Ca&Bone

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

BUDAY BARBARA1,2, IZSÓNÉ KATZ MELITTA1, NAGY ELVIRA1, PAPP ZSUZSA3, KORÁNYI LÁSZLÓ1

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.]

AFFILIATIONS

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

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Further articles in this publication

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.]

Ca&Bone

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HORVÁTH CSABA

Ca&Bone

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

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

[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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[Sacral insufficiency fractures]

FERENC Mária, PUHL Mária, VARGA Péter Pál

[BACKGROUND - The spontaneous osteoporotic fracture of the sacrum, known as a sacral insufficiency fracture (SIF) was first described as an unrecognized syndrome of the elderly by Laurie, in 1982. Numerous case histories and a few series of cases have been discussed in medical journals; however, none have been reported in Hungary. GOAL - To delineate the leading diagnostic steps in the recognition of SIF and review the therapeutic guidelines. CASE HISTORIES, METHODS - Between January 2009 and the first six months of 2010 11 cases of SIF were diagnosed at the National Center for Spinal Disorders. We examined the clinical aspects of the illness, the radiological modalities, the fracture markings, the pace of recovery and duration. RESULTS - The 11 patients were found to have various SIF predestining etiological factors and the following classic fractures - H-type, unilateral, horizontal, unilateralhorizontal and vertical as well as a bilateral pattern. In cases often not showing obvious clinical symptoms and in cases resulting in conventional radiological examinations of low sensitivity and specificity, we used mapping techniques in setting up the exact diagnosis. CONCLUSION - If we consider SIF from patient history and known risk factors, diagnostic procedure (primer original) may be shortened and a number of unnecessary tests (biopsy) may be avoided.]

Clinical Neuroscience

[Treatment of osteoporotic vertebral compression fracture with PMMA augmented pedicle screw fixation]

PADÁNYI Csaba, MISIK Ferenc, PAPP Zoltán, VITANOVICS Dusan, BALOGH Attila, VERES Róbert, LIPÓTH László, BANCZEROWSKI Péter

[Background - Over the last few decades many innovative operation technique were developed due to the increase of porotic vertebral fractures. These new techniques aim to reach the required stability of the vertebral column. In case of significant instability, spinal canal stenosis or neural compression, decompressive intervention may be necessary, which results in further weakening of the column of the spine, the minimal invasive percutan vertebroplasty is not an adequate method to reach the required stability, that is why insertion of complementary pedicular screws is needed. Considering the limited screw-fixing ability of the porotic bone structure, with this new technique we are able to reach the appropriate stability of cement-augmented pedicle screws by dosing cement carefully through the screws into the vertebral body. We used this technique in our Institute in case of 12 patients and followed up the required stability and the severity of complications. Methods - Fifteen vertebral compression fractures of 12 patients were treated in our Institute. Using the classification proposed by Genant et al. we found that the severity of the vertebral compression was grade 3 in case of 13, while grade 2 in case of two fractures. The average follow up time of the patients was 22 months (12-39), during this period X-ray, CT and clinical control examinations were taken. During the surgery the involved segments were localised by using X-ray and after the exploration the canulated screws were put through the pedicles of the spine and the vertebral body was filled through the transpedicular screws with bone cement. Depending on the grade of the spinal canal stenosis, we made the decompression, vertebroplasty or corpectomy of the fractured vertebral body, and the replacement of the body. Finally the concerned segments were fixed by titanium rods. Results - In all cases the stenosis of spinal canal was resolved and the bone cement injected into the corpus resulted in adequated stability of the spine. In case of six patients we observed cement extravasation without any clinical signs, and by one patient - as a serious complication - pulmonary embolism. Neurological progression or screw loosening were not detected during the follow up period. Part of the patients had residual disability after the surgery due to their older ages and the problem of their rehabilitation process. Conclusion - After the right consideration of indications, age, general health condition and the chance of successful rehabilitation, the technique appears to be safe for the patients. With the use of this surgical method, the stability of the spine can be improved compared to the preoperative condition, the spinal canal stenosis can be solved and the neural structures can be decompressed. The severity of complications can be reduced by a precise surgical technique and the careful use of the injected cement. The indication of the surgical method needs to be considered in the light of the expected outcome and the rehabilitation.]

Hypertension and nephrology

[Prognostic role of arterial stiffness in IgA nephropathy]

SÁGI Balázs, KÉSŐI István, VAS Tibor, CSIKY Botond, KOVÁCS Tibor, NAGY Judit

[Background: Arterial stiffness has a prognostic role in chronic cardiovascular diseases. Pulse wave velocity (PWV) determined by the carotid-femoral pulse detection is accepted as a gold standard method. Further diagnostic procedures are in use to assess the arterial stiffness including the finger photoplethysmography. The prognostic role of this method is limited in chronic renal diseases. The goal of our investigation was to determine the prognostic significance of the stiffness index (SIDVP) measured by the photoplethysmographic method in IgA nephropathy. Patients and methods: One hundred and three histologically proved IgA nephropathy patients with chronic kidney disease stage 1-4 were investigated (67 male, 36 female, 45 ± 11 years) and followed for an average 65 (6-107) months. The stiffness index was determined by the volume alteration of the digital artery during the cardiac cycle (Pulse Trace system, Micro Medical, Gilingham, Kent, UK). The primary combined end point was total mortality, major cardiovascular events (stroke, myocardial infarction or cardiovascular procedure, for example revascularisation) plus achieving end stage renal disease. The secondary end points were cardiovascular and renal end points alone. Results: The patients with increased stiffness index (> 10 m/s) had significantly more combined primary end point events (10/60 vs. 19/43, P = 0.015). In case of the secondary end points the renal end points were significantly more frequent in patients with higher stiffness index. Stiffness index has also proved to be an independent predictor on survival from other cardiovascular risk factors (age, hypertension, diabetes, obesity, lipid disturbances and decrease of renal function) using the Cox regression model in IgA nephropathy. Every 1 m/s increase in stiffness index resulted a 17% gain in the occurrence of the combined primary end point. Conclusions: Stiffness index determined by finger photoplethysmography is an eligible parameter to assess the prognosis in IgA nephropathy. Increased stiffness index in IgA nephropathy seems to be a good prognostic tool for identification of higher risk patients.]

LAM KID

[Does the vitamin K2 play a role in the prevention or treatment of osteoporosis? - a systematic review]

SZILI Balázs, TAKÁCS István

[The physiological role of vitamin K in blood clotting and bone metabolism is well known. A number of articles have been published recently about the effects of vitamin K2 on bone. Non-professional media promotes vitamin K2 as a potent tool for the prevention and treatment of osteoporosis. Nevertheless vitamin K2 is not included in either Hungarian, or European, or Ameri­can guidelines as an anti-osteoporotic me­dication. Our aim was to review the literature and provide a systematic review on the role of vitamin K2 in the prevention and treatment of osteoporosis. We have searched articles on http://pubmed.org available on 14. February 2014. Our search terms were: („vitamin K2” OR „menaquinon” OR „MK-7” OR „menantrenon”) AND „osteoporosis”. We have only reviewed original articles that discussed the relationship of vitamin K2 and osteoporosis, and had at least the abstract available in English. Of the 155 articles found, 135 had a relevant topic, 126 had at least the abstract in English. Of these, 73 were original articles, including 44 human studies (8 double-blind, controlled, 26 open-label, controlled, 5 observational and 5 cross-sectional studies) and 29 animal or in vitro models. In the non-Asian population there is no evidence for fracture-preventing or BMD-increasing effect of vitamin K2 treatment. The currently recommended anti-osteoporotic medications are significantly more efficient compared with the BMD increase observed in some Asian studies. ]

Lege Artis Medicinae

[CARDIOVASCULAR EFFECTS OF MENOPAUSAL HORMONE REPLACEMENT THERAPY]

PARAGH György, HARANGI Mariann

[The incidence of coronary heart disease in women rises sharply in the years following menopause. Hormone replacement therapy involves the administration of oestrogen, which provides postmenopausal symptom relief and reverses the changes in calcium and lipid metabolism. Moreover, oestrogen is also postulated to engage multiple mechanisms that defend against hypertension. Early observations suggested that postmenopausal women treated with hormone replacement therapy have significantly reduced cardiovascular risk. However, the results of primary and secondary prevention randomized clinical trials confirmed an increased cardiovascular risk rather than a beneficial effect of hormone replacement therapy in highrisk women. Controversy between results of observational and randomized clinical trials may partly be due to the unexplored genetic background. The authors summarize the effects of oestrogen on lipids, inflammation, haemostatic parameters, blood pressure and vascular wall. Genetic factors that modulate the effect of oestrogen as well as current recommendations on hormone replacement therapy after menopause in high risk women are also presented.]