[The concept of adherence and its significance in osteoporosis]


JULY 20, 2011

LAM KID - 2011;1(01)

[Today, in relation to the economical aspects of medical therapies, the patterns of patients’ drug taking have come into focus. One of the important indicators is adherence, which consists of four different concepts concerning faithfulness to therapy: acceptance, concordance, persistance and compliance. In chronic diesases, medical therapy without a certain degree of adherence is no more useful than no therapy at all. A number of international clinical studies show that in osteoporosis, the therapy can only lead to a decrease in the number of fracture in case of sufficient adherence.]



Further articles in this publication


[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.]


[Calcium supplementation and the risk of cardiovascular disease - Real apprehension or picking the spin?]


[Some data shows that calcium supplementation, a basic intervention for treating osteoporosis in postmenopausal women, may increase the risk of atherosclerotic vascular disease. Coronary artery calcified plaque is a marker for atheromatous plaque burden and predicts future risk of cardiovascular events. However, the deposition of calcium into the vascular wall is due to an active mechanism, involving such genes and proteins which play role in bone metabolism. In this work the data about the cardiovascular side effect of calcium supplementation are reviewed. Also, I demonstrate studies with the conclusions that calcium supplements with or without vitamin D do not increase the risk of cardiovascular events, especially that of myocardial infarction.]


[Vertebroplasty and kyphoplasty in the clinical practice]


[Osteoporosis affects about 600 thousand women and 300 thousand men in Hungary. The fractures give the illness its significance, among them 30-40 thousand vertebral fractures occur annually. One fifth of the patients suffering from vertebral compression fracture (VCF) sustaines an other VCF within a year. The intense pain can not always be controlled under conservative care and an efficient and fast intervention is needed to restore the quality of life of the patients. The cement augmentation (vertebroplasty or kyphoplasty) may help in days. The authors wish to present for the colleagues the details of indication, technical questions of the procedures and their complications based upon the data of numerous operated cases. They emphasize that osteoporotic patients sustained a VCF need complex care and nurture. They also mention that the danger of fracture of a neighbouring vertebra is increased due to the rigidity of the cemented one.]


[Gout therapeutics: new drugs for an old disease]



[New approaches to the treatment of osteoporosis]


[Osteoporosis is a significant health care problem, and its treatment is of major interest. Despite of the wide spectrum of therapeutical modalities, the effective cure for all forms of this condition has not yet been developed. For this reason, the focus is on the development of new pharmacological approaches. The RANK/RANKL/OPG system discovered one and a half decades ago provides a tool for the neutralization of the osteoclast-stimulating RANKL by the use of monoclonal antibodies. Catepsin-K inhibitors offer another pathway for the inhibition of bone degradation. Anti-sclerostin and anti-Dkk-1 antibodies may stimulate bone formation by the release of Wnt signal transduction system. Other administration methods for PTH analogs, new generations of selective estrogen receptor modulators and antibodies against vitronectin receptors as well as potential new drug targets will enable us to fight bone loss more efficiently.]

All articles in the issue

Related contents

LAM Extra for General Practicioners


SOMOGYI Péter, GAÁL János, SPEER Gábor

[The significance of osteoporosis is well known, however, the number of patients receiving treatment is only a small fraction of ideal. Besides, the fact that the population is uninformed, the difficulties of making an appointment with a specialist and the unsatisfactory communication of the doctor all play a part in the fact that a high proportion of patients receiving mediation give up treatment prematurely. The Inter - na tional Osteoporosis Foundation supports the establishment of public patient clubs with regular training courses and grants and by doing so it also acknowledges their importance in the prevention and treatment of osteoporosis. The publication, based on the questionnaire filled in by the members of the first Hungarian patient club, the Hungarian Society of Osteopo - rosis Patients in district 3rd, introduces the Hungarian results and points out how important patient clubs are in increasing the success of treatment and it also draws attention to the necessity of establishing further patient clubs in the future.]

Lege Artis Medicinae

[Localised and generalised osteoporosis in autoimmune polyarthritis]


[In this article, recent data are summarised on the osteoporosis occurring in autoimmune polyarthritis. Involvement of the bone in patients with autoimmune diseases occurs in two forms: localised (around inflamed joints) and generalised. Paraarticular osteoporosis has been known for a long time but new methods of bone measurements highlight the rate and cause of bone loss. Generalised skeletal changes in rheumatoid arthritis, in systemic lupus erythematosus and juvenile chronic arthritis have been proved by epidemiological studies. At present, there is no evidence supporting generalised bone loss in other chronic inflammatory diseases. Despite the fact that clinically apparent osteoporosis in autoimmune diseases is associated with severe health impairment and reduced survival rates, osteoporosis is still underdiagnosed and prophylactic strategies have yet to be found for this group of patients. These facts indicate calling specialists’ attention to the importance of osteoporosis in inflammatory diseases.]

LAM Extra for General Practicioners


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 Ameri - can guidelines as an anti-osteoporotic me - dication. 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 doubleblind, 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.]


[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.]


[A magnézium és csonthatásai]


[Since 1932, a number of animal studies have demonstrated the correlation of hypomagnesaemia and hypocalcaemia, and the variety of skeletal abnormalities resulting from low magnesium (Mg) intake. Several studies have shown that patients with osteoporosis have a decreased serum magnesium level, which is related to decreased bone mineral content and increased bone fragility. Mg has multiple physiological effects, thus it is not surprising that dozens of hypomagnesaemia-related diseases and symptoms have been reported. Adequate Mg concentration is necessary for the secretion of parathormone and its effect on target organs, activation of vitamin D in the kidney, the maintenance of calcium homeostasis, bone mineralisation and regeneration. Mild hypomagnesaemia is associated with general, atypical symptoms, whereas severe Mg deficiency is a life-threatening condition. Its concentration should be measured in serum and urine. Mg metabolism is determined by its absorption from the intestines and reabsorption in the kidneys. Recently revealed details of these processes give some insights into the mechanisms underlying a number of Mg deficient conditions related to genetic or medical reasons. Mg supplementation may be indicated for patient populations with the highest risk of hypomagnesaemia. For supplementation, the recommended total Mg dose is 350 mg, first in higher doses, several times per day for a longer period, complemented with Ca and K supplementation. Overdosing can only occur in patients with impaired renal function, which necessitates careful monitoring. Adequate Mg supplementation is an inexpensive, safe and effective preventive and therapeutic option for many diseases.]