Mean Serum Osteocalcin Research Articles

CORRELATION OF SERUM OSTEOCALCIN LEVEL WITH THE INDICES OF OBESITY AND LIPID PROFILE IN TYPE II DIABETIC SUDANESE PATIENTS

Objectives:Osteocalcin, an osteoblast-specific protein, has recently been reported to affect energy metabolism, this study aimed to assess the relationship between serum total osteocalcin and measurements of adiposity and lipid profile in type II diabetic Sudanese patients. Methods: In this cross-sectional study, 115 people with type II diabetes (34 men, 81 women) aged 18 to 94 years were enrolled in the study. Total osteocalcin and insulin were measured using ELISA (enzyme-linked immunosorbent assay) technique. Fasting blood glucose and lipid profile were measured by a spectrophotometer. Results: Mean serum osteocalcin concentration in diabetic patients was significantly lower than those in control subjects (p ≤ 0.001). When the test was done between TOC and lipid profile, there was a moderate negative correlation between TOC and TCHOL. Which was statistically significant (P = 0.003). There was a moderate negative correlation between TOC and TG. Which was statistically non-significant (P = 0.057). There was a strong positive correlation between TOC and HDL. Which was statistically significant (P = 0.000). There was a weak positive correlation between TOC and LDL. That is statistically non-significant P = 0.105. Conclusion:Our findings showed a statistically highly significant negative correlation between TOC and fasting blood glucose concentration. Similarly, the correlation between FBG and ucOC, age, BMI, TCHOL, and HDL showed a negative correlation that was not significant.

Serum osteocalcin – A biochemical marker for pubertal growth assessment

Objectives: Growth evaluation methods have made great strides in the shift from radiologic to non-radiologic biomarkers. Osteocalcin (OC), a bone protein, has been reportedly used as a biomarker for osteoblastic bone formation. The present study aimed at evaluation of serum OC in Class II skeletal patterns for accurate assessment of pubertal growth spurt to facilitate functional jaw orthopedics during the growth period. Material and Methods: Eighty subjects, comprising 38 males and 42 females with skeletal Class II malocclusion in the age range of 11–18 years, were recruited for the study. Human serum OC was quantitatively assessed with enzyme-linked immunosorbent assay. The cervical vertebral stages were assessed from lateral cephalograms. Statistical analysis for gender-wise comparison of mean serum levels of OC at each cervical stage (CS) and in the intervals of the CSs was carried out using Kruskal–Wallis test and for intergroup comparisons, Mann–Whitney U-test with Bonferroni’s correction was done. Results: Gender-wise comparison of mean serum OC levels revealed that it was highest in CS2 in both males (72.24 ng/mL) and females (74.71 ng/mL) with another discernible peak in CS5 in males (66.82 ng/mL) and in CS6 in females (63.78 ng/mL), exhibiting thereby a circadian rhythm in bone modeling during the entire adolescent growth spurt. Conclusion: Despite a pre-pubertal and a late pubertal spike in both the genders, the mean OC serum levels actually exhibited a circadian rhythmicity across all the CSs, exhorting thereby the importance of bone remodeling during the complete circumpubertal growth period.

Bone density and bone health alteration in boys with Duchenne Muscular Dystrophy: a prospective observational study.

Boys with Duchenne Muscular Dystrophy (DMD) are at increased risk for compromised bone health, manifesting as low-impact trauma long bone fractures and vertebral compression fractures. In a prospective observational study, we studied bone health parameters in North Indian boys with DMD. We consecutively enrolled ambulatory boys with DMD on glucocorticoid therapy. Bone health was evaluated with X-ray spine, Dual-energy X-ray absorptiometry (DXA), serum calcium, vitamin D3 (25[OH]D), 1,25-dihyroxyvitamin D3 (1,25[OH]2D3), serum osteocalcin, osteopontin, and N terminal telopeptide of type 1 collagen (Ntx) levels. A total of 76 boys with DMD were enrolled. The median age was 8.5 (interquartile range [IQR] 7.04-10.77)years. Among these, seven (9.2%) boys had long bone fractures, and four (5.3%) had vertebral compression fractures. Fifty-four (71%) boys underwent DXA scan, and among these 31 (57%) had low bone mineral density (BMD, ≤-2 z-score) at the lumbar spine. The mean BMD z-score at the lumbar spine was-2.3 (95% confidence interval [CI]=-1.8,-2.8), and at the femoral neck was-2.5 (95% CI=-2,-2.9). 25(OH)D levels were deficient in 68 (89.5%, n=76) boys, and 1,25(OH)2D3 levels were deficient in all. Mean serum osteocalcin levels were 0.68±0.38ng/mL (n=54), serum osteopontin levels were 8.6±4.6pg/mL (n=54) and serum Ntx levels were 891±476nmol/L (n=54). Boys with low BMD received glucocorticoids for longer duration, in comparison to those with normal BMD (median, IQR [16.9(6-34) months vs. 7.8(4.8-13.4) months]; p=0.04). Bone health is compromised in North Indian boys with DMD. BMD at the lumbar spine is reduced in more than half of boys with DMD and nearly all had vitamin D deficiency on regular vitamin D supplements. Longer duration of glucocorticoid therapy is a risk factor for low BMD in our cohort.

Serum osteocalcin: A potential biomarker for primary osteoporosis

Osteoporosis is a silent killer usually asymptomatic and noticed only after a fracture. Women irrespective of their origin and social strata show an accelerated phase of bone loss, for about 10 yrs after the cessation of ovarian function due to hormonal imbalance. Until now for the diagnosis of osteoporosis Bone mineral density (BMD) and DEXA was used, which is costly hence bone turns over markers have come to vogue in suggesting the risk of osteoporotic fractures. Objectives of the Study: To assess the potentiality of serum osteocalcin as a diagnostic tool for osteoporosis in post menopausal women and thus overcome the risk of fractures. Materials and Methods: This study was conducted on 50 apparently healthy pre menopausal women and 50 postmenopausal women with immediate fractures sustained as a result of trivial trauma. Results: The mean serum osteocalcin level was (2.63 ± 1.76) in the post menopausal women with fractures as compared to the pre menopausal women (5.55 ± 2.92) which was statistically significant. (p value Conclusion: Osteocalcin is a highly sensitive bone formation marker and can be used as a diagnostic or screening tool in post menopausal women for Osteoporosis. The decreased serum osteocalcin levels after menopause could hence predict and prevent the risk of fractures. Keywords: Osteocalcin, Pre-menopausal women, Postmenopausal women with fractures, Calcium, Phosphorous, Alkaline phosphatase, Total protein, Albumin and osteoporosis.

Biochemical Status of Beta-Thalassemia Major Patients in Erbil City

Background and objectives: β -thalassemia major patient is one of the hereditary hemolytic diseases, which can cause many hematological and biochemical changes in the affected patient. And these changes can happen even when the patient is treated adequately. The objective was to study biochemical changes in the level of serum hepcidin, osteocalcin, calcium, ferritin, iron, PTH and IL-6 in patients with β- thalassemia major and to compare it with control subjects. Patients and method: In this research 40 patients with beta thalassemia major, 20 Female and 20 Male (age ranged from 10 to 38 years), and 40 control subjects 20 Female and 20 Male (age ranged from 9 to 33 years) were studied. Measurement of serum hepcidin, osteocalcin, calcium, ferritin, iron, PTH and IL-6 were done by the researcher for both cases and control groups. Results: Serum Ferritin and Iron were higher significantly in all thalassemic patients (P< 0.001), this increment was proportional with increasing number of units of blood transfusion and aging. Mean serum Hepcidin, PTH, Osteocalcin and IL6 were significantly lower in thalassemic patients in contrast to the control subjects (P< 0.001). Reduction in S-PTH was proportional to increasing number of blood transfusion and aging. Conclusion: Our study demonstrates that in B-thalassemia major patients Serum Ferritin and Iron were increased proportionally with increasing age and number of units of blood transfusion. Mean serum PTH, osteocalcin, hepcidin, and IL-6 were reduced, but mean serum calcium was remained normal.

Serum osteocalcin levels in postmenopausal osteoporotic women receiving alendronate

Osteoporosis is characterized by low bone mass, changes in the microscopic structure of bone, and increased bone fragility. Monitoring response to treatment is critical for the appropriate management of osteoporosis. Serum osteocalcin has become known as a bone formation biomarker for the evaluation of treatment response in postmenopausal osteoporosis. The present study assessed the effect of alendronate on serum osteocalcin levels in patients with postmenopausal osteoporosis. Thirty-four women with postmenopausal osteoporosis diagnosed by DEXA received alendronate 10 mg/day for 3 months. Serum osteocalcin, calcium, phosphorus, and alkaline phosphatase (ALP) were measured at baseline and after 45 and 90 days. Mean age and duration of menopause were 57.91±7.68 and 9.37±8.43 years, respectively. Mean serum osteocalcin at baseline was 15.27±3.7 ng/ml, which decreased significantly after 45 and 90 days of treatment with alendronate (p=0.009 and p<0.001, respectively). The levels of serum osteocalcin at days 45 and 90 in patients aged < 60 and ≥ 60 years were not significantly different. The levels of serum osteocalcin at days 45 and 90 in patients with a menopause duration of < 5 and ≥ 5 years were not significantly different. No significant difference was observed in serum osteocalcin levels at days 45 and 90 in patients with osteoporosis only in the femoral neck (n=7), only in the lumbar spine (n=20), and in both femoral neck and lumbar spine (n=7). Measurement of serum osteocalcin is a less expensive, more available tool for monitoring the results of treatment in osteoporotic patients. It provides a practical suggestion about the effectiveness of treatment earlier than densitometry. As expected, osteocalcin levels decreased after treatment of osteoporosis.

Serum bone biomarkers osteocalcin and pyridinoline in mares during pregnancy and lactation, and in foals during early post-natal life

Breeding mares typically foal yearly. Little is known about the dynamics of maternal bone stores during gestation and lactation, the timing of any maternal bone mobilisation, re-accretion post-foaling, or the dynamics of bone metabolism in foals. We measured serum osteocalcin (OC) and serum pyridinoline (PYD) concentrations in 18 mares monthly from 6months gestation to foaling, and in both mares and foals for 4months after birth. From 6 to 11months of gestation, there was no change in mean monthly OC. Serum PYD increased between 7months gestation and foaling. After foaling, mean serum OC was low up to 14days, rising to peak at 1month. Serum PYD rose concomitantly during this period, but subsequently declined. The mare OC:PYD ratio fell to a nadir within 14days of birth, before rising to a peak at 2months. In foals, OC rose within the first 24h of birth to peak at 3months. PYD fell from birth levels by 1month of age. Maternal bone mobilisation occurs progressively from 8months of gestation until term, before increasing markedly in very early lactation. Net mobilisation switches to accretion by one to two months of foaling, suggesting that this is a period during which mares replenish their own bone stores. Changes in the ratio of OC to PYD indicate adaptation to the prevailing biological milieu. In foals, the increase in the OC:PYD ratio in early life reflects the dominance of bone accretion.

Osteocalcin: A New Biomarker for Non Alcoholic Fatty Liver Disease (NAFLD) in Children and Adolescents

Background: Nonalcoholic fatty liver disease (NAFLD) is a common liver disease in adults but uncommon in Pediatrics. Patients with chronic liver disease are at increasing risk of developing metabolic bone disease which may be attributed to decreased Osteocalcin which is involved in bone extracellular matrix mineralization. Aim of the work: was to measure serum osteocalcin levels in children and adolescents with NAFLD and to investigate the relationship with variables degrees of NAFLD. Materials and methods: This study was carried out upon 60 children with NAFL detected by abdominal ultrasonography. Forty apparently healthy children, matched for age, sex and body mass index (BMI) were chosen as controls. They were subjected to history taking, clinical examination, investigations included liver function tests, fasting serum glucose and insulin levels, Homeostasis Model Assessment method of Insulin Resistance (HOMA-IR), serum osteocalcin level and abdominal Ultrasonography to assess semiquantitavely the degree of steatosis. Results: Mean serum osteocalcin level was significantly lower in patients than in controls. Mean serum level of ALT, total cholesterol and triglycerides, fasting insulin and HOMA-IR were markedly increases as the hepatic steatosis advancing in severity. There was a parallel decrease of mean serum osteocalcin level with advancing the degree of hepatic steatosis by ultrasound. Serum osteocalcin levels were inversely correlated with the values of W/H ratio, fasting insulin and HOMA-IR. Conclusions: NAFLD had lower serum levels of osteocalcin compared to controls. It were inversely associated with the degrees of steatosis so can considered as a biomarker for severity NAFLD in pediatric age.

Osteocalcin is inversely associated with adiposity and leptin in adolescent boys.

Recently, osteocalcin (OC), an osteoblast-derived hormone, has been found to correlate with adiposity, adipocytokines and insulin resistance in adults, but few studies have investigated this in children. The aim of this study was to investigate these associations in adolescent boys, for whom it is a time of significant bone mineral accrual, taking into account possible confounders related to adipose and bone tissues. Participants were 141 adolescent boys (mean age 13.9±0.7 years), who were divided into tertiles according to OC levels. Across these groups, differences in total body fat mass (FM), body fat distribution, adiponectin, leptin and insulin resistance values were examined with relation to age, pubertal stage, daily energy and calcium intakes, and physical activity. Mean body mass index (BMI), FM, body fat% and leptin differed significantly between subjects in the three OC tertiles after adjustment for age, pubertal stage, energy and calcium intakes, and physical activity. There were no differences in fat free mass (FFM), bone mineral content, energy and calcium intakes, physical activity, adiponectin and insulin resistance values between study groups. For the entire cohort, mean serum OC was 130.2±45.2 ng/mL and was related to body mass, BMI, FM, body fat distribution and leptin. Circulating OC was not associated with FFM, daily energy and calcium intakes, physical activity, adiponectin or insulin resistance (insulin, glucose, homeostasis model assessment-insulin resistance) values. In male adolescents, OC is inversely related to body adiposity and leptin values, even after consideration of several factors that may affect bone and adipose tissues.

Estimation of Serum Osteocalcin Levels in Osteoporotic Postmenopausal Iraqi Women with Type 2 Diabetes Mellitus

Background: Osteoporosis (OP) is a systemic disease characterized by low bone mass and micro architectural deterioration of bone tissue, resulting in an increased risk of fractures and has touched rampant proportions. Osteocalcin, one of the osteoblast-specific proteins, showed that its functions as a hormone improves glucose metabolism and reduces fat mass ratio. This study is aimed to estimate the osteocalcin and glucose level in blood serum of osteoporotic postmenopausal Women with and without Type 2 Diabetes.Materials and methods: 60 postmenopausal women with osteoporosis divided into two groups depending on with or without T2DM, 30 patients for each. Serum samples of 30 healthy postmenopausal women were collected as control group. Osteocalcin was measured by ELISA method using a kit of (CUSABIO. China). Glucose was determined by spectrophotometric method. Results: Mean serum osteocalcin in postmenopausal osteoporotic women without Type II Diabetes is higher than control group and the group with T2DM (p ? 0.001). Conclusion: Bone formation marker increases at postmenopausal osteoporosis women; Hyperglycemia also induces osteoblast function and reduces of production osteocalcin at T2DM.

Estimation of Serum Osteocalcin Levels in Osteoporotic Postmenopausal Iraqi Women with Type 2 Diabetes Mellitus

Background: Osteoporosis (OP) is a systemic disease characterized by low bone mass and micro architectural deterioration of bone tissue, resulting in an increased risk of fractures and has touched rampant proportions. Osteocalcin, one of the osteoblast-specific proteins, showed that its functions as a hormone improves glucose metabolism and reduces fat mass ratio. This study is aimed to estimate the osteocalcin and glucose level in blood serum of osteoporotic postmenopausal Women with and without Type 2 Diabetes.Materials and methods: 60 postmenopausal women with osteoporosis divided into two groups depending on with or without T2DM, 30 patients for each. Serum samples of 30 healthy postmenopausal women were collected as control group. Osteocalcin was measured by ELISA method using a kit of (CUSABIO. China). Glucose was determined by spectrophotometric method. Results: Mean serum osteocalcin in postmenopausal osteoporotic women without Type II Diabetes is higher than control group and the group with T2DM (p ? 0.001). Conclusion: Bone formation marker increases at postmenopausal osteoporosis women; Hyperglycemia also induces osteoblast function and reduces of production osteocalcin at T2DM.

Association between serum osteocalcin, adiposity and metabolic risk in obese children and adolescents

Childhood obesity has been associated with the development of insulin resistance, potentially leading to several metabolic disorders. Osteocalcin has been reported to contribute to the regulation of glucose tolerance and insulin sensitivity. The purpose of this study was to examine the relationship between serum osteocalcin and metabolic risk factors in obese children and adolescents. Age, gender, pubertal stage, adiposity markers (standard deviation score of body mass index: BMI-SDS, percentage of body fat, waist circumference), blood pressure, serum osteocalcin (OC), fasting plasma glucose and insulin, glycated haemoglobin level (HbA1c), insulin resistance estimated by homeostasis model assessment (HOMA-IR), lipid profile, C-reactive protein (CRP), fibrinogen (FB), white blood cell count (WBC) and 25-hydroxyvitamin D (25-OH-D) were evaluated in 142 obese children and adolescents. Stepwise multiple regression analysis was used to determine the relationship between serum osteocalcin and metabolic risk parameters. Mean serum osteocalcin level was 72.0 ± 20.5 μg/L (range: 16.8-181.5 µg/L). After adjustment for multiple potential confounders, serum osteocalcin concentration was inversely associated with adiposity markers as well as HOMA-IR, HbA1c, triglycerides, CRP, FB and positively with 25-OH-D and HDL-cholesterol. In stepwise multiple linear regression analysis adjusted for age, gender and pubertal stage, osteocalcin was significantly negatively related to HOMA-IR, triglycerides and waist circumference. Serum osteocalcin concentration is associated with blood markers of dysmetabolic phenotype and measures of adiposity, suggesting that osteocalcin is important not only for bones but also for glucose and fat metabolism as early as during childhood.

Evaluation of Serum Osteocalcin Level in Iraqi Postmenopausal Women with Primary Osteoporosis

Background: Osteoporosis (OP) is a chronic and a progressive disease characterized by low bone mass and micro-architectural deterioration of bone tissue, resulting in an increased risk of fracture. Osteocalcin is a non-collagenous protein synthesized and secreted by osteoblasts. Its main physiological functions are calcium ion homeostasis, maintain the normal bone mineralization rate, inhibit the abnormal formation of hydroxyapatite crystal, and to be involved in bone remodeling through a negative feedback mechanism.Objective: This study was planned to evaluate serum level of bone formation marker osteocalcin (OC) in postmenopausal women with and without primary osteoporosis; and study the correlation between serum osteocalcin level with women’s age.Subjects and Methods: Forty four (44) postmenopausal women were included in this study with age range (51-68 years). Subjects were divided into two groups: group A: twenty three (23) women with primary osteoporosis and group B: twenty one (21) women without primary osteoporosis (serve as controls). Patients were diagnosed as osteoporosis and controls as normal by measuring bone mineral density (BMD), using dual energy x-ray absorptiometry (DXA). In addition, serum calcium, phosphorous and alkaline phosphatase measured by spectrophotometer, while serum osteocalcin measured by enzyme linked immuno sorbent assay (ELISA).Results: Mean serum osteocalcin level in postmenopausal women with primary osteoporosis was significantly higher than controls (P&lt;0.0001) Moreover, a positive correlation between serum osteocalcin level with age for both patients (r=0.86, P&lt;0.0001) and controls (r=0.71, P&lt;0.001).Conclusion: Increasing serum osteocalcin level in postmenopausal women with osteoporosis plays an important role in development of primary osteoporosis.

Association of Osteocalcin and Abdominal Aortic Calcification in Older Women: The Study of Osteoporotic Fractures

Osteocalcin (OC) is produced by osteoblasts and vascular smooth muscle cells. In animal models, serum OC levels are strongly correlated with vascular calcium content, however, the association of OC with vascular calcification in humans is uncertain. The Study of Osteoporotic Fractures (SOF) enrolled community-living women, age ≥65 years. The present study included a subsample of 363 randomly selected SOF participants. Serum total OC was measured by ELISA, and abdominal aortic calcification (AAC) was evaluated on lateral lumbar radiographs. We examined the cross-sectional association between serum OC and AAC. The mean serum OC level was 24 ± 11 ng/ml and AAC was present in 188 subjects (52%). We observed no association of OC and AAC in either unadjusted or adjusted analyses. For example, each standard deviation higher OC level was associated with an odds ratio (OR) for AAC prevalence (AAC score >0) near unity (OR = 1.06; 95% CI, 0.82–1.36) in models adjusted for CVD risk factors. Further adjustment for intact parathyroid hormone, bone-specific alkaline phosphatase, 25-hydroxyvitamin D, and hip and spine bone mineral density did not materially change the results (OR = 1.22; 95% CI, 0.86–1.75). Similarly, higher OC levels were not associated with severity of AAC (P = 0.87). In conclusion, among community-living older women, serum OC is not associated with AAC. These findings suggest that serum OC levels may more closely reflect bone formation than vascular calcification in humans.

The Effect of Physical Activity on Bone Turnover in Young Adults

Physical activity has been suggested as one of the determinants of bone turnover and to prevent the involutional age related bone loss. However, the degree to which physical exercise is necessary to induce changes in bone turnover and calciotropic hormones have been widely discussed (Williams et al., 1984; Cook et al., 1987; Smith et al., 1985). The aim of this study was to examine the rate of bone formation measured by osteocalcin in 56 healthy volunteers before and after 4 and 8 weeks of physical exercise (PE) and its dependence on various parameters of calcium and phosphate metabolism. The studied group consisting of 44 men and 12 women, mean age 24.8 and 24.3 years, respectively, performed a standardized physical training of 8 weeks. Mean serum osteocalcin levels were significantly (p less than 0.01) reduced after 4 weeks (men: 2.26 +/- 1.8 ng/ml; women: 0.94 +/- 1.6 ng/ml) compared to the values before PE (men: 4.01 +/- 2.18 ng/ml; women: 1.69 +/- 1.7 ng/ml) and returned to normal values after 8 weeks. Similarly, magnesium levels (0.82 mmol/l) decreased significantly (p less than 0.01) after 4 weeks of PE (0.79 mmol/l), returning to normal values after 8 weeks. Concomitantly, there was only a slight, but significant fall of serum calcium from 2.48 +/- 0.07 to 2.45 +/- 0.07 returning to initial values again. Furthermore, serum phosphate increased slightly in men from 1.01 mmol/l to 1.13 and 1.15 mmol/l after 4 and 8 weeks, respectively. In contrast, alkaline phosphatase and serum creatinine remained in the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone and Cartilage Turnover Markers, Bone Mineral Density, and Radiographic Damage in Men with Ankylosing Spondylitis

PurposeTo determine the levels of bone and cartilage turnover markers in men with ankylosing spondylitis (AS) and to investigate their associations with disease activity, bone mineral density, and radiographic damage of the spine.Patients and MethodsThis cross-sectional study enrolled 35 men with newly diagnosed AS. The bone mineral densities (BMD) of their lumbar spines and proximal femurs, Bath AS Disease Activity Index (BASDAI), and Bath AS Radiographic Index (BASRI) were evaluated. Urinary C-terminal telopeptide fragments of type I collagen (CTX-I) and type II collagen (CTX-II) levels were determined by enzyme-linked immunosorbent assay, and serum levels of bone-specific alkaline phosphatase (BALP) and osteocalcin were determined by an enzyme immunoassay. Levels of biochemical markers were compared with those of 70 age-matched healthy men.ResultsPatients with AS had significantly higher mean urinary CTX-I and CTX-II levels than control subjects (p < 0.05). Elevated urinary CTX-I levels correlated well with BASDAI, femoral BMD, and femoral T score (p < 0.05), and elevated urinary CTX-II levels correlated well with spinal BASRI (p < 0.05) in patients with AS. Mean serum BALP and osteocalcin levels did not differ between patients and controls and did not show any significant correlations with BMD, BASDAI, or BASRI in men with AS.ConclusionsElevated CTX-I reflects disease activity and loss of femoral BMD while elevated CTX-II levels correlate well with radiographic damage of the spine, suggesting the usefulness of these markers for monitoring disease activity, loss of BMD, and radiographic damage in men with AS.

Effect of daily parathyroid hormone (1–34) on lumbar fusion in a rat model

Background context Despite numerous studies evaluating the anabolic effects of intermittent administration of parathyroid hormone (PTH) on bone, there are no published studies examining its effect on spinal fusion outcomes. Purpose To determine the effect of daily injection of human recombinant PTH(1–34) on posterolateral lumbar fusions in a rat model. Study design Prospective, case-controlled, preclinical animal study. Outcome measures Manual palpation and serum osteocalcin. Methods Single-level, intertransverse process spinal fusions were performed with iliac crest autograft in 56 Sprague-Dawley rats. Animals received daily injections of placebo or PTH(1–34). At 6 weeks, fusion masses were assessed by manual palpation. Serum osteocalcin levels were assessed in a subset of the animals. Results Manual palpation revealed the control group to have a fusion rate of 37% (10/27) and the PTH(1–34)-treated group to have a fusion rate of 52% (15/29). Mean serum osteocalcin levels were 59.8 and 88.6 ng/L for the control and PTH(1–34) groups, respectively. Conclusions There was a trend towards greater fusion rate in the PTH(1–34) group as compared with the placebo group. Further, PTH(1–34) administration was associated with a significant increase in osteocalcin levels. Certainly, further investigations are warranted, as an injectable agent capable of increasing fusion rates would be of great clinical value.

Type 2 Diabetes Mellitus in Nursing Home Patients: Effects on Bone Turnover, Bone Mass, and Fracture Risk

Fractures are a major health burden in elderly institutionalized persons. Type 2 diabetes mellitus (DM) has a high prevalence in nursing home patients and has been associated with positive effects on bone mass in younger, community-dwelling elderly. The objective of this study was to investigate whether type 2 DM affects bone mass, bone turnover, or prospective fracture rates in frail, elderly women living in nursing homes. This study was a prospective cohort of 583 patients with type 2 DM and 1081 control (CTR) individuals above age 70 recruited from 95 nursing homes in Austria. Patients were enrolled and followed up by mobile study teams. We performed quantitative bone ultrasound measurements at the calcaneus, radius, and proximal third phalanx, measurements of quadriceps strength, and biochemical parameters of mineral metabolism and bone turnover. Patients were prospectively followed for hip and other nonvertebral fractures over 2 yr. Patients with type 2 DM had significantly higher age-, weight-, and mobility score-adjusted calcaneal stiffness (P < 0.0001), radial speed of sound (P < 0.005), and phalangeal speed of sound (P < 0.05) measurements when compared with CTRs. Mean serum PTH (-20.7%) and osteocalcin levels (-22.3%) were significantly lower (both P < 0.0001) in patients with treated type 2 DM despite comparable low serum 25-hydroxyvitamin D levels and slightly higher adjusted total serum calcium levels compared with CTRs. Important independent determinants of bone turnover in both patient groups were PTH, creatinine clearance, alanine aminotransferase, as well as glycosylated hemoglobin levels, together accounting for 30-40% of its variance. A total of 110 hip fractures occurred during the observation period, corresponding to a hip fracture rate of 3.1% (in CTRs) and 3.4% (in type 2 DM) per 100 patient years; this was not significantly different for CTRs and diabetics. Decreased PTH levels and higher levels of glycemia independently contribute to lower bone turnover in elderly nursing home patients with type 2 DM. Despite higher bone mass and lower bone turnover, hip fracture risk is comparable with women without DM.

Effects of dehydroepiandrosterone (DHEA) supplementation on hormonal, metabolic and behavioral status in patients with hypoadrenalism

Oral DHEA administration to patients with hypoadrenalism, in addition to glucocorticoid and mineralcorticoid replacement, may improve both well-being and hormonal/metabolic parameters. Twenty patients (13 men, 7 women, 26-76 yr, 11 with Addison's disease, 9 with central hypoadrenalism) were recruited in a placebo-controlled, randomized study. Hormone levels, carbohydrate and lipid parameters, bone metabolism, body composition and psychological parameters were evaluated at baseline and after treatment with DHEA 50 mg/day or placebo for 4 months. After 4 months of DHEA administration, serum DHEAS levels raised both in men (from 0.71+/-0.18 to 8.28+/-1.66 micropmol/l, p<0.005) and in women (from 0.25+/-0.07 to 5.65+/-1.93 micromol/l, p<0.05). Only in hypoadrenal women an increase in testosterone (T; from 0.4+/-0.1 to 1.45+/-0.26 nmol/l, p<0.05) and androstenedione (A; from 0.86+/-0.34 to 2.05+/-0.29 nmol/l, p<0.05) levels was observed. In men no significant modifications in T and 17-hydroxyprogesterone (17-OHP) levels were found, whereas serum SHBG significantly decreased. As far as the metabolic parameters are concerned, only in patients with Addison's disease a significant decrease in total cholesterol and in low-density lipoproteins after 4 months of DHEA administration was found. No changes in glucose metabolism and insulin sensitivity were observed. In basal conditions, mean serum osteocalcin (OC) was normal and significantly decreased after DHEA treatment. A significant reduction in body fat mass percentage (BF%) after DHEA administration was observed. As far as well-being is concerned, DHEA replacement did not cause any relevant variation of subjective health scales and sexuality in both sexes. Our study confirms that DHEA may be beneficial for female patients with hypoadrenalism, mainly in restoring androgen levels. Concerning the health status, more sensitive and specific instruments to measure the effects of DHEA treatment could be necessary.

Effects of short-time (3 months) tibolone treatment on bone turnover in postmenopausal women.

This study was planned to elucidate the effects of tibolone on bone biochemistry parameters in postmenopausal women at 3 month intervals. There were 56 healthy postmenopausal women enrolled in the study. The women had not received hormone replacement therapy (HRT) previously. Tibolone (2.5 mg/day) was prescribed for 3 months. Serum osteocalcin, calcium, phosphorus, alkaline phosphatase, creatinine and urine calcium, phosphorus creatinine, deoxypyridinoline were measured, and physical examinations were performed at the onset and at the end of the study. The mean serum osteocalcin level and deoxypyridinoline/creatinine (DPD/cr) ratio both decreased significantly (50.3% and 22.9%; P=0.012 and P=0.001, respectively). The slight decreases in serum alkaline phosphatase (4.5%) and urine calcium (13.6%) levels were not statistically significant. There was a positive correlation between DPD/cr and urine calcium ( r=0.66, P=0.001). We conclude that bone formation may be increased early by tibolone after short-term administration.