1.
Effects of valproic acid on bone mineral density and bone metabolism: A meta-analysis.
Fan, D, Miao, J, Fan, X, Wang, Q, Sun, M
Seizure. 2019;:56-63
Abstract
PURPOSE Numerous studies have shown that the risk of fracture is increased by long-term antiepileptic drugs (AEDs). Valproic acid (VPA) is one of the most commonly used AEDs. In this meta-analysis, we aimed to assess the effects of VPA on bone mineral density (BMD) and bone metabolism. METHODS PubMed, Embase, Cochrane and Web of Science databases were searched from inception to January 2019 for articles focusing on the effects of VPA on BMD and bone metabolism in adults or children. A meta-analysis was performed using RevMan 5. 3 software. RESULTS 18 studies were included in the meta-analysis. The BMD of lumber spine (MD= -0.06, 95%CI: -0.09 to -0.03, P < 0.0001) and femoral neck (MD= -0.05, 95% CI= -0.08 to -0.01, P = 0.02) was markedly decreased in the VPA group compared to healthy controls. Serum bone-specific alkaline phosphatase (BALP) level (SMD = 0.85, 95% CI: 0.30-1.40, P = 0.002) was notably increased in the VPA group compared to healthy groups. In the child group, the serum parathyroid hormone (PTH) level was higher than in healthy groups (SMD= -0.22, 95% CI: -0.40 to -0.04, P = 0.02); besides, the serum 25-hydroxy vitamin D3 (25(OH)D3) level was decreased (SMD= -0.22, 95% CI: -0.40 to -0.04, P = 0.02), while no significant alteration of these parameters was noted in the adult VPA group (P ≥ 0.05). CONCLUSIONS VPA may reduce the BMD of lumbar spine and femoral neck in patients with epilepsy while increasing the serum BALP level. Serum PTH level are increased and serum 25(OH)D3 level decreased in children with epilepsy treated with VPA. These parameters were unaltered in adults.
2.
A systematic review and meta-analysis of randomized placebo-controlled trials of DHEA supplementation of bone mineral density in healthy adults.
Lin, H, Li, L, Wang, Q, Wang, Y, Wang, J, Long, X
Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology. 2019;(11):924-931
Abstract
To find out if DHEA replacement improves bone mineral density (BMD) in healthy older adults. We systematically searched Medline via PubMed, Embase, and the Cochrane Library Center Register to identify randomized controlled trials up to October 2018. Effect estimates were performed in random effect models. Bone mineral density of hip and trochanter, total body, lumbar spine, and femoral neck were conducted. Hip BMD increased significantly above placebo group in women who took DHEA supplementation (SMD -0.5[-0.95, -0.04], p = .03). The SMD of trochanter BMD of women in placebo group than DHEA group was -0.55 [-1.10, 0.00], p = .05. Insulin-like growth factor 1 (IGF-1) did not change in men compared to placebo group also (-0.56 [-1.22, 0.10], p = .09). In women, IGF-1 significantly improved in DHEA supplementation group than placebo group (-2.61 [-4.85, -0.38], p = .02). In summary, the results of this meta-analysis suggest that DHEA replacement therapy can partially increase BMD of hip and trochanter in women. Similar results were not observed in men. More trials may be necessary to allow for a positive and clinically significant effect of DHEA on BMD.
3.
Associations between bone-alkaline phosphatase and bone mineral density in adults with and without diabetes.
Chen, H, Li, J, Wang, Q
Medicine. 2018;(17):e0432
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Abstract
Insufficient evidence is available to reliably compare the roles of bone alkaline phosphatase (BAP) and bone mineral density (BMD) in diabetes. This study aimed to compare associations between BAP and BMD in adults with and without diabetes to elucidate fracture risk in diabetes.Data were extracted from the National Health and Nutrition Examination Survey (NHANES), 2001-2004, including 4197 adults aged 20 to 49 years, 143 with diabetes (DM group), and 4054 without (non-DM group). Main outcome measure was BMD and regression analyses were performed to identify serum BAP and other covariates associated with total BMD.BMD decreased significantly in DM patients when BAP was increased. In the non-DM group, all BMD results were significantly decreased when BAP was increased. Factors associated with total BMD varied with DM status. Lifestyle measures such as smoking and physical activity were also associated with BMD in the non-DM group.BAP and BMD are inversely associated in DM and non-DM patients. BAP is significantly associated with BMD after controlling for other variables, suggesting that BAP may interact with other factors altering bone metabolism in DM patients.