Adina Ghemigian, Ana Valea, Mara Carsote, Otilia Radu, Razvan Petrescu and Rene Baloescu

ABSTRACT

The field of osteoporosis, especially of primary type, tidily connected with estrogen deprivation and aging, is complex and dynamic. Bone turnover markers (BTM) have been and still are a hot spot on this panorama, because no straight cut lines are found yet. We aim to briefly introduce the current status of BTM, as a short commentary. BTM have a high inter- and intra- individual variation, they are rather expensive for daily practice, they are not necessary to diagnose osteoporosis. Low or normal levels do not necessary mean that a person will not suffer fragility fracture while a higher level is associated with an increased fracture risk. Moreover, BTM seem better players for clinical studies to point out the efficacy of anti-osteoporotic drugs rather than helping each patient’s decision. BTM prematurely detect remodelling variations before DXA. No algorithm or calculation model of fracture prediction has incorporated yet BTM, most probably due to heterogeneity of reports. Traditional BTM are alkaline phosphates, osteocalcin, and collagen- derived fragments. New BTM, that proved useful, are represented by P1NP. Atypical BTM like osteoprotegerin, sclerostin, and serotonin are still far from daily practitioners’ assessment. Regardless classical or modern, the way that BTM represent a reflection of skeleton health is still an emerging subject.

Keywords: bone turnover marker, serotonin, osteoporosis

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Adina Ghemigian, Ana Valea, Andra Buruiana, Mara Carsote, Nicoleta Dumitru and Otilia Radu

ABSTRACT

Vitamin D in menopause is essential for skeleton and metabolic involvement. Our purpose is to introduce the level of evidence regarding menopause – related hypovitaminosis D through a brief review of papers published on PubMed in 2016. The correlation between low vitamin D and risk of falls is a traditional observation. Lack of vitamin D remains one of the major contributors to osteoporotic fractures which have an annual incidence of 8.9 million worldwide. Yale FIT trial referring to menopausal cancer survivors after 12 months of aerobic physical exercise confirmed the bone loss under aromatase inhibitors opposite to tamoxifen is significant, a bone loss that is lower if vitamin D ranges are low. Arzoxifene Generations Trial followed for 5 years menopausal women treated only with vitamin D and calcium and found a fracture risk increase by 46% for each unit of lumbar T-score that decreases. A meta-analysis of 34 studies on 11,090 patients treated with ibandronate showed that hypovitaminosis D at baseline is a predictor of bone mineral density improvement only at lumbar spine. Another study revealed that 77% of menopausal females have 25-hydoxyvitamin D (25-OH D) less than 30 ng/mL while a negative correlation between 25-OH D and waist circumference was found knowing that android fat disposition in women with hipovitaminosis D is a hallmark of metabolic syndrome. Overall, in 2016, PubMed published papers regarding vitamin D in menopause still reflect its deficiency and associated metabolic risk.

Keywords: menopause, hypovitaminosis D, vitamin D

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