Association between Casual Serum Triglyceride Levels and Bone Resorption Activity in Japanese Middle-aged and Elderly Women

High serum triglyceride (TG) levels may lower bone fracture risk, but the association between serum TG and bone resorption activity is unclear. The aim of the present study was to analyze this association using casual serum TG levels in patients with and without accelerated bone resorption. A case-control study was performed in 39 patients with accelerated bone resorption and in 69 controls, treated between April 2011 and March 2016 at the Internal Medicine Clinic. Bone resorption activity was assessed by urinary N-telopeptide of type I collagen (uNTx; a marker of bone resorption), which is routinely measured at the Internal Medicine Clinic. Cases were female outpatients aged ≥40 years in whom uNTx levels were ≥54.3nmol bone collagen equivalent (BCE)/mmol creatinine. Subjects with casual serum TG levels ＞150mg/dl were diagnosed with potential hypertriglyceridemia (PHTG). Propensity score-adjusted multinomial logistic regression was performed to estimate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for PHTG in cases compared with controls. Correlations between uNTX and casual serum TG levels in all patients were evaluated using multivariate regression. The prevalence of PHTG was significantly lower in cases than in controls (OR 0.20; 95% CI 0.05-0.65; P=0.006). uNTx levels were negatively associated with casual serum TG levels in all patients (r=-0.07, P=0.046). These results suggest that serum TG levels are negatively associated with bone resorption activity. Reduced bone resorption activity may explain, in part, the reduced fracture risk in Japanese middle-aged and elderly female patients with hypertriglyceridemia

Percutaneous balloon valvuloplasty for bioprosthetic mitral valve stenosis.

Percutaneous transcatheter mitral valvuloplasty is the indicated treatment of choice for symptomatic native mitral valve stenosis, but there have been limited reports of successful procedures of balloon valvuloplasty for bioprosthetic mitral valve stenosis. We present the case of a 62-year-old woman suffering from progressive dyspnea due to bioprosthetic mitral valve stenosis. The measured mean pressure gradient across the mitral valve was 30 mmHg and the mitral valve area was 0.73 cm(2). Redoing mitral replacement was considered high risk and was refused by the patient. Percutaneous balloon valvuloplasty was performed with an Inoue balloon catheter inflated to 20 mm. The patient's symptoms immediately improved after the procedure, with no procedure-related complications. The mean pressure gradient across the valve decreased to 19 mmHg, and the mitral valve area increased to 1.21 cm(2) in postprocedural echocardiography. We conducted a literature search and identified 26 cases of balloon valvuloplasty for degenerated bioprosthetic valves. Of these, 14 cases were bioprosthetic mitral valves, and the results were favorable. However, more case reports are required to establish an evidence base for future expert recommendation of balloon valvuloplasty of prosthetic mitral valve. Meanwhile, balloon valvuloplasty will serve a niche role in highly selected patients with prosthetic mitral valve stenosis