Vol 21, No 4 (2018)

Original study
Pilot study of 10-year absolute fracture risk assessment tool (FRAX®) introduction into the structure of undegraduate practical training "physician assistant” course
Popov A.A., Teplyakova O.V., Vorontsova A.V., Sarapulova A.V., Bogoslovskaya L.V.

Background: high fracture rates throughout the Eastern Europe and Central Asia region have been reported. Major fractures rate increasing, primary care physicians need to be aware of risk assessment and prevention tools.

Aims: The aim of this pilot study was to assess main issues of FRAX tool introduction into undergraduate medical education.

Material and methods: Russian version of the IOF approved presentation on FRAX application procedure, results assessment and interpretation as well as Russian Association for Osteoporosis clinical guidelines and reference to www.osteoporoz.ru site have been provided to 248 undergraduate medical students. To increase osteoporosis related issues study motivation the students were asked to apply the Russian version of on-line FRAX calculator to assess risk fracture in their close relatives of appropriate age. Also the students were asked to create a FRAX assessment based patient management program.

Results: 207 FRAX assessment reports were received as feedback. Derived intervention threshold was reached in 41 cases (19.8%), while in 45 reports (21.7%) body mass index (BMI) value was mistaken for a 10-year fracture risk. There were 123 cases of the students’ parents assessments. These subjects appeared to be quite young (median 48, range 42 – 62) and relatively healthy to report no fracture risk factors. The students’ grandparents or great-grandparents (68 cases) were assessed on rare occasions due to lack of information or absence of personal contacts between students and their relatives. The students reported appreciable difficulties in decision making. Lifestyle and diet modification were not included in 165 of recommendations, while calcium and vitamin D prescriptions were severely biased by TV advertising. The students reported that it was quite difficult for them to give the patients recommendations regarding the choice of drug and administration timeframe.

Conclusion: pilot study of FRAX introduction into undergraduate medical education helped to ascertain several gaps in teaching of osteoporosis diagnosis, prevention and treatment to be covered during undergraduate medical education

Osteoporosis and Bone Diseases. 2018;21(4):4-9
Joint and muscle involvement in primary hyperparathyroidism
Mokrysheva N.G., Eremkina A.K., Mirnaya S.S., Volodicheva V.L., Panevin T.S., Melnichenko G.A.

In addition to the classical symptoms such as osteoporosis, renal stones and gastric ulcers primary hyperparathyroidism (PHPT) could be presented with “non-classical” manifestations, including muscle and joint pathology. Moreover, in some cases the articular and neuromuscular impairment might be the main signs of the disease. Despite the long research history the true prevalence of these PHPT complications remains unknown. Discrepancies in studies results may be due the non-specific and different symptoms that patients complain about, various study design, uncorrected comorbid conditions, the different PHPT populations, a wide methods variety in the assessment of neuromuscular and articular involvement. However, the underestimated muscle dysfunction and joint damage can lead to decreased quality of life and disability, primarily from fragility fractures. In the majority of the studies parathyroidectomy improved muscle strength, but there is no clear results for articular manifestations. Basic research and large randomized control trials are limited. The main goal of this review is to summarize currently available data on muscle and joint involvement in patients with PHPT.

Osteoporosis and Bone Diseases. 2018;21(4):10-18
Case report
Case report of Sagliker syndrome in a young patient with secondary hyperparathyroidism and chronic renal failure
Grebennikova T.A., Gronskaia S.A., Zenkova T.S., Belaya Z.E.

Sagliker syndrome is a rare complication of renal osteodystrophy, characterized by severe skeletal and cranium deformities, neurologic and soft tissue abnormalities in patients with chronic renal failure (CRF) and untreated secondary hyperparathyroidism.

This article reports a 29-year-old female patient with end-stage CRF after 9 years of hemodialysis. She had severe secondary hyperparathyroidism, hyperplasia of three parathyroid glands and cranium and skeletal bone structure deformation. The first changes appeared after 4 years of therapy with peritoneal dialysis. They included uglifying face appearances, short stature, severe maxillary changes, chest deformity. During the examination we revealed severe tomographical and X-ray changes: maxillary and mandibular hyperplasia, temporomandibular articulation changes, affected cheekbones, sphenoid bone and bones of the cranial vault, fingertip changes, vertebral body compression.

Although surgical parathyroidectomy was effective at biochemical abnormalities, severe bone deformities were not regressed.

This case highlights the importance of clinicians’ attention for early monitoring and appropriate treatment of secondary hyperparathyroidism in patients with end-stage CRF.

Osteoporosis and Bone Diseases. 2018;21(4):19-23
Tumor-induced osteomalacia: a clinical case report
Grebennikova T.A., Umiarova D.S., Slashchuk K.Y., Degtyarev M.V., Rodionova S.S., Rumyantsev P.O., Belaya Z.E.

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome usually caused by small-sized tumors. Tumors secrete fibroblast growth factor 23 (FGF23), which has a phosphaturic effect. The clinical signs of TIO are non-specific, and include fatigue, bone pain and muscle weakness, which makes timely diagnosis of the disease difficult and treatment is often delayed.

Well-timed diagnosis is essential and combined with complete tumor resection it leads to complete relief of symptoms and good postoperative prognosis. In cases of undetected tumors, medical treatment with phosphate supplements and active vitamin D medications is usually successful, however, treatment is associated with numerous complications and side effects can be burdensome for the patients. Due to the risk of recurrence or metastasis, patients with TIO require long-term management and follow-up.

In this article, we present a clinical case of successful diagnosis and treatment of TIO in a young patient with type 1 diabetes mellitus.

Osteoporosis and Bone Diseases. 2018;21(4):24-28

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