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J Bone Miner Res. 2002 Nov;17 Suppl 2:N154-7.
The basis for the post-parathyroidectomy increase in bone mass.

Heaney RP.

Creighton University, Omaha, Nebraska 68131, USA.

The bone remodeling transient is a self-limited change in measurable bone mass, detectable by dual-energy X-ray absorptiometry (DXA) or by calcium balance methods, which occurs whenever the skeleton undergoes a shift in bone remodeling activity from one steady state to another. Assessing the true effect on bone mass of therapy that alters remodeling requires both a period of observation long enough to characterize the new steady state and explicit provision for the transient. To help with such analysis, a multivariate computer model of the bone remodeling system has been developed and applied usefully to a variety of data sets describing the response to treatment. Because parathyroid hormone (PTH) is the principal determinant of the quantity of bone remodeling, it follows that efficacious treatment of hyperparathyroidism will produce a bone remodeling transient. Using published values for the level of bone remodeling activity in postmenopausal women with mild hyperparathyroidism, it can be calculated that successful treatment would produce an increase in measurable spine bone mineral density (BMD) of about 12% by 1 year after surgery. In more severe cases, with higher levels of remodeling, one-time BMD increases of more than 30% will occur. In general, it can be said that, in typical postmenopausal women, a doubling of remodeling rate in the hyperparathyroid state will, on successful treatment, produce a positive transient amounting to about 8% above the presurgery BMD level.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12412794&dopt=Abstract

J Bone Miner Res. 2002 Nov;17(11):2038-47.
Mechanisms for the enhancement of fracture healing in rats treated with intermittent low-dose human parathyroid hormone (1-34).

Nakajima A, Shimoji N, Shiomi K, Shimizu S, Moriya H, Einhorn TA, Yamazaki M.

Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Japan.

Recent reports have demonstrated that intermittent treatment with parathyroid hormone (1-34) [PTH(1-34)] increases callus formation and mechanical strength in experimental fracture healing. However, little is known about the optimal dose required for enhancement of fracture repair or the molecular mechanisms by which PTH regulates the healing process. In this study, we analyzed the underlying molecular mechanisms by which PTH affects fracture healing and tested the hypothesis that intermittent low-dose treatment with human PTH(1-34) can increase callus formation and mechanical strength. Unilateral femoral fractures were produced and a daily subcutaneous injection of 10 microg/kg of PTH(1-34) was administered during the entire healing period. Control animals were injected with vehicle solution alone. The results showed that on day 28 and day 42 after fracture, bone mineral content (BMC), bone mineral density (BMD), and ultimate load to failure of the calluses were significantly increased in the PTH-treated group compared with controls (day 28, 61, 46, and 32%; day 42, 119, 74, and 55%, respectively). The number of proliferating cell nuclear antigen (PCNA)-positive subperiosteal osteoprogenitor cells was significantly increased in the calluses of the PTH-treated group on day 2, and TRAP+ multinucleated cells were significantly increased in areas of callus cancellous bone on day 7. The levels of expression of type I collagen (COLlA1), osteonectin (ON), ALP, and osteocalcin (OC) mRNA were increased markedly in the PTH-treated group and accompanied by enhanced expression of insulin-like growth factor (IGF)-I mRNA during the early stages of healing (days 4-7). The increased expression of COL1A1, ON, ALP, and OC mRNA continued during the later stages of healing (days 14-21) despite a lack of up-regulation of IGF-I mRNA. These results suggest that treatment of fractures with intermittent low dose PTH(1-34) enhances callus formation by the early stimulation of proliferation and differentiation of osteoprogenitor cells, increases production of bone matrix proteins, and enhances osteoclastogenesis during the phase of callus remodeling. The resultant effect to increase callus mechanical strength supports the concept that clinical investigations on the ability of injectable low-dose PTH(1-34) to enhance fracture healing are indicated.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12412812&dopt=Abstract

J Bone Miner Res. 2002 Nov;17(11):2061-7.
When should densitometry be repeated in healthy peri- and postmenopausal women: the Danish osteoporosis prevention study.

Abrahamsen B, Nissen N, Hermann AP, Hansen B, Barenholdt O, Vestergaard P, Tofteng CL, Pors Nielsen S.

Department of Endocrinology, Odense University Hospital, Denmark.

Intervention should be considered in postmenopausal women with bone mineral density (BMD) > or = 1 SD below the reference (T or Z score < -1). However, it is unclear when densitometry should be repeated. This study aimed at determining the need for repeat DXA within 5 years in untreated peri-/postmenopausal women to detect declines of T or Z score to below -1 with 85% confidence. A cohort of 925 healthy women (aged 51.2 +/- 2.9 years) were followed within the Danish Osteoporosis Prevention Study (DOPS) for 5 years without hormone-replacement therapy (HRT). DXA of spine, hip, and forearm was done at 0,1, 2, 3, and 5 years (Hologic QDR-1000/2000). The annual loss in SD units was 0.12 +/- 0.10 at the spine (1.3%), 0.10 +/- 0.09 at the femoral neck (1.2%), and 0.07 +/- 0.09 at the ultradistal (UD) forearm (1.0%). Accordingly, T scores below -1 developed earlier at the spine. The need for a future DXA scan to predict declines of T and Z scores below -1 depended strongly on baseline BMD. In subjects with a positive T score, the risk of developing T < -1 remained at <15% for 5 years at all measured sites. A new scan was needed after 1 year if the T score was below -0.5, and after 3 years if the T score was between 0 and -0.5. Slightly longer intervals apply if Z scores are used. Follow-up densitometry in untreated women should be individually targeted from baseline BMD rather than scheduled at fixed time intervals. An algorithm for planning repeat densitometry in perimenopausal women is provided.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12412814&dopt=Abstract

Acta Paediatr. 2002;91(9):897-902.
Leptin levels in breast-fed and formula-fed infants.

Savino F, Costamagna M, Prino A, Oggero R, Silvestro L.

Dipartimento di Scienze Pediatriche e dell'Adolescenza, Universita di Torino, Ospedale Regina Margherita, Italy. savinediatria.unito.it

AIM: Leptin, a hormone that regulates food intake and energy metabolism, is present in breast milk and thus may be involved in body composition differences between breastfed and formula-fed infants. The aim of this study was to evaluate whether diet and gender affect plasma leptin concentration in breastfed and formula-fed infants during the first months of life. METHODS: Anthropometric and bioelectrical impedance measurements [total body water (TBW) calculated with the Fjeld equation] were made and venous blood plasma samples were analysed for leptin concentration in healthy, exclusively breastfed or formula-fed Italian infants in the first year of life. Infants were subdivided in two ways: three groups (periods) in relation to age, and five groups in relation to weight. RESULTS: The average serum concentration of leptin was 7.35 ng x ml(-1). Serum leptin values were higher in breastfed than in formula-fed infants. Breastfed infants in group I had a statistically higher serum leptin concentration (2,500-3,749 g). There were no significant differences in anthropometric measurements, body mass index or skinfold thickness between breastfed and formula-fed infants. In the periods I and II, breastfed infants had a significantly higher TBW than formula-fed infants. Males had a significantly higher TBW than females in periods I and II. Breastfed infants in group 2 (3,750-4,999 g) had a significantly higher TBW than formula-fed infants. CONCLUSION: The data on TBW, weight and skinfold thickness suggest that the higher leptin concentration observed in breastfed infants in the first months of life may be due not only to adipose tissue production but also to human milk.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12412862&dopt=Abstract

Acta Paediatr. 2002;91(9):966-71.
Psychological functioning in boys of short stature: effects of different levels of growth hormone secretion.

Erling A, Wiklun I, Albertsson Wikland K.

International Pediatric Growth Research Centre, Department of Psychology, Goteborg University, Sweden. Ann.Erlinsy.gu.se

AIM: To examine the relationship between growth hormone (GH) and psychological functioning, especially self-perception and well-being, in 60 prepubertal boys of short stature with a wide range of GH levels. METHODS: A comparison was made of the well-being and self-perception of children with GH insufficiency, children with idiopathic short stature (ISS), a normative sample and healthy boys with normal stature. RESULTS: Children with GH insufficiency had a more negative perception of their own physical appearance than the normative sample. They perceived themselves as more alert but also more inhibited than both the children with ISS and the healthy boys with normal stature. In comparison with the healthy boys with normal stature they perceived themselves as having more stability. The parents of the boys with GH insufficiency also perceived their children as being more stable compared with how the parents of boys with ISS perceived their children. To elucidate the effects of GH on psychological functioning a multiple regression analysis was performed. CONCLUSION: The lower the levels of GH the more inhibited were the boys of short stature, as perceived both by themselves and by their parents. The boys with GH insufficiency had a more negative perception of their physical appearance than the normative sample.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12412874&dopt=Abstract

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