Effect of multiparity on bone mineral density, evaluated with bone turnover markers / Efeito da multiparidade sobre a densidade mineral óssea, avaliada por marcadores de remodelação óssea

Abstract Objective: Our aim was to investigate the effect of parity on osteoporosis by evaluating bone mineral density, markers of bone turn-over and other factors that are effective in osteoporosis in multiparous (five deliveries or more) and nulliparous women in the post-menopausal period. Methods: A total of 91 multiparous (five deliveries or more) and 31 nulliparous postmenopausal women were included in this study. All patients were interviewed on sociodemographic characteristics, gynecologic history, personal habits, levels of physical activity, and life-long intake of calcium. Bone mineral density was measured at lumbar (L1-4) and femoral neck regions with Dexa. Results: The mean age of multiparous women was 58.79 ± 7.85 years, and the mean age of nulliparous women was 55.84 ± 7.51. The femoral BMD was 0.94 ± 0.16 and lumbar BMD 1.01 ± 0.16 in multiparous women, femoral BMD was 0.99 ± 0.16 and lumbar BMD 1.07 ± 0.14 in nulliparous women. There were no statistical differences between the femoral and lumbar T scores and BMD values of the two groups. Lumbar T scores and lumbar BMD showed a decrease with increasing total duration of breast-feeding in multiparous women. The independent risk factors for osteoporosis in the regression analysis of multiparous women were found to be the duration of menopause and body weight of 65 kg and less. Conclusion: There is no difference between the bone mineral densities of multiparous and nulliparous women. Females with lower body-weight and longer duration of menopause should be followed-up more carefully for development of osteoporosis.

Resumo Objetivo: Investigar o efeito da paridade sobre a osteoporose por meio da avaliação da densidade mineral óssea, marcadores de remodelação óssea e outros fatores eficazes na avaliação da osteoporose em multíparas (cinco partos ou mais) e nulíparas no período pós-menopausa. Métodos: Foram incluídas neste estudo 91 multíparas (cinco partos ou mais) e 31 nulíparas, todas na pós-menopausa. As pacientes foram entrevistadas para a determinação das características sociodemográficas, história ginecológica, hábitos pessoais, níveis de atividade física e ingestão de cálcio ao longo da vida. A densidade mineral óssea foi medida na região lombar (L1-4) e do colo femoral com a Dexa. Resultados: A média de idade das multíparas e nulíparas foi de 58,79 ± 7,85 anos e 55,84 ± 7,51, respectivamente. Nas multíparas, a DMO femoral e lombar foi de 0,94 ± 0,16 e 1,01 ± 0,16, respectivamente; nas nulíparas, a DMO femoral e lombar foi de 0,99 ± 0,16 e 1,07 ± 0,14, respectivamente. Não houve diferença estatisticamente significativa entre os T-escores femoral e lombar e os valores de DMO dos dois grupos. O T-escore e a DMO lombar mostraram uma diminuição em caso de aumento na duração total da lactação materna em multíparas. Encontrou-se que os fatores de risco independentes para a osteoporose na análise de regressão das multíparas são a duração da menopausa e o peso corporal menor ou igual a 65 kg. Conclusão: Não há diferença entre a densidade mineral óssea de multíparas e nulíparas. As mulheres com menor peso corporal e maior duração da menopausa devem ser acompanhadas com mais atenção para determinar se há desenvolvimento de osteoporose.

Evaluación de la respuesta densitométrica en pacientes con osteoporosis posmenopáusica tratadas con ranelato de estroncio o denosumab / Densitometric response in postmenopausal osteoporosis treated with strontium ranelate or denosumab

Tanto el ranelato de estroncio (RSr) como el denosumab (Dmab) son eficaces en el tratamiento de la osteoporosis (OP) posmenopáusica (PM). El efecto de cada fármaco por separado sobre la densidad mineral ósea (DMO) ha sido estudiado recientemente. Con ambas drogas se observó, al año de tratamiento, un aumento significativo de la DMO en columna lumbar (CL), cuello femoral (CF) y cadera total (CT). En este trabajo comparamos la respuesta densitométrica al año de tratamiento con una y otra droga. Utilizamos los registros de 425 pacientes PMOP tratadas con Dmab y 441 tratadas con RSr. En cada paciente analizamos el porcentaje de cambio; se clasificaron como respondedoras aquellas que mostraron un cambio ≥3%. Adicionalmente se comparó la respuesta en pacientes no previamente tratadas con bifosfonatos (BF-naïve) en comparación con pacientes que habían recibido previamente un BF. Al analizar el grupo completo para Dmab, el porcentaje de pacientes respondedoras fue de 68,4% en CL, 63,3% en CF y 49,3% en CT. Por otro lado, en el grupo de pacientes tratadas con RSr, el porcentaje de respondedoras (53,8% en CL, 40,0% en CF y 35,6% en CT) fue estadísticamente menor. Cuando comparamos la respuesta entre las pacientes BF-naïve que recibieron RSr o Dmab, el Dmab indujo mayor respuesta en CL y CF que el grupo RSr, sin diferencias en CT. Cuando se analizaron los subgrupos BF-previo, las tratadas con Dmab mostraron mayor respuesta en todas las regiones. Conclusión: en pacientes con OP-PM, el tratamiento con Dmab produjo mayores incrementos densitométricos que el RSr, siendo el porcentaje de pacientes respondedoras mayor con Dmab que con RSr. (AU)

Both strontium ranelate (SrR) and denosumab (Dmab) are effective in the treatment of postmenopausal osteoporosis (PMOP). The effect of each drug on bone mineral density (BMD) has been studied separately by us. With both treatments, there was a significant increase after one year of treatment at the lumbar spine (LS) and hip. In this paper we compared the densitometric response after one year of treatment with both drugs used separately. We used the clinical records of 425 PM patients treated with Dmab and 441 treated with SrR. For each patient we analyzed the percentage of change; those who showed a change ≥3% were classified as responders. Additionally, the response was compared in patients not previously treated with bisphosphonates (BP-naïve) compared to patients who had previously received a BP. When analyzing the complete group for Dmab, the percentage of "responders" was 65.2% at the LS, 62.9% at the femoral neck (FN) and 47.4% at the total hip (TH). On the other hand, in the group of patients treated with SrR the percentage of responders (53.8% at the LS, 40.0% at the FN and 35.6% at the TH) was statistically lower. When comparing the response between in BF-naïve patients receiving RSr or Dmab, Dmab induced a greater response at the LS and FN than the RSr group, with no statistical differences at the TH. When the subgroups with prior BP treatment were analyzed, those treated with Dmab showed greater response in all regions. Conclusion: in patients with PMOP treatment with Dmab produced greater densitometric increments than SrR, and the percentage of responders was higher with Dmab than with SrR. (AU)

Serum 25-hydroxyvitamin D levels are associated with functional capacity but not with postural balance in osteoporotic postmenopausal women

OBJECTIVES: In post-menopausal women with osteoporosis, insufficient vitamin D levels decrease calcium fixation in the bones and calcium transport in the sarcoplasmic reticulum, which impairs muscle strength, possibly leading to detrimental consequences for the preservation of functional capacity and postural balance, fall prevention, and fracture risk. The aim of this study was to evaluate the association between vitamin D levels and knee muscle strength, postural balance and functional mobility among postmenopausal women with osteoporosis. METHODS: This cross-sectional study included 63 osteoporotic older women (aged 60.6±3.1 years). The subjects completed the Timed Up and Go Test to measure functional mobility, and postural balance was assessed on the AccuSway Plus portable force platform. Maximal strength was tested using an isokinetic dynamometer for knee flexion and extension. The subjects were assessed as a group and were divided into quartiles according to their vitamin D levels. Clinicaltrials.gov: NCT02771834. RESULTS: Vitamin D status was independently associated with the normalized peak torque of the knee extensors (β=0.59; p=0.04) and Timed Up and Go Test (β=-0.07; p<0.001). No between-group differences were observed in the demographic and clinical variables or postural balance; however, significant differences were observed in the Timed Up and Go Test, and the group with the highest vitamin D levels exhibited better performance than the group with the lowest vitamin D levels (p<0.001). CONCLUSION: The serum vitamin D levels were independently associated with normalized knee extension strength and functional mobility in postmenopausal women with osteoporosis.

Utilidad del tratamiento secuencial con teriparatide y denosumab en la osteoporosis de alto riesgo: nuestra experiencia asistencial / Benefits of sequential treatment of high risk osteoporosis with teripartide and denosumab: our experience

El tratamiento de las formas graves de osteoporosis representa un desafío en la práctica asistencial. Reportamos tres pacientes con formas graves de osteoporosis tratadas en el Instituto de Diagnóstico e Investigaciones Metabólicas con un esquema secuencial de teriparatide 20 µg/día durante 18 meses, seguidos de 12 meses de denosumab 60 mg semestral. Luego de 18 meses de tratamiento con teriparatide la densidad mineral ósea en columna aumentó 5,86±1,01% y en cuello femoral 1,92±3,10%; al finalizar los doce meses de tratamiento con denosumab se constató un aumento total en columna de 10,45±1,70% y en cuello femoral 9,28±3,86%. El tratamiento con teriparatide se acompañó de un aumento en los niveles plasmáticos de telopéptidos del colágeno óseo (CTX) y en el período de tratamiento con denosumab dichos valores disminuyeron de manera significativa, mostrando el impacto de estos fármacos sobre el remodelado óseo. Concluimos que el tratamiento secuencial con teriparatide y denosumab en dosis convencionales resultó beneficioso en las tres pacientes tratadas. Sería de utilidad ampliar esta experiencia en un trabajo prospectivo. (AU)

High risk osteoporosis treatment is a challenge in daily medical practice. We report three patients that attended our institution with severe osteoporosis who received sequentially teriparatide (20 ug daily) for eighteen months followed by denosumab (60 mg every six months) for twelve months. After teriparatide treatment bone mineral density increased 5.86±1.01% at lumbar spine and 1.92±3.10 % at femoral neck, while after denosumab it continued increasing to reach a total of 10.45±1.70% at lumbar spine and 9.28±3.86% at femoral neck. Teriparatide treatment increased bone resorption evidenced by high serum CTX while after denosumab it fell abruptly, showing the impact of these two drugs on bone turnover. We conclude that sequential treatment with teriparatide and denosumab in approved doses was beneficial for these three patients. Prospective studies are needed. (AU)

Relationship between plasminogen activator inhibitor type-1 (PAI-1) gene polymorphisms and osteoporosis in Turkish women

OBJECTIVE: The development of osteoporosis is associated with several risk factors, such as genetic structures that affect bone turnover and bone mass. The impact of genetic structures on osteoporosis is not known. Plasminogen activator inhibitor type-1 regulates the bone matrix and bone balance. This study assessed the correlation between plasminogen activator inhibitor type-1 gene 4G/5G polymorphisms and osteoporosis in a population of Turkish women. METHODS: A total of 195 postmenopausal female patients who were diagnosed with osteoporosis (Group I) based on bone mineral density measurements via dual-energy x-ray absorptiometry and 90 females with no osteoporosis (Group II) were included in this study. Correlations between PAI-1 gene 4G/5G polymorphisms and osteoporosis were investigated through the identification of PAI-1 gene 4G/5G polymorphism genotypes using the polymerase chain reaction. RESULTS: No significant differences in the genotype and allele frequency of 4G/5G plasminogen activator inhibitor type-1 polymorphisms were observed between the two groups, and both groups exhibited the most frequently observed 4G5G genotype. CONCLUSION: No correlation between the development of osteoporosis in the female Turkish population and 4G/5G plasminogen activator inhibitor type-1 gene polymorphisms was observed.

Estudio comparativo de la excreción urinaria de boro, calcio, magnesio y fósforo en mujeres posmenopáusicas con y sin osteoporosis / Comparative study of the urinary excretion of boron, calcium, magnesium and phosphorus in postmenopausal women with and without osteoporosis

Con el propósito de comparar la posible relación entre las concentraciones urinarias de boro y las concentraciones de calcio, de magnesio y de fósforo en suero y orina de mujeres posmenopáusicas con y sin osteoporosis, seleccionamos 45 mujeres posmenopáusicas con más de 47 años de edad, divididas en dos subgrupos: grupo I mujeres posmenopáusicas clínicamente sanas y grupo II mujeres posmenopáusicas con osteoporosis, sin enfermedades renales, hepáticas o diabetes mellitus. Se determinó el boro (B), el fósforo (P), el calcio total (Ca) y el magnesio total (Mg) en la orina de dos horas por espectroscopia de emisión atómica con plasma acoplado por inducción (ICPA-ES), el calcio y el magnesio total en suero por espectroscopia de absorción atómica en llama (FAAS) y el fósforo inorgánico en suero y la creatinina en suero y orina por espectroscopia de absorción molecular. Los resultados obtenidos sugieren preliminarmente una diferencia significativa (p<0,05) en las concentraciones de boro y de fósforo en la orina de dos horas entre los grupos estudiados. El análisis de regresión lineal aplicado, sugiere relación entre el índice boro/creatinina y los índices calcio/creatinina, magnesio/creatinina y fósforo/creatinina en la orina de las mujeres posmenopáusicas con osteoporosis.

In order to compare the possible relationship between urinary concentrations of boron, calcium, magnesium and phosphorus in serum and urine of postmenopausal women with and without osteoporosis, we selected 45 postmenopausal women over 47 years of age, divided into two groups: group I clinically healthy postmenopausal women and group II postmenopausal women with osteoporosis, without chronic kidney and hepatic diseases or diabetes mellitus. We determined the boron (B), phosphorus (P), total calcium (Ca) and total magnesium (Mg) in the urine of two hours, by atomic emission spectroscopy with induction-coupled plasma (ICPA-ES). Total calcium and total magnesium in serum were determined by atomic flame absorption spectroscopy (FAAS) and inorganic phosphorus in serum, and creatinine in serum and urine, by molecular absorption spectrometry. The preliminary results suggest the existence of a significant difference (p <0.05) in boron and phosphorus concentrations in the urine of two hours between the groups. The model of linear regression analysis used showed a relationship between urinary concentrations of boron/creatinine index and calcium/ creatinine, magnesium/creatinine and phosphorus/creatinine indexes in the urine of postmenopausal women with osteoporosis.

Diagnostic Utility of Osteocalcin, Undercarboxylated Osteocalcin, and Alkaline Phosphatase for Osteoporosis in Premenopausal and Postmenopausal Women

BACKGROUND: We aimed to investigate the diagnostic utility of osteocalcin (OC), undercarboxylated osteocalcin (ucOC), and alkaline phosphatase (ALP) in pre- and postmenopausal women for femoral neck, L1-4, and L2-4 bone mineral density (BMD) values by taking into consideration their age, body mass index (BMI), and menopausal status. METHODS: Premenopausal (N=40) and postmenopausal cases (N=42) were classified as 25-34 or 35-45 yr of age and within the first 5 yr or 5 yr or more after the onset of menopause, respectively. RESULTS: Among the groups, statistical differences were found for age, BMI, OC, ucOC, ALP, femoral neck BMD, L1-4 BMD, and L2-4 BMD. The highest serum OC, ucOC, and ALP levels were observed in cases within the first 5 yr after the onset of menopause, probably due to a more rapid bone turnover rate. The best predictors for the femoral neck osteoporosis were ALP, OC, and calcium (areas under the ROC curve [AUC]=0.882, 0.829, and 0.761, respectively), and those for L1-4 and L2-4 osteoporosis were OC, ALP, and ucOC (AUC=0.949, 0.873, and 0.845; and 0.866, 0.819, and 0.814, respectively). Multiple logistic regression analysis revealed that the most discriminative parameter for osteoporosis was OC. CONCLUSIONS: These results indicate that serum OC levels, with or without ucOC and ALP, may be useful to monitor follow-up changes that currently cannot be assessed with BMD and to diagnose femoral neck, L1-4 spine, and L2-4 spine osteoporosis.

The effects of discontinuing long term alendronate therapy in a clinical practice setting / Efeitos da retirada do uso prolongado de alendronato na prática clínica

OBJECTIVE: To assess bone turnover markers (BTM) and bone mineral density (BMD) after discontinuation of alendronate treatment used for five or more years. SUBJECTS AND METHODS: 40 patients (pt) with post-menopausal osteoporosis treated with alendronate (10 mg/d) for at least five years (Group 1, G1) had their medication discontinued. Group 2 (G2): 25 pt treated with alendronate for at least one year. Group 3 (G3): 23 treatment-naïve osteoporotic pt. BMD was evaluated in G1 and G2 at baseline and after 12 months. Collagen type I cross-linked C-telopeptide (CTX) and procollagen type 1 N-terminal propeptide (P1NP) levels were measured in all pt at baseline, and in G1 and G2 every three months for 12 months. Data were analyzed using ANOVA on ranks and Mann-Whitney tests. RESULTS: Mean BMD values in G1 and G2 did not differ during follow-up. However, 16 pt (45.7 percent) in G1 and one (5.2 percent) in G2 lost BMD (P < 0.001). BTM at baseline was not different between G1 and G2, and both were lower than G3. A significant increase in BTM levels was detected in G1 pt after three months, but not in G2. CONCLUSION: Observed BMD loss and BTM rise after alendronate withdrawal imply that bone turnover was not over suppressed, and alendronate discontinuation may not be safe.

OBJETIVO: Avaliar a evolução dos marcadores de metabolismo ósseo (MMO) e da densidade mineral óssea (DMO) após cinco anos de uso de alendronato em mulheres osteoporóticas na pós-menopausa. SUJEITOS E MÉTODOS: 40 pacientes (pct) osteoporóticas, na pós-menopausa, em uso de alendronato (10 mg/dia) por pelo menos 5 anos (Grupo 1 − G1) tiveram o uso do bisfosfonato suspenso. O grupo 2 (G2): 25 mulheres na pós-menopausa, em uso de alendronato (10 mg/dia) há pelo menos 1 ano. Grupo 3 (G3): 23 pct osteoporóticas, controles ainda sem tratamento. G1 e G2 submeteram-se à avaliação da DMO por DXA (basal e após 12 meses de seguimento). Todas as pct colheram amostras basais de CTX e P1NP, e G1 e G2 submeteram-se a coletas trimestrais de CTX e P1NP durante 1 ano. Resultados foram analisados por ANOVA on ranks e Mann-Whitney. RESULTADOS: Níveis médios de DMO não variaram em G1 ou G2 durante o estudo; no entanto, 16 pct (45,7 por cento) no G1 e 1 pct (5,2 por cento) no G2 apresentaram redução clinicamente significativa de DMO (P < 0,001). Níveis basais de CTX e P1NP não diferiram entre G1 e G2, com ambos inferiores aos níveis de G3. Em G1, observou-se elevação significativa de CTX e P1NP após 3 meses. Os níveis de CTX e P1NP em G2 permaneceram estáveis durante todo o seguimento. CONCLUSÃO: Não parece haver supressão excessiva do metabolismo ósseo na prática clínica. A suspensão temporária do alendronato após seu uso prolongado pode não ser segura.

Effects of D-003 (10 mg/day) on Bone Mineral Density of the Lumbar Spine and Femoral Neck in Postmenopausal Women: A Randomized, Double-Blinded Study

BACKGROUND/AIMS: Increased osteoclast activity is a pivotal finding in osteoporosis. This increase is mediated via the mevalonate-to-cholesterol pathway, which is involved in producing the intermediates required for osteoclast activity. D-003, a mixture of high molecular weight sugarcane wax acids, has been shown to inhibit cholesterol synthesis prior to mevalonate production, resulting in a reduction of bone loss and resorption in ovariectomized rats. Moreover, previous studies have demonstrated that short-term D-003 treatment reduces urinary excretion of deoxypyridinoline/creatinine in postmenopausal women. METHODS: We performed a double-blinded, placebo-controlled study to investigate the effects of D-003 (10 mg/day) treatment for 3 years on bone mineral density (BMD) in 83 postmenopausal women with low BMD. RESULTS: Over 3 years, D-003 treatment increased lumbar spine BMD (5.1%, p < 0.01) and improved osteoporosis-related quality of life scores as compared with placebo-treated controls. D-003 was also well tolerated; the frequency of adverse events in the bone, joints, or muscle with D-003 treatment (p < 0.05) was lower than in the placebo group. CONCLUSIONS: D-003 treatment (10 mg/day) for 3 years increased lumbar spine BMD and produced clinical improvements in postmenopausal women with low BMD. Further studies, however, will be required to confirm these results.

Concentração plasmática de 25 hidroxivitamina D em mulheres na pós-menopausa com baixa densidade mineral óssea / Concentration of 25-hydroxyvitamin D in postmenopausal women with low bone mineral density

OBJETIVOS: Determinar as concentrações plasmáticas médias de 25 hidroxivitamina D (25OHD) em mulheres na pós-menopausa com baixa densidade mineral óssea (DMO); encontrar o ponto de corte de elevação do paratormônio (PTH); avaliar a correlação entre 25OHD e DMO, parâmetros bioquímicos e presença de fraturas vertebrais. MÉTODOS: Estudo transversal, com dosagem de 25OHD e de PTH, e realização de DMO e radiografia de coluna. RESULTADOS: Houve elevada frequência de concentrações plasmáticas inadequadas de 25OHD (68,3 por cento) e 8 por cento de hiperparatireoidismo secundário. Não foram observadas diferenças significativas entre as concentrações plasmáticas de 25OHD e os parâmetros avaliados, exceto PTH, que apresentou associação inversa. O ponto de corte determinado foi de 61,5 nmol/L. CONCLUSÕES: A alta frequência de hipovitaminose D em idosas com baixa DMO sugere que a avaliação sistemática das concentrações plasmáticas de 25OHD deve ser realizada nessa população. Recomenda-se o uso de ponto de corte de 61,5 nmol/L até a realização de estudo epidemiológico que represente toda a cidade do Rio de Janeiro (RJ).

OBJECTIVES: This study was designed to determine mean serum concentrations of 25-hydroxyvitamin D (25OHD) in postmenopausal women with low bone mineral density (BMD), to find the cutoff of parathormone (PTH) elevation, and to evaluate the correlation 25OHD with BMD, biochemical parameters and vertebral fracture presence. METHODS: Transversal study, with collection of 25OHD and PTH, and determination of DMO and column radiograph. RESULTS: A high incidence of inadequate serum concentrations of 25OHD (68.3 percent) was found and 8 percent of secondary hyperparathyreoidism. No significant differences were found between 25OHD serum concentrations and the evaluated parameters, except for PTH, which showed a negative association. The established cutoff was 61.5 nmol/L. CONCLUSIONS: The elevated incidence of hipovitaminosis D in elderly women with low BMD suggests that a systematic evaluation of 25OHD serum concentrations must be done for this population.The use of 61.5 nmol/L as a cutoff is recommended until the realization of an epidemiologic study that represents all Rio de Janeiro city (RJ, Brazil).

Vitamin D status and hyperparathyroisism in postmenopausal osteoporotic patients in Cipto Mangunkusumo hospital Jakarta.

AIM: to determine the profile of vitamin D and parathyroid hormone (PTH) and the proportion of vitamin D inadequacy in a population of postmenopausal osteoporotic patients from a rheumatologic outpatient clinic. METHODS: a cross sectional study was conducted between October and December 2006 in the Rheumatology Clinic, Cipto Mangunkusumo Hospital with osteoporosis confirmed by bone mineral densitometry (T score less than -2.5 at the lumbar spine or hip). Patients were excluded if there was a history of oral glucocorticoid treatment within 30 days, vitamin D supplementation, and have renal and/or liver function impairments. Forty-two postmenopausal osteoporotic patients aged 51-77 years old who had been postmenopausal for 5-28 years were included in this study. Vitamin D inadequacy was defined as the plasma levels of 25(OH)D less than 50 nmol/L whereas hyperparathyroidism was defined as the PTH level more than 69 pg/dL. RESULTS: vitamin D inadequacy was found in 61.9% of patients and 34.6% of them or 23.8% of total patients were also having high PTH level. There was an inverse correlation between 25(OH)D with PTH levels and positive correlation between duration of menopause and PTH level. Vitamin D inadequacy is common (61.9%) in postmenopausal osteoporotic patients who visited Rheumatology outpatient clinic of Cipto Mangunkusumo Hospital Jakarta. CONCLUSION: the low concentration of 25(OH)D was correlated with PTH level and duration of menopause. This finding should be confirmed in a larger epidemiological study, either hospital-or community-based to assess vitamin D status among postmenopausal women in Indonesia.

Serum concentration of undercarboxylated osteocalcin and the risk of osteoporosis in thai elderly women.

The elevation of undercarboxylated osteocalcin (ucOC) means vitamin K insufficiency is significantly increased in elderly women, and is associated with high skeletal turnover, low BMD, and increased risk of osteoporotic fracture. The objective of the present study was to find out the level of ucOC and the prevalence of vitamin K deficiency in elderly Thai women. The upper limit of normal premenopausal ucOC level was 2.314 ng/ml, represented the cut-off level for vitamin K deficiency, 39.1% of elderly women had serum ucOC concentration above this level. Women with high serum ucOC level had a significantly lower BMD of ultradistal radius, distal 1/3 of radius and 25(OH)D level, higher serum PTH and alkaline phosphatase activity than women with a normal ucOC (p<0.05). Serum ucOC was correlated positively with PTH (r = 0.411, p< 0.001), modest negatively with serum 25(OH)D (r = -0.17, p= 0.013). The ucOC level of urbanized elderly was higher than that of rural elderly. It was concluded that vitamin K deficiency is one of the risks of osteoporosis with high prevalence in the Thai elderly especially urbanized ones, the supplement of vitamin K should be recommended in Thai osteoporotic patients especially the urbanized elderly.

Comparing the effect of short term post meals and bedtime calcium supplementation on the C-terminal telopeptide crosslinks and PTH levels in postmenopausal osteopenic women.

BACKGROUND: Calcium supplement for postmenopausal osteopenic women can significantly reduce bone loss and the risk of fractures. However, the optimal time for calcium supplementation remains controversial. OBJECTIVE: The aim of the present study was to compare the effect of twice daily post meals and bedtime calcium supplementation for a two week periods, on C-terminal telopeptide crosslinks and PTH levels in postmenopausal osteopenic women. DESIGN: A randomized double blind placebo-control, crossover design, was carried out on 3 consecutive periods 3 of a 2-week treatment regimen. In the first period, all the subjects randomly received either two calcium carbonate tablets (Chalk Cap all subjects randomly received either two calcium 334 mg per tab) or placebo at bedtime with one tablet of calcium tablet or placebo after breakfast and dinner for two weeks. In the second period, subjects received only placebo tablets after the meals and at bedtime for 2 weeks. In the third period subjects received either calcium carbonate or placebo for another two weeks. The C-terminal telopeptide crosslinks were measured at 8.00 am and serum PTH were sampled at 8 time points (12.00 am, 2.00 am, 4.00 am, 6.00 am, 8.00 am, 9.00 am, 5.00 pm, and 7.00 pm respectively by the end of each study at the first and third period. RESULTS: The present study showed thirty-six postmenopausal subjects (mean age 63.9 + 3.66 years) participated in the present study. The mean T-score BMD of the spine and hip were -2.96 + 0.87 and -2.96 + 0.77 gm/cm2. C-terminal telopeptide crosslinks levels of the bedtime supplementation were significantly lower than the post meal supplementation (0.228 + 0.002 ng/ml vs 0.313 + 0.003 ng/ml, p < 0.001). The mean night time serum PTH level during the bedtime was significantly lower than the post meal period. (25.17 + 2.31 pg/ml vs 31.930 + 2.677 pg/ml, p < 0.001). No differences in the post meal PTH level between two periods were observed CONCLUSION: The bedtime calcium supplementation appeared to reduce the bone resorption marker and night time serum PTH levels greater than the post meal calcium supplementation in this short term period study. However, long term comparison may be needed.

Cytokine Production by Whole Blood Cells: Relationship to Interleukin Gene Polymorphism and Bone Mass

The aims of this study were to investigate the relationships between the production of interleukin-1 (IL-1), and IL-6 system by whole blood cells, and bone mineral density (BMD), and polymorphisms in IL-1 system and IL-6 gene in postmenopausal Korean women. The production of IL-1alpha, IL-1beta, IL-1 receptor antagonist (IL-1ra), IL-6, and soluble IL-6 receptor (sIL-6r) by lipopolysaccharide-stimulated whole blood cells was measured by ELISA in 110 subjects. Serum osteocalcin, C-telopeptide of type I collagen, and BMD at lumbar spine and proximal femur were measured. IL-1alphaC(-889)T polymorphism, IL-1beta C(-511)T polymorphism, 86-base pair variable number tandem repeat polymorphism in the IL-1ra gene, and IL-6 C(-634)G polymorphism were analyzed. The production of IL-1beta correlated positively with BMD at femoral neck, whereas the production of other ILs did not correlate with BMD at the skeletal sites examined. No significant differences in the production of ILs were observed among normal, osteopenic and osteoporotic postmenopausal women, and among the different IL system polymorphisms groups studied. No correlation between bone turnover markers and the production of ILs was noted. In conclusion IL-1beta may regulate bone metabolism at femoral neck, and the IL system polymorphism do not affect the production of ILs by whole blood cells.

Fisiopatologia da osteoporose pós-menopausa / Osteoporosis in post menopause physiopathology

A osteoporose pós menopáusica se caracteriza por um aumento da remodelaçao óssea, havendo predomínio da reabsorçao sobre a formaçao óssea, com balanço de cálcio negativo e perda progressiva de massa óssea. O hipoestrogenismo pós menopáusico é responsável por esse processo, havendo por outro lado, conservaçao da massa óssea em pacientes sob terapêutica de reposiçao hormonal. Os mecanismos pelos quais os estrogênios atuam na conservaçao da massa óssea sao revisados neste artigo, à luz dos conhecimentos atuais. O metabolismo local do tecido ósseo é enfocado, referindo-se o papel das citocinas no controle da freqüência de ativaçao das unidades de remodelaçao óssea e suas inter-relaçoes com os níveis plasmáticos e tissulares de estrogênios.

Funçäo da glândula paratiróide em mulheres osteopênicas após a menopausa / Function of the parathyroid gland in osteopenic women after menopause

Níveis de hormônio paratiroidiano já foram descritos mais baixos, inalterados e até mais elevados em mulheres com osteoporose pós-menopausa. Alguns autores, ao infundirem EDTA e medirem o cálcio ionizado em mulheres menopausadas, observaram uma reatividade menor das glândulas paratiróides nessas mulheres. A resposta da glândula paratiróide ao estímulo com fosfato oral, em mulheres osteopênicas, nos primeiros anos da menopausa (1-6 anos) foi investigado. Doze mulheres osteopênicas (densidade óssea na coluna entre 0,900 e 0,970g/cm2), menopausadas, com idade entre 50 e 55 anos, e 11 mulheres saudáveis, controles (densidade óssea na coluna maior que 1.100g/cm2) receberam 1,5 gramas de fosfato oral, durante 15 dias. O cálcio, fósforo, fosfatase alcalina e creatinina séricas, bem como o Ca/Cr e hidroxiprolina/Cr urinários foram semelhantes nos dois grupos no início do estudo. Entretanto, o PTH aminoterminal foi estatisticamente inferior nas mulheres osteopênicas. Após ingestäo de fosfato oral, o Ca/Cr urinário nos dois grupos apresentou queda ao redor de 42-46%. O PTH aminoterminal subiu significantemente no grupo controle normal após administraçäo do fosfato, porém 75% das osteopênicas näo apresentaram qualquer alteraçäo. A resposta negativa nas mulheres ostopênicas pode ser devida a sensibilidade alterada ao PTH nessas pacientes. Os autores propöem novos estudos com sobrecarga de fosfato em todas as mulheres, nos primeiros anos da menopausa, para verificar se as "näo respondedoras" perdem mais massa óssea que as "respondedoras"

Níveis séricos de hormônio paratiroidiano (PTH) em mulheres osteopênicas na pós-menopausa / Serum levels of parathyroid hormones (PTH) in osteopenic women in post-menopause

Níveis alterados de PTH imunorreativo podem exercer influência na perda de massa óssea após a menopausa. Níveis elevados, normais e diminuídos já foram descritos em mulheres portadoras de osteoporose com idade entre 60 e 65 anos. Este estudo mediu os níveis de PTH em mulheres osteopênicas mais jovens, pós-menopausadas, com idade entre 50 e 55 anos. Dez mulheres osteopênicas e 11 mulheres normais foram estudadas. Os níveis séricos de PTH aminoterminal foram estatisticamente mais baixos nas mulheres osteopênicas que nas mulheres controles normais. Os níveis de PTH carboxiterminal foram semelhantes nos dois grupos, Uma possível explicaçäo para os resultados obtidos é que as mulheres osteopênicas tenham um limiar de resposta alterado para a secreçäo de PTH.