Combination therapy of curcumin and alendronate modulates bone turnover markers and enhances bone mineral density in postmenopausal women with osteoporosis

ABSTRACT Objective: This study evaluated the effects of combination therapy of curcumin and alendronate on BMD and bone turnover markers in postmenopausal women with osteoporosis. Subjects and methods: In a randomized, double-blind trial study, 60 postmenopausal women were divided into three groups: control, alendronate, and alendronate + curcumin. Each group included 20 patients. Total body, total hip, lumbar spine and femoral neck BMDs were measured by dual-energy X-ray absorptiometry (DXA) at baseline and after 12 months of therapy. Bone turnover markers such as bone-specific alkaline phosphatase (BALP), osteocalcin and C-terminal cross-linking telopeptide of type I collagen (CTx) were measured at the outset and 6 months later. Results: Patients in the control group suffered a significant decrease in BMD and increased bone turnover markers at the end of study. The group treated with only alendronate showed significantly decreased levels of BALP and CTx and increased levels of osteocalcin compared to the control group. The alendronate group also showed significant increases in the total body, total hip, lumbar spine and femoral neck BMDs at the end of study compared to the control group. In the curcumin + alendronate group, BALP and CTx levels decreased and osteocalcin levels increased significantly at the end of study compared to the control and alendronate groups. BMD indexes also increased in four areas significantly at the end of study compared to the control and alendronate groups. Conclusion: The combination of curcumin and alendronate has beneficial effects on BMD and bone turnover markers among postmenopausal women with osteoporosis. Arch Endocrinol Metab. 2018;62(4):438-45

Comparative study of oral and salivary parameters in patients with and without loss of bone mass

Abstract Osteoporosis is an insidious and increasingly prevalent disease that can cause fractures and affect patients' quality of life. The current study comparatively evaluates patients with and without loss of bone mass in terms of salivary calcium, viscosity, and pH. A controlled cross-sectional study was conducted in two groups of 32 postmenopausal women subjected to a bone densitometry scan and later referred for dental management at the Federal University of Minas Gerais, Brazil. The patients were assigned to two groups: Group 1 - patients with low bone mineral density (BMD) and Group 2 - patients without bone mineral changes. The following salivary parameters were evaluated: calcium concentration, flow rate, viscosity, pH, and average total protein. An oral examination was performed for assessment of DMFT variables and tongue coating. Data were analyzed using descriptive and inferential statistics, adopting a p-value < 0.05. The patients' mean age was 60 years (± 7.35). Salivary flow, pH, and viscosity were similar among the groups. Average total protein was 14.8 mg/mL and 19.0 mg/mL in Groups 1 and 2, respectively. Tongue coating and salivary calcium levels were significantly higher in Group 1 (p < 0.001). Salivary calcium is an important screening tool and may eventually be used for the diagnosis of bone mineral changes.

Association between low bone mass and calcium and caffeine intake among perimenopausal women in Southern Brazil: cross-sectional study / Associacao entre baixa massa ossea e ingestao de calcio e cafeina em mulheres climatericas na regiao Sul do Brasil: estudo transversal

CONTEXT AND OBJECTIVE: Osteoporosis is a skeletal abnormality characterized by reduction and alteration of bone microarchitecture that results in increased fragility and greater predisposition to fractures. Age and low bone mass are the main non-modifiable risk factors for osteoporotic fractures. The modifiable factors include sedentary lifestyle, inadequate calcium intake, excessive alcohol and/or caffeine consumption, smoking and low body weight. The aim here was to evaluate the association between low bone mass and calcium and caffeine intake among perimenopausal women in Southern Brazil. DESIGN AND SETTING: Cross-sectional study conducted in Porto Alegre and Canoas, Rio Grande do Sul, Brazil. METHODS: Women (n = 155) of mean age 53.6 ± 9.5 years were evaluated through a cross-sectional study in Southern Brazil. Food frequency questionnaires, bone mass evaluation using calcaneal ultrasound and anthropometric assessment were used. RESULTS: The prevalence of overweight was 67.7%. In the bone mass screening, 30.3% had low bone mass and 4.5% had osteoporosis. The median calcium intake was 574.94 mg/day and the caffeine intake was 108.11 mg/day. No association was found between bone mass and anthropometric parameters, calcium intake or caffeine intake. It was found that 38.4% of the women had low bone mass. CONCLUSIONS: No association was found between calcium and caffeine intake and bone mass. High prevalence of low bone mass was observed. .

CONTEXTO E OBJETIVO: A osteoporose é uma alteração esquelética caracterizada pela redução e pela alteração da microarquitetura óssea, que resultam em aumento da fragilidade e maior predisposição a fraturas. A idade e a baixa massa óssea são os principais fatores de risco não modificáveis para fraturas osteoporóticas. Os fatores modificáveis incluem sedentarismo, inadequada ingestão de cálcio, excessivo consumo de álcool e/ou cafeína, tabagismo e baixo peso corporal. O objetivo foi avaliar associação entre baixa massa óssea e ingestão de cálcio e cafeína por mulheres climatéricas no Sul do Brasil. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado em Porto Alegre e Canoas, Rio Grande do Sul, Brasil. MÉTODOS: Mulheres (n = 155) com idade média de 53,6 ± 9,5 anos foram avaliadas em um estudo transversal na região Sul do Brasil. Foram utilizados questionários de frequência alimentar, avaliação da massa óssea por ultrassonometria de calcâneo e avaliação antropométrica. RESULTADOS: A preval ência de sobrepeso foi de 67,7%. No rastreamento de massa óssea, 30,3% apresentou baixa massa óssea e 4,5%, osteoporose. A ingestão mediana de cálcio foi de 574,94 mg/dia e de cafeína foi de 108,11 mg/dia. Não foi encontrada associação entre massa óssea e os parâmetros antropométricos, ingestão de cálcio ou de cafeína. Verificou-se que 38,4% das mulheres apresentaram perda de massa óssea. CONCLUSÕES: Não foi encontrada associação entre a ingestão de cálcio e cafeína com a massa óssea. Foi observada alta prevalência de baixa massa óssea. .

Use of the plasma CTX for assessing the bone activity of the mandible among osteopenic and osteoporotic patients

The aim of this study was to determine whether the plasma CTX bone remodeling marker is useful for indicating the bone metabolic activity level of the mandible. Thirty-six patients were selected; all were postmenopausal and aged 50 years or over. In accordance with the WHO criteria for osteoporosis, a control group was set up (n = 10) in which the T-score was greater than -1 and a diseased group with T-score less than -1. Using MDP-99mTc samples, the radioisotope uptake in the femoral neck (R2) and mandibular body (R1) was analyzed. A third examination was performed using the plasma CTX biochemical bone-modeling marker. The inferential results for the diseased group showed that Ln(R1) presented a statistically significant linear relationship with Ln(CTx) (p = 0.067) and with the T-score (p = 0.018). The plasma CTX bone remodeling marker is useful for monitoring the bone metabolic activity of the mandible.

Adipogénesis y osteoporosis: [revisión] / Adipogenesis and osteoporosis: [review]

Mesenchymal stem cells (MSCs) found in bone marrow stroma, are able to differentiate into osteoblasts and adipocytes, among other cellphenotypes. In normal bone marrow balance osteoblastic an adipocytes cell differentiation favour bone formation, while in osteoporosis there is an increased adipocytes content. Since osteoblasts and adipocytes originate from a common MSC precursor cell, here we discuss whether quantitative and qualitative stem cell defects may be the cause of alterations in the number and function of differentiated cells. This review analyzes some conditions that contribute to different osteogenic/adipogenic potentials in human bone marrow MSCs obtained from control and osteoporotic postmenopausal women. We analyze the protective effect exerted by locally generated factors like estradiol and leptin on MSCs differentiation, because altered bioavailability of these factors may play a role in osteoporosis. Osteoporotic MSCs (o-MSCs) are characterized by increased adipogenic potential as compared to control cells. Leptin exerted a direct protective action against adiposeness only in control cells. In contrast, leptin action on o-MSCs is hampered, suggesting that inadequate leptin action may be associated to lipid accumulation in bone marrow.

Clinical application of biochemical markers of bone turnover / Marcadores bioquímicos da remodelação óssea

With the ageing population in most countries, disorders of bone and mineral metabolism are becoming increasingly relevant to every day clinical practice. Consequently, the interest in, and the need for effective measures to be used in the screening, diagnosis and follow-up of such pathologies have markedly grown. Together with clinical and imaging techniques, biochemical tests play an important role in the assessment and differential diagnosis of metabolic bone disease. In recent years, the isolation and characterisation of cellular and extracellular components of the skeletal matrix have resulted in the development of molecular markers that are considered to reflect either bone formation or bone resorption. These biochemical indices are non-invasive, comparatively inexpensive and, when applied and interpreted correctly, helpful tools in the diagnostic and therapeutic assessment of metabolic bone disease. This review provides an overview of the current evidence regarding the clinical use of biochemical markers of bone remodelling in bone disease, with an emphasis on osteoporosis.

Tendo em vista o crescimento da população idosa na maioria dos países, os distúrbios do metabolismo ósseo e mineral estão tornando-se cada vez mais relevantes na prática clínica diária. Conseqüentemente, o interesse e a necessidade de medidas efetivas para serem usadas no rastreamento, diagnóstico e seguimento de tais patologias vêm crescendo acentuadamente. Além da avaliação clínica e de técnicas de imagens, os marcadores bioquímicos desempenham um importante papel na avaliação e diagnóstico das doenças ósseas metabólicas. Recentemente, a melhor caracterização dos componentes intracelulares e extracelulares da matriz óssea resultou no desenvolvimento dos marcadores moleculares, os quais refletem tanto a formação como a reabsorção óssea. Estes marcadores bioquímicos não são invasivos e comparativamente são de mais baixo custo, e quando aplicados e interpretados corretamente são instrumentos úteis no diagnóstico e tratamento das doenças ósseas metabólicas. Esta revisão abordará evidências atuais, levando em consideração o uso clínico dos marcadores bioquímicos da remodelação óssea nas doenças metabólicas ósseas, com ênfase na osteoporose.

O mineral boro na alimentação, prevenção e tratamento da osteoporose / Intake of mineral borum, prevention and treatment of osteoporosis

Osteoporosis is a disorder characterized by reduced bone density, which is more prevalent in post-menopausal women. Hormone replacement, use of calcium and Vitamin D has been used as the treatment of choice. Currently, studies have been conducted to search for alternative preventive treatments, based on changes in life style and feeding. Borum is a micromineral, which has shown satisfactory results in the maintenance of bone density. This review aims at presenting the action of borum on bone mineralization and in the treatment of bone loss in post-menopausal patients

La osteoporosis es una enfermedad que se caracteriza por la disminución de la masa óssea y se presenta principalmente en mujeres después de la menopausia. L reposición hormonal y la ingestión de calcio y vitamina D han sido los tratamientos de elección. Investigaciones recientes han procurado tratamentos preventivos alternativos a través de modificaciones en el estilo de vida y en la alimentación. El boro es un micro mineral que ha sido estudiado en ese sentido con resultados satisfactorios en la manutención de la densidade mineral ósea. Esta revisión tiene por objetivo relacionar la actividad del boro en la mineralización ósea y en el tratamiento de la pérdida ósea en pacientes después de la menopausia

A osteoporose é um distúrbio caracterizado pela diminuição da densidade mineral óssea que acomete principalmente mulheres pós-menopausa. A reposição hormonal, o uso de cálcio e vitamina D, têm sido o tratamento escolhido. Atualmente, pesquisas têm sido realizadas buscando alternativas de tratamentos preventivos baseados na alteração no estilo de vida e na alimentação. O boro é um micromineral que vem sendo estudado com resultados satisfatórios na manutenção da densidade mineral óssea. Esta revisão tem o objetivo de relacionar a atividade do boro na mineralização óssea e no tratamento da perda óssea em pacientes pós-menopausa

An immunohistochemical study of chromogranin A and Sp-1 immunoreactive cells in the gastrointestinal tract of ovariectomized rats

The changes on the regional distributions and frequencies of two types of chromogranin, chromogranin A (CGA) and bovine Sp-1 chromogranin (BCG)-immunoreactive (IR)cells in gastrointestinal (GI)tract of osteoporotic Sprague-Dawley rat induced by ovariectomy were studied by immunohistochemical methods. The experimental animals were divided into two groups, one is non-ovariectomized group (Sham)and the other is ovariectomized group (OVX). Samples were collected from each part of GI tract at 10th week after ovariectomy or sham operation. CGA-IR cells were restricted to the stomach regions with various frequencies regardless of ovariectomy except for the fundus of OVX in which no cells were detected. In addition, BCG-IR cells were also restricted to the pylorus and duodenum regardless of ovariectomy. A significantly decrease of CGA IR cells was detected in OVX compared to that of Sham in both fundus and pylorus, and BCG-IR cells were also significantly decreased in the duodenum(p<0. 05). However, in the pylorus, BCG-IR cells in OVX showed similar frequency compared to that of Sham. In conclusion, the abnormality in density of chromogranin, a generally used GI endocrine cell marker, detected in this study may contribute to the development of GI symptoms in osteoporosis such as impairments of calcium and some lipids, frequently encountered in patients with postmenopausal osteoporosis.

Osteoporosis in postmenopausal Saudi women using dual x-ray bone densitometry

A pilot study to estimate the prevalence of osteopenia and osteoporosis in postmenopausal Saudi women. Lumbar spine bone density was measured in 830 postmenopausal Saudi women 50-80 years of age [average 59 years], using dual x-ray absorptiometry [DXA] at the King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between 1989 and 1999. The results of the bone mineral density [BMD] in gm/cm2 were compared to the peak bone density [PBD] in healthy young women [T-score]. Based on the definition of World Health Organization [WHO], the T-score value was considered for analysis. Accordingly, 248 [29.9%] subjects showed normal result, mean BMD of 1.117 +/- 0.13 and T-score of -0.66 SD; while 254 [30.6%] subjects showed osteopenia, mean BMD of 0.983 +/- 0.11 and T-score of -2.4 SD and 328[39.5%] subject showed osteoporosis, mean BMD of 0.767 +/- 0.11 and T-score of -3.4 SD. When the 830 subjects were analyzed by decades, there were 42.3% normal, 33.4% osteopenia and 24.3% osteoporosis in age 50-59 years; 11% normal, 27% with osteopenia and 62% with osteoporosis in age 60-69 years while in older age 70-79 years only 4.6% had normal BMD, 21.5% had osteopenia and 73.8% had osteoporosis. Osteopenia and osteoporosis are common among postmenopausal Saudi women and should be considered as a matter of public health. Bone densitometry should be used to assess the severity of bone loss, identify those who need therapy and for follow up and early diagnosis of those with osteopenia in order to institute proper therapy and avoid future osteoporosis

Influence of body composition on the bone mass of postmenopausal women

Aims: To investigate the influence of body weight (BW), fat mass (FM) and lean mass (LM) on the bone mineral density (BMD) of several areas of the skeleton. Participants: Sixty one white postmenopausal women (50.1 + 4.8 years). Measurements: Measurement of BMD by dual energy x-ray absorptiometry. The results were analyzed by linear regression and the slopes of each curve were compared. Results: The results showed that the correlations between BW, FM and LM to BMD were positive, whilst the correlations between age and years since menopause to BMD were negative. LM was the main factor that influence BMD in almost all areas. Conclusions: FM and LM present a positive effect on BMD, although LM is the main determinant of bone mass. Moreover, higher values of LM and FM present a protective effect against the reduction of BMD combined with menopause. Therefore postmenopausal women with low BM, especially low LM, present serious risk for developing osteoporosis.

Sensibilidad de los marcadores del remodelamiento óseo: su modificación en la menopausia, ante la terapia estrogénica de reemplazo y ante una enfermedad metabólica generalizada / Markers of bone turnover, their sensibility to bone remodeling: changes in menopause, in hormone replacement therapy and in a metabolic bone disease

Evalua una batería de marcadores bioquímicos específicos y sensibles para predecir cambios en la velocidad del remodelamiento óseo. Se estudió a mujeres sanas pre y postmenospáusicas y en estas últimas a su vez se evaluó los cambios producidos después de 90 días de una terapia hormonal de reemplazo. Respecto de los marcadores bioquímicos de formación, la FA total aumentó en las postmenospáusicas respecto del grupo premenospáusico (P < 0,0001), al igual que la BGP (1 < 0,01); en cambio, la FA ósea no registró cambios significativos. Luego de la terapia hormonal de reemplazo ninguno de estos marcadores registraron cambios significativos. Todos los marcadores de resorción aumentaron en als mujeres postmenospáusicas. Los convencionales tales como el calcio urinario/creatinina y la hidroxiprolina con un p < 0,01 y p < 0,006 respectivamente. Los nuevos marcadores de resorción presentaron los siguientes cambios: Pyr p < 0,001; 72 por ciento; D-Pyr p < 0,003, 27 por ciento y Crosslaps p < 0,003, 70 por ciento de aumento respectivamente. Ante la terapia estrogénica, si bien los marcadores convencionales no mostraron diferencias significativas respecto del nivel basal, la Pyr disminuyó significativamente en un 15 por ciento (p < 0,03), la D-Pyr en un 15 por ciento (p < 0,04) y los Crosslaps en un 39 por ciento (p < 0,001). También se investigó la precisión diagnóstica de los marcadores bioquímicos en pacientes con un remodelamiento óseo aumentado, como es el caso de enfermedades celíacas. Estas se compararon con los normales que presentaban igual estado estrogénico observándose distintos comportamientos entre pre y postmenospáusicas. La BGP aumentó sólo en las celíacas premenospáusicas (p < 0,003). La FA total en los dos grupos estrogénicos (p < 0,0001 y p < 0,005 respectivamente), al igual que la FA ósea (p < 0,0003 y p< 0,0004, respectivamente). El marcador de resorción D-Pyr no presentó diferencias significativas en ninguno de los dos grupos, la Pyr sílo en las premenopáusicas (p < 0,01). La hidroxiprolina aumentó en ambos (p < 0,04 y p < 0,004, respectivamente), al igual que los Crosslaps (p < 0,001 para los dos grupos estrogénicos)

Osteoporose / Osteoporosis

A osteoporose representa sério problema de saúde publica pela alta prevalência na populaçäo pós-menopausal. Em funçäo da longevidade a alteraçäo estrutural ossea em ocorrência crescente. Os autores discutem as influências hormonais e näo hormonais sobre o metabolismo osseo. Concluem ser a reposiçäo esteroidica importante meio de estabilizacao da perda da massa ossea. Discutem novas opçöes terapeuticas tais como o uso de progesteronas, androgenios, tibolona, calcitonina e bifosfonatos