Low free 25-hydroxyvitamin D and high vitamin D binding protein and parathyroid hormone in obese Caucasians. A complex association with bone?

Background

Studies have shown altered vitamin D metabolism in obesity. We assessed differences between obese and normal-weight subjects in total, free, and bioavailable 25-hydroxyvitamin D (25(OH)D, 25(OH)D_Free, and 25(OH)D_Bio, respectively), vitamin D binding protein (DBP), parathyroid hormone (PTH) and bone traits.

Methods

595 37-47-year-old healthy Finnish men and women stratified by BMI were examined in this cross-sectional study. Background characteristic and intakes of vitamin D and calcium were collected. The concentrations of 25(OH)D, PTH, DBP, albumin and bone turnover markers were determined from blood. 25(OH)D_Free and 25(OH)D_Bio were calculated. pQCT was performed at radius and tibia.

Results

Mean±SE (ANCOVA) 25(OH)D_Free (10.8±0.6 vs 12.9±0.4 nmol/L; P = 0.008) and 25(OH)D_Bio (4.1±0.3 vs 5.1±0.1 nmol/L; P = 0.003) were lower in obese than in normal-weight women. In men, 25(OH)D (48.0±2.4 vs 56.4±2.0 nmol/L, P = 0.003), 25(OH)D_Free (10.3±0.7 vs 12.5±0.6 pmol/L; P = 0.044) and 25(OH)D_Bio (4.2±0.3 vs 5.1±0.2 nmol/L; P = 0.032) were lower in obese. Similarly in all subjects, 25(OH)D, 25(OH)D_Free and 25(OH)D_Bio were lower in obese (P<0.001). DBP (399±12 vs 356±7mg/L, P = 0.008) and PTH (62.2±3.0 vs 53.3±1.9 ng/L; P = 0.045) were higher in obese than in normal-weight women. In all subjects, PTH and DBP were higher in obese (P = 0.047and P = 0.004, respectively). In obese women, 25(OH)D was negatively associated with distal radius trabecular density (R² = 0.089, P = 0.009) and tibial shaft cortical strength index (CSI) (R² = 0.146, P = 0.004). 25(OH)D_Free was negatively associated with distal radius CSI (R² = 0.070, P = 0.049), radial shaft cortical density (CorD) (R² = 0.050, P = 0.045), and tibial shaft CSI (R² = 0.113, P = 0.012). 25(OH)D_Bio was negatively associated with distal radius CSI (R² = 0.072, P = 0.045), radial shaft CorD (R² = 0.059, P = 0.032), and tibial shaft CSI (R² = 0.093, P = 0.024).

Conclusions

The associations between BMI and 25(OH)D, 25(OH)D_Free, and 25(OH)D_Bio, DBP, and PTH suggest that obese subjects may differ from normal-weight subjects in vitamin D metabolism. BMI associated positively with trabecular bone traits and CSI in our study, and slightly negatively with cortical bone traits. Surprisingly, there was a negative association of free and bioavailable 25(OH)D and some of the bone traits in obese women.

Effect of vitamin D, calcium and multiple micronutrients supplementation on lipid profile in pre-menopausal Bangladeshi garment factory workers with hypovitaminosis D

Elevated total cholesterol and low-density lipoprotein cholesterol in sera are both well-known risk factors of coronary heart disease. Adequate vitamin D status is important for optimal function of many organs and tissues of our body. There is continuing controversy about the effect of adequate vitamin D consumption on serum lipids and lipoproteins. The present study assessed the effect of vitamin D, calcium and multiple micronutrients supplementation on the lipid profile in Bangladeshi young female garment factory workers who have hypovitaminosis D. This placebo-controlled intervention trial conducted over a period of one year randomly assigned a total of 200 apparently healthy subjects aged 16-36 years to 4 groups. The subjects received daily supplements of 400 IU of vitamin D (VD group) or 400 IU of vitamin D+600 mg of calcium lactate (VD-Ca group), or multiple micronutrients with 400 IU of vitamin-D+600 mg of calcium lactate (MMN-VD-Ca group), or the group consuming placebo (PL group). Serum concentrations of lipid and lipoprotein, 25-hydroxyvitamin D (25OHD) and intact parathyroid hormone (iPTH) were measured at baseline and after one year of follow-up. No significant changes in the serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), LDL-C/HDL-C ratio were observed in the supplemented groups compared to the placebo group. Supplementation had a positive effect (p<0.05) on very low-density-lipoprotein cholesterol (VLDL-C) and triacylglycerol (TAG). A negative correlation between changes in serum iPTH and HDL-C was observed, which indicated that subjects with the greatest decline in S-iPTH had the greatest increase in HDL-C. The results suggest that consumption of adequate vitamin D with calcium or MMN for one-year may have no impact on serum lipid profile in the subjects studied. Longer-term clinical trials with different doses of supplemental vitamin D are warranted in evaluating the effect of intervention.

Associations of dietary polyunsaturated fatty acids with bone mineral density in elderly women

BACKGROUND/OBJECTIVES

Significance of dietary fatty acids on bone health is not clear, and the evidence is controversial. This study aimed to investigate the relationship between dietary polyunsaturated fatty acids (PUFAs) and bone mineral density (BMD) among elderly women.

SUBJECTS/METHODS

Subjects (n=554) were drawn from the Kuopio OSTPRE Fracture Prevention Study. At baseline they filled a 3-day food record and a questionnaire on lifestyle factors, diseases and medications. BMD was measured at lumbar spine (L2-L4), femoral neck and total body by dual energy X-ray absorptiometry at baseline and after 3 years. The associations between dietary fatty acids and BMD were analyzed by a linear mixed model adjusting for potential dietary and non-dietary confounders.

RESULTS

Our findings suggested a positive relationship between the dietary PUFAs and BMD at lumbar spine and in total body but not at femoral neck. Further analyses revealed that these results were due to associations among the women without hormone therapy (HT) at baseline. Among them, the intake of total PUFAs as well the intakes of linoleic and linolenic acids and total n-3 and n-6 fatty acids were significantly associated with BMD at lumbar spine; P for trend over the quartiles ranged between 0.013 and 0.001. Similarly, significant associations were demonstrated for total body BMD and fatty acids with an exception of total PUFA. No significant associations were found among women with HT at baseline.

CONCLUSIONS

Our findings among elderly women without HT support the suggested beneficial effect of dietary PUFAs on bone health.

Bone health-related factors and the use of bisphosphonates in community setting--15-year follow-up study

The present study investigated the bone health related factors that were associated with the use of bisphosphonates (BP) among 2,050 postmenopausal Finnish women. Low BMD + low trauma energy fracture was the strongest determinant of BP use, while other secondary causes of osteoporosis were less strongly related with BP use. BP use was associated with reduced femoral neck (FN) and lumbar spine (LS) bone loss rate.

INTRODUCTION

The aim was to identify bone health related factors associated with the use of BP in a community setting.

METHODS

A population-based sample of 2,050 Finnish postmenopausal women was measured with dual X-ray absorptiometry at the FN and LS in 1989, 1994, 1999 and 2004, and information on osteoporosis risk factors, including low-trauma energy fractures, were collected with postal inquiries. Self-reported use of BP in 2004 was considered as the end point variable.

RESULTS

Among BP users, 12% had T-score > -2.0 SD and no fracture during follow-up (FU). In women without any bone medication, 26% had T-score < -2.0 SD or low-trauma energy fracture or both during the FU. In BP users, a significant reduction in FN and LS bone loss rate, cumulative with duration of use, was observed in ANCOVA (p < 0.001). Among BP users, there was a significantly higher proportion of women with several independent risk factors for osteoporosis and more spine and humerus fractures but less ankle fractures. T-score < -2 SD combined with low-trauma energy fracture was significantly related to the use of BPs (p < 0.001, OR = 15.96) and T-score < -2 SD was a stronger predictor of BP use (p < 0.001, OR = 13.29) than fracture (p > 0.05, OR = 1.35) in multivariate logistic regression. Other factors related with BP use were vitamin D use (p = 0.001, OR = 2.27), high number of medications (p < 0.001, OR = 1.26) and rheumatoid arthritis (p < 0.05, OR 2.55).

CONCLUSIONS

These findings reveal the recent bone health-related indications for BP prescription.

Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65-71 years: a 3-year randomized population-based trial (OSTPRE-FPS)

SUMMARY

The Osteoporosis Risk Factor and Prevention-Fracture Prevention Study (OSTPRE-FPS) was a randomized population-based open trial (n = 593). The supplementation group (n = 287) received daily cholecalciferol 800 IU + calcium 1,000 mg for 3 years while the control group (n = 306) received neither supplementation nor placebo. Daily vitamin D and calcium supplementation have a positive effect on the skeleton in ambulatory postmenopausal women.

INTRODUCTION

vitamin D deficiency is common in the elderly, and vitamin D levels are associated with low bone mineral density (BMD). The working hypothesis was that vitamin D and calcium supplementation could prevent bone loss in ambulatory postmenopausal women.

METHODS

the OSTPRE-FPS was a randomized population-based open trial with a 3-year follow-up in 3,432 women (aged 66 to 71 years). A randomly selected subsample of 593 subjects underwent BMD measurements. The supplementation group (n = 287) received daily cholecalciferol 800 IU + calcium 1,000 mg for 3 years while the control group (n = 306) received neither supplementation nor placebo.

RESULTS

in the intention-to-treat analysis, total body BMD (n = 362) increased significantly more in the intervention group than in the control group (0.84% vs. 0.19%, p = 0.011). The BMD change differences at the lumbar spine (p = 0.372), femoral neck (p = 0.188), trochanter (p = 0.085), and total proximal femur (p = 0.070) were statistically nonsignificant. Analyses in compliant women (≥ 80% of use) resulted in stronger and statistically significant effects at the total body and femoral regions.

CONCLUSION

daily vitamin D and calcium supplementation have a positive effect on the skeleton in ambulatory postmenopausal women with adequate nutritional calcium intake.

Effects of a low-frequency sound wave therapy programme on functional capacity, blood circulation and bone metabolism in frail old men and women

Objective: To evaluate the effects of a low-frequency sound wave therapy programme on functional capacity, blood circulation and bone metabolism of the frail elderly.

Design: Single-blind, randomized, controlled trial.

Setting: Two senior service centres.

Subjects: Forty-nine volunteers (14 males and 35 females) aged 62—93 years with up to 12 diagnosed diseases were allocated in either the intervention group (n = 30) or control group (n = 19).

Intervention: The intervention group underwent sound wave therapy, 3—5 times a week for 30 minutes per session over a period of 6 months. The control group received no intervention.

Main measurements: Blood pressure, functional capacity, mobility, bone density, biochemical markers, isometric muscle strength, balance, and skin surface temperature.

Results: Compared with the control group, the intervention group’s mobility and the amount of self-reported kilometres walked per week increased by 3 km (P<0.05), while levels of cholesterol (4.97 (0.72) to 4.52 (0.65) mmol/L, P =0.019), low-density lipoprotein (2.82 (0.72) to 2.45 (0.61) mmol/L, P =0.022), bone markers of total osteocalcin (11.0 (6.5) to 10.3 (5.9) ng/mL, P =0.048)) and tartrate-resistant acid phosphatase isoform 5b (2.50 (1.0) to 2.41 (1.1) IU/L, P =0.021)) decreased. The average skin surface temperature was significantly higher during active sessions at the end of the intervention than in the beginning (P = 0.004). No change was found during placebo sessions.

Conclusions: Low-frequency sound wave therapy may have the potential to promote well-being of frail elderly subjects via improved functional capacity, especially in subjects who are too frail to undertake exercise.

Association between functional capacity tests and fractures: an eight-year prospective population-based cohort study

This study of postmenopausal women (n=2,928) with an eight-year follow-up revealed that impairment in functional status associated with the increased fracture risk. The standing-on-one-foot and grip strength tests and a question about self-assessed ability to move can be used to identify women with a high risk of suffering a fracture.

INTRODUCTION

Poor functional status has pointed to associate with injurious falls and consequent fractures. Our aim was to define association between functional capacity and fractures.

METHODS

This study was based on the Osteoporosis Risk Factor and Prevention Study (OSTPRE). A total of 2,928 postmenopausal women took part in the functional capacity and muscle strength tests. The duration of fracture follow-up varied from 6.43 to 9.86 (mean 8.37) years and the first fracture was the end-point event for the statistical analyses. All analyses were done with Cox-regression.

RESULTS

A total of 261 end-point fractures occurred. In multivariate analysis the inability to stand-on-one-foot for 10 seconds increased the risk of hip fracture (hazard ratio with 95% CI) 9.11-fold (1.98-42.00). Decreased grip strength associated with 1.05-fold (1.01-1.09) increased risk of hip fractures. Low leg extension strength associated with 1.02-fold (1.00-1.03) higher risk for all fractures. The self-assessed ability to walk less than 100 meters at baseline increased the risk of ankle 2.36-fold (1.10-5.08), hip 11.57-fold (2.73-49.15) and clinical vertebral fractures 3.85-fold (1.45-10.22).

CONCLUSION

According to these results the standing-on-one-foot less than 10 seconds, grip strength and a question about ability to walk less than 100 meters may help to predict postmenopausal fractures.

A seasonal variation of calcitropic hormones, bone turnover and bone mineral density in early and mid-puberty girls – a cross-sectional study

The importance of the seasonal variation of calcitropic hormones to growing skeleton has not been established. We studied whether there exists a seasonal variation in calcitropic hormones, bone mineral density (BMD) and bone remodelling markers in early puberty girls. One hundred and ninety-six girls, mean age 11.4 (sd 0.4) years, in Tanner stage 2 (early puberty) and 3 (mid-puberty) were studied during September to March. The BMD was measured from the lumbar vertebrae and the left femur by dual-energy X-ray absoptiometry. Their serum 25-hydroxyvitamin D (S-25-OHD), serum intact parathyroid hormone (S-iPTH), serum osteocalcin, urinary pyridinoline and urinary deoxypyridinoline were analysed from fasting samples. The concentration of S-25-OHD and serum osteocalcin differed among months (P < 0.01), reflecting a seasonal variation. The parathyroid hormone correlated negatively with S-25-OHD (r -0.325, P < 0.001). Moreover, the BMD in the femur (P = 0.047) and to a lesser extent in vertebrae (P = 0.057) differed between months in early puberty girls but this was not seen in mid-puberty. Seasonal variation in S-25-OHD and bone remodelling markers accompanied by negative correlation between S-25-OHD and S-iPTH was seen in this cross-sectional study of adolescent girls. In addition, the seasonal rhythm contributed 7.0-7.6 % difference in the BMD of lumbar vertebrae and left femur in early puberty girls. This variation should be avoided since it could hamper peak bone mass attainment.

How much vitamin D3 do the elderly need?

BACKGROUND

Vitamin D insufficiency poses a problem in many parts of the world, the elderly being an especially vulnerable group. This insufficiency results from an inadequate amount of sunshine and a low dietary intake of vitamin D. Typically, insufficiency is accompanied with high intact parathyroid hormone, (S-iPTH) concentrations.

AIMS OF THE STUDY

We studied how serum 25-hydroxy vitamin D (S-25-OHD) concentrations respond to different doses of vitamin D3 supplementation. Secondly to determine the smallest efficient dose to maintain serum 25-OHD concentration above the insufficiency level. We also studied which dose would be efficient in decreasing S-iPTH concentration in these subjects.

SUBJECTS AND METHODS

Forty-nine 65- to 85-year-old women participated. The women were randomly assigned into one of four groups receiving 0 (placebo), 5, 10 or 20 microg of vitamin D3 daily for 12 weeks. Fasting morning blood was drawn at the beginning of the study, and thereafter every second week. Calciotropic variables were assessed from serum and urine samples.

RESULTS

The S-25-OHD concentration increased significantly (p < 0.001) in all supplemented groups [5 microg: by 10.9 (8.5) nmol/L, 10 microg: by 14.4 (6.9) nmol/L, 20 microg: by 23.7 (11.9) nmol/L], whereas it decreased in the placebo group by 8.3 (13.2) nmol/L. Equilibrium in S-25-OHD concentration was reached in all groups after 6 weeks of supplementation at 57.7 (8.9) nmol/L, 59.9 (8.9) nmol/L and 70.9 (8.9) nmol/L in the groups with increasing vitamin D supplementation. The dose-response to supplementation decreased with increasing vitamin D status at baseline, r = -0.513, p = 0.002. S-iPTH tended to decrease in those with highest dose response to supplementation.

CONCLUSIONS

A clear dose response was noted in S-25-OHD to different doses of vitamin D3. The recommended dietary intake of 15 microg is adequate to maintain the S-25-OHD concentration around 40-55 nmol/L during winter, but if the optimal S-25-OHD is higher than that even higher vitamin D intakes are needed. Interestingly, subjects with lower vitamin D status at baseline responded more efficiently to supplementation than those with more adequate status.

A positive dose-response effect of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo-controlled 1-year intervention

The effect of vitamin D supplementation on bone mineral augmentation in 212 adolescent girls with adequate calcium intake was studied in a randomized placebo-controlled setting. Bone mineral augmentation determined by DXA increased with supplementation both in the femur and the lumbar vertebrae in a dose-responsive manner. Supplementation decreased the urinary excretion of resorption markers, but had no impact on formation markers.

INTRODUCTION

Adequate vitamin D intake protects the elderly against osteoporosis, but there exists no indisputable evidence that vitamin D supplementation would benefit bone mineral augmentation. The aim of this 1-year study was to determine in a randomized double-blinded trial the effect of 5 and 10 microg vitamin D3 supplementation on bone mineral augmentation in adolescent girls with adequate dietary calcium intake.

MATERIALS AND METHODS

Altogether, 228 girls (mean age, 11.4 +/- 0.4 years) participated. Their BMC was measured by DXA from the femur and lumbar spine. Serum 25-hydroxyvitamin D [S-25(OH)D], intact PTH (S-iPTH), osteocalcin (S-OC), and urinary pyridinoline (U-Pyr) and deoxypyridinoline (U-Dpyr) were measured. Statistical analysis was performed both with the intention-to-treat (IT) and compliance-based (CB) method.

RESULTS

In the CB analysis, vitamin D supplementation increased femoral BMC augmentation by 14.3% with 5 microg and by 17.2% with 10 microg compared with the placebo group (ANCOVA, p = 0.012). A dose-response effect was observed in the vertebrae (ANCOVA, p = 0.039), although only with the highest dose. The mean concentration of S-25(OH)D increased (p < 0.001) in the 5-microg group by 5.7 +/- 15.7 nM and in the 10-microg group by 12.4 +/- 13.7 nM, whereas it decreased by 6.7 +/- 11.3 nM in the placebo group. Supplementation had no effect on S-iPTH or S-OC, but it decreased U-DPyr (p = 0.042).

CONCLUSIONS

Bone mineral augmentation in the femur was 14.3% and 17.2% higher in the groups receiving 5 and 10 microg of vitamin D, respectively, compared with the placebo group, but only 10 mug increased lumbar spine BMC augmentation significantly. Vitamin D supplementation decreased the concentration of bone resorption markers, but had no impact on bone formation markers, thus explaining increased bone mineral augmentation. However, the positive effects were noted with the CB method but not with IT.

Safety aspects and cholesterol-lowering efficacy of low fat dairy products containing plant sterols

OBJECTIVE

The aim of this study was to investigate whether a plant sterol mixture would reduce serum cholesterol when added to low fat dairy products in subjects with hypercholesterolaemia, and to examine the effects of the mixture on the serum plant sterol and fat-soluble vitamin levels.

DESIGN

A parallel, double-blind study.

SETTING

The study was performed in three different locations in Finland.

SUBJECTS

In total, 164 mildly or moderately hypercholesterolaemic subjects participated in the study.

METHODS

The subjects were randomly divided into two groups: a plant sterol group and a control group. The subjects consumed the products for 6 weeks after a 3-week run-in period. The targeted plant sterol intake was 2 g/day in the sterol group.

RESULTS

During the treatment period, there was a 6.5% reduction in serum total cholesterol in the sterol group while no change was observed in the control group (P<0.0005). Serum low-density lipoprotein (LDL) cholesterol was reduced by 10.4% in the sterol group and by 0.6% in the control group (P<0.00005). There was no change during the trial in serum high-density lipoprotein (HDL) cholesterol or triacylglycerol concentrations. The HDL/LDL cholesterol ratio increased by 16.1% in the sterol group and by 4.3% in the control group (P=0.0001). Serum plant sterol levels increased significantly (P=0.0001) in the sterol group. None of the fat-soluble vitamin levels decreased significantly when changes in serum total cholesterol were taken into account. The hypocholesterolaemic effect of sterol administration was not influenced by apolipoprotein E phenotype.

CONCLUSIONS

Yoghurt, low-fat hard cheese and low-fat fresh cheese enriched with a plant sterol mixture reduced serum cholesterol in hypercholesterolaemic subjects and no adverse effects were noted in the dietary control of hypercholesterolaemia.

Teenage girls and elderly women living in northern Europe have low winter vitamin D status

OBJECTIVE

To determine the vitamin D status (serum 25-hydroxyvitamin D; S-25OHD) in adolescent girls and elderly community-dwelling women living in four countries of northern Europe and to explain differences in S-25OHD concentrations between and within the countries.

DESIGN

A cross-sectional observational study conducted in a standardised way during February-March. S-25OHD was analysed by high-performance liquid chromatography. Vitamin D and calcium intake was calculated using a standardised food composition database.

SETTING

Denmark, Finland, Ireland, and Poland.

SUBJECTS

A total of 199 girls (mean (s.d.) age 12.6 (0.5) y) and 221 women (mean (s.d.) age 71.8 (1.4) y).

RESULTS

The median (inter quartiles) concentration of S-25OHD was 29.4 (20.3, 38.3) nmol/l for the girls and 40.7 (28.0, 54.2) nmol/l for the women. S-25OHD below 25 nmol/l was found in 37% of the girls and 17% of the women, and S-25OHD below 50 nmol/l was found in 92% of the girls and 37% of the women. Positive significant determinants for S-25OHD in girls were use of vitamin D supplements, and in women sun habits, dietary vitamin D intake, use of vitamin D and calcium supplements. Body mass index and smoking were negative determinants in women. For women predictors could explain the differences between countries (P(country) = 0.09, R(2) = 0.39), but for girls the difference remained significant even after including predictors (P(country) = 0.03, R(2) = 0.15).

CONCLUSION

Vitamin D status is low in northern Europe during winter. More than one-third of the adolescent girls have vitamin D status below 25 nmol/l and almost all are below 50 nmol/l. Two-thirds of the elderly community-dwelling women have vitamin D status below 50 nmol/l. Use of vitamin D supplements is a significant positive determinant for S-25OHD for both girls and women (P = 0.001).

SPONSORSHIP

The European Fifth Framework Programme (Contract No. QLK1-CT-2000-00623).

Effects of long-term intervention with Lactobacillus helveticus-fermented milk on bone mineral density and bone mineral content in growing rats

BACKGROUND

Lactobacillus helveticus-fermented milk has been shown to increase calcium absorption compared to ordinary sour milk. In the present study the possible effect of L. helveticus-fermented milk on bone was studied in growing rats.

METHODS

Spontaneously hypertensive male rats, which develop an osteoporotic bone disorder with age, were randomized into 5 groups (n = 10) receiving milk fermented with L. helveticus 16H and, as reference drinks, milk fermented with L. helveticus and Saccharomyces cerevisiae, sour milk, skim milk or water, for 14 weeks. After the intervention bone mineral density and bone mineral content were measured by dual-energy X-ray absorptiometry. The femur weight, length and volume were measured before ashing. From the ashes the weight and mineral content were assessed.

RESULTS

As the body weight gain differed significantly between the groups, the results were related to the body weight. The L. helveticus-fermented milk intervention significantly increased the bone mineral density and bone mineral content compared to the sour milk, skim milk and water interventions. The mean values of the bone mineral density and bone mineral content were higher in the L. helveticus-fermented milk group compared to the Saccharomyces-fermented milk group but the difference was not statistically significant.

CONCLUSION

L. helveticus-fermented milk increases bone mineral density and bone mineral content in relation to body weight in the long-term feeding of growing rats. The mechanism of L. helveticus remains to be discovered.

Association of low 25-hydroxyvitamin D concentrations with elevated parathyroid hormone concentrations and low cortical bone density in early pubertal and prepubertal Finnish girls

BACKGROUND

Very few studies have evaluated both parathyroid hormone (PTH) and 25-hydroxyvitamin D [25(OH)D] and their effects on bone mass in children.

OBJECTIVE

We studied the associations of serum 25(OH)D and intact PTH (iPTH) with bone mineral content (BMC) and bone mineral density (BMD) at different bone sites and the relation between serum 25(OH)D and iPTH in early pubertal and prepubertal Finnish girls.

DESIGN

The subjects were 10-12-y-old girls (n = 193) at Tanner stage 1 or 2, who reported a mean (+/- SD) dietary calcium intake of 733 +/- 288 mg/d. 25(OH)D, iPTH, tartrate-resistant acid phosphatase 5b (TRAP 5b), urinary calcium excretion, BMC, areal BMD, and volumetric BMD were assessed by using different methods.

RESULTS

Thirty-two percent of the girls were vitamin D deficient [serum 25(OH)D < or = 25 nmol/L], and 46% of the girls had an insufficient concentration (26-40 nmol/L). iPTH and TRAP 5b concentrations were significantly higher in the deficient group than in the insufficient and sufficient groups [iPTH: 43.9 +/- 15.7 compared with 38.6 +/- 11.2 pg/L (P = 0.049) and 32.7 +/- 12.1 pg/L (P < 0.001), respectively; TRAP 5b: 12.2 +/- 2.9 compared with 11.0 +/- 2.8 U/L (P = 0.009) and 10.9 +/- 1.9 U/L (P = 0.006), respectively]. The girls in the deficient group also had significantly lower cortical volumetric BMD of the distal radius (P < 0.001) and tibia shaft (P = 0.002). High iPTH concentrations were also associated with low total-body apparent mineral density and urinary calcium excretion (P < 0.007).

CONCLUSIONS

Vitamin D-deficient girls have low cortical BMD and high iPTH concentrations, which are consistent with secondary hyperparathyroidism. A low vitamin D concentration accompanied by high bone resorption (TRAP 5b) may limit the accretion of bone mass in young girls.

Dietary calcium intake in premenopausal Bangladeshi women: do socio-economic or physiological factors play a role?

OBJECTIVE

Evaluation of data on dietary calcium intake in premenopausal women of two socio-economic groups in Bangladesh.

DESIGN

A cross sectional study. Three days dietary records were used to estimate habitual calcium intake.

SETTING

Two regions of Bangladesh. The Dhaka city area and the Betagair Union in the sub-district Nandail, Mymensingh.

SUBJECTS

A total of 191 subjects of two groups (low socio-economic group=group L, n=101 and high socio-economic group=group H, n=90) of Bangladeshi women aged 16-40 y. About 87% of the subjects were housewives and the rest 13% were distributed in other different professions. Each group consisted of three sub-groups (non-pregnant non-lactating=1, pregnant=2 and lactating=3).

RESULTS

: The influence of socio-economic status on dietary intake of calcium (P<0.001) was observed in this study. The dietary intake of calcium was influenced by physiological status (PS) in high income group only (P<0.005). The mean dietary calcium intake was significantly higher (P&<0.005) in all sub-groups of this group compared with the corresponding sub-groups in low income group. Although in group H, 47% of subjects failed to meet even the lowest level (400-500 mg/day) of WHO recommended dietary allowances (RDA) of calcium for adult women. No subject in group L was found to meet the RDA level. Moreover, 63% of the women in group L had calcium intake lower than 200 mg/day. These figure could be more critical in both groups if we consider the recent USA-RDAs of calcium for adult women (1000 mg/day). The observed sources of dietary calcium were different in the two groups.

CONCLUSIONS

The results of the study suggested that low calcium intake could reduce the bone accretion rates and increase the risk of osteoporosis in the subjects of the present study. Calcium rich food may be recommended for women in both groups.

Caseinphosphopeptides in milk and fermented milk do not affect calcium metabolism acutely in postmenopausal women

BACKGROUND

Caseinphosphopeptides (CPPs) are formed in food processing or during digestion in the gastrointestinal tract. CPPs prevent the formation of insoluble calcium salts; thus, the hypothesis is that CPPs increase the absorption of calcium.

OBJECTIVE

We examined the effect of additional caseinphosphopeptides in milk and fermented milk on acute calcium metabolism by measuring intact PTH (iPTH), ionized calcium (iCa), total calcium (Ca) and phosphate (P) from serum, and 24-hour calcium from urine (U-Ca).

METHODS

The study consisted of two separate parts, both applying a double-blind randomized crossover study with two interventions, in nine postmenopausal women. The acute effect on calcium metabolism was analysed by measuring iPTH, iCa, Ca and P from serum during the first six hours after the administration of the study milks. U-Ca was analysed 24 hours prior to the study and 0, 2, 4, 6, 12 and 24 hours after the administration of the study milks. The study included two parts, both consisting of two study days with a one-week washout period in between. In the first part the effect of control milk and CPP-enriched milk was measured. The second part evaluated the effect of fermentation by giving subjects milk or fermented milk, both enriched with CPPs.

RESULTS

In the first part of the study there were no statistically significant differences in iPTH, iCa, Ca, P or U-Ca between the groups receiving control milk compared to CPP-containing milk. There was no difference in the AUC((0-6)) of iCa and iPTH. In the second part, fermentation did not affect calcium metabolism, when results from the CPP-enriched milk and CPP-enriched fermented milk groups were compared.

CONCLUSION

One gram of caseinphosphopeptides does not affect calcium metabolism acutely in postmenopausal women.

Functionality of endogenous folates from rye and orange juice using human in vivo model

BACKGROUND

Cereals contribute about a quarter of the daily folate intake from a typical diet in several European countries. However, studies on bioavailability of endogenous folates, in particular of cereal sources, are scarce.

AIM OF THE STUDY

We aimed to study how well natural folates from rye (different rye breads and muesli made of malted rye) and orange juice function in improving folate status of human volunteers compared to a diet containing folic acid fortified wheat bread.

METHODS

Healthy human volunteers aged 20-66 y took part in a four-week intervention trial in which bread, breakfast cereal and juice were provided. The study had a parallel design with two groups, 1) rye and orange juice group (33 volunteers) and 2) fortified wheat bread and apple juice group (31 volunteers). The test foods provided on average 184 microg and 188 microg folate per day in rye and wheat groups, respectively. Test foods were consumed as part of the subjects' normal diet.

RESULTS

In both groups statistically significant increases in serum and red cell folates were observed after the intervention period. The serum folate increased 26 % and 31 %, and red cell folate levels increased 17 % and 15 % in rye and orange juice and wheat and apple juice groups, respectively. The effects did not differ between the rye and wheat groups. Increases in serum and red cell folate were more profound among subjects with low starting folate levels. Decrease in the plasma homocysteine concentrations was observed only in the highest tertile of both groups but not in the group means.

CONCLUSIONS

Endogenous folates incorporated into a healthy diet, even in moderate amounts, is an efficient way to improve folate status among healthy adults. Folates from different rye products and orange juice showed good bioavailability that was similar to folic acid from fortified white bread.

Vitamin D receptor gene BsmI-polymorphism in Finnish premenopausal and postmenopausal women: its association with bone mineral density, markers of bone turnover, and intestinal calcium absorption, with adjustment for lifestyle factors

Bone mineral density (BMD) is regulated by genetic and environmental factors. Sixty percent to 80% of bone mass is suggested to be under polygenetic control, but the role of individual genes seems to be modest. Several studies have indicated that the vitamin D receptor ( VDR) gene has a role in the regulation of BMD and bone metabolism, but the results are very controversial. We studied the associations between BsmI-polymorphism of the VDR gene and BMD and bone metabolism in 24 premenopausal (aged 22-45 years) and 69 postmenopausal (aged 48-65 years) Finnish women. The BMD of the lumbar spine and femoral neck and bone turnover markers were measured, and the intestinal calcium absorption was investigated, using a method based on the absorption of non-radioactive strontium. The genotype distribution was 16%, BB; 34.5%, Bb; and 49.5%, bb, which differs from the genotype distribution found in other Caucasian populations, but is similar to earlier Finnish reports. The winter value of 25-hydroxyvitamin-D (25-OH-D) was highest for the BB genotype in both age groups (analysis of covariance [ANCOVA]; premenopausal women P = 0.5, postmenopausal women P = 0.03, and for the groups combined P = 0.02). Lumbar spine BMD and intestinal strontium absorption were highest for the BB genotype in both age groups, but these results were nonsignificant. The markers of bone metabolism did not differ significantly between the VDR genotypes. The BB genotype had the best vitamin D status, which could explain the differences in calcium absorption between the genotypes. However, the conclusions of our study are limited because of the small number of subjects.

Vitamin D deficiency: a concern in premenopausal Bangladeshi women of two socio-economic groups in rural and urban region

OBJECTIVE

The study was designed to evaluate the vitamin D status in women of different physiological status of two socio-economic groups in Bangladesh.

DESIGN

A cross-sectional study, using serum 25-hydroxyvitamin D (25-OHD), calcium, phosphorus and alkaline phosphatase activity.

SETTING

Two regions of Bangladesh. The Dhaka city area and west region of Nandail (Betagair Union), Mymensingh.

SUBJECTS

Representative subjects of two groups (low socio-economic group=group L, n=99; and high socio-economic group=group H, n=90) of Bangladeshi women aged 16-40 y. About 87% of the subjects were housewives and the rest, 13%, were distributed among other different professions. Each group comprised of three sub-groups (non-pregnant non-lactating=1, pregnant=2, and lactating=3).

RESULTS

The influence of socio-economic status and physiological status on serum 25-OHD concentration (P=0.038, P=0.015, respectively), serum calcium concentration (P<0.001, P<0.001, respectively) and alkaline phosphatase activity (P<0.001, P<0.001, respectively) were observed. The distribution of serum 25-OHD concentration in both groups was shifted overall toward the lower limit of the normal range. Seventeen percent of women in group L and 12% of women in group H had serum 25-OHD concentration <25 nmol/l. Hypovitaminosis D (serum 25-OHD concentration < or = 37.5 nmol/l) was observed in 50% of subjects in group L and 38% of subjects in group H, respectively. The prevalence of hypovitaminosis was higher in lactating subjects of the groups L and H (63 and 46%, respectively) than in the other sub-groups in the same group.

CONCLUSIONS

The results of the study suggested that women in Bangladesh were at risk of hypovitaminosis D and lactation was an additional risk factor in low income groups. The situation may increase the risk of bone loss.

Novel non-TGF-β-binding splice variant of LTBP-4 in human cells and tissues provides means to decrease TGF-β deposition

Small latent TGF-β consists of latency associated peptide (LAP) bound to the 25 kDa TGF-β by noncovalent interactions. Small latent TGF-β is secreted from cells and deposited into the extracellular matrix as covalent complexes with its binding proteins, LTBPs. Four LTBPs have been molecularly cloned and their structures contain repetitive sequences. The 3rd 8-Cys repeats of LTBP-1, -3 and -4 are able to associate with small latent TGF-β. We analyzed by RT-PCR the expression of LTBPs 1-4 in a panel of cultured human cell lines including fibroblasts of different origin, endothelial cells and immortalized keratinocytes. LTBPs were expressed in an overlapping manner, but differences in their expression levels were detected. SV-40 transformed human embryonic lung fibroblasts contained less of the mRNAs for the LTBPs, suggesting that malignant transformation leads to decrease in LTBP expression. A novel alternatively spliced form of LTBP-4 lacking the 3rd 8-Cys repeat (LTBP-4Δ8-Cys3rd) was identified. LTBP-4Δ8-Cys3rd does not bind TGF-β and it was found to be expressed in the same tissues as the full length LTBP-4. The exon-intron structure of LTBP-4 around the 3rd 8-Cys repeat was similar to those of LTBP-2 and -3. LTBP-4Δ8-Cys3rd was produced by alternative splicing over two exons. In addition, HL-60 promyelocytic leukemia cells expressed a splice variant lacking only one exon of this region. The expression of the non-TGF-β-binding variant of LTBP-4 may be important for the regulation of TGF-β deposition in tissues. Since LTBPs are a part of the extracellular matrix microfibrils, the LTBP-4Δ8-Cys3rd protein may also be involved in various structural functions not related to TGF-β signaling.

Preliminary description of antigenic components characteristic of Stachybotrys chartarum

The objective of this study was to characterize preliminarily immunogenic components characteristic of Stachybotrys chartarum to be used later for the development of a detection method for the fungus in environmental samples. The procedure for S.chartarum extract preparation was first optimized related to the age of the culture, culture type, and growth medium, and the antigenic composition of S. chartarum cultured in two different media was then characterized by the sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting method. Cross-reactivity of S. chartarum antigenic components with 10 other fungal species was identified by the inhibition immunoblotting method. The 10-day-old S. chartarum culture extract cultured in malt extract broth revealed a wider selection of proteins and antigenic components than the 30-day-old culture extract or the culture medium extracts. When cultured in cellulose broth, S. chartarum produced a higher number of proteins and antigenic components than in malt extract broth. The most dominant immunogenic components of S. chartarum cultured in cellulose broth were those of 65, 50, 37, and 27 kDa. The components of 65 and 50 kDa proved to be the most characteristic of this fungus according to the inhibition immunoblotting analyses. Several of the S. chartarum components were identified as glycoproteins. Carbohydrate moieties of the S. chartarum components also possessed an antibody binding activity.

Bone mass and markers of bone and calcium metabolism in postmenopausal women treated with 1,25-dihydroxyvitamin D (Calcitriol) for four years

To evaluate the long-term effect of calcitriol treatment on bone mineral density (BMD) of the femoral neck and lumbar spine and the parameters of calcium and bone metabolism in elderly women, 55 healthy, postmenopausal women, all aged 66 years, were enrolled in the study. Eighteen started a 4-year supplementation with 0.5 microg of calcitriol daily and 37 served as controls. Calcium intake of all the subjects was adjusted to 800 mg daily. In 4 years femoral neck BMD increased by 3.0% in the calcitriol group, but decreased by 1.6% in the control group (P = 0.009). The respective changes in lumbar spine BMD were +2.3% and +0.9% (P = 0.067). Two years' treatment with calcitriol increased the intestinal absorption of strontium by 57% (P < 0.001), doubled the urinary excretion of calcium (P < 0. 001), and decreased the mean parathyroid hormone (PTH) level by 32% (P < 0.01). In the calcitriol group the marker of bone formation, serum osteocalcin, decreased by 27% (P < 0.01), and the marker of bone resorption, serum C-telopeptide of type I collagen (CTx), by 33% (P = 0.05) after 2 years. In two subjects the calcitriol dose had to be reduced because of hypercalciuria. We conclude that calcitriol treatment increases bone mass at the femoral neck and lumbar spine, the increases being maintained for up to 4 years. The gain in bone mass results from reduced bone turnover which is partly a consequence of the enhanced intestinal absorption of calcium and suppressed serum PTH levels.

Addition of inulin to breakfast does not acutely affect serum ionized calcium and parathyroid hormone concentrations

BACKGROUND/AIMS

The aim of the present study was to investigate the effects of inulin on calcium metabolism. The study consisted of two separate parts both of which had a randomized two-period cross-over design.

METHODS

Fifteen young healthy women volunteered to participate in this study. During the first part of the study, cheese containing 210 mg of calcium, either with 15 g of inulin or without any inulin, was ingested at breakfast, and in the second part, 210 mg of calcium as a supplement, either with 15 g inulin or without inulin, was ingested. The whole day's diet was standardized. Before breakfast, and 2, 4, 6 and 8 h after breakfast, a blood sample was taken, and intact parathyroid hormone (iPTH), ionized calcium (iCa) and total calcium were measured. Urine was collected throughout the day, and the 8-, 12- and 24-hour calcium excretion was calculated.

RESULTS

The iPTH or iCa concentration curves (AUCs) did not differ over 8 h, whether or not inulin was consumed at breakfast. The postload urinary calcium excretion was not affected by the inulin.

CONCLUSION

Fifteen grams of inulin in fresh cheese or with a calcium supplement (210 mg Ca) taken at breakfast does not acutely affect the markers of calcium metabolism as opposed to a corresponding breakfast without inulin.

Vitamin D intake is low and hypovitaminosis D common in healthy 9- to 15-year-old Finnish girls

OBJECTIVES

To study the prevalence of hypovitaminosis D, the effect of vitamin D supplementation on serum 25-hydroxyvitamin D [S-25(OH)D], and the intakes of vitamin D and calcium in Finnish 9- to 15-year-old athletic and nonathletic girls.

DESIGN

1-year follow-up study (February 1997-March 1998) with three months of vitamin D supplementation (10 microg/d) from October to January.

SETTING

Turku University Central Hospital, Finland.

SUBJECTS

191 female volunteers aged 9-15 y (131 athletes and 60 controls).

METHODS

Vitamin D and calcium intakes were estimated by a four-day food recording and a semi-quantitative food frequency questionnaire (FFQ). S-25(OH)D was followed by radioimmunoassay (RIA).

RESULTS

At baseline the mean S-25(OH)D concentration was 33.9 nmol/l among all girls. In winter severe hypovitaminosis D (S-25(OH)D < 20 nmol/l) occurred in 13.4% of the participants and in 67.7% S-25(OH)D was below 37.5 nmol/l. By the next summer the mean S-25(OH)D concentration was 62.9 nmol/l and in 1.6% of the subjects it was below 37.5 nmol/l. The prevalence of severe hypovitaminosis D was not significantly reduced by three months of vitamin D (10 microg/d) supplementation. At baseline, the mean intake of vitamin D was 2.9 microg/d by food recording and 4.3 microg/d by FFQ. The mean calcium intake was 1256 mg/d and 1580 mg/d, respectively. The intakes of vitamin D and calcium remained unchanged during the follow-up period. The athletes consumed more calcium than nonathletic controls, whereas the intake of vitamin D was quite similar among both groups. The vitamin D intake by FFQ correlated with the S-25(OH)D concentration in wintertime (r = 0.28, P < 0.01).

CONCLUSION

Hypovitaminosis D is fairly common in growing Finnish girls in the wintertime, and three months of vitamin D supplementation with 10 microg/d was insufficient in preventing hypovitaminosis D. The daily dietary vitamin D intake was insufficient (< 5 microg/d) in the majority of participants, while the calcium intake was usually sufficient.

Bone recovery after a gluten-free diet: a 5-year follow-up study

The purpose of our study was to investigate the recovery of bone disease in celiac patients during 5 years of a gluten-free diet. The study group consisted of 28 newly diagnosed celiac patients (9 men, 19 women) recruited between 1990 and 1991. Six patients withdrew from the 5-year follow-up. Compliance with the gluten-free diet was good: 96% at 1 year and 82% at 5 years. During the follow-up period, the body mass index increased significantly (8%). Both in men and women, bone mineral density (BMD) values determined by dual X-ray absorptiometry (DXA) increased at the lumbar spine (2%), the femoral neck (1%), the trochanter (6%), and the Wards' area (3%) during the follow-up. The increase in BMD was found already during the first year of follow-up. After 1 year, BMD increased or remained the same in 69% of the patients at the lumbar spine and in 67% of the patients at the femoral neck, 89% of patients at the throchanter, and 67% of patients at the Wards' area. During the 5-year follow-up, these figures were 52%, 46%, 68%, and 59%, respectively. At the baseline, 19 out of 28 patients, after 1 year, 14 out of 26 patients, and after 5 years, 2 out of 26 patients had low serum 25(OH)D vitamin values (p = 0.0001). A high serum parathormone value was noticed in 6 out of 25 patients at the baseline, but after 1 year, 5 of them showed normalized values (p = 0.03). According to our results, bone disease in celiac patients is cured in most patients during 5 years on a gluten-free diet. The improvement in BMD mostly occurred already within the first year after the establishment of a gluten-free diet.

Endothelial receptor tyrosine kinases activate the STAT signaling pathway: mutant Tie-2 causing venous malformations signals a distinct STAT activation response

Endothelial receptor tyrosine kinases (RTKs) and their signaling mechanisms are of interest because they may control tumor angiogenesis and thereby tumor growth. In this report we have examined activation of the signal transducers and activators of transcription (STATs) by the three known vascular endothelial growth factor receptors (VEGFR1-3), as well as by the endothelial Tie-1 and -2 receptors. We also studied signaling by the R849W mutant of Tie-2 (MTie-2), which has been shown to cause venous malformations. When overexpressed in 293T cells, MTie-2 activated STAT1 while the other endothelial RTKs failed to do so. In contrast, the three VEGFRs were strong activators of STAT3 and STAT5, suggesting that they activate only a specific subset of these signal transducers. STAT3 and STAT5 were also activated by Tie-2 and, more so, by MTie-2. Tyrosine phosphorylation and DNA binding of STATs correlated with their ability to activate transcription as judged by luciferase assays. When co-expressed with STAT5, VEGFR-1 as well as both the Tie-2 receptor forms increased expression of the cell cycle inhibitor p21. Interestingly, co-expression of the Tie-2 receptors with STAT1 resulted in appearance of a novel, p21 related transcript. Taken together, these findings identify STAT proteins as novel targets for signal transduction by the endothelial RTKs, suggesting that they may be involved in the regulation of endothelial function.

Evaluation of the variably ossified collateral cartilages of the distal phalanx and adjacent anatomic structures in the Finnhorse with computed tomography and magnetic resonance imaging

Six Finnhorse cadaver forefeet were selected to represent radiographically different types and grades of ossification of the collateral cartilages of the distal phalanx. These cartilages and adjacent tissues were evaluated with computed tomography (CT) and high field magnetic resonance imaging (MRI). In CT the internal structure of the cartilages was consistent, but in MRI some differences were noted. The shape of the collateral cartilages and their ligamentous attachments varied. The border between ossified and non-ossified cartilage appeared distinct, with considerable variation in the extent of the ossified area in regard to the cross-sectional area of the cartilage. Ossification originating from the palmar processes and extending in the proximal/palmaroproximal direction, without separate centers of ossification, generally appeared smooth and inactive. Palmar ossification followed the irregular shape of the cartilage. Separate centers of ossification had a medullary cavity or were sclerotic. Presence of a medullary cavity or sclerosis were also found at the base of the cartilages. The incomplete fusion lines between separate centres of ossification and the ossified base of the cartilage varied from congruent and inactive to reactive with marked sclerosis, flared margins and parachondral changes. Incomplete fusion may be clinically significant. Local conformational adaptations of the hoof were also documented with extensive ossification of the collateral cartilage.

An acute intake of phosphate increases parathyroid hormone secretion and inhibits bone formation in young women

We studied the effects of a single oral phosphate (Pi) dose as well as those of three consecutive oral phosphate doses on calcium and bone metabolism. In the first part of the study (P1 study) 10 female volunteers were given orally 1500 mg of Pi in water, as a single dose, or plain water in randomized order at two different sessions. In the second part of the study (P3 study), 10 female volunteers were given orally 1500 mg of Pi, as three separate 500 mg doses in water, or plain water in randomized order. Calcium and bone metabolism was monitored for 24 h by measuring the concentrations of serum ionized calcium (S-iCa), urinary calcium, serum phosphate (S-P), urinary P, serum intact parathyroid hormone (PTH), serum carboxy-terminal propeptide of type I collagen (PICP), serum osteocalcin (BGP), serum carboxy-terminal telopeptide of type I collagen (ICTP), urine deoxypyridinoline (DPD) and bone-specific alkaline phosphatase activity (B-ALP). The S-P increased (p = 0.00005 and p = 0.0005, in the P1 and P3 studies, respectively), the S-iCa concentration declined significantly only in the P1 study (p = 0.0014), the urinary calcium excretion decreased (p = 0.02 and 0.013, in the P1 and P3 studies, respectively), and the PTH concentration rose (p = 0.0083 and p = 0.014, in the P1 and P3 studies, respectively) during the phosphate experiment as compared with the control session. Of the three markers of bone formation studied, PICP declined in the P1 study (p = 0.04), and B-ALP declined in both parts of the study (p = 0.027, p = 0.026, in the P1 and P3 studies, respectively) after phosphate administration, whereas there was no significant change in BGP in either of the studies. The markers of bone resorption, ICTP and DPD, were unaffected by the phosphate load in both studies. In conclusion, acute ingestion of phosphate leads to an increase in S-P, a decrease in S-iCa, and an increase in intact PTH secretion. Our results indicate that these events may lead to an acute inactivation of the early phases of bone formation. In this setting, there was no indication of enhanced bone resorption despite the increase in PTH secretion, which could be due to the combined effect of phosphate and PTH on bone resorption.

Dietary calcium intake and its relation to bone mineral density in patients with inflammatory bowel disease

OBJECTIVES

To investigate calcium intake and its association with bone mineral density (BMD) and the type and extent of the disease in patients with inflammatory bowel disease (IBD).

SETTING

University hospital clinic.

SUBJECTS

A total of 152 unselected IBD patients and 73 healthy controls.

MEASUREMENTS

Dietary calcium intake was assessed with a food frequency questionnaire and BMD of the lumbar spina and proximal femur was measured.

RESULTS

The IBD patients had lower dietary calcium intake (1034 [SD 493] mg) than the controls (1334 [514] mg, P < 0.001). The difference was significant in the males (1047 [552] mg and 1575 [586] mg, respectively, P < 0.001), but not in the females (1020 [422] mg and 1112 [303] mg). The dietary daily calcium intake was below 1000 mg in 53% of the patients and 27% of the controls (P = 0.0004) and below 400 mg in 9.2% of the patients and none of the controls (P = 0.007). The calcium intake was not associated with the severity or the type of IBD. Seventy-one (47%) patients and eight (11%) controls avoided lactose in their diet (P < 0.001). In the IBD patients, no association between the calcium intake and BMD was detected, whereas in the controls a positive correlation between the calcium intake and the BMD of the proximal femur was found.

CONCLUSIONS

Calcium intakes below the recommendations are seen more often in the IBD patients than in the healthy controls, but in the IBD patients the calcium intake is not associated with BMD in a cross-sectional study. A low-lactose diet is common among IBD patients. To reduce the risk of inadequate calcium intake, unnecessary dietary restrictions concerning, e.g. milk products, should be avoided for these patients.

Common polymorphism of the vitamin D receptor gene is associated with variation of peak bone mass in young finns

Previous studies suggested a relation between polymorphism of the vitamin D receptor (VDR) gene and bone mineral density (BMD) at perimenopausal age. To enlighten the possible association of the VDR gene polymorphism and BMD, we studied young (20-29 years) adults whose BMD provides a measure of their maximal bone mass. After sequencing the DNA regions flanking the polymorphic BsmI site, we set up a specific solid-phase minisequencing technique to assay this allelic variation. BMD values were adjusted for age, sex, weight, physical activity, smoking, and calcium intake. Young subjects homozygous for the b allele (BsmI site present) had a significantly higher BMD in lumbar spine and femoral neck than those homozygous for the B allele (BsmI site absent). This data shows that the BsmI polymorphism of the VDR gene is associated with peak bone mass. The implication of this result regarding the prevention of osteoporosis deserves further attention.

Lower limb amputees in Southern Finland

The purpose of this study was to look at the current epidemiological trends of lower limb amputees in 1992 in the area of Southern Finland with 1.2 million inhabitants. Similar data was collected earlier in 1984-85 and 1989. The amputation incidence was found to be 27.4 per 100,000 inhabitants. The trans-tibial/trans-femoral ratio was 0.78. The percentage of prosthetic fitting among patients undergoing unilateral trans-tibial amputation was 68% and the corresponding figure among the trans-femoral patients was 35%. The epidemiological data showed an improvement on that found 8 years earlier although the overall age structure is shifting upwards.

Exercise, smoking, and calcium intake during adolescence and early adulthood as determinants of peak bone mass. Cardiovascular Risk in Young Finns Study Group

OBJECTIVE

To evaluate the contribution to peak bone mass of exercise, smoking, and calcium intake in adolescents and young adults.

DESIGN

Prospective cohort study with end point measurement (bone mineral density) after 11 years' follow up for lifestyle.

SETTING

Five university hospital clinics.

SUBJECTS

264 (153 females, 111 males) subjects aged 9 to 18 years at the beginning of the follow up and 20 to 29 years at the time of measurement of bone mineral density.

MAIN OUTCOME MEASURE

Bone mineral density of lumbar spine and femoral neck by dual energy x ray absorptiometry; measures of physical activity and smoking and estimates of calcium intake repeated three times during follow up.

RESULTS

In the groups with the lowest and highest levels of exercise the femoral bone mineral densities (adjusted for age and weight) were 0.918 and 0.988 g/cm2 for women (P = 0.015, analysis of covariance) and 0.943 and 1.042 g/cm2 for men (P = 0.005), respectively; at the lumbar spine the respective values were 1.045 and 1.131 (P = 0.005) for men. In men the femoral bone mineral densities (adjusted for age, weight, and exercise) were 1.022 and 0.923 g/cm2 for the groups with the lowest and highest values of smoking index (P = 0.054, analysis of covariance). In women the adjusted femoral bone mineral density increased by 4.7% together with increasing calcium intake (P = 0.089, analysis of covariance). In multiple regression analysis on bone mineral density of the femoral neck, weight, exercise, age, and smoking were independent predictors for men; with weight, exercise, and age for women. These predictors together explained 38% of the variance in bone mineral density in women and 46% in men. At the lumbar spine, weight, smoking, and exercise were predictors for men; and only weight for women.

CONCLUSIONS

Regular exercise and not smoking is important in achieving maximal peak bone mass in adolescents and young adults.

Bone mineral density measured by dual-energy x-ray absorptiometry and novel markers of bone formation and resorption in patients on antiepileptic drugs

In patients on antiepileptic drugs, bone loss has been mainly demonstrated at radial sites using old technology and has been ascribed to drug-induced vitamin D deficiency rather than to any direct effects of the treatment on bone cells. We examined 38 epileptic patients (24 women and 14 men) aged 20-49 years who were using either carbamazepine or phenytoin or both. Bone mineral density (BMD) at the lumbar spine and three femoral sites was measured by dual-energy x-ray absorptiometry (DXA) and serum and urine markers of bone and mineral metabolism were determined. The latter included the C-terminal extension peptide of type I procollagen (PICP), a putative serum marker of bone formation, and the cross-linked carboxyl-terminal telopeptide of human type I collagen (ICTP), a novel serum marker of bone matrix degradation. In female patients on phenytoin, weight- and height-adjusted BMD was reduced at the femoral neck and the Ward's triangle (p < 0.05) but was at the control level in the other patient groups at all four measurement sites. Compared with controls, the serum concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were reduced by 26% (p < 0.01) and by 27% (p < 0.001) in female patients. These changes were independent of the therapy used. They were not present in male patients. For both genders the serum levels of vitamin D binding protein were normal. Both female and male patients had hypocalcemia, but women only showed hypocalciuria.(ABSTRACT TRUNCATED AT 250 WORDS)

Low serum 25-hydroxyvitamin D concentrations and secondary hyperparathyroidism in middle-aged white strict vegetarians

The vitamin D status of vegetarians was studied in the winter. The groups studied were strict vegetarians (G1), lactovegetarians (G2), lactoovovegetarians eating some fish (G3), and vegetarians who were taking vitamin D supplements or who had been exposed to abundant sunlight during the last 6 mo (G4). A group of healthy women served as control subjects (C). The serum 25-hydroxyvitamin D [25(OH)D] concentration was significantly lower, the serum intact parathyroid hormone (S-iPTH) concentration significantly higher, and the dietary vitamin D intake significantly lower in G1 than in C. S-iPTH correlated negatively with serum 25(OH)D and dietary calcium intake. In conclusion, white strict vegetarians are at risk of vitamin D deficiency, at least in the winter, primarily because of a low dietary vitamin D intake, despite a normal sunlight exposure in summer. Low serum 25(OH)D concentrations are accompanied by high S-iPTH concentrations, which also are affected by a low calcium intake. The effect of these changes on bone health remains to be evaluated.

Is alcohol an osteoporosis-inducing agent for young and middle-aged women?

The effects of alcohol abuse on the bone of women have scarcely been investigated, although women are more prone than men to osteoporosis. We studied 19 noncirrhotic female alcoholics (aged 24 to 48 years) hospitalized for 2 weeks for withdrawal and three groups of control women (n = 182). Sixteen patients and all control subjects had regular menstrual cycles. Forearm bone mineral content (BMC) and axial bone mineral density (BMD) were measured by single-photon absorptiometry and dual-energy x-ray absorptiometry, respectively. Parameters of bone metabolism were analyzed at the beginning and end of the withdrawal period. BMC and BMD did not differ between patients and controls at any of the five measurement sites. On admission, bone formation of the alcoholics was depressed as reflected by osteocalcin levels (-48%, P < .01); it normalized during abstention (P < .01). Urinary hydroxyproline, a parameter of bone resorption, and serum intact parathyroid hormone were at the control level throughout the observation period. Serum ionized calcium level increased by 4% (P < .0001), and serum free fatty acid (FFA) levels decreased by 30% (P < .05) during withdrawal; there was an inverse correlation between changes in these two parameters (r = -.49, P < .05). On admission, serum concentrations of 25-hydroxyvitamin D3 [25-OH-D3] and 1,25-dihydroxyvitamin D3 [1,25-(OH)2-D3] were reduced by 46% (P < .001) and 16% (P = .16); these did not normalize during abstention. In conclusion, provided that liver cirrhosis and gonadal dysfunction are not contributing, even heavy drinking does not seem to decrease bone mass in young and middle-aged women.(ABSTRACT TRUNCATED AT 250 WORDS)

[The "hyena disease" of cattle in Finland]

The first occurrence of "Hyena disease" in cattle in Finland is described. The affected beef bulls consumed very high doses of vitamins A, D and E. Some of them developed to "Hyena" bulls and some to "Hyena/dwarf"-bulls. The radiological signs in the skeleton were similar to those which can occur in connection with vitamin A and D overdoses.

Prosthetic use and functional and social outcome following major lower limb amputation

A total of 175 consecutive below and above-knee amputees sent to the prosthetic workshop in Helsinki for prosthetic fitting from 32 hospitals were reviewed to determine their functional ambulation and social adaptation. The average age of the patients was 62.2 years at the time of the prosthetic fitting. The mortality was 11% (19) during the first postoperative year. One-year postoperative information was obtained for 141 of the surviving patients (90%) by personal contact. At the time of the review, 68% of the amputees (96 patients) who had been fitted with a prosthesis made extensive and regular use of it. Half of all the above-knee amputees and 79% of the below-knee amputees used their prosthesis throughout the day or over seven hours a day. A total of 72% of the above-knee amputees (33/46) and 85% of the below-knee amputees (67/79) had useful ambulation, at least indoors. Of the 141 patients contacted, 124 (88%) lived in their own homes. The remaining 16 patients (11%) lived in apartment houses for the aged or old people's homes. A total of 48 amputees (34%) needed a regular home help.

Deranged vitamin D metabolism but normal bone mineral density in Finnish noncirrhotic male alcoholics

To study the effect of prolonged ethanol consumption on calcium metabolism and on the prevalence of osteoporosis we examined 38 Finnish noncirrhotic male alcoholics (30-55 years of age) with dietary interviews and biochemical measurements and by measuring the bone mineral content of the forearm using single photon absorptiometry (SPA) and the bone mineral density of the spine, humerus and proximal femur using nonquantified computer tomography (CT) and dual-energy x-ray absorptiometry (DEXA). In comparison two groups of healthy controls were studied. The mean daily dietary intake of calcium was 1.3 g in the patients and 1.2 g in the controls. The dietary intake of vitamin D was equal in the study groups, too. The serum levels of calcium, phosphate and parathyroid hormone did not show any difference between the patients and controls but in the alcoholics the urinary excretion of calcium was reduced by 42% (p less than 0.0001) as compared to the controls. The serum levels of 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3, and 24,25-dihydroxyvitamin D3 were reduced in the alcoholics by 40% (p less than 0.0001), 23% (p less than 0.01), and 48% (p less than 0.0001), respectively, as compared to the controls. The alcoholic men had normal levels of serum testosterone and they did not have hypercortisolism. The bone mineral content of the dominant forearm measured by SPA was similar in the study groups as were the bone mineral densities (BMD) of the lumbar and humeral areas measured by CT. The BMD at the lumbar, femoral neck, Ward's triangle and trochanter sites measured by DEXA did not differ, either.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluating the accuracy of canine pregnancy diagnosis and litter size using real-time ultrasound

A total of 135 bitches suspected of being pregnant were examined with a real-time ultrasound equipment. 58 bitches were not pregnant. In pregnancy diagnosis ultrasound produced an overall accuracy of 99.3%, sensitivity 98.7%, and specificity 100.0%. Estimation of the litter size was fairly reliable in small litters of 1–3 puppies.

Osteochondrotic changes in the vertebrae of four ataxic horses suffering from cervical vertebral malformation

Ataxia caused by a focal compression of the cervical spinal cord was diagnosed in four young standardbred trotting horses. Diagnosis was verified by myelography. Changes in the cervical vertebral column were studied using microradiographic and histologic methods. In the vertebrae involved, there was irregularity of the cartilaginous growth zone, cracks with a loose fragment and disturbance in the enchondral ossification. These changes resemble osteochondrosis. Porous appearance in lateral and ventral funiculi as well as mural calcified plaques in the small vessels of the white matter were found in the spinal cord.

Transplantable hamster tumors induced with the BK virus

Two tumors induced by BK virus in hamsters of an inbred strain were serially transplanted by subcutaneous injection of tumor explants. Both the original tumors as well as the transplants grew as solid, localized, encapsulated tumors. Histologically tumors were classified as fusocellular fibrosarcomas. Polymorphic tumor tissue was by an abundance of collagen fibers and multinucleated giant cells. Cell lines established from tumors contained nuclear T antigen which stained with sera from a number of tumor-carrying hamsters, but also with SV40 T antiserum. Viron antigens were not detected in these cell lines, and no virus was isolated when tumor extracts were inoculated in Vero cells.