Bone mineralization disorders as a complication of anorexia nervosa - etiology, prevalence, course and treatment. / Zaburzenia mineralizacji kosci jako powiklanie jadlowstretu psychicznego - etiologia, rozpowszechnienie, przebieg i leczenie.

Anorexia nervosa (AN) most often has its onset in adolescence, which is a crucial period to achieve peak bone mass. The hormonal abnormalities (hypoestrogenism, hypercortisolism, decreased secretion of dehydroepiandrosterone, testosterone, insulin-like growth factor) and malnutrition are associated with profound bone mineralization disorders. Densitomertic bone mineral density (BMD) values for osteopenia and osteoporosis were found respectively in 35-98% and 13-50% of women with AN. Prospective studies indicate a further decline in BMD at the beginning of treatment and a crucial importance of weight gain and return of spontaneous menses for its growth. Due to frequent chronic and relapsing course of AN densitometric assessment of BMD is recommended in all patients with AN and amenorrhea lasting around twelve months. In order to establish standards for the treatment of osteoporosis in AN, studies on pharmacological treatment are conducted. There are promising results indicating the improvement in BMD after treatment with physiologic oestrogen replacement treatment and sequential administration of medroxyprogesterone in teenage girls and bisphosphonates in adult women. Supplementation of vitamin D and adequate consumption of calcium from diet are recommended. Further studies on the effectiveness of long-term treatment of osteoporosis with regard to the possibility of increase in BMD and reducing the risk of osteoporotic fractures are needed.

[Bone loss in women with malignant genital neoplasms]. / Utrata masy kostnej u pacjentek z notwtworami zlosliwymi narzadów plciowych.

Nowadays, women with genital cancers live longer due to early diagnosis and better treatment schemes. Only few studies assessed bone mass in patients with genital cancer Osteoporosis is a condition characterized by progressive loss of bone mass, weakening of the spatial structure of the bone, and increased susceptibility to fractures. Osteopenia is a condition of reduced, but not yet reaching the pathological values, bone density in relation to norms for age and sex. Metastases are the primary cause of death in cancer patients. It is estimated that approximately half of people dying due to cancer have bone metastases. Osteoporosis in neoplastic disease may occur due to bone metastases or therapy-related adverse effects, i.e. reduced bone mineral density (BMD). Bone microenvironment provides a good medium for the growth of cancer cells. BMD of the femur and spine should be measured by DXA. Computed tomography (CT) and magnetic resonance imaging (MRI) are the techniques used to detect bone metastases. Lifestyle is the key to improving the quality of life and maximize any pharmacological treatment in cancer patients. It is proposed that treatment of cancer without bone metastases does not require therapy increasing bone mass. Further studies in women treated for gynecological malignancies undergoing oophorectomy and adjuvant treatment are needed to elucidate the mechanisms associated with bone loss.

Enfermedad hepática alcohólica y alteraciones de la densidad mineral ósea / Alcoholic liver disease and changes in bone mineral density

La osteoporosis y la osteopenia son alteraciones de la densidad mineral ósea (DMO) que se desarrollan frecuentemente en la enfermedad hepática crónica (EHC). Dichas alteraciones han sido estudiadas predominantemente en la enfermedad colestásica crónica y en la cirrosis hepática. El consumo de alcohol es un factor de riesgo independiente para la aparición de osteoporosis, cuya prevalencia estimada en pacientes con enfermedad hepática por alcohol (EHA) varía entre un 5 % y un 40 %. La pérdida de DMO en la EHA se produce por un disbalance entre formación y resorción ósea. Su etiopatogenia es multifactorial y comprende la toxicidad del alcohol sobre el hueso, las alteraciones endocrinológicas y nutricionales secundarias al alcoholismo y el déficit de osteocalcina, vitamina D e IGF-1, entre otras. El diagnóstico de las alteraciones de la DMO en la EHA se basa en su medición mediante densitometría ósea. El tratamiento incluye el abandono del alcohol y medidas generales de tipo nutricional, abandono del tabaco y ejercicio físico. La suplementación con calcio y vitamina D se recomienda en todos los pacientes con EHA y osteoporosis. Los bisfosfonatos son los principales fármacos para el tratamiento específico de esta entidad. Otras alternativas son el raloxifeno, el tratamiento hormonal sustitutivo y la calcitonina. La presente revisión abordará los aspectos más relevantes para el manejo clínico de las alteraciones de la DMO en el contexto de la EHA, incluyendo su prevalencia, etiopatogenia y diagnóstico. Por otra parte, se efectuará una revisión del tratamiento de la osteoporosis en la EHC en general, incidiendo en los aspectos específicos relacionados con la pérdida de masa ósea en la EHA (AU)

Osteoporosis and osteopenia are alterations in bone mineral density (BMD) that frequently occur in the context of chronic liver disease (CLD). These alterations have been studied predominantly in chronic cholestatic disease and cirrhosis of the liver. Alcohol consumption is an independent risk factor for the onset of osteoporosis, whose estimated prevalence in patients with alcoholic liver disease (ALD) ranges between 5 % and 40 %. The loss of BMD in ALD is the result of an imbalance between bone formation and resorption. Its pathogenesis is multifactorial and includes the toxic effects of alcohol on bone and endocrine and nutritional disorders secondary to alcoholism and a deficiency of osteocalcin, vitamin D and insulin growth factor-1. The diagnosis of BMD alterations in ALD is based on its measurement using bone densitometry. Treatment includes smoking and alcohol cessation and general measures such as changes in nutrition and exercise. Calcium and vitamin D supplements are recommended in all patients with ALD and osteoporosis. Bisphosphonates are the most commonly prescribed drugs for the specific treatment of this condition. Alternatives include raloxifene, hormone replacement therapy and calcitonin. This review will address the most important aspects involved in the clinical management of abnormal BMD in the context of ALD, including its prevalence, pathogenesis and diagnosis. We will also review the treatment of osteoporosis in CLD in general, focusing on specific aspects related to bone loss in ALD (AU)

A study to evaluate the cause of bone demineralization in gynecological cancer survivors.

BACKGROUND: An association between treatment for gynecological cancers and risk of osteoporosis has never been formally evaluated. Women treated for these cancers are now living longer than ever before, and prevention of treatment-induced morbidities is important. We aimed to distinguish, in gynecological cancer survivors, whether cancer therapy has additional detrimental effects on bone health above those attributable to hormone withdrawal. METHODS: We performed a retrospective cross-sectional analysis of dual energy x-ray absorptiometry (DEXA) scan results from 105 women; 64 had undergone bilateral salpingo-oophorectomy (BSO) followed by chemotherapy or radiotherapy for gynecological malignancies, and 41 age-matched women had undergone BSO for benign etiologies. All were premenopausal prior to surgery. RESULTS: The median age at DEXA scan for the cancer group was 42 years, and 66% had received hormonal replacement therapy (HRT) following their cancer treatment. For the benign group, the median age was 40 years, and 87% had received HRT. Thirty-nine percent of cancer survivors had abnormal DEXA scan results compared to 15% of the control group, with the majority demonstrating osteopenia. The mean lumbar spine and femoral neck bone mineral densities (BMDs) were significantly lower in cancer patients. A history of gynecological cancer treatment was associated with significantly lower BMD in a multivariate logistic regression. CONCLUSIONS: Women treated for gynecological malignancies with surgery and adjuvant chemotherapy have significantly lower BMDs than age-matched women who have undergone oophorectomy for noncancer indications. Prospective evaluation of BMD in gynecological cancer patients is recommended to facilitate interventions that will reduce the risk of subsequent fragility fractures.

[Recommendations for the management of bone demineralization in cystic fibrosis]. / Recommandations pour la prise en charge de la déminéralisation osseuse dans la mucoviscidose.

A high prevalence of low bone mineralization is documented in adult patients with cystic fibrosis (CF). Osteopenia is present in as much as 85% of adult patients and osteoporosis in 13 to 57% of them. In children, studies are discordant probably because of different control database. Denutrition, inflammation, vitamin D and vitamin K deficiency, altered sex hormone production, glucocorticoid therapy, and physical inactivity are well known risk factors for poor bone health. Puberty is a critical period and requires a careful follow-up for an optimal bone peak mass. This review is a consensus statement established by the national working group of the French Federation of CF Centers to develop practice guidelines for optimizing bone health in patients with CF. Recommendations for screening and for calcium, vitamin D and K supplementation are given. Further work is needed to define indications for treatment with biphosphonates and anabolic agents.