Hip fracture risk and different gene polymorphisms in the turkish population

BACKGROUND: We aimed to discuss the risk assessments for both patients with hip fractures due to fall-related, low energy traumas and non-fractured control patients by examining bone mineral density and genetic data, two features associated with femoral strength and hip fracture risk. METHODS: Twenty-one osteoporotic patients with proximal femur fractures and non-fractured, osteoporotic, age- and gender-matched controls were included in the study. Bone mineral density measurements were performed with a Lunar DXA. The COL1A1, ESR, VDR, IL-6, and OPG genes were amplified, and labeling of specific gene sequences was performed in a multiplex polymerase chain reaction using the osteo/check PCR kit from the whole blood of all subjects. RESULTS: The bone mineral density (trochanteric and total bone mineral density values) of the fracture group was significantly decreased relative to the control group. We were not able to conduct statistical tests for the polymorphisms of the COL1A1, ESR, and VDR genes because our results were expressed in terms of frequency. Although they were not significant, we did examine differences in the IL-6 and OPG genes polymorphisms between the two groups. We concluded that increasing the number of cases will allow us to evaluate racial differences in femoral hip fracture risk by genotypes

Hip Fracture Risk and Different Gene Polymorphisms in the Turkish Population

BACKGROUND: We aimed to discuss the risk assessments for both patients with hip fractures due to fall-related, low energy traumas and non-fractured control patients by examining bone mineral density and genetic data, two features associated with femoral strength and hip fracture risk. METHODS: Twenty-one osteoporotic patients with proximal femur fractures and non-fractured, osteoporotic, age- and gender-matched controls were included in the study. Bone mineral density measurements were performed with a Lunar DXA. The COL1A1, ESR, VDR, IL-6, and OPG genes were amplified, and labeling of specific gene sequences was performed in a multiplex polymerase chain reaction using the osteo/check PCR kit from the whole blood of all subjects. RESULTS: The bone mineral density (trochanteric and total bone mineral density values) of the fracture group was significantly decreased relative to the control group. We were not able to conduct statistical tests for the polymorphisms of the COL1A1, ESR, and VDR genes because our results were expressed in terms of frequency. Although they were not significant, we did examine differences in the IL-6 and OPG genes polymorphisms between the two groups. We concluded that increasing the number of cases will allow us to evaluate racial differences in femoral hip fracture risk by genotypes

Prospective evaluation of free radicals and antioxidant activity following 6-month risedronate treatment in patients with postmenopausal osteoporosis

In addition to the well-described implications of estrogen deficiency in postmenopausal osteoporosis (PMO), free radicals are also effective on bone metabolism. The antioxidant vitamins C and E play an important role in the production of collagen, mesenchymal cell differentiation into osteoblasts, and bone mineralization. Therefore, the incidence of osteoporosis and the risk of fractures were decreased with vitamin C and E. It was proposed that free oxygen radicals are responsible for biological aging, atherosclerosis, carcinogenesis, and osteoclastic activity via their negative effects on the cell and DNA. In this study, we aimed to investigate and compare the levels of free radicals and serum antioxidant activity in patients with PMO and healthy subjects before and after six-month treatment with risedronate, which is an inhibitor of bone resorption. Twenty-three postmenopausal patients aged between 52–83 (mean [± standard deviation] 67.6 ± 8.17) with T scores below -2.5 in femur neck or L1-L4, and 23 postmenopausal healthy subjects were enrolled into the study. Patients who had received any medications within the last 6 months that could alter bone metabolism were excluded. Serum malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) levels were analyzed in both groups. The patients with PMO were commenced on 5 mg of risedronate, 1,200 mg of calcium, and 800 IU of vitamin D daily. The patients were reevaluated at the end of the sixth month. MDA and SOD levels were similar in patients with PMO when compared to the healthy group before the treatment, while the GPx levels were lower in patients with PMO (P = 0.014). GPx (P = 0.028) and MDA (P = 0.04) levels were increased in patients with PMO after the treatment. In contrast, SOD levels were decreased when compared to the initial levels (P = 0.006). There may be an insufficiency in different steps of the enzymatic antioxidant systems in patients with PMO without treatment. We observed an increment in lipid peroxidation levels and GPx levels with risedronate. We think that the decrement in SOD levels may be related with the utilized antioxidants due to the increased free radicals and the compensatory increment in the other steps of the antioxidant system

Obstructive Sleep Apnea in Ischemic Stroke patients

OBJECTIVE: To investigate the prevalence of obstructive sleep apnea in patients with ischemic stroke and to evaluate the effectiveness of nasal continuous positive airway pressure treatment. METHODS: Overnight polysomnography was performed by a computerized system in 19 subjects with ischemic stroke. Patients with an apnea-hypopnea index > 5 were considered to have obstructive sleep apnea. The appropriate level of continuous positive airway pressure for each patient was determined during an all-night continuous positive airway pressure determination study. Attended continuous positive airway pressure titration was performed with a continuous positive airway pressure auto-titrating device. RESULTS: Obstructive sleep apnea prevalence among patients with ischemic stroke was 73.7%. The minimum SaO2 was significantly lower, and the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer in patients with obstructive sleep apnea. In two patients with severe obstructive sleep apnea, we observed a decrease in the apnea-hypopnea index, an increase in mean wake time, mean SaO2, and minimum SaO2, and alterations in sleep structures with continuous positive airway pressure treatment. CONCLUSION: As the diagnosis and treatment of obstructive sleep apnea is of particular importance in secondary stroke prevention, we suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started

Open, Prospective, Multi-Center, Two-Part Study of Patient Preference with Monthly Ibandronate Therapy in Women with Postmenopausal Osteoporosis Switched From Daily or Weekly Alendronate or Risendronate-BONCURE: Results of Turkish Sub-Study

Aim: BONCURE (Bonviva for Current Bisphosphonate Users Regional European Trial), aimed to evaluate patient preference with monthly ibandronate in women with postmenopausal osteoporosis who previously received daily or weekly alendronate or risendronate. Materials and Methods: This prospective, open-label study consisted of two sequential stages, Part A (screening) and Part B (treatment). Patients enrolled into Part A completed the Candidate Identification Questionnaire (CIQ). In Part B, after completing the Osteoporosis Patient Satisfaction Questionnaire (OPSATQ), patients received monthly oral ibandronate 150 mg for 6 months. Following treatment, patients completed the OPSAT-Q and Preference Questionnaire. Results: A total of 223 patients (mean age, 63.7±9.51 years) were enrolled in Part A from Turkey. Among them, 103 (46.2%) answered “YES” to at least one CIQ question. The mean composite OPSAT-Q domain scores increased for convenience (mean change, 15.3±17.7 points), quality of life (10.4±20.4 points), overall satisfaction (11.9±22.7 points), and side effects (3.3±18.8 points). At month 6, 177 subjects (92.7%) preferred once-monthly dosing schedule and 99.0% were compliant (≥80%) with study treatment. Thirty (15.6%) subjects experienced mild to moderate adverse events, mostly gastrointestinal. Conclusion: Postmenopausal women with osteoporosis prefer and are more satisfied and compliant with monthly dosing of ibandronate than daily or weekly bisphosphonate treatment. (Turkish Journal of Osteoporosis 2012;18:1-7

Changes in Serum and Urine N-Telopeptide Levels of Postmenopausal Osteoporotic Patients Within 6-months of Risedronate Treatment - Original Investigation

Aim: N-Telopeptides (NTX), which are known as bone turnover markers are being increasingly used in early diagnosis of osteoporosis, determining the fracture risk and following up of the treatment outcome. Material and Method: In this study serum and urine NTX levels of postmenapousal patients [ages 60-83 (mean 69.45), n: 11] with no previous treatment of osteoporosis are compared with the levels after 6-months of risedronate treatment and serum and urine NTX levels of the control group [ages 57-73 (mean 64.64), n: 11]. Results: Consequently serum NTX (sNTX) levels of postmenapousal patients before risedronate therapy were significantly higher then the sNTX levels of the control group. After risedronate therapy sNTX levels were significantly higher and urine (uNTX) levels were lower when compared with the NTX levels before treatment. Also either sNTX or uNTX levels before and after the treatment were positively and strongly correlated. Discussion and Conclusion: Eventually bone turnover markers carry much importance in diagnosis and follow-up the treatment. Also the strong correlation between levels of NTX before and after the treatment shows that the sensitivity and specifity of these methods are high. Therefore they can be used as an alternative and adjunct method to bone densitometry to assess the response to treatment, especially to demonstrate the early changes. (Osteoporoz Dünyasından 2006;12:55-9

Obstructive sleep apnea syndrome as an uncommon cause of fibromyalgia: a case report

WOS: 000249803400012PubMed: 17589851Fibromyalgia syndrome (FMS) is characterized by chronic widespread musculoskeletal pain, stiffness and tenderness at multiple points. Sleep disturbances are common in FMS and patients usually complain about nonrestorative sleep. Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive pharyngeal collapse during sleep. Recurrent arousals from sleep occurs to restore pharyngeal patency in OSAS and this results in increased sympathetic activity and fragmentation of sleep. Sleep disturbances may lead to musculoskeletal pain and some studies suggest a relation between OSAS and FMS. Since OSAS is strongly associated with increased risk of myocardial infarction, cerebrovascular accidents and congestive heart failure, its diagnosis and treatment are of particular importance. Herein we present a female patient with diagnosis of FMS for 10 years who had complaints of morning fatigue, restless sleep, sleepiness during day and snoring besides musculoskeletal symptoms. Severe OSAS was diagnosed after polysomnographic analysis and FMS symptoms were totally improved with nasal continuous positive airway pressure treatment

Evaluation of allantoin levels as a new marker of oxidative stress in Behcet's disease

The increased production of reactive oxygen species (ROS) from activated neutrophils in Behcet's disease ( BD) and recurrent aphthous stomatitis (RAS) may result in increased oxidative stress. Uric acid can react rapidly with neutrophil-derived ROS to form allantoin. The purpose of the study was to evaluate the serum levels of allantoin as a new marker of oxidative stress in BD compared with malondialdehyde (MDA) levels as a well-known marker. Blood samples were obtained from 23 BD patients, 22 RAS patients as positive controls, and 21 healthy controls. When compared to the healthy controls, we found higher allantoin and MDA levels in the BD patients and higher MDA levels in the RAS patients. Serum ascorbic acid levels in the BD patients were significantly lower than in the controls. Increased allantoin and MDA levels suggest the possible involvement of free radicals in BD. As allantoin is only a product of uric acid oxidation by reactive oxygen and nitrogen species, it may also be used as a marker of oxidative stress in BD

Our Patients with Knee Osteoarthritis Risk Factors and Relationship with Osteoarhritis-Osteoporosis

Aim: Osteoarthritis (OA) is a degenerative disease, that developes as a result of the impairment of formation and destruction processes in cartilage and sinovial tissues, with the effect of various traumatic, biomechanic, inflammatory and genetic factors. Material and Methods: In this study, risk factors and relation between OA and OP (osteoporosis) is evaluated in 127 patients with knee OA. Age, gender, obesity, menopause, ligamentous laxity, DM, injury of joint, genetic predisposition and proprioceptive defects are the risk factors in knee OA. Results: No relation was observed between radiographic knee OA and scores of tests which evaluate pain and disability such as WOMAC and Lequesne; but there was a significant relation between obesity and WOMAC and Lequesne scores. Thus, obesity is a disability determinant in knee OA. We think that smoking has protective effects on OA, but this claim has to be proven with studies containing large control groups. In accordance with literature, we determined a significant concurrence between hand and knee OA. This relation gets stronger as severity of radiographic disease increases. In our patients with knee OA depriving clinical inflammation signs, CRP values were higher than control group and this was statistically significant. Therefore, we may not deny a chronic inflammatory response in OA. No significant relation observed between serum cholesterol values, lipid values, blood pressure and OA. However, presence of DM accelerates the radiographic progression of OA. Serum uric acid levels were significantly higher in our OA patients than in controls. The literature data, that high serum uric acid levels play role especially in generalised OA’s multifactorial etiology, is also supported by our results. Conclusion: Age, gender, menopause and genetic predisposition seemed to have more effects on the incidence of knee OA; while obesity, period of menopause, ligamantous laxity and DM seemed to have more effects on OA progression according to our results. (Turkish Journal of Osteoporosis 2011;17:14-20

Günlük veya haftalık alendronat veya risendronat alan postmenopozal osteoporozlu kadınlarda aylık ibandronat için hasta tercihinin değerlendirildiği açık- etiketli, prospektif, çok-merkezi, iki-aşamalı çalışma-BONCURE: Türkiye alt-çalışması

Amaç: BONCURE (Mevcut Bisfosfonat Kullanıcıları İçin Bonviva Bölgesel Avrupa Çalışması) ile daha önce günlük veya haftalık alendronat veya risendronat alan postmenopozal osteoporozu olan kadınlarda aylık ibandronat için hasta tercihinin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Bu prospektif, açık-etiketli çalışma, iki ardışık aşamadan oluşmuştur: A (tarama) ve B (tedavi) aşaması. A aşamasına kaydolan hastalar Aday Kimlik Anketi (CIQ) tamamladı. B aşamasında, Osteoporoz Hasta Memnuniyeti Anketi (OPSAT Q) tamamladıktan sonra, hastalar 6 ay boyunca aylık oral 150 mg ibandronat aldı. Tedaviden sonra, hastalar OPSAT-Q ve Tercihi Anketi tamamladı. Bulgular: Türkiye’den 223 hasta (yaş ortalaması 63,7±9,51) A aşamasına dahil edildi. Bunların arasında, 103’ü (%46,2) en az bir CIQ sorusunu "EVET" yanıtladı. Ortalama bileşik OPSAT-Q alan puanları; kolaylık (ortalama değişiklik, 15,3±17,7 puan), yaşam kalitesi (10,4±20,4 puan), genel memnuniyet (11,9±22,7 puan) ve yan etkiler (3,3±18,8 puan) için arttı. Altıncı ayda 177 hasta (%92,7) bir kez aylık doz programını tercih etti ve %99,0’u çalışma tedavisi ile uyumlu (?%80) idi. Otuz hasta (%15,6) çoğunlukla gastrointestinal olan hafif ve orta şiddette advers olay yaşadı. Sonuç: Postmenopozal osteoporozu olan kadınlar, günlük veya haftalık bifosfonat tedavisine göre aylık ibandronatı daha çok tercih etmekte ve bu tedavi ile daha memnun ve uyumlu olmaktadır. (Türk Os te opo roz Dergisi 2012;18:1-7)Aim: BONCURE (Bonviva for Current Bisphosphonate Users Regional European Trial), aimed to evaluate patient preference with monthly ibandronate in women with postmenopausal osteoporosis who previously received daily or weekly alendronate or risendronate. Materials and Methods: This prospective, open-label study consisted of two sequential stages, Part A (screening) and Part B (treatment). Patients enrolled into Part A completed the Candidate Identification Questionnaire (CIQ). In Part B, after completing the Osteoporosis Patient Satisfaction Questionnaire (OPSATQ), patients received monthly oral ibandronate 150 mg for 6 months. Following treatment, patients completed the OPSAT-Q and Preference Questionnaire. Results: A total of 223 patients (mean age, 63.7±9.51 years) were enrolled in Part A from Turkey. Among them, 103 (46.2%) answered “YES” to at least one CIQ question. The mean composite OPSAT-Q domain scores increased for convenience (mean change, 15.3±17.7 points), quality of life (10.4±20.4 points), overall satisfaction (11.9±22.7 points), and side effects (3.3±18.8 points). At month 6, 177 subjects (92.7%) preferred once-monthly dosing schedule and 99.0% were compliant (≥80%) with study treatment. Thirty (15.6%) subjects experienced mild to moderate adverse events, mostly gastrointestinal. Conclusion: Postmenopausal women with osteoporosis prefer and are more satisfied and compliant with monthly dosing of ibandronate than daily or weekly bisphosphonate treatment. (Turkish Journal of Osteoporosis 2012;18:1-7