LAM KID

[The importance of balneotherapy in osteology]

BENDER Tamás, KULISCH Ágota, KOVÁCS Csaba, HORVÁTH Katalin, GYARMATI Noémi, TEFNER Ildikó

DECEMBER 10, 2012

LAM KID - 2012;2(04)

[The authors overview the role of hydro-and balneotherapy in osteology. AsHungary is very rich in thermal-mineralwater, this kind of therapy has a greatimportance in the rehabilitation of locomo-tor diseases. In the past years, an increasingnumber of data have been published aboutthe immunomodulatory, metabolic andanalgesic role of hydro- and balneothera-py. Although balneotherapy’s mechanismof action has not been clarified yet, a num-ber of reviews and metaanalyses havefound that hydro- and balneotherapy havea beneficial effect on locomotor diseases.The majority of these articles - many ofthem written by Hungarian authors - dis-cusses the treatment of arthrosis. Further-more, an increasing amount of data isavailable on calcium supplementation withmineral water. In this paper, we discuss therole of hydro- and balneotherapy in thetherapy of osteological diseases, on thebasis of the available evidence. ]

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LAKATOS Péter, TÓTH Emese, LANG Zsolt, NAGY Bence, SZEKERES László, TAKÁCS István

[INTRODUCTION - Osteoporosis is defined as a loss of bone tissue and bone mass that leads to a compromised trength and quality of bones and thus to an increased risk of fractures. In many women, menopausal hormonal changes are associated with an increased bone loss. This population has postmenopausal osteoporosis. The essence of osteporosis treatment is the adequate calcium and vitamin D supplementation, which, if needed, might be combined with drug therapy to inhibit the process of bone loss. METHODS - We assessed the adherence to therapy of Hungarian patients and its effect on the risk of bone fractures, using data recorded by the National Health Insurance Fund Administration between 2004 and 2010 (n=223068, mean age: 69.9 years). We performed a statistical analyses of the available data. Medication possession ratio (MPR) for each treatment and the ratio of patients receiving continuous treatment in the study period (for 12, 18 and 24 months) were estimated. Medication persistence was investigated using Kaplan-Meier survival analysis. A multivariate Cox proportional hazard model was used to determine the factors influencing the risk of fracture. RESULTS, CONCLUSION - The results of our study show that medication adherence to treatment is low among Hungarian patients [mean MPR: 57.9%; 95% CI (57.7%- 58.0%) and persistence rate: 32.4%; 95% CI (32.2%-32.6%) in the first year]. These parameters are substantially influenced by the administration route and the frequency of treatments [mean MPR ranged 41.5%- 100% and persistence rates ranged 18.8%- 100% in the first year, differences between subgroups were significant (p<0,05)]. Our compliance as well as persistance studies showed that parenteral administration had more beneficial effects. Confirming our preliminary hypotheses, the improvement of patient compliance significantly reduced fracture risk (good compliance was defined as MPR>80%, which was associated with RR: 0.57, p<0.05 for fracture risk). Further improvement might be achieved by parenteral administration [RR for fracture risk 0.60 compared with non-compliant patients and 0.44 compared with compliant subgroups treated with oral and parenteral medications (p<0.05)].]

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[INTRODUCTION - Metastatic bone disease is frequently associated with breast and prostate cancer. Bisphosphonate treatment of bone metastases is palliative: its primary goal is to relieve pain, while it's also important to decrease the risk of bone fractures, prolong survival and maintain physical activity of the patients. Pain is the most common symptom of bone metastases. PATIENTS AND METHODS - In total 845 patients were enrolled in our open, multicenter, prospective, observational study, the first of its kind in Hungary. The agent tested was zoledronic acid (Zometa®). Duration of the study was 20 months and its primary goal was to assess the correlation between pain and quality of life during the treatment of patients with bone metastases from breast or prostate carcinoma. RESULTS - During the 18 months of the study, the average intensity of pain, measured on the visual analog scale showed a 42% reduction (p<0.0001). By the end of the 18. month, the ratio of patients free of symptoms has increased by 15% and the number of patients with substantial complaints has decreased by 73%. CONCLUSION - Our study supports the observation published in the international literature that in patients with bone metastases from breast and prostate cancer, zoledronic acid treatment is beneficial for reducing pain and thus for improving quality of life.]

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[Efficient, new medicines as well as recent scientific results have substantially changed the options and daily practice of osteoporosis treatment. Besides the indicated duration of therapies, their indication has also changed in several key points, and the range of possibilities for switching therapies have expanded. Despite the availability of a steadily increasing number of data, large-scale studies do not always help making therapeutic decisions, so we have to rely on professional protocols and our own experience, as well as on logical thinking. Moreover, we also have to observe financial regulations. This summary is intended to serve as a guideline for the most important decision situations from the initiation of therapy until its cessation.]

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BENDER Tamás, KULISCH Ágota, KOVÁCS Csaba, HORVÁTH Katalin, GYARMATI Noémi, TEFNER Ildikó

[The authors overview the role of hydroand balneotherapy in osteology. As Hungary is very rich in thermal-mineral water, this kind of therapy has a great importance in the rehabilitation of locomotor diseases. In the past years, an increasing number of data have been published about the immunomodulatory, metabolic and analgesic role of hydro- and balneotherapy. Although balneotherapy’s mechanism of action has not been clarified yet, a number of reviews and metaanalyses have found that hydro- and balneotherapy have a beneficial effect on locomotor diseases. The majority of these articles - many of them written by Hungarian authors - discusses the treatment of arthrosis. Furthermore, an increasing amount of data is available on calcium supplementation with mineral water. In this paper, we discuss the role of hydro- and balneotherapy in the therapy of osteological diseases, on the basis of the available evidence.]

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[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

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