Skip to main content
Erschienen in: Calcified Tissue International 5/2016

12.01.2016 | Original Research

Palmitic Acid Reduces Circulating Bone Formation Markers in Obese Animals and Impairs Osteoblast Activity via C16-Ceramide Accumulation

verfasst von: Ahmad Alsahli, Kathryn Kiefhaber, Tziporah Gold, Munira Muluke, Hongfeng Jiang, Serge Cremers, Ulrike Schulze-Späte

Erschienen in: Calcified Tissue International | Ausgabe 5/2016

Einloggen, um Zugang zu erhalten

Abstract

Obesity and impaired lipid metabolism increase circulating and local fatty acid (FA) levels. Our previous studies showed that a high high-saturated -fat diet induced greater bone loss in mice than a high high-unsaturated-fat diet due to increased osteoclast numbers and activity. The impact of elevated FA levels on osteoblasts is not yet clear. We induced obesity in 4 week old male mice using a palmitic acid (PA)- or oleic acid (OA)-enriched high fat high-fat diet (HFD) (20 % of calories from FA), and compared them to mice on a normal (R) caloric diet (10 % of calories from FA). We collected serum to determine FA and bone metabolism marker levels. Primary osteoblasts were isolated; cultured in PA, OA, or control (C) medium; and assessed for mineralization activity, gene expression, and ceramide levels. Obese animals in the PA and OA groups had significantly lower serum levels of bone formation markers P1NP and OC compared to normal weight animals (*p < 0.001), with the lowest marker levels in animals on an PA-enriched HFD (*p < 0.001). Accordingly, elevated levels of PA significantly reduced osteoblast mineralization activity in vitro (*p < 0.05). Elevated PA intake significantly increased C16 ceramide accumulation. This accumulation was preventable through inhibition of SPT2 (serine palmitoyl transferase 2) using myriocin. Elevated levels of PA reduce osteoblast function in vitro and bone formation markers in vivo. Our findings suggest that saturated PA can compromise bone health by affecting osteoblasts, and identify a potential mechanism through which obesity promotes bone loss.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Rodan GA, Martin TJ (2000) Therapeutic approaches to bone diseases. Science (New York, N.Y.) 289:1508–1514CrossRef Rodan GA, Martin TJ (2000) Therapeutic approaches to bone diseases. Science (New York, N.Y.) 289:1508–1514CrossRef
2.
Zurück zum Zitat Boyle WJ, Simonet WS, Lacey DL (2003) Osteoclast differentiation and activation. Nature 423:337–342CrossRefPubMed Boyle WJ, Simonet WS, Lacey DL (2003) Osteoclast differentiation and activation. Nature 423:337–342CrossRefPubMed
3.
Zurück zum Zitat Hannan MT, Felson DT, Anderson JJ (1992) Bone mineral density in elderly men and women: results from the Framingham osteoporosis study. J Bone Miner Res 7:547–553CrossRefPubMed Hannan MT, Felson DT, Anderson JJ (1992) Bone mineral density in elderly men and women: results from the Framingham osteoporosis study. J Bone Miner Res 7:547–553CrossRefPubMed
4.
Zurück zum Zitat Edelstein SL, Barrett-Connor E (1993) Relation between body size and bone mineral density in elderly men and women. Am J Epidemiol 138:160–169PubMed Edelstein SL, Barrett-Connor E (1993) Relation between body size and bone mineral density in elderly men and women. Am J Epidemiol 138:160–169PubMed
5.
Zurück zum Zitat Wosje KS, Khoury PR, Claytor RP, Copeland KA, Kalkwarf HJ, Daniels SR (2009) Adiposity and TV viewing are related to less bone accrual in young children. J Pediatr 154(79–85):e72 Wosje KS, Khoury PR, Claytor RP, Copeland KA, Kalkwarf HJ, Daniels SR (2009) Adiposity and TV viewing are related to less bone accrual in young children. J Pediatr 154(79–85):e72
6.
Zurück zum Zitat Pollock NK, Bernard PJ, Gutin B, Davis CL, Zhu H, Dong Y (2011) Adolescent obesity, bone mass, and cardiometabolic risk factors. J Pediatr 158:727–734CrossRefPubMedPubMedCentral Pollock NK, Bernard PJ, Gutin B, Davis CL, Zhu H, Dong Y (2011) Adolescent obesity, bone mass, and cardiometabolic risk factors. J Pediatr 158:727–734CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Kim JH, Choi HJ, Kim MJ, Shin CS, Cho NH (2011) Fat mass is negatively associated with bone mineral content in Koreans. Osteoporos Int 23:2009–2016CrossRefPubMed Kim JH, Choi HJ, Kim MJ, Shin CS, Cho NH (2011) Fat mass is negatively associated with bone mineral content in Koreans. Osteoporos Int 23:2009–2016CrossRefPubMed
8.
Zurück zum Zitat Greco EA, Fornari R, Rossi F, Santiemma V, Prossomariti G, Annoscia C, Aversa A, Brama M, Marini M, Donini LM, Spera G, Lenzi A, Lubrano C, Migliaccio S (2010) Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index. Int J Clin Pract 64:817–820CrossRefPubMed Greco EA, Fornari R, Rossi F, Santiemma V, Prossomariti G, Annoscia C, Aversa A, Brama M, Marini M, Donini LM, Spera G, Lenzi A, Lubrano C, Migliaccio S (2010) Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index. Int J Clin Pract 64:817–820CrossRefPubMed
9.
Zurück zum Zitat Fu X, Ma X, Lu H, He W, Wang Z, Zhu S (2011) Associations of fat mass and fat distribution with bone mineral density in pre- and postmenopausal Chinese women. Osteoporos Int 22:113–119CrossRefPubMed Fu X, Ma X, Lu H, He W, Wang Z, Zhu S (2011) Associations of fat mass and fat distribution with bone mineral density in pre- and postmenopausal Chinese women. Osteoporos Int 22:113–119CrossRefPubMed
10.
Zurück zum Zitat Hsu YH, Venners SA, Terwedow HA, Feng Y, Niu T, Li Z, Laird N, Brain JD, Cummings SR, Bouxsein ML, Rosen CJ, Xu X (2006) Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women. Am J Clin Nutr 83:146–154PubMed Hsu YH, Venners SA, Terwedow HA, Feng Y, Niu T, Li Z, Laird N, Brain JD, Cummings SR, Bouxsein ML, Rosen CJ, Xu X (2006) Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women. Am J Clin Nutr 83:146–154PubMed
12.
Zurück zum Zitat Campbell PJ, Carlson MG, Nurjhan N (1994) Fat metabolism in human obesity. Am Jo Physiol 266:E600–605 Campbell PJ, Carlson MG, Nurjhan N (1994) Fat metabolism in human obesity. Am Jo Physiol 266:E600–605
13.
Zurück zum Zitat Listenberger LL, Han X, Lewis SE, Cases S, Farese RV Jr, Ory DS, Schaffer JE (2003) Triglyceride accumulation protects against fatty acid-induced lipotoxicity. Proc Natl Acad Sci USA 100:3077–3082CrossRefPubMedPubMedCentral Listenberger LL, Han X, Lewis SE, Cases S, Farese RV Jr, Ory DS, Schaffer JE (2003) Triglyceride accumulation protects against fatty acid-induced lipotoxicity. Proc Natl Acad Sci USA 100:3077–3082CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Koliwad SK, Streeper RS, Monetti M, Cornelissen I, Chan L, Terayama K, Naylor S, Rao M, Hubbard B, Farese RV Jr (2010) DGAT1-dependent triacylglycerol storage by macrophages protects mice from diet-induced insulin resistance and inflammation. J Clin Invest 120:756–767CrossRefPubMedPubMedCentral Koliwad SK, Streeper RS, Monetti M, Cornelissen I, Chan L, Terayama K, Naylor S, Rao M, Hubbard B, Farese RV Jr (2010) DGAT1-dependent triacylglycerol storage by macrophages protects mice from diet-induced insulin resistance and inflammation. J Clin Invest 120:756–767CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat DeFronzo RA (2010) Insulin resistance, lipotoxicity, type 2 diabetes and atherosclerosis: the missing links. The Claude Bernard Lecture 2009. Diabetologia 53:1270–1287CrossRefPubMedPubMedCentral DeFronzo RA (2010) Insulin resistance, lipotoxicity, type 2 diabetes and atherosclerosis: the missing links. The Claude Bernard Lecture 2009. Diabetologia 53:1270–1287CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Drosatos-Tampakaki Z, Drosatos K, Siegelin Y, Gong S, Khan S, Van Dyke T, Goldberg IJ, Schulze PC, Schulze-Spate U (2014) Palmitic acid and DGAT1 deficiency enhance osteoclastogenesis, while oleic acid-induced triglyceride formation prevents it. J Bone Miner Res 29:1183–1195CrossRefPubMed Drosatos-Tampakaki Z, Drosatos K, Siegelin Y, Gong S, Khan S, Van Dyke T, Goldberg IJ, Schulze PC, Schulze-Spate U (2014) Palmitic acid and DGAT1 deficiency enhance osteoclastogenesis, while oleic acid-induced triglyceride formation prevents it. J Bone Miner Res 29:1183–1195CrossRefPubMed
18.
Zurück zum Zitat Titorencu I, Pruna V, Jinga VV, Simionescu M (2014) Osteoblast ontogeny and implications for bone pathology: an overview. Cell Tissue Res 355:23–33CrossRefPubMed Titorencu I, Pruna V, Jinga VV, Simionescu M (2014) Osteoblast ontogeny and implications for bone pathology: an overview. Cell Tissue Res 355:23–33CrossRefPubMed
19.
Zurück zum Zitat Kotake S, Nanke Y (2014) Effect of TNFalpha on osteoblastogenesis from mesenchymal stem cells. Biochim Biophys Acta 1840:1209–1213CrossRefPubMed Kotake S, Nanke Y (2014) Effect of TNFalpha on osteoblastogenesis from mesenchymal stem cells. Biochim Biophys Acta 1840:1209–1213CrossRefPubMed
20.
Zurück zum Zitat Yeh LC, Ford JJ, Lee JC, Adamo ML (2014) Palmitate attenuates osteoblast differentiation of fetal rat calvarial cells. Biochem Biophys Res Commun 450:777–781CrossRefPubMedPubMedCentral Yeh LC, Ford JJ, Lee JC, Adamo ML (2014) Palmitate attenuates osteoblast differentiation of fetal rat calvarial cells. Biochem Biophys Res Commun 450:777–781CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Wong GL, Cohn DV (1975) Target cells in bone for parathormone and calcitonin are different: enrichment for each cell type by sequential digestion of mouse calvaria and selective adhesion to polymeric surfaces. Proc Natl Acad Sci USA 72:3167–3171CrossRefPubMedPubMedCentral Wong GL, Cohn DV (1975) Target cells in bone for parathormone and calcitonin are different: enrichment for each cell type by sequential digestion of mouse calvaria and selective adhesion to polymeric surfaces. Proc Natl Acad Sci USA 72:3167–3171CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Drosatos K, Bharadwaj KG, Lymperopoulos A, Ikeda S, Khan R, Hu Y, Agarwal R, Yu S, Jiang H, Steinberg SF, Blaner WS, Koch WJ, Goldberg IJ (2011) Cardiomyocyte lipids impair beta-adrenergic receptor function via PKC activation. Am J Physiol 300:E489–499 Drosatos K, Bharadwaj KG, Lymperopoulos A, Ikeda S, Khan R, Hu Y, Agarwal R, Yu S, Jiang H, Steinberg SF, Blaner WS, Koch WJ, Goldberg IJ (2011) Cardiomyocyte lipids impair beta-adrenergic receptor function via PKC activation. Am J Physiol 300:E489–499
23.
Zurück zum Zitat Clugston RD, Jiang H, Lee MX, Piantedosi R, Yuen JJ, Ramakrishnan R, Lewis MJ, Gottesman ME, Huang LS, Goldberg IJ, Berk PD, Blaner WS (2011) Altered hepatic lipid metabolism in C57BL/6 mice fed alcohol: a targeted lipidomic and gene expression study. J Lipid Res 52:2021–2031CrossRefPubMedPubMedCentral Clugston RD, Jiang H, Lee MX, Piantedosi R, Yuen JJ, Ramakrishnan R, Lewis MJ, Gottesman ME, Huang LS, Goldberg IJ, Berk PD, Blaner WS (2011) Altered hepatic lipid metabolism in C57BL/6 mice fed alcohol: a targeted lipidomic and gene expression study. J Lipid Res 52:2021–2031CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Kindt E, Wetterau J, Mueller SB, Castle C, Boustany-Kari CM (2010) Quantitative sphingosine measurement as a surrogate for total ceramide concentration-preclinical and potential translational applications. BMC 24:752–758PubMed Kindt E, Wetterau J, Mueller SB, Castle C, Boustany-Kari CM (2010) Quantitative sphingosine measurement as a surrogate for total ceramide concentration-preclinical and potential translational applications. BMC 24:752–758PubMed
25.
Zurück zum Zitat Bose R, Kolesnick R (2000) Measurement of ceramide levels by the diacylglycerol kinase reaction and by high-performance liquid chromatography–fluorescence spectrometry. In: John CR (ed) Methods in enzymology. Academic Press, Waltham, pp 373–378 Bose R, Kolesnick R (2000) Measurement of ceramide levels by the diacylglycerol kinase reaction and by high-performance liquid chromatography–fluorescence spectrometry. In: John CR (ed) Methods in enzymology. Academic Press, Waltham, pp 373–378
26.
Zurück zum Zitat Okere IC, Chandler MP, McElfresh TA, Rennison JH, Sharov V, Sabbah HN, Tserng KY, Hoit BD, Ernsberger P, Young ME, Stanley WC (2006) Differential effects of saturated and unsaturated fatty acid diets on cardiomyocyte apoptosis, adipose distribution, and serum leptin. Am J Physiol Heart Circ Physiol 291:H38–44CrossRefPubMed Okere IC, Chandler MP, McElfresh TA, Rennison JH, Sharov V, Sabbah HN, Tserng KY, Hoit BD, Ernsberger P, Young ME, Stanley WC (2006) Differential effects of saturated and unsaturated fatty acid diets on cardiomyocyte apoptosis, adipose distribution, and serum leptin. Am J Physiol Heart Circ Physiol 291:H38–44CrossRefPubMed
27.
Zurück zum Zitat Lu ZH, Mu YM, Wang BA, Li XL, Lu JM, Li JY, Pan CY, Yanase T, Nawata H (2003) Saturated free fatty acids, palmitic acid and stearic acid, induce apoptosis by stimulation of ceramide generation in rat testicular Leydig cell. Biochem Biophys Res Commun 303:1002–1007CrossRefPubMed Lu ZH, Mu YM, Wang BA, Li XL, Lu JM, Li JY, Pan CY, Yanase T, Nawata H (2003) Saturated free fatty acids, palmitic acid and stearic acid, induce apoptosis by stimulation of ceramide generation in rat testicular Leydig cell. Biochem Biophys Res Commun 303:1002–1007CrossRefPubMed
28.
Zurück zum Zitat Morales A, Lee H, Goni FM, Kolesnick R, Fernandez-Checa JC (2007) Sphingolipids and cell death. Apoptosis Int J Program Cell Death 12:923–939CrossRef Morales A, Lee H, Goni FM, Kolesnick R, Fernandez-Checa JC (2007) Sphingolipids and cell death. Apoptosis Int J Program Cell Death 12:923–939CrossRef
29.
Zurück zum Zitat Glaros EN, Kim WS, Garner B (2010) Myriocin-mediated up-regulation of hepatocyte apoA-I synthesis is associated with ERK inhibition. Clin Sci (London, England: 1979) 118:727–736CrossRef Glaros EN, Kim WS, Garner B (2010) Myriocin-mediated up-regulation of hepatocyte apoA-I synthesis is associated with ERK inhibition. Clin Sci (London, England: 1979) 118:727–736CrossRef
31.
Zurück zum Zitat Baylin A, Kabagambe EK, Siles X, Campos H (2002) Adipose tissue biomarkers of fatty acid intake. Am J Clin Nutr 76:750–757PubMed Baylin A, Kabagambe EK, Siles X, Campos H (2002) Adipose tissue biomarkers of fatty acid intake. Am J Clin Nutr 76:750–757PubMed
32.
Zurück zum Zitat Lu Y, Cheng J, Chen L, Li C, Chen G, Gui L, Shen B, Zhang Q (2015) Endoplasmic reticulum stress involved in high-fat diet and palmitic acid-induced vascular damages and fenofibrate intervention. Biochem Biophys Res Commun 458:1–7CrossRefPubMed Lu Y, Cheng J, Chen L, Li C, Chen G, Gui L, Shen B, Zhang Q (2015) Endoplasmic reticulum stress involved in high-fat diet and palmitic acid-induced vascular damages and fenofibrate intervention. Biochem Biophys Res Commun 458:1–7CrossRefPubMed
33.
Zurück zum Zitat Ardawi M-SM, Akhbar DH, AlShaikh A, Ahmed MM, Qari MH, Rouzi AA, Ali AY, Abdulrafee AA, Saeda MY (2013) Increased serum sclerostin and decreased serum IGF-1 are associated with vertebral fractures among postmenopausal women with type-2 diabetes. Bone 56:355–362CrossRefPubMed Ardawi M-SM, Akhbar DH, AlShaikh A, Ahmed MM, Qari MH, Rouzi AA, Ali AY, Abdulrafee AA, Saeda MY (2013) Increased serum sclerostin and decreased serum IGF-1 are associated with vertebral fractures among postmenopausal women with type-2 diabetes. Bone 56:355–362CrossRefPubMed
34.
Zurück zum Zitat Hinton PS, Shankar K, Eaton LM, Scott Rector R (2015) Obesity-related changes in bone structural and material properties in hyperphagic OLETF rats and protection by voluntary wheel running. Metabolism 64:905–916CrossRefPubMed Hinton PS, Shankar K, Eaton LM, Scott Rector R (2015) Obesity-related changes in bone structural and material properties in hyperphagic OLETF rats and protection by voluntary wheel running. Metabolism 64:905–916CrossRefPubMed
35.
Zurück zum Zitat Wang JW, Tang QY, Ruan HJ, Cai W (2014) Relation between serum osteocalcin levels and body composition in obese children. J Pediatr Gastroenterol Nutr 58:729–732CrossRefPubMed Wang JW, Tang QY, Ruan HJ, Cai W (2014) Relation between serum osteocalcin levels and body composition in obese children. J Pediatr Gastroenterol Nutr 58:729–732CrossRefPubMed
36.
Zurück zum Zitat Bao Y, Ma X, Yang R, Wang F, Hao Y, Dou J, He H, Jia W (2013) Inverse relationship between serum osteocalcin levels and visceral fat area in Chinese men. J Clin Endocrinol Metab 98:345–351CrossRefPubMed Bao Y, Ma X, Yang R, Wang F, Hao Y, Dou J, He H, Jia W (2013) Inverse relationship between serum osteocalcin levels and visceral fat area in Chinese men. J Clin Endocrinol Metab 98:345–351CrossRefPubMed
37.
Zurück zum Zitat Hotamisligil GS, Shargill NS, Spiegelman BM (1993) Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science (New York, N.Y.) 259:87–91CrossRef Hotamisligil GS, Shargill NS, Spiegelman BM (1993) Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science (New York, N.Y.) 259:87–91CrossRef
38.
Zurück zum Zitat Listenberger LL, Ory DS, Schaffer JE (2001) Palmitate-induced apoptosis can occur through a ceramide-independent pathway. J Biol Chem 276:14890–14895CrossRefPubMed Listenberger LL, Ory DS, Schaffer JE (2001) Palmitate-induced apoptosis can occur through a ceramide-independent pathway. J Biol Chem 276:14890–14895CrossRefPubMed
39.
Zurück zum Zitat Cacicedo JM, Benjachareowong S, Chou E, Ruderman NB, Ido Y (2005) Palmitate-induced apoptosis in cultured bovine retinal pericytes: roles of NAD(P)H oxidase, oxidant stress, and ceramide. Diabetes 54:1838–1845CrossRefPubMed Cacicedo JM, Benjachareowong S, Chou E, Ruderman NB, Ido Y (2005) Palmitate-induced apoptosis in cultured bovine retinal pericytes: roles of NAD(P)H oxidase, oxidant stress, and ceramide. Diabetes 54:1838–1845CrossRefPubMed
40.
Zurück zum Zitat Elbaz A, Wu X, Rivas D, Gimble JM, Duque G (2010) Inhibition of fatty acid biosynthesis prevents adipocyte lipotoxicity on human osteoblasts in vitro. J Cell Mol Med 14:982–991CrossRefPubMedPubMedCentral Elbaz A, Wu X, Rivas D, Gimble JM, Duque G (2010) Inhibition of fatty acid biosynthesis prevents adipocyte lipotoxicity on human osteoblasts in vitro. J Cell Mol Med 14:982–991CrossRefPubMedPubMedCentral
41.
Zurück zum Zitat Pinto SN, Silva LC, Futerman AH, Prieto M (2011) Effect of ceramide structure on membrane biophysical properties: the role of acyl chain length and unsaturation. Biochim Biophys Acta 1808:2753–2760CrossRefPubMed Pinto SN, Silva LC, Futerman AH, Prieto M (2011) Effect of ceramide structure on membrane biophysical properties: the role of acyl chain length and unsaturation. Biochim Biophys Acta 1808:2753–2760CrossRefPubMed
42.
Zurück zum Zitat Mehra VC, Jackson E, Zhang XM, Jiang XC, Dobrucki LW, Yu J, Bernatchez P, Sinusas AJ, Shulman GI, Sessa WC, Yarovinsky TO, Bender JR (2014) Ceramide-activated phosphatase mediates fatty acid-induced endothelial VEGF resistance and impaired angiogenesis. Am J Pathol 184:1562–1576CrossRefPubMedPubMedCentral Mehra VC, Jackson E, Zhang XM, Jiang XC, Dobrucki LW, Yu J, Bernatchez P, Sinusas AJ, Shulman GI, Sessa WC, Yarovinsky TO, Bender JR (2014) Ceramide-activated phosphatase mediates fatty acid-induced endothelial VEGF resistance and impaired angiogenesis. Am J Pathol 184:1562–1576CrossRefPubMedPubMedCentral
43.
Zurück zum Zitat Hanada K (2003) Serine palmitoyltransferase, a key enzyme of sphingolipid metabolism. Biochim Biophys Acta 1632:16–30CrossRefPubMed Hanada K (2003) Serine palmitoyltransferase, a key enzyme of sphingolipid metabolism. Biochim Biophys Acta 1632:16–30CrossRefPubMed
44.
45.
Zurück zum Zitat Fernandez-Real JM, Bullo M, Moreno-Navarrete JM, Ricart W, Ros E, Estruch R, Salas-Salvado J (2012) A Mediterranean diet enriched with olive oil is associated with higher serum total osteocalcin levels in elderly men at high cardiovascular risk. J Clin Endocrinol Metab 97:3792–3798CrossRefPubMedPubMedCentral Fernandez-Real JM, Bullo M, Moreno-Navarrete JM, Ricart W, Ros E, Estruch R, Salas-Salvado J (2012) A Mediterranean diet enriched with olive oil is associated with higher serum total osteocalcin levels in elderly men at high cardiovascular risk. J Clin Endocrinol Metab 97:3792–3798CrossRefPubMedPubMedCentral
Metadaten
Titel
Palmitic Acid Reduces Circulating Bone Formation Markers in Obese Animals and Impairs Osteoblast Activity via C16-Ceramide Accumulation
verfasst von
Ahmad Alsahli
Kathryn Kiefhaber
Tziporah Gold
Munira Muluke
Hongfeng Jiang
Serge Cremers
Ulrike Schulze-Späte
Publikationsdatum
12.01.2016
Verlag
Springer US
Erschienen in
Calcified Tissue International / Ausgabe 5/2016
Print ISSN: 0171-967X
Elektronische ISSN: 1432-0827
DOI
https://doi.org/10.1007/s00223-015-0097-z

Weitere Artikel der Ausgabe 5/2016

Calcified Tissue International 5/2016 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.