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Clinical Cases in mineral and bone metabolism

Effects of endocrine disrupting compounds on Vitamin D circulating levels

Clinical Protocol, 132 - 137
doi: 10.11138/ccmbm/2018.15.1.132
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Vitamin D3 (cholecalciferol) is an inactive prohormone, which is derived either from 7- dehydrochlesterol conversion in the skin by solar ultraviolet B radiation, or from food. Vitamin D is a hormone produced by the kidneys that helps control the concentration of calcium in the blood, and is a key point for bone metabolism.
Studies on endocrine disruptors started a long time ago.
In 1996, Kavlock et al. introduced the definition of endocrine disrupting compound (EDC) to describe agents/molecules that interfere with the synthesis, secretion, transport, binding, or elimination of natural hormones in the body. The EDCs are highly heterogeneous, and can be classified in two categories: naturally occurring and synthesized (i.e. bisphenol A BPA and phthalates). Synthetic EDCs can be classified as persistent organic pollutants and short-lived pollutants, categories that include phthalates and bisphenol A, found ubiquitously in plastic.
Several studies have evaluated the effect of EDCs on health, showing that the exposure of BPA and phthalates results in adverse health outcomes, including bone loss. BPA can affect bone health by decreasing the plasma calcium level and inhibiting calcitonin secretion, and by interfering via the RANKL pathway, apoptosis pathway and Wnt/β-catenin signaling pathway. Urinary phthalate metabolites have been associated with low BMD and high osteoporosis risk in postmenopausal women.
Epidemiological studies suggest that both phthalates and BPA may alter sex and thyroid hormones in pregnant women. Since active vitamin D metabolite is similar in structure to that of classic sex steroid hormones, and its nuclear receptors belong to the same superfamily of sex steroids and thyroid hormone receptors, it might be hypothesized that BPA and phthalates could alter the vitamin D axis.
Vitamin D insufficiency is very common worldwide, especially in elderly and osteoporotic subjects, in whom it worsens bone fragility. Epidemiological studies show that the prevalence of hypovitaminosis D is very high and is possibly re-emerging as a global health problem.
Recent studies underline an inverse association between urinary metabolites of BPA and phthalates and total plasma 25 (OH) D, suggesting the hypothesis that these compounds may alter the circulating levels of vitamin D both in pregnant women and in the adult population.

Vol. XV (No. 3) 2018 September - December

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    doi: 10.11138/ccmbm/2018.15.1.132