Metabolomics analysis in adults with high bone mass identifies a relationship between bone resorption and circulating citrate which replicates in the general population

Metabolomics of Osteoporosis in Humans: A Systematic Review

PURPOSE OF REVIEW

To systematically review recent studies investigating the association between metabolites and bone mineral density (BMD) in humans.

METHODS

Using predefined keywords, we searched literature published from Jan 1, 2019 to Feb 20, 2022 in PubMed, Web of Science, Embase, and Scopus. Studies that met the predefined exclusion criteria were excluded. Among the included studies, we identified metabolites that were reported to be associated with BMD by at least three independent studies.

RECENT FINDINGS

A total of 170 studies were retrieved from the databases. After excluding studies that did not meet our predefined inclusion criteria, 16 articles were used in this review. More than 400 unique metabolites in blood were shown to be significantly associated with BMD. Of these, three metabolites were reported by ≥ 3 studies, namely valine, leucine and glycine. Glycine was consistently shown to be inversely associated with BMD, while valine was consistently observed to be positively associated with BMD. Inconsistent associations with BMD was observed for leucine. With advances in metabolomics technology, an increasing number of metabolites associated with BMD have been identified. Two of these metabolites, namely valine and glycine, were consistently associated with BMD, highlighting their potential for clinical application in osteoporosis. International collaboration with a larger population to conduct clinical studies on these metabolites is warranted. On the other hand, given that metabolomics could be affected by genetics and environmental factors, whether the inconsistent association of the metabolites with BMD is due to the interaction between metabolites and genes and/or lifestyle warrants further study.

High Bone Mass Disorders: New Insights From Connecting the Clinic and the Bench

Monogenic high bone mass (HBM) disorders are characterized by an increased amount of bone in general, or at specific sites in the skeleton. Here, we describe 59 HBM disorders with 50 known disease-causing genes from the literature, and we provide an overview of the signaling pathways and mechanisms involved in the pathogenesis of these disorders. Based on this, we classify the known HBM genes into HBM (sub)groups according to uniform Gene Ontology (GO) terminology. This classification system may aid in hypothesis generation, for both wet lab experimental design and clinical genetic screening strategies. We discuss how functional genomics can shape discovery of novel HBM genes and/or mechanisms in the future, through implementation of omics assessments in existing and future model systems. Finally, we address strategies to improve gene identification in unsolved HBM cases and highlight the importance for cross-laboratory collaborations encompassing multidisciplinary efforts to transfer knowledge generated at the bench to the clinic. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Increasing calcium phosphate aqueous solubility and spontaneous supersaturation combining citrate and gluconate with perspectives for functional foods

Uptake of calcium from food depends on solubility of calcium salts in the intestines, and precipitation of calcium phosphates decreases bioaccessibility of food calcium. Citrate as a high affinity complex binder for calcium was found spontaneously to create strongly supersaturated solutions by rapid dissolution of calcium hydrogen phosphate characterized by short lag phases for precipitation. Gluconate with weaker affinity for calcium binding showed longer lag phases for precipitation from supersaturated solutions. For citrate/gluconate combinations, the highest degree of supersaturation with longest lag phases for precipitation were found by trial-and-error experiments for a citrate/gluconate ratio of 1:10 for dissolution of calcium hydrogen phosphate resulting in supersaturation factors around three and without precipitation for more than a month. The aim of the present study was to provide a physicochemical explanation of this robust supersaturation. Calcium speciation based on electrochemical calcium activity measurement identified a low [Ca²⁺]·[HCitr^2-] product as critical for supersaturation.

Strontium increasing calcium accessibility from calcium citrate

Strontium chloride added to aqueous suspensions of metastable calcium citrate tetrahydrate increased calcium ion activity measured electrochemically without transition of metastable tetrahydrate to stable calcium citrate hexahydrate as shown by DSC. Calcium activity increase was explained by lower solubility of strontium citrate pentahydrate formed (8.9 × 10^-4 M at 25 °C) increasing with temperature compared to calcium citrate tetrahydrate (1.6 × 10^-3 M) decreasing with temperature. Strontium binding to citrate was found endothermic, ΔH⁰ = 45 kJ∙mol^-1 at 25 °C, while calcium binding shows variation from ΔH⁰ = 94 kJ∙mol^-1 at 10 °C becoming exothermic above physiological temperature with ΔH⁰ = -9 kJ∙mol^-1 at 45 °C as determined from temperature and concentration variation in electric conductivity. These differences in solution thermodynamics and pH effect on complex formation between calcium and strontium citrate are discussed in relation to biomineralization.

Slow lactate gluconate exchange in calcium complexes during precipitation from supersaturated aqueous solutions

Saturated solutions of calcium l-lactate in water or in deuterium oxide continuously dissolve calcium l-lactate by addition of solid sodium d-gluconate and become strongly supersaturated in calcium d-gluconate due to no or slow precipitation. The quantification of total dissolved calcium allied with the calcium complexes equilibrium constants allowed an ion speciation, which shows an initial non-thermal and spontaneous supersaturation of more than a factor of 50 at 25 °C only slowly decreasing after initiation of precipitation of calcium d-gluconate after a lag phase of several hours. A mathematical model is proposed, based on numerical solution of coupled differential equations of dynamics of l-lactate and d-gluconate exchange during the lag phase for precipitation and during precipitation. A slow exchange of l-lactate coordinated to calcium with d-gluconate is indicated with a time constant of 0.20 h^-1 in water and of 0.15 h^-1 in deuterium oxide and a kinetic deuterium/hydrogen isotope effect of 1.25. Such spontaneous non-thermal supersaturation and slow ligand exchange with a pseudo first order equilibration process with a half-life of 3.5 h in water for calcium hydroxycarboxylates can help to understand the higher calcium bioavailability from calcium hydroxycarboxylates compared to simple salts.

Calcium availability from whey mineral residues increased by hydrogen citrate

Insoluble mineral residues from whey processing dominated by hydroxyapatite and calcium hydrogen phosphate were found to dissolve isothermally in aqueous sodium hydrogen citrate. Dissolution occurred spontaneously and the resultant homogeneous solutions were found to be supersaturated solutions in both calcium citrate and calcium hydrogen phosphate. Supersaturation was investigated by visual inspection combined with turbidity measurements and analyses of calcium and phosphorous by ICP. The maximal supersaturation was found to be proportional to total hydrogen citrate concentration. For 0.2 M hydrogen citrate, maximum calcium concentration was achieved in the first hours of dissolution resulting in the supersaturation of calcium hydrogen phosphate with a factor of 10. Calcium citrate rather than calcium hydrogen phosphate precipitated from the supersaturated solutions and the time elapsing before precipitation began, increased with increasing concentrations of excess of hydrogen citrate. This lag phase for precipitation ranged from several hours for 0.2 M hydrogen citrate to more than a day for higher hydrogen citrate concentrations, for which the solutions were saturated in calcium hydrogen phosphate and became supersaturated only in calcium citrate due to the strong binding of calcium by citrate. The appearance and decay of supersaturation was kinetically studied in order to provide the background for future exploration of whey minerals in functional foods for improved calcium nutrition.

Metabolomic Associations with Serum Bone Turnover Markers

Bone is a dynamic tissue that is in a constant state of remodeling. Bone turnover markers (BTMs), procollagen type I N-terminal propeptide (P1NP) and C-terminal telopeptides of type I collagen (CTX), provide sensitive measures of bone formation and resorption, respectively. This study used ultra-high-resolution metabolomics (HRM) to determine plasma metabolic pathways and targeted metabolites related to the markers of bone resorption and formation in adults. This cross-sectional clinical study included 34 adults (19 females, mean 27.8 years), without reported illnesses, recruited from a US metropolitan area. Serum BTM levels were quantified by an ELISA. Plasma HRM utilized dual-column liquid chromatography and mass spectrometry to identify metabolites and metabolic pathways associated with BTMs. Metabolites significantly associated with P1NP (p < 0.05) were significantly enriched in pathways linked to the TCA cycle, pyruvate metabolism, and metabolism of B vitamins important for energy production (e.g., niacin, thiamin). Other nutrition-related metabolic pathways associated with P1NP were amino acid (proline, arginine, glutamate) and vitamin C metabolism, which are important for collagen formation. Metabolites associated with CTX levels (p < 0.05) were enriched within lipid and fatty acid beta-oxidation metabolic pathways, as well as fat-soluble micronutrient pathways including, vitamin D metabolism, vitamin E metabolism, and bile acid biosynthesis. P1NP and CTX were significantly related to microbiome-related metabolites (p < 0.05). Macronutrient-related pathways including lipid, carbohydrate, and amino acid metabolism, as well as several gut microbiome-derived metabolites were significantly related to BTMs. Future research should compare metabolism BTMs relationships reported here to aging and clinical populations to inform targeted therapeutic interventions.

Metabolomics analysis in adults with high bone mass identifies a relationship between bone resorption and circulating citrate which replicates in the general population

OBJECTIVE

Bone turnover, which regulates bone mass, may exert metabolic consequences, particularly on markers of glucose metabolism and adiposity. To better understand these relationships, we examined cross-sectional associations between bone turnover markers (BTMs) and metabolic traits in a population with high bone mass (HBM, BMD Z-score ≥+3.2).

DESIGN

β-C-terminal telopeptide of type-I collagen (β-CTX), procollagen type-1 amino-terminal propeptide (P1NP) and osteocalcin were assessed by electrochemiluminescence immunoassays. Metabolic traits, including lipids and glycolysis-related metabolites, were measured using nuclear magnetic resonance spectroscopy. Associations of BTMs with metabolic traits were assessed using generalized estimating equation linear regression, accounting for within-family correlation, adjusting for potential confounders (age, sex, height, weight, menopause, bisphosphonate and oral glucocorticoid use).

RESULTS

A total of 198 adults with HBM had complete data, mean [SD] age 61.6 [13.7] years; 77% were female. Of 23 summary metabolic traits, citrate was positively related to all BTMs: adjusted ββ-CTX  = 0.050 (95% CI 0.024, 0.076), P = 1.71 × 10-4 , βosteocalcin  = 6.54 × 10-4 (1.87 × 10-4 , 0.001), P = .006 and βP1NP  = 2.40 × 10-4 (6.49 × 10-5 , 4.14 × 10-4 ), P = .007 (β = increase in citrate (mmol/L) per 1 µg/L BTM increase). Inverse relationships of β-CTX (β = -0.276 [-0.434, -0.118], P = 6.03 × 10-4 ) and osteocalcin (-0.004 [-0.007, -0.001], P = .020) with triglycerides were also identified. We explored the generalizability of these associations in 3664 perimenopausal women (age 47.9 [4.4] years) from a UK family cohort. We confirmed a positive, albeit lower magnitude, association between β-CTX and citrate (adjusted βwomen  = 0.020 [0.013, 0.026], P = 1.95 × 10-9 ) and an inverse association of similar magnitude between β-CTX and triglycerides (β = -0.354 [-0.471, -0.237], P = 3.03 × 10-9 ).

CONCLUSIONS

Bone resorption is positively related to circulating citrate and inversely related to triglycerides. Further studies are justified to determine whether plasma citrate or triglyceride concentrations are altered by factors known to modulate bone resorption, such as bisphosphonates.