General and specific pathological endocrine processes that accompany development of skeleton osteoporotic changes

Abstract

Оbjective. The purpose of the study was to determine the pattern and influence of hormonal regulation of calcium-phosphorus metabolism on the development of osteoporotic changes in woman bones in premenopausal (for comparison as a control) and postmenopausal periods.Materials and methods. In the study were enrolled 130 patients who were divided into two groups. The first – the patient’s pre-menopausal (with later stages of reproductive age – stages –IIIa and –ІІІb by STROW classification) and the second – in postmenopausal patients with persistent absence of menstruation for more than one year (stage +Ia and +Ib according to the STROW classification). The magnitude of the T-test bone DEXA scans revealed the absence of osteoporotic changes in the skeleton (the value of the T-score of –1 SD to +1 SD), osteopenia (T-score value is from –2,5 SD up to –1 SD) and osteoporosis (presence of clinically significant pathological vertebral fractures on bone DEXA scans at (T-score less than –2,5 SD). The content of calcium, phosphorus, and other biologically active substances were determined in the blood by ELISA.Results and discussion. The common pathogenic processes which cause the development of osteoporotic changes in women’s skeleton in pre- and postmenopausal periods were hypocalcemia, deep hypoestrogenemia, hyperparathyroidism and increased osteocalcin with a decrease of calcitonin. In subjects with osteoporosis observed hyperfosfatemia, thyroid disturbance, progressive activation of alkaline phosphatase, and hypogonadism with hypoandrogenia and hypoprogestinemia, increased levels of cortisol and a higher level of activity proinflammatory cytokine IL-1β. Diagnostic criteria of osteoporotic skeletal changes were parathyroid hormone levels (above 42 pg/ml) and level of estradiol (less than 59 pmol/l) in blood; for postmenopausal women – level of osteocalcin (above 14 ng/l) and the diagnostic criteria for postmenopausal osteoporosis were blood levels of progesterone and calcitonin (respectively below 7 pg/ml and 15 nmol/l).Conclusions. Thus, for an assessment of the general and specific pathological processes of violation of hormonal regulation calcium-phosphorus exchange needs to be defined the blood levels of the paratireoidny hormone and estradiol, in the postmenopausal period – osteokalcine level, whereas decrease in blood levels of calcitonin and progesterone testifies to existence of postmenopausal osteoporosis.