Calcium-vitamin D Research Articles

Comparative Effectiveness of Therapeutic Interventions in Pregnancy and Lactation-Associated Osteoporosis: A Systematic Review and Meta-analysis.

The optimal management of pregnancy and lactation-associated osteoporosis (PLO) has not been designated. To systematically review the best available evidence regarding the effect of different therapeutic interventions on bone mineral density (BMD) and risk of fractures in these patients. A comprehensive search was conducted in PubMed/Scopus databases until December 20, 2022. Data were expressed as weighted mean difference (WMD) with 95% CI. The I2 index was employed for heterogeneity. Studies conducted in women with PLO who received any antiosteoporosis therapy were included. Studies including women with secondary causes of osteoporosis or with transient osteoporosis of the hip were excluded. Data extraction was independently completed by 2 researchers. Sixty-six studies were included in the qualitative analysis (n = 451 [follow-up time range 6-264 months; age range 19-42 years]). The increase in lumbar spine (LS) BMD with calcium/vitamin D (CaD), bisphosphonates, and teriparatide was 2.0% to 7.5%, 5.0% to 41.5%, and 8.0% to 24.4% at 12 months, and 11.0% to 12.2%, 10.2% to 171.9%, and 24.1% to 32.9% at 24 months, respectively. Femoral neck (FN) BMD increased by 6.1% with CaD, and by 0.7% to 18% and 8.4% to 18.6% with bisphosphonates and teriparatide (18-24 months), respectively. Meta-analysis was performed for 2 interventional studies only. Teriparatide induced a greater increase in LS and FN BMD than CaD (WMD 11.5%, 95% CI 4.9-18.0%, I2 50.9%, and 5.4%, 95% CI 1.2-9.6%, I2 8.1%, respectively). Due to high heterogeneity and lack of robust comparative data, no safe conclusions can be made regarding the optimal therapeutic intervention in women with PLO.

Estimation of the levels of vitamin D3 and interleukin 10 in the serum of people recovering from corona virus in Nineveh Governate

The research included an estimation of some biochemical parameters such as Interleukin10, Vitamin D3, A c-reactive protein, Alkaline phosphatase, Iron, Calcium, Phosphorus, in serum of patientes with corona virus in comaperation with control group, vaccinated recovering group, unvaccinated recovering group, were diagnosed by specialized doctors at Alfya Lab in Mousl. The samples were (30) control unvaccinated, (23) control vaccinated, (25) recovering unvaccinated, (25) vaccinated recovering, (7) Patients of virus corona of the same age. The results showed a significant increase in the levels of Interleukin10, A c-reactive protein, Alkaline phosphatase. In serum of Patients of virus corona and vaccinated recovering group in compared with Control, unvaccinated groups. Where the levels of iron, calcium, Vitamin D3 shwed a significant decrease in serum of patients with corona virus in comaperation with other groups. The results also clarified a positive correlation between Interleukin10 and iron, calcium and a negative correlation with Vitamin D3 , Phosphorus , A c-reactive protein and Alkaline phosphatase. The results also showed that there was a significant increase in the levels of Interleukin10, A c-reactive protein, Alkaline phosphatase and significant decrease in the levels of iron, calcium Vitamin D3 in serum of female group in comaperation with male group.

The Investigation of Metabolic Syndrome Among Middle-Aged Women, Kamyaran, Iran: A Cross-sectional Study

Objectives: Physical activity and nutrition can affect some serum markers associated with metabolic syndrome (MetS). We aimed to ascertain the prevalence and predictors of MetS among middle-aged women in this study. Materials and Methods: This cross-sectional descriptive-analytical study was performed on 164 eligible middle-aged women. Sampling was performed by two-stage cluster random sampling among all the health care centers in Kamyaran, Iran. Data were collected through anthropometrics, Food Records, and International Physical Activity Questionnaires. Serum lipid profile and glycemic control indexes, calcium, and 25-hydroxy vitamin D3 were assayed. Blood pressure was measured. The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria were used to detection of MetS. Results: Forty-one women (25.0%; 95% CI: 18.4% to 31.6%) had MetS. Fasting blood sugar (FBS) (adjusted odds ratio (aOR): 0.020; 95% CI: 1.001 to 1.039), triglyceride (aOR: 1.024; 95% CI: 1.015-1.033), low physical activity: walking (aOR: 0.999; 95% CI: 0.998 0.999), dietary iron (aOR: 1.059; 95% CI: 0.989- 1.134) and waist circumference (aOR: 1.062: 95% CI; 1.020 1.105) have been detected as the MetS predictors in this study. Conclusions: Higher serum levels of FBS and triglyceride, higher iron intake and waist circumference, and low physical activity enhanced the chance of getting MetS.

Effect of Dipeptidyl Peptidase-4 Inhibitors on Bone Health in Patients with Type 2 Diabetes Mellitus

Patients with type 2 diabetes (T2DM) have a higher risk of bone fracture even when bone mineral density (BMD) values are normal. The trabecular bone score (TBS) was recently developed and used for evaluating bone strength in various diseases. We investigated the effect of DPP-4 inhibitors on bone health using TBS in patients with T2DM. This was a single-center, retrospective case-control study of 200 patients with T2DM. Patients were divided into two groups according to whether they were administered a DPP-4 inhibitor (DPP-4 inhibitor group vs. control group). Parameters related to bone health, including BMD, TBS, and serum markers of calcium homeostasis, were assessed at baseline and after one year of treatment. We found TBS values increased in the DPP-4 group and decreased in the control, indicating a significant difference in delta change between them. The BMD increased in both groups, with no significant differences in delta change between the two groups observed. Serum calcium and 25-hydroxy vitamin D3 increased only in the DPP-4 inhibitor group, while other glycemic parameters did not show significant differences between the two groups. Treatment with DPP-4 inhibitors was associated with favorable effects on bone health evaluated by TBS in patients with T2DM.

A STUDY TO DETECT THE PROPORTION OF ALTERED SERUM CALCIUM, PHOSPHOROUS AND VITAMIN D3 LEVEL IN NEWLY DIAGNOSED PULMONARY TUBERCULOSIS PATIENTS ATTENDING CHEST OPD IN BURDWAN MEDICAL COLLEGE & HOSPITAL

Introduction: Pulmonary Tuberculosis (PTB) is still a very common cause of morbidity & morbidity in India.[7] Calcium and phosphorus metabolism plays an important role in the healing of lesions in PTB. Vitamin D deficient individuals have a greater susceptibility to develop TB[14] and worse disease progression if infected with TB.[15] Due to paucity of studies this study was carried out to estimate the mean value of serum calcium phosphorous and Vitamin D3 level in newly diagnosed PTB patients and find out correlation among the altered values of these biochemical parameters.
 Methods: This was an observational cross sectional hospital based study carried out on 120 patients attending Burdwan Medical College over a period of one and a half years. All patients of PTB were included, while patients with Sarcoidosis, hepatitis, chronic kidney disease, post menopausal women were excluded from study. Serum Calcium, Phosphorus and Vitamin D3 were estimated in these patients. Data collected was entered in Excel Spreadsheet, and analysed in SPSS version 19.0 using descriptive statistical methods, percentiles and scatter diagrams.
 Main Findings: Serum calcium and phosphorus was not significantly decreased in our study. Moderate prevalence of vitamin D deficiency was found among newly diagnosed PTB patients. Significant correlation was found between altered vitamin D3, serum phosphorus and serum calcium level.
 Conclusion: Since Serum vitamin D3 is significantly decreased in pulmonary tuberculosis it is essential to monitor the serum levels of vitamin D3 in PTB patients and provide adequate supplementation of vitamin D3.
 Keywords: Pulmonary Tuberculosis, Calcium, Vitamin D3, Phosphorus

Effects of a multi-modal resistance exercise program and calcium-vitamin D3 fortified milk on blood pressure and blood lipids in middle-aged and older men: secondary analysis of an 18-month factorial design randomised controlled trial.

Physical activity and dietary interventions are recommended as front-line therapy for prevention and management of cardiovascular disease. This study investigated the independent and combined effects of low-fat, calcium-vitamin D3 fortified milk and multi-modal exercise training on blood pressure (BP) and blood lipids in middle-aged and older men. This was a pre-planned secondary analysis of an 18-month, randomised controlled trial. Community-dwelling men aged 50-79years (n = 180) were randomised into (i) exercise + fortified milk; (ii) fortified milk; (iii) exercise; or (iv) control. The low-fat milk (400mL/day) was fortified with 1,000mg/day calcium and 800IU/day of vitamin-D3, whilst the exercise intervention consisted of three sessions/week of resistance- and weight-bearing impact exercises. Resting BP and fasting lipids were assessed at baseline, 6 (lipids only), 12 and 18months. Mean ± SD serum 25(OH)D and calcium intake for the entire cohort at baseline was 86 ± 36nmol/L and 1002 ± 397mg/day, respectively, with 10% classified as vitamin-D insufficient and 58% reportinga calcium intake below 1000mg/day. There were no exercise-by-fortified milk interactions, nor any main-group effects for exercise or milk on BP or lipids at any time. However, there were significant reductions from baseline to 18months in systolic (mean change, 5-8mmHg) and diastolic (4-6mmHg) BP in the exercise, fortified milk and control groups. All results remained largely unchanged after adjusting for use of anti-hypertensive or lipid lowering medication, weight or fat mass, or only including men with hypertension (n = 89) or dyslipidemia (n = 130) at baseline. Supplementation with low-fat, calcium + vitamin D3 fortified milk and a multi-modal exercise program, alone or in combination, was not effective for improving BP or blood lipids in community-dwelling middle-aged and older men.

Parycalcitol + J131 - A New Route to Treatment Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease on Long-term Dialysis?

Two cases with the dramatic course of secondary hyperparathyroidism in patients with chronic kidney disease on long-term dialysis. Has anything possible been done in management of these patients? Complications associated with impaired bone mineralization among patients with chronic kidney disease on long-term dialysis are observed frequently with an array of pathologic processes being found. Kidney osteodystrophy may be associated with either increased or decreased (adynamic bone disease, osteomalacia, aluminum-induced osteopenia) bone metabolism, as well as mixed forms related to the B2 microglobulin amyloidosis. Differential diagnosis of various types of osteopathy is difficult and is usually based on the histologic assessment of the bone biopsy. The most typical bone complication in patients with impaired kidney function is osetodistophy with increased bone metabolism, caused by secondary hyperparathyroidism clinically manifesting as osteitis fibrosa. High serum levels of PTH induce osteoclast and osteoblast activity. Early changes, with characteristic increase in the woven osteoid suggesting early, increased osteoplastic bone resorption may be found in a significant percentage of patients with GFR>60ml/min/1,73m2 of the body surface. Lower values of the GFR are associated with both faster bone synthesis and more active resorption with progressive increase in the intraosseous fibrosis and decreased bone mineralization. As the abnormalities progress, which is especially marked in patients on long-term dialysis, a rage of clinical symptoms, such as: severe bone and joint pain, bone deformation, pathological fractures, especially in the spinal region, calcifications of the soft tissues and vessels, including heart valves and lungs. In children, the most common abnormality is growth impairment. In some patient’s skin calcifications, with subsequent necrosis, due to increased calcium deposition in small and medium arteries. The diagnosis is based on the typical clinical picture, biochemical parameters (calcium and phosphate ratio, parathormone levels, characteristic radiologic charges and sometimes, bone histology. Prevention and treatment of these complications includes effective dialysis, appropriate low-phosphate diet with limitation of the protein supply to the 0.8g/kg of the body mass, adequate calcium and active Vitamin D3 supply, introduction of the phosphate binding medications (sevelamer or lantan) as well as calcimimetic use (substances activating parathyroid gland calcium receptors inhibiting both its up-regulation and PTH secretion). In the severe cases, with insufficient effect of the treatment described above, parathyroidectomy is required after close ultrasound and scintigraphy-based assessment of these glands. However, even such treatment may be insufficient in some cases, as presented below.

Effects of a multicomponent exercise program combined with calcium-vitamin D3-enriched milk on health-related quality of life and depressive symptoms in older men: secondary analysis of a randomized controlled trial.

Osteoporosis is associated with both lower health-related quality of life and depression in older people. We examined the independent and combined effects of a multi-component exercise program and calcium-vitamin D3 fortified milk on health-related quality of life (HR-QoL) and depression in older men. In this 12-month, factorial design randomized controlled trial, 180 healthy community-dwelling men aged 50-79years with normal to below average bone mineral density were allocated into one of four groups: exercise + fortified milk; exercise; fortified milk; or controls. Exercise consisted of high-intensity resistance training with weight-bearing exercise (3days per week; 60-75min per session). Men assigned to fortified milk consumed 400ml/day of low-fat milk containing 1000mg/day calcium and 800IU/day vitamin D3. Questionnaires were used to assess HR-QoL (SF-36) and depressive symptoms (Center for Epidemiologic Studies Depression Scale) at baseline, and 6 and 12months. A linear mixed model analysis was used to test whether there was a synergistic interaction between exercise and calcium-vitamin D3. If no significant interactions were detected, the main effects of exercise and fortified milk were examined. Mean adherence to the exercise program and fortified milk was 67% (95% CI 61, 73%) and 90% (95% CI 86, 93%), respectively. There were no exercise-by-fortified milk interactions nor main effects of exercise or calcium-vitamin D for any of the HR-QoL measures or depressive symptoms. In healthy community-dwelling older men, exercise training and/or calcium-vitamin D fortified milk did not improve HR-QoL or depressive symptoms.

PSI-41 Tibia attributes in aged Lohmann LSL-lite hens fed corn-soybean meal diet with different levels of calcium and 25-hydroxy vitamin D3.

PSI-41 Tibia attributes in aged Lohmann LSL-lite hens fed corn-soybean meal diet with different levels of calcium and 25-hydroxy vitamin D3.

Pulsed electromagnetic fields improve bone mineral density and bone metabolism after stroke

Objective To investigate the effect of a pulsed electromagnetic field (PEMFS) on bone mineral density and bone metabolism in males with osteoporosis after a stroke. Methods Fifty male stroke survivors with osteoporosis were randomly divided into a control group and a treatment group, both of 25. Both groups were treated with routine rehabilitation, oral calcium carbonate and vitamin D3 tablets, while the treatment group was additionally provided with PEMFS treatment. The subjects′ bone mineral density (BMD) and their blood levels of bone-specific alkaline phosphatase (B-ALP), type I procollagen amino-terminal peptide (PINP) and type β-I collagen cross-linked carboxy-terminal peptide (β-CTx) were measured before and after the 12 weeks of treatment. Results After the treatment the BMD values of the lumbar spine, femoral neck, trochanter and Ward′s triangle had increased significantly in both groups, but the average BMD values of the lumbar spine and femoral neck in the treatment group were significantly higher than those of the control group. After the treatment, the average B-ALP, PINP and β-CTx levels of both groups had also improved significantly compared with before the treatment, but the average improvement in all three among the treatment group was significantly greater than among the controls. Conclusion PEMFS treatment supplementing routine rehabilitation, oral calcium carbonate and vitamin D3 tablets can improve bone formation, reduce bone resorption and increase bone mineral density in men after a stroke. Key words: Electromagnetic fields; Pulsed electromagnetic fields; Bone metabolism; Bone mineral density

DRUG USE EVALUATION OF CORTICOSTEROIDSIN SYSTEMIC LUPUS ERYTHEMATOSUS OUTPATIENTS

Corticosteroids was the mainstay therapy for SLE, an autoimmune chronic desease. Prolonged use of Corticosteroid caused many side effects’ risk. This study was aimed to evaluate corticosteroid drug use in SLE outpatients. This study was conducted on April 2017 to August 2017. Cross sectional design was used and presented with analytical descriptive. The result is, 192 SLE outpatients pass the inclusion criteria and 98,96% are women. Methylprednisolon per oral is the most corticosteroid used for SLE outpatients, combine with 1 other immnunsuppresant ( 65,10 %) and combine with 2 other immunsuppresant ( 8,33% ). From BMI, 26,05% subjects are overweight, perhaps because of corticosteroids side effect, such as weight gain. More than a half SLE outpatients (58,33%) get Calcium supplement and vitamin D3 as prophylactive for osteoporosis because of prolonged use of corticosteroid and 61 SLE outpatients get drug for gastrointestinal use to avoid peptic ulcer. There are 44 cases of potential corticosteroid interaction with other drug that are given together, the most are corticosteroid and aspirin interaction, on 14 patients.

Circulating Levels of Inflammation and the Effect on Exercise-Related Changes in Bone Mass, Structure and Strength in Middle-Aged and Older Men.

Chronic, low-grade systematic inflammation has been associated with bone loss and increased fracture risk. We previously reported that exercise improved femoral neck bone mineral density (BMD), geometry and strength and lumbar spine trabecular BMD in middle-aged and older men, but had no effect on markers of inflammation. The aim of this study was to examine the association between basal inflammatory status and the adaptive skeletal responses to exercise. Secondary analysis was completed on 91 men aged 50-79years who participated in an 18-month program of progressive resistance training plus weight-bearing impact exercise (3day/week) with and without additional calcium-vitamin D3. Markers of inflammation (serum hs-CRP, TNF-α and IL-6) and DXA and QCT-derived BMD, bone structure and strength at the lumbar spine and proximal femur were measured at baseline and 18months. Multiple regression was used to assess associations between skeletal changes and both baseline levels of individual inflammatory markers and a composite inflammatory index derived from the number of markers categorized into the highest tertile. Baseline serum hs-CRP, TNFα and IL-6 and the composite inflammatory index score were not associated with skeletal changes at any site after adjusting for age, change in lean mass, disease(s)/medication use and adherence to the exercise intervention. In conclusion, this study indicates that basal inflammatory status does not influence the osteogenic response to exercise training in healthy middle-aged and older men.

The Eeffect of Metformin Combined with Calcium-Vitamin D3 Against Diet-Induced Nonalcoholic Fatty Liver Disease.

Purpose: Metformin is one of the most popular drugs tested against nonalcoholic fatty liver disease (NAFLD). The present study aimed to investigate whether calcium-vitamin D3 cosupplementation will intensify the effect of metformin on the prevention of high-fat, high-fructose (HFFr) diet-induced hepatic steatosis.Methods: Male wistar rats (210±16 g) were assigned into the following seven groups: a Control group to receive a standard chow and six HFFr-fed groups to receive diets containing either normal (0.5% calcium and 1000 IU/kg vitamin D3) or high amount of calcium and vitamin D3 (2.4% calcium and 10000 IU/kg vitamin D3) (CaD), in combination with gastric gavage administration of either saline or 25 or 200 mg/kg body weight/day metformin. After 60 days, rats were assessed with respect to their anthropometric, metabolic and hepatic parameters, as well as their hepatic AMP-activated protein kinase (AMPK) phosphorylation.Results: Metformin and CaD, either alone or in combination, caused a significant reduction in HFFr diet-induced high serum aspartate aminotransferase (AST), hepatic steatosis and lipid accumulation without effect on insulin resistance and AMPK phosphorylation. In addition, slightly (and non-significantly) better effects of the combination in ameliorating steatosis and hepatic cholesterol content were observed.Conclusion: Taken together, our results suggest that metformin and CaD could protect against the onset of HFFr diet-induced NAFLD in an insulin and AMPK-independent manner, without any marked additional benefits of their combination.

Vitamin D status in children with headache: A case-control study

Vitamin D is a fat soluble vitamin with hormonal properties, plays crucial functions in bone and mineral metabolism and has important regulatory functions in brain development, cell differentiation and apoptosis. Some studies have shown a link between vitamin D deficiency and headache. In this study, 147 patients with headache (migraine or either tension-type headache (TTH)) and 69 healthy controls, aged 5 to 16 years, were evaluated. Each group was also divided into two separate sub-groups based on presentation to the clinic in either high solar-exposure (HSE) and low solar-exposure (LSE).We retrospectively evaluated the levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and 25-OH vitamin-D3. Levels below 20ng/ml were described as vitamin D deficiency and levels of 2030ng/ml as vitamin D insufficiency. The levels of 25-OH vitamin-D3 were statistically significantly lower when compared to the control group (17.1±9.4 vs. 25.8±12.8ng/mL, respectively; p<0.001). This held true for both the HSE and LSE group compared to the control group (for the group 1; 24.6±11.8 vs. 32.1±10.6ng/mL, respectively; p=0.007, and for the group 2; 14.5±6.8 vs. 19.6±13.5ng/mL, respectively; p=0.003). Also in headache subgroups (migraine and TTH), vitamin D levels were significantly lower than the control group (17.3±9.0, 16.9±9.9 and 25.8±12.8ng/mL respectively; p<0.001). There may be a relationship between vitamin D deficiency and headache, with particular significance in LSE. We suggest that this conclusion needs to be supported with randomised clinical studies containing a larger numbers of samples and controls.

Serum 25-hydroxyvitamin D concentrations and lung cancer risk in never-smoking postmenopausal women.

Vitamin D has been implicated in lowering lung cancer risk, but serological data on the association among never-smoking women are limited. We report results examining the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with lung cancer risk among female never smokers. We also examined whether the association was modified by vitamin D supplementation and serum vitamin A concentrations. In the Women's Health Initiative, including the calcium/vitamin D (CaD) Trial, we selected 298 incident cases [191 non-small cell lung cancer (NSCLC) including 170 adenocarcinoma] and 298 matched controls of never smokers. Baseline serum 25(OH)D was assayed by a chemiluminescent method. Logistic regression was used to estimate odds ratios (ORs) for quartiles and predefined clinical cutoffs of serum 25(OH)D concentrations. Comparing quartiles 4 versus 1 of serum 25(OH)D concentrations, ORs were 1.06 [95% confidence interval (CI) 0.61-1.84] for all lung cancer, 0.94 (95% CI 0.52-1.69) for NSCLC, and 0.91 (95% CI 0.49-1.68) for adenocarcinoma. Comparing serum 25(OH)D ≥ 75 (high) versus <30nmol/L (deficient), ORs were 0.76 (95% CI 0.31-1.84) for all lung cancer, 0.71 (95% CI 0.27-1.86) for NSCLC, and 0.81 (95% CI 0.31-2.14) for adenocarcinoma. There is suggestive evidence that CaD supplementation (1g calcium + 400IU D3/day) and a high level of circulating vitamin A may modify the associations of 25(OH)D with lung cancer overall and subtypes (p interaction <0.10). In this group of never-smoking postmenopausal women, the results did not support the hypothesis of an association between serum 25(OH)D and lung cancer risk.

Incidence of hematologic malignancy and cause-specific mortality in the Women's Health Initiative randomized controlled trial of calcium and vitamin D supplementation.

Prior evidence of a possible link between vitamin D status and hematologic malignancy (HM) in humans comes from observational studies, leaving unresolved the question of whether a true causal relationship exists. The authors performed a secondary analysis of data from the Women's Health Initiative Calcium/Vitamin D (CaD) trial, a large randomized controlled trial of CaD supplementation compared with placebo in older women. Kaplan-Meier and Cox proportional hazards survival analysis methods were used to evaluate the relationship between treatment assignment and 1) incident HM and 2) HM-specific mortality over 10 years following randomization. HMs were classified by cell type (lymphoid, myeloid, or plasma cell) and analyzed as distinct endpoints in secondary analyses. A total of 34,763 Women's Health Initiative CaD trial participants (median age, 63 years) had complete baseline covariate data and were eligible for analysis. Women assigned to CaD supplementation had a significantly lower risk of incident HM (hazard ratio [HR], 0.80; 95% confidence interval [95% CI], 0.65-0.99) but not HM-specific mortality (HR, 0.77 [95% CI, 0.53-1.11] for the entire cohort; and HR, 1.03 [95% CI, 0.70-1.51] among incident HM cases after diagnosis). In secondary analyses, protective associations were found to be most robust for lymphoid malignancies, with HRs of 0.77 (95% CI, 0.59-1.01) and 0.46 (95% CI, 0.24-0.89), respectively, for cancer incidence and mortality in those assigned to CaD supplementation. The current post hoc analysis of data from a large and well-executed randomized controlled trial demonstrates a protective association between modest CaD supplementation and HM risk in older women. Additional research concerning the relationship between vitamin D and HM is warranted. Cancer 2017;123:4168-4177. © 2017 American Cancer Society.

Effects of Enhanced Exercise and Combined Vitamin D and Calcium Supplementation on Muscle Strength and Fracture Risk in Postmenopausal Chinese Women.

Objective To observe the effects of enhanced exercise and combined vitamin D and calcium supplementation on muscular strength and fracture occurrence in postmenopausal women with a high risk of osteoporosis.Methods Totally 614 postmenopausal women at high risk factors of osteoporosis were enrolled in Dongcheng district of Beijing and randomized into four groups:group A(control group,n=173),group B(regular Tai Chi exercise,n=171),group C(calcium 600 mg/d+VitD3 800 U/d,n=139),and group D[calcium 600 mg/d+25 hydroxyl vitamin D(25OHD) 0.25 μg/d,n=131].Muscular strength was measured at baseline and one and two years after intervention.Bone turnover markers were measured at baseline and during the two-year follow-up.Falls and fractures were recorded.Results The incidence of 25OHD<50 nmol/L was approximately 92.6%.During the follow-up,the left grip strength decreased significantly two years after intervention(t=-3.252,P=0.001)in group A.Right grip strength decreased significantly in group B(t=2.460,P=0.015)while left grip strength improved significantly in group C(t=-2.051,P=0.043)one year after intervention.In group D,muscular strength in both 12-month and 24-month did not change compared with baseline(both P>0.05).Furthermore,serum procollagen type I N-terminal propeptide elevated significantly in group A(t=-2.962,P=0.004),group B(t=-2.888,P=0.005),and group C(t=-2.441,P=0.016),whereas β-C-terminal telopeptide of type I collagen decreased significantly in group B(t=2.285,P=0.024)and group D(t=2.596,P=0.011)two years after intervention.Conclusion Enhanced exercise and combined calcium vitamin D supplementation may help sustain muscle strength in postmenopausal women,while calcium and vitamin D supplementation may improve muscular strength within a short period of time.

Calcium-vitamin D supplementation; does it affect lipid profile of menopaused women with normal renal function?

Introduction: The association between dyslipidemia and cardiovascular disease in women has been proposed and many studies investigated calcium-vitamin D (CaD) supplementation and their effect on lipid concentrations. Objectives: This randomized single-blind study aimed to evaluate the effect of CaD supplementation on serum lipid levels of menopaused women with normal renal function. Patients and Methods: In this study, 100 women 50-75 years old with cholesterol of 200-239 mg/dL, triglyceride (TG) of 150-199 mg/dL, low-density lipoprotein (LDL-C) of 100-159 mg/dL and vitamin D level less than 30 ng/mL and normal glomerular filtration rate (GFR) (>90 mL/min/1.73 m2) were investigated. First, body mass index (BMI) and waist circumference were calculated. The patients were given CaD supplement tablets made by Tehran Shimi Pharmaceutical Manufacturing Co. twice-daily (containing 500 mg calcium and 200 IU vitamin D) before breakfast and before lunch for 6 months. Then, blood lipid levels were collected after 3 and 6 months and were compared with initial data. Results: One hundred women with average age of 62.76 ± 7.02 years and BMI of 27.98 ± 3.44 kg/m2 were enrolled. FBS, cholesterol, HDL-C and LDL-C of the patients significantly increased (P < 00.001) but the mean TG and LDL/HDL ratio significantly decreased (P < 00.001). Also, the difference in LDL/HDL ratio was not significant after 3 months, but it was significant after 6 months (P = 00.155 and P < 00.001, respectively). Conclusion: Supplemental CaD significantly increased HDL-C and decreased TG and LDL/HDL ratio. Thus, it is recommended in menopaused women.

Knowledge of osteoporosis and related health education among Beijing community residents

Objective To investigate the awareness of osteoporosis and to evaluate the effect of related health education among Beijing community residents. Methods Total 1 000 patients, who visited in 4 community health service centers in Beijing from June to December 2011, were selected as study participants. The questionnaire survey on the awareness of osteoporosis was conducted in all participants, and the items of questionnaire included the risk factors, symptoms, prevalence of osteoporosis, the recommended daily calcium intake and risk of falls. Five hundred participants in 2 health service centers were designated as intervention group and 500 in another health service centers as control group. In intervention group the health education of osteoporosis was conducted every 2 to 3 months and the outpatient follow-up was provided every 2 months; the contents of health education included the clinical manifestation, prevention and control of osteoporosis, and the prevention of fall. In control group only the general outpatient consultation and referral were provided. The second questionnaire survey was conducted 2 years after intervention, the results were compared with baseline and the intervention effect was evaluated. Results Before intervention, 58.0%(580/1 000)participants had exercise, 43.1%(431/1 000)participants took calcium supplement and vitamin D, and 12.1%(121/1 000)took medication following doctor's advance. The rates of fall prevention and administration of calcium vitamin D in intervention group before intervention [27.8% (139/500) and 38.7% (194/500)] were lower than those in control group [33.8% (308/500) and 47.5% (237/500)]. After two-years of intervention the adoption rate of health behavior in intervention group was improved markedly, the highest one was diet control [increased by 38.4%(192/500)]and the lowest one was medication [increased by 17.3%(87/500)]. Compared to control group the diet control rate in intervention group was significantly higher [74.0%(370/500) vs. 23.6%(108/457), χ2=261.887, P=0.000]. In addition, unhealthy behaviors were also reduced: 55.0% participants reduced caffeine consumption and 72.2% participants reduced sodium intake in intervention group. Conclusion The awareness of osteoporosis among Beijing community residents is not satisfactory, but intervention focusing on osteoporosis prevention education is effective to change their behavior. Key words: Osteoporosis; Health behavior; Intervention studies

Age of menopause and fracture risk in postmenopausal women randomized to calcium + vitamin D, hormone therapy, or the combination: results from the Women's Health Initiative Clinical Trials.

We previously reported that in the absence of hormone therapy (HT) or calcium/vitamin D (Ca/D) supplementation, earlier menopause age was associated with decreased bone mineral density and increased fracture risk in healthy postmenopausal women. Treatment with HT and Ca/D is protective against fractures after menopause. In this analysis, we asked if the age of menopause onset alters fracture risk in healthy postmenopausal women receiving HT, Ca/D, or a combination. Hazard ratios (HRs) for any fracture among 21,711 healthy postmenopausal women enrolled in the Women's Health Initiative Clinical Trial, who were treated with HT, Ca/D, or HT + Ca/D, and who reported age of nonsurgical menopause of <40, 40 to 49, and ≥50 years, were compared. Women with menopause <40 years had significantly higher HR for fracture than women with menopause 40 to 49 or ≥50 years, regardless of treatment intervention (HR [95% CI]: menopause <40 y vs ≥50 y, 1.36 [1.11-1.67]; menopause <40 y vs 40-49 y, 1.30 [1.06-1.60]). In the overall Women's Health Initiative Clinical Trial cohort and within each treatment group, women with younger menopause age (<40 y) had a higher risk of any fracture than women reporting older menopause ages. The effect of menopause age on fracture risk was not altered by any of the treatment interventions (HT, Ca/D, HT + Ca/D), suggesting that early age of menopause is an independent contributor to postmenopausal fracture risk.