Calcium-creatinine Ratio Research Articles

English

Early diagnosis of osteoporosis is important to take early prevention and treatment. Dual energy X-ray absorbtiometry (DEXA) scan is gold standard diagnosis of osteoporosis. However, it is high technology and high cost. Biochemical marker using calcium could be developed for diagnosis of osteoporosis. The study was conducted to evaluate the correlation between serum calcium ions level as well as urine calcium and urine creatinine (UCa/UCr) ratio and Bone Mineral Density (BMD) in perimenopausal and postmenopausal women. This was an observational study with cross-sectional design involving women aged 45-75 years who fulfilled the inclusion and exclusion criteria. Bone Mineral Density was measured using DEXA method. Serum and urine calcium ions were measured using ISE method, while serum and urine creatinine were determined using Jaffe method. Ratio of UCa/UCr were then calculated. The correlation between serum calcium ions as well as the ratio UCa/UCr and BMD of subjects were then analyzed. A total 63 subjects were involved in this study consists of 21 normal subjects, 22 subjects with osteopenia and 20 subjects with osteoporosis. Negative correlation between BMD and age (r=-0.591; p=0.001) and positive correlation between BMD and body mass index (BMI) (r=0.432; p=0.001) were observed. No correlation between serum calcium ions and BMD (r= -0.145; p=0.258), however negative correlation between UCa/UCr ratio and BMD (r=-0.310; p=0.013) were reported. Furthermore, no correlation was found between serum calcium ions and lumbar BMD (r=0.036; p=0.778), while negative correlation was found between UCa/UCr ratio and lumbar BMD (r= - 0.414; p=0.001). In conclusion, there is no correlation between serum calcium ions levels and BMD, however there is a weak negative correlation between UCa/UCr ratio and BMD

PICO Questions: What Are They and Why Bother?

Pico is an acronym that describes the elements of a well-formed clinical question to support evidence-based decision-making. The PICO question can be used to frame a search for evidence to manage a single patient, or may be used to describe the study of a clinical problem in a population. The structure includes:We start the PICO process with P, where it is helpful to describe a group with a similar problem and include important characteristics of the patient or patients. Next, I indicates what is done to the patient(s), and may include a medication or other treatment, a diagnostic test, or an exposure (for example, to a potential toxin). The C step should be specific and generally limited to one alternative choice. The final step, O, should specify the measurable results used to compare the intervention or exposure to its alternative. At times, a comparison may not be relevant.For example, a parent might ask whether a single shot of a steroid would work as well as 5 days of oral steroids for a young child sent home from the emergency department after an asthma exacerbation. The clinical question in “PICO format” would be: “Among young children with an acute asthma exacerbation (P), is a single dose of intramuscular dexamethasone (I) comparable to 5 days of oral prednisolone (C) for resolution of asthma symptoms (O)?”The elements of the PICO question can guide the search for relevant and useful information, not only from literature databases but also from clinical consultants.1 A good PICO question can also guide clinical research. Many clinical research studies are designed to answer just this sort of well-structured clinical question.Since 2008, each study in AAP Grand Rounds that addresses a clinical question has been accompanied by a PICO question, enabling readers to judge how well the investigators have answered these questions. The PICO format works best for questions about therapies or other interventions (things we do to patients) but can be modified slightly to describe diagnostic tests, prognoses, or studies about the possible causes of a problem, by substituting a test result or exposure to a risk factor for the “intervention” and presence or occurrence of the disease for the “outcome.”For example, for a question about a diagnostic test, the “outcome” will be the “gold standard” test: “Among children with suspected hypercalciuria, does the calcium-creatinine ratio accurately reflect 24-hour urinary calcium?” and for a question about harm, the “intervention” will be an exposure: “Among children with acute otitis media caused by Streptococcus pneumoniae, does exposure to PCV7 vaccine (vs no vaccination) result in a greater likelihood of antimicrobial-resistant organisms?” Some publications abstracted in AAP Grand Rounds do not attempt to answer a specific clinical question, but instead describe a population, summarize a clinical recommendation or discuss an important general issue, so these abstracts are not accompanied by PICO questions.PICO questions, when well framed, should enhance the value of AAP Grand Rounds by clarifying study questions.

Index of Suspicion

The reader is encouraged to write possible diagnoses for each case before turning to the discussion. We invite readers to contribute case presentations and discussions. Please inquire first by contacting Dr. Deepak Kamat at DKamat@med.wayne.edu. An 18-year-old male with a 3-year history of alcohol abuse is referred from a rehabilitation center for fever, nausea, and nonbloody diarrhea for 3 days. Six weeks ago, he enrolled in an alcohol rehabilitation program and stopped drinking alcohol. Three weeks later, he noticed yellowing of his eyes and skin, difficulty sleeping, and dyspnea. On examination, his temperature is 100.6°F (38.1°C), blood pressure is 99/62 mm Hg, pulse is 124 beats per minute, and respiratory rate is 24 breaths per minute. He is slow to answer questions. There is no asterixis. He appears thin and jaundiced with enlarged parotid glands. Decreased breath sounds are noted on the right. A tender, enlarged liver and mild abdominal distension are noted. Trace bilateral lower-extremity edema is present. No stigmata of chronic liver disease are found. Laboratory findings reveal the following: white blood cell count, 25,600/μL (25.6 × 109/L) (87% neutrophils); hemoglobin, 8.2 g/dL (82 g/L); mean corpuscular volume, 106 fL; platelets, 40 × 103/μL (40 × 109/L); sodium, 135 mEq/L (135 mmol/L); potassium, 3.5 mEq/L (3.5 mmol/L); chloride, 106 mEq/L (106 mmol/L); bicarbonate, 15 mEq/L (15 mmol/L); blood urea nitrogen, 24 mg/dL (8.6 mmol/L); creatinine, 1.01 mg/dL (89 μmol/L); glucose, 118 mg/dL (6.6 mmol/L); alkaline phosphatase, 182 U/L; aspartate aminotransferase (AST), 194 U/L; alanine aminotransferase (ALT), 71 U/L; total bilirubin, 11.8 mg/dL (201.8 μmol/L); direct bilirubin, 7.3 mg/dL (124.9 μmol/L); albumin, 2.7 g/dL (27 g/L); prothrombin time, 19.2 seconds; and international normalized ratio, 1.4. Ethanol and acetaminophen were not detected in the serum. A chest radiograph reveals a right pleural effusion …

Hereditary Hypophosphatemic rickets with Hypercalciuria: A case report and review of literature

Hereditary hypophosphatemic rickets with Hypercalciuria (HHRH) is one of the four entities of hereditary hypophosphatemic rickets, characterized by vitamin D refractory rickets, Hyperphosphaturia, Hypercalciuria, hypophosphatemia, elevated serum 1, 25-dihydroxyvitamin D levels, normal serum Calcium, 25-hydroxyvitamin D and PTH levels. Clinically, it is difficult to differentiate the four entities without a genetic test. However, presence of Hypercalciuria by a simple bedside urine examination of spot calcium-creatinine ratio differentiates HHRH from other three entities of hereditary hypophosphatemic rickets. Correction of all the abnormalities, except for renal inorganic phosphate wasting can be achieved by simple prescription of oral phosphate supplementation. It is also the only type of refractory rickets in which Vitamin D supplementation is more hazardous than beneficial. In this study, we review the literature and describe a case of two year old female child who presented with vitamin D refractory rickets at our tertiary level pediatric centre in Cuttack, Odisha, India whose phenotypic characteristics corresponded with HHRH.

Bone mineral density and factors influencing it in Asian Indian population with type 2 diabetes mellitus.

Objective:To assess bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) patients and its relation, if any, to clinical, hormonal and metabolic factors.Materials and Methods:A prospective evaluation of 194 T2DM patients (97 men and 97 women) was carried out. BMD was done with dual energy X-ray absorptiometry (DXA) at the lumbar spine and total hip. Physical activity, nutritional intake and sunlight exposure were calculated. Biochemical and hormonal tests included serum 25 hydroxy vitamin D [25(OH) D], parathyroid hormone, estrogen, testosterone and urinary calcium-creatinine ratio. Glycosylated hemoglobin and complete lipid profiles were done in patients with diabetes. Five hundred and seventy one non-diabetic controls (262 males and 309 females) were evaluated for BMD alone.Results:BMD was normal (Z score > -2) in 156 (80.5%) and low (Z score ≤ -2) in 38 (19.5%) patients in the diabetes study group. BMD in the diabetes group was significantly higher than the control group in both sexes at the hip and spine. The difference was no longer significant on analysis of a BMI matched control subgroup. Weight and BMI showed significant correlation to BMD. Duration of T2DM, degree of glycemic control, use of drugs like statins and thiazolidinediones, 25(OH) D levels, calcium intake, sunlight exposure and physical activity did not significantly affect BMD in this cohort of individuals with diabetes.Conclusions:Bone mineral density of Asian Indian T2DM subjects was similar to that of healthy volunteers in this study.

Determination of upper reference value of urinary calcium-creatinine ratio for the paediatric population in Burdwan district

To estimate the rate of excretion of urinary calcium, a 24-hour sample of urine is required and this is not always easy to collect accurately in infant and children. So, random urine calcium to creatinine ratio (Ca/Cr ratio) has been developed. But as the ratio varies worldwide, reference values of the parameter in paediatric population are not developed. To determine reference value, the present study was conducted in healthy paediatric population in Burdwan district, West Bengal. This study was performed on 693 healthy paediatric subjects, aged between 3 months to 18 years and divided into five groups. Early morning non-fasting urine samples from all study groups were analyzed for Ca/Cr ratio. A negative correlation was observed between age and urinary Ca/Cr ratio, but there was no significant difference of urinary Ca/Cr ratio between two sexes. Considering 97.5th percentile of the underlying distribution of values as the upper limit of reference range, upper reference values of urinary Ca/Cr ratio for age groups of

Efficacy of 4:1 (classic) versus 2.5:1 ketogenic ratio diets in refractory epilepsy in young children: A randomized open labeled study

The ketogenic (lipid to non-lipid) ratio may play an important role in the efficacy and tolerability of ketogenic diets (KD). This study was planned to compare the efficacy and tolerability of 2.5:1 versus 4:1 lipid:non-lipid ratio KD in young children with refractory epilepsy. Children aged 6 months to 5 years with refractory epilepsy were enrolled. They were randomized to receive either a 4:1 or 2.5:1 ketogenic ratio diet, which was introduced using a non-fasting protocol. Seizure frequency, biochemical profile (liver and kidney function tests, fasting lipid profile, and spot urinary calcium-creatinine ratio), and adverse effects were recorded at three months in both groups. Thirty eight children were enrolled, 19 in each group. At three months, 11 children (58%) in the 4:1 group and 12 (63%) in the 2.5:1 group had more than 50% reduction in seizures (p=0.78). Five children (26%) in the 4:1 group and four (21%) in 2.5:1 group became seizure free. There was no significant difference in the biochemical parameters between the two groups. 2.5:1 ratio KD is possibly as effective as 4:1 KD in controlling seizures and has fewer adverse effects.

Randomized open‐label trial of two weekly oral vitamin D3 supplementation regimens during the third trimester of pregnancy in Bangladeshi women: effects on maternal vitamin D status and safety

To study the potential maternal-infant benefits of improving antenatal vitamin D status in South Asia, safe high-dose vitamin D3 supplementation regimens need to be established. Pregnant women at 27–30 weeks gestation in Dhaka (N=28) were randomized to 70,000 IU initial dose + 35,000 IU/week vitamin D3 (A) or 14,000 IU/week vitamin D3 (B), until delivery. Baseline serum 25-hydroxyvitamin D ([25(OH)D]) were similar in groups A (35 nmol/L) and B (31 nmol/L, P=0.34). Group A had a more robust [25(OH)D] response than B, demonstrated by several outcomes: 1) final mean [25(OH)D] was higher in A (98 nmol/L) vs. B (76 nmol/, P=0.04); 2) the modeled mean rise above baseline [25(OH)D] at steady-state was 16 nmol/L (95% CI, 5 – 26) higher in A vs. B; and, 3) the area under the Δ [25(OH)D]-time curve was larger in A vs. B (P=0.028). Importantly, 90% of women in group A attained [25(OH)D]>80 nmol/L at 10weeks vs. 56% in group B. Mean albumin-adjusted serum calcium ([Ca]) and urinary calcium-creatinine ratio (ca:cr) increased slightly after supplement initiation and then stabilized in group A; but mean [Ca] and ca:cr in groups A and B were within normal ranges and did not significantly differ between the groups in follow-up. There were no supplement-related serious adverse events. In this preliminary study in Bangladesh, 70,000 IU initial + 35,000 IU/week vitamin D3 in the 3rd trimester optimized vitamin D status and was non-hypercalcemic. Grant Funding Source: Center for Global Health, Johns Hopkins University; Department of International Health, Johns Hopkins Bloomberg School of Public Health

The effect of anti epileptic drug therapy on serum 25-hydroxyvitamin D and parameters of calcium and bone metabolism—A longitudinal study

Background Chronic antiepileptic drug use is associated with bone loss. We sought to assess the longitudinal effect of antiepileptic drug on serum 25-hydroxyvitamin D [25(OH)D] levels and bone mineral metabolism markers. Methods Patients in the emergency services or those in neurology outpatient department with history of seizure were characterized and included in the study prospectively. Daily dietary intake of calories, calcium, phosphorus and phytates were characterized by dietary recall method. Base line bone mineral parameters – serum calcium, phosphorus, alkaline phosphatase (SAP), tartrate resistant acid phosphatase (TRACP), 25(OH)D levels, parathyroid hormone (PTH) and urinary calcium creatinine ratio (Ca.Cr), urinary calcium/kg/bodyweight (BW) and phosphate excretion index (PEI) were determined. Patients on AED therapy with normal 25(OH)D levels were followed up and were re-evaluated at the end of 6 months. Results The daily dietary calcium intake of the subjects was lower than the RDA (Recommended Dietary Allowance) by ICMR (Indian Council of Medical Research). The diet was high in phytates. Two-thirds of the recruited subjects were vitamin D deficient. Subjects with normal 25(OH)D levels at base line showed a significant fall of 25(OH)D levels, urinary calcium, urinary calcium/kg/BW and TRACP levels at the end of 6 months irrespective of the AED used or the plasma level of AED. Conclusions Hypovitaminosis D is common in our population. Subjects with normal 25(OH)D levels, irrespective of the type of antiepileptic medications even at sub-therapeutic serum levels of the drug, went into 25(OH)D deficiency and insufficiency states. Theoretically it can be worthwhile to supplement calcium and vitamin D even before initiation of antiepileptic therapy.

Diagnosis and treatment of osteoporotic fractures

Diagnosis and treatment of osteoporotic fractures

Growth Restriction at Birth and Kidney Function During Childhood

Individuals born small for gestational age (SGA) are at risk of developing hypertension and kidney disease later in life. The time that this may occur is unknown. This study aims to examine kidney function in preschool children who were SGA. A case-control study. The study included 100 children, 60 SGA and 40 appropriate-for-gestational-age (AGA) controls matched with the SGA children according to birth characteristics (gestational age and sex) and characteristics at the time of the study (body weight, body height, body mass index, and age). SGA children were classified according to severity of growth restriction into 2 groups: birth weight less than the 3rd percentile (n = 25) and birth weight from the 3rd to 10th percentile (n = 35). Being SGA and severity of growth restriction at birth. Kidney function was estimated at a mean age of 5 years by using serum creatinine level; estimated glomerular filtration rate; urinary albumin excretion; fractional excretion of sodium, potassium, phosphate, magnesium, and uric acid; transtubular potassium gradient; and urinary calcium-creatinine ratio calculated from 3-hour urine collections. Blood pressure and kidney length also were measured. Kidney length, serum creatinine level, and estimated glomerular filtration rate did not differ among the 3 groups. Systolic and diastolic blood pressures were greater in SGA children with birth weight less than the third centile versus controls (107.5 +/- 11 versus 102 +/- 10 mm Hg [P = 0.03] and 69 +/- 7.5 versus 65 +/- 8.6 mm Hg [P = 0.02] for systolic and diastolic blood pressure, respectively). Both groups of SGA children had greater urinary calcium excretion than AGA children (urinary calcium-creatinine ratio, 0.16 +/- 0.08 and 0.16 +/- 0.10 in SGA with birth weight < 3rd and 3rd to 10th percentiles versus 0.10 +/- 0.09 in AGA; P = 0.04 and P = 0.03, respectively). SGA children also had lower uric acid excretion despite greater serum uric acid levels (fractional excretion of uric acid, 7.4% +/- 4% and 6.9% +/- 5% versus 10.5% +/- 5.9%; P = 0.02 and P = 0.003, respectively). Relatively small sample size, blood pressure was measured on a single visit. Children born SGA showed alterations in calcium and uric acid urinary excretion at preschool age, and blood pressure was related to the severity of growth restriction.

Seizure control and biochemical profile on the ketogenic diet in young children with refractory epilepsy—Indian experience

Aim This study evaluated the efficacy and tolerability of the ketogenic diet (KD) in young Indian children with refractory epilepsy. The changes in biochemical and lipid profile with KD were also assessed. Methods Children aged 6 months to 5 years who had daily seizures (or at least 7 seizures/week) despite the appropriate use of at least three antiepileptic drugs were enrolled. KD was introduced using a non-fasting gradual initiation protocol. Seizure frequency, biochemical profile (liver and kidney function tests, fasting lipid profile, and spot urinary calcium–creatinine ratio) and adverse effects were recorded. Patients continuing KD were followed up for a minimum period of 12 months. Results Twenty-seven children were enrolled. Non-fasting gradual KD initiation was well tolerated. Eighty-eight percent remained on KD at 3 months, 55% remained on KD at 6 months, and 37% remained on it at 1 year. Intention-to-treat analysis revealed that 48% (13 of 27) had >50% reduction in seizures, and four children (15 %) were seizure free at 6 months. At 1 year, 37% had >50% reduction in seizures and five children (18.5%) were seizure free. Adverse effects included constipation (74%), weight loss (14.8%), edema due to hypo-albuminemia (7.4%) and renal stones (3.7%). Biochemical profile did not reveal significant changes over time, except for reduced serum albumin and increased spot urinary calcium–creatinine ratio. Conclusion KD is an effective and well-tolerated treatment option in young Indian children with refractory epilepsy. However, careful ongoing medical supervision is needed.

Long-term effects of giving nursing home residents bread fortified with 125 μg (5000 IU) vitamin D3 per daily serving

Background: In older adults, a serum 25-hydroxyvitamin D [25(OH)D] concentration >75 nmol/L lowers the risk of fracture. An oral intake of 125 μg (5000 IU) vitamin D3/d may be required to achieve this target.Objective: The objective was to characterize the safety and efficacy of fortifying bread with a biologically meaningful amount of vitamin D3.Design: In a single-arm design, 45 nursing home residents consumed one bun daily that had been fortified with 125 μg (5000 IU) vitamin D3 and 320 mg elemental calcium.Results: The initial mean (±SD) serum 25(OH)D concentration was 28.5 ± 10.8 nmol/L. After 12 mo, the 25(OH)D concentration was 125.6 ± 38.8 nmol/L, and it exceeded 74 nmol/L in 92% of the patients. At every 3-mo follow-up, serum parathyroid hormone was lower than at baseline (P = 0.001). No changes in serum calcium or cases of hypercalcemia were observed at the follow-up assessments. Both mean total urinary calcium and the mean urinary calcium-creatinine ratio increased from baseline at one follow-up time point (P < 0.05). Between baseline and the 12-mo visit, z scores for bone mineral density at the lumbar spine and the hip both increased significantly (P < 0.001).Conclusions: Fortification of bread with much more vitamin D than used previously produced no evident adverse effects on sun-deprived nursing home residents and improved bone density measures. Fortification of bread with 5000 IU vitamin D3/d provided reasonable assurance that vitamin D–deficient older adults attained a serum 25(OH)D concentration greater than the desirable objective of >75 nmol/L. This trial was registered at clinicaltrials.gov as NCT00789503.

Effect of Bimonthly Supplementation With Oral Cholecalciferol on Serum 25-Hydroxyvitamin D Concentrations in HIV-Infected Children and Adolescents

Vitamin D insufficiency occurs commonly in HIV-infected youth in the United States. In light of the importance of vitamin D for skeletal and nonskeletal health, including innate immunity, developing methods for improving vitamin D status in HIV-infected children and adolescents is an important area of clinical research. The objective of this study was to evaluate the effect of administration of oral cholecalciferol, 100,000 IU every 2 months, and 1 g/day calcium on serum 25-hydroxyvitamin D concentrations, serum and urine calcium, and HIV disease progression during a 12-month period. HIV-infected children and adolescents who were aged 6 to 16 years were randomly assigned to receive vitamin D (100,000 IU bimonthly) and calcium (1 g/day; n = 29) or double placebo (n = 27). Serum 25-hydroxyvitamin D concentrations as measured by radioimmunoassay, albumin-corrected calcium concentrations, and spot urinary calcium-creatinine ratios were determined monthly. No abnormalities in serum calcium concentration were observed. One participant who received placebo developed hypercalciuria. No group differences were seen in the change in CD4 count or CD4% or viral load during 12 months. The overall mean monthly serum 25-hydroxyvitamin D concentrations were higher in the group that received vitamin D and calcium than in the placebo group, as was the monthly serum 25-hydroxyvitamin D area under the curve. After completing 12 months of study, 2 (6.7%) participants in the group that received vitamin D and calcium had a trough serum 25-hydroxyvitamin D concentration <20 ng/mL compared with 14 (50%) in the placebo group. Twelve (44.4%) in the group that received vitamin D and calcium had a trough serum 25-hydroxyvitamin D concentration of > or =30 ng/mL compared with 3 (11.1%) in the placebo group. Administration of oral cholecalciferol to HIV-infected children and adolescents at a dosage of 100,000 IU every 2 months, together with 1 g/day calcium, is safe and results in significant increases in serum 25-hydroxyvitamin D concentrations.

Late Side Effects of High-dose Steroid Therapy on Skeletal System in Children With Idiopathic Thrombocytopenic Purpura

Corticosteroids have been widely used in the treatment of idiopathic thrombocytopenic purpura (ITP). We evaluated the late side effects of high-dose methylprednisolone (HDMP) therapy on bone metabolism in children with ITP. Twenty-eight children with acute ITP treated with HDMP (30 mg/kg/d for 3 d then 20 mg/kg/d for 4 d) and 28 controls were enrolled in the study. Bone mineral density (BMD), urinary calcium creatinine ratio, urinary levels of deoxypyridinoline, serum levels of calcium, phosphate, parathyroid hormone, total alkaline phosphatase, and bone-specific alkaline phosphatase were measured in both groups. Magnetic resonance imaging of the femoral head was performed only in study group. The mean levels of serum phosphate, parathyroid hormone, urinary deoxypyridinoline, and calcium creatinine ratio were significantly increased in the study group. There was no significant difference between the 2 groups in terms of serum calcium, total alkaline phosphatase, bone-specific alkaline phosphatase, and BMD values. There was a statistically significant negative correlation between cumulative steroid dose and BMD values in study group (r = -0.379). Osteonecrosis was observed in 3 of 25 patients by magnetic resonance imaging. In conclusion, HDMP therapy, especially in high cumulative doses, increases the bone resorption and may cause osteonecrosis in children with ITP.

Predicting proteinuria in hypertensive pregnancies with urinary protein-creatinine or calcium-creatinine ratio

Evaluate the value of random urinary protein-creatinine (PrCr) and calcium-creatinine (CaCr) ratios to predict 24-h proteinuria in hypertensive pregnancies. Spot urine samples were collected before routine 24-h urine collections from consecutive pregnant women with hypertension (n=83). Reliability of spot urinary PrCr and CaCr to detect significant proteinuria (>or=300 mg/day) using 24-h urine protein as 'gold-standard' was assessed by receiver-operating characteristic (ROC) curve. Fifty-one patients (61.4%) had significant proteinuria (45 pre-eclampsia, 5 superimposed pre-eclampsia, 1 renal hypertension). Area under ROC curve to predict proteinuria was 0.82 (95% confidence interval (CI) 0.73 to 0.92, P<0.001) for PrCr and 0.55 (95% CI 0.43 to 0.68, P=0.2) for CaCr. A cutoff value of >0.19 for PrCr best predicted significant proteinuria with sensitivity, specificity, positive and negative predictive values and likelihood ratios (positive and negative), respectively, of 80.4, 68.8, 80.4, 68.8%, 2.57 and 3.51. Spot urinary PrCr predicts total urinary protein excretion in hypertensive pregnancies.

A Case of Familial Hypocalciuric Hypercalcemia Coexisting with Low Bone Mass

Familial hypocalciuric hypercalcemia is caused by heterozygous loss-of-function mutation of the calcium sensing receptor gene, and this is characterized by mild, persistently elevated levels of serum calcium without symptoms or complications. We present a case of clinically diagnosed familial hypocalciuric hypercalcemia with unexpected low bone mass. A 19-year-old man presented with incidentally discovered hypercalcemia. He showed normal growth and sexual maturation. Biochemical studies showed hypercalcemia, increased parathyroid hormone, hypocalciuria, a decreased urinary calcium-creatinine ratio and decreased serum 25-hydroxy-vitamin D. The other hormonal studies were normal. Dual energy x-ray absorptiometry showed low bone mineral density, and the Sestamibi scan showed no abnormality in the parathyroid glands. Iliac bone biopsy showed a general decrease in bone density and increased porosity of the cortical bone. Normal mineralization was also shown, but in part, osteoid deposition was also found. Direct sequencing of the patient's calcium sensing receptor gene showed a point mutation at exon7, Q926R. (J Kor Endocrinol Soc 21:583~588, 2006) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Evaluating Bone Metabolism In Asthmatic Cases Using Inhaled Steroids

Background: Bronchial asthma is a chronic inflammatory disease in which eosinophils and different cells play a major role in pathogenesis, characterized by increased bronchial sensitivity of the airways. Topical steroids had been used to avoid long-term side effects of systemic steroids in asthma. The systemic effects of inhaled corticosteroids may be explained by the combined effects of many factors. Objective: This study was performed to investigate the effects of inhaled steroids on bone mineralization and also on bone density. Methods: Ninety-seven children divided into three groups, diagnosed with bronchial asthma and followed up in 2002 and 2003 at the GATA Haydarpasa Teaching Hospital were included in the study. Bone remodeling and destruction markers were used to examine the effects of inhaled steroids on bone metabolism. Results: Comparisons between groups and among all three groups revealed no statistical differences in bone specific alkaline phosphatase (bALP), hydroxyproline (HP), carboxy-terminal telopeptide of type1 collagen (ICTP), calcium-creatinine ratio (Ca/GF), calcium (Ca) and phosphor (P) levels. Analysis of the groups in the study revealed that bone mineral density (BMD) scores were significantly higher in pubertal stage cases compared with those in the prepubertal stage.

Pathogenesis of bone loss in heart transplant candidates and recipients

Background Heart transplantation (HTX) is associated with decreased bone mineral density and changes in bone metabolism. We conducted this study to evaluate the pathophysiology of bone metabolism in HTX candidates and recipients. Methods Thirty-six HTX recipients were compared with 36 HTX candidates concerning biochemical parameters of bone metabolism and bone mineral density. Results Osteocalcin, bone-specific alkaline phosphatase, cross-linked-N-telopeptide of type I collagen, estradiol, serum creatinine, and blood urea nitrogen concentrations were significantly higher, whereas the calcium–creatinine ratio, thyrotropin, thyroxine, and bone mineral density were significantly lower in HTX recipients than in HTX candidates. Compared with a control group, HTX candidates had decreased renal function and increased bone resorption, whereas HTX recipients additionally had increased alkaline phosphatase and osteocalcin levels. In HTX recipients, we found positive correlations between creatinine clearance and bone mineral density; daily and cumulative cortisone doses were not associated with bone mineral density. Conclusion In HTX candidates, disturbances in bone metabolism with increased bone resorption may be caused partly by existing low-grade renal insufficiency, regular intake of loop diuretics, and restriction of mobility. In HTX recipients, immunosuppressive therapy—glucocorticoids and cyclosporine—seem to be responsible for changes in bone metabolism.

58-Year-Old Man With Fatigue and Flank Pain

58-Year-Old Man With Fatigue and Flank Pain