Risedronate improves bone mineral density in Crohn's disease: A two year randomized controlled clinical trial

BackgroundPatients with Crohn's disease have an increased frequency of osteopenia and osteoporosis. This randomized, controlled, double-blind study assessed the efficacy of risedronate versus placebo in treating low bone mineral density (BMD) in patients with Crohn's disease.Methods88 Crohn's disease outpatients with BMD T-score < − 1.0 by dual-energy X-ray absorptiometry were randomly assigned to one of two treatment groups for the two year study duration: one group received risedronate 35 mg weekly while another received placebo. Both groups received daily calcium (Ca; 500 mg) and vitamin D (D; 400 IU) supplementation. Percent change in BMD relative to baseline was compared between the two therapies at 12 and 24 months.ResultsUsing intent-to-treat analysis, at 12 months, risedronate + Ca + D increased BMD, relative to baseline, more than placebo + Ca + D in the femoral trochanter (1.4 ± 3.4% vs − 0.1 ± 3.1%; p = 0.03) and total hip (1.1 ± 2.7% vs − 0.1 ± 2.5%;p = 0.04). This trend in greater BMD continued for the 24 month duration of the study. There was no difference between the two treatment groups for changes in spine BMD. Subgroup analysis revealed that risedronate + Ca + D resulted in significantly better improvement in femoral trochanter BMD in non-smokers (p = 0.01), males (p = 0.01), those with a history of corticosteroid use in the preceding year (p = 0.01), and current users of immunosuppressants (p = 0.04).ConclusionsRisedronate, in addition to daily calcium and vitamin D supplementation, is superior to calcium and vitamin D alone in improving femoral trochanter and total hip BMD in patients with Crohn's disease.     

The relationship between plasma homocysteine levels and bone mineral density in post-menopausal women

BackgroundWhether or not mild hyperhomocysteinemia and low serum levels of folates or vitamin B12 are risk factors for osteoporosis in the elderly is controversial.Aims and methodsTo investigate whether or not plasma levels of total homocysteine (tHcy) and serum levels of folates and vitamin B12 are associated with bone mineral density (BMD), we carried out a cross-sectional study on 446 post-menopausal women (mean age: 65.1 ± 9.4 years), consecutively seen at the Siena Unit (Tuscany region, Central Italy) for BMD evaluation over a two-year period. BMD of the total femur, femoral neck and lumbar spine was detected by dual-energy X-ray absorptiometry.ResultsThe age-adjusted geometric mean of plasma tHcy levels (µmol/L) was 9.96 ± 1.29 in women with normal BMD, 11.06 ± 1.32 in those with osteopenia and 11.88 ± 1.35 in those with osteoporosis (p < 0.0001). On multiple linear regression analysis, adjusting for age, body mass index, folates, vitamin B12, creatinine clearance, smoking habit and alcohol intake, tHcy was negatively related to BMD of the total femur [β estimate for log-homocysteine: ? 0.050 (95% CI: ? 0.100 to ? 0.001, p = 0.048; R² = 0.02)], but not of femoral neck or lumbar spine. There was no significant association between BMD and serum levels of folates and vitamin B12.ConclusionstHcy is negatively associated with BMD of the total femur. The contribution of tHcy to explain the variance of BMD is small (2% of the total variance) but clinically relevant, considering the high prevalence of osteoporosis among post-menopausal women and the possibility to lower tHcy by vitamin supplementation.     

Combination therapy with an immunomodulator and anti-TNFα agent improves bone mineral density in IBD patients

ObjectiveThere is a high prevalence of low bone mineral density (BMD) among patients with inflammatory bowel disease (IBD) although there is a lack of clinical data on the impact of IBD specific medications and recommended vitamin D (VD) and calcium (Ca) supplements on it.DesignThe cohort consisted of 150 IBD patients. The average change in BMD at the lumbar spine per year (∆BMDL/year) was calculated and the impact of clinical characteristics, medications and VD and Ca supplements was analysed.ResultsThe prevalence of osteopenia was 69/150 (46%) and osteoporosis was identified in 15/150 (10%) patients at baseline. The presence of osteoporosis was associated with the disease duration OR = 1.07 per year of disease duration (95% CI = 1.01–1.14), p = 0.03. The average ∆BMDL/year was 0.010 g/cm²/year. Among patients with no IS the ∆BMDL/year was − 0.001 ± 0.010 g/cm²/year, with AZA − 0.001 ± 0.013 g/cm²/year, with anti-TNFα 0.003 ± 0.006 g/cm²/year and with COMBO 0.027 ± 0.004 g/cm²/year; p < 0.05 COMBO vs any other subgroup. ∆BMDL/year among patients treated with CS was − 0.031 ± 0.012 g/cm²/year versus CS free patients 0.013 ± 0.004 g/cm²/year; p < 0.001. There was no effect of VD/Ca supplementation on BMDL.ConclusionsThe prevalence of low BMD was 55%. Duration of disease was the only independent predictor of low BMD. The BMDL was reduced by high cumulative dose of CS and improved by combined anti-TNFα/AZA therapy. The supplementation with recommended doses of VD and Ca had no effect on BMDL.     

Increase in bone mineral density in strictly treated Crohn's disease patients with concomitant calcium and vitamin D supplementation

Background and aimsDecreased bone mineral density (BMD) is common in Crohn's disease (CD) patients. This paper reports on the prevalence of decreased BMD in a referral cohort study of CD-patients next to the change of BMD over time in relation with CD-associated clinical characteristics.Methods205 CD patients of a referral hospital were enrolled between januari 1998-January 2010 when measurement of BMD by dual X-ray absorptiometry (DXA) was available. Follow-up DXA scan was performed in subjects with known risk factors besides Crohn indicative for low BMD. Treatment of CD patients was according to a protocol which is comparable to the current (inter)national guidelines. In osteopenic patients, supplemental vitamin D (800 IU) and Calcium (500–1000 mg) were prescribed.ResultsMean BMD at baseline was 0.97 ± 0.16 gram/cm² in lumbar spine and 0.87 ± 0.12 gram/cm² in the total hip. At baseline, higher age and low Body Mass Index (BMI), were negatively correlated with BMD. Eighty-four patients underwent a second BMD assessment with a median interval period of 4 years (IQR 3–6). A mean annual increase of + 0.76% (95%CI: − 2.63%; + 3.87%) in lumbar spine and + 0.43% (95%CI: − 2.65% ; + 1.11%) in total hip was observed.ConclusionsHigher age, male sex, low BMI, and a higher age at diagnosis of CD were associated with low BMD. Follow-up of BMD in CD patients showed a contraintuitive small increase of BMD at lumbar spine and total hip in CD patients only using supplemental vitamin D and calcium next to strict treatment of CD.     

Vitamin D depletion in hip fracture women is associated with the occurrence of simultaneous upper limb fractures independently of bone mineral density

IntroductionSevere vitamin D deficiency is associated with the occurrence of simultaneous fractures at both hip and upper limb due to a single fall. We hypothesized that reduced bone mineral density (BMD) could explain the association.MethodsWe investigated 549 white women consecutively admitted to a rehabilitation hospital because of their first fall-related hip fracture. Thirty-three (6%) of the 549 women sustained a concomitant upper limb fracture of either distal radius (24 women) or proximal humerus (nine women). We assessed serum levels of 25-hydroxyvitamin D, hip BMD by dual-energy X-ray absorptiometry, and spine deformity index scores by lateral spine radiographs, 19.5 ± 7.1 (mean ± SD) days after fracture occurrence.ResultsSerum levels of 25-hydroxyvitamin D were significantly lower in the 33 women with concomitant fractures of both hip and upper limbs than in the remaining 516 (mean difference between groups 5.6 ng/ml, 95% CI from 3.5 to 7.6, P < 0.001). Conversely, no significant differences were found in hip BMD or spine deformity index scores between the two groups. After adjustment for eight potential confounders, the occurrence of simultaneous fractures due to a single fall was significantly associated with low levels of 25-hydroxyvitaimn D (P = 0.001), but not with femoral BMD or spine deformity index scores.ConclusionThe association between severe vitamin D deficit and the occurrence of concomitant fractures at both hip and upper limbs due to a single fall is independent of femur BMD. Further investigations should focus on altered fall pattern or reaction to fall.     

Association of vitamin D deficiency and insulin resistance with breast cancer in premenopausal Algerian women: A cross-sectional study

BackgroundLow 25(OH)D levels are mainly related to breast cancer (BC) risk in postmenopausal women, while the impact of insulin resistance (IR) on BC prognosis is controversial.ObjectiveConsidering the high prevalence of BC in younger Algerian women, this cross-sectional study analyzed whether vitamin D status and IR are biomarkers for breast tumor status in premenopausal women.MethodsIn 96 women (mean age, 40.96 ± 0.65years) newly diagnosed with BC, tumor status was determined immunohistochemically, classified by molecular subtype, then correlated with body-mass index, total plasma 25(OH)D, insulin and glucose levels and HOMA-IR, using Chi², Student t, Spearman and ANOVA tests and multivariate logistic regression.ResultsA total of 66 of the 96 patients (68.75%) showed vitamin D deficiency (9.74 ng/mL). Overweight and obese patients with HOMA-IR > 2.5, positive for HER2 and with high Ki-67 index had the most severe vitamin D deficiency. There was a significant association between vitamin D deficiency, high Ki-67 index (OR, 14.55; 95% CI: 3.43–82.59; P = 0.00078) and IR (OR, 4.99; 95% CI: 1.27–24.47; P = 0.03), and between IR and HER2-positivity (OR, 3.23; 95% CI: 1.05–10.56; P = 0.04).ConclusionsVitamin D deficiency and IR are potential biomarkers for poorer prognosis in BC patients, independently of and/or synergically with high Ki-67 index and HER2-positivity in premenopausal overweight or obese women. The potential relationship of vitamin D receptor gene expression with breast cancer survival in Algerian patients will be investigated in a large cohort.     

Serum calcium,vitamin D and parathyroid hormone relationship among diabetic and non-diabetic pregnant women and their neonates

AimsThe purpose of the study was to determine the prevalence of osteomalacia and hypovitaminosis D among diabetic and non-diabetic pregnant women and in their neonates.MethodsSerum calcium, phosphorus, heat labile alkaline phosphatase, 25(OH) vitamin D and PTH were measured in 32 non-diabetic, 16 gestational diabetic and 8 Type 1 diabetic pregnant women and in cord blood of their newborn.ResultsAmong 32 non-diabetic subjects, 4 subjects (12.5%) had biochemical osteomalacia. 4 out of 16 gestational diabetic subjects (25%) had biochemical osteomalacia whereas 5 out of 8 Type 1 diabetic subjects (62.5%) had biochemical osteomalacia. Mean concentration of 25(OH) vitamin D in the non-diabetic group was 17.18 ± 9.88 ng/ml. Mean concentration of 25(OH) vitamin D in the Gestational diabetic group was 14.75 ± 6.90 ng/ml, while in Type 1 diabetic group, it was 7.81 ± 3.79 ng/ml. 50% of neonates of normal pregnant women had vitamin D deficiency whereas, 50% had vitamin D insufficiency. 40% of neonates of Gestational diabetic pregnant women had vitamin D deficiency whereas, 40% had vitamin D insufficiency.ConclusionVitamin D deficiency and biochemical osteomalacia was present in significant percentage of normal pregnant women and their neonates. Gestational diabetes and Type 1 diabetic women were more prone to develop vitamin D deficiency and biochemical osteomalacia.     

Vitamin D replacement in children,adolescents and pregnant women in the Middle East and North Africa: A systematic review and meta-analysis of randomized controlled trials

IntroductionHypovitaminosis D affects one-third to two-thirds of children and pregnant women from the Middle East and North Africa (MENA) region.ObjectiveTo evaluate in infants, children, adolescents and pregnant women, from the MENA region, the effect of supplementation with different vitamin D doses on the change in 25-hydroxyvitamin D [25(OH)D] level reached, and other skeletal and non-skeletal outcomes.MethodsThis is a systematic review of randomized controlled trials of vitamin D supplementation conducted in the MENA region. We conducted a comprehensive literature search in 7 databases, without language or time restriction, until November 2016. Two reviewers abstracted data from the included studies, independently and in duplicate. We calculated the mean difference (MD) and 95% CI of 25(OH)D level reached when at least 2 studies were eligible in each comparison (low (< 800 IU), intermediate (800–2000 IU) or high (> 2000 IU) daily dose of vitamin D, or placebo). We pooled data using RevMan version 5.3.ResultsWe identified a total of 15 eligible trials: one in infants, 4 in children and adolescents and 10 in pregnant women.In children and adolescents, an intermediate vitamin D dose (1901 IU/d), resulted in a mean difference in 25(OH)D level of 13.5 (95% confidence interval (CI) 8.1–18.8) ng/ml, compared to placebo, favoring the intermediate dose (p < 0.001). The proportion of children and adolescents reaching a 25(OH)D level ≥ 20 ng/ml was 74% in the intermediate dose group.In pregnant women, four trials started supplementation at 12–16 weeks of gestation and continued until delivery, and six trials started supplementation at 20–28 weeks' gestation and stopped it at delivery. The MD in 25(OH)D level reached was 8.6 (95% CI 5.3–11.9) ng/ml (p < 0.001) comparing the high dose (3662 IU/d) to the intermediate dose (1836 IU/d), and 12.3 (95% CI 6.4–18.2) ng/ml (p < 0.001), comparing the high dose (3399 IU/d) to the low dose (375 IU/d). Comparing the intermediate (1832 IU/d) to the low dose (301 IU/d), the MD in 25(OH)D level achieved was 7.8 (95% CI 4.5–10.8) ng/ml (p < 0.001). The proportion of pregnant women reaching a 25(OH)D level ≥ 20 ng/ml was 80%–90%, 73% and 27%–43% in the high, intermediate, and low dose groups, respectively.The risk of bias in the included studies, for children, adolescents and pregnant women, ranged from low to high across all doamins.ConclusionIn children, adolescents and pregnant women from the MENA, an intermediate vitamin D dose of 1000–2000 IU daily may be necessary to allow for the majority of the population to reach a desirable 25(OH)D level of 20 ng/ml. Further high quality RCTs are required to confirm/refute the beneficial impact of vitamin D supplementation on various clinically important outcomes.     

Vitamin D and nutritional supplements in the revalidation of older people after hip surgery

IntroductionHypovitaminosis D is common in older people. Low vitamin D may contribute to hip fracture risk.MethodsDuring a 15-week period all people admitted for revalidation after hip surgery (elective or after fracture) were screened for hypovitaminosis D. A standard substitution was given consisting of 100,000 IU vitamin D at day 1 followed by calcium/vit D 1000/880 once daily together with a high caloric nutritional supplement. Vitamin D, PTH and nutritional parameters were measured at baseline and at follow-up.ResultsOne hundred and three patients were enrolled (78% women, mean age 82.1 ± 6.2 years) of which 82% were treated for hip fracture. In the fracture group there is a significantly higher prevalence of osteoporosis (63.9% versus 20.0%; p ≤ 0.005). Vitamin D insufficiency (< 30 ng/ml) is extremely prevalent in both groups (94.2% versus 92.8%) with levels below 15 ng/ml in respectively 35.3% and 53.0% for the elective and the fracture group. Highest values of PTH were seen in people with the lowest levels of vitamin D. After intervention there is a significant rise in serum vitamin D (15.6–26.3 ng/ml; p ≤ 0.001) and a significant reduction in plasma PTH (40.2–32.1 pg/ml; p ≤ 0.001).ConclusionA majority of patients after hip surgery has vitamin D deficiency. People with traumatic fracture were significantly more osteoporotic. By implementing standard vitamin D and caloric supplementation in the revalidation after hip surgery PTH levels are significantly lowered and nutritional parameters improve.     

Effect of vitamin D supplementation in type 2 diabetes patients with pulmonary tuberculosis

AimDiabetes and vitamin D deficiency are widely prevalent in India. Studies have proven correlation between low vitamin D levels and pulmonary tuberculosis (PTB) and low vitamin D levels and insulin resistance. We evaluated the effects of vitamin D supplementation on type 2 diabetes mellitus patients with pulmonary tuberculosis (PTB).MethodsForty-five subjects (M:F = 34:11) were screened. Inclusion criteria were age >15 years, newly diagnosed PTB cases with uncontrolled diabetes, serum vitamin D < 20 ng/ml. The patients with vitamin D level < 20 ng/ml were randomly assigned to 2 groups. Group 1 subjects received oral cholecalceferol (60,000 units/week) and calcium carbonate (1 g/day) along with anti tubercular treatment (ATT), while group 2 subjects did not. Sputum was checked at interval of 2 weeks for 12 weeks. Primary end point was time to achieve sputum smear conversion.ResultsFifteen patients having vitamin D > 20 ng/ml were excluded. Age of the patients was 42.9 ± 13.2 years and serum vitamin D levels were 18.4 ± 15.3 ng/ml. Sputum smear conversion was 6 weeks in group 1 versus 8 weeks in group 2 (p = 0.067). Glycated hemoglobin levels reduced from 11.1 ± 1.3 to 7.7 ± 0.9 in group1 versus 10.3 ± 1.2 to 7.8 ± 1.1 (p > 0.1).ConclusionVitamin D can serve as adjuvant treatment of tuberculosis in diabetics with vitamin D deficiency. Further studies are required to validate this observation and define a cut off for vitamin D level to prevent immunological alterations.     

Pediatric-onset inflammatory bowel disease poses risk for low bone mineral density at early adulthood

BackgroundInflammatory bowel disease (IBD) is known to pose a risk for low bone mineral density (BMD) in children and adults. We aimed to evaluate the impact of pediatric-onset IBD on BMD in adulthood.MethodsRecords of pediatric-IBD patients were retrospectively reviewed for documentation of dual-energy X-ray absorptiometry (DXA) scans in adulthood. BMD was expressed as z-score.ResultsSixty one patients were included. Mean (±SD) age at diagnosis was 14.7 (±2.4) years. Mean age at first DXA scan in adulthood was 23.9 years (±4.8). Median BMD z-score was −1.2 SD (IQR, −1.8 to −0.4), significantly lower than expected in normal population (p < 0.001). Osteopenia (BMD z-score ≤−1 SD) was noted in 44.3% (n = 27), and osteoporosis (BMD z-score ≤−2.5 SD) in 8.2% (n = 5). Bone-status showed no correlation with age, disease severity, vitamin D status at diagnosis, IBD subtype or duration of disease. Positive correlation (r = 0.306) was identified between low weight z-score at diagnosis and abnormal bone-status in adulthood. Among 36 patients with multiple DXA scans, there was no significant change in BMD during follow-up of 2.4 years.ConclusionsOsteopenia and osteoporosis are frequent in adult IBD patients with pediatric-onset disease and correlates with low weight z-score at diagnosis.     

Frequency of vitamin D inadequacy among Saudi males visiting a Rheumatology Outpatient Clinic of a tertiary hospital in Al-Qassim region: Effect of vitamin D supplementation

Background: Vitamin D inadequacy (deficiency and insufficiency) has become an epidemic with the assumption that women in Arab countries are at a higher risk due to their clothing style of wearing dark colored suits or a veil. Aim of the work: To determine the frequency of vitamin D inadequacy among young adult and early middle-aged males in Al-Qassim region and to study the effect of vitamin D supplementation. Patients and methods: Sixty Saudi males visiting Rheumatology Outpatient Clinic of a tertiary hospital in Al-Qassim region were enrolled and evaluated for musculoskeletal state including assessment of chronic diffuse musculoskeletal pains using Numeric Rating Pain Scale (NRPS) and functional evaluation of lower limb proximal muscle power using chair–rise performance test. Serum 25(OH)D was evaluated. Vitamin D supplementation was provided for symptomatic subjects. Follow-up clinical evaluation as well as serum 25(OH)D measurement after 12 weeks vitamin D3 supplementation was performed. Results: The mean age of the patients was 43.2 ± 6.4 years. 54 (90%) had vitamin D inadequacy; 42 (70%) deficiency and 12 (20%) had insufficiency. Significant increase in baseline serum 25(OH)D (13.92 ± 5.67 ng/ml) after 12 weeks of supplementation (35.94 ± 4.11 ng/ml) with significant decrease in NPRS (7.42 ± 2.12 vs 2.06 ± 2.04) (p < 0.001), as well as significant improvement of functional status scores of chair–rise performance test (93.95 ± 23.56 vs 203.1 ± 58.6 (p < 0.001). Conclusion: Vitamin D inadequacy is a major health problem not only in elderly people or women with in-door residency and dark-colored clothes, but also in Saudi male young adults in Al-Qassim region.     

Hypovitaminosis D is an independent associated factor of overactive bladder in older adults

Aim of the studyUrinary incontinence and vitamin D deficiency are common problems encountered in geriatric population. We aimed to investigate if there is a relationship between these conditions.Subjects and methodAmong 2281 patients who were admitted to our geriatric medicine outpatient clinic spanning the last three years, 705 patients with known vitamin D status, urinary incontinence and subtype, and calcium plus vitamin D therapy data were included in statistical analysis. Patients who are using calcium plus vitamin D therapy were excluded. SPSS (Statistical Package for Social Sciences) version 15.0 for Windows was used for statistical analysis and p < 0.05 was considered as statistically significant.ResultsMean age of the study population was 72.3 ± 6.4 years and 62.8% were female. Plasma vitamin D level (OR: 0.968, 95%CI: 0.943–0.993, p = 0.013), MMSE (Mini Mental State Examination) score (OR: 0.944, 95%CI: 0.902–0.989, p = 0.014), and serum ALP (Alkaline Phosphatase) level (OR: 0.995, 95%CI: 0.992–0.998, p = 0.001) were found to be inversely correlated factors, and serum calcium level (OR: 1.772, 95%CI: 1.008–2.888, p = 0.022) was found to be a positively correlated factor of overactive bladder. Considering the different clinical subtypes of urinary incontinence, only urgency incontinence was associated with lower plasma vitamin D level (p = 0.013).ConclusionsVitamin D deficiency and insufficiency are independent associated factors for overactive bladder in older adults. This is explicable by effects of vitamin D on muscle growth and function.     

Bone mineral density and vitamin D concentration: the challenges in taking care of children and adolescents infected with HIV

Background

The increase in life expectancy for patients living with human immunodeficiency virus (HIV) infection has resulted in health complications related to a chronic disease.

Vitamin D status and seasonal changes in plasma concentrations of 25-hydroxyvitamin D in office workers in Ankara,Turkey

BackgroundLack of sun exposure is one of the primary causes of epidemic vitamin D deficiency worldwide. The aim of this study was to investigate vitamin D status and seasonal changes in summer and winter in office workers.MethodsThis study was conducted in Ankara located at 39°52ʹ30ʺ N, 32°52ʹ E. The study consisted of 118 premenopausal women and men aged between 21 and 52 years-old. Seasonal changes were evaluated in August and February. Fasting serum was obtained for intact parathyroid hormone (iPTH) and 25-hydroxyvitamin D (25OHD). Additional data were collected by a questionnaire that enquired about age, weight, height, wearing style, dietary calcium intake and sunlight exposure. Serum 25OHD concentration was measured using a precise HPLC assay. Low vitamin D status was defined as a 25OHD concentration less than 30 ng/mL.ResultsMean serum 25OHD concentration in summer was 28.4 ± 10.4 ng/mL and 13.8 ± 6.6 ng/mL in winter (p < 0.001). 35.6% of the subjects were vitamin D insufficient in summer and 12.7% in winter (p < 0.001) while 31.5% were vitamin D deficient in summer and 83.9% in winter (p < 0.001). A significant increase in iPTH levels (33.1 ± 15.9 pg/mL vs 49.6 ± 24.3 pg/mL, p < 0.001) was observed throughout the seasonal change. No significant association was found between 25OHD levels and iPTH, body mass index, age and sun exposure index (p > 0.05 for all) in both seasons.ConclusionVitamin D deficiency is very prevalent in office workers even in summer time and this should be accepted as a public health problem.     

Serum leptin and osteoporosis in postmenopausal women with primary knee osteoarthritis

Aim of the workThe purpose of this study was to evaluate the relationship of serum leptin level and osteoporosis in postmenopausal women with knee osteoarthritis (KOA).Patients and methodsThe study included 40 postmenopausal women with primary KOA and 37 age-matched postmenopausal healthy controls. Plain X-ray knees were performed and assessed using the Kellgren–Lawrence (KL) grading scale. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry (DXA) in lumbar spine, hip and forearm regions. As a bone turn-over marker serum osteocalcin was measured. Serum leptin level was assessed in patients and control.ResultsThe mean age of the KOA patients was 58.05 ± 5.7 years. Osteoporosis was detected among 15% of the KOA patients and 35.1% of the control. The BMD was significantly increased at the spine and wrist in the patients than in the control (p = 0.011 and p = 0.015 respectively). The serum osteocalcin was comparable between patients (19.74 ± 8.05 ng/ml) and control (21.2 ± 8.36 ng/ml) (p = 0.5). Serum leptin was significantly higher in the patient (58.7 ± 27.17 ng/ml) compared to the control (48.75 ± 13.19 ng/ml) (p = 0.048), and significantly correlated with the degree of KOA (p = 0.017). No significant correlation was found between serum osteocalcin level or the BMD and the degree of KOA. There was a significant negative correlation between serum osteocalcin level and forearm BMD in KOA patients (r = −0.33, p = 0.038).ConclusionsAlthough postmenopausal women with KOA had significantly higher BMD, both diseases can coexist. It seemed that osteoarthritis does not prevent the occurrence of osteoporosis. Our study suggested a promising role of leptin as a biomarker of KOA.     

Vitamin D supplementation and glycemic control in type 2 diabetes patients: A systematic review and meta-analysis

IntroductionLow vitamin D status has been found to be associated with impaired glycemic control in patients who suffer from type 2 diabetes; however, whether vitamin D supplementation is associated with improved glycemic status remains controversial. The aim of this study was to summarize evidence from randomized controlled trials (RCTs) to assess the efficacy of vitamin D supplementation in reducing glycosylated haemoglobinA1c (HbA1c) and fasting blood glucose (FBG) levels.Materials/MethodsWe searched PubMed, Web of Science and the Cochrane Library for reports published up to March 2017. We selected parallel RCTs investigating the effect of vitamin D or vitamin D analogues on HbA1c or FBG levels in type 2 diabetes patients. Cohen's d was calculated to represent the standardized mean difference (SMD) for each study, and the SMDs with 95%confidence intervals (CIs) were pooled using a random effects model.ResultsTwenty-four studies were included that evaluated HbA1c levels and 18 studies were included that evaluated FBG levels. Meta-analyses showed that vitamin D supplementation was associated with reduced HbA1c levels (standardized mean difference (SMD) − 0.25 [− 0.45 to − 0.05]) but had no influence on FBG levels (SMD − 0.14 [− 0.31 to 0.03]). However, the subgroup analyses suggested that vitamin D supplementation was associated with reduced HbA1c levels (SMD − 0.39 [− 0.67 to − 0.10]) and FBG (SMD − 0.27 [− 0.46 to − 0.07]) among patients with 25-hydroxyvitamin D (25(OH) D) deficiency at baseline. Significantly reduced HbA1c levels were also observed in association with vitamin D supplementation in the subgroup including type 2 diabetes patients with a body mass index (BMI) < 30 kg m^− 2 (SMD − 0.30 [− 0.54 to − 0.07]).ConclusionsVitamin D supplementation could be effective at improving glycemic control in vitamin D deficient or non-obese type 2 diabetes patients.     

Effect of 1, 25(OH)(2) vitamin D(3) on glucose homeostasis and DNA damage in type 2 diabetic mice

AimsThe purpose of the study was to examine the effect of 1, 25(OH)₂ VitaminD₃ supplementation on type 2 diabetic (T2DM) mice.Materials and MethodsA total of 24 mice were taken and divided into three groups of control; diabetic and diabetic + vitamin D supplemented ones. Serum calcium level, fasting blood glucose level (FBG), hexokinase activity, glucose-6-phosphatse and fructose 1,6 bisphosphatase activity were measured to establish a relevant correlation between vitamin D supplementation and hyperglycemia in T2DM.ResultsThere occurred an increase in FBG levels (250 ± 0.41 mg/dl) and a significant decrease in serum calcium levels in the diabetic group (8.63 ± 0.40 mg/ml) both of which reached near control levels on vitamin D₃ supplementation. The activity of the glucose metabolic enzymes was also assayed in diabetic group and was found to be deviated from control group; hexokinase (0.0241 ± 0.014 μg/mg/ml) FBPase (0.433 ± 0.002 μg/mg/ml) and G6Pase (0.918 ± 0.02 μg/mg/ml). However, the activity of these enzymes returned to near control values with hexokinase activity reaching 0.717 ± 0.003 μg/mg/ml on vitamin D₃ supplementation. The FBPase and G6Pase activities were decreased to 0.2733 ± 0.008 μg/mg/ml and G6Pase 0.71 ± 0.01 μg/mg/ml respectively. In addition to enzymatic analysis, the organs of all three groups of mice were subjected to comet assay. The diabetic group receiving vitamin D supplementation showed a marked recovery exhibiting shorter tail length both in liver (21.80 ± 2.40 μm) and pancreatic cells (19.25 ± 1.90 μm) as compared to the diabetic group exhibiting a tail length of 30.41 ± 2.50 μm and 32.45 ± 2.87 μm in liver and pancreatic cells respectively.ConclusionThe present study shows that vitamin D₃ supplementation is positively correlated with decrease in blood glucose level and serum calcium level in fasting condition. This suggests a positive influence of vitamin D on glucose homeostasis. Besides, the activity of various glucose metabolic enzymes (hexokinase, FBPase and G6Pase) as shown by our results and the remarkable shortening of DNA tail length in vitamin D supplemented diabetic group as compared to diabetic group without supplementation further support the idea that vitamin D supplementation might be an add-on therapy for patients with T2DM.     

Bone mineral density and associated parameters in pre-pubertal children with asthma treated with long-term fluticasone propionate

AimsThe primary aim of the objective of the study was to determine the effects of long-term treatment with the recommended dose of inhaled fluticasone propionate spray usage on bone mineral status in children with asthma.MethodsThis cross-sectional, case–control study was of 270 pre-pubertal children with asthma, who had used inhaled fluticasone propionate at a mean daily dose of 200 μg (range: 200–350 μg) for at least 5 years. The bone mineral density (BMD) of the lumbar spine was measured by dual-energy X-ray absorptiometry (DEXA). The results were compared to untreated controls (n = 200), who were newly diagnosed children with asthma without any corticosteroid treatment.ResultsThe 270 study patients (175 males) were aged between 6 and 13 years. The average age (±SEM) was 9.2 ± 0.6 years, and the mean (±SEM) steroid dosage used was 183.3 ± 57.0 μg daily, with 236.5 ± 17.2 g total steroid use during treatment. Between the study and the control groups, no significant difference was observed in BMD (p > 0.05).ConclusionThe findings suggest that long-term periodical treatment for 5 years with inhaled fluticasone propionate, 100 μg twice daily, in children with asthma revealed no negative effect on bone mineral density by using DEXA.