Effect of Chronic Inflammation on Bone Density in Type 2 Diabetes Following Total Hip Arthroplasty

BACKGROUND

Patients with Type 2 Diabetes Mellitus (T2DM) constitute 20% of patients qualified for Total Hip Arthroplasty (THA). Poor glycemic control may result in a worse prognosis after THA. The aim of the study was to evaluate the effect of T2DM-induced inflammation on changes in bone density around the endoprosthesis stem in female patients.

MATERIAL AND METHODS

The investigational group consisted of female patients with T2DM and HbA1c> 6.5% who underwent THA. A control group consisted of female patients with T2DM and HbA1c≤6.5% who underwent THA. Anthropometric measurements, laboratory testing and functional status assessment according to the Harris Hip Score (HSS) were performed. A DXA bone density scan was performed within the first day after THA. The measurements and assessments were repeated after one year.

RESULTS

The Body Mass Index (BMI) was higher in the investigational group (33.802.93) than in the control group (31.223.40). Patients in the investigational group had higher CRP (4.661.59) as well as Bone Mineral Density (BMD) values in the operated (1.280.22) and opposite limb (0.940.14) on initial testing. After one year, there was a statistically significantly higher CRP in the investigational group (3.441.74) than in the control group (1.921.51).

CONCLUSIONS

1. The level of HbA1c in patients with T2DM is not associated with periprosthetic changes in BMD. 2. BMD changes may be associated with chronic inflammation and may mask severe abnormalities in bone microarchitecture. 3. Patients with T2DM after THA should undergo long-term clinical follow-up.

Clinical efficacy and safety of use of alfacalcidol and calcitriol in daily endocrinological practice

This paper aims to discuss and compare 2 vitamin D derivatives available on the Polish market, alfacalcidol and calcitriol, in the context of their effectiveness and safety in endocrine patients. Both above-mentioned substances find a number of applications, including in hypoparathyroidism, which is one of the most common indications for their use. We would also like to draw the reader's attention to the fact that there are quite a lot of reports in the literature on the positive effect of alfacalcidol and calcitriol on maintaining bone mass and the risk of fractures, which may bring additional potential benefits to our patients.

Osteoporosis treatment with denosumab in routine clinical practice in Poland

INTRODUCTION

The receptor activator for nuclear factor k B ligand (RANKL) inhibitor denosumab is approved for the treatment of osteoporosis in postmenopausal women and men at increased fracture risk. The objectives were to describe the characteristics of patients with osteoporosis initiating denosumab in Polish clinical practice and their clinical management during the first 12 months of denosumab treatment.

MATERIAL AND METHODS

This prospective, observational study enrolled denosumab-naïve women and men in Poland with osteoporosis, who had received at least one denosumab injection in the 8 weeks prior to enrolment. Patients were enrolled from specialist osteoporosis treatment centres, and orthopaedic, rheumatological, and family doctor centres. Outcomes included patient characteristics, denosumab treatment patterns, bone mineral density (BMD), and fracture; all analyses were descriptive.

RESULTS

The study enrolled 463 patients; most (96%) were women, aged ≥ 65 years (84%), with prior fractures (88%). Approximately two-thirds of the women had received prior osteoporosis therapy, with the main reasons for discontinuation being adverse events (75%) and lack of effect (73%). Across all patients, the most common reasons for prescribing denosumab were low bone mineral density (BMD/T-score) (93%) and history of osteoporotic fracture (78%). Mean BMD at denosumab initiation ranged from T-score -3.00 (lumbar spine) to T-score -2.6 (total hip), and BMD increased by 2.8-6.2% at month 12. Most patients completed follow-up (86%) and were due to receive a third denosumab injection (81%).

CONCLUSION

The article presents detailed sociodemographic and disease-related characteristics of patients who routinely implemented denosumab therapy. Most of them continued denosumab for at least 12 months, with increased BMD T-scores.

Guidelines for the diagnosis and management of osteoporosis in Poland. Update 2022

Guidelines to provide an update of the previously published Polish recommendations for the management of women and men with osteoporosis have been developed in line with advances in medical knowledge, evidence-based data, and new concepts in diagnostic and therapeutic strategies. A Working Group of experts from the Multidisciplinary Osteoporosis Forum and from the National Institute of Geriatrics, Rheumatology, and Rehabilitation in Warsaw performed a thorough comprehensive review of current relevant publications in the field (including all age groups of people and management of secondary osteoporosis), and they evaluated epidemiological data on osteoporosis in Poland and the existing standards of care and costs. A voting panel of all co-authors assessed and discussed the quality of evidence to formulate 29 specific recommendations and voted independently the strength of each recommendation. This updated practice guidance highlights a new algorithm of the diagnostic and therapeutic procedures for individuals at high and very high fracture risk and presents a spectrum of general management and the use of medication including anabolic therapy. Furthermore, the paper discusses the strategy of primary and secondary fracture prevention, detection of fragility fractures in the population, and points to vital elements for improving management of osteoporosis in Poland.

Dietary Behaviors, Serum 25(OH)D Levels and Quality of Life in Women with Osteoporotic Disorders

Data obtained in recent years clearly demonstrate the aging process of European populations. Consequently, the incidence of osteoporosis has been rising. The aim of this study is to assess the quality of life (QoL) of women with osteoporosis. A total of 260 women participated in this study. The patient group consisted of 170 women with osteoporotic disorders. The control group consisted of 90 healthy women. Participants' quality of life was measured with the Qualeffo-41 Questionnaire. The total 25(OH)D concentration level was assessed with an assay using the chemiluminescent immunoassay. To assess the pain level, the Visual Analogue Scale (VAS) was used. To assess dietary behaviors, data were obtained by a 13-item Food Frequency Questionnaire. To assess the nutrition knowledge of participants, the Beliefs and Eating Habits Questionnaire was used. Based on the frequency of food intake, participants were classified into three patterns of behavior, i.e., Prudent, Western, and Not Prudent-Not Western. The patients assessed their quality of life as average (36.6 ± 19.9 points). The most favorable scores were obtained in the domains of "Ability to do jobs around the house" and "Mobility". The worst rated domain among the respondents was "Mental function". There were significant differences identified in quality of life depending on diet, nutritional knowledge, comorbidities and occurrence of fractures in the subjects. The individuals in the "Prudent" group reported a significantly higher quality of life as compared to the "Not Prudent-Not Western" and "Western" groups and those with high nutritional knowledge as compared to those with moderate and low. Lower quality of life was also observed among women with comorbidities and with bone fractures. Depending on serum 25(OH)D levels, poorer quality of life was characterized women with vitamin D deficiency. Patient education, implementation of effective methods aimed at alleviating pain and maintaining the optimal concentration of vitamin D can help improve the quality of life in patients with osteoporotic disorders.

Fracture risk in obesity: a narrative review

While low body mass index (BMI) is a risk factor for fractures, the association between obesity and fracture risk is inconsistent and puzzling. Several studies reported higher fracture risk (FR), and others reported lower FR in obese populations. Our narrative review presents the overall incidence of fractures by anatomic locations in adult patients, geriatric populations, and in those after bariatric surgery. In conclusion, obesity should be considered as a fracture risk in adults, as well as falls and fractures in geriatric patients, in particular in those with sarcopenic obesity, and after bariatric surgery. The specific characteristics of fractures risk associated with obesity should be considered by physicians in the diagnostic and therapeutic work-up of obese patients. This review outlines the current literature on this topic and aims to guide physicians regarding proper decisions to prevent fractures in patients with obesity.

Correlation between the Positive Effect of Vitamin D Supplementation and Physical Performance in Young Male Soccer Players

The aim of this study was to determine whether supplementation with vitamin D during eight weeks of high-intensity training influences muscle power and aerobic performance in young soccer players. A total of 25 athletes were divided into two groups: the supplemented group (GS; n = 12; vitamin D 20,000 IU, twice a week) and the non-supplemented group (GN; n = 13). A set of measurements, including sprint tests, explosive power test, maximal oxygen uptake (VO2max), and serum 25(OH)D concentration, were obtained before (T1) and after (T2) the intervention. A significant group x time interaction was found in the 25(OH)D serum levels (p = 0.002; ES = 0.36, large). A significant improvement in VO2max was found in the TG (p = 0.0004) and the GS (p = 0.031). Moreover, a positive correlation between 25(OH)D and VO2max (R = 0.4192, p = 0.0024) was calculated. The explosive power tests revealed insignificant time interactions in the average 10-jump height and average 10-jump power (p = 0.07, ES = 0.13; p = 0.10, ES = 0.11, respectively). A statistically insignificant trend was observed only in the group-by-time interaction for the sprint of 10 m (p = 0.05; ES = 0.15, large). The present study provides evidence that vitamin D supplementation has a positive but trivial impact on the explosive power and locomotor skills of young soccer players, but could significantly affect their aerobic performance.

Resting Metabolic Rate in Women with Endocrine and Osteoporotic Disorders in Relation to Nutritional Status, Diet and 25(OH)D Concentration

There are speculations that vitamin D may be an important regulator of the energy metabolism. The aim of this study was to evaluate the influence of serum 25(OH)D concentration and nutritional status on the resting metabolic rate. The study group consisted of 223 women with endocrine and/or osteoporotic disorders. The control group consisted of 108 women, clinically healthy. The total 25(OH)D concentration level was measured with an assay using chemiluminescent immunoassay technology. Indirect calorimetry was applied to assess the resting metabolic rate. The mean resting metabolic rate was significantly lower in the group of women with metabolic disorders than in the control group. A correlation was found between serum 25(OH)D levels in healthy subjects and the resting metabolic rate. Significantly higher resting metabolic rate was found in women with normal serum 25(OH)D levels in comparison to subjects with deficient vitamin D levels. The control group demonstrated a relationship between body fat tissue and fat-free body mass and the resting metabolic rate. Both 25(OH)D concentration and body composition were factors influencing the resting metabolic rate in the group of healthy subjects. More research is needed to clarify the relationship between vitamin D status and metabolic rate in individuals with endocrine and osteoporotic disorders.

Vitamin D status in Polish women with endocrine and osteoporotic disorders in relation to diet, supplement use and exposure to ultraviolet radiation

BACKGROUND

In Europe, the rate of 25(OH)D deficiency is considered high. Thus, it seems necessary to conduct population-based studies to fully assess vitamin D deficiency in various groups of patients.

OBJECTIVES

To evaluate serum 25(OH)D levels and the frequency of deficiency in women in Poland with endocrine and osteoporotic disorders. The influences of diet, use of vitamin/mineral supplementation and exposure to ultraviolet (UVB) radiation on vitamin D status in women with metabolic disorders were also examined.

MATERIAL AND METHODS

The patient group consisted of 223 women aged 19-81 years diagnosed with endocrine and/or osteoporotic disorders. The control group consisted of 108 clinically healthy women aged 26-72 years. Serum 25(OH)D concentration was assessed using a chemiluminescent immunoassay (CLIA). An ad hoc questionnaire was used to assess the participants' exposure to UVB radiation. Food intake was assessed using a three-day 24-hour questionnaire interview.

RESULTS

The following groups showed significantly higher 25(OH)D levels: women taking vitamin D supplements compared to women not taking vitamin D supplements (29.3 ±3.2 compared to 19.5 ±3.7 ng/mL, p = 0.0024); premenopausal women compared to postmenopausal women (28.9 ±5.2 compared to 21.5 ±4.5 ng/mL, p = 0.0021); women who visited sunny countries in the last 6 months compared to women who did not (28.1 ±3.1 ng/mL compared to 24.5 ±5.3 ng/mL, p = 0.0031); and normal weight or overweight women (according to body mass index (BMI)) compared to obese women (27.4 ±4.5 ng/mL compared to 22.3 ±4.7 ng/mL, p = 0.0431). In addition, 25(OH)D concentration correlated with total dietary vitamin D intake in the patient group (R = 0.17, p = 0.0021). Of all examined food groups, fish consumption affected serum 25(OH)D levels in patients (R = 0.20, p = 0.0421) and controls (R = 0.29, p = 0.0002). Consumption of fish products contributed to statistical differences between the patient group (R = 0.17, p = 0.0072) and healthy subjects (R = 0.19, p = 0.0032).

CONCLUSIONS

The most crucial factors influencing vitamin D status in the studied women were regular fish consumption, spending holidays in sunny destinations and regular intake of vitamin D preparations.

VDR polymorphisms effect on bone mineral density in Polish postmenopausal women

Purpose: Osteoporosis is the most widespread systemic disease of the skeleton. According to estimated data for Poland, it affects ca. 3 million people. Although the disease is multifactorial, with significant influence of environmental factors on the increase of the risk of its occurrence, genetic factors play an important role in its pathogenesis. The aim of this study was an analysis of the relation of the ApaI, BsmI and TaqI polymorphisms of the VDR gene, with bone mineral density measured in lumbar spine and/or in proximal femur in a group of polish women. Methods: The study included 135 women at the postmenopausal age from the area of central Poland. BMD was measured at the hip and/or at the lumbar spine, using dual-energy X-ray absorptiometry. The influence of the selected VDR genotypes on bone mineral density was studied using the ApaI, the BsmI and the TaqI restriction enzymes. Lifestyle information was obtained via questionnaire. Results: Women with the 'bb' genotype showed lower BMD values of the hip (Total BMD value) comparing to patients with 'BB' or 'Bb' genotypes. We did not observe similar correlation for the lumbar spine. The remaining polymorphisms (ApaI and TaqI) did not demonstrate a significant relation with the differentiation of the mean BMD values obtained from the hip nor from lumbar vertebrae. Conclusion: The present study has demonstrated that the BsmI polymorphism of the vitamin D receptor gene is a factor of bone mineral density changes in postmenopausal women from Poland.

Assessment of Wnt pathway selected gene expression levels in peripheral blood mononuclear cells (PBMCs) of postmenopausal patients with low bone mass

The purpose of the study was to assess the expression of selected genes of the Wnt pathway: APC, AXIN1, CTNNB1, DKK1, GSK3B, KREMEN1, SFRP1, and WNT1 in peripheral blood mononuclear cells (PBMC) of patients, selected in consideration of their bone mineral density (BMD), and the occurrence of low-energy fractures. The study involved 45 postmenopausal women, divided into four groups, according to BMD and fracture history. Measurements of laboratory parameters and RNA expression in PBMC cells were carried out in material, collected once at the inclusion visit. The densitometric examination was performed on all participants. In the analysis of the relative expression levels (RELs) of the studied genes in the entire population, we observed an overexpression for SFRP1 in 100% of samples and WNT1. In addition, the REL of DKK1, APC, and GSK3B genes were slightly elevated versus the calibrator. In contrast, CTNNB1 and AXIN1 presented with a slightly decreased RELs. Analysis did not show any significant differences among the groups in the relative gene expression levels (p < 0.05) of particular genes. However, we have observed quite numerous interesting correlations between the expression of the studied genes and BMD, the presence of fractures, and laboratory parameters, both in the whole studied population as well as in selected groups. In conclusion, the high level of CTNNB1 expression maintains normal BMD and/or protects against fractures. It also appears that the changes in expression levels of the Wnt pathway genes in PBMCs reflect the expected changes in bone tissue.

The efficacy of pharmacotherapy in postmenopausal osteoporosis: a longitudinal observational study

INTRODUCTION

The aim of the study was an assessment of longitudinal changes in fracture probability in postmenopausal women.

MATERIAL AND METHODS

A group of 226 postmenopausal women at baseline mean age 66.46 ± 7.96 years were studied. There were 21 women without therapy, 102 taking calcium + vitamin D, and 103 women on antiresorptive therapy, in the study group. Data concerning clinical risk factors for osteoporosis and hip BMD were gathered. Fracture probability for major and hip fractures was established using FRAXTM.

RESULTS

Mean follow-up time was 2.43 ± 0.59 years. Baseline FRAX value in the whole group for major fracture was 7.1 ± 4.18, and at follow-up it was 7.44 ± 4.04. Respective results for FRAX for hip fracture were 3.17 ± 2.69 and 3.02 ± 2.35. In the whole group the probability for major fractures significantly increased during follow-up (p < 0.05) and for hip fracture did not change. In non-treated patients and patients taking calcium + vitamin D the fracture probability increased significantly. In patients on antiresorptive therapy the fracture probability did not change, which was connected with an improvement in bone status assessed by DXA. Femoral neck T-score in the whole group did not change, in those not treated and taking calcium + vitamin D it decreased significantly (p < 0.05), while in treated women it increased significantly (p < 0.05). In patients with improved bone status the FRAX values for major and hip fractures decreased by 0.44 ± 1.62 and 0.36 ± 1.19, respectively. Conversely, in patients with worsening T-score value the FRAX values increased by 1.33 ± 1.42 and 0.66 ± 1.25, respectively.

CONCLUSION

Antiresorptive therapy stabilises fracture probability in postmenopausal women due to improvement in bone status.

Effects of physical activity on sclerostin concentrations

Osteoporosis is a serious medical and socioeconomic problem of the 21st century. Mechanical load is a key regulator which controls bone formation and remodelling, with participation of osteocytes. Sclerostin is produced and released by mature osteocytes into bone surface, where it inhibits the conveyance of osteoblast proliferation and differentiation activating signals from mesenchymal cells, thus suppressing new bone formation. The goal of the study was an evaluation of the effects of a 12-week physical training programme on the levels of bone turnover markers [Sclerostin, Osteocalcin (OC), C-terminal telopeptide of type I collagen (β-CTX)] in blood serum of women with osteopenia.

MATERIALS & METHODS

The study included 50 women of the Regional Menopause and Osteoporosis Centre of the WAM Teaching Hospital, at the age of 50-75 years with the diagnosis of osteopenia, obtained on the basis of hip and/or lumbar spine densitometry (T-score from -1.0 to -2.5 SD). During the initial 12 weeks (between point 1 and 2), the patients maintained their previous, normal level of physical activity. During subsequent 12 weeks (between point 2 and 3), a programme of exercise was implemented. The programme included the interval training on a bicycle ergometer, three times a week for 36 minutes. During the entire study duration, all the patients received a supplementation of calcium (500 mg) and vit. D3 (1800 IU) once daily. Serum levels of OC, alkaline phosphatase (ALP), β-CTX and sclerostin were assayed at 3 time points.

RESULTS

After the course of the exercise cycle, the OC concentration was increased, sclerostin levels decreased, while no statistical differences were observed in β-CTX levels vs. the period of physical inactivity. No correlations were found between sclerostin level changes and osteocalcin level changes during the training time, because of too small groups. Neither statistically significant were the differences in alkaline phosphatase, calcium and phosphorus levels.

CONCLUSIONS

The obtained results emphasise the role of physical training as an effective stimulation method of bone formation processes in women with osteopenia. Sclerostin can be a marker of physical activity. < /p > < p >.

The role of selenium in thyroid gland pathophysiology

It is now assumed that proper functioning of the thyroid gland (TG), beside iodine, requires also a number of elements, including selenium, iron, zinc, copper, and calcium. In many cases, only an adequate supply of one of these microelements (e.g. iodine) may reveal symptoms resulting from deficits of other microelements (e.g. iron or selenium). Selenium is accounted to the trace elements of key importance for homeostasis of the human system, in particular, for the proper functioning of the immune system and the TG. Results of epidemiological studies have demonstrated that selenium deficit may affect as many as one billion people in many countries all over the world. A proper sequence of particular supplementations is also worth emphasising for the significant correlations among the supplemented microelements. For example, it has been demonstrated that an excessive supplementation of selenium may enhance the effects of iodine deficit in endemic regions, while proper supplementation of selenium in studied animals may alleviate the consequences of iodine excess, preventing destructive-inflammatory lesions in the TG. This paper is a summary of the current knowledge on the role of selenium in the functionality of the TG.

Evaluation of vitamin D concentration in a population of young, healthy women - the effects of vitamin D supplementation

INTRODUCTION

The goal of the study was an evaluation of serum vitamin D concentrations in healthy young women.

MATERIAL AND METHODS

A total of 106 healthy women, aged 20-30 years, were included in the study. Monthly evaluation - for three months - of the effects of calcium (500 mg) and vitamin D (1500 IU) administration in women with baseline values of vitamin D < 20 ng/mL (Group 1) plus the effects of an 800 IU/d dose in women with the baseline value of D > 20 ng/mL (Group 2). Additionally, calcium and PTH concentrations were assessed at the study onset and after a three-month supplementation. Only 67 women adhered to the prescribed therapeutic regime during the three months of observation.

RESULTS

The mean vitamin D concentration in the entire study group was 16.56 ng/mL, being 12.6 ng/mL in Group 1 and 25.22 ng/mL in Group 2. In the course of vitamin D administration, its concentration increased statistically significantly, both in the entire group and in the subgroups, at all time points compared with the study onset. Moreover, its concentration in the whole population and in Group 1 was significantly higher in each of the time points not only in relation to the baseline, but also in comparison with the results of the previous measurements (after 1 and 2 months of supplementation). In Group 2, vitamin D levels also increased systematically throughout the whole study period, and after 3 months its concentration was significantly higher than after 1 and 2 months. Although there were no differences in calcium concentration after those three months, a statistically significant drop of PTH (p < 0.05) was recorded in the entire population and in Group 1.

CONCLUSIONS

A moderate deficiency of vitamin D was observed in the studied population of young women. A supplementation with calcium plus vitamin D brought about an increase of vitamin D concentration as early as in the first month of administration. The optimal concentration of > 30 ng/mL was achieved in Group 1 after three months of vitamin D administration in 1500 IU/d dose.

Correlations between 10-year risk of death from cardiovascular diseases

INTRODUCTION

Osteoporosis and cardiovascular diseases (CVD) are more common in the elderly population and have similar risk factors. THE GOAL: was an evaluation of the correlation between 10-year risk of death from CVD and 10-year bone fracture risk (FRAX).

MATERIAL AND METHODS

A total of 79 patients of the Regional Centre of Menopause and Osteoporosis of the Military Teaching Hospital in Lodz (Poland), aged 50-83 years, consulted for osteoporosis were divided into two groups: study group - with osteoporosis (O; T-score ≤ -2.5 SD) and control - without osteoporosis (T-sc > -2.5). Bone mineral density was evaluated by densitometric scanning of spine (L2-L4 T-score) and/or femoral neck (Neck T-score) and/or total hip (Total Hip T-score). Total cholesterol (TC), fasting glucose, arterial blood pressure, medical history, and family history were obtained. The risk of fatal-CVD was assessed by Euro Heart Score (EHS), and major osteoporotic (MOFR) and hip fracture risk (HFR) by the FRAX scale.

RESULTS

80% of the patients (32/40) with osteoporosis and 51% (20/39) of the patients without osteoporosis revealed a HeartScore ≥ 5%. There was correlation in the group of all patients between EHS and Neck T-score (p < 0.05; Spearman rank correlation coefficient (Rs) = -0.3806), L2-L4 T-score (p < 0.05; Rs = -0.2891), and Total Hip T-score (p < 0.005; Rs = -0.3561), and in the control group - between EHS and Neck T-score (p < 0.05; Rs = -0.3502). There was a 2.33% difference between the average EHS level to the disadvantage of patients with osteoporosis (p < 0.05). EHS positively correlated with MOFR (p < 0.001) and HFR (p < 0.001) in the whole study popula-tion and with MOFR (p < 0.05) and HFR (p < 0.01) in the group of osteoporotic patients. There were differences between groups in TC (p < 0.001) and BMI (p < 0.001) levels.

CONCLUSIONS

The 10-year risk of fatal-CVD correlated with osteoporosis and with the 10-year osteoporotic fracture risk. This conclusion may help identify patients who require extended cardiotherapy protocols.

Assessment of OPG, RANKL, bone turnover markers serum levels and BMD after treatment with strontium ranelate and ibandronate in patients with postmenopausal osteoporosis

INTRODUCTION

The aim of this study was to evaluate quantitative changes in OPG and RANKL proteins after treatment with strontium ranelate (SR) and ibandronate in patients with postmenopausal osteoporosis.

MATERIAL AND METHODS

A total of 89 women with postmenopausal osteoporosis (PO), aged 51-85 years, patients of the Outpatient Clinic of Osteoporosis of the Military Teaching Hospital in Lodz, were enrolled in the study. The patients were randomly assigned to different therapies: ibandronate and (SR). Patients of the control group received only calcium and vitamin D3 supplements. The patients' visits were repeated after three and six months. Measurements of beta-CTX (C-terminal Telopeptide of type 1 collagen), osteocalcin, RANKL, osteoprotegerin (OPG), alkaline phosphatase concentrations in serum, as well as of total 24-hour calcium and phosphate levels in serum and urine, were carried out in material collected at baseline and after three and six months of therapy. Left hip and lumbar spine densitometry was done twice (at baseline visit and after six months).

RESULTS

In all three groups there were no significant differences noted in the concentrations of OPG and RANKL serum protein levels during the study period. Both negative and positive correlations or tendencies of correlations were found between OPG serum concentrations and BMD changes in the SR group.

CONCLUSIONS

Both ibandronate and SR do not seem to cause any significant changes in OPG and RANKL protein serum levels during the first six months of treatment. OPG may play a role in osteoclast activity suppression in the course of treatment with ibandronate in patients with PO. OPG may play an important role in the mechanism of SR therapy and may be viewed as a potentially valuable parameter for monitoring and predicting the course of treatment with SR in PO.

Single nucleotide polymorphisms in the STAT3 gene influence AITD susceptibility, thyroid autoantibody levels, and IL6 and IL17 secretion

STAT3 (signal transducer and activator of transcription 3) is an important cellular effector in the Jak/STAT signaling pathway, which plays a pivotal role in human immune system regulation, mediating the effect of different cytokines. In the present study, we assessed the correlation between STAT3 polymorphisms (rs3816769 C>T and rs744166 A>G) and risk of the autoimmune thyroid diseases (AITDs) Hashimoto’s thyroiditis (HT) and Graves’ disease (GD) in the Polish population. Moreover, we evaluated the association of polymorphisms with the thyroid autoantibody levels (TPOAb, TgAb, TRAb) and the correlation between circulating proinflammatory IL6 and IL17 cytokines and thyroid autoantibody levels. The study included 71 AITD patients with HT (n = 39) or GD (n = 32) and a control group (n = 40). DNA SNP genotyping was performed using TaqMan probes. Serum levels of thyroid autoantibodies, IL6 and IL17 were measured according to enhanced chemiluminescence (ECL) assay. Allele A of STAT3 SNP rs744166 A>G was significantly more frequent in both HT and GD patients, while allele G was significantly more frequent in the control group. Similarly, allele C and CC genotype of STAT3 SNP rs3816769 C>T were significantly more frequent in the control group in comparison to HT and GD patients. Significantly higher TgAb median values were associated with CT rs3816769 genotype in HT patients. Serum levels of IL6 and IL17 positively correlated with TPOAb in the HT group. Serum level of IL6 positively correlated with TPOAb in the AITD group. Both studied polymorphisms seem to play a significant role in susceptibility to AITD (HT and GD). STAT3 SNPs may influence TAb level in AITD patients.

FRAX calculator and Garvan nomogram in male osteoporotic population

PURPOSE

The aim of the study was the presentation of osteoporotic fracture prediction in men.

METHODS

Eight-hundred and one men at the mean age of 70.8 ± 9.31 years were examined. The 10-year fracture prediction was established, using the FRAX calculator and Garvan nomogram.

RESULTS

The mean value for any fracture and hip fracture probabilities for FRAX were 7.26 ± 5.4% and 3.68 ± 4.25%, respectively. For Garvan fracture, risk values were 26.44 ± 23.83% and 12.02 ± 18.1%. The mean conformity for any fracture and hip fracture prediction for threshold of 20% (any fracture) and 3% (hip fracture) between Garvan and FRAX values was 55.8% (κ 0.041) and 79.65% (κ 0.599), respectively. ROC analyses showed the following areas under the ROC curves (AUC) for any fractures: FRAX 0.808 and Garvan nomogram 0.843 (p = 0.059). The AUC values for hip fractures were 0.748 for Garvan nomogram and for 0.749 FRAX, and did not differ. On the base of ROC data, the cut-off values with best accuracy to predict fractures for both methods were established. The conformity between methods for thresholds indicated by ROC analysis was 72.5% (κ 0.435) for any and 77.7% (κ 0.543) for hip fractures.

CONCLUSION

The conformities between FRAX and Garvan in regard to hip fracture prediction were acceptable for a threshold of 3% and thresholds derived by ROC analysis, while for any fracture we recommend to use thresholds established by ROC analysis. This may suggest that the use of "universal" cut-off points is probably misleading.

CTLA-4 polymorphisms (+49 A/G and -318 C/T) are important genetic determinants of AITD susceptibility and predisposition to high levels of thyroid autoantibodies in Polish children - preliminary study

Autoimmune thyroid diseases (AITDs), including Hashimoto' s thyroiditis (HT) and Graves' disease (GD), are related to environmental and genetic factors. We analyzed the association of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) gene two polymorphisms (+49 A/G, -318 C/T) with HT and GD development in Polish children, and correlated both polymorphisms with the production of thyroid autoantibodies (TPOAb and TgAb). The study involved 49 AITD patients (age 10-19) with HT (n=25) or GD (n=24) and 69 healthy controls. SNP genotyping was performed using genomic DNA and TaqMan® probes. The obtained results indicated that CTLA-4 +49 GG genotype was significantly more frequent in both HT and GD patients, whereas the AA genotype was more common in controls. CTLA-4-318 CT genotype was significantly more frequent in AITD, and the CC genotype more often occurred in controls. Significantly higher median TPOAb and TgAb values were associated with G allele in HT, and with T allele in GD patients. Concluding, both studied polymorphisms seem to be important genetic determinants of the risk of HT and GD, and appear to be associated with a predisposition to high levels of TAbs and clinical AITD. The obtained results give more information on the distribution of the CTLA-4 polymorphism in Polish AITD children, and further support the proposal that the CTLA-4 gene plays an important role in a TAb production.

CTLA-4 polymorphisms (+49 A/G and -318 C/T) are important genetic determinants of AITD susceptibility and predisposition to high levels of thyroid autoantibodies in Polish children - preliminary study

Autoimmune thyroid diseases (AITDs), including Hashimoto' s thyroiditis (HT) and Graves' disease (GD), are related to environmental and genetic factors. We analyzed the association of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) gene two polymorphisms (+49 A/G, -318 C/T) with HT and GD development in Polish children, and correlated both polymorphisms with the production of thyroid autoantibodies (TPOAb and TgAb). The study involved 49 AITD patients (age 10-19) with HT (n=25) or GD (n=24) and 69 healthy controls. SNP genotyping was performed using genomic DNA and TaqMan® probes. The obtained results indicated that CTLA-4 +49 GG genotype was significantly more frequent in both HT and GD patients, whereas the AA genotype was more common in controls. CTLA-4-318 CT genotype was significantly more frequent in AITD, and the CC genotype more often occurred in controls. Significantly higher median TPOAb and TgAb values were associated with G allele in HT, and with T allele in GD patients. Concluding, both studied polymorphisms seem to be important genetic determinants of the risk of HT and GD, and appear to be associated with a predisposition to high levels of TAbs and clinical AITD. The obtained results give more information on the distribution of the CTLA-4 polymorphism in Polish AITD children, and further support the proposal that the CTLA-4 gene plays an important role in a TAb production.

Assessment of OPG/RANK/RANKL gene expression levels in peripheral blood mononuclear cells (PBMC) after treatment with strontium ranelate and ibandronate in patients with postmenopausal osteoporosis

CONTEXT

Recent research results have confirmed the high significance of the OPG/RANK/RANKL system in the development of bone diseases.

AIM

The aim of the reported study was to assess gene expression levels of the OPG/RANK/RANKL system in peripheral blood mononuclear cells (PBMCs) after strontium ranelate (SR) and ibandronate administered to patients with postmenopausal osteoporosis.

PATIENTS AND METHODS

A total of 89 postmenopausal women, aged 51 to 85 years, patients of the Outpatient Clinic of Osteoporosis of the Military Teaching Hospital in Lodz, were enrolled into the study. The patients were randomly assigned to different medical therapies: ibandronate and SR. Patients of the control group received only calcium and vitamin D₃ supplements. Patient visits were repeated after 3 and 6 months. Measurements of serum alkaline phosphatase concentrations and of RNA expression in PBMCs as well as of total serum calcium and phosphate levels and of their 24-hour urine excretion rates were carried out in material, collected at baseline and after 3 and 6 months of the therapy. Densitometry of the left hip and of the lumbar spine was done at the baseline visit and after 6 months.

RESULTS

The differences in gene expressions of RANKL and RANK were not significant during the study period and did not differ between the groups in a statistically significant manner. No OPG gene expression was observed in PBMCs of patients in any of the studied groups and at any time point. The tendency of correlation (P = .07) was observed between decreasing RANK gene expression and increasing bone mineral density in the patients treated with SR.

CONCLUSIONS

Both ibandronate and SR do not seem to cause any significant changes in gene expression levels of OPG/RANK/RANKL in PBMCs during the first 6 months of treatment.

The role of counselling and other factors in compliance of postmenopausal osteoporotic patients to alendronate 70 therapy

INTRODUCTION

The aim of the study was to assess the role of patient counselling, nurse assistance and effects of biochemical examinations in adherence of women with postmenopausal osteoporosis to alendronate 70 administration over 12 months of therapy.

MATERIAL AND METHODS

Compliance and persistence to alendronate 70 therapy were assessed in a prospective study of 123 postmenopausal women, followed up for one year. The patients were divided into 4 groups (controls, counselled group, biochemical group and nurse assisted group) with monitoring every 6 months; in the nurse assisted group, additional phone contacts were made after 3 and 9 months of treatment. After 12 months, compliance and persistence were analysed. The medication possession ratio (MPR) was regarded as optimal when its value exceeded 80%.

RESULTS

The compliance to alendronate 70 therapy was 54.03% in the control group and the mean persistence with medication was 197 days. The MPR above 80% was observed in 37.5%, and, after 1 year, 43.75% of patients were found persistent with the therapy. In the remaining groups, both compliance and persistence were higher but not statistically significantly, compared to the control group. Neither patient's age, education, diet, nor physical activity influenced the compliance with prescribed therapy. The most common reason to discontinue therapy was either its side effects or smoking.

CONCLUSIONS

The obtained results suggest that better adherence with medical recommendations is observed in patients who receive additional attention, e.g. counselling, biochemical tests or nursing care. The critical elements for therapy discontinuation were side effects and smoking.

Prognostic factors in patients surgically treated after hip fracture

INTRODUCTION

By the impact of demographic changes and as the result of the 'incorrect' lifestyles pursued in developed societies, osteoporosis has become a serious social problem. Hip fracture is the most serious complication of osteoporosis and is associated with high mortality rates or permanent health impairment. The goal of this study was an evaluation of the impact of selected socio-economic factors and of the time period from fracture to surgical intervention on the patient's prognosis.

MATERIAL AND METHODS

A group of 148 patients (114 women and 34 men) participated in the study, their age varying between 48 and 93 years, all of them after surgical treatment of hip fracture. A questionnaire study was carried out, encompassing all the participants.

RESULTS

During a year-long follow up, thirty-four (34) patients, i.e. 23% of the whole group, passed away. Further comparisons were performed between two groups: Group A - 114 patients, who survived the follow up period, and Group B - those who died. The mean age of patients was 76.3 and 82.6 years in Groups A and B, respectively (p 〈 0.05). In Group A, 79.8% of the patients declared full self-dependence prior to fracture episode vs. 44.1% of the patients in Group B (p 〈 0.05). Regular physical activity - in various forms - was undertaken by 39.5% of the patients in Group A and 11.8% of those in Group B (p 〈 0.05). Active ways of spending outdoor time were reported by 32.5% of the patients in Group A vs. 14.7% in Group B (p 〈 0.05). Fracture unfavourably influenced the material situation of affected patients. No relationship was found between the time period from fracture to surgery and the patient's prognosis.

CONCLUSIONS

1. Despite the currently available surgical treatment methods, hip fracture is still laden with a high risk of fatality. 2. High physical activity, especially outdoors, self-dependence and having a partner positively influence patient's prognosis after hip fracture. 3. Hip fracture negatively changes the material situation of patients. 4. The length of time from hip fracture to operation has no effect on the survival rate.

CTLA-4 gene polymorphisms and their influence on predisposition to autoimmune thyroid diseases (Graves' disease and Hashimoto's thyroiditis)

INTRODUCTION

Autoimmune thyroid disease (AITD) is associated with both genetic and environmental factors which lead to the overactivity of immune system. Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) gene polymorphisms belong to the main genetic factors determining the susceptibility to AITD (Hashimoto's thyroiditis, HT and Graves' disease, GD) development. The aim of the study was to evaluate the relationship between CTLA-4 polymorphisms (A49G, 1822 C/T and CT60 A/G) and HT and/or GD in Polish patients.

MATERIAL AND METHODS

Molecular analysis involved AITD group, consisting of HT (n=28) and GD (n=14) patients, and a control group of healthy persons (n=20). Genomic DNA was isolated from peripheral blood and CTLA-4 polymorphisms were assessed by polymerase chain reaction-restriction fragment length polymorphism method, using three restriction enzymes: Fnu4HI (A49G), BsmAI (1822 C/T) and BsaAI (CT60 A/G).

RESULTS

Statistical analysis (χ(2) test) confirmed significant differences between the studied groups concerning CTLA-4 A49G genotypes. CTLA-4 A/G genotype was significantly more frequent in AITD group and OR analysis suggested that it might increase the susceptibility to HT. In GD patients, OR analysis revealed statistically significant relationship with the presence of G allele. In controls, CTLA-4 A/A genotype frequency was significantly increased suggesting a protective effect. There were no statistically significant differences regarding frequencies of other genotypes and polymorphic alleles of the CTLA-4 gene (1822 C/T and CT60 A/G) between the studied groups.

CONCLUSIONS

CTLA-4 A49G polymorphism seems to be an important genetic determinant of the risk of HT and GD in Polish patients.

Influence of social competence of physicians on patient compliance with osteoporosis medications--a study on Polish postmenopausal women

OBJECTIVE

The aim of the study was to examine the impact of social competence of physicians on the effectiveness of patient compliance and persistence with therapy.

MATERIAL AND METHODS

The study included physicians and their patients, previously diagnosed with osteoporosis, and eligible to receive pharmacological treatment. The physicians were evaluated with the social competence questionnaire involving three dimensions: social exposure, intimacy and assertiveness, as well as in the combined scale. All patients in the study group were prescribed the same medication: alendronate once a week. Compliance and persistence of the patients were juxtaposed with social interaction skills of physicians during 7 scheduled appointments at 2-month intervals.

RESULTS

Doctor's effectiveness in situations demanding close interpersonal contact was higher in the group with good compliance--group A (p < 0.001), as well as in the situations of social exposure, (p < 0.001). On the other hand, their assertiveness was higher in the group with poor compliance--group B (p < 0.001). Co-morbid conditions (group A: 76%, group B: 74%), as well as earlier fractures (40.43% vs. 36.78%) were comparable in both groups. Disease acceptance and suggested methods of treatment were more often accepted by patients from group A than group B (56% vs. 33%, respectively).

CONCLUSIONS

(1) Disease acceptance is essential for effective treatment. (2) Social skills of physicians influence patient adherence to therapy recommendations. (3) Close interpersonal contact between physicians and their patients eliminates the feeling of fear and

6-methoxytryptophol reduces lipopolysaccharide-induced lipid peroxidation in vitro more effectively than melatonin

Bacterial lipopolysaccharide (LPS) causes lipid peroxidation (LPO). We have found that LPS induces LPO in tissue homogenates in vitro in a concentration-dependent manner, the concentration of 400 μg/ml demonstrating the most efficient lipid damaging effect. Antioxidant properties of melatonin are unquestionable and have been proved both in vivo and in vitro. It has been demonstrated that also melatonin metabolites and derivatives inhibit oxidative stress. The aim of our study was to compare the effects of melatonin (MEL) and indole compound: 6-methoxytryptophol, on LPS-induced LPO in vitro. Malondialdehyde (MDA) plus 4-hydroxyalkenal (4-HDA) concentrations were measured as the indicators of induced membrane peroxidative damage in brain, liver and kidney homogenates. Both melatonin and 6-methoxytryptophol were used at increasing concentrations, starting from 0.01-5 mM, together with LPS at one concentration of 400 μg/ml. In all the examined tissues, LPS stimulated LPO, while both melatonin and 6-methoxytryptophol released LPS-stimulated LPO. Furthermore, the capacity of 6-methoxytryptophol reducing LPO was higher than that of melatonin. The results of the reported study clearly indicate that 6-methoxytryptophol is a much stronger antioxidant in vitro than melatonin in terms of reducing oxidative damage to lipid membranes. However, it remains still unclear how the features relate to in vivo circumstances.

The role of i.v. ibandronate administration in osteoporosis therapy

Osteoporosis is a chronic disease of the osseous system characterised by decreased strength of bone tissue, which in turn leads to increased fracture risk. It has been demonstrated that osteoporosis affects more than 30% of women after the menopause (WHO, 1994). However, the disease is also observed in men. The primary goals of osteoporosis therapy include prevention of low-energy fractures and general improvement of quality of life. Any patient with diagnosed osteoporosis requires, besides prevention, the application of proper treatment. Of the available therapeutic options, the best are bisphosphonates, medical agents with well identified properties, therapeutic efficacy, and safety which has been confirmed in many clinical studies. Therefore, they are recommended as first line drugs for osteoporosis. The efficacy of oral preparations may be limited, due to low bioavailability, complications and adverse effects from the gastrointestinal tract. So the parenteral administration of bisphosphonates is a valuable alternative. A fine example of such therapy is the intravenous administration of ibandronate. Short injection time periods and the relatively long, three-month intervals between administrations are unquestionable advantages of this therapy mode. In addition, the therapy does not constrain a patient's everyday activity, and simultaneously provides regular contact with doctors and the therapeutic centre. Additionally, a good tolerance of the drug and its high therapeutic efficacy, proven by appreciably reduced fracture risks, significantly improves the quality of life of patients suffering from osteoporosis. This paper is a thorough review of current knowledge on the efficacy and safety of i.v. ibandronate in osteoporosis therapy, as presented in the latest literature reports.

Current indications for prevention and therapy of steroid-iduced osteoporosis in men and women

Steroid-induced osteoporosis is a textbook example of the secondary type of this medical condition. Glucocorticosteroids suppress bone formation by their direct and indirect effect on osteoblasts, osteoclasts and osteocytes, increasing their resorption and, eventually, leading to negative bone balance. A clinical problem arises regarding the fact that approximately 50% of patients on chronic steroid therapy undergo asymptomatic bone fractures. The treatment mode includes minimising the dose of administered steroids, encouraging an improved lifestyle and supplementation with adequate calcium and vitamin D3 doses. Bisphosphonates are a group of medical agents used both to prevent and treat steroid-induced osteoporosis, although new therapies have also become available in recent years.

Alendronate 70 therapy in elderly women with post-menopausal osteoporosis: the problem of compliance

INTRODUCTION

More than half of those with chronic diseases, including osteoporosis, discontinue treatment during the first year of its administration. This problem increases over the course of continued follow-up. Additionally, it has been observed that 13% of women, prescribed oral daily alendronate, do not even start the treatment, while 20% of patients discontinue the therapy during the first four months. On the other hand, those patients who are compliant achieve increased bone mass density with a simultaneous decrease of fracture risk. The aim of our study was to assess the adherence to the recommended alendronate 70 administration protocol over the course of 12 months by women with post-menopausal osteoporosis.

MATERIAL AND METHODS

Adherence (compliance plus persistence) to alendronate 70 therapy was assessed in a prospective study of 153 post-menopausal women, followed up for one year with monitoring every two months.

RESULTS

Adherence to therapy of all the study participants was high during the entire study period, the patients remaining compliant after a year in 95.08 ± 1.39% (mean ± SEM) of cases, and the mean persistence with medication was 347.05 ± 5.07 days. In the group of patients who interrupted treatment, the mean persistence was 212.44 days. One of the study participants did not start the treatment, and another two discontinued the therapy within 30-60 days of the study onset (between the first two visits). Facilitated contacts with the doctor, continuous access to prescribed treatment and frequent visits significantly improved patient compliance. The common reason for discontinuation was side effects, while age (but not education) affected the rate of compliance with therapy. The worst results were obtained in the group of patients with osteoporosis diagnosed more than five years before the study, particularly in the subgroup where alendronate was being used for the first time or where treatment resumed after a substantial break.

CONCLUSIONS

The obtained results indicate that better adherence to alendronate 70 therapy, administered once a week, depends on more frequent monitoring of treated patients.

[Current indications for prevention and therapy of steroid-induced osteoporosis in men and women]

Steroid-induced osteoporosis is a textbook example of the secondary type of this medical condition. Glucocorticosteroids suppress bone formation by their direct and indirect effect on osteoblasts, osteoclasts and osteocytes, increasing their resorption and, eventually, leading to negative bone balance. A clinical problem arises regarding the fact that approximately 50% of patients on chronic steroid therapy undergo asymptomatic bone fractures. The treatment mode includes minimising the dose of administered steroids, encouraging an improved lifestyle and supplementation with adequate calcium and vitamin D(3) doses. Bisphosphonates are a group of medical agents used both to prevent and treat steroid-induced osteoporosis, although new therapies have also become available in recent years.

[The role of i.v. ibandronate administration in osteoporosis therapy]

Osteoporosis is a chronic disease of the osseous system characterised by decreased strength of bone tissue, which in turn leads to increased fracture risk. It has been demonstrated that osteoporosis affects more than 30% of women after the menopause (World Health Organization, 1994). However, the disease is also observed in men. The primary goals of osteoporosis therapy include prevention of low-energy fractures and general improvement of quality of life. Any patient with diagnosed osteoporosis requires, besides prevention, the application of proper treatment. Of the available therapeutic options, the best are bisphosphonates, medical agents with well identified properties, therapeutic efficacy, and safety which has been confirmed in many clinical studies. Therefore, they are recommended as first line drugs for osteoporosis. The efficacy of oral preparations may be limited, due to low bioavailability, complications and adverse effects from the gastrointestinal tract. So the parenteral administration of bisphosphonates is a valuable alternative. A fine example of such therapy is the intravenous administration of ibandronate. Short injection time periods and the relatively long, three-month intervals between administrations are unquestionable advantages of this therapy mode. In addition, the therapy does not constrain a patient's everyday activity, and simultaneously provides regular contact with doctors and the therapeutic centre. Additionally, a good tolerance of the drug and its high therapeutic efficacy, proven by appreciably reduced fracture risks, significantly improves the quality of life of patients suffering from osteoporosis. This paper is a thorough review of current knowledge on the efficacy and safety of i.v. ibandronate in osteoporosis therapy, as presented in the latest literature reports.

[Bisphosphonates and the risk of atrial fibrillation]

Osteoporosis is a growing problem in an ageing society. It affects women of post-menopausal age, as well as elderly subjects of both sexes, often with dysfunction of the cardiovascular system or with an increased risk of circulation disorders. It has been found that the mortality rate of subjects with osteoporosis is comparable to that of patients suffering from such diseases as obturative pulmonary disease or myocardial ischaemia. Bisphosphonates are the most thoroughly studied group of drugs prescribed for the treatment of osteoporosis. Their administration is, however, associated with a risk of adverse symptoms, which can occur as gastro-intestinal tract disturbances, muscular-osseous pains, mandible necrosis, atypical fractures and other symptoms. Recently, there has been discussion about an increased risk of atrial fibrillation in bisphosphonate-using female patients. This paper focuses on this particular problem, while summing up the actual status of knowledge regarding possible associations of bisphosphonates with cardiac rhythm disturbances.

Bisphosphonates and the risk of atrial fibrillation

Osteoporosis is a growing problem in an ageing society. It affects women of post-menopausal age, as well as elderly subjects of both sexes, often with dysfunction of the cardiovascular system or with an increased risk of circulation disorders. It has been found that the mortality rate of subjects with osteoporosis is comparable to that of patients suffering from such diseases as obturative pulmonary disease or myocardial ischaemia. Bisphosphonates are the most thoroughly studied group of drugs prescribed for the treatment of osteoporosis. Their administration is, however, associated with a risk of adverse symptoms, which can occur as gastro-intestinal tract disturbances, muscular-osseous pains, mandible necrosis, atypical fractures and other symptoms. Recently, there has been discussion about an increased risk of atrial fibrillation in bisphosphonate-using female patients. This paper focuses on this particular problem, while summing up the actual status of knowledge regarding possible associations of bisphosphonates with cardiac rhythm disturbances.

Vitamin D supplementation in adults - guidelines

Vitamin D is necessary in maintaining appropriate calcium and phosphate homeostasis in the body (classical function) and ensuring appropriate functioning of many tissues, organs and cells, unrelated to mineral economy (non-classical function). Vitamin D deficiency in adults may cause osteomalacia, increase fracture risk in osteoporosis, induce cardiovascular diseases, diabetes type 1 and 2, multiple sclerosis, Lesniowski-Crohn disease, and cancer, including colon, breast, and prostate cancer. Possible causes of vitamin D deficiency in a healthy population include decreased cutaneous synthesis and an inadequate intake of vitamin D, both in food and in supplements. Vitamin D deficiency level (25(OH) D. 〈 20 ng/mL), is fairly widespread, being found in a substantial percentage of healthy subjects around the world, regardless of race, gender and age. Daily vitamin D dose, as determined by the Food and Nutrition Board in 1997, is now rather insufficient, the biggest problem being associated with maximal vitamin D levels (50 μg/day) in actually available food supplements. Nowadays, it is recommended that adults need a minimum of 800-1,000 U/day when their exposure to the sun is inadequate (in Poland from October to April). This dosage should be provided to all subjects who avoid sunlight, as well as to those aged over 65 because of their slower skin synthesis of vitamin D and for its proven anti-fracture and anti-fall effects.

Ten-year probability of osteoporotic fracture in 2012 Polish women assessed by FRAX and nomogram by Nguyen et al.-Conformity between methods and their clinical utility

PURPOSE

The aim of the cross-sectional study was to establish the degree of conformity between 10-year probability of osteoporotic fracture, assessed by FRAX, and using the nomograms, as proposed by Nguyen at al.

METHODS

Postmenopausal Polish women (2012) were examined in their mean age of 68.5+/-7.9 years (age range 55-90 years). Fracture probability by FRAX was based on age, BMI, prior fracture, hip fracture in parents, steroid use, rheumatoid arthritis, alcohol use, secondary osteoporosis and T-score for femoral neck BMD. Fracture probability by Nguyen's nomograms was based on age, the number of prior fractures, the number of falls and T-score for femoral neck BMD.

RESULTS

The mean conformity rate was 79.1% for any fracture risk (for threshold 20%) and 79.5% for hip fracture (threshold 3%). Any and hip fracture risks were significantly higher for both methods in women with fracture history in comparison to those without fracture and increased with ageing. The influence of prior fracture and ageing was more evident in Nguyen's nomograms. ROC analyses of any fracture risk in FRAX and Nguyen's methods demonstrated the area under curve (AUC) at 0.833 and 0.879, respectively. Similar analyses for hip fracture demonstrated AUCs for FRAX and Nguyen's technique at 0.726 and 0.850, respectively. The AUCs for Nguyen's nomograms were significantly larger than the AUCs for FRAX (p<0.0001).

CONCLUSION

The mean conformity for any fracture risk is 79.1% and 79.5% for hip fracture. Nguyen's nomograms seem to be more efficient in fracture risk assessment, especially for hip fractures, due to a higher accuracy of the method. The information on the number of falls during the last year and multiple fractures ought to be incorporated into the method of fracture risk prediction.

MINI-ABSTRACT

The degree of conformity was assessed in a group of 2012 women between 10-year FRAX prognosis of fracture and Nguyen et al.'s nomograms. The mean conformity for any fracture risk is 79.1% and 79.5% for hip fracture. Nguyen's nomograms seem to be more efficient in fracture risk assessment due to higher accuracy.

N-acetylserotonin reduces lipopolysaccharide-induced lipid peroxidation in vitro more effectively than melatonin

OBJECTIVE

Bacterial lipopolysaccharide (LPS) causes lipid peroxidation (LPO). We have found that LPS induces LPO in vitro, in tissue homogenates in a concentration-dependent manner, the concentration of 400 µg/ml demonstrating the most efficient lipid damaging effect . Both melatonin and its precursor, N-acetylserotonin, must possess antioxidant activities, both in vivo or in vitro, however, following some claims, N-acetylserotonin is a more effective extra- and intracellular antioxidant than melatonin. The aim of our study was to compare the effects of melatonin and N-acetylserotonin on the LPS-induced LPO in vitro.

METHODS

Malondialdehyde (MDA) plus 4-hydroxyalkenal (4-HDA) concentrations were measured as the indices of induced membrane peroxidative damage in brain, liver and kidney homogenates. Both melatonin and N-acetylserotonin were used at increasing concentrations, starting from 0.01-5 mM, together with LPS at one concentration level of 400 µg/ml.

RESULTS

In all the examined tissues, LPS stimulated LPO, while both melatonin and N-acetylserotonin decreased LPS-stimulated LPO. Furthermore, the capacity of N-acetylserotonin reducing LPO was higher than that of melatonin.

CONCLUSIONS

The results of the reported study clearly indicate that N-acetylserotonin is a much stronger antioxidant in vitro than melatonin in terms of reducing oxidative damage to lipid membranes. However, it remains still unclear how the features relate to in vivo circumstances.

[Vitamin D supplementation in adults--guidelines]

Vitamin D is necessary in maintaining appropriate calcium and phosphate homeostasis in the body (classical function) and ensuring appropriate functioning of many tissues, organs and cells, unrelated to mineral economy (non-classical function). Vitamin D deficiency in adults may cause osteomalacia, increase fracture risk in osteoporosis, induce cardiovascular diseases, diabetes type 1 and 2, multiple sclerosis, Lesniowski-Crohn disease, and cancer, including colon, breast, and prostate cancer. Possible causes of vitamin D deficiency in a healthy population include decreased cutaneous synthesis and an inadequate intake of vitamin D, both in food and in supplements. Vitamin D deficiency level (25(OH) D. <20 ng/mL), is fairly widespread, being found in a substantial percentage of healthy subjects around the world, regardless of race, gender and age. Daily vitamin D dose, as determined by the Food and Nutrition Board in 1997, is now rather insufficient, the biggest problem being associated with maximal vitamin D levels (50 μg/day) in actually available food supplements. Nowadays, it is recommended that adults need a minimum of 800-1,000 U/day when their exposure to the sun is inadequate (in Poland from October to April). This dosage should be provided to all subjects who avoid sunlight, as well as to those aged over 65 because of their slower skin synthesis of vitamin D and for its proven anti-fracture and anti-fall effects.

Effects of certain antioxidants on lipid peroxidation process in lung homogenates of L thyroxine-receiving rats

OBJECTIVE

A possible role of antioxidants in thyreotoxicosis was investigated. We examined the parameters of lipid peroxidation (LPO): conjugated dienes (CD), malondialdehyde (MDA), Schiff bases (SB) in lung homogenates of male Wistar rats.

METHODS

Two control groups were created: Group 1 - intact animals and Group 2 - animals injected with 0,9% NaCl. In Experiment I, the animals received L-thyroxin (LT4) i.p. (Groups 3-7). After one week the rats received additionally: Group 4 - melatonin (MEL); Group 5 - propylthiouracil (PTU); Group 6 - Ambroxol (AMB); Group 7 - N-acetylocysteine (NAC). In Experiment II, the animals received only antioxidants.

RESULTS

In Experiment I, we noticed a significantly higher MDA and SB level in Group 2, compared to that in Group 1. Moreover, we observed a significantly higher MDA and SB level in Group 3, vs. that in Group 1, but SB level was lower in Group 3 than in Group 2. Melatonin, PTU and NAC reduced CD; PTU, AMB diminished MDA and MEL, AMB lowered SB levels as compared to Group 3. In Experiment II, we observed significantly higher MDA and SB level in Group 2, vs. that in Group 1. Melatonin, AMB and NAC decreased MDA and SB level, when compared to Group 2 but PTU elevated MDA and SB level vs. that in Group 1.

CONCLUSIONS

1) L-T4 suppresses LPO, 2) MEL, AMB and NAC protect against LPO, 3) PTU is an antioxidant in thyreotoxicosis, however, when administered alone, it enhances LPO, 4) stress accelerate LPO.

Compliance with alendronate 10 treatment in elderly women with postmenopausal osteoporosis

INTRODUCTION

It has been shown that more than 50% of people with a chronic disease, including osteoporosis, discontinue treatment during its first year. This problem increases with the time of observation. The aim of this study was to assess alendronate compliance over a period of 6 or 18 months in clinical practice of postmenopausal osteoporosis.

MATERIAL AND METHODS

Using a retrospective study of clinical histories (357) obtained in our Outpatient Clinic, as well as telephone interviews with patients, the compliance with alendronate therapy in postmenopausal patients was assessed.

RESULTS

After 1.5 years on observation 20.4% of patients, and after 0.5 years 8.5% of patients, discontinued their treatment as a result of intolerance (especially side effects on the gastrointestinal tract) (47.8%), health problems unrelated to osteoporosis (8.7%), inconvenience of the daily regimen (13.1%), costs (4.3%), and improvement of clinical condition (26.1%). It is worth mentioning that in both periods of observation (1.5 and 0.5 years) almost the same percentage of patient discontinued visits at our Outpatient Clinic (15.6% and 14.4%, respectively). Telephone interviews with patients who stopped attending the Outpatient Clinic at the Regional Centre of Menopause and Osteoporosis revealed that more than 50% of them discontinued the treatment.

CONCLUSIONS

Not all patients treated with alendronate are compliant. Osteoporosis is a chronic disease, which needs long clinical observation and constant adherence to medication. Effective communication between doctor and patient, and follow-up visits that are more frequent would greatly improve the adherence to osteoporosis treatment modalities. Compliant patients achieved increases in bone mass density with simultaneous fracture risk reduction.

The effects of melatonin on glutathione peroxidase activity in serum and erythrocytes after adriamycin in normal and pinealectomised rats

INTRODUCTION

Adriamycin (ADR) is a potent chemotherapeutic agent, effective in the treatment of leukaemias, lymphomas and many solid tumours. However, its clinical usage is often limited by cardiotoxicity, induced by oxygen radical damage of the membrane lipids. Melatonin (MEL) is a well-known antioxidant. It has been shown that MEL can scavenge free radicals, both directly and indirectly, stimulating the activity of antioxidative enzymes such as glutathione peroxidase (GSH-Px).

THE AIM OF THE STUDY

The aim of the study was to examine the effect of MEL on serum and erythrocyte GSH-Px activity after ADR in normal and pinealectomised rats.

MATERIAL AND METHODS

Wistar rats were divided into the three groups: control animals (Intact), sham-operated (Sham-PX) and pinealectomised (Px). Each of the groups was divided into four subgroups, injected with: 1--saline, 2--MEL, 3--ADR and 4--ADR + MEL. ADR was administered 2 months after Px as a single dose (15 mg/kg, i.p.) 1 hour after the fourth melatonin injection. Melatonin (5 mg/kg, i.p.) was administered for 4 days before and 2 days after ADR. After 6 days of treatment, the rats were killed by decapitation. Their blood was collected for measurements.

RESULTS

In serum GSH-Px activity decreased in all the groups after ADR. Pinealectomy decreased the activity of the enzyme in all the groups of animals examined. In erythrocytes GSH-Px decreased after ADR in the Px-animals. The effect of pinealectomy on erythrocyte GSH-Px activity was not as strongly expressed as serum GSH-Px activity. MEL did not change GSH-Px activity after ADR.

CONCLUSION

Melatonin, in pharmacological concentrations, did not influence the activity of GSH-Px, either in normal or in pinealectomised rats after ADR. A deficiency of endogenous melatonin production may inhibit GSH-Px activity.

Potassium iodide changes the levels of thyroid hormones in goitrogenic rats on selenium deficient diet

OBJECTIVE

A possible link was proposed between selenium [Se(-)], iodine deficiency and thyroid pathology. The aim of the study was to examine changes in FT3 and FT4 concentrations, weights of the thyroid glands and ioduria after potassium iodide (KI) in normal and goitrogenic rats on Se(-) diet.

METHODS

Wistar rats in Group 1 received the standard diet. Other animals remained (3 months) either on a Se(-) diet alone [Groups 2-5] or supplemented with selenium [Se(+)] (Group 6-8). After 9 weeks, Groups 3, 4, 6, 7 received sodium perchlorate [I(-); 1 month]. KI (1 mg/rat) was injected in Groups 4, 5, 7, 8. The animals were decapitated 3 days after the injections.

RESULTS

FT4 was higher in serum of Se(-) rats than in that of Se(+). The differences of FT3 were not statistically significant. In I(-) Groups, the levels of FT3 and FT4 were very low. KI increased both thyroid hormones in I(-) rats but the effect was especially pronounced for FT3. KI decreased the weights of the glands, enlarged in the I(-) animals, both on Se(-) and Se(+) diet. Urine iodide concentrations were lower in Se(-) animals; KI increased ioduria.

CONCLUSIONS

These data demonstrate that selenium and iodine deficiencies may play an essential role in thyroid hormone metabolism.

Effect of propylthiouracil on the level of Schiff's bases in tissues of rats on diet with different doses of potassium iodide

OBJECTIVES

Iodide administration to animals, living in iodine-deficient areas, can induce oxidative processes in the thyroid gland and increase concentration of lipid peroxidation (LPO). Propylthiouracil (PTU)--a well-known antithyroid drug--may also act as an antioxidant. There are some reports, which consider the protective ability of this drug against LPO. The goal of the study was to evaluate oxidative processes and the protective role of PTU in three rat organs during treatment with pharmacological doses of iodide.

MATERIAL AND METHODS

Schiff's bases (SB) concentrations (a parameter of oxidative stress) were measured in liver, lung and kidney homogenates of male Wistar rats. For 2 weeks the animals received iodides in their diet in the following concentrations: Group 1--Controls (standard diet, approx. 0.7 mg of potassium iodide per kg; KI/kg); Group 2--diet containing 0.25 mg KI/kg; Group 3--diet with 4.0 mg KI/kg; Group 4--diet with 8.0 mg KI/kg. Group 5--standard diet with 0.1% of PTU in drinking water for two weeks. Subsequent tree groups (6-8) received KI in their diet in doses as above, respectively, together with PTU.

RESULTS

We noted increased SB levels in the lungs and in the liver, compared to those observed in the control group. We also found decreased SB concentrations in liver and lung homogenates after the administration of PTU but, unexpectedly, the level of SB increased in kidney homogenates of all the groups.

CONCLUSIONS

The results of this study indicate that iodine is involved in oxidative processes in different organs and PTU protects against iodine-induced oxidative stress.

Evaluation of bone mineral density on the basis of the results of studies of selected skeleton populations from the microregion of Brześć Kujawski

INTRODUCTION

Osteoporosis is a systemic disease of the skeletal system characterised by reduced bone strength leading to increased risk of fracture. Bone strength is a combined derivative of bone mineral density (BMD) and of bone tissue quality. Osteoporosis is a serious medical problem because of its complications, most frequently manifesting itself in spine fractures, fractures of distal sections of the forearm and, in later periods of life, hip fractures. Reduced BMD is an independent risk factor of osteoporosis. The goal of the study was an evaluation of bone mineral density of the population inhabiting the micro-region of Brześć Kujawski from the 11(th) century until the beginning of the 19th century.

MATERIAL AND METHODS

Human bones obtained from archaeological excavations at four archaeological sites: Kolonia (11th-13th centuries), SBK-4 (12th-16th centuries), Fara (14th-17th centuries) and Swiety Duch (16th-19th centuries) and from the collections of the Katedra of Anthropology of the University of Łódź were subjected to study. Bone mineral densities of the skeleton populations were compared with those of the control group, namely the present living population of the Łódź Province. The incidence of osteoporosis was evaluated by densitometric assessment, which was performed by dual energy X-ray absorptiometry (DXA) on a DPX device (LUNAR, USA).

RESULTS

The densitometric measurements performed enabled differences to be identified in the mineral density of the osseous tissue. The skeletal groups studied were characterised by a significantly higher mean BMD than the contemporary living population. Changes in BMD indicative of osteopenia prevailed in women.

CONCLUSIONS

On the basis of the results obtained it cannot definitively be stated that the skeletal groups studied, despite their significantly higher BMD, were affected by a lower risk of osteoporosis and its complications. A continuation of studies on the mineral content of bones and on the relationship between the mineral content and bone mineral density is required.

Effects of different antioxidants on lipid peroxidation in brain homogenates, induced by L-thyroxine administration in rats

OBJECTIVE

It is known that thyrotoxicosis induces lipid peroxidation (LPO). In contrast, propylthiouracil (PTU), a thyrostatic drug is a well-known antioxidant. Also melatonin has been shown to protect against free radical-induced neuronal destruction. At the same time, it is generally accepted that the brain is the most vulnerable tissue to oxidative stress.

METHODS

The goal of the study was to examine the components of LPO, i.e., conjugated dienes (CD), malondialdehyde (MDA) and Schiff's bases (SB), in the brain of male Wistar rats. Two experiments were performed, with two control groups created for each experiment: Group 1--intact animals and Group 2--animals injected with 0.9% NaCl. In Experiment I, the animals received L-thyroxine (L-T4) in a dose of 100 microg/kg BW, i.p., daily, for two weeks (Groups 3-5). After one week of L-T4 treatment, the following agents were added during a subsequent week: Group 4--PTU in drinking water (45 mg/kg BW/day); Group 5--melatonin (5 mg/kg BW, daily). In Experiment II, lasting 7 days, the animals were divided into the following groups: Group 1--intact animals; Group 2--animals injected with 0.9% NaCl; Group 3--PTU in drinking water (45 mg/kg BW/day); Group 4--melatonin (5 mg/kg BW, daily).

RESULTS

In Experiment I, we observed a significantly higher SB level in saline treated animals and a significant increase in both CD and SB levels in rats treated with L-T4, compared to those in non treated control. CD levels were also elevated in rats treated with L-T4, compared to values in the saline only treated animals. Melatonin and PTU reduced CD levels and melatonin diminished SB levels, as compared to those in L-T4-treated rats. In Experiment II, we observed significantly higher CD, SB and MDA levels in saline treated rats, when compared to respective values in non treated control. Melatonin decreased CD levels, when compared to CD levels in both the non treated and saline injected controls. Additionally, melatonin reduced SB levels relative to change in the brains of saline treated rats. Furthermore, PTU decreased CD levels in brain homogenates compared to non-treated animals.

CONCLUSIONS

(1) L-thyroxine administration stimulates LPO in the rat brain; (2) All the examined antioxidants decrease LPO in L-T4-administered animals; (3) All the examined antioxidants reduce the basal LPO; 4) Stress, when induced by handling, intensifies oxidative processes in the organism.

Melatonin effects on Schiff's base levels induced by iodide administration in rats

OBJECTIVES

Administration of iodides to animals, living in iodine-deficient areas, can induce necrosis and fibrosis of the thyroid gland. It is believed that structural and functional changes of the thyroid may be related to oxidative processes. Increased lipid peroxidation levels were reported in murine thyroid glands after high doses of iodine. Melatonin (MEL) is believed to exert its effects via electron donation to directly detoxify free radicals, such as, e.g., the highly toxic hydroxyl radical. In numerous reports related to the antioxidative action of MEL, the authors have considered the protective ability of this hormone against peroxidation of lipids. The goal of the study was to evaluate oxidative processes and the protective role of MEL in three organs of the rat (the liver, the brain, and the lungs) during treatment with different doses of iodide.

MATERIAL AND METHODS

Schiff's bases (SB) concentrations (a parameter of oxidative stress) were measured in liver, lung and brain homogenates of male Wistar rats. The animals received iodides in their diet in the following concentrations, for 2 weeks: Group 1--Controls (standard normal-iodine diet, containing approx. 0.7 mg of kalium iodide per kg; KI/kg); Group 2--diet containing 0,25 mg KI/kg; Group 3--diet with 4,0 mg KI/kg; Group 4--diet with 8,0 mg KI/kg. Group 5--standard normal-iodine diet and MEL alone in a dose of 1 mg/kg BW i.p. at 3.00 pm, every day for two weeks. Subsequent three groups (6-8) received KI in their diet in doses as above, respectively, together with MEL.

RESULTS

We noted increased levels of SB in the lungs and in the liver, when compared to those observed in controls. We also found decreased SB concentrations in liver and lung homogenates after an administration of MEL but--unexpectedly--the level of SB increased in the group with the highest dose of iodine in diet in lung homogenates. Increased levels of Schiff's bases suggest that iodine is involved in oxidative processes not only in the thyroid but also in other tissues, and MEL protects against the iodine-induced oxidative stress.

CONCLUSION

Our results confirm the differences in lipid peroxidation among the examined organs. These alterations can possibly be related to different sensitivity rates of examined tissues to oxidative damage.

Melatonin and the cardiovascular system

Melatonin concentrations in serum, as well as urinary levels of its main metabolite, 6-sulphatoxymelatonin, decrease with age. In the course of aging, the frequency of heart diseases, both acute and chronic, systematically increases. The evidence from the last 10 years suggests that melatonin influences the cardiovascular system. The presence of vascular melatoninergic receptors/binding sites has been demonstrated; these receptors are functionally linked with vasoconstrictor or vasodilatory effects of melatonin. Melatonin can contribute in cardioprotection of the rat heart, following myocardial ischemia. It has been shown that patients with coronary heart disease have a low melatonin production rate, especially those with higher risk of cardiac infarction and/or sudden death. There are clinical data reporting some alterations of melatonin in human stroke and coronary heart disease. The suprachiasmatic nucleus and, possibly, the melatoninergic system may also modulate cardiovascular rhythmicity. Hypercholesterolemia and hypertension are the other age-related symptoms. People with high levels of LDL-cholesterol have low levels of melatonin. It has been shown that melatonin suppresses the formation of cholesterol by 38% and reduces LDL accumulation by 42%. A 10-20% reduction of cholesterol concentration in women using the B-oval pill has been observed. It is a very important because, even a 10-15% reduction in blood cholesterol concentration has bee shown to result in a 20 to 30% decrease in the risk of coronary heart disease. People with hypertension have lower melatonin levels than those with normal blood pressure. The administration of the hormone in question declines blood pressure to normal range. It has been observed that melatonin, even in a dose 1 mg, reduced blood pressure and decreased catecholamine level after 90 min in human subjects. Melatonin may reduce blood pressure via the following mechanisms: 1) by a direct effect on the hypothalamus; 2) as an antioxidant which lowers blood pressure; 3) by decreasing the level of catecholamines, or 4) by relaxing the smooth muscle in the aorta wall.

Effects of melatonin on the oxidative stress induced by thyrotoxicosis in rats

High concentrations of thyroid hormones can affect the metabolism of oxygen in aerobic conditions and stimulate free radicals generation in mitochondria. Reactive oxygen species are toxic to biomembranes and lead to peroxidation of lipids unless they are not removed by free radical scavengers. A few years ago melatonin (MEL), a pineal hormone, was described as a scavenger of free radicals, especially of hydroxyl and peroxyl radicals. The goal of the study was to examine the parameters of oxidative stress [the levels of conjugated dienes (CD), malondialdehyde (MDA) and Schiff bases (SB)] in male rats with thyrotoxicosis, induced by the injection of L-thyroxine (L-T4) in a dose of 100 &mgr;g/kg B.W. After one week of treatment with L-T4, the animals received MEL in a dose 5 mg/kg B.W., i.p., daily, for 7 days. Diagnosis of thyrotoxicosis was confirmed, using hormonal assays. We observed the increased concentration of free T4 (fT4) and free T3 (fT3) after L-T4 injections. The concentration of fT3 was diminished after MEL in L-T4-injected animals. In the liver, we did not observe any changes in the content of both CD and MDA after L-T4 injections but the content of SB was higher after L-T4 injections when compared to the control group. In the liver, melatonin did not change any parameters of oxidative stress, either alone or after L-T4. The changes in the parameters of oxidative stress were better expressed in the kidney, compared to the liver. Melatonin decreased the concentration of CD and SB in the kidneys of a group of animals with thyrotoxicosis. Additionally, MEL decreased the basal concentrations of CD and SB, when compared to the control group.

Thymidine kinase and adenosine kinase activities in homogenates of thyroid lobes in hemithyroidectomized rats; effects of melatonin in vitro

OBJECTIVES: Thymidine kinase (TK, EC 2.7.1.21) is a part of the pyrimidine salvage pathway, involved in DNA synthesis. In turn, adenosine kinase (AK, EC 2.7.1.20) functions as a part of the purine metabolic pathway, involved in DNA synthesis. Melatonin (Mel) is an indoleamine which is known to inhibit growth processes in the thyroid gland and also in other endocrine and non-endocrine tissues. The aim of our study was to examine TK and AK activities in homogenates of the rat thyroid lobes remaining after contralateral hemithyroidectomy (hemiTx); additionally, incubations with Mel (10(-6), 10(-9), and 10(-12) M) were performed. METHODS: The experiment was performed on young male Wistar rats (6-week old). The enzyme activities were measured by ascending chromatography and expressed as the amounts of radioactive reaction products of the phosphorylation of dThd (for TK) and of dAdo (for AK). RESULTS: 1. HemiTx increased TK activity in homogenates of the remaining thyroid lobe; 2. Mel increased TK activity in all the groups (intact, sham-operated- and hemiTx-rats), except for the concentrations of 10(-9) and 10(-12) M in the hemiTx-rats, in which the increasing effects of Mel on TK activity reached the borderline statistical significance only; 3. Mel increased the AK activity in intact and in shamTx animals; 4. No statistically significant changes were found in AK activity following Mel in vitro in the incubated remaining thyroid lobes, collected from hemiTx-rats.

Influence of hemithyroidectomy on bromodeoxyuridine incorporation into DNA of rat thyroid follicular cells

OBJECTIVE

To examine the bromodeoxyuridine (BrdU) incorporation into DNA of thyroid follicular cells (TFC) in the remaining thyroid lobe after hemithyroidectomy (hemiTx) in 1, 2, 3 and 4 weeks time after surgery.

METHODS

The experiment was performed on male Wistar rats. The Cell Proliferation Kit (Amersham, UK) was used in order to detect the incorporated BrdU. The BrdU incorporation was expressed as a BrdU labeling index (BrdULI; a number of BrdU-immunopositive TFC per 1000 TFC).

RESULTS

1. No statistically significant changes of BrdULI were observed between the particular groups of sham-operated (shamTx)-rats in 1, 2, 3 and 4 weeks time after surgery, and in comparison of each of them to the controls (at time "0"); 2. In the first 2-week period after hemiTx, an increasing effect of that surgical procedure on BrdULI value was observed (the highest BrdULI value was detected 2 weeks after hemiTx); 3. In the third and fourth week after hemiTx, a decrease of BrdULI value was observed, as compared to BrdULI groups (in 1- and 2-week time after hemiTx), and to the controls (at time "0"); 4. An increase of weight of contralateral lobe was shown in 1, 2, 3 and 4 weeks after hemiTx in comparison to thyroid lobe weight in intact rats.

CONCLUSIONS

During the first 2 weeks after hemiTx, the thyroid growth in the remaining thyroid lobe seems to ensue by hyperplasia mechanisms. The thyroid growth processes during subsequent 2 weeks (3rd and 4th) could result from other mechanisms - for example, from hypertrophy.