Serum Parathyroid Hormone Predicts Time to Fall Independent of Vitamin D Status in a Frail Elderly Population

Sambrook, Philip N.; Chen, J. S.; March, Lyn; Cameron, Ian D.; Cumming, Robert G.; Lord, Stephen R.; Zochling, Jane; Sitoh, Yih Yiow; Lau, Tang Ching; Schwarz, J. M.; Seibel, Markus J.

doi:10.1210/jc.2003-031782

Cited by 113 publications

(83 citation statements)

References 26 publications

(31 reference statements)

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“…Studies employing specific bone markers indicate that bone turnover continues to be increased (and to be associated with bone loss) during late menopause (28)(29)(30)(31)(32)(33). In some postmenopausal women (34), but particularly in the very elderly (35)(36)(37), this increase in bone turnover is often, but not always, found to be due to vitamin D and/or calcium deficiency and secondary hyperparathyroidism.…”

Section: Menopause and Ageingmentioning

confidence: 99%

“…Together with the fact that high bone turnover may be sustained for long periods and bone loss may increase with age (44), these findings may provide a rationale for designing more effective intervention strategies. However, other factors such as age (see above), medication (6,18,(46)(47)(48)(49)(50)(51), immobilisation (32,35), thyroid function (52), co-morbidity (35) and the fracture itself (40,53,54) do influence bone metabolism and therefore need to be considered in the interpretation of biochemical data and their use in individual patients. Clearly, none of the biochemical markers of bone turnover has proven useful as a single diagnostic index of osteoporosis.…”

Section: Bone Turnover In Osteoporosismentioning

confidence: 99%

“…For example, markers of bone turnover may reflect changes in bone metabolism induced by oophorectomy (57,125), hyperparathyroidism (126,127), Paget's disease (128), physical exercise (129), immobilisation (32,130), alcoholism (131), smoking (132), vitamin D deficiency (33,35,37,133), chronic inflammatory bowel disease (134,135), chronic starvation (136), thyroid disorders (52,137) as well as the pharmacological effects of glucocorticosteroids (48,139,140), androgens (6,7,141), gonadotropin-releasing hormone agonists (142), warfarin (143), growth hormone or insulin-like growth factors (144). Bone turnover markers may be useful in the diagnosis and management of certain of the above conditions, but in most cases has not been rigorously examined.…”

Section: Other Conditionsmentioning

confidence: 99%

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Clinical application of biochemical markers of bone turnover

Seibel

2006

Arq Bras Endocrinol Metab

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With the ageing population in most countries, disorders of bone and mineral metabolism are becoming increasingly relevant to every day clinical practice. Consequently, the interest in, and the need for effective measures to be used in the screening, diagnosis and follow-up of such pathologies have markedly grown. Together with clinical and imaging techniques, biochemical tests play an important role in the assessment and differential diagnosis of metabolic bone disease. In recent years, the isolation and characterisation of cellular and extracellular components of the skeletal matrix have resulted in the development of molecular markers that are considered to reflect either bone formation or bone resorption. These biochemical indices are non-invasive, comparatively inexpensive and, when applied and interpreted correctly, helpful tools in the diagnostic and therapeutic assessment of metabolic bone disease. This review provides an overview of the current evidence regarding the clinical use of biochemical markers of bone remodelling in bone disease, with an emphasis on osteoporosis. RESUMO Marcadores Bioquímicos da Remodelação Óssea.Tendo em vista o crescimento da população idosa na maioria dos paí-ses, os distúrbios do metabolismo ósseo e mineral estão tornando-se cada vez mais relevantes na prática clínica diária. Conseqüentemente, o interesse e a necessidade de medidas efetivas para serem usadas no rastreamento, diagnóstico e seguimento de tais patologias vêm crescendo acentuadamente. Além da avaliação clínica e de técnicas de imagens, os marcadores bioquímicos desempenham um importante papel na avaliação e diagnóstico das doenças ósseas metabólicas. Recentemente, a melhor caracterização dos componentes intracelulares e extracelulares da matriz óssea resultou no desenvolvimento dos marcadores moleculares, os quais refletem tanto a formação como a reabsorção óssea. Estes marcadores bioquímicos não são invasivos e comparativamente são de mais baixo custo, e quando aplicados e interpretados corretamente são instrumentos úteis no diagnóstico e tratamento das doenças ósseas metabólicas. Esta revisão abordará evidências atuais, levando em consideração o uso clínico dos marcadores bioquímicos da remodelação óssea nas doenças metabólicas ósseas, com ênfase na osteoporose.

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Section: Menopause and Ageingmentioning

confidence: 99%

Section: Bone Turnover In Osteoporosismentioning

confidence: 99%

Section: Other Conditionsmentioning

confidence: 99%

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Clinical application of biochemical markers of bone turnover

Seibel

2006

Arq Bras Endocrinol Metab

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“…[2][3][4] As a result, investigators have postulated that vitamin D supplementation may reduce the risk of falling.…”

mentioning

confidence: 99%

Vitamin D: A Narrative Review Examining the Evidence for Ten Beliefs

Allan

Cranston²,

Lindblad

et al. 2016

J GEN INTERN MED

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Over the past decade, a large body of observational evidence has suggested an association between lower vitamin D status (25-hydroxyvitamin D) and multiple acute and chronic disorders, including cancer, multiple sclerosis, depression and respiratory tract infections. This evidence has fostered the hypothesis that increasing vitamin D intake may treat and prevent such disorders. Our objective was to perform a critical analysis of the highestlevel evidence for ten common beliefs regarding vitamin D for the prevention of falls, fractures and respiratory tract infections, the reduction of cancer incidence/mortality and overall mortality, and the prevention or treatment of depression/mental well-being, rheumatoid arthritis and multiple sclerosis, as well as maximum dosing and regular testing. We searched the Cochrane Database of Systematic Reviews and PubMed (up to August 2014) for randomized controlled trials and systematic reviews/ meta-analyses based on those studies. All searches were performed, all evidence reviewed and each section written by at least two authors. The evidence shows that vitamin D supplementation provides some benefit in fracture prevention (likely ∼10-15 % relative reduction), particularly at a dose ≥800 IU and with calcium; a likely benefit in the rate of falls, though it is less clear whether the number of fallers changes; and a possible small (∼5 %) relative reduction in mortality. Evidence does not support the use of vitamin D supplementation for the prevention of cancer, respiratory infections or rheumatoid arthritis. Similarly, evidence does not support vitamin D supplementation for the treatment of multiple sclerosis and rheumatoid arthritis or for improving depression/mental well-being. Regular testing of 25-hydroxyvitamin D is generally not required, and mega-doses (≥300,000 IU) appear to increase harms. Much of the evidence is at high risk of bias, with multiple flaws, including analyses of secondary endpoints, small and underpowered studies, inconsistent results and numerous other issues. Therefore, enthusiasm for a vitamin D panacea should be tempered.

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“…O mesmo foi observado em trabalho mais recente, também realizado por um grupo australiano (38), em que os níveis de PTH e de 25OHD foram preditores significantes para primeira queda, porém após ajustes para idade, incontinência e severidade da doença, apenas os níveis de PTH permaneceram como preditores significantes. Em células musculares de ratos, o tratamento com PTH reduziu o conteúdo de fosfato inorgânico e da cálcio-ATPpase (39), alterações estas que também ocorrem em culturas de células de animais deficientes em vitamina D. Em estudos clínicos, pacientes com hiperparatiroidismo primário apresentavam fadiga e fraqueza muscular que tiveram melhora importante após paratiroidecetomia bem sucedida (40).…”

Section: Papel Do Hiperparatiroidismo Secundáriounclassified

Papel da vitamina D na função neuro-muscular

Pedrosa

Castro

2005

Arq Bras Endocrinol Metab

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RESUMOA vitamina D, através de suas ações no intestino, rim, osso e glândulas paratiróides, é um hormônio fundamental para a homeostase do cálcio e para o desenvolvimento de um esqueleto saudável. Além disso, receptores deste hormônio podem ser encontrados em quase todos os tecidos do organismo e outras ações não relacionadas ao metabolismo mineral têm sido imputadas a ele. Na célula muscular esquelética, a vitamina D atua através do mecanismo clássico de ligação a um receptor nuclear e também através da ligação a um receptor de membrana, realizando ações que envolvem o transporte de cálcio, a síntese protéi-ca e a velocidade de contração muscular. Clinicamente, a deficiência de vitamina D, que é bastante comum em idosos, inclusive em nosso país, tem sido relacionada a um aumento da incidência de quedas, a uma diminuição da força muscular e a uma deterioração do equilíbrio, avaliada pela oscilação do corpo na postura ereta. Por outro lado, tem sido demonstrado que a suplementação associada de cálcio e vitamina D em idosos deficientes contribui para melhoria destes aspectos da função neuro-muscular. Nesta revisão, serão discutidos os mecanismos conhecidos envolvidos na associação entre vitamina D e função neuromuscular, e também a suplementação de vitamina D e cálcio na prevenção de fraturas osteoporóticas não-vertebrais sob a perspectiva dos efeitos neuro-musculares. Through its action in the kidney, intestines, bone and parathyroid glands vitamin D is a major regulator of calcium homeostasis and for the development of a healthy skeleton. Moreover, receptors for this hormone are present in almost all body tissues and other actions which are not related to the mineral metabolism have been imputed to it. In the skeletal muscle cell, vitamin D acts through the classic mechanism of binding to a nuclear receptor and also by binding to a membrane receptor, carrying out actions that involve calcium transport, protein synthesis and kinetics of muscle contraction. Clinically, vitamin D deficiency, which is very common among the elderly, including the ones in our country, has been related to an increase in the incidence of falls, as well as the reduction of muscle strength and deterioration of body sway, evaluated by the oscillation of the body in the erect position. On the other hand, it has been demonstrated that supplementation of calcium associated to vitamin D in deficient elderly contributes to the improvement of these aspects of the neuro-muscular function. In this review, the mechanisms involved in the association between vitamin D and neuro-muscular function will be discussed, as well as the supplementation of vitamin D and calcium to prevent non-vertebral osteoporotic fractures under the perspective of the neuro-muscular effects.

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Serum Parathyroid Hormone Predicts Time to Fall Independent of Vitamin D Status in a Frail Elderly Population

Cited by 113 publications

References 26 publications

Clinical application of biochemical markers of bone turnover

Clinical application of biochemical markers of bone turnover

Vitamin D: A Narrative Review Examining the Evidence for Ten Beliefs

Papel da vitamina D na função neuro-muscular

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