Summary Introduction: Investigations in rodents in addition to in vitro experiments have advised an anabolic affect of particular collagen peptides (SCP) on bone formation and bone mineral density (BMD). The aim of the examine was to analyze the impact of 12-month day by day oral administration of 5 g SCP vs. placebo (CG: management group) on BMD in postmenopausal ladies with major, age-related discount in BMD. Strategies: 131 ladies had been enrolled on this randomized, placebo-controlled double-blinded investigation. The first endpoint was the change in BMD of the femoral neck and the backbone after 12 months. As well as, plasma ranges of bone markers—amino-terminal propeptide of kind I collagen (P1NP) and C-telopeptide of kind I collagen (CTX 1)—had been analysed. Outcomes: A complete of 102 ladies accomplished the examine, however all topics had been included within the intention-to-treat (ITT) evaluation (age 64.3 ± 7.2 years; Physique Mass Index, BMI 23.6 ± 3.6 kg/m2; T-score backbone −2.4 ± 0.6; T-score femoral neck −1.4 ± 0.5). Within the SCP group (n = 66), BMD of the backbone and of the femoral neck elevated considerably in comparison with the management group (n = 65) (T-score backbone: SCP +0.1 ± 0.26; CG −0.03 ± 0.18; ANCOVA p = 0.030; T-score femoral neck: SCP +0.09 ± 0.24; CG −0.01 ± 0.19; ANCOVA p = 0.003). P1NP elevated considerably within the SCP group (p = 0.007), whereas CTX 1 elevated considerably within the management group (p = 0.011). Conclusions: These knowledge reveal that the consumption of SCP elevated BMD in postmenopausal ladies with major, age-related discount of BMD. As well as, SCP supplementation was related to a positive shift in bone markers, indicating elevated bone formation and lowered bone degradation. Key phrases: osteoporosis, collagen hydrolysate, SCP, bone marker, protein supplementation
1. Introduction The etiology of osteoporosis features a lack of bodily exercise, malnutrition, underlying ailments, drug ingestion and non-modifiable elements, comparable to ageing, gender, and acquainted predisposition. Satisfactory prevention or remedy of osteoporosis is a vital aim for particular person and public well being, as a result of osteoporotic bone fractures are chargeable for continual ache, inactivity and invalidity within the aged. It’s estimated that, worldwide, each third ladies, and one in 5 males over the age of fifty, will maintain an osteoporotic-induced bone fracture [1]. At current, there are a variety of therapeutic approaches for the prevention and therapy of osteoporosis. Non-pharmacological approaches, comparable to day by day bodily exercise, smoking cessation and discount of alcohol consumption, are essential cofactors in sustaining bone well being. As well as, supplementation with calcium and vitamin D is advisable in osteoporosis administration, however has not been proven to considerably scale back bone fracture threat. Pharmacological therapy contains substances comparable to bisphosphonates, human monoclonal antibody remedy and selective estrogen receptor modulators. Bisphosphonates are essentially the most widely-used remedy and are designated because the “gold standard” anti-catabolic remedy in fracture prophylaxis. Nevertheless, though the risk-benefit ratio favors therapy with bisphosphonates, some negative effects, comparable to bisphosphonate-related osteonecrosis of the jaw (BRONJ), gastrointestinal problems, ulcer of the mucosa, hypocalcaemia or predisposed renal failure have been described within the literature [2,3,4]. Different remedy varieties concentrate on recombinant synthesized hormones or the manipulation of hormone receptors; nonetheless, these therapies, may additionally induce a variety of negative effects [5,6,7]. In comparison with different continual medicines, compliance issues are comparatively excessive in sufferers taking anti-osteoporotic remedy. Though a relationship with acute or continual negative effects has not been clearly established, about 40% of sufferers with oral bisphosphonates discontinue their remedy through the first 12 months of remedy and roughly 75% of sufferers accomplish that by 5 years [8]. As soon as osteopenia or osteoporosis has been identified, primary therapies, with elevated bodily exercise, a balanced, calcium-rich food regimen and the discount of alcohol and nicotine, could shield in opposition to an additional lack of bone mineral density (BMD). However, these approaches will not be prone to induce an enchancment in BMD. Therefore, efficient and compliant therapeutic approaches presently rank very excessive, significantly in a interval of worldwide demographic change. Preclinical in vitro research or investigations with rodents have proven that administration of collagen peptides elevated the natural part of bones [9], improved bone metabolism in addition to bone microarchitecture [10,11,12] and enhanced the biomechanical resistance of vertebrae [13]. Furthermore, supplementation with collagen peptides together with calcitonin has proven constructive results in postmenopausal ladies [14]. Within the latter examine, supplementation with collagen peptides led to a statistically vital decreased excretion of bone collagen breakdown merchandise, compared to placebo therapy. Furthermore, the impact of remedy with collagen peptides was persistent over a interval of at the very least three months after the final administration, suggesting an anabolic impact of collagen peptide therapy. Subsequently, within the current examine, the longer-term results of a particular bioactive collagen peptide supplementation on BMD of the decrease backbone and the femoral neck, decided by DXA (twin vitality X-ray absorptiometry), had been examined. For this goal, postmenopausal ladies, aged 46–80 years (imply age 63 years) obtained 5 g particular collagen peptide (SCP)/day or 5 g maltodextrin as a placebo (management group: CG), in a randomized, placebo-controlled design, for 12 months.
2. Topics and Strategies 2.1. Topics and Consort Circulate Diagram A complete of 131 postmenopausal ladies with a lowered bone mineral density (DXA T-score of −1 or decrease on both the femoral neck or the lumbar backbone) had been included on this examine. Particular knowledge relating to affected person recruitment, allocation and follow-up are offered in . Open in a separate window 2.2. Inclusion Standards The inclusion standards had been as follows: feminine topics with lowered BMD of the decrease backbone or the femoral neck, decided by DXA; menopause (amenorrhea for at the very least 1 12 months); no prognosis of any extreme chronical illness or co-morbidity; regular state physique weight and diet; no contraindications for nutraceuticals or protein-rich dietary supplements. 2.3. Exclusion Standards The exclusion standards had been as follows: medical therapy for osteoporosis inside the final 12 months; osteoporosis with excessive threat for bone fractures and indication for medical therapy; allergy to collagen; medical or endocrinological induced osteoporosis; malignant ailments inside the earlier 5 years; diabetes mellitus kind I or II; renal or liver ailments induced by a excessive protein load; current immobilization for a number of weeks. 2.4. Examine Design The investigation was designed as a single-center, potential, randomized, double-blind, placebo-controlled examine. The scientific trial was a section III examine and was carried out based on GCP (good scientific apply) necessities. The examine protocol was accredited by the moral committee of the College of Freiburg. All topics gave written knowledgeable consent. The trial was registered with DRKS-ID: DRKS0009708. The individuals of the examine had been randomly assigned to the therapy group (supplementation with collagen peptides, SCP) or to the placebo group (maltodextrin). Randomization was carried out utilizing a random quantity generator [15]. Blinding of investigators and individuals was not lifted till all knowledge had been entered, the dataset was secured, and the statistical analyses had been carried out. The individuals needed to dissolve the content material of 1 sachet of the investigational product (SCP or maltodextrin) and drink it in a glass of water, earlier than breakfast. Topics in each teams had been instructed by a doctor on the useful results of normal bodily exercise and balanced diet on osteopenia or osteoporosis [16,17]. As well as, topics had been inspired to take calcium and vitamin D dietary supplements in a day by day dose of roughly 0.5–0.8 g (relying on weight) and 400–800 IU, respectively. Nevertheless, the dietary supplements weren’t prescribed, and the consumption was not managed. Compliance, relating to the consumption of the investigational product, was checked by the gathering of unused dietary supplements. As well as, topics had been requested to maintain day by day data about negative effects or different issues associated to the dietary supplements. As well as, blood samples had been taken initially and the tip of the examine for evaluation of bone markers and to judge the protection of the product and to confirm hostile reactions. The examine was carried out over a complete timeframe of 12 months. All phases of the examine are summarized in . Open in a separate window 2.5. DXA BMD of the decrease lumbar backbone (L1–L4) and the femoral neck was measured earlier than and after the 12-month examine interval utilizing DXA (Stratos DR 2D Fan Beam, Degen Medizintechnik, Heppenheim, Germany). 2.6. Dietary Conduct and Bodily Exercise Dietary conduct, with particular reference to macronutrients (fats, carbohydrate, protein), calcium and vitamin D, was evaluated earlier than and on the finish of the examine, through the use of a 4-day dietary protocol. Topics had been requested to fill out the protocol utilizing family measurements on 3 working days and someday off work. The protocols had been analyzed utilizing PRODI 6.0 (Prodi, Stuttgart, Germany). Bodily exercise was assessed with an evaluated questionnaire, in German language, by which the quantity and depth of bodily exercise was queried, and the whole quantity of energy burned by these actions was calculated [18]. 2.7. Protein Supplementation For this examine, a combination of particular bioactive collagen peptides (SCP) with a imply molecular weight of approx. 5 kDa, derived from a fancy multi-step hydrolysis of collagen, was used (FORTIBONE®, GELITA AG, Eberbach, Germany). The sachets containing 5 g SCP or placebo (maltodextrin, CARGILL, Paris, France) had been an identical in look and the merchandise had been equal in taste and texture. 2.8. Pattern Dimension The pattern dimension for the examine was calculated on the premise of the current statistical publication from the Heart of Illness Management (CDC) of March 2012 [19]. An influence evaluation was carried out, primarily based on the idea that the bone mineral density of postmenopausal ladies between 50–59 years was 0.99 ± 0.1 g/cm2, as described by CDC. Contemplating the truth that a remedy with bisphosphonates elevated bone density by about 5%, much like findings by Adam et al. [14], for SCP a hypothetical development to 1.04 g/cm2 was anticipated. With the usual deviation of 0.1 g/cm2 and an supposed take a look at energy of 80% with a significance degree of α = 0.05 and a calculated drop-out charge of 10%, the variety of 64 individuals per examine group was calculated and regarded adequate. 2.9. Endpoints The first endpoint of this examine was outlined as evaluating variations in bone mineral density (BMD) of the backbone (L1–L4) between each examine teams (SCP versus placebo). The second major end result was outlined as adjustments in BMD of the femoral neck. Adjustments in bone metabolism had been evaluated utilizing the bone biomarkers, amino-terminal propeptide of kind I collagen (P1NP) and C-telopeptide of kind I collagen (CTX 1). Amino-terminal propeptide of kind I collagen (P1NP) was assessed as an indicator of bone formation, whereas C-telopeptide of kind I collagen (CTX 1) was measured as marker for bone resorption. Bone turnover was calculated by evaluating the variety of biomarkers (in ng/mL) within the plasma samples on the finish of the examine (t 12 ), to the worth recorded initially of the examine (t 0 ). An in vitro enzyme immunoassay was used for the quantitative analyses of CTX 1 (BlueGene Biotech., Shanghai, China) and P1NP (Cloud-Clone Corp., Houston, TX, USA). The ELISA exams had been carried out based on the respective instruction manuals. The sensitivities of the exams had been indicated as 12.5 ng/mL and 0.91 ng/mL, respectively. 2.10. Statistical Strategies All quantitative parameters are offered as imply ± SD. Statistical analyses had been carried out utilizing the Statistical Bundle for the Social Sciences Software program (IBM SPSS Statistics 23, IBM, Armonk, NY, USA). The entire statistical analysis was primarily based on the intention-to-treat inhabitants (ITT). Lacking values of all take a look at parameters after the 12-month intervention had been accomplished by a linear development at level (LTAP) examination. Lacking values had been estimated by SPSS, primarily based on the entire examine inhabitants. The baseline values of all parameters had been in contrast between the examine teams, utilizing the unpaired Pupil’s T-test. Testing for adjustments of the first examine aims on bone mineral density between the examine teams was carried out through the use of an Evaluation of the Variances, with the baseline values as Covariate (ANCOVA). Variations between the examination on the baseline degree and after the 12-month intervention inside the examine teams had been carried out by the paired Pupil’s T-test. Alterations within the bone blood biomarkers, P1NP and CTX 1, inside the examine teams, had been examined utilizing the Pupil’s T-test for paired samples. All of the exams within the descriptive evaluation had been carried out as two-sided exams; the degrees of significance had been assessed to α = 0.05 at anybody time. A p-value of < 0.05 was thought-about to point statistical significance. As no hierarchy for the 2 major end-points had been outlined within the protocol, an evaluation, based on Bonferroni–Holm, was carried out.
3. Outcomes 3.1. Topics A complete of 131 ladies (age 64.3 ± 7.2 years; physique mass index, BMI 23.6 ± 3.6 kg/m2; BMD backbone T-score: −2.4 ± 0.6; BMD femoral neck T-score: −1.4 ± 0.5) had been enrolled within the examine and had been included within the statistical evaluation (ITT). Twenty-nine ladies dropped out through the examine; there have been no vital variations within the variety of drop-outs between the teams. Not one of the drop-outs had been associated to any negative effects brought on by the consumption of the precise collagen peptides or the placebo. No hostile occasions had been famous, and, particularly, no pathological findings had been noticed as a result of consumption of the take a look at substances. To guage the homogeneity of the info, at baseline, between the SCP and placebo group, all parameters had been in contrast between each examine teams. On the baseline go to, the individuals within the SCP group had statistically vital decrease bone densities within the backbone, in comparison with the placebo group (p = 0.005; ). Subsequently, an ANCOVA mannequin was chosen for the statistical evaluation, thereby contemplating the imbalance in baseline knowledge. Additionally, BMI, regardless of being within the regular vary in each teams, was considerably completely different at baseline. For all the opposite knowledge, no statistically vital variations between the examine teams had been decided at baseline ( ). Desk 1 SCP (n = 66) Placebo (n = 65) p-Worth Age [years] 63.8 ± 7.4 64.9 ± 7.1 0.378 Top [m] 1.64 ± 6.8 1.62 ± 7.0 0.222 BMI 24.4 ± 3.7 22.9 ± 3.4 0.016 BMD backbone [T] −2.5 ± 0.6 −2.3 ± 0.6 0.005 BMD femoral neck [T] −1.4 ± 0.5 −1.4 ± 0.5 0.903 Open in a separate window 3.2. Adjustments in Bone Mineral Density In the course of the course of the examine, the bone mineral density elevated considerably within the backbone (p = 0.021) and within the femoral neck (p = 0.002) after the SCP therapy ( ). In distinction, no vital adjustments for these parameters had been decided within the placebo group (p = 0.185 and p = 0.552 respectively; ). Desk 2 Group n X ¯ 0 ± SD 0 X ¯ 12 ± SD 12 p-Worth * ANCOVA p-Worth BMD backbone [T] SCP 66 −2.54 ± 0.6 −2.47 ± 0.6 0.021 0.030 Placebo 65 −2.25 ± 0.6 −2.28 ± 0.6 0.185 BMD femoral neck [T] SCP 66 −1.41 ± 0.5 −1.32 ± 0.5 0.002 0.003 Placebo 65 −1.42 ± 0.5 −1.44 ± 0.5 0.552 Open in a separate window The variations noticed between the SCP group and the placebo group had been verified by evaluation of covariance (ANCOVA), contemplating the unbalanced baseline values. The evaluation confirmed that bone density considerably (p = 0.030) elevated within the backbone and the femoral neck after SCP therapy in comparison with placebo (p = 0.003; ). Within the SCP group, BMD elevated by nearly 3.0% within the backbone and 6.7% within the femoral neck, whereas, in the identical interval, bone density decreased within the placebo group (−1.3% for backbone and −1.0% within the femoral neck) ( ). Open in a separate window Desk 3 Group n X ¯ 0 ± SD 0 X ¯ 12 ± SD 12 p-Worth * P1NP [ng/mL] SCP 66 33.34 ± 24.70 37.22 ± 27.70 0.007 Placebo 65 38.74 ± 27.00 40.6 ± 28.35 0.248 CTX 1 [ng/mL] SCP 66 0.81 ± 0.40 0.80 ± 0.35 0.747 Placebo 65 0.68 ± 0.31 0.80 ± 0.58 0.011 Open in a separate window As no precedence or hierarchy had been outlined within the examine protocol for the 2 major end-points, evaluation based on Bonferroni–Holm was carried out. The calculated p-values in had been listed in an ascending rating order, and the statistical significance was evaluated by a Bonferroni–Holm correction. It was demonstrated that therapy with SCP led to a statistically vital improve within the bone density of each major examine end-points “BMD changes in the spine” and “BMD changes in the femoral neck”, as assessed by DXA scans ( ). Because the calculated p-values for each parameters of the predefined major end-points are smaller than the p-values calculated based on the foundations of Bonferroni–Holm, it may be concluded that there was a statistically vital distinction between SCP therapy and that of the placebo group, with SCP being superior to placebo. This consequence was confirmed by the pronounced impact dimension of the SCP supplementation (d = 0.473 for backbone and d = 0.504 for the femoral neck) in comparison with placebo therapy. 3.3. Bone Biomarkers Blood samples had been analyzed to judge particular biomarkers for bone formation and degradation in each therapy teams. At baseline, bone particular amino-terminal propeptide of kind I collagen (P1NP) and C-telopeptide of kind I collagen (CTX 1) had been comparable between the examine teams. In the course of the course of the examine, P1NP considerably elevated within the SCP group (p = 0.007), indicating a stimulation of bone formation. In distinction, within the placebo group, no adjustments in P1NP focus had been decided (p = 0.248; ), whereas the bone degradation marker, CTX 1, considerably elevated (p = 0.011). In distinction, within the individuals that had been handled with SCP, no adjustments in bone degradation markers could possibly be decided (p = 0.747). 3.4. Dietary Consumption and Bodily Exercise There have been no vital baseline variations between the 2 teams, with respect to macronutrients, calcium and vitamin D ( ). Nevertheless, vitamin D consumption was decrease than advisable (20 µg/day) in each examine teams, earlier than in addition to after, the intervention (consumption of calcium and vitamin D dietary supplements weren't thought-about within the evaluation). Moreover, absolute protein and fats intakes had been considerably above the reference values for nutrient consumption. Bodily exercise and caloric expenditure tended to extend all through the 12-month examine interval, however adjustments didn't attain significance (knowledge not proven). Desk 4 Group X ¯ 0 ± SD 0 X ¯ 12 ± SD 12 RDA US (Ladies 51–70 Years) Power [kcal] SCP 1978 ± 387 2010 ± 485 2403 (19 years) 1 Placebo 2029 ± 524 2030 ± 576 Protein [g] SCP 75 ± 18 a 73 ± 19 a 46 (≙0.8 g/kg BW) Placebo 85 ± 39 a 87 ± 29 a Fats [%] SCP 35 ± 7 34 ± 7 ND Placebo 38 ± 7 34 ± 7 Calcium [mg] SCP 1086 ± 262 1064 ± 348 1200 Placebo 1383 ± 590 1220 ± 466 Vitamin D [µg] SCP 1.94 ± 2.9 b 2.13 ± 2.4 b 15 Placebo 2.92 ± 2.8 b 4.00 ± 3.1 b Open in a separate window 3.5. Blood and Security Parameters Blood security parameters (i.e., hemogram, kidney, liver and inflammatory parameters) confirmed no clinically related adjustments through the course of the 12-month therapy. Nevertheless, systolic blood strain (134.5 ± 16.8 vs. 128.1 ± 12.9 mmHg; p < 0.001) and in addition diastolic blood strain (81.2 ± 9.6 vs. 78.6 ± 7.0 mmHg; p = 0.015) had been considerably decrease within the SCP group after the intervention, as calculated by paired Pupil’s t-tests. Within the placebo group, blood strain remained relatively fixed. 4. Dialogue The primary end result of this randomized, double-blinded and placebo-controlled examine in postmenopausal ladies was that particular collagen peptides considerably elevated bone mineral density (BMD) in each the lumbar backbone and femoral neck. In distinction, no vital adjustments for these parameters had been decided within the placebo group. Contemplating the lower in BMD within the management group, topics within the SCP group confirmed a 4.2% larger BMD within the backbone and a 7.7% larger BMD within the femoral neck, suggesting a clinically related impact of the 12-month therapy with SCP [22]. The anabolic impact of SCP consumption was additionally confirmed by a big improve within the bone formation biomarker, amino-terminal propeptide of kind I collagen (P1NP). In distinction, solely within the management group, a big improve within the focus of the bone degradation marker C-telopeptide of kind I collagen (CTX 1) could possibly be detected after the 12-month examine interval. To the writer’s information, solely two research have investigated the impact of collagen peptides on bone markers and bone mineral density in people. In a single examine, the results of collagen peptides had been investigated, with and with out calcitonin [14]. The authors measured urinary pyridinoline cross-links and advised, from their outcomes, that calcitonin plus collagen peptides had a higher impact on the inhibition of bone collagen breakdown. One other investigation, utilizing a complement with a mix of collagen + calcium + vitamin D, discovered that the loss in BMD was considerably decrease within the collagen supplemented group than within the group with calcium + vitamin D alone [23]. Direct scientific proof to elucidate the constructive results of collagen supplementation in people continues to be missing. Nevertheless, some findings from cell experiments and in vivo research in rodents have enhanced our information of how collagen peptides may improve bone formation and improve BMD. Initially, it has been proven that collagen peptides are quickly absorbed from the gastrointestinal tract [24,25]. As well as, collagen peptides are absorbed within the small gut to a substantial quantity in peptide kind and should act as signaling molecules, thereby positively influencing anabolic processes [25,26]. Particularly for connective tissue, this stimulating impact has beforehand been demonstrated [27,28,29]. With respect to myoblast differentiation and myotube hypertrophy, Kitakaze et al. recognized the dipeptide (Hyp-Gly) from collagen as a signaling peptide that prompts the PI3K/Akt/mTOR pathway [30]. Subsequently, it could be assumed that additionally the stimulation of collagen formation within the bone could possibly be mediated through signaling proteins derived from collagen peptides. Collagen peptides have been proven to extend gene expression of collagen kind 1, alpha 1 (COLIA1). As well as, the authors discovered that the ERK/MAPK signaling pathway was concerned within the collagen-induced improve in COLIA1 expression [31]. Collagen is by far the foremost constituent of bone mass. Outcomes from rodent research have demonstrated that collagen peptides considerably improve the natural substance of the bone [9]. Subsequently, a rise on this natural fraction and the next mineralization of the bone could end in an elevated BMD. Within the current examine, an anabolic impact, with respect to collagen synthesis and bone anabolism, was mirrored by a rise within the bone marker P1NP within the SCP supplemented group. In distinction, the bone degradation marker, CTX1, was considerably elevated within the management group solely. Comparable outcomes had been additionally present in ovariectomized rats, following oral administration of bovine collagen peptides [32]. Different animal research have proven that collagen peptides or gelatin hydrolysates improve the longitudinal bone development in rats [33], improve the bone mass in each rising rats following treadmill coaching [34] in addition to mature rats [35], inhibit bone loss in ovariectomized rats [12,36] and forestall bone loss in estrogen-deficient rats, in all probability by lowering the degrees of proinflammatory cytokines [11]. Collectively, the rising information concerning the signaling traits of collagen peptides [30,31,37], in addition to the aforementioned encouraging findings in animal research, make the outcomes of the present investigations understandable, though significantly extra knowledge are wanted from human research. However, there's nonetheless inadequate information about which sort of collagen peptides (marine, porcine, bovine and so forth.) exerts essentially the most favorable impact. Furthermore, not all collagen peptides could have the identical results in several type of ailments, and, lastly, the manufacturing course of may even have an affect on the organic and physiological properties of collagen peptides and thus, their effectiveness. Other than the truth that we want extra and bigger human research, we additionally want further knowledge relating to the optimum timing and dosage in addition to findings associated to longer-term results of supplementation with collagen peptides. 5. Conclusions In conclusion, the findings of this randomized, placebo-controlled trial reveal, that supplementation with 5 g of particular collagen peptides considerably will increase bone mineral density of the lumbar backbone and the femoral neck in addition to blood ranges of the bone marker, P1NP, in postmenopausal ladies with age-related decline in BMD. Acknowledgments A part of the examine was financially supported by GELITA AG, Germany. The planning, group of the examine in addition to knowledge analyses was carried out solely by the investigators. Creator Contributions Daniel König was the principal investigator of the examine. Stephan Scharla and Steffen Oesser had been concerned within the design and/or execution of the examine and manuscript preparation. All authors learn and accredited the ultimate manuscript.