Sistemska nemaligna osteoporoza skeleta i resorpcija bezubih grebenova vilica

Introduction. Systemic osteoporosis damages skeletal bones to different degrees. The aim of this study was to determine the intensity and correlation of the osteoporotic changes in the bone density of the skeleton and body mass index (BMI) with a reduction in edentulous mandibles, and to assess possibility of reparation of layers of mandibles with increase of mineral content in jaws of patients affected by osteoporosis. Material and Methods. In this study, 99 edentulous patients with decreased bone density comprised the experimental group, and 48 edentulous patients with normal bone densities formed the control. The age of the examined patients was 69.02 ± 7,9, range 53-74 of females and 69.11 ± 7.1, range 59-76 years. Radiographs of the hands and panoramic radiographs were done for all the patients. The values of BMI, metacarpal index, density of lumbar spine (L2-L4), in the phalanx and in segments of the mandibles as well as the edentulous alveolar ridges heights were measured, assessed and calculated. Results. The lowest value of the total skeletal density was established in the osteoporotic patients on the basis of the average T-score of- 2.5 in men, and - 2.6 in women. Minimum values of the edentulous ridges heights (right/left, in mm) were measured in both osteoporotic females (21.84/22.39) and males 24.90/24.96) patients. By comparison of the densities of the metacarpal bones, proximal phalanx, segments of the edentulous mandibles and based on the numerical values of the edentulous ridges heights, x2 = 3.81 was found in men and x2 = 4.03 was found in women with normal bone densities; x2 = 5.92 was found in men and x2 = 6.25 was found in women with osteopenia; x2 = 2.63 was found in men and x2 = 3.85 was found in women with osteoporosis, on the level of probability of 0.05. After application of calcium and calcitonin in solutions, moderate increment of density (p lt 0.05; p lt 0.01) was verified, compensating up to 4% of total loss of mass, minerals and solidity of denture bearing areas of osteoporotic mandibles. Conclusion. Systemic osteoporosis leads to decrease of densities of bones of mandibles and causes reduction of edentulous ridges.Uvod. Sistemska osteoporoza oštećuje kosti humanih skeleta u različitoj meri. Cilj ove studije je bio da se utvrde intenzitet i povezanost promena u gustini skeleta usled osteoporoze i indeks telesne mase (BMI) sa redukcijom bezube mandibule, i da se proceni mogućnost reparacije slojeva u mandibuli praćena porastom mineralnog sadržaja u vilicama pacijenata obolelih usled osteoporoze. Materijal i metode. U ovoj studiji, 99 bezubih pacijenata sa smanjenom gustinom kosti su sačinjavali eksperimentalnu grupu, a 48 bezubih pacijenata sa normalnom gustinom kosti su bili kontrolna grupa. Godine starosti ispitanih pacijenata i pacijentkinja su iznosile 69,02 ± 7,9, u granicama od 53 do74 godine kod žena, i 69,11 ±7,1, u granicama od 59 do76 godina kod muškaraca. Radiografije šaka i ortopantomogrami sunačinjeni kod svih ispitanih pacijenata. Vrednosti BMI, metakarpalnih indeksa, gustine tela lumbalnih pršljenova (L2-L4), u falangama i u segmentima donjih vilica, a takođe i visine bezubih alveolarnih grebenova su bile ispitane, izmerene i izračunate. Rezultati. Najmanja vrednost ukupne gustine skeleta je utvrđena kod pacijenata obolelih od osteoporoze na osnovu T veličine od -2,5 kod muškaraca, i -2,6 kod žena. Minimalne vrednosti visina bezubih grebenova (desno/levo, u mm) su bile izmerene i kod žena (21,84/22,39) i kod muškaraca (24,90/24,96) obolelih od osteoporoze. Upoređivanjima gustina metakarpalnih kostiju, proksimalnih falangi, segmenata (prostora) bezubih mandibula, i na osnovu numeričkih vrednosti izmerenih visina bezubih grebenova, x2 = 3,81 je izračunato kod muškaraca, a x2 = 4,03 kod žena sa normalnom koštanom gustinom; x2 = 5.92 je izračunato kod muškaraca, a x2 = 6,25 kod žena sa osteopenijom; x2 = 2,63 je izračunato kod muškaraca, a x2 = 3,85 je izračunato kod žena sa osteoporozom, na osnovu nivoa verovatnoće od 0,05. Posle aplikovanja kalcijuma i kalcitonina u rastvoru, umeren porast gustine (p lt 0,05; p lt 0,01) je zabeležen, nadoknađujući, na taj način ukupno do 4% gubitka koštane mase i mineralnog sadržaja u nosećim i potpornim tkivima osteoporoznih donjih vilica. Zaključak. Sistemska osteoporoza dovodi do smanjenja gustine kosti donje vilice i uzrokuje resorpciju bezubih grebenova

Znanje o osteoporozi kod žena u postmenopauzi u Srbiji

Background/Aim. Osteoporosis mainly affects women in the early years following menopause. The aim of this study was to determine the level of knowledge about osteoporosis and osteoporosis related risk factors in postmenopausal women in Serbia. Methods. The study included postmenopausal women regardless if suffering from osteoporosis or not. Assessment of knowledge was carried out by using the Osteoporosis Knowledge Assessment Tool - Shorter Version (OKAT-S) questionnaire that was validated for Serbian population. Answers to the 9 questions were coded as 1 - true, or 0 - false or 'do not know'. Also, the following risk factors data for osteoporosis were collected: age, the onset and duration of menopause, body mass index (BMI), data on fractures, the incidence of falls, smoking, lifestyle (active, sedentary), regular sunbathing, calcium and vitamin D supplementation, intake of milk and dairy products. Results. A total of 132 postmenopausal women responded to the questionnaire with the response rate of 90.41%. Their knowledge varied from 27.94% to 74.26% of the correct answers, with the average OKAT-S score of 4.5 (SD = 2.55), which was 50% of the maximum possible score. Only 2 participants (1.47%) filled the all OKAT-S items correctly, while 11 (8.09%) of them did not have the proper answer to any question. A reduced bone density (T-score below -1) was registered in 40.91% of the women, previous fractures in 49 (34.51%), and more or less 3 falls registered in 9.59% or 4.79%, respectively. Conclusion. The Serbian version of the questionnaire OKAT-S revealed generally poor knowledge on osteoporosis among postmenopausal women in Serbia. Developing effective interventions and public health programms could be helpful in general education towards understanding osteoporosis and risk factors. Promotion of preventive measures and healthy behaviour may prevent or at least slow down the accelerated bone loss in postmenopausal women.Uvod/Cilj. Osteoporoza uglavnom pogađa žene u ranim godinama posle menopauze. Cilj rada bio je da se proceni znanje o osteoporozi i faktorima rizika kod žena u postmenopauzi u Srbiji. Metode. U studiju su bile uključene žene u postmenopauzi nezavisno od toga da li boluju od osteoporoze ili ne. Procena znanja o osteoporozi vršena je pomoću upitnika Osteoporosis Knowledge Assessment Tool - Shorter Version (OKAT-S) koji je validiran za srpsku populaciju. Odgovori na 9 pitanja kodirani su sa 1 - pravilan ili 0 - nepravilan odgovor ili 'ne znam'. Takođe, sakupljeni su sledeći podaci o faktorima rizika od osteoporoze: starost, početak i dužina trajanja menopauze, indeks telesne mase [body mass index (BMI)], podaci o prelomima, broj padova, pušenje, životni stil (sedeći ili aktivni), redovno sunčanje, dopuna kalcijumom i vitaminom D, korišćenje mleka i mlečnih proizvoda. Rezultati. Od ukupno 146 ispitanica, upitnik OKAT-S popunile su 132 ispitanice (nivo odgovora od 90,41%). Nivo njihovog znanja varirao je od 27,94% do 74,26% ispravnih odgovora, sa prosečnim OKAT-S skorom od 4,5 (SD = 2,55), što čini 50% od maksimalno mogućeg skora. Samo dve ispitanice (1,47%) pravilno su odgovorile na sva pitanja, dok njih 11 (8,09%) nije imalo nijedan ispravan odgovor. Snižen T-skor, manje od -1, registrovan je kod 40,91% ispitanica, a prethodni prelom kod 49 (34,51%). Kod 9,59% ispitanica registrovano je više od 3, a kod 4,79% manje od 3 pada. Zaključak. Srpska verzija upitnika OKAT-S otkrila je generalno loše znanje o osteoporozi kod žena u postmenopauzi u Srbiji. Poboljšano znanje o osteoporozi i faktorima rizika moguće je postići razvojem efikasnih interventnih i javnih zdravstvenih programa. Promocija preventivnih mera i zdravog ponašanja može sprečiti ili bar usporiti prerani gubitak koštane mase kod žena u postmenopauzi

Multiple Major and Minor Anomalies Associated With Klippel-Feil Syndrome: A Case Report

Klippel-Feil syndrome is defined as congenital fusion of two or more cervical vertebrae. In this article, we report a 55-year-old male patient with one-year history of neck pain, headaches, and one episode of syncope after a severe trauma. X-rays and magnetic resonance imaging of cervical spine revealed fused vertebral bodies of C2-C5. The major anomalies associated with Klippel-Feil syndrome (small stature, thoracic kyphoscoliosis, lumbar scoliosis, restricted opening mouth, and bilateral sensorineural hearing loss) as well as multiple minor anomalies (mild face asymmetry, high arched palate, rhinoscoliosis, high nasal bridge, inclined septi nasi, and thin upper lip) were detected. This is a rare case describing the anomalies of the nose in Klippel-Feil syndrome patients. Our patient had no central cord impairment following a severe trauma

Novi lekovi u terapiji osteoporoze - pregled 2. i 3. - faze kliničkih istraživanja

Osteoporosis is a chronic disease with increasing incidence that predominantly occurs in female population. There are evidences that bisphosphonates, selective estrogen receptor modulators, denosumab, teriparatide and strontium renalate, prevent vertebral fractures while alendronate, risedronate, zoledronic acid, denosumab and strontium renalate prevent hip fractures. Although these drugs are effective in osteoporosis treatment, their use is limited by their side-effects and low-adherence. The aim of this review article was to compare efficacy of new drugs for osteoporosis currently in phase 2 and 3 clinical trials. After reviewing 57 articles available on PubMed and Scopus databases that evaluated efficacy of osteoporosis medications, 10 papers, that fulfilled the review criteria, were selected for the analysis. Finally, the efficacy of five drugs was compared. Efficacy was evaluated by the values of bone mineral density (BMD) and bone turnover markers (BTM). In all the analyzed articles the BMD increased and changes of BTM were noted. The highest increase of lumbar BMD from the baseline values was achieved after six months of subcutaneous application of 20 μg/day teriparatide (11.3%). The lowest increase of BMD in the same region was recorded after six months of risedronate therapy 100 mg per os once monthly (2.1%). From ten selected articles, only one has reported data about fracture risk.Osteoporoza je hronična bolest koja je sve više zastupljena i to pretežno kod osoba ženskog pola. Postoje dokazi da bisfosfonati, selektivni modulatori estrogenskih receptora, denosumab, teriparatid i stroncijum ranelat mogu da preveniraju prelom kuka. Iako su ovi lekovi efikasni u lečenju osteoporoze, njihova upotreba je ograničena usled ispoljavanja neželjenih reakcija, a time i postojanja niske adherencije bolesnika. Cilj ovog preglednog rada bio je upoređivanje efikasnosti novih lekova za lečenje osteoporoze koji su trenutno u 2. i 3. fazi kliničkih istraživanja. Nakon pregleda 57 originalnih radova koji su imali za cilj da pokažu efikasnost lekova u lečenju osteoporoze, dostupnih na PubMed i Scopus bazi, za analizu je odabrano 10 radova koji su zadovoljili kriterijume za pretraživanje. Na kraju analize, poređena je efikasnost pet lekova. Efikasnost je evaluirana na osnovu vrednosti mineralne koštane gustine (BMD) i koštanih markera (BTM). Povećanje BMD vrednosti i promene u vrednostima BTM zabeležene su u svim radovima. Najveće povećanje BMD (za 11,3%) lumbalnog skeletnog regiona postignuto je nakon šestomesečne subkutane terapije teriparatidom u dozi 20 μg dnevno. Najmanje povećanje BMD (za 2,1%) istog skeletnog regiona zabeleženo je nakon šestomesečne per os terapije risedronatom u dozi od 100 mg jednom mesečno. Od deset analiziranih studija, samo je jedna prikazala podatke o riziku od frakture

Validation of the osteoporosis quality of life questionnaire QUALEFFO-41 for the Serbian population

Background: Vertebral fractures could lead to reduced physical, social and mental functioning, and loss of personal independence. Therefore, during the treatment of osteoporosis, it has become necessary to examine the changes in everyday functioning, well-being and health related quality of life (HRQOL). To that effect, this study aims to translate, culturally adapt, and validate the Serbian version of Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) for patients with vertebral fractures. Methods: Nine female patients with osteoporosis participated in the pre-validation study. A validation, case-control study included two groups of female patients: one that consisted of 50 female patients with osteoporosis, and with at least one vertebral fracture, and another one that consisted of 50 control patients with osteoporosis but without fractures. They completed the QUALEFFO-41 and the EuroQol group questionnaire with five dimensions (EQ-5D) twice within a month. The validation study examined internal consistency, concurrent validity, test-retest reliability, sensitivity and specificity. Results: During the pre-validation study, three of the items in the QUALEFFO-41 were slightly changed. Afterwards, during the validation study, the statistically significant differences (adjusted for: age, duration of menopause, current employment and marital status) in the mean values of all domains and total scores between the groups were noted. For the case group, the internal consistency of the QUALEFFO-41 domains and of total questionnaire was above 0.70. The test-retest reliability was tested by the intraclass correlation coefficients (ICC) that were in range 0.87 - 0.96 for the case, and 0.15 - 0.83 for the control group. Correlations between the total scores of the QUALEFFO-41 and the EQ-5D health state value, for both groups were negative and statistically significant (r = -0.78, p lt 0.001 and r = -0.73, p lt 0.001, respectively). The QUALEFFO-41 had a better prediction of the value of HRQOL of cases compared to the generic questionnaire EQ-5D (the AUC difference was 0.099, p = 0.013). Conclusions: The Serbian QUALEFFO-41 version is reliable, valid, sensitive and predictive for examinations of HRQOL in patients with prevalent vertebral fractures and can be used in further studies

Značaj procene kvaliteta života pacijenata sa osteoporozom I prisutnim fakturama

Subjektivna merenja zdravlja, kao što je merenje kvaliteta života se fokusiraju na proceni uticaja bolesti i terapije na život pojedinaca. U cilju sticanja celokupne slike lečenja pacijenata i uspešnosti terapije, neophodno je da se pored kliničkih parametara prate i ekonomski i humanistički ishodi lečenja. Mnogim studijama je pokazano da se kvalitet života pacijenata sa dijagnozom osteoporoze razlikuje u zavisnosti od postojanja osteoporotične frakture, mesta nastanka frakture i broja fraktura. Domeni kvaliteta života koji su najčešće pogoršani usled bolesti jesu bol, nemogućnost obavljanja kućnih poslova, umanjena mogućnost fizičkog funkcionisanja, društvena izolacija, anksioznost, depresija, osećaj gubitka samopouzdanja i smanjene energije. Procena kvaliteta života pacijenata može da pomogne u izboru adekvatne terapije i omogući procenu efikasnosti terapije. Vrednosti kvaliteta života, ukoliko se praćenje izvrši u određenom vremenskom periodu, mogu da ukažu na efikasnost jednog leka, da omoguće poređenje efikasnosti dva ili više leka, ili da ukažu na bolju adherencu pacijenata kada se poredi upotreba više lekova. Merenje kvaliteta života omogućuje primenu farmakoekonomskih metoda koje se baziraju na poređenju troškova tokom terapije i promena u kvalitetu života pacijenata tokom lečenja. Budući da je osteoporoza hronična bolest, neophodan je multidiciplinaran pristup u lečenju. Razumevanje socijalnih dimenzija povezanih sa lečenjem bolesti je od velike važnosti u izboru adekvatne terapije i nege pacijenata.Predavanje po pozivu štampano u celin

Antiresorptivna terapija osteoporoze

Kost je dinamično tkivo u kome se neprekidno odigrava proces remodeliranja koji podrazumeva ciklus resorpcije starog koštanog tkiva i njegove zamene novim. U osteoporozi dolazi do disbalansa ova dva procesa u pravcu povećane koštane resorpcije, što slabi snagu koštanog tkiva i povećava rizik za prelome. Farmakološka terapija odobrena za prevenciju i lečenje osteoporoze je predominantno bazirana na antiresorptivnim agensima (aminobisfosfonati, SERM, kalcitonin, denosumab i estrogeni sa ili bez progesterona) različitog mehanizma dejstva. Aminobisfosfonati su najčešće prepisivani lekovi za ovu indikciju. Pokazano je da svi bisfosfonati redukuju vertebralne prelome. Osim sličnosti, bisfosfonati se međusobno razlikuju po 3D strukturi, afinitetu kojim se vezuju za koštani mineralni matriks, po farmakološkoj jačini i dužini supresije. Čini se da je glavni mehanizam kojim lekovi ove klase deluju, inhibicija ključnog enzima mevalonatnog puta (farnesil pirofosfataze) u osteoklastima, što indukuje njihovu apoptozu. Zbog akumulacije u kosti, bisfosfonati nastavljaju da se oslobađaju iz kosti godinama posle prestanka lečenja i njihova zaštita od preloma se produžava 3-5 godina po prestanku lečenja. Novi agens denosumab je humano monoklonsko antitelo koje inhibira aktivnost liganda za receptor aktivator NFkB (RANKL), glavnog stimulatora stvaranja i aktivacije osteoklasta. Dok vodiči pružaju dobre smernice koji bolesnici treba da dobiju anti osteoporotičnu terapiju, oni ne daju specifične preporuke lekaru koji lek treba da prepiše u kojoj situaciji. Odabir leka u lečenju osteoporoze mora da bude individualizovan za svakog pojedinačnog bolesnika. Da bi se odabrao najbolji lek za pojedinačnog bolesnika, lekar u dogovoru sa bolesnikom mora da razmotri nekoliko važnih osobina svake terapijske mogućnosti: efikasnost, sigurnost, cenu, pogodnost primene (dozni režim i način primene), ali i druge moguće ekstraskeletne koristi od antiosteoporotične terapije, koja nije direktno povezana sa osteoporozom (napr. bol, redukcija relativnost rizika za karcinom dojke).Predavanje štampano u celin

Osteoporoza - prevencija i farmakoterapija

Иако је остеопороза болест и жена и мушкараца, преваленција је већа код жена и повећава се у менопаузи. Према етиологији болести разликујемо примарну (идиопатску) и секундарну остеопорозу. Третман остеопорозе може се поделити на мере превенције и лечење специфичном фармакотерапијом. Разматрање улоге кофактора у процесу ремоделовања костију олакшава разумевање механизма дејства дијететских намирница и лекова који се могу користити у превенцији и/или терапији остеопорозе. Неопходно је да здравствени радници буду у потпуности упознати са предностима и ризицима при постављању дијагнозе и лечењу остеопорозе.Although osteoporosis affects both men and women, it is more prevalent among women and increases during menopause. Based on the etiology osteoporosis may be primary (idiopathic) or secondary. The treatment of osteoporosis is divided into the basic measures for fracture prevention and/or the specific pharmacotherapy. By understanding the role of cofactors in the processes of bone remodeling we can explain the mechanisms of action of dietary supplements and drugs which can be used in the prevention or treatment of osteoporosis. It is important for health care providers to be fully aware of the potential risks and benefits of diagnosis and treating osteoporosis