Printer Friendly

Treatment Outcomes of Postmenopausal Osteoporosis in Patients with Stable Hypothyroidism: A 5-Year Follow-up Retrospective Study.

INTRODUCTION

Thyroid hormones and vitamin D are endocrine molecules which have multipl functions in metabolism and act through their nuclear receptor signalling pathways (1). Most of the metabolic effects of thyroid hormones are mediated by triiodothyronine (T3) which is producted from a prohormone thyroxine (T4) (2). T4 has complex effects on bone metabolism including both stimulation of bone formation and resorption (3). Primary hypothyroidism is characterized by increased thyroid stimulating hormone (TSH) and decreased T4 levels (4). According to the National Health and Nutrition Examination Survey (NHANES III) the prevalence of hypothyroidism in United States is found 0,5% (5).

As T3 and T4 act in several metabolic pathways, their dysfunction is associated with broad range of metabolic disorders including osteoporosis, hypercholesterolemia, obesity and cardiovascular disease (6-8). Osteoporosis and increased risk of fracture are common in patients with hypothyroidism (9). Even subclinical hypothyroidism is reported to be in association with insufficient bone mineralization and decreased bone strength (10). However, the results of the studies about the association between TSH levels and bone mineral density (BMD) scores are controversial. Marhawa et al. (11) have found no correlation between TSH levels and T scores in Indian population. Like their study, Loida et al. (12) have found no difference in T scores, prevalence of vertebral and non vertebral fractures in Puerto Rico population. On the other hand in contrast with these results, Kim et al. (13) suggested that lower TSH concentrations are associated with lower T scores in Korean male population.

Except the study of Kisakol et al. (10), the relationship between hypothyroidism and osteoporosis in Turkish population was not examined previously. The aim of the present study is to evaluate the effect of hypothyroidism on prognosis of osteoporosis treatment in long term.

MATERIALS and METHODS

Study Design

The study was set as a retrospective cohort which evaluated 97 patients who were followed up by our outpatient clinic between January 2010-2015 and met WHO osteoporosis criteria.

50 patients who were diagnosed as postmenopausal osteoporosis (PMOP) with lomber and/or femur neck BMD screening but have no history of PMOP treatment including calcium and vitamin D, have comorbid hypothyroidism and treated with levothyroxine at least a year were conducted for patient group. Control group was constituted with 47 patients with PMOP at same age but have no comorbidity. Patients who had additional comorbidity except hypothyroidism or diagnosed with any comorbid disease during follow up, had taken PMOP treatment irregularly, under 50 years and had secondary osteoporosis or premature menopause were excluded.

Patients were informed about the study and their written consents were obtained before the study. The study was approved by the local Ethical Board (S.B Diskapi Yildirim Beyazit Education and Research Hospital Medical Research and Experimental Studies Ethical Board 26.01.2015 19/14) and was performed in accordance with the principles of the Declaration of Helsinki.

Demographics and Disease Characteristics

Demographic features of patients including age, height, weight, body mass index (BMI=weight/[height.sup.2], kg/[m.sup.2]), educational level, number of pregnancy, age of menarche and menopause, daily calcium, coffee and tea consumption, smoking, daily exercise level, clothing style, maternal history of fracture and duration of hypothyroidism were recorded. Educational level was determined as "not reader and/or writer", "only reader and/or writer", "primary school degree" (5 years of formal education), "junior high school degree" (8 years of formal education), "high school degree" (11 years of formal education) or "university degree" (over 11 years of formal education). Clothing style was determined as "conservative clothing" which refers to clothes that cover the body completely, "traditional clothing" which refers to clothes that cover arms and legs and "modern clothing" which refers to clothes that do not cover arms and legs. Daily calcium consumption was interrogated by questioning "everyday", "at least twice a week" or "never" usage of a 250 mililiters of milk, 30 grams of cheese or a 200 grams of yoghurt which consists 150 miligrams of calcium. Tea, coffee and alchol consumption was considered as "overuse" if it is over 150 miligrams/day and "normal" if it is under. Individuals who walk at least 30 minutes a day were accepted as "normal physically active" and if not accepted as "physically inactive".

Measurements of BMD were done by using a DXA (Norland XR-46 system, Coopersurgical, Fort Atchinson, WI, USA). The BMDs of the lumbar spine (L1 to L4) and the hip region (total hip and femoral neck) were measured according to standard protocols and T- scores of the measurements were assessed. Biochemical parameters for all subjects were including serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathormone (PTH), TSH, calcidiol (25(OH)D3), osteocalcine (OC) and urine Ca and P levels.

All individuals were instructed for daily PMOP exercises (range of motion, stretching and isokinetic exercises) and daily activities. Range of motion (ROM) exercises include shoulder, elbow, wrist, hip and ankle joints with 5 repetition twice a day and stretching exercises include muscles associated with these joints. Isokinetic exercises include non weight bearing exercises with low force (e.g: low load high repetition exercises). For daily activities patients were allowed to choose one or more dynamic weight bearing exercises with low or high force like walking, jogging, jumping or running. 70 miligrams of alendronate weekly, 2500 miligrams of calcium carbonate (equivalent to 1000 miligrams of calcium ion) and 880 international units (IU) of vitamin D3 daily were prescribed for all subjects. All subjects were followed up during 5 years with same BMD values and biochemical measurements.

Comparisons

BMD values and biochemical parameters were compared in and between patient and control groups before treatment, one year and five years after treatment.

Sample Size

A power analysis was performed using G Power 3.1.8. We determined that a sample size of 42 (for each group) would be a sufficient number of patients to provide an 80% power with a significance of 0.05, given an effect size of 0.3. The effect size was calculated to determine a 10% difference in the DXA screening recommendation with a standard deviation of 10%.

Statistical Analysis

Data analyses were performed using the Statistical Package for the Social Sciences (SPSS), version 22.0 (IBM Corp.; Armonk, NY, USA) for Windows. The continuous variables were evaluated with the Kolmogorov-Smirnow test to determine if they were different from normal distribution and descriptive statistics were described as mean [+ or -] standard deviation and median (1st-3rd quartile) for continuous variables and frequencies and percentages (%) for nominal variables using Pearson chi-square test. Statistically significant differences in repeated measurements within the group were evaluated with the Wilcoxon Signed Rank test. In group comparisons, Bonferroni correction was performed to avoid estimated type 1 error and p<0.017 values were accepted as statistically significant. Parameters were compared in and between groups before treatment, one year and five years after treatment with Mann-Whitney U test and p<0.05 scores were accepted as significant.

RESULTS

All the participants were female, and the average age of the patient group was 59.10[+ or -]8.70 years, while the average age of the control group was 57.36[+ or -]9.10 years. Most of the individuals had a primary school degree (n=44, 45.4%) or were housewives (n=87, 89.7%). The demographic features, the BMD values, and the biochemical parameters before the treatment of the patient and control groups are presented in Tables 1 and 2.

Demographic features were not different between the patient and control groups (p>0.005). The mean BMD score for total lumbar (L1-L4) region was -2.63[+ or -]1.02, while for femur neck was -2.42[+ or -]1.03. In the patient group, the mean TSH level was 3.18[+ or -]1.12 mlU/L (normal: 0.4-4.5 mlU/L), the mean FT3 level was 2.48[+ or -]1.27 pg/mL (normal: 2-4.4 pg/mL), and the mean FT4 level was 1.13[+ or -]0.72 pg/mL (normal: 0.7-2 pg/mL). In the control group, the mean TSH level was 3.21[+ or -]1.08 mIU/L, the mean FT3 level was 2.47[+ or -]1.41pg/mL, and the mean FT4 level was 1.13[+ or -]0.72 pg/mL. The TSH, FT3, and FT4 levels were not significantly different between the patient and control groups (p=0.338, p=0.182, and p=0.114, respectively). Biochemical parameters and the BMD values were not different between the patient and control groups.

The biochemical parameters and the BMD values of the subjects at the first and fifth year of treatment are given in Tables 3 and 4.

Biochemical parameters of the individuals at the first and fifth years of the treatment were not different (p>0.005).

In group analysis, a significant increase in the total lumbar (L1-L4) and femur neck T-scores between the baseline and the fifth year of treatment were found in the patient (p=0.001 for each) and control group (p=0.001 for each). At the fifth year of treatment, the same parameters were found to be significantly improved compared to the first year, both in the patient (p=0.003 and p=0.004, respectively) and control group (p=0.008 and p=0.002, respectively).

DISCUSSION

Osteoporosis is one of the major complications of thyroid dysfunction. Despite obvious increase of fracture risk, hypothyroidism is known to be associated with higher T scores compared to healthy subjects (14). The counterregulation between thyroid hormones and PTH may be the potential mechanism for decreased bone turnover in patients with hypothyroidism (15). In the present study, PTH, calcidiol and osteocalcine levels were not significantly different between patient and control groups. We found slightly increased PTH and osteocalcine and decreased calcidiol levels in both groups due to osteoporosis of all conducted subjects. Increased PTH levels both in patient and control groups are related with poor calcium intake in both groups. However, we found daily calcium excretion in urine decreased due to the same cause.

It has been proposed that both osteoblasts and osteoclasts have TSH receptors and thyroid dysfunction is related with both bone formation and resorption (16). Several studies indicate the correlation between hypothyroidism and increased risk of fracture (17). But this issue is controversial. Some studies report an association between duration of hypothyroid period and subsequent risk of osteoporotic fractures in young and middle aged men but not in women (18) because of pronounced effects of hypothyroidism on gonadal steroids and low levels of testosterone (19). On the other hand, there is a general consensus suggesting that over treatment of hypothyroidism with levothyroxine may lead to excessive bone loss and increased risk of osteoporotic fractures (20). In our study we did not find any difference between the lumbar and femur neck T scores of the patient and control groups. Current study was conducted with female patients recieving levothyroxine treatment at least one year and in euthyroid stage. Further expert studies including men and patients who are not in euthyroid state may have different results.

Another controversial issue about the effect of hypothyroidism on PMOP treatment is the effect of levothyroxine treatment. Most of the previous studies about the effect of hypothyroidism on PMOP and bone metabolism had conducted with patients when they were in hypothyroid period (10,18). Patients with thyroid dysfunction who recieve levothyroxine treatment can not be classified as "hypothyroid", however it has been proposed that although levothyroxine theraphy compansed the metabolic dysfunction, underlying thyroid metabolism disorder might influence the metabolic processes including bone metabolism (21). Vestergaard et al. noted an increased risk of fracture limited to forearms in patients with hypothyroidism who are over 50 years old (22). In another study of the same author, it was reported that there was an increase in the risk of any fracture within the first 10 years after the diagnosis of hypothyroidism regardless from levothyroxine treatment (10). Lee et al. concluded that the risk of hip fracture is increased in men over 65 years old with subclinical hypothyroidism but the effect of thyroxine treatment is unknown (23). In the present study, we evaluated patients with hypothyroidism in "euthyroid" period and our results are in association with recent data. We found no significant difference in lumbar BMD values between patient and control group suggesting that levothyroxine treatment have no effect on PMOP in Turkish population.

There are some limitations for the present study. We conducted the study with limited participants. We evaluated the patients in "euthyroid" period. Studies with larger patient population which evaluates the patients both in "hypothyroid" and "euthyroid" period may evaluate the exact effect of thyroid dysfunction on bone metabolism in patients with hypothyroidism.

CONCLUSION

Hypothyroidism can be seen as a comorbidity in Turkish postmenopausal patients with osteoporosis The effects of subclinical hypothyroidism on PMOP has been studied previously (10) but to our best knowledge this is the first study which evaluates the effect of thyroid dysfunction on PMOP in long term follow up in Turkish population. According to our results, we found no difference between BMD scores of the patients with PMOP and PMOP comorbid hypothyroidism. In long term, hypothyroidism has no significant effect on PMOP treatment with an antiresorptive agent, calcium and vitamin D.

Ethics Committee Approval: Ethics committee approval was received for this study from local Ethical Board Diskapi Yildirim Beyazit Training and Research Hospital Medical Research and Experimental Studies Ethical Board (Decision Date: 01.26.2015 /Decision No: 19/14).

Informed Consent: Written informed consent was obtained from patients who participated in this study.

Peer-review: Externally peer-reviewed.

Author Contributions: Conceived and designed the experiments or case: VY, EU. Performed the experiments or case: VY, IG. Analyzed the data: VY, EU. Wrote the paper: VY, NT. All authors have read and approved the final manuscript.

Conflict of Interest: The authors have no conflicts of interest to declare.

Financial Disclosure: The authors declared that this study has received no financial support.

REFERENCES

(1.) Jang J, Kim Y, Shin J, Lee SA, Choi Y, Park EC. Association between thyroid hormones and metabolic syndrome. BMC Endocr Disord 2018; 18(1): 2-9.

(2.) Kinne A, Schulein R, Krause G. Primary and secondary thyroid hormone transporters. Thyroid Res 2011; 3(4): 7.

(3.) Nicholls JJ, Brassill NJ, Williams GR, Bassett JHD. The skeletal consequences of thyrotoxicosis. J Endocrinol 2012; 213: 209-21.

(4.) Khan SH, Manzoor SM, Niazi NK, Asif N, Ijaz A, Fazal N. Association of metabolic risks with subclinical hypothyroidism: A cross sectional study. Pak J Med Sci 2018; 34: 357-62.

(5.) Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR. Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002). Thyroid 2007; 17(12):1211-23.

(6.) Chang CH, Yeh YC, Caffrey JL, Chuang LM, Tu YK. Metabolic syndrome is associated with an increased incidence of subclinical Hypothyroidism. Sci Rep 2017; 7(1): 3-8.

(7.) Tagami T, Kimura H, Ohtani S, Tanaka T, Hata S, Saito M, et al. Multi-center study on the prevalence of hypothyroidism in patients with hypercholesterolemia. Endocr J 2011; 58(6): 449-57.

(8.) Razvi S, Weaver JU, Vanderpump MP, Pearce SH. The incidence of ischemic heart disease and mortality in people with subclinical hypothyroidism: reanalysis of the Whickham Survey cohort. J Clin Endocrinol Metab 2010; 95(4):1734-40.

(9.) Ahmed LA, Schirmer H, Berntsen GK, Fonnebo V, Joakimsen RM. Self-reported diseases and the risk of non-vertebral fractures: the Tromso study. Osteoporos Int 2006; 17(1): 46-53.

(10.) Kisakol G, Kaya A, Gonen S, Tunc R. Bone and calcium metabolism in subclinical autoimmune hyperthyroidism and hypothyroidism. Endocr J 2003; 50(6): 657-61.

(11.) Marwaha RK, Garg MK, Tandon N, Kanwar R, Narang A, Sastry A, et al. Thyroid function and bone mineral density among Indian subjects. Indian J Endocrinol Metab 2012; 16(4): 575-9.

(12.) Gonzalez-Rodriguez LA1, Felici-Giovanini ME, Haddock L. Thyroid dysfunction in an adult female population: A population-based study of Latin American Vertebral Osteoporosis Study (LAVOS) - Puerto Rico site. P R Health Sci J 2013; 32(2): 57-62.

(13.) Kim BJ, Lee SH, Bae SJ, Kim HK, Choe JW, Kim HY, et al. The association between serum thyrotropin (TSH) levels and bone mineral density in healthy euthyroid men. Clin Endocrinol 2010; 73(3): 396-403.

(14.) Chawia J, Sharma N, Arora D, Arora M, Shukla L. Bone densitometry status and its associated Factors in peri and post menopausal females: A cross sectional study from a tertiary care centerin India. Taiwan J Obstet Gynecol 2018; 57(1): 100-5.

(15.) Segna D, Bauer DC, Feller M, Schneider C, Fink HA, Aubert CA et al. Association between subclinical thyroid dysfunction and change in bone mineral density in prospective cohorts. J Intern Med 2018; 283(1): 56-72.

(16.) Williams GR, Bassett JHD. Thyroid disease and bone health. J Endocrinol Invest 2018; 41(1): 99-109.

(17.) Polovina SP, Miljic D, Zivojinovic S, Milic N, Micic D, Popovic Brkic V. The impact of thyroid autoimmunity (TPOAb) on bone density and fracture risk in postmenopausal women. Hormones (Athens) 2017; 16(1): 54-61.

(18.) Abrahamsen B, Jorgensen HL, Laulund AS, Nybo M, Bauer DC, Brix TH, et al. The excess risk of major osteoporotic fractures in hypothyroidism is driven by cumulative hyperthyroid as opposed to hypothyroid time: an observational register-based time-resolved cohort analysis. J Bone Miner Res 2015; 30(5): 898-905.

(19.) Kyriakakis N, Lynch J, Ajjan R, Murray RD. The effects of pituitary and thyroid disorders on haemostasis: potential clinical implications. Clin Endocrinol (Oxf) 2016; 84(4): 473-84.

(20.) Viniol A, Hickstein L, Walker J, Donner-Banzhoff N, Baum E, Becker A. Influence of thyroid hormone therapy on fracture rate: A claims data cohort study. Bone 2016; (86): 86-90.

(21.) Ercolano M, Drnovsek M, Croome M, Moos M, Fuentes AM, Viale F, Feldt-Rasmussen U, et al. Negative correlation between bone mineral density and TSH receptor antibodies in long-term euthyroid postmenopausal women with treated Graves' disease. Thyroid Res 2013; 6(1): 11.

(22.) Vestergaard P, Weeke J, Hoeck H, Nielsen H, Rungby J, Rejnmark L, et al. Fractures in patients with primary idiopathic hypothyroidism. Thyroid 2000; 10(4): 335-40.

(23.) Lee W, Oh K, Rhee E, Jung C, Kim S, Yun E, et al. Relationship between subclinical thyroid dysfunction and femoral neck bone mineral density in women. Arch Med Res 2006; 37(4): 511-6.

Volkan Yilmaz [iD], Ebru Umay [iD], Ibrahim Gundogdu [iD], Nihal Tezel [iD]

Cite this article as:

Yilmaz V, Umay E, Gundogdu i, Tezel N. Treatment Outcomes of Postmenopausal Osteoporosis in Patients with Stable Hypothyroidism: A 5-Year Follow-up Retrospective Study. Erciyes Med J 2018; 40(4): 194-9.

Clinic of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

Submitted

26.04.2017

Accepted

01.10.2018

Available Online Date

19.11.2018

Correspondence

Volkan Yilmaz, Clinic of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

Phone:+903125262000

e.mail:

dryilmazv@hotmail.com

DOI: 10.5152/etd.2018.17065
Table 1. Demographic features of the patient and control groups

Parameters                              Patient Group (n=50)
                                        mean[+ or -]SD n (%)

Age (years)                             59.10[+ or -]8.70
BMI (kg/[m.sup.2])                      29.72[+ or -]5.67
Educational level
 not reader and/or writer                0
 only reader and/or writer               6 (12)
 primary school degree                  13 (26)
 junior high school degree              26 (52)
 high school degree                      2 (4)
 university degree                       3 (6)
Number of pregnancies                    3.44[+ or -]2.20
Menarche age (years)                    14.04[+ or -]1.47
Menopause age (years)                   54.72[+ or -]6.31
Fragility fracture before menopause      6 (12)
Daily Ca Intake
 Everyday                                3(6)
 At least twice a week                  26 (52)
 Never                                  21 (42)
Tea, coffee and alcohol consumption
 Overuse                                12 (24)
 Normal                                 38 (76)
Clothing style
 Closed clothing                         1 (2)
 Traditional clothing                   42 (84)
 Modern clothing                         7 (14)
Physical activity
 Normal physically inactive             38 (76)
 Physically inactive                    12 (24)
Maternal history of fragility fracture  10 (20)

Parameters                              Control group (n=47)
                                        mean[+ or -]SD n (%)    p

Age (years)                              57.36[+ or -]9.10    0.339
BMI (kg/[m.sup.2])                       30.11[+ or -]5.22    0.172
Educational level
 not reader and/or writer                 1 (2.1)             0.122
 only reader and/or writer               13 (27.7)
 primary school degree                   18 (38.3)
 junior high school degree                7 (14.9)
 high school degree                       4 (8.5)
 university degree                        4 (8.5)
Number of pregnancies                     3.19[+ or -]2.22    0.813
Menarche age (years)                     14.34[+ or -]1.80    0.974
Menopause age (years)                    54.68[+ or -]6.02    0.821
Fragility fracture before menopause       8 (17)              0.724
Daily Ca Intake
 Everyday                                 4 (8.5)             0.218
 At least twice a week                   31 (66.0)
 Never                                   12 (25.5)
Tea, coffee and alcohol consumption
 Overuse                                  8 (17)              0.137
 Normal                                  39 (83)
Clothing style
 Closed clothing                          3 (6.4)             0.131
 Traditional clothing                    34 (72.3)
 Modern clothing                         10 (21.3)
Physical activity
 Normal physically inactive              33 (70.2)            0.163
 Physically inactive                     14 (29.8)
Maternal history of fragility fracture    9 (19.1)            0.882

Values are expressed as the mean[+ or -]standard deviation, median
(1st-3rd quartiles) or n (%); BMI: body mass index; Ca: calcium

Table 2. BMD scores and biochemical parameters of the patient and
control groups before treatment

                                           Patient Group (n=50)
Parameters                             Median (1st-3rd quartile) n (%)

Total lumbar (L1-4) T score                -2.50 (-3.20-1.42)
Total femur neck T score                   -2.60 (-3.30-1.90)
Serum Ca (9-11 mg/dL) (*)                   7.90 (7.70-8.12)
Serum P (3-4.5 mg/dL) (*)                   3.60 (2.90-4.10)
Serum ALP (30-120 U/l) (*)                 58.50 (21.25-92.10)
Serum PTH (12-65 ng/L) (*)                 54.10 (41.80-64.40)
Serum Calcidiol (20-40 ng/mL) (*)          11.03 (8.20-16.90)
Serum osteocalcine (3-13ug/L) (*)          12.60 (6.62-20.82)
24 hours urine Ca (50-150 mg/day) (*)      41.20 (24.61-69.30)
24 hours urine P (0.4-1.3 gr/day) (*)       0.82 (0.46-1.16)

                                           Control Grup (n=47)
Parameters                             Median (1st-3rd quartile) n (%)

Total lumbar (L1-4) T score                -2.60 (-2.82-2.00)
Total femur neck T score                   -2.75 (-3.27-2.06)
Serum Ca (9-11 mg/dL) (*)                   7.80 (7.70-8.00)
Serum P (3-4.5 mg/dL) (*)                   3.30 (3.00-3.90)
Serum ALP (30-120 U/l) (*)                 41.50 (28.12-98.20)
Serum PTH (12-65 ng/L) (*)                 48.50 (26.20-68.33)
Serum Calcidiol (20-40 ng/mL) (*)          13.40 (8.27-19.35)
Serum osteocalcine (3-13ug/L) (*)          14.25 (7.71-19.74)
24 hours urine Ca (50-150 mg/day) (*)      40.60 (18.50-61.68)
24 hours urine P (0.4-1.3 gr/day) (*)       1.07 (0.70-1.48)

Parameters                              p

Total lumbar (L1-4) T score            0.094
Total femur neck T score               0.612
Serum Ca (9-11 mg/dL) (*)              0.725
Serum P (3-4.5 mg/dL) (*)              0.317
Serum ALP (30-120 U/l) (*)             0.521
Serum PTH (12-65 ng/L) (*)             0.823
Serum Calcidiol (20-40 ng/mL) (*)      0.331
Serum osteocalcine (3-13ug/L) (*)      0.178
24 hours urine Ca (50-150 mg/day) (*)  0.106
24 hours urine P (0.4-1.3 gr/day) (*)  0.158

Values are expressed as the mean[+ or -]standard deviation, median
(1st-3rd quartiles) or n (%), Ca: calcium; P: phosphate; ALP: alkaline
phosphatase; PTH: parathormone

Table 3. BMD scores and biochemical parameters of the subjects at the
first year of treatment

                                          Patient Group (n=50)
Parameters                             Median (1st-3rd quartile), n (%)

Total lumbar (L1gL4) T-score              -1.90 (-3.32-1.12)
Total femur neck T-score                  -2.55 (-3.30-1.72)
Serum Ca (9-11 mg/dL) (*)                  8.90 (8.65-12.45)
Serum p (3-4.5 mg/dL) (*)                  3.60 (3.15-4.20)
Serum ALP (30-120 U/l) (*)                66.50 (29.25-137.21)
Serum PTH (12-65 ng/l) (*)                38.20 (20.70-60.87)
Serum calcidiol (20-40 ng/mL) (*)         19.85 (11.54-30.80)
Serum osteocalcine (3-13
[micro]g/l) (*)                           17.68 (12.76-21.25)
24 hours urine Ca (50-150 mg/day) (*)     48.56 (41.15-62.28)
24 hours urine p (0.4-1.3 gr/day) (*)      0.51 (0.35-1.34)

                                          Control Group (n=47)
Parameters                             Median (1st-3rd quartile), n (%)

Total lumbar (L1gL4) T-score              -2.20 (-3.03-1.18)
Total femur neck T-score                  -2.50 (-2.97-2.06)
Serum Ca (9-11 mg/dL) (*)                  9.90 (9.72-10.05)
Serum p (3-4.5 mg/dL) (*)                  3.50 (3.15-4.10)
Serum ALP (30-120 U/l) (*)                72.02 (37.12-136.40)
Serum PTH (12-65 ng/l) (*)                30.50 (23.95-66.28)
Serum calcidiol (20-40 ng/mL) (*)         18.50 (11.60-25.40)
Serum osteocalcine (3-13
[micro]g/l) (*)                           19.75 (14.42-20.90)
24 hours urine Ca (50-150 mg/day) (*)     49.42 (40.19-59.27)
24 hours urine p (0.4-1.3 gr/day) (*)      0.47 (0.40-1.05)

Parameters                               p

Total lumbar (L1gL4) T-score           0.853
Total femur neck T-score               0.918
Serum Ca (9-11 mg/dL) (*)              0.351
Serum p (3-4.5 mg/dL) (*)              0.721
Serum ALP (30-120 U/l) (*)             0.684
Serum PTH (12-65 ng/l) (*)             0.472
Serum calcidiol (20-40 ng/mL) (*)      0.261
Serum osteocalcine (3-13
[micro]g/l) (*)                        0.918
24 hours urine Ca (50-150 mg/day) (*)  0.832
24 hours urine p (0.4-1.3 gr/day) (*)  0.083

Values are expressed as the mean[+ or -]standard deviation, median
(1st-3rd quartiles), or n (%); Ca: calcium; P: phosphate; ALP: alkaline
phosphatase; PTH: parathormone

Table 4. BMD scores and biochemical parameters of the subjects at the
fifth year of treatment

                                          Patient Group (n=50)
Parameters                             Median (1st-3rd quartile), n (%)

Total lumbar (L1-L4) T-score               -1.30 (-2.05-0.60)
Total femur neck T-score                   -1.40 (-2.30-0.52)
Serum Ca (9-11 mg/dL) (*)                   9.20 (8.80-11.28)
Serum P (3-4.5 mg/dL) (*)                   3.10 (2.70-4.15)
Serum ALP (30-120 U/l) (*)                 68.12 (41.18-95.62)
Serum PTH (12-65 ng/l) (*)                 44.58 (26.31-66.57)
Serum calcidiol (20-40 ng/mL) (*)          20.45 (12.57-29.80)
Serum osteocalcine (3-13
[micro]g/l) (*)                            13.09 (7.30-18.65)
24 hours urine Ca (50-150 mg/day) (*)      58.20 (52.14-75.17)
24 hours urine p (0.4-1.3 gr/day) (*)       0.72 (0.34-1.08)

                                          Control Group (n=47)
Parameters                             Median (1st-3rd quartile), n (%)

Total lumbar (L1-L4) T-score               -1.21 (-2.40-0.75)
Total femur neck T-score                   -1.30 (-2.43-0.92)
Serum Ca (9-11 mg/dL) (*)                   9.18 (8.80-13.90)
Serum P (3-4.5 mg/dL) (*)                   3.80 (3.20-3.95)
Serum ALP (30-120 U/l) (*)                 59.08 (35.10-87.11)
Serum PTH (12-65 ng/l) (*)                 42.60 (11.40-72.30)
Serum calcidiol (20-40 ng/mL) (*)          26.50 (15.10-31.60)
Serum osteocalcine (3-13
[micro]g/l) (*)                            14.02 (12.11-18.05)
24 hours urine Ca (50-150 mg/day) (*)      55.96 (42.41-68.24)
24 hours urine p (0.4-1.3 gr/day) (*)       0.61 (0.47-0.82)

Parameters                              p

Total lumbar (L1-L4) T-score           0.147
Total femur neck T-score               0.231
Serum Ca (9-11 mg/dL) (*)              0.845
Serum P (3-4.5 mg/dL) (*)              0.344
Serum ALP (30-120 U/l) (*)             0.193
Serum PTH (12-65 ng/l) (*)             0.261
Serum calcidiol (20-40 ng/mL) (*)      0.658
Serum osteocalcine (3-13
[micro]g/l) (*)                        0.586
24 hours urine Ca (50-150 mg/day) (*)  0.712
24 hours urine p (0.4-1.3 gr/day) (*)  0.335

Values are expressed as the mean[+ or -]standard deviation, median
(1st-3rd quartiles), or n (%); Ca: calcium; P: phosphate; ALP: alkaline
phosphatase; PTH: parathormone
COPYRIGHT 2018 AVES
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2018 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:ORIGINAL ARTICLE
Author:Yilmaz, Volkan; Umay, Ebru; Gundogdu, Ibrahim; Tezel, Nihal
Publication:Erciyes Medical Journal
Article Type:Report
Date:Dec 1, 2018
Words:4569
Previous Article:Functions of the Human Intestinal Microbiota in Relation to Functional Foods.
Next Article:Comparison of Sternum Closure Techniques with Sternal Cable and Simple Wire After Open Heart Surgery.
Topics:

Terms of use | Privacy policy | Copyright © 2021 Farlex, Inc. | Feedback | For webmasters |