Nocturnal rise in markers of bone resorption is not abolished by bedtime calcium or calcitonin

The "Mechanostat" Principle and the Osteoprotegerin-OPG/RANKL/RANK System PART II. The Role of the Hypothalamic-Pituitary Axis

Recent literature provides us with the indication that the ratio of OPG/RANKL concentrations fluctuate in a non-linear (bell-shaped) mode, according to Frost's "mechanostat" theory, during the application of mechanical strain. A similar cellular signal transduction mechanism to mechanical loading, that may also regulate bone resorptive activities, has nowdays been proposed. Since the skeleton is considered to be an endocrine organ, as such, it may likewise be subject to hypothalamic control. This central regulatory system may continually modulate the adaptation of the bone homeostatic system to external challenges. The hypothalamic-pituitary-gonadal axis may play a role in the regulation of OPG/RANKL secretion. The "mechanostat" principle may well characterize the oscillatory properties of the signal transduction mechanism that controls hard tissue metabolism and includes biochemical apart from mechanical stimuli. J. Cell. Biochem. 118: 962-966, 2017. © 2016 Wiley Periodicals, Inc.

Melatonin and the skeleton

Melatonin may affect bone metabolism through bone anabolic as well as antiresorptive effects. An age-related decrease in peak melatonin levels at nighttime is well documented, which may increase bone resorption and bone loss in the elderly. In vitro, melatonin reduces oxidative stress on bone cells by acting as an antioxidant. Furthermore, melatonin improves bone formation by promoting differentiation of human mesenchymal stem cell (hMSC) into the osteoblastic cell linage. Bone resorption is reduced by increased synthesis of osteoprogeterin (OPG), a decoy receptor that prevents receptor activator of NK-κB ligand (RANKL) in binding to its receptor. Moreover, melatonin is believed to reduce the synthesis of RANKL preventing further bone resorption. In ovariectomized as well as nonovariectomized rodents, melatonin has shown beneficial effects on bone as assessed by biochemical bone turnover markers, DXA, and μCT scans. Furthermore, in pinealectomized animals, bone mineral density (BMD) is significantly decreased compared to controls, supporting the importance of sufficient melatonin levels. In humans, dysfunction of the melatonin signaling pathway may be involved in idiopathic scoliosis, and the increased fracture risk in nighttime workers may be related to changes in the circadian rhythm of melatonin. In the so-far only randomized study on melatonin treatment, no effects were, however, found on bone turnover markers. In conclusion, melatonin may have beneficial effects on the skeleton, but more studies on humans are warranted in order to find out whether supplementation with melatonin at bedtime may preserve bone mass and improve bone biomechanical competence.

The physiology of the circadian rhythm of parathyroid hormone and its potential as a treatment for osteoporosis

PURPOSE OF REVIEW

A circadian rhythm exists for parathyroid hormone, with a biphasic pattern showing a late afternoon/early evening rise and fall and a broader, longer-lasting increase late evening/early morning reaching nadir mid-morning. This review explores the characteristics of the circadian rhythm, factors regulating the rhythm and its role in bone metabolism.

RECENT FINDINGS

Gender differences exist in the circadian rhythm for parathyroid hormone. Ageing in women alters the response to calcium infusion, increasing the suppression of parathyroid hormone secretion and decreasing bone resorption. There is no difference between young and elderly men in the parathyroid hormone response to calcium infusion. Loop diuretic ingestion alters the parathyroid hormone circadian rhythm reflecting loop diuretic effects on phosphate and calcium metabolism. Adult growth hormone deficiency alters parathyroid hormone secretion and end organ sensitivity, but the circadian rhythm is retained. Growth hormone replacement therapy enhances the parathyroid hormone circadian rhythm and increases end organ responses. Exogenous parathyroid hormone (1-34) and (1-84) administered by daily injection has an anabolic effect on bone, increasing bone mass and decreasing fracture. Calcilytic drugs stimulate and calcimimetic drugs suppress parathyroid hormone secretion and have been used to treat disorders of bone metabolism.

SUMMARY

The circadian nature of parathyroid hormone secretion is confirmed by many publications. The underlying rhythm is endogenous. Life style factors and nutritional intake modulate the pattern of secretion. Direct association with bone resorption and formation is tentative. It is suggested that acute changes in these rhythms have little effect on resorption, but longer-term manipulation of parathyroid hormone secretion alters bone cell function. Growth hormone therapy in adult deficiency increases parathyroid hormone activity, indicating growth hormone may have therapeutic potential for osteoporosis. Manipulation of the endogenous parathyroid hormone rhythm, using timed supplements of phosphate or calcium or by calcilytic and calcimimetic molecules, offers a novel approach to osteoporosis treatment.

Assessment and Recommendations on Factors Contributing to Preanalytical Variability of Urinary Pyridinoline and Deoxypyridinoline

Background: Pyridinoline (PYD) and deoxypyridinoline (DPD) are two of the most extensively characterized biochemical bone markers, but the interpretation of results is hampered by biologic and other preanalytical variability. We reviewed factors contributing to preanalytical variation of pyridinium cross-links in urine.

Methods: We searched four databases for English-language reports on PYD and/or DPD in urine. Searches were restricted to humans, except for studies of stability, when the search was expanded to other species. The 599 identified articles were supplemented with references from those articles and with articles known to the authors.

Results: The mean reported within-day variability was 71% for PYD (range, 57–78%) and 67% for DPD (range, 53–75%). The mean interday variability was 16% for both DPD and PYD (range for PYD, 12–21%; range for DPD, 5–24%). The mean intersubject variabilities across studies were 26% for PYD (range, 12–63%) and 34% for DPD (range, 8–98%) for healthy premenopausal women and 36% (range, 22–61%) and 40%, (range, 27–54%) for postmenopausal women, respectively. Specimen instability and errors in creatinine measurements were additional sources of variability.

Conclusions: Intra- and intersubject variability can be reduced by collecting specimens at a specific time of the day and by maintaining similar patient status at each specimen collection regarding factors such as medications and dietary supplements.

Does it make a difference how and when you take your calcium? The acute effects of calcium on calcium and bone metabolism

BACKGROUND

Calcium supplements are widely used to prevent osteoporosis. However, little is known about the metabolic effects of different dosages and of the timing of the dosages.

OBJECTIVE

The aim was to study the effects of the timing of the dose (study 1), the effects of the size of the dose (study 2), and the effects of small repetitive doses (study 3) of calcium on calcium and bone metabolism in women.

DESIGN

The investigation was conducted in 3 parts, each with 10 participants. In study 1, calcium loads (0 and 25 mg/kg body wt) were taken at 0900 and 2100. In study 2, calcium loads of 0, 250, and 1000 mg were taken at 0900. In study 3, calcium loads of 0 and 200 mg were taken 4 times/d. Markers of calcium and bone metabolism were followed.

RESULTS

There was no significant difference in the response of serum parathyroid hormone (PTH) to the calcium load taken at 0900 and that at 2100. There was a significant dose-response effect of the calcium load on serum ionized calcium (P = 0.00005) and serum PTH (P = 0.0003). Small calcium doses (200 mg) taken 4 times/d kept the PTH secretion at a lower level than during the control day (P = 0.016). None of the doses caused significant changes in the markers of bone formation and resorption measured.

CONCLUSIONS

The calcium loads had no significant effect on the markers of bone formation and resorption measured, although even small calcium doses decreased serum PTH and increased serum ionized calcium concentrations rapidly. The effect was similar whether calcium was taken in the morning or in the evening.

Considerações sobre os marcadores bioquímicos do metabolismo ósseo e sua utilidade prática

O uso de marcadores bioquímicos do metabolismo ósseo na prática clínica tem se expandido de maneira considerável. Isto se deve ao surgimento de novos métodos e de um melhor conhecimento sobre a fisiopatologia das doenças ósteo-metabólicas, em especial a osteoporose. Os marcadores podem ser divididos em marcadores de formação, que refletem a atividade dos osteoblastos, e os de reabsorção, que refletem a atividade dos osteoclastos. Dentre os primeiros destacam-se a fosfatase alcalina óssea e a osteocalcina, e dentre os últimos os fragmentos derivados da reabsorção do colágeno, como as piridino-linas e os telopeptídeos carboxi e amino terminais. Além das aplicações já consagradas, como o diagnóstico e acompanhamento de patologias com importantes repercussões ósseas como a doença de Paget, o hiperparatiroidismo primário e outras, novas aplicações têm sido estudadas. Dentre estas, a que mais parece fundamentada é o acompanhamento do efeito de terapêutica específica no tratamento da osteoporose; a curto prazo, 1 a 3 meses, é possível a verificação da eficácia terapêutica, fato só possível com densitometria óssea após 1 a 2 anos. Novos métodos, em especial para a medida de marcadores de reabsorção no soro, devem tornar ainda mais abrangente a aplicação destes ensaios.

Evaluation of a nonhuman primate model to study circadian rhythms of calcium metabolism

We evaluated primate models for the study of circadian rhythms in calcium and bone metabolism. Blood and urine were collected from two cynomolgus macaques every 4 h for 24 h. Studies were initiated at three different clock times to separate the effects of repeated experimental sampling from circadian effects. Also, samples were collected from seven monkeys at times of expected maxima and minima. Some parameters exhibited the expected circadian rhythm with increases at night (serum total calcium) or in the early morning (urinary collagen cross-links). Others displayed the effects of the experimental procedure, either increasing (urinary creatinine and phosphorus) or decreasing (osteocalcin, urinary calcium) with repeated sampling. Serum phosphorus, cortisol, and type I procollagen were influenced by both clock time and experimental procedures. Alkaline phosphatase and parathyroid hormone did not show any differences with time or sampling. This data is consistent with findings in humans that bone resorption increases at night and that endogenous corticosteroids decrease bone formation. The usefulness of the monkey model is limited by the physiological stress of sample collection in these subjects.

Biochemical markers in the assessment of bone disease

As the mean age of our population increases, increasing attention has been paid to the diseases associated with aging, including diseases of the skeleton such as osteoporosis. Effective means of treating and possibly preventing such skeletal disorders are emerging, making their early recognition an important goal for the primary care physician. Although bone density measurements and skeletal imaging studies remain of primary diagnostic importance in this regard, a large number of assays for biochemical markers of bone formation and resorption are being developed that promise to complement the densitometry measurements and imaging studies, providing an assessment of the rates of bone turnover and an earlier evaluation of the effects of therapy. In this review, emphasizing the recent literature, the major biochemical markers currently in use or under active investigation are described, and their application in a number of diseases of the skeleton including osteoporosis is evaluated.

Morning or evening administration of nasal calcitonin? Effects on biochemical markers of bone turnover

The purpose of this study was to examine the effect of intranasal salmon calcitonin (sCT) administration (200 IE), given either in the morning (8:00) or evening (21:00), on the known circadian variation in biochemical markers of bone turnover. An open, placebo-controlled, randomized, crossover study, with three 24 h studies of blood samples drawn every third hour and urine collected in 3 h aliquots was undertaken. Subjects consisted of nine healthy postmenopausal women, aged 58 +/- 7 years. Urinary CrossLaps (a measure of bone resorption) was measured by ELISA and corrected for creatinine (Cr). Serum osteocalcin (sOC) was measured by radioimmunoassay (RIA). The first 24 h study was performed without intervention. Prior to this control study the participants were randomized to either morning (8:00) or evening (21:00) sCT (200 IE). sCT administrations were given 4-5 days prior to and during the second study. After a washing-out period of 2 weeks the participants were given 200 IE of sCT at the reverse time of the day 5 days prior to and during the third study. At all timepoints, urinary CrossLaps/Cr exhibited a significant (p < 0.001) circadian rhythm with its zenith in early morning and nadir in late afternoon. Both morning and evening administration of sCT significantly decreased the urinary excretion of CrossLaps/Cr approximately 3-6 h after administration with a subsequent rebound effect. sOC did not exhibit a significant circadian variation and was not affected by the calcitonin. The 24 h mean urinary CrossLaps/Cr and sOC remained unchanged. Both morning and evening sCT significantly decreased the urinary excretion of CrossLaps/Cr 3-6 h after administration, with a rebound effect approximately 12 h later. However, the present study does not indicate that neither evening nor twice-daily administration is superior to morning administration.