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Physical exercise associated with improved BMD independently of sex and vitamin D levels in young adults.
Tønnesen, R, Schwarz, P, Hovind, PH, Jensen, LT
European journal of applied physiology. 2016;(7):1297-304
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PURPOSE Young men and women accrue the majority of their bone mass in their teens and twenties, where their bone mass peaks (PBM), yet little is known about the roles of physical exercise, vitamin D levels and bone mineral density (BMD) near PBM. METHODS To comparatively examine the effect of physical exercise and two vitamin D levels (insufficient s-25[OH]D <50 nmol/L and sufficient s-25[OH]D >80 nmol/L) on the BMD measured at the femoral neck, total hip (bilaterally) and the lumbar spine (L2-L4) in male and female participants approaching PBM. RESULTS The insufficient s-25[OH]D group, median age 21.6 (19.8-22.8) years, and BMI 24.2 ± 5.0 kg/m(2) had BMD 0.10 (0.03, 0.17) g/cm(2) (p = 0.008) lower at all DXA-scan sites compared to the sufficient s-25[OH]D group, median age 19.5 (19.0-22.3) years, and BMI of 22.6 ± 1.8 kg/m(2). Exercise was positively associated with the BMD at all DXA-scan sites (p trend = 0.0001) and with equal benefit; there was no interaction between exercise and the DXA-scan site (p = 0.09). The male participants did not have a systematically higher BMD than the female participants for all scan sites; only for hips total and femoral neck bilaterally, while it was equal at the lumbar spine. CONCLUSION The BMD in young healthy adults is associated with physical exercise, independent of sex and s-25[OH]D status. A sufficient s-25[OH]D status was systematically associated with a higher BMD for all levels of exercise. For both sexes and vitamin D levels exercise was equally positively associated with BMD.
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Circulating semaphorin-4D and plexin-B1 levels in postmenopausal women with low bone mass: the 3-month effect of zoledronic acid, denosumab or teriparatide treatment.
Anastasilakis, AD, Polyzos, SA, Makras, P, Gkiomisi, A, Sakellariou, G, Savvidis, M, Papatheodorou, A, Kokkoris, P, Terpos, E
Expert opinion on therapeutic targets. 2015;(3):299-306
Abstract
OBJECTIVE The evaluation of circulating semaphorin-4D (sema4D) and plexin-B1 in postmenopausal women with low bone mass and the effect of antiresorptive or osteoanabolic treatment. METHODS Serum samples were obtained from postmenopausal women with low bone mass at baseline and 3 months after zoledronic acid infusion (n = 30), denosumab injection (n = 30) or teriparatide initiation (n = 28) and from controls matched for age, age at menopause and body mass index (n = 30) at the same time points. MAIN OUTCOME MEASURES Circulating sema4D and plexin-B1. RESULTS Circulating sema4D increased following denosumab (p = 0.026), whereas decreased following teriparatide (p = 0.013). Sema4D/plexin-B1 ratio increased following denosumab (p = 0.004). At baseline, sema4D and plexin-B1 levels were higher in patients pre-treated with bisphosphonates compared to naïve ones (p < 0.001 and p = 0.001, respectively). In bivariate correlations sema4D was inversely correlated with serum carboxyterminal telopeptide of type 1 collagen (rs -0.282, p = 0.002), intact parathyroid hormone (rs -0.388, p < 0.001) and 25(OH)D (rs -0.316, p < 0.001), whereas there was a trend towards correlation with lumbar spine bone mineral density (rs -0.191, p = 0.053). CONCLUSIONS Sema4D levels are independently associated with previous bisphosphonate treatment, intact parathyroid hormone and 25(OH)D levels. Denosumab and teriparatide seem to exert an opposite effect on circulating sema4D levels. Further studies are needed to evaluate whether sema4D mediates the coupling effect that occurs following both antiresorptive and osteoanabolic treatment.
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Bone mineral content in patients with congenital generalized lipodystrophy is unaffected by metreleptin replacement therapy.
Christensen, JD, Lungu, AO, Cochran, E, Collins, MT, Gafni, RI, Reynolds, JC, Rother, KI, Gorden, P, Brown, RJ
The Journal of clinical endocrinology and metabolism. 2014;(8):E1493-500
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CONTEXT Leptin alters bone and mineral metabolism in rodents, but this has not been verified in humans. PATIENTS with congenital generalized lipodystrophy (CGL) have low leptin due to deficient adipose mass and serve as models of leptin deficiency and replacement. OBJECTIVE To study the effects of recombinant human methionyl leptin (metreleptin) on bone mineral content (BMC) and mineral metabolism. DESIGN AND SETTING An open-label nonrandomized study at the National Institutes of Health. PATIENTS Thirty-one patients with CGL (ages 4.3 to 46.7 y). INTERVENTION Metreleptin (0.06 to 0.24 mg/kg/d) for 6 months to 11 years. OUTCOME MEASURES BMC was assessed by dual-energy x-ray absorptiometry. SD scores (SDS) for BMC were calculated based on height, race, sex, and age using population normative data. Calcium, phosphorus, PTH, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D were measured at baseline and follow-up. RESULTS At baseline, patients demonstrated significantly increased total body less head BMC (mean SDS, 1.8 ± 0.7), height (mean SDS, 1.3 ± 1.3), and lean mass index, defined as lean body mass per height squared (mean SDS, 1.5 ± 0.83), vs population normative data. No change in total body less head BMC was observed after metreleptin. Lean mass index decreased with metreleptin. Serum calcium decreased with metreleptin, but remained within normal limits. No changes were seen in phosphorus, PTH, or vitamin D. CONCLUSIONS In contrast to rodent models, CGL patients have increased BMC in the leptin-deficient state, which does not change with leptin replacement. The high BMC in these patients is partially explained by high lean mass and tall stature.
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Changes in bone mineral density in men starting androgen deprivation therapy and the protective role of vitamin D.
Alibhai, SM, Mohamedali, HZ, Gulamhusein, H, Panju, AH, Breunis, H, Timilshina, N, Fleshner, N, Krahn, MD, Naglie, G, Tannock, IF, et al
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2013;(10):2571-9
Abstract
SUMMARY Androgen deprivation therapy in 80 men was associated with declines in bone mineral density (BMD), which were greatest in the first year, and in the lumbar spine compared to controls. Vitamin D use was associated with improved BMD in the lumbar spine and in the first year. INTRODUCTION Decreased BMD is a common side effect of androgen deprivation therapy (ADT), leading to increased risk of fractures. Although loss of BMD appears to be greatest within the first year of starting ADT, there are few long-term studies of change in BMD, and risk factors for bone loss are not well-characterized. METHODS Men aged 50+ with nonmetastatic prostate cancer starting continuous ADT were enrolled in a prospective longitudinal study. BMD was determined by dual-energy x-ray absorptiometry at baseline and yearly for 3 years. Matched controls were men with prostate cancer not receiving ADT. Multivariable regression analysis examined predictors of BMD loss. RESULTS Eighty ADT users and 80 controls were enrolled (mean age 69 years); 52.5 % had osteopenia and 8.1 % had osteoporosis at baseline. After 1 year, in adjusted models, ADT was associated with significant losses in lumbar spine BMD compared to controls (-2.57 %, p = 0.006), with a trend towards greater declines at the total hip (p = 0.09). BMD changes in years 2 and 3 were much smaller and not statistically different from controls. Use of vitamin D but not calcium was associated with improved BMD in the lumbar spine in year 1 (+6.19 %, p < 0.001) with smaller nonsignificant increases at other sites (+0.86 % femoral neck, +0.86 % total hip, p > 0.10) primarily in the first year. CONCLUSIONS Loss of BMD associated with ADT is greatest at the lumbar spine and in the first year. Vitamin D but not calcium may be protective particularly in the first year of ADT use.
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Bone mineral density is not significantly reduced in adult patients on low-dose glucocorticoid replacement therapy.
Koetz, KR, Ventz, M, Diederich, S, Quinkler, M
The Journal of clinical endocrinology and metabolism. 2012;(1):85-92
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CONTEXT Patients with primary adrenal insufficiency (PAI) and patients with congenital adrenal hyperplasia (CAH) receive glucocorticoid replacement therapy, which might cause osteoporosis. OBJECTIVES Questions addressed by this study were: 1) Is bone mineral density (BMD) reduced in PAI and CAH on lower glucocorticoid doses than previously reported? 2) Is BMD in PAI influenced by the type of glucocorticoid used? and 3) Does DHEA treatment affect BMD in PAI women? DESIGN AND PATIENTS We conducted a prospective, cross-sectional study including 81 PAI patients and 41 CAH patients. MAIN OUTCOME MEASURES BMD was measured by dual-energy x-ray absorptiometry. Serum levels of bone turnover markers, minerals, vitamins, hormones, and urinary crosslinks were measured. RESULTS PAI and CAH patients received average daily hydrocortisone doses of 12.0 ± 2.7 mg/m(2) (range, 4.9-19.1) and 15.5 ± 7.8 mg/m(2) (range, 5.7-33.7), respectively. BMD varied within the normal reference range (-2 to +2) in both cohorts. However, lower Z-scores for femoral neck and Ward's region were found in CAH compared to PAI women, but not in men. Prednisolone treatment showed significant lower osteocalcin levels and lower Z-scores for lumbar spine and femoral neck compared to PAI patients on hydrocortisone. PAI women treated with DHEA had significantly lower urinary collagen crosslinks and bone alkaline phosphatase, and significantly higher Z-scores in lumbar spine and femoral Ward's region compared to non-DHEA-treated women. CONCLUSIONS Adult PAI and CAH patients on low glucocorticoid doses showed normal BMD within the normal reference range. The use of longer acting prednisolone resulted in significantly lower BMD in PAI. In addition, DHEA treatment may have a beneficial effect on bone in Addison's women.
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Serum 25(OH)D3 vitamin status of elderly Finnish women is suboptimal even after summer sunshine but is not associated with bone density or turnover.
Pekkarinen, T, Turpeinen, U, Hämäläinen, E, Löyttyniemi, E, Alfthan, H, Välimäki, MJ
European journal of endocrinology. 2010;(1):183-9
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OBJECTIVE Concentrations of 50 and 75 nmol/l are proposed as serum 25-hydroxyvitamin D (25(OH)D) target for older people from the view of bone health. We evaluated vitamin D status of elderly Finnish women in light of these definitions, its relationship to bone mineral density (BMD) and turnover, and improvement by summer sunshine. DESIGN Population-based study. METHODS A total of 1604 ambulatory women aged 62-79 years were studied; 66% used vitamin D supplements. Serum 25(OH)D(3) was measured with HPLC before and after summer, and heel BMD in spring. In subgroups, serum parathyroid hormone (PTH) and type I procollagen aminoterminal propeptide (PINP) were analyzed. RESULTS In spring, 60.3% of the women had 25(OH)D(3) CONCLUSIONS Vitamin D status of elderly Finnish women is suboptimal if 25(OH)D(3) levels of 50 or 75 nmol/l are used as a threshold. It is moderately increased by supplement intake and summer sunshine. However, 25(OH)D(3) concentrations did not influence bone density in terms of serum PINP and bone turnover rate.
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Bone mineral density and metabolism in levothyroxine-treated adolescent girls with euthyroid diffuse goiter.
Matusik, P, Małecka-Tendera, E, Franek, E, Januszek-Trzciakowska, A
Endokrynologia Polska. 2010;(1):14-9
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INTRODUCTION Bone and mineral metabolism is influenced by thyroid hormones, and levothyroxine (LT(4)) therapy may be associated with reduced bone mass in postmenopausal women. MATERIAL AND METHODS The aim of the study was to assess the influence of one year of LT(4) treatment in a group of 21 adolescent girls with euthyroid diffuse goiter. Lumbar (L(2)-L(4)) and total body bone mineral density (TOBMD) (Lunar - DXA), serum PTH, osteocalcin, bone alkaline phosphate, vitamin D(3), calcium, and phosphorus levels and urinary excretion of Ca, P, and hydroxyproline were measured before and after one year of combined LT(4) and iodine treatment. RESULTS Patients were matched for age, sex, BMI, and maturation status, with controls treated with iodine only. Markers of bone turnover changed in a similar manner in both groups. There was no significant difference in TOBMD value after one year of therapy between LT(4) treated group and controls. Densitometric lumbar spine parameters increased significantly after 12 months in both groups, with no significant differences between them. CONCLUSION It can be concluded that one year of LT(4) treatment of adolescent girls with euthyroid diffuse goiter does not have a negative impact on their bone remodelling and metabolism. (Pol J Endocrinol 2010; 61 (1): 14-19).
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Ultrasound bone mass in schizophrenic patients on antipsychotic therapy.
Rey-Sánchez, P, Lavado-García, JM, Canal-Macías, ML, Gómez-Zubeldia, MA, Roncero-Martín, R, Pedrera-Zamorano, JD
Human psychopharmacology. 2009;(1):49-54
Abstract
OBJECTIVE To determine bone mass using quantitative phalangeal bone ultrasound in institutionalized schizophrenic patients under chronic treatment with antipsychotic drugs. METHODS A total of 73 patients with schizophrenia (25 women, mean age 59.84 +/- 17.01 years; 48 men, mean age 61.89 +/- 12.95 years) and 73 healthy subjects (25 women, mean age 60.37 +/- 17.16 years; 48 men, mean age 61.24 +/- 13.09 years) participated in the study. Bone status was assessed using an ultrasound device that measures the amplitude-dependent speed of sound (Ad-SoS) in metres per second. Measurements were made on the phalanges (II-V) of the non-dominant hand, and the mean value was computed. RESULTS The schizophrenic women had higher levels of prolactin (PRL), parathyroid hormone (PTH), alkaline phosphatase (AlPh), and tartrate-resistant acid phosphatase (TRAP) (all p < 0.0001), and lower 25-hydroxyvitamin D(25(OH)D3) levels (p < 0.0001) and Ad-SoS values (p < 0.05) than controls. Ad-SoS was higher in schizophrenic men (p < 0.05). CONCLUSIONS Schizophrenic women in treatment with antipsychotic drugs had a loss of phalangeal bone mass that was associated with the levels of vitamin D or PTH, and increased bone turnover.
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Vitamin K treatment reduces undercarboxylated osteocalcin but does not alter bone turnover, density, or geometry in healthy postmenopausal North American women.
Binkley, N, Harke, J, Krueger, D, Engelke, J, Vallarta-Ast, N, Gemar, D, Checovich, M, Chappell, R, Suttie, J
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2009;(6):983-91
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Low vitamin K status is associated with low BMD and increased fracture risk. Additionally, a specific menaquinone, menatetrenone (MK4), may reduce fracture risk. However, whether vitamin K plays a role in the skeletal health of North American women remains unclear. Moreover, various K vitamers (e.g., phylloquinone and MK4) may have differing skeletal effects. The objective of this study was to evaluate the impact of phylloquinone or MK4 treatment on markers of skeletal turnover and BMD in nonosteoporotic, postmenopausal, North American women. In this double-blind, placebo-controlled study, 381 postmenopausal women received phylloquinone (1 mg daily), MK4 (45 mg daily), or placebo for 12 mo. All participants received daily calcium and vitamin D(3) supplementation. Serum bone-specific alkaline phosphatase (BSALP) and n-telopeptide of type 1 collagen (NTX) were measured at baseline and 1, 3, 6, and 12 mo. Lumbar spine and proximal femur BMD and proximal femur geometry were measured by DXA at baseline and 6 and 12 mo. At baseline, the three treatment groups did not differ in demographics or study endpoints. Compliance with calcium, phylloquinone, and MK4 treatment was 93%, 93%, and 87%, respectively. Phylloquinone and MK4 treatment reduced serum undercarboxylated osteocalcin but did not alter BSALP or NTX. No effect of phylloquinone or MK4 on lumbar spine or proximal femur BMD or proximal femur geometric parameters was observed. This study does not support a role for vitamin K supplementation in osteoporosis prevention among healthy, postmenopausal, North American women receiving calcium and vitamin D supplementation.
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Effect of community-based nutrition education intervention on calcium intake and bone mass in postmenopausal Vietnamese women.
Hien, VT, Khan, NC, Mai, le B, Lam, NT, Phuong, TM, Nhung, BT, Nhien, NV, Nakamori, M, Yamamoto, S
Public health nutrition. 2009;(5):674-9
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OBJECTIVE To examine the effect of community-based nutrition education intervention on calcium intake and bone mass in Vietnamese postmenopausal women. DESIGN A controlled trial was conducted in two groups as intervention and control. The intervention group was given nutrition education during 18 months to improve calcium intake, while the control subjects had the usual diet. Calcium intake and bone mass were evaluated every 6 months. Bone mass was assessed by speed of sound (SOS) at calcaneus, referred to as quantitative ultrasound measurement. Anthropometric indices and serum parathyroid hormone (PTH) were determined at baseline and at the end of intervention. SETTING Two rural communes of Hai Duong province located in the Red River Delta in Vietnam. SUBJECTS A total of 140 women aged 55-65 years, who were more than 5 years postmenopausal and with low calcium intake (<400 mg/d), were recruited. After 18 months of intervention, 108 women completed the study. RESULTS Calcium intake in the intervention group had increased significantly (P < 0.01) while it had no significant changes in controls. SOS values were not changed significantly in the intervention subjects while it decreased significantly by 0.5 % in the controls (P < 0.01). The intervention led to a decrease in serum PTH by 12 % (P < 0.01). In the controls, there was an increase in serum PTH by 32 % (P < 0.001). CONCLUSION Nutrition education intervention was effective in improving calcium intake and retarding bone loss in the studied subjects.