Vol 22, No 4 (2019)

Original study
The assessment of trabecular bone score to improve the sensitivity of FRAX in patients with type 2 diabetes mellitus
Yalochkina T.O., Belaya Z.E., Chernova T.O., Sazonova N.I., Tarbaeva N.V., Tsoriev T.T., Rozhinskaya L.Y., Melnichenko G.A.

Aim. To estimate the trabecular bone score (TBS) for evaluation of fracture probability in order to make decisions about starting osteoporosis treatment in patients with type 2 diabetes mellitus (T2DM).

Materials and methods. We obtained the bone mineral density (BMD) and trabecular bone score (TBS) using dual energy X-ray absorptiometry (iDXA) in patients with T2DM (with and without a history of osteoporotic fractures) versus the control group. Before and after TBS measurements we assessed the ten-year probability of fracture using the Fracture Risk Assessment Tool (FRAX).

Results. We enrolled 48 patients with T2DM, including 17 with a history of low-traumatic fracture, 31 patients without fractures and 29 subjects of a control group. BMD was higher in patients with T2DM compared to the control group at L1–L4 (mean T-score 0.44, 95% CI -3.2 – 4.9 vs mean T-score 0.33, 95% CI -2.9 – 3.0 in a control group p=0.052) and Total Hip (mean T-score 0.51, 95% CI -2.1 – 3.0 vs mean T-score -0.03, 95% CI -1.4 – 1.2 in a control group p=0,025). The TBS and 10-year probability of fracture (FRAX) was not different in patients with T2DM versus the control group. However, when the TBS was entered as an additional risk factor, the 10-year probability of fracture became higher in patients with T2DM (10-year probability of fracture in T2DM- 8.68, 95% CI 0.3-25.0 versus 6.68, 95% CI 0.4–15.0 in control group, p=0.04). Among patients with diabetes with and without fractures the FRAX score was higher in subjects with fractures, but no difference was found in regards to BMD or TBS. Entering BMD and TBS values into the FRAX tool in subjects with diabetes and fractures decreased the FRAX score. However, patients with low-traumatic fractures should be treated for osteoporosis without a BMD, TBS or FRAX assessment.

Conclusion. TBS improves the results of FRAX assessment in patients with T2DM and should be entered while evaluating FRAX in patients with T2DM. However, additional research is needed to develop a more sensitive tool to evaluate fracture risk in patients with T2DM.

Osteoporosis and Bone Diseases. 2019;22(4):4-11
Review of certain articles of the American society of bone and mineral research (ASMBR) annual congress 2019
Belaya Z.E.

The annual congress of the American Society of Bone and Mineral Research (ASBMR) presents the most significant results among the basic and clinical research in the field of osteoporosis and other metabolic bone diseases. Professor of Medicine John Bilezikian, M.D., Columbia University College of Physicians and Surgeons New York, New York and Lynda F. Bonewald Ph.D. Director, Indiana Center for Musculoskeletal Health, Indianapolis, Indiana, every year present the most outstanding abstracts before the ASBMR. However, not all of these researches are relevant for Russia, as some of them relates to the epidemiology and pharmacoeconomics of osteoporosis specifically in the US. This review presents only a very limited selection of congress abstracts, combined on topics that seem relevant today.

Osteoporosis and Bone Diseases. 2019;22(4):12-18
A view at sarcopenia by endocrinologist
Mokrysheva N.G., Krupinova J.A., Volodicheva V.L., Mirnaya S.S., Melnichenko G.A.

Sarcopenia is one of the syndromes that significantly affects the health and life of the patient. Sarcopenia is a polyetiological syndrome with a complex, insufficiently studied pathogenesis, in which endocrine factors play a leading role. Comorbidity of elderly patients creates difficulties in differential diagnosis of existing pathology. The combination of sarcopenia with various endocrine pathologies, such as obesity, osteoporosis, hypothyroidism, hypoparathyroidism, vitamin D deficiency leads to a more severe course of disease and a worse prognosis for the quality and life expectancy of the patient. In this case, in some situations, the patient’s condition can be improved by assessing pathogenetic causes and their elimination. Thus, the endocrinologist should pay more attention to the sarcopenia syndrome and its correction, as well as for its prevention at the earliest stages.

Osteoporosis and Bone Diseases. 2019;22(4):19-26
Effect of complex therapy of medulloblastoma in childhood and adolescence on bone mineral density
Kim E.I., Golounina O.O., Pavlova M.G., Yudina A.E., Fadeev V.V.

Medulloblastoma is the most common childhood malignant tumor of the posterior cranial fossa. A comprehensive treatment approach, including surgery, polychemotherapy and radiation therapy, inevitably leads to the development of various long-term consequences from the endocrine system, including a negative impact on bone tissue. Reduced linear growth rate, low adult height and low peak bone mass are well-known long-term effects of treatment. Based on data from Russian and foreign researchers, as well as our own experience, this review presents the endocrine consequences of treatment of malignant tumors of the central nervous system in childhood and adolescence, and summarizes the risk factors for various endocrine system disorders, including a decrease in bone mineral density (BMD). The review pays special attention to the assessment of BMD in a group of patients who have had cancer in childhood and adolescence and have undergone complex treatment, as well as the prevention and treatment of osteoporosis in children.

Osteoporosis and Bone Diseases. 2019;22(4):27-33

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