Wanda Horst-Sikorska

Influence of lean and fat mass on bone mineral density (BMD) in postmenopausal women with osteoporosis.

Despite known positive association between body mass and bone mineral density (BMD), relative contribution of fat and lean tissue to BMD remains under debate. We aimed at investigating the effect of selected anthropometric parameters, including fat content and lean body mass (LBM) on BMD in postmenopausal, osteoporotic women with body mass index (BMI) > 20 kg/m(2). The study involved 92 never-treated women (mean age 69.5 ± 7.3). L1-L4 and femoral neck (FN) BMD were measured by dual energy X-ray absorptiometry (DEXA). Absolute (kg) and relative (%) fat and LBM were assessed by means of electric bioimpedance method. We showed both FN and L1-L4 BMD were positively correlated with body mass, waist circumference (WC), hip circumference (HC) and LBM (kg). Fat content correlated with FN BMD (r = 0.36, p < 0.001). Regression analysis revealed the only predictor of L1-L4 BMD was LBM (R(2) = 0.18, p < 0.05), for FN--both LBM and fat (R(2) = 0.18, p < 0.05 and p < 0.001, respectively). Of the women, 44.5% were overweight, 18.4% obese. Obese women displayed the highest BMD. Both L1-L4 and FN BMD were higher in women with WC > 80 cm. In postmenopausal osteoporotic women with BMI > 20 kg/m(2) both fat and lean tissue might contribute to BMD. Positive association between body mass and BMD does not make obesity and osteoporosis mutually exclusive.

Association analysis of the polymorphisms of the VDR gene with bone mineral density and the occurrence of fractures

Associations of the FokI, BsmI, ApaI, and TaqI polymorphisms of the vitamin D receptor (VDR) gene with the bone mineral density (BMD) of the lumbar part of the spinal column (BMD LS) and the neck of the femur (BMD FN), and with the occurrence of fractures, were studied using the polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis on DNA isolated from peripheral blood of 239 women and 40 men from the region of western Poland. Three polymorphisms of the 3′ end of the VDR gene (BsmI, ApaI, TaqI) indicated a strong linkage disequilibrium. Association analysis of the VDR gene FokI polymorphism with BMD LS showed a dose effect of allele f. The association of the bAT haplotype of the BsmI, ApaI, and TaqI polymorphisms of the VDR gene with BMD FN was statistically significant. The association of the ApaI polymorphism with the occurrence of fractures was observed. Associations were also observed between the occurrence of fractures and the baT haplotypes of the VDR gene.

The attractiveness of family medicine among Polish medical students.

Abstract Background: In many developed countries tuning supply and demand of medical doctors is a continuous challenge to meet the ever changing needs of community and individual patients. The long study period for medical doctors creates the opportunity to observe the current career preferences of medical students and evolution in time. Objectives: To investigate the career choices of Polish students in different stages of their medical education. Methods: Medical students at five Polish medical universities were questioned about their career aspirations in the first, third and sixth year. Results: A total of 2020 students were recruited for the survey. Among first year students 17% preferred family medicine as final career option, compared to 20% in the third year, and 30% in the sixth year (significant trend, P < 0.0001). In particular, female students prefer family medicine: 71% women versus 62% women in the group with a preference for a non-family medicine orientation (P = 0.008). Medical students rejecting a career as a family doctor stated that the impossibility to work in a hospital environment was the determining factor. Conclusion: The opportunity for professional development seems to be an important determining factor in the choice of a medical specialty in Poland. The proportion of Polish students choosing family medicine increases during their progress in medical education, with one third of students interested in a career in family medicine by year six.

The importance of vitamin D in the pathology of bone metabolism in inflammatory bowel diseases.

Etiological factors of bone metabolism disorders in inflammatory bowel diseases have been the subject of interest of many researchers. One of the questions often raised is vitamin D deficiency. Calcitriol acts on cells, tissues and organs through a vitamin D receptor. The result of this action is the multi-directional effect of vitamin D. The reasons for vitamin D deficiency are: decreased exposure to sunlight, inadequate diet, inflammatory lesions of the intestinal mucosa and post-gastrointestinal resection states. This leads not only to osteomalacia but also to osteoporosis. Of significance may be the effect of vitamin D on the course of the disease itself, through modulation of the inflammatory mechanisms. It is also necessary to pay attention to the role of vitamin D in skeletal pathology in patients with inflammatory bowel diseases and thus take measures aimed at preventing and treating these disorders through the supplementation of vitamin D.

Prevalence of beta allele of the insulin gene in type II diabetes mellitus

Fifty-two patients and 36 controls were compared in a search for insulin gene variants among type II diabetic patients with fasting hyperinsulinemia (above 90 (μU/ml) and a fasting C-peptide to insulin molar ratio between 1.11 and 1.50. Alpha and beta alleles of the insulin gene were characterized by restriction analysis of polymerase chain reaction (PCR) products and direct sequencing. The more frequent occurrence of the alpha allele of the insulin gene within the control population as compared with a prevalence of the beta allele in the diabetic patients (P, 0.05) was observed. The beta allele, usually described as the rare allele, seems to be associated with the disease.

Osteoprotegerin, s-RANKL, and selected interleukins in the pathology of bone metabolism in patients with Crohn’s disease

Introduction Crohns disease (CD) promotes the development of osteopaenia/osteoporosis, the cytokine background of which is not fully known. Aim Evaluation of bone mineral density (BMD), the prevalence of osteopaenia and osteoporosis, and the determination of the levels of selected interleukins (IL), osteoprotegerin (OPG), and s-RANKL proteins in patients with CD in relation to a control group and assessment of the relationship between the tested cytokines, OPG, s-RANKL, and BMD. Material and methods Thirty-seven CD patients and 37 healthy volunteers (control group) were enrolled into the study. Densitometry of the lumbar spine (L2–L4) and of the femoral neck using the DXA technique was carried out. Serum levels of: IL-13, IL-4, IL-17, IL-1β, OPG, and s-RANKL were determined using the ELISA method. Progression-of-disease questionnaires were collected. Results The prevalence of osteoporosis and osteopaenia in the CD group was: 18.92% and 32.43% in L2–L4; 13.51% and 35.13% in the neck, respectively. The IL-13 and IL-1β concentrations were significantly higher and OPG was significantly lower in CD patients when compared to controls. In the case of all subjects: IL-13 correlated negatively with the BMD of the neck, IL-17 correlated negatively with the Z-score of L2–L4, and OPG correlated negatively with the IL-13. In the case of CD patients, IL-4 correlated negatively with the BMD of L2–L4. Conclusions The incidence of osteopaenia and osteoporosis in Polish CD patients is high. IL-13, IL-1β, and IL-4 seem to be connected with the pathology of decreased BMD in CD. It can be hypothesised that IL-13 may lower BMD by modulating OPG.

Association analysis of the COL1A1 polymorphism with bone mineral density and prevalent fractures in Polish postmenopausal women with osteoporosis

Introduction Polymorphism in the promoter region of collagen type 1α (COL1A1) +1245G/T (Sp1, rs1800012) was in some studies shown to be relevant for bone mineral density (BMD) and low-energy fracture prediction. The aim of the study was to confirm this finding in a group of postmenopausal women diagnosed with osteoporosis. Material and methods We investigated 311 Caucasian women (mean age: 65.2 ±9.39 years) either after low-energy fractures (regardless of the location) or meeting World Health Organization (WHO) criteria for osteoporosis. All patients underwent clinical examination in order to exclude secondary osteoporosis; hip and lumbar spine DEXA was performed (Lunar). The three genotypes of Sp1 polymorphism were determined by RFLP (restriction fragment length polymorphism). Results Distribution of COL1A1 genotypes (SS/Ss/ss) agreed with Hardy-Weinberg equilibrium. No relation between COL1A1 genotypes and hip/L1-L4 BMD was found. Fractures were reported in 26.3% of women. Prevalence of low-energy fractures, regardless of the type, was 50.0% in ss genotype carriers, 26.4% in SS homozygotes and 23.7% in Ss heterozygotes. There was no statistically significant recessive or dominant effect of any Sp1 genotype on fracture prevalence (p = 0.613). Conclusions We failed to observe that COL1A1 Sp 1 genotypes contribute to BMD determination or are associated with prevalent low-energy fractures in a Polish cohort of postmenopausal osteoporotic women.

Vitamin D – beyond skeletal activities

Witamina D jest znanym od lat czynnikiem niezbędnym dla kości oraz prawidłowego funkcjonowania gospodarki mineralnej. Udział jej niedoborów w patogenezie schorzeń z pogranicza endokrynologii, ginekologii i reumatologii, tj. krzywicy, osteomalacji oraz osteoporozy, jest dobrze udokumentowany. Głównym źródłem witaminy D u ludzi jest synteza skórna. Pomimo braku wspólnie przyjętej definicji optymalnego stężenia witaminy D w surowicy liczne opublikowane prace donoszą o rozpowszechnieniu hipowitaminozy D na całym świecie. Polscy eksperci zalecają wdrożenie populacyjnej strategii uzupełniania cholekalcyferolu u osób dorosłych. Szczególnie ważna w tym zakresie jest grupa kobiet w wieku okołomenopauzalnym – udowodniono dla niej skuteczność suplementacji witaminą D w profilaktyce złamań osteoporotycznych zarówno kręgowych, jak i pozakręgowych. Pośrednio prawidłowe zaopatrzenie w witaminę D wpływa na ryzyko upadków, które także stanowią czynnik złamania osteoporotycznego. Coraz więcej jest doniesień mówiących o licznych, pozaustrojowych działaniach tej rozpuszczalnej w tłuszczach witaminy, m.in.: w modulowaniu odpowiedzi immunologicznej, hamowaniu nowotworzenia, wpływie na wysokość ciśnienia tętniczego i gospodarkę węglowodanową. Hipowitaminozę D łączy się także ze zwiększonym ryzykiem rozwoju chorób sercowo-naczyniowych oraz śmiertelności z tych przyczyn. Molekularne podłoże tych zależności jest ciągle dyskutowane. Brakuje jednoznacznych dowodów co do wpływu suplementacji cholekalcyferolu na rozwój omawianych procesów, jednak dane z badań przekrojowych i obserwacyjnych wskazują na związek hipowitaminozy D z rozlicznymi patologiami. Słowa kluczowe: witamina D, cholekalcyferol, osteoporoza, nadciśnienie tętnicze, choroby autoimmunologiczne, choroby sercowo-naczyniowe, cukrzyca.

Barriers in the Delivery of Preventive Procedures in Primary Health Care

Objectives: Aim of the study was to evaluate general practitioners’ opinions on barriers in the delivery of preventive procedures and ways of solving the problem. 100s of physicians working in Primary Care Practices in Wielkopolska Region (Poland), during a period in 2010, filled questionnaires. Results: The most common barrier was lack of time and inadequate finances identified by 90% and 78% of doctors. Doctors’ or patients’ negative attitude to prevention was noted by 12% and 16% respondents. Insufficient skills and difficulties in updating knowledge were recognized by 9% of the doctors. As a solution 76% respondents pointed at increasing consultation time and 66% - to additional financial incentives. Some of surveyed doctors suggested the need for improvement of the national health programs and increasing their number. Workshops for medical staff were chosen by 48% of questioned doctors. Conclusions: 1. Lack of time is the main barrier in the delivery of preventive procedures in primary care. 2. According to the asked doctors financial incentives would increase the amount of health promotion in primary care.