LAM KID

[Alterations in bone metabolism associated with gastrointestinal diseases]

LŐRINCZY Katalin1, LAKATOS Péter László2, MIHELLER Pál1, RÁCZ Károly1

MARCH 20, 2012

LAM KID - 2012;2(01)

[Osteoporosis is commonly associated with certain gastrointestinal diseases. Osteoporosis occurs most often in patients with coeliac disease, inflammatory bowel disease, chronic liver disease and following gastric surgery. Prevention, diagnosis and therapy are based on the experiences with elderly and postmenopausal patients with osteoporosis. In this review, we summarise the clinical data regarding bone loss associated with gastrointestinal diseases.]

AFFILIATIONS

  1. Semmelweis Egyetem, Általános Orvostudományi Kar, II. Sz. Belgyógyászati Klinika
  2. Semmelweis Egyetem, Általános Orvostudományi Kar, I. Sz. Belgyógyászati Klinika

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[The largest group of the patients with osteoporosis is postmenopausal women characterized by a state of menopausal hormone deficiency which is results in accelerated bone loss. This increased bone resorption significantly elevates the risk of bone fractures including the most common type, i.e. vertebral fractures. In addition to the increased risk of fractures, estrogen deficiency affects other organs, thus, increasing the incidence of cardiovascular diseases, cancers, mood disorders and the symptoms of menopausal syndrome in women after menopause. In postmenopausal osteoporosis, the primary objective is to maintain the existing bone mass, a priority for the prevention and treatment of bone fractures. Hormone deficiency may be prevented by the administration of estrogen but the treatment may have adverse effects such as increased risk of endometrial cancer. An etiological therapy is desirable where the compound used for treatment exerts effects similar to that of estrogen to prevent postmenopausal bone loss as well as reduces the risk of cardiovascular disease without the stimulation of reproductive tissues.]

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[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, unilateral-horizontal 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.]

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[BACKGROUND - A number of international data demonstrate the relationship between cardiovascular disease and bone density, osteoporosis and osteopenia. It is possible that bone formation/remodeling and vascular calcification are influenced by common pathogenetic factors (adipocytokines, inflammatory processes). Our aim was to assess this relationship among Hungarian patients. PATIENTS AND METHODS - We examined 82 patients (49 men and 33 women). The patients underwent a DEXA measurement and fasting blood sampling with full metabolic profiling within one month following an elective coronarography. Coronary state was characterised by the Gensini-score. RESULTS - Femur neck T-score values showed significant decreases in the CHD+ group (patients having at least one significant coronary stenosis), compared with the CHD- group (patients with no history of significant coronary stenosis) (-0.22 vs. -0.85, p<0.05) when the two genders were examined together. In women, lumbar BMD showed a significant positive correlation (r=+0.37, p=0.03), and the levels of adiponectin and HDL-cholesterol showed significant negative correlations (r=-0.311, p=0.04, és r=-0.38, p=0.03) with the Gensini-score. Neither the HOMA-index that characterises insulin resistance, nor the majority of conventional lipid and lipoprotein risk factors showed any association with the severity of coronary heart disease. CONCLUSION - On the basis of our results, the relationships between femur and lumbar regions and coronary heart disease are opposite in nature, which is probably explained by the different regulatory mechanisms in these two regions. Adiponectin may have an important role in the regulation of this relationship, which is independent of insulin resistance.]

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