Single center, observational study to analyze correlation between vitamin D-3 deficiency and age in patients with orthopedic disorders

<p><strong>Background:</strong> Vitamin D deficiency has been strongly associated with various health outcomes, including all-cause mortality. Chronic vitamin D deficiency in adults and in old age results in osteomalacia, osteoporosis, muscle weakness, and increased risk of fall and long bone fractures. <strong></strong></p><p><strong>Methods:</strong> We examined records of 1029 such patients and to analyze association of vitamin d-3 levels and categories of age groups (1-20, 21-30, 31-40, 41-50, 51-60, 61-70, 71-80, 81-90 years). We categorized mild, moderate and severe cases age wise.</p><p><strong>Results: </strong>During the study period records for 1029 patients were evaluated, of which 347 (33.72%) male and 682 (66.27) were female the mean age with standard deviation for male was 38.25±15.64 years and for female was 41.43±15.23 years. Vitamin D deficiency (&lt;20 ng/ml) was present in 623 patients (61%), 189 patients (18%) had vitamin D level 20-30 ng/ml and 217 patients (21%) had sufficient levels of vitamin D.</p><p><strong>Conclusions:</strong> Our study concludes that although there is high prevalence of vitamin D-3 deficiency across all age groups among orthopedic patients, age group 31-40 years, was found to be more affected.</p><p><strong> </strong></p>

Associations between Sclerostin and Anthropometric and Metabolic Parameters in Children and Adolescents

(1) Background: Bone plays an important role in the regulation of the systemic glucose and energy metabolism. Sclerostin, secreted by osteocytes, is an inhibitor of the Wnt/β–catenin bone metabolic pathway, and is involved in osteoporosis and metabolic disease. The aim of this study was to investigate the relationship between sclerostin and anthropometric and metabolic parameters in children and adolescents with obesity or who are overweight. (2) Methods: This study included 63 children and adolescents (20 obese, 11 overweight and 32 healthy control subjects). We evaluated the correlation between serum sclerostin and anthropometric parameters, metabolic parameters related to glucose (homeostasis model assessment of insulin resistance [HOMA–IR]), lipid, and bone metabolism (osteocalcin and 25-hydroxy vitamin D). (3) Results: Sclerostin and osteocalcin levels did not differ between obese and control groups. Sclerostin level was higher in boys than in girls (median 20.7 vs. 18.9 pmol/L, respectively; p = 0.04). In all subjects, sclerostin levels were negatively correlated with fasting insulin (r = −0.26; p = 0.04) and HOMA–IR (r = −0.28; p = 0.03), and positively correlated with serum concentrations of triglycerides (r = 0.29; p = 0.04), alkaline phosphatase (r = 0.41; p = 0.002), and osteocalcin (r = 0.33; p = 0.008). In obese patients, sclerostin levels were correlated negatively with fasting glucose (r = −0.49; p = 0.03) and HOMA–IR (r = −0.48; p = 0.03) and positively correlated with triglyceride levels (r = 0.53; p = 0.02). In the healthy control, sclerostin levels were correlated negatively with fasting insulin levels (r = −0.61; p < 0.001) and HOMA–IR (r = −0.36; p = 0.04). After adjusting for age, sex, and height SDS, a negative correlation between sclerostin and HOMA–IR was found (r = −0.39; p = 0.003) in all of the subjects. This association was more evident in obese patients (r = −0.60; p = 0.01) than in healthy controls (r = −0.39; p = 0.047). (4) Conclusions: Among children and adolescents with obesity, serum sclerostin was negatively correlated with HOMA–IR. Further studies are needed to clarify the mechanisms involved to understand how sclerostin affects the glucose metabolism.

Vitamin D3 and calcium carbonate supplementation for adolescents with HIV to reduce musculoskeletal morbidity and immunopathology (VITALITY Trial): study protocol for a randomised placebo-controlled trial

Background: Of the 2 million children living with HIV globally, 90% live in sub-Saharan Africa. Despite antiretroviral therapy, longstanding HIV infection is associated with several chronic complications in children including growth failure, particularly stunting and delayed puberty. Vitamin D deficiency, which is highly prevalent among children living with HIV in sub-Saharan Africa, has further adverse impact on bone health. This trial aims to establish whether supplementation with vitamin D 3 and calcium carbonate improves musculoskeletal health among peripubertal children living with HIV. Methods/design: We will conduct an individually randomised, double-blinded, placebo-controlled trial of weekly high-dose vitamin D 3 (20000iu) plus daily calcium carbonate (500mg) supplementation for 48 weeks. 840 children living with HIV aged 11-19 years taking ART for ≥6 months will be enrolled and followed up for 96 weeks. The primary outcome is total body less-head bone mineral content for lean mass adjusted for height (TBLH-BMC LBM ) Z-score at 48 weeks, measured by dual-energy x-ray absorptiometry (DEXA). Secondary outcomes are DEXA-measured Lumbar Spine Bone Mineral Apparent Density Z-score, number of respiratory infections, lean muscle mass and grip-strength at 48 and 96 weeks, and TBLH-BMC LBM Z-scores at 96 weeks. Sub studies will investigate the effect of the intervention on vitamin D 3 pathway metabolites and markers of bone turnover, intestinal microbiota, and innate and acquired immune function. Discussion: This is the largest trial to date of vitamin D supplementation in children living with HIV. Intervening to address deficits in bone accrual through childhood is critical for optimising adolescent and early adult bone health, and prevention of later adult osteoporotic fractures. Trial results will draw attention to the need to screen for and treat long-term comorbidities in children living with HIV in resource-limited settings.Trial registration: Pan African Clinical Trials Registry ID: PACTR20200989766029. Date ofregistration: 3 September 2020. URL of trial registry record: https://pactr.samrc.ac.za