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      Ingesta de calcio y proteínas: relación con marcadores bioquímicos óseos en mujeres pre y posmenopáusicas de Comodoro Rivadavia (Argentina)


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          Se estudió la relación de la ingesta de calcio y de proteínas con algunos marcadores de recambio óseo en 50 mujeres, 28 premenopáusicas (Pre) y 22 posmenopáusicas (Pos), de Comodoro Rivadavia (Argentina) con densidad mineral ósea (DMO) normal. Las ingestas de calcio (ICa) y de proteínas (IPr) se calcularon por encuesta de 7 días y frecuencia de consumo de alimentos. En orina de 24 h se determinaron: calcio (Ca), creatinina (Crea) y deoxipiridinolina (Dpir); en suero: fosfatasa alcalina ósea (BAPh). Los resultados (promedio ± DE, mínimo y máximo) fueron, para Pre y Pos, respectivamente: ICa (mg/d): 694 ± 411 (190 - 2.117); 918 ± 304 (471 - 1.740) (p<0,01); IPr (g/d): 64,6 ± 25,4 (33,5 - 136); 63,7 ± 17,6 (41,5 - 95,2); calciuria (mg/d): 123 ± 85 (20 - 369); 114 ± 66 (17 - 252); Ca/crea (mg/mg): 0,124 ± 0,086 (0,014 - 0,372); 0,131 ± 0,077 (0,020 - 0,338); Dpir/crea (nM/mM): 5,5 ± 1,5 (3,4 - 10,3); 7,1 ± 2,3 (3,9 - 14,5) (p<0,01); BAPh (UI/l): 58 ± 12 (28 - 94); 70 ± 20 (32 - 99) (p<0,01). La ICa fue inferior a la Ingesta Adecuada para la edad en el 86 % de Pre y en el 82 % de Pos. Los indicadores bioquímicos no correlacionaron significativamente con ICa ni con IPr. Estos resultados sugieren que en estas mujeres, sin pérdida de masa ósea, existiría adaptación a un amplio rango de ICa y que la masa ósea se mantendría mediante un equilibrio entre el incremento de la formación ósea y el de la resorción.

          Translated abstract

          Healthy premenopausal women (Pre n=28) and posmenopausal (Pos n=22), living in Comodoro Rivadavia (Argentina), with normal femoral neck and lumbar spine bone mineral density (BMD) were studied. Usual daily calcium intake (CaI) and protein intake (PrI) were calculated according to an special questionaire and the National Food Composition Tables. Fasting blood samples and 24 h urine were collected. Laboratory measurements were: in urine (U): calcium (Ca), creatinine (Crea) and deoxypiridinoline (Dpyr); in serum: Bone Alkaline Phosphatase (BAPh). The results presented the following media ± SD (minimum - maximum) in Pre and Pos, respectively: CaI (mg/d): 694 ± 411 (190 - 2,117); 918 ± 304 (471 - 1,740) (p<0.01); PrI (g/d): 64.6 ± 25.4 (33.5 - 136); 63.7 ± 17.6 (41.5 - 95.2); daily UCa (mg/d): 123 ± 85 (20 - 369); 114 ± 66 (17 - 252); Ca/crea (mg/mg): 0.124 ± 0.086 (0.014 - 0.372); 0.131 ± 0.077 (0.020 - 0.338); Dpyr/crea (nM/mM): 5.5 ± 1.5 (3.4 - 10.3); 7.1 ± 2.3 (3.9 - 14.5) (p<0.01); BAPh (UI/l): 58 ± 12 (28 - 94); 70 ± 20 (32 - 99) (p<0.01). CaI was lower than the Adequate Dietary calcium intake in 86 % and 82 % of the Pre and Pos women, respectively. There was no correlation between CaI, PrI and the biochemical indicators. Conclusions: in these healthy women, without bone mass loss and with wide range of CaI, although usually low, markers of bone turnover, would be a balance between the increase of bone formation and resorption.

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          Most cited references40

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          Epidemiology, etiology, and diagnosis of osteoporosis.

          Nancy Lane (2006)
          Osteoporosis, a major public health problem, is becoming increasingly prevalent with the aging of the world population. Osteoporosis is a skeletal disorder characterized by compromised bone strength, which predisposes the individual to an increased risk of fractures of the hip, spine, and other skeletal sites. The clinical consequences and economic burden of this disease call for measures to assess individuals who are at high risk to allow for appropriate intervention. Many risk factors are associated with osteoporotic fracture, including low peak bone mass, hormonal factors, the use of certain drugs (eg, glucocorticoids), cigarette smoking, low physical activity, low intake of calcium and vitamin D, race, small body size, and a personal or a family history of fracture. All of these factors should be taken into account when assessing the risk of fracture and determining whether further treatment is required. Because osteoporotic fracture risk is higher in older women than in older men, all postmenopausal women should be evaluated for signs of osteoporosis during routine physical examinations. Radiologic laboratory assessments of bone mineral density generally should be reserved for patients at highest risk, including all women over the age of 65, younger postmenopausal women with risk factors, and all postmenopausal women with a history of fractures. The evaluation of biochemical markers of bone turnover has been useful in clinical research. However, the predictive factor of these measurements is not defined clearly, and these findings should not be used as a replacement for bone density testing. Together, clinical assessment of osteoporotic risk factors and objective measures of bone mineral density can help to identify patients who will benefit from intervention and, thus, can potentially reduce the morbidity and mortality associated with osteoporosis-associated fractures in this population.
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            Clinical use of serum and urine bone markers in the management of osteoporosis.

            Osteoporosis is a common disease characterized by decreased bone mass, increased bone turnover, and increased susceptibility to fracture. Almost 44 million Americans are estimated to have low bone mass, which puts them at increased risk of developing osteoporosis and fractures. Osteoporosis is diagnosed by a low bone density (BMD) measurement, because a low BMD is known to contribute to increased fracture risk, which is the main source of morbidity and mortality for osteoporosis. However, changes in bone mass and density in response to anti-resorptive therapy account for only a small portion of the predicted fracture risk reduction. Whereas dynamic changes in bone turnover, estimated by measurement of bone biochemical markers, such as breakdown products of type-I collagen and proteins secreted by osteoblasts and osteoclasts in blood and urine, can account for a major portion of anti-fracture efficacy of anti-resorptive agents. Most anti-resorptive agents act by rapidly reducing bone markers. This has led to advocacy for use of bone turnover markers, in complement to BMD measurement, in the management of osteoporosis. In general, higher bone turnover is associated with accelerated bone loss and potential deterioration in bone quality. Several clinical trials have established the potential utility of markers to identify patients with rapid bone loss, to aid in therapeutic decision-making, and to monitor therapeutic efficacy of various treatments. Elevated marker levels have been shown to be associated with increased risk of fracture in elderly women, but their utility in predicting fracture is not yet established. In this article, we provide a brief summary to primary practitioners about the role bone markers can play in the management of osteoporosis.
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              Short-term changes in calcium but not protein intake alter the rate of bone resorption in healthy subjects as assessed by urinary pyridinium cross-link excretion.

              This study was conducted to determine whether the markers of bone resorption, pyridinium cross-links of collagen, are sensitive to changes in dietary protein and calcium intake. Fifteen young healthy subjects (7 males and 8 females) participated in three 5-d diet periods. Dietary intake during each dietary period consisted of: 1) low nitrogen and low calcium [0.49 +/- 0.11 g protein/ (kg.d), 429 +/- 190 mg calcium/d]; 2) low nitrogen and high calcium [0.44 +/- 0.08 g protein/(kg.d), 1643 +/- 171 mg calcium/d]; and 3) a high nitrogen and high calcium [2.71 +/- 0.75 g protein/(kg.d), 1589 +/- 633 mg calcium/d] diet, and this was compared with subjects' baseline dietary intake [0.99 +/- 0.51 g protein/(kg.d), 589 +/- 152 mg calcium/d]. The order of these diets was randomly assigned. Twenty-four-hour and 3-h urine samples were collected before and during each dietary period and were analyzed for pyridinium cross-links (pyridinoline, deoxypyridinoline), nitrogen and creatinine. The rate of pyrdinium cross-link excretion did not vary with protein intake but was approximately 33% lower (P < 0.01) during periods of high compared with low calcium intake. These data indicate that a short-term increase in calcium intake is accompanied by a reduced rate of bone resorption and that this effect is independent of dietary protein intake.

                Author and article information

                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Archivos Latinoamericanos de Nutrición
                Sociedad Latinoamericana de Nutrición (Caracas )
                September 2006
                : 56
                : 3
                : 237-243
                [1 ] Universidad Nacional de la Patagonia San Juan Bosco Argentina



                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0004-0622&lng=en
                NUTRITION & DIETETICS

                Nutrition & Dietetics
                Calcium and protein intake,bone turnover markers,bone mineral density,women,Ingesta de calcio y proteínas,marcadores óseos,densidad mineral ósea


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