Ca&Bone

[Paget’s disease of the bones]

DONÁTH Judit

FEBRUARY 20, 2003

Ca&Bone - 2003;6(01)

[The author provides a summary of the current knowledge on Paget’s disease. Recently, the greatest advances have been made in the fields of genetics and therapy.The incidence of the disease is far greater than the number of cases diagnosed. Current research focuses on proving the virus hypothesis of etiology as well as on genetic causes.Various new biochemical markers have become available, but serum alkaline phosphatase is still the most widely used parameter. Radiological studies remain the gold standard for the diagnosis of Paget’s disease. Clinical trials of the most recent bisphosphonates are ongoing.]

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Ca&Bone

[7th Congress of OROM]

SOMOGYI Péter

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[Dear Colleagues and Readers!]

HORVÁTH CSABA

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[National Fracture Prevention and Risk Reduction Programme]

SOMOGYI Péter, LAKATOS Péter, POÓR Gyula, HORVÁTH CSABA

[Prevention of fractures due to osteoporosis is of crucial importance given the high mortality associated with these fractures, especially with those of the hip and vertebrae. Patients with fractures often lose their independence or require institutionalization. Osteoporosis is a special disease in that even though its public health significance is well known only 10% of patients are medically treated.There are 900,000 patients with osteoporosis in Hungary, out of which about 130,000 to 150,000 are currently treated. In April 2003 a new fracture prevention programme was launched.The aim of the programme is to prevent subsequent fractures in patients with fractures of the distal radius, proximal humerus, hip and vertebrae by thorough examination, risk assessment and therapy if necessary in the osteoporosis centres and in the traumatological units associated with them.The National Fracture Prevention and Osteoporosis Risk Reduction Programme has been adapted from Glasgow, Scotland, and is the first of its kind that aims to cover a whole country.]

Ca&Bone

[Is there any association between the location of the parathyroid adenoma and the presence of nephrolithiasis in primary hyperparathyroidism?]

CSUPOR EMŐKE, TÓTH EDIT, MÉSZÁROS SZILVIA, FERENCZ VIKTÓRIA, SZŰCS János, LAKATOS Péter, HORÁNYI János, PERNER Ferenc, HORVÁTH CSABA

[INTRODUCTION - The majority of patients with primary hyperparathyroidism recurrently produce kidney stones, while the rest have other clinical manifestations (metabolic bone disease, acute pancreatitis, depression, etc.).The aim of this study was to examine whether there is any association between the clinical symptoms and the location of adenoma. PATIENTS AND METHODS - The records of 91 patients (10 males, 81 females, mean age: 61.9 years, range: 20-70 ys) operated for primary hyperparathyroidism between 1995 and 2000 were retrospectively evaluated. One patient was excluded from the study because of parathyroid cancer. Nephrolithiasis was noted in 55 cases and other clinical symptoms in 35 cases. The diagnosis of pHPT was confirmed by the surgery, which also determined the precise location of the adenoma. RESULTs - In the kidney stone group, the adenoma was located in the left inferior parathyroid gland in 50 cases (91 %), (χ2=67.5, p<0,00001), in the left superior parathyroid gland in 2 patients, while in 3 patients multiple hyperplasia was found. In the group without nephrolithiasis the adenoma was located in the right inferior parathyroid gland in 24 patients (69 %), (χ2=43.9, p<0,0001), while in 3 patients each it was detected in the left and right superior parathyroid gland, respectively. Multiple hyperplasia was also observed in 3 patients and ectopic location in 2 patients. CONCLUSION - The results raise the possibility that the clinical manifestation of the pHPT, i.e., whether it is or is not accompanied with nephrolithiasis, may be influenced by the location of the adenoma.This suggests that either the biological effects of the parathyroid hormone or its biologically active hormone fragments are different according to in which of the four glands it is produced.Therefore, we recommend that in patients with kidney stones where the preoperative imaging fails to reveal the location of the adenoma, during surgery the search for the adenoma should be started at the left inferior parathyroid gland.]

Ca&Bone

[Hypophosphatasia]

MÉSZÁROS SZILVIA, GYŐRI Gabriella, MAGDICS Mária, LAKATOS Péter, HORVÁTH CSABA

[INTRODUCTION - The authors describe a rare metabolic bone disorder causing a differencial diagnostic problem in a 44- year-old female patient. CASE REPORT - The patient has had a history of lower back and hip pain for 30 years, as a cause of which vitamin-D resistant rickets had been diagnosed and short-term vitamin-D therapy was applied several times. The laboratory tests of the patient (weight: 41 kg, hight: 142 cm) showed decreased levels of serum alkaline phosphatase and parathyroid hormone, normal serum calcium and ionized calcium, and an elevated phosphate concentration. On X-ray examination of the bones, calcified disci under the V. and XII. dorsal vertebrae, a pathologic curve of both femoral diaphyses and a Looser line among other degenerative changes were noted. CONCLUSION - The clinical, laboratory and radiological findings supported the authors’ diagnosis of hypophosphatasia. The clinical and diagnostic findings of hypophosphatasia may also be suggestive of hypoparathyreosis with consecutive disturbance of vitamin-D activation.The differenciation of the two disorders is essential for adequate treatment.]

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