Bone mineral density and disorders of mineral metabolism in chronic liver disease

AIM： To estimate the prevalence and identify the risk factors for metabolic bone disease in patients with cirrhosis. METHODS： The study was performed on 72 Indian patients with cirrhosis （63 male, 9 female; aged 〈 50 years）. Etiology of cirrhosis was alcoholism （n = 37）, hepatitis B （n = 25） and hepatitis C （n = 10）. Twenty-three patients belonged to Child class A, while 39 were in class B and 10 in class C. Secondary causes for metabolic bone disease and osteoporosis were ruled out. Sunlight exposure, physical activity and dietary constituents were calculated. Complete metabolic profiles were derived, and bone mineral density （BMD） was measured using dual energy X ray absorptiometry. Low BMD was defined as a Z score below -2. RESULTS： Low BMD was found in 68% of patients. Lumbar spine was the most frequently and severely affected site. Risk factors for low BMD included low physical activity, decreased sunlight exposure, and low lean body mass. Calcium intake was adequate, with unfavorable calcium： protein ratio and calcium： phosphorus ratio. Vitamin D deficiency was highly prevalent （92%）. There was a high incidence of hypogonadism （41%）. Serum estradiol level was elevated significantly in patients with normal BMD. Insulin-like growth factor （IGF） 1 and IGF binding protein 3 levels were below the age-related normal range in both groups. IGF-1 was significantly lower in patients with low BMD. Serum osteocalcin level was low （68%） and urinary deoxypyridinoline to creatinine ratio was high （79%）, which demonstrated low bone formation with high resorption. CONCLUSION： Patients with cirrhosis have low BMD. Contributory factors are reduced physical activity, low lean body mass, vitamin D deficiency and hypogonadism and low IGF-1 level.

Effects of Different Hemodialysis Treatments on Abnormal Mineral and Bone Metabolism in Patients with Chronic Renal Failure

Objective:To investigate the effects of different hemodialysis treatments on abnormal mineral and bone metabolism in patients with chronic renal failure.Methods:A random number table was used to divide 80 patients with chronic renal failure admitted to our hospital from January 2018 to January 2019 into 2 groups,with 40 cases in each group.Group A was treated with low-flux hemodialysis,and group B was treated with high-flux hemodialysis.The related indicators of mineral and bone metabolism of the two groups were compared.Results:Before treatment,the blood calcium,blood phosphorus,intact parathyroid hormone(iPTH),type I procollagen amino terminal peptide(PINP),fibroblast growth factor 23(FGF23),serum creatinine(Scr)indicators of the two groups were compared.The difference was not statistically significant(P>0.05);After treatment,the blood calcium levels of the two groups were higher than before treatment,the blood phosphorus,iPTH,PINP,FGF23,and Scr levels were lower than before treatment,and the blood calcium level of group B was higher than that of group A,while blood phosphorus,iPTH,PINP,FGF23,and Scr levels were lower than group A,the difference was statistically significant(P<0.05).Conclusion:Compared with low-flux hemodialysis,patients with chronic renal failure treated with highflux hemodialysis have better results,which can correct abnormal bone metabolism and improve Scr levels.

Effects of raloxifene hydrochloride on bone mineral density,bone metabolism and serum lipids in postmenopausal women:a randomized clinical trial in Beijing

Objective To determine the effects of raloxifene hydrochloride (RLX) on bone mineral density (BMD),bone metabolism markers and serum lipids in healthy postmenopausal women in Beijing.Methods A multicenter,randomized,double-blind,placebo-controlled study was conducted in a total of 204 healthy postmenopausal women (age 59.5±5.0 years and weight 62.8±8.7 kg) treated with either RLX 60 mg (n=102) or placebo (n=102) daily for 12 months. BMD,serum lipids,and bone markers were measured before and after drug administration.Results Compared with placebo,RLX produced a significant increase in both total lumbar spine and total hip BMD. For the lumbar spine,percentage increase in total BMD was 2.3% with RLX compared with a decrease of 0.1% with placebo ( P <0.001). Corresponding values for total hip BMD were a 2.5% increase for RLX and a 1.1% increase for placebo ( P =0.011). For biochemical markers of bone metabolism,serum osteocalcin and C-telopeptide,percentage decreases were 27.65% and 24.02% in RLX-treated subjects. Corresponding values in placebo were a 10.64% decrease and a 15.75% increase (RLX compared with placebo,both P <0.001). For total cholesterol and low-density lipoprotein cholesterol levels,percentage decreases were 6.44% and 34.58% in the RLX-treated group. Corresponding values in placebo-treated patients were a 1.44% increase and a 19.07% decrease (RLX compared with placebo,both P <0.001). No differences were found for high-density lipoprotein cholesterol or triglyceride levels between the two groups. Only 5 subjects discontinued early owing to an adverse event (3 in the RLX group and 2 in the placebo group). Conclusions This study confirms that RLX exerts positive effects on the skeleton,increasing BMD and decreasing biochemical markers of bone metabolism,and has a positive effect on the overall serum lipid profile in postmenopausal women in China.

Interleukin-1 gene polymorphism disease activity and bone mineral metabolism in rheumatoid arthritis

Objective To determine whether interleukin-1α and 1β gene polymorphism is associated with rheumatoid arthritis disease activity and bone mineral metabolism, and whether there is any relationship between IL-1β and rheumatoid arthritis (RA) motif gene. Methods IL-1 gene polymorphisms were analyzed in 65 RA patients who met American College of Radiology (ACR) criteria and 60 controls. From genomic DNA, 2 polymorphisms in each gene for IL1α-889 and IL-1β+3953 were typed by PCR-RFLP and HLA-DRB1 allele typing was also undertaken by PCR-SSOP. Some clinical and laboratory parameters were collected. The allelic frequencies and carriage rates were compared between RA patients and controls and between patients with active and quiescent disease. Comparison was also made between IL-1 polymorphism and parameters of bone mineral metabolism and between patients with the HLA-DRB1 RA motif plus IL-1β 2 and patients without the two alleles. Fisher test and the analysis of variance was used to analyze the data.Results There was no significant difference in the frequency and carriage rate of IL-1α polymorphisms between RA patients and the controls. The β2/2 genotype of IL-1β was more common in female RA patients compared with controls (P=0.001). A lower carriage rate of IL-1β 2 occurred in male RA patients (P=0.001). A higher carriage rate of IL-1α2 is associated with a higher ESR (P=0.008), HAQ score (P=0.03), and vit-D 3 (P【0.001), but conversely a lower SJC (p=0.002), a lower RF (P=0.002) and a lower BMD at the lumbar spine (P=0.001). A higher frequency of IL-1α1 is associated with a lower CRP value (P=0.009). An increased IL-1β2 carriage is associated with active rheumatoid disease as indicated by a higher CRP (P【0.001), ESR (P【0.001) and pain score (P=0.001) and a higher BMD at the lumbar spine (P=0.007), lower vit-D 3 and. Udpd/Crea level The presence of the HLA DRB1 RA motif and IL-1β allele 2 at same time did not contribute to disease activity.Conclution Polymorphisms of the IL-β gene may affect the RA occurrence. Carriage of IL-1β2 polymorphisms is associated with more active disease in RA and the presence of both the IL-1α2 and the IL-1β1 allele in RA influences bone resorption.

Contribution of Musculoskeletal Disorders to Chronic Lumbago in Parkinson’s Disease

Purpose: To clarify the impact of bone metabolism disorder on lumbago in Parkinson’s Disease (PD). Methods: Data was retrospectively analyzed from 52 patients with PD in our outpatient clinic for more than 1 year (mean age, 63 ± 4 years old;mean duration from onset, 6.3 ± 0.8 years). Patients’ characteristics, comorbid musculoskeletal disorders, serum bone metabolism biomarkers, and bone mineral density were examined. Results: Twenty-one PD patients (40.2%) had chronic lumbago. Severe comptocormia and scoliosis were the most common musculosketal disorders in this group (47.6%) affected by lumbago, followed by osteoporosis (14.3%), compression fracture (4.8%). There was no significant difference in the duration of PD, body mass index, frequency of falls, bone mineral density, tartrate-resistant acid phosphatase-5b, osteocalcin, and N-terminal telopeptide between PD patients with or without chronic lumbago. Multivaritae logistic regression analysis identified the independent predictors of chroni lumbago in PD patients as Hoen-Yahr stage (odds ration [OR] = 2.794, 95%CI 1.103 - 7.076), and elevated serum 1,25-OH2 vitamin D level ([OR] = 0.92, 95%CI 0.86 - 98). Conclusion: Bone metabolism disorders are found to be associated with chronic lumbago in PD patients.