Elena Segal

Comparison of Daily, Weekly, and Monthly Vitamin D3 in Ethanol Dosing Protocols for Two Months in Elderly Hip Fracture Patients

BACKGROUND Different dosing protocols have been used for vitamin D supplementation, but there has been a lack of comparative data among them. OBJECTIVE Our objective was to determine whether the same cumulative dose of vitamin D3 produces different effects if it is given daily, weekly, or monthly. DESIGN Women, age 81 +/- 8 yr (+/- sd, n = 48), who had undergone surgery to repair hip fracture were randomized to vitamin D3-supplementation protocols at 1,500 IU daily, or 10,500 IU once weekly, or 45,000 IU once every 28 d. The primary outcome measure was the serum 25-hydroxyvitamin D [25(OH)D] concentration attained. RESULTS Initially, serum 25(OH)D concentrations for daily, weekly, and monthly groups were, respectively, 15.13 +/- 6.9, 15.7 +/- 10.1, and 16.2 +/- 10.1 ng/ml. By d 7, these had increased significantly in all the groups (P < 0.001). On the first day after the monthly dose, both serum 25(OH)D and serum 1,25-dihydroxyvitamin D had increased significantly (P < 0.012 each), whereas these did not change significantly on the day after daily or weekly doses. After 2 months, serum 25(OH)D with daily, weekly, and monthly dosing were, respectively, 33.2 +/- 8.5, 29.2 +/- 8.9, and 37.1 +/- 10.3 ng/ml; there were no significant differences among these values. CONCLUSIONS Supplementation with vitamin D can be achieved equally well with daily, weekly, or monthly dosing frequencies. Therefore, the choice of dose frequency can be based on whichever approach will optimize an individuals adherence with long-term vitamin D supplementation.

Predominant factors associated with bone loss in liver transplant patients: after prolonged post-transplantation period

Abstract: Introduction: Osteoporosis is a major cause of morbidity in liver transplant recipients and is associated with multiple factors.

Bone Density in Axial and Appendicular Skeleton in Patients with Lactose Intolerance: Influence of Calcium Intake and Vitamin D Status

Background: Lactose intolerance (LI) is a common enzymatic insufficiency, manifesting by poor tolerance of dairy products, leading to low calcium intake and poor calcium absorption from dairy products. These changes might lead to an impairment of bone metabolism [1]. Objectives: To evaluate the impact of LI on quantitative bone parameters in axial and appendicular skeletal sites. To assess the impact of calcium intake from dairy and non-dairy nutritional sources, calcium regulating hormones and bone turnover on quantitative bone parameters in LI patients. Methods: We evaluated calcium intake and bone status in sixty-six patients with LI, 49 women and 17 men, aged 20 to 78. Bone mass was assessed at the lumbar spine (LS), total hip (TH) and femoral neck (FN) by dual-energy x-ray absorptiometry (DEXA) and at the radius, tibia, phalanx by quantitative ultrasound. Serum calcium, albumin, inorganic phosphate, calcium regulating hormones and markers of bone turnover were evaluated. Results: Total daily calcium intake was below the recommended by the American Dietetic Association [2] in all study participants (mean 692 mg/day ± 162). Elevated level of urinary deoxypyridinoline crosslinks (DPD) was observed in 63 (96%) patients and was negatively correlated with total daily calcium intake (r = −0.998, p = 0.025) and with nondairy calcium intake (r = −0.34, p = 0.015). Parathyroid hormone (PTH) level in the upper third of normal range (45–65 ng/L) was observed in 11 (17%) patients. Parathyroid hormone (PTH) was inversely correlated with total calcium intake (r = −0.4, p = 0.001), dairy calcium intake (r = −0.83, p = 0.05), non-dairy calcium intake (r = −0.29, p = 0.043), 25OHD3 serum level (r = −0.3, p = 0.007) and positively correlated with bone turnover markers (deoxypyridinoline crosslinks [DPD], r = 0.36, p = 0.01 and bone specific alkaline phosphatase [BSAP] r = 0.36, p = 0.01). Decrease in quantitative bone parameters compared to age-matched controls was observed in the axial and in the appendicular skeleton in men and in postmenopausal women: mean z-score for LS −0.87 ± 0.22 and −1.32 ± 0.65, p = 0.004 and 0.015, tibia −1.15 ± 0.53 and −0.44 ± 0.044, p < 0.001 and 0.27, phalanx −0.98 ± 0.22 and −0.52 ± 0.98, p < 0.001. We observed decrease in bone mass in patients with serum PTH in the upper tertile of normal range in the FN (z-score −0.57 ± 0.6 versus −0.03 ± 0.9, p = 0.025), TH (−0.51 ± 0.96 versus 0.04 ± 0.9, p = 0.05) and radius (−1.84 ± 0.27 versus −0.07 ± 1.61, p = 0.025, respectively). z-scores in FN and TH positively correlated with serum 25OHD3 level (r = 0.31, 0.29; p = 0.014, 0.019). In postmenopausal women serum 25OHD3 level correlated also with LS z-scores (r = 0.52, p = 0.004); FN and TH z-scores negatively correlated with DPD level (r = −0.51, p = 0.02 and r = −0.55, p = 0.04). Conclusion: LI state may lead to increased bone turnover and decreased bone mass especially in men and postmenopausal women. Impaired vitamin D status and low calcium intake may be deleterious to bone in this condition.

Low patient compliance—A major negative factor in achieving vitamin D adequacy in elderly hip fracture patients supplemented with 800 IU of vitamin D3 daily

Achievement of adequate vitamin D3 level is crucial for the treatment of hip fracture patients. Currently used vitamin D3 supplementation in Israel ranges between 200 and 800IU/day. The study objectives were to evaluate the effects of 800IU/day vitamin D3 and 1.200mg of calcium carbonate supplementation to achieve adequate vitamin D3 level of 30ng/ml in elderly hip fracture patients. One hundred and twenty-two elderly patients after surgical hip fracture correction aged 73.0+/-9.5, who were enrolled in a post-surgical treatment program (PSTP). The patients received 800IU of vitamin D3 and 1.200mg of calcium carbonate daily. Serum 25(OH)D and plasma PTH levels were assessed during initial hospital stay and at quarterly follow-up visits for 2 years. At baseline, 120 patients (98.4%) had 25(OH)D serum level <30ng/ml. Forty-two patients (34.4%) had 25(OH)D serum level <10ng/ml and these were considered as vitamin D(3) deficient. After 3 months, 29 patients (23.8%) were fully adherent to the supplement, 32 were (26.2%) partially adherent. The dropout rate at 1 year was 55.7%. The major reason for the discontinuation of participation was non-compliance. We conclude that the majority of elderly hip fracture patients had inadequate 25(OH)D serum levels. Compliance with calcium and vitamin D3 supplements was extremely low. An adequate vitamin D status was not achieved with daily vitamin D3 supplementation of 800IU. Supplementation strategies using a periodic single high dose of vitamin D3 might be more appropriate and should be considered in these patients.

Sialochemical and oxidative analyses in radioactive I131-treated patients with thyroid carcinoma

BACKGROUND I131 in relatively high doses has been shown in the past to cause damaging salivary effects and oral discomfort in patients. Although lower dosage is now widely accepted, I131 may still be the source of salivary damage over the long-term and subsequent harmful effects on both the oral cavity and the gastrointestinal tract, into which the saliva is swallowed. This study examined the effects of radioactive I131 on salivary gland activity, saliva composition and oxidative profile, and related oral discomfort complaints following thyroidectomy due to carcinoma of thyroid gland. METHODS Out of 40 consenting female post-thyroidectomy patients, 23 (mean age 50+/-4 years old) were treated with I131 while 17 (mean age 46+/-4) were not. Whole saliva from all subjects was analyzed for antioxidant and biochemical composition and flow rate. RESULTS The salivary flow rates of both groups were similar but their composition differed considerably. Salivary superoxide dismutase enzyme (SOD), total protein, and albumin concentrations were significantly reduced in the treated patients by 40, 25, and 18% respectively (P<0.05), as were all other salivary antioxidants. Oral discomfort complaints were far more prevalent in the I131-treated patients. CONCLUSIONS I131-dependent damage to the salivary glands was evidenced by a broad spectrum of compositional alterations and oral complaints. Reduction in salivary antioxidant status, SOD enzyme, and the uric acid molecule leaves the oral cavity less protected against oxidative stress. This is the first report of radioactive I131 treatment being harmful to salivary glands due to compromised salivary compositional and oxidative profile and oral discomfort complaints.

Monitoring Response to Osteoporosis Therapy With Alendronate by a Multisite Ultrasound Device: A Prospective Study

BACKGROUND Osteoporotic fractures are a major health problem among postmenopausal women. A significant proportion of subjects with low bone density are currently undiagnosed. Peripheral devices can be used for osteoporosis diagnosis, but their role in long-term monitoring of skeletal changes is unclear. The current study evaluated the ability of quantitative ultrasound (QUS) measurements to follow osteoporotic subjects treated with alendronate. METHODS QUS measurements were done with Sunlight Omnisense (Omnisense, Sunlight Medical Ltd., Tel Aviv, Israel), which determines the bone speed of sound (SOS) in several skeletal sites. Postmenopausal women with T-scores of -2 or less at one site were recruited and treated with alendronate for at least 1 yr. Follow-up was done with QUS and dual-energy X-ray absorptiometry (DXA) (Lunar DPX scanner, Madison, WI, USA) measurements. RESULTS After 12 mo, bone mineral density (BMD) increased significantly at the lumbar spine (LS) (0.34 +/- 0.08 T-score, p = 0.0001 with 95% CI [0.19, 0.49]) and QUS at the tibia (TIB) (0.21 +/- 0.09 T-score, p = 0.02 with 95% CI [0.03, 0.39]). After 12 mo, a significant increase in mean T-scores was demonstrated in all sites assessed according to baseline T-score of -2 or less. CONCLUSIONS Peripheral QUS measurement may be considered for follow-up on skeletal changes in response to alendronate treatment.

Hip fractures in the elderly in Israel - possible impact of preventable conditions.

In the present study we evaluated the possible contribution of different factors to the occurrence of hip fractures in Israel. We assessed medical history, physical activity, body mass index, smoking status, bone turnover markers and calcium regulating hormones levels of 142 consecutive elderly hip fracture patients (HFP), and compared them to 96 community dwelling elderly people without a history of hip fracture. Age and female gender were the strongest predictors of hip fracture, p<0.001 and 0.013. Stepwise logistic regression demonstrated that HFP had higher PTH and lower 25(OH)D(3) levels, p=0.002, p<0.001; they were less physically active, p<0.001, and had higher rate of vitamin D insufficiency during winter-spring, compared to summer-autumn, p=0.033. Diabetics had higher risk for hip fracture, p=0.06, OR=3.9 (95% CI 1.50-10.4). Deoxypyridinoline (DPD) cross links levels were 19.35+/-10.58mg/mg creatinine in HFP and 9.12+/-3.52 in controls, p<0.0001. Bone alkaline phosphatase (BAP)/DPD ratio was 1.5 in controls compared to 0.53 in HFP. We conclude that age and female gender were the strongest predictors for hip fracture. Diabetic patients had threefold risk for hip fracture. Bone formation/bone resorption ratio was lower in HFP. Vitamin D deficiency and physical inactivity are important preventable risk factors for hip fracture.