LAM KID

[Estimating the risk of new fracture - Which factors confer an increased fracture risk?]

TAKÁCS István

SEPTEMBER 20, 2012

LAM KID - 2012;2(03)

[This risk of osteoporosis-related fractures is influenced by a number of well-known risk factors. Among the approaches to quantify bone fracture risk, the FRAX questionnaire is the most widespread in everyday practice. However, this method only provides a probability percentage for the physician, and it is unable to specify or weigh the factors that may have a particular importance in evaluating individual fracture risk, or choosing the appropriate therapy in patients with previous osteoporotic fracture. This summary aims to provide practical help for the evaluation of individual fracture risk in patients who have had bone fractures.]

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LAM KID

[Efficiency of osteoporosis treatment in Hungary - An analysis of the Hungarian National Insurance Company’s data]

LAKATOS Péter, TÓTH Emese, SZEKERES László, POÓR Gyula, HÉJJ Gábor, TAKÁCS István

[The treatment of osteoporosis and its consequences place a significant burden on the health care of developed countries. Modern therapeutical approaches are able to efficiently decrease the risk of osteoporotic bone fractures. However, we do not know whether the interventions introduced in the past 15 years have significantly reduced the number of osteoporotic fractures in real life, and if they have, how cost-effective this effect was. To answer these questions, we have analysed data of the Hungarian National Insurance Company collected between 2004-2010. During these 7 years, the number of bone fractures among patients treated for osteoporosis continuously decreased. This was also observed in the incidence of hip fractures. Interestingly, the mortality of osteoporotic patients was significantly lower than that of the same age group in the average population. Besides the efficient treatment of osteoporosis, this finding is also due to the outstanding general care provided by the specialised osteoporosis centers of the country. As a consequence of the reduction in fractures, 3.4 billion HUF was saved per year by the insurance company, which is approximately equal to the 3.5 billion HUF spent on the reimbursement of medicines used for the treatment of osteoporosis, which means that the investments show a return. The calculation of the quality- adjusted life years, which is the internationally accepted method of the WHO for the study of cost-effectiveness, shows that the above results were achieved in a remarkably cost-efficient way. At the same time, it is noteworthy and calls for caution that the decrease in reimbursement by the insurance company in 2007 resulted in a 51% drop in the number of patients receiving treatment, which radically reduced the observed efficiency.]

LAM KID

[Vitamin D deficiency and infections]

LUDWIG Endre, KRIVÁN Gergely

[Studies performed in the past few years have confirmed that vitamin D is essential for maintaining the optimal immune defense, and its immunomodulatory effect has a role in the defense against infections as well. A lot of data suggest that low serum 25-(OH)-D concentration is associated with an increased frequency of certain infections and it adversely influences pathological processes. Data on this adverse effect are available mostly in case of Mycobacterium tuberculosis, respiratory viral infections in general, HIV, hepatitis C and sepsis. The outcomes of severe infections are usually influenced by a number of factors and it seems that vitamin D deficiency is one of those factors that shift the process towards an unfavourable outcome. Further studies should evaluate the significance of this role and the influence of vitamin D supplementation on pathological processes.]

LAM KID

[Association between osteoporosis and nutrition during the history of human evolution]

KISS Zoltán, KISS István, JÓZSA László

[From the Palaeolithic age to the twentieth century, nutritional habits as well as the quality and composition of nutritients changed dramatically. The protein-based calorie intake of former Homo species had been replaced by a carbohydrate-based nutrition since the Neolithic revolution (the transition to agriculture). The start of food production also changed the range of nutrients and the start of sedentary lifestyle. At the same time, approximately five thousand years ago osteoporosis appeared. In this paper, the authors give a short review of eating habits and foods of early Homo species in the Palaeolithic Age and of Homo sapiens in Neolithic Age, Antiquity, Middle Ages and Modern Age, and discuss the possible relationship of nutrition and osteoporosis.]

LAM KID

[The effect of nonsteroidal anti-inflammatory drugs on articular cartilage]

GÁTI Tamás, JUHÁSZ István, ROJKOVICH Bernadette

[In developed countries, the treatment of osteoarthritis costs up to 1-2% of the GNP. The poor hygroscopy of hyaline cartilage and of glycosaminoglycan (GAG) molecules that are components of proteoglycans plays a key role in the development of the disease. Age-related osteoarthritis mostly affects the weight-bearing joints of the lower extremities, the hips and knees, and - more frequently than the former ones - the small joints of the hands, causing chronic pain and disability. Nonsteroidal anti-inflammatory drugs (NSAIDs) used for the treatment of osteoarthritis-related pain influence not only pain but also cartilage metabolism, and - among others - GAG molecules. NSAIDs diminish the biosynthesis of prostaglandins (PG) that have a role in inflammatory processes, and influence oxygen free radicals, the levels of interleukins (ILs) and the function of metalloproteinases. The ideal NSAID for the joints stimulates cartilage formation, reduces cartilage resorption, and the level of katabolic cytokines. Aceclofenac was found to have the most beneficial effect on multiple aspects of cartilage metabolism.]

LAM KID

[Why twins are different? - About twin research]

ERDŐS Edina, BÁLINT Bálint László

[Twin studies had an important role in the development of medicine. In this review, we present the available data of Hungarian twin studies and the number of twins in Hungary on the basis of statistical data. Comparing these data with international ones and taking into account probable prevalences, we aim to provide an estimation of the number of twins in Hungary who have cancerous diseases. Our estimation suggests that creation of a national database for such twins is feasible and could provide a great help for a better understanding of the causes and mechanisms of cancerous diseases.]

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

BALOGH Ádám, BHATTOA Harjit Pál

[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.]

LAM KID

[Efficiency of osteoporosis treatment in Hungary - An analysis of the Hungarian National Insurance Company’s data]

LAKATOS Péter, TÓTH Emese, SZEKERES László, POÓR Gyula, HÉJJ Gábor, TAKÁCS István

[The treatment of osteoporosis and its consequences place a significant burden on the health care of developed countries. Modern therapeutical approaches are able to efficiently decrease the risk of osteoporotic bone fractures. However, we do not know whether the interventions introduced in the past 15 years have significantly reduced the number of osteoporotic fractures in real life, and if they have, how cost-effective this effect was. To answer these questions, we have analysed data of the Hungarian National Insurance Company collected between 2004-2010. During these 7 years, the number of bone fractures among patients treated for osteoporosis continuously decreased. This was also observed in the incidence of hip fractures. Interestingly, the mortality of osteoporotic patients was significantly lower than that of the same age group in the average population. Besides the efficient treatment of osteoporosis, this finding is also due to the outstanding general care provided by the specialised osteoporosis centers of the country. As a consequence of the reduction in fractures, 3.4 billion HUF was saved per year by the insurance company, which is approximately equal to the 3.5 billion HUF spent on the reimbursement of medicines used for the treatment of osteoporosis, which means that the investments show a return. The calculation of the quality- adjusted life years, which is the internationally accepted method of the WHO for the study of cost-effectiveness, shows that the above results were achieved in a remarkably cost-efficient way. At the same time, it is noteworthy and calls for caution that the decrease in reimbursement by the insurance company in 2007 resulted in a 51% drop in the number of patients receiving treatment, which radically reduced the observed efficiency.]

Ca&Bone

[Denosumab - pharmacokinetic and clinical evidences]

MÉSZÁROS SZILVIA

[Denosumab is a fully human monoclonal antibody to RANKL modifying bone resorption in a rapid, sustained and reversible way. In postmenopausal women with low bone mineral density, denosumab 60 mg every 6 months increased mineral density, and reduced bone turnover. In postmenopausal women, it reduced the risk of vertebral, hip, and non-vertebral fractures. Increase in body mass index and reduction in bone turnover was more pronounced with denosumab than with alendronate. In patients who were switched from alendronate to denosumab, positive effects on bone were more pronounced than in those continuing alendronate. Denosumab was safe and well tolerated, and it holds the promise of becoming an efficacious therapy for postmenopausal osteoporosis.]

Clinical Neuroscience

[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, 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.]

Ca&Bone

[Effect of cigarette smoking on bone density]

MÉSZÁROS SZILVIA, FERENCZ VIKTÓRIA, DELI Mónika, BORS Katalin, HORVÁTH CSABA

[INTRODUCTION - Smoking is associated with a decreased bone mass and increased risk of osteoporotic fractures.The aim of this study was to investigate the impact of current tobacco smoking to bone mineral density (BMD) in Hungarian females. PATIENTS AND METHODS - We measured BMD in 43 (25-72 yrs) smoker and 43 age- and BMI-matched non-smoker women by dual X-ray absorptiometry (Prodigy, GE Lunar) at the lumbar spine and proximal femur and by single photon absorptiometry at the radius midshaft of the non-dominant side (NK 364, Gamma). RESULTS - Osteoporosis (T-score at any measured site below - 2.5) was found to be more common among smokers compared to non smokers (63.6% vs 36.4%, χ2-test p=0.009). Among premenopausal women no difference was found in BMD between the two groups, whereas postmenopausal smoker women tended to have a lower BMD value compared to those who didn’t smoke. In postmenopausal women a decrease of borderline significance was found in lumbar BMD (0.977 vs 1.04; p=0.06). CONCLUSION - Our observation suggests that there is only a slight decrease in bone mass due to smoking, however, added to menopausal bone loss this effect can be a significant contributor to the increased fracture risk of involutional age.]