Vitamin D supplementation,bone turnover,and inflammation in HIV-infected patients

Objective

To assess whether vitamin D supplementation could be associated with a modification of inflammatory markers and bone turnover in HIV-1-infected patients.

Vitamin K, bone turnover, and bone mass in girls

BACKGROUND: Vitamin K has been suggested to have a role in bone metabolism, and low vitamin K intake has been related to low bone density and increased risk of osteoporotic fracture. OBJECTIVE: The objective of this study was to determine whether phylloquinone (vitamin K(1)) intake and biochemical indicators of vitamin K status are related to bone mineral content (BMC) and markers of bone formation and bone resorption in girls. DESIGN: Vitamin K status [plasma phylloquinone concentration and percentage of undercarboxylated osteocalcin (%ucOC)] was measured at baseline in a study of 245 healthy girls aged 3-16 y. Cross-linked N-telopeptide of type 1 collagen (NTx) breakdown, osteocalcin, and bone-specific alkaline phosphatase were measured to reflect bone resorption and formation. BMC of the total body, lumbar spine, and hip and dietary phylloquinone intake were measured annually for 4 y. RESULTS: Phylloquinone intake (median: 45 microg/d) was not consistently associated with bone turnover markers or BMC. Better vitamin K status (high plasma phylloquinone and low %ucOC) was associated with lower bone resorption and formation. Plasma phylloquinone was inversely associated with NTx and osteocalcin concentrations (P < 0.05), and %ucOC was positively associated with NTx and bone-specific alkaline phosphatase concentrations (P < 0.05). Indicators of vitamin K status were not consistently associated with current BMC or gain in BMC over the 4-y study period. CONCLUSIONS: Better vitamin K status was associated with decreased bone turnover in healthy girls consuming a typical US diet. Randomized phylloquinone supplementation trials are needed to further understand the potential benefits of phylloquinone on bone acquisition in growing children.     

Growth hormone favorably affects bone turnover and bone mineral density in patients with short bowel syndrome undergoing intestinal rehabilitation

BACKGROUND: Patients with short bowel syndrome (SBS) have a high prevalence of metabolic bone disease due to nutrient malabsorption and potential effects of parenteral nutrition (PN). Human growth hormone (hGH) has been shown in some studies to have anabolic effects on bone, but hGH effects on bone in patients with SBS are unknown. METHODS: Adults with PN-dependent SBS underwent a 7-day period of baseline studies while receiving usual oral diet and PN and then began receiving modified diets designed to improve nutrient absorption and daily oral calcium/vitamin D supplements (1500 mg elemental calcium and 600 IU vitamin D, respectively). Subjects were randomized to receive in a double-blind manner either subcutaneous (sc) saline placebo as the control or hGH (0.1 mg/kg/d for 3 weeks, then 0.1 mg/kg 3 days a week for 8 subsequent weeks). Open-label hGH was given from week 13 to week 24 in subjects who required PN after completion of the 12-week double-blind phase. Markers of bone turnover (serum osteocalcin and urinary N-telopeptide [NTX]), vitamin D nutriture (serum calcium, 25-hydroxyvitamin D [25-OH D] and parathyroid hormone [PTH] concentrations), and intestinal calcium absorption were measured at baseline and at weeks 4 and 12. Dual x-ray absorptiometry (DXA) of the hip and spine was performed to determine bone mineral density (BMD) at baseline and weeks 12 and 24. RESULTS: The majority of subjects in each group exhibited evidence of vitamin D deficiency at baseline (25-OH D levels<30 ng/mL; 78% and 79% of control and hGH-treated subjects, respectively). Subjects treated with hGH demonstrated a significant increase from baseline in serum osteocalcin levels at 12 weeks (+62%; p<.05). The levels of NTX were increased over time in the hGH-treated group; however, this did not reach statistical significance. Both NTX and osteocalcin remained unchanged in control subjects. BMD of the spine and total hip was unchanged in subjects treated with placebo or hGH at 24 weeks. However, femoral neck BMD was slightly but significantly decreased in the placebo group at this time point but remained unchanged from baseline in the hGH-treated subjects. CONCLUSIONS: hGH therapy significantly increased markers of bone turnover during the initial 3 months of therapy and stabilized femoral neck bone mass over a 6-month period in patients with severe SBS undergoing intestinal rehabilitation.     

鹿骨粉治疗大鼠卵巢摘除后所致的骨质疏松

目的:探讨鹿骨粉对卵巢摘除后骨质疏松症(0P)大鼠骨微结构及骨矿物质的影响.方法:Wistar大鼠行双侧卵巢摘除术,采用X线摄片确认发生OP之后,将模型大鼠随机分为假手术组、模型组、鹿骨粉低剂量(200 mg/kg)组(鹿骨粉低剂量组)、鹿骨粉中剂量(400 mg/kg)组(鹿骨粉中剂量组)、鹿骨粉高剂量(800 mg/kg)组(鹿骨粉高剂量组)、葡萄糖酸钙(160 mg/kg)组(葡萄糖酸钙组).术后模型大鼠给药治疗4个月后,利用X线摄片观察骨质微结构,采用小动物成像仪获取股骨全段骨密度(BMD)值,应用生化分析仪及ELISA试剂盒检测血清中钙、镁、磷离子浓度以及碱性磷酸酶(ALP)、抗酒石酸酸性磷酸酶(TRACP)含量.结果:与模型组比较,鹿骨粉低剂量组、鹿骨粉中剂量组、鹿骨粉高剂量组和葡萄糖酸钙组股骨骨松质减少,骨密质和骨小梁增多,股骨各段BMD均增高,钙、镁离子浓度增高、磷离子浓度以及ALP、TRACP含量降低,差异有统计学意义(P＜0.05).结论:鹿骨粉改善卵巢摘除所致的骨质微结构及血清学指标的变化,提示其能够预防及治疗雌激素下降所致的OP.     

Effect of cyclical intravenous clodronate therapy on bone mineral density and markers of bone turnover in patients receiving home parenteral nutrition

BACKGROUND: Patients receiving home parenteral nutrition (HPN) because of intestinal failure are at high risk of developing osteoporosis. OBJECTIVE: We studied the effect of the bisphosphonate clodronate on bone mineral density (BMD) and markers of bone turnover in HPN patients. DESIGN: A 12-mo, double-blind, randomized, placebo-controlled trial was conducted to study the effect of 1500 mg clodronate, given intravenously every 3 mo for 1 y, in 20 HPN patients with a bone mass T score of the hip or lumbar spine of less than -1. The main outcome measure was the difference in the mean percentage change in the BMD of the lumbar spine measured by dual-energy X-ray absorptiometry. Secondary outcome measures included changes in the BMD of the hip, forearm, and total body and biochemical markers of bone turnover, ie, serum osteocalcin, urinary pyridinoline, and urinary deoxypyridinoline. RESULTS: The mean (+/-SEM) BMD of the lumbar spine increased by 0.8 +/- 2.0% in the clodronate group and decreased by 1.6 +/- 2.0% in the placebo group (P = 0.43). At all secondary skeletal sites (ie, hip, total body, and distal forearm), we observed no changes or small increases in the BMD of the clodronate group and decreases in the BMD of the placebo group. In the clodronate group, biochemical markers of bone resorption decreased significantly (P < 0.05). CONCLUSIONS: Clodronate significantly inhibits bone resorption as assessed by changes in biochemical markers of bone turnover. Although the mean BMD increased in the clodronate group, cyclic clodronate therapy failed to increase spinal BMD significantly at 12 mo.     

Retention of skeletal fluoride during bone turnover in rats

Deposition of fluoride (F) in the skeleton is a major factor in the metabolic regulation of F. The progressive increase in bone F levels with age suggests that F is rather firmly sequestered once it is deposited in bone. We have examined the extent to which F is resorbed and redeposited during bone turnover in growing rats. The skeleton was first preloaded with F by intake of water containing a high level of F (50 mg F/L) and simultaneously labeled with [3H]tetracycline (3H-TC) to provide a measure of subsequent bone turnover. Rats were then changed to a very low F intake, and bone F loss was compared with 3H-TC loss in animals undergoing normal bone turnover or turnover accelerated by a low calcium (Ca) intake. Approximately 60% of F mobilized during bone resorption was redeposited in the skeleton (humerus and vertebrae). The redeposition of F showed a positive correlation with mineral deposition. Thus the retention of F in the skeleton of growing rats results predominantly from redeposition of resorbed F rather than passive retention associated with low bone turnover.     

氟骨症骨转换的影像学价值

目的探讨氟骨症骨转换的X线、CT和MRI表现及影像学不同检查技术的诊断价值。方法报告氟骨症骨转换28例,对其影像学表现进行比较分析。结果28例患者有不同程度的氟斑牙。主要症状为四肢关节和肌肉酸痛,关节活动受限功能障碍13例,脊柱疼痛28例,以腰腿痛明显26例(92．85％)。影像学表现以骨量增多为主者17例,以骨量减少为主者11例,其中骨小梁模糊不清5例,骨皮质松化9例,骨松质硬化19例,合并椎体双凹状变形7例,骨盆变形6例,假骨折线形成4例,骨生长发育障碍7例。结论MRI能清晰地显示氟骨症骨转换的早期改变且诊断敏感性高。     

阿法骨化醇对绝经后妇女骨密度及骨转换标志物的影响

目的探讨阿法骨化醇对绝经后妇女骨密度及骨转换标志物的影响。方法选择2009年9月至2011年12月在本院更年期门诊经骨密度（BDM）测量诊断为骨量减少或骨质疏松症,年龄在55～75岁之间的67例绝经后女性为观察对象,随机分为试验组36例,对照组31例。试验组口服氨基酸螯合钙1 000mg/d,阿法骨化醇0.25μg/次,一天两次;对照组口服氨基酸螯合钙1 000mg/d。两组均连续服药48周。两组治疗前、后采用双能X线吸收法测定股骨颈、大粗隆、Ward三角区及腰椎L2-4骨密度;同时采用酶联免疫法检测血清骨碱性磷酸酶（BALP）、抗酒石酸酸性磷酸酶（TRACP）、25羟维生素D3[25-（OH）D3]结果治疗前试验组与对照组间股骨颈、大粗隆、Ward三角区及L2-4骨密度差异均无统计学意义（P〉0.05）。试验组各部位BMD治疗后均有显著增加（P〈0.05）,而对照组治疗前后仅L2-4有显著增加（P〈0.05）。治疗后试验组与对照组各部位BMD差异均有统计学意义（P〈0.05）。血清BALP、TRACP及25-（OH）D3水平治疗前试验组与对照组间比较,差异均无统计学意义（P〉0.05）,治疗后组间比较差异均有统计学意义（P〈0.05）。试验组治疗前血清BALP、TRACP及25-（OH）D3水平分别为（26.52±6.07）μg/L、（2.84±0.97）U/L、（53.91±19.04）nmol/L,治疗后分别为（21.85±5.96）μg/L、（2.37±0.88）U/L、（57.87±19.24）nmol/L,BALP、TRACP均呈显著降低,25-（OH）D3有显著升高（P〈0.05）;对照组治疗前后各骨代谢指标改变差异无统计学意义（P〉0.05）。结论阿法骨化醇可用于绝经后骨质疏松症的治疗,可增加骨密度、降低骨转换,对治疗骨质疏松症有理论依据和临床意义。     

Inhibition of bone turnover by milk intake in postmenopausal women

Increased postmenopausal bone turnover leads to bone loss and fragility fracture risk. In the absence of osteoporosis, risk preventive measures, particularly those modifying nutritional lifestyle, are appropriate. We tested the hypothesis that milk supplementation affects bone turnover related to biochemical markers in a direction that, in the long term, may be expected to reduce postmenopausal bone loss. Thirty healthy postmenopausal women aged 59.3 (SD 3.3) years were enrolled in a prospective crossover trial of 16 weeks. After a 4-week period of adaptation with diet providing 600 mg calcium plus 300 mg ingested as 250 ml semi-skimmed milk, participants were maintained during 6 weeks under the same 600 mg calcium diet and randomized to receive either 500 ml semi-skimmed milk, thus providing a total of 1200 mg calcium, or no milk supplement. In the next 6 weeks they were switched to the alternative regimen. At the end of the each period, i.e. after 4, 10 and 16 weeks, blood and urinary samples were collected. The changes in blood variables between the periods of 6 weeks without and with milk supplementation were: for parathyroid hormone, -3.2 pg/ml (P=0.0054); for crosslinked telopeptide of type I collagen, -624 pg/ml (P<0.0001); for propeptide of type I procollagen, -5.5 ng/ml (P=0.0092); for osteocalcin, -2.8 ng/ml (P=0.0014). In conclusion, a 6-week period of milk supplementation induced a decrease in several biochemical variables compatible with diminished bone turnover mediated by reduction in parathyroid hormone secretion. This nutritional approach to postmenopausal alteration in bone metabolism may be a valuable measure in the primary prevention of osteoporosis.     

小剂量17β-雌二醇对预防卵巢切除大鼠骨丢失的研究

为观察生理剂量的１７β－雌二醇（Ｅ２）对卵巢切除大鼠骨代谢、骨密度和骨力学特性的影响。将大鼠分为假手术组（Ａ）、去卵巢组（Ｂ）和去卵巢并给雌二醇组（Ｃ）。给Ｅ２９周后同时处死各组大鼠。结果Ｂ组大鼠血清碱性磷酸酶（ＡＬＰ）和骨钙素（ＯＣ）水平明显上升,右股骨近端１／３及第三腰椎骨密度（ＢＭＤ）明显低于对照组,雌二醇可逆转上述情况。Ｂ组骨力学参数明显低于对照组,而Ｃ组力学参数未见好转。结论认为生理剂量Ｅ２可抑制骨吸收和骨形成并增强骨量,但骨强度未见明显改善。     

骨转化标志物在早产儿代谢性骨病诊疗中的意义

目的探讨骨转化标志物(BTM)[包括Ⅰ型胶原羧基端肽B特殊序列(CTX)、总Ⅰ型胶原氨基端前肽(P1NP)和N端骨钙素(OC)]在早产儿代谢性骨病(MBDP)诊疗中的意义,为临床诊治提供参考依据。方法收集所有于2016年3月-2017年3月在河北医科大学第二医院住院治疗的符合MBDP诊断标准的患儿作为研究对象,定期监测血磷(P),血钙(Ca),碱性磷酸酶ALP的数值,并均在治疗前后留取静脉血标本检测血清25羟基维生素D_3[25 (OH) VD_3]及BTM (CTX、P1NP、OC)。结果治疗前后两组间25 (OH) VD3及血清Ca差异无统计学意义(均P0. 05),治疗前后血清BTM (CTX、P1NP、OC)水平,差异有统计学意义(均P0. 05)。结论早期检测血清BTM (CTX、P1NP、OC)水平能够帮助诊断MBDP病情,监测BTM (CTX、P1NP、OC)可以帮助判断临床疗效。     

原发性肝细胞癌手术患者的病因分析

目的探讨原发性肝细胞癌(primary hepatocellular carcinoma,PHC)手术患者的人口学、乙型肝炎病毒(HBV)感染及其临床特征。方法通过查阅病历,获取原发性肝细胞癌手术患者的临床资料进行描述性分析。结果 PHC高发年龄为41~60岁(占55.17%);以男性居多(占88.51%);患者吸烟率、饮酒率和肿瘤家族史分别为48.56%、35.34%和16.09%;HBsAg阳性率为87.64%,感染模式以HBsAg、抗-HBe、抗-HBc三项阳性为多见(占53.16%);血清AFP水平升高者占65.81%,AST升高者占61.21%,ALT升高者占48.28%,γ-GGT升高者占69.83%,伴有肝硬化者占67.53%。结论 PHC患者以中老年男性为主,其发生与HBV感染关系密切,患者吸烟、饮酒、肿瘤家族史比例较高;对有HBV感染、年龄41~60岁人群,定期体检对肝癌及早发现有重要意义。