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Goyal A, Kubihal S, Gupta Y, Shalimar, Kandasamy D, Kalaivani M, Tandon N. Bone mass, microarchitecture and turnover among young Indian women with non-alcoholic fatty liver disease. Endocrine 2024:10.1007/s12020-024-03934-w. [PMID: 38914745 DOI: 10.1007/s12020-024-03934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/14/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE To evaluate comprehensive bone health among young Indian women, including bone mass, microarchitecture, and turnover, in relation to their non-alcoholic fatty liver disease (NAFLD) status. METHODS This cross-sectional study (May 2018-November 2019) recruited women with a history of gestational diabetes mellitus (GDM) and normoglycemia in their index pregnancy, who were at least 6 months postpartum. All participants underwent abdominal ultrasonography for determination of NAFLD status (grades 2 and 3: severe NAFLD) and transient elastography (FibroScan) for hepatic fibrosis (LSM >6 kPa). Bone mass was assessed by DXA, bone microarchitecture with trabecular bone score {TBS} (low TBS ≤ 1.310) and bone turnover with markers of bone formation (osteocalcin and P1NP), and resorption (CTX). RESULTS Bone mineral density (BMD) at femoral neck (p = 0.026) and total hip (p = 0.007) was significantly higher among women with NAFLD (n = 170) compared to those without (n = 124). There was no significant difference in bone turnover markers between the two groups. The presence of NAFLD [adjusted OR: 1.82 (1.07, 3.11)] was associated with low TBS, with a greater strength of association among women with severe NAFLD [adjusted OR: 2.97 (1.12, 7.88)]. However, these associations were attenuated and no longer significant after additionally adjusting for BMI. Women with NAFLD and hepatic fibrosis manifested significantly higher BMD at lumbar spine, femoral neck, and total hip (p < 0.001 for all) and significantly lower bone turnover markers (osteocalcin, p = 0.009 and CTX, p = 0.029), however, the association with low TBS was not observed. CONCLUSION Among young Indian women, NAFLD is associated with increased bone mass and impaired bone microarchitecture, and hepatic fibrosis with increased bone mass and reduced bone turnover.
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Affiliation(s)
- Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Suraj Kubihal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Kumar V, Barik S, Kumari K, Richa R, Raj V, Shukla M, Kumar A, Kumar R. Comparison of bone health among pre-menopausal and post-menopausal females in rural Eastern India: A pilot study. Post Reprod Health 2024:20533691241265027. [PMID: 38914519 DOI: 10.1177/20533691241265027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
PURPOSE The aim of this study was to identify the at-risk female population (pre- and post-menopausal), identify the risk factors for low bone mineral density (BMD) and assess the knowledge of the subjects regarding osteoporosis by Osteoporosis Knowledge Assessment Tool (OKAT) in both the groups and to determine areas for early intervention in a predominantly rural and tribal area of Eastern India. STUDY DESIGN This was a cross-sectional hospital-based study conducted in a predominant tribal and rural area of Eastern India. Females who were pre- and post-menopausal without a prior diagnosis of osteoporosis were included in the study. MAIN OUTCOME MEASURES Factors affecting osteoporosis and quantified knowledge regarding the disease. RESULTS A total of 388 females were included in the study (pre-menopausal = 190 and post-menopausal = 198). Although no significant difference was noted in the age at menarche between both the groups, a gradual significant shift in the age at menarche was noted in the younger females (p = .031). The mean OKAT score in the pre-menopausal and post-menopausal group was 9.5 ± 3.4 and 9.2 ± 3.5, respectively. 80% of females in the pre-menopausal group had normal T-scores whereas only 25% of the females in the post-menopausal group had normal T-scores. CONCLUSION Targeted educational programs which influence the preventive health behaviour in general and osteoporosis knowledge in particular would bridge this gap. Peer-led community intervention programs which focus on behaviour change with respect to lifestyle and diet modification in the younger population should be the step ahead to reduce the prevalence of the disease.
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Affiliation(s)
- Vishal Kumar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sitanshu Barik
- All India Institute of Medical Sciences Nagpur, Nagpur, India
| | - Kusum Kumari
- All India Institute of Medical Sciences - Deoghar, Deoghar, India
| | - Richa Richa
- All India Institute of Medical Sciences - Deoghar, Deoghar, India
| | - Vikash Raj
- All India Institute of Medical Sciences - Deoghar, Deoghar, India
| | - Mamta Shukla
- All India Institute of Medical Sciences - Deoghar, Deoghar, India
| | - Aman Kumar
- All India Institute of Medical Sciences - Deoghar, Deoghar, India
| | - Rajesh Kumar
- All India Institute of Medical Sciences - Deoghar, Deoghar, India
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Singh W, Kushwaha P. Potassium: A Frontier in Osteoporosis. Horm Metab Res 2024; 56:329-340. [PMID: 38346690 DOI: 10.1055/a-2254-8533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Osteoporosis is a significant public health concern, particularly in aging populations, leading to fractures, decreased mobility, and reduced quality of life. While calcium and vitamin D have long been recognized as essential for bone health, emerging research suggests that potassium may play a crucial role in maintaining bone density and preventing osteoporosis. This manuscript explores the relationship between potassium and osteoporosis, delving into the mechanisms, epidemiological evidence, and potential therapeutic implications of potassium in bone health. Furthermore, the manuscript discusses the sources of dietary potassium, its impact on bone metabolism, and the future directions in research and clinical practice regarding potassium's role in osteoporosis management.
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Jalaja AR, Nair A, Bindumadhavan V, Soumya NPP, Rauf AA. Targeting the Role of PRME in Regulating Bone Remodelling During Postmenopausal Osteoporosis. Chem Biodivers 2024; 21:e202400172. [PMID: 38369572 DOI: 10.1002/cbdv.202400172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
Kariavattom Campus Postmenopausal osteoporosis (PMO) is an old age disorder associated with estrogen deficiency, which reduces bone mass and makes bones more prone to fracture. The present study was proposed to evaluate the invivo osteogenic efficiency of Pterospermum rubiginosum methanolic bark extract (PRME) in the PMO model. Molecular docking studies on transcription factor NFATC1 showed excellent interactions with phytochemical ligands with the lowest binding energies. Female Sprague Dawley (SD) rats (n=24) were divided into four groups, (n=6 each) sham control (Group I) and osteoporotic control (Group II) groups treated with saline, PRME (50 mg/kg/day) and alendronate (10 mg/kg/day) treated with Group III and Group IV (n=6) respectively. The serum tartrate-resistant acid phosphatase 5b and cathepsin-K also exhibited a significant rise after PRME treatment 12.33±2.30 mU/ml and 427.68±46.97 pg/ml, respectively. DEXA results exhibited a remarkable increase in total bone mineral content and density values in PRME-treated animals (0.175±0.002 g/cm2) and (7.95±0.23 g) when compared to osteoporotic control (0.163±0.004 g/cm2) and (6.83±0.34 g). Long-term toxicity study revealed that PRME is non-toxic, up to 100 mg/kg bodyweight for 6 months. Our findings suggest PRME protects osteoporotic SD rats from PMO damage resulting from estrogen deficiency by regulating bone remodelling markers and upregulating BMD indices.
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Affiliation(s)
- Anish Rajamohanan Jalaja
- Department of Biochemistry, University of Kerala, Kariavattom Campus, Trivandrum, Thiruvananthapuram, 695581, India Tel
| | - Aswathy Nair
- Department of Biochemistry, University of Kerala, Kariavattom Campus, Trivandrum, Thiruvananthapuram, 695581, India Tel
- Kerala State Palmyrah Products Development and Workers' Welfare Corporation Limited, Trivandrum, India
| | | | - Neelakanta Pillai Padmakumari Soumya
- Department of Biochemistry, University of Kerala, Kariavattom Campus, Trivandrum, Thiruvananthapuram, 695581, India Tel
- Kerala State Animal Husbandry Department, Mararikulam south, Alappuzha, Kerala, India
| | - Arun A Rauf
- Department of Biochemistry, University of Kerala, Kariavattom Campus, Trivandrum, Thiruvananthapuram, 695581, India Tel
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Babu LK, Shaw S, Ghosh D. Bone mineral metabolism and different indices of skeletal health of Ladakhi women living at high altitude. Osteoporos Sarcopenia 2023; 9:131-136. [PMID: 38374823 PMCID: PMC10874723 DOI: 10.1016/j.afos.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/26/2023] [Accepted: 11/16/2023] [Indexed: 02/21/2024] Open
Abstract
Objectives High altitude possesses a great challenge for human survival owing to low oxygen tension and has been reported to cause bone deterioration among sojourns of high altitude. The bone health of Ladakhi women is investigated for the first time in this study. Methods Dual energy X-ray absorptiometry of Ladakhi women and sea level women was done at the radius and calcaneus using EXA-3000 (Osteosys, Korea), followed by colorimetric and Enzyme Linked Immunosorbent Assay analysis of parameters regulating bone health. Results There was no statistically significant difference between bone mineral density of Ladakhi women and sea level women at radius (P = 0.287) or calcaneus (P = 0.839). Almost similar cases of osteopenia were reported at both sites measured in the study among both groups. Two post-menopausal Ladakhi women however, had osteoporosis at the radius while 4 had osteoporosis at calcaneus. Significant increase in calcium levels with a decrease in intact parathyroid hormone and an increase in calcitonin levels were observed in Ladakhi women as compared to sea level women. Though there was no significant difference in 25-hydroxy vitamin D levels of both groups, a higher percentage of 25-hydroxy vitamin D deficiency (77% vs 23%) was observed in Ladakhi women as compared to sea level women. Estradiol levels were similar in both groups. Conclusions The present study suggest that there is no significant relationship between high altitude living and bone mineral density among Ladakhi women.
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Affiliation(s)
- Lijy K. Babu
- Applied Physiology Lab, Defence Institute of Physiology and Allied Sciences, Delhi, India
| | - Snigdha Shaw
- Applied Physiology Lab, Defence Institute of Physiology and Allied Sciences, Delhi, India
| | - Dishari Ghosh
- Applied Physiology Lab, Defence Institute of Physiology and Allied Sciences, Delhi, India
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Agrawal AC, Garg AK. Epidemiology of Osteoporosis. Indian J Orthop 2023; 57:45-48. [PMID: 38107804 PMCID: PMC10721571 DOI: 10.1007/s43465-023-01012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/26/2023] [Indexed: 12/19/2023]
Abstract
Background India has a population capacity of 1.2 billion people. With a worldwide aging population, the prevention and management of osteoporosis has become a significant healthcare challenge. It is crucial to recognize the factors impacting poor bone health and appreciate the many hurdles to treat the disease to provide a better quality of life and decrease the financial burden on healthcare. Purpose In this review article, we discuss the epidemiology of osteoporosis and address the definition, incidence, and prevalence, geographical variation in the occurrence of osteoporosis, and the risk factors for osteoporosis. Methods Search terms using various combinations of the keywords 'osteoporosis,' 'epidemiology,' 'incidence,' 'prevalence,' 'fracture,' 'India,' 'world,' 'screening,' and 'FRAX' was done to review all relevant literature till June 2023. Results & Conclusion India has a recent estimate of population capacity of 1.2 billion people. Various studies have revealed an osteoporosis prevalence in Indian women ranging from 8% to 62%. Poor dietary calcium intake, low vitamin D, and lifestyle changes contribute to osteoporosis.
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Affiliation(s)
- Alok Chandra Agrawal
- Department of Orthopaedics, All India Institute of Medical Sciences, Raipur, India
| | - Ankit Kumar Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, Raipur, India
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Tiwari JP. Osteoporosis in Renal Disease. Indian J Orthop 2023; 57:192-199. [PMID: 38107809 PMCID: PMC10721758 DOI: 10.1007/s43465-023-01021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/09/2023] [Indexed: 12/19/2023]
Abstract
Introduction Osteoporosis is a disorder characterized by decreased bone mass and skeletal fragility with increased fracture risk. Chronic kidney disease presents with wide range of bone metabolic disorders, including osteoporosis. Osteoporosis prevalence is high in early stages of CKD; whereas in late stages, it coexists with renal osteodystrophy. Risk factors Risk factors for osteoporosis include advancing age, low bone mineral density (BMD), glucocorticoid therapy, smoking, alcohol intake, etc. Diagnosis The diagnosis of osteoporosis in renal disease is made after assessment of BMD, in addition to exclusion of chronic kidney disease-mineral bone disorder (CKD-MBD), eliciting history of prior fragility fractures and relevant laboratory investigations. Management The treatment of osteoporosis varies with the different stages of CKD, with management in stages 1-3 being similar to the general population. Special emphasis must be laid on prevention of fractures as well.
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Affiliation(s)
- Jai Prakash Tiwari
- Department of Nephrology, Goa Medical College, Bambolim, Goa 403202 India
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Litin Y, Rastogi S, Agarwal A, Misra S, Agrawal P, Malviya D. A Prospective Evaluation of Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fracture Patients. Cureus 2023; 15:e40255. [PMID: 37440815 PMCID: PMC10335599 DOI: 10.7759/cureus.40255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Background Osteoporotic vertebral compression fracture (OVCF) is a common problem in old age, which causes incapacitating pain and leads to significant disability, morbidity, and mortality. Percutaneous vertebroplasty (PVP), a minimally invasive procedure, results in immediate pain relief with decreased morbidity. The primary aim of this study was to evaluate the quality of life (QOL), as denoted by the Roland-Morris Disability Questionnaire (RMDQ) score. In contrast, the secondary aims were determining pain relief using the 11-point Numeric Pain Rating Scale (NPRS) and vertebral height restoration and wedge angle measurements after PVP. Methodology This prospective, longitudinal, interventional study on the efficacy of PVP was conducted among patients with low back pain due to osteoporotic vertebral collapse in a tertiary care institute. Patients with OVCF were managed by PVP and followed at one week, one month, three months, and six months for improvement in QOL by the RMDQ score and pain relief using the NPRS. The pre and post-vertebroplasty wedge angle and vertebral height (anterior, middle, and posterior columns) at one week and six months were also compared by pre and post-vertebroplasty lateral view skiagrams. Results A total of 24 patients were included in this study based on the inclusion and exclusion criteria. The demographic data were comparable. The RMDQ score showed a statistically significant difference in post-PVP at one week (p = 0.044), one month (p = 0.031), three months (p = 0.022), and six months (p = 0.018). There was a statistically significant difference in the NPRS at six months compared to the pre-PVP status, showing drastic pain relief in patients after PVP. The mean wedge angle (20.5 ± 2.07) measurement was reduced with a statistically significant increase in anterior body height restoration from pre-PVP to six months. There was no significant change in height at the middle and posterior columns compared to the pre-PVP height. Conclusions PVP is an effective, safe, minimally invasive pain and spine intervention for OVCFs with improved QOL and restoration of vertebral height.
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Affiliation(s)
- Yasum Litin
- Department of Anaesthesiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Shivani Rastogi
- Department of Anaesthesiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Anurag Agarwal
- Department of Anaesthesiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Shilpi Misra
- Department of Anaesthesiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Pankaj Agrawal
- Department of Orthopaedics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Deepak Malviya
- Department of Anaesthesiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
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Raj V, Barik S, Raj M. Attention to the Bone Health of a Neglected Rural-Tribal Population in India: A Pilot Study. Indian J Community Med 2023; 48:501-504. [PMID: 37469910 PMCID: PMC10353670 DOI: 10.4103/ijcm.ijcm_685_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 04/20/2023] [Indexed: 07/21/2023] Open
Abstract
Objective The aim of this pilot study was to analyze the need and feasibility of conducting prospective research on the epidemiological factors of bone mineral density (BMD) in the at-risk population in a rural and tribal-dominated area based on a screening test. Methods This community-based retrospective cross-sectional study was based on data from the medical records from July 2021 to September 2021 at community camps organized in a rural area of Deoghar district of Jharkhand, India, and the at-risk patients who had undergone ultrasound-based BMD measurement were included in this study. Results The mean age of the patients (N = 216) was 68.2 ± 10.2 years (range 35-73 years) with a mean T-score of -0.83 ± 0.09 (range -2.78-0.3, 95% CI 0.19). 70.3% (n = 152) of the patients were diagnosed as either osteopenic or osteoporotic based on the T-score. 14.8% (n = 32) of the patients had a comorbidity making them susceptible for low BMD. BMD was significantly low in patients above 60 years of age (t - 3.36, P - 0.0005), presence of comorbidity (t - 3.12, P - 0.001), and urban population (t - -1.93, P - 0.02). Conclusion Although DEXA remains the study of choice, QUS can be used in primary healthcare systems in the developing world for the purposes of screening. Females, elderly, and urban residence have an increased chance of low BMD. This pilot study shows that a large-scale prospective study analyzing various aspects of bone health including dietary and lifestyle practices is the need of the hour.
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Affiliation(s)
- Vikash Raj
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Manish Raj
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
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Muacevic A, Adler JR. Whole-Body Vibration Therapy as a Modality for Treatment of Senile and Postmenopausal Osteoporosis: A Review Article. Cureus 2023; 15:e33690. [PMID: 36793830 PMCID: PMC9925023 DOI: 10.7759/cureus.33690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Whole-body vibration therapy is an intentional biomechanical stimulation of the body using various frequencies of vibrations with the motive of health improvement. Ever since its discovery, this therapy has been extensively used in physiotherapeutic measures and the sports industry. For its property of increasing bone mass and density, space agencies use this therapy on astronauts who return to Earth after long-term space missions to regain lost bone and muscle mass. The potential of this therapy to restore bone mass encouraged researchers to look for its scope in the treatment of age-related bone degenerative diseases such as osteoporosis and sarcopenia, as well as in the correction of posture control and gait in geriatrics and post-menopausal women. Osteoporosis and osteopenia account for roughly half of all fractures worldwide. These degenerative diseases also cause gait and posture changes. Bisphosphonates, monoclonal antibodies, parathyroid hormone fragments, hormone replacement therapies, and calcium and vitamin D supplementation are among the medical treatments available. Lifestyle changes and physical exercise are advised. However, vibration therapy's scope as a treatment option is yet to be explored. The safe range of frequency, amplitude, duration, and intensity of the therapy is still to be determined. This article is a review of the results of various clinical trials done in the last 10 years that target the effect of vibration therapy in both osteoporotic women and the elderly for the treatment of such ailments and deformities. We collected data from PubMed using advanced search and applied the exclusion criteria. In total, we analyzed nine clinical trials.
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Muacevic A, Adler JR, Chhabra HS, Jain A. Impact of Lumbar Postures on the Functioning of Pelvic Floor Muscles Among Osteoporotic Post-Menopausal Women. Cureus 2022; 14:e32869. [PMID: 36578851 PMCID: PMC9785378 DOI: 10.7759/cureus.32869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Maintaining continence and providing support to the abdominal contents and sexual functioning are among the primary roles of pelvic floor muscles. The pelvic floor muscles work in synergy with the abdominal muscle to perform these functions. Abdominal muscle activation in the sagittal plane is influenced by the lumbar spine posture. As pelvic floor dysfunction is common among post-menopausal women, this study aims to find out the relationship between lumbar posture and electromyographic (EMG) activity of the rectus abdominis (RA) muscle and vaginal pressure (VP) as a functioning of the pelvic floor muscles among osteoporotic post-menopausal females. Methods A total of 78 osteoporotic post-menopausal women were recruited and allocated into three groups depending on lumbar lordotic angle, namely normal lordosis (n=26) hyperlordosis (n=26), and hypolordosis (n=26). All the subjects were recorded for RA EMG activity and VP for pelvic floor function in the quiet standing (QS) position, and voluntary dynamic tasks such as maximal coughing (MC) and Valsalva maneuver (VM). Data were analyzed using one-way analysis of variance (ANOVA) and post hoc analysis. A 5% probability level was considered statistically significant, i.e., p<0.05. Results The results showed a significant reduction in the RA activity and VP during the dynamic tasks (MC and VM) among subjects with the altered lumbar lordotic angle (p<0.05). The reduction in RA activity and VP was found to be significantly higher (p<0.05) in subjects with hyperlordotic lumbar spine than in those with hypolordotic lumbar spine as compared to normal lordosis during QS, MC, and VM. Conclusion We conclude that osteoporotic post-menopausal women with different lumbar lordotic angle show variations in RA activity and pressure generated by the vagina as a function of the pelvic floor during voluntary dynamic tasks.
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Pingali U, Nutalapati C. Shilajit extract reduces oxidative stress, inflammation, and bone loss to dose-dependently preserve bone mineral density in postmenopausal women with osteopenia: A randomized, double-blind, placebo-controlled trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 105:154334. [PMID: 35933897 DOI: 10.1016/j.phymed.2022.154334] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/27/2022] [Accepted: 07/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Accelerated bone loss associated with aging and estrogen withdrawal is mediated in part by increased oxidative stress and inflammation. OBJECTIVE Investigate dietary supplementation with a standardized aqueous extract of shilajit with clinically demonstrated antioxidant, anti-inflammatory, and collagen-promoting activity on attenuating bone loss in postmenopausal women with osteopenia. DESIGN Sixty postmenopausal women aged 45 - 65 years with osteopenia were randomized to receive 1 of 3 treatments daily for 48 weeks: (1) placebo, (2) 250 mg shilajit extract, or (3) 500 mg shilajit extract. Bone mineral density (BMD) of the lumbar spine (LS) and femoral neck (FN) were measured at weeks 0, 24, and 48, and circulating markers of bone turnover (CTX-1, BALP, RANKL, OPG), oxidative stress (MDA, GSH), and inflammation (hsCRP) at weeks 0, 12, 24, and 48. RESULTS BMD of both the LS and FN progressively decreased in women receiving placebo but was dose-dependently attenuated with shilajit extract supplementation, resulting in significantly increased percentage changes from baseline in BMD at 24- and 48-weeks in both supplemented groups compared to placebo (p < 0.001). CTX-1, BALP, and RANKL decreased, whereas OPG increased, in both groups supplemented with the shilajit extract, but not in the placebo group, resulting in significantly decreased or increased percentage changes from baseline, respectively. MDA was significantly decreased (p < 0.001) and GSH was significantly increased (p < 0.001) in both supplemented groups compared to placebo from week 12 for the duration of the study. Progressive reductions in hsCRP were observed in both supplemented groups, resulting in significantly decreased percentage changes from baseline in supplemented women compared to placebo (p < 0.001). CONCLUSION Daily supplementation with this shilajit extract supports BMD in postmenopausal women with osteopenia in part by attenuating the increased bone turnover, inflammation and oxidative stress that coincides with estrogen deficiency in this population at increased risk for osteoporosis and bone fractures.
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Affiliation(s)
- Usharani Pingali
- Nizam's Institute of Medical Sciences, Department of Pharmacology and Therapeutics, Telangana, India.
| | - Chandrasekhar Nutalapati
- Nizam's Institute of Medical Sciences, Department of Pharmacology and Therapeutics, Telangana, India
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Gandham A, Scott D, Bonham MP, Kulkarni B, Kinra S, Ebeling PR, Zengin A. Sex Differences in Bone Health Among Indian Older Adults with Obesity, Sarcopenia, and Sarcopenic Obesity. Calcif Tissue Int 2022; 111:152-161. [PMID: 35507092 PMCID: PMC9300534 DOI: 10.1007/s00223-022-00981-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/06/2022] [Indexed: 01/01/2023]
Abstract
Age-related changes in fat and lean mass contribute to bone health, but these associations may be influenced by sex and ethnicity. This study investigated sex-specific associations of obesity and sarcopenia with bone mineral density (BMD) and bone mineral apparent density (BMAD) among Indian older adults. 1057 adults aged ≥ 50 years were included. Dual-energy X-ray absorptiometry (DXA) measured BMD at the hip, spine and whole-body, and BMAD was calculated as BMD/√bone area. Obesity was defined by body fat percentage (cut points; > 25% for men and > 35% for women), and sarcopenia was defined using the revised Asian Working Group for Sarcopenia classification with low hand grip strength (< 28 kg for men and < 18 kg for women) and appendicular lean mass index (< 7.0 kg/m2 for men and < 5.4 kg/m2 for women). Participants were classified into four groups: controls (no obesity or sarcopenia), obesity, sarcopenia, or sarcopenic obesity. Linear regression (β-coefficients and 95%CI) analyses were performed with adjustments for age, smoking status, protein intake, and socioeconomic status. Prevalence of sarcopenia (37%) and sarcopenic obesity (6%) were higher in men than women (17% and 4%, respectively). Compared with controls, men with obesity had lower whole-body BMD and BMAD, but women with obesity had higher hip and spine BMD and BMAD (all p < 0.05). Men, but not women, with sarcopenic obesity, had lower hip and whole-body BMD and BMAD (all p < 0.05) than controls. Men with sarcopenia had lower BMD and BMAD at the hip only, whereas women had lower BMD at all three sites and had lower BMAD at the hip and spine (all p < 0.05), compared with controls. Obesity, sarcopenia, and sarcopenic obesity have sex-specific associations with BMD and BMAD in Indian older adults. With the aging population in India, it is important to understand how body composition contributes to poor bone health among older adults.
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Affiliation(s)
- Anoohya Gandham
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Maxine P Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Bharati Kulkarni
- Clinical Division, National Institute of Nutrition, Jamai Osmania PO, Hyderabad, India
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia.
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Sandeep NV, Joseph A, Cherian KE, Kapoor N, Paul TV. Impact of teriparatide therapy in Indian postmenopausal women with osteoporosis with regard to DXA-derived parameters. Ther Adv Endocrinol Metab 2022; 13:20420188221112903. [PMID: 35923461 PMCID: PMC9340409 DOI: 10.1177/20420188221112903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 06/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background There is paucity of literature on the impact of teriparatide on hip geometry and bone microarchitecture globally and none from the Indian subcontinent. This study examined the outcome of teriparatide therapy on vertebral fractures, bone mineral density (BMD), hip structural analysis (HSA), and trabecular bone score (TBS) in Indian postmenopausal women with severe osteoporosis. Methodology Ambulatory postmenopausal women above the age of 50 years with either severe osteoporosis or vertebral fractures, or both, were recruited. All patients received cholecalciferol (2000 IU/day), calcium carbonate (elemental calcium 1 g/day), and teriparatide (20 mcg subcutaneously/day) for 24 months. Baseline bone biochemistry, BMD, TBS, and HSA were assessed and repeated after 24 months of therapy. Incident vertebral and nonvertebral fractures were also studied. Results A total of 51 postmenopausal women with mean (SD) age of 65.7(8.6) years, and mean (SD) body mass index of 22.7 (3.5) kg/m2 were recruited in this study. Vertebral fractures were present in 74.5% (38/51) at baseline. Following teriparatide therapy, significant improvement was observed in the BMD (g/cm2) at both the lumbar spine (0.706-0.758: p < 0.001) and femoral neck (0.551-0.579: p = 0.047) as well as the TBS (1.160-1.271: p < 0.001). Most indices of proximal hip geometry also showed significant improvement following teriparatide therapy at 24 months. Incident vertebral fractures were noted in only 7.8% (4/51) of participants, while 92% (47/51) of participants did not develop any new vertebral fractures on follow-up. Conclusion In South Indian postmenopausal women with either severe osteoporosis or vertebral fractures, or both, teriparatide was effective in improving the bone mineral parameters and bone quality.
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Affiliation(s)
- Nandipati Venkata Sandeep
- Department of Endocrinology, Diabetes &
Metabolism, Christian Medical College, Vellore, Vellore, India
| | - Aneez Joseph
- Department of Endocrinology, Diabetes &
Metabolism, Christian Medical College, Vellore, Vellore, India
| | - Kripa Elizabeth Cherian
- Department of Endocrinology, Diabetes &
Metabolism, Christian Medical College, Vellore, Vellore, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes &
Metabolism, Christian Medical College, Vellore, Vellore, India
| | - Thomas V Paul
- Professor & Head, Department of
Endocrinology, Diabetes & Metabolism, Christian Medical College,
Vellore, Ida Scudder Road, Vellore 632004, India
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15
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Imran M, Singh A, Bhardwaj A, Agrawal D. Prevalence of Osteoporosis and Associated Risk Factors among Postmenopausal Women: A Cross-Sectional Study from Northern India. J Midlife Health 2022; 13:206-212. [PMID: 36950199 PMCID: PMC10025819 DOI: 10.4103/jmh.jmh_114_22] [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: 06/23/2022] [Revised: 07/11/2022] [Accepted: 08/18/2022] [Indexed: 01/28/2023] Open
Abstract
Context Prevalence statistics of postmenopausal osteoporosis and knowledge regarding its independent predictors are lacking, especially in India, where every third woman and every eighth man is suffering from it. Aim This study aims to investigate the prevalence of osteoporosis and associated risk factors among postmenopausal women. Study Settings and Design This was a hospital-based prospective cross-sectional study. Methods This study was carried out among postmenopausal women, who attended orthopaedics outpatient department from August 2020 to July 2021 and 587 women ranging in age between 50 and 80 years who had confirmed menopause were enrolled for the study. Finally, 539 women were recommended for bone mineral density testing, using dual energy X-ray absorptiometry. Statistical Analysis To analyze the differences between the groups, a Chi-square and Student's t-test were used for the categorical and continuous variables, respectively. P < 0.05 was considered to show significant associations. Results In our study, 54.7% of subjects belonged to <60 years of age group. Half of the subjects (51.9%) were illiterate. 37.7% of subjects were having 6 or more children. 14.5% of subjects were currently smoking or chewing tobacco. Age of menopause among 38.0% of subjects was after 50 years of age and duration of menopause at the time of enrolment in the study was more than 10 years in 48.8% of subjects. The prevalence of osteoporosis increased with the increase in the parity and increased number of abortions. Subjects with family history of symptoms related to osteoporosis, and fragility fracture; and self-history of fragility fracture had higher prevalence of osteoporosis (P < 0.05). Conclusion In our study, the overall prevalence of osteoporotic fractures among postmenopausal females was 82.2% (osteoporosis: 37.5% and osteopenia: 44.7%). The findings of current study and previous studies clearly indicate the urgent need of collective efforts towards the growing problem of osteoporosis in postmenopausal women.
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Affiliation(s)
- Mohammad Imran
- Department of Pharmacology, Maharaja Jitendra Narayan Medical College and Hospital, Cooch Behar, West Bengal, India
| | - Abhishek Singh
- Department of Community Medicine, SHKM Government Medical College, Mewat, Haryana, India
| | - Anu Bhardwaj
- Department of Community Medicine, Dr. BR Ambedkar Institute of Medical Sciences, Mohali, Punjab, India
| | - Deepika Agrawal
- Department of Community Medicine, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
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Shlisky J, Mandlik R, Askari S, Abrams S, Belizan JM, Bourassa MW, Cormick G, Driller‐Colangelo A, Gomes F, Khadilkar A, Owino V, Pettifor JM, Rana ZH, Roth DE, Weaver C. Calcium deficiency worldwide: prevalence of inadequate intakes and associated health outcomes. Ann N Y Acad Sci 2022; 1512:10-28. [PMID: 35247225 PMCID: PMC9311836 DOI: 10.1111/nyas.14758] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/26/2022] [Indexed: 12/18/2022]
Abstract
Dietary calcium deficiency is considered to be widespread globally, with published estimates suggesting that approximately half of the world's population has inadequate access to dietary calcium. Calcium is essential for bone health, but inadequate intakes have also been linked to other health outcomes, including pregnancy complications, cancers, and cardiovascular disease. Populations in low- and middle-income countries (LMICs) are at greatest risk of low calcium intakes, although many individuals in high-income countries (HICs) also do not meet recommendations. Paradoxically, many LMICs with lower calcium intakes show lower rates of osteoporotic fracture as compared with HICs, though data are sparse. Calcium intake recommendations vary across agencies and may need to be customized based on other dietary factors, health-related behaviors, or the risk of calcium-related health outcomes. The lack of standard methods to assess the calcium status of an individual or population has challenged efforts to estimate the prevalence of calcium deficiency and the global burden of related adverse health consequences. This paper aims to consolidate available evidence related to the global prevalence of inadequate calcium intakes and associated health outcomes, with the goal of providing a foundation for developing policies and population-level interventions to safely improve calcium intake and status where necessary.
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Affiliation(s)
| | - Rubina Mandlik
- Hirabai Cowasji Jehangir Medical Research InstitutePuneIndia
| | - Sufia Askari
- Children's Investment Fund FoundationLondonUnited Kingdom
| | | | - Jose M. Belizan
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP)Instituto de Efectividad Clínica y Sanitaria (IECS‐CONICET)Buenos AiresArgentina
| | | | - Gabriela Cormick
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP)Instituto de Efectividad Clínica y Sanitaria (IECS‐CONICET)Buenos AiresArgentina
| | | | - Filomena Gomes
- The New York Academy of SciencesNew YorkNew York
- NOVA Medical SchoolUniversidade NOVA de LisboaLisboaPortugal
| | | | - Victor Owino
- Division of Human HealthInternational Atomic Energy AgencyViennaAustria
| | - John M. Pettifor
- Faculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
| | | | - Daniel E. Roth
- The Hospital for Sick Children/University of TorontoTorontoOntarioCanada
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17
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Kajale N, Khadilkar A, Shah N, Padidela R, Mughal Z, Chiplonkar S, Ekbote V, Khadilkar V. Impact of Adolescent Pregnancy on Bone Density in Underprivileged Pre-Menopausal Indian Women. J Clin Densitom 2022; 25:178-188. [PMID: 34911660 DOI: 10.1016/j.jocd.2021.11.001] [Citation(s) in RCA: 1] [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: 04/21/2021] [Revised: 09/29/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
High prevalence (31.5%) of adolescent pregnancies (AP) have been reported in India. Reports suggest that pregnancy during adolescence may have deleterious effects on peak bone mass. Very few studies have described the long-term effects of a history of AP on bone mass. The objective of this study was to compare bone mineral density (BMD) and bone geometry of premenopausal women with first childbirth during adolescence (i.e., before age of 19 years) or after 20 years. A cross-sectional study was conducted in 242 women (age 28.0-54.5 years) from Pune, India (November, 2015 to November, 2017). Women were divided into 2-groups: Group-1: women-who had 1st-pregnancy and childbirth before 19 years of age (AP n = 131) and Group-2: women-who had 1st pregnancy after 20 years of age (non-AP n = 111). Demographic data, anthropometric measurements, and biochemical tests were performed using standard protocols. Physical activity and nutrient intakes were recorded using validated questionnaires. Areal BMD and bone geometry were measured using Dual-Energy-Absorptiometry-DXA (Lunar-iDXA, GE Healthcare) and peripheral-quantitative-computed-tomography-pQCT (XCT2000, Stratec Inc.). Mean age of the study group was 37 ± 4.6 years; in women from group-1 mean age at first delivery was 16.9 ± 1.6 years as against 22.6 ± 3.1 years in group-2. Both groups were similar in body mass index and socioeconomic status. pQCT measured radial diaphyseal cortical thickness (1.97 ± 0.3 mm vs 1.88 ± 0.3 mm resp., p = 0.016, periosteal circumference (38.0 ± 3.6 mm vs 36.7 ± 2.5 mm, resp. p = 0.016), total bone area (114.3 ± 24.8 mm2 vs 108.7 ± 14.7 mm2 resp. p = 0.026) and stress-strain index (SSI = 217 ± 75 vs 201 ± 40 mm3 resp. p = 0.042) were significantly higher in group-1 than group-2. After adjusting for anthropometric and lifestyle parameters, pQCT measured cortical thickness (1.98 ± 0.03 mm in group-1, 1.87 ± 0.03 mm group-2, p = 0.01, mean ± SE) and iDXA derived aBMD at forearm were still significantly higher (0.599 ± 0.006 g/cm3 vs 0.580 ± 0.006 g/cm3, p = 0.023) in Group-1. Our data suggest that women with a history of adolescent pregnancy had better bone geometry and higher aBMD at radius in later years. We speculate that early exposure to pregnancy resulted in higher aBMD at the radius and induced changes at radial diaphysis with bones becoming thicker and wider among these women.
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Affiliation(s)
- Neha Kajale
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India.
| | - Nikhil Shah
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India; Department of Pediatrics, Cloudnine Hospital, Malad, Mumbai
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, Manchester
| | - Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, Manchester
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
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Aggarwal D, Palta A, Jindal R, Kumar A, Sodhi M, Saini V. Prevalence and predictors of osteoporosis in patients of interstitial lung disease: An observational study from North India. INDIAN JOURNAL OF RESPIRATORY CARE 2022. [DOI: 10.4103/ijrc.ijrc_86_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Anupama DS, Noronha JA, Acharya KKV, Prabhu MM, Shetty J, Shankar R, Nayak BS. Burden of Osteopenia and Osteoporosis Among Postmenopausal Women in India: A Systematic Review and Meta-Analysis. J Midlife Health 2022; 13:107-114. [PMID: 36276622 PMCID: PMC9583365 DOI: 10.4103/jmh.jmh_207_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/21/2022] [Accepted: 06/25/2022] [Indexed: 11/04/2022] Open
Abstract
Aim Postmenopausal osteoporosis is a major public health problem around the world. The objective of this systematic review is to determine the prevalence of osteoporosis in postmenopausal women in India. Materials and Methods This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified relevant studies through a search of literature published from 2010 to January 2021 in the databases PubMed, Web of Science, ProQuest, CINHAL, and PEDro databases. We searched for cross-sectional studies involving India that were published in English. Results There was a total of 1631 hits in the initial search and out of which 60 studies were selected for full-text review. Twelve studies were selected for qualitative analysis. Excluded studies were 48 with reasons: 20 studies had included other diseases such as knee arthritis, celiac diseases, diabetes mellitus, and kidney diseases. Eleven studies included premenopausal women, young adults, and men. Ten studies outcomes were different, and seven studies were excluded as they have done retrospective analysis and were commentaries. The pooled prevalence of osteoporosis at the lumbar spine region was 29%, the hip region was 6% and the femoral neck region was 29% whereas the pooled prevalence of osteopenia at the lumbar spine region was 37%, the hip was 6%, and femoral neck region was 37%. Conclusion This systematic review found that postmenopausal women are at significant risk of developing low bone mineral density, and the prevalence of osteoporosis and osteopenia was high in the lumbar area.
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Affiliation(s)
- D. S. Anupama
- Department of OBG Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Judith Angelitta Noronha
- Department of OBG Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India,Address for correspondence: Dr. Judith Angelitta Noronha, Department of OBG Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal - 576 104, Karnataka, India. E-mail:
| | - Kiran K. V. Acharya
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Mukhyaprana M Prabhu
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Jyothi Shetty
- Department of OBG, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Ravi Shankar
- Department of Biostatistics, Vallabhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Baby S. Nayak
- Department of Paediatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
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20
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Seshadri MS, Gopi M, Murali P, Kumar K. Osteoporosis in a Rural Community - Long-Term Effects of a Community Level Program of Calcium and Vitamin D Supplementation - A Prospective Observational Study. Indian J Endocrinol Metab 2021; 25:305-312. [PMID: 35136737 PMCID: PMC8793951 DOI: 10.4103/ijem.ijem_141_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 11/06/2022] Open
Abstract
In a defined geographic area in rural India (1,60,000 population), osteoporosis detection and calcium and vitamin D supplementation program was instituted. Of the eligible 15,386 subjects, 5,992 (38%) participated in the program; 2,882 (48%) had osteopenia and osteoporosis; supervised calcium and vitamin D supplementation was instituted; 2,113 (73.3% of those identified) completed 2 years of supplementation. The mean duration of the follow-up was 5 years (range 2-8 years). On follow-up, three groups emerged; those who were regular, those who were irregular, and those who did not take supplements. In those who were regular with calcium and vitamin D supplementation, we found a significant reduction in fractures (RR 0.27, 95% CI 0.09-0.81) compared with those who did not take supplements. There was no significant difference in falls between the three groups. Mortality was significantly lower (RR 0.53, 95% CI 0.31-0.91) in those who were regular with calcium and vitamin D supplements compared to those who did not take supplements. While the reduction in fractures was probably due to calcium and vitamin D supplementation, the reduction in mortality was probably because those who took regular supplements accessed healthcare services more readily for other comorbidities as part of their follow-up program.
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Affiliation(s)
- Mandalam S. Seshadri
- Department of Medicine and Endocrinology, Thirumalai Mission Hospital, Vanapadi Road, Ranipet, Vellore, Tamil Nadu, India
| | - Manigandan Gopi
- Department of Medicine and Endocrinology, Thirumalai Mission Hospital, Vanapadi Road, Ranipet, Vellore, Tamil Nadu, India
| | - Priyanka Murali
- Department of Medicine and Endocrinology, Thirumalai Mission Hospital, Vanapadi Road, Ranipet, Vellore, Tamil Nadu, India
| | - Kaliyaperumal Kumar
- Department of Medicine and Endocrinology, Thirumalai Mission Hospital, Vanapadi Road, Ranipet, Vellore, Tamil Nadu, India
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21
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Bhadada SK, Chadha M, Sriram U, Pal R, Paul TV, Khadgawat R, Joshi A, Bansal B, Kapoor N, Aggarwal A, Garg MK, Tandon N, Gupta S, Kotwal N, Mahadevan S, Mukhopadhyay S, Mukherjee S, Kukreja SC, Rao SD, Mithal A. The Indian Society for Bone and Mineral Research (ISBMR) position statement for the diagnosis and treatment of osteoporosis in adults. Arch Osteoporos 2021; 16:102. [PMID: 34176015 DOI: 10.1007/s11657-021-00954-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/26/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED The Indian Society for Bone and Mineral Research (ISBMR) has herein drafted clinical practice guidelines for the diagnosis and management of osteoporosis for the people of India. Implementation of the position statement in clinical practice is expected to improve the overall care of patients with osteoporosis in India. PURPOSE In India, osteoporosis is a major public health problem. However, in the absence of any robust regional guidelines, the screening, treatment, and follow-up of patients with osteoporosis are lagging behind in the country. METHODS The Indian Society for Bone and Mineral Research (ISBMR), which is a multidisciplinary group of physicians, researchers, dietitians, and epidemiologists and who study bone and related tissues, in their annual meeting, drafted the guidelines for the diagnosis and management of osteoporosis that would be appropriate in a resource constraint setting like India. RESULTS Diagnosis of osteoporosis can be made in a patient with minimal trauma fracture without the aid of any other diagnostic tools. In others, bone mineral density measured by dual-energy X-ray absorptiometry remains the modality of choice. Data indicates that osteoporotic fractures occur at an earlier age in Indians than in the West; hence, screening for osteoporosis should begin at an earlier age. FRAX can be used for fracture risk estimation; however, it may underestimate the risk of future fractures in our population and still needs validation. Maintaining optimum serum 25-hydroxyvitamin D levels is essential, which, in most cases, would require regular vitamin D supplementation. Pharmacotherapy should be guided by the presence/absence of vertebral/hip fractures or the severity of risk based on clinical factors, although bisphosphonates remain the first choice in most cases. Regular follow-up is essential to ensure adherence and response to therapy. CONCLUSIONS Implementation of the position statement in clinical practice is expected to improve the overall care of patients with osteoporosis in India.
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Affiliation(s)
- Sanjay K Bhadada
- Department of Endocrinology, Post Graduate Institute Of Medical Education and Research, Chandigarh, 160012, India.
| | - Manoj Chadha
- Department of Endocrinology, Parmanand Deepchand Hinduja Hospital, Mumbai, 400016, India
| | - Usha Sriram
- Endocrinology and Diabetology Division, Voluntary Health Services Hospital, Chennai, 600020, India
| | - Rimesh Pal
- Department of Endocrinology, Post Graduate Institute Of Medical Education and Research, Chandigarh, 160012, India
| | - Thomas V Paul
- Department of Endocrinology, Christian Medical College, Vellore, 632002, India
| | - Rajesh Khadgawat
- Department of Endocrinology, All India Institute Of Medical Sciences, New Delhi, 110023, India
| | - Ameya Joshi
- Endocrinology Division, Bhaktivedanta Hospital, Thane, 401107, India
| | - Beena Bansal
- Endocrinology and Diabetes Division, Door to Care, Gurgaon, 122018, India
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, 632002, India
| | - Anshita Aggarwal
- Department of Endocrinology, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Mahendra K Garg
- Department of Endocrinology, All India Institute Of Medical Sciences, Jodhpur, 342001, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute Of Medical Sciences, New Delhi, 110023, India
| | - Sushil Gupta
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Narendra Kotwal
- Department of Endocrinology, Army Hospital Research & Referral, New Delhi, 110010, India
| | - Shriraam Mahadevan
- Endocrinology Division, Sri Ramachandra Medical Center, Chennai, 600116, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, 700020, India
| | - Soham Mukherjee
- Department of Endocrinology, Post Graduate Institute Of Medical Education and Research, Chandigarh, 160012, India
| | - Subhash C Kukreja
- Department of Medicine, University of Illinois, Chicago, IL, 60612, USA
| | - Sudhaker D Rao
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Bone & Mineral Disorders, Henry Ford, Health System, Detroit, MI, 48202, USA
| | - Ambrish Mithal
- Endocrinology and Diabetes Division, Max Healthcare, New Delhi, 110017, India.
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22
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Sharma A, Sharma L, Saini RV, Kumar A, Goyal R. Pinus roxburghii alleviates bone porosity and loss in postmenopausal osteoporosis by regulating estrogen, calcium homeostasis and receptor activator of nuclear factor-κB, osteoprotegerin, cathepsin bone markers. J Pharm Pharmacol 2021; 73:901-915. [PMID: 33769535 DOI: 10.1093/jpp/rgaa014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/08/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The study was aimed to evaluate the potential of hydroalcoholic extract of Pinus roxburghii (PRE) stem bark in post-menopausal osteoporosis and its underlying mechanisms. METHODS In silico docking of the markers was done using AutoDock version 4.2. for molecular targets: receptor activator of nuclear factor-κB (RANK), osteoprotegerin (OPG) and Cathepsin. Female Wistar rats of bodyweight 200-250 g were employed and surgical ovariectomy (OVX) was performed. PRE was administered at a dose of 100 and 200 mg/kg whereas standard drug, raloxifene given at 1 mg/kg orally for eight weeks. KEY FINDINGS PRE (20 and 40 µg/mL) significantly increased the cellular proliferation in osteoblastic UMR cell lines 11.58 and 15.09% respectively. Eight weeks after surgical removal of ovaries, a significant bone porosity was confirmed by modulation in bone breaking strength of tibia, lumber, and femur; bone mineral density (BMD), calcium, phosphorus, hydroxyproline levels in OVX group. Treatment with PRE 100 and 200 mg/kg significantly restored the bone loss. Real-time polymerase chain reaction (RT-PCR) analysis of molecular markers RANK, OPG and cathepsin and histology also confirmed the attenuation of bone loss. The quantification of quercetin, gallic acid, caffeic acid, catechin, tannic acid and ascorbic acid was done by high-performance liquid chromatography (HPLC) and high performance thin layer chromatography. CONCLUSIONS P. roxburghii produced anti-osteoporotic effect possibly due to estrogenic modulation, and improved bone remodeling.
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Affiliation(s)
- Aditi Sharma
- School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, India
| | - Lalit Sharma
- School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, India
| | - Reena V Saini
- Animal Biotechnology Laboratory, Faculty of Applied Sciences and Biotechnology, Shoolini University, Himachal Pradesh, India
| | - Ashwani Kumar
- Department of BT/BI, Jaypee University of Information Technology, Waknaghat, Himachal Pradesh, India
| | - Rohit Goyal
- School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, India
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Bone mineral density in healthy adult Indian population: the Chandigarh Urban Bone Epidemiological Study (CUBES). Arch Osteoporos 2021; 16:17. [PMID: 33479804 DOI: 10.1007/s11657-020-00868-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/01/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Osteoporosis is a disease with a high burden of morbidity. For its accurate diagnosis, using indigenous data as reference standards is needed. However, normative data on bone density is lacking in India. Therefore, we aimed to determine the reference range for bone density for the healthy population of north India. INTRODUCTION Osteoporosis is a major public health problem around the globe including India, resulting in significant morbidity, mortality, and health care burden. However, the reference values used for its diagnosis are largely based on data from the western population, which may lead to over- or underdiagnosis of osteoporosis in Indians. Our study aimed to determine the reference range for bone mineral density for the healthy population of India. METHODS This is a cross-sectional study of 825 subjects (men 380, women 445) (median age: 41 years, IQR 32-55 years), recruited by a house-to-house survey. The population was stratified into decade-wise groups and biochemical measurements including renal and liver function tests, glycated hemoglobin, serum calcium, 25-hydroxyvitamin D, parathyroid hormone, and bone mineral density were performed in all the subjects. The T-scores for men aged > 50 years and post-menopausal women were calculated based on the data generated from this study in young men and women aged 20-40 years. RESULTS According to the BMD manufacturer's data, which is based on the western population, 70% of the Indian men (> 50 years) and 48% of the post-menopausal Indian women had osteopenia while 18% of the men and 25% of the women had osteoporosis. However, according to the re-calculated T-scores from the current study, only 56% and 7.2% of men and 33% and 5% of women had osteopenia and osteoporosis, respectively. An age-related decline in bone mineral density, as seen in the western population, was also seen in both Indian men and women. CONCLUSION We have established a reference database for BMD in healthy Indian adult population, which may have clinical implications for the diagnosis and intervention strategies for the management of osteoporosis.
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Bhadada S, Pal R, Dhiman V. Prevention of vertebral fractures in primary osteoporosis with once-weekly teriparatide: A systematic review and meta-analysis of randomized controlled trials. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2021. [DOI: 10.4103/jncd.jncd_11_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Thejaswi SG, Rai A, Sherpa M, Singh A, Bhutia R. Bone alkaline phosphatase and urine hydroxyproline assay in pre and postmenopausal women in the state of sikkim and its correlation with bone mineral density. J Midlife Health 2021; 12:304-309. [PMID: 35264838 PMCID: PMC8849151 DOI: 10.4103/jmh.jmh_73_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/11/2021] [Accepted: 12/07/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction: Osteoporosis could be viewed as a metabolic disease. The WHO guidelines for diagnosing osteoporosis reflect structural damage only and not the metabolic imbalance that leads to it. Biochemical markers of bone turnover have been shown to provide valuable information for diagnosing and monitoring metabolic bone disease. The present study analyzed bone-specific alkaline phosphatase (BALP) and urinary hydroxyproline in pre- and postmenopausal women and correlated them with changes in bone mineral density (BMD) in the state of Sikkim. The study also intended to know the ethnicity-based disease burden in Sikkim. Materials and Methods: A hospital-based cross-sectional study was done at a tertiary hospital in Sikkim. Blood and 24-h urine samples from 50 premenopausal and 50 postmenopausal women were analyzed for total alkaline phosphatase (ALP), BALP, and Urine Hydroxyproline. BMD was measured using the quantitative ultrasound technique by Achilles densitometer. Results: There was a statistically significant increase in serum calcium (P = 0.01), ALP (P = 0.01), and urine hydroxyproline (P = 0.03) levels in postmenopausal women as compared to premenopausal women. Although ALP was higher in postmenopausal women, BALP isoform was more elevated in premenopausal women (P = 0.001). BMD was significantly lower in postmenopausal women (P < 0.001). It was also noted that there was a significant difference in BMD between tribal and nontribal populations (P = 0.003). Total ALP and BALP as the bone formation marker and urine hydroxyproline as a bone resorption marker added statistically significant r to BMD prediction (P < 0.05). Conclusion: In this study, BALP combined with Urine Hydroxyproline was helpful as a screening biomarker to predict osteoporosis in postmenopausal women.
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Aditya S, Rattan A. Sclerostin inhibition: A novel target for the treatment of postmenopausal osteoporosis. J Midlife Health 2021; 12:267-275. [PMID: 35264832 PMCID: PMC8849148 DOI: 10.4103/jmh.jmh_106_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/15/2021] [Accepted: 12/11/2021] [Indexed: 11/29/2022] Open
Abstract
Osteoporosis, a widespread skeletal disorder with a substantial economic load, is characterized by increased porosity of the bones resulting in vulnerability to fractures. When activated, the canonical Wnt signaling pathway results in osteoblastogenesis and bone formation. A Wnt ligand forms a complex with low-density lipoprotein receptor-related proteins 5 and 6 (Lrp5/6) and stimulates intracellular signaling cascades, leading to nuclear translocation of β-catenin and transcription of downstream molecules involved in osteoblast differentiation, maturation, and survival. Sclerostin (SOST), a glycoprotein produced by osteocytes, is an extracellular Wnt antagonist that blocks the binding of Wnt ligands to Lrp5/6, preventing the activation of the pathway and osteoblast-mediated bone formation subsequently. Inhibition of SOST represents a new therapeutic paradigm for the treatment of osteoporosis. Monoclonal antibodies to SOST include romosozumab, blosozumab, and setrusumab. With its unique dual effect of increasing bone formation (anabolic action) and decreasing bone resorption, the Food and Drug Administration approved romosozumab, a promising new treatment for postmenopausal osteoporosis. Its efficacy and safety have been established in trials. However, patients at high risk of cardiovascular or cerebrovascular events should not be prescribed romosozumab.
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Veronese N, Kolk H, Maggi S. Epidemiology of Fragility Fractures and Social Impact. PRACTICAL ISSUES IN GERIATRICS 2021. [DOI: 10.1007/978-3-030-48126-1_2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AbstractHip fracture is an important and debilitating condition in older people, especially in women. The epidemiological data vary between countries, but it is globally estimated that hip fractures currently affect around 18% of women and 6% of men. Although the age-standardised incidence is gradually decreasing in many countries, this is far outweighed by the ageing of the population. Thus, the global number of hip fractures is expected to increase. The direct costs associated with this condition are enormous since it requires a long period of hospitalisation and subsequent rehabilitation. Furthermore, hip fracture is associated with the development of other negative consequences, such as disability, depression, and cardiovascular diseases, with additional costs for society. At the same time, increasing attention is given to other osteoporotic fractures, such as vertebral ones, that are associated with negative health outcomes and enormous costs. In this chapter, we describe the most recent epidemiological data regarding hip and other osteoporotic fractures, with special attention to the well-known risk factors and conditions that seem relevant for determining fractures in older people. A specific part is dedicated to the social costs due to fractures. Although the costs of hip fracture are probably comparable to other common diseases with a high hospitalisation rate (e.g. cardiovascular disease), the other social costs (due to onset of new comorbidities, sarcopenia, poor quality of life, disability and mortality) are probably greater.
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Singh I, Jose V, Patel R, Arora S. Denosumab biosimilar in postmenopausal osteoporotic women: A randomized, assessor-blind, active-controlled clinical trial. Indian J Pharmacol 2021; 53:6-12. [PMID: 33975993 PMCID: PMC8216120 DOI: 10.4103/ijp.ijp_346_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE: The study assessed the efficacy, safety, pharmacokinetic (PK), and immunogenicity profiles of denosumab-biosimilar and denosumab-reference in postmenopausal osteoporotic women from India. MATERIALS AND METHODS: In this randomized, assessor-blind, active-control, multicenter trial, 114 patients were randomly allocated to receive denosumab-biosimilar (n = 58) or denosumab-reference (n = 56) at a subcutaneous dose of 60 mg every 6 months, for a year. Vitamin D and oral calcium were given daily. Lumbar spine bone mineral density (BMD) change was the primary end point. RESULTS: Of 114 randomized patients, 111 (denosumab-biosimilar, n = 56; denosumab-reference, n = 55) completed the study. All 114 patients were part of safety and immunogenicity analyses, 110 (denosumab-biosimilar, n = 56; denosumab-reference, n = 54) were part of efficacy analysis, and 20 (denosumab-biosimilar, n = 10; denosumab-reference, n = 10) were part of PK analysis. The bone mineral density (BMD) (lumbar spine) percent change at 1 year with denosumab-biosimilar and denosumab-reference (7.22 vs. 7.62; difference:−0.40; 95% confidence interval: −5.92, 5.12) showed no statistically relevant difference. Likewise, alkaline phosphatase (bone-specific) and PK parameters also did not show statistically relevant differences. Adverse events were reported in 44.83% of patients on denosumab-biosimilar versus 33.93% of patients on denosumab-reference; most events were mild or moderate and not related to the study drugs. No patients showed anti-denosumab antibody positivity. CONCLUSIONS: Denosumab-biosimilar and denosumab-reference showed biosimilarity in osteoporotic postmenopausal women. Availability of denosumab-biosimilar provides a treatment alternative for patients.
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Affiliation(s)
- Inderjeet Singh
- Clinical Development and Medical Affairs, Intas Pharmaceuticals Ltd. (Biopharma)., Ahmedabad, Gujarat, India
| | - Vinu Jose
- Clinical Development and Medical Affairs, Intas Pharmaceuticals Ltd. (Biopharma)., Ahmedabad, Gujarat, India
| | - Ronak Patel
- Biostatistics and Programming, Lambda Therapeutic Research Ltd., Ahmedabad, Gujarat, India
| | - Sumit Arora
- Clinical Trial Operations and Medical Services, Lambda Therapeutic Research Ltd., Ahmedabad, Gujarat, India
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Bhadada SK, Chandran M, Pal R, Chadha M, Mithal A. APCO Framework of Clinical Standards of Care: A Major Leap Forward in Streamlining Osteoporosis Care in India. Indian J Endocrinol Metab 2021; 25:12-13. [PMID: 34386387 PMCID: PMC8323625 DOI: 10.4103/ijem.ijem_156_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/28/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manju Chandran
- Department of Endocrinology, Osteoporosis and Bone Metabolism Unit, Singapore General Hospital, 20, College Road, Academia, Singapore
| | - Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj Chadha
- Department of Endocrinology, PD Hinduja Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Ambrish Mithal
- Department of Endocrinology and Diabetes, Max Healthcare, Saket, Press Enclave Road, New Delhi, India
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Kaur M, Nagpal M, Singh M. Osteoblast-n-Osteoclast: Making Headway to Osteoporosis Treatment. Curr Drug Targets 2020; 21:1640-1651. [DOI: 10.2174/1389450121666200731173522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/02/2020] [Accepted: 07/15/2020] [Indexed: 12/18/2022]
Abstract
Background:
Bone is a dynamic tissue that continuously undergoes the modeling and remodeling
process to maintain its strength and firmness. Bone remodeling is determined by the functioning
of osteoblast and osteoclast cells. The imbalance between the functioning of osteoclast and osteoblast
cells leads to osteoporosis. Osteoporosis is divided into primary and secondary osteoporosis.
Generally, osteoporosis is diagnosed by measuring bone mineral density (BMD) and various osteoblast
and osteoclast cell markers.
Methods:
Relevant literature reports have been studied and data has been collected using various
search engines like google scholar, scihub, sciencedirect, pubmed, etc. A thorough understanding of
the mechanism of bone targeting strategies has been discussed and related literature has been studied
and compiled.
Results:
Bone remodeling process has been described in detail including various approaches for targeting
bone. Several bone targeting moieties have been stated in detail along with their mechanisms.
Targeting of osteoclasts and osteoblasts using various nanocarriers has been discussed in separate sections.
The toxicity issues or Biosafety related to the use of nanomaterials have been covered.
Conclusion:
The treatment of osteoporosis targets the inhibition of bone resorption and the use of
agents that promote bone mineralization to slow disease progression. Current osteoporosis therapy involves
the use of targeting moieties such as bisphosphonates and tetracyclines for targeting various
drugs. Nanotechnology has been used for targeting various drug molecules such as RANKLinhibitors,
parathyroid hormone analogues, estrogen agonists and antagonists, Wnt signaling enhancer
and calcitonin specifically to bone tissue (osteoclast and osteoblasts). So, a multicomponent treatment
strategy targeting both the bone cells will be more effective rather than targeting only osteoclasts and
it will be a potential area of research in bone targeting used to treat osteoporosis.
The first section of the review article covers various aspects of bone targeting. Another section comprises
details of various targeting moieties such as bisphosphonates, tetracyclines; and various
nanocarriers developed to target osteoclast and osteoblast cells and summarized data on in vivo models
has been used for assessment of bone targeting, drawbacks of current strategies and future perspectives.
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Affiliation(s)
- Malkiet Kaur
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Manju Nagpal
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Manjinder Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
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Kalavathy N, Anantharaj N, Sharma A, Chauhan T. Effect of serum vitamin D, calcium, and phosphorus on mandibular residual ridge resorption in completely edentulous participants: A clinical study. J Prosthet Dent 2020; 127:93-99. [PMID: 33218746 DOI: 10.1016/j.prosdent.2020.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
STATEMENT OF PROBLEM Published data regarding association between edentulous mandibular residual ridge resorption and nutritional status of geriatric patients is limited. PURPOSE The purpose of this clinical study was to evaluate the degree of mandibular residual ridge resorption in completely edentulous participants and to investigate the role of dietary nutrients in the resorption process. MATERIAL AND METHODS Three hundred (55% men and 45% women; aged between 35 and 85 years) completely edentulous participants with specific inclusion and exclusion criteria were enrolled for the study. A standardized panoramic radiograph was made, measurements were made digitally, and the amount of resorption was calculated using the Wical and Swoope method. The blood plasma levels of vitamin D3 were analyzed by using the direct competitive chemiluminescence immunoassay (CLIA) method, whereas the total calcium and phosphorus were determined by using spectrophotometer method. Statistical data of serum nutrient levels (calcium, phosphorus, and vitamin D3), age, sex, and residual ridge resorption were subjected to the Mann-Whitney U test, the Spearman correlation test, and a stepwise multiple linear regression analysis (α=.05). RESULTS Calcium (P=.003) and phosphorus (P<.001) levels were significantly increased in the female participants as compared with the male participants. Vitamin D3 levels were similar in all the participants. Moreover, metabolic levels of calcium (rho=-0.09), phosphorus (rho=-0.10), and vitamin D3 (rho=-0.02) were found to be reduced with increasing age. However, male participants had increased mandibular residual ridge resorption (P<.001) with positive correlation (rho=0.06) when compared with female participants. Mandibular ridge resorption was increased with a decrease in levels of serum nutrients. CONCLUSIONS Increased levels of mandibular residual ridge resorption were observed in participants with decreased levels of systemic biochemical parameters, including calcium, phosphorus, and vitamin D3. Moreover, male participants showed increased residual ridge resorption when compared with female participants, who showed a significantly higher level of serum nutrient levels. Serum nutrient levels decreased, whereas mandibular residual ridge resorption increased with age.
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Affiliation(s)
- Natarajan Kalavathy
- Professor, Department of Prosthodontics, D.A.P.M.R.V. Dental College, Bangalore, Karnataka, India.
| | - Nikhil Anantharaj
- Post-Graduate student, Department of Prosthodontics, D.A.P.M.R.V. Dental College, Bangalore, Karnataka, India
| | - Ankita Sharma
- Post-Graduate student, Department of Prosthodontics, D.A.P.M.R.V. Dental College, Bangalore, Karnataka, India
| | - Tanuj Chauhan
- Post-Graduate student, Department of Prosthodontics, D.A.P.M.R.V. Dental College, Bangalore, Karnataka, India
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Barik A, Ray SK, Byram PK, Sinha R, Chakravorty N. Extensive early mineralization of pre-osteoblasts, inhibition of osteoclastogenesis and faster peri-implant bone healing in osteoporotic rat model: principle effectiveness of bone-specific delivery of Tibolone as evaluated in vitro and in vivo. ACTA ACUST UNITED AC 2020; 15:064102. [PMID: 33226007 DOI: 10.1088/1748-605x/abb12b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hydrophobic drug molecules pose a significant challenge in immobilization on super-hydrophobic metallic surfaces like conventional titanium implants. Pre-coating surface modifications may yield a better platform with improved wettability for such purposes. Such modifications, as depicted in this study, were hypothesized to provide the requisite roughness to assist deposition of polymers like silk fibroin (SF) as a drug-binding matrix in addition to significant improvement in early protein adsorption, which facilitates faster cellular adhesion and proliferation. A silk-based localized drug delivery module was developed on the titanium surface and tested for its surface roughness, wettability, biocompatibility and in vitro differentiation potential of cells cultured on the coated metallic surfaces with/without external supplementation of the active metabolite of Tibolone. Conditioning of the matrix-coated implants with osteogenic as well as osteoclastogenic media supplemented with Tibolone stimulated the expression of early osteogenic gene and calcium deposition in the extracellular matrix. Significant inhibition in resorptive activity was also observed in the presence of the drug. To assess the efficacy of localized delivery of Tibolone via topographically modified titanium implants for inducing early peri-implant bone formation, osteoporosis was artificially induced in rats subjected to bilateral ovariectomy and implants were placed thereafter. Bone-specific release of Tibolone through the biomimetic matrix in osteoporotic rats collectively indicated significant improvement in peri-implant bone growth after 2 and 4 weeks (p < 0.05 compared to dummy-coated implants). These findings demonstrate for the first time that Tibolone released from SF matrix-coated implants can accelerate the biological stability of bone fixtures.
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Affiliation(s)
- Anwesha Barik
- School of Medical science and Technology, IIT Kharagpur, Kharagpur, West Bengal Pin code-721302, India
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Hatkar SS, Kadam SS, Khatkhatay MI, Desai MP. Screening and Assessment of Bone Health in Indian Women Using an Indigenous ELISA of Human Osteocalcin a Bone Turnover Marker. Indian J Clin Biochem 2020; 35:436-441. [PMID: 33013013 DOI: 10.1007/s12291-019-00841-0] [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: 04/22/2019] [Accepted: 06/15/2019] [Indexed: 11/29/2022]
Abstract
Osteoporosis a major public health problem of the elderly, is associated with substantial morbidity and socio economic burden. The aim of the study was to screen women with low bone mass using the indigenously developed Osteocalcin (OC) ELISA kit and compare it with commercial ELISA kit and evaluate. The diagnostic potential of the assay was assessed in 359 samples from neighboring tertiary care hospitals over a period of 2 years. OC levels were estimated by the developed indigenous assay in samples, correlated with the Bone Mineral Density (BMD) measurements and compared by a commercial ELISA kit. On the basis of T-scores the women were stratified into Normal and case groups as Osteopenia and Osteoporosis. The serum biochemical parameters calcium and phosphorus were estimated on an auto-analyzer. To compare two different assays Bland-Altman plot and Deming linear regression analysis was performed. The prevalence of Osteopenia was high (56%) and Osteoporosis (13%) in the healthy Indian women aged 21-65 years with significant differences in OC levels in normal and women with low bone mass. Good correlation (p < 0.0001) in the OC levels by the two assays was observed. Cut off limits established earlier with indigenous assay (11.9 ng/mL and 14.9 ng/mL) for Osteopenia and Osteoporosis were similar to those with the commercial kit (13.2 ng/mL and 16.8 ng/mL) respectively. The diagnostic sensitivity, specificity and accuracy of the OC prototype was > 85%. The cost effective OC prototype can be used in screening and management of Indian women with low bone mass.
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Affiliation(s)
- Sonam S Hatkar
- Department of Molecular Immunodiagnostics, ICMR-National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012 India
| | - Seema S Kadam
- Department of Molecular Immunodiagnostics, ICMR-National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012 India
| | - M Ikram Khatkhatay
- Department of Molecular Immunodiagnostics, ICMR-National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012 India
| | - Meena P Desai
- Department of Molecular Immunodiagnostics, ICMR-National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012 India
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Anupama DS, Norohna JA, Acharya KK, Ravishankar, George A. Effect of exercise on bone mineral density and quality of life among postmenopausal women with osteoporosis without fracture: A systematic review. Int J Orthop Trauma Nurs 2020; 39:100796. [PMID: 33041224 DOI: 10.1016/j.ijotn.2020.100796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 06/04/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Osteoporosis is a progressive disease commonly seen in postmenopausal women which is characterized by decreased bone mass. This is becoming an important public health issue in India. This review aimed to evaluate the effect of exercise on quality of life and bone health status among postmenopausal osteoporotic women. METHODS We searched the following databases: Pubmed-Medline, Proquest, CINAHL, Scopus, Cochrane Central and PEDro. The review included randomized controlled trials that examined the use of exercise aimed at improving bone mineral density and quality of life in postmenopausal osteoporotic women without a history of fracture. Risk of bias was assessed by the Cochrane Risk of Bias tool. RESULTS This review suggests exercise is effective in improving the bone mineral density and quality of life of postmenopausal women with osteoporosis. The exercise interventions included in the studies were heterogeneous and included: Tai Chi, high intensity aerobic exercises, Modified Eight Section Brocade exercises, progressive slow loading low impact exercises, pilates and closed kinetic exercises. Four studies had a small sample size and in three studies, interventions were for a shorter duration. Meta-analysis could not be performed as the studies were not homogenous. CONCLUSION There is a need to conduct more experimental trials with robust research methods so that a high risk of bias can be avoided. The available evidence supports the positive effects of exercises on postmenopausal osteoporosis.
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Affiliation(s)
- D S Anupama
- Manipal College of Nursing, MAHE, Manipal, India
| | - Judith A Norohna
- Department of OBG nursing, Manipal college of Nursing, MAHE, Manipal, India.
| | | | - Ravishankar
- Department of Statistics, Prasanna School of Public Health, MAHE, Manipal, India
| | - Anice George
- Manipal College of Nursing, MAHE, Manipal, India
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Kim SH, Sobez LM, Spiro JE, Curta A, Ceelen F, Kampmann E, Goepfert M, Bodensohn R, Meinel FG, Sommer WH, Sommer NN, Galiè F. Structured reporting has the potential to reduce reporting times of dual-energy x-ray absorptiometry exams. BMC Musculoskelet Disord 2020; 21:248. [PMID: 32299400 PMCID: PMC7164197 DOI: 10.1186/s12891-020-03200-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/10/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In recent years, structured reporting has been shown to be beneficial with regard to report completeness and clinical decision-making as compared to free-text reports (FTR). However, the impact of structured reporting on reporting efficiency has not been thoroughly evaluted yet. The aim of this study was to compare reporting times and report quality of structured reports (SR) to conventional free-text reports of dual-energy x-ray absorptiometry exams (DXA). METHODS FTRs and SRs of DXA were retrospectively generated by 2 radiology residents and 2 final-year medical students. Time was measured from the first view of the exam until the report was saved. A random sample of DXA reports was selected and sent to 2 referring physicians for further evaluation of report quality. RESULTS A total of 104 DXA reports (both FTRs and SRs) were generated and 48 randomly selected reports were evaluated by referring physicians. Reporting times were shorter for SRs in both radiology residents and medical students with median reporting times of 2.7 min (residents: 2.7, medical students: 2.7) for SRs and 6.1 min (residents: 5.0, medical students: 7.5) for FTRs. Information extraction was perceived to be significantly easier from SRs vs FTRs (P < 0.001). SRs were rated to answer the clinical question significantly better than FTRs (P < 0.007). Overall report quality was rated significantly higher for SRs compared to FTRs (P < 0.001) with 96% of SRs vs 79% of FTRs receiving high or very high-quality ratings. All readers except for one resident preferred structured reporting over free-text reporting and both referring clinicians preferred SRs over FTRs for DXA. CONCLUSIONS Template-based structured reporting of DXA might lead to shorter reporting times and increased report quality.
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Affiliation(s)
- Su Hwan Kim
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Lara M Sobez
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Judith E Spiro
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Adrian Curta
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Felix Ceelen
- Munich Transplant Center, University Hospital, LMU Munich, Munich, Germany
| | - Eric Kampmann
- Department of Internal Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Martin Goepfert
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Raphael Bodensohn
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Felix G Meinel
- Department of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Wieland H Sommer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nora N Sommer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Franziska Galiè
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
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Dela SS, Paruk F, Brown SL, Lukhele M, Kalla AA, Jordaan JD, Conradie M, Mohamed O, Chutterpaul P, Cassim B. Ethnic and gender-specific incidence rates for hip fractures in South Africa: A multi-centre study. Bone 2020; 133:115253. [PMID: 31987987 DOI: 10.1016/j.bone.2020.115253] [Citation(s) in RCA: 21] [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] [Received: 09/06/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data exist on the incidence of hip fractures in South Africa (SA). We report gender and ethnic specific incidence rates of hip fractures in SA. METHODS In a multicentre prospective study, conducted in geographically defined municipalities of three provinces in SA, a structured questionnaire was administered to all subjects aged 40 years and over, presenting with a new atraumatic hip fracture, from 1 April 2017 to 31 March 2018. Gender and ethnic specific incidence rates (IR) of hip fractures were calculated using population statistics from Statistics SA. FINDINGS Of the 2767 subjects enrolled, 1914 (69·2%) were women and 853 (30·8%) were men. The majority of subjects were from the White population (40·9%) followed by those from the African (26·4%), Coloured (18·7%) and Indian (13·9%) populations. Men with hip fractures were significantly younger than women in the total group (69 [IQR 59-79] versus 77 years [IQR 68-84], p < 0·001) and in each ethnic group. White subjects were significantly older (p < 0·0001) and Africans significantly younger (p < 0·0001) than the other ethnic groups. In women, the highest IR was noted in the White population (176·0 per 100,000), followed by that in the Indian (147·7 per 100,000), Coloured (73·2 per 100,000) and African populations (43·6 per 100,000). A similar pattern was seen in men albeit at lower rates, with the highest rate in White men at 76·5 per 100,000. In the total study population and the African population, the IR was higher in men compared to women in subjects under 60 years. In the White population, the IR was higher in men compared to women in the 40-44 years age group. While in the Coloured and Indian populations the IR was higher in men compared to women in the 40-49 years and 45-54 years age groups, respectively. There was an increase in the relative risk ratios with age in the total study population, and in all ethnic groups in both women and men. INTERPRETATION Hip fractures occur in all ethnic groups in South Africa with higher IRs in the White and Indian populations compared to the Coloured and African populations. Consistent with the published literature, the overall hip fracture IR was higher in women than in men, except in the younger age groups, and increased with age. FUNDING South African Medical Research Council and the University of KwaZulu-Natal Competitive Research Grant.
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Affiliation(s)
- S S Dela
- Department of Internal Medicine, Edendale Hospital, School of Clinical Medicine (SCM), University of KwaZulu-Natal (UKZN), South Africa.
| | - F Paruk
- Division of Internal Medicine, SCM, College of Health Sciences, UKZN, South Africa
| | - S L Brown
- Mahatma Gandhi Memorial Hospital, Durban, South Africa
| | - M Lukhele
- Department of Orthopaedics, University of Witwatersrand, South Africa
| | - A A Kalla
- Division of Rheumatology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - J D Jordaan
- Division of Orthopaedics, Stellenbosch University, South Africa
| | - M Conradie
- Division of Endocrinology, Stellenbosch University, South Africa
| | - O Mohamed
- Discipline of Public Health Medicine, SCM, College of Health Sciences, UKZN, South Africa
| | - P Chutterpaul
- Division of Internal Medicine, SCM, College of Health Sciences, UKZN, South Africa
| | - B Cassim
- Department of Geriatrics, SCM, College of Health Sciences, UKZN, South Africa
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SLN based alendronate in situ gel as an implantable drug delivery system – A full factorial design approach. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2019.101415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Negative correlation of high-density lipoprotein-cholesterol and bone mineral density in postmenopausal Iranian women with vitamin D deficiency. Menopause 2019; 25:458-464. [PMID: 29557847 DOI: 10.1097/gme.0000000000001082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the association between high-density lipoprotein (HDL) and bone status taking into account serum vitamin D levels in postmenopausal Iranian women. METHODS During January 2015 and February 2016, a total of 488 postmenopausal Iranian women participated in this cross-sectional study, all of whom were not taking osteoporosis medication and were not suffering from any chronic disorder. Dual X-ray absorptiometry was used to assess bone mineral density (BMD) of the total hip, femoral neck, and lumbar vertebrae (L2-L4). Each person was categorized based on the World Health Organization osteoporosis criteria in at least one skeletal region. At the end of the data collection, lipid profiles and vitamin D levels were measured for all participants. Vitamin D serum levels less than 30 ng/mL were defined as vitamin D deficiency or insufficiency. RESULTS 27.9% of all participants displayed osteoporosis. Osteoporotic participants tended to be older with higher HDL serum levels (P < 0.001). No significant difference was seen in low-density of lipoprotein, total triglyceride, and total cholesterol levels among participants (P > 0.05). In a univariate model, after adjusting for age, menopausal age, obesity, physical activity, and use of antihyperlipidemic drugs (statins), there were significant negative associations among HDL levels and BMD values and T-score in the three regions (P < 0.004). Interestingly, after classification of participants based on vitamin D levels and adjustment for confounding factors, these significant negative associations between HDL levels and BMD values as well as T-score were observed only in participants with vitamin D deficiency or insufficiency, in the three regions (P < 0.008). CONCLUSIONS Our data show that in postmenopausal women with vitamin D deficiency, serum levels of HDL have negative correlation with bone status.
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Gokhale CN, Simon SS, Hadaye RS, Lavangare SR. A cross-sectional study to screen community health volunteers for hip/knee-osteoarthritis and osteoporosis. J Family Med Prim Care 2019; 8:2101-2105. [PMID: 31334187 PMCID: PMC6618193 DOI: 10.4103/jfmpc.jfmpc_261_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 03/30/2019] [Accepted: 04/19/2019] [Indexed: 12/29/2022] Open
Abstract
CONTEXT Osteoarthritis (OA) is a degenerative disease mainly affecting hip and knee joints, and osteoporosis is characterized by diminution of bone mass. Both these diseases have a substantial economic impact on society. Community health volunteers (CHVs) being peripheral health workers are prone to such diseases owing to their sociodemographic and occupational profile. AIM This study was conducted to estimate the proportion of hip/knee OA and osteoporosis among CHVs and understand determinants of their current bone health status. MATERIALS AND METHODS Screening for OA was done using a tool adopted from a previous study after obtaining due permissions. Weight, height, blood pressure, and bone mineral density of all participants were recorded. Statistical tests such as Chi-square and multiple logistic regression were used for analysis of data. RESULTS Out of 80 participants, 50 (62.5%) had increased body mass index (overweight + obese), 10 (12.5%) were hypertensive, 14 (17.5%) CHVs screened positive for hip OA, and 29 (36.3%) were positive for knee OA. Hip OA was associated with advancing age, parity, and obesity. Knee OA was associated with age and exercise. In total, 16.3% subjects were found to have osteoporosis and 61.2% had osteopenia. CONCLUSIONS This study showed that a remarkable proportion of CHVs had bone and joint problems. CHVs must, therefore, receive preventive measures such as health education and screening for these diseases.
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Affiliation(s)
- Chinmay N. Gokhale
- Department of Community Medicine, Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr. Rustom Narsi Cooper Municipal General Hospital, Mumbai, Maharashtra, India
| | - Sophie S. Simon
- Department of Community Medicine, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - Rujuta S. Hadaye
- Department of Community Medicine, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - Sujata R. Lavangare
- Department of Community Medicine, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
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Binu AJ, Cherian KE, Kapoor N, Jebasingh FK, Asha HS, Paul TV. Bone Health after Fifth Decade in Rural Ambulatory South Indian Postmenopausal Women. Indian J Community Med 2019; 44:205-208. [PMID: 31602103 PMCID: PMC6776936 DOI: 10.4103/ijcm.ijcm_161_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: The incidence of postmenopausal osteoporosis continues to rise, as population ages. The morbidity and mortality associated with osteoporotic fractures have a significant negative impact on the economy and quality of life of the affected individual and the community, at large. Objectives: We aimed to study the prevalence of osteoporosis in ambulant rural postmenopausal women, and to look at their dietary calcium intake (DCI) and Vitamin D status. Subjects and Methods: This was a cross-sectional study conducted in 1565 ambulant South Indian rural postmenopausal women. Bone mineral density was estimated by a dual-energy X-ray absorptiometry scan at the femoral neck (FN) and lumbar spine (LS). DCI was calculated by recall for the previous week, and the blood bone biochemical profile was measured. Results: The mean standard deviation (SD) age and body mass index of this population were 60.7 (7.2) years and 26.2 (4.8) kg/m2, respectively. The prevalence of osteoporosis was 22% at the FN and 39% at the LS. An increase in the prevalence of osteoporosis was noted at both sites, in successive age categories. Mean (SD) DCI was 420 (282) mg/24 h. Fifty-four percent had Vitamin D deficiency (VDD) (<20 ng/ml) and 6% had severe VDD (<10 ng/ml). Conclusion: A significant proportion of this large cohort of south Indian healthy rural postmenopausal women had osteoporosis at either site with advancing age. Most of them had a suboptimal DCI, and over half of them had VDD.
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Affiliation(s)
- Aditya John Binu
- Department of Internal Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Kripa Elizabeth Cherian
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Felix K Jebasingh
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Hesarghatta Shyamasunder Asha
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Thomas Vizhalil Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Cherian KE, Kapoor N, Paul TV. Utility of FRAX (fracture risk assessment tool) in primary care and family practice setting in India. J Family Med Prim Care 2019; 8:1824-1827. [PMID: 31334139 PMCID: PMC6618219 DOI: 10.4103/jfmpc.jfmpc_385_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The prevalence of osteoporosis in postmenopausal women is about 35 to 50% and the mortality associated with hip fractures is about 20%. Despite these figures, osteoporosis continues to be under diagnosed in the primary care setting. One of the reasons for this is attributed to the poor availability of DXA (Dual Energy X-ray Absorptiometry) scanners in rural areas. The fracture risk assessment tool (FRAX) is an online web-based tool that takes into account multiple factors that help in predicting the 10-year risk of developing hip or major osteoporotic fractures. The tool was developed and validated in independent cohorts. The advantages of using the FRAX tool are that, it is inexpensive, easily available, and does not need the technical expertise that is required in the use of a DXA scanner. Besides these merits, it is a tool that is easy to use for the rural health care worker as well as the family physician in identifying those subjects at risk for developing osteoporotic fractures. These benefits make it a suitable fracture prediction tool in the primary care setting in India.
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Affiliation(s)
- Kripa Elizabeth Cherian
- Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Thomas Vizhalil Paul
- Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Raj JP, Venkatachalam S, Shekoba M, Norris JJ, Amaravati RS. Conventional antidiabetic agents and bone health: A pilot case-control study. Perspect Clin Res 2019; 10:177-182. [PMID: 31649868 PMCID: PMC6801990 DOI: 10.4103/picr.picr_125_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background and Objectives: The burden of noncommunicable diseases such as diabetes (type 2 diabetes mellitus [T2DM]) and osteoporosis is increasing with increasing longevity. Uncontrolled T2DM is an independent risk factor for osteoporosis explained by the insulin osteocalcin pathway. Due to limited information on the effect of various commonly used antidiabetic agents (ADA) on bone health, our study aims to analyze the association between the two. Methodology: This is a case–control study, with 100 cases of clinical osteoporosis and 100 age-, sex-, and dietary status-matched controls in whom osteoporosis was ruled out by dual-energy X-ray absorptiometry scan. Prescription details of T2DM, physical activity levels, and disease status were collected using a pretested questionnaire. Exposure to each ADA was compared using the Chi-squared test. Binary logistic regression was performed to adjust the two main confounders, namely glycemic control and physical activity levels, and adjusted risk estimates were calculated. Results: There were a total of 74 T2DM patients, of whom 45 (60.8%) were cases and 29 (39.2%) were controls. Sulfonylureas (adjusted odds ratio [aOR] = 0.164, P = 0.004) and insulin (aOR = 0.248, P = 0.042) showed a significant protective effect on bone health. Biguanides (OR = 1.994, P = 0.029) and thiazolidinediones (OR: 5.444, P = 0.033), which demonstrated that an increased risk of osteoporosis in univariate analysis became insignificant after multivariate analysis. Conclusion: Sulfonylureas and insulin through the insulin osteocalcin pathway show favorable effect on bone health, but the probability of increased fractures secondary to hypoglycemic falls should be borne in mind. We recommend larger prospective studies to confirm this association.
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Affiliation(s)
- Jeffrey Pradeep Raj
- Department of Pharmacology, St. John's Medical College, Bengaluru, Karnataka, India
| | | | - Mahesh Shekoba
- Department of Orthopaedics, St. John's Medical College, Bengaluru, Karnataka, India
| | | | - Rajkumar S Amaravati
- Department of Orthopaedics, St. John's Medical College, Bengaluru, Karnataka, India
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Meeta, Raut AA, Agashe SV, Wajahat A, Sarada CV, Vaidya ADB, Vaidya RA. A Clinical Study of a Standardized Extract of Leaves of Dalbergia sissoo (Roxb ex DC) in Postmenopausal Osteoporosis. J Midlife Health 2019; 10:37-42. [PMID: 31001055 PMCID: PMC6459066 DOI: 10.4103/jmh.jmh_22_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Context: Dalbergia sissoo had shown anti-osteoporotic and fracture-healing activities in animal models of postmenopausal osteoporosis (PMO). Standardized extract of leaves of D. sissoo (SEL-Ds) was clinically evaluated for osteoporosis. Aims: To investigate the anti-osteoporotic activity of D. sissoo in PMO by dual-energy X-ray absorptiometry (DXA), biochemical markers, and effect on clinical profile. Tolerability was assessed by organ function tests and adverse events. Settings and Design: An open-labeled prospective clinical study in ambulant settings was conducted at the menopausal health-care facility of a women's hospital. Materials and Methods: Thirty women (45–69 years) were enrolled for this 1-year study. Evaluations were basally, fortnightly twice, and three monthly four times. SEL-Ds (300 mg) twice daily was administered orally. Calcium (250 mg) and Vitamin D (200 IU) were given twice a day. The efficacy of SEL-Ds was assessed by DXA-scan (spine, femur), by biochemical markers, alkaline phosphatase (ALP), tumor necrosis factor-alpha (TNF-α), and anti-inflammatory marker high-sensitivity C-reactive protein (hs-CRP). Baseline symptom changes and adverse events were carefully recorded. Statistical Analysis: Summary statistics (n, mean, standard deviation, median, and maximum and minimum values) of changes from baseline values and Student's “t-” test for P values were used. Results and Discussion: SEL-Ds was well tolerated at given dose for 1 year. Anti-osteoporotic and anti-inflammatory activities of SEL-Ds were demonstrated by reduction in TNF-α (12.04 ± 2.81–2.35 ± 1.08 pg/ml), ALP (208.75 ± 45.88–154.52 ± 37.25 IU/L), and hs-CRP (6.1 ± 0.77–3.9 ± 0.47 mg/L). BMD-score on DXA-scan also remained unchanged at majority of the bone locations (increased 13/75, unchanged 51/75, and decreased 08/75). Conclusions: D. sissoo has demonstrated anti-osteoporotic and anti-inflammatory activities as indicated by decline in circulating TNF-α along with concurrent reduction in ALP. The nondecline in BMD index in the majority confirms the anti-osteoporotic activity.
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Affiliation(s)
- Meeta
- Department of Obstetrics and Gynecology, Tanvir Hospital, Hyderabad, Telangana, India
| | | | - Shubhada V Agashe
- Medical Research Centre-Kasturba Health Society, Mumbai, Maharashtra, India
| | - Afroz Wajahat
- Department of Obstetrics and Gynecology, Tanvir Hospital, Hyderabad, Telangana, India
| | | | - Ashok D B Vaidya
- Medical Research Centre-Kasturba Health Society, Mumbai, Maharashtra, India
| | - Rama Ashok Vaidya
- Medical Research Centre-Kasturba Health Society, Mumbai, Maharashtra, India
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Nayak Y, Shah A, Gourishetti K. Osteogenic activity of resveratrol in human fetal osteoblast cells. Pharmacogn Mag 2019. [DOI: 10.4103/pm.pm_619_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Referral pattern for DXA scanning in a tertiary care centre from southern India. Arch Osteoporos 2018; 13:133. [PMID: 30460412 DOI: 10.1007/s11657-018-0548-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/12/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Referral patterns for bone mineral density testing by dual energy X-ray absorptiometry (DXA) scanning are seldom studied. In our study, the overall proportion of referrals from specialties remained low. This highlights the need for adequate utilisation of DXA by specialties treating subjects at risk for osteoporosis. PURPOSE/OBJECTIVES The knowledge of referral patterns for DXA scanning (dual energy X-ray absorptiometry) for bone mineral density (BMD) measurement is relevant in a developing country like India. We studied the referral source and clinical and densitometric profile of patients referred for DXA scanning at a south Indian tertiary care centre. METHODS We conducted a cross-sectional study over 3 months and included subjects referred during this period for BMD assessment (lumbar spine and femoral neck) by DXA scan. Details regarding referring departments and reasons for referral were collected. The number of patients seen in individual departments was obtained during the study period and respective proportions of patients referred were calculated. RESULTS Of the 1932 subjects included in the study, we observed a definite female preponderance (90.2%), with a mean (SD) age of 51.6 (13.3) years. The greatest number of referrals came from the departments of rheumatology (37%; n = 724) and endocrinology (20%; n = 382). Overall, 36% were referred for inflammatory arthritis or systemic inflammatory disorders (n = 696) and 34% for postmenopausal state screening (n = 657). In relation to the individual outpatient strength, the departments who referred the highest proportion of their patients were rheumatology (6.8%), endocrinology (1.76%) and geriatrics (1.05%). A diagnosis of osteoporosis at any one site was made in 41% (448 of 1107) and the BMD was below the expected range for age in 37% (304 of 825) of the referrals. CONCLUSION Most referrals for DXA scanning were from rheumatology. Among the referred patients, about two fifth had osteoporosis and over one third had BMD below expected range for age. Although referrals by rheumatology were relatively higher, overall referrals from all departments remained low. This underscores the need for adequate utilisation of DXA by specialties treating subjects at risk for osteoporosis.
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Saoji R, Das RS, Desai M, Pasi A, Sachdeva G, Das TK, Khatkhatay MI. Association of high-density lipoprotein, triglycerides, and homocysteine with bone mineral density in young Indian tribal women. Arch Osteoporos 2018; 13:108. [PMID: 30306279 DOI: 10.1007/s11657-018-0525-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/27/2018] [Indexed: 02/07/2023]
Abstract
UNLABELLED This study investigated association between lipids and homocysteine (Hcy) with bone mineral density (BMD) in young women as opposed to previous studies on elderly women. HDL, triglyceride, and Hcy are significantly associated with BMD in young women and tobacco and alcohol consumption have no effect on this association. PURPOSE The present study investigates whether the association of serum lipids and homocysteine (Hcy) with bone mineral density (BMD) reported mostly in elderly population can be generalized to young or premenopausal women, consequently suggesting screening of young women with low BMD for dyslipidemia or any cardiovascular events and vice versa. METHODS Women (n = 293, aged 20-47 years) from Northeast India belonging to Tibeto-Burman origin were enrolled. Information about their physical and clinical attributes were collected by a structured questionnaire. Their BMDs at lumbar spine and femur were measured by dual-energy X-ray absorptiometry (DXA) and sera were profiled for lipid parameters and Hcy by auto-analyzer and ELISA, respectively. Women consuming tobacco and/or alcohol were grouped as consumers and others as non-consumers for the analysis. RESULTS Positive correlation of BMD with HDL (spine and femur r = 0.38, p < 0.0001) and triglyceride (spine r = 0.534, p < 0.0001; femur r = 0.423, p < 0.0001) was observed, whereas Hcy correlated negatively with BMD (spine r = - 0.189, p = 0.0026; femur r = - 0.273, p < 0.0001). LDL showed a weak negative correlation with BMD (spine r = - 0.128, p = 0.0283; femur r = - 0.199, p = 0.0006). However, after adjusting for age, BMI, and consumption, HDL, triglyceride, and Hcy continued to show significant correlation with BMD at both the sites. Logistic regression analyses indicated that HDL, triglyceride, and Hcy were significant predictors of osteopenia and osteoporosis in our study cohort; however, consumption did not contribute to its prediction. CONCLUSION Low levels of HDL and triglyceride and high levels of Hcy are significantly associated with osteopenia and osteoporosis in young Northeast Indian women.
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Affiliation(s)
- Rucha Saoji
- ICMR-National Institute for Research in Reproductive Health, J. M. Street, Parel, Mumbai, Maharashtra, 400012, India
| | - Rajat Subra Das
- Agartala Government Medical College, Agartala, Tripura, 799006, India
| | - Meena Desai
- ICMR-National Institute for Research in Reproductive Health, J. M. Street, Parel, Mumbai, Maharashtra, 400012, India
| | - Achhelal Pasi
- Airport Health Organisation, Ministry of Health & Family Welfare (GOI), Andheri, Mumbai, Maharashtra, 400099, India
| | - Geetanjali Sachdeva
- ICMR-National Institute for Research in Reproductive Health, J. M. Street, Parel, Mumbai, Maharashtra, 400012, India
| | - Tapan Kumar Das
- Agartala Government Medical College, Agartala, Tripura, 799006, India
| | - M Ikram Khatkhatay
- ICMR-National Institute for Research in Reproductive Health, J. M. Street, Parel, Mumbai, Maharashtra, 400012, India.
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Vaishya R, Vijay V, Agarwal AK, Maheshwari P. Assessment of osteoporotic fracture risk in urban Indian population using quantitative ultrasonography & FRAX tool. Indian J Med Res 2018; 146:S51-S56. [PMID: 29578195 PMCID: PMC5890596 DOI: 10.4103/ijmr.ijmr_1220_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives There have been studies around the world on the prevalence of osteoporosis and its related risk factors, but there have been limited studies on risk factors and osteoporosis in the Indian population. In this study, the incidence of osteoporosis and the associated clinical risk factors (CRFs) were studied in the urban Indian population. Methods Bone mineral density of 445 individuals >38 yr of age using qualitative ultrasound (QUS) was assessed. The patients were also questioned regarding the presence of the various CRFs as per the FRAX tool. The patients were categorized into normal, osteopenia and osteoporosis groups on the basis of T-score from QUS. Results There were 223 males and 222 females in this study. Sex was significantly associated with T-score (P<0.001). Forty (8.99%) patients were osteoporotic, 265 (59.55%) were osteopenic and the remaining 140 (31.46%) were normal. A significant association of T-score was found with parent history of fracture (P<0.05), rheumatoid arthritis (P<0.05) and secondary osteoporosis (P<0.05). Previous history of fracture's association was not found to be significant. Smoking, alcohol intake and steroid intake were not found to be significantly associated with T-scores. Interpretation & conclusions The incidence of osteoporosis was found to be high in the urban Indian population. More care and attention should be targeted towards elderly, especially the ones with the risk factors to prevent osteoporosis in future.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - Vipul Vijay
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - Amit K Agarwal
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
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Chawla J, Sharma N, Arora D, Arora M, Shukla L. Bone densitometry status and its associated factors in peri and post menopausal females: A cross sectional study from a tertiary care centre in India. Taiwan J Obstet Gynecol 2018; 57:100-105. [PMID: 29458876 DOI: 10.1016/j.tjog.2017.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Osteoporosis is a skeletal disorder characterized by diminished bone strength that increases the risk of fracture at instances of trivial trauma. Asians have a lower bone mass than the west. The present study was designed to add data from India on women above the age of 40 years with respect to low bone mineral density (BMD) and its associated high risk factors. MATERIALS AND METHODS After a written informed consent, a detailed history was taken. Basal metabolic index was recorded, and biochemical and endocrine tests were done, followed by dual X ray absorptiometry scan. RESULTS Average age of the study population was 46.54 years and BMI 26.58. The prevalence of osteopenia in the study was 36%, and that of osteoporosis, 4%; the overall prevalence of low BMD being 40%. Proportion of women with low BMD increased with advancing age and menopausal status. On endocrine evaluation, 53.44% cases with insufficient vitamin D, 62.5% with hyperparathyroidism, 100% with hypothyroidism, 75% with hyperthyroidism suffered from low BMD. Among chronic diseases, 75% women with diabetes, 33.3% with hypertension, 25% with deranged liver function and 50% with rheumatoid arthritis were found to have low BMD. 46.75% women with sun exposure less than one hour daily had poor bone mineralization. The proportion of women with normal BMD decreased from 84.09% to 43.33% with decrease in daily physical work. On logistic regression analysis, insufficient serum vitamin D concentrations, less physical work and inadequate sun exposure were found to be significantly associated with low BMD. CONCLUSION Low BMD is not a disorder confined to postmenopausal women alone. It is widely prevalent in women above 40 years of age. Screening women above 40 in the absence of any high risk factors has the potential of nipping this silent killer in the bud.
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Affiliation(s)
- Jaya Chawla
- Department of OB GYN, PGIMER & Dr. RML Hospital, New Delhi, India.
| | - Neena Sharma
- Department of OB GYN, ACMS & BHDC, New Delhi, India
| | - Devendra Arora
- Department of OB GYN, Command Hospital, (SC), Pune, India
| | - Manisha Arora
- Department of Community Medicine, ACMS & BHDC, New Delhi, India
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Ashok Kumar D, Anburajan M, Snekhalatha U. Evaluation of low bone mass and prediction of fracture risk using metacarpal radiogrammetry method: a comparative study with DXA and X-ray phantom. Int J Rheum Dis 2018; 21:1350-1371. [PMID: 29968333 DOI: 10.1111/1756-185x.13326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Devaraj Ashok Kumar
- Department of Biomedical Engineering; SRM Institute of Science and Technology; Chennai Tamil Nadu India
| | | | - Umapathy Snekhalatha
- Department of Biomedical Engineering; SRM Institute of Science and Technology; Chennai Tamil Nadu India
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Kaushal N, Vohora D, Jalali RK, Jha S. Prevalence of osteoporosis and osteopenia in an apparently healthy Indian population - a cross-sectional retrospective study. Osteoporos Sarcopenia 2018; 4:53-60. [PMID: 30775543 PMCID: PMC6362954 DOI: 10.1016/j.afos.2018.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/08/2018] [Accepted: 04/26/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES An understanding of bone mineral density (BMD) pattern in a population is crucial for prevention and diagnosis of osteoporosis and management of its complications in later life. This study aimed to screen the bone health status and factors associated with osteoporosis in an apparently healthy Indian population. METHODS A retrospective review of medical records was done in a tertiary-care hospital for the subjects who had undergone preventive health-check-ups that included BMD measurements at femur-neck, total-femur, and lumbar-spine. RESULTS We evaluated 524 subjects (age, 50.0 ± 12.4 years) including 41.2% female and 58.8% male subjects. Osteoporosis was present in 6.9% subjects (female, 11.1%; male, 4.2%) and osteopenia in 34% subjects (female, 40.3%; male, 29.9%). Absolute BMD was higher in male subjects (P < 0.001) compared to female subjects at all bone sites. Prevalence of osteoporosis increased with age in female subjects, but not in male subjects. Osteoporosis rates in the age-groups of 30-39, 40-49, 50-59, 60-69, and ≥70 years were 3%, 3.4%, 14.3%, 18.6%, and 36.4%, respectively in female subjects while prevalence in male subjects was 0%, 4%, 6.5%, 4.3%, and 5.6%, respectively, at lumbar spine. Height (r = 0.234-0.358), weight (r = 0.305-0.388), body mass index (r = 0.143-0.285) and physical activity (r = 0.136-0.153) were positively; and alkaline phosphatase (r = -0.133 to -0.203) was negatively correlated with BMD (all P < 0.01) at all sites. These parameters retained significant correlation after controlling for age and sex. No correlation of serum 25-hydroxy-vitamin-D and calcium was noted with BMD (P > 0.05) at any site. CONCLUSIONS Further data on absolute BMD, T scores, and prevalence rates of osteoporosis/osteopenia on multiple bone sites have been presented in this article.
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Affiliation(s)
- Neelam Kaushal
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Divya Vohora
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Rajinder K. Jalali
- Medical Affairs & Clinical Research, Sun Pharmaceutical Industries Limited, Gurgaon, India
| | - Sujeet Jha
- Institute of Endocrinology, Diabetes and Metabolism, Max Healthcare Inst. Ltd., New Delhi, India
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