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.

Singh index screening for femoral neck osteoporosis.

The present study included 130 elderly women living in Khon Kaen, Thailand, and all but one underwent both DEXA-BMD and AP radiographs of the left hip joint. The mean (SD) of age, weight, height and BMI of the 129 participants was 72.5 (5.3) years, 49.8 (10.3) kg, 1.49 (0.06) m, and 22.21 (4.13) kg/m2, respectively. The authors found both poor sensitivity and a positive predictive value for a Singh grade of < or = 4 or < or = 3 (viz. 58 and 29 or 19 and 43 percent, respectively). The ROC curve showed the poor diagnostic value of the Singh index since the area under the curve was approximately 40% the Singh index is therefore a poor screening tool for femoral neck osteoporosis.

Difference in serum calcidiol and parathyroid hormone levels between elderly urban vs suburban women.

The present study initially included 106 volunteers, elderly women living in urban or suburban Khon Kaen, Thailand. One case was excluded because of extremely high levels of alkaline phosphatase. The means (+/- SD) of the serum calcidiol and the PTH concentrations in the urban vs suburban groups were 31.45(+/- 1.15) ng/mL vs 36.15(+/- 2.4) pg/mL and 41.53(+/- 3.94) ng/mL vs 17.43(+/- 2.88)pg/mL, respectively. The urban group had a higher percentage and a higher risk of hypovitaminosis D and osteoporosis of the femoral neck than the suburban group, an odds ratio of more than 4 times higher.

Modified OSTA index for referring women for DEXA measurement.

A retrospective study of 696 postmenopausal women with hip measurement by Dual-energy X-ray absorptionmetry (DEXA) from Sapphasittprasong Hospital, Ubon Rahatani and Srinagarind Hospital, Khon Kaen University. All variables: T-score, age and weight were collected and calculated by the original OSTA index and modified OSTA index. Thai osteoporosis foundation recognized Original OSTA index the cut point below or equal 4 as high risk of osteoporosis. The authors used the modified OSTA index for calculation without truncate, the authors found that the cut off point was <-3.5 making 79% sensitivity and 58.7% specificity while the original OSTA gave 73%, 62% respectively. The authors proposed modified OSTA index as a making-decision tool before sending the patient for bone mass measurement. That saves the expense of further investigation.

Level of undercarboxylated osteocalcin in reproductive Thai females.

Osteocalcin is a vitamin K dependent protein requiring vitamin K as a cofactor for the enzyme gamma glutamyl carboxylase which converts the glutamate residues at 17, 21, 24 position of the molecule into gamma carboxyglutamate or Gla residues.The carboxylation makes immature osteocalcin or undercarboxylated osteocalcin (ucOC) into mature osteocalcin which enhances calcium binding in bone. The level of undercarboxylated osteocalcin is recognized as a marker of vitamin K2 bone.The level of undercarboxylated osteocalcin is recognized as a marker of vitamin K2 in blood necessary for this process. Mature osteocalcin has a higher affinity for hydroxyapatite than undercarboxylated osteocalcin. Foreign studies have shown that ucOC level is increased in elderly women and postmenopausal women in comparison with young, healthy, reproductive women and level of ucOC is also the marker to predict the risk of hip fracture. The standard value of undercarboxylated osteocalcin in Thai women is not available. The aim of the present study was to find the level of ucOC in reproductive Thai females. 357 healthy female volunteers who had regular menstruation, 20-50 years of age, average age 38.5 years old. The volunteers had no intake of any kind of medicine affecting bone metabolism before blood examination. The mean value of undercarboxylated osteocalcin is 2.69 ng/ml, median is 2.10_ng/ml standard deviation = 2.02,_standard error = 0.107 with 95% confident interval = 2.485 to 2.906 ng/ml. In the authors previous pilot study in elderly and postmenopausal women, the authors found that the mean of ucOC in Thai elderly and postmenopausal women was higher than that of reproductive women.