Although known for its importance in the coagulation cascade, vitamin K has other functions. It is an essential vitamin for bone health, taking part in the carboxylation of many bone-related proteins, regulating genetic transcription of osteoblastic markers, and regulating bone reabsorption. Vitamin K deficiency is not uncommon, as deposits are scarce and dependent upon dietary supplementation and absorption. Vitamin K antagonist oral anticoagulants, which are prescribed to many patients, also induce vitamin K deficiency. Most studies find that low serum K1 concentrations, high levels of undercarboxylated osteocalcin (ucOC), and low dietary intake of both K1 and K2 are associated with a higher risk of fracture and lower BMD. Studies exploring the relationship between vitamin K supplementation and fracture risk also find that the risk of fracture is reduced with supplements, but high quality studies designed to evaluate fracture as its primary endpoint are needed. The reduction in risk of fracture with the use of non-vitamin K antagonist oral anticoagulants instead of warfarin is also of interest although once again, the available evidence offers disparate results. The scarce and limited evidence, including low quality studies reaching disparate conclusions, makes it impossible to extract solid conclusions on this topic, especially concerning the use of vitamin K supplements.

Celia Rodr&#xed;guez-Olleros Rodr&#xed;guez

Manuel D&#xed;az Curiel

Vitamin K and Bone Health: A Review on the Effects of Vitamin K Deficiency and Supplementation and the Effect of Non-Vitamin K Antagonist Oral Anticoagulants on Different Bone Parameters

Introduction. The appropriate intake of calcium and vitamin D in women&#x2019;s diet is significant for a proper maintenance of the skeletal system. Research Aim. The aim of the research was to assess the calcium and vitamin D supply in a diet among women regularly practicing sport. Methodology. The research was completed by 593 women at the age of 18&#x2013;50 (median 25) who played sports regularly (at least 2 times a week). To assess the calcium and vitamin D intake, short Food Frequency Questionnaires for calcium and vitamin D (VIDEO-FFQ) were used. The examined group was provided with the questionnaires via social media. To assess intake levels, the authors applied the group-based cutoff point method (calcium norm was EAR 800&#x2009;mg/day; vitamin D norm was AI 15&#x2009;&#x3bc;g/day). Results. The median of calcium and vitamin D intake in a diet was 502&#x2009;mg/day and 5.2&#x2009;&#x3bc;g/day, respectively (Q25 and Q75 for calcium was 387&#x2009;mg/day and 627&#x2009;mg/day, respectively, and for vitamin D was 3.4&#x2009;&#x3bc;g/day and 8.2&#x2009;&#x3bc;g/day, respectively). In relation to the EAR norm for calcium and AI norm for vitamin D, 92.0&#x0025; of the examined participants in a group demonstrated lower than recommended calcium intake levels and 97.3&#x0025; showed lower than recommended vitamin D intake levels. Calcium and vitamin D supplementation was used by 13.1&#x0025; (in this subgroup, 11.5&#x0025; of the examined group members did not need it) and 56.8&#x0025; of the examined women (in this subgroup, 2.4&#x0025; of the examined group did not need it), respectively. After including the calcium and vitamin D intake, the supply median for the whole group was 535&#x2009;mg/day and 28.8&#x2009;&#x3bc;g/day, respectively (Q25 and Q75 for calcium was 402&#x2009;mg/day and 671&#x2009;mg/day, and for vitamin D was 6.3&#x2009;&#xb5;g/day and 55.7&#x2009;&#x3bc;g/day, respectively); 87.5&#x0025; of the examined participants did not meet the EAR norms for calcium and 42.0&#x0025; did not meet the AI norm for vitamin D. Among the women supplementing calcium, 58.9&#x0025; did not reach the reference intake value; however, all women supplementing vitamin D fulfilled the expected nutritional need. Conclusions. It is important to educate women about the necessity to provide the body with proper calcium and vitamin D intake levels in a diet in order to avoid health problems resulting from the deficit of the nutrients.

Micha&#x142; Wrzosek

Jakub Wo&#x17a;niak

Dorota Kozio&#x142;-Kaczorek

Dariusz W&#x142;odarek

The Assessment of the Supply of Calcium and Vitamin D in the Diet of Women Regularly Practicing Sport

Introduction. Low bone mineral density is a risk factor for fractures. The aim of this follow-up study was to assess the association of various bone properties with fall-related fractures. Materials and Methods. 187 healthy women aged 55 to 83&#x2009;years at baseline who were either physically active or inactive were followed for 20&#x2009;years. They were divided into two groups by whether or not they sustained fall-related fractures: fracture group (F) and nonfracture group (NF). At baseline, several bone properties were measured with DXA and pQCT, and their physical performance was also assessed. Results. During the follow-up, 120 women had no fall-related fractures, while 67 (38&#x0025;) sustained at least one fall with fracture. NF group had about 4 to 11&#x0025; greater BMD at the femoral neck and distal radius; the mean differences (95&#x0025; CI) were 4.5 (0.3 to 8.6) &#x0025; and 11.1 (6.3 to 16.1) &#x0025;, respectively. NF group also had stronger bone structure at the tibia, the mean difference in BMC at the distal tibia was 6.0 (2.2 to 9.7) &#x0025;, and at the tibial shaft 3.6 (0.4 to 6.8) &#x0025;. However, there was no mean difference in physical performance. Conclusions. Low bone properties contribute to the risk of fracture if a person falls. Therefore, in the prevention of fragility fractures, it is essential to focus on improving bone mass, density, and strength during the lifetime. Reduction of falls by improving physical performance, balance, mobility, and muscle power is equally important.

Kirsti Uusi-Rasi

Saija Karinkanta

Kari Tokola

Pekka Kannus

Harri Siev&#xe4;nen

Bone Mass and Strength and Fall-Related Fractures in Older Age

Osteoporosis represents an imbalance between bone formation and bone resorption. As a result of low estrogen levels, it is markedly prevalent during menopause, thus making such patients susceptible to fractures. Both bone formation and resorption are modulated by nitric oxide (NO). Currently, there are no risk-free pharmaceutical prevention therapies for osteoporosis. COMB-4, a nutraceutical combination of Paullinia cupana, Muira puama, ginger, and L-citrulline, known to activate the NO-cGMP pathway, was reported to accelerate fracture healing in the rat. To determine whether COMB-4 could be effective in preventing menopausal osteoporosis, it was compared to estradiol (E2) in an ovariectomized (OVX) rat osteoporosis model. Nine-month-old female Sprague Dawley rats were divided into SHAM, OVX, OVX+E2, and OVX+COMB-4. After 100 days of treatment, bone mineral density (BMD) and bone mineral content (BMC) were measured by DXA scan. TRAP staining was performed in the femur and lumbar vertebrae. TRACP 5b and osteocalcin levels were assayed in the serum. MC3T3-E1 cells were differentiated into osteoblasts and treated with COMB-4 for one week in order to evaluate calcium deposition by Alizarin staining, cGMP production by ELISA, and upregulation of the nitric oxide synthase (NOS) enzymes by RT-PCR. OVX resulted in a decrease in BMD, BMC, and serum osteocalcin and an increase in serum TRACP 5b. Except for an increase in BMC with COMB-4, both E2 and COMB-4 reverted all bone and serum markers, as well as the number of osteoclasts in the vertebrae, to SHAM levels. Incubation of MC3T3-E1 cells with COMB-4 demonstrated an increase in the three NOS isoforms, cGMP, and calcium deposition. COMB-4 increased BMD in OVX rats by inhibiting bone resorption and increasing calcium deposition presumably via activation of the NO-cGMP pathway. It remains to be determined whether COMB-4 could be a potential nutraceutical therapy for the prevention of premenopausal bone loss.

Rebecca A. Rajfer

Manuel Flores

Andrea Abraham

Eduardo Garcia

Natalhy Hinojosa

Mina Desai

Jorge N. Artaza

Monica G. Ferrini

Prevention of Osteoporosis in the Ovariectomized Rat by Oral Administration of a Nutraceutical Combination That Stimulates Nitric Oxide Production

Background. Bone mineral density (BMD) is the measure of the minerals, mostly calcium and phosphorous, contained in certain volume of bone to diagnose osteoporosis. The aim of the study was to find out the association of lifestyle and food consumption with BMD. Methods. An analytical cross-sectional study was conducted among 169 people of age 50 years and above who underwent Dual Energy X-Ray Absorptiometry (DEXA or DXA) scan in the hospitals of Kathmandu valley of Nepal. Food frequency questionnaire and 24-hour recall methods were followed. The DXA reports of the participants were observed to identify osteoporosis. Chi-square test, independent sample t-test, and binary logistic regression were applied to explore the association of BMD with different variables. Result. The prevalence of osteoporosis, osteopenia, and normal BMD was 37.3&#x25;, 38.5&#x25;, and 24.2&#x25;, respectively. The prevalence of osteoporosis increased with sex and age (AOR 3.339, CI: 1.240-8.995, p-value 0.017; AOR 3.756, CI: 1.745-8.085, p-value 0.001), respectively. Higher BMI was associated with lower odds of osteoporosis (AOR 0.428, CI: 0.209-0.877, p-value 0.020). Smoking had bad effect on the health of bone (AOR 3.848, CI: 1.179-12.558, p-value 0.026). Daily dietary calcium intake had negative association with osteoporosis with the p-value of 0.003; however, the daily consumption of vitamin D rich food had no association with osteoporosis. Conclusion. High prevalence of osteoporosis and osteopenia was found in older people. Osteoporosis was found to be significantly associated with sex, age, lower BMI, smoking habit, and daily calcium consumption. Further research can be conducted by making the relationship of calcium consumption with the numerical T-value of scanned body parts.

Narendra Kumar Chaudhary

Mukti Nath Timilsena

Dev Ram Sunuwar

Pranil Man Singh Pradhan

Raj Kumar Sangroula

Association of Lifestyle and Food Consumption with Bone Mineral Density among People Aged 50 Years and Above Attending the Hospitals of Kathmandu, Nepal

Daily assumption of antiretroviral drugs and HIV-related immune activation lead to important side effects, which are particularly evident in vertically infected patients. Bone homeostasis impairment and reduction of bone mineral density (BMD) is one of the most important side effects. Primary aim of this study is to assess the prevalence of bone homeostasis alterations in a group of vertically infected patients; secondary aim is to analyze the relationship between bone homeostasis alterations and anthropometric data, severity of HIV infection, and antiretroviral therapy. We studied 67 patients with vertically transmitted HIV-1 (aged 6-31 years), followed by the Pediatric Infectious Disease Unit of the University Hospital of Padua, Italy. We analyzed bone turnover markers (P1NP and CTx) and we performed lumbar spine and femoral dual energy X-ray absorption densitometry (DXA). Personal and anthropometric data and information on HIV-infection severity and antiretroviral therapy were collected for all patients. We found that BMD values recorded by DXA showed a significant correlation with age, race, BMI, physical activity, and antiretroviral therapy duration. P1NP was increased in 43&#x25; of patients, while CTX in 61&#x25; of them. P1NP alteration was related to age, race, BMI, physical activity, therapy duration, and ever use of protease inhibitors and nucleotide reverse transcriptase inhibitors. CTX alteration was found to be correlated only with age. In conclusion, our study confirms that a wide percentage of HIV vertically infected patients show reduced BMD and impaired bone homeostasis. Strict monitoring is needed in order to early identify and treat these conditions.

D. Don&#xe0;

E. Mozzo

D. Luise

R. Lundin

A. Padoan

O. Rampon

C. Giaquinto

Impact of HIV-1 Infection and Antiretroviral Therapy on Bone Homeostasis and Mineral Density in Vertically Infected Patients

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Journal of Osteoporosis provides a platform for scientists and clinicians working on the diagnosis, prevention, treatment and management of osteoporosis and other metabolic bone diseases.

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Journal of Osteoporosis maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.

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Journal of Osteoporosis - Table of contents 2019

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Journal of Osteoporosis provides a platform for scientists and clinicians working on the diagnosis, prevention, treatment and management of osteoporosis and other metabolic bone diseases.

Journal of Osteoporosis