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Osteoporosis: HELP
Articles from Malta
Based on 16 articles published since 2008

These are the 16 published articles about Osteoporosis that originated from Malta during 2008-2019.
+ Citations + Abstracts
1 Guideline EMAS position statement: Bone densitometry screening for osteoporosis. 2011

Brincat, Mark / Calleja-Agius, Jean / Erel, C Tamer / Gambacciani, Marco / Lambrinoudaki, Irene / Moen, Mette H / Schenck-Gustafsson, Karin / Tremollieres, Florence / Vujovic, Svetlana / Rees, Margaret / Rozenberg, Serge / Anonymous5790679. ·Department of Obstetrics and Gynaecology, Mater Dei Hospital, BKR 2090 B’Kara, Malta. brincatm@maltanet.net ·Maturitas · Pubmed #21093180.

ABSTRACT: INTRODUCTION: Osteoporosis and its consequent fractures is a major public health problem. AIM: To formulate a position statement on the use of bone densitometry in screening postmenopausal women for osteoporosis and in their management. MATERIALS AND METHODS: Literature review and consensus of expert opinion. RESULTS AND CONCLUSIONS: Bone densitometry has an important role in screening postmenopausal women for osteoporosis. For higher sensitivity and specificity, there may be a stronger case for screening in later life, depending on the extent to which risk factors add to the value of bone mineral density tests.

2 Review Management of atypical femoral fracture: a scoping review and comprehensive algorithm. 2016

Toro, Giuseppe / Ojeda-Thies, Cristina / Calabrò, Giampiero / Toro, Gabriella / Moretti, Antimo / Guerra, Guillermo Martínez-Díaz / Caba-Doussoux, Pedro / Iolascon, Giovanni. ·Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Via De Crecchio, 4, 80138, Naples, Italy. · Trauma Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario 12 de Octubre, Madrid, Spain. · Unit of Orthopaedics and Traumatology, Villa Malta Hospital, Sarno, Italy. · Unit of Radiology, Santa Maria della Speranza Hospital, Battipaglia, Italy. · Metabolic Bone Disease Unit, Department of Endocrinology, Hospital Universitario 12 de Octubre, Madrid, Spain. ·BMC Musculoskelet Disord · Pubmed #27215972.

ABSTRACT: BACKGROUND: Atypical femoral fractures (AFF) are a rare type of femoral stress fracture recently described, potentially associated with prolonged bisphosphonate therapy. Evidence-based recommendations regarding diagnosis and management of these fractures are scarce. The purpose of this study is to propose an algorithm for the diagnosis and management of AFF. METHODS: We performed a PubMed search of the last ten years using the keywords "atypical femoral fractures" and identified further articles through an evaluation of the publications cited in these articles. Relevant studies were included by agreement between researchers, depending on their specialization. Pertinent points of debate were discussed based on the available literature, allowing for consensus regarding the proposed management algorithm. RESULTS: Using a systematic approach we performed a scoping review that included a total of 137 articles. CONCLUSIONS: A practical guide for diagnosis and management of AFF based on the current concepts is proposed. In spite of the impressive large volume of published literature available since AFF were initially identified, the level of evidence is mostly poor, in particular regarding treatment choice. Therefore, further studies are required.

3 Review The role of vitamin D in osteoporosis. 2015

Brincat, Max / Gambin, Jeannine / Brincat, Mark / Calleja-Agius, Jean. ·Department of Obstetrics and Gynaecology, Mater Dei Hospital, Malta. Electronic address: maxbrincat@gmail.com. · Department of Obstetrics and Gynaecology, Mater Dei Hospital, Malta. · Department of Obstetrics and Gynaecology, Mater Dei Hospital, Malta; Department of Anatomy, Faculty of Medicine and Surgery, University of Malta MSD2080. Electronic address: jean.calleja-agius@um.edu.mt. ·Maturitas · Pubmed #25660912.

ABSTRACT: It is known that circulating vitamin D predominantly originates from cutaneous synthesis and therefore should be considered as a hormone rather than a vitamin. Vitamin D deficiency (<50nmol/L) is a worldwide epidemic with multiple implications on human health, due to its role in various physiological systems. Various studies have shown that with higher serum 25 hydroxyvitamin D levels, there is a decrease in the incidence of non-vertebral and hip fractures. There is limited research data on the management of vitamin D deficiency using therapeutic doses. The majority of studies focus on lower physiological doses rather than high pharmacological doses. In order to reach serum levels of 75nmol/L from a deficiency state, higher doses than 800-1000IU/day are required. Future focus should be on the implications of a rise in systemic 25(OH)D3 levels from a deficiency state to 75nmol/L on bone density and fracture risk, and the use of high doses in cases of vitamin D deficiency. Vitamin D treatment and supplementation need to be re-evaluated in the light of new evidence suggesting that high pharmacological doses need to be used in order to obtain the desired effect in the prevention of osteoporosis and recurrence of osteoporotic fractures.

4 Review The role of cytokines in postmenopausal osteoporosis. 2014

Brincat, S D / Borg, M / Camilleri, G / Calleja-Agius, J. ·Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Malta - jean.calleja-agius@um.edu.mt. ·Minerva Ginecol · Pubmed #25020058.

ABSTRACT: Postmenopausal osteoporosis is a silent systemic progressive disease characterised by a decrease in bone mass per unit volume. This condition compromises the physical strength of the skeleton and increases the susceptibility to fractures on minor trauma. The imbalance between bone formation and bone resorption is known to be responsible for postmenopausal bone loss. Estrogen deficiency contributes to bone loss by increasing the production of pro-inflammatory cytokines by bone marrow and bone cells. Clinical and molecular evidence indicates that estrogen-regulated cytokines exert regulatory effects on bone turnover implicating their role as being the primary mediators of the accelerated bone loss at menopause. The current perspective on the role and interaction of cytokines such as IL-1, IL-4, IL-6, IL-17, TNF, IFN-γ and TGF-β in bone loss linked with estrogen deficiency is reviewed. Current treatment options and emerging drug therapies in the management of postmenopausal osteoporosis are also evaluated.

5 Review Estrogens and the intervertebral disc. 2009

Calleja-Agius, J / Muscat-Baron, Y / Brincat, M P. ·Department of Obstetrics and Gynaecology, Mater Dei Hospital, Malta. jean@waldonet.net.mt ·Menopause Int · Pubmed #19723683.

ABSTRACT: Intervertebral discs are an integral part of the vertebral column. It has been shown that menopause has a negative effect on bone and on intervertebral discs. Estrogen has a beneficial effect of preserving the health of collagen-containing tissues, including the intervertebral disc. The intervertebral disc allows for mobility of the spine, and maintains a uniform stress distribution of the area of the vertebral endplates. Also, the disc influences spinal height. The disc tissue is adapted for this biomechanical function. The function of the spine is impaired if there is a loss of disc tissue. Narrowing of the disc space due to degeneration of intervertebral discs is associated with a significantly increased risk of vertebral fractures. Estrogen should be seen as the first-choice therapy for bones and other collagen-rich tissues, such as intervertebral discs, because it maintains homeostasis of the bone-remodelling unit. Unlike bisphosphonates, estrogen is unique in its ability to regenerate bone collagen after its disintegration, apart from suppressing osteoclastic activity. Besides, there is insufficient data on deterioration in bone qualities and micro-cracks in patients on long-term bisphosphonates.

6 Review Hormone replacement therapy post Women's Health Initiative study: where do we stand? 2008

Calleja-Agius, Jean / Brincat, Mark P. ·Department of Obstetrics and Gynaecology, Mater Dei Hospital, Msida, Malta. jean@waldonet.net.mt ·Curr Opin Obstet Gynecol · Pubmed #18989125.

ABSTRACT: PURPOSE OF REVIEW: The aim of this review is to look at all publications from the past 18 months, which deal with the impact of the Women's Health Initiative Trial on hormone replacement therapy. RECENT FINDINGS: There is a definite decline in the use of hormone replacement therapy among menopausal women. SUMMARY: More research needs to be done on the long-term effects of hormone replacement therapy, especially with regard to ultra-low dose hormone therapy.

7 Article Bone mineral density and intervertebral disc height in type 2 diabetes. 2016

Agius, Rachel / Galea, Raymond / Fava, Stephen. ·Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta. · Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta. Electronic address: stephen.fava@um.edu.mt. ·J Diabetes Complications · Pubmed #26954485.

ABSTRACT: BACKGROUND: Studies of the effect of type 2 diabetes (T2D) on bone mineral density (BMD have produced conflicting results, possibly due to failure to adjust for potential confounding factors. Nonetheless, T2D has consistently been associated with increased fracture risk, suggesting that other factors might play a role. OBJECTIVE: This study assesses the relationship between T2D and BMD at the femoral neck and spine in diabetic and non-diabetic subjects, after adjusting for multiple covariates which may affect BMD. Intervertebral disc height was also investigated in view of its possible relation to fracture risk. METHODS: A cross-sectional study of 100 patients with T2DM of at least 5 years duration and 86 non-diabetic subjects was carried out. RESULTS: There were no significant differences in T scores in either the spine or femoral neck after adjustment for potential confounding variables between T2D subjects and controls. Diabetic patients had a statistically lower intervertebral disc height between the 2nd and 3rd lumbar vertebrae (D3) after adjustment for potential confounders (p=0.004). Urinary albumin:creatinine ratio, total cholesterol, LDL-cholesterol and cigarette smoking were independently associated with lower height of D3 in diabetic subjects. CONCLUSIONS: There is no significant independent association between T2D and BMD. However we found a novel association of significantly lower disc height in patients with T2D. This may contribute to the increased vertebral fracture risk in subjects with T2D. Further studies are needed to investigate the relationship of disc height, T2D and fracture risk.

8 Article Biochemical Predictors of Low Bone Mineral Density and Fracture Susceptibility in Maltese Postmenopausal Women. 2016

Formosa, Melissa M / Xuereb-Anastasi, Angela. ·Department of Applied Biomedical Science, Faculty of Health Sciences, Block A, Level 1, Mater Dei Hospital, University of Malta, Msida, MSD 2080, Malta. melissa.m.formosa@um.edu.mt. · Department of Applied Biomedical Science, Faculty of Health Sciences, Block A, Level 1, Mater Dei Hospital, University of Malta, Msida, MSD 2080, Malta. ·Calcif Tissue Int · Pubmed #26400554.

ABSTRACT: Osteoporosis and fractures are complex conditions influenced by an interplay of genetic and environmental factors. The aim of the study was to investigate three biochemical parameters including total serum calcium, total serum alkaline phosphatase (sALP) and albumin in relation to bone mineral density (BMD) at the lumbar spine and femoral neck (FN), and with all-type of low-trauma fractures in Maltese postmenopausal women. Levels were also correlated with age and physical activity. A case-control study of 1045 women was performed. Women who suffered a fracture were classified as cases whereas women without a fracture history were included as controls subdivided into normal, osteopenic, or osteoporotic according to their BMD measurements. Blood specimens were collected following good standard practice and testing was performed by spectrophotometry. Calcium and sALP levels were weakly correlated with FN BMD levels (calcium: r = -0.111, p = 0.002; sALP: r = 0.089, p = 0.013). Fracture cases had the lowest serum levels of calcium, sALP and albumin relative to all other control groups, which decreased with increasing age, possibly increasing fracture risk. Biochemical levels were lowest in women who sustained a hip fracture and more than one fracture. Biochemical parameters decreased with reduced physical activity; however, this was most evident for fracture cases. Reduced physical activity was associated with lower BMD levels at the hip, and to a lower extent at the spine. In conclusion, results suggest that levels of serum calcium and albumin could be indicative of fracture risk, whereas calcium levels and to lower extent sALP levels could be indicators of hip BMD.

9 Article A polymorphism at the translation start site of the vitamin D receptor gene is associated with the response to anti-osteoporotic therapy in postmenopausal women from southern Italy. 2015

Conti, Valeria / Russomanno, Giusy / Corbi, Graziamaria / Toro, Giuseppe / Simeon, Vittorio / Filippelli, Walter / Ferrara, Nicola / Grimaldi, Michela / D'Argenio, Valeria / Maffulli, Nicola / Filippelli, Amelia. ·Department of Medicine and Surgery, University of Salerno, Baronissi 84081, Italy. vconti@unisa.it. · Doctoral School of Translational and Clinical Medicine, University of Salerno, Baronissi 84081, Italy. grussomanno@unisa.it. · Department of Medicine and Health Sciences, University of Molise, Campobasso 86100, Italy. graziamaria.corbi@unimol.it. · Unit of Orthopaedics and Traumatology, "Martiri del Villa Malta" Hospital, Sarno 84087, Italy. giuseppe.toro@gmail.com. · Laboratory of Pre-clinical and Translational Research, Reference Cancer Center of Basilicata, Scientific Institute of Hospitalization and Treatment, Rionero in Vulture 85028, Italy. vittoriosimeon@gmail.com. · Department of Studies for Institutions and Territorial Systems, University "Parthenope" of Naples, Naples 80133, Italy. walter.filippelli@uniparthenope.it. · Department of Medical Translational Sciences, University of Naples Federico II, Naples 80131, Italy. nicola.ferrara@unina.it. · Maugeri Foundation, Scientific Institute of Telese, IRRCS, Telese Terme 82037, Italy. nicola.ferrara@unina.it. · Department of Medicine and Surgery, University of Salerno, Baronissi 84081, Italy. · Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples 80131, Italy. dargenio@ceinge.unina.it. · Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84081, Italy. nmaffulli@unisa.it. · Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK. nmaffulli@unisa.it. · Department of Medicine and Surgery, University of Salerno, Baronissi 84081, Italy. afilippelli@unisa.it. ·Int J Mol Sci · Pubmed #25764158.

ABSTRACT: The present study investigated the effect of two single nucleotide polymorphisms (SNPs) of the vitamin D receptor (VDR) gene, rs1544410 A/G and rs2228570 C/T, in modulating bone mineral density (BMD) and the response to treatment with bisphosphonates or strontium ranelate in postmenopausal osteoporosis (PMO). Four hundred eighteen postmenopausal women from Southern Italy treated with bisphosphonates or strontium ranelate for three years were enrolled and stratified according to their genotype. Changes in BMD were expressed as the delta t-score (Δt-score). Allelic frequencies for rs1544410 A/GSNP were 11.2% AA, 50.0% GA and 38.8% GG; for rs2228570 C/TSNP were 54.8% CC, 39.5% TC and 5.7% TT. TT carriers showed a lower t-score than TC and CC (both p < 0.02) genotypes and were more responsive to the therapy when compared to both TC (p < 0.02) and CC (p < 0.05) carriers. Specifically, TT carriers receiving alendronate demonstrated a significant improvement of the Δt-score compared to TC and CC (both p < 0.0001) carriers. After adjustment for confounders, the Δt-score showed evidence of a statistically significant positive association with TT in all treatments considered. Therapy response was independent of rs1544410 A/G SNP; instead, rs2228570 C/TSNP was associated with a better response to antiresorptive treatment, thus suggesting that the therapy for PMO should be personalized.

10 Article Risk factors for osteoporosis in Crohn's disease: infliximab, corticosteroids, body mass index, and age of onset. 2013

Azzopardi, Neville / Ellul, Pierre. ·Division of Gastroenterology, Mater Dei Hospital (Malta), Mellieha, Malta. oldcharm@onvol.net ·Inflamm Bowel Dis · Pubmed #23511037.

ABSTRACT: BACKGROUND: We analyzed the characteristics associated with increased risk of osteoporosis in patients with Crohn's disease in Malta. METHOD: Eighty-three patients with histologically and endoscopically confirmed Crohn's disease underwent a DEXA bone density scan and their phenotypic characteristics were analyzed. RESULTS: There was a significant association between body mass index and bone mineral density (P = 0.004) and a significant difference in the T scores of patients according to age at diagnosis (Montreal Classification: P = 0.0006) with patients diagnosed <17 years (n = 13) having lower T scores than those diagnosed at older age groups (n = 70). There was a significant difference between the T scores of patients on infliximab (n = 33) and those not on biological therapy (n = 50, P = 0.0058). Patients with high cumulative corticosteroid doses (>10 mg/d for >3 mo, n = 18) had lower bone mineral densities than patients who received smaller corticosteroid doses (P = 0.013). There was however no significant difference in the T scores of patients according to disease location (P = 0.18), disease type (P = 0.64), gender (P = 0.30), and history of ileal resection (P = 0.68). There was also no significant correlation between disease duration and T scores (hip) (P = 0.61). CONCLUSIONS: Low body mass index, early disease onset, high corticosteroid doses and, anti-tumor necrosis factor α therapy are associated with increased risk of osteoporosis. Lower T scores in patients on infliximab occur as patients receiving this therapy have more severe inflammation, which is associated with elevated osteoclastogenic factors, rather than as a side-effect of the anti-tumor necrosis factor-α therapy.

11 Article Functional polymorphisms within the TNFRSF11B (osteoprotegerin) gene increase the risk for low bone mineral density. 2011

Vidal, Christopher / Formosa, Robert / Xuereb-Anastasi, Angela. ·DNA Laboratory, Department of Applied Biomedical Science, Faculty of Health Sciences Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta. ·J Mol Endocrinol · Pubmed #21994215.

ABSTRACT: Polymorphisms within the TNFRSF11B gene have been studied and associated with osteoporosis and fracture risk. Osteoprotegerin (OPG), the product of this gene, is a key negative regulator of osteoclastogenesis and is secreted by osteoblasts/stromal cells. A previous study in Maltese postmenopausal women showed positive association of low bone mineral density (BMD) with a polymorphism found within the promoter region of this gene (C950T). In this study, direct DNA sequencing revealed 12 variants with polymorphisms C950T, G1181C and rs4876869 observed to be in strong linkage disequilibrium. The constructed haplotype T-G-T was found to increase the risk for a low BMD, while C-G-T and C-C-C have a protective role; thus, we investigated the functional role of both C950T and rs4876869 in vitro. The promoter region, including the C950T alleles, was amplified by PCR, cloned into pGL3 enhancer vector and transfected into HeLa, COS-7 and RAW264.7 cell lines. After incubation, luciferase activity was measured. The T/C (rs4876869) change was tested for its possible effect on pre-mRNA splicing, using an exon-trapping vector. A statistical significant difference in gene expression was observed between the alleles for T950C, with the T allele showing a lower luciferase expression in all cell lines (P<0.01). For rs4876869, exon skipping was observed for the C allele, while only one transcript harbouring the whole exon was observed for the T allele. Our findings suggest that the T-G-T haplotype might be increasing the risk for osteoporosis due to lower quantities of the full OPG transcript being expressed resulting in a higher bone resorption.

12 Article Effects of a synonymous variant in exon 9 of the CD44 gene on pre-mRNA splicing in a family with osteoporosis. 2009

Vidal, Christopher / Cachia, Adela / Xuereb-Anastasi, Angela. ·Department of Pathology, University of Malta, Medical School, G'Mangia, Malta. ·Bone · Pubmed #19580891.

ABSTRACT: In a previous linkage study, suggestive linkage to osteoporosis was observed in marker D11S1392 on chromosome 11p12. The CD44 gene, found at this locus, was sequenced in one of the families studied. Sequencing all coding regions and promoter in affected and non-affected family members revealed a number of sequence variants, one of which was found to be linked and inherited identical by descent together with the linked STR allele. This G to A variant, which does not cause an amino acid change, was found in exon 9 of the CD44 gene, 32 base pairs upstream from the exon-intron junction. Preliminary analysis using a bioinformatics tool suggested that the presence of the A allele abolished an exon splicing enhancer (ESE) site, thus possibly affecting RNA splicing. It was observed using an exon-trapping vector, that in the presence of the A allele, only one transcript was observed in RAW264.7 cells, as opposed to two transcripts transcribed in the presence of the G allele. These observations suggest that the linked synonymous variant found in exon 9 of the CD44 gene might be increasing susceptibility to osteoporosis in this family by affecting the splicing mechanism.

13 Article Intervertebral disc height correlates with vertebral body T-scores in premenopausal and postmenopausal women. 2009

Baron, Yves Muscat / Brincat, M P / Calleja-Agius, J / Calleja, N. ·Department of Obstetrics and Gynaecology, Mater Dei Hospital, B'Kara By-pass, B'Kara MSD 2090, Malta. yambaron@synapse.net.mt ·Menopause Int · Pubmed #19465670.

ABSTRACT: OBJECTIVE: To assess the correlation between vertebral body T-score and intervertebral disc height in premenopausal and postmenopausal women. METHODS: A total of 203 women were recruited from a large bone densitometer directory. The disc heights measured were those between the 12th thoracic and third lumbar vertebra. The discs were assigned the symbols D, whereby D1 applies for the disc between the 12th thoracic and first lumbar vertebra. The disc height of the group of women (n=38) with osteoporotic vertebral fractures was compared with the disc heights of hormone-treated women (n=47), untreated postmenopausal women (n=77) and another group of premenopausal women (n=41). Bone density measurements were taken by a Norland Bone Densitometer (DEXA 586). RESULTS: The lowest disc heights were found in the fracture group. The total disc height in the fracture group was 1.42+/-0.25 cm, significantly lower (P<0.0001) than the untreated group (1.82+/-0.3 cm), which in turn was significantly (P<0.0001) lower than the hormone-treated group (2.2+/-0.26 cm) and the premenopausal group (2.11+/-0.21 cm). The lowest T-scores were also noted in the vertebral fracture group (T-score=-3.1+/-0.3) (P<0.0001). The highest T-score recorded for the premenopausal group was -0.38+/-45, higher than that of the untreated menopausal -1.4+/-0.32 and hormone treated women -0.65+/-0.3, all three significantly higher than the fracture group (P<0.0001). The lowest T-scores were also noted in the vertebral fracture group (T-score=-3.1+/-0.3) (P<0.0001). The highest T-score recorded for the premenopausal group was -0.38+/-45, higher than that of the untreated menopausal -1.4+/-0.32 and hormone treated women -0.65+/-0.3, all three significantly higher than the fracture group (P<0.0001). Bone density across all groups revealed a correlation with disc height (R=0.29) (P<0.05). The group with vertebral osteoporotic fractures was the only group to show a negative correlation (-0.21) between disc height and vertebral bone density. Conversely, a significant correlation (R=0.47) (P<0.001) between the T-score and the total lumbar intervertebral disc height was noted in the premenopausal group of women. The menopausal group of untreated women also showed a significant correlation between the T-score and disc height (R=0.25 P<0.05); however, an insignificant positive correlation was found in the hormone-treated group. CONCLUSION: The fracture group was noted to have the lowest intervertebral disc height and lowest T-scores compared with the other three groups. The hormone-treated and the premenopausal women had the highest disc heights and T-scores recorded. Positive correlations between T-score and disc height were noted for all the groups except for the fracture group. These results suggest a coupling between the vertebral body and intervertebral disc, which if disrupted may lead to increased risk for fracture. The combination of both T-score and disc height may improve the screening sensitivity for vertebral body fracture risk.

14 Article Effects of hormone replacement therapy on connective tissue: why is this important? 2009

Calleja-Agius, Jean / Brincat, Mark P. ·jean@waldonet.net.mt ·Best Pract Res Clin Obstet Gynaecol · Pubmed #19095501.

ABSTRACT: Oestrogen deprivation has a negative effect on connective tissue and its turnover, although it can be difficult to distinguish these changes from those related to age. Such an effect can be prevented to some extent, and in some cases reversed, with oestrogen therapy. This has been shown to happen in the skin dermis, bone matrix, carotid artery media and intervertebral discs. This effect is also likely to extend to the extracellular non-collagenous matrix in all these systems, as oestrogen has profound effects on connective tissue turnover, regardless of the site. This has implications not only in maintaining the structure and aesthetic appearance of tissue, but also its strength and stiffness, and the functioning of neighbouring and surrounding organs. Large-scale clinical trials are necessary to help make informed recommendations regarding postmenopausal oestrogen use and its role in connective tissue turnover.

15 Minor Letter: abnormal bone densitometry in patients with coeliac disease -beyond malabsorption and sunlight exposure. 2016

Ellul, P / Schembri, J / Torpiano, P / Borg, J / Azzopardi, N. ·Gastroenterology, Mater Dei Hospital, Tal Qroqq, Malta. ellul.pierre@gmail.com. · Gastroenterology, Mater Dei Hospital, Tal Qroqq, Malta. ·Aliment Pharmacol Ther · Pubmed #26843349.

ABSTRACT: -- No abstract --

16 Minor Reply to the "Comment on Vitamin D" by Kim et al. [Maturitas (doi:10.1016/j.maturitas.2015.03.008)]. 2015

Calleja-Agius, Jean. ·Department of Obstetrics and Gynaecology, Mater Dei Hospital, Malta. Electronic address: jean.calleja-agius@um.edu.mt. ·Maturitas · Pubmed #25963098.

ABSTRACT: -- No abstract --