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Association between bone mineral density, muscle strength, and vitamin D status in patients with myasthenia gravis: a cross-sectional study

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Abstract

Summary

Myasthenia gravis (MG) patients had low proximal hip BMD, which could be explained by reduced muscle strength, elevated bone resorption markers, vitamin D deficiency, and increased PTH levels in those with MG compared to controls.

Introduction

Muscle strength is closely correlated with bone mineral density (BMD) and vitamin D status. Here, we evaluated muscle strength, BMD, and vitamin D status in a large sample of Chinese patients with MG.

Methods

In this cross-sectional survey, 86 patients with MG without glucocorticoid treatment and 86 healthy controls were included. Serum levels of 25-hydroxyvitamin D [25OHD], parathyroid hormone (PTH), bone turnover markers (BTMs), and BMD were measured and compared between the two groups. Grip strength and one-leg standing time (OLST) were also assessed in MG patients.

Results

Low grip strength and short OLST were found in 11 (12.8%) and 12 (14.0%) MG patients, respectively. There were 3 (3.5%) MG patients with low bone mass for chronological age. Serum beta C-terminal telopeptide and PTH levels were higher (p < 0.001 and p = 0.001, respectively), and BMD at the femoral neck and trochanter were lower in MG patients (p < 0.001 and p < 0.001, respectively) compared to healthy controls. In patients with MG, grip strength was positively correlated with BMD. Serum 25OHD levels were lower in MG patients than in healthy controls (17.36 ± 6.64 vs. 22.11 ± 7.28 ng/ml, p < 0.001).

Conclusion

Grip strength was positively correlated with BMD in Chinese patients with MG. MG patients tended to have low proximal hip BMD, which may partially be explained by reduced muscle strength, vitamin D deficiency, increased PTH levels, and elevated bone resorption markers compared to controls.

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Acknowledgments

This work was supported by National Natural Science Foundation of China (No. 81570802 and No.81400068) and CAMS Initiative for Innovative Medicine (2016-I2M-3-003). We appreciate the cooperation of all participants who enrolled in our study.

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Author notes

  1. Yuzhou Guan and Fang Lv contributed equally to this work and listed as the co-first-author.

Authors and Affiliations

  1. Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Y. Guan

  2. Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China

    F. Lv, D. Ma, X. Xu, Y. Song, O. Wang, Y. Jiang, W. Xia, X. Xing & M. Li

  3. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Y. Meng

  4. Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China

    J. Zhang

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Correspondence to M. Li.

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Guan, Y., Lv, F., Meng, Y. et al. Association between bone mineral density, muscle strength, and vitamin D status in patients with myasthenia gravis: a cross-sectional study. Osteoporos Int 28, 2383–2390 (2017). https://doi.org/10.1007/s00198-017-4041-0

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  • DOI: https://doi.org/10.1007/s00198-017-4041-0

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