Impact of restricted phosphorus, calcium-adjusted diet on musculoskeletal and mental health in Hypophosphatasia

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  • Julius Maximilian University of Würzburg
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Details

Original languageEnglish
Article numberbvad150
JournalJournal of the Endocrine Society
Volume8
Issue number1
Early online date4 Dec 2023
Publication statusPublished - Jan 2024

Abstract

Context

Impairments in musculoskeletal and mental health are common in adults with Hypophosphatasia (HPP). Restricted phosphorus intake has been suggested to positively affect symptoms in HPP, but there is lack of interventional evidence.
Objective

To evaluate the impact of a phosphorus-restricted, calcium-adjusted diet on musculoskeletal and mental health in HPP.
Design

Prospective, non-controlled, single-center interventional study (NuSTEPS II).
Setting

Outpatients at the Osteology Department, University of Wuerzburg, Germany.
Participants

26 adults with established HPP diagnosis.
Intervention

Standardized diet with defined daily intake of phosphorus (1160-1240 mg/d) and calcium (870-930 mg/d) over 8 weeks.
Main Outcome Measures

Functional testing and patient-reported outcome measures.
Results

At 8 weeks, significant improvements were observed in usual gait speed (p=.028) and the chair-rise test (p=.019) while no significant changes were seen in the 6-minute walk test (p=.468) and the timed up-and-go test (p=.230). Pain was not significantly reduced according to visual analogue scale (VAS) (p=.061), pain subscale of the 36-Item Short-Form Health Survey (SF-36) (p=.346) and Pain Disability Index (p=.686). Further, there was a significant improvement in the SF-36 vitality subscale (p=.022) while all other subscales as well as the Lower Extremity Functional Scale (p=.670) and the Fatigue Assessment Scale (p=.392) did not change significantly. Adjustments of mineral intake were not associated with relevant alterations regarding the intake of energy and energy-supplying nutrients or body composition.
Conclusion

Adjusting phosphorus and calcium intake may positively affect individual symptoms in adults with HPP, but overall clinical effectiveness regarding major issues like pain and endurance appears limited.

Keywords

    dietary calcium, dietary phosphorus, fatigue, hypophosphatasia, pain, physical function

ASJC Scopus subject areas

Sustainable Development Goals

Cite this

Impact of restricted phosphorus, calcium-adjusted diet on musculoskeletal and mental health in Hypophosphatasia. / Kuehn, Katinka; Hahn, Andreas; Seefried, Lothar.
In: Journal of the Endocrine Society, Vol. 8, No. 1, bvad150, 01.2024.

Research output: Contribution to journalArticleResearchpeer review

Kuehn K, Hahn A, Seefried L. Impact of restricted phosphorus, calcium-adjusted diet on musculoskeletal and mental health in Hypophosphatasia. Journal of the Endocrine Society. 2024 Jan;8(1):bvad150. Epub 2023 Dec 4. doi: 10.1210/jendso/bvad150
Kuehn, Katinka ; Hahn, Andreas ; Seefried, Lothar. / Impact of restricted phosphorus, calcium-adjusted diet on musculoskeletal and mental health in Hypophosphatasia. In: Journal of the Endocrine Society. 2024 ; Vol. 8, No. 1.
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abstract = "ContextImpairments in musculoskeletal and mental health are common in adults with Hypophosphatasia (HPP). Restricted phosphorus intake has been suggested to positively affect symptoms in HPP, but there is lack of interventional evidence.ObjectiveTo evaluate the impact of a phosphorus-restricted, calcium-adjusted diet on musculoskeletal and mental health in HPP.DesignProspective, non-controlled, single-center interventional study (NuSTEPS II).SettingOutpatients at the Osteology Department, University of Wuerzburg, Germany.Participants26 adults with established HPP diagnosis.InterventionStandardized diet with defined daily intake of phosphorus (1160-1240 mg/d) and calcium (870-930 mg/d) over 8 weeks.Main Outcome MeasuresFunctional testing and patient-reported outcome measures.ResultsAt 8 weeks, significant improvements were observed in usual gait speed (p=.028) and the chair-rise test (p=.019) while no significant changes were seen in the 6-minute walk test (p=.468) and the timed up-and-go test (p=.230). Pain was not significantly reduced according to visual analogue scale (VAS) (p=.061), pain subscale of the 36-Item Short-Form Health Survey (SF-36) (p=.346) and Pain Disability Index (p=.686). Further, there was a significant improvement in the SF-36 vitality subscale (p=.022) while all other subscales as well as the Lower Extremity Functional Scale (p=.670) and the Fatigue Assessment Scale (p=.392) did not change significantly. Adjustments of mineral intake were not associated with relevant alterations regarding the intake of energy and energy-supplying nutrients or body composition.ConclusionAdjusting phosphorus and calcium intake may positively affect individual symptoms in adults with HPP, but overall clinical effectiveness regarding major issues like pain and endurance appears limited.",
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N2 - ContextImpairments in musculoskeletal and mental health are common in adults with Hypophosphatasia (HPP). Restricted phosphorus intake has been suggested to positively affect symptoms in HPP, but there is lack of interventional evidence.ObjectiveTo evaluate the impact of a phosphorus-restricted, calcium-adjusted diet on musculoskeletal and mental health in HPP.DesignProspective, non-controlled, single-center interventional study (NuSTEPS II).SettingOutpatients at the Osteology Department, University of Wuerzburg, Germany.Participants26 adults with established HPP diagnosis.InterventionStandardized diet with defined daily intake of phosphorus (1160-1240 mg/d) and calcium (870-930 mg/d) over 8 weeks.Main Outcome MeasuresFunctional testing and patient-reported outcome measures.ResultsAt 8 weeks, significant improvements were observed in usual gait speed (p=.028) and the chair-rise test (p=.019) while no significant changes were seen in the 6-minute walk test (p=.468) and the timed up-and-go test (p=.230). Pain was not significantly reduced according to visual analogue scale (VAS) (p=.061), pain subscale of the 36-Item Short-Form Health Survey (SF-36) (p=.346) and Pain Disability Index (p=.686). Further, there was a significant improvement in the SF-36 vitality subscale (p=.022) while all other subscales as well as the Lower Extremity Functional Scale (p=.670) and the Fatigue Assessment Scale (p=.392) did not change significantly. Adjustments of mineral intake were not associated with relevant alterations regarding the intake of energy and energy-supplying nutrients or body composition.ConclusionAdjusting phosphorus and calcium intake may positively affect individual symptoms in adults with HPP, but overall clinical effectiveness regarding major issues like pain and endurance appears limited.

AB - ContextImpairments in musculoskeletal and mental health are common in adults with Hypophosphatasia (HPP). Restricted phosphorus intake has been suggested to positively affect symptoms in HPP, but there is lack of interventional evidence.ObjectiveTo evaluate the impact of a phosphorus-restricted, calcium-adjusted diet on musculoskeletal and mental health in HPP.DesignProspective, non-controlled, single-center interventional study (NuSTEPS II).SettingOutpatients at the Osteology Department, University of Wuerzburg, Germany.Participants26 adults with established HPP diagnosis.InterventionStandardized diet with defined daily intake of phosphorus (1160-1240 mg/d) and calcium (870-930 mg/d) over 8 weeks.Main Outcome MeasuresFunctional testing and patient-reported outcome measures.ResultsAt 8 weeks, significant improvements were observed in usual gait speed (p=.028) and the chair-rise test (p=.019) while no significant changes were seen in the 6-minute walk test (p=.468) and the timed up-and-go test (p=.230). Pain was not significantly reduced according to visual analogue scale (VAS) (p=.061), pain subscale of the 36-Item Short-Form Health Survey (SF-36) (p=.346) and Pain Disability Index (p=.686). Further, there was a significant improvement in the SF-36 vitality subscale (p=.022) while all other subscales as well as the Lower Extremity Functional Scale (p=.670) and the Fatigue Assessment Scale (p=.392) did not change significantly. Adjustments of mineral intake were not associated with relevant alterations regarding the intake of energy and energy-supplying nutrients or body composition.ConclusionAdjusting phosphorus and calcium intake may positively affect individual symptoms in adults with HPP, but overall clinical effectiveness regarding major issues like pain and endurance appears limited.

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