Serum 25(OH)D and adipokines levels in people with abdominal obesity.

Abdominal obesity is a risk factor for cardiovascular disease and diabetes mellitus and has been associated with vitamin D deficiency. Some studies have suggested an association between obesity and adipokine levels as well as low serum 25-hydroxyvitamin D (25(OH)D) level but the underlying mechanisms of the interlink between vitamin D status and serum leptin and adiponectin concentrations are still disputed. We included 435 residents (132 males) from St. Petersburg, Russia into this study. All subjects had physical examination and demographics noted. Blood was collected after an overnight fast and plasma glucose, insulin, serum lipids, 25(OH)D and adipokines (adiponectin and leptin) concentrations were determined at baseline in all participants. Abdominal obesity was diagnosed in 310 (71.3%) subjects (251 females and 59 males). Vitamin D insufficiency and deficiency were found in 314 (72.2%) subjects. Mean (95% CI) age, body mass index (BMI) and serum 25(OH)D for the cohort were 47.6±11.3years; 28.7±0.2kg/m2 and 62.5±24.3nmol/l respectively. Serum 25(OH)D level inversely correlated with body weight, waist circumference (WC) and BMI in females but not in males, was lower in diabetic than non-diabetic subjects, and was not significantly different in subjects with and without MetS. WC was positively correlated with leptin and negatively correlated with adiponectin. We found correlation between leptin and serum 25(OH)D level (r=-0.15, p=0.01) but this finding was a characteristic seen only in women. Our study showed a high prevalence of abdominal obesity, vitamin D deficiency and insufficiency in residents from North-West region of Russia, close association between adipokine (leptin, adiponectin) concentrations as well as vitamin D status and body composition (WC, BMI). However in our study the interlink between leptin level and 25(OH)D was found only in females. Further investigations are required to study the relationship between serum 25(OH)D level, obesity and serum adipokine levels.

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

"BACKGROUND: Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. EVIDENCE: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. PROCESS: Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. RESULTS: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. CONCLUSION: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required."

Idiopathic juvenile osteoporosis--an analysis of the muscle-bone relationship.

INTRODUCTION: Idiopathic Juvenile Osteoporosis (IJO), a disease of unknown etiology, manifests typically by pain, bone deformities and fractures. Due to limits in BMD data interpretation, evaluation of the muscle-bone functional unit has recently been proposed as a means to assess the general competence of the skeleton. The aim of this study was to evaluate skeletal status during the acute phase of IJO and during recovery from the disease in relation to muscles. MATERIALS AND METHODS: The study population comprised 61 IJO children, including 34 girls (mean age: 13.6+/-3.1 years; range: 7-18) and 27 boys (14.3+/-3.3; 5-18 years). DXA total body (TB) and lumbar spine (S) bone mineral content (BMC) and density (BMD) were measured. Lean body mass (LBM) was employed to calculate SBMC/LBM, TBBMC/LBM, body height (BH)/LBM and LBM/body weight (BW) ratios. Previously established references for healthy controls were utilized for the calculation of Z-score values in IJO cases in respect to phase of the disease. RESULTS: IJO patients had significantly decreased Z-score values for TBBMD, SBMD, SBMC/LBM and TBBMC/LBM ratios but not for the LBM and BH/LBM or LBM/BW ratios. During the acute phase IJO girls had mean Z-scores for TBBMD and SBMD of -2.49+/-0.61 and -3.27+/-1.03, respectively, which were significantly lower than Z-scores during the recovery phase: -0.90+/-0.66, -1.38+/-0.95 (p<0.0001). IJO boys during the acute phase had Z-scores of -2.08+/-0.65 and -2.75+/-1.19 for TBBMD and SBMD, respectively, which were significantly lower than those during the recovery phase (-0.51+/-1.04 and -1.39+/-1.49; p<0.0001). Further, during the acute phase, TBBMC/LBM Z-scores of -2.95+/-1.15 and -2.56+/-1.49 were noted in girls and boys, respectively; the corresponding SBMC/LBM Z-scores were -2.66+/-1.07 and -2.22+/-1.62. During the recovery from IJO, TBBMC/LBM and SBMC/LBM Z-scores of -1.07+/-0.99 and -0.91+/-1.16 and of -1.15+/-1.40 and -0.68+/-1.45 were noted in girls and boys, respectively, and all were significantly higher than those during the acute phase (p<0.0001). CONCLUSIONS: The results of this study indicate that IJO is a bone disorder characterized by an imbalanced muscle-bone relationship and fractures at onset and during the acute phase and by at least a partial recovery without bone pain and new fractures. Implementation of the BH/LBM, TBBMC/LBM and SBMC/LBM ratios to the armamentarium of pediatricians diagnosing bone disorders will provide mechanically meaningful data for diagnostic purposes and, hopefully, for proper therapeutic decisions.

Bone turnover rate in postmenopausal women: bimodal distribution?

There is considerable evidence that elevated bone turnover is an independent form of low bone mineral density (BMD) risk factor of osteoporotic fractures. The aim of our study was to test whether a group of postmenopausal women could be divided into subgroups of high and low bone turnover rate using different pairs of bone turnover markers (one resorption, one formation). Cluster analysis was used to obtain high and low bone turnover subgroups within the study group. A magnitude of difference in lumbar spine BMD (expressed as Z-score) between high- and low-turnover groups was used as a criterion of division success. According to this criterion, the division obtained with a urinary type I collagen crosslinked N-telopeptide/bone alkaline phosphatase pair of markers appeared to be the most significant. This method of separation of two subgroups was highly concordant with the division based on the upper thresholds of the normal values for those markers found for the premenopausal women. It seems that the observed existence of high-and low-turnover subject clusters is not an incidental phenomenon, because the effects obtained for the whole study group were further confirmed by the consistent results of cluster analysis, performed separately for two randomly selected subgroups (A and B) from the study group. The results obtained appear to support the view that bone turnover rate in postmenopausal women is distributed in the bimodal fashion. This finding seems to justify further investigations of more elaborated models, enabling clinicians to individually classify their patients as low- or high-turnover cases with higher efficiency, as in the case of cutoff values for single markers.

[Indices of mechanical strength of the distal radius in healthy women and women with Colles fracture]. / Wskazniki wytrzymalosci mechanicznej dystalnego odcinka kosci promieniowej u kobiet zdrowych i ze zlamaniem typu Collesa.

Wrist fractures (Colles) are one of the most frequently observed osteoporotic fractures in postmenopausal women. The aim of our study was the comparison of mechanical properties of distal radius of women with Colles fracture using a Stratec XCT 960 peripheral quantitative computed tomography (pQCT) in relation to age-pair controls without a wrist fracture. Using the pQCT method for estimation of SSI (Strength Strain Index), we found significant differences of SSI values in Colles subjects. In clinical practice, pQCT offers new diagnostic tools which cannot be provided by conventional densitometric methods.

[Age-related changes of densitometric and strength parameters evaluated with QCT method in healthy women]. / Zwiazane z wiekiem zmiany wartosci parametrów densytometrycznych i wytrzymalosciowych wyznaczonych u zdrowych kobiet metoda pQCT.

In the present study the age-related changes of pQCT values in normal Polish women were examined. The volumetric bone mineral density, trabecular density, cortical density and Strength Strain Index was measured using peripheral quantitative computed tomography (Stratec XCT 960) in 459 healthy women aged 18-60 years. Bone mineral measurement of the distal and proximal radius may be useful in evaluation of age-related bone loss, fracture risk and for diagnosis of osteoporosis.