Forms Of Osteoporosis Research Articles

MiRNA-seq analysis of high glucose induced osteoblasts provides insight into the mechanism underlying diabetic osteoporosis

The present study aims to explore the etiology of Diabetic osteoporosis (DOP), a chronic complication associated with diabetes mellitus. Specifically, the research seeks to identify potential miRNA biomarkers of DOP and investigated role in regulating osteoblasts. To achieve this, an animal model of DOP was established through the administration of a high-sugar and high-fat diet, and then injection of streptozotocin. Bone microarchitecture and histopathology analysis were analyzed. Rat calvarial osteoblasts (ROBs) were stimulated with high glucose (HG). MiRNA profiles of the stimulated osteoblasts were compared to control osteoblasts using sequencing. Proliferation and mineralization abilities were assessed using MTT assay, alkaline phosphatase, and alizarin red staining. Expression levels of OGN, Runx2, and ALP were determined through qRT-PCR and Western blot. MiRNA-sequencing results revealed increased miRNA-702-5p levels. Luciferase reporter gene was utilized to study the correlation between miR-702-5p and OGN. High glucose impaired cell proliferation and mineralization in vitro by inhibiting OGN, Runx2, and ALP expressions. Interference with miR-702-5p decreased OGN, Runx2, and ALP levels, which were restored by OGN overexpression. Additionally, downregulation of OGN and Runx2 in DOP rat femurs was confirmed. Therefore, the miRNA-702-5p/OGN/Runx2 signaling axis may play a role in DOP, and could be diagnostic biomarker and therapeutic target for not only DOP but also other forms of osteoporosis.

Study on the Mechanism of Action of the Traditional Chinese Medical Prescription Gushukang in Treating Osteoporosis Based on Network Pharmacology and Experimental Verification.

Gushukang (GSK), a traditional Chinese medical prescription, has made a great and extensive contribution to the treatment of different forms of osteoporosis, but polypharmacology studies of its mechanism of action are lacking. This study investigates the pharmacological mechanism of osteoporosis using network pharmacology and molecular docking. Experimental verification was carried out to confirm the efficacy of GSK on RANKLinduced osteoclast differentiation in RAW264.7 cells to verify the network pharmacology studies. The effective chemical components and corresponding targets of osteoporosis with oral bioavailability of more than 30% and drug-like properties greater than 0.18 were searched in the TCMSP and TCM-ID databases. DrugBank, GeneCards, OMIM, TTD, and other databases were examined for targets related to osteoporosis. Using Cytoscape software, a network of possible TCM-active ingredient-osteoporosis targets was created. STRING software was used to create the networks of protein-protein interactions. The DAVID program was carried out to conduct GO and KEGG pathway enrichment analyses of the targets. Molecular docking and pattern of action analysis were carried out using software like AutoDock Vina and Discovery Studio Visualizer. The growth media for RAW264.7 cells contained varying doses of GSK serum and 50 ng/mL RANKL. The activity of TRAP was altered. Additionally, genes related to osteoclasts were examined using an RT-PCR assay. Network pharmacological analysis revealed that the primary efficacy targets of osteoporosis were PTGS2, PTGS1, HSP90AA1, NCOA2, ADRB2, ESR1, NCOA1, and AR. The pharmacological targets of osteoporosis may be mediated by substances including quercetin, kaempferol, luteolin, naringenin, icariin, anthocyanin, tanshinone IIA, and cryptotanshinone. GSK markedly inhibited RANKL-induced TRAP activity. qRT-PCR results revealed decreased expression of the PTGS2 and ADRB2 genes upon GSK treatment. The findings of network pharmacology, molecular docking, as well as experimental verification provide a new further study for elucidating the pharmacodynamic substance basis and polypharmacology mechanism of GSK in treating osteoporosis.

Denosumab improves trabecular bone score in relationship with decrease in fracture risk of women exposed to aromatase inhibitors.

Trabecular bone score (TBS) is a gray-level textural metric that has shown to correlate with risk of fractures in several forms of osteoporosis. The value of TBS in predicting fractures and the effects of bone-active drugs on TBS in aromatase inhibitors (AIs)-induced osteoporosis are still largely unknown. The primary objective of this retrospective study was to assess the effects of denosumab and bisphosphonates (BPs) on TBS and vertebral fractures (VFs) in women exposed to AIs. 241 consecutive women (median age 58years) with early breast cancer undergoing treatment with AIs were evaluated for TBS, bone mineral density (BMD) and morphometric VFs at baseline and after 18-24months of follow-up. During the study period, 139 women (57.7%) received denosumab 60mg every 6months, 53 (22.0%) BPs, whereas 49 women (20.3%) were not treated with bone-active drugs. Denosumab significantly increased TBS values (from 1.270 to 1.323; P < 0.001) accompanied by a significant decrease in risk of VFs (odds ratio 0.282; P = 0.021). During treatment with BPs, TBS did not significantly change (P = 0.849) and incidence of VFs was not significantly different from women untreated with bone-active drugs (P = 0.427). In the whole population, women with incident VFs showed higher decrease in TBS vs. non-fractured women (P = 0.003), without significant differences in changes of BMD at any skeletal site. TBS variation predicts fracture risk in AIs treated women. Denosumab is effective to induce early increase of TBS and reduction in risk of VFs.

Zoledronic acid for osteoporosis and associated low-energy fractures

Zoledronic acid is a third-generation amino-containing BF that has been used to treat patients with osteoporosis for more than 15 years. Over the years, numerous experimental and clinical studies have proven the high efficacy of the drug in osteoporosis, both in women of various age groups, and in men, with primary and secondary osteoporosis, in patients with varying degrees of bone loss and risk of fractures. Intravenous infusions of zoledronic acid have been shown to result in a rapid gain of bone mass, a significant reduction in the risk of low-energy fractures of the vertebrae (spine), proximal femoral and nonvertebral fractures on the whole. However, in recent years, the use of the drug has significantly decreased, which is associated both with the lack of awareness of primary care physicians about the possibilities of this drug, and the fear of such complications of its use as atypical fractures and osteonecrosis of the jaw bones. The presented review aims to increase the knowledge of physicians regarding the mechanism of action of zoledronic acid, the regimens for prescribing the drug in various forms of osteoporosis and fractures against its background. The given clinical example shows the ability of zoledronic acid (osteostatics) to increase the mass of not only cancellous, but also the cortical bone of the proximal femur, which increases the role of zoledronic acid in the prevention of recurrent fractures. On top of that, the prolonged effect of the drug allows, when the desired therapeutic effect is achieved, to reduce the frequency of prescribing according to the ‘drug holiday’ principal, decreasing economic expenditures and medical and social burden.

Морфологічні аспекти репаративної регенерації кісткової тканини в умовах впливу протипухлинної хіміотерапії

The occurrence of fractures in the development of cancer in the body is due to changes in bone metabolism in the form of osteoporosis and metastatic bone damage. Their appearance leads to the postponement or cessation of treatment of cancer, which affects the life expectancy of such patients and the chances of recovery. Antitumor chemotherapy, as one of the main methods of cancer treatment, is prescribed for long-term courses and affects the healing of fractures. However, according to the literature, the effect of antitumor chemotherapeutics on reparative regeneration is poorly understood today. The purpose of the work is to study the morphological features of reparative osteogenesis under the influence of antitumor chemotherapy. Materials and methods. The study was performed on 96 white laboratory male rats 7 months of age weighing 230±10 g. All animals had a perforated defect with a diameter of 2 mm spherical cutter to the bone marrow canal in the middle third of the femoral shaft. Animals were divided into control (n = 24, without chemotherapy) and three experimental groups (I, II, III, n = 72), which after injury and every 21 days of the study were administered intraperitoneal anticancer chemotherapeutics: I (n = 24) – doxorubicin (60 mg / m²), II (n = 24) – 5-fluorouracil (600 mg / m²), III (n = 24) – methotrexate (40 mg / m²). On the 15th, 30th, 45th, 60th days after injury, the animals were removed from the experiment, followed by removal of the injured long tubular bones. Histological preparations stained with hematoxylin-eosin, followed by their morphometry, scanning electron microscopy with the method of X-ray energy dispersion spectroscopy, immunohistochemical examination were performed. Results and discussion. Antitumor chemotherapeutics causes delayed callus formation, which is manifested by an increase in the area of connective and reticulofibrous bone tissue in the regenerate, along with the slow formation of lamellar bone tissue. Chemotherapy leads to disorders of phosphorus-calcium metabolism both in the regenerate and in the maternal bone in the form of reducing the intensity of mineralization of the newly formed bone matrix and slowing down the remodeling activity of the maternal bone. Chemotherapy is accompanied by an increase in the expression of the bone resorption marker cathepsin K and a decrease in the expression of the osteopontin bone marker, which indicates a delay in the formation of regenerate in the area of injury and a decrease in the rate of reparative regeneration. Conclusion. The most pronounced delay in the processes of remodeling of bone regenerate was found with the use of doxorubicin and methotrexate, while 5-fluorouracil showed less inhibitory effect on these processes

Use of alendronate in the therapy of osteoporosis

Treatment of osteoporosis is a difficult task due to the need for long-term medication and maximum safety. The main goal of osteoporosis treatment is to prevent bone fractures. According to the national clinical guidelines for the treatment of osteoporosis, nitrogen-containing bisphosphonates are among the first-line drugs for the prevention and treatment of this disease. The diversity in the side chain structure determines the strength with which bisphosphonates bind to hydroxyapatite, are distributed, and remain in bone tissue for a certain time after treatment has been completed. They are the drugs of choice as they have proven efficacy in reducing the risk of fractures, and at the same time an acceptable safety profile. Bisphosphonates are the most well-known and studied drugs, successfully used in all countries for the treatment of various forms of osteoporosis. When using oral forms of bisphosphonates, the most expected undesirable phenomenon is esophagitis. The development of new forms of well-known and proven medicines that reduce adverse events and increase adherence to treatment is extremely important and promising. Of the latest achievements in this regard, it should be noted a new form of alendronate-Binosto-effervescent soluble tablet, the use of which reduces the risk of irritating effects on the upper gastrointestinal tract.

Мінеральна щільність кісткової тканини у хворих із коксартрозом із супутньою патологією хребта

Summary. Relevance. Combined pathology of the lumbar spine and hip joint is rightly considered one of the serious problems of modern orthopedics. Among the many factors that can cause lumbar spine pain, a decrease in bone mineral density (BMD) of the vertebral bodies in the form of osteoporosis may play a role. Objective: to study BMD in patients with osteoarthritis of the hip joints with concomitant pathology of the spine. Materials and Methods. The analysis of data of densitometric and statistical research of 62 patients who had grade III-IV coxarthrosis (CA) with concomitant pathology of the spine was carried out. Results. Decreased BMD in patients with grade III CA was found in 22 (35.4%) in the form of osteopenia and in 8 (12.9%) as osteoporosis; in patients with grade IV CA – in 4 (6.4%) and in 17 (27.4%) – respectively. It was found that BMD in patients with grade IV CA is significantly lower than in patients with grade III and there is a probable medium-strength relationship between a stage of CA and BMD of the femoral neck. It has been proven that patients with hypoplastic coxarthrosis and the true form of lumbar vertebral syndrome (LVS) have probably lower mean BMD values and exactly these groups of patients have the highest incidence of osteopenia and osteoporosis. Conclusions. 51 (82%) patients with grade III-IV CA revealed a decrease in BMD in the form of osteopenia and osteoporosis, the degree of which depends on the severity of the disease and functional insufficiency of the limb. Changes in BMD have their own characteristics in patients with different types of CA and forms of LVS.

Pharmacological management of osteoporosis in postmenopausal women: The current state of the art.

Osteoporosis is a common disease that increases fracture risk. Fragility fractures bring heavy consequences in terms of mortality and disability, with burdensome health and social costs. In subjects with clinical bone fragility, the first goal is to identify the secondary forms of osteoporosis, especially in young subjects, in males and in patients who recently experienced a fragility fracture. In addition, before considering any sort of treatment, it is fundamental to check for adequate calcium and vitamin D intake, since their deficiency is the most common reason for drug failure.In the last decade of the 20th century, several molecules have been developed and proved to be effective in achieving the true goal of any antiosteoporotic drug: fracture prevention.In this article, we considered the most commonly prescribed antiresorptive drugs (hormonal therapy, bisphosphonates, and denosumab), the anabolic agents (teriparatide), the dual-action drugs (romosozumab), and the drugs characterized by an unclear mechanism of action (strontium ranelate) to provide physicians with useful insights for their clinical practice. We discussed the main criteria for the appropriate choice selection and management of each treatment. Finally, we addressed the current controversies related to treatment discontinuation, sequential, and combination therapy.

Reproductive disorders, osteoporosis and secondary hyperparathyroidism with celiac disease

A clinical observation of a patient with celiac disease, aged 23, with severe form of osteoporosis, accompanied by atraumatic fractures bones, lameness, late onset of menstruation and pathology of pregnancy is described. It is emphasized that only a timely diagnosis celiac disease and timely prescribed treatment make it possible to avoid severe complications.

RISK FACTORS OF BONE MINERAL DENSITY DEFICIT AND LOW-ENERGY FRACTURES IN PRIMARY OSTEOPOROSIS IN MEN

Purpose:to evaluate the role of well-known factors on the formation of bone mineral density (BMD) and risk of fractures in primary osteoporosis in men.Patients and methods.The influence of well-known osteoporosis risk factors such as age, smoking, alcohol consumption, obesity, genetic disorders in genes encoding COL1A1, COL1A2 and VDR-receptor products, history of low-energy fractures in first-line relatives upon the BMD value and risk of fractures was evaluated in 231 patients with primary osteoporosis. All patients were divided into three age groups according to the following forms of osteoporosis: 17-20 years (n=26) – juvenile form, 21-50 (n=103) – idiopathic form, patients over 51 years (n=102). To assess the influence of study factors on the risk of fractures the patients were subdivided into 5 groups according to fracture localization.Results.The relationship between BMD deficit and mutations in homozygous form of gene rs2412298 (encodes collagen), and the tendency to a reliable increase of BMD deficit in L1 – L4 vertebrae under polymorphism in homozygous form of 1800012 gene was noted that might be evidence of their contribution to the development of primary osteoporosis in men. At the same time, smoking, alcohol consumption, age, mutations in homozygous form of gene rs2412298 and a history of low-energy fractures in first-line relatives increased the risk of low-energy fractures of the vertebral bodies and proximal femur.

Effect of a bisphosphonate and selective estrogen receptor modulator on bone remodeling in streptozotocin-induced diabetes and ovariectomized rat model

Background ContextDiabetes and menopause can cause severe osteoporosis. In general, menopause and diabetes can lead to an imbalance in bone turnover, which results in secondary osteoporosis. However, the efficacy of antiresorptive drugs against this form of osteoporosis has not been extensively evaluated. ObjectiveThe aim of this study was to determine the changes in vertebral bone remodeling when postmenopausal osteoporosis is accompanied by diabetes and to compare the efficacy of bisphosphonates and selective estrogen-receptor modulators (SERMs) against these outcomes. Study designStreptozotocin-induced diabetic, ovariectomized Sprague-Dawley rats were used as the disease model. Alendronate and raloxifene were used as the bisphosphonate and SERM, respectively. MethodsWe divided 62 female rats into five groups: (1) control (n=14), (2) DM (diabetes) (n=12), (3) DM+OVX (diabetes+ovariectomy) (n=12), (4) DM+OVX+A (diabetes+ovariectomy+alendronate) (n=12), and (5) DM+OVX+R (diabetes+ovariectomy+raloxifene) (n=12). Serum biochemical markers of bone turnover, including osteocalcin and the C-telopeptide of type I collagen (CTX-1), were analyzed. We measured histomorphometric parameters of the fourth lumbar vertebrae using microcomputed tomography. Mechanical strength was evaluated by a compression test. ResultsIn the DM and DM+OVX group, only the levels of osteocalcin significantly decreased compared with those of the control group at 8 weeks after OVX. At 12 weeks, the serum CTX-1 levels in the DM+OVX+A and DM+OVX+R groups were significantly lower than those of the DM+OVX group, but there were no changes in the levels of osteocalcin. Bone mineral density and mechanical strength were higher in the DM+OVX+A and DM+OVX+R groups than in the DM and DM+OVX groups (p<.05). ConclusionsEven if postmenopausal osteoporosis is accompanied by diabetes in this animal model, both alendronate and raloxifene seem to show antiresorptive effects, decreased bone turnover rates, and improved bone mechanical strength. Therefore, alendronate and raloxifene are effective in the treatment of osteoporosis even for bone loss caused by DM and postmenopausal osteoporosis.

Risk factors of bone mineral density deficit and low-energy fractures in primary osteoporosis in men

Purpose: to evaluate the role of well-known factors on the formation of bone mineral density (BMD) and risk of fractures in primary osteoporosis in men. Patients and methods. The influence of well-known osteoporosis risk factors such as age, smoking, alcohol consumption, obesity, genetic disorders in genes encoding COL1A1, COL1A2 and VDR-receptor products, history of low-energy fractures in first-line relatives upon the BMD value and risk of fractures was evaluated in 231 patients with primary osteoporosis. All patients were divided into three age groups according to the following forms of osteoporosis: 17-20 years (n=26) - juvenile form, 21-50 (n=103) - idiopathic form, patients over 51 years (n=102). To assess the influence of study factors on the risk of fractures the patients were subdivided into 5 groups according to fracture localization. Results. The relationship between BMD deficit and mutations in homozygous form of gene rs2412298 (encodes collagen), and the tendency to a reliable increase of BMD deficit in L1 - L4 vertebrae under polymorphism in homozygous form of 1800012 gene was noted that might be evidence of their contribution to the development of primary osteoporosis in men. At the same time, smoking, alcohol consumption, age, mutations in homozygous form of gene rs2412298 and a history of low-energy fractures in first-line relatives increased the risk of low-energy fractures of the vertebral bodies and proximal femur.

Regulatory Perspectives in Pharmacometric Models of Osteoporosis.

Osteoporosis is a disorder of the bones in which they are weakened to the extent that they become more prone to fracture. There are various forms of osteoporosis: some of them are induced by drugs, and others occur as a chronic progressive disorder as an individual gets older. As the median age of the population rises across the world, the chronic form of the bone disease is drawing attention as an important worldwide health issue. Developing new treatments for osteoporosis and comparing them with existing treatments are complicated processes due to current acceptance by regulatory authorities of bone mineral density (BMD) and fracture risk as clinical end points, which require clinical trials to be large, prolonged, and expensive to determine clinically significant impacts in BMD and fracture risk. Moreover, changes in BMD and fracture risk are not always correlated, with some clinical trials showing BMD improvement without a reduction in fractures. More recently, bone turnover markers specific to bone formation and resorption have been recognized that reflect bone physiology at a cellular level. These bone turnover markers change faster than BMD and fracture risk, and mathematically linking the biomarkers via a computational model to BMD and/or fracture risk may help in predicting BMD and fracture risk changes over time during the progression of a disease or when under treatment. Here, we discuss important concepts of bone physiology, osteoporosis, treatment options, mathematical modeling of osteoporosis, and the use of these models by the pharmaceutical industry and the Food and Drug Administration.

Harnessing Finger Millet to Combat Calcium Deficiency in Humans: Challenges and Prospects.

Humans require more than 20 mineral elements for healthy body function. Calcium (Ca), one of the essential macromineral, is required in relatively large quantities in the diet for maintaining a sound overall health. Young children, pregnant and nursing women in marginalized and poorest regions of the world, are at highest risk of Ca malnutrition. Elderly population is another group of people most commonly affected by Ca deficiency mainly in the form of osteoporosis and osteopenia. Improved dietary intake of Ca may be the most cost-effective way to meet such deficiencies. Finger millet [Eleusine coracana (L.) Gaertn.], a crop with inherently higher Ca content in its grain, is an excellent candidate for understanding genetic mechanisms associated with Ca accumulation in grain crops. Such knowledge will also contribute toward increasing Ca contents in other staple crops consumed on daily basis using plant-breeding (also known as biofortification) methods. However, developing Ca-biofortified finger millet to reach nutritional acceptability faces various challenges. These include identifying and translating the high grain Ca content to an adequately bioavailable form so as to have a positive impact on Ca malnutrition. In this review, we assess some recent advancements and challenges for enrichment of its Ca value and present possible inter-disciplinary prospects for advancing the actual impact of Ca-biofortified finger millet.

Exploiting the WNT Signaling Pathway for Clinical Purposes.

The goal of this paper is to evaluate critically the literature published over the past 3years regarding the Wnt signaling pathway. The Wnt pathway was found to be involved in bone biology in 2001-2002 with the discovery of a (G171V) mutation in the lipoprotein receptor-related protein 5 (LRP5) that resulted in high bone mass and another mutation that completely inactivated Lrp5 function and resulted in osteoporosis pseudoglioma syndrome (OPPG). The molecular biology has been complex, and very interesting. It has provided many opportunities for exploitation to develop new clinical treatments, particularly for osteoporosis. More clinical possibilities include: treatments for fracture healing, corticosteroid osteoporosis, osteogenesis imperfecta, and others. In addition, we wish to provide historical information coming from distant publications (~350years ago) regarding bone biology that have been confirmed by study of Wnt signaling. A recent finding is the development of an antibody to sclerostin that is under study as a treatment for osteoporosis. Development of treatments for other forms of osteoporosis, such as corticosteroid osteoporosis, is also underway. The full range of the applications of the work is not yet been achieved.

Osteocytes signaling events induced by intermittent vs continuous Teriparatide treatment affect in vitro osteoblast differentiation and mineralization

PTH(1-34), also known as Teriparatide, is an active anabolic drug used in the treatment of some forms of osteoporosis and occasionally exploited to speed fracture healing. The effect of such therapies are dependent on the type of administration, in fact it has been largely demonstrated that a short administration of Teriparatide (also called intermittent) increases the bone mass, meanwhile a long administration of the same agent (known as continuous) leads to an increased resorption. The molecular reason why the type of administration is so critical for the fate of the bone remodeling is still largely unknown but it is probably due to the fact that it affects several signaling pathways and alters the biological activity of a cohort of cells: osteoblasts, lining cells, osteoclasts, and osteocytes. In the present work, we firstly focused the attention on molecular events induced by intermittent vs continuous Teriparatide treatment in a well-known osteocytes in vitro model, the MLO-Y4 cells. By the use of a gene array platform, we found many molecules upregulated or downregulated depending on the the temporal administration modes, suggesting that the drug affects in diverse manner the osteocytes related signaling pathways. In particular, we paid attention to Wisp-2, a protein of the Wnt pathway that has been demonstrated to be able to interact and influence the differentiation of osteoblasts into osteocytes and their mineralization. Secondly, through the mineralization assay, we analyzed the functional effects, involving the differentiation of osteoblast IDG-SW3 cell line, upon the conditioning culture with MLO-Y4 medium, that were pre-treated with short and long time administration of Teriparatide. These findings, consistent with the crucial role performed by osteocytes on osteoblast differentiation, clarify the molecular events downstream the short treatment with Teriparatide, suggesting that the perturbation of certain signaling patwhays, such as the Wnt pathway, is crucial for the positive regulation of bone formation.

EFFECT OF A 5-YEAR ALFACALCIDOL TREATMENT IN COMBINATION WITH CALCIUM CARBONATE ON BONE MINERAL DENSITY IN THE PRIMARY FORMS OF SYSTEMIC OSTEOPOROSIS IN MEN

The article presents the results of 5-year treatment with a combination of alfacalcidol and calcium carbonate in 47 men with primary forms of systemic osteoporosis. The obtained results show the effectiveness of this treatment in patients with low and normal turnover forms of osteoporosis. Significant increase of BMD at L1-L4 was observed after the first year of treatment, at the Neck region - after 3-rd year of treatment. Comparison of the magnitude of the annual increase of BMD has shown that the effectiveness of the treatment increases with its duration. The possibility of hypercalcemia was excluded by monitoring of calcium levels in blood and urine at intervals of 3-6 months throughout the treatment period.

Bone metabolism in non-alcoholic fatty liver disease: vitamin D status and bone mineral density.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease and abnormal liver enzyme worldwide. NAFLD is reported to be associated with other extra-hepatic diseases including cardiovascular disease, diabetes mellites and thyroid gland abnormalities. Liver is also the source of many proteins involved in bone metabolism and is the regulator of several bone metabolism pathways. Although underlying pathogenesis is not clear, the association between NAFLD and low bone mineral density (BMD) in the forms of osteoporosis and osteopenia has been recently reported. This study aimed to review current evidences supporting the association between bone metabolism including low BMD and serum vitamin D level in patients with NAFLD. Epidemiolocal studies indicating lower BMD and vitamin D in patients with NAFLD have been reviewed. The main pathophysiological mechanisms including association of insulin resistance, serum adiponectin, ghrelin, osteopontin, osteoprotegerin, and osteocalcin with NAFLD and low BMD have been briefly reviewed and summarized. Results of current clinical trials investigating the role of vitamin D supplementation for treatment of hepatic steatosis and non-alcoholic steatohepoatitis (NASH) have been also summarized. As a conclusion, increasing evidences are now available suggesting low BMD in patients with NAFLD. Some of these studies showed association of NAFLD severity with low vitamin D and BMD. Screening and surveillance of skeletal system regarding osteoporosis/osteomalacia in patients with NAFLD may be considered in future strategies and guidelines for NAFLD management.

Clinical aspects and importance of nutrition in homeostasis of the bone tissue

Substantial changes have occurred in the nutritional management of many diseases in the last twenty years. Introduction of standards, clinical review and implementation of evidence based practice led to re-evaluation of some established dietary interventions. The most common form of osteoporosis is the primary osteoporosis, which is the result of the bone loss and deterioration of bone structure, as people age. Bone loss and osteoporosis can be prevented through adequate nutrition, physical activity, and, if necessary, appropriate treatment. This review will focus on nutritional and clinical aspects of bone tissue homeostasis, with references to physiological and pathophysiological processes.

Body composition and bone health in long-term survivors of acute lymphoblastic leukaemia in childhood and adolescence: the protocol for a cross-sectional cohort study

IntroductionSuccess in the treatment of young people with cancer, as measured conventionally by survival rates, is mitigated by late effects of therapy that impose a burden of morbidity and limit...