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CNAA / Theses / 2006 / July /

Clinical and evolvement aspects of postmenopausal osteoporosis and treatment efficacy of bisphosphonates


Author: Sergiu Golubciuc
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Rheumatology
Year:2006
Scientific adviser: Liliana Groppa
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Valentin Gudumac
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 6 July, 2006
Approved by NCAA on the 28 September, 2006

Abstract

Adobe PDF document0.36 Mb / in romanian

Thesis

CZU 616.71-007.234:618.173+616.71-007.234

Adobe PDF document 1.05 Mb / in romanian
95 pages


Keywords

postmenopausal osteoporosis, bone resorbtion markers, osteocalcine, bone specific alkaline phosphatase, ceruloplasmine, histidine and histidine dipeptides, bone-mineral density, sodium alendronate

Summary

The results of the study, involving 113 patients with postmenopausal osteoporosis showed a high frequency of the following risk factors: early menopause (22,1%), and late menarche (42,4%). A long lactation period was stated in 42,4%. Food calcium deficiency was appreciated in 67,3%, gastrointestinal chronic diseases – in 17,7%. Trying to appreciate the levels of the relation between clinical features, risk factors and instrumental data (X-ray spondilography and bone densitometry), it was shown a high level of classification capacity (92,3%) between the II-III grades of radiological changes in the spine and the following clinical features (for the I grade of radiological changes the level of classification capacity was 85,4%): the pain syndrome located in the thoracic column, gastrointestinal chronic diseases, bone pain in the limbs, personal history of radius fractures, history of a maternal hip fracture. The concordance of the same group of factors with osteoporosis (-2,5 SD and below, T score) was 87,5%, and for osteopenia (T score between -1SD and -2,5 SD) – 74%.

To appreciate the treatment efficacy, patients were randomized: group 1 (n=37) received alendronate sodium 10 mg and calcium carbonate 1500 mg+Vit. D3 400 IU daily; group 2 (n=76) received calcium carbonate 1500 mg+Vit. D3 400 IU daily. Both groups received the treatment for 6 months. A positive clinical evolution was appreciated in group 1 comparing to group 2 (p<0,05). As well, the quality of life was improved in the 1st group statistically better comparing to group 2.

All of the bone formation and resorption markers were reduced after treatment in group 1 (p<0,05): bone specific alkaline phosphatase, tartrate resistant acid phosphatase and osteocalcine; in group 2 the reduction of bone formation and resorbtion markers was less significant, the level of tartrate resistant acid phosphatase increased.

The bone mineral density (BMD) increased in group 1 from -3,33±0,24 SD (T score) to -3,1±0,25SD; in group 2 BMD was static on the line -3,34±0,17 SD – before treatment and -3,4±0,18 SD – after the treatment.