Viktória Ferencz

Decreased bone density, elevated serum osteoprotegerin, and β-cross-laps in Wilson disease

Osteopathia has been reported in Wilson disease (WD), but bone density has not been measured; therefore, we performed bone mineral density (BMD), bone mineral content (BMC), and quantitative bone ultrasound (QUS) assessments, as well as measured the serum levels of osteocalcin (OCN), β‐cross‐laps (β‐CTxs), and the recently discovered osteoprotegerin (OPG) and its ligand RANKL to investigate the underlying mechanism of osseous disorders. Serum OCN, β‐CTx, OPG, and RANKL levels were measured by ELISA in 21 WD patients and in 20 age‐ and gender‐matched healthy subjects. BMD, BMC, and QUS parameters were also determined. Osteoporosis was present in 9/21 (43%) WD patients. Abnormal QUS parameters were found in 7 (33%) of the patients. Although serum OCN levels were similar in patients and controls (29.93 ± 24.65 mg/ml vs. 29.84 ± 6.89 mg/ml), β‐CTx and OPG levels were significantly increased in WD compared with the healthy controls (625.4 ± 312.3 pg/ml vs. 423.6 ± 144.3 pg/ml and p = 0.022 and 7.2 ± 3.4 pM vs. 3.5 ± 1.0 pM and p < 0.001, respectively). No difference was observed in the RANKL level. There was a positive correlation between OCN and β‐CTx (r = 0.55; p = 0.01). We proved high occurrence of osteoporosis in WD. Negative bone remodeling balance is a consequence of increased bone resorption, which is indicated by elevated β‐CTx. The novel finding of elevated serum OPG may reflect a compensatory reaction to enhanced osteoclast activity, despite the normal OCN level.

Assessment of the mineral density and mineral content of the equine third metacarpal and first phalanx bone by dual energy x-ray absorptiometry.

In the first part of this methodological study eleven metacarpi of 9 skeletally normal horses were examined from 4 directions by dual energy x-ray absorptiometry (DXA). The differences between the dorsopalmar-palmarodorsal and lateromedial-mediolateral (opposite sites) bone mineral density (BMD) values were found to be nonsignificant. In the second part of the study the precision of the Norland XR-26 densitometer was tested by measuring 34 metacarpal bones and 34 proximal phalanges, each of them three times, from a single direction. The difference between the individual measurements of the first phalanges and of the metacarpal bones originating from the right or the left side of the same horse were not significant, nor did the age or breed have a significant effect on BMD or bone mineral content (BMC). However, both BMD and BMC are greater in the metacarpal bones than in the proximal phalanges and are higher in geldings than in mares or to stallions, while the BMD or BMC values of mares and stallions did not differ from each other significantly. These data point to the necessity of further BMD studies in a higher number of patients.

The Relationship between 25-hydroxyvitamin D Levels, Insulin Sensitivity and Insulin Secretion in Women 3 Years after Delivery

OBJECTIVES There is a direct correlation between 25-hydroxyvitamin D (25[OH]D) levels and insulin sensitivity. Furthermore, women with gestational diabetes (GDM) may have lower levels of 25(OH)D compared to controls. The present study intended to investigate 25(OH)D levels and their association with insulin sensitivity and insulin secretion in women with prior GDM and in controls 3.2 years after delivery. METHODS A total of 87 patients with prior GDM and 45 randomly selected controls (age range, 22 to 44 years) with normal glucose tolerance during pregnancy nested within a cohort of all deliveries at Saint Margit Hospital, Budapest, between January 1 2005, and December 31 2006, were examined. Their 25(OH) D levels were measured by radioimmunoassay. Insulin sensitivity and fasting insulin secretion were estimated using the homeostasis model asssessment (HOMA) calculator and early insulin secretion by the insulinogenic index based on a 75 g oral glucose tolerance test. RESULTS There was no significant difference in 25(OH)D levels between cases and controls (27.2±13.1 [±SD] vs. 26.9±9.8 ng/L). There was a positive association between HOMA insulin sensitivity and 25(OH)D levels (beta = 0.017; 95% CI 0.001 to 0.034/1 ng/mL) that was robust to adjustment for age and body mass index. There was a nonsignificant association between HOMA insulin secretion and 25(OH)D (p=0.099), while no association was found with the insulinogenic index. CONCLUSIONS Prior GDM status was not associated with 25(OH)D levels; however, 25(OH) D levels were associated with HOMA insulin sensitivity. It is hypothesized that the association between HOMA insulin secretion and 25(OH)D levels is related to the autoregulation of fasting glucose levels because no association between 25(OH)D and insulinogenic index was found.

A csonttörés kockázati tényezőinek vizsgálata postmenopausás, osteoporosisos nőbetegek körében@@@Evaluation of risk factors for fractures in postmenopausal women with osteoporosis

Bevezetés: Az osteoporosis fő következménye a csonttörés. A csonttörés esélyét a csont mennyiségén kívül számos tényező befolyásolja. A kockázati tényezők egy csoportja egyszerű kérdőívekkel vizsgálható. Célkitűzés: A jelen vizsgálat (Score-HU) célja volt, hogy felmérje az osteoporosisban szenvedő, oszteológiai szakrendelésre irányított postmenopausás nőknél (n = 11 221) az ismert kockázati tényezők előfordulási gyakoriságát. Módszer: A kockázati tényezőket minden beteg esetében egyszerű kérdőív segítségével rögzítették. Eredmények: A csonttörés legfontosabb kockázati tényezői gyakorisági sorrendben a következők voltak: korábbi csonttörés (79,4%), nem antiporotikus gyógyszerek szedése (vérnyomáscsökkentők 67,9%, altatók 36%, antidepresszánsok 26,5%, kortikoszteroidok 13,5%), mozgásképesség csökkenése (44,6%), korai menopausa (31,9%), dohányzás (31,2%), gyakori elesés (29,1%), rossz egészségi állapot (legalább 3 krónikus betegség előfordulása 24,1%). Következtetések: Az említett kockázati tényezők egyszerű klinikai felmérése alapján az osteoporoticus betegek csonttörési kockázatát pontosabban adhatjuk meg, mint ha csupán az oszteodenzitometriás mérési eredményre hagyatkozunk a törési kockázatbecslés során. Orv. Hetil., 2015, 156(4), 146–153.INTRODUCTION The main consequence of osteoporosis is bone fracture. Bone fracture risk is determined by several risk factors beyond osteodensitometric results. Some of these factors could be estimated by simple clinical questionnaires. AIM The aim of the present study (Score-HU) was to investigate the risk factors of bone fracture among osteoporotic postmenopausal women (n = 11,221), who were examined in an osteologic outpatient departments. METHOD Risk factors of each patient were recorded with the use of a simple identical data sheet. RESULTS The incidence of risk factors were the following: previous bone fracture (79.4%), medication (except antiporotic treatment, antihypertensive drugs 67.9%, sleeping pills 36%, antidepressants 26.5%, corticosteroids 13.5%), decreased mobility (44.6%), early menopause (31.9%), smoking (31.2%), frequent falls (29.1%), and poor health status (more than 3 chronic diseases; 24.1%). CONCLUSIONS Estimating the above mentioned risk factors we could assess the bone fracture risk more accurately than taking alone the bone mineral density results into consideration.

Evaluation of risk factors for fractures in postmenopausal women with osteoporosis

Bevezetés: Az osteoporosis fő következménye a csonttörés. A csonttörés esélyét a csont mennyiségén kívül számos tényező befolyásolja. A kockázati tényezők egy csoportja egyszerű kérdőívekkel vizsgálható. Célkitűzés: A jelen vizsgálat (Score-HU) célja volt, hogy felmérje az osteoporosisban szenvedő, oszteológiai szakrendelésre irányított postmenopausás nőknél (n = 11 221) az ismert kockázati tényezők előfordulási gyakoriságát. Módszer: A kockázati tényezőket minden beteg esetében egyszerű kérdőív segítségével rögzítették. Eredmények: A csonttörés legfontosabb kockázati tényezői gyakorisági sorrendben a következők voltak: korábbi csonttörés (79,4%), nem antiporotikus gyógyszerek szedése (vérnyomáscsökkentők 67,9%, altatók 36%, antidepresszánsok 26,5%, kortikoszteroidok 13,5%), mozgásképesség csökkenése (44,6%), korai menopausa (31,9%), dohányzás (31,2%), gyakori elesés (29,1%), rossz egészségi állapot (legalább 3 krónikus betegség előfordulása 24,1%). Következtetések: Az említett kockázati tényezők egyszerű klinikai felmérése alapján az osteoporoticus betegek csonttörési kockázatát pontosabban adhatjuk meg, mint ha csupán az oszteodenzitometriás mérési eredményre hagyatkozunk a törési kockázatbecslés során. Orv. Hetil., 2015, 156(4), 146–153.INTRODUCTION The main consequence of osteoporosis is bone fracture. Bone fracture risk is determined by several risk factors beyond osteodensitometric results. Some of these factors could be estimated by simple clinical questionnaires. AIM The aim of the present study (Score-HU) was to investigate the risk factors of bone fracture among osteoporotic postmenopausal women (n = 11,221), who were examined in an osteologic outpatient departments. METHOD Risk factors of each patient were recorded with the use of a simple identical data sheet. RESULTS The incidence of risk factors were the following: previous bone fracture (79.4%), medication (except antiporotic treatment, antihypertensive drugs 67.9%, sleeping pills 36%, antidepressants 26.5%, corticosteroids 13.5%), decreased mobility (44.6%), early menopause (31.9%), smoking (31.2%), frequent falls (29.1%), and poor health status (more than 3 chronic diseases; 24.1%). CONCLUSIONS Estimating the above mentioned risk factors we could assess the bone fracture risk more accurately than taking alone the bone mineral density results into consideration.

Large increase in the prevalence of self-reported diabetes based on a nationally representative survey in Hungary

AIMS To estimate and compare the prevalence of self-reported diabetes based on nationally representative surveys of the Hungarian adult population in 2002 (published data - Hungarostudy) and a survey in 2012. METHODS A cross-sectional computer-assisted telephone interview survey on a stratified representative sample of community-dwelling adults (n=1000) in 2012. To describe self-reported diabetes prevalence and its temporal changes generalized linear models were used and results were compared to figures from Hungarostudy. RESULTS Age standardized prevalence of self-reported type 2 diabetes was 11.7% (95%CI 10.0-13.8%) without gender or rural-urban differences in 2012. People with self-reported diabetes were older than controls (mean [SE]: 63.9 [0.9] vs. 45.9 [0.3] years, p<0.0001). The prevalence of diabetes sharply increased after 40 years of age and peaked at age 70 (27.7% [2.5], page*age<0.0001). The prevalence of self-reported diabetes increased by 89% (OR 1.89, 95%CI 1.53-2.32) from 6.2 to 11.7% between the two surveys with the most pronounced increase in the age group 55-64 years (from 11.6 to 24.4%). CONCLUSIONS We reported an alarming increase in the prevalence of self-reported type 2 diabetes in the last decade that mostly affects working age people. If this trend continues, a major public health crisis in Hungary can be envisaged.

A normoglykaemia elérésének korlátai inzulinkezelt 2-es típusú cukorbetegekben

Insulin therapy is the most effective treatment of diabetes. It is proven to prevent microvascular disease and likely to decrease the risk of cardiovascular complications. However, these benefits are associated with a 2-3 times increased risk of hypoglycaemia and a faster weight gain compared to other antidiabetic medications. In addition, one study found elevated all-cause mortality among patients on intensive therapy (requiring more frequent insulinisation). Insulin has growth factor properties that may translate to increased mitogenicity. These factors could prevent the medical team or the patient from initiation or intensification of insulin therapy. The authors describe evidence on long-term remission related to transient intensified insulin therapy at diabetes diagnosis. The currently recommended method of insulin initiation is once daily basal insulin treatment that offers different schedules for intensification. The authors review the pharmacokinetics of analogue insulins that translate to similar efficacy to human insulins with a 20-30% lower risk of hypoglycaemia.

The severity of gestational diabetes mellitus affects microvascular dysfunction measured three years after pregnancy that may be related to increased oxidative stress

INTRODUCTION Oxidative-nitrative stress and poly(ADP-ribose) polymerase activation observed in gestational diabetes may play role in the increased cardiovascular risk in later life. AIM The present study aimed to examine the influence of the severity of previous gestational diabetes (insulin need) on vascular function three years after delivery. Furthermore, the authors investigated the relation of vascular function with oxidative-nitrative stress and poly(ADP-ribose) polymerase activation. METHOD Macrovascular function was measured by applanation tonometry; microvascular reactivity was assessed by provocation tests during Laser-Doppler flowmetry in 40 women who had gestational diabetes 3 years before the study. Oxidative-nitrative stress and poly(ADP-ribose) polymerase activity in blood components were determined by colorimetry and immunohistochemistry. RESULTS Three years after insulin treated gestational diabetes impaired microvascular function and increased oxidative stress was observed compared to mild cases. CONCLUSIONS The severity of previous gestational diabetes affects microvascular dysfunction that is accompanied by elevated oxidative stress. Nitrative stress and poly(ADP-ribose) polymerase activity correlates with certain vascular factors not related to the severity of the disease.Absztrakt Bevezetes: Gestatios diabetes mellitusban emelkedett oxidativ-nitrativ stressz es poli(ADP-riboz)-polimeraz-aktivacio van jelen, amely szerepet jatszhat a kesőbbi elet soran tapasztalt magasabb cardiovascularis kockazat kialakulasaban. Celkitűzes: A szerzők azt vizsgaltak, hogy 3 evvel a szules utan a megelőző gestatios diabetes sulyossaga befolyasolja-e az anyak errendszerenek allapotat, valamint milyen osszefugges mutathato ki az erfunkcio romlasa es az oxidativ-nitrativ stressz es poli(ADP-riboz)-polimeraz-aktivacio kozott. Modszer: Korabban sulyos (inzulinnal kezelt) vagy enyhe (dietaval kezelt) gestatios diabetesen atesett 40 nő nagyarteriainak funkciojat applanacios tonometriaval, a mikrokeringest provokacios tesztek elvegzese soran lezer-Doppler-modszerrel vizsgaltak. A veralkotokban merhető oxidativ-nitrativ stresszt es poli(ADP-riboz)-polimeraz-aktivaciot kolorimetras, valamint immunhisztokemiai technikaval hataroztak meg. Eredmenyek: Inzulinnal kezelt gestatios diabetesben a mikrokerin...