Comparison of Serum Level of Bone Resorption Markers with Bone Densitometry in Elderly Individuals in Port Harcourt, Rivers State

Introduction: This study concentrated on serum bone markers, N and C-telopeptide and tartrate resistant acid phosphatase (TRAP), and their concentrations were evaluated in the serum of elderly participants and compared with that of the young of the same gender. Markers for bone resorption are proteins, and they are mainly measured in the urine and serum, where theyserve to assess bone turnover.Methodology: A cross-sectional prospective study conducted at the orthopaedic and Family Medicine Departments of the University of Port Harcourt Teaching Hospital, a public tertiary healthcare facility located in Choba and Alakahia communities of Obio/Akpor Local Government Areas of Rivers state, Nigeria, among elderly patients aged 60 years and above.Results: Considering the age of the test population, all the females were post-menopausal and no statistical difference was observed in relation to the results for gender in the study. Also, the plasma creatinine, calcium and albumin results of both controls and participants were within normal reference range. The study was necessitated by the fact that, in the environment of the study (Port Harcourt), elderly individuals frequently complain of bone pain, thus, the serum levels of the aforementioned bone resorption markers (N and C telopeptide and tartrate resistant acid phosphatase) was estimated among these elderly individuals, with the view that its outcome can help physicians to initiate protocols that will prevent the consequences of increased bone resorption, intervenes before bone becomes fragile and aid the prediction of osteoporosis.Conclusion:This study was able to establish that the serum levels of NTX, CTX and TRAP were increased in elderly participants above the age of sixty years than controls

A Cross-sectional Study: Bone Markers in Different Body Mass Index Groups of Newly Diagnosed Breast Cancer Females in Karachi, Pakistan

Background: Pakistan is a big victim of breast cancer and vitamin D deficiency. Interestingly, bones are the common site of breast cancer metastasis and vitamin D deficiency makes this condition more worst. The present study designed to estimate bone markers and minerals in different BMI groups of newly diagnosed breast cancer patients. Materials & Methods: diagnosed breast cancer females were approached and their characteristics including age, marital status, menstrual & family history, receptor status, tumor grade & type and presence of metastasis were noted from their medical reports. Whereas bone markers and minerals viz., alkaline phosphatase (ALP), bone specific ALP (BALP), vitamin D, carboxyl terminal collagen crosslinks (CTX), human epidermal growth factor 2 receptor (Her2) protein, albumin, calcium (Ca), phosphorus (P) and magnesium (Mg) were estimated plus body mass index (BMI) measured. Results: Most of the recruited females found aged less than 50 yrs, wedded, belonged to plump to obese BMI groups, had invasive ductal carcinoma, expressed triple positive receptor status and tumor grade II. Very few had metastasis and family history of breast cancer. Patients in all BMI groups showed insufficient level of vitamin D but normal levels of ALP, Ca, Mg, P, albumin, Her2 protein and CTX. Whereas Ca and BALP found slightly low in underfed BMI group patients. Conclusion: The results concluded and recommended that vitamin D levels must be monitored in breast cancer patients before and after treatment otherwise it will decrease more and may affect other bone markers.

Marcadores de formación y resorción ósea y su utilidad para determinar el final del periodo de aposición ósea / Bone formation and resorption markers to evaluate the end of bone apposition

El pico de masa ósea (PMO) se alcanza entre los 20 y 35 años, pero la aposición ósea continúa hasta alcanzar el pico de fortaleza ósea (PFO). Se crea así una ventana entre ambos picos que podría ser evaluada mediante marcadores bioquímicos de recambio óseo, ya que durante dicho período la densidad mineral permanece constante. El objetivo fue determinar el final de la aposición ósea mediante marcadores bioquímicos óseos. Se evaluaron por décadas entre 20 y 49 años de edad 139 sujetos sanos de ambos sexos (69 hombres y 70 mujeres), determinando fosfatasa alcalina ósea (FAO), osteocalcina (OC), propéptido amino terminal del colágeno tipo 1 (P1NP) y telopéptido C-terminal del colágeno tipo 1 (CTX). Los marcadores correlacionan negativamente con la edad (OC: r= -0,3; p<0,01; P1NP: r= -0,4; p< 0,01 y CTX: r= -0,4; p<0,01), exceptuando FAO. En hombres de 20-29 años, P1NP y el CTX fueron significativamente mayores vs. 30-39 años (p<0,05 y p<0,001, respectivamente), y entre 30-39 años vs. de 40-49 años en P1NP y CTX (p<0,05; p<0,001, respectivamente). En mujeres de 20-29 años, P1NP y CTX fueron significativamente mayores vs. 30-39 años (p<0,0001 y p<0,01, respectivamente). Conclusión: los marcadores de remodelado óseo más sensibles y específicos permitirían determinar bioquímicamente el fin de la aposición ósea que se produce entre el PMO y el PFO. Si bien es necesario ampliar el número de sujetos evaluados, los datos que surgen de la presente investigación sentarían las bases para futuros estudios epidemiológicos referidos al fin de la aposición ósea. (AU)

Peak bone mass is achieved between 20-35 years; however bone apposition continues to reach an optimal skeleton strength. The window between peak bone mass and peak bone apposition may be evaluated by biochemical bone turnover markers. The objective of this study was to determine the end of bone apposition through biochemical bone markers in both sexes. A total of 139 subjects (69 men and 70 women) were divided by decades between 20 and 49 years of age. Bone alkaline phosphatase (BAL), osteocalcin (OC), type I collagen propeptide (P1NP) and type I collagen C-terminal telopeptide (CTX) were evaluated. Except BAL, the other bone markers negatively correlated with the age [OC (r= -0.3; p<0.01); P1NP (r= -0.4; p<0.01) and CTX (r= -0.4; p<0.01)]. Regarding men aged 20 to 29 years, P1NP and CTX were significantly higher vs. 30-39 years (p<0.05 y p<0.001, respectively) and. vs. 40-49 years (p<0.05; p<0.001, respectively). In women, the results were similar. Regarding 20-29 years, P1NP and CTX were higher vs. 30-39 years (p<0.001 y p<0.01, respectively). Bone remodeling rate decreases after the third decade, suggesting the end of the apposition period of peak bone mass. Conclusion: The most specific and sensitive bone markers would biochemically determine the end of bone apposition that extends between the peak of bone mass and the peak of bone strength. Although it is necessary to increase the number of subjects evaluated, the data that emerge from the present study would establish the bases for future epidemiological studies referring to the end of bone apposition. (AU)

Efficacy and Improvement on Quality of Life in Senile Osteoporosis Treated with Teriparatide / 医药导报

Objective To explore the changes of bone mineral density (BMD) and bone markers in senile osteoporosis patients treated with teriparatide,and evaluate the improvement on quality of life (QOL) as well as the clinical significance.Methods Forty-five senile osteoporosis inpatients were treated with 20 μg of teriparatide for one year.BMD and bone markers were detected before treatment and also in the third,sixth and twelfth month during treatment.The level of numerical rating scale (NRS) and QOL were assessed.Results The NRS before treatment was (4.96±2.25) , and those after treatment of 3, 6 and 12 months were(2.84±1.41), (1.56±1.16) and (1.36±1.00), respectively (P<0.01).The total scores of SF-36 significantly increased after treatment (P<0.01).After treatment of 3, 6 and 12 months, BMD of lumbar vertebra had increased 7.7%, 12.3% and 15.4%, respectively;that of femoral neck had increased 3.0%, 6.1% and 7.6%, respectively;and that of intertrochanteric bone had increased 5.7%, 8.6% and 10.0%, respectively.Meanwhile, the serum levels of osteocalcin, bone alkaline phosphatase and N terminal propeptide of type I procollagen were significantly higher than those before treatment (P<0.01), nevertheless beta collagen cross-linked C-terminal peptide (β-CTX) only significantly decreased at the 12th month after treatment (P<0.05).Conclusion Chronic teriparatide therapy could significantly relieve bone pain,improve the quality of life and increase lumbar vertebra BMD in senile osteoporosis.

Marcadores óseos en niños y adolescentes / Bone markers in children and adolescents / Marcadores ósseos em crianças e adolescentes

Los marcadores óseos son moléculas específicas que pueden clasificarse en dos categorías: formación y resorción óseas. Cuando se los compara con los adultos, los niños tienen muy elevadas concentraciones de los marcadores óseos debido a la elevada velocidad de crecimiento y a la rápida remodelación ósea. No solo reflejan el crecimiento (modelación esquelética y crecimiento linear), sino también la remodelación ósea. Ningún marcador es específico para cada uno de estos procesos y no son fáciles de interpretar en niños y adolescentes dado que están influenciados por varios factores fisiológicos como edad, sexo, velocidad de crecimiento y estadio puberal. Es necesario conocer la velocidad de crecimiento y el desarrollo puberal para interpretar correctamente los resultados. Además, muestran variaciones diurnas en sus concentraciones con picos por la mañana y nadir por la tarde. A la actualidad, existe una variada referencia de datos de marcadores óseos en niños y adolescentes. Se presenta una revisión de hallazgos científicos de varios marcadores séricos y urinarios que reflejan la formación y resorción óseas durante la niñez y adolescencia. Los marcadores óseos son de mucha utilidad en investigación clínica y fisiología del metabolismo óseo, sin embargo, su uso de rutina en clínica aún no está bien establecido.

Bone markers are specific bone-derived molecules that can be classified into two categories: bone formation and bone resorption markers. Compared to adults, children have dramatically elevated bone marker concentrations due to high skeletal growth velocity and rapid bone turnover. They reflect growth (skeletal modelling) and remodelling and no marker is specific for any of the different biological processes of remodelling, modelling or epiphyseal growth. Bone turnover markers may not be easy to interpret in children as they are influenced by many physiological factors, such as age, gender, growth velocity, and pubertal stage. Knowledge of growth velocity and pubertal development is necessary to interpret the values of biological markers of bone turnover correctly. Turnover markers also show a diurnal variation, with a peak of concentrations in the morning and nadir of concentrations in the late afternoon. To date, a variety of pediatric references for bone markers have been reported. This review describes research findings on various sera and urine markers that reflect bone formation and resorption in children and adolescents. While bone markers are useful in research in the field of bone metabolism, their utility in routine clinical applications in pediatrics has not been established.

Marcadores ósseos são moléculas específicas que podem ser classificadas em duas categorias: formação e reabsorção óssea. Em comparação com os adultos, as crianças têm concentrações altamente elevadas de marcadores ósseos devido à alta velocidade de crescimento e à remodelação óssea rápida. Não só refletem o crescimento (modelagem esquelética e crescimento linear), mas também a remodelação óssea. Nenhum marcador é específico para cada um desses processos e não são fáceis de interpretar em crianças e adolescentes visto que estão influenciados por vários fatores fisiológicos, tais como idade, sexo, velocidade de crescimento e desenvolvimento púbere. É necessário o conhecimento da velocidade de crescimento e o desenvolvimento do púbere para interpretar corretamente os resultados. Além disso, mostram variações diurnas em suas concentrações com picos de manhã e nadir pela tarde. Atualmente, existe uma variada referência de dados de marcadores ósseos em crianças e adolescentes. Apresenta-se uma revisão de achados científicos de vários marcadores séricos e urinários que refletem a formação e reabsorção ósseas em crianças e adolescentes. Embora os marcadores ósseos sejam úteis na investigação clínica e fisiologia do metabolismo ósseo, sua utilidade em aplicações clínicas de rotina ainda não foi bem estabelecida.

Utilidad de los marcadores de remodelado óseo teniendo en cuenta el valor de referencia para el cambio / Clinical Utility of Bone Remodeling Markers Taking Into Account the Reference Value Change

La Modelación y el Remodelado de hueso son llevados a cabo a través del proceso de Recambio Óseo en sitios específicos llamados Unidades de Remodelación Ósea (URO). Este proceso puede evaluarse a través de marcadores bioquímicos de Formación y de Resorción que reflejan cambios globales del metabolismo esquelético. Estos marcadores de remodelado óseo son utilizados para investigación de enfermedades óseo-metabólicas, porque proveen información dinámica del metabolismo del hueso y pueden ser cuantificados en suero o en orina. La variación de estos marcadores se deben principalmente a variables preanalíticas, analíticas y biológicas y debe interpretarse teniendo en cuenta el Valor de Referencia para el Cambio significativo (VRC), que resulta de un cálculo en el que intervienen la variabilidad biológica (VB) del analito y el error aleatorio del método utilizado en el laboratorio.

The Modeling and Remodeling processes are conducted through the process of replacement bone at specific sites called Units Bone Remodeling (URO).These can be evaluated by biochemical markers of formation and resorption that reflect changes in skeletal metabolism. These markers of bone turnover are used for research óseo-metabolic diseases because they provide dynamic information of bone metabolism and can be quantified in serum or urine. The variation of these markers is mainly due to preanalytical, analytical and biological variables and should be interpreted taking into account the Reference Value Change (VRC), which results from a calculation in which the biological variability (VB) of the analyte and the random error of the method used in the laboratory are involved.

Efficacy of a Once-Monthly Pill Containing Ibandronate and Cholecalciferol on the Levels of 25-Hydroxyvitamin D and Bone Markers in Postmenopausal Women with Osteoporosis

BACKGROUND: The present study evaluated the efficacy of a combination of ibandronate and cholecalciferol on the restoration of the levels of 25-hydroxyvitamin D (25[OH]D) and various bone markers in postmenopausal women with osteoporosis. METHODS: This was a randomized, double-blind, active-controlled, prospective 16-week clinical trial conducted in 20 different hospitals. A total of 201 postmenopausal women with osteoporosis were assigned randomly to one of two groups: the IBN group, which received a once-monthly pill containing 150 mg ibandronate (n=99), or the IBN+ group, which received a once-monthly pill containing 150 mg ibandronate and 24,000 IU cholecalciferol (n=102). Serum levels of 25(OH)D, parathyroid hormone (PTH), and various bone markers were assessed at baseline and at the end of a 16-week treatment period. RESULTS: After 16 weeks of treatment, the mean serum levels of 25(OH)D significantly increased from 21.0 to 25.3 ng/mL in the IBN+ group but significantly decreased from 20.6 to 17.4 ng/mL in the IBN group. Additionally, both groups exhibited significant increases in mean serum levels of PTH but significant decreases in serum levels of bone-specific alkaline phosphatase and C-telopeptide of type 1 collagen (CTX) at 16 weeks; no significant differences were observed between the groups. However, in subjects with a vitamin D deficiency, IBN+ treatment resulted in a significant decrease in serum CTX levels compared with IBN treatment. CONCLUSION: The present findings demonstrate that a once-monthly pill containing ibandronate and cholecalciferol may be useful for the amelioration of vitamin D deficiency in patients with postmenopausal osteoporosis. Moreover, this treatment combination effectively decreased serum levels of resorption markers, especially in subjects with a vitamin D deficiency, over the 16-week treatment period.

Bone markers and osteoporosis therapy / Marcadores de turnover ósseo e tratamento da osteoporose

Several factors are involved in determining bone quality including bone density, bone turnover, the extent of trabecular bone connectivity, cortical porosity and geometry. Metabolically active and in a continuous process of remodeling, approximately 20% of bone tissue is renewed annually. Bone turn over markers (BTM) are frequently used in clinical trials and to provide valid information about the effectiveness of osteoporosis treatment, reflecting the state of bone metabolism and its response to treatment, although they are not useful alone to estimate bone loss. In this review the behavior of BTM from different clinical trials or different osteoporotic drugs will be addressed.

Diversos fatores estão envolvidos na determinação da qualidade óssea, incluindo a densidade óssea, a remodelação óssea, a extensão da conectividade do osso trabecular, porosidade cortical e geometria. Metabolicamente ativo e, em um processo contínuo de remodelação, cerca de 20% do tecido ósseo é renovado anualmente. Por sua vez, marcadores de turnover ósseo (BTM) são frequentemente utilizados em estudos clínicos e fornecem informações válidas sobre a eficácia do tratamento da osteoporose, o que reflete o metabolismo ósseo e sua resposta ao tratamento, embora eles não sejam úteis somente para estimar a perda óssea. Nesta revisão, o comportamento dos BTM em ensaios clínicos diferentes e com diferentes drogas osteoporóticas será abordado.

Estudo dos mecanismos envolvidos no processo de diferenciação em linhagem osteogênica de células-tronco mesenquimais da medula óssea de ratos Wistar e ratos espontaneamente hipertensos (SHR) / Study of the mechanisms involved in the process of differentiation into osteogenic lineage of mesenchymal stem cells from bone marrow of wistar rats and spontaneously hypertensive rats (SHR)

Células-tronco mesenquimais (CTMs) obtidas a partir da medula óssea são capazes de se diferenciarem, sobretudo, em condrócitos, adipócitos e osteoblastos. Durante a osteogênese in vitro, alguns parâmetros são utilizados para caracterizar este processo, tais como atividade da fosfatase alcalina (FAL), mineralização e expressão de proteínas associadas à osteoblastos. Ratos espontaneamente hipertensos (SHR) são um modelo animal de hipertensão essencial humana e desenvolvem hipertensão após 4 semanas de idade. Esta linhagem apresenta alterações significativas no metabolismo ósseo. O objetivo do presente estudo foi investigar se, o genótipo hipertensivo poderia interferir na diferenciação osteoblástica das CTMs de ratos SHR e qual mecanismo está alterado quando comparadas com a linhagem progenitora, ratos Wistar. Para isso, nós obtivemos CTMs da medula óssea de ratos Wistar e SHR com 4 semanas de idade, sem a hipertensão estabelecida, afim de avaliar somente o possível efeito do genótipo hipertensivo na diferenciação osteogênica in vitro. Nós induzimos, ou não, a diferenciação osteogênica in vitro por meio da utilização dos indutores osteogênicos: ácido ascórbico, β-glicerofosfato e dexametasona. Os resultados demonstraram que, CTMs indiferenciadas de SHR (SHRC) demonstraram taxa de proliferação aumentada em comparação a CTMs, na mesma condição, de Wistar (WC), e após a indução da osteogênica, a taxa de proliferação apresentou uma diminuição acentuada no grupo SHR (SHRMO) do que no grupo Wistar na mesma condição (WMO). Embora não fora observada diferença significativa na atividade da FAL entre SHRMO e WOM no 7° dia, a mineralização e a diferenciação osteoblástica foram menores no grupo SHRMO no mesmo período experimental. Os fatores de transcrição Osterix e β-catenina parecem estar envolvidos na diferenciação reduzida no grupo SHRMO, pois apresentaram menor expressão neste grupo experimental. Além disso, a expressão diminuída de proteínas associadas...

Mesenchymal stem cells (MSCs) from bone marrow are able to differentiate mainly into chondrocytes, adipocytes and osteoblasts. During in vitro osteogenesis, some parameters are used to characterize this process, such as the activity of alkaline phosphatase (ALP), mineralization and osteoblast-associated proteins expression. Spontaneously hypertensive rats (SHR) is an animal model of human essential hypertension. This animals developing hypertension after 4 weeks of age. This strain shows significant changes in bone metabolism. The aim of this study was to investigate whether the hypertensive genotype could influence the osteoblastic differentiation of MSCs from SHR and which mechanism are altered when compared to the parental strain, Wistar rats. For that, we have obtained bone marrow MSCs from Wistar and SHR rats at 4 weeks of age, without hypertension established in order to evaluate only the possible effect of hypertensive genotype on osteogenic differentiation in vitro. We induced or non-osteogenic differentiation in vitro using osteogenic inducers: ascorbic acid, dexamethasone and β-glycerophosphate. The results demonstrate that undifferentiated MSCs SHR (SHRC) showed increased proliferation rate compared to MSCs, in the same condition Wistar (WC) and after osteogenic induction, proliferation rate showed a marked decrease in SHR (SHRMO) than in Wistar group in the same condition (WMO). Although it was not observed significant difference in ALP activity between WMO and SHRMO on day 7, mineralization and osteoblast differentiation were lower on group SHRMO in the same experimental period. The transcription factors Osterix and β-catenin appear to be involved in reduced differentiation in SHRMO group because they showed lower expression in this experimental group. Furthermore, the decreased osteoblast-associated proteins such as OCN, BSP, OPN expression suggest that extracellular matrix SHRMO group has a lower quality in comparison to WMO group. Higher...

Teriparatide (recombinant human parathyroid hormone 1-34) for the treatment of osteoporosis: a review / 中华内分泌代谢杂志

Teriparatide is an injectable recombinant human parathyroid hormone (1-34) [rhPTH(1-34)],which has been approved for the treatment of osteoporosis worldwide,including China since 2011.In pre-clinical studies,teriparatide was shown to exhibit anabolic effects on bone with a unique mechanism of action that is distinct from that of antiresorptive agents,including bisphosphonates,selective estrogen receptor modulators (SERMs),calcitonin,and estrogen.This bone-building effect has been supported by clinical trials in men and postmenopausal women,with reductions in fracture risk,and increases in bone turnover markers,including serum osteocalcin and procollagen type Ⅰ N-terminal propeptide (PINP),and bone mineral density (BMD),and improvements in bone quality.Recent studies in Asian patient populations show similar results and support the findings for bone markers and BMD when compared with current antiresorptive medications.

Serum Bisphenol A Concentration in Postmenopausal Women with Osteoporosis

OBJECTIVES: Bishphenol A (BPA) is a representative endocrine disruptor and is also known as a xenoestrogen. The objective of the present study is to investigate how many patients are exposed to BPA and to analyze the relationships between serum BPA concentration, bone mineral density (BMD) and biochemical bone markers in postmenopausal women with osteoporosis. METHODS: Total 51 patients were enrolled for measuring BPA and clinical variables including BMD and bone markers. The relationship between BPA and clinical variables were analyzed by the Pearson's correlation test and the Kruskal-Wallis test. Serum BPA concentration was measured by enzyme linked immunosorbent assay (ELISA). RESULTS: BPA was detected in all samples. The mean BPA concentration was 1.44 +/- 0.52 ng/mL. There was no statistically significant correlation between BPA and clinical variables. CONCLUSION: There was no statistical significance between serum BPA concentration and clinical variables related to bone metabolism. To clarify the effect of BPA on bone metabolism, further large scaled and high risk group investigation may be needed.

Effect of oligofructose-enriched inulin on bone metabolism in girls with low calcium intakes

In the present clinical study, the effect of oligofructose-enriched inulin was studied on bone metabolism in girls from 9 to 12 years old, with low habitual calcium intakes, who attended public schools. Two calcium-enriched formulations, supplemented with oligofructose-enriched inulin (test drink) or without (standard drink) were made. Sixty pre-pubertal girls were randomized into a double-blind and crossover design, divided into three groups and received one daily portion of either the standard drink (group 1) or test drink (group 2) during 11 weeks, followed by a three-week washout period. Group control did not receive any supplementation. Biochemical evaluations of serum calcium, intact parathyroid hormone - iPTH - and bone alkaline phosphatase - BAP - were performed at baseline and after 4, 8 and 11 weeks of each intervention period. In group 1, a significant increase in serum calcium and BAP and a reduction of iPTH were observed after consumption of the test drink.

No presente ensaio clínico, o efeito de oligofrutose enriquecida com inulina foi estudado no metabolismo ósseo de meninas de 9 a 12 anos com baixa ingestão habitual de cálcio, matriculadas em escolas públicas. Duas formulações foram suplementadas ou não (bebida padrão) com oligofrutose enriquecida com inulina (bebida teste). Sessenta meninas pré-púberes foram aleatorizadas em estudo duplo cego crossover e divididas em três grupos e receberam uma porção diária da bebida padrão (grupo 1) ou teste (grupo 2) durante 11 semanas, seguidos por um período de intervalo de três semanas. O grupo controle não recebeu nenhuma suplementação. As avaliações bioquímicas de cálcio sérico, paratormônio intacto - PTHi e fosfatase alcalina fração óssea - FAO foram executadas ao início e após 4, 8 e 11 semanas de cada período de intervenção. No grupo 1, um aumento significante no cálcio sérico e FAO e uma redução no PTHi foram observadas após o consumo da bebida teste.

Effects of Arginine Supplementation on Bone Mineral Density and Bone Markers in OVX Rats

As far as we know, there were no studies of the effect of L-arginine on bone metabolism in post-menopausal women or ovariectomized rats. The primary objective of the current study was to determine whether arginine supplementation was associated with alterations in femoral and spinal bone mineral density (BMD) and bone markers in ovariectomized (Ovx) rats. Forty female Sprague-Dawley rats were divided into two groups, Ovx and sham groups, which were each randomly divided into two subgroups that were fed control and arginine supplemented diet. All rats were fed on experimental diet and deionized water ad libitum for 9 weeks. Bone formation was measured by serum osteocalcin and alkaline phosphatase (ALP) concentrations. Bone resorption was measured by deoxypyridinoline (DPD) crosslinks immunoassay and corrected for creatinine. Serum osteocalcin, growth hormone, insulin-like growth factor-1 (IGF-1), parathyroid hormone (PTH) and calcitonin were analyzed using radioimmunoassay kits. Bone mineral density (BMD) and bone mineral content (BMC) were measured using PIXImus (GE Lunar Co, Wisconsin, USA) in spine and femur. The serum and urine concentrations of Ca and P were determined. The plasma was analyzed for arginine. Diet did not affect weight gain, mean food intake, and plasma arginine concentration. Urinary Ca excretion was decreased by arginine supplementation in Ovx rats, but statistically not significant. The Ovx rats fed arginine-supplemented diet were not significantly different in ALP, osteocalcin, crosslinks value, PTH, calcitonin and IGF-1 compared to those fed control diet. The arginine-supplemented group had significantly higher serum Ca and growth hormone than control group. Spine and femur BMD were significantly increased by arginine supplementation on 5th and 9th weeks after feeding. Our findings indicate that dietary L-arginine supplementation decreased bone mineral density loss in Ovx rats. Therefore, dietary arginine supplementation may represent a potentially useful strategy for the management of osteoporosis.

Lack of relationship between glycemic control and bone mineral density in type 2 diabetes mellitus

We assessed the effect of chronic hyperglycemia on bone mineral density (BMD) and bone remodeling in patients with type 2 diabetes mellitus. We investigated 42 patients with type 2 diabetes under stable control for at least 1 year, 22 of them with good metabolic control (GMC: mean age = 48.8 ± 1.5 years, 11 females) and 20 with poor metabolic control (PMC: mean age = 50.2 ± 1.2 years, 8 females), and 24 normal control individuals (CG: mean age = 46.5 ± 1.1 years, 14 females). We determined BMD in the femoral neck and at the L2-L4 level (DEXA) and serum levels of glucose, total glycated hemoglobin (HbA1), total and ionic calcium, phosphorus, alkaline phosphatase, follicle-stimulating hormone, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25-OH-D), insulin-like growth factor I (IGFI), osteocalcin, procollagen type I C propeptide, as well as urinary levels of deoxypyridinoline and creatinine. HbA1 levels were significantly higher in PMC patients (12.5 ± 0.6 vs 7.45 ± 0.2 percent for GMC and 6.3 ± 0.9 percent for CG; P < 0.05). There was no difference in 25-OH-D, iPTH or IGFI levels between the three groups. BMD values at L2-L4 (CG = 1.068 ± 0.02 vs GMC = 1.170 ± 0.03 vs PMC = 1.084 ± 0.02 g/cm²) and in the femoral neck (CG = 0.898 ± 0.03 vs GMC = 0.929 ± 0.03 vs PMC = 0.914 ± 0.03 g/cm²) were similar for all groups. PMC presented significantly lower osteocalcin levels than the other two groups, whereas no significant difference in urinary deoxypyridine was observed between groups. The present results demonstrate that hyperglycemia is not associated with increased bone resorption in type 2 diabetes mellitus and that BMD is not altered in type 2 diabetes mellitus.

Effects of Arginine Supplementation on Bone Markers and Hormones in Growing Female Rats

An important related question is whether arginine has influence bone metabolism. The effect of arginine supplements on bone markers and related hormones were studied in young female Sprague-Dawley rats fed either an arginine supplemented diet or control diet. Twenty four rats (body weight 83 +/- 5 g) were randomly assigned to one of two groups, consuming casein or casein with supplemented arginine diet. All rats were fed on experimental diet and deionized water ad libitum for 9 weeks. Bone formation was measured by serum osteocalcin and alkaline phosphatase (ALP) concentrations. And bone resorption rate was measured by deoxypyridinoline (DPD) crosslinks immunoassay and corrected for creatinine. Serum osteocalcin, growth hormone, estrogen, insulin-like growth factor-1 (IGF-1), parathyroid hormone (PTH) and calcitonin were analyzed using radioimmunoassay kits. The weight gain and mean food intake were not affected regardless of diets. The rats fed arginine-supplemented diet had not significantly different in ALP, osteocalcin, crosslinks value, PTH, estradiol, and IGF-1 compared to those fed casein diet group. The arginine-supplemented group had significantly higher growth hormone and calcitonin than casein group. This study suggests that arginine is beneficial for bone formation in growing female rats. Therefore exposure to diet which rich in arginine early in life may have benefits for bone formation and osteoporosis prevention.

Laboratory Evaluation of Bone Metabolism Index Using Elecsys 2010 / 대한진단검사의학회지

BACKGROUND: Bone markers can provide a prognostic information about the risk of osteoporotic fracture and are useful tools for monitoring the efficacy of antiresorptive therapy. We evaluated the analytical performance of the bone markers of Elecsys 2010 (Roche Diagnostics Corp., Indianapolis, USA). METHODS: We evaluated the analytical performance of the Elecsys 2010 for serum parathyroid hormone (PTH), osteocalcin, and serum bone-derived degradation products of type I collagen C-telopeptide (S-CTX) using control material and patients' specimens. For the comparison studies, an immunoradiometric assay was used for PTH and an ELISA for serum osteocalcin and serum bone-derived degradation products of type I collagen N-telopeptide (S-NTX). We established the reference intervals of S-CTX and serum osteocalcin by analyzing 4569 Korean healthy subjects according to sex and age. RESULTS: Within-run and total CV of most items were below 5% except S-CTX low level (5.42%). Elecsys 2010 showed a good linearity (r> or =0.99, P<0.01). Good correlations with other methods were found in osteolcalcin (r=0.95, P<0.01) and PTH (r=0.96, P<0.01). S-CTX showed a good correlation with S-NTX (r=0.76, P<0.01). Reference intervals of serum osteocalcin (ng/mL) and S-CTX (ng/mL) were 9.58-33.62 and 0.18-0.89, respectively, in adult male, 8.00-31.46 and 0.11-0.81 in 31-50 years old female, and 8.30-43.50 and 0.11-1.00 in 51-80 years old female. CONCLUSIONS: Elecsys 2010 bone markers showed a satisfactory precision, linearity, and a good correlation with other methods. With its 'one system-many capabilities' features, Elecsys 2010 would be a useful tool for measuring bone metabolism indices.

Bone Mineral Density and Bone Markers in the Children with Epilepsy Taking on Chronic Anticonvulsants / 소아과

PURPOSE: Long-term administration of anticonvulsants in children with epilepsy may cause short stature, hypocalcemia and low bone mineral density. This study was performed for the early detection of abnormal bone metabolism in children with epilepsy on taking anticonvulsants. METHODS: Thirty children aged 5 to 16 years who were diagnosed with epilepsy were enrolled in this study. All had taken anticonvulsants for more than one year. Bone mineral density of lumbar vertebra was measured by dual-energy X-ray absorptiometry. Serum calcium, phosphorous, alkaline phosphatase, 25-hydroxycholecalciferol[25(OH)D3], parathyroid hormone, and urine deoxypyridinoline were measured as biochemical bone markers. Bone age and body mass index were also calculated. RESULTS: Bone minreal density, body mass index, bone age, and height were significantly decreased in two female patients who had taken two antiepileptic drugs for more than four years and they also had chronic diseases such as cerebral palsy with microcephaly, encephalomalacia, and microcephaly with atrial septal defect. Bone mineral density had significant positive correlations with body mass index(P<0.01) and bone age(P<0.01). CONCLUSION: This study showed chronic medication of anticonvulsants in children may cause low bone mineral density and short stature. Bone age and body mass index could be the important surrogate markers to find the population at risk. More studies, including a large study population and long term cohort study, will be required.

Changes of BMD & Markers of Bone Turnover after 1-year Treatment with HRT and Fluocalcic in Postmenopausal Korean Women with Decreased BMD

BACKGROUND: Although fluoride has an ability to increase BMD at lumbar spine, it does not result in a reduction in vertebral fractures. After the introduction of monofluorophosphate instead of NaF, there is a revival of the use of fluoride in the treatment of osteoporosis. METHODS: We evaluated 39 subjects out of the 50 who finished a 1-year treatment. Fifty postmenopausal Korean women with decreased bone density were enrolled from Oct. 2000 to Mar. 2001 and stratified 2-groups by treatment regimen. One group was treated with Fluocalcic (Disodium monofluorophosphate; 100 mg and calcium carbonate; 1,250 mg) and HRT, the other group with HRT only at climacteric clinic in Samsung Cheil Hospital & Women's Healthcare Center. Markers of bone turnover, changes of BMD and demographic data were obtained and compared in both groups. RESULTS: Compared with the baseline value, osteocalcin and total alkaline phosphatase, the formation markers of bone turnover were not decreased significantly after 3-month treatment in HRT and fluoride treated group. But, DPYD, the resorption marker, was decreased slightly after the 3-months treatment. Changes of both resorption and formation markers of bone turnover in HRT only treated group were significantly decreased after the treatment. The spinal BMD increased significantly compared to the baseline value in both groups. Changes of spinal BMD after 1-year treatment in HRT and fluoride treated group was increased significantly than HRT only group (15.1 12.6% vs 4.2 3.4%). CONCLUSION: This study shows that changes of spinal BMD after combined treatment with HRT and fluoride were increased significantly than HRT only treatment. Therefore, combined use of Fluoride and HRT was effective to increase spinal BMD in postmenopausal women with decreased spinal BMD.

Comparative Study on Treatment of Postmenopausal Symptoms with Black Cohosh Root Extract and Hormone Replacement Therapy / 대한산부인과학회잡지

OBJECTIVE: The fears and side effects of a prolonged hormone replacement therapy on the postmenopausal symptoms reinforce a growing interest about alternatives. The present study was performed to investigate whether black cohosh root extract (BCRE) can be used or not as an alternative to hormone replacement therapy (HRT) in order to relieve postmenopausal symptoms. MATERIAL & METHODS: Randomized, double-blind prospective clinical trial examined the effects of BCRE and HRT on Kupperman index, biochemical bone markers, lipid profiles, and side effects in 74 women with postmenopausal symptoms. Treatments included placebo (Festal(R)) (n=12), BCRE (Feramin(R)) (n=32) and HRT (Premarin(R)) (n=30) for 3 months. Kupperman index, biochemical bone markers (osteocalcin and deoxypyridinoline), and lipid profiles (total cholesterol, triglyceride and HDL-cholesterol) were measured at 0, 1 and 3 months. Side effects were checked at 3 months. RESULTS: BCRE was significantly effective in lowering of Kupperman index as much as HRT at two control times (1 month: p<0.05, 3 months: p<0.001). It also showed slightly favorable effects on biochemical bone markers and lipid profiles but not statistically significant. Fewer side effects were seen in BCRE than HRT. CONCLUSION: BCRE appears to be a safe and effective alternative to HRT for early postmenopausal symptoms and may be especially useful in women with intolerances or contraindications to traditional HRT.

Comparative Study on Treatment of Postmenopausal Symptoms with Black Cohosh Root Extract and Hormone Replacement Therapy / 대한산부인과학회잡지

OBJECTIVE: The fears and side effects of a prolonged hormone replacement therapy on the postmenopausal symptoms reinforce a growing interest about alternatives. The present study was performed to investigate whether black cohosh root extract (BCRE) can be used or not as an alternative to hormone replacement therapy (HRT) in order to relieve postmenopausal symptoms. MATERIAL & METHODS: Randomized, double-blind prospective clinical trial examined the effects of BCRE and HRT on Kupperman index, biochemical bone markers, lipid profiles, and side effects in 74 women with postmenopausal symptoms. Treatments included placebo (Festal(R)) (n=12), BCRE (Feramin(R)) (n=32) and HRT (Premarin(R)) (n=30) for 3 months. Kupperman index, biochemical bone markers (osteocalcin and deoxypyridinoline), and lipid profiles (total cholesterol, triglyceride and HDL-cholesterol) were measured at 0, 1 and 3 months. Side effects were checked at 3 months. RESULTS: BCRE was significantly effective in lowering of Kupperman index as much as HRT at two control times (1 month: p<0.05, 3 months: p<0.001). It also showed slightly favorable effects on biochemical bone markers and lipid profiles but not statistically significant. Fewer side effects were seen in BCRE than HRT. CONCLUSION: BCRE appears to be a safe and effective alternative to HRT for early postmenopausal symptoms and may be especially useful in women with intolerances or contraindications to traditional HRT.