ChiroACCESS Article



Carotenoids, Vitamin E and Osteophytes



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ChiroACCESS Editorial Staff

  

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January 12, 2012

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For the first time, lumbar spine osteophyte formation has been linked to levels of carotenoids and vitamin E.  “The levels of carotenoids and vitamin E were significantly lower in subjects with lumbar osteophyte formation, and a low B-carotene level was the strongest risk factor for lumbar osteophytes. This is the first evidence of an association between carotenoids and lumbar osteophyte formation”.1 

In light of the fact that chiropractic practice is focused on the musculoskeletal system and the sequela of extensive osteophyte formation, it is valuable to know there is evidence for a more natural means of management and more importantly the potential prevention of spinal osteophytes.  Some of the same Japanese researchers had published a paper in 2010 that concluded that “High serum values of beta-/gamma-tocopherols were found to be significantly associated with a low OR for radiographic knee osteoarthritis. The decreasing risk with a high serum value of beta-/gamma-tocopherols may support the possible protective effects against knee OA.” 2 The previous year a Thai study also suggested that Vitamin E may have a role in the management of knee osteoarthritis.

Note:  These mini-reviews are designed as updates and direct the reader to the full text of current research.  The abstracts presented here are no substitute for reading and critically reviewing the full text of the original research.  Where permitted we will direct the reader to that full text.

The Effect of ß-Carotene on Lumbar Osteophyte Formation.  [Link]

Spine (Phila Pa 1976). 2011 Dec 15;36(26):2293-2298.

Imagama S, Hasegawa Y, Seki T, Matsuyama Y, Sakai Y, Ito Z, Ishiguro N, Ito Y, Hamajima N, Suzuki K.
*Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; †Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan; ‡Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; §Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan; ¶Department of Preventive Medicine/Biostatistcs and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; [BULLET OPERATOR]Department of Public Health, Fujita Health University of Health Sciences, Toyoake, Aichi, Japan.

STUDY DESIGN: Cross-sectional cohort study of elderly people.

OBJECTIVE: The relationships of osteophyte formation on plain lumbar radiographs with serum levels of antioxidants (carotenoids, vitamin A, vitamin E) and other factors were investigated to examine whether antioxidants are involved in lumbar spine degeneration.

SUMMARY OF BACKGROUND DATA: Antioxidants have inhibitory effects on the onset of many diseases. However, the association of lumbar osteophyte formation with antioxidant levels in the general population has not been investigated.

METHODS: The subjects were 286 people (103 men and 183 women; mean age = 68 years) who underwent resident health screening. Osteophyte formation on lumbar lateral radiographs (Nathan classification), lumbar lordosis angles, sacral inclination angles, serum levels of antioxidants, triglyceride levels, body mass index, osteoporosis, back muscle strength, history of alcohol intake, and smoking history were studied in these subjects.

RESULTS: Lumbar osteophyte formation was detected in 48 subjects (17%). Osteophyte formation was significantly more common in elderly persons, men, and subjects with a history of alcohol intake; and had a significant correlation with sacral inclination angle. The levels of a-tocopherol, ß-tocopherol, zeaxanthin/lutein, cryptoxanthin, lycopene, a-carotene, and ß-carotene were significantly lower in subjects with osteophytes. Logistic regression analysis adjusted for all factors showed that a higher age (odds ratio [OR] = 1.1, 95% confidence interval [CI] = 1.02-1.16; P = 0.02) and a low ß-carotene level (OR = 6.7, 95% CI = 1.39-32.6; P = 0.02) were risk factors for osteophyte formation.

CONCLUSION: The serum levels of carotenoids and vitamin E were significantly lower in subjects with lumbar osteophyte formation, and a low ß-carotene level was the strongest risk factor for lumbar osteophytes. This is the first evidence of an association between carotenoids and lumbar osteophyte formation. This finding suggests that appropriate dietary intake of antioxidants is important for inhibition of lumbar spine degeneration in a rapidly aging society.


Association of serum carotenoids, retinol, and tocopherols with radiographic knee osteoarthritis: possible risk factors in rural Japanese inhabitants.  [Link]

J Orthop Sci. 2010 Jul;15(4):477-84. Epub 2010 Aug 19.

Seki T, Hasegawa Y, Yamaguchi J, Kanoh T, Ishiguro N, Tsuboi M, Ito Y, Hamajima N, Suzuki K.
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.

BACKGROUND: The consumption of antioxidant nutrients may influence the development and progression of osteoarthritis (OA). To determine the association between serum antioxidants and radiographic knee osteoarthritis, we undertook a cross-sectional investigation in a community-based study in Japan.

METHODS: A total of 562 subjects (224 male, 338 female) > or = 40 years of age were enrolled in the Comprehensive Health Examination Program (CHEP, Yakumo Study) from 2003 to 2005. Subjects were categorized to the OA group (n = 140) if either knee was graded as Kellgren-Lawrence (K-L) grade > or = 2. The no-OA group was defined as showing radiographic findings of K-L 0 or 1 in either knee (n = 422). The serum levels of retinol, beta-/gamma-tocopherols, alpha-tocopherol, zeaxanthin/lutein, canthaxanthin, cryptoxanthin, lycopene, alpha-carotene, and beta-carotene were measured by high-performance liquid chromatography. The values of these antioxidants were divided into tertiles, and a logistic regression analysis was performed to analyze the association between them and radiographic knee OA, adjusting for potential confounders.

RESULTS: Logistic regression analysis showed that compared to the lowest tertile of beta-/gamma-tocopherols the adjusted odds ratio (OR) was 0.52 [95% confidence interval (CI) 0.29-0.93] in the highest tertile; it also indicated a linear trend across tertiles. Furthermore, the adjusted OR was significantly decreased only in the middle tertile of alpha-tocopherol (OR 0.51, 95% CI 0.29-0.90). We reevaluated any independent association for these tocopherols after adjustment by entering them into the model simultaneously. The significance of beta-/gamma-tocopherols was maintained. In contrast, no associations were found with any carotenoids or retinol.

CONCLUSIONS: High serum values of beta-/gamma-tocopherols were found to be significantly associated with a low OR for radiographic knee osteoarthritis. The decreasing risk with a high serum value of beta-/gamma-tocopherols may support the possible protective effects against knee OA.


Lipid peroxidation, glutathione, vitamin E, and antioxidant enzymes in synovial fluid from patients with osteoarthritis.  [Link]

Int J Rheum Dis. 2009 Dec;12(4):324-8.

Sutipornpalangkul W, Morales NP, Charoencholvanich K, Harnroongroj T.
Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. tewsv@mahidol.ac.th

AIM: To compare levels of lipid peroxidation and antioxidants in synovial fluid from primary knee osteoarthritis (OA) patients with severe cartilage damage undergoing total knee replacement with those in the synovial fluid from injured knee joint patients with intact cartilage undergoing knee arthroscopy.

METHODS: Thirty-two OA patients and 10 injured knee joint patients were recruited. Lipid peroxidation (thiobarbituric acid reactive substances [TBARs]), iron and glutathione (GSH) were measured using a colorimetric method. Vitamin E was measured with high-performance liquid chromatography (HPLC). Activities of antioxidant enzymes (glutathione peroxidase [GPx], superoxide dismutase [SOD]) were analyzed with the use of a kinetic method.

RESULTS: TBARs, iron and GSH levels in synovial fluid were not significantly different between OA patients and injured knee joint patients. Antioxidant enzymes such as GPx and SOD activities also indicated no significant difference. Only vitamin E level was significantly lower in the synovial fluid of OA patients than in that of the injured knee joint patients.

CONCLUSIONS: Oxidative stress may have a role in pathogenesis of knee osteoarthritis. Vitamin E supplementation may have a role in the management of patients.


The antioxidant vitamins A, C, E and selenium in the treatment of arthritis: a systematic review of randomized clinical trials.  [Link]

Rheumatology (Oxford). 2007 Aug;46(8):1223-33. Epub 2007 May 23.

Canter PH, Wider B, Ernst E.
Department of Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK. peter.canter@pms.ac.uk

OBJECTIVE: To systematically review the evidence from randomized clinical trials (RCTs) for the effectiveness of the antioxidant vitamins A, C, E or selenium or their combination in the treatment of arthritis.

METHODS: A systematic search of computerized databases from inception to September 2006 for relevant RCTs, application of pre-defined inclusion/exclusion criteria and independent data extraction by two authors. Methodological quality was assessed using the Jadad scale.

RESULTS: The searches identified 20 unique RCTs meeting the inclusion criteria: 11 in inflammatory arthritis and 9 in osteoarthritis (OA). The studies included are generally of poor quality. They fall into three main clusters: selenium for rheumatoid arthritis (n = 5); vitamin E for inflammatory arthritis (n = 5) and vitamin E for OA (n = 7). One RCT suggests superiority of vitamin E over placebo and three RCTs suggest equivalence between vitamin E and diclofenac in the treatment of inflammatory arthritis. In OA, four RCTs compared vitamin E with placebo. Two shorter-term studies were positive and two longer-term studies were negative. Two further RCTs suggest equivalence between vitamin E and diclofenac in the treatment of OA. Findings for selenium, vitamin A and a combination product in inflammatory arthritis and for vitamin A, and a combination product in OA were negative. An isolated positive result for vitamin C in OA is of doubtful clinical significance.

CONCLUSIONS: Clinical trials testing the efficacy of vitamin E in the treatment of OA and inflammatory arthritis have been methodologically weak and have produced contradictory findings. There is presently no convincing evidence that selenium, vitamin A, vitamin C or the combination product selenium ACE is effective in the treatment of any type of arthritis.
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