Bone Metabolism In Children Research Articles

Bone metabolism in children with normal weight and overweight/obesity in a northeastern region of Spain.

Bone mass progressively increases to peak during childhood and adolescence, which determines future bone health. Bone formation-resorption processes are assessed using bone markers. However, studies on the impact of obesity on bone turnover markers at this age are limited, and results are inconsistent. The objective of this study was to examine the potential impact of overweight/obesity on bone metabolism. A study was performed to compare parameters of bone metabolism in 45 girls and boys with normal weight (controls) and in a group of 612 girls and boys with overweight/obesity (cases) from the Exergames study (University of Zaragoza). Ages ranged from 8 to 12 years. Higher values of phosphorus and IGFBP-3 were observed in children with overweight/obesity, as compared to children with normal weight, (p=0.042) and (p=0.042), respectively. BAP, osteocalcin, magnesium, vitamin D and IGF-I concentrations were lower in the group with overweight/obesity, whereas calcium concentrations were higher in this group, although differences were not statistically significant. A negative correlation was found (r=-0.193) (p=0.049) between BAP and BMI. Although differences did not reach statistical significance, BAP and osteocalcin concentrations were lower in children with overweight/obesity. This added to the negative correlation found between BAP and MIC may demonstrate that overweight/obesity may negatively affect bone health already at a young age.

Vitamin D level and indicators of bone tissue metabolism in kazakh infants

BACKGROUND: Insufficiency and deficiency of vitamin D are recorded in a significant part of the population. Vitamin D, along with the formation of bone tissue, is included in all types of metabolism, determining the growth and development of the body, immunity, and the normal development of the nervous system. The consequences of deficiency can be long-term and in some cases irreversible. The problem of deficiency in infants is not well understood.
 AIM: To determine the content of vitamin D and indicators of bone metabolism in children of the first year of life of the Kazakh population.
 MATERIALS AND METHODS: 250 infants of the Kazakh population were examined. The content of vitamin D in the blood was determined. The state of bone metabolism was assessed by the results of a blood test to determine the serum concentration of calcium, phosphorus, parathyroid hormone, osteocalcin, calcitonin, and in the urine deoxypyridinoline.
 RESULTS: There is a wide prevalence (77.8%) of vitamin D insufficiency/deficiency in children under one year old in the Kazakh population. The greatest decrease in vitamin D was found in newborns. Statistically significant differences were found in the levels of bone metabolism indicators, such as total calcium, phosphorus, calcitonin and osteocalcin in different age groups. Indicators of bone metabolism, such as total calcium, phosphorus, parathyroid hormone, osteocalcin, depend on the degree of decrease in vitamin D levels. The most sensitive indicator that responds to changes in vitamin D levels is osteocalcin. The level of serum vitamin D can be used as a marker for the preclinical diagnosis of metabolic disorders of bone homeostasis in children.
 CONCLUSIONS: The study confirms the effect of vitamin D on metabolic processes in the skeletal system. The most sensitive indicator that responds to changes in vitamin D levels is osteocalcin. Research in this direction may be the basis for discussing the feasibility of vitamin D substitution and clarifying prenatal care schemes.

Both epilepsy and anti-seizure medications affect bone metabolism in children with self-limited epilepsy with centrotemporal spikes.

Bone metabolism can be influenced by a range of factors. We selected children with self-limited epilepsy with centrotemporal spikes (SeLECTS) and lifestyles similar to those of healthy children to control for the confounding factors that may influence bone metabolism. We aimed to identify the specific effects of epilepsy and/or anti-seizure medications (ASMs) on bone metabolism. Patients with SeLECTS were divided into an untreated group and a monotherapy group, and the third group was a healthy control group. We determined the levels of various biochemical markers of bone metabolism, including procollagen type I nitrogenous propeptide (PINP), alkaline phosphatase (ALP), osteocalcin (OC), collagen type I cross-linked C-telopeptide (CTX), calcium, magnesium, phosphorus, parathyroid hormone (PTH), and vitamin D3 (VD3 ). A total of 1487 patients (from 19 centers) were diagnosed with SeLECTS; 1032 were analyzed, including 117 patients who did not receive any ASMs (untreated group), 643 patients who received only one ASM (monotherapy group), and 272 children in the healthy control group. Except for VD3 , other bone metabolism of the three groups were different (p < .001). Bone metabolism was significantly lower in the untreated group than the healthy control group (p < .05). There were significant differences between the monotherapy and healthy control group in the level of many markers. However, when comparing the monotherapy and untreated groups, the results were different; oxcarbazepine, levetiracetam, and topiramate had no significant effect on bone metabolism. Phosphorus and magnesium were significantly lower in the valproic acid group than the untreated group (adjusted p < .05, Cliff's delta .282-.768). CTX was significantly higher in the lamotrigine group than in the untreated group (adjusted p = .012, Cliff's delta = .316). Epilepsy can affect many aspects of bone metabolism. After controlling epilepsy and other confounders that affect bone metabolism, we found that the effects of ASMs on bone metabolism differed. Oxcarbazepine, levetiracetam, and topiramate did not affect bone metabolism, and lamotrigine corrected some of the abnormal markers of bone metabolism in patients with epilepsy.

Effect of antiepileptic drugs on bone metabolism in children using biochemical markers: a case control study

Background: Most epileptic patients are diagnosed and treated in childhood and adolescence and this period is crucial in attaining peak bone mass. Few studies are conducted on children showing long term effects of AEDs on bone metabolism. So, the present study was conducted to evaluate correlation of long-term uses of AEDs with changes in bone metabolism using biochemical marker. Methods: Total of 140 subjects divided into 70cases - Epileptic children aged 1 to 14 years who are on AEDs for at least 6months and 70 Controls- Children aged 1 to 14 years not on AEDs. Semi structured questionnaire was used to collect demographic data. Venous blood samples were collected and sent for laboratory investigations like Serum vitamin D, serum calcium, serum phosphorus, Parathyroid hormone and alkaline phosphatase levels. Results: Mean age of study population in cases was 7.74±4.43 years and in controls was7.65±3.72 years. Mean vitamin-D, calcium, phosphorus decreases while PTH and ALP increases with duration of treatment in epileptic children with a statistically significant difference between them (P&lt;0.05). Mean serum vitamin D level in cases and in controls was with no statistical significant difference between two groups. Mean serum calcium, phosphorus, parathormone and alkaline phosphatase levels in cases and controls all had a statistically significant mean difference between two groups. Serum vitamin-D, serum calcium, serum phosphorus was low in patients treated with enzyme inducing when compared to non-enzyme inducing drugs in epileptic children with a statistically significant difference between them (P&lt;0.05). Serum vitamin-D, serum calcium, serum phosphorus was high in patients on monotherapy when compared polytherapy in epileptic children with a statistically significant difference between them (P&lt;0.05). Conclusions: Present study shows that children on AEDs for longer duration had low bone mineral parameters when compared to normal children. The study emphasizes that mineral levels need to be monitored in epileptic patients as they are at a higher risk of falling and bone fractures.

The role of osteoprotegerin and sclerostin in bone metabolism in children with congenital adrenal hyperplasia

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

The Effect of Valproic Acid and Levetiracetam on Bone Metabolism in Children with Epilepsy

Background: Epilepsy is not an uncommon neurological condition among Egyptian children. Early diagnosis of bone metabolism abnormalities in epileptic children using biochemical markers could be a valuable issue. One of these markers is the total serum vitamin D level which can provide a novel insight into the pathogenesis of the bone metabolism disorders. Aim: To explore the function of total serum vitamin D in children with epilepsy receiving valproic acid or levetiracetam or both and to correlate lowered level with development of bone metabolism disorders. Patients and methods: This case-control study was conducted at Zagazig University's paediatric neurology and endocrinology centre and paediatric outpatient clinic Hospitals on 70 children. Patients were divided into control Group: included 35 children with epilepsy as a control group and case group: included 35 children with epilepsy subdivided into 3 subgroups according to the type of treatment: BI: 10 patients received Navalporate, BII: 10 patients received levatiracetam and BIII: 15 patients received both of Navalporate+ levatiracetam. All patients were subjected to laboratory and Z ray investigations. Results: There is statistically significance compared to the other investigated groups, the case group had significantly lower levels of vitamin D. Statistically, there is a significant difference between the studied groups concerning osteopenia changes which was significantly higher in case group (40%) than control group (0%). There is no statistically significant difference between the treatment groups osteopenia changes. Conclusion: Antiepileptic medicines had a deleterious impact on bone health, with no discernible differences between LEV and VPA.

Effect of a high vs. standard dose of vitamin D3 supplementation on bone metabolism and kidney function in children with chronic kidney disease.

We investigated the effects of high- vs. standard-dose vitamin D supplementation on kidney function and bone metabolism in children with chronic kidney disease (CKD). Children were randomized to receive one of two formulations: 75 participants received 2,000 IU/D of oral supplementation of vitamin D, while 75 participants received 400 IU/d for a minimum of 4 months. We investigated the effects of vitamin D supplementation on kidney-related indicators and bone metabolism-related indicators at different doses. A total of 158 participants were screened, among whom 150 met the inclusion criteria. The indicators of chronic kidney disease such as eGFR and serum uric acid were negatively correlated with the 25(OH)D level and BMD. Serum 25(OH)D and osteocalcin levels were positively correlated with spine BMD. The standard dose of vitamin D can improve the serum uric acid level, but high doses of vitamin D supplementation had no significant effect on the serum uric acid level. High doses of vitamin D supplementation can also improve the alkaline phosphatase level. When comparing the results of different doses of vitamin D supplementation, it was found that high-dose vitamin D supplementation did not improve bone density in the spine and femur neck relative to the standard dose of vitamin D but improved hypocalcemia and N-terminal propeptide of the human procollagen type I (PINP) level. Among the children with clinical kidney disease, high-dose vitamin D treatment for 4 months resulted in statistically significant improvement in kidney function but no significant difference in bone metabolism compared with the standard-dose vitamin D treatment.

Mineral and bone metabolism in children with a dystrophic form of сongenital epidermolysis bullosa: the effect of Cholecalciferol therapy

In the dystrophic form of CEB (DEB), malnutrition is more often observed with prominent deficiency of micro- and macroelements, especially calcium and vitamin D, that can lead to rickets and osteoporosis with fractures.Aim of the study. To study the features of mineral and bone metabolism in patients with DHE and evaluate the effectiveness of prescribing different doses of vitamin D.Methods and mаterials. The study group included 71 children with DEB (girls 55 %, boys 45 %), the median age was 8.5 years [3.67; 11.92] and 5.75 years [3.13; 10.46], respectively. All patients underwent a complex laboratory and instrumental examination before and after 6 months of Cholecalciferol therapy.Results. We found a high rate of vitamin D insufficiency (22.5 %) and deficiency (40 %), hypocalcemia of total calcium (40 %), a decrease in bone mineral density (BMD) down to osteopenia (33.8 %) and osteoporosis (19.7 %). Osteocalcin (OC) and C-terminal telopeptide of type I collagen (CTx-1) levels in the group of patients with hypocalcemia were significantly lower than in the subgroup with normal levels of calcium (p=0.001 for OC, p=0.015 for CTx-1). Wasting of higher degree was noted in the group with hypocalcemia (p=0.001). 53.6 % of patients took Cholecalciferol irregularly (IU 1100 IU [700; 1500]), 35.2 % of patients constantly took the medicine (IU 2000 IU [1000; 3000]) (p = 0.021). After 6 months, normal levels of 25(OH)D were noted in 62 % of children; the levels of P1NP (p&lt;0.001), phosphorus (p=0.012) decreased, and BMD improved (p=0.024). According to the plan developed in our study, with level of 25(OH)D ≤ 30 ng/ml, children aged 1–7 years old should be given at least 1500 IU; at 7–12 years – 2500 IU; at 12–18 years – 3000 IU.Conclusion. To achieve optimal levels of vitamin D, calcium, and bone turnover markers in children with DEB, it is necessary to use a personalized approach for colecalciferol prescription.

Evaluation of Bone Metabolism in Children Using Antiseizure Drugs: A Single-Center Experience and Review of the Literature

AbstractThe effect of anti-seizure drugs (ASDs) on bone mineral density (BMD) is a controversial topic. This study investigated the effect of monotherapy and polytherapy drugs separately. Patients with a history of epilepsy treated with the same ASDs for more than 6 months were included in the study. Data regarding patient demographics, biochemical markers related to bone metabolism (calcium, phosphorus, alkaline phosphatase, parathyroid hormone, vitamin D), and BMD with dual-energy X-ray absorptiometry (DXA) were collected and compared. In total, 104 children with epilepsy using valproic acid (VPA), levetiracetam (LEV), carbamazepine (CBZ) alone or in combination and 22 healthy controls were evaluated. The ages of the children (64 boys, 62 girls) ranged between 2 and 17, with a mean of 9.50 ± 4.03 years. BMD or Z-scores did not differ among the monotherapy groups or between them and the polytherapy group. The lowest mean Z-score was in the VPA group but without statistical significance. Alkaline phosphatase levels were significantly higher in the group using CBZ. Calcium levels significantly differed between the groups (p = 0.001). The CBZ and LEV groups had the lowest calcium levels. However, phosphorus and vitamin D measurements did not significantly differ by ASDs used. Unfortunately, low vitamin D levels were evident in all children with epilepsy and even among controls. Physical activity, sun exposure, and calcium intake might be recommended in children treated with ACDs and in combination with additional risk factors monitoring via DXA should be considered. Further studies in a large population are necessary to judge which ASDs are more at risk to reduce bone mineralization than others.

Impact of Obesity on Bone Metabolism in Children.

Obesity is an epidemic disease that can increase the incidence of type 2 diabetes, cardiovascular disease, malignancy, hypertension, and other health problems that affect the musculoskeletal system. There is a complex interaction between obesity and bone metabolism. In children with obesity, the peroxisome proliferator-activated receptor gamma pathway causes the differentiation of mesenchymal stem cells into adipocytes via osteoblasts, in which results in low bone mass and osteoporosis. Systemic inflammation in obesity has negative effects on bone metabolism. An increase in the number and size of adipose tissue and adipocytokines secreted from adipocytes affect the bone mass of the whole body with hormonal and biochemical effects. The skeletal effects of obesity are mediated by higher oxidative stress and increased production of proinflammatory cytokines. Osteoporosis due to obesity has increased morbidity and mortality in recent years, resulting in important health problems in developed and developing countries.

Phosphorus-Calcium and Bone Metabolism in Children with Dystrophic Epidermolysis Bullosa: Cross-Sectional Study

Background. Dystrophic epidermolysis bullosa (EB) is a rare skin disease, and secondary osteoporosis is one of its complications. The bone remodeling condition in this pathology has not been studied enough. Objective. The aim of the study is to study the characteristics of phosphorus-calcium and bone metabolism in children with dystrophic EB.Methods. The study included children with dystrophic EB aged from 3 to 18 years undergoing inpatient treatment. The ratio of children with phosphorus-calcium metabolism disorders was determined: reduced concentration of total calcium &lt; 2.2 mmol/l, and phosphorus &lt; 1.25 mmol/l. Additionally, deviations from reference values for 25(OH)D, parathormone, osteocalcin, C-terminal telopeptide of type 1 collagen (CTX-I) concentrations and alkaline phosphatase activity were established.Results. Hypocalcemia was revealed in 16 patients (41%) and hypophosphatemia — in 3 (8%) patients out of 39 children with EB (22 girls, median age 77 (46; 136) months). Vitamin D level was lower than optimal (&lt; 30 ng/ml) in 20 (77%) children with EB, while lower osteocalcin concentration — in 26 (67%), and lower CTX-I concentration — in all patients. At the same time, the median CTX-I concentration (1.32 ng/ml) more than doubled the upper values of the reference range for this indicator (&lt; 0.573 and &lt; 0.584 ng/ml for girls and boys, respectively). The low parathormone concentration was revealed in 1 (3%) patient. The alkaline phosphatase activity was within the reference range in all cases.Conclusion. Disorders of phosphoruscalcium (mainly calcium) metabolism are present in large number of children with dystrophic EB. Therewith, most patients have shown vitamin D deficiency, as well as signs of bone resorption dominance (high CTX-I concentration) over bone development (low osteocalcin concentration). In general, all revealed changes in the biochemical indicators of bone remodeling indicate the development of secondary osteoporosis in most children with EB.

Correlation between vitamin D levels and bone metabolism in children with cow's milk allergy.

ObjectiveResearch is limited regarding biochemical markers of bone metabolism among children with cow’s milk protein allergy (CMPA). We aimed to determine differences in vitamin D and bone metabolism markers between infants with CMPA and healthy infants and explore relationships between these in a cross-sectional study.MethodsIn total, we included 41 children diagnosed with CMPA and under systematic medical and nutritional care at our center, and 50 healthy children as a control group. We reviewed demographic and clinical characteristics and measured serum biomarkers.ResultsWe found that serum 25-hydroxyvitamin D (25(OH)D) levels among infants in the CMPA group were significantly lower than those in the control group, and levels of bone-specific alkaline phosphatase (BALP), serum phosphorus, and serum calcitonin were reduced. Pearson correlation analysis showed that serum 25(OH)D concentrations in the CMPA group were negatively correlated with parathyroid hormone but not significantly correlated with calcitonin and BALP. Logistic regression showed that CMPA was a risk factor for vitamin D deficiency.ConclusionsOur study indicated that CMPA was associated with disturbances in bone metabolism. Levels of vitamin D in children with CMPA were lower than those in healthy children. CMPA was a risk factor for vitamin D deficiency.

Effect of physical activity and BMI SDS on bone metabolism in children and adolescents.

Children with obesity are known to have reduced bone density and are at a higher risk for fractures. This may be caused by decreased physical activity or a metabolic phenomenon. In this study, we evaluated associations of physical activity with bone metabolism in children and adolescents with and without obesity. Results from 574 visits of 397 subjects, 191 girls and 206 boys aged five to 18years (mean: 11.7±2.8) representing 180 children with (mean BMI SDS 2.5±0.4) and 217 without obesity (mean BMI SDS 0.2±1.0) from the LIFE Child study, a population-based cohort of children/adolescents with normal weight and with obesity were analyzed for the impact of their daily physical activity (MET/day, SenseWear Accelerometer) on serum SDS levels for bone formation (alkaline phosphatase, osteocalcin, procollagen type I N propeptide [P1NP]), bone resorption (beta-crosslaps), and calcium homeostasis (parathormone, OH-25-vitamin D) by a linear regression model adjusted for gender- and age-based differences. For male subjects, BMI SDS significantly influenced the association of physical activity to PTH, vitamin D, and beta-crosslaps SDS levels. A higher physical activity was accompanied by increased PTH but decreased vitamin D SDS levels in children with normal weight. In males with obesity, all levels remained unaltered. In females, BMI SDS significantly impacted the association of physical activity to PTH, vitamin D, P1NP, beta-crosslaps, and osteocalcin SDS levels. In females with obesity, higher physical activity was related to higher SDS levels of vitamin D, P1NP, and beta-crosslaps. In contrast, in normal weight females, only PTH SDS was higher. The effect of daily physical activity on bone metabolic markers and calciotropic hormones depends significantly on gender and BMI SDS. However, higher levels of physical activity were associated with increased bone turnover for female subjects with obesity only. Thus, motivating especially girls with obesity to be physically active may help improve their bone health.

Динаміка сироваткового вмісту маркерів метаболізму кісткової тканини у дітей, хворих на бронхіальну астму, на фоні вживання вітаміну D3 та солей кальцію

Мета дослідження: оптимізація діагностики порушень стану кальцій-фосфорного обміну та контролю ефективності лікувально-профілактичного застосування вітаміну D та кальцію у дітей, хворих на бронхіальну астму. Матеріали та методи. Обстежено 120 дітей у 2 групах, по 60 осіб у кожній: 1-ша — діти, хворі на бронхіальну астму; 2-га — умовно здорові діти (контрольна група). Проведено 2 курси терапії розчином вітаміну D3 і карбонату/цитрату кальцію: 4 тижні — 2000 МО та 1000 мг на добу відповідно; 8 тижнів — 1000 МО та 500 мг на добу відповідно. Результати. Серед дітей з бронхіальною астмою зареєстроване зменшення кількості осіб з нормальним сироватковим вмістом загального кальцію (P &lt; 0,05), остеокальцину (P &lt; 0,05), паратгормону (P &lt; 0,05), С-телопептидів колагену 1-го типу (P &lt; 0,05), 25(ОН)D (P &lt; 0,05), активності лужної фосфатази (P &lt; 0,05). Через 1 місяць терапії збільшилася кількість дітей з нормальними показниками активності лужної фосфатази (P &lt; 0,05), остеокальцину (P &lt; 0,05), С-телопептидів колагену 1-го типу (P &lt; 0,05); через 3 місяці — загального кальцію (P &lt; 0,05), 25(ОН)D (P &lt; 0,05). Висновки. Використання розчину вітаміну D3 та кальцію нормалізує показники метаболізму кісткової тканини у дітей з бронхіальною астмою. Оптимальний термін контролю ефективності медикаментозного відновлення кісткового метаболізму у дітей з бронхіальною астмою дорівнює 3 місяцям.

Диагностированные нарушения минеральной плотности костной ткани и уровней кальциотропных гормонов у детей с ювенильным гипертиреозом

The development of the skeletal system occur during childhood. Thyroid hormones play an important role in the skeleton's maturation and maintenance of the structure and mass of bones. Juvenile hyperthyroidism affects bone metabolism. This study aimed to identify abnormalities in bone mineral density and the level of calciotropic hormones in juvenile hyperthyroidism to further improve the diagnosis of complications of juvenile hyperthyroidism. Materials and methods. The study was conducted by 21 health controls and 71 children and adolescents with juvenile hyperthyroidism. Anthropometric indicators were calculated using the WHO Anthro Plus personal computer software. Thyroid status and thyroid antibodies, osteocalcin, parathyroid hormone, vitamin D, calcium, phosphorus, alkaline phosphatase were determined using a closed-type immunochemistry analyzer Cobas e 411 Hitachi company Hoffman Le Roche (Switzerland) and its reagents. Bone mineral density was evaluated by dual-energy absorptiometry on a Stratos X-ray densitometer from Diagnostic Medical Systems, France. Results. In juvenile hypertrichosis, in comparison with the control, significantly low values of vitamin D and calcium in the blood serum were noted, the mean values of osteocalcin and alkaline phosphatase were substantially higher. There was no significant difference in the levels of parathyroid hormone and phosphorus in the blood serum in the compared groups. In 45.1% of patients, a decrease in bone mass was diagnosed compared to the age norm. A reliable direct correlation of vitamin D and calcium with bone density was revealed in all X-ray densitometry parameters and a reliable inverse correlation of osteocalcin, alkaline phosphatase and bone mineral density. Osteocalcin had a stronger inverse correlation with all dual-energy X-ray absorptiometry parameters and became a better biomarker than alkaline phosphatase. Conclusions. There is a decrease in bone mineral density in children with juvenile hyperthyroidism. Changes in the level of calciotropic hormones indicate a deranged bone metabolism. Serum osteocalcin can be used as a biomarker of bone metabolism in children with juvenile hyperthyroidism. It is recommended to assess the bones' condition during the initial examination of children with juvenile hyperthyroidism. The study was carried out following the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the parents of the children was obtained for the research. The author declares no conflicts of interest. Key words: juvenile hyperthyroidism, children, adolescents, bone mineral density; dual energy X-ray absorptiometry, osteocalcin, vitamin D.

Evaluation of bone metabolism in children with cystic fibrosis.

Cystic fibrosis (CF) bone disease (CFBD) has attracted considerable recent interest from researchers, although several aspects of CFBD pathophysiology remain poorly understood. The objective of this research was to investigate CFBD in children with CF and its relation to clinical and bone metabolism markers. In a prospective observational study of 68 patients with CF and 63 healthy controls, we studied bone turnover biomarkers and bone mineral density (BMD). The biomarkers included osteocalcin, total-alkaline phosphatase, bone-alkaline phosphatase, N-terminal propeptide of type-1-procollagen, osteoprotegerin (OPG), interleukine-6, tumor necrosis factor alpha (TNF-α), type-1-collagen cross-linked C-telopeptide (CTX), parathormone (PTH), 25-vitamin D, 1,25-vitamin D, calcium and phosphorus. BMD was examined in lumbar spine, comparing two healthy Spanish populations. Two regression analyses were applied to any significant associations to evaluate predictors of BMD and of CF, expressed as odds ratios (OR) with 95% confidence intervals. After adjusting for age, sex, and height Z-score, gains in BMD LS in children and adolescents (6-16years) with CF were not less than in healthy reference population. Patients with CF showed significant associations with different bone turnover biomarkers. Age, gender, body mass index, PTH, CTX and OPG were significant predictors of BMD (R2=0.866, p<0,001). Moreover, we found that PTH (OR=1.070; 95% CI 1.019-1.123), and TNFα (OR=2.173; 95% CI 1.514-3.118) were significantly linked to CF, and calcium (OR=0.115; 95% CI 0.025-0.524), 1,25-vitamin D (OR=0.979; 95% CI 0.962 0.996) and OPG (OR=0.189; 95% CI 0.073-0.489) were significant reduced. A normal bone mineral density along with altered remodeling was found in CF patients with a normal nutritional status and without acute lung disease.

Effect of vitamin K2 and vitamin D3 on bone mineral density in children with acute lymphoblastic leukemia: a prospective cohort study.

Current treatment protocols in acute lymphoblastic leukemia (ALL) are associated with high remission rates and long life expectancy, enhancing the importance of quality of life and prevention of treatment-related complications in patient care. As osteoporosis is a frequent complication in patients under chemotherapy, we investigated the effect of vitamin K2 (100 mcg menaquinone-7) and vitamin D3 (10 mcg calcitriol) on bone metabolism in children with ALL. Twenty-nine consecutive patients recently diagnosed with B precursor ALL (B-ALL) and treated according to the Turkish Acute Lymphoblastic Leukemia Berlin Frankfurt Münster 2000 protocol were randomly assigned into study and control groups. The study group (n=15, M/F: 8/7, age 1-14.5years, mean 6.5years) received vitamin K2 and vitamin D3 with their chemotherapy, while the control group (n=14, M/F 9/5, age 2-17years, mean 7.1years) received chemotherapy only. Serum calcium, phosphorus, magnesium, alkaline phosphatase, bone-specific alkaline phosphatase, uncarboxylated osteocalcin (ucOC), tartrate resistant acid phosphatase 5b, carboxyl terminal procollagen propeptide (PICP), osteoprotegerin (OPG), and receptor activator nuclear kappa B ligand (RANKL) were measured and bone mineral density (BMD) was determined at baseline and first, second, third and sixth months. The study group had higher serum OPG/RANKL ratio and lower ucOC levels compared to the control group at the first month; PICP levels were higher in the study group at second and third months. These results suggest an early beneficial effect of the combination of vitamin K2 and vitamin D3 on BMD in ALL patients especially during the period of intensive steroid therapy in the first months.

The effect of levetiracetam and oxcarbazepine monotherapy on thyroid hormones and bone metabolism in children with epilepsy: A prospective study

BackgroundLong-term treatment with certain antiepileptic drugs may lead to thyroid function disturbances or alterations in bone metabolism; the data on the effects of new antiepileptic drugs on this are limited and conflicting, especially in children with epilepsy. Therefore, the aim of this study was to investigate the effects of levetiracetam and oxcarbazepine on thyroid hormone levels and bone metabolism in children with epilepsy. MethodsA total of 51 children with new-onset partial epilepsy were selected. They were randomly treated with either levetiracetam (n = 25), or oxcarbazepine (n = 26) monotherapy. Eight of the 51 patients were excluded for failing to take the drug continuously or failing to undergo a regular review. Thus, 43 patients were finally included (levetiracetam: 23 patients, oxcarbazepine: 20 patients). A control group consisting of age- and sex-matched healthy subjects (n = 20) was included for comparison. Serum triiodothyronine, tetraiodothyronine, free triiodothyronine, free thyroxine, thyroid-stimulating hormone, calcium, phosphorus, alkaline phosphatase, osteocalcin, parathyroid hormone, and 25-hydroxyvitamin D levels and bone mineral density values were measured before and at 6 and 12 months after therapy in all groups. ResultsAt baseline, thyroid hormone levels, bone metabolism index, and bone mineral density values did not differ between the control group and the drug-treated groups. Levetiracetam-treated patients showed no significant changes in thyroid hormone levels, bone metabolism, and bone mineral density during the 12-month follow-up period compared with baseline values. In the oxcarbazepine group, compared to baseline values, serum free thyroxine levels decreased after 12 months of treatment (Z = −3.115, p = 0.002), and after 6 and 12 months of treatment, calcium levels decreased (Z = −3.705, p < 0.001 and Z = −3.884, p < 0.001, respectively) and parathyroid hormone levels increased (Z = −3.698, p < 0.001 and Z = −3.921, p < 0.001, respectively); however, all other parameters did not differ from baseline values. ConclusionOur data show that levetiracetam treatment has no significant effect on thyroid function and bone metabolism in children with epilepsy. Long-term use of oxcarbazepine may reduce serum free thyroxine levels, resulting in impaired thyroid function, and may reduce serum calcium and increase parathyroid hormone levels, leading to bone metabolism disorders.

Markers of bone metabolism in children with rickets

The problem of rickets remains relevant due to the widespread prevalence of the disease and unsatisfactory results of diagnosis and treatment. Objective. To identify changes in the biochemical parameters of bone metabolism and to establish their relationship with the clinical condition of children with rickets. Materials and methods . The authors conducted a simultaneous controlled clinical comparative study of 108 children aged from 5 months to 2 years. C-terminal telopeptide of type I collagen (CrossLaps), calcitriol, calcitonin, osteocalcin, and blood osteoprote-gerin were analyzed by the enzyme-linked immunosorbent assay method. The level of calcium was determined by colorimetric method, phosphorus — by photometric test. Alkaline phosphatase activity was evaluated in blood serum by an optimized kinetic method. Results . We determined a decrease in the level of serum calcitriol, calcitonin, calcium and phosphorus, as well as an increase in the concentration of the C-terminal telopeptide of type I collagen, osteocalcin, parathyroid hormone, osteoprotegerin, acid and alkaline phosphatase activity. The greatest increase in the level of osteoprotegerin was recorded in children with the II degree of rickets, both in acute and subacute course. The concentration of osteocalcin was increased in all groups of patients with the highest values in patients with the II degree of rickets, regardless of the course of the disease. The activity of acid phosphatase in the blood of patients was also increased. A decrease in the concentration of calcitriol, calcitonin, calcium and phosphorus in the blood was observed in all groups of children with rickets. Conclusion. The authors recorded the correlations between the studied indicators of bone metabolism in patients with rickets. An increase in the level of osteoprotegerin is apparently a new link in the pathogenesis of rickets.

Vitamin D deficiency negatively affects both the intestinal epithelial integrity and bone metabolism in children with Celiac disease

Background and aimWe aim to evaluate serum vitamin D levels, vitamin D receptor (VDR) expression in the intestinal epithelium, and their relation with epithelial barrier proteins and bone metabolism in children with Celiac disease (CD). MethodsImmunostaining for VDR, Claudin-2 and E-cadherin was performed in duodenal samples of the patients with CD and controls. H-score [∑Pi(I+1)] where I is the intensity score and Pi is the corresponding percentage of stained cells was calculated for each samples. The clinic, laboratory and histopathological findings were compared between patients and controls. ResultsThirty-six patients with CD and age and sex matched 36 controls were enrolled. 25-OH vitamin D levels were significantly lower in the patient group compared to the control group. The mean bone mineral density (BMD) value was significantly lower in patients with vitamin D deficiency compared to patients with normal vitamin D level. H-scores for both VDR and Claudin-2 were significantly lower in patient group when compared to the control group. H-scores for VDR, Claudin-2 and E-cadherin were significantly lower in patients with vitamin D deficiency compared to patients with normal vitamin D level. There were positive correlations between 25-OH vitamin D level and H-scores for VDR, E-cadherin and Claudin-2 in patient group. ConclusionsOur findings showed that vitamin D deficiency is common among children with CD. Expression of VDR and epithelial barrier proteins Claudin-2 and E-cadherin which have important roles in paracellular pathway, was decreased in children with CD in correlation with histological findings of disease severity. Furthermore, deficiency of vitamin D was related to decreased expression of VDR and epithelial barrier proteins E-cadherin and Claudin-2. These findings indicate that paracellular pathway structures responsible for calcium absorption are disturbed in CD which is aggravated by vitamin D deficiency.