Ca&Bone

[Hungarian and international results in compliance of antiporotic treatment]

BORS Katalin1, HORVÁTH CSABA2

SEPTEMBER 20, 2005

Ca&Bone - 2005;8(03)

[The studies investigate the compliance of treatment showed that the compliance is one of the most important factor which influence the success of an otherwise effective treatment. Not only the patients, but also the doctors and nurses are responsible for the unsuccessful treatment. Our article shortly review Hungarian and international data about the compliance of antiporotic treatment and summarises a study which we plan to achieve in the near future.]

AFFILIATIONS

  1. Fôvárosi Önkormányzat Visegrádi Rehabilitációs Szakkórháza
  2. Semmelweis Egyetem, Általános Orvosi Kar, I. sz. Belgyógyászati Klinika, Budapest

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[Serum 25(OH)-Vitamin D levels and bone metabolism in patients on maintenance hemodialysis]

ALMÁSI Csilla, AMBRUS Csaba, DEÁK György, MARTON Adrienn, BERTA Klára, LAKATOS Péter, SZABÓ András, HORVÁTH CSABA, MUCSI István

[INTRODUCTION - Increasing evidence suggests that 25- hydroxy vitamin D3 (25(OH)D3) may contribute to the bone health of patients with chronic kidney disease.However, there is very little information available on the vitamin D3 status of patients with chronic renal failure. In a cross-sectional study we assessed the association between vitamin D3 status and parathyroid function, bone turnover, bone mass and structure in patients on maintenance haemodialysis. PATIENTS AND METHODS - Sixty-nine patients on maintenance haemodialysis were assessed by bone densitometry (DEXA) and quantitative bone ultrasound. Serum 25-hydroxy vitamin D3 levels and serum markers of bone turnover were simultaneously measured. RESULTS - A high prevalence of potentially significant vitamin D3 deficiency was found in this patient group; 59% of the patients had their 25(OH)D3 vitamin level below 20 nmol/l.There was a significant negative correlation between serum 25(OH)D3 and serum intact parathormone (iPTH) levels (r=-0.231, p<0.05) and this association remained significant after controlling for potential co-variables. Furthermore, a positive correlation was observed between serum 25(OH)D3 concentration and bone mineral density measured at the radius (r=0.424, p<0.01). Finally,we show for the first time that 25(OH)D3 levels are significantly and independently associated with broad band ultrasound attenuation (β =0.237, p<0.05) measured with calcaneal quantitative bone ultrasound in patients with chronic renal failure. CONCLUSION - Vitamin D3 deficiency may contribute to the impaired bone health of patients on maintenance dialysis, therefore, it seems to be warranted regularly monitoring and carefully controlling the D3-vitamin level of these patients.The results also suggest that quantitative bone ultrasound is useful in assessing bone health of patients with chronic renal failure.]

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BALOGH Ádám

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[The role of calcium in the chemoprevention of colorectal cancer]

FUSZEK Péter, SPEER Gábor

[One of the most exciting research areas of the past decade has concerned the chemoprevention of colorectal cancer (CRC). Numerous clinical studies have been conducted on the preventive role of NSAIDs, high fibre intake, selenium, phytooestrogens, hormone replacement therapy, antioxidants, COX-inhibitors, folic acid and calcium, however, their results are controversial. Among the suggested chemopreventive agents, the preventive role of calcium is supported by the strongest evidence.This paper aims to review the available facts on the role of calcium. Recent studies suggest that appropriate calcium intake may partially counterbalance the effect of the genes that contribute to the development of CRC. Experimental data show that calcium directly influences the expression of several genes involved in tumorigenesis and that it is also involved in a number of signalling pathways that control cell proliferation, differentiation and apoptosis.These effects mostly arise through the activation of the calcium sensing receptor. The main goal of this review is to draw attention to the established chemopreventive role of calcium in CRC. Published data suggest that a lifelong daily calcium intake between 1200 to 1500 mg (even 2000 mg in high risk groups) would significantly decrease the incidence of CRC by inhibition of tumorigenesis.]

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HOSSZÚ ÉVA, PÁL Csilla, TOMSITS Erika

[INTRODUCTION - Children with pituitary insufficiency normally receive growth hormone and thyroid hormone substitution, but glucocorticoid treatment is rarely necessary. Sex hormone replacement is introduced in puberty, which, at the same time, promotes growth and bone maturation. In this study the effect of testosterone replacement on bone mineral content was examined. PATIENTS AND METHODS - Nine boys (16.3±1.3 years) with hypopituitarism were involved in the study who had been receiving growth hormone and thyroid hormone replacement for several years by the beginning of the study.Androgen was substituted by the intramuscular administration of 50 mg testosterone biweekly.The children's height,weight, the rate of pubescence, and bone age were checked, and bone mineral density was measured by single photon absorptiometry every six month. During the substitution treatment serum thyroxin and testosterone levels remained in the normal ranges. RESULTS - A significant increase in bone mineral density was observed during the testosterone treatment, with Z-scores -1.80, -0.91 and +0.14 at baseline, 12 and 24 months, respectively (p<0,001). Z-scores adjusted for bone age remained in the normal range throughout the study (-0.904 at baseline and -0.946 at one year). CONCLUSION - The increase rate of bone mineral density (0.16 g/cm/year) was significantly higher compared both to the normal reference in this age group (0.07 g/cm/yr, p=0.0015) and to the normal reference relative to their bone age (p<0.0006). The increase in bone mineral density suggests that testosterone replacement has an important role both in the quantitative and qualitative development of bones.]

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[Dear Colleagues and Readers!]

HORVÁTH CSABA

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[INTRODUCTION - MERLIN (Management of Osteoporosis in Elderly with Calcitonin) is an open-label, multicenter, prospective, follow-up study conducted in Hungary, part of which is to assess the impact of treatment with Miacalcic, - an intranasal salmon calcitonin, on the quality of life (QoL) among patients with osteoporosis. In this paper we report the preliminary results of the MERLIN study. PATIENTS - The study initially involved 1949 senior patients (aged >65 years) to whom calcitonin was prescribed for osteoporosis according to the application instructions. Patients presented at outpatient clinics and consisted of two groups; they were either newly diagnosed or they had been receiving a therapy for osteoporosis other than calcitonin. METHODS - This latter group discontinued their previous treatment and all patients received 200 IU intranasal salmon calcitonin (SCT) once daily for three months. Patient and physician questionnaires were used to collect information on the patients' QoL (EQ-5D VAS) and their general well-being at baseline and at follow-up visits at week 4 and week 12. RESULTS - Calcitonin use was associated with improvements in all EQ-5D domains and component scores as well as in VAS. Patients with previously known osteoporosis who, switched to calcitonin therapy achieved better results (0,046 QALY), than the newly diagnosed patients (0,0405 QALY). CONCLUSIONS - We conclude that intranasal SCT 200 IU daily is safe and effective in improving QoL of both, male and female patients with low bone mineral density.The conclusions that can be drawn from this study are limited due to the lack of a control group and to the unblinded design. Further placebo-controlled studies are needed to confirm these results. Nevertheless, our study was the first in Hungary to evaluate the quality of life impact of an osteoporosis treatment, and hopefully it will be followed by more such studies directed to other osteoporosis treatments.]

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[INTRODUCTION - In addition to several other causes constitutional factors play an important role in the development of osteoporosis.Various aspects of bone metabolism were examined to explain the differences in bone density between women with low and high body mass index (BMI). PATIENTS AND METHOD - One hundred and ninetytwo postmenopausal women were included in the study. Bone density was measured by forearm densitometry.To assess bone formation, serum osteocalcin levels were measured, while the rate of bone absorption was estimated from C-terminal telopeptide levels of collagen type I measured in urine and blood. RESULTS - The prevalence of osteoporosis was higher in women with low BMI than in those with normal or higher BMI. Bone metabolism - both formation and absorption - was increased in both groups, however, in women with low BMI this increase was more pronounced and bone metabolism tended to be shifted to absorption compared to patients with normal or higher BMI. CONCLUSION - Postmenopausal lean women have accelerated bone metabolism compared to obese women. This fact and the shift to absorption may be the main reasons for the higher frequency of osteoporosis found by densitometry in women with low BMI than in those with higher BMI.]

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[INTRODUCTION - Data on bone mineral density (BMD) in diabetes mellitus are contradictory in the literature. Early studies described a decreased bone mineral density in type 1 diabetes mellitus (T1DM), but recent studies report no osteopenia in T1DM.The BMD may depend on the quality of treatment for diabetes mellitus and on the presence of chronic complications. In type 2 diabetes mellitus (T2DM) the BMD is not decreased, occasionally it can even be increased. PATIENTS AND METHODS - Bone mineral density was measured in 122 regularly controlled diabetic patients (T1DM: n=73, mean age: 43.6±11.1 years,T2DM: n=49, mean age: 61.8±9.8 years) by dual energy X-ray absorptiometry at the lumbar spine and at the femur. Results were compared to those of 40 metabolically healthy control persons with a mean age of 47.5±11.9 years.The patients’ carbohydrate metabolism was assessed by the average HbA1c level of the last three years.These values were 7.9±1.4 % in T1DM, and 7.5±1.7 % in T2DM. BMDs were classified based on the T-score and Z-score using the WHO criteria. RESULTS - There was no significant difference in T1DM or in T2DM compared to the reference group in the prevalence of either osteoporosis or of osteoporosis and osteopenia combined. CONCLUSION - BMD was not found to be decreased in patients with well-controlled metabolism compared to healthy controls.]

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[Controlled clinical studies on statins have produced evidence that the aggressive lowering of LDL-cholesterol (LDL-C) level reduces the mortality rate of ischaemic heart disease. About 40% of treated patients achieve the cholesterol target level. The observance of medication instructions on a daily basis (compliance) and willingness for long-term taking of the drug (persistence) are crucially important to avoid severe complications. In the long term, patients take only about 50% of their medicines according to the instructions. As a result of the generally poor compliance and persistence in taking the medications, the decrease in morbidity and mortality observed in clinical studies do not occur under real-life conditions. Patients with poor compliance (<80%) will experience only a minimal health benefit and the cost-effectiveness of the therapy will markedly decrease. For patients with poor persistence who discontinue their treatment before benefits at the clinical endpoints could manifest, the resources invested into the therapy will be lost. Both compliance and persistence deteriorate as the number of concurrently taken medicines increases. Since less than 50% of the programmes aimed at improving patient co-operation are successful, therapeutic decisions should preferably be made by taking into consideration the expected compliance/persistence already at the time of choosing the medication. By widening the use of fixed-dose combination therapies, the efficiency of treatment can substantially be increased in patients who concurrently take several medicines and require aggressive lowering of blood pressure or LDL-C level.]

LAM KID

[„HOPE for people with fracture”: Results of the HOPE (Hungarian Osteoporosis Project for Elderly) study]

SPEER Gábor, NÁDAS Katalin, FERENCZ VIKTÓRIA, MÉSZÁROS SZILVIA, HORVÁTH CSABA, BORS Katalin

[We conducted a multicentre, prospective, single cross-sectional, 12-month, open-label study for the assessment of treatment satisfaction using TSQM (Treatment Satisfaction Questionnaire for Medication) for zoledronic acid therapy used in patients with osteoporosis, who suffered minor traumatic fractures. PATIENTS AND METHODS - In total 1736 patients from 94 centers completed the study and filled in the TSQM questionnaire at both visit 1 and visit 2. TSQM is suitable for measuring the patient’s satisfaction with a treatment, by evaluating side-effects, efficacy and convenience of the treatment and the patient’s overall satisfaction rated on a scale of 0 to 100. RESULTS - Patients included in the study previously received a mean of 1.58 other therapies for osteoporosis and their case history included a mean of 1.24 fractures. This real-life study demonstrated that even one year of zoledronate treatment significantly (p<0.0001) improved the satisfaction of patients regarding efficacy (a mean change from a score of 56.15 to 70.89) as well as the occurrence of side-effects on a TSQM score. Regarding the convenience of treatment, the mean score increased from 62.96 to 79.34 (p<0.0001), whereas the overall treatment satisfaction changed from 59.3 to 75.48 by visit 2 (p<0.0001). CONCLUSIONS - Our study demonstrated beneficial TSQM results associated with zoledronic acid treatment, which is a basic requirement for appropriate adherence as well. ]