DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20170936

Association of vitamin D and osteocalcin levels in post-menopausal women with osteoporosis

Yogiraj Vaijanathrao Chidre, Amir Babansab Shaikh

Abstract


Background: Osteoporosis is a common age related problem especially in women, with a consequent increase in bone fragility and susceptibility to fracture. Apart from Calcium, another nutrient that plays an important role in the mineralization of skeleton in Vitamin D. Osteocalcin, which is produced primarily by osteoblasts during bone formation, is considered to be one of the markers for osteoporosis.

Methods: 314 women above the age of 40 were included into the study. A thorough physical and clinical examination, assessment of vital parameters, anthropometry evaluation was done for all patients. Bone mineral density was calculated using central DXA osteodensitometer at lumbar spine L1-L4, hip and ultradistal radius (in some cases.). Blood samples were taken for the detection of ionized calcium, phosphorus, alkaline phosphatase, 25hydroxivitamin D (25 ODH) and serum parathyroid hormone (PTH) by chemiluminiscent assay. Bone markers such as osteocalcin were measured as required.

Results: Out of the 314 women attending our OPD, 96 of them were diagnosed as having osteoporosis. 24 out of them had fragility fractures, mainly of the hip, and 82 had ostepenia. Elevated levels of calcium (8.96 mg/dl), parathyroid hormone (58.76 pg/ml) and osteocalcin (24.46 ng/ml) were observed. Vitamin D deficiency of ≤ 20 was seen in 59 (63%) of the cases, insufficient in 23 (24%) and only 12 (13%) of these women had normal Vitamin D levels.

Conclusions: Osteocalcin is a promising marker for the detection of osteoporosis. There is a considerable Vitamin D deficiency among the women with osteoporosis, and it is under-treated. It is essential to provide Vitamin D supplementation to these women especially those who are at high risk for fragility fractures.


Keywords


Osteocalcin, Osteoporosis, Post-menopause, Viamin D deficiency

Full Text:

PDF

References


Axelrod DW, Teitelbaum SL. Results of long-term cyclical etidronate therapy: bone histomorphometry and clinical correlates. J Bone Miner Res. 1994;9S1:136.

Sambrook P and Cooper C. Osteoporosis. Lancet 2006;367:2010-8.

Jagtap VR, Ganu JV, Nagane NS. BMD and serum intact osteocalcin in post-menopausal osteoporosis women. Indian J Clin Biochem; 2011;26:70-3.

Moyad MA. Preventing male osteoporosis: prevalence, risks, diagnosis and imaging tests. Urol Clin N Am. 2004;31:321-30.

Heaney RP, Recker RR, Saville PD. Menopausal changes in bone remodeling. J Lab Clin Med. 1978;92:964-70.

Uebelhart D, Schlemmer A, Johansen JS, Gineyts E, Christiansen C, Delmas PD. Effect of menopause and hormone replacement therapy on the urinary excretion of pyridinium cross-links. J Clin Endocrinol Metab. 1991;72:367-73.

Manolagas SC, Jilka RL. Bone marrow, cytokines, and bone remodeling: emerging insights into the pathophysiology of osteoporosis. N Engl J Med. 1995;332:305–311.

Gennari C, Agnusdei D, Nardi P, Civitelli R. 1990 Estrogen preserves a normal intestinal responsiveness to 1,25-dihydroxyvitamin D3 in oophorectomized women. J Clin Endocrinol Metab. 71:1288 –1293.

Zittermann A. Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr. 2003;89:552-72.

Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-81.

Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascularn events: an 8-year follow-up of 14719 initially healthy American women. Circulation. 2003;107:391-7.

Vasikaran S, Eastell R, Bruyere O, Foldes AJ, Garnero P, Griesmacher A, McClung M, Morris HA, Silverman S, Trenti T, Wahl DA, Cooper C, Kanis JA. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int. 2011,22:391-420.

Price PA, Parthemore JG, Deftos LJ. New biochemical marker for bone metabolism. Measurement by radioimmunoassay of bone GLA protein in the plasma of normal subjects and patients with bone disease. J Clin Invest. 1980;66:878-83.

Lukert B, Higgins J, Stoskopf M. Menopausal bone loss is partially regulated by dietary intake of vitamin D. Calcif Tissue Int. 1992;51:173-9.

Beg M, Akhtar N, Alam MF, Rizvi I, Ahmad J, Gupta A. Vitamin D status and serum osteocalcin levels in post-menopausal osteoporosis: Effect of bisphosphonate therapy. JIACM. 2014;15(3-4):172-6.

Capatina C, Carsote M Caagheorgheopol A, poiana C, Berteanu M. Vitamin D deficiency in postmenopausal women-biological correlates. Maedica (Buchar). 2014;9(4):316-22.

Neetakumar, Ammini AC, Tandon N, Goswami R, Dineshkumar, Singh A. Ethnic variation of host and risk factors in silent epidemic of osteoporosis. Orthoped Today. 2004;VI(4):240-4.

Johannes WG, Pet PMM, Ron NJ, Lems WF, Roland FJ, Ann MH, Ale A, Erik B, Lorenz CH, George AWB, Ben ACD. Prevention of glucocorticoid induced osteoporosis with alendronate or alfa calcidiol: relations of change in bone mineral density, bone markers and calcium homeostasis. J Rheumatol. 2007;34:1051-7.

Nasser M Al-Daghri, Sobhy Yakout, Eman Al-Shehri, Hanan A Al-Fawaz, Naji Aljohani, Yousef Al-Saleh. Inflammatory and bone turnover markers in relation to PTH and vitamin D status among saudi postmenopausal women with and without osteoporosis. Int J Clin Exp Med. 2014;7(10):3528-35.

De Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fuji-wara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ 3rd, Meunier PJ, Pols HA, Reeve J, Silman A and Tenenhouse A. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16:1330-8.

Reid IR. Relationships among body mass, its components, and bone. Bone. 2002;31:547-55.

Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87:1080S-6S.

Lips, P, Duong, T, Oleksik, A, Black D, Cummings S, Cox D et al. A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: Baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J Clin Endocrinol Metab. 2001;86:1212-21.

Harris SS, Soteriades E, Dawson-Hughes B. Secondary hyperparathyroidism and bone turnover in elderly blacks and whites. J Clin Endocrinol Metab. 2001;86:3801-4.

Ghazali A, Fardellone P, Pruna A, Atik A, Achard JM, Oprisiu R et al. Is low plasma 25-(OH) vitamin D a major risk factor for hyperparathyroidism and Looser's zones independent of calcitriol? Kidney Int. 1999;55:2169-77.

Gómez-Alonso C1, Naves-Díaz ML, Fernández-Martín JL, Díaz-López JB, Fernández-Coto MT, Cannata-Andía JB. Vitamin D status and secondary hyperparathyroidism: the importance of 25-hydroxyvitamin D cut-off levels. Kidney Int Suppl. 2003;(85):S44-8.

Pino JD, Gomez EM, Rodriguez MM, Sosa CL, Cordero M, Lanchares JL, Talavera JRG. Influence of sex, age and menopause in serum osteocalcin (BGP) levels. J Mol Med. 1991;69(24):1135-8.

Verit FF, Yazgan P, Geyikli C, Zer Y, Celik A. Diagnostic value of TRAP 5b activity in postmenopausal osteoporosis. J Turkish-German Gynecol Assoc. 2006;7(2):120-4.

Cabrera CD, Henriquez MS, Traba ML, Villafane EA, Piedra DL. Biochemical markers of bone formation in the study of postmenopausal osteoporosis. Osteoporos Int. 1998;8(2):147-51.

Rosenquist C, Qvist P, Bjarnason N, Christiansen C. Measurement of a more stable region of osteocalcin in serum by ELISA with two monoclonal antibodies. Clin Chem. 1995;41(10):1439-45.