[Bone metabolism and the 10-year probability of hip fracture and a major osteoporotic fracture using the country specific FRAX algorithm in men with type 2 diabetes mellitus]


FEBRUARY 20, 2014

LAM KID - 2014;4(04)

[Objectives: Was to evaluate 10-year probability of hip fracture and a major osteoporotic fracture using the FRAX algorithm, vitamin D status, bone mineral density (BMD) and biochemical markers of bone turnover in men over 50 years of age with type 2 diabetes (T2DM). We compared FRAX-predicted 10-year fracture probability, levels of 25-hydroxyvitamin D (25-OH-D), markers of bone turnover and bone mineral density at L1-L4 (LS) and femur neck (FN) in 68 men with T2DM with an age- and gender-matched group (n=68). The mean (range) age of the T2DM group was 61.4 (51-78) years. The prevalence of hypovitaminosis D (25-OH-D <75 nmol/L) was 59%. The mean (range) FRAX hip fracture and FRAX major osteoporotic fracture was 0.7 (0-2.8)% and 3.2 (0-8.5)%, respectively. BMD at the FN (0.974 gm/cm2 vs. 0.915 gm/cm2; p = 0.008) and LS (1.221 gm/cm2 vs. 1.068 gm/cm2; p < 0.001) was significantly higher in the T2DM cohort as compared to the healthy age matched males. 25-OH-vitamin D (67.7 nmol/L vs.79.8 nmol/L; p < 0.001), crosslaps (0.19 μg/L vs. 0.24 μg/L; p = 0.004) and osteocalcin (13.3 μg/L vs. 15.7 μg/L; p = 0.004) were significantly lower in the T2DM group. There was no difference in FRAX-related fracture probability between the two groups. The increased BMD in T2DM and the lack of inclusion of T2DM as a risk factor in the FRAX algorithm are probable explanations for the discordance between literature-observed and FRAX-related fracture probabilities.]


  1. Debreceni Egyetem, Általános Orvostudományi Kar, Reumatológiai Tanszék
  2. Debreceni Egyetem, Általános Orvostudományi Kar, Laboratóriumi Medicina Intézet
  3. Regionális Osteoporosis Centrum, Szülészeti és Nôgyógyászati Klinika
  4. Debreceni Egyetem, Általános Orvostudományi Kar, Belgyógyászati Intézet



Further articles in this publication


[The impact of vitamin D in infertility and the role in pregnancy and in nursing period]


[Various medical associations issue different recommendations for the prevention and treatment of vitamin D deficiency. These significant differences are partly explained by the different definition of normal vitamin D level and the use of completely different mathematical models to predict the increase in vitamin D level as a response to therapy. According to the Institute of Medicine, the target vitamin D level is 20 ng/ml, whereas the Endocrine Society recommends 30 ng/m as the minimum target value. These differences show that the two Society have different views on the risk of adverse effects. Screening, however, is not recommended by either society. In this review I summarize the role of the vitamin D supplementation in the prevention of infertility. Also, I suggest the protective effect of the vitamin D during the pregnancy. In my opinion screening program against D hypovitaminosis should be performed in case of infertility and in pregnancy, because data show a protective role of vitamin D against many disease of newborn. ]


[Comparison of different schemes of vitamin D3 therapy]

SZILI Balázs, BAKOS Bence, KATÓ Karina, KIRSCHNER Gyöngyi, TOBIÁS Bálint, BALLA Bernadett, HORVÁTH Péter

[Vitamin D plays an important role in several pathways in humans. Its relation with several diseases has been previously de­scribed. Vitamin D deficiency affects al­most the full population on temperate zone at the end of the winter. Recommendations on vitamin D supplementation are inconsistent and there are only a few data about the efficacy of cholecalcipherol given not in daily manner. In the present paper, we examine the different administration mo­dalities, and their efficacy in increasing serum vitamin D levels. High doses administered rarely appear to be equally efficient and safe compared to low doses provided frequently.]


[Challenges of quality insurance in new generation of sequencing methods]

KÖVESDI Andrea, KÓSA János Pál


[Experiences from the dissection room. Quantitative and qualitative study among Hungarian medical students]


[BACKGROUND - The anatomy and pathology are the most outstanding field of the medical curriculum. These subjects mean the first practical experiences of dissection. The international literatures results shows that experience of dissection are important stages of becoming physician, but not always problemless. METHODS - Quantative (n=733) and qualitative (n=45) exploratory research among Hungarian medical students. We tried to present the effects and experiences of dissection pratcise using both analytical methods. Validity of the research was greatly improved by using the two methods. RESULTS - 50% of medical students reported that they were affected by dissection practice. The female students and those in clinical training (III-VI.years) reported about negative effects significantly more frequently. The results of the qualitative survey verified that dissection practices have decisive effect during the training and coping with experiences was often difficult especially for females students. CONCLUSIONS - Our research confirmed the hypothesis of dissection experiences play outstanding role in becoming physician. The successful coping isn’t the repression or ignorance of emotion, but understanding and finding effective solutions strategies for the negative emotions of experiences. Managing these experiences are a crucial factor of latter wellbeing of physicians and decisive factor of doctors-patient relationship.]


[A prospective study of holiday weight gain]

BALLA Bernadett

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[Self-monitoring of blood glucose in type 2 diabetes]

POZSÁR Hajnalka, POZSÁR Csaba

[Self-monitoring of blood sugar levels is an essential element in the treatment of diabetes, it provides an insight to the success of treatment and self-management, the development of metabolic processes, and ensures the early recognition and treatment of significant blood sugar fluctuations. The aim of this study was to evaluate the habits of self-monitoring of sugar levels in patients with type 2 diabetes, and among them the frequency, recognition and treatment of hypo- and hyperglycemia. The research was conducted as a cross-sectional study in 2018 in the Health Centre in Subotica/Serbia. The sample included 107 patients diagnosed with type 2 diabetes. Data were collected through interviews with patients using a customized questionnaire, during the regular control examinations. The patients’ level of blood sugar in the capillary blood was measured by glucometer. The statistical package IBM-SPSS 20.0 and descriptive analytic methods were used for data analysis. The mean age of the sample was 63.7 ± 7.7 years. Two-thirds of them performed opportunistic self-monitoring mostly before breakfast. A large number of patients never recognized variations of blood glucose (in 65% hyperglycemia and in 51% hypoglycemia). However, a month before 81% of patients had hyper- and 31% hypoglycemic episodes respectively. 12% of patients did not take any action in such cases. It is recommended to emphasize again and again the importance and way of self-monitoring at each follow-up examination. The shortcomings identified in the study provide guidelines what to focus on when caring for diabetic patients.]


[New findings in the cortical bone biology and its role in bone fractures]


[The authors surveyed the already known factors responsible for the osteoporotic bone fragility. Then the results of using modern imaging techniques (micro-CT, high-resolution peripheral computed quantitative tomograph - HR-pQCT) and advanced computer analytic methods (finite element analysis, FEA) are presented. These data - beyond the already known fracture risk factors (age, risk of falling, bone mineral density - BMD, and fine structure damage of trabecular bone) are stressing the importance of the (micro)damage of cortical bone as a fracture risk factor, which has been still underrated. The cortical thickening and increased porosity - verified on various population samples - are increasing the risk of fractures in certain subgroups of subjects having identical BMD values, even among those, who are considered only osteopenic by the earlier classification based on BMD values. Backed with modern software batteries, the new imaging techniques are expected to enter clinical application in the near future. Pharmacologic agents with stronger cortical effect are already available and research is continuing to find new drugs to use in the management of osteoporotic patients of high fracture risk.]


[The role of alfacalcidol in the prevention of osteopenia following renal transplantation]


[AIM - The aim of this prospective study was the long-term evaluation of the effect of calcium and alfacalcidol treatment on calcium metabolism in patients with renal transplantation. METHODS - Patients were divided in two groups. Patients in Group 1 (n=159) received calcium substitution, while patients in Group 2 (n=81) were treated with alfacalcidol. Serum Ca, P, Mg, alkaline phosphatase (AP) and PTH levels were determined before and after transplantation regularly for three years. Femur neck and lumbar vertebral bone mineral densities (BMD) were measured at the same time after transplantation. RESULTS - After transplantation the mean serum calcium level significantly increased, while the mean serum phosphate level significantly decreased in both groups. After the operation the PTH levels decreased in both groups and it was found to be more pronounced in the alfacalcidol group.The majority of patients had osteopenia in the follow-up period. Between the third month and the third year after transplantation, BMD increased by 9.4% in Group1, and decreased by 4% in Group 2 at the lumbar spine. At 3 years the mean BMD value at the femoral neck was increased by 6.5% in Group 1, and by 6.7% in Group 2, compared to the 3-month values.The change in BMD was only significant at the lumbar spine, in Group 1 (p=0.019). During the follow-up period osteonecrosis was diagnosed in 6 patients in Group 1 and in 9 cases in Group 2. CONCLUSION - Alfacalcidol treatment decreased secondary hyperparathyroidism more rapidly and effectively, which was also indicated by the more pronounced decrease of serum PTH levels. During the 3 years follow-up period, BMD increased in both groups except for the lumbar spine in Group 2, however, the majority of the patients still had osteopenia.The study could not demonstrate a superiority of alfacalcidol over calcium supplementation in the prevention of posttransplantational osteopenia.]

Image challenge

What do you see on the feet of the diabetic patient?