1
|
Al-Daghri NM, Wani K, Khattak MNK, Alnaami AM, Al-Saleh Y, Sabico S. The single point insulin sensitivity estimator (SPISE) is associated with bone health in Arab adults. Aging Clin Exp Res 2024; 36:136. [PMID: 38904881 PMCID: PMC11192813 DOI: 10.1007/s40520-024-02789-5] [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: 03/10/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND The Single Point Insulin Sensitivity Estimator (SPISE) index is a surrogate marker for insulin sensitivity. Given the emerging role of bone as an active endocrine organ, its associations with non-invasive measures of extra-skeletal functions such as insulin sensitivity warrant investigation. AIMS This study aimed to explore the relationship between the SPISE index and Bone Mineral Density (BMD) in an adult population. METHODS Data from a total of 1270 Arab adults (84% females, mean age 56.7 ± 8.1 years) from the Osteoporosis Registry Database of the Chair for Biomarkers of Chronic Diseases in King Saud University, Riyadh, Saudi Arabia was used in this study. T-scores and SPISE were calculated. Regression models were used to determine associations between SPISE and bone health indices. RESULTS The low BMD group (N = 853; T-score <-1.0) had significantly higher SPISE values than those with normal BMD (N = 417; T-score - 1.0 and above) (4.6 ± 1.3 vs. 4.3 ± 1.2, p < 0.001). Multivariate linear regression, adjusted for covariates, confirmed a significant inverse association between SPISE and BMD for all participants (β=-0.22, p < 0.001), as well as both groups [normal BMD (β = -0.10, p = 0.02) and low BMD groups (β = -0.15, p < 0.001)]. SPISE, family history of T2DM, and history of fractures collectively account for 17% of the variances perceived in T-score for all participants (p < 0.001). CONCLUSIONS A significant inverse association between the SPISE index and BMD was observed in adults, suggesting a link between BMD and extra-skeletal health. Underlying mechanisms need to be investigated prospectively using BMD as secondary outcomes in lifestyle modification programs.
Collapse
Affiliation(s)
- Nasser M Al-Daghri
- Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia.
| | - Kaiser Wani
- Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Malak N K Khattak
- Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Abdullah M Alnaami
- Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Yousef Al-Saleh
- Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
- Department of Medicine, Health Oasis Hospital, Riyadh, Saudi Arabia
| | - Shaun Sabico
- Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| |
Collapse
|
2
|
Löffler J, Noom A, Ellinghaus A, Dienelt A, Kempa S, Duda GN. A comprehensive molecular profiling approach reveals metabolic alterations that steer bone tissue regeneration. Commun Biol 2023; 6:327. [PMID: 36973478 PMCID: PMC10042875 DOI: 10.1038/s42003-023-04652-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open
Abstract
Bone regeneration after fracture is a complex process with high and dynamic energy demands. The impact of metabolism on bone healing progression and outcome, however, is so far understudied. Our comprehensive molecular profiling reveals that central metabolic pathways, such as glycolysis and the citric acid cycle, are differentially activated between rats with successful or compromised bone regeneration (young versus aged female Sprague-Dawley rats) early in the inflammatory phase of bone healing. We also found that the citric acid cycle intermediate succinate mediates individual cellular responses and plays a central role in successful bone healing. Succinate induces IL-1β in macrophages, enhances vessel formation, increases mesenchymal stromal cell migration, and potentiates osteogenic differentiation and matrix formation in vitro. Taken together, metabolites-here particularly succinate-are shown to play central roles as signaling molecules during the onset of healing and in steering bone tissue regeneration.
Collapse
Affiliation(s)
- Julia Löffler
- Julius Wolff Institute (JWI), Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
- Berlin Institute for Medical Systems Biology, Max-Delbrück-Center for Molecular Medicine, 10115, Berlin, Germany
| | - Anne Noom
- Julius Wolff Institute (JWI), Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Agnes Ellinghaus
- Julius Wolff Institute (JWI), Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Anke Dienelt
- Julius Wolff Institute (JWI), Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Stefan Kempa
- Berlin Institute for Medical Systems Biology, Max-Delbrück-Center for Molecular Medicine, 10115, Berlin, Germany.
| | - Georg N Duda
- Julius Wolff Institute (JWI), Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany.
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany.
| |
Collapse
|
3
|
Abstract
PURPOSE OF REVIEW This review article presents the most recent research on bone fragility in individuals with diabetes from a medical imaging perspective. RECENT FINDINGS The widespread availability of dual-energy X-ray absorptiometry (DXA) and trabecular bone score (TBS) software has led to recent assessments of bone fragility with this texture parameter in several studies of type 2 diabetes mellitus (T2D), but in few of type 1 diabetes mellitus (T1D). Although most studies show a trend of reduced TBS values in T2D independent of areal bone mineral density (aBMD) of the lumbar spine, some studies also show the limitations of TBS in both T2D and T1D. Given the limitations of DXA to assess bone strength and investigate the etiology of bone fragility in diabetes, more investigators are incorporating three-dimensional (3D) medical imaging techniques in their studies. Recent use of 3D medical imaging to assess bone fragility in the setting of diabetes has been mostly limited to a few cross-sectional studies predominantly incorporating high-resolution peripheral quantitative computed tomography (HR-pQCT). Although HR-pQCT studies indicate higher tibial cortical porosity in subjects with T2D, results are inconsistent in T1D due to differences in study designs, sample sizes, and subject characteristics, among other factors. With respect to central CT, recent studies support a previous finding in the literature indicating femoral neck geometrical impairments in subjects with T2D and provide encouraging results for the incorporation of finite element analysis (FEA) to assess bone strength in studies of T2D. In the recent literature, there are no studies assessing bone fragility in T1D with QCT, and only two studies used pQCT reporting tibial and radial impairments in young women and children with T1D, respectively. Magnetic resonance imaging (MRI) has not been recently used in diabetic studies of bone fragility. SUMMARY As bone fragility in diabetes is not explained by DXA-derived aBMD and given the limitations of cross-sectional studies, it is imperative to use 3D imaging techniques for longitudinal assessments of the density, quality, and microenvironment of bone to improve our understanding of the effects of diabetes on bone and reduce the risk of fracture in this large and vulnerable population of subjects with diabetes.
Collapse
Affiliation(s)
- Julio Carballido-Gamio
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
4
|
Ubago-Guisado E, Moratalla-Aranda E, González-Salvatierra S, Gil-Cosano JJ, García-Fontana B, García-Fontana C, Gracia-Marco L, Muñoz-Torres M. Do patients with type 2 diabetes have impaired hip bone microstructure? A study using 3D modeling of hip dual-energy X-ray absorptiometry. Front Endocrinol (Lausanne) 2022; 13:1069224. [PMID: 36699041 PMCID: PMC9868930 DOI: 10.3389/fendo.2022.1069224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/15/2022] [Indexed: 01/12/2023] Open
Abstract
AIM Patients with type 2 diabetes (T2DM) have more risk of bone fractures. However, areal bone mineral density (aBMD) by conventional dual-energy x-ray absorptiometry (DXA) is not useful for identifying this risk. This study aims to evaluate 3D-DXA parameters determining the cortical and trabecular compartments in patients with T2DM compared to non-diabetic subjects and to identify their determinants. MATERIALS AND METHODS Case-control study in 111 T2DM patients (65.4 ± 7.6 years old) and 134 non-diabetic controls (64.7 ± 8.6-year-old). DXA, 3D-DXA modelling via 3D-Shaper software and trabecular bone score (TBS) were used to obtain aBMD, cortical and trabecular parameters, and lumbar spine microarchitecture, respectively. In addition, biochemical markers as 25-hydroxyvitamin d, type I procollagen N-terminal propeptide (P1NP), C-terminal telopeptide of type I collagen (CTX), and glycated haemoglobin (HbA1c) were analysed. RESULTS Mean-adjusted values showed higher aBMD (5.4%-7.7%, ES: 0.33-0.53) and 3D-DXA parameters (4.1%-10.3%, ES: 0.42-0.68) in the T2DM group compared with the control group. However, TBS was lower in the T2DM group compared to the control group (-14.7%, ES: 1.18). In addition, sex (β = 0.272 to 0.316) and body mass index (BMI) (β = 0.236 to 0.455) were the most consistent and positive predictors of aBMD (p ≤ 0.01). BMI and P1NP were negative predictors of TBS (β = -0.530 and -0.254, respectively, p ≤ 0.01), while CTX was a positive one (β = 0.226, p=0.02). Finally, BMI was consistently the strongest positive predictor of 3D-DXA parameters (β = 0.240 to 0.442, p<0.05). CONCLUSION Patients with T2DM present higher bone mass measured both by conventional DXA and 3D-DXA, suggesting that 3D-DXA technology is not capable of identifying alterations in bone structure in this population. Moreover, BMI was the most consistent determinant in all bone outcomes.
Collapse
Affiliation(s)
- Esther Ubago-Guisado
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Epidemiology and Control of Chronic Diseases, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Enrique Moratalla-Aranda
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Nuclear Medicine, University Hospital Clínico San Cecilio, Granada, Spain
| | - Sheila González-Salvatierra
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Medicine, University of Granada, Granada, Spain
- Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Granada, Spain
| | - José J Gil-Cosano
- PROFITH "PROmoting FITness and Health through Physical Activity", Research Group, Sport and Health University Research Institute (iMUDS), Departament of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Communication and Education, Universidad Loyola Andalucía, Dos Hermanas (Sevilla), Spain
| | - Beatriz García-Fontana
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, Granada, Spain
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina García-Fontana
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, Granada, Spain
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Gracia-Marco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- PROFITH "PROmoting FITness and Health through Physical Activity", Research Group, Sport and Health University Research Institute (iMUDS), Departament of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Manuel Muñoz-Torres
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Medicine, University of Granada, Granada, Spain
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, Granada, Spain
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
5
|
Löffler J, Sass FA, Filter S, Rose A, Ellinghaus A, Duda GN, Dienelt A. Compromised Bone Healing in Aged Rats Is Associated With Impaired M2 Macrophage Function. Front Immunol 2019; 10:2443. [PMID: 31681320 PMCID: PMC6813416 DOI: 10.3389/fimmu.2019.02443] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022] Open
Abstract
Fracture repair is initiated by a multitude of immune cells and induction of an inflammatory cascade. Alterations in the early healing response due to an aged adaptive immune system leads to impaired bone repair, delayed healing or even formation of non-union. However, immuno-senescence is not limited to the adaptive immunity, but is also described for macrophages, main effector cells from the innate immune system. Beside regulation of pro- and anti-inflammatory signaling, macrophages contribute to angiogenesis and granulation tissue maturation. Thus, it seems likely that an altered macrophage function due to aging may affect bone repair at various stages and contribute to age related deficiencies in bone regeneration. To prove this hypothesis, we analyzed the expression of macrophage markers and angiogenic factors in the early bone hematoma derived from young and aged osteotomized Spraque Dawley rats. We detected an overall reduced expression of the monocyte/pan-macrophage markers CD14 and CD68 in aged rats. Furthermore, the analysis revealed an impaired expression of anti-inflammatory M2 macrophage markers in hematoma from aged animals that was connected to a diminished revascularization of the bone callus. To verify that the age related disturbed bone regeneration was due to a compromised macrophage function, CD14+ macrophage precursors were transplanted locally into the osteotomy gap of aged rats. Transplantation rescued bone regeneration partially after 6 weeks, demonstrated by a significantly induced deposition of new bone tissue, reduced fibrosis and significantly improved callus vascularization.
Collapse
Affiliation(s)
- Julia Löffler
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - F Andrea Sass
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Filter
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander Rose
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Agnes Ellinghaus
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anke Dienelt
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
6
|
Bautista CRG, Santos IVD, Moraes RM, Chiba FY, Sumida DH, Moraes MBD, Vasconcellos LMRD, Anbinder AL. Sitagliptin’s effects on bone tissue and osseointegration in diabetic rats. Arch Oral Biol 2019; 102:238-243. [DOI: 10.1016/j.archoralbio.2019.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 02/07/2023]
|
7
|
Affiliation(s)
- Aoibhe M Pasieka
- 1 School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Michael C Riddell
- 1 School of Kinesiology and Health Science, York University, Toronto, Canada
- 2 LMC Diabetes & Endocrinology, Toronto, Canada
| |
Collapse
|
8
|
Abstract
Diabetes mellitus, both type 1 and type 2 (T2DM), is associated with decreased bone strength as well as increased fracture risk. Bone mineral density is decreased in type 1 diabetes but increased in T2DM, compared with controls. This suggests alterations in bone quality are a major player in the pathogenesis of fragility fractures in patients with diabetes. The link between diabetes and bone appears to be mediated by complex pathways, including the insulin-insulin growth factors system, accumulation of advanced glycation end-products in bone collagen, microangiopathy, and increased bone marrow fat content. Bone fragility in T2DM, which is not reflected by bone mineral density and bone mass reduction, depends on deterioration of bone quality. Also, at least in T2DM, the classical diagnosis of osteoporosis by dual-energy X-ray absorptiometry and the fracture risk estimation by FRAX (fracture risk assessment tool) are only partially useful in assessing fracture risk. Trabecular bone score and trabecular bone score-adjusted FRAX offer an enhanced estimation of fracture risk in these patients. Specific risk stratification criteria are needed in the future. The development of improved methods to assess the material properties of bone to better characterize fracture risk is also a priority. Adequate glycemic control is generally associated with decreased fracture risk, with the exception of specific antidiabetics (thiazolidinediones, canagliflozin) that have been shown to have a detrimental effect. Most currently used antiosteoporotic treatments seem equally effective in diabetic patients as compared with patients without diabetes, but clinical data regarding the reduction in fracture risk specifically in patients with diabetes mellitus are lacking.
Collapse
Affiliation(s)
- Catalina Poiana
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; C.I.Parhon National Institute of Endocrinology, Bucharest, Romania.
| | - Cristina Capatina
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; C.I.Parhon National Institute of Endocrinology, Bucharest, Romania
| |
Collapse
|
9
|
Sass FA, Schmidt-Bleek K, Ellinghaus A, Filter S, Rose A, Preininger B, Reinke S, Geissler S, Volk HD, Duda GN, Dienelt A. CD31+ Cells From Peripheral Blood Facilitate Bone Regeneration in Biologically Impaired Conditions Through Combined Effects on Immunomodulation and Angiogenesis. J Bone Miner Res 2017; 32:902-912. [PMID: 27976803 DOI: 10.1002/jbmr.3062] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 12/07/2016] [Accepted: 12/12/2016] [Indexed: 12/30/2022]
Abstract
Controlled revascularization and inflammation are key elements regulating endogenous regeneration after (bone) tissue trauma. Peripheral blood-derived cell subsets, such as regulatory T-helper cells and circulating (endothelial) progenitor cells, respectively, can support endogenous tissue healing, whereas effector T cells that are associated with an aged immune system can hinder bone regeneration. CD31 is expressed by diverse leukocytes and is well recognized as a marker of circulating endothelial (precursor) cells; however, CD31 is absent from the surface of differentiated effector T cells. Thus, we hypothesized that by separating the inhibitory fractions from the supportive fractions of circulating cells within the peripheral blood (PB) using the CD31 marker, bone regeneration in biologically compromised conditions, such as those observed in aged patients, could be improved. In support of our hypothesis, we detected an inverse correlation between CD31+ cells and effector T cells in the hematomas of human fracture patients, dependent on the age of the patient. Furthermore, we demonstrated the regenerative capacity of human PB-CD31+ cells in vitro. These findings were translated to a clinically relevant rat model of impaired bone healing. The transplantation of rat PB-CD31+ cells advanced bone tissue restoration in vivo and was associated with an early anti-inflammatory response, the stimulation of (re)vascularization, and reduced fibrosis. Interestingly, the depletion or enrichment of the highly abundant CD31+/14+ monocytes from the mixed CD31+ cell population diminished tissue regeneration at different levels, suggesting combined effects within the PB-CD31+ subsets. In summary, an intraoperative enrichment of PB-CD31+ cells might be a novel option to facilitate endogenous regeneration under biologically impaired situations by supporting immunomodulation and vascularization. © 2016 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- F Andrea Sass
- Julius Wolff Institute (JWI) and Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - University Medicine Berlin, Berlin, Germany
| | - Katharina Schmidt-Bleek
- Julius Wolff Institute (JWI) and Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - University Medicine Berlin, Berlin, Germany
| | - Agnes Ellinghaus
- Julius Wolff Institute (JWI) and Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Sebastian Filter
- Julius Wolff Institute (JWI) and Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Alexander Rose
- Julius Wolff Institute (JWI) and Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Bernd Preininger
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Simon Reinke
- Julius Wolff Institute (JWI) and Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - University Medicine Berlin, Berlin, Germany
| | - Sven Geissler
- Julius Wolff Institute (JWI) and Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - University Medicine Berlin, Berlin, Germany
| | - Hans-Dieter Volk
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - University Medicine Berlin, Berlin, Germany.,Institute of Medical Immunology, Charité - University Medicine Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute (JWI) and Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - University Medicine Berlin, Berlin, Germany
| | - Anke Dienelt
- Julius Wolff Institute (JWI) and Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - University Medicine Berlin, Berlin, Germany
| |
Collapse
|
10
|
Abstract
Marrow adipose tissue (MAT) is a recently identified endocrine organ capable of modulating a host of responses. Given its intimate proximity to the bone microenvironment, the impact marrow adipocytes exert on bone has attracted much interest and scientific inquiry. Although many questions and controversies remain about marrow adipocytes, multiple conditions/disease states in which alterations occur have provided clues about their function. The consensus is that MAT is associated inversely with bone density and quality. While further investigation is warranted, MAT has clearly been demonstrated as an active dynamic depot that contributes to bone turnover and overall metabolic homeostasis.
Collapse
Affiliation(s)
| | - Clifford J Rosen
- Maine Medical Center Research Institute, 81 Research Drive, Scarborough, ME 04074, USA.
| |
Collapse
|
11
|
Patrocínio-Silva TL, Souza AMFD, Goulart RL, Pegorari CF, Oliveira JR, Fernandes KR, Magri AMP, Pereira RMR, Ribeiro DA, Nagaoka MR, Rennó ACM. Low-level laser therapy associated to a resistance training protocol on bone tissue in diabetic rats. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 60:457-464. [PMID: 27812609 PMCID: PMC10118645 DOI: 10.1590/2359-3997000000190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/26/2016] [Indexed: 11/22/2022]
Abstract
Objective The present study aimed to evaluate the in vivo response of a resistance training and low-level laser therapy (LLLT) on tibias and femurs of rats with diabetes mellitus (DM). Materials and methods Forty male Wistar rats were randomly distributed into four experimental groups: control group (CG), diabetic group (DG), diabetic trained group (TG) and diabetic trained and laser irradiated group (TLG). DM was induced by streptozotocin (STZ) and after two weeks laser and resistance training started, performed for 24 sessions, during eight weeks. At the end of the experiment, animals were euthanized and tibias and femurs were removed for analysis. Histological, histomorphometrical, immunohistochemistry and mechanical analyses were performed. Results Trained groups, with or without laser irradiation, showed increased cortical area, bone density and biomechanical properties. The immunohistochemical analysis revealed that TG and TLG demonstrated an increased RUNX2 expression. RANK-L immunoexpression was similar for all experimental groups. Conclusion In conclusion, it can be suggested that the resistance exercise program stimulated bone metabolism, culminating in increased cortical tibial area, bone mineral content, bone mineral density and biomechanical properties. Furthermore, the association of physical exercises and LLLT produced higher values for bone mineral content and stiffness. Consequently, these data highlight the potential of physical exercise in the management of bone loss due to DM and the possible extra osteogenic stimulus offered by lasertherapy. Further long-term studies should be carried out to provide additional information.
Collapse
Affiliation(s)
| | | | - Raul Loppi Goulart
- Departamento de Biociências, Universidade Federal de São Paulo (Unifesp), Santos, SP, Brasil
| | | | | | | | | | | | - Daniel Araki Ribeiro
- Departamento de Biociências, Universidade Federal de São Paulo (Unifesp), Santos, SP, Brasil
| | - Márcia Regina Nagaoka
- Departamento de Biociências, Universidade Federal de São Paulo (Unifesp), Santos, SP, Brasil
| | - Ana Claudia Muniz Rennó
- Departamento de Biociências, Universidade Federal de São Paulo (Unifesp), Santos, SP, Brasil
| |
Collapse
|
12
|
Cui R, Zhou L, Li Z, Li Q, Qi Z, Zhang J. Assessment risk of osteoporosis in Chinese people: relationship among body mass index, serum lipid profiles, blood glucose, and bone mineral density. Clin Interv Aging 2016; 11:887-95. [PMID: 27445467 PMCID: PMC4938238 DOI: 10.2147/cia.s103845] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The aim of our study was to investigate the relationship among age, sex, body mass index (BMI), serum lipid profiles, blood glucose (BG), and bone mineral density (BMD), making an assessment of the risk of osteoporosis. MATERIALS AND METHODS A total of 1,035 male and 3,953 female healthy volunteers (aged 41-95 years) were recruited by an open invitation. The basic information, including age, sex, height, weight, waistline, hipline, menstrual cycle, and medical history, were collected by a questionnaire survey and physical examination. Serum lipid profiles, BG, postprandial blood glucose, and glycosylated hemoglobin were obtained after 12 hours fasting. BMD in lumbar spine was measured by dual-energy X-ray absorptiometry scanning. RESULTS The age-adjusted BMD in females was significantly lower than in males. With aging, greater differences of BMD distribution exist in elderly females than in males (P<0.001), and the fastigium of bone mass loss was in the age range from 51 to 55 in females and from 61 to 65 years in males. After adjustment for sex, there were significant differences in BMD among BMI-stratified groups in both males and females. The subjects with a BMI of <18.5 had a higher incidence of osteoporosis than BMI ≥18.5 in both sexes. BMD in type 2 diabetes mellitus with a BG of >7.0 mmol/L was lower than in people with BG of ≤7.0 mmol/L (P<0.001). People with serum high-density lipoprotein cholesterol levels of ≥1.56 mmol/L had a greater prevalence of osteoporosis compared with high-density lipoprotein cholesterol ≤1.55 mmol/L. Logistic regression with odds ratios showed that no association was found among total cholesterol, triglyceride, low-density lipoprotein cholesterol, glycosylated hemoglobin, postprandial blood glucose and BMD. CONCLUSION The present study further confirmed that factors such as age, sex, weight, BMI, high-density lipoprotein cholesterol, and diabetes are significant predictors of osteoporosis in the Chinese people.
Collapse
Affiliation(s)
- Rongtao Cui
- Department of Orthopedic and Trauma Surgery, Surgical Research, Duisburg-Essen University Hospital, Essen, Germany
| | - Lin Zhou
- Department of Orthopedics, Dalian Central Hospital, Dalian
| | - Zuohong Li
- Department of Orthopedics, Dalian Central Hospital, Dalian
| | - Qing Li
- Department of Orthopedics, Dalian Central Hospital, Dalian
| | - Zhiming Qi
- Department of Orthopedics, Dalian Central Hospital, Dalian
| | - Junyong Zhang
- Department of Gastroenterology, Shandong Provincial Hospital, Jinan, People’s Republic of China
| |
Collapse
|
13
|
Rendina-Ruedy E, Graef JL, Davis MR, Hembree KD, Gimble JM, Clarke SL, Lucas EA, Smith BJ. Strain differences in the attenuation of bone accrual in a young growing mouse model of insulin resistance. J Bone Miner Metab 2016; 34:380-94. [PMID: 26058493 DOI: 10.1007/s00774-015-0685-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 05/09/2015] [Indexed: 12/24/2022]
Abstract
Skeletal fractures are considered a chronic complication of type 2 diabetes mellitus (T2DM), but the etiology of compromised bone quality that develops over time remains uncertain. This study investigated the concurrent alterations in metabolic and skeletal changes in two mouse strains, a responsive (C57BL/6) and a relatively resistant (C3H/HeJ) strain, to high-fat diet-induced glucose intolerance. Four-week-old male C57BL/6 and C3H/HeJ mice were randomized to a control (Con = 10 % kcal fat) or high-fat (HF = 60 % kcal fat) diet for 2, 8, or 16 weeks. Metabolic changes, including blood glucose, plasma insulin and leptin, and glucose tolerance were monitored over time in conjunction with alterations in bone structure and turn over. Elevated fasting glucose occurred in both the C57BL/6 and C3H/HeJ strains on the HF diet at 2 and 8 weeks, but only in the C57BL/6 strain at 16 weeks. Both strains on the HF diet demonstrated impaired glucose tolerance at each time point. The C57BL/6 mice on the HF diet exhibited lower whole-body bone mineral density (BMD) by 8 and 16 weeks, but the C3H/HeJ strain had no evidence of bone loss until 16 weeks. Analyses of bone microarchitecture revealed that trabecular bone accrual in the distal femur metaphysis was attenuated in the C57BL/6 mice on the HF diet at 8 and 16 weeks. In contrast, the C3H/HeJ mice were protected from the deleterious effects of the HF diet on trabecular bone. Alterations in gene expression from the femur revealed that several toll-like receptor (TLR)-4 targets (Atf4, Socs3, and Tlr4) were regulated by the HF diet in the C57BL/6 strain, but not in the C3H/HeJ strain. Structural changes observed only in the C57BL/6 mice were accompanied with a decrease in osteoblastogenesis after 8 and 16 weeks on the HF diet, suggesting a TLR-4-mediated mechanism in the suppression of bone formation. Both the C57BL/6 and C3H/HeJ mice demonstrated an increase in osteoclastogenesis after 8 weeks on the HF diet; however, bone turnover was decreased in the C57BL/6 with prolonged hyperglycemia. Further investigation is needed to understand how hyperglycemia and hyperinsulinemia suppress bone turnover in the context of T2DM and the role of TLR-4 in this response.
Collapse
Affiliation(s)
- Elizabeth Rendina-Ruedy
- Department of Nutritional Sciences, HSci 420 Oklahoma State University, Stillwater, OK, 74078, USA
| | - Jennifer L Graef
- Department of Nutritional Sciences, HSci 420 Oklahoma State University, Stillwater, OK, 74078, USA
| | - McKale R Davis
- Department of Nutritional Sciences, HSci 420 Oklahoma State University, Stillwater, OK, 74078, USA
| | - Kelsey D Hembree
- Department of Nutritional Sciences, HSci 420 Oklahoma State University, Stillwater, OK, 74078, USA
| | - Jeffrey M Gimble
- Stem Cell Biology Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Stephen L Clarke
- Department of Nutritional Sciences, HSci 420 Oklahoma State University, Stillwater, OK, 74078, USA
| | - Edralin A Lucas
- Department of Nutritional Sciences, HSci 420 Oklahoma State University, Stillwater, OK, 74078, USA
| | - Brenda J Smith
- Department of Nutritional Sciences, HSci 420 Oklahoma State University, Stillwater, OK, 74078, USA.
| |
Collapse
|
14
|
Russo GT, Giandalia A, Romeo EL, Nunziata M, Muscianisi M, Ruffo MC, Catalano A, Cucinotta D. Fracture Risk in Type 2 Diabetes: Current Perspectives and Gender Differences. Int J Endocrinol 2016; 2016:1615735. [PMID: 28044077 PMCID: PMC5164892 DOI: 10.1155/2016/1615735] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 02/07/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of osteoporotic fractures, resulting in disabilities and increased mortality. The pathophysiological mechanisms linking diabetes to osteoporosis have not been fully explained, but alterations in bone structure and quality are well described in diabetic subjects, likely due to a combination of different factors. Insulin deficiency and dysfunction, obesity and hyperinsulinemia, altered level of oestrogen, leptin, and adiponectin as well as diabetes-related complications, especially peripheral neuropathy, orthostatic hypotension, or reduced vision due to retinopathy may all be associated with an impairment in bone metabolism and with the increased risk of fractures. Finally, medications commonly used in the treatment of T2DM may have an impact on bone metabolism and on fracture risk, particularly in postmenopausal women. When considering the impact of hypoglycaemic drugs on bone, it is important to balance their potential direct effects on bone quality with the risk of falling-related fractures due to the associated hypoglycaemic risk. In this review, experimental and clinical evidence connecting bone metabolism and fracture risk to T2DM is discussed, with particular emphasis on hypoglycaemic treatments and gender-specific implications.
Collapse
Affiliation(s)
- Giuseppina T. Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- *Giuseppina T. Russo:
| | - Annalisa Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Elisabetta L. Romeo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Morabito Nunziata
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marco Muscianisi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Concetta Ruffo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonino Catalano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domenico Cucinotta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| |
Collapse
|
15
|
Mathen PG, Thabah MM, Zachariah B, Das AK. Decreased Bone Mineral Density at the Femoral Neck and Lumbar Spine in South Indian Patients with Type 2 Diabetes. J Clin Diagn Res 2015; 9:OC08-12. [PMID: 26500934 DOI: 10.7860/jcdr/2015/14390.6450] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/15/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND With prevalence of diabetes in India reaching epidemic proportions and increase in the population of geriatric age group and risks of falls, it is important to understand the effect that diabetes has on bone health. AIM The objective was to assess bone mineral density (BMD) of patients with type 2 diabetes mellitus (T2DM) and to study factors contributing to BMD in patients with T2DM. MATERIALS AND METHODS This was a prospective cross-sectional study on 150 patients with T2DM (diagnosed at age > 30 years) and an equal number (n=150) of age and sex matched healthy controls from September 2012 to July 2014 at a tertiary care center located in Southern India. BMD was measured at the femoral neck and lumbar spine (L2-L4) by dual energy absorptiometry (DXA) in cases and controls. Serum total calcium, phosphorus and alkaline phosphatase (ALP) and 25-OH- vitamin D3 was measured in patient group. RESULTS Mean age (SD) was 51.29 (±8.05) and 51 (±8.3) years in cases and controls, respectively. The femoral neck and lumbar spine BMD was significantly lower in T2DM cases compared to controls. Also the femoral neck and lumbar spine T-score was significantly lower in T2DM cases compared to controls. Femoral neck BMD among male patients with T2DM was significantly lower compared to controls (men). Among women, BMD at femoral neck as well as lumbar spine was significantly lower in cases when compared to controls. Ninety six out of 150 (64%) T2DM cases had Vitamin D values <20 ng/mL. There was weak negative correlation between age of patient, duration of diabetes and HbA1C with femoral neck BMD. There was weak negative correlation between HbA1C and lumbar spine BMD. CONCLUSION Indian subjects with type 2 diabetes have significantly lower BMD at both femoral neck and lumbar spine compared to age and sex matched healthy controls. We conclude that osteopenia and osteoporosis are overlooked complications of diabetes. Longitudinal studies are needed to see for actual incidence of fractures among this high risk group.
Collapse
Affiliation(s)
| | - Molly Mary Thabah
- Associate Professor, Department of Medicine, JIPMER , Puducherry, India
| | - Bobby Zachariah
- Professor and Head, Department of Biochemistry, JIPMER , Puducherry, India
| | - Ashok Kumar Das
- Senior Professor, Department of Medicine, JIPMER , Puducherry, India
| |
Collapse
|
16
|
de Waard EAC, van Geel TACM, Savelberg HHCM, Koster A, Geusens PPMM, van den Bergh JPW. Increased fracture risk in patients with type 2 diabetes mellitus: an overview of the underlying mechanisms and the usefulness of imaging modalities and fracture risk assessment tools. Maturitas 2014; 79:265-74. [PMID: 25192916 DOI: 10.1016/j.maturitas.2014.08.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/06/2014] [Indexed: 12/11/2022]
Abstract
Type 2 diabetes mellitus has recently been linked to an increased fracture risk. Since bone mass seems to be normal to elevated in patient with type 2 diabetes, the increased fracture risk is thought to be due to both an increased falling frequency and decreased bone quality. The increased falling frequency is mainly a result of complications of the disease such as a retinopathy and polyneuropathy. Bone quality is affected through changes in bone shape, bone micro-architecture, and in material properties such as bone mineralization and the quality of collagen. Commonly used methods for predicting fracture risk such as dual energy X-ray absorptiometry and fracture risk assessment tools are helpful in patients with type 2 diabetes mellitus, but underestimate the absolute fracture risk for a given score. New imaging modalities such as high resolution peripheral quantitative computed tomography are promising for giving insight in the complex etiology underlying the fragility of the diabetic bone, as they can give more insight into the microarchitecture and geometry of the bone. We present an overview of the contributing mechanisms to the increased fracture risk and the usefulness of imaging modalities and risk assessment tools in predicting fracture risk in patients with type 2 diabetes.
Collapse
Affiliation(s)
- Ellis A C de Waard
- Maastricht University Medical Centre/NUTRIM, Department of Internal Medicine, Subdivision of Rheumatology, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Tineke A C M van Geel
- Maastricht University/CAPHRI and NUTRIM, Department of Family Medicine, P.O. Box 616, 6200MD Maastricht, The Netherlands
| | - Hans H C M Savelberg
- Maastricht University Medical Centre/NUTRIM, Department of Human Movement Science, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Annemarie Koster
- Maastricht University/CAPHRI, Department of Social Medicine, School for Public Health and Primary Care, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Piet P M M Geusens
- Maastricht University Medical Centre/CAPHRI, Department of Internal Medicine, Subdivision of Rheumatology, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; University of Hasselt, Biomedical Research Institute, P.O. Box 6, 3590 Diepenbeek, Belgium
| | - Joop P W van den Bergh
- Maastricht University Medical Centre/NUTRIM, Department of Internal Medicine, Subdivision of Rheumatology, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; University of Hasselt, Biomedical Research Institute, P.O. Box 6, 3590 Diepenbeek, Belgium; VieCuri Medical Centre, Department of Internal Medicine, Subdivision of Endocrinology, P.O. Box 1926, 5900 BX Venlo, The Netherlands
| |
Collapse
|
17
|
Gallagher EJ, Sun H, Kornhauser C, Tobin-Hess A, Epstein S, Yakar S, LeRoith D. The effect of dipeptidyl peptidase-IV inhibition on bone in a mouse model of type 2 diabetes. Diabetes Metab Res Rev 2014; 30:191-200. [PMID: 24023014 PMCID: PMC5496098 DOI: 10.1002/dmrr.2466] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/05/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Individuals with type 2 diabetes (T2D) are at greater risk of bone fractures than those without diabetes. Certain oral diabetic medications may further increase the risk of fracture. Dipeptidyl peptidase-IV (DPP-IV) inhibitors are incretin-based therapies that are being increasingly used for the management of T2D. It has been hypothesized that these agents may reduce fracture risk in those with T2D. In this study, we used a mouse model of T2D to examine the effects of the DPP-IV inhibitor, MK-0626, on bone. METHODS Male wild type (WT) and diabetic muscle-lysine-arginine (MKR) mice were treated with MK-0626, pioglitazone, alendronate or vehicle. The effects of treatment with MK-0626 on bone microarchitecture and turnover were compared with treatment with pioglitazone, alendronate and vehicle. Osteoblast differentiation was determined by alkaline phosphatase staining of bone marrow cells from WT and MKR mice after treatment with pioglitazone, MK-0626 or phosphate buffered saline. RESULTS We found that MK-0626 had neutral effects on cortical and trabecular bone in diabetic mice. Pioglitazone had detrimental effects on the trabecular bone of WT but not of diabetic mice. Alendronate caused improvements in cortical and trabecular bone architecture in diabetic and WT mice. MK-0626 did not alter osteoblast differentiation, but pioglitazone impaired osteoblast differentiation in vitro. CONCLUSIONS Overall, the DPP-IV inhibitor, MK-0626, had no adverse effects on bone in an animal model of T2D or directly on osteoblasts in culture. These findings are reassuring as DPP-IV inhibitors are being widely used to treat patients with T2D who are already at an increased risk of fractures.
Collapse
Affiliation(s)
- Emily Jane Gallagher
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Hui Sun
- David B. Kriser Dental Center, Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, NY, USA
| | - Caroline Kornhauser
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Aviva Tobin-Hess
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Sol Epstein
- Department of Medicine and Geriatrics, Mount Sinai School of Medicine, New York, NY, USA
| | - Shoshana Yakar
- David B. Kriser Dental Center, Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, NY, USA
| | - Derek LeRoith
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
- Correspondence to: Derek LeRoith, Division of Endocrinology, Metabolism, and Bone Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA.
| |
Collapse
|