12 results on '"Hans-Georg Zmierczak"'
Search Results
2. Prevalence of vertebral fractures and non-fracture deformities in young healthy men
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Stephanie De Smet, Hans-Georg Zmierczak, and Stefan Goemaere
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Diseases of the musculoskeletal system ,RC925-935 - Published
- 2021
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3. Relatively higher bone formation markers during puberty are correlated with more bone mass accrual independent of longitudinal growth in boys
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Thiberiu Banica, Sara Vandewalle, Hans-Georg Zmierczak, Stefan Goemaere, Jean De Schepper, Jean-Marc Kaufman, and Bruno Lapauw
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Diseases of the musculoskeletal system ,RC925-935 - Published
- 2020
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4. A Novel Disorder of Osteoporosis, Osteonecrosis, and Metaphyseal Fracture
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Hans‐Georg Zmierczak, Guy Taylor, and Tim Cundy
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BISPHOSPHONATES ,METAPHYSEAL FRACTURES ,OSTEONECROSIS ,OSTEOPOROSIS ,Orthopedic surgery ,RD701-811 ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
ABSTRACT We describe two unrelated women who in their fifth decade developed a severe disorder characterized by large joint osteonecrosis and multiple minimal trauma fractures in both the axial and appendicular skeleton, including unusual metaphyseal fractures of the proximal tibia. Bone density testing showed borderline osteoporosis of the spine and osteopenia of the femur. Therapy with bisphosphonates and teriparatide failed to prevent further fractures. To our knowledge, this disorder has not been described previously. Investigations to date, including a genetic screen, have not revealed its cause. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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- 2020
- Full Text
- View/download PDF
5. The relationship between circulating hormone levels, bone turnover markers and skeletal development in healthy boys differs according to maturation stage
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Thiberiu Banica, Sara Vandewalle, Hans-Georg Zmierczak, Stefan Goemaere, Stefanie De Buyser, Tom Fiers, Jean-Marc Kaufman, Jean De Schepper, Bruno Lapauw, Mental Health and Wellbeing research group, Clinical sciences, Biology of the Testis, and Pediatrics
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Male ,puberty ,Histology ,Adolescent ,Estradiol ,Physiology ,Endocrinology, Diabetes and Metabolism ,skeletal growth ,wnt-signalling markers ,Bone Density ,Child, Preschool ,healthy boys ,Humans ,Testosterone ,sex steroids ,Bone Remodeling ,Insulin-Like Growth Factor I ,Child ,bone turnover markers - Abstract
INTRODUCTION: This study investigates peri-pubertal changes in bone turnover markers, Wnt-signalling markers, insulin-like growth factor-1 (IGF-1) and sex steroid levels, and how they reflect skeletal development in peri-pubertal boys. MATERIALS AND METHODS: Population-based study in 118 peri-pubertal boys from the NINIOS cohort (age range at baseline 5.1-17.3 years) with repeated measurements at baseline and after two years. Serum levels of the classical bone turnover markers (BTM) procollagen type 1 N-terminal propeptide and carboxy-terminal collagen crosslinks, as well as sex-hormone binding globulin, IGF-1, osteoprotegerin, sclerostin and dickkopf-1 were measured using immunoassays. Sex steroids (estradiol, testosterone, and androstenedione) were measured using mass spectrometry and free fractions calculated. Dual energy x-ray absorptiometry was used for bone measurements at the lumbar spine and whole body. Volumetric bone parameters and bone geometry at the proximal and distal radius were assessed by peripheral QCT. Pubertal development was categorized based on Tanner staging. RESULTS: During puberty, sex steroid and IGF-1-levels along with most parameters of bone mass and bone size increased every next Tanner stage. In contrast, classical bone turnover markers and sclerostin peaked around mid-puberty, with subsequent declines towards adult values in late puberty. Especially classical BTM and sex steroid levels showed consistent associations with areal and volumetric bone parameters and bone geometry. However, observed associations differed markedly according to pubertal stage and skeletal site. CONCLUSION: Serum levels of sex steroids, IGF-1 and bone metabolism markers reflect skeletal development in peri-pubertal boys. However, skeletal development during puberty is nonlinear, and the relations between skeletal indices and hormonal parameters are nonlinear as well, and dependent on the respective maturation stage and skeletal site.
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- 2022
6. European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021)
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Jens Bollerslev, Lars Rejnmark, Alexandra Zahn, Ansgar Heck, Natasha M Appelman-Dijkstra, Luis Cardoso, Fadil M Hannan, Filomena Cetani, Tanja Sikjaer, Anna Maria Formenti, Sigridur Björnsdottir, Camilla Schalin-Jäntti, Zhanna Belaya, Fraser Gibb, Bruno Lapauw, Karin Amrein, Corinna Wicke, Corinna Grasemann, Michael Krebs, Eeva Ryhänen, Özer Makay, Salvatore Minisola, Sébastien Gaujoux, Jean-Philippe Bertocchio, Zaki Hassan-Smith, Agnès Linglart, Elizabeth M Winter, Martina Kollmann, Hans-Georg Zmierczak, Elena Tsourdi, Stefan Pilz, Heide Siggelkow, Neil Gittoes, Claudio Marcocci, Peter Kamenický, Zillikens Carola, Frost Morten, Rolighed Lars, Sitges-Serra Antonio, Corbetta Sabrina, Decallonne Brigitte, Gherlan Iuliana, Gianotti Laura, Grigorie Daniel, Hindié Elif, Kiely Mairead, Lindner Kirsten, Makras Polyzois, Obermayer-Pietsch Barbara, R Perez-Lopez Fastino, Pretorius Mikkel, Saponaro Federica, Trummer Christian, Vamvakidis Kyriakos, Vashakmadze Natia, and P Yavropoulou Maria
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Adult ,Hypoparathyroidism ,Endocrinology, Diabetes and Metabolism ,Parathyroid Diseases ,Review ,CALCITROPIC HORMONES ,CALCIUM-SENSING RECEPTOR ,Endocrinology ,Pregnancy ,QUALITY-OF-LIFE ,Medicine and Health Sciences ,Humans ,Lactation ,VITAMIN-D ,PRIMARY HYPERPARATHYROIDISM ,LONG-TERM TREATMENT ,Infant, Newborn ,General Medicine ,AMERICAN ASSOCIATION ,Hyperparathyroidism, Primary ,SECONDARY HYPERPARATHYROIDISM ,Parathyroid Hormone ,FAMILIAL HYPOCALCIURIC HYPERCALCEMIA ,Hypercalcemia ,Calcium ,Female ,BONE-MINERAL DENSITY - Abstract
This European expert consensus statement provides recommendations for the diagnosis and management of primary hyperparathyroidism (PHPT), chronic hypoparathyroidism in adults (HypoPT), and parathyroid disorders in relation to pregnancy and lactation. Specified areas of interest and unmet needs identified by experts at the second ESE Educational Program of Parathyroid Disorders in 2019 were discussed during two virtual workshops in 2021 and subsequently developed by working groups with interest in the specified areas. PHPT is a common endocrine disease. However, its differential diagnosis of familial hypocalciuric hypercalcemia (FHH), the definition and clinical course of normocalcemic PHPT, and the optimal management of its recurrence after surgery represents areas of uncertainty requiring clarifications. HypoPT is an orphan disease characterized by low calcium concentrations due to insufficient PTH secretion, most often secondary to neck surgery. Prevention and prediction of surgical injury to the parathyroid glands are essential to limit the disease-related burden. Long-term treatment modalities including the place for PTH replacement therapy and the optimal biochemical monitoring and imaging surveillance for complications to treatment in chronic HypoPT need to be refined. The physiological changes in calcium metabolism occurring during pregnancy and lactation modify the clinical presentation and management of parathyroid disorders in these periods of life. Modern interdisciplinary approaches to PHPT and HypoPT in pregnant and lactating women and their newborn children are proposed. The recommendations on clinical management presented here will serve as background for further educational material aimed at a broader clinical audience and were developed with the focus on endocrinologists in training.
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- 2022
7. Prevalence of vertebral fractures and non-fracture deformities in young healthy men
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Stefan Goemaere, Hans-Georg Zmierczak, and Stephanie De Smet
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RC925-935 ,business.industry ,Endocrinology, Diabetes and Metabolism ,Fracture (geology) ,Medicine ,Dentistry ,Orthopedics and Sports Medicine ,Diseases of the musculoskeletal system ,business - Published
- 2021
8. Indications for a genetic association of a VCP polymorphism with the pathogenesis of sporadic Paget's disease of bone, but not for TNFSF11 (RANKL) and IL-6 polymorphisms
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Filip Vanhoenacker, Stefan Goemaere, Hans-Georg Zmierczak, René Westhovens, Greet Beyens, Piet Geusens, Leon Verbruggen, Steven Boonen, Wim Van Hul, Jan Van Offel, Jean-Pierre Devogelaer, Fenna de Freitas, Pui Yan Jenny Chung, Internal Medicine Specializations, Interne Geneeskunde, and RS: CAPHRI School for Public Health and Primary Care
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Male ,Candidate gene ,Endocrinology, Diabetes and Metabolism ,Valosin-containing protein ,Population ,Cell Cycle Proteins ,Single-nucleotide polymorphism ,Bioinformatics ,Polymorphism, Single Nucleotide ,Biochemistry ,Association ,Endocrinology ,Gene Frequency ,Valosin Containing Protein ,Genetics ,medicine ,Humans ,SNP ,Genetic Predisposition to Disease ,education ,Molecular Biology ,Alleles ,Genetic association ,Adenosine Triphosphatases ,education.field_of_study ,biology ,Interleukin-6 ,RANK Ligand ,Haplotype ,RANKL ,Middle Aged ,Osteitis Deformans ,medicine.disease ,TNFSF11 ,IL6 ,Paget's disease of bone ,Haplotypes ,biology.protein ,Female ,Human medicine ,Kappa-B ligand ,VCP - Abstract
Paget's disease of bone (PDB) is, after osteoporosis, the second most common metabolic bone disorder in the elderly Caucasian population. Mutations in the sequestosome 1 gene (SQSTM1) are responsible for the etiology of PDB in a subset of patients, but the disease pathogenesis in the remaining PDB patients is still unknown. Therefore association studies investigating the relationship between genetic polymorphisms and sporadic PDB have been performed in order to find the susceptibility polymorphisms. In this paper, we sought to determine whether polymorphisms in 3 functional candidate genes play a role in the development of sporadic PDB: TNFSF11 (receptor activator of nuclear factor κB ligand, RANKL), VCP (valosin-containing protein) and IL-6 (interleukin 6). Analyzing 9 tag SNPs and 2 multi-marker tests (MMTs) in TNFSF11, 3 tag SNPs and 1 MMT in VCP and 8 tag SNPs in IL-6 in a population of 196 Belgian patients with sporadic PDB and 212 Belgian control individuals revealed that one VCP SNP (rs565070) turned out to be associated with PDB in this Belgian study population (p = 5.5 × 10− 3). None of the tag SNPs or MMTs selected for TNFSF11 or IL-6 was associated with PDB. Still, replication of our findings in the VCP gene in other populations is important to confirm our results. However, when combining data of VCP with those from other susceptible gene regions from previous association studies (i.e. TNFRSF11A, CSF1, OPTN and TM7SF4), independent effect of each gene region was found and the cumulative population attributable risk is 72.7%.
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- 2011
9. Serum sclerostin levels in men with idiopathic osteoporosis
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Julien Collette, Sara Vandewalle, Jean-Marc Kaufman, Stefan Goemaere, Youri Taes, Bruno Lapauw, and Hans-Georg Zmierczak
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Male ,when adjusting for age ,Endocrinology, Diabetes and Metabolism ,+0%2E11%29%2E+Testosterone%22">neither were sclerostin levels associated with BMC at the radius or lumbar spine (all P > 0.11). Testosterone ,Pathogenesis ,chemistry.chemical_compound ,Endocrinology ,Absorptiometry, Photon ,Medicine and Health Sciences ,Quantitative computed tomography ,Child ,Testosterone ,Bone mineral ,Aged, 80 and over ,medicine.diagnostic_test ,Osteoblast ,General Medicine ,Middle Aged ,medicine.anatomical_structure ,Bone Morphogenetic Proteins ,P < 0.001). In both groups ,+0%2E14%29%2E+In+multivariate+analyses%22">no associations with anthropometrics were observed (P > 0.14). In multivariate analyses ,was inversely related to sclerostin levels in the probands. No difference in sclerostin levels was found in their sons when compared with their controls ,Adult ,Genetic Markers ,as well as with trabecular and cortical volumetric bone mineral density (vBMD) at the tibia in the probands. No clear associations were observed in the control group ,medicine.medical_specialty ,Adolescent ,In 116 men with idiopathic osteoporosis (<= 65 years old) [Methods] ,and volumetric and geometric bone parameters were measured using peripheral quantitative computed tomography. Serum analytes were measured using immunoassays and estradiol (E-2) levels using liquid chromatography-tandem mass spectrometry ,areal bone parameters were measured using dual-energy X-ray absorptiometry ,Men with idiopathic low bone mass had lower levels of sclerostin than the controls (0.54 +/- 0.17 vs 0.66 +/- 0.23 ng/ml [Results] ,Young Adult ,sclerostin levels were strongly associated with age ,but not E-2 ,Internal medicine ,medicine ,Humans ,Lower rather than higher serum sclerostin levels in the probands with idiopathic low bone mass suggest that aberrant sclerostin secretion is not involved in the pathogenesis of low bone mass in these subjects. [Conclusion] ,Tibia ,40 of their sons and healthy controls ,Adaptor Proteins, Signal Transducing ,Aged ,Sclerostin inhibits osteoblast differentiation and bone formation. If aberrant sclerostin action is involved in less efficient bone acquisition in men with idiopathic low bone mass [Objective] ,business.industry ,this might be reflected in higher serum sclerostin levels ,Anthropometry ,sclerostin levels displayed a positive association with whole-body bone mineral content (BMC) and areal BMD (aBMD) ,chemistry ,Sclerostin ,Osteoporosis ,business ,Biomarkers - Abstract
ObjectiveSclerostin inhibits osteoblast differentiation and bone formation. If aberrant sclerostin action is involved in less efficient bone acquisition in men with idiopathic low bone mass, this might be reflected in higher serum sclerostin levels.MethodsIn 116 men with idiopathic osteoporosis (≤65 years old), 40 of their sons and healthy controls, areal bone parameters were measured using dual-energy X-ray absorptiometry, and volumetric and geometric bone parameters were measured using peripheral quantitative computed tomography. Serum analytes were measured using immunoassays and estradiol (E2) levels using liquid chromatography–tandem mass spectrometry.ResultsMen with idiopathic low bone mass had lower levels of sclerostin than the controls (0.54±0.17 vs 0.66±0.23 ng/ml;PP>0.14). In multivariate analyses, sclerostin levels displayed a positive association with whole-body bone mineral content (BMC) and areal BMD (aBMD), as well as with trabecular and cortical volumetric bone mineral density (vBMD) at the tibia in the probands. No clear associations were observed in the control group, neither were sclerostin levels associated with BMC at the radius or lumbar spine (allP>0.11). Testosterone, but not E2, was inversely related to sclerostin levels in the probands. No difference in sclerostin levels was found in their sons when compared with their controls.ConclusionLower rather than higher serum sclerostin levels in the probands with idiopathic low bone mass suggest that aberrant sclerostin secretion is not involved in the pathogenesis of low bone mass in these subjects.
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- 2013
10. The majority of the genetic risk for Pagets disease of bone is explained by genetic variants close to the **CSF1**, **OPTN**, **TM7SF4**, and **TNFRSF11A** genes
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Greet Beyens, Leon Verbruggen, Stefan Goemaere, Erik Fransen, Filip Vanhoenacker, Pui Yan Jenny Chung, Rene Westhovens, Wim Van Hul, Piet Geusens, Steven Boonen, Socrates E. Papapoulos, Marcel Karperien, Hans-Georg Zmierczak, Jan Van Offel, Jean-Pierre Devogelaer, Interne Geneeskunde, RS: CAPHRI School for Public Health and Primary Care, Internal Medicine Specializations, and Faculty of Science and Technology
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Adult ,Male ,Familial aggregation ,Candidate gene ,IR-58571 ,SQSTM1 mutations ,Cell Cycle Proteins ,Genome-wide association study ,Single-nucleotide polymorphism ,Biology ,Polymorphism, Single Nucleotide ,Transcription Factor TFIIIA ,Genetics ,medicine ,Humans ,Genetic Predisposition to Disease ,Gene ,Genetics (clinical) ,Adaptor Proteins, Signal Transducing ,Aged ,Genetic association ,METIS-273440 ,Aged, 80 and over ,Receptor Activator of Nuclear Factor-kappa B ,Chromosome 18Q ,Macrophage Colony-Stimulating Factor ,Osteoclast formation ,nf-kappa-b ubiquitin-associated domain sqstm1 mutations uba domain familial aggregation chromosome 18q osteoclast formation sequestosome-1 gene functional-analysis british descent ,Haplotype ,Membrane Proteins ,Membrane Transport Proteins ,Ubiquitin-associated domain ,Middle Aged ,NF-Kappa-B ,Osteitis Deformans ,medicine.disease ,Paget's disease of bone ,Haplotypes ,UBA domain ,Chromosomal region ,Female ,Human medicine ,Genome-Wide Association Study - Abstract
Paget's disease of bone (PDB) is one of the most frequent metabolic bone disorders (1-5%), next to osteoporosis, affecting individuals above age 55. Sequestosome1 mutations explain a part of the PDB patients, but still the disease pathogenesis in the remaining PDB patients is largely unknown. Therefore, association studies investigating the relationship between genetic polymorphisms and sporadic PDB have been performed to find the genetic risk variants. Previously such studies indicated a role of the OPG and RANK gene. The latter was recently confirmed in a genome-wide association study (GWAS) which also indicated the involvement of chromosomal regions harbouring the CSF1 and OPTN gene. In this study, we sought to replicate these findings in a Belgian and a Dutch population. Similar significant results were obtained for the single nucleotide polymorphisms and the haplotypes. The most significant results are found in the CSF1 gene region, followed by the OPTN and TNFRSF11A gene region (p values ranging from 1.3 × 10(-4) to 3.8 × 10(-8), OR = 1.523-1.858). We next obtained significant association with a polymorphism from the chromosomal region around the TM7SF4 gene (p = 2.7 × 10(-3), OR = 1.427), encoding DC-STAMP which did not reach genome-wide significance in the GWAS, but based on its function in osteoclasts it can be considered a strong candidate gene. After meta-analysis with the GWAS data, p values ranged between 2.6 × 10(-4) and 8.8 × 10(-32). The calculated cumulative population attributable risk of these four loci turned out to be about 67% in our two populations, indicating that most of the genetic risk for PDB is coming from genetic variants close to these four genes.
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- 2010
11. Founder effect in different European countries for the recurrent P392L **SQSTM1** mutation in Paget's disease of bone
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Pui Yan Jenny Chung, Liesbeth Van Wesenbeeck, Karen Jennes, Greet Beyens, Rene Westhovens, Wim Van Hul, Marcel Karperien, Jan Van Offel, Marelise E. M. W. Eekhoff, Hans-Georg Zmierczak, Erwin Offeciers, Jean-Pierre Devogelaer, Steven Boonen, Socrates E. Papapoulos, Núria Guañabens, Piet Geusens, Internal medicine, and Faculty of Science and Technology
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Endocrinology, Diabetes and Metabolism ,DNA Mutational Analysis ,Single-nucleotide polymorphism ,Biology ,Polymorphism, Single Nucleotide ,White People ,Endocrinology ,Sequestosome-1 Protein ,medicine ,Humans ,Orthopedics and Sports Medicine ,Mutation frequency ,Adaptor Proteins, Signal Transducing ,Genetics ,Genetic heterogeneity ,Haplotype ,IR-83265 ,METIS-253646 ,Osteitis Deformans ,medicine.disease ,Founder Effect ,Europe ,Paget's disease of bone ,Haplotypes ,Mutation ,Mutation (genetic algorithm) ,Mutation testing ,Human medicine ,Founder effect - Abstract
Paget's Disease of Bone (PDB) is one of the most frequent metabolic bone diseases, affecting 1-5% of Western populations older than 55 years. Mutations in the sequestosome1 (SQSTM1) gene cause PDB in about one-third of familial PDB cases and in 2.4-9.3% of nonfamilial PDB cases, with the 1215C→T (P392L) mutation being the most frequent one. We investigated whether a founder effect of the P392L SQSTM1 mutation was present in Belgian (n = 233), Dutch (n = 82), and Spanish (n = 64) patients without a PDB family history. First, direct sequencing analysis of exon 8 in these three populations showed that the P392L mutation occurred in 17 Belgian patients (7.3%), three Dutch patients without a family history (3.7%), and two Dutch patients with a family history. In the Spanish population, 15.6% of patients (n = 10) had the P392L mutation, including one homozygous mutant. This is by far the highest mutation frequency of all populations investigated so far. Next, we examined the genetic background of 33 mutated chromosomes by analyzing haplotypes. We genotyped four single-nucleotide polymorphisms (SNPs) in exon 6 and the 3′-untranslated region of SQSTM1 (rs4935C/T, rs4797G/A, rs10277T/C, and rs1065154G/T) and used software programs WHAP and PHASE to reconstruct haplotypes. Finally, allele-specific primers allowed us to assign the mutation to one of the two haplotypes from each individual. Sequencing results revealed that all 33 P392L mutations were on the CGTG (H2) haplotype. The chance to obtain this result due to 33 independent mutation events is 3.97 × 10-14, providing strong evidence for a founder effect of the P392L SQSTM1 mutation in Belgian, Dutch, and Spanish patients with PDB.
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- 2008
12. Identification of sex-specific associations between polymorphisms of the osteoprotegerin gene, TNFRSF11B, and Paget's disease of bone
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Wim Van Hul, Filip Vanhoenacker, René Westhovens, Erik Fransen, Fenna de Freitas, Anna Daroszewska, Hans-Georg Zmierczak, Greet Beyens, Jan Van Offel, Leon Verbruggen, Jean-Pierre Devogelaer, Stuart H. Ralston, and Internal Medicine Specializations
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Male ,Ubiquitin binding ,Endocrinology, Diabetes and Metabolism ,Population ,Single-nucleotide polymorphism ,Biology ,association study ,Polymorphism, Single Nucleotide ,Belgium ,Meta-Analysis as Topic ,medicine ,TNFRSF11B ,Humans ,Orthopedics and Sports Medicine ,Genetic Predisposition to Disease ,International HapMap Project ,education ,Genotyping ,Aged ,HapMap SNP selection ,Genetics ,Aged, 80 and over ,education.field_of_study ,Sex Characteristics ,Haplotype ,Exons ,Middle Aged ,medicine.disease ,Osteitis Deformans ,United Kingdom ,Paget's disease of bone ,Haplotypes ,osteoprotegerin ,Population study ,Female ,Biomarkers - Abstract
We studied the role of TNFRSF11B polymorphisms on the risk to develop Paget's disease of bone in a Belgian study population. We observed no association in men, but a highly significant association was found in women, and this was confirmed in a population from the United Kingdom. Introduction: Juvenile Paget's disease has been shown to be caused by mutations in TNFRSF11B encoding osteoprotegerin. Although mutations in this gene have never been found in patients with typical Paget's disease of bone (PDB), there are indications that polymorphisms in TNFRSF11B might contribute to the risk of developing PDB. Materials and Methods: We recruited a population of 131 Belgian patients with sporadic PDB and 171 Belgian controls. By means of the HapMap, we selected 17 SNPs that, in combination with four multimarker tests, contain most information on common genetic variation in TNFRSF11B. To replicate the findings observed in the Belgian study population, genotyping data of SNPs generated in a UK population were reanalyzed. Results: In our Belgian study population, associations were found for two SNPs (rs11573871, rs1485286) and for one multimarker test involving rs1032129. When subsequently analyzing men and women separately, these associations turned out to be driven by women (56 cases, 78 controls). In addition, three other tagSNPs turned out to be associated in women only. These were rs2073617 (C950T), rs6415470, and rs11573869. Reanalysis of genotyping data from a UK study population indicated that the associations found for C950T and C1181G were also exclusively driven by women (146 cases, 216 controls). Meta-analysis provided evidence for risk increasing effects of the T allele of C950T and the G allele of C1181G in the female population (p = 0.002 and 0.003, respectively). The haplotypes formed by the SNPs associated in the Belgian population were also distributed differentially between female cases and controls. Conclusions: We showed for the first time that SNPs influencing the risk to develop PDB could be sex-specific. Further research is necessary to identify the causative variants in TNFRSF11B and to elucidate the molecular pathogenic mechanism.
- Published
- 2007
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