Ca&Bone

[Serum 25(OH)-Vitamin D levels and bone metabolism in patients on maintenance hemodialysis]

ALMÁSI Csilla1, AMBRUS Csaba1,2, DEÁK György1,2, MARTON Adrienn1, BERTA Klára2, LAKATOS Péter1, SZABÓ András3, HORVÁTH CSABA4, MUCSI István1,2

SEPTEMBER 20, 2005

Ca&Bone - 2005;8(03)

[INTRODUCTION - Increasing evidence suggests that 25- hydroxy vitamin D3 (25(OH)D3) may contribute to the bone health of patients with chronic kidney disease.However, there is very little information available on the vitamin D3 status of patients with chronic renal failure. In a cross-sectional study we assessed the association between vitamin D3 status and parathyroid function, bone turnover, bone mass and structure in patients on maintenance haemodialysis. PATIENTS AND METHODS - Sixty-nine patients on maintenance haemodialysis were assessed by bone densitometry (DEXA) and quantitative bone ultrasound. Serum 25-hydroxy vitamin D3 levels and serum markers of bone turnover were simultaneously measured. RESULTS - A high prevalence of potentially significant vitamin D3 deficiency was found in this patient group; 59% of the patients had their 25(OH)D3 vitamin level below 20 nmol/l.There was a significant negative correlation between serum 25(OH)D3 and serum intact parathormone (iPTH) levels (r=-0.231, p<0.05) and this association remained significant after controlling for potential co-variables. Furthermore, a positive correlation was observed between serum 25(OH)D3 concentration and bone mineral density measured at the radius (r=0.424, p<0.01). Finally,we show for the first time that 25(OH)D3 levels are significantly and independently associated with broad band ultrasound attenuation (β =0.237, p<0.05) measured with calcaneal quantitative bone ultrasound in patients with chronic renal failure. CONCLUSION - Vitamin D3 deficiency may contribute to the impaired bone health of patients on maintenance dialysis, therefore, it seems to be warranted regularly monitoring and carefully controlling the D3-vitamin level of these patients.The results also suggest that quantitative bone ultrasound is useful in assessing bone health of patients with chronic renal failure.]

AFFILIATIONS

  1. Semmelweis Egyetem, I. Sz. Belgyógyászati Klinika, Budapest
  2. Semmelweis Egyetem, Fresenius Medical Care Dialízis Állomás
  3. Semmelweis Egyetem, I. Sz. Gyermekgyógyászati Klinika, Budapest
  4. Semmelweis Egyetem, I. sz. Belgyógyászati Klinika, Budapest

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[One of the most exciting research areas of the past decade has concerned the chemoprevention of colorectal cancer (CRC). Numerous clinical studies have been conducted on the preventive role of NSAIDs, high fibre intake, selenium, phytooestrogens, hormone replacement therapy, antioxidants, COX-inhibitors, folic acid and calcium, however, their results are controversial. Among the suggested chemopreventive agents, the preventive role of calcium is supported by the strongest evidence.This paper aims to review the available facts on the role of calcium. Recent studies suggest that appropriate calcium intake may partially counterbalance the effect of the genes that contribute to the development of CRC. Experimental data show that calcium directly influences the expression of several genes involved in tumorigenesis and that it is also involved in a number of signalling pathways that control cell proliferation, differentiation and apoptosis.These effects mostly arise through the activation of the calcium sensing receptor. The main goal of this review is to draw attention to the established chemopreventive role of calcium in CRC. Published data suggest that a lifelong daily calcium intake between 1200 to 1500 mg (even 2000 mg in high risk groups) would significantly decrease the incidence of CRC by inhibition of tumorigenesis.]

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HOSSZÚ ÉVA, PÁL Csilla, TOMSITS Erika

[INTRODUCTION - Children with pituitary insufficiency normally receive growth hormone and thyroid hormone substitution, but glucocorticoid treatment is rarely necessary. Sex hormone replacement is introduced in puberty, which, at the same time, promotes growth and bone maturation. In this study the effect of testosterone replacement on bone mineral content was examined. PATIENTS AND METHODS - Nine boys (16.3±1.3 years) with hypopituitarism were involved in the study who had been receiving growth hormone and thyroid hormone replacement for several years by the beginning of the study.Androgen was substituted by the intramuscular administration of 50 mg testosterone biweekly.The children's height,weight, the rate of pubescence, and bone age were checked, and bone mineral density was measured by single photon absorptiometry every six month. During the substitution treatment serum thyroxin and testosterone levels remained in the normal ranges. RESULTS - A significant increase in bone mineral density was observed during the testosterone treatment, with Z-scores -1.80, -0.91 and +0.14 at baseline, 12 and 24 months, respectively (p<0,001). Z-scores adjusted for bone age remained in the normal range throughout the study (-0.904 at baseline and -0.946 at one year). CONCLUSION - The increase rate of bone mineral density (0.16 g/cm/year) was significantly higher compared both to the normal reference in this age group (0.07 g/cm/yr, p=0.0015) and to the normal reference relative to their bone age (p<0.0006). The increase in bone mineral density suggests that testosterone replacement has an important role both in the quantitative and qualitative development of bones.]

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[INTRODUCTION - Data on bone mineral density (BMD) in diabetes mellitus are contradictory in the literature. Early studies described a decreased bone mineral density in type 1 diabetes mellitus (T1DM), but recent studies report no osteopenia in T1DM.The BMD may depend on the quality of treatment for diabetes mellitus and on the presence of chronic complications. In type 2 diabetes mellitus (T2DM) the BMD is not decreased, occasionally it can even be increased. PATIENTS AND METHODS - Bone mineral density was measured in 122 regularly controlled diabetic patients (T1DM: n=73, mean age: 43.6±11.1 years,T2DM: n=49, mean age: 61.8±9.8 years) by dual energy X-ray absorptiometry at the lumbar spine and at the femur. Results were compared to those of 40 metabolically healthy control persons with a mean age of 47.5±11.9 years.The patients’ carbohydrate metabolism was assessed by the average HbA1c level of the last three years.These values were 7.9±1.4 % in T1DM, and 7.5±1.7 % in T2DM. BMDs were classified based on the T-score and Z-score using the WHO criteria. RESULTS - There was no significant difference in T1DM or in T2DM compared to the reference group in the prevalence of either osteoporosis or of osteoporosis and osteopenia combined. CONCLUSION - BMD was not found to be decreased in patients with well-controlled metabolism compared to healthy controls.]

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KERÉNYI ZSUZSA, TAMÁS GYULA, TABÁK Gy. Ádám, SPEIZER SZABINA, SPEER Gábor, MÉSZÁROS SZILVIA, LAKATOS Péter, HORVÁTH CSABA

[AIMS - Because of contradictory data in literature our aim was to study bone metabolic disturbances and their correlates with anthropometric and metabolic parameters in type 1 diabetic patients (T1DM). Since quantitative bone ultrasound (QUS) measures bone qualities different from BMD, and it has only been scarcely investigated in T1DM, our aim was to describe covariates of QUS parameters. PATIENTS AND METHODS - Osteodensitometry was performed (lumbal spine, femur neck - DEXA; calcaneal ultrasound) on 115 T1DM patients (34 male, 81 female; mean age: 41.4±11 [± SD] yrs; BMI: 23.9±3.0 kg/m2; diabetes duration: 21.6±11.7 yrs; HbA1c: 8.1±1.3%). In addition anthropometric, blood pressure and laboratory parameters (HbA1c, lipids, renal function, fibrinogen, homocystein, PTH, TSH, β-CrossLaps, vitamine D3, osteocalcin, osteoprotegerin) were measured, data using a questionnaire were collected. RESULTS - The prevalence of osteoporosis was 9/112 (8%). A further 21/62 patients with osteopenia were found. Disturbances of bone metabolism have been more frequently proven on lumbal spine (p<0.001). Using multiple linear regression modelling, the independent covariates of osteopathy were systolic blood pressure, body weight, β-CrossLaps and cystatin C. The average broadband ultrasound attenuation (BUA) was 114.2±14.9 in males vs. 108.4±16.3 dB/MHz in females (p=0.07), the mean speed of sound (SOS) 1552±26 in males vs. 1559±32 m/s in females (p=0.32). SOS values in addition to bone density were associated with fracture risk. The independent covariates of BUA were body weight and height (R=0.473, p<0.001), and of SOS only fibrinogen (R=0.305, p=0.032). CONCLUSIONS - According to our results the prevalence of osteoporosis in acceptable controlled T1DM patients is relatively low. The more common metabolic calcipenic osteopathy show a correlation with body weight, markers of bone resorption and diabetic complications/co-morbidities (nephropathy, hypertension) being therefore not only an a priori consequence but also a complication of diabetes mellitus. Our data provide baseline data of QUS in type 1 diabetic patients. Because of the frequency of lower bone mineral content and their known high fracture risk bone metabolism screening of T1DM patients has to be considered.]