Omega-3 fatty acid and menaquinone-7 combination are helpful for aortic calcification prevention, reducing osteoclast area of bone and Fox0 expression of muscle in uremic rats.

BACKGROUND: Osteopenia, sarcopenia, and vascular calcification (VC) are prevalent in patients with chronic kidney disease and often coexist. In the absence of proven therapies, it is necessary to develop therapeutic or preventive nutrients supplementation for osteopenia, sarcopenia, and VC. The present study investigated the effect of omega-3 fatty acid (FA) and menaquinone-7 (MK-7) on osteopenia, sarcopenia, and VC in adenine and low-protein diet-induced uremic rats. METHODS: Thirty-two male Sprague-Dawley rats were fed diets containing 0.75% adenine and 2.5% protein for three weeks. Rats were randomly divided into four groups that were fed diets containing 2.5% protein for four weeks: adenine control (0.9% saline), omega-3 FA (300 mg/kg/day), MK-7 (50 µg/kg/day), and omega-3 FA/MK-7. Von Kossa staining for aortic calcification assessment was performed. Osteoclast surface/bone surface ratio (OcS/BS) of bone and muscle fiber were analyzed using hematoxylin and eosin staining. Osteoprotegerin (OPG) immunohistochemical staining was done in the aorta and bone. Molecules related with sarcopenia were analyzed using western blotting. RESULTS: Compared to the normal control, OcS/BS and aortic calcification, and OPG staining in the aorta and bone were significantly increased in the adenine controls. OPG staining and aortic calcification progressed the least in the group supplemented with both omega-3 FA/MK-7. In the adenine controls, the regular arrangement of muscle fiber was severely disrupted, and inflammatory cell infiltration was more prominent. These findings were reduced after combined supplementation with omega-3 FA/MK-7. Furthermore, decreased mammalian target of rapamycin and increased Forkhead box protein 1 expression was significantly restored by combined supplementation. CONCLUSIONS: Combined nutrients supplementation with omega-3 FA and MK-7 may be helpful for aortic VC prevention, reducing osteoclast activation and improving sarcopenia-related molecules in adenine and low-protein diet induced uremic rats.

Long-term Bone Loss and Deterioration of Microarchitecture After Gastric Bypass in African American and Latina Women.

CONTEXT: The prevalence of obesity is burgeoning among African American and Latina women; however, few studies investigating the skeletal effects of bariatric surgery have focused on these groups. OBJECTIVE: To investigate long-term skeletal changes following Roux-en-Y gastric bypass (RYGB) in African American and Latina women. DESIGN: Four-year prospective cohort study. PATIENTS: African American and Latina women presenting for RYGB (n = 17, mean age 44, body mass index 44 kg/m2) were followed annually for 4 years postoperatively. MAIN OUTCOME MEASURES: Dual-energy x-ray absorptiometry (DXA) measured areal bone mineral density (aBMD) at the spine, hip, and forearm, and body composition. High-resolution peripheral quantitative computed tomography measured volumetric bone mineral density (vBMD) and microarchitecture. Individual trabecula segmentation-based morphological analysis assessed trabecular morphology and connectivity. RESULTS: Baseline DXA Z-Scores were normal. Weight decreased ~30% at Year 1, then stabilized. Parathyroid hormone (PTH) increased by 50% and 25-hydroxyvitamin D was stable. By Year 4, aBMD had declined at all sites, most substantially in the hip. There was significant, progressive loss of cortical and trabecular vBMD, deterioration of microarchitecture, and increased cortical porosity at both the radius and tibia over 4 years. There was loss of trabecular plates, loss of axially aligned trabeculae, and decreased trabecular connectivity. Whole bone stiffness and failure load declined. Risk factors for bone loss included greater weight loss, rise in PTH, and older age. CONCLUSIONS: African American and Latina women had substantial and progressive bone loss, deterioration of microarchitecture, and trabecular morphology following RYGB. Further studies are critical to understand the long-term skeletal consequences of bariatric surgery in this population.

Antiviral therapy and the development of osteopenia/osteoporosis among Asians with chronic hepatitis B.

BACKGROUND: Recent studies have suggested a potential increase in the incidence of osteoporosis for patients receiving tenofovir disoproxil fumarate (TDF), but this issue remains controversial. METHODS: The retrospective cohort study of 1224 Asian chronic hepatitis B (CHB) patients greater than 18 years without baseline osteopenia/osteoporosis seen at four US centers from 2008 to 2016. Patients were categorized into three groups-treatment-naive patients who initiated therapy with TDF (1) or entecavir (ETV) (2), or untreated patients (3). Patients were followed until the development of osteopenia/osteoporosis or end of the study. RESULTS: Of the 1224 study patients, 276 were treated with TDF, 335 with ETV, and 613 were untreated. The prevalence of cirrhosis was lower for untreated patients (2.6% vs 16.3% for TDF and 17.6% for ETV; P < 0.001). The 8-year cumulative incidence rate of osteopenia/osteoporosis was 13.17% for TDF, 15.09% for ETV, and 10.17% for untreated patients, with no statistically significant difference among the three groups ( P = 0.218). On multivariate Cox regression controlling for demographics, osteoporosis risk factors, albumin, and hepatitis B virus (HBV) DNA levels, neither TDF (adjusted hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.34 and 1.59) nor ETV (adjusted HR = 0.98; 95% CI: 0.51 and 1.90) were associated with increased osteopenia/osteoporosis risk compared with untreated patients. CONCLUSIONS: Our retrospective study suggests that there is no significant increase in the incidence of osteopenia/osteoporosis for patients with CHB treated with TDF or ETV during a median follow-up of about 4 to 5 years. However, further study with longer follow-up is needed as an anti-HBV therapy, which is often lifelong or long-term and the development of osteopenia/osteoporosis can be a slow process.

Efficacy and safety of alfacalcidol in Chinese postmenopausal women aged over 65 with osteoporosis or osteopenia: An open label, non-comparative, post marketing observational study.

This study aimed to explore the therapeutic efficacy and safety of alfacalcidol among Chinese postmenopausal women (age >65 years) with osteoporosis or osteopenia.A total of 62 postmenopausal women with osteoporosis or osteopenia (>65 years) were recruited from urban residential community of Beijing. The patients daily took oral calcium and alfacalcidol (Alpha D3, 1 µg) for 9 months. Safety and efficacy assessments were performed at baseline and regular intervals. Alfacalcidol was adjusted to a daily dose of 0.5 µg in case of hypercalcemia or hypercalciuria.A significant improvement in "timed up and go test" and "chair rising test" was achieved 3 months after treatment. Significant decreases in bone turnover markers were observed 3 months after the treatment and lasted throughout the study. Nineteen patients discontinued due to adverse events (17 hypercalciuria, 1 hydronephrosis, and 1 stomach ache), while alfacalcidol was adjusted to a daily dose of 0.5 µg in 18 patients (29.0%). Increased serum creatinine was observed when compared to baseline (P <.001), but all the values were in normal range.The treatment with 1 µg alfacalcidol can significantly improve muscle function and bone metabolism. Regular monitoring of urine calcium and timely dosage-adjustments are very important to guarantee the safety of alfacalcidol treatment in Chinese menopausal women.

Association of high-density lipoprotein, triglycerides, and homocysteine with bone mineral density in young Indian tribal women.

This study investigated association between lipids and homocysteine (Hcy) with bone mineral density (BMD) in young women as opposed to previous studies on elderly women. HDL, triglyceride, and Hcy are significantly associated with BMD in young women and tobacco and alcohol consumption have no effect on this association. PURPOSE: The present study investigates whether the association of serum lipids and homocysteine (Hcy) with bone mineral density (BMD) reported mostly in elderly population can be generalized to young or premenopausal women, consequently suggesting screening of young women with low BMD for dyslipidemia or any cardiovascular events and vice versa. METHODS: Women (n = 293, aged 20-47 years) from Northeast India belonging to Tibeto-Burman origin were enrolled. Information about their physical and clinical attributes were collected by a structured questionnaire. Their BMDs at lumbar spine and femur were measured by dual-energy X-ray absorptiometry (DXA) and sera were profiled for lipid parameters and Hcy by auto-analyzer and ELISA, respectively. Women consuming tobacco and/or alcohol were grouped as consumers and others as non-consumers for the analysis. RESULTS: Positive correlation of BMD with HDL (spine and femur r = 0.38, p < 0.0001) and triglyceride (spine r = 0.534, p < 0.0001; femur r = 0.423, p < 0.0001) was observed, whereas Hcy correlated negatively with BMD (spine r = - 0.189, p = 0.0026; femur r = - 0.273, p < 0.0001). LDL showed a weak negative correlation with BMD (spine r = - 0.128, p = 0.0283; femur r = - 0.199, p = 0.0006). However, after adjusting for age, BMI, and consumption, HDL, triglyceride, and Hcy continued to show significant correlation with BMD at both the sites. Logistic regression analyses indicated that HDL, triglyceride, and Hcy were significant predictors of osteopenia and osteoporosis in our study cohort; however, consumption did not contribute to its prediction. CONCLUSION: Low levels of HDL and triglyceride and high levels of Hcy are significantly associated with osteopenia and osteoporosis in young Northeast Indian women.

Association between Urinary Sodium Excretion and Bone Health in Male and Female Adults.

BACKGROUND: High salt intake is a well-known risk factor for osteoporosis, but the association between bone mass and urinary sodium excretion has not been studied as yet. This study investigates the hypothesis that urinary sodium excretion is negatively associated with bone mass and the risk of osteoporosis. METHODS: This cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey, 2008-2011. Participants (n = 16,279) were divided into age groups; men were categorized as younger than 50 years of age or 50 years or greater, women were categorized as pre- or post-menopausal. RESULTS: Multivariate linear regression analysis showed that urinary sodium excretion was negatively associated with bone mineral content (BMC) and bone mineral density (BMD) in premenopausal and postmenopausal women. Sodium excretion was negatively associated with BMC and BMD of the lumbar spine in women with normal bone health, osteopenia and osteoporosis, but there was no association in men. Increased sodium excretion was significantly associated with risk for osteoporosis/osteopenia in premenopausal women. CONCLUSIONS: This study demonstrates that urinary sodium excretion is negatively associated with bone health, suggesting that high salt intake could be a possible risk factor for osteoporosis in Korean women, but not in men.

Optimal serum cholesterol concentrations are associated with accelerated bone loss in African ancestry men.

UNLABELLED: We tested if serum lipid and lipoprotein cholesterol levels are associated with longitudinal measures of bone mineral density (BMD) in 1289 African ancestry men. After 6 years of mean follow-up, men with clinically optimal levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), or triglycerides at baseline experienced the greatest BMD loss, independent of potential confounding factors (all p < 0.05). INTRODUCTION: Studies of lipid and lipoprotein cholesterol associations with bone mineral density (BMD) and bone loss have been inconclusive, and longitudinal data are sparse. Therefore, the aim of this study was to test if fasting serum lipid and lipoprotein cholesterol levels are associated with areal and volumetric BMD and BMD change. METHODS: We determined the association of serum triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol concentrations with cross-sectional and longitudinal (mean follow-up, 6.1 years) measures of BMD in a cohort of 1289 in African ancestry men (mean age, 56.4 years). Fasting serum triglycerides, HDL, and LDL were measured at baseline concurrent with BMD assessments. Dual-energy X-ray absorptiometry was used to quantify integral hip BMD, and peripheral quantitative computed tomography at the radius and tibia was used to quantify volumetric BMD. Men were categorized as optimal, borderline, or high risk for triglyceride, HDL, and LDL concentrations based on Adult Treatment Panel III guidelines. RESULTS: Lower serum triglyceride or LDL and higher HDL concentrations were associated with lower trabecular BMD at baseline (all p < 0.05). Similarly, men classified as having optimal levels of LDL, HDL, or triglycerides at baseline experienced the greatest integral BMD loss at the hip and trabecular BMD loss at the tibia (all p < 0.05), independent of potential confounding factors. CONCLUSIONS: We found that clinically optimal serum lipid and lipoprotein cholesterol concentrations were associated with accelerated bone loss among Afro-Caribbean men. Further studies are needed to better understand the mechanisms involved and potential clinical significance of these findings.

Alkaline Phosphatase, iPTH and Bone Turnover Markers in Chinese Advanced Chronic Kidney Disease Patients.

BACKGROUND: Clinicians may use several biochemical markers of bone turnover to assess or guide the care of patients with chronic kidney disease (CKD). The aims of this study are to describe changes and correlations of markers of bone remodeling in patients with different stages of CKD. METHODS: A total of 317 Chinese patients with advanced CKD (stage 3-5) were enrolled. We measured serum levels of intact-parathyroid hormone (iPTH), N-terminal midfragment (N-MID) osteocalcin, procollagen type 1 amino-terminal propeptide (P1NP), ß-isomerized C-terminal telopeptide (ß-CTx), total alkaline phosphatase (ALP), and 25-hydroxyvitamin D (25[OH]D). RESULTS: Levels of iPTH, N-MID osteocalcin, P1NP, and ß-CTx and serum phosphorus were significantly different among patients with different stages of CKD. Serum levels of ALP and 25(OH)D were higher in hemodialysis (HD) patients than in peritoneal dialysis (PD) patients. Levels of ALP, osteocalcin, and P1NP were significantly higher in dialysis patients than in non-dialysis patients. Correlations between the levels of iPTH, ALP, N-MID os- teocalcin, P1NP, and ß-CTx were statistically significant but weak. There was no correlation between 25(OH)D and iPTH or ALP. CONCLUSIONS: Our results suggest that measurement of N-MID osteocalcin, P1NP, ß-CTx, and iPTH may be useful for assessment of CKD-mineral bone disorder (MBD) in patients with CKD.

Renal Function and Bone Loss in a Cohort of Afro-Caribbean Men.

Poor renal function is associated with increased rates of bone loss and osteoporotic fractures in Caucasian men. The importance of kidney function for skeletal health in African ancestry men, who are a population segment with a high prevalence of chronic kidney disease as well as high peak bone mass, is not well known. We examined the relationship between estimated glomerular filtration rate (eGFR) and rates of bone loss in a large population cohort of otherwise healthy Afro-Caribbean men aged 40 years and older. Dual X-ray absorptiometry of the proximal femur and quantitative computed tomography of the proximal radius and tibia were obtained approximately 6 years apart. We calculated eGFR from serum creatinine that was measured in fasting samples in 1451 men. Impaired kidney function (IKF, eGFR<60 ml/min/1.7 m(2)) was observed in 8.6% of the cohort. The relationship between IKF and baseline BMD and annualized rate of change in BMD was analyzed controlling for potentially important confounders. IKF was not associated with baseline BMD. In contrast, men with IKF experienced a rate of decline in areal BMD at the total hip, femoral neck and trochanter and cortical volumetric BMD compared to those with normal kidney function (p<0.05 for all). Impaired kidney function was not associated with changes in trabecular volumetric BMD. In conclusion, poorer kidney function is associated with accelerated bone loss among otherwise healthy Afro-Caribbean men even after controlling for age and other important medical and lifestyle related variables.

Validation of the Quality-of-Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-26) in Korean population.

We aimed to evaluate the reliability and validity of the adapted Korean version of the Quality-of-Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-26). Translation/retranslation of the English version of QUALEFFO was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the visual analog scale measure of pain, QUALEFFO-26 and the previously validated Short Form-36 (SF-36) were mailed to 162 consecutive patients with osteoporosis. Factor analysis and reliability assessment by kappa statistics of agreement for each item, the intraclass correlation coefficient and Cronbach's α were conducted. Construct validity was also evaluated by comparing the responses of QUALEFFO-26 with the responses of SF-36 using Pearson's correlation coefficient. Factor analysis extracted 3 factors. All items had a kappa statistics of agreement greater than 0.6. The QUALEFFO-26 showed good test/retest reliability (QUALEFFO-26: 0.8271). Internal consistency of Cronbach's α was found to be very good (QUALEFFO-26: 0.873). The Korean version of QUALEFFO-26 showed good significant correlation with SF-36 total score and with single SF-36 domains scores. The adapted Korean version of the QUALEFFO-26 was successfully translated and showed acceptable measurement properties and, as such, is considered suitable for outcome assessments in the Korean-speaking patients with osteoporosis.

Factors associated with the treatment of osteoporosis in Korean postmenopausal women.

This retrospective study was designed to investigate the treatment rate of osteopenia and osteoporosis after diagnosis and determine factors related to osteoporosis treatment in Korea. This analysis included postmenopausal women who had visited the health promotion center from March 2010 to May 2011 (n = 375) and been diagnosed with osteoporosis (19.5%) or osteopenia (45.9%). Telephone surveys were performed one year after diagnosis. We employed multiple logistic regression to determine factors associated with treatment using clinical risk factors as covariates in a FRAX model. Receipt of osteoporosis treatment (nutrition, exercise, and medications) to prevent osteoporotic fracture was reported by 108 of 172 (63.4%) women with osteopenia and 66 of 73 (90.4%) with osteoporosis. Only consultation with a doctor for osteopenia or osteoporosis was significantly related to receiving osteoporosis treatment for osteopenia (odds ratio [OR], 5.01; 95% confidence interval [CI], 2.01-12.00) and osteoporosis (OR, 4.91; 95% CI, 1.16-20.75). In the osteopenic group, increased age, being a current smoker, having a history of parental fracture or previous fracture, and secondary osteoporosis were related to consultation with a doctor. Of women with osteopenia 36.6% and 64.4% with osteoporosis received consultation with a doctor. Consultation with a doctor for osteopenia or osteoporosis after being diagnosed could be an effective strategy to increase osteoporosis treatment.

Bone disease in systemic sclerosis: outcomes and associations.

OBJECTIVES: The relationship between systemic sclerosis (SSc) and low bone mineral density (BMD) is poorly understood. The aim of this study is to improve our understanding of low bone density in SSc and its potential consequences. METHODS: Fifty consecutive unselected SSc patients were approached. Demographics, disease manifestations, BMD (lumbar spine and femoral neck) were collected at baseline and occurrence of fracture and death were collected over 2 years. The 10-year risk of osteoporotic fracture was estimated using the fracture risk assessment tool (FRAX) v2.0 with the Canadian population reference. Fisher's Exact and Student's t-tests were used to evaluate differences between patients with and without low BMD. Logistic regression was used for multivariate analysis. RESULTS: Forty-five patients had complete BMD data. Twenty-eight patients (62%) had low BMD, of those 10 (36%) had osteoporosis. There was no difference in age, sex, or disease duration between both groups. Low BMD was associated with non-Caucasian race (57% vs. 18%, p=0.01), postmenopausal status (83% vs. 47%, p<0.01), low body mass index (24.5 vs. 26.2, p=0.05). The mean 10-year risk of developing a major osteoporotic fracture and a femoral neck fracture was higher in the low BMD group (10.2% vs. 4.8%, p=0.12) and (4.1% vs. 0.5%, p = 0.16) respectively. Fourteen percent (4/28) of SSc patients with low BMD had a fracture, compared to 6% (1/17) SSc patients without low BMD. Fracture-related mortality did not occur in any patients. CONCLUSIONS: Low BMD and fracture are frequently seen in SSc patients. A number of clinically relevant factors are associated with low BMD. Further research is needed to evaluate these factors and the role of bone-specific treatments in SSc.

Vitamin D deficiency and low bone mineral density in native Chinese rheumatoid arthritis patients.

OBJECTIVE: We aimed to examine the risk factors related to the development of osteoporosis in rheumatoid arthritis (RA) patients and whether there is an association among the changes in bone mineral density (BMD), disease activities (modified DAS28), serum 25-hydroxyvitamin D (25OHD) levels, and disease duration. METHODS: There were 110 patients with RA and 110 age- and sex-matched healthy controls who were concurrently studied. All of the patients underwent the following measurements: erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and serum 25OHD. Dual-energy X-ray absorptiometry (DEXA) was also used to measure the BMD of the left femur at the time of recruitment. Patients taking vitamin D supplement or corticosteroids were excluded. RESULTS: The incidences of osteopenia (45.6% vs. 36.4%, P = 0.170) and osteoporosis (33.6% vs. 5.45%, P = 0.000) were higher in the RA patients than in the healthy controls. There was a significant negative correlation between vitamin D levels and DAS28 (r = -0.325, P = 0.001) and a significant positive correlation between vitamin D levels and BMD (r = 0.422, P = 0.000). The multiple regression analysis revealed that 25OHD levels were significantly correlated with disease activity and BMD (F = 11.087, P = 0.000). Stepwise multiple regression analysis showed that serum 25OHD levels were the significant predictors for low BMD and high disease activity (DAS28) in RA patients. CONCLUSION: The incidences of osteoporosis and osteopenia were higher in RA patients compared to the age- and gender-matched healthy controls. Low serum 25OHD levels correlate with low BMD and high disease activity in RA patients.

Racial and ethnic differences in physical activity and bone density: National Health and Nutrition Examination Survey, 2007-2008.

INTRODUCTION: Participation in regular physical activity (PA) may help maintain bone health as people age. However, most American adults do not engage in the recommended minimum levels of PA, and there are racial/ethnic differences in PA participation. This study aimed to determine whether current physical activity is related to bone density in a racially/ethnically diverse sample after controlling for age, sex, body mass index, poverty-income ratio, tobacco use, vitamin D and calcium intake, and use of osteoporosis medications. METHODS: We obtained data on femoral bone mineral density for 2,819 adults aged 40 to 80 years who self-reported their race/ethnicity on the 2007-2008 National Health and Nutrition Examination Survey. Data on PA levels were obtained by self-report. We used linear regression models to examine the association between PA and bone density for each racial/ethnic group. RESULTS: A greater percentage of non-Hispanic blacks (60.9%) and Hispanics (53.3%) reported low levels of PA than non-Hispanic whites (45.3%, P < .001). Non-Hispanic blacks (16.3%) and Hispanics (18.5%) had a lower prevalence of osteopenia than non-Hispanic whites (25.5%; P = .01) but were similar in the prevalence of normal and osteoporosis categories when compared with whites. There was a 0.031 g/cm(2) difference in bone density between those in the high PA versus the low PA category (P = .003). This association remained (ß = 0.027, P < .001) after adjusting for race/ethnicity, sex, body mass index, poverty-income ratio, tobacco use, and use of osteoporosis medications. CONCLUSION: Despite lower levels of activity, blacks and Hispanics were not more likely to have osteoporosis, and high levels of activity were significantly associated with higher bone density even when controlling for race/ethnicity and confounders. The lack of consistency in bone density differences suggests that the cause of the differences maybe multifactorial.

Panoramic images of white and black post-menopausal females evidencing carotid calcifications are at high risk of comorbid osteopenia of the femoral neck.

OBJECTIVES: Femoral neck fractures in older females resulting from decreased bone mineral density (BMD; osteopenia) are associated with increased morbidity and mortality. Bone mineralization inhibition is probably controlled by proteins which also foster vascular calcification. Therefore, we evaluated the relationship between calcified carotid artery plaque (CCAP) on panoramic images and BMD on dual energy X-ray absorptiometry (DXA) bone scans. METHODS: Images and hospital records identified by dentists defined two study groups (20 white females and 24 black females) having CCAP and an incidentally obtained bone scan. Ethnically matched (age±7 years, body mass index ±3 units) control groups with panoramic images devoid of CCAP and accompanying DXA scan were likewise constituted. A physician determined the BMD on the DXA. RESULTS: Females with CCAP had significantly (p = 0.03) poorer BMD at the femoral neck than those without CCAP. Although mean femoral neck BMD was significantly lower (p = 0.009) for white than for black females, there was no significant interaction between race and CCAP (p = 0.80). CONCLUSION: We observed a significant inverse association between the CCAP on panoramic images and femoral neck BMD in post-menopausal white females.

Vitamin D status in young HIV infected women of various ethnic origins: incidence of vitamin D deficiency and possible impact on bone density.

BACKGROUND: Decreased bone mineral density (BMD) was reported in HIV infected patients. Mechanisms leading to this decrease are poorly understood. AIMS: To assess factors relating to BMD in young HIV infected Israeli women of Ethiopian and Caucasian origin. PATIENTS AND METHODS: 75 young HIV infected women aged 34.5 ± 8.5 followed up at the Institute of Allergy, Clinical Immunology & AIDS filled a questionnaire about sun exposure, daily calcium intake and dress habits. Data about HIV status and treatment regimens were collected from the patients' charts. Serum hydroxyvitamin D [25(OH)D] levels, bone turnover markers and bone densitometry were evaluated. RESULTS: 28 (65%) of Ethiopians and 2 (6.25%) of Caucasians had 25(OH)D serum levels <10 ng/ml (vitamin D deficiency), p = 0.001. 21 (67.7%) Ethiopians and 16 (39%) Caucasians avoided sun exposure, p = 0.019. Mean daily calcium intake was 491 ± 268.6 mg and 279 ± 252.6 mg, respectively, p = 0.001. Z scores < -1 found at Lumbar spine in 26 (89.7%), at Femoral neck in 20 (69%) at Total hip in 17 (58.6%) of vitamin D deficient patients compared to 20 (48.8%), 17 (41.5%), 9 (22%), in patients with 25(OH)D > 10 ng/ml, p < 0.01, <0.03, <0.001, respectively. Significantly more Ethiopian than Caucasian women covered their face (32.3% and 9.5%, p = 0.003) and hands (58.1% and 30.9%, p = 0.03). There was no difference in bone turnover markers levels. CONCLUSION: Poorer vitamin D status was observed in Ethiopian women might be one of the important factors related to lower BMD in this group.

Association between ghrelin levels and BMD: a cross sectional trial.

OBJECTIVE: Our aim was to determine whether the level of plasma total ghrelin varies with the menopause stage (pre-, peri-, and postmenopause). PARTICIPANTS AND INTERVENTIONS: Women were divided in three groups: premenopausal, perimenopausal and postmenopausal. All participants had bone mineral densitometry and blood assay of plasma ghrelin, estradiol E2. Correlation between plasma ghrelin levels, their reproductive status and BMD was done. RESULTS: The mean plasma level of ghrelin was significantly decreased in the perimenopausal and postmenopausal groups in comparison to the premenopausal group. A significant positive correlation was found between ghrelin and each of E2 and BMD (at one or more of the three sites assessed) in all subjects, as well as, in peri- and postmenopausal women, whereas a significant negative correlation was found between ghrelin and FSH. CONCLUSION: It may be assumed that ghrelin can affect BMD. Whether ghrelin and estrogen work independent or through convergent mechanisms needs further studies.

Effect of race and genetics on vitamin D metabolism, bone and vascular health.

The pathophysiology of chronic kidney disease-mineral and bone disorder accounts for an inverse relationship between bone mineralization and vascular calcification in progressive nephropathy. Inverse associations between bone mineral density (BMD) and calcified atherosclerotic plaque are also observed in individuals of European and African ancestry without nephropathy, suggesting a mechanistic link between these processes that is independent of kidney disease. Despite lower dietary calcium intake and serum 25-hydroxyvitamin D (25(OH)D) concentrations, African Americans have higher BMD and develop osteoporosis less frequently than do European Americans. Moreover, despite having more risk factors for cardiovascular disease, African Americans have a lower incidence and severity of calcified atherosclerotic plaque formation than do European Americans. Strikingly, evidence is now revealing that serum 25(OH)D and/or 1,25 dihydroxyvitamin D levels associate positively with atherosclerosis but negatively with BMD in African Americans; by contrast, vitamin D levels associate negatively with atherosclerosis and positively with BMD in individuals of European ancestry. Biologic phenomena, therefore, seem to contribute to population-specific differences in vitamin D metabolism, bone and vascular health. Genetic and mechanistic approaches used to explore these differences should further our understanding of bone-blood vessel relationships and explain how African ancestry protects from osteoporosis and calcified atherosclerotic plaque, provided that access of African Americans to health care is equivalent to individuals of European ethnic origin. Ultimately, in our opinion, a new mechanistic understanding of the relationships between bone mineralization and vascular calcification will produce novel approaches for disease prevention in aging populations.

Determinants of circulating 25-hydroxyvitamin D and bone mineral density in young physicians.

OBJECTIVE: To examine determinants of serum 25-hydroxyvitamin D [25(OH)D] and bone mineral density (BMD) in young physicians, a group not well studied previously. METHODS: We analyzed data from a questionnaire completed by young physicians as well as results of serum 25(OH)D, serum parathyroid hormone, and BMD measurements. RESULTS: Among 104 study subjects, 42% were white, 46% were Asian, 12% were "other" (10 Hispanic and 2 African American subjects), and 75% were women. The mean age and body mass index (BMI) were 28.1 years and 23.0 kg/m², respectively. White subjects had a higher mean serum 25(OH)D level (27.3 ng/mL) than did Asian subjects (15.9 ng/mL) and other subjects (22.3 ng/mL) (P<.0001). White subjects tended to have higher Z-scores than Asian subjects and other subjects for the hip (P = .06), trochanter (P = .08), and lumbar spine (P = .08). The serum 25(OH)D level was negatively associated with serum parathyroid hormone (r = -0.44; P<.01) but not with BMD. The prevalence of vitamin D insufficiency [serum 25(OH)D <30 ng/mL, 77% for the entire group] was higher (P<.01) in Asian subjects (93%) than in white subjects (61%) and other subjects (73%). Significant determinants of serum 25(OH)D included age, ethnicity, exposure to sunlight, use of vitamin D supplements, and family history of osteoporosis (P<.05 for all), and together with sex, calcium supplements, exercise, and BMI, these factors explained 49% of serum 25(OH)D level variability. Significant determinants of low BMD (osteopenia plus osteoporosis, prevalence 37.5%) included sex (P = .002) and BMI (P<.0001) but not serum 25(OH)D; Asian ethnicity reached borderline significance (P = .088). Age, sex, ethnicity, smoking, and BMI explained 20% to 30% of the Z-score variations. CONCLUSION: In young physicians with a healthful lifestyle, determinants of low serum 25(OH)D and BMD included modifiable risk factors. Vitamin D insufficiency and low BMD could be important contributors to future osteoporotic fractures in this population.

Importance of ethnic base standard references for the diagnosis of osteoporosis in Thai women.

Many studies demonstrated the importance of using ethnic-specific normal database in the diagnosis of osteoporosis (OP). Aims of this study were to assess diagnostic agreement, prevalence of OP, and diagnostic misclassification between Caucasian, Japanese, and Thai normal databases. The cross-sectional study of 3181 Thai women who had bone mineral density (BMD) measurement between January 2008 and December 2010 was performed. BMDs at lumbar spine (LS), femoral neck (FN), and total hip (TH) were derived to T-score by using Caucasian, Japanese, and Thai standard references. Kappa statistic was used to assess diagnostic agreement and misclassification. Diagnostic agreements between Caucasian and Thai reference databases were 0.39 for LS and 0.90 for FN. No statistical agreement was found in TH region (0.01, p value=0.264). Applying the Japanese reference, diagnostic agreements were 0.71 for LS, 0.76 for FN, and 0.94 for TH regions. Prevalence of OP in postmenopausal women was 64.1%, 37.7%, and 41.4% using Caucasian, Japanese, and Thai standard references. Percentage of misclassification was varied by menopausal status and reference database from 11.2% to 48.7%. When applying Japanese databases instead of Caucasian normal databases, overall diagnostic misclassification decreased from 35.1% to 16.1%. Choice of reference database has a significant effect on the diagnosis of low bone mass and OP. Japanese reference database has better diagnostic agreement with previously studied Thai reference database in 1999 than Caucasian reference database.