The combination of osteoporosis and sarcopenia is wider known as “osteosarcopenia”, and it is considered to be a “hazardous duet” for the patient. The clinical consequences of this geriatric syndrome include a higher risk of fractures and mortality compared to osteoporosis or sarcopenia alone. Fractures are considered to be a burden for the patient but also for the health care system from an economic point of view, therefore it is important to prevent them. Emerging evidence shows that osteosarcopenia is an increasingly prevalent disease. The Fracture Risk Assessment Tool (FRAX) is of major importance for the management of a patient, however, muscle weakness is not part of this instrument. It has been suggested to go “beyond the FRAX” and to evaluate muscle mass/strength besides bone mineral density when it comes to the management of a patient with a sustained fragility fracture. In this review we try to answer whether this is feasible or not when it comes to Romanian patients.
Tag Archives: osteoporosis
The Wnt Signalling Pathways: A Short Review and Specific Roles in Bone Biochemistry
As musculoskeletal diseases become an emerging healthcare problem worldwide, profound and comprehensive research has been focused on the biochemistry of bone metabolism in the past decades. Wnt signalling, one of the novel described pathways influencing bone metabolism from the early stages of tissue development, has been recently in the centre of attention. Several Wnt ligands are implied in bone forming pathways via canonical (β-catenin dependent) and non-canonical (β-catenin independent) signalling. Osteoporosis, a catabolic bone disease, has its pathologic background related, inter alia, to alterations in the Wnt signalling, thus key modulators of these pathways became one of the most promising targets in the treatment of osteoporosis. Antibodies inhibiting the activity of endogenous Wnt pathway inhibitors (sclerostin, dickkopf) are recently under clinical trials. The current article offers a brief review of the Wnt signalling pathways, its implication in bone metabolism and fate, and the therapeutic possibilities of osteoporosis through Wnt signalling.
COPD – Risk Factor for Complex Chronic Comorbidities, a Retrospective Case-Control Study
Background: Increasing evidence indicates that chronic obstructive pulmonary disease (COPD) is a complex disease involving more than airflow obstruction. Systemic inflammation can initiate or worsen comorbid diseases, such as ischemic heart disease, heart failure, arrhythmia, diabetes, osteoporosis, lung cancer and depression.
Material and method: We explored the Medprax database, from an ambulatory care in order to obtain rates of comorbidities in COPD patients. Medprax electronic database is a locally developed system designed to fulfil the requirements of an integrated healthcare system. We identified a population of 9,659 patients (4472 men and 5187 women) aged ≥ 30 years registered between 01.01.2000 and 01.02.2010.
Results: The overall prevalence of COPD was 5.17% (384 men and 116 women). Compared to the non-COPD patients, COPD was found to be a significant risk factor in both sexes for cardiovascular events: ischemic heart disease (OR = 3.06, 95%CI 2.54–3.68), atrial fibrillation (OR = 2.70, 95%CI 2.12–3.43) and heart failure (OR = 4.49, 95%CI 3.74–5.40) regardless of age. Association with diabetes mellitus type 2 was extremely significant in COPD men (OR = 1.69, 95%CI 1.26–2.27), but not in COPD women. Significant correlation with osteoporosis (OR = 3.26, 95%CI 1.94–5.48) was found only in women over 60 years and men under 60. Pulmonary malignancy was found only in male COPD patient compared to non-COPD patients (OR = 5.04, 95%CI 2.02–12.44). The impact on
depressive disorders was noted only in younger COPD men (OR = 5.71, 95%CI 1.94–16.82).
Conclusions: Our results indicate that COPD is a risk factor for all these comorbid conditions and that in the management of COPD all these conditions need to be carefully evaluated.
Mineral Bone Disorder in Hemodialysis Patients – a New Face of an Old Concept
Aim: We studied in a hemodialysis (HD) population the correlations between bone metabolism markers measured by DEXA compared with other bone markers: serum calcium, serum phosphate, serum iPTH level and the inflammatory status, known as high risk for morbidity in HD patients which has not been studied yet.
Method: Twenty-seven patients from a hemodialysis unit were included in the study. The following parameters were measured: serum calcium (Ca), serum phosphate (P), total alkaline phosphatase (AP), intact parathormon level (iPTH) as bone metabolism markers and fibrinogen and C reactive protein (CRP) as inflammatory markers. Osteodensitometry was measured with DEXA technique and T-score was recorded. Statistical data were analyzed with the program Excel 2007 and mean, SD, Pearson’s correlation coefficient r and χ2-test were calculated.
Results: Significant correlations were found between serum Ca levels and P (p=0.002), AP (p=0.002) and T-score (p=0.0003). Also there was a correlation between CRP and phosphate (p=0.029) and CRP and fibrinogen (p=0.037). Calculating the correlation coefficient r, the significant correlation threshold was relevant to Ca and AP (r=0.33, p <0.05), Ca and BMD (r=0.31, p <0.05), P and BMD (0.30, p <0.05), P and fibrinogen (r=0.6, p <0.01).
Conclusions: In HD patients, CRP is correlated with bone metabolism, in the absence of infection. Serum phosphate is the only marker correlated
with bone markers, inflammatory markers and T-score for osteodystrophy, being an important tool for the future prognostic of these patients.
Hypolipemiant Treatment: Making the Right Choice for Osteoporotic Patients
Introduction: It has been shown that dyslipidemia is related to bone mineral density and fragility. Hypolipemiant drugs as statins or fibrates seem to increase the bone mineral density and probably to protect against fractures. The question that arises in this context is whether statins or fibrates have a positive effect on bone fracture repair process and which is their behaviour in an osteoporotic context. Our objective was to study the incidence of osteoporosis, dyslipidemia and of the association of these diseases, and to compare the effect of statins and fibrates on fracture repair in experimental conditions.
Material and method: We studied the incidence of dyslipidemia and osteoporosis in the activity of a private family medicine cabinet. In the experimental part we observed from a radiographic point of view the fracture repair process of rats’ femurs. We analyzed 6 subgroups of 12 rats each: (1) ovariectomized control, (2) ovariectomized treated with statins, (3) ovariectomized treated with fibrates, (4) nonovariectomized control, (5) ) nonovariectomized treated with statins, (6) ) nonovariectomized treated with fibrates. The radiographic aspect has been objectified with a score at 2, 4, 6 and 8 weeks.
Results: From the total of 646 patients included in the study, 193 (29.87%) had dyslipidemia while osteoporosis was diagnosed at 152 (23.53%) patients. 301 (46.6%) patients presented the association of these diseases. Comparing the subgroups of the OVX group, we had the following results: subgroup 1 – 5.5 points, group 2 – 11 points and group 3 – 4.5 points. In the case of the NOVX subgroups, the scores were: subgroup 4 – 7.5 points, subgroup 5 – 10 points and subgroup 6 – 6.5 points.
Conclusions: The fact that the incidence of dyslipidemia is higher than that of osteoporosis is an argument for the necessity of choosing a hypolipemiant treatment that has, at the same time, a protective effect on bone. Hypolipemiant treatment influences the fracture repair process. The positive effect of statins on this process is more important on the ovariectomized group, in contrast with fibrates which have an accentuated effect on the nonovariectomized group and this suggests an interference between hypolipemiant treatment and estrogens level. However, the treatment with fibrates delays the fracture repair, groups (3) and (6) scores being inferior to those of the control group. We sustain the helping effect of statins treatment on fracture repair process.
Therapeutical Approach of Osteoporosis — a Multidisciplinary Issue
Osteoporosis is the most frequent systemic disease of the bone, that affects elderly, mainly women in menopause. It can be defined by lowering of bone mass and microarchitectural deterioration of the bone tissue, resulting in an increased bone fragility. Main complications of osteoporosis are fractures of the vertebrae, hips and forearm. In view of its large variety of causes and manifestations, diagnostic and therapeutical approach in osteoporosis represents a multidisciplinary issue. The accurate diagnosis of osteoporosis is based on a method that measures the bone mineral density, expressed by the T-score, using dual energy X-ray absorptiometry, so called DXA. Lately, in practice in order for establishing the risk of osteoporosis and osteoporotic fracture the FRAX tool is increasingly used (The Fracture Risk Assessment). Treatment of osteoporosis is complex involving non-pharmacological and pharmacological measures. Non-pharmacological methods include preventive measures like exercise, external hip protectors, increase of dietary intake of calcium, vitamin D and proteins, especially in elderly, over 65 years. Pharmacological measures are represented by different types of drugs, including biphosphonates, bone formation stimulatory drugs, agents with new mechanisms of action, hormone replacement therapy and they will be indicated only after a detailed clinical and paraclinical examination of the patient. Regardless of the chosen pharmacological measure, periodical follow-up of efficacy, side-effects and complications of antiosteoporotic treatment, by clinical examination and laboratory investigations targeting bone remodelling, is strongly indicated.