Osteoporosis is a widespread problem and a major public health challenge, with one in two women and one in five men over the age of 50 years expected to experience an osteoporotic fracture. Various factors contribute to an increased risk of disease including female gender, Caucasian ethnicity, age, physical inactivity, inadequate status of calcium and vitamin D, excessive alcohol intake and smoking. In recent years convincing evidence has emerged linking low B-vitamins, the related metabolite homocysteine (Hcy), and a common polymorphism in folate metabolism (the MTHFR 677C~T polymorphism) with low bone mineral density (BMD) and an increased fracture risk. Patients with coeliac disease (CD), a common autoimmune inflammatory condition characterised by intestinal damage due to gluten consumption, are at increased risk both of osteoporosis and inadequate B-vitamin status. The aim of this thesis was to investigate the role of the B-vitamins, Hcy and the MTHFR 677C~T polymorphism in bone health and disease, including an evaluation of the potential protective role of Bvitamin supplementation in the maintenance of BMD in CD patients. The findings within this thesis provide evidence to supplier an association between bone health and biomarkers of B-vitamin status, particularly vitamin B 12 and vitamin B6, and Hcy (women only). Among those with the variant MTHFR 677TT genotype, a low status of riboflavin (women only), and folate, were associated with a 1.8-2.1 times increased risk of osteoporosis. Preliminary findings from the on-going randomised controlled trial (RCT) suggest a beneficial effect of combined folic acid (400 Ilg/d) and vitamin B 12 (10 Ilg/d) supplementation for a 2 year period on BMD, particularly at the spine in male CD patients, but no firm conclusions can be drawn until completion of the trial. In conclusion, the achievement of optimal B-vitamin status may be important for bone health in normal ageing and within CD patients.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:669658 |
| Date | January 2013 |
| Creators | Clarke, Michelle Mary |
| Publisher | Ulster University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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