Vol 15, No 2 (2012)

Articles
SERUM CONCENTRATIONS OF PROTEIN REGULATORS OSTEOBLASTOGENESIS AND OSTEOCLASTOGENESIS IN PATIENTS WITH ENDOGENOUS HYPERCORTICISM
Belaya Z.E., Rozhinskaya L.Y., Dragunova N.V., Solodovnikov A.G., Ilyin A.V., Melnichenko G.A., Dedov I.I., Dzeranova L.K.
Abstract
Purpose. Endogenous Cushing’s syndrome (CS), usually affecting young and otherwise healthy patients, is a good model to validate the effects of supraphysiological levels of glucocorticoids in humans. This study evaluates circulating levels of extracellular antagonists of Wnt/ß-catenin signaling pathway (sclerostin, Dickkopf1 (Dkkl), secretedfrizzled-related protein 1 (SFRP1)) along with osteoprotegerin (OPG) and soluble receptor activator of nuclear factor kappa-beta ligand (RANKL) in patients with CS as compared to healthy individuals. Materials and methods. Forty patients with clinically and biochemically evident CS and 40 sex, age and body-mass index matched healthy individuals provided fasting serum samples (8:00-10:00AM) for measurement of sclerostin, SFRP1 and Dkkl, RANKL., OPG along with bone turnover markers. Serum samples on RANKL., OPG., Dkkl, SFRP1, sclerostin were frozen and then concurrently measured by an enzyme immunoassay (ELISA) using commercially available reagents. Serum samples on osteocalcin (OC), carboxyterminal cross-linked telopeptide of type I collagen (CTx), cortisol in serum and saliva were assayed by electrochemiluminescence (ECLIA) Cobas e601 Roche. Urinary free cortisol (24hUFC) was measured by an immunochemiluminescence assay (extraction with diethyl ether) on a Vitros ECi. All participants were questioned regarding any recent low traumatic fractures. Patients with CS underwent standard spinal radiographs in anterior-posterior and lateral positions of the vertebrae Th4-L4 (Axiom Icons R200 "Siemens"). Results. Patents with CS (30 (26-40) years old with 24hUFC 2575 (1184-4228) nmol/l (Me (Q25-Q75)) had suppressed OC and normal CTx levels as compared to healthy subjects. A significant correlation, which we observed between OC and CTx (po=0.724 (p<0.001)) among the healthy volunteers, weakened to a non-significant level (po - 0.285 (p=0.083)) when analyzing patients with CS only. 24hUFC correlated with OC po = - 0.464 p=0.003, but not with CTx po= 0.245 (p=0.132) in patients with CS. Patients with CS had higher sclerostin levels versus healthy control subjects (p=0.032). Differences in sclerostin were due to the lack of lower sclerostin values rather than an increase in protein levels above the upper-limits of the healthy control individuals. Sclerostin levels higher than 662 pg/ml were four times more frequent in patients with CS as compared to healthy subjects (OR=4,19, 95% CI 1,44-12,22), p=0,006. Dkk1, SFRP1 did not differ from the control group. Patients with CS had a significantly lower level of RANKL (0.083 (0.075 0.093) pmol/L) as compared to healthy subjects (0.106 (0.089 0.131) pmol/L) p<0.001. Conversely, no difference was found between the OPG level in patients with CS (6.65 (4.92-7.66) pmol/L) and healthy individuals (5.77 (5.00-6.40) pmol/L), p=0.14. RANKL was lower (p=0.02) and OPG was higher (p=0.04) in patients with CS and low traumatic fractures (n=19) versus patients without fractures (n=21). Conclusions. Patients with CS have higher sclerostin level as compared to healthy subjects. Hypercotisolism prevents the normal physiological suppression of sclerostin rather than raising its absolute level. Of all the tested proteins (sclerostin, Dkk1, SFRP1, RANKL., OPG) only sclerostin seems to be a promising therapeutic approach to treating osteoporosis in patients with endogenous CS.
Osteoporosis and Bone Diseases. 2012;15(2):3-8
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SOSTOYaNIE MINERAL'NOY PLOTNOSTI KOSTNOY TKANI U ZhENShchIN, PERENESShIKh MALOTRAVMATIChNYE PERELOMY V VOZRASTE 50 LET I STARShE
Dobrovol'skaya O.V., Demin N.V., Toroptsova N.V.
Abstract
This study was aimed to evaluate the bone mineral density (BMD) in women at the age of 50 years and older with the his tory of fracture(s) after a low-energy trauma. For this purpose the osteodensitometry of three areas was performed in 173 women with different low-traumatic fractures. Osteoporosis and osteopenia were found in 77% and 21% of patients respectively. Osteoporosis at least in one of three areas was revealed in 80% of women with hip fracture, in 77% of women with wrist fractures, in 73% of patients with humeral fractures, in 86% women after vertebral fractures and in 62% of patients with ankle fractures. Moreover, in these subgroups the osteoporosis in two areas of three was found in 38%, 23%, 30%, 33% and 24% of cases respectively. Osteoporosis in all three areas was detected more frequently in women with wrist fractures (in 39% of cases). The high frequency of osteoporosis in women with the history of low-traumatic fractures argues the need of an adequate antiosteoporotic treatment without mandatory verification of the reduced BMD by the mean of the osteodensitometry.
Osteoporosis and Bone Diseases. 2012;15(2):9-12
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BONE MINERAL DENSITY AND VASCULAR WALL CHARACTERISTICS IN WOMEN AFTER OVARIECTOMY AND PROLONGED HORMONE THERAPY
Mitrokhina T.V., Yureneva S.V., Maychuk E.Y., Kuznetsov S.Y., Voevodina I.V., Moiseenko S.V.
Abstract
Osteoporosis and atherosclerosis are the most socially significant chronic non-infectious diseases. This is due to their high prevalence and medical, social and economic consequences from osteoporotic bone fractures and myocardial infarction and stroke as a result of cardiovascular diseases (CVD). The level of estrogen is essential for the formation and maintenance of bone mass in women. The sharp decline in estrogen levels after bilateral ovariectomy plays the role of trigger factor in the development of complex disorders of the bone and the cardiovascular system. Pathogenetically justified approach to the correction of the estrogen-deficient states is the use of hormone replacement therapy (HRT). To study the effect of HRT on the cardiovascular system and bone mineral density (BMD) we examined 50 women with surgical menopause which received HRT for more than a 10-year period. We studied the anthropometric and biochemical parameters (blood cholesterol and its fractions, fasting blood glucose), performed Doppler ultrasonography of head and neck vessels with measurement of pulse velocity, dual-energy x-ray absorptiometry (DEXA) for BMD estimation. Examination was carried out twice - in the early period after the operation (the first year) and after 10 years. Analysis of the cardio-vascular system and the BMD has demonstrated more severe atherosclerotic vascular changes and a greater decrease in BMD in patients who discontinued use of HRT. The severity of atherosclerosis and the level of the BMD were dependent on HRT use.
Osteoporosis and Bone Diseases. 2012;15(2):13-17
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RISK FACTORS OF LOW BONE MINERAL DENSITY IN CHILDREN WITH CELIAC DISEASE
Mukhina Y.G., Banina T.V., Scheplyagina L.A.
Abstract
The study shows that the long-term non-adherence to glutenfree diet, growth retardation, biological maturation are factors that adversely affect the parameters of BMC and BMD. On gluten-free diet patients with celiac retain physiological principles of accumulation of the mineral and bone remodeling in the skeleton.
Osteoporosis and Bone Diseases. 2012;15(2):18-20
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EFFECT OF ZOLEDRONIC AND IBANDRONIC ACIDS ON BONE METABOLISM IN WOMEN WITH POSTMENOPAUSAL OSTEOPOROSIS
Yakushevskaya O.V., Bordakova E.V., Gavisova A.A., Kuznetsov S.Y., Yureneva S.V., Ivanets T.Y., Smetnik V.P., Sukhikh G.T.
Abstract
In open prospective study we determine the efficacy of zoledronic and ibandronic acids on bone metabolism markers and bone mineral density in women with postmenopausal osteoporosis. 225 women with postmenopausal osteoporosis treated with zoledronic acid in dose 5 mg, intravenously, once a year and 64 women treated ibandronic acid were followed up. The investigators assessed clinical and medical history data, evaluated the gynecological and somatic statuses, and made laboratory and instrumental studies: clinical, biochemical blood tests, general urinalysis, determination of serum bone metabolism markers (B-Crosslaps, osteocalcin), osteodensitometry and electrocardiography, therapist ’s examination if needed. Therapy with zoledronic acid 5 mg once a year and ibandronic acid 150 mg once a month was followed by a significant reduction in resorption markers (B-Crosslaps) just following one month. Formation markers decreased to a lesser degree, which was indicative of preserved positive bone remodeling balance during the therapy. Determination of biochemical markers of bone remodeling permits assessment of an individual patient response to antiresorbtive therapy just in the first month after infusion. Zoledronic acid or ibandronic acid therapy exerts a rapid and potent effect on bone metabolism, mainly by inhibiting the resorption processes.
Osteoporosis and Bone Diseases. 2012;15(2):21-24
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MARKERS OF BONE METABOLISM IN LONG BONE’S ADHESION
Pobel E.A., Bengus L.M., Dedukh N.V.
Abstract
This review presents the current evidence about the use of markers of bone metabolism in the prediction of fracture healing, differences in concentrations of blood markers of bone metabolism in patients with normal and delayed consolidation of bone fragments. We analyze the relationship between the fracture site, time-stage features of its healing and urinary macromolecules, reflecting bone metabolism. Increase in bone turnover, which is observed after the fracture, is characterized by activation markers of bone resorption, with a subsequent increase in the concentration of blood markers of bone formation. However, there is a marked variability in data concerning the levels of bone markers in plasma at different stages of fracture healing. We show that in patients with delayed fracture healing there is a significant delay in raising osteocalcin levels. Prognostic features for determining fracture nonunion include low concentrations of N-terminal propeptide of procollagen type I. Determination of markers of bone metabolism in blood can serve as informative criterion for the course of reparative osteogenesis, but one must consider the nature of traumatic injury, time passed from injury, especially the state of bone tissue at the time of injury, age of the patient to identify the early stages of consolidation disturbances.
Osteoporosis and Bone Diseases. 2012;15(2):25-32
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THE EDUCATIONAL PROGRAM FOR PATIENTS WITH OSTEOPOROSIS AND ITS IMPACT ON ADHERENCE TO TREATMENT: RESULTS OF A MULTICENTER RANDOMIZED TRIAL
Evstigneeva L.P., Lesnyak O.M., Kuznetsova N.M., Safonova Y.A., Bulgakova S.V., Kirpikova M.N., Strunina M.V., Telyuschenk M.V., Nekrasova M.R., Nesmeyanova O.B., Vorob’yova A.A.
Abstract
Introduction: Adherence to treatment in osteoporosis (OP) remains poor. Educating patients is the possible way for improving the situation. Purpose: To evaluate the effect of different forms of educational programs on treatment adherence. Materials and methods: 479 patients (mean age 66.1±7.9 years, 98.1% were women) with osteoporosis from seven centers of Russia were included in the study. The patients were randomly assigned to two groups. Treatment group (241 subjects) was trained at the School of the OP for 4 classes using interactive teaching methods with 7-10 people at a time. Patients of the control group (238 subjects) received information on the OP as a booklet. The number of patients taking calcium and vitamin D, as well as antiosteoporotic medications was not significantly different between groups at baseline. Patients had four centers interim visits at 3 and 6 months. The final visit for all patients was 12 months. Adherence was assessed at 12 months. Results: After the educational program 78.6% of study group and 80.1% of the control group took calcium with vitamin D regularly during 12 months (p>0.05). Antiosteoporotic medications were taken regularly by 55.4% of intervention and 35.1% of the control group, p<0,001. Other factors affecting adherence were: maternal hip fracture (OR=3,09; 1,55-6,16), intermediate visits at 3 and 6 months (OR=2,41; 1,47-3,96), the presence of disability group (OR=2,03; 1,35-3,06). Conclusion: Patient education in the classroom in small groups using interactive methods more effectively influences adherence than getting the information from a booklet.
Osteoporosis and Bone Diseases. 2012;15(2):33-37
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FRAX - A NEW TOOL FOR THE ASSESSMENT OF FRACTURE RISK: APPLICATION IN CLINICAL PRACTICE AND THRESHOLDS FOR INTERVENTION
Kanis J.A., Oden A., Johansson H., Borgstrom F., Strom O., McCloskey I.V.
Abstract
ФРАКС (FRAX®) - активно разрабатываемый метод, который по мере появления новых данных по эпидемиологии и клиническим факторам риска переломов будет обновляться с целью расширения возможностей и повышения надежности оценки... Выбор клинических факторов риска, используемых в алгоритме ФРАКС, основывается на целом ряде мета-анализов, в которых были выявлены факторы, независимо влияющие на риск остеопорозного перелома. В этих мета-анализах использовались индивидуальные данные практически для 60 тыс. мужчин и женщин. ФРАКС (FRAX®) (http: //www.shef.ac.uk/FRAX) — это реализованный на web-сайте метод, разработанный Сотрудничающим центром Всемирной организации здравоохранения (ВОЗ) по метаболическим заболеваниям скелета (Университет Шеффилд, Великобритания), в основу которого положены модели оценки вероятности перелома у мужчин и женщин. Эти модели, созданные на основании исследований в популяционных когортах в Европе, Северной Америке, Азии и Австралии, были тщательно проверены в дополнительных популяционных когортах с объемом данных более 1 млн. пациентов в год. Алгоритмы ФРАКС интегрируют хорошо проверенные клинические факторы риска, такие как возраст, индекс массы тела, и некоторые дихотомические переменные (например, перелом в анамнезе, курение, лечение кортикостероидами, ревматоидный артрит), как с учетом минеральной плотности костной ткани (МПК), так и без нее. В моделях используется регрессия Пуассона для вычисления рисков смерти или перелома в зависимости от исходных данных, а конечный результат выводится в виде 10-летних вероятностей событий (те перелома бедра, основного остеопорозного перелома [бедра, позвонка, плеча или предплечья]). Эти модели более точно настроены для ряда стран, которые предоставили эпидемиологические данные по переломам. В настоящем обзоре рассматриваются практические аспекты разработки рекомендаций по диагностике и лечению, в которых методика ФРАКС будет признана необходимым компонентом определения риска переломов у пациентов, наблюдающихся в учреждениях первичного звена здравоохранения. Основные области применения ФРАКС включают выявление пациентов, нуждающихся в определении МПК и медикаментозном лечении (в ряде случаев для этого достаточно данных о клинических факторах риска). В практических рекомендациях, в которые уже включена методика ФРАКС, также указаны пороговые уровни для начала лечения, варьирующие в зависимости от страны (ввиду не только клинических, но и экономических соображений). Что касается самой методики ФРАКС, работа над ней продолжается, и появление новых данных о многих клинических факторах риска позволит обогатить ее алгоритмы, что приведет только к увеличению надежности, точности и значимости прогностической оценки.
Osteoporosis and Bone Diseases. 2012;15(2):38-44
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EFFICACY AND SAFETY OF STRONTIUM RANELATE IN THE TREATMENT OF MALE OSTEOPOROSIS
Kaufman J.M., Audran M., Bianchi G., Boonen S., Josse R., Francis R.M., Goemaere S., Palacios S., Diaz Curiel M., Ringe J.D., Felsenberg D.
Abstract
Osteoporosis and Bone Diseases. 2012;15(2):45-45
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PERVOE IZVEShchENIE
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Abstract
Osteoporosis and Bone Diseases. 2012;15(2):46-46
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RULES FOR PREPARING MANUSCRIPTS FOR THE JOURNAL «OSTEOPOROSIS AND OSTEOPATHY»
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Abstract
Osteoporosis and Bone Diseases. 2012;15(2):47-48
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