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Tomasiuk R, Zubrzycki IZ, Wiacek M. Age-dependent changes in fat- and water-soluble vitamins—National Health and Nutrition Examination Surveys study. Front Med (Lausanne) 2022; 9:907067. [PMID: 36388949 PMCID: PMC9641218 DOI: 10.3389/fmed.2022.907067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/28/2022] [Indexed: 11/28/2022] Open
Abstract
Aging is an independent risk factor for the development of various diseases associated, among others, with detrimental blood levels of fat- and water-soluble vitamins. Thus, the objective of this study is to investigate age-related changes in blood levels of vitamin A, B12, C, D, and E. Subject serum vitamin levels were obtained from the combined National Health and Nutrition Examination Surveys (NHANES). NHANESIII and NHANES 1999–2000, 2001–2002, 2003–2004, and 2005–2006. The raw data set was stratified into five age groups G1- G5: 20 ≤ G1 < 30, 30 ≤ G2 < 40, 40 ≤ G3 < 50, 50 ≤ G4 < 60, and 60 ≤ G5 < 70 years of age. Age stratified data was cleaned using the modified Horn algorithm. The reference range for the vitamin level of a specific age group was defined as data between the first and third quartile of the subject defined by normal blood pressure and normal bone density. Age-dependent changes in serum/plasma vitamin levels were assessed using the bootstrap technique with 10,000 repeats and Bonferroni adjustment. There was a continuous increase in vitamin A, B12, D, and E levels in the blood. However, the vitamin C concentration remained virtually constant in all age groups. There was a lack of cross-correlations between lipid and water-soluble vitamin levels and blood pressure and bone health. The following reference levels for vitamin A, B12, C, D, and E in subjects older than 20 years of age were established: vitamin A: 1.32–2.8 mmol/L, vitamin B12: 257.94–498.33 pmol/L, vitamin C: 38.18–79.2 mmol/L, vitamin D: 76.33–199.36 nmol/L and vitamin E: 3.65–41.12 μmol/L.
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Affiliation(s)
- Ryszard Tomasiuk
- Faculty of Medical and Health Sciences, Kazimierz Pułaski University of Technology and Humanities in Radom, Radom, Poland
| | - Igor Z. Zubrzycki
- Faculty of Medical and Health Sciences, Kazimierz Pułaski University of Technology and Humanities in Radom, Radom, Poland
- Department of Biometry and Mathematics, Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - Magdalena Wiacek
- Faculty of Medical and Health Sciences, Kazimierz Pułaski University of Technology and Humanities in Radom, Radom, Poland
- *Correspondence: Magdalena Wiacek,
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Migliorini F, Maffulli N, Spiezia F, Tingart M, Maria PG, Riccardo G. Biomarkers as therapy monitoring for postmenopausal osteoporosis: a systematic review. J Orthop Surg Res 2021; 16:318. [PMID: 34006294 PMCID: PMC8130375 DOI: 10.1186/s13018-021-02474-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background Biochemical markers of bone turnover (BTMs), such as bone alkaline phosphatase (bALP), procollagen type I N propeptide (PINP), serum cross-linked C-telopeptides of type I collagen (bCTx), and urinary cross-linked N-telopeptides of type I collagen (NTx), are commonly used for therapy monitoring purposes for osteoporotic patients. The present study evaluated the potential role of BTMs as therapy monitoring. Methods All randomized clinical trials (RCTs) comparing two or more pharmacological treatments for postmenopausal osteoporosis were accessed. Only studies that reported the value of bALP, PINP, bCTx, and NTx at last follow-up were included. A multivariate analysis was performed to assess associations between these biomarkers and clinical outcomes and rate of adverse events in patients with postmenopausal osteoporosis. A multiple linear model regression analysis through the Pearson product-moment correlation coefficient was used. Results A total of 16 RCTs (14,446 patients) were included. The median age was 67 years, and the median BMI 25.4 kg/m2. The median vertebral BMD was 0.82, hip BMD 0.79, and femur BMD 0.64 g/cm2. The ANOVA test found optimal within-group variance concerning mean age, body mass index, and BMD. Greater bALP was associated with lower femoral BMD (P = 0.01). Greater NTx was associated with a greater number of non-vertebral fractures (P = 0.02). Greater NTx was associated with greater rate of therapy discontinuation (P = 0.04). No other statistically significant associations were detected. Conclusion Our analysis supports the adoption of BTMs in therapy monitoring of osteoporotic patients. Level of evidence Level I, systematic review of RCTs.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England.,Centre for Sports and Exercise Medicine, Mile End Hospital, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England
| | - Filippo Spiezia
- Department of Orthopedics and Trauma Surgery, Ospedale San Carlo Potenza, Via Potito Petrone, Potenza, Italy
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peretti Giuseppe Maria
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Orthopedics and Traumatology, University of Milan, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giorgino Riccardo
- Orthopedics and Traumatology, University of Milan, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Aul AJ, Dudenkov DV, Mara KC, Juhn YJ, Wi CI, Maxson JA, Thacher TD. The relationship of 25-hydroxyvitamin D values and risk of fracture: a population-based retrospective cohort study. Osteoporos Int 2020; 31:1787-1799. [PMID: 32377805 PMCID: PMC7725389 DOI: 10.1007/s00198-020-05436-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/22/2020] [Indexed: 12/16/2022]
Abstract
UNLABELLED Our study investigates 25-hydroxyvitamin D levels and fracture risk using population-level data. 25-Hydroxyvitamin D values < 12, 12-19, and > 50 ng/mL were not associated with increased risk of fractures overall compared with values 20-50 ng/mL. Severely low levels may be associated with increased risk of osteoporotic fracture, particularly of the wrist. INTRODUCTION Studies of the relationship between serum 25-hydroxyvitamin D (25(OH)D) levels and fracture risk have been inconsistent. We hypothesized that high 25(OH)D concentrations (> 50 ng/mL) would be associated with increased risk of fracture. METHODS We identified all adult patients living in Olmsted County, Minnesota, between January 1, 2005 and December 31, 2011, who had at least one 25(OH)D measurement. Fracture outcomes were retrieved starting 30 days after 25(OH)D measurement and until patients' final clinical visit as an Olmsted County resident, December 31, 2014, or death. Data were analyzed using Cox proportional hazard regression. RESULTS Of 11,002 individuals with a 25(OH)D measurement, 5.8% had a 25(OH)D value ˂ 12 ng/mL, and 5.1% had a value > 50 ng/mL. Compared with subjects with 25(OH)D values 20-50 ng/mL (reference group), values < 12, 12-19, and > 50 ng/mL displayed no association with overall fracture risk. After adjusting for a prior diagnosis of osteoporosis/osteopenia, only individuals with values ˂ 12 ng/mL had increased risk of any osteoporotic fracture (aHR = 1.41; 95% CI 1.05-1.89) and wrist fracture (aHR = 2.11; 95% CI 1.27-3.48) compared with the reference group. Compared with the reference group, values ˂ 12 ng/mL were associated with increased risk of any fracture (aHR = 1.35; 95% CI 1.01-1.80), osteoporotic fracture (aHR = 2.18; 95% CI 1.44-3.31), and wrist fracture (aHR = 2.39; 95% CI 1.19-4.81) in subjects without a prior diagnosis of osteoporosis/osteopenia, but not in those with a prior diagnosis of osteoporosis/osteopenia. CONCLUSION Severely low 25(OH)D levels may be associated with increased risk of osteoporotic fracture, particularly of the wrist, but 25(OH)D values > 50 ng/mL were not associated with increased fracture risk.
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Affiliation(s)
- A J Aul
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - D V Dudenkov
- Department of Internal Medicine, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - K C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Y J Juhn
- Department of Community Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - C I Wi
- Department of Community Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - J A Maxson
- Department of Family Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - T D Thacher
- Department of Family Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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A comparison of exercise interventions from bed rest studies for the prevention of musculoskeletal loss. NPJ Microgravity 2019; 5:12. [PMID: 31098391 PMCID: PMC6506471 DOI: 10.1038/s41526-019-0073-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/14/2019] [Indexed: 12/27/2022] Open
Abstract
Musculoskeletal loss in actual or simulated microgravity occurs at a high rate. Bed rest studies are a reliable ground-based spaceflight analogue that allow for direct comparison of intervention and control participants. The aim of this review was to investigate the impact of exercise compared to no intervention on bone mineral density (BMD) and muscle cross-sectional area (muscle CSA) in bed rest studies relative to other terrestrial models. Eligible bed rest studies with healthy participants had an intervention arm with an exercise countermeasure and a control arm. A search strategy was implemented for MEDLINE. After screening, eight studies were identified for inclusion. Interventions included resistive exercise (RE), resistive vibration exercise (RVE), flywheel resistive exercise, treadmill exercise with lower body negative pressure (LBNP) and a zero-gravity locomotion simulator (ZLS). Lower limb skeletal sites had the most significant BMD losses, particularly at the hip which reduced in density by 4.59% (p < 0.05) and the tibial epiphysis by 6% (p < 0.05). Exercise attenuated bone loss at the hip and distal tibia compared to controls (p < 0.05). Muscle CSA changes indicated that the calf and quadriceps were most affected by bed rest. Exercise interventions significantly attenuated loss of muscle mass. ZLS, LBNP treadmill and RE significantly attenuated bone and muscle loss at the hip compared to baseline and controls. Despite exercise intervention, high rates of bone loss were still observed. Future studies should consider adding bisphosphonates and pharmacological/nutrition-based interventions for consideration of longer-duration missions. These findings correlate to terrestrial bed rest settings, for example, stroke or spinal-injury patients.
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Abstract
Reference intervals are relied upon by clinicians when interpreting their patients' test results. Therefore, laboratorians directly contribute to patient care when they report accurate reference intervals. The traditional approach to establishing reference intervals is to perform a study on healthy volunteers. However, the practical aspects of the staff time and cost required to perform these studies make this approach difficult for clinical laboratories to routinely use. Indirect methods for deriving reference intervals, which utilise patient results stored in the laboratory's database, provide an alternative approach that is quick and inexpensive to perform. Additionally, because large amounts of patient data can be used, the approach can provide more detailed reference interval information when multiple partitions are required, such as with different age-groups. However, if the indirect approach is to be used to derive accurate reference intervals, several considerations need to be addressed. The laboratorian must assess whether the assay and patient population were stable over the study period, whether data 'clean-up' steps should be used prior to data analysis and, often, how the distribution of values from healthy individuals should be modelled. The assumptions and potential pitfalls of the particular indirect technique chosen for data analysis also need to be considered. A comprehensive understanding of all aspects of the indirect approach to establishing reference intervals allows the laboratorian to harness the power of the data stored in their laboratory database and ensure the reference intervals they report are accurate.
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Salerno G, Ceccarelli M, de Waure C, D'Andrea M, Buonsenso D, Faccia V, Pata D, Valentini P. Epidemiology and risk factors of hypovitaminosis D in a cohort of internationally adopted children: a retrospective study. Ital J Pediatr 2018; 44:86. [PMID: 30053889 PMCID: PMC6062984 DOI: 10.1186/s13052-018-0527-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/18/2018] [Indexed: 01/20/2023] Open
Abstract
Background Predictors of hypovitaminosis D were extensively studied in the adult population, leading to an approximately complete understanding of them, while there is a lack of studies in the pediatric population, especially in migrant and internationally adopted children. In this retrospective study, we tried to identify the major laboratory predictors of hypovitaminosis D in a cohort of internationally adopted children. Methods Data were extracted from the database of the “Ethnopediatrics Outpatient Clinic” of the “A. Gemelli” Foundation University Hospital in Rome, Italy. Our study included 873 children evaluated from March 2007 to May 2016. Analysis of variance, chi square test, t test and multivariate logistic regression were performed, a “p” value < 0.05 was considered significant, with a confidence interval of 95%. Results We did not find any significant correlation between Vitamin D and Calcium, Phosphates or Magnesium levels within the population we examined. Moreover, parathyroid hormone is not a good predictor of Vitamin D Status. Conclusions Considering the strong influence Vitamin D status has not only on bone health, but also on general well-being, it is due to perform a vitamin D assessment as soon as possible, especially in internationally adopted children. Electronic supplementary material The online version of this article (10.1186/s13052-018-0527-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gilda Salerno
- Department of Woman and Child Health, "A. Gemelli" University Hospital Foundation, Unit of Pediatrics, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Chiara de Waure
- Public Health Institute, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Marianna D'Andrea
- Public Health Institute, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health, "A. Gemelli" University Hospital Foundation, Unit of Pediatrics, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Valerio Faccia
- Department of Gynecologic, Pediatric and Neonatologic Sciences, "Sant'Andrea" University Hospital, Unit of Pediatrics, University "Sapienza" of Rome, Rome, Italy
| | - Davide Pata
- Department of Woman and Child Health, "A. Gemelli" University Hospital Foundation, Unit of Pediatrics, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health, "A. Gemelli" University Hospital Foundation, Unit of Pediatrics, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
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Zou L, Wang C, Chen K, Shu Y, Chen X, Luo L, Zhao X. The Effect of Taichi Practice on Attenuating Bone Mineral Density Loss: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091000. [PMID: 28862661 PMCID: PMC5615537 DOI: 10.3390/ijerph14091000] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 02/08/2023]
Abstract
Objective: The purpose of this study was to determine the effects of practicing Taichi on attenuating bone mineral density (BMD) loss. Methods: Both electronic and manual searches were performed for randomized controlled trials (RCTs) examining Taichi for bone health. Two review authors independently performed study selection and data extraction according to inclusion criteria. A third party (Lin Luo) emerged to discuss with the two review authors and resolve a disagreement. Results: Twenty RCTs were found to meet the inclusion criteria and used for meta-analysis with a total effective sample of 1604. The aggregated results from this systematic review have shown significant benefits in favour of Taichi on BMD at lumbar spine (Standard Mean Difference, SMD) = 0.29; 95% CI 0.15 to 0.43; p < 0.0001), femur neck (SMD = 0.56; 95% CI 0.38 to 0.75; p < 0.00001), femur trochanter (SMD = 0.04; 95% CI 0.01 to 0.07; p = 0.007), total hip BMD (SMD = 0.46; 95% CI 0.16 to 0.76; p = 0.003). Conclusions: The aggregated results from this systematic review suggests that Taichi is effective on attenuating BMD loss at the regions of lumbar spine and proximal femur neck in special populations (e.g., older adults, perimenopausal and postmenopausal women, people with osteoarthritis, and cancer survivors). Researchers should further examine the effect of Taichi on the proximal femur trochanter and total hip so that a more definitive claim can be made regarding the beneficial effects for attenuating BMD loss in these musculoskeletal regions.
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Affiliation(s)
- Liye Zou
- Psychosomatic Laboratory, Springfield College, Springfield, MA 01109, USA.
- College of Sports Science, Jishou 416000, China.
| | - Chaoyi Wang
- College of Physical Education, Jilin University, Changchun 130022, China.
| | - Kevin Chen
- Integrative Medicine Lab, University of Maryland, Baltimore, MD 21201, USA.
| | - Yankai Shu
- College of Sports Science, Jishou 416000, China.
| | - Xiaoan Chen
- College of Sports Science, Jishou 416000, China.
| | - Lin Luo
- Department of Physical Education, North China Electric Power University, Beijing 102206, China.
| | - Xitang Zhao
- Department of Physical Education, ZhaoQing University, Zhaoqing 526061, China.
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Straub L, Riedel J, Luppa PB, Wissing J, Artmann A, Kiechle M, Seifert-Klauss VR. Mammographic Density and Vitamin D Levels - A Cross-sectional Study. Geburtshilfe Frauenheilkd 2017; 77:257-267. [PMID: 28392579 DOI: 10.1055/s-0043-102694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Some studies have already proposed an inverse association between vitamin D levels and breast density. As breast density is already considered an established risk factor for breast cancer, such a connection could offer a new starting point for the prevention of breast cancer. Material and Methods To investigate this suggested connection, a total of 412 pre- and 572 post-menopausal women for whom mammography was indicated were recruited into this cross-sectional study. In addition to a questionnaire-based interview on the patient's general and gynecological medical history, her eating habits and lifestyle, serum levels of 25-hydroxyvitamin D [25(OH)D], calcium, phosphate and creatinine were determined. Breast density was determined by mammography and categorized as 1 to 4 according to the ACR classification. In addition to performing descriptive analysis to get a better overview of the data, a number of multivariate regression models were developed to determine the impact of confounders and the connection between vitamin D and mammographic density. Results More than half of all participants had low levels of 25(OH)D (< 20 ng/ml) and only a small minority of women (5.7 %) had what are currently considered to be optimal serum levels of 25(OH)D of at least 30 ng/ml. The significant majority of the cohort had a medium mammographic density (n = 463 had ACR 2; n = 343 had ACR 3). Logistic regression analysis showed that lower 25(OH)D serum levels were associated significantly more often with high rather than medium breast density. This association remained, even after adjusting for other factors which influence breast density such as age, BMI and menopausal status (p = 0.032 for ACR 4 vs. ACR 2; p = 0.028 for ACR 4 vs. ACR 3). When the same analysis was done separately for pre-menopausal and post-menopausal women, BMI in both groups was found to be inversely correlated with breast density and this inverse correlation was highly significant. In post-menopausal women, age was found to be similarly correlated while 25(OH)D did not appear to be associated with ACR. In pre-menopausal women the opposite was the case: although there was no correlation between age and breast density, higher vitamin D levels tended to be associated with lower breast density (p = 0.06 for ACR 2 vs. ACR 4) in this smaller sample (n = 412). When vitamin D-rich food and food supplements were also taken into account, regular intake of vitamin D preparations was associated with lower breast density; this association achieved borderline statistical significance (p = 0.05 for ACR 3 vs. ACR 4). When the analysis also took menopausal status into account, the breast density of pre-menopausal women was lower following regular vitamin D intake and this lower breast density of pre-menopausal women was statistically highly significant (p < 0.001 for ACR 1 and ACR 2 vs. ACR 4, respectively). This effect was not found in post-menopausal women. Frequent intake of vitamin D-containing nutrition had no significant impact on ACR in either of the groups. Conclusion These results reinforce the assumption previously proposed by several authors that higher levels of 25(OH)D pre-menopause and vitamin D substitution are associated with lower breast density and could reduce the risk of breast cancer. The findings did not confirm any post-menopausal association between vitamin D and mammographic breast density.
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Affiliation(s)
- Loreen Straub
- Klinik und Poliklinik für Frauenheilkunde, Technische Universität München, München, Germany; Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Johanna Riedel
- Klinik und Poliklinik für Frauenheilkunde, Technische Universität München, München, Germany
| | - Peter B Luppa
- Institut für Klinische Chemie und Pathobiochemie, Technische Universität München, München, Germany
| | - Johanna Wissing
- Klinik und Poliklinik für Frauenheilkunde, Technische Universität München, München, Germany
| | | | - Marion Kiechle
- Klinik und Poliklinik für Frauenheilkunde, Technische Universität München, München, Germany
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Abe Y, Nishimura T, Arima K, Kanagae M, Mizukami S, Tomita Y, Okabe T, Goto H, Horiguchi I, Aoyagi K. Effect of self-reported walking difficulty on bone mass and bone resorption marker in Japanese people aged 40 years and over. J Physiol Anthropol 2016; 35:25. [PMID: 27729080 PMCID: PMC5057479 DOI: 10.1186/s40101-016-0114-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 09/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to examine the association of walking difficulty with bone mass or bone turnover among community-dwelling Japanese people aged 40 years and older. Methods We studied 1097 community-dwelling Japanese people aged 40 years and older (379 men and 718 women) who were invited to participate in periodic health examinations in 2006–2009. Walking difficulty was defined as having difficulty walking 100 m on a level surface (self-administered questionnaire). Calcaneal stiffness index (bone mass) was measured by quantitative ultrasound. Spot urine samples were collected, and urinary N-terminal cross-linking telopeptide of type I collagen (NTx) was measured. Values were corrected for creatinine (Cre) concentration. Results The prevalence of walking difficulty was significantly higher in women than in men (7.4 vs. 3.4 %, p = 0.011) and significantly increased with age in men (p for trend = 0.02) and women (p for trend <0.001). In univariate analysis, men and women with walking difficulty were older (p < 0.001) and had a lower stiffness index (p < 0.001), compared with those without walking difficulty. Among women, individuals with walking difficulty had significantly higher urinary NTx/Cre than those without walking difficulty (p < 0.001); however, this was not so among men (p = 0.39). Multiple regression analysis adjusted for age, weight, and menopausal status showed a significant association between walking difficulty and lower stiffness index in men (p = 0.004) and women (p = 0.005). In women, walking difficulty was significantly associated with higher NTx/Cre (p = 0.001), but not in men (p = 0.35). Conclusions Walking difficulty may contribute to low bone mass in both sexes but might cause high bone turnover in women only.
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Affiliation(s)
- Yasuyo Abe
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Takayuki Nishimura
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuhiko Arima
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mitsuo Kanagae
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | - Satoshi Mizukami
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | - Yoshihito Tomita
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | - Takuhiro Okabe
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | | | - Itsuko Horiguchi
- Center for Public Relations Strategy, Nagasaki University, Nagasaki, Japan
| | - Kiyoshi Aoyagi
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Riedel J, Straub L, Wissing J, Artmann A, Schmidmayr M, Kiechle M, Seifert-Klauss VR. Vitamin D and Mammographic Findings. Geburtshilfe Frauenheilkd 2016; 76:570-578. [PMID: 27239067 DOI: 10.1055/s-0042-106208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: Pleiotropic immune-modulatory and anti-proliferative effects of vitamin D and hopes to stop cancerogenesis have led to an increased interest in possible reduction of breast cancer with higher vitamin D levels. Mammographic density is an established risk factor for breast cancer risk, and its association with serum vitamin D is complex, as recent studies have shown. Patients and Methods: In this cross-sectional study, 1103 participants were recruited in the breast diagnostic unit of the Klinikum rechts der Isar, TU Munich. A standardised questionnaire and blood samples for 25-OH-vitamin D were taken on the day of mammography. Histologic results of biopsies in suspicious mammographies were documented. Results: In the 1090 data-sets analysed, vitamin D-deficiency was common among women under 40. Highest vitamin D values were observed in participants aged 60-69 years, but average values for all age cohorts were below 20 ng/ml of vitamin D. 15.6 % of all participants had very low vitamin D values (< 10 ng/ml), 51.3 % were vitamin D-deficient (10-19 ng/ml) and only 5.7 % were above 30 ng/ml, i.e. showed sufficient vitamin D. Patients with malignant results had vitamin D < 10 ng/ml more often (16.9 %; p = 0.61), and only 3.4 % in this group had sufficient vitamin D supply (> 30 ng/ml). There were no significant differences in vitamin D-levels between density groups according to the American College of Radiology (ACR) criteria. Conclusion: Vitamin D values were lower than in comparable US women. Up to now, there is no direct clinical evidence for a relationship between the risk for breast cancer and a specific vitamin D value.
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Affiliation(s)
- J Riedel
- Frauen- und Poliklinik der TU München, Munich
| | - L Straub
- Frauen- und Poliklinik der TU München, Munich
| | - J Wissing
- Frauen- und Poliklinik der TU München, Munich
| | | | | | - M Kiechle
- Frauen- und Poliklinik der TU München, Munich
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McKibben RA, Zhao D, Lutsey PL, Schneider ALC, Guallar E, Mosley TH, Michos ED. Factors Associated With Change in 25-Hydroxyvitamin D Levels Over Longitudinal Follow-Up in the ARIC Study. J Clin Endocrinol Metab 2016; 101:33-43. [PMID: 26509869 PMCID: PMC4701839 DOI: 10.1210/jc.2015-1711] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/22/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT A single measurement of 25-hydroxyvitamin D (25 [OH] D) may not accurately reflect long-term vitamin D status. Little is known about change in 25(OH)D levels over time, particularly among blacks. OBJECTIVE The objective of the study was to determine the longitudinal changes in 25(OH)D levels among Atherosclerosis Risk in Communities (ARIC) study participants. DESIGN This was a longitudinal study. SETTING The study was conducted in the general community. PARTICIPANTS A total of 9890 white and 3222 black participants at visit 2 (1990-1992), 888 whites and 876 blacks at visit 3 (1993-1994), and 472 blacks at the brain visit (2004-2006) participated in the study. MAIN OUTCOME MEASURE The 25(OH)D levels were measured, and regression models were used to assess the associations between clinical factors and longitudinal changes in 25(OH)D. RESULTS Vitamin D deficiency (<50 nmol/L [<20 ng/mL]) was seen in 23% and 25% of whites at visits 2 and 3, and in 61%, 70%, and 47% of blacks at visits 2, 3, and the brain visit, respectively. The 25(OH)D levels were correlated between visits 2 and 3 (3 y interval) among whites (r = 0.73) and blacks (r = 0.66). Among blacks, the correlation between visit 2 and the brain visit (14 y interval) was 0.33. Overall, increases in 25(OH)D levels over time was associated with male gender, use of vitamin D supplements, greater physical activity, and higher high-density lipoprotein-cholesterol (P < .001). Decreases in 25(OH)D levels over time were associated with current smoking, higher body mass index, higher education, diabetes, and hypertension (all P < .05). CONCLUSIONS Among US blacks and whites, 25(OH)D levels remained relatively stable over time. Certain modifiable lifestyle factors were associated with change in 25(OH)D levels over time.
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Affiliation(s)
- Rebeccah A McKibben
- Department of Medicine (R.A.M., E.D.M.), Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Department of Epidemiology (D.Z., A.L.C.S., E.G., E.D.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; Division of Epidemiology and Community Health (P.L.L.), School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson, Mississippi 39216
| | - Di Zhao
- Department of Medicine (R.A.M., E.D.M.), Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Department of Epidemiology (D.Z., A.L.C.S., E.G., E.D.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; Division of Epidemiology and Community Health (P.L.L.), School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson, Mississippi 39216
| | - Pamela L Lutsey
- Department of Medicine (R.A.M., E.D.M.), Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Department of Epidemiology (D.Z., A.L.C.S., E.G., E.D.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; Division of Epidemiology and Community Health (P.L.L.), School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson, Mississippi 39216
| | - Andrea L C Schneider
- Department of Medicine (R.A.M., E.D.M.), Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Department of Epidemiology (D.Z., A.L.C.S., E.G., E.D.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; Division of Epidemiology and Community Health (P.L.L.), School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson, Mississippi 39216
| | - Eliseo Guallar
- Department of Medicine (R.A.M., E.D.M.), Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Department of Epidemiology (D.Z., A.L.C.S., E.G., E.D.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; Division of Epidemiology and Community Health (P.L.L.), School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson, Mississippi 39216
| | - Thomas H Mosley
- Department of Medicine (R.A.M., E.D.M.), Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Department of Epidemiology (D.Z., A.L.C.S., E.G., E.D.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; Division of Epidemiology and Community Health (P.L.L.), School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson, Mississippi 39216
| | - Erin D Michos
- Department of Medicine (R.A.M., E.D.M.), Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Department of Epidemiology (D.Z., A.L.C.S., E.G., E.D.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; Division of Epidemiology and Community Health (P.L.L.), School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson, Mississippi 39216
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High prevalence of vitamin D insufficiency in community-dwelling postmenopausal Polish women. MENOPAUSE REVIEW 2014; 13:289-92. [PMID: 26327868 PMCID: PMC4520378 DOI: 10.5114/pm.2014.46471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 08/27/2014] [Accepted: 09/01/2014] [Indexed: 11/17/2022]
Abstract
Introduction Inadequate vitamin D level is associated with altered bone turnover and bone loss, which increases the fracture risk. Aim To assess the seasonal prevalence of inadequate (insufficient or deficient) serum vitamin D levels in community-dwelling postmenopausal Polish women screened for osteoporosis. Material and methods A cross-sectional observational study based on the regional urban non-institutionalized sample (n = 107) of postmenopausal Caucasian women in the age range of 51-83 years, not taking any medication and free from any condition likely to affect vitamin D status or calcium/bone metabolism. The outcome measures were the mean 25-OH vitamin D level across all the seasons and the percentage of vitamin D deficiency and insufficiency and defined as < 20 ng/dl (50 nmol/l) and 20-30 ng/dl (50-75 nmol/l), respectively. Results No statistically significant difference has been found in the mean vitamin D level, regardless of the season (p = 0.4). The prevalence of vitamin D deficiency and insufficiency were in spring 54% and 32%, in summer 46% and 46%, in autumn 67% and 27%, and in winter 61% and 22%, respectively. Conclusions Vitamin D inadequacy is common in a sample of Polish community-dwelling postmenopausal women regardless of the season.
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Abstract
CONTEXT To establish the clinical utility of serum sclerostin levels, it is important to know whether there is seasonal variation in the measurements. OBJECTIVE This study was done to determine whether serum sclerostin levels vary by season in healthy older men and women. METHODS Serum sclerostin levels were measured in archived serum of 314 healthy men and women aged 65 years and older and examined for seasonal variation. Several factors known to vary by season and previously reported to be associated with serum sclerostin levels, including serum osteocalcin, physical activity, and serum PTH levels, were also measured in these subjects. Sex did not modify the association of season with sclerostin, so the men and women were analyzed together. RESULTS Serum sclerostin levels varied significantly by season (P < .001, after adjustment for sex). Sclerostin levels in the wintertime were 20% higher than the all-year mean, the levels gradually declined through the spring and summer, and by the fall, they were 20% below the all-year mean. Adjustment for serum osteocalcin, physical activity, and serum PTH did not alter the seasonal means. Seasonal differences in serum osteocalcin, physical activity, and serum PTH were not statistically significant. CONCLUSIONS This study documents marked seasonal variation in serum sclerostin levels. It is important to recognize this source of biological variability when considering the potential clinical utility of sclerostin measurements.
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Affiliation(s)
- Bess Dawson-Hughes
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging (B.D.-H., S.S.H., L.C., N.J.P.), Tufts University, and Division of Endocrinology, Diabetes, and Metabolism (B.D.-H., L.C.), Tufts Medical Center, Boston, Massachusetts 02111
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Wheater G, Elshahaly M, Tuck SP, Datta HK, van Laar JM. The clinical utility of bone marker measurements in osteoporosis. J Transl Med 2013; 11:201. [PMID: 23984630 PMCID: PMC3765909 DOI: 10.1186/1479-5876-11-201] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/21/2013] [Indexed: 02/07/2023] Open
Abstract
Osteoporosis is characterised by low bone mass and structural deterioration of bone tissue, resulting in increased fragility and susceptibility to fracture. Osteoporotic fractures are a significant cause of morbidity and mortality. Direct medical costs from such fractures in the UK are currently estimated at over two billion pounds per year, resulting in a substantial healthcare burden that is expected to rise exponentially due to increasing life expectancy. Currently bone mineral density is the WHO standard for diagnosis of osteoporosis, but poor sensitivity means that potential fractures will be missed if it is used alone. During the past decade considerable progress has been made in the identification and characterisation of specific biomarkers to aid the management of metabolic bone disease. Technological developments have greatly enhanced assay performance producing reliable, rapid, non-invasive cost effective assays with improved sensitivity and specificity. We now have a greater understanding of the need to regulate pre-analytical sample collection to minimise the effects of biological variation. However, bone turnover markers (BTMs) still have limited clinical utility. It is not routinely recommended to use BTMs to select those at risk of fractures, but baseline measurements of resorption markers are useful before commencement of anti-resorptive treatment and can be checked 3–6 months later to monitor response and adherence to treatment. Similarly, formation markers can be used to monitor bone forming agents. BTMs may also be useful when monitoring patients during treatment holidays and aid in the decision as to when therapy should be recommenced. Recent recommendations by the Bone Marker Standards Working Group propose to standardise research and include a specific marker of bone resorption (CTX) and bone formation (P1NP) in all future studies. It is hoped that improved research in turn will lead to optimised markers for the clinical management of osteoporosis and other bone diseases.
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Affiliation(s)
- Gillian Wheater
- Department of Biochemistry, The James Cook University Hospital, Middlesbrough TS4 3BW, UK.
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Gómez-Bruton A, Gónzalez-Agüero A, Gómez-Cabello A, Casajús JA, Vicente-Rodríguez G. Is bone tissue really affected by swimming? A systematic review. PLoS One 2013; 8:e70119. [PMID: 23950908 PMCID: PMC3737199 DOI: 10.1371/journal.pone.0070119] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 06/14/2013] [Indexed: 11/18/2022] Open
Abstract
Background Swimming, a sport practiced in hypogravity, has sometimes been associated with decreased bone mass. Aim This systematic review aims to summarize and update present knowledge about the effects of swimming on bone mass, structure and metabolism in order to ascertain the effects of this sport on bone tissue. Methods A literature search was conducted up to April 2013. A total of 64 studies focusing on swimmers bone mass, structure and metabolism met the inclusion criteria and were included in the review. Results It has been generally observed that swimmers present lower bone mineral density than athletes who practise high impact sports and similar values when compared to sedentary controls. However, swimmers have a higher bone turnover than controls resulting in a different structure which in turn results in higher resistance to fracture indexes. Nevertheless, swimming may become highly beneficial regarding bone mass in later stages of life. Conclusion Swimming does not seem to negatively affect bone mass, although it may not be one of the best sports to be practised in order to increase this parameter, due to the hypogravity and lack of impact characteristic of this sport. Most of the studies included in this review showed similar bone mineral density values in swimmers and sedentary controls. However, swimmers present a higher bone turnover than sedentary controls that may result in a stronger structure and consequently in a stronger bone.
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Affiliation(s)
- Alejandro Gómez-Bruton
- GENUD “Growth, Exercise, NUtrition and Development” Research Group, Universidad de Zaragoza, Zaragoza, Spain
| | - Alejandro Gónzalez-Agüero
- GENUD “Growth, Exercise, NUtrition and Development” Research Group, Universidad de Zaragoza, Zaragoza, Spain
- Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom
| | - Alba Gómez-Cabello
- GENUD “Growth, Exercise, NUtrition and Development” Research Group, Universidad de Zaragoza, Zaragoza, Spain
| | - José A. Casajús
- GENUD “Growth, Exercise, NUtrition and Development” Research Group, Universidad de Zaragoza, Zaragoza, Spain
- Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, Universidad de Zaragoza, Huesca, Spain
| | - Germán Vicente-Rodríguez
- GENUD “Growth, Exercise, NUtrition and Development” Research Group, Universidad de Zaragoza, Zaragoza, Spain
- Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, Universidad de Zaragoza, Huesca, Spain
- * E-mail:
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Bhattoa HP, Nagy E, More C, Kappelmayer J, Balogh A, Kalina E, Antal-Szalmas P. Prevalence and seasonal variation of hypovitaminosis D and its relationship to bone metabolism in healthy Hungarian men over 50 years of age: the HunMen Study. Osteoporos Int 2013; 24:179-86. [PMID: 22422303 DOI: 10.1007/s00198-012-1920-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 01/25/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED This study reports a high prevalence of hypovitaminosis D and low bone mineral density (BMD) in a healthy Hungarian male cohort over 50 years of age. Men with 25-hydroxyvitamin D levels of <75 nmol/L had a significantly higher 10-year hip and major osteoporotic fracture probability using the country-specific fracture risk assessment (FRAX) algorithm. INTRODUCTION The aim of this study is to characterize the prevalence and seasonal variation of hypovitaminosis D and its relationship to bone metabolism in healthy Hungarian men over 50 years of age. METHODS We determined levels of 25-hydroxyvitamin D (25-OH-D), PTH, osteocalcin (OC), C-terminal telopeptides of type-I collagen (CTX-I), procollagen type 1 amino-terminal propeptide (PINP), BMD at L1-L4 (LS) and femur neck (FN), daily dietary calcium intake, and the 10-year probability of hip fracture and a major osteoporotic fracture using the country-specific FRAX algorithm in 206 randomly selected ambulatory men. RESULTS The mean (range) age of the volunteers was 60 (51-81) years. The prevalence of hypovitaminosis D (25-OH-D, <75 nmol/L) was 52.9%. The prevalence of low (T-score < -1.0) BMD at the FN and LS was 45% and 35.4%, respectively. The mean (range) FRAX hip fracture and FRAX major osteoporotic fracture was 0.8% (0-9.4%) and 3.8% (1.7-16%), respectively. On comparing the vitamin D sufficient to the insufficient group, there was a statistically significant difference between the FRAX hip fracture and FRAX major osteoporotic fracture indexes. There was significant seasonal variation in the vitamin D levels; the lowest levels were measured in winter and the highest in summer. CONCLUSIONS A high prevalence of hypovitaminosis D and low BMD were observed in the studied Hungarian male population. This is the first study reporting higher 10-year hip and major osteoporotic fracture probability using the country-specific FRAX algorithm in individuals with hypovitaminosis D.
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Affiliation(s)
- H P Bhattoa
- Department of Laboratory Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
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17
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Abstract
The awareness of osteoporosis has grown world wide in recent years. This silently progressing metabolic bone disease is widely prevalent in India, and osteoporotic fractures are a common cause of morbidity and mortality in adult Indian men and women. Rapid bone loss occurs in postmenopausal women due to hormonal factors which lead to increased risk of fractures. Biochemical markers of bone metabolism are used to assess skeletal turnover. A cross-sectional study of 150 pre- and post menopausal women was carried out at S.D.M College of Medical Sciences and Hospital, Dharwad, during the period of May 2005 to September 2005. The study group consisted of 75 Premenopausal women in the age group of 25-45 years and 75 Postmenopausal women in the age group of 46-65 years. Bone formation markers (Total Calcium, lonised calcium, Phosphorus, Alkaline phosphatase), and bone resorption markers (Urinary Hydroxyproline) were analysed in pre and post menopausal women. Bone formation markers, Total and lonised calcium were significantly decreased (p<0.001) and Alkaline phosphatase was significantly increased (p<0.001) in postmenopausal women compared to premenopausal women. Bone resorption markers, Urinary hydroxyproline excretion was significantly increased (p<0.001) in postmenopausal women. The results from this study suggest that simple, easy, common biochemical markers can still be used to assess the bone turnover in postmenopausal women and hence their risk of developing osteoporosis and fractures.
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18
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Berger C, Greene-Finestone LS, Langsetmo L, Kreiger N, Joseph L, Kovacs CS, Richards JB, Hidiroglou N, Sarafin K, Davison KS, Adachi JD, Brown J, Hanley DA, Prior JC, Goltzman D. Temporal trends and determinants of longitudinal change in 25-hydroxyvitamin D and parathyroid hormone levels. J Bone Miner Res 2012; 27:1381-9. [PMID: 22407786 PMCID: PMC5101062 DOI: 10.1002/jbmr.1587] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Vitamin D is essential for facilitating calcium absorption and preventing increases in parathyroid hormone (PTH), which can augment bone resorption. Our objectives were to examine serum levels of 25-hydroxyvitamin D [25(OH)D] and PTH, and factors related to longitudinal change in a population-based cohort. This is the first longitudinal population-based study looking at PTH and 25(OH)D levels. We analyzed 3896 blood samples from 1896 women and 829 men in the Canadian Multicentre Osteoporosis Study over a 10-year period starting in 1995 to 1997. We fit hierarchical models with all available data and adjusted for season. Over 10 years, vitamin D supplement intake increased by 317 (95% confidence interval [CI] 277 to 359) IU/day in women and by 193 (135 to 252) IU/day in men. Serum 25(OH)D (without adjustment) increased by 9.3 (7.3 to 11.4) nmol/L in women and by 3.5 (0.6 to 6.4) nmol/L in men but increased by 4.7 (2.4 to 7.0) nmol/L in women and by 2.7 (-0.6 to 6.2) nmol/L in men after adjustment for vitamin D supplements. The percentage of participants with 25(OH)D levels <50 nmol/L was 29.7% (26.2 to 33.2) at baseline and 19.8% (18.0 to 21.6) at year 10 follow-up. PTH decreased over 10 years by 7.9 (5.4 to 11.3) pg/mL in women and by 4.6 (0.2 to 9.0) pg/mL in men. Higher 25(OH)D levels were associated with summer, younger age, lower body mass index (BMI), regular physical activity, sun exposure, and higher total calcium intake. Lower PTH levels were associated with younger age and higher 25(OH)D levels in both women and men and with lower BMI and participation in regular physical activity in women only. We have observed concurrent increasing 25(OH)D levels and decreasing PTH levels over 10 years. Secular increases in supplemental vitamin D intake influenced both changes in serum 25(OH)D and PTH levels.
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Affiliation(s)
- Claudie Berger
- CaMos Coordinating Centre, McGill University, 687 Pine Avenue West, Montréal, Québec, Canada
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Turner S, Torode M, Climstein M, Naughton G, Greene D, Baker MK, Fiatarone Singh MA. A randomized controlled trial of whole body vibration exposure on markers of bone turnover in postmenopausal women. J Osteoporos 2011; 2011:710387. [PMID: 21772975 PMCID: PMC3135216 DOI: 10.4061/2011/710387] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 03/28/2011] [Accepted: 04/14/2011] [Indexed: 12/02/2022] Open
Abstract
Purpose. To examine the effects of two doses of low-frequency (12 Hz), low-magnitude (0.3 g), whole body vibration on markers of bone formation and resorption in postmenopausal women. Methods. Women were recruited and randomized into a sham vibration control group, one time per week vibration group (1×/week), or three times per week vibration group (3×/week). Vibration exposure consisted of 20 minutes of intermittent vibration for the 1×/week and 3×/week groups, and sham vibration (<0.1 g) for the control group for eight weeks. Double-blinded primary outcome measures were urine markers of bone resorption: N-telopeptide X normalised to creatinine (NTx/Cr) and bone formation: bone-specific alkaline phosphatase (ALP). Results. Forty-six women (59.8 ± 6.2 years, median 7.3 years since menopause) were enrolled. NTx/Cr was significantly reduced (34.6%) in the 3×/wk vibration group but not in the 1×/wk vibration group compared with sham control (P < .01) group. No effect of time or group allocation was observed on the bone formation marker ALP (P = .27). Conclusion. We have shown for the first time that low-frequency, low-magnitude vibration 3×/week for eight weeks in postmenopausal women results in a significant reduction in NTx/Cr, a marker of bone resorption, when compared with sham vibration exposure.
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Affiliation(s)
- Sarah Turner
- Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW 1825, Australia
| | - Margaret Torode
- Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW 1825, Australia
| | - Mike Climstein
- School of Exercise Science, Australian Catholic University, Strathfield, NSW 2135, Australia
| | - Geraldine Naughton
- School of Exercise Science, Australian Catholic University, Strathfield, NSW 2135, Australia,Centre of Physical Activity Across the Lifespan, Australian Catholic University, Fitzroy, Victoria 3065, Australia
| | - David Greene
- School of Exercise Science, Australian Catholic University, Strathfield, NSW 2135, Australia
| | - Michael K. Baker
- Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW 1825, Australia,School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia,The Boden Institute of Obesity, Nutrition, and Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Maria A. Fiatarone Singh
- Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW 1825, Australia,The Boden Institute of Obesity, Nutrition, and Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia,Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia,Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Center on Aging, Tufts University, Boston, MA 02111-1524, USA,*Maria A. Fiatarone Singh:
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Leidig-Bruckner G, Roth HJ, Bruckner T, Lorenz A, Raue F, Frank-Raue K. Are commonly recommended dosages for vitamin D supplementation too low? Vitamin D status and effects of supplementation on serum 25-hydroxyvitamin D levels--an observational study during clinical practice conditions. Osteoporos Int 2011; 22:231-40. [PMID: 20556359 DOI: 10.1007/s00198-010-1214-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 01/19/2010] [Indexed: 12/14/2022]
Abstract
UNLABELLED Vitamin D deficiency is associated with increased fracture risk. The observational study aimed to investigate vitamin D status and supplementation in ambulatory patients. Only 20% of patients had optimal serum 25-hydroxyvitamin D [25(OH)D] levels. Commonly recommended dosages were insufficient to achieve clinically relevant increase of 25(OH)D levels. Higher dosages were safe and effective under clinical practice conditions. INTRODUCTION Vitamin D deficiency is associated with adverse health outcome. The study aimed to investigate vitamin D status and supplementation in ambulatory patients. METHODS Nine hundred seventy-five women and 188 men were evaluated for bone status from January 2008 to August 2008 within an observational study; 104 patients (n = 70 osteoporosis) received follow-up after 3 months. Dosage of vitamin D supplementation was documented and serum 25(OH)D and parathyroid hormone (PTH) determined. RESULTS In all patients (age, 60.4 ± 14.1 years), distribution of 25(OH)D was 56.3 ± 22.3 nmol/L (normal range, 52-182 nmol/L) and PTH 53.8 ± 67.5 ng/L (normal range, 11-43 ng/L). The proportion of patients with 25(OH)D < 25, 25 to <50, 50 to <75, ≥75 nmol/L was 7.5%, 33.3%, 38.9% and 20.2% in the total group and 20.1%, 38.5%, 30.8%, 10.6% at baseline in the follow-up group, respectively. After 3 months, 3.9% had still 25(OH)D < 25 nmol/L; only 12.5% achieved 25(OH)D ≥ 75 nmol/L. In osteoporosis patients, 25(OH)D increased more in those taking ≥1,500 (median, 3,000) IU vitamin D per day (33.1 ± 14.7 nmol/L) compared with ≤1,000 (median, 800) IU/day (10.6 ± 20.0 nmol/L) (p < 0.0008). PTH decreased more in patients taking ≥1,500 IU/day (-13.2 ± 15.2 ng/L) compared with ≤1,000 IU/day (-7.6 ± 19.2 ng/L; p = 0.29). 25(OH)D was negatively correlated to PTH (r = -0.49, p < 0.0001). An increase of 25(OH)D ≥ 75 nmol/L resulted in normalised PTH. CONCLUSION Supplementation with higher vitamin D dosages (2,000-3,000 IU/day) is required to achieve a relevant increase of 25(OH)D and normalisation of PTH.
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Affiliation(s)
- G Leidig-Bruckner
- Gemeinschaftspraxis für Endokrinologie, Nuklearmedizin und Humangenetik, Brückenstr. 21, 69120, Heidelberg, Germany.
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21
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Hall WB, Sparks AA, Aris RM. Vitamin d deficiency in cystic fibrosis. Int J Endocrinol 2010; 2010:218691. [PMID: 20148079 PMCID: PMC2817861 DOI: 10.1155/2010/218691] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 09/01/2009] [Accepted: 10/23/2009] [Indexed: 11/21/2022] Open
Abstract
Cystic Fibrosis is the most common inherited genetic respiratory disorder in the Western World. Hypovitaminosis D is almost universal in CF patients, likely due to a combination of inadequate absorption, impaired metabolism, and lack of sun exposure. Inadequate levels are associated with the high prevalence of bone disease or osteoporosis in CF patients, which is associated with increased morbidity including fractures, kyphosis, and worsening pulmonary status. Treatment goals include regular monitoring 25 hydroxyvitamin D (25OHD) levels with aggressive treatment for those with levels <75 nmol/L (<30 ng/mL). More research is needed to determine optimal supplementation goals and strategies.
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Affiliation(s)
- William B. Hall
- Division of Pulmonary and Critical Care Medicine and the
School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Amy A. Sparks
- Division of Pulmonary and Critical Care Medicine and the
School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Robert M. Aris
- Division of Pulmonary and Critical Care Medicine and the
School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- *Robert M. Aris:
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Heiss C, Hoesel LM, Pausch M, Meissner SA, Horas U, Kilian O, Wehr U, Rambeck WA, Schnettler R. [Biochemical bone resorption markers during the healing of osteoporotic fractures]. Unfallchirurg 2008; 111:695-702. [PMID: 18618089 DOI: 10.1007/s00113-008-1465-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study investigated the progression and clinical relevance of biochemical resorption marker values during fracture healing in osteoporosis. PATIENTS AND METHODS In 44 patients with distal radius fractures and 29 patients without fractures, the blood and urine concentrations of pyridinoline (PYD), deoxypyridinoline (DPD), N-telopeptides (NTx), and bone sialoprotein (BSP) were recorded on the day of trauma as well as during further progression. All postmenopausal patients underwent bone density measurement. Accordingly, patients were divided into premenopausal, postmenopausal osteoporotic, and postmenopausal nonosteoporotic groups. RESULTS Between the groups, PYD, DPD, and NTx showed significant differences in their initial values. However, their further relative progression was primarily affected by the chosen therapy. CONCLUSION Bone resorption markers can diagnostically point to osteoporosis and are significant parameters in fracture healing.
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Affiliation(s)
- C Heiss
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Giessen-Marburg GmbH, Rudolf-Buchheim-Str. 7, 35385 Giessen, Deutschland.
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23
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Abstract
Osteomalacia is caused by impaired vitamin D receptor (VDR) signaling, calcium deficiency, and altered bone mineralization. This can be due to insufficient sunlight exposure, malabsorption, reduced D hormone activation in chronic kidney disease, and rare alterations of VDR signaling and phosphate metabolism. Leading symptoms are bone pain, muscular cramps, and increased incidence of falls in the elderly. The adequate respective countermeasures are to optimize the daily intake of calcium and vitamin D3 and to replace active D hormone and phosphate if deficient. Osteoporosis is characterized by bone fragility fractures upon minor physical impact. Indications for diagnosis and treatment can be established by estimating the absolute fracture risk, taking into account bone mineral density, age, gender, and individual risk factors. Exercise, intervention programs to avoid falls, and specific drugs are capable of substantially reducing fracture risk even in the elderly. Secondary osteoporosis primarily requires both bone-altering medications and effective treatment of underlying diseases.
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Affiliation(s)
- F Jakob
- Orthopädisches Zentrum für Muskuloskelettale Forschung, Lehrstuhl Orthopädie, Orthopädische Klinik König-Ludwig-Haus, Universität Würzburg, Brettreichstrasse 11, 97074, Würzburg, Germany.
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24
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Shea MK, Benjamin EJ, Dupuis J, Massaro JM, Jacques PF, D'Agostino RB, Ordovas JM, O'Donnell CJ, Dawson-Hughes B, Vasan RS, Booth SL. Genetic and non-genetic correlates of vitamins K and D. Eur J Clin Nutr 2007; 63:458-64. [PMID: 18030310 DOI: 10.1038/sj.ejcn.1602959] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the genetic and nongenetic correlates of circulating measures of vitamins K and D status in a community-based sample of men and women. SUBJECTS/METHODS A cross-sectional study of 1762 participants of the Framingham Offspring Study (919 women; mean age 59 years). Vitamin K status was measured as plasma phylloquinone and serum percent undercarboxylated osteocalcin (ucOC), and vitamin D was measured using plasma 25-hydroxyvitamin D (25(OH)D). Associations between vitamin K status and vitamin D status with biologically plausible nongenetic factors were assessed using stepwise regression. Heritability and linkage were determined using Sequential Oligogenic Linkage Analysis Routines (SOLAR). RESULTS Nongenetic factors accounted for 20.1 and 12.3% of the variability in plasma phylloquinone in men and women respectively, with triglycerides and phylloquinone intake being the primary correlates. In men 12.2% and in women 14.6% of the variability in %ucOC was explained by nongenetic factors in our models. Heritability estimates for these vitamin K status biomarkers were nonsignificant. Season, vitamin D intake, high-density lipoprotein (HDL) cholesterol and waist circumference explained 24.7% (men) and 24.2% (women) of the variability in plasma 25(OH)D. Of the three vitamins examined, only 25(OH)D was significantly heritable (heritability estimate=28.8%, P<0.01), but linkage analysis of 25(OH)D did not achieve genome-wide significance. CONCLUSIONS Variability in biomarkers of vitamin K status was attributed to nongenetic factors, whereas plasma 25(OH)D was found to be significantly heritable. Further studies are warranted to investigate genetic loci influencing vitamin D status.
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Affiliation(s)
- M K Shea
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA
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25
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Zwart SR, Hargens AR, Lee SMC, Macias BR, Watenpaugh DE, Tse K, Smith SM. Lower body negative pressure treadmill exercise as a countermeasure for bed rest-induced bone loss in female identical twins. Bone 2007; 40:529-37. [PMID: 17070743 PMCID: PMC1876821 DOI: 10.1016/j.bone.2006.09.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Revised: 09/07/2006] [Accepted: 09/12/2006] [Indexed: 10/24/2022]
Abstract
Supine weight-bearing exercise within lower body negative pressure (LBNP) alleviates some of the skeletal deconditioning induced by simulated weightlessness in men. We examined this potential beneficial effect in women. Because dietary acid load affected the degree of bone resorption in men during bed rest, we also investigated this variable in women. Subjects were 7 pairs of female identical twins assigned at random to 2 groups, sedentary bed rest (control) or bed rest with supine treadmill exercise within LBNP. Dietary intake was controlled and monitored. Urinary calcium and markers of bone resorption were measured before bed rest and on bed rest days 5/6, 12/13, 19/20, and 26/27. Bone mineral content was assessed by dual-energy X-ray absorptiometry before and after bed rest. Data were analyzed by repeated-measures two-way analysis of variance. Pearson correlation coefficients were used to define the relationships between diet and markers of bone metabolism and to estimate heritability of markers. During bed rest, all markers of bone resorption and urinary calcium and phosphorus increased (P<0.001); parathyroid hormone (P=0.06), bone-specific alkaline phosphatase (P=0.06), and 1,25-dihydroxyvitamin D (P=0.09) tended to decrease. LBNP exercise tended to mitigate bone density loss. The ratio of dietary animal protein to potassium was positively correlated with urinary calcium excretion for all weeks of bed rest in the control group, but only during weeks 1 and 3 in the exercise group. Pre-bed rest data suggested that many markers of bone metabolism have strong genetic determinants. Treadmill exercise within LBNP had less of a protective effect on bone resorption during bed rest in women than previously published results had shown for its effect in men, but the same trends were observed for both sexes. Dietary acid load of these female subjects was significantly correlated with calcium excretion but not with other bone resorption markers.
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Affiliation(s)
- Sara R. Zwart
- Universities Space Research Association, Houston, Texas, USA 77058
| | - Alan R. Hargens
- Department of Orthopaedic Surgery, University of California, San Diego, UCSD Medical Center, San Diego, California, USA 92103
| | | | - Brandon R. Macias
- Department of Orthopaedic Surgery, University of California, San Diego, UCSD Medical Center, San Diego, California, USA 92103
| | - Donald E. Watenpaugh
- Department of Integrative Physiology, University of North Texas Health Sciences Center, Fort Worth, Texas, USA 76104
| | - Kevin Tse
- Department of Orthopaedic Surgery, University of California, San Diego, UCSD Medical Center, San Diego, California, USA 92103
| | - Scott M. Smith
- Human Adaptation and Countermeasures Office, National Aeronautics and Space Administration Lyndon B. Johnson Space Center, Houston, Texas, USA 77058
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26
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Rockell JEP, Skeaff CM, Williams SM, Green TJ. Serum 25-hydroxyvitamin D concentrations of New Zealanders aged 15 years and older. Osteoporos Int 2006; 17:1382-9. [PMID: 16832715 DOI: 10.1007/s00198-006-0118-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Accepted: 03/13/2006] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Vitamin D plays an important role in bone health. Our purpose was to measure serum 25-hydroxyvitamin D concentrations and their determinants in a national sample (n=2,946) of New Zealanders aged 15 years and over. FINDINGS Mean (99% CI) serum 25-hydroxyvitamin D concentrations were 47 (45-50) nmol/l in women and 52 (49-55) nmol/l in men. Mean concentrations in New Zealand European and Others (NZEO, n=2,440), Māori (n=370), and Pacific (n=136) were 51 (49-53), 42 (38-46) and 37 (33-42) nmol/l, respectively. Three percent of New Zealanders had serum 25-hydroxyvitamin D concentrations indicative of deficiency (<or=17.5 nmol/l); 48% and 84% were insufficient based on cutoffs of <or=50 and <or=80 nmol/l. Determinants of serum 25-hydroxyvitamin D concentrations in women were age, ethnicity, obesity, latitude and season; determinants in men were ethnicity and season. Serum 25-hydroxyvitamin D in women declined with age; mean concentration was 13 (8-18) nmol/l lower in women 65 years or older and 9 (5-13) nmol/l lower in women 45-64 years compared with women 15-18 years. Spring to summer differences in serum 25-hydroxyvitamin D were 31 (28-34) and 28 (25-31) nmol/l in women and men, respectively. Obese women had lower vitamin status than normal-weight women by 6 (3-10). Women living in the South Island had a mean serum 25-hydroxyvitamin D that was 6 (3-9) nmol/l lower than women living in the North Island. Ethnicity and season are the major determinants of serum 25-hydroxyvitamin D in New Zealanders. CONCLUSION The high prevalence of vitamin D insufficiency in New Zealanders, particularly in older women, may warrant strategies to improve vitamin D status.
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Affiliation(s)
- J E P Rockell
- Department of Human Nutrition, University of Otago, P.O. Box 56, Dunedin, New Zealand
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27
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Sowers MR, Greendale GA, Bondarenko I, Finkelstein JS, Cauley JA, Neer RM, Ettinger B. Endogenous hormones and bone turnover markers in pre- and perimenopausal women: SWAN. Osteoporos Int 2003; 14:191-7. [PMID: 12730778 DOI: 10.1007/s00198-002-1329-4] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2002] [Accepted: 09/11/2002] [Indexed: 10/20/2022]
Abstract
We tested the hypothesis that higher serum osteocalcin and urinary N-telopeptide of type I collagen (NTx) concentrations would be found in women with increasing cycle irregularity or increased follicle stimulating hormone concentrations. We studied 2,375 pre- and early perimenopausal women from the Study of Women's Health Across the Nation (SWAN), aged 42-52 years, who self-identified their race/ethnic origin as African-American (28.3%), Caucasian (49.4%), Japanese (10.5%) or Chinese (11.8%). Outcome measures were serum osteocalcin, a measure of bone formation, and NTx, a measure of bone resorption. The explanatory variables were menopausal status, based on self-reported regularity of menstrual bleeding, and circulating endogenous hormone concentrations including estradiol (E(2)), testosterone (T), sex hormone binding globulin (SHBG) and follicle stimulating hormone (FSH) concentrations. Additionally, we evaluated the association of the bone turnover markers with the Free Androgen Index (FAI) and the Free Estradiol Index (FEI), ratios of total testosterone and estradiol concentrations to SHBG, respectively. Higher FSH concentrations were associated with higher NTx concentrations ( beta=0.003, partial r2=2.1%, p<0.0001), both before and after adjusting for other covariates (total explained variability of 9%). Higher FSH concentrations were also associated with higher osteocalcin concentrations ( beta=-0.216, partial r2=4.1%, p<0.0001, total explained variability of 15.4%). There were no significant associations of the bone turnover markers with other endogenous hormones, following adjustment for covariates. Mean osteocalcin and NTx values were not significantly different in premenopausal women compared to early perimenopausal women. In these pre- and early perimenopausal women, higher FSH concentrations, but not other serum reproductive hormone concentrations, are positively associated with greater bone turnover prior to the last menstrual period.
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Affiliation(s)
- M R Sowers
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA.
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Shields AT, Chesnut CH. Diagnosis of postmenopausal osteoporosis: reviews in endocrine and metabolic disorders. Rev Endocr Metab Disord 2001; 2:23-33. [PMID: 11704977 DOI: 10.1023/a:1010050823176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A T Shields
- Department of Radiology, University of Washington Medical Center, Osteoporosis Research Group, 1107 NE 45th Street, Suite 440, Seattle, WA 98105-4631, USA
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