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Monitoring bone strontium intake in osteoporotic females self-supplementing with strontium citrate with a novel in-vivo X-ray fluorescence based diagnostic tool.
Moise, H, Chettle, DR, Pejović-Milić, A
Bone. 2014;:48-54
Abstract
Ten female volunteers were recruited as part of the Ryerson and McMaster University Strontium (Sr) in Bone Research Study to have their bone Sr levels measured as they self-supplemented with Sr supplements of their choice. Of the ten volunteers, nine were suffering from osteopenia and/or osteoporosis. Non-invasive bone Sr measurements were performed using an in vivo x-ray fluorescence (IVXRF) I-125 based system. Thirty minute measurements were taken at the finger and ankle, representing primarily cortical and trabecular bone, respectively. For analysis, the 14.2keV Sr K-alpha peak normalized to the Coherent peak at 35.5keV was used. Baseline readings, representing natural bone Sr levels were acquired since all volunteers had no previous intake of Sr based supplements or medications. Once Sr supplements were started, a 24h reading was taken, followed by frequent measurements ranging from weekly, biweekly to monthly. The longest volunteer participation was 1535days. The mean baseline Sr signal observed for the group was 0.42±0.13 and 0.39±0.07 for the finger and ankle, respectively. After 24h, the mean Sr signal rose to 1.43±1.12 and 1.17±0.51, for the finger and ankle, respectively, representing a statistically significant increase (p=0.0043 & p=0.000613). Bone Sr levels continued to increase throughout the length of the study. However the Sr signal varied widely between the individuals such that after three years, the highest Sr signal observed was 28.15±0.86 for the finger and 26.47±1.22 for the ankle in one volunteer compared to 3.15±0.15 and 4.46±0.36, for the finger and ankle, respectively in another. Furthermore, while it was previously reported by our group, that finger bone Sr levels may plateau within two years, these results suggest otherwise, indicating that bone Sr levels will continue to rise at both bone sites even after 4years of Sr intake.
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Zoledronic acid for treatment of osteopenia and osteoporosis in women with primary breast cancer undergoing adjuvant aromatase inhibitor therapy.
Hines, SL, Sloan, JA, Atherton, PJ, Perez, EA, Dakhil, SR, Johnson, DB, Reddy, PS, Dalton, RJ, Mattar, BI, Loprinzi, CL
Breast (Edinburgh, Scotland). 2010;(2):92-6
Abstract
BACKGROUND Postmenopausal women with osteoporosis/osteopenia are at increased risk of fracture. Aromatase inhibitors further increase bone loss in these patients. This study evaluates whether zoledronic acid prevents the bone loss expected when these patients initiate letrozole. PATIENTS AND METHODS Postmenopausal women with estrogen and/or progesterone receptor-positive breast cancer and a bone mineral density (BMD) T-score <-2.0 were given letrozole 2.5mg/vitamin D 400 international units daily, calcium 500mg twice daily, and 4mg zoledronic acid every 6 months. The BMD was assessed at baseline and 1 year. The primary endpoint was the mean change in lumbar spine (LS) BMD at 1 year. RESULTS Forty-six patients completed 1 year of treatment. LS BMD increased by 2.66% (p=0.01), femoral neck (FN) by 4.81% (p=0.01), and any measured endpoint by 4.55% (p=0.0052). CONCLUSIONS Zoledronic acid prevents bone loss in postmenopausal women with osteoporosis/osteopenia starting letrozole and is associated with improvements in BMD.
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Long-term 1,25(OH)2 vitamin D therapy increases bone mineral density in osteopenic women. Comparison with the effect of plain vitamin D.
Zofkova, I, Hill, M
Aging clinical and experimental research. 2007;(6):472-7
Abstract
BACKGROUND AND AIMS Although the bone protective effect of vitamin D has been studied intensively, the usefulness of 1,25(OH)2D3 in treating osteoporosis is still questionable. The aim of the present prospective study was to evaluate the effect of a standard pharmacological dose of 1,25(OH)2D3 in postmenopausal unsubstituted women. METHODS Our study group comprised 52 post-menopausal women with low normal or osteopenic values of bone mineral density (BMD). Thirty-two of them were treated with 1,25(OH)2D3 for 3 years. In parallel, another group of women was treated with cholecalciferol (n=20). Vitamin D adequacy before administration of 1,25(OH)2D3 and compliance with treatment were checked by serum PTH levels, which were assessed at the start and three times in the course of treatment. RESULTS Increase in BMD at the spine at the end of the 1st, 2nd and 3rd years of treatment with 1,25(OH)2D3 (expressed as a percentage of the value before treatment) was higher, but did not significantly differ from the effect of plain vitamin D. A significant increase in BMD at the hip at the end of the 3rd (but not the 1st and 2nd) year of treatment with 1,25(OH)2D3 was found (p<0.05, compared with the effect of plain vitamin D). The protective effect of cholecalciferol was found only on spine but not hip BMD. CONCLUSION The study supports the hypothesis that long-term administration of 1,25(OH)2D3 is effective in treating low bone mass in postmenopausal women.
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Intravenous pamidronate prevents femoral bone loss and renal stone formation during 90-day bed rest.
Watanabe, Y, Ohshima, H, Mizuno, K, Sekiguchi, C, Fukunaga, M, Kohri, K, Rittweger, J, Felsenberg, D, Matsumoto, T, Nakamura, T
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2004;(11):1771-8
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Abstract
UNLABELLED Long-term bed rest has potential risks of bone loss and renal stone formation. We examined the effects of resistive exercise and intravenous pamidronate on BMD, bone turnover, urinary calcium, and renal stone formation in 25 healthy males during 90-day bed rest. Pamidronate prevented femoral bone loss and renal stone formation, but resistive exercise showed little effects. INTRODUCTION Long-term bed rest increases the risks of bone loss and urinary stone formation. Resistive exercise increases bone formation, and bisphosphonates reduce bone resorption. However, the effects of muscle exercise and bisphosphonates have not been examined side-by-side. The objectives of this study are to compare the effects of pamidronate with resistive exercise on BMD and renal stone formation during prolonged bed rest. MATERIALS AND METHODS Twenty-five male white volunteers, 26-45 years of age, were randomly assigned to the control (n = 9), exercise (n = 9), and pamidronate (n = 7) groups and underwent 90-day 6 degrees head-down tilt bed rest. Exercise group performed squats and heel raises on a flywheel device for 30 minutes every 3 days. Pamidronate (60 mg) was administered intravenously 14 days before bed rest. BMD of the head, forearm, lumbar spine, and proximal femur; biochemical bone markers; calcium (Ca) metabolism; and abdominal radiographs were examined during 90 days of bed rest and 360 days of reloading. RESULTS In controls, proximal femoral BMD decreased, and bone resorption markers and urinary Ca increased during bed rest, along with development of renal stones in two of nine subjects. Resistive exercise increased bone formation but was unable to prevent femoral BMD decrease and increases in bone resorption and urinary Ca during bed rest, with formation of renal stones in four of nine subjects. Pamidronate maintained femoral BMD, reduced bone resorption and urinary Ca, and completely prevented renal stone formation. CONCLUSIONS Resistive exercise increased bone formation but could not reduce bone resorption and the risk of renal stones. In contrast, inhibition of bone resorption by pamidronate could preserve bone mineral and reduce the risk of renal stone formation during prolonged bed rest.
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Effects of Morinda citrifolia on quality of life and auditory function in postmenopausal women.
Langford, J, Doughty, A, Wang, M, Clayton, L, Babich, M
Journal of alternative and complementary medicine (New York, N.Y.). 2004;(5):737-9
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Treatment of osteopenia and osteoporosis in renal transplant children and adolescents.
El-Husseini, AA, El-Agroudy, AE, El-Sayed, MF, Sobh, MA, Ghoneim, MA
Pediatric transplantation. 2004;(4):357-61
Abstract
Successful renal transplantation corrects many of the metabolic abnormalities associated with the development of renal osteodystrophy, but despite a well-functioning graft osteopenia, growth failure, spontaneous fractures, and avascular necrosis remain prevalent in adult and pediatric kidney recipients. A paucity of information exists regarding the effects of different therapies to prevent and treat bone loss in the renal transplant recipients. We constructed a design to study the effect of different modalities of treatment on bone mass in our renal transplant children. Among 93 patients who underwent renal transplantation at the age of 17 yr or less and were subjected to dual-energy X-ray absorptiometry (DEXA), we blindly randomized 60 patients who had osteopenia or osteoporosis (T-score = -1 by DEXA) in a prospective study. Their mean age at time of transplantation was 13.4 +/- 4.3 yr. The mean duration after transplantation was 48 +/- 34 months. The patients were classified randomly into four groups. Each group consisted of 15 patients: group 1 was the control group, group 2 received oral alfacalcidol 0.25 microg daily, group 3 received oral alendronate 5 mg daily, and group 4 received 200 IU/day nasal spray calcitonin. Parameters of bone turnover, calcium metabolism, and DEXA were measured before and after 12 months of treatment duration. The characteristics of all groups were comparable at the beginning of the study. At the lumber spine, bone mass density decreased from -2.4 to -2.8 in group 1, increased from -2.3 to -0.5 in group 2, from -2.3 to -1.9 in group 3, and from -2.3 to -1.0 in group 4. The four groups had similar patient profiles, serum creatinine, intact parathyroid hormone, osteocalcin, and deoxypyridinoline. This study confirmed the value of alfacalcidol and antiresorptive agents in the treatment of osteopenia and osteoporosis in young renal transplant recipients.These therapies were safe, tolerable, simple to administer and potentially applicable to other renal transplant patients.
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Bone loss following hematopoietic stem cell transplantation: a long-term follow-up.
Schulte, CM, Beelen, DW
Blood. 2004;(10):3635-43
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Abstract
Transplantation-associated bone loss is a well-known phenomenon, however, effects of hematopoietic stem cell transplantation are insufficiently characterized. We conducted a prospective, unicentric, long-term follow-up in 280 patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Bone mineral density (BMD) was measured before transplantation and then yearly for at least 4 years. Patients received vitamin D plus calcium until steroid withdrawal. Mean baseline BMD was normal. We demonstrated significant bone loss with nadir BMD at month 6 for the spine and at month 24 for total body and femoral neck. Average annual bone loss was 0.6% for spine, 0.4% for total body, 2.3% for femoral neck, and 3.5% for Ward triangle. While spine and total body BMD returned to baseline, bone loss at femoral neck sites was attenuated, but BMD did not return to baseline until month 48 (P <.0001 for femoral neck and Ward triangle). Univariate factor analysis of 15 potential risk factors for rapid bone loss revealed a positive correlation of bone loss with steroid and cyclosporine A use, baseline BMD, and loss of muscle mass (overwhelming power of steroid use in multifactor analysis). Such rapid BMD changes probably increase fracture risk consecutive to irreversible microarchitectural changes even if osteodensitometry shows long-term recovery.
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Evaluation of treadmill exercise in a lower body negative pressure chamber as a countermeasure for weightlessness-induced bone loss: a bed rest study with identical twins.
Smith, SM, Davis-Street, JE, Fesperman, JV, Calkins, DS, Bawa, M, Macias, BR, Meyer, RS, Hargens, AR
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2003;(12):2223-30
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UNLABELLED Counteracting bone loss is required for future space exploration. We evaluated the ability of treadmill exercise in a LBNP chamber to counteract bone loss in a 30-day bed rest study. Eight pairs of identical twins were randomly assigned to sedentary control or exercise groups. Exercise within LBNP decreased the bone resorption caused by bed rest and may provide a countermeasure for spaceflight. INTRODUCTION Bone loss is one of the greatest physiological challenges for extended-duration space missions. The ability of exercise to counteract weightlessness-induced bone loss has been studied extensively, but to date, it has proven ineffective. We evaluated the effectiveness of a combination of two countermeasures-treadmill exercise while inside a lower body negative pressure (LBNP) chamber-on bone loss during a 30-day bed rest study. MATERIALS AND METHODS Eight pairs of identical twins were randomized into sedentary (SED) or exercise/LBNP (EX/LBNP) groups. Blood and urine samples were collected before, several times during, and after the 30-day bed rest period. These samples were analyzed for markers of bone and calcium metabolism. Repeated measures ANOVA was used to determine statistical significance. Because identical twins were used, both time and group were treated as repeated variables. RESULTS Markers of bone resorption were increased during bed rest in samples from sedentary subjects, including the collagen cross-links and serum and urinary calcium concentrations. For N-telopeptide and deoxypyridinoline, there were significant (p < 0.05) interactions between group (SED versus EX/LBNP) and phase of the study (sample collection point). Pyridinium cross-links were increased above pre-bed rest levels in both groups, but the EX/LBNP group had a smaller increase than the SED group. Markers of bone formation were unchanged by bed rest in both groups. CONCLUSIONS These data show that this weight-bearing exercise combined with LBNP ameliorates some of the negative effects of simulated weightlessness on bone metabolism. This protocol may pave the way to counteracting bone loss during spaceflight and may provide valuable information about normal and abnormal bone physiology here on Earth.
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[Alendronate in postmenopausal women with osteopenia and osteoporosis: effects on bone mineral density during treatment and after withdrawal].
Jiang, Y, Li, M, Xia, W, Xing, X, Yu, W, Tian, J, Meng, X, Zhou, X
Zhonghua yi xue za zhi. 2002;(18):1254-6
Abstract
OBJECTIVE To determine the efficacy of alendronate (Fosamax) administration and withdrawal on the bone mineral density (BMD) in postmenopausal women with osteopenia and osteoporosis. METHODS Alendronate (10 mg) and calcium carbonate (containing calcium 500 mg) were administered daily to 25 Chinese menopausal women with osteopenia and osteoporosis for 6 months and to 15 women for 12 months. After the withdrawal of alendronate, calcium carbonate was administered continuously. Follow-up was made three times for the 6-month group: before treatment, 6 months after treatment, and 13 +/- 4 months (6 - 24 months) after aldoronate withdrawal, and was made four times for the 12-month group: before treatment, 6 months and 12 months after treatment, and 23 +/- 7 months (14 - 36 months) after alendronate withdrawal to determine the BMD of lumbar spine 2 approximately 4, neck of femur, Wards triangle, and greater trochanter and blood alkaline phosphatase (ALP). RESULTS Compared to the baseline value, the BMD in lumbar spine and hip increased significantly 6 months after treatment in 6-month group, with the BMD in lumbar spine 2 - 4 increased by 5.3% (P < 0.001). In the 6 month group, no significant decline was found in the BMD in lumbar spine and hip 13 +/- 4 months after alendronate withdrawal, the BMD in greater trochanter even increased further compared with that 6 months after treatment. In the 12-month group, the BMD significantly increased except in the Wards triangle after 6 months' treatment with an increase by 4.2% in lumbar spine 2 - 4 (P < 0.001). After 12 months' treatment the increment of BMD in lumbar spine 2 - 4 was 6.1% (P < 0.001) and the BMD of the hip remained unchanged. 23 +/- 7 months after the alendronte withdrawal the values of BMD in lumbar spine and hip were almost the same as that 12 months after treatment. CONCLUSION Alendronate increases the BMD in spine and hip, especially in lumbar spine. The skeletal benefits are maintained for at least 13 - 23 months in spine and hip after withdrawal of alendrenate.
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Effect of intravenous pamidronate on bone mineral density in adults with cystic fibrosis.
Haworth, CS, Selby, PL, Adams, JE, Mawer, EB, Horrocks, AW, Webb, AK
Thorax. 2001;(4):314-6
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BACKGROUND Low bone mineral density (BMD) is prevalent in adults with cystic fibrosis. The aim of this study was to assess the effect of intravenous pamidronate on BMD in these subjects. METHODS Patients were invited to participate if they had a BMD Z score of -2 or less in the lumbar spine, proximal femur, or distal forearm. Patients were randomised to receive either 30 mg intravenous pamidronate every 3 months + 1 g calcium daily (pamidronate group) or 1 g calcium daily (control group). All pancreatic insufficient patients were prescribed oral vitamin D supplements. RESULTS After 6 months of treatment the pamidronate group (n=13) showed a significant increase in absolute BMD compared with the control group (n=15) in the lumbar spine (mean difference 5.8% (CI 2.7% to 8.9%)) and total hip (mean difference 3.0% (CI 0.3% to 5.6%)). However, the pamidronate group showed a reduction in BMD compared with the control group in the distal forearm (mean difference -1.7% (CI -3.7% to 0.3%)). The use of pamidronate was associated with a high incidence of bone pain in non-corticosteroid treated individuals. CONCLUSION Intravenous pamidronate increases axial BMD in adults with cystic fibrosis, but the high incidence of bone pain associated with this treatment might limit its use.