Manual Chapter 30, Extraskeletal Bone Formation

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  1. Chapter 30, Extraskeletal Bone Formation
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  3. Musculoskeletal System - Bone Development - Embryology
  4. How to cite and reference

Main description: During embryonic development, induction of bone formation is spatially and temporally regulated to form the skeletal elements.

After birth, new bone formation is normally limited to bone regeneration during fracture repair, a process that is also precisely regulated. Induction of extraskeletal bone formation, also known as heterotopic ossification HO , is a pathological condition in which bone forms in tissues outside of the normal skeleton.

Heterotopic ossification forms through endochondral or intramembranous processes and produces qualitatively normal bone tissue. Extensive heterotopic ossification that begins during childhood occurs in two clinically distinct genetic diseases: fibrodysplasia ossificans progressiva FOP and progressive osseous heteroplasia POH.

Extraskeletal bone formation also can occur in cases other than these rare genetic diseases; such conditions are referred to as nonhereditary heterotopic ossification NHHO. Several meta-analysis have described an inverse association between 25 OH D and the incidence of colorectal cancer [ 23 ]. At the moment, there is no evidence that vitamin D influences in the progression of colorectal cancer, although it seems to have a protective effect on mortality [ 25 ]. Vitamin D deficiency has been associated with inflammation and endothelial and platelet dysfunction, which favours the risk of cardiovascular complications [ 26 ].

Vitamin D also regulates blood pressure by decreasing gene expression of renin and aldosterone synthesis.

Chapter 30, Extraskeletal Bone Formation

All these explain why vitamin D deficiency has been associated with cardiovascular disease, including hypertension, ischemic heart disease and heart failure [ 27 ]. In these patients, supplementation with vitamin D could reduce blood pressure by decreasing the activity of renin and angiotensin II values, although this effect has not been demonstrated in all studies.

However, one of the effects of vitamin D is the increase in phosphate levels and a high amount of phosphorus increases vascular calcification and, consequently, may increase morbidity and mortalidad [ 32 ]. It is, therefore, important to keep vitamin D levels in a safe threshold, where the benefits outweigh the risks. Vitamin D also has receptors in pancreatic cells and exerts a regulatory action on glucose metabolism.

A meta-analysis revealed that vitamin D supplementation in children reduces the risk of developing type 1 diabetes odds ratio: 0. Some studies have reported a higher prevalence of some autoimmune diseases at higher latitudes, suggesting that sun exposure and, therefore, the production of vitamin D may play a role in the pathogenesis of some diseases such as type 1 diabetes, multiple sclerosis and Crohn disease [ 33 ]. The risk of developing multiple sclerosis is also associated with lower levels of 25 OH D. Vitamin D seems to have a protective role in rheumatoid arthritis RA.

Vitamin D has a protective role against infections by stimulating the production of cathelicidin antimicrobial peptide and modulating the production of cytokines and the inflammatory cascade during the infection [ 40 ], so vitamin D deficiency has also been associated with an increased risk of infections, especially those of the respiratory tract, including tuberculosis [ 41 ]. It has also been suggested that vitamin D may play a role in the development of some chronic liver diseases such as non-alcoholic fatty liver disease, cholestatic disease and autoimmune liver disease; and that supplementation with vitamin D could improve the patient response to antiviral therapy in hepatitis C [ 42 ].

Vitamin D has a direct effect on muscle strength through its action on specific receptors on the muscle. Vitamin D deficiency has been associated with type II muscle fibres atrophy, which leads to impaired muscle function and disability, increasing the risk of falls, especially in the elderly [ 43 ].

This reduction in the risk of falls seems apparent already in the first 6 months of treatment with vitamin D.

Besides the well-known benefits on the skeleton, especially as regards on reducing the risk of non-vertebral and hip fracture, vitamin D also has other favourable effects on many organs. Its immunomodulatory, anti-inflammatory, antitumour and antimicrobial effects, as well as their effects on glucose metabolism, cardiovascular system and muscle, are remarkable. Although the association of vitamin D deficiency with many diseases, as well as the benefits of supplementation, seems clear, it is not easy to establish a cause-effect relationship.

Observational studies with larger numbers of patients and well-designed randomized clinical trials are needed with accurate determination and close monitoring of vitamin D. Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3. Help us write another book on this subject and reach those readers.

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Login to your personal dashboard for more detailed statistics on your publications. Edited by Sivakumar Joghi Thatha Gowder. We are IntechOpen, the world's leading publisher of Open Access books. Built by scientists, for scientists. Our readership spans scientists, professors, researchers, librarians, and students, as well as business professionals. Downloaded: Abstract Vitamin D exerts its principal actions on bone metabolism, so it has important benefits on the skeleton.

Colon and rectal cancer have also been associated with vitamin D deficiency, especially rectal cancer. Several meta-analysis have described an inverse association between 25 OH D and the incidence of colorectal cancer [ 23 ]. At the moment, there is no evidence that vitamin D influences in the progression of colorectal cancer, although it seems to have a protective effect on mortality [ 25 ]. Vitamin D deficiency has been associated with inflammation and endothelial and platelet dysfunction, which favours the risk of cardiovascular complications [ 26 ].

Vitamin D also regulates blood pressure by decreasing gene expression of renin and aldosterone synthesis. All these explain why vitamin D deficiency has been associated with cardiovascular disease, including hypertension, ischemic heart disease and heart failure [ 27 ]. In these patients, supplementation with vitamin D could reduce blood pressure by decreasing the activity of renin and angiotensin II values, although this effect has not been demonstrated in all studies.

However, one of the effects of vitamin D is the increase in phosphate levels and a high amount of phosphorus increases vascular calcification and, consequently, may increase morbidity and mortalidad [ 32 ]. It is, therefore, important to keep vitamin D levels in a safe threshold, where the benefits outweigh the risks.

Vitamin D also has receptors in pancreatic cells and exerts a regulatory action on glucose metabolism. A meta-analysis revealed that vitamin D supplementation in children reduces the risk of developing type 1 diabetes odds ratio: 0. Some studies have reported a higher prevalence of some autoimmune diseases at higher latitudes, suggesting that sun exposure and, therefore, the production of vitamin D may play a role in the pathogenesis of some diseases such as type 1 diabetes, multiple sclerosis and Crohn disease [ 33 ].

The risk of developing multiple sclerosis is also associated with lower levels of 25 OH D. Vitamin D seems to have a protective role in rheumatoid arthritis RA. Vitamin D has a protective role against infections by stimulating the production of cathelicidin antimicrobial peptide and modulating the production of cytokines and the inflammatory cascade during the infection [ 40 ], so vitamin D deficiency has also been associated with an increased risk of infections, especially those of the respiratory tract, including tuberculosis [ 41 ].

Musculoskeletal System - Bone Development - Embryology

It has also been suggested that vitamin D may play a role in the development of some chronic liver diseases such as non-alcoholic fatty liver disease, cholestatic disease and autoimmune liver disease; and that supplementation with vitamin D could improve the patient response to antiviral therapy in hepatitis C [ 42 ].

Vitamin D has a direct effect on muscle strength through its action on specific receptors on the muscle. Vitamin D deficiency has been associated with type II muscle fibres atrophy, which leads to impaired muscle function and disability, increasing the risk of falls, especially in the elderly [ 43 ]. This reduction in the risk of falls seems apparent already in the first 6 months of treatment with vitamin D. Besides the well-known benefits on the skeleton, especially as regards on reducing the risk of non-vertebral and hip fracture, vitamin D also has other favourable effects on many organs.

Its immunomodulatory, anti-inflammatory, antitumour and antimicrobial effects, as well as their effects on glucose metabolism, cardiovascular system and muscle, are remarkable. Although the association of vitamin D deficiency with many diseases, as well as the benefits of supplementation, seems clear, it is not easy to establish a cause-effect relationship.

How to cite and reference

Observational studies with larger numbers of patients and well-designed randomized clinical trials are needed with accurate determination and close monitoring of vitamin D. Help us write another book on this subject and reach those readers. Login to your personal dashboard for more detailed statistics on your publications.

Edited by Sivakumar Joghi Thatha Gowder.

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We are IntechOpen, the world's leading publisher of Open Access books. Built by scientists, for scientists. Our readership spans scientists, professors, researchers, librarians, and students, as well as business professionals. Downloaded: Abstract Vitamin D exerts its principal actions on bone metabolism, so it has important benefits on the skeleton.

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