25-hydroxyvitamin-d-2 and Osteoporosis

Clinical studies have suggested a possible association of low serum vitamin D levels in patients with bone fractures. This, coupled with a high prevalence of fractures and increases in associated disability and mortality, begs the question, is there evidence to support a role for therapeutic drug monitoring of vitamin D levels to prevent bone fractures? We use a previously published nine-step decision-making algorithm to answer this question. Optimal dosages of vitamin D have not been determined, although daily intake guidelines are suggested. Current vitamin D assays yield varying results, making it challenging for clinicians to interpret results from clinical trials and apply them directly to patients and their specific serum level data. Fracture risk is not easily assessable clinically, with no clear relationship between vitamin D concentrations and bone mineral density. The existing primary literature shows no clear relationship between vitamin D concentrations and fracture risk; target concentrations are not well established. Although the pharmacokinetic parameters of vitamin D are unpredictable and vitamin D supplementation is frequently lifelong, results of a vitamin D assay are unlikely to make a significant difference in the clinical decision-making process (i.e., provide more information than clinical judgment alone). Most published studies on vitamin D levels and fracture risk did not control for other potential reasons to monitor levels, multifactorial risks for fractures, and other confounders. Given limited data to support a direct relation between vitamin D levels and clinical outcome of fracture, inconsistent between-assay results, and no consensus on optimal levels, there is insufficient evidence to recommend routine therapeutic drug monitoring of vitamin D for fracture prevention; however, other reasons for monitoring might exist that are beyond the scope of this review. Recent availability of vitamin D assay standards may lead to future improvements in comparability of research data, establishment of a target range, and interpretability of patient results.

Topics: 25-Hydroxyvitamin D 2; Algorithms; Biomarkers; Blood Chemical Analysis; Bone and Bones; Bone Density; Calcifediol; Calcium; Decision Making; Dietary Supplements; Drug Monitoring; Fractures, Bone; Humans; Osteoporosis; Risk Factors; Vitamin D; Vitamin D Deficiency

The onset of idiopathic osteoporosis after delivery is called "Post-Pregnancy Osteoporosis", which was suggested for the syndrome by Nordin in 1955. Back pain and vertebral collapse are the most frequent feature. This disease usually occurs in the first pregnancy and dose not recur, but the mechanisms remains to be elucidated. It is suggested that in patients with post-pregnancy osteoporosis there may have been a transient failure of the usual changes in calciotropic hormones such as 1,25-(OH)2D, calcitonin and parathyroid hormone (PTH) to prepare the maternal skeleton due to the stress of childbirth. The clinical course of these patients accords well with previous reports.

Topics: 25-Hydroxyvitamin D 2; Adult; Bone and Bones; Calcitonin; Female; Humans; Lactation; Osteoporosis; Parathyroid Hormone; Parity; Postpartum Period; Pregnancy

Topics: 25-Hydroxyvitamin D 2; Calcitriol; Ergocalciferols; Fractures, Bone; Humans; Osteoporosis

Bedridden patients are at risk of osteoporosis and fractures, although the long-term bone metabolic processes in these patients are poorly understood. Therefore, we aimed to determine how long-term bed confinement affects bone metabolism.. This study included 36 patients who had been bedridden from birth due to severe immobility. Bone mineral density and bone metabolism markers were compared to the bedridden period in all study patients. Changes in the bone metabolism markers during a follow-up of 12 years were studied in 17 patients aged <30 years at baseline.. The bone mineral density was reduced (0.58±0.19 g/cm3), and the osteocalcin (13.9±12.4 ng/mL) and urine N-terminal telopeptide (NTX) levels (146.9±134.0 mM BCE/mM creatinine) were greater than the cutoff value for predicting fracture. Among the bone metabolism markers studied, osteocalcin and NTX were negatively associated with the bedridden period. During the follow-up, osteocalcin and parathyroid hormone were decreased, and the 25(OH) vitamin D was increased. NTX at baseline was negatively associated with bone mineral density after 12 years.. Unique bone metabolic abnormalities were found in patients who had been bedridden for long periods, and these metabolic abnormalities were altered by further bed confinement. Appropriate treatment based on the unique bone metabolic changes may be important in long-term bedridden patients.

Topics: 25-Hydroxyvitamin D 2; Adult; Age Factors; Beds; Bone Density; Disabled Persons; Female; Follow-Up Studies; Humans; Immobilization; Male; Osteocalcin; Osteoporosis

In a random and prospective study, Alzheimer's disease (AD) patients were assigned to regular sunlight exposure (n = 132) or sunlight deprivation (n = 132) and followed for 1 year. Serum 25-OHD level increased by 2.2-fold in the sunlight-exposed group. Eleven patients sustained fractures in the sunlight-deprived group, and three fractures occurred among the sunlight-exposed group (p = 0.0362; odds ratio = 3.7).. A high incidence of fractures, particularly of the hip, represents an important problem in patients with Alzheimer's disease (AD), who are prone to falls and have osteoporosis. We previously showed that 25-hydroxyvitamin D (25-OHD) deficiency caused by sunlight deprivation with compensatory hyperparathyroidism causes reduced BMD in elderly women with AD. This study was undertaken to address the possibility that sunlight exposure with calcium supplementation may maintain BMD and reduce the incidence of nonvertebral fractures in elderly women with AD.. In a random and prospective study, AD patients were assigned to regular sunlight exposure (n = 132) or sunlight deprivation (n = 132) and followed for 1 year. BMD of the second metacarpal bone was measured using a computed X-ray densitometer (CXD). The CXD method measures BMD and cortical thickness at the middle of the second metacarpal bone on a radiogram of the hand and an aluminum step wedge as a standard (20 steps; 1 mm/step). Incidence of nonvertebral fractures in the two patient groups during the 1-year follow-up period was assessed.. At baseline, average hospitalization period was 1.7 years in both groups, and activity of daily living (ADL) was decreased. Patients of both groups showed vitamin D deficiency caused by sunlight deprivation and decreased dietary intake of vitamin D with compensatory hyperparathyroidism. The exposed group patients were exposed to sunlight (3615 minutes/year). BMD increased by 2.7% in the sunlight-exposed group and decreased by 5.6% in the sunlight-deprived group (p < 0.0001). Serum 25-OHD level increased from 24.0 to 52.2 nM in the sunlight-exposed group. Eleven patients sustained fractures in the sunlight-deprived group, and three fractures occurred among the sunlight-exposed group (p = 0.0362; odds ratio = 3.7). Sunlight exposure can increase the BMD of vitamin D-deficient bone by increasing 25-OHD concentration and lead to the prevention of nonvertebral fractures.

Topics: 25-Hydroxyvitamin D 2; Absorptiometry, Photon; Aged; Alzheimer Disease; Biomarkers; Bone and Bones; Bone Density; Female; Fractures, Bone; Heliotherapy; Humans; Muscles; Osteoporosis; Treatment Outcome; Vitamin D Deficiency

Vitamin K (VK) as well as vitamin D (VD) plays an important role in osteoporosis. Vitamin K1 (VK1), vitamin K2 (VK2, menaquinone-4 (MK-4), and menaquinone-7 (MK-7)) are significant for the metabolism of skeletal muscle. 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 (25(OH)D2 and 25(OH)D3) reflect circulating VD levels. More sensitive measurements remain to be developed. In the present study, a new high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed for the determination of VK1, VK2 (MK-4 and MK-7), as well as 25(OH)D2 and 25(OH)D3 levels in human serum.. We developed a simple LC-MS/MS method for the determination of VK1, MK-4, MK-7, 25(OH)D2, and 25(OH)D3 levels in human serum and validated the method in a study cohort of 200 patients divided into the premenopausal women group and postmenopausal osteoporosis patient group.. The overall precision (coefficient of variation) ranged from 2.66 to 10.11% in the specified working range (0.05-5 ng/mL) for VK1, MK-4, and MK-7. Serum VK1, MK-4, and MK-7 levels in postmenopausal women with osteoporosis were 1.187 ± 0.094 ng/mL, 0.058 ± 0.009 ng/mL, and 0.885 ± 0.064 ng/mL, respectively (mean ± standard deviation). Serum VK1, MK-4, and MK-7 levels in premenopausal women were 1.143 ± 0.103 ng/mL, 0.028 ± 0.003 ng/mL, and 1.553 ± 0.226 ng/mL, respectively. Serum 25(OH)D2 and 25(OH)D3 levels in postmenopausal women with osteoporosis were 0.757 ± 0.056 ng/mL and 11.72 ± 0.632 ng/mL, respectively. Serum 25(OH)D2 and 25(OH)D3 levels in premenopausal were 1.793 ± 0.575 ng/mL and 12.42 ± 1.069 ng/mL, respectively.. A new LC-MS/MS method for determination of serum VK and VD levels was evaluated and validated. MK-7 in plasma decreased earlier than VD in postmenopausal osteoporosis patients. MK-7 status is significantly associated with osteoporosis and could be considered a predictable biomarker in the diagnosis of osteoporosis in postmenopausal women.

Topics: 25-Hydroxyvitamin D 2; Calcifediol; Chromatography, Liquid; Female; Humans; Osteoporosis; Osteoporosis, Postmenopausal; Tandem Mass Spectrometry; Vitamin D; Vitamin K 1; Vitamins

Osteoporosis is one of the most commonly diagnosed age-related bone diseases worldwide, and it is also one of the leading causes of fracture. MicroRNAs (miRNAs) are critical molecular regulators that are involved in the bone re-modelling processes, and the circulating miRNAs were stable in the peripheral blood. Thus, to detect the level of miRNAs in plasma of osteoporotic patients may be an efficient, repeatable, and inexpensive method for the early diagnosis and evaluation of the therapeutic efficacy of osteoporosis. The aim of the present study was to investigate the potential diagnostic value of miR-100 in plasma of patients with osteoporosis.. A total of 120 osteoporotic patients were recruited and 120 healthy individuals were also included as the control group. The plasma of the participants was collected and the RNAs were extracted. The expressions of miR-100 in different clinical samples were examined using the RT-qPCR method. Furthermore, receiver operating characteristics curve (ROC) was drawn to determine the diagnostic value of miR-100 for osteoporosis. Next, the correlation between the plasma levels of miR-100 and T-scores of the patients were evaluated and, finally, the correlation between the plasma level of miR-100 and the expression levels of 25OH-D2 and 25OH-D3 were analyzed.. miR-100 was significantly increased in plasma of patients with osteoporosis in comparison with healthy individuals; moreover, results of ROC analysis indicated that plasma level of miR-100 is a sensitive biomarker that could distinguish osteoporosis patients from healthy controls (AUC, 0.8916, 95% confidence interval (CI), 0.8468 to 0.9364). Furthermore, miR-100 was found to be negatively correlated with both vBMD (r = -0.3117, p = 0.0005) and Lumbar Spine L2-L4 T-score in patients with osteoporosis (r = -0.2929, p = 0.012). Finally, the plasma level of miR-100 was negatively correlated with the levels of 25OH-D2 (r = -0.3002, p = 0.0008) and 25OH-D3 (r = -0.3105, p = 0.0006) of the osteoporotic patients.. miR-100 was abnormally increased in the plasma of osteoporotic patients, suggesting that circulating miR-100 could serve as potential biomarker for the diagnosis and treatment osteoporosis.

Topics: 25-Hydroxyvitamin D 2; Aged; Biomarkers; Calcifediol; Circulating MicroRNA; Female; Gene Expression Regulation; Humans; Male; MicroRNAs; Middle Aged; Osteoporosis; ROC Curve

Within the Developmental Origins of Adult Disease (DOHaD) model, early life environmental exposures can confer a long-term legacy on human health. This mechanism may be adaptive or maladaptive depending on lifestyle circumstances. This article examines the role of first trimester UV-exposure on late-life vitamin D levels, and potentially related adaptive and maladaptive phenotypes (height and osteoporosis respectively).. Six hundred and forty nine subjects were examined for vitamin D. Solar irradiance over the first 90 days postconception correlated positively with late-life vitamin D. Increased solar irradiance/UV exposure during the first trimester of pregnancy calibrates adult vitamin D metabolism, which is an important hormone in maintaining calcium balance. This may explain how very early lifecycle UV exposure can influence skeletal development (adult height) and modify risk for the skeletal degenerative disorder osteoporosis. The data demonstrate humans are tuned to the world (exposome) in ways we have not yet fully considered, and which are entrained at the earliest phase of the lifecycle.

Topics: 25-Hydroxyvitamin D 2; Aged; Body Height; Calcifediol; Cross-Sectional Studies; Female; Homeostasis; Humans; Male; Middle Aged; New South Wales; Osteoporosis; Phenotype; Pregnancy; Pregnancy Trimester, First; Ultraviolet Rays; Vitamin D

Estimation of the parathyroid hyperplasia prevalence after the ChNPP accident in adults exposed to ion izing radiation and their descendants using the diagnostic ultrasound and its methodology elaboration.. The pilot prospective study of the prevalence of parathyroid hyperplasia among the Chornobyl Nuclear Power Plant (ChNPP) accident adult survivors (n=686) and their descendants (54 children) was performed using diagnostic ultrasound examination of thyroid and parathyroids. Among the study subjects there were 339 ChNPP accident clean up workers (ACUW), 32 persons were evacuated from the 30 km exclusion zone and 224 ones were included to the control group. Diagnostic ultrasound of thyroid and parathyroids was performed according to the standard method. Additionally, in children with parathyroid hyperplasia an additional assay of 25 hydroxyvitamin D levels in serum was performed. In calculating the statistical significance, its level p < 0.05 was considered statistically significant.. Parathyroids are a few small but critically important endocrine glands that synthesize parathyroid hormone, regulating mainly phosphoric calcium metabolism. Insufficient (hypoparathyroidism) or excessive (hyperparathy roidism) function of parathyroids is harmful to the patients affecting the state of nervous and cardiovascular sys tem. Parathyroidss can accumulate isotopes of cesium, strontium and radioactive iodine. The available data testify to an increased incidence of clinically significant hyperplasia of parthyroids (more than 9 mm in adults and more than 5 mm in children) among persons exposed toionizng radiation as a result of the accident at the ChNPP (28.64%) and their descendants (23.8-70.6%). First of all are concerned those adults who live in contaminated areas in comparison with the control group (24.15% in not irradiated). Evacuees from the 30 km exclusion zone being the category of people who were exposed to the absorbed iodine isotopes in the first days of the Chernobyl accident are the another risk group. These data demonstrate sensitivity of parathyroidss to the impact of incorpo rated isotopes (iodine, cesium and strontium), which in the long term exposure create conditions for structural and functional changes in regulation of phosphorous calcium metabolism being the basis for a significant prevalence of osteopenia and osteoporosis in irradiated individuals and their descendants. A number of further studies are required to clarify the findings and to disclose the hormonal mechanisms of radiation effects on parathyroids.. Parathyroid glands are radiosensitive and susceptible to effects of strontium, cesium and iodine iso topes, which cause parathyroid irradiation and subsequent structural and functional changes, being a prerequisite for development of osteopenia and osteoporosis in the ChNPP accident survivors and their descendants. High inci dence of parathyroid hypertrophy is found in the inhabitants of the radiation contaminated territories (long term irradiation by cesium isotopes), as well as in evacuated from the 30 km exclusion zone (irradiation by iodine iso topes in the early days of the accident).. Meta. Vyznachennia poshyrenosti giperplaziy̆ pryshchytopodibnykh zaloz u oprominenykh vnaslidok avariï na ChAES do roslykh ta ïkh nashchadkiv pry skryningovomu ul'trazvukovomu doslidzheni ta vidpratsiuvaty y̆ogo metodologiiu. Materialy ta metody. Pilotne prospektyvne doslidzhennia poshyrenosti giperplaziï PShchPZ sered osib, postrazh dalykh vnaslidok avariï na Chornobyl's'kiy̆ atomniy̆ elektrostantsiï (ChAES) doroslogo viku (686 osib) ta ïkh na shchadkiv (54 ditey̆) provedeno UZD ShchPZ ta PShchPZ, z iakykh 339 vidnosylysia do uchasnykiv likvidatsiï naslidkiv avariï na ChAES, 32 osoby – evakuy̆ovani z 30 km zony vidchuzhennia ta 224 osib z grupy kontroliu. Provedeno ul'trazvu kove doslidzhennia shchytopodibnoï ta pryshchytopodibnykh zaloz za standartnoiu metodykoiu. Dodatkovo u ditey̆ z giperplaziieiu pryshchytopodibnykh zaloz provodylos' vybirkove doslidzhennia rivnia 25 gidroksyvitaminu D u syro vattsi krovi. Pry rozrakhunku statystychnoï znachushchosti, ïï riven' r < 0,05 vvazhaly statystychno dostovirnym. Rezul'taty. Pryshchytopodibni zalozy – tse dekil'ka nevelykykh ale vplyvovykh endokrynnykh zaloz, shcho syntezu iut' paratgormon, reguliuiut', golovnym chynom, fosforno kal'tsiievyy̆ obmin. Nedostatnia (gipoparatyreoz) abo nadlyshkova (giperparatyreoz) funktsiia pryshchytopodibnykh zaloz ie shkidlyvymy dlia patsiientiv, vplyvaie na stan nervovoï ta sertsevo sudynnoï systemy. Pryshchytopodibni zalozy mozhut' nakopychuvaty izotopy tseziiu, strontsiiu i radioaktyvnogo y̆odu. Otrymani dani svidchat' pro pidvyshchennia chastoty klinichno znachushchykh giperplaziy̆ pryshchyto podibnykh zaloz (ponad 9 mm u doroslykh, bil'she 5 mm u ditey̆) sered oprominenykh osib vnaslidok avariï na ChAES (28,64 %) ta ïkh nashchadkiv (23,8–70,6 %), persh za vse tykh, iaki meshkaiut' na zabrudnenykh terytoriiakh doroslogo viku v porivnianni z kontrol'noiu grupoiu (neopromineni – 24,15 %). Inshoiu grupoiu ryzyka buly evakuy̆ovani z 30 km zony vidchuzhennia – kategoriia osib, iaka zaznala diï poglynutykh izotopiv y̆odu v pershi dni avariï na ChAES.Tsi dani demonstruiut' chutlyvist' pryshchytopodibnykh zaloz do diï inkorporovanykh izotopiv (y̆odu, tseziiu i strontsiiu), shcho u viddaleni terminy oprominennia stvoriuiut' umovy dlia strukturno funktsional'nykh zmin u systemi reguliatsiïfosforno kal'tsiievogoobminu,iepidґruntiamdlia znachnoïposhyrenostiosteopeniïtaosteoporozuuop rominenykh osib ta ïkh nashchadkiv. Neobkhidno provesty nyzku doslidzhen' dlia podal'shogo utochnennia

Topics: 25-Hydroxyvitamin D 2; Adult; Bone Diseases, Metabolic; Calcium; Case-Control Studies; Chernobyl Nuclear Accident; Child; Female; Humans; Hyperplasia; Male; Osteoporosis; Parathyroid Glands; Phosphorus; Pilot Projects; Prospective Studies; Radiation Dosage; Radiation Exposure; Radiation, Ionizing; Radioisotopes; Survivors; Thyroid Gland; Ukraine; Ultrasonography

Decreased bone density secondary to osteoporosis and osteomalacia represents a significant risk factor for bony fracture and spinal instrumentation failure. We evaluated the incidence of vitamin D deficiency in patients undergoing elective spinal instrumentation to investigate which patient-level risk factors are associated with deficient vitamin D levels.. Serum 25-OH vitamin D levels were evaluated postoperatively (<72 hours) in patients undergoing elective spinal fusion from 2011 through 2012. Patients >18 years with a diagnosis of degenerative spinal spondylosis or spinal instability treated with spinal fusion were included. Risk factors for vitamin D deficiency (<20 ng/mL) were analyzed using univariate and multiple logistic regression to identify independent predictors of deficiency.. The mean preoperative neck and Oswestry disability indexes of the 230 consecutive patients (mean, 57 ± 13.9 years) were 21.0 ± 9.8 and 22.2 ± 8.5, respectively. Mean 25-OH vitamin D level was 25.9 ± 12.4 ng/mL (range, 6-77 ng/mL). Sixty-nine (30.0%) patients had laboratory-confirmed vitamin D deficiency and 89 (38.9%) had laboratory-confirmed vitamin D insufficiency (20-30 ng/mL). The risk of vitamin D deficiency was greater in men (odds ratio [OR] 2.53; P = 0.009), patients aged 40-60 years (OR 2.45; P = 0.018), and those who had body mass index >40 (OR 7.55; P = 0.004), an existing diagnosis of diabetes (OR 3.29; P = 0.019), or no vitamin D supplementation (OR 4.96; P = 0.043).. Vitamin D deficiency was common in patients with degenerative spondylosis undergoing spinal fusion. Middle-aged patients, men, the morbidly obese, those with a history of diabetes, and those with no history of supplementation had a higher incidence of vitamin D deficiency.

Topics: 25-Hydroxyvitamin D 2; Adult; Aged; Body Mass Index; Confounding Factors, Epidemiologic; Cross-Sectional Studies; Diabetes Complications; Elective Surgical Procedures; Female; Humans; Logistic Models; Male; Medical Records; Middle Aged; Obesity, Morbid; Odds Ratio; Osteoporosis; Predictive Value of Tests; Prevalence; Retrospective Studies; Risk Assessment; Risk Factors; Spinal Fusion; Spondylosis; United States; Vitamin D Deficiency; Vitamins

Decreased bone mineral density (BMD) was reported in HIV infected patients. Mechanisms leading to this decrease are poorly understood.. To assess factors relating to BMD in young HIV infected Israeli women of Ethiopian and Caucasian origin.. 75 young HIV infected women aged 34.5 ± 8.5 followed up at the Institute of Allergy, Clinical Immunology & AIDS filled a questionnaire about sun exposure, daily calcium intake and dress habits. Data about HIV status and treatment regimens were collected from the patients' charts. Serum hydroxyvitamin D [25(OH)D] levels, bone turnover markers and bone densitometry were evaluated.. 28 (65%) of Ethiopians and 2 (6.25%) of Caucasians had 25(OH)D serum levels <10 ng/ml (vitamin D deficiency), p = 0.001. 21 (67.7%) Ethiopians and 16 (39%) Caucasians avoided sun exposure, p = 0.019. Mean daily calcium intake was 491 ± 268.6 mg and 279 ± 252.6 mg, respectively, p = 0.001. Z scores < -1 found at Lumbar spine in 26 (89.7%), at Femoral neck in 20 (69%) at Total hip in 17 (58.6%) of vitamin D deficient patients compared to 20 (48.8%), 17 (41.5%), 9 (22%), in patients with 25(OH)D > 10 ng/ml, p < 0.01, <0.03, <0.001, respectively. Significantly more Ethiopian than Caucasian women covered their face (32.3% and 9.5%, p = 0.003) and hands (58.1% and 30.9%, p = 0.03). There was no difference in bone turnover markers levels.. Poorer vitamin D status was observed in Ethiopian women might be one of the important factors related to lower BMD in this group.

Topics: 25-Hydroxyvitamin D 2; Biomarkers; Bone and Bones; Bone Density; Bone Diseases, Metabolic; Calcifediol; Calcium, Dietary; Clothing; Diet; Ethiopia; Female; Follow-Up Studies; HIV Infections; Humans; Incidence; Israel; Middle Aged; Nutritional Status; Osteoporosis; Sunlight; Vitamin D Deficiency; White People

The primary aim of the study was to explore the potential relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and Mini Nutritional Assessment (MNA) score, a surrogate for protein energy undernutrition, in elderly (≥65 years old) subjects with and without a hip fracture. A secondary aim of the study was to provide estimates of the MNA discriminatory performance in the detection of subjects with low levels of 25(OH)D (<20 ng/ml). The study population consisted of 101 patients with a hip fracture, recruited from a single urban Hospital in Athens, Greece, and 85 community dwelling subjects with no history of hip fracture. Serum 25(OH)D was measured, nutritional status was determined by the MNA questionnaire in all subjects, and linear correlation between variables was investigated. Receiver operator characteristic (ROC) curve analysis was performed and discriminatory performance was further assessed by calculating positive and negative likelihood ratios (LR). MNA scores were significantly correlated with 25(OH)D levels (rho=0.685, p<0.001) and this finding was robust in both groups and unaffected by gender. ROC curve analysis demonstrated an area under the curve (AUC) of 0.860 [standard error (SE): 0.026, 95% confidence interval (CI): 0.810-0.910], which provided a significantly better estimation of 25(OH)D status than simple guess (p<0.001). The lowest cutoff value in MNA score, providing a sensitivity over 90% was 25.25, which was associated with a sensitivity of 90.9% and a specificity of 53.6%. The same analysis revealed acceptable results only within hip fracture patients. MNA score might be a satisfactory surrogate marker for 25(OH)D levels with which it is linearly correlated. However, it appears that its discriminatory performance, as a diagnostic tool for 25(OH)D insufficiency, is rather suboptimal.

Topics: 25-Hydroxyvitamin D 2; Aged; Aged, 80 and over; Biomarkers; Calcifediol; Cohort Studies; Cross-Sectional Studies; Female; Geriatric Assessment; Greece; Hip Fractures; Humans; Male; Nutrition Assessment; Nutritional Status; Osteoporosis; Osteoporotic Fractures; Protein-Energy Malnutrition; Sensitivity and Specificity; Vitamin D Deficiency

Blood levels of 25-hydroxyvitamin D [25(OH)D] is the generally accepted indicator of vitamin D status, but no universal reference level has been reached.. The objective of the study was to determine the threshold at which low plasma 25(OH)D levels are associated with fractures in elderly men and clarify the importance of low levels on total fracture burden.. In the Uppsala Longitudinal Study of Adult Men, a population-based cohort (mean age, 71 yr, n = 1194), we examined the relationship between 25(OH)D and risk for fracture. Plasma 25(OH)D levels were measured with high-pressure liquid chromatography-mass spectrometry.. The study was conducted in the municipality of Uppsala in Sweden, a country with a high fracture incidence.. Time to fracture was measured.. During follow-up (median 11 yr), 309 of the participants (26%) sustained a fracture. 25(OH)D levels below 40 nmol/liter, which corresponded to the fifth percentile of 25(OH)D, were associated with a modestly increased risk for fracture, multivariable-adjusted hazard ratio 1.65 (95% confidence interval 1.09-2.49). No risk difference was detected above this level. Approximately 3% of the fractures were attributable to low 25(OH)D levels in this population.. Vitamin D insufficiency is not a major cause of fractures in community-dwelling elderly men in Sweden. Despite the fact that cutaneous synthesis of previtamin D during the winter season is undetectable at this northern latitude of 60 degrees, only one in 20 had 25(OH)D levels below 40 nmol/liter, the threshold at which the risk for fracture started to increase. Genetic adaptations to limited UV light may be an explanation for our findings.

Topics: 25-Hydroxyvitamin D 2; Aged; Aged, 80 and over; Algorithms; Calcifediol; Chromatography, High Pressure Liquid; Cohort Studies; Diet; Fractures, Bone; Humans; Male; Mass Spectrometry; Middle Aged; Motor Activity; Osteoporosis; Population; Risk Factors; Seasons; Smoking; Sweden; Vitamin D

Topics: 25-Hydroxyvitamin D 2; Adult; Aged; Bone and Bones; Bone Diseases; Cohort Studies; Diet; Female; Fractures, Bone; Humans; Longitudinal Studies; Male; Middle Aged; Nutritional Physiological Phenomena; Osteoporosis; Sunlight; Vitamin D; Vitamin D Deficiency; Vitamins

The ketogenic diet (KD) is a high-fat, low-carbohydrate, and protein diet that effectively treats intractable epilepsy (IE).. The purpose of this study was to measure the change in bone mineral content (BMC) in children with IE treated with the KD for 15 mo.. Prepubertal children >or=5 y of age with IE were eligible. A 4:1 ketogenic diet was maintained for 15 mo, and whole-body and spine BMCs were measured with dual-energy X-ray absorptiometry. Z scores were generated by comparing the children with IE with a cohort of 847 healthy children. Other measurements included demographics, anthropometry, serum 25-hydroxyvitamin D (25-OHD), intact parathyroid hormone, electrolytes, and dietary intake. All measurements were performed at baseline and at 3, 6, 12, and 15 mo. Longitudinal mixed effects models were used to analyze change in BMC over time.. Twenty-five children (9 girls, 16 boys) with IE [age (x +/- SD): 7.3 +/- 1.9 y] participated. Growth and bone health status were suboptimal as were serum 25-OHD concentrations and dietary intake of calcium and vitamin D. Whole-body and spine BMC-for-age both declined by 0.6 z score/y and whole-body and spine BMC-for-height declined 0.7 z score/y and 0.4 z score/y, respectively. Height declined 0.5 z score/y. Body mass index (BMI; in kg/m(2)) z score, age, and ambulation were positive predictors of BMC, which declined sharply over 15 mo of KD treatment.. Bone health in children with IE was poor, particularly for younger nonambulatory children with low BMI status. The KD resulted in progressive loss of BMC. The mechanism is unclear. Further studies are needed.

Topics: 25-Hydroxyvitamin D 2; Absorptiometry, Photon; Body Mass Index; Bone and Bones; Bone Density; Calcium; Calcium, Dietary; Child; Diet, Ketogenic; Epilepsy; Female; Humans; Ketosis; Longitudinal Studies; Male; Nutritional Status; Osteoporosis; Vitamin D

Young adults with cystic fibrosis (CF) frequently develop bone disease. One suggested aetiological factor is suboptimal vitamin K status with impaired carboxylation of osteocalcin and abnormal bone formation.. We measured bone mineralization and turnover in thirty-two 8-12 year old CF patients (14 boys) using Dual Energy X-ray absorptiometry (whole body (WB) and lumbar spine (LS)), 25-OH Vitamin D, PTH and markers of bone formation (plasma osteocalcin, N-terminal pro-peptide of type 1 collagen (P1NP)), plus an indirect measure of vitamin K status, undercarboxylated osteocalcin (uc-OC).. LS bone mineral density (BMD) standard deviation (SD) scores were < -1.0 in 20% of subjects. Size-adjusted LS and WB bone mass was normal. Compared to reference data, % uc-OC was high and P1NP low. LS bone mass was predicted by % uc-OC but not other markers (0.4% decrease in size-adjusted LSBMC (p=0.05); 0.04 SD decrease in LSBMAD (p=0.04) per 1% increase in uc-OC).. Markers suggestive of sub-optimal vitamin K status and low bone formation were present despite normal size-adjusted bone mass. The association between LSBMC and % uc-OC is consistent with the hypothesis that sub-optimal vitamin K status is a risk factor for CF bone disease. This should ideally be investigated in an intervention trial.

Topics: 25-Hydroxyvitamin D 2; Absorptiometry, Photon; Bone Density; Bone Remodeling; Child; Cohort Studies; Cystic Fibrosis; Female; Humans; Male; Osteocalcin; Osteoporosis; Parathyroid Hormone; Vitamin K Deficiency

To compare biochemical variables, renal function and calcium and vitamin D intakes in euparathyroid and hyperparathyroid patients with primary osteoporosis and osteopenia and describe the measures necessary to normalize serum PTH in the patients with secondary hyperparathyroidism.. We reviewed the charts of normocalcemic patients with primary osteoporosis and osteopenia first seen during the years 1991-2003 and identified 75 with elevated serum PTH levels at baseline. These patients were compared to all the 143 euparathyroid patients first seen in 1998 and 1999. Patients were restudied after 1 year and we attempted to follow patients with secondary hyperparathyroidism until PTH levels became normal.. At baseline serum PTH, ionized calcium, inorganic phosphate, alkaline phosphatase, creatinine, a complete blood count and serum 25 hydroxy vitamin D were measured in the early morning fasting state. These tests were repeated at follow up.. In one-third of the hyperparathyroid patients, the standard baseline treatment failed to correct the secondary hyperparathyroidism necessitating extraordinary measures including unusually large doses of vitamin D (i.e. 50 000 IU vitamin D(2) twice weekly) or the substitution of calcium citrate for calcium carbonate as a calcium supplement.. Large doses of vitamin D are frequently necessary to suppress secondary hyperparathyroidism in patients with primary osteoporosis and osteopenia. This suggests that vitamin D metabolism may be altered in some of these patients.

Topics: 25-Hydroxyvitamin D 2; Alkaline Phosphatase; Bone Diseases, Metabolic; Calcium; Calcium Citrate; Calcium, Dietary; Cholecalciferol; Creatinine; Female; Humans; Hyperparathyroidism, Secondary; Osteoporosis; Parathyroid Hormone; Phosphates; Retrospective Studies; Vitamin D

Age-related decline in IGF-I and gonadal hormones have been postulated to play an important role in the pathogenesis of age-related bone loss in men. In this cross-sectional study, the relation between serum IGF-I and gonadal hormones with bone mineral density (BMD) was examined in community-dwelling men.. Serum IGF-I, testosterone and BMD were examined in 61 community-dwelling men over the age of 27, who were randomly selected from the Calgary cohort of 1000 subjects in the Canadian Multicentre Osteoporosis Study. In the present study, IGF-I, serum testosterone, SHBG, free androgen index (FAI), parathyroid hormone (PTH), 25-hydroxy-vitamin D [25(OH)D] and other markers of bone turnover were measured. BMD was measured at the spine and hip (HOLOGIC 4500). Simple linear regression was used to assess the linear relation between IGF-I, testosterone, BMD and other biochemical markers of bone metabolism and potential confounding variables and subsequent multivariate regression models were constructed separately for each BMD measurement to assess the importance of IGF-I and testosterone in the presence of potential confounding variables.. Serum IGF-I, FAI and SHBG significantly decreased as a function of age, whereas serum levels of PTH increased. Only 25(OH)D, total testosterone and FAI were positively associated with serum IGF-I after adjusting for age and BMI. Multiple linear regression models revealed that IGF-I was a significant predictor of BMD at the total hip, femoral neck and femoral trochanter neck (P < or = 0.001). In contrast, the FAI was a significant predictor of BMD at the lumbar spine and wards area (P < or = 0.011), and SHBG was a significant predictor at the total hip and femoral trochanter (P < or = 0.045).. These data support the hypothesis that the age-related decline in bone mass in men is associated with declining levels of IGF-I and testosterone.

Topics: 25-Hydroxyvitamin D 2; Adult; Age Factors; Aged; Aged, 80 and over; Androgens; Biomarkers; Bone Density; Bone Remodeling; Canada; Cross-Sectional Studies; Health Surveys; Humans; Insulin-Like Growth Factor I; Male; Middle Aged; Multivariate Analysis; Osteoporosis; Parathyroid Hormone; Sex Hormone-Binding Globulin; Testosterone

To analyse the results from a fracture and osteoporosis (FO) outpatient clinic in order to achieve efficient case-finding for osteoporosis in patients of 50 years and older with a fracture due to low-energy trauma.. Descriptive.. Following the publication of new professional guidelines for case-finding and treatment of osteoporosis, an FO outpatient clinic was opened at the University Hospital of Groningen, The Netherlands, to which patients of 50 years and older with a fracture due to low-energy trauma could be referred for further diagnosis and treatment after initial treatment for trauma. Bone-mineral density of the lumbar spine, hip and distal radius was assessed with dual-energy X-ray absorptiometry (DEXA). Patients with manifest osteoporosis, defined as having a fracture and a T-score < or = -2 SD at one of the measured sites, were put on medication. The results from the first 100 patients were analysed.. In the first five months 74% (116/156) of the patients were seen in the FO clinic. In January 2004 the first 100 patients completed the diagnostic process. A total of 67 patients had manifest osteoporosis, 20 osteopenia and 13 had normal bone density. Furthermore, 48% of the patients between 50 and 60 years old had manifest osteoporosis. Unrecognised vertebral fractures were found in 21 patients. Forty-three percent of patients with manifest osteoporosis had low 25-OH-vitamine D levels (< 30 nmol/l). Eleven patients were sent to the Department of Internal Medicine on indication of secondary osteoporosis.. The FO outpatient clinic proved to be effective and useful for identifying and treating a population at risk of osteoporosis.

Topics: 25-Hydroxyvitamin D 2; Absorptiometry, Photon; Bone Density; Fractures, Bone; Humans; Middle Aged; Netherlands; Osteoporosis; Prevalence; Risk Factors

Vitamin D is one of the most important regulating agents in the development of bone mass. Therefore administration of calciferol along with calcium in patients with nutritional vitamin D deficiency leads to improvement of bone density. In patients with osteoporosis who do not respond to vitamin D, insensitivity of osseous tissue to the active metabolite of vitamin D--1,25(OH)2 D3--is involved or inadequate synthesis of active metabolites in the liver or kidneys. Administration of 1alpha-OH vitamin D3 and in particular 1,25(OH) 2D3 improves the general calcium balance in the organism and increases by direct osteoforming action the value of bone mass and improves its quality. Administration of active vitamin D metabolites is unequivocally better in treatment of involutional osteoporosis, either along with calcium or in combination with some antiresorption substance, in osteoporosis associated with chronic inflammatory diseases, after organ transplantation or glukcocorticoid treatment. Even patients with postmenopausal osteoporosis respond better to 1,25(OH)2D3.

Topics: 25-Hydroxyvitamin D 2; Calcitriol; Ergocalciferols; Humans; Osteoporosis; Vitamin D

The aim of this work was to clarify levels of serum parathyroid hormone (PTH) in healthy adult women and to study the relationship between PTH and 25-hydroxyvitamin D [25(OH)D]. One hundred sixty-nine healthy women aged 40 years or older in a community were studied. The average age of the subjects was 65.3 years (SD 8.2). All subjects had normal serum creatinine levels. Serum intact PTH and 25(OH)D were measured in these subjects. The mean intact PTH concentration was 2.19 pmol/l (SD 1.02). High intact PTH levels above the reference range were observed in four women (2.4%), all of whom were aged 70 years or older. Intact PTH increased with age with a correlation coefficient of 0.192 (p = 0.013). However, there was no correlation (r = -0.125, p = 0.105) between intact PTH and 25(OH)D whose concentrations were more than 37.5 nmol/l. In conclusion, PTH levels of healthy adult Japanese women are lower than previous reports from Western countries, which may be due to the high 25(OH)D levels of the present subjects and/or an ethnic difference. In addition, there is no association between serum 25(OH)D and PTH levels in this Japanese population, supporting a cutoff level of 25(OH)D less than 37.5 nmol/l for the elevated PTH level.

Topics: 25-Hydroxyvitamin D 2; Adult; Aged; Aged, 80 and over; Ethnology; Female; Health Status; Humans; Japan; Middle Aged; Osteoporosis; Parathyroid Hormone

Age-related bone loss in men is receiving increased attention. In light of this, animal models for male bone loss are desirable. This study examined the effects of age and osteoarthritis (OA) on bone mineral content (BMC), bone mineral density (BMD), and markers of bone turnover and skeletal relevance in 56 male rhesus monkeys 4-34 years of age. BMC and BMD increased at all sites from 4 to 10 years of age. Male rhesus monkeys reach peak bone mass at approximately 10 years of age after which bone mass is lower at the lateral spine and distal radius. Markers of bone turnover (osteocalcin and carboxyterminal telopeptide of type I collagen [ICTP]) decreased with age. There was no relationship between PTH, 25-hydroxyvitamin D, FSH, or testosterone and age. With advancing age, the prevalence of lumbar spine OA increases dramatically, masking decreases in posteroanterior spine bone mass that are clear in the lateral projection. These data suggest that male rhesus monkeys sustain age-related bone loss in the absence of nutritional or gonadal steroid deficiencies. These animals may prove useful in studying the mechanisms of age-related bone loss.

Topics: 25-Hydroxyvitamin D 2; Absorptiometry, Photon; Aging; Alkaline Phosphatase; Animals; Biomarkers; Bone Density; Collagen; Collagen Type I; Disease Models, Animal; Lumbar Vertebrae; Macaca mulatta; Male; Osteoarthritis; Osteocalcin; Osteoporosis; Peptides; Testosterone

The aim of this study was to determine whether the presence of vitamin D insufficiency increases bone turnover and enhances bone loss by examining the relationship between bone turnover markers and Bone mineral density (BMD) in vitamin D insufficient and vitamin D sufficient patients, with established vertebral osteoporosis.. 119 consecutive, active, community dwelling, elderly women were assessed over a 7-month period between the months of March to October.. There was a significant correlation between parathyroid hormone (PTH) and 25 hydroxyvitamin D (25(OH)D), r = - 0. 42 (P < 0.01). The prevalence of vitamin D insufficiency was 26.9% (defined by a 25(OH)D >/= 6.1 microg/l and

Topics: 25-Hydroxyvitamin D 2; Aged; Aged, 80 and over; Alkaline Phosphatase; Amino Acids; Bone Density; Bone Remodeling; Calcium; Creatine; Female; Humans; Hydroxyproline; Osteocalcin; Osteoporosis; Parathyroid Hormone; Phosphates; Prevalence; Spinal Diseases; Vitamin D Deficiency

Topics: 25-Hydroxyvitamin D 2; Acid Phosphatase; Aging; Alkaline Phosphatase; Biomarkers; Calcitonin; Calcium; Humans; Osteocalcin; Osteoporosis; Parathyroid Hormone; Phosphorus

In a longitudinal study of 283 elderly subjects aged 60 years or over living in the community, 9 subjects (7 women and 2 men) developed osteoporosis-related fractures in 30 months. These subjects initially had higher random urinary hydroxyproline/creatinine and calcium/creatinine ratios, and lower plasma 25-hydroxyvitamin D concentrations. These biochemical variables may be useful predictors of osteoporosis-related fractures and may provide a suitable community screening method to identify those most at risk.

Topics: 25-Hydroxyvitamin D 2; Aged; Asian People; Biomarkers; Calcium; Cohort Studies; Creatinine; Data Collection; Female; Fractures, Bone; Hong Kong; Humans; Hydroxyproline; Male; Middle Aged; Osteoporosis; Risk Factors

Radio-calcium absorption, plasma 25-hydroxyvitamin D [25-(OH)D] and 1,25-dihydroxyvitamin D [1,25-(OH)2D] concentrations were measured in 19 elderly women with, and 21 without, vertebral fractures, before and after treatment with 25-hydroxyvitamin D3 [25-(OH)D3], to establish whether malabsorption of calcium in elderly women with vertebral fractures has a cause different from that in elderly women without vertebral fractures. Malabsorption of calcium and low plasma 25-(OH)D and 1,25-(OH)2D concentrations were common in both groups of women but there was no significant difference in these variables between the two groups. After treatment with 40 micrograms of 25-(OH)D3 daily for 7 days, there was a significant increase in plasma 25-(OH)D and 1,25-(OH)2D in both groups of women, but radio-calcium absorption increased significantly only in the group without vertebral fractures. Elderly women with vertebral fractures have malabsorption of calcium which is resistant to the action of vitamin D metabolites at concentrations which correct calcium malabsorption in elderly women without vertebral fractures.

Topics: 25-Hydroxyvitamin D 2; Aged; Calcifediol; Calcium; Calcium Radioisotopes; Ergocalciferols; Female; Fractures, Spontaneous; Humans; Intestinal Absorption; Middle Aged; Osteoporosis; Spinal Injuries

Proximal muscular weakness is a feature of many metabolic bone diseases but is not well recognized in spinal osteoporosis. Thirty-six post-menopausal women presenting with back pain, with or without osteoporosis, were therefore studied in order to define the relationship between abnormal electromyographic findings and disturbed vitamin D metabolism, as both low plasma 1,25 dihydroxy vitamin D concentrations and malabsorption of calcium have been reported in osteoporosis. Patients with abnormal electromyograms had lower concentrations of plasma 1,25 dihydroxy vitamin D (mean 78.3 pmol/l, SD 20.5, n = 15) than normal subjects of similar age (mean 110.4 pmol/l, SD 39.4, n = 21; P less than 0.01), but electromyographic abnormality was not associated with changes in radiocalcium absorption, plasma 25 hydroxy vitamin D, plasma calcium or phosphate or urinary calcium or hydroxy-proline excretion or impaired renal function. There was no relationship between abnormal electromyography and osteoporosis assessed by spinal radiographs and iliac crest biopsy. These findings are consistent with our previous suggestion that muscle weakness in many unrelated bone disorders is related to low plasma 1,25 dihydroxy vitamin D concentrations, but suggest that there is no relationship between proximal myopathy and spinal osteoporosis in post-menopausal women.

Topics: 25-Hydroxyvitamin D 2; Aged; Back Pain; Calcitriol; Calcium; Electromyography; Ergocalciferols; Female; Humans; Menopause; Middle Aged; Muscle Hypotonia; Muscles; Osteoporosis

Twelve of fourteen female patients with primary biliary cirrhosis, receiving vitamin D supplementation, exhibited unequivocal signs of osteoporosis but not of osteomalacia. Vitamin D treatment reproduced normal 25-hydroxyvitamin D levels in all but two patients and the 1,25 and 24,25-dihydroxyvitamin D metabolic pathways appeared to be unimpaired. A possible mechanism for the vitamin D resistant osteoporosis has been identified following the observation that, in those patients with severe cirrhosis, the circulating concentration of intact PTH was elevated. The increase in intact hormone appears to be at the expense of the carboxyl-regional PTH produced by hepatic Kupffer cell mediated cleavage of intact PTH. As a defect in Kupffer cell function is documented in primary biliary cirrhosis we postulate that the increased intact PTH/decreased carboxyl-regional PTH concentrations arise as a result of diminished Kupffer cell mediated cleavage. The reduced generation of cleaved PTH, due to this loss of Kupffer cell activity, would thus contribute to the development of osteoporosis in primary biliary cirrhosis.

Topics: 24,25-Dihydroxyvitamin D 3; 25-Hydroxyvitamin D 2; Adult; Aged; Calcitriol; Calcium; Cholecalciferol; Dihydroxycholecalciferols; Ergocalciferols; Female; Humans; Kupffer Cells; Liver; Liver Cirrhosis, Biliary; Middle Aged; Osteoporosis; Parathyroid Hormone

Serum concentrations of 25-hydroxyvitamin D were measured in a group of women with symptomatic postmenopausal osteoporosis, before and after long-term treatment with physiological doses of 1,25-dihydroxyvitamin D3. A competitive protein binding assay was used, which included a chromatographic step. The treatment resulted in a significant decrease in serum 25-hydroxyvitamin D levels that were higher than normal in basal conditions, the mean values before and after therapy being 27.7 ng/ml (+/- 17.1 SD) and 19.7 ng/ml (+/- 12.7), respectively. These findings seem to confirm the hypothesis that an inadequate product-inhibition of liver 25-hydroxylase is responsible for the increased basal levels of 25-hydroxyvitamin D found in postmenopausal osteoporosis.

Topics: 25-Hydroxyvitamin D 2; Aged; Calcitriol; Ergocalciferols; Female; Humans; Intestinal Absorption; Menopause; Middle Aged; Osteoporosis

This study was carried out to evaluate the effects of an iv injection of parathyroid extract on serum levels of 1,25-dihydroxyvitamin D [1,25-(OH)2D3] in elderly osteopenic patients and age-matched nonosteopenic controls. Serum concentrations of 1,25-(OH)2D were reduced in elderly osteopenic subjects (mean +/- SEM, 20 +/- 3 pg/ml) compared with values in age-matched nonosteopenic controls (35 +/- 3 pg/ml), whereas no differences were found in serum 24,25-dihydroxyvitamin D levels (1.5 +/- 0.3 and 2.2 +/- 0.5 ng/ml, respectively). An iv injection of parathyroid extract was followed by a significant increase in serum 1,25-(OH)2D levels in both osteopenic patients (16 +/- 6 pg/ml) and controls (15 +/- 5 pg/ml). The mean 4-h increases in serum 1,25-(OH)2D of 11-18 pg/ml were not significantly different in the two groups. The results indicate that the reduced 1,25-(OH)2D concentrations in the osteopenic patients are secondary to changes in factors that normally stimulate this enzyme system.

Topics: 24,25-Dihydroxyvitamin D 3; 25-Hydroxyvitamin D 2; Aged; Aging; Calcitriol; Calcium; Dihydroxycholecalciferols; Ergocalciferols; Female; Humans; Male; Middle Aged; Osteoporosis; Parathyroid Hormone; Phosphates; Time Factors; Vitamin D

Serum concentrations of 25-hydroxy-vitamin D were measured in a group of women with symptomatic postmenopausal osteoporosis, assessed by bone biopsy. A competitive protein binding assay was used, which included a chromatographic step. Accurate surveys of dietary or therapeutic vitamin D intake and light environment were obtained in each patient. Women with severe postmenopausal osteoporosis were found to have significantly (P less than 0.001) higher serum levels of 25-hydroxyvitamin D than age-matched normal women, the mean values being 27.5 ng/ml (+/- 13.6 SD) and 9.2 ng/ml (+/-5.7), respectively. The authors hypothesize that the reduction in 1,25-dihydroxyvitamin D, recently reported in postmenopausal osteoporotic women, might be responsible for the increased serum levels of 25-hydroxyvitamin D through an inadequate product inhibition of liver vitamin D 25-hydroxylase.

Topics: 25-Hydroxyvitamin D 2; Adult; Aged; Calcium; Cyclic AMP; Ergocalciferols; Female; Humans; Menopause; Middle Aged; Osteoporosis; Reference Values