Senda M, Hamano T, Fujii N, Ito T, Sakaguchi Y, Matsui I, Isaka Y, Moriyama T
Health Care Division, Health and Counseling Center, Osaka University, Osaka, Japan.
Department of Internal Medicine, Self-Defense Forces Central Hospital, Tokyo, Japan.
Osteoporos Int. 2021 Dec;32(12):2533-2541. doi: 10.1007/s00198-021-06030-1. Epub 2021 Jun 17.
Our human observational study showed that elevated arginine vasopressin levels by heavy exercise, not catecholamines, were associated with elevated serum tartrate-resistant acid phosphatase 5b (TRACP-5b). The increase in serum calcium was positively associated with percent changes of TRACP-5b, implying the involvement of bone resorption in the pathogenesis of exercise-induced hypercalcemia.
It remains unclear whether enhanced bone resorption explains exercise-induced hypercalcemia. An experimental study demonstrated that arginine vasopressin (AVP) stimulated osteoclast activity.
We conducted a prospective observational study, enrolling 65 trained healthy male officers of the Japan Self-Defense Forces (34 and 31 in waves 1 and 2, respectively). Before and after a 5-h heavy exercise, we collected laboratory data including bone markers, symptoms, and ionized calcium (iCa; wave 2 only). As blood calcium levels change after exercise, we estimated calcium (corrected calcium) levels immediately after the exercise using the correlation between blood calcium and time from the end of exercise in another cohort.
Body weight decreased by 6.9% after the exercise. Corrected post-exercise serum total calcium (tCa) and iCa levels were significantly higher than pre-exercise levels, and 18% of participants showed hypercalcemia defined as corrected tCa >10.4 mg/dL or iCa >1.30 mmol/L. Serum tartrate-resistant acid phosphatase 5b (TRACP-5b), plasma three fractions of catecholamines, and AVP elevated significantly (median 14.3 pg/mL), while procollagen type 1 N-terminal propeptide and whole parathyroid hormone showed significant decreases. Corrected tCa increase showed a non-linear positive association with percent changes of TRACP-5b (%ΔTRACP-5b) even after adjustment for confounders. In addition, %ΔTRACP-5b was not associated with catecholamines, but with post-exercise AVP levels after adjustment for pre-exercise TRACP-5b. Symptoms of nausea or vomiting (observed in 20%) were positively associated with corrected post-exercise iCa after adjustment for post-exercise blood pH.
AVP elevation may explain bone resorption and the following hypercalcemia in the setting of heavy exercise.
我们的人体观察性研究表明，剧烈运动导致精氨酸加压素水平升高而非儿茶酚胺水平升高，与血清抗酒石酸酸性磷酸酶5b（TRACP - 5b）升高相关。血清钙升高与TRACP - 5b的百分比变化呈正相关，这意味着骨吸收参与了运动诱导的高钙血症的发病机制。
骨吸收增强是否能解释运动诱导的高钙血症尚不清楚。一项实验研究表明，精氨酸加压素（AVP）可刺激破骨细胞活性。
我们进行了一项前瞻性观察性研究，纳入了65名训练有素的日本自卫队健康男性军官（第1波和第2波分别为34名和31名）。在进行5小时剧烈运动前后，我们收集了包括骨标志物、症状和离子钙（仅第2波）在内的实验室数据。由于运动后血钙水平会发生变化，我们利用另一队列中血钙与运动结束后时间的相关性估算了运动后即刻的钙（校正钙）水平。
运动后体重下降了6.9%。运动后校正血清总钙（tCa）和离子钙（iCa）水平显著高于运动前，18%的参与者出现高钙血症，定义为校正tCa>10.4mg/dL或iCa>1.30mmol/L。血清抗酒石酸酸性磷酸酶5b（TRACP - 5b）、血浆儿茶酚胺的三个组分和AVP显著升高（中位数为14.3pg/mL），而I型前胶原N端前肽和全甲状旁腺激素显著下降。即使在调整混杂因素后，校正tCa升高与TRACP - 5b的百分比变化（%ΔTRACP - 5b）仍呈非线性正相关。此外，%ΔTRACP - 5b与儿茶酚胺无关，但在调整运动前TRACP - 5b后与运动后AVP水平相关。恶心或呕吐症状（20%的参与者出现）在调整运动后血pH后与运动后校正iCa呈正相关。
AVP升高可能解释剧烈运动情况下的骨吸收及随后的高钙血症。
