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Objective:To investigate the effect of self-made Bushen Jiangu Decoction on bone transformation markers in elderly patients with osteoporotic vertebral compression fracture after operation, and to evaluate the clinical efficacy.Methods:Prospective cohort study. A total of 92 patients with osteoporotic vertebral compression fracture after operation in Fangshan Hospital of Beijing University of Chinese Medicine from April 2020 to December 2021 who met the inclusion criteria were divided into 2 groups by random drawing method, with 46 in each group. The control group was treated with routine western medicine after operation, and the observation group was treated with self-made Bushen Jiangu Decoction on the basis of the control group. Both groups were treated for 3 months. TCM symptom scores were performed before and after treatment, and the prognosis of the patients was evaluated with the Chinese Osteoporosis Quality of Life (COQOL), VAS scale, and the Oswestry Dysfunction Index (ODI). The levels of amino terminal propeptide (PINP), cross-linked terminal peptide β special sequence (β-CTX) and bone morphogenetic protein 6 (BMP6) of type Ⅰ procollagen were determined by contrast chromogenic method with o-benzaldehyde. The adverse reactions during treatment were recorded and the clinical efficacy was evaluated.Results:The total effective rate was 95.7% (44/46) in the observation group and 82.6% (38/46) in the control group, and there was a significant difference between the two groups ( χ 2=4.04 , P=0.044). After treatment, the scores of fracture nonunion, pain in back and loin, chilliness and lassitude, and pallor in the observation group were significantly lower than those in the control group ( t values were 4.84, 4.09, 4.87, 4.14, respectively, P<0.01). The scores of COQOL, VAS and ODI in the observation group were significantly lower than those in the control group ( t values were 6.26, 10.57 and 6.15, respectively, P<0.01). The levels of PINP [(44.93±5.86)μg/L vs. (49.76±6.02)μg/L, t=3.90] and β-CTX [(0.49±0.17) μg/L vs. (0.68±0.20) μg/L, t=4.91] in observation group were significantly lower than those in the control group after treatment ( P<0.05). The level of BMP6 [(81.23±9.14) μg/L vs. (75.14±8.25) μg/L, t=3.36] in observation group was significantly higher than that of the control group ( P<0.05). During the treatment,the incidence of adverse reactions in the observation group was 13.0% (6/46), while that in the control group was 8.7% (4/46), and there was no significant difference between the two groups ( χ 2=0.45, P=0.503). Conclusion:The self-made Bushen Jiangu Decoction combined with conventional western medicine therapy can adjust the level of bone transformation markers in elderly patients with osteoporotic vertebral compression fractures, improve the lumbar function and quality of life, and improve the clinical efficacy.
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Objective:To investigate the correlation between the level of thyrotropin receptor antibody(TRAb) and bone turnover markers(BTMs) in the patients with newly-diagnosed Graves′ disease(GD).Methods:The clinical data of GD patients who were newly-diagnosed in the First Affiliated Hospital of Zhengzhou University from October 2016 to June 2021 were collected, including free triiodothyronine(FT 3), free thyroxine(FT 4), thyroid stimulating hormone, thyroid related antibodies, N-terminal procollagen of type I collagen(PINP), N-terminal osteocalcin(N-MID), β-cross-linked C-telopeptide of type I(β-CTX), blood lipid and renal function, etc. Results:There were 618 GD patients with an average age of(43.7±13.2) years(male∶female=1∶1.99). The PINP and β-CTX level in male GD patients were significantly higher than those in female(all P<0.05). Spearman correlation analysis showed that PINP, N-MID and β-CTX were positively correlated with FT 3, FT 4, TRAb, serum calcium and serum phosphorus; and negatively correlated with body mass index and low density lipoprotein cholesterol(all P<0.05). Linear regression analysis showed that TRAb was positively correlated with lg-PINP, lg-N-MID and sqrt-β-CTX in the univariate model of total GD patients( β were 0.006, 0.005, and 0.006, respectively; all P<0.001); positive correlation remained after adjusting for thyroid function(all β=0.004, all P<0.001); and for multiple confounding factors(model 3 and 4, all P<0.05). Results of univariate and adjusted thyroid function models with GD in different genders were consistent with the total patients(all P<0.05). Conclusion:TRAb is a risk factor for accelerated bone turnover in GD patients which is independent of thyroid function.
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Objective:To explore the value of hemagglutination index in the diagnosis of osteoporosis in patients with spinal degenerative diseases.Methods:In this retrospective study, 313 patients with spinal degenerative diseases who were admitted to the Department of Spine Surgery of Beijing Jishuitan Hospital from November 2018 to April 2020 were selected and divided into osteoporosis group (119 cases), osteopenia group (101 cases) and normal group (93 cases) according to quantitative computed tomography (QCT) detection results. Fasting venous blood samples were taken to test coagulation indicators and bone turnover markers. One-way ANOVA or Kruskal-Wallis H tests were used to analyze the differences among three groups. The independent risk factors associated with Osteoporosis(OP)in patients with spinal degenerative diseases were screened from the blood indices. Furthermore, the osteopenia group and the normal group were combined into the non-osteoporosis group. Binary Logistic regression analysis was performed between the non-osteoporosis group and the osteoporosis group. Receiver operating curve (ROC) was used to evaluate the diagnostic value of relevant indicators in patients with spinal degenerative diseases.Results:Gender (χ 2=13.555, P=0.001), age ( F=17.53, P<0.001), Body Mass Index (BMI) ( F=4.068, P=0.018), β-C-terminal telopeptide of type I collagen (β-CTx) (χ 2=8.684, P=0.013), 25-hydroxyvitamin D [25(OH)D] (χ 2=6.155, P=0.046), D-dimer (χ 2=8.111, P=0.017) and platelet (PLT) ( F=6.809, P=0.001) were different significantly among three groups. The age ( P=0.006), D-dimer ( P=0.020) and PLT ( P=0.002) in normal group were remarkably lower than those in osteoporosis group. Age ( P<0.001) and PLT ( P=0.006) in osteopenia group were considerably lower than those in osteoporosis group, while β-CTX ( P=0.015) and BMI ( P=0.014) were significantly higher than those in osteoporosis group. The differences between non-osteoporosis group and osteoporosis group in gender, age, BMI, β-CTx, D-dimer and PLT were statistically significant (ALL P<0.05). Logistic regression showed that age [ OR=1.164, 95% CI (1.097-1.236)], gender [ OR=0.495, 95% CI (0.274-0.896)], BMI [ OR=0.890, 95% CI (0.816-0.971)] and PLT [ OR=1.008, 95% CI (1.003-1.103)] were independent risk factors for the osteoporosis group ( P<0.05). The AUCs (area under the curve) were detected separately by age AUC=0.715[95% CI (0.647-0.783)], gender AUC=0.612[95% CI (0.539-0.684)], BMI AUC=0.694[95%C I (0.622-0.766)], PLT AUC=0.610[95% CI (0.539-0.682)], and the combination of the former four indicators AUC=0.768[95% CI (0.706-0.829)] ( P<0.05). Conclusions:Based on the QCT results, the PLT count has considerable value in the diagnosis of osteoporosis in patients with spinal degenerative diseases. PLT combined with age, gender and BMI can greatly improve the diagnostic efficiency of osteoporosis.
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Objective:To investigate the effect of alendronate treatment and assess the value of bone turnover markers (BTMs) in predicting the changes of bone mineral densities (BMDs) in postmenopausal women with osteoporosis.Methods:In this retrospective study, 409 postmenopausal women with osteoporosis aged (64.86±7.21) years in the Department of Osteoporosis and Bone Disease, Shanghai Sixth People′s Hospital were enrolled from 2012 to 2020. BMDs at lumbar spine 1-4, femoral neck, and total hip, serum β cross-linked C-telopeptide of type 1 collagen (β-CTX), and osteocalcin (OC) were measured before and after treatment.Results:After alendronate treatment for 1 year, BMDs at lumbar spine 1-4, femoral neck and total hip increased 4.84%, 2.13%, and 2.89%, respectively ( P<0.05). At 6 months and 1 year on treatment, β-CTX and OC levels decreased by 77.7%, 42.3% and 78.2%, 49.5%, respectively ( P<0.05). Linear regression analysis showed that for every 10% decrease in the change of β-CTX at 6 months after alendronate treatment, the rate changes in BMDs at the lumbar spine 1-4, femoral neck, and total hip decreased by 0.417%, 0.127%, and 0.213% at 1 year after alendronate treatment; for every 10% decrease in OC, the change rates in BMDs at the lumbar spine 1-4, femoral neck, and total hip decreased by 0.582%, 0.258%, and 0.375%. Conclusions:Alendronate significantly increases BMDs and decreases BTMs levels in elderly women with osteoporosis. BTMs have a predictive value for the changes of BMDs, allowing early monitoring for the effect of alendronate treatment.
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Objective:To study the effects of a simulated plateau environment on fracture healing in rats.Methods:A rat model of mid-femoral fracture was established by hacksaw truncation and intramedullary fixation with Kirschner wires in 60 male Wistar rats which were divide into 2 groups ( n=30) by the random number table method. The rats in the control group were raised in the animal experiment center of The 940 Hospital of Joint Logistic Support Force of Chinese PLA at an altitude of 1,400 m, while the rats in the plateau group were placed in an animal experimental cabin in a simulated plateau environment at a simulated altitude of 5,000 m. The body weight was weighed once a week and X-ray films were taken every 2 weeks. Blood samples were collected after 4 weeks for detection of biochemical indicators of bone metabolism. After 8 weeks, the femurs of the surgical side were taken for bone biomechanical detection and the bone mineral density of the healthy side was detected. After 4 and 8 weeks, the femurs of the surgical side were taken for in vitro Micro-CT scanning and angiography detection. After 1, 2, 4 and 8 weeks, the femurs of the surgical side were taken for bone histopathologic detection. Results:During the entire experiment, no rats in the control group died while the mortality rate of the rats in the plateau group was as high as 26.7% (8/30). In the plateau group, some organs were pathologically damaged in the rats, fracture union was delayed, and the callus differentiated and matured slowly with the chondrocytes still dominant at the 8th week. The bone mineral density and the maximum load of the femur in the plateau group were significantly lower than those in the control group ( P< 0.05). Angiography showed that the rats in the plateau group had microvascular proliferation which did not penetrate the fracture end at the 8th week. The bone formation indexes like osteocalcin, procollagen type Ⅰ N-terminal propeptide (PⅠNP), and osteoprotegerin of the rats in the plateau group were significantly lower than those in the control group at the 4th week ( P<0.05). The bone resorption indexes like tartrate resistant acid phosphatase 5b (TRACP-5b) and receptor activator for nuclear factor-κB ligand (RANKL) in the plateau group were significantly higher than those in the control group ( P<0.05). Conclusion:A simulated plateau environment at an altitude of 5,000 m may lead to delayed fracture healing in rats.
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ObjectiveTo study the effect on quality of life and the bone turnover markers of Buzhong Yiqitang in the treatment of senile osteoporotic vertebral compression fracture （OVCF， syndrome of Qi deficiency in spleen and stomach） after operation based on ''spleen governing muscle''. MethodA total of 135 senile patients with OVCF treated by percutaneous kyphoplasty in Rizhao Hospital of Traditional Chinese Medicine from January 2020 to January 2021 were enrolled in this study. They were randomly assigned to two groups on the basis of block randomization at a ratio of 2∶1 （90 cases in the observation group and 45 cases in the control group）. Both groups were administrated with calcitriol capsules （0.5 μg·d-1） and caltrate D （1 200 mg·d-1） for basic treatment of osteoporosis. The observation group was additionally treated with Buzhong Yiqitang. Bone mineral density （BMD）， procollagen type Ⅰ N-terminal propeptide （PINP）， osteocalcin （OST）， β cross-linked C-telopeptide of type 1 collagen （β-CTx）， appendicular skeletal muscle mass index （ASMI）， and quadriceps muscle strength were compared between the two groups before and 6， 12 months after treatment. Additionally， traditional Chinese medicine （TCM） symptom score and visual analogue score （VAS） before and 3， 6 months after treatment， as well as quality of life questionnaire of the European Foundation for osteoporosis （QUALEFFO） score before and 3， 6， 12 months after treatment， were compared between the two groups. ResultA total of 85 patients in the observation group and 41 patients in the control group were followed up. The general curative effect of the observation group was better than that of the control group （χ2=10.503， P<0.05）. Specifically， the observation group had higher PINP， BMD， ASMI， and quadriceps muscle strength but lower β-CTx， TCM symptom score， VAS， and QUALEFFO score than the control group （P<0.05， P<0.01）. No adverse reactions related to Buzhong Yiqitang were observed. ConclusionBuzhong Yiqitang can regulate bone metabolism indexes， promote osteogenesis， increase bone density， enhance skeleton appendiculare and quadriceps muscle strength， relieve clinical symptoms， and improve quality of life in patients with senile OVCF （syndrome of Qi deficiency in spleen and stomach）， being worthy of promotion in clinical application.
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BACKGROUND: The pathological changes of alcohol-induced osteonecrosis of the femoral head (ONFH) are the result of a combination of various factors, and its specific pathogenesis is inconclusive. Related studies have shown abnormal bone metabolism in patients with avascular necrosis of the femoral head. OBJECTIVE: To explore the bone turnover markers in patients with alcohol-induced ONFH and to explore the relationship between different stages of ONFH and bone metabolism. METHODS: This study retrospectively selected 193 male patients with alcohol-induced ONFH (necrosis group), including 35 cases of ARCO stage II, 131 cases of ARCO stage III and 27 cases of ARCO stage IV. Among them, there were 65 cases of a little drinking of alcohol 52 cases of moderate drinking, and 76 cases of heavy drinking. Another 182 healthy males undergoing physical examination with no history of drinking were taken as control group. The bone turnover markers [procollagen type 1 N-terminal propeptide (P1NP), C-terminal cross-linked telopeptides of type 1 collagen (β-CTX), molecular fragment of N-terminal osteocalcin (N-MID) and 25 hydroxyvitamin D (25OHD)] and biochemical indexes were tested and compared between two groups, followed by logistic regression analysis and correlation analysis. The study protocol was performed in line with the relevant ethic requirements of the First Affiliated Hospital of Guangzhou University of Chinese Medicine. All participants in the trial had been fully informed of the trial process. RESULTS AND CONCLUSION: In the necrosis group, P1NP, β-CTX, N-MID, 25OHD, serum calcium, uric acid, alkaline phosphatase, serum phosphorus levels were significantly higher than that of the control group (P < 0.05), and apolipoprotein A1 and high-density lipoprotein levels in the necrosis group were significantly lower than those in the control group (P < 0.05). Compared with patients with low level of alcohol, β-CTX and N-MID levels were significantly reduced in the patients with heavy drinking (P < 0.05). The P1NP level of patients with ARCO stage IV was significantly higher than that of patients with ARCO stage II and III (P < 0.05), and the β-CTX level of patients with ARCO stage IV was significantly higher than that of patients with ARCO stage III (P < 0.05). The correlation analysis results showed that alcohol intake levels were negatively correlated with β-CTX, alkaline phosphatase level was positively correlated with P1NP and β-CTX, and 25OHD was negatively correlated with low-density lipoprotein. Logistic regression analysis results showed that: P1NP (odds ratio=0.984, P=0.004), β-CTX (odds ratio=0.325, P=0.043), and high-density lipoprotein (odds ratio=2.622, P=0.014). To conclude, male patients with alcohol-induced ONFH have active bone formation and bone resorption, and obvious abnormalities in lipid metabolism. The progression of alcohol-induced ONFH can be predicted by these bone turnover markers.
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Background: Individuals with diabetes mellitus are at increased risk of metabolic bone disease due to decrease in bone strength and quality. Several bone turnover markers like serum procollagen type I N propeptide (P1NP) and serum osteocalcin are powerful tools for studying osteoporosis and fracture risk across population to provide diagnostic and prognostic information of bone health. The aim of this study was to recognize possible correlation of levels of serum P1NP and osteocalcin in type-2 diabetic (T2DM) postmenopausal women as compared to healthy postmenopausal women.Methods: The study included 100 proven cases of type-2 diabetic postmenopausal women with age matched healthy postmenopausal women as controls. P1NP, osteocalcin, and other relevant parameters were measured. Differences between diabetics and controls were analyzed.Results: The body mass index was higher in diabetic group as compared to controls. The HbA1c% was (6.94±1.43) in diabetic group and (5.57±1.21) in non-diabetics. Low serum level of 25 (OH) D was observed both in diabetic and non-diabetic groups but significantly lower in T2DM. Procollagen type 1 N propeptide was lower in diabetic group (37.59±17.20 ng/mL) as compared to non-diabetic (52.14±24.82 ng/mL). Osteocalcin was lower (15.64±8.06 ng/ml) as compared to non-diabetic group (21.85±9.12 ng/ml). Lower osteocalcin and P1NP levels found in this study suggests slower bone metabolism with reduced bone formation in postmenopausal diabetics.Conclusions: Serum procollagen type 1 N propeptide and osteocalcin in postmenopausal diabetic women were lower as compared to non-diabetic group.
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Objective: To investigate the correlation between bone turnover markers (BTMs) with bone mineral density (BMD) and the risk of fragility fracture in patients with lumbar degeneration. Methods: One hundred fifty-eight patients with lumbar degeneration were selected from May 2016 to May 2017 in the General Hospital of Western Theater Command. The lumbar BMD of all patients were measured by dual energy X-ray absorptiometry. The levels in fasting venous blood of procollagen type-1 N-terminal propeptide (PINP), Osteocalcin (OC), bone-specific alkaline phosphatase (BALP), C-terminal crosslinking telopeptides of type I collagen (β-CTX), 25-hydroxy Vitamin D (25-(OH)VitD) and tartrate resistant alkaline phosphatase (TRACP) were analyzed with Roche chemiluminescence. The past fragility fractures were analyzed by inquiring medical history and X-ray examination. The correlation between BTMs with BMD and fragility fracture risk were evaluated by multiple logistic regression and linear regression analysis. Results: The incidence of fragility fractures in 158 patients with lumbar degeneration was 20.3%. The BMD was significantly lower in patients with fragility fracture than in patients with no fragility fracture (P<0.05). The levels of PINP, BALP, OC and β-CTX were significantly higher in patients with fragility fracture than in those with no fragility fracture (P<0.05). PINP, BALP, OC, β-CTX and TRACP were negatively correlated with lumbar BMD (β=-0.431, -0.234, -0.167, -0.314 and -0.198, respectively; P=0.021, 0.009, 0.034, 0.033 and 0.049, respectively), and β-CTX and PINP were positively correlated with the fragility fracture risk (P<0.05). Conclusion: PINP, BALP, OC, β-CTX and TRACP were negatively correlated with BMD, and β-CTX and PINP were positively correlated with fragility fracture risk in patients with lumbar degeneration, implying that early monitoring BTMs and early anti-osteoporosis treatment may reduce the risk of long-term screw loosening and fragility fracture in patients with lumbar degeneration after surgery.
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Bone turnover markers (BTMs) have important role in the management of osteoporosis. Recently the clinical application of BTMs has achieved significant progress and measurement of BTMs give us better understanding of pathogenesis of osteoporosis. However, the use of BTMs is still insufficient in Korea. We summarized the available methods and standard interval of the BTMs in Korea. Also we reviewed published literatures on pre-analytical variability in the measurement of BTMs and provided recommendations for standardized sample handling and patient preparation for reducing those pre-analytical variabilities. The clinical application of BTMs in patients with chronic kidney disease who have a higher fracture risk than the general population is summarized.
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Humans , Biomarkers , Bone Remodeling , Korea , Osteoporosis , Renal Insufficiency, ChronicABSTRACT
ABSTRACT Objective: The role of bone markers on insulin resistance (IR) remains controversial. The objective of this study is to evaluate the association between bone mineral density (BMD) and glucose metabolism and investigate if visceral hyperadiposity, evaluated by waist circumference (WC), is an effect modifier of this association. Subjects and methods: Cross-sectional analysis with 468 young adults from the fourth follow-up of the 1978/79 Ribeirão Preto prospective birth cohort, Brazil. BMD, total osteocalcin (OC), fasting plasma glucose and insulin concentrations were assessed. IR, sensitivity (S) and secretion (β) were estimated by homeostasis model assessment (HOMA) indexes. Multiple linear regression models were constructed to estimate the association between BMD and glucose metabolism. Beta coefficient, R2 and p-values were provided. WC was tested as an effect modifier and OC as a confounder. The covariates were selected based on Direct Acyclic Graph. Results: Significant interaction between BMD (femoral neck and proximal femur areas) and WC on glucose metabolism was observed in the adjusted models. Subjects with increased WC presented a positive association between BMD and log HOMA1-IR while an inverse association was found in those with normal WC (femoral neck R2 = 0.17, p = 0.036; proximal femur R2 = 0.16, p = 0.086). BMD was negatively associated with log HOMA2-S in individuals with increased WC and positively in those with normal WC (femoral neck R2 = 0.16, p = 0.042; proximal femur R2 = 0.15, p = 0.097). No significant associations between BMD, log HOMA2-β and OC and glucose metabolism markers were observed. Conclusions: BMD was associated with glucose metabolism, independently of OC, and WC modifies this association.
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Humans , Male , Female , Adult , Blood Glucose/metabolism , Bone Density/physiology , Intra-Abdominal Fat/physiology , Waist Circumference/physiology , Immunologic Factors/physiology , Blood Glucose/physiology , Osteocalcin/blood , Cross-Sectional Studies , Fasting , Insulin/bloodABSTRACT
ABSTRACT Objectives: Obesity is a multifactorial disease characterized by the presence of the pro-inflammatory state associated with the development of many comorbidities, including bone turnover marker alterations. This study aimed to investigate the role of the inflammatory state on bone turnover markers in obese adolescents undergoing interdisciplinary weight loss treatment for one year. Subjects and methods: Thirty four post-pubescent obese adolescents with primary obesity, a body mass index (BMI) greater than > 95th percentile of the CDC reference growth charts, participated in the present investigation. Measurements of body composition, bone turnover markers, inflammatory biomarkers and visceral and subcutaneous fat were taken. Adolescents were submitted to one year of interdisciplinary treatment (clinical approach, physical exercise, physiotherapy intervention, nutritional and psychological counseling). Results: Reduction in body mass, body fat mass, visceral and subcutaneous fat, as well as, an increase in the body lean mass and bone mineral content was observed. An improvement in inflammatory markers was seen with an increase in adiponectin, adiponectin/leptin ratio and inteleukin-15. Moreover, a positive correlation between the adiponectin/leptin ratio and osteocalcin was demonstrated. Further, both lean and body fat mass were predictors of osteocalcin. Negative associations between leptin with osteocalcin, adiponectin with Beta CTX-collagen, and visceral fat with adiponectin were observed. Conclusions: It is possible to conclude that the inflammatory state can negatively influence the bone turnover markers in obese adolescents. In addition, the interdisciplinary weight loss treatment improved the inflammatory state and body composition in obese adolescents. Therefore, the present findings should be considered in clinical practice.
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Humans , Male , Female , Adolescent , Adult , Young Adult , Osteocalcin/blood , Leptin/blood , Diet, Reducing , Adiponectin/blood , Exercise Therapy , Obesity/therapy , Biomarkers/blood , Weight Loss , Body Mass Index , Bone Density , Bone Remodeling , Combined Modality Therapy , Resistance Training , Obesity/bloodABSTRACT
Objective To explore the gender differences in the association between iron metabolism and bone turnover markers in elderly patients with fragility fracture.Methods A total of 271 patients admitted in our hospital from Aug 2014 to Oct 2017 with osteoporotic fractures were divided into two groups:109 males and 162 females,aged from 60 to 92 years.Both groups were further divided into 3 age groups(60 to 70,71 to 80,and ≥81 year group).Biochemical indicators,serum ferritin and bone turnover markers were detected eight hours after admission.Results In the male group,there were no statistical differences in serum ferritin and serum procollagen type Ⅰ Nterminal propeptide(PINP) among age groups (all P ＞ 0.05).Serum β-carboxy terminal telopeptide of collagen type Ⅰβ-CTX(β-CTX)was elevated with ageing.In the female group,serum ferritin,PINP,and β-CTX were elevated with ageing.There was a significant positive correlation between serum ferritin and β-CTX in two gender groups (all P ＜ 0.05)without gender difference.Gender difference was observed in the correlation between serum ferritin and PINP between two gender groups:a significant positive correlation in the female group (r =0.255,P =0.001)whereas a significant negative correlation in the male group(r=-0.207,P=0.031).Conclusions There are gender differences in correlations of serum ferritin with bone turnover markers.Increased iron accumulation in postmenopausal women is closely correlated with high bone turnover rate.
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Objective:To investigate the relationship between bone metabolism biochemical markers and clinic features (course,AIS,etc.)in spinal cord injury patients.Method:Totally 73 patients aged from 13 to 89 years with SCI were enrolled.The injury time was recorded,and patients' AIS was assessed.25-hydroxyvitamin D [25(OH)D],collagen type Ⅰ C-terminal telopeptide (CTX)and N-terminal propeptide of type 1 precollagen(P1NP) were measured.Result:In our observation of patients with spinal cord injury,the ratio of 25(OH)D deficience was 98.6％.Correlation between 25(OH)D and clinic features was not found.P1NP showed positive correlation with course (R=-0.235,P＜0.05)and negative correlation with AIS (R=0.442,P＜0.01).CTX showed negative correlation with AIS and age(R was-0.232 and-0.296,P＜0.05).There is no difference between tetraplegia and paraplegia (AIS C and D) in 25(OH)D、P1NP and CTX.CTX is higher in traumatic spinal cord injury patients,(Z=-.2.086,P ＜ 0.05)Conclusion:In patients with spinal cord injury,a lack of vitamin D has a high proportion.The lower AIS was,the higher P1NP and CTX was,which meant severe bone loss.Bone loss may be faster in younger SCI patients and traumatic spinal cord injury patients.
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Objective To discuss efficacy of movement combined with calcium vitamin D in preventing osteoporosis in early postmenopausal women .Methods There were 100 cases ,which were divided into treatment group(50 cases) and control group(50 cases) ,to detect x-ray bone density and three kinds of absorptiometry bone markers as a baseline .The treatment group were given calcium carbonate ,vitamin D3 tablets ,continuous 3 ,6 ,12 ,18 months after the detection of bone mineral density and bone markers a-gain ,observe the change of various index .Results Early menopause women are very high in bone metabolic conversion rate .Com-bined therapy with calcium carbonate and vitamin D ,could significantly affect the level of the three types of bone markers ,there were negative phase ,and the changes in bone turnover markers were preference to BMD Treatment group three kinds of bone mark-ers had changed within three months ,fell by 25% ,12% and 10% respectively .Vitamin D and calcium carbonate effects on bone markers in monitoring ,and so ,three kinds of bone markers with different characteristics .Type Ⅰ collage carboxy-terminal peptide (β-CTX) in the early days could be a significant reduction in 3 months ,6 months after basic hadn′t changed much ;Type Ⅰ procol-lagen amino-terminal peptide (P1NP) and N-terminal osteocalcin (N-MID) reaction time was longer ,the heavy absorption resist-ance was remarkable changes after 6 months ,1 years maintained at a certain level ,and the change of bone mineral density(BMD) at least need more than 12 months .Conclusion Exercise and calcium carbonate and vitamin D supplement ,which could effectively re-duce the bone absorption and improve vitamin D levels ,prevent bone loose women in early menopause has great significance
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Aims: Type 1 DM (T1DM) patients are shown having lower bone mineral density (BMD). Wnt signaling pathway is important in bone homestasis. Sclerostin is a major inhibitor of this pathway. The objectives of our study are to evaluate sclerostin levels of T1DM patients and to analyse its relationships with bone turnover markers. Place and Duration of Study: Department of Endocrinology, Tekirdağ State Hospital, between January to December 2013. Methodology: 48 T1DM patients and age, sex and BMI-matched 40 healthy control cases were included in this study. BMD measurements of T1DM patients were done by dual energy x ray absorptiometry. Serum samples were used to measure albumin, calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone, osteocalcin, pyrilinks-D, 25(OH) Vitamin D and sclerostin levels of all cases. Results: Sclerostin levels of T1DM patients (803,9±92,01 pg/ml) were significantly higher than control cases (522,9±76,23 pg/ml) (P=0.000). Sclerostin has no correlation with age or gender. Sclerostin level was negatively correlated with lumbar vertebrae and femur neck BMD; however, positively correlated with alkaline phosphatase, intact parathyroid hormone, osteocalcin, pyrilinks-D. Lumbar vertebrae and femur neck BMD has negative correlation with HbA1c and duration of T1DM. Conclusions: Sclerostin is increased in T1DM patients and this increment is associated with degradation of lumbar vertebrae and femur neck BMD.
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Background: Morbidity and mortality associated with osteoporosis continues to be high in India due to late diagnosis. This study aims to find the difference in the levels of bone turn over markers in premenopausal and postmenopausal women, in order to assess whether these markers can be used as predictors of low bone mineral density which can develop in later life. Methods: Study was conducted on 350 women aged 30-65 years. Women were classified into premenopausal and postmenopausal groups based on their menstrual history. Serum samples were analyzed for osteocalcin and telopeptide-C. Student’s t-test and logistic regression are used for statistical confirmations. Results: Levels of these markers (ng/ml) were found to be lower in premenopausal women (Osteocalcin = 9.0 ± 1.0; telopeptide-C = 0.270 ± 0.099) than in postmenopausal women (Osteocalcin = 9.8 ± 1.7; telopeptide-C = 0.490 ± 0.135) and this difference was found to be significant (P <0.001) for both the markers. In both the groups, telopeptide-C made significant contribution to prediction of low BMD [(Premenopausal group - odds ratio (OR) = 2.9; 95% confidence interval (95%CI) = 1.3-6.5 and postmenopausal group - OR = 9.6; 95%CI = 6.0-13.23) but osteocalcin could not (premenopausal group - OR = 0.91; 95%CI = 0.58-1.42 and postmenopausal group - OR = 0.87; 95%CI = 0.54-1.4)]. In premenopausal women increase in telopeptide-C by a unit increased chance of developing low BMD by 2.9 times while in postmenopausal women increase in telopeptide-C by a unit increased chance of developing low BMD by 9.6 times. Conclusion: Women with higher levels of telopeptide-C need to be identified at an early stage as it provides with an early warning of the possibility of future development of osteoporosis so that preventive measures can be taken timely.
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Metabolic markers were released in the process of bone resorption and formation during bone remodelling. These markers have been extensively studied in trials of osteoporosis and other metabolic bone disorders during the past de?cades. Bone metabolic markers can replenish bone mineral density in the management of osteoporosis, but their use in clini?cal practice is challenged by their variability. Recently, there are many great progress in research of bone metabolic markers application in non metabolic bone disorders.
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INTRODUÇÃO: Foi documentada uma associação entre níveis séricos elevados de homocisteína (S-Hci) e baixa densidade mineral óssea (DMO) e aumento do risco de fratura em mulheres na pós-menopausa. São escassos os dados concernentes à S-Hci e à saúde óssea em crianças. OBJETIVO: Avaliar S-Hci em crianças e adolescentes com comprometimento da saúde óssea e procurar por relações com dados clínicos e laboratoriais. PACIENTES E MÉTODOS: Avaliamos os níveis de S-Hci em 37 crianças e adolescentes (22 meninos e 15 meninas; média de idade, 13,9 ± 3,5 anos) com fraturas prevalentes por trauma de baixa energia (média 3,3 ± 2,3 por paciente) e/ou baixa DMO espinhal/L1-L4 (escore Z abaixo de -2 DP; DXA Lunar GE). Também avaliamos S-ALP, CrossLaps sérico (S-Hci-CrossLaps), osteocalcina (S-OC), altura, peso corporal, índice de massa corporal (IMC) e níveis séricos de folato e vitamina B12. Por ocasião da avaliação, as crianças não estavam tomando qualquer medicação que sabidamente influenciasse o metabolismo ósseo. Os parâmetros dependentes de idade foram expressos como escores Z ± DP. RESULTADOS: O escore Z para S-Hci foi significativamente mais alto (1,3 ± 1,5; P < 0,0001) e o escore Z de para DMO/L1-L4 foi significativamente mais baixo (-1,7 ± 1,3; P < 0,0001), respectivamente, em comparação com os valores de referência. S-ALP não diferiu dos valores de referência (P = 0,88), enquanto S-CrossLaps e S-osteocalcina foram mais elevados (1,2 ± 1,8 e 0,4 ± 0,5; P = 0,0001 e P = 0,001, respectivamente). S-Hci estava inversamente correlacionada com DMO/L1-L4 (r = -0,33; P = 0,05) e S-ALP (r = -0,36; P = 0,04) não tendo relação com o número de fraturas prevalentes (r = 0,01), S-osteocalcina (r = -0,22) ou S-CrossLaps (r = 0,003). CONCLUSÃO: Esses resultados sugerem aumento na remodelação óssea e uma influência negativa da S-Hci elevada na formação óssea e na DMO em crianças e adolescentes com fraturas recorrentes.
INTRODUCTION: Association between high serum homocysteine (S-Hcy) levels and low bone mineral density (BMD) and increased fracture risk in postmenopausal women has been documented. Data concerning S-Hcy and bone health in children are scarce. OBJECTIVE: Our aim was to evaluate S-Hcy in children and adolescents with impaired bone health and look for correlations with clinical and laboratory data. PATIENTS AND METHODS: We assessed S-Hcy levels in 37 children and adolescents (22 boys and 15 girls; mean age 13.9 ± 3.5 years) with prevalent low-energy trauma fractures (mean 3.3 ± 2.3 per patient) and/or low spinal L1-L4 BMD (below -2SD Z-score; DXA Lunar GE). We also evaluated S-ALP, serum CrossLaps, osteocalcin (S-OC), body height, weight, body mass index (BMI) and serum levels of folate and vitamin B12. At the time of assessment, the children were not taking any drugs known to influence bone metabolism. The age-dependent parameters were expressed as Z-scores ± SD. RESULTS: S-Hcy Z-score was significantly higher (1.3 ± 1.5; P < 0.0001) and L1-L4 BMD Z-score was significantly lower (-1.7 ± 1.3; P < 0.0001), respectively, in comparison with reference values. S-ALP did not differ from reference values (P = 0.88), while S-CrossLaps and S-osteocalcin were higher (1.2 ± 1.8 and 0.4 ± 0.5; P = 0.0001 and P = 0.001, respectively). S-Hcy was inversely correlated to L1-L4 BMD (r = -0.33; P = 0.05) and S-ALP (r = -0.36; P = 0.04) and not related to number of prevalent fractures (r = 0.01), S-osteocalcin (r = -0.22) or S-CrossLaps (r = 0.003). CONCLUSION: These results suggest increased bone turnover and negative influence of elevated S-Hcy on bone formation and BMD in children and adolescents with recurrent fractures.
Subject(s)
Adolescent , Child , Female , Humans , Male , Fractures, Bone/blood , Homocysteine/blood , Bone Density , Bone and Bones/metabolism , Fractures, Bone/metabolismABSTRACT
Osteoporosis is a major health problem worldwide, and is projected to increase exponentially due to the aging of the population. The absolute fracture risk in individual subjects is calculated by the use of algorithms which include bone mineral density (BMD), age, gender, history of prior fracture and other risk factors. This review describes the laboratory investigations into osteoporosis which include serum calcium, phosphate, creatinine, alkaline phosphatase and 25-hydroxyvitamin D and, additionally in men, testosterone. Parathyroid hormone (PTH) is measured in patients with abnormal serum calcium to determine its cause. Other laboratory investigations such as thyroid function testing, screening for multiple myeloma, and screening for Cushing's syndrome, are performed if indicated. Measurement of bone turnover markers (BTMs) is currently not included in algorithms for fracture risk calculations due to the lack of data. However, BTMs may be useful for monitoring osteoporosis treatment. Further studies of the reference BTMs serum carboxy terminal telopeptide of collagen type I (s-CTX) and serum procollagen type I N-terminal propeptide (s-PINP) in fracture risk prediction and in monitoring various treatments for osteoporosis may help expedite their inclusion in routine clinical practice.