1. Calcium and vitamin D supplements are effective at reversing secondary hyperparathyroidism in older individuals and are associated with increased bone mineral density and reduced bone loss.
2. Vitamin D supplementation lowers the risk of falling by 14-23% and a daily dose of at least 800 IU is most effective. While data is limited in men, they appear to benefit similarly to women in terms of fall reduction.
3. Calcium and vitamin D supplementation have proven antifracture efficacy when targeted to individuals with documented deficiencies or insufficiencies, through mechanisms of reducing bone loss and fall risk.
Osteoporosis is often asymptomatic until a fracture occurs. Several risk factors increase the risk of osteoporosis and fractures, including older age, female gender, low body weight, smoking, excessive alcohol, and lack of exercise. Simple interventions like calcium and vitamin D supplementation, exercise, smoking cessation, and falls prevention can help maintain bone mineral density and reduce fracture risk. BMD testing is recommended for those over 65, younger postmenopausal women or men with risk factors, and anyone with prior fractures or conditions affecting bone health to diagnose osteoporosis based on T-scores and estimate 10-year fracture risk using FRAX.
This document summarizes research on the relationship between calcium, vitamin D, and bone health. It discusses how calcium and vitamin D are important for bone health, and reviews epidemiological studies showing links between vitamin D and calcium intake and bone diseases. Animal and human studies are also summarized, providing evidence that calcium and vitamin D supplementation can help prevent bone loss and fractures. The document concludes that current nutrient guidelines for calcium and vitamin D intake are generally sufficient for bone health, based on the literature reviewed.
Ckd-MBD & osteoporosis the management dilemma Ayman Seddik
This document discusses the management of chronic kidney disease-mineral and bone disorder (CKD-MBD) and osteoporosis in elderly patients. It outlines that CKD-MBD and osteoporosis are common in elderly populations and impact mortality and morbidity. Management is based on the stage of CKD and involves controlling serum phosphorus and calcium levels, using phosphate binders to treat hyperphosphatemia, and treating abnormal PTH levels. Guidelines recommend treating bone disease with bisphosphonates and other osteoporosis medications according to the condition and stage of CKD. The risks and benefits of different treatment options must be considered based on each patient's situation.
Increase in Bone Mass Density and Overall Bone Health Following High-Impact o...CrimsonPublishers-SBB
Vitamin D3 and calcium are the main bone health supplements required for quality of life. The present study aimed to find out the role of Consciousness Energy Healing based vitamin D3 and DMEM medium on bone health parameters in vitro using MG-63 cells. The parameters of bone health tested are Alkaline Phosphatise Enzyme (ALP) activity, collagen levels, and bone mineralization. The Test Items (TI) i.e. vitamin D3 and DMEM medium were divided into two parts. The test samples received Consciousness Energy Healing Treatment by Krista Joanne Callas and samples were defined as the Bio-field Energy Treated (BT) samples, while the other parts of each sample were denoted as the untreated test items (UT). Cell viability using MTT assay exhibited increased cell viability range from 72% to 122% with safe and nontoxic profile among test samples on the MG-63 cell line. was significantly increased by 129.6%, 392%, and 255.7%in the UT-DMEM+BT-TI, BT-DMEM+UT-TI, and BT-DMEM+BT-TI groups, respectively at 100μg/mL as compared with the untreated group.
Osteroporosis - clinical features and managementRohit Rajeevan
Osteoporosis is defined as low bone mass and deterioration of bone tissue, leading to increased bone fragility and fracture risk. It is diagnosed based on bone mineral density measurements. Risk factors include older age, female sex, family history, smoking, excessive alcohol, low body weight, and medications like glucocorticoids. The disease results from an imbalance between bone resorption by osteoclasts and bone formation by osteoblasts. Treatment involves lifestyle modifications like calcium, vitamin D, and exercise as well as pharmacologic therapies such as bisphosphonates, SERMs, calcitonin, PTH, and strontium which reduce resorption or stimulate formation to increase bone mineral density and reduce fractures.
Vicki Harber
LA GIOVANE ATLETA
Il ciclo mestruale, punto di riferimento per un sviluppo sano della giovane atleta
Nel processo di sviluppo delle giovani atlete è necessario che siano integrati il monitoraggio continuo del menarca e il controllo del loro stato mestruale. Promuovere lo sviluppo di una giovane atleta e supervisionarne l’allenamento è impegnativo e complesso. Se dispongono di una conoscenza maggiore della funzione mestruale le giovani atlete e le loro famiglie hanno strumenti migliori per rispondere alle esigenze dell’allenamento e delle gare. Lo stato mestruale rappresenta un indicatore globale della salute e del benessere che fornisce informazioni che riguardano l’energia, il rischio di lesioni scheletriche e muscolari, l’apporto alimentare, il profilo metabolico e ormonale, il recupero e altri elementi, importanti per la prestazione. Inoltre, con l’uso crescente dei contraccettivi orali da parte delle giovani atlete che non hanno raggiunto la loro maturità scheletrica, allenatori, allenatrici e genitori debbono essere informati dei risultati recenti che riguardano la salute delle ossa.
This presentation focuses on calcium intake and calcium deficiencies. Calcium is essential for building strong bones and teeth and maintaining bone density. It is also important for nerve and muscle function. The recommended daily intake varies depending on age and physiological state. Dietary sources of calcium include dairy products, leafy greens, fish, and fortified foods. Calcium balance is regulated by hormones like parathyroid hormone and calcitonin. Deficiencies can increase the risk of osteoporosis and bone fractures.
Osteoporosis is often asymptomatic until a fracture occurs. Several risk factors increase the risk of osteoporosis and fractures, including older age, female gender, low body weight, smoking, excessive alcohol, and lack of exercise. Simple interventions like calcium and vitamin D supplementation, exercise, smoking cessation, and falls prevention can help maintain bone mineral density and reduce fracture risk. BMD testing is recommended for those over 65, younger postmenopausal women or men with risk factors, and anyone with prior fractures or conditions affecting bone health to diagnose osteoporosis based on T-scores and estimate 10-year fracture risk using FRAX.
This document summarizes research on the relationship between calcium, vitamin D, and bone health. It discusses how calcium and vitamin D are important for bone health, and reviews epidemiological studies showing links between vitamin D and calcium intake and bone diseases. Animal and human studies are also summarized, providing evidence that calcium and vitamin D supplementation can help prevent bone loss and fractures. The document concludes that current nutrient guidelines for calcium and vitamin D intake are generally sufficient for bone health, based on the literature reviewed.
Ckd-MBD & osteoporosis the management dilemma Ayman Seddik
This document discusses the management of chronic kidney disease-mineral and bone disorder (CKD-MBD) and osteoporosis in elderly patients. It outlines that CKD-MBD and osteoporosis are common in elderly populations and impact mortality and morbidity. Management is based on the stage of CKD and involves controlling serum phosphorus and calcium levels, using phosphate binders to treat hyperphosphatemia, and treating abnormal PTH levels. Guidelines recommend treating bone disease with bisphosphonates and other osteoporosis medications according to the condition and stage of CKD. The risks and benefits of different treatment options must be considered based on each patient's situation.
Increase in Bone Mass Density and Overall Bone Health Following High-Impact o...CrimsonPublishers-SBB
Vitamin D3 and calcium are the main bone health supplements required for quality of life. The present study aimed to find out the role of Consciousness Energy Healing based vitamin D3 and DMEM medium on bone health parameters in vitro using MG-63 cells. The parameters of bone health tested are Alkaline Phosphatise Enzyme (ALP) activity, collagen levels, and bone mineralization. The Test Items (TI) i.e. vitamin D3 and DMEM medium were divided into two parts. The test samples received Consciousness Energy Healing Treatment by Krista Joanne Callas and samples were defined as the Bio-field Energy Treated (BT) samples, while the other parts of each sample were denoted as the untreated test items (UT). Cell viability using MTT assay exhibited increased cell viability range from 72% to 122% with safe and nontoxic profile among test samples on the MG-63 cell line. was significantly increased by 129.6%, 392%, and 255.7%in the UT-DMEM+BT-TI, BT-DMEM+UT-TI, and BT-DMEM+BT-TI groups, respectively at 100μg/mL as compared with the untreated group.
Osteroporosis - clinical features and managementRohit Rajeevan
Osteoporosis is defined as low bone mass and deterioration of bone tissue, leading to increased bone fragility and fracture risk. It is diagnosed based on bone mineral density measurements. Risk factors include older age, female sex, family history, smoking, excessive alcohol, low body weight, and medications like glucocorticoids. The disease results from an imbalance between bone resorption by osteoclasts and bone formation by osteoblasts. Treatment involves lifestyle modifications like calcium, vitamin D, and exercise as well as pharmacologic therapies such as bisphosphonates, SERMs, calcitonin, PTH, and strontium which reduce resorption or stimulate formation to increase bone mineral density and reduce fractures.
Vicki Harber
LA GIOVANE ATLETA
Il ciclo mestruale, punto di riferimento per un sviluppo sano della giovane atleta
Nel processo di sviluppo delle giovani atlete è necessario che siano integrati il monitoraggio continuo del menarca e il controllo del loro stato mestruale. Promuovere lo sviluppo di una giovane atleta e supervisionarne l’allenamento è impegnativo e complesso. Se dispongono di una conoscenza maggiore della funzione mestruale le giovani atlete e le loro famiglie hanno strumenti migliori per rispondere alle esigenze dell’allenamento e delle gare. Lo stato mestruale rappresenta un indicatore globale della salute e del benessere che fornisce informazioni che riguardano l’energia, il rischio di lesioni scheletriche e muscolari, l’apporto alimentare, il profilo metabolico e ormonale, il recupero e altri elementi, importanti per la prestazione. Inoltre, con l’uso crescente dei contraccettivi orali da parte delle giovani atlete che non hanno raggiunto la loro maturità scheletrica, allenatori, allenatrici e genitori debbono essere informati dei risultati recenti che riguardano la salute delle ossa.
This presentation focuses on calcium intake and calcium deficiencies. Calcium is essential for building strong bones and teeth and maintaining bone density. It is also important for nerve and muscle function. The recommended daily intake varies depending on age and physiological state. Dietary sources of calcium include dairy products, leafy greens, fish, and fortified foods. Calcium balance is regulated by hormones like parathyroid hormone and calcitonin. Deficiencies can increase the risk of osteoporosis and bone fractures.
Recent updates about Vitamin D (sunshine vitamin) & bone health. Co-testing of vitamin D(25-OH vitamin D) along with PTH is a scientific, holistic approach for diagnosis & monitoring of vitamin D deficiency.
—Chronic patients of spinal cord injury has been detected severe reduction of bone density. Patients with SCI show mostly osteopenia or osteoporosis of the hip and spine. Vitamin D deficiency may contribute to development of osteoporosis in SCI. So a study was conducted on 100 chronic SCI patients to find out status of correlation of Vitamine D and bone mineral density (BMD). Blood samples were collected and investigated routine biochemistry with serum 25(OH)D. DXA scan of hip and spine was also done. This study observed that 55% patients had suboptimal vitamin D. Positive correlation was found between vitamin D & bone mineral density. It is concluded from this study that monitoring of Serum 25(OH)D levels and annual surveillance of bone mineral density is crucial among persons with chronic SCI to reduce progression of osteoporosis and minimize the risk for further fractures. Keywords: 25(OH)D: 25 Hydroxy Vitamin D, DXA: Dual Energy X-Ray Absorptiometry, BMD: Bone Mineral Density.
This document discusses ensuring better bone health. It begins by explaining that bone is made up of collagen and calcium phosphate, which gives it strength and flexibility. It then notes that more than 99% of the body's calcium is contained in bones and teeth. The document outlines why bone health is important by explaining that bones support the body, facilitate movement, and protect organs. It then discusses several factors that affect bone health, including diet, physical activity, tobacco/alcohol use, gender, and age. The document emphasizes getting sufficient calcium and vitamin D through foods like dairy. It recommends regular weight-bearing exercise, avoiding smoking and excess alcohol, speaking to a doctor about bone health, and getting bone density tests when appropriate.
This study aims to examine the effects of physical exercise on ferritin levels in female NCAA Division 1 athletes. It hypothesizes that blood samples taken after exercise will have different ferritin levels than those taken without exercise, and that ferritin levels will vary between sports teams and across a season. The study will take blood samples from female athletes on various teams both with and without prior exercise to measure ferritin levels. Statistical analysis will compare ferritin levels between the two sampling conditions and across teams using t-tests and ANOVAs. Issues around funding and participant recruitment are also discussed.
Osteoporosis is a disease where decreased bone mass leads to an increased risk of bone fractures. It is most common in older women, especially after menopause, but can affect anyone. Key factors that contribute to osteoporosis include a lack of calcium and vitamin D in the diet, lack of exercise, smoking, excessive alcohol consumption, low body weight, and certain medical conditions or medications. Osteoporosis has serious health impacts as fractures can limit mobility and independence, and even lead to death in severe cases such as hip fractures. Diagnosis is typically done through bone mineral density testing to assess fracture risk and ways to prevent fractures through treatment and lifestyle changes.
For info log on to www.healthlibrary.com. Osteoporosis of Bones By Dr. Prakash Khalap
OSTEOPOROSIS which is more in Elderly, Osteoporosis is Common in both females and males after 60 yrs. Fractures, reduction in height, Backache, vague Pain of body are common symptoms which many elderly suffers unknowingly.
Advances in Frailty-understanding and managementv3venu
1. The document discusses the concept of frailty in older adults, describing it as a medical syndrome characterized by decreased reserves and resilience leading to vulnerability. It provides several definitions and models of frailty.
2. Assessment tools for frailty are discussed, including the Fried phenotype model and the FRAIL scale. Management strategies covered include exercise, nutritional supplementation, vitamin D, and reducing polypharmacy.
3. The effects of different interventions are summarized from systematic reviews, including benefits of exercise on physical function, high protein diets on outcomes, and vitamin D on strength and balance. Comprehensive geriatric assessment is recommended for full evaluation and management of frailty.
Novel CAM Therapies in the Management of Osteogenic ImperfectaKimmer Collison-Ris
Osteogenic Imperfecta (OI) is a lifelong disease variably affecting individuals across the lifespan from birth. This paper discusses the various manifestations of OI and suggests novel nutritional, dietary, and complimentary therapies in its management for increased quality of life.
This document discusses injuries and attrition in the military, their causes and costs. It notes that female injury rates are higher than male rates, and injuries can be reduced through interventions like iron supplementation and multi-vitamins. The document examines the role of nutrition, exercise history, smoking and other factors in bone health and injury rates. It advocates for more screening of recruits to identify risk factors and optimize training programs to decrease injuries and their effects on readiness.
Osteoporosis is estimated to affect about 200 million women worldwide with more patients from Europe, USA and Japan. Do you knwo that about 1 fracture is taking place every 3 reasons just because of this ailment. This ailment is most affected by womens who are more than 60 years of age and several factors pave the way to this condition and the main reason is the lack of physical activity and low intake of calcium rich diet during the earlier stage of life.
If a person is affected with osteoporosis he / she should take in more calcium and continue with moderate physical activity. Take in dietary products to supplement the lack of calcium in the body and use natural remedies / herbal food supplements to cure it.
This document provides an overview of an online learning module about osteoporosis for family medicine residents. It begins with introductions and learning objectives. The module then reviews key topics like definitions of osteoporosis, risk factors, screening guidelines, fracture risk assessment tools, and conservative and pharmacological treatment options. The overall goal is to equip residents with knowledge of the current guidelines for diagnosing and managing osteoporosis in primary care practice.
The document discusses falls prevention in the elderly population. It summarizes that falls are the main risk factor for fractures in older adults, not osteoporosis. Exercise interventions, particularly those focused on balance, strength and gait training, can effectively reduce falls rates. A multifactorial assessment of fall risks followed by tailored interventions is recommended approach to address modifiable risk factors and prevent falls.
Frailty is a state of increased vulnerability resulting from cumulative decline across multiple physiological systems, leaving the elderly vulnerable to minor stressors that could significantly deteriorate their health. It is common, affecting 15% of non-institutionalized elders, and associated with adverse outcomes like falls, disability, nursing home placement and mortality. While frailty was traditionally viewed as an inevitable part of aging, evidence shows that resistance exercise and nutrition interventions can potentially prevent or partially reverse frailty's declines in muscle mass, strength, and physical performance. Emerging technologies also offer promising tools to address frailty's physical, cognitive and social dimensions but require further assessment and adaptation for elderly users.
The document provides an overview of key nutrients that are important for bone health, including calcium, phosphorus, vitamin D, magnesium, and fluoride. It discusses the roles and functions of these nutrients in bone growth, maintenance, and repair. Deficiency and toxicity risks are addressed for each nutrient. Dietary sources and intake recommendations are also reviewed.
1) Obesity is an unhealthy accumulation of body fat that is seen as a metabolic/nutritional disease in the United States. It is associated with numerous health risks like congestive heart failure, chronic obstructive pulmonary disease, and type 2 diabetes.
2) Obesity rates have significantly increased in both adults and children in America in recent decades. It is estimated that 60 million American adults and 9 million children are obese. Obesity is linked to increased risk of diseases like cancer and heart disease.
3) Treatment of obesity involves lifestyle changes like diet, exercise, and behavior modification. Medications and weight loss surgeries are also used but come with risks. Common bariatric surgeries include gastric bypass
1. Vitamin D plays an important role in maintaining calcium and phosphorus balance for bone health and has protective functions for kidneys, heart, diabetes prevention, immune regulation, and cancer prevention.
2. Vitamin D deficiency is not uncommon in Taiwan, and people with vitamin D deficiency may need vitamin D supplementation treatment.
3. Currently there is no evidence that high-dose vitamin D is more effective.
4. Vitamin D supplementation is beneficial for bone health protection, but more research is still needed to confirm its protective effects on non-skeletal diseases.
This document discusses possible links between vitamin D deficiency and various geriatric syndromes and common comorbidities. It begins by outlining how vitamin D receptors are present in many tissues beyond the musculoskeletal system. It then examines potential associations between vitamin D deficiency and increased risks of frailty, urinary incontinence, dementia/cognitive impairment, and depression in elderly populations. While evidence is limited and relationships are not clearly causal, several observational studies have found correlations between low vitamin D levels and higher rates of these conditions. More research is still needed, but maintaining adequate vitamin D status may help reduce risks of age-related diseases and functional decline.
This document discusses osteoporosis, including risk factors, prevention, and treatment. Some key points:
- 44 million Americans have osteoporosis or are at risk due to factors like aging, gender, family history, smoking, and certain medications.
- Osteoporosis increases the risk of bone fractures, which can significantly reduce quality of life and mobility.
- Getting sufficient calcium and vitamin D through diet and/or supplements is important for bone health. Dairy products, leafy greens, tofu, and fortified foods contain calcium.
- Exercise that stresses bones, like weight-bearing and resistance activities, can help build bone density. Balance exercises are also important for preventing falls.
The document discusses several key points about factors that impact bone health and injury risk for female athletes and military personnel:
1) Nutrition, training load, and other lifestyle factors are interlinked and influence bone health and risk of injury, rather than individual factors alone. Inadequate intake of key nutrients can limit the benefits of exercise on bone health.
2) Past injuries increase future risk of re-injury, highlighting the importance of addressing underlying nutrition, training, and other issues to aid recovery and prevent reoccurrence.
3) Nutrients like calcium, vitamin D, and protein work together synergistically to support bone health, so optimizing one without others may not improve outcomes. A whole diet approach is
1) Vitamin D plays an important role in muscle strength and performance, especially in the elderly. Studies show that treatment with vitamin D can increase the size and number of type II muscle fibers which are important for strength.
2) Maintaining serum 25(OH)D levels of at least 75 nmol/L through vitamin D3 supplementation of 800-1000 IU per day can reduce the risk of falls and fractures in older adults as well as lower the risk of other chronic diseases.
3) According to studies, a significant portion of the United States population has serum 25(OH)D levels below recommended levels for optimal health benefits. Certain groups like blacks, the elderly, and northerners are particularly
This document discusses osteoporosis and bone fragility. It begins by defining key terms like osteoporosis, bone fragility, and T-scores. It then discusses the importance of both bone quantity and quality in determining fracture risk. The document outlines the key regulators of bone remodeling like RANK, RANKL, and OPG. It explains how chronic immune activation can uncouple the bone remodeling process and lead to increased fragility through a diversion of stem cell differentiation toward osteoclast formation. Finally, it discusses how biomarkers can help evaluate nutritional interventions aimed at reducing inflammation and supporting bone health.
Bone density scanning (DXA) uses x-ray technology to measure bone loss by assessing bone mineral density, most often of the lower spine and hips. DXA is commonly used to diagnose osteoporosis, a condition where decreased bone density causes bones to become brittle and more prone to breaking. It can also be used to monitor osteoporosis treatment effects. Those at high risk for osteoporosis due to factors like post-menopause, family history, smoking or medication use should consider DXA screening. A radiologist will analyze DXA scans and send results to the patient's doctor to discuss.
Recent updates about Vitamin D (sunshine vitamin) & bone health. Co-testing of vitamin D(25-OH vitamin D) along with PTH is a scientific, holistic approach for diagnosis & monitoring of vitamin D deficiency.
—Chronic patients of spinal cord injury has been detected severe reduction of bone density. Patients with SCI show mostly osteopenia or osteoporosis of the hip and spine. Vitamin D deficiency may contribute to development of osteoporosis in SCI. So a study was conducted on 100 chronic SCI patients to find out status of correlation of Vitamine D and bone mineral density (BMD). Blood samples were collected and investigated routine biochemistry with serum 25(OH)D. DXA scan of hip and spine was also done. This study observed that 55% patients had suboptimal vitamin D. Positive correlation was found between vitamin D & bone mineral density. It is concluded from this study that monitoring of Serum 25(OH)D levels and annual surveillance of bone mineral density is crucial among persons with chronic SCI to reduce progression of osteoporosis and minimize the risk for further fractures. Keywords: 25(OH)D: 25 Hydroxy Vitamin D, DXA: Dual Energy X-Ray Absorptiometry, BMD: Bone Mineral Density.
This document discusses ensuring better bone health. It begins by explaining that bone is made up of collagen and calcium phosphate, which gives it strength and flexibility. It then notes that more than 99% of the body's calcium is contained in bones and teeth. The document outlines why bone health is important by explaining that bones support the body, facilitate movement, and protect organs. It then discusses several factors that affect bone health, including diet, physical activity, tobacco/alcohol use, gender, and age. The document emphasizes getting sufficient calcium and vitamin D through foods like dairy. It recommends regular weight-bearing exercise, avoiding smoking and excess alcohol, speaking to a doctor about bone health, and getting bone density tests when appropriate.
This study aims to examine the effects of physical exercise on ferritin levels in female NCAA Division 1 athletes. It hypothesizes that blood samples taken after exercise will have different ferritin levels than those taken without exercise, and that ferritin levels will vary between sports teams and across a season. The study will take blood samples from female athletes on various teams both with and without prior exercise to measure ferritin levels. Statistical analysis will compare ferritin levels between the two sampling conditions and across teams using t-tests and ANOVAs. Issues around funding and participant recruitment are also discussed.
Osteoporosis is a disease where decreased bone mass leads to an increased risk of bone fractures. It is most common in older women, especially after menopause, but can affect anyone. Key factors that contribute to osteoporosis include a lack of calcium and vitamin D in the diet, lack of exercise, smoking, excessive alcohol consumption, low body weight, and certain medical conditions or medications. Osteoporosis has serious health impacts as fractures can limit mobility and independence, and even lead to death in severe cases such as hip fractures. Diagnosis is typically done through bone mineral density testing to assess fracture risk and ways to prevent fractures through treatment and lifestyle changes.
For info log on to www.healthlibrary.com. Osteoporosis of Bones By Dr. Prakash Khalap
OSTEOPOROSIS which is more in Elderly, Osteoporosis is Common in both females and males after 60 yrs. Fractures, reduction in height, Backache, vague Pain of body are common symptoms which many elderly suffers unknowingly.
Advances in Frailty-understanding and managementv3venu
1. The document discusses the concept of frailty in older adults, describing it as a medical syndrome characterized by decreased reserves and resilience leading to vulnerability. It provides several definitions and models of frailty.
2. Assessment tools for frailty are discussed, including the Fried phenotype model and the FRAIL scale. Management strategies covered include exercise, nutritional supplementation, vitamin D, and reducing polypharmacy.
3. The effects of different interventions are summarized from systematic reviews, including benefits of exercise on physical function, high protein diets on outcomes, and vitamin D on strength and balance. Comprehensive geriatric assessment is recommended for full evaluation and management of frailty.
Novel CAM Therapies in the Management of Osteogenic ImperfectaKimmer Collison-Ris
Osteogenic Imperfecta (OI) is a lifelong disease variably affecting individuals across the lifespan from birth. This paper discusses the various manifestations of OI and suggests novel nutritional, dietary, and complimentary therapies in its management for increased quality of life.
This document discusses injuries and attrition in the military, their causes and costs. It notes that female injury rates are higher than male rates, and injuries can be reduced through interventions like iron supplementation and multi-vitamins. The document examines the role of nutrition, exercise history, smoking and other factors in bone health and injury rates. It advocates for more screening of recruits to identify risk factors and optimize training programs to decrease injuries and their effects on readiness.
Osteoporosis is estimated to affect about 200 million women worldwide with more patients from Europe, USA and Japan. Do you knwo that about 1 fracture is taking place every 3 reasons just because of this ailment. This ailment is most affected by womens who are more than 60 years of age and several factors pave the way to this condition and the main reason is the lack of physical activity and low intake of calcium rich diet during the earlier stage of life.
If a person is affected with osteoporosis he / she should take in more calcium and continue with moderate physical activity. Take in dietary products to supplement the lack of calcium in the body and use natural remedies / herbal food supplements to cure it.
This document provides an overview of an online learning module about osteoporosis for family medicine residents. It begins with introductions and learning objectives. The module then reviews key topics like definitions of osteoporosis, risk factors, screening guidelines, fracture risk assessment tools, and conservative and pharmacological treatment options. The overall goal is to equip residents with knowledge of the current guidelines for diagnosing and managing osteoporosis in primary care practice.
The document discusses falls prevention in the elderly population. It summarizes that falls are the main risk factor for fractures in older adults, not osteoporosis. Exercise interventions, particularly those focused on balance, strength and gait training, can effectively reduce falls rates. A multifactorial assessment of fall risks followed by tailored interventions is recommended approach to address modifiable risk factors and prevent falls.
Frailty is a state of increased vulnerability resulting from cumulative decline across multiple physiological systems, leaving the elderly vulnerable to minor stressors that could significantly deteriorate their health. It is common, affecting 15% of non-institutionalized elders, and associated with adverse outcomes like falls, disability, nursing home placement and mortality. While frailty was traditionally viewed as an inevitable part of aging, evidence shows that resistance exercise and nutrition interventions can potentially prevent or partially reverse frailty's declines in muscle mass, strength, and physical performance. Emerging technologies also offer promising tools to address frailty's physical, cognitive and social dimensions but require further assessment and adaptation for elderly users.
The document provides an overview of key nutrients that are important for bone health, including calcium, phosphorus, vitamin D, magnesium, and fluoride. It discusses the roles and functions of these nutrients in bone growth, maintenance, and repair. Deficiency and toxicity risks are addressed for each nutrient. Dietary sources and intake recommendations are also reviewed.
1) Obesity is an unhealthy accumulation of body fat that is seen as a metabolic/nutritional disease in the United States. It is associated with numerous health risks like congestive heart failure, chronic obstructive pulmonary disease, and type 2 diabetes.
2) Obesity rates have significantly increased in both adults and children in America in recent decades. It is estimated that 60 million American adults and 9 million children are obese. Obesity is linked to increased risk of diseases like cancer and heart disease.
3) Treatment of obesity involves lifestyle changes like diet, exercise, and behavior modification. Medications and weight loss surgeries are also used but come with risks. Common bariatric surgeries include gastric bypass
1. Vitamin D plays an important role in maintaining calcium and phosphorus balance for bone health and has protective functions for kidneys, heart, diabetes prevention, immune regulation, and cancer prevention.
2. Vitamin D deficiency is not uncommon in Taiwan, and people with vitamin D deficiency may need vitamin D supplementation treatment.
3. Currently there is no evidence that high-dose vitamin D is more effective.
4. Vitamin D supplementation is beneficial for bone health protection, but more research is still needed to confirm its protective effects on non-skeletal diseases.
This document discusses possible links between vitamin D deficiency and various geriatric syndromes and common comorbidities. It begins by outlining how vitamin D receptors are present in many tissues beyond the musculoskeletal system. It then examines potential associations between vitamin D deficiency and increased risks of frailty, urinary incontinence, dementia/cognitive impairment, and depression in elderly populations. While evidence is limited and relationships are not clearly causal, several observational studies have found correlations between low vitamin D levels and higher rates of these conditions. More research is still needed, but maintaining adequate vitamin D status may help reduce risks of age-related diseases and functional decline.
This document discusses osteoporosis, including risk factors, prevention, and treatment. Some key points:
- 44 million Americans have osteoporosis or are at risk due to factors like aging, gender, family history, smoking, and certain medications.
- Osteoporosis increases the risk of bone fractures, which can significantly reduce quality of life and mobility.
- Getting sufficient calcium and vitamin D through diet and/or supplements is important for bone health. Dairy products, leafy greens, tofu, and fortified foods contain calcium.
- Exercise that stresses bones, like weight-bearing and resistance activities, can help build bone density. Balance exercises are also important for preventing falls.
The document discusses several key points about factors that impact bone health and injury risk for female athletes and military personnel:
1) Nutrition, training load, and other lifestyle factors are interlinked and influence bone health and risk of injury, rather than individual factors alone. Inadequate intake of key nutrients can limit the benefits of exercise on bone health.
2) Past injuries increase future risk of re-injury, highlighting the importance of addressing underlying nutrition, training, and other issues to aid recovery and prevent reoccurrence.
3) Nutrients like calcium, vitamin D, and protein work together synergistically to support bone health, so optimizing one without others may not improve outcomes. A whole diet approach is
1) Vitamin D plays an important role in muscle strength and performance, especially in the elderly. Studies show that treatment with vitamin D can increase the size and number of type II muscle fibers which are important for strength.
2) Maintaining serum 25(OH)D levels of at least 75 nmol/L through vitamin D3 supplementation of 800-1000 IU per day can reduce the risk of falls and fractures in older adults as well as lower the risk of other chronic diseases.
3) According to studies, a significant portion of the United States population has serum 25(OH)D levels below recommended levels for optimal health benefits. Certain groups like blacks, the elderly, and northerners are particularly
This document discusses osteoporosis and bone fragility. It begins by defining key terms like osteoporosis, bone fragility, and T-scores. It then discusses the importance of both bone quantity and quality in determining fracture risk. The document outlines the key regulators of bone remodeling like RANK, RANKL, and OPG. It explains how chronic immune activation can uncouple the bone remodeling process and lead to increased fragility through a diversion of stem cell differentiation toward osteoclast formation. Finally, it discusses how biomarkers can help evaluate nutritional interventions aimed at reducing inflammation and supporting bone health.
Bone density scanning (DXA) uses x-ray technology to measure bone loss by assessing bone mineral density, most often of the lower spine and hips. DXA is commonly used to diagnose osteoporosis, a condition where decreased bone density causes bones to become brittle and more prone to breaking. It can also be used to monitor osteoporosis treatment effects. Those at high risk for osteoporosis due to factors like post-menopause, family history, smoking or medication use should consider DXA screening. A radiologist will analyze DXA scans and send results to the patient's doctor to discuss.
The document discusses how power training, which involves moving loads quickly through their full range of motion, can be an effective way for older adults to maintain functionality. While resistance training helps build strength and prevent muscle loss, research shows that improving muscular power through exercises performed at higher speeds is even more important for functional tasks like rising from a chair or climbing stairs. The document provides guidelines for personal trainers on how to safely implement power training for older adult clients, such as starting slowly with light loads and focusing on proper form and control during fast movements.
Chronic exercise prevents lean muscle loss in master athletes (sep11) Mayayo Oxigeno
Chronic exercise preserves lean muscle mass in masters athletes. A study of 40 recreational athletes aged 40-81 found that mid-thigh muscle area and lean mass did not decrease with age despite an increase in total body fat percentage. Muscle area, quadriceps area, and strength did not decline with age. Chronic exercise may prevent the loss of lean muscle mass and strength seen in sedentary aging adults. This maintenance of muscle mass and strength can decrease falls, functional decline, and loss of independence in aging.
This study examined bone mineral density (BMD) in 54 children and adolescents with juvenile idiopathic arthritis before and after a 12-week exercise program. The participants were randomly assigned to an exercise group or control group. The exercise group performed 100 two-footed jumps with a rope and muscle strength exercises 3 times per week. BMD was measured at the start, after 3 months, and after 6 months using dual-energy x-ray absorptiometry. The results showed that BMD values in the total body increased significantly in the exercise group after the program, while BMD measurements remained stable in the control group and for all participants remained within the normal reference range compared to other children. Thus, a short-
Bone mineral density of indian populationmionresearch
Abstract
Background and objectives:
Bone density measurements by dual-energy X-ray absorptiometry (DEXA) recognized now as a safe and accu-rate technique [1] is being done frequently. But the T-score and Z-score values are interpreted using the refer-ence value of Asian population provided by the manufacturer and not with Indian population. This may lead to improper diagnosis of Osteoporosis in Indian population. In this context we compared the young reference values and age related values of bone density of the normal Indian population with the reference value of Asian population provided by the manufacturer.
Methods:
Through DEXA normal healthy individuals who were prospective renal donors were scanned.
Results & Conclusion
Bone Mineral Density (BMD) of distal radius and ulna, proximal radius and ulna, proximal radius of normal In-dian female and BMD of proximal radius and ulna of male population are found to be less considering the ref-erence value of Asian population provided by the manufacturer. Hence it may be inappropriate to use the refer-ence value of Asian population provided by the manufacturer to calculate the T-score and Z-score in Indian population.
This document discusses calcium supplementation for post-menopausal women. It states that supplementation is not needed for most women as calcium levels are tightly regulated by hormones. Supplementation may be needed for women who are calcium or vitamin D deficient, or who have a higher body mass index (BMI) putting mechanical stress on bones. Weight-bearing exercise can also create mechanical demand where calcium supplementation may be beneficial.
Osteoporosis and bone densitometry measurementsSpringer
This document discusses therapies for osteoporosis. It describes two categories of drugs: antiresorptive agents, which inhibit bone resorption, and anabolic agents, which stimulate bone formation. Several antiresorptive drugs are discussed, including bisphosphonates like alendronate, risedronate, and ibandronate, which are the mainstay of osteoporosis treatment. SERMs like raloxifene and bazedoxifene are also described. The goal of any osteoporosis treatment is to prevent fractures by inhibiting bone loss and promoting bone formation.
BMD is the largest manufacturer of automotive furnishing fabric in India. It produces woven, knitted, decorative, and flame retardant fabrics. Key points:
- BMD is TS 16949 certified and supplies most major automotive companies.
- It has a large, well-equipped manufacturing plant in Banswara, Rajasthan with advanced machinery from Europe.
- BMD focuses on research and design to continuously meet global standards. It has an in-house design studio using CAD/CAM software.
- The summary project report covers BMD's production process, corporate social responsibility policy, areas of production planning, and products.
This document provides guidelines for exercise to improve bone mineral density (BMD) and prevent osteoporosis. It discusses that weight-bearing exercises like walking and resistance training are the most effective types of exercise for improving BMD. High-impact activities combined with resistance training seem to provide the best results. The document recommends including exercises that load the skeleton against gravity, such as jumping or lifting weights, to stimulate bone formation through modeling and remodeling.
Effect of aerobic exercise on walking capacity in subjects with parkinsonism-...Sports Journal
This literature review examines the effect of aerobic exercise on walking capacity in subjects with parkinsonism. Seven studies that utilized aerobic exercises like treadmill training and body weight supported treadmill training with subjects with Parkinson's disease were reviewed. The results across the studies found that aerobic exercise improved walking parameters like speed, stride length, home ambulation, and reduced movement initiation time. The literature review concluded that aerobic exercises can improve walking capacity in patients with parkinsonism.
This document is a clinician's guide to the prevention and treatment of osteoporosis developed by the National Osteoporosis Foundation. It provides recommendations for assessing risk, diagnosing, and managing osteoporosis in patients. The guide was created with input from numerous medical organizations and experts in bone health. It is intended to help clinicians make treatment decisions for individual patients based on personal health factors and cost-effectiveness analyses.
Physiological responses of general vs. specific aerobic endurance exercises i...Fernando Farias
The study aimed to compare the physiological and perceptual
responses of two high intensity intermittent aerobic exercises (HIIE), i.e. the
15s/15s exercise and an exercise on the Hoff track (HTE).
Depo-Provera: It’s Detrimental Effects on Bone Health
Should there be an age restriction on its prescribing to teens
who have yet to reach optimal bone mineral density?
This document summarizes a thesis submitted by Eliot Mar examining whether the amount of naturally occurring UV radiation affects stress fracture rates in female athletes via changes in vitamin D production. The document provides background on vitamin D production and role in bone health, defines stress fractures and the female athlete triad, and reviews studies examining the relationship between UV exposure, vitamin D levels, and stress fracture rates in female athletes and military recruits. The thesis examines whether female athletes in areas with lower annual UV radiation are at higher risk of stress fractures compared to those in areas with higher UV radiation.
Reducing fracture risk with Calcium and Vitamin D
Osteoporotic fractures are a major health problem that most commonly affect the spine and hip. Low calcium intake and vitamin D deficiency increase fracture risk by reducing bone mineral density and strength. Clinical trials show that calcium and vitamin D supplementation can reduce fracture risk, especially when vitamin D doses reach 800 IU daily and calcium intake reaches 1000-1200 mg. For older individuals, supplementation is most effective for those at high risk of deficiency living in nursing homes or with low dairy intake.
This document discusses the role of calcium and vitamin D in reducing fracture risk. It notes that osteoporotic fractures are increasing with aging and are associated with morbidity, disability, and mortality. Adequate calcium and vitamin D intake helps maximize bone mineral density and prevents falls. The document reviews clinical trials on calcium and vitamin D supplementation for fracture prevention and concludes that daily supplementation of 800 IU of vitamin D and 1000 mg of calcium can effectively reduce fracture risk, especially in institutionalized elderly individuals. Compliance with long-term supplementation is important to maintain benefits.
The document summarizes nutritional aspects of bone health and fracture healing. It discusses how insufficient intake of certain vitamins and nutrients can negatively impact bone health and fracture healing time. Specifically, it covers how vitamins A and D, calcium, phosphorus, sodium, and other micronutrients like copper and zinc are important for bone health and influence fracture risk and healing. Maintaining adequate intake of both macro and micronutrients through diet is essential for bone health, decreasing fracture risk, and enhancing healing after fractures.
This document summarizes key information about osteoporosis. It defines osteoporosis as a systemic skeletal disease characterized by low bone mass and deterioration of bone tissue, leading to fragile bones and increased risk of fractures. It discusses risk factors like age, estrogen levels, family history and lifestyle factors. It also covers the global incidence of osteoporosis, noting that 200 million women worldwide are affected. Future directions are identified like better understanding nutrient requirements in different populations and roles of nutrients beyond calcium and vitamin D in bone health.
This document reviews risk factors for osteoporosis. It discusses various vitamin and mineral deficiencies that can increase risk, such as deficiencies in calcium, vitamin D, and selenium. Dietary patterns like high salt and protein intake are also examined. Other risk factors covered include alcohol consumption. The review focuses on environmental factors that can be modified through lifestyle changes to help prevent osteoporosis.
Raccomandazioni della iof (international osteoporosis foundation) sull’impieg...Merqurio
This position paper from the International Osteoporosis Foundation makes recommendations for vitamin D intake in older adults. Based on randomized controlled trials, daily vitamin D intake of 20-25 μg (800-1000 IU) is estimated to achieve a target serum 25OHD level of 75 nmol/L (30 ng/ml), which is associated with reduced risk of falls and fractures. Higher daily intakes may be needed for those with risk factors like obesity, limited sun exposure, or malabsorption. Doses above 20 μg/day have not been thoroughly evaluated, so higher intakes cannot be generally recommended at this time.
This document discusses osteoporosis, including its definitions, epidemiology, risk factors, pathophysiology, clinical manifestations, diagnosis, and treatment options. Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue, leading to fragile bones and increased risk of fractures. It affects millions of people worldwide, especially postmenopausal women, and can be caused by aging, genetics, lifestyle factors, and certain medical conditions or medications. Treatment involves lifestyle modifications like diet, exercise and fall prevention as well as pharmacologic options like calcium, vitamin D, bisphosphonates, and drugs that modify bone metabolism.
CALCIUM AND VITAMIN D IN PREVENTION OF OSTEOPOROSIS lavanyabonny
1) Calcium and vitamin D play an important role in bone health by aiding the formation of bone mineral and increasing intestinal absorption of calcium and phosphorus.
2) Peak bone mass is an important determinant of future bone health, and adequate calcium and vitamin D intake during childhood and adolescence can help maximize bone mass.
3) Many Indians are at high risk of vitamin D deficiency and osteoporosis due to low dietary calcium intake and limited sun exposure, so calcium and vitamin D supplements may be necessary in addition to diet to prevent osteoporosis.
Vitamin D supplementation, especially at doses of 700-800 IU/day of cholecalciferol, has been shown to reduce the risk of hip fractures and nonvertebral fractures when combined with calcium intake of at least 500 mg/day. Several meta-analyses found the greatest benefits in individuals with vitamin D levels <50 nmol/L or calcium intake <700 mg/day. While vitamin D alone showed no significant fracture reduction, supplementation that achieved 25(OH)D levels >75 nmol/L or included additional calcium intake was more effective in preventing fractures.
losses of both vitamin D binding protein and 25(OH)D in the urine
The urinary losses of vitamin D binding protein may be secondary to proteinuria.
Deficiency in 25(OH)D may lead to hypocalcemia, hyperparathyroidism, and diminished bone mineral density/content.
Vitamin D deficiency has also been associated with multiple systemic effects including elevated blood pressure ,metabolic syndrome, cardiovascular disease ,anemia and impaired immune system regulation .
Vitamin D deficiency and nutritional management of patients within FLS_Slidek...dinaismail27
This document summarizes a presentation on vitamin D and nutritional management of patients in fracture liaison services. It discusses:
- The high prevalence of vitamin D deficiency and insufficiency in Qatar and other regional countries.
- Recommendations that vitamin D levels below 30 ng/ml are insufficient for fracture prevention and muscle function. Supplementation with calcium and vitamin D can reduce fracture risk.
- The importance of adequate protein intake of 0.8-1.3 g/kg daily for older adults to prevent sarcopenia and fractures. Malnutrition in hospitals can increase risks of poor outcomes.
- Fracture liaison services provide an opportunity to address secondary fracture prevention through vitamin D and nutritional
This document discusses recent advances in the diagnosis and management of osteoporosis. It begins by defining osteoporosis and describing the changes in bone density that occur with age. It then discusses risk factors, medical conditions associated with increased risk, drugs that can reduce bone mass, and tools for assessing fracture risk such as FRAX. It provides guidelines on who should receive bone mineral density testing and describes new assessment tools. The document concludes by covering non-pharmacological and pharmacological prevention and treatment options for osteoporosis, including calcium, vitamin D, exercise, falls prevention, hormone therapy, bisphosphonates, and other medications.
This document discusses the importance of vitamin D and other micronutrients for orthopedic patients. It summarizes that vitamin D plays a key role in bone metabolism and calcium homeostasis. Vitamin D deficiency has been linked to impaired fracture healing and increased risk of falls. The document recommends maintaining vitamin D levels of 30-35 ng/mL or higher for optimal bone health in orthopedic patients. Other micronutrients discussed include calcium and the roles of various vitamins and minerals in bone health and orthopedic outcomes.
This document summarizes guidelines for managing vitamin D deficiency and osteoporosis. It discusses vitamin D metabolism and functions, manifestations of deficiency, relationships between vitamin D and bone and cardiovascular health, risk groups for deficiency in the UK, recommended thresholds and dosing strategies for treatment, and recommendations regarding supplements for pregnant/breastfeeding women. It also notes that high calcium doses are not needed to treat vitamin D deficiency alone, and that licensed preparations should be used where possible.
Osteoporosis is a progressive bone disease characterized by decreased bone mass and density, leading to an increased risk of fracture. It is caused by an imbalance between bone resorption by osteoclasts and bone formation by osteoblasts. Risk factors include a family history, lifestyle factors like smoking and excessive alcohol, certain medications, and hormonal changes in women after menopause. Symptoms may include fractures, loss of height, and back pain. Diagnosis involves bone mineral density testing. Treatment focuses on lifestyle changes to prevent bone loss, calcium and vitamin D supplements, medications to reduce bone resorption, and surgery for fractures. Nursing interventions include education, medication management, fall prevention, and exercise promotion.
Vitamin D deficiency is common worldwide and can cause many health issues. It is involved in calcium absorption and bone health. Deficiency leads to osteomalacia and rickets in children, and increases risk of fractures in adults. It may also play roles in cardiovascular disease, diabetes, cancer prevention, autoimmune disease, pregnancy complications, muscle weakness, and mortality. Treatment involves dietary sources of vitamin D, supplementation, and sunlight exposure.
Osteoporosis is a skeletal disorder characterized by low bone density and quality, increasing the risk of fractures. It affects over 10 million Americans, with women at higher risk than men. Risk factors include age, weight, family history, smoking, chronic inflammation, and use of corticosteroids. Treatment options include medications like bisphosphonates, calcium and vitamin D supplements, exercise, and nutrition to build strong bones and prevent osteoporosis and fractures. Maintaining bone health, especially in younger years, is important to reduce osteoporosis risk later in life.
Previous year question on osteoporosis based on neet pg, usmle, plab and fmge...Abhishek Gupta
Dual energy X-ray absorptiometry (DEXA) is considered the gold standard for diagnosing osteoporosis. It is a quantitative method for measuring bone mass using low energy X-rays. The World Health Organization criteria for osteoporosis is a DEXA T-score at or below -2.5. Ultrasound, single energy X-ray absorptiometry, and quantitative computed tomography are not as accurate as DEXA for diagnosing osteoporosis.
Similar to Calcium and vitamin d supplementation in men (20)
The document summarizes a study that investigated the effects of iron supplementation alone and in combination with vitamins on hematological status, oxidative stress, and erythrocyte membrane fluidity in anemic pregnant women. 164 anemic pregnant women were randomly assigned to receive placebo, iron alone, iron with folic acid, or iron with folic acid, retinol, and riboflavin for 2 months. The study found that supplementation significantly increased hemoglobin and ferritin levels and decreased oxidative stress markers in all treatment groups compared to placebo. Erythrocyte membrane fluidity also increased with supplementation.
Mitochondrial dysfunction and oxidative damage are thought to play a role in Parkinson's disease (PD) pathogenesis. Recent animal studies show that inhibiting mitochondrial complex I with rotenone closely mimics PD's biochemical and histological features. Several agents like creatine, coenzyme Q10, and acetyl-L-carnitine have shown benefits in animal models by modulating energy metabolism and reducing oxidative stress. These agents warrant further study as potential neuroprotective treatments for PD.
La conduzione del nervo surale dorsale in pazienti con carenza di vitamina B1...MerqurioEditore_redazione
This study investigated peripheral neuropathy in vitamin B12 deficient patients with megaloblastic anemia using dorsal sural nerve conduction studies and tibial sensory-evoked potentials. Dorsal sural nerve responses were absent in over half of patients but only one third had abnormalities on conventional nerve conduction studies. Patients with recordable dorsal sural nerves had prolonged latencies, reduced amplitudes, and slower conduction velocities compared to controls, suggesting dorsal sural nerve conduction is more sensitive for detecting early neuropathy. Over 70% of patients showed evidence of myelopathy on tibial sensory-evoked potentials and neurological examination.
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
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Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
As the world population is aging, Health tourism has become vitally important and will be increased day by day. Because
of the availability of quality health services and more favorable prices as well as to shorten the waiting list for medical
services regionally and internationally. There are some aspects of managing and doing marketing activities in order for
medical tourism to be feasible, in a region called as clustering in a region with main stakeholders groups includes Health
providers, Tourism cluster, etc. There are some related and affecting factors to be considered for the feasibility of medical
tourism within this study such as competitiveness, clustering, Entrepreneurship, SMEs. One of the growth phenomenon
is Health tourism in the city of Izmir and Turkey. The model of five competitive forces of Porter and The Diamond model
that is an economical model that shows the four main factors that affect the competitiveness of a nation and its industries
in this study. The short literature of medical tourism and regional clustering have been mentioned.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
“Environmental sanitation means the art and science of applying sanitary, biological and physical science principles and knowledge to improve and control the environment therein for the protection of the health and welfare of the public”.The overall importance of sanitation are to provide a healthy living environment for everyone, to protect the natural resources (such as surface water, groundwater, soil ), and to provide safety, security and dignity for people when they defecate or urinate .Sanitation refers to public health conditions such as drinking clean water, sewage treatment, etc. All the effective tools and actions that help in keeping the environment clean come under sanitation. Sanitation refers to public health conditions such as drinking clean water, sewage treatment. All the effective tools and actions that help in keeping the environment clean and promotes public health is the necessary in todays life.
Allopurinol, a uric acid synthesis inhibitor acts by inhibiting Xanthine oxidase competitively as well as non- competitively, Whereas Oxypurinol is a non-competitive inhibitor of xanthine oxidase.
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
BBB and BCF
control the entry of compounds into the brain and
regulate brain homeostasis.
restricts access to brain cells of blood–borne compounds and
facilitates nutrients essential for normal metabolism to reach brain cells
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
2. 2 Journal of Osteoporosis
2. Effect of Calcium and Vitamin D on Vitamin D receptors (VDRs) are present in skeletal muscle
Secondary Hyperparathyroidism, Bone cells and may account for these effects [20, 21]. In a recent
Mineral Density, and Bone Turnover meta-analysis, vitamin D therapy (200–1000 IU per day)
lowered the risk of falling with 14% (RR 0.86, 95% CI 0.79–
Both calcium and vitamin D supplements reverse the age- 0.93) compared with calcium or placebo [22]. In this meta-
associated secondary hyperparathyroidism in older individu- analysis of ten trials, the number needed to treat with vitamin
als. This reduction in serum PTH is greater with combined D to prevent one fall was 15, and—although a dose of 800 IU
calcium and vitamin D supplementation than with vitamin vitamin D or greater was most effective—a significantly
D alone [3] and depends on baseline calcium balance, lower fall risk was also seen with 400 IU [22].
with the greatest effect of supplementation observed in In an earlier meta-analysis of eight double blind ran-
individuals with the lowest calcium intake and/or vitamin domized controlled trials, on the other hand, a 19% fall
D levels [9]. Gender, however, apparently is an independent reduction (RR 0.81, 95% CI 0.71–0.92) was only observed
determinant of serum vitamin D [10], and to keep PTH with a dose of at least 700 IU vitamin D per day and a 23% fall
within the normal range, women seem to require higher reduction (RR 0.77, 95% CI 0.65–0.90) with serum vitamin
levels of vitamin D than men [11]. D concentrations of at least 60 nmol/L (24 ng/mL), while less
A decrease in levels of PTH is associated with an increase than 700 IU vitamin D per day did not reduce fall risk (RR
in BMD, as has been demonstrated in a recent meta-analysis 1.10, 95% CI 0.89–1.35) [23]. Subgroup analyses were unable
in more than 40000 men and women aged 50 years and older to document a significant reduction in falls in men but the
[12]. In this meta-analysis of 24 trials reporting BMD as an subset was small (N = 211) and the analyses underpowered.
outcome, 19 trials included only women, while four trials In an earlier meta-analysis of the effect of vitamin D on
included men and women [13–16], and one trial included falls, sex-specific subgroup analyses suggested that the fall-
only men [17]. Of the five trials that included men, two trials preventing effect of vitamin D is independent of sex: vitamin
determined the difference in bone loss between calcium in D reduced the odds ratio of falling in men by 21% (OR
monotherapy (±750 mg per day) and placebo [13, 15], while 0.79, 95% CI 0.57–1.1; P = 0.17) and in women by 19%
the others compared calcium (500 mg to 1000 mg per day) (OR 0.81, 95% CI 0.65–1.00; P = 0.05). Again, the result of
plus vitamin D (500 IU to 1000 IU per day) with placebo the sex-specific subgroup analysis in men was not significant
[14, 16, 17]. Overall, treatment with calcium plus vitamin
due to the small number of men in the included trials, but
D or with calcium alone was associated with a significantly
numerically similar to the reduction seen in women [24].
reduced rate of bone loss at the hip and spine. No subgroup
analyses were performed to evaluate the influence of sex Future research should determine the optimal dose of
on treatment effect on BMD, but in line with the overall vitamin D to prevent falls, but available evidence suggests
conclusion of this meta-analysis, reduced bone loss was seen that men benefit to a similar extent as women.
in most of the studies that included men [13–16]. However,
the one available men-only trial could not demonstrate a 4. Antifracture Efficacy of Calcium
reduction of bone loss in spite of supplementation with and Vitamin D
1000 mg calcium and 1000 IU vitamin D per day during three
years [17]. This negative result may reflect the high baseline A negative calcium balance contributes to fracture risk
dietary calcium intake in the men included in the study by enhancing bone degradation through secondary hyper-
(1160 mg per day) compared to lower doses of calcium in the parathyroidism and by increasing the risk of falling through
other trials, such as a daily dose of 700 mg calcium [14] or a negative effect on muscle strength, muscle function, and
less (550 mg [15]), supporting the concept that substitution balance. Substitution with calcium and vitamin D is there-
therapy only makes sense when calcium balance is negative. fore considered the first-line strategy in the prevention of
The decrease in PTH with calcium and vitamin D sup- osteoporotic fractures. To establish the antifracture efficacy
plementation is also associated with reduced bone turnover of substitution, several individual trials and meta-analyses
[15, 16]. Meier et al. observed that calcium and vitamin D have been performed with calcium or vitamin D alone or
supplementation during winter prevented seasonal changes combined calcium plus vitamin D.
in PTH and bone loss in both men and women, although
the effect on bone turnover was stronger in women. In this 4.1. Effect of Calcium or Vitamin D Alone on Fracture Risk.
context, it should be noted that seasonal changes of bone Meta-analyses comparing the effect of calcium alone with
turnover markers are only significant in women and almost placebo showed that calcium in monotherapy does not
absent in men [16]. significantly reduce fracture risk [25, 26]. Of these meta-
analyses, one included only women [25], while the other
3. Effect of Calcium and Vitamin D on Muscle included both genders and conducted sex-specific analyses
Strength and the Risk of Falls on the reduction of hip fracture risk [26]. Although data
in men were limited, this meta-analysis did not reveal a
Supplementation with calcium and vitamin D not only redu- differential effect of calcium in men or women: in both sexes
ces bone loss but also reduces the risk of falling by improving calcium in monotherapy was unable to reduce (hip) fracture
muscle strength, muscle function, and balance [7, 18, 19]. risk.
3. Journal of Osteoporosis 3
The same holds true for the effect of vitamin D alone on fractures [12]. Six of these trials included men and
versus placebo: a meta-analysis of four randomized con- women, 11 included only women, and there were no men-
trolled trials (N = 9083) showed that vitamin D alone was only trials. Calcium or calcium plus vitamin D was associated
insufficient for fracture prevention, even when trials with with a 12% risk reduction in fractures of all types (RR
vitamin D used in higher dose (700–800 IU per day) were 0.88, 95% CI 0.83–0.95). This treatment effect was similar
evaluated separately [27]. A more recent meta-analysis came across women and men, as suggested indirectly (since there
to the same conclusion: irrespective of sex, 400 to 800 IU were no men-only trials) by the comparison of the women-
vitamin D alone is no more effective in preventing fractures only to the mixed-sex trials. In this meta-analysis, subgroup
than placebo [28]. analyses showed that reduction in fracture risk was greater
These results should not come as a surprise because in individuals with low dietary calcium intake (<700 mg per
the negative calcium balance in older and institutionalized day) and in those with low serum vitamin D concentration
adults is often the result of insufficiencies in both calcium (<25 nmol/L or <10 ng/mL). Treatment effect was most
and vitamin D. For example, community-dwelling French effective with at least 1200 mg calcium and at least 800 IU
women aged 75–90 years had a mean daily calcium intake of vitamin D. In this particular analysis, the combination
of just 569 mg and 39% had a serum vitamin D less of calcium and vitamin D (RR 0.87, 95% CI 0.77–0.97)
than 30 nmol/L (12 ng/mL) [29]. In another trial, 66% of and calcium in monotherapy (RR 0.90, 95% CI 0.80–1.00)
institutionalized women had a daily calcium intake less than were equally effective (P = 0.63) in the prevention of
800 mg and a serum vitamin D less than 30 nmol/L [30]. osteoporotic fractures, a finding that is difficult to reconcile
As a result, in these elderly and institutionalized individuals, with evidence from other meta-analyses that calcium alone
supplementation with calcium alone or vitamin D alone does not significantly reduce fracture risk [25, 26].
would fail to restore calcium balance and prevent fractures Overall, there is increasing evidence from several meta-
[8]. analyses for a beneficial effect of combined calcium and
vitamin D supplementation on fracture risk with no firm
4.2. Effect of Combined Calcium and Vitamin D Supplemen- reasons to assume that men would respond differently
tation on Fracture Risk. A meta-analysis of six randomized from women. However, results of individual trials assessing
controlled trials (N = 45509) comparing the effect of fracture reduction with combined calcium and vitamin
combined calcium and vitamin D supplementation with D supplementation have been inconsistent. Some of these
placebo [27] showed that this combination therapy, contrary individuals trials, such as the Women’s Health Initiative
to calcium or vitamin D alone, significantly reduced fracture (WHI) trial [31] and the RECORD trial [33], failed to
risk. The risk reduction was 12% for all nonvertebral demonstrate a significant reduction in fracture risk, whereas
fractures, 18% for hip fractures, and 21% for hip fractures other trials found a beneficial effect of calcium and vitamin
when the one trial in this meta-analysis that did not use D supplementation on fracture risk [14, 30, 34]. These
700 to 800 IU but 400 IU vitamin D [31] was excluded. inconsistencies can be attributed to several factors, including
Similarly, a recent Cochrane review found that calcium plus differences in targeting of the supplementation and differ-
vitamin D prevented hip fractures in frail elderly [32] and the ences in compliance [8].
DIPART group concluded that the combination of calcium
and vitamin D significantly reduced the risk of any fractures 4.3. Determinants of Antifracture Efficacy of Calcium and
and hip fractures and probably reduced the risk of clinical Vitamin D Supplementation. To be effective, supplementa-
vertebral fractures [28]. In their meta-analysis, the DIPART tion with calcium and vitamin D has to be targeted to men
group adjusted analyses for several factors including sex and with documented or particularly at risk of calcium and/or
found that the risk reduction of combined calcium and vitamin D insufficiencies, while general supplementation
vitamin D was independent of sex [28]. in the community is not necessary. Except for extremely
Compared with vitamin D alone, combined calcium and minor subsets, baseline vitamin D status was not assessed
vitamin D supplementation reduced the risk for hip fractures in participants of the WHI trial and the RECORD trial [31,
by 25% in an indirect comparison of meta-analyses [27]. 33]. In fact, most of these study participants were mobile,
This might be explained by the greater effect of combined healthy, and community-dwelling, who are less likely to have
calcium and vitamin D on secondary hyperparathyroidism vitamin D insufficiency and therefore less likely to benefit
and bone loss [3]. In this context, it should be noted that from substitution. This may have contributed significantly
the only trial that directly compared the effect of combined to the negative results of these studies [8]. Men who will
calcium and vitamin D supplementation with vitamin D [33] benefit most from substitution therapy are older (>75 years
could not document a beneficial effect of the combination of age) or institutionalized persons in whom calcium and
therapy, but this study—like many individual trials in this vitamin D insufficiency is highly prevalent, as well as men
field—suffered from a lack of statistical power, a lack of with documented osteoporosis or receiving glucocorticoids.
targeting of the supplements to individuals with documented The addition of calcium and vitamin D to antiresorptive or
insufficiencies and a lack of compliance [27], which we will anabolic therapy in patients with established osteoporosis
discuss in more detail later. is essential, given that calcium and vitamin D insufficiency
Finally, one meta-analysis including 17 trials compared is common in patients with osteoporosis and osteoporosis
the effect of calcium plus vitamin D with calcium alone medication is most effective in calcium and vitamin D
4. 4 Journal of Osteoporosis
replete individuals. Glucocorticoids suppress intestinal and 6. Conclusion
renal calcium absorption and increase urinary calcium
excretion, resulting in a negative calcium balance [35]. Age-associated bone loss due to secondary hyperparathy-
Therefore, patients on glucocorticoids are particularly prone roidism and an increased risk of falling are key determinants
to fractures and supplementation therapy should be initiated of osteoporosis and osteoporotic fractures. Substitution with
as soon as glucocorticoids are prescribed [3, 8]. Most meta- calcium and vitamin D reduces bone loss by reversing sec-
analyses recommend a combination of 1000 to 1200 mg ondary hyperparathyroidism and prevents falls by improving
calcium with 700 to 800 IU vitamin D per day [12, 27] or muscle strength, muscle function, and balance. As a result,
at least a dose in excess of 400 IU (482–770 IU) vitamin D calcium and vitamin D supplementation is generally recom-
[36]. The aim is to increase serum levels of vitamin D to the mended in the prevention of osteoporotic fractures. In men,
50–75 nmol/L (20–30 ng/mL) range [37, 38]. data on the effect of calcium and vitamin D supplements on
In addition to adequate targeting of supplementation, BMD and the risk of falls and fractures are limited. However,
compliance with calcium and vitamin D is critical as well, from the mechanism of bone loss and from the available evi-
to optimize clinical efficacy. Within 6 weeks after calcium dence, there is no reason to assume that men would respond
and vitamin D have been discontinued, bone remodeling differently to calcium and vitamin D supplementation
resumes to pretreatment levels [39]. In line with these compared to women. Combined supplementation with 1000
findings, any positive effects of calcium and vitamin D to 1200 mg calcium and 800 IU vitamin D per day should
on bone density will not persist after discontinuation of be particularly considered in older or institutionalized men,
the supplements [40]. Therefore, to prevent osteoporotic men receiving glucocorticoids, and in male osteoporosis
fractures, compliance and persistence with calcium and patients on antiresorptive or anabolic medication.
vitamin D are essential. However, even in relatively healthy
trial participants in studies like the WHI and the RECORD
trial, a significant proportion of individuals did not comply Conflict of Interests
with supplementation: in both trials, estimated compliance The authors have no conflict of interests.
was only 40–60% [31, 33]. The negative outcome of these
trials can, at least partly, be explained by this lack of
compliance and emphasizes the importance of adherence to Acknowledgments
treatment [8].
S. Boonen is a senior clinical investigator of the Fund for
Scientific Research (FWO-Vlaanderen) and holder of the
5. Safety Concerns about Supplementation Leuven University Chair in Gerontology and Geriatrics. This
work was supported by grant G.0488.08 from the Fund
While (conventionally dosed) vitamin D has not been
for Scientific Research (FWO-Vlaanderen) to S. Boonen. D.
associated with safety concerns, a recent meta-analysis has
provided evidence to suggest that calcium supplements Vanderschueren is a senior clinical investigator of the Leuven
(without coadministered vitamin D) may potentially be University Hospital Clinical Research Fund.
associated with cardiovascular risks. This safety concern may
potentially be even more of an issue in men than in women. References
However, in the meta-analysis, sex-specific subgroup analysis
[1] National Osteoporosis Foundation, Clinician’s Guide to Pre-
showed this elevated cardiovascular risk to be independent
vention and Treatment of Osteoporosis, National Osteoporosis
of sex [41]. Although these findings constitute a safety Foundation, Washington, DC, USA, 2008.
signal that has to be taken seriously, the data have to be [2] R. P. Heaney, “Is the paradigm shifting?” Bone, vol. 33, no. 4,
interpreted with some caution. When dietary intake was pp. 457–465, 2003.
taken into account, there was no significant correlation [3] S. Boonen, H. A. Bischoff-Ferrari, C. Cooper et al., “Address-
between calcium intake and risk of infarction. In addition, ing the musculoskeletal components of fracture risk with
there was no effect of calcium on strokes or death, none calcium and vitamin D: a review of the evidence,” Calcified
of the trials had adjudicated cardiovascular outcomes in Tissue International, vol. 78, no. 5, pp. 257–270, 2006.
[4] S. Boonen, D. Vanderschueren, P. Geusens, and R. Bouillon,
a standardized manner, and the statistical outcome was
“Age-associated endocrine deficiencies as potential deter-
only borderline significant. Finally, there are numerous large minants of femoral neck (type II) osteoporotic fracture
studies of calcium plus vitamin D that have shown no occurrence in elderly men,” International Journal of Andrology,
increased risk of cardiovascular events [31, 42] and studies vol. 20, no. 3, pp. 134–143, 1997.
of calcium alone that did not provide evidence of an [5] M. Visser, D. J. H. Deeg, and P. Lips, “Low vitamin D and high
increased cardiovascular risk with daily supplemental intake parathyroid hormone levels as determinants of loss of muscle
of 1200 mg calcium in women [43] or 1000 mg calcium in strength and muscle mass (Sarcopenia): the longitudinal
aging study Amsterdam,” Journal of Clinical Endocrinology and
men [44]. Nevertheless, reassessment of the role of calcium
Metabolism, vol. 88, no. 12, pp. 5766–5772, 2003.
supplements to prevent osteoporotic fractures is warranted. [6] C. Annweiler, A. M. Schott, G. Berrut, B. Fantino, and O.
Because, in general, men are more at risk of heart disease Beauchet, “Vitamin D-related changes in physical perfor-
than women, future studies with supplements should include mance: a systematic review,” Journal of Nutrition, Health and
cardiovascular endpoints and carefully assess safety in men. Aging, vol. 13, no. 10, pp. 893–898, 2009.
5. Journal of Osteoporosis 5
[7] H. A. Bischoff-Ferrari, M. Conzelmann, H. B. St¨ helin et al.,
a [21] H. A. Bischoff, M. Borchers, F. Gudat et al., “In situ detection
“Is fall prevention by vitamin D mediated by a change in of 1,25-dihydroxyvitamin D3 receptor in human skeletal
postural or dynamic balance?” Osteoporosis International, vol. muscle tissue,” Histochemical Journal, vol. 33, no. 1, pp. 19–24,
17, no. 5, pp. 656–663, 2006. 2001.
[8] S. Boonen, D. Vanderschueren, P. Haentjens, and P. Lips, [22] R. R. Kalyani, B. Stein, R. Valiyil, R. Manno, J. W. Maynard,
“Calcium and vitamin D in the prevention and treatment of and D. C. Crews, “Vitamin D treatment for the prevention
osteoporosis—a clinical update,” Journal of Internal Medicine, of falls in older adults: systematic review and meta-analysis,”
vol. 259, no. 6, pp. 539–552, 2006. Journal of the American Geriatrics Society, vol. 58, no. 7, pp.
[9] P. Lips, T. Duong, A. Oleksik et al., “A global study of 1299–1310, 2010.
vitamin D status and parathyroid function in postmenopausal [23] H. A. Bischoff-Ferrari, B. Dawson-Hughes, H. B. Staehelin et
women with osteoporosis: baseline data from the multiple al., “Fall prevention with supplemental and active forms of
outcomes of raloxifene evaluation clinical trial,” Journal of vitamin D: a meta-analysis of randomised controlled trials,”
Clinical Endocrinology and Metabolism, vol. 86, no. 3, pp. BMJ, vol. 339, article b3692, 2009.
1212–1221, 2001. [24] H. A. Bischoff-Ferrari, B. Dawson-Hughes, W. C. Willett et al.,
[10] H. M. Perry, M. Horowitz, J. E. Morley et al., “Longitudinal “Effect of vitamin D on falls: a meta-analysis,” Journal of the
changes in serum 25-hydroxyvitamin D in older people,” American Medical Association, vol. 291, no. 16, pp. 1999–2006,
Metabolism, vol. 48, no. 8, pp. 1028–1032, 1999. 2004.
[11] C. J. E. Lamberg-Allardt, T. A. Outila, M. U. M. K¨ rkk¨ inen,
a a [25] B. Shea, G. Wells, A. Cranney et al., “VII. Meta-analysis of cal-
H. J. Rita, and L. M. Valsta, “Vitamin D deficiency and bone cium supplementation for the prevention of postmenopausal
health in healthy adults in Finland: could this be a concern in osteoporosis,” Endocrine Reviews, vol. 23, no. 4, pp. 552–559,
other parts of Europe?” Journal of Bone and Mineral Research, 2002.
vol. 16, no. 11, pp. 2066–2073, 2001. [26] H. A. Bischoff-Ferrari, B. Dawson-Hughes, J. A. Baron et al.,
[12] B. M. Tang, G. D. Eslick, C. Nowson, C. Smith, and A. “Calcium intake and hip fracture risk in men and women: a
Bensoussan, “Use of calcium or calcium in combination with meta-analysis of prospective cohort studies and randomized
vitamin D supplementation to prevent fractures and bone loss controlled trials,” American Journal of Clinical Nutrition, vol.
in people aged 50 years and older: a meta-analysis,” The Lancet, 86, no. 6, pp. 1780–1790, 2007.
vol. 370, no. 9588, pp. 657–666, 2007.
[27] S. Boonen, P. Lips, R. Bouillon, H. A. Bischoff-Ferrari,
[13] T. Chevalley, R. Rizzoli, V. Nydegger et al., “Effects of
D. Vanderschueren, and P. Haentjens, “Need for additional
calcium supplements on femoral bone mineral density and
calcium to reduce the risk of hip fracture with vitamin D
vertebral fracture rate in vitamin-D-replete elderly patients,”
supplementation: evidence from a comparative metaanal-
Osteoporosis International, vol. 4, no. 5, pp. 245–252, 1994.
ysis of randomized controlled trials,” Journal of Clinical
[14] B. Dawson-Hughes, S. S. Harris, E. A. Krall, and G. E. Dallal,
Endocrinology and Metabolism, vol. 92, no. 4, pp. 1415–1423,
“Effect of calcium and vitamin D supplementation on bone
2007.
density in men and women 65 years of age or older,” The New
[28] DIPART Group, “Patient level pooled analysis of 68 500
England Journal of Medicine, vol. 337, no. 10, pp. 670–676,
patients from seven major vitamin d fracture trials in us and
1997.
europe,” BMJ, vol. 340, article b5463, 2010.
[15] M. Peacock, G. Liu, M. Carey et al., “Effect of calcium or 25OH
vitamin D3 dietary supplementation on bone loss at the hip in [29] M. C. Chapuy, A. M. Schott, P. Garnero, D. Hans, P. D.
men and women over the age of 60,” Journal of Clinical Endo- Delmas, and P. J. Meunier, “Healthy elderly French women
crinology and Metabolism, vol. 85, no. 9, pp. 3011–3019, 2000. living at home have secondary hyperparathyroidism and high
[16] C. Meier, H. W. Woitge, K. Witte, B. Lemmer, and M. J. Seibel, bone turnover in winter,” Journal of Clinical Endocrinology and
“Supplementation with oral vitamin D3 and calcium during Metabolism, vol. 81, no. 3, pp. 1129–1133, 1996.
winter prevents seasonal bone loss: a randomized controlled [30] M. C. Chapuy, R. Pamphile, E. Paris et al., “Combined
open-label prospective trial,” Journal of Bone and Mineral calcium and vitamin D3 supplementation in elderly women:
Research, vol. 19, no. 8, pp. 1221–1230, 2004. confirmation of reversal of secondary hyperparathyroidism
[17] E. S. Orwoll, S. K. Oviatt, M. R. McClung, L. J. Deftos, and and hip fracture risk: the decalyos II study,” Osteoporosis
G. Sexton, “The rate of bone mineral loss in normal men and International, vol. 13, no. 3, pp. 257–264, 2002.
the effects of calcium and cholecalciferol supplementation,” [31] R. D. Jackson, A. Z. LaCroix, M. Gass et al., “Calcium plus
Annals of Internal Medicine, vol. 112, no. 1, pp. 29–34, 1990. vitamin D supplementation and the risk of fractures,” The New
[18] H. A. Bischoff-Ferrari, T. Dietrich, E. J. Orav et al., “Higher 25- England Journal of Medicine, vol. 354, no. 7, pp. 669–683, 2006.
hydroxyvitamin D concentrations are associated with better [32] A. Avenell, W. J. Gillespie, L. D. Gillespie, and D. O’Connell,
lower-extremity function in both active and inactive persons “Vitamin D and vitamin D analogues for preventing fractures
aged ≥60 y,” American Journal of Clinical Nutrition, vol. 80, associated with involutional and post-menopausal osteoporo-
no. 3, pp. 752–758, 2004. sis,” Cochrane Database of Systematic Reviews, no. 2, Article ID
[19] R. Gupta, U. Sharma, N. Gupta et al., “Effect of cholecalciferol CD000227, 2009.
and calcium supplementation on muscle strength and energy [33] A. M. Grant, “Oral vitamin D3 and calcium for secondary
metabolism in vitamin D-deficient Asian Indians: a random- prevention of low-trauma fractures in elderly people (Ran-
ized, controlled trial,” Clinical Endocrinology, vol. 73, no. 4, pp. domised Evaluation of Calcium or vitamin D, RECORD): a
445–451, 2010. randomised placebo-controlled trial,” The Lancet, vol. 365, no.
[20] C. Annweiler, M. Montero-Odasso, A. M. Schott, G. Berrut, 9471, pp. 1621–1628, 2005.
B. Fantino, and O. Beauchet, “Fall prevention and vitamin D [34] M. C. Chapuy, M. E. Arlot, P. D. Delmas, and P. J. Meunier,
in the elderly: an overview of the key role of the non-bone “Effect of calcium and cholecalciferol treatment for three years
effects,” Journal of NeuroEngineering and Rehabilitation, vol. 7, on hip fractures in elderly women,” British Medical Journal,
no. 1, article 50, 2010. vol. 308, no. 6936, pp. 1081–1082, 1994.
6. 6 Journal of Osteoporosis
[35] J. Iwamoto, T. Takeda, and Y. Sato, “Prevention and treatment
of corticosteroid-induced osteoporosis,” Yonsei Medical Jour-
nal, vol. 46, no. 4, pp. 456–463, 2005.
[36] H. A. Bischoff-Ferrari, W. C. Willett, J. B. Wong et al.,
“Prevention of nonvertebral fractures with oral vitamin D and
dose dependency: a meta-analysis of randomized controlled
trials,” Archives of Internal Medicine, vol. 169, no. 6, pp. 551–
561, 2009.
[37] B. Dawson-Hughes, A. Mithal, J. P. Bonjour et al., “IOF
position statement: vitamin D recommendations for older
adults,” Osteoporosis International, vol. 21, no. 7, pp. 1151–
1154, 2010.
[38] P. Lips, R. Bouillon, N. M. van Schoor et al., “Reducing frac-
ture risk with calcium and vitamin D,” Clinical Endocrinology,
vol. 73, no. 3, pp. 277–285, 2010.
[39] K. M. Prestwood, A. M. Pannullo, A. M. Kenny, C. C. Pilbeam,
and L. G. Raisz, “The effect of a short course of calcium and
vitamin D on bone turnover in older women,” Osteoporosis
International, vol. 6, no. 4, pp. 314–319, 1996.
[40] B. Dawson-Hughes, S. S. Harris, E. A. Krall, and G. E. Dallal,
“Effect of withdrawal of calcium and vitamin D supplements
on bone mass in elderly men and women,” American Journal
of Clinical Nutrition, vol. 72, no. 3, pp. 745–750, 2000.
[41] M. J. Bolland, A. Avenell, J. A. Baron et al., “Effect of
calcium supplements on risk of myocardial infarction and
cardiovascular events: meta-analysis,” BMJ, vol. 341, article
c3691, 2010.
[42] M. C. Chapuy, M. E. Arlot, F. Duboeuf et al., “Vitamin D3 and
calcium to prevent hip fractures in elderly women,” The New
England Journal of Medicine, vol. 327, no. 23, pp. 1637–1642,
1992.
[43] J. R. Lewis, J. Calver, K. Zhu, L. Flicker, and R. L. Prince,
“Calcium supplementation and the risks of atherosclerotic
vascular disease in older women: results of a 5-year RCT and a
4.5-year follow-up,” Journal of Bone and Mineral Research, vol.
26, no. 1, pp. 35–41, 2011.
[44] W. K. Al-Delaimy, E. Rimm, W. C. Willett, M. J. Stampfer, and
F. B. Hu, “A prospective study of calcium intake from diet and
supplements and risk of ischemic heart disease among men,”
The American Journal of Clinical Nutrition, vol. 77, no. 4, pp.
814–818, 2003.