Effect of a mixture of calcium, vitamin D, inulin and soy isoflavones on bone metabolism in post-menopausal women: a retrospective analysis.

OBJECTIVES: Aging might affect the effectiveness of the sole supplementation of calcium and vitamin D in post-menopausal women, due to the development of vitamin D resistance in the gut, which limits calcium absorption. Thus, we wanted to test the efficacy of a mixture of calcium (500 mg), 25-hydroxyvitamin D [25(OH)D; 300 IU], inulin (3 g) and soy isoflavones (40 mg), to improve calcium absorption in this type of population. STUDY DESIGN: It is a retrospective study on otherwise healthy post-menopausal women. MAIN OUTCOME MEASURES: The following parameters were evaluated at baseline and after 3 months of supplementation: daily calciuria as an indirect marker of calcium absorption, serum 25(OH)D, parathormone, insulin-like growth factor 1 (IGF1) as a marker of bone anabolism, collagen telopeptide and osteocalcin as markers of bone resorption and bone turnover, respectively. RESULTS: Twenty-eight women (median age 67 years) were included in the analysis. The supplementation markedly increased daily calciuria (+60 %; p = 0.00009), while reducing parathormone levels (-18 %; p = 0.02) and leaving 25(OH)D unaltered. An increase in IGF1 (+16 %; p = 0.01) and a reduction in collagen telopeptide (-17 %; p = 0.04) were observed, too, as well as a modest trend towards osteocalcin reduction, although not significant. CONCLUSIONS: These results suggest that the considered mixture improved intestinal calcium absorption and bone metabolism in post-menopausal women. Since the amount of supplemented calcium was relatively low and 25(OH)D levels were unchanged, the observed effects are likely due to the combined contributions of inulin and soy isoflavones.

Different vitamin D substrate-product relationship after oral vitamin D supplementation in familial benign hypercalcemia, primary hyperparathyroidism, and healthy controls.

CONTEXT: In healthy subjects and in patients with primary hyperparathyroidism (PH), the administration of a low dose of 25(OH)D (25 µg/day) increases the serum levels of both 25(OH)D and 1,25(OH)(2)D. It is unknown whether this relationship is present in patients affected by familial benign hypocalciuric hypercalcemia (FBH). OBJECTIVE: To evaluate the different vitamin D substrate-product relationship after oral vitamin D supplementation in familial benign hypercalcemia, PH, and healthy controls. DESIGN: We evaluated the main physiological regulators of 1α-hydroxylase and the substrate-product relationship of 25(OH)D and 1,25(OH)(2)D in 20 patients with PH, 25 with FBH, and 122 healthy sex- and age-matched controls before and after administration of 25(OH)D for 2 weeks. RESULTS: 25(OH)D increased significantly in all subjects, whereas 1,25(OH)(2)D serum levels increased significantly in PH patients and healthy controls but not in patients with FBH. Therefore, a significant positive substrate-product relationship of 25(OH)D-1,25(OH)(2)D was found in PH and healthy controls, but not in FBH. Monomeric calcitonin (hCT-M) was significantly lower at baseline and after 25(OH)D supplementation in the FBH group compared with the other two groups. CONCLUSIONS: The lack of 1,25(OH)(2)D increase in FBH may be due to a direct inhibitory effect on 1α-hydroxylase of hypercalcemia per se, increased metabolic clearance of 1,25(OH)(2)D, or a decreased stimulus of 1α-hydroxylase related to persistently low levels of hCT.

Bosentan and sildenafil: should the combination therapy be a valid alternative in childhood to prostacyclin infusion?

We report a case of a seven-yr-old girl with a PAH treated with continuation therapy of bosentan and sildenafil. The combination therapy revealed safety and efficacy in long-term follow up.