cholecalciferol and Bone-Diseases--Metabolic

Vitamin D is the sunshine vitamin for good reason. During exposure to sunlight, the UV B photons enter the skin and photolyze 7-dehydrocholesterol to previtamin D3 which in turn is isomerized by the body's temperature to vitamin D3. Most humans have depended on sun for their vitamin D requirement. Skin pigment, sunscreen use, aging, time of day, season and latitude dramatically affect previtamin 13 synthesis. Vitamin D deficiency was thought to have been conquered, but it is now recognized that more than 50% of the world's population is at risk for vitamin D deficiency. This deficiency is in part due to the inadequate fortification of foods with vitamin D and the misconception that a healthy diet contains an adequate amount of vitamin D. Vitamin D deficiency causes growth retardation and rickets in children and will precipitate and exacerbate osteopenia, osteoporosis and increase risk of fracture in adults. The vitamin D deficiency has been associated pandemic with other serious consequences including increased risk of common cancers, autoimmune diseases, infectious diseases and cardiovascular disease. There needs to be a renewed appreciation of the beneficial effect of moderate sunlight for providing all humans with their vitamin D requirement for health.

Topics: Aging; Bone Diseases, Metabolic; Cholecalciferol; Dehydrocholesterols; Humans; Osteoporosis; Photolysis; Rickets; Skin; Skin Neoplasms; Skin Pigmentation; Sunlight; Sunscreening Agents; Ultraviolet Rays; Vitamin D; Vitamin D Deficiency

Reduction in serum 1,25 (OH) (2)D level plays an important role in the pathophysiology of altered bone and mineral metabolism among patients with advanced stages of CKD. The use of vitamin D receptor activators (VDRA) has brought great progress in medical management of CKD-MBD. A number of observational studies have shown that the nonuse of VDRA, and low serum concentrations of 1,25 (OH) (2)D or 25 (OH) D are the predictors of poor clinical outcomes in CKD patients including dialysis patients, raising a possibility that the pleiotropic actions of vitamin D may be systemically involved in the poor survival of patients with CKD-MBD. Randomized controlled trials are needed to clarify whether or not VDRA could be beneficial in the protection of the cardiovascular system and good longevity.

Topics: Bone Diseases, Metabolic; Cardiovascular Diseases; Cholecalciferol; Chronic Disease; Ergocalciferols; Humans; Kidney Diseases; Minerals; Randomized Controlled Trials as Topic; Receptors, Calcitriol; Risk; Vitamin D

Atherosclerosis is common in patients with chronic kidney disease (CKD), and cardiovascular disease (CVD) represents a major cause of death in these patients, especially, in patients with end-stage renal disease(ESRD). The pathological features in ESRD patients are intimal atherosclerosis and medial calcific sclerosis. The important risk factors for CVD in ESRD patients are hypertension, dyslipidemia and CKD bone and mineral disorder (CKD-MBD). Atherosclerosis has been evaluated by measurements of intima-media thickness and pulse-wave velocity. Although the target blood pressure still undetermined, hypertension would be treated with renin-angiotensin system inhibitors. In addition, treatment of dyslipidemia with statins may lead to favorable CVD outcome. Finally, inhibition of vascular calcification should be important by treatment with active vitamin D and sevelamer.

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Atherosclerosis; Bone Diseases, Metabolic; Calcinosis; Cholecalciferol; Chronic Disease; Dyslipidemias; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypertension; Kidney Failure, Chronic; Polyamines; Risk Factors; Sevelamer; Tunica Intima; Vascular Diseases

Vitamin D is obtained from cutaneous production when 7-dehydrocholesterol is converted to vitamin D(3) (cholecalciferol) by ultraviolet B radiation or by oral intake of vitamin D. Rickets appeared to have been conquered with vitamin D intake, and many health care professionals thought the major health problems resulting from vitamin D deficiency had been resolved. However, rickets can be considered the tip of the vitamin D deficiency iceberg. In fact, vitamin D deficiency remains common in children and adults. An individual's vitamin D status is best evaluated by measuring the circulating 25-hydroxyvitamin D (25(OH)D3) concentration. There is increasing agreement that the optimal circulating 25(OH)D3 level should be approximately 30 ng/mL or above. Using this definition, it has been estimated that approximately three-quarters of all adults have low levels. In utero and during childhood, vitamin D deficiency can cause growth retardation and skeletal deformities and may increase the risk of hip fracture later in life. Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture. More recently, associations between low vitamin D status and increased risk for various non-skeletal morbidities have been recognized; whether all of these associations are causally related to low vitamin D status remains to be determined. The discovery that most tissues and cells in the body have vitamin D receptors and that several possess the enzymatic machinery to convert the 25-hydroxyvitamin D3, to the active form, 1,25-dihydroxyvitamin D3, has provided new insights into the function of this vitamin. Of great interest is its role in decreasing the risk of many chronic illnesses, including common cancers, autoimmune diseases, infectious diseases, and cardiovascular disease. In this review I consider the nature of vitamin D deficiency, discuss its role in skeletal and non-skeletal health, and suggest strategies for prevention and treatment.

Topics: Asthma; Biomarkers; Bone Density Conservation Agents; Bone Diseases, Metabolic; Cholecalciferol; Dietary Supplements; Ergocalciferols; Humans; Metabolic Syndrome; Nervous System Diseases; Parathyroid Hormone; Rickets; Risk Factors; Sunlight; Vitamin D; Vitamin D Deficiency

Since the World Health Organisation's announcement of the "Bone and Joint Decade 2000-2010" diseases of the musculoskeletal system attract more and more attention throughout patients and professional health care providers. In an aging society especially osteoporosis represents a major public health concern. Fragility fractures are the most limiting condition in osteoporosis with the highest impact on both, life quality and health care systems worldwide. Orthopaedic surgeons play a key role in implementing primary diagnostics and therapy in patients with fragility fractures. Objective of this effort is the reduction of the common subsequent fractures in patients with osteoporosis. According to national and international guidelines implementation of contemporary clinical pathways to diagnose and treat patients with fractures due to diminished bone mineral density is fast, simple and proven to be effective.

Topics: Absorptiometry, Photon; Adult; Age Factors; Aged; Aged, 80 and over; Bone Density; Bone Density Conservation Agents; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Diphosphonates; Estrogen Receptor Modulators; Female; Fractures, Bone; Humans; Male; Middle Aged; Osteoporosis; Practice Guidelines as Topic; Quality of Life; Risk Factors; World Health Organization

Topics: Animals; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Gastrointestinal Diseases; Humans; Intestinal Absorption; Malabsorption Syndromes; Phosphates; Postgastrectomy Syndromes; Vitamin D

Collagen peptides (CPs) seem to exert beneficial effects on bone and may have a role as a treatment option. In the present randomized prospective study, we aimed to examine the efficacy, as expressed by changes in P1NP and CTX, and the tolerability of 3-month supplementation of calcium, vitamin D with or without bioactive CPs in postmenopausal women with osteopenia.. Fifty-one female, postmenopausal women with osteopenia were allocated to two groups: Group A received a sachet containing 5 g CPs, 3.6 g calcium lactate (equivalent to 500 mg of elemental calcium) and 400 IU vitamin D3 and group B received a chewable tablet containing 1.25 g calcium carbonate (equivalent to 500 mg of elemental calcium) and 400 IU vitamin D3 daily.. In group A, the P1NP levels significantly decreased by 13.1% (p<0.001) and CTX levels decreased by 11.4% (p=0.058) within 3 months of supplementation. In group B, P1NP and CTX did not change. Group A presented better compliance in comparison to group B and no adverse events contrary to group B.. These findings may reflect the reduction of the increased bone turnover in postmenopausal women with the use of calcium, vitamin D and CPs supplements. The addition of CPs in a calcium and vitamin D supplement may enhance its already known positive effect on bone metabolism. Clinical Trial ID: NCT03999775.

Topics: Aged; Bone Density; Bone Diseases, Metabolic; Bone Remodeling; Calcium Compounds; Cholecalciferol; Collagen; Dietary Supplements; Drug Therapy, Combination; Female; Humans; Lactates; Middle Aged; Peptide Fragments; Postmenopause; Treatment Outcome

Topics: Adult; Aged; Bone Density; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Dietary Supplements; Female; Humans; Male; Medicine, Ayurvedic; Middle Aged; Osteocalcin; Osteoporotic Fractures; Plant Preparations; Quality of Life

Topics: Adult; Aged; Biomarkers; Bone Diseases, Metabolic; Calcitriol; Cholecalciferol; Dietary Supplements; Female; Humans; Male; Middle Aged; Minerals; Parathyroid Hormone; Renal Insufficiency, Chronic; Vitamin D

The liver is involved in the metabolism of vitamin D. The prevalence of osteopenia in alcoholic liver disease (ALD) patients is 34-48%, and the prevalence of osteoporosis is 11-36%. Advanced liver disease is considered a risk factor for the development of osteoporosis. The aim of this study was to establish the relationship between vitamin D level and Child-Pugh score in patients with alcoholic liver cirrhosis (ALC), and to evaluate the effects of oral vitamin D supplementation.. Seventy male ALC patients in the absence of active alcohol intake were enrolled and their clinical and laboratory data were recorded. A supplementation of cholecalciferol 1000 IU/day was administered. The vitamin D status was analyzed during the study, in patients stratified by Child-Pugh score.. The study was completed by fifty patients. At the enrollment, the mean level of vitamin D was 60.73±28.02, 50.53±39.52 and 26.71±12.81 nmol/L, respectively for Child-Pugh score class A, B and C. During vitamin D supplementation it was found in all the patients a significant increase of its levels during the first six months (P<0.05). However, in class C the improvement was consistent also after year (P<0.05). At the end of the study, two of seven patients initially in class C changed in class A, four from class C to B, and one remained in class C (P=0.012). Out of seventeen patients initially in class B, eleven changed to class A, and six remained in class B.. In patients with ALC, higher level of vitamin D level is related with lower Child-Pugh score. The supplementation of 1000 IU/day of vitamin D in these patients was optimal for a period of at least six months. A decrease in the Child-Pugh score was also found, with a redistribution of the patients in different classes.

Topics: Bilirubin; Bone Diseases, Metabolic; Cholecalciferol; Dietary Supplements; Humans; International Normalized Ratio; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Osteoporosis; Prospective Studies; Serum Albumin; Severity of Illness Index; Treatment Outcome; Vitamin D; Vitamin D Deficiency

The pivotal role of vitamin D (vit D) in skeletal health is well known. Neonatal vit D storage at birth is dependent on maternal levels, and newborns receive 50-70% of their mother's 25-hydroxyvitamin D [25(OH)D]. Deficiency of vit D can lead to prematurity bone disease, with an incidence of up to 55% in infants weighing < 1000 g. The aim of this study is to assess the effectiveness of monitored supplementation of vit D in a population of preterm infants.. Preterm infants born at 24-32 weeks of gestation will be recruited within the first 7 days of life. Depending on the type of feeding, and after reaching partial enteral feeding or at 7 days of life, vit D supplementation will consist of 500 IU and an additional 150-300 IU/kg included in human milk fortifiers (if fed exclusively with breast milk) or 190 IU/kg in milk formulas. Subjects will be randomised to either monitored (with an option of dose modification based on 25(OH)D levels as per protocol) or standard therapy up to 52 weeks of post-conceptional age (PCA). The primary outcome measure will be the number of neonates with deficiency or excess levels of 25(OH)D at 40  ±2 weeks of PCA. Additional 25(OH)D levels will be measured at birth, at 4 and 8 weeks of age, and/or at 35 and 52  ±2 weeks of PCA. Secondary objectives will include the incidence of osteopenia, nephrocalcinosis and nephrolithiasis. Serum parameters of calcium phosphorus metabolism will also be measured.. Despite multiple years of research and numerous publications, there is still a lack of consensus in regard to how much vit D infants should receive and how long they should receive it. Because 80% of calcium and phosphorus placental transfer occurs between 24 and 40 weeks of gestation, preterm infants are especially prone to adverse effects of vit D insufficiency. However, both inadequate and excessive amounts of vit D may be unsafe and lead to serious health issues. The results of our study may shed new light on these concerns and contribute to optimising vit D supplementation.. ClinicalTrials.gov, NCT03087149 . Registered on 15 March 2017.

Topics: Biomarkers; Bone Diseases, Metabolic; Cholecalciferol; Clinical Protocols; Dietary Supplements; Gestational Age; Humans; Incidence; Infant; Infant, Newborn; Infant, Premature; Nephrocalcinosis; Nephrolithiasis; Poland; Premature Birth; Research Design; Time Factors; Treatment Outcome; Vitamin D; Vitamin D Deficiency

Low vitamin D serum levels have been associated with unfavourable lipid profile and poorer response to atorvastatin. Aims of this study were to test the effects of 25-hydroxyvitamin D3 (calcifediol) compared to parental vitamin D3 (cholecalciferol) supplementation on modifications of plasma 25(OH)D levels and lipid profile.. Fifty-seven postmenopausal women (aged 59.03 ± 6.73 years) who were at low risk of fracture and with basal plasma 25(OH)D < 30 ng/mL were included if they were on atorvastatin treatment prescribed as appropriate. Recruited women were randomized to receive oral calcifediol or cholecalciferol, both at a dose of 140 μg according to a weekly regimen.. At baseline, 25(OH)D was negatively associated with BMI (r = -0.37; P = 0.004), total cholesterol (r = -0.31; P = 0.01) and LDL-C (r = -0.32; P = 0.02). After 24 weeks, 25(OH)D increased significantly in both groups (P < 0.001), although higher levels were obtained with calcifediol as compared with cholecalciferol (P < 0.001). Only in the calcifediol group, a significant reduction of LDL-C (P = 0.01) and an increase of HDL-C (P = 0.02) were obtained, even after adjustment for age, and baseline BMI, 25(OH)D and lipid levels (P < 0.05). The percentage changes in 25(OH)D levels were associated with the variations of LDL-C (r = -0.44; P = 0.01) and HDL-C levels (r = 0.30; P = 0.10).. Calcifediol administration in osteopenic and dyslipidemic postmenopausal women with low 25(OH)D improves lipid profile when added to an ongoing atorvastatin treatment.

Topics: Administration, Oral; Atorvastatin; Bone Diseases, Metabolic; Calcifediol; Cholecalciferol; Dietary Supplements; Drug Therapy, Combination; Dyslipidemias; Female; Heptanoic Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Lipid Metabolism; Middle Aged; Postmenopause; Pyrroles; Vitamin D; Vitamin D Deficiency; Vitamins

Our pilot study tested the efficacy, acceptability and tolerability of DHA supplementation in addition to calcium and vitamin D in individuals with osteopenia.. 40 participants were randomised to either algal oil containing 400mg docosahexanoic acid (DHA) daily or placebo. All participants received 1200 mg calcium carbonate with vitamin D(3) 1000 IU daily.. Bone mineral density (BMD) was measured at baseline and 12 months. Bone turnover was assessed with serum c-terminal telopeptides (CTx) at baseline and 12 months. Tolerability and acceptability were assessed using a validated questionnaire.. Mean CTx was suppressed after 12 months for all participants (p=0.04) with no difference in effect size between DHA and control groups (p=0.53). Changes in CTx at 12 months were significantly correlated with changes in BMD at the lumbar spine (p=0.01) and total proximal femur (TPF) (p=0.03). There was a non-significant trend towards rising BMD at 12 months. Participants rated the supplements as tolerable and acceptable, with few adverse events.. The combination of oral calcium, vitamin D(3) and DHA was safe, tolerable and acceptable when used for 12 months by osteopenic individuals in this pilot study. The combination had a positive effect on bone health as indicated by serum CTx, with no effect demonstrated from the addition of DHA 400mg. Changes in BMD at the lumbar spine and TPF were significantly correlated with changes in CTx, which may be useful in monitoring bone health and response to treatment.

Topics: Bone Density; Bone Density Conservation Agents; Bone Diseases, Metabolic; Calcium; Calcium Carbonate; Cholecalciferol; Dietary Supplements; Docosahexaenoic Acids; Drug Therapy, Combination; Female; Femur; Humans; Lumbar Vertebrae; Male; Middle Aged; Patient Satisfaction; Peptides; Pilot Projects; Treatment Outcome

Mounting evidence supports a physiological role for silicon (Si) as orthosilicic acid (OSA, Si(OH)4) in bone formation. The effect of oral choline-stabilized orthosilicic acid (ch-OSA) on markers of bone turnover and bone mineral density (BMD) was investigated in a double-blind placebo-controlled trial.. Over 12-months, 136 women out of 184 randomized (T-score spine < -1.5) completed the study and received, daily, 1000 mg Ca and 20 microg cholecalciferol (Vit D3) and three different ch-OSA doses (3, 6 and 12 mg Si) or placebo. Bone formation markers in serum and urinary resorption markers were measured at baseline, and after 6 and 12 months. Femoral and lumbar BMD were measured at baseline and after 12 months by DEXA.. Overall, there was a trend for ch-OSA to confer some additional benefit to Ca and Vit D3 treatment, especially for markers of bone formation, but only the marker for type I collagen formation (PINP) was significant at 12 months for the 6 and 12 mg Si dose (vs. placebo) without a clear dose response effect. A trend for a dose-corresponding increase was observed in the bone resorption marker, collagen type I C-terminal telopeptide (CTX-I). Lumbar spine BMD did not change significantly. Post-hoc subgroup analysis (baseline T-score femur < -1) however was significant for the 6 mg dose at the femoral neck (T-test). There were no ch-OSA related adverse events observed and biochemical safety parameters remained within the normal range.. Combined therapy of ch-OSA and Ca/Vit D3 had a potential beneficial effect on bone collagen compared to Ca/Vit D3 alone which suggests that this treatment is of potential use in osteoporosis. NTR 1029.

Topics: Aged; Biomarkers; Bone Density; Bone Density Conservation Agents; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Choline; Collagen; Drug Therapy, Combination; Female; Humans; Middle Aged; Placebos; Postmenopause; Silicic Acid; Treatment Outcome

Topics: Absorptiometry, Photon; Adult; Biomarkers; Body Mass Index; Bone Density Conservation Agents; Bone Diseases, Metabolic; Calcium Carbonate; Cholecalciferol; Diphosphonates; Female; Fractures, Bone; Humans; Imidazoles; Liver Transplantation; Male; Middle Aged; Prospective Studies; Treatment Outcome; Zoledronic Acid

We examined the serum level of undercarboxylated osteocalcin (uc OC), which is a sensitive marker of vitamin K status, and levels of bone turnover markers in early postmenopausal women receiving vitamin K2 treatment with or without vitamin D3.. Thirty-four postmenopausal women with a mean age of 53 years whose bone mineral density (BMD) was less than 0.809 g/cm2 (osteopenia and osteoporosis) were treated with vitamin K2 or with a combination of vitamin K2 and vitamin D3. Seventeen women received daily oral administration of 45 mg vitamin K2 and 17 women received daily oral administration of 45 mg vitamin K2 plus 0.75 microg 1alpha-hydroxyvitamin D3. Serum levels of uc OC, intact osteocalcin (OC) and bone alkaline phosphatase (BAP), urinary deoxypyridinoline (DPD) levels and BMD at the lumbar spine were measured before and at 1 and 2 years after the start of treatment.. Serum uc OC levels in women treated with vitamin K2 alone and with both vitamin K2 and vitamin D3 decreased significantly (p < 0.05). Serum levels of intact OC and BAP in women treated with vitamin K2 did not show significant changes, while those in women who received the combined treatment decreased significantly (p < 0.05). On the other hand, urinary DPD level in women treated with vitamin K2 did not change, while that in women who received the combined treatment tended to decrease (p < 0.1).. Serum uc OC levels in early postmenopausal women who received vitamin K2 decreased due to carboxylation of uc OC. Combined treatment with vitamin K2 and vitamin D3 may be effective for sustaining BMD in early postmenopausal women whose bone turnovers are highly activated.

Topics: Alkaline Phosphatase; Amino Acids; Bone Density; Bone Density Conservation Agents; Bone Diseases, Metabolic; Cholecalciferol; Drug Therapy, Combination; Female; Humans; Middle Aged; Osteocalcin; Osteoporosis, Postmenopausal; Postmenopause; Vitamin K 2

The purpose of this study was to (1) quantify the healing process of the human osteoporotic proximal humerus fracture (PHF) expressed in terms of callus formation over the fracture region using BMD scanning, and (2) quantify the impact of medical intervention with vitamin D3 and calcium on the healing process of the human osteoporotic fracture. The conservatively treated PHF was chosen in order to follow the genuine fracture healing without influence of osteosynthetic materials or casts. Thirty women (mean age = 78 years; range = 58-88) with a PHF, osteoporosis or osteopenia (based on a hip scan, WHO criteria), and not taking any drugs related to bone formation, including calcium or vitamin D supplementation, were randomly assigned to either oral 800 IU vitamin D3 plus 1 g calcium or placebo, in a double-blind prospective study. We measured biochemical, radiographic, and bone mineral density effect parameters to evaluate the impact on the healing process. Scanning procedures of the fractured shoulder included use of a fixation device to obtain the highest possible precision. Double scans of the fractured shoulder revealed a coefficient of variation (CV) on BMD measurements that improved from 2.8% immediately after fracture occurrence to 1.7% at 12 weeks (P = 0.003) approaching the 1.2% levels observed over the healthy shoulder. BMD was similar in the two groups at baseline (active 0.534 g/cm2 vs. placebo 0.518 g/cm2), and both increased over the 12-week observation period, with peak levels in week 6. By week 6 BMD levels were higher in the active group (0.623 g/cm2) compared with the placebo group (0.570 g/cm2, P = 0.006). Thirty seven percent of the patients presented with vitamin D levels below 30 nmol/l, indicative of mild vitamin D insufficiency. In conclusion, we have demonstrated that it is possible to quantify callus formation of the PHF with sufficiently high precision to demonstrate the positive influence of vitamin D3 and calcium over the first 6 weeks after fracture. Whether this results in more stable fractures, extends to other fracture types, or applies to other osteogenic bone agents such as bisphosphonates remains to be examined.

Topics: Absorptiometry, Photon; Aged; Aged, 80 and over; Bone Density; Bone Diseases, Metabolic; Calcium, Dietary; Cholecalciferol; Dietary Supplements; Female; Fracture Healing; Humans; Humeral Fractures; Humerus; Middle Aged; Osteoporosis; Prospective Studies

Although reduced bone mineral density (BMD) is associated with a higher risk of fractures, morbidity, and mortality in kidney transplant patients (KTRs), there is no consensus on optimal treatment for the alterations of BMD in this population. This study aims at assessing the effect of cholecalciferol supplementation on BMD over a follow-up period of 2 years in a cohort of long-term KTRs. Patients with age ≥ 18 years were included and divided into two subgroups based on treatment with bisphosphonate and/or calcimimetics and/or active vitamin D sterols (KTRs-treated) or never treated with the above medications (KTRs-free). BMD was evaluated at lumbar vertebral bodies (LV) and right femoral neck (FN) with standard DEXA at the beginning and end of the study. According to World Health Organization (WHO) criteria, results were expressed as T-score and Z-score. Osteoporosis and osteopenia were defined as T score ≤ -2.5 SD and T score < -1 and >-2.5 SD, respectively. Cholecalciferol was supplemented at a dose of 25,000 IU/week over 12 weeks followed by 1500 IU/day. KTRs-free (

Topics: Adolescent; Bone Density; Bone Diseases, Metabolic; Cholecalciferol; Diphosphonates; Humans; Kidney Transplantation; Sterols; Vitamin D

In this study, we aimed to investigate the effect of long-term administration of alendronate to treat bone loss in renal transplant patients.. Eighty-two renal transplant recipients were divided into 3 groups. Group 1 included patients who were treated with calcium, vitamin D3, and alendronate; group 2 included patients who were treated with calcium and vitamin D3; and group 3 included patients who did not receive these medications. All patients' sociodemographic data, biochemical parameters, and bone mineral density (BMD) measurements were recorded.. There were no significant differences between sociodemographic and laboratory findings at the beginning of study in all groups. The BMD of lumbar spine and femoral neck was significantly less in group 1 at the beginning, 12 and 24 months of the study when compared with other group. At 12 and 24 months of the study, the BMD levels were decreased both group 2 and group 3, whereas in group 1, it was stable at 12 months and increased thereafter. In group 1, the initial femoral neck BMD was negatively correlated with parathormone, sex, and body mass index, and positively correlated with creatinine level. While there was a positive correlation between basal body mass index and femur neck BMD in group 2, there was no correlation between baseline parameters, demographic data, and bone mineral density in group 3 patients.. In conclusion, bone loss is inevitable despite calcium and vitamin D replacement. However, bone loss can be stopped and even reversed with alendronate therapy.

Topics: Alendronate; Bone Density; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Humans; Kidney Transplantation; Minerals

Routine therapy of metabolic bone disorder (MBD) after gastrectomy for gastric cancer has not been established yet. We have reported that administering an active vitamin D3 agent to patients who had undergone gastrectomy for gastric cancer improved MBD. Recently, the usefulness of alendronate, an osteoclast inhibitor, has been reported for MBD. Here we report the effects of alendronate for MBD after gastrectomy for gastric cancer.. Dual energy X-ray absorptiometry was performed consequently in 14 patients, who had been gastrectomized for gastric cancer and survived more than 5 years without recurrence, to evaluate the MBD and compared before and after treatment. The 14 patients were divided into two groups: in group VD3, 1 μg/d of alfacalcidol, an active vitamin D3 agent, was administered; and in group ALN, 5 mg/d or 35 mg/wk of alendronate or both alfacalcidol and alendronate were administered. These drugs had been administered to the patients for > 2 years, and the patients were followed up.. After 12 months, dual energy X-ray absorptiometry revealed that bone mineral density and T score were significantly increased in group ALN. Changes in serum bone-specific alkaline phosphatase after 24 months were -9.1 μg/L in the ALN group and 3.75 μg/L in the VD3 group, showing a significant difference (p = 0.02). No serious adverse events were observed in either group.. These results showed the usefulness of alendronate and alendronate+activated vitamin D3 combination therapy, suggesting that these treatments might prevent postgastrectomic MBD.

Topics: Absorptiometry, Photon; Aged; Alendronate; Bone Density; Bone Diseases, Metabolic; Cholecalciferol; Cohort Studies; Female; Gastrectomy; Humans; Japan; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Stomach Neoplasms; Treatment Outcome

This one-year double blind randomized control trial assessed the effects of nightly melatonin, strontium (citrate), vitamin D3 and vitamin K2 (MK7; MSDK) on bone mineral density (BMD) and quality of life (QOL) in postmenopausal osteopenic women (ages 49-75). Compared to placebo, MSDK treatment increased BMD in lumbar spine (4.3%) and left femoral neck (2.2%), with an upward trend for total left hip (p=0.069). MSDK increased serum P1NP levels and reduced bone turnover (CTx:P1NP). Psychometric analyses indicated that mood and sleep quality improved for the MSDK group. MSDK-exposed human mesenchymal stem cells (hMSCs) and human peripheral blood monocytes (hPBMCs) plated in transwells or layered demonstrated increases in osteoblastogenesis, decreases in osteoclastogenesis, increases in OPG (TNFRSF11B) and decreases in RANKL (TNFSF11) levels. In transwell osteoblasts, MSDK increased pERK1/2 (MAPK1/MAPK3) and RUNX2 levels; decreased ERK5 (MAPK7); and did not affect the expression of NFκB (NFKB1) and β1integrin (ITGB1). In layered osteoblasts, MSDK also decreased expression of the metabolic proteins PPARγ (PPARG) and GLUT4 (SLC2A4). In adipose-derived human MSCs, MSDK induced osteoblastogenesis. These findings provide both clinical and mechanistic support for the use of MSDK for the prevention or treatment of osteopenia, osteoporosis or other bone-related diseases.

Topics: Aged; Bone and Bones; Bone Density; Bone Diseases, Metabolic; Bone Remodeling; Cholecalciferol; Coculture Techniques; Double-Blind Method; Female; Glucose Transport Proteins, Facilitative; Health Status; Humans; Melatonin; Micronutrients; Middle Aged; Osteoblasts; Osteoclasts; Osteoprotegerin; Postmenopause; PPAR gamma; Quality of Life; RANK Ligand; Strontium; Vitamin K 2

Vitamin D deficiency is common and may contribute to osteopenia, osteoporosis and falls risk in the elderly. Screening for vitamin D deficiency is important in high-risk patients, especially for patients who suffered minimal trauma fractures. Vitamin D deficiency should be treated according to the severity of the deficiency. In high-risk adults, follow-up serum 25-hydroxyvitamin D concentration should be measured 3-4 months after initiating maintenance therapy to confirm that the target level has been achieved. All patients should maintain a calcium intake of at least 1,000 mg for women aged ≤ 50 years and men ≤ 70 years, and 1,300 mg for women > 50 years and men > 70 years.

Topics: Aged; Bone Density; Bone Diseases, Metabolic; Calcium, Dietary; Cholecalciferol; Female; Hip Fractures; Humans; Male; Middle Aged; Osteoporosis; Practice Guidelines as Topic; Prevalence; Primary Health Care; Risk Factors; Vitamin D; Vitamin D Deficiency

The aim of the study was to evaluate the effect of risedronate on bone mineral density (BMD) and bone turnover markers in HIV-infected osteoporotic males, according to their gonadal status. HIV patients were followed up for 24 months and divided into two groups: patients with osteoporosis or osteopenia with fractures (group A, n = 20) and those without (group B, n = 21). Group A and B were further divided according to the presence of reduced androgenizations. Both groups were treated with cholecalciferol 800 I.U. and calcium (Ca) 1,000 mg orally every day for the first 12 months. Risedronate 75 mg for two consecutive days a month orally was then added in group A, for another 12 months. Group B continued treatment with Ca and vitamin D. Every 6 months each patient underwent biochemical evaluation, and BMD measurement. A significant increase in lumbar BMD was observed in HIV males with adequate androgenization after 12 months of risedronate treatment in group A together with a reduction of bone turnover markers. BMD remained stable with a concomitant significant slight reduction of bone turnover markers in group B. Risedronate increased BMD and reduced bone turnover markers to a greater extent in patients with adequate androgenization compared to osteoporotic HIV males with symptomatic hypoandrogenization.

Topics: Adult; Aged; Bone Density; Bone Density Conservation Agents; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Drug Therapy, Combination; Etidronic Acid; HIV Infections; Humans; Hypogonadism; Lumbar Vertebrae; Male; Middle Aged; Osteoporosis; Osteoporotic Fractures; Pilot Projects; Risedronic Acid; Testosterone; Treatment Outcome

Low bone mineral density, which increases the risk of stress fragility fractures, is a frequent, often persistent finding in patients with major depressive disorder (MDD). The clinical association between major depressive disorder and osteopenia is still unclear, although several factors are associated with a loss of bone mass. The aim of our study, therefore, was to evaluate bone mineral density and bone metabolism in patients with MDD. Bone mineral density was evaluated in fifty postmenopausal women with MDD, and in 50 matched postmenopausal control women by dual-energy X-ray absorptiometry of the lumbar spine and femur, and by ultrasonography of the calcaneus and phalanges. Serum levels of 25-hydroxivitamin D, parathyroid hormone, Osteoprotegerin/Receptor Activator for Nuclear Factor κB Ligand ratio, bone turnover markers, serum and urinary cortisol were examined. Bone mineral density of the lumbar spine (BMD: 0.72 ± 0.06 vs. 0.82 ± 0.09 g/cm(2), p < 0.001), femoral neck (BMD: 0.58 ± 0.04 vs. 0.71 ± 0.07 g/cm(2), p < 0.001) and total femur (BMD 0.66 ± 0.09 vs. 0.54 ± 0.06 g/cm(2), p < 0.001); and ultrasound parameters at calcaneus (SI: 81.30 ± 6.10 vs. 93.80 ± 7.10, p < 0.001) and phalanges (AD-SOS: 1915.00 ± 37.70 vs. 2020.88 ± 39.46, p < 0.001; BTT : 1.30 ± 0.8 vs. 1.45 ± 0.9, p < 0.001) are significantly lower in patients with MDD compared with controls. Moreover bone turnover markers, parathyroid hormone levels and Receptor Activator for Nuclear Factor κB Ligand are significantly higher in MDD patients compared with controls, while serum levels of 25-hydroxivitamin D and osteoprotegerin are significantly lower. There are no differences in urinary excretion and serum cortisol between groups. Postmenopausal women with depressive disorder have an elevated risk for osteoporosis. Our data suggest that a high level of parathyroid hormone may play a role in the pathogenetic process underlying osteopenia in these patients.

Topics: Bone Density; Bone Diseases, Metabolic; Bone Remodeling; Calcaneus; Cholecalciferol; Comorbidity; Depressive Disorder, Major; Disease Progression; Female; Finger Phalanges; Humans; Middle Aged; Parathyroid Hormone; Postmenopause; Risk Factors; Ultrasonography

Osteopenia and osteoporosis are diseases frequently occurring after liver transplantation (OLT).. In a prospective study, we have investigated the effect of ibandronate, vitamin D(3), and calcium on the prevention and treatment of posttransplant osteopenia and osteoporosis.. The bone mineral density (BMD) of the lumbar spine (LS) and of the femoral neck (FN) were measured in 74 patients prospectively pre- and post-OLT.. Postoperatively the study group showed a consistent percentage increase in BMD (g/cm(2)) and a significantly increased BMD after 12 and 24 months in the LS (12 months: 1.05 ± 0.21 g/cm(2); P < .001 24 months: 1.11 ± 0.19 g/cm(2); P < .001) and the FN (12 months: 0.88 ± 0.16 g/cm(2); P < .002 24 months: 0.90 ± 0.15 g/cm(2); P < .001) in comparison with baseline pre-OLT (LS pre-OLT 0.98 ± 0.19 g/cm(2), FN 0.86 ± 0.14 g/cm(2)). The overall bone fracture rate was 5.4% up to 24 months.. Ibandronate once monthly per os significantly increased the BMD in the LS and FN after OLT at 12 and 24 months. The increased BMD limits the risk of fracture.

Topics: Absorptiometry, Photon; Administration, Oral; Alkaline Phosphatase; Amino Acids; Biomarkers; Bone Density; Bone Density Conservation Agents; Bone Diseases, Metabolic; Calcium; Chi-Square Distribution; Cholecalciferol; Creatinine; Dietary Supplements; Diphosphonates; Drug Administration Schedule; Femur Neck; Fractures, Bone; Germany; Humans; Ibandronic Acid; Liver Transplantation; Lumbar Vertebrae; Osteoporosis; Prospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome

This report describes the investigations into the cause and treatment of metabolic bone disease (MBD) in captive native New Zealand frogs (Leiopelma spp.) and the role of fluoride in the disease. MBD was diagnosed in Leiopelma archeyi and Leiopelma hochstetteri in 2008 at three institutions: Auckland Zoo, Hamilton Zoo, and the University of Otago. Most of these frogs had originally been held at the University of Canterbury for several years (2000-2004) but some were collected directly from the wild. Radiographs on archived and live frogs showed that MBD had been present at Canterbury, but at a lower rate (3%) than in the current institutions (38-67%). Microcomputed tomography showed that the femoral diaphyses of the captive frogs at Auckland Zoo had greater bone volume, bone surface, cross-sectional thickness, and mean total cross-sectional bone perimeter, which is consistent with osteofluorosis. On histology of the same femurs, there was hyperplasia, periosteal growth, and thickening of trabeculae, which are also consistent with skeletal fluorosis. An increase in fluoride levels in the water supply preceded the rise in the incidence of the above pathology, further supporting the diagnosis of osteofluorosis. Analysis of long-standing husbandry practices showed that ultraviolet B (UVB) exposure and the dietary calcium:phosphorus ratio were deficient when compared with wild conditions-likely causing chronic underlying MBD. To prevent multifactorial MBD in captive Leiopelma, the authors recommend increasing dietary calcium by incorporating into the captive diet inherently calcium-rich invertebrates; increasing exposure to natural or artificial (UVB) light; and using defluoridated water. Addressing these three factors at Auckland Zoo reduced morbidity, bone fractures, and mortality rates.

Topics: Animals; Animals, Zoo; Anura; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Dietary Supplements; Fluorides; New Zealand; Retrospective Studies

Genistein aglycone (GEN) has a favorable effect on bone loss. We investigated the effects of GEN alone or in combination with supplemental calcium and vitamin D(3) in an animal model of bone loss to evaluate if there was additional benefit. Ovariectomized (OVX) and SHAM-OVX rats were used. OVX were divided into 12 groups and randomized to receive: GEN at 27, 54, 200, 500 or 1000 mg (human equivalent dose (HED)/day/ip injection alone or with calcium carbonate (Ca) (360 mg/kg/day/gavages) and vitamin D(3) (D(3)) (50 IU/kg/day/gavages) or Ca/D(3) without GEN or untreated for 6 weeks. SHAM-OVX were randomized into 7 groups and treated with: Ca and D(3) alone or in combination with GEN (same doses as OVX), or left untreated. Bone mineral density (BMD), bone-alkaline phosphatase (b-ALP), collagen C-telopeptides (CTX), osteoprotegerin (OPG) and soluble receptor activator of NFκB ligand (sRANKL) were assessed. Femurs were excised and tested for breaking strength and histology. Uterine weight was analyzed to assess GEN's estrogenic effects on the SHAM-OVX. The most effective dose of GEN, independent of Ca/D(3) supplementation, was 54 mg/day. Higher doses yielded no further improvement in bone biomarkers, histology or strength. Only 1000 mg/day HED of genistein produced statistically significant changes in uterine weight of the SHAM-OVX. This study suggests that 54 mg/day of GEN is the threshold dose for efficacy. In addition, supplemental calcium and vitamin D(3), beyond normal dietary intake do not enhance the effects of genistein on improving measures of bone loss. This observation has implications regarding the use of calcium and vitamin D(3) supplementation.

Topics: Alkaline Phosphatase; Animals; Bone Density; Bone Density Conservation Agents; Bone Diseases, Metabolic; Calcium Carbonate; Cholecalciferol; Compressive Strength; Disease Models, Animal; Drug Therapy, Combination; Female; Femur; Genistein; Osteoprotegerin; Ovariectomy; Plant Extracts; Random Allocation; RANK Ligand; Rats; Rats, Sprague-Dawley; Sophora; Uterus

Many studies have demonstrated the prevalence of vitamin D insufficiency in the older population.. This study sought to determine whether supplementation with intramuscular vitamin D improved 25OH vitamin D levels significantly.. Ninety female inpatients aged over 65 years were assigned to receive 300,000 IU of intramuscular vitamin D3 (cholecalciferol) or no intervention.. Baseline 25OH vitamin D and intact parathyroid hormone (iPTH) levels were taken and repeated 3 months after supplementation.. Patients who received treatment showed a significant improvement in 25OH vitamin D levels, from 25.5 to 81 nmol/L with 11% remaining deficient. No patient became hypercalcaemic after treatment.. Vitamin D deficiency is common throughout all age groups in the Irish population and particularly the older female population who have increased risk of osteoporosis and fractures. Intramuscular vitamin D significantly improves 25OH vitamin D levels compared to no treatment and may combat non-compliance with oral medication.

Topics: Age Factors; Aged; Aged, 80 and over; Bone Density Conservation Agents; Bone Diseases, Metabolic; Cholecalciferol; Dietary Supplements; Feasibility Studies; Female; Fractures, Bone; Hospitalization; Humans; Injections, Intramuscular; Ireland; Parathyroid Hormone; Prevalence; Risk Assessment; Vitamin D Deficiency

Vitamin D(3) analogues were shown to be beneficial for osteoporosis and other indications, but their narrow therapeutic window between efficacy and hypercalcemia has limited their clinical utility. A nonsecosteroidal, tissue-selective, orally bioavailable, vitamin D receptor (VDR) ligand was ascertained to be efficacious in bone while having modest calcemic effects in vivo. This compound (VDRM2) potently induced Retinoid X Receptor alpha (RXR)-VDR heterodimerization (EC(50) = 7.1 +/- 1.6 nM) and induced osteocalcin promoter activity (EC(50) = 1.9 +/- 1.6 nM). VDRM2 was less potent in inducing Ca(2+) channel transient receptor potential cation channel, subfamily V, member 6 (TRPV6) expression (EC(50) = 37 +/- 12 nM). VDRM2 then was evaluated in osteopenic ovariectomized (OVX) rats and shown to dose-dependently restore vertebral bone mineral density (BMD) from OVX to sham levels at 0.08 microg/kg per day. Hypercalcemia was observed at a dose of 4.6 microg/kg per day of VDRM2, suggesting a safety margin of 57 [90% confidence interval (CI) 35-91]. 1alpha,25-dihydroxyvitamin D(3) [1alpha,25(OH)(2)D], ED71, and alfacalcidol restored BMD at 0.030, 0.0055, and 0.046 microg/kg per day, respectively, whereas hypercalcemia was observed at 0.22, 0.027, and 0.23 microg/kg per day, indicating a safety margin of 7.3, 4.9, and 5.0, respectively (90% CIs 4.1-13, 3.2-7.7, and 3.5-6.7, respectively). Histomorphometry showed that VDRM2 increased cortical bone area and stimulated the periosteal bone-formation rate relative to OVX at doses below the hypercalcemic dose. By contrast, ED71 increased the periosteal bone-formation rate only above the hypercalcemic dose. VDRM2 suppressed eroded surface on trabecular bone surfaces at normal serum calcium dosage levels, suggesting dual anabolic and antiresorptive activity. In summary, vitamin D analogues were more potent than VDRM2, but VDRM2 had a greater safety margin, suggesting possible therapeutic potential.

Topics: Animals; Binding, Competitive; Biological Assay; Biomechanical Phenomena; Bone and Bones; Bone Density; Bone Diseases, Metabolic; Cholecalciferol; Female; Humans; Hypercalcemia; Ligands; Luciferases; Osteocalcin; Protein Multimerization; Rats; Rats, Sprague-Dawley; Receptors, Calcitriol; Retinoid X Receptors; Transcriptional Activation; Treatment Outcome; TRPV Cation Channels

Topics: Bone Density; Bone Diseases, Metabolic; Cholecalciferol; Cohort Studies; Comorbidity; Dietary Supplements; Disease Progression; Female; Humans; Middle Aged; Osteoporosis, Postmenopausal; Postmenopause; Prevalence; Scleroderma, Systemic; Spain; Vitamin D; Vitamin D Deficiency

To study the incidence of osteopenia in patients with initial systemic lupus erythematosus (SLE). Investigate the levels of the vitamin D (VitD) endocrine system in peripheral blood of SLE patients and its relation to bone mineral density (BMD). Analyse the relationship between the estrogen receptor (ER) and BMD and evaluate the role of ER in the pathogenesis osteopenia.. Serum levels of 25-OH VitD(3) and 1,25-(OH)(2) VitD(3) were detected by enzyme linked immunosorbent assay. The gene expression levels of VitD receptor (VDR) and ER were determined by real-time PCR. BMD measurements in the lumbar spine (L1-L4) and left proximal femur (femoral neck) were performed using dual X-ray absorptiometry before treatment.. The initial SLE patients had significantly lower BMD values, and higher frequency of bone loss at both sites of measurement compared with normal controls (P < 0.05). The levels of 25-OH VitD(3) and 1,25-(OH)(2) VitD(3) were lower in the initial SLE patients than normal controls (P < 0.01 both). There is no difference in the levels of 25-OH VitD(3) and 1,25-(OH)(2) VitD(3) between the osteopenia SLE group and the normal BMD SLE group (P > 0.05, P > 0.05). There are no correlations between the VitD and BMD in initial SLE patients (P > 0.05 both). The expressions of VDR gene were significantly increased in the initial SLE patients compared with the normal controls (P < 0.01). There was no difference in VDR gene expression between osteopenia SLE group and normal BMD SLE group (P > 0.05). The VDR gene expression does not correlate with the bone mass (P > 0.05). The levels of ER-beta gene expression are higher in the initial SLE group than the normal controls (P < 0.01).. The incipient SLE patients may have lower BMD than expected. SLE patients present abnormal VitD endocrine system and higher ER-beta mRNA expression than those in normal controls, but these weren't concerned with osteopenia.

Topics: Adolescent; Adult; Bone Density; Bone Diseases, Metabolic; Case-Control Studies; Child; Cholecalciferol; Estrogen Receptor beta; Female; Gene Expression; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Receptors, Calcitriol; RNA, Messenger; Young Adult

Nutritional metabolic bone disease (NMBD) is one of the most frequently observed pathological conditions in herpetoculture. To develop guidelines for NMBD prevention in growing veiled chameleons (Chamaeleo calyptratus), 56 hatchlings were divided into 6 groups [group UV, with UVB exposure; group No: no supplements; group CaAUV: with calcium (Ca), vitamin A, UVB; group CaA: with Ca, vitamin A; group CaADUV: with Ca, vitamin A, cholecalciferol, UVB; and group CaAD, with Ca, vitamin A, cholecalciferol] and reared for 6 mo on locust-based diets. The nutrient composition of the locusts' diet and the locust-based diet for the chameleons was determined. The diagnosis included the detailed description of clinical findings, histopathology, measurements of serum Ca, 25-hydroxycholecalciferol (25-OHD(3)), liver 25-OHD(3), vitamin A, bone mineral density, and bone mineral concentration. Chameleons that received no dietary supplementation of Ca, vitamin A, and cholecalciferol developed NMBD. When Ca and vitamin A were supplemented, the chameleons did not develop NMBD, independently of additional UVB and dietary cholecalciferol. The best prevention for NMBD was achieved by chameleons that received locusts gut-loaded with 12% Ca and dusted with 250,000 IU/kg (75 mg/kg) vitamin A and 25,000 IU/kg (0.625 mg/kg) cholecalciferol plus provision of long (10 h/d), low irradiation exposure (3-120 μW/cm(2)) to UVB. Chameleons that were fed diets low in vitamin A, cholecalciferol, and Ca were diagnosed with fibrous osteodystrophy. We noticed an interaction of vitamin A and cholecalciferol supplementation in the storage of vitamin A in the liver and formation of colon calcifications. From these findings, recommendations for the rearing of juvenile chameleons were derived.

Topics: Animal Husbandry; Animals; Behavior, Animal; Bone and Bones; Bone Density; Bone Diseases, Metabolic; Calcifediol; Calcinosis; Calcium; Cholecalciferol; Colon; Colonic Diseases; Diet; Grasshoppers; Liver; Lizards; Nymph; Ultraviolet Rays; Vitamin A

The study was undertaken to find out the effects of over supplementation of dietary calcium and vitamin D3 on the mineralization of growing skeleton, taking rabbit as an animal model; further to study the effects of Nandrolone deconoate and TGF-beta1 on the mineralization of osteopenic bones. Twenty four New Zealand White rabbits of either sex, 60 day old, were randomly divided in 4 equal groups, A, B, C and D. The animals of groups B, C and D were administered with oral supplementation of calcium (2000 mg/kg of standard rabbit feed) and vit-D3 (1000 IU/kg of standard feed) for 60 days. The animals of group A were given standard ration without any supplementation. After 60 days, the Ca-vit.D3 supplementation was discontinued; and the animals of group C were administered with TGF-beta1 (10 ng, i.m.) once in every three days and animals of group D were given Nandrolone deconoate (10 mg, i.m.) once every week for 30 days, whereas in animals of group B, no treatment was given. All the animals were evaluated based on different observations like body weight, radiographic observations, circulating biochemical and hormone profile (plasma Ca, IP, AP, OC and iPTH) every 15 days up to 60 days after initiation of treatment. The results indicated that the body weight of rabbits in different groups increased gradually and steadily at different intervals till the end of observation period, however, the increase was non-significantly more in group D. The CI in group A increased gradually at different intervals; whereas in groups B, C and D, there was no appreciable increase in the CI during the period of Ca-vit.D3 supplementation, suggesting development of osteopenia. Treatment with TGF-beta1 did not increase the CI significantly, whereas Nandrolone treatment resulted in significant increase in the CI on days 45 and 60. The plasma Ca levels showed slight but gradual increase from day 0 to 60 in almost all groups. Subsequently also, there was no marked change at different intervals in groups A and B; however, significant reduction in plasma Ca was noticed in group C on 15(th) day and in group D on 60(th) day after initiation of treatment. Plasma IP levels in groups B and C showed a decreasing trend up to day 60. After discontinuation of Ca-vit.D3 supplementation, in group B, it further decreased to remain significantly lower on 15(th) day, and in groups C and D, it increased significantly on 60(th) post-treatment day. There was no significant change in the AP activity dur

Topics: Alkaline Phosphatase; Anabolic Agents; Animals; Body Weight; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Female; Male; Nandrolone; Nandrolone Decanoate; Osteocalcin; Parathyroid Hormone; Phosphorus; Rabbits; Random Allocation; Transforming Growth Factor beta1

Long term use of several antiepileptic drugs is known to cause alteration in bone metabolism. Therefore, we investigated the effect of new antiepileptic drug, oxcarbazepine, on bone metabolism.. Twenty eight patients who were on oxcarbazepin therapy (18 female, 10 males; mean age: 27.82 +/- 10.98 years (range: 15-45)) with no additional antiepileptic drug use history in one year period prior to the study and 28 control subjects were involved in the study. Measurement of calcium, phosphate, alkaline phosphatase and Vitamin D3 levels and bone density measurements with DEXA method were performed in patient and age-matched control groups. The baseline parameters were compared with the control group and with those measured at the end of one year.. The biochemical (calcium, phosphate, alkaline phosphatase and Vitamin D3) parameters and densitometry values after one year of therapy were not different than the baseline values indicating that those were not affected by the therapy (P > 0.05).. In previous studies, anticonvulsant drugs that induce enzymes increase bone degradation by causing vitamin D deficiency. According to the results of this study, oxcarbazepin with little effect on enzyme induction was shown not to affect bone mineral metabolism.

Topics: Absorptiometry, Photon; Adolescent; Adult; Alkaline Phosphatase; Anticonvulsants; Bone and Bones; Bone Density; Bone Diseases, Metabolic; Calcium; Carbamazepine; Cholecalciferol; Female; Humans; Male; Middle Aged; Oxcarbazepine; Phosphates

To investigate the prevalence of both calcium metabolism alterations and bone defects in children with celiac disease (CD).. We studied 54 untreated patients with CD (mean age, 7 years). We compared the serum concentration of calcium, magnesium, 25(OH)vitamin D3, alkaline phosphatase, and parathyroid hormone (PTH) of patients with CD with those of 60 healthy children. Children with CD with 2 laboratory alterations underwent DEXA examination, which was evaluated after 6 months of a gluten-free diet (GFD).. The calcium and the 25(OH)vitamin D3 levels were lower in children with CD than in control subjects, and the PTH level was higher in children with CD than in control subjects (P < .001). Hyperparathyroidism was found in 29 children with CD. Twenty patients tested positive for 2 laboratory alterations, and 10 of them were osteopenic. After 6 months of GFD calcium, 25(OH)vit.D3 and PTH levels normalized, with the improvement of bone mineral density.. Calcium metabolism defects are common in untreated children with CD, and they returned to normal after GFD. A detailed, time-consuming, and expensive study of bone metabolism is not necessary in children with CD shortly exposed to gluten who follow the GFD.

Topics: Absorptiometry, Photon; Alkaline Phosphatase; Biomarkers; Bone Diseases, Metabolic; Calcium; Celiac Disease; Child; Cholecalciferol; Comorbidity; Costs and Cost Analysis; Female; Glutens; Humans; Magnesium; Male; Parathyroid Hormone; Prevalence

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

Three cases of metabolic bone disease (MBD) were identified in juvenile Humboldt penguins (Spheniscus humboldti) in a zoological collection. Diagnosis, monitoring, and treatment were challenging, in part because radiographs and traditional serum biochemistries did not provide adequate information to guide appropriate clinical management. Normal values for ionized calcium (iCa), 25-hydroxyvitamin D3 [25-(OH) D3], and parathyroid hormone (PTH) have not been reported for any species in the order Sphenisciformes. This study aimed to establish reference ranges for these parameters to provide a method for assessing clinical cases of MBD and other disease processes. iCa was measured in 33 healthy adult birds from two zoological collections by using a portable clinical analyzer. iCa also was measured from 14 of these birds at a commercial laboratory. Mean and standard deviation were determined to be 1.21 +/- 0.09 and 1.29 +/- 0.10 mmol/L, respectively. Limited data exist on iCa in avian species, but these results are consistent with other reports and provide a useful clinical parameter. Analysis of PTH and 25-(OH) D3 was performed at a commercial laboratory on samples from 14 healthy adult penguins in one collection. Means and standard deviations for PTH and 25-(OH) D3 were 0.8 +/- 0.3 pmol/L and 3.7 +/- 2.4 nmol/L, respectively. These results are near the minimal functional detectable limits of the assays; raising uncertainty about the validity and usefulness of currently available PTH and 25-(OH) D3 tests in this species.

Topics: Animals; Animals, Zoo; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Diagnosis, Differential; Female; Male; Parathyroid Hormone; Reference Values; Spheniscidae

Dual energy X-ray absorptiometry (DEXA) is a non-invasive, rapid, accurate and highly reproducible method for the assessment of antiepileptic drug (AED)-induced osteopenia in epileptic children. In this study, we investigated bone mineral density (BMD) using DEXA in 56 epileptic children receiving long-term AED treatment for at least 2 years. All children received AED monotherapy or polytherapy plus a standard vitamin D3 supplement (400 U/day). BMD measurements were made from lumbar spine (L2-L4) regions. Age- and sex-specific BMD SD scores were calculated for each child. Osteopenia was defined as SD scores less than -1.5. There was no significant difference in mean BMD values between epileptic children receiving monotherapy or polytherapy. The results were also compared to the age- and sex-specific BMD SD scores obtained from healthy Turkish children. Only three patients (5%) receiving AED therapy had a BMD SD score less than -1.5. This rate is relatively lower than the rates of previous studies conducted on ambulatory children on long-term AED treatment without vitamin D3 supplementation.

Topics: Absorptiometry, Photon; Anticonvulsants; Bone Density; Bone Diseases, Metabolic; Child; Cholecalciferol; Cross-Sectional Studies; Drug Therapy, Combination; Epilepsy; Female; Humans; Male; Turkey

The aim of this work was to study bone turnover markers, calcium homeostasis and bone mineral density (BMD) in children with acute leukemia at diagnosis, after induction chemotherapy, and during maintenance therapy to delineate abnormalities present. After evaluation of L2-L4 BMD using dual-energy X-ray absorptiometry in patients with acute myeloid and lymphoid leukemia at presentation and after treatment, the results were compared to 352 healthy age- and sex-matched Egyptian controls. Calcium homeostasis parameters and bone turnover biochemical markers (serum osteocalcin and urinary deoxypyridinoline) were also assayed and the results were compared to 12 healthy age- and sex-matched controls. Osteopenia was observed at diagnosis and during treatment in patients with acute leukemia. At diagnosis osteopenia was observed in 27 patients (62.8%): 10 (23.3%) had non severe osteopenia and 17 (39.5%) had severe osteopenia. This low BMD persisted in those who were followed up. Parathyroid hormone (PTH) (pg/ml) levels demonstrated non significant differences between children with acute leukemia at different stages of therapy and controls, while, 25 (OH) D3 (ng/ml) was significantly lower in acute leukemia patients at different stages of therapy compared to controls (p<0.001). Osteocalcin (ng/ml) is significantly lower in patients at different stages of the disease compared to controls (p<0.001) but there was no significant difference between patients at different stages of therapy. Deoxy-pyridoline cross links showed non-significant difference between the different types of acute leukemia and with controls. Osteopenia is a significant problem in children with acute leukemia at presentation and after chemotherapy. Osteopenia in acute leukemia appears to be of the low turnover type (decreased osteoblastic activity and decreased bone mineralization).

Topics: Acute Disease; Adolescent; Bone Density; Bone Diseases, Metabolic; Bone Remodeling; Child; Child, Preschool; Cholecalciferol; Egypt; Humans; Infant; Leukemia; Male; Osteoblasts; Osteocalcin; Parathyroid Hormone

Negative mineral balance in postmenopausal women appears to be an important risk factor for osteoporosis and subsequent bone fractures. Its pathogenesis has not been elucidated.. To elucidate the participation of the kidney and ageing on mineral balance in postmenopausal women.. 36 postmenopausal women with osteopenia or osteoporosis, aged 46-75 years were evaluated by determination of mineral balance, kidney functions, 25(OH)-cholecalciferol [25(OH)D], 1,25(OH)2-cholecalciferol [1,25(OH)2D] and intact parathormone plasma levels.. Plasma calcium (Ca) concentrations were low and they did not decrease further with ageing. Urinary Ca excretion decreased (r = -0.425, p < 0.01) with age without changes in the fractional excretion of Ca. A similar decrease of urinary excretion was found in the urinary excretion of phosphorus (Pi) (r = -0.335; p < 0.03) and magnesium (Mg) (r = -0.355; p < 0.03). All patients' kidney functions were in the age-related reference range. Plasma 25(OH)D concentrations were in the range of moderate to severe deficiency, related inversely to age (r = -0.357; p < 0.03) and Ca urinary excretion (r = 0.343; p < 0.04) and to plasma creatinine concentration (r = 0.381; p < 0.02). Plasma 1,25(OH)2D concentrations were also low, they did not change with age and were highly correlated with Ca urinary excretion (r = 0.458; p < 0.005). The intact parathormone (iPTH) plasma concentrations were in the reference range, without any changes during aging.. Pi, Mg and dominantly Ca imbalance in postmenopausal women with osteopenia or osteoporosis accentuates with age and besides their insufficient intake the vitamin D deficiency takes part. These data support the need for increased supplementation of Ca and vitamin D with increasing age. (Tab. 3, Fig. 4, Ref. 18.).

Topics: Aged; Aging; Bone Density; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Creatinine; Female; Humans; Kidney; Magnesium; Middle Aged; Osteoporosis, Postmenopausal; Phosphorus

In spite of essential enrichment of our pathophysiological knowledge in the field of the calcium-phosphate metabolism and bone alterations in renal transplant patients, both diagnosis and therapy of these abnormalities still remain a challenge for nephrologists and transplantologists. The present study aimed to establish the diagnostic value of traditional and contemporary markers of Ca-P metabolism and bone alterations in kidney transplant patients 4 or more years after Tx and the main factors responsible for osteodystrophy after Tx respectively. 61 patients and 21 controls were examined. The assessed parameters were: serum levels of total (Ca) and ionized calcium (Ca2+), serum concentration of phosphorus (P), intact PTH, calcitonin, osteocalcin, 25-OH-D3, collagen type I cross-linked C-telopeptide and activity of alkaline phosphatase (total and bone isoenzyme). In all subjects bone densitometry of the total body, L2-L4 vertebrae and femoral neck were performed. In kidney transplant patients routinely assessed markers of calcium-phosphate metabolism (Ca, Ca2+, P, alkaline phosphatase total and bone fraction) were in the normal range while significantly elevated serum concentrations of PTH, osteocalcin and CTx were found. In more than 20% of renal transplant patients osteoporosis and in further 50% patients osteopenia were found by DEXA. The intensity of bone abnormalities was dependent on the duration of dialysis therapy before Tx, time after Tx, degree of impairment of the graft, intensity of hyperparathyroidism and total dose of corticosteroids. From results obtained in this study estimation of serum concentration of 25-OH-D3, PTH, CTx and the BMD respectively is mandatory to detect Ca-P abnormalities and osteoporosis or osteopenia in Tx patients.

Topics: Absorptiometry, Photon; Adult; Biomarkers; Bone and Bones; Bone Density; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Chronic Kidney Disease-Mineral and Bone Disorder; Female; Follow-Up Studies; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Osteoporosis; Parathyroid Hormone; Phosphates; Poland; Prospective Studies; Renal Dialysis

Bisphosphonates, potent inhibitors of bone resorption, have been used clinically to correct the continued loss of bone mass in osteoporosis and in other conditions. However, there has been some concern that long-term treatment with these compounds, as well as more recently developed drugs, may also decrease the rate of bone formation. Bisphosphonates, which are strongly bound to hydroxyapatite crystals, may alter the structure and reactivity of the crystals, interfere with new crystal nucleation and growth, as well as alter the short-range order of newly formed crystals. We have investigated the chemistry and structure of the solid calcium-phosphate mineral phase of lumbar vertebrae of ovariectomized, 6.5-month-old rats treated with bisphosphonates for 1 year after onset of osteopenia. Appropriate control groups were used for comparison. The techniques used to assess the mineral phase were chemical analyses, Fourier transform-infrared (FT-IR) and FT-Raman spectroscopy, FT-IR microspectroscopy, and phosphorus-31 magic-angle-sample spinning nuclear magnetic resonance spectroscopy ((31)P MAS NMR). The (31)P MAS NMR spectra of trabecular bone of lumbar vertebrae of control, ovariectomized, and treated animals were similar. However, there were several significant differences in the results obtained by FT-IR spectroscopy of the whole tissue samples, FT-IR microspectroscopy of sections of bone, and chemical analyses. For example, whereas chemical analyses demonstrated that the CO(3) content of the mineral phase of the ovariectomized animals was decreased compared with controls, FT-IR microspectroscopy of bone sections showed no changes in the relative CO(3) content, but some changes in the environment of the CO(3) groups. However, chemical analyses of the crystals, combined with data from all three spectroscopic methods and with data from serum analysis, did indicate small changes in the mineral phase after ovariectomy, corrected after treatment with bisphosphonates. In any event, the chemical and structural data in the present studies demonstrate that the bisphosphonate, tiludronate, does not significantly alter the mineral components of bone after 1 year of treatment during the course of which bone loss was reversed.

Topics: Animals; Apatites; Bone Diseases, Metabolic; Bone Resorption; Calcium; Cholecalciferol; Diphosphonates; Disease Models, Animal; Female; Lumbar Vertebrae; Magnetic Resonance Spectroscopy; Ovariectomy; Parathyroid Hormone; Phosphorus; Phosphorus Radioisotopes; Rats; Rats, Sprague-Dawley; Spectroscopy, Fourier Transform Infrared; Weight Loss

The association of in vitro tests and in vivo bone implants, has significantly improved the characterization of biomaterials for orthopaedic devices before their clinical use. However, neither cell cultures nor most animals models used for these tests entirely reflect the clinical conditions in which biomaterials are implanted. Pathological animal models are considered to substantially improve our knowledge of osteointegration of biomaterials; for this reason researchers increasingly use aged, osteopenic or arthritic animals in their experimental tests. The development of "pathological cell cultures" would also be of great importance for the study of biomaterials. It would allow a complete material evaluation, beginning with a biocompatibility test to a more finalized and specific preclinical evaluation. The present study, looks at the possibility of using cell culture methodology for the improvement of in vitro biomaterials characterization in the case of osteopenia. Cultures derived from normal (NB-OST) rats were compared to those of osteopenic (OB-OST) rats, by testing the osteoblasts against common parameters of characterization. Moreover, the reaction of these cultures to two biological glasses of known in vivo behavior (both in normal and osteopenic bone) by means of parameters on biocompatibility and bone formation index, was evaluated. Our results showed that there was no evidence of differences between the NB-OST and OB-OST cultures. After 6 days of culturing, the bioglass that did not osteointegrate in osteopenic animals, did not induce cytotoxicity in NB-OST, but a significative reduction of viability and Osteocalcin level in OB-OST was observed. We think that these data should stimulate researchers to develop further tests in order to improve preliminary in vitro comprehension on biomaterials.

Topics: Alkaline Phosphatase; Animals; Biocompatible Materials; Bone Diseases, Metabolic; Bone Substitutes; Cell Culture Techniques; Cell Survival; Ceramics; Cholecalciferol; Female; Materials Testing; Osseointegration; Osteoblasts; Osteocalcin; Phenotype; Prostheses and Implants; Rats; Rats, Sprague-Dawley

Tibolone is a synthetic steroid with tissue-specific estrogenic, progestogenic, and androgenic properties. The therapeutic effects of tibolone on bone mass and strength, bone metabolic markers, and indices of histomorphometry were investigated in ovariectomized (ovx) rats on a low (0.1%)-calcium diet in comparison with 17alpha-ethynylestradiol (EE) or 1alpha-hydroxyvitamin D3 [1alpha(OH)D3]. Tibolone (0.1-3 mg/kg/day), EE (0.1 mg/kg/day), or 1alpha(OH)D3 (0.5 microg/kg/day) was administered orally once a day for 16 weeks, starting 12 weeks after ovariectomy, when the bone mineral density (BMD) of lumbar vertebrae (L4-5) and femur (global, proximal, and distal regions) had already been decreased by the combination of ovariectomy and low dietary calcium. The BMD of the lumbar vertebrae and the femur were higher in the groups treated with tibolone, EE, or 1alpha(OH)D3 than in the ovx control group. The BMD of the mid-diaphysial regions of femur and tibia, which consist mainly of cortical bone, were decreased 28 weeks after ovariectomy in the ovx control group. The BMD of the mid-diaphysial femur was higher in the groups treated with 1alpha-(OH)D3, and the BMD of mid-diaphysial tibia was higher in the groups treated with tibolone or 1alpha(OH)D3 than in the ovx control group. Like BMD, the compressive strength of the vertebral body of L2, corrected for the volume of each individual vertebra tested, was higher in the groups treated with tibolone, EE, or 1alpha(OH)D3 than in the ovx control group. Trabecular bone volume and trabecular number were reduced 12 and 28 weeks after ovariectomy but there was no change in trabecular thickness. These reduced indices were increased in the groups treated with tibolone, EE, or 1alpha(OH)D3 when compared with the ovx control group. Tibolone or EE decreased serum levels of osteocalcin and bone alkaline phosphatase and urinary levels of deoxypyridinoline and pyridinoline compared with the ovx control group. Furthermore, tibolone or EE decreased the mineralizing surface and bone formation rate as well as the osteoclast surface and osteoclast numbers. 1Alpha(OH)D3, however, did not affect these serum and urinary parameters. These data suggest that tibolone suppresses the accelerated bone turnover induced by a combination of ovariectomy and low dietary calcium, and indicate that tibolone may be a potentially useful drug for the treatment of postmenopausal osteoporosis.

Topics: Absorptiometry, Photon; Alkaline Phosphatase; Amino Acids; Anabolic Agents; Animals; Bone and Bones; Bone Density; Bone Diseases, Metabolic; Calcium; Calcium, Dietary; Cholecalciferol; Ethinyl Estradiol; Female; Norpregnenes; Osteocalcin; Ovariectomy; Rats; Rats, Sprague-Dawley; Weight-Bearing

The aim of the study was to evaluate the efficacy of half-year treatment of bone mineral disturbances with calcitonin in the patients with multiple myeloma. Thirty five patients (11 men and 24 women) were examined. They were treated among other with prednisone. Nineteen patients (15 patients with normal bone mineral density of lumbar spine and femoral neck and 4 with low bone mineral density who could not be treated with calcitonin) were treated only with chemotherapy. Other 16 patients with low bone mineral density have received also calcitonin (100 units subcutaneous daily) with vitamin D3 and calcium carbonate. Bone mineral density was evaluated with dual energy X-ray absorptiometry in lumbar spine and femoral neck. After treatment with calcitonin there was more pronounced influence on bone mineral density in lumbar spine and femoral neck than after treatment with chemotherapy only but the difference was not statistically significant. Because the bone mineral disturbances in the patients with multiple myeloma is the big problem there is a need for further and longer evaluation of the treatment of these disturbances.

Topics: Aged; Bone Density; Bone Diseases, Metabolic; Calcification, Physiologic; Calcitonin; Calcium Carbonate; Cholecalciferol; Female; Femur Neck; Humans; Lumbar Vertebrae; Male; Middle Aged; Multiple Myeloma; Prednisone; Radiography

Serum osteocalcin has been found to correlate with bone formation. However, present literature gives only limited data on osteocalcin and bone histomorphometry in patients undergoing peritoneal dialysis. This study assessed serum osteocalcin, dialysate osteocalcin, peritoneal clearance of osteocalcin (Clp-osteocalcin) and mass transfer of osteocalcin (MTp-osteocalcin), and evaluated relationships between these values and bone histomorphometry. Eighteen patients were treated by continuous ambulatory peritoneal dialysis (CAPD). Bone biopsies, serum and dialysate osteocalcin, serum levels of parathyroid hormone, alkaline phosphatase, aluminum, phosphate, Ca2+ and vitamin D3 metabolites were measured at the start and in 10 of the patients a year later. Serum osteocalcin was found to be elevated. Osteocalcin was detected in the dialysate resulting in significant values of Clp-osteocalcin and MTp-osteocalcin. Serum and dialysate levels of osteocalcin correlated significantly (r = 0.66, P < 0.001) and like MTp-osteocalcin with serum levels of alkaline phosphatase and PTH. Histomorphometry showed that osteitis fibrosa was the predominant bone disease detected. Serum concentration of osteocalcin correlated with osteoid thickness, eroded and osteoclast surfaces, aluminum staining, and some of the bone dynamic parameters. Dialysate osteocalcin, MTp-osteocalcin, PTH and alkaline phosphatase correlated with practically the same histomorphometric parameters as serum osteocalcin. No correlations were seen between Clp-osteocalcin and any histomorphometric parameters. Serum osteocalcin was elevated above the normal range, and significant positive correlations between serum osteocalcin and bone formation parameters were found. Serum osteocalcin correlated with almost the same histomorphometric parameters as PTH. Thus, serum levels of PTH and osteocalcin gave additional information to one another as non-invasive parameters in this group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Alkaline Phosphatase; Biopsy; Bone Density; Bone Diseases, Metabolic; Cholecalciferol; Dialysis Solutions; Female; Humans; Kidney Diseases; Male; Middle Aged; Osteocalcin; Parathyroid Hormone; Peritoneal Dialysis, Continuous Ambulatory

To explore the pathogenesis of diabetes associated osteopenia, we characterized the osteopenia in streptozotocin (STZ)-diabetic rats pharmacologically and biochemically. The femur metaphyseal bone mineral density measured by single photon absorptiometry decreased time-dependently in the STZ rats compared with that in control, and the difference reached statistical significance from 2 weeks after treatment with STZ. Closely similar bone loss was obtained in ovariectomized (Ovx) and vitamin D deficient(D(-)) rats. Daily oral treatment with a bone resorption inhibitor, FR78844 (a bisphosphonate compound, 100 mg/kg), for 4 weeks significantly attenuated the osteopenia in the STZ and Ovx rats, but not in the D(-) rats, while 1 alpha-hydroxyvitamin D3 (1 alpha-(OH)D3) significantly attenuated the osteopenia in the STZ and D(-) rats in a dose of 0.1 microgram/kg/day, and that in the Ovx rats in 1 microgram/kg/day. The latter dose of 1 alpha-(OH)D3 significantly increased the metaphyseal bone mineral density of the femur in normal rats. Serum levels of 1 alpha, 25-dihydroxyvitamin D (1 alpha, 25-(OH)2D), the most active metabolite of vitamin D, hardly changed in the Ovx rats compared with that in control, but decreased to 24 and 76% that of control in the STZ and D(-) rats, respectively. Serum PTH levels in the STZ, Ovx and D(-) rats were comparable with those in controls, but serum calcitonin levels were reduced to 60 and 66% of control in the STZ and Ovx rats, respectively. Serum osteocalcin levels also decreased in the STZ rats compared to control. It is thus speculated that the predominance of bone resorption over bone formation and the reduction of 1 alpha, 25-(OH)2D are involved in the pathogenesis of diabetes associated osteopenia.

Topics: Animals; Bone Density; Bone Diseases, Metabolic; Bone Resorption; Cholecalciferol; Diabetes Mellitus, Experimental; Diphosphonates; Female; Hydroxycholecalciferols; Ovariectomy; Rats; Rats, Wistar; Streptozocin; Vitamin D Deficiency

Zinc is a trace element important to bone mineralization as well as, in general, nutrition. It is known that cholecalciferol (vitamin D3) affects bone metabolism. In this study, toxic doses of vitamin D3 were injected subcutaneously (25 micrograms/d) to rats for 5 wk. It caused a significant increase in serum zinc levels (p < 0.02). On the other hand, no significant increase was detected in the other groups. Excessive amounts of vitamin D3 caused bone breakdown and increased the levels of zinc in blood.

Topics: Alkaline Phosphatase; Animals; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Male; Rats; Rats, Wistar; Zinc

26 years after a partial gastric resection (Billroth II) for recurrent gastric ulcer a 62-year-old man developed severe intestinal osteopathy. For three years he had increasing pain in the lower back and hip with a noticeable waddling gait. Serum concentration of calcium (2.0 mmol/l) and 25-hydroxy-vitamin D3 (38 mmol/l) were reduced, those of alkaline phosphatase (572 U/l) and parathormone (532 pg/ml) increased. Radiology demonstrated Looser's zones in the ribs and iliac crest. Osteodensitometry showed obviously diminished bone density. Iliac crest biopsy revealed signs of osteomalacia and secondary hyperparathyroidism. Within three months of starting oral vitamin D3 and calcium the symptoms had definitely receded and serum concentrations of calcium and alkaline phosphatase had become normal (2.4 mmol/l and 156 U/l, respectively). Osteopathic symptoms are often the expression of an abnormal calcium/phosphate metabolism. The cause often lies in the gastrointestinal tract; not rarely it is a late complication of a gastrojejunostomy.

Topics: Bone and Bones; Bone Density; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Diagnosis, Differential; Drug Therapy, Combination; Gastrostomy; Humans; Intestinal Diseases; Jejunostomy; Male; Middle Aged; Postgastrectomy Syndromes; Radiography; Time Factors

To investigate osteodystrophy in liver cirrhosis, 99Tcm MDP (methylene diphosphonate) bone scintigraphy was performed on 36 patients with liver cirrhosis. Abnormal lesions were detected in 17 out of 36 scans (47.2%). On the other hand, areas of increased uptake were uncommon in patients with chronic active hepatitis (1/11 cases). Plasma vitamin D3 fractions [25(OH)D3, 24.25(OH)2D3 and 1.25(OH)2D3] were decreased. Statistically significant depletion of 1.25(OH)2D3 was observed in cases with positive bone scintigraphy. 1 alpha(OH)D3 (1-2 micrograms/day) was administered for 6 months to nine patients having abnormal bone scans. Six of them showed improvement without any apparent side-effects. We conclude that hepatic cirrhotic osteodystrophy can be diagnosed positively by 99Tcm MDP bone scintigraphy and can be treated accordingly.

Topics: Adult; Aged; Aged, 80 and over; Bone Diseases, Metabolic; Cholecalciferol; Evaluation Studies as Topic; Female; Hepatitis, Chronic; Humans; Hydroxycholecalciferols; Liver Cirrhosis; Male; Middle Aged; Radionuclide Imaging; Ribs; Spine; Technetium Tc 99m Medronate

This study was conducted to determine if the adverse effects of anticonvulsant drug therapy and nonambulancy on bone status could be overcome with vitamin D therapy in severely handicapped individuals. Six male and five female gastrostomy fed, nonambulant, epileptic, profoundly mentally retarded individuals ranging in age from 7 to 17 years were given vitamin D therapy at a dosage of 4,000 IU/m2 body surface area/day for 6 months. Photon absorptiometry and biochemical indices of bone status were measured to follow the effects of therapy. Bone mineral content expressed as a percentage of normal improved by 11 percent (p less than 0.01), from 59.6 to 66.1 percent. Tartrate-resistant acid phosphatase, total alkaline phosphatase, and the bone isoenzyme activities declined 11 percent, 18 percent, and 11 percent respectively. These reductions were not statistically significant but they were consistent with the improvements observed by photon absorptiometry. The results of our study suggest that a conservative supplement of vitamin D will improve the bone status of severely disabled youths.

Topics: Adolescent; Anticonvulsants; Bone and Bones; Bone Diseases, Metabolic; Calcifediol; Child; Cholecalciferol; Epilepsy; Female; Humans; Institutionalization; Locomotion; Male; Minerals

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Diseases, Metabolic; Cholecalciferol; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Vitamin D Deficiency

Twenty-four children with vitamin D intoxication and a follow-up of one to thirteen years old (means: four years and seven months) are reviewed. Over-dosage was prescribed by medical order in 66.6% of patients and by the mother herself in 16.6%. Intensity of clinical symptoms (renal, neurologic, digestive) were related with daily dose administered whilst final secuelae depends on duration of overdosage. Hipercalcemia was easily corrected by association of low calcium diet, corticoesteroids and/or furosemide in least than a month in 81% of cases. Two patients died during the acute fase and 22.7% remain with permanent damage (five in chronic renal failure, one in haemodialysis and three with low IC).

Topics: Bone Diseases, Metabolic; Calcinosis; Calcium; Child; Child, Preschool; Cholecalciferol; Female; Humans; Hypertension; Infant; Male; Nephrocalcinosis

Research over the last fifteen years has led to the identification of several metabolites of vitamin D, elucidation of their mechanism of action, clarification of the pathogenesis of several metabolic bone diseases, and development of new diagnostic tests and more effective and safe treatment. 1, 25(OH)2 D, the most active metabolite, can be regarded as a highly potent steroid hormone, with its formation from its precursors tightly coupled to physiological need by a variety of ionic and hormonal regulating mechanisms.

Topics: Animals; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Dihydroxycholecalciferols; Ergocalciferols; Humans; Hydroxycholecalciferols; Intestinal Absorption; Kidney; Phosphorus

Topics: Bone Diseases, Metabolic; Cholecalciferol; Humans; Kidney Cortex; Vitamin D

Topics: Bone Diseases, Metabolic; Cholecalciferol; Chronic Disease; Humans; Hydroxycholecalciferols; Liver Diseases; Osteomalacia; Osteoporosis; Vitamin D

Topics: Adult; Bone and Bones; Bone Diseases, Metabolic; Calcium; Cholecalciferol; Female; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Male; Renal Dialysis; Vitamin D Deficiency

Topics: Animals; Bone Diseases, Metabolic; Calcitonin; Calcium; Child; Cholecalciferol; Dehydrocholesterols; Female; Growth; Humans; Lactation; Male; Parathyroid Hormone; Pregnancy