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Vitamin D Supplementation and Its Impact on Different Types of Bone Fractures. Nutrients 2022; 15:nu15010103. [PMID: 36615761 PMCID: PMC9824692 DOI: 10.3390/nu15010103] [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: 11/20/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Vitamin D helps to balance the levels of calcium and phosphorus to maintain proper bone structure. It is also involved in essential biological roles and displays a wide spectrum of potential benefits in the human body. Since there are many types of fractures that occur at specific ages and due to different circumstances, the influence of vitamin D on the frequency of a particular fracture may differ. Thus, the authors investigated the possible preventive effect of vitamin D on the risks of vertebral fractures, hip fractures, stress fractures and pediatric fractures. Additional aspects of vitamin D, especially on recuperation after injures and its impact on the severity of particular fractures, were also discussed. It was suggested that vitamin D supplementation may contribute to a reduction in hip fracture risk due to reduced bone turnover, decreased frequency of falls and improved muscle function. Furthermore, vitamin D appears to lower the risk of stress fractures in athletes and military recruits. Due to a nonunified protocol design, presented investigations show inconsistencies between vitamin D supplementation and a decreased risk of vertebral fractures. However, a vitamin D preventive effect on pediatric fractures seems to be implausible.
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Yazan CD, Yaman A, Haklar G, Sirikci O, Deyneli O. Free and Bioavailable Vitamin D Levels of Patients with Type 1 Diabetes Mellitus and Association with Bone Metabolism. J Diabetes Metab Disord 2022; 21:689-695. [PMID: 35673502 PMCID: PMC9167174 DOI: 10.1007/s40200-022-01032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
Abstract
Aim Vitamin D deficiency is known to be associated with metabolic bone diseases. The aim of this study is to evaluate vitamin D and calculated free and bioactive vitamin D levels of type 1 diabetic patients and to evaluate the association with bone turnover markers. Method This cross-sectional study includes 60 patients admitted to endocrinology outpatient clinic with diagnosis of type 1 diabetes mellitus and 60 controls. Weight, height and waist circumference were recorded and blood samples were taken for measurement of 25-hydroxyvitamin D (25(OH)D), vitamin D binding protein (VDBP), osteocalcin, bone alkaline phosphatase (bone-ALP), c-telopeptide. Free and bioavailable vitamin D levels were calculated with formula. Results Vitamin D levels of type 1 diabetic patients were significantly higher (p = 0.01). Parathormone levels of the group with vitamin D level under 20 ng/ml was significantly higher (p = 0.029). VDBP levels were similar in both groups. Correlation analysis of free and bioavailable vitamin D level with osteocalcin, c-telopeptide, bone alkaline phosphatase revealed only a weak significant correlation between free vitamin D and osteocalcin (r = -0.201; p = 0.028). A negative correlation was determined between 25(OH)D and parathormone levels (r = -0.294; p < 0.005). Serum osteocalcin, bone alkaline phosphatase and c-telopeptide levels of control group were significantly higher. Conclusion 25(OH)D levels of the study population was extremely low. The measurement of VDBP and calculated free and bioactive vitamin D levels did not show a better correlation with bone turnover markers according to 25(OH)D levels.
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Affiliation(s)
- Ceyda Dincer Yazan
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
| | - Ali Yaman
- Department of Biochemistry, Marmara University School of Medicine, Istanbul, Turkey
| | - Goncagul Haklar
- Department of Biochemistry, Marmara University School of Medicine, Istanbul, Turkey
| | - Onder Sirikci
- Department of Biochemistry, Marmara University School of Medicine, Istanbul, Turkey
| | - Oguzhan Deyneli
- Department of Endocrinology and Metabolism, Koc University School of Medicine, Istanbul, Turkey
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Mendonça F, Neves JS, Silva MM, Salazar D, Ferreira MJ, Guerreiro V, Pedro J, Varela A, Souto S, Lau E, Preto J, Freitas P, Carvalho D. Type 2 Diabetes Mellitus and Bariatric Surgery: Impact on Parathyroid Hormone, Calcium, and Vitamin D Levels. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2021.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fernando Mendonça
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto (I3S), Porto, Portugal
| | - Maria Manuel Silva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Daniela Salazar
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Maria João Ferreira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Vanessa Guerreiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Jorge Pedro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Ana Varela
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto (I3S), Porto, Portugal
- Centro de Responsabilidade Integrado em Obesidade, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Selma Souto
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto (I3S), Porto, Portugal
- Centro de Responsabilidade Integrado em Obesidade, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Eva Lau
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto (I3S), Porto, Portugal
- Centro de Responsabilidade Integrado em Obesidade, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - John Preto
- Centro de Responsabilidade Integrado em Obesidade, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto (I3S), Porto, Portugal
- Centro de Responsabilidade Integrado em Obesidade, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto (I3S), Porto, Portugal
- Centro de Responsabilidade Integrado em Obesidade, Centro Hospitalar e Universitário de S. João, Porto, Portugal
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Cellini M, Piccini S, Ferrante G, Carrone F, Olivetti R, Cicorella N, Aroldi M, Pini D, Centanni M, Lania AG, Mazziotti G. Secondary hyperparathyroidism and thoracic vertebral fractures in heart failure middle-aged patients: a 3-year prospective study. J Endocrinol Invest 2020; 43:1561-1569. [PMID: 32240522 DOI: 10.1007/s40618-020-01237-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/23/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Vertebral fractures (VFs) were described in elderly patients with heart failure (HF) whereas their prevalence and determinants in younger HF patients are still unknown. This study aimed at assessing whether secondary hyperparathyroidism (SHPT) may influence the risk of VFs in middle-aged patients with HF. METHODS 84 patients (44 males, median age 48.5 years, range 43-65) with HF were prospectively evaluated at the baseline and after 36-month follow-up for bone mineral density (BMD) and VFs by quantitative morphometry on chest X-rays. Serum PTH, calcium, 25-hydroxyvitamin D and 24-h-urinary calcium were evaluated at the baseline and every 6-12 months during the study period. RESULTS At baseline, SHPT, hypovitaminosis D and VFs were found in 43 patients (51.2%), 73 patients (86.9%) and 29 patients (34.5%), respectively. SHPT was associated with VFs at baseline [inverse probability-weighted (ipw) odds ratio (OR) 12.2, p < 0.001]. Patients were treated with vitamin D3 alone (56%), vitamin D3 plus calcium carbonate (21.4%), calcitriol alone (4.8%), bisphosphonates plus vitamin D3 (8.3%) or a combination of bisphosphonates, vitamin D3 and calcium carbonate (9.5%). At the end of follow-up, hypovitaminosis D was corrected in all patients, whereas 19/84 patients (22.6%) had persistent SHPT. During the follow-up, 16 patients developed incident VFs which resulted to be associated with baseline SHPT (ipw OR 55.7, p < 0.001), even after adjusting from BMD change from baseline to follow-up (ipw OR 46.4, p < 0.001). CONCLUSIONS This study provides a first evidence that SHPT may be a risk factor for VFs in middle-aged patients with HF.
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Affiliation(s)
- M Cellini
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - S Piccini
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - G Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - F Carrone
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - R Olivetti
- Endocrinology Unit, ASST Carlo Poma, Mantova, Italy
| | - N Cicorella
- Cardiology Unit, ASST Carlo Poma, Mantova, Italy
| | - M Aroldi
- Cardiology Unit, ASST Carlo Poma, Mantova, Italy
| | - D Pini
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - M Centanni
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - A G Lania
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - G Mazziotti
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Abstract
PURPOSE OF REVIEW Hyperparathyroidism may be due to an autonomous hypersecretion of parathyroid hormone (PTH) or occurs in response to a number of physiological stimuli. A number of recent findings have provided new insights into the importance of the calcium-parathyroid-vitamin D axis to bone in normal physiology and pathological conditions. RECENT FINDINGS PTH is known to affect bone microarchitecture with different effects on cortical and trabecular bone compartments. In trabecular bone, PTH may exert anabolic effects, whereas PTH promotes bone resorption in cortical bone. Vertebral fractures are prevalent in primary hyperparathyroidism (PHPT), and patients seem to fracture at higher values of bone mineral density (BMD) than patients with osteoporosis. This may be explained by changes in bone microarchitecture, which cannot be detected by measuring BMD. Even in mild PHPT, bone seems to benefit from parathyroidectomy. In secondary hyperparathyroidism, bone seems much more susceptible to fracture with insufficient levels of vitamin D compared with a replete vitamin status. If elevated PTH levels cannot be explained by conditions known to cause secondary hyperparathyroidism, the condition is termed normocalcemic PHPT, which also has been associated with an increased risk of fractures. Hyperparathyroidism is harmful to bone, which is why it is of importance to normalize PTH levels either by parathyroidectomy in PHPT or by counteracting conditions known to increase PTH in secondary hyperparathyroidism.
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MESH Headings
- Adenoma/complications
- Adenoma/metabolism
- Adenoma/surgery
- Bone Density
- Bone Diseases, Metabolic/etiology
- Bone Diseases, Metabolic/metabolism
- Bone Diseases, Metabolic/pathology
- Bone Remodeling
- Fractures, Spontaneous/etiology
- Humans
- Hypercalcemia/congenital
- Hypercalcemia/metabolism
- Hypercalcemia/pathology
- Hyperparathyroidism, Primary/complications
- Hyperparathyroidism, Primary/metabolism
- Hyperparathyroidism, Primary/pathology
- Hyperparathyroidism, Primary/surgery
- Hyperparathyroidism, Secondary/complications
- Hyperparathyroidism, Secondary/metabolism
- Hyperparathyroidism, Secondary/pathology
- Hyperparathyroidism, Secondary/therapy
- Parathyroid Neoplasms/complications
- Parathyroid Neoplasms/metabolism
- Parathyroid Neoplasms/surgery
- Parathyroidectomy
- Risk Factors
- Spinal Fractures/etiology
- Vitamin D Deficiency/metabolism
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Affiliation(s)
- Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Henriette Ejlsmark-Svensson
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, Denmark
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Jiajue R, Jiang Y, Qi X, Wang Q, Wang W, Pei Y, Wang X, Huang W, Zheng X, Ning Z, Wang O, Li M, Xing X, Yu W, Xu L, Xia W. Calciotropic Hormones and the Prevalence of Vertebral Fractures in Chinese Postmenopausal Women with Vitamin D Insufficiency: Peking Vertebral Fracture Study. Calcif Tissue Int 2019; 104:622-630. [PMID: 30737534 DOI: 10.1007/s00223-019-00531-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/28/2019] [Indexed: 01/27/2023]
Abstract
This case-control study aimed to examine the effect of high serum parathyroid hormone (PTH) level, especially the effect of secondary hyperparathyroidism (SHPT) related to hypovitaminosis D, on bone metabolism and bone phenotypes. We included a total of 830 Chinese postmenopausal women aged ≥ 50 years with serum 25-hydroxyvitamin D (25(OH)D) level < 30 ng/ml, among whom 415 women had prevalent vertebral fractures (VFs) and others were age-matched controls. We measured serum levels of 25(OH)D, PTH and bone turnover markers (BTMs), which included C-terminal telopeptide of type I collagen (β-CTX), N-aminoterminal prepeptide of type I procollagen (P1NP) and osteocalcin (OC). Bone mineral densities (BMDs) at lumbar spine and femoral neck were quantified by dual-energy X-ray absorptiometry. Morphometric VFs were validated by lateral radiograph of thoracolumbar spine. Compared to fracture-free controls, women with VFs exhibited a higher serum level of PTH and a higher percentage of SHPT (both p < 0.05), but had a similar serum level of 25(OH)D (p = 0.166). Positive correlations were depicted between PTH and BTMs (all p < 0.01), and between 25(OH)D and bone formation markers (p = 0.013 for OC, p = 0.068 for P1NP), whereas no significant correlation was identified between both calciotropic hormones and BMDs or between 25(OH)D and β-CTX (all p > 0.05). Increasing PTH was associated with an increased risk of VFs independent of 25(OH)D and BMD [odds ratio (OR) per SD increase in PTH 1.016, 95% confidence interval (95% CI) 1.006-1.027]. Moreover, women with SHPT (i.e., > 68 pg/ml) had about three times odds for VF compared to women with normal PTH levels (OR 3.270, 95% CI 1.581-6.760). These data suggest that evaluated serum PTH level might promote the bone remodeling and then lead to increased risks of VFs among Chinese postmenopausal women with vitamin D insufficiency.
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Affiliation(s)
- Ruizhi Jiajue
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Xuan Qi
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Qiuping Wang
- Department of Endocrinology, Beijing Liangxiang Hospital, Beijing, 102401, China
| | - Wenbo Wang
- Department of Endocrinology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Yu Pei
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiran Wang
- Department of Cadre Unit, General Hospital of the Rocket Force, Beijing, 100088, China
| | - Wei Huang
- Department of Endocrinology, Beijing Haidian Hospital, Beijing, 100080, China
| | - Xin Zheng
- Department of Endocrinology, China Rehabilitation Research Center, Beijing, 100068, China
| | - Zhiwei Ning
- Department of Endocrinology, Beijing Chaoyang Hospital, Beijing, 100020, China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Xiaoping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Ling Xu
- Department of Gynaecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Weibo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, National Commission of Health, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
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Rødbro LL, Bislev LS, Sikjær T, Rejnmark L. Bone metabolism, density, and geometry in postmenopausal women with vitamin D insufficiency: a cross-sectional comparison of the effects of elevated parathyroid levels. Osteoporos Int 2018; 29:2211-2218. [PMID: 29955908 DOI: 10.1007/s00198-018-4602-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/05/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED Increased levels of parathyroid hormone (PTH) may have adverse effects on bone health. In a cross-sectional design, we investigated this hypothesis among 102 postmenopausal vitamin D insufficient women. Elevated PTH was associated with altered bone geometry, decreased bone mineral density in the spine, and increased bone turnover. INTRODUCTION In vitamin D insufficiency, elevated parathyroid hormone (PTH) levels may contribute to adverse effect on bone. We assessed effects of PTH responses to vitamin D insufficiency on bone metabolism, density, and geometry. METHODS Using a cross-sectional design, we investigated 102 healthy postmenopausal women with low 25-hydroxy-vitamin D (< 50 nmol/L) levels, who had either secondary hyperparathyroidism with elevated PTH levels (> 6.9 pmol/L, N = 51) or normal PTH levels (N = 51). Bone mineral density (BMD) and bone geometry were assessed by Dual-Energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT) and high-resolution peripheral QCT (HRpQCT) scans. Bone metabolism was assessed by biochemistry including bone turnover markers. RESULTS Levels of 25(OH)D were 38 (IQR 31-45) nmol/L with no differences between groups. PTH levels were 8.5 (IQR 7.5-9.5) in women with SHPT and 5.2 (4.4-6.6) pmol/L in women with normal PTH (p < 0.001). BMI and eGFR did not differ between groups. SHPT was associated with lower total- and trabecular bone area, lower cortical perimeter, and increased cortical area in tibia and radius. SHPT was associated with a lower weight-adjusted BMD at the lumbar spine (p < 0.05). High compared to normal PTH levels were associated with significantly lower plasma levels of 1,25(OH)2D, phosphate, but higher levels of osteocalcin and borderline higher levels of CTx. PTH correlated to osteocalcin and CTx. CONCLUSIONS High PTH levels are associated with altered bone geometry, increased bone turnover, and reduced BMD at the spine. Whether an increased cortical thickness with a lower trabecular volume is an effect of PTH or not needs further elucidations.
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Affiliation(s)
- L L Rødbro
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark.
| | - L S Bislev
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - T Sikjær
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark
| | - L Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Keser I, Cvijetić S, Bituh M, Rumora Samarin I, Ilich JZ, Colić Barić I, Rumbak I. Vitamin D and parathyroid hormone in relation to bone health in Croatian women. Arch Osteoporos 2018; 13:69. [PMID: 29936589 DOI: 10.1007/s11657-018-0483-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/31/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED In N = 400 women (46.9 ± 15.5 years), the prevalence of severe (< 25 nmol/l) and mild (≥ 25 and < 50 nmol/l) 25(OH)D deficiency was 7 and 32.2%, respectively, while 60.8% women had adequate status. Serum iPTH increased (> 37.0 pg/ml) when 25(OH)D was < 46.9 nmol/l. BMD was not significantly lower in the participants with iPTH > 37.0 pg/ml. PURPOSE Bone mineral density (BMD) is affected by serum 25-hydroxyvitamin D (25(OH)D) and intact parathyroid hormone (iPTH). Our objective was to analyze the association between serum 25(OH)D and iPTH and their mutual regulatory influence on BMD in women with 25(OH)D deficiency. We also attempted to establish a threshold for the serum 25(OH)D below which serum iPTH increases. METHODS The participants were 400 generally healthy women (46.9 ± 15.5 years) recruited from local communities. BMD was measured by dual-energy X-ray absorptiometry, and serum 25(OH)D, iPTH, calcium, phosphorus, alkaline phosphatase, osteocalcin, and C-telopeptide (CTX) were analyzed from the fasting blood samples. Multivariate regression models were used to investigate the relationships among serum 25(OH)D, iPTH, and BMD. RESULTS Serum iPTH increased when 25(OH)D concentrations were below 46.9 nmol/l. Severe 25(OH)D deficiency (< 25 nmol/l) was found in 7% of the participants and was associated with significantly higher iPTH compared to participants with serum 25(OH)D ≥ 25 nmol/l. BMD was negatively associated with iPTH only in the group with severe 25(OH)D deficiency. However, BMD was not significantly lower in the participants with severe 25(OH)D deficiency compared to those with mild deficiency or with adequate status. CONCLUSIONS Our results showed that threshold level of 25(OH)D below which iPTH started to rise was 46.9 nmol/l. There was no negative impact of iPTH on BMD or bone turnover markers in women with severe 25(OH)D deficiency. This might be due to the relatively young age of our participants in whom the unfavorable effect of 25(OH)D deficiency on bone might have not yet appeared.
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Affiliation(s)
- Irena Keser
- Laboratory for Nutrition Science, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, Zagreb, Croatia.
| | - Selma Cvijetić
- Institute for Medical Research and Occupational Health, Ksaverska Cesta 2, Zagreb, Croatia
| | - Martina Bituh
- Laboratory for Food Chemistry and Biochemistry, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, Zagreb, Croatia
| | - Ivana Rumora Samarin
- Laboratory for Food Chemistry and Biochemistry, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, Zagreb, Croatia
| | - Jasminka Z Ilich
- Institute for Successful Longevity, Florida State University, Tallahassee, FL, 32311, USA
| | - Irena Colić Barić
- Laboratory for Nutrition Science, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, Zagreb, Croatia
| | - Ivana Rumbak
- Laboratory for Nutrition Science, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, Zagreb, Croatia
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Ogata M, Iwasaki N, Ide R, Takizawa M, Tanaka M, Tetsuo T, Sato A, Uchigata Y. Role of vitamin D in energy and bone metabolism in postmenopausal women with type 2 diabetes mellitus: A 6-month follow-up evaluation. J Diabetes Investig 2017; 9:211-222. [PMID: 28371517 PMCID: PMC5754515 DOI: 10.1111/jdi.12666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 03/02/2017] [Accepted: 03/23/2017] [Indexed: 12/15/2022] Open
Abstract
AIMS/INTRODUCTION Resting energy expenditure was associated with a serum bone turnover marker in postmenopausal women with type 2 diabetes (T2DMPW) in the present cross-sectional study. To clarify the fundamental pathological factor for the correlation of bone metabolism and basal metabolism in type 2 diabetes, a 6-month prospective follow-up study was carried out with supplementation of vitamin D. MATERIALS AND METHODS A total of 44 T2DMPW were enrolled. The following factors were evaluated at the beginning and the end of the summer: procollagen type 1 N-terminal propeptide, carboxy-terminal collagen crosslinks-1, intact parathyroid hormone and 25-hydroxyvitamin D (25[OH]D), as well as diabetic complications, body composition, respiratory quotient and resting energy expenditure. A total of 23 patients with low 25(OH)D levels (˂20 ng/mL) were instructed to increase vitamin D levels by lifestyle change. Among them, 15 patients with osteoporosis were also administered alfacalcidol. RESULTS Serum 25(OH)D increased in 25 patients and decreased in 19 patients. Patients who did not receive the study intervention at the start tended to have a decreased 2525(OH)D level; therefore, the average 25(OH)D level of all patients was not changed. Changes in resting energy expenditure were positively correlated with those of procollagen type 1 N-terminal propeptide/carboxy-terminal collagen crosslinks-1. Changes in the respiratory quotient correlated with the mean glycated hemoglobin levels; procollagen type 1 N-terminal propeptide levels positively correlated with serum 25(OH)D after the intervention. These correlations were prominent in patients with increased 25(OH)D and those with alfacalcidol supplementation. CONCLUSIONS Restoration of vitamin D level might be a prerequisite for a normal correlation between bone and basal metabolism in T2DMPW. Lifestyle intervention for retention of vitamin D level is important even in summer, in T2DMPW.
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Affiliation(s)
- Makiko Ogata
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan.,Department of Nutrition, Faculty of Nursing and Nutrition, Shukutoku University, Chiba, Japan
| | - Naoko Iwasaki
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Risa Ide
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Miho Takizawa
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Mizuho Tanaka
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Tamaki Tetsuo
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Asako Sato
- Clinical Laboratory, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
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10
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Alba M, Xie J, Fung A, Desai M. The effects of canagliflozin, a sodium glucose co-transporter 2 inhibitor, on mineral metabolism and bone in patients with type 2 diabetes mellitus. Curr Med Res Opin 2016; 32:1375-85. [PMID: 27046479 DOI: 10.1080/03007995.2016.1174841] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Sodium glucose co-transporter 2 (SGLT2) inhibitors lower blood glucose levels in patients with type 2 diabetes mellitus (T2DM) by increasing urinary glucose excretion. This review provides a comprehensive summary of preclinical and clinical data on the effects of the SGLT2 inhibitor canagliflozin on mineral balance and bone. METHODS Published articles and internal study reports through November 2015 were included. RESULTS In clinical studies, canagliflozin was not associated with meaningful changes in serum or urine calcium, parathyroid hormone, or vitamin D. Canagliflozin was associated with increases in serum magnesium and phosphate without changes in their urinary excretion. Increases in serum collagen type-1 beta-carboxy-telopeptide (beta-CTX), a bone resorption marker, and osteocalcin, a bone formation marker, were observed with canagliflozin. Decreases in total hip bone mineral density (BMD) of up to 1.2% were seen with canagliflozin after 2 years; no changes in BMD were seen at other skeletal sites. Changes in total hip BMD and serum beta-CTX with canagliflozin correlated with decreases in body weight. In a clinical program-wide analysis, canagliflozin was associated with increased fracture risk that was driven by a higher incidence in the cardiovascular safety study (CANVAS), with no fracture imbalance seen in pooled data from other Phase 3 studies. The fracture imbalance occurred within 12 weeks after initiating treatment, most frequently in the distal portion of the upper and lower extremities. CONCLUSIONS Across clinical studies, canagliflozin did not meaningfully affect calcium homeostasis or hormones regulating calcium homeostasis. Increases in bone turnover markers and decreases in BMD at the total hip, but not at other sites, that correlated with weight loss were seen with canagliflozin. Canagliflozin was associated with a higher fracture incidence within 12 weeks, primarily in distal extremities. Data from ongoing canagliflozin studies will provide additional information on fracture risk.
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Affiliation(s)
- Maria Alba
- a Janssen Research & Development, LLC , Raritan , NJ , USA
| | - John Xie
- a Janssen Research & Development, LLC , Raritan , NJ , USA
| | - Albert Fung
- a Janssen Research & Development, LLC , Raritan , NJ , USA
| | - Mehul Desai
- a Janssen Research & Development, LLC , Raritan , NJ , USA
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11
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Li M, Lv F, Zhang Z, Deng W, Li Y, Deng Z, Jiang Y, Wang O, Xing X, Xu L, Xia W. Establishment of a normal reference value of parathyroid hormone in a large healthy Chinese population and evaluation of its relation to bone turnover and bone mineral density. Osteoporos Int 2016; 27:1907-16. [PMID: 26733373 DOI: 10.1007/s00198-015-3475-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/21/2015] [Indexed: 01/06/2023]
Abstract
UNLABELLED A normal reference value of parathyroid hormone (PTH) was established for the first time in a large sample of healthy Chinese subjects by completely excluding interference of vitamin D deficiency. A high PTH level correlated significantly with an elevated bone turnover and a reduced bone mineral density (BMD). INTRODUCTION The aims of this study are to establish a normal reference value for serum PTH and to evaluate the effect of parathyroid gland status on bone turnover and BMD. METHODS Our cross-sectional study included 1436 healthy individuals from 5 different Chinese cities. Concentrations of serum PTH, 25-hydroxyvitamin D (25OHD), procollagen I N-terminal peptide (P1NP, a bone formation marker), and carboxyl-terminal telopeptide of type I collagen (β-CTX, a bone resorption marker) were measured by electrochemiluminescence immunoassay. BMD was measured by dual-energy X-ray absorptiometry. The relation of PTH concentration to age, gender, height, and weight was examined. Reference values of PTH were established for all subjects and for subjects categorized by serum 25OHD concentrations. Correlations of PTH levels with bone turnover biomarkers and BMD were statistically analyzed. RESULTS Reference values of PTH were 8.84-69.95 pg/mL in all the subjects and 7.48-60.73 and 5.83-56.78 pg/mL in the subjects with serum 25OHD concentrations of ≥20 and ≥30 ng/mL, respectively. Serum PTH showed a negative linear correlation with 25OHD, and the breakpoint was 18.21 ng/mL, below which the PTH level rapidly increased. The increase in PTH levels with age showed a positive linear correlation with P1NP and β-CTX concentrations and a negative linear correlation with BMD at the lumbar spines and the femoral neck. CONCLUSIONS A reference value of PTH was established in a large sample of healthy Chinese subjects according to 25OHD status, gender, and age. A high PTH level correlated significantly with an elevated bone turnover and a reduced BMD.
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Affiliation(s)
- M Li
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - F Lv
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Z Zhang
- Department of Osteoporosis, Sixth People's Hospital, Shanghai Jiaotong University, No. 600 Yishan Road, Shanghai, 200233, China
| | - W Deng
- Department of Geriatrics, General Hospital of Guangzhou Military Command, No. 111 Liuhua Road, Guangzhou, 510010, China
| | - Y Li
- Department of Laboratory, Hubei General Hospital, No. 238 Jiefang Road, Wuhan, 430060, China
| | - Z Deng
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang road, Chongqing, 400010, China
| | - Y Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - O Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - X Xing
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - L Xu
- Department of Obstetrics and Gynecology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - W Xia
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China.
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12
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Mazziotti G, Dordoni C, Doga M, Galderisi F, Venturini M, Calzavara-Pinton P, Maroldi R, Giustina A, Colombi M. High prevalence of radiological vertebral fractures in adult patients with Ehlers-Danlos syndrome. Bone 2016; 84:88-92. [PMID: 26708925 DOI: 10.1016/j.bone.2015.12.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 11/12/2015] [Accepted: 12/17/2015] [Indexed: 11/26/2022]
Abstract
Previous studies have reported an increased prevalence of osteoporosis in Ehlers–Danlos syndrome (EDS), but these were limited by a small number of patients and lack of information on fragility fractures. In this crosssectional study, we evaluated the prevalence of radiological vertebral fractures (by quantitative morphometry) and bone mineral density (BMD, at lumbar spine, total hip and femoral neck by dual-energy X-ray absorptiometry) in 52 consecutive patientswith EDS (10 males, 42 females; median age 41 years, range: 21–71; 12with EDS classic type, 37 with EDS hypermobility type, 1 with classic vascular-like EDS, and 2 without specific classification) and 197 control subjects (163 females and 34 males; median age 49 years, range: 26–83) attending an outpatient bone clinic. EDS patients were also evaluated for back pain by numeric pain rating scale (NRS- 11).Vertebral fractures were significantly more prevalent in EDS as compared to the control subjects (38.5% vs. 5.1%; p b 0.001) without significant differences in BMD at either skeletal sites. In EDS patients, the prevalence of vertebral fractures was not significantly (p = 0.72) different between classic and hypermobility types. BMD was not significantly different between fractured and non-fractured EDS patients either at lumbar spine (p = 0.14), total hip (p=0.08), or femoral neck (p=0.21). Severe back pain(≥7 NRS)was more frequent in EDS patients with vertebral fractures as compared to thosewithout fractures (60% vs. 28%; p=0.04). Inconclusion, this is the first study showing high prevalence of vertebral fractures in a relatively large population of EDS patients. Vertebral fractures were associated with more severe back pain suggesting a potential involvement of skeletal fragility in determining poor quality of life. The lack of correlation between vertebral fractures and BMD is consistent with the hypothesis that bone quality may be impaired in EDS.
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Affiliation(s)
| | - C Dordoni
- Biology and Genetics, University of Brescia, Italy
| | - M Doga
- Endocrinology, University of Brescia, Italy
| | | | | | | | - R Maroldi
- Radiology, University of Brescia, Italy
| | - A Giustina
- Endocrinology, University of Brescia, Italy.
| | - M Colombi
- Biology and Genetics, University of Brescia, Italy
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13
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Oei L, Zillikens MC, Rivadeneira F, Oei EHG. Osteoporotic Vertebral Fractures as Part of Systemic Disease. J Clin Densitom 2016; 19:70-80. [PMID: 26376171 DOI: 10.1016/j.jocd.2015.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/13/2015] [Indexed: 12/31/2022]
Abstract
Our understanding of the genetic control of skeletogenesis and bone remodeling is expanding, and normally, bone resorption and bone formation are well balanced through regulation by hormones, growth factors, and cytokines. Osteoporosis is considered a systemic disease characterized by low bone mass and microarchitectural deterioration of bone tissue. Consequent increased bone fragility results in higher fracture risk. The most common osteoporotic fractures are located in the spine, and they form a significant health issue. A large variety of systemic diseases are associated with risk of osteoporotic vertebral fractures, illustrating its multifactorial etiology. Prevalences of these conditions vary from common to extremely rare, and incidence peaks differ according to etiology. This review appreciates different aspects of osteoporotic vertebral fractures as part of systemic disease, including genetic, immunologic, inflammatory, metabolic, and endocrine pathways. It seems impossible to be all-comprehensive on this topic; nevertheless, we hope to provide a reasonably thorough overview. Plenty remains to be elucidated in this field, identifying even more associated diseases and further exposing pathophysiological mechanisms underlying osteoporotic vertebral fractures.
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Affiliation(s)
- Ling Oei
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands; Department of Internal Medicine, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Abstract
PURPOSE OF REVIEW Predicting fracture risk is a major challenge because it allows the prevention of major osteoporotic fracture in high-risk populations. With the aging of the population, this matter will become of even greater importance. In recent years, novel clinical, biochemical, and imaging tools have been developed to improve the assessment of fracture risk. RECENT FINDINGS The present review summarizes novel clinical strategies, Dual energy X-ray absorptiometry (DXA)-derived tools, imaging techniques, and biochemical markers that have been developed recently to improve fracture risk prediction. SUMMARY DXA and clinical fracture risk prediction tools are preferential markers of fracture risk. Clinical fracture risk alone might be used if DXA facilities are unavailable. The fracture risk assessment tool may be used in osteoporosis consultation in many countries. Other tools may be used soon after more studies are performed, particularly trabecular bone score, quantitative ultrasound, bone turnover markers. Specific factors for example falls, hip axis length, vertebral fracture assessment could be used in individual patients. This may significantly improve the clinical decision-making.
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Affiliation(s)
- Catherine Cormier
- aDepartment of Rheumatology A, Cochin Hospital bPhysiology Department, Necker-Enfants-Malades Hospital, Paris Descartes University, Paris, France
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Silverberg SJ, Clarke BL, Peacock M, Bandeira F, Boutroy S, Cusano NE, Dempster D, Lewiecki EM, Liu JM, Minisola S, Rejnmark L, Silva BC, Walker MD, Bilezikian JP. Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 2014; 99:3580-94. [PMID: 25162667 PMCID: PMC5393491 DOI: 10.1210/jc.2014-1415] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This report summarizes data on traditional and nontraditional manifestations of primary hyperparathyroidism (PHPT) that have been published since the last International Workshop on PHPT. PARTICIPANTS This subgroup was constituted by the Steering Committee to address key questions related to the presentation of PHPT. Consensus was established at a closed meeting of the Expert Panel that followed. EVIDENCE Data from the 5-year period between 2008 and 2013 were presented and discussed to determine whether they support changes in recommendations for surgery or nonsurgical follow-up. CONSENSUS PROCESS Questions were developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies was undertaken. After extensive review and discussion, the subgroup came to agreement on what changes in the recommendations for surgery or nonsurgical follow-up of asymptomatic PHPT should be made to the Expert Panel. CONCLUSIONS 1) There are limited new data available on the natural history of asymptomatic PHPT. Although recognition of normocalcemic PHPT (normal serum calcium with elevated PTH concentrations; no secondary cause for hyperparathyroidism) is increasing, data on the clinical presentation and natural history of this phenotype are limited. 2) Although there are geographic differences in the predominant phenotypes of PHPT (symptomatic, asymptomatic, normocalcemic), they do not justify geography-specific management guidelines. 3) Recent data using newer, higher resolution imaging and analytic methods have revealed that in asymptomatic PHPT, both trabecular bone and cortical bone are affected. 4) Clinically silent nephrolithiasis and nephrocalcinosis can be detected by renal imaging and should be listed as a new criterion for surgery. 5) Current data do not support a cardiovascular evaluation or surgery for the purpose of improving cardiovascular markers, anatomical or functional abnormalities. 6) Some patients with mild PHPT have neuropsychological complaints and cognitive abnormalities, and some of these patients may benefit from surgical intervention. However, it is not possible at this time to predict which patients with neuropsychological complaints or cognitive issues will improve after successful parathyroid surgery.
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Affiliation(s)
- Shonni J Silverberg
- Columbia University College of Physicians & Surgeons (S.J.S., N.E.C., D.D., M.D.W., J.P.B.) New York, New York 10032; Mayo Clinic (B.L.C.), Rochester, Minnesota 55902; Indiana University School of Medicine (M.P.), Indianapolis, Indiana 46202; University of Pernambuco School of Medicine (F.B.), 52050-450 Recife, Brazil; INSERM UMR 1033, Université de Lyon (S.B.), 69437 Lyon, France; New Mexico Clinical Research and Osteoporosis Center (E.M.L.), University of New Mexico School of Medicine, Albuquerque, New Mexico 87106; Shanghai Jiao-tong University School of Medicine (L.J.-M.), Shanghai 200025, People's Republic of China; Sapienza University of Rome (S.M.), 00161 Rome, Italy; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; and Federal University of Minas Gerais (B.C.S.), Belo Horizonte 30.130-100, Brazil
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Masoni AM, Menoyo I, Bocanera R, Pezzotto SM, Morosano ME. Hypovitaminosis D and Associated Risk Factors in Postmenopausal Women. Health (London) 2014. [DOI: 10.4236/health.2014.611145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Garg M, Mahalle N. Calcium homeostasis, and clinical or subclinical vitamin D deficiency – Can a hypothesis of “intestinal calcistat” explain it all? Med Hypotheses 2013; 81:253-8. [DOI: 10.1016/j.mehy.2013.04.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 04/17/2013] [Indexed: 01/25/2023]
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