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Carugo S, Vescini F, Giusti A, Mauro GL, Tafaro L, Festuccia F, Muraca L, Menè P, Rossini M. The essential role of combined calcium and vitamin D supplementation in the osteoporosis scenario in italy: Expert opinion paper. Arch Osteoporos 2024; 19:99. [PMID: 39438361 PMCID: PMC11496317 DOI: 10.1007/s11657-024-01451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 09/23/2024] [Indexed: 10/25/2024]
Abstract
An Italian multidisciplinary working group discussed the current Italian scenario of osteoporosis management during a meeting and highlighted the essential role of calcium and vitamin D supplementation in the prevention of fragility fractures. PURPOSE This paper aims to review and discuss data on calcium and vitamin D requirements and the role of combined calcium and vitamin D supplementation in the treatment of patients with osteoporosis. METHODS The discussion of the experts covered literature data on calcium and vitamin D supplementation, gaps in the diagnosis and treatment of osteoporosis, and the role of the primary care physician in identifying and treating patients with osteoporosis. Articles for consideration were identified through PubMed searches using different combinations of pertinent keywords. RESULTS The discussion highlighted that insufficient calcium or vitamin D intake increases the risk of fragility fractures. The experts also drew attention to the essential role of calcium and vitamin D supplementation in achieving an anti-fracture effect and supporting the efficacy of anti-osteoporotic agents without increasing nephrolithiasis and cardiovascular risks. In addition, the discussion underlined the role of the primary care physician in the initial clinical approach to patients with osteoporosis. CONCLUSIONS The experts believe that efficient treatment for patients with osteoporosis should include calcium and vitamin D supplementation to achieve adequate levels that are able to inhibit the parathyroid hormone and bone resorption.
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Affiliation(s)
- Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Vescini
- Endocrinology Unit University Hospital of Udine, Udine, Italy
| | - Andrea Giusti
- Division of Internal Medicine, Department of Medicine & Cardiology, "Villa Scassi" Hospital, Genoa, Italy, ASL3, 16132, Genoa, Italy
| | - Giulia Letizia Mauro
- Department of Precision Medicine in the Medical, Surgical and Critical Care Area (Me.Pre.C.C.), University of Palermo, 90127, Palermo, Italy
| | - Laura Tafaro
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | | | - Lucia Muraca
- Department of Primary Care, ASP Catanzaro, 88100, Catanzaro, Italy
| | - Paolo Menè
- Division of Nephrology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Rossini
- Department of Medicine, Rheumatology Unit, University of Verona, Verona, Italy.
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Telli H, Özdemir Ç. Is nociplastic pain, a new pain category, associated with biochemical, hematological, and inflammatory parameters? Curr Med Res Opin 2024; 40:469-481. [PMID: 38204412 DOI: 10.1080/03007995.2024.2304106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/08/2024] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The aim of the study was to evaluate the relationship between biochemical, hematological, and inflammatory parameters and pain in patients with nociplastic pain. METHODS In this cross-sectional study, a total of 8632 patients, aged between 20 and 65, were evaluated according to the nociplastic pain diagnosis criteria determined by IASP. Excluding individuals who did not meet the criteria for nociplastic pain, the study included a total of 660 participants. The biochemical, hematological, and inflammatory parameters of all individuals were examined. The pain levels of the patients were assessed using the Visual Analogue Scale (VAS). The patients were categorized based on nociplastic pain types and pain regions for evaluation. RESULTS In this study, the female gender was more prevalent both in all nociplastic pain categories and in all pain region groups (p < 0.05). In the nociplastic pain categories, it was observed that vitamin D levels were lower in patients with chronic widespread pain, while ferritin and C-reactive protein levels were higher in patients with chronic primary musculoskeletal pain. Among patients with chronic widespread pain with low hemoglobin and/or ferritin levels, the Visual Analog Scale activity score was higher. For patients with chronic widespread pain and low vitamin D levels and/or high erythrocyte sedimentation rate levels, the Visual Analog Scale rest score was higher. In patients with fibromyalgia and high parathyroid hormone levels, the Visual Analog Scale activity score was higher. For patients with fibromyalgia and high Neutrophil/Lymphocyte ratio levels, the Visual Analog Scale rest score was higher. In patients with chronic primary musculoskeletal pain and high erythrocyte sedimentation rate and/or C-reactive protein levels, the Visual Analog Scale activity score was higher. While vitamin B12 levels were found to be lower in patients with widespread pain, no significant relationship was identified between electrolytes, other blood count results, and nociplastic pain. CONCLUSION In our study, it was observed that levels of vitamin D in individuals with nociplastic pain were low, while erythrocyte sedimentation rate, C-reactive protein, and Neutrophil/Lymphocyte ratio were high, and hemoglobin and ferritin levels were elevated. Furthermore, these findings were found to be associated with both the presence of pain and the severity of pain assessed using the visual analog scale.
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Affiliation(s)
- Hilal Telli
- Evliya Çelebi Training and Research Hospital, Physical Therapy and Rehabilitation Clinic, Kütahya Health Sciences University, Kütahya, Turkey
| | - Çağla Özdemir
- Evliya Çelebi Training and Research Hospital, Family Medicine Clinic, Kütahya Health Sciences University, Kütahya, Turkey
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Ye YW, Lu K, Yin Y, Yang XF, Xu SM, Xu MZ, Shi Q, Gong YQ. Association between serum 25-hydroxyvitamin D and fasting blood glucose in osteoporosis patients. Sci Rep 2023; 13:18812. [PMID: 37914715 PMCID: PMC10620140 DOI: 10.1038/s41598-023-45504-6] [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: 03/17/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023] Open
Abstract
Osteoporosis (OP) is often associated with other complications, such as impaired glucose homeostasis. Vitamin D deficiency is common and has been linked to bone metabolism and the regulation of blood sugar levels. The aim of this study was to evaluate the independent relationship between serum 25-hydroxyvitamin D (25[OH]D) and fasting blood glucose levels (FBG) in a group of patients diagnosed with OP. This is a retrospective cross-sectional study from a prospectively collected database at our tertiary referral center. Consecutive 2084 OP patients who were hospitalization were finally analyzed in this study. FBG is the dependent variable, serum 25(OH)D level of OP patients is exposure variable of this study. There was a linear significantly negative association between serum 25(OH)D and FBG (β, - 0.02; 95% CI - 0.03 to - 0.01; P = 0.0011) in the fully adjusted models. Specifically, when serum 25(OH)D level was less than 23.39 ng/mL, FBG decreased by 0.04 mmol/L for every 1 ng/mL increase of serum 25(OH)D level. When serum 25(OH)D was greater than 23.39 ng/ mL, the negative association was insignificant (P = 0.9616). If the association is confirmed, the clinical management of blood glucose in OP patients with serum 25(OH)D deficiency has instructive implications.
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Affiliation(s)
- Yao-Wei Ye
- Department of Orthopedics, The First People's Hospital of Kunshan, Gusu School, Nanjing Medical University, Suzhou, 215300, Jiangsu, China
| | - Ke Lu
- Department of Orthopedics, The First People's Hospital of Kunshan, Gusu School, Nanjing Medical University, Suzhou, 215300, Jiangsu, China
| | - Yi Yin
- Department of Orthopedics, The First People's Hospital of Kunshan, Gusu School, Nanjing Medical University, Suzhou, 215300, Jiangsu, China.
| | - Xu-Feng Yang
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, 215300, Jiangsu, China
| | - Si-Ming Xu
- Department of Orthopedics, The First People's Hospital of Kunshan, Gusu School, Nanjing Medical University, Suzhou, 215300, Jiangsu, China
| | - Min-Zhe Xu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, 215300, Jiangsu, China
| | - Qin Shi
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute of Soochow University, Suzhou, 215031, Jiangsu, China
| | - Ya-Qin Gong
- Information Department, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, 215300, Jiangsu, China
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Lecomte M, Tomassi D, Rizzoli R, Tenon M, Berton T, Harney S, Fança-Berthon P. Effect of a Hop Extract Standardized in 8-Prenylnaringenin on Bone Health and Gut Microbiome in Postmenopausal Women with Osteopenia: A One-Year Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients 2023; 15:2688. [PMID: 37375599 DOI: 10.3390/nu15122688] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Estrogen deficiency increases the risk of osteoporosis and fracture. The aim of this study was to investigate whether a hop extract standardized in 8-prenylnaringenin (8-PN), a potent phytoestrogen, could improve bone status of osteopenic women and to explore the gut microbiome roles in this effect. In this double-blind, placebo-controlled, randomized trial, 100 postmenopausal, osteopenic women were supplemented with calcium and vitamin D3 (CaD) tablets and either a hop extract (HE) standardized in 8-PN (n = 50) or a placebo (n = 50) for 48 weeks. Bone mineral density (BMD) and bone metabolism were assessed by DXA measurements and plasma bone biomarkers, respectively. Participant's quality of life (SF-36), gut microbiome composition, and short-chain fatty acid (SCFA) levels were also investigated. In addition to the CaD supplements, 48 weeks of HE supplementation increased total body BMD (1.8 ± 0.4% vs. baseline, p < 0.0001; 1.0 ± 0.6% vs. placebo, p = 0.08), with a higher proportion of women experiencing an increase ≥1% compared to placebo (odds ratio: 2.41 ± 1.07, p < 0.05). An increase in the SF-36 physical functioning score was observed with HE versus placebo (p = 0.05). Gut microbiome α-diversity and SCFA levels did not differ between groups. However, a higher abundance of genera Turicibacter and Shigella was observed in the HE group; both genera have been previously identified as associated with total body BMD. These results suggest that an 8-PN standardized hop extract could beneficially impact bone health of postmenopausal women with osteopenia.
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Affiliation(s)
| | | | - René Rizzoli
- Service of Bone Disease, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva, Switzerland
| | | | | | - Sinead Harney
- Rheumatology Department, Cork University Hospital, T12 DFK4 Cork, Ireland
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Jeong C, Ha J, Yoo JI, Lee YK, Kim JH, Ha YC, Min YK, Byun DW, Baek KH, Chung HY. Effects of Bazedoxifene/Vitamin D Combination Therapy on Serum Vitamin D Levels and Bone Turnover Markers in Postmenopausal Women with Osteopenia: A Randomized Controlled Trial. J Bone Metab 2023; 30:189-199. [PMID: 37449351 PMCID: PMC10345998 DOI: 10.11005/jbm.2023.30.2.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of bazedoxifene/vitamin D combination therapy in preventing osteoporosis in postmenopausal women with osteopenia. METHODS This was an open-label, multicenter randomized-controlled, phase 4 clinical trial. Women between ages of 55 and 70 years in 9 medical tertiary centers in Korea were enrolled and assigned into 2 groups: an experiment group and a control group. The experimental group received bazedoxifene 20 mg/vitamin D 800 IU tablets for 6 months, and the control group received calcium 100 mg/vitamin D 1,000 IU tablets for 6 months. RESULTS A total of 142 patients (70 in the experimental group and 72 in the control group) were included. The least-square mean±standard error of change in propeptide of type I collagen after 3 months was -6.87±2.56% in the experimental group and 1.22±2.54% in the control group. After 6 months, it was -21.07±2.75% in the experimental group and 1.26±2.71% in the control group. The difference between the 2 groups was -22.33% (p<0.01). The change of C-terminal telopeptide was -12.55±4.05% in the experimental group and 11.02±4.03% in the control group after 3 months. It was -22.0±3.95% and 10.20±3.89, respectively, after 6 months. The difference between the 2 groups was -32.21% (p<0.01) after 6 months. There was no significant difference in adverse events between the 2 groups. CONCLUSIONS The osteoporosis preventive effect and safety of administering bazedoxifene/vitamin D combination pill were confirmed in postmenopausal women who needed osteoporosis prevention.
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Affiliation(s)
- Chaiho Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon,
Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Jung Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul,
Korea
| | - Yong-Ki Min
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Dong-Won Byun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul,
Korea
| | - Ki-Hyun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Ho Yeon Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul,
Korea
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HILKENS LUUK, VAN SCHIJNDEL NICK, WEIJER VERA, BOERBOOM MARLEEN, VAN DER BURG ESTHER, PETERS VELIBOR, KEMPERS ROBERT, BONS JUDITH, VAN LOON LUCJC, VAN DIJK JANWILLEM. Low Bone Mineral Density and Associated Risk Factors in Elite Cyclists at Different Stages of a Professional Cycling Career. Med Sci Sports Exerc 2023; 55:957-965. [PMID: 36595659 PMCID: PMC10090358 DOI: 10.1249/mss.0000000000003113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE This study aimed to assess the prevalence of low bone mineral density (BMD) in male and female elite cyclists at different stages of a professional cycling career and to identify potential risk factors of low BMD. METHODS In this cross-sectional study, 93 male and female early career, advanced career, and postcareer elite cyclists completed dual-energy x-ray absorptiometry at the hip, femoral neck, lumbar spine, and total body; blood sampling; assessment of training history and injuries; and the bone-specific physical activity questionnaire. Backward stepwise multiple regression analyses were conducted to explore associations between BMD and its potential predictors in early and advanced career (i.e., active career) cyclists. RESULTS With a mean Z -score of -0.3 ± 0.8, -1.5 ± 1.0, and -1.0 ± 0.9, low BMD ( Z -score < -1) at the lumbar spine was present in 27%, 64%, and 50% of the early, advanced, and postcareer elite male cyclists, respectively. Lumbar spine Z -scores of -0.9 ± 1.0, -1.0 ± 1.0, and 0.2 ± 1.4 in early, advanced, and postcareer elite female cyclists, respectively, indicated low BMD in 45%, 45%, and 20% of these female subpopulations. Regression analyses identified body mass index, fracture incidence, bone-specific physical activity, and triiodothyronine as the main factors associated with BMD. CONCLUSIONS Low BMD is highly prevalent in elite cyclists, especially in early career females and advanced career males and females. These low BMD values may not fully recover after the professional cycling career, given the substantial prevalence of low BMD in retired elite cyclists. Exploratory analyses indicated that low BMD is associated with low body mass index, fracture incidence, lack of bone-specific physical activity, and low energy availability in active career elite cyclists.
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Affiliation(s)
- LUUK HILKENS
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
- Department of Human Biology, NUTRIM, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - NICK VAN SCHIJNDEL
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
| | - VERA WEIJER
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
- Department of Human Biology, NUTRIM, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - MARLEEN BOERBOOM
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
| | - ESTHER VAN DER BURG
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
| | - VELIBOR PETERS
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
| | | | - JUDITH BONS
- Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - LUC J. C. VAN LOON
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
- Department of Human Biology, NUTRIM, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - JAN-WILLEM VAN DIJK
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
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Shin HR, Lee YJ, Ly SY. Optimal Serum 25(OH)D Levels and Vitamin D Intake in Korean Postmenopausal Women. Nutrients 2023; 15:nu15081856. [PMID: 37111073 PMCID: PMC10144100 DOI: 10.3390/nu15081856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Vitamin D plays a crucial role in regulating the growth and maintenance of the musculoskeletal system. Postmenopausal women are vulnerable to bone fractures because of the decrease in bone mineral density (BMD). Therefore, this study aimed to identify the determinants that influence BMD and the 25(OH)D levels in Korean postmenopausal women. This study collected general and dietary intake information, measured biochemical indices, and conducted BMD tests in 96 postmenopausal women residing in a metropolitan area in Korea. This study analyzed factors that influenced serum 25-hydroxyvitamin D (25(OH)D) and BMD, as well as the correlation between the intact parathyroid hormone (iPTH) and serum 25(OH)D levels. The serum 25(OH)D levels increased by 0.226 ng/mL in the summertime, 0.314 ng/mL in the wintertime, and 0.370 ng/mL on annual average when vitamin D intake rose by 1 µg/1000 kcal. When the serum 25(OH)D levels were ≥18.9 ng/mL, the iPTH levels did not rapidly increase. To maintain the serum 25(OH)D levels at ≥18.9 ng/mL, a daily vitamin D intake of ≥13.21 µg was required. Consequently, consuming vitamin D-fortified foods or vitamin D supplements is necessary to improve both bone health and vitamin D nutritional status.
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Affiliation(s)
- Hye Ran Shin
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Ye Jin Lee
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Sun Yung Ly
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Republic of Korea
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Foroni MZ, Cendoroglo MS, Sakane EN, Marin-Mio RV, Moreira PFDP, Maeda SS, Lazaretti-Castro M. Serum 25 hydroxyvitamin D concentrations in individuals over 80 years old and their correlations with musculoskeletal and health parameters. Endocrine 2023; 79:559-570. [PMID: 36305996 DOI: 10.1007/s12020-022-03231-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/09/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE The present study aims to evaluate the serum concentrations of 25 hydroxyvitamin D[25(OH)D] in individuals aged ≥80 years, independent, free-living in Sao Paulo, Brazil (Lat 23.5 oS), and to investigate their associations with musculoskeletal system, physical performance and health markers. METHOD This cross-sectional study included 212 community dwellers aged ≥80 years and evaluated serum 25(OH)D, PTH, calcium, albumin, phosphorus, creatinine, bone markers, and bone mineral density. Physical performance was evaluated with stationary march, Flamingo, and functional reach tests, questionnaires to assess falls and fractures in the previous year, energy expenditure (MET), and Charlson index. Physical activity was evaluated with the International Physical Activity Questionnaire. RESULTS Vitamin D deficiency (<20 ng/mL) was observed in 56% and severe vitamin D deficiency (<10 ng/mL) in 13% of those individuals. Serum concentrations of 25(OH)D were significantly and positively associated with BMD total hip (p = 0.001), femoral neck (p = 0.011) and 33% radius (p = 0.046) BMDs, MET (p = 0.03) and functional reach test (p = 0.037) and negatively with age (p = 0.021), PTH (p = 0.004) and osteoporosis diagnosis (p = 0.012). Long-lived individuals with 25(OH)D ≥ 20 ng/mL had higher total hip and femoral neck BMDs (p = 0.012 and p = 0.014, respectively) and lower PTH (p = 0.030). In multiple linear regression analysis, age and osteoporosis diagnosis remained negatively associated with 25(OH)D levels (p = 0.021 and p = 0.001, respectively), while corrected calcium and cholecalciferol use remained positively associated (p = 0.001 and p = 0.024, respectively). CONCLUSION We observed high vitamin D inadequacy prevalence in those Brazilian community dwellers' oldest old. Serum concentrations of 25(OH)D were positively associated with bone mass and dynamic balance, and negatively with PTH and osteoporosis diagnosis. Additionally, 25(OH)D ≥ 20 ng/mL was associated with better bone mass and lower PTH levels.
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Affiliation(s)
- Mariana Zuccolotto Foroni
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Maysa Seabra Cendoroglo
- Division of Geriatrics, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Eliane Naomi Sakane
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Rosangela Villa Marin-Mio
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Sergio Setsuo Maeda
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marise Lazaretti-Castro
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Wang D, Yang Y. The Relationship Between Serum 25-Hydroxyvitamin D Levels and Osteoporosis in Postmenopausal Women. Clin Interv Aging 2023; 18:619-627. [PMID: 37096217 PMCID: PMC10122466 DOI: 10.2147/cia.s405317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
Background Vitamin D status is indicated by serum 25-hydroxyvitamin D [25(OH)D] levels, and the positive effects of high levels of vitamin D on bone mineral density (BMD) have not been ascertained. Therefore, we performed a study to analyze the association between serum 25(OH)D levels and osteoporosis in postmenopausal women. Methods We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES). Multiple logistic regression was used to explore the relationship between serum 25(OH)D and osteoporosis of total femur, femoral neck and lumbar spine, with stratified analyses for age (<65 and ≥65 years), BMI (<25, 25 to <30, ≥30 kg/m2) and survey months (winter months and summer months). Results In total, 2058 participants were enrolled in our study. In the fully adjusted model, compared with serum 25(OH)D levels <50 nmol/L, the odds ratios (ORs) and 95% confidence intervals (CIs) of serum 25(OH)D 50-<75 nmol/L and ≥75 nmol/L were 0.274 (0.138, 0.544) and 0.374 (0.202, 0.693) in osteoporosis of total femur, 0.537 (0.328, 0.879) and 0.583 (0.331, 1.026) in osteoporosis of femoral neck, and 0.614 (0.357, 1.055) and 0.627 (0.368, 1.067) in osteoporosis of lumbar spine, respectively. The protective effect of high 25(OH)D was observed at all three skeletal sites in those ≥65 years of age, whereas it was observed only in the total femur in those <65 years of age. Conclusion In conclusion, adequate vitamin D may reduce the risk of osteoporosis in postmenopausal women in the United States, especially in those aged 65 years and older. More attention should be given to serum 25 (OH) D levels to prevent osteoporosis.
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Affiliation(s)
- Dongmei Wang
- Department of Radiology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yimei Yang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong, People’s Republic of China
- Correspondence: Yimei Yang, Affiliated Hospital of Nantong University, #20 Xisi Road, Nantong, 226001, People’s Republic of China, Email
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Han A, Park Y, Lee YK, Park SY, Park CY. Position Statement: Vitamin D Intake to Prevent Osteoporosis and Fracture in Adults. J Bone Metab 2022; 29:205-215. [PMID: 36529863 PMCID: PMC9760769 DOI: 10.11005/jbm.2022.29.4.205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/01/2022] [Indexed: 12/13/2022] Open
Abstract
Adequate vitamin D status is essential for bone health. New randomized controlled trials investigating the effect of vitamin D supplementation on bone health have recently been published. This position statement updates and expands on the previous 2015 position statement of the Korean Society for Bone and Mineral Research on the adequate vitamin D status for healthy older adults (age ≥ 70 years) and those at high risk of osteoporosis and fracture (adults on osteoporosis medications) to maintain serum 25-hydroxy-vitamin D (25[OH]D) levels ≥ 20 ng/mL but < 50 ng/mL. A serum 25(OH)D level of 30 ng/mL may be beneficial for those on anti-resorptives. Vitamin D can be obtained from ultraviolet light exposure and diet. To reach the target vitamin D status through intake, adults must consume at least 400 IU/day to reach 20 ng/mL and 800 to 1,000 IU/day to reach 30 ng/mL. Foods familiar to the Korean diet that are high in vitamin D content or consumed frequently enough to positively impact vitamin D status are introduced in addition to the amount required to help reach one's target vitamin D status.
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Affiliation(s)
- Anna Han
- Department of Food Science and Human Nutrition, Jeonbuk National University, Jeonju,
Korea,K-Food Research Center, Jeonbuk National University, Jeonju,
Korea
| | - Yongsoon Park
- Department of Food and Nutrition, College of Human Ecology, Hanyang University, Seoul,
Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - So Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital, Seoul,
Korea
| | - Clara Yongjoo Park
- Department of Food and Nutrition, Chonnam National University, Gwangju,
Korea
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11
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Kazemian E, Pourali A, Sedaghat F, Karimi M, Basirat V, Sajadi Hezaveh Z, Davoodi SH, Holick MF. Effect of supplemental vitamin D3 on bone mineral density: a systematic review and meta-analysis. Nutr Rev 2022; 81:511-530. [PMID: 36308775 DOI: 10.1093/nutrit/nuac068] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Context
There is still controversy over the effect of vitamin D3 supplementation on bone health.
Objective
The effects of vitamin D3 supplementation on bone mineral density (BMD) and markers of bone turnover, as well as the dose-response relationship between vitamin D3 and bone health in adults, were evaluated.
Data Sources
The PubMed, Scopus, Cochrane, Web of Science, and AGRIS databases were searched for articles published through April 30, 2022. Thirty-nine of the 6409 records identified met the inclusion criteria
Data Extraction
Data were extracted from articles by 2 authors, and data extraction was cross-checked independently. A random-effects model was used to estimate the pooled effect size and the associated 95%CI for the effect of vitamin D3 for each outcome. A one-stage random-effects dose-response model was used to estimate the dose-response relationship between vitamin D3 supplementation and BMD.
Data Analysis
Results of meta-analysis showed a beneficial effect of vitamin D3 at the lumbar spine (standardized mean difference [SMD] = 0.06; 95%CI, 0.01–0.12) and femoral neck (SMD = 0.25; 95%CI, 0.09–0.41). Dose-response analysis revealed a linear relationship between vitamin D3 supplementation doses and BMD at the femoral neck, lumbar spine, and total hip sites. No significant effect of vitamin D3 supplementation on whole-body or total hip BMD was observed (P > 0.05). Vitamin D3 supplementation significantly decreased BMD at both proximal and distal forearm (SMD = −0.16; 95%CI, −0.26 to −0.06). The variables of ethnicity, age, baseline 25-hydroxyvitamin D (25[OH]D), menopause status, vitamin D3 dosing frequency, and bone health status (P interaction = 0.02) altered the effect of vitamin D3 supplementation on BMD. Additionally, a nonlinear relationship between vitamin D3 supplement doses and markers of bone turnover was found.
Conclusion
A protective effect of vitamin D3 supplementation on BMD of the lumbar spine, femoral neck, and total hip is implicated.
Systematic Review Registration
PROSPERO registration number CRD42017054132.
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Affiliation(s)
- Elham Kazemian
- Alborz University of Medical Sciences Non-Communicable Diseases Research Center, , Karaj, Iran
| | - Ali Pourali
- Mazandaran University of Medical Sciences Faculty of Medicine, , Sari, Iran
| | - Fatemeh Sedaghat
- National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences Department of Cellular and Molecular Nutrition, Faculty of Nutrition Sciences and Food Technology, , Tehran, Iran
| | - Mehrdad Karimi
- Department of Public Health, Khoy University of Medical Sciences , Khoy, West Azerbaijan, Iran
| | - Vahid Basirat
- Isfahan University of Medical Sciences and Health Services Department of Gastroenterology, School of Medicine, , Isfahan, Iran
| | - Zohreh Sajadi Hezaveh
- Shahid Beheshti University of Medical Sciences Cancer Research Center, , Tehran, Iran
- National Nutrition and Food Technology Research Institute Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, , Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayed Hossein Davoodi
- National Nutrition and Food Technology Research Institute Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, , Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Michael F Holick
- is with the Section of Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine , Boston, Massachusetts, USA
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12
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Both indirect maternal and direct fetal genetic effects reflect the observational relationship between higher birth weight and lower adult bone mass. BMC Med 2022; 20:361. [PMID: 36192722 PMCID: PMC9531399 DOI: 10.1186/s12916-022-02531-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Birth weight is considered not only to undermine future growth, but also to induce lifelong diseases; the aim of this study is to explore the relationship between birth weight and adult bone mass. METHODS We performed multivariable regression analyses to assess the association of birth weight with bone parameters measured by dual-energy X-ray absorptiometry (DXA) and by quantitative ultrasound (QUS), independently. We also implemented a systemic Mendelian randomization (MR) analysis to explore the causal association between them with both fetal-specific and maternal-specific instrumental variables. RESULTS In the observational analyses, we found that higher birth weight could increase the adult bone area (lumbar spine, β-coefficient= 0.17, P < 2.00 × 10-16; lateral spine, β-coefficient = 0.02, P = 0.04), decrease bone mineral content-adjusted bone area (BMCadjArea) (lumbar spine, β-coefficient= - 0.01, P = 2.27 × 10-14; lateral spine, β-coefficient = - 0.05, P = 0.001), and decrease adult bone mineral density (BMD) (lumbar spine, β-coefficient = - 0.04, P = 0.007; lateral spine; β-coefficient = - 0.03, P = 0.02; heel, β-coefficient = - 0.06, P < 2.00 × 10-16), and we observed that the effect of birth weight on bone size was larger than that on BMC. In MR analyses, the higher fetal-specific genetically determined birth weight was identified to be associated with higher bone area (lumbar spine; β-coefficient = 0.15, P = 1.26 × 10-6, total hip, β-coefficient = 0.15, P = 0.005; intertrochanteric area, β-coefficient = 0.13, P = 0.0009; trochanter area, β-coefficient = 0.11, P = 0.03) but lower BMD (lumbar spine, β-coefficient = - 0.10, P = 0.01; lateral spine, β-coefficient = - 0.12, P = 0.0003, and heel β-coefficient = - 0.11, P = 3.33 × 10-13). In addition, we found that the higher maternal-specific genetically determined offspring birth weight was associated with lower offspring adult heel BMD (β-coefficient = - 0.001, P = 0.04). CONCLUSIONS The observational analyses suggested that higher birth weight was associated with the increased adult bone area but decreased BMD. By leveraging the genetic instrumental variables with maternal- and fetal-specific effects on birth weight, the observed relationship could be reflected by both the direct fetal and indirect maternal genetic effects.
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13
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McArthur C, Hillier L, Ioannidis G, Adachi JD, Giangregorio L, Hirdes J, Papaioannou A. Developing a Fracture Risk Clinical Assessment Protocol for Long-Term Care: A Modified Delphi Consensus Process. J Am Med Dir Assoc 2021; 22:1726-1734.e8. [PMID: 32972869 DOI: 10.1016/j.jamda.2020.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/21/2020] [Accepted: 08/13/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To develop a fracture risk Clinical Assessment Protocol (CAP) based on long-term care (LTC) fracture prevention recommendations and an embedded fracture risk assessment tool. DESIGN A modified Delphi consensus approach including 2 survey rounds and a face-to-face meeting was implemented to reach consensus on matching of LTC fracture prevention guideline statements to Fracture Risk Scale (FRS) risk levels. SETTING AND PARTICIPANTS A national panel of recognized experts in osteoporosis, fractures, and long-term care, including an LTC resident and family members. METHODS Round 1 survey respondents (n = 24) were provided the LTC fracture prevention guidelines matched to FRS risk levels and were asked whether they agreed the guideline was appropriate for the risk level (yes, no, I don't know, I agree with some but not all of it) and to provide comments. In round 2, guideline statements that did not achieve consensus (≥80% agreement) were revised consistent with comments provided in round 1 and respondents were asked again if they agreed with the guideline statement. Statements that did not achieve consensus were to be discussed and resolved in an in-person meeting (n = 17). RESULTS In round 1 (75% response rate), consensus was achieved in 7/14 guideline statements. In round 2 (56% response rate), 5 statements were revised based on round 1 feedback and for 2 statements additional information was provided. Consensus was achieved in all but one statement related to the inappropriateness of pharmacologic therapy for residents with life expectancy less than 1 year. Following facilitated meeting discussions, consensus was obtained to revise the guideline statement to reflect that life expectancy was but one of several criteria that should be used to inform medication decisions. CONCLUSIONS AND IMPLICATIONS An evidence-based fracture risk CAP was developed that will be embedded in international routine clinical assessment tools to guide fracture prevention in LTC.
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Affiliation(s)
- Caitlin McArthur
- McMaster University, Hamilton, Ontario, Canada; GERAS Centre for Aging Research, Hamilton, Ontario, Canada.
| | | | - George Ioannidis
- McMaster University, Hamilton, Ontario, Canada; GERAS Centre for Aging Research, Hamilton, Ontario, Canada
| | | | - Lora Giangregorio
- University of Waterloo, Waterloo, Ontario, Canada; Schlegel-UW Research Institute for Aging, Hamilton, Ontario, Canada
| | - John Hirdes
- University of Waterloo, Waterloo, Ontario, Canada
| | - Alexandra Papaioannou
- McMaster University, Hamilton, Ontario, Canada; GERAS Centre for Aging Research, Hamilton, Ontario, Canada
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14
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Saadah OI, Annese V, Mosli MH. Prevalence and Predictors of Reduced Bone Density in Child and Adolescent Patients With Crohn's Disease. J Clin Densitom 2021; 24:252-258. [PMID: 32553268 DOI: 10.1016/j.jocd.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022]
Abstract
Reduced bone mineral density (BMD) has broadly been found to be associated with inflammatory bowel disease across a number of geographical locations and cultures. We aimed to estimate the prevalence of reduced BMD and identify clinical predictors in a cohort of Crohn's disease patients (CD) in Saudi Arabia. We conducted a retrospective study involving children and adolescents with CD between 2013 and 2018. BMD was evaluated using dual-energy X-ray absorptiometry scans of the spine and body. A multivariate analysis was performed for the detection of predictors of low BMD. Sixty-four patients were enrolled. The median age was 16 years (range, 8-19 years) and 55% of patients were males. Total body BMD scanning identified 25 patients (39%) with osteoporosis. Twenty patients (31.3%) were found to have z scores consistent with osteopenia. A multivariate regression analysis identified a low weight-for-age z score (B coefficient = 0.347, 95% confidence interval [CI] = 0.211-0.482, p < 0.001 for Spine BMD and B coefficient = 0.321, 95% CI = 0.170-0.472, p < 0.001 for total body BMD), a low height-for-age z score (B coefficient = 0.187, 95% CI = 0.035-0.338, p = 0.017 for spine BMD and B coefficient = 0.0.258, 95% CI = 0.089-0.427, p = 0.004 for total body BMD), a low 25-hyroxyvitamin D level (B coefficient = 0.026, 95% CI = 0.013-0.038, p < 0.001 for spine BMD and B coefficient = 0.016, 95% CI = 0.002-0.031, p = 0.026 for total body BMD), and a higher number of corticosteroid induction courses (B coefficient = -0.567, 95% CI = -0.923 to -0.212, p = 0.003 for spine BMD and B coefficient = -0.566, 95% CI = 0.963-0.169, p = 0.007 for total body BMD) as predictors of low BMD. In the spine BMD analysis, older age at the time of presentation was identified as a significant predictor for low bone density (B coefficient = 0.254, 95% CI = 0.141-0.368, p < 0.001). In conclusion, Saudi Arabian children and adolescents with CD have a high prevalence rate of low bone density compared to Western populations. Several clinical characteristics are identified as significant predictors for low BMD.
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Affiliation(s)
- Omar I Saadah
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Inflammatory Bowel Disease Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Vito Annese
- Valiant Clinic & American Hospital, Dubai, United Arab Emirates
| | - Mahmoud H Mosli
- Inflammatory Bowel Disease Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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15
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Mosli MH, Saadah OI. Metabolic bone disease in children and adolescent patients with ulcerative colitis. J Pediatr (Rio J) 2021; 97:242-247. [PMID: 32335076 PMCID: PMC9432293 DOI: 10.1016/j.jped.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Metabolic bone disease concerns a broad spectrum of conditions related to reduced bone density. Metabolic bone disease has been linked to chronic inflammatory diseases, such as ulcerative colitis. This study examines the prevalence of metabolic bone disease in ulcerative colitis patients and explores possible clinical predictors. METHOD The authors performed a retrospective study involving children and adolescents with confirmed ulcerative colitis between January 2013 and December 2018. Bone density was evaluated through a dual-energy X-ray absorptiometry scan of the spine and total body. Osteoporosis was defined as a bone mineral density Z-score of <-2 and osteopenia as a Z-score of between -1.0 and -2. RESULTS A total of 37 patients were included in this analysis, with a mean age of 13.4±3.9 years and a mean duration of illness of 2.1±2.4 years. Using lumbar spine Z-scores and total body Z-scores, osteoporosis and osteopenia were identified by dual-energy X-ray absorptiometry scan measurements in 11 patients (29.7%) and 15 patients (40.5%), and in ten patients (27%) and 13 patients (35%), respectively. Lumbar spine Z-scores were significantly positively associated with male gender (B=2.02; p=0.0001), and negatively associated with the presence of extraintestinal manifestations (B=-1.51, p=0.009) and the use of biologics (B=-1.33, p=0.004). However, total body Z-scores were positively associated with body mass index Z-scores (B=0.26, p=0.004) and duration of illness in years (B=0.35, p=0.003). CONCLUSIONS Metabolic bone disease is very common in this cohort of Saudi Arabian children and adolescents with ulcerative colitis and its occurrence appears to increase in female patients who suffer from extraintestinal manifestations.
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Affiliation(s)
- Mahmoud Hisham Mosli
- Inflammatory Bowel Disease Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar Ibrahim Saadah
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Inflammatory Bowel Disease Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.
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16
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Cheng WZ, Lin YL, Su YC, Lin MC, Tseng CH, Lin RM, Huang ST. Post-surgery cholecystectomy, hepatectomy, and pancreatectomy patients increase the risk of osteoporotic vertebral fracture. J Bone Miner Metab 2021; 39:174-185. [PMID: 32757040 DOI: 10.1007/s00774-020-01129-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/11/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Data is currently lacking regarding association between the cholecystectomy/hepatectomy/pancreatectomy and the development of osteoporotic fracture. A retrospective cohort study was conducted to investigate the relationship between cholecystectomy/hepatectomy/pancreatectomy and the subsequent risk of developing osteoporotic fracture. MATERIALS AND METHODS Patients having undergone cholecystectomy, hepatectomy, or pancreatectomy between 2000 and 2012 were selected from the All Population Based Hospitalization File as the surgery cohort (n = 304,081), which was frequency matched with the control cohort (n = 304,081). The Cox proportional hazard model and Kaplan-Meier analysis were applied to measure the hazard ratios and the cumulative incidence of osteoporotic fracture. RESULTS A total of 1136 patients in the surgery cohort and 1179 patients in the control cohort were newly diagnosed with osteoporotic fracture. The overall osteoporotic fracture risk in the surgery cohort was 1.12-fold higher [95% confidence interval (CI), 1.03-1.21]. Specifically, surgery cohort had higher vertebral fracture risk than non-surgery cohort [adjusted hazard ratio (aHR) 1.12, Cl, 1.03-1.22]. In addition, patients underwent cholecystectomy (includes open and laparoscopic approaches), hepatectomy (only open approach), and pancreatectomy group (only open approach) were 1.10 (95% CI, 1.01-1.19), 1.49 (95% CI, 1.10-2.01), and 1.88 (95% CI, 1.23-2.87) times more likely to develop osteoporotic fracture, respectively. No significant difference of osteoporotic fracture risk was observed between open and laparoscopic cholecystectomy. The risk of osteoporotic fracture was significantly increased in females, patients aged ≥ 40 years old, and patients with some comorbidity. CONCLUSIONS Patients post cholecystectomy, hepatectomy, or pancreatectomy significantly increased risk of developing osteoporotic fracture, suggesting closer attention in post-operative care is needed.
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Affiliation(s)
- Wei-Zen Cheng
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, 40447, Taiwan
| | - Yun-Lan Lin
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, 40447, Taiwan
| | - Yuan-Chih Su
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chang-Hsing Tseng
- Tainan Municipal An-Nan Hospital-China Medical University, No. 66, Section 2, Changhe Road, Annan District, Tainan city, 70965, Taiwan
| | - Ruey-Mo Lin
- Tainan Municipal An-Nan Hospital-China Medical University, No. 66, Section 2, Changhe Road, Annan District, Tainan city, 70965, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, 40447, Taiwan.
- Tainan Municipal An-Nan Hospital-China Medical University, No. 66, Section 2, Changhe Road, Annan District, Tainan city, 70965, Taiwan.
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.
- Chinese Medicine Research Center, China Medical University, Taichung, Taiwan.
- Research Center for Chinese Herbal Medicine, China Medical University, Taichung, Taiwan.
- Department of Medical Research, Cancer Research Center for Traditional Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.
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Sheth B, Akil Prabhakar S, Pawar P, Ganwir H, Panchal S, Jain A. Calcium prescription by Indian orthopaedic surgeons: A survey and a review of literature. J Clin Orthop Trauma 2021; 16:292-298. [PMID: 33747782 PMCID: PMC7972954 DOI: 10.1016/j.jcot.2021.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/10/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Orthopaedic surgeons prefer calcium supplement for various pathologies like fracture, osteoporosis, chronic musculoskeletal pain, yet there is no proper evidence to support the benefits of taking them regularly. The average requirement for calcium is around 500-1000 mg/day for a healthy adult, this amount of calcium is not achieved by diet, especially in developing countries like India. Despite this, the serum calcium level remains unaltered, due to the well-controlled absorption and excretion of calcium by the human body. As there is no clarity over the dose, duration and the prefered calcium salts, we constructed a survey to find the preferred dose, duration, the preferred calcium salts among orthopaedic surgeons, and to give an in-depth review of literature about dose, duration, timing, preferred calcium salt and various other calcium-related queries. MATERIALS AND METHOD The survey included 15 pre-structured questionnaires; these questions were formatted and validated by senior surgeons and other specialists after a through a review of calcium-related literature. These questionnaires were used in a pilot study conducted within the department and were later modified and separated into 7 sections. Data were collected by both online survey (google forms) and direct interviews. RESULT AND CONCLUSION 128 Orthopedic surgeons responded. The total number of response obtained was 2355. Unanswered questions were 152. From the survey, it was found that most orthopaedic surgeons prefer to prescribe calcium routinely (55.46%). The commonly used calcium salt was calcium carbonate (47.65%), followed by citrate (32.8%). 42.18% were not aware of the efficiency of prescribing calcium in divided doses. Most responded that calcium is not to be given for patients with renal stones, but literature shows that calcium prescribed reduces the recurrence of commonest kidney stones, calcium oxalate stones.
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Affiliation(s)
- Binoti Sheth
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Hospital, 1st floor College Building, LTMC Hospital, Dr Babasaheb Ambedkar Rd, RB2 Central Railway Quarters, Sion West, Sion, Mumbai, Maharashtra, 400022, India
| | - S. Akil Prabhakar
- Department of Orthopaedics, KEM Hospital, 6th floor Department of Orthopaedics, MS Building, Acharya Donde Marg, Parel East, Parel, Mumbai, Maharashtra, 400012, India,Corresponding author.
| | - Pankaj Pawar
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Hospital, 1st floor College Building, LTMC Hospital, Dr Babasaheb Ambedkar Rd, RB2 Central Railway Quarters, Sion West, Sion, Mumbai, Maharashtra, 400022, India
| | - Himanshu Ganwir
- Department of Orthopaedics, 1st floor College Building, LTMC Hospital, Dr Babasaheb Ambedkar Rd, RB2 Central Railway Quarters, Sion West, Sion, Mumbai, Maharashtra, 400022, India
| | - Sameer Panchal
- Department of Orthopaedics, Grant Medical college and Sir JJ group of hospitals, Sir JJ hospital, Byculla, Mumbai, 400008, Maharashtra, India
| | - Akash Jain
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Hospital, 1st floor College Building, LTMC Hospital, Dr Babasaheb Ambedkar Rd, RB2 Central Railway Quarters, Sion West, Sion, Mumbai, Maharashtra, 400022, India
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Ames BN, Grant WB, Willett WC. Does the High Prevalence of Vitamin D Deficiency in African Americans Contribute to Health Disparities? Nutrients 2021; 13:499. [PMID: 33546262 PMCID: PMC7913332 DOI: 10.3390/nu13020499] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
African Americans have higher incidence of, and mortality from, many health-related problems than European Americans. They also have a 15 to 20-fold higher prevalence of severe vitamin D deficiency. Here we summarize evidence that: (i) this health disparity is partly due to insufficient vitamin D production, caused by melanin in the skin blocking the UVB solar radiation necessary for its synthesis; (ii) the vitamin D insufficiency is exacerbated at high latitudes because of the combination of dark skin color with lower UVB radiation levels; and (iii) the health of individuals with dark skin can be markedly improved by correcting deficiency and achieving an optimal vitamin D status, as could be obtained by supplementation and/or fortification. Moderate-to-strong evidence exists that high 25-hydroxyvitamin D levels and/or vitamin D supplementation reduces risk for many adverse health outcomes including all-cause mortality rate, adverse pregnancy and birth outcomes, cancer, diabetes mellitus, Alzheimer's disease and dementia, multiple sclerosis, acute respiratory tract infections, COVID-19, asthma exacerbations, rickets, and osteomalacia. We suggest that people with low vitamin D status, which would include most people with dark skin living at high latitudes, along with their health care provider, consider taking vitamin D3 supplements to raise serum 25-hydroxyvitamin D levels to 30 ng/mL (75 nmol/L) or possibly higher.
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Affiliation(s)
- Bruce N. Ames
- Molecular and Cell Biology, Emeritus, University of California, Berkeley, CA 94720, USA;
| | - William B. Grant
- Sunlight, Nutrition and Health Research Center, San Francisco, CA 94164-1603, USA
| | - Walter C. Willett
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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Vitamin D and parathyroid hormone status in community-dwelling elderly patients with mild-to-moderate kidney impairment. Int Urol Nephrol 2021; 53:973-983. [PMID: 33420892 DOI: 10.1007/s11255-020-02695-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/27/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Evidence on vitamin D and parathyroid hormone (PTH) status in patients with early kidney impairment is limited. We aimed to determine the associations among kidney function, vitamin D, and PTH status in community-dwelling elderly patients with mild-to-moderate kidney impairment. METHODS Community-dwelling elderly patients were enrolled in this Institutional Review Board approved cross-sectional study. The eligibility criteria were as follows: age > 60 years, no recent hospitalization within the past 12 months, no conditions that affect vitamin D status including vitamin D supplementation, and eGFR > 30 mL/min/1.73 m2. Serum 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) levels were assessed. RESULTS A total of 226 patients were enrolled. Data were expressed as mean ± SD. The mean serum 25(OH)D was 26.61 ± 10.44 ng/mL and the mean serum PTH was 50.67 ± 22.67 pg/mL. The prevalence of vitamin D deficiency [25(OH)D < 20 ng/mL] and secondary hyperparathyroidism [PTH > 65 pg/mL] were 25.3% and 18.1%, respectively. Patients with eGFR 30- < 60 mL/min/1.73m2 had significantly higher prevalence of 25(OH)D < 20 ng/mL (33.7% versus 19.4%, p < 0.05) than patients with eGFR ≥ 60 mL/min/1.73 m2. Multiple regression analysis showed independent negative association of serum PTH level with eGFR (mL/min/1.73 m2, β: - 0.261, 95% CI [- 0.408, - 0.114]) and serum 25(OH)D (ng/mL, β: - 0.499, 95% CI [- 0.775, - 0.223], adjusted for possible confounders). CONCLUSIONS The prevalence of vitamin D deficiency was higher in patients with eGFR 30 - < 60 mL/min/1.73 m2 than those with eGFR ≥ 60 mL/min/1.73 m2. Both decreased serum 25(OH)D levels and decreased eGFR were independently associated with increased serum PTH levels among these patients.
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Thompson MJW, Jones G, Balogun SA, Aitken DA. Skin Photosensitivity is Associated with 25-Hydroxyvitamin D and BMD but not Fractures Independent of Melanin Density in Older Caucasian Adults. Calcif Tissue Int 2020; 107:335-344. [PMID: 32696106 DOI: 10.1007/s00223-020-00728-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/10/2020] [Indexed: 11/24/2022]
Abstract
Whether skin photosensitivity modulates sun exposure behaviours, consequent vitamin D status and skeletal health outcomes independently of constitutive pigmentation have not been systematically investigated. 1072 community-dwelling adults aged 50-80 years had skin photosensitivity quantified by questionnaire and melanin density by spectrophotometry. Bone mineral density (BMD), falls risk and 25-hydroxyvitamin D (25OHD) were measured using DXA, short form physiological profile assessment and radioimmunoassay, respectively. Sun exposure and symptomatic fractures were assessed by questionnaire. Participants were followed up at 2.5 (n = 879), 5 (n = 767) and 10 (n = 571) years. Higher resistance to sunburn and greater ability to tan were associated with reduced sun protection behaviours (RR 0.87, p < 0.001 & RR 0.88, p < 0.001), higher lifetime discretionary sun exposure in summer (RR 1.05, p = 0.001 & RR 1.07, p = 0.001) and winter (RR 1.07, p = 0.001 & RR 1.08, p = 0.02) and fewer lifetime sunburns (RR 0.86, p < 0.001 & RR 0.91, p = 0.001). Higher resistance to sunburn was associated with lower total body (β = - 0.006, p = 0.047) and femoral neck (β = - 0.006, p = 0.038) BMD, but paradoxically, fewer prevalent fractures (RR 0.94, p = 0.042). Greater ability to tan was associated with higher 25OHD (β = 1.43, p = 0.04), lumbar spine (β = 0.014, p = 0.046) and total body (β = 0.013, p = 0.006) BMD, but not fracture or falls risk. These associations were independent of constitutive melanin density. Cutaneous photosensitivity was associated with sun exposure behaviours, cutaneous sequelae and, consequently, 25OHD and BMD in older Caucasian adults independent of constitutive melanin density. There was no consistent association with fracture outcomes, suggesting environmental factors are at least as important.
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Affiliation(s)
- M J W Thompson
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia.
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - S A Balogun
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - D A Aitken
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
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Thompson MJW, Jones G, Balogun S, Aitken DA. Constitutive melanin density is associated with prevalent and short-term, but not long-term, incident fracture risk in older Caucasian adults. Osteoporos Int 2020; 31:1517-1524. [PMID: 32239236 DOI: 10.1007/s00198-020-05304-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/15/2020] [Indexed: 12/19/2022]
Abstract
UNLABELLED Higher cutaneous melanin reduces vitamin D3 production. This may increase fracture risk. We found that cutaneous melanin density was associated with prevalent and short-term, but not long-term, incident fracture risk in older Caucasian adults. Melanin density either acts as a surrogate marker or its relationship with fracture changes with time. INTRODUCTION Higher cutaneous melanin reduces vitamin D3 production. This may impact lifetime vitamin D status and increase fracture risk. This study aimed to describe the relationship between spectrophotometrically determined constitutive melanin density, prevalent and incident fractures in a cohort of exclusively older Caucasian adults. METHODS 1072 community-dwelling adults aged 50-80 years had constitutive melanin density quantified using spectrophotometry. Participants were followed up at 2.5 (n = 879), 5 (n = 767), and 10 (n = 571) years after the baseline assessment. Prevalence and number of symptomatic fractures were assessed by questionnaire. RESULTS Higher melanin density was independently associated with greater prevalence of any fracture (RR 1.08, p = 0.03), vertebral fracture (RR 1.41, p = 0.04) and major fracture (RR 1.12, p = 0.04) and the number of fractures (RR 1.09, p = 0.04) and vertebral fractures (RR 1.47, p = 0.04) in cross-sectional analysis. At the 2.5-year follow-up, higher melanin density was associated with incident fractures (RR 1.42, p = 0.01) and major fractures (RR 1.81, p = 0.01) and the number of incident fractures (RR 1.39, p = 0.02) and major fractures (RR 2.14, p = 0.01). The relationship between melanin density and incident fracture attenuated as the duration of follow-up increased and was not significant at the 5- or 10-year follow-up. CONCLUSIONS Constitutive melanin density was associated with prevalent and short-term, but not long-term, incident fracture risk in older Caucasian adults. This suggests melanin density either acts as a surrogate marker for an unmeasured fracture risk factor or the relationship between melanin density and fracture changes with time.
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Affiliation(s)
- M J W Thompson
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, 7000, Australia.
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, 7000, Australia
| | - S Balogun
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, 7000, Australia
| | - D A Aitken
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, 7000, Australia
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Machado V, Lobo S, Proença L, Mendes JJ, Botelho J. Vitamin D and Periodontitis: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:E2177. [PMID: 32708032 PMCID: PMC7468917 DOI: 10.3390/nu12082177] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023] Open
Abstract
To explore the vitamin D levels of periodontitis patients in comparison with periodontally healthy ones, and to assess the influence of vitamin D supplementation as an adjunctive during nonsurgical periodontal treatment (NSPT). Five databases (Pubmed, Embase, Scholar, Web of Sciences, and Cochrane Library) were searched until May 2020. Mean difference (MD) meta-analysis with corresponding 95% confidence interval (95% CI) and sensitivity tests via meta-regression were used. We followed Strength of Recommendation Taxonomy (SORT) to appraise the strength and quality of the evidence. Sixteen articles were included, fourteen case-control and two intervention studies, all reporting 25-hydroxyvitamin D (25(OH)D) levels. Compared with the healthy controls, the circulating 25(OH)D levels were significantly lower in chronic periodontitis patients (pooled MD = -6.80, 95% CI: -10.59 to -3.02). Subgroup analysis revealed differences among 25(OH)D measurements, with liquid chromatography-mass spectrometry being the most homogeneous method (pooled MD = -2.05, 95% CI: -3.40 to -0.71). Salivary levels of 25(OH)D showed no differences between groups. Due to the low number of studies, conclusions on aggressive periodontitis and in the effect of vitamin D supplementation after NSPT were not possible to ascribe. Compared with healthy controls, 25(OH)D serum levels are significantly lower in chronic periodontitis patients, with an overall SORT A recommendation. Future studies are needed to clarify the effect of vitamin D supplementation and the biological mechanisms linking vitamin D to the periodontium.
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Affiliation(s)
- Vanessa Machado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal; (S.L.); (J.B.)
- Periodontology Department, CiiEM, IUEM, 2829-511 Almada, Portugal;
| | - Sofia Lobo
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal; (S.L.); (J.B.)
| | - Luís Proença
- Quantitative Methods for Health Research (MQIS), CiiEM, IUEM, 2829-511 Almada, Portugal;
| | - José João Mendes
- Periodontology Department, CiiEM, IUEM, 2829-511 Almada, Portugal;
| | - João Botelho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal; (S.L.); (J.B.)
- Periodontology Department, CiiEM, IUEM, 2829-511 Almada, Portugal;
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24
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Muñoz-Garach A, García-Fontana B, Muñoz-Torres M. Nutrients and Dietary Patterns Related to Osteoporosis. Nutrients 2020; 12:nu12071986. [PMID: 32635394 PMCID: PMC7400143 DOI: 10.3390/nu12071986] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023] Open
Abstract
Osteoporosis is a common chronic disease characterized by a decrease in bone mineral density, impaired bone strength, and an increased risk of fragility fractures. Fragility fractures are associated with significant morbidity, mortality and disability and are a major public health problem worldwide. The influence of nutritional factors on the development and progression of this disease can be significant and is not yet well established. Calcium intake and vitamin D status are considered to be essential for bone metabolism homeostasis. However, some recent studies have questioned the usefulness of calcium and vitamin D supplements in decreasing the risk of fractures. The adequate intake of protein, vegetables and other nutrients is also of interest, and recommendations have been established by expert consensus and clinical practice guidelines. It is important to understand the influence of nutrients not only in isolation but also in the context of a dietary pattern, which is a complex mixture of nutrients. In this review, we evaluate the available scientific evidence for the effects of the main dietary patterns on bone health. Although some dietary patterns seem to have beneficial effects, more studies are needed to fully elucidate the true influence of diet on bone fragility.
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Affiliation(s)
- Araceli Muñoz-Garach
- Department of Endocrinology and Nutrition, Virgen de las Nieves Hospital, 18014 Granada, Spain
- Correspondence: (A.M.-G.); (M.M.-T.)
| | - Beatriz García-Fontana
- Instituto de Investigación Biosanitaria (Ibs.GRANADA), 18014 Granada, Spain;
- CIBERFES, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Manuel Muñoz-Torres
- Instituto de Investigación Biosanitaria (Ibs.GRANADA), 18014 Granada, Spain;
- CIBERFES, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Unidad de Gestión Clínica Endocrinología y Nutrición, Hospital Universitario San Cecilio de Granada, 18016 Granada, Spain
- Department of Medicine, University of Granada, 18016 Granada, Spain
- Correspondence: (A.M.-G.); (M.M.-T.)
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25
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Anagnostis P, Bosdou JK, Kenanidis E, Potoupnis M, Tsiridis E, Goulis DG. Vitamin D supplementation and fracture risk: Evidence for a U-shaped effect. Maturitas 2020; 141:63-70. [PMID: 33036705 DOI: 10.1016/j.maturitas.2020.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 02/02/2023]
Abstract
During the last decade, a cascade of evidence has questioned the anti-fracture efficacy of vitamin D supplementation. In general, vitamin D status, reflected by serum 25-hydroxy-vitamin D [25(OH)D] concentrations, seems to predict fracture risk and bone mineral density (BMD). Despite the well-documented detrimental effect of vitamin D deficiency on bones, vitamin D monotherapy does not seem to reduce the risk of fractures. On the other hand, high vitamin D doses, either at monthly (60,000-100,000 IU) or daily intervals (>4000 IU), appear to be harmful with regard to falls, fracture risk and BMD, especially for people without vitamin D deficiency and at low fracture risk. Therefore, a U-shaped effect of vitamin D on the musculoskeletal system may be supported by the current evidence. Vitamin D supplementation could be of value, at daily doses of at least 800 IU, co-supplemented with calcium (1000-1200 mg/day), in elderly populations, especially those with severe vitamin D deficiency [25(OH)D <25-30 nmol/L (<10-12 ng/mL)], although its anti-fracture and anti-fall efficacy is modest. Good compliance and at least 3-5 years of therapy are required.
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Affiliation(s)
- Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece; Academic Orthopedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece.
| | - Julia K Bosdou
- Unit for Human Reproduction, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece
| | - Eustathios Kenanidis
- Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece; Academic Orthopedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Michael Potoupnis
- Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece; Academic Orthopedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece; Academic Orthopedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
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26
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Affiliation(s)
- Walter C Willett
- From the Departments of Nutrition (W.C.W., D.S.L.) and Epidemiology (W.C.W.), Harvard T.H. Chan School of Public Health; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School (W.C.W.); the Department of Pediatrics, Harvard Medical School (D.S.L.); and the New Balance Foundation Obesity Prevention Center, Boston Children's Hospital (D.S.L.) - all in Boston
| | - David S Ludwig
- From the Departments of Nutrition (W.C.W., D.S.L.) and Epidemiology (W.C.W.), Harvard T.H. Chan School of Public Health; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School (W.C.W.); the Department of Pediatrics, Harvard Medical School (D.S.L.); and the New Balance Foundation Obesity Prevention Center, Boston Children's Hospital (D.S.L.) - all in Boston
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27
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Zhang Y, Shen Q, Zhu M, Wang J, Du Y, Wu J, Li J. Modified Quinoxaline‐Fused Oleanolic Acid Derivatives as Inhibitors of Osteoclastogenesis and Potential Agent in Anti‐Osteoporosis. ChemistrySelect 2020. [DOI: 10.1002/slct.201904521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Yu‐Chao Zhang
- State Key Laboratory of Analytical Chemistry for Life Science, Collaborative Innovation Centre of Chemistry for Life SciencesJiangsu Key Laboratory of Advanced Organic Materials, School of Chemistry and Chemical Engineering, Nanjing University Nanjing 210023 China
| | - Qi Shen
- State Key Laboratory of Analytical Chemistry for Life Science, Collaborative Innovation Centre of Chemistry for Life SciencesJiangsu Key Laboratory of Advanced Organic Materials, School of Chemistry and Chemical Engineering, Nanjing University Nanjing 210023 China
| | - Ming‐Wu Zhu
- Department of Clinical Laboratorythe First Affiliated Hospital of Xinxiang Medical University Weihui 453100 P. R. China
| | - Jie Wang
- State Key Laboratory of Analytical Chemistry for Life Science, Collaborative Innovation Centre of Chemistry for Life SciencesJiangsu Key Laboratory of Advanced Organic Materials, School of Chemistry and Chemical Engineering, Nanjing University Nanjing 210023 China
| | - Yun Du
- State Key Laboratory of Analytical Chemistry for Life Science, Collaborative Innovation Centre of Chemistry for Life SciencesJiangsu Key Laboratory of Advanced Organic Materials, School of Chemistry and Chemical Engineering, Nanjing University Nanjing 210023 China
| | - Jing Wu
- State Key Laboratory of Analytical Chemistry for Life Science, Collaborative Innovation Centre of Chemistry for Life SciencesJiangsu Key Laboratory of Advanced Organic Materials, School of Chemistry and Chemical Engineering, Nanjing University Nanjing 210023 China
| | - Jian‐Xin Li
- State Key Laboratory of Analytical Chemistry for Life Science, Collaborative Innovation Centre of Chemistry for Life SciencesJiangsu Key Laboratory of Advanced Organic Materials, School of Chemistry and Chemical Engineering, Nanjing University Nanjing 210023 China
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28
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Higgins S, Sokolowski CM, Vishwanathan M, Schmidt MD, Evans EM, Lewis RD. Sex-Specific Muscular Mediation of the Relationship Between Physical Activity and Cortical Bone in Young Adults. J Bone Miner Res 2020; 35:81-91. [PMID: 31499590 DOI: 10.1002/jbmr.3868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/06/2019] [Accepted: 08/23/2019] [Indexed: 11/07/2022]
Abstract
Muscle mass is a commonly cited mediator of the relationship between physical activity (PA) and bone, representing the mechanical forces generated during PA. However, neuromuscular properties (eg, peak force) also account for unique portions of variance in skeletal outcomes. We used serial multiple mediation to explore the intermediary role of muscle mass and force in the relationships between cortical bone and moderate-to-vigorous intensity PA (MVPA). In a cross-sectional sample of young adults (n = 147, 19.7 ± 0.7 years old, 52.4% female) cortical diaphyseal bone was assessed via peripheral quantitative computed tomography at the mid-tibia. Peak isokinetic torque in knee extension was assessed via Biodex dynamometer. Thigh fat-free soft tissue (FFST) mass, assessed via dual-energy X-ray absorptiometry, represented the muscular aspect of tibial mechanical forces. Habitual MVPA was assessed objectively over 7 days using Actigraph GT3X+ accelerometers. Participants exceeded MVPA guidelines (89.14 ± 27.29 min/day), with males performing 44.5% more vigorous-intensity activity relative to females (p < 0.05). Males had greater knee extension torque and thigh FFST mass compared to females (55.3%, and 34.2%, respectively, all p < 0.05). In combined-sex models, controlling for tibia length and age, MVPA was associated with strength strain index (pSSI) through two indirect pathways: (i) thigh FFST mass (b = 1.11 ± 0.37; 95% CI, 0.47 to 1.93), and (i) thigh FFST mass and knee extensor torque in sequence (b = 0.30 ± 0.16; 95% CI, 0.09 to 0.73). However, in sex-specific models MVPA was associated with pSSI indirectly through its relationship with knee extensor torque in males (b = 0.78 ± 0.48; 95% CI, 0.04 to 2.02) and thigh FFST mass in females (b = 1.12 ± 0.50; 95% CI, 0.37 to 2.46). Bootstrapped CIs confirmed these mediation pathways. The relationship between MVPA and cortical structure appears to be mediated by muscle in young adults, with potential sex-differences in the muscular pathway. If confirmed, these findings may highlight novel avenues for the promotion of bone strength in young adults. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Simon Higgins
- Department of Kinesiology, University of Georgia, Athens, GA, USA.,Department of Exercise Science, Elon University, Elon, NC, USA
| | | | | | | | - Ellen M Evans
- Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Richard D Lewis
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
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29
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Charoenngam N, Shirvani A, Holick MF. The ongoing D-lemma of vitamin D supplementation for nonskeletal health and bone health. Curr Opin Endocrinol Diabetes Obes 2019; 26:301-305. [PMID: 31644469 DOI: 10.1097/med.0000000000000508] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to give some perspective on the results and conclusions of three recent randomized controlled vitamin D intervention studies that have challenged the health benefit of vitamin D supplementation for reducing risk for cardiovascular disease, cancer, all-cause mortality and type 2 diabetes and improving bone health. RECENT FINDINGS Vitamin D supplementation to adults who were vitamin D sufficient or insufficient did not reduce risk for developing cardiovascular disease, cancer, type 2 diabetes nor increases bone mineral density (BMD). Patients who were vitamin D deficient with cancer and received vitamin D reduced risk for mortality by 25% and prediabetic adults who were vitamin D deficient and received vitamin D reduced their risk of developing type 2 diabetes by 62%. Older adults receiving 4000 and 10 000 IUs of vitamin D3 daily for 3 years had reduced radial BMD but had no change in either total hip areal bone density or bone strength in the radius and tibia. SUMMARY Caution is needed when evaluating results and conclusions from randomized controlled trials that investigate health benefits of vitamin D; most studies suggest health benefits when vitamin D supplementation is provided to vitamin D deficient populations and little benefit when given to populations that are vitamin D sufficient/insufficient.
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Affiliation(s)
- Nipith Charoenngam
- Vitamin D, Skin and Bone Research Laboratory, Section of Endocrinology, Nutrition, and Diabetes, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Arash Shirvani
- Vitamin D, Skin and Bone Research Laboratory, Section of Endocrinology, Nutrition, and Diabetes, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Michael F Holick
- Vitamin D, Skin and Bone Research Laboratory, Section of Endocrinology, Nutrition, and Diabetes, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
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Abstract
Ageing is associated with the accumulation of damage to all the macromolecules within and outside cells leading to progressively more cellular and tissue defects and resulting in age-related frailty, disability and disease. As a result of the aging process the bone deteriorates in composition, structure and function. Age-related musculoskeletal losses are a major public health burden because they can cause physical disability and increased mortality. We tried to find out on a small set of old women, without risk factors for osteoporosis, what caused them the loss of bone minerals. All 492 women had just only one risk factor - the old age. Laboratory findings have shown a decreased serum C telopeptide and low serum alkaline phosphatase circulating markers, used to quantify bone resorption and formation, and very low level of vitamin D. Very low level of vitamin D that disrupted calcium absorption through the intestine, and decreased calcemia increased parathyroid hormone levels with resulting bone effect. The manifestation of physiological aging is worsening eyesight, peripheral neuropathy, depression, worsening of physical condition, skin aging, sarcopenia and bone mineral loss. Senile osteoporosis, which is not caused by known risk factors for osteoporosis, does not appear to be a separate disease, but is part of the physiological process of aging. Treatment of senile osteoporosis should be focused on the control of secondary hyperparathyroidism by administration of vitamin D and calcium. The risk of fractures in the advanced age is determined by a large number of factors ranging from hazards in the home environment to frailty and poor balance.
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Affiliation(s)
- Petr Broulík
- 3rd Department of Medicine - Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
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31
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Hong AR, Kim JH, Lee JH, Kim SW, Shin CS. Metabolic characteristics of subjects with spine-femur bone mineral density discordances: the Korean National Health and Nutrition Examination Survey (KNHANES 2008-2011). J Bone Miner Metab 2019; 37:835-843. [PMID: 30607617 DOI: 10.1007/s00774-018-0980-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/16/2018] [Indexed: 01/29/2023]
Abstract
The diagnosis of osteoporosis is determined based on the lowest bone mineral density (BMD) T-score at the lumbar spine (LS) and hip. However, there are occasional marked discordances between the T-score of LS and femur neck (FN). We aimed to examine the prevalence and characteristics of individuals with spine-femur BMD discordance using a nationwide survey. A total of 3233 men aged ≥ 50 years and 2915 postmenopausal women were included from the Korean National Health and Nutrition Examination Surveys (2008-2011). The spine-femur discordance was defined as a difference of ≥ 1.5 SD between LS and FN BMD. Subjects were divided into three groups: low LS (LS < FN), low FN (LS > FN), and no discordance. Four-hundred and seventeen men (12.9%) and two hundred and ninety women (10%) exhibited spine-femur BMD discordance. The prevalence of hypertension and diabetes was higher in men and women with low FN BMD than in any other group. Fasting plasma glucose and homeostasis model assessment of insulin resistance was the highest in subjects with low FN BMD among the three groups. Low FN BMD revealed higher serum parathyroid hormone and lower 25-hydroxyvitamin D3 levels compared to any other group in women, but this was not observed in men. Osteoporosis was prevalent in subjects with discordance in both genders, particularly, in those with low LS BMD (31.6% in men and 63.5% in women). Given the high prevalence of spine-femur BMD discordance, low FN BMD may be associated with vitamin D deficiency and insulin resistance, but low LS BMD may present severe osteoporosis.
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Affiliation(s)
- A Ram Hong
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
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32
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Jorde R, Stunes AK, Kubiak J, Joakimsen R, Grimnes G, Thorsby PM, Syversen U. Effects of vitamin D supplementation on bone turnover markers and other bone-related substances in subjects with vitamin D deficiency. Bone 2019; 124:7-13. [PMID: 30959189 DOI: 10.1016/j.bone.2019.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/14/2019] [Accepted: 04/04/2019] [Indexed: 12/31/2022]
Abstract
In observational studies, vitamin D deficiency is a risk factor for low bone density and future fractures, whereas a causal relation has been difficult to show in randomized controlled trials (RCTs). Similarly, vitamin D deficiency has been associated with increased bone turnover, but RCTs with vitamin D have not shown conclusive effects. This could be due to inclusion of vitamin D sufficient subjects and low vitamin D doses. In the present study 399 subjects with mean baseline serum 25-hydroxyvitamin D (25(OH)D) 34.0 nmol/L completed a four months intervention with vitamin D3 20,000 IU per week versus placebo. Mean serum 25(OH)D increased to 89.0 nmol/L in the vitamin D group and decreased slightly in the placebo group. A small, but significant, decrease in the bone formation marker procollagen of type 1 amino-terminal propeptide (P1NP) was seen in the vitamin D group as compared to the placebo group (mean delta P1NP -1.2 pg/mL and 1.5 ng/mL, respectively, P < 0.01). No significant effects were seen on serum carboxyl-terminal telopeptide of type 1 collagen (CTX-1), Dickkopf-1, sclerostin, tumor necrosis factor-alpha, osteoprotegerin, receptor activator of nuclear factor ĸB ligand, or leptin. Subgroup analyses on subjects with low baseline serum 25(OH)D did not yield additional, significant results. In subjects with high baseline serum parathyroid hormone (PTH) > 6.5 pmol/L and post-intervention decrease in PTH, the decrease in P1NP was more pronounced, they also exhibited significantly reduced serum CTX-1 and increased serum sclerostin. In conclusion, supplementation with vitamin D appears to suppress bone turnover, possibly mediated by PTH reduction. Our findings need to be confirmed in even larger cohorts with vitamin D insufficient subjects.
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Affiliation(s)
- Rolf Jorde
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, 9038 Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway.
| | - Astrid Kamilla Stunes
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Julia Kubiak
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, 9038 Tromsø, Norway.
| | - Ragnar Joakimsen
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, 9038 Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway.
| | - Guri Grimnes
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, 9038 Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway.
| | - Per Medbøe Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Aker Hospital, Oslo, Norway.
| | - Unni Syversen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
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Association between 25-Hydroxyvitamin D, Parathyroid Hormone, Vitamin D and Calcium Intake, and Bone Density in Healthy Adult Women: A Cross-Sectional Analysis from the D-SOL Study. Nutrients 2019; 11:nu11061267. [PMID: 31167443 PMCID: PMC6628165 DOI: 10.3390/nu11061267] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/22/2019] [Accepted: 05/29/2019] [Indexed: 11/17/2022] Open
Abstract
There is still limited data on the association between 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), and bone health in healthy younger adults, particularly in Latin America. This cross-sectional analysis aimed to investigate the associations of 25(OH)D and plasma PTH concentrations with bone parameters, and potential confounders, in women living in a high (England) or low (Brazil) latitude country. Bone was assessed by either peripheral quantitative computed tomography (pQCT) (England) or dual-energy x-ray absorptiometry (DXA) scan (Brazil), serum 25(OH)D concentrations by high performance liquid chromatography tandem mass spectrometry (HPLC-MS) and PTH by the chemiluminescent method. In participants living in England, total volumetric bone mineral density (vBMD) was significantly higher in women <29 years compared to ≥30 years, and total and cortical vBMD values at the 66% site were negatively correlated with weight and body mass index (BMI). In participants living in Brazil, age was positively correlated with bone mineral density (BMD) at the femur and bone mineral content (BMC), and weight, BMI, and body fat were correlated with BMD (lumbar spine and femur) and BMC. PTH concentrations were negatively correlated with 25(OH)D concentrations, and the prevalence of secondary hyperparathyroidism was 28.6% (n = 14) in participants with concentrations <25 nmol/L and 12.2% (n = 41) with concentrations between 25 and 49.9 nmol/L, compared to 6.3% (n = 79) in those with concentrations ≥50 nmol/L. In conclusion, weight and BMI were significantly correlated with bone parameters in both groups and age was significantly correlated with BMD at the femoral neck for women living in Brazil only. Although 25(OH)D concentrations were not correlated to bone parameters at any sites, in either country, PTH concentrations showed a significant correlation with total vBMD at the 66% site for women living in England. Secondary hyperparathyroidism was more common amongst those with deficient and insufficient vitamin D status.
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Chandran M, Tay D, Mithal A. Supplemental calcium intake in the aging individual: implications on skeletal and cardiovascular health. Aging Clin Exp Res 2019; 31:765-781. [PMID: 30915723 DOI: 10.1007/s40520-019-01150-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/11/2019] [Indexed: 12/12/2022]
Abstract
Adequate calcium intake during childhood is necessary to achieve optimal peak bone mass and this has the potential by increasing bone reserves, to modulate the rate of age-associated bone loss. However, data regarding the efficacy of calcium obtained either through the diet or in the form of medicinal supplementation, for prevention of bone loss and osteoporotic fractures in the elderly is conflicting. Calcium alone is unlikely to be of benefit for this purpose though the co-administration of calcium and vitamin D may have modest fracture risk benefits. Supplemental calcium with or without vitamin D has recently come into the spotlight after the publication of the findings from a controversial randomized controlled trial that associated calcium supplementation with an increased risk of myocardial infarction. Since then, multiple studies have explored this potential link. The data remains conflicting and the potential mechanistic link if any exists, remains elusive. This review examines the relationship between supplemental calcium intake and skeletal and cardiovascular health in the aging individual through an appraisal of studies done on the subject in the last three decades. It also briefly details some of the studies evaluating fractional absorption of calcium in the elderly and the rationale behind the current recommended dietary allowances of calcium.
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Affiliation(s)
- Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, 20 College Road, 169856, Academia, Singapore.
| | - Donovan Tay
- Department of Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Ambrish Mithal
- Division of Endocrinology and Diabetes, Medanta-The Medicity, Gurgaon, New Delhi, India
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Byun SE, Lee S, Kim JW, Ha YC, Kim CH, Ha C, Ryu KJ, Koh JM, Kim HK, Chang JS. Preventive Effects of Low Parathyroid Hormone Levels on Hip Fracture in Patients with Vitamin D Deficiency. J Bone Metab 2019; 26:89-95. [PMID: 31223605 PMCID: PMC6561850 DOI: 10.11005/jbm.2019.26.2.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 01/05/2023] Open
Abstract
Background The objective of the current study is to determine the role of serum parathyroid hormone (PTH) on hip fracture development by retrospectively analyzing the relationship between vitamin D and PTH levels and hip fracture prevalence. Methods Among 288 patients over 50 years of age, 113 patients with hip fracture and 111 controls without fracture were analyzed after excluding patients with conditions affecting bone metabolism. Bone mineral density and serum biochemical markers were measured, while demographic data were obtained. Patients were divided into 4 groups according to serum 25-hydroxy-vitamin D (25-[OH]D) and PTH levels: LowD+LowP (low 25[OH]D and PTH); LowD+HighP, (low 25[OH]D and high PTH); HighD+LowP (high 25[OH]D and low PTH); and HighD+HighP, patients with (high 25[OH]D and PTH). Measured values and percentages of patients with hip fracture in each group were then determined and compared. Results The number of patients included in the LowD+LowP, LowD+HighP, HighD+LowP, and HighD+HighP groups was 116, 17, 87, and 4, while the percentages of patients with hip fracture in the same groups were 60.3%, 88.2%, 27.6%, and 100%, respectively. The percentage of hip fracture was significantly lower in the LowD+LowP than the LowD+HighP group (P=0.049). Conclusions Patients with low serum 25(OH)D and PTH levels showed lower hip fracture prevalence, indicating the potential protective role of low PTH levels on bone health in patients with vitamin D deficiency. Therefore, clinicians should pay more attention to the possibility of fractures in patients with vitamin D deficiency who present with high PTH levels.
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Affiliation(s)
- Seong-Eun Byun
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Chul-Ho Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheungsoo Ha
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Keun Jung Ryu
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Kyung Kim
- Department of Pathology, Kyung Hee University Hospital at Gang-dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Suk Chang
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yoo KO, Kim MJ, Ly SY. Association between vitamin D intake and bone mineral density in Koreans aged ≥ 50 years: analysis of the 2009 Korea National Health and Nutrition Examination Survey using a newly established vitamin D database. Nutr Res Pract 2019; 13:115-125. [PMID: 30984355 PMCID: PMC6449542 DOI: 10.4162/nrp.2019.13.2.115] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/09/2018] [Accepted: 11/29/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/OBJECTIVES Vitamin D plays an important role in skeletal growth and maintenance and in the prevention of various diseases. We investigated the relationship between vitamin D intake and bone mineral density (BMD) in Korean adults aged ≥ 50 years using the 2009 Korea National Health and Nutrition Examination Survey data. SUBJECTS/METHODS This study was conducted in 1,808 subjects aged ≥ 50 years with BMD data in Korea. Dietary vitamin D levels were assessed by the 24-hour recall method. BMD was measured using dual-energy X-ray absorptiometry. We investigated general characteristics and the association between these characteristics, vitamin D status, and BMD. RESULTS Vitamin D intake was significantly lower in the osteoporosis group among women (P < 0.05). Among all subjects, the higher the serum 25(OH)D concentration, the higher the whole-body total BMD (WBT-BMD), femoral total hip BMD, and femoral neck BMD (P < 0.01). In the serum vitamin D-deficient group of both the total population and women, serum 25(OH)D concentration was associated with WBT-BMD (P < 0.05). Among women with a calcium intake < 537.74 mg/day, BMD of those with a vitamin D intake > 2.51 µg/day (average intake of women) was higher than that of women with a vitamin D intake ≤ 2.51 µg/day (P < 0.001). CONCLUSIONS Korean adults should increase their BMD by increasing serum 25(OH)D concentration. Furthermore, increasing vitamin D intake could improve BMD, especially in Korean women who consume less calcium than the estimated average requirement.
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Affiliation(s)
- Kyoung-Ok Yoo
- Food and Nutrition Major, Woosong University, Daejeon 34606, Korea
| | - Mi-Ja Kim
- Department of Food and Nutrition, Daejeon Institute of Science and Technology, Daejeon 35408, Korea
| | - Sun Yung Ly
- Department of Food and Nutrition, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea
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37
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Zhang Y, Chai Y, Pan X, Shen H, Wei X, Xie Y. Tai chi for treating osteopenia and primary osteoporosis: a meta-analysis and trial sequential analysis. Clin Interv Aging 2019; 14:91-104. [PMID: 30655662 PMCID: PMC6322510 DOI: 10.2147/cia.s187588] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The aim of this meta-analysis was to evaluate the efficacy of Tai chi (TC) as an adjuvant treatment for osteopenia and primary osteoporosis. Methods We went through eight databases to identify relevant randomized controlled trials that compared TC with a control group. The primary outcome was osteoporosis-related fractures (fracture incidence). Meta-analyses and trial sequential analyses (TSA) were conducted using RevMan 5.3 and TSA 0.9. Results Fifteen randomized controlled trials involving a total of 857 patients were included in the analyses. No trials reported primary outcome; however, bone mineral density (BMD) values differed significantly in subgroup 1 (TC vs no treatment; weighted mean difference [WMD] =0.05 g/cm2, 95% CI 0.03 to 0.07; P<0.00001; P for heterogeneity =0.22, I2=22%) and subgroup 2 (TC vs conventional treatments; WMD =0.16 g/cm2, 95% CI 0.11 to 0.21; P<0.00001; P for heterogeneity =0.008, I2=75%). In addition, two trials compared TC with conventional treatments, which found a significant difference in bone gla protein (standardized mean difference =−1.18, 95% CI −1.66 to −0.70; P<0.00001; P for heterogeneity =0.58, I2=75%). The results of the BMD were confirmed by TSA. Also, TC may have a certain effect on the relief of osteoporotic pain (WMD = −2.61, 95% CI −3.51 to −1.71; WMD = −1.39, 95% CI −2.01 to −0.77). However, it did not promote the quality of life, level of serum calcium, serum phosphorus, and also had no effect on bone turnover markers. Conclusion Although there is no study monitoring fracture incidence, TC may be beneficial for patients in improving BMD values, level of bone gla protein, and relieving osteoporotic pain. However, due to the low methodological quality, current evidence for treating osteopenia and primary osteoporosis through TC is insufficient.
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Affiliation(s)
- Yili Zhang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China, .,School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Chai
- Department of Epidemiology, University of California, Los Angeles, CA, USA
| | - Xiaojie Pan
- Department of Human Nutrition and Health, Wageningen University and Health, Wageningen, The Netherlands
| | - Hao Shen
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China,
| | - Xu Wei
- Department of Scientific Research, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China,
| | - Yanming Xie
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China,
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Abstract
Osteoporosis is a "skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture" which, in light of demographic change, is becoming an increasing burden on health care worldwide. Increasing age and female gender are associated with the condition, although a wider range of clinical risk factors are being used increasingly to identify those at risk of osteoporosis and its most important sequelae, fracture.While osteoporosis and fracture have long been associated with women in the post-menopausal age, fracture incidence increases because of the ageing of our population. Interventions to abate the progression of osteoporosis and to prevent fractures must focus on the old and the very old. Evidence associating nutritional factors, particularly calcium and vitamin D are reviewed as are the association of falls risk with fracture and the potential for interventions to prevent falls. Finally, the assessment of frailty in the oldest old, associated sarcopenia and multi-morbidity are considered in the evaluation of fall and fracture risk and the management of osteoporosis in the ninth decade of life and beyond.
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Affiliation(s)
- Terry J Aspray
- NIHR Biomedical Research Centre, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK. .,Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK. .,Institute of Ageing, Newcastle University, Newcastle-Upon-Tyne, UK.
| | - Tom R Hill
- Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK.,Institute of Ageing, Newcastle University, Newcastle-Upon-Tyne, UK.,Human Nutrition Research Centre, Newcastle University, Newcastle-Upon-Tyne, UK
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Charoenngam N, Shirvani A, Holick MF. Vitamin D for skeletal and non-skeletal health: What we should know. J Clin Orthop Trauma 2019; 10:1082-1093. [PMID: 31708633 PMCID: PMC6834997 DOI: 10.1016/j.jcot.2019.07.004] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 02/08/2023] Open
Abstract
Vitamin D plays an essential role in regulating calcium and phosphate metabolism and maintaining a healthy mineralized skeleton. Humans obtain vitamin D from sunlight exposure, dietary foods and supplements. There are two forms of vitamin D: vitamin D3 and vitamin D2. Vitamin D3 is synthesized endogenously in the skin and found naturally in oily fish and cod liver oil. Vitamin D2 is synthesized from ergosterol and found in yeast and mushrooms. Once vitamin D enters the circulation it is converted by 25-hydroxylase in the liver to 25-hydroxyvitamin D [25(OH)D], which is further converted by the 25-hydroxyvitamin D-1α-hydroxylase in the kidneys to the active form, 1,25-dihydroxyvitamin D [1,25(OH)2D]. 1,25(OH)2D binds to its nuclear vitamin D receptor to exert its physiologic functions. These functions include: promotion of intestinal calcium and phosphate absorption, renal tubular calcium reabsorption, and calcium mobilization from bone. The Endocrine Society's Clinical Practice Guideline defines vitamin D deficiency, insufficiency, and sufficiency as serum concentrations of 25(OH)D of <20 ng/mL, 21-29 ng/mL, and 30-100 ng/mL, respectively. Vitamin D deficiency is a major global public health problem in all age groups. It is estimated that 1 billion people worldwide have vitamin D deficiency or insufficiency. This pandemic of vitamin D deficiency and insufficiency is attributed to a modern lifestyle and environmental factors that restrict sunlight exposure, which is essential for endogenous synthesis of vitamin D in the skin. Vitamin D deficiency is the most common cause of rickets and osteomalacia, and can exacerbate osteoporosis. It is also associated with chronic musculoskeletal pain, muscle weakness, and an increased risk of falling. In addition, several observational studies observed the association between robust levels of serum 25(OH)D in the range of 40-60 ng/mL with decreased mortality and risk of development of several types of chronic diseases. Therefore, vitamin D-deficient patients should be treated with vitamin D2 or vitamin D3 supplementation to achieve an optimal level of serum 25(OH)D. Screening of vitamin D deficiency by measuring serum 25(OH)D is recommended in individuals at risk such as patients with diseases affecting vitamin D metabolism and absorption, osteoporosis, and older adults with a history of falls or nontraumatic fracture. It is important to know if a laboratory assay measures total 25(OH)D or only 25(OH)D3. Using assays that measure only 25(OH)D3 could underestimate total levels of 25(OH)D and may mislead physicians who treat patients with vitamin D2 supplementation.
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Affiliation(s)
- Nipith Charoenngam
- Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, Vitamin D, Skin and Bone Research Laboratory, Boston University Medical Center, Boston, MA, USA,Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand,Corresponding author. Vitamin D, Skin, and Bone Research Laboratory Boston University School of Medicine, 85 E Newton St, M-1013 Boston, MA 01228, USA.
| | - Arash Shirvani
- Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, Vitamin D, Skin and Bone Research Laboratory, Boston University Medical Center, Boston, MA, USA
| | - Michael F. Holick
- Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, Vitamin D, Skin and Bone Research Laboratory, Boston University Medical Center, Boston, MA, USA
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40
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Abstract
The last decade has seen a dramatic increase in general interest in and research into vitamin D, with many athletes now taking vitamin D supplements as part of their everyday dietary regimen. The most recognized role of vitamin D is its regulation of calcium homeostasis; there is a strong relationship between vitamin D and bone health in non-athletic individuals. In contrast, data have consistently failed to demonstrate any relationship between serum 25[OH]D and bone health, which may in part be due to the osteogenic stimulus of exercise. Vitamin D may interact with extra-skeletal tissues such as muscle and the immune system to modulate recovery from damaging exercise and infection risk. Given that many athletes now engage in supplementation, often consuming extreme doses of vitamin D, it is important to assess whether excessive vitamin D can be detrimental to health. It has been argued that toxic effects only occur when serum 25[OH]D concentrations are greater than 180 nmol·l-1, but data from our laboratory have suggested high-dose supplementation could be problematic. Finally, there is a paradoxical relationship between serum 25[OH]D concentration, ethnicity, and markers of bone health: Black athletes often present with low serum 25[OH]D without physiological consequences. One explanation for this could be genetic differences in vitamin D binding protein due to ethnicity, resulting in greater concentrations of bioavailable (or free) vitamin D in some ethnic groups. In the absence of any pathology, screening may be unnecessary and could result in incorrect supplementation. Data must now be re-examined, taking into consideration bioavailable or "free" vitamin D in ethnically diverse groups to enable new thresholds and target concentrations to be established; perhaps, for now, it is time to "set vitamin D free".
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Affiliation(s)
- Daniel J Owens
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Richard Allison
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.,Exercise and Sport Science Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Arsenal Football Club, Bell Lane, London Colney, St Albans, Shenley, AL2 1DR, UK
| | - Graeme L Close
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.
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Li J, Ding W, Cao J, Sun L, Liu S, Zhang J, Zhao H. Serum 25-hydroxyvitamin D and bone mineral density among children and adolescents in a Northwest Chinese city. Bone 2018; 116:28-34. [PMID: 30006192 DOI: 10.1016/j.bone.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/02/2018] [Accepted: 07/08/2018] [Indexed: 12/24/2022]
Abstract
Although vitamin D is essential for bone health, little is known about prevalence of vitamin D deficiency and low bone mineral density (BMD) among children, especially those in developing countries. It also remains unclear whether serum 25-hydroxyvitamin D [25(OH)D] is associated with BMD among children. We investigated these questions among children and adolescents in Yinchuan (latitude: 38° N), Ningxia, an economically underdeveloped province in Northwest China. A total of 1582 children (756 boys and 826 girls), aged 6-18 years, were recruited from schools using the stratified random sampling method in fall 2015. Serum 25(OH)D concentrations were measured by enzyme-linked immunosorbent assay, and BMD was quantified by dual-energy X-ray absorptiometry. Vitamin D deficiency (defined as serum 25(OH)D ≤ 37.5 nmol/L) was present in 35.5% of study subjects. There were no clear patterns of differences in serum 25(OH)D concentrations across the four age groups compared (6-9 years, 10-13 years, 14-16 years, and 17-18 years). The prevalence of low total body less head (TBLH) BMD (defined as a Z-score of ≤ -2.0 standard deviations away from the mean BMD values of the Chinese pediatric reference population) among children examined was 1.8% and was not significantly different among the four age groups considered. Linear regression analysis revealed that age, weight, and height were significantly and positively associated with TBLH BMD and that the strongest determinant of TBLH BMD was age in boys and weight in girls. There were no significant correlations between serum 25(OH)D concentrations and BMD obtained for total body and at various skeletal sites (r ranged from -0.005 to 0.014) regardless of whether children evaluated were sufficient, insufficient, or deficient in vitamin D. In conclusion, more than one-third of children and adolescents in a Northwest Chinese city were deficient in vitamin D but only <2% of them developed low BMD.
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Affiliation(s)
- Jing Li
- Department of Child and Adolescent Health, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Wenqing Ding
- Department of Child and Adolescent Health, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Juan Cao
- Department of Child and Adolescent Health, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Lijiao Sun
- Department of Child and Adolescent Health, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Shanghong Liu
- Department of Child and Adolescent Health, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Jianjun Zhang
- Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
| | - Haiping Zhao
- Department of Child and Adolescent Health, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China.
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Ohta H, Kuroda T, Tsugawa N, Onoe Y, Okano T, Shiraki M. Optimal vitamin D intake for preventing serum 25-hydroxyvitamin D insufficiency in young Japanese women. J Bone Miner Metab 2018; 36:620-625. [PMID: 29124437 DOI: 10.1007/s00774-017-0879-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 10/06/2017] [Indexed: 11/26/2022]
Abstract
Populations of East Asian countries have been known to have low calcium intakes and low serum 25(OH)D concentrations, suggesting that Ca and vitamin D (VitD)-deficiencies are commonly observed. These nutritional imbalances may lead to low peak bone mass (PBM). The low PBM seen in Ca/VitD-deficient individuals may lead to osteoporosis, as well as an increased risk of fracture. A survey was conducted in young Japanese women (n = 296, 21.2 ± 2.3 years old) on their Ca/VitD intakes and serum 25(OH)D levels, which demonstrated a significant positive correlation between VitD intake and serum 25(OH)D levels (R 2 = 0.020, P = 0.016), and the proportion with serum 25(OH)D over 20 ng/mL was significantly increased with VitD intake (P = 0.013). Serum 25(OH)D was negatively correlated to serum intact parathyroid hormone (R 2 = 0.053, P < 0.001). On receiver operating characteristic curve analysis, the VitD intake threshold for maintaining 25(OH)D levels at 20 ng/mL or higher was 11.6 μg/day or greater. It was suggested that the recommended VitD intake allowance, defined in the Adequate Intakes as 5.5 μg/day, may not be sufficient to maintain serum 25(OH)D levels for bone health.
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Affiliation(s)
- Hiroaki Ohta
- Clinical Medical Research Center, International University of Health and Welfare, Women's Medical Center, Sanno Medical Center, 8-5-35 Akasaka, Minato-ku, Tokyo, 107-0052, Japan.
| | - Tatsuhiko Kuroda
- Public Health Research Foundation, 1-1-7 Nishiwaseda, Shinjuku-ku, Tokyo, 169-0051, Japan
| | - Naoko Tsugawa
- Laboratory of Public Health, Department of Health and Nutrition, Osaka Shoin Women's University, 4-2-26 Hishiyanishi, Higashi-Osaka, Osaka, 577-8550, Japan
| | - Yoshiko Onoe
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University Hospital, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Toshio Okano
- Kobe Pharmaceutical University, 4-19-1 Motoyamakita-machi, Higashinada-ku, Kobe, 658-8558, Japan
| | - Masataka Shiraki
- Department of Internal Medicine, Research Institute and Practice for Involutional Diseases, 1610-1 Meisei, Misato, Azumino, Nagano, 399-8101, Japan
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Thompson MJW, Jones G, Aitken DA. Constitutive melanin density is associated with higher 25-hydroxyvitamin D and potentially total body BMD in older Caucasian adults via increased sun tolerance and exposure. Osteoporos Int 2018; 29:1887-1895. [PMID: 29858632 DOI: 10.1007/s00198-018-4568-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Abstract
UNLABELLED Greater skin pigmentation reduces dose equivalent cutaneous vitamin D3 production, potentially impacting lifetime vitamin D status and fracture risk. We show that melanin density was positively associated with 25-hydroxyvitamin D and total body bone mineral density. These relationships were partially explained by greater sun exposure due to more permissive skin phenotype. INTRODUCTION Higher cutaneous melanin reduces vitamin D3 production. This may impact lifetime vitamin D status and increase fracture risk. This study aimed to describe the relationship between spectrophotometrically determined constitutive melanin density, osteoporotic risk factors and potential intermediaries in a cohort of exclusively older Caucasian adults. METHODS One thousand seventy-two community-dwelling adults aged 50-80 years had constitutive melanin density quantified using spectrophotometry. Sun exposure, skin phenotype, non-melanoma skin cancer (NMSC) prevalence and smoking status were assessed by questionnaire. Bone mineral density (BMD), falls risk, physical activity and 25-hydroxyvitamin D were measured using DXA, the short form Physiological Profile Assessment, pedometer and radioimmunoassay, respectively. RESULTS Higher melanin density was independently associated with greater ability to tan (RR = 1.27, p < 0.001), less propensity to sunburn (RR = 0.92, p < 0.001), fewer lifetime sunburns (RR = 0.94, p = 0.01), current smoking (RR = 1.41, p < 0.001), female sex (RR = 1.24, p < 0.001) and less photodamage (RR = 0.98, p = 0.01). The associations between melanin density and sun exposure (RR = 1.05-1.11, p < 0.001-0.01), sun protection behaviours (RR = 0.89, p < 0.001) and NMSC prevalence (RR = 0.75, p = 0.001) were no longer significant after taking into account skin phenotype and sun exposure, respectively. 25-Hydroxyvitamin D was strongly associated with higher melanin density (β = 1.71-2.05, p = 0.001). The association between melanin density and total body BMD (β = 0.007, p = 0.04) became non-significant after adjustment for 25-hydroxyvitamin D. There was no association between melanin density and physical activity, falls risk or BMD at other sites. CONCLUSIONS Our data support a model of higher constitutive melanin density underpinning a less photosensitive skin phenotype, permitting greater sun exposure with fewer sequelae and yielding higher 25-hydroxyvitamin D and, potentially, total body BMD.
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Affiliation(s)
- M J W Thompson
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, 7000, Australia.
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, 7000, Australia
| | - D A Aitken
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, 7000, Australia
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Wimalawansa SJ, Razzaque MS, Al-Daghri NM. Calcium and vitamin D in human health: Hype or real? J Steroid Biochem Mol Biol 2018; 180:4-14. [PMID: 29258769 DOI: 10.1016/j.jsbmb.2017.12.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/04/2017] [Accepted: 12/14/2017] [Indexed: 12/18/2022]
Abstract
The incidence and prevalence of vitamin D deficiency are increasing worldwide. It is estimated that over 50% of the world's population have low vitamin D (i.e., hypovitaminosis D; serum levels below 30 ng/mL). In vitamin D inadequacy, human physiological systems work inefficiently. In humans, 80% of the vitamin D is synthesized in the presence of ultraviolet rays from sunlight; for the rest, we rely on diet and nowadays, supplements. The latter becomes important when one is exposed to less than optimal amounts of sunlight, inability to generate vitamin D in the skin efficiently, and/or having conditions that lead to decreased intestinal absorption or increased catabolism of vitamin D. The normal serum 25-hydroxyvitamin D [25(OH)D] level is around 30 ng/mL (75 nmol/L) and the optimal range is between 30 and 60 ng/mL (75-150 nmol/L). In 2011, the Institute of Medicine (IOM) suggested that 600IU of vitamin D is adequate for people below age 71 who are not exposed to sunshine. Although this might be relevant to the ambulatory healthy white Caucasians to achieve serum 25(OH)D level of 20 ng/mL, but it is insufficient for other ethnic groups. Moreover, the IOM recommendations are not suitable for those who live outside North America. Vitamin D requirements are higher during adolescence, pregnancy and lactation, and in many other disease conditions. Most clinicians consider 30 ng/mL as the minimum serum level of 25(OH)D necessary to maintain good health. In the absence of sunlight exposure and with daily oral intake of 600IU vitamin D, very few people would reach serum 25(OH)D level above 30 ng/mL. While an additional daily intake of 1000IU of vitamin D are required for people with lighter-skin color, those with darker complexion and the elderly, require a minimum of 2000IU/day to maintain serum 25(OH)D levels over 30 ng/mL; 5000 IU/day supplement is considered as the safe daily upper limit of supplementation. Vulnerable groups such as the disabled and/or house-bound, obese, with gastrointestinal abnormalities and/or malabsorption syndromes, institutionalized people (e.g., nursing homes, prisons, etc.), and pregnant and lactating women need approximately 4000IU per day for optimal physiological activity. Vitamin D is essential for gastrointestinal calcium absorption, mineralization of osteoid tissue and maintenance of serum ionized calcium level. It is also important for other physiological functions, such as muscle strength, neuromuscular coordination, hormone release, subduing autoimmunity, and curtailing the development of certain cancers.
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Affiliation(s)
- Sunil J Wimalawansa
- Endocrinology, Metabolism & Nutrition, 661 Darmody Avenue North Brunswick, NJ, 08902, USA.
| | - Mohammed S Razzaque
- Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Nasser M Al-Daghri
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Department of Biochemistry, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
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Abstract
One hundred years has passed since the discovery of vitamin D as the active component of cod-liver oil which cured the bone disease rickets. Since then our knowledge of vitamin D has expanded tremendously and has included recognition of the importance of UV radiation as a source of the vitamin as well as the discovery of the vitamin as a nutrient, a pro-hormone and a potent steroid hormone with a major role in calcium and bone metabolism. In the last 25 years or so, the discovery of the vitamin D receptor in over 30 different body tissues together with the existence of the alpha-1-hydroxylase enzyme in these tissues provided evidence of a pleiotropic role of vitamin D outside its classical role in the skeleton. These important discoveries have provided the basis for the increasing interest in vitamin D in the context of nutritional requirements for health including the prevention of chronic diseases of ageing. The recent publication of the Dietary Reference Intake report on vitamin D and calcium by the North American Institute of Medicine (IOM) is the most comprehensive report to date on the basis for setting nutritional requirements for vitamin D. This chapter will summarize the nutritional aspects of vitamin D and discuss the changes in vitamin D metabolism and requirements with ageing. It will summarize key evidence on the relationship between vitamin D status and some of the main ageing related health outcomes including bone, muscle and cognitive health as well as survival focusing on the published literature in very-old adults (those >= 85 years of age).
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Affiliation(s)
- Tom R Hill
- Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, UK.
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
- Institute of Ageing, Newcastle University, Newcastle Upon Tyne, UK.
| | - Antoneta Granic
- Institute of Ageing, Newcastle University, Newcastle Upon Tyne, UK
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle University, Newcastle Upon Tyne, UK
| | - Terence J Aspray
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
- Institute of Ageing, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle University, Newcastle Upon Tyne, UK
- The Bone Clinic, Freeman Hospital, Newcastle Upon Tyne, UK
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Cano A, Chedraui P, Goulis DG, Lopes P, Mishra G, Mueck A, Senturk LM, Simoncini T, Stevenson JC, Stute P, Tuomikoski P, Rees M, Lambrinoudaki I. Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide. Maturitas 2018; 107:7-12. [DOI: 10.1016/j.maturitas.2017.10.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Lee YK, Chang JS, Min YK, Byun DW, Park Y, Ha YC. Low calcium and vitamin D intake in Korean women over 50 years of age. J Bone Miner Metab 2017; 35:522-528. [PMID: 27683158 DOI: 10.1007/s00774-016-0782-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/29/2016] [Indexed: 12/01/2022]
Abstract
Inadequate calcium and vitamin D intake is a possible risk factor of osteoporosis. Our purposes were to estimate calcium and vitamin D intake in Korean women, and to determine associated risk factors for low calcium and vitamin D intake. This is a multicenter, hospital-based, and cross-sectional study on osteoporosis. In this study, 1516 women of 50 years or older were involved. Dietary calcium and vitamin D intake were evaluated using the self-reporting KCAT questionnaire. Average daily calcium intake was 662.8 ± 473.8 mg, and vitamin D intake 9.5 ± 10.7 μg. In multivariate analysis, older age (OR 1.02, 95 % CI 1.00-1.04, p = 0.001), and rural residence (OR 2.43, 95 % CI 1.34-4.43, p = 0.004) were significant risk factors for lower calcium intake, and older age (OR 1.03, 95 % CI 1.02-1.04, p < 0.001), and rural residence (OR 1.85, 95 % CI 1.10-3.11, p < 0.001) were significant risk factors for lower vitamin D intake. About 70 % of women aged 50 years or older had calcium and vitamin D intake below the recommended dietary intake. Older age and rural residence were significant risk factors for lower calcium and vitamin D intake in Korean women.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Suk Chang
- Department of Orthopaedic Surgery, Asan Medical Center, Seoul, Korea
| | - Yong-Ki Min
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Won Byun
- Department of Endocrinology, Soon Chun Hyang University Hospital, Seoul, Korea
| | - Yongsoon Park
- Department of Food and Nutrition, College of Human Ecology, Hanyang University, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-ku, Seoul, 156-755, South Korea.
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Allison RJ, Farooq A, Cherif A, Hamilton B, Close GL, Wilson MG. Why don’t serum vitamin D concentrations associate with BMD by DXA? A case of being ‘bound’ to the wrong assay? Implications for vitamin D screening. Br J Sports Med 2017; 52:522-526. [DOI: 10.1136/bjsports-2016-097130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 05/04/2017] [Accepted: 06/28/2017] [Indexed: 11/04/2022]
Abstract
BackgroundThe association between bone mineral density (BMD) and serum25-hydroxyvitamin D (25(OH)D) concentration is weak, particularly in certain races (eg, BlackAfrican vs Caucasian) and in athletic populations. We aimed to examine if bioavailable vitamin D rather than serum 25(OH)D was related to markers of bone health within a racially diverse athletic population.MethodsIn 604 male athletes (Arab (n=327), Asian (n=48), Black (n=108), Caucasian (n=53) and Hispanic (n=68)), we measured total 25(OH)D, vitamin D-binding protein and BMD by DXA. Bioavailable vitamin D was calculated using the free hormone hypothesis.ResultsFrom 604 athletes, 21.5% (n=130) demonstrated severe 25(OH)D deficiency, 37.1% (n=224) deficiency, 26% (n=157) insufficiency and 15.4% (n=93) sufficiency. Serum 25(OH)D concentrations were not associated with BMD at any site. After adjusting for age and race, bioavailable vitamin D was associated with BMD (spine, neck and hip). Mean serum vitamin D binding protein concentrations were not associated with 25(OH)D concentrations (p=0.392).ConclusionRegardless of age or race, bioavailable vitamin D and not serum 25(OH)D was associated with BMD in a racially diverse athletic population. If vitamin D screening is warranted, clinicians should use appropriate assays to calculate vitamin D binding protein and bioavailable vitamin D levels concentrations than serum 25(OH)D. In turn, prophylactic vitamin D supplementation to ‘correct’ insufficient athletes should not be based on serum 25(OH)D measures.
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Thompson MJW, Aitken DA, Otahal P, Cicolini J, Winzenberg TM, Jones G. The relationship between cumulative lifetime ultraviolet radiation exposure, bone mineral density, falls risk and fractures in older adults. Osteoporos Int 2017; 28:2061-2068. [PMID: 28321507 DOI: 10.1007/s00198-017-4001-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/07/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED Data linking cumulative lifetime vitamin D status with skeletal outcomes are lacking. We show that increasing cumulative sun exposure was associated with higher bone mineral density in younger males and protective against fractures in females independent of current vitamin D. This supports the concept that cumulative sun exposure is an important contributor to skeletal health. INTRODUCTION While low 25-hydroxyvitamin D levels are associated with increased fracture risk, this reflects only recent sun exposure. The Beagley-Gibson (BG) method utilises microtopographical skin changes to quantify cumulative lifetime ultraviolet radiation (sun) exposure. This study aimed to describe the relationship between BG grade, BMD, falls risk and fractures in older adults. METHODS Eight hundred thirty-five community-dwelling adults aged 53-83 years had silicone casts from the dorsum of both hands graded by the BG method. BMD was measured using DXA and falls risk using the short form of the Physiological Profile Assessment. Vertebral deformities and symptomatic fractures were assessed by DXA and questionnaire, respectively. RESULTS The relationship between BG grade, spine BMD and vertebral fracture varied depending upon sex. In females, increasing grade was associated with lower vertebral fracture prevalence (OR = 0.44/grade, p = 0.018) and fewer fractures (OR = 0.82/grade, p = 0.021), particularly major fractures (OR = 0.75/grade, p = 0.03). In males, increasing grade was associated with more DXA-detected vertebral deformities (RR = 1.28/grade, p = 0.001), but not symptomatic fractures. These relationships were independent of BMD, falls risk, smoking and current 25-hydroxyvitamin D. BG grade was not associated with falls risk. For BMD, there were interactions between BG grade and both age and sex and a positive trend with hip BMD in younger males. CONCLUSIONS BG grade demonstrated beneficial associations with fracture outcomes in females and BMD in younger males independent of current 25-hydroxyvitamin D. These data support the concept that cumulative ultraviolet radiation exposure is an important determinant of skeletal health. The association with vertebral deformities in males may reflect outdoor physical trauma in younger life.
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Affiliation(s)
- M J W Thompson
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, 7000, Australia.
| | - D A Aitken
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, 7000, Australia
| | - P Otahal
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, 7000, Australia
| | - J Cicolini
- University of Otago, Dunedin, Otago, New Zealand
| | - T M Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, 7000, Australia
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, 7000, Australia
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Abstract
AbstractA high Ca intake has been recommended for osteoporosis prevention; however, little research has examined the relationship between dietary Ca and bone health in men. We examined associations between dietary Ca intake, bone mineral density (BMD) and change in BMD at the total body, hip and spine over 2 years in a cohort of men (mean age 57 years, BMI 26 kg/m2) from a trial. Data from the total cohort (n 323) were used in the analysis of Ca intake and BMD at baseline, and data from the placebo group (n 99) were used in the longitudinal analysis of Ca intake and change in BMD. Parathyroid hormone (PTH) and the markers of bone turnover serum total alkaline phosphatase activity, serum C-telopeptide and serum procollagen type-1 N-terminal propeptide were measured in a subset of participants at baseline (n 150), and associations with dietary Ca at baseline were examined. Mean Ca intake was 870 mg/d. Baseline BMD was not related to dietary Ca intake at any site, before or after adjustment for covariables. Similarly, bone loss over 2 years was not related to Ca intake at any site, before or after adjustment. Dietary Ca intake was inversely correlated with PTH at baseline (r −0·19, P=0·02), but was not associated with the markers of bone turnover. BMD and rates of bone loss were unrelated to Ca intake in these men. This suggests that strategies to increase Ca intake are unlikely to impact on the prevalence of and morbidity from male osteoporosis.
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