Course Of Osteoporosis Research Articles

The influence of aquatic activity on osteoarthritis

© 2024 Medical University of Lublin. This is an open access article distributed under the Creative Commons Attribution-NonComercial-No Derivs licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) Abstract Introduction. In 2020, osteoarthritis (OA) affected up to 595 million people in the world, which is 7% of the population. Three quarters of them are over 55 years old and 60% are women. The pathophysiological basis of degenerative disease is a disturbance in the balance between the processes of formation and degradation of articular cartilage. Additionally, degeneration processes affect other elements of the musculoskeletal system, such as the synovial capsule, ligaments and muscles around the joint. Due to the severe pain, degenerative disease leads to a significant reduction in the quality of life and limited mobility. In the final stage it leads to disability. Arthritis most often involves the knee, hip joints, arms as well as vertebral column. To slow down the degenerative processes and minimize the complications of the disease, effective preventive methods should be implemented as soon as possible. Especially since there is currently no effective drug available for this disease. A popular method of combating pain is aquatic activity. The physical properties of water have a positive effect on the musculoskeletal and nervous systems. This review article assessed the effectiveness of aquatherapy depending on risk factors and the stage of osteoarthritis. Aim. Review and presentation of the current state of knowledge about water exercises on the course of osteoporosis, taking into account groups at risk of degenerative disease. Material and methods. Analysis of the studies available on open access sources at PubMed, Google Scholar, National Library of Medicine and Coachrane. The research was conducted through word analysis key words such as: “arthritis”, „aquatic activity”, „osteoarthritis”. Selection criteria for articles included consideration of their title, abstract, and publication date, with a focus on English-language publications. Conclusion and Results.This article demonstrates the positive impact of water exercises on the course of osteoporosis, as well as their preventive effect. The relationship between hydrotherapy and OA in individual risk groups was presented. Aquatic activity has been shown to be effective in inhibiting degenerative processes, reducing joint stiffness, improving walking distance, and mental condition. Keywords: osteoarthritis, aquatic activity, arthritis, WOMAC, degenerative disease, DALY.

Different Statin Dosages and Their Effects on Osteoporosis

The aim of the study was to investigate the effect of different doses of statins on the progression of osteoporosis during a 36-month follow-up period. The study included 98 postmenopausal women diagnosed with osteoporosis and the presence of atherosclerosis of lower limb arteries. Patients were divided into 2 groups: women who received statins as part of atherosclerosis treatment (group 1, n=53) and those who did not receive statin therapy for hyperlipidemia (group 2, n=45). After 36 months of follow-up, patients were divided into two groups — with unfavorable (n=42) and favorable (n=56) course of osteoporosis. Progression of osteoporosis was considered unfavorable if during the follow-up period the patients had low traumatic fractures of large bones and/or progressive decrease in bone mineral density (BMD). Depending on the statin dose taken, patients were divided into groups: 1) those taking atorvastatin 20 mg or rosuvastatin 10 mg; 2) those taking atorvastatin 40 mg or rosuvastatin 20 mg. The results revealed a significant association between statin therapy and a favorable course of osteoporosis (OR=0.316, 95% C.I. =0.137-0.727, p=0.003). The use of higher doses of statins (atorvastatin 40 mg or rosuvastatin 20 mg) was associated with the development of low traumatic fractures of large bones and/or progressive decrease in MPC during 36 months of follow-up (OR=3.0, 95% C.I.=1.119-8.040, p=0.030). On the other hand, the use of lower doses of statins (20 mg atorvastatin or 10 mg rosuvastatin) was associated with a favorable course of osteoporosis (OR=0.047, 95% C.I.=0.010-0.212, p=0.030). The dose of statin taken was also moderately negatively correlated with IPC (r=−0.45; p=0.005). Thus, the use of statins for a long period (36 months) in low doses (atorvastatin 20 mg or rosuvastatin 10 mg) is an effective and safe method of treating cardiovascular comorbidities represented by atherosclerosis of lower limb vessels and osteoporosis in postmenopausal women and is characterized by a reduced risk of osteoporosis-related large bone fractures.

ПРОФИЛАКТИКА ОСТЕОПОРОЗА

The work studied the effectiveness of preventive measures for osteoporosis in adults, since most modern methods of its prevention do not always give a positive result than expected. Taking into account the long asymptomatic course of osteoporosis, in fact, secondary prevention of recurrent complications is carried out. At the same time, the main attention is paid to the consumption of calcium, as the main mineral for strengthening bone density, however, according to statistics, this does not lead to a decrease in the incidence of osteoporosis. Therefore, to assess the effectiveness of preventive measures, a literary review was carried out, both fatherland and foreign scientific sources, on the state of bone tissue for the entire period of life. The aim of our work is to identify periods of primary disorders of bone synthesis and its causes and, consequently, ways of preserving and restoring bone tissue throughout life. It was found, analyzing these sources on the state of bone tissue in childhood and adulthood, taking into account different geographical locations, that the quality of the structure of bone tissue, in the first place, depends on the quality of food and, first of all, on its mineral composition and vitamins. But, at present, taking into account factors that worsen both the external environment and food, bone mineralization is deteriorating, which requires constant replenishment of minerals, calcium preparations and natural vitamins. Particularly noteworthy is the fact that, as noted in all sources, bone formation disorders begin from childhood, therefore, maintaining normal bone mineralization in this period contributes to the formation of its strength for the rest of life, which forms the basis for the prevention of osteoporosis in adults. Moderate physical activity also plays an important role.

Alzheimer's disease-associated inflammatory pathways might contribute to osteoporosis through the interaction between PROK2 and CSF3.

This study aimed to explore the potential molecular pathways and targets of Alzheimer's disease leading to osteoporosis using bioinformatics tools. The Alzheimer's and osteoporosis microarray gene expression data were retrieved from the Gene Expression Omnibus, and differentially expressed genes in the blood microenvironment related to Alzheimer's disease and osteoporosis were identified. The intersection of the three datasets (GSE97760, GSE168813, and GSE62402) was used to obtain 21 co-expressed targets in the peripheral blood samples in patients with Alzheimer's disease and osteoporosis. Based on the degree algorithm, the top 10 potential core target genes related to these diseases were identified, which included CLEC4D, PROK2, SIGLEC7, PDGFB, PTCRA, ECH1, etc. Two differentially expressed mRNAs, Prokineticin 2 (PROK2) and three colony-stimulating factor 3 (CSF3), were screened in the GSE62402 dataset associated with osteoporosis. Protein–protein rigid docking with ZDOCK revealed that PROK2 and CSF3 could form a stable protein docking model. The interaction of PROK2 and CSF3, core genes related to osteoporosis inflammation, plays an important role in the mechanism of osteoporosis in patients with Alzheimer's. Therefore, abnormalities or alterations in the inflammatory pathways in the peripheral blood samples of Alzheimer's patients may affect the course of osteoporosis.

Effects of a pulsed electromagnetic field on the course of osteoporosis in postmenopausal women

BACKGROUND: Pulsed electromagnetic field therapy is non-invasive, pain-relieving and preventing bone loss in osteoporosis. This study analyzes the effects of rehabilitation of postmenopausal women after spinal fracture after treatment with a pulsed electromagnetic field.
 AIM: is to analyze the effect of pulsed electromagnetic field on fractures and osteoporosis after spinal fracture surgery.
 MATERIAL AND METHODS: A randomized controlled trial was conducted, respectively, in the pulsed electromagnetic field treatment group (40 cases) and the control group (42 cases), respectively. The results of the assessment of health-related quality of life (HRQOL), back pain, body function, hip bone density at 1 month and 3 months after surgery were studied.
 RESULTS: Compared with the control group, the pulsed electromagnetic field treatment group can significantly improve the psychological score, the 6-minute walk test, and the sitting position in a chair one month after surgery. And 3 months after surgery, the pulsed electromagnetic field treatment group can significantly improve health-related quality of life (HRQOL), back pain, and body function scores.
 CONCLUSION: Pulsed electromagnetic field therapy has a positive effect on pain relief, functional changes in the body and bone loss after spinal fracture surgery.

TO THE QUESTION OF PREPARATION OF PATIENTS WITH OSTEOPOROSIS DURING THE PREMENOPAUSE WHEN PLANNING DENTAL IMPLANTATION

The article describes materials on the literature review on the preparation of patients with osteoporosis in the climacteric period when planning implantation. The clinical significance of osteoporosis in menopause lies in the leaching of calcium from the bone into the blood, which makes it possible to minimize the negative influence of the human factor, the high percentage of patients of older age groups, especially women, for the elimination of defects in the dentition with the help of dental implants makes this problem particularly urgent. , since the asymptomatic, inexpressive course of osteoporosis can be the reasons for the development of complications during the treatment with the use of intraosseous implants.

Osteoporosis in patients with coronary artery disease after coronary bypas surgery

Aim. To determine the most significant predictors of an unfavorable progress of osteoporosis (OP) in men with coronary artery disease after coronary artery bypass grafting (CABG) according to long-term (5 years) follow-up data.Methods. The prospective study included 393 patients (men) hospitalized for CABG. All patients underwent multispiral computed tomography of the coronary and carotid arteries to assess the calcium score (CS) and determine the equivalent density of calcium deposits (EDCD), coronary angiography, and dual-energy X-ray absorptiometry. After 5 years (average 59 months) of follow-up, the prognosis (status alive/dead) was assessed in 335 patients. Mortality during follow-up in patients after CABG was 10.7% (36 patients died). 257 patients underwent repeated osteodensitometry, quantitative assessment of coronary and carotid calcification, assessment of the “end points” of bone status (osteoporotic fractures, osteoporosis).Results. During the five-year follow-up an increase in the prevalence of OP was noted from 76.1% to 90.7%, while in 43.6% of cases, the progression of OP was recorded. Fractures occurred in 39 patients (15.2%), and in 34 (13.2%) osteoporosis developed for the first time. OP progression is associated with smoking (OR 5.3, 95% CI 3.1–9.4), 30% or more carotid artery stenosis (OR 5.6, 95% CI 2.9–10.7), baseline severe (more than 400) calcification of the coronary arteries (OR 2.7 at 95% CI 1.3–9.8), low density of (EDCD less than 0.19 g/mm3 ) coronary (OR 1.7 at 95% CI 1.1–8.2) and carotid (OR 2.4, 95% CI 1.4–10.3) calcium deposits. Linear regression analysis made it possible to establish that the reliable predictors of an unfavorable course of OP are coronary CS, EDCD of the carotid arteries, and the absence of statin therapy.Conclusion. OP progression in patients in the long-term period (5 years) after CABG was noted in 43.6%. The predictors of OP progression and the complications are a high level of coronary artery calcification, a low EDCD in the carotid arteries, and 30% or more stenosis of the carotid arteries. Patients receiving statins were associated with a lower risk of osteoporosis.

Оптимизация вторичной профилактики переломов костей при остеопорозе у менопаузальных женщин и роль коморбидного метаболического синдрома

Актуальность. Остеопороз (ОП) характеризуется хрупкостью скелета и подверженностью людей переломам, обусловленным уменьшением костной массы и ухудшением микроархитектуры кости. У неменструирующих женщин ломкость костей более выражена, а остеопоротические переломы встречаются втрое чаще. Ухудшает течение ОП у менопаузальных женщин наличие коморбидного метаболического синдрома (МС) и его тяжесть, что требует совершенствования лечебных мероприятий у таких больных. Цель исследования: повысить эффективность лечения ОП у менопаузальных женщин с МС и качество вторичной профилактики у них костных переломов. Материалы и методы. В течение двух лет под наблюдением находились 28 неменструирующих женщин с ОП в возрасте от 37 до 72 лет (в среднем 50 лет). Во всех случаях наступила физиологическая менопауза. Минеральную плотность кости оценивали по Т-индексу остеоденситограмм, рентгенологическим индексам Барнетта — Нордина, Рохлина и клиновидности. В сыворотке крови исследовали показатели, которые отражали состояние костного метаболизма и МС. ­Результаты. У менопаузальных женщин, страдающих ОП, переломы бедренной кости, позвоночника, костей запястья и ІІ плюсневой диагностированы в 39 % случаев. Остеофрактуры были прямо связаны с возрастом больных, параметром остеоденситометрического индекса, наличием и тяжестью течения коморбидного МС, составляющих его факторов (IV типа гиперлипидемии и сахарного диабета второго типа), с наличием диабетической нейропатии, а также с исходными концентрациями в крови Mg, Mn, Pb и Se. Разработана оптимальная вторичная профилактика костных переломов у менопаузальных женщин с коморбидными ОП и МС, основанная на индивидуальных подходах к длительному назначению препаратов Са, Se, Zn, бисфосфонатов, ранелата Sr, фибратов и урикодепрессоров с учетом характера и тяжести течения МС. Выводы. Предложенная медицинская технология лечения ОП у неменструирующих женщин с МС позволила сократить число остеофрактур в 10 раз, уменьшить активность в крови щелочной фосфатазы и показатель остеоденситометрического индекса.

Characteristics of geriatric and somatic status in patients with osteoporosis

Older adults with osteoporosis (OP) and high risk of falls are the most vulnerable group of patients with respect to the development of fractures. Falls and fractures in elderly patients with OP are associated with geriatric syndromes and worse functional status. To аssess comorbidity and geriatric status in elderly and senile patients with and without OP. The study included 607 patients over 60 years of age hospitalized in the geriatric department. According to the presence of OP, the patients were divided into 2 groups: group 1 - patients with OP (n=178, 29.3%), group 2 - patients without OP (n=429, 70.7%). All patients underwent a general clinical study, an assessment of comorbidity -according to the Charlson index, and a comprehensive geriatric score. OPs had 178 (29.3%) patients, more often these were women. 55.6% of patients with OP were disabled. Age--related diseases such as Alzheimer's disease, Parkinson's disease, osteoarthritis, anemia, thyroid disease, varicose veins were significantly more common in patients with OP. With almost all of these diseases, a univariate analysis revealed an association with OP. Geriatric syndromes such as frailty, hypodynamia, malnutrition, polypharmacy, urinary incontinence were significantly more common in group 1 patients. Patients with OP were more likely to live alone and use mobility aids compared to patients without OP.The univariate analysis demonstrated that OP is associated (OR 1.54 to 2.00) with frailty, hypodynamia, the use of aids in movement, sleep disorders, sensory vision deficiency, urinary incontinence. The Functional status of patients with OP was worse compared to patients without OP. Patients with OP suffered more fractures, and vertebral fractures were significantly more frequent. Patients with OP have a high comorbidity, a burdened geriatric status. In elderly patients, it is necessary not only to screen and diagnose OP, to assess the risk of 10-years probability of major pathological fractures using the FRAX algorithm, but also to conduct a comprehensive geriatric assessment to diagnose geriatric syndromes that weaken the course of OP and lead to more serious consequences.

Характеристика гериатрического и соматического статуса у пациентов с остеопорозом

BACKGROUND : Older adults with osteoporosis (OP) and high risk of falls are the most vulnerable group of patients with respect to the development of fractures. Falls and fractures in elderly patients with OP are associated with geriatric syndromes and worse functional status. AIM : To аssess comorbidity and geriatric status in elderly and senile patients with and without OP. MATERIALS AND METHODS : The study included 607 patients over 60 years of age hospitalized in the geriatric department. According to the presence of OP, the patients were divided into 2 groups: group 1 — patients with OP (n=178, 29.3%), group 2 — patients without OP (n=429, 70.7%). All patients underwent a general clinical study, an assessment of comorbidity ­according to the Charlson index, and a comprehensive geriatric score. RESULTS : OPs had 178 (29.3%) patients, more often these were women. 55.6% of patients with OP were disabled. Age-­related diseases such as Alzheimer’s disease, Parkinson’s disease, osteoarthritis, anemia, thyroid disease, varicose veins were significantly more common in patients with OP. With almost all of these diseases, a univariate analysis revealed an association with OP. Geriatric syndromes such as frailty, hypodynamia, malnutrition, polypharmacy, urinary incontinence were significantly more common in group 1 patients. Patients with OP were more likely to live alone and use mobility aids compared to patients without OP. The univariate analysis demonstrated that OP is associated (OR 1.54 to 2.00) with frailty, hypodynamia, the use of aids in movement, sleep disorders, sensory vision deficiency, urinary incontinence. The Functional status of patients with OP was worse compared to patients without OP. Patients with OP suffered more fractures, and vertebral fractures were significantly more frequent. CONCLUSION : Patients with OP have a high comorbidity, a burdened geriatric status. In elderly patients, it is necessary not only to screen and diagnose OP, to assess the risk of 10-years probability of major pathological fractures using the FRAX algorithm, but also to conduct a comprehensive geriatric assessment to diagnose geriatric syndromes that weaken the course of OP and lead to more serious consequences.

Prophylaxis of Pain and Fractures within Feet in the Course of Osteoporosis: The Issue of Diagnosing.

Background Considering the enormous risk of fractures in the course of osteoporosis in the area of the feet, an important aspect of prophylaxis is periodic and, in special cases, ongoing monitoring of defects and deformations as well as pressure distribution. The purpose of this article is to indicate the role of the examination of posture and pressure distribution during standing, postural balance, and gait, in the prevention of fatigue fractures in the course of osteoporosis, based on the literature review and examples of patients. Methods The manuscript consists of two parts; it has a review-analytical character. The first part reviews the literature. The data were obtained using the MEDLINE (PubMed), as well as Cochrane and Embase databases. The database review was carried out focusing mainly on English-language publications, while taking into account the topicality of scientific and research works in the area of osteoporosis. The problem of multiaspects in the area of bone density was pointed out. Considering the above, in the second part, the authors analyzed 11 exemplary patients with osteoporosis, referring to the assessment of foot and lower limb defects using traditional posturological methods and including pedobarography to diagnostic procedures that are used in the assessment of pressure distribution, standing and moving, and an attempt to balance. Results Analysis of the research and scientific literature proved the lack of unambiguous diagnostic procedures of the locomotor system recommended for the prevention of fatigue fractures in the course of osteoporosis. The main diagnostic recommendations are imaging tests (most often X-ray), which are recommended in the case of specific clinical symptoms. The analysis of exemplary patients with osteoporosis showed numerous disorders in the distribution of pressure in the plantar part of the feet, which are related, among other things, with their individual defects and lower limbs. Conclusions Detailed posture diagnostics and gait estimation, along with the analysis of pressure distribution within the feet are a very important aspect of the prevention of structural degradation and fatigue fractures within the feet. An important postulate for further research and scientific work is the elaboration of the procedures that will serve the preventive diagnostics of the locomotor system, aimed at early detection of threats of fatigue fractures.

Vertebral Fractures: Which Radiological Criteria Are Better Associated With the Clinical Course of Osteoporosis?

Morphometric methods categorize potential osteoporotic vertebral fractures (OVF) on the basis of loss of vertebral height. A particular example is the widely used semiquantitative morphometric tool proposed by Genant (GSQ). A newer morphologic algorithm-based qualitative (mABQ) tool focuses on vertebral end-plate damage in recognizing OVF. We used data from both sexes in the Canadian Multicentre Osteoporosis Study (CaMos) to compare the 2 methods in identifying OVF at baseline and during 10 years of follow-up. We obtained lateral thoracic and lumbar spinal radiographs (T4-L4) 3 times, at 5-year intervals, in 828 participants of the population-based CaMos. Logistic regressions were used to study the association of 10-year changes in bone mineral density (BMD) with incident fractures. At baseline, 161 participants had grade 1 and 32 had grade 2 GSQ OVF; over the next 10 years, only 9 of these participants had sustained incident GSQ OVF. Contrastingly, 21 participants at baseline had grade 1 and 48 grade 2 mABQ events; over the next 10 years, 79 subjects experienced incident grade 1 or grade 2 mABQ events. Thus, incident grades 1 and 2 morphologic fractures were 8 times more common than morphometric deformities alone. Each 10-year decrease of 0.01 g/cm2 in total hip BMD was associated with a 4.1% (95% CI: 0.7-7.3) higher odds of having an incident vertebral fracture. This analysis further suggests that morphometric deformities and morphologic fractures constitute distinct entities; morphologic fractures conform more closely to the expected epidemiology of OVF.

СОВРЕМЕННЫЙ ВЗГЛЯД НА ПРОБЛЕМУ ОСТЕОПОРОЗА ПРИ АНКИЛОЗИРУЮЩЕМ СПОНДИЛИТЕ

The study included 72 men with a reliable diagnosis of AS, mean age – 43,2±9,1 years. X-ray examination of the axial skeleton and peripheral joints was carried out, HLA-B27 was determined. Disease activity was assessed using the index ВАSDАI, functional disorders with the help of the BASFI index. BMD was determined by two-energy x-ray absorptiometry. The control group consisted of 74 healthy men, mean age – 46,7±0,9 years. Given the chronic nature and asymptomatic course of osteoporosis, the task of doctors working with this group of patients is an active search for osteoporosis using all available diagnostic techniques for the early detection of this condition and subsequent correction of the drug treatment.

Prevalence, Risk Factors and Course of Osteoporosis in Patients with Crohn’s Disease at a Tertiary Referral Center

Background: Patients with Crohn’s disease are at increased risk for fractures due to low bone mineral density (BMD). Real-world data are necessary to optimize surveillance and treatment strategies. Methods: Patients with Crohn’s disease who underwent at least one dual-energy X-ray absorptiometry (DXA) scans were recruited. The primary study endpoints were (1) prevalence of osteoporosis, and (2) factors influencing changes of BMD. To identify potential risk factors for reduced BMD, Mann–Whitney U-test was used for ordinal and continuous variables and x²-tests for categorical variables. Results with p < 0.05 were included in a multivariable analysis. To identify potential factors influencing changes in BMD, a generalized linear mixed model was applied. Results: 39.9% of the patients were diagnosed with normal BMD, 40.2% with osteopenia, and 19.8% with osteoporosis. The main risk factors for osteoporosis were low body mass index (BMI), previous bowel resections and male sex. The main risk factors for reduced BMD during further along the disease course were steroid use, history of immunomodulator treatment, female sex and decreased BMI. Conclusion: Low BMI, previous bowel resections and male sex were the main risk factors for the development of osteoporosis. Steroid use reduced BMD even under anti-inflammatory therapy, underlining that they should be used with great care in that patient group.

COMPLE X TRE ATMENT OF OSTEOPOROSIS IN PATIENTS WITH 2 T YPE DIABETES MELLITUS IN COMBINATION WITH NON-ALCOHOLIC FATTY LIVER DISEASE

An actual problem of modernity is the relationship between type 2 diabetes mellitus (DM) and osteoporosis(OP), as well as type 2 DM with non-alcoholic fatty liver disease (NAFLD), which are actively considered by scientists.There are different data on the development and course of OP, depending on gender, age and race. So theaim of the study was to determine the tactics of treatment of OP in patients with type 2 DM with NAFLD. 37patients with type 2 DM with OP and NAFLD (15 men and 22 women) were examined and treated. When examiningpatients with type 2 DM with OP and NAFLD before treatment, there was a deficiency of vitamin D, thatis, none of the patients had an adequate supply of vitamin D, while the indicators of the level of CA were in thenormal range, and the indicators of Ca++ were reduced, so they were prescribed therapy with magnesium, vitaminD, calcium in daily doses, depending on gender, age, revealed pathology and laboratory abnormalities, andall patients received individually selected therapy with sugar-lowering. To assess the degree of compensationof carbohydrate metabolism was carried out to study the level of glycosylated hemoglobin (HbA1c) and furthercorrection zakreslajac therapy. According to the results of the study, the expediency of prescribing drugs that affectthe improvement of bone structure in patients with type 2 DM with OP in daily doses depending on gender,age, degree of detected violations and deviations of laboratory parameters was proved, and it was determinedthat the improvement of bone tissue has a positive effect on the compensation of carbohydrate metabolism in theexamined patients. It was found that patients with type 2 DM with OP and NAFLD require monitoring withdensitometry and laboratory diagnosis in dynamics against the background of treatment.

Bone-Muscle Crosstalk: Unraveling New Therapeutic Targets for Osteoporosis.

Osteoporosis is a condition featured by bone mass loss and bone tissue microarchitectural alterations due to impaired tissue homeostasis favoring excessive bone resorption versus deposition. The trigger of such an impairment and the downstream molecular pathways involved are yet to be clarified. The natural course of osteoporosis is particularly worrisome because, through a "silent" progression, it enhances bone fragility, increases the risk of fractures and is associated with increased risk of disability and mortality. To date, the assessment of bone mineral density by dual-energy X-ray absorptiometry, represents the non-invasive gold standard for the evaluation of bone mineralization and the diagnosis of osteoporosis. Although long known as a condition merely related to the hormonal-driven loss of bone homeostasis, emerging evidence supports the need of reframing osteoporosis in the context of structural and functional changes of the musculoskeletal system as a whole. Several age-related alterations of bone microenvironment and an altered bone-muscle crosstalk have been suggested to be relevant contributors to loss of bone strength and mass characterizing osteoporosis. The present work provides an overview of the current knowledge of the pathophysiology of osteoporosis obtained through advances in epigenetics, cell biology and osteoimmunology. In light of the increasingly recognized importance of bone-muscle interconnection, this review also discusses relevant pathways that may be dissected for identifying new therapeutic targets for age-related musculoskeletal degeneration.

Draft Recommendations. Pharmacotherapy for the Prevention of Repeated Fractures in Patients with Osteoporosis after Surgical Treatment of Pathologic Proximal Femur Fracture

Treatment of pathologic proximal femur fractures complicating the course of systemic osteoporosis is most often limited by surgical intervention as until now trauma and orthopaedic surgeons have no concrete recommendations on pharmacologic correction of metabolism disorders typical to the pathology, that aggravate in the postoperative period due to operative trauma. Proposed draft recommendations are a part of National clinical recommendations “Treatment for pathologic fractures of skeleton bones complicating the course of osteoporosis”. This issue of recommendations is only applicable to pharmacotherapy directed to the correction of bone tissue remodeling with regard for the fracture localization and volume of surgical intervention. Present recommendations are intended for the improvement of patients’ life quality, reduction of present and future losses from pathologic fracture as well as the prevention of repeated fractures.

Draft Recommendations. Pharmacotherapy for the Prevention of Repeated Fractures in Patients with Osteoporosis after Surgical Treatment of Pathologic Proximal Femur Fracture

Treatment of pathologic proximal femur fractures complicating the course of systemic osteoporosis is most often limited by surgical intervention as until now trauma and orthopaedic surgeons have no concrete recommendations on pharmacologic correction of metabolism disorders typical to the pathology, that aggravate in the postoperative period due to operative trauma. Proposed draft recommendations are a part of National clinical recommendations “Treatment for pathologic fractures of skeleton bones complicating the course of osteoporosis”. This issue of recommendations is only applicable to pharmacotherapy directed to the correction of bone tissue remodeling with regard for the fracture localization and volume of surgical intervention. Present recommendations are intended for the improvement of patients’ life quality, reduction of present and future losses from pathologic fracture as well as the prevention of repeated fractures.

Effet des médicaments de l’ostéoporose sur les maladies cardiovasculaires et effet des médicaments à visée cardiovasculaire sur l’ostéoporose

Osteoporosis and cardiovascular diseases are epidemiologically associated. Calcification phenomena of atherosclerotic plaque involve cytokines and growth factors also involved in bone remodeling. Drugs given for either of these two conditions could act on these mechanisms. Can osteoporosis drugs have an influence on the occurrence of cardiovascular events? Conversely, can the treatment of hypertension alter the course of osteoporosis? It is possible that administration of high doses of calcium (1g/day) in patients who already have important dietary intake can increase the risk of myocardial infarction. Epidemiological studies show links between low serum vitamin D levels and cardiovascular disease but interventional studies show that vitamin D administration in moderately deficient subjects vitamin D does not prevent the occurrence of cardiovascular events. Cohort studies show a beneficial effect of beta-blockers and thiazides administered to hypertensive patients: they reduce by 20% risk of fracture of the proximal femur. Should we focus on these anti-hypertensive treatments for our patients with osteoporosis?

Increased Bone Mass in Female Mice Lacking Mast Cell Chymase.

Here we addressed the potential impact of chymase, a mast-cell restricted protease, on mouse bone phenotype. We show that female mice lacking the chymase Mcpt4 acquired a persistent expansion of diaphyseal bone in comparison with wild type controls, reaching a 15% larger diaphyseal cross sectional area at 12 months of age. Mcpt4-/- mice also showed increased levels of a bone anabolic serum marker and higher periosteal bone formation rate. However, they were not protected from experimental osteoporosis, suggesting that chymase regulates normal bone homeostasis rather than the course of osteoporosis. Further, the absence of Mcpt4 resulted in age-dependent upregulation of numerous genes important for bone formation but no effects on osteoclast activity. In spite of the latter, Mcpt4-/- bones had increased cortical porosity and reduced endocortical mineralization. Mast cells were found periosteally and, notably, bone-proximal mast cells in Mcpt4-/- mice were degranulated to a larger extent than in wild type mice. Hence, chymase regulates degranulation of bone mast cells, which could affect the release of mast cell-derived factors influencing bone remodelling. Together, these findings reveal a functional impact of mast cell chymase on bone. Further studies exploring the possibility of using chymase inhibitors as a strategy to increase bone volume may be warranted.