Signs Of Osteoporosis Research Articles

Peculiar features of life quality in patients with type 2 diabetes mellitus and postmenopausal osteoporosis

Aim. To study the peculiarities of the quality of life in patients with type 2 diabetes mellitus (DM2) and postmenopausal osteoporosis (PO).
 Materials and methods. 104 postmenopausal women aged 49–67 were examined. They were divided into 3 groups: group 1 (38 persons) – patients with DM2 and PO, group 2 (24 persons) – patients with PO, group 3 (42 persons) – postmenopausal patients with DM2 without any osteoporosis signs. Their quality of life was assessed using SF-36 survey, sensations of pain – with four-component visual analogue scale.
 Results. Physical component of health (PH) was statistically significantly lower in DM2 and PO group. Most patients of this group had decreased psychical component of health. In DM2 and PO group as compared with PO group statistically significantly lower values according to physical status-conditioned role functioning scales (RP) (p = 0,018), emotional status-conditioned role functioning (p = 0,028), PH (p = 0,038) were detected. When compared with DM2 group, physical functioning (p = 0,04), RP (p = 0,014), pain intensity (p = 0,049), PH (p = 0,014) appeared to be statistically significantly lower. The factors, negatively influencing the quality of life in patients of DM2 and PO group were the following: remoteness of diabetes, comorbidity, level of pain sensations, presence of diabetic polyneuropathy, insulin therapy in treatment, unsatisfactory glycemic control.
 Conclusions. Osteoporosis in patients with type 2 diabetes mellitus worsens their quality of life, in particular at the expense of elevated intensity of pain sensations.

Dyspnea on swallowing: a case of thyroid lymphoma

Purpose: The main sign of osteoporosis is a significant decrease of bone mass that is caused by imbalance between resorption and osteogenesis. There are two main factors that contribute to the genesis of this illness. All these factors bring todecrease of thickness of bone and its destruction doesn’t depend on their combination. Therefore, our objective was to study the changes in the alveolar bones of elderly people in secondary edentulous.Material and Methods: For deeper study of morphological changes in segments of teeth we have conducted pathological researches of biopsy material of dead patients at the Center of Pathological Studies of the Sumy Medical University. The first group of patients included n=7 who died of various somatic abnormalities and had no significant atherosclerotic lesions. The second group includes segments of teeth and jaws of patients n=7 who died from complications of atherosclerosis In our studies, we used: Histological study; Fluorescence microscopy; Immunohistochemistry; Microphotography and image analysis; Mathematical calculations.Results: Based on the statistical analysis we can see a downward trend in the number of osteocytes in trabeculae of the periapical third part of the tooth at atherosclerosis 26.85±7.44; P=0.05. We can also see the dependence of trabecular thinning of toothless area of the alveolar bone 226.57±70.53; P=0.02 from losing of teeth against the background of atherosclerosis with hypertension. The osteopontin expression and fluorescencetion of toothless bone area also tend to decrease in atherosclerosis and hypertension 42.81±16.24; P=0.048.Conclusion: The cause of tooth loss is difficult to determine, since it is not clear whether it is due to osteoporosis or some forms of periodontitis in patients. The bone resorption has actived by reactive oxygen species both during atherosclerosis. Through our research found out that in order to reduce changes in the toothless bone we should reduce the pressure on chewing toothless alveolar sprout by dental implants.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.138-141

Type ii osteoporosis pathogenesis as a result of secondary edentulous

Purpose: The main sign of osteoporosis is a significant decrease of bone mass that is caused by imbalance between resorption and osteogenesis. There are two main factors that contribute to the genesis of this illness. All these factors bring todecrease of thickness of bone and its destruction doesn’t depend on their combination. Therefore, our objective was to study the changes in the alveolar bones of elderly people in secondary edentulous.
 Material and Methods: For deeper study of morphological changes in segments of teeth we have conducted pathological researches of biopsy material of dead patients at the Center of Pathological Studies of the Sumy Medical University. The first group of patients included n=7 who died of various somatic abnormalities and had no significant atherosclerotic lesions. The second group includes segments of teeth and jaws of patients n=7 who died from complications of atherosclerosis In our studies, we used: Histological study; Fluorescence microscopy; Immunohistochemistry; Microphotography and image analysis; Mathematical calculations.
 Results: Based on the statistical analysis we can see a downward trend in the number of osteocytes in trabeculae of the periapical third part of the tooth at atherosclerosis 26.85±7.44; P=0.05. We can also see the dependence of trabecular thinning of toothless area of the alveolar bone 226.57±70.53; P=0.02 from losing of teeth against the background of atherosclerosis with hypertension. The osteopontin expression and fluorescencetion of toothless bone area also tend to decrease in atherosclerosis and hypertension 42.81±16.24; P=0.048.
 Conclusion: The cause of tooth loss is difficult to determine, since it is not clear whether it is due to osteoporosis or some forms of periodontitis in patients. The bone resorption has actived by reactive oxygen species both during atherosclerosis. Through our research found out that in order to reduce changes in the toothless bone we should reduce the pressure on chewing toothless alveolar sprout by dental implants.
 Bangladesh Journal of Medical Science Vol.16(1) 2017 p.127-137

Imaging Findings in Osteogenesis Imperfecta

A 14 months -old male patient is brought to the outpatient clinic with a history of multiple bone fractures, he was born with fractures in left femur and humerus and presented 3 more fractures until the first consultation. There was no family history of genetic disorders and consanguinity. At physical examination, short stature for his age, discolored and translucent teeth, triangular face shape and bluish color of eye sclera were noticed. Initial radiographic studies of bones showed diffuse signs of osteoporosis, deformed limb bones and multiple long bone fractures with different ages. The radiograph of the skull showed small intra-sutural bones in between the cranial sutures, known as Wormian bones (figure 1). Diagnosis of osteogenesis imperfecta (OI) was confirmed and treatment with cyclic sodium pamidronate was started. At 3 years old a total of ten fractures were reported on tibias, femurs and proximal left humerus. The following radiographic studies showed the “zebra stripe sign” - sclerotic growth recovery lines in the metaphysis of long bones (figures 2 and 3). Palavras-chave: Osteogenesis imperfecta; pediatrics; radiology

Clinical Management of Patients Older than 75 Years of Age With Fractures of the Proximal Femur

This paper presents a review of publications dedicated to the complex clinical management of patients older than 75 years of age who have had fractures of the proximal femur and presented signs of osteoporosis. Descriptive and analytical methods were used in the research. The work with the publications was performed by entering the relevant MeSH terms and subheadings in the search systems of databases. The study found that most researchers think that this problem still needs to be studied in the context of the search for effective clinical management strategies, including the surgical treatment as early as possible and the prescription of medications which influence bone remodeling mechanisms.

Alveolar bone loss in osteoporosis: a loaded and cellular affair?

Maxillary and mandibular bone mirror skeletal bone conditions. Bone remodeling happens at endosteal surfaces where the osteoclasts and osteoblasts are situated. More surfaces means more cells and remodeling. The bone turnover rate in the mandibular alveolar process is probably the fastest in the body; thus, the first signs of osteoporosis may be revealed here. Hormones, osteoporosis, and aging influence the alveolar process and the skeletal bones similarly, but differences in loading between loaded, half-loaded, and unloaded bones are important to consider. Bone mass is redistributed from one location to another where strength is needed. A sparse trabeculation in the mandibular premolar region (large intertrabecular spaces and thin trabeculae) is a reliable sign of osteopenia and a high skeletal fracture risk. Having dense trabeculation (small intertrabecular spaces and well-mineralized trabeculae) is generally advantageous to the individual because of the low fracture risk, but may imply some problems for the clinician.

The management of osteoporosis in children.

This article reviews the manifestations and risk factors associated with osteoporosis in childhood, the definition of osteoporosis and recommendations for monitoring and prevention. As well, this article discusses when a child should be considered a candidate for osteoporosis therapy, which agents should be prescribed, duration of therapy and side effects. There has been significant progress in our understanding of risk factors and the natural history of osteoporosis in children over the past number of years. This knowledge has fostered the development of logical approaches to the diagnosis, monitoring, and optimal timing of osteoporosis intervention in this setting. Current management strategies are predicated upon monitoring at-risk children to identify and then treat earlier rather than later signs of osteoporosis in those with limited potential for spontaneous recovery. On the other hand, trials addressing the prevention of the first-ever fracture are still needed for children who have both a high likelihood of developing fractures and less potential for recovery. This review focuses on the evidence that shapes the current approach to diagnosis, monitoring, and treatment of osteoporosis in childhood, with emphasis on the key pediatric-specific biological principles that are pivotal to the overall approach and on the main questions with which clinicians struggle on a daily basis. The scope of this article is to review the manifestations of and risk factors for primary and secondary osteoporosis in children, to discuss the definition of pediatric osteoporosis, and to summarize recommendations for monitoring and prevention of bone fragility. As well, this article reviews when a child is a candidate for osteoporosis therapy, which agents and doses should be prescribed, the duration of therapy, how the response to therapy is adjudicated, and the short- and long-term side effects. With this information, the bone health clinician will be poised to diagnose osteoporosis in children and to identify when children need osteoporosis therapy and the clinical outcomes that gauge efficacy and safety of treatment.

ABSORPTIOMETRIC ANALYSIS OF SOME QUANTITATIVE AND QUALITATIVE INDICATORS OF BONE TISSUE STATUS ASSESSED BY A QUANTITATIVE COMPUTED TOMOGRAPHY IN WOMEN OF DIFFERENT AGES

Aim. To study the characteristics of the quantitative and qualitative characteristics of bone mineral density in women. Materials and methods. Quantitative computed tomography with additional quantitative and qualitative assessments was performed in 127 women of different ages without clinical signs of osteoporosis. Results. We had calculated the size and the ratio of cortical bone and spongy tissue at the lumbar vertebrae considering the density range characterized as the maximum and minimum of mineralized areas that represent not only quantitative but also qualitative state of the bone tissue. Conclusions. The obtained data can be used to assess the changes in the quality of bone in osteoporosis and osteopenia.

Osteoporosis in children with chronic illness: lessons from natural history studies that guide clinical practice

Children with serious chronic illnesses have the potential for significant bone morbidity, particularly in the context of disorders with impaired muscle function and the need for glucocorticoid (GC) treatment. Recently, studies have shown that vertebral fractures are often the first sign of osteoporosis in this context. Longitudinal studies have taught us that vertebral fractures are most frequent in the first year of GC therapy among children with GC-treated diseases, that vertebral fractures are often asymptomatic and thereby go undetected in the absence of routine monitoring, and that even asymptomatic vertebral fractures predict an increased risk of future fractures. Other discrete clinical predictors of incident vertebral fractures are evident early in the course of GC therapy, including decreases in spine BMD Z-scores and increases in body mass index Z-scores in the first 6 months of GC therapy. Taken together, these observations highlight that the first year of GC therapy is a critical period for monitoring in order to identify bone morbidity in a timely fashion. Children with risk factors for bone morbidity other than GC therapy (such as neuromuscular disorders and immobilization) are also at increased risk for vertebral and non-vertebral fractures fractures. As such, routine surveillance for vertebral fractures (for example, with a lateral spine radiograph) is now considered a key facet of the bone health evaluation in children with chronic immobilization or GC-treated diseases. While some risk factors for osteoporosis will be permanent (such as immobilization arising from disorders such as cerebral palsy), other children will experience transient threats to bone health. This is an important distinction, since children with transient threats have the potential for vertebral body reshaping, either spontaneously or with bone-targeted treatment such as bisphosphonate therapy. Recovery from fracture-induced deformity is growth-dependent, underscoring the importance of timely diagnosis and intervention during childhood in those with limited potential for spontaneous vertebral body reshaping. Prevention begins with optimization of conservative measures, including physical activity, nutrition, treatment of co-morbid endocrinopathies and aggressive treatment of the underlying disease using the lowest effective GC dose. These measures may be insufficient to prevent first-time fractures in some, raising the need for bone-specific therapy in line with a secondary prevention approach. Secondary prevention is predicated upon identification of early signs of osteoporosis and intervention to prevent disease progression. Since bone-targeted treatment is typically reserved for children with overt fragility, careful monitoring to avoid advanced osteoporosis presentations is paramount. Bisphosphonates are the most commonly prescribed agents in children; however, interest in the use of novel osteo-anabolic therapy is mounting given bone histomorphometric observations that osteoporosis in children with serious chronic illnesses is typically characterized by significant reductions in bone turnover.

Evidence-based review of Colles’ fracture

Background A Colles’ fracture occurs as a transverse fracture of the metaphyseal region of the distal radius, approximately 25–40 mm proximal to the radio-carpal joint, and is associated with dorsal displacement and angulation of the distal fragment. Other features include radial shortening and palmar tilt. Key radiological measurements usually noted are that of radial length (normally 11 mm), dorsal angulation of the distal radius (normally 10° volar angulation) and radial inclination (normally 22°). A Colles’ fracture is one of the most common types of osteoporotic fractures seen, especially in females above the age of 50. Incidence of men vs. women over the age of 35 was 9/10,000 vs. 37/10,000, respectively. Management Conservative management is commonly an option in stable or minimally displaced fractures which are described as ≤2 mm loss of radial height, ≤5° change in radial inclination and ≤10° of dorsal angulation. This can be managed in a plaster cast for five to six weeks. Furthermore, age of >60 years was found to be the most important factor in predicting whether a reduced unstable fracture would redisplace. Kirschner-wire fixation is a useful and simple operative method to help stabilise fragments that are not severely comminuted. This option was found to be better than plaster cast management alone, but was associated with surgical complications such as infection and nerve injuries. A more common management option utilised for unstable fractures today is open reduction and internal fixation using either dorsal or volar plates. Dorsal plates are less commonly used due to increased risk of volar collapse and tendon rupture with up to a 22% removal of implant rate due to tendon irritation. Volar plates are more popular as they allow a more stable fixation and thus early mobilisation with a better radiological outcome when compared against K-wire fixation. They are also associated with a lower incidence of tendon complications. External fixation management options may either be bridging or nonbridging in regards to the radio-carpal joint. Immobilising the wrist with a bridging external fixation device can be an option when managing a severely comminuted fracture without a large enough distal fragment to secure a distal pin. However, dorsal malunion was six times more likely when compared against a nonbridging option. Though studies showed external fixation devices provided better radiological outcomes when compared to conservative management, there is insufficient evidence to conclude that long-term functional outcomes are also improved. Prevention Often a fracture of this nature is considered as one of the first signs of osteoporosis in a middle-aged adult. Hormone replacement therapies and use of bisphosphonate therapy have been proven to reduce the risk of osteoporotic fractures with alendronate being found to significantly reduce the risk of spine, hip and wrist fractures in postmenopausal women with a mean age of 70 years. Incorporation of other health care professionals such as physiotherapists and occupational therapists is also of vital importance to ensure osteoporotic patients are at a lower risk of sustaining falls.

Use of Panoramic Radiographs to Detect Signs of Osteoporosis in Edentulous

Objective: The objective is to analyze the importance of panoramic and carpal radiographs for evaluation of edentulous individuals in different ages, demonstrating the contribution of different dental radiographic techniques in detecting patients with signs of osteoporosis. Methods: The study was developed using panoramic and carpal digital radiographs of 30 edentulous women (age ranged 50 - 90 years). The panoramic radiographs were performed to measure the thickness of the mental index—MI and gonial index—GI, and evaluation of the morphology of the mandibular cortical shape (Klemetti classification). The carpal radiographs were performed to measure the cortical thickness of the 2nd, 3rd and 4th metacarpals (metacarpal index). Statistics analyzed the relationship of these indices with the patient’s age and the contribution of dental radiographs in detecting patients at risk for osteoporosis. Results: The average age of subjects was 68.43 years. In the analysis of cortical thickness of the panoramic radiographs, the mean values of mental index (MI) and gonial index (GI) for the age group 50 to 59 years were considered normal values (≥3.1 mm and ≥1.2 mm , respectively). To analyze the morphology of the cortex, the C3 group corresponded to the majority of cases (43.33%). The higher the age range, more morphological changes were observed (sum of the characteristics of groups C2 and C3). For the hand-wrist radiographs, the highest values of the metacarpal index (BMI) were found in the youngest age group (50 - 59 years). Conclusions: There was positive correlation between age and indices of quantitative assessment (IM, IG, BMI) and qualitative (analysis Klemetti) on panoramic and carpal radiographs. Age is a risk factor for the onset of osteoporosis.

Avascular osteonecrosis mechanism – between osteoporosis and antiphospholipid syndrome

HIV infected patients receiving antiretroviral therapy (ART) can develop avascular osteonecrosis, 45 times greater than the general population. Avascular osteonecrosis increased in the last few years in patients with HIV infection. The most important mechanisms for avascular osteonecrosis in HIV-infected patients are: changes in bone metabolism, especially osteoporosis correlated with protease inhibitors and coagulopathy and antiphospholipid syndrome, frequently described in HIV infection. Aim: to describe different mechanisms of avascular osteonecrosis We present two HIV-infected patients under antiretroviral therapy who developed avascular osteonecrosis. First patient, male, 38 year-old, with AIDS-C3, with good immuno-virological outcome under AZT-3TC and lopinavir/ritonavir, developed severe osteoporosis after 5 years of ART, diagnosed by DXA test with a T-score <-2,5. The patient had: C4-C5-C6 severe osteoporosis with high fracture risk, with segmental instrumentation applied at those levels, and then bilateral avascular necrosis of femoral head (ANFH) with bilateral hip arthroplasty. ART regimen was changed and the patient received 3TC-ABC and Nevirapine. The patient didn’t have other risk factors for avascular osteonecrosis or osteoporosis: nonsmoker, normal CD4, undetectable viral load, without dyslipidemia. Despite ART changes, the patient developed bilateral osteonecrosis of the right knee and of both humeral heads. The second patient, male, 23 year-old with HIV-B3, was treated in 2007 with AZT-3TC and lopinavir/ritonavir. After 9 months of ART the patient had normal CD4 count and undetectable viral load but developed right ANFH stage II, diagnosed by MRI, without surgery recommendation. DXA didn’t show signs of osteoporosis or osteopenia. The ART regimen was changed and the patient received 3TC-ABC and raltegravir with good ANFH outcome. After one year the patient discontinued the ART. One year later symptoms related with avascular osteonecrosis reappeared and bilateral ANFH was diagnosed by MRI. The patient had low CD4 count (<200/cmm), high HIV viral load and positive antiphospholipid antibodies. The patient had risk factors for coagulopathies: smoker, recreational drug user, alcohol consumer, uncontrolled HIV infection with low CD4. We restarted the same regimen with 3TC-ABC and raltegravir with a good outcome for bone affliction. When HIV infection was well-controlled, the antiphospholipid antibodies became negative and bone affliction was improved. We emphasize the importance of metabolic disturbances in HIV-infected patients, among them avascular osteonecrosis with different mechanisms. Both, ART and uncontrolled HIV infection can affect bone metabolism and vascularization.

Warning signs of osteoporosis

Warning signs of osteoporosis

Prethodni prelomi kao prediktori nastanka osteoporoze

Introduction: Fractures are often the first sign of osteoporosis. Aim: To establish importance of previous fractures as a predictor of osteoporosis. Material and Methods: The prospective analysis encompassed 2328 patients by merging two ,,Bonlink' databases from two reference osteodensitometric centers in Serbia: one from Special Hospital for Rheumatic Diseases Novi Sad and other from Railway Healthcare Center, Belgrade. All patients had their bone mineral density (BMD) measured at the lumbar spine and at the hip. Results were interpreted according to the valid definition of osteoporosis. All patients were questioned regarding previous low-trauma fractures and/or their radiographic findings were observed from medical documentation. In statistical analysis, descriptive statistics, central tendency measures, and chi-square test were used. Results: 97% of patients were women and 3% were men, with average 64.39±8.84 years of age. According to the T score of the hip and the lumbar spine, most patients had their BMD on the osteopenia and osteoporosis level. From all subjects, 31% had low energy fractures. Regarding differences between subjects with different T score at the hip and low energy fractures X2 = 60.19; p = 0.00) and differences between subjects with different T score at the lumbar spine and low energy fractures X2 = 31.89; p = 0.00) there was statistical difference between subjects with osteopenia/osteoporosis and those with regular Tscore results regarding previous low-trauma fractures (p<0.01). Conclusion: Low energy fractures are important predictor of osteoporosis. Therefore early diagnosis of osteoporosis is of utmost importance, before the first fracture occurs.

Abstract A83: Modifications of the bone marrow microenvironment in the transition from monoclonal gammopathy of undetermined significance to multiple myeloma in Vk*MYC mice.

Abstract Multiple myeloma (MM) is a neoplastic plasma cell (PC) disorder of the oldster, and it is characterized by clonal proliferation of PC in the bone marrow (BM), monoclonal protein in biological fluids and organ dysfunction. While monoclonal gammopathy of undetermined significance (MGUS) often anticipates MM, the role of the cellular components of the BM microenvironment in the shift from MGUS to MM is unknown. Our aim was to define if the immune system has a role in this process. Thus, clinical signs of disease development and progression were investigated in the peripheral blood, bone marrow, kidney and bone of aging Vk*MYC mice to pinpoint the shift from MGUS to MM. We have also defined by immunohistochemistry and multiparametric flow-cytometry the phenotypic and functional characteristics of tumor infiltrating immune cells in the different phases of disease. We have found that the BM of Vk*MYC mice is the primary organ of PC accumulation, and accrual of PC in the BM associates with the presence of a measurable M-spike. Based on the frequency of PC in the BM and the quantification of M-spike in serum we were able to segregate MGUS from MM. The transition from MGUS to MM in Vk*MYC mice was characterized by increased vascularization of the BM that associated with local enrichment of proangiogenic molecules such as VEGF-A and IL18. The BM was also enriched in molecules that favor survival and proliferation of myeloma cells, and signs of osteoporosis accompanied these alterations. A comparison between Vk*MYC mice affected by MGUS and age matched wild type C57BL/6 mice revealed precocious alteration of the CD4/CD8 T cell ratio, increased percentage of IL2 and IL4 producing CD4+ T cells, and CD8+ T cells more prone to produce IFNγ in the BM of the former. In summary, our data suggest that early in disease development, yet unknown factors elicit an inflammatory reaction that significantly modifies the cellular composition of the BM and associates with neoangiogenesis and PC accumulation. Being the pathology in the Vk*MYC mouse similar to the human disease, our data might be relevant to understand the mechanisms of progression from MGUS to MM in humans. Citation Format: Arianna Calcinotto, Matteo Grioni, Maria Teresa Sabrina Bertilaccio, Marta Chesi, Leif Bergsagel, Giulia Casorati, Paolo Dellabona, Matteo Bellone. Modifications of the bone marrow microenvironment in the transition from monoclonal gammopathy of undetermined significance to multiple myeloma in Vk*MYC mice. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology: Multidisciplinary Science Driving Basic and Clinical Advances; Dec 2-5, 2012; Miami, FL. Philadelphia (PA): AACR; Cancer Res 2013;73(1 Suppl):Abstract nr A83.

Osteoporosis and osteoarthritis: similarities and differences

Osteoporosis and osteoarthritis are two different medical conditions, which beside the first part of their name „osteo“, have very little in common. Osteoporosis is a disorder which influences bones in terms of reduction of quality and quantity, which can easily result in bone fracture. Clinical signs of osteoporosis show no pain or other symptoms which could point to changes in bone structure, unless a bone fracture is diagnosed. Osteoarthritis is a disease which influences joints and its surrounding tissues. Seeing through clinical signs, changes could be verifi ed in terms of pain and limitations of movement and the cause of pain and way of its treatment are numerous. A person can suffer from osteoporosis and osteoarthritis at the same time. Although these medical conditions are more frequent in female than in male population, mechanisms which lead to them may interfere. Osteoporosis and osteoarthritis are muscular-bone disorders with signifi cant morbidity and mortality, but clinical experiences and epidemiological studies have shown their negative correlation.

Quantitative evaluation of the degrees of traditional Chinese medicine qualitative syndromes of osteoporosis

To establish a quantitative estimate model for diagnosing traditional Chinese medicine (TCM) syndromes of patients with osteoporosis. Symptoms and signs of osteoporosis and methodology related to syndrome research were collected by reviewing medical literature. The symptoms and sighs were quantitatively classified into three, two or one category according to a 100-mm visual analog scale. Fuzzy comprehensive evaluation model of TCM qualitative syndromes was performed based on analytic hierarchy process. Then "Hall for Workshop of Metasynthetic Engineering" expert symposium was held on subjects of syndrome quantification method and weight of evaluation indices in different levels for developing the analysis model of common syndromes. For clinical verification, the created models were applied to patients with osteoporosis for discriminating syndromes. Syndrome of each patient was also identified by 8 experts major in integrative medicine treating osteoporosis for comparing the coincidence rate using a self-made clinical questionnaire. Through literature reviewing, symptoms and signs quantification and expert discussing, the authors formed estimate models of essence deficit, qi deficiency, yin deficiency, yang deficiency, and blood stasis. A total of 220 patients with osteoporosis were enrolled and filled the clinical questionnaire. All 8 experts completed and returned the questionnaire (1 760 cases), and 1 545 of them were filled in completely. Experts' opinion on syndrome differentiation was exactly coincidence to estimate model in 611 cases and almost coincidence in 639 cases. The total coincidence rate reached to 94.05%. The estimate model for syndrome differentiation of osteoporosis has a high-coincidence rate with the fuzzy evaluation from experts, with good rationality and feasibility, and is worthy of promotion in the clinical study.

Magnetic resonance tomographic semiotics of osteoporotic compression fractures of the spine

The article contains an analysis of MRI in presence of osteoporotic compression fractures in 35 patients. In the process of their research, the authors specified signs of osteoporosis in MRI cases through comparison with DXA) data, as well as developed and specified MRI semiotics of osteoporotic compression fractures of the spine (bone marrow oedema, “fluid” sign, compression of the central part of the body, remains of yellow bone marrow, compression of a Breschet [basilovertebral] vein, fracture of a vertebral end plate, ring-shaped oedema of paravertebral tissues).

Secondary hyperparathyroidism but stable bone‐mineral density in patients with chronic myeloid leukemia treated with imatinib

Imatinib is currently the standard treatment for chronic myeloid leukemia(CML). Previous studies have shown that imatinib affects bone metabolism in CML patients. However, these effects are not well-studied prospectively. The authors studied bone-mineral density (BMD) and bone metabolism in 17 CML patients and matched controls in 2007 and now repeated the analyses prospectively in 2011. All CML patients were in complete cytogenetic remission during this 4-year period and treated with 400 mg imatinib q.d. (n 5 15) or 600 mg imatinib q.d. (n 5 2). Mean treatment duration was 102 months (range 69–129) in 2011. The authors found that serum levels of parathyroid hormone increased significantly in the patients between 2007 and 2011, and seven out of 17 patients had secondary hyperparathyroidism in 2011. However, the mean areal and volumetric BMDs were stable in the CML patients over the 4-year-observation period. Moreover, the CML patients had significantly higher volumetric BMD in the cortical compartment when compared with controls in 2011 and 2007. Thus, despite a high incidence of secondary hyperparathyroidism,there were no signs of osteoporosis or osteomalacia in imatinib-treated CML patients as suggested earlier.

Comparative pathological and cytogenetical study of ethanolic extract of Vinca rosea L. and Vinblastine in treating mammary gland adenocarcinoma implanted mice

Pathological, cytogenetical comparative study was the main objectives of this project between the influence of ethanolic extract of Vinca rosea and Vinblastine (vinca alkaloid) as chemotherapy. Fourty female adult Swiss albino balb/C mice of approximately body weight (20-26g) and age (8-10) weeks were used in whole experiments. In cytogenetic study two parameters mitotic index (MI) and blast index (BI) were used. The results showed significant increase (p‹0.05) in mitotic index (MI) and blast index (BI) values in groups treated with ethanolic extract of Vinca rosea. Also the results showed significant decrease in these values in groups treated with Vinblastine. Histopathological sections in control group showed the presence of tumor growth characterized by formation of acinar like structures, with pleomorphic tumor cells and hyperchromatic nuclei with a tendency to form giant cells and high numbers of mitotic figures with extensive areas of necrosis. The tumor showed metastasis in liver and Lung, with aggregation of tumor associated macrophages in liver. Histopathological sections in groups of tumor-bearing female mice, treated with ethanolic extract, were showed large areas of necrosis, mononuclear cell infiltration and encapsulate with fibrous connective tissue capsule with mononuclear cell infiltrations in lung and formation of early granuloma in liver. In chemotherapy, tissue sections showed vacuolation and necrosis of tumor cells which encapsulated with fibrous connective tissue. The pathological changes characterized by alopecia, and large pneumonic areas with extensive coagulative necrosis and apoptosis in liver with hyperplastic nodules formation. Bone section showed marked depletion of hemopoietic tissue of bone marrow and increased in the number of megakaryocytes, with signs of osteoporosis. We concluded that both ethanolic extract of Vinca rosea and Vinblastine have cytotoxic effect on transplanted mammary tumor cells in mice, with no side effect in case of Vinca rosea in comparison with vinblastine which cause severe pathological changes in internal target organs with signs of osteoporosis and precancerous lesions, with significant changes in the blood picture and in cytogenetic parameters.