Bone disorders in experimentally induced liver disease in growing rats

AIM： To investigate the change of bone parameters in a new model of experimentally induced liver cirrhosis and hepatocellular carcinoma （HCC） in growing rats. METHODS： Fischer-344 rats （n = 55） were used. Carbon tetrachloride （CCh）, phenobarbital （PB）, and a single diethylnitrosamine （DEN） injection were used. Animals were killed at wk 8 and 16. Bone mineral content, femoral length, cortical index （quotient of cortical thickness and whole diameter） and ultimate bending load （Fmax） of the femora were determined. The results in animals treated with DEN＋PB＋CCh （DPC, n = 21） were com- pared to those in untreated animals （UNT, n = 14） and in control group treated only with DEN＋PB （DP, n = 20）. RESULTS： Fatty liver and cirrhosis developed in each DPC-treated rat at wk 8 and HCC was presented at wk 16. No skeletal changes were found in this group at wk 8, but each parameter was lower （P〈0.05 for each） at wk 16 in comparison to the control group. Neither fatty liver nor cirrhosis was observed in DP-treated animals at any time point. Femoral length and Fmax values were higher （P〈0.05 for both） in DP-treated animals at wk 8 compared to the UNT controls. However, no difference was found at wk 16. CONCLUSION： Experimental liver cirrhosis and HCC are accompanied with inhibited skeletal growth, reduced bone mass, and decreased mechanical resistance in growing rats. Our results are in concordance withthe data of other studies using different animal models. A novel finding is the transiently accelerated skeletal growth and bone strength after a 8-wk long phenobarbital treatment following diethylnitrosamine injection.

Impact of dietary nutrition regimens based on body composition analysis on bone metabolism in Alzheimer’s disease patients

BACKGROUND Body composition analysis(BCA)is primarily used in the management of conditions such as obesity and endocrine disorders.However,its potential in providing nutritional guidance for patients with Alzheimer’s disease(AD)remains relatively unexplored.AIM To explore the clinical efficacy of BCA-based dietary nutrition scheme on bone metabolism in AD patients.METHODS This retrospective study included 96 patients with AD complicated by osteoporosis who were admitted to The Third Hospital of Quzhou between January 2023 and December 2024.Based on data from previous similar studies,the patients were randomly assigned to either a routine diet(RD)group(n=48)or a personalized nutrition(PN)group(n=48).The RD group received conventional dietary guidance,while the PN group received individualized diet intervention measures based on human BCA.The intervention period lasted for 12 weeks.Bone mineral density(BMD),body mass index(BMI),muscle mass,mineral content,osteocalcin,25-hydroxyvitamin D,procollagen type I N-terminal propeptide(PINP),beta C-terminal telopeptide of type I collagen(β-CTX),and serum calcium were measured and compared between the two groups before and 12 weeks after the intervention.RESULTS No significant differences were observed between groups in terms of age,sex,height,BMI,or other baseline data(P>0.05).In both groups,BMI did not show significant changes after the intervention(P>0.05),whereas muscle mass and mineral content were significantly increased(P<0.05).After the intervention,BMI in the PN group did not differ significantly from that of the RD group,but muscle mass and mineral content were significantly higher in the PN group(P<0.05).After the intervention,a higher proportion of patients in the PN group had a T score>-1 compared to the RD group(P<0.05).The mini-mental state examination(MMSE)score was similar in both groups before the intervention.However,12 weeks after the intervention,the MMSE score in the PN group was significantly higher than that in the RD group(P<0.05).In both groups,the MMSE score significantly increased 12 weeks post-intervention compared to pre-intervention levels(P<0.05).Before the intervention,the levels of osteocalcin,serum calcium,PINP,β-CTX,and 25-hydroxyvitamin D were not significantly different between the two groups(P>0.05).After 12 weeks of intervention,the PN group exhibited higher levels of osteocalcin,serum calcium,and 25-hydroxyvitamin D,as well as lower levels of PINP andβ-CTX,compared to the RD group(P<0.05).In both groups,osteocalcin,serum calcium,and 25-hydroxyvitamin D levels were significantly higher,while PINP andβ-CTX levels were significantly lower after 12 weeks of intervention compared to baseline(P<0.05).CONCLUSION The human BCA-based dietary nutrition regimen plays a crucial role in improving BMD and bone metabolism,with effects that surpass those of conventional nutrition strategies.The findings of this study provide strong evidence for the nutritional management of AD patients.

Impact of bisphosphonate treatment on bone mineral density after kidney transplant

BACKGROUND Mineral bone disease is associated with chronic kidney disease and persists after kidney transplantation.Immunosuppressive treatment contributes to the patho-genesis of this disease.Bisphosphonate treatments have shown positive but inde-finite results.AIM To evaluate the effectiveness and safety of bisphosphonate treatment on post kidney transplantation bone mineral density(BMD).METHODS We included kidney transplant recipients(KTRs)whose BMD was measured after the operation but before the initiation of treatment and their BMD was measured at least one year later.We also evaluated the BMD of KTRs using two valid mea-surements after transplantation who received no treatment(control group).RESULTS Out of 254 KTRs,62(39 men)were included in the study.Bisphosphonates were initiated in 35 KTRs in total(20 men),1.1±2.4 years after operation and for a period of 3.9±2.3 years while 27(19 men)received no treatment.BMD improved significantly in KTRs who received bisphosphonate treatments(from-2.29±1.07 to-1.66±1.09,P<0.0001).The control group showed a non-significant decrease in BMD after 4.2±1.4 years of follow-up after surgery.Kidney function was not affected by bisphosphonate treatment.In KTRs with established osteoporosis,active treatment had a similar and significant effect on those with osteopenia or normal bone mass.CONCLUSION In this retrospective study of KTRs receiving bisphosphonate treatment,we showed that active treatment is effective in preventing bone loss irrespective of baseline BMD.

Cemented vertebra and adjacent vertebra refractured in a chronic kidney disease-mineral and bone disorder patient: A case report

BACKGROUND Although percutaneous vertebral augmentation(PVA)is a commonly used procedure for treating vertebral compression fracture(VCF),the risk of vertebral refracture should be considered.Chronic kidney disease-mineral and bone disorder(CKD-MBD)is a systemic disease of mineral and bone metabolism.It is associated with an increased risk of fracture.Few studies have reported the use of PVA in patients with CKD-MBD.We herein report a rare case wherein the cemented vertebra and the adjacent vertebra refractured simultaneously in a CKD-MBD patient after PVA.CASE SUMMARY A 74-year-old man suffered from low back pain after taking a fall about 3 wk ago.According to physical examination,imaging and laboratory findings,diagnoses of T12 VCF,CKD-MBD,and chronic kidney disease stage 5 were established.He then received percutaneous vertebroplasty at T12 vertebra.Fourteen weeks later,he presented with T12 and L1 vertebral refractures caused by lumbar sprain.Once again,he was given PVA which was optimized for the refractured vertebrae.Although the short-term postoperative effect was satisfactory,he reported chronic low back pain again at the 3-month follow-up.CONCLUSION It is necessary that patients with CKD-MBD who have received PVA are aware of the adverse effects of CKD-MBD.It may increase the risk of vertebral refracture.Furthermore,the PVA surgical technique needs to be optimized according to the condition of the patient.The medium-and long-term effects of PVA remain uncertain in patients with CKD-MBD.

Optimizing dialysis modalities for diabetic end-stage kidney disease: A focus on personalized care and resource-limited settings

Diabetes is the leading cause of chronic kidney disease(CKD)and end-stage kidney disease(ESKD)worldwide.While both haemodialysis(HD)and peritoneal dialysis(PD)are commonly used treatment options for ESKD,the choice of dialysis modality in diabetic ESKD patients remains a critical decision influenced by various patient-related,healthcare system,and socio-economic factors.This article examines the factors influencing the selection of dialysis modalities for diabetic patients,with a focus on the challenges and opportunities in low-resource settings.Key considerations include the impact of comorbidities such as peripheral arterial disease and CKD-related mineral bone disorder(MBD),as well as patient preferences,caregiver burden,and the availability of healthcare infrastructure.The article highlights the need for personalized approaches to dialysis selection,considering both clinical outcomes and quality of life.It also emphasizes the potential benefits of home dialysis,including home HD and PD,in improving patient autonomy and long-term survival.The article advocates for better government policies,increased awareness,and improved support systems to enhance the accessibility and efficacy of dialysis treatments,particularly in underserved populations.Further research comparing the outcomes of different dialysis modalities across diverse settings is essential to guide global treatment strategies for diabetic ESKD patients.

Potential efficacy and mechanism of medicinal plants on chronic kidney disease-associated vascular calcification:a review

Vascular calcification is a crucial risk factor that affects the incidence and mortality of cardiovascular disease in chronic kidney disease patients.Modern medicine relies on calcium-phosphorus binding agents,calcium mimetics,active vitamin D,and hemodialysis to prevent and treat vascular calcification,however,their efficacy is unsatisfactory and adverse reactions often occur.Medical plant therapy can act as an integrative regulator in patients with chronic kidney disease-associated vascular calcification,which can significantly improve patients’symptoms,but its specific mechanism has not been fully elucidated yet.In this paper,we reviewed the domestic and international theoretical studies on the pathogenesis mechanism of chronic kidney disease-associated vascular calcification in recent years,summarized eight active ingredients of medicinal plants as well as four compound formulas for improving chronic kidney disease-associated vascular calcification,and explored the mechanism of action of herbal medicine,which will provide a new strategy for promoting the prevention and treatment of vascular calcification.

Central blood pressure and chronic kidney disease

In this review, we focused on the relationship between central blood pressure and chronic kidney diseases(CKD). Wave reflection is a major mechanism that determines central blood pressure in patients with CKD. Recent medical technology advances have enabled non-invasive central blood pressure measurements. Clinical trials have demonstrated that compared with brachial blood pressure, central blood pressure is a stronger risk factor for cardiovascular(CV) and renal diseases. CKD is characterized by a diminished renal autoregulatory ability, an augmented direct transmission of systemic blood pressure to glomeruli, and an increase in proteinuria. Any elevation in central blood pressure accelerates CKD progression. In the kidney, interstitial inflammation induces oxidative stress to handle proteinuria. Oxidative stress facilitates atherogenesis, increases arterial stiffness and central blood pressure, and worsens the CV prognosis in patients with CKD. A vicious cycle exists between CKD and central blood pressure. To stop this cycle, vasodilator antihypertensive drugs and statins can reduce central blood pressure and oxidative stress. Even in early-stage CKD, mineral and bone disorders(MBD) may develop. MBD promotes oxidative stress, arteriosclerosis, and elevated central blood pressure in patients with CKD. Early intervention or prevention seems necessary to maintain vascular health in patients with CKD.

Correlation between Vascular Calcification and Serum Sclerostin in MHD Patients

Objective Investigate the correlation between serum sclerostinlevel and chronic kidney disease-mineral and bone disorder(CKD-MBD),especially vascular calcification,in maintenance hemodialysis(MHD)patients.Methods This is across-sectional study,a total of 72 MHD patients were included from the first affiliated hospital of Jinan university.Measure the biochemical indicators of mineral metabolism,renal function,and serum sclerostin level by ELISA.The abdominal aorta calcification score(AACS)was assessed according to Kauppila method on lateral spine imaging using DEXA.Patients were distributed into two groups according to the level of serum sclerostin:low sclerostingroup(≤125 pg/ml)and high sclerostingroup(>125 pg/ml).Analyze the association of serum sclerostin level with the indicators of CKD-MBD.Results There was significant difference in i PTH level between high sclerost in group and low sclerost in group.Multivariate Logistic regression analysis demonstrated that dialysis duration,male and anuria were independent risk factor of high sclerostin level,and i PTH and Kt/V were protective factors.Conclusion Dialysis duration,man,anuria was independent risk factors and i PTH,Kt/V were protective factors of high serum sclerostin level in MHD patients.There was no correlation between abdominal aorta calcification and serum sclerostin level.

The Research Progression of Calcitonin for the Therapy of Renal Osteodystrophy

Calcitonin is a common medicine used in the treatment of osteoporosis,which could restrain the activity of osteoclasts,stop the loss of osteocalcin and reduce the transfer of osteocalcin.Calcitonin can also be used in the treatment of the pain-caused diseases which usually cause by hypercalcemia and others such like Paget's disease and bone tumors.As is approved by several clinic researches,calcitonin is powerful in adjusting the level of calcium,phosphorus and PTH during the treatment of renal osteodystrophy.In addition,it could improves the life quality of the patients who suffered from chronic kidney disease(CKD)and extending their life period.At present,several studies have shown us Calcitonin could be treated in renal osteodystrophy.However,the treatment experiences of Calcitonin are still lacking.Better understanding of the clinical evaluation for calcitonin in the treatment of renal osteodystrophy will hopefully help us to improve outcomes for these patients.

Mineral and Bone Disorder and Its Association with Cardiovascular Parameters in Chinese Patients with Chronic Kidney Disease

Background：Mineral and bone disorder （MBD）,especially hyperphosphatemia,is an independently risk factor for adverse prognosis in patients with chronic kidney disease （CKD）.However,CKD-MBD among Chinese population was poorly studied.This study aimed to investigate the status of MBD and its association with cardiovascular parameters in Chinese patients with predialysis CKD.Methods：Chinese Cohort Study of Chronic Kidney Disease （C-STRIDE） is a prospective multicenter cohort study involving predialysis CKD patients in China.Markers of MBD,including serum phosphorus,calcium,and intact parathyroid hormone,were measured in baseline samples at the patients＆#39; entry.The association between serum phosphorus and abdominal aortic calcification （AAC）,left ventricular hypertrophy （LVH） were examined by logistic regression models.Results：Altogether 3194 predialysis patients with mean estimated glomerular filtration of 51.8 ± 33.1 ml·min^- 1· 1.73 m^- 2 were included.The proportion of patients with hyperphosphatemia were 2.6%,2.9%,6.8%,and 27.1% in CKD Stages 3a,3b,4,and 5,respectively.Moreover,71.6% of the patients with hyperphosphatemia did not receive any phosphate-binder （PB）.Lateral abdominal X-rays were obtained in 2280 patients,9.8% of the patients were diagnosed as having AAC.Altogether 2219 patients had data of echocardiography,and 13.2% of them were diagnosed with LVH.Multivariate logistic regression analysis showed that serum phosphorus was independently associated with the presence of AAC and LVH.Conclusions：In Chinese patients with CKD,the percentage of hyperphosphatemia is comparable to that of other countries while the usage of PBs is suboptimal.The prevalence of vascular calcification in Chinese patients is relatively lower compared with the Caucasian population.

Magnesium implantation or supplementation ameliorates bone disorder in CFTR-mutant mice through an ATF4-dependent Wnt/β-catenin signaling

Magnesium metal and its alloys are being developed as effective orthopedic implants;however,the mechanisms underlying the actions of magnesium on bones remain unclear.Cystic fibrosis,the most common genetic disease in Caucasians caused by the mutation of CFTR,has shown bone disorder as a key clinical manifestation,which currently lacks effective therapeutic options.Here we report that implantation of magnesium-containing implant stimulates bone formation and improves bone fracture healing in CFTR-mutant mice.Wnt/β-catenin signaling in the bone is enhanced by the magnesium implant,and inhibition of Wnt/β-catenin by iCRT14 blocks the magnesium implant to improve fracture healing in CFTR-mutant mice.We further demonstrate that magnesium ion enters osteocytes,increases intracellular cAMP level and activates ATF4,a key transcription factor known to regulate Wnt/β-catenin signaling.In vivo knockdown of ATF4 abolishes the magnesium implant-activated β-catenin in bones and reverses the improved-fracture healing in CFTR-mutant mice.In addition,oral supplementation of magnesium activates ATF4 and β-catenin as well as enhances bone volume and density in CFTR-mutant mice.Together,these results show that magnesium implantation or supplementation may serve as a potential anabolic therapy for cystic fibrosis-related bone disease.Activation of ATF4-dependent Wnt/β-catenin signaling in osteocytes is identified as a previously undefined mechanism underlying the beneficial effect of magnesium on bone formation.

Identification of differentially expressed miRNAs associated with chronic kidney disease-mineral bone disorder

The purpose of this study is to characterize a meta-signature of differentially expressed mRNA in chronic kidney disease （CKD） to predict putative microRNA （miRNA） in CKD-mineral bone disorder （CKD- MBD） and confirm the changes in these genes and miRNA expression under uremic conditions by using a cell culture system. PubMed searches using MeSH terms and keywords related to CKD, uremia, and mRNA arrays were conducted. Through a computational analysis, a meta-signature that characterizes the significant intersection of differentially expressed mRNA and expected miRNAs associated with CKD-MBD was determined. Additionally, changes in gene and miRNA expressions under uremic conditions were confirmed with human Saos-2 osteoblast-like cells. A statistically significant mRNA meta-signature of upregulated and downregulated mRNA levels was identified. Furthermore, miRNA expression profiles were inferred, and computational anaIyses were performed with the imputed mieroRNA regulation based on weighted ranked expression and putative microRNA targets （IMRE） method to identify miRNAs associated with CKD occurrence. TLR4 and miR-146b levels were significantly associated with CKD-MBD. TLR4 levels were significantly downregulated, whereas pri- miR-146b and miR-146b were upregulated in the presence of uremic toxins in human Saos-2 osteoblast-like cells. Differentially expressed miRNAs associated with CKD-MBD were identified through a computational analysis, and changes in gene and miRNA expressions were confirmed with an in vitro cell culture system.