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Published in: Calcified Tissue International 5/2011

01-05-2011 | Original Research

Role of Parathyroid Hormone in Bone Fragility of Postmenopausal Women with Vitamin D Insufficiency

Authors: Mika Yamauchi, Hiroshi Kaji, Kiyoko Nawata, Shin Takaoka, Toru Yamaguchi, Toshitsugu Sugimoto

Published in: Calcified Tissue International | Issue 5/2011

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Abstract

Vitamin D insufficiency is related to an increase in PTH, which might be critical for an increase in bone fragility. However, the role of endogenous PTH in vitamin D insufficiency-induced fracture risk remains unclear. The present study was performed to examine the relationships among vitamin D insufficiency, bone fragility, and PTH in 202 Japanese postmenopausal women. Serum 25-hydroxyvitamin D (25[OH]D) levels were measured. The percentages of subjects with 25(OH)D levels below 10, 15, and 20 ng/ml were 5.0, 41.0, and 80.7%, respectively. Serum 25(OH)D levels were negatively related to age and serum levels of Cr and PTH; they were positively related to bone mineral density (BMD). In multiple regression analysis, BMD was significantly related to 25(OH)D levels when adjusted for age, body mass index (BMI), and serum levels of Cr and PTH. Multiple logistic regression analysis showed that lower 25(OH)D levels were significantly related to prevalent fracture risk when adjusted for age, BMI, serum levels of Cr and PTH, as well as femoral neck BMD. The proportion of subjects with prevalent fractures was significantly higher in the group with lower PTH and lower 25(OH)D than in the group with lower PTH and higher 25(OH)D or higher PTH and higher 25(OH)D. In conclusion, vitamin D insufficiency was found to be related to prevalent fracture risk independently of PTH. Functional hypoparathyroidism, rather than functional hyperparathyroidism, might be a risk factor for bone fragility in vitamin D insufficiency.
Literature
1.
go back to reference Mithal A, Wahl DA, Bonjour JP et al (2009) Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20:1807–1820PubMedCrossRef Mithal A, Wahl DA, Bonjour JP et al (2009) Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20:1807–1820PubMedCrossRef
2.
go back to reference Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501PubMedCrossRef Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501PubMedCrossRef
3.
go back to reference Priemel M, von Domarus C, Klatte TO et al (2010) Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res 25:305–312PubMedCrossRef Priemel M, von Domarus C, Klatte TO et al (2010) Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res 25:305–312PubMedCrossRef
4.
go back to reference Abrams SA, Griffin IJ, Hawthorne KM, Gunn SK, Gundberg CM, Carpenter TO (2005) Relationships among vitamin D levels, parathyroid hormone, and calcium absorption in young adolescents. J Clin Endocrinol Metab 90:5576–5581PubMedCrossRef Abrams SA, Griffin IJ, Hawthorne KM, Gunn SK, Gundberg CM, Carpenter TO (2005) Relationships among vitamin D levels, parathyroid hormone, and calcium absorption in young adolescents. J Clin Endocrinol Metab 90:5576–5581PubMedCrossRef
5.
go back to reference Harkness L, Cromer B (2005) Low levels of 25-hydroxyvitamn D are associated with elevated parathyroid hormone in healthy adolescent females. Osteoporos Int 16:109–113PubMedCrossRef Harkness L, Cromer B (2005) Low levels of 25-hydroxyvitamn D are associated with elevated parathyroid hormone in healthy adolescent females. Osteoporos Int 16:109–113PubMedCrossRef
6.
go back to reference Snijder MB, van Dam RM, Visser M et al (2005) Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women. J Clin Endocrinol Metab 90:4119–4123PubMedCrossRef Snijder MB, van Dam RM, Visser M et al (2005) Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women. J Clin Endocrinol Metab 90:4119–4123PubMedCrossRef
7.
go back to reference Pepe J, Romahnoli E, Nofroni I et al (2005) Vitamin D status as the major factor determining the circulating levels of parathyroid hormone: a study in normal subjects. Osteoporos Int 16:805–812PubMedCrossRef Pepe J, Romahnoli E, Nofroni I et al (2005) Vitamin D status as the major factor determining the circulating levels of parathyroid hormone: a study in normal subjects. Osteoporos Int 16:805–812PubMedCrossRef
8.
go back to reference Okazaki R, Sugimoto T, Kaji H et al (2010) Vitamin D insufficiency defined by serum 25-hydroxyvitamin D and parathyroid hormone before and after oral vitamin D3 load in Japanese subjects. J Bone Miner Metab 29:103–110PubMedCrossRef Okazaki R, Sugimoto T, Kaji H et al (2010) Vitamin D insufficiency defined by serum 25-hydroxyvitamin D and parathyroid hormone before and after oral vitamin D3 load in Japanese subjects. J Bone Miner Metab 29:103–110PubMedCrossRef
9.
go back to reference Hannan MT, Litman HJ, Araujo AB et al (2008) Serum 25-hydroxyvitamin D and bone mineral density in a racially and ethnically diverse group of men. J Clin Endocrinol Metab 93:40–46PubMedCrossRef Hannan MT, Litman HJ, Araujo AB et al (2008) Serum 25-hydroxyvitamin D and bone mineral density in a racially and ethnically diverse group of men. J Clin Endocrinol Metab 93:40–46PubMedCrossRef
10.
go back to reference Bischoff-Ferrari HA, Kiel DP, Dawson-Hughes B et al (2009) Dietary calcium and serum 25-hydroxyvitamin D status in relation to BMD among U.S. adults. J Bone Miner Res 24:935–942PubMedCrossRef Bischoff-Ferrari HA, Kiel DP, Dawson-Hughes B et al (2009) Dietary calcium and serum 25-hydroxyvitamin D status in relation to BMD among U.S. adults. J Bone Miner Res 24:935–942PubMedCrossRef
11.
go back to reference Kuchuk NO, Pluijm SM, van Schoor NM, Looman CW, Smit JH, Lips P (2009) Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons. J Clin Endocrinol Metab 94:1244–1250PubMedCrossRef Kuchuk NO, Pluijm SM, van Schoor NM, Looman CW, Smit JH, Lips P (2009) Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons. J Clin Endocrinol Metab 94:1244–1250PubMedCrossRef
12.
go back to reference Kuchuk NO, van Schoor NM, Pluijm SM, Chines A, Lips P (2009) Vitamin D status, parathyroid function, bone turnover, and BMD in postmenopausal women with osteoporosis: global perspective. J Bone Miner Res 24:693–701PubMedCrossRef Kuchuk NO, van Schoor NM, Pluijm SM, Chines A, Lips P (2009) Vitamin D status, parathyroid function, bone turnover, and BMD in postmenopausal women with osteoporosis: global perspective. J Bone Miner Res 24:693–701PubMedCrossRef
13.
go back to reference Ensrud KE, Taylor BC, Paudel ML et al (2009) Serum 25-hydroxyvitamin D levels and rate of hip bone loss in older men. J Clin Endocrinol Metab 94:2773–2780PubMedCrossRef Ensrud KE, Taylor BC, Paudel ML et al (2009) Serum 25-hydroxyvitamin D levels and rate of hip bone loss in older men. J Clin Endocrinol Metab 94:2773–2780PubMedCrossRef
14.
go back to reference Visser M, Deeg DJ, Lips P (2003) Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the longitudinal aging study Amsterdam. J Clin Endocrinol Metab 88:5766–5772PubMedCrossRef Visser M, Deeg DJ, Lips P (2003) Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the longitudinal aging study Amsterdam. J Clin Endocrinol Metab 88:5766–5772PubMedCrossRef
15.
go back to reference Suzuki T, Kwon J, Kim H et al (2008) Low serum 25-hydroxyvitamin D levels associated with falls among Japanese community-dwelling elderly. J Bone Miner Res 23:1309–1317PubMedCrossRef Suzuki T, Kwon J, Kim H et al (2008) Low serum 25-hydroxyvitamin D levels associated with falls among Japanese community-dwelling elderly. J Bone Miner Res 23:1309–1317PubMedCrossRef
16.
go back to reference Snijder MB, van Schoor NM, Pluijm SM, van Dam RM, Visser M, Lips P (2006) Vitamin D status in relation to one-year risk of recurrent falling in older men and women. J Clin Endocrinol Metab 91:2980–2985PubMedCrossRef Snijder MB, van Schoor NM, Pluijm SM, van Dam RM, Visser M, Lips P (2006) Vitamin D status in relation to one-year risk of recurrent falling in older men and women. J Clin Endocrinol Metab 91:2980–2985PubMedCrossRef
17.
go back to reference Cauley JA, Parimi N, Ensrud KE et al (2010) Serum 25-hydroxyvitamin D and the risk of hip and nonspine fractures in older men. J Bone Miner Res 25:545–553PubMedCrossRef Cauley JA, Parimi N, Ensrud KE et al (2010) Serum 25-hydroxyvitamin D and the risk of hip and nonspine fractures in older men. J Bone Miner Res 25:545–553PubMedCrossRef
18.
go back to reference Looker AC, Mussolino ME (2008) Serum 25-hydroxyvitamin D and hip fracture risk in older U.S. white adults. J Bone Miner Res 23:143–150PubMedCrossRef Looker AC, Mussolino ME (2008) Serum 25-hydroxyvitamin D and hip fracture risk in older U.S. white adults. J Bone Miner Res 23:143–150PubMedCrossRef
19.
go back to reference Ruohola JP, Laaksi I, Ylikomi T et al (2006) Association between serum 25(OH)D concentrations and bone stress fractures in Finnish young men. J Bone Miner Res 21:1483–1488PubMedCrossRef Ruohola JP, Laaksi I, Ylikomi T et al (2006) Association between serum 25(OH)D concentrations and bone stress fractures in Finnish young men. J Bone Miner Res 21:1483–1488PubMedCrossRef
20.
go back to reference Cauley JA, Lacroix AZ, Wu L et al (2008) Serum 25-hydroxyvitamin D concentrations and risk for hip fractures. Ann Intern Med 149:242–250PubMed Cauley JA, Lacroix AZ, Wu L et al (2008) Serum 25-hydroxyvitamin D concentrations and risk for hip fractures. Ann Intern Med 149:242–250PubMed
21.
go back to reference Garnero P, Munoz F, Sornay-Rendu E, Delmas PD (2007) Associations of vitamin D status with bone mineral density, bone turnover, bone loss and fracture risk in healthy postmenopausal women. The OFELY study. Bone 40:716–722PubMedCrossRef Garnero P, Munoz F, Sornay-Rendu E, Delmas PD (2007) Associations of vitamin D status with bone mineral density, bone turnover, bone loss and fracture risk in healthy postmenopausal women. The OFELY study. Bone 40:716–722PubMedCrossRef
22.
go back to reference Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005) Estimates of optimal vitamin D status. Osteoporos Int 16:713–716PubMedCrossRef Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005) Estimates of optimal vitamin D status. Osteoporos Int 16:713–716PubMedCrossRef
23.
go back to reference Khosla S, Melton LJ 3rd, Wermers RA, Crowson CS, O’Fallon W, Riggs B (1999) Primary hyperparathyroidism and a risk of fracture: a population-based study. J Bone Miner Res 14:1700–1707PubMedCrossRef Khosla S, Melton LJ 3rd, Wermers RA, Crowson CS, O’Fallon W, Riggs B (1999) Primary hyperparathyroidism and a risk of fracture: a population-based study. J Bone Miner Res 14:1700–1707PubMedCrossRef
24.
go back to reference Kaji H, Yamauchi M, Chihara K, Sugimoto T (2008) Relationship between endogenous parathyroid hormone and bone metabolism/geometry in female patients with glucocorticoid. Horm Metab Res 40:60–65PubMedCrossRef Kaji H, Yamauchi M, Chihara K, Sugimoto T (2008) Relationship between endogenous parathyroid hormone and bone metabolism/geometry in female patients with glucocorticoid. Horm Metab Res 40:60–65PubMedCrossRef
25.
go back to reference Kaji H, Kuroki Y, Murakawa Y et al (2010) Effect of alendronate on bone metabolic indices and bone mineral density in patients with high-dose glucocorticoid: a prospective study. Osteoporos Int 21:1565–1571PubMedCrossRef Kaji H, Kuroki Y, Murakawa Y et al (2010) Effect of alendronate on bone metabolic indices and bone mineral density in patients with high-dose glucocorticoid: a prospective study. Osteoporos Int 21:1565–1571PubMedCrossRef
26.
go back to reference Papadimitropoulos E, Wells G, Shea B, et al (2002) Meta-analyses of therapies for postmenopausal osteoporosis. VIII: meta-analysis of the efficacy of vitamin D treatment in preventing osteoporosis in postmenopausal women. Endocr Rev 23:560–569 Papadimitropoulos E, Wells G, Shea B, et al (2002) Meta-analyses of therapies for postmenopausal osteoporosis. VIII: meta-analysis of the efficacy of vitamin D treatment in preventing osteoporosis in postmenopausal women. Endocr Rev 23:560–569
27.
go back to reference Schmidt-Gayk H, Spanuth E, Kotting J et al (2004) Performance evaluation of automated assays for β-CrossLaps, N-MID-osteocalcin and intact parathyroid hormone (BIOROSE Multicenter Study). Clin Chem Lab Med 42:90–95PubMedCrossRef Schmidt-Gayk H, Spanuth E, Kotting J et al (2004) Performance evaluation of automated assays for β-CrossLaps, N-MID-osteocalcin and intact parathyroid hormone (BIOROSE Multicenter Study). Clin Chem Lab Med 42:90–95PubMedCrossRef
28.
go back to reference Garnero P, Vergnaud P, Hoyle N (2008) Evaluation of a fully automated serum assay for total N-terminal propeptide of type I collagen in postmenopausal osteoporosis. Clin Chem 54:188–196PubMedCrossRef Garnero P, Vergnaud P, Hoyle N (2008) Evaluation of a fully automated serum assay for total N-terminal propeptide of type I collagen in postmenopausal osteoporosis. Clin Chem 54:188–196PubMedCrossRef
29.
go back to reference Leino A, Turpeinen U, Koskinen P (2008) Automated measurement of 25-OH vitamin D3 on the Roche modular E170 analyzer. Clin Chem 54:2059–2062PubMedCrossRef Leino A, Turpeinen U, Koskinen P (2008) Automated measurement of 25-OH vitamin D3 on the Roche modular E170 analyzer. Clin Chem 54:2059–2062PubMedCrossRef
30.
go back to reference Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a SQ technique. J Bone Miner Res 8:1137–1148PubMedCrossRef Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a SQ technique. J Bone Miner Res 8:1137–1148PubMedCrossRef
31.
go back to reference Lewiecki EM, Laster AJ (2006) Clinical review: clinical applications of vertebral fracture assessment by dual-energy X-ray absorptioometry. J Clin Endocrinol Metab 91:4215–4222PubMedCrossRef Lewiecki EM, Laster AJ (2006) Clinical review: clinical applications of vertebral fracture assessment by dual-energy X-ray absorptioometry. J Clin Endocrinol Metab 91:4215–4222PubMedCrossRef
32.
go back to reference Vignali E, Viccica G, Diacinti D et al (2009) Morphometric vertebral fractures in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab 94:2306–2312PubMedCrossRef Vignali E, Viccica G, Diacinti D et al (2009) Morphometric vertebral fractures in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab 94:2306–2312PubMedCrossRef
33.
go back to reference Fuerst T, Wu C, Genant HK et al (2009) Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting. Osteoporos Int 20:1199–1205PubMedCrossRef Fuerst T, Wu C, Genant HK et al (2009) Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting. Osteoporos Int 20:1199–1205PubMedCrossRef
34.
go back to reference Nakamura K, Tsugawa N, Saito T et al (2008) Vitamin D status, bone mass, and bone metabolism in 600 home-dwelling postmenopausal Japanese women: Yokogoshi study. Bone 42:271–277PubMedCrossRef Nakamura K, Tsugawa N, Saito T et al (2008) Vitamin D status, bone mass, and bone metabolism in 600 home-dwelling postmenopausal Japanese women: Yokogoshi study. Bone 42:271–277PubMedCrossRef
35.
go back to reference Holick MF, Siris ES, Binkley N et al (2005) Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 90:3215–3224PubMedCrossRef Holick MF, Siris ES, Binkley N et al (2005) Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 90:3215–3224PubMedCrossRef
36.
go back to reference Levis S, Gomez A, Jimenez C et al (2005) Vitamin D deficiency and seasonal variation in an adult south Florida population. J Clin Endocrinol Metab 90:1557–1562PubMedCrossRef Levis S, Gomez A, Jimenez C et al (2005) Vitamin D deficiency and seasonal variation in an adult south Florida population. J Clin Endocrinol Metab 90:1557–1562PubMedCrossRef
37.
go back to reference Thomas MK, Lloyd-Jones DM, Thadhani RI et al (1998) Hypovitaminosis D in medical inpatients. N Engl J Med 338:777–783PubMedCrossRef Thomas MK, Lloyd-Jones DM, Thadhani RI et al (1998) Hypovitaminosis D in medical inpatients. N Engl J Med 338:777–783PubMedCrossRef
38.
go back to reference Ooms ME, Lips P, Roos JC et al (1995) Vitamin D status and sex hormone binding globulin: determinants of bone turnover and bone mineral density in elderly women. J Bone Miner Res 10:1177–1184PubMedCrossRef Ooms ME, Lips P, Roos JC et al (1995) Vitamin D status and sex hormone binding globulin: determinants of bone turnover and bone mineral density in elderly women. J Bone Miner Res 10:1177–1184PubMedCrossRef
39.
go back to reference Inoue Y, Kaji H, Hisa I et al (2008) Vitamin D status affects osteopenia in postmenopausal patients with primary hyperparathyroidism. Endocr J 55:57–65PubMedCrossRef Inoue Y, Kaji H, Hisa I et al (2008) Vitamin D status affects osteopenia in postmenopausal patients with primary hyperparathyroidism. Endocr J 55:57–65PubMedCrossRef
40.
go back to reference Cummings SR, Browner WS, Bauer D et al (1998) Endogenous hormone and the risk of hip and vertebral fractures among older women. N Engl J Med 339:733–738PubMedCrossRef Cummings SR, Browner WS, Bauer D et al (1998) Endogenous hormone and the risk of hip and vertebral fractures among older women. N Engl J Med 339:733–738PubMedCrossRef
41.
go back to reference Roddam AW, Neale R, Appleby P, Allen NE, Tipper S, Key TJ (2007) Association between plasma 25-hydroxyvitamin D levels and fracture risk: the EPIC-Oxford study. Am J Epidemiol 166:1327–1336PubMedCrossRef Roddam AW, Neale R, Appleby P, Allen NE, Tipper S, Key TJ (2007) Association between plasma 25-hydroxyvitamin D levels and fracture risk: the EPIC-Oxford study. Am J Epidemiol 166:1327–1336PubMedCrossRef
42.
go back to reference Melhus H, Snellman G, Gedeborg R et al (2010) Plasma 25-hydroxyvitamn D levels and fracture risk in a community-based cohort of elderly men in Sweden. J Clin Endocrinol Metab 95:2637–2645PubMedCrossRef Melhus H, Snellman G, Gedeborg R et al (2010) Plasma 25-hydroxyvitamn D levels and fracture risk in a community-based cohort of elderly men in Sweden. J Clin Endocrinol Metab 95:2637–2645PubMedCrossRef
43.
go back to reference Wicherts IS, van Schoor NM, Boeke AJP et al (2007) Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab 92:2058–2065PubMedCrossRef Wicherts IS, van Schoor NM, Boeke AJP et al (2007) Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab 92:2058–2065PubMedCrossRef
44.
go back to reference Sahota O, Mundey MK, San P, Godber IM, Lawson N, Hosking DJ (2004) The relationship between vitamin D and parathyroid hormone, calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 35:312–319PubMedCrossRef Sahota O, Mundey MK, San P, Godber IM, Lawson N, Hosking DJ (2004) The relationship between vitamin D and parathyroid hormone, calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 35:312–319PubMedCrossRef
45.
go back to reference Sahota O, Gaynor K, Harwood RH, Hosking DJ (2001) Hypovitaminosis D and “functional hypoparathyroidism”—the NoNoF (Nottingham Neck of Femur) study. Age Ageing 30:467–472PubMedCrossRef Sahota O, Gaynor K, Harwood RH, Hosking DJ (2001) Hypovitaminosis D and “functional hypoparathyroidism”—the NoNoF (Nottingham Neck of Femur) study. Age Ageing 30:467–472PubMedCrossRef
46.
go back to reference Rejnmark L, Vestergaard P, Brot C, Mosekilde L (2008) Parathyroid response to vitamin D insufficiency: relations to bone density, body composition, and to life style characteristics. Clin Endocrinol 69:29–35CrossRef Rejnmark L, Vestergaard P, Brot C, Mosekilde L (2008) Parathyroid response to vitamin D insufficiency: relations to bone density, body composition, and to life style characteristics. Clin Endocrinol 69:29–35CrossRef
47.
go back to reference Stein MS, Wark JD, Scherer SC et al (1999) Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel. J Am Geriatr Soc 47:1195–1201PubMed Stein MS, Wark JD, Scherer SC et al (1999) Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel. J Am Geriatr Soc 47:1195–1201PubMed
48.
go back to reference Rubin MR, Dempster DW, Zhou H et al (2008) Dynamic and structural properties of the skeleton in hypoparathyroidism. J Bone Miner Res 23:2018–2024PubMedCrossRef Rubin MR, Dempster DW, Zhou H et al (2008) Dynamic and structural properties of the skeleton in hypoparathyroidism. J Bone Miner Res 23:2018–2024PubMedCrossRef
Metadata
Title
Role of Parathyroid Hormone in Bone Fragility of Postmenopausal Women with Vitamin D Insufficiency
Authors
Mika Yamauchi
Hiroshi Kaji
Kiyoko Nawata
Shin Takaoka
Toru Yamaguchi
Toshitsugu Sugimoto
Publication date
01-05-2011
Publisher
Springer-Verlag
Published in
Calcified Tissue International / Issue 5/2011
Print ISSN: 0171-967X
Electronic ISSN: 1432-0827
DOI
https://doi.org/10.1007/s00223-011-9464-6

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