Hypercalciuria in Postmenopausal Women With Reduced Bone Mineral Density Is Associated With Different Mineral Metabolic Profiles: Effects of Treatment With Thiazides and Anti-resorptives

Hypercalciuria may represent a challenge during the workup for osteoporosis management. The present study aimed: (1) to describe the phenotype associated with hypercalciuria in vitamin D-sufficient (serum 25 hydroxyvitamin D (25OHD) > 20 ng/ml) patients with osteopenia/osteoporosis; (2) to analyze the effects of thiazides and anti-resorptive drugs on urine calcium excretion (UCa), mineral metabolic markers, and bone mineral density. Seventy-seven postmenopausal women with hypercalciuria (Uca > 4.0 mg/kg body weight/24 h on two determinations) were retrospectively evaluated in a real-life setting. Median UCa was 5.39 (4.75–6.70) mg/kg/24 h. Kidney stones occurred in 32.9% of patients, who had median UCa similar to that of patients without kidney stones. Clustering analysis considering the three variables, such as serum calcium, phosphate, and parathormone (PTH), identified two main clusters of hypercalciuric patients. Cluster 1 (n = 13) included patients with a primary hyperparathyroidism-like profile, suggesting a certain degree of autonomous PTH secretion from parathyroid glands. Within cluster 2 (n = 61), two subgroups were recognized, cluster 2A (n = 18) that included patients with relatively increased PTH and normophosphatemia, and cluster 2B (n = 43) that included patients with the normal mineral profile. After a follow-up of 33.4 ± 19.6 months, 49 patients treated with thiazidic diuretics (TZD) were reevaluated; 20 patients were treated with hydrochlorothiazide (HCT; 12.5–37.5 mg/day), 29 with indapamide (IND; 1.50–3.75 mg/day). Any significant difference could be detected in all the parameters both basal and treated conditions between patients treated with HCT or IND. TZD induced a mean 39% reduction in UCa and 63.3% of patients obtained Uca < 4.0 mg/kg/24 h, independent of their mineral metabolic profile. Moreover, TZD induced a significant decrease in PTH levels. TZD-treated patients normalizing UCa experienced an increase in bone mineral densities when concomitantly treated with anti-resorptives, while any gain could be observed in TZD-treated patients with persistent hypercalciuria. Finally, multiple regression analysis showed that UCa reduction was at least in part related to denosumab treatment. In conclusion, in postmenopausal osteoporotic women, hypercalciuria is associated with kidney stones in about one-third of patients and with a wide range of impaired PTH secretion, determining a diagnostic challenge. TZD efficiently reduces UCa and normalization contributes to increasing anti-resorptives positive effect on bone mineral density.

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The effect of different exercise programs on bone mineral density and physical function in women with osteoporosis: A randomized controlled trial

International Journal of Growth and Development ◽

10.25081/ijgd.2017.v1i1.48 ◽

2017 ◽

Vol 1 (1) ◽

pp. 47

Author(s):

Lumnije Hoxha Kamberi

Keyword(s):

Bone Mineral Density ◽

Muscle Strength ◽

Physical Function ◽

Postmenopausal Women ◽

Bone Mineral ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Mineral Density ◽

Significant Difference

Aim: Osteoporosis is a multifactorial progressive skeletal disorder characterized by reduced bone mass. Exercise is widely recommended to reduce osteoporosis, falls and related fragility fractures. The purpose of this study was to investigate the effects of land exercise (LE) and aquatic exercise (AE) on physical function and bone mineral density (BMD). Methods: Fifty-eight postmenopausal women, aged 50-70 years, diagnosed with osteoporosis according to BMD measures, enrolled in this study. The subjects were randomly assigned to either the intervention group (LE group) or the control group (AE group). Physical function and BMD were assessed in all subjects in both groups before and after 10 months of intervention. The muscle strength, flexibility, balance, gait time and pain were measured to assess physical function. Bone mineral density at the lumbar spine was measured by dual energy X-ray absorptiometry (DEXA). Results: There were no significant differences between the two groups in the baseline anthropometric data. The two groups were similar with respect to age, weight, height, and body mass index (p>0.05). After the exercise program, muscle strength, flexibility, gait time, pain, and bone density (p<0.001) significantly improved with LE compared to AE. There was no significant difference between the two groups in balance at the 10-month follow-up. Conclusion: Significant improvements in physical function and BMD suggest that LE is a possible alternative for postmenopausal women with OP. Clinical rehabilitation impact: In the current available literature there is insufficient data regarding combined regimens, additionally, conclusions from our research can inspire further studies in order to promote land and water based exercise.

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Low Bone Mineral Density Is Not Associated with Subclinical Atherosclerosis: A Population-Based Study in Rural China

Cardiology ◽

10.1159/000493166 ◽

2018 ◽

Vol 141 (2) ◽

pp. 78-87 ◽

Cited By ~ 4

Author(s):

Yanfeng Jiang ◽

Zehan Fan ◽

Yingzhe Wang ◽

Chen Suo ◽

Mei Cui ◽

...

Keyword(s):

Bone Mineral Density ◽

Femoral Neck ◽

Postmenopausal Women ◽

Bone Mineral ◽

Rural China ◽

Subclinical Atherosclerosis ◽

Ankle Brachial Index ◽

Mineral Density ◽

Low Bone Mineral Density ◽

Significant Difference

Objectives: Loss of bone mass may affect the progression of atherosclerosis. We investigated the relationship between low bone mineral density (BMD) and subclinical atherosclerosis in rural China. Methods: In total, 333 men and 421 postmenopausal women aged 55–65 years were enrolled. BMD was measured in the lumbar spine, femoral neck, and total hip using dual-energy X-ray absorptiometry. Subclinical atherosclerosis was defined as increased carotid artery intima-media thickness (CIMT ≥0.9 mm), the presence of carotid plaques, high brachial-ankle pulse wave velocity (baPWV ≥1,400 cm/s), and low ankle-brachial index (ABI ≤1). Binary logistic regression analyses were used to estimate the association between low BMD and subclinical atherosclerosis. Results: There was no significant difference in BMD between the normal group and the subclinical atherosclerosis group. After full adjustment for the relevant covariates, a boundary significant association was found between low BMD in the femoral neck and baPWV in postmenopausal women (odds ratio = 1.77, p = 0.049). After full adjustment, neither BMD nor low BMD were significantly associated with subclinical atherosclerosis in men or postmenopausal women. Conclusions: Low BMD is not associated with subclinical atherosclerosis in Chinese individuals aged 55–65 years resident in rural China.

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The comparison of bone mineral density in primary hyperparathyroidim, vitamin D induced secondary hyperparathyroidism, and patients with both condition: a single center experience

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20201909 ◽

2020 ◽

Vol 8 (5) ◽

pp. 1683

Author(s):

Hande Peynirci ◽

Canan Ersoy ◽

Ayten Girgin ◽

Vildan Gürsoy ◽

Mehmet Ali Asik ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Bone Mineral ◽

Calcium Excretion ◽

Lumbar Region ◽

Disease Group ◽

Mineral Density ◽

Blood Calcium ◽

Significant Difference ◽

Z Scores

Background: To compare bone mineral densities via dual energy X-ray absorptiometry method (DXA) between various hyperparathyroidism (HPT) types such as primary, vitamin D induced secondary, and both conditions.Methods: Participants who were aged between 18-45 years and had elevated parathyroid hormone levels were included. After initial evaluations, patients were divided into 3 groups according to diagnoses: primary HPT (pHPT), vitamin D induced secondary HPT (sHPT), and combined (primary+secondary) one. In addition to the bone mineral density (BMD), demographic and laboratory datas were recorded.Results: Of 166 patients, 147 of the patients were female, 19 were male, and average age was 38.10±7.24 years. Significant difference was found in terms of age (p=0.03) between pHPT and sHPT. Blood calcium, PTH, 25-OH vitamin D, and daily urine calcium excretion levels were significantly higher and phosphorus levels were lower in the pHPT group compared to the sHPT and combined disease group. Both T and Z scores of the pHPT group were significantly lower than the sHPT group especially in the lumbar region. However, no significant difference was noted between pHPT and combined disease group with respect to T and Z scores in all regions.Conclusions: The results of this study indicate that pHPT has a significantly worse impact on skeletal mineral density particularly in the lumbar region than sHPT. The addition of vitamin D deficiency to the clinical picture seems to have no significant influence on BMD in pHPT. To confirm and clarify these findings, prospective studies with larger number of participants are needed.

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Calcium-sensing receptor gene polymorphism is not associated with bone mineral density in Italian postmenopausal women

Acta Endocrinologica ◽

10.1530/eje.0.1480603 ◽

2003 ◽

pp. 603-607 ◽

Cited By ~ 10

Author(s):

F Cetani ◽

E Pardi ◽

S Borsari ◽

E Vignali ◽

G Dipollina ◽

...

Keyword(s):

Bone Mineral Density ◽

Postmenopausal Women ◽

Bone Mineral ◽

Receptor Gene ◽

Osteoporotic Fractures ◽

Fragility Fractures ◽

Mineral Density ◽

Calcium Sensing Receptor ◽

Calcium Sensing ◽

Significant Difference

OBJECTIVE: Calcium-sensing receptor (CaR) is a candidate gene for osteoporosis susceptibility. Several CaR polymorphisms have been identified and an association between the A986S genotype and serum calcium levels has been found in Canadian postmenopausal women. We investigated whether the presence of 986S allele was associated with bone mineral density (BMD) and osteoporotic fractures. DESIGN: The study group consisted of 164 Italian postmenopausal women without fragility fracture (Fx(-)) and 55 women with fracture (Fx(+)). METHODS: A fragment of exon 7 of CaR gene containing three polymorphisms (A986S, R990G and Q1011E) was amplified by PCR and sequenced. Anthropometric characteristics and BMD were evaluated. RESULTS: The A986S polymorphism was the most commonly observed (27.9%), whereas the other two CaR polymorphisms, R990G and Q1011E, occurred in a minority of cases (8.8 and 5.5% respectively). There was no significant difference in the frequency distribution of any CaR allele between Fx(-) and Fx(+) patients. Body mass index was found to predict BMD at the lumbar spine and femoral neck. The A986S polymorphism and Years since menopause were not independent predictors of BMD at any site. As far as fracture occurrence, there was no statistically significant difference in the prevalence of fractures between women carrying or not carrying the 986S allele. CONCLUSIONS: Our data do not support a role of A986S CaR polymorphism in BMD and in the prevalence of fragility fractures in Italian postmenopausal women.

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Relationship between vasomotor symptoms and metabolic syndrome in postmenopausal women

Journal of International Medical Research ◽

10.1177/0300060518790709 ◽

2018 ◽

Vol 46 (10) ◽

pp. 4157-4166 ◽

Cited By ~ 2

Author(s):

Sena Sayan ◽

Tanju Pekin ◽

Begüm Yıldızhan

Keyword(s):

Bone Mineral Density ◽

Metabolic Syndrome ◽

Femoral Neck ◽

Postmenopausal Women ◽

Bone Mineral ◽

International Diabetes Federation ◽

High Body Mass Index ◽

Vasomotor Symptoms ◽

Mineral Density ◽

Significant Difference

Objective This study was performed to compare the vasomotor symptoms and bone mineral density of postmenopausal women with and without metabolic syndrome. Methods We performed a cross-sectional study of 200 postmenopausal women attending routine health check-ups at Marmara Faculty of Medicine Pendik Training and Research Hospital from June 2015 to December 2015. The vasomotor symptoms scored were hot flashes and night sweats. Metabolic syndrome was defined using the consensus criteria of the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. Results Women with vasomotor symptoms had no metabolic syndrome and were younger than those without vasomotor symptoms. There was no significant difference in vasomotor symptoms between patients with osteopenia in the femoral neck, total femur, and spine and patients with normal bone mineral density. The vasomotor symptoms were similar between smokers and nonsmokers. Conclusion The presence of metabolic symptoms is inversely associated with metabolic syndrome in postmenopausal women. Lipid abnormalities and a high body mass index may be important metabolic components associated with these symptoms. No relationship is present between vasomotor symptoms and the bone mineral density of the spine, femoral neck, and total femur.

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