A case of atypical femur fracture during long-term treatment with bisphosphonates in patient with postmenopausal osteoporosis

Bisphosphonates is a first-line therapy for treatment of osteoporosis. In the last decade, the number of atypical femur fracture (AFF) cases during long-term treatment with bisphosphonates has increased. The aim of this article was to analyze the literature data on this problem, to define the diagnostic criteria of AFF and to present the case of AFF in the patient who received treatment with alendronate for 3.5 years. A 78-year-old woman, receiving oral bisphosphonate for severe postmenopausal osteoporosis for 3.5 years, suddenly started feeling pain in her right thigh while walking. Three months later, she had got a fracture in middle third of the right femur after falling from her standing height. According to instrumental diagnostics, this fracture had all criteria of AFF. Blocking intramedullary osteosynthesis with shafts was performed. A retrospective analysis of soft tissue magnetic resonance imaging in the area of right thigh, done before the fracture, showed the presence of undiagnosed incomplete right femur fracture in the middle third, which subsequently led to a complete fracture. Presented clinical case demonstrates the complexity of AFF diagnostics. The purpose of the publication is to draw attention of medical specialists to the issue of this rare side effect of bisphosphonate treatment

ORIGINAL METHOD OF FEMORAL NECK OSTEOSYNTHESIS WITH NON-FREE AUTOPLASTY

Applied topographic-anatomical studies were carried out on 12 fixed lower extremities and revealed that in the anterior portion of the middle gluteus muscle 4 cm in width the upper branches of the gluteal vessels are always held supplying the area of the iliac crest. Taking into account the received data the authors proposed a new method of femoral neck osteosynthesis with non-free autoplasty by the autograft from the iliac crest, which is moved at constant muscle-vascular supply pin and fixed with screw in the fracture. Osteosynthesis using the proposed method was performed in 24 patients and provided the union of fractures in all cases in a period of 5 to 8 months. Analysis of long-term results of treatment of 22 patients performed 3 years after the operations showed good function of injured joints and no evidence of avascular necrosis of the femoral head in 18 (83.3%) cases

Features of fractal conformity and bioconsolidation in the early myogenesis gene expression and their relationship to the genetic diversity of chicken breeds

Simple Summary In the bodies of animals, including birds, gene expression leads to the synthesis of many proteins. To provide optimal cellular and organismal properties and functions, many genes should work in concert, reaching certain balanced relationships (or networks) between them and the intensities of their expression. Here, we studied the expression of several genes responsible for muscle formation and growth in chick embryos of diverse breeds belonging to various utility types. Using two mathematical (fractal) models and the respective indices, we showed that there are specific coordinated patterns of gene expression in the embryonic breast and thigh muscles. These patterns correlated with growth rate of chicks after hatching and depended on a utility type of the breeds studied. Overall, the proposed models contributed to an expanded understanding of the coordinated gene expression in early development and growth, providing additional characteristics of genetic diversity in chickens. Abstract Elements of fractal analysis are widely used in scientific research, including several biological disciplines. In this study, we hypothesized that chicken breed biodiversity manifests not only at the phenotypic level, but also at the genetic-system level in terms of different profiles of fractal conformity and bioconsolidation in the early myogenesis gene expression. To demonstrate this effect, we developed two mathematical models that describe the fractal nature of the expression of seven key genes in the embryonic breast and thigh muscles in eight breeds of meat, dual purpose, egg and game types. In the first model, we produced breed-specific coefficients of gene expression conformity in each muscle type using the slopes of regression dependencies, as well as an integral myogenesis gene expression index (MGEI). Additionally, breed fractal dimensions and integral myogenesis gene expression fractal dimension index (MGEFDI) were determined. The second gene expression model was based on plotting fractal portraits and calculating indices of fractal bioconsolidation. The bioconsolidation index of myogenesis gene expression correlated with the chick growth rate and nitric oxide (NO) oxidation rate. The proposed fractal models were instrumental in interpreting the genetic diversity of chickens at the level of gene expression for early myogenesis, NO metabolism and the postnatal growth of chicks

Unraveling signatures of chicken genetic diversity and divergent selection in breed-specific patterns of early myogenesis, nitric oxide metabolism and post-hatch growth

Due to long-term domestication, breeding and divergent selection, a vast genetic diversity in poultry currently exists, with various breeds being characterized by unique phenotypic and genetic features. Assuming that differences between chicken breeds divergently selected for economically and culturally important traits manifest as early as possible in development and growth stages, we aimed to explore breed-specific patterns and interrelations of embryo myogenesis, nitric oxide (NO) metabolism and post-hatch growth rate (GR). These characteristics were explored in eight breeds of different utility types (meat-type, dual purpose, egg-type, game, and fancy) by incubating 70 fertile eggs per breed. To screen the differential expression of seven key myogenesis associated genes (MSTN, GHR, MEF2C, MYOD1, MYOG, MYH1, and MYF5), quantitative real-time PCR was used. We found that myogenesis associated genes expressed in the breast and thigh muscles in a coordinated manner showing breed specificity as a genetic diversity signature among the breeds studied. Notably, coordinated (“accord”) expression patterns of MSTN, GHR, and MEFC2 were observed both in the breast and thigh muscles. Also, associated expression vectors were identified for MYOG and MYOD1 in the breast muscles and for MYOG and MYF5 genes in the thigh muscles. Indices of NO oxidation and post-hatch growth were generally concordant with utility types of breeds, with meat-types breeds demonstrating higher NO oxidation levels and greater GR values as compared to egg-type, dual purpose, game and fancy breeds. The results of this study suggest that differences in early myogenesis, NO metabolism and post-hatch growth are breed-specific; they appropriately reflect genetic diversity and accurately capture the evolutionary history of divergently selected chicken breeds

Breed-specific patterns of early myogenesis, nitric oxide metabolism, and post-hatch growth in relation to genetic diversity and divergent selection in chickens [Породоспецифичные модели раннего миогенеза, метаболизма оксида азота и постнатального роста в связи с генетическим разнообразием и разнонаправленной селекцией у кур]

Aims: There is currently a significant genetic diversity across poultry breeds as a result of long-term domestication, breeding, and divergent selection, with each breed having its own distinctive phenotypic and genetic characteristics [1,2]. We presumed and set out to investigate whether differences between chicken breeds divergently selected for economically and culturally significant traits [3] manifest as early as possible in development and growth stages. Methods: Breed-specific patterns and relationships of embryo myogenesis, nitric oxide (NO) metabolism, and post-hatch growth rate were studied and analyzed [4]. Results: Our research revealed that myogenesis genes were coordinatedly expressed in the thigh and breast muscles, demonstrating breed uniqueness. Indicators of NO oxidation and post-hatch growth were largely consistent with utility breed types, with meat breeds showing higher NO oxidation levels and better growth rate values in comparison to egg, dual purpose, game, and fancy breeds. Conclusions: The findings of this study indicate that breed-specific variations in early myogenesis, NO metabolism, and post-hatch growth adequately represent genetic variety and reliably depict the evolutionary history of diversely chosen chicken breeds

Комплексный подход к выбору терапии у пациентов с остеоартритом при первичном обращении к врачу. Консенсус экспертов (обзор литературы и резолюция)

Osteoarthritis (OA) is the most common pathology of the musculoskeletal system and is a serious medical and social problem. OA is of particular importance in elderly and senile people due to the high frequency of comorbid pathology. Pain relief is a priority in the formation of individual therapeutic programs for patients with OA, starting from their first request for medical assistance. At the same time, due to the ambiguity of existing clinical recommendations, most experts note a number of difficulties in prescribing treatment for patients with OA.The article presents a consensus position of experts regarding a complex approach to the choice of therapy in patients with OA at the initial visit to the doctor. The article discusses: current clinical guidelines for the management of patients with OA; most common problems in the management of patients with OA in real clinical practice; goals of treatment strategies for OA taking into account the risk factors for its progression; an algorithm of pain relief during initial treatment in patients with OA; prevention of OA exacerbations with the use of basic structure-modifying drugs; recommendations for the choice of non-steroidal anti-inflammatory drugs.According to experts, a rational approach to the treatment of OA is based on the combined use of non-drug and pharmacological methods with constant monitoring of therapy regimens and side effects. These recommendations can be considered disease-modifying strategies that in many cases allow improving functional status and achieving long-term remission in patients with OA.Остеоартрит (ОА) – наиболее распространенная патология опорно-двигательного аппарата, являющаяся серьезной медико-социальной проблемой. Особое значение ОА приобретает у лиц пожилого и старческого возраста из-за высокой частоты коморбидной патологии. Купирование болевого синдрома является приоритетным при формировании индивидуальных терапевтических программ для пациентов с ОА, начиная с момента их первичного обращения за медицинской помощью. Вместе с тем из-за неоднозначности существующих клинических рекомендаций большинство экспертов отмечают ряд сложностей при назначении лечения больным ОА.В статье представлена согласованная позиция экспертов, касающаяся комплексного подхода к выбору терапии у пациентов с ОА при первичном обращении к врачу. Рассмотрены имеющиеся на сегодняшний день клинические рекомендации по ведению пациентов с ОА, наиболее часто возникающие проблемы при курации больных ОА в реальной клинической практике, цели лечебных стратегий при ОА с учетом факторов риска его прогрессирования, алгоритм лечения боли у пациентов с ОА при первичном обращении и профилактики обострений ОА с использованием базисных структурно-модифицирующих препаратов, рекомендации по выбору нестероидных противовоспалительных препаратов.По мнению экспертов, рациональный подход к терапии ОА основан на комбинированном использовании немедикаментозных и фармакологических методов при постоянном мониторинге режимов терапии и побочных эффектов. Данные рекомендации можно рассматривать как болезнь-модифицирующие стратегии, позволяющие во многих случаях улучшить функциональный статус и добиться длительной ремиссии у пациентов с ОА

Терапия остеоартрита коленных суставов с точки зрения доказательной медицины: ожидаемые краткосрочные, среднесрочные и долгосрочные результаты применения рецептурного кристаллического глюкозамина сульфата

The need for effective drugs for the treatment of knee osteoarthritis (OA) is constantly growing. Current guidelines recommend the use of symptomatic slow acting drugs for osteoarthritis (SYSADOA) such as glucosamine (GCA) in this disease. Among various drugs containing GCA, high bioavailability and clinical efficacy have been shown only for prescription crystalline GCA sulfate (pGCAS) administration. Several meta-analyses and network meta-analyses have shown that efficacy of pGCAS 1500 mg once daily is superior to other GCA-based products (such as GCA hydrochloride with or without sodium sulfate) and the combination of GCA with chondroitin sulfate (CS) in terms of reducing the intensity of pain and improving the functional state. These studies confirmed the favorable safety profile of pGCAS, which was comparable to placebo in the incidence of adverse events. Pharmacoeconomic studies have also demonstrated greater cost-effectiveness of pGCAS compared to other GCA drugs.A group of Russian experts at a meeting of the advisory committee reviewed the evidence in favor of the use of pGCAS and evidence of its effectiveness in the treatment of knee OA in comparison with other products that include GCA, and the fixed combination of GCA with CS. Taking into account the results obtained, the use of pGCAS at a dose of 1500 mg once a day is recommended as a rational choice for the treatment of knee OA.Потребность в эффективных препаратах для терапии остеоартрита (ОА) коленных суставов (КС) постоянно растает. В современных руководствах рекомендуется применять при этом заболевании симптоматические средства замедленного действия (SYSADOA), такие как глюкозамин (ГКА). Среди различных лекарственных средств, содержащих ГКА, высокая биодоступность и клиническая эффективность доказаны только для рецептурного кристаллического ГКА сульфата (рГКАС). В нескольких метаанализах и сетевых метаанализах было показано, что рГКАС в дозе 1500 мг 1 раз в сутки превосходит по эффективности другие продукты на основе ГКА (такие как ГКА гидрохлорид с натрия сульфатом или без него) и комбинации ГКА с хондроитина сульфатом (ХС) с точки зрения снижения интенсивности боли и улучшения функционального состояния. В этих исследованиях был подтвержден благоприятный профиль безопасности рГКАС, который по частоте развития нежелательных явлений был сопоставим с плацебо. Фармакоэкономические исследования также продемонстрировали большую экономическую эффективность рГКАС по сравнению с другими лекарственными средствами ГКА.Группа российских экспертов на совещании консультативного комитета рассмотрела свидетельства в пользу применения рГКАС и доказательства его эффективности при лечении ОА КС в сравнении с другими продуктами, в состав которых входит ГКА, и фиксированной комбинации ГКА с ХС. С учетом полученных результатов использование рГКАС в дозе 1500 мг 1 раз в сутки рекомендовано в качестве рационального выбора для лечения ОА КС

Метаанализ клинических исследований эффективности лечения остеоартрита препаратом Хондрогард

Aim. A meta-analysis of 8 controlled studies (n=771, age 53.6±6.2 years) of tie use of tie Chondroguard (100 mg i.m. first 3 injections, from tie 4th injection - 200 mg i.m., EOD, course 20-30 injections) in the complex therapy of osteoarthritis (OA).Materials and Methods. Tie meta-analysis according to tie fixed-effects model included all published clinical studies on tie efficacy and safety of the CG drug in OA). The effectiveness of therapy was assessed using the VAS, Lequesne, WOMAC scales/indices. For each study, information was collected on 23 features. Data analysis was carried out using the MEDSTUDY and "R" software packages.Results. Meta-analysis confirmed significant associations between the use of Chondroguard (CG. and pain reduction assessed by the visual analog scale (V)S. - CG: a decrease in pain intensity by -28.3 points, control: -11.6; p=0.042. There was a significant reduction in pain according to VAS at night (CG: -20.1; control: -9.9; p=0.05018., while sitting or lying down (CG: -15.5; control: -7.6; p=0.01656., when walking (CG: -28.2; control: -17.0; p=0.04957). The use of CG led to a significant decrease in the scores of the Lequesne index (CG: -4.3; control: -1.4; p=0.0349., and of the WOMAC index (CG: -338.4; control: -219.8; p=0.004., including WOMAC "function" (CG: -247.8; control: -96; p=0.0027., and WOMAC "stiffness" (CG: -25.4; control: -11.2; p=0.0462.. The incidence of side effects did not differ significantly from the control.Conclusion. Chondroguard is an effective treatment for osteoarthritis and has a good safety profile.Цель. Метаанализ восьми контролируемых исследований (n=771, возраст - 53,6±6,2 лет) применения препарата Хондрогард (ХГ) (100 мг в/м первые 3 инъекции, с 4-й инъекции - по 200 мг в/м, ч/д, курс - 20-30 инъекций) в комплексной терапии остеоартрита (ОА).Материалы и методы. В метаанализ по модели фиксированных эффектов вошли все опубликованные клинические исследования эффективности и безопасности использования препарата ХГ при ОА. Эффективность терапии оценивалась по шкалам/индексам ВАШ, Лекена, WOMAC. По каждому исследованию была собрана информация по 23 показателям. Анализ данных проводился программными пакетами MEDSTUDY и "R".Результаты. Подтверждены достоверные ассоциации между применением препарата ХГ и снижением боли по визуальной аналоговой шкале (ВАШ) - ХГ: снижение на -28,3 мм, контроль: -11,6; p=0,042. Установлено достоверное снижение боли по ВАШ ночью (ХГ: -20,1, контроль: -9,9; p=0,05018), сидя или лежа (ХГ: -15,5, контроль: -7,6; p=0,01656), при ходьбе (ХГ: -28,2, контроль: -17,0; p=0,04957). Применение ХГ приводило к значимому снижению баллов индекса Лекена (ХГ: -4,3, контроль: -1,4; p=0,0349) и суммарного индекса WOMAC (ХГ: -338,4, контроль: -219,8; p=0,004), в т.ч. WOMAC «функция» (ХГ:-247,8, контроль: -96; р=0,0027) и WOMAC «скованность» (ХГ: -25,4, контроль: -11,2; p=0,0462). Встречаемость побочных эффектов достоверно не отличалась от контроля.Заключение. Препарат Хондрогард является эффективным средством лечения остеоартирита и обладает хорошим профилем безопасности