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

Inhalation Therapy of Calcitonin Relieves Osteoarthritis of the Knee

This study was conducted to determine if nasal salmon calcitonin has additional beneficial effects on clinical symptoms, serum NO, IL-1beta, matrix metalloproteinase 3, urinary C-terminal telopeptide type II collagen (CTX-II) levels and MRI findings in knee osteoarthritis (OA) when used concomitantly with exercise therapy. Fifty female patients with knee OA were randomized into two groups. The first group (n = 30) received 200 IU/day nasal salmon calcitonin and a home exercise program; the second group (n = 20) received a home exercise program for 6 months. Compared with baseline,while significant improvements were observed in visual analogue scale (VAS), WOMAC pain, physical function scores, 20-m walking time (P < 0.001) and WOMAC stiffness score (P = 0.041) in the first group, walking and resting VAS, and WOMAC physical function scores were improved (P = 0.029) in the second group after treatment. Significantly increased levels of serum NO and urinary CTX-II (P < 0.001) and significant improvements in the area of medial femoral condyle (P < 0.05) were noted only in the first group. There were significant differences in VAS activation values (P = 0.032) and NO levels (P < 0.001) in the favor of the first group. In conclusion, nasal salmon calcitonin may have possible chondroprotective effects besides its known effects on symptoms in patients with knee OA.

Inhalation Therapy of Calcitonin Relieves Osteoarthritis of the Knee

This study was conducted to determine if nasal salmon calcitonin has additional beneficial effects on clinical symptoms, serum NO, IL-1beta, matrix metalloproteinase 3, urinary C-terminal telopeptide type II collagen (CTX-II) levels and MRI findings in knee osteoarthritis (OA) when used concomitantly with exercise therapy. Fifty female patients with knee OA were randomized into two groups. The first group (n = 30) received 200 IU/day nasal salmon calcitonin and a home exercise program; the second group (n = 20) received a home exercise program for 6 months. Compared with baseline,while significant improvements were observed in visual analogue scale (VAS), WOMAC pain, physical function scores, 20-m walking time (P < 0.001) and WOMAC stiffness score (P = 0.041) in the first group, walking and resting VAS, and WOMAC physical function scores were improved (P = 0.029) in the second group after treatment. Significantly increased levels of serum NO and urinary CTX-II (P < 0.001) and significant improvements in the area of medial femoral condyle (P < 0.05) were noted only in the first group. There were significant differences in VAS activation values (P = 0.032) and NO levels (P < 0.001) in the favor of the first group. In conclusion, nasal salmon calcitonin may have possible chondroprotective effects besides its known effects on symptoms in patients with knee OA.

Bone and Cartilage Turnover Markers, Bone Mineral Density, and Radiographic Damage in Men with Ankylosing Spondylitis

PURPOSE: To determine the levels of bone and cartilage turnover markers in men with ankylosing spondylitis (AS) and to investigate their associations with disease activity, bone mineral density, and radiographic damage of the spine. PATIENTS AND METHODS: This cross-sectional study enrolled 35 men with newly diagnosed AS. The bone mineral densities (BMD) of their lumbar spines and proximal femurs, Bath AS Disease Activity Index (BASDAI), and Bath AS Radiographic Index (BASRI) were evaluated. Urinary C-terminal telopeptide fragments of type I collagen (CTX-I) and type II collagen (CTX-II) levels were determined by enzyme-linked immunosorbent assay, and serum levels of bone-specific alkaline phosphatase (BALP) and osteocalcin were determined by an enzyme immunoassay. Levels of biochemical markers were compared with those of 70 age-matched healthy men. RESULTS: Patients with AS had significantly higher mean urinary CTX-I and CTX-II levels than control subjects (p < 0.05). Elevated urinary CTX-I levels correlated well with BASDAI, femoral BMD, and femoral T score (p < 0.05), and elevated urinary CTX-II levels correlated well with spinal BASRI (p < 0.05) in patients with AS. Mean serum BALP and osteocalcin levels did not differ between patients and controls and did not show any significant correlations with BMD, BASDAI, or BASRI in men with AS. Conclusions: Elevated CTX-I reflects disease activity and loss of femoral BMD while elevated CTX-II levels correlate well with radiographic damage of the spine, suggesting the usefulness of these markers for monitoring disease activity, loss of BMD, and radiographic damage in men with AS.

Markers of type II collagen synthesis and degradation as a predictor of radiographic progression in knee osteoarthritis

The aim of this study was to evaluate serum PIIANP and urinary CTXII as a parameters of type II collagen synthesis and degradation, respectively, in patients with OA knees and to investigate whether the use of these two molecular markers could predict the progression of joint damage evaluated by radiography during a period of 3 years. Sixty patients had symptomatic primary knee OA of Kellgren-Lawrence [K-L] grade I-III and met ACR criteria. These patients were evaluated prospectively for 3 years. Serum PIIANP and urinary CTX-II levels were measured by ELISA at baseline and at study end and their levels compared according to the changes in joint space width [JSW], K-L grade and WOMAC index, over 3 years. Also, we assessed the diagnostic value of those molecular markers and their performance for prediction of radiological progression. Serum and urinary levels also compared with 40 matched healthy subjects as a control group. There were significant decrease in the baseline serum PIIANP [P<0.001] and increase in the baseline urinary excretion of CTX-II [P<0.001] in knee OA patients in comparison with the control, in bilateral than unilateral cases [P<0.05], [P<0.05] and also with increasing the K-L radiological severity of the disease [P<0.05], [P<0.001], respectively. There were significant decrease in the mean baseline serum PIIANP and highly significant increase in the mean baseline urinary excretion of CTXII in progressors [JSW narrowing > 0.5 mm] and in patients showed increase in K-L grading either of the signal or both knees [P<0.05], [P<0.001], respectively. There were significant decrease in the mean study end serum PIIANP and highly significant increase in the mean study end urinary excretion of CTX-II in progressors [JSW narrowing > 0.5 mm] and in patients showed increase in K-L grading either of signal or both knees [P<0.05], [P<0.001], respectively. There were insignificant correlation between serum PIIANP and urinary CTX-II either at the baseline or study end and also insignificant correlation between those molecular markers with disease duration, BMI and WOMAC index [P>0.05]. Urinary CTX-II showed a higher diagnostic sensitivity and specificity [75% - 92%] than serum PIIANP [60% - 90%], respectively. The diagnostic specificity was greatest when both tests were found in combination [96%]. Also, combination of tests showed higher diagnostic sensitivity [92.3%] and specificity [55.3%] for predicting the radiological progression over 3 years than either one alone. In conclusion: using specific molecular markers serum PIIANP and urinary CTX-II, we found that patients with knee OA are characterized by depressed type II collagen synthesis and increased type II collagen degradation. Combining these two molecular markers allows the identification of patients with a high risk of subsequent progression of joint damage