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   2008| March  | Volume 127 | Issue 3  
    Online since May 11, 2011

 
 
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REVIEW ARTICLES
Osteoporosis in Indians
N Malhotra, A Mithal
March 2008, 127(3):263-268
PMID:18497441
Osteoporosis is characterized by low bone mass with micro architectural deterioration of bone tissue leading to enhance bone fragility, thus increasing the susceptibility to fracture. Although exact numbers are not available, based on available data and clinical experience, on estimated 25 million Indians may be affected. Osteoporotic fractures in India occur commonly in both sexes, and may occur at a younger age than in the West. Recently published data have clearly demonstrated widespread vitamin D deficiency across India, at all ages and in both sexes, particularly in the urban areas. Poor sunlight exposure, skin pigmentation and a vitamin D-deficient diet are some obvious causes for this finding. Indians have low BMD as compared to the western Caucasians. This could be attributed to differences in skeletal size; however, the high prevalence of vitamin D deficiency is a major factor in the low BMD and poor bone health of Indians. Healthy lifestyle (diet, exercise and sunlight exposure) can have a major positive impact on the bone metabolism and bone health of Indians. These public health measures are recommended for the population at large as they are efficacious, safe and cost-effective. The peak bone mass of the population can be increased significantly by appropriate and timely intervention in children. Pharmacological interventions are expensive and should therefore be targeted to only those at high risk of fractures.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  332 455 -
Prevalence & potential significance of vitamin D deficiency in Asian Indians
R Goswami, SK Mishra, N Kochupillai
March 2008, 127(3):229-238
PMID:18497436
Studies from our center and other parts of India have drawn attention towards wide prevalence of vitamin D deficiency (VDD) in our country. VDD has been reported in all age groups including toddlers, school children, pregnant women and their neonates and adult males and females residing in rural and urban India. We reviewed implications of VDD in our population based on the preliminary data available from Indian studies on skeletal health. Besides, a brief review is made on the importance of VDD in various other disorders prevalent in equivalent proportions among Indians such as type 2 diabetes mellitus (DM), cardiovascular diseases (CVD), immune competence including relation to tuberculosis, malignancy and osteoarthritis. Data from the West have also associated VDD with increased prevalence of type 2DM, CVD, autoimmune disorders, tuberculosis, prostate, breast and colon malignancy and osteoarthritis. Such association has not been studied to date in our country. Overall results of various studies conducted to date in urban and rural Indians indicate that widely prevalent VDD is functionally relevant to skeletal health including osteomalacia and rickets. However, there is a need to explore its association with osteoporosis related fractures and various other non skeletal disorders linked with VDD.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  290 323 -
ORIGINAL ARTICLE
Vitamin D status in Andhra Pradesh : a population based study
CV Harinarayan, T Ramalakshmi, UV Prasad, D Sudhakar
March 2008, 127(3):211-218
PMID:18497434
Full text not available  [PDF]  [PubMed]
  192 419 -
REVIEW ARTICLES
Nutritional bone disease in Indian population
SP S Teotia, M Teotia
March 2008, 127(3):219-228
PMID:18497435
Syndromes of bone disease and deformities consequent to disorders of nutrition, bone and mineral metabolism constitute a serious national health problem. The studies on this subject are scanty. Data on nutritional bone disease are described and discussed. We had surveyed 337.68 million population residing in 0.39 million villages in 22 States of India during the period 1963 to 2005. Of the 4,11,744 patients identified with the disorders of bone and mineral metabolism, 2,13,760 (52%) had nutritional bone disease, 1,77,200 (43%) had endemic skeletal fluorosis and 20,784 (5%) had metabolic bone disease and in 41 patients (0.19%) the bone disease was rare, mixed or unidentified. Vitamin D deficiency osteomalacia and rickets caused by inadequate exposure to sunlight (290-315 nm), dietary calcium deficiency (<300 mg/day) and fluoride interaction syndromes, calcium deficiency induced osteoporosis and calcium and vitamin D deficiency induced osteoporosis in the elderly, were the commonest disorders responsible for bone disease and deformities, besides caused by endemic skeletal fluorosis as a single entity in endemic fluorosis villages. Calcium deficiency per se dose not cause rickets, as revealed in our long-term follow up study on 47,500 calcium deficient children. Only mothers with severely depleted bone mineral and vitamin D stores gave birth to their babies with congenital rickets. Vitamin D deficiency rickets in children and osteomalacia in the mothers are the commonest disorders prevalent in the rural population of India. These disorders and the syndromes of calcium deficiency and fluoride interactions are largely responsible for the morbidity and mortality in the young and promising individuals, with economic consequences.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  330 218 -
Vitamin D & bone mineral density of healthy school children in northern India
RK Marwaha, G Sripathy
March 2008, 127(3):239-244
PMID:18497437
Studies on bone mineral health in children have been primarily based on clinical, biochemical and radiological evidence. Measurement of vitamin D levels and bone mass by non invasive imaging techniques like dual energy X-ray absorptiometry (DEXA), have led to a plethora of data regarding various factors responsible for bone mineral health from various countries including India. We reviewed the currently available evidence on status of calcium-vitamin D-parathormone (PTH) relationship and bone mineral density (BMD) in apparently healthy children. High prevalence of clinical and biochemical hypovitaminosis D exists in apparently healthy school children from north India. Also, children from upper socio-economic strata (USES) from Delhi had significantly higher mean BMD values at distal forearm (BMDdf) and calcameum (BMDca) than those from lower socio-economic strata (LSES). Age, nutrition, height and weight were seen to be significantly associated with BMD at peripheral sites.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  214 266 -
Vitamin D &/or calcium deficiency rickets in infants & children : a global perspective
John M Pettifor
March 2008, 127(3):245-249
PMID:18497438
It was only in the early part of the 20th century with the discovery of vitamin D and of the role that ultraviolet light irradiation plays in vitamin D formation that rational and appropriate therapy became available and rickets was all but eradicated in a number of developed countries. Since then, there has been a resurgence of the disease in many countries such as in Europe and the USA probably due to an increase in the prevalence of breast feeding, the immigration of dark skinned families to countries of high latitude, and the avoidance of direct sunlight because of the risk of the development of skin cancers. The disease is also widely recognised in many developing countries, including some situated in subtropical regions. Studies have led to the realization that nutritional rickets may be caused by either vitamin D or calcium deficiency, but in the majority of situations variable combinations of both probably play a role. Although low dietary calcium intakes appear to be central to the pathogenesis of rickets in Nigeria, genetic and/or other environmental factors are likely to contribute. But to date no single factor has been isolated as contributing significantly. The results of a recently conducted study suggest that in situation of low dietary calcium intakes vitamin D requirements may be higher than normal, possibly predisposing those children with vitamin D levels in the low normal range to rickets. If this is so, it would indicate that the currently accepted normal range for vitamin D sufficiency would need to be adjusted depending on dietary calcium intakes. Yet we are still unclear as to the factors which predispose some children to the disease.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  335 126 -
Dietary calcium intake - a critical reappraisal
V Bhatia
March 2008, 127(3):269-273
PMID:18497442
The clinical implications of calcium deficiency include rickets, poor bone mass accrual as well as abnormal foetal programming during pregnancy, poor peak bone mass due to poor accrual in childhood and adolescence, postmenopausal osteoporosis and osteoporosis of the elderly. Serum calcium is maintained within a narrow normal range, chiefly by resorption from the skeleton and alteration of urinary calcium loss and absorption from gut. Absorption is dependent on vitamin D sufficiency, presence of calcium binders in diet (such as phosphate, oxalate and phytate), age group and physiological state. A 2004 WHO expert panel has examined available data on calcium balance studies as well as calcium deficiency states and recommended daily calcium intake in the adult to be 1000 mg per day, with adjustments suggested for other age groups and physiological states. Daily calcium intake in India, both the reality and the recommendations, are far lower than the Western data. A reappraisal of dietary calcium recommendations may be necessary for India.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  239 165 -
Vitamin D deficiency in exclusively breast-fed infants
S Balasubramanian, R Ganesh
March 2008, 127(3):250-255
PMID:18497439
Exclusive breast-feeding is recommended up to 6 months of age with all its beneficial effects on child survival. Several studies have concluded that adequate intake of vitamin D cannot be met with human milk as the sole source of vitamin D. As breast-feeding rates increase, the incidence of vitamin D deficiency rickets is also expected to rise. One of the potential sources of vitamin D synthesis is in the skin from the ultraviolet rays of sunlight. Risk factors for developing vitamin D deficiency and rickets include low maternal levels of vitamin D, indoor confinement during the day, living at higher altitudes, living in urban areas with tall buildings, air pollution, darker skin pigmentation, use of sunscreen and covering much or all of the body when outside. In a study of 50 cases of hypocalcaemia reported from an urban tertiary care children's hospital in Chennai, 13 exclusively breast-fed infants presented with hypocalcaemia due to vitamin D deficiency and most of them with seizures. None of them had received vitamin D supplementation and all their mothers had biochemical evidence for vitamin D deficiency. This review discusses the rising incidence of vitamin D deficiency in infancy and the need to consider and implement methods to prevent the same by supplementation and increased exposure to sunlight without the hazards of ultraviolet rays on the skin. Further research to define the magnitude of vitamin D deficiency in exclusively breast-fed infants as a public health and paediatric problem and to recommend programmes to prevent the same are of utmost importance.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  209 154 -
Role of calcium-sensing receptor in bone biology
K Sharan, JA Siddiqui, G Swarnkar, N Chattopadhyay
March 2008, 127(3):274-286
PMID:18497443
Bone turnover helps accomplish long-term correction of the extracellular calcium (Ca2+ o) homeostasis by the actions of osteoblasts and osteoclasts. These processes are highly regulated by the actions of hormones, most prominently parathyroid hormone (PTH), the release of which is a function of the Ca2+ o, and is regulated by the action of the Ca2+ -sensing receptor (CaR) in the parathyroid gland. Various mutations of the CaR gene give rise to gain or loss of functions leading respectively to hypo- or hypercalcaemic conditions. CaR could conceivably be a target for local changes in the Ca2+ o in the bone microenvironment thereby acting as a 'growth factor' in various cells residing in the bone marrow. This review discusses about the roles of the CaR in bone. In osteoblasts, CaR promotes its proliferation, differentiation and mineralization. In osteoclasts, CaR mediates high Ca2+ o-stimulated osteoclast differentiation as well as osteoclast apoptosis. CaR regulates localization of haematopoietic stem cells from the foetal liver to endosteal niche, the socalled homing. Although the CaR plays a key role in the defense against hypercalcaemia, its function can be aberrant in humoral hypercalcaemia of malignancy in which CaR activation stimulates secretion of parathyroid hormone-related peptide (PTHrP) secretion. Increased levels of PTHrP cause a vicious hypercalcaemic state resulting from its increased bone-resorptive and positive renal calcium reabsorbing effects give rise to hypercalcaemia. CaR mediates a variety of functions of Ca2+ o in the bone microenvironment under both normal and pathological conditions.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  233 89 -
The physiology of vitamin D : current concepts
N Kochupillai
March 2008, 127(3):256-262
PMID:18497440
The vitamin D endocrine system, besides playing pivotal roles in calcium homeostasis & bone mineral metabolism, is now recognized to subserve a wide range of fundamental biological functions in cell differentiation, inhibition of cell growth as well as immuno modulation. Vitamin D is a prohormone which is converted into its active hormonal form 1, 25 (OH)D2 D, 1, 25 (OH)D2 D activates its cellular receptor (VDR) which activate target genes to engender its biological actions. This review provides a summary of recent understanding of the complex actions of the vitamin D hormone 1, 25 (OH)2 D which is a final product of 1alpha hydroxylation in the proximal tubular cells of kidneys. Emerging evidence also indicates both 1, 25 (OH)2 D3 independent as well as depended action of vitamin D receptor (VDR). Thus, the vitamin D system action may involve more than one single receptor and legand. The presence of 1alpha hydroxylase in many target cells other than proximal renal tubular cells indicates autocrine and paracrine functions for 1, 25 (OH)2 D3 in the control of cell proliferation and differentiation. Vitamin D and related molecules belong to a elaborate endocrine system that acts on target genomic receptors in several organ systems to control cell proliferation and differentiation.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  157 126 -
EDITORIAL
Nutrition & bone health
S Gopalan, P Ramachandran
March 2008, 127(3):207-210
PMID:18497433
Full text not available  [PDF]  [PubMed]
  92 114 -
SOME FORTHCOMING SCIENTIFIC EVENTS
Some forthcoming scientific events

March 2008, 127(3):287-287
Full text not available  [PDF]
  84 93 -
ANNOUNCEMENT
Announcement

March 2008, 127(3):287-287
Full text not available  [PDF]
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