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Endocrine. 2017 Apr;56(1):196-204. doi: 10.1007/s12020-016-1012-8. Epub 2016 Jul 15.

Bone turnover response is linked to both acute and established metabolic changes in ultra-marathon runners.

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Laboratory of Experimental Biochemistry & Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.
Department of Biomedical Sciences for Health, University of Milano, Milano, Italy.
CeRiSM, Research Centre "Sport, Mountain and Health", University of Verona, Rovereto, Italy.
Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
Department of Biosciences, Università degli Studi di Milano, Milano, Italy.
Interuniversity Centre for Molecular Medicine and Applied Biophysics (CIMMBA), Università degli Studi di Milano, Milano, Italy.
IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy.
Department of Neurological and Movement Sciences, Università degli Studi di Verona, Verona, Italy.
Vita-Salute San Raffaele University, Milano, Italy.
Laboratory of Experimental Biochemistry & Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.


Bone and energy metabolisms regulation depends on a two-way street aimed at regulating energy utilization. Mountain ultra-marathons are highly demanding aerobic performances that deeply affect the whole body homeostasis. In this study we aimed to investigate and characterize the metabolic profile (in terms of hormones involved in energy metabolism), the inflammatory adipokines, and the bone turnover; in particular the osteocalcin-mediated response has been compared in experienced mountain ultra-marathons runners versus control subjects. Serum concentrations of specific markers of bone turnover (pro-collagen type I N-terminal propeptide, carboxylated/undercarboxylated osteocalcin), measured by enzyme-linked immunosorbent assay, and metabolic hormones (C-peptide, insulin, glucagon, glucagon-like peptide, gastric-inhibitory peptide, ghrelin, leptin, resistin, and visfatin), measured by fluorescent-based multiplex assay, were compared before and after a 65 km mountain ultra-marathons in 17 trained runners and 12 age-matched controls characterized by a low physical activity profile. After the mountain ultra-marathons, runners experienced a reduction in pro-collagen type I N-terminal propeptide, though it remained higher than in controls; while carboxylated osteocalcin remained unchanged. Among the metabolic hormones, only glucagon and leptin were different between runners and controls at rest. C-peptide and leptin decreased after the mountain ultra-marathons in runners; while glucagon, glucagon-like peptide 1, resistin, and visfatin were all increased. Uncarboxylated osteocalcin (and uncarboxylated/carboxylated osteocalcin ratio) was decreased and this highly correlated with insulin and C-peptide levels. In conditions of high energy expenditure, homeostasis is maintained at expenses of bone metabolism. Changes in the uncarboxylated osteocalcin clearly mark the global energy needs of the body.


Bone turnover; Energy metabolism; Fatigue; Mountain ultra-marathon; Osteocalcin

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