Changes in Bone Mineral Density Following Conventional Oral Phosphonate Treatment of Hypophosphatemic Osteomalacia: A Non-Randomized Controlled Study.

PURPOSE: There are limited clinical studies aimed at solving the problem of the efficiency of conventional treatment with oral phosphate and calcitriol in adults with hypophosphatemic osteomalacia (HO). In addition, there still had no good non-hazardous markers to evaluate the severity of bone loss of osteomalacia before and after treatment. Therefore, the purpose of this study was to assess the efficacy of conventional treatment with a self-blended phosphate supplementation and calcitriol on patients with HO and whether bone mineral density (BMD) can be helpful for monitoring the efficacy. PATIENTS AND METHODS: A total of 21 HO patients and 105 healthy controls were enrolled. All patients were tested for serum biomarkers and BMD of the lumbar spine (L1-L4), femoral neck, and total left hip. After three years of treatment, 11 of 21 HO patients were recalled for BMD measurement. According to the administration of drugs, HO patients with calcium and calcitriol were divided into three phosphate treatment groups: patients in group A (n = 3) received continuous phosphate supplementation, patients in group B (n = 5) received intermittent phosphate supplementation and patients in group C (n = 3) received no phosphate supplementation. RESULTS: The diagnoses of 21 HO patients were 5 cases of hereditary hypophosphatemic rickets, 4 cases of Fanconi syndrome with the features of renal tubular acidosis and vitamin D deficiency, and 12 cases of hereditary vitamin D abnormality. The average initial serum phosphorus level of the patient group was approximately 50% lower than that of the control group. Lower BMD was significantly observed in the HO group than the control group at the lumbar spine and total hip. Continuous treatment with the phosphate supplement could increase BMD in the lumbar spine and total hip by 33.4-52.3% and in the femoral neck increased by 43.2-79.3% compared with baseline, and the effect appears to be continued once treatment is discontinued. CONCLUSION: These findings suggest that conventional therapy can improve bone mineral defects in patients with HO, especially in the femoral neck. Detection of BMD in HO patients is a good tool to assess the extent of bone defects and the therapeutic effect. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR-OOC-16010095. Registered 7 December 2016. Retrospectively registered.

Nail Selenium Level and Diabetes in Older People in Rural China.

This cross-sectional study aimed to examine the association between selenium levels and diabetes in an older population with life-long natural exposure to selenium in rural China. A total of 1856 subjects aged 65 years or older from four Chinese rural counties with different environmental selenium levels were evaluated. Analysis of covariance models and logistic regression models were used to examine the relationship between nail selenium levels and serum glucose, serum insulin, insulin resistance [using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)], and the risk of diabetes. The mean nail selenium level was 0.461 µg/g and the prevalence rate of diabetes was 8.3% in this population. The mean nail selenium level was significantly higher in the group with diabetes than in the group without diabetes (P<0.0001). The adjusted odds ratios for diabetes were 2.65 (95% CI: 1.48 to 4.73), 2.47 (95% CI: 1.37 to 4.45), and 3.30 (95% CI: 1.85 to 5.88) from the second selenium quartile to the fourth quartile, respectively, compared with the first quartile group. The mean serum glucose and HOMA-IR in the higher selenium quartile groups were significantly higher than those of the lowest quartile group. However, no significant differences in insulin were observed among the four quartile groups. A long-term, higher level of exposure to selenium may be associated with a higher risk of diabetes. Future studies are needed to elucidate the association between selenium and insulin resistance.

Epidemiology and management of osteoporosis in the People's Republic of China: current perspectives.

With the progressive aging of the population, osteoporosis has gradually grown into a global health problem for men and women aged 50 years and older because of its consequences in terms of disabilities and fragility fractures. This is especially true in the People's Republic of China, which has the largest population and an increasing proportion of elderly people, as osteoporosis has become a serious challenge to the Chinese government, society, and family. Apart from the fact that all osteoporotic fractures can increase the patient's morbidity, they can also result in fractures of the hip and vertebrae, which are associated with a significantly higher mortality. The cost of osteoporotic fractures, moreover, is a heavy burden on families, society, and even the country, which is likely to increase in the future due, in part, to the improvement in average life expectancy. Therefore, understanding the epidemiology of osteoporosis is essential and is significant for developing strategies to help reduce this problem. In this review, we will summarize the epidemiology of osteoporosis in the People's Republic of China, including the epidemiology of osteoporotic fractures, focusing on preventive methods and the management of osteoporosis, which consist of basic measures and pharmacological treatments.

[Effect of ultra-early hyperbaric oxygenation on spinal edema and hind limb motor function in rats with complete spinal cord transection].

OBJECTIVE: To evaluate the effect of ultra-early hyperbaric oxygenation on spinal edema and hind limb motor function in rats with complete spinal cord transection. METHODS: Fifty-five healthy 3-month-old female SD rats were randomly divided into sham-operated group (n=15), complete spinal cord transection group (CSCT group, n=20) and hyperbaric oxygen group (HBO group, n=20). The rats in the sham-operated group underwent only laminectomy, while those in the other 2 groups underwent CSCT at the T10 level. The rats in HBO group were placed in an oxygen chamber 3 h after the operation for 10 days as a treatment course, and 3 treatment courses were administered at the interval of 6 days. In the first treatment course, 2 hyperbaric oxygenation sessions were given daily, and in the following 2 course, only 1 session was given daily. The recovery of hindlimb motor function was evaluated using the open-field Basso-Beattie-Bresnahan (BBB) scoring system once a week for 6 weeks. All the rats were sacrificed 6 weeks after the operation to measure the water content in the injured tissues. RESULTS: The BBB scores of CSCT group and HBO group gradually increased with the passage of time after the operation, and from week 2 to week 6, HBO group had significantly higher scores than CSCT group (P<0.05). The water content was markedly increased in CSCT group at 6 weeks after the operation as compared with that in the sham-operated group (P<0.01), and significantly reduced in HBO group in comparison with that in the CSCT group (P<0.05). CONCLUSION: Ultra-early HBO can suppress spinal cord edema and promote hindlimb locomotor recovery in rats with complete spinal cord transection.

[Protective effects of puerarin against myocardial injury in patients with hypertension during perioperational period].

OBJECTIVE: To investigate the protective effects of puerarin against myocardial injury in patients with hypertension during perioperational period. METHODS: Thirty-four patients with hypertension underwent general anesthesia were randomly divided into the control group and the puerarin group, 500mg puerarin was given to the puerarin group 1hr before anesthesia induction by venoclysis and to the control group, normal saline was given instead. The concentration of serum cardiac troponin I (cTnI) and isoenzyme of creatine kinase containing M and B subunits (CK-MB) were measured before anesthesia induction and 2 hrs after operation respectively. RESULTS: The serum concentration of cTnI and CK-MB were insignificantly different in the two groups before induction, the two indexes increased in different degrees (P <0.01) 2 hrs after operation in both groups, but the increments in the puerarin group were significantly lower than those in the control group (P< 0.01). CONCLUSION: Stress of operation and anesthesia could induce myocardial injury in patients with hypertension, which can be prevented by puerarin medicated during perioperational period.

[Compound nylestriol tablet to prevent bone loss in osteoporotic rats].

OBJECTIVE: To investigate the effects of compound nylestriol tablet (CNT), containing nylestriol and levonorgestrel with a ratio of 1:0.3) and its components on the osteoporotic rat model induced by retinoic acid (RA) and ovariectomy (OVX). METHODS: We randomly divided 144 female SD rats (aged 7-month-old) into 12 groups (12 in each). In addition, 120 female SD rats aged 4-month were randomly divided into 10 groups (10 in each). Three dosage levels of CNT (0.039, 0.117 and 0.39 mg/kg body weight, daily), nylestriol (NYL, 0.30, 0.09 and 0.03 mg/kg body weight, daily) and levonorgestrel (LEV, 0.09, 0.027 and 0.009 mg/kg body weight, daily) were designed to prevent the bone loss of the osteoporotic rat model induced by RA and OVX respectively. Serum total calcium (Ca), phosphate (Pi), ALP, triglyceride (TG), total cholesterol (TC), HDL-C, total body BMD, isolated left femoral BMD and femoral Ca, and Pi after ashing were determined. RESULTS: Osteoporotic models could be induced by RA (70 mg/kg body weightdaily given intragastrically for 14 days) or by ovariectomy; CNT and its components had the preventive effects on bone loss in both models; The preventive effect of CNT was dose-dependent and stronger than its components; Many observed markers showed us the levels of high and moderate CNT given to be the strongest, corresponding to an optimal choice of the moderate dose CNT about one tablet per week in adult women. CONCLUSIONS: CNT therapy can prevent the bone loss of RA-induced and OVX-induced osteoporotic rats, and its therapeutic and preventive effect is better than its components used alone.