Role of nutritional vitamin D in osteoporosis treatment
Clinica Chimica Acta, Vol 484, Sept 2018, pg 179-191, https://doi.org/10.1016/j.cca.2018.05.035 $42 for PDF
lYi-Chou Houab Chia-Chao WucMin-Tser Liaode Jia-Fwu Shyuf Chi-Feng Hunggh Tzung-Hai Yenijk Chien-Lin Lub Kuo-Cheng Lub
- Osteoporosis is composed by quality and quantity of bone mass.
- Treatment for osteoporosis should be focused on the bone turnover rate in order to normalize the bone remodeling.
- Nutritional vitamin D is an important regulator to maintain the bone remodeling due to its pleotropic effect.
Osteoporosis is a systemic skeletal disorder characterized by a decrease in bone mass and microarchitectural deterioration of bone tissue. The World Health Organization has defined osteoporosis as a decrease in bone mass (50%) and bony quality (50%). Vitamin D, a steroid hormone, is crucial for skeletal health and in mineral metabolism. Its direct action on osteoblasts and osteoclasts and interaction with nonskeletal tissues help in maintaining a balance between bone turnover and bone growth. Vitamin D affects the activity of osteoblasts, osteoclasts, and osteocytes, suggesting that it affects bone formation, bone resorption, and bone quality. At physiological concentrations, active vitamin D maintains a normal rate of bone resorption and formation through the RANKL/OPG signal. However, active vitamin D at pharmacological concentration inhibits bone resorption at a higher rate than that of bone formation, which influences the bone quality and quantity. Nutritional vitamin D rather than active vitamin D activates osteoblasts and maintains serum 25(OH)D3 concentration. Despite many unanswered questions, much data support nutritional vitamin D use in osteoporosis patients. This article emphasizes the role of nutritional vitamin D replacement in different turnover status (high or low bone turnover disorders) of osteoporosis together with either anti-resorptive (Bisphosphonate, Denosumab et.) or anabolic (Teriparatide) agents when osteoporosis persists.