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Osteoporosis in pre-dialysis chronic kidney disease (CKD) patients has been overlooked, and the risk factors of osteoporosis in these patients have not been adequately studied. To identify risk factors for osteoporosis in pre-dialysis CKD patients and develop predictive models to estimate the likelihood of osteoporosis. Dual-energy X-ray absorptiometry was used to measure bone mineral density, and clinical examination results were collected from 326 pre-dialysis CKD patients. Binary logistic regression was employed to explore the risk factors associated with osteoporosis and develop predictive models. In this cohort, 53.4% (n = 174) were male, 46.6% (n = 152) were female, and 21.8% (n = 71) were diagnosed with osteoporosis. Among those diagnosed with osteoporosis, 67.6% (n = 48) were female and 32.4% (n = 23) were male. Older age and low 25-(OH)-Vitamin D levels were identified as risk factors for osteoporosis in males. For females, older age, being underweight, higher bone alkaline phosphatase (NBAP), and advanced CKD (G5) were significant risk factors, while higher iPTH was protective. Older age, being underweight, and higher NBAP were risk factors for osteoporosis in the G1-4 subgroup. In the G5 subgroup, older age and higher NBAP increased the risk, while high 25-(OH)-Vitamin D or iPTH had protective effects. Nomogram models were developed to assess osteoporosis risk in pre-dialysis patients based on gender and renal function stage. Risk factors for osteoporosis vary by gender and renal function stages. The nomogram clinical prediction models we constructed may aid in the rapid screening of patients at high risk of osteoporosis. [ABSTRACT FROM AUTHOR]

Context Current osteoporosis pharmacological treatment has undesirable side effects. There is increasing focus on naturally derived food substances that contain phytonutrients with antioxidant effects in promoting health and regulating immune response. Objective This review aims to systematically evaluate the effectiveness of anthocyanin-rich foods on bone remodeling biomarkers in middle-aged and older adults (≥40 y old) at risk of osteoporosis. Data Sources Randomized controlled trials were searched on 8 bibliographic databases of PubMed, Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Food Science and Technology Abstracts, Cochrane Library, and ProQuest. Data Extraction and Analysis Thirteen studies were included in the meta-analysis. Receptor activator of nuclear factor kappa-B ligand (RANKL) is exhibited from osteoblastic cells that gathered osteoclasts to bone sites for bone resorption, accelerating bone loss. Anthocyanin-rich food consumption showed statistically nonsignificant effects, with no substantial heterogeneity on bone remodeling biomarkers. However, there was a significant increase in lumbar spine L1–L4 bone mineral density. Mild-to-small effects were seen to largely favor the consumption of anthocyanin-rich foods. Berries (d = –0.44) have a larger effect size of RANKL than plums (d = 0.18), with statistically significant subgroup differences. Random-effects meta-regression found body mass index, total attrition rate, total energy, and dietary carbohydrate and fat intake were significant covariates for the effect size of RANKL. All outcomes had low certainty of evidence. Conclusion Anthocyanin-rich foods may improve bone health in middle-aged and older adults at risk of osteoporosis. This review contributes to the growing interest in nutrient-rich foods as a low-cost and modifiable alternative to promote human health and reduce disease burden. Future high-quality studies with larger sample sizes and longer treatment durations are required to fully understand the effect of anthocyanin-rich foods on bone health. Systematic Review Registration PROSPERO registration no. CRD42022367136. [ABSTRACT FROM AUTHOR]

Background: We assessed the long-term (24 months) efficacy and safety of monthly calcifediol (0.266 mg) in the correction and maintenance of total 25(OH)D levels in postmenopausal women with basal values <30 ng/mL. Methods: We initially enrolled 45 consecutive patients during the period September 2019–September 2020. After an initial visit, patients were instructed to return at 3, 6, 9, 12 and 24 months for measuring serum total 25(OH)D, ionised calcium, creatinine and isoenzyme of alkaline phosphatase (bALP). Here, we report only the per-protocol analysis, because the COVID-19 pandemic precluded adherence to the scheduled visits for some patients. Results: The patients' mean age was 62.4 ± 9.0 years. Mean basal 25(OH)D levels were 20.5 ± 5.3 ng/mL. There was a continuous increase of mean 25(OH)D values (p for trend < 0.001). However, mean values at month 24 (36.7 ± 15.9) were not significantly different in respect to values at month 12 (41.2 ± 11.18). At 24 months, only 1 out 19 patients had a value <20 ng/mL. There was a significant decrease with time of mean values of bALP (p < 0.0216), with no significant changes between 12 and 24 months. No significant changes were observed as far as ionised calcium or creatinine were concerned. Conclusions: The long-term administration of calcifediol maintains stable and sustained 25(OH)D concentrations, with no safety concerns. [ABSTRACT FROM AUTHOR]

Background: Electromagnetic fields are forces associated with moving electric charges and have electrical, magnetic components and contain electromagnetic energy, one of which is radio frequency (RF) energy which is commonly used in telecommunications. Cell phones are one of the RF electromagnetic radiation devices that can emit 90-2450 MHz waves and are often placed near the head. The human body works like an electromagnetic field in that each cell has its own electrical circuit characteristics. As the number of electromagnetic radiation devices in the environment increases, the electromagnetic balance in the human body may be disturbed by the magnetic waves produced by cell phones. Electromagnetic radiation is known to have the ability to induce oxidative stress, which is characterized by the accumulation of reactive oxygen species (ROS) in tissues. The accumulation of ROS in the body leads to osteoblast cell death. Osteoblasts are needed for mineralization of the extracellular matrix during bone growth. Therefore, bone growth is not optimal and can caused malocclusion. Purpose: This study aims to evaluate the relationship between electromagnetic radiation and osteocalcin and bone alkaline phosphatase (BALP) serum levels. Methods: Experimental laboratory research with a pre- and post-control group design approach was carried out on 12 Rattus norvegicus Wistar strain. Osteocalcin and BALP serum levels were calculated before and after treatment. This study used the t-test as a comparative study (p

Vitamin D is a vital indicator of musculoskeletal health, as it plays an important role through the regulation of bone and mineral metabolism. This meta-analysis was performed to investigate the effects of vitamin D supplementation/fortification on bone turnover markers in women. All human randomised clinical trials reported changes in bone resorption markers (serum C-terminal telopeptide of type-I collagen (sCTX) and urinary type I collagen cross-linked N-telopeptide (uNTX)) or bone formation factors (osteocalcin (OC), bone alkaline phosphatase (BALP) and procollagen type-1 intact N-terminal propeptide (P1NP)) following vitamin D administration in women (aged ≥ 18 years) were considered. Mean differences (MD) and their respective 95 % CI were calculated based on fixed or random effects models according to the heterogeneity status. Subgroup analyses, meta-regression models, sensitivity analysis, risk of bias, publication bias and the quality of the included studies were also evaluated. We found that vitamin D supplementation had considerable effect on sCTX (MD: −0·038, n 22) and OC (MD: −0·610, n 24) with high heterogeneity and uNTX (MD: −8·188, n 6) without heterogeneity. Our results showed that age, sample size, dose, duration, baseline vitamin D level, study region and quality of studies might be sources of heterogeneity in this meta-analysis. Subgroup analysis also revealed significant reductions in P1NP level in dose less than 600 μg/d and larger study sample size (>100 participants). Moreover, no significant change was found in BALP level. Vitamin D supplementation/fortification significantly reduced bone resorption markers in women. However, results were inconsistent for bone formation markers. [ABSTRACT FROM AUTHOR]

This article, published in the Dental Journal, examines the impact of cell phone radiation on bone health. The study conducted experiments on rats and discovered that exposure to cell phone radiation resulted in lower levels of bone growth markers in the blood. The researchers propose that this decrease may be due to oxidative stress and cell death in bone cells caused by the radiation. This study highlights the potential negative effects of cell phone radiation on bone health and calls for further research in this area. [Extracted from the article]

Trauma, tooth loss, cancer surgery, congenital malformations, periodontal disease, and oral-maxillofacial surgery are all major causes of bone loss, deformity, or fracture. Bone healing is a physiologically complicated process that also incorporates mechanical factors. Too many doubts concerning bone regeneration and the conditions that promote it have persisted for far too long. To assess the impact of systemic teriparatide therapy on mandibular bone defects healing.Forty male albino rats were randomly divided into two groups: the control group and the treatment group, with 20 rats per group. All rats had the same surgical technique. A small hole was created in the mandible, measuring 3 mm in diameter and 3 mm in depth, and then left unoccupied. The treatment group received a daily subcutaneous injection of Teriparatide at a dose of 10 µg/kg. Animals were subjected to euthanasia at four distinct time intervals (7, 14, 21, and 28) days. Biochemical analyses were done. Teriparatide was shown to elevate serum levels of bone alkaline phosphatase (BALP), elevate serum calcium concentration levels, and lower serum phosphate. There were statistically significant differences in the levels of BALP between the control group and the treated group at 7, 14, and 21 days after the surgical procedure and there was a statistically significant difference in serum calcium levels between the treated group and the control group on day 14 of the experiment. The findings of this research suggest that the systemic administration of teriparatide resulted in an acceleration of bone healing. This was evidenced by a notable elevation in bone alkaline phosphatase levels as seen in the biochemical analysis. Teriparatide slightly elevated serum calcium levels and lowered serum phosphate levels because it is a synthetic parathyroid hormone.

Abstract Background Osteoporosis is a bone metabolic disease that usually causes fracture. The improvement of the clinical diagnostic efficiency of osteoporosis is of great significance for the prevention of fracture. The predictive and diagnostic values of bone alkaline phosphatase (B-ALP) and 25-oxhydryl-vitamin D (25-OH-VD) for osteoporotic vertebral compression fractures (OVCFs) were evaluated. Methods 110 OVCFs patients undergoing percutaneous vertebroplasty were included as subjects and their spinal computed tomography (CT) images were collected. After that, deep convolutional neural network model was employed for intelligent fracture recognition. Next, the patients were randomly enrolled into Ctrl group (65 cases receiving postoperative routine treatment) and VD2 group (65 cases injected with vitamin D2 into muscle after the surgery). In addition, 100 healthy people who participated in physical examination were included in Normal group. The differences in Oswestry dysfunction indexes (ODI), imaging parameters, B-ALP and 25-OH-VD expressions, and quality of life (QOL) scores of patients among the three groups were compared. The values of B-ALP and 25-OH-VD in predicting and diagnosing OVCFs and their correlation with bone density were analyzed. Results It was demonstrated that computer intelligent medical image technique was more efficient in fracture CT recognition than artificial recognition. In contrast to those among patients in Normal group, B-ALP rose while 25-OH-VD declined among patients in Ctrl and VD2 groups (P

Trauma, tooth loss, cancer surgery, congenital malformations, periodontal disease, and oral-maxillofacial surgery are all major causes of bone loss, deformity, or fracture. Bone healing is a physiologically complicated process that also incorporates mechanical factors. Too many doubts concerning bone regeneration and the conditions that promote it have persisted for far too long. To assess the impact of systemic teriparatide therapy on mandibular bone defects healing. Forty male albino rats were randomly divided into two groups: the control group and the treatment group, with 20 rats per group. All rats had the same surgical technique. A small hole was created in the mandible, measuring 3 mm in diameter and 3 mm in depth, and then left unoccupied. The treatment group received a daily subcutaneous injection of Teriparatide at a dose of 10 µg/kg. Animals were subjected to euthanasia at four distinct time intervals (7, 14, 21, and 28) days. Biochemical analyses were done. Teriparatide was shown to elevate serum levels of bone alkaline phosphatase (BALP), elevate serum calcium concentration levels, and lower serum phosphate. There were statistically significant differences in the levels of BALP between the control group and the treated group at 7, 14, and 21 days after the surgical procedure and there was a statistically significant difference in serum calcium levels between the treated group and the control group on day 14 of the experiment. The findings of this research suggest that the systemic administration of teriparatide resulted in an acceleration of bone healing. This was evidenced by a notable elevation in bone alkaline phosphatase levels as seen in the biochemical analysis. Teriparatide slightly elevated serum calcium levels and lowered serum phosphate levels because it is a synthetic parathyroid hormone. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the levels of bone alkaline phosphatase (BALP) and osteocalcin (OC) in the saliva of growing patients of different maturation levels. The sample consisted of 55 patients (34 females and 21 males of 7–16 years old). Two milliliters of saliva were collected and BALP and OC levels were assessed. Skeletal age was estimated using the cervical vertebral maturation method (CVM). The relationship between the biomarkers' concentration in saliva and skeletal age was examined with the Spearman's coefficient "ρ" (rho). Correlations between skeletal age groups and BALP and OC concentrations were assessed with the Kruskal–Wallis or the Mann–Whitney tests. No statistically significant differences in the levels of BALP (p = 0.568) and OC (p = 0.996) in saliva were identified according to the patient's skeletal age. The use of BALP and OC levels in saliva seems to be dubious for skeletal growth assessment. However, slightly differentiated levels of those biomarkers, especially of BALP, through the different maturation stages, with higher concentrations at the pubertal phase, have been noticed. More studies are needed to clarify the exact potential role of these biomarkers as predictors of pubertal onset. [ABSTRACT FROM AUTHOR]

The study aimed to determine the osteointegration markers after dental implantation and evaluate their predictive value. The study was performed on 60 practically healthy persons who needed teeth rehabilitation using dental implants. The conical-shaped implants (CI) and hexagonal implants (HI) were used. The content of Osteopontin (OPN), Osteocalcin (OC), Alkaline Phosphatase (ALP), Osteoprotegerin (OPG), and nitric oxide (NO) was determined in patients’ gingival crevicular fluid (GCF) and peri-implant sulcular fluid (PISF), collected 1, 3, and 6 months after implantation. During the 3–6 months of observation level of OPN increased in patients with CIs ( 50 years) and HIs (50 years F = 30.104, p < 0.001; HI < 50 years F = 2.246, p < 0.001), ALP increased in patients with CIs (50 years: F = 12.01; p = 0.001) and HIs (50 years - on the 3 days month (CI: F = 18.82, p < 0.001; HI: F = 26.26, p < 0.001), but sharply decreased at the end of sixth month. OPG increased during 1–3 months of the observation in patients 50 years) during 1–6 months of the observation (F = 27.657, p < 0.001). During the post-implantation period, age-related differences in osteointegration were observed. Patients

Background: Osteoporosis is a bone metabolic disease that usually causes fracture. The improvement of the clinical diagnostic efficiency of osteoporosis is of great significance for the prevention of fracture. The predictive and diagnostic values of bone alkaline phosphatase (B-ALP) and 25-oxhydryl-vitamin D (25-OH-VD) for osteoporotic vertebral compression fractures (OVCFs) were evaluated. Methods: 110 OVCFs patients undergoing percutaneous vertebroplasty were included as subjects and their spinal computed tomography (CT) images were collected. After that, deep convolutional neural network model was employed for intelligent fracture recognition. Next, the patients were randomly enrolled into Ctrl group (65 cases receiving postoperative routine treatment) and VD2 group (65 cases injected with vitamin D2 into muscle after the surgery). In addition, 100 healthy people who participated in physical examination were included in Normal group. The differences in Oswestry dysfunction indexes (ODI), imaging parameters, B-ALP and 25-OH-VD expressions, and quality of life (QOL) scores of patients among the three groups were compared. The values of B-ALP and 25-OH-VD in predicting and diagnosing OVCFs and their correlation with bone density were analyzed. Results: It was demonstrated that computer intelligent medical image technique was more efficient in fracture CT recognition than artificial recognition. In contrast to those among patients in Normal group, B-ALP rose while 25-OH-VD declined among patients in Ctrl and VD2 groups (P < 0.05). Versus those among patients in Ctrl group, ODI, Cobb angle, and B-ALP reduced, while bone density, the height ratio of the injured vertebrae, 25-OH-VD, and QOL score increased among patients in VD2 group after the treatment (P < 0.05). The critical values, accuracy, and areas under the curve (AUC) of the diagnosis of OVCFs by B-ALP and 25-OH-VD amounted to 87.8 μg/L versus 30.3 nmol/L, 86.7% versus 83.3%, and 0.86 versus 0.82, respectively. B-ALP was apparently negatively correlated with bone density (r = − 0.602, P < 0.05), while 25-OH-VD was remarkably positively correlated with bone density (r = 0.576, P < 0.05). Conclusion: To sum up, deep learning-based computer CT image intelligent detection technique could improve the diagnostic efficacy of fracture. B-ALP rose while 25-OH-VD declined among patients with OVCFs and OVCFs could be predicted and diagnosed based on B-ALP and 25-OH-VD. Postoperative intramuscular injection of VD2 could effectively improve the therapeutic effect on patients with OVCFs and QOL. [ABSTRACT FROM AUTHOR]

Bone turnover markers (BTMs) are used widely, in both research and clinical practice. In the last 20 years, much experience has been gained in measurement and interpretation of these markers, which include commonly used bone formation markers (bone alkaline phosphatase, osteocalcin, and procollagen I N-propeptide); and commonly used resorption markers (serum C-telopeptides of type I collagen, urinary N-telopeptides of type I collagen, and tartrate-resistant acid phosphatase type 5b). BTMs are usually measured by enzyme-linked immunosorbent assay or automated immunoassay. Sources contributing to BTM variability include uncontrollable factors (eg, age, gender, ethnicity) and controllable factors, particularly relating to collection conditions (eg, fasting/feeding state, and timing relative to circadian rhythms, menstrual cycling, and exercise). Pregnancy, season, drugs, and recent fracture(s) can also affect BTMs. BTMs correlate with other methods of assessing bone turnover, such as bone biopsies and radiotracer kinetics, and can usefully contribute to diagnosis and management of several diseases such as osteoporosis, osteomalacia, Paget's disease, fibrous dysplasia, hypophosphatasia, primary hyperparathyroidism, and chronic kidney disease–mineral bone disorder. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the levels of bone alkaline phosphatase (BALP) and osteocalcin (OC) in the saliva of growing patients of different maturation levels. The sample consisted of 55 patients (34 females and 21 males of 7–16 years old). Two milliliters of saliva were collected and BALP and OC levels were assessed. Skeletal age was estimated using the cervical vertebral maturation method (CVM). The relationship between the biomarkers’ concentration in saliva and skeletal age was examined with the Spearman’s coefficient “ρ” (rho). Correlations between skeletal age groups and BALP and OC concentrations were assessed with the Kruskal–Wallis or the Mann–Whitney tests. No statistically significant differences in the levels of BALP (p = 0.568) and OC (p = 0.996) in saliva were identified according to the patient’s skeletal age. The use of BALP and OC levels in saliva seems to be dubious for skeletal growth assessment. However, slightly differentiated levels of those biomarkers, especially of BALP, through the different maturation stages, with higher concentrations at the pubertal phase, have been noticed. More studies are needed to clarify the exact potential role of these biomarkers as predictors of pubertal onset.

Alkaline phosphatases (ALPs) are a group of isoenzymes, situated on the external layer of the cell membrane; they catalyze the hydrolysis of organic phosphate esters present in the extracellular space. Zinc and magnesium are significant co-factors for the biological activity of these enzymes. Although ALPs are available in various body tissues and have distinct physiochemical properties, they are true isoenzymes since they catalyze a similar reaction. In the liver, ALP is cytosolic and present in the canalicular membrane of the hepatocytes. ALPs are available in placenta, ileal mucosa, kidney, bone, and liver. However, most of the ALPs in serum (over 80%) are delivered from liver and bone and in more modest quantities from the intestines. Despite the fact that alkaline phosphatases are found in numerous tissues all through the body, their exact physiological function remains largely unknown. [ABSTRACT FROM AUTHOR]

Our study aimed to investigate the systemic and topical effect of xylitol on the bone Alkaline Phosphatase and the bone mineral density in rabbits at the healing site in femur bone postoperatively. Twenty-four healthy white male, New Zealand rabbits, will be taken from the same species; the same age, Weight, and circumstance were chosen in this study. The Weight ranges from (1.3- 1.8) Kg and aged (6-8) months were used in this study ). All animals were submitted to operation in the femur bone region. The groove of 2mm diameter was drilled in the femur bone by using the heavy-duty dental engine. After the operation, the rabbits were randomly divided into three groups (8 rabbits/group); each group was subdivided into 2 experimental periods (14,28 days) four rabbits for each period as follows: Control group, n=8 (the hole was not filled by anything), locally treated group n=8 (xylitol powder was applied and condensed well in the hole) and systemically treated group n=8 (the hole was not filled by anything but the rabbits received orally of 1mg/kg of xylitol. Bone alkaline phosphates and radiological analysis were measured after 14 and 28 days, respectively. Statistical analysis showed significant differences between all groups (control and treated). Biochemical analysis for bone alkaline phosphatase showed a significant increase in bone Alkaline Phosphatase in the systemically treated group compared with the control one. The estimated bone healing by measuring the diameter of bone defect showed a highly significant difference in diameter in the bone defect at day 14 between the control group (36.0±0.05) in comparison with the treated local group and systemic treated group (39± 0.78) and (25± 0.90) respectively. Also, we found a significant difference between the local treated group (39± 0.78) and systemic treated group (25± 0.90) in diameter. Still, on day 28, there was no significant difference between the control group (28.0±0.55) and the local treated group in diameter in the bone defects. There were significant differences between the control and the local treated groups compared with the systemic treated group (24.0 ± 0.23) at p ≤0.05. This study concluded that xylitol was accelerating bone healing when used topically and systemically, and this was indicated by increasing the bone alkaline phosphates and bone mineral density in densitometric analysis.

Preventing osteoporotic fractures is an issue requiring urgent attention to reduce mortality. However, unlike chronic kidney disease-mineral and bone disorder (CKD-MBD), osteoporosis is inadequately addressed in patients undergoing chronic dialysis. In fact, little is known about the proper use of anti-osteoporotic drugs for patients with CKD-MBD. A recent study showed that romosozumab, an anti-osteoporotic drug, increased bone mineral density in osteoporotic patients on hemodialysis without clinically significant adverse events. However, the efficacy and safety of coadministering romosozumab with a calcium-sensing receptor (CaSR) agonist, a pivotal drug used in the management of CKD-MBD, remain unclear. Here, we report the case of a postmenopausal woman undergoing chronic hemodialysis and treated with add-on romosozumab for osteoporosis to CaSR agonist for secondary hyperparathyroidism. After 1 year of treatment, her bone mineral density increased; however, hypocalcemia occurred during the treatment. These results suggest that the concomitant use of romosozumab with CaSR agonist may be a possible treatment option for severe osteoporosis in postmenopausal women receiving chronic hemodialysis with a high fracture risk, but serum calcium levels should be monitored closely and those at risk of ectopic calcification might not be ideal candidates for such treatment.

Introduction/Background Children with moderate-to-severe atopic dermatitis (AD) are at increased risk of lower bone mineral density (BMD) and fractures. Peak bone mass achieved during prepubescence is a major determinant of lifetime risk of fractures and osteoporosis. Bone alkaline phosphatase (BALP) promotes bone mineralization and contributes to density and linear growth in children. Systemic corticosteroids (SCS) negatively impact growth and bone health. Objectives To describe the impact of dupilumab treatment on BALP in children aged 6–11 years with moderate-to-severe AD and prior history of SCS use. Methods BALP levels in sera from participants receiving dupilumab 300 mg every 4 weeks (q4w) or placebo in LIBERTY AD PEDS (NCT03345914) and dupilumab 300 mg q4w in LIBERTY AD PED-OLE (NCT02612454) were analyzed at baseline and at 8, 12, 16 (PEDS), and 52 weeks (PED-OLE). Serum BALP levels (mcg/L) were stratified by prior use (with SCS; n = 42) or with no prior use of SCS (without SCS; n = 203), as captured in PEDS patient history at baseline. Results Regardless of prior SCS use, dupilumab treatment led to significant increase in BALP levels in children with moderate-to-severe AD at Week 16 compared with the placebo group (with SCS: 300 mg q4w [n = 25] vs placebo [n = 17], mean change [standard deviation] in BALP levels of 15.1 mcg/L [16.5] vs −5.5 mcg/L [16.0], P = 0.0099; without SCS: 300 mg q4w [n = 97] vs placebo [n = 106], 11.8 mcg/L [18.8] vs 2.2 mcg/L [16.3], P = 0.0074). By Week 52, BALP levels further increased vs baseline regardless of prior SCS use and were comparable with reference intervals (with SCS: 24.5 mcg/L [16.8], P = 0.0044; without SCS: 13.4 mcg/L [19.4], P = 0.0002). Patients in the placebo group who switched to dupilumab in PED-OLE had improved to levels similar to those of patients continuing treatment by Week 52 (with SCS: 23.3 mcg/L [19.3], P = 0.0067 [vs baseline]; without SCS: 18.4 mcg/L [20.4], P < 0.0001 [vs baseline]). Conclusions Dupilumab treatment increased BALP levels in children aged 6-11 years with moderate-to-severe AD irrespective of prior history of SCS use. These results add to the body of evidence that moderate-to-severe AD can negatively impact BALP levels, and that this effect may be improved with dupilumab in this age group, regardless of history of SCS use. The increase in BALP levels suggests that dupilumab may help improve bone mineralization in children with moderate-to-severe AD when treated during prepubescence. [ABSTRACT FROM AUTHOR]

BACKGROUND: Due to the super-healing effect, platelet-rich plasma is gradually used in the clinic. Nevertheless, high-quality clinical comparative studies are currently absent to identify its effect on fracture nonunion and its action mechanism. OBJECTIVE: To compare the effects between platelet-rich plasma combined with surgery and surgery alone in the treatment of nonunion after tibial shaft fractures, and to analyze the corresponding laboratory indicators of fracture repair. METHODS: Thirty patients with nonunion of tibial shaft fractures treated in Weihai Central Hospital Affiliated to Qingdao University from January 2017 to January 2020 were enrolled in this study. According to the second operation method, these patients were divided into platelet-rich plasma combined surgery group (n=16; autologous platelet-rich plasma injection once every other week for three injections) and operation group (n=14). Blood samples were taken from patients of the two groups to detect the levels of osteocalcin, bone alkaline phosphatase and β-I collagen carboxyl terminal peptide on the day of surgery (before surgery) and at 2, 4, 8, and 12 weeks after surgery. The surgical incision healing of the patients was observed between the two groups. At 3, 6, and 9 months after surgery, the callus and fracture line imaging scores and visual analogue scale scores were analyzed in the two groups, and the clinical healing and bone healing time were recorded in the two groups. The protocol was approved by the Ethics Committee of Weihai Central Hospital Affiliated to Qingdao University (approval No. 2016-Lunshen-07). RESULTS AND CONCLUSION: (1) The levels of serum osteocalcin, bone alkaline phosphatase and β-I collagen carboxyl terminal peptide increased in the two groups after surgery. The osteocalcin level in the platelet-rich plasma combined surgery group was higher than that in the operation group at 2 and 4 weeks after surgery (P < 0.05). Bone alkaline phosphatase was higher in the platelet-rich plasma combined surgery group than that in the operation group at 2, 4, and 8 weeks after surgery (P < 0.05). The β-I collagen carboxyl terminal peptide level was higher in the platelet-rich plasma combined surgery group than that in the operation group after surgery (P < 0.05). (2) The grade A healing rates of incisions were 88% and 64% in the platelet-rich plasma combined surgery group and the operation group, respectively. The clinical fracture healing time and bone healing time were shorter in the platelet-rich plasma combined surgery group than those in the operation group (P < 0.05). (3) The imaging scores of callus and fracture line were higher in the platelet-rich plasma combined surgery group than those of the operation group at 3, 6, and 9 months after surgery (P < 0.05). Visual analogue scale scores were lower in the platelet-rich plasma combined surgery group than those of the operation group (P < 0.05). (4) These findings indicate that the effect of platelet-rich plasma combined with surgery for nonunion of tibial shaft fractures is better than that of surgery alone. Their combination can increase the serum levels of osteocalcin, bone alkaline phosphatase, and β-I collagen carboxyl terminal peptide, and is helpful to investigate the mechanism of platelet-rich plasma for fracture nonunion and to judge the clinical prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Osteoporosis could be viewed as a metabolic disease. The WHO guidelines for diagnosing osteoporosis reflect structural damage only and not the metabolic imbalance that leads to it. Biochemical markers of bone turnover have been shown to provide valuable information for diagnosing and monitoring metabolic bone disease. The present study analyzed bone-specific alkaline phosphatase (BALP) and urinary hydroxyproline in pre- and postmenopausal women and correlated them with changes in bone mineral density (BMD) in the state of Sikkim. The study also intended to know the ethnicity-based disease burden in Sikkim. Materials and Methods: A hospital-based cross-sectional study was done at a tertiary hospital in Sikkim. Blood and 24-h urine samples from 50 premenopausal and 50 postmenopausal women were analyzed for total alkaline phosphatase (ALP), BALP, and Urine Hydroxyproline. BMD was measured using the quantitative ultrasound technique by Achilles densitometer. Results: There was a statistically significant increase in serum calcium (P = 0.01), ALP (P = 0.01), and urine hydroxyproline (P = 0.03) levels in postmenopausal women as compared to premenopausal women. Although ALP was higher in postmenopausal women, BALP isoform was more elevated in premenopausal women (P = 0.001). BMD was significantly lower in postmenopausal women (P < 0.001). It was also noted that there was a significant difference in BMD between tribal and nontribal populations (P = 0.003). Total ALP and BALP as the bone formation marker and urine hydroxyproline as a bone resorption marker added statistically significant r to BMD prediction (P < 0.05). Conclusion: In this study, BALP combined with Urine Hydroxyproline was helpful as a screening biomarker to predict osteoporosis in postmenopausal women.

Alkaline phosphatase (ALP) is an evolutionary conserved enzyme and widely used biomarker in clinical practice. Tissue-nonspecific alkaline phosphatase (TNALP) is one of four human isozymes that are expressed as distinct TNALP isoforms after posttranslational modifications, mainly in bone, liver, and kidney tissues. Beyond the well-known effects on bone mineralization, the bone ALP (BALP) isoforms (B/I, B1, B1x, and B2) are also involved in the pathogenesis of ectopic calcification. This narrative review summarizes the recent clinical investigations and mechanisms that link ALP and BALP to inflammation, metabolic syndrome, vascular calcification, endothelial dysfunction, fibrosis, cardiovascular disease, and mortality. The association between ALP, vitamin K, bone metabolism, and fracture risk in patients with chronic kidney disease (CKD) is also discussed. Recent advances in different pharmacological strategies are highlighted, with the potential to modulate the expression of ALP directly and indirectly in CKD–mineral and bone disorder (CKD-MBD), e.g., epigenetic modulation, phosphate binders, calcimimetics, vitamin D, and other anti-fracture treatments. We conclude that the significant evidence for ALP as a pathogenic factor and risk marker in CKD-MBD supports the inclusion of concrete treatment targets for ALP in clinical guidelines. While a target value below 120 U/L is associated with improved survival, further experimental and clinical research should explore interventional strategies with optimal risk–benefit profiles. The future holds great promise for novel drug therapies modulating ALP. [ABSTRACT FROM AUTHOR]

Aim:The Amelogenesis Imperfecta (AI) term includes numerous inherited congenital enamel defects indicating clinical and genetic heterogeneity. The aim of the present study was to emphasize the importance of the potential prediction of AI via biochemical parameters.Materials and Methods:In total, 50 children were assessed in the study. The subjects included 13 syndromic AI, 22 isolated AI and 15 healthy children with a mean-age of 12.01±3.79 years old. The bone alkaline Phosphatase (BALP) and growth hormone (GH) blood levels of the children were evaluated. All data were statistically analysed by the SPSS 15.0 programme, one-way ANOVA and chi-square tests.Results:72.7% of syndromic AI and 47.6% of isolated AI group children have higher than normal BALP levels; 33% of syndromic AI and 28% of isolated AI group children have lower than normal blood GH levels. Subjects with AI have statistically significant abnormal blood BALP and GH levels and the presence of an Additional syndrome other than AI did not affect the results.Conclusion:Pediatricians may have a key role in early AI diagnosis via the evaluation of abnormal BALP and GH levels in blood tests and may help in providing comprehensive dental treatment in terms of prevention, prognosis and restoration of teeth in children with AI.

Our study aimed to investigate the systemic and topical effect of xylitol on the bone Alkaline Phosphatase and the bone mineral density in rabbits at the healing site in femur bone postoperatively. Twenty-four healthy white male, New Zealand rabbits, will be taken from the same species; the same age, Weight, and circumstance were chosen in this study. The Weight ranges from (1.3-1.8) Kg and aged (6-8) months were used in this study). All animals were submitted to operation in the femur bone region. The groove of 2mm diameter was drilled in the femur bone by using the heavy-duty dental engine. After the operation, the rabbits were randomly divided into three groups (8 rabbits/group); each group was subdivided into 2 experimental periods (14,28 days) four rabbits for each period as follows: Control group, n=8 (the hole was not filled by anything), locally treated group n=8 (xylitol powder was applied and condensed well in the hole) and systemically treated group n=8 (the hole was not filled by anything but the rabbits received orally of 1mg/kg of xylitol. Bone alkaline phosphates and radiological analysis were measured after 14 and 28 days, respectively. Statistical analysis showed significant differences between all groups (control and treated). Biochemical analysis for bone alkaline phosphatase showed a significant increase in bone Alkaline Phosphatase in the systemically treated group compared with the control one. The estimated bone healing by measuring the diameter of bone defect showed a highly significant difference in diameter in the bone defect at day 14 between the control group (36.0±0.05) in comparison with the treated local group and systemic treated group (39± 0.78) and (25± 0.90) respectively. Also, we found a significant difference between the local treated group (39± 0.78) and systemic treated group (25± 0.90) in diameter. Still, on day 28, there was no significant difference between the control group (28.0±0.55) and the local treated group in diameter in the bone defects. There were significant differences between the control and the local treated groups compared with the systemic treated group (24.0 ± 0.23) at p ≤0.05. This study concluded that xylitol was accelerating bone healing when used topically and systemically, and this was indicated by increasing the bone alkaline phosphates and bone mineral density in densitometric analysis. [ABSTRACT FROM AUTHOR]

Despite the current debate on the best therapeutic approach, i.e. symptomatic vs intensive strategy, one zoledronate (Zol) infusion is effective in most patients with Paget's disease of bone (PDB), whereas few need retreatment, whose predictors are not well established. We aimed to evaluate long-term efficacy of intensive Zol therapy and predictors of retreatment in PDB. Pagetic complications, clinical and biochemical response to Zol together with frequency of retreatment were retrospectively assessed in forty-seven PDB patients (age, mean ± SD: 72.5 ± 8.9 years, M/F: 24/23; symptomatic/asymptomatic: 16/31). Statistical analysis for retreatment prediction were based on Mann–Whitney U test, Pearson's Χ2 and ROC curve analysis. During seven-year follow-up, all patients achieved pain relief and only one underwent arthroplasty. Bone alkaline phosphatase (BAP) detected three non-responder (6%) and six relapsing (13%) patients needing retreatment. Retreated patients had less old age (66.1 ± 11.2 vs 74.0 ± 7.7 years), higher frequency of polyostotic disease (78% vs 40%) and higher baseline (96.5 ± 24.8 vs 44.9 ± 27.7 mcg/l) and post-Zol nadir BAP levels (24.7 ± 24.1 vs 8.1 ± 4.1 mcg/l) than patients treated once (p < 0.05 for all comparisons). In multivariate analysis both serum baseline and post-Zol nadir BAP significantly predicted retreatment (OR 1.09, 95%CI 1.01–1.17 and 1.29, 1.03–1.62, respectively), with ROC curve analysis showing the greatest accuracies for threshold values of 75.6 and 9.9 mcg/l (sensitivity 88 and 90%, specificity 94 and 86%, AUC 0.92 and 0.93, respectively). Our data in mostly asymptomatic, metabolically active PDB patients treated with intensive Zol therapy show a negligible incidence of pagetic complications and long-term optimal disease control, with BAP being the best predictor of retreatment. [ABSTRACT FROM AUTHOR]

Introduction: Osteoporosis could be viewed as a metabolic disease. The WHO guidelines for diagnosing osteoporosis reflect structural damage only and not the metabolic imbalance that leads to it. Biochemical markers of bone turnover have been shown to provide valuable information for diagnosing and monitoring metabolic bone disease. The present study analyzed bone-specific alkaline phosphatase (BALP) and urinary hydroxyproline in pre- and postmenopausal women and correlated them with changes in bone mineral density (BMD) in the state of Sikkim. The study also intended to know the ethnicity-based disease burden in Sikkim. Materials and Methods: A hospital-based cross-sectional study was done at a tertiary hospital in Sikkim. Blood and 24-h urine samples from 50 premenopausal and 50 postmenopausal women were analyzed for total alkaline phosphatase (ALP), BALP, and Urine Hydroxyproline. BMD was measured using the quantitative ultrasound technique by Achilles densitometer. Results: There was a statistically significant increase in serum calcium (P = 0.01), ALP (P = 0.01), and urine hydroxyproline (P = 0.03) levels in postmenopausal women as compared to premenopausal women. Although ALP was higher in postmenopausal women, BALP isoform was more elevated in premenopausal women (P = 0.001). BMD was significantly lower in postmenopausal women (P < 0.001). It was also noted that there was a significant difference in BMD between tribal and nontribal populations (P = 0.003). Total ALP and BALP as the bone formation marker and urine hydroxyproline as a bone resorption marker added statistically significant r to BMD prediction (P < 0.05). Conclusion: In this study, BALP combined with Urine Hydroxyproline was helpful as a screening biomarker to predict osteoporosis in postmenopausal women. [ABSTRACT FROM AUTHOR]

Background: Problem of the variability between the different methods using for bone alkaline phosphatase (bALP) determination greately influences the clinical significance of bALP as direct marker of bone metabolism. The aim of this study was to compare immunoassay with electrophoresis technique for bALP determination. Methods: We measured bALP in 71 patients on hemo - dialysis with agar gel electrophoresis (ISO-PAL, SEBIA) and immunoassay (OSTASE, Beckman Coulter). Results: The analyzed methods showed significant correlation (Spearman's rho: 0.776, P < 0.01), but we found statistically significant (P < 0.01) positive bias (27%) for the results measured by immunoassay. In support of this, using electrophoresis technique we have detected presence of the intestinal isoenzymes of alkaline phosphatase in 55% of patients with median value of 30% of the total alkaline phoshatase and presence of liver-2 alkaline phosphatase isoform in 42% of patients with median value of 16.6%. The Kendall's W of 0.787 (P

The aim of the present study was to characterize biomarkers of bone turnover and their relation with bone mineral mass in a cross-sectional cohort of girls with Rett syndrome (RTT) and to examine the role of dietary, biochemical, hormonal, and inflammatory factors on bone mineral mass and bone biomarkers in this disorder.Total body bone mineral content (BMC) and bone mineral density (BMD) were determined by dual-energy x-ray absorptiometry. Dietary nutrient intakes were determined from 3-day food records. Biomarkers of bone turnover, bone metabolites, vitamin D metabolites, hormones, and inflammatory markers were measured by standard clinical laboratory methods.Serum osteocalcin, bone alkaline phosphatase, and C-telopeptide showed significant inverse relations with age in the RTT cohort. Mean osteocalcin concentrations were significantly lower and mean bone alkaline phosphatase concentrations were significantly higher for individual age groups in the RTT cohort than mean values for their respective age ranges in the reference population. Significant inverse associations were identified between urinary calcium losses, expressed as calcium:creatinine ratios, and total body BMC and BMD z scores. Dietary protein, calcium, and phosphorus intakes, expressed as a proportion of Dietary Reference Intakes for age and sex, showed significant positive associations with total body BMD z scores.The present study suggests decreased bone formation instead of increased bone resorption may explain in part the deficits in bone mineral mass in RTT and that attention to the adequacy of dietary protein, calcium, and phosphorus intakes may offer an opportunity to improve bone health in RTT.

Bone is an important organ for supports the body that stores reserve of calcium, phosphorus, and other minerals. In fracture conditions where bleeding, soft tissue edema, nerve damage, and blood vessels around the bone damage happen, they can cause the mobilization of these minerals in the surrounding tissue. One of the efforts made in the treatment of these fractures is reconnection, in which it works by filling of bone defect with a matrix and administration of anti-infection. Biomaterial filling in defective bone is thought to accelerate the healing process of bone fracture and prevent osteomyelitis. For this reason, this study evaluates the acceleration of bone fracture healing using natural hydroxyapatite (NHA) bone filler in rabbits with bone defect model. Fracture modeling was performed by surgical technique and drilling of bones with a 4.2 mm diameter to form a defect in the rabbit femur. Bone implant contained bovine hydroxyapatite-gelatin-glutaraldehyde (BHA implant) or bovine hydroxyapatite-gelatin-glutaraldehyde-gentamicin (BHA-GEN implant) that was inserted in bone defects. 27 rabbits were divided into 3 groups: the control group who had bone defect, the bone defect group was given BHA implant and the bone defect group was given BHA-GEN implant. Observation of osteoclast, osteoblast, osteocyte, BALP level, and bone morphological integrity was carried out on the 14th, 28th, and 42nd days after surgery. Histological observation of rabbit femur showed a significant difference on the number of osteoclast, osteoblast and osteocyte in all three groups. The BALP level also showed a significant difference in the group given the natural BHA bone implant compared to the control group on day 14 (p = 0.0361). Based on the result of the X-ray, there was also a better integration of rabbit femur bone in groups with the use of BHA or BHA-GEN bone implant. Thus, it can be concluded that the use of a natural BHA implant can accelerate the process of bone repair in the fracture of rabbit femur. In addition, BHA implants were compatible as a matrix for supporting the bone cell growth.

Objective: To study the mechanism of the effect of iguratimod on bone mineral density and serum Bone alkaline phosphatase (B-ALP) and Type I collagen crosslinked carboxy terminal peptide (CTX-I) in patients with refractory rheumatoid arthritis. Methods: 134 patients of refractory rheumatoid arthritis who received therapy from January 2019 to December 2020 in our hospital were selected as research objects, according to the random number table, they were divided into the observation group and the control group, 67 cases in each group. The control group was treated with methotrexate combined with etanercept, and the observation group was treated with iguratimod combined with etanercept, they were continuous treatment 12 weeks. The clinical remission rate, laboratory indexes, disease evaluation (DAS28 score), bone mineral density, serum B-ALP, CTX-I and adverse reactions were compared between the two groups. Results: After treatment, the clinical remission rate in the observation group was 90.00%, significantly higher than the control group 72.50% (P＜0.05); the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti cyclic peptide antibody (anti CCP) and DAS28 scores in the observation group were (23.53±2.77) mm/h, (11.73±2.30) mg/L, (17.45±3.08) U/L, (43.22±7.17) RU/mL, (2.74±0.34) scores respectively, which were significantly lower than the control group (31.27±5.04) mm/h, (19.11± 2.12) mg/L, (24.47±2.59) U/L, (55.23±7.44) RU/mL, (3.21±0.50) scores, the difference were statistically significant (P＜0.05); the bone mineral density and serum B-ALP in the observation group were (0.83±0.05) g/cm³, (117.02±15.65) U/L, which were significantly higher than the control group (0.77±0.04) g/cm³, (101.19±9.59) U/L, the CTX-I in the observation group were (0.36±0.04) μg/L, which were significantly lower than the control group (0.47±0.04) μg/L, the difference were statistically significant (P＜0.05); the total incidence of adverse reactions in the two groups was 4.44% and 2.22% respectively, there were no significant difference (P＞0.05). Conclusion: Iguratimod combined with etanercept is well for refractory rheumatoid arthritis, which can effectively improve the expression of BMD, serum B-ALP and CTX-I, improve the clinical remission rate, and has good safety, which is worth popularizing. [ABSTRACT FROM AUTHOR]

Background: Tartrate-resistant acid phosphatase 5b (TRACP5b) is a bone resorption marker that is mainly used in clinical management of osteoporosis. For proper interpretations of test results for serum TRACP5b, we explored their biological sources of variation, esp. age-related changes, and associations with other bone-related markers in healthy Japanese adults. Methods: During the 2009 East-Southeast Asian multicentre study for determination of reference intervals, 72 major laboratory tests were measured by centralized assays in 3541 well-defined healthy volunteers. The current study included 1980 test results in Japanese subjects for five bone-related markers: TRACP5b, bone alkaline phosphatase, intact parathyroid hormone, calcium and inorganic phosphate. Information on sources of variation, including body mass index, smoking habits and ABO-blood group, were obtained from a health status questionnaire. Results: Gender-specific profiles of age-related changes were observed for each parameter. Increased values starting from 40 years of age in females were most prominent for TRACP5b, followed by bone alkaline phosphatase and inorganic phosphate. TRACP5b in males decreased with body mass index, bone alkaline phosphatase and TRACP5b were higher in blood type-O subjects, especially in males. TRACPT5b was closely correlated with bone alkaline phosphatase, and moderately correlated with adjusted calcium and inorganic phosphate, especially in females aged ≥45 years. Reference intervals for each analyte were determined parametrically based on gender and age. Conclusions: This study elucidated sources of variation of TRACP5b and related bone markers in healthy Japanese subjects and demonstrated a specific age profile for each marker. These results are of relevance for better clinical usage and interpretations of serum levels of bone markers. [ABSTRACT FROM AUTHOR]

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In clinical veterinary practice, changes in mineral metabolism after nephrectomy have been studied. While these changes are not fully established, alterations in biomarkers of bone metabolism, particularly in nephrectomized dogs, have not yet been studied. The goal of this study was to investigate both bone-specific alkaline phosphatase (BALP) changes as a biomarker of bone turnover and changes in other parameters of mineral metabolism after unilateral nephrectomy in dogs. Ten apparently clinically healthy Egyptian stray dogs were used in this study. While complete hemogram was done before surgery, physical examination and serum biochemistry were performed immediately before (0 day), 5, and 30 days after surgery. There are no changes between clinical parameters for all dogs before and after surgery which are within normal references value. Serum biochemistry showed that BALP increased significantly (40.76 ± 11.83 IU/ L, P < 0.01) 30 days after nephrectomy. There were no significant changes in serum concentrations of total calcium (Ca), inorganic phosphorus (Ph), sodium (Na) and creatinine after surgery while alanine aminotransferase (ALT) activity showed a significant (289.50 ± 14.73 IU/L, P < 0.0005) increase after surgery. We concluded that complete unilateral nephrectomy in dogs is accompanied by a change in BALP, a biomarker of bone turnover, and a change in liver function. Appropriate care following nephrectomy in canine kidney donors or urological indications may be concerned to avoid those changes. [ABSTRACT FROM AUTHOR]

Background: Radium-223 is an active therapy option for bone metastatic castration-resistant prostate cancer (mCRPC). The lack of adequate biomarkers for patient selection and response assessment are major drawbacks for its use., Objective: To assess the prognostic value of bone metabolism biomarkers (BMBs) in ra-223-treated mCRPC patients., Design, Setting, and Participants: A prospective cohort study of mCRPC patients treated with Ra-223 (PRORADIUM study: NCT02925702) was conducted., Outcome Measurements and Statistical Analysis: The main objective of the study was to evaluate the association between high (≥median) baseline values in at least three bone formation (bone alkaline phosphatase [BAP] and C-terminal type-I collagen propeptide) and bone resorption (N-terminal telopeptide and pyridinoline) biomarkers, and survival. The independent prognostic value of each BMB was also assessed. The association with time to radiographic, clinical, and prostate-specific antigen (PSA) progression; time to skeletal-related events; and PSA response were secondary objectives. Multivariable (MV) Cox-regression models were evaluated., Results and Limitations: A total of 169 patients were included. Of the patients, 70.4% received Ra-223 in second/third line; 144 (85.2%) were Eastern Cooperative Oncology Group 0-1, 126 (74.6%) were in pain, and 80 (47.5%) had more than ten bone metastases. Sixty-seven (39.6%) patients had elevation in at least three BMBs. The median overall survival was 12.1 mo (95% confidence interval [CI]: 10-14.7). No association was observed with other treatment-related secondary outcome parameters. Patients with high values in three or more BMBs had significantly worse survival (9.9 vs 15.2 mo; hazard ratio [HR]: 1.8 [95% CI: 1.3-2.5]; p < 0.001) in the univariate analysis, but not independent in the MV analysis (HR: 1.33; 95% CI: 0.89-2; p = 0.181). High baseline BAP was the only biomarker associated with survival in the MV model (HR: 1.89; 95% CI: 1.28-2.79; p = 0.001). Addition of BAP to the MV clinical model increased the area under the receiver operating characteristic curve 2-yr value from 0.667 to 0.755 (p = 0.003)., Conclusions: Biomarkers of bone formation, especially BAP, have prognostic value in mCRPC patients treated with radium-223. Its predictive value remains to be assessed, ideally in prospective, adequately powered, randomised clinical trials., Patient Summary: In this study, we evaluate the role of bone metabolism biomarkers to help improve the use of radium-223 as therapy for advanced prostate cancer. We found that bone alkaline phosphatase may be a suitable tool., (Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Despite being studied extensively, there are still many knowledge gaps in milk fever prevention and it is still a prevalent disease. Various interventions have been used in its prevention; however, none has proven to be entirely effective. The study aimed to assess the effectiveness of high dose vitamin D3 parenteral (intramuscularly) administration and the mechanism of its action by studying blood minerals and biochemical bone markers. Further, we assessed the potential of biochemical bone markers, measured in the close-up dry period, as predictors of clinical milk fever after calving. The study was conducted on 56 high yielding, clinically healthy dairy cows, before their 4th or higher lactation. They were divided into three groups based on season (summer and winter) and administration (vitamin D). The winter group was considered as the control group. Cows (n = 13) were parenterally administered a single dose of 10 million IU of vitamin D3 (DUPHAFRAL® D3) ranging between 10 and 2 days before calving (median = 3 days). Each cow was blood sampled once during four sampling period ranges: ~1 month before calving, 10 to 2 days before calving, 12–48 h after calving and 10–20 days after calving. The samples were analyzed for blood minerals, bone specific alkaline phosphatase (bALP) and C-terminal telopeptide of type I collagen (CTx), alkaline phosphatase, and estradiol. Values were compared between samplings and groups. A receiver operating characteristic (ROC) analysis and logistic regression were used to assess the diagnostic accuracy of biochemical bone markers in predicting milk fever. In this study high dose vitamin D3 supplementation did not statistically reduced the incidence of milk fever (milk fever incidences were 15.4, 39.1, and 25% in the vitamin D, winter and summer groups, respectively). A significant effect of vitamin D3 administration on blood minerals or biochemical bone markers was not found at any sampling. We found that the use of biochemical bone markers in the close-up dry period to predict clinical milk fever was applicable only in the winter (housed) group. The area under the curve (AUC) for bALP was 0.804 and 0.846 for CTx using ROC analysis. The bALP curve had the best ratio at the cut-off point 13.85 U/L with 90% sensitivity and 64.3% specificity. While CTx had the ratio of 90% sensitivity and 78.6% specificity at the cut-off point 0.149 ng/mL. Close-up dry dairy cows with CTx ≥0.121 ng/mL had a 3.8 times higher chance of succumbing to milk fever. We were unable to prove that high dose vitamin D3 parenteral administration is a viable technique for milk fever prevention. Biochemical bone markers are a promising tool for predicting milk fever; however, further studies are needed to confirm their clinical use.

Background: Bone remodeling is disrupted in metastatic disease, which affects > 70% of metastatic castration-resistant prostate cancer (mCRPC) patients. As a result, abnormal levels of specific bone turnover biomarkers (BTMs) are released. In this prospective ancillary analysis of the Italian real-world study ABITUDE, four markers were measured during abiraterone acetate plus prednisone (AAP) treatment in chemotherapy-naïve mCRPC men failing androgen-deprivation therapy. Methods: Patients were enrolled if a blood sample was obtained before the first administration of abiraterone (baseline); ad-hoc blood samples were withdrawn during routine tests after 3, 6, and 12 months. A centralized lab measured bone alkaline phosphatase (BALP, osteoblast activity marker), type-I collagen-C-telopeptide (CTX-1, bone resorption marker), parathyroid hormone (PTH) and vitamin D (vitD). At each time point, intra-patient variations vs baseline were compared by the signed-rank test (statistical significance: P-value

Background: Chronic kidney disease (CKD) is associated with numerous complications such as bone mineral disorder. The aim of our study was to analyze the correlation of bone turnover markers with Bone Mineral Density (BMD) measurements in Tunisian end stage renal diseases (ESRD) patients. Methods: This study included 100 ESRD Tunisian patients. Their estimated glomerular filtration rate (eGFR) was < 15 mL X min-1 X (1.73 m2)-1, which requires hemodialysis. Bone-specific alkaline phosphatase (BALP) serum concentration was determined with a chemiluminescence immunoassay. Fibroblast Growth Factor 23 (FGF23) serum was assessed by Enzyme-Linked Immunosorbent Assay method. The serum levels of 25-Hydroxyvitamin D (25(O H)D), intact parathyroid hormone (iPTH) and Beta cross-laps (CTX) was measured by Electrochemiluminescence Technology. DEXA (dual-energy x-ray absorptiometry) technique was used to evaluate BMD. Results: We observed a statistically significant negative correlation between BALP levels and total body BMD (r =-0.268; P = 0.015) particularly in femoral neck (FN) (r = - 0.219; P = 0.037). BALP concentrations were negatively associated with total BMD especially in FN for patients with BMI < 30, FGF23 concentrations were also negatively correlated with BMD in lumbar spine site (LS) (r = -0.209; P = 0.046). For osteopenic patients we found an inverse correlation between 25(OH)D concentrations and BMD in LS position (r = -0.336; P = 0.038). In men group, we have also found a negative correlation between iPTH and total BMD (r = -0.326; P = 0.015). However we found a positive correlation between calcium expression and BMD in LS site (r = 0.270; P = 0.031). Conclusions: FGF23 and BALP can predict bone loss in ESRD through their strong correlation with BMD in LS and FN sites respectively.

Abstract Background The bone markers bone alkaline phosphatase (BAP) and C-terminal telopeptide of type I collagen crosslinks (CTX) are correlated with growth rate during normal puberty. The objective of this study was to evaluate the relationship between the serum concentrations of BAP and CTX and growth evolution in girls with idiopathic central precocious puberty (CPP) to help predict adult height. Methods A retrospective single-center study was conducted in 74 girls with CPP for whom a serum sample at initial evaluation was available to retrospectively measure BAP and CTX concentrations; 66.2% of them were untreated. Results The serum BAP concentrations showed significant positive correlations with height in standard deviations (SDS) at the initial evaluation (n = 62; r = 0.31; p = 0.015) and with the difference between bone and chronological ages (n = 61; r = 0.39; p = 0.002). BAP was also positively correlated with adult height as measured in both cm and SDS in untreated patients (n = 19; r = 0.58; p = 0.009). The serum CTX concentrations showed significant positive correlations with growth rate the year before the initial evaluation as measured in both cm and SDS (n = 65; r = 0.34; p = 0.006). Conclusions This study revealed significant correlations of serum BAP and CTX concentrations with growth evolution in girls with CPP. The high positive correlation between serum BAP and adult height in untreated girls suggests that BAP can possibly be used to optimize models of adult height prediction in girls with CPP.

Background: Growth differentiation factor 15 (GDF15), is a newly identified member of the transforming growth factor-beta (TGF-β) family. It circulates as a 24.5-kDa homodimer. However, the function of GDF15 in bone metabolism remains unclear. In this study, we investigated the function of GDF15 in postmenopausal Chinese women. Methods: We measured serum GDF15 levels, bone mineral density (BMD), and bone turnover markers in 201 postmenopausal Chinese women ranging in age from 47 to 80 years. Results: The concentration of serum GDF15 increased with age. Growth differentiation factor 15 levels displayed a negative correlation with lumbar spine, femoral neck, and total hip BMD. After adjusting for age, this association still existed and was significant. We identified age, GDF15, body mass index (BMI), and estradiol to be associated with BMD. Furthermore, we found that GDF15 levels had a significant negative relationship with bone alkaline phosphatase (BAP) levels; this relationship remained significant after adjustment. However, there was no significant correlation between levels of GDF15 and N-terminal telopeptide of type I collagen (NTX). Conclusions: For postmenopausal Chinese women, GDF15 is a negative predictor of BMD and has a negative correlation with bone formation biomarker BAP. In other words, GDF15 exerts negative regulation on bone mass by inhibiting bone formation. [ABSTRACT FROM AUTHOR]

Objectives; To explore the application value of bone mineral density test in early diagnosis of rickets. Methods: 600 infants and young children diagnosed and treated in the outpatient department of Harrison International Peace Hospital in Hengshui City were collected and divided into non-rickets group and rickets group with serum vitamin D3<27.5 nmol/L as the criterion. vitamin D3, bone alkaline phosphatase and bone mineral density of the infants and young children in the two groups were compared, ROC curves of diagnosis results of vitamin D3, bone alkaline phosphatase and bone mineral density were drawn, and the bone mineral density test results were evaluated. Results: Vitamin D 3 and bone mineral density Z values of infants in rickets group were significantly lower than those in non-rickets group, and bone alkaline phosphatase was significantly higher than that in non-rickets group (P<0.05). The area under ROC curve of vitamin D3 in the diagnosis of rickets was 0.951, the sensitivity was 0.973, and the specificity was 0.840. The area under ROC curve of bone alkaline phosphatase in the diagnosis of rickets was 0.866, the sensitivity was 0.824, and the specificity was 0.747. The area under ROC curve for diagnosing rickets with bone density Z value was 0.923, the sensitivity was 0.826, and the specificity was 0.875. There is no statistical significance between the area under curve for diagnosing rickets with bone density index and vitamin D3(P>0.05), but the area under the curve of bone mineral density index in diagnosis of rickets was larger than that of bone alkaline phosphatase (P<0.05). Conclusions: Ultrasonic bone density detection has certain value in the early diagnosis of infantile rickets. Its diagnostic sensitivity, specificity and accuracy are equal to vitamin D3 and bone density detection with the advantages of non-invasive and high repeatability. [ABSTRACT FROM AUTHOR]

Aim: The Amelogenesis Imperfecta (AI) term includes numerous inherited congenital enamel defects indicating clinical and genetic heterogeneity. The aim of the present study was to emphasize the importance of the potential prediction of AI via biochemical parameters. Materials and Methods: In total, 50 children were assessed in the study. The subjects included 13 syndromic AI, 22 isolated AI and 15 healthy children with a mean-age of 12.01±3.79 years old. The bone alkaline Phosphatase (BALP) and growth hormone (GH) blood levels of the children were evaluated. All data were statistically analysed by the SPSS 15.0 programme, one-way ANOVA and chi-square tests. Results: 72.7% of syndromic AI and 47.6% of isolated AI group children have higher than normal BALP levels; 33% of syndromic AI and 28% of isolated AI group children have lower than normal blood GH levels. Subjects with AI have statistically significant abnormal blood BALP and GH levels and the presence of an Additional syndrome other than AI did not affect the results. Conclusion: Pediatricians may have a key role in early AI diagnosis via the evaluation of abnormal BALP and GH levels in blood tests and may help in providing comprehensive dental treatment in terms of prevention, prognosis and restoration of teeth in children with AI. [ABSTRACT FROM AUTHOR]

Background: Assessing bone turnover in paediatric populations is crucial for understanding the physiological changes occurring during skeletal development and identifying potential abnormalities. The objective of this study was to assess osteocalcin (OC), bone alkaline phosphatase (BALP), and C-terminal telopeptide of type I collagen (CTX-I) levels reflecting bone formation and resorption for age and sex in Polish healthy children and adolescents., Materials and Methods: A total of 355 healthy normal-weight children and adolescents (46.5% girls) aged 1-18 years old were recruited. Total body less head (TBLH) and spine L1-L4 were used in children to assess bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA). Bone marker concentrations were determined by immunoenzymatic methods., Results: Bone marker levels in girls and boys started with higher values in the first year of life and subsequently decreased until reaching a nadir during the prepubertal period. The pubertal peak values of bone markers were reached at 11-13 years old in boys and at 9-11 years old in girls. After puberty, the adolescents showed a gradual decline in bone marker concentrations to the values observed in adults. We found positive correlations between OC level and TBLH-BMD (r = 0.329, p = 0.002), TBLH-BMD Z-score (r = 0.245, p = 0.023), and L1-L4 BMD (r = 0.280, p = 0.009) in the prepubertal group., Conclusions: We showed serum levels of bone turnover markers-BALP, OC, and CTX-I-in relation to age and sex in healthy Polish children and adolescents. The age intervals of these markers for girls and boys aged 1-18 years old may be clinically useful in the assessment of bone metabolism in individuals with skeletal disorders., (© 2024 Joanna Gajewska et al., published by Sciendo.)

The aim of this work was to study changes in the state of phosphorus-calcium metabolism, indicators of certain hormones, cytokine profile, and histological structure of bone tissue in experimental hypothyroidism in rats. Experimental hypothyroidism was caused by daily intragastric administration of Thiamazole in a dose of 2.5 mg / 100 g body weight for 21 days. The colorimetric method was used to determine blood serum calcium, phosphorus, and magnesium content. Bone metabolism markers, thyrotropin level, total T3 and T4, testosterone, follicle-stimulating (FSH) and luteinizing (LH) hormones, parathyroid hormone (PTH), interleukin-1β (IL-1β) and -6 (IL-6), necrosis factor tumors-alpha (TNF-α) were studied using an enzyme immunoassay. To determine the histological structure of bone tissue, prepared sections of the femoral diaphysis were studied under a microscope of the MZ-300 series (Austria). It was found that hypothyroidism development is confirmed by decreased content of thyroxine and triiodothyronine on the background of the increased secretion of thyroidstimulating hormone. Experimental hypothyroidism is accompanied by a decrease in the concentration of bone alkaline phosphatase in the blood serum while maintaining the collagen C-terminal telopeptides type 1, reflecting impaired remodeling processes, there is also a decrease in testosterone secretion, an increase in gonadotropins, parathyroid hormone, pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α). Signs characteristic for the developing dysplastic osteoporosis are histologically revealed in the diaphysis of the tubular bones. [ABSTRACT FROM AUTHOR]

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Background The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend targets based on multiples of the upper limit of normal (ULN) of parathyroid hormone (PTH) concentration. However, the ULN has not always been correctly established by manufacturers. While it is known that the ULN is supposed to be higher in African Americans than in Caucasians, it is largely unknown in Africans. Methods We established the ULN of PTH concentration in a population of 240 healthy Ivorians using second- and third-generation PTH assays before and after supplementation with 100 000 IU of cholecalferol. We measured the levels of PTH, bone alkaline phosphatase, 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in 100 haemodialysed Ivorian patients. Results The prevalence of vitamin D deficiency in Ivory Coast is low. The ULN obtained using the third-generation PTH assay was similar to that obtained in Caucasians but was higher when PTH was measured using the second-generation PTH assay. According to the KDIGO guidelines, ∼20% of the haemodialysed patients were below twice the ULN and 30% were above nine times the ULN. Approximately 25% of the patients were even >12 times the ULN. We observed a discrepancy in the results between the two PTH assays (14%) that was relatively more important than what we observed from previous studies in Caucasians using the same strategy. Conclusions We found a low prevalence of vitamin D deficiency in a tropical country like Ivory Coast. We also established the PTH reference range, which could prove useful for the follow-up of haemodialysed patients, particularly for the large number of patients suffering from secondary hyperparathyroidism who are at high risk of adverse bone events. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to examine the association of neuro-otological examination, blood test, and scoring questionnaire data with treatment-resistant intractability in idiopathic benign paroxysmal positional vertigo (BPPV) patients.Methods: We experienced 1520 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University during May 2014 to April 2018. Six hundred and eleven patients were diagnosed as BPPV (611/1520; 40.2%) according to the diagnostic guideline of the International Classification of Vestibular Disorder in 2015. Among BPPV patients, there were 201 intractable patients (201/611; 32.9%), 66 of whom were idiopathic and enrolled to be hospitalized and receive neuro-otological examinations, including the caloric test (C-test), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV), glycerol test (G-test), electrocochleogram (ECoG), inner ear magnetic resonance imaging (ieMRI), blood tests including anti-diuretic hormone (ADH) and bone alkaline phosphatase (BAP), and self-rating questionnaires of depression score (SDS). Sixty-six patients were diagnosed as horizontal type cupula (hBPPVcu; n=30), horizontal type canal (hBPPVca; n=10), posterior type (n=20), and probable and/or atypical BPPV (n=6). Data are presented as ratios (+) of the number of idiopathic BPPV patients with examination and questionnaire data outside of the normal range.Results: The ratio (+) data were as follows: C-test=21.2% (14/66), cVEMP=24.2% (16/66), SVV=48.5% (32/66), G-test=18.2% (12/66), ECoG=18.2% (12/66), ieMRI=12.1% (8/66), ADH=9.1% (6/66), BAP=13.6% (9/66), and SDS=37.9% (25/66). Multivariate regression analysis revealed that the periods of persistent vertigo/dizziness were significantly longer in BPPV patients with hBPPVcu, C-test (+), endolymphatic hydrops (+), and BAP (+) compared with those with negative findings.Conclusion: Although patients with idiopathic BPPV are usually treatable and curable within 1 month, the presence of hBPPVcu, canal paresis, endolymphatic hydrops, and elevated BAP may make the disease intractable, and thus require additional treatments. [ABSTRACT FROM AUTHOR]

Abstract: Although the Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend a dialysate calcium concentration between 2.5 and 3.0 mEq/L, its optimal concentration remains unclear. A total of 53 hemodialysis patients with intact parathyroid hormone (PTH) levels <150 pg/mL were enrolled in this prospective observational study. A dialysate calcium concentration was converted from 3.0 to 2.75 mEq/L and bone metabolic markers including bone alkaline phosphatase (BAP) and tartrate‐resistant acid phosphatase‐5b (TRACP‐5b) were examined. After 3 months, serum corrected calcium levels decreased (P < 0.001), while serum intact PTH, BAP and TRACP‐5b levels increased (P < 0.05, P < 0.05 and P < 0.001, respectively). Multiple regression analyses showed that the amount of change in BAP was significantly associated with dialysis vintage (P < 0.01). In conclusion, the lowering of dialysate calcium concentration stimulated parathyroid gland and bone remodeling in hemodialysis patients with suppressed PTH, particularly with longer dialysis vintage. [ABSTRACT FROM AUTHOR]

Alkaline phosphatases (APs) remove the phosphate (dephosphorylation) needed in multiple metabolic processes (from many molecules such as proteins, nucleotides, or pyrophosphate). Therefore, APs are important for bone mineralization but paradoxically they can also be deleterious for other processes, such as vascular calcification and the increasingly known cross-talk between bone and vessels. A proper balance between beneficial and harmful activities is further complicated in the context of chronic kidney disease (CKD). In this narrative review, we will briefly update the complexity of the enzyme, including its different isoforms such as the bone-specific alkaline phosphatase or the most recently discovered B1x. We will also analyze the correlations and potential discrepancies with parathyroid hormone and bone turnover and, most importantly, the valuable recent associations of AP's with cardiovascular disease and/or vascular calcification, and survival. Finally, a basic knowledge of the synthetic and degradation pathways of APs promises to open new therapeutic strategies for the treatment of the CKD-Mineral and Bone Disorder (CKD-MBD) in the near future, as well as for other processes such as sepsis, acute kidney injury, inflammation, endothelial dysfunction, metabolic syndrome or, in diabetes, cardiovascular complications. However, no studies have been done using APs as a primary therapeutic target for clinical outcomes, and therefore, AP's levels cannot yet be used alone as an isolated primary target in the treatment of CKD-MBD. Nonetheless, its diagnostic and prognostic potential should be underlined. [ABSTRACT FROM AUTHOR]

Children with atopic dermatitis (AD) are at risk for low bone mineral density (BMD), which is associated with an increased prevalence of osteopenia, osteoporosis, and fracture risk.1,2 Factors such as restricted nutrition, vitamin D deficiency, poor sleep and corticosteroid use contribute to lower bone alkaline phosphatase (BALP) levels, a marker of bone mineralization, seen in children with moderate-to-severe AD compared with healthy children.³ A major determinant for the lifetime risk of fractures and osteoporosis is the magnitude of peak bone mass achieved during prepubescent years. Low BALP and BMD in children with moderate-to-severe AD could contribute to a higher prevalence of osteopenia and osteoporosis. The objective of this analysis is to report the impact of dupilumab treatment on markers of bone formation in children aged ≥ 6 to <12 years with moderate-to-severe AD. The analysis was performed retrospectively on sera from participants in LIBERTY AD PEDS (NCT03345914) and LIBERTY AD PED-OLE (NCT02612454). In LIBERTY AD PEDS, a double-blind, 16-week, phase 3 trial, children aged 6 to <12 years were randomized 1 : 1 : 1 to 300 mg dupilumab every 4 weeks (300 mg q4w), a weight-based regimen of dupilumab every 2 weeks (100 mg q2w for patients with baseline weight <30 kg, and 200 mg q2w for those with baseline weight ≥30 kg), or placebo; with concomitant medium-potency topical corticosteroids (TCS). After the initial 16-week trial, children aged 6 to <12 years were enrolled in the open-label extension study LIBERTY AD PED-OLE. Patients received dupilumab 300 mg q4w, which could be titrated up in case of inadequate clinical response at week 16 (200 mg q2w for patients with baseline weight <60 kg, and 300 mg q2w for those with baseline weight ≥60 kg); with concomitant medium-potency TCS. Bone biomarkers including BALP, procollagen type 1 N-terminal propeptide, C-terminal crosslinking telopeptide of type 1 collagen, osteocalcin, and insulin-like growth factor 1 were analysed at baseline, 8, 12, 16 and BALP only at 52 weeks. Dupilumab treatment led to a rapid and significant increase in geometric mean (standard error) levels of BALP in children with moderate-to-severe AD at 16 weeks compared with patients in the placebo group (77.7(1.02) μgL−1 vs. 65.0(1.04) μgL−1; P<0.0001). As well as a rapid and significant increase in BALP levels in children from the placebo group once they joined the OLE trial. BALP levels increased over 52 weeks in all treated children, reaching a level of 78–84 μgL−1 which constitutes a significant improvement compared with baseline, and is comparable to healthy reference intervals. An increasing trend from baseline to 16 weeks of dupilumab treatment was observed for other biomarkers, however, there was a limited number of data points due to insufficient volumes of serum available for analysis. These placebo-controlled results show, for the first time, a rapid and significant increase in BALP, and a possible trend in other biomarkers, in children with AD during treatment with dupilumab. These results suggest increased bone mineralization during the treatment period. [ABSTRACT FROM AUTHOR]