Bone health in prostate cancer patients: A survivorship issue requiring intervention.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 247-247
Author(s):  
George A. Dawson ◽  
Anne Greener ◽  
Dalila Reyes-Dawson ◽  
Sheetal Malhotra ◽  
Sarah Weinbrom ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Vitamin D ◽  
Alcohol Abuse ◽  
Cancer Patients ◽  
Tobacco Use ◽  
Bone Disease ◽  
Bone Health ◽  
Increased Risk ◽  
Vitamin D Levels

247 Background: In general, men are not routinely screened for bone health. Prostate cancer patients are at an increased risk because of treatment with androgen deprivation therapy (ADT). Unlike other patients diagnosed with a malignancy, they may survive a long time. Some risk factors include inadequate calcium, vitamin D deficiency, tobacco use and alcohol abuse. We implemented a pre-ADT program to mitigate the effects of ADT on bone health. This study evaluates the pre-existing risk factors and bone health by baseline DEXA scans pre-ADT initiation. Methods: We completed a chart review of 182 veterans referred to Radiation Oncology for curative treatment of prostate cancer from 2009 to 2013. Of those, 160 patients underwent baseline DEXA scans. Clinical variables analyzed were demographics, tobacco and alcohol use, vitamin D levels, incidence of AODM (adult onset diabetes mellitus), and calcium or vitamin D intervention. Descriptive statistics and bivariate analysis including Chi Square tests and odds ratios were carried out. Results: The mean age of the study participants was 66.6 years (range 47-82.8 years). Baseline DEXA scans were abnormal in 63% of patients, showing osteoporosis and/or osteopenia. Vitamin D levels were abnormal in 61% of patients- 26% of whom had normal DEXA scans. Twenty percent had a history of alcohol abuse, and 56% used tobacco; 33% had AODM. Smokers with an abnormal Vitamin D level were at increased risk of bone disease as compared to non smokers (OR 3.23, 95% CI 1.35-7.69 p<0.01). Variables significantly impacting bone health were age (OR 1.087, p=0.012, 95% CI 1.018-1.161) and Tobacco use (OR 0.424, p=0.045, 95% CI 0.183-0.980). Almost 90% of the patients in this study had intermediate risk prostate cancer with an expected cancer specific survival of 85 to 90% at 5 to 10 years. Conclusions: Pre-ADT screening confirms the risk of underlying bone disease in this veteran population with an expectation of long term survival. Guidelines for treatment and prevention of bone disease should be implemented in all patients over age of 50. Particular attention should be paid to patients who underwent ADT. This can affect the quality of life in this group of cancer survivors.

scholarly journals Association of 25-hydroxyvitamin D with cardiometabolic risk factors and metabolic syndrome: a mendelian randomization study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Chi Chen ◽  
Yi Chen ◽  
Pan Weng ◽  
Fangzhen Xia ◽  
Qin Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Vitamin D ◽  
Cardiometabolic Risk ◽  
Mendelian Randomization ◽  
Cardiometabolic Risk Factors ◽  
Metabolic Traits ◽  
Increased Risk ◽  
Vitamin D Levels ◽  
Genetically Determined

Abstract Background Low circulating vitamin D levels have been associated with increased risk of metabolic syndrome (MS) and cardiometabolic risk factors in multiple epidemiology studies. However, whether this association is causal is still unclear. We aimed to test whether genetically lowered vitamin D levels were associated with MS and its metabolic traits, using mendelian randomization (MR) methodology. Methods Ten thousand six hundred fifty-five participants were enrolled from the SPECT-China study, which was performed in 23 sites in East China during 2014 to 2016. Using four single-nucleotide polymorphisms (SNPs) in the DHCR7, CYP2R1, GC and CYP24A1 genes with known effects on 25(OH) D concentrations, we created a genetic risk score (GRS) as instrumental variable (IV) to estimate the effect of genetically lowered 25(OH) D on MS and cardiometabolic risk factors. MS was defined according to the International Diabetes Federation criteria. Results Lower measured 25(OH)D levels were associated with MS (OR 0.921, 95% CI 0.888, 0.954) after multivariable adjustment. However, the MR-derived odds ratio of genetically determined 25(OH) D for risk of MS was 0.977 (95% CI 0.966, 1.030). The MR-derived estimates for raised fasting plasma glucose was 0.578 (95% CI 0.321, 0.980) per 10 nmol/L GRSsynthesis determined increase of 25(OH) D levels. Conclusions We found no evidence that genetically determined reduction in 25(OH)D conferred an increased risk of MS and its metabolic traits. However, we created our GRS only on the basis of common variants, which represent limited amount of variance in 25(OH)D. MR studies using rare variants, and large-scale well-designed RCTs about the effect of vitamin D supplementation on MS are warranted to further validate the findings.

Bone loss and vitamin D deficiency post gastrectomy for gastro-esophageal malignancy.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 165-165 ◽  
Author(s):  
Kiran Virik ◽  
Robert Wilson
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Bone Disease ◽  
Bone Health ◽  
Nutritional Supplementation ◽  
Type I ◽  
Mineral Density ◽  
Post Surgery

165 Background: Metabolic bone disease is a known but incompletely understood consequence of gastrectomy. Post gastrectomy osteoporosis (OP) is multifactorial. Evidence suggests that patients who undergo this surgery require long term bone health assessment and nutritional support. Methods: 30 post gastrectomy patients (2000-2008) from a single centre in Australia were evaluated re bone health post surgery and post nutritional supplementation. Exploratory analysis included: age, gender, pathology, type of surgery, 25 OH-vitamin D, calcium, parathyroid hormone (PTH), bone mineral density (BMD), vertebral XRs, urinary calcium and N telopeptides of type I collagen. Other risk factors evaluated were: smoking, corticosteroid use, alcohol intake, hyperthyroidism, menopausal status, hyperparathyroidism (hPTH), pre-existing bone disease. Results: The median age of the cohort was 67.5 (range 53-83) of whom 22 (73%) were male. Histology showed 16 (53%) gastric adenocarcinoma, 6 (20%) esophageal adenocarcinoma, 2 (7%) GISTs, 5 (17%) gastric/duodenal lymphoma and 1 other category. Similar numbers of patients underwent total (12) and partial/distal gastrectomy (12), with 6 having a subtotal gastrectomy. 22 (73%) had a Roux-en-Y or BR II reconstruction and 8 had a BRI/other. Median time from surgery to first BMD was 54.5 months (range 12-360) with median correlative calcium level 2.24 (range 1.97-2.49), median vitamin D level 43 (range 11-82) and median PTH 6.4 (range 1.8-13.8). Osteoporosis was diagnosed in 14 (47%) of patients, osteopenia in 14 and 2 (7%) patients had a normal BMD. Low vitamin D was seen in 23 (77%) patients, low calcium levels in 5 (17%) and secondary hPTH in 12 (41%). Post nutritional supplementation preliminary results showed 2/23 (9%) had a low vitamin D level, 3/11 (27%) had secondary hPTH, 5/19 (26%) had osteoporosis, 12/19 (63%) had osteopenia and 2/19 had a normal BMD. Analysis of other risk factors is to follow. Conclusions: Poor bone health and vitamin D deficiency is a clinically significant problem post gastrectomy. Patients should undergo long term nutritional and bone health surveillance in addition to their oncological follow up post resection.

scholarly journals Associations Between Serum Vitamin D and Adverse Pathology in Men Undergoing Radical Prostatectomy

2016 ◽  
Vol 34 (12) ◽  
pp. 1345-1349 ◽  
Author(s):  
Yaw A. Nyame ◽  
Adam B. Murphy ◽  
Diana K. Bowen ◽  
Gregory Jordan ◽  
Ken Batai ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Vitamin D ◽  
Radical Prostatectomy ◽  
Univariate Analysis ◽  
Serum Vitamin ◽  
Serum Vitamin D ◽  
Cancer Aggressiveness ◽  
Increased Risk ◽  
Vitamin D Levels ◽  
The Relationship

Purpose Lower serum vitamin D levels have been associated with an increased risk of aggressive prostate cancer. Among men with localized prostate cancer, especially with low- or intermediate-risk disease, vitamin D may serve as an important biomarker of disease aggression. The aim of this study was to assess the relationship between adverse pathology at the time of radical prostatectomy and serum 25-hydroxyvitamin D (25-OH D) levels. Methods This cross-sectional study was carried out from 2009 to 2014, nested within a large epidemiologic study of 1,760 healthy controls and men undergoing prostate cancer screening. In total, 190 men underwent radical prostatectomy in the cohort. Adverse pathology was defined as the presence of primary Gleason 4 or any Gleason 5 disease, or extraprostatic extension. Descriptive and multivariate analyses were performed to assess the relationship between 25-OH D and adverse pathology at the time of prostatectomy. Results Eighty-seven men (45.8%) in this cohort demonstrated adverse pathology at radical prostatectomy. The median age in the cohort was 64.0 years (interquartile range, 59.0 to 67.0). On univariate analysis, men with adverse pathology at radical prostatectomy demonstrated lower median serum 25-OH D (22.7 v 27.0 ng/mL, P = .007) compared with their counterparts. On multivariate analysis, controlling for age, serum prostate specific antigen, and abnormal digital rectal examination, serum 25-OH D less than 30 ng/mL was associated with increased odds of adverse pathology (odds ratio, 2.64; 95% CI, 1.25 to 5.59; P = .01). Conclusion Insufficiency/deficiency of serum 25-OH D is associated with increased odds of adverse pathology in men with localized disease undergoing radical prostatectomy. Serum 25-OH D may serve as a useful biomarker in prostate cancer aggressiveness, which deserves continued study.

Toward Understanding of Environmental Risk Factors in Systemic Sclerosis

2020 ◽  
pp. 120347542095795
Author(s):  
Lydia Ouchene ◽  
Anastasiya Muntyanu ◽  
Jérôme Lavoué ◽  
Murray Baron ◽  
Ivan V. Litvinov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Systemic Sclerosis ◽  
Organic Solvents ◽  
Epoxy Resins ◽  
Twin Studies ◽  
Breast Implants ◽  
Welding Fumes ◽  
Increased Risk ◽  
Vitamin D Levels

Importance Systemic sclerosis (SSc) is a severe, chronic, and incurable autoimmune fibrotic skin disease with significant extracutaneous involvement. Low concordance rate in twin studies and unequal geographic distribution of SSc argues for importance of environment in disease initiation and progression. Objective In this manuscript we provide a summary of all investigated potential external risk factors for SSc. Data sources A literature search in PubMed and EMBASE database was performed for studies published until January 1, 2020 by 2 reviewers (EN and LO) independently. Findings Occupational and/or environmental exposures to silica and organic solvents are associated with increased incidence and severity of SSc. Exposure to epoxy resins, asbestos, and particulate air pollution favors increased risk of SSc, but data are based on limited number of observational studies. There is insufficient evidence to conclude an association between SSc development and other occupational (eg, welding fumes) or personal exposures (eg, smoking, vitamin D deficiency). Association of SSc with silicone breast implants has been disproven. Infectious pathogens (eg, Helicobacter pylori and angiotropic viruses) and dysbiosis seem to play a role in SSc development and severity, but their role remains to be clarified. Conclusions and relevance It may be prudent to counsel our patients with SSc (or those at risk of SSc) to avoid occupations with exposure to silica, organic solvents, asbestos and epoxy resins; restraint from smoking, using cocaine or drugs with pro-fibrotic potential. While the association between low vitamin D and SSc remains to be confirmed, we believe that SSc patients should be encouraged to maintain healthy vitamin D levels as benefits outweigh the risks.

Bone Health in Adults Treated with Endocrine Therapy for Early Breast or Prostate Cancer

2015 ◽  
pp. e567-e574 ◽  
Author(s):  
Catherine H. Van Poznak
Keyword(s):  
Prostate Cancer ◽  
Vitamin D ◽  
Bone Resorption ◽  
Endocrine Therapy ◽  
Sex Hormones ◽  
Bone Health ◽  
Estrogen Therapy ◽  
Fragility Fractures ◽  
Mineral Density ◽  
Increased Risk

Bone is a hormonally responsive organ. Sex hormones and calcium regulating hormones, including parathyroid hormone, 1–25 dihydroxy vitamin D, and calcitonin, have effects on bone resorption and bone deposition. These hormones affect both bone quality and bone quantity. The sex hormone estrogen inhibits bone resorption, and estrogen therapy has been developed to prevent and treat osteoporosis. Androgens are an important source of estrogen through the action of the enzyme aromatase and may themselves stimulate bone formation. Hence, the sex steroids play a role in bone metabolism. Breast cancer and prostate cancer are frequently hormonally responsive and may be treated with antiestrogens or antiandrogens respectfully. In addition, chemotherapy and supportive medications may alter the patient's endocrine system. In general, the suppression of sex hormones has a predictable affect on bone health, as seen by loss of bone mineral density and increased risk of fragility fractures. The bone toxicity of cancer-directed endocrine therapy can be mitigated through screening, counseling on optimization of calcium and vitamin D intake, exercise, and other lifestyle/behavioral actions, as well as the use of medications when the fracture risk is high. Maintaining bone health in patients who are treated with endocrine therapy for breast and prostate cancer is the focus of this review.

A systematic review of modifiable risk factors in the progression of multiple sclerosis

2017 ◽  
Vol 23 (4) ◽  
pp. 525-533 ◽  
Author(s):  
Susanne Hempel ◽  
Glenn D Graham ◽  
Ning Fu ◽  
Elena Estrada ◽  
Annie Y Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Vitamin D ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Rapid Decline ◽  
Modifiable Risk Factors ◽  
Presenting Symptoms ◽  
Increased Risk ◽  
Vitamin D Levels

Background: The presenting symptoms and rate of progression of multiple sclerosis (MS) are very heterogeneous. The diverse clinical manifestations and the clinical course of the disease may vary with modifiable risk factors. Objective: To systematically review modifiable risk factors and exposures associated with MS progression. Methods: We searched six databases till March 2015, reference-mined reviews, and consulted with experts (PROSPERO 2015:CRD42015016461). Two reviewers screened and extracted data. We used random meta-analysis models and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the quality of evidence. Results: In total, 59 studies met inclusion criteria. Lower vitamin D levels were associated with higher Expanded Disability Status Scale (EDSS) scores ( r = −0.22; confidence interval (CI) = −0.32, −0.12; 11 studies; I2 = 66%), smokers had an increased risk of MS progression (hazard ratio (HR) = 1.55; CI = 1.10, 2.19; I2 = 72%; seven studies), and there was no association of MS progression with the use of epidural analgesics during childbirth delivery (three studies). There was insufficient evidence to draw conclusions for 11 risk factors due to conflicting results or use of different predictor and outcome measures. Conclusion: MS progression was consistently associated with low vitamin D levels, and smoking was associated with a more rapid decline in MS disability. Studies used a variety of methods, predictors, and outcomes making it difficult to draw conclusions. Future studies should focus on prospective assessments.

Vitamin D and Vascular Disease

2020 ◽  
Vol 19 (3) ◽  
pp. 250-268 ◽  
Author(s):  
Ioanna Gouni-Berthold ◽  
Heiner K. Berthold
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Vitamin D Supplementation ◽  
Plasma Vitamin ◽  
Cvd Risk ◽  
Vitamin D Receptors ◽  
Cell Proliferation And Differentiation ◽  
Increased Risk ◽  
Vitamin D Levels

: Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. Vitamin D deficiency has been identified as a potential risk factor for a number of diseases unrelated to the classical skeletal pathophysiology, such as cancer and CVD, but the effects of vitamin D supplementation are less clear. Purpose of this narrative review is to discuss the evidence suggesting an association between vitamin D status and CVD as well as the results of supplementation studies. Vitamin D deficiency has been associated with CVD risk factors such as hypertension, dyslipidemia and diabetes mellitus as well as with cardiovascular events such as myocardial infarction, stroke and heart failure. While vitamin D deficiency might contribute to the development of CVD through its association with risk factors, direct effects of vitamin D on the cardiovascular system may also be involved. Vitamin D receptors are expressed in a variety of tissues, including cardiomyocytes, vascular smooth muscle cells and endothelial cells. Moreover, vitamin D has been shown to affect inflammation, cell proliferation and differentiation. While observational studies support an association between low plasma vitamin D levels and increased risk of CVD, Mendelian randomization studies do not support a causal association between the two. At present, high quality randomized trials do not find evidence of significant effects on CVD endpoints and do not support supplementation of vitamin D to decrease CVD events.

scholarly journals Association of Body Mass Index with Serum Vitamin D and PSA Levels among Sudanese Prostate Cancer Patients

2021 ◽  
Vol 11 (6) ◽  
pp. 1-5
Author(s):  
Yousif Abdelhameed Mohammed ◽  
Ameer M Dafalla ◽  
Dafalla O Abuidris ◽  
Adam D. Abakar ◽  
A Mergani ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Body Mass Index ◽  
Vitamin D ◽  
Cancer Patients ◽  
Body Mass ◽  
Specific Antigen ◽  
Serum Vitamin ◽  
The United States ◽  
Serum Vitamin D ◽  
Vitamin D Levels

Background: Prostate cancer is the second most common cancer in men worldwide and the second leading cause of cancer deaths in men in the United States. Obesity has been consistently associated with lower 25-hydroxyvitamin D (25(OH)D) concentrations. Objectives: This cross-sectional study aimed to evaluate the serum vitamin D and PSA levels in Sudanese Obese and Non-Obese prostate cancer (PCa) attending the National Cancer Institute. Patients and Methods: Eighty six prostate cancer patients were included in this study, they were identified by clinical examination, histopathology and prostate-specific antigen (PSA). The mean age of them was 71.78 ± 8.04 years. Serum Vitamin D and PSA were measured by Electrochemiluminescence (ECL) immunoassay reactions using (Cobase411, serial No: 0868-16, manufactured by Hitachi high technologies corporation, Tokyo-Japan) the Elecsys reagents kit (Roche – Germany) Results: The means of serum vitamin D levels of among  obese was 35.5 ± 15.4 ng/dL and 38.4 ± 16.2 ng/dL  among non-obese group with non-significant differences(P=0.505). No significant association was observed between PSA levels and obese and non-obese (P=0.351). Vitamin D levels non-significantly negative correlated with BMI (r = -0.031, P = 0.778) and PSA (r = -0.062, P = 0.569), but there was insignificantly Positive correlated between PSA and vitamin D level (r = 0.151, P = 0.164). Conclusion: insignificant differences between vitamin D and serum PSA with BMI, Oral supplementation is recommended for individuals with low level of vitamin D. Keywords: Prostate cancer, Body mass index, Vitamin D, PSA, Sudanese.

HIV and Bone Health

2019 ◽  
pp. 493-504
Author(s):  
Edgar Turner Overton
Keyword(s):  
Risk Factors ◽  
Hiv Infection ◽  
Bone Disease ◽  
Bone Health ◽  
Metabolic Bone Disease ◽  
Risk Of Fracture ◽  
Metabolic Bone ◽  
Increased Risk ◽  
Common Manifestation

Upon completion of this chapter, the reader should be able to • Familiar with the concept that metabolic bone disease is a common manifestation of HIV infection leading to an increased risk of fracture. • The reader should also recognize key risk factors for metabolic bone disease and strategies to mitigate this risk....

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