Ca&Bone

[Decreased bone resorption in H1-receptorantagonist treated allergic children]

FERENCZ VIKTÓRIA, BOJSZKÓ ÁGNES, PALLINGER ÉVA, LAKATOS Péter, FALUS ANDRÁS, HORVÁTH CSABA

NOVEMBER 10, 2007

Ca&Bone - 2007;10(04)

[INTRODUCTION - Histamine receptor antagonists seems to have effect on bone metabolism according to previous studies. We investigated the bone turnover in allergic children who were treated with H1-histaminreceptor (H1R) antagonists. PATIENTS AND METHODS - The biochemical bone turnover markers [β-CrossLaps (β-CTx), osteocalcin (OCN), β-CTx/OCN ratio], parathyroid hormone (PTH) and the 25(OH)vitamin D3 were determined in 37 H1Rantagonist treated multiplex allergic children and in 21 age and gender matched healthy children. The intracytoplasmatic histidine decarboxylase (HDC), histamin, and surface H1 and H2 receptors expression were assessed by flow cytometry on peripheral leukocytes. The distribution of lymphocyte subpopulation were also determined. RESULTS - The serum OCN, PTH and 25(OH)vitamin D3 levels did not differ between the healthy and the allergic groups. However, the β-CTx was lower in the H1Rantagonists treated allergic children (1090.82±80.25 pg/ml) in comparison with controls (1456.58±95.81 pg/ml; p=0.006). The β-CTx/OCN ratio was found to be lower in the H1R-antagonists treated allergic than in the controls (9.24±0.608 vs. 12.65±0.53; p=0.001). β-CTx serum level correlated with OCN in the controls (r=0.845, p<0.001) and in the H1R-antagonist treated allergic, too (r=0.519, p=0.005). Higher HDC expression and H1 receptor down regulation was found in allergic children. The CD3+/CD16-56+ T cells were in higher rate in children of control group. CONCLUSION - Decreased bone resorption was found among H1 receptor antagonist treated allergic children, which is indicated by serum markers. Therefore, bone turnover is shifted toward bone formation in the H1Rantagonist treated allergic subjects.]

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Ca&Bone

[Dear Colleagues and Readers!]

HORVÁTH CSABA

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[Relationship of cardiovascular risk factors and bone status in a large adult population of the Balaton Region]

BUDAY BARBARA, IZSÓNÉ KATZ MELITTA, NAGY ELVIRA, PAPP ZSUZSA, KORÁNYI LÁSZLÓ

[BACKROUND - Numerous international studies have investigated the relationship between bone metabolism and type 2 diabetes mellitus. The results are controversial, there are those proving an increasing effect of diabetes on bone density but we know data that prove the opposite results. Our aim was to investigate the relationship between bone density, obesity and carbohydrate metabolism on a large Hungarian population. PATIENTS AND METHODS - The data from a large population screening (n=6287, mean age 56±13 years, men: n=1561, women: n=4726), carried out in the Balaton Region, Hungary, were analyzed (anthropometry, blood glucose and total cholesterol, blood pressure, calcaneus ultrasound T-score). RESULTS - Analyzing the relationship between type 2 diabetes and osteoporosis/osteopenia, we found, that the prevalence of osteopenia is significantly higher in diabetic women between 50-60 years of age than that of normal glucose tolerance, (50 vs. 36.34%, OR: 1.711, 95% CI: 1.076-2.722, p<0.022), however in different age groups and in males there were no significant differences, similar to the metabolic syndrome which did not influence the prevalence of osteoporosis/osteopenia. In normal weight (male and female) diabetic population over 60 years of age, the frequency of osteoporosis/ ostepenia was much higher, than in the normal weight normal glucose tolerance group, which difference was borderline-significant in the case of osteoporosis (63.63 vs. 26.2%, OR: 2.71, 95% CI: 0.969-7.6, p=0.054), and did not reach it with osteopenia (53.38 vs. 43.31%, p=0.359). In the same age group, within the “all glucose intolerant” and “all normal glucose tolerance” groups the prevalence of osteoporosis/osteopenia did not differ. We found significant correlation between BMI and T score only in women and it was strongest in age group of over 70 years (r=+0.23, p<0.001). CONCLUSION - Our data suggest that the increased bone density often measured in type 2 diabetic patients is actually the consequence of the accompanying obesity, and not of diabetes itself, which is rather a risk factor for bone loss.]

Ca&Bone

[MOOT-COMP study - Compliance of patients with antiporotic treatment]

BORS Katalin, BOROS Erzsébet

[INTRODUCTION - Several studies prove the importance of the lack of compliance in the ineffectiveness of drugs which have been tested by clinical studies. In our study we finded the reasons of leaving off the antiporotic treatment. PATIENTS AND METHODS - 1067 osteoporotic patients (91% women, 9% men) were enrolled to examine compliance and to find explanation of non-compliance. We asked the patients about medications, exercises, electrotherapy and medical aids. RESULTS - Medications were recommended for most patients and exercise was the secondary most common therapeutic method. Electrotherapy was prescribed for one third and medical aids were recommended for one fifth of the recruited patients. Two third of patients reported to take all pills, most of them suffered from bone fracture. More than one fifth of patients sometimes or often forgot to take the treatment. 10% more patients did exercises than it was recommended by the practitioner. However, only 25% of all patients did exercises appropriate frequency and at least 20 minutes per day. Electrotherapy was not prescribed by the doctors for more than half of patients on this treatment. Medical aids were not used by 10% of patients despite the recommendations. Almost one third of the enrolled patients reported a fact which disturbed keeping recommendations of the doctors. These facts were financial problems, long waiting lists and low motivation of patients for keeping recommendations. The compliance did not correlate with education and social status. The patients with multiple fractures were more comply with medications and exercises. CONCLUSION - Drawing the informed patient into decision making and knowing the therapeutic outcome are important factors for keeping therapeutic recommendations. The high fracture rate in Hungary attracts our attention for enhance patient compliance.]

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Ca&Bone

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[INTRODUCTION - The effect of short-term calcium and vitamin D supplementation by a clinical nutriment on bone formation and resorption was studied in postmenopausal women with normal or decreased calcidiol serum levels. PATIENTS AND METHODS - Ninety-one postmenopausal women (age, 60-75 years) were enrolled in the study to investigate the effect of 1120 mg calcium and 208 IU vitamin D in a complex composition (Fortimel®, Nutricia) on bone turnover after 4 weeks of treatment. All women suffered from osteopenia or osteoporosis detected by bone densitometry. Serum parathyroid hormone levels and bone turnover markers (serum β-CrossLaps, osteocalcin and alkaline phosphatase) were determined before and after the treatment. Moreover, calcidiol serum level was also measured at the beginning of the study to assess vitamin D supply. A questionnaire was used to assess gastrointestinal side effects and urinary calcium/creatinine ratio was calculated to estimate the risk of kidney stone development. RESULTS - In the entire patient group the mean serum level of β-CrossLaps was elevated (526.97±29.26 pg/ml) before the study and decreased during the treatment (485.58±28.27 pg/ml, p=0.03).The mean serum level of osteocalcin (28.58±1.37 vs. 27.03±1.36 ng/ml, p=0.025) and serum alkaline phosphatase activity (200.46±8.72 vs. 186.94±11.64 U/l, p=0.033) both decreased.The serum 25-OH vitamin D3 was below 30 ng/ml in 20 patients before the treatment, suggesting vitamin D deficiency.A correlation (r=0.508, p<0.001) between the decrease of bone formation and the decrease of bone resorption was found only in patients with normal serum 25-OH vitamin D3 concentration (>30 ng/ml). However, bone turnover did not decrease in patients with calcidiol deficiency. Urinary calcium/creatinine ratio remained unchanged during the treatment, but two patients suffered from constipation and one of them had diarrhea due to the calcium supplementation. CONCLUSIONS - Calcium and vitamin D supplementation in a complex clinical nutriment proved to be effective in decreasing bone turnover in postmenopausal women with good vitamin D supply, even after a short treatment period of 4 weeks. However, this treatment was ineffective in patients with vitamin D deficiency suggesting the importance of serum calcidiol measurement before calcium supplementation. Calcium in complex with other nutrients such as citrate did not increase the risk of renal stone formation in the short run, and only caused gastrointestinal problems in a tiny fraction of patients.]