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1
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The importance of patient clubs in the management of osteoporotic patients

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Gaál J., Farkas L., Bender T., Somogyi P.
Open Medicine
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2011
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vol. 6
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issue 6
821-825
EN
Although the significance of osteoporosis is well known worldwide, the number of patients undergoing therapy for this disease corresponds to a fraction only of the optimal proportion. In many countries, patients at a high risk of fracture - including those who have in fact sustained a typical fracture - do not receive therapy at all. Unawareness of the population, difficulties in accessing specialist care, as well as insufficient communications all contribute to the fact that a substantial percentage of patients discontinue drug therapy prematurely. Using information from a survey conducted in a club of osteoporotic patients, this paper discusses the achievements and substantiates the existence of patient associations, as well as emphasizes the need for establishing new patient clubs in Hungary.
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How to identify osteoporotic patients’ attitudes towards pharmaceutical practice?

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Veszelyné Kotán E., Vincze Z., Mészáros Á.
Acta Poloniae Pharmaceutica - Drug Research
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2019
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vol. 76
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issue 3
569-579
EN
In aging populations osteoporosis is a serious problem. Low adherence to osteoporotic therapies is a well-known fact. There is a crisis in the therapy of osteoporosis: even with a diagnosis of osteoporosis or after an osteoporotic fracture there are patients without adequate therapy. The aim of the study was to analyze the association between the patients’ subjective importance of osteoporosis and medication adherence, quality of life, depression status and self-reported socio-economic factors, and find the risk groups which can be identified in the community pharmacy setting to improve the quality of care of osteoporotic patients. A cross-sectional study was conducted in four public hospitals in Hungary. Medication adherence was measured by the Morisky Medication Adherence Scale, quality of life was measured by the EQ5D-3L, depression status was checked by the Beck Depression Scale. Patients were asked to what extent their life was affected by osteoporosis compared to their chronic co-morbidities. Three patient groups were analyzed: High, Low and No osteoporosis importance groups. Statistical analyzes were carried out by SPSS program. Significant differences were found between the groups of osteoporosis importance in age, T-score, working status, type of the medication, existing fracture, frequency of pain and number of chronic diseases. The main target of pharmaceutical therapy management is to maintain a therapy-length lasting, periodic contact with the osteoporotic patient to improve the patients’ subjective perception of quality of life. Improving the importance of the disease in patients with low osteoporosis importance could help to improve the patients’ quality of life.
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Risk factors for osteoporosis in healthy males

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Seven Ö., Karapolat H., Eyigor S., Kirazlı Y., Durmaz B.
Open Medicine
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2010
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vol. 5
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issue 5
593-600
EN
We investigated the correlation of bone mineral density (BMD) with risk factors and laboratory parameters (e.g., markers of bone turnover, biochemical indicators, and hormonal factors) in males without secondary osteoporosis. A total of 105 males were divided into two groups: Group 1 (n: 52) <60 years, and Group 2 (n:53) ≥ 60 years. The subjects were evaluated for risk factors (European Vertebral Osteoporosis Study (EVOS) and BMD) and for biochemical (i.e., blood calcium, blood phosphorus, urinary calcium/phosphorus, creatinine clearance, osteocalcin, and deoxypyridinoline) and hormonal markers (follicle-stimulating hormone [FSH], luteinizing hormone [LH], free testosterone [fT], and parathyroid [PTH]) of bone mineral metabolism. In Group 1, no significant relationship was observed between risk factors for both lumbar and femoral neck BMDs and risk factors and laboratory parameters (p>0.05). On the other hand, we observed in Group 2 a significant positive correlation between lumbar BMD and BMI, BMI at 25 years of age, and fT; in the same group, a negative correlation between lumbar BMD and deoxypyridinoline (p<0.05) was seen. We saw a significant positive correlation between femoral neck BMD and BMI, BMI at 25 years of age, and daily activities of life in Group 2. In addition, we saw a negative correlation between femoral neck BMD and height difference, fT, LH, and deoxypyridinoline in Group 2 (p<0.05). Risk factors for male osteoporosis were multifactorial: demographic and clinical data (difference of height, BMI, physical activity) together with biochemical and hormonal data (deoxypyridinoline, fT, LH) were significant, and most of the risk factors analyzed were related to bone loss in the proximal femur.
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Effects of two-month walking exercise on bone mass density in young, thin women

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Habibzadeh N.
Biomedical Human Kinetics
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2010
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vol. 2
5-8
EN
Study aim: To examine the effects of a walking programme on the bone mass density (BMD) in sedentary, thin women aimed at preventing bone losses.Material and methods: Twenty thin (BMI<20) women aged 22.0 ± 1.5 years volunteered to participate in the study. They were randomly assigned into the exercise (n = 10) or control (n = 10) groups, those from the experimental group being submitted to a training programme lasting two months. The programme consisted of 3 walking sessions per week, 30 min each, at 50 - 75% of maximal heart rate. Anthropometric measurements, bone mass density (by DXA) at the hip and lumbar spine (L2 - L4) and oestradiol concentration in serum (by radioimmunoassay kits) in the follicular phase were made before and after the training programme. The same diet was maintained throughout the study and was monitored by 7-day recalls.Results: The walking programme induced significant increases in BMD (by 5.2% in the hip site, p<0.001, and by 7.3% in the spine, p<0.05). Significant decreases were found in calcium concentration in both groups (by about 5%) and in phosphorus concentration in the experimental group (by about 16%). In the experimental group also the relative body fat content significantly decreased (by 7.7%).Conclusion: Walking exercise practiced for two months reduced the risk of bone loss by significantly increasing bone density.
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Correlation between total cardiovascular risk and bone density in postmenopausal women

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Popovic M., Tasić I., Dimić A., Stojanović S., Stamenković B., Kostić S., Popović D., Savić T., Tasić N., Manojlovic S., Ivanović B.
Open Medicine
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2011
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vol. 6
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issue 6
795-803
EN
The aim of the paper was to examine the correlation between the total risk of cardiovascular events, determined by the SCORE (Systematic Coronary Risk Evaluation) system, and bone density in postmenopausal women. Examinees and method: The research involved 300 postmenopausal women. On the basis of bone density measurements, the participants were divided into three groups: group I - 84 examinees had osteoporosis, group II - 115 examinees had osteopenia, and group III - 101 examinees had normal bone mineral density (BMD). Results: Participants with high SCORE risk were statistically significantly older compared to low-risk women (60±3 vs. 55±5; p<0.001). They had significantly lower BMD and T scores (−1.09±0.94 vs. −2.86±0.63; p<0.001). Elevation of the SCORE risk by 1% caused a BMD decrease of 0.033 g/cm2(0.029 to 0.036 gr/cm2). Multivariate logistic regression analysis showed that the following factors caused a significant increase in the risk of decreasing BMD: every year of life by 20%, menopause duration by 26%, increase in systolic blood pressure (BP) by 1 mm Hg by 7%, increase in SCORE risk by 1% by 5.31 times, physical inactivity by 5.96 times, and osteoporosis in the family history by 3.91 times. Conclusion: Postmenopausal women who are at high risk for cardiovascular diseases have a lower BMD than those who are not at high risk for cardiovascular diseases.
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The effect of milk consumption on bone mass density in obese and thin adult women

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Habibzadeh N.
Biomedical Human Kinetics
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2010
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vol. 2
81-84
EN
Study aim: To assess the effect of milk consumption lasting two months on BMD of obese and thin young women.Material and methods: A group of 38 untrained women (18 obese [O] - BMI>30, and 20 thin [T] - BMI<20), aged 20 - 25, years participated in the study. They were randomly assigned into BMI-matched experimental [E] or control [C] groups containing 9 obese and 10 thin subjects each. Experimental groups were given 2 glasses of milk (600 mg/day of calcium; fat content 1.5%) for 2 months, 3 days a week. At the beginning (Pre) and at the end (Post) of the study, bone mass density (BMD) at the hip and spine (L2-L4) was measured using DEXA technique, and oestrogens, calcium and phosphorus were determined in serum. Body fat content (%F) and lean body mass (LBM) were determined using the bioimpedance (BIA) technique.Results: In both experimental groups BMD significantly (p<0.05 - 0.001) increased in both areas by 4 - 7%. In the TE group, %F significantly (p<0.05) decreased by 8% and LBM significantly (p<0.001) increased by 3%. Serum calcium decreased in all groups except OC by 3 - 5% (p<0.05 - 0.01) and oestrogens markedly increased in all groups except TC.Conclusion: The data suggest that adequate milk intake (thus calcium) in adolescence is an indicator of attaining adequate bone mass density, thus preventing the risk of osteoporosis.
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Fracture risk prediction with FRAX in Slovak postmenopausal women

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Némethová E., Killinger Z., Payer J.
Open Medicine
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2013
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vol. 8
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issue 5
571-576
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Evaluation of the Singh index and femur geometry in osteoporotic women

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Karabulut Ö., Tuncer M., Karabulut Z., Hatipoğlu E., Nazaroğlu H., Akkuş Z.
Open Medicine
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2010
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vol. 5
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issue 5
601-610
EN
We aimed to compare the Singh index with bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), body mass index (BMI) and femur geometry in the right proximal femur of osteoporotic women, using different statistical tests. Radiographs of each patient were assessed to determine the Singh index by five observers. The observers consisted of a consultant radiologist, physical therapist and anatomists who studied the series of radiographs. They were asked to apply the Singh index by comparing the trabecular bone pattern in the proximal right femur with the reference scale published by Singh et al. [1]. This has a six point scale from grade VI to grade I. We evaluated 47 osteoporotic women in this study. The subjects’ mean age, weigth, and height were 63,21 ± 10,106, 66,72 ± 12.523, 154,94 ± 7,026 respectively. We found a significant relationship between the Singh index and BMD. The Singh index correlated significantly with hip axis length, femoral neck diamater and trochanteric width. And, BMD correlated significantly with femoral head and neck diameter, femoral neck cortex width, medial calcar femoral cortex width and femoral shaft cortex width. The evaluation of the Singh index grades in its self, there was a significant relation among them.
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Endocrine disorders in patients with hereditary hemochromatosis

88%
Banaszkiewicz K., Sikorska K., Sworczak K.
European Journal of Translational and Clinical Medicine
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2019
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vol. 1
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issue 2
72-76
EN
Hereditary hemochromatosis (HH) is a rare genetic disorder, developing secondary to the accumulation of iron in tissues, which may lead to multiple organ failure. If untreated, it may result in liver cirrhosis or cardiomyopathy. The damage to the pancreas and the anterior pituitary, on the other hand, leads to a decreased production and secretion of hormones that are essential to life. Common symptoms of HH, that are distressing for patients, include joint pain, particularly involving hands and wrists, as well as the chronic fatigue syndrome. Iron overload affects the skeletal system, leading to osteoporosis. The pathological accumulation of iron in the anterior pituitary impairs the gonadotropin synthesis, resulting in reduced serum levels of testosterone in men and estrogens in women. This, however, contributes to lower bone mass. In vivo tests have also revealed that abnormal iron accumulation is related to an increased activity and number of osteoclasts, as well as the influence on the differentiation and activity of osteoblast-lineage cells. Based on a systematic review of literature, hereditary hemochromatosis (HH) will be presented as a chronic disease, affecting most of the endocrine glands.
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Bone mineral density, carotid artery intima-media thickness, and Klotho gene polymorphism in postmenopausal women

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Muntean L., Simon S.-p., Popp R., Albu A., Fodor D.
Open Medicine
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2014
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vol. 9
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issue 2
315-324
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Adherence to osteoporosis guideline: survey among Czech general practitioners

88%
Vytrisalova M., Fuksa L., Palicka V., Byma S., Blazkova S., Stepan J., Hendrychova T., Vlcek J., Pavek P.
Open Medicine
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2014
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vol. 9
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issue 5
687-693
12
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Content available

Endocrine disorders in patients with hereditary hemochromatosis

88%
Banaszkiewicz K., Sikorska K., Sworczak K.
European Journal of Translational and Clinical Medicine
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2019
|
vol. 1
|
issue 2
72-76
EN
Hereditary hemochromatosis (HH) is a rare genetic disorder, developing secondary to the accumulation of iron in tissues, which may lead to multiple organ failure. If untreated, it may result in liver cirrhosis or cardiomyopathy. The damage to the pancreas and the anterior pituitary, on the other hand, leads to a decreased production and secretion of hormones that are essential to life. Common symptoms of HH, that are distressing for patients, include joint pain, particularly involving hands and wrists, as well as the chronic fatigue syndrome. Iron overload affects the skeletal system, leading to osteoporosis. The pathological accumulation of iron in the anterior pituitary impairs the gonadotropin synthesis, resulting in reduced serum levels of testosterone in men and estrogens in women. This, however, contributes to lower bone mass. In vivo tests have also revealed that abnormal iron accumulation is related to an increased activity and number of osteoclasts, as well as the influence on the differentiation and activity of osteoblast-lineage cells. Based on a systematic review of literature, hereditary hemochromatosis (HH) will be presented as a chronic disease, affecting most of the endocrine glands.
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Accuracy of quantitative ultrasound parameters in the diagnosis of osteoporosis

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Pais R., Campean R., Simon S.-P., Bolosiu C., Muntean L., Bolosiu H.
Open Medicine
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2010
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vol. 5
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issue 4
478-485
EN
Quantitative ultrasound (QUS) is of increasing interest for evaluation of osteoporosis because, compared with dual-energy X-ray absorptiometry (DXA), it is portable, less expensive, and radiation-free. The aim of our study was to determine the sensitivity, specificity, and cut-off values of quantitative ultrasound parameters in identifying patients with osteoporosis compared to the World Health Organization (WHO) standard definition. We performed a cross-sectional investigational study of 73 subjects, and determined total hip and lumbar spine T-scores by dual-energy X-ray absorptiometry (DXA) (Prodigy Advance Lunar-GE). The QUS parameters (broadband ultrasound attenuation [BUA], speed of sound, bone mineral density, the stiffness index, and QUS T-score) were determined with Sahara Hologic equipment. The AUC was 0.81 (95% CI 0.67–0.95, p<0.05) for speed of sound (SOS) and 0.76 (95% CI 0.62–0.90, p<0.05) for BUA for the patients with DXA T-scores ≥ −1 DS; the cut-off values were 1542.2 meters per second for SOS and 63.3 dB/MHz for BUA. In patients with DXA T-scores ≤ − 2.5 DS, AUC was 0.80 (95% CI 0.70–0.90, p<0.05) for SOS, and 0.76 (95% CI 0.65–0.87, p<0.05) for BUA. The cut-off values were 1504.95 meters per second for SOS and 49.5 dB/MHz for BUA. Pearson correlation coefficients were positive and statistically significant (> 50%) for all QUS parameters in both groups, (2-tailed, p<0.05). QUS parameters correctly identified normal patients (false negative 34.21% and false positive 2.53%) and those with osteoporosis (false negative 8.55% and false positive 7.82%). The patients with QUS parameters between the cut-off values corresponding to DXA T-scores of −1 SD and − 2.5 SD should be further evaluated by DXA.
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Degree of mineralisation of bones in children with idiopathic scoliosis. Do these children show a reduced bone mineral density?

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Deja A., Nowacka-Pikuła D.
Medical Rehabilitation
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2015
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vol. 19(2)
5-9
PL
Wstęp: Skolioza idiopatyczna jest trójpłaszczyznową deformacją kręgosłupa o nieznanej etiologii. Stanowi ona u dzieci poważny problem kliniczny z uwagi na możliwość jej progresji, deformacji tułowia oraz możliwych zaburzeń oddychania. Wciąż nie jest do końca jasny związek między mineralizacją kości a ryzykiem rozwoju skoliozy u dzieci. Potwierdzenie takiej korelacji mogłoby przyczynić się zarówno do zmiany dotychczasowego leczenia, jak również do wczesnej interwencji rehabilitacyjnej dzieci z obniżoną gęstością kości. Cel pracy: Celem pracy była ocena gęstości mineralnej kości u dzieci ze skoliozą idiopatyczną, zgodnie z wytycznymi Międzynarodowego Towarzystwa Densytometrii Klinicznej (ISCD). Materiał i metody: 57 dzieci ze skoliozą idiopatyczną w wieku od 5,5 do 18 lat. Kąt skoliozy wyznaczano na zdjęciu rtg kręgosłupa metodą Cobba. Kąt rotacji tułowia wg Bunnella oceniano w teście Adamsa za pomocą skoliometru. Badania densytometryczne kręgosłupa L1-L4 wykonano za pomocą densytometru, opartego o metodę absorpcjometrii promieniowania rentgenowskiego o podwójnej energii (DEXA). Wyniki: Spośród 57 pacjentów ze skoliozą Z-score równy lub poniżej – 2,0 SD występował u 5 badanych dzieci (9%). Nie zaobserwowano statystycznie istotnej korelacji między gęstością mineralną kości a skrzywieniem kręgosłupa, jak również między wartością Z-score a skrzywieniem kręgosłupa. Wnioski: Nasze badania wskazują, że u dzieci ze skoliozą nie obserwuje się obniżonej gęstości mineralnej kości. Badanie densytometryczne u dzieci ze skoliozą jest trudne do interpretacji, ponieważ obok czynników związanych z ciągłym procesem rośnięcia szkieletu i dużymi różnicami międzyosobniczymi w rozmiarze kości u dzieci w tym samym wieku, na wynik wpływają też czynniki związane ze skoliozą, tj. rotacja kręgu w miejscu pomiaru oraz deficyt wzrostu związany ze skrzywieniem kręgosłupa.
EN
Introduction: Idiopathic scoliosis constitutes a serious clinical problem due to the risk of progression, trunk deformation and possible respiratory disorders. The relation between the bone mineral density (BMD) and the risk of scoliosis developing in children is still unclear. However, confirmation of such a relation could result in both modifications of the current treatment and an earlier rehabilitation in children with decreased bone mineral density. Aim: The aim of the study was to assess the BMD in children with idiopathic scoliosis, in accordance with the guidelines of the International Society of Clinical Densitometry (ISCD). Materials and methods: a total of 57 children with idiopathic scoliosis aged 5.5 to 18.0 years took part in the study. Anteroposterior (AP) radiographs were taken to determine the Cobb angles. Also, the trunk axial rotation angles according to Bunnell were evaluated using Adam’s test with a scoliometer. The densitometric examinations of the L1-L4 spine were performed using a densitometer, based on Dual-energy X-ray absorptiometry (DEXA). Results: Among the 57 patients with scoliosis, a Z-score equal or below – 2.0 SD occurred in 5 of the examined children (9%). a statistically significant correlation between the BMD and the spine angle, and between the Z-score value and the spine angle, was not observed. Conclusions: Our study indicates that a decreased bone mineral density is not observed in the population of children with scoliosis. The densitometric examination of the children with scoliosis is difficult to interpret, due to their continuous skeletal grow and the great differences in bone size between individuals of the same age, as well as rotations of the analysed vertebrae, and the limited growth due to scoliosis.
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Is there any relationship between decrease in bone mineral density in women, and deterioration in quality of life?

63%
Mika A.
Medical Rehabilitation
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2005
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vol. 9(2)
15-19
PL
Cel: Osteoporoza jako uogólniona choroba szkieletu skutkuje wystąpieniem złamań, którym często towarzyszy ból i utrata sprawności. Efektem tych często przewlekłych dolegliwości są zaburzenia natury psycho-społecznej wpływające na jakość życia. Celem pracy jest stwierdzenie czy samoocena jakości życia, czyli czynniki takie jak ból, stan emocjonalny, sprawność fizyczna wykazują związek ze stwierdzonym u pacjentów stanem funkcjonalnym kręgosłupa oraz gęstością mineralną kości? Materiał i Metoda: Badaniami objęto 189 kobiet w wieku 50–80 lat. U każdego pacjenta wykonano następujące pomiary, na podstawie których podzielono badaną populację na podgrupy: pomiar gęstości tkanki kostnej (BMD), pomiar kąta kifozy piersiowej, pomiar zakresu ruchomości w płaszczyźnie strzałkowej odcinka piersiowego kręgosłupa, pomiar siły mięśni prostowników kręgosłupa oraz ocena poziomu aktywności fizycznej. Do oceny jakości życia pacjentów zastosowano kwestionariusz samooceny SF–36. Wyniki: Osoby aktywne fizycznie wykazywały statystycznie istotnie lepszą samoocenę jakości życia w zakresie wszystkich analizowanych kategorii w porównaniu z pacjentami prowadzącymi siedzący tryb życia (p<0,01). W przypadku, gdy siła mięśni stanowiła kryterium grupujące stwierdzono statystycznie istotne różnice w 5 z 8 analizowanych kategorii samooceny jakości życia (p<0,001) – osoby silniejsze oceniały jakość swojego życia lepiej niż słabsze. Osoby, u których zakres ruchomości kręgosłupa w płaszczyźnie strzałkowej był większy wykazywały lepszą samoocenę w 2 kategoriach (p<0,001). Nie stwierdzono statystycznie istotnych różnic zarówno, gdy analizowano zmienność w samoocenie jakości życia w zależności od stwierdzonej u pacjentów gęstości masy kostnej (p>0,05), jak i w zależności od wielkości kąta kifozy piersiowej (p>0,05). Wnioski: Na pogorszenie jakości życia wpływa ograniczenie ruchomości kręgosłupa i spadek siły mięśniowej. Zaobserwowano też gorszą samoocenę u osób prowadzących siedzący tryb życia w porównaniu z osobami aktywnymi fizycznie.
EN
Background: Osteoporosis is a chronic metabolic bone disease leading to progressive destruction of bone microarchitecture and loss of function. Osteoporosis as a chronic disease can contribute to psychosocial disorders like changes in quality of life. The aim of our study was to assess if quality of life, especially such factors like pain, emotional status, physical fitness, are related to functional state of the spine of evaluated patients?Methods:189 female subjects aged 50 to 80 years were evaluated in this study. All were evaluated for: bone mineral density (BMD), the thoracic kyphosis, range of spinal thoracic motion in sagittal plane, strength of the back extensors and the physical activity level. Quality of life was assessed by SF–36 questionnaire.Results: Physically active subjects assessed their quality of life significantly better in all evaluated categories than sedentary subjects (p<0.01). When the cohort was divided according to their back extensor strength value there were significant differences in 5 from among 8 categories of quality of life (p<0.001), where stronger subjects assessed their quality of life better than sedentary. Subjects with a greater range of sagittal spinal motion assessed better their quality of life in 2 categories (p<0.001). There were no significant differences in quality of life both when the cohort were divided according to their BMD (p>0.05) and to thoracic kyphosis (p>0.05).Conclusion: The decrease in quality of life is influenced by pain, restriction in spinal range of motion, and decrease in back muscle strength. It was also observed that sedentary subjects assessed their quality of life worse in comparison to people who were physically active.
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Osteoporoza - patofizjologia, objawy, profilaktyka i leczenie

63%
Dobosz A., Smektała A.
Farmacja Polska
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2020
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vol. 76
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issue 6
344-352
EN
Osteoporosis is a disease that leads to the weakening of bone structure and increases the possibility of bone fractures. It can affect especially an old people and the women in the postmenopausal age. The reason is the osteoclasts resorption hyperactivity in the relation to the bone forming cells. Osteoporosis can remain latent for many years and symptoms can occur in the case of fractures, most often of the vertebrae, radius bone or bonehead of the femur. In many cases, disability resulting from the development of the disease, causes depression, social withdrawal, reluctance to live and chronic pain. Osteoporosis affects about 38% of people older then 50 years,, when calcium absorption in the intestines becomes less efficient and bone mass undergoes faster resorption. In the postmenopausal age, the estrogen deficiency consists of stimulating osteoblast activity and maintaining calcium and phosphorus homeostasis in the body. Diagnosis of osteoporosis is based mainly on the densitometric BMD (Bone Mineral Density) measurement. Another diagnostic method is FRAX (Fracture Risk Assessment Tool), a 10-year fracture probability calculator. In order to take into account the risk of osteoporosis, ancillary laboratory tests such as measuring calcium levels and activ forms of vitamin D in the blood, can be used. By taking preventive action, the process of bone dissolution can be slowed down. Prophylaxis of osteoporosis affects the change in the lifestyle and diet, which must ensure adequate consumption of calcium and magnesium ions, proteins, vitamins D and K2. Deficiency of vitamin D and calcium ions leads to the activation of compensatory mechanisms in the body, which can start the osteoporosis. Magnesium ions prevent soft tissue calcification, induce bone mineralization and affect ostoblast activity. Vitamin K2 provides participation in osteocalcin synthesis and stimulates bone mineralization. The most commonly used drugs in the pharmacotherapy of osteoporosis are bisphosphonic acids, additionary with calcium and vitamin D3 supplements. Molecular mechanisms of bisphosphonic action depend on their structure, specially the length of the side chain and the presence of a nitrogen atom. Bisphosphonates should be taken on an empty stomach and the patient should not change body position for 30 minutes. The most common side effects of these drugs are diarrhea, stomach ache, reflux, indigestion and tarry stools. Other drugs used nowadays in the therapy are denosumab, strontium renalate, raloxifene and teriparatide. The aim of this work is to present the pathophysiology, symptoms, diagnostics, prevention and treatment methods of the osteoporosis. Unfortunately this disease often occurs in the society, and it is necessary to broaden the knowledge how to prevent its progression and treatment, specially at the initial stage of the disease, when the therapy gives the highest therapeutic benefit.
PL
Osteoporoza jest chorobą, która prowadzi do osłabienia struktury kości i zwiększa prawdopodobieństwo złamań, szczególnie w wieku starszym i u kobiet po menopauzie. Wynika ona z nadaktywności resorpcyjnej osteoklastów w stosunku do komórek kościotwórczych. Osteoporoza pozostaje przez wiele lat w stanie utajonym, a objawy występują przy złamaniu, najczęściej kręgu, kości promieniowej lub bliższego końca kości udowej. Choroba występuje u około 38% osób po 50 r.ż, kiedy wchłanianie wapnia w jelitach zachodzi z mniejszą wydajnością, a masa kostna ulega szybszej resorpcji. W wieku pomenopauzalnym obserwuje się niedobór estrogenu, stymulującego aktywność osteoblastów i utrzymującego homeostazę jonów wapnia i fosforu w organizmie. Diagnostyka osteoporozy opiera się głownie na densytometrycznym pomiarze gęstości mineralnej kości (BMD) oraz dodatkowo na kalkulatorze ryzyka złamania w najbliższych 10 latach (FRAX). Dzięki podjęciu działań prewencyjnych, można zapobiec lub spowolnić proces rozpuszczania kości oraz zachować ich odpowiednią twardość i strukturę. Profilaktyka osteoporozy opiera się głównie na zmianie trybu życia oraz diety, która powinna zapewniać odpowiednie spożycie jonów wapnia, magnezu, białka, witaminy D i K2. Najczęściej stosowanymi lekami w farmakoterapii osteoporozy są kwasy bisfosfonowe, obok których dodatkowo stosuje się suplementację wapniem i witaminą D¬3. Innymi współcześnie stosowanymi lekami są denosumab, renalinian strontu, raloksifen i teryparatyd. Mechanizm działania bisfosfonianów zależy od ich struktury, szczególnie długości łańcucha bocznego i obecności atomu azotu w cząsteczce. Niniejsza praca ma na celu przedstawienie patofizjologii osteoporozy oraz jej objawów, diagnostyki, profilaktyki i sposobów leczenia. Choroba ta ma charakter cywilizacyjny, dlatego niezbędne jest poszerzanie wiedzy na temat zapobiegania jej postępowi oraz leczenia, które podjęte w początkowym stadium chorobowym, przynosi największą korzyść terapeutyczną.
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