OBJECTIVETo investigate the clinical value of serum total procollagen type 1 aminoterminal propeptide (total P1NP), cross-linked C-terminal telopeptide of type I collagen (β-CTX) and 25(OH)D3 detection in evaluating the risks of fragile hip fracture in elderly patients with osteoporosis.

METHODSSerum levels of total P1NP, β-CTX and 25(OH)D3 was measured in 68 elderly osteoporotic patients with fragile hip fracture and 68 age- and gender-matched osteoporotic controls without fragile hip fracture. In both groups, bone mineral density (BMD) was detected with dual X-ray absorptiometry.

RESULTSThe serum levels of total P1NP and β-CTX were significantly higher and 25(OH)D3 level was significantly lower in fragile hip fracture group than in the control group (P<0.05), but the two groups showed no significant difference in lumbar or total hip BMD. Bivariate correlation analysis suggested that in fragile hip fracture group, serum 25(OH)D3 level was positively, while serum total P1NP and β-CTX levels were inversely correlated with lumbar and total hip BMD (P<0.05). In control group, 25(OH)D3 was not related to lumbar or total hip BMD, and serum total P1NP and β-CTX levels were inversely correlated with total hip BMD (P<0.05) but not related to lumbar BMD.

CONCLUSIONIn osteoporotic elderly patients with close BMD levels, high serum levels of total P1NP and β-CTX and low serum levels of 25(OH)D3 might independently indicate high fragile hip fracture risk, and detection of the three markers can help identify high-risk individuals.

Aged ; Aged, 80 and over ; Biomarkers ; blood ; Bone Density ; Calcifediol ; blood ; Collagen Type I ; blood ; Female ; Hip Fractures ; blood ; diagnosis ; etiology ; Humans ; Male ; Osteoporosis ; complications ; diagnosis ; Osteoporosis, Postmenopausal ; blood ; diagnosis ; Peptides ; blood ; Procollagen ; blood

BACKGROUND: We aimed to investigate the diagnostic utility of osteocalcin (OC), undercarboxylated osteocalcin (ucOC), and alkaline phosphatase (ALP) in pre- and postmenopausal women for femoral neck, L1-4, and L2-4 bone mineral density (BMD) values by taking into consideration their age, body mass index (BMI), and menopausal status. METHODS: Premenopausal (N=40) and postmenopausal cases (N=42) were classified as 25-34 or 35-45 yr of age and within the first 5 yr or 5 yr or more after the onset of menopause, respectively. RESULTS: Among the groups, statistical differences were found for age, BMI, OC, ucOC, ALP, femoral neck BMD, L1-4 BMD, and L2-4 BMD. The highest serum OC, ucOC, and ALP levels were observed in cases within the first 5 yr after the onset of menopause, probably due to a more rapid bone turnover rate. The best predictors for the femoral neck osteoporosis were ALP, OC, and calcium (areas under the ROC curve [AUC]=0.882, 0.829, and 0.761, respectively), and those for L1-4 and L2-4 osteoporosis were OC, ALP, and ucOC (AUC=0.949, 0.873, and 0.845; and 0.866, 0.819, and 0.814, respectively). Multiple logistic regression analysis revealed that the most discriminative parameter for osteoporosis was OC. CONCLUSIONS: These results indicate that serum OC levels, with or without ucOC and ALP, may be useful to monitor follow-up changes that currently cannot be assessed with BMD and to diagnose femoral neck, L1-4 spine, and L2-4 spine osteoporosis.
Adult ; Aged ; Alkaline Phosphatase/*blood ; Body Mass Index ; Bone Density ; Discriminant Analysis ; Female ; Follow-Up Studies ; Humans ; Logistic Models ; Middle Aged ; Osteocalcin/*blood ; Osteoporosis/blood/*diagnosis ; Osteoporosis, Postmenopausal/blood/diagnosis ; Postmenopause ; Premenopause

Osteoporosis is a major health problem worldwide, and is projected to increase exponentially due to the aging of the population. The absolute fracture risk in individual subjects is calculated by the use of algorithms which include bone mineral density (BMD), age, gender, history of prior fracture and other risk factors. This review describes the laboratory investigations into osteoporosis which include serum calcium, phosphate, creatinine, alkaline phosphatase and 25-hydroxyvitamin D and, additionally in men, testosterone. Parathyroid hormone (PTH) is measured in patients with abnormal serum calcium to determine its cause. Other laboratory investigations such as thyroid function testing, screening for multiple myeloma, and screening for Cushing's syndrome, are performed if indicated. Measurement of bone turnover markers (BTMs) is currently not included in algorithms for fracture risk calculations due to the lack of data. However, BTMs may be useful for monitoring osteoporosis treatment. Further studies of the reference BTMs serum carboxy terminal telopeptide of collagen type I (s-CTX) and serum procollagen type I N-terminal propeptide (s-PINP) in fracture risk prediction and in monitoring various treatments for osteoporosis may help expedite their inclusion in routine clinical practice.
Algorithms ; Biological Markers/*blood ; Clinical Laboratory Techniques ; Collagen Type I/blood ; Fractures, Bone/prevention & control ; Humans ; Osteoporosis/*diagnosis ; Peptide Fragments/blood ; Peptides/blood ; Procollagen/blood

BACKGROUNDHyperparathyroidism (HPT) occurs at an early age and has a high disability rate. Unfortunately, confirmed diagnosis in most patients is done at a very late stage, when the patients have shown typical symptoms and signs, and when treatment does not produce any desirable effect. It has become urgent to find a method that would detect early bone diseases in HPT to obtain time for the ideal treatment. This study evaluated the accuracy of high field magnetic resonance imaging (MRI) combined with spiral computed tomography (SCT) scan in detecting early bone diseases in HPT, through imaging techniques and histopathological examinations on an animal model of HPT.

METHODSEighty adult rabbits were randomly divided into two groups with forty in each. The control group was fed normal diet (Ca:P = 1:0.7); the experimental group was fed high phosphate diet (Ca:P = 1:7) for 3, 4, 5, or 6-month intervals to establish the animal model of HPT. The staging and imaging findings of the early bone diseases in HPT were determined by high field MRI and SCT scan at the 3rd, 4th, 5th and 6th month. Each rabbit was sacrificed after high field MRI and SCT scan, and the parathyroid and bones were removed for pathological examination to evaluate the accuracy of imaging diagnosis.

RESULTSParathyroid histopathological studies revealed hyperplasia, osteoporosis and early cortical bone resorption. The bone diseases in HPT displayed different levels of low signal intensity on T(1)WI and low to intermediate signal intensity on T(2)WI in bone of stage 0, I, II or III, but showed correspondingly absent, probable, osteoporotic and subperiosteal cortical resorption on SCT scan.

CONCLUSIONHigh field MRI combined with SCT scan not only detects early bone diseases in HPT, but also indicates staging, and might be a reliable method of studying early bone diseases in HPT.

Animals ; Bone Diseases ; diagnosis ; pathology ; Calcium ; blood ; Female ; Hyperparathyroidism ; complications ; Magnetic Resonance Imaging ; methods ; Male ; Osteoporosis ; diagnosis ; Phosphorus ; blood ; Rabbits ; Tomography, Spiral Computed ; methods

Bone disease is a serious complication to diabetes. Patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) suffer from an increased risk of fracture, most notably at the hip, compared with patients without diabetes. Confounders such as patient sex, age, body mass index, blood glucose status, fall risk, and diabetes medications may influence the fracture risk. Different underlying mechanisms contribute to bone disease in patients with diabetes. Bone quality is affected by low bone turnover in T1D and T2D, and furthermore, incorporation of advanced glycation end-products, changes in the incretin hormone response, and microvascular complications contribute to impaired bone quality and increased fracture risk. Diagnosis of bone disease in patients with diabetes is a challenge as current methods for fracture prediction such as bone mineral density T-score and fracture risk assessment tools underestimate fracture risk for patients with T1D and T2D. This review focuses on bone disease and fracture risk in patients with diabetes regarding epidemiology, underlying disease mechanisms, and diagnostic methods, and we also provide considerations regarding the management of diabetes patients with bone disease in terms of an intervention threshold and different treatments.
Blood Glucose ; Body Mass Index ; Bone Density ; Bone Diseases ; Bone Remodeling ; Diagnosis ; Epidemiology ; Hip ; Humans ; Incretins ; Osteoporosis ; Risk Assessment

OBJECTIVETo investigate whether blood stasis is one of the main causes in the pathogenesis of postmenopausal osteoporosis.

METHODSThe clinical manifestation of blood stasis syndrome were comprehensively scored in sixty postmenopausal osteoporosis patients, their vascular endothelial function and platelet activating capacity were also detected, and compared with those in 30 healthy women as control.

RESULTSThe molecular indexes as vascular endothelial function and platelet activating capacity, as well as comprehensive scores of clinical manifestation of blood stasis syndrome in postmenopausal osteoporosis patients were significantly different to those of healthy women (P < 0.05, P < 0.01).

CONCLUSIONThere is objective molecular pathologic change of blood stasis syndrome in postmenopausal osteoporosis. Blood stasis plays an important role in pathogenesis of postmenopausal osteoporosis.

Aged ; Blood Viscosity ; Diagnosis, Differential ; Endothelium, Vascular ; physiopathology ; Female ; Hemorheology ; Humans ; Medicine, Chinese Traditional ; Middle Aged ; Osteoporosis, Postmenopausal ; blood ; etiology ; Platelet Activation ; physiology

OBJECTIVETo investigate the age- and gender-related changes in serum biochemical markers for bone metabolic turnover to establish the reference ranges for these markers for osteoporosis prevention and monitoring.

METHODSIn 276 healthy individuals, serum type I collagen C-telopeptide (beta-Crosslaps), osteocalin and alkaline phosphatase levels were measured by electrochemiluminescence immunoassay, radioimmunoassay and consecutive monitoring, respectively.

RESULTSNo significant changes in serum phosphatase was found in relation to age and gender. Serum beta-crosslaps levels tended to increase with age in male and female subjects, but only until the age of 50-59 years, such changes began to be statistically significant (P<0.05) as compared with the levels in the youngest group. Above this age range, beta-crosslaps level in female subjects increased dramatically, showing significant difference between adjacent age groups (P<0.05), which, however, was out observed in male subjects. Serum osteocalin level was lowered with age in female subjects before the age of 50 years, but a significant increase occurred at the age of 50-59 years (P<0.05) followed by a relatively stable and mild increase that did not result in significant difference between adjacent age groups. In male subjects, serum osteocalin level reached the peak level at the age of 30-39 years followed by stable and mild decrease with age. The ratio of beta-crosslaps/osteocalin tended to increase with age in both male and female subjects.

CONCLUSIONThere are age- and gender-related changes in serum beta-crosslaps, osteocalin and especially beta-crosslaps/osteocalin ratio, suggesting the value of testing serum beta-crosslaps and osteocalin in the prevention and treatment of osteoporosis.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Alkaline Phosphatase ; blood ; Bone and Bones ; metabolism ; Collagen Type I ; blood ; Female ; Humans ; Male ; Middle Aged ; Osteocalcin ; blood ; Osteoporosis ; blood ; diagnosis ; Peptides ; blood ; Sex Factors ; Young Adult

Pemphigus foliaceus is a chronic vesiculobullous dermatosis which seems to be an autoimmune etiology, and favorable results are usually able to obtain with massive doses of corticosteroids administration and Imuran or other anticancer drugs. Two cases of typical pemphigus foliaceus, who showed cutaneous candidiasis, one with clinical improvements, and the other one who had lung abscesses of aspergilli as a complication of the long-term corticosteroid treatment, have been presented. The diagnosis of pemphigus foliaceus was confirmed by histopathologically subcorneal bullae containing acantholytic cells, also Tzank test and Nikolsky's sign. First case, 37 year old man who has the history of corticostcroid therapy for 3 years tor rheumatoid arthritis, was treated with high dosage of prednisolone and antibiotics with nystatin for cutaneous candidiasis, but lung abscesses of aspergilli developed while we couldn't even notice its progress and he died suddenly because of it although skin lesions showed marked improvement. Second case, 36 year old house wife who has the history of recurrent aphthous stomatitis like eruptions was recovered from pemphigus foliceus after steroid treatment and cutaneous candidiasis after using antibiotics and nystatin. As the complication of corticosteroid therapy, cushingoid feature, blurred vision, and cutaneous candidiasis were occurred in both patients, especially in the first case, hyperglycemia and metabolic alkaloses were developed. And so, as mention of Saunders, we checked the patient's complete history, body weight everyday, and CBC and occult blood every week, but urine sugar or blood sugar and chest X-ray not periodically. We used anabolic agent for osteoporosis, antibiotics, mycostatm, diuretics, and antacid regimen, but failed to deveIopment of aspergillosis.
Adrenal Cortex Hormones ; Adult ; Alkalosis ; Anti-Bacterial Agents ; Arthritis, Rheumatoid ; Aspergillosis ; Azathioprine ; Blood Glucose ; Body Weight ; Candidiasis, Cutaneous ; Diagnosis ; Diuretics ; Humans ; Hyperglycemia ; Lung Abscess ; Nystatin ; Occult Blood ; Osteoporosis ; Pemphigus* ; Prednisolone ; Skin ; Skin Diseases ; Spouses ; Stomatitis, Aphthous ; Thorax

PURPOSE: Up to 71% of South Korean postmenopausal women have vitamin D deficiency {serum 25-hydroxyvitamin D [25(OH) D] level <50 nmol/L}. Data on vitamin D supplementation was collected during the screening phase of an efficacy/safety study of denosumab in Korean postmenopausal women with osteoporosis. This report describes the effect of vitamin D supplementation on repletion to 25(OH)D levels ≥50 nmol/L in Korean postmenopausal women with osteoporosis. MATERIALS AND METHODS: Vitamin D levels of Korean postmenopausal women (60-90 years old) were measured by extracting 25(OH)D2 and 25(OH)D3 from serum samples via protein precipitation and using liquid chromatography with tandem mass spectrometry detection. Calibration curves were constructed from the mass chromatograms to obtain total vitamin D levels. Subjects with serum 25(OH)D levels <50 nmol/L were supplemented with 1000 IU of vitamin D tablets during the 2.5-month-long screening period. Dose, frequency, and duration were determined by the investigator. If repletion was achieved (≥50 nmol/L) on retest, subjects were eligible to be rescreened for study entry. RESULTS: Of 371 subjects screened, 191 (52%) required vitamin D supplementation, and 88% (168 of 191) were successfully repleted. More than half of the subjects (58%) who were successfully repleted received doses of 2000 IU daily. The mean time to successful repletion was 31 days (standard deviation 8.4 days; range 11-48 days). CONCLUSION: Supplementation with daily median doses of 2000 IU vitamin D successfully repleted 88% of Korean postmenopausal women with osteoporosis within 48 days to a serum vitamin D level of 50 nmol/L.
Aged ; Aged, 80 and over ; *Asian Continental Ancestry Group ; Bone Density Conservation Agents/*therapeutic use ; *Dietary Supplements ; Double-Blind Method ; Female ; Humans ; Middle Aged ; Osteoporosis, Postmenopausal/*complications/drug therapy/ethnology ; Postmenopause/blood ; Republic of Korea ; Vitamin D/analogs & derivatives/blood/*therapeutic use ; Vitamin D Deficiency/diagnosis/*drug therapy/ethnology

Vitamin D deficiency is common and may contribute to osteopenia, osteoporosis and falls risk in the elderly. Screening for vitamin D deficiency is important in high-risk patients, especially for patients who suffered minimal trauma fractures. Vitamin D deficiency should be treated according to the severity of the deficiency. In high-risk adults, follow-up serum 25-hydroxyvitamin D concentration should be measured 3-4 months after initiating maintenance therapy to confirm that the target level has been achieved. All patients should maintain a calcium intake of at least 1,000 mg for women aged ≤ 50 years and men ≤ 70 years, and 1,300 mg for women > 50 years and men > 70 years.
Aged ; Bone Density ; Bone Diseases, Metabolic ; prevention & control ; Calcium, Dietary ; therapeutic use ; Cholecalciferol ; administration & dosage ; Female ; Hip Fractures ; complications ; epidemiology ; Humans ; Male ; Middle Aged ; Osteoporosis ; prevention & control ; Practice Guidelines as Topic ; Prevalence ; Primary Health Care ; methods ; Risk Factors ; Vitamin D ; analogs & derivatives ; blood ; Vitamin D Deficiency ; diagnosis ; epidemiology