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

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.

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P1621VITAMIN D SUPPLEMENTATION: CHANGES IN BONE MINERAL DENSITY IN KIDNEY TRANSPLANT PATIENTS WITH LONG TERM DURATION OF THE GRAFT

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa143.p1621 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Yuri Battaglia ◽

Michele Provenzano ◽

Francesco Tondolo ◽

Antonio Bellasi ◽

Pasquale Esposito ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Kidney Transplant ◽

Bone Mineral ◽

Categorical Variables ◽

Z Score ◽

Mineral Density ◽

T Score

Abstract Background and Aims In the medical literature, several studies have linked bone mineral density (BMD) with vitamin D deficiency in kidney transplant patients (KTRs). However, in spite of the fact that ergocalciferol, cholecalciferol and calcifediol reduce parathyroid hormone (PTH) and improves calcium levels, their effects on the bone mineral density (BMD) in KTRs remain undefined. In consideration of the lack of data available, we aim at investigating the effect of inactive form of vitamin D supplementation on the BMD over a follow-up period up to 2 year, in a real-life cohort of long-term kidney transplant(KT). Method This study was carried out in KTRs who were followed up in a Nephrology Unit. Exclusion criteria were parathyroidectomy, therapy with bisphosphonate, previous history of bone fractures. Demographic, clinical and immunosuppressive agents were collected. Based on 25-OH-D levels, KTRs were classified as suffering from deficiency (< 30 ng/mL). BMD was evaluated at lumbar vertebral bodies (LV) and right femoral hip (FH) by a single operator, using a standard dual energy X-ray absorptiometry. According to WHO criteria, results were expressed as T-score (standard deviation [SD] relative to young healthy adults), and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as T score ≤ −2.5 SD and T score < −1 and > −2.5 SD, respectively. Laboratory data, 25-OH-D, and BMD were measured at baseline and after 24 months of supplementation therapy. Vitamin D deficiency was corrected using standard treatment strategy recommended for general population. Continuous variables were expressed as mean ± SD whereas categorical variables as percentage. The Student’s t test and chi-square test were used to compare to compare continuous and categorical variables, respectively. For before and after comparisons of continuous variables, the paired t-test or one-sample Wilcoxon signed rank test were used based on variable’s distribution. Results Data pertaining to 111 out of 133 consecutive outpatients were collected, of whom most were males (69.4%), no-smokers (89.1%) and treated with glucocorticoids (84%). The mean age was 53.9±11.6 years and months after transplant was 161.6±128.3. No statistical differences were found among patients with normal BMD, osteopenia or osteoporosis at LV and FH in terms of age at transplant, gender distribution, time on dialysis, BMI and eGFR, serum calcium, serum phosphate, 25-OH-D and iPTH. At baseline, 25-OH-D was 13.9±7.2 ng/ml and the prevalence of osteopenia/osteoporosis was 40.9% (T-Score -1.69±0.37; Z-score -1.16±1.09) and 21.8 % (T-Score -3.15±0.50; Z-score -2.27±0.58) at LV; 55.3 % (T-Score -1.8±0.46; Z-score -0.84±0.633) and 14 % (T-Score -2.83±0.39; Z-score -1.65±0.49) at FH. After 27.6±3.7 months of therapy with cholecalciferol at mean dose of 13.396±7.537 UI at week, 25-OH-D values increased to 29.4±9.4 ng/ml (p<0.0001) while no statistically significant changes were found in Z-score and T-score at both sites, except for a mild improvement in lumbar vertebral Z-score, reaching −0.82± 0.7 (p = 0.06) in KTRs with osteopenia Conclusion Our study showed BMD remained stable after up to 2 years of inactive vitamin D therapy in long-term kidney transplant with vitamin D deficiency. A mild increase in Z-score was observed in the L-spine. Further designated studies should be conducted to demonstrate the effect of vitamin D on BMD.

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Hip bone mineral density, bone turnover and risk of fracture in patients on long-term suppressive L-thyroxine therapy for differentiated thyroid carcinoma

Acta Endocrinologica ◽

10.1530/eje.1.01933 ◽

2005 ◽

Vol 153 (1) ◽

pp. 23-29 ◽

Cited By ~ 43

Author(s):

A Caroline Heijckmann ◽

Maya S P Huijberts ◽

Piet Geusens ◽

Jolanda de Vries ◽

Paul P C A Menheere ◽

...

Keyword(s):

Risk Factors ◽

Bone Mineral Density ◽

Vertebral Fracture ◽

Thyroid Carcinoma ◽

Differentiated Thyroid Carcinoma ◽

Clinical Risk Factors ◽

Type I ◽

Mineral Density ◽

Clinical Risk

Objective: Untreated hyperthyroidism and treatment with high doses of thyroid hormone are associated with osteoporosis. However, their effect on bone turnover, their contribution to bone mineral density (BMD) in the context of other clinical risk factors for osteoporosis and the prevalence of vertebral fractures is not well documented. Design: Cross-sectional study. Methods: We studied 59 patients receiving L-thyroxine suppressive therapy for differentiated thyroid carcinoma (DTC). BMD of the hip was measured by dual X-ray absorptiometry (DXA) and lateral DXA pictures of the lumbar and thoracic vertebrae were performed. Bone resorption was measured by C-telopeptides of type I collagen (ICTP) and bone formation by procollagen type I N-propeptide (PINP). Clinical risk factors for osteoporosis were evaluated using a questionnaire. Results: Z-scores of BMD were similar as the NHANES (National Health and Nutrition Examination Survey) III reference group in women and men, also after long-term (>10 years) suppression therapy. Patients in the lowest and highest quartile of BMD showed significant differences in the presence of clinical risk factors. ICTP levels were significantly higher than in age-matched controls, PINP levels were not different. We found four patients with a prevalent vertebral fracture. Conclusions: We conclude that patients with well-differentiated thyroid carcinoma are not at increased risk of developing low bone mass nor have a higher prevalence of vertebral fracture at least when treated with relatively low doses of l-thyroxine.

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Seasonal variation in vitamin D status, bone health and athletic performance in competitive university student athletes: a longitudinal study

Journal of Nutritional Science ◽

10.1017/jns.2020.1 ◽

2020 ◽

Vol 9 ◽

Cited By ~ 1

Author(s):

Saskia L. Wilson-Barnes ◽

Julie E. A. Hunt ◽

Emma L. Williams ◽

Sarah J. Allison ◽

James J. Wild ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Physical Performance ◽

Bone Health ◽

Quantitative Computed Tomography ◽

Performance Outcomes ◽

Vitamin D Status ◽

Mineral Density ◽

Parametric Testing ◽

University Athletes

Abstract Vitamin D deficiency has been commonly reported in elite athletes, but the vitamin D status of UK university athletes in different training environments remains unknown. The present study aimed to determine any seasonal changes in vitamin D status among indoor and outdoor athletes, and whether there was any relationship between vitamin D status and indices of physical performance and bone health. A group of forty-seven university athletes (indoor n 22, outdoor n 25) were tested during autumn and spring for serum vitamin D status, bone health and physical performance parameters. Blood samples were analysed for serum 25-hydroxyvitamin D (s-25(OH)D) status. Peak isometric knee extensor torque using an isokinetic dynamometer and jump height was assessed using an Optojump. Aerobic capacity was estimated using the Yo-Yo intermittent recovery test. Peripheral quantitative computed tomography scans measured radial bone mineral density. Statistical analyses were performed using appropriate parametric/non-parametric testing depending on the normality of the data. s-25(OH)D significantly fell between autumn (52·8 (sd 22·0) nmol/l) and spring (31·0 (sd 16·5) nmol/l; P < 0·001). In spring, 34 % of participants were considered to be vitamin D deficient (<25 nmol/l) according to the revised 2016 UK guidelines. These data suggest that UK university athletes are at risk of vitamin D deficiency. Thus, further research is warranted to investigate the concomitant effects of low vitamin D status on health and performance outcomes in university athletes residing at northern latitudes.

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PREVALENCE OF VITAMIN DEFICIENCY IN ELDERLY PATIENTS PLANNED FOR SPINE SURGERY

Успехи геронтологии ◽

10.34922/ae.2020.33.6.024 ◽

2021 ◽

pp. 1193-1199

Author(s):

И. А. Степанов ◽

В. А. Белобородов ◽

М. А. Шамеева ◽

И. И. Томашов ◽

З. С. Саакян ◽

...

Keyword(s):

Vitamin D ◽

Elderly Patients ◽

Vitamin D Deficiency ◽

Surgical Procedures ◽

Active Form ◽

Binary Logistic Regression ◽

Mineral Density ◽

Binary Logistic Regression Model ◽

Surgical Interventions

Снижение минеральной плотности костной ткани выступает наиболее частной причиной формирования осложнений в отдаленном периоде послеоперационного наблюдения. Цель исследования - изучить распространенность дефицита витамина D у пациентов пожилого возраста, планируемых к выполнению оперативных вмешательств на позвоночнике. В исследование включены 63 пациента пожилого возраста, госпитализированных в спинальные хирургические клиники для планового оперативного вмешательства по поводу дегенеративных заболеваний шейного и пояснично-крестцового отделов позвоночника (34 женщины, 29 мужчин, средний возраст - 63,6±3,2 года). Построение модели бинарной логистической регрессии показало, что достоверно ассоциированы с наличием дефицита активной формы витамина D у пациентов, планируемых к выполнению оперативных вмешательств на позвоночнике, следующие параметры: мужской пол, возраст (старше 65 лет), ИМТ (>30 кг/м) и сахарный диабет. Определение факторов риска, ассоциированных с наличием дефицита витамина D , и исследование маркеров костного метаболизма представляют собой важнейший этап предоперационной подготовки пациентов старшей возрастной группы, планируемых к выполнению оперативных вмешательств на позвоночнике. A decrease in bone mineral density is the most common cause of complications in the long-term period of postoperative observation. The purpose of the study was to study the prevalence of vitamin D deﬁciency in elderly patients who are planning to perform spine surgical procedures. The study included 63 elderly patients hospitalized in spine surgical clinics in order to perform planned surgical procedures for degenerative diseases of the cervical and lumbar spine (34 women, 29 men, average age 63,6±3,2 years). The construction of a binary logistic regression model showed that the following parameters are reliably associated with a deﬁciency of the active form of vitamin D in patients who are planning to perform surgical interventions on the spine: male gender, age (over 65 years), body mass index (more than 30 kg/ m) and diabetes. The identiﬁcation of risk factors associated with the presence of vitamin D deﬁciency and the study of markers of bone metabolism represent the most important stage in the preoperative preparation of older patients who are planning to perform surgical interventions on the spine.

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Prevalence of Vitamin D Deficiency in Patients With Talar Osteochondral Lesions

Foot & Ankle International ◽

10.1177/1071100717745501 ◽

2018 ◽

Vol 39 (4) ◽

pp. 471-478 ◽

Cited By ~ 9

Author(s):

Jessica J. M. Telleria ◽

Lauren V. Ready ◽

Eric M. Bluman ◽

Christopher P. Chiodo ◽

Jeremy T. Smith

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Health Care Providers ◽

Hypovitaminosis D ◽

Control Group ◽

Osteochondral Lesions ◽

Care Providers ◽

Mineral Density ◽

Level Of Evidence

Background: Vitamin D deficiency affects over 1 billion people worldwide and is common in foot and ankle patients. The prevalence in those with osteochondral lesions of the talus (OLTs) is unknown. This study identified the prevalence and risk factors for hypovitaminosis D in patients with an OLT. Methods: Serum 25(OH)D levels were obtained from patients presenting with an OLT from May to November during 2007 to 2016. Hypovitaminosis D was defined as 25(OH)D less than 30 ng/mL (75 nmol/L). Patients presenting with an acute ankle sprain (AS) during the same months served as a control group. Specific medical risk factors for hypovitaminosis D were recorded. The final OLT population included 46 patients (31 women [67.4%]; mean [SD] age 43.6 [14.8] years). The comparison AS group had 40 patients (32 women [80.0%]; mean [SD] age 56.2 [13.0] years). Results: The mean (SD) 25(OH)D in the OLT and AS cohorts were 31.2 (12.6) ng/mL and 37.1 (13.5) ng/mL, respectively ( P = .039). Hypovitaminosis D was identified in 54% of the OLT population and 28% of the AS population ( P = .012). Conclusion: Hypovitaminosis D is intimately related to decreased bone mineral density. This study identified a significantly higher rate of hypovitaminosis D in patients with an OLT compared to a cohort of AS patients. These findings suggest that when patients present with an OLT, health care providers should consider evaluating for and treating hypovitaminosis D. Level of Evidence: Level III, comparative study.

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Prevalence and risk factors for vitamin D deficiency in long‐term childhood cancer survivors

Pediatric Blood & Cancer ◽

10.1002/pbc.29048 ◽

2021 ◽

Author(s):

Rusha Bhandari ◽

Jennifer Berano Teh ◽

Claudia Herrera ◽

Meagan Echevarria ◽

Lanie Lindenfeld ◽

...

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Cancer Survivors ◽

Childhood Cancer ◽

Vitamin D Deficiency ◽

Childhood Cancer Survivors

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Evaluation of risk factors associated with fragility fractures and recommendations to optimise bone health in children with long-term neurological condition

Singapore Medical Journal ◽

10.11622/smedj.2021124 ◽

2021 ◽

Author(s):

XYJ Leow ◽

JTC Tan ◽

TH Yeo ◽

KPL Wong ◽

A Mahadev ◽

...

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Bone Health ◽

Fragility Fractures ◽

Neurological Condition ◽

Factors Associated ◽

Fractures In Children ◽

Neurology Clinic

Introduction: The growing years are paramount for bone growth and mineral accrual. Children with long-term neurological condition (LTNC) have multiple risk factors for poor bone health and fragility fractures. In Singapore, this has not been studied systematically therefore we aim to evaluate the risk factors associated with fragilty fractures in children with LTNC. Methods: In this study, the search for fragility fractures was done by a retrospective review of patients with LTNC who are under follow-up in the Paediatric Neurology clinic and of patients who presented with fracture to the Paediatric Orthopaedic clinic. Information on patient’s demographics, medical history, intervention, biochemical bone markers and fracture history were collected. Results: In a tertiary clinic population of 136 patients with LTNC, 65% were dependent on mobility (GMFCS V), 60% were underweight and 60% were fed via gastrostomy or nasogastric tube, or on oral pureed diet. Furthermore, 60% were on anticonvulsants. The fracture rate was 3% in this population and was associated with low-impact activities such as transfer and dressing. Only 7.4% had a vitamin D level measured and 33% had calcium measured. Conclusion: The local prevalence of fragility fractures in children with LTNC who are under follow-up at the Neurology clinic was found to be 3%. Risk factors identified were limited ambulation and compromised nutritional status associated with feeding difficulty. Recommendations to optimize bone health in children with LTNC were made. These include promoting weight-bearing activities, looking out for underweight, avoiding vitamin D deficiency and ensuring adequate calcium intake.

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Celiac Disease in Patients with Cystic Fibrosis-Related Bone Disease

Case Reports in Endocrinology ◽

10.1155/2017/2652403 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Melissa S. Putman ◽

Alexandra Haagensen ◽

Isabel Neuringer ◽

Leonard Sicilian

Keyword(s):

Risk Factors ◽

Bone Mineral Density ◽

Cystic Fibrosis ◽

Vitamin D ◽

Celiac Disease ◽

General Population ◽

Bone Disease ◽

Gluten Free ◽

Mineral Density ◽

The Past

Both cystic fibrosis (CF) and celiac disease can cause low bone mineral density (BMD) and fractures. Celiac disease may occur at a higher frequency in patients with CF than the general population, and symptoms of these conditions may overlap. We report on two patients presenting with CF-related bone disease in the past year who were subsequently found to have concurrent celiac disease. Because adherence to a gluten-free diet may improve BMD in patients with celiac disease, this could have important implications for treatment. Clinicians should consider screening for celiac disease in patients with CF who have low BMD, worsening BMD in the absence of other risk factors, and/or difficult to treat vitamin D deficiency.

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