cholecalciferol and Osteoporosis

Low serum 25-hydroxy-vitamin D [25(OH)D] levels are prevalent worldwide. Although the benefits of vitamin D supplementation have focused on skeletal disorders (eg, rickets, osteomalacia, osteoporosis), emerging evidence for nonskeletal health merits further discussion.. The purpose of this review was to critically examine the vitamin D supplementation literature pertaining to nonskeletal health to help guide clinicians.. A scoping review that included observational studies and randomized clinical trials (RCTs) was performed. Evidence from meta-analyses and individual RCTs are discussed, and controversies and future directions are considered.. 25(OH)D deficiency is a ubiquitous condition associated with multiple nonskeletal diseases, including cardiometabolic (heart disease, diabetes, and kidney disease), immune (HIV/AIDS and cancer), lung (from traditional chronic disorders to coronavirus disease 2019), and gut diseases. Vitamin D deficiency also affects health across the life span (children, pregnant, and elderly), mental illness, and reproduction in both men and women. In contrast, vitamin D supplementation does not necessarily improve major medical outcomes, even when low 25(OH)D levels are treated. Screening for 25(OH)D status remains an important practice, primarily for high-risk patients (eg, elderly, women with osteoporosis, people with low exposure to sunlight). It is reasonable to supplement with vitamin D to treat 25(OH)D deficiency, such that if beneficial nonskeletal health occurs, this may be considered as a coadjutant instead of the central tenet of the disease. Furthermore, optimizing dosing regimens is an important clinical consideration.. Although 25(OH)D deficiency is prevalent in nonskeletal diseases, there is no uniform evidence that vitamin D supplementation improves major medical outcomes, even when low 25(OH)D levels are corrected. Findings from RCTs warrant caution due to possible selection bias. Overall, vitamin D supplementation must be guided by circulating levels as a reasonable medical practice to correct 25(OH)D deficiency.

Topics: Aged; Child; Cholecalciferol; COVID-19; Dietary Supplements; Female; Humans; Male; Osteoporosis; Pregnancy; Vitamin D; Vitamin D Deficiency; Vitamins

(1) Background: In the present paper we aimed to review the evidence about the potential implication of vitamin D in the pathogenesis and management of systemic sclerosis (SSc); (2) Methods: we performed a review of the literature looking for studies evaluating the potential role of vitamin D and its analogs in SSc. We searched the PubMed, Medline, Embase, and Cochrane libraries using the following strings: (vitamin D OR cholecalciferol) AND (systemic sclerosis OR scleroderma). We included cohort studies, case-control studies, randomized controlled trials, and observational studies. (3) Results: we identified nine pre-clinical and 21 clinical studies. Pre-clinical data suggest that vitamin D and its analogs may suppress fibrogenesis. Clinical data are concordant in reporting a high prevalence of hypovitaminosis D and osteoporosis in SSc patients; data about the association with clinical manifestations and phenotypes of SSc are, conversely, far less consistent; (4) Conclusions: in vitro data suggest that vitamin D may play an antifibrotic role in SSc, but clinical data confirming this finding are currently lacking. Hypovitaminosis D is common among SSc patients and should be treated to reduce the risk of osteoporosis.

Topics: Cholecalciferol; Humans; Osteoporosis; Rickets; Scleroderma, Systemic; Vitamin D; Vitamin D Deficiency; Vitamins

Osteoporosis is a metabolic disease of the skeletal system which currently affects over 200 million patients worldwide. The WHO criteria define osteoporosis as low bone mineral density, with a T-score ≤ -2.5 found in the spine, the neck of the femur, or during a full hip examination. Osteoporosis considerably reduces a patient's quality of life. QoL should be carefully evaluated before fractures occur to enable the development of an appropriate treatment plan. The progression of osteoporosis may be significantly inhibited by following a proper diet, leading a healthy lifestyle, taking dietary supplements, and receiving appropriate treatment. Education and the prevention of the disease play a major role. Potentially modifiable risk factors for osteoporosis are vitamin D deficiency, smoking, alcohol consumption, low calcium intake, low or excessive phosphorus intake, protein deficiency or a high-protein diet, excessive consumption of coffee, a sedentary lifestyle or lack of mobility, and insufficient exposure to the sun. Pharmaceutical treatment for osteoporosis involves bisphosphonates, calcium and vitamin D3, denosumab, teriparatide, raloxifene, and strontium ranelate. Data indicates that 30%-50% of patients do not take their medication correctly. Other methods of treatment include exercise, kinesitherapy, treatment at a health resort, physical therapy, and diet.

Topics: Cholecalciferol; Denosumab; Dietary Supplements; Diphosphonates; Exercise; Humans; Kinesiology, Applied; Osteoporosis; Raloxifene Hydrochloride; Risk Factors; Teriparatide; Thiophenes

Vitamin D deficiency is a global health problem due to its high prevalence and its negative consequences on musculoskeletal and extra-skeletal health. In our comparative review of the two exogenous vitamin D supplementation options most used in our care setting, we found that cholecalciferol has more scientific evidence with positive results than calcifediol in musculoskeletal diseases and that it is the form of vitamin D of choice in the most accepted and internationally recognized clinical guidelines on the management of osteoporosis. Cholecalciferol, unlike calcifediol, guarantees an exact dosage in IU (International Units) of vitamin D and has pharmacokinetic properties that allow either daily or even weekly, fortnightly, or monthly administration in its equivalent doses, which can facilitate adherence to treatment. Regardless of the pattern of administration, cholecalciferol may be more likely to achieve serum levels of 25(OH)D (25-hydroxy-vitamin D) of 30-50 ng/mL, an interval considered optimal for maximum benefit at the lowest risk. In summary, the form of vitamin D of choice for exogenous supplementation should be cholecalciferol, with calcifediol reserved for patients with liver failure or severe intestinal malabsorption syndromes.

Topics: Animals; Calcifediol; Cholecalciferol; Dietary Supplements; Humans; Musculoskeletal System; Osteoporosis; Vitamin D; Vitamin D Deficiency

Osteoporosis is a major cause of morbidity and mortality worldwide and its prevention in order to avert fractures was considered of great importance in maintaining well-being and independence among the elderly. Strategies for osteoporosis prevention are well delineated, but research shows that the treatment options offered today could still be improved. The role of plain vitamin D (cholecalciferol) in bone health and the prevention of osteoporosis are well documented; however, as a treatment for osteoporosis, either with or without calcium, it has been shown to be ineffective. This is due in part to the strong negative feedback mechanisms in place in vitamin D-replete patients. However, other factors linked directly to ageing such as oestrogen depletion, reduced kidney or liver function may also be involved in reducing the body's capability to activate plain vitamin efficiently. This is why active vitamin D analogues such as alfacalcidol, 1-α-(OH)D3, are of clinical interest. Alfacalcidol requires only one hydroxylation reaction to become active 1,25-(OH)2-vitamin D3, and the 25-hydroxylase catalyzing this reaction is found in the liver and also interestingly in osteoblasts suggesting a local effect. Registered for use in postmenopausal osteoporosis, in most countries worldwide, alfacalcidol has also shown efficacy in glucocorticoid-induced and male osteoporosis. The present review provides compelling evidence for the efficacy of this compound in the treatment of osteoporosis and prevention of fractures both in monotherapy and when combined with other osteoporotic drugs where additive effects are clear. The safety profile of alfacalcidol is shown to be highly acceptable and it is considered less likely to induce hypercalcaemia than another more widely used analogue, calcitriol. Therefore, it remains unclear as to why alfacalcidol is not more widely used in clinical practice.

Topics: Aged; Cholecalciferol; Female; Humans; Male; Osteoporosis; Osteoporosis, Postmenopausal; Vitamin D; Vitamins

To review the available literature regarding a possible relationship between vitamin D and bone marrow adipose tissue (BMAT), and to identify future avenues of research that warrant attention.. Results from in vivo animal and human studies all support the hypothesis that vitamin D can suppress BMAT expansion. This is achieved by antagonizing adipogenesis in bone marrow stromal cells, through inhibition of PPARγ2 activity and stimulation of pro-osteogenic Wnt signalling. However, our understanding of the functions of BMAT is still evolving, and studies on the role of vitamin D in modulating BMAT function are lacking. In addition, many diseases and chronic conditions are associated with low vitamin D status and low bone mineral density (BMD), but BMAT expansion has not been studied in these patient populations. Vitamin D suppresses BMAT expansion, but its role in modulating BMAT function is poorly understood.

Topics: Adipogenesis; Adipose Tissue; Aging; Animals; Bone Marrow; Cholecalciferol; Diabetes Mellitus, Type 2; Humans; Mesenchymal Stem Cells; Obesity; Osteogenesis; Osteoporosis; PPAR gamma; Receptors, Calcitriol; Renal Insufficiency, Chronic; Vitamin D; Wnt Signaling Pathway

Osteoporotic fractures are common in patients with chronic kidney disease (CKD). Morbidity and mortality are higher in CKD patients with a fracture than in the general population. The assessment of bone mineral density for fracture prediction may be useful at all CKD stages. It should be considered when this influences treatment decisions. Vitamin D deficiency is common in patients with CKD, particularly in patients with proteinuria, due to loss of 25-hydroxyvitamin D and its binding protein. Vitamin D supplementation should be prescribed early in the course of renal disease. For treatment and prevention of vitamin D deficiency in CKD patients cholecalciferol 800 IU/day or the equivalent per month is recommended just as in the general population.

Topics: Bone Density Conservation Agents; Cholecalciferol; Humans; Osteoporosis; Osteoporotic Fractures; Renal Insufficiency, Chronic; Vitamin D; Vitamin D Deficiency

Middle East Respiratory Syndrome (MERS) is a novel respiratory illness firstly reported in Saudi Arabia in 2012. It is caused by a new corona virus, called MERS corona virus (MERS-CoV). Most people who have MERS-CoV infection developed severe acute respiratory illness.. This work is done to determine the clinical characteristics and the outcome of intensive care unit (ICU) admitted patients with confirmed MERS-CoV infection.. This study included 32 laboratory confirmed MERS corona virus infected patients who were admitted into ICU. It included 20 (62.50%) males and 12 (37.50%) females. The mean age was 43.99 ± 13.03 years. Diagnosis was done by real-time reverse transcription polymerase chain reaction (rRT-PCR) test for corona virus on throat swab, sputum, tracheal aspirate, or bronchoalveolar lavage specimens. Clinical characteristics, co-morbidities and outcome were reported for all subjects.. Most MERS corona patients present with fever, cough, dyspnea, sore throat, runny nose and sputum. The presence of abdominal symptoms may indicate bad prognosis. Prolonged duration of symptoms before patients' hospitalization, prolonged duration of mechanical ventilation and hospital stay, bilateral radiological pulmonary infiltrates, and hypoxemic respiratory failure were found to be strong predictors of mortality in such patients. Also, old age, current smoking, smoking severity, presence of associated co-morbidities like obesity, diabetes mellitus, chronic heart diseases, COPD, malignancy, renal failure, renal transplantation and liver cirrhosis are associated with a poor outcome of ICU admitted MERS corona virus infected patients.. Plasma HO-1, ferritin, p21, and NQO1 were all elevated at baseline in CKD participants. Plasma HO-1 and urine NQO1 levels each inversely correlated with eGFR (. SnPP can be safely administered and, after its injection, the resulting changes in plasma HO-1, NQO1, ferritin, and p21 concentrations can provide information as to antioxidant gene responsiveness/reserves in subjects with and without kidney disease.. A Study with RBT-1, in Healthy Volunteers and Subjects with Stage 3-4 Chronic Kidney Disease, NCT0363002 and NCT03893799.. HFNC did not significantly modify work of breathing in healthy subjects. However, a significant reduction in the minute volume was achieved, capillary [Formula: see text] remaining constant, which suggests a reduction in dead-space ventilation with flows > 20 L/min. (ClinicalTrials.gov registration NCT02495675).. 3 组患者手术时间、术中显性失血量及术后 1 周血红蛋白下降量比较差异均无统计学意义（. 对于肥胖和超重的膝关节单间室骨关节炎患者，采用 UKA 术后可获满意短中期疗效，远期疗效尚需进一步随访观察。.. Decreased muscle strength was identified at both time points in patients with hEDS/HSD. The evolution of most muscle strength parameters over time did not significantly differ between groups. Future studies should focus on the effectiveness of different types of muscle training strategies in hEDS/HSD patients.. These findings support previous adverse findings of e-cigarette exposure on neurodevelopment in a mouse model and provide substantial evidence of persistent adverse behavioral and neuroimmunological consequences to adult offspring following maternal e-cigarette exposure during pregnancy. https://doi.org/10.1289/EHP6067.. This RCT directly compares a neoadjuvant chemotherapy regimen with a standard CROSS regimen in terms of overall survival for patients with locally advanced ESCC. The results of this RCT will provide an answer for the controversy regarding the survival benefits between the two treatment strategies.. NCT04138212, date of registration: October 24, 2019.. Results of current investigation indicated that milk type and post fermentation cooling patterns had a pronounced effect on antioxidant characteristics, fatty acid profile, lipid oxidation and textural characteristics of yoghurt. Buffalo milk based yoghurt had more fat, protein, higher antioxidant capacity and vitamin content. Antioxidant and sensory characteristics of T. If milk is exposed to excessive amounts of light, Vitamins B. The two concentration of ZnO nanoparticles in the ambient air produced two different outcomes. The lower concentration resulted in significant increases in Zn content of the liver while the higher concentration significantly increased Zn in the lungs (p < 0.05). Additionally, at the lower concentration, Zn content was found to be lower in brain tissue (p < 0.05). Using TEM/EDX we detected ZnO nanoparticles inside the cells in the lungs, kidney and liver. Inhaling ZnO NP at the higher concentration increased the levels of mRNA of the following genes in the lungs: Mt2 (2.56 fold), Slc30a1 (1.52 fold) and Slc30a5 (2.34 fold). At the lower ZnO nanoparticle concentration, only Slc30a7 mRNA levels in the lungs were up (1.74 fold). Thus the two air concentrations of ZnO nanoparticles produced distinct effects on the expression of the Zn-homeostasis related genes.. Until adverse health effects of ZnO nanoparticles deposited in organs such as lungs are further investigated and/or ruled out, the exposure to ZnO nanoparticles in aerosols should be avoided or minimised.

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YAP-Signaling Proteins; Yogurt; Young Adult; Zebrafish; Zebrafish Proteins; Ziziphus

Clinical studies investigating relationships between D3 and 25OHD3 vary in dosing regimen, assays, demographics, and control of exogenous D3. This leads to uncertain and conflicting exposure-related associations with D3 and 25OHD3. To elucidate this parent-metabolite system, a PPK model was developed to predict mean D3 and 25OHD3 exposure from varied doses and administration routes. Sources of exposure variability related to metabolite baseline, weight, and assay type were explored. Specific search criteria were used in PUBMED to identify public source PK data pertaining to D3 and 25OHD3 in healthy or osteoporotic populations. Overall 57 studies representing 5395 individuals were selected, including 25 individual-level profiles and treatment-arm data. IV, oral, single and multiple dose data were used, with D3 and 25OHD3 dosing. A nonlinear mixed effects model was developed to simultaneously model PK dispositions of D3 and 25OHD3 (NONMEM v7.2), which were described by 2-compartment models with nonlinear and linear clearances, respectively. Proportional and additive assay variances were included on the 25OHD3 prediction. Unit-level random effects were weighted by treatment-arm size. D3 model estimates, relative to bioavailability were: maximum rate of metabolism ([Formula: see text], 1.62 nmol/h), Michaelis-Menten constant ([Formula: see text], 6.39 nmol/L), central volume of distribution ([Formula: see text], 15.5 L), intercompartmental clearance ([Formula: see text], 0.185 L/h), peripheral volume of distribution ([Formula: see text], 2333 L/h), and baseline concentration ([Formula: see text], 3.75 nmol/L). For 25OHD3 ([Formula: see text] = metabolite): [Formula: see text] = 0.0153 L/h, [Formula: see text] = 4.35 L, [Formula: see text] = 6.87 L, [Formula: see text] = 0.0507 L/h. Simulations of 25OHD3 concentration indicated an inverse relationship between 25OHD3 baseline and response, as well as a less than proportional 25OHD3 response. Estimation of assay bias parameters suggested that HPLC-MS and RIA produced similar measurement results, whereas CPBA and CHEMI are over-predictive of 25OHD3 concentration, relative to HPLC-MS.

Topics: Biological Availability; Calcifediol; Cholecalciferol; Drug Administration Routes; Healthy Volunteers; Humans; Models, Theoretical; Nonlinear Dynamics; Osteoporosis

Glucocorticoid-induced osteoporosis is the most common cause of secondary osteoporosis. Moreover, it is the most common reason for an osteoporosis among young adults. The clinical use of oral glucocorticoids increases the fracture incidence already within three months after starting the therapy. There does not seem to be a lower threshold: even doses as low as 2,5 mg of prednisone equivalent increase the risk of fractures. Adequate diagnostic and therapy are able to significantly reduce the resulting fracture risk. This article will discuss the pathophysiology of glucocorticoid-induced osteoporosis and give a summary of the current recommendations including the recently updated German guidelines.

Topics: Administration, Oral; Bone Density; Calcium, Dietary; Cholecalciferol; Dose-Response Relationship, Drug; Glucocorticoids; Humans; Long-Term Care; Osteoporosis; Osteoporotic Fractures; Prednisolone; Risk; Young Adult

As the population of people living with HIV ages, the increase in non-AIDs morbidities is expected to increase in parallel. Maintaining bone health in those with HIV will be an important area of focus for the HIV clinician to prevent the morbidity and mortality associated with fragility fractures, the principal clinical sequela of low bone mineral density (BMD). Rates of fractures and prevalence of low bone mineral density, a risk factor for future fragility fractures, are already increased in the HIV positive population.. This review examines the strategies to maintain bone health in those living with HIV from screening through to managing those with established low BMD or fracture, including the role for choice of or modification of antiretroviral therapy to maintain bone health. Expert commentary: The increasing complexity of managing bone health in the age of succesful antiretroviral therapy and an aging patient population as well as future perspectives which may help achieve the long term aim of minimising the impact of low BMD in those with HIV are discussed and explored.

Topics: Absorptiometry, Photon; Anti-Retroviral Agents; Bone Density; Bone Density Conservation Agents; Cholecalciferol; Ergocalciferols; Fractures, Bone; HIV Infections; Humans; Osteoporosis; Risk Factors

Vitamin D supplementation is recommended whenever patients are given therapeutic drugs for osteoporosis, to make their calcium (Ca) balance positive. Vitamin D is converted to 25-hydroxyvitamin D in the liver, and then activated to become 1α,25-dihydroxyvitamin D in the kidneys. The active vitamin D acts in the intestine to stimulate Ca absorption and maintain the Ca balance. 2β-(3-Hydroxypropyloxy)-1α,25-dihydroxyvitamin D3 (eldecalcitol) and 2-methylene-19-nor-(20S)-1α,25-dihydroxyvitamin D3 (2MD) are newly developed vitamin D analogs, with a substitution at the 2 position of 1α,25-dihydroxyvitamin D3 (calcitriol). Eldecalcitol and 2MD share common structural and biological characteristics. Both compounds increase serum Ca levels more markedly than calcitriol, increase bone mineral density (BMD), and improve bone strength in ovariectomized (OVX) rats. In a randomized, placebo-controlled, double-blind, 1 year clinical trial, eldecalcitol dose-dependently increased lumbar and hip BMD and suppressed bone turnover markers in patients with osteoporosis. Whereas, 2MD markedly increased the bone turnover markers, but it did not change the BMD of postmenopausal women with osteopenia in a 1 year clinical trial. After a randomized, double-blind, 3 year fracture-prevention trial comparing it with alfacalcidol, eldecalcitol was approved for the treatment of osteoporosis in Japan. On the other hand, the manufacturer discontinued the clinical development of 2MD. In this review, we discuss the similarities and differences between these 2 compounds, and the reasons why different outcomes resulted from their clinical trials.

Topics: Animals; Cholecalciferol; Humans; Osteoporosis; Randomized Controlled Trials as Topic; Treatment Outcome; Vitamin D

Renal osteodystrophy is the damage of bone morphology by CKD and treatment and occurred abnormal bone metabolism through renal dysfunction. It demonstrated that the control of P and Ca improves to normalization of mineral metabolism. Protein energy wasting and malnutrition are common in patients with CKD stage 5 and has been associated with life prognosis. In CKD patients, nutritional management is a critical role of treatment. Also it may be important of nutritional management that control P and Ca and improve nutritional status in renal osteodystrophy patients.

Topics: Bone and Bones; Calcium; Cholecalciferol; Chronic Kidney Disease-Mineral and Bone Disorder; Diphosphonates; Humans; Nutrition Therapy; Nutritional Status; Osteoporosis; Phosphorus; Prognosis; Protein-Energy Malnutrition; Renal Insufficiency, Chronic

Osteoporosis is a common and under-diagnosed disease characterized by the systemic impairment and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist. Recent progress in osteoporosis revealed new information on its pathogenesis, the relative risks of fragility fractures, and new treatment measures. In the wake of progress in osteoporosis research, the Japanese Society for Bone and Mineral Research (JSBMR) and Japan Osteoporosis Society Joint Review Committee revised the diagnostic criteria for primary osteoporosis, aimed at obtaining international consensus on the new findings, in 2012. The JSBMR also published guidelines for the use of bone metabolic markers in the diagnosis and treatment of osteoporosis in that year. Then, the JSBMR revised the guidelines on the management and treatment of glucocorticoid-induced osteoporosis in 2014. This article focuses on the diagnosis and pharmacological treatment of osteoporosis, with an overview of the Japanese guidelines.

Topics: Absorptiometry, Photon; Biomarkers; Bone Density Conservation Agents; Cholecalciferol; Diphosphonates; Fractures, Spontaneous; Humans; Osteoporosis; Practice Guidelines as Topic; Reference Standards; Risk; Selective Estrogen Receptor Modulators

Topics: Adult; Algorithms; Calcifediol; Calcitriol; Child; Cholecalciferol; Diabetes Mellitus; Disease Management; Female; Humans; Infant, Newborn; Kidney Diseases; Male; Obesity; Osteoporosis; Pregnancy; Recommended Dietary Allowances; Risk; Vitamin D Deficiency

Findings from recent meta-analyses of vitamin D supplementation without co-administration of calcium have not shown fracture prevention, possibly because of insufficient power or inappropriate doses, or because the intervention was not targeted to deficient populations. Despite these data, almost half of older adults (older than 50 years) continue to use these supplements. Bone mineral density can be used to detect biologically significant effects in much smaller cohorts. We investigated whether vitamin D supplementation affects bone mineral density.. We searched Web of Science, Embase, and the Cochrane Database, from inception to July 8, 2012, for trials assessing the effects of vitamin D (D3 or D2, but not vitamin D metabolites) on bone mineral density. We included all randomised trials comparing interventions that differed only in vitamin D content, and which included adults (average age >20 years) without other metabolic bone diseases. We pooled data with a random effects meta-analysis with weighted mean differences and 95% CIs reported. To assess heterogeneity in results of individual studies, we used Cochran's Q statistic and the I(2) statistic. The primary endpoint was the percentage change in bone mineral density from baseline.. Of 3930 citations identified by the search strategy, 23 studies (mean duration 23·5 months, comprising 4082 participants, 92% women, average age 59 years) met the inclusion criteria. 19 studies had mainly white populations. Mean baseline serum 25-hydroxyvitamin D concentration was less than 50 nmol/L in eight studies (n=1791). In ten studies (n=2294), individuals were given vitamin D doses less than 800 IU per day. Bone mineral density was measured at one to five sites (lumbar spine, femoral neck, total hip, trochanter, total body, or forearm) in each study, so 70 tests of statistical significance were done across the studies. There were six findings of significant benefit, two of significant detriment, and the rest were non-significant. Only one study showed benefit at more than one site. Results of our meta-analysis showed a small benefit at the femoral neck (weighted mean difference 0·8%, 95% CI 0·2-1·4) with heterogeneity among trials (I(2)=67%, p<0·00027). No effect at any other site was reported, including the total hip. We recorded a bias toward positive results at the femoral neck and total hip.. Continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate.. Health Research Council of New Zealand.

Topics: Aged; Bone Density; Cholecalciferol; Dietary Supplements; Ergocalciferols; Female; Humans; Male; Osteoporosis; Vitamin D

The aim of osteoporosis treatment is to reduce fracture risk. Many kinds of anti-osteoporosis drugs are available in these days, and most of them increase bone mineral density and reduce the risk of fractures. Japanese 2011 guidelines for prevention and treatment of osteoporosis documents the recommendation level of each osteoporosis drugs. It is important to select drugs appropriate for each osteoporosis patient considering the mechanisms of drug action and their clinical efficiency.

Topics: Antibodies, Monoclonal, Humanized; Bone Density Conservation Agents; Cholecalciferol; Denosumab; Diphosphonates; Drug Therapy, Combination; Fractures, Spontaneous; Humans; Ibandronic Acid; Molecular Targeted Therapy; Osteoporosis; Practice Guidelines as Topic; Raloxifene Hydrochloride; Selective Estrogen Receptor Modulators; Spinal Fractures; Teriparatide

Topics: Animals; Bone and Bones; Bone Density; Bone Density Conservation Agents; Cholecalciferol; Diphosphonates; Disease Models, Animal; Drug Administration Schedule; Drug Synergism; Drug Therapy, Combination; Durapatite; Haplorhini; Humans; Ibandronic Acid; Infusions, Intravenous; Osteoporosis; Randomized Controlled Trials as Topic; Rats; Spinal Fractures

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

Vitamin D3 is a key regulator of vertebrates homeostasis. It is synthesized from the precursor 7-dehydrocholesterol upon UVB exposure in the skin and then hydrolyzed in the liver in position 25, to be finally converted into its active form, 1,25-dihydroxyvitamin D (1,25(OH)2D or calcitriol), in the kidneys. The biological activity of this molecule depends on its binding to the nuclear receptor VDR, which binds VDRE once complexed with RXR-alpha. Despite being present in different types of food, the best way to assume it at physiological levels remains the exposure to UVB radiation at certain hours of the day and at particular angles of the Earth's crust. There is plenty of evidence that altered levels of vitamin D3 are associated with pathological conditions, such as osteoporosis, cancer, immunological and infectious diseases. In this review, we discuss vitamin D3 metabolism, its role in several diseases and the link between vitamin D3 and immune cells.

Topics: Animals; Cholecalciferol; Humans; Infections; Neoplasms; Osteoporosis; Skin

Frailty is an extremely common and serious health problem in the elderly. Frailty has been described as "a biologic syndrome of decreased reserve and resistance to stressors, resulting from cumulative declines across multiple physiologic systems and causing vulnerability to adverse health outcomes" by Fried and colleagues. Frailty is associated with incident falls, functional limitation, disability, and mortality. There are many reports that vitamin D deficiency may play roles in diabetes mellitus, cancers, multiple sclerosis, and other autoimmune diseases, and was associated with poorer physical performance, falls and fractures, and a greater risk of nursing home admission. Recently, researches suggest that vitamin D may provide treatment and prevention from these diseases lead to frailty. Vitamin D is expected to be a treatment for frailty in an aging society.

Topics: Accidental Falls; Aged; Aged, 80 and over; Cholecalciferol; Frail Elderly; Humans; Osteoporosis; Osteoporotic Fractures; Vitamin D Deficiency

Topics: Bone Density; Bone Density Conservation Agents; Calcium; Cholecalciferol; Female; Humans; Middle Aged; Osteoporosis; Osteoporotic Fractures; Proton Pump Inhibitors; Risk Factors

Steroid-induced osteoporosis is a textbook example of the secondary type of this medical condition. Glucocorticosteroids suppress bone formation by their direct and indirect effect on osteoblasts, osteoclasts and osteocytes, increasing their resorption and, eventually, leading to negative bone balance. A clinical problem arises regarding the fact that approximately 50% of patients on chronic steroid therapy undergo asymptomatic bone fractures. The treatment mode includes minimising the dose of administered steroids, encouraging an improved lifestyle and supplementation with adequate calcium and vitamin D(3) doses. Bisphosphonates are a group of medical agents used both to prevent and treat steroid-induced osteoporosis, although new therapies have also become available in recent years.

Topics: Bone Density Conservation Agents; Calcium; Cholecalciferol; Diphosphonates; Female; Fractures, Bone; Glucocorticoids; Humans; Male; Osteoblasts; Osteoclasts; Osteogenesis; Osteoporosis

This review summarizes recently published data on the epidemiology, pathophysiology and treatment of cystic fibrosis (CF)-related low bone mineral density (BMD).. A systematic literature review reports that the pooled prevalence of osteoporosis in adults with CF is 23.5% [95% confidence interval (CI) 16.6-31.0] and the pooled prevalences of radiologically confirmed vertebral and nonvertebral fractures are 14% (95% CI 7.8-21.7) and 19.7% (95% CI 6.0-38.8), respectively. Recent data suggest that the cystic fibrosis transmembrane conductance regulator (CFTR) is expressed in bone cells and that CFTR dysfunction affects bone cell activity. The secondary effects of CFTR dysfunction also influence bone metabolism. For example, bone resorption increases during CF pulmonary exacerbations due to the stimulatory effects of proinflammatory cytokines on osteoclast activity. Bisphosphonates inhibit osteoclastic bone resorption and recent data show that both oral and intravenous bisphosphonates improve BMD in patients with CF.. CF-related low BMD is a common but treatable complication of CF.

Topics: Bone Density; Calcium; Cholecalciferol; Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Diphosphonates; Humans; Osteoporosis; Vitamin K

Current evidence indicates that vitamin D3 plays significant role in calcium balance and bone metabolism through lifetime. There are also evidence on preventive efficacy of vitamin D3 in diabetes, insulin-resistance, hypertension and malignancy.. The aim of the systematic review was to gather evidence regarding vitamin D3 in prevention of diseases in adults. MEDLINE via Pubmed was searched using key words: "vitamin D3, "prevention", "adults", "cardiovascular diseases", cancer", "osteoporosis", "common cold", "cold", "diabetes", "obesity", "depression". 26 trials were included into analysis: 17 randomized clinical trials, five observational studies, two systematic reviews, and two metaanalysis.. Vitamin D3 appears to has beneficial effect in depression therapy, protective effect on beta-cells in diabetic patients and reducing frequency of adverse events such as thrombosis in patients with prostate cancer. Supplementing with vitamin D3 results with no significant improve in reducing body weight, fat, blood pressure, risk of hypertension, level of lipids in serum, response to treatment in cancer prostate (together with dexamethasone and carboplatin). Many studies highlights beneficial influence of vitamin D3 with calcium on bone mineral density in whole body. Another studies show improve in bone mineral density in hips and pelvic bones only. There were inconsistencies of studies results regarding role of vitamin D3 in prevention of diabetes, risk of breast cancer and influence on bone mineral density.. Despite all inconsistencies supplementation of vitamin D3 is important and plays role in effective osteoporotic management and there is evidence on preventive efficacy of vitamin D3 in different diseases.

Topics: Adult; Bone Density; Calcium; Cardiovascular Diseases; Cholecalciferol; Diabetes Mellitus; Dietary Supplements; Humans; Hypertension; Neoplasms; Osteoporosis; Thrombosis

Vitamin D and calcium are indispensable for the maintenance of bone mass and integrity. Active vitamin D3 has been most widely used in Japan for the treatment of osteoporosis. These drugs mildly increase bone mineral density, but it has little consistent effects on bone metabolic markers. Although weak, there is also some clinical evidence for their efficacy as a fracture-preventing drug. Recent reports suggest that vitamin D3 not only enhances intestinal calcium absorption but may also improve neuromuscular function to reduce the number of falls, thereby contributing to fracture prevention. Besides such extraskeletal effects, vitamin D analogues may also have direct bone anabolic effects, preventing fractures even under native vitamin D and calcium supplement.

Topics: Accidental Falls; Bone and Bones; Bone Density; Calcium; Cholecalciferol; Evidence-Based Medicine; Fractures, Bone; Fractures, Spontaneous; Humans; Intestinal Absorption; Meta-Analysis as Topic; Osteoporosis; Quality of Life

Only bisphosphonates have reliable evidence to decrease the risk of vertebral fractures in patients taking glucocorticoids. Relative risk at 1 year treatment with bisphosphonates for incident vertebral fractures and non-vertebral fractures were 0.46 (95% confidence interval: 0.28-0.77) and 0.77 (95% confidence interval: 0.39-1.51), respectively. Two year extension of the alendronate trial showed that relative risk for incident vertebral fractures was 0.10 (95% confidence interval: 0.01-0.90). The bisphosphonates have been recommended as first-line drugs and active vitamin D3 and vitamin K2 have been recommended as second-line drugs in Japanese guidelines on the management and treatment of glucocorticoid-induced osteoporosis of The Japanese Society for Bone and Mineral Research (2004 edition).

Topics: Alendronate; Bone Density Conservation Agents; Cholecalciferol; Clinical Trials as Topic; Diphosphonates; Glucocorticoids; Humans; Osteoporosis; Practice Guidelines as Topic; Spinal Fractures; Vitamin K 2

A-TOP research consortium has been authorized at 2000 by the Japanese Society of Osteoporosis and assisted by Public Health Research Foundation in order to obtain the clinical evidences regarding osteoporosis treatment. Each clinical trial program was named as JOINT (Japanese Osteoporosis Intervention Trial), which was multi-center randomized open label trial and was registered into clinical trial registry. JOINT-02 was started at 2003 to confirm the effect of combination treatment of active vitamin D3 and alendronate in the prevention of osteoporotic bone fracture occurrence. This trial will be terminated at 2009 and the subsequent third clinical trial to obtain the evidence regarding the combination effects of risedronate and vitamin K2 as JOINT-03 project has been started from 2008. Each trial included around 2,000 participants mainly from practitioner and the registration of the cases in JOINT-02 has been finished within 3 years, suggesting that the participated practitioner would have sympathy with the research aims. The A-TOP research group would have carried out epidemiological studies regarding establishment of osteoporosis database (JOB study), which will contribute the additional knowledge of Japanese osteoporosis.

Topics: Alendronate; Bone Density Conservation Agents; Cholecalciferol; Drug Therapy, Combination; Evidence-Based Medicine; Fractures, Bone; Fractures, Spontaneous; Humans; Japan; Multicenter Studies as Topic; Osteoporosis; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Societies, Medical; Vitamin K 2

Osteoporosis is a systemic disease of the skeleton, characterized by reduction of bone mass and concurrent deterioration of bone structure. Consequently, bones are more fragile, and there is increased risk of fractures. The potential for acquisition of maximum bone mass is influenced by a number of factors. Among those are heredity, sex, nutrition, endocrine factors, mechanical influences and some risk factors. The best documented nutrient for metabolism of bone is calcium. Major role in the pathogenesis of osteoporosis have some micro and macro nutrients, prebiotics, alcohol, alternative diets, starvation and anorexia. Meta analysis of 29 randomized trials showed that supplementation with calcium and vitamin D3 reduces risk of bone fractures by 24 % and significantly reduces loss of bone mass. Osteoporosis has multi factor etiology. Osteoporosis is one of diseases which are influenced by nutrition and life style. It is preventable by means of adequate nutrition and sufficient physical activity.

Topics: Bone Density; Calcium; Calcium, Dietary; Cholecalciferol; Diet; Dietary Supplements; Exercise; Humans; Nutritional Physiological Phenomena; Osteoporosis; Practice Guidelines as Topic; Risk Reduction Behavior

Many readers may have only a vague idea about vitamin D. This is made complicated, in part, because it is also expressed with suffixes such as vitamin D(2) or vitamin D(3). Otherwise the prefix of "active" is also occasionally used. Vitamin D is often referred to as an important nutrient for calcium intake, especially for growing children and the elderly. On the other hand, it serves as a therapeutic drug for osteoporosis and psoriasis. Recent studies have suggested an association with a number of diseases such as cancer, diabetes and Alzheimer's disease. The author has been involved in the research and development of vitamin D applications for over 25 years, and has often witnessed even world-class experts confuse the two roles - vitamin and hormone - of "substance" D. Assuming some readers are not familiar with vitamin D, D hormone or osteoporosis, an outline of vitamin D and D hormone is delineated with a particular focus on the treatment of osteoporosis. Furthermore, development of alfacalcidol as the first prodrug of D hormone (calcitriol) and eldecalcitol as a characteristic new D hormone derivative and basic relationship between calcemic activity and effect on bone in vitamin D (cholecalciferol), D hormone (calcitriol/alfacalcidol), and a new D hormone derivative (eldecalcitol) are introduced.

Topics: Calcitriol; Calcium; Cholecalciferol; Ergocalciferols; Humans; Hydroxycholecalciferols; Osteoporosis; Vitamin D

Active vitamin D3 has been most widely used in Japan for the treatment of osteoporosis. Although it mildly increases bone mineral density, it has little consistent effect on bone metabolic markers, and clinical evidence for its efficacy as a fracture-preventing drug is rather weak. Recent reports suggest that (active) vitamin D3 may prevent fracture incidence not only by promoting intestinal calcium absorption but also by improving neuromuscular function to reduce the number of falls.

Topics: Bone Density; Bone Density Conservation Agents; Cholecalciferol; Clinical Trials as Topic; Evidence-Based Medicine; Femoral Neck Fractures; Humans; Meta-Analysis as Topic; Osteoporosis; Quality of Life; Spinal Fractures

The high prevalence of vitamin D deficiency and insufficiency in the human population results from its inadequate cutaneous production and low dietary intake. Vitamin D status in the organism is determined by circulating levels of 25-hydroxycholecalciferol [25(OH)D3]. 25(OH)D3 is metabolized by a renal 25-hydroxyvitamin D-1alpha-hydroxylase (CYP27B1) into the vitamin D hormone 1,25 dihydroxycholecalciferol (calcitriol), which generates a wide range of biological responses via both the regulation of gene transcription and nongenomic pathways. Most of the circulating metabolite originates from cholecalciferol, which is synthesized in the skin upon exposure to the UVB spectrum of sunlight. The dietary source of vitamin D is extraordinarily low (10%) compared with endogenous production (90%). Recent epidemiological data demonstrated a strong association between poor vitamin D status (i.e. serum 25(OH)D3 levels below 50 nmol/l) and increased risk for chronic illnesses of various etiology. It is now recognized that maintaining a serum 25(OH)D3 level of 80 nmol/l (32 ng/ml) or greater is beneficial in the prevention of osteoporosis, cardiovascular diseases, certain autoimmune diseases, and some forms of cancer. It seems that sensible sun exposure and the use of supplements are the most effective ways of preventing vitamin D deficiency. The aim of the present article is to review new developments related to vitamin D deficiency and insufficiency and their consequences.

Topics: Autoimmune Diseases; Calcium; Calcium, Dietary; Causality; Cholecalciferol; Comorbidity; Dietary Supplements; Humans; Kidney; Neoplasms; Osteoporosis; Sunlight; Vitamin D; Vitamin D Deficiency

We evaluated the effect of supplementation with vitamin D(3) (excluding the potential effect of calcium supplementation) on the risk of fall and fracture, primarily in postmenopausal women, using a systematic literature review of MEDLINE, EMBASE, BIOSIS and the Cochrane Database of Systematic Reviews for the period January 1985 to June 2005. Studies examining the effect of vitamin D versus placebo on the risk of fall or fracture in postmenopausal females were of particular interest. Studies of vitamin D in combination with calcium were also included where the control group was treated with calcium alone. Studies of men and women where results for men and women were not presented separately were included. Nine studies met the inclusion criteria. Our primary meta-analyses examined the effect of vitamin D(3) on the risk of fall or fracture; additional analyses examined baseline and difference between baseline and final levels of several serum and urinary biochemical markers. The pooled relative risk (RR) for vitamin D(3) preventing falls was 0.88 (95%CI 0.78-1.00). For fractures, the pooled RR for vitamin D(3) preventing non-vertebral fractures was 0.96 (95%CI 0.84-1.09) and the pooled RR for vitamin D(3) preventing vertebral fractures was 1.22 (95%CI 0.64-2.31). In a subgroup analysis of post-menopausal women, the pooled RR for vitamin D(3) preventing falls was 0.92 (95%CI 0.75-1.12) and in preventing non-vertebral fractures the pooled RR was 0.81 (95%CI 0.48-1.34). There is a trend towards a reduction in the risk of fall among patients treated with vitamin D(3) alone compared with placebo, suggesting that vitamin D(3) should be an integral part of effective osteoporosis management.

Topics: Accidental Falls; Aged; Aged, 80 and over; Bone Density Conservation Agents; Cholecalciferol; Dietary Supplements; Female; Hip Fractures; Humans; Male; Middle Aged; Osteoporosis; Postmenopause; Risk Factors; Spinal Fractures; Treatment Outcome; Vitamin D Deficiency

Recently a number of therapies have been reported on the treatment efficacy for glucocorticoid-induced osteoporosis (GIOP) . Especially, bisphosphonates have been proven to have both prevention and treatment of GIOP by large-scale randomized double-blinded placebo controlled studies and recommended the use of them as a first line therapy by treatment guideline in many countries. On the other hand, activated vitamin D(3) analogues also have been reported the effectiveness of GIOP although the effect is lower than bisphosphonates. Vitamin K(2) analogues suggested to have the efficacy in treatment of GIOP in Japan. This article reviews the evidence of treatment efficacy of current treatment especially bisphosphonates in patients with GIOP.

Topics: Alendronate; Bone Density Conservation Agents; Calcitonin; Cholecalciferol; Etidronic Acid; Evidence-Based Medicine; Glucocorticoids; Humans; Osteoporosis; Randomized Controlled Trials as Topic; Risedronic Acid; Vitamin K 2

There has been accumulating evidence that various diseases and drugs cause increased risk of fracture. Although the treatment of primary diseases and discontinuation of drugs are the first and ideal option for the cure of secondary osteoporosis, medical intervention for osteoporosis is often necessary. The mechanisms, which induce bone fragility, are supposed to be different, depending on diseases and drugs. Guidelines for the evaluation and treatment of secondary osteoporosis have not been established except glucocorticoid-induced osteoporosis. In patients with osteoporosis caused by primary hyperparathyroidism, hyperthyroidism, diabetes mellitus as well as hormone deprivation therapy, bisphosphonate is effective in increasing bone mineral density but no data have been available about the fracture risk. Guidelines on the management and treatment of each secondary osteoporosis are desirable.

Topics: Aromatase Inhibitors; Bone Density Conservation Agents; Cholecalciferol; Diabetes Complications; Diphosphonates; Glucocorticoids; Humans; Hyperparathyroidism; Hyperthyroidism; Osteoporosis; Parathyroidectomy; Risk; Vitamin K 2

The incidence of osteoporotic fractures increases along aging and the importance of their prevention is more emphasized in the elderly. Although the major determinants for fragile fractures in the elderly are not only the lower bone strength but also frailty and fall, treatments with anti-resorbers are effective also in the elderly. On the other hands, nutritional agents such as active vitamin D3 and vitamin K2 are effective in reducing the fracture incidences in spite of their modest effects on bone mineral density. Recently, the effects of vitamin Ds on the reduction of fall events are noticed and the prevention of osteoporotic fractures in the elderly through extra-skeletal mechanisms seems promising.

Topics: Accidental Falls; Aged; Aged, 80 and over; Bone Density; Bone Density Conservation Agents; Cholecalciferol; Diphosphonates; Estrogen Replacement Therapy; Fractures, Bone; Humans; Osteoporosis; Randomized Controlled Trials as Topic; Selective Estrogen Receptor Modulators; Vitamin K 2

Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Bone Density Conservation Agents; Cholecalciferol; Clinical Trials as Topic; Denosumab; Diphosphonates; Drug Administration Schedule; Drug Design; Humans; Organometallic Compounds; Osteoporosis; Parathyroid Hormone; Patient Compliance; Raloxifene Hydrochloride; RANK Ligand; Selective Estrogen Receptor Modulators; Thiophenes

The 2006 version of the guideline for prophylaxis and treatment of osteoporosis recommends vitamin K(VK)supplementation in the state of its deficiency. As VK(2) gained grade B in all aspects in the guideline, single use of the drug is limited. VK(2) may be used concurrently with other drugs in the treatment of osteoporosis. In this paper, the results of our concurrent use of two of vitamin D(3), VK(2), and EHDP are summarized, and the combined therapy including VK(2) will be reviewed.

Topics: Bone Density; Bone Density Conservation Agents; Cholecalciferol; Diphosphonates; Drug Therapy, Combination; Estrogen Replacement Therapy; Etidronic Acid; Female; Humans; Male; Multicenter Studies as Topic; Osteoporosis; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Spinal Fractures; Vitamin K 2

Topics: Bone Density Conservation Agents; Cardiovascular Diseases; Cholecalciferol; Diphosphonates; Gastrointestinal Diseases; Hot Flashes; Humans; Hypercalcemia; Jaw Diseases; Macular Edema; Necrosis; Osteoporosis; Raloxifene Hydrochloride; Venous Thrombosis

Topics: Bone Density; Bone Density Conservation Agents; Calcium; Cholecalciferol; Diphosphonates; Evidence-Based Medicine; Femoral Neck Fractures; Humans; Meta-Analysis as Topic; Osteoporosis; Practice Guidelines as Topic; Raloxifene Hydrochloride; Randomized Controlled Trials as Topic; Selective Estrogen Receptor Modulators; Spinal Fractures

Topics: Bone Density; Bone Density Conservation Agents; Cholecalciferol; Diphosphonates; Dose-Response Relationship, Drug; Glucocorticoids; Humans; Japan; Osteoporosis; Practice Guidelines as Topic; Risk Factors

Topics: Bone Density Conservation Agents; Calcitonin; Cholecalciferol; Diphosphonates; Fractures, Bone; Humans; Japan; Osteoporosis; Randomized Controlled Trials as Topic; Risk Assessment; Selective Estrogen Receptor Modulators; World Health Organization

Topics: Aged; Aged, 80 and over; Bone Density Conservation Agents; Calcium Carbonate; Cholecalciferol; Drug Therapy, Combination; Fractures, Bone; Fractures, Stress; Humans; Osteoporosis; Randomized Controlled Trials as Topic; Risk

Topics: Alendronate; Bone Density Conservation Agents; Calcitonin; Calcium; Cholecalciferol; Diphosphonates; Drug Therapy, Combination; Humans; Osteoporosis; Raloxifene Hydrochloride; Selective Estrogen Receptor Modulators; Vitamin K 2

Topics: Accidental Falls; Bone and Bones; Bone Density; Cholecalciferol; Evidence-Based Medicine; Fractures, Bone; Glucocorticoids; Humans; Osteoporosis

Topics: Bone and Bones; Bone Density; Bone Density Conservation Agents; Cholecalciferol; Collagen Diseases; Diphosphonates; Glucocorticoids; Humans; Hyperlipidemias; Osteoporosis; Vitamin K 2

Topics: Absorptiometry, Photon; Animals; Biomarkers; Bone and Bones; Bone Density; Bone Density Conservation Agents; Cholecalciferol; Collagen; Diabetes Complications; Diphosphonates; Fractures, Bone; Glycation End Products, Advanced; Humans; Insulin Resistance; Insulin-Like Growth Factor I; Osteoporosis

It is well established that activated vitamin D(3) affects bone metabolism and its bone fracture reducing effect is prominent considering relatively weak effect on increase of bone mineral density. The risk of osteoporotic bone fracture generally correlates with bone mineral density. On the other hand, fall is a major cause of bone fracture in the elderly people. Therefore, bone fracture reducing effect of activated vitamin D(3) can be presumed as the result of reduction of fall incidents (such as the effects on the stability of body balance and muscle strength), as well as the effects on bone strength and quality. In this manuscript, the relation between fall, bone fracture and vitamin D would be introduced.

Topics: Accidental Falls; Aged; Aged, 80 and over; Bone and Bones; Bone Density; Cholecalciferol; Female; Fractures, Bone; Humans; Middle Aged; Muscle Weakness; Osteoporosis; Randomized Controlled Trials as Topic; Risk Factors

Glucocorticoid-induced osteoporosis (GIO) is the most common secondary cause of osteoporosis. The use of glucocorticoid (GC) is associated with an increase in bone loss, especially at vertebral spine, and risk of fracture. Active vitamin D(3) (VD(3)) is expected to preserve bone mineral density at vertebral spine, however it is inferior to bisphosphonates (BP) with respect to preventing incidental vertebral fractures. In the guidelines on the management and treatment of GIO in Japan, VD(3) is recommended as the second-lined drug for GIO. The combination of VD(3) and BP is thought to be a beneficial therapy in prevention and or treatment of GIO.

Topics: Anti-Inflammatory Agents; Bone Density; Cholecalciferol; Diphosphonates; Drug Therapy, Combination; Glucocorticoids; Humans; Hypercalcemia; Lumbar Vertebrae; Osteoporosis; Practice Guidelines as Topic; Randomized Controlled Trials as Topic

In 2002, Adequate Treatment of Osteoporosis (A-TOP) Research Group was organized to obtain the evidence for treatment of osteoporosis in Japan. The group has designed and carried out an intervention trial plan, Japanese Osteoporosis Intervention Trial (JOINT)-02 to demonstrate the possible combination effect of alendronate plus active vitamin D(3). In this report, we summarize the past activity and the perspective of the future of the A-TOP research group.

Topics: Alendronate; Bone Density Conservation Agents; Cholecalciferol; Clinical Trials as Topic; Drug Therapy, Combination; Evidence-Based Medicine; Humans; Japan; Osteoporosis; Practice Guidelines as Topic; Research; Societies, Medical; Spinal Fractures

Osteoporosis is a skeletal disease characterized by increased risk of fracture due to reduced bone strength. Osteoporosis-associated fractures not only impair patients' quality of life (QOL) but also diminishes life expectancy. The most important goal in the treatment of osteoporosis is fracture prevention. To achieve this goal, in addition to lifestyle changes including balanced diet, increased exercise and fall prevention, most high-risk patients need pharmacological intervention. Based on the currently available evidence, the first-line medications are bisphosphonates and raloxifene. Active vitamin D alone may not be efficacious enough but may particularly be important in Japan as a surrogate for vitamin D and calcium supplementation. A new bone anabolic therapy by parathyroid hormone (PTH), which is already in clinical use in other countries, is also expected to become available in Japan in the near future.

Topics: Cholecalciferol; Diphosphonates; Estrogens; Female; Humans; Osteoporosis; Parathyroid Hormone; Selective Estrogen Receptor Modulators

Osteoporosis is the most frequent adverse effect of glucocorticoids. Management guidelines for glucocorticoid-induced osteoporosis have been established in the United States, the United Kingdom, and many other countries. The 2004 edition of the guidelines on the management and treatment of glucocorticoid-induced osteoporosis have been proposed by The Japanese Society for Bone and Mineral Research. The subjects were patients with using or planning to use oral glucocorticoids for 3 months or longer. The criterion for starting treatment was patients with prior fragility fracture and with new fractures during treatment, patients with less bone mineral density (BMD) than 80% of young adult mean, and patients with using as a dose of 5mg/day or higher (mean daily dose) as prednisolone equivalent. The bisphosphonates have been recommended as first-line drugs and active vitamin D(3) and vitamin K(2) have been recommended as second-line drugs.

Topics: Bone Density; Bone Density Conservation Agents; Cholecalciferol; Diphosphonates; Evidence-Based Medicine; Fractures, Bone; Glucocorticoids; Humans; Japan; Osteoporosis; Practice Guidelines as Topic; Prednisolone; Time Factors; Vitamin K 2

Glucocorticoid therapy is associated with bone loss starting soon after the therapy is initiated and an increased risk of fracture. Activated forms of vitamin D(3), which are frequently prescribed for postmenopausal osteoporosis in Japan, are one of a useful agent to prevent glucocorticoid-induced osteoporosis. In this review, the effect of activate form vitamin D(3) is compared with plain vitamin D or bisphosphonate.

Topics: Bone Density Conservation Agents; Cholecalciferol; Diphosphonates; Glucocorticoids; Humans; Meta-Analysis as Topic; Osteoporosis; Randomized Controlled Trials as Topic; Vitamin D

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

Contemporary evidence-based approaches to the diagnostics, treatment, and prophylaxis of system osteoporosis (OP) are presented in the article. The main principles of therapeutic and preventive measures in OP are formulated. Bone tissue mineral density was studied with dual-energy x-ray absorptiometry using a QDR-4500A HOLOGIC osteodensitometer; the results and the authors' own experience in the application of pharmaceuticals was analyzed.

Topics: Bone Density Conservation Agents; Cholecalciferol; Humans; Osteoporosis; Treatment Outcome

In Japan, insufficient calcium (Ca) intake is serious problem for health which may be associated with the high prevalence of osteoporosis among the aged. The intake of most nutrients has been sufficient, however, the Ca intake has never been sufficient. Eggshell Ca has as much as 38% of Ca and low phosphorus content. Eggshell Ca was more soluble than Ca carbonate and was as much as milk products. Eggshell Ca has been shown to exhibit higher absorptivity and availability than Ca carbonate. Furthermore, it has been reported that eggshell Ca is more effective in increasing bone mineral density in ovariectomized osteoporotic rats. These results suggest that eggshell Ca could be beneficial for bone and we propose Ca fortified foods which contain eggshell Ca as a nutraceutical.

Topics: Animals; Bone Density; Bone Resorption; Calcium; Cholecalciferol; Drug Therapy, Combination; Egg Shell; Humans; Hypercalcemia; Intestinal Absorption; Osteoporosis; Parathyroid Hormone; Rats; Solubility

Topics: Bone Density; Bone Resorption; Calcitonin; Calcium; Cholecalciferol; Diphosphonates; Estradiol; Estrogens, Conjugated (USP); Female; Humans; Male; Osteoporosis; Osteoporosis, Postmenopausal; Progesterone; Raloxifene Hydrochloride; Selective Estrogen Receptor Modulators; Vitamin D

Osteoporosis is the most frequent adverse effect observed during glucocorticoids therapy. The 2004 edition of the guideline on the management and treatment of glucocorticoid-induced osteoporosis has been proposed by The Japanese Society for Bone and Mineral Research. The subjects were patients with using or planning to use oral glucocorticoids for 3 months or longer. The criterion for starting treatment consisted patients with prior fragility fracture and with new fractures during treatment, patients with less BMD than %YAM80, and patients with using as a dose of 5 mg/day or higher (mean daily dose) as prednisolone equivalent. The Bisphosphonates have been recommended as first-line drugs. Active vitamin D3 and vitamin K2 have been recommended as second-line drugs.

Topics: Bone and Bones; Bone Density; Cholecalciferol; Diphosphonates; Fractures, Bone; Glucocorticoids; Humans; Osteocalcin; Osteoporosis; Practice Guidelines as Topic; Prednisolone; Randomized Controlled Trials as Topic; Risk; Vitamin K 2

In the WHO technical report, vitamin D metabolites have been suggested to have a role as an adjunctive therapy when given with an antiresorptive agent. Beneficial effects on BMD have been reported following the addition of calcitriol to alendronate, etidronate, and HRT, but no data on fracture rates are available. Here we summarize our clinical study on the concurrent therapy and review reports on the concurrent treatments.

Topics: Aged; Bone Density; Cholecalciferol; Clinical Trials as Topic; Diphosphonates; Drug Therapy, Combination; Estrogen Replacement Therapy; Etidronic Acid; Female; Fractures, Bone; Humans; Male; Multicenter Studies as Topic; Osteoporosis; Vitamin K 2

Alendronate/colecalciferol 70 mg/2800 IU, a once-weekly tablet containing the bisphosphonate alendronate and colecalciferol (the precursor of the biologically active form of vitamin D), has been approved for the treatment of osteoporosis in women and for increasing bone mass in men with osteoporosis. The mean oral bioavailability of alendronate or colecalciferol is similar when administered alone or as one once-weekly tablet containing alendronate/colecalciferol 70 mg/2800 IU. In a 15-week, randomized, double-blind, multicenter study in patients with osteoporosis, the proportion of patients with serum 25-hydroxyvitamin D3 levels <15 ng/mL was significantly lower with alendronate/colecalciferol than with alendronate alone. Markers of bone turnover were not significantly different in recipients of alendronate/colecalciferol or alendronate alone. Alendronate is generally well tolerated in men and women with osteoporosis, with adverse events being mainly transient and associated with the upper gastrointestinal tract. The treatment-related adverse event profile of once-weekly alendronate/colecalciferol 70 mg/2800 IU was similar to that of once-weekly alendronate in the 15-week, double-blind study in patients with osteoporosis.

Topics: Alendronate; Biological Availability; Cholecalciferol; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Female; Humans; Male; Maximum Tolerated Dose; Osteoporosis; Randomized Controlled Trials as Topic

Osteoporosis is: (1) Underrated. Currently costs about 7 billion dollars annually in Australia. Has high morbidity and 2-3-fold increase in risk of death after any major osteoporotic fracture. Genetic factors contribute highly to risk, modified by lifestyle and hormonal factors. (2) Underdiagnosed. Bone density is a good predictor of subsequent risk. Anyone with a low-trauma fracture has osteoporosis unless proven otherwise. Every individual with a low trauma fracture should be investigated for exclusion of underlying osteoporosis and considered for effective treatment to reduce future fracture risk. More than 75% of women and about 90% of men with a high likelihood of osteoporosis are not investigated. (3) Undertreated. More than 75% of those affected are not treated. Effective treatments (eg, hormone replacement therapy, selective oestrogen receptor modifiers and bisphosphonates) reduce fracture risk by 30%-60%. Simple measures like vitamin D and calcium supplementation and use of hip protectors can reduce hip fractures, particularly in institutionalised and housebound elderly people

Topics: Aged; Bone Density; Calcium, Dietary; Cholecalciferol; Diagnostic Errors; Diphosphonates; Estrogen Replacement Therapy; Female; Fractures, Spontaneous; Humans; Male; Osteoporosis; Raloxifene Hydrochloride; Risk Factors; Selective Estrogen Receptor Modulators; Treatment Failure

Topics: Alendronate; Bone Density; Cholecalciferol; Diphosphonates; Drug Design; Fractures, Bone; Humans; Osteoporosis; Parathyroid Hormone; Reference Standards; Risk; Selective Estrogen Receptor Modulators; Strontium

Topics: Accidental Falls; Calcium; Cholecalciferol; Humans; Muscle Tonus; Osteogenesis; Osteoporosis; Spinal Fractures

Topics: Alendronate; Bone Density; Cholecalciferol; Drug Therapy, Combination; Etidronic Acid; Humans; Multicenter Studies as Topic; Osteoporosis; Prognosis; Randomized Controlled Trials as Topic; Spinal Fractures

The aim of this review with meta-analysis was to determine if there is a rationale to use activated forms of vitamin D3 to treat or prevent glucocorticoid-induced osteoporosis, and to compare the effect of active vitamin D3 metabolites with that of other anti-osteoporosis therapies. We performed a systemic search using MEDLINE/PubMed (1966-2003). Animal studies and clinical trials involving humans with data on therapy to treat or prevent glucocorticoid-induced osteoporosis with active vitamin D3 analogues were included. Animal studies and basic research studies with active vitamin D3 were reviewed (qualitative review). Meta-analysis (quantitative review) on clinical trials (including organ transplantation studies) was performed with percent change in lumbar spine bone mineral density or bone mineral content as the primary outcome measure; the secondary outcome measure was incidence of vertebral fractures. Fifty-four articles were found. Animal and basic research studies showed that active vitamin D3 analogues can inhibit bone loss during treatment with glucocorticoids. Concerning the effect on bone mineral density, the pooled effect size of active vitamin D3 analogues compared with no treatment, placebo, plain vitamin D3 and/or calcium was 0.35 (95% confidence interval (CI) 0.18, 0.52). Compared with bisphosphonates, the pooled effect size was -1.03 (95% CI -1.71, -0.36). The pooled estimate of the relative risk for vertebral fractures of active vitamin D3 analogues compared with no treatment, placebo, plain vitamin D3 and/or calcium was 0.56 (95% CI 0.34, 0.92) and compared with bisphosphonates it was 1.20 (95% CI 0.32, 4.55). Active vitamin D3 analogues not only preserve bone during glucocorticoid therapy more effectively than no treatment, placebo, plain vitamin D3 and/or calcium, but are also more effective in decreasing the risk of vertebral fractures. Bisphosphonates, however, are more effective in preserving bone and decreasing the risk of vertebral fractures than active vitamin D3 analogues.

Topics: Animals; Bone Density; Cholecalciferol; Glucocorticoids; Humans; Lumbar Vertebrae; Osteoporosis; Randomized Controlled Trials as Topic; Spinal Fractures; Transplantation

The article entitled “Effects of Vitamin K2 on Osteoporosis, published in Curr Pharm Des 2004; 10(21): 2557-76, by Iwamoto\ J, Takeda T and Sato Y.” has been retracted by the Editorial office of the journal Current Pharmaceutical Design, as the text,\ data and some figures used/referred in this review article are from sources which have been retracted or under investigation on\ the basis of data fabrication and falsification, authorship misconduct, duplicate publication, unethical research practices, text\ recycling/self-plagiarism, and unresolved concerns about data integrity and research conduct. The authors were informed of\ this complaint and were requested to give justification on the matter in their defense. However, no reply was received from\ their side in this regard. Some sources that have been retracted are as follows:. 1. Iwamoto J, Takeda T, Ichimura S. Combined treatment with vitamin K2 and bisphosphonate in postmenopausal women with osteoporosis. Yonsei Med J 2003; 44: 751-6. Available at: https://eymj.org/DOIx.php?id=10.3349/ymj.2019.60.1.115.. 2. Sato Y, Honda Y, Kuno H, Oizumi K. Menatetrenone ameliorates osteopenia in disuse-affected limbs of vitamin D- and K-deficient stroke patients. Bone 1998; 23: 291-6. Available at: https://www.sciencedirect.com/science/article/pii/S8756328298001082.. 3. Sato Y, Honda Y, Kaji M, Asoh T, Hosokawa K, Kondo I, et al. Amelioration of osteoporosis by menatetrenone in elderly female\ Parkinson's disease patients with vitamin D deficiency. Bone 2002; 31: 114-8. Available at: https://pubmed.ncbi.nlm.nih.gov/\ 12110423/.. Bentham Science apologizes to its readers for any inconvenience this may have caused. The Bentham Editorial Policy on Article. Retraction can be found at https://benthamscience.com/editorial-policies-main.php. It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously submitted or published elsewhere. Furthermore, any data, illustration, structure or table that has been published elsewhere must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submitting the article for publication the authors agree that the publishers have the legal right to take appropriate action against the authors, if plagiarism or fabricated information is discovered. By submitting a manuscript, the authors agree that the copyright of their article is transferred to the publishers if and when the article is accepted for publication.

Topics: Animals; Calcium; Cholecalciferol; Drug Therapy, Combination; Female; Hip Fractures; Humans; Liver Diseases; Male; Osteocalcin; Osteoporosis; Osteoporosis, Postmenopausal; Space Flight; Vitamin K 2; Weightlessness

The study of vitamin D(3) topical applications has begun at Osaka University after Morimoto S. reported a patient with senile osteoporosis whose psoriasis was cured after treatment with 1-alpha-hydroxyvitamin D(3) [1 alpha (OH) D(3)]. Another study of the first use of vitamin D(3) for psoriasis was reported in the same year in both Europe and the United States independently. Calcipotriol ointment came first onto the market for the treatment of psoriasis in Denmark in 1990. In Japan, where tacalcitol ointment was first approved in 1993, six kinds of topical vitamin D(3) applications are now available. Now new applications of vitamin D(3) are anticipated to replace therapeutic drugs currently in use for psoriasis and other skin diseases.

Topics: Administration, Topical; Cholecalciferol; Drug Design; History, 20th Century; Humans; Ointments; Osteoporosis; Psoriasis

Steroid-induced osteoporosis is the most common form of osteoporosis in the dermatological diseases, but there have been only few data concerning the treatment based on clinical evidences. For management of osteoporosis, the efficacy of vitamin D(3) and bisphosphonate had been demonstrated by meta-analytic approach. Ten dermatological patients in our clinic who had received long-term oral steroids and showed bone loss were treated with 5 mg/day of alendronate for one year, and showed significant increase in the bone mineral density of the lumbar spine. In dermatological patients requiring long-term systemic steroids, administration of drugs such as vitamin D(3) or bisphosphonate should be started earlier.

Topics: Aged; Alendronate; Anti-Inflammatory Agents; Bone Density; Cholecalciferol; Drug Therapy, Combination; Evidence-Based Medicine; Female; Humans; Lumbar Vertebrae; Male; Meta-Analysis as Topic; Middle Aged; Osteoporosis; Prednisolone; Skin Diseases

Osteoporosis and cardiovascular disease have numerous epidemiologic changes, health economic consequences, and molecular mechanisms in common, which are highlighted in this short review.. The incidence of osteoporosis and cardiovascular disease is increasing in western societies, and genetic background, nutrition and psychologic factors play important roles in the pathogenesis of both diseases. The presence of a decreased bone mass or osteoporotic vertebral fractures are associated with an increased cardiovascular mortality. Calcaneal bone loss of 1 SD (standard deviation) as measured by osteodensitometry is associated with a 1.31 times increased risk for the occurrence of stroke.. The observed increase in interleukin-6 and tumor necrosis factor serum concentrations during the menopause contributes to osteoporotic bone loss and is associated with arteriosclerosis. Furthermore, the presence of hydroxyapatite in arteriosclerotic plaques supports the notion of common pathogenetic mechanisms for both, osteoporosis and arteriosclerosis. Osteopontin, bone GLA protein and bone morphogenetic protein-2, which have first been isolated from the organic bone matrix, are also present in arteriosclerotic plaques. 1,25-dihydroxycholecalciferol potently stimulates bone matrix mineralization and is also a negative regulator of the renin-angiotensin system; therefore vitamin D(3) deficiency in addition to bone metabolism also affects blood pressure. Osteoporosis and arteriosclerosis develop in mice lacking the osteoprotegerin gene and also in klotho gene knockout mice.. Diagnosis of osteopenia, osteoporosis and osteoporotic vertebral or hip fractures indicates the presence of an increased cardiovascular risk which needs to be addressed by the physician who cares for patients with osteoporosis. The experimental finding of an osteoanabolic effect of statins supports the possibility of common pathogenetic disturbances which may be responsible for the simultaneous and frequent manifestation of osteoporosis and arteriosclerosis in elderly patients.

Topics: Animals; Cardiovascular Diseases; Causality; Cholecalciferol; Comorbidity; Fractures, Spontaneous; Glucuronidase; Glycoproteins; Humans; Klotho Proteins; Membrane Proteins; Mice; Mice, Knockout; Osteoporosis; Osteoprotegerin; Receptors, Cytoplasmic and Nuclear; Receptors, Tumor Necrosis Factor; Risk; Spinal Fractures

It is established in Japan that treatment with 1alpha-hydroxyvitamin D3 (alfacalcidol) slightly reduces bone turnover, sustains lumbar bone mineral density (BMD), and prevents osteoporotic vertebral fractures in postmenopausal women with osteoporosis, while vitamin K2 (menatetrenone) enhances gamma-carboxylation of bone glutamic acid residues and secretion of osteocalcin, sustains lumbar BMD, and prevents osteoporotic fractures in patients with osteoporosis. Available evidence suggests that the effect of vitamin K2 on mineralization by human periosteal osteoblasts is enhanced in the presence of 1,25 dihydroxyvitamin D3 in vitro. The effect of vitamin K2 on BMD in ovariectomized rats is affected by the plasma 25-hydroxyvitamin D3 level in vivo, and is significant only when rats are fed a diet containing vitamin D3. Based on this line of evidence, combined treatment with alfacalcidol and menatetrenone for osteoporosis is surmised to be more effective than treatment with menatetrenone alone, and may have anabolic effects on osteoporotic bone. This combined treatment may increase bone formation as well as bone resorption over the mild anti-resorptive effect of alfacalcidol itself, and shows the greatest effect on lumbar BMD or the incidence of vertebral fractures in studies in which the mean age and years since menopause of subjects were low and the degree of osteoporosis was mild. It may be effective for mild postmenopausal osteoporosis in which age-related deterioration of trabecular bone properties remains below the threshold for vertebral fractures, even if bone resorption is increased and trabecular bone has deteriorated.

Topics: Animals; Bone and Bones; Bone Resorption; Cholecalciferol; Clinical Trials as Topic; Female; Humans; Middle Aged; Osteoporosis; Postmenopause; Rats; Vitamin K 2

Topics: Alendronate; Bone Density; Cholecalciferol; Clinical Trials as Topic; Estrogen Replacement Therapy; Etidronic Acid; Fractures, Bone; Humans; Hydroxycholecalciferols; Osteoporosis; Raloxifene Hydrochloride; Vitamin K 2

Topics: Bone Density; Calcitonin; Calcium; Cholecalciferol; Diphosphonates; Estrogen Replacement Therapy; Fractures, Stress; Humans; Osteoporosis; Practice Guidelines as Topic; Reference Standards; Spinal Fractures; Vitamin K 2

Topics: Arthritis, Rheumatoid; Bone Density; Bone Resorption; Calcium, Dietary; Cholecalciferol; Cytokines; Glycoproteins; Humans; Methotrexate; Osteoclasts; Osteoporosis; Osteoprotegerin; Receptors, Cytoplasmic and Nuclear; Receptors, Tumor Necrosis Factor; Synovial Membrane

Topics: Bone Density; Calcium; Cholecalciferol; Estrogen Replacement Therapy; Exercise Therapy; Female; Follow-Up Studies; Fractures, Stress; Health Education; Humans; Middle Aged; Multiphasic Screening; Osteoporosis; Spinal Fractures

Topics: Absorptiometry, Photon; Calcium; Cholecalciferol; Fractures, Bone; Humans; Osteoporosis; Risk Factors

Orthodontic tooth movement and bone remodeling activity are dependent on systemic factors such as nutritional factors, metabolic bone diseases, age, and use of drugs. Therefore, a comprehensive review of the effects of these factors on orthodontic tooth movement is attempted in this article. Systemic hormones such as estrogen, androgen, and calcitonin are associated with an increase in bone mineral content, bone mass, and a decrease in the rate of bone resorption. Consequently, they could delay orthodontic tooth movement. On the contrary, thyroid hormones and corticosteroids might be involved in a more rapid orthodontic tooth movement during orthodontic therapy and have a less stable orthodontic result. Drugs such as bisphosphonates, vitamin D metabolites, and fluorides can probably cause a reduction of tooth movement after the orthodontic force is applied. Nonsteroidal anti-inflammatory drugs have also been shown to reduce bone resorption. Long-term administration of these drugs may therefore delay the necessary bone response to respective tooth-borne pressure and should not be administered for long periods of time to patients undergoing orthodontic tooth movement. Attention has also been focused on the effects of prostaglandins and leukotrienes in orthodontic tooth movement. It seems that they might have future clinical applications that could result in enhanced tooth movement. The use of the above drugs should be considered by every dentist in evaluating the treatment time and in planning treatment when tooth movement is attempted.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Bone Remodeling; Cholecalciferol; Diphosphonates; Eicosanoids; Fluorides; Hormones; Humans; Hyperparathyroidism; Osteoporosis; Tooth Movement Techniques

While strict criteria have been developed for defining osteoporosis in women (bone mineral density measurements more than 2.5 standard deviations below the mean for young adult normal women, i.e. t-score value < -2.5), there still remains a controversy regarding the definition in men. Spinal fractures occur in 5% and hip fractures in 6% of men older than 50 years. There are significant differences between men and women with respect to the pathogenesis of osteoporosis, underlying medical conditions and postfracture sequelae.. To provide an overview of the pathogenesis, diagnosis and prevention of osteoporosis in men.. Osteoporosis is increasingly recognised. Data from the Dubbo Osteoporosis Epidemiology Study suggests that 30% of men in Australia aged over 60 years will suffer from an osteoporotic fracture. It is estimated that 30-60% of men presenting with spinal fractures will have another illness contributing to their bone loss. Osteoporotic fractures in men are associated with higher morbidity and mortality than in women. Lifestyle changes together with daily calcium supplementation should be implemented and vitamin D3 should be considered in men with osteopenia.

Topics: Bone Density; Calcium, Dietary; Cholecalciferol; Humans; Male; Middle Aged; Osteoporosis; Risk Factors

Topics: Age Factors; Bone Density; Calcitriol; Calcium; Calcium Channel Blockers; Cholecalciferol; Dietary Supplements; Drug Therapy, Combination; Estrogen Replacement Therapy; Female; Fractures, Bone; Humans; Osteoporosis; Osteoporosis, Postmenopausal; Randomized Controlled Trials as Topic; Selective Estrogen Receptor Modulators; Vitamin D Deficiency

The Health Council of the Netherlands has issued a report on the recommended use of calcium, vitamin D and a number of other vitamins. The recommendations for calcium and vitamin D have been adjusted (upward) in view of recent evidence that these nutrients affect the occurrence of osteoporosis and bone fractures in all stages of life.

Topics: Adult; Age Factors; Aged; Calcifediol; Calcitriol; Calcium Channel Agonists; Calcium, Dietary; Child; Cholecalciferol; Dietary Supplements; Ergocalciferols; Fractures, Bone; Humans; Netherlands; Nutrition Policy; Osteoporosis; Vitamin D; Vitamin D Deficiency

Topics: Calcitonin; Cholecalciferol; Estrogen Replacement Therapy; Exercise Therapy; Humans; Osteoporosis; Parathyroid Hormone

The number of agents for the treatment of osteoporosis has increased over the past few years allowing more and more differentiated therapy. Calcitonin, vitamin D3, bisphosphonate, estrogen, vitamin K2 and calcium are administered for the treatment of osteoporosis in Japan. The purpose of drug delivery system (DDS) is to provide a practical approach to increasing efficacy and minimizing side effects of the drugs. In fact by the development of DDS, topical administration, prodrug and targeting therapy are used in the treatment for osteoporosis. It is well known that calcitonin in susceptible to proteolysis in the intestine. So, calcitonin must be given intramuscular or subcutaneous injection for therapy. DDS of calcitonins is studying in many routes of administration, such as nasal, transdermal, ocular, oral, bronchial, rectal and vaginal.

Topics: Calcitonin; Calcium; Cholecalciferol; Drug Administration Routes; Drug Delivery Systems; Estrogens; Humans; Osteoporosis; Parathyroid Hormone

Topics: Analgesics; Bone Density; Calcitonin; Cholecalciferol; Dietary Proteins; Diphosphonates; Estrogen Replacement Therapy; Humans; Isoflavones; Life Style; Osteoporosis; Risk Factors

Twenty-five per cent of the patients using corticosteroids for long periods of time develops at least one fracture. Corticosteroids lead to osteoporosis through increase of renal calcium excretion and decrease of intestinal calcium absorption, bone formation by osteoblasts and serum levels of sex hormones. In spite of guidelines according to which patients protractedly using corticosteroids should take sufficient calcium and cholecalciferol, only about one-tenth of them takes any form of medication to prevent osteoporosis. It seems advisable to prescribe additional anti-osteoporosis medication for patients using > or = 7.5 mg prednisone during at least 3 months and who have a low mineral density of bone; only of biphosphonates a preventive effect clearly has been demonstrated. For postmenopausal women, hormonal supplementation therapy may offer additional benefit, reducing the risk of cardiovascular disease.

Topics: Adrenal Cortex Hormones; Bone Density; Calcium Compounds; Cholecalciferol; Diphosphonates; Estrogen Replacement Therapy; Female; Humans; Male; Middle Aged; Osteoporosis

Topics: Aged; Aged, 80 and over; Aging; Calcitriol; Cholecalciferol; Female; Humans; Hydroxycholecalciferols; Osteoporosis; Vitamin D; Vitamin D Deficiency

Topics: Aged; Calcium, Dietary; Cholecalciferol; Female; Food, Fortified; Hip Fractures; Humans; Hyperparathyroidism, Secondary; Osteoporosis; Risk Factors

A new definition of osteoporosis has been proposed by an expert panel of the World Health Organization, in which cutoff diagnostic and therapeutic values are derived from bone mass measurements, leading to the practical idea of densitometric osteoporosis with or without fractures. At the individual level, risk factors of bone fragility are not accurate enough to allow definition of an "at risk" population. Thus, bone densitometry remains the major parameter to be analyzed. In terms of therapy, all protocols refer to the more academic definition of osteoporosis, so that no true innovation appeared in the literature over the past year. The roles of calcium, exercise, hormone replacement therapy, calcitonin, fluoride, and bisphosphonates are more accurately defined in established osteoporosis. However, new studies are needed in the investigation of densitometric osteoporosis.

Topics: Aged; Calcitonin; Calcium; Cholecalciferol; Exercise Therapy; Female; Fluorides; Humans; Male; Osteoporosis

Topics: Adult; Aged; Calcitonin; Cholecalciferol; Diphosphonates; Estrogen Replacement Therapy; Female; Fluorides; Humans; Male; Middle Aged; Osteoporosis; Osteoporosis, Postmenopausal

This paper reviews the pharmacologic therapies for the prevention and the treatment of osteoporosis. Vitamin D metabolites, estrogen, estrogen-progestin, calcitonin and ipriflavone are effective regimens for the prevention of bone loss and the treatment of osteoporosis. Since estrogen deficiency is the main cause for postmenopausal osteoporosis, estrogen supplementation is the most effective therapy for postmenopausal osteoporosis. Estrogen progestin combination therapy is one of the most potent therapies to increase both cortical and trabecular bone mass. Vitamin D has efficacy on increasing intestinal calcium absorption and decreasing fracture rate in osteoporotic patients. Calcitonin inhibits osteoclastic bone resorption and also has inherent analgesic properties. Several studies have suggested that new delivery systems of estrogen (transdermal) and calcitonin (transnasal) are effective in osteoporosis. Recent studies revealed that bisphosphonate and hPTH (1-34) were new potent agents for the treatment of osteoporosis. Bisphosphonate would be effective to osteoporosis by reducing bone resorption. hPTH may have a primary action to increase bone formation. Treated patients should be monitored using bone mineral density and biochemical markers for evaluating the response to therapy.

Topics: Bone Density; Bone Remodeling; Calcitonin; Calcium; Cholecalciferol; Estrogens; Female; Humans; Male; Osteoporosis

The two main determinants of hip fractures are falls and bone loss leading to an intrinsic femoral fragility. Substantial femoral bone loss continues throughout old age, with a continuous and exponential increase in the risk of hip fracture; thus any reduction or arrest of this loss will induce an important reduction in the incidence of hip fracture. Preventive measures may be achieved during childhood by increasing peak bone mass with calcium and exercise, by using long-term estrogen replacement therapy after menopause, but also by using vitamin D and calcium supplements for late prevention in the elderly. Vitamin D insufficiency and a deficit in calcium intake are very common in the elderly living either in institutions or at home and the cumulative response to these deficits is a negative calcium balance which stimulates parathyroid hormone secretion. This senile secondary hyperparathyroidism is one of the determinants of femoral bone loss and can be reversed by calcium and vitamin D supplements. We have shown in a 3-year controlled prospective study that the daily use of supplements (1.2 g calcium and 800 IU vitamin D3) given in a large population of 3270 elderly ambulatory women living in nursing homes reduced the number of hip fractures by 23% (intention-to-treat analysis). In parallel, serum parathyroid hormone concentrations were reduced by 28% and low baseline serum 25-hydroxyvitamin D concentration returned to normal values. After 18 months of treatment the bone density of the total proximal femoral region had increased by 2.7% in the vitamin D3-calcium group and decreased by 4.6% in the placebo group (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Accidental Falls; Aged; Bone Density; Bone Resorption; Calcium Compounds; Cholecalciferol; Female; Hip Fractures; Humans; Hyperparathyroidism, Secondary; Osteoporosis; Prospective Studies; Risk Factors

Hormonal control of skeletal growth, modeling, and remodeling is characterized by a complex interaction between the calciotropic hormones (25-hydroxycholecalciferol, 1,25-dihydroxycholecalciferol, parathyroid hormone, and calcitonin), growth, and thyroid hormones in addition to the estrogenic and androgenic gonadal hormones. Although both growth and thyroid hormones are essential skeletal growth and modeling and also can produce detrimental skeletal effects in adults when circulating in excess concentrations, these hormones assume a minor role in the day-to-day bone remodeling of the mature skeleton. Following the attainment of the peak bone mass, bone mineral content begins to decline in the fourth and fifth decades of life, accelerating in females in the first 5-7 years after the menopause as a result of estrogen deficiency. Associated with this age-dependent loss in skeletal mass are decreases in calcitonin reserve primarily in the 5-7 years following the menopause, decreases in circulating 25-hydroxycholecalciferol, intestinal resistance to 1,25-dihydroxycholecalciferol, and a gradual progressive rise in blood parathyroid hormone. These changes in calciotropic hormone profiles, together with poor nutritional habits, anticonvulsant, glucocorticoid, and thyroid medications, diseases such as type I diabetes, immobilization, or decreased physical activity all serve to weaken the aging skeleton. The result is a gradual and subtle change in skeletal anatomy, which progresses to alterations in vertebral structure, such as kyphosis, scoliosis, and pseudospondylolisthesis, and a variety of sciatic and nerve entrapment syndromes. Vertebral, forearm, and hip fractures and edentulism ultimately comprise the syndrome of age-related bone loss, resulting in lifestyle disabilities, extensive morbidity, analgesic drug abuse, hospitalization, and escalating annual health care expenditures.

Topics: Aging; Androgens; Calcifediol; Calcitonin; Cholecalciferol; Estrogens; Female; Growth Substances; Hormones; Humans; Osteoporosis; Osteoporosis, Postmenopausal; Thyroid Hormones

Elderly women and men lose bone at a rate of < or = 1% per year. This results in an increasing risk of most fractures, of which hip fractures account for the greatest proportion of death, disability, and medical costs. Falls are the immediate precipitating factor for about 90% of hip fractures and 80% of other types of fractures in women. Since the rate of bone remodeling increases with age, antiresorptive therapies are likely to be at least as effective in the elderly as in younger adults. Calcium supplementation, for example, slows bone loss more effectively in older women than in those within 5 years of menopause, although the effectiveness of calcium for prevention of fractures remains uncertain. Vitamin D deficiency is more common in the elderly, and supplementation of deficient women appears to slow bone loss, at least during winter. Calcium plus vitamin D may substantially reduce the risk of hip fracture in the frail elderly. A randomized trial showed that estrogen remains effective in preventing vertebral fractures in older women. There is no reason to believe that the effectiveness of other agents would diminish with age. Preventive therapy offers greatest and most immediate benefit to those who have the highest risk of fracture: the elderly, those with previous fractures, those at increased risk of falling, and those with lowest bone mass. Since the relationship between bone mass and risk of fracture remains strong in elderly women, bone mass measurements may also be as useful in the elderly as in younger adults.

Topics: Aged; Aged, 80 and over; Bone Density; Bone Remodeling; Calcium, Dietary; Cholecalciferol; Female; Fractures, Bone; Humans; Male; Middle Aged; Osteoporosis; Osteoporosis, Postmenopausal

Topics: Adolescent; Adult; Child, Preschool; Cholecalciferol; Fanconi Syndrome; Female; Humans; Hypophosphatemia, Familial; Male; Osteomalacia; Osteoporosis; Phosphates; Vitamin D

Osteoporosis is a disease that characteristically afflicts postmenopausal women. It is estimated that millions of people are plagued yearly with this debilitating disease. Associated health care costs are in the billions of dollars, annually. Much research has been conducted in the area of osteoporosis and mineral supplementation, mainly focusing on calcium and vitamin D. Nonetheless, more recent studies have reported possible improvements in bone mineral density in women who were supplemented with the ultratrace mineral, boron. Boron may play a role in bone metabolism, but its role is most likely to be associated with its interactions with other minerals and vitamins such as calcium, magnesium and vitamin D. Although the focus of this review will be to discuss the interactive role of boron with magnesium and bone metabolism, some discussion of its interactive role with vitamin D is also necessary.

Topics: Bone Density; Boron; Cholecalciferol; Female; Humans; Magnesium; Male; Osteoporosis; Risk Factors

It is now accepted that vitamin D is an integral part of a complex endocrine system, one with far-reaching implications in mineral metabolism. Reviews of the sources, functions and metabolism of vitamin D, as currently understood, are presented as a prelude to discussions of the role of vitamin D in calcium and phosphorous homeostatis and possible specific roles for vitamin D in mineralized tissues. Data describing a possible regulatory function for vitamin D in bone and bone protein metabolism are presented. Some of the controversy which presently exists regarding the biochemical mechanism of the action of this vitamin is discussed. Finally, the possible relationship of vitamin D and disorders of skeletal tissues is described.

Topics: Animals; Bone and Bones; Bone Resorption; Calcium; Cell Nucleus; Chemical Phenomena; Chemistry; Cholecalciferol; Chronic Kidney Disease-Mineral and Bone Disorder; Glucocorticoids; Humans; Hydroxylation; Intestinal Mucosa; Kidney; Osteogenesis; Osteoporosis; Parathyroid Hormone; Proteins; Rats; Vitamin D; Vitamin D Deficiency; Vitamin D-Binding Protein

Topics: Calcitonin; Calcium; Cholecalciferol; Estrogens; Female; Humans; Menopause; Middle Aged; Osteoporosis; Sodium Fluoride

Topics: Aged; Aging; Calcium; Cholecalciferol; Color; Humans; Hypocalcemia; Light; Lighting; Osteoporosis; Sunlight; Ultraviolet Rays; Vision, Ocular; Vitamin D; Vitamin D Deficiency

Animal-experimental examinations show that the peroral or intramuscular application of a high dose of vitamin D2 or of D3 leads to a toxic effect of these compounds on the osteocytes and that the hypercalcaemia evoked by this is mainly to be traced back to an increased deliberation of calcium from the bones. After application of a larger dose of vitamin D the activation mechanism in the liver and in the kidneys is much inhibited for several weeks so that no formation of 1,25-hydroxy-vitamin-D takes place; consequently, no furthering effect on the mineralisation of the bones is performed. Therefore, it is recommended to use physiological doses in the prevention of rachitis (500-1,000 IU a day). During the pregnancy the activity of the enzymes which participate in the activation of the D-vitamins increases in the liver and the kidneys. The kidneys of the fetuses are able to form 1,25-hydroxy-vitamin-D. Vitamin D and 25-hydroxy-vitamin-D transgress through the placenta into the fetuses. Due to the adaptation mentioned and the increased formation of 1,25-hydroxy-vitamin-D the absorption of calcium and phosphate increases during pregnancy. Recent pathobiochemical knowledge concerning the metabolism of the D-vitamins in several diseases are described.

Topics: Bone and Bones; Calcium; Cholecalciferol; Ergocalciferols; Female; Glomerular Filtration Rate; Humans; Hypocalcemia; Infant, Newborn; Infant, Premature, Diseases; Intestinal Absorption; Liver; Osteogenesis; Osteoporosis; Parathyroid Hormone; Phosphates; Pregnancy; Rickets; Skin; Vitamin D

Topics: 25-Hydroxyvitamin D3 1-alpha-Hydroxylase; Androgens; Animals; Bone and Bones; Calcium; Carrier Proteins; Cholecalciferol; Cytochrome P-450 Enzyme System; Ergocalciferols; Estrogens; Female; Ferredoxins; Humans; Hydroxycholecalciferols; Intestine, Small; Kidney; Male; Osteoporosis; Parathyroid Glands; Parathyroid Hormone; Phosphorus; Vitamin D; Vitamin D Deficiency

During the past decade, an explosion of information has become available on the metabolism and function of vitamin D which is of great importance to clinicians in the treatment of metabolic bone disease. We have learned that vitamin D is the precursor of at least one hormone and that this hormone carries out functions in calcium and phosphorus metabolism bringing about mineralization of bone on one hand, and the prevention of hypocalcaemic tetany on the other. It may also function in the prevention of such degenerative bone diseases as osteoporosis. An important analogue of this hormone, 1alpha-hydroxyvitamin D3 has been prepared and is used successfully in the treatment of a variety of clinical conditions. This presentation will summarize these findings and their possible implications in these metabolic bone diseases.

Topics: Aged; Aging; Animals; Bone and Bones; Calcification, Physiologic; Calcium; Cholecalciferol; Chronic Kidney Disease-Mineral and Bone Disorder; Estradiol; Humans; Hydroxycholecalciferols; Kidney; Middle Aged; Osteoporosis; Parathyroid Hormone; Phosphorus; Rats; Vitamin D

Topics: Androsterone; Animals; Bone Diseases; Calcium; Cholecalciferol; Dihydroxycholecalciferols; Enzyme Induction; Epilepsy; Estradiol; Humans; Hydroxycholecalciferols; Microsomes, Liver; Osteoporosis; Phosphates; Progesterone; Rickets; Testosterone; Vitamin D

Topics: Calcium; Calcium Metabolism Disorders; Cholecalciferol; Cushing Syndrome; Diagnosis, Differential; Fanconi Syndrome; Fractures, Bone; Glomerular Filtration Rate; Humans; Hypercalcemia; Hyperparathyroidism; Hyperthyroidism; Kidney Calculi; Nephrocalcinosis; Osteitis Deformans; Osteoporosis; Parathyroid Hormone; Sarcoidosis

Topics: Calcium; Cholecalciferol; Chronic Kidney Disease-Mineral and Bone Disorder; Humans; Hyperparathyroidism, Secondary; Hypocalcemia; Intestinal Absorption; Kidney Failure, Chronic; Kidney Transplantation; Osteoporosis; Osteosclerosis; Phosphates; Transplantation, Homologous; Vitamin D

Topics: Bone Density; Cholecalciferol; Dietary Supplements; Humans; Kidney Transplantation; Osteoporosis; Parathyroid Hormone; Vitamin D; Vitamin D Deficiency

Evidence linking prenatal maternal vitamin D supplementation with the offspring's risk of atopic eczema is inconsistent, with most data coming from observational studies.. To examine the influence of maternal cholecalciferol supplementation during pregnancy on the risk of atopic eczema in the offspring at ages 12, 24 and 48 months.. Within the UK Maternal Vitamin D Osteoporosis Study (MAVIDOS) double-blind, randomized placebo-controlled trial, we examined the relationship of maternal vitamin D supplementation during pregnancy with offspring atopic eczema at ages 12, 24 and 48 months. In MAVIDOS, pregnant women were allocated to either cholecalciferol 1000 IU per day or matched placebo, taken from around 14 weeks' gestation until delivery, with the primary outcome of neonatal whole-body bone mineral content. The prevalence of atopic eczema in the offspring was ascertained at ages 12 (n = 635), 24 (n = 610) and 48 (n = 449) months, based on the UK Working Party criteria for the definition of atopic dermatitis. The trial was registered with ISRCTN (82927713) and EudraCT (2007-001716-23).. The characteristics of mothers and offspring were similar between the intervention and placebo groups, apart from longer breastfeeding duration in the intervention group. Adjusting for breastfeeding duration, offspring of mothers who received cholecalciferol 1000 IU daily had a lower odds ratio (OR) of atopic eczema at age 12 months [OR 0·55, 95% confidence interval (CI) 0·32-0·97, P = 0·04]; this effect weakened and was not statistically significant at ages 24 months (OR 0·76, 95% CI 0·47-1·23) or 48 months (OR 0·75, 95% CI 0·37-1·52). The statistical interaction of intervention and breastfeeding duration in relation to eczema at age 12 months was not significant (P = 0·41), but stratification showed reduced infantile eczema risk in the intervention group for infants breastfed for ≥ 1 month (OR 0·48, 95% CI 0·24-0·94, P = 0·03) but not in those breastfed for < 1 month (OR 0·80, 95% CI 0·29-2·17, P = 0·66).. Our data provide the first randomized controlled trial evidence of a protective effect of antenatal cholecalciferol supplementation on the risk of infantile atopic eczema, with the effect potentially being via increased breast milk cholecalciferol levels. The findings support a developmental influence on atopic eczema, and point to a potentially modifiable perinatal influence on atopic eczema. What is already known about this topic? There are currently no antenatal interventions proven to reduce the incidence of infantile atopic eczema in the general population. However, observational studies have led to speculation that antenatal vitamin D supplementation may be beneficial.

Topics: Child; Child, Preschool; Cholecalciferol; Dermatitis, Atopic; Dietary Supplements; Double-Blind Method; Female; Humans; Infant; Infant, Newborn; Osteoporosis; Pregnancy; Vitamin D; Vitamins

Vitamin D supplements are widely recommended for bone health in the general population, but data on whether they prevent fractures have been inconsistent.. In an ancillary study of the Vitamin D and Omega-3 Trial (VITAL), we tested whether supplemental vitamin D. Among 25,871 participants (50.6% women [13,085 of 25,871] and 20.2% Black [5106 of 25,304]), we confirmed 1991 incident fractures in 1551 participants over a median follow-up of 5.3 years. Supplemental vitamin D. Vitamin D

Topics: Aged; Cholecalciferol; Dietary Supplements; Double-Blind Method; Fatty Acids, Omega-3; Female; Fractures, Bone; Hip Fractures; Humans; Male; Middle Aged; Osteoporosis; Vitamin D Deficiency

Current treatment protocols in acute lymphoblastic leukemia (ALL) are associated with high remission rates and long life expectancy, enhancing the importance of quality of life and prevention of treatment-related complications in patient care. As osteoporosis is a frequent complication in patients under chemotherapy, we investigated the effect of vitamin K2 (100 mcg menaquinone-7) and vitamin D3 (10 mcg calcitriol) on bone metabolism in children with ALL.. Twenty-nine consecutive patients recently diagnosed with B precursor ALL (B-ALL) and treated according to the Turkish Acute Lymphoblastic Leukemia Berlin Frankfurt Münster 2000 protocol were randomly assigned into study and control groups. The study group (n=15, M/F: 8/7, age 1-14.5 years, mean 6.5 years) received vitamin K2 and vitamin D3 with their chemotherapy, while the control group (n=14, M/F 9/5, age 2-17 years, mean 7.1 years) received chemotherapy only. Serum calcium, phosphorus, magnesium, alkaline phosphatase, bone-specific alkaline phosphatase, uncarboxylated osteocalcin (ucOC), tartrate resistant acid phosphatase 5b, carboxyl terminal procollagen propeptide (PICP), osteoprotegerin (OPG), and receptor activator nuclear kappa B ligand (RANKL) were measured and bone mineral density (BMD) was determined at baseline and first, second, third and sixth months.. The study group had higher serum OPG/RANKL ratio and lower ucOC levels compared to the control group at the first month; PICP levels were higher in the study group at second and third months.. These results suggest an early beneficial effect of the combination of vitamin K2 and vitamin D3 on BMD in ALL patients especially during the period of intensive steroid therapy in the first months.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Bone and Bones; Bone Density; Child; Child, Preschool; Cholecalciferol; Female; Gene Expression Regulation; Humans; Infant; Male; Osteoporosis; Osteoprotegerin; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Procollagen; Prospective Studies; RANK Ligand; Vitamin K 2; Vitamins

The efficacy of once-weekly risedronate with and without cholecalciferol in bone mineral density (BMD) in Korean patients with osteoporosis was compared. After 12 months, both spine and hip BMD increased significantly in both groups, but there was no significant difference between two groups.. This study investigated the efficacy and safety of once-weekly risedronate with and without cholecalciferol in BMD in Korean patients with osteoporosis.. This was a prospective, 12-month, randomized, open-labeled, actively controlled trial involving 41 hospitals. A total of 841 subjects with osteoporosis were randomized to once-weekly risedronate (35 mg) and cholecalciferol (5600 IU) in a single pill (RSD+, n = 642) or once-weekly risedronate (35 mg) alone (RSD, n = 199). BMD was measured via dual-energy X-ray absorptiometry at the lumbar spine and hip, and the serum levels of 25-hydroxy vitamin D (25(OH) D), parathyroid hormone (PTH), and alkaline phosphatase (ALP) were assayed at baseline and after 12 months of treatment.. After 12 months, the lumbar spine, femoral neck, and total hip BMD increased significantly in both groups; there was no significant difference between two groups. Women in the RSD+ group exhibited significantly increased lumbar spine BMD, and subjects with previous fracture history in the RSD+ group had significantly increased total hip BMD compared with the RSD group. The serum 25(OH) D level increased significantly in the RSD+ group. The serum PTH level decreased in the RSD+ group but increased in the RSD group. The serum ALP level significantly decreased in both groups; there was no significant difference between two groups.. A once-weekly pill containing risedronate and cholecalciferol had the equivalent antiresorptive efficacy on BMD compared with risedronate alone and improved 25(OH) D serum levels after 12 months of treatment without significant adverse events in Korean patients with osteoporosis.

Topics: Absorptiometry, Photon; Aged; Alkaline Phosphatase; Bone Density; Bone Density Conservation Agents; Cholecalciferol; Drug Administration Schedule; Drug Therapy, Combination; Female; Femur Neck; Humans; Lumbar Vertebrae; Middle Aged; Osteoporosis; Parathyroid Hormone; Pelvic Bones; Prospective Studies; Republic of Korea; Risedronic Acid; Treatment Outcome; Vitamin D

There is limited information on the influence of vitamin D on physical performance in black Americans.. To determine if maintenance of serum 25(OH)D >75 nmol/L prevents a decline in physical performance.. The Physical Performance, Osteoporosis and Vitamin D in African American Women (PODA) trial had a prospective, randomized, placebo controlled, double-dummy design with two arms: one of which is placebo vitamin D3 adjusted to maintain serum 25(OH)D >75 nmol/L.. The target population was healthy elderly black women with serum 25(OH)D between 20 and 65 nmol/L. The trial was 3 years in duration with measurement of physical performance every 6 months: grip strength, Short Physical Performance Battery (SPPB), 10 chair rises, and 6-minute walk distance. A total of 260 women entered the study and 184 completed 3 years. Mean age was 68.2 years. Baseline 25(OH)D was 53 nmol/L; total SPPB was 11 (10 to 12).. Research center in an academic health center.. Prevention of decline in physical performance measures.. Participants were randomly assigned to placebo or active vitamin D. Vitamin D3 dose was adjusted to maintain serum 25(OH)D >75 nmol/L.. There was a decline with time in grip strength and the 6-minute walk test. The SPBB increased with time. There were no substantial differences between the placebo and active vitamin D3 groups with respect to the temporal patterns observed for any of the performance measures.. There is no benefit of maintaining serum 25(OH)D >75 nmol/L in preventing the decline in physical performance in healthy black American women.

Topics: Aged; Black or African American; Case-Control Studies; Cholecalciferol; Dietary Supplements; Double-Blind Method; Female; Follow-Up Studies; Humans; Middle Aged; Osteoporosis; Physical Functional Performance; Prognosis; Prospective Studies; Vitamin D Deficiency; Vitamins

Vitamin D deficiency is associated with bone loss, poor muscle strength, falls and fracture. This information in older African Americans (AAs) is sparse.. The study of the relationship of Physical performance, Osteoporosis prevention with vitamin D in older African Americans (PODA) is a randomized, double-blind, placebo-controlled 3-year trial examining the effect of vitamin D on bone loss and physical performance in older AA women.. SPPB gait speed, grip strength and 6MWD showed a significant positive correlation with free 25OHD. 1pg/ml increase in free 25OHD predicted a 32% increase in the odds of having higher gait speed and a 1.42lb. increase in grip strength. No significant differences in BMI, BMD, muscle mass, grip strength, serum total 25OHD and free 25OHD were observed between groups. None of the measures of physical performance showed an association with baseline serum 25OHD.. This is the first study to show an association between free 25OHD and physical performance. These findings indicate a positive relationship of free 25OHD with gait speed and grip strength in older AA women. Further studies are needed to understand the role of free 25OHD.

Topics: Aged; Black or African American; Body Weights and Measures; Bone Density; Calcifediol; Cholecalciferol; Double-Blind Method; Female; Health Behavior; Humans; Middle Aged; Muscle Strength; Muscle, Skeletal; Osteoporosis; Physical Functional Performance; Walk Test

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 Mediterranean diet (MD) is widely recommended for the prevention of chronic disease, but evidence for a beneficial effect on bone health is lacking.. The aim of this study was to examine the effect of a Mediterranean-like dietary pattern [NU-AGE (New Dietary Strategies Addressing the Specific Needs of the Elderly Population for Healthy Aging in Europe)] on indexes of inflammation with a number of secondary endpoints, including bone mineral density (BMD) and biomarkers of bone and collagen degradation in a 1-y multicenter randomized controlled trial (RCT; NU-AGE) in elderly Europeans.. An RCT was undertaken across 5 European centers. Subjects in the intervention group consumed the NU-AGE diet for 1 y by receiving individually tailored dietary advice, coupled with supplies of foods including whole-grain pasta, olive oil, and a vitamin D3 supplement (10 µg/d). Participants in the control group were provided with leaflets on healthy eating available in their country.. A total of 1294 participants (mean ± SD age: 70.9 ±4.0 y; 44% male) were recruited to the study and 1142 completed the 1-y trial. The Mediterranean-like dietary pattern had no effect on BMD (site-specific or whole-body); the inclusion of compliance to the intervention in the statistical model did not change the findings. There was also no effect of the intervention on the urinary biomarkers free pyridinoline or free deoxypyridinoline. Serum 25-hydroxyvitamin D significantly increased and parathyroid hormone decreased (P < 0.001) in the MD compared with the control group. Subgroup analysis of individuals with osteoporosis at baseline (site-specific BMD T-score ≤ -2.5 SDs) showed that the MD attenuated the expected decline in femoral neck BMD (n = 24 and 30 in MD and control groups, respectively; P = 0.04) but had no effect on lumbar spine or whole-body BMD.. A 1-y intervention of the Mediterranean-like diet together with vitamin D3 supplements (10 µg/d) had no effect on BMD in the normal age-related range, but it significantly reduced the rate of loss of bone at the femoral neck in individuals with osteoporosis. The NU-AGE trial is registered at clinicaltrials.gov as NCT01754012.

Topics: Aged; Amino Acids; Biomarkers; Bone and Bones; Bone Density; Cholecalciferol; Collagen; Diet, Mediterranean; Dietary Supplements; Europe; Female; Femur Neck; Humans; Male; Olive Oil; Osteoporosis; Parathyroid Hormone; Vitamin D; Whole Grains

The aim of the the study is to compare the effects of cholecalciferol and calcitriol on bone mineral metabolism in women with vitamin D deficiency. Calcitriol was associated with a significant increase in bone mineral density at the lumbar spine in patients with low vitamin D levels.. Active vitamin D analogs may have larger impact in decreasing bone loss and fracture rate compared to cholecalciferol in osteoporosis. However, their effects in the treatment of vitamin D deficiency compared to cholecalciferol are not clear. The aim of the present study is to compare the effects of cholecalciferol and calcitriol on bone mineral metabolism and bone mineral density in pre- and postmenopausal women with vitamin D deficiency.. This was a 6-month prospective, open-label, controlled clinical trial. Eligible 120 participants were pre- and postmenopausal women diagnosed with vitamin D deficiency. Forty-three subjects (group 1) received 1000 IU of cholecalciferol and 1 g of calcium daily. The other 77 subjects (group 2) received 0.5 μg calcitriol in addition to 400 IU of cholecalciferol and 1 g of calcium daily.. Oral vitamin D supplementation did not increase bone mineral density after 6 months of intervention in group 1. On the other hand, bone mineral density at the lumbar spine increased from 0.809 ± 0.172 to 0.848 ± 0.161 g/cm. Oral daily calcitriol was associated with a significant increase in bone mineral density at the lumbar spine in patients with low vitamin D, elevated PTH, and osteoporosis.

Topics: Bone Density; Bone Density Conservation Agents; Calcitriol; Calcium; Cholecalciferol; Dietary Supplements; Female; Humans; Lumbar Vertebrae; Middle Aged; Osteoporosis; Prospective Studies; Treatment Outcome; Vitamin D; Vitamin D Deficiency

It is generally believed that Thai people do not suffer from hypovitaminosis D because there is abundant sunlight throughout the year, and that taking vitamin D supplements could result in abnormally high levels of vitamin D. This is a Thai FDA-driven study to investigate this risk over a period of 26 weeks of taking alendronate sodium/vitamin D3 combination tablets.. Osteoporosis patients in Thailand were recruited to a multicenter, open-label, 6-month trial of oral alendronate sodium 70 mg/vitamin D3 5600 IU. Patients received study medication once a week for 26 weeks. Serum 25-hydroxyvitamin D (25(OH)D) and Beta-CrossLaps (β-CTx) levels were measured at baseline and 26 weeks. The primary endpoint was the proportion of patients with 25(OH)D ≥ 50 ng/mL at week 26; it was hypothesized that 26 weeks' treatment would not result in 25(OH)D serum levels ≥ 50 ng/mL in > 7% of osteoporosis patients.. One hundred ninety-eight patients were recruited. At baseline, 67.2% of the patients had 25(OH)D < 30 ng/mL; this declined to 34.4% by week 26. The mean 25(OH)D level improved from 27.8 ng/mL at baseline to 33.6 ng/mL at week 26. Five patients (2.69% of the full analysis set) had 25(OH)D levels ≥ 50 ng/mL at 26 weeks. The highest 25(OH)D level, 64.3 ng/mL, was observed in a patient whose baseline level was 102.2 ng/mL. The majority (62.9%) of the patients had optimal 25(OH)D levels (30-50 ng/mL). β-CTx levels were reduced by 57.7% after 26 weeks' treatment. No clinically significant cases of hypercalcemia which could be associated with hypervitaminosis D were identified during physical examination, in vital signs, or in laboratory results. Overall, 73 patients (36.9%) reported at least one adverse event (AE), with 13 (6.6%) reporting drug-related AEs. Four patients discontinued due to AEs, two of which were drug-related. Serious AEs were reported for four patients, of which one was considered drug-related.. Oral alendronate sodium 70 mg plus vitamin D3 5600 IU once weekly had an acceptable safety profile in this study, and increased serum 25(OH)D and reduced β-CTx levels in osteoporosis patients. This treatment improved 25(OH)D levels, without causing abnormally high levels, after 26 weeks' treatment.. Clinical Trials.gov NCT01437111 , Registered September 19, 2011.

Topics: Administration, Oral; Aged; Alendronate; Bone Density Conservation Agents; Cholecalciferol; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Osteoporosis; Thailand; Treatment Outcome; Vitamin D

People with multiple sclerosis have high risk of osteoporosis and fractures. A poor vitamin D status is a risk factor for MS, and vitamin D supplementation has been recommended both to prevent MS progression and to maintain bone health.. We assessed the effect of 20,000 IU vitamin D. Serum levels of 25-hydroxyvitamin D more than doubled in the vitamin D group, and parathyroid hormone decreased in the vitamin D group compared to the placebo group at week 48 and week 96. There was however no effect on bone formation as measured by procollagen type I N propeptide (PINP), or on bone resorption as measured by C-terminal cross-linking telopeptide of type I collagen (CTX1). Neither PINP nor CTX1 predicted bone loss from baseline to week 96.. These findings corroborate the previously reported lack of effect of weekly high dose vitamin D supplementation on bone mass density in the same patients, and suggest that such vitamin D supplementation does not prevent bone loss in persons with MS who are not vitamin D deficient.. The trial was registered at ClinicalTrials.gov on April 4 2008, registration number NCT00785473 .

Topics: Adult; Biomarkers; Bone Density Conservation Agents; Cholecalciferol; Dietary Supplements; Female; Humans; Male; Middle Aged; Multiple Sclerosis, Relapsing-Remitting; Osteoporosis; Treatment Outcome; Vitamin D; Young Adult

Middle East Respiratory Syndrome (MERS) is a novel respiratory illness firstly reported in Saudi Arabia in 2012. It is caused by a new corona virus, called MERS corona virus (MERS-CoV). Most people who have MERS-CoV infection developed severe acute respiratory illness.. This work is done to determine the clinical characteristics and the outcome of intensive care unit (ICU) admitted patients with confirmed MERS-CoV infection.. This study included 32 laboratory confirmed MERS corona virus infected patients who were admitted into ICU. It included 20 (62.50%) males and 12 (37.50%) females. The mean age was 43.99 ± 13.03 years. Diagnosis was done by real-time reverse transcription polymerase chain reaction (rRT-PCR) test for corona virus on throat swab, sputum, tracheal aspirate, or bronchoalveolar lavage specimens. Clinical characteristics, co-morbidities and outcome were reported for all subjects.. Most MERS corona patients present with fever, cough, dyspnea, sore throat, runny nose and sputum. The presence of abdominal symptoms may indicate bad prognosis. Prolonged duration of symptoms before patients' hospitalization, prolonged duration of mechanical ventilation and hospital stay, bilateral radiological pulmonary infiltrates, and hypoxemic respiratory failure were found to be strong predictors of mortality in such patients. Also, old age, current smoking, smoking severity, presence of associated co-morbidities like obesity, diabetes mellitus, chronic heart diseases, COPD, malignancy, renal failure, renal transplantation and liver cirrhosis are associated with a poor outcome of ICU admitted MERS corona virus infected patients.. Plasma HO-1, ferritin, p21, and NQO1 were all elevated at baseline in CKD participants. Plasma HO-1 and urine NQO1 levels each inversely correlated with eGFR (. SnPP can be safely administered and, after its injection, the resulting changes in plasma HO-1, NQO1, ferritin, and p21 concentrations can provide information as to antioxidant gene responsiveness/reserves in subjects with and without kidney disease.. A Study with RBT-1, in Healthy Volunteers and Subjects with Stage 3-4 Chronic Kidney Disease, NCT0363002 and NCT03893799.. HFNC did not significantly modify work of breathing in healthy subjects. However, a significant reduction in the minute volume was achieved, capillary [Formula: see text] remaining constant, which suggests a reduction in dead-space ventilation with flows > 20 L/min. (ClinicalTrials.gov registration NCT02495675).. 3 组患者手术时间、术中显性失血量及术后 1 周血红蛋白下降量比较差异均无统计学意义（. 对于肥胖和超重的膝关节单间室骨关节炎患者，采用 UKA 术后可获满意短中期疗效，远期疗效尚需进一步随访观察。.. Decreased muscle strength was identified at both time points in patients with hEDS/HSD. The evolution of most muscle strength parameters over time did not significantly differ between groups. Future studies should focus on the effectiveness of different types of muscle training strategies in hEDS/HSD patients.. These findings support previous adverse findings of e-cigarette exposure on neurodevelopment in a mouse model and provide substantial evidence of persistent adverse behavioral and neuroimmunological consequences to adult offspring following maternal e-cigarette exposure during pregnancy. https://doi.org/10.1289/EHP6067.. This RCT directly compares a neoadjuvant chemotherapy regimen with a standard CROSS regimen in terms of overall survival for patients with locally advanced ESCC. The results of this RCT will provide an answer for the controversy regarding the survival benefits between the two treatment strategies.. NCT04138212, date of registration: October 24, 2019.. Results of current investigation indicated that milk type and post fermentation cooling patterns had a pronounced effect on antioxidant characteristics, fatty acid profile, lipid oxidation and textural characteristics of yoghurt. Buffalo milk based yoghurt had more fat, protein, higher antioxidant capacity and vitamin content. Antioxidant and sensory characteristics of T. If milk is exposed to excessive amounts of light, Vitamins B. The two concentration of ZnO nanoparticles in the ambient air produced two different outcomes. The lower concentration resulted in significant increases in Zn content of the liver while the higher concentration significantly increased Zn in the lungs (p < 0.05). Additionally, at the lower concentration, Zn content was found to be lower in brain tissue (p < 0.05). Using TEM/EDX we detected ZnO nanoparticles inside the cells in the lungs, kidney and liver. Inhaling ZnO NP at the higher concentration increased the levels of mRNA of the following genes in the lungs: Mt2 (2.56 fold), Slc30a1 (1.52 fold) and Slc30a5 (2.34 fold). At the lower ZnO nanoparticle concentration, only Slc30a7 mRNA levels in the lungs were up (1.74 fold). Thus the two air concentrations of ZnO nanoparticles produced distinct effects on the expression of the Zn-homeostasis related genes.. Until adverse health effects of ZnO nanoparticles deposited in organs such as lungs are further investigated and/or ruled out, the exposure to ZnO nanoparticles in aerosols should be avoided or minimised.

Topics: A549 Cells; Acetylmuramyl-Alanyl-Isoglutamine; Acinetobacter baumannii; Acute Lung Injury; Adaptor Proteins, Signal Transducing; Adenine; Adenocarcinoma; Adipogenesis; Administration, Cutaneous; Administration, Ophthalmic; Adolescent; Adsorption; Adult; Aeromonas hydrophila; Aerosols; Aged; Aged, 80 and over; Aging; Agriculture; Air Pollutants; Air Pollution; Airway Remodeling; Alanine Transaminase; Albuminuria; Aldehyde Dehydrogenase 1 Family; Algorithms; AlkB Homolog 2, Alpha-Ketoglutarate-Dependent Dioxygenase; Alzheimer Disease; Amino Acid Sequence; Ammonia; Ammonium Compounds; Anaerobiosis; Anesthetics, Dissociative; Anesthetics, Inhalation; Animals; Anti-Bacterial Agents; Anti-HIV Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Antibiotics, Antineoplastic; Antibodies, Antineutrophil Cytoplasmic; Antibodies, Monoclonal, Humanized; Antifungal Agents; Antigens, Bacterial; Antigens, CD; Antigens, Differentiation, Myelomonocytic; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Antioxidants; Antitubercular Agents; Antiviral Agents; Apolipoproteins E; Apoptosis; Arabidopsis; Arabidopsis Proteins; Arsenic; Arthritis, Rheumatoid; Asthma; Atherosclerosis; ATP-Dependent Proteases; Attitude of Health Personnel; Australia; Austria; Autophagy; Axitinib; Bacteria; Bacterial Outer Membrane Proteins; Bacterial Proteins; Bacterial Toxins; Bacterial Typing Techniques; Bariatric Surgery; Base Composition; Bayes Theorem; Benzoxazoles; Benzylamines; beta Catenin; Betacoronavirus; Betula; Binding Sites; Biological Availability; Biological Oxygen Demand Analysis; Biomarkers; Biomarkers, Tumor; Biopsy; Bioreactors; Biosensing Techniques; Birth Weight; Blindness; Blood Chemical Analysis; Blood Gas Analysis; Blood Glucose; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Blood-Brain Barrier; Blotting, Western; Body Mass Index; Body Weight; Bone and Bones; Bone Density; Bone Resorption; Borates; Brain; Brain Infarction; Brain Injuries, Traumatic; Brain Neoplasms; Breakfast; Breast Milk Expression; Breast Neoplasms; Bronchi; Bronchoalveolar Lavage Fluid; Buffaloes; Cadherins; Calcification, Physiologic; Calcium Compounds; Calcium, Dietary; Cannula; Caprolactam; Carbon; Carbon Dioxide; Carboplatin; Carcinogenesis; Carcinoma, Ductal; Carcinoma, Ehrlich Tumor; Carcinoma, Hepatocellular; Carcinoma, Non-Small-Cell Lung; Carcinoma, Pancreatic Ductal; Carcinoma, Renal Cell; Cardiovascular Diseases; Carps; Carrageenan; Case-Control Studies; Catalysis; Catalytic Domain; Cattle; CD8-Positive T-Lymphocytes; Cell Adhesion; Cell Cycle Proteins; Cell Death; Cell Differentiation; Cell Line; Cell Line, Tumor; Cell Movement; Cell Nucleus; Cell Phone Use; Cell Proliferation; Cell Survival; Cell Transformation, Neoplastic; Cell Transformation, Viral; Cells, Cultured; Cellulose; Chemical Phenomena; Chemoradiotherapy; Child; Child Development; Child, Preschool; China; Chitosan; Chlorocebus aethiops; Cholecalciferol; Chromatography, Liquid; Circadian Clocks; 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YAP-Signaling Proteins; Yogurt; Young Adult; Zebrafish; Zebrafish Proteins; Ziziphus

Combined treatment with alendronate and eldecalcitol was found to be more effective in reducing the bone turnover markers and increasing bone mineral density than alendronate treatment with vitamin D3 and calcium supplementation in the osteoporotic patients.. We compared the clinical efficacy and safety of combined treatment with alendronate plus eldecalcitol (ALN + ELD) with those of treatment with ALN plus vitamin D and calcium (ALN + VitD).. Osteoporotic 219 patients were randomly assigned to the ALN + ELD, or the ALN + VitD group. Primary endpoint was the inter-group differences in lumbar spine BMD (L-BMD) at patient's last visit. Secondary endpoints included the differences in BMD at other sites and the bone turnover marker (BTM) levels.. L-BMD, total hip BMD and femoral neck (FN-BMD) increased from baseline by 7.30, 2.41, and 2.70 % in the ALN + ELD group, and by 6.52, 2.27, and 1.18% in the ALN + VitD group, respectively. Inter-group differences of the L-BMD and total hip BMD values were not significant. The increase of the FN-BMD was larger in the ALN + ELD group than the ALN + VitD group. Reductions of the BTMs were greater in the ALN + ELD group than the ALN + VitD group. Interaction of the percent increase of the L-BMD with the baseline values of the BTMs was observed in the ALN + VitD group only. The increases of the FN-BMD in patients with lower baseline values of type-I-collagen C-telopeptide (sCTX) and serum 25(OH) D levels <20 ng/mL were significantly larger in the ALN + ELD group than the other group.. Combination treatment of ALN plus ELD was more effective in reducing the BTMs and increasing the FN-BMD than ALN treatment with vitamin D3 and calcium.

Topics: Aged; Aged, 80 and over; Alendronate; Biomarkers; Bone Density; Bone Density Conservation Agents; Bone Remodeling; Calcium; Cholecalciferol; Drug Therapy, Combination; Female; Humans; Japan; Lumbar Vertebrae; Male; Middle Aged; Osteoporosis; Radiography; Treatment Outcome; Vitamin D

In a randomized, cross-over study, once monthly administration of vitamin D3 was preferred over a once daily administration of a fixed-dose combination of vitamin D3 and calcium, with a better compliance but without any significant difference in the increase in vitamin D levels.. The aim of the present study was to compare a once-monthly administration of vitamin D3 to a daily administration of a fixed-dose combination of vitamin D3 and calcium during two treatment periods of 6 months.. One hundred volunteers aged 50 years old or older were randomized to receive either one drinkable ampoule containing 25,000 IU vitamin D3 (D-Cure®, SMB) once monthly (group VD) or one chewable tablet containing 1000 mg calcium carbonate + 800 IU vitamin D3 (Steovit Forte®, Takeda) once daily (group VDCa) during 6 months. After the first 6 months of treatment, the groups were reversed according to the randomized cross-over design. Treatment compliance (i.e. the primary outcome), preference, acceptability and vitamin D levels and adverse events were all collected.. For the two periods, the patients had a significantly higher compliance in the VD group than in the VDCa group (p < 0.0001). During the study, 50 (56.8 %) patients preferred the VD treatment, 16 (18.2 %) patients preferred the VDCa, and for 22 (25.0 %) patients, neither treatment was preferred. At the end of the first 6 months of treatment, the mean (SD) increase of 25(OH)D was 6.57 ng/mL (8.19) in the VD group and 3.88 ng/mL (10.0) in the VDCa group (p = 0.16 between groups).. In this study, a once-monthly administration of vitamin D3 was preferred over a once-daily administration of a fixed-dose combination of vitamin D3 and calcium, with a better compliance but without any significant difference in the increase in vitamin D levels.

Topics: Aged; Calcium; Cholecalciferol; Cross-Over Studies; Drug Administration Schedule; Drug Combinations; Female; Humans; Male; Medication Adherence; Middle Aged; Osteoporosis

This study aims to investigate the efficacy and safety of oral fixed-dose combination of strontium ranelate 2  g/vitamin D₃ 1000  IU daily vs strontium ranelate 2  g daily for correcting vitamin D insufficiency in osteoporosis.. A 6-month international, randomized, double-blind, parallel-group, phase 3 study.. A total of 518 men and postmenopausal women aged ≥50 years with primary osteoporosis (T-score ≤-2.5 s.d.) and serum 25-hydroxyvitamin D (25(OH)D) >22.5 nmol/l were included. Patients were allocated to strontium ranelate 2 g/vitamin D₃ 1000  IU daily (n=413) or strontium ranelate 2 g daily (n=105). The participants received calcium 1 g daily. The primary endpoint was serum 25(OH)D at last post-baseline evaluation during 3 months.. Both groups were comparable at baseline. Mean baseline of 25(OH)D was 44.1 ± 14.6 nmol/l. After 3 months, the percentage of patients with 25(OH)D ≥50 nmol/l was higher with strontium ranelate/vitamin D₃ vs strontium ranelate (84 vs 44%, P<0.001; adjusted between-group odds ratio=6.7; 95% CI, 4.2-10.9). The efficacy of the fixed-dose combination on 25(OH)D was maintained at 6 months (86 vs 40%, P<0.001). Mean 25(OH)D was 65.1 and 49.5 nmol/l, respectively, after 3 months and 66.9 and 45.4 nmol/l after 6 months. Physical performance improved in both groups. Falls were 17 and 20% in the strontium ranelate/vitamin D₃ and strontium ranelate groups respectively. Parathyroid hormone levels were inversely correlated with 25(OH)D. No clinically relevant differences in safety were observed.. This study confirms the efficacy and safety of fixed-dose combination of strontium ranelate 2 g/vitamin D₃ 1000 IU for correction of vitamin D insufficiency in osteoporotic patients.

Topics: Aged; Cholecalciferol; Female; Humans; Male; Middle Aged; Osteoporosis; Osteoporosis, Postmenopausal; Strontium; Thiophenes; Vitamin D; Vitamin D Deficiency

Calcium supplements are widely used among older adults for osteoporosis prevention and treatment. However, their effect on creatinine levels and kidney function has not been well studied.. We investigated the effect of calcium supplementation on blood creatinine concentration in a randomized controlled trial of colorectal adenoma chemoprevention conducted between 2004-2013 at 11 clinical centers in the United States. Healthy participants (N = 1,675) aged 45-75 with a history of colorectal adenoma were assigned to daily supplementation with calcium (1200 mg, as carbonate), vitamin D3 (1000 IU), both, or placebo for three or five years. Changes in blood creatinine and total calcium concentration were measured after one year of treatment and multiple linear regression was used to estimate effects on creatinine concentrations.. After one year of treatment, blood creatinine was 0.013±0.006 mg/dL higher on average among participants randomized to calcium compared to placebo after adjustment for other determinants of creatinine (P = 0.03). However, the effect of calcium treatment appeared to be larger among participants who consumed the most alcohol (2-6 drinks/day) or whose estimated glomerular filtration rate (eGFR) was less than 60 ml/min/1.73 m2 at baseline. The effect of calcium treatment on creatinine was only partially mediated by a concomitant increase in blood total calcium concentration and was independent of randomized vitamin D treatment. There did not appear to be further increases in creatinine after the first year of calcium treatment.. Among healthy adults participating in a randomized clinical trial, daily supplementation with 1200 mg of elemental calcium caused a small increase in blood creatinine. If confirmed, this finding may have implications for clinical and public health recommendations for calcium supplementation.. ClinicalTrials.gov NCT00153816.

Topics: Adult; Aged; Calcium, Dietary; Cholecalciferol; Creatinine; Dietary Supplements; Female; Humans; Kidney Function Tests; Male; Middle Aged; Osteoporosis

Perimenopausal women can experience rapid bone loss at skeletal sites with both cortical and cancellous bone, increasing the prevalence of osteoporosis following menopause.. We conducted a 12-month randomized placebo-controlled trial evaluating the effects of alendronate 70 mg with 2800 IU cholecalciferol administered once per week for 12 months in comparison with placebo and cholecalciferol. The primary end-point was the percentage change in the lumbar spine bone mineral density (BMD) from baseline to 12 months. Secondary end-points were the change in BMD at the femoral neck and changes in biochemical markers of bone turnover.. Forty-five women were recruited to participate in the study. Five subjects withdrew from the study before randomization for unrelated reasons. Forty subjects were randomly allocated to the alendronate and placebo groups. The mean lumbar spine MD in women treated with alendronate increased by 3.66% (mean paired difference, μd = 0.032; ± 0.008 SE) at 12 months, compared with a reduction of 3.33% (μd = -0.030; ± 0.008 SE) in the control group (P < 0.001). In the femoral neck, the mean BMD in the alendronate group increased by 2.07% (μd = 0.014; ± 0.009 SE) at 12 months, compared with a reduction of 1.87% (μd = -0.014; ± 0.008 SE) in the control group (P = 0.046). There were no differences in BMD between the alendronate and placebo groups at the total hip sites after 12 months. At 12 months, both bone-specific alkaline phosphatase and urinary N-telopeptide were significantly reduced, by 37.79% (μd = -9.90; ± 1.92 SE) and 27.21% (μd = -11.68; ± 4.80 SE) respectively, in the alendronate group; in the control group, these levels increased (P < 0.001).. Weekly treatment with alendronate 70 mg and cholecalciferol 2800 IU increases BMD and decreases bone turnover in perimenopausal women.

Topics: Adult; Alendronate; Bone Density Conservation Agents; Bone Remodeling; Cholecalciferol; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Middle Aged; Osteoporosis; Perimenopause

Bone health is influenced by the intake of both calcium and vitamin D.. Our objective was to evaluate the influence of calcium and vitamin D supplementation on PTH and bone turnover. SETTING, PATIENTS, AND DESIGN: At an ambulatory research center, 159 postmenopausal healthy white women participated in this double-blind, placebo-controlled parallel, longitudinal factorial study that was 6 months in duration.. Subjects were randomly allocated to 4 groups: 1) double placebo, 2) calcium (1200 mg daily) plus placebo, 3) vitamin D3 (100 μg) plus placebo, and 4) vitamin D3 and calcium. Serum and urine were collected fasting and 2 hours after a calcium load at baseline and at 3 and 6 months.. Serum PTH, cross-linked C-telopeptide (CTX), and procollagen type I N-terminal propeptide (P1NP) were measured.. Before study medication, a calcium load resulted in a decline in PTH and CTX and an increase in urinary calcium excretion. Serum CTX and P1NP declined over time with calcium supplementation but did not change with increased vitamin D intake. There was a decline in PTH in the vitamin D groups in the fasting state compared with placebo. Suppression of PTH was greater after a calcium load in the vitamin D groups. A calcium load decreased PTH and CTX and raised urinary calcium.. Fasting PTH declines with vitamin D supplementation. PTH declines after calcium intake. Supplementation of the diet with 1200 mg calcium/d reduces bone turnover markers, whereas supplementation with up to100 μg vitamin D3/d does not.

Topics: Aged; Bone and Bones; Bone Remodeling; Calcium; Calcium, Dietary; Cholecalciferol; Collagen Type I; Dietary Supplements; Female; Fractures, Bone; Humans; Longitudinal Studies; Middle Aged; Osteomalacia; Osteoporosis; Parathyroid Hormone; Peptide Fragments; Peptides; Placebos; Postmenopause; Procollagen; Vitamins

We conducted a single-arm clinical trial in institutionalized seniors, on the effects of high-dose vitamin D3-fortified bread daily intake (clinicaltrials.gov registration NCT00789503).. At 1 and 3 years after the dietary fortification was stopped, serum 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH) and bone mineral density were measured in 23 of the original study subjects, aged 60-82 years who had consumed bread buns (100 g) fortified with 320 mg elemental calcium and 125 μg (5,000 IU) vitamin D3 daily for one year.. At the end of the 1-year supplementation phase (receiving vitamin D3 fortified bread daily), mean (SD) serum 25(OH)D was 127.3 ± 37.8 nmol/L (baseline for this follow-up). At 1-year follow-up, the serum 25(OH)D was 64.9 ± 24.8 nmol/L (p = 0.001, vs. baseline); and at 3-year follow-up it was 28.0 ± 15.0 nmol/L (p = 0.001 vs. baseline). Serum PTH was 18.8 ± 15.6 pg/ml at baseline while at Year 3 it was 48.4 ± 18.4 pg/ml (p = 0.001 vs. baseline). Lumbar spine BMD did not change from baseline to Year 3. However, by Year 3, hip BMD had decreased (0.927 ± 0.130 g/cm² vs. 0.907 ± 0.121 g/cm², p = 0.024).. Vitamin D nutritional status exhibits a long half-life in the body, and a true steady-state plateau may not even be reached 1 year after a discontinuation in dose. Furthermore, once the need for vitamin D has been established, based on a low baseline serum 25(OH)D concentrations, the appropriate action is to maintain corrective vitamin D supplementation over the long term.

Topics: Absorptiometry, Photon; Aged; Aged, 80 and over; Aging; Bone Density; Bread; Calcifediol; Calcium, Dietary; Cholecalciferol; Follow-Up Studies; Food, Fortified; Hip Joint; Homes for the Aged; Humans; Lumbar Vertebrae; Middle Aged; Nursing Homes; Osteoporosis; Parathyroid Hormone; Recurrence; Romania; Vitamin D Deficiency

Vitamin D and vitamin B deficiency are common in elderly subjects and are important risk factors for osteoporosis and age-related diseases. Supplementation with these vitamins is a promising preventative strategy. The objective of this study was to evaluate the effects of vitamins D3 and B supplementation on bone turnover and metabolism in elderly people.. Healthy subjects (n=93; >54 years) were randomly assigned to receive either daily vitamin D3 (1200 IU), folic acid (0.5 mg), vitamin B12 (0.5 mg), vitamin B6 (50 mg), and calcium carbonate (456 mg) (group A) or only vitamin D3 plus calcium carbonate (group B) in a double blind trial. We measured at baseline and after 6 and 12 months of supplementation vitamins, metabolites, and bone turnover markers.. At baseline mean plasma 25-hydroxy vitamin D [25(OH)D] was low (40 or 30 nmol/L) and parathormone was high (63.7 or 77.9 pg/mL). 25(OH)D and parathormone correlated inversely. S-Adenosyl homocysteine and S-adenosyl methionine correlated with bone alkaline phosphatase, sclerostin, and parathormone. One year vitamin D3 or D3 and B supplementation increased plasma 25(OH)D by median 87.6% (group A) and 133.3% (group B). Parathormone was lowered by median 28.3% (A) and 41.2% (B), bone alkaline phosphatase decreased by 2.8% (A) and 16.2% (B), osteocalin by 37.5% (A) and 49.4% (B), and tartrate-resistant-acid-phosphatase 5b by 6.1% (A) and 36.0% (B). Median total homocysteine (tHcy) was high at baseline (group A: 12.6, group B: 12.3 µmol/L) and decreased by B vitamins (group A) to 8.9 µmol/L (29.4%). tHcy lowering had no additional effect on bone turnover.. One year vitamin D3 supplementation with or without B vitamins decreased the bone turnover significantly. Vitamin D3 lowered parathormone. The additional application of B vitamins did not further improve bone turnover. The marked tHcy lowering by B vitamins may modulate the osteoporotic risk.

Topics: Acid Phosphatase; Aged; Aged, 80 and over; Alkaline Phosphatase; Biomarkers; Bone and Bones; Cholecalciferol; Dietary Supplements; Double-Blind Method; Drug Administration Schedule; Female; Humans; Isoenzymes; Male; Middle Aged; Osteoporosis; Parathyroid Hormone; S-Adenosylhomocysteine; S-Adenosylmethionine; Tartrate-Resistant Acid Phosphatase; Vitamin B Complex; Vitamin D

Vitamin D deficiency is often treated or prevented by high intermittent doses of vitamin D to achieve a better treatment adherence, but treatment outcomes were contradictory, and even a transient increase in fracture and fall risk was reported.. The objective of the study was to investigate the short-term effects on bone turnover markers of a single bolus of vitamin D₃.. Twelve elderly subjects (eight women, four men; mean age 76 ± 3 yr) were given a single oral bolus of 600,000 IU vitamin D₃. Blood samples were taken at baseline and 1, 3, 7, 14, 30, 60, and 90 d after vitamin D₃ administration. Twenty-four subjects served as controls.. Changes in serum levels of 25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D, PTH, C-terminal-telopeptides of type I collagen, cross-linked N-telopeptide of type I collagen (sNTX), osteocalcin, and bone-specific alkaline phosphatase.. No relevant changes in 25OHD and bone turnover markers were observed in the controls. In treated subjects, serum 25OHD attained a peak increment to 67.1 ± 17.1 ng/ml (P < 0.001) at d 3. Subsequently it slowly decreased to 35.2 ± 5.8 ng/ml (P <0.01 vs. a baseline value of 21.7 ± 5.6 ng/ml). Mean serum PTH concentration decreased by 25-50% and serum 1,25-dihydroxyvitamin D rose by 25-50%. Serum CTX and sNTX rose significantly at d 1 (P < 0.01), they attained a peak increment greater than 50% at d 3, and they subsequently decreased almost back to baseline values at d 90. Serum osteocalcin slightly rose within the first 3 d and then declined by d 60. No changes were observed in serum bone-specific alkaline phosphatase.. Our results indicate that the use of large doses of vitamin D may be associated with acute increases in C-terminal-telopeptides of type I collagen and sNTX, which may explain the negative clinical results obtained by using intermittent high doses of vitamin D to treat or prevent vitamin D deficiency.

Topics: Administration, Oral; Aged; Biomarkers; Biotransformation; Bone and Bones; Bone Density Conservation Agents; Calcifediol; Calcitriol; Cholecalciferol; Collagen Type I; Female; Humans; Male; Osteocalcin; Osteoporosis; Parathyroid Hormone; Peptides; Phosphopeptides; Procollagen; Vitamin D Deficiency

MAVIDOS is a randomised, double-blind, placebo-controlled trial (ISRCTN82927713, registered 2008 Apr 11), funded by Arthritis Research UK, MRC, Bupa Foundation and NIHR.. Osteoporosis is a major public health problem as a result of associated fragility fractures. Skeletal strength increases from birth to a peak in early adulthood. This peak predicts osteoporosis risk in later life. Vitamin D insufficiency in pregnancy is common (31% in a recent Southampton cohort) and predicts reduced bone mass in the offspring. In this study we aim to test whether offspring of mothers supplemented with vitamin D in pregnancy have higher bone mass at birth than those whose mothers were not supplemented.. Women have their vitamin D status assessed after ultrasound scanning in the twelfth week of pregnancy at 3 trial centres (Southampton, Sheffield, Oxford). Women with circulating 25(OH)-vitamin D levels 25-100 nmol/l are randomised in a double-blind design to either oral vitamin D supplement (1000 IU cholecalciferol/day, n = 477) or placebo at 14 weeks (n = 477). Questionnaire data include parity, sunlight exposure, dietary information, and cigarette and alcohol consumption. At 19 and 34 weeks maternal anthropometry is assessed and blood samples taken to measure 25(OH)-vitamin D, PTH and biochemistry. At delivery venous umbilical cord blood is collected, together with umbilical cord and placental tissue. The babies undergo DXA assessment of bone mass within the first 14 days after birth, with the primary outcome being whole body bone mineral content adjusted for gestational age and age. Children are then followed up with yearly assessment of health, diet, physical activity and anthropometric measures, with repeat assessment of bone mass by DXA at age 4 years.. As far as we are aware, this randomised trial is one of the first ever tests of the early life origins hypothesis in human participants and has the potential to inform public health policy regarding vitamin D supplementation in pregnancy. It will also provide a valuable resource in which to study the influence of maternal vitamin D status on other childhood outcomes such as glucose tolerance, blood pressure, cardiovascular function, IQ and immunology.

Topics: Absorptiometry, Photon; Administration, Oral; Age Factors; Biomarkers; Bone and Bones; Bone Density; Child, Preschool; Cholecalciferol; Dietary Supplements; Double-Blind Method; England; Female; Gestational Age; Humans; Infant; Infant, Newborn; Osteoporosis; Pregnancy; Pregnancy Complications; Research Design; Treatment Outcome; Vitamin D; Vitamin D Deficiency

Vitamin D insufficiency is a risk for both skeletal and nonskeletal health. However, some ambiguity remains about threshold serum 25(OH)D for vitamin D insufficiency. To determine the threshold serum 25(OH)D to maintain normal calcium availability without elevation in serum parathyroid hormone (PTH) among Japanese subjects with various calcium intakes, we conducted a multicenter prospective open-labeled study. We recruited 107 ambulatory subjects without disorders affecting vitamin D metabolism to whom oral vitamin D₃ 800 IU/day for 4 weeks or 1,200 IU/day for 8 weeks was given. Serum 25(OH)D, PTH, calcium, phosphate, and magnesium were measured before and after vitamin D₃ supplementation. Calcium intake was assessed by questionnaires. When all the data were combined, serum 25(OH)D was negatively correlated with PTH. The cubic spline curve between serum 25(OH)D and PTH indicated PTH reached its plateau between 35 and 40 pg/ml at 25(OH)D between 25 and 30 ng/ml. Vitamin D₃ supplementation increased serum 25(OH)D and decreased PTH. Change in PTH correlated positively with baseline serum 25(OH)D. From the regression analyses, baseline serum 25(OH)D above 28 ng/ml corresponded to the threshold level without reduction in PTH after vitamin D₃ supplementation. In multivariate regression analyses, age but not calcium intake was a significant determinant of PTH. We concluded that a serum 25(OH)D level of 28 ng/ml was identified as a threshold for vitamin D insufficiency necessary to stabilize PTH to optimal levels.

Topics: Adult; Aged; Aged, 80 and over; Cholecalciferol; Female; Humans; Male; Middle Aged; Osteoporosis; Parathyroid Hormone; Prospective Studies; Vitamin D; Vitamin D Deficiency

Exercise and calcium-vitamin D are independently recognized as important strategies to prevent osteoporosis, but their combined effects on bone strength and its determinants remain uncertain.. To assess whether calcium-vitamin D(3) fortified milk could enhance the effects of exercise on bone strength, structure, and mineral density in middle-aged and older men.. An 18-month factorial design randomized controlled trial in which 180 men aged 50-79 years were randomized to the following: exercise + fortified milk; exercise; fortified milk; or controls. Exercise consisted of progressive resistance training with weight-bearing impact activities performed 3 d/week. Men assigned to fortified milk consumed 400 ml/d of 1% fat milk containing 1000 mg/d calcium and 800 IU/d vitamin D(3).. Changes in bone mineral density (BMD), bone structure, and strength at the lumbar spine (LS), proximal femur, mid-femur, and mid-tibia measured by dual energy x-ray absorptiometry and/or quantitative computed tomography.. There were no exercise-by-fortified milk interactions at any skeletal site. Main effect analysis showed that exercise led to a 2.1% (95% confidence interval, 0.5-3.6) net gain in femoral neck section modulus, which was associated with an approximately 1.9% gain in areal BMD and cross-sectional area. Exercise also improved LS trabecular BMD [net gain 2.2% (95% confidence interval, 0.2-4.1)], but had no effect on mid-femur or mid-tibia BMD, structure, or strength. There were no main effects of the fortified milk at any skeletal site.. A community-based multi-component exercise program successfully improved LS and femoral neck BMD and strength in healthy older men, but providing additional calcium-vitamin D(3) to these replete men did not enhance the osteogenic response.

Topics: Aged; Bone and Bones; Bone Density; Calcium, Dietary; Cholecalciferol; Combined Modality Therapy; Compressive Strength; Drug Combinations; Drug Synergism; Exercise; Exercise Therapy; Humans; Male; Middle Aged; Osteoporosis; Research Design; Time Factors

Whether ergocalciferol (D(2)) and cholecalciferol (D(3)) are equally effective to increase and maintain serum 25-hydroxyvitamin D [25(OH)D] concentration is controversial.. The aim of the study was to evaluate the effect of daily and once monthly dosing of D(2) or D(3) on circulating 25(OH)D and serum and urinary calcium.. In a university clinical research setting, 64 community dwelling adults age 65+ were randomly assigned to receive daily (1,600 IU) or once-monthly (50,000 IU) D(2) or D(3) for 1 yr.. Serum 25(OH)D, serum calcium, and 24-h urinary calcium were measured at months 0, 1, 2, 3, 6, 9, and 12. Serum PTH, bone-specific alkaline phosphatase, and N-telopeptide were measured at months 0, 3, 6, and 12.. Serum 25(OH)D was less than 30 ng/ml in 40% of subjects at baseline; after 12 months of vitamin D dosing, levels in 19% of subjects (n = 12, seven receiving daily doses and five monthly doses) remained low, despite compliance of more than 91%. D(2) dosing increased 25(OH)D(2) but produced a decline (P < 0.0001) in 25(OH)D(3). Substantial between-individual variation in 25(OH)D response was observed for both D(2) and D(3). The highest 25(OH)D observed was 72.5 ng/ml. Vitamin D administration did not alter serum calcium, PTH, bone-specific alkaline phosphatase, N-telopeptide, or 24-h urine calcium.. Overall, D(3) is slightly, but significantly, more effective than D(2) to increase serum 25(OH)D. One year of D(2) or D(3) dosing (1,600 IU daily or 50,000 IU monthly) does not produce toxicity, and 25(OH)D levels of less than 30 ng/ml persist in approximately 20% of individuals. Substantial between-individual response to administered vitamin D(2) or D(3) is observed.

Topics: Aged; Aged, 80 and over; Bone Density Conservation Agents; Calcium; Cholecalciferol; Circadian Rhythm; Dosage Forms; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Ergocalciferols; Female; Humans; Male; Osteoporosis; Placebos; Vitamin D

Multiple sclerosis (MS) is a possible cause of secondary osteoporosis. In this phase II trial we assessed whether a weekly dose of 20,000 IU vitamin D(3) prevents bone loss in ambulatory persons with MS age 18-50 years. ClinicalTrials.gov ID NCT00785473. All patients managed at the University Hospital of North Norway who fulfilled the main inclusion criteria were invited to participate in this double-blinded trial. Participants were randomised to receive 20,000 IU vitamin D(3) or placebo once a week and 500 mg calcium daily for 96 weeks. The primary outcome was the effect of the intervention on percentage change in bone mineral density (BMD) at the hip, the spine, and the ultradistal radius over the study period. Of 71 participants randomised, 68 completed. Mean serum 25-hydroxyvitamin D [25(OH)D] levels in the intervention group increased from 55 nmol/L at baseline to 123 nmol/L at week 96. After 96 weeks, percentage change in BMD did not differ between groups at any site. BMD decreased at the hip, by 1.4% in the placebo group (95% CI -2.3 to -0.4, SD 2.7, p = 0.006) and by 0.7% in the treatment group (-1.6 to 0.2, 2.7, p = 0.118), difference 0.7% (-1.9 to 0.7, p = 0.332). Findings were not altered by adjustment for sex or serum 25(OH)D. Supplementation with 20,000 IU vitamin D(3) a week did not prevent bone loss in this small population. Larger studies are warranted to assess the effect of vitamin D on bone health in persons with MS.

Topics: Adult; Bone Density Conservation Agents; Cholecalciferol; Dietary Supplements; Double-Blind Method; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Osteoporosis; Placebos; Young Adult

We performed a randomized, double-blind, prospective, 16-week clinical trial to evaluate the efficacy and safety of risedronate with and without cholecalciferol on 25-hydroxyvitamin D [25(OH)D] levels and bone markers in Korean patients with osteoporosis.. We randomly assigned 164 adults with osteoporosis to one of two treatment groups: weekly risedronate 35 mg and cholecalciferol 5600 IU combined in a single pill (RSD+) or weekly risedronate 35 mg alone (RSD). We measured serum levels of 25(OH)D, parathyroid hormone (PTH), and bone markers and performed muscle function tests, at baseline and after 16 weeks of treatment.. After 16 weeks of treatment, mean serum 25(OH)D increased significantly from 39·8 to 70·8 nmol/l in the RSD+ group and declined significantly from 40·5 to 35 nmol/l in the RSD group. Although both treatment groups had significant increases in serum PTH over baseline during the study, the RSD group had a significantly larger increase than the RSD+ group (13·6 vs 4·8 ng/l; P = 0·0005). In both groups, serum bone-specific alkaline phosphatase (BSAP) and C-terminal telopeptide (CTX) declined rapidly; there were no significant differences between groups. There was also no significant difference between groups in lower-extremity function tests. The overall incidence of clinical adverse events was not significantly different between groups.. In patients with osteoporosis, a once-weekly pill of risedronate and cholecalciferol provided equivalent antiresorptive efficacy to risedronate alone in terms of bone turnover and improved 25(OH)D level over a 16-week treatment period without significant adverse events.

Topics: Aged; Alkaline Phosphatase; Asian People; Bone Density; Bone Density Conservation Agents; Cholecalciferol; Collagen Type I; Double-Blind Method; Drug Therapy, Combination; Etidronic Acid; Female; Gastrointestinal Diseases; Humans; Korea; Male; Middle Aged; Osteoporosis; Osteoporosis, Postmenopausal; Parathyroid Hormone; Peptides; Prospective Studies; Radioimmunoassay; Risedronic Acid; Treatment Outcome; Vitamin D

Epidemiological evidence supports a relationship between vitamin D and mental well-being, although evidence from large-scale placebo-controlled intervention trials is lacking.. To examine if vitamin D supplementation has a beneficial effect on mood in community-dwelling older women; if a single annual large dose of vitamin D has a role in the prevention of depressive symptoms; and if there is an association between serum 25-hydroxyvitamin D levels and mental health.. A double-blind, randomised, placebo-controlled trial of women aged 70 or older (the Vital D Study: ISRCTN83409867 and ACTR12605000658617). Participants were randomly assigned to receive 500 000 IU vitamin D(3) (cholecalciferol) orally or placebo every autumn/winter for 3-5 consecutive years. The tools utilised at various time points were the General Health Questionnaire, the 12-item Short Form Health Survey, the Patient Global Impression-Improvement scale and the WHO Well-Being Index. Serum 25-hydroxyvitamin D levels were measured in a subset of 102 participants.. In this non-clinical population, no significant differences between the vitamin D and placebo groups were detected in any of the measured outcomes of mental health. Serum 25-hydroxyvitamin D levels in the vitamin D group were 41% higher than the placebo group 12 months following their annual dose. Despite this difference, scores from the questionnaires did not differ. Furthermore, there was no interaction between those on antidepressant/anxiety medication at baseline and the treatment groups.. The lack of improvement in indices of mental well-being in the vitamin D group does not support the hypothesis that an annual high dose of vitamin D(3) is a practical intervention to prevent depressive symptoms in older community-dwelling women.

Topics: Aged; Aged, 80 and over; Anxiety; Cholecalciferol; Data Interpretation, Statistical; Depression; Double-Blind Method; Female; Fractures, Bone; Health Status; Humans; Intention to Treat Analysis; Mental Health; Middle Aged; Osteoporosis; Outcome Assessment, Health Care; Placebos; Risk Factors; Time Factors; Vitamin D; Vitamin D Deficiency; Vitamins

Osteoporosis commonly afflicts Crohn's disease (CD) patients. Management remains unclear, with limited results for intravenous (i.v.) bisphosphonates and a follow-up longer than one year. Intravenous bisphosphonates bypass gastrointestinal-tract irritation offering an interesting alternative suitable for CD patients. We tested the long-term efficacy and safety of colecalciferol and calcium with sodium-fluoride or i.v. ibandronate for osteoporosis in CD.. 66 CD patients with lumbar osteoporosis (T-score<-2.5) were randomized to receive colecalciferol (1000 IU), calcium-citrate (800 mg) and intermittent sustained-release sodium-fluoride (50 mg) [groupA, n=33] or i.v. ibandronate (1 mg/3-monthly) [groupB, n=33]. Dual-energy X-ray absorptiometry of the lumbar-spine and right femur and X-rays of the spine were performed at baseline and after 1.0, 2.25 and 3.5 years. Fracture-assessment included visual reading and quantitative morphometry of X-rays.. 55 (83.3%) patients completed at least the 1st year available for intention-to-treat (ITT) analysis, 42 (63.6%) completed the 2nd and 35 (53.0%) the 3rd year available for per-protocol analysis. Lumbar T-score increased by +0.23±0.43 (95%CI: 0.057-0.407, p<0.05), +0.71±1.05 (95%CI: 0.193-1.232, p<0.001) and +0.73±0.82 (95%CI: 0.340-1.336, p<0.001) (group A), and +0.28±0.41 (95%CI: 0.132-0.459, p<0.05), +0.43±0.55 (95%CI: 0.184-0.671, p<0.01) and +0.51±0.74 (95%CI: 0.145-0.882, p<0.001) (group B) during 1.0, 2.25 and 3.5 years follow-up time. In 2.71 years of follow-up, with the ITT analysis, the lumbar T-score increased by +0.66±0.97 (group A, p<0.001) and +0.46±0.67 (group B, p<0.001). One vertebral fracture with sodium-fluoride was not enough to detect differences between groups and the study was not powered for this. Study medication was well-tolerated and safe.. Sodium-fluoride and i.v. ibandronate improved osteoporosis. Keeping in mind bisphosphonates as a standard of osteoporosis care that reduce fracture-rate, data we do not have for sodium-fluoride, CD patients with osteoporosis can be treated safely with i.v. ibandronate.

Topics: Absorptiometry, Photon; Adult; Bone Density; Bone Density Conservation Agents; Calcium Citrate; Cholecalciferol; Crohn Disease; Delayed-Action Preparations; Diphosphonates; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Ibandronic Acid; Incidence; Injections, Intravenous; Male; Middle Aged; Osteoporosis; Prevalence; Sodium Fluoride; Spinal Fractures; Treatment Outcome; Young Adult

Due to the recent advances in the treatment of osteoporosis, clinicians can utilize many kinds of drugs to prevent fractures. Evidence of drug supplied to clinicians was mainly obtained from the results of the developmental studies. However, the evidence is still lack for the treatment in an individual patient in the"real world". This is a reason why we build up A-TOP (Adequate Treatment of Osteoporosis) research group and why we perform JOINT (Japanese Osteoporosis Intervention Trial) protocol to obtain the evidences, which are required by the clinicians. The two protocols were aimed to investigate whether concurrent treatment with bisphosphonates and active vitamin D3 (JOINT02) or vitamin K2 (JOINT03) is effective or not comparing to the mono-therapy. The former project was finished the 2-year observation and the latter project is currently underwent. The present paper introduces the aims, rationale, and organization of JOINT studies.

Topics: Cholecalciferol; Diphosphonates; Drug Therapy, Combination; Evidence-Based Medicine; Humans; Osteoporosis; Vitamin K 2

Our previous study indicated that soy protein with isoflavones lessened lumbar spine bone loss in midlife women.. We examined the efficacy of isoflavones (extracted from soy protein) on bone mineral density (BMD) in nonosteoporotic postmenopausal women. We hypothesized that isoflavone tablets would spare BMD, with biological (age, body weight, serum 25-hydroxyvitamin D) and lifestyle (physical activity, dietary intake) factors modulating BMD loss.. Our double-blind, randomized controlled trial (36 mo) included healthy postmenopausal women (aged 45.8-65.0 y) with intent-to-treat (n = 224) and compliant (n = 208) analyses. Treatment groups consisted of a placebo control group and 2 soy isoflavone groups (80 compared with 120 mg/d); women received 500 mg calcium and 600 IU vitamin D(3). Outcomes included lumbar spine, total proximal femur, femoral neck, and whole-body BMD.. Analysis of variance for intent-to-treat and compliant (> or =80%) models, respectively, showed no treatment effect for spine (P = 0.46, P = 0.21), femur (P = 0.86, P = 0.46), neck (P = 0.17, P = 0.14), or whole-body (P = 0.86, P = 0.78) BMD. From baseline to 36 mo, BMD declined regardless of treatment. In intent-to-treat and compliant models, respectively, BMD decreases were as follows: spine (-2.08%, -1.99%), femur (-1.43%, -1.38%), neck (-2.56%, -2.51%), and whole body (-1.66%, -1.62%). Regression analysis (compliant model) indicated that age, whole-body fat mass, and bone resorption were common predictors of BMD change. After adjustment for these factors, 120 mg (compared with placebo) was protective (P = 0.024) for neck BMD. We observed no treatment effect on adverse events, endometrial thickness, or bone markers.. Our results do not show a bone-sparing effect of extracted soy isoflavones, except for a modest effect at the femoral neck. This trial was registered at clinicaltrials.gov as NCT00043745.

Topics: Aged; Bone Density; Calcium; California; Cholecalciferol; Double-Blind Method; Female; Glycine max; Humans; Iowa; Isoflavones; Life Style; Middle Aged; Osteoporosis; Patient Selection; Postmenopause; Surveys and Questionnaires; Tablets

Preference for a drug formulation is important in adherence to long-term medication for chronic illnesses such as osteoporosis. We investigated the preference for and acceptability of chewable tablet containing calcium and vitamin D (Calci Chew D(3), Nycomed) compared to that of a sachet containing calcium and vitamin D(3) (Cad, Will-Pharma). This open, randomised, cross-over trial was set up to compare the preference and acceptability of two calcium plus vitamin D(3) formulations (both with 500 mg calcium and 400/440 IU vitamin D3), given twice a day in patients with osteoporosis. Preference and acceptability were assessed by means of questionnaires. Preference was determined by asking the question, which treatment the patient preferred, and acceptability was measured by scoring five variables, using rating scales. Of the 102 patients indicating a preference for a trial medication, 67% preferred the chewable tablet, 19% the sachet with calcium and vitamin D(3,) and 15% stated no preference. The significant preference for Calci Chew D(3) (p < 0.0001) was associated with higher scores for all five acceptability variables. The two formulations were tolerated equally well. A significant greater number of patients considered the chewable tablet as preferable and acceptable to the sachet, containing calcium and vitamin D(3).. Current Controlled Trials ISRCTN18822358.

Topics: Adult; Aged; Aged, 80 and over; Calcium; Cholecalciferol; Cross-Over Studies; Dietary Supplements; Female; Humans; Male; Middle Aged; Models, Statistical; Osteoporosis; Patient Preference; Surveys and Questionnaires

Given the high risk of subsequent fracture among elderly persons with fracture, it is important to initiate secondary treatment for osteoporosis. Acute rehabilitation centers may offer a unique opportunity to introduce treatment. Therefore, we evaluated willingness-to-participate and compliance with evidence-based interventions for the secondary prevention of osteoporotic fracture in a non-randomized study conducted in the acute rehabilitation setting. We also described differences in baseline characteristics between study participants and non-participants.. All consecutive, community dwelling admissions to an acute rehabilitation unit (Boston, MA) with the diagnosis of fracture were screened for enrollment. Eligible subjects were offered a free, 6-month supply of alendronate/cholecalciferol (70 mg/2800 IU weekly), calcium and vitamin D supplements, and fall prevention strategies. Six-month compliance (> or =75% consumption of medication or supplement) with the interventions was determined at a home visit.. Among 62 eligible subjects, 25 agreed to participate. Non-participants were older than participants (86 vs 80 yrs, p<0.01). There was no significant difference between other characteristics of participants and non-participants including sex, weight, type of fracture, cognitive status, and functional status. The most common reason for non-participation was reluctance to take another medication. Among participants, only 52% were compliant with alendronate and 58% were compliant with calcium and vitamin D supplementation at 6 months.. Willingness- to-participate and compliance with secondary prevention strategies for osteoporosis was low in the acute rehabilitation setting, even when medications were provided free of cost. Educating individuals with fracture and their families on the consequences and treatment of osteoporosis may help to decrease the risk of sustaining a second fracture by accepting secondary preventive measures.

Topics: Acute Disease; Aged; Aged, 80 and over; Alendronate; Bone Density Conservation Agents; Calcium; Cholecalciferol; Female; Fractures, Bone; Humans; Male; Medication Adherence; Osteoporosis; Patient Acceptance of Health Care; Refusal to Participate; Rehabilitation Centers; Vitamin D; Vitamins

Although vitamin D supplementation is a fundamental part of osteoporosis treatment, many patients do not regularly take adequate amounts. A once-weekly (OW) alendronate (ALN) preparation that includes 2800 IU of vitamin D3 in a single combination tablet (ALN+D2800) is available for treating patients and ensuring intake of vitamin D that is consistent with existing guidelines. This randomized, double-blind study extension was conducted to evaluate the safety and tolerability of ALN+D2800 and ALN+D2800 plus an additional 2800 IU vitamin D3 single tablet supplement (ALN+D5600) administered for 24 weeks in men and postmenopausal women with osteoporosis previously treated OW for 15 weeks with either ALN or ALN+D2800. The primary endpoint was the proportion of participants who developed hypercalciuria (defined as a 24-hour urine calcium >300 mg in women or >350 mg in men and an increase of >25% versus randomization baseline) at week 39. The key secondary endpoint was the proportion of participants with vitamin D insufficiency (serum 25(OH)D <15 ng/mL [37.4 nmol/L]) at the end of the study. Hypercalciuria incidence (4.2% [ALN+D5600] vs. 2.8% [ALN+D2800]), did not differ between groups (p = 0.354). No participants developed hypercalcemia. Among the participants with vitamin D insufficiency at the week 0 baseline, the prevalence of insufficiency at the end of the study was reduced by 92% in the ALN+D5600 group and by 86% in the ALN+D2800 group. The incidences of clinical adverse experiences, including drug-related adverse experiences, were similar in both groups. In subjects previously treated with ALN+D2800 for 15 weeks, the addition of 2800 IU D3 for 24 weeks did not produce hypercalcemia nor increase the risk of hypercalciuria.

Topics: Aged; Alendronate; Bone Density; Bone Density Conservation Agents; Cholecalciferol; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Hypercalciuria; Male; Osteoporosis; Postmenopause

In southern Europe, calcium supplementation alone is a common practice for osteoporosis prevention. The present study aimed to examine whether calcium supplementation alone could be as effective in achieving favourable changes on bone metabolism indices of Greek post-menopausal women as a holistic dietary approach combining consumption of dairy products fortified with calcium and vitamin D(3) and nutrition counselling sessions for five winter months.. A sample of 101 post-menopausal women was randomised to a dairy intervention group (IG: n = 39), receiving approximately 1200 mg of calcium and 7.5 microg of vitamin D(3) per day via fortified dairy products and attending biweekly nutrition counselling sessions; a calcium-supplemented group (SG: n = 26) receiving a total of 1200 mg calcium per day; and a control group (CG: n = 36).. Regarding insulin-like growth factor (IGF)-I, a higher increase was observed for the IG compared to the changes in the CG and the SG (P = 0.049). Regarding serum parathyroid hormone (PTH) levels, the increase observed in the CG was higher than the changes observed in the other two groups but the differences were of marginal significance (P = 0.055). No significant differences were observed among groups regarding the changes in serum osteocalcin and type I collagen cross-linked C-telopeptide levels.. The application of a holistic intervention approach combining nutrition counselling and consumption of fortified dairy products for five winter months induced some more favourable changes in IGF-I and PTH levels compared to calcium supplementation alone. Intervention periods longer than 5 months might be required to achieve significant differences among groups for bone remodelling biomarkers as well.

Topics: Aged; Biomarkers; Calcium; Cholecalciferol; Collagen Type I; Dairy Products; Dietary Supplements; Energy Intake; Female; Food, Fortified; Greece; Health Promotion; Humans; Insulin-Like Growth Factor I; Micronutrients; Middle Aged; Osteocalcin; Osteoporosis; Parathyroid Hormone; Peptides; Postmenopause; Vitamins

Topics: Aged; Aged, 80 and over; Aging; Calcium; Cholecalciferol; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Female; Fractures, Spontaneous; Glucose Intolerance; Humans; Male; Metabolic Syndrome; Osteoporosis; Placebos; Risk Factors; Vitamin D Deficiency; Vitamins

Hyperprolactinaemia is associated with the use of potent dopamine-2 receptor blocking anti-psychotic agents in schizophrenia and with bone loss in the general population. Significantly higher rates of reduced bone mineral density (BMD) have been identified in young pre-menopausal females with schizophrenia receiving prolactin-raising anti-psychotics compared to those receiving prolactin-sparing anti-psychotics. This prospective study compared BMD alterations over a period of 1 year in patients maintained on either prolactin-raising (e.g. risperidone, amisulpride or depot anti-psychotics) or prolactin-sparing (olanzapine) anti-psychotics. The effects of specific interventions to improve BMD were also examined in the context of whether patients were receiving either prolactin-raising or anti-psychotics or Olanzapine.. Pre-menopausal females (n=38) with a diagnosis of schizophrenia, who had received exclusively either prolactin-raising (n=25) or prolactin-sparing (n=13) anti-psychotics during their treatment history, had clinical, endocrine and bone marker assessments performed at baseline and every 3 months for a period of 1 year. BMD was measured by DEXA scan at baseline and at 1-year follow-up. Patients from both groups either received specific interventions (n=16) or no interventions (n=16) to improve bone density.. There was an overall gain in lumbar BMD values in the prolactin-sparing subgroup, compared to an overall loss in the prolactin-raising subgroup (p=0.02), for the groups that received no specific interventions to improve BMD. Within the group that received specific interventions, the subgroup receiving prolactin-sparing anti-psychotics had a significant increase in lumbar (p=0.01) and hip (p=0.01) BMD over time, whereas alterations in the prolactin-raising subgroup were not significant.. Women taking prolactin-raising anti-psychotics and not receiving specific interventions to improve bone density had evidence of ongoing bone demineralisation over a year; whereas women taking prolactin-sparing anti-psychotics had a modest overall increase in BMD. Most clinical interventions appeared to be helpful, but were significantly more effective in those taking prolactin-sparing anti-psychotics.

Topics: Absorptiometry, Photon; Adult; Antipsychotic Agents; Bone Density; Calcium, Dietary; Cholecalciferol; Combined Modality Therapy; Estradiol; Estrogen Replacement Therapy; Exercise; Female; Follow-Up Studies; Humans; Osteoporosis; Premenopause; Prolactin; Prospective Studies; Referral and Consultation; Schizophrenia

To compare the effect of calcium/vitamin D supplements with a combination of calcium/vitamin D supplements and exercise/protein on risk of falling and postural balance.. Randomized clinical trial.. University hospital physiotherapy department.. Twenty-four independently living elderly females aged 65 years and older with osteopenia or osteoporosis and mean total hip T-score (SD) of -1.8 (0.8).. A three-month programme consisting of exercise/protein including training of muscular strength, co-ordination, balance and endurance. Calcium/ vitamin D was supplemented in all participants for a 12-month period.. Assessment took place prior to and following the months 3, 6, 9 and at the end of the study; primary dependent variables assessed were risk of falling (Berg Balance Test) and postural balance (forceplate). Secondary measures included body composition, strength, activity level, number of falls, bone mineral content, biochemical indices, nutritional status and general health.. Significant reductions of risk of falling (repeated measures ANOVA F = 8.90, P = 0.008), an increase in muscular strength (ANOVA F = 3.0, P = 0.03), and an increase in activity level (ANOVA F = 3.38, P = 0.02) were found in the experimental group as compared to the control group. Further on, there was 89% reduction of falls reported in the experimental group (experimental pre/post 8/1 falls; control group pre/post 5/6 falls).. This study provides support for our intervention programme aimed at reducing the risk of falling in elderly participants diagnosed with osteopenia or osteoporosis. The data obtained from the pilot study allow the calculation of the actual sample size needed for a larger randomized trial.

Topics: Accidental Falls; Aged; Bone Density Conservation Agents; Calcium, Dietary; Cholecalciferol; Dietary Proteins; Exercise; Female; Humans; Muscle Strength; Osteoporosis; Physical Therapy Modalities; Pilot Projects; Proprioception; Prospective Studies

In this 2-year randomized controlled study of 167 men >50 years of age, supplementation with calcium-vitamin D3-fortified milk providing an additional 1000 mg of calcium and 800 IU of vitamin D3 per day was effective for suppressing PTH and stopping or slowing bone loss at several clinically important skeletal sites at risk for fracture.. Low dietary calcium and inadequate vitamin D stores have long been implicated in age-related bone loss and osteoporosis. The aim of this study was to assess the effects of calcium and vitamin D3 fortified milk on BMD in community living men >50 years of age.. This was a 2-year randomized controlled study in which 167 men (mean age +/- SD, 61.9 +/- 7.7 years) were assigned to receive either 400 ml/day of reduced fat ( approximately 1%) ultra-high temperature (UHT) milk containing 1000 mg of calcium plus 800 IU of vitamin D3 or to a control group receiving no additional milk. Primary endpoints were changes in BMD, serum 25(OH)D, and PTH.. One hundred forty-nine men completed the study. Baseline characteristics between the groups were not different; mean dietary calcium and serum 25(OH)D levels were 941 +/- 387 mg/day and 77 +/- 23 nM, respectively. After 2 years, the mean percent change in BMD was 0.9-1.6% less in the milk supplementation compared with control group at the femoral neck, total hip, and ultradistal radius (range, p < 0.08 to p < 0.001 after adjusting for covariates). There was a greater increase in lumbar spine BMD in the milk supplementation group after 12 and 18 months (0.8-1.0%, p < or = 0.05), but the between-group difference was not significant after 2 years (0.7%; 95% CI, -0.3, 1.7). Serum 25(OH)D increased and PTH decreased in the milk supplementation relative to control group after the first year (31% and -18%, respectively; both p < 0.001), and these differences remained after 2 years. Body weight remained unchanged in both groups at the completion of the study.. Supplementing the diet of men >50 years of age with reduced-fat calcium- and vitamin D3-enriched milk may represent a simple, nutritionally sound and cost-effective strategy to reduce age-related bone loss at several skeletal sites at risk for fracture in the elderly.

Topics: Aged; Animals; Bone Density; Calcium; Cholecalciferol; Food, Fortified; Hormones; Humans; Male; Middle Aged; Milk; Osteoporosis; Treatment Outcome

The long-term effects of calcium and vitamin D supplementation on bone material and structural properties in older men are not known. The aim of this study was to examine the effects of high calcium (1000 mg/day)- and vitamin-D(3) (800 IU/day)-fortified milk on cortical and trabecular volumetric BMD (vBMD) and bone geometry at the axial and appendicular skeleton in men aged over 50 years. One hundred and eleven men who were part of a larger 2-year randomized controlled trial had QCT scans of the mid-femur and lumbar spine (L(1)-L(3)) to assess vBMD, bone geometry and indices of bone strength [polar moment of inertia (I(polar))]. After 2 years, there were no significant differences between the milk supplementation and control group for the change in any mid-femur or L(1)-L(3) bone parameters for all men aged over 50 years. However, the mid-femur skeletal responses to the fortified milk varied according to age, with a split of 62 years being the most significant for discriminating the changes between the two groups. Subsequent analysis revealed that, in the older men (>62 years), the expansion in mid-femur medullary area was 2.8% (P < 0.01) less in the milk supplementation compared to control group, which helped to preserve cortical area in the milk supplementation group (between group difference 1.1%, P < 0.01). Similarly, for mid-femur cortical vBMD and I(polar), the net loss was 2.3 and 2.8% less in the milk supplementation compared to control group (P < 0.01 and <0.001, respectively). In conclusion, calcium-vitamin-D(3)-fortified milk may represent an effective strategy to maintain bone strength by preventing endocortical bone loss and slowing the loss in cortical vBMD in elderly men.

Topics: Aged; Aged, 80 and over; Animals; Body Height; Body Mass Index; Body Weight; Bone and Bones; Bone Density; Calcium; Cholecalciferol; Femur; Food, Fortified; Humans; Male; Middle Aged; Milk; Osteoporosis; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

Many osteoporosis patients have low 25-hydroxyvitamin D (25OHD) and do not take recommended vitamin D amounts. A single tablet containing both cholecalciferol (vitamin D3) and alendronate would improve vitamin D status concurrently, with a drug shown to reduce fracture risk. This study assessed the efficacy, safety, and tolerability of a once-weekly tablet containing alendronate 70 mg and cholecalciferol 70 microg (2800 IU) (ALN + D) versus alendronate 70 mg alone (ALN).. This 15-week, randomized, double-blind, multi-center, active-controlled study was conducted during a season when 25OHD levels are declining, and patients were required to avoid sunlight and vitamin D supplements for the duration of the study. Men (n = 35) and postmenopausal women (n = 682) with osteoporosis and 25OHD >or= 9 ng/mL were randomized to ALN + D (n = 360) or ALN (n = 357).. Serum 25OHD, parathyroid hormone, bone-specific alkaline phosphatase (BSAP), and urinary N-telopeptide collagen cross-links (NTX).. Serum 25OHD declined from 22.2 to 18.6 ng/mL with ALN (adjusted mean change = -3.4; 95% confidence interval [CI]: -4.0 to -2.8), and increased from 22.1 to 23.1 ng/mL with ALN + D (adjusted mean change = 1.2; 95% CI: 0.6 to 1.8). At 15 weeks, adjusted mean 25OHD was 26% higher (p < 0.001, ALN + D versus ALN), the adjusted relative risk (RR) of 25OHD < 15 ng/mL (primary endpoint) was reduced by 64% (incidence 11% vs. 32%; RR = 0.36; 95% CI: 0.27 to 0.48 [p < 0.001]), and the RR of 25OHD < 9 ng/mL (a secondary endpoint) was reduced by 91% (1% vs. 13%; RR = 0.09; 95% CI: 0.03 to 0.23 [p < 0.001]). Antiresorptive efficacy was unaltered, as measured by reduction in bone turnover (BSAP and NTX).. In osteoporosis patients who avoided sunlight and vitamin D supplements, this once-weekly tablet containing alendronate and cholecalciferol provided equivalent antiresorptive efficacy, reduced the risk of low serum 25OHD, improved vitamin D status over 15 weeks, and was not associated with hypercalcemia, hypercalciuria or other adverse findings, versus alendronate alone.

Topics: Aged; Alendronate; Bone and Bones; Cholecalciferol; Double-Blind Method; Drug Combinations; Female; Humans; Male; Middle Aged; Osteoporosis; Osteoporosis, Postmenopausal; Parathyroid Hormone; Postmenopause; Vitamin D

New and potent immunosuppressive regimens allow for reduced doses of corticosteroids after renal transplantation. The aims of our study were to investigate whether the use of low-dose corticosteroids is associated with a reduction in posttransplant bone loss and to assess the ability of cholecalciferol supplementation to further decrease bone loss in this setting.. Ninety patients admitted for renal transplantation and scheduled to be treated per protocol with low doses of prednisolone were randomized to receive either 400 mg daily oral calcium (Ca group, n=44) or the same dose of calcium in association with a monthly dose of 25,000 IU of vitamin D3 (CaVitD group, n=46). Bone mineral density (BMD) was measured by dual energy absorptiometry at baseline and at 1 year.. The overall population experienced a moderate but significant -2.3+/-0.9% loss of lumbar spine BMD (P<0.01) but no bone loss at the femoral neck and shaft during the first posttransplant year. Bone loss tended to be slightly higher in the CaVitD group, but the difference did not reach statistical significance. Patients in the CaVitD group had significantly higher 25(OH) but not 1,25(OH)2 vitamin D levels. We observed a highly significant negative correlation between 25(OH) vitamin D and intact parathyroid hormone (iPTH) serum levels.. Kidney-transplant recipients receiving modern immunosuppressive regimens with low doses of corticosteroids experience only minimal loss of BMD during the first posttransplant year. Cholecalciferol supplementation did not prevent posttransplant bone loss but contributed to the normalization of iPTH levels after renal transplantation.

Topics: Adult; Aged; Bone Density; Calcium; Cholecalciferol; Female; Graft Rejection; Humans; Kidney Transplantation; Male; Middle Aged; Osteoporosis; Parathyroid Hormone; Prednisolone; Prospective Studies; Risk Factors

We investigated whether treatment with calcium carbonate and vitamin D3 can improve the bone mineral content of patients with ileal reservoirs for continent urinary diversion and a reduced glomerular filtration rate (GFR).. Twenty-six patients with Kock reservoirs were included in the study. Bone mineralization was determined using dual-energy X-ray absorptiometry. Kidney function was estimated from Cr-EDTA clearance and serum cystatin C concentration. Osteocalcin and parathyroid hormone in serum were also measured. Patients with reduced GFR were treated with calcium carbonate and vitamin D3 perorally.. Bone mineral density in the femur neck and hip increased in the treatment group, as reflected by an improved T score.. Patients with ileal reservoirs for continent urinary diversion and reduced kidney function should be supplemented with calcium carbonate and vitamin D3 in order to reduce the long-term risk of osteoporosis.

Topics: Bone Density; Calcium; Cholecalciferol; Colonic Pouches; Cystatin C; Cystatins; Dietary Supplements; Female; Glomerular Filtration Rate; Humans; Male; Middle Aged; Osteoporosis; Urinary Reservoirs, Continent

Supplementation therapy with plain vitamin D plus calcium is in general regarded as effective prevention or first-step treatment of glucocorticoid-induced osteoporosis (GIOP). The aim of our study was to compare the therapeutic efficacy of the D-hormone analog alfacalcidol with plain vitamin D in patients with established GIOP with or without vertebral fractures. Patients on long-term glucocorticoid (GC) therapy were included as matched pairs to receive randomly either 1 microg alfacalcidol plus 500 mg calcium per day (group A, n=103) or 1000 IU vitamin D3 plus 500 mg calcium (group B, n=101). The two groups were well matched in terms of mean age, sex ratio, mean height and weight, daily dosage, and duration of GC therapy, and the percentages of the three underlying diseases included chronic obstructive pulmonary disease, rheumatoid arthritis, and polymyalgia rheumatica. The baseline mean bone mineral density (BMD) values at the lumbar spine for the two groups were -3.26 (alfacalcidol) and -3.25 (vitamin D(3)) and, at the femoral neck, -2.81 and -2.84, respectively (T scores). Rates of prevalent vertebral and nonvertebral fractures did not differ between groups. During the 3-year study, we observed a median percentage increase of BMD at the lumbar spine of 2.4% in group A and a loss of 0.8% in group B ( P<0.0001). There also was a larger median increase at the femoral neck in group A (1.2%) than in group B (0.8%) ( P<0.006). The 3-year rates of patients with at least one new vertebral fracture were 9.7% among those assigned to the alfacalcidol group and 24.8% in the vitamin D group (risk reduction 0.61, 95% CI 0.24-0.81, P=0.005). The 3-year rates of patients with at least one new nonvertebral fracture were 15% in the alfacalcidol group and 25% in the vitamin D group (risk reduction 0.41, 95% CI 0.06-0.68, P=0.081). The 3-year rates of patients with at least one new fracture of any kind were 19.4% among those treated with alfacalcidol and 40.65% with vitamin D (risk reduction 0.52, 95% CI 0.25-0.71, P=0.001). In accordance with the observed fracture rates, the alfacalcidol group showed a substantially larger decrease in back pain than the plain vitamin D group ( P<0.0001). Generally, side effects in both groups were mild, and only three patients in the alfacalcidol group and two in the vitamin D group had moderate hypercalcemia. We conclude that alfacalcidol plus calcium is highly superior to plain vitamin D3 plus calcium in the treatment of established G

Topics: Adjuvants, Immunologic; Aged; Calcium; Cholecalciferol; Female; Glucocorticoids; Humans; Hydroxycholecalciferols; Male; Metals, Alkaline Earth; Middle Aged; Osteoporosis; Spinal Fractures; Treatment Outcome; Vitamins

Bone metabolism follows a seasonal pattern with high bone turnover and bone loss during the winter. In a randomized, open-label 2-year sequential follow-up study of 55 healthy adults, we found that supplementation with oral vitamin D3 and calcium during winter abolished seasonal changes in calciotropic hormones and markers of bone turnover and led to an increase in BMD. Supplementation with oral vitamin D3 and calcium during the winter months seems to counteract the effects of seasonal changes in vitamin D and thus may be beneficial as a primary prevention strategy for age-related bone loss.. Bone metabolism follows a seasonal pattern characterized by high bone turnover and bone loss during winter. We investigated whether wintertime supplementation with oral vitamin D3 and calcium had beneficial effects on the circannual changes in bone turnover and bone mass.. This prospective study comprised an initial observation period of 12 months ("year 1"), followed by an intervention during parts of year 2. Fifty-five healthy subjects living in southwestern Germany (latitude, 49.5 degrees N) were randomized into two groups: 30 subjects were assigned to the treatment group and received oral cholecalciferol (500 IU/day) and calcium (500 mg/day) during the winter months of year 2 (October-April), while 25 subjects assigned to the control group obtained no supplements. Primary endpoints were changes in calciotropic hormones [serum 25(OH)D, 1,25(OH)2D, and parathyroid hormone], markers of bone formation (serum bone-specific alkaline phosphatase) and of bone resorption (urinary pyridinoline and deoxypyridinoline), and changes in lumbar spine and femoral neck BMD.. Forty-three subjects completed the study. During year 1, calciotropic hormones, markers of bone turnover, and BMD varied by season in both groups. During the winter months of year 1, bone turnover was significantly accelerated, and lumbar spine and femoral BMD declined by 0.3-0.9%. In year 2, seasonal changes in calciotropic hormones and markers of bone turnover were either reversed or abolished in the intervention group while unchanged in the control cohort. In the subjects receiving oral vitamin D3 and calcium, lumbar and femoral BMD increased significantly (lumbar spine: +0.8%, p = 0.04 versus year 1; femoral neck: +0.1%, p = 0.05 versus year 1), whereas controls continued to lose bone (intervention group versus control group: lumbar spine, p = 0.03; femoral neck, p = 0.05).. Supplementation with oral vitamin D3 and calcium during winter prevents seasonal changes in bone turnover and bone loss in healthy adults. It seems conceivable that annually recurring cycles of low vitamin D and mild secondary hyperparathyroidism during the winter months contributes, at least in part and over many years, to age-related bone loss. Supplementation with low-dose oral vitamin D3 and calcium during winter may be an efficient and inexpensive strategy for the primary prevention of bone loss in northern latitudes.

Topics: Absorptiometry, Photon; Adult; Aged; Alkaline Phosphatase; Amino Acids; Bone and Bones; Bone Density; Bone Resorption; Calcium; Cholecalciferol; Dietary Supplements; Female; Femur Neck; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteoporosis; Parathyroid Hormone; Prospective Studies; Seasons; Treatment Outcome; Vitamin D

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

Today, androgen deprivation therapy is a cornerstone of treatment for advanced prostate cancer, although it presents important complications such as osteoporosis. Neridronate, a relatively new bisphosphonate, is able to prevent bone loss in patients with prostate cancer during androgen ablation.. Androgen-deprivation therapy (ADT) is a cornerstone of treatment for advanced prostate cancer. This therapy has iatrogenic complications, such as osteoporosis. The aim of our study was to evaluate the efficacy of neridronate, a relatively new bisphosphonate, to prevent bone loss during androgen ablation.. Forty-eight osteoporotic patients with prostate cancer, treated with 3-month depot triptorelina, were enrolled and randomly assigned to two different treatment groups: group A (n = 24) was treated with a daily calcium and cholecalciferol supplement (500 mg of elemental calcium and 400 IU cholecalciferol), and group B (n = 24) received in addition to the same daily calcium and cholecalciferol supplement, 25 mg of neridronate given intramuscularly every month. All patients also received bicalutamide for 4 weeks. Lumbar and femoral BMD was evaluated by DXA at baseline and after 1 year of therapy; moreover, deoxypyridinoline (DPD) and bone alkaline phosphatase (BALP) were determined at the beginning, midway through, and at the end of the study.. After 6 and 12 months, whereas patients treated only with calcium and cholecalciferol (group A) showed a marked bone loss, with increased levels of DPD and BALP compared with baseline values, patients treated also with neridronate (group B) had substantially unchanged levels of these markers. After 1 year of treatment, lumbar and total hip BMD decreased significantly in patients treated only with calcium and cholecalciferol (group A), whereas it did not change significantly at any skeletal site in patients treated also with neridronate (group B). No relevant side effects were recorded during our study.. Neridronate is an effective treatment in preventing bone loss in the hip and lumbar spine in men receiving ADT for prostate cancer.

Topics: Absorptiometry, Photon; Aged; Alkaline Phosphatase; Amino Acids; Androgen Antagonists; Androgens; Antineoplastic Agents, Hormonal; Bone and Bones; Bone Density; Calcium; Cholecalciferol; Diphosphonates; Humans; Male; Osteoporosis; Prostatic Neoplasms; Time Factors; Triptorelin Pamoate

We have investigated the effects of GH treatment on bone turnover, bone size, bone mineral density (BMD), and bone mineral content (BMC) in 29 men, 27-62 yr old, with idiopathic osteoporosis. The patients were randomly assigned to treatment with GH, either as continuous treatment with daily injections of 0.4 mg GH/d (group A, n = 14) or as intermittent treatment with 0.8 mg GH/d for 14 d every 3 months (group B, n = 15). All patients were treated with GH for 24 months, with a follow-up period of 12 months, and also received 500 mg calcium and 400 U vitamin D3 daily during all 36 months. Fasting morning urine and serum samples were obtained for assay of IGF-I, bone markers, and routine laboratory tests at baseline, after 1, 12, 24, and 36 months. Body composition, BMD, and BMC were determined by dual-energy x-ray absorptiometry at baseline and every 6 months. After 2 yr, there was an increase in BMD in lumbar spine (by 4.1%) in group A, and in total body (by 2.6%) in group A and (by 2.7%) in group B. BMC of the total body and lean body mass increased, whereas fat mass decreased in both treatment groups. After 36 months, the BMD and BMC in lumbar spine and total body had increased further in both groups. We conclude that 2 yr of intermittent or continuous treatment with GH in men with idiopathic osteoporosis results in an increase in BMD and BMC that is sustained for at least 1 yr post treatment.

Topics: Absorptiometry, Photon; Adult; Biomarkers; Body Composition; Bone Density; Bone Remodeling; Calcitriol; Calcium; Cholecalciferol; Human Growth Hormone; Humans; Insulin-Like Growth Factor I; Male; Middle Aged; Osteocalcin; Osteoporosis

Oral bone and tooth loss are correlated with bone loss at nonoral sites. Calcium and vitamin D supplementation slow the rate of bone loss from various skeletal sites, but it is not known if intake of these nutrients affects oral bone and, in turn, tooth retention.. Tooth loss was examined in 145 healthy subjects aged 65 years and older who completed a 3-year, randomized, placebo-controlled trial of the effect of calcium and vitamin D supplementation on bone loss from the hip, as well as a 2-year follow-up study after discontinuation of study supplements. Teeth were counted at 18 months and 5 years. A comprehensive oral examination at 5 years included assessment of caries, oral hygiene, and periodontal disease. The odds ratio (OR) and 95% confidence interval (CI) of tooth loss were estimated by stepwise multivariate logistic regression. Initial age (mean +/- SD) of subjects was 71 +/- 5 years, and the number of teeth remaining was 22 +/- 7.. During the randomized trial, 11 of the 82 subjects (13%) taking supplements and 17 of the 63 subjects (27%) taking placebo lost one or more teeth (OR = 0.4; 95% CI: 0.2 to 0.9). During the 2-year follow-up period, 31 of the 77 subjects (40%) with total calcium intake of at least 1000 mg per day lost one or more teeth compared with 40 of the 68 subjects (59%) who consumed less (OR = 0.5; 95% CI: 0.2 to 0.9).. These findings suggest that intake levels of calcium and vitamin D aimed at preventing osteoporosis have a beneficial effect on tooth retention.

Topics: Aged; Bone Density; Calcium; Calcium, Dietary; Cholecalciferol; Citric Acid; Dietary Supplements; Double-Blind Method; Female; Femur Neck; Follow-Up Studies; Humans; Malates; Male; Odds Ratio; Oral Health; Oral Hygiene; Osteoporosis; Radiography; Tooth; Tooth Loss

Low bone density with an increased risk of vertebral fractures is a frequent complication in inflammatory bowel disease. Since the aetiology of osteopathia in these patients is different compared to postmenopausal or steroid-induced osteoporosis, no treatment strategy is established. Supplementation of calcium and vitamin D has been shown to prevent further bone loss, but no data are available showing the anabolic effect of sodium fluoride in Crohn's disease.. We carried out a one-year prospective clinical trial in 33 patients with chronic active Crohn's disease who were randomly assigned to receive either calcium (500 mg b.i.d.) and 1000 IU vitamin D3 only, or retarded-release sodium fluoride (25 mg t.i.d.) additionally. The diagnosis of Crohn's disease had been made at least two years ago, and all patients had received systemic high-dose steroid therapy during the previous year. Eleven of 15 patients who received calcium/vitamin D and 15 of 18 patients who additionally received sodium fluoride completed the study. The primary endpoint of the study was the increase of bone mineral density, measured by dual energy X-ray absorptiometry (DXA) after one year of treatment. Bone-specific alkaline phosphatase and osteocalcin were used as markers for bone turnover.. In the calcium/vitamin D only group, bone density was not significantly changed after one year of treatment, whereas in the calcium/vitamin D/fluoride group, bone density of the lumbar spine increased from -1.39+/-0.3 (Z-score, mean +/- SEM) to -0.65+/-0.3 (P<0.05) after one year of treatment. Increase of bone density was positively correlated to the osteoblastic markers bone-specific alkaline phosphatase (r = 0.53) and osteocalcin (r = 0.43).. Sodium fluoride in combination with vitamin D and calcium is an effective, well-tolerated and inexpensive treatment to increase lumbar bone density in patients with chronic active Crohn's disease and osteoporosis.

Topics: Adult; Bone Density; Calcium; Cholecalciferol; Crohn Disease; Drug Therapy, Combination; Female; Humans; Male; Osteoporosis; Prospective Studies; Sodium Fluoride

Vitamin D/calcium substitution is generally regarded as an effective first step treatment for glucocorticoid-induced osteoporosis (GIOP). The aim of our study was to evaluate the efficacy of the active vitamin D metabolite alfacalcidol (1alpha) compared with the native vitamin D(3) in patients with established GIOP with or without vertebral fractures. Patients on long-term corticoid therapy were given either 1 microg alfacalcidol plus 500 mg calcium per day (group A, n = 43) or 1000 IU vitamin D(3) plus 500 mg calcium (group B, n = 42). The two groups were alike in age range, sex ratio, percentages of underlying diseases, average initial bone density values (lumbar spine: mean T-score -3.28 and -3.25, respectively), and rates of vertebral and nonvertebral fractures. During the 3-year study we found a small but significant increase of lumbar spine density in group 1alpha (+2.0%, P < 0.0001) and no significant changes at the femoral neck. In the D(3) group, there were no significant changes at both sites. At the end of the study, 12 new vertebral fractures had occurred in 10 patients of the group 1alpha and 21 in 17 patients of the D(3) group. In accordance with the observed fracture rates, the alfacalcidol group showed a significant decrease in back pain (P < 0.0001) whereas no change was seen in the vitamin D group. We conclude that with the doses used in this trial, alfacalcidol is superior to vitamin D in the treatment of established GIOP.

Topics: Adult; Aged; Calcium; Cholecalciferol; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Hydroxycholecalciferols; Male; Middle Aged; Osteoporosis

To determine the effects of low dose methotrexate (MTX) on bone mineral density (BMD) of patients with rheumatoid arthritis (RA).. We examined the relationship between BMD and disease modifying antirheumatic drug (DMARD) use with data from a prospective, randomized, placebo controlled trial assessing the effects of calcium and vitamin D3 supplementation on BMD of patients with RA. Measurements of BMD of the lumbar spine and femoral neck were performed at baseline and at yearly followup visits over 3 years.. Information about DMARD use and BMD was available for 133 patients at baseline, and for 95 patients at Year 3. Lumbar spine and femoral neck BMD of MTX and non-MTX treated patients were similar at the start of the study. At the end of 3 years of followup, there was no significant differences in the change in BMD of the femoral neck and lumbar spine in MTX and non-MTX treated patients, in general. However, patients treated with prednisone > or = 5 mg/day plus MTX had greater loss of BMD in the lumbar spine than patients treated with a similar dose of prednisone without MTX (difference -8.08% over 3 years; p = 0.004).. At the end of 3 years, low dose MTX use was not associated with change in femoral neck or lumbar spine BMD in patients who were not treated with corticosteroids. However, among patients treated with prednisone > or = 5 mg/day, combined treatment with MTX and prednisone was associated with greater bone loss in the lumbar spine than treatment with prednisone without MTX.

Topics: Absorptiometry, Photon; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Antirheumatic Agents; Arthritis, Rheumatoid; Bone Density; Calcium; Cholecalciferol; Drug Therapy, Combination; Female; Femur Neck; Humans; Lumbar Vertebrae; Male; Methotrexate; Middle Aged; Osteoporosis; Prednisone; Prospective Studies

To determine whether long-term dietary supplementation with low doses of vitamin D helps to prevent bone loss and the development of osteoporosis or osteomalacia in out-patients with Crohn's disease.. A randomized controlled study.. The out-patient clinic of a tertiary centre (university hospital).. Seventy-five out-patients (31 men and 44 women, aged 16-77 years) with Crohn's disease.. All patients were randomly assigned to receive either an oral supplement of 1000 IU/day vitamin D for 1 year or no supplement. Bone mineral density, assessed in the distal part of the nondominant forearm using single photon absorptiometry, and serum levels of 25-hydroxyvitamin D, assessed using a competitive protein binding assay, were measured before and after the period of dietary supplementation.. Relative change of bone mineral density.. Serum levels of 25-hydroxyvitamin D increased in 57% of patients who received a supplement (compared with 37% of control patients). Bone mineral density decreased significantly in control patients [median -7%, interquartile range -12.6-(+0.4%)] but not in patients who received a supplement [median -0.2%, interquartile range -3.8-(+14%); P < 0.005]. Increases in bone mineral density were especially prevalent among patients who received the supplement and had normal serum levels of 25-hydroxyvitamin D (68%), whereas increases occurred in only 18% of patients with low serum levels of 25-hydroxyvitamin D (P = 0.008). Patients without an intestinal resection and receiving the vitamin D supplement had a marginally greater increase in bone mineral content than patients who had undergone a resection (P = 0.05).. Long-term oral vitamin D supplementation seems to be an efficient means of preventing bone loss in patients with Crohn's disease and could be recommended, especially for patients at high risk of osteoporosis.

Topics: Absorptiometry, Photon; Adult; Bone Density; Calcifediol; Cholecalciferol; Crohn Disease; Female; Humans; Male; Osteomalacia; Osteoporosis; Time Factors

The two main determinants of hip fractures are falls and bone loss leading to an intrinsic femoral fragility. Substantial femoral bone loss continues throughout old age, with a continuous and exponential increase in the risk of hip fracture; thus any reduction or arrest of this loss will induce an important reduction in the incidence of hip fracture. Preventive measures may be achieved during childhood by increasing peak bone mass with calcium and exercise, by using long-term estrogen replacement therapy after menopause, but also by using vitamin D and calcium supplements for late prevention in the elderly. Vitamin D insufficiency and a deficit in calcium intake are very common in the elderly living either in institutions or at home and the cumulative response to these deficits is a negative calcium balance which stimulates parathyroid hormone secretion. This senile secondary hyperparathyroidism is one of the determinants of femoral bone loss and can be reversed by calcium and vitamin D supplements. We have shown in a 3-year controlled prospective study that the daily use of supplements (1.2 g calcium and 800 IU vitamin D3) given in a large population of 3270 elderly ambulatory women living in nursing homes reduced the number of hip fractures by 23% (intention-to-treat analysis). In parallel, serum parathyroid hormone concentrations were reduced by 28% and low baseline serum 25-hydroxyvitamin D concentration returned to normal values. After 18 months of treatment the bone density of the total proximal femoral region had increased by 2.7% in the vitamin D3-calcium group and decreased by 4.6% in the placebo group (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Accidental Falls; Aged; Bone Density; Bone Resorption; Calcium Compounds; Cholecalciferol; Female; Hip Fractures; Humans; Hyperparathyroidism, Secondary; Osteoporosis; Prospective Studies; Risk Factors

A randomized double-blind controlled trial of a single oral dose of 2.5 mg (100,000 IU) cholecalciferol (vitamin D3) was conducted in the winter in 189 healthy free-living men and women aged 63-76 y. The mean baseline serum concentration for 25-hydroxyvitamin D was 34.5 nmol/L and for parathyroid hormone 3.18 pmol/L. After 5 wk, mean serum 25-hydroxyvitamin D concentrations were 60% higher in the treated than in the placebo group (P < 0.001). There was a 12% difference in parathyroid hormone concentrations in the treated compared with the placebo group (P < 0.001). No differences in serum calcium were seen. Findings suggest that 25-hydroxyvitamin D has a physiological role in the regulation of parathyroid secretion independent of serum calcium in healthy elderly people. Parathyroid concentrations rise and 25-hydroxyvitamin D concentrations decline with age. These results may have implications for the prevention of osteoporotic fractures that occur with increased frequency in winter and in elderly people.

Topics: Aged; Calcifediol; Cholecalciferol; Double-Blind Method; Female; Humans; Male; Middle Aged; Osteoporosis; Parathyroid Hormone; Seasons

To determine the rate of bone loss in normal men, and to examine the effects of dietary calcium and cholecalciferol supplementation on bone loss in men.. Double-blinded, placebo-controlled 3-year trial of supplementation with calcium (1000 mg/d) and cholecalciferol (25 micrograms/d).. Clinical research center at a university medical facility.. Normal men 30 to 87 years old, recruited from the Portland community.. Radial bone mineral content (assessed by single-photon absorptiometry) fell by 1.0%/y (95% CI, -1.3% to 0.7%) at a proximal radial site and 1.0%/y (95% CI, -1.4% to -0.6%) at a distal radial site. Vertebral bone mineral content (assessed by dual-energy quantitative computed tomography) declined by 2.3%/y (95% CI, -2.8% to -1.8%). In these healthy men with a high basal dietary calcium intake (1159 mg/d), calcium and cholecalciferol supplementation did not affect bone loss at any site.. Normal men experience a substantial bone loss at both axial and appendicular sites that is not prevented by calcium and vitamin D supplementation in a well-nourished population.

Topics: Adult; Aged; Aged, 80 and over; Aging; Bone Density; Calcium Carbonate; Cholecalciferol; Data Interpretation, Statistical; Double-Blind Method; Humans; Longitudinal Studies; Male; Middle Aged; Osteoporosis; Randomized Controlled Trials as Topic; Reference Values

The therapeutic effect of 1,25-dihydroxycholecalciferol (1,25(OH)2D3) in postmenopausal osteoporosis was tested in a single blind, randomized prospective study. Thirty-nine women, 50-65 years of age, were treated for three years with 0.5 microgram 1,25(OH)2D3 daily. In a control group, 37 women were given 400 IU vitamin D3 daily. There was no significant difference in annual bone loss from the distal or proximal forearm between the groups. New vertebral fractures were evaluated, and in the treatment group, the annual increase in vertebral fractures was 0.18 +/- 0.387 and in the control group 0.13 +/- 0.330. New long bone fractures were 7 and 5, respectively. None of the observed differences were statistically significant. In the 1,25(OH)2D3 group, 28% had to reduce the dose because of slight hypercalcaemia. We conclude that 1,25(OH)2D3 as used in this study is not effective in the treatment of osteoporosis.

Topics: Aged; Calcitriol; Cholecalciferol; Clinical Trials as Topic; Female; Fractures, Bone; Humans; Menopause; Middle Aged; Osteoporosis; Prospective Studies; Random Allocation; Time Factors

Topics: Aged; Back Pain; Calcium; Cholecalciferol; Clinical Trials as Topic; Female; Humans; Intestinal Absorption; Male; Middle Aged; Osteoporosis; Spinal Diseases

Topics: Adult; Benzothiadiazines; Calcium; Cholecalciferol; Clinical Trials as Topic; Diuretics; Double-Blind Method; Estrogens; Female; Fluorides; Humans; Menopause; Middle Aged; Osteoporosis; Sodium Chloride Symporter Inhibitors

Topics: Cholecalciferol; Clinical Trials as Topic; Drug Evaluation; Fluorides; Humans; Osteoporosis; Time Factors

The aim of this study was to investigate changes in systemic and local immune factors, namely, interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α, in patients with and without osteoporotic fractures and to explore the effects of active vitamin D3 treatment on immune function and fracture prognosis in patients with osteoporotic fractures.. The mRNA expression levels of IL-1β, IL-6 and TNF-α were measured before the operation. After the operation, the patients in the control group were treated with conventional fracture treatment and calcium supplementation, and the patients in the treatment group were treated with calcium plus active vitamin D3 in addition to conventional fracture treatment. The serum of each patient was collected on the seventh day after the operation.. The expression levels of the three immune factors (IL-1β, IL-6 and TNF-α) in the fracture end hematoma samples were significantly positively correlated with those in the serum samples (P < 0.05). The mean values of the serums of IL-1β, IL-6 and TNF-α in the osteoporosis group were significantly higher than those in the non-osteoporosis group (P < 0.05). The average number of hematomas in the osteoporosis group was significantly higher than that in the non-osteoporosis group (P < 0.05). The results for the active vitamin D3 treatment group were significantly lower than those for the control group (P < 0.05). The mean wrist function score of the active vitamin D3 treatment group was significantly better than that of the control group (P < 0.05). The average fracture healing time of the treatment group was significantly shorter than that of the control group (P < 0.05).. The relative expression of IL-1β, IL-6, and TNF-α in the fracture end hematoma samples was positively correlated with the corresponding levels of these immune factors in the serum samples. The levels of IL-1β, IL-6 and TNF-α in the serum and fracture end hematoma samples of the osteoporotic fracture patients were higher than those of the non-osteoporotic fracture patients. Active vitamin D3 treatment promoted fracture healing by affecting the levels of these immune factors.

Topics: Calcium; Cholecalciferol; Hematoma; Humans; Immunologic Factors; Interleukin-6; Osteoporosis; Osteoporotic Fractures; Tumor Necrosis Factor-alpha

Topics: Benign Paroxysmal Positional Vertigo; Calcifediol; Cholecalciferol; Female; Humans; Male; Osteoporosis; Vitamin D; Vitamin D Deficiency

To evaluate the relationship between the gut microbial composition and intestinal cholecalciferol absorption in patients with severe osteoporosis (SOP).. Eighteen patients with primary osteoporosis (OP) and 18 with SOP were included. Their clinical data were collected and their circulating concentrations of cholecalciferol and 25(OH)D. Differences in the intestinal microecology, especially Bifidobacterium, are associated with differences in the absorption of cholecalciferol and in the circulating 25(OH)D

Topics: Cholecalciferol; Feces; Gastrointestinal Microbiome; Humans; Intestinal Absorption; Osteoporosis

Intestinal absorption of vitamin D is an important way to improve the vitamin D level in senile osteoporosis (SOP). There is a link between oral probiotics and vitamin D, but the mechanism is still unclear. We aimed to evaluate whether Lactobacillus rhamnosus GG culture supernatant (LCS) can affect cholecalciferol absorption, transport, and hydroxylation in SOP, and explore underlying mechanisms. In the study, specific-pathogen-free SAMP6 mice were randomly divided into an experimental group administered undiluted LCS and a control group administered normal drinking water. Furthermore, levels of cholecalciferol absorption were compared between Caco-2 cells cultured with varying concentrations of cholecalciferol and stimulated with LCS or de Man, Rogosa, and Sharpe (MRS) broth (control). Similarly, LCS-stimulated HepG2 cells were compared with MRS-stimulated HepG2 cells. Finally, protein levels of VD transporters in small intestine tissues and Caco-2 cells, as well as vitamin D-binding protein and 25-hydroxylase in liver tissues and HepG2 cells, were detected by western blot. The results showed that plasma concentrations of cholecalciferol and 25OHD

Topics: Animals; Caco-2 Cells; Cholecalciferol; Humans; Intestinal Absorption; Lacticaseibacillus rhamnosus; Mice; Osteoporosis; Vitamin D; Vitamins

This study aimed to investigate the effect of ovariectomy and vitamin D3 on bone microstructure; this effect was examined in three regions of interest at one femoral and two mandibular sampling sites bone in an ovariectomized mouse model.. Thirty-six week-old female mice were randomly divided into three groups: 10 subjects were given oral cholecalciferol (vitamin D3) daily for 6 weeks after undergoing bilateral ovariectomy (D3 group), while 10 ovariectomized subjects (OVX) and 10 subjects who underwent a sham operation (SHAM) received peanut oil daily during the investigation. After extermination, the left hemimandible and femur were removed and scanned by micro-CT. The bone micromorphology parameters were analyzed and the BMD was calculated.. The bone volume fraction (BV/TV) was significantly lower in the trabecular bone of the mandibular condyle in the OVX group than in the SHAM and D3 groups. Also there was a significant difference between the SHAM and D3 groups. The specific bone surface (BS/BV) was significantly higher in the OVX and D3 groups than in the SHAM group. Trabecular thickness (Tb.Th) was significantly higher in the SHAM group, and the trabecular bone pattern factor (Tb.Pf) was significantly higher in the OVX group than in the other two groups. Bone mineral density (BMD) of the femur and the mandible was significantly lower in the OVX group than in the SHAM and D3 groups.. Our results show that ovariectomy causes a significantly weaker bone microstructure in the mandibular condyle, where the protective effect of vitamin D3 resulted in a partial resorption.

Topics: Animals; Bone Density; Cholecalciferol; Female; Humans; Mandibular Condyle; Mice; Osteoporosis; Ovariectomy; X-Ray Microtomography

Topics: Aged; Bayes Theorem; Cholecalciferol; Databases, Factual; Dietary Supplements; Female; Humans; Incidence; Male; Middle Aged; Network Meta-Analysis; Osteoporosis; Osteoporotic Fractures; Vitamin D

Topics: Anti-Inflammatory Agents, Non-Steroidal; Back Pain; Calcium-Regulating Hormones and Agents; Cholecalciferol; Humans; Hypercalciuria; Lumbar Vertebrae; Lumbosacral Region; Male; Mastocytosis, Systemic; Middle Aged; Neck Pain; Osteoporosis; Phenalenes; Treatment Outcome

Osteoporosis is the most common condition contributing to 95% of fractures in older patients hospitalized for fracture treatment. Despite the significant impact of fragility fractures on patient morbidity and mortality, efforts in optimizing osteoporotic treatment and prevention remain inadequate. In contrast, in patients with limited life expectancy, withholding specific osteoporosis drug treatment appears reasonable. The threshold between under- and overtreatment is still unclear.. In 2016, we implemented a fracture liaison service (FLS) for 18 months to improve the quality of osteoporosis care. We collected prospectively the patient's history, current treatment for osteoporosis, and risk factors for fragility fractures using a standardized protocol. Recommendations for drug therapy are discussed during the interdisciplinary ward round. The primary outcome parameter was a recommendation for specific osteoporosis drug treatment. We included 681 patients (mean age 82.5 years, 502 (73.7%) females). The inclusion criteria were the following: age of 70 years or older, admission to geriatric fracture center between April 2016 and December 2018.. Based on our data, specific osteoporosis drug therapy was recommended in 467 (68.6%) patients. Six hundred fifty-one (95.6%) patients received vitamin D3, and 546 (80.2%) calcium. After adjustment, only age (every 5 years, OR 0.57; 95% CI 0.45-0.72; p < 0.0001), cognitive impairment (OR 0.41; 95% CI 0.23-0.74; p = 0.003), pre-fracture mobility (OR 1.54; 95% CI 1.34-1.75; p < 0.0001), and living in a nursing home (OR 0.52; 95% CI 0.27-0.99; p = 0.049) remained as independent predictors for an indication of specific osteoporosis drug therapy.. We found a higher rate of recommendations for specific osteoporosis drug therapy compared with usual treatment rates in literature. Though in some cases withholding of specific osteoporosis drug therapy seems reasonable, the main proportion of fragility fracture patients is undertreated. Our results could be a benchmark for the quality of osteoporosis care in older fragility fracture patients treated in a geriatric fracture center.

Topics: Aged; Aged, 80 and over; Bone Density Conservation Agents; Calcium, Dietary; Cholecalciferol; Female; Geriatric Assessment; Health Services Misuse; Hip Fractures; Hospitalization; Humans; Male; Osteoporosis; Osteoporotic Fractures; Prospective Studies; Risk Factors; Secondary Prevention

Phosphatidylserine nanocochleates (Nanocochs) are novel delivery systems that may play a prominent osteoprotective role with their cargo, vitamin D3 (Vit-D3), against osteoporosis. Therefore, this study was conducted to characterize a Nanococh containing vitamin D3 (Nanococh-D3) and investigate its potential role in improving GIO in a rat model. Roll-shaped Nanococh-D3 particles were obtained in a size range of 320 nm with a sustained release performance. Oral Nanococh-D3 significantly increased the bioavailability of Vit-D3, enhanced bone mechanical strength, and improved osteogenic biomarkers including B-ALP, osteocalcin, Ca, and OPG in GIO rats. This formulation markedly suppressed gene expression of RANK and RANKL in treated rats. Histomorphometric analysis showed significant repairs in bone tissues and TRAP staining indicated a significant decrease in osteoclasts using Nanococh-D3 in osteoporotic rats. Nanococh alone similar to Nanococh-D3 acted better than AL as a standard anti-osteoporotic drug in the improvement of bone strength. In conclusion, our results established the potential role of Nanococh-D3 against osteoporosis in rats.

Topics: Animals; Cholecalciferol; Drug Combinations; Drug Delivery Systems; Gene Expression Regulation; Glucocorticoids; Humans; Osteocalcin; Osteoclasts; Osteogenesis; Osteoporosis; Osteoprotegerin; RANK Ligand; Rats

With intermittent vitamin D supplementation, serum 25-hydroxyvitamin D (25OHD) levels may remain stable only if the dosing interval is shorter than 3 months, the ideal perhaps being about 1 month. Recent data support moderate daily vitamin D doses instead of high intermittent doses, notably in elderly patients prone to falls. The level of evidence is low, however, with no head-to-head comparisons of clinical outcomes such as fractures and falls in groups given identical dosages daily versus intermittently. A challenge to daily vitamin D supplementation in France is the absence of a suitable pharmaceutical formulation. In addition, daily dosing carries a high risk of poor adherence. Until suitable vitamin D3 formulations such as tablets or soft capsules each containing 1000 or 1500 IU become available, we suggest intermittent supplementation according to 2011 GRIO guidelines. Among the available dosages, the lowest should be preferred, with the shortest possible interval, e.g., 50,000 IU monthly rather than 100,000 every two months.

Topics: Aged; Cholecalciferol; Dietary Supplements; France; Humans; Osteoporosis; Vitamin D; Vitamin D Deficiency

Senile osteoporosis (SOP) is a related disease of systematic degenerative changes in bones during natural aging. Increasing age is an important factor in its pathogenesis. This experiment was to evaluate the comprehensive effect of calcium with vitamin D3 (CaD) on SOP based on multilayer perception (MLP)-artificial neural network (ANN) methods. 15-month-old male Sprague-Dawley rats were administered CaD for 2 months, while 3-, 6-, 9-, 12-, 15- and 17-month-old rats were used as the mature or aging control groups. We detected the bone mass and bone mineral density (BMD), performed biomechanical testing and measured micro-CT properties to evaluate the degree of osteoporosis. Levels of alkaline phosphatase (ALP) and tartrate-resistant acid phosphatase (TRACP), and the ratio of ALP to TRACP both in serum and bone were measured for the evaluation of the bone turnover rate. The bone mRNA and protein expression of ATP6v0d2, IGF-1, BMP2, M-CSF, Wnt5a and TGF-β1 were detected by western blotting (WB), immunofluorescence (IF) and quantitative real time polymerase chain reaction (qRT-PCR) for evaluating bone metabolism in the bone microenvironment. The MLP-ANN model was constructed and used to evaluate the importance of related parameters and the comprehensive action of CaD. Our data showed that bone mass, BMD, maximal load, ultimate displacement, ALP and TRACP in serum and tibia, and the protein and mRNA expressions of ATP6v0d2, IGF-1, BMP2, M-CSF, Wnt5a and TGF-β1 in tibia reached a peak in 6 m rats, and then were gradually decreased with the increase of age to the lowest in 17 m rats. This study demonstrated the degeneration of the bone structure and bone metabolism in SOP rats during the aging process of rats aged 3 to 17 months. CaD could effectively increase bone mass and bone strength, alleviate the degradation of the bone microstructure and rebalance bone remodeling. In addition, the MLP model was a comprehensive method for evaluating the effects of drugs on SOP, which provided a new direction for future drug and nutrition evaluation.

Topics: Alkaline Phosphatase; Animals; Bone Density; Bone Morphogenetic Protein 2; Bone Remodeling; Calcium; Cholecalciferol; Drug Evaluation, Preclinical; Humans; Male; Osteoporosis; Rats; Tartrate-Resistant Acid Phosphatase; Tibia; Transforming Growth Factor beta1

Topics: Aged; Bone Density; China; Cholecalciferol; Cross-Sectional Studies; Female; Glomerular Filtration Rate; Humans; Male; Middle Aged; Multivariate Analysis; Osteoporosis; Prevalence; Regression Analysis; Socioeconomic Factors; Uric Acid

Topics: Bone Density Conservation Agents; Calcium Citrate; Cholecalciferol; Female; Fractures, Bone; Humans; Hypocalcemia; Ibandronic Acid; Middle Aged; Osteoporosis; Pubic Bone; Sacrum; Vitamin D Deficiency

Fragility hip fractures treated in a center in the Middle East were retrospectively studied for adequacy of osteoporosis management. Of the 318 patients treated, over 70% did not have a structured investigation and about 30% did not receive any therapeutic supplements. Our series showed a preventable 8.8% secondary fracture rate.. To study the adequacy of evaluation and treatment of osteoporosis after fragility fractures of the hip. The study also attempts to estimate the prevalence of secondary fractures after the original injury.. This is a retrospective evaluation of the electronic database to search all the admissions for fractures of the hip in patients over 50 years at a tertiary care Trauma and Orthopaedic center in the Sultanate of Oman. The study period was defined as October 2010 to December 2015. Their case records, BMD reports, and laboratory data were analyzed. Pharmacological interventions and the documented compliance with such therapy were also recorded.. Over the study period, 318 fragility fractures of the hip were treated. Of these, 233 (73.3%) did not receive a DEXA scan and 94% did not have their vitamin D. Less than 27% patients receive BMD test following fragility fracture of the hip and only 6% a vit D3 assay. Secondary fractures of the hip tend to occur in approximately 9% of the cases in Oman; this seems to occur equally in patients who have had as well as not had any calcium and vit D supplements after the index injury.

Topics: Absorptiometry, Photon; Aged; Aged, 80 and over; Calcium, Dietary; Cholecalciferol; Cohort Studies; Databases, Factual; Dietary Supplements; Female; Hip Fractures; Hospitalization; Humans; Male; Middle Aged; Osteoporosis; Osteoporotic Fractures; Prevalence; Racial Groups; Retrospective Studies; Secondary Prevention; Vitamin D

There is clinical uncertainty as to the testing of serum 25--Hydroxy vitamin D (25[OH]D) concentrations and when to use high-dose supplementation. Data show that there has been a rapid increase in the number of tests performed within the Northumbria Healthcare NHS Foundation Trust over the past 8 years and an increase in high-dose supplementation over the past 5 years. We performed a retrospective analysis of the 25(OH)D test requests over the period from January to -October 2017. A total of 17,405 tests were performed in this time period. The overall average concentration was 57.5 nmol/L and this figure was similar across age groups, although a larger proportion of patients aged over 75 had a concentration <25 nmol/L. Test requests were classified into 'appropriate', 'inappropriate' and 'uncertain' categories based on current expert opinion. We found that between 70.4% and 77.5% of tests could be inappropriate, depending on whether the 'uncertain' categories of falls and osteoporosis are considered to be justified. Tiredness, fatigue or exhaustion was the reason for testing in 22.4% of requests. We suggest that a more rational approach to testing, and subsequent treating, could lead to reductions in costs to the healthcare system and patients.

Topics: Accidental Falls; Adult; Aged; Alkaline Phosphatase; Cholecalciferol; Clinical Laboratory Techniques; Dietary Supplements; Female; Humans; Hypocalcemia; Hypophosphatemia; Male; Medical Overuse; Middle Aged; Osteoporosis; Retrospective Studies; State Medicine; United Kingdom; Vitamin D; Vitamin D Deficiency; Vitamins

Osteoporotic hip fractures are associated with increased morbidity, mortality, and secondary fractures. Although osteoporosis treatment can reduce future fracture risk, patients often do not receive it. We report results of a coordinator-less fracture liaison service in Israel addressing hip fracture patients. The primary endpoint was attending the Metabolic Clinic. Secondary endpoints included vitamin D measurement, calcium and vitamin D recommendations, initiation of osteoporosis treatment, and mortality 1-year post-fracture.. This prospective study included 219 hip fracture patients who were compared with historical controls. Data on hospitalized patients were collected before and after implementation of a structured protocol for hip fracture patients, led by a multidisciplinary team, without a coordinator.. The study included 219 and 218 patients ≥60 years old who were operated on in 2013 and 2012, respectively. Metabolic Clinic visits increased from 6.4 to 40.2% after the intervention ( P<.001). Among 14 patients who attended the Clinic in 2012, 85.7% began osteoporosis therapy; among 88 who attended in 2013, 45.5% were treated at the first visit. Vitamin D measurements and calcium and vitamin D supplementation increased postintervention (0.5-80.1%, P<.001; 30.8-84.7%, P<.001, respectively). Patients receiving osteoporosis medications had lower mortality rates than untreated patients (4.3% vs. 21.8%).. An Orthopedic-Metabolic team implemented by existing staff without a coordinator can improve osteoporosis care for hip fracture patients. Yet, gaps remain as only 40% had Metabolic Clinic follow-up postintervention, and of these, only half received specific treatment recommendations. Hospitals are encouraged to adopt secondary fracture prevention protocols and continuously improve them to close the gaps between current management and appropriate metabolic assessment and treatment.. CHS = Clalit Health Services; CI = confidence interval; FLS = fracture liaison service; HMO = health maintenance organization; OR = odds ratio.

Topics: Age Factors; Aged; Aged, 80 and over; Ambulatory Care; Arthroplasty, Replacement, Hip; Bone Density Conservation Agents; Calcium, Dietary; Cholecalciferol; Cognitive Dysfunction; Comorbidity; Cooperative Behavior; Dementia; Dietary Supplements; Disease Management; Endocrinology; Female; Fracture Fixation, Internal; Hip Fractures; Humans; Independent Living; Israel; Logistic Models; Male; Nursing Homes; Orthopedic Procedures; Orthopedics; Osteoporosis; Osteoporotic Fractures; Proportional Hazards Models; Risk Factors; Secondary Prevention; Sex Factors; Vitamin D

In Pakistani population the prevalence of Calcium and vitamin D deficiency is at alarming rate. Previous studies show that globally vertebral osteoporosis is most commonly recognized site causing deterioration to personal life satisfaction. It is very unfortunate that in Pakistan ample amount of research work has not been done in the area, consequently, information on rate of vertebral osteoporosis & fracture are rare in Pakistan. There is no reduction in T-score on supplementation with calcium and vitamin D3 administration. There is reduction in T-score on supplementation with calcium and vitamin D3 administration. The prime objective of the current work was to determine vertebral spine osteoporosis treatment efficacy in local population. This is an intervention experimental study with no control. The study population was selected from the local community; consisting of individuals with vertebral spine osteoporosis, further they were followed for up to 6 months. Data was analyzed by SPSS-22. Tabs Chewable: Calcium: 1250 mg, Cholecalciferol: 125 IU, BD/Day was advised. The mean T-score before and after treatment were recorded as; Mean ±S.D: 2.890 ±1.7217 and Mean ±S.D: -2.456±0.8064 respectively. The findings of the current work do not provide support for routine supplementation with calcium and vitamin D3 orally for osteoporosis.

Topics: Absorptiometry, Photon; Administration, Oral; Adult; Aged; Aged, 80 and over; Bone Density; Bone Density Conservation Agents; Calcium; Cholecalciferol; Drug Combinations; Female; Humans; Male; Middle Aged; Osteoporosis; Pakistan; Spine; Time Factors; Treatment Outcome; Young Adult

We identified significantly slower uptake, and consistently lower proportions of new oral bisphosphonate formulations dispensed in rural regions compared to urban regions of Ontario. Further research examining regional differences in outcomes may provide insight as to whether urban-rural differences in prescribing translate into health disparities between regions.. The aim of this study was to examine urban-rural differences in the uptake of new oral bisphosphonate formulations available on the Ontario drug formulary: alendronate + vitamin D3 (January 2007), monthly risedronate (June 2009), and risedronate delayed-release (February 2012).. We plotted the monthly proportion of new formulation claims of all claims with the same drug molecule, from their formulary listing date until March 2014. Results were stratified by major urban, nonmajor urban, and rural regions as defined by the Rurality Index of Ontario. We compared the rate of uptake over the first year of formulary availability using linear regression, and compared proportions dispensed between regions using chi-squared tests.. We identified a regional gradient in uptake for alendronate + vitamin D3 and monthly risedronate; major urban regions had the fastest uptake, followed by nonmajor urban regions, and rural regions had the slowest uptake. Rural regions also had the slowest uptake of risedronate delayed-release; however, uptake in major urban and nonmajor urban regions were similar. Rural regions dispensed the lowest proportions for all new formulations 1 year after formulary availability: alendronate + vitamin D3 (32% major urban, 23% nonmajor urban, 12% rural), monthly risedronate (26% major urban, 21% nonmajor urban, 16% rural), and risedronate delayed-release (21% major urban, 22 % nonmajor urban, 13% rural). This pattern persisted throughout our study.. We identified significantly slower uptake and lower proportions of new formulations dispensed in rural regions compared to urban regions. Further research examining regional differences in outcomes may demonstrate whether urban-rural differences in prescribing translate into health disparities between regions.

Topics: Administration, Oral; Aged; Alendronate; Bone Density Conservation Agents; Cholecalciferol; Diphosphonates; Female; Humans; Male; Ontario; Osteoporosis; Patient Acceptance of Health Care; Risedronic Acid; Rural Health; Urban Health

Anti-osteoporotic drugs directly control bone metabolism. Then, they are possibly involved in interactions between bone and many other tissues. It is not, however, clear how they influence several organs other than bone, or what clinical significance they have. Recently, accumulating evidence suggests that osteocalcin as a humoral factor from bone is actively involved in glucose metabolism. Since interaction between osteoporosis and diabetes mellitus is an emerging clinical issue, there are several clinical questions under vigorous investigations.

Topics: Animals; Bone Density; Bone Density Conservation Agents; Cholecalciferol; Diphosphonates; Humans; Osteoporosis; RANK Ligand

The measurement of 25-hydroxyvitamin D is of increasing importance in the management of patients with mineral disorders. However, there are a great variety of test results for 25-hyroxyvitamin D depending on the method used. In this report a new automated method provided by Roche diagnostics (Elecsys Vitamin D Total assay) and the previously marketed method are compared to a reference method (Immundiagnostik ELISA). Further, we tested the new Roche method for its ability to monitor vitamin D supplementation.. Serum aliquots of 80 consecutive patients were prepared and 25-hydroxyvitamin D was measured by two automated methods provided by Roche diagnostics and by ELISA (Immundiagnostik, Bensheim, Germany). Further, we collected samples from 80 osteoporosis patients on vitamin D supplementation (1000 IU daily) and measured serum 25-hydroxyvitamin D using the Roche Elecsys Vitamin D Total assay.. The new Roche Vitamin D Total assay showed better correlation with the ELISA (r = 0.73) than the old automated method (r = 0.41). The 25-hydroxyvitamin D values obtained with the old automated Roche method were much lower compared to the new method or the ELISA, resulting in overestimation of vitamin D deficiency. In this respect, the new Roche Vitamin D Total assay was in rather good agreement with the ELISA. Moreover, the application of the new Roche Vitamin D Total assay in the monitoring of vitamin D supplementation gave clinically useful results: 90% of the patients receiving 1000 IU of vitamin D3 daily had a 25-hydroxyvitamin D serum concentration of > 50 nmol/L, which is in the expected range. Moreover, the 25-hydroxyvitamin D concentrations were negatively correlated to PTH proving the plausibility of the results.. 25-hydroxyvitamin D measurements show a large variability. Results from previous studies obtained with the old Roche automated method should be used with caution. The new automated Roche Vitamin D Total assay exhibits a reasonable concordance with the ELISA and can be used for monitoring patients in clinical practice. However, because of the variability, the results for individual patients are of limited use and general population based screening for vitamin D deficiency cannot be advocated.

Topics: Aged; Bone Density Conservation Agents; Cholecalciferol; Enzyme-Linked Immunosorbent Assay; Female; Germany; Humans; Immunoassay; Male; Middle Aged; Osteoporosis; Vitamin D

The aim of this study was to evaluate the effects of fortification and nano-size reduction on calcium absorption and bioavailability of milk powder formula in sham, ovariectomized, and ovariectomized-osteoporosis rats as a menopause and menopause-osteoporosis model. Skim milk powder and skim milk powder fortified with calcium citrate and the suitable doses of inulin, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and vitamins D3, K1, and B6 were formulated based on the North American and Western European recommended dietary allowances. Optimization on cycle and pressure of high-pressure homogenizer was done to produce nano-fortified milk powder. In vivo study demonstrated that fortification and calcium citrate nano-fortified milk powder increased absorption and bioavailability of calcium, as well as bone stiffness and bone strength in sham, ovariectomized, and ovariectomized-osteoporosis rats. This study successfully developed an effective fortified milk powder for food application.

Topics: Animals; Biological Availability; Bone Density; Calcium Citrate; Cholecalciferol; Dietary Supplements; Female; Food, Fortified; Humans; Milk; Osteoporosis; Ovariectomy; Powders; Rats

Most of the elderly have vitamin D deficiency, which is defined as a serum level below 30 ng/mL.. To identify the characteristics of patients over 65 receiving vitamin D supplements by their primary care physician. A descriptive and transverse study was performed on patients over 65 years old admitted to Care Following at the La Croix Rouge in Nantes from September 2012 to February 2013. The criteria for vitamin D supplementation, the type (vitamin D2 or D3, continuous prescription or not, route of administration) and starting date of vitamin D supplementation were identified. Serum 25-hydroxyvitamin D (25OHD) was measured at admission.. Of 163 patients included, 44% received vitamin D supplements (n=71). The patient aged over 80 benefited more often from vitamin D supplementation (p=0.019), so did women (p=0.034), patients with fractures (p=0.05), patients with osteoporosis treatments (p<0.001) and those treated with long-term corticosteroids (p<0.001). Dark skinned patients received vitamin D supplementation less often than the others (p=0.046). The dosage of the vitamin D was normal for 28% of patients (n=46).. The prescription of vitamin D supplements to the elderly is still too scarce and should be encouraged, especially in non-bone indications.

Topics: Adrenal Cortex Hormones; Age Factors; Aged; Aged, 80 and over; Cholecalciferol; Dietary Supplements; Ergocalciferols; Female; France; Humans; Male; Osteoporosis; Primary Health Care; Sex Factors; Skin Pigmentation; Vitamin D; Vitamin D Deficiency; Vitamins

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

Active vitamin D3 is used for the treatment for osteoporosis in Japan. Recently, data have accumulated that collagen cross-link formation in bone affect bone strength. In fact, impaired enzymatic cross-linking, over-hydroxylation of crosslinks, and an increase in non-enzymatic crosslinking advanced glycation end products (AGEs) such as pentosidine, in bone collagen have been proposed as a major cause of bone fragility in osteoporosis. We reported that alfacalcidol and eldecalcitol improves bone material properties such as collagen cross-link formation, microarchitecture, and microcrack resulting in the increase of bone strength (Saito M, Bone 2010;46:1170-1179, Calcif Tissue Int 2011;88:314-324, Bone, 2015;73:8-15). In this review, we described how active vitamin D3 improve bone collagen cross-link formation and mineral qualities.

Topics: Animals; Bone and Bones; Bone Density; Bone Density Conservation Agents; Cholecalciferol; Collagen; Humans; Hydroxycholecalciferols; Osteoporosis

Discrepancies in bone healing between osteoporotic and non-osteoporotic bone remain uncertain. The focus of the current work is to evaluate potential healing discrepancies in a metaphyseal defect model in rat femora. Female Sprague-Dawley rats were either ovariectomized (OVX, n=14) and combined with a calcium-, phosphorus- and vitamin D3-, soy- and phytoestrogen-free diet or received SHAM operation with standard diet rat (SHAM, n=14). Three months post-ovariectomy, DEXA measurement showed a reduction of bone mineral density reflecting an osteoporotic bone status in OVX rats. Rats then underwent a 3 mm wedge-shaped osteotomy at the distal metaphyseal area of the left femur stabilized with a T-shaped mini-plate and allowed to heal for 6 weeks. Biomechanical competence by means of a non-destructive three-point bending test showed significant lower flexural rigidity in the OVX rats at 3 mm lever span compared to SHAM animals (p=0.048) but no differences at 10 mm lever span. Microcomputer tomography (μCT) showed bridging cortices and consolidation of the defect in both groups, however, no measurable differences were found in either total ossified tissue or vascular volume fraction. Furthermore, histology showed healing discrepancies that were characterized by cartilaginous remnant and more unmineralized tissue presence in the OVX rats compared to more mature consolidation appearance in the SHAM group. In summary, bone defect healing in metaphyseal bone slightly differs between osteoporotic and non-osteoporotic bone in the current 3 mm defect model in both 3mm lever span biomechanical testing and histology.

Topics: Animals; Bone Density; Calcium; Cholecalciferol; Disease Models, Animal; Ergocalciferols; Female; Femoral Fractures; Fracture Healing; Osteoporosis; Osteoporotic Fractures; Ovariectomy; Rats; Rats, Sprague-Dawley; Vitamin D Deficiency

Topics: Aged; Alendronate; Bone Density Conservation Agents; Calcitonin; Calcium; Cholecalciferol; Humans; Lumbosacral Region; Male; Osteoporosis; Osteoporotic Fractures

Nursing home residents have severe vitamin D deficiency and increased risk of falls and fractures. These individuals may need 125 μg of vitamin D3 to achieve desirable 25-hydroxyvitamin D [25(OH)D] concentrations to improve overall health. We evaluated health-related quality of life (HRQoL) in 45 nursing home residents (28 women and 17 men, aged 58-89 years) with 25(OH)D concentrations <50 nM who consumed daily one bun that had been fortified with 125 μg vitamin D3. The Romanian version of Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) was applied at baseline and after 12 months. Data were analyzed using repeated measures analyses of variance (ANOVA). After one year supplementation, serum 25(OH)D reached optimal status (>75 nM) and bone health has improved significantly. Nursing home residents who consumed daily bread fortified with 125 μg vitamin D3 reported significant (P=.02 for the effect of time) improvement in HRQoL (total score of QUALEFFO-41). The interaction time x treatment was also statistically significant on pain (P=.04), daily activities (P=.02), and locomotion (P=.04). To ensure the serum concentrations of 25(OH)D recommended by medical groups for bone- and general-health in the older nursing residents, the practical experience shows that much higher amounts of vitamin D3 are required. Fortification of bread and cereals is a feasible way to improve vitamin D nutrition.

Topics: Activities of Daily Living; Aged; Aged, 80 and over; Bone Density; Bread; Calcium, Dietary; Cholecalciferol; Female; Food, Fortified; Frail Elderly; Humans; Male; Middle Aged; Nursing Homes; Osteoporosis; Osteoporotic Fractures; Pain; Quality of Life; Surveys and Questionnaires; Vitamin D; Vitamin D Deficiency

Topics: Aged, 80 and over; Calcium; Cholecalciferol; Diagnosis, Differential; Diphosphonates; Female; Glomerular Filtration Rate; Humans; Hypercalcemia; Osteoporosis; Renal Insufficiency, Chronic

Although osteoporosis is a progressive bone disease leading to increased risk of fracture, it has rarely been investigated on a large scale in older people with intellectual disabilities (ID). In this study, 768 persons with ID (aged ≥ 50 years) were measured with quantitative ultrasound to determine the prevalence of low bone quality. The association of low bone quality with patient characteristics, mobility, physical activity, body mass index (BMI), prior fractures, anticonvulsant drug use, intake of calcium, and vitamin D3 levels was also investigated. The prevalence of low bone quality was 43.9%. Low bone quality was positively associated with female gender, age, more severe level of ID, mobility impairment, and anticonvulsant drug use, and negatively with BMI. In clinical practice, people with ID who are at risk for low bone quality should periodically be screened for osteoporosis and be given advice about nutritional supplements and appropriate lifestyle.

Topics: Aged; Aged, 80 and over; Anticonvulsants; Body Mass Index; Calcaneus; Calcium, Dietary; Cholecalciferol; Female; Humans; Intellectual Disability; Male; Middle Aged; Motor Activity; Netherlands; Osteoporosis; Overweight; Prevalence; Risk Factors; Ultrasonography

The National Osteoporosis Society (NOS) published its document, Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management, in 2013 as a practical clinical guideline on the management of vitamin D deficiency in adult patients with, or at risk of developing, bone disease. There has been no clear consensus in the UK on vitamin D deficiency its assessment and treatment, and clinical practice is inconsistent. This guideline is aimed at clinicians, including doctors, nurses and dieticians. It recommends the measurement of serum 25 (OH) vitamin D (25OHD) to estimate vitamin D status in the following clinical scenarios: bone diseases that may be improved with vitamin D treatment; bone diseases, prior to specific treatment where correcting vitamin D deficiency is appropriate; musculoskeletal symptoms that could be attributed to vitamin D deficiency. The guideline also states that routine vitamin D testing is unnecessary where vitamin D supplementation with an oral antiresorptive treatment is already planned and sets the following serum 25OHD thresholds: <30 nmol/l is deficient; 30-50 nmol/l may be inadequate in some people; >50 nmol/l is sufficient for almost the whole population. For treatment, oral vitamin D3 is recommended with fixed loading doses of oral vitamin D3 followed by regular maintenance therapy when rapid correction of vitamin D deficiency is required, although loading doses are not necessary where correction of deficiency is less urgent or when co-prescribing with an oral antiresorptive agent. For monitoring, serum calcium (adjusted for albumin) should be checked 1 month after completing a loading regimen, or after starting vitamin D supplementation, in case primary hyperparathyroidism has been unmasked. However, routine monitoring of serum 25OHD is generally unnecessary but may be appropriate in patients with symptomatic vitamin D deficiency or malabsorption and where poor compliance with medication is suspected. The guideline focuses on bone health as, although there are numerous putative effects of vitamin D on immunity modulation, cancer prevention and the risks of cardiovascular disease and multiple sclerosis, there remains considerable debate about the evaluation of extraskeletal factors and optimal vitamin D status in these circumstances.

Topics: Administration, Oral; Biomarkers; Bone Density Conservation Agents; Cholecalciferol; Dietary Supplements; Humans; Osteoporosis; Predictive Value of Tests; Recommended Dietary Allowances; Reproducibility of Results; Risk Factors; Treatment Outcome; 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

The objective is to present an update on the diagnosis and treatment of hypovitaminosis D, based on the most recent scientific evidence.. The Department of Bone and Mineral Metabolism of the Brazilian Society of Endocrinology and Metabology (SBEM) was invited to generate a document following the rules of the Brazilian Medical Association (AMB) Guidelines Program. Data search was performed using PubMed, Lilacs and SciELO and the evidence was classified in recommendation levels, according to the scientific strength and study type.. A scientific update regarding hypovitaminosis D was presented to serve as the basis for the diagnosis and treatment of this condition in Brazil.

Topics: Bariatric Surgery; Brazil; Calcifediol; Calcium, Dietary; Cholecalciferol; Databases, Bibliographic; Ergocalciferols; Evidence-Based Medicine; Humans; Hyperparathyroidism; Malabsorption Syndromes; Osteoporosis; Osteoporotic Fractures; Parathyroid Hormone; Risk Factors; Vitamin D Deficiency

Objectives To evaluate the serum 25-hydroxyvitamin D [25(OH)D] concentration in Brazilian osteoporotic patients and the modifiable factors of vitamin D status in this population. Subjects and methods In a cross-sectional study, 363 community-dwelling patients who sought specialized medical care were evaluated between autumn and spring in São Paulo, Brazil. Serum levels of 25(OH)D and parathormone (PTH), biochemical and anthropometric measurements, and bone density scans were obtained. The group was assessed using two questionnaires: one questionnaire covered lifestyle and dietary habits, skin phototype, sun exposure, medical conditions, and levels of vitamin D supplementation (cholecalciferol); the other questionnaire assessed health-related quality-of-life. Logistic regression and a decision tree were used to assess the association between the variables and the adequacy of vitamin D status. Results The mean age of the overall sample was 67.9 ± 8.6 years, and the mean 25(OH)D concentration was 24.8 ng/mL. The prevalence of inadequate vitamin D status was high (73.3%), although 81.5% of the subjects were receiving cholecalciferol (mean dose of 8,169 IU/week). 25(OH)D was positively correlated with femoral neck bone mineral density and negatively correlated with PTH. In the multivariate analysis, the dose of cholecalciferol, engagement in physical activity and the month of the year (September) were associated with improvement in vitamin D status. Conclusions In this osteoporotic population, vitamin D supplementation of 7,000 IU/week is not enough to reach the desired 25(OH)D concentration (≥ 30 ng/mL). Engagement in physical activity and the month of the year are modifiable factors of the vitamin D status in this population.

Topics: Aged; Aged, 80 and over; Ambulatory Care; Ambulatory Care Facilities; Bone Density Conservation Agents; Brazil; Calcium, Dietary; Cholecalciferol; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Motor Activity; Multivariate Analysis; Osteoporosis; Parathyroid Hormone; Public Sector; Seasons; Sunbathing; Surveys and Questionnaires; Vitamin D

People with intellectual disabilities have a high risk of osteoporosis and fractures, which could partly be as a result of vitamin D deficiency.. To compare the serum vitamin D (25(OH)D) levels of 155 patients with intellectual disabilities under psychiatric care and 192 controls, investigate potential risk factors for vitamin D deficiency in people with intellectual disabilities and assess available treatments.. Cross-sectional observational study followed by treatment evaluation. Results Almost twice as many patients with intellectual disabilities had vitamin D deficiency (25(OH)D <50 nmol/l) compared with controls (77.3% v. 39.6%, P<0.0001). In the intellectual disabilities group, winter season (P<0.0001), dark skin pigmentation (P<0.0001), impaired mobility (P = 0.002) and obesity (P = 0.001) were independently associated with lower serum 25(OH)D. In most patients, 800 IU colecalciferol daily normalised 25(OH)D levels.. Vitamin D deficiency is highly prevalent in people with intellectual disabilities, partly because of insufficient exposure to sunlight. Screening and treatment strategies, aiming to reduce these patients' high fracture risk, should be introduced. Similar strategies may be required in other psychiatric populations at risk for fractures and with a tendency to spend excessive time indoors.

Topics: Adult; Bone Density Conservation Agents; Cholecalciferol; Cross-Sectional Studies; Drug Administration Schedule; Female; Fractures, Bone; Humans; Intellectual Disability; Male; Middle Aged; Mobility Limitation; Obesity; Osteoporosis; Risk Factors; Sunlight; Treatment Outcome; Vitamin D; Vitamin D Deficiency

The expediency of Vitrum Calcium 600 + D400 and Risendros using in the complex treatment of the patients with a chronic pancreatitis and osteodeficiency syndrome has been proved. As a result the status of the bone mineralization is improved, the mineral density of the bone tissue is increased.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Density; Bone Density Conservation Agents; Calcification, Physiologic; Calcium Carbonate; Cholecalciferol; Etidronic Acid; Female; Humans; Male; Middle Aged; Osteoporosis; Pancreatitis, Chronic; Risedronic Acid

Osteoporosis is a widespread disease characterised by low bone mass and structural deterioration of bone resulting in an increased susceptibility to fractures. Osteoporosis affects women more frequently than men; every second woman older than 50 years suffers from an osteoporotic fracture, frequently a vertebral fracture. The aim of this study was to induce osteoporosis in rats to establish an osteoporotic small-animal model that simulates the human pathology particularly in the spine. Therefore, bone density parameters, which are routinely determined in the spine of osteoporotic patients, were investigated by Dual-Energy X-ray Absorptiometry (DEXA).. Fourteen-week-old female Sprague-Dawley rats (n = 50) were either sham-operated (control group: sham) or ovariectomised (experimental group). Ovariectomised rats were further divided into two groups; one received calcium/vitamin D2/D3 deficient diet (OVX + diet), and the other received subcutaneous steroid injections (dexamethasone 0.3 mg/kg body weight) twice a month (OVX + steroid). Rats were scanned by DEXA at three time points (Month = M, 0 M, 1 M and 3 M). DEXA measurement of the spine delivered T-value, Z-value, bone mineral content (BMC), and the scanned area. Fifteen female patients at an age of 57-72 years were scanned in 8-10 regions of the spine (150 measurements). T-values and Z-values were pre-calculated based on patient databases. Statistical analysis was performed using two-way ANOVA followed by Bonferroni correction, with significance considered at p < 0.05.. T-value and Z-value of both rat groups were compared with the patient data as well as with each others. Both treated rat groups revealed significantly lower T- and Z-values than controls. Despite the significant difference, the reference line (-2.5 for T-value and -1.5 for Z-value) was only reached by the OVX + diet group. On the other hand, the sham group showed an increase in BMC over time, while no change was seen in OVX + diet or OVX + steroid. Bone area demonstrated a significant increase up to M3. However, the increase in bone area within the OVX + diet group was notably higher than in both sham and OVX + steroid groups. Patients showed significantly lower T- and Z-values than sham and OVX + steroid but insignificant ones when compared with OVX + diet.. A reproducible vertebral osteoporosis can be generated in a rat model by combination of ovariectomy with administration of a calcium/vitamin D3 deficient diet. T- and Z-values of this experimental group mimicked values obtained from osteoporotic patients, reflecting a simulation of their pathology. Interestingly, the increase in bone area over time with the steady BMC results in lower mineral density (BMD) of the OVX + diet group. Therefore, this rat model presents a reliable experimental set-up that may serve as a tool to better understand and treat osteoporosis.

Topics: Animals; Calcium; Cholecalciferol; Disease Models, Animal; Ergocalciferols; Female; Osteoporosis; Ovariectomy; Radiography; Rats; Rats, Sprague-Dawley; Spinal Diseases

In an extension of our study on gamma hydroxy carboxylic acid analogs, we explored a series of nonsecosteroidal vitamin D receptor (VDR) agonists in which 1,3-diol of 1,25(OH)2D3 had been replaced by aryl acetic acid. These analogs showed very potent activity in vitro compared with 1,25(OH)2D3. An X-ray analysis of 8d showed that the inserted phenyl ring well mimicked the folded methylene linker of the gamma hydroxy carboxylic acid moiety but the carboxylic acid of 8d interacted with VDR in a different manner from gamma hydroxy carboxylic acids. Through our in vivo screening in an osteoporosis rat model using immature rats, we identified a potent active vitamin D3 analog, compound 7e. In mature rats of the same model, compound 7e also showed good PK profiling and excellent ability to prevent bone mineral density loss without severe hypercalcemia. Our nonsecosteroidal VDR agonist 7e (CH5036249) could be a possible new drug candidate for treating osteoporosis in human.

Topics: Animals; Benzhydryl Compounds; Bone Density; Cell Line; Cholecalciferol; Crystallography, X-Ray; Humans; Male; Models, Molecular; Molecular Docking Simulation; Osteocalcin; Osteoporosis; Pyridines; Rats; Rats, Sprague-Dawley; Receptors, Calcitriol

To evaluate the expression of Dickkopf-1 protein factor (DKK-1), DKK-2, and β-catenin, components of the Wnt pathway, in human osteoarthritic (OA) and osteoporotic (OP) osteoblasts and to correlate it to cell metabolic activity, proliferation, and receptor activator of nuclear factor-κB ligand/osteoprotegerin (RANKL/OPG) expression.. Primary human osteoblast cultures were obtained from healthy, OA, and OP donors. In each cell population we evaluated DKK-1, DKK-2, nonphosphorylated β-catenin and RANKL/OPG expression, osteocalcin and alkaline phosphatase (ALP) synthesis, and cell proliferation, both in basal condition and after vitamin D3 stimulation.. DKK-1 and DKK-2 showed opposite patterns of expression in OA and OP osteoblasts. The RANKL/OPG ratio was significantly higher in the OP group because of a greater expression of RANKL, whereas it was significantly lower in the OA group because of a higher expression of OPG. Treatment with vitamin D3 increased the RANKL/OPG ratio and DKK-2 expression and reduced DKK-1 expression in each cell population, but did not affect β-catenin levels. Both osteocalcin and ALP production and cell proliferation were enhanced in OA cells and reduced in the OP ones.. These data confirm that OA and OP are characterized by opposite bone changes, consisting of reduced bone remodeling processes with increased osteoblast activity in OA, and enhanced bone resorptive activity with reduction of osteoblast metabolism in OP, and suggest that the Wnt pathway is involved in the pathogenesis of both diseases.

Topics: Adult; Aged; Alkaline Phosphatase; Bone Resorption; Cell Proliferation; Cells, Cultured; Cholecalciferol; Female; Humans; Intercellular Signaling Peptides and Proteins; Male; Middle Aged; Osteoarthritis; Osteoblasts; Osteoporosis; Osteoprotegerin; RANK Ligand; Wnt Signaling Pathway

Vascular Endothelial Growth Factor (VEGF) is a potent angiogenic factor, which also regulates bone remodeling. Osteoblasts not only respond to VEGF stimulation, but also express and synthesize this factor. The present study was aimed to evaluate in vitro differences in VEGF production and expression of cultured human osteoblastic cells derived from healthy donors and from subjects affected by osteoarthritis and osteoporosis, under basal conditions than after vitamin D3, and to investigate the angiogenic activity of culture media obtained by these cells in chick embryo chorioallantoic membrane (CAM) assay. The results showed that normal and pathological osteoblasts produce and express VEGF and 1,25 dihydroxy-vitamin D3 treatment increases protein and m-RNA VEGF levels. In addition culture media of pathological osteoblasts induce a strong angiogenic response, greater than observed with culture medium of normal cells, suggesting the involvement of osteoblast-derived VEGF in the pathogenesis of bone diseases.

Topics: Adult; Aged; Animals; Bone Density Conservation Agents; Cells, Cultured; Chick Embryo; Cholecalciferol; Chorioallantoic Membrane; Culture Media; Female; Humans; Male; Middle Aged; Neovascularization, Physiologic; Osteoarthritis; Osteoblasts; Osteoporosis; Vascular Endothelial Growth Factor A; Vitamins

Recent studies have highlighted a significant association between the severity of atherosclerosis and bone mineral density (BMD) among healthy subjects, although its connection to angiographically determined peripheral artery disease (PAD) has never been investigated. We evaluated the connection between the angiographic severity and site specificity of peripheral atherosclerosis and osteoporosis among patients with chronic lower limb ischemia. In our cross-sectional study we investigated 172 patients with PAD. The anatomic sites of the lesions were analyzed. The severity of atherosclerosis was diagnosed using the Bollinger angiographic score (BS). BMD was measured at the lumbar spine (l-BMD) and at femoral (f-BMD) and radial (r-BMD) sites by dual-energy X-ray absorptiometry. Dyslipidemia, the level of vitamin D(3), and different bone turnover markers were also noted. Among PAD patients, regardless of the lesion site, we did not find any association between BMD and BS. Among patients with iliac disease, BS was associated with l-BMD (p = 0.038, r = -0.467) and with f-BMD (p = 0.002, r = -0.642). The level of r-BMD among patients with iliac disease was not associated with BS (p = 0.233, r = -0.306). We did not find any difference between the group of patients with and that without dyslipidemia and low or normal levels of vitamin D(3). Our results show a connection between the severity of atherosclerosis and osteoporosis among patients with PAD, specific to the site of the lesion. The findings regarding dyslipidemia, bone markers, and site specificity support the hypothesis that reduced blood flow is the key factor responsible for the inverse association of BMD with atherosclerosis.

Topics: Absorptiometry, Photon; Aged; Atherosclerosis; Bone Density; Cholecalciferol; Cross-Sectional Studies; Dyslipidemias; Female; Humans; Male; Middle Aged; Osteoporosis; Peripheral Arterial Disease

Bone health was assessed for inhabitants of an area affected by the Fukushima nuclear plant incident. Osteoporotic patients, who had been treated with active vitamin D3 and/or bisphosphonate at Soma Central Hospital before the Fukushima incident, were enrolled. Changes in bone turnover markers and bone mineral density were retrospectively analyzed. Serum levels of a bone resorption marker, serum type I collagen cross-linked N-telopeptide were decreased in all the treated groups, whereas those of a bone formation marker, bone-specific alkaline phosphatase, were increased. Accordingly, bone mineral density, estimated by dual-energy X-ray absorptiometry, was increased in the lumbar spine of all groups, but bone mass increase in the proximal femur was detected only in the group treated with the two agents in combination. From the degree of these parameter changes, the antiosteoporotic treatments looked effective and were equivalent to the expected potency of past observations. At this stage, the present study implies that the Fukushima nuclear incident did not bring an acute risk to bone health in the affected areas.

Topics: Alkaline Phosphatase; Biomarkers; Bone Density; Cholecalciferol; Collagen Type I; Femur; Fukushima Nuclear Accident; Humans; Lumbar Vertebrae; Osteoporosis; Peptides; Retrospective Studies

To evaluate vascular endothelial growth factor (VEGF) mRNA expression and protein synthesis in primary human osteoblast cultures from healthy, osteoporotic and osteoarthritic subjects. Normal primary human osteoblast cultures were obtained from healthy subjects undergoing surgery for the reduction in traumatic fractures. Pathological osteoblasts were obtained from patients undergoing to total hip replacement for osteoporotic hip fracture or advanced osteoarthritis. VEGF mRNA expression and protein synthesis were evaluated in cultured cells, by semiquantitative real-time PCR and ELISA, respectively, both under basal conditions than after vitamin D3 stimulation. Osteoarthritic osteoblasts showed a significantly higher VEGF expression compared to the normal and OP osteoblasts, both under basal conditions than in the presence of vitamin D3, whereas no difference was found between osteoporotic and normal osteoblast. Vitamin D3 significantly enhanced VEGF expression in normal and pathological osteoblasts. This preliminary study supports the hypothesis that VEGF is involved in the pathogenic mechanisms underlying the bone alterations typical of osteoarthritis and confirms the crucial role of vitamin D3 supplementation in metabolic bone diseases.

Topics: Adult; Aged; Cells, Cultured; Cholecalciferol; Enzyme-Linked Immunosorbent Assay; Gene Expression Profiling; Humans; Middle Aged; Osteoarthritis; Osteoblasts; Osteoporosis; Real-Time Polymerase Chain Reaction; Vascular Endothelial Growth Factor A

Several studies have shown that soy isoflavones have estrogen-like activities and might constitute an alternative to hormone replacement treatment. The present study investigated the effects of soy isoflavones alone and combined with vitamin D3 on prevention of bone loss.. Sprague-Dawley rats were sham-operated (n = 8) or ovariectomized (OVX; n = 40), and then the OVX rats were randomly assigned to five groups that were untreated or treated for 14 wk with vitamin D3, 17β-estradiol, soy isoflavone extract (SIE), or vitamin D3 plus SIE. The effects of the isoflavones and 1α,25(OH)(2)D(3) on cultured osteoblasts and osteoclasts also were investigated.. In OVX rats, the bone mineral density and trabecular bone volume loss were improved by 17β-estradiol, SIE, or SIE plus vitamin D3 treatment. SIE treatment was more effective than vitamin D3 or 17β-estradiol in inhibiting increases in serum tumor necrosis factor-α levels and osteoblast osteoprotegerin expression. SIE plus vitamin D3 was more effective in increasing osterix expression than each alone. Bone cell cultures showed that the isoflavones induced preosteoblasts to differentiate into osteoblasts and increased osteoblast mineralization. Isoflavones inhibited preosteoclasts and osteoclast proliferation and decreased osteoclast resorption. The combination of isoflavones plus 1α,25(OH)(2)D(3) showed additive effects on the increase in cell proliferation of cultured preosteoblasts.. Treatment with soy isoflavones might be an alternative to hormone replacement therapy in decreasing bone loss from postmenopausal estrogen deficiency. In addition, there are further effects on increasing transcription factor osterix expression and preosteoblast proliferation when these were combined with vitamin D3.

Topics: Alkaline Phosphatase; Animals; Bone Density; Cholecalciferol; Disease Models, Animal; Drug Synergism; Estradiol; Female; Glycine max; Humans; Interleukin-1beta; Isoflavones; Osteoblasts; Osteocalcin; Osteoclasts; Osteogenesis; Osteoporosis; Ovariectomy; Phytoestrogens; Rats; Rats, Sprague-Dawley; RNA, Messenger; Tumor Necrosis Factor-alpha

Topics: Animals; Bone Density Conservation Agents; Cathepsin K; Cholecalciferol; Diphosphonates; Estrogens; Female; Humans; Molecular Targeted Therapy; Osteoporosis; RANK Ligand; Selective Estrogen Receptor Modulators

There is no protocol of vitamin D supplementation used worldwide due to a great disparity of vitamin D supplements available in different countries. The aim of this study was to evaluate the efficiency of the protocol most often used in France to correct vitamin D deficiency defined by a serum 25-hydroxy vitamin D (25OHD) level of less than 30 ng/mL.. This was a pragmatic multicentric study of vitamin D supplementation in 257 osteopenic/osteoporotic, vitamin D deficient patients who received 100,000 UI vitamin D3 vials every two weeks according to their initial serum 25OHD level (four vials when 25OHD less than 10 ng/mL, three when 25OHD was 10-19 ng/mL, two when 25OHD was 20-29 ng/mL). Blood samples were obtained at baseline, one (M1), two (M2), and three months (M3), after the end of the supplementation protocol.. At M1, 198/257 (77%) patients had a serum 25OHD level more than 30 ng/mL. Eighty-five percent of those with a BMI less than 25 kg/m2 had a 25OHD concentration more than 30 ng/mL, whereas only 66% of those with a BMI more than 25 had a level more than 30 ng/mL. At M2 and M3, 25OHD levels decreased significantly with 55% and 46% having still a level more than 30 ng/mL respectively, without any significant difference according to the initial 25OHD level.. This protocol was effective in rising serum 25OHD of most vitamin D insufficient patients with a BMI less than 25 kg/m2, but not in overweight patients. As almost one half of our patients had a serum 25OHD level less than 30 ng/mL at M2, we suggest that regular doses should be started quite soon after this initial supplementation.

Topics: Administration, Oral; Aged; Cholecalciferol; Clinical Protocols; Dietary Supplements; Female; Humans; Male; Middle Aged; Osteoporosis; Overweight; Reference Values; Vitamin D; Vitamin D Deficiency; Vitamins

Pregnancy and lactation-associated osteoporosis (PLO) is very rare, but it can cause severe vertebral compression fractures with disabling back pain. PLO patients have commonly been treated with antiresorptive agents against high bone turnover. There are, however, some concerns regarding the use of bisphosphonates: (1) PLO occurs during the first pregnancy with a high possibility of recurrence during the second pregnancy, (2) long-term outcomes of bisphosphonates in PLO are lacking, and (3) there is a possibility of bisphosphonates accumulated in the bones crossing the placenta. Therefore, alternative therapies must be considered. We analyzed the effect of teriparatide (TPTD), the human recombinant parathyroid hormone (1-34), for 18 months in three women with PLO. Multiple vertebral fractures with severe back pain appeared within 6 months after their first childbirth. Two of them had a family history of osteoporosis. Lactation was discontinued immediately after diagnosis of PLO. Calcium carbonate, cholecalciferol, and TPTD were prescribed. The back pain immediately resolved. Bone mineral density (BMD) increased by 14.5-25.0% (mean 19.5%) at the lumbar spine and by 9.5-16.7% (mean 13.1%) at the femoral neck, after 18 months of treatment. The final Z scores in these PLO patients were nearly normalized. Two women had a second baby without any complication. BMD significantly improved after 18 months of treatment with TPTD without further fractures. In conclusion, TPTD should be considered to avoid long-term morbidity in young patients with PLO and is highly encouraged for use in PLO patients with multiple vertebral fractures.

Topics: Adult; Back Pain; Bone Density; Calcium Carbonate; Cholecalciferol; Diphosphonates; Female; Femur Neck; Fractures, Compression; Humans; Lactation; Osteoporosis; Parathyroid Hormone; Pregnancy; Pregnancy Complications; Spinal Fractures; Teriparatide

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 study aimed to investigate the effects of 1,25(OH)(2)D(3) on implant osseointegration in osteoporotic rats.. Twelve weeks after bilateral ovariectomy, each rat had 2 titanium screws implanted in the proximal tibiae. All animals were then randomly divided into 2 groups: control (10 rats) and 1,25(OH)(2)D(3) (10 rats). 1,25(OH)(2)D(3) was administered through oral gavage at 0.1 μg/kg/d, and control animals were given vehicle. Eight weeks later, tibiae with screws were harvested for μCT, histologic, and biomechanical analysis.. Compared with control, 1,25(OH)(2)D(3) increased percent bone volume by 96.0%, percent osseointegration by 94.4%, mean trabecular number by 112.5%, mean trabecular thickness by 51.8%, trabecular connective density by 38.0%, and decreased trabecular separation by 39.3% in μCT analysis. The 1,25(OH)(2)D(3) increased bone area density by 1.2-fold and bone-to-implant contact by 1.5-fold in histomorphometry, and increased the maximal push-out force by 2.0-fold in biomechanical test.. The 1,25(OH)(2)D(3) improves implant osseointegration in osteoporotic rats.

Topics: Animals; Bone Density; Cholecalciferol; Dental Implantation, Endosseous; Histological Techniques; Implants, Experimental; Osseointegration; Osteoporosis; Ovariectomy; Rats; Rats, Sprague-Dawley; Tibia; Titanium; X-Ray Microtomography

Topics: Calcitonin; Calcium; Cholecalciferol; Diphosphonates; Estrogens; Female; Humans; Osteoporosis; Parathyroid Hormone; Selective Estrogen Receptor Modulators; Vitamin K 2

Suboptimal vitamin D status is common in elderly individuals. However, the extent of vitamin D inadequacy in men and women being treated for osteoporosis in a family practice setting has not been well characterized.. To describe the distribution of serum 25-hydroxyvitamin D (25-[OH] D) in Canadian men and postmenopausal women with osteoporosis taking 400 IU or less of vitamin D daily and to evaluate the safety, tolerability, and impact of vitamin D(3) supplementation 400 IU daily taken concurrently with alendronate sodium 70 mg weekly.. This was a prospective, single-cohort, open-label, multicenter study. Community-dwelling men and postmenopausal women with osteoporosis were recruited at 197 sites across Canada. Patients received vitamin D(3) 400 IU/day supplementation coadministered with alendronate 70 mg/wk for 16 weeks. The primary outcome was the distribution of serum 25-(OH) D at baseline. Secondary outcome measures included changes from baseline in serum 25-(OH) D levels, adherence to study treatments, and incidence of treatment-related adverse events (AEs).. Of the 681 patients included in the analysis, 485 (71.2%) completed the study. Patients were predominantly female (83.1%) with a mean (SD) age of 67.6 (10.7) years. At baseline, mean (SD) serum 25-(OH) D concentration was 25.4 (9.9) ng/mL and 68.0% of the patients had inadequate (less than 30 ng/mL) vitamin D status. At week 16, concentrations increased by 35.1% to 31.2 (9.2) ng/mL (p < 0.001) and the proportion of patients with inadequate 25-(OH) D levels was reduced to 47.0%. Adherence to the treatment regimen was high (greater than 95%). Gastrointestinal disorders were the most frequently reported (6.9%) treatment-related AEs.. About two thirds of patients previously diagnosed with osteoporosis have inadequate vitamin D status. A treatment regimen consisting of alendronate 70 mg/wk administered with daily vitamin D(3) 400 IU supplementation significantly increased patients' serum 25-(OH) D levels, but 47% did not achieve optimal levels. These results support both the National Osteoporosis Foundation and Osteoporosis Canada recommendations for higher vitamin D supplement doses (at least 800 IU daily) in osteoporotic patients receiving pharmacologic therapy for osteoporosis and for monitoring their serum 25-(OH) D response.

Topics: Aged; Alendronate; Bone Density Conservation Agents; Canada; Cholecalciferol; Cohort Studies; Dietary Supplements; Female; Humans; Male; Osteoporosis; Osteoporosis, Postmenopausal; Prospective Studies; Treatment Outcome; Vitamin D

Vitamin D is important for bone metabolism and neuromuscular function. While a routine dosage is often proposed in osteoporotic patients, it is not so evident in rheumatology outpatients where it has been shown that the prevalence of hypovitaminosis D is high. The aim of the current study was to systematically evaluate the vitamin D status in our outpatient rheumatology population to define the severity of the problem according to rheumatologic diseases. During November 2009, all patients were offered a screening test for 25-OH vitamin D levels and categorised as deficient (<10 µg/l [ng/ml] [25 nmol/l]), insufficient (10 µg/l to 30 µg/l [25 to 75 nmol/l]) or normal (>30 µg/l [75 nmol/l]). A total of 272 patients were included. The mean 25-OH vitamin D level was 21 µg/l (range 1.5 to 45.9). A total of 20 patients had vitamin D deficiency, 215 patients had an insufficiency and 37 patients had normal results. In the group of patients with osteoporosis mean level of 25-OH vitamin D was 25 µg/l and 31% had normal results. In patients with inflammatory rheumatic diseases (N = 219), the mean level of 25-OH vitamin D was 20.5 µg/l, and only 12% had normal 25-OH vitamin D levels. In the small group of patients with degenerative disease (N = 33), the mean level of 25-OH vitamin D was 21.8 µg/l, and 21% had normal results. Insufficiency and deficiency were even seen in 38% of the patients who were taking supplements. These results confirm that hypovitaminosis D is highly prevalent in an outpatient population of rheumatology patients, affecting 86% of subjects. Despite oral supplementation (taken in 38% of our population), only a quarter of those on oral supplementation attained normal values of 25-OH vitamin D.

Topics: Adult; Aged; Aged, 80 and over; Cholecalciferol; Chronic Disease; Cross-Sectional Studies; Dietary Supplements; Female; Humans; Low Back Pain; Lupus Erythematosus, Systemic; Male; Middle Aged; Osteoporosis; Prevalence; Rheumatic Diseases; Switzerland; Vitamin D; Vitamin D Deficiency

Topics: Bone Density Conservation Agents; Calcium; Cholecalciferol; Cost Savings; Diphosphonates; Drug Costs; Germany; Humans; Osteoporosis; Osteoporotic Fractures

Novel vitamin D(3) analogs with carboxylic acid were explored, focusing on a nonsecosteroidal analog, LG190178, with a bisphenyl skeleton. From X-ray analysis of these analogs with vitamin D receptor (VDR), the carboxyl groups had very unique hydrogen bonding interactions in VDR and mimicked 1α-hydroxy group and/or 3β-hydroxy group of 1α,25-dihydroxyvitamin D(3). A highly potent analog, 6a, with good in vitro activity and pharmacokinetic profiles was identified from an SAR study. Compound 6a showed significant prevention of bone loss in a rat osteoporosis model by oral administration.

Topics: Animals; Bone Density; Bone Density Conservation Agents; Calcitriol; Calcium; Cell Line; Cholecalciferol; Drug Evaluation, Preclinical; Female; Humans; Mice; Osteocalcin; Osteoporosis; Rats; Rats, Sprague-Dawley; Receptors, Calcitriol; Steroids; Structure-Activity Relationship

To evaluate the effects of different doses of phytoestrogen (genitein) combined with calcium and vitamin D3 on preventing osteoporosis in ovariectomized (OVX) mice.. 63 female CD-1 mice, 29g average weight, were randomly divided into 7 groups. Including Sham group, OVX group and groups of treatment with calcium, vitamin D3 and genistein in high dose (GH, 67 mg/kg), genistein in moderate does (GM, 33.5 mg/kg), genistein in low dose(GL,16.75 mg/kg), pure genistein (G) and pure 17-betaestradiol (E2). After six weeks treatment, bone mineral density (BMD), bone mineral content (BMC), Biomechanical characteristics bone strength and bone biochemical markers were measured in all mice.. In the groups of GH, GM and GL, it was stimulative effect of genistein on elevating uterine weight in ovariectomized mice and the effect in GL group is lower. BMD, BMC, length and width of femora were significantly increased in GM group mice than those in OVX mice (P < 0.01), as well as BMD of femora in GL group mice were markedly increased (P < 0.01). Peak load and resilience of femora were the most conspicuously increased in GL group mice than those in others treatment group mice (P < 0.01). In GL group, bone alkaline phosphatase (BALP) increased and tartrate-resistant acid phosphatase (TRAP) decreased (P < 0.01).. It was lower stimulative effect of low dose of phytoestrogen (genitein) combined with calcium and vitamin D3 on elevating uterine weight in ovariectomized mice. Low dose of Phytoestrogen (genistein) combined with calcium and vitamin D3 might increase BMD, improve the mechanical strength of bone, promote bone fromation and inhibit bone resorption significantly. It might reduce the dose of genistein administrated and be safter than E2.

Topics: Animals; Bone Density; Calcium; Cholecalciferol; Drug Therapy, Combination; Female; Genistein; Mice; Mice, Inbred ICR; Osteoporosis; Ovariectomy; Phytoestrogens

Although it is known that neurofibromatosis 1 (NF1) patients suffer from vitamin D deficiency and display decreased bone mineral density (BMD), a systematic clinical and histomorphometrical analysis is absent. Our data demonstrate that NF1 patients display high bone turnover and accumulation of osteoid and that supplementation of vitamin D has a beneficial effect on their BMD.. Neurofibromatosis 1 results in a wide range of clinical manifestations, including decreased BMD. Although it has been reported that NF1 patients have decreased vitamin D serum levels, the manifestation of the disease at the bone tissue level has rarely been analyzed.. Thus, we performed a clinical evaluation of 14 NF1 patients in comparison to age- and sex-matched control individuals. The analysis included dual X-ray absorptiometry osteodensitometry, laboratory parameters, histomorphometric and quantitative backscattered electron imaging (qBEI) analyses of undecalcified bone biopsies.. NF1 patients display significantly lower 25-(OH)-cholecalciferol serum levels and decreased BMD compared to control individuals. Histomorphometric analysis did not only reveal a reduced trabecular bone volume in biopsies from NF1 patients, but also a significantly increased osteoid volume and increased numbers of osteoblasts and osteoclasts. Moreover, qBEI analysis revealed a significant decrease of the calcium content in biopsies from NF1 patients. To address the question whether a normalization of calcium homeostasis improves BMD in NF1 patients, we treated four patients with cholecalciferol for 1 year, which resulted in a significant increase of BMD.. Taken together, our data provide the first complete histomorphometric analysis from NF1 patients. Moreover, they suggest that low vitamin D levels significantly contribute to the skeletal defects associated with the disease.

Topics: Absorptiometry, Photon; Adult; Aged; Biopsy; Bone Density; Bone Density Conservation Agents; Bone Remodeling; Calcifediol; Calcium; Cholecalciferol; Female; Hip Joint; Humans; Ilium; Lumbar Vertebrae; Male; Middle Aged; Neurofibromatosis 1; Osteoporosis; Parathyroid Hormone; Phosphates; Vitamin D Deficiency; Young Adult

Vitamin D may act as an immune modulator in experimental and human organ transplantation, but these data are yet to be confirmed in human liver transplantation (LT).. This study aimed to assess the relationship between acute liver allograft cellular rejection (ACR) and pretransplant serum vitamin D concentration or post-transplant vitamin D supplementation.. We studied 133 LT recipients who underwent two per protocol allograft biopsies in the early post-operative period, plus on-demand biopsies as clinically indicated. ACR estimate was given according to the Banff scheme in biopsies obtained along two follow-up periods: (a) from the transplant operation to the end of the second month (0-2 months); (b) and from the third month to the end of the eighth month (3-8 months) post-LT.. The median pretransplant serum 25-hydroxyvitamin D concentration was 12.5 ng/ml; 40 patients had concentrations < or =12.5 ng/ml, of whom six had < or =5.0 ng/ml. Seventy-nine recipients received oral vitamin D(3) supplementation to treat post-transplant osteoporosis. In the 0-2 months period, moderate-to-severe rejection episodes were independently associated with cytomegalovirus reactivation (P<0.005) and progressively lower pretransplant serum 25-hydroxyvitamin D concentrations (P<0.02). Early vitamin D(3) supplementation was independently associated with a lack of ACR (P<0.05).. These results suggest that vitamin D may favour immune tolerance towards the liver allograft.

Topics: Acute Disease; Adult; Aged; Calcifediol; Calcitriol; Cholecalciferol; Female; Graft Rejection; Humans; Liver; Liver Transplantation; Male; Middle Aged; Osteoporosis; Vitamins; Young Adult

Osteoporosis is characterized by low bone mineral density (BMD), resulting in increasing susceptibility to bone fractures. In men, it has been related to some diseases and toxic habits, but in some instances the cause of the primary--or idiopathic--osteoporosis is not apparent. In a previous study, our group compared histomorphometric measurements in cortical and cancellous bones from male idiopathic osteoporosis (MIO) patients to those of control subjects and found reduced bone formation without major differences in bone resorption. To confirm these results, this study analyzed the etiology of this pathology, examining the osteoblast behavior in vitro. We compared two parameters of osteoblast activity in MIO patients and controls: osteoblastic proliferation and gene expression of COL1A1 and osteocalcin, in basal conditions and with vitamin D(3) added. All these experiments were performed from a first-passage osteoblastic culture, obtained from osteoblasts that had migrated from the transiliac explants to the plate. The results suggested that the MIO osteoblast has a slower proliferation rate and decreased expression of genes related to matrix formation, probably due to a lesser or slower response to some stimulus. We concluded that, contrary to female osteoporosis, in which loss of BMD is predominantly due to increased resorption, low BMD in MIO seems to be due to an osteoblastic defect.

Topics: Adult; Aged; Bone and Bones; Cell Proliferation; Cells, Cultured; Cholecalciferol; Collagen Type I; Collagen Type I, alpha 1 Chain; Down-Regulation; Extracellular Matrix; Gene Expression Regulation; Genetic Markers; Humans; Male; Middle Aged; Osteoblasts; Osteocalcin; Osteogenesis; Osteoporosis; RNA, Messenger; Sex Characteristics

Topics: Accidental Falls; Aged, 80 and over; Algorithms; Biomarkers; Black or African American; Blood Chemical Analysis; Bone and Bones; Cholecalciferol; Decision Making; Drug Monitoring; Ergocalciferols; Female; Fractures, Bone; Hip Fractures; Humans; Osteoporosis; Practice Guidelines as Topic; Vitamin D; Vitamin D Deficiency

Plant-derived estrogen-like compounds such as isoflavones (IF) especially daidzein and genistein are said to be preserving the bone in the osteoporotic conditions. However, it is not known whether a combination of IF and calcium (Ca) supplementation attenuates losses in bone mass and prevents the loss of vitamin D (VD). The present study addresses the role of phytoestrogens (PE) and Ca supplementation in low Ca and low VD diet induced osteoporosis (OSP). Cowpea (CP) which has high amount of the IF was selected to study its effect on diet induced osteoporotic conditions. Female weanling WNIN rats (total of 68) were divided into five groups and fed for five weeks on semisynthetic diet with low Ca (0.15%) and low VD (0.1IU/day/rat) in combination with low (10 mg/kg) or high (25 mg/kg) concentrations of PEs derived from CPIF. The study groups are: (I) normal Ca(0.47%) and normal VD (25IU/day/rat), (II) low Ca+low VD, (III) low Ca+low VD+low CPIF (10 mg/kg diet), (IV) low Ca+low VD+high CPIF (25 mg/kg diet) and (V) low Ca+low VD+17-(-estradiol (3.2 mg/kg diet). After the development of OSP the group II was subgrouped into: (SG I) continued on low Ca+VD, (SG II) low CPIF, (SG III) high CPIF, (SG IV) 17-beta-estradiol and (SG V) normal Ca and VD. Serum 25-VD levels were in the range of 14-38 ng/ml in groups I, III, IV and V, where as the values were very low in the group II (5.8 ng/ml). These were partially reversed upon supplementation of CPIF. The results correlated with altered Ca levels, body weight, bone mineral density and content and other related biochemical parameters. The paper further explains the possibility of protective and therapeutic role of VD in the presence of CPIF in osteoporotic health manifestations.

Topics: Animals; Bone Density; Calcium; Cholecalciferol; Dietary Supplements; Disease Models, Animal; Female; Genistein; Isoflavones; Osteoporosis; Phosphorus; Phytoestrogens; Plants; Rats; Vitamin D

Development and maintenance of skeletal health is essential since the resultant effect of poor bone health is an increased risk of osteoporotic fracture. Osteoporosis is currently a major public health problem and with predicted demographic changes, its future health and economic impact is likely to be phenomenal. Adult bone health is predominantly governed by two factors: (i) Maximum attainment of peak bone mass; and (ii) rate of bone loss which occurs with ageing. Both aspects are determined by a combination of endogenous and exogenous factors and, although genetic influences are believed to account for up to three-quarters of the variation in bone mass, there is still room for the modifiable factors (including nutrition) to play an important role. This article covers clinical evidences of the positive effect of vitamin K2 on osteoporosis. The activity of vitamin K2 involves both an increase in the bone-building process and decrease in the bone-loss process. Article covers effect of vitamin K2 on bone homeostasis and its safety in children, hepatic and renal impairment. Vitamin K2 should be considered for prevention and treatment in those conditions known to contribute to osteoporosis.

Topics: Adult; Bone Density Conservation Agents; Cholecalciferol; Drug Therapy, Combination; Fractures, Spontaneous; Humans; Osteocalcin; Osteoporosis; Vitamin K 2

Topics: Arthritis, Rheumatoid; Cholecalciferol; Diabetes Mellitus, Type 2; Humans; Osteoporosis; Respiratory Tract Infections; Vitamin D Deficiency

The two main sources of vitamin D3 are de novo synthesis induced by exposure to ultraviolet (UV) light from the sun, and diet. Vitamin D3 deficiency causes rickets or osteoporosis. Oak mushrooms (Lentinula edodes) that are exposed to UV radiation contain enhanced vitamin D2 and have much higher calcium content than unmodified (non-irradiated) mushrooms. Such modified edible mushrooms have been proposed as a natural alternative source of dietary vitamin D. In the current study, we have examined whether modified oak mushrooms could improve or prevent osteoporosis-like symptoms in mice fed with low calcium and vitamin D3-deficient diet. Four-week-old male mice were fed low calcium, vitamin D3-deficient diets supplemented with 5, 10, or 20% unmodified, calcium-enhanced, or calcium plus vitamin D2-enhanced oak mushrooms for 4 weeks. To assess the effects of the supplemented diets, we evaluated femur density and length, bone histology, the expression of active calcium transport genes, and serum calcium levels. Mice fed with low calcium and vitamin D3-deficient diet developed osteoporosis-like symptoms within 4 weeks. Femur density and tibia thickness were significantly higher in mice fed calcium plus vitamin D2-enhanced mushrooms, and the expression of duodenal and renal calcium transport genes was significantly induced. These results indicate that in mice, vitamin D2 and/or calcium derived from irradiated oak mushrooms may improve bone mineralization through a direct effect on the bone, and by inducing the expression of calcium-absorbing genes in the duodenum and kidney.

Topics: Animals; Biological Transport, Active; Calcium; Calcium, Dietary; Cholecalciferol; Diet; Duodenum; Ergocalciferols; Gene Expression; Kidney; Male; Mice; Mice, Inbred ICR; Osteoporosis; Polymerase Chain Reaction; Shiitake Mushrooms; Ultraviolet Rays

Topics: Calcium; Cholecalciferol; Ergocalciferols; Humans; Osteoporosis; Overweight; Parathyroid Hormone

This study intended to determine whether the replacement of vitamin D3 with alfacalcidol results in any bone mineral density (BMD) increase in 76 patients unresponsive to the combination of alendronate and conventional vitamin D3 treatment. In these patients the conventional vitamin D3 had been replaced with alfacalcidol (0.5 μg/day), and then the patients were followed up for a year. After treatment for 1 year, Wilcoxon test revealed a small but statistically significant (P < 0.001) increase in the BMD values of the forearm and lumbar vertebrae, in the serum calcium and urinary calcium/creatinine ratio in first-voided morning urine. However, the serum alkaline phosphatase activity, phosphorus, parathormone, osteocalcin levels and the urinary d-pyr/creatinine ratio decreased significantly (P < 0.001). As suggested by our results, combination therapy with alendronate and alfacalcidol increases bone density and improves the biochemical markers of bone turnover, without any substantial increase in the incidence of adverse effects.

Topics: Absorptiometry, Photon; Aged; Alendronate; Biomarkers; Bone Density; Bone Density Conservation Agents; Bone Remodeling; Cholecalciferol; Diphosphonates; Drug Resistance; Drug Therapy, Combination; Female; Follow-Up Studies; Fractures, Bone; Humans; Hungary; Hydroxycholecalciferols; Male; Middle Aged; Osteoporosis; Time Factors; Treatment Outcome

A 28-year-old woman was referred to hospital with a spontaneous femoral neck fracture. Dual energy X-ray absorptiometry showed severe osteoporosis without apparent cause or risk factors. The basic endocrinologic evaluation revealed hypercortisolism, and the diagnosis of Cushing's disease could be made following biochemical test and magnetic resonance imaging. A transsphenoidal resection of the pituitary gland tumor was performed and led to a cure of the disease. The patient received calcium and vitamin D substitution as well as biphosphonates.. Glucocorticoid-induced osteoporosis is the most frequent cause of secondary osteoporosis. Only few cases with occult endogenous Cushing's syndrome and osteoporosis as the main manifestation of the disease have been reported. Nevertheless, hypercortisolism should be excluded whenever osteoporosis without apparent cause is diagnosed.

Topics: ACTH-Secreting Pituitary Adenoma; Adult; Bone Density Conservation Agents; Calcium; Cholecalciferol; Combined Modality Therapy; Cushing Syndrome; Diagnosis, Differential; Female; Femoral Neck Fractures; Fractures, Spontaneous; Humans; Hypophysectomy; Magnetic Resonance Imaging; Osteoporosis; Pituitary ACTH Hypersecretion; Pituitary Function Tests; Pituitary Neoplasms

Topics: Aged; Awareness; Cholecalciferol; Humans; Incidence; Male; Middle Aged; Obesity; Osteoporosis; United States; Vitamin D Deficiency

Topics: Age Factors; Aged; Bone Density Conservation Agents; Calcium, Dietary; Cholecalciferol; Diphosphonates; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Folic Acid; Humans; Male; Middle Aged; Nutritional Requirements; Osteoporosis; Practice Guidelines as Topic; Risk Factors; Vitamin B 12

The 14-epimer of MART-10, namely 14-epi-MART-10 (14-epi-2alpha-(3-hydroxypropyl)-1alpha,25-dihydroxy-19-norvitamin D3) and its 2-epimeric analog (14-epi-MART-11) were efficiently synthesized using the Julia coupling reaction to connect between the C5 and C6 positions (steroid numbering). An A-ring precursor was prepared from (-)-quinic acid as shown in the previous MART-10 synthesis. The novel 14-epi-CD-ring coupling partner with an elongated two carbon unit as a sulfone was synthesized from 14-epi-25-hydroxy Grundmann's ketone in good yield. The subsequent coupling reaction followed by a deprotection step afforded a mixture of 14-epi-MART-10 and 14-epi-MART-11 in 40% yield. To separate 14-epi-MART-10 and 14-epi-MART-11, each primary hydroxyl group was esterified with a pivaloyl group and the resulting pivalates 2alpha and 2beta were separated by high performance liquid chromatography. After the separation, the C2-stereochemistry of each (2alpha or 2beta) was determined by 1H NMR (nuclear magnetic resonance) studies including NOE (nuclear Overhauser effect) experiments. The pivaloyl group was removed under basic conditions to obtain the target molecules of 14-epi-MART-10 and 14-epi-MART-11, respectively. The VDR (vitamin D receptor)-binding affinity, HL-60 (human promyelocytic leukemia) cell differentiation activity, antiproliferative activity in PZ-HPV-7 (immortalized normal prostate) cells and transactivation activity of the osteocalcin promoter in HOS (human osteoblast cell line) cells (serum-free conditions) were investigated. In addition, the effects on bone mineral density (BMD) and the blood and urine calcium concentrations of ovariectomized (OVX) rats were examined. 14-epi-MART-10 has much greater antiproliferative and cell differentiation activities compared to 1alpha,25-dihydroxyvitamin D3 (1alpha,25(OH)2D3).

Topics: Animals; Bone Density; Cell Differentiation; Cholecalciferol; Chromatography, High Pressure Liquid; Crystallography, X-Ray; Female; HL-60 Cells; Humans; Magnetic Resonance Spectroscopy; Neoplasms; Osteocalcin; Osteoporosis; Promoter Regions, Genetic; Rats; Rats, Sprague-Dawley; Receptors, Calcitriol; Transcriptional Activation

Tenofovir-containing antiviral therapy might result in acute renal failure and is able to induce tubular dysfunction with hypocalcemia. On the other hand, hypercalcemia induced by intoxication with colecalciferol has been described to induce renal failure in HIV-positive individuals as well. Here, the authors describe the unusual case of reversible renal failure due to hypercalcemia in a patient with low-dose colecalciferol substitution treated with tenofovir.. A 31-year-old HIV-positive female, CDC stage C3, was admitted to the authors' hospital with progressive renal failure and hypercalcemia. Antiretroviral therapy consisted of tenofovir and emtricitabine in combination with efavirenz. Additionally, she was on low-dose vitamin D(3) substitution (25 microg/d) and calcium supplementation (500 mg/d) due to systemic steroid treatment.. Additionally to regular control of renal function, serologic level of calcium should be supervised in patients concomitantly treated with tenofovir and colecalciferol.

Topics: Acquired Immunodeficiency Syndrome; Acute Kidney Injury; Adenine; Adrenal Cortex Hormones; Adult; AIDS-Related Opportunistic Infections; Alkynes; Anti-HIV Agents; Antitubercular Agents; Benzoxazines; Calcium; Cholecalciferol; Cyclopropanes; Deoxycytidine; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Emtricitabine; Female; Humans; Hypercalcemia; Immune Reconstitution Inflammatory Syndrome; Kidney Function Tests; Mycobacterium avium-intracellulare Infection; Organophosphonates; Osteoporosis; Tenofovir

Topics: Aged; Aged, 80 and over; Cholecalciferol; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Frail Elderly; Humans; Male; Osteoporosis; Prospective Studies; Vitamin D; Vitamin D Deficiency

Vitamin D functions in the body through both an endocrine mechanism (regulation of calcium absorption) and an autocrine mechanism (facilitation of gene expression). The former acts through circulating calcitriol, whereas the latter, which accounts for more than 80% of the metabolic utilization of the vitamin each day, produces, uses, and degrades calcitriol exclusively intracellularly. In patients with end-stage kidney disease, the endocrine mechanism is effectively disabled; however, the autocrine mechanism is able to function normally so long as the patient has adequate serum levels of 25(OH)D, on which its function is absolutely dependent. For this reason, calcitriol and its analogs do not constitute adequate replacement in managing vitamin D needs of such patients. Optimal serum 25(OH)D levels are greater than 32 ng/mL (80 nmol/L). The consequences of low 25(OH)D status include increased risk of various chronic diseases, ranging from hypertension to diabetes to cancer. The safest and most economical way to ensure adequate vitamin D status is to use oral dosing of native vitamin D. (Both daily and intermittent regimens work well.) Serum 25(OH)D can be expected to rise by about 1 ng/mL (2.5 nmol/L) for every 100 IU of additional vitamin D each day. Recent data indicate that cholecalciferol (vitamin D(3)) is substantially more potent than ergocalciferol (vitamin D(2)) and that the safe upper intake level for vitamin D(3) is 10,000 IU/d.

Topics: Administration, Oral; Animals; Calcitriol; Cardiovascular Diseases; Cholecalciferol; Communicable Diseases; Diabetes Mellitus; Ergocalciferols; Humans; Kidney Failure, Chronic; Neoplasms; Nutrition Policy; Osteoporosis; Receptors, Calcitriol; Signal Transduction; Vitamin D; Vitamin D Deficiency; Vitamins

Epidemiological studies have reported an association between arterial calcification and bone loss after menopause. However, the underlying mechanism of the association remains unclear. Therefore, to explore the possible mechanisms of the association, we tried to develop a new combined model rat of ovariectomy (OVX, an animal model of osteoporosis) and vitamin D(3) plus nicotine (VDN rat, an animal model of arterial calcification). We tested them by using sham-operated control rats (SC), OVX control rats (OC), and OVX plus VDN-treated rats (OVN). Dissections were performed twice at 4 (4SC, 4OC, and 4OVN) and 8 (8SC, 8OC, and 8OVN) weeks after treatment. 8OVN showed bone loss and arterial calcification, although 8OC showed only bone loss. Moreover, arterial calcium content was associated with indexes of bone loss at 8 weeks. Thus, the OVN rat is considered a good model to examine the relationship of the two disorders after menopause. Additionally, the arterial endothelin-1 (ET-1, a potent regulator of arterial calcification) levels increased in both 4OVN and 8OVN, and the level was associated with arterial calcium content at 8 weeks. Furthermore, the arterial endothelial nitric oxide synthase (eNOS) protein, which is an enzyme that produces nitric oxide (an antiatherosclerotic substance), was significantly reduced in only 8OVN. Estrogens affect the alterations of the eNOS and ET-1 proteins. Therefore, we suggest that impairment of the ET-1- and NO-producing system in arterial tissue during periods of rapid bone loss by estrogen deficiency might be a mechanism of the relationship between the two disorders seen in postmenopausal women.

Topics: Animals; Arteries; Calcinosis; Calcium; Cholecalciferol; Disease Models, Animal; Endothelin-1; Estradiol; Female; Femur; Nicotine; Nitric Oxide Synthase Type III; Osteoporosis; Ovariectomy; Rats; Rats, Sprague-Dawley; Receptors, Estrogen; Tibia

Posttransplant steroid doses have been reduced with the use of new and potent immunosuppressive agents. However, posttransplant osteoporosis is still a serious problem. Our aim in this study was to investigate the effect of low-dose cholecalciferol and calcium supplementation on bone loss after transplantation in renal transplant patients.. Fifty-eight renal transplantation patients were included in the study. Fourteen newly transplanted patients (group 1) and 44 renal transplantation patients with a graft age of at least six months (group 2) were involved. All patients received 400 IU/day orally cholecalciferol (vitamin D3) and 600 mg/day orally calcium replacement starting from the second day posttransplantation. All patients baseline serum and urine biochemistry, serum 25-hydroxy vitamin D3 (25 (OH)D3), and bone mineral density (BMD) tests were performed. Also, the same measurements were performed at the 12th month in group 1.. After one year of treatment, BMDs were improved in group 1. Patients in group 1 had a nonsignificant increase of lumbar spine (8.12 +/- 18.64% of baseline BMD) and femoral total (7.10 +/- 13.48% of baseline BMD) BMD at the end of the first year. On the other hand, there was a significant increase in femoral neck (10.06 +/- 15.70% of baseline BMD, p < 0.05) measurements. The baseline results of group 2 were similar to group 1. In group 1, 25 (OH)D3 levels were increased while PTH levels were decreased at the end of the year.. In renal transplant patients who use low-dose metilprednisolon and new immunosuppressive agents together, low doses of vitamin D3 and calcium replacement for one year provides a reduction in lumbar spine, femoral neck, and femoral total bone loss and prevents bone loss in group 2. In addition, it contributed to the normalization of PTH levels.

Topics: Adrenal Cortex Hormones; Adult; Bone Density; Bone Resorption; Calcium; Cholecalciferol; Dietary Supplements; Female; Humans; Immunosuppression Therapy; Kidney Function Tests; Kidney Transplantation; Male; Middle Aged; Osteoporosis; Prospective Studies; Young Adult

To investigate the effects of Chinese kidney-tonifying drugs on bone mineral density, biomechanics, 25-hydroxy Vitamin D3 and 1,25-dihydroxy Vitamin D3 of ovariectomized osteoporosis rats, and explore the mechanism of treating osteoporosis with the drugs.. Thirty-six female SD rats (four months) were randomly divided into model group, sham group and treatment group. All the rats had been ovariectomied except those in sham group. Selecting 4, 8, 12 weeks in the experiment, the value of bone mineral density (BMD) was measure by dual energy X-ray absorptiometry (DEXA) of femoral head, while the biomechanics machine was applied to analysis femoral head biomechanics index and ELISA method was used to detect the content of 25-hydroxy Vitamin D3 and 1,25-dihydroxy Vitamin D3 discern in blood-serum, liver and kidney.. Treatment group rats' BMD of femoral head was enhance compared with model group, significant differences were absent (P<0.05), and the maximal load and maximal stress measurement were improved, significant differences were absent (P<0.05). As the content of 25-hydroxy Vitamin D3 and 1,25-dihydroxy Vitamin D3 discern in blood-serum, liver and kidney were elevate, furthmore there were significant differences in group comparison, all significant differences were absent (P<0.05). But those compared with sham group, there was no significant difference (P>0.05).. In the early period in absence of estrogenic hormone, the Chinese kidney-tonifying drugs could activate bone metabolism to raise BMD and reinforce quality of bone through up-regulating expression of 25-hydroxy Vitamin D3 and 1,25-dihydroxy Vitamin D3 at protein level.

Topics: Animals; Biomechanical Phenomena; Bone Density; Cholecalciferol; Drugs, Chinese Herbal; Female; Femur Head; Humans; Osteoporosis; Ovariectomy; Random Allocation; Rats; Rats, Sprague-Dawley; Renal Agents

beta-Cryptoxanthin displays a unique anabolic effect on bone calcification. In women with osteoporosis, serum beta-cryptoxanthin and 25-OH-vitamin D(3) showed a weak but significant correlation and exhibited a complementary seasonal distribution. The potential role of beta-cryptoxanthin as a nutritional approach to improving bone health deserves further evaluation.. Dietary intake and serum levels of beta-cryptoxanthin have been inversely related to different bone and joint disorders and in vitro and animal studies have shown that beta-cryptoxanthin displays a unique anabolic effect on bone calcification. Due to the emerging role of beta-cryptoxanthin in bone biology, we aimed to assess the serum distribution and variability of beta-cryptoxanthin and their potential relation to 25-OH-vitamin D(3) in women with osteoporosis.. Serum concentrations of alpha- and beta-cryptoxanthin and 25-OH- D(3) in women with osteoporosis (N = 644) were analyzed using a quality-controlled high-performance liquid chromatography (HPLC) method.. Overall, significant seasonal variations were found for the three analytes and inter-individual variation was also high (60-73%). beta-cryptoxanthin and 25-OH-vitamin D(3) exhibited a marked complementary seasonal distribution in serum, with vitamin D displaying the highest values in summer and beta-cryptoxanthin in winter.. Given the anabolic effect of beta-cryptoxanthin on bone calcification and its complementary seasonal distribution with respect to 25-OH-vitamin D(3), the potential role of beta-cryptoxanthin as a sustainable nutritional approach to improving bone health deserves to be further evaluated.

Topics: Aged; Analysis of Variance; Biomarkers; Bone Density; Bone Resorption; Cholecalciferol; Cryptoxanthins; Female; Humans; Middle Aged; Osteoporosis; Seasons; Vitamin D Deficiency; Xanthophylls

To evaluate the cost-effectiveness of a fixed dose combination of alendronate 70 mg and cholecalciferol 2800 IU (alendronate/vitamin D3; Fosavance) versus no treatment, alendronate with dietary vitamin D supplements and ibandronate in the treatment of osteoporosis in the UK and Netherlands.. A patient simulation model was developed. One-year cycles included health states related to hip, vertebral, wrist and proximal humerus fractures, as well as death due to hip fractures and other causes. Effect of treatment was extracted from alendronate and ibandronate clinical trials. Direct costs and utilities were derived from other literature. Analyses were performed for women with a history of vertebral fractures and osteoporosis aged 50, 60, 70 and 80 years. Probabilistic sensitivity analyses were undertaken to estimate the uncertainty of outcomes.. In the UK, alendronate/vitamin D3 was cost-effective compared to no treatment in women 70 years and older with osteoporosis ( pound17 439 per quality-adjusted life year [QALY] gained) and women 60 years and older with a history of vertebral fractures ( pound29 283 per QALY gained). For women 80 years of age alendronate/vitamin D3 was cost-saving combined with QALY gains. Alendronate/vitamin D3 was cost-saving relative to alendronate with dietary supplements. Relative to ibandronate, alendronate/vitamin D3 was cost-effective in women 50 years ( pound19 095 per QALY gained) and economically dominant in women 60 years or older. Comparable results were observed for the Netherlands.. Given the underlying assumptions and data used, this economic modelling study showed that alendronate/vitamin D3 is cost-effective in women 70 years or older with osteoporosis and in women 60 years or older with a history of vertebral fractures in the UK and Netherlands. Alendronate/vitamin D3 is economically dominant over ibandronate in women with a history of vertebral fractures aged 60 and over and cost-saving relative to alendronate with dietary supplements.

Topics: Aged; Aged, 80 and over; Alendronate; Bone Density Conservation Agents; Cholecalciferol; Cost-Benefit Analysis; Diphosphonates; Drug Combinations; Drug Costs; Female; Fractures, Bone; Humans; Ibandronic Acid; Middle Aged; Models, Economic; Netherlands; Osteoporosis; Patient Compliance; Patient Simulation; Quality-Adjusted Life Years; United Kingdom

In a previous 2-y randomized controlled trial, we showed that calcium- and vitamin D3-fortified milk stopped or slowed bone loss at several clinically relevant skeletal sites in older men.. The present study aimed to determine whether the skeletal benefits of the fortified milk were sustained after withdrawal of the supplementation.. One hundred nine men >50 y old who had completed a 2-y fortified milk trial were followed for an additional 18 mo, during which no fortified milk was provided. Bone mineral density (BMD) of the total hip, femoral neck, lumbar spine, and forearm was measured by using dual-energy X-ray absorptiometry.. Comparison of the mean changes from baseline between the groups (adjusted for baseline age, BMD, total calcium intake, and change in weight) showed that the net beneficial effects of fortified milk on femoral neck and ultradistal radius BMD at the end of the intervention (1.8% and 1.5%, respectively; P < 0.01 for both) were sustained at 18-mo follow-up (P < 0.05 for both). The nonsignificant between-group differences at the total hip (0.8%; P = 0.17) also persisted at follow-up (0.7%; P = 0.10), but there were no lasting benefits at the lumbar spine. The average total dietary calcium intake in the milk supplementation group at follow-up approximated recommended amounts for Australian men >50 y old (1000 mg/d) but did not differ significantly from that in the control subjects (1021 versus 890 mg/d).. Supplementation with calcium- and vitamin D3-fortified milk for 2 y may provide some sustained benefits for BMD in older men after withdrawal of supplementation.

Topics: Absorptiometry, Photon; Animals; Bone Density; Bone Density Conservation Agents; Calcium, Dietary; Cholecalciferol; Follow-Up Studies; Food, Fortified; Humans; Male; Middle Aged; Milk; Osteoporosis; Treatment Outcome

Osteoporosis is a frequent complication in patients with inflammatory bowel disease. Recent studies have shown bisphosphonates to considerably reduce fracture risk in patients with osteoporosis, and preventing fractures with bisphosphonates has been reported to be cost effective in older populations. However, no studies of the cost effectiveness of these agents in preventing fractures in patients with inflammatory bowel disease are available.. To investigate the cost effectiveness of the bisphosphonate ibandronate combined with calcium/colecalciferol ('ibandronate') in patients with osteopenia or osteoporosis due to inflammatory bowel disease in Germany. Treatment strategies used for comparison were sodium fluoride combined with calcium/colecalciferol ('fluoride') and calcium/colecalciferol ('calcium') alone.. A cost-utility analysis was conducted using data from a randomized controlled trial (RCT). Changes in bone mineral density (BMD) were adjusted and predicted for a standardized population receiving each respective treatment. A Markov model was developed, with probabilities of transition to fracture states consisting of BMD-dependent and -independent components. The BMD-dependent component was assessed using predicted change in BMD from the RCT. The independent component captured differences in bone quality and micro-architecture resulting from prevalent fractures or treatment with anti-resorptive drugs. The analysis was conducted for a population with a mean age of the RCT patients (women aged 36 years, men aged 38 years) with osteopenia (T-score about -2.0 at baseline), a population of the same age with osteoporosis (T-score of -3.0 at baseline) and for an older population (both sexes aged 65 years) with osteoporosis (T-score of -3.0). Outcomes were measured as costs per QALY gained from a societal perspective. The treatment duration in the RCT was 42 months. A 5-year period was assumed to follow, during which the treatment effects linearly declined to 0. The simulation time was 10 years. Prices for medication and treatment were presented as year 2004 values; costs and effects were discounted at 5%. To test the robustness of the results, univariate and probabilistic sensitivity analyses (Monte Carlo simulation) were conducted.. The calcium strategy dominated the fluoride strategy. When the ibandronate strategy was compared with the calcium strategy, the base-case cost-effectiveness ratios (costs per QALY gained) were between euro 407 375 for an older female population with osteoporosis and euro 6 516 345 for a younger female population with osteopenia. Univariate sensitivity analyses resulted in variations between 4% of base-case results and dominance of calcium. In Monte Carlo simulations, conducted for the various populations, the probability of an ICER of ibandronate below euro 50 000 per QALY was never greater than 20.2%.. The ibandronate strategy is unlikely to be considered cost effective by decision makers in men or women with characteristics of those in the target population of the RCT, or in older populations with osteoporosis.

Topics: Adult; Aged; Bone Density; Bone Density Conservation Agents; Calcium; Cholecalciferol; Cost-Benefit Analysis; Diphosphonates; Drug Therapy, Combination; Female; Fractures, Bone; Germany; Humans; Ibandronic Acid; Inflammatory Bowel Diseases; Male; Markov Chains; Models, Economic; Osteoporosis; Quality-Adjusted Life Years; Sodium Fluoride

Vitamin D insufficiency is widespread, regardless of geographical location. It is particularly prevalent in the elderly and has far-ranging health consequences including: osteoporosis, falls, increased risk of cancer, and altered glucose and lipid metabolism. Increasing evidence strongly supports the benefits of vitamin D supplementation and also reveals that present recommendations are inadequate, especially for older individuals. Although additional studies are still needed to further optimize diagnostic and therapeutic approaches, physicians should consider prescribing cholecalciferol--at least 2000 international units (IU) per day--to all elderly patients. Oral cholecalciferol supplementation at that level is inexpensive, safe, and effective, and has great potential to improve the quality of life of the elderly.

Topics: Accidental Falls; Aged; Cholecalciferol; Fractures, Bone; Humans; Inflammation; Metabolic Syndrome; Neoplasms; Osteoporosis; Ultraviolet Rays; Vitamin D; Vitamin D Deficiency; Vitamins

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

The aim of the present study was to clarify if patients with osteoporotic bone fractures have exocrine pancreatic insufficiency, especially reduced fecal elastase 1, connected with lowered serum levels of vitamin D3 that could be relevant for predominant osteoporosis.. Between October 1999 and September 2001, we investigated on 167 patients with an average age of approx. 69 years suffering from typical osteoporotic bone fractures, as well as 20 healthy controls with an average age of 53 years. A standardized osteodensitometry via dual energy X-ray absorptiometry (DEXA) was performed in all participants. Levels of PTH, 1,25(OH)(2) Vitamin D(3), 25(OH) Vitamin D(3), calcium and phosphate in serum, elastase 1 in feces as well as the body mass index were determined in all patients and controls.. In patients 25(OH)D3 was more than 60% and 1,25(OH)(2)D(3) was more than 53% decreased compared to controls. Fecal elastase 1 was lower than the lowest reference of 200 microg/g feces in more than 34% of the patients and it was more than 65% reduced in comparison to healthy controls (fecal elastase 1 patients: 240.7 +/- 96.3 microg/g; controls 694.9 +/- 138.6 microg/g). Separation of the patients in accordance with the elastase 1 contend in feces into four groups (below 100 microg/g, between 100 and 200 microg/g, between 201 and 300 microg/g and above 300 microg/g) resulted in significant variations for 25(OH)D(3), 1,25(OH)(2)D(3), calcium and PTH between these groups (p < 0.01). Furthermore 25(OH)D(3), 1,25(OH)(2)D(3), calcium and PTH correlated significantly with elastase 1 in feces (p < 0.01) the way, that lower fecal elastase 1 was connected with lower levels of the other parameters. BMI shows no relevant differences within the patients or between patients and controls.. Exocrine pancreatic insufficiency, especially lowered fecal elastase 1, may be much more frequent in patients with osteoporotic bone fractures than suggested so far. Lowered exocrine pancreatic function with lowered fecal elastase 1 seems to be relevant as a reason for reduced levels of circulating vitamin D3 metabolites being an appropriate additional cause for predominant osteoporosis.

Topics: Absorptiometry, Photon; Adult; Aged; Aged, 80 and over; Case-Control Studies; Cholecalciferol; Feces; Fractures, Bone; Humans; Middle Aged; Osteoporosis; Pancreatic Elastase

130 young and middle age patients of both sexes with chronic form of coronary heart disease: functional class II-III stable exertional angina pectoris including functional class I-III chronic cardiac insufficiency were studied. In protocol 1 cured 70 patients (48 (68.6%) males and 22 (31.4%) females) 32-59 years of age (medium age was 48.4 +/- 3.25 years) with coronary heart disease. In protocol 2 (with prescription of calcium-D3) cured 60 patients (40 (66.7%) males and 20 (33.3%) females) 34-58 years of age (medium age was 47.8 +/- 3.12 years) with coronary heart disease. The groups were comparable on key parameters of disease. All patients had alimentary calcium deficit and (or) risk factors of osteoporosis, instrumental signs (X-ray filming and densitometry) of initial or evident osteoporosis. Correction of alimentary calcium deficit was realized by prescription of 1-3 tablets of calcium- Ds in different food intakes. Positive dynamics in decrease of functional class of angina pectoris and nitroglycerin requirement in both groups was noticed. Negative influence of calcium- D3 on studied indices of coronary heart disease severity was absent. The thirst and dry mouth in patients, who took furosemide, in group 1 were noticed against the background of body weight decrease (p < 0.05) and increase of diuresis. Decrease of the therapy antiarrhythmic action (p < 0.05) in patients, who took hydrochlorothiazide, was noticed too. It leaded to needs of furosemide and hydrochlorothiatide dose correction in protocol 1. In whole use of calcium- D3 together with anti-ischemic drugs in patients with chronic forms of coronary heart disease did not impair clinical course of angina pectoris and did not decrease efficiency of coronary heart disease therapy.

Topics: Calcium; Cholecalciferol; Coronary Disease; Diuretics; Drug Interactions; Female; Furosemide; Humans; Male; Middle Aged; Osteoporosis; Sodium Chloride Symporter Inhibitors

A role for vitamin D in the pathogenesis of autoimmune and inflammatory diseases is emerging. We undertook an audit of 25-hydroxyvitamin D (25OHD) investigation and treatment in rheumatology outpatients.. Serum 25OHD requests were matched to electronic medical records from rheumatology and metabolic bone clinics (April 2006-March 2007). Data were analysed separately for two groups, 'Documented osteoporosis/osteopaenia' (Group 1) and 'General rheumatology outpatients' (Group 2, sub-divided by diagnosis). Hypovitaminosis D was defined by 25OHD levels <50 nmol/l. Values were compared with healthy adults to calculate geometric z-scores.. A total of 263 patients were included (Group 1, n = 122; Group 2, n = 141) with an overall median 25OHD of 44 nmol/l. The 25OHD level among general rheumatology patients (median 39 nmol/l, mean z score -1.2, was statistically significantly lower than among osteoporotic/osteopaenic patients (median 49 nmol/l, mean z score of -0.9, p < 0.05 for the difference). 25OHD was lower in inflammatory arthritis and chronic pain/fibromyalgia than in other groups. Prescribing was recorded in 100 in Group 1 (of whom 95% were prescribed calcium/800 IU cholecalciferol) and 83 in Group 2 (91% calcium/800 IU). Only 31% of the patients with 25OHD <50 nmol/l would have been identified using general guidelines for screening patients at 'high risk' of hypovitaminosis D.. Improved guidelines for managing hypovitaminosis D in rheumatology patients are needed. We found a high prevalence of hypovitaminosis D among secondary care patients in rheumatology and widespread supplementation with 800 IU cholecalciferol. Substantially reduced levels of serum 25OHD were identified among patients with inflammatory arthritis and chronic pain.

Topics: Adult; Aged; Autoimmune Diseases; Calcium; Cholecalciferol; Fibromyalgia; Humans; Middle Aged; Osteoporosis; Retrospective Studies; Rheumatic Diseases; Vitamin D; Vitamin D Deficiency

Vitamin D is essential for intestinal calcium absorption, bone mineralisation and plays an important role in neuromuscular functions. Vitamin D insufficiency is highly prevalent among postmenopausal women with osteoporosis and in the elderly. In turn, supplements of vitamin D3 (cholecalciferol), and to a lesser extent vitamin D2 (ergocalciferol), may decrease falls and fracture risk by 25%. Despite some recent negative studies, the actual question is not to know whether vitamin D is necessary, but rather how much vitamin D is sufficient to prevent secondary hyperparathyroidism, falls and fractures. Moreover, the risk of osteoporosis and of fragility fractures may be influenced by genetic variation in the vitamin D receptor (VDR).

Topics: Accidental Falls; Aged; Bone Density Conservation Agents; Calcification, Physiologic; Calcium; Cholecalciferol; Ergocalciferols; Female; Fractures, Bone; Humans; Hyperparathyroidism, Secondary; Intestinal Absorption; Neuromuscular Junction; Osteoporosis; Osteoporosis, Postmenopausal; Receptors, Calcitriol; Vitamin D; Vitamins

Transient osteoporosis of the hip is a rare clinical disorder of unknown etiology, characterized by hip pain and functional disability that resolves spontaneously in 6-24 months. Despite a benign prognosis, the long clinical course causes prolonged disability. We report on a case of transient osteoporosis of the hip during pregnancy that was rapidly resolved with the use of calcitonin. An accurate diagnosis was made 2 months after the onset of symptoms (4 weeks postpartum) based on findings in the form of bone marrow edema of the right hip by magnetic resonance imaging. The patient received calcitonin for 8 weeks and the beneficial effect was observed after 3 weeks of therapy with full resolution of symptoms after 8 weeks of therapy (4 months after onset of symptoms). We suggest that the use of calcitonin may be considered as a therapeutic intervention to shorten the disease duration.

Topics: Adult; Bone Density Conservation Agents; Calcitonin; Calcium; Cholecalciferol; Diphosphonates; Drug Therapy, Combination; Female; Hip Joint; Humans; Magnetic Resonance Imaging; Organotechnetium Compounds; Osteoporosis; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third; Puerperal Disorders; Radionuclide Imaging

Parathyroidectomy is the only effective therapy for osteitis fibrosa cystica in hyperparathyroidism.. The objective of this study was to describe the changes of skeletal and nonskeletal manifestations in a patient with hyperparathyroidism and renal failure after oral vitamin D therapy.. This was a descriptive case report.. The patient was followed up in a referral center.. A 55-yr-old male patient with moderate renal failure was referred for expansile lytic lesions affecting several ribs and the spinous process of T12. His creatinine was 1.8 mg/dl; calcium, 8.9 mg/dl; PTH, 666 pg/ml; and 1,25 dihydroxy-vitamin D, 27 pg/ml. Bone mineral density (BMD) Z-scores by dual-energy x-ray absorptiometry were -4.1 at the spine, -1.7 at the hip, and -4.3 at the forearm.. The main outcome measures were the skeletal manifestations of hyperparathyroidism.. At 10 months of therapy, calcium level was 10 mg/d, PTH level declined to 71 pg/ml, and BMD increased by 12% at the spine and 18% at the hip. Computerized tomography (CT) cuts revealed marked regression in the lytic lesions. At 2 yr, BMD increased by an additional 6% at the spine, and there were no further changes in the lytic lesions by CT. The vitamin D receptor genotype using the restriction enzymes Bsm1, Taq1, and Apa1 was Bb, tt, and AA.. We showed regression of severe skeletal abnormalities of hyperparathyroidism documented by serial CT images in response to oral vitamin D therapy. It is possible that the vitamin D receptor genotype of the patient modulated this response.

Topics: Bone Density; Bone Diseases; Calcium; Cholecalciferol; Genotype; Humans; Hydroxycholecalciferols; Hyperparathyroidism, Secondary; Kidney Failure, Chronic; Male; Middle Aged; Osteitis Fibrosa Cystica; Osteoporosis; Receptors, Calcitriol; Thalassemia; Tomography, X-Ray Computed; Vitamin D

Topics: Alendronate; Awards and Prizes; Bone Density Conservation Agents; Cholecalciferol; Clinical Trials as Topic; Drug Combinations; Female; Germany; Humans; Male; Osteoporosis; Practice Guidelines as Topic

Topics: Aged; Calcium; Cholecalciferol; Female; Germany; Guideline Adherence; Humans; Male; Osteoporosis; Patient Compliance; Patient Education as Topic

Osteoporosis and fragility fractures are common in the elderly population and represent a large public health burden. Non-pharmacological recommendations for the management of osteoporosis include modification of lifestyle behaviours, increased weight-bearing exercise and consumption - through dietary or supplement sources - of adequate amounts of calcium and vitamin D. Although current guidelines include recommendations on calcium and vitamin D intake, patients frequently do not take sufficient amounts, even when supplements are provided free of charge. Vitamin D is essential for mineral metabolism, and low levels are associated with impaired skeletal metabolism and neuromuscular function. Nutritional sources of vitamin D are limited, and supplementation is usually necessary. A high prevalence of low vitamin D levels has been reported in a number of populations worldwide, including women being treated for osteoporosis and those with fragility fractures. At present, bisphosphonates are the most commonly prescribed pharmacological treatments for osteoporosis, and alendronic acid is the most frequently prescribed bisphosphonate. A nitrogen-containing bisphosphonate, alendronic acid has demonstrated anti-fracture efficacy at vertebral and non-vertebral skeletal sites, including the hip, in addition to long-term safety and efficacy. Weekly administration of alendronic acid takes advantage of the pharmacokinetics of the drug and osteoclast biology to optimise treatment, and may improve patient adherence. Combining alendronic acid 70mg and colecalciferol (vitamin D(3)) 2800 IU in a single, once-weekly tablet has the advantage of combining the proven efficacy of an established bisphosphonate, alendronic acid, with the amount of vitamin D currently recommended for osteoporosis management.

Topics: Alendronate; Bone and Bones; Bone Density Conservation Agents; Calcium; Cholecalciferol; Drug Combinations; Humans; Osteoporosis; Vitamin D; Vitamin D Deficiency

Topics: Bone Density; Bone Remodeling; Carrier Proteins; Case-Control Studies; Cholecalciferol; Female; Glycoproteins; Humans; Male; Membrane Glycoproteins; Osteoporosis; Osteoprotegerin; RANK Ligand; Receptor Activator of Nuclear Factor-kappa B; Receptors, Cytoplasmic and Nuclear; Receptors, Tumor Necrosis Factor; Solubility; Thalassemia

Topics: Adult; Aged; Australia; Child; Cholecalciferol; Comorbidity; Dose-Response Relationship, Drug; Female; Humans; Infant; Injections, Intramuscular; Male; Osteoporosis; Prevalence; Treatment Outcome; Vitamin D; Vitamin D Deficiency

The objective of this study was to evaluate the metabolic in vitro effect of the bisphosphonate neridronate on normal and pathological human osteoblasts. Primary human osteoblast cultures were obtained from cancellous bone of osteoarthritic (OA) and osteoporotic (OP) patients and a corresponding healthy control group. Osteocalcin production was evaluated by cultured cells in neridronate 10(-4) M and 10(-6) M, both under basal conditions and after vitamin D3 stimulation. In the absence of neridronate, vitamin D3 increased osteocalcin production in all cell cultures; under the same conditions, and in the absence of vitamin D3, OA osteoblasts showed a significantly higher osteocalcin production whereas OP osteoblasts showed a significantly lower osteocalcin production compared to the normal osteoblasts, respectively. In all cellular populations neridronate at a higher concentration (10(-4) M) induced a reduction in osteocalcin synthesis, but in normal and osteoarthritic osteoblasts did not reduce the stimulatory effect of vitamin D3, whereas it inhibited the vitamin D3-induced increase of osteocalcin synthesis in the osteoporotic cells. In normal and osteoporotic osteoblasts stimulation with the lower neridronate concentration (10(-6) M) significantly increased osteocalcin production, which was further enhanced by vitamin D3 as an additional effect of the combined treatment. In OA osteoblasts, neridronate 10(-6) M did not induce an increase in osteocalcin synthesis and the additional effect of combined treatment with vitamin D3 was not observed. Neridronate can modify the metabolic activity of human osteoblasts by enhancing or decreasing their biosynthetic activity, both in normal and in pathological conditions, depending on compound concentration and on different cell types. These results confirm the validity of using neridronate at doses usually administered in treating osteoporosis, and they suggest using it to treat other diseases which show an altered osteoblast metabolism, such as osteoarthritis.

Topics: Adult; Aged; Cells, Cultured; Cholecalciferol; Diphosphonates; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Osteoarthritis; Osteoblasts; Osteocalcin; Osteoporosis

Topics: Aged; Alendronate; Calcium; Cholecalciferol; Costs and Cost Analysis; Hip Fractures; Humans; Osteoporosis; Recurrence

In postmenopausal osteoporosis, the administration of alfacalcidol to women resulted in an increase in trabecular bone mineral density (BMD), prevention of cortical bone loss, and a significant reduction in the incidence of further vertebral fractures. There is now robust evidence that alfacalcidol may be particularly active in conditions characterized by an increased rate of bone loss. Alfacalcidol 1 microg/day fully prevented vertebral bone loss over 3 years in women after the first year of menopause. In a large cohort of individuals starting treatment with high dose corticosteroid (CS, 46.6 mg equivalent prednisolone per day), the spinal bone loss observed in untreated patients was fully prevented by administration of 1 microg/day alfacalcidol. In patients with established CS-induced osteoporosis, with or without prevalent vertebral fractures, 1 microg/day of alfacalcidol, given for 3 years, increased lumbar spine density, reduced back pain, and showed a significant reduction in the rate of new vertebral fractures, compared to native vitamin D. In cardiac transplant recipients, alfacalcidol and calcium reduced spinal and femoral bone loss, compared to a control group treated with etidronate and calcium. Alfacalcidol-treated patients experienced fewer new vertebral fractures over the 2-year followup. When alfacalcidol and vitamin D3 were compared in elderly women with radiologic evidence of vertebral fracture, fractional calcium absorption was increased after 3 months with alfacalcidol but was unchanged with vitamin D3. In a recent metaanalysis of 14 studies of native vitamin D and 19 studies of D-hormone analogs (alfacalcidol and calcitriol), the D-analogs exerted a higher preventive effect on bone loss and fracture rates in patients with no exposure to CS. In head-to-head studies comparing D-analogs and native vitamin D in patients receiving CS, this metaanalysis identified significant effects favoring D-analogs for femoral neck BMD and spinal fractures. In conclusion, improvement in bone turnover, increase in BMD, and reduction in fracture rates have been described during alfacalcidol treatment in situations characterized by a high rate of bone loss, including CS-induced osteoporosis, early postmenopausal bone loss, and organ transplant. Compared to plain vitamin D, alfacalcidol exerts higher bone-protective effects, thus allowing the doses to be minimized and lowering the risk of adverse effects, including hypercalcemia.

Topics: Adrenal Cortex Hormones; Animals; Bone Density; Bone Density Conservation Agents; Bone Remodeling; Cholecalciferol; Clinical Trials as Topic; Female; Fractures, Bone; Humans; Hydroxycholecalciferols; Osteoporosis; Osteoporosis, Postmenopausal; Spinal Fractures; Transplantation

Vertebral fractures due to osteoporosis are a common but frequently unrecognized complication in established ankylosing spondylitis (AS). It is known that inflammatory activity in rheumatic diseases (i.e., proinflammatory cytokines) itself plays a possible role in the pathophysiology of bone loss. The aim of this study was to analyze whether inflammatory activity and an alteration of the vitamin D metabolism play a substantial role in the loss of bone mass in AS. In this cross-sectional study, 58 patients with established AS and an age- and sex-matched control group were examined. The vitamin D status was investigated, as was, in parallel, the relationship to disease activity (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), markers of bone metabolism (parathyroid hormone [PTH], 1.25 vitamin D3, 25 vitamin D3), calcium, bone alkaline phosphatase (bone-AP), urine cross-links, and plasma tumor necrosis factor alpha (TNFalpha). Bone mineral density was measured by quantitative computed tomography (QCT) of the lumbar spine. Osteoporosis was diagnosed in early as well as in progressive stages of AS (23/58=39.6%). Furthermore, serum levels of 1.25 vitamin D3 and PTH were negatively correlated with disease activity and TNFalpha. The excretion of cross-links showed a positive correlation with disease activity and TNFalpha, and 1.25 vitamin D3 and PTH were positively correlated with bone-AP. TNFalpha also positively correlated with disease activity. AS patients with osteoporosis showed significantly increased CRP, ESR, cross-links and PTH and a significantly decreased 1.25 D3. Osteoporosis is frequent in AS and high disease activity is associated with an alteration in vitamin D metabolites and increased levels of bone resorption in active AS. Our findings propose a close association of BMD, bone metabolism and inflammatory activity, possibly related to vitamin D inflammation interactions.

Topics: Adolescent; Adult; Aged; Biomarkers; Bone and Bones; Bone Density; Cholecalciferol; Cross-Sectional Studies; Disease Progression; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteoporosis; Parathyroid Hormone; Spondylitis, Ankylosing; Tomography, X-Ray Computed; Vitamin D Deficiency

Osteoporosis and diseases of bone loss are a major public health problem for the present and the future since longevity and prevalence of the disease are increasing in all parts of the world. The bisphosphonates, widely used in the treatment of osteoporosis, act by inhibiting bone resorption. However, there are few agents that promote or increase bone formation in patients who have suffered substantial bone loss. To facilitate the identification of novel anabolic therapies, the authors have developed a rapid, high-throughput in vivo screen using larval zebrafish (Danio rerio) in which they are able to identify agents with anabolic effects in the skeleton within a 6-day time period. Vitamin D3 analogs and intermittent parathyroid hormone (PTH) result in dose-dependent increases in the formation of mineralized bone, whereas continuous exposure to PTH results in net bone loss. Because this model is fast, economical, and genetically tractable, it provides a powerful adjunct to mammalian models for the identification of new anabolic bone agents and offers the potential for genetic elucidation of pathways important in osteoblastic activity.

Topics: Animals; Bone Density Conservation Agents; Bone Remodeling; Calcification, Physiologic; Cholecalciferol; Drug Evaluation, Preclinical; Etidronic Acid; Feasibility Studies; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Models, Animal; Osteoblasts; Osteoporosis; Parathyroid Hormone; Zebrafish

Topics: Administration, Oral; Calcium; Cholecalciferol; Dietary Supplements; Drug Combinations; Humans; Nutritional Physiological Phenomena; Osteoporosis; Practice Guidelines as Topic; Practice Patterns, Physicians'; Treatment Outcome

Topics: Adjuvants, Immunologic; Cholecalciferol; Dose-Response Relationship, Drug; Glucocorticoids; Humans; Hydroxycholecalciferols; Osteoporosis; Treatment Outcome

The aim of the present study was to survey the interest of Japanese orthopedists in preventing fractures in the elderly, and investigate their awareness with regard to main prevention strategies such as medications and hip protectors. From the list of 20,899 members of the Japanese Orthopedic Association, we randomly selected a sample of 2035 people. Each orthopedist was sent an anonymous survey consisting of 12 questions during July to August 2001. At that time, risedronate, raloxifene, and parathyroid hormone had not been approved for clinical use in Japan, and even alendronate had just been approved. Of the survey forms sent, 1011 responses were received, for a response rate of 50%. Analysis of these responses showed a very high interest in osteoporosis, fractures in the elderly from falls, and the prevention of such fractures. This interest was associated with physician age, with those above the age of 50 years being 2.3 times more likely to have an interest in each of these than physicians below that age. The respondents considered the most promising measure for the prevention of fractures in the elderly from falls to be fall prevention, followed by exercise and osteoporosis medications. The medication considered to be effective as a monotherapy by the overwhelming number of respondents was bisphosphonates, followed by vitamin D3 and calcitonin. Combination agents cited were vitamin D3, bisphosphonates, and calcitonin, in that order. Forty-two percent of respondents had some knowledge of hip protectors, but confidence in them as a means to prevent fractures was still low. The practical information from our survey should serve as a starting point for comparison to periods when new bisphosphonates or hip protectors become commonly available to Japanese orthopedists. The overall results indicate that Japanese orthopedists are very positive toward fracture prevention.

Topics: Accidental Falls; Adult; Age Factors; Aged; Attitude of Health Personnel; Calcitriol; Calcium; Calcium Channel Agonists; Cholecalciferol; Diphosphonates; Drug Therapy, Combination; Female; Fractures, Bone; Hip; Humans; Japan; Male; Middle Aged; Orthopedics; Osteoporosis; Protective Devices

Independent use of K(2) and D(3) and simultaneous application of K(2) and D(3) inhibited the development of osteoporosis caused by PD food intake. The ALP activity of urine as a marker of bone formation osteoporosis did not rise in rats fed PD foods containing D(3), K(2) or both together. Body and womb weights fell in rats fed PD foods with D(3) K(2) and both D(3), K(2). Osteoporosis caused by PD food intake found to be very similar to type II osteoporosis in respects of inhibition by D(3) and K(2) and rising urinary ALP activity.

Topics: Alkaline Phosphatase; Animals; Body Weight; Bone Density; Cholecalciferol; Diet, Protein-Restricted; Female; Osteoporosis; Rats; Rats, Wistar; Vitamin K 2

In a group of 34 psychogeriatric patients (mean age 79 years) the prevalence of hypovitaminosis D was found to be 82%, taking 30 nmol/l as cut-off for calcidiol. We found 47% of the whole group to be severely deficient having values lower than 20 nmol/l. Results of related test are presented and discussed. Patient were treated with oral calcium and vitamin D3 medication. Origin, presentation and risks of hypovitaminosis D, including muscle weakness and the aggravating role of low calcium intake, are discussed with special attention to psychogeriatric patients. Suppletion of vitamin D and calcium is suggested for this patient group.

Topics: Aged; Calcifediol; Calcium; Cholecalciferol; Female; Geriatric Assessment; Humans; Male; Netherlands; Nutritional Status; Osteoporosis; Pilot Projects; Prevalence; Treatment Outcome; Vitamin D; Vitamin D Deficiency

The population of thyroid C-cells of female rabbits with ovariectomy-induced osteoporosis was studied using immunohistochemical method with antibodies against calcitonin (CT) and morphometrically. The development of osteoporosis was confirmed using radiology and densitometry. 8 weeks after the operation, after the detection of hypercalcemia and hypercalciuria, some of the animals were given a correcting treatment with calcium-containing drug and vitamin D3 or with a combination of calcium drug with hormonal estrogen-containing drug. 4 weeks after the treatment was started, thyroid C-cells in animals that received the drugs, were significantly larger than in the cells of control and ovariectomized rabbits that received no treatment. Following 12 and 22 weeks, in the animals treated with hormonal drug, both calcium concentrations in blood and urine and C-cell dimensions were normalized. Large C-cells with an intensive reaction to CT were observed at weeks 12 and 22 (weeks 20 and 30 after the operation) in the thyroid gland of the animals that received no treatment and of the animals that received calcium with food. In the last case, the morphological changes of C-cells were more pronounced, despite the insignificant differences in blood calcium concentrations in both groups. These results permit to suggest that the intensity of CT synthesis by C-cells may be influenced by calcium concentrations not only in the blood, but also in the intestinal lumen.

Topics: Animals; Calcitonin; Calcium; Cholecalciferol; Drug Therapy, Combination; Female; Follicle Stimulating Hormone; Immunohistochemistry; Osteoporosis; Ovariectomy; Rabbits; Thyroid Gland

Topics: Age Factors; Aged; Alendronate; Calcium; Cholecalciferol; Diphosphonates; Drug Therapy, Combination; Evidence-Based Medicine; Female; Humans; Male; Meta-Analysis as Topic; Middle Aged; Osteoporosis; Osteoporosis, Postmenopausal; Practice Guidelines as Topic; Raloxifene Hydrochloride; Randomized Controlled Trials as Topic; Risk Factors; Selective Estrogen Receptor Modulators; Sex Factors

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

Rheumatoid arthritis (RA) is often complicated by generalized osteopenia due to increased bone resorption by osteoclasts. We analysed a number of cellular and humoral factors that influence osteoclast formation from circulating precursors in RA patients.. Monocytes isolated from RA patients and normal controls were cultured with macrophage colony-stimulating factor (M-CSF) and nuclear factor-kappaB ligand (RANKL), or with RANKL-expressing UMR106 cells and 1,25 dihydroxyvitamin D(3) [1,25(OH)(2)D(3)]. Osteoclast differentiation was assessed by expression of tartrate-resistant acid phosphatase (TRAP) and vitronectin receptors (VNR) and lacunar resorption.. Osteoclasts formed from RA patients exhibited increased resorptive activity but there was no difference in the relative proportion of circulating osteoclast precursors between RA patients and normal controls. Osteoclast precursors in RA patients were not more sensitive to the osteoclastogenic effects of 1,25(OH)(2)D(3), M-CSF or RANKL. Dexamethasone, but not interleukin (IL) 1beta, tumour necrosis factor alpha and IL-6, increased osteoclast formation and lacunar resorption.. There is an increase in the extent of lacunar resorption carried out by osteoclasts formed from circulating precursors in RA patients. This is not due to an increase in the number of circulating precursors or increased sensitivity to the osteoclastogenic effects of 1,25(OH)(2)D(3), M-CSF, RANKL or inflammatory cytokines. Our findings suggest that increased osteoclast functional activity rather than osteoclast formation is more likely to play a role in the generalized bone loss that occurs in RA, and that corticosteroids stimulate osteoclast formation and resorption.

Topics: Adult; Aged; Arthritis, Rheumatoid; Bone Resorption; Carrier Proteins; Case-Control Studies; Cell Division; Cells, Cultured; Cholecalciferol; Culture Media, Conditioned; Dexamethasone; Female; Humans; Interleukin-1; Interleukin-6; Macrophage Colony-Stimulating Factor; Male; Membrane Glycoproteins; Middle Aged; Monocytes; Osteoclasts; Osteoporosis; RANK Ligand; Receptor Activator of Nuclear Factor-kappa B; Reference Values; Sensitivity and Specificity; Tumor Necrosis Factor-alpha

Topics: Aged; Bone Density; Calcium; Cholecalciferol; Drug Combinations; Female; Humans; Male; Middle Aged; Osteoporosis

Topics: Calcium; Cholecalciferol; Diphosphonates; Estrogen Replacement Therapy; Female; Humans; Long-Term Care; Male; Osteoporosis

Topics: Calcium; Calcium, Dietary; Cholecalciferol; Drug Combinations; Femoral Neck Fractures; Fractures, Spontaneous; Humans; Osteoporosis

The objective of this study was to examine the economics of administering calcium and vitamin D3 to post-menopausal women in Sweden. We focus primarily on the cost-effectiveness of treating older women for whom clear evidence of efficacy is available. We supplement this information, however, with estimates of the cost-effectiveness of treating certain high-risk groups of younger women, while acknowledging the greater uncertainty involved.. We developed a Markov model for analyzing the occurrence and timing of hip fractures, based almost entirely on peer-reviewed data from Sweden. In a 3-year randomized clinical trial, the combination of calcium and vitamin D3 was shown to reduce the risk of hip fractures by 27%. Costs for treating hip fractures were based on 1,080 women who were hospitalized in Stockholm.. Treatment of 70-year-old women was cost saving at efficacy as low as two-thirds that seen in the clinical trials, and upwards. Even at modest rates of efficacy, treatment of the high-risk 50- and 60-year-old cohorts was generally cost-effective and in some cases even cost saving. Particularly cost-effective was treatment of women with identified osteoporosis or a maternal family history of hip fracture.. Simulation results suggest a role for lifetime treatment of older women with calcium and vitamin D3 in Sweden. While there is more uncertainty underlying the treatment of younger women, our simulation results suggest that treatment may also be cost saving or at least cost-effective for many cohorts of high-risk 50- and particularly 60-year-old women, in particular those with osteoporosis or a maternal family history of hip fracture.

Topics: Aged; Aged, 80 and over; Calcium; Cholecalciferol; Clinical Trials as Topic; Cohort Studies; Cost of Illness; Cost-Benefit Analysis; Data Collection; Female; Hip Fractures; Humans; Incidence; Markov Chains; Middle Aged; Osteoporosis; Quality of Life; Quality-Adjusted Life Years; Sweden; Treatment Outcome

Osteoporosis features include reduction of bone mass and increased predisposition to fractures. Osteoporosis is considered as one of frequent diseases developing in menopausal women and old men. The values of peak bone mass are the determinant of osteoporosis development. It is estimated that the peak bone mass is reached at the age between 16 and 30 years. (NIH Consensus, 2001). Insufficient intake of calcium and vitamin D in diet, with reduced sun exposure, low physical activity, low body weight are well documented risk factors for this disease in human. For that reason, in osteoporosis prevention it should be tried to ensure adequate supply of calcium in diet from early life, with adequate supply of vitamin D, as factors determining adequate mineralization of osseous tissue. The study was carried out for assessing changes of the levels of calcium and 25-OH cholecalciferol in serum replacing butter in usual diet with margarine enriched with vitamin D. After a period of diet stabilization the study group received first diet with butter, followed by diet with margarine in place of butter. Throughout the whole experiment the diet contained unchanged amounts of dairy products as a source of alimentary calcium. In the experiment 41 young healthy men aged 22.6 +/- 1.2 years participated. Every subject consumed in a period of 4 weeks 30 g of butter daily, and during the following 4 weeks margarine 30 g daily. Substitution of margarine for butter in usual diet raised 25-OH cholecalciferol level in serum by 5.56 ng/ml, that is 32.4% (p < 0.001), with consequent 0.12 mg (5%) rise of serum calcium level (p < 0.05). The intake of calcium with diet from dairy products was unchanged throughout the experiment 576-581 mg daily, that is 72% of the recommended intake. The obtained results suggest that independently of the amount of vitamin D intake with food and calcium with diet substitution of margarine enriched with vitamin D for butter was beneficial raising serum vitamin D level, and at the same time increasing calcium absorption from food. It can be accepted that the obtained results could support the opinion on beneficial effects of the consumption of high-quality margarine in daily diet as prevention of the development not only of atherosclerosis but also osteoporosis.

Topics: Adult; Bone and Bones; Butter; Calcium; Cholecalciferol; Dietary Supplements; Humans; Male; Margarine; Osteoporosis; Poland; Risk Factors; Time Factors; Vitamin D

Patients with chronic liver disease (CLD) have an increased prevalence of osteoporosis. The aim of this study was to evaluate prospectively the rate of bone loss and potential predictors of increased bone loss in a cohort of patients with CLD.. Bone mineral density (BMD) was measured at baseline and at follow-up by dual-energy X-ray absorptiometry at the lumbar spine and the femoral neck.. Forty-three patients (31 female, 12 male) were available for a second measurement of BMD, with a median of 25 months (range 18-41) between the measurements. Mean annual bone loss at the lumbar spine and the femoral neck, respectively, was 0.6 +/- 2.0% and 1.5 +/- 2.4% in females and 0.8 +/- 1.9% and 2.9 +/- 2.0% in males. The BMD Z score decreased significantly over time at the femoral neck (P = 0.005 and P = 0.02 for females and males, respectively). Bone loss was increased significantly at the lumbar spine in patients classified as Child-Pugh B + C compared with those classified as Child-Pugh A (P = 0.04). Serum levels of bilirubin correlated independently and positively, and 25-hydroxy vitamin D3 levels negatively, with bone loss at the femoral neck.. Patients with CLD have increased bone loss at the femoral neck. Advanced liver disease is associated with increased bone loss, and hyperbilirubinaemia and low levels of vitamin D3 are predictors of increased bone loss.

Topics: Adult; Aged; Aged, 80 and over; Bone Density; Cholecalciferol; Chronic Disease; Female; Femur Neck; Humans; Hyperbilirubinemia; Liver Diseases; Lumbar Vertebrae; Male; Middle Aged; Osteoporosis; Prospective Studies

Pregnancy-associated osteoporosis is a rare condition. Due to the rareness of pregnancy-associated osteoporosis, no guidelines concerning an adequate therapy exist. However, since many antiresorptive drugs are potentially teratogenous, the therapeutic approach is limited.. In a 30-year-old patient, pubic fracture occurred during her first pregnancy. Osteodensitometry revealed a distinct osteoporosis. The bone density improved under therapy with sex hormones, alendronate, 1,000 mg calcium and 1,000 IU cholecalciferol daily, but still remained osteoporotic when the patient again became pregnant 3 years later. During her triplet pregnancy the patient was treated with 3,000 mg calcium and 1,500 IU cholecalciferol daily. After delivery the bone density remained at the same level as immediately before the second pregnancy.. Regarding the nonoccurrence of the expected considerable bone loss with this treatment the efficacy of this therapeutic approach during pregnancy warrants further study.

Topics: Adult; Alendronate; Bone Density; Calcium Channel Agonists; Calcium, Dietary; Cholecalciferol; Contraindications; Drug Therapy, Combination; Female; Fractures, Spontaneous; Humans; Osteoporosis; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy, Multiple; Pubic Bone; Radiography; Secondary Prevention; Treatment Outcome

The chronotherapeutic effects of 1-alpha-(OH) vitamin D3, a pro-drug of 1,25(OH)2 vitamin D3 (1,25(OH)2D3), were evaluated by repeated dosing of the drug in aged stroke-prone spontaneously hypertensive male rats, a model of osteoporosis. Animals (7 months old) were kept in rooms with a 12-h light/dark cycle. Drug (0.5 microg/kg) or vehicle was given once daily at 2 or 14 h after lights on for 3 months. The severity of adverse effects such as body weight loss, hypercalcemia and hyperphosphatemia was significantly less when the drug was given at 14 h after lights on (14 HALO). Serum 1,25(OH)2 vitamin D3 concentrations of 2 h after lights on (2 HALO) group and 14 HALO group did not differ significantly after dosing. The decrease in parathyroid hormone (PTH) level 12 weeks after the start of the study was greater in the 14 HALO group than in the 2 HALO group. Urinary excretion of inorganic Ca and P in the 2 HALO group was greater than that in the 14 HALO group. Urinary excretion of deoxypyridiniline, an index of the bone resorption capacity of osteoclasts, was much suppressed in the 14 HALO group, suggesting that the efficacy of vitamin D3 for suppressing bone resorption might vary with the dosing time. The increase in bone density of both femurs, determined by dual-energy X-ray absorption at the end of the study, was greater in the 14 HALO group than in the 2 HALO group. This is the first study to show the dosing time-dependent efficacy and toxicity of active vitamin D3 in an animal model of osteoporosis. These results indicate that a chronopharmacological approach is beneficial for establishing a more effective and/or safer regimen of active vitamin D3 for the treatment of osteoporosis.

Topics: Aging; Amino Acids; Animals; Body Weight; Bone Density; Calcium; Cholecalciferol; Chronotherapy; Disease Models, Animal; Hypercalcemia; Hypertension; Male; Osteoporosis; Parathyroid Hormone; Phosphates; Rats; Rats, Inbred SHR; Steroid Hydroxylases; Time Factors; Weight Loss

Topics: Alkaline Phosphatase; Amino Acids; Biomarkers; Bone Resorption; Cholecalciferol; Collagen; Collagen Type I; Diphosphonates; Enzyme-Linked Immunosorbent Assay; Hormone Replacement Therapy; Humans; Osteoporosis; Peptides

Topics: Bias; Cholecalciferol; Clinical Laboratory Techniques; Humans; Osteoporosis; Radioimmunoassay; Reference Values; Vitamin D

Chronic pancreatitis is a longlasting inflammatory disease manifested clinically in the advanced stage by malabsorption syndrome. Its manifestations include also changes in the calcium metabolism and the occurrence of osteoporosis and osteomalacia or their combination. The objective of the study was to assess the vitamin D3 blood concentration in patients with chronic pancreatitis. The group comprised 15 patients (8 men and 7 women), median age 45.0 years. The authors found a significantly reduced serum concentration of vitamin D3 (p < 0.01) in patients with chronic pancreatitis. They assume that vitamin D deficiency is one of the decisive causes of bone complications in prolonged pancreatitis. Supplementation with vitamin D or its metabolites is then a necessary part of preventive and therapeutic provisions.

Topics: Adult; Aged; Cholecalciferol; Chronic Disease; Female; Humans; Male; Middle Aged; Osteomalacia; Osteoporosis; Pancreatitis; Vitamin D Deficiency

Topics: Adult; Cholecalciferol; Diagnosis, Differential; Diagnostic Imaging; Female; Humans; Low Back Pain; Osteoporosis; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third

Although alfacalcidol is widely used in the treatment of osteoporosis, its mechanism of action in bone is not fully understood. Alfacalcidol stimulates intestinal calcium (Ca) absorption, increases urinary Ca excretion and serum Ca levels, and suppresses parathyroid hormone (PTH) secretion. It remains to be clarified, especially under vitamin D-replete conditions, whether alfacalcidol exerts skeletal effects solely via these Ca-related effects, whether the resultant suppression of PTH is a prerequisite for the skeletal actions of alfacalcidol, and, by inference, whether alfacalcidol has an advantage over vitamin D in the treatment of osteoporosis. To address these issues, we (1) compared the effects of alfacalcidol p.o. (0.025-0.1 microg/kg BW) vis-à-vis vitamin D(3) (50-400 microg/kg BW) on bone loss in 8-month-old, ovariectomized (OVX) rats as a function of their Ca-related effects, and (2) examined whether the skeletal effects of alfacalcidol occur independently of suppression of PTH, using parathyroidectomized (PTX) rats continuously infused with hPTH(1-34). The results indicate that (1) in OVX rats, alfacalcidol increases BMD and bone strength more effectively than vitamin D(3) at given urinary and serum Ca levels: larger doses of vitamin D(3) are required to produce a similar BMD-increasing effect, in the face of hypercalcemia and compromised bone quality; (2) at doses that maintain serum Ca below 10 mg/dl, alfacalcidol suppresses urinary deoxypyridinoline excretion more effectively than vitamin D(3); and (3) alfacalcidol is capable of increasing bone mass in PTX rats with continuous infusion of PTH, and therefore acts independently of PTH levels. It is suggested that alfacalcidol exerts bone-protective effects independently of its Ca-related effects, and is in this respect superior to vitamin D(3), and that the skeletal actions of alfacalcidol take place, at least in part, independently of suppression of PTH. Together, these results provide a rationale for the clinical utility of alfacalcidol and its advantage over vitamin D(3) in the treatment of osteoporosis.

Topics: Animals; Bone Resorption; Calcium; Cholecalciferol; Female; Femur; Humans; Hydroxycholecalciferols; Lumbar Vertebrae; Osteoporosis; Parathyroid Hormone; Rats; Rats, Wistar; Tibia

Topics: Age Factors; Aged; Aged, 80 and over; Cholecalciferol; Clinical Trials as Topic; Female; Femoral Fractures; Fractures, Bone; Humans; Male; Osteoporosis; Risk Factors; Time Factors; Vitamin D; Vitamin D Deficiency

Topics: Cholecalciferol; Cortisone; Crohn Disease; Drug Therapy, Combination; Female; Humans; Middle Aged; Osteoporosis; Psoriasis; Risk Factors; Treatment Outcome

To study effects of calcium (1000 mg/day) and vitamin D3 (Calcium-D3 Nikomed, 400 IN/day) in the treatment of steroid osteoporosis.. Calcium-D3 Nikomed was used in combined treatment of 20 patients with hormone-dependent bronchial asthma (BA) receiving glucocorticoid tablets in daily dose 5-40 mg (prednisolone calculation), mean dose 20.4 mg. Density of bone tissue was measured by CT of the lumbar spine (L2-L4), concentrations of osteocalcine and 25 (OH) vitamin D3--by radioimmunoassay, serum and 24-h urine calcium--by atomic-absorption spectrophotometry and selective ionometry.. Calcium-D3 Nikomed intake for 6 months (2 tablets a day) resulted in decline of ossalgia, inhibition of bone tissue density loss, elevation of D3 vitamin 25 (OH) concentration in blood serum. Concentrations of osteocalcine, blood and 24-h urine calcium were close to the baseline. Therapeutic effect of physiological doses of vitamin D3 may be due to normalization of cholecalcipherol metabolism, activation of calcium intestinal absorption and suppression of bone resorption entailed by long-term administration of glucocorticoid tablets.. High clinical efficiency and absence of side effects recommend calcium-D3 Nikomed for management of steroid osteoporosis in patients with hormone-dependent bronchial asthma.

Topics: Adult; Asthma; Calcifediol; Calcium; Calcium Carbonate; Cholecalciferol; Drug Combinations; Female; Glucocorticoids; Humans; Male; Middle Aged; Osteocalcin; Osteoporosis; Prednisolone; Radioimmunoassay; Spectrophotometry, Atomic; Substance-Related Disorders; Treatment Outcome

Further studies of mimosine toxicity in broiler chicks were done to clarify a possibility of osteopathy. The mineral content and density of femur and the strength, ductility, and toughness for the index of mechanical properties significantly decreased in the 1% mimosine group, compared with those in the control and restricted groups. The stiffness had a decreasing tendency in the 1% mimosine group. Consequently, it was concluded that chicks fed ad libitum a 1% mimosine diet for 12 days developed osteopathy. The bone mineral density and the strength of the restricted group were lower than those of the control group, and those of the 1% mimosine group were still lower than those of the restricted group. Contents of pyridinoline and deoxypyridinoline in the excrement were significantly higher in the restricted group than those in the control group, but the contents in the 1% mimosine group were significantly lowest among the groups. Osteopathy in chicks fed mimosine, therefore, seemed to be done by loss of appetite and changing to a low turnover of bone caused by mimosine.

Topics: Amino Acids; Animal Feed; Animals; Body Weight; Bone Density; Calcifediol; Calcium; Chickens; Cholecalciferol; Corticosterone; Fabaceae; Femur; Iron; Magnesium; Male; Mimosine; Organ Size; Osteoporosis; Plant Poisoning; Plants, Medicinal; Zinc

Sex steroids were suggested as regulators of vitamin D metabolism. While considerable data is available regarding interaction between estradiol and vitamin D, very little is known about interactions between testosterone and vitamin D. A similar gap exists with regard to the involvement of the vitamin D endocrine system in the pathogenesis of the female versus the male osteoporosis syndrome. In the present study we studied the effect of long-term treatment with testosterone on the metabolism of vitamin D in vitamin D3 replete sexually immature male chicks. We were able to show under this treatment, circulating levels of 1,25-dihydroxy vitamin D3 (1,25(OH)2D3) are significantly reduced, but intestine and bone concentrations are significantly increased. The increased concentration of 1,25(OH)2D3 in bone was accompanied by an increase in the ash content of this tissue. The reduction in serum 1,25(OH)2D3 was not dependent on reduced activity of the renal 25-hydroxy vitamin D3 - alpha - hydroxylase. Based on these findings it is proposed that testosterone is involved in the stimulation of the biological response to vitamin D in the classical target-organs, such as intestine and bone, and this observation may provide partial explanation to the pathogenesis of osteoporosis in hypogonadal men.

Topics: Animals; Bone and Bones; Bone Density; Calcifediol; Calcitriol; Chickens; Cholecalciferol; Female; Humans; Intestinal Mucosa; Male; Osteoporosis; Testosterone

Topics: Adrenal Cortex Hormones; Calcium Carbonate; Cholecalciferol; Humans; Osteoporosis

Topics: Aging; Bone Density; Calcifediol; Calcitriol; Cholecalciferol; Humans; Osteoporosis; Vitamin D

Topics: Aged; Calcium; Cholecalciferol; Dose-Response Relationship, Drug; Female; Humans; Male; Osteoporosis; Practice Guidelines as Topic; Risk Factors

Topics: Aged; Calcium; Calcium Gluconate; Calcium Phosphates; Cholecalciferol; Drug Combinations; Female; Fractures, Spontaneous; Germany; Humans; Middle Aged; Osteoporosis

Topics: Aged; Aged, 80 and over; Calcium; Cholecalciferol; Drug Therapy, Combination; Female; Humans; Male; Osteoporosis; Patient Compliance

Topics: Aged; Calcitonin; Calcitriol; Calcium; Cholecalciferol; Estrogen Replacement Therapy; Female; Fluorides; Humans; Middle Aged; Osteoporosis; Parathyroid Hormone; Postmenopause

Topics: Bone and Bones; Cholecalciferol; Osteoporosis; Vitamin D

Topics: Calcium; Cholecalciferol; Female; Humans; Male; Osteoporosis

Topics: Cholecalciferol; Fractures, Bone; Humans; Osteoporosis; Xanthomatosis

Topics: Aged; Aged, 80 and over; Bone Density; Cholecalciferol; Female; Humans; Hydroxycholecalciferols; Lumbosacral Region; Middle Aged; Osteoporosis; Ovariectomy; Spine; Time Factors

Topics: Aged; Bone and Bones; Calcitonin; Cholecalciferol; Estrogens; Female; Humans; Osteoporosis

In the femoral extremities of the adult rat containing the metaphysis, the epiphyseal cartilage, and the epiphysis, four alkaline phosphatase (AP) forms were distinguished on polyacrylamide gel electrophoresis. Two soluble forms were present in the 160,000 g supernatant: one of Mr 165 kDa and another of Mr 110-115 kDa, which exhibited a strong catalytical activity. Moreover, from the pellet, three membrane-bound forms of Mr 130, 110-115, and 100 kDa could be extacted with sodium deoxycholate. When denaturated AP was visualized by postelectrophoretic autoradiography of the phosphorylated intermediates, subunits always appeared as three monomers of Mr 75-80, 60-70, and 50-60 kDa. As four native forms but only three types of subunits were found to be present in the femur, it seems that, apart from homodimers, some heterodimers could also occur. Three types of diets were administered to three groups of rats for 5 weeks. Two are known to disturb bone mineralization: (1) a vitamin D3-deficient diet, and (2) the same as (1) but enriched with 12% sorbitol. The third was a normal diet containing vitamin D3. Concerning the effects on AP of dietary sorbitol and the vitamin D3-deficient diet, it was found that rats receiving the diet supplemented with sorbitol showed a substantial rise in the activity of the Mr 165 kDa form with the concomitant appearance of a new monomer of Mr 100 kDa. In contrast, rats fed the vitamin D3-deficient diet always displayed an increase in enzyme activity, principally of the Mr 100 and 110 kDa forms.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Alkaline Phosphatase; Animals; Bone Density; Cholecalciferol; Electrophoresis, Polyacrylamide Gel; Femur; Food, Formulated; Growth Plate; Isoenzymes; Male; Osteoporosis; Rats; Rats, Inbred Strains; Rickets; Sorbitol; Vitamin D Deficiency

A new hypothesis is presented for the first time to explain the etiology of osteoporosis. Prostaglandins (E2 and F2 alpha) at precise concentrations, have been observed to be involved in bone formation. A close association exists between levels of prostaglandins (E2 and F2 alpha) demonstrated in the neonatal mouse leading to bone formation, with estimated prostaglandins (E2 and F2 alpha) concentrations reported in man. Several hormones (vasopressin, oxytocin, luteinizing hormone, follicle-stimulating hormone, cortisol, estradiol, and testosterone) can indirectly affect prostaglandin formation leading to reduced bone formation. The association between these hormones and prostaglandins (E2 and F2 alpha) explains the physiological mechanism whereby estradiol can be effective for the treatment of osteoporosis. This association also explains the etiology of lumbar spondylitis/spondylodynia, reasons for complaints of increased pain in wet cold weather among arthritics and a multitude of other events. Mechanisms related to this interaction between various hormones and the effect of prostaglandins (E2 and F2 alpha) on bone formation are discussed.

Topics: Animals; Bone and Bones; Bone Development; Bone Resorption; Calcitonin; Cholecalciferol; Cortisone; Dinoprost; Dinoprostone; Female; Humans; Menopause; Models, Biological; Osteoporosis; Oxytocin; Parathyroid Hormone; Vasopressins

Radiological investigation of the vertebral column in two patients with low-back pain (53-year-old woman and a 52-year-old man) revealed unusually marked osteoporosis and sintering fractures of the 3rd, and 1st and 4th lumbar vertebrae, respectively. Biochemical tests failed to provide any evidence about metabolic or endocrinological abnormality. Iliac crest biopsy showed mastocytosis. There were no skin changes in either patient. Additional examinations excluded involvement of any internal organs. Despite treatment with calcium, sodium fluoride, vitamin D3 and calcitonin in the woman, and aspirin and chromoglycinic acid in the man the osteoporosis has slowly progressed during the last 7 and 5 years, but the disease has remained limited to the skeletal system. In a case of unusually marked osteoporosis, mastocytosis should be included in the differential diagnosis even in the absence of urticaria pigmentosa.

Topics: Aspirin; Bone Marrow Examination; Calcitonin; Calcium; Cholecalciferol; Diagnosis, Differential; Female; Humans; Lumbar Vertebrae; Male; Mastocytosis; Middle Aged; Osteoporosis; Sodium Fluoride; Spinal Fractures; Time Factors

A 37-year-old male with cerebrotendinous xanthomatosis showed brain abnormal MRI findings and osteoporosis. His parents had no similar symptoms. He had mental retardation since childhood. Swelling of Achilles tendons was noticed at age 28, and gait disturbance appeared at age 34. Physical examination revealed bilateral cataracts and swelling of Achilles tendons. Neurologically, he showed mental retardation, cerebellar ataxia and spastic tetraparesis. Cerebrotendinous xanthomatosis was diagnosed by marked elevations of serum cholestanol level (24.3 micrograms/ml) and cholestanol/cholesterol ratio (1.81%) as well as characteristic clinical manifestations. On brain MRI study, T2-weighted sequence showed bilateral focal lesions with high intensity signal in the globus pallidus and cerebellar white matter adjacent to the dentate nucleus, and T1-weighted sequence showed low to iso-intensity signal in the same regions. These findings suggested demyelination rather than xanthoma or lipid infiltration. Radiological examination showed mild osteoporosis of lumbar bone. However, serum levels of vitamin D3 and calcitonin were within normal range, and renal function was normal. Osteoporosis in this patient possibly resulted from disuse bone atrophy for several years. The combination therapy of oral administration of chenodeoxycholic acid and HMG-CoA reductase inhibitor (pravastatin), and LDL apheresis slightly improved EEG abnormality and gait disturbance, but not brain MRI abnormality.

Topics: Adult; Brain; Brain Diseases; Cholecalciferol; Humans; Intellectual Disability; Magnetic Resonance Imaging; Male; Muscular Diseases; Osteoporosis; Tendons; Xanthomatosis

Increasing pain in the region of the lumbar vertebrae occurred in a 23-year-old woman known for the past 6 1/2 years to have Crohn's disease affecting the ileocolon. Radiology revealed marked osteopenia with collapse and deformation of the vertebral bodies. The only pointer to a bone disease was a markedly lowered serum level of 25-OH-vitamin D (less than 10 ng/ml). Biopsy from the ileal crest revealed pure osteoporosis without osteomalacia. Decisive pathogenetic factors were, in the main, glucocorticoid medication, malnutrition and the long duration of Crohn's disease. During treatment with monofluorophosphate, 152 g daily, in fixed combination with 600 mg calcium as well as calcitonin (initially 100 I.U. daily subcutaneously for two weeks, then 100 I.U. every other day s.c.) and vitamin D (3 x 1,000 I.U. daily by mouth) she became free of symptoms, and she has remained so for 9 months.

Topics: Adult; Biopsy; Bone Density; Cholecalciferol; Combined Modality Therapy; Crohn Disease; Female; Humans; Ilium; Lumbar Vertebrae; Osteoporosis; Tomography, X-Ray Computed

Topics: Adult; Calcium; Cholecalciferol; Crohn Disease; Female; Humans; Male; Osteoporosis

Adult laying hens were fed diets deficient in phosphorus, calcium, calcium and phosphorus, and vitamin D3 to determine their effects on bone histology and parathyroid gland size. The phosphorus deficient diet caused an insignificant decrease in parathyroid size while the other diets caused significant increases. A considerable amount of individual variation in medullary bone volume and osteoid seam width was observed in all groups but, despite this, the calcium, calcium and phosphorus and vitamin D3 deficient diets clearly resulted in increased osteoid. Birds receiving diets deficient in calcium and phosphorus, and in vitamin D3 for longer periods were observed to have partially or completely resorbed medullary bone. Osteodystrophia fibrosa was noted in vitamin D3 deficient birds which had no follicular activity.

Topics: Animals; Calcium; Chickens; Cholecalciferol; Female; Femur; Osteoporosis; Oviposition; Parathyroid Glands; Phosphorus; Poultry Diseases

Topics: Adult; Age Factors; Bone and Bones; Calcitriol; Calcium; Cholecalciferol; Diagnosis, Differential; Humans; Male; Osteoporosis; Radiography

Treatment of patients with osteoporosis includes drugs to influence bone metabolism but also gymnastics for pain relief and in order to improve mobility in general. Fluorides (20 to 25 mg ions/day) are used in patients, where reduction in bone mass caused vertebral fractures. Their beneficial effects were proven in clinical studies; recent studies, however, did not confirm this. Calcium (1000 mg/day) and Vitamin D3 (3000 units/day) complete therapy. Calcitonins (3 x 100 units/week) are given to patients during progressioning fracturing and in painful disease. Diphosphonates have been used as experimental therapy, but they are still not available for general use.

Topics: Aged; Calcitonin; Calcium; Cholecalciferol; Exercise Therapy; Fluorides; Fractures, Bone; Humans; Osteoporosis; Self-Help Groups

Investigation of 44 patients with endogenous hypercorticism (EH) of various degrees of severity showed that the development of osteoporosis was accompanied by changes in the indices of calcium-phosphorus metabolism and calcium regulating hormones. Marked variations in the level of parathyroidin, calcitonin, vitamin D3 were observed in a severe type of EH. All the examinees were characterized by a decrease in the transport form of vitamin D3, which was most noticeable in a mild form of EH. A significant decrease in the concentration of the transport form of vitamin D3 against a background of hypercalcemia and hypercalciuria in mild EH can be regarded as the most informative indicators in early diagnosis of initial symptoms of osteoporosis.

Topics: Adolescent; Adrenocortical Hyperfunction; Adult; Biological Transport; Calcium; Calcium-Binding Proteins; Cholecalciferol; Combined Modality Therapy; Female; Homeostasis; Humans; Male; Middle Aged; Osteoporosis; Phosphorus

Topics: Aged; Calcitonin; Cholecalciferol; Drug Evaluation; Drug Tolerance; Female; Humans; Male; Middle Aged; Osteoporosis; Parathyroid Hormone

The available methods to quantitate vertebral deformity in osteoporotics are not satisfactory in comparing follow-up measurements in patients. This paper describes a newly developed 'spine deformity index' (SDI) which allows the quantitation of the extent of vertebral fractures. It is based on the observation that, in 110 normal persons, the heights of all vertebral bodies were related to each other in a predictable and constant manner. This relation was independent of the body height of the individual and was preserved despite growth acceleration during the last century. Since in all but one of our osteoporotic patients the 4th thoracic vertebra was unfractured we were able to compare the actual size of their fractured vertebrae to the calculated presumable original heights. The differences between presumable original and actual heights gave a measure of the extent of vertebral compression and allowed to define an index representing the sum of all spinal fractures in osteoporotics. The method was applied retrospectively to X-rays of 39 patients with idiopathic osteoporosis. Thirty-two of them were treated orally with 80 mg sodium fluoride, 1,000 mg calcium and 3000 IE vitamin D daily. Treatment resulted in a reduction of the progression of vertebral deformity. Seven inadequately treated patients had more pronounced progression of vertebral deformity.

Topics: Adult; Aged; Anthropometry; Body Height; Calcium; Cholecalciferol; Female; Fractures, Bone; Humans; Male; Middle Aged; Osteoporosis; Sodium Fluoride; Thoracic Vertebrae

An epidemiological study was carried out to elucidate whether or not there are bone changes peculiar to diabetes. The subjects of this study were 100 diabetic patients. The MD method and the Jikei method for classification of spinal bone atrophy were employed as the tools of this study. Cases with a severity of Grade I or higher were detected in 18% (18 patients) of the subjects by the MD method and 19% (19 patients) by the Jikei method. When factor analysis was performed on osteopenia cases on the basis of patient background, it was found that the incidence of osteopenia increased in proportion to the severity of diabetes. Serum Ca, P and Al-P were determined in all subjects, and biochemical endocrinological factors such as Ca-regulating hormone were determined in 60 subjects. 24,25(OH)2D3 was found to be decreased in 65% of the subjects. The disturbance of vitamin D metabolism thus appears to be generally present in patients with diabetic osteopenia.

Topics: Adolescent; Adult; Aged; Alkaline Phosphatase; Calcitonin; Calcium; Cholecalciferol; Diabetes Complications; Diabetes Mellitus; Female; Humans; Male; Middle Aged; Osteoporosis; Phosphorus

Topics: Cholecalciferol; Humans; Osteoporosis; Rickets; Vitamin D; Vitamin D Deficiency

Topics: Animals; Bone and Bones; Calcium; Cell Membrane Permeability; Cholecalciferol; Female; Kidney; Male; Osteoporosis; Rats; Rats, Inbred Strains; Vitamin A; Vitamin E

The effect of a pulse dose of Vitamin D3 on uptake of [99mTc]MDP by fractured and osteoporotic bone, respectively, was compared with D3's effect on uptake by normal bone in rats. At 4, 7, and 14 days, respectively, after femoral fracture, basal uptake was significantly (p less than 0.005) increased at the fracture site by 336.8, 276.1, and 183.5%, respectively, over the contralateral control site. D3-treated rats had lower uptakes than untreated controls at all three fracture sites and at 12 of 15 normal bone sites but analysis of variance showed the uptake differences were not significant. Cortisone-induced osteoporosis caused a significant (p less than 0.05) decrease in basal uptake. The decrease occurred in all nine bone areas studied. D3 caused a significant (p less than 0.05) increase (mean 16.2%) in uptake by these osteoporotic bones, but a significant (0.1 greater than p greater than 0.05) decrease (mean 13.0%) in uptake by the same bones in normal controls. Thus, D3 had an effect on uptake by the bone lesion, osteoporosis, that differed from D3's effect on uptake by fracture or normal bone.

Topics: Animals; Bone and Bones; Cholecalciferol; Cortisone; Diphosphonates; Female; Femoral Fractures; Femur; Male; Osteoporosis; Rats; Rats, Inbred Strains; Technetium; Technetium Tc 99m Medronate; Time Factors

The effects of active vitamin D3 analogues on radial mineral content (RMC) in postmenopausal osteoporosis were examined. Seventy eight subjects with postmenopausal osteoporosis were divided into 5 groups; Group 1 (n = 23) as the control group and Group 2 (n = 27), Group 3 (n = 8), Group 4 (n = 9) and Group 5 (n = 11) which were given 1 microgram of 1, 24(R) (OH)2D3 per day, 1 microgram of 1, 24(S)(OH)2D3 per day, 0.5 and 1 microgram of 1 alpha-OHD3 per day for 6 to 24 months, respectively. After 3-months administration of these drugs, RMC values were significantly increased in Groups 2 (102.8 +/- 1.8%), 4 (103.9 +/- 3.3%) and 5 (114.2 +/- 3.6%), when compared with the controls (97.9 +/- 2.4%). RMC in Group 3 (97.9 +/- 2.4%) was not significantly different from the control value. The administration of 1 alpha-OHD3 caused in increase in RMC in a dose-related manner. A rapid decrease in RMC was observed after withdrawal of the treatment in Groups 2, 4, and 5. A subsequent increase in RMC was observed after re-administration of 1 alpha-OHD3 and 1, 24(R)(OH)2D3. Serum Ca levels were increased in the group treated with 1, 24(R)(OH)2D3 and were decreased after the discontinuation of 1 alpha-OHD3 administration. Serum A1-P activity was decreased by treatment with 1 alpha-OHD3 (1 microgram per day) and a subsequent increase was observed in both groups treated with 1, 24(R)(OH)2D3 and 1 alpha-OHD3. Serum PTH levels were decreased by the administration of 1, 24(R)(OH)2D3 and 1 alpha-OHD3. In the group treated with 1 microgram of 1 alpha-OHD3 per day, hypercalcemia (2 out of 11 cases and these patients took calcium tablets) and an increase in BUN (1 out of 2 hypercalcemic patients) were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Alkaline Phosphatase; Calcifediol; Calcitriol; Calcium; Cholecalciferol; Female; Humans; Hydroxycholecalciferols; Menopause; Osteoporosis; Parathyroid Hormone; Phosphorus; Time Factors

Topics: Acute Kidney Injury; Aged; Bone Marrow Diseases; Cholecalciferol; Female; Humans; Hypercalcemia; Osteoporosis; Sarcoidosis

Two patients with moderate renal failure sustained spontaneous bilateral hip fractures during treatment with fluoride, calcium, and vitamin D for osteoporosis. They had been taking sodium fluoride (40-60 mg/day) for 11 and 21 months, respectively. Histological examination of a specimen of the bone showed severe fluorosis in the first case, and quantitative analysis of bone showed osteomalacia and skeletal fluorosis in the other case. These abnormalities were considered to be the consequence of excessive retention of fluoride due to renal insufficiency. As bilateral femoral neck fractures are very rare these data suggest a causal link between fractures and fluoride in patients with renal failure. Thus fluoride should be given at a lower dosage, if at all, to patients with even mild renal failure.

Topics: Aged; Bone and Bones; Calcium; Cholecalciferol; Drug Therapy, Combination; Female; Femoral Neck Fractures; Fractures, Spontaneous; Humans; Kidney Failure, Chronic; Osteomalacia; Osteoporosis; Sodium Fluoride

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

Recognition over the last ten years of the fact that vitamin D does not act as such, but must be converted into a hormonal form, has filled in the picture physiological endocrine regulation of calcium and phosphate homeostasis. While vitamin D has thus lost the dietetic significance associated with it for over 50 years. Nevertheless, new interpretations of the aetiopathogenesis of many demineralizing bone diseases are of much greater utility. Nor is it futuristic to suppose that all the biochemical parameters establishing one of the metabolisms that are under strict homeostatic control in the body, such as that of calcium and that of phosphate, are understood.

Topics: Bone Diseases; Calcium; Cholecalciferol; Chronic Kidney Disease-Mineral and Bone Disorder; Glucocorticoids; Humans; Hypoparathyroidism; Iatrogenic Disease; Intestinal Absorption; Osteomalacia; Osteoporosis; Phosphates; Rickets; Vitamin D

Calcium and phosphate metabolism as well as those substances which are essential in regulating this metabolism (parathyroid hormone, thyrocalcitonin and cholecalciferol) are briefly discussed. Of three known forms of bone disease (nutritional secondary hyperparathyroidism, rickets and hypervitaminosis A), the clinical symptoms, radiological changes, (histo)pathological findings, therapeutic procedures as well as the aetiological, pathogenic and pathophysiological features will be reviewed.

Topics: Animal Nutritional Physiological Phenomena; Animals; Birds; Bone and Bones; Bone Diseases; Calcitonin; Cat Diseases; Cats; Cholecalciferol; Dog Diseases; Dogs; Hyperparathyroidism, Secondary; Minerals; Osteoporosis; Parathyroid Hormone; Rickets; Vitamin A

Topics: Calcium Metabolism Disorders; Cholecalciferol; Chronic Kidney Disease-Mineral and Bone Disorder; Ergocalciferols; Humans; Hypoparathyroidism; Osteomalacia; Osteoporosis; Phosphorus Metabolism Disorders; Renal Dialysis; Vitamin D

Topics: Alkaline Phosphatase; Bendroflumethiazide; Bone and Bones; Calcium; Cholecalciferol; Estrogens; Female; Humans; Menopause; Middle Aged; Minerals; Osteoporosis; Phosphates; Sodium Fluoride

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

A half century ago, vitamin D was recognized as a vitamin. Now it has become clear that it is also a hormone--indeed the biochemical cornerstone of a major hormonal system involved in regulating the body's calcium economy. The active metabolite, calcitriol, produced in the kidney, acts on bone and intestine and has been found effective in therapy of osteodystrophy and perhaps other metabolic bone diseases.

Topics: Calcium; Cholecalciferol; Chronic Kidney Disease-Mineral and Bone Disorder; Humans; Hypoparathyroidism; Hypophosphatemia, Familial; Osteoporosis; Phosphates; Phosphorus; Vitamin D

Topics: Acid-Base Equilibrium; Adolescent; Adult; Aged; Calcitonin; Calcium; Child; Child, Preschool; Cholecalciferol; Cholesterol; Humans; Hyperparathyroidism; Hypocalcemia; Infant; Infant, Newborn; Intestinal Absorption; Middle Aged; Osteoporosis; Parathyroid Hormone; Phosphates; Tetany; Vitamin D

Topics: Adult; Aged; Aging; Calcium; Cholecalciferol; Dihydroxycholecalciferols; Estradiol; Female; Fractures, Bone; Humans; Hydroxycholecalciferols; Male; Middle Aged; Osteoporosis; Parathyroid Hormone; Sex Factors; Testosterone

Topics: Animals; Bone and Bones; Calcification, Physiologic; Cholecalciferol; Coturnix; Egg Shell; Female; Hydroxycholecalciferols; Osteoporosis; Oviposition; Quail; Structure-Activity Relationship; Tibia

The metabolism of isotopically-labelled cholecalciferol and the response to small doses of 1,25-dihydroxycholecalciferol (1,25-(OH)2D3) was studied in a group of women with osteoporosis presenting with crush vertebral fracture. No abnormality of vitamin D metabolism was detected. The administration of 1 microgram 1,25-(OH)2D3 for between 8 and 20 days was associated with an increased intestinal absorption and urinary excretion of calcium but caused no improvement in calcium balance. There was a small but significant rise in serum calcium and phosphorus and significant reduction in immunoassayable parathyroid hormone levels during treatment. It is concluded that 1,25-(OH)2D3 is unlikely to be of value in the management of osteoporosis.

Topics: Aged; Alkaline Phosphatase; Calcium; Cholecalciferol; Creatinine; Dihydroxycholecalciferols; Feces; Female; Humans; Hydroxycholecalciferols; Intestinal Absorption; Middle Aged; Osteoporosis; Parathyroid Hormone; Phosphates; Reference Values; Serum Albumin

Topics: Aged; Calcium; Cholecalciferol; Dihydroxycholecalciferols; Feces; Female; Humans; Hydroxycholecalciferols; Middle Aged; Osteoporosis

Rats deprived of adrenal and gonadel sex hormones are more sensitive than normal rats to the hypercalcaemic (osteolytic) effect of parathormone and toxic doses of vitamin D3. It is suggested that sex hormone deficiency and the consecutive decrease of calcitonin sensitivity in postmenopausal osteoporosis makes the patients unprotected against factors inducing increased bone resorption, and this leads over the years of osteoporosis.

Topics: Adrenalectomy; Animals; Bone Resorption; Calcium; Castration; Cholecalciferol; Female; Gonadal Steroid Hormones; Menopause; Osteoporosis; Parathyroid Hormone; Rats

Topics: Animals; Calcitonin; Calcium; Cholecalciferol; Dihydroxycholecalciferols; Estrogens; Fluorides; Glucagon; Humans; Kidney; Organophosphonates; Osteitis Deformans; Osteoporosis; Parathyroid Glands; Parathyroid Hormone; Plicamycin; Salmon; Swine

Topics: Adult; Aged; Bone Diseases; Calcitonin; Child; Cholecalciferol; Ergocalciferols; Humans; Hypercalcemia; Metabolic Diseases; New Zealand; Organophosphonates; Osteitis Deformans; Osteomalacia; Osteoporosis; Parathyroid Hormone; Sarcoidosis; Vitamin D; Vitamin D Deficiency

Topics: Adult; Age Factors; Aged; Child; Cholecalciferol; Humans; Osteomalacia; Osteoporosis; Rickets; Sex Factors; Ultraviolet Rays; United Kingdom; Vitamin D; Vitamin D Deficiency

Topics: Anticonvulsants; Cholecalciferol; Epilepsy; Half-Life; Humans; Intestinal Absorption; Kidney; Liver; Osteoporosis

Topics: Adult; Age Factors; Alkaline Phosphatase; Biological Transport; Bone and Bones; Bone Resorption; Calcium; Calcium Radioisotopes; Cholecalciferol; Creatinine; Female; Humans; Hydroxyproline; Intestinal Absorption; Male; Middle Aged; Osteoblasts; Osteoclasts; Osteoporosis; Phosphates; Sex Factors; Time Factors; Tritium

Topics: Absorptiometry, Photon; Adrenal Cortex Hormones; Bone and Bones; Bone Diseases; Child; Cholecalciferol; Cobalt Isotopes; Humans; Iodine Radioisotopes; Lead; Methods; Microradiography; Minerals; Nephrotic Syndrome; Osteoporosis; Radioisotopes; Rickets

Isolation of the liver from the circulation of rats eliminates almost completely their ability to convert [1,2]-(3)H vitamin D(3) into its biologically active metabolite, 25-hydroxycholecalciferol, as well as certain other metabolites. It is concluded that the liver is the major if not the only physiologic site of hydroxylation of vitamin D(3) (cholecalciferol) into 25-hydroxycholecalciferol. The osteodystrophy and the higher requirements for vitamin D observed in hepatic insufficiencies may be due to an inability of the liver to transform vitamin D into its metabolically active form.

Topics: Animals; Cholecalciferol; Chromatography; Hepatectomy; Liver; Liver Diseases; Male; Osteomalacia; Osteoporosis; Rats; Rickets; Tritium; Vitamin D

Topics: Adolescent; Adult; Anticonvulsants; Child; Child, Preschool; Cholecalciferol; Epilepsy; Hand; Humans; Leg; Osteoporosis; Radiography

Topics: Animals; Bone Diseases; Cholecalciferol; Deficiency Diseases; Hypocalcemia; Osteoporosis; Rats; Rickets