Jerzy Przedlacki

Bone mineral density in adolescent girls with anorexia nervosa--a cross-sectional study.

The total body and lumbar spine bone mineral density (BMD) were measured in order to determine the prevalence and possible risk factors of decreased BMD in anorexia nervosa (AN). Subjects Sixty-one in-patient girls with DSM III-R AN: age 14.7±2.16 years; duration of AN 12.9±15.1 months; percentage of ideal body weight 70±8.7 %; body mass index score −1.62±0.79. Method Total body (in 61 patients) and lumbar spine BMD (in 43 patients), content of lean and fat tissue mass were measured by DXA during the first month of treatment. Results Low total body BMD was found in 23.7 % and low lumbar spine BMD in 36.6 % of patients. There was a negative correlation between BMD and age, age of menarche, degree of undernourishment, duration of AN and amenorrhea. A step-wise linear regression analysis revealed that age of menarche was the most important factor related to BMD in this group.

Long-term cholecalciferol administration in hemodialysis patients: a single-center randomized pilot study.

Background Data on the potent pleiotropic extraskeletal effects of vitamin D have renewed interest in its use in selected populations, including patients with chronic kidney disease, but the available data are still insufficient to make recommendations. This study assessed the long-term effect of small cholecalciferol doses on serum vitamin D, parathormone (PTH), and bone mineral density (BMD) in hemodialysis patients. Material/Methods Nineteen patients with serum 25(OH)D <20 ng/mL were randomized into cholecalciferol (2000 IU 3×/week) and no-treatment groups, then observed for 1 year. Patients with hypercalcemia, hyperphosphatemia, and receiving vitamin D/calcimimetics were excluded. Serum 25(OH)D, 1,25(OH)2D, PTH, and alkaline phosphatase activity were examined every 2 months and BMD was measured before and after the study. Results We observed normalization of serum 25(OH)D with an increase in medians from 11.3 to 44.9 ng/mL (P=0.02) in the cholecalciferol group and no change in the controls (P<0.001). Simultaneously, median serum 1,25(OH)2D increased from 18.2 to 43.1 pmol/L (P=0.02) in the cholecalciferol group and from 10.6 to 21.2 pmol/L (P=0.02) in controls (P=0.013). The treatment was associated with a small increase in serum calcium, but serum phosphate, PTH, alkaline phosphatase, and BMD remained unchanged in both groups. Conclusions Oral cholecalciferol at a dose of 2000 IU/3×/week is an effective and safe way to treat vitamin D deficiency in hemodialysis patients, leading to a significant increase in serum 1,25(OH)2D. However, it was insufficient to suppress the activity of parathyroid glands or to significantly change BMD.

Markers of Bone Metabolism in Children with Nephrotic Syndrome Treated with Corticosteroids

The aim of the study was to assess bone mineral density, bone metabolism markers, and vitamin D level in children with idiopathic nephrotic syndrome in the course of 1-year observation. Twenty five children with nephrotic syndrome aged 5-17 years were enrolled into the study. The median number of relapses was 6 (range 1-22). All patients were treated with prednisone and vitamin D (800 IU/day). Bone mineral density of total body (TB-BMD) and lumbar spine (L-BMD), evaluated by dual energy X-ray absorptiometry (DXA) expressed as Z-score, and serum calcium, phosphorus, parathormone (iPTH), alkaline phosphatase (ALP), bone alkaline phosphatase (BAP), osteocalcin (OC), albumin, creatinine, 25(OH)D3, 1,25(OH)2D3 and urine calcium/creatinine ratio (uCa/Cr) were evaluated at the enrollment visit and after 1 year of therapy. After 1 year significant decreases of TB-BMD Z-score (from -0.24±1.34 to -0.74±1.31, p<0.05) and 25(OH)D3 serum level (from 31.7±16.3 to 23.7±9.3; p<0.05) were observed. No other appreciable differences were found. At the study onset, negative correlations were found between L-BMD Z-score and serum ALP, BAP, and phosphorus and between TB-BMD Z-score and urine uCa/Cr. After 1 year, L-BMD Z-score correlated negatively with serum BAP and OC, and positively with serum 25(OH)D3. Multivariate analysis showed that BAP was the strongest predictor of L-BMD Z-score (beta=-0.49; p<0.05). We conclude that children with nephrotic syndrome treated with corticosteroids are at risk of bone mass loss. Serum BAP concentration seems to be a good indicator of spongy bone metabolism in these children, who should be supplemented with vitamin D in an adjustable dose, possibly higher than 800 IU/24 h to prevent osteopenia.

Bone mineralization disorders as a complication of anorexia nervosa - etiology, prevalence, course and treatment.

Anorexia nervosa (AN) most often has its onset in adolescence, which is a crucial period to achieve peak bone mass. The hormonal abnormalities (hypoestrogenism, hypercortisolism, decreased secretion of dehydroepiandrosterone, testosterone, insulin-like growth factor) and malnutrition are associated with profound bone mineralization disorders. Densitomertic bone mineral density (BMD) values for osteopenia and osteoporosis were found respectively in 35-98% and 13-50% of women with AN. Prospective studies indicate a further decline in BMD at the beginning of treatment and a crucial importance of weight gain and return of spontaneous menses for its growth. Due to frequent chronic and relapsing course of AN densitometric assessment of BMD is recommended in all patients with AN and amenorrhea lasting around twelve months. In order to establish standards for the treatment of osteoporosis in AN, studies on pharmacological treatment are conducted. There are promising results indicating the improvement in BMD after treatment with physiologic oestrogen replacement treatment and sequential administration of medroxyprogesterone in teenage girls and bisphosphonates in adult women. Supplementation of vitamin D and adequate consumption of calcium from diet are recommended. Further studies on the effectiveness of long-term treatment of osteoporosis with regard to the possibility of increase in BMD and reducing the risk of osteoporotic fractures are needed.

Bone metabolism and vitamin D status in patients with multiple sclerosis.

BACKGROUND Vitamin D (VD), an important factor for bone health immobilization and immune regulation, has been shown to have low serum concentration in multiple sclerosis (MS) patients. Those patients have also multiple fracture risk factors, including progressive immobilization and long-term glucocorticoids treatment. The aim of the study was to analyze bone health (osteopenia or osteoporosis prevalence) and VD serum concentration in MS patients as well as the influence of disease activity and treatment on bone health. MATERIALS AND METHODS The study involved 72 MS patients: 52 women and 20 men. Mean age was 40.3±10.5 yrs, mean EDSS (Expanded Disability Status Scale) 3.3±1.9. Bone health was analyzed using standard densitometry in the lumbar spine and femoral neck. Serum levels of VD, calcium, phosphate and parathormone were assessed. We compared two groups of patients with multiple sclerosis: relapsing - remitting MS (RRMS) and progressive relapsing MS (PRMS). RESULTS Densitometry revealed osteopenia in twenty-six (36.1%) patients and osteoporosis in eleven (15.3%), no bone fractures were presented. Sixty-eight MS patients (94.4%) had lower VD serum level if compared to population referential values. Thirteen patients (18.1%) had severe VD deficiency. Densitometry parameter (T-score of the lumbar spine) worsened with EDSS increase (r=-0.43, P=0.001). There was a statistically significant negative correlation between VD concentration and EDSS score (r=-0.31; P=0.009). CONCLUSIONS Our study indicates that patients with MS have high incidence of osteopenia and osteoporosis and vitamin D deficiency. Bone health disturbances studied by densitometry are related to the disability caused by MS.

Bone mineralization and densitometric evaluation of vertebral fractures in women 6-21 years after the onset of anorexia nervosa symptoms

OBJECTIVES We attempted to assess bone mineralization and the frequency of fractures occurrence in women with a history of treatment of anorexia nervosa (AN) in adolescence. METHODS 47 women (age 20-36.8 years) were re-examined 6.33-21,2 years after the onset of AN symptoms. Bone mineral density (BMD) of total body, lumbar spine, femoral neck, total hip (DXA) and densitometric Vertebral Fracture Assessment (VFA) were performed on 46 of women and BAP, P1NP, CTX, estradiol, testosterone, cortisol, IGF-1, leptin, DHEA-S on 45 of women entered for the current study. Current BMD results were compared with available baseline results from the time of hospitalization. RESULTS Currently BMD Z-score <-1 examined at any location occurred in 28 from 46 women (including Z-score <-2 in 5 women). In 11 from 12 women with reduced BMD at the time of hospitalization current total body BMD was within the normal range. Lumbar spine BMD was normalized or improved respectively in 5 and 6 from 15 women. Currently increased levels/activity of bone formation markers: P1NP in 27 (60%) and BAP in 28 women (62.2%) were observed. In 7 women (15.6%) increased values of bone formation markers with increased marker of bone resorption (CTX) occurred. Osteoporotic fractures and fractures in the spine in VFA were not observed during the observation period. CONCLUSIONS Despite early treatment of adolescent-onset AN and good outcomes of the treatment, decreased BMD was currently present in 60.9% of women. During follow-up normalization or significant improvement in BMD results (total body, lumbar spine) were observed in majority of cases.

Cross-Linked C-Terminal Telopeptide of Type I Collagen in Serum before and after Treatment with Alfacalcidol and Calcium Carbonate in Early and Moderate Chronic Renal Failure

The diagnosis of renal osteodystrophy (RO) in chronic renal failure (CRF) in everyday practice depends on noninvasive methods. Still there is no widely accepted bone resorption marker in RO. The aim of the study was to evaluate the correlation of serum cross-linked C-terminal telopeptide of type I collagen (s-CTx) as the resorption marker with clinical and biochemical data and to evaluate s-CTx level changes after treatment with low dose of alfacalcidol and calcium carbonate. Sixty patients (36 men and 24 women) with creatinine serum level 3.0 ± 1.5 mg% were examined. The result of s-CTx was normal in 27 patients and increased in 33. There was a significant positive correlation of s-CTx and serum creatinine (p < 0.001), alkaline phosphatase activity (p < 0.05) and duration of CRF (p < 0.05) in men and serum creatinine (p < 0.001) and phosphorus (p < 0.05) in postmenopausal women. Patients with increased s-CTx had significantly higher serum creatinine (p < 0.001), phosphorus (p < 0.01), alkaline phosphatase activity (p < 0.001) and longer duration of CRF (p < 0.001) than patients with normal s-CTx. Next, 25 patients were treated for 6 months with alfacalcidol in dose of 0.25 µg every other day and calcium carbonate in dose of 3.0 µg per day and 25 patients with calcium carbonate only. There was a statistically significant decrease of s-CTx in both groups of patients (p < 0.01). We conclude, that in patients with CRF, s-CTx can be taken as the marker of bone resorption changes after treatment of RO but the value of s-CTx as a diagnostic marker in these patients ought to be evaluated in comparison with histomorphometry.

Scuba diving does not affect bone mineral density or bone mineral content.

OBJECTIVES Scuba diving is a very specialized, physically demanding activity. The bones of divers are subjected to stress from water pressure, from the forces generated when their muscles resist water pressure, and from weightlessness. Notably, few studies have addressed the effects of diving on bone mineral density (BMD) and bone mineral content (BMC), and the results have been controversial. The goal of the study was to assess BMD and BMC in a group of professional scuba divers. METHODS The study group (diving group [D]) included 16 male professional scuba divers who also worked as firemen. The control group included 14 firemen who did not scuba dive (non-diving group [ND]). The groups were matched by age, weight, and height. The BMD and BMC of the whole skeleton, L1-L4, total hip, and femoral neck were assessed by dual-energy X-ray absorptiometry. RESULTS There were no differences in BMD or in BMC in the two groups, and the BMD and BMC values were within one standard deviation in terms of Z- and T-scores. There was no correlation between total diving time (hours) and BMD in the D group. CONCLUSION Scuba diving does not negatively influence bone turnover.