KIDNEY STONE DISEASE AND OSTEOPOROSIS - TOPIC ISSUES OF COMORBIDITY

the prevalence of kidney stone disease (KSD) and osteoporosis (OP) increases every year. In the prevention of osteoporosis, it is important to consume a sufficient amount of calcium-rich foods in the daily diet, as well as the use of calcium. One of the important reasons for the insufficient use of calcium-containing products and medicines is the anxiety not only of patients, but, very importantly, of doctors as much as possible. This has serious justification, as nephrolithiasis occurs in approximately 5% of the population, and the risk of developing kidney stones during life is 8-10%. It is believed that secondary hyperparathyroidism, which is caused by hypocalcemia due to insufficient consumption of calcium-containing products and impaired renal function, leads to increased bone resorption, formation of kidney stone disease. It is important to consider that against the background of hypertensive, atherosclerotic kidney disease, tubulo-interstitial lesions of the kidneys with decreasing glomerular filtration rate decreases the synthesis of 1α-hydroxylase - an enzyme by which 25-hydroxycholecalciferol (25 (OH) active D3, calcium) form of vitamin D3–1.25 dihydroxycholecalciferol (1.25 (OH) 2D3, calcitriol - D-hormone) and secondary hyperparathyroidism develops. In this case, the purpose of correction along with the treatment of urolithiasis (spa treatment, given the attendance of the presence of KSD, to carry out the distance lithotripsy), intake of active metabolites of vitamin D (should be started with low doses, independent of the initial PTH concentration, and then titrated based on the PTH response) conducting X-ray densitometry.

Relationship between Structure and Biological Activity of Various Vitamin K Forms

Vitamin K is involved many biological processes, such as the regulation of blood coagulation, prevention of vascular calcification, bone metabolism and modulation of cell proliferation. Menaquinones (MK) and phylloquinone vary in biological activity, showing different bioavailability, half-life and transport mechanisms. Vitamin K1 and MK-4 remain present in the plasma for 8–24 h, whereas long-chain menaquinones can be detected up to 96 h after administration. Geometric structure is also an important factor that conditions their properties. Cis-phylloquinone shows nearly no biological activity. An equivalent study for menaquinone is not available. The effective dose to decrease uncarboxylated osteocalcin was six times lower for MK-7 than for MK-4. Similarly, MK-7 affected blood coagulation system at dose three to four times lower than vitamin K1. Both vitamin K1 and MK-7 inhibited the decline in bone mineral density, however benefits for the occurrence of cardiovascular diseases have been observed only for long-chain menaquinones. There are currently no guidelines for the recommended doses and forms of vitamin K in the prevention of osteoporosis, atherosclerosis and other cardiovascular disorders. Due to the presence of isomers with unknown biological properties in some dietary supplements, quality and safety of that products may be questioned.

Exercise and Nutrition Impact on Osteoporosis and Sarcopenia—The Incidence of Osteosarcopenia: A Narrative Review

Osteoporosis and sarcopenia are diseases which affect the myoskeletal system and often occur in older adults. They are characterized by low bone density and loss of muscle mass and strength, factors which reduce the quality of life and mobility. Recently, apart from pharmaceutical interventions, many studies have focused on non-pharmaceutical approaches for the prevention of osteoporosis and sarcopenia with exercise and nutrition to being the most important and well studied of those. The purpose of the current narrative review is to describe the role of exercise and nutrition on prevention of osteoporosis and sarcopenia in older adults and to define the incidence of osteosarcopenia. Most of the publications which were included in this review show that resistance and endurance exercises prevent the development of osteoporosis and sarcopenia. Furthermore, protein and vitamin D intake, as well as a healthy diet, present a protective role against the development of the above bone diseases. However, current scientific data are not sufficient for reaching solid conclusions. Although the roles of exercise and nutrition on osteoporosis and sarcopenia seem to have been largely evaluated in literature over the recent years, most of the studies which have been conducted present high heterogeneity and small sample sizes. Therefore, they cannot reach final conclusions. In addition, osteosarcopenia seems to be caused by the effects of osteoporosis and sarcopenia on elderly. Larger meta-analyses and randomized controlled trials are needed designed based on strict inclusion criteria, in order to describe the exact role of exercise and nutrition on osteoporosis and sarcopenia.

Osteoporotic changes in bone and cartilaginous tissue in women with ovarian hypofunction

Annotation. Osteoporosis is the most common disease of the musculoskeletal system, which ranks 4th in the world as a cause of disability and mortality among non-communicable diseases. This is a polyetiological systemic disease of bone tissue, characterized by a decrease in bone mass and deterioration of bone structure and increased fragility. This problem has not only a medical aspect, but also important socio-economic significance in all countries of the world due to the high cost of treatment of such patients and high disability. The aim of the work is to study and analyze the scientific literature and give a generalized description of etiological factors, pathogenesis, primary and secondary methods of prevention of osteoporosis in women with ovarian hypofunction in the pre- and menopausal periods. An analysis of recent research and publications on the problem of osteoporosis and changes in the skeletal system. The main risk factors, etiology and pathogenesis of osteoporosis in the pre- and menopausal period of a woman's life are determined, the main methods of prevention of osteoporosis are described. The most common form of primary osteoporosis is postmenopausal osteoporosis, the trigger of which is hypogonadal states, estrogen deficiency, which causes a sharp acceleration of bone loss. I guarantee healthy bone tissue and prevention of osteopenia and osteoporosis are: accumulation of bone mass in the first 30 years, mechanical stress contributes to the restructuring and remodeling of bone tissue throughout life, timely and early compensation of hypogonadal conditions, improvement of blood flow, improvement of blood flow stability of mineral metabolism and hormonal background. Not all women with hypogonadal condition develop osteoporosis, so studying the use of methods to prevent osteopenia and strengthen bone tissue from a young age is the basis of quality life of modern women at any time in her life in the XXI century, so it needs further study.

Effectiveness of Structured Teaching Programme on Knowledge Regarding Prevention of Osteoporosis among Premenopausal Women

Osteoporosis, which means “porous bone”, is a disease in which the bones gradually become weak and brittle. Osteoporosis is often known as the silent thief because bone losses occur without symptoms and progressive loss and thinning of bone tissue happens over many years. The aim of the study was to assess the effectiveness of Structured Teaching Programme on knowledge regarding prevention of Osteoporosis among premenopausal women (35-50 years) attending OPDs in a selected hospital, Raipur. Objectives To assess the pretest level of knowledge regarding prevention of osteoporosis among premenopausal women in experimental group and control group. To determine the effectiveness of structured teaching programme on prevention of osteoporosis in experimental group. To find out the association between knowledge regarding prevention of osteoporosis and selected demographics variables of the premenopausal women. Review of literature was prepared relevant to the study. The conceptual framework of the study was based on “Kenny’s open system model. Pilot study was done among patients in general medicine OPD in a selected hospital, Raipur. The main study was conducted in Orthopedics and Obstetrics & Gynecology OPDs in a selected hospital, Raipur. A total of 90 patients included in the study and they were selected using convenient sampling. The instrument used for data collection was structured knowledge questionnaire. Validity and reliability of the tool was done. Data was collected for the period of 4 weeks. Descriptive and inferential statistics were used to analyse the data. It was observed in present study that majority (70%) of the total sample in experimental and control group had inadequate level of knowledge regarding prevention of Osteoporosis. And it was observed that the mean post test score of experimental group with standard deviation was 19.98±3.02 which was apparently higher than that of post test score of control group 14.11±4.74. Statistical differences were computed and the independent t value is 7.003 which was found significant at 0.05. Hence, Structured Teaching Programme was effective on knowledge regarding prevention of Osteoporosis. The study findings also shows that the association between knowledge score and educational status (ᵡ2=9.511, P=0.05), religion (ᵡ2=7.053, P=0.05) and previous knowledge (ᵡ2=46.44, P=0.05) were highly significant. Hence there was a significant association between pre-test knowledge and selected demographic variables of premenopausal women such as age, gender, education, income, religion, marital status, dietary pattern, age of menarche, age of marriage and previous knowledge. Key words: Structured Teaching Programme, Knowledge, Prevention of Osteoporosis, Premenopausal Women, Effectiveness.

Biochemical Targets and Molecular Mechanism of Ginsenoside Compound K for Treating Osteoporosis Based on Network Pharmacology

Ginsenosides have been proven to be potential beneficial in treatment of osteoporosis. To investigate the potential of ginsenosides in osteoporosis, ginsenoside compound K (GCK) was selected to explore the potential therapy targets and mechanism based on network pharmacology (NP). 206 and 6590 targets were obtained for GCK and osteoporosis, respectively, in which 138 targets were identified as co-targets of GCK and osteoporosis based on intersection analysis. Five central gene clusters and hub genes (STAT3, PIK3R1, VEGFA, JAK2 and MAP2K1) were identified through protein-protein interaction network analysis. Gene Ontology (GO) enrichment implied that phosphatidylinositol-related biological process, molecular modification and function may play an important role for GCK in treatment and prevention of osteoporosis. Functions and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis suggested that 16 targets were enriched in the osteoclast differentiation. Also, except for being identified as hub targets, MAPK and phosphatidylinositol-related proteins were enriched in the downstream signaling of c-Fms in the osteoclast differentiation pathway. Molecular docking further confirmed that GCK could interact with active cavity on the surface of c-Fms (osteoclast differentiation-related membrane receptor), and their complex could be stabilized by three H-bonds with residues including Glu 664 (3.19 Å), Glu 664 (2.62 Å) and Cys 666 (2.78 Å). Summarily, GCK could interfere the occurrence and progress of osteoporosis through c-Fms-mediated MAPK and phosphatidylinositol-related signaling regulating osteoclast differentiation.

Anti-Osteoporotic Effect of Morroniside on Osteoblast and Osteoclast Differentiation In Vitro and Ovariectomized Mice In Vivo

Bone remodeling is a continuous process of bone synthesis and destruction that is regulated by osteoblasts and osteoclasts. Here, we investigated the anti-osteoporotic effects of morroniside in mouse preosteoblast MC3T3-E1 cells and mouse primary cultured osteoblasts and osteoclasts in vitro and ovariectomy (OVX)-induced mouse osteoporosis in vivo. Morroniside treatment enhanced alkaline phosphatase activity and positively stained cells via upregulation of osteoblastogenesis-associated genes in MC3T3-E1 cell lines and primary cultured osteoblasts. However, morroniside inhibited tartrate-resistant acid phosphatase activity and TRAP-stained multinucleated positive cells via downregulation of osteoclast-mediated genes in primary cultured monocytes. In the osteoporotic animal model, ovariectomized (OVX) mice were administered morroniside (2 or 10 mg/kg/day) for 12 weeks. Morroniside prevented OVX-induced bone mineral density (BMD) loss and reduced bone structural compartment loss in the micro-CT images. Taken together, morroniside promoted increased osteoblast differentiation and decreased osteoclast differentiation in cells, and consequently inhibited OVX-induced osteoporotic pathogenesis in mice. This study suggests that morroniside may be a potent therapeutic single compound for the prevention of osteoporosis.

FEATURES OF MANAGEMENT IN PATIENTS WITH OSTEOPOROSIS AND DIABETES MELLITUS

The number of patients with diabetes mellitus in the world has been progressively increasing in recent years, therefore, the fight against complications of diabetes mellitus is an important problem of our time. The purpose of our review is to analyze the literature data on the risks of osteoporosis in patients with diabetes mellitus, effective diagnostic methods, as well as current recommendations for the treatment and prevention of osteoporosis in this category of patients. Results. We have processed and analyzed literary sources and internationalrecommendations, which identify the main mechanisms and risk factors that contribute to the development of osteoporosis in patients with type 1 and 2 diabetes mellitus; methods for the timely diagnosis of osteoporosis are indicated, methods for correcting the condition of patients with diabetes mellitus, which can help prevent the development of osteoporosis in this group of patients, are given. The current recommendations for the treatment of osteoporosis in men and women are presented. Conclusions. Taking into account the data of the analysis of literary sources, osteoporosis can be considered one of the complications of diabetes mellitus. Today, densitometry and fracture risk assessment FRAX are quite sensitive methods for early diagnosis of osteoporosis in patients with type 1 diabetes mellitus, but not sufficient for patients with type 2 diabetes mellitus, therefore there is a need to determine the trabecular bone index during densitometry, as well as additional actions when assessing the risk of fractures on the FRAX scale. Therapy of patients with osteoporosis with concomitant diabetes mellitus should be based on the achievement of target glycemic levels and the use of bisphosphonates with target level of calcium and vitamin D.