Resistance training and detraining may alter leptin and adiponectin responses in an intensity-dependent manner. Leptin and adiponectin changes were strongly associated with RMR and anthropometric changes.

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The interaction between obesity and bone metabolism is complex. The effects of fat on the skeleton are mediated by both mechanical and biochemical factors. Though obesity is characterized by higher bone mineral density, studies conducted on bone microarchitecture have produced conflicting results. The majority of studies indicate that obesity has a positive effect on skeletal strength, even though most likely the effects are site-dependent and, in fact, obese individuals might be at risk of certain types of fractures. Mechanical loading and higher lean mass are associated with improved outcomes, whereas systemic inflammation, observed especially with abdominal obesity, may exert negative effects. Weight loss interventions likely lead to bone loss over time. Pharmacological treatment options seem to be safe in terms of skeletal health; however, the skeletal effects of bariatric surgery are dependent on the type of surgical procedure. Malabsorptive procedures are associated with higher short-term adverse effects on bone health. In this narrative review, we discuss the effects of obesity and weight loss interventions on skeletal health.

RESEARCH DESIGN AND METHODS -Nine lean and eight obese men performed 30 min of circuit resistance exercise. Adipose tissue and blood were sampled during exercise for TGLA, metabolite, and hormone determinations. Respiratory exchange ratio (RER) was measured throughout exercise.RESULTS -Energy expenditure of exercise relative to body mass was higher in the lean and RER was higher in the obese men, suggesting lower fat oxidation. TGLA increased 18-fold at 5 min of exercise in the lean men and 16-fold at 10 min of exercise in the obese men. The delayed lipolytic activation in the obese men was reflected in serum nonesterified fatty acid and glycerol concentrations. Plasma insulin increased in the obese but did not change in the lean men.CONCLUSIONS -Resistance exercise upregulated adipose tissue lipolysis and enhanced energy expenditure in lean and obese men, with a delayed lipolytic activation in the obese men.

Normocalcemic PH is characterized by catabolic actions at both cortical and cancellous sites (38 and 4%, respectively), an effect accentuated in hypercalcemic patients. Cortical geometric properties are adversely affected even in normocalcemic patients, whereas trabecular properties are generally preserved.

We read with great interest the case report by Bartko and colleagues (1) concerning a patient with osteomalacia due to longstanding hypophosphatemia after long-term intravenous (iv) iron administration. We would like to add our experience regarding a similar case of a male patient with Hirschsprung disease suffering from severe hypophosphatemia due to continuous iv iron administration. A 31-year-old man with extensive Hirschsprung disease (involving the colon and the distal one-third of ileum) was referred to our department suffering from insufficiency fractures and severe hypophosphatemia. Disease onset was on the second day after birth with meconium ileus. By the age of 2 years, he underwent near total colectomy and excision of the distal one-third of the ileum by the Duhamel retrorectal transanal technique. Since then, he suffered from mild iron-deficiency anemia (IDA) and B12 and vitamin D deficiency, managed with oral iron treatment (OIT) and B12 and D2 im injections. Serum phosphate levels were within normal range (1.065 to 1.227 mmol/L). At the age of 26 years, IDA became refractory to OIT because of multiple bleeding ulcers at the site of rectal anastomosis. At that time, monthly ferric carboxymaltose (FCM) iv injections were administered for the management of IDA along with occasional need for blood transfusions. At the age of 29 years, he suffered multiple insufficiency fractures (4th left metatarsal and bilateral rib fractures). Laboratory evaluations performed on several occasions revealed severe hypophosphatemia (as low as 0.355 mmol/L) and secondary hyperparathyroidism. At presentation, the patient had diffuse skeletal pain, gait disturbance, and progressive loss of mobility. Laboratory evaluation revealed severe hypophosphatemia (0.419 mmol/L), mild hypocalcemia (2.09 mmol/L), and secondary hyperparathyroidism (parathyroid hormone [PTH] 104.8 pg/mL). 25 (OH) D levels were normal (77.25 nmol/L), whereas 1,25 (OH) 2 D levels were at the low normal level (24 pg/mL). Urinary calcium excretion was low (1.28 mmol/24 hr), whereas phosphate excretion was elevated (32.16 mmol/24 hr, tubular maximum reabsorption of phosphate to glomerular filtration rate [TmP/GFR] 0.2827 mmol/L [reference range 1.00-1.35]; Table 1). Intact FGF-23 level (Kainos Laboratories, Inc., Tokyo, Japan) was elevated (96 pg/mL [reference range 10-50] (2) ). Dual-energy X-ray absorptiometry (DXA) revealed a low BMD at the lumbar spine (LS) (0.92 mg/cm 2 , Z-score -2.7) and the femoral neck (FN) (0.725, Z-score -2.1). These results pointed to a combined defect: FGF-23 mediated hypophosphatemia due to FCM iv injections, leading to renal phosphate wasting and low calcitriol levels, and calcium and phosphate malabsorption due to low calcitriol and short bowel syndrome. Secondary hyperparathyroidism amplified phosphate wasting.The patient was treated with calcium citrate (500 mg tid) and alphacalcidol (1 mcg bid), was instructed to increase milk intake, and switched to oral iron therapy (ferric hydroxide polymaltose). He was referred to a te...

This study determined dietary intake and energy balance of elite premenarcheal rhythmic gymnasts during their preseason training. Forty rhythmic gymnasts and 40 sedentary age-matched females (10-12 yrs) participated in the study. Anthropometric profile and skeletal ages were determined. Dietary intake and physical activity were assessed to estimate daily energy intake, daily energy expenditure, and resting metabolic rate. Groups demonstrated comparable height, bone age, pubertal development, resting metabolic rate. Gymnasts had lower body mass, BMI, body fat than age-matched controls. Although groups demonstrated comparable daily energy intake, gymnasts exhibited a higher daily energy expenditure resulting in a daily energy deficit. Gymnasts also had higher carbohydrate intake but lower fat and calcium intake. Both groups were below the recommended dietary allowances for fiber, water, calcium, phosphorus and vitamin intake. Gymnasts may need to raise their daily energy intake to avoid the energy deficit during periods of intense training.