Journal of Bone and Mineral Metabolism最新文献

Introduction: This cross-sectional study aimed to investigate the associations between serum homocysteine levels and missing teeth, as well as to explore the threshold effect of serum homocysteine levels on the number of missing teeth.

Materials and methods: This study involved 4746 participants (aged ≥ 40 years) from NHANES data 2003-2006. Negative binomial regression was used to assess the association between serum homocysteine levels and tooth loss. Non-linear and dose-response relationships were analyzed using smooth curve fitting and threshold effect analysis. In addition, we supplemented the relationship between serum homocysteine levels and tooth loss and conducted subgroup analysis to determine the impact of covariates on the relationship between serum homocysteine levels and tooth loss.

Results: In a fully adjusted negative binomial regression model, higher levels of serum Hcy concentration in the Q2-Q4(Q2: IRR = 1.46, 95%CI (1.67,1.79)); Q3: IRR = 1.42, 95%CI (1.36,1.48); Q4: IRR = 1.47,95%CI (1.01,1.78)) groups increased the likelihood of tooth loss compared with quartile Q1 (low level of serum homocysteine). Threshold effect analysis revealed that the log2-transformed Hcy infection point was at 2.95 μmol/L.

Conclusion: The likelihood of tooth loss increased by 47% for each unit increase in serum homocysteine level. There was a non-linear positive correlation between serum homocysteine and tooth loss, with a threshold effect of approximately log2(Hcy) = 2.95 μmol/L. This link emphasizes the importance of maintaining appropriate homocysteine levels to prevent oral health problems.

Introduction: Patient satisfaction with two teriparatide (TPTD) self-injection regimens [once-daily (1/D)-TPTD and twice-weekly (2/W)-TPTD] was compared in a randomized crossover study involving patients with osteoporosis at high fracture risk.

Materials and methods: Questionnaires evaluated overall satisfaction, satisfaction with treatment effectiveness, satisfaction with utility of the self-injection device, and preference for a particular injection regimen after crossover. Quality of life (QOL), visual analogue scale pain scores, and bone mineral density (BMD) were also analyzed. Safety was evaluated based on the incidence and severity of adverse events (AEs).

Results: The 1/D-TPTD and 2/W-TPTD groups comprised 180 (mean age: 75.9 ± 7.3 years) and 178 (75.4 ± 6.9 years) patients, respectively. After 26 weeks of treatment, the injection regimens were switched and treatment continued for another 26 weeks. Significantly higher persistence was observed in the 1/D-TPTD to 2/W-TPTD group (p = 0.032). No significant between-group differences in overall satisfaction scores or satisfaction with treatment were observed. Satisfaction with the utility of the injection device was significantly higher with the 2/W-TPTD regimen (p < 0.05); this regimen was preferred by 69.4% of patients after crossover (p < 0.001). A significant increase in BMD from baseline was observed at the lumbar vertebrae in both groups and at the hip area in the 1/D-TPTD to 2/W-TPTD group at 52 weeks (p < 0.05). Significant improvement in the QOL score was observed in both groups (p < 0.05). No serious AEs were reported.

Conclusion: Continuation of this study will further clarify patient satisfaction, treatment effects, and tolerability.

Osteoanabolic drugs are sometimes prescribed off-label for "fracture healing and spinal fusion." This study examines the scientific validity of such practices by analyzing existing clinical reports. The purported bone union-promoting effect of teriparatide in fracture cases has been refuted in clinical trials. While teriparatide shows efficacy in accelerating spinal fusion after surgery for patients with osteoporosis, there is no scientific justification for its off-label use in patients without osteoporosis. For osteoporosis patients, no clear evidence suggests that teriparatide is superior to antiresorptive drugs, making the rationale for switching from antiresorptive drugs to teriparatide weak. The efficacy in postoperative spinal fusion may primarily be attributed to systemic improvements in bone quality and quantity, enhancing the mechanical engagement of implants. The clinical evidence for the off-label use of romosozumab, another osteoanabolic drug, in fracture healing and spinal fusion is insufficient to support its efficacy. In conclusion, osteoanabolic drugs, like antiresorptive drugs, primarily have systemic functions in osteoporosis patients, with limited evidence supporting their role in promoting localized bone formation in fractures or spinal fusions.

Introduction: The aim of this study was to validate the effectiveness of the osteoporosis self-assessment tool for Asians (OSTA) in the screening and diagnosis of osteoporosis in men aged over 50 years and postmenopausal women in the northern Vietnam population.

Materials and methods: This study included 8077 participants (7044 postmenopausal women and 1033 men aged over 50) who attended health examinations at the National Institute of Nutrition, Vietnam, from 2010-2019. Osteoporosis is defined by a T-score ≤ -2.5 at the femoral neck, total hip, or L1-L4. OSTA scores were assessed for identifying osteoporosis via receiver operating characteristic (ROC) curves. The optimal cut-off points, sensitivity, specificity, and areas under the ROC curves (AUCs) were determined.

Results: The study showed that the prevalence of osteoporosis was 13.4% in men and 25.5% in women. In women, a higher BMI and OSTA scores decreased the OR of osteoporosis (all p-values < 0.001). In men, a higher BMI decreased the OR of osteoporosis (p-value < 0.001). The results showed that the OSTA value was -1 which had a sensitivity of over 70% in both men and women. The OSTA value was -4 which had a sensitivity of over 90% and specificity of over 80% in both men and women. The optimal OSTA value was -3 which had a sensitivity of over 90% and a specificity of over 80% in both men and women.

Conclusions: The OSTA might be a simple tool for the screening and diagnosis of osteoporosis in Vietnamese postmenopausal women and men aged over 50 years.

Introduction: The natural alignment of the lower extremities shifts rapidly from genu varum to neutral during early childhood. However, persistent or worsening genu varum, termed physiological genu varum, may be associated with vitamin D (VitD) deficiency. This study aimed to evaluate the effect of low-dose VitD supplementation on genu varum improvement in toddlers, given the prevalence of VitD deficiency and lack of supplementation practices in Japan.

Materials and methods: This retrospective study included 90 toddlers aged 10-30 months with genu varum (tibiofemoral angle > 5°). The supplement group (n = 30) received 400 IU/day of VitD and moderate sun exposure, while the non-supplement group (n = 60) received only follow-up care. Radiographic parameters, including tibiofemoral angle (TFA), metaphyseal-diaphyseal angle (MDA), and metaphyseal-metaphyseal angle (MMA), were measured at baseline, 6 months, and 12 months. Seasonal variations in ultraviolet (UV) exposure were also considered. Statistical analyses used the Kruskal-Wallis and Mann-Whitney tests.

Results: Both groups showed significant radiographic improvements over 12 months. However, the supplement group demonstrated greater reductions in TFA (p = 0.04), MDA (p < 0.01), and MMA (p < 0.01) at both 6 and 12 months. Seasonal UV variations influenced outcomes, with moderate-high UV seasons showing more pronounced improvements. Despite a low dose of VitD, the supplement group experienced significantly enhanced alignment compared to the non-supplement group.

Conclusion: Low-dose VitD supplementation may accelerate the natural improvement of genu varum, particularly in populations with prevalent VitD deficiency. Genu varum may serve as a visible indicator of VitD deficiency. A prospective randomized-controlled trial is warranted to validate these findings.

Introduction: The periodontal ligament (PDL) is a structure between the alveolar bone and cementum, essential for tooth stability and composed of diverse cell types. Mohawk homeobox (Mkx) is a master transcription factor that regulates tendon and ligament homeostasis. However, the specific cell populations expressing Mkx and its role in mechanotransduction during orthodontic tooth movement (OTM) remain unclear.

Materials and methods: We conducted single-cell RNA sequencing on wild-type rat PDL at 0 day, 1 week, and 2 weeks of post-OTM using coil springs to elucidate Mkx's function and the changes in cell populations under continuous mechanical stimulation. In addition, RT-qPCR was performed to assess the relationship between tenogenic gene expression and Mkx expression in human PDL cells.

Results: The rat PDL was identified to consist of 14 clusters, with Mkx and Scleraxis (Scx) expressed in distinct cell populations. Collagen and ECM production increased throughout the OTM period, while the sterile inflammatory response was initially heightened and later diminished, indicating that bone remodeling occurs later in the inflammatory response. Overexpression of MKX in human PDL cells enhanced COL1A1 and DECORIN expression.

Conclusion: Mechanical stimulation of the PDL appears to trigger an aseptic inflammatory response that disrupts PDL homeostasis and promotes bone remodeling. Mkx may exert a protective effect on the PDL during mechanical stimulation.

Introduction: Gaucher disease (GD) is a lysosomal storage disorder causing systemic and skeletal complications. This study evaluates bone health in adult GD type 1 patients, focusing on skeletal complications, bone mineral density (BMD), and biochemical markers.

Material and methods: A cohort of adult GD type 1 patients followed up at Ege University Pediatric Metabolism Department were retrospectively examined.

Results: This study included 32 patients with GD type 1, comprising 11 males (34.4%) and 21 females (65.6%). The median age at diagnosis was 20.5 years (min: 3-max:65), and at enrolment, it was 35 years (min:18-max:71). Most patients (93.8%) had organomegaly, and 93.8% had cytopenia. Common genetic variants were p.Asn409Ser (60.9%), p.Leu483Pro (7.8%), and p.Asp448His(4.7%). All patients were on enzyme replacement therapy (ERT) for a median of 11 years (min:2-max:18). Bone complications included pathologic fractures in six patients (19%) and avascular necrosis in 12 patients (37.5%). Bone pain was reported by 93.7% of patients at admission and persisted in 59.4% during follow-up. DXA scans showed abnormal bone mineral density (BMD) in 62.5% of patients initially, with a significantly low bone density in 3.1% and reduced bone density in 59.3%. BMD improved with treatment, as evidenced by a significant increase in Z scores (p < 0.05). Elevated chitotriosidase (75%), ferritin (50%), and immunoglobulin G (21.9%) levels were noted but did not correlate with BMD. Seven patients (22%) were splenectomized, all with bone issues.

Discussion: Bone health in GD involves multiple factors beyond biochemical markers. While ERT improves BMD, bone pain and fractures remain significant issues. Comprehensive management, including regular BMD monitoring and better vitamin D supplementation adherence, is crucial. Further research is needed to improve treatments for bone complications in GD.