LATEST FINDINGS IN THE FIELD OF OSTEOPOROSIS : UKRAINIANPORTUGUESE DIALOGUE

На сторінках нашого видання ми постійно висвітлюємо діяльність Української асоціації остеопорозу. Особливо приємно кожного разу розповідати про успіхи команди українських науковців, які займаються проблемою остеопорозу, на міжнародному рівні. Протягом останніх років членами Української асоціації остеопорозу під керівництвом її президента — керівника відділу клінічної фізіології та патології опорно-рухового апарату ДУ «Інститут геронтології імені Д.Ф. Чеботарьова НАМН України», керівника Українського науково-медичного центру проблем остеопорозу, д.м.н., проф. В.В. Поворознюка — було проведено багато міжнародних конференцій як в Україні, так і за кордоном, члени асоціації є постійними учасниками та лекторами міжнародних конгресів та конференцій з питань остеопорозу та захворювань опорно-рухового апарату. Одне з недавніх визначних досягнень — отримання проф. В.В. Поворознюком нагороди Міжнародної асоціації клінічної денситометрії за лідерство та досягнення в цій галузі, урочисте вручення якої відбулося 4 червня в м. Голуей (Ірландія). Три роки тому розпочалося співробітництво Української асоціації остеопорозу з португальськими колегами. Усі ці роки професор ендокринології Mάrio Rui Mascarenhas (медичний факультет університету Лісабона, Santa Maria Hospital) та президент Португальського товариства остеопорозу та метаболічних захворювань кісток (Portuguese Society of Osteoporosis and Bone Metabolic Diseases — SPODOM) Ana Paula Barbosa — постійні учасники та лектори наукових медичних заходів, що проводить Українська асоціація остеопорозу під керівництвом проф. В.В. Поворознюка. Під час однієї із зустрічей українських та португальських науковців на зимовій школі з остеопорозу в м. Яремче виникла ідея проведення українсько-португальської конференції з питань остеопорозу, яку успішно було реалізовано 21–22 червня 2016 року в м. Лісабоні (Португалія) спільними зусиллями Португальської та Української асоціацій остеопорозу та особисто професорами Mάrio Rui Mascarenhas, Ana Paula Barbosa та В.В. Поворознюком. Тісна співпраця та зацікавленість в обміні професійним досвідом сприяли дружній та піднесеній атмосфері, що панувала під час усього перебування делегації українських науковців у Лісабоні. Від Української асоціації остеопорозу в цій конференції взяли участь 12 вчених-лікарів різних спеціальностей, які займаються вивченням проблем остеопорозу. Членами української делегації було представлено 10 усних та 3 постерні доповіді. Крім того, 23 червня українські та португальські колеги, які займаються вивченням проблем дефіциту та недостатності вітаміну D, провели спільне робоче засідання, на якому обговорювали вплив порушень статусу вітаміну D на різні системи організму, використання сучасних методів діагностики та лікування. Після закінчення конференції делегатів Української асоціації остеопорозу очікували декілька приємних сюрпризів, що свідчать про визнання високого наукового рівня їх діяльності та важливість українсько-португальського співробітництва. Але ж дозвольте розповісти все по черзі...

Після закінчення конференції делегатів Української асоціації остеопорозу очікували декілька приємних сюрпризів, що свідчать про визнання високого наукового рівня їх діяльності та важливість українсько-португальського співробітництва.Але ж дозвольте розповісти все по черзі… The mid-summer season (21-22 of June) witnessed the First Ukrainian-Portuguese conference on osteoporosis in Lisbon (Portugal).Cooperation of Ukrainian and Portugal medical scientists in the fruitful eff ort of studying osteoporosis started three years ago.Since then, Mάrio Rui Mascarenhas, Professor of Endocrinology at the Medical Faculty of the University of Lisbon, Santa Maria Hospital, Lisbon, Portugal, and Ana Paula Barbosa, President of the Portuguese Society of osteoporosis and metabolic bone diseases (SPODOM), have been attending and making reports at the international conferences conducted by Professor Vladyslav Povoroznyuk, President of the Ukrainian Association of Osteoporosis, in Yaremche, Donetsk, Lviv, and Kyiv.All this time the Ukrainian and Portuguese colleagues have been exchanging views on medical care for patients with osteoporosis, especially with comorbid endocrinological diseases in situ.The cooperation has resulted in the idea of organizing the Ukrainian-Portuguese conference on osteoporosis.Fortunately this dream quite recently came true -the First Ukrainian-Portuguese conference on osteoporosis was organized by the united eff orts of Mάrio Rui Mascarenhas, Ana Paula Barbosa and Vladyslav Povoroznyuk.At the meeting the Ukrainian Association of osteoporosis was represented by 12 medical scientists and physicians of diff erent specialties, equally interested in osteoporosis, making 10 oral and 3 poster presentations.
Besides that, on June 23 rd , the Ukrainian and Portuguese colleagues held a workshop on the defi ciency and insuffi ciency of vitamin D and the impact of vitamin D status on various systems of human organism and modern methods of diagnostics and treatment.
The conference's highlight was the Honorary Awards Ceremony, crowning three days of engaging talks devoted to the issues of utmost importance in the fi eld of medicine.

Epidemiology of osteoporosis in Portugal and Ukraine
Reports in the section devoted to epidemiology of osteoporosis demonstrated that the problem of osteoporosis and its complications was a focus of attention both in Portugal and in Ukraine.
Prof. Jose Antonio Pereira da Silva (Faculty of Medicine, University of Coimbra, Coimbra, Portugal) reported that Portugal had one of the lowest osteoporotic fracture incidences among the European countries.However, according to A. Marques et al. (2013), hip fracture incidence rates demonstrate an annual increase (from 9725 incidences per year in 2006 to 10 918 in 2010) and are higher in women than in men.According to the FRAX model evaluation, the lowest incidence of hip fracture was observed in the 40-44 yrs group and the highest rate -in the 95-100 yrs group.Mean individual fracture-related costs were 13,434 Euro for the first year and 5985 Euro for the second year following the fracture (Marques А. et al., 2015).Hip fractures in Portugal are associated with a significant mortality: 26.9 % patients died within 2 years after fracture.The results also demonstrated a heavy impact of hip fracture on the quality of life.The EQ-5D index 1 month after the fracture was reported to be «worse than death».After 1 year, there was a considerable recovery rate, but the life quality remained significantly below baseline levels.
Генетичні фактори ризику остеопорозу в українській популяції були розглянуті в доповіді академіка В.В.Безрукова (ДУ «Інститут геронтології імені Д.Ф.Чеботарьова НАМН України», Україна).Існують дві основні групи генетично обумовлених захво-highest in the group of 40-49 yrs, however it significantly declined with age and was the lowest in the age group of 70-79 yrs.TBS in the Ukrainian men was the lowest in the age group of 60-69 yrs and the highest -in 40-49 yrs group.TBS values (L 1 -L 4 ) in Ukrainian men with/ without vertebral fractures revealed that in all age groups (from 30-44 to 75-89 yrs) of men with osteoporotic vertebral fractures the TBS values were significantly lower than in men of control group and decreased with age.Distal forearm fracture prevalence was studied in the central region of Ukraine depending on age and sex.It was determined that in the age groups over 35 yrs the frequency of fractures was higher in women compared with men.The highest frequency of forearm fracture in women was determined at 70-74 yrs (about 120 per 10 000 persons a year).Seasonal frequency rate showed that both in men and women of all age groups the highest rate of forearm fractures had been in December.

Genetics of osteoporosis
Prof. Manuel Bicho (Lisbon, Portugal) presented a few results of osteoporosis genetic studies in a sample of the Portuguese population.He noted that studies of the genetics of osteoporosis were intended to define the role of heredity in BMD regulation, as well as the role of quality of the bone microarchitecture in the risk of fractures.Serotonin (5HT) was a neurotransmitter that inhibited proliferation of osteoblasts and bone formation.5HT synaptic and extracellular concentrations were strictly regulated by a specific serotonin transporter (5HTT, SLC6A4).Serotonin transporter was located in 17p11.2region and was organized into 14 exons and had 31Kb.It had two polymorphic regions: one located in the promoter (5HTTLPR), and one -in intron 2 (5HTTVNTR).In the study of association of 5HTT gene polymorphisms -5HTTVN-TR and 5HTTLPR -with osteoporosis, the increased frequency of genotypes 12/10 and 12/12 in the osteoporosis group was determined (92.1 vs 81.7 %), together with increased risk for developing osteoporosis.Another study showed that genotypes BB/BC/AC increased acid phosphatase and decreased alkaline phosphatase in case of normal BMD and increased cholesterol, LDL and acid phosphatase in case of osteoporosis.BMD was related to the modulation of blood pressure by ACE at a molecular or biochemical level.Subjects with a reduced BMD and carriers of I allele had a risk of 1.885 times for the development of hypertension.ACE enzymatic activity decreased in individuals with reduced BMD and HTA but increased in normotensive individuals with a reduced BMD.In population at large, association between Hp polymorphism and LDL levels was found.Female Hp1.1 or Hp1.3 showed higher levels of LDL.LDL levels were also higher in osteoporotic group compared with the group of normal BMD levels.
Genetic risk factors for osteoporosis in Ukrainian population were presented in the report of Academician Vladyslav Bezrukov (D.F.Chebotarev Institute of Gerontology NAMS of Ukraine, Kyiv, Ukraine).First of all it was noted, that there were two major groups of Конгреси, симпозіуми, школи / Congresses, Symposiums, Schools
gene-related diseases: the genetic diseases (they had almost 100 % realization) and diseases with familiar predisposition (they were realized only in case of presence of other risk factors).Modifications in one gene might cause many diseases and one disease may be associated with changes in many genes.For example, the polymorphisms of mtDNA genes could cause mitochondrial diseases, diabetes mellitus (DM), Parkinson and Alzheimer diseases, polymorphism in the IL-6 gene involved in bone metabolism and CV disease.On the other hand, polymorphisms of APO CIII, IGF-IR, TH-INS-Fok1, P13KCB, YTHDF2 genes might be associated with diabetes type 2. Such genes as WNT (transmembrane proteins), LRP5/6 (low density lipoprotein receptor-related proteins), BMP (bone morphogenetic proteins), Sost, RUNX2, Col 1A1 (collagen type 1 gene), VDR (vitamin D receptor gene), OPG (osteoprotegerine) were playing an important role in development of osteoporosis.In the study of patients with osteoporosis in Ukraine (141 women with osteoporosis and 103 women without osteoporosis were examined) the association of polymorphism 60890 A/G of vitamin D receptor gene and 1546 T/G polymorphism of Col 1A1 gene with the risk of osteoporosis development were found.Also it was estimated that GG genotype of Col 1A1 gene (1546 T/G) was associated with higher fracture risk and osteoporosis.GT genotype of Col 1A1 gene (1546 T/G) was associated with low BMD.TT genotype of SOST gene (rs1513670) was associated with higher risk of osteoporosis and fracture.And TT genotype of OPG gene (rs6993813) was associated with higher risk of osteoporosis.The results showed the benefits of using genetic tests to identify predisposition to the osteoporosis in Ukrainian population.Further studies should be aimed at gender/individual differences/similarities of the changes, age pattern of gene modifications, additive or multiplying effects of various genes modifications.

Bone mineral density
Osteoporosis is a major clinical problem in patients with rheumatoid arthritis (RA).Such patients have a 2-fold increased risk of fragility fractures as compared to those in general population.Tatyana Karasevska (Bogomolets National Medical University, Kyiv, Ukraine) presented results of examination of the state of bone in 134 patients (aged 30-79 yrs) with rheumatoid arthritis (mean duration of the disease -9.1 ± 7.6 years) to determine the risk factors of bone loss.Decrease of TBS (L 1 -L 4 ) and BMD (at different skeletal sites) with age was estimated; the significant values being in patients over 50 yrs.Patients with disease duration of more than 10 years had a significantly decreased BMD of lumbar spine, femoral neck and radius total.Physical disability was recognized as an independent risk factor of osteoporosis in patients with RA.In conclusion, the following risk factors of osteoporosis in patients with RA were selected: duration of the disease of more than 10 years, duration of the postmenopausal period of more than 5 years, decreasing physical activity and treatment with glucocorticoids.
The reaction of skeleton to the fracture is an important problem in both a scientific and a practical aspect.The majority of investigators pay attention to the changes in the injured or/and contralateral extremity.Data on systemic reaction of skeleton to various types of fractures remains poor and contradictory.Andrii Makogonchuk (National Pirogov Memorial Medical University, Vinnitsa, Ukraine) presented results of investigation into possible effects of femur fracture on bone mineral loss in vivo, using different fracture models.A midshaft tranverse femur fracture in rats stabilized with an intramedullary pin (n = 20) and a perforated metadiaphysis fracture without immobilization (n = 20) were carried out.Control group (n = 20) was represented by non-operated animals.On the 30 th day after fracture, rats with a perforated metadiaphysis fracture had an increasing BMD at most skeletal sites except a statistically significant (P < 0.01) decrease of legs' BMD.This reduction could be explained by an increase in bone remodeling activity within a cortical bone at the affected and probably opposite limb.In rats with a midshaft pinfixed fracture, intensive loss of bone mass at all skeletal sites was observed.Along with an increased bone remodeling, this decrease of BMD could probably be explained by an increased consumption of calcium and recruitment of bone mineral needed for callus formation which is considerably larger in case of midshaft fracture.The fact was confirmed by a statistically significant Конгреси, симпозіуми, школи / Congresses, Symposiums, Schools нижніх кінцівок.Отже, тип перелому й розмір кісткової мозолі впливають на тяжкість посттравматичної остеопенії в щурів з різними переломами стегна.

TBS evaluation
At the section on TBS and BMD evaluation, prof.Mário Rui Mascarenhas and prof.Vladyslav Povoroznyuk discussed data of recent studies in Portugal, Ukraine and other countries.
Prof. Mário Rui Mascarenhas (Medical Faculty of the University of Lisbon, Santa Maria Hospital, Lisbon, Portugal) presented results of TBS evaluation in Portuguese population.In the study of bone quality by TBS in 39 post-menopausal women (66.5 years) and 33 men (61.2 years) (Mascarenhas et al., 2013) there was no significant correlation detected between TBS data and vitamin D and iPTH levels.However, low TBS values were estimated in men and post-menopausal women with low 25(OH)D.The negative influence of ageing on the bone quality was noted.
The bone mass and sexual steroids in adult males seemed to decline slowly with the aging process, but the impact of the androgens on the age-related BMD alte-rations in the male were controversial.The relationship between the lumbar spine bone quality as assessed by the TBS and the BMD at the spine and at the hip, as well as the testosterone levels, were evaluated in a group of 80 normal adult men (age 53.5 ± 16.6 yrs) (Mascarenhas et al., 2012).A weak correlation estimated between spine TBS and BMD, meaning that the TBS measured other bone properties than the BMD.Bone quality assessed by the TBS was influenced by height, weight and BMI and, to a larger extends, by age.It was also concluded that testosterone might influence bone quality (TBS).Indeed, normal men with a low total testosterone plasma levels tended to have both diminished BMD and bone quality and thus a weaker bone strength.In the investigation (Mascarenhas et al., 2015) of correlation between spine TBS and osteocalcin (46 men of age 31.9-83.8years) men with low osteocalcin blood levels tended to have reduced spine TBS.In another study (Mascarenhas et al., 2012) the impact of male hypogonadism on the bone quality (by TBS) was evaluated.The correlation between spine BMD and TBS had confirmed that TBS measured different bone properties than BMD.The reductions in both BMD and TBS had suggested an important negative impact in the bone strength of hypogonadal men, which might be associated to an increased osteoporotic fracture risk.
Prof. Mário Rui Mascarenhas observed the effect of obesity on bone mineral density.He noted that the correlation was not very clear, because studies had shown some conflicting results.Nevertheless, in obese adults the results of several studies had shown a higher BMD at the proximal femur.To investigate the contributions of weight, body mass index (BMI), total body fat mass, blood insulin concentration and homeostasis model assessment (HOMA) to the TBS and vitamin D values in a group of men, 63 normal adult men (age 55.0 ± 12.3 yrs) without chronic diseases influencing the bone mass were examined.The results of the study supported the hypothesis that weight, total body fat mass, insulin and insulin resistance were inversely associated with TBS values and played a direct role in bone metabolism.Moreover, those data suggested that obesity and blood vitamin D concentrations might have an important influence on the bone quality assessed by TBS.
Thus, according to the data of recent studies, TBS significantly decreased with age; TBS results were lower in women who sustained a fragility fracture but in whom DXA did not indicate osteoporosis or even osteopenia; in postmenopausal women TBS predicted fracture risk as well as lumbar spine BMD measurements; combination of any BMD measurement with TBS significantly improved fracture prediction compared with BMD and TBS alone.

Endocrine diseases and osteoporosis
The connection between osteoporosis and endocrine disorders was also discussed during the conference.
Prof. Ana Paula Barbosa (Endocrinology University Clinic of the University of Lisbon, Endocrinology, Diabetes and Metabolism Department, Santa Maria Hospital, Lisbon, Portugal) told about influence of hyperthyroidism on bone.She noticed that heart and bone complications were relatively common in patients with hyperthyroidism, especially among the elderly.Regarding the adult skeleton, several anomalies were described, namely a reduced BMD and a higher osteoporotic fracture risk.Indeed, hyperthyroidism had been recognized as an important cause of secondary osteoporosis and a risk factor for hip fracture in women.Moreover, those osteoporotic fractures were associated with a risk of precocious mortality, namely in the elderly.In adult life, after the acquisition of peak bone mass, the excess of circulating thyroid hormones could lead to an increase in bone resorption, however, the mechanisms involved in their skeletal action were far from totally clarified.While T 3 was considered an important regulator of the bone tissue integrity and of the bone formation, T 4 could stimulate directly or indirectly the activity of osteoclasts.Bone remodeling accelerated while the bone formation period decreased, resulting in an incomplete substitution with new bone cells and loss of mineralized bone.It was estimated that about 10 % of mineralized bone was lost per cycle.Furthermore, TSH was a negative regulator of bone remodeling, inhibiting the formation, survival of osteoclasts and differentiation of osteoblasts.Recent studies had shown that low TSH levels, per se, could lead to osteoporosis and fragility fractures.Hypercalcemia, hypercalciuria and a negative balance of calcium were also described.The weight loss and the gastrointestinal changes (decrease in intestinal calcium absorption and modified vitamin D metabolism) were associated to the reduction of the body lean mass, thus inducing a higher risk of fragility fractures.In old and young Portuguese patients with endogenous hyperthy-Конгреси, симпозіуми, школи / Congresses, Symposiums, Schools у чоловіків, так і в жінок, спостерігалося значне зниження МЩКТ у різних ділянках скелета й збільшення частоти остеопорозу/низька МЩКТ.До того ж у молодих португальських чоловіків, хворих на гіпертиреоз, відзначалася тенденція до збільшення частоти остеопоротичних вертебральних переломів.У групі постменопаузальних жінок з гіпертиреозом порівняно з контрольною групою встановлено більш високу частоту низької МЩКТ у всіх ділянках скелета, а також остеопорозу.При субклінічному гіпертиреозі в постменопаузальних жінок встановлені значимі кореляції не тільки маркерів, але й деяких гормонів, залучених у процеси метаболізму кісткової тканини.
Доповідь проф.В.В.Поворознюка (м.Київ, Україна) була присвячена остеопорозу в чоловіків.20 років тому цій темі приділялася незначна увага, але зараз вона є серйоз-roidism, both men and women, significant decreases in the BMD at several skeletal regions and an increase in the prevalence of osteoporosis/low BMD were observed.Moreover, in young Portuguese men with hyperthyroidism, a trend for an increase in the prevalence of osteoporotic vertebral fractures detected by VFA was found.In a group of postmenopausal women with hyperthyroidism compared to a control group, a significantly higher prevalence of reduced BMD at all skeletal sites and also of osteoporosis was detected.Regarding subclinical hyperthyroidism in postmenopausal women, significant correlations not only in bone turnover markers but also in some of the hormones implicated in bone metabolism was estimated.
The influence of diabetes mellitus on the bone mass was a focus of Prof. Mário Rui Mascarenhas' (Lisbon, Portugal) presentation.It was noted that both diabetes mellitus and osteoporosis had become the expanding epidemic.According to statistics, every 7 seconds 1 person died from DM, every 30 seconds a new osteoporotic fracture occurred.The prevalence of DM among people of 20-79 yrs in Portugal was 13.0 %, and osteoporosis -10.2 %.DM had a negative impact on bone by various mechanisms.Hyperglycemia caused the increasing urine calcium loss and bone formation inhibition; advanced glycosylation end products might affect bone fragility; in cases of a long standing DM, vascular lesions led to a low bone mass and increased risk of fractures.All those effects resulted in a low BMD and increased risk of hip fracture (6.3-6.9 times higher than in non-diabetics), as well as micro-and macrovascular complications might increase fracture risk by their effects on bone or by association with an increased risk of falling, and neuropathy-related local bone loss might increase fracture risk at foot and ankle.It was estimated that type 2 DM men aged  60 years old, duration  10 years had an increased risk for osteoporosis (Mascarenhas M.R. et al., 2010).The low free androgen index might suggest the presence of a risk factor for osteoporosis in males with type 2 DM.Also diabetes was associated with higher BMD at all sites as well as lower lumbar spine TBS in unadjusted and adjusted models (Leslie W.D. et al., 2013).Type 2 DM also resulted in an increased risk of fractures at multiple sites (Bond, 2006).Prof. M.R. Mascarenhas paid attention to the influence of some anti-diabetic drugs on bone.The potentially positive effect of metformin on BMD and on fractures, as well as positive effect of GLP-1 analogues and DPP-4 inhibitors on BMD and potentially positive effects of those medications on fractures were proved.Negative effects of thiazolidinediones on BMD and fractures were estimated.There were few data about sulphonylureas' influence.In conclusion, Prof. M.R. Mascarenhas mentioned reduced bone mass, osteoporosis and osteoporotic fractures prevention in patients with DM and metabolic syndrome.Lifestyle changes, sun light exposure, calcium and vitamin D supplements, bone resorption inhibitors or/and PTH1-34 or PTH1-84 were recommended to those groups of patients.
Recommendations for management of osteoporosis in men were formulated in the Clinical Practice Guidelines of the Endocrine society in 2012 (Nelson B. Watts, Robert A. Adler et al.).Clinical monitoring of the BMD by DXA at spine and hip every 1-2 yrs was suggested to assess the response to treatment.If the BMD reached a plateau, the frequency of BMD measurements might be reduced.Also the measurement of bone turnover marker was to be taken at 3-6 months after initiation of treatment using a bone resorbtion marker (such as serum C-telopeptide of type I collagen or serum or urine N-telopeptide of type I collagen) for antiresorptive therapy and bone formation mar ker (such as serum procollagen I N-telopeptide) for anabo lic therapy.As for the osteoporosis prevention, the Guidelines recommended to men with a risk of osteoporosis to consume 1000-1200 mg of calcium daily, ideally from dietary sources or with calcium supplements.It was suggested to men with low vitamin D levels to receive vitamin D supplementations to achieve blood 25(OH)D levels of at least 30 ng/ml.Men at risk for osteoporosis should participate in weight-bearing activities for 30-40 min per session, three or four sessions per week.Bisphosphonates, strontium ranelate, denosumab ets.were recommended for treatment of osteoporosis in men.

Sarcopenia in Ukrainian population
Sarcopenia is one of burning health-care problems on the scientific and clinical agenda in the recent years.
Nataliia Dzerovych (D.F.Chebotarev Institute of Gerontology NAMS of Ukraine, Ukrainian Scientific-Medical Centre for the Problems of Osteoporosis, Kyiv, Ukraine) told about her own experience in studying sarcopenia in the Ukrainian elderly women.She emphasized that sarcopenia was a geriatric syndrome often observed in the elderly and senile patients which reduced their physical abilities, affected their quality of life, and as a result increased the incidence of falls.The first index proposed for diagnosing sarcopenia according to the muscle mass was the Appendicular muscle mass index, still widely used in different countries (Pagotto V. et al.).Most studies determined the cut-off points for low appendicular skeletal muscle mass by an approach similar to that of osteoporosis.Older persons with an appendicular skeletal muscle mass of less than two standard deviations from the mean of a young reference population (18-39 yrs) were considered sarcopenic.
nal Study of Osteoporosis in Women (GLOW) (a cohort of 52 960 women) had found PD to be the strongest contributor to fracture risk compared with other studied factors.In PubMed and Cochrane Library, only 3 articles were found according to the criteria of «PD» and «osteoporosis».Lower BMD, lower vitamin D levels and increased risk of fractures were evidenced in patients with PD.The reduction of bone mass in PD seemed to be mainly caused by limited mobility.Female sex, PD duration and severity, advanced age and low BMD were associated with a severe osteoporosis.Those facts should alert the clinicians about the importance of osteoporosis screening in PD patients.In the article by V. Lyell et al., published in 2015 in the «Age and aging» journal, a PDspecific algorithm for the fracture risk assessment and management of bone health in patients with PD and related movement disorders was proposed.The algorithm considered calcium and vitamin D replacement and maintenance, quantification of prior falls and fractures, calculation of 10-year major osteoporotic and hip fracture risks.If a fracture risk was high, application of fracture risk thresholds and antiresorptive treatment with or without dual X-ray absorptiometry were recommended, and in case of low risk the reassessment with FRAX and application of National Osteoporosis Guidelines Group (NOGG) guidance were suggested.
Prof. Liliya Martinyuk (I.Horbachevsky Ternopil State Medical University, Ternopil, Ukraine) discussed the topic of mineral and bone disorders in patients with a chronic kidney disease (CKD).She emphasized that patients with CKD frequently had disorders of calcium and phosphorus metabolism, abnormalities of vitamin D -parathyroid hormone (PH) homeostasis and bone disorders.Traditionally, the mineral and bone disorders in patients with CKD had been grouped under the term of renal osteodystrophy.In 2005, KDIGO ® proposed a new classification in order to distinguish among various disorders associated with CKD.Prof. Liliya Martinyuk noted that much of what was known about mineral and bone disorders in case of CKD was based on knowledge obtained from the dialysis patients and much less was known about those disorders in patients who were not yet on dialysis.She presented data of the study of 220 adult patients with CKD aged 20-61 yrs.78 (35.5 %) of them had II-IV stages of CKD and 142 (64.5 %) of them were on dialysis.It had been established that dominant disorders of mineral metabolism were hypocalcemia, hyperphosphatemia, increased Ca and P production, secondary hyperparathyroidism and 25(OH)D 3 insufficiency.Such disorders occurred at the early stages of CKD and progressed with the decline of renal function, especially in patients on dialysis and resulted in bone loss.Patients with CKD had a higher risk of low BMD compared with population at large.The risk factors of bone loss in patients with CKD were duration of CKD, female gender, older age and lower body weight.Prof. Iryna Mazur (Shupyk National Medical Academy of Postgraduate Education MH of Ukraine, Kyiv, Ukraine) highlighted the relationship between periodontal diseases and bone metabolism.She noted that during the previous 25 years a lot of studies were conducted to reveal the role of metabolic bone disorders in the development of periodontal diseases.The relation between BMD and activity of inflammatory-destructive processes in periodontal tissues, the influence of osteopenia and osteoporosis on the periodontal diseases, the relationship between mineral density of alveolar process and skeleton were proved.In the study conducted by the American center of women health (NHANES III), it was indicated that patients with osteoporosis had a greater progression of alveolar bone loss compared with subjects without osteoporosis in a 3-year period, which might prove that osteoporosis or low systemic BMD should be considered as a risk factor for periodontal disease progression.Prof. Iryna Mazur presented data of the independent clinical study of BMD and bone metabolism in patients with periodontitis.78 patients with healthy periodontal status and 194 patients with a generalized peroidontitis took part in the study.Decreased BMD was determined in 47 % of women with periodontal disease and osteoporosis was diagnosed in 7 % of women.Normal BMD was identified in 72 % of men with periodontitits.Osteoporosis was determined in 4 %, osteopenia -in 24 % of men.The administration of ibandronic acid (150 mg/month during threemonth course) in a complex therapy of periodontitis prevented alveolar bone loss, normalized bone metabolism and bone resorbtion and might produce more predictable outcomes of the periodontal treatment.
Nearly all the reports by both the Ukrainian and Portuguese speakers led to discussions and exchange of scientific experience.After the conference came to an end, the chairman of the Organizing committee Prof. Mário Rui Mascarenhas thanked all the participants and especially the speakers for their hard work and interesting lectures.He announced that the Committee established an Award for the best report presented at the conference.This Award was given to the speakers from Ukraine -prof.Vladyslav Povoroznyuk and Nataliia Dzerovych -for the report «Sarcopenia in Ukrainian elderly women» and to a speaker from Lisbon -Cristina de Mello-Sampayo -for the report of study results about prevention of bone changes associated with estrogen deficiency in rats.
All participants expressed their hope that the Ukrainian-Portuguese Conference on Osteoporosis would become a tradition.Professor V. Povoroznyuk offered to organize and hold the next Ukrainian-Portuguese conference in one of the beautiful Ukrainian cities.
It should be noted that the organizing committee of the conference provided a lot of opportunities for the Ukrainian guests to discover the beautiful Lisbon.This city called «The Sleeping Beauty of Europe» has an ancient history, being the capital of one of the most influential European countries.From the Portuguese shores, numerous discoverers started their expeditions searching for new lands.This is the place where famous Vasco da Gama launched his voyage to India and discovered the route between Europe and Asia.This passion for discovery of the Portuguese explorers resulted in the great era in world history -the Age of Discovery Remark of the Editorial desk: the review of workshop on vitamin D, which was held on June 23 in Lisbon, will be published in the next issue.
. The descendants of famous discoverers, the modern Portuguese scientists, are also open to everything new.Their willingness to cooperate, to share experiences and obtain a new knowledge have contributed to advantageous communication among members of the Portuguese and Ukrainian associations of osteoporosis.The scientists of two countries -Ukraine and Portugal (the former situated in the geographical center of Europe, and the lattergeographically the western-most country of the European continent) -together have built a solid professional bridge, the road to a new scientific knowledge, shared experience, future collaboration in solving the problem of osteoporosis.Let the great collaboration continue for many years ahead!Prepared by Nataliia Kuprinenko Від редакції: огляд робочого засідання з вітаміну D, яке було проведено 23 червня у м.Лісабоні, буде опублікований у наступному номері журналу.