scholarly journals Osteomalacia in practice of endocrinologist: etiology, pathogenesis, differential diagnosis with osteoporosis

2020 ◽  
Vol 22 (2) ◽  
pp. 23-31
Author(s):  
Olga O. Golounina ◽  
Gyuzel E. Runova ◽  
Valentin V. Fadeyev
Keyword(s):  
Vitamin D ◽  
Differential Diagnosis ◽  
Vitamin D Deficiency ◽  
Clinical Symptoms ◽  
Fibroblast Growth Factor 23 ◽  
Bone Matrix ◽  
Bone Diseases ◽  
Mineral Density ◽  
Bone Formation Rate ◽  
Metabolic Bone Diseases

Osteoporosis is the most common cause of low bone mineral density (BMD) and low-traumatic fractures in adults. However, differential diagnosis should also consider other causes of decreased BMD, including osteomalacia, as treatment for these conditions vary significantly. Osteomalacia is a systemic disorder characterized by decrease in bone strength due to of excessive accumulation of non-mineralized osteoid and uncoupling between bone matrix formation and mineralization. Osteomalacia in adults mostly develops due to severe vitamin D deficiency of any etiology, less often along with kidney pathology, mesenchymal tumors secreting fibroblast growth factor 23 or hereditary metabolic bone diseases. Clinical symptoms of osteomalacia are nonspecific and mostly manifest by generalized diffuse bone pain, muscle weakness, skeletal deformities and often go unnoticed at initial stage of the disease. Histomorphometric examination is the most accurate method of the diagnosis, which allows assessment of bone formation rate and calcification. The utmost priority of the treatment of osteomalacia of any etiology is the elimination of vitamin D deficiency, hypocalcemia, hypophosphatemia and prevention of bone deformities progression and muscle hypotension.

scholarly journals Bone biology in the elderly: clinical importance for fracture treatment

2016 ◽  
Vol 1 (2) ◽  
pp. 49-55
Author(s):  
Tim Rolvien ◽  
Michael Amling
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Fragility Fractures ◽  
The Elderly ◽  
Bone Diseases ◽  
Local Health ◽  
Bone Density Measurement ◽  
Secondary Fracture ◽  
Metabolic Bone Diseases

AbstractAge-related bone impairment often leads to fragility fractures in the elderly. Although excellent surgical care is widely provided, diagnosis and treatment of the underlying bone disorder are often not kept in mind. The interplay of the three major bone cells – osteoblasts, osteoclasts, and osteocytes – is normally well regulated via the secretion of messengers to control bone remodeling. Possible imbalances that might occur in the elderly are partly due to age, genetic risk factors, and adverse lifestyle factors but importantly also due to imbalances in calcium homeostasis (mostly due to vitamin D deficiency or hypochlorhydria), which have to be eliminated. Therefore, the cooperation between the trauma surgeon and the osteologist is of major importance to diagnose and treat the respective patients at risk. We propose that any patient suffering from fragility fractures is rigorously screened for osteoporosis and metabolic bone diseases. This includes bone density measurement by dual-energy X-ray absorptiometry, laboratory tests for calcium, phosphate, vitamin D, and bone turnover markers, as well as additional diagnostic modalities if needed. Thereby, most risk factors, including vitamin D deficiency, can be identified and treated while patients who meet the criteria for a specific therapy (i.e. antiresorptive and osteoanabolic) receive such. If local health systems succeed to manage this process of secondary fracture prevention, morbidity and mortality of fragility fractures will decline to a minimum level.

scholarly journals Has vitamin D had its day? An audit of vitamin D, prolactin and HBA1C monitoring over one year in an in-patient secure service

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S330-S331
Author(s):  
Oleg Lujanschi ◽  
Toral Thomas
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Best Practice ◽  
Clinical Symptoms ◽  
Vitamin D Supplementation ◽  
Service Users ◽  
Reference Ranges ◽  
Mineral Density ◽  
Increased Risk ◽  
One Year

AimsTo ensure that service users in in-patient secure services have prolactin, vitamin D and HbA1c monitoring as per current best practice guidance.BackgroundService users prescribed antipsychotic medication are at risk of developing raised prolactin levels and metabolic syndrome. In both sexes, long-standing hyperprolactinaemia can lead to low bone mineral density with an increased risk of developing osteoporosis.In recent years there has been increasing controversy on the increase in Vitamin D monitoring despite the poor evidence for complications from vitamin D deficiency in adults. Not undertaking this test in the absence of symptoms will potentially reduce anxiety for service users could save £17 per test and £50 for a 12-week course of Vitamin D supplementation. Local and national guidance indicate Vitamin D monitoring should only be done in symptomatic people.MethodFifty-five service users in the five in-patient wards had their electronic records and pathology results reviewed over a one-year period. All service users were expected to have a minimum of an annual HbA1c and prolactin level but to only have vitamin D monitoring if symptomatic for deficiency.ResultAlthough 100% of service users in MSU were tested, vitamin D testing was consistently undertaken without documented clinical evidence of deficiency. The ranges across all units were: prolactin (72- 1384mU/L), HbA1c (30–90 mmol/mol) and vitamin D (15–124 nmol/L). Local reference ranges are prolactin (53- 360mU/L), HbA1c (<48 mmol/mol) and Vitamin D (50–120 nmol/L).Prolactin levels were highest on the male medium secure wards.The other two units had significantly less testing with prolactin and HbA1c levels being the least measured (18% of service users on male LSU and 23% on the female ward respectively). Vitamin D testing on these two wards were 38% on the female ward and 18% on the male ward for both tests.ConclusionNorthside House has a dedicated physical health team and this is likely to explain its 100% score. However, vitamin D testing was being undertaking automatically rather than based on symptoms.The recommendation is to add prolactin and HbA1c to the physical screens done before CPA meetings for all service users prescribed an antipsychotic but to stop Vitamin D testing in the absence of clinical symptoms of vitamin D deficiency.

scholarly journals The relationship between serum 25-hydroxyvitamin D and parathyroid hormone concentration in assessing vitamin D deficiency in pet rabbits

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
J. Mäkitaipale ◽  
S. Sankari ◽  
H. Sievänen ◽  
O. Laitinen-Vapaavuori
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Vitamin D Deficiency ◽  
Bone Diseases ◽  
Hormone Concentration ◽  
Metabolic Bone Diseases ◽  
Hydroxyvitamin D ◽  
Metabolic Bone ◽  
Ionised Calcium ◽  
25 Hydroxyvitamin D

Abstract Background Vitamin D deficiency and related metabolic bone diseases in pet rabbits have been intermittently debated. In human research, the parathyroid hormone concentration in relation to the 25-hydroxyvitamin D concentration is used to determine vitamin D deficiency. Thus, this study aimed to identify the breakpoint in the 25-hydroxyvitamin D concentration indicating a significant change in the parathyroid hormone concentration in 139 pet rabbits. An enzyme immunoassay kit was used for 25-hydroxyvitamin D analysis and the intact parathyroid hormone (PTH 1–84) immunoradiometric assay kit for parathyroid hormone analysis. The mid-tibial cortical bone density was measured using peripheral quantitative computed tomography. A segmented linear regression analysis was performed, with the 25-hydroxyvitamin D concentration as the independent variable, and parathyroid hormone, ionised calcium, total calcium, inorganic phosphorus concentrations and the mid-tibial cortical density as the dependent variables. Results The breakpoint for the parathyroid hormone concentration occurred at a 25(OH)D concentration of 17 ng/mL, whereas the cortical bone density breakpoint occurred at a 25-hydroxyvitamin D concentration of 19 ng/mL. No breakpoints were found for ionised calcium, total calcium or phosphorus. Conclusions These results suggest that a serum 25-hydroxyvitamin D concentration of 17 ng/mL serves as the threshold for vitamin D deficiency in rabbits. Nearly one-third of the rabbits had a serum 25-hydroxyvitamin D concentration below this threshold. Concerns persist regarding the high prevalence of vitamin D deficiency in pet rabbits and the possible health consequences caused by a chronic vitamin D deficiency, including the risk for metabolic bone diseases.

scholarly journals Effects of Supplementary Vitamin D on Vitamin D3 Serum Level in Nephrotic Syndrome Patients Receiving Steroid Therapy

2020 ◽  
Vol 5 (4) ◽  
pp. 142-146
Author(s):  
Hashem Mahmoodzadeh ◽  
Mohammad Valizadeh ◽  
Ahmadali Nikibakhsh ◽  
Ezatollah Abbasi
Keyword(s):  
Vitamin D ◽  
Nephrotic Syndrome ◽  
Vitamin D Deficiency ◽  
Steroid Therapy ◽  
Vitamin D3 ◽  
Serum Vitamin ◽  
Serum Levels ◽  
Bone Diseases ◽  
Glomerular Diseases ◽  
Metabolic Bone Diseases

Introduction: Nephrotic syndrome is one of the most common glomerular diseases in children who are also at risk of metabolic bone diseases. In this study the effect of supplementary use of vitamin D3 was assessed on serum levels of vitamin D3 in patients with nephrotic syndrome receiving steroid therapy. Methods: Thirty children with nephrotic syndrome were included in this study. After obtaining blood samples to measure 25(OH) D levels, all patients were supplemented with daily doses of Vitamin D for one month. Serum 25(OH) D level was checked again, and these patients were supplemented for another month if they had been recognized with deficiency at the last check. Results: Out of 30 children, 60% were male and 40% were female with a mean age of 6.91 ± 3.34 years. Before intervention, 70% of patients had severe vitamin D deficiency, and 26.7% had mild to moderate deficiency, and none of the patients had normal serum levels of 25-(OH)-D. After one month, only one patient gained normal levels which was not statistically significant (P=0.500). After two months of intervention, 12 patients escaped deficiency but still exhibited insufficient levels followed by 8 people with deficiency, and 10 patients reached normal values which was statistically significant (P=0.002). The mean level of 25(OH) D was 8.277±0.84 ng/ mL rising to 14.364±1.14 ng/mL after two months (P=0.001). Conclusion: This study showed a high incidence of vitamin D deficiency in the children with nephrotic syndrome warranting routine surveillance of vitamin D serum levels in these patients. Daily doses of vitamin D in the first month of onset of the disease was insufficient. We suggest that children may benefit from routine measurement of their serum vitamin D from diagnosis and later in follow-up visits so an individual strategy for vitamin D supplementation could be given.

Influence of vitamin D deficiency on the bone mineral density in schoolchildren

2015 ◽  
Author(s):  
Vladyslav Povoroznyuk ◽  
Nataliya Balatska ◽  
Olga Tyazhka ◽  
Tetiana Budnik ◽  
Inga Kubey ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Bone Mineral ◽  
Mineral Density

Calcium and Vitamin D Supplementation. Myths and Realities with Regard to Cardiovascular Risk

2019 ◽  
Vol 17 (6) ◽  
pp. 610-617 ◽  
Author(s):  
Giovanna Muscogiuri ◽  
Luigi Barrea ◽  
Barbara Altieri ◽  
Carolina Di Somma ◽  
Harjit pal Bhattoa ◽  
...  
Keyword(s):  
Vitamin D ◽  
Side Effects ◽  
Secondary Hyperparathyroidism ◽  
Calcium Supplementation ◽  
Physiological Role ◽  
Bone Diseases ◽  
Current Evidence ◽  
Bone Homeostasis ◽  
Mineral Density ◽  
Muscle Health

Vitamin D and calcium are considered crucial for the treatment of bone diseases. Both vitamin D and calcium contribute to bone homeostasis but also preserve muscle health by reducing the risk of falls and fractures. Low vitamin D concentrations result in secondary hyperparathyroidism and contribute to bone loss, although the development of secondary hyperparathyroidism varies, even in patients with severe vitamin D deficiency. Findings from observational studies have shown controversial results regarding the association between bone mineral density and vitamin D/calcium status, thus sparking a debate regarding optimum concentrations of 25-hydroxyvitamin D and calcium for the best possible skeletal health. Although most of the intervention studies reported a positive effect of supplementation with calcium and vitamin D on bone in patients with osteoporosis, this therapeutic approach has been a matter of debate regarding potential side effects on the cardiovascular (CV) system. Thus, the aim of this review is to consider the current evidence on the physiological role of vitamin D and calcium on bone and muscle health. Moreover, we provide an overview on observational and interventional studies that investigate the effect of vitamin D and calcium supplementation on bone health, also taking into account the possible CV side-effects. We also provide molecular insights on the effect of calcium plus vitamin D on the CV system.

scholarly journals Association of vitamin D and osteocalcin levels in post-menopausal women with osteoporosis

2017 ◽  
Vol 6 (4) ◽  
pp. 1244
Author(s):  
Yogiraj Vaijanathrao Chidre ◽  
Amir Babansab Shaikh
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Vitamin D Deficiency ◽  
Fragility Fractures ◽  
Bone Fragility ◽  
Vitamin D Supplementation ◽  
Mineral Density ◽  
Age Related ◽  
Calcium Phosphorus ◽  
Post Menopausal

Background: Osteoporosis is a common age related problem especially in women, with a consequent increase in bone fragility and susceptibility to fracture. Apart from Calcium, another nutrient that plays an important role in the mineralization of skeleton in Vitamin D. Osteocalcin, which is produced primarily by osteoblasts during bone formation, is considered to be one of the markers for osteoporosis.Methods: 314 women above the age of 40 were included into the study. A thorough physical and clinical examination, assessment of vital parameters, anthropometry evaluation was done for all patients. Bone mineral density was calculated using central DXA osteodensitometer at lumbar spine L1-L4, hip and ultradistal radius (in some cases.). Blood samples were taken for the detection of ionized calcium, phosphorus, alkaline phosphatase, 25hydroxivitamin D (25 ODH) and serum parathyroid hormone (PTH) by chemiluminiscent assay. Bone markers such as osteocalcin were measured as required.Results: Out of the 314 women attending our OPD, 96 of them were diagnosed as having osteoporosis. 24 out of them had fragility fractures, mainly of the hip, and 82 had ostepenia. Elevated levels of calcium (8.96 mg/dl), parathyroid hormone (58.76 pg/ml) and osteocalcin (24.46 ng/ml) were observed. Vitamin D deficiency of ≤ 20 was seen in 59 (63%) of the cases, insufficient in 23 (24%) and only 12 (13%) of these women had normal Vitamin D levels.Conclusions: Osteocalcin is a promising marker for the detection of osteoporosis. There is a considerable Vitamin D deficiency among the women with osteoporosis, and it is under-treated. It is essential to provide Vitamin D supplementation to these women especially those who are at high risk for fragility fractures.

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