Martin Kuzma

Effect of growth hormone on bone status in growth hormone-deficient adults.

BACKGROUND Growth hormone deficiency (GHD) is associated with reduced bone mineral content and increased risk of osteoporotic fractures. Reduced peak bone mass might explain the low bone mineral density (BMD) among patients with childhood onset GHD (CO-GHD) whilst the cause of osteopenia in adult-onset GHD (AO-GHD) is not fully understood. OBJECTIVES Prospective multicentric study to asses bone status in GHD adults after two years of recombinant growth hormone replacement treatment. METHODS In 94 GHD adults (49 men; Ø 34.5 yrs) we have measured BMD and bone markers (CTX, osteocalcin) during two years of rhGH treatment (at baseline, after 3 and 6 months, and after 1 and 2 years). Patients were adequately substituted for GHD and other pituitary deficiencies. RESULTS We have observed an increase in BMD-lumbar spine: n=42, 0.8155 →0.9418 g/cm2, p<0.0001; femoral neck n=41; 0.8468 →0.9031; p= 0.0004; BMD-whole body 1.0179 →1.0774; p=0.0003. We have compared gender difference: BMD-L-spine by 15.8 % in men (n=21) and by 5.6 % in women (n=19) (p= 0.008); BMD-femoral neck increased by 11.03 % in men and by about 3.0 % in women (p=0.032). In women, the initial decrease in BMD was recorded after 3 months. CO-GHD adults yielded a higher increase in BMD -L-spine (16.6 %, p=0.022). A correlation exists between IGF-I levels and BMD in lumbar spine (1st year: R=0.348, p=0.026; 2nd year: R= 0.33, p=0.0081) and between IGF-I and osteocalcin (1st year: R=0.383; p=0.0038). CONCLUSION Two-year therapy with recombinant human growth hormone improved bone status. IGF-I appears to be a good indicator of rhGH effect on bone (Tab. 3, Fig. 9, Ref. 36). Text in PDF www.elis.sk.

Decrease of trabecular bone score reflects severity of Crohn’s disease: results of a case–control study

Objectives Osteoporosis and osteopaenia are known chronic complications of inflammatory bowel diseases. The trabecular bone score (TBS) provides an indirect measurement of bone microarchitecture, independent of bone mineral density (BMD). Patients and methods The study was designed as a case–control study with the aim to assess and compare bone quantity and quality in patients with Crohn’s disease (CD). We purposefully excluded postmenopausal women and patients on long-term corticosteroid therapy. Results The cohort consisted of 50 CD patients and 25 healthy controls who matched in age, sex, weight, or vitamin D status. There was no significant difference between CD patients versus controls in the mean lumbar BMD of 0.982±0.119 versus 0.989±0.12 g/cm2 and the mean TBS score of 1.37±0.12 versus 1.38±0.12. We observed significantly lower TBS, but not lumbar BMD, in CD patients with stricturing (B2, 1.36±0.08) or penetrating (B3, 1.32±0.11) disease compared with those with luminal disease (B1, 1.42±0.11; P=0.003 and <0.0001, respectively). We also observed lower mean±SD TBS in patients on versus not on anti-tumour necrosis factor-&agr; therapy: 1.341±0.138 versus 1.396±0.099, respectively. However, the difference between these groups failed to reach statistical significance (P=0.11). No similar finding was seen comparing lumbar BMD in these groups. Conclusion For the first time, it was observed that TBS, but not BMD, correlates with the severity of CD. Our results therefore suggest that TBS can potentially help to identify high fracture risk CD patients better than BMD alone.

Biologic treatment in comparison to methotrexate has positive effect on trabecular bone score in rheumatoid arthritis patients: 1-year follow-up

ABSTRACT Introduction: Biologic treatment may influence activity of rheumatoid arthritis (RA), as well as areal bone mineral density (aBMD). Decreased aBMD explains the fracture risk in RA patients only partially. The trabecular bone score (TBS), novel texture parameter reflects degradation of trabecular bone and therefore could be used as a further parameter to predict the risk of fragility fracture. Objective: To compare the effects of biological disease-modifying antirheumatic drugs (bDMARDs) and conventional synthetic (cs) DMARDs (methotrexate) on aBMD and TBS in patients suffering from active RA. Methods: A 12 month prospective trial was performed in 105 active RA patients. The cohort was divided into two groups: group 1 (n = 84, mean age 54 yrs) treated with bDMARDs and group 2 (n = 21, mean age 53 yrs) treated with csDMARDs. The mean daily dose of prednisone at baseline was 6.2 and 6.6 mg (NS) between group 1 and 2, respectively. Patients with anti-osteoporotic treatment were not included. All patients received calcium (600 mg) and cholecalciferol (800IU). Lumbar spine (LS) and FN aBMD (by DXA, Hologic) were measured at baseline and after 1 year of treatment. TBS was generated using TBS Insight software (Medimaps, Switzerland). Results: Treatment with bDMARDS led to decrease in mean prednisone dose and to increase of 1.7% (p < 0.05) in TBS and OC levels of 26% (p < 0.001) but not on aBMD and CTX after treatment. The greatest TBS increase (2.7%, p < 0.05) was observed in premenopausal females within group 1. No effect of csDMARDS on measured parameters was observed. Conclusion: Treatment of patients suffering from active RA with bDMARDs in comparison to csDMARDS led to increase of TBS, with greater increment of TBS in premenopausal women, despite no change in aBMD.

Trabecular bone score in patients with inflammatory bowel diseases

The cohort consisted of 84 IBD patients, 53 with Crohn’s disease (CD) and 31 with ulcerative colitis (UC). Clinical characteristics i.e. age, gender, anthropometry, clinical behaviour, medication were recorded. The BMD was determined by dual-energy X-ray absorptiometry (DXA, Hologic Discovery) at the lumbar spine. TBS was determined by TBS Insight® software (Medimaps, France). The clinical characteristics of the cohort are shown in table 1. TRABECULAR BONE SCORE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES

Treatment efficiency of resistant hypertension in cardiologist's office.

BACKGROUND The target values of blood pressure have not been achieved in our population of patients sufficiently. The most difficult is a control of patients with resistant hypertension. We do not have data about efficiency treatment of these patients today. OBJECTIVES The aim of our study was to assess current treatment status and by antihypertensive treatment modification we tried to reach an adequate blood pressure control. METHODS Fifty two patients suffering from resistant hypertension 2-3 degree ESC/ESH with high cardiovascular risk have been observed. Reaching of the target blood pressure values was verified by 24-hour ambulatory blood pressure monitoring. RESULTS The target blood pressure values were achieved in 50 % of patients during 18 months. We noticed a statistically significant difference (p<0.001) in a decrease of casual and 24-hour ambulatory blood pressure in the group of controlled hypertensive patients in comparison with a group where blood pressure did not decrease sufficiently. In case of 50 % patients, the target blood pressure values have not been reached in spite of more antihypertensive drugs and a higher dose. CONCLUSION Adequately and systematically controlled patients were treated less intensively in comparison with an inadequately controlled group. 24-hour blood pressure monitoring analysis confirmed correction of the patological diurnal rhythm mostly in adequate blood pressure controlled group. In this group, we have noticed a statistically significant decrease of blood urea and creatinin levels and albumin/creatinin ratio in urine. Resistant hypertension needs multi-faceted approach with consistent control of all comorbidities in a case of problematic blood pressure control (Tab. 6, Fig. 1, Ref. 21).