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


NOVEMBER 10, 2007

Ca&Bone - 2007;10(04)

[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.]


  1. Regionális Osteoporosis Központ, DRC Kft., Balatonfüred
  2. Fõvárosi Önkormányzat Péterfy Sándor Utcai Kórház, Kardiológiai Osztály, Budapest
  3. Adware Kft., Veszprém



Further articles in this publication


[Dear Colleagues and Readers!]


[2007;10;04 last paper]


[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.]


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


[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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Clinical Neuroscience

Management of bone metabolism in epilepsy

UÇAN TOKUÇ Ezgi Firdevs , FATMA Genç, ABIDIN Erdal, YASEMIN Biçer Gömceli

Many systemic problems arise due to the side effects of antiepileptic drugs (AEDs) used in epilepsy patients. Among these adverse effects are low bone mineral density and increased fracture risk due to long-term AED use. Although various studies have supported this association with increased risk in recent years, the length of this process has not been precisely defined and there is no clear consensus on bone density scanning, intervals of screening, and the subject of calcium and vitamin D supplementation. In this study, in accordance with the most current recommendations, our applications and data, including the detection of possible bone mineralization disorders, treatment methods, and recommendations to prevent bone mineralization disorders, were evaluated in epilepsy patients who were followed up at our outpatient clinic. It was aimed to draw attention to the significance of management of bone metabolism carried out with appropriate protocols. Epilepsy patients were followed up at the Antalya Training and Research Hospital Department of Neurology, Epilepsy Outpatient Clinic who were at high risk for osteoporosis (use of valproic acid [VPA] and enzyme-inducing drugs, using any AED for over 5 years, and postmenopausal women) and were evaluated using a screening protocol. According to this protocol, a total of 190 patients suspected of osteoporosis risk were retrospectively evaluated. Four patients were excluded from the study due to secondary osteoporosis. Of the 186 patients who were included in the study, 97 (52.2%) were women and 89 (47.8%) were men. Prevalence of low bone mineral density (BMD) was 42%, in which osteoporosis was detected in 11.8% and osteopenia in 30.6% of the patients. Osteoporosis rate was higher at the young age group (18-45) and this difference was statistically significant (p=0.018). There was no significant difference between male and female sexes according to osteoporosis and osteopenia rates. Patients receiving polytherapy had higher osteoporosis rate and lower BMD compared to patients receiving monotherapy. Comparison of separate drug groups according to osteoporosis rate revealed that osteoporosis rate was highest in patient groups using VPA+ carbamazepine (CBZ) (29.4%) and VPA polytherapy (19.4%). Total of osteopenia and osteoporosis, or low BMD, was highest in VPA polytherapy (VPA+ non-enzyme-inducing AED [NEID]) and CBZ polytherapy (CBZ+NEID) groups, with rates of 58.3% and 55.1%, respectively. In addition, there was no significant difference between drug groups according to bone metabolism markers, vitamin D levels, and osteopenia-osteoporosis rates. Assuming bone health will be affected at an early age in epilepsy patients, providing lifestyle and diet recommendations, avoiding polytherapy including VPA and CBZ when possible, and evaluating bone metabolism at regular intervals are actions that should be applied in routine practice.

Clinical Neuroscience

Association of cardiovascular risk factors and Parkinson’s disease - case-control study in South East Hungary


Aims - Parkinson’s disease (PD) has the second highest incidence among neurodegenerative diseases in the world population. The study aimed to investigate the presence of some cardiovascular risk factors - dyslipidemia, diabetes, and hypertension - in PD patients and to compare their risk with non-PD population in South East Hungary. Methods - A case-control study was conducted at the Department of Neurology, University of Szeged, Hungary. The study included 1299 subjects out of which 620 patients were identified as cases of diagnosed PD and 679 as controls. Logistic regression analyses were conducted to reveal the association of vascular risk factors with PD. Results - In the univariate analysis, diabetes mellitus was positively associated with PD, while dyslipidemia showed negative association to it in the total population, and no significant associations were found between hypertension and PD. The multivariate logistic regression models showed that the odds of diabetes mellitus was higher (OR=2.86), while the odds of dyslipidemia was lower (OR=0.58) among PD patients than in the control group. Hypertension showed a different pattern by gender: the odds of registered hypertension was significantly lower in female PD patients (OR=0.68), whereas the result was not significant in males. Conclusions - This is the first study that provides a comprehensive view of the cardiovascular risk factors in PD patients in Hungary and shows considerable relationship between diabetes mellitus and PD.


[Evaluation of quality of life following treatment with calcitonin nasal spray in patients with osteoporosis: preliminary results of the MERLIN study]


[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.]


[Bone metabolism and body mass index in postmenopausal women]

TÁRCZY Csaba, TOLDY Erzsébet, SZERB János, VARGA László

[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.]


[Bone mineral density and diabetes mellitus - First results]


[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.]