Lege Artis Medicinae

[Evaluation of bone mineral density in renal form of primary hyperparathyroidism]


FEBRUARY 20, 2003

Lege Artis Medicinae - 2003;13(02)

[INTRODUCTION - The most frequent manifestations of primary hyperparathyroidism are renal stones or calcipenic osteopathy. The aim of authors was to examine how bones are affected (change of bone mineral density and frequency of fractures) in the renal form of primary hyperparathyroidism. METHODS - Mean age of the patients was 57 years (26 -81 years), (4 men, 33 women). Bone mineral density was measured in the lower third of the radius, femoral neck and lumbar 2-4 vertebrae by densitometers. Moreover, occurrence of fractures and biochemical parameters characteristic for hyperparathyroidism (serum parathyroid hormone levels, calcium, phosphorus, alkaline phosphatase, urinary calcium/ creatinine) were examined. RESULTS - Bone mineral density was normal in 6 cases, osteopenic in 10 patients and 21 patients had osteoporosis. Altogether five patients had fractures. Bone mineral density and biochemical parameters were not different in patients with or without fractures. CONCLUSIONS - Bone mineral density decreases in renal form of primary hyperparathyroidism even if there is no bone disease in the clinical picture. Therefore, bone mineral density measurement is advisable for every patient with hyperparathyroidism.]



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[A 6-month, placebo-controlled study comparing lung function and health status changes in COPD patients treated with tiotropium or salmeterol]


Lege Artis Medicinae

[Secondary prevention following ischemic stroke - A documentational process audit]

TÖRÖK Miklós, MIHÁLKA László, RÁCZ Sándor, FEKETE István, CSIBA László, BERECZKI Dániel

[INTRODUCTION - A previous stroke or a transient ischemic attack is an important risk factor for stroke, therefore measures for secondary prevention have great importance. Based on the results of multicenter randomized controlled trials guidelines for medical and surgical methods for secondary stroke prevention have been established in the last years. In our study - that can be considered a documentational process audit - we analyzed whether there was a change in the past 5 years in the documented recommendations for secondary stroke prevention in the discharge reports of patients with ischemic stroke. PATIENTS AND METHODS - The periods of examination were the first 3 months of 1995 and 2000. We reviewed the discharge reports of all patients discharged from the stroke unit with the diagnosis of ischemic stroke. We tabulated the history, the results of examinations, the condition of the patients at discharge, the stroke subtype, the indications and contraindications for antiplatelet and anticoagulant treatment and of carotid endarterectomy, and the recommended measure for secondary stroke prevention as documented in the discharge report. Data of 205 patients were analyzed. RESULTS - For the majority of patients medical treatment was recommended for secondary prevention. Only 5 patients were candidates for carotid endarterectomy. CONCLUSIONS - The documented practice of secondary stroke prevention significantly improved between 1995 and 2000: the recommendation of internationally accepted guidelines based on the results of randomized controlled trials are reflected better in the discharge reports of patients treated in 2000 (p = 0,0013).]

Lege Artis Medicinae

[Diuretic treatment]

RADÓ János

[Diuretics are used almost in all fields of medical practice for treating patients in various conditions associated with or without oedema. They exert their effects through profound alterations in the fluid volumes, ion content of the body and in the osmoregulation. They act mainly on the kidneys but the functions of several other organs are also influenced including the heart and vessels, the lungs, liver and the brain. Summarising our knowledge on the diuretics is justified by the broadened use of these drugs and the differences regarding their site of action, potency, way of administration, dosing and side effects. The special indications for diuretic therapy and combined usage of different diuretics are also reviewed.]

Lege Artis Medicinae

[Association of Chlamydia pneumoniae with coronary artery disease and its progression is dependent on the modifying effect of mannose-binding lectin]

RUGONFALVY-KISS Szabolcs, ÉS munkatársai

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[Significance of quantitative ultrasound bone densitometry and its introduction into pediatric bone medicine]


[INTRODUCTION - Quantitative Ultrasound (QUS) examination of the bones provides information about not only bone mineral mass but also its quality. Adaptation of the method to the continuous growing of body size allowed its pediatric use. However, for introduction into routine use, a normal reference range in healthy children has to be established. The primary aim of this study was to establish the Hungarian reference range for QUS of the bone - in both genders and across a wide range of ages. As a secondary aim, QUS and the bone density were compared to internationally accepted data to comparatively determine correlations of specific QUS measurements to photon absorption based values. SUBJECTS AND METHODS - Measurement was performed on the calcaneus by Achilles Insight (Lunar, WI) device. Bone Mineral Density (BMD) of the lumbar spine was measured using the Double X-ray Absorptiometry (DXA) device DPX-L (Lunar, WI). Latter was also used to measure total body calcium content. Measurements were performed in 154 healthy boys and girls aged 5 to 18 years. We analyzed data as a function of age, and correlated results of he two types of measurement. RESULTS - Gender-specific reference ranges for normally developing children of the above ages were built up for Broadband Ultrasound Attenuation (BUA) and Speed of Sound (SOS). BUA showed the best correlation to BMD. SOS and Stiffness Index (SI) derived from BUA and SOS, correlated weaker to BMD, consonantly with the fact that SOS reflects bone elasticity (quality) rather than bone mineral mass. CONCLUSION - These newly constructed normal ranges can provide a basis of performing pediatric bone examinations using QUS, which is less expensive and more mobile.]


[The effect of intranasal salmon calcitonin therapy on bone mineral density in idiopathic male osteoporosis without vertebral fractures]


[INTRODUCTION -The aim of this study was to examine the effect of intranasal salmon calcitonin therapy on bone mineral density in idiopathic male osteoporosis without vertebral fractures. MATERIALS - The randomised, prospective, controlled trial involved 71 male patients (mean age 59±6 years) suffering from idiopathic osteoporosis (lumbal spine and femoral neck T-score <-2.5) without vertebral deformity. Study design: Treatment protocol: Patients in the control group (n=31) received 400 IU Vitamin D + 1000 mg elemental calcium daily while the treatment group (n=40) received 400 IU Vitamin D, 1000 mg elemental calcium and 200 IU calcitonin nasal spray daily, by an intermittent monthly dose. METHODS - 1. Osteodensitometry: lumbar spine (L2-4) and femoral neck were measured by dual photon absorptiometry (LUNAR DPX-L, USA), whereas non-dominant radius was measured by single photon absorptiometry (NK 364, Gamma, Hungary). 2. Roentgenomorphorphometry was done onthoracic IV to lumbar IV spines and deformity indeces were calculated. The treatment period was 18 months. Examinations were performed at baseline and at the end of treatment.The primary end-point was the change of bone density measured by osteodensitometry. Secondary end-points included the side effects of medication. RESULTS - Nasal calcitonin was associated with significant increase in bone mineral density at the lumbar spine (+3.5±4.3% vs. +0.83±6.4%, p=0.04) and the femoral neck (+3.2±3.9% vs. -0.68±5.7%, p=0.004). No significant difference was observed at the radius between the treatment groups (+1.4±8.8% vs. +1.4±10.9%, p=0.98). No osteoporotic fractures occurred in the treated group, but there were 3 fractures in the control group. Treatment was well tolerated with no premature discontinuations nor significant side effects compared to the control group. CONCLUSION - 200 IU salmon calcitonin nasal spray used daily, intermittently proved to be an effective and safe therapy in male idiopathic osteoporosis.]


[The effect of biological therapy on generalised osteoporosis in patients with rheumatoid arthritis]


[In rheumatoid arthritis, the inflammation and damage of multiple joints can lead to generalised osteoporosis. This process is mostly mediaated by cells and cytokines that are also important for maintaining inflammation, by inhibiting bone formation as well as stimulating bone resorption. Data from the literature show that biological therapies that effectively decrease inflammation can also stimulate bone formation and inhibit bone resorption. This results in an increased bone density and bone protection, which is highly important to prevent subseqent fractures.]


[Bone status in praediabetic state - Relationship of bone density and energy homeostasis before the manifestation of type 2 diabetes mellitus]


[INTRODUCTION - All forms of diabetes are associated with increased fracture risk. In type 2 diabetes, bone mineral density is increased. In order to determine whether increased bone density is a consequence of diabetes-related metabolic changes or rather a primary alteration independent of these changes, we examined women and men with the following characteristics: normal glucose tolerance; genetically determined risk of T2DM but healthy on the basis of detailed metabolic tests; or incipient glucose intolerance, praediabetic state. PATIENTS AND METHODS - We included 72 men with normal glucose tolerance; seven men with normal glucose tolerance and first-degree relative(s) with diabetes; 64 body fat mass adjusted and BMI-adjusted men with glucose intolerance; 36 healthy women with normal glucose tolerance; 12 women with normal glucose tolerance and first-degree relative(s) with T2DM and 88 women with glucose intolerance. Muscle glucose uptake was measured by hyperinsulinaemic-normoglycaemic clamp, and bone density was measured by DEXA. RESULTS - In healthy men, the connection between leptin and BMDL1-4 is positive and the relationship between testosterone and BMDL1-4 is negative, but both correlations disappear in the early praediabetic stage. In the whole female study population, negative correlations were found between total BMD and adiponectin (r=-0.318, p<0.0001), and osteocalcin (r=-0.412, p<0.0000), which stayed significant after adjustments for body fat percent and age in case of impaired glucose tolerance. CONCLUSION - In women with healthy glucose metabolism who have first-degree relative(s) with diabetes, increased bone density is not related to changes in glucose metabolism. Our study emphasizes the substantial gender differences in the relationship between density of the femur and vertebrae and metabolism. Our data question the mediatory role of adiponectin shown in animal studies in the insulin-sensitizing, glucose metabolism improving effect of osteocalcin in men.]


[Higher bone fracture prevalence in postmenopausal pollen allergic women]


[Our aim was to investigate whether pollen allergy can affect bone mass and fractures in postmenopausal women. A total of 125 postmenopausal pollen allergic women (mean age 61.26 years) were split into four groups: treated neither with H1 histamine receptor (H1R) antagonist nor with inhaled corticosteroid (n=43), treated only with H1R antagonist (n=53), treated both with H1R antagonist and inhaled corticosteroid (n=17), treated only with inhaled corticosteroid (n=12) for at least five years, seasonally. One-hundred non-allergic postmenopausal subjects matched for age, body mass index (BMI) and age at menopause served as controls. Overweight and obesity (25 kg/m2 ≤ BMI) were common among allergic women (76%). Allergic patients without treatment had a slightly lower bone density than their non-allergic mates. Untreated allergic had almost triple the rate of prevalent low-energy fractures (distal forearm, hip and clinical vertebral fractures: 34.9%) compared to non-allergic women (13%, χ2 p=0.003). Bone fracture occurred more often in H1R-only treated patients (30.19%) than in controls (χ2 p=0.01), however, clinical vertebral or hip fractures developed neither in those treated only with H1R antagonist nor in those who received both H1R antagonist and inhaled corticosteroid. Bone fractures were more frequent among patients with inhaled steroid treatment than among patients with a combined treatment of inhaled steroid and antihistamine (50% vs. 29.4%). BMI predicted prevalent fractures at 1.278 (95% CI, 1.047 to 1.559, p=0.016) for 1 kg/m2 increase among untreated allergic patients. In conclusion we found a high prevalence of low-energy fractures among pollen-allergic postmenopausal women, which was associated with obesity. It is possible that the H1R antagonists compensate for the negative effect of pollen-allergy and the adverse effect of inhaled corticosteroid treatment on bone fracture risk.]