Guidelines for the diagnosis and management of osteoporosis in Poland : Update 2017

In the rapidly ageing society in Poland, osteoporosis is a growing epidemiological problem, and osteoporosis-related fractures are a cause of chronic disability and considerable increase of death risk. It turns out that 80 to 90% of patients suffering from osteoporosis, including osteoporosis accompanied by fractures, do not receive adequate pharmacotherapy. In this paper, a Guideline Working Group of experts from the Multidisciplinary Osteoporosis Forum update the existing Polish guidelines concerning the diagnosis and management of osteoporosis (last revised in 2013), taking account of the latest literature, availability and reimbursement of drugs, and current health care organisation. In the revised guidelines, we still postulate that tasks are divided between primary care doctors (stage I) and specialists in osteoporosis management (stage II). We emphasise the necessity of early initiation of pharmacotherapy and rehabilitation in all patients with low-energy fractures. We recommend that the 10-year fracture risk should be estimated in all patients (including those without fractures) who are over 50 years of age, and that the Polish threshold for therapeutic intervention should be adopted: ≥ 10% for FRAX PL calculator. We add strategies of drug choice and therapy monitoring with imaging, and densitometric and biochemical diagnostics. We define basic guidelines concerning prevention of falls, rehabilitation, and dietary procedures, and elimination of environmental and other fracture risk factors. We point to two vital elements for improving osteoporosis management: 1) strategy of supervision over fractures management — Fracture Liaison Service (FLS), and, optimally, 2) strategies of short-term monitoring of the therapeutic efficacy with the use of biochemical markers

Large-Scale Evidence for the Effect of the COLIA1 Sp1 Polymorphism on Osteoporosis Outcomes: The GENOMOS Study

BACKGROUND: Osteoporosis and fracture risk are considered to be under genetic control. Extensive work is being performed to identify the exact genetic variants that determine this risk. Previous work has suggested that a G/T polymorphism affecting an Sp1 binding site in the COLIA1 gene is a genetic marker for low bone mineral density (BMD) and osteoporotic fracture, but there have been no very-large-scale studies of COLIA1 alleles in relation to these phenotypes. METHODS AND FINDINGS: Here we evaluated the role of COLIA1 Sp1 alleles as a predictor of BMD and fracture in a multicenter study involving 20,786 individuals from several European countries. At the femoral neck, the average (95% confidence interval [CI]) BMD values were 25 mg/cm (2) (CI, 16 to 34 mg/cm (2)) lower in TT homozygotes than the other genotype groups ( p < 0.001), and a similar difference was observed at the lumbar spine; 21 mg/cm (2) (CI, 1 to 42 mg/cm (2)), ( p = 0.039). These associations were unaltered after adjustment for potential confounding factors. There was no association with fracture overall (odds ratio [OR] = 1.01 [CI, 0.95 to 1.08]) in either unadjusted or adjusted analyses, but there was a non-significant trend for association with vertebral fracture and a nominally significant association with incident vertebral fractures in females (OR = 1.33 [CI, 1.00 to 1.77]) that was independent of BMD, and unaltered in adjusted analyses. CONCLUSIONS: Allowing for the inevitable heterogeneity between participating teams, this study—which to our knowledge is the largest ever performed in the field of osteoporosis genetics for a single gene—demonstrates that the COLIA1 Sp1 polymorphism is associated with reduced BMD and could predispose to incident vertebral fractures in women, independent of BMD. The associations we observed were modest however, demonstrating the importance of conducting studies that are adequately powered to detect and quantify the effects of common genetic variants on complex diseases

Viabilidade da mensuração de marcadores de remodelação óssea em mulheres com lúpus eritematoso sistêmico

Objetivo: Investigar a viabilidade dos marcadores de remodela&#231;&#227;o &#243;ssea (MRO) na avalia&#231;&#227;o do metabolismo &#243;sseo em pacientes com l&#250;pus eritematoso sist&#234;mico (LES), de acordo com as diretrizes da International Osteoporosis Foundation e da International Federation of Clinical Chemistry and Laboratory Medicine. M&#233;todos: O estudo incluiu 43 pacientes do sexo feminino com LES. Foram medidos os n&#237;veis s&#233;ricos de propept&#237;deo N-terminal do procol&#225;geno tipo I (PINP), telopept&#237;deo C-terminal do col&#225;geno tipo I (CTX), osteocalcina, HPT, 25(OH)D, anticorpos anticardiolipina, antidsDNA e antinucleossomo. Resultados: Os n&#237;veis de PINP e CTX estavam elevados em pacientes com LES com idade > 45, em compara&#231;&#227;o com aqueles com idade < 45 anos, embora com signific&#226;ncia estat&#237;stica lim&#237;trofe (p = 0,05). Foram encontradas correla&#231;&#245;es entre os MRO: a mais forte foi entre o PINP e a osteocalcina (&#964; = 0,69, p < 0,05). Encontrou-se que o PINP e a osteocalcina est&#227;o correlacionados com o HPT (&#964; = 0,3, &#964; = 0,29, respectivamente, p < 0,05). A idade estava correlacionada com o PINP (&#964; = 0,23, p < 0,05). Valores elevados de PINP foram encontrados em maior frequ&#234;ncia do que valores elevados de osteocalcina ou CTX, tanto em pacientes com idade < 45 (p = 0,001) quanto > 45 (p < 0,001). N&#227;o houve diferen&#231;a estatisticamente significativa nos n&#237;veis de PINP, osteocalcina ou CTX com rela&#231;&#227;o &#224; esta&#231;&#227;o do ano, nem em todo o grupo de pacientes com LES, nem naqueles com mais ou menos de 45 anos. O uso pr&#233;vio de glucocorticoides n&#227;o esteve associado a diferen&#231;as nos MRO. Conclus&#245;es: O aumento nos MRO no LES parece refletir predominantemente o padr&#227;o de remodela&#231;&#227;o &#243;ssea relacionado com a idade. Pode-se esperar que o PINP aumentado seja o desfecho mais comumente encontrado entre os MRO. &#201; necess&#225;rio incluir melhores diagn&#243;sticos de dist&#250;rbios &#243;sseos com MRO, feitos de acordo com as normas internacionais de refer&#234;ncia, na abordagem de pacientes com LES, al&#233;m de avaliar a densidade mineral &#243;ssea