Negative association between 25-hydroxyvitamin D and inflammatory markers in rheumatologic diseases / Asociación negativa entre 25-hidroxi vitamina D y los marcadores inflamatorios en enfermedades reumatológicas

Objective: The main purpose of this study was to evaluate serum 25-hydroxyvitamin D (25OHD) levels and its association with in"ammatory markers in patients with rheumatologic diseases (RD). Methods: A cross-sectional study in 154 women with RD (rheumatoid arthritis, spondyloarthritis and other connective tissue diseases) and 112 healthy individuals as a control group (CG) was carried out. Results: No differences in serum and urine calcium, serum phosphate, and urinary deoxypyridinoline were found. RD group had lower 25OHD and higher PTH compared to CG. RD group had higher C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) compared to CG. The overall mean level of 25OHD (ng/ml) was 26.3±12.0 in the CG and 19.4±6.8 in the RD group (p<0.0001). Moreover, CG had lower percentage of individuals with 25OHD de!ciency compared to RD (29.9% vs 53.2%). The femoral neck BMD was signi!cantly lower in postmenopausal RD women compared to CG. 25OHD levels signi!cantly correlated with ESR and CRP as in"ammatory markers. Age, BMI, presence of RD, and CRP were signi!cantly and negatively associated with 25OHD levels through linear regression analysis. According to univariate logistic regression analysis for 25OHD deficiency (<20 ng/ml), a significant and negative association with BMI, presence of RD, ESR and CRP were found. Conclusion: Patients with RD had lower 25OHD levels than controls and the presence of a RD increases by 2.66 the risk of vitamin D de!ciency. In addition, 25OHD has a negative correlation with ESR and CRP as in"ammatory markers. (AU)

Objetivo El objetivo principal de este estudio fue evaluar los niveles séricos de 25-hidroxivitamina D (25OHD) y su asociación con marcadores inflamatorios en enfermedades reumatológicas. Materiales y métodos: Se realizó un estudio transversal en 154 mujeres con enfermedades reumatológicas (artritis reumatoide, espondiloartritis y otras enfermedades del tejido conectivo) y 112 individuos sanos como grupo control (GC). Resultados: No se encontraron diferencias en el calcio sérico y urinario, el fosfato sérico y la desoxipiridinolina urinaria entre el GC y los sujetos con enfermedades reumatológicas. El grupo de pacientes con enfermedades reumatológicas tenía 25OHD más bajo y PTH más alto en comparación con el GC. Asimismo, el grupo de individuos con enfermedades reumatológicas tenía proteína C reactiva (PCR) y velocidad de eritrosedimentación (VES) más altas en comparación con el GC. El nivel de 25OHD (ng/ml) fue 26,3±12,0 en el GC y 19,4±6,8 en el grupo con enfermedades reumatológicas (p<0,0001). Además, el GC presentó un porcentaje menor de deficiencia de 25OHD en comparación con el grupo con enfermedades reumatológicas (29,9% vs 53,2%). La DMO del cuello femoral fue significativamente menor en las mujeres posmenopáusicas con enfermedades reumatológicas en comparación con el GC. La 25OHD correlacionó significativamente con la VES y la PCR como marcadores inflamatorios. El análisis de regresión lineal mostró que la edad, el IMC, la presencia de una enfermedad reumatológica y la PCR se asociaron significativa y negativamente con los niveles de 25OHD. Mientras que el análisis de regresión logística univariada mostró que la deficiencia de 25OHD (<20 ng/ml), se asoció significativa y negativamente con el IMC, la presencia de una enfermedad reumatológica, la VES y los niveles de PCR. Conclusiones: Los pacientes con enfermedades reumatológicas tenían niveles de 25OHD más bajos que los controles y la presencia de una enfermedad reumatológica aumenta en 2.66 el riesgo de deficiencia de vitamina D. Además, la 25OHD mostró correlación negativa con la VES y la PCR como marcadores inflamatorios. (AU)

Levetiracetam and lamotrigine effects as mono- and polytherapy on bone mineral density in epileptic patients / Efeitos do levetiracetam e lamotrigina, em mono e politerapia, na densidade mineral óssea de pacientes epilépticos

ABSTRACT The purpose of this study was to determine the effect of lamotrigine (LTG) and levetiracetam (LEV) as mono- and polytherapy on biochemical markers of bone turnover and bone mineral density in Egyptian adult patients with epilepsy. Methods Forty-eight patients were divided into four groups: two received monotherapy of either LTG or LEV, and the other two groups received polytherapy comprising (valproate [VPA] + LTG or VPA + LEV). Thirty matched healthy participants were included in the study. Participants completed a nutritional and physical activity questionnaire. Biochemical markers of bone and mineral metabolism and bone mineral density of the lumbar spine were measured at baseline and at six months. Results In the LEV monotherapy group, the bone formation markers showed a significant decrease in serum alkaline phosphatase and serum osteocalcin levels while the bone resorption marker showed a significant increase in urinary deoxypyridinoline levels. After six months of treatment, bone mineral density showed a significant decrease in all treated groups, while among monotherapy groups, this significant decrease was more prevalent in the LEV monotherapy group compared with the LTG monotherapy group. Furthermore, there was significant negative correlation between urinary deoxypyridinoline levels and bone mineral density in the LEV monotherapy group. Conclusion Using new generation antiepileptics, LEV monotherapies and polytherapy showed harmful effects on bone but LTG did not.

RESUMO O objetivo deste estudo foi determinar o efeito da lamotrigina (LTG) e levetiracetam (LEV) como mono e politerapia em marcadores bioquímicos de remodelação óssea e densidade mineral óssea em pacientes adultos egípcios com epilepsia. Métodos Quarenta e oito pacientes foram divididos em quatro grupos: dois grupos receberam monoterapia de LTG ou LEV e os outros dois grupos receberam politerapia (valproato [VPA] + LTG ou VPA + LEV). Trinta participantes saudáveis controle foram incluídos no estudo. Os participantes preencheram um questionário nutricional e de atividade física. Marcadores bioquímicos do metabolismo ósseo e mineral e densidade mineral óssea da coluna lombar foram medidos no início e aos seis meses. Resultados No grupo de monoterapia LEV, os marcadores de formação óssea mostraram uma diminuição significativa nos níveis séricos de fosfatase alcalina e osteocalcina sérica, enquanto o marcador de reabsorção óssea mostrou um aumento significativo nos níveis de desoxipiridinolina urinária. Após seis meses de tratamento, a densidade mineral óssea mostrou uma diminuição significativa em todos os grupos tratados, enquanto entre os grupos de monoterapia, esta diminuição significativa foi mais prevalente no grupo de monoterapia LEV em comparação com o grupo de monoterapia LTG. Além disso, houve correlação negativa significativa entre os níveis de desoxipiridinolina urinária e densidade mineral óssea no grupo de monoterapia LEV. Conclusão Utilizando antiepilépticos de nova geração, as monoterapias LEV e a politerapia mostraram efeitos prejudiciais no osso, mas a LTG não.

Bone turnover after bariatric surgery

ABSTRACT Objective The aim of the present study was to evaluate parameters of bone and mineral metabolism after bariatric surgery. Subjects and methods This sectional study included data from medical records from 61 bariatric surgery (BS) patients (minimum period of 6 months after the procedure) and from 30 class II and III obese patients as a control group (Cont), consisting of daily dietary intake of macronutrients, calcium and sodium, serum 25(OH)D and parathyroid hormone (PTH) and other biochemical serum and urinary parameters. Bone alkaline phosphatase (BAP), leptin, fibroblast growth factor-23 (FGF-23) and deoxypyridinoline (DPYD) were determined from available banked serum and urinary samples. Results Mean body mass index (BMI), median energy, carbohydrate, protein and sodium chloride consumption were significantly lower in the BS versus Cont, but calcium and lipids were not. No significant differences were found in ionized calcium, 25(OH)D, PTH and fibroblast growth factor 23 (FGF-23) between groups. Mean serum BAP was significantly higher for BS versus Cont and had a positive correlation with time after the surgical procedure. Mean serum leptin was significantly lower and median urinary DPYD higher in BS versus Cont. Conclusion The present study showed an increase in bone markers of both bone formation and resorption among bariatric patients up to more than 7 years after the surgical procedure, suggesting that an increased bone turnover persists even at a very long-term follow-up in such patients.

Effect of low level laser therapy on local bone resorption during orthodontic treatment: a randomized controlled trial / Efecto del laser terapéutico en la reabsorción osea local durante tratamientos de ortodoncia: un ensayo clínico aleatoriamente controlado

The aim of this study was to assess whether the application of low-level laser therapy (LLLT) during the first stage of orthodontic treatment has an effect on local bone resorption and is detectable at the systemic level by measuring deoxypyridinoline levels (Pyrilinks) in urine. This was a randomized (1:1), double-blind, active-controlled, parallel-group trial. 28 adult patients who were going to start orthodontic treatment were randomly divided into the control group (n: 13) and the experimental group (n: 15), the latter of which received LLLT. All of the subjects underwent testing of urine samples: the first one on the day before the beginning of orthodontic treatment (T0), and the second one 5 days after bracket placement to measure Pyrilinks values (Dpd/Cr) in urine. Group differences were evaluated with Student's paired t-test. At the beginning of the study, the Pyrilinks were in the normal range for 53.57 % of the patients, and 46.43 % had elevated values according to the normal ranges. Only taking into account the normal values at (T0), the average Pyrilinks for control group (T0) were 5.75± 1.20 nM/mM, (T1): 6.02±3.00 nM/mM. For experimental group, (T0) was 5.71± 0.72, and it was 6.63± 0.73 in (T1).There were no significant differences in the Pyrilinks changes. (p= 0.75). In the experimental group levels raised statistically significant (p = 0.009). LLLT on patients starting orthodontic treatment with normal Pyrilinks levels have a statistically significant increment on their levels 5 days post irradiation.

El objetivo de este trabajo fue evaluar si la aplicación de la terapia láser de bajo nivel (TLBN) durante la primera etapa del tratamiento ortodóncico tiene un efecto sobre la resorción ósea local y es detectable a nivel sistémico midiendo los niveles de desoxipiridinolina en la orina. Se trató de un ensayo aleatorizado (1:1), doble ciego, controlado de forma activa y paralelo. 28 pacientes adultos que iban a iniciar el tratamiento de ortodoncia se dividieron al azar en el grupo control (n: 13) y el grupo experimental (n: 15), el último de los cuales recibió TLBN. Todos los sujetos fueron sometidos a pruebas de muestras de orina: la primera en el día anterior al inicio del tratamiento ortodóncico (T0) y la segunda 5 días después de la colocación del bracket para medir los valores de Pyrilinks (Dpd / Cr) en la orina. Las diferencias grupales se evaluaron con la prueba t de Student pareada. Al inicio del estudio, los Pyrilinks estaban en el rango normal para 53,57 % de los pacientes, y 46,43 % tenían valores elevados según los rangos normales. Sólo teniendo en cuenta los valores normales en (T0), los Pyrilinks medios para el grupo de control (T0) fueron 5,75 ± 1,20 nM / mM, (T1): 6,02 ± 3,00 nM / mM. Para el grupo experimental, (T0) fue de 5,71 ± 0,72, y fue de 6,63 ± 0,73 en (T1). No hubo diferencias significativas en los cambios de Pyrilinks. (P = 0,75). En el grupo experimental los niveles aumentaron estadísticamente (p = 0,009). LLLT en los pacientes que comienzan el tratamiento ortodóncico con niveles normales de Pyrilinks tienen un incremento estadísticamente significativo en sus niveles 5 días después de la irradiación.

Effect of three months of periodized hydrogymnastics exercise program on urinary concentration of deoxypyridinoline in older women

ABSTRACT Objective To determine the effect of three months of periodized hydrogymnastics exercise program on urinary concentration of deoxypyridinoline in older women. Subjects and methods Twenty-six subjects were randomly assigned in two, intervention group (n = 16) and control group (n = 10). The intervention group followed 12-week of periodized hydrogymnastics training program five times a week, 50 minutes of water exercise with work heart rate reserve of 40-50% (1-6thweek) increasing the load to 50-60% (7-12th week); the control group was not involved in exercise and remained sedentary. The urinary concentration of deoxypyridinoline was evaluated by high resolution liquid chromatography using the reactive immulite pyrilinks-D siemens medical solutions, pretest at the baseline and at the end post-test of the 12-week of water-exercise. As statistical analyses mixed 2 x 2 ANOVA was used, also percentage changes (Δ %) was calculated. Results The results did not show significant improvement (p < 0.05) comparing the interaction intergroup and the measurements of urinary concentration of deoxypyridinoline (p = 0.504), percentage change (Δ %) showed positive improvements in the experimental group of -13.7 (nM/mMcreatine) in comparison with -7.1 (nM/mMcreatine) from the control group. Conclusion The present study involves periodization increasing the load heart rate reserve of hydrogymnastics exercise in order to produce grater adaptations, but the results showed than is not possible to infer that hydrogymnastics is effective in increase urinary concentration of deoxypyridinoline in older women, will be appropriated in the future more studies to better clarify the possibilities of improvements between hydrogymnastics and urinary concentration of deoxypyridinoline. Arch Endocrinol Metab. 2015;59(6):523-7.

Effects of steroid treatment on bone mineral metabolism in children with Glucocorticoid-sensitive Nephrotic Syndrome / Efectos del tratamiento de esteroides sobre el metabolismo mineral del hueso en niños con Síndrome Nefrótico Sensible a los Glucocorticoides

Glucocorticoids have been used in nephrotic syndrome (NS) treatment for many years. In this study, we aimed to evaluate the effect of steroids on bone mineralization in children with glucocorticoid-sensitive nephrotic syndrome (GSNS). Twenty children who were first diagnosed as GSNS received glucocorticoid therapy for four months. Before treatment, at the 4th and 12th week of initial therapy, bone mineral density (BMD) and levels of the markers for bone turnover were evaluated. At the 4th and 12th week of treatment, mean serum calcium (Ca) and osteocalcin levels were found to be significantly lower than those at the beginning ofthe therapy. Mean serum total alkaline phosphatase (t-ALP), bone-specific alkaline phosphatase (b-ALP) and urine calcium creatinine ratio (Ca/Cr), urinary deoxypyridinoline levels were significantly increased in comparison to the beginning of therapy. There was no significant relationship between serum levels of phosphate and parathyroid hormone (PTH) at the beginning of treatment and at the 4th and 12th week of treatment. Mean value of BMD was significantly lower at the 4th and 12th week of treatment than that at the beginning of the therapy. In conclusion, bone mineralization was negatively affected by steroid treatment in children with NS. These children should undergo regular BMD evaluation, and an appropriate therapeutic approach should be planned.

Por muchos años se han venido usando glucocorticoides en el tratamiento del síndrome nefrótico (SN). Este estudio se encamina a evaluar el efecto de los esteroides sobre la mineralización ósea en niños con síndrome nefrótico sensible a los glucocorticoides (SNSG). Veinte niños que fueron diagnosticados primeramente con SNSG, recibieron terapia con glucocorticoides durante cuatro meses. Antes del tratamiento, en las semanas 4 y 12 de la terapia inicial, se evaluaron la densidad mineral ósea (DMO) y los niveles de los marcadores del recambio óseo. En el tratamiento de las semanas 4 y 12, se halló que el calcio (Ca) sérico promedio y los niveles de osteocalcina eran significativamente más bajos que los existentes a comienzos de la terapia. Los niveles de fosfatasa alcalina sérica total promedio, fosfatasa alcalina (t-ALP), fosfatasa alcalina especifica ósea media (b-ALP), la relación calcio/creatinina en la orina (Ca/Cr), y los niveles de deoxipiridinolina urinaria, aumentaron significativamente en comparación con los existentes al comienzo de la terapia. No hubo relación significativa alguna entre los niveles séricos de fosfato y hormona paratiroidea (PTH) ni al principio del tratamiento ni en las semanas 4 y 12 de tratamiento. El valor promedio de la DMO fue significativamente más bajo en las semanas 4 y 12 de tratamiento que al principio de la terapia. En conclusión, la mineralización del hueso fue afectada negativamente por el tratamiento con esteroides en los niños con SN. Estos niños deben tener una evaluación regular de DMO, para lo cual es necesario planear un enfoque terapéutico apropiado.

Ehlers-Danlos syndrome type VI in a 17-year-old Iranian boy with severe muscular weakness - a diagnostic challenge?

The Ehlers-Danlos syndrome type VI [EDSVI] is an autosomal recessive connective tissue disease which is characterized by severe hypotonia at birth, progressive kyphoscoliosis, skin hyperelasticity and fragility, joint hypermobility and [sub-]luxations, microcornea, rupture of arteries and the eye globe, and osteopenia. The enzyme collagen lysyl hydroxylase [LH1] is deficient in these patients due to mutations in the PLOD1 gene. We report a 17-year-old boy, born to related parents, with severe kyphoscoliosis, scar formation, joint hypermobility and multiple dislocations, muscular weakness, rupture of an ocular globe, and a history of severe infantile hypotonia. EDS VI was suspected clinically and confirmed by an elevated ratio of urinary total lysyl pyridinoline to hydroxylysyl pyridinoline, abnormal electrophoretic mobility of the alpha-collagen chains, and mutation analysis. Because of the high rate of consanguineous marriages in Iran and, as a consequence thereof, an increased rate of autosomal recessive disorders, we urge physicians to consider EDS VI in the differential diagnosis of severe infantile hypotonia and muscular weakness, a disorder which can easily be confirmed by the analysis of urinary pyridinolines that is highly specific, sensitive, robust, fast, non-invasive, and inexpensive

Non-Type I Cystinuria Associated with Mental retardation and Ataxia in a Korean Boy with a New Missence Mutation(G173R) in the SLC7A9 Gene

Cystinuria is an inherited renal and intestinal disease characterized by defective amino acids reabsorption and cystine urolithiasis. It is unusually associated with neurologic symptoms. Mutations in two genes, SLC3A1 and SLC7A9, have been identified in cystinuric patients. This report presents a 13-yr-old boy with cystinuria who manifested difficulty in walking, ataxia, and mental retardation. Somatosensory evoked potential of posterior tibial nerve stimulation showed the central conduction dysfunction through the posterior column of spinal cord. He was diagnosed non-type I cystinuria by urinary amino acid analysis and oral cystine loading test. We screened him and his family for gene mutation by direct sequencing of SLC3A1 and SLC7A9 genes. In this patient, we identified new missence mutation G173R in SLC7A9 gene.

Inborn errors of metabolism revealed by organic acid profile analysis in high risk Egyptian patients: six years experience

To determine the prevalence and types of inborn errors of amino acid or organic acid metabolism in a group of high risk Egyptian children with clinical signs and symptoms suggestive of inherited metabolic diseases. 117 [79 males = 67.5% and 38 females = 32.5%] high risk patients with signs and symptoms of a metabolic disorder were studied, their ages ranged from 3 days to 12 years. Analysis of urine organic acids by gas chromatography/mass spectrometry [GC/MS] was performed to all patients. 22[18.8% of the total] cases were diagnosed with different types of aminoacidopathies or organic acidurias. The disease profile showed increased lactate in 12 cases [54%], glutaric aciduria type I 3 cases [13%], phenylketonuria 2 cases [9%], maple syrup urine disease 1 case [4.5%], glutaric aciduria type II 1 case [4.5%], methylmalonic aciduria 1 case [4.5%], Canavan disease 1 case [4.5%] and non ketotic hyperglycemia 1 case [4.5%]. The results demonstrate the importance of the organic acid profile in the diagnosis of high risk patients. The diagnosed organic acid pattern in this study showed that 10.2% of the patients had a mitochondrial energy defect

Marked Individual Variation in Isoflavone Metabolism After a Soy Challenge Can Modulate the Skeletal Effect of Isoflavones in Premenopausal Women

Soy-isoflavones may act as estrogenic agonists or antagonists depending on the endogenous hormone status. These clinical effects can be exerted variably in individuals by the metabolic ability to produce a more potent metabolite than precursors. The objective of this randomized, double-blind, placebo-controlled study was to investigate the skeletal effect of isoflavones according to their metabolic variability in premenopausal women. Volunteers were randomly assigned to receive either soy-extract isoflavones (n=32) or lactose (n=21) once a day for three menstrual cycles. After intervention, the urinary excretions of isoflavones and their metabolites were significantly higher in the soy group than in the placebo group and showed a large inter-individual variation. Women in the soy group were divided into subgroups according to their ability to excrete more potent metabolites. Serum osteocalcin and urine deoxypyridinoline showed a tendency to increase after a challenge in equol high-excretors. Serum osteocalcin concentration in the genistein high-excretors increased significantly after a challenge (P=0.04) but did not increase in either the placebo or genistein low-excretors. An estrogenic antagonistic effect of isoflavones on bone turnover was observed in premenopausal women who are able to produce more potent metabolites.

Some bone markers in children with type I diabetes mellitus

Diabetes mellitus and osteoporosis are chronic disease with great socioeconomic consequences, mainly due to the late complications and consequences disabilities. Type I diabetes mellitus [DM 1] has been related to a reduced bone mineral density [BMD] in childhood. In order to evaluate alternation in the one metabolism in type I diabetes we measured a urine osteocalsic marker for bone resorption; deoxypyridinoline [DPD] as well as, the circulating osteoblastic markers; serum osteocalcin and osteoprotegerin [OPG]. Further more, we evaluated their relation to the disease duration and severity. The influenced of sex and age on bone health were also assessed. Cross-sectional case-control study was conducted on forty children with DMI and twenty control subjects matched for age and sex with similar socioeconomic and cultural status. Serum levels of osteocalcin and osteoprotegerin were measured, also urinary levels of deoxypyridinoline [DPD] was measured. Children with DMI showed lower serum levels of osteoclacin and OPG and a rise in urinary level of [DPD] in comparison with control subjects. The osteoblast function significantly decreased in diabetic patients, which one best is characterized as a maturation defect. Altered bone mineral acquisition in children with DMI may limit peak bone mass acquisition and increase the risk of osteoporosis in later life. So the clinical management of diabetic osteopenia would become important for the reservation of quality of life in diabetic patients

Changes in urinary deoxypyridinoline [DPD] and serum osteocalcin levels in cadmium chloride induced liver damage in rats before and after vitamin D therapy

Chronic liver diseases have an increased prevalence of metabolic bone diseases in the form of osteopenia and osteoporosis, however, there is little information about the mechanisms of these effects. The present study was aimed to investigate the importance of changes of urinary deoxypyridinoline [Dpd] and serum osteocalcin levels in experimentally induced hepatocellular injury in rats by cadmium chloride [CdCl[2]] as well as to clarify the effect of l,25 [OH][2] D[3] administration. Thirty adult male albino rats were used. The study included 3 groups each of 10 rats, group 1 was normal rats used as a control group, group 2 consisted of rats with induced hepatic damage by CdCl[2] [0.1 mg/kg subcutaneously for 4 weeks] and group 3 consisted of rats with CdCl[2]induced damage and treated with 1,25 [OH][2] D[3] administration [0.1 micro g/kg orally once daily for one week]. Blood and urine samples were collected from all rats at the end of the experiment to measure the levels of the following parameters: serum alanine and aspartate aminotransferases [ALT and AST], urinary Dpd levels as well as serum osteocalcin levels. The results of the present study showed that CdCl[2] induced a significant elevation in the mean values of ALT and AST. Urinary Dpd levels were significantly high after CdCl[2] injection. On the other hand, serum osteocalcin levels were significantly reduced especially in group 2 as compared to the other groups. The present study showed that administration of 1,25 [OH][2] D[3] to group 3 lead to reduction in levels of urinary Dpd and increased levels of serum osteocalcin but did not affect levels of serum transaminases. It was concluded that CdCl[2] induced hepatocellular injury is associated with increased bone resorption and decreased bone formation. Administration of 1.25 [OH][2] D[3] can stop these changes by preventing the progression of bone dystrophy associated with hepatocellular damage

Study of the possible oxidative effect of ovariectomy on bone and the protective role of exercise in rats

There is increasing evidence suggesting the role of free radicals in bone resorption and bone loss. Ovariectomized rats have been used as animal models for the study of osteoporosis. Oxidative stress due to reactive oxygen species [ROS] can cause oxidative damage to cells. Even though, there are studies suggesting the role of free radicals in bone loss, however, the preventive role of exercise on oxidative stress remains obscure. The aim of the present study was to investigate the impact of ovariectomy [OVX] on bone and the possible effects of swim-training regimen on the bone turnover markers and oxidant/antioxidant system in adult rats. The present study was carried out on thirty female albino rats classified into 2 groups. Group I [n=10] underwent sham operation, while group II [n=20] underwent bilateral Ovariectomy [OVX]. Eight weeks after OVX, 10 rats of group 2 [group II a] were left for free cage movement while the other 10 rats [group II b] started to practice swim-training regimen for 1 hour daily, 5 days per week, for 7 weeks. Fifteen weeks from the start of the experiment, blood and urine samples were taken for estimation of biochemical markers of bone turnover [calcium, phosphorous, alkaline phosphatase [ALP], Osteocalcin [OC] and urinary deoxypyridinoline [DPD]]. Then, the rats were killed and the femora were removed. The bone tissue homogenates were used for the estimation of oxidant/antioxidant system markers [superoxide dismutase [SOD], glutathione peroxidase [GPx], malondialdehyde [MDA] and hydrogen peroxide [H2O2]]. The results showed that OVX induced bone oxidative stress with in- creased levels of MDA and H2O2 associated with decreased activity of SOD and GPx significantly when compared to control sham-operated rats. Serum ALP, OC and urinary DPD were elevated significantly in the sedentary OVX rats compared to the sham-operated control rats. Swimming exercise improved OVX-induced bone oxidative stress with significantly lower levels of MDA and H2O2 associated with higher levels of SOD and GPx in exercised rats when compared to sedentary OVX rats. Similarly, exercise limited OVX-induced increase in bone turnover by suppression of serum ALP, OC, and urinary DPD levels. It was concluded that OVX in rats induced bone oxidative stress with increased bone turnover and altered its biochemical markers. Short-term swimming exercise for 7 weeks partially stabilized bone turnover and improved oxidative stress but not able to fully reverse the abnormalities induced by OVX. Further researches are indicated to detect the effect of long-term exercise especially on bone mineral content and density

Usefulness of Bone Metabolic Markers in the Diagnosis of Bone Metastasis from Lung Cancer

Bone metastasis is common in lung cancer patient and the diagnosis of bone metastasis is usually made by using imaging techniques, especially bone scintigraphy. However, the diagnostic yield from bone scintigraphy is limited. The aim of this study is to assess the clinical usefulness of urinary pyridinoline cross-linked N-telopeptides of Type I collagen (NTx), urinary deoxypyridinoline (DPD), and serum alkaline phosphatase (ALP) in the assessment of bone metastasis in patients with lung cancer. Urinary NTx, DPD, and serum ALP were measured in 151 lung cancer patients (33 with and 118 without bone metastasis). Lung cancer patients with bone metastasis had a higher urinary excretion of NTx and DPD, and a higher serum ALP than those without bone metastasis. NTx had a better receiver operating characteristic (ROC) curve than DPD and ALP, since the areas under the ROC curve were 0.82, 0.79, and 0.71, respectively. Although correlation coefficients among NTx, DPD and ALP were significantly positive (p < 0.005), the strongest relationship was appeared between NTx and DPD (R=0.616). In conclusion, our results showed the utility of the new bone markers in detecting bone metastasis and suggested that measurement of urinary NTx was valid diagnostic method of bone metastasis from lung cancer.

Intolerancia congénita a la lactosa y hepatoesplenomegalia. A propósito de un caso / Congenital intolerance to lactose and hepatosplenomegaly

Se describe el caso de un lactante con intolerancia congénita a la lactosa que se presentó con mal ascenso ponderal, vómitos y hepatoesplenomegalia. Los exámenes complementarios mostraron proteinuria, movilización de enzimas hepáticas, cuerpos reductores en orina positivos correspondientes a lactosa y aminoaciduria generalizada. La inmediata institución de dieta libre de lactosa, fue seguida de una rápida recuperación clínica y paraclínica. La intolerancia congénita a la lactosa (ICL) es un raro trastorno de intolerancia a los azúcares. La afección fue descrita por Durand en 1958. Se caracteriza clínicamente por vómitos y mal ascenso ponderal con lactosuria, de inicio en los primeros días de vida siempre que el paciente esté alimentado con leche materna o fórmula con lactosa. Se acompaña de compromiso renal dado por aminoaciduria generalizada y acidosis tubular, hepático dado por movilización de transaminasas y en algunos casos compromiso ocular. Se subraya la importancia de descartar esta afección en los casos de vómitos y desnutrición de los primeros meses de vida dado que es una enfermedad potencialmente fatal si no se suprime el aporte alimentario de lactosa.

effect of rehabilitation program on bone turnover in patients with stroke

The hemiplegia accelerates hone loss and is associated with an increased bone turnover. To study any difference of bone mineral density [BMD] between the affected and the unaffected sides of chronic stroke patients and the effect of rehabilitation program on bone mass and on the markers of bone resorption: urinary excretion of pyridinohine and deoxypyridinoline. Cohort correlational study. Prince Abdullah Bin Abdul Aziz hospital, Bisha, Saudi Kingdom Patients: 33 males, with mean age 59.6 +/- 4.1 yr [range, 54-67 yr] at the time of ad mission. On the paretic and nonparetic sides and biochemical markers of bone turnover were measured at the time of admission and after completing a 3 months rehabilitation program. BMI] was measured by dual energy X-ray absorptiometry [l]EXA] at the lumbar spine, femoral neck, and distal radius. Urinary f-pyr and f-Dpyr were measured in fasting urine samples by spectrofluorometry after high performance liquid chromatography [HPLC] and corrected for creatinine excretion. The baseline values of UMD were lower than normal in all selected regions and a significant difference of BMD was found between the paretic and nonparetic limbs. A significant increase in the BMD was observed only in the femoral neck after 3 months of rehabilitation program [<0.05]. The baseline values of bone resorption markers f-Pyr and f-Dpyr, were higher than normal and a significant improvement in the levels of these markers was observed after the rehabilitation program [p<0.001 and<0.05 respectively]. Patients with hemiplegia have increased bone resorption. Additionally, the results suggest that the early weight-bearing and electrically stimulated muscle contraction can have a beneficial effect on the preservation of hone mass and reduces the progression of osteoporosis found in those patients. BMD in our patients showed no significant difference before and after rehabilitation program while bone markers increased significantly reflecting a decrease in the bone resorption rate. The bone markers are therefore more useful than DEXA for therapeutic monitoring of patients with osteoporosis

The Effects of Sulphasalazine on Urinary Excretion of the Hydroxypyridinium Crosslinks of Collagen in Patients with Rheumatoid Arthritis

Secondary osteoporosis is a feature of rheumatoid arthritis (RA). In recent years, several attempts have been made to develop specific markers for monitoring connective tissue metabolism in arthritic diseases. Our purpose, in this study was to assess pyridinium crosslinks (PYD and DPYD) excretion in relation to the activity of RA (changes related to sulphasalazine treatment). Fourty premenopausal female patients with active RA (mean age; 36.0 7.2 years), 20 postmenopausal women with active RA (mean age; 60.0 6.8 years), 23 postmenopausal women with OA (mean age; 56.1 6.6 years) and 17 premenopausal healthy subjects (mean age; 28.3 4.28 years) were enrolled in our study. All of the 40 premenopausal female patients with active RA were given sulphasalazine. The mean follow up period for these patients was 10.3 1.1 months. In all of these patients, urine samples were collected both in the active and in the inactive periods. Urine PYD and DPYD levels were measured by ELISA. Urine PYD levels were significantly higher in the active period (14.01 3.16 nmol/mmol cr) than in the inactive (8.25 4.23 nmol/mmol cr) period in patients with premenopausal RA (p 0.05). Urine PYD levels were significantly high in postmenopausal active RA patients (19.06 3.26 nmol/mmol cr) compared to premenopausal active and ind inactive, postmenopausal inactive RA patients, osteoarthritis and healthy controls. Urine DPYD excretion was similar in patients with premenopausal RA in the active (7.46 2.13 nmol/mmol cr) and inactive periods (5.08 0.87 nmol/mmol cr) (p 0.05). In active premenopausal RA patients, a correlation was found between PYD excretion and RAI, ESR, CRP and functional capacity (r=0.5729 p 0.01, r=0.5953 p 0.01, r=0.6125 p 0.01 and r=0.6232, p 0.01 respectively). But in the inactive period, no such correlation was was evident. In disease activity parameters did not correlate with DPYD excretion in either the active or the inactive period. As a result, urine PYD excretion was significantly high in patients with active RA. During sulphasalazine treatment, urine PYD levels decreased. This is attributed to improvement in bone destruction.

Effect of hormone replacement therapy on the bone mass and urinary excretion of pyridinium cross-links

CONTEXT: The menopause accelerates bone loss and is associated with an increased bone turnover. Bone formation may be evaluated by several biochemical markers. However, the establishment of an accurate marker for bone resorption has been more difficult to achieve. OBJECTIVE: To study the effect of hormone replacement therapy (HRT) on bone mass and on the markers of bone resorption: urinary excretion of pyridinoline and deoxypyridinoline. DESIGN: Cohort correlational study. SETTING: Academic referral center. SAMPLE: 53 post-menopausal women, aged 48-58 years. MAIN MEASUREMENTS: Urinary pyr and d-pyr were measured in fasting urine samples by spectrofluorometry after high performance liquid chromatography and corrected for creatinine excretion measured before treatment and after 1, 2, 4 and 12 months. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DEXA) before treatment and after 12 months of HRT. RESULTS: The BMD after HRT was about 4.7 percent (P < 0.0004); 2 percent (P < 0.002); and 3 percent (P < 0.01) higher than the basal values in lumbar spine, neck and trochanter respectively. There were no significant correlations between pyridinium cross-links and age, weight, menopause duration and BMD. The decrease in pyr and d-pyr was progressive after HRT, reaching 28.9 percent (P < 0.0002), and 42 percent (P < 0.0002) respectively after 1 year. CONCLUSIONS: Urinary pyridinoline and deoxypyridinoline excretion decreases early in hormone replacement therapy, reflecting a decrease in the bone resorption rate, and no correlation was observed with the bone mass evaluated by densitometry

Changes in biochemical bone markers during pregnancy and puerperium

To elucidate the changes in bone turnover during pregnancy and puerperium, we measured serially the levels of serum osteocalcin and urine deoxypyridinoline (Dpy) as markers of bone formation and bone resorption, respectively, in 22 healthy women with normal pregnancy. Nineteen non-pregnant women served as control. The Dpy levels increased significantly at 16 weeks of pregnancy and remained elevated thereafter. The levels of osteocalcin, however, were significantly decreased at 16 weeks of pregnancy and elevated later at 6 weeks postpartum. Bone turnover ratio (Dpy/osteocalcin) continued to rise during pregnancy, but returned to control levels 6 weeks after delivery. Dpy levels and bone turnover ratio during puerperium tended to be higher in 17 breast-feeding women than those of 5 exclusive bottle-feeders. In conclusion, bone resorption begins to increase from the second trimester of pregnancy and calcium release from bone tissue might play a major role in calcium homeostasis during the whole period of pregnancy as well as during lactation.