Management of glucocorticoid-induced osteoporosis: prevalence, and emerging treatment options

An excess amount of glucocorticoids represents the primary and most frequent etiological factor influencing secondary osteoporosis. Patients receiving glucocorticoids, but also those with the endogenous form of hypercorticism, are at high risk for the loss of bone density, with the subsequent occurrence of pathological fractures. In this review, we summarize the currently available methods of prevention and the treatment of glucocorticoid-induced osteoporosis. We also include a proposal for both a prophylactic and therapeutic approach that takes into account the risk factors typical for long-term users of glucocorticoids

Osteoporosis, Fractures, and Diabetes

It is well established that osteoporosis and diabetes are prevalent diseases with significant associated morbidity and mortality. Patients with diabetes mellitus have an increased risk of bone fractures. In type 1 diabetes, the risk is increased by ∼6 times and is due to low bone mass. Despite increased bone mineral density (BMD), in patients with type 2 diabetes the risk is increased (which is about twice the risk in the general population) due to the inferior quality of bone. Bone fragility in type 2 diabetes, which is not reflected by bone mineral density, depends on bone quality deterioration rather than bone mass reduction. Thus, surrogate markers and examination methods are needed to replace the insensitivity of BMD in assessing fracture risks of T2DM patients. One of these methods can be trabecular bone score. The aim of the paper is to present the present state of scientific knowledge about the osteoporosis risk in diabetic patient. The review also discusses the possibility of problematic using the study conclusions in real clinical practice

ICT Based Diabetes Management System with Comprehensive Mobile Application: Clinical Usefulness Evaluation

Objective of the presented study is to introduce telemedicine system that integrates all of the most implemented features that appear in different mobile diabetes applications in addition to blood glucose: tracking of insulin or other medications, communication, diet management, physical activity, weight, blood pressure, personal health record, education, social media, and alerts. Presented telemedicine system employs these features for management of Type 1 and Type 2 diabetes patients. Clinical evaluation after 3 months of intervention showed change of HbA1c in both patient groups was not only statistical significant but it had also a clinical dimension. The HbA1c decreased by 0,5% represents significant change for reduction of diabetic complications. Baseline for HbA1c in 29 T1DM patients: 8.1±1.5% versus 7.5±1.2% (P = 0.008). Baseline for HbA1c in 26 T2DM patients: 7.4±1.2% versus 6.8±1.1% (p=0.001). Results show statistically significant tendency to decrease in T2DM patients in weight 93.2±13.6kg compared to 91.9±14.2kg (P=0.08); and BMI 30.7±4.1 kg/m2 compared to 30.2±4.2 kg/m2 (P=0.08)

DataSheet_1_Supplementation with myo-inositol and Selenium improves the clinical conditions and biochemical features of women with or at risk for subclinical hypothyroidism.pdf

PurposeThe present study aims to evaluate the effect of myo-Inositol plus Selenium supplementation in patients affected by subclinical hypothyroidism.MethodsOne hundred and forty-eight patients were included in the study from 8 different centers of Slovakia, and treated for 6 months with a daily dose of 600 mg myo-Ins plus 83 mcg Se. The patients included at the enrollment were women of reproductive age (18-50), who exhibit values of TSH in the range 2.5-5 mU/l and positivity to antibodies TPO-Ab/TG-Ab, or otherwise values of TSH in the range 5-10 mU/l both with and without positivity to antibodies TPO-Ab/TG-Ab.ResultsPatients affected by subclinical hypothyroidism exhibited a significant improvement of their condition when treated for 6 months with a combination of myo-Inositol and Selenium. The TSH values significantly ameliorated along with the index of autoimmunity and the thyroid status. In a sub-class of patients, the auto-antibody titer decreased after myo-inositol + Selenium administration. The treatment also induces a regularization of the menstrual cycle and a reduction of the cholesterol in the patients enrolled for the study. Furthermore, a significant improvement is observed in the perception of the symptoms associated with subclinical hypothyroidism over the treatment period.ConclusionA dietary supplementation with of myo-Inositol and Selenium in the treatment of patients affected by subclinical hypothyroidism exhibits a beneficial role in the recovery of TSH values, in the improvement of the symptoms associated to this condition and in the maintenance of the thyroid functions.The trial was approved by the Ethical Committee from National Institute of Endocrinology and Diabetology of Lubochna, Slovakia, date 18.12.2018, registration number: 3124/2018.</p

McCune-Albright syndrome

McCune-Albright syndrome (MAS) is a very rare disease characterizedby the triad of bone defects, skin hyperpigmentation, andvarious types of endocrine and non-endocrine manifestations. Itfalls into the category of sporadic genetic disorders and its exactincidence is unknown. In its more severe forms, the disease manifestsitself already in early childhood and can gradually affectmore and more organs throughout life. The extent and degree ofinvolvement of affected tissues are heterogeneous due to themosaicism of the genetic mutation. The disease is the subject ofextensive research and new pathogenetic mechanisms are beingelucidated, leading to new diagnostic and therapeutic choices. Inaddition, the authors present a case report of an adult femalepatient with McCune-Albright syndrome. The clinical picture isdominated by bone involvement, thyroid hyperfunction and persistenthyperestrogenism. The case report underlines the fact thatmanagement of patients with McCune-Albright syndrome continuesto be a challenge

Serum 25-hydroxyvitamin D Concentration Significantly Decreases in Patients with COVID-19 Pneumonia during the First 48 Hours after Hospital Admission

It is unclear how ongoing inflammation in Coronavirus Disease 2019 (COVID-19) affects 25-hydroxyvitamin D (25[OH]D) concentration. The objective of our study was to examine serum 25(OH)D levels during COVID-19 pneumonia. Patients were admitted between 1 November and 31 December 2021. Blood samples were taken on admission (day 0) and every 24 h for the subsequent four days (day 1–4). On admission, 59% of patients were 25(OH)D sufficient (>30 ng/mL), and 41% had 25(OH)D inadequacy (p p = 0.230) and day 3 and day 4 (25.8 ng/mL vs. 25.9 ng/mL; p = 0.703). The absolute 25(OH)D change between hospital admission and day 4 was 16% (4.8 ng/mL; p p = 0.018). Therefore, serum 25(OH)D concentration after hospital admission in acutely ill COVID-19 patients should be interpreted with caution. Whether low 25(OH)D in COVID-19 reflects tissue level vitamin D deficiency or represents only a laboratory phenomenon remains to be elucidated in further prospective trials of vitamin D supplementation

Prevalence and epidemiological characteristics of patients with diabetic retinopathy in Slovakia: 12-month results from the DIARET SK study.

PURPOSE:To evaluate the prevalence and epidemiological characteristics of diabetic retinopathy (DR) in Slovakian patients with Type 1 and 2 diabetes mellitus (DM) in the DIARET SK study. PATIENTS AND METHODS:An epidemiological multi-center survey that included 4,078 adult patients (aged ≥18 years) from 51 diabetologists and 47 ophthalmologists. Data were collected from February to December 2015. RESULTS:The final data set consisted of 4,014 patients; 3,700 were enrolled (Type 2 DM = 3,405, Type 1 DM = 295) using a quasi-random approach; 16 (Type 2 DM = 15, Type 1 DM = 1) patients in the pre-specified group had DM duration of 11.0 HbA1c in Type 1 DM (5.8%) than Type 2 (2.0%). The mean (SD) duration of Type 2 DM was shorter compared with Type 1 (7.5 [5.2] vs 10.3 [6.9] years). In Type 2 DM patients, there were 516 (15.5%) cases of DR, 19 (0.56%) of proliferative DR (PDR), and 106 (3.11%) of diabetic macular edema (DME). In Type 1 DM patients, there were 86 (29.15%) cases of DR, 10 (3.39%) PDR, and 12 (4.07%) DME. CONCLUSIONS:In Slovakian patients with DM, the duration of disease and higher HbA1c were the most prevalent factors that contributed to the development of DR and DME