Serum Bone-specific Alkaline Phosphatase Research Articles

Association between polycyclic aromatic hydrocarbons exposure and bone turnover in adults.

Cigarette smoking is a risk factor of osteoporosis and bone fracture. Tobacco smoke contains several polycyclic aromatic hydrocarbons. Thus, we hypothesized that environmental polycyclic aromatic hydrocarbon exposure is associated with bone loss and fracture risk. The present study examined the association between polycyclic aromatic hydrocarbon exposure and bone turnover in the general adult population. A total of 1408 eligible participants from the National Health and Nutrition Examination Survey (NHANES 2001-2006) were included in this cross-sectional analysis. The levels of urinary N-telopeptide and serum bone-specific alkaline phosphatase, which are biomarkers of bone resorption and formation, respectively, were assessed. Meanwhile, polycyclic aromatic hydrocarbon exposure was evaluated using the concentrations of urinary polycyclic aromatic hydrocarbon metabolites. The association between polycyclic aromatic hydrocarbon exposures and N-telopeptide, and bone-specific alkaline phosphatase levels was assessed using a multivariate linear regression model. All polycyclic aromatic hydrocarbon metabolites except 3-phenanthrene were significantly associated with increased N-telopeptide levels (P < 0.05) after adjustment of relevant covariables. However, no significant relationship was observed between polycyclic aromatic hydrocarbon metabolites and bone-specific alkaline phosphatase levels. This relationship remained significant after the participants were assessed according to sex (P < 0.05). Additionally, all polycyclic aromatic hydrocarbon metabolites showed a positive association with N-telopeptide levels in participants aged <60 years (P < 0.05). Polycyclic aromatic hydrocarbon exposure is associated with increased bone resorption among the general adult population in the United States. Further studies must assess the potential mechanisms associated with the adverse effects of polycyclic aromatic hydrocarbon exposure on bone loss.

Increasing calcium from deficient to adequate concentration in diets for gestating sows decreases digestibility of phosphorus and reduces serum concentration of a bone resorption biomarker.

The objective of this experiment was to test the hypothesis that the concentration of Ca in diets fed to late gestating sows affects the apparent total tract digestibility (ATTD) and retention of Ca and P, serum concentrations of Ca and P, hormones, and blood biomarkers for bone formation and resorption. Thirty-six sows (average parity = 2.8) were housed in metabolism crates from day 91 to day 104 of gestation and fed 1 of 4 experimental diets containing 25, 50, 75, or 100% of the requirement for Ca. All diets met the requirement for P. The initial 5 d of each period were the adaptation period, which was followed by 4 d of quantitative collection of feces and urine. At the end of the collection period, a blood sample was collected from all sows. Results indicated that feed intake, weights of dried fecal and urine samples, and the ATTD of DM were not affected by dietary Ca, but ATTD of Ca increased (quadratic, P < 0.05) as Ca in diets increased. Urine Ca output was not affected by dietary Ca, but Ca retention increased (quadratic, P < 0.05) as Ca intake increased. Fecal P output increased (linear, P < 0.001) as dietary Ca increased, which resulted in a linear decrease (P < 0.001) in the ATTD of P. Urine P output also decreased (linear, P < 0.001) as dietary Ca increased, but P retention increased (linear, P < 0.05). Regressing the apparent total tract digestible Ca against dietary Ca intake resulted in a regression line with a slope of 0.33, indicating that true total tract digestibility of Ca in calcium carbonate was 33%. Serum concentrations of Ca and P and estrogen, calcitonin, and parathyroid hormone were not affected by dietary Ca. Serum concentration of carboxyterminal cross-linked telopeptide of type I collagen (CTX-I) decreased (linear, P < 0.05) as dietary Ca increased, which is a result of reduced bone resorption as dietary Ca increased. Serum bone-specific alkaline phosphatase tended to decrease (linear, P < 0.10) as Ca in diets increased, but the concentration of osteocalcin (OC) in serum was not affected by dietary Ca. The ratio between OC and CTX-I tended to increase (P < 0.10) as dietary Ca increased, which indicated that there was more bone formation than resorption in sows as dietary Ca increased. In conclusion, P digestibility in late gestating sows decreased, but retention of P increased, as dietary Ca increased from inadequate to adequate levels and blood biomarkers for bone resorption changed as Ca and P retention increased.

Interactive effects of dietary vitamin K3 and Bacillus subtilis PB6 on the growth performance and tibia quality of broiler chickens with sex separate rearing

Both vitamin K and probiotics can promote the bone health of poultry and mammals. The present study was conducted to investigate the interactive effects between vitamin K3 (VK3) and Bacillus subtilis PB6 on the growth performance and tibia quality of broiler chickens with sex separate rearing. In a 3 × 2 × 2 factorial arrangement, 720 one-day-old broiler chicks (Arbor Acres) were assigned to 12 groups with three levels of dietary VK3 (0, 0.5 and 4.0 mg/kg), with or without probiotic supplementation (500 g/t) and with sex separation (male and female). Each group included 3 replicates with 20 birds per replicate. During day 1 to 21, 0.5 and 4.0 mg/kg of VK3 increased average daily gain (ADG) of all birds and average daily feed intake of male birds (P < 0.05). During day 22 to 42, probiotic supplementation increased the ADG of birds (P < 0.05). Probiotic addition increased the weight, length, diameter and strength of tibia in all birds, and 0.5 and 4.0 mg/kg of VK3 increased the tibial breaking strength of male birds at day 21 (P < 0.05). Vitamin K3 and probiotic synergistically increased tibial breaking strength at day 42 and ash content at day 21 (P < 0.05). Three factors exhibited interactive effects on the chemical composition of tibia at day 42, and female birds fed 4 mg/kg of VK3 and probiotic had the highest contents of ash, calcium and phosphorus (P < 0.05). Bacillus subtilis PB6 increased the serum phosphorus level of male birds at day 21 and serum calcium level of female ones at day 42 (P < 0.05). At day 21, in the probiotic-supplemented birds, serum osteocalcin (OCN) and bone-specific alkaline phosphatase (BALP) were increased by 0 and 4.0 mg/kg of VK3, respectively (P < 0.05). Probiotic increased serum OCN and cooperated with VK3 to increase the serum BALP at day 42 (P < 0.05). Vitamin K3 and probiotic synergistically down-regulated the mRNA expression of Runt-related transcription factor 2 and OCN at day 21 (P < 0.05). Vitamin K3 down-regulated the alkaline phosphatase (liver/bone/kidney) expression in male birds at day 21 and 42, but probiotic up-regulated the expression of these genes at day 42 (P < 0.05). In conclusion, VK3 and B. subtilis PB6 promoted the growth performance of broilers during starter and grower phases, respectively. They synergistically improved the physical and chemical traits of tibias, especially in grower phase, by modulating calcium and phosphorus metabolism as well as osteogenic gene expression.

Association between mineral and bone disorder in patients with acute kidney injury following cardiac surgery and adverse outcomes

BackgroundNumerous studies have evaluated the prevalence and importance of mineral and bone disorders among patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, little is known about dysregulated mineral and bone metabolism in acute kidney injury (AKI).MethodsWe evaluated the association between mineral and bone metabolites and clinical outcomes in 158 patients who underwent cardiac surgery and developed AKI between June 2014 and January 2016. The baseline characteristics of the patients were recorded, and the levels of mineral and bone metabolites, including calcium, phosphate, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25D), bone-specific alkaline phosphatase (BAP), tartrate-resistant acid phosphatase 5b (TRACP-5b) and C-terminal fibroblast growth factor 23 (cFGF23) were measured within 12 h after establishing the clinical diagnosis.ResultsThe serum phosphate, iPTH and cFGF23 levels were significantly associated with the 28-day mortality (phosphate: Hazard Ratio [HR] =2.620, 95% CI: 1.083 to 6.338, p = 0.035; iPTH: HR = 1.044, 95% CI: 1.001 to 1.090, p = 0.046; cFGF23: HR = 1.367, 95% CI: 1.168 to 1.599, p < 0.001). Moreover, higher serum cFGF23 and BAP levels were independently associated with an increased risk of adverse outcomes. Additionally, we found that the serum cFGF23 levels rose most significantly and were associated with the severity of AKI (P < 0.001).ConclusionsMineral and bone metabolites are dysregulated and are associated with adverse clinical outcomes among patients with AKI.Trial registrationwww.clinicaltrials.gov NCT 00953992. Registered 6 August 2009.

Longitudinal evaluation of the association between Insulin-like growth factor-1, Bone specific alkaline phosphatase and changes in mandibular length

The aim of the current longitudinal study was to assess the levels of serum Bone-specific alkaline phosphatase (BALP) and serum Insulin like growth factor-1 (IGF-1) in different cervical vertebral maturation index (CVMI) stages and observe their association with the mandibular growth. Blood samples and lateral cephalograms of 63 subjects (age group of 11–17 years) were obtained at two time points, 12 months apart. On the basis of CVMI, all subjects were divided into six groups based on whether the subjects remained in same CVMI stage or transitioned to the next CVMI stage. Annual mandibular length was related with serum BALP and serum IGF-1 levels estimated using ELISA. Serum IGF-1 and BALP attained highest levels at CVMI stage 3 with peak BALP levels observed earlier than IGF-1. Although a positive correlation was determined between IGF-1 and BALP but BALP followed skeletal growth pattern more precisely. Overall IGF-1 and BALP were negatively correlated with mandibular length with notable growth in CVMI groups 3–3 (P < 0.01), 3-4 (P < 0.01), 4-4 (P < 0.001) and 5-5 (P < 0.001). In conclusion, BALP is a potential biomarker for skeletal growth assessment. However, the mandibular growth pattern was independent of changes in IGF-1 and BALP.

Erişkin hastalarda genel ve rejyonel anestezinin kemik belirteçleri ve kırık iyileşmesi üzerine uzun dönem etkileri

Purpose: Bone metabolism can be monitored quantitatively by measuring bone turnover markers in serum and/or urine. We aimed to investigate long-term effect of the type of the anesthesia on bone turnover markers and fracture healingMaterials and Methods:Thirty patients with American Society of Anesthesiologist physical status I-II whom were aged 40-70 years, scheduled for hip fracture were recruited. Patients were divided into the two groups as general anesthesia and regional anesthesia. Only morphine and tramadol were used for postoperative analgesia till the 12th weeks. Serum bone-specific alkaline phosphatase, osteocalcine, β-C terminal telopeptide and urine β-C terminal telopeptide levels were measured at preoperative, 4.th week and 12.th week of fracture. Results:A total of 25 patients were eligible for the study. There were no statistically significant between groups for values of bone turnover markers at the time point of preoperative, 4.th and 12.th weeks. With using linear regression analysis, serum β-CTX levels at 12.th week can be predict by 4.th weeks β-CTX levels (R2: 0.944) and urine β-CTX levels at 12.th week can be predicted by first week level.Conclusion: This pilot study showed that both general and regional anesthesia has similar effect on bone turnover markers and fracture healing.

Effects of lanthanum carbonate on bone markers and bone mineral density in incident hemodialysis patients.

Recent clinical studies demonstrated the favorable effects of calcium-free phosphate binders on mortality and vascular calcification in hemodialysis (HD) patients. The aim of the present study was to investigate the effects of a calcium-free phosphate binder, lanthanum carbonate (LC), on bone metabolic markers and bone mineral density (BMD), compared with those of calcium carbonate (CC), in subjects new to HD. The present study included 65 subjects from our previous randomized controlled trial (LC group, N = 31; CC group, N = 34). We investigated the effects of LC on serum intact parathyroid hormone (iPTH), osteocalcin (OC), bone-specific alkaline phosphatase (BAP), tartrate-resistant acid phosphatase 5b (TRACP-5b), sclerostin levels, and BMD, compared with those of CC in patients new to HD at baseline and at 12 and 18months. Serum OC levels at 18months were significantly higher in the LC group than in the CC group. During the study period, serum BAP and TRACP-5b and iPTH levels tended to be higher in the LC group than in the CC group. At 18months, the percentage of low bone turnover, based on a serum BAP cutoff value, was significantly lower in the LC group than in the CC group. There were no significant differences in the lumbar and femoral BMD between the two groups. The results of the present study suggest that LC has potential in preventing low bone turnover, in comparison to CC, in patients new to HD.

Potential effectiveness of exenatide in experimentally-induced osteoporosis

Aim of the workTo study the possible protective and therapeutic effects of exenatide on experimentally-induced osteoporosis in adult ovariectomized female albino rats. Materials and methodsThe study included 40 mature female albino rats, matched for age and weight (150–250 gm). Osteoporosis was experimentally-induced by bilateral ovariectomy (OVX) and the animals were left untreated for 6 weeks. Rats were divided into 4 groups: Sham group (group-I), ovariectomized (OVX) non-treated (group-II), prophylactic exenatide (group-III: received 1 μg/kg/d SC for 6 weeks immediately after ovariectomy) and treated group-IV (Left untreated for 6 weeks after ovariectomy then received treatment for 8 weeks) was subdivided into subgroup-IVa: treated with exenatide in a dose of 1 μg/kg/d SC and subgroup IVb: treated with vitamin Din a dose 0.25 µg/day orally for 5 days/week. Serum bone-specific alkaline phosphatase (BsALP) level was measured and bone histomorphometry assessed. ResultsNon-treated rats showed a significant elevation of BsALP level by 182%, reduction of cortical thickness by 36% and osteocyte number by 29% compared to Sham group-I. Rats of prophylactic exenatide, therapeutic exenatide and therapeutic vitamin D showed a significant reduction of BsALP level by 62.4%,62.5% and 62.2%, respectively, increase of the cortical thickness by 38.7%, 29.4% and40.9% respectively and osteocyte number by 29%,26% and 42%, respectively compared to OVX non-treated group-II. The mean BsALP in group IV improved to levels comparable to Sham group-I. There was no significant difference in all previous results between groups-III and IVa or IVb. ConclusionExenatide has a potential prophylactic and therapeutic role in the management postmenopausal osteoporosis. The non-inferiority of exenatide to vitamin D in treatment of osteoporosis is deduced.

PS1107 IMPACT OF SEVERITY OF THE DISEASE AND FVIII INHIBITOR ON BONE MINERAL DENSITY AND BONE TURNOVER MARKER IN CHILDREN WITH HEMOPHILIA A

Background:Recurrent hemarthroses, and prolonged immobilization may predispose to low bone mineral density in children with hemophilia. Furthermore, adequate dietary calcium intake is a major determinant of bone mass accrual.Aims:To evaluate the impact of severity of the disease and history of FVIII inhibitor on bone density and bone turnover markers in children with hemophilia A.Methods:Children with hemophilia A (severe FVIII: &lt;1 iu/dl, moderate: ≤ 1‐ 5 iu/dl), aged 6–18 years, were evaluated for bone mineral density (BMD) and bone turnover markers. Positive FVIII inhibitor (&gt;0.6 BU, Bethesda units) history was recorded. Patients were categorized into three groups. Group I: severe cases with inhibitor, II: severe cases without inhibitor and III: moderate cases. Dual‐energy X‐Ray absorptiometry (DXA) of total body (TB) and/or lumbar spine (LS) was applied for BMD measurement and expressed as z‐score (low for chronological age, z‐score ≤ ‐2). Bone resorption [urinary deoxypyridinoline/cretinine (uDPD/uCr), urinary excretion of calcium (uCa/uCr), tartrate‐resistant acid phosphatase (Trap)] and bone formation markers [serum total and bone specific alkaline phosphatase (ALP, bALP), osteocalcin and carboxy‐terminal propeptides of type I collagen], as well as vitamin D, parathormone and serum Ca were measured. All patients completed a validated questionnaire about their dietary calcium intake.Results:Fifty one children with hemophilia A (severe 40), mean age: 11.7 ± 3.6 years, were included. Fourteen children (27.4%) had history of FVIII inhibitor. Mean z‐score for LS BMD was −0.51 ± 0.98 [4/40 (10%) had z‐score ≤ ‐2 and 8/40 (20%) had z‐score between −1 and −2)]. Mean z‐score for TB BMD was 0.18 ± 0.85 [none had z‐score ≤ ‐2 and 4/44 (9.1%) had z‐score between −1 and −2)]. Significant difference was found in mean TB and LS BMD between severe and moderate cases (0.81 ± 0.13 vs 0.94 ± 0.18, p = 0.017). Furthermore, hemophilic children with history of inhibitor had lower mean BMD both on TB (0.74 ± 0.069 vs 0.88 ± 0.16, p = 0.005) and LS measurement site (0.66 ± 0.7 vs 0.87 ± 0.24, p = 0.013). Mean TB and LS BMD was significantly higher in group I compared to groups II and III (p &lt; 0.05). On the other hand, patients with severe hemophilia had increased levels of uCa/uCr compared to children with moderate disease (0.35 ± 0.27 vs 0.17 ± 0.08, p &lt; 0.05). In addition, mean value of uDPD/uCr was increased in children with history of inhibitor in comparison to non inhibitor (40.49 ± 11.1 vs 29.09 ± 15.04, p = 0.014). Group I had higher uDPD/uCr values (p &lt; 0.05) compared to group II and group III (40.49 ± 11.1 vs 30.7 ± 16.3 and 24.78 ± 10.54). No differences were observed in other bone markers among all groups. The dietary calcium intake was adequate (&gt; of EAR, Estimated Average Requirement) in only 19% of children, but no differences in both LS and TB BMD were revealed. Nevertheless, children with inadequate calcium intake had significant increased (p &lt; 0.05) ALP/bALP, compared to the rest of patients.Summary/Conclusion:In our study, 10% of children with Haemophilia A had low for chronological age LS BMD. Severe disease and history of FVIII inhibitor seem to burden bone health, as measured with DXA. Resorption markers were found to be impaired. Homeostasis of calcium seem to overweigh low dietary intake. Severe cases, especially those with history of inhibitor, are in higher risk to develop bone metabolic disturbances; thus, close monitoring of bone status seems to be necessitated.

Trabecular bone score and quantitative ultrasound measurements in the assessment of bone health in breast cancer survivors assuming aromatase inhibitors.

Aromatase inhibitors (AIs) represent the first-line adjuvant therapy for hormone receptor-positive breast cancer (BC) women. AIs have been associated with an increased rate of fractures. The aim of our study was to investigate trabecular bone score (TBS) and bone quantitative ultrasound (QUS) measurements as bone quality surrogates in AIs users. Sixty postmenopausal BC women starting AIs and forty-two controls (mean age 61.64 ± 8.33years) were considered. Bone mineral density (BMD) at lumbar spine and femoral neck and TBS were measured by DXA; QUS-derived Amplitude-Dependent Speed of Sound (AD-SoS), Bone Transmission Time (BTT), and Ultrasound Bone Profile Index (UBPI) were assessed at phalangeal site; morphometric vertebral fractures (Vfx) by X-ray, serum bone-specific alkaline phosphatase (BSAP), and C-telopeptide of type 1 collagen (CTX) were also evaluated. After 18months, changes of TBS vs baseline were significantly different between AIs group and controls [Δ TBS - 2.2% vs - 0.4%, respectively, p = 0.001]. AD-SoS, BTT and UBPI values decreased only in AIs' group (- 3.7%, - 6.45%, -8.5%, vs baseline, respectively, pall < 0.001). 3 Vfx occurred in AIs users and were associated with the greater TBS and AD-SoS modifications. In the AIs' group, ΔTBS was associated with ΔAD-SoS (r = 0.58, p < 0.001) and ΔUBPI (r = 0.415, p = 0.001), but not with ΔBMD. Moreover, ΔTBS was independently predicted by ΔAD-SoS, after correcting for BMD, CTX and BSAP level changes (β = 0.37, SE = 2.44, p < 0.001). TBS and phalangeal QUS provide useful information related to bone quality in AI-treated BC survivors and could be considered for fracture risk evaluation.

Relationship between bone turnover markers and the heel stiffness index measured by quantitative ultrasound in post-menopausal Japanese women

Background: Osteoporosis in women is a serious health problem. The relationships between biochemical markers of bone turnover and bone mineral density (BMD) in women have been reported, but no study has examined relationships between tartrate-resistant acid phosphatase-5b (TRACP-5b) or bone-specific alkaline phosphatase (BAP) and bone mass measured by quantitative ultrasound (QUS) in Japanese post-menopausal women.Aim: To investigate the serum TRACP-5b and BAP levels and to determine their associations with the heel stiffness index measured by QUS in post-menopausal women.Subjects and methods: The subjects were 510 post-menopausal women who were invited to participate in periodic health examinations in 2011–2013 (the Unzen Study). The heel stiffness index (bone mass) was measured by QUS. Serum samples were collected and TRACP-5b and BAP levels were measured.Results: Multiple regression analysis showed that a higher log (TRACP-5b) was correlated with a lower stiffness index (p = 0.014) and log (BAP) was not correlated with stiffness index after adjusting for covariates (p = 0.136).Conclusion: Higher rates of bone resorption are associated with a lower stiffness index in Japanese post-menopausal women. These results may indicate that high bone resorption affects bone mass more than bone formation, resulting in a low bone mass.

Bushen-Qingxin decoction combined conjugated estrogen tablets for perimenopausal women osteoporosis in patients with bone mineral density and bone metabolic markers

Objective Bushen-Qingxin decoction combined conjugated estrogen tablets of modulation perimenopausal women osteoporosis patients, explore the impact of bone mineral density and bone metabolic markers. Methods A total of 160 female patients were recruited in our hospital by the random number table method, and were divided into the control group 80 cases and the observation group 80 cases. The control group was treated with standard dose of conjugated estrogen tablets, while the observation group was treated with Bushen Qingxin decoction on the basis of the control group. Both groups were treated 3 period with 28 days per period. The enzyme-linked immunity analyzer was used to detect serum bone-specific alkaline phosphatase (BALP), C-terminal cross linked peptide (CTX-Ⅰ), tartrate resistant acid phosphatase -5b (TRACP-5b) level, and the dual-energy X-ray absorptiometry measurement method was used to detect bone mineral density values. The clinical curative effect was compared between two groups. Results The total effective rate of the observation group was 91.3%, while the control group was 78.8%, which showed the difference was statistically significant (χ2=3.971, P=3.971). After treatment, the serum BALP levels (88.55 ± 10.33 U/L vs. 80.47 ± 8.67 U/L, t=5.399) of the observation group were significantly higher than this of the control group (P<0.01). After treatment, the serum TRACP-5b (501.31 ± 35.77 pg/L vs. 538.51 ± 37.69 pg/L, t=6.498), CTX-Ⅰ(130.09 ± 17.55 ng/ml vs. 164.71 ± 19.45 ng/ml, t=11.928) of the observation group were significantly lower than those of the control group (P<0.01). After treatment, the bone mineral density of the observation group rose up from the baseline (t=3.396, P=0.010). Conclusions The Bushen-Qingxin decoction combined conjugated estrogen tablets can increase on women in the menopausal transition of osteoporosis in patients with bone mineral density values and serum BALP levels, reduce serum TRACP-5b, CTX-Ⅰ level. Key words: Osteoporosis; Perimenopause; Bone density; Bone metabolic markers; Bushen-Qingxin decoction; Therapies, investigational

SAT-522 Markers of Mineral Homeostasis and Bone Turnover in Patients Presenting with Acute Hip Fractures

We previously reported on the very low rate of bone density assessment and vitamin D nutritional (VDN) status among 135 patients presenting with proximal hip fractures (ENDO-2018). It is generally assumed that bone turnover increases soon after a fracture, particularly after a major fracture such as hip. However, very little data exists on bone turnover markers (BTM) immediately after a hip fracture. In addition, it is unclear if the BTMs are related to prevailing VDN and parathyroid function. As part of ongoing project we assessed these characteristics in a larger sample (162), and further evaluated the indices of mineral homeostasis (as assessed by serum PTH and 25-OHD levels), and bone turnover (as assessed by serum CTX and bone specific alkaline phosphatase (BSAP); commonly used markers of bone resorption and formation respectively, in clinical practice. 162 patients were admitted with proximal femur fractures over 5y (1/1/2011 to 12/31/2016). The electronic health records (EHR) of 162 patients were reviewed to determine the rate of BMD testing, VDN, parathyroid function and BTMs. There were 112 women (69%) and 72 (44%) Caucasians with a mean age 78.6 ± 12.4y (range 49-98y). Mean 25-OHD was 22.6 ±12.9 ng/ml, and PTH was 61.1 ± 37.9 pg/ml. Mean serum CTX was 481 ± 241 mmol/mol and BSAP was 20.2 ± 14.6. Prevalence of vitamin D deficiency (<20ng/ml) was 44%, insufficiency (<30ng/ml) was 36%, and only 20% had optimal VDN. Serum PTH >70pg/ml in 25% (17/69), of whom 8 had 25-OD <20 ng/ml. By contrast, 42% (22/52) patients with serum PTH <70 pg/ml had a serum 25-OHD <20 ng/ml; the difference in vitamin D insufficiency was similar between the two groups of patients with and without hyperparathyroidism. Serum CTX was <300 mmol/mol in 25% (21/80) patients, which we considered as low bone turnover, and the mean BSAP in these patients was 13.4 ± 4.9 µg/L. Sixteen patients (20%) had serum BSAP >22 µg/L, all of whom had serum CTX >300 mmol/mol, which we considered as high bone turnover. The remaining 55% had high serum CTX 300-600 mmol/mol and the mean BSAP in these patients was 16.2 ± 7.9 µg/L. In a sub-set of 51 patients with BMD, osteopenia was seen in 13% using spine and 12% using femoral neck T-Scores, and osteoporosis in 9% using spine and 14% using femoral neck T scores. Neither spine nor femoral neck BMD correlated with VDN, PTH, or BTMs. Conclusions: Despite acute major fracture 26% have low bone turnover as assessed by BTMs. Only 25% had PTH >70 pg/ml that was not related to the prevailing VDN or renal function, but was related to age. High bone turnover was present in 74%, but was not related to PTH level or VDN. This is the first and most comprehensive study of mineral and skeletal homeostasis in a large sample of patients with hip fracture. Considering the large variation in BTMs, our findings may have therapeutic (antiresoprtive/anabolic) implications. Further studies are need to either confirm or refute our observations.

Treatment of Glucocorticoid-Induced Osteoporosis with Bisphosphonates Alone, Vitamin D Alone or a Combination Treatment in Eastern Asians: A Meta-Analysis.

Background: Glucocorticoid (GC)-induced osteoporosis and fractures have become a serious problem for Eastern Asians. Bisphosphonates (BPs), vitamin D and a combination treatment are effective methods to prevent and treat GC-induced osteoporosis. Objective: The study aimed to compare the efficacy of BPs, vitamin D and a combination treatment for preventing and managing GC-induced osteoporosis in Eastern Asians. Methods: A comprehensive search in the PubMed, EMBASE, Web of Science and Cochrane CENTRAL databases was undertaken for randomized controlled trials (RCTs) on the effect of BPs, vitamin D and the combination treatment on GCs-induced osteoporosis in Eastern Asian populations. Primary outcome measures were the change in bone mineral density (BMD) and bone turnover markers. The final search was performed in March 2019. Results:Nine RCTs were included. A total of 545 patients met the inclusion criteria. Compared with vitamin D, BPs and the combination treatment significantly alleviated osteoporosis of the spine and femoral neck in Eastern Asians with GC-induced osteoporosis. At the same time, the change in serum bone-specific alkaline phosphatase (BAP) and serum C-telopeptide of type I collagen (CTX) levels was observed to be significantly less with BPs and the combination treatment with vitamin D alone. No significant difference was found between BPs and the combination treatment in the markers mentioned above.Conclusion: Compared with vitamin D alone, BPs alone and the combination treatment were significantly effective on Eastern Asians with GC-induced osteoporosis. Compared with the combination treatment, BPs alone were observed to be effective enough to increase the BMDs of the spine and femoral neck on both sides and thus prevent GC-induced osteoporosis in Eastern Asians.

Skeletal Fragility and Its Clinical Determinants in Children With Type 1 Diabetes.

Type 1 diabetes (T1D) is associated with an increased fracture risk at all ages. To understand the determinants of bone health and fractures in children with T1D. Case-control study of children with T1D on bone-turnover markers, dual-energy X-ray absorptiometry, and 3 Tesla-MRI of the proximal tibia to assess bone microarchitecture and vertebral marrow adiposity compared with age- and sex-matched healthy children. Thirty-two children with T1D at a median (range) age of 13.7 years (10.4, 16.7) and 26 controls, aged 13.8 years (10.2, 17.8), were recruited. In children with T1D, serum bone-specific alkaline phosphatase (BAP) SD score (SDS), C-terminal telopeptide of type I collagen SDS, and total body (TB) and lumbar spine bone mineral density (BMD) SDS were lower (all P < 0.05). Children with T1D also had lower trabecular volume [0.55 (0.47, 0.63) vs 0.59 (0.47, 0.63); P = 0.024], lower trabecular number [1.67 (1.56, 1.93) vs 1.82 (1.56, 1.99); P = 0.004], and higher trabecular separation [0.27 (0.21, 0.32) vs 0.24 (0.20, 0.33); P = 0.001] than controls. Marrow adiposity was similar in both groups (P = 0.25). Bone formation, as assessed by BAP, was lower in children with poorer glycemic control (P = 0.009) and who were acidotic at initial presentation (P = 0.017) but higher in children on continuous subcutaneous insulin infusion (P = 0.025). Fractures were more likely to be encountered in children with T1D compared with controls (31% vs 19%; P< 0.001). Compared with those without fractures, the T1D children with a fracture history had poorer glycemic control (P = 0.007) and lower TB BMD (P < 0.001) but no differences in bone microarchitecture. Children with T1D display a low bone-turnover state with reduced bone mineralization and poorer bone microarchitecture.

Cross-sectional evaluation of the relationship between vitamin D status and supplement use across levels of kidney function in adults

ObjectivesThe objective of this study was to assess vitamin D status of US non-pregnant adults using a standardised assay across 15 mL/min/1.73 m2 increments of kidney function, report the use...

Green tea extract suppresses osteoclastogenesis and opposes glucocorticoid-induced osteoporosis in rats

Background/aim Glucocorticoids-induced osteoporosis (GIO) through suppression of osteoblast activity, induction of receptor activator of nuclear factor-κB ligand (RANKL), and downregulation of osteoprotegerin (OPG). Green tea has antioxidant and anti-inflammatory properties. This study aims to evaluate the effects of green tea extract (GTE) supplementation on bone proteins, mineralization, and markers in GIO. Materials and methods The study was performed on 30 adult male Wistar rats, which were divided into three groups: control (C, n=10); GIO (n=10), which received dexamethasone 7 mg/kg body weight intramuscular once/week for 4 weeks; and GTE-supplemented osteoporotic (GT-GIO, n=10), which received dexamethasone, followed by 300 mg/kg per day of GTE by gavage for 4 weeks, with continuation of the dexamethasone. Serum calcium, phosphate, alkaline phosphatase activity, parathyroid hormone, deoxypyridinoline, osteocalcin, OPG, and RANKL were determined. Samples of left tibia were used for histopathological examination of bone. Results A significant decrease in serum Ca++, PO4, osteocalcin, and OPG, accompanied by a significant increase in serum bone-specific alkaline phosphatase, deoxypyridinoline, and RANKL was detected in the GIO group compared with the control group. GT-GIO group showed a significant increase in serum Ca++, PO4, osteocalcin, and OPG, with a significant decrease in serum bone-specific alkaline phosphatase, deoxypyridinoline, and RANKL compared with the GIO group. Bone examination of GIO rats revealed thinning, loss of architecture, erosions, and increased osteoclasts. Bone sections of the GT-GIO group revealed significant improvement, regain of normal architecture, and decreased osteoclast number. Conclusion GTE had an antiosteoporotic effect in GIO, and its effects are much more than its antioxidant characteristics.

Determination of serum bone-specific alkaline phosphatase isoenzyme activity in captive Asian elephants (Elephas maximus) using an agarose gel electrophoresis method.

The bone-specific alkaline phosphatase (ALP) isoenzyme activity was measured in 51 serum samples from four captive Asian elephants (Elephas maximus) using a conventional method with wheat germ lectin precipitation and a commercial agarose gel electrophoresis (AGE) kit; the isoenzymes were designated as bone-specific ALP (BAP) and ALP isoenzyme 3 (ALP3), respectively. This study examined the suitability of the AGE kit for analyzing blood biochemistry in Asian elephants. The serum ALP3 and BAP activities were strongly positively correlated and met the evaluation criteria for agreement using Bland-Altman analysis. The results indicate that the AGE kit can be used to examine the blood biochemistry in Asian elephants instead of the conventional method.

Efficacy of 4-year denosumab treatment alone or in combination with teriparatide in Japanese postmenopausal osteoporotic women

Purpose: This extended randomized prospective study aimed to compare the 4-year clinical outcomes of denosumab treatment alone or in combination with teriparatide in treatment-naïve postmenopausal Japanese patients with osteoporosis.Methods: Between July 2013 and December 2016, 30 eligible women from our previous study were enrolled. After newly adding 17 randomly assigned patients, 47 patients were classified into the denosumab alone group (denosumab group, n = 22) or denosumab plus teriparatide group (combination group, n = 25). Serum bone-specific alkaline phosphatase (BAP), serum tartrate-resistant acid phosphatase (TRACP)-5b, urinary cross-linked N-terminal telopeptide of type I collagen (NTX), and bone mineral density (BMD) of the lumbar 1–4 vertebrae (L-BMD) and bilateral total hips (H-BMD) were determined at the first visit and at regular time points up to 48 months of treatment to determine percentage changes.Results: BAP was significantly decreased from baseline in both groups from 24 to 48 months, with significant differences at all time points between the groups. TRACP-5b and urinary NTX were comparably decreased at every time point in both groups versus pretreatment levels. L-BMD was significantly more increased by combination therapy over denosumab alone at 24 and 30 months (21.1% increase vs. 14.2% increase at 48 months). There were no significant differences in H-BMD between the groups, although levels tended to be higher in the combination group throughout the study period (9.7% increase vs. 6.8% increase at 48 months).Conclusion: Long-term denosumab and teriparatide combination therapy represents an effective treatment option for primary osteoporosis patients with low L-BMD.

Circulating bone-specific alkaline phosphatase and abdominal aortic calcification in maintenance hemodialysis patients.

To explore the relationship between circulating bone-specific alkaline phosphatase (BALP) levels and abdominal aortic calcification (AAC) in patients receiving maintenance hemodialysis (MHD). A total of 156 MHD patients were enrolled. Serum BALP levels were measured using ELISA, and AAC was assessed via lateral abdominal radiography. BALP was positively correlated with AAC score (r=0.389; p <0.01). Multivariate logistic regression analysis showed that high-sensitivity C-reactive protein, dialysis vintage and BALP were independent risk factors for AAC in MHD patients. Receiver-operating characteristic analysis indicated that the area under the curve of BALP for the prediction of AAC was 0.737 (95% CI: 0.619-0.855; p <0.01). When the detection cut-off level was 17.55μg/l, its sensitivity was 81.7% and specificity was 74.5%. Serum BALP is closely correlated with vascular calcification in MHD patients.