Osteoporosis and Bone Diseases

Анализ динамики переломов в Твери за период 1994-2004 гг. показал, что наряду с такими характерными и для других городов параметрами эпидемиологии переломов проксимального отдела бедра, как прогрессирующее увеличение их числа, независимо от пола, с возрастом старше 50 лет, преобладание у женщин во всех возрастных группах, начиная с 60 лет, имеются и некоторые особенности. Так, не отмечено прогрессивного роста относительной частоты переломов в последние годы. В то же время максимальное их число независимо от пола во всех возрастных группах было отмечено в 1996, 1998 и 2001 гг., что, возможно, связано с таким фактором, как экономическая обстановка в стране. Начиная с 2002 года во всех возрастных группах, за исключением возраста старше 80 лет, отмечено снижение относительной частоты переломов. Изменение ситуации связывается с улучшением в городе ранней диагностики остеопороза и проведением лечения в группах риска. Продолжающийся рост заболеваемости у лиц старше 80 лет на фоне тенденции старения популяции дает основание полагать, что у лиц этой возрастной группы проводимых мероприятий недостаточно и необходимы дальнейшие меры, направленные на снижение заболеваемости остеопорозом и числа переломов проксимального отдела бедра на его фоне.

The aim was to estimate the effects of treatment with alendronate (Fosomax 35 mg) in postmenopausal women with osteoporosis and subclinical hyperthyroidism. Thirty postmenopausal women (64 (60-69) years old) with osteoporosis (T-score ≤ -2,5) and subclinical hyperthyroidism (77% with endogenous subclinical hyperthyroidism and 23% on L-thyroxine suppres-sive therapy after thyroidectomy due to differentiated thyroid cancer) were randomly assigned into two groups: 1-14 women received Fosamax 35 mg a week in combination with 500 mg of calcium and 400 UI of Vitamin D3 (VD) daily; 2-16 women received 1000 mg of calcium and 800 UI of VD daily. Euthyroidism was achieved in all women with endogenous subclinical hyperthyroidism. An increase in physical activity was recommended to all patients and a hypolipidemic diet was given to those who had had high cholesterol level. Biochemical parameters (calcium (Ca), phosphorous (P), creatinine (Cre), alkaline phosphatase (ALP), cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TG), cholesterol/HDL ratio) in fasting serum as well as calcium/creatinine ratio in fasting urine (U-Ca/U-Cre); biochemical markers of bone metabolism: osteocalcin (OC) and C-terminal telopeptide of type I collagen (b-CTx) serum ("ECLIA", Roche Elecsys 1010/2010), BMD (DXA; Prodigy, Lunar) at the lumbar spine (L1-L4), femoral neck (FN), total hip (TH) and radius total (RT) were measured at the baseline visit and after 1 year of treatment. At the baseline visit there were not found any differences between the 1 and the 2 groups. After 12 months of treatment the markers of bone metabolism as well as ALP decreased significantly in both groups, though the decreases were significantly greater (p<0.001 for both OC and b-CTx) in the 1 versus the 2 group. BMD in the 1 group increased by 7,6% at L1-L4 (p=0,003), 2,8% at FN (р=0,013), 3,3 % at TH (p=0,012) and 3,2 % at RT (р=0,047). There was not detected any BMD loss in the 2 group. The changes were not significant between the two groups. The levels of Ca, P, Cre, U-Ca/U-Cre did not change in both groups. Significant improvements in lipid levels were found: HDL increased (р=0.035 1 group p=0,034 2 group), cholesterol/HDL ratio decreased (p=0,011 - 1; p=0,004 - 2). In addition, cholesterol (р=0,003); TG (p=0,016) and LDL (p=0,006) decreased for patients from the 1 group. Conclusion: The achievement of euthyroidism and Fosamax 35 mg a week increase BMD in all regions of the skeleton in postmenopausal women with osteoporosis and subclinical hyperthyroidism and reduce bone resorption significantly more than Calcium and VD supplementation.

The presence of risk factors for osteoporosis has been found in 87,1% of investigated patients with somatic diseases. Osteoporosis was diagnosed more frequently in males with somatic diseases, than in females with somatic diseases. Moreover, males had lower BMD versus females. The prevalence of osteoporosis depended on age for men, but did not for women. The presence of somatic disease and/or the risk factors for osteoporosis are the most important factors in the development of osteoporosis without any dependence on sex.