and hormone replacement therapy is often necessary for other endocrine dysfunctions. Liver transplantation can address some of these problems.
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Affiliation(s)
| | | | | | | | | | | | | | - Alejandro Román-González
- Department of Endocrinology, Hospital Universitario de San Vicente Fundación, Medellin 050010, Colombia
- Internal Medicine, Universidad de Antioquia, Medellín 050010, Colombia
| | - José Paz-Ibarra
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima 15081, Peru
- Department of Endocrinology, Hospital Nacional Edgardo Rebagliati Martins, Lima 15072, Peru
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Stulic M, Jadzic J, Dostanic N, Zivkovic M, Stojkovic T, Aleksic J, Stojkovic S, Stojkovic Lalosevic M, Vojnovic M, Vlaisavljevic Z, Martinov Nestorov J, Nikolić T, Culafic Vojinovic V, Culafic D, Djonic D. Clinical Indicators of Bone Deterioration in Alcoholic Liver Cirrhosis and Chronic Alcohol Abuse: Looking beyond Bone Fracture Occurrence. Diagnostics (Basel) 2024; 14:510. [PMID: 38472981 DOI: 10.3390/diagnostics14050510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Although previous studies indicated that chronic alcohol abuse (CAA) and alcoholic liver cirrhosis (ALC) are associated with increased bone fragility, understanding bone fragility determinants is still modest in these individuals. We used a comprehensive individualized clinical fracture risk assessment approach (vertebral osteodensitometry, femoral osteodensitometry and geometry, and serum bone turnover biomarkers) to compare adult male patients with ALC who have not previously had femoral or vertebral fractures (n = 39), patients with CAA (without liver cirrhosis, n = 78) who have not previously had femoral or vertebral fractures and healthy age- and sex-matched controls (n = 43). Our data suggested that intertrochanteric bone mineral density was significantly lower in ALC and CAA patients than in controls. Also, the trabecular bone score was considerably lower in ALC patients compared with CAA and control individuals. The most significant inter-group differences in femoral geometry were noted on the femoral shaft. Patients with ALC and CAA have a higher 10-year risk of major osteoporotic fractures compared to the controls. Analysis of bone turnover biomarkers showed increased osteoprotegerin and beta-C-terminal telopeptide serum concentrations and decreased insulin growth factor-1 concentrations in patients with ALC compared to CAA and control groups. Our data revealed that bone alterations are present in patients with ALC and CAA even if they did not sustain a nontraumatic bone fracture, but it is also indicative that current bone-assessing clinical methods are not entirely reliable. Thus, future studies should focus on developing a reliable integrative clinical tool that can be used to accurately predict and prevent bone fracture occurrences in patients with ALC and CAA.
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Affiliation(s)
- Milos Stulic
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Jadzic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Natasa Dostanic
- Special Hospital for Addiction Diseases "Drajzerova", 11000 Belgrade, Serbia
| | - Milica Zivkovic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Tihomir Stojkovic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Aleksic
- Institute for Health Protection of Workers of Serbian Railways, 11000 Belgrade, Serbia
| | - Stefan Stojkovic
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milica Stojkovic Lalosevic
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Vojnovic
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Zeljko Vlaisavljevic
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jelena Martinov Nestorov
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Tatjana Nikolić
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | | | - Djordje Culafic
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Danijela Djonic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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6
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Mohajeri-Tehrani MR, Alemzadeh SA, Marzbali FA, Nasserisina S, Hosnan F, Naghghash A, Hamidieh AA, Behfar M, Mohseni F, Rashidian H, Shirazi S, Aboee-Rad M, Qorbani M, Larijani B, Hamidi Z. How Age, Sex and Transfusion Affects the Incidence of Endocrine and Bone Density Disorders in Major Thalassemic Patients. IRANIAN JOURNAL OF PUBLIC HEALTH 2024; 53:433-442. [PMID: 38894828 PMCID: PMC11182464 DOI: 10.18502/ijph.v53i2.14928] [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: 04/18/2023] [Accepted: 06/19/2023] [Indexed: 06/21/2024]
Abstract
Background Beta-thalassemia major patients frequently have endocrinopathies. We tried to determine relation between demographic and transfusion factor and endocrinopathies. Methods Major beta-thalassemia patients (n=114 cases), 3-38 yr of age, entered this study. Female to male ratio was 51/63. Children (less than 20 yr) formed 57% of participants. Information about bone mineral density (BMD) and hormonal and biochemistry blood evaluation including fasting blood sugar (FBS), ferritin, triiodothyronine (T3), thyroxine (T4) and thyroid-stimulating hormone (TSH), luteinizing hormone (LH) and follicle-stimulating hormone (FSH), testosterone (males), and estradiol (females) entered data sheet. Results Sex and ferritin level showed no significant correlation with above disorders. Age significantly correlated to short stature, diabetes, low BMD at femur and neck (P, 0.031, 0.008, 0.009 and <0.001, respectively) . The risk of short stature had increased in 12 yr and older patients 7.71 times than younger patients (P= 0.008). The risk of diabetes had increased in 35 yr and older patients 26.25 times than younger patients (P= 0.03). The risk of Z-score ≤ -2 in femoral region has increased in 19 yr and older patients 5.84 times than younger patients (P= 0.002). The risk of Z-score ≤ -2 in spinal region has increased in 14 yr and older patients 17 times than younger patients (P= 0.007). Conclusion The main factor related with endocrinopathies was age. The correlation between age and short stature, diabetes and low BMD was positive. Therefore, we recommend early monitoring of thalassemia patients (in their late childhood and early teenage) for these complications.
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Affiliation(s)
- Mohammad-Reza Mohajeri-Tehrani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Amirsina Alemzadeh
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Abbaszadeh Marzbali
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf Nasserisina
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hosnan
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Naghghash
- Thalassemia Department, Torfeh Hospital, Shahid Beheshti University, Tehran, Iran
| | - Amir Ali Hamidieh
- Pediatric Stem Cell Transplant Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Behfar
- Pediatric Stem Cell Transplant Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Mohseni
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Rashidian
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Shirazi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Aboee-Rad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Science, Karaj, Iran
| | - Bagher Larijani
- Thalassemia Department, Torfeh Hospital, Shahid Beheshti University, Tehran, Iran
| | - Zohreh Hamidi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Ferrantelli V, Vasto S, Alongi A, Sabatino L, Baldassano D, Caldarella R, Gagliano R, Di Rosa L, Consentino BB, Vultaggio L, Baldassano S. Boosting plant food polyphenol concentration by saline eustress as supplement strategies for the prevention of metabolic syndrome: an example of randomized interventional trial in the adult population. Front Nutr 2023; 10:1288064. [PMID: 38196756 PMCID: PMC10774224 DOI: 10.3389/fnut.2023.1288064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/24/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction Phenolic compounds in lettuce can increase by the application of positive stress (eustress) such as moderate saline stress. Phenolic compounds possess antioxidant capacity that is a key factor in the detoxification of excess reactive oxygen species. A double-blinded randomized interventional and placebo- controlled study design was carried out to compare the effect of daily dietary eustress lettuce ingestion in hepatic, lipid, bone, glucose, and iron metabolism. Methods Forty-two healthy volunteers, 19 female and 23 male participants, were divided into two groups. Participants were randomized into a polyphenol-enriched treatment (PET) arm or control arm. Each arm consumed 100 g/day of control or eustress (polyphenols enriched treatment = PET) lettuce for 12 days. Primary study outcomes were serological analysis for assessing hepatic, lipid, bone, iron, and glucose markers at baseline and after 12 days. Secondary outcomes assessed body composition. Results Salinity stress reduced plant yield but increased caffeic acid (+467%), chlorogenic acid (+320%), quercetin (+538%), and rutin (+1,095%) concentrations. The intake of PET lettuce reduced PTH, low-density lipoprotein (LDL), cholesterol, alanine transaminase (ALT), and aspartate transaminase (AST) enzyme levels and increased vitamin D and phosphate levels, while iron and glucose metabolism were unaffected. Discussion Supplementation with eustress lettuce by increasing polyphenols concentration ameliorates hepatic, lipid, and bone homeostasis. Body composition was not affected. Clinical trial registration https://classic.clinicaltrials.gov/ct2/show/NCT06002672, identifier: NCT06002672.
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Affiliation(s)
| | - Sonya Vasto
- Euro-Mediterranean Institutes of Science and Technology (IEMEST), Palermo, Italy
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, Palermo, Italy
| | - Angelina Alongi
- Experimental Zooprophylactic Institute of Sicily, Palermo, Italy
| | - Leo Sabatino
- Dipartimento Scienze Agrarie, Alimentari e Forestali, University of Palermo, Palermo, Italy
| | - Davide Baldassano
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Rosalia Caldarella
- Department of Laboratory Medicine, “P. Giaccone” University Hospital, Palermo, Italy
| | - Rosaria Gagliano
- Experimental Zooprophylactic Institute of Sicily, Palermo, Italy
| | - Luigi Di Rosa
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, Palermo, Italy
| | | | - Lorena Vultaggio
- Dipartimento Scienze Agrarie, Alimentari e Forestali, University of Palermo, Palermo, Italy
| | - Sara Baldassano
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, Palermo, Italy
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8
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Shang Y, Shen Q, Tapper EB, Wester A, Hagström H. Risk of injuries before and after a diagnosis of cirrhosis: A population-based cohort study. Hepatol Commun 2023; 7:e0238. [PMID: 37820289 PMCID: PMC10578726 DOI: 10.1097/hc9.0000000000000238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/04/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Cirrhosis is often asymptomatic prior to decompensation. Still, cognitive impairment and sarcopenia may be present before decompensation, possibly increasing the risk of injuries. We estimated the risk of injuries during the period shortly before and after cirrhosis diagnosis. METHODS All patients (N=59,329) with a diagnosis of cirrhosis from 1997 to 2019 were identified from the Swedish National Patient Register. We used a self-controlled case series design to compare the incidence rates (IR) of injuries during a "diagnostic period" (within 3 months before or after the cirrhosis diagnosis date) to a self-controlled "prediagnostic period" (the same 6 calendar months 3 years before diagnosis), using conditional Poisson regression. Injuries were ascertained from the National Patient Register. RESULTS We identified 23,733 (40.0%) patients with compensated and 35,595 (60.0%) with decompensated cirrhosis. There were 975 injuries (IR 2.8/1000 person-months) during the prediagnostic period, and 3610 injuries (IR 11.6/1000 person-months) identified during the diagnostic period. The IR ratio was 8.1 (95% CI 7.5-8.7) comparing the diagnostic period with the prediagnostic period. For patients with compensated cirrhosis, the risk increment of injuries was highest just before the diagnosis of cirrhosis, whereas the risk increase was highest shortly after the diagnosis for those with decompensation. CONCLUSIONS The incidence of injuries increases shortly before and after the diagnosis of cirrhosis. These findings indicate that cirrhosis is frequently diagnosed in conjunction with an injury, and highlight the need for injury prevention after cirrhosis diagnosis, especially in patients with decompensation.
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Affiliation(s)
- Ying Shang
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Qing Shen
- Center of Public Health Sciences, University of Iceland, Reykjavík, Iceland
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elliot B. Tapper
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Axel Wester
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Hannes Hagström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Unit of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden
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9
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Bhadada S, Malhotra B, Shetty A, Mukherjee S. Metabolic bone disease heralding the diagnosis of Wilson's disease. BMJ Case Rep 2023; 16:e252290. [PMID: 37491126 PMCID: PMC10373720 DOI: 10.1136/bcr-2022-252290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
We report a short-statured, young man in his 20s presenting with bilateral cataract, recurrent kidney stones, history of refractory rickets and bone deformity. He had been consuming calcium and vitamin D supplements and had been operated for cataract and renal stone disease, prior to reporting in our clinic without any significant laboratory or clinical improvement. The patient was diagnosed as having Fanconi's syndrome attributable to Wilson's disease. This patient highlights that in case of resistant rickets, a high index of suspicion must be invoked for Wilson's disease. Timely recognition of this entity results in prompt ministrations and prevention of disability.
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Affiliation(s)
- Sanjay Bhadada
- Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhanu Malhotra
- Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anirudh Shetty
- Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Soham Mukherjee
- Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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10
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Rini SS, Wibawa IDN. Evaluation and Management of Chronic Cholestatic Liver Diseases. Middle East J Dig Dis 2023; 15:148-155. [PMID: 38023462 PMCID: PMC10660321 DOI: 10.34172/mejdd.2023.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 05/07/2023] [Indexed: 12/01/2023] Open
Abstract
Cholestasis is defined as stagnation or a marked reduction in bile secretion and flow. Cholestatic jaundice can thus be classified as intrahepatic or extrahepatic cholestatic, depending on the level of obstruction to bile flow. It is important to recognize the complications of cholestatic in patients with chronic cholestatic liver disease. The two most common complications of cholestasis are pruritus and fatigue, with the former being the most responsive to treatment. Cholestyramine is the first-line treatment for cholestatic pruritus. Rifampicin and oral opioid antagonist naltrexone are extremely effective second-line treatments. To date, there are no specific treatments for chronic cholestatic fatigue management. Osteoporosis is a complication that can arise in chronic cholestatic conditions. It appears to be more prominent in individuals with cholestatic liver disease than in patients with other chronic liver diseases with an increased risk of fracture. The evaluation of osteoporosis in individuals with chronic cholestasis is similar to that in the general population. Antiresorptive agents such as bisphosphonates are the first-line treatment choice for osteoporosis in patients with chronic cholestasis. Other less common complications include dyslipidemia, fat-soluble vitamin deficiency, and steatorrhea. Understanding and treating these conditions can have a significant impact on the morbidity and quality of life in this group of patients. This review aimed to provide further information about the complications of chronic cholestasis and to highlight evidence-based test practices for the evaluation and effective management of these complications.
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Affiliation(s)
- Sandra Surya Rini
- Department of Internal Medicine, Bali Jimbaran Hospital, Badung, Bali, Indonesia
| | - I Dewa Nyoman Wibawa
- Department of Internal Medicine and Endoscopic Unit, BaliMed Hospital, Denpasar, Bali, Indonesia
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11
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Joshi M, Uday S. Vitamin D Deficiency in Chronic Childhood Disorders: Importance of Screening and Prevention. Nutrients 2023; 15:2805. [PMID: 37375708 DOI: 10.3390/nu15122805] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Vitamin D plays a vital role in regulating calcium and phosphate metabolism and maintaining bone health. A state of prolonged or profound vitamin D deficiency (VDD) can result in rickets in children and osteomalacia in children and adults. Recent studies have demonstrated the pleiotropic action of vitamin D and identified its effects on multiple biological processes in addition to bone health. VDD is more prevalent in chronic childhood conditions such as long-standing systemic illnesses affecting the renal, liver, gastrointestinal, skin, neurologic and musculoskeletal systems. VDD superimposed on the underlying disease process and treatments that can adversely affect bone turnover can all add to the disease burden in these groups of children. The current review outlines the causes and mechanisms underlying poor bone health in certain groups of children and young people with chronic diseases with an emphasis on the proactive screening and treatment of VDD.
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Affiliation(s)
- Madhura Joshi
- Birmingham Women's and Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Suma Uday
- Birmingham Women's and Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston B15 2TT, UK
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12
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Sarici KB, Akbulut S, Uremis MM, Garzali IU, Kucukakcali Z, Koc C, Turkoz Y, Usta S, Baskiran A, Aloun A, Yilmaz S. Evaluation of Bone Mineral Metabolism After Liver Transplantation by Bone Mineral Densitometry and Biochemical Markers. Transplant Proc 2023; 55:1239-1244. [PMID: 37127514 DOI: 10.1016/j.transproceed.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 05/03/2023]
Abstract
AIM This study aimed to evaluate the course of bone and mineral metabolism after liver transplantation (LT) in patients with chronic liver disease. METHODS One hundred four patients who had undergone LT and had a minimum of 6 months of follow-up after LT were included in this prospective cohort study. The following parameters were evaluated for each patient: preoperative and postoperative (postoperative day [POD]30, POD90, POD180) osteocalcin, bone-specific alkaline phosphatase (BALP), type 1 collagen, beta-C-terminal end telopeptide (β-CTx), vitamin D, parathyroid hormone (PTH), ALP, calcium, phosphate, sedimentation, and bone mineral densitometer scores (L2, L4, L total, and F total). The parameters were compared in terms of sex, presence of liver tumor (hepatocellular carcinoma [HCC; n = 19] vs non-HCC [n = 85]), and presence of autoimmune liver disease (autoimmune liver disease [ALD; n = 8] vs non-ALD [n = 96]). RESULTS The median age of the patients (n = 81 men and n = 23 women) was 52 years (95% CI, 50-56). There was a significant change in the defined time intervals in parameters such as osteocalcin (P < .001), BALP (P < .001), β-CTx (P < .001), vitamin D (P < .001), PTH (P < .001), ALP (P = .001), calcium (P < .001), phosphate (P = .001), L2 (P = .038), L total (P = .026), and F total (P < .001) scores. There was a significant difference in POD90 ALP (P = .033), POD180 calcium (P = .011), POD180 phosphate (P = .011), preoperative sedimentation (P = .032), and POD180 F total (P = .013) scores between both sexes. There was a significant difference in POD180 osteocalcin (P = .023), POD180 β-CTx (P = .017), and preOP calcium (P = .003) among the HCC and non-HCC groups. Furthermore, we found significant differences in preoperative ALP (P = .008), preoperative sedimentation (P = .019), POD90 (P = .037) and POD180 L2 (P = .005) scores, preoperative (P = .049) and POD180 L4 (P = .017), and POD180 L total (P = .010) and F total (P = .022) scores between the patients with and without ALD. CONCLUSION This study shows that the bone and mineral metabolism of the LT recipients was negatively affected after LT. In addition, we showed that bone and mineral metabolism was more prominent in patients with HCC, and bone mineral density scores were higher in patients with ALD.
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Affiliation(s)
- Kemal Baris Sarici
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey; Department Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Muhammed Mehdi Uremis
- Department of Medical Biochemistry, Inonu University Faculty of Medicine, Malatya, Turkey
| | | | - Zeynep Kucukakcali
- Department Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cemalettin Koc
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yusuf Turkoz
- Department of Medical Biochemistry, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sertac Usta
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Adil Baskiran
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ali Aloun
- King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Sezai Yilmaz
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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13
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Nielsen CV, Folkestad L, Krøijer R, Hansen SG. The risk of osteoporosis is not increased after cholecystectomy. A nationwide cohort study. Bone 2023; 173:116782. [PMID: 37120083 DOI: 10.1016/j.bone.2023.116782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/04/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Catharina Vind Nielsen
- Department of Diabetes and Endocrinology, University Hospital Southern Denmark, Esbjerg, Denmark
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rasmus Krøijer
- Department of Surgery, University Hospital Southern Denmark, Esbjerg, Denmark
| | - Stinus Gadegaard Hansen
- Department of Diabetes and Endocrinology, University Hospital Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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14
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Tenório JR, Bueno MV, Franco JB, Peres MPSDM, Moratto BMN, Munhoz L, Arita ES, Ortega KL. Assessment of mandibular cortical index in patients with hepatic cirrhosis: A case-control study. SPECIAL CARE IN DENTISTRY 2023; 43:119-124. [PMID: 35709388 DOI: 10.1111/scd.12747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/18/2022] [Accepted: 05/28/2022] [Indexed: 11/26/2022]
Abstract
AIMS To assess the presence of alterations suggestive of reduced bone mineral density (BMD) by using mandibular cortical index (MCI) in panoramic radiographs of cirrhotic individuals and to evaluate their relationship with other characteristics of hepatic cirrhosis (HC). METHODS AND RESULTS This is an observational case-control study assessing the medical records of 165 cirrhotic patients matched by sex and age with healthy individuals. MELD (model of end stage liver disease) score, etiology, complications, comorbidities, and serum levels of vitamin D were collected. MCI was used to obtain BMD. Binary logistic regression was used to test associations and the risk estimates were expressed in odds ratio. Most of the sample consisted of men (73.93%) with median age of 56 years old. In the study group, the mean value of MELD was 16.5 and hepatitis C was the main etiology of HC (33.9%). Cirrhotic individuals are 3.99 times more likely to present alterations suggestive of reduced BMD (p < .01). There was no statistical significance in the association of MCI with levels of vitamin D, comorbidities, etiology or cirrhosis complications. CONCLUSIONS MCI suggestive of reduced BMD is more likely to be identified in panoramic radiographs of cirrhotic individuals than of healthy ones.
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Affiliation(s)
- Jefferson Rocha Tenório
- Special Care Dentistry Centre (CAPE), Department of Stomatology of the University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
- Department of Pathology and Oral Diagnosis of the Federal University of Rio de Janeiro, School of Dentistry, Rio de Janeiro, RJ, Brazil
| | - Marcus Vinícius Bueno
- Special Care Dentistry Centre (CAPE), Department of Stomatology of the University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Juliana Bertoldi Franco
- Division of Dentistry of the Clinics Hospital of the University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | | | - Beatriz Mota Nunes Moratto
- Special Care Dentistry Centre (CAPE), Department of Stomatology of the University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Luciana Munhoz
- Division of Oral Radiology, Department of Stomatology of the University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Emiko Saito Arita
- Division of Oral Radiology, Department of Stomatology of the University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Karem L Ortega
- Special Care Dentistry Centre (CAPE), Department of Stomatology of the University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
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15
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Kavlekar DB, Rathod S, Mummigatti SB. Spontaneous Bilateral Neck Femur Fracture Secondary to Chronic Liver Disease and Vitamin D3 Deficiency. J Orthop Case Rep 2023; 13:13-16. [PMID: 37187815 PMCID: PMC10178813 DOI: 10.13107/jocr.2023.v13.i03.3566] [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: 01/11/2023] [Revised: 01/29/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Spontaneous bilateral neck femur fracture occurs following many conditions. It is very rare event. It can be seen in young, middle aged, and elderly people with no preceding trauma. We report a case in middle aged person who got fracture secondary to chronic liver disease and Vitamin D3 deficiency and who underwent bilateral hemiarthroplasty. Case Report A 46-year-old man came with sudden onset of bilateral hip pain with no history of trauma. It was started with difficulty in moving the left lower limb since February 2020 and after about 1-month period patient got right hip pain which made the patient completely bedridden. He also complained of yellowish discoloration of eyes associated with weight loss, malaise. No history of tremors in hand. No history of seizures. Conclusion It is a not a common condition. Spontaneous bilateral neck femur fracture occurs following chronic liver disease and Vitamin D3 deficiency. Both these conditions lead to increase osteoporosis and osteomalacia thus making it more susceptible to fracture.
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Affiliation(s)
| | - Santosh Rathod
- Department of Orthopaedic Surgery, Goa Medical College, Bambolim, Goa, India
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16
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Wang Q, Xu F, Chen J, Xie YQ, Xu SL, He WM. Serum Leukocyte Cell-Derived Chemotaxin 2 (LECT2) Level Is Associated with Osteoporosis. Lab Med 2023; 54:106-111. [PMID: 35976970 DOI: 10.1093/labmed/lmac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The aim of this study was to examine serum leukocyte cell-derived chemotaxin 2 (LECT2) levels in osteoporosis subjects to confirm its association with osteoporosis. METHODS A total of 204 adult subjects were recruited. Bone mineral densities (BMD) were assessed and blood samples were collected for measurements of biomedical parameters and the bone turnover markers. Serum LECT2 levels were measured by enzyme-linked immunosorbent assay. The relationships between serum LECT2 levels and other parameters were analyzed using the Spearman correlation coefficient. RESULTS Serum LECT2 levels were significantly increased in osteoporosis subjects over controls. We found a significantly negative correlation of serum LECT2 with BMD, 25-hydroxy-vitamin D, and creatinine and a significantly positive correlation with C-terminal telopeptide of type 1 collagen and total cholesterol. CONCLUSION Serum LECT2 levels were significantly upregulated in osteoporosis subjects and correlated with the severity of bone loss. Serum LECT2 could be a potential biomarker to assess the risk of bone loss.
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Affiliation(s)
- Qiang Wang
- Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Feng Xu
- Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Jiong Chen
- Laboratory of Biochemistry and Molecular Biology, School of Marine Sciences, Meishan Campus, Ningbo University, Ningbo, Zhejiang, China.,State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products, Ningbo University, Ningbo, Zhejiang, China
| | - Yan-Qing Xie
- Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Su-Ling Xu
- Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Wen-Ming He
- Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
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17
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Holman A, Parikh N, Clauw DJ, Williams DA, Tapper EB. Contemporary management of pain in cirrhosis: Toward precision therapy for pain. Hepatology 2023; 77:290-304. [PMID: 35665522 PMCID: PMC9970025 DOI: 10.1002/hep.32598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 02/03/2023]
Abstract
Chronic pain is highly prevalent in patients with cirrhosis and is associated with poor health-related quality of life and poor functional status. However, there is limited guidance on appropriate pain management in this population, and pharmacologic treatment can be harmful, leading to adverse outcomes, such as gastrointestinal bleeding, renal injury, falls, and hepatic encephalopathy. Chronic pain can be categorized mechanistically into three pain types: nociceptive, neuropathic, and nociplastic, each responsive to different therapies. By discussing the identification, etiology, and treatment of these three mechanistic pain descriptors with a focus on specific challenges in patients with cirrhosis, we provide a framework for better tailoring treatments, including nonpharmacologic therapies, to patients' needs.
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Affiliation(s)
- Alexis Holman
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Neehar Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Dan J. Clauw
- Chronic Pain and Fatigue Research Center, Anesthesiology Department, University of Michigan, Ann Arbor, Michigan, USA
| | - David A. Williams
- Chronic Pain and Fatigue Research Center, Anesthesiology Department, University of Michigan, Ann Arbor, Michigan, USA
| | - Elliot B. Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
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18
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Quah Y, Yi-Le JC, Park NH, Lee YY, Lee EB, Jang SH, Kim MJ, Rhee MH, Lee SJ, Park SC. Serum biomarker-based osteoporosis risk prediction and the systemic effects of Trifolium pratense ethanolic extract in a postmenopausal model. Chin Med 2022; 17:70. [PMID: 35701790 PMCID: PMC9199188 DOI: 10.1186/s13020-022-00622-7] [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: 03/21/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recent years, a soaring number of marketed Trifolium pratense (red clover) extract products have denoted that a rising number of consumers are turning to natural alternatives to manage postmenopausal symptoms. T. pratense ethanolic extract (TPEE) showed immense potential for their uses in the treatment of menopause complications including osteoporosis and hormone dependent diseases. Early diagnosis of osteoporosis can increase the chance of efficient treatment and reduce fracture risks. Currently, the most common diagnosis of osteoporosis is performed by using dual-energy x-ray absorptiometry (DXA). However, the major limitation of DXA is that it is inaccessible and expensive in rural areas to be used for primary care inspection. Hence, serum biomarkers can serve as a meaningful and accessible data for osteoporosis diagnosis. Methods The present study systematically elucidated the anti-osteoporosis and estrogenic activities of TPEE in ovariectomized (OVX) rats by evaluating the bone microstructure, uterus index, serum and bone biomarkers, and osteoblastic and osteoclastic gene expression. Leverage on a pool of serum biomarkers obtained from this study, recursive feature elimination with a cross-validation method (RFECV) was used to select useful biomarkers for osteoporosis prediction. Then, using the key features extracted, we employed five classification algorithms: extreme gradient boosting (XGBoost), random forest, support vector machine, artificial neural network, and decision tree to predict the bone quality in terms of T-score. Results TPEE treatments down-regulated nuclear factor kappa-B ligand, alkaline phosphatase, and up-regulated estrogen receptor β gene expression. Additionally, reduced serum C-terminal telopeptides of type 1 collagen level and improvement in the estrogen dependent characteristics of the uterus on the lining of the lumen were observed in the TPEE intervention group. Among the tested classifiers, XGBoost stood out as the best performing classification model with the highest F1-score and lowest standard deviation. Conclusions The present study demonstrates that TPEE treatment showed therapeutic benefits in the prevention of osteoporosis at the transcriptional level and maintained the estrogen dependent characteristics of the uterus. Our study revealed that, in the case of limited number of features, RFECV paired with XGBoost model could serve as a powerful tool to readily evaluate and diagnose postmenopausal osteoporosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13020-022-00622-7.
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Affiliation(s)
- Yixian Quah
- College of Veterinary Medicine and Cardiovascular Research Institute, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, Republic of Korea.,Reproductive and Development Toxicology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Jireh Chan Yi-Le
- Centre of IoT and Big Data, Universiti Tunku Abdul Rahman, 31900, Kampar, Perak, Malaysia
| | - Na-Hye Park
- Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Republic of Korea
| | - Yuan Yee Lee
- College of Veterinary Medicine and Cardiovascular Research Institute, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, Republic of Korea
| | - Eon-Bee Lee
- College of Veterinary Medicine and Cardiovascular Research Institute, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, Republic of Korea
| | - Seung-Hee Jang
- Teazen Co. Ltd., Gyegok-myeon, Haenam-gun, Jeollanam-do, 59017, Republic of Korea
| | - Min-Jeong Kim
- Teazen Co. Ltd., Gyegok-myeon, Haenam-gun, Jeollanam-do, 59017, Republic of Korea
| | - Man Hee Rhee
- College of Veterinary Medicine and Cardiovascular Research Institute, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, Republic of Korea
| | - Seung-Jin Lee
- Reproductive and Development Toxicology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea.
| | - Seung-Chun Park
- College of Veterinary Medicine and Cardiovascular Research Institute, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, Republic of Korea.
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19
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Lu K, Shi TS, Shen SY, Shi Y, Gao HL, Wu J, Lu X, Gao X, Ju HX, Wang W, Cao Y, Chen D, Li CJ, Xue B, Jiang Q. Defects in a liver-bone axis contribute to hepatic osteodystrophy disease progression. Cell Metab 2022; 34:441-457.e7. [PMID: 35235775 DOI: 10.1016/j.cmet.2022.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 11/26/2021] [Accepted: 02/08/2022] [Indexed: 12/12/2022]
Abstract
Hepatic osteodystrophy (HOD) is a metabolic bone disease that is often associated with chronic liver disease and is marked by bone loss. Here, we demonstrate that hepatic expression of the phosphatase PP2Acα is upregulated during HOD, leading to the downregulation of expression of the hepatokine lecithin-cholesterol acyltransferase (LCAT). Loss of LCAT function markedly exacerbates the bone loss phenotype of HOD in mice. In addition, we found that alterations in cholesterol levels are involved in the regulation of osteoblast and osteoclast activities. We also found that LCAT improves liver function and relieves liver fibrosis in the mouse HOD model by promoting reversal of cholesterol transport from the bone to the liver. In summary, defects in a liver-bone axis occur during HOD that can be targeted to ameliorate disease progression.
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Affiliation(s)
- Ke Lu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China; Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, 321 Zhongshan Road, Nanjing 210008, China; Faculty of Pharmaceutical Sciences, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Tian-Shu Shi
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China; Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, 321 Zhongshan Road, Nanjing 210008, China
| | - Si-Yu Shen
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China; Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, 321 Zhongshan Road, Nanjing 210008, China
| | - Yong Shi
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China; Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, 321 Zhongshan Road, Nanjing 210008, China
| | - Hong-Liang Gao
- Core Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211166, China
| | - Jing Wu
- Core Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211166, China
| | - Xiang Lu
- Core Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211166, China
| | - Xiang Gao
- Model Animal Research Center of Nanjing University, Xuefu Road, Nanjing 210032, China
| | - Huang-Xian Ju
- State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing 210023, China
| | - Wei Wang
- National Laboratory of Solid-State Microstructures, Department of Physics, Nanjing University, Nanjing 210093, China
| | - Yi Cao
- National Laboratory of Solid-State Microstructures, Department of Physics, Nanjing University, Nanjing 210093, China
| | - Di Chen
- Faculty of Pharmaceutical Sciences, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China.
| | - Chao-Jun Li
- Ministry of Education Key Laboratory of Model Animal for Disease Study, Model Animal Research Center of the Medical School, Nanjing University, Nanjing 210093, China; State Key Laboratory of Reproductive Medicine and China International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China.
| | - Bin Xue
- Core Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211166, China.
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China; Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, 321 Zhongshan Road, Nanjing 210008, China.
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20
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Warner ER, Aloor FZ, Satapathy SK. A narrative review of nutritional abnormalities, complications, and optimization in the cirrhotic patient. Transl Gastroenterol Hepatol 2022; 7:5. [PMID: 35243114 PMCID: PMC8826036 DOI: 10.21037/tgh-20-325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/08/2021] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE The purpose of this manuscript is to identify the pathophysiology of the metabolic abnormalities observed in cirrhosis and to uncover associations, if any, to its complications, such as sarcopenia and hepatic encephalopathy (HE). BACKGROUND Liver dysfunction in cirrhosis is known to be a precipitating factor in the disruption of many physiological pathways, specifically nutrient metabolism. As a result, affected patients are highly susceptible to derangements of processes affecting multiple classes of macro- and micronutrients, including proteins, carbohydrates, electrolytes, vitamins, and minerals. These disruptions are thought to be contributory to the pathogenesis of known complications of cirrhosis. METHODS Literature research of relevant topics was conducted for the above stated objective; sources were limited to articles from peer-reviewed journals published within the last 30 years. CONCLUSION This research established that there is positive correlation between nutrient derangements and the increased risk of complications of cirrhosis, which themselves carry significant morbidity and mortality risk. It also established that some nutrient and electrolyte abnormalities are independent indicators of prognosis and adverse outcomes, such as mortality. This also highlights the importance of comprehension of anomalous metabolism and its complications as it necessitates serious consideration in clinical care. In addition to medical management, cirrhotic patients also require ancillary assessment, such as comprehensive nutritional evaluation, to identify and treat reversible nutritional derangements. This consideration provides the best opportunity to achieve maximal health outcomes in the cirrhotic patient population.
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Affiliation(s)
- Edgewood R. Warner
- Department of Medicine, Donald and Barbara Zucker School of Medicine/Northwell Health, Manhasset, NY, USA
| | | | - Sanjaya K. Satapathy
- Division of Hepatology and Sandra Atlas Bass Center for Liver Diseases and Transplantation, Department of Medicine, Donald and Barbara Zucker School of Medicine/Northwell Health, Manhasset, New York, USA
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21
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Rhyu J, Yu R. Newly discovered endocrine functions of the liver. World J Hepatol 2021; 13:1611-1628. [PMID: 34904032 PMCID: PMC8637678 DOI: 10.4254/wjh.v13.i11.1611] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/05/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
The liver, the largest solid visceral organ of the body, has numerous endocrine functions, such as direct hormone and hepatokine production, hormone metabolism, synthesis of binding proteins, and processing and redistribution of metabolic fuels. In the last 10 years, many new endocrine functions of the liver have been discovered. Advances in the classical endocrine functions include delineation of mechanisms of liver production of endocrine hormones [including 25-hydroxyvitamin D, insulin-like growth factor 1 (IGF-1), and angiotensinogen], hepatic metabolism of hormones (including thyroid hormones, glucagon-like peptide-1, and steroid hormones), and actions of specific binding proteins to glucocorticoids, sex steroids, and thyroid hormones. These studies have furthered insight into cirrhosis-associated endocrinopathies, such as hypogonadism, osteoporosis, IGF-1 deficiency, vitamin D deficiency, alterations in glucose and lipid homeostasis, and controversially relative adrenal insufficiency. Several novel endocrine functions of the liver have also been unraveled, elucidating the liver’s key negative feedback regulatory role in the pancreatic α cell-liver axis, which regulates pancreatic α cell mass, glucagon secretion, and circulating amino acid levels. Betatrophin and other hepatokines, such as fetuin-A and fibroblast growth factor 21, have also been discovered to play important endocrine roles in modulating insulin sensitivity, lipid metabolism, and body weight. It is expected that more endocrine functions of the liver will be revealed in the near future.
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Affiliation(s)
- Jane Rhyu
- Division of Endocrinology, Diabetes, and Metabolism, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Run Yu
- Division of Endocrinology, Diabetes, and Metabolism, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, United States
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22
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Pan B, Yan J, Zhao P, Liu J, Fu S. Relationship between nonalcoholic fatty liver disease and bone mineral density in type 2 diabetic patients. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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23
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Kim EG, Bae G, Kwon HY, Yang H. Aging and direct medical costs of osteoporotic fractures. J Bone Miner Metab 2021; 39:589-597. [PMID: 33417008 DOI: 10.1007/s00774-020-01192-0] [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: 12/17/2019] [Accepted: 12/03/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This study estimated the direct medical costs of osteoporotic fractures from a large claims database in Korea. MATERIALS AND METHODS We compared the medical costs of hip, vertebral, and wrist fractures between two age groups (50-64 years vs 65 years and older). We used a generalized linear model to investigate the drivers of osteoporotic fracture medical costs. RESULTS Hip fractures had the highest costs, regardless of age, followed by vertebral and wrist. The cost of hip fracture was USD 7285 for those aged 65 years and over and USD 6589 for those aged 50-64 years. The length of hospital days was higher in hip fracture patients, regardless of age, followed by vertebral and wrist. As the number of hospitalizations increased, the medical cost increased by 33.0% (p < 0.0001). Patients older than 65 years who were hospitalized for a fracture had a longer total length of hospital stay, compared to patients aged 50-64, regardlessness of the site of the fracture. The cost of treating fractures among those 65 years and older increased by 31.8% compared to those 50-64 years old (p < 0.0001). The direct medical costs increased by 8.6% as the number of fractures increased (p = 0.041). CONCLUSIONS We identified that osteoporotic fracture-related medical costs and hospitalization days increased with age. Interventions are effective in reducing fracture risk the potential to yield substantial cost savings.
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Affiliation(s)
- Eu Gene Kim
- Graduate school of Public Health, Seoul National University, Seoul, Korea
| | - Green Bae
- Collge of Pharmacy, Ewha Woman's University, Seoul, South Korea
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24
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Talebian R, Kampleitner C, Sagl B, Kuchler U, Dehpour AR, Gruber R. Bone healing around titanium implants in a preclinical model of bile duct ligation-induced liver injury. Clin Oral Implants Res 2021; 32:980-988. [PMID: 34114694 PMCID: PMC8453542 DOI: 10.1111/clr.13792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/12/2021] [Accepted: 05/20/2021] [Indexed: 12/27/2022]
Abstract
Objectives Chronic liver disease increases the risk for periodontal disease and osteoporotic fractures, but its impacts on bone regeneration remain unknown. Herein, we studied the impact of liver cirrhosis on peri‐implant bone formation. Material and Methods A total of 20 male Wistar rats were randomly divided into two groups: one with the common bile duct ligated (BDL) and the respective sham‐treated control group (SHAM). After four weeks of disease induction, titanium mini‐screws were inserted into the tibia. Successful induction of liver cirrhosis was confirmed by the presence of clinical symptoms. Another four weeks later, peri‐implant bone volume per tissue volume (BV/TV) and bone‐to‐implant contact (BIC) were determined by histomorphometric analysis. Results Peri‐implant bone formation was not significantly different between the SHAM and BDL groups. In the cortical compartment, the median percentage of peri‐implant new bone was 10.1% (95% CI of mean 4.0–35.7) and 22.5% (13.8–30.6) in the SHAM and BDL groups, respectively (p = .26). Consistently, the new bone in direct contact with the implant was 18.1% (0.4–37.8) and 23.3% (9.2–32.8) in SHAM and BDL groups, respectively (p = .38). When measuring the medullary compartment, the new bone area was 7.1% (4.8–10.4) and 10.4% (7.2–13.5) in the SHAM and BDL groups, respectively (p = .17). Medullary new bone in direct contact with the implant was 10.0% (1.2–50.4) and 20.6% (16.8–35.3) in SHAM and BDL groups, respectively, and thus comparable between the two groups (p = .46). Conclusions Bile duct ligation has no significant impact on the early stages of peri‐implant bone formation.
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Affiliation(s)
- Reza Talebian
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Experimental Medicine Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Carina Kampleitner
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Benedikt Sagl
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Ulrike Kuchler
- Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Ahmad Reza Dehpour
- Experimental Medicine Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reinhard Gruber
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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25
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Bukhari T, Jafri L, Majid H, Khan AHH, Siddiqui I. Determining Bone Turnover Status in Patients With Chronic Liver Disease. Cureus 2021; 13:e14479. [PMID: 33996337 PMCID: PMC8120131 DOI: 10.7759/cureus.14479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Hepatic osteodystrophy is an osteoporotic bone disease that occurs in chronic liver disease patients. The global prevalence of osteoporosis in patients with chronic liver disease is 30% to 40%. The pathogenesis of hepatic bone disease is not clear, but it occurs due to unstable bone remodeling with increased bone resorption and decreases bone formation. There has been an interest in determining the clinical utility of bone turnover markers (BTMs) in the assessment of osteoporosis in chronic liver patients. Methods This was a cross-sectional study conducted in patients with chronic liver disease at the section of chemical pathology, department of pathology and laboratory medicine, Aga Khan University (AKU). A total of 50 patients with age >8 years and a history of liver disease >6 months were recruited from January to October 2019. Liver function tests, i.e. aspartate aminotransferase (AST), alanine transaminase (ALT), albumin, and bilirubin, along with clinical signs of liver disease chronicity, were noted. The samples for BTMs, i.e. total serum alkaline phosphatase (ALP) and serum C-terminal telopeptide of type-1 collagen (CTX) were withdrawn and analyzed on Microlab (ELItech Group, Puteaux, France) and ADVIA Centaur (Siemens Diagnostics, NY), respectively. Results The majority of patients were males (n=34, 68%). Twenty-four (48%) patients suffered from fibrosis while 26 (52%) were without fibrosis. Median platelet count (68×109/L (102.5-50)) and median cholesterol levels (102.5 mg/dl (147-99.5)) were decreased, whereas gamma-glutamyl transferase (GGT) levels were higher in the fibrosis group as compared to the non-fibrosis group. The median levels of total ALP were 91.5 IU/L (103-82), and the median levels of CTX were 0.24 pg/ml (0.34-0.21). Conclusion In the present study, no significant difference was found in the BTMs of patients with and without chronic liver disease (CLD). However, there was a positive and significant correlation of BTMs, particularly CTX with age, bilirubin levels, and hepatomegaly.
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Affiliation(s)
- Tayyaba Bukhari
- Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Lena Jafri
- Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Hafsa Majid
- Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Aysha Habib H Khan
- Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Imran Siddiqui
- Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
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26
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Yang YJ, Kim DJ. An Overview of the Molecular Mechanisms Contributing to Musculoskeletal Disorders in Chronic Liver Disease: Osteoporosis, Sarcopenia, and Osteoporotic Sarcopenia. Int J Mol Sci 2021; 22:ijms22052604. [PMID: 33807573 PMCID: PMC7961345 DOI: 10.3390/ijms22052604] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023] Open
Abstract
The prevalence of osteoporosis and sarcopenia is significantly higher in patients with liver disease than in those without liver disease and osteoporosis and sarcopenia negatively influence morbidity and mortality in liver disease, yet these musculoskeletal disorders are frequently overlooked in clinical practice for patients with chronic liver disease. The objective of this review is to provide a comprehensive understanding of the molecular mechanisms of musculoskeletal disorders accompanying the pathogenesis of liver disease. The increased bone resorption through the receptor activator of nuclear factor kappa (RANK)-RANK ligand (RANKL)-osteoprotegerin (OPG) system and upregulation of inflammatory cytokines and decreased bone formation through increased bilirubin and sclerostin and lower insulin-like growth factor-1 are important mechanisms for osteoporosis in patients with liver disease. Sarcopenia is associated with insulin resistance and obesity in non-alcoholic fatty liver disease, whereas hyperammonemia, low amount of branched chain amino acids, and hypogonadism contributes to sarcopenia in liver cirrhosis. The bidirectional crosstalk between muscle and bone through myostatin, irisin, β-aminoisobutyric acid (BAIBA), osteocalcin, as well as the activation of the RANK and the Wnt/β-catenin pathways are associated with osteosarcopenia. The increased understandings for these musculoskeletal disorders would be contributes to the development of effective therapies targeting the pathophysiological mechanism involved.
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Affiliation(s)
- Young Joo Yang
- Department of Internal Medicine, Hallym University College of Medicine, Gangwon-do, Chuncheon 24252, Korea;
- Institute for Liver and Digestive Diseases, Hallym University, Gangwon-do, Chuncheon 24253, Korea
| | - Dong Joon Kim
- Department of Internal Medicine, Hallym University College of Medicine, Gangwon-do, Chuncheon 24252, Korea;
- Institute for Liver and Digestive Diseases, Hallym University, Gangwon-do, Chuncheon 24253, Korea
- Correspondence:
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27
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Cheng WZ, Lin YL, Su YC, Lin MC, Tseng CH, Lin RM, Huang ST. Post-surgery cholecystectomy, hepatectomy, and pancreatectomy patients increase the risk of osteoporotic vertebral fracture. J Bone Miner Metab 2021; 39:174-185. [PMID: 32757040 DOI: 10.1007/s00774-020-01129-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/11/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Data is currently lacking regarding association between the cholecystectomy/hepatectomy/pancreatectomy and the development of osteoporotic fracture. A retrospective cohort study was conducted to investigate the relationship between cholecystectomy/hepatectomy/pancreatectomy and the subsequent risk of developing osteoporotic fracture. MATERIALS AND METHODS Patients having undergone cholecystectomy, hepatectomy, or pancreatectomy between 2000 and 2012 were selected from the All Population Based Hospitalization File as the surgery cohort (n = 304,081), which was frequency matched with the control cohort (n = 304,081). The Cox proportional hazard model and Kaplan-Meier analysis were applied to measure the hazard ratios and the cumulative incidence of osteoporotic fracture. RESULTS A total of 1136 patients in the surgery cohort and 1179 patients in the control cohort were newly diagnosed with osteoporotic fracture. The overall osteoporotic fracture risk in the surgery cohort was 1.12-fold higher [95% confidence interval (CI), 1.03-1.21]. Specifically, surgery cohort had higher vertebral fracture risk than non-surgery cohort [adjusted hazard ratio (aHR) 1.12, Cl, 1.03-1.22]. In addition, patients underwent cholecystectomy (includes open and laparoscopic approaches), hepatectomy (only open approach), and pancreatectomy group (only open approach) were 1.10 (95% CI, 1.01-1.19), 1.49 (95% CI, 1.10-2.01), and 1.88 (95% CI, 1.23-2.87) times more likely to develop osteoporotic fracture, respectively. No significant difference of osteoporotic fracture risk was observed between open and laparoscopic cholecystectomy. The risk of osteoporotic fracture was significantly increased in females, patients aged ≥ 40 years old, and patients with some comorbidity. CONCLUSIONS Patients post cholecystectomy, hepatectomy, or pancreatectomy significantly increased risk of developing osteoporotic fracture, suggesting closer attention in post-operative care is needed.
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Affiliation(s)
- Wei-Zen Cheng
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, 40447, Taiwan
| | - Yun-Lan Lin
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, 40447, Taiwan
| | - Yuan-Chih Su
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chang-Hsing Tseng
- Tainan Municipal An-Nan Hospital-China Medical University, No. 66, Section 2, Changhe Road, Annan District, Tainan city, 70965, Taiwan
| | - Ruey-Mo Lin
- Tainan Municipal An-Nan Hospital-China Medical University, No. 66, Section 2, Changhe Road, Annan District, Tainan city, 70965, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, 40447, Taiwan.
- Tainan Municipal An-Nan Hospital-China Medical University, No. 66, Section 2, Changhe Road, Annan District, Tainan city, 70965, Taiwan.
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.
- Chinese Medicine Research Center, China Medical University, Taichung, Taiwan.
- Research Center for Chinese Herbal Medicine, China Medical University, Taichung, Taiwan.
- Department of Medical Research, Cancer Research Center for Traditional Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.
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Khan Z, Agarwal NB, Bhurani D, Khan MA. Risk Factors for Hematopoietic Stem Cell Transplantation-Associated Bone Loss. Transplant Cell Ther 2021; 27:212-221. [PMID: 33045384 DOI: 10.1016/j.bbmt.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT), including bone marrow transplantation, is the treatment of choice for many hematologic diseases, including hematologic malignancies and different types of anemia. The use of HSCT is increasing annually, mainly because advanced research that has been conducted in this area has exponentially expanded the indications for HSCT and significantly improved transplantation techniques and supportive care practices. Collectively, these improvements have led to an increase in the overall survival of HSCT patients. However, as post-HSCT survival is increasing, awareness of the potential late complications of HSCT is also growing. Unpredictable bone loss is one of the major post-HSCT complications that can cause significant morbidity and impair the quality of life of survivors. Although the exact mechanism of post-HSCT bone loss is not yet known, previous studies have suggested that numerous factors, including destructive preparative regimens (eg, high-dose chemotherapy, total body irradiation), treatment-related complications (eg, graft-versus-host disease), endocrine abnormalities (eg, diabetes mellitus, thyroid dysfunction, adrenal insufficiency), lack of physical activity, and the underlying disease itself are responsible for HSCT-associated bone loss. Sufficient data have been collected to suggest that post-HSCT bone loss can be prevented and treated using the same preventive and treatment modalities as used for the general population. Various guidelines have been formulated to help keep a check on HSCT recipients' deteriorating bone health.
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Affiliation(s)
- Zehva Khan
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Nidhi B Agarwal
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Dinesh Bhurani
- Department of Hemato-Oncology and Bone Marrow Transplantation, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Mohd Ashif Khan
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India.
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Takahashi A, Abe M, Yasunaka T, Arinaga-Hino T, Abe K, Takaki A, Torimura T, Zeniya M, Yoshizawea K, Kang JH, Suzuki Y, Nakamoto N, Inui A, Tanaka A, Takikawa H, Ohira H. Quality of life among patients with autoimmune hepatitis in remission: A comparative study. Medicine (Baltimore) 2020; 99:e22764. [PMID: 33120784 PMCID: PMC7581115 DOI: 10.1097/md.0000000000022764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Health-related quality of life (HRQOL) is lower in individuals with autoimmune hepatitis (AIH) than in the general population. However, previous evaluations of HRQOL for AIH have included a broad range of disease activities. The aim of this study was to clarify HRQOL among patients with AIH in remission.We assessed HRQOL in patients with AIH in remission, patients with chronic hepatitis C (CHC) with eradicated hepatitis C virus (HCV) and patients with primary biliary cholangitis (PBC) using the Japanese version of the Chronic Liver Disease Questionnaire (CLDQ).Participants comprised 62 patients with AIH in remission, 39 patients with CHC with eradicated HCV and 66 patients with PBC. Median ages of patients were 63, 69, and 64 years, respectively. Overall score (5.6 vs 5.9, P = .02) and fatigue (5.2 vs 5.6, P = .01) and worry (5.6 vs 6.0, P = .01) domain scores of the CLDQ were significantly lower in patients with AIH in remission than in CHC with eradicated HCV, and similar to scores except for the systemic symptoms domain in patients with PBC. Disease duration was associated with lower scores on systemic symptoms and activity domains of the CLDQ in patients with AIH in remission.Patients with AIH in remission show impaired HRQOL associated with disease duration.
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Affiliation(s)
- Atsushi Takahashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima
| | - Masanori Abe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, To-on, Ehime
| | - Tetsuya Yasunaka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-city
| | - Teruko Arinaga-Hino
- Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka
| | - Kazumichi Abe
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima
| | - Akinobu Takaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-city
| | - Takuji Torimura
- Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka
| | - Mikio Zeniya
- Sanno Medical Center, International University of Health and Welfare, 8-10-16 Akasaka, Minato-ku, Tokyo
| | - Kaname Yoshizawea
- Department of Gastroenterology, National Hospital Organization, Shinshu Ueda Medical Center, 1-27-21 Midorigaoka, Ueda-City, Nagano
| | - Jong-Hon Kang
- Center for Gastroenterology, Teine Keijinkai Hospital, 1-12 Maeda, Teine-ku, Sapprro
| | - Yoshiyuki Suzuki
- Department of Hepatology, Toranomon Hospital, Toranomon 2-2-2, Minato-ku
| | - Nobuhiro Nakamoto
- Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo
| | - Ayano Inui
- Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama-City, Kanagawa
| | - Atsushi Tanaka
- Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku
| | - Hajime Takikawa
- Faculty of Medical Technology, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima
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30
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Hidalgo DF, Boonpheng B, Sikandar S, Nasr L, Hidalgo J. Chronic Liver Disease and the Risk of Osteoporotic Fractures: A Meta-Analysis. Cureus 2020; 12:e10483. [PMID: 33083184 PMCID: PMC7567329 DOI: 10.7759/cureus.10483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction Chronic liver disease (CLD) causes more than 1 million deaths every year and remains a pandemic in the last decade affecting more than 600,000 patients in the United States. Previous studies found patients with CLD had increased risk of osteoporosis, so fractures were inferred to be complications of this condition. The aim of this meta-analysis is to summarize the best evidence that correlates CLD patients and the risk to develop osteoporotic fractures versus control patients without CLD. Methods A review of the literature using MEDLINE and EMBASE database was performed during December 2017. We included cross-sectional and cohort studies that reported relative risks (RR), odds ratios (OR) and hazard ratios (HR) comparing the risk of developing osteoporotic fractures among patients with CLD versus patients without CLD. Pooled OR and 95% confidence interval (CI) were calculated using generic inverse- variance method. The Newcastle-Ottawa scale was used to determine the quality of the studies. Effect estimates from the individual study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Results After the review of the literature, seven studies fulfilled the eligibility criteria established during the analysis. Significant association was found between CLD and osteoporotic fractures with a pooled OR of 2.13 (95% CI, 1.79 - 2.52). High heterogeneity among the studies was found (I2=88.5). No publication bias was found using Egger regression test (p=0.44). Conclusion We found a significant association between CLD and the risk of developing osteoporotic fractures. The calculated risk was 2.13 times higher for patients with CLD when compared with controls. The results showed high heterogeneity but no publication bias. More prospective studies are needed to fully understand the mechanisms involved in loss of bone density and osteoporotic fractures in order to improve the morbidity associated with this disease.
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Affiliation(s)
- Diego F Hidalgo
- Geriatrics, Jackson Memorial Hospital, University of Miami, Miami, USA
| | | | - Sehrish Sikandar
- Geriatrics, Miami Geriatric Research Education and Clinical Center Veterans Successful Aging for Frail Elders (VSAFE), Miami, USA
| | - Lubna Nasr
- Geriatrics, University of Miami Miller School of Medicine, Miami, USA.,Geriatrics, Miami Geriatric Research Education and Clinical Center Veterans Successful Aging for Frail Elders (VSAFE), Miami, USA
| | - Jessica Hidalgo
- Internal Medicine, San Francisco de Quito University, Quito, ECU
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Abstract
INTRODUCTION Iron overload, a state with excessive iron storage in the body, is a common complication in thalassemia patients which leads to multiple organ dysfunctions including the bone. Iron overload-induced bone disease is one of the most common and severe complications of thalassemia including osteoporosis. Currently, osteoporosis is still frequently found in thalassemia even with widely available iron chelation therapy. STUDY SELECTION Relevant publications published before December 2019 in PubMed database were reviewed. Both pre-clinical studies and clinical trials were obtained using iron overload, thalassemia, osteoporosis, osteoblast, and osteoclast as keywords. RESULTS Increased ROS production is a hallmark of iron overload-induced impaired bone remodeling. At the cellular level, oxidative stress affects bone remodeling by both osteoblast inhibition and osteoclast activation via many signaling pathways. In thalassemia patients, it has been shown that bone resorption was increased while bone formation was concurrently reduced. CONCLUSION In this review, reports on the cellular mechanisms of iron overload-associated bone remodeling are comprehensively summarized and presented to provide current understanding this pathological condition. Moreover, current treatments and potential interventions for attenuating bone remodeling in iron overload are also summarized to pave ways for the future discoveries of novel agents that alleviate this condition.
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Cystic Fibrosis-related Liver Disease is Associated With Increased Disease Burden and Endocrine Comorbidities. J Pediatr Gastroenterol Nutr 2020; 70:796-800. [PMID: 32443033 DOI: 10.1097/mpg.0000000000002694] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cystic fibrosis-related liver disease (CFLD) is the leading nonpulmonary cause of mortality in cystic fibrosis (CF). We evaluated and compared the burden of disease and nonrespiratory comorbidities of those with severe CFLD and those without (noCFLD). METHODS A retrospective nationwide (Australia) longitudinal review (from 1998 to 2016) of severe CFLD patients compared with noCFLD controls (matched 1 : 1 for age, genotype, pancreatic insufficiency, and center). RESULTS One hundred sixty-six patients with severe CFLD and 166 with noCFLD were identified. Forced expiratory volume in 1 second percentage of predicted (FEV1%) was significantly lower in CFLD than noCFLD across all ages (estimate [SE] -6.05% [2.12]; P = 0.004). Median (IQR) hospitalizations per patient per year were higher in CFLD than noCFLD for: respiratory indications (0.6 [0.2-1.3] vs 0.4 [0.1-0.9]; P = 0.002); gastrointestinal indications (0.09 [0-0.2] vs 0 [0-0.05]; P < 0.001); and other indications (0.05 [0-0.2] vs 0 [0-0.1]; P = 0.03). In the CFLD cohort, there was increased use of nasogastric (12.6% vs 5.4%; OR 2.51 [95% CI 1.06-6.46]; P = 0.03) and gastrostomy nutritional supplementation (22.9% vs 13.2%; OR 1.93 [95% CI 1.05-3.63]; P = 0.03). Additionally, the CFLD cohort had a higher frequency of bone diseases, osteopenia (26.5% vs 16.8%; OR 1.77 [95%CI 1.01-3.15]; P = 0.04) and osteoporosis (16.2% vs 8.4%; OR 2.1 [95% CI 1.01-4.52]; P = 0.04), as well as CF-related diabetes (38.5% vs 19.2%; OR 2.61 [95% CI 1.55-4.47]; P = 0.001). CONCLUSIONS Patients with severe CFLD have greater disease burden, with higher number of hospitalizations (both respiratory and nonrespiratory indications), nutritional interventions, and are at higher risk of CF-related bone disease and diabetes.
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Xu X, Wang R, Wu R, Yan W, Shi T, Jiang Q, Shi D. Trehalose reduces bone loss in experimental biliary cirrhosis rats via ERK phosphorylation regulation by enhancing autophagosome formation. FASEB J 2020; 34:8402-8415. [PMID: 32367591 DOI: 10.1096/fj.201902528rrr] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Xingquan Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School Nanjing P.R. China
- Joint Research Center for Bone and Joint Disease, Model Animal Research Center (MARC) Nanjing University Nanjing P.R. China
| | - Rongliang Wang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School Nanjing P.R. China
- Joint Research Center for Bone and Joint Disease, Model Animal Research Center (MARC) Nanjing University Nanjing P.R. China
| | - Rui Wu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School Nanjing P.R. China
- Joint Research Center for Bone and Joint Disease, Model Animal Research Center (MARC) Nanjing University Nanjing P.R. China
| | - Wenjin Yan
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School Nanjing P.R. China
- Joint Research Center for Bone and Joint Disease, Model Animal Research Center (MARC) Nanjing University Nanjing P.R. China
| | - Tianshu Shi
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School Nanjing P.R. China
- Joint Research Center for Bone and Joint Disease, Model Animal Research Center (MARC) Nanjing University Nanjing P.R. China
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School Nanjing P.R. China
- Joint Research Center for Bone and Joint Disease, Model Animal Research Center (MARC) Nanjing University Nanjing P.R. China
| | - Dongquan Shi
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School Nanjing P.R. China
- Joint Research Center for Bone and Joint Disease, Model Animal Research Center (MARC) Nanjing University Nanjing P.R. China
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Al Hamam NM, Al-Moaibed GF, Alfayez EH, Alfayez EH, Al-Mubaddil MS, Alramadhan NA. Prevalence and risk factors for osteoporotic fracture among adults with comorbidities in Al-Ahsaa, Saudi Arabia. J Family Med Prim Care 2020; 9:877-882. [PMID: 32318438 PMCID: PMC7114042 DOI: 10.4103/jfmpc.jfmpc_982_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 12/15/2022] Open
Abstract
Background and Aims Little is known about the prevalence of osteoporotic fracture, its sociodemographic correlates, and its comorbid conditions among the adult population of the Kingdome of Saudi Arabia (KSA). Hence, the present work aimed to assess the prevalence of adults at high risk of osteoporotic fracture in the presence of its known risk factors. As well, to determine the most commonly associated comorbidities of osteoporosis in Saudi Arabia. Methods A cross-sectional study was performed among 518 Saudi adults aged over 45 years in Al-Ahsaa city, KSA. The Arabic version of the fracture risk assessment FRAX without bone mineral density (BMD) was presented in an online questionnaire. Results The 10-year risk for major osteoporotic fracture was found in 50.81% of the participants; 23.48% of them were at high risk and 25.71% at moderate risk. Also, 26.27% of the respondents were at high risk of hip fracture. Significant correlates of osteoporotic fractures included female gender (P = 0.003), old age (P = 0.000), age at menopause (P = 0.000), low body mass index (BMI; P = 0.000), previous fracture (P = 0.000), alcohol consumption (P = 0.000), positive family history (P = 0.000), corticosteroids (P = 0.000), rheumatoid arthritis (P = 0.000), thyroid hyperactivity (P = 0.000), gonadal insufficiency (P = 0.000), chronic liver disease (P = 0.000), nutritional, or gestational disease (P = 0.000). Conclusion More than a third of the surveyed population had osteoporosis, which was associated with many sociodemographic and clinical characteristics. Therefore, early interventions for osteoporosis and the prevention of other comorbidities may improve the outcome of osteoporosis.
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Affiliation(s)
- Naif M Al Hamam
- Orthopedic Consultant, College of Medicine, King Faisal University, Al Ahsaa City, Saudi Arabia
| | - Ghusoon F Al-Moaibed
- Medical Intern, College of Medicine, King Faisal University, Al Ahsaa City, Saudi Arabia
| | - Emad H Alfayez
- Medical Intern, College of Medicine, Najran University, Najran City, Saudi Arabia
| | - Eman H Alfayez
- Medical Student, College of Medicine, Alfarabi Colleges, Riyadh, Saudi Arabia
| | | | - Narjes Ali Alramadhan
- Medical Student, College of Medicine, King Faisal University, Al Ahsaa City, Saudi Arabia
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Stirnimann J, Stirnimann G. Nutritional Challenges in Patients with Advanced Liver Cirrhosis. J Clin Med 2019; 8:jcm8111926. [PMID: 31717529 PMCID: PMC6912781 DOI: 10.3390/jcm8111926] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022] Open
Abstract
Patients with advanced liver cirrhosis are at risk of malnutrition and nutrition-associated complications. Significant ascites, a frequent finding in these patients, has an especially negative impact on oral nutrition. A negative caloric and protein balance can further deteriorate the already impaired synthetic function of the cirrhotic liver. An important factor in this situation is the diminished capacity of glycogen production and storage in the cirrhotic liver and, consequently, a reduced tolerability for fasting episodes. These episodes are frequently observed in hospitalized patients, e.g., while waiting for investigations, interventions or surgery. A comprehensive work-up of patients with advanced liver cirrhosis should include not only a thorough assessment regarding nutritional deficits, but also a muscularity analysis to identify patients with sarcopenia. The overall nutritional treatment goal is to cover caloric deficits and assure a sufficiently high protein intake. Furthermore, vitamin and micronutrient deficiencies should be identified and corrective measures implemented where required. Ideally, optimal nutrition management can not only prevent the progression of malnutrition and sarcopenia in patients with advanced liver cirrhosis, but positively influence the evolution of the liver disease.
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Affiliation(s)
- Jessica Stirnimann
- Division of Diabetology, Endocrinology, Nutritional Medicine and Metabolism, University Hospital Inselspital and University of Bern, 3010 Bern, Switzerland;
| | - Guido Stirnimann
- University Clinic for Visceral Surgery and Medicine, University Hospital Inselspital and University of Bern, 3010 Bern, Switzerland
- Correspondence: or ; Tel.: +41-31-632-2111
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Onochie E, Kayani B, Dawson-Bowling S, Millington S, Achan P, Hanna S. Total hip arthroplasty in patients with chronic liver disease: A systematic review. SICOT J 2019; 5:40. [PMID: 31674904 PMCID: PMC6824439 DOI: 10.1051/sicotj/2019037] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Chronic liver disease (CLD) is a significant and increasingly prevalent co-morbidity in patients undergoing total hip arthroplasty (THA). These patients may develop metabolic bone disease (MBD) and systemic dysfunction, which pose challenges to THA surgery. This systematic review of literature aims to examine clinical outcomes and complications in patients with CLD undergoing THA and provide evidence-based approaches as to the optimization of their perioperative care. METHODS A Pubmed search was performed, identifying eight studies on 28 514 THAs for inclusion. Two additional studies reported on 44 patients undergoing THA post liver transplant. These were reviewed separately. RESULTS Increased early perioperative complications are reported recurrently. Review of long-term complications demonstrates an increased postoperative infection rate of 0.5% (p < 0.001) and perioperative mortality of 4.1% (p < 0.001). The need for revision surgery is more frequent at 4% (p < 0.001). Aetiology of need for revision surgery included; periprosthestic infection (70%), aseptic loosening (13%), instability (13%), periprosthetic fracture (2%) and liner wear (2%). THA in patients with liver transplants seems to offer functional improvement; however, no studies have formally assessed functional outcomes in the patient with active CLD. DISCUSSION A multidisciplinary perioperative approach is suggested in order to minimize increased complication risks. Specific measures include optimizing haemoglobin and taking measures to reduce infection. This review also highlights gaps in available literature and guides future research to appraise functional outcomes, further detail long-term failure reasons and study any differences in outcomes and complications based on the range of operative approaches and available implant choices.
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Affiliation(s)
- Elliot Onochie
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, UK
| | - Sebastian Dawson-Bowling
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, UK
| | - Steven Millington
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, UK
| | - Pramod Achan
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, UK
| | - Sammy Hanna
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, UK
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Kapoor N, Cherian KE, Sajith KG, Thomas M, Eapen CE, Thomas N, Paul TV. Renal Tubular Function, Bone Health and Body Composition in Wilson's Disease: A Cross-Sectional Study from India. Calcif Tissue Int 2019; 105:459-465. [PMID: 31317233 DOI: 10.1007/s00223-019-00588-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022]
Abstract
There is limited literature from India with regard to the prevalence and magnitude of renal tubular and bone manifestations in Wilson's disease (WD). Thus, we studied the prevalence of renal tubular acidosis among Indian patients with WD and also evaluated bone health and body composition in them. It was a cross-sectional study conducted at a south Indian tertiary care center. Twenty-five consecutive patients with WD aged more than 12 years attending the hepatology and neurology departments and 50 age, sex and BMI-matched controls were recruited. After clinical assessment, they underwent biochemical testing to assess renal tubular dysfunction. Bone mineral density (BMD) and body composition were assessed using a dual energy X-ray absorptiometry (DXA) scanner. Fifty-six percent (14/25) of patients with WD had renal tubular acidosis (RTA). Of them, 24% were diagnosed to have distal RTA. RTA was more common in hepatic WD patients who had prolonged duration of illness. Patients with WD had significantly lower BMD as compared to control subjects (p < 0.05). Low BMI, low IGF-1 and a shorter duration of therapy were key determinants of low bone mass in them (p < 0.05). Patients with WD had significantly more body fat (p = 0.01) and lower lean muscle mass (p = 0.03) when compared to age, sex and BMI-matched controls. In conclusion, renal tubular acidosis was common in patients with Wilson's disease. These patients had a lower bone mineral density, higher body fat percentage and lower lean muscle mass as compared to controls.
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Affiliation(s)
- Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Kripa Elizabeth Cherian
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - Maya Thomas
- Department of Neurology, Christian Medical College, Vellore, India
| | | | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Thomas V Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, 632004, India.
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Milman NT, Schioedt FV, Junker AE, Magnussen K. Diagnosis and Treatment of Genetic HFE-Hemochromatosis: The Danish Aspect. Gastroenterology Res 2019; 12:221-232. [PMID: 31636772 PMCID: PMC6785287 DOI: 10.14740/gr1206] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022] Open
Abstract
This paper outlines the Danish aspects of HFE-hemochromatosis, which is the most frequent genetic predisposition to iron overload in the five million ethnic Danes; more than 20,000 people are homozygous for the C282Y mutation and more than 500,000 people are compound heterozygous or heterozygous for the HFE-mutations. The disorder has a long preclinical stage with gradually increasing body iron overload and eventually 30% of men will develop clinically overt disease, presenting with symptoms of fatigue, arthralgias, reduced libido, erectile dysfunction, cardiac disease and diabetes. Subsequently the disease may progress into irreversible arthritis, liver cirrhosis, cardiomyopathy, pancreatic fibrosis and osteoporosis. The effective standard treatment is repeated phlebotomies, which in the preclinical and early clinical stages ensures a normal survival rate. Early detection of the genetic predisposition to the disorder is therefore important to reduce the overall burden of clinical disease. Population screening seems to be cost-effective and should be considered.
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Affiliation(s)
- Nils Thorm Milman
- Digestive Disease Center K, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Frank Vinholt Schioedt
- Digestive Disease Center K, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anders Ellekaer Junker
- Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Karin Magnussen
- Department of Blood Center and Medical Biochemistry, Innlandet Hospital Trust, Lillehammer, Norway
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The influence of TRAIL, adiponectin and sclerostin alterations on bone loss in BDL-induced cirrhotic rats and the effect of opioid system blockade. Life Sci 2019; 233:116706. [DOI: 10.1016/j.lfs.2019.116706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/24/2019] [Accepted: 07/28/2019] [Indexed: 12/31/2022]
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Jeong HM, Kim DJ. Bone Diseases in Patients with Chronic Liver Disease. Int J Mol Sci 2019; 20:E4270. [PMID: 31480433 PMCID: PMC6747370 DOI: 10.3390/ijms20174270] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023] Open
Abstract
Osteoporosis is a frequently observed complication in patients with chronic liver disease, particularly liver cirrhosis and cholestatic liver diseases. In addition, osteoporosis is critical in patients receiving a liver transplant. Nevertheless, few studies have evaluated bone diseases in patients with more frequently observed chronic liver disease, such as chronic viral hepatitis, nonalcoholic fatty liver disease and alcoholic liver disease. Osteoporosis is a disease caused by an imbalance in the activities of osteoblasts and osteoclasts. Over the last few decades, many advances have improved our knowledge of the pathogenesis of osteoporosis. Importantly, activated immune cells affect the progression of osteoporosis, and chronic inflammation may exert an additional effect on the existing pathophysiology of osteoporosis. The microbiota of the intestinal tract may also affect the progression of bone loss in patients with chronic liver disease. Recently, studies regarding the effects of chronic inflammation on dysbiosis in bone diseases have been conducted. However, mechanisms underlying osteoporosis in patients with chronic liver disease are complex and precise mechanisms remain unknown. The following special considerations in patients with chronic liver disease are reviewed: bone diseases in patients who underwent a liver transplant, the association between chronic hepatitis B virus infection treatment and bone diseases, the association between sarcopenia and bone diseases in patients with chronic liver disease, and the association between chronic liver disease and avascular necrosis of the hip. Few guidelines are currently available for the management of low bone mineral density or bone diseases in patients with chronic liver disease. Due to increased life expectancy and therapeutic advances in chronic liver disease, the importance of managing osteoporosis and other bone diseases in patients with chronic liver disease is expected to increase. Consequently, specific guidelines need to be established in the near future.
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Affiliation(s)
- Hae Min Jeong
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-do 24253, Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Gangwon-do 24253, Korea
| | - Dong Joon Kim
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Gangwon-do 24253, Korea.
- Department of Internal Medicine, Hallym University College of Medicine, Seoul 05355, Korea.
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Wei MT, Le AK, Chang MS, Hsu H, Nguyen P, Zhang JQ, Wong C, Wong C, Cheung R, Nguyen MH. Antiviral therapy and the development of osteopenia/osteoporosis among Asians with chronic hepatitis B. J Med Virol 2019; 91:1288-1294. [PMID: 30776311 DOI: 10.1002/jmv.25433] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Recent studies have suggested a potential increase in the incidence of osteoporosis for patients receiving tenofovir disoproxil fumarate (TDF), but this issue remains controversial. METHODS The retrospective cohort study of 1224 Asian chronic hepatitis B (CHB) patients greater than 18 years without baseline osteopenia/osteoporosis seen at four US centers from 2008 to 2016. Patients were categorized into three groups-treatment-naive patients who initiated therapy with TDF (1) or entecavir (ETV) (2), or untreated patients (3). Patients were followed until the development of osteopenia/osteoporosis or end of the study. RESULTS Of the 1224 study patients, 276 were treated with TDF, 335 with ETV, and 613 were untreated. The prevalence of cirrhosis was lower for untreated patients (2.6% vs 16.3% for TDF and 17.6% for ETV; P < 0.001). The 8-year cumulative incidence rate of osteopenia/osteoporosis was 13.17% for TDF, 15.09% for ETV, and 10.17% for untreated patients, with no statistically significant difference among the three groups ( P = 0.218). On multivariate Cox regression controlling for demographics, osteoporosis risk factors, albumin, and hepatitis B virus (HBV) DNA levels, neither TDF (adjusted hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.34 and 1.59) nor ETV (adjusted HR = 0.98; 95% CI: 0.51 and 1.90) were associated with increased osteopenia/osteoporosis risk compared with untreated patients. CONCLUSIONS Our retrospective study suggests that there is no significant increase in the incidence of osteopenia/osteoporosis for patients with CHB treated with TDF or ETV during a median follow-up of about 4 to 5 years. However, further study with longer follow-up is needed as an anti-HBV therapy, which is often lifelong or long-term and the development of osteopenia/osteoporosis can be a slow process.
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Affiliation(s)
- Mike T Wei
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
| | - An K Le
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
| | - Matthew S Chang
- Department of Gastroenterology, Kaiser Permanente, Northern California, Santa Clara, California
| | - Holden Hsu
- Department of Medical Research, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Pauline Nguyen
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
| | | | - Chris Wong
- C. Wong Clinic, San Francisco, California
| | | | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Mindie H Nguyen
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
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Sun Y, Dai W, Liang Y, Yang P, Yang Q, Liang M, Xia N. Relationship between nonalcoholic fatty liver disease and bone mineral density in adolescents with obesity: a meta-analysis. Diabetes Metab Syndr Obes 2019; 12:199-207. [PMID: 30787626 PMCID: PMC6363492 DOI: 10.2147/dmso.s192256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Many studies have reported the relationship between nonalcoholic fatty liver disease (NAFLD) and bone mineral density (BMD) among adults. However, fewer studies on this topic have been reported in adolescents. We thus conducted a meta-analysis to show the association between NAFLD and BMD in adolescents with obesity. MATERIALS AND METHODS Computer retrieval was carried out via PubMed, Embase, Cochrane Library and the Cochrane Central Register of Controlled Trials from inception to September 2018. Six published case-control studies that assessed the relationship between NAFLD and BMD were included. RESULTS The six studies included 217 obese adolescents with NAFLD and 236 controls. The meta-analysis indicated that obese children with NAFLD had a lower BMD and Z-score than the control group (weighted mean difference [WMD]-0.03, 95% CI [-0.05, -0.02], P=0.000; [WMD] -0.26, 95% CI [-0.37, -0.14], P=0.000). However, we analyzed the factor of bone mineral content, and there was no correlation between the two groups ([WMD]-55.99, 95% CI [-132.16, 20.18], P=0.150). CONCLUSION Obese children with NAFLD are more susceptible to osteoporosis than children with only obesity. Because of the limitations related to the quantity and quality of the included literature, further studies are still needed.
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Affiliation(s)
- Yue Sun
- Geriatric Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China,
| | - Weiran Dai
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Yuzhen Liang
- Department of Endocrinology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Pijian Yang
- Geriatric Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China,
| | - Qiong Yang
- Geriatric Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China,
| | - Min Liang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Ning Xia
- Geriatric Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China,
- Department of Science and Technology Education, Guangxi Zhuang Autonomous Region Health Committee, Nanning, Guangxi, People's Republic of China
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Zofkova I, Nemcikova P. Osteoporosis complicating some inborn or acquired diseases. Physiol Res 2018; 67:S441-S454. [PMID: 30484671 DOI: 10.33549/physiolres.934027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Osteoporosis in chronic diseases is very frequent and pathogenetically varied. It complicates the course of the underlying disease by the occurrence of fractures, which aggravate the quality of life and increase the mortality of patients from the underlying disease. The secondary deterioration of bone quality in chronic diseases, such as diabetes of type 1 and type 2 and/or other endocrine and metabolic disorders, as well as inflammatory diseases, including rheumatoid arthritis - are mostly associated with structural changes to collagen, altered bone turnover, increased cortical porosity and damage to the trabecular and cortical microarchitecture. Mechanisms of development of osteoporosis in some inborn or acquired disorders are discussed.
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Affiliation(s)
- I Zofkova
- Institute of Endocrinology, Prague, Czech Republic, Department of Nuclear Medicine, České Budějovice Hospital, Czech Republic.
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Abstract
Bone health is critical to overall health and quality of life. Although genetic factors play a key role in bone formation, there are several external factors that can be modified to preserve bone health. Diet, exercise, menstrual irregularities, medications, disease states, weight, and environmental factors can all affect fracture risk. Osteoporosis is characterized by decrease in bone mass and microarchitectural changes in the bone that increases fracture risk. Screening for osteoporosis may help facilitate treatment before fractures occur. Preventing fractures needs patient and physician understanding of bone health to improve and requires a team effort.
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Bihari C, Lal D, Thakur M, Sukriti S, Mathur D, Patil AG, Anand L, Kumar G, Sharma S, Thapar S, Rajbongshi A, Rastogi A, Kumar A, Sarin SK. Suboptimal Level of Bone-Forming Cells in Advanced Cirrhosis are Associated with Hepatic Osteodystrophy. Hepatol Commun 2018; 2:1095-1110. [PMID: 30202823 PMCID: PMC6128237 DOI: 10.1002/hep4.1234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/07/2018] [Indexed: 12/19/2022] Open
Abstract
Bone loss is common in advanced cirrhosis, although the precise mechanisms underlying bone loss in cirrhosis are unknown. We studied the profile and functionality of bone-forming cells and bone-building proteins in bone marrow (BM) of individuals with cirrhosis (n = 61) and individuals without cirrhosis as normal controls (n = 50). We also performed dual energy X-ray absorptiometry for clinical correlation. BM mesenchymal cells (MSCs) were analyzed for colony-forming units-fibroblasts and their osteogenic (fibronectin-1 [FN1], insulin-like growth factor binding protein 3 [IGFBP3], collagen type 1 alpha 1 chain [COL1A1], runt-related transcription factor 2 [RUNX2], and alkaline phosphatase, liver [ALPL]) and adipogenic ( adiponectin, C1Q, and collagen domain containing [ADIPOQ], peroxisome proliferator-activated receptor gamma [PPARγ], and fatty acid binding protein 4 [FABP4]) potentials. Colony-forming units-fibroblasts were lower in patients with cirrhosis (P = 0.002) than in controls. Cirrhotic BM-MSCs showed >2-fold decrease in osteogenic markers. Compared to controls, patients with cirrhosis showed fewer osteocytes (P = 0.05), osteoblasts, chondroblasts, osteocalcin-positive (osteocalcin+) area, clusters of differentiation (CD)169+ macrophages (P < 0.001, each), and nestin+ MSCs (P = 0.001); this was more apparent in Child-Turcotte-Pugh (CTP) class C than A (P < 0.001). Multivariate logistic regression showed low nestin+ MSCs (P = 0.004) as a predictor of bone loss. Bone-resolving osteoclasts were comparable among CTP groups, but >2-fold decreased anti-osteoclastic and increased pro-osteoclastic factors were noted in patients with CTP C compared to CTP A. Bone-building proteins (osteocalcin [P = 0.008], osteonectin [P < 0.001], and bone morphogenic protein 2 [P = 0.001]) were decreased while anti-bone repair factors (fibroblast growth factor 23 [P = 0.015] and dipeptidyl peptidase 4 [P < 0.001]) were increased in BM and peripheral blood; this was more apparent in advanced cirrhosis. The dual energy X-ray absorptiometry scan T score significantly correlated with the population of osteoblasts, osteocytes, MSCs, and CD169+ macrophages. Conclusion: Osteoprogenitor cells are substantially reduced in patients with cirrhosis and more so in advanced disease. Additionally, increased anti-bone repair proteins enhance the ineffective bone repair and development of osteoporosis in cirrhosis. Hepatology Communications 2018;0:0-0).
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Affiliation(s)
- Chhagan Bihari
- Department of PathologyInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Deepika Lal
- Department of PathologyInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Monika Thakur
- Department of PathologyInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Sukriti Sukriti
- Department of Molecular and Cellular MedicineInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Dhananjay Mathur
- Department of Molecular and Cellular MedicineInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Anupama G. Patil
- Department of PathologyInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Lovkesh Anand
- Department of HepatologyInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Guresh Kumar
- Department of Molecular and Cellular MedicineInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Shvetank Sharma
- Department of Molecular and Cellular MedicineInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Shalini Thapar
- Department of RadiologyInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Apurba Rajbongshi
- Department of PathologySatyavadi Raja Harish Chandra HospitalDelhiIndia
| | - Archana Rastogi
- Department of PathologyInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Anupam Kumar
- Department of Molecular and Cellular MedicineInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Shiv K. Sarin
- Department of Molecular and Cellular MedicineInstitute of Liver and Biliary SciencesNew DelhiIndia
- Department of HepatologyInstitute of Liver and Biliary SciencesNew DelhiIndia
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Ghapanchi J, Zahed M, Haghnegahdar A, Niakan N, Sadeghzadeh A. Osteoporosis and Jaw Abnormalities in Panoramic Radiography of Chronic Liver Failure Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4280312. [PMID: 30225253 PMCID: PMC6129325 DOI: 10.1155/2018/4280312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/22/2018] [Accepted: 07/24/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Patients with chronic liver failure (CLF) are faced with many complications, because this organ is involved in various metabolic activities. Hepatic osteodystrophy is one of the major health issues encountered by this group of patients. The current study evaluated osteoporosis and bone changes in oral panoramic radiographies of cirrhotic patients. MATERIALS AND METHODS In this study, 138 panoramic views of CLF patients, candidates for liver transplant (65 females, 73 males, aged 19-68 years) referred to Shiraz University Dental Clinic (Shiraz, Iran) for pretransplant oral examination, were evaluated. Also 138 healthy individuals (69 females, 69 males, aged 18-70 years) referred to the same clinic were examined. Abnormalities such as osteoporosis, pathologic radiolucencies, pathologic calcifications, tonsilloliths, condylar degeneration, and other findings in the alveolar bones were recorded. RESULTS Osteoporosis was a common finding in CLF patients (p<0.001), and the probability of detecting low bone density in the panoramic view was 20.37 times higher among patients than healthy subjects. The probability of detecting pathologic jaw radiolucencies was 8.92 times higher in the case group than in the controls (p<0.001). Other bone abnormalities such as condylar degeneration and idiopathic osteosclerosis were also more prevalent in CLF patients compared to healthy subjects (p<0.001). CONCLUSION Cirrhotic patients are prone to osteoporosis of the alveolar bones. Also, pathologic jaw radiolucencies as a result of oral infections are more prevalent in this group of patients. Routine oral panoramic views are acceptable and cost-effective radiographies for use in detecting such abnormalities in the alveolar bones as well as overall dental health. These findings also support the importance of dental health examinations prior to liver transplantation to reduce the risk of organ rejection.
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Affiliation(s)
- Janan Ghapanchi
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Zahed
- Oral and Dental Disease Research Center, Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolaziz Haghnegahdar
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloofar Niakan
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azita Sadeghzadeh
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Lee HS, Chen CY, Huang WT, Chang LJ, Chen SCC, Yang HY. Risk of fractures at different anatomic sites in patients with irritable bowel syndrome: a nationwide population-based cohort study. Arch Osteoporos 2018; 13:80. [PMID: 30032473 DOI: 10.1007/s11657-018-0496-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/14/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study was to investigate the fracture risk of irritable bowel syndrome (IBS) in comparison with non-IBS group. Our results found that IBS group has increased risk for fracture, in particular of the spine, forearm, hip, and hand. INTRODUCTION Patients with IBS might also be at increased risk of osteoporosis and osteoporotic fractures. Up to now, the association between IBS and the risk of fractures at different anatomic sites occurrences is not completely clear. We conducted a population-based cohort analysis to investigate the fracture risk of IBS in comparison with non-IBS group. METHODS We identified 29,505 adults aged ≥ 20 years with newly diagnosed IBS using the Taiwan National Health Insurance Research Database in 2000-2012. A comparison group was constructed of patients without IBS who were matched according to gender and age. The occurrence of fracture was monitored until the end of 2013. We analyzed the risk of fracture events to occur in IBS by using Cox proportional hazards regression models. RESULTS Patients with IBS had a higher incidence of osteoporotic fractures compared with the non-IBS group (12.34 versus 9.45 per 1000 person-years) and an increased risk of osteoporotic fractures (adjusted hazard ratio [aHR] = 1.27, 95% confidence interval [CI] = 1.20-1.35). Site-specific analysis showed that the IBS group had a higher risk of fractures for spine, forearm, hip, and hand than did the non-IBS group. With further stratification for gender and age, a higher aHR value for osteoporotic fractures in the IBS group was seen across all age groups in males, but seen in elderly females. In addition, female, elderly, low income, hypertension, coronary artery disease, cerebrovascular disease, and depressive disorders as independent osteoporotic fracture risk factors in IBS patients. CONCLUSIONS The IBS is considered as a risk factor for osteoporotic fractures, particularly in female individuals and fracture sites located at the spine, forearm, hip, and hand.
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Affiliation(s)
- Herng-Sheng Lee
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, 813, Taiwan
| | - Chi-Yi Chen
- Department of Internal medicine, Division of Gastroenterology and Hepatology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, 600, Taiwan
| | - Wan-Ting Huang
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, 600, Taiwan
| | - Li-Jen Chang
- Department of Internal medicine, Division of Gastroenterology and Hepatology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, 600, Taiwan
| | - Solomon Chih-Cheng Chen
- Heng Chun Christian Hospital, Pingtung County, 946, Taiwan
- Department of Pediatrics, School of Medicine, Taipei Medical University, Taipei, 110, Taiwan
| | - Hsin-Yi Yang
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, 600, Taiwan.
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Miao C, Xie Z, Chang J. Critical Roles of microRNAs in the Pathogenesis of Fatty Liver: New Advances, Challenges, and Potential Directions. Biochem Genet 2018; 56:423-449. [PMID: 29951838 DOI: 10.1007/s10528-018-9870-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 06/20/2018] [Indexed: 12/17/2022]
Abstract
In this review, we summarize the current understanding of microRNA (miRNA)-mediated modulation of the gene expression in the fatty liver as well as related signaling pathways. Because of the breadth and diversity of miRNAs, miRNAs may have a very wide variety of biological functions, and much evidence has confirmed that miRNAs are involved in the pathogenesis of fatty liver. In the pathophysiological mechanism of fatty liver, miRNAs may be regulated by upstream regulators, and have their own regulatory targets. miRNAs display important roles in the pathological mechanisms of alcoholic liver disease and non-alcoholic fatty liver disease. At present, most of the miRNA studies are focused on cell and tissue levels, and in vivo studies will help us elucidate the regulation of miRNAs and help us evaluate the potential of miRNAs as diagnostic markers and therapeutic targets. Furthermore, there is evidence that miRNAs are involved in the mechanism of natural medicine treatment in fatty liver. Given the important roles of miRNAs in the pathogenesis of fatty liver, we predict that studies of miRNAs in the pathogenesis of fatty liver will contribute to the elucidation of fatty liver pathology and the treatment of fatty liver patients.
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Affiliation(s)
- Chenggui Miao
- Department of Pharmacy, School of Life and Health Science, Anhui Science and Technology University, Fengyang, 233100, China
| | - Zhongwen Xie
- State Key Laboratory of Tea Biochemistry and Biotechnology, School of Science and Technology of Tea and Food, Anhui Agricultural University, No. 130, Changjiang West Road, Hefei, 230036, Anhui, China.
| | - Jun Chang
- Fourth Affiliated Hospital, Anhui Medical University, Hefei, 230032, China
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Seto WK, Asahina Y, Brown TT, Peng CY, Stanciu C, Abdurakhmanov D, Tabak F, Nguyen TT, Chuang WL, Inokuma T, Ikeda F, Santantonio TA, Habersetzer F, Ramji A, Lau AH, Suri V, Flaherty JF, Wang H, Gaggar A, Subramanian GM, Mukewar S, Brunetto MR, Fung S, Chan HLY. Improved Bone Safety of Tenofovir Alafenamide Compared to Tenofovir Disoproxil Fumarate Over 2 Years in Patients With Chronic HBV Infection. Clin Gastroenterol Hepatol 2018:S1542-3565(18)30633-5. [PMID: 29933096 DOI: 10.1016/j.cgh.2018.06.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/25/2018] [Accepted: 06/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Long-term use of tenofovir disoproxil fumarate (TDF) reduces bone mineral density (BMD). Tenofovir alafenamide (TAF), a new prodrug of tenofovir, has shown non-inferior efficacy to TDF in patients with chronic hepatitis B virus (HBV) infection, with improved bone effects at 48 weeks. We performed a randomized trial to evaluate the bone safety of TAF compared with TDF over 2 years, assessing baseline risk factors for bone loss, were evaluated after 2 years of treatment. METHODS In a double-blind study, hepatitis B e antigen (HBeAg)-positive patients (n = 873) and HBeAg-negative patients (n = 425) were randomly assigned (2:1) to groups given TAF (25 mg; n = 866) or TDF (300 mg; n = 432) once daily. We assessed bone safety, including hip and spine BMD, using dual-energy X-ray absorptiometry and measured changes in serum markers of bone turnover over 96 weeks. RESULTS At baseline, treatment groups were well matched. At week 96, patients receiving TAF had significantly smaller decreases in hip BMD (mean reduction of 0.33%) than patients receiving TDF (mean reduction of 2.51%) (P < .001) and spine BMD (reduction of 0.75% in patients receiving patients receiving TAF vs reduction of 2.57% in patients receiving TDF) (P < .001). For hip BMD, the magnitude of difference in bone loss between the TAF and TDF groups increased at week 96 compared to week 48 (P < .001). The TAF group had minimal changes in markers of bone turnover by 12 weeks of treatment, but the TDF group had significant changes, compared to baseline. Risk factors for bone loss had fewer effects in patients receiving TAF than TDF at week 96. CONCLUSIONS In double-blind randomized trials, we found that after 2 years of treatment, patients receiving TAF had continued improvements in bone safety compared with patients receiving TDF. Clinicaltrial.gov ID NCT01940471 and NCT01940341.
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Affiliation(s)
- Wai-Kay Seto
- Department of Medicine, The University of Hong Kong, Hong Kong.
| | - Yasuhiro Asahina
- Department of Gastroenterology and Hepatology and Department of Liver Disease Control, Tokyo Medical and Dental University, Tokyo, Japan
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Cheng-Yuan Peng
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Grigore T. Popa," Iasi, Romania
| | | | - Fehmi Tabak
- Deparment of Infectious Diseases, Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | - Wan-Long Chuang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tetsuro Inokuma
- Department of Gastroenterology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Fusao Ikeda
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Teresa Antonia Santantonio
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Foggia, Fogia, Italy
| | - François Habersetzer
- Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Institut Hospitalo-Universitaire, Inserm U 1110, Institut sur les Maladies Virales et Hépatiques, Université de Strasbourg, Strasbourg, France
| | - Alnoor Ramji
- Gastrointestinal Research Institute, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | - Maurizia R Brunetto
- Clinical and Experimental Medicine Department, University of Pisa, Pisa, Italy
| | - Scott Fung
- Toronto General Hospital, Toronto, Ontario, Canada
| | - Henry Lik-Yuen Chan
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, Hong Kong
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Zhu S, Wei W, Liu Z, Yang Y, Jia H. Tanshinone‑IIA attenuates the deleterious effects of oxidative stress in osteoporosis through the NF‑κB signaling pathway. Mol Med Rep 2018; 17:6969-6976. [PMID: 29568934 PMCID: PMC5928650 DOI: 10.3892/mmr.2018.8741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 05/16/2017] [Indexed: 02/04/2023] Open
Abstract
Osteoclasts are responsible for bone resorption caused by bone microstructural damage and bone-related disorders. Evidence shows that tanshinone IIA (Tan‑IIA), a traditional Chinese medicine, is used clinically as a drug for the treatment of cardiovascular and cerebrovascular diseases. However, the efficacy and mechanism underlying the effect of Tan‑IIA on the viability of osteoclasts remain to be fully elucidated. The present study investigated the therapeutic effects of Tan‑IIA on osteoblast differentiation and oxidative stress in vitro and in vivo. Cell viability was analyzed and oxidative stress was examined in the osteoblasts. Wnt1sw/sw mice were used to investigate the therapeutic effects of Tan‑IIA on spontaneous tibia fractures and severe osteopenia. The bone strength, collagen and mineral were examined in the tibia. Osteoblast activity was also analyzed in the experimental mice. The Tan‑IIA‑induced differentiation of osteoclasts and the mechanism of action were investigated in osteocytes. The data showed that Tan‑IIA treatment improved cell viability. The data also demonstrated that Tan‑IIA decreased the levels of H2O2, accumulation of reactive oxygen species and apoptosis of osteoblasts. Tan‑IIA inhibited the deleterious outcomes triggered by oxidative stress. In addition, Tan‑IIA inhibited the activation of nuclear factor (NF)‑κB and its target genes, tumor necrosis factor (TNF)‑α, inducible nitric oxide synthase and cyclooxygenase 2, and increased the levels of TNF receptor‑associated factor 1 and inhibitor of apoptosis protein‑1/2 in the osteocytes. Furthermore, it was shown that Tan‑IIA reduced the propensity to fractures and severe osteopenia in mice with osteoporosis. Tan‑IIA also exhibited improved bone strength, mineral and collagen in the bone matrix of the experimental mice. It was found that the Tan‑IIA‑mediated benefits on osteoblast activity and function were through the NF‑κB signaling pathway. Taken together, the data obtained in the present study suggested that Tan‑IIA had protective effects against oxidative stress in osteoblastic differentiation in mice with osteoporosis by regulating the NF‑κB signaling pathway.
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Affiliation(s)
- Shaowen Zhu
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Wanfu Wei
- Department of Orthopedics, Tianjin Hospital, Tianjin 300211, P.R. China
| | - Zhiwei Liu
- Basic Medicine Institution, Public Health Center, Peking University, Beijing 100871, P.R. China
| | - Yang Yang
- Department of Orthopedics, Tianjin Hospital, Tianjin 300211, P.R. China
| | - Haobo Jia
- Department of Orthopedics, Tianjin Hospital, Tianjin 300211, P.R. China
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