Features of the clinical course of endocrine osteoporosis in patients with primary hyperparathyroidism of different ages

Aim: to study the dynamics of the structural and functional state of the skeletal system, vitamin D3 content in patients with primary hyperparathyroidism (PHPT) during treatment, depending on age, duration of the disease, variant of menstrual function, development of recommendations for the prevention and treatment of endocrine osteoporosis. Material and research methods: 12 women with a bone form of PHPT were examined. To study the dynamics of the structural and functional state of the skeletal system, all patients were divided into two groups. Patients in the 1st group noted changes in gait, pain in the feet. In patients of the 2nd group there was loosening and loss of teeth, bone pain. During the illness, everyone had a decrease in body weight and a decrease in growth. In all patients of the 1st and 2nd groups, multiple fractures of the ribs and ilium were noted. All patients of the 2nd group showed arterial hypertension. The study found that the actual calcium intake was less than WHO recommended. There was a decrease in the level of vitamin D3 total in the blood serum of patients in both groups. In women of the 2nd group, the availability of vitamin D3 was significantly lower than in the 1st group patients (p <0.05). The examined women of both groups showed hypercalcemia, an increase in parathyroid hormone, urinary hydroxyproline excretion, osteoporosis diagnosed by X-ray morphometry, ultrasound osteodensitometry, and the FRAX algorithm. All women underwent surgical treatment – removal of parathyroid adenoma. In the postoperative period, patients received calcitriol and calcium preparations. An X-ray examination determined the consolidation of fractures of the ribs and iliac bones. The restoration of bone structure was slower in patients of the 2nd group. Recommendations on the prevention and treatment of endocrine osteoporosis відбувалось повільніше у хворих 2-ї групи. Розроблено рекомендації щодо профілактики та лікування ендокринного остеопорозу у хворих з патологією паращитовидних залоз (ПЩЗ). Висновки: 1. Остеопороз у жінок старших вікових груп, хворих на первинний гіперпаратиреоз, проявляється тяжким перебігом, супроводжується більшою кількістю переломів кісток, виразнішою та ранньою маніфестацією захворювання. 2. Серед причин розвитку та активного прогресування остеопоротичного процесу в жінок старших вікових груп, хворих на первинний гіперпаратиреоз, крім гіперсекреції паратиреоїдного гормону, слід розглядати тривалість менопаузи, а також дефіцит вітаміну D3, підвищене руйнування колагену в кістці, про що свідчить збільшення екскреції оксипроліну (р < 0,05). 3. З метою запобігання розвитку та прогресування остеопоротичного процесу в жінок різних вікових груп обов’язкове моніторування результатів алгоритму FRAX, показників рентгенморфометрії скелета, остеоденситометрії, кальцієвого балансу вже на етапі діагностики патології паращитовидних залоз. Kлючові слова: паращитовидні залози, первинний гіперпаратиреоз, вітамін D3 total, алгоритм FRAX, ендокринний остеопороз, профілактика, лікування. Для цитування: Терехова ГМ. Особливості клінічного перебігу ендокринного остеопорозу у хворих на первинний гіперпаратиреоз різного віку. Журнал Національної академії медичних наук України. 2019;25(4).423–30.

Calcium-phosphorus metabolism and bone metabolism in patients with diffuse toxic goiter

Three groups of premenopausal women with diffuse toxic goiter (DTG) of different duration and different activity of thyrotoxicosis were examined for assessing calcium-phosphorus metabolism, osseous metabolism, and mineral compactness of bone tissue by ultrasonic (US) densitometry and bienergetic x-ray absorptiometry. Manifest hypercalciuria and hyperphosphaturia with normal levels of Ca2+ and inorganic phosphorus in the blood were revealed in patients with newly detected and recurrent DTG. In patients with hyperthyrosis the blood alkaline phosphatase activity and hydroxyproline excretion with the urine on an empty stomach were increased, these changes being most of all expressed in the group with newly detected thyrotoxicosis; however, these shifts were liable to normalize when stable drug-induced euthyrosis was attained. A reliable correlation between free T4 in the blood serum and osseous metabolism was revealed, which may indicate a direct effect of TH excess on bone tissue metabolism. The osteopenic syndrome was detected primarily in the proximal portions of the femoral bone, the severity of osteopenia reliably correlating with the disease duration. The authors come to a conclusion about the informative value of US densitometry and bienergy x-ray absorptiometry for the diagnosis of early stages of the osteopenic syndrome in DTG.

Biomonitoring exposure to environmental tobacco smoke (ETS): A critical reappraisal

1 The most frequently used biomarkers for exposure to environmental tobacco smoke (ETS) are cotinine and thiocyanate in body fluids, carboxyhaemoglobin in red blood cells (COHb) and carbon monoxide in the expired air. Although not ideal, cotinine in blood, saliva or urine is an established biomarker for ETS exposure within the past 1-3 days. Comparison with cotinine concentrations in cigarette smokers reveals that passive smokers take up less than 1/100 of the nicotine dose of smokers. 2 Biomonitoring data available for the ETS-related exposure to genotoxic substances comprise uptake of benzene, polycyclic aromatic hydrocarbons (PAH), aromatic amines, tobacco-specific nitrosamines (TSNA), electrophilic compounds giving rise to ur inary thioethers, mutagens causing urinary mutagenic activity and the formation of various DNA adducts. With the exception of TSNA, these biomarkers are related to chemicals occurring ubiquitously in the environment and in the food. As a consequence, the background levels in unexposed nonsmokers are high compared to the observed increases (if any) associated with ETS exposure. 3 Some markers of biological effects, which, by defini tion, are non-specific with regard to the underlying exposure, have also been investigated in relation to ETS exposure. These markers comprise cytogenetic effects, aryl hydrocarbon hydroxylase (AHH) induc tion, urinary hydroxyproline excretion and various factors indicative of cardiovascular risks. The avail able data suggest that passive smoking is associated with a small induction of placental AHH and also with effects on cardiovascular risk markers. The latter findings in particular may be confounded by other risk factors, which have been observed to be more frequent in passive smokers than in unexposed nonsmokers.