Effect of a Nutritional Supplementation on Bone Health in Chilean Elderly Subjects with Femoral Osteoporosis

Objective: To study the effects of a special nutritional supplement on bone mineral density and bone turnover markers in Chilean elderly subjects with femoral osteoporosis.

Setting: Public primary health care clinics in Chile.

Subjects: Free living elderly subjects with femoral osteoporosis.

Interventions: Subjects were randomized to receive the usual nutritional supplement provided by the Chilean Ministry of Health or a special nutritional supplement providing, among other nutrients, 90 mg isoflavones, 800 mg calcium, 400 IU vitamin D, 60 ug vitamin K and 31 g proteins per day.

Measures of Outcome: At baseline, and after six and twelve months of supplementation, body composition, bone mineral density, serum 25 OH vitamin D, intact parathyroid hormone (iPTH), osteocalcin, decarboxylated osteocalcin, urinary aminoterminal telopeptide of type I collagen (NTX), deoxypyridoline cross links (Dpd) and equol were measured. Every month, urinary daidzein was measured in a morning urine sample.

Results: No differences between treatment groups were observed in body composition or bone mineral density changes. The group receiving the special supplement had a significant increase in serum 25 OH vitamin D and a significant decrease in serum iPTH and decarboxylated osteocalcin. No association between daidzein or equol excretion and changes in bone mineralization was observed.

Conclusions: A special supplement delivered to elderly subjects with osteoporosis improved serum vitamin D and reduced serum iPTH and undercarboxylated osteocalcin levels but did not affect BMD.     

Vitamin D status affects serum parathyroid hormone concentrations during winter in female adolescents: associations with forearm bone mineral density

BACKGROUND: Vitamin D deficiency leads to secondary hyperparathyroidism, which has a negative effect on bone metabolism in the elderly. Puberty is an important time of bone metabolism and growth. The effect of serum 25-hydroxyvitamin D [25(OH)D] concentrations on parathyroid hormone concentrations and bone mineral density (BMD) has not been well studied cross-sectionally in adolescents. OBJECTIVE: We studied the effect of vitamin D status on serum intact parathyroid hormone (iPTH) concentrations and bone metabolism in adolescents. DESIGN: One hundred seventy-eight healthy female adolescents (aged 14-16 y) volunteered for this study, which was conducted in Finland (Helsinki, 60 degrees N) during the winter. Forearm BMD at radial and ulnar sites was measured by dual energy X-ray absorptiometry. The determinants of different variables were studied by use of regression models. RESULTS: On the basis of the relation between serum 25(OH)D and iPTH concentrations, serum 25(OH)D concentrations > approximately 40 nmol/L were needed to keep serum iPTH concentrations low. One hundred ten subjects (61.8%) had serum 25(OH)D concentrations < or =40 nmol/L. Twenty-four subjects (13.5%) were considered vitamin D deficient when the serum 25(OH)D concentration of 25 nmol/L was used as a cutoff. Subjects with serum 25(OH)D concentrations < or =40 nmol/L had low mean forearm BMD values at both the radial (P = 0.04) and ulnar (P = 0.08) sites. CONCLUSION: A large percentage of adolescent females have low vitamin D status during the winter in Finland, which seems to have negative effects on bone health.     

Effect of withdrawal of calcium and vitamin D supplements on bone mass in elderly men and women

BACKGROUND: Supplementation with calcium and vitamin D reduces bone loss and prevents fractures in elderly people, but it is not known whether any lasting benefit remains if the supplements are discontinued. OBJECTIVE: The objective was to determine whether gains in bone mineral density (BMD) induced by calcium and vitamin D supplementation persist after supplement withdrawal. DESIGN: Two-hundred ninety-five healthy, elderly men and women (aged >/=68 y) who had completed a 3-y randomized, placebo-controlled trial of calcium and vitamin D supplementation were followed for an additional 2 y during which no study supplements were given. BMD was measured by dual-energy X-ray absorptiometry, and biochemical variables related to calcium metabolism and bone turnover were measured. RESULTS: In the 128 men, supplement-induced increases in spinal and femoral neck BMD were lost within 2 y of supplement discontinuation, but small benefits in total-body BMD remained. In the 167 women, there were no lasting benefits in total-body BMD or at any bone site. Consistent with the observations on BMD, the bone turnover rates in both men and women (as measured by serum osteocalcin concentrations) returned to their original higher concentrations within the same 2-y period. CONCLUSION: Discontinued calcium and vitamin D supplementation has limited cumulative effect on bone mass in men and women aged >/=68 y.     

Bone mineral density and serum 25-hydroxyvitamin D level: is there any difference according to the dressing style of the female university students

Nutrition plays a role in the etiology of osteoporosis. Two of the most important nutrients for bone health are calcium and vitamin D. Plasma 25-hydroxyvitamin D [25-(OH)D] is the most sensitive clinical index of vitamin D status and has been found to be positively related to bone mineral density (BMD) in middle-aged and elderly women, and positive relations exist between the BMD of adult women and their calcium consumption throughout life.

The aim of the present study was to determine relationships between BMD, serum vitamin D levels and dietary calcium intake of female young adult students who dressed in different styles. We studied two groups of volunteer female students (total=67). Students in the first group dressed in a style that exposed the skin to sunlight, students in the second group wore dresses completely covering the skin except for the face and hands. Serum 25-(OH)D levels were measured by radioimmunoassay, BMDs were determined at the lumbar spine and femoral neck by dual-energy X-ray absorptiometry, and calcium intakes were estimated with a 3-day food recording questionnaire.

The serum 25-(OH)D level was significantly lower in the second group. There was no significant difference in BMD between the two groups. The dietary calcium intake of the two groups were lower than the adequate intake of 1000 mg daily for this age. There was a correlation between the serum 25-(OH)D level and BMD at the femoral neck in the first group.

Our results indicate that vitamin D and calcium requirements for normal bone mineral accrual in young adults may advance until a certain age, and the covered dressing style causes vitamin D insufficiency and most of the students were under risk for osteoporosis in later life.     

Bone mineral density and serum 25-hydroxyvitamin D level: is there any difference according to the dressing style of the female university students

Nutrition plays a role in the etiology of osteoporosis. Two of the most important nutrients for bone health are calcium and vitamin D. Plasma 25-hydroxyvitamin D [25-(OH)D] is the most sensitive clinical index of vitamin D status and has been found to be positively related to bone mineral density (BMD) in middle-aged and elderly women, and positive relations exist between the BMD of adult women and their calcium consumption throughout life.The aim of the present study was to determine relationships between BMD, serum vitamin D levels and dietary calcium intake of female young adult students who dressed in different styles. We studied two groups of volunteer female students (total = 67). Students in the first group dressed in a style that exposed the skin to sunlight, students in the second group wore dresses completely covering the skin except for the face and hands. Serum 25-(OH)D levels were measured by radioimmunoassay, BMDs were determined at the lumbar spine and femoral neck by dual-energy X-ray absorptiometry, and calcium intakes were estimated with a 3-day food recording questionnaire.The serum 25-(OH)D level was significantly lower in the second group. There was no significant difference in BMD between the two groups. The dietary calcium intake of the two groups were lower than the adequate intake of 1000 mg daily for this age. There was a correlation between the serum 25-(OH)D level and BMD at the femoral neck in the first group.Our results indicate that vitamin D and calcium requirements for normal bone mineral accrual in young adults may advance until a certain age, and the covered dressing style causes vitamin D insufficiency and most of the students were under risk for osteoporosis in later life.     

绝经后女性良性阵发性位置眩晕患者血清钙离子、维生素D及骨转换代谢指标研究

目的探讨绝经后女性良性阵发性位置性眩晕(BPPV)患者血清钙离子、维生素D以及骨转换代谢相关指标的关系。方法选取2016年5月-2019年6月本院收治的绝经后BPPV患者180例为研究对象,依据骨密度分为正常骨密度组(47例)、骨密度减少组(54例)和骨质疏松组(79例),选择同期60例骨质疏松症(无眩晕)患者作为对照组,回顾分析各组间维生素D、血钙离子及骨转换代谢相关指标。结果骨质疏松组维生素D水平明显低于其他3组,尿脱氧吡啶啉(u-DPD)明显高于其他3组,骨钙蛋白明显高于正常骨密度组和骨密度减少组,差异均有统计学意义(P <0.05);多元回归分析显示骨质疏松与血清维生素D缺乏症是BPPV发生的危险因素(OR值分别为2.804、2.003,P <0.05)。结论骨质疏松、维生素D缺乏以及骨转换代谢指标与绝经后BPPV有关,临床需予以高度重视。     

The influence of smoking on vitamin D status and calcium metabolism

OBJECTIVE: To assess the influence of smoking on serum parathyroid hormone (PTH), serum vitamin D metabolites, serum ionized calcium, serum phosphate, and biochemical markers of bone turnover in a cohort of 510 healthy Danish perimenopausal women. DESIGN: A cross-sectional study. SETTING: Copenhagen, Denmark. SUBJECTS: Five-hundred-and-ten healthy women aged 45-58 y, included 3-24 months after last menstrual bleeding. None were using hormone replacement therapy. METHODS: The women were grouped according to their current smoking status. The two groups were compared with regard to serum levels of 25-hydroxyvitamin D (25OHD) and 1, 25-dihydroxyvitamin D (1,25-(OH)2D), intact PTH, ionized calcium and phosphate, osteocalcin, as well as urine pyridinolines. Bone mineral density (BMD) was measured with DEXA-scans. Multiple regression analyses were performed to detect the effect of potentially confounding lifestyle factors, such as calcium and vitamin D intakes, alcohol and coffee consumption, sunbathing, and physical exercise. RESULTS: Fifty percent were current smokers. Smokers had significantly reduced levels of serum 25OHD (P=0.02), 1,25(OH)2D (P=0.001), and PTH (P<0.001). There was no difference in serum ionized calcium between smokers and non-smokers. We found a negative effect of smoking on serum osteocalcin (P=0.01), while urinary pyridinolines were similar in the two groups. The small differences in lifestyle between the two groups could not explain these findings. Smokers had small but significant reductions in bone mineral density. CONCLUSIONS: Smoking has a significant effect on calcium and vitamin D metabolism, which is not likely to be explained by other confounding lifestyle factors. The depression of the vitamin D-PTH system seen among smokers may represent another potential mechanism for the deleterious effects of smoking on the skeleton, and may contribute to the reported risk of osteoporosis among smokers. Sponsorship: Grants from the Karen Elise Jensens Foundation.     

Vitamin D deficiency and low bone status in adult female garment factory workers in Bangladesh

The manufacture of garments is the main industry in Bangladesh and employs 1.6 million female workers. Due to the indoor lifestyle and low dietary intake of calcium, we hypothesised that they are at risk of low vitamin D and bone mineral status. Two hundred female garment workers (aged 18-36 years) were randomly selected. Serum 25-hydroxyvitamin D (S-25OHD), serum intact parathyroid hormone (S-iPTH), serum calcium (S-Ca), serum phosphate (S-P) concentration and serum alkaline phosphatase activity (S-ALP) were measured from fasting samples. Bone indexes of hip and spine were measured by dual-energy X-ray absorptiometry. The mean S-25OHD (36.7 nmol/l) was low compared to that recommended for vitamin D sufficiency. About 16% of the subjects were found to be vitamin D-deficient (S-25OHD 21 ng/l) was associated with progressive reduction in bone mineral density at the femoral neck and lumbar spine. According to the WHO criteria, the mean T-score of the femoral neck and lumbar spine of the subjects were within osteopenic range. We observed that subjects with a bone mineral density T-score < -2.5 had a trend of lower values of BMI, waist-hip circumference, mid-upper-arm circumference, S-25OHD and higher S-iPTH and S-ALP. The high prevalence of hypovitaminosis D and low bone mineral density among these subjects are indicative of higher risk for osteomalacia or osteoporosis and fracture.     

Vitamin D Deficiency in Women with Breast Cancer: A Correlation with Osteoporosis? A Machine Learning Approach with Multiple Factor Analysis

Breast cancer (BC) is the most frequent malignant tumor in women in Europe and North America, and the use of aromatase inhibitors (AIs) is recommended in women affected by estrogen receptor-positive BCs. AIs, by inhibiting the enzyme that converts androgens into estrogen, cause a decrement in bone mineral density (BMD), with a consequent increased risk of fragility fractures. This study aimed to evaluate the role of vitamin D3 deficiency in women with breast cancer and its correlation with osteoporosis and BMD modifications. This observational cross-sectional study collected the following data regarding bone health: osteoporosis and osteopenia diagnosis, lumbar spine (LS) and femoral neck bone mineral density (BMD), serum levels of 25-hydroxyvitamin D3 (25(OH)D3), calcium and parathyroid hormone. The study included 54 women with BC, mean age 67.3 ± 8.16 years. Given a significantly low correlation with the LS BMD value (r² = 0.30, p = 0.025), we assessed the role of vitamin D3 via multiple factor analysis and found that BMD and vitamin D3 contributed to the arrangement of clusters, reported as vectors, providing similar trajectories of influence to the construction of the machine learning model. Thus, in a cohort of women with BC undergoing Ais, we identified a very low prevalence (5.6%) of patients with adequate bone health and a normal vitamin D3 status. According to our cluster model, we may conclude that the assessment and management of bone health and vitamin D3 status are crucial in BC survivors.     

Dietary vitamin D intake is not associated with 25-hydroxyvitamin D3 or parathyroid hormone in elderly subjects,whereas the calcium-to-phosphate ratio affects parathyroid hormone

This cross-sectional study investigates whether serum 25-hydroxyvitamin D₃ [25(OH)D₃] and intact parathyroid hormone (iPTH) are affected by vitamin D, calcium, or phosphate intake in 140 independently living elderly subjects from Germany (99 women and 41 men; age, 66-96 years). We hypothesized that habitual dietary intakes of vitamin D, calcium, and phosphate are not associated with 25(OH)D₃ or iPTH and that body mass index confounds these associations. Serum 25(OH)D₃ and iPTH were measured by an electrochemiluminescence immunoassay. Dietary intake was determined using a 3-day estimated dietary record. The median dietary intake levels of vitamin D, calcium, and phosphate were 3 μg/d, 999 mg/d, and 1250 mg/d, respectively. Multiple regression analyses confirmed that dietary vitamin D and calcium did not affect 25(OH)D₃ or iPTH; however, supplemental intakes of vitamin D and calcium were associated with 25(OH)D₃ after adjustment for age, sex, body composition, sun exposure, physical activity, and smoking. In addition, phosphate intake and the calcium-to-phosphate ratio were associated with iPTH after multiple adjustments. In a subgroup analysis, calcium and vitamin D supplements, as well as phosphate intake, were associated with 25(OH)D₃ and/or iPTH in normal-weight subjects only. Our results indicate that habitual dietary vitamin D and calcium intakes have no independent effects on 25(OH)D₃ or iPTH in elderly subjects without vitamin D deficiency, whereas phosphate intake and the calcium-to-phosphate ratio affect iPTH. However, vitamin D and calcium supplements may increase 25(OH)D₃ and decrease iPTH, even during the summer, but the impact of supplements may depend on body mass index.     

Vitamin D and attainment of peak bone mass among peripubertal Finnish girls: a 3-y prospective study

BACKGROUND: Little is known about the effect of vitamin D status on bone gain in adolescents. OBJECTIVE: The objective was to examine whether vitamin D status is associated with accrual of bone mineral density (BMD) and bone mineral apparent density (BMAD). DESIGN: This 3-y prospective study examined the association between changes in BMD or BMAD and serum 25-hydroxyvitamin D [25(OH)D] in 171 healthy Finnish girls aged 9-15 y. Lumbar spine and femoral neck BMDs were measured by dual-energy X-ray absorptiometry. RESULTS: Baseline 25(OH)D correlated significantly with the unadjusted 3-y change in BMD at the lumbar spine (r = 0.35, P < 0.001) and femoral neck (r = 0.32, P < 0.001) in all participants. The difference from baseline in adjusted 3-y BMD accumulation between those with severe hypovitaminosis D [25(OH)D < 20 nmol/L] and those with a normal vitamin D status [25(OH)D > or = 37.5 nmol/L] was 4% (12.7%, 13.1%, and 16.7% for the lowest, middle, and highest tertiles of 25(OH)D, respectively; P for trend = 0.01) at the lumbar spine in the girls with advanced sexual maturation at baseline (n = 129). Moreover, the adjusted change in lumbar spine BMD was 27% greater in the highest vitamin D intake tertile than in the lowest tertile in the same girls (P for trend = 0.016). CONCLUSIONS: Pubertal girls with hypovitaminosis D seem to be at risk of not reaching maximum peak bone mass, particularly at the lumbar spine. Dietary enrichment or supplementation with vitamin D should be considered to ensure an adequate vitamin D status.     

Relationship between nutrient intake and vitamin D status in osteoporotic women

Vitamin D is essential for maintaining calcium homeostasis and optimizing bone health. Its inadequacy is related to many factors including dietary intake. The aim of the present study was to evaluate serum 25(OH)D and its relationship with nutrient intakes in postmenopausal Brazilian women with osteoporosis. This cross-sectional study comprised 45 free-living and assisted elderly at S?o Paulo Hospital. Three-day dietary records were used to assess dietary intakes. Bone mineral density was measured with a dual-energy X-ray absorptiometer (DXA). Blood and urine sample were collected for analysis of biochemical markers of bone and mineral metabolism. Insufficiency of vitamin D was observed in 24.4% of the women and optimal levels (> or = 50 nmol/L) were observed in 75.6%. Parathyroid hormone was above the reference range in 51% of the participants. The mean calcium (724 mg/day) and vitamin D (4.2 microg/day) intakes were lower than the value proposed by The Food and Nutrition Board and sodium intake was more than two-fold above the recommendation. Higher levels of serum 25(OH)D were inversely associated with sodium intake. Dietary strategies to improve serum vitamin D must focus on increasing vitamin D intake and should take a reduction of sodium intake into consideration.     

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.     

老年骨质疏松患者服用钙加维生素D后骨密度及生化指标的改变

目的了解补充钙和维生素D对骨丢失和骨转换的影响。方法对31例门诊原发性骨质疏松症和骨量减少患每日服用1片碳酸钙和维生素D复合剂(每片含元素钙600mg和维生素D125IU),连服6个月。治疗前后检测腰椎骨密度(BMD)、骨矿含量(BMC)及骨转换生化指标。结果碳酸钙和维生素D复合剂每日1片能明显改善骨质疏松引起的腰背疼和腿痛性痉挛,有明显疗效。可以维持腰椎骨密度,明显增加男性腰椎骨矿含量( 2．7％),与治疗前比较,明显提高血清250HD( 13．8％)和BGP(％29．5％),减少尿HOP／Cr比值(-17．5％)。结论老年人每天1片碳酸钙和维生素D复合剂对防止骨丢失,改善维生素D的营养状态,促进骨形成和抑制骨吸收有一定作用。     

Vitamin A Intake,Serum Vitamin D and Bone Mineral Density: Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES, 2008–2011)

The association of high vitamin A intake and low bone mineral density (BMD) is still controversial. To determine the association of dietary vitamin A intake and serum 25-hydroxyvitamin D (25(OH)D) concentration with BMD, a total of 6481 subjects (2907 men and 3574 women) aged ≥50 years from the Korean National Health and Nutrition Examination Survey (2008–2011) were divided into groups according to dietary vitamin A intake (tertiles) and serum 25(OH)D (<50, 50–75, >75 nmol/L), and evaluated for BMD after adjusting for relevant variables. Mean dietary vitamin A intakes were 737 and 600 μg RE (Retinol Equivalents) in men and women, respectively. Total hip and femoral neck BMD in men and lumbar spine BMD in women were both positively correlated with dietary vitamin A intake in subjects with serum 25(OH)D >75 nmol/L. Among men with serum 25(OH)D <50 nmol/L, both the top (mean 1353 μg RE) and bottom (mean 218 μg RE) tertiles of dietary vitamin A intake had lower BMD than the middle group (mean 577 μg RE). In this population, BMD was the highest among men and women with serum 25(OH)D = 50–75 nmol/L and that there were no differences in BMD by vitamin A intake in these vitamin D adequate groups. This cross-sectional study indicates that vitamin A intake does not affect bone mineral density as long as the serum 25(OH)D concentration is maintained in the moderate level of 50–75 nmol/L.     

Nutrition, mild hyperparathyroidism, and bone mineral density in young Japanese women

BACKGROUND: The adverse effects of poor nutrition on the bones of young Asian women have not been fully elucidated. OBJECTIVE: The purpose of this study was to investigate possible associations of vitamin D nutrition, calcium intake, and other nutrients with bone metabolism and bone mass in young Japanese women. DESIGN: The subjects were 108 female college students aged 19-25 y. Dietary nutrients were measured by using the duplicate sampling method on 3 weekdays. Serum 25-hydroxyvitamin D [25(OH)D], intact parathyroid hormone, and bone turnover markers were also measured. Bone mineral density (BMD) of the spine and femur was measured by dual-energy X-ray absorptiometry. RESULTS: The proportions of the subjects with low 25(OH)D (< 30 nmol/L) and high intact parathyroid hormone (> or = 6.9 pmol/L) concentrations were 32.4% and 15.7%, respectively. Serum 25(OH)D concentrations (P = 0.0265) and calcium intake (P = 0.0103) were inversely associated with serum intact parathyroid hormone. In addition to weight and physical activity, the presence of mild hyperparathyroidism was associated with a low BMD of the lumbar spine (P = 0.0062) and the femoral neck (P = 0.0250), and a low calcium intake was associated with a low BMD of the femoral neck (P = 0.0044). CONCLUSIONS: Low calcium intake (based on low BMD of the femoral neck only) and mild hyperparathyroidism (based on low BMD of both the femoral neck and lumbar spine), partly explained by low vitamin D nutrition and a low calcium intake, are important predictors of low BMD in young Japanese women. Effects of poor nutrition and mild hyperparathyroidism on bone peak bone mass in young women should be further investigated in longitudinal studies.     

女性系统性红斑狼疮患者骨密度与骨代谢生化参数的相关性

目的 测定绝经前女性系统性红斑狼疮患者骨密度(BMD)与骨代谢的生化参数并探讨二者的相关性。方法 用双能量X线吸收测量仪测定30例SLE患者腰椎和股骨BMD；常规测定分别测定30例SLE患者和39名正常健康者校正后的血清钙、磷、碱性磷酸酶、肌酐和白蛋白，用ELISA法测定卵泡促激素、黄体生成素、甲状旁腺素、骨钙素、脱氧吡诺林的分泌，用RIA法测定雌二醇、孕酮、睾丸酮、25-OH维生素D、I型原胶原C端前肽、碱性磷酸酶骨特异性同工酶、交联的I型胶原端肽。结果 根据世界卫生组织的标准，在腰椎位点39％患者BMD正常，46％患者骨质减少，15％患者骨质疏松；在股骨颈位点，38．5％患者BMD正常，38．5％患者骨质减少，23％患者骨质疏松。狼疮患者骨钙素、血清磷显著性降低(P=0．03、P=0．002)，而患者校正后的血清钙则显著性升高(P=O．0001)；除了患者睾丸酮的血清水平降低和卵泡促激素血清水平升高外(P=0.001、P=0．42)，其它性激素水平没有显著性差异。结论 绝经前女性SLE患者腰椎和股骨颈的骨质疏松和骨质减少发生率高，至少部分因骨形成的减少所致。     

Seemingly paradoxical seasonal influences on vitamin D status in nursing-home elderly people from a Mediterranean area

OBJECTIVE: We investigated vitamin D status in institutionalized elderly subjects by measuring serum 25-hydroxyvitamin D (25[OH]D) and its association with season and other factors: age, gender, nutritional status, cognitive function, functional ability, dietary intake, vitamin D supplement consumption, and disease. METHODS: The cross-sectional study included 86 subjects, 65-94 y of age (29 men and 57 women), who lived in three nursing homes in Murcia, a Spanish Mediterranean area. The Mini Nutritional Assessment, Short Portable Mental Status Questionnaire, and BI were used to evaluate nutritional status, functional ability, and cognitive function, respectively. Serum 25(OH)D concentrations were used to assess vitamin D status. The thresholds of inadequacy were considered to be <25 nmol/L (vitamin D deficiency) and <50 nmol/L (vitamin D insufficiency). RESULTS: Body mass index was 28.8 +/- 5.8 kg/m(2) (mean +/- SD). Vitamin D dietary intake was very much below the recommended dietary intake. The Mini Nutritional Assessment was 23.6 +/- 4.0, cognitive function was 7.8 +/- 1.9, and functional ability 82.9 +/- 23.1. The percentages of subjects with inadequate serum 25(OH)D concentrations were 58.2% and 32.6%, taking into consideration cutoffs of 50 and 25 nmol/L, respectively. Vitamin D deficiency was more common in women (40.3%) than in men (20.7%). Serum 25(OH)D concentrations varied significantly with the season in which the samples were taken, but not with the other factors analyzed. CONCLUSION: In this Mediterranean area, a substantial percentage of institutionalized subjects showed an inadequate vitamin D status, which could be remedied by the consumption of vitamin D-fortified foods and/or vitamin D supplements, especially during the summer months.     

337例婴儿维生素D水平与超声骨密度的分析

目的 通过探讨婴儿维生素D水平与超声骨密度及身长发育等因素的关系,旨在及早的发现婴儿维生素D缺乏性佝偻病的高危因素,为确定维生素D缺乏性佝偻病的诊断标准提供依据。方法 选取2010年3月-2011年4月在本院出生,并在儿保科常规建册系统管理的9个月婴儿337例,根据生长发育指标测量方法进行体重、身长的体格测量并记录,同时进行喂养方式等相关问卷调查。9个月体检时采集婴儿静脉血5 mL,采用酶联免疫法(ELISA)检测血清25-(OH)D浓度;进行婴儿胫骨SOS测量,并采用Z值进行比较,了解骨矿化状况。并采用单因素方差分析及独立样本t检验等进行婴儿维生素D水平与超声骨密度及身长发育等的关系分析;结果 不同喂养方式、母乳喂养持续时间、户外活动时间比较,其不同组间的维生素D水平及超声骨密度Z值均有差异(P均＜0.05)。婴儿不同组间的25-(OH)D,其骨密度Z值及身长差异有统计学意义(P＜0.05)。结论 婴儿的维生素D营养状况与婴儿的骨矿物质含量密切相关,合理适量的补充维生素D是今后儿保工作的重点。证实了25-(OH)D是诊断维生素D缺乏性佝偻病的金标准。     

Strategies for skeletal health in the elderly

Osteoporosis is a common disease in the elderly, and the fractures that result from this disorder affect 40 % of women and 14 % of men over the age of 50 years. The risk of fracture relates to bone mineral density and the risk of falling, among other factors. Low bone mineral density in the elderly can result from either low peak bone mass or accelerated bone loss, or a combination of the two. Nutritional factors play a role in both the attainment of peak bone mass and in the rate of age-related bone loss. The main determinants of peak bone mass are genetic factors, early-life nutrition, diet and exercise. Of the nutritional factors Ca, and particularly milk, are the most important contributors to peak bone mass. Some of these factors may interact; for example, a low dietary Ca in addition to an unfavourable vitamin D receptor gene polymorphism may result in low peak bone mass. The age-related changes in bone mass may also have a genetic basis, but deficiency of oestrogen is a major contributor. In addition, undernutrition is common in the elderly, and lack of dietary protein contributes both to impaired bone mineral conservation and increased propensity to fall. There is a decreased ability of the intestine to adapt to a low-Ca diet with increasing age. Other dietary factors include vitamin K, Zn and fruit and vegetables. Adequate nutritional status, particularly of Ca and vitamin D, is essential for the successful pharmaceutical treatment of osteoporosis. Thus, strategies for enhancing skeletal health in the elderly must begin in early childhood, and continue throughout life.