Vitamin D receptor gene polymorphisms, bone mineral density and fractures in postmenopausal women with osteoporosis.

The goal of the study was to investigate the possibility of an association between polymorphisms and single alleles of BsmI, ApaI, TaqI of the vitamin D receptor (VDR) gene with bone mineral density (BMD) and prevalence of vertebral/non-vertebral fractures in a group of postmenopausal Polish women with osteoporosis. The study group comprised of 501 postmenopausal females with osteoporosis (mean age 66.4 ± 8.9), who were diagnosed on the basis of either the WHO criteria or self-reported history of low-energy fractures. The three polymorphisms were determined by PCR (polymerase chain reaction) and RFLP (restriction fragment length polymorphism). BMD at the lumbar spine and femoral neck was assessed by dual energy X-ray absorptiometry (DXA). 285 fractures were reported in the whole group (168 vertebral and 117 non-vertebral). Incidence of non-vertebral fractures was significantly higher in the carriers of single alleles a of ApaI, b of BsmI and T of TaqI VDR gene polymorphisms (p = 0.021, 0.032, 0.020, respectively). No significant associations between allelic variants of the studied polymorphisms and BMD or fracture incidence were found. (1).The presence of single alleles a,b and T of ApaI, BsmI, TaqI VDR gene polymorphisms respectively, might serve as an indicator of non-vertebral fractures. (2). Lack of association between the VDR gene polymorphisms and BMD suggests that VDR contributes to low-energy fractures also through other ways.

Pregnancy associated osteoporosis--a case report.

Loss of bone mineral density (BMD)--usually temporary--occurs during pregnancy and lactation. Pregnancy associated osteoporosis (PAO) is an uncommon disease of unknown etiology. We present a case of a 35-year old woman with PAO, manifesting initially at the end of the first pregnancy as back pain. It reappeared in the second pregnancy four years later X-ray revealed multilevel compression fractures of Th12, L1, L2. DEXA showed L2-L4 T-score: -3.3 SD, hip T-score: -2.09 SD. Laboratory findings were irrelevant. She was put on antiresorptive treatment, calcium and vitamin D. Although there has been an improvement in BMD, the patient is a definite candidate for vertebral kyphoplasty due to disabling pain.

Influence of social competence of physicians on patient compliance with osteoporosis medications--a study on Polish postmenopausal women.

OBJECTIVE: The aim of the study was to examine the impact of social competence of physicians on the effectiveness of patient compliance and persistence with therapy. MATERIAL AND METHODS: The study included physicians and their patients, previously diagnosed with osteoporosis, and eligible to receive pharmacological treatment. The physicians were evaluated with the social competence questionnaire involving three dimensions: social exposure, intimacy and assertiveness, as well as in the combined scale. All patients in the study group were prescribed the same medication: alendronate once a week. Compliance and persistence of the patients were juxtaposed with social interaction skills of physicians during 7 scheduled appointments at 2-month intervals. RESULTS: Doctor's effectiveness in situations demanding close interpersonal contact was higher in the group with good compliance--group A (p < 0.001), as well as in the situations of social exposure, (p < 0.001). On the other hand, their assertiveness was higher in the group with poor compliance--group B (p < 0.001). Co-morbid conditions (group A: 76%, group B: 74%), as well as earlier fractures (40.43% vs. 36.78%) were comparable in both groups. Disease acceptance and suggested methods of treatment were more often accepted by patients from group A than group B (56% vs. 33%, respectively). CONCLUSIONS: (1) Disease acceptance is essential for effective treatment. (2) Social skills of physicians influence patient adherence to therapy recommendations. (3) Close interpersonal contact between physicians and their patients eliminates the feeling of fear and

British and Polish general practitioners' opinions on the importance of preventive medicine.

The delivery of preventive services in GPs' surgeries falls below recommended levels. Different attempts are performed to change the situation. The introduction in the UK in 2004 of a new GP contract based on a QOF fundamentally changed the way that primary practitioners are paid. Success of this intervention caused international interest in using financial incentives as a method of improving general practice. Polish primary care is still under development. In contemplating reform and the possible introduction of some of these British solutions in Poland, it would be valuable to compare what British and Polish GPs' think about prevention and see how their opinions can be affected by context in which they work. The aim of the survey involving 65 British and 65 Polish GPs was to compare what are their views of health promotion. The questionnaire solicited information on doctors' demographic characteristics, attitudes toward prevention, time they think they spend on preventive procedures and perceptions of the importance of 13 selected preventive procedures. Most British and Polish GPs answered that prevention is very important and they spend 10-30% of each consultation on it. Almost all doctors rated blood pressure measurement as important. For British GPs BMI, blood glucose, lipid profile, anti-alcohol and anti-smoking advice were important, in contrast to Polish doctors. In the presence of clear clinical guidelines, age and gender do not affect doctors' opinion on the importance of preventive procedures. Procedures in which GPs are directly involved are more important for them.

The role of hormonal therapy in osteoporosis.

In developed societies, the post-menopausal period covers approximately one third of a woman's life. The deficit of oestrogens observed during the post-menopausal period significantly affects the course of many metabolic processes, causing a number of diseases and in consequence diminishing quality of life. Among others, bones belong to oestrogen-dependent tissues. The deficit of the protective influence of oestrogens compromises the dynamic balance of the bone transformation process towards resorption, thus reducing bone mass and quality, while increasing the risk of low-energy fractures. In recent years, differing views on the application of oestrogen/gestagen therapy have reached the level of controversy. The results of numerous clinical studies are far from unequivocal, with the whole subject one of heated debate. It has been confirmed that hormonal therapy prevents bone quality deterioration, while opening a protective umbrella around the bone, reducing the risk of osteoporotic fractures. A rational approach to weighing possible advantages against possible risks and a thorough evaluation of a patient's health condition allows for optimal therapy selection.

The role of anorexia nervosa in secondary osteoporosis development with the risk for low energy fractures.

Anorexia nervosa (AN) has in recent years become considerably more common. The disease primarily affects girls and young women, and also boys and young men. AN is a risk factor for secondary osteoporosis. AN-related metabolic disturbances lead to diminished bone quality and increased risk of fractures. The consequences of low energy fractures are the main causes of death in women with AN. Hormonal disturbances (e.g. hypoestrogenism, increased levels of ghrelin and Y peptide, changes in leptin and endocannabinoid levels), as well as the mechanisms involved in bone resorption (RANK/RANKL/OPG), are considered to be of great importance for anorectic bone quality. The risk of osteoporotic, non-vertebral fractures in AN patients is significantly higher than in healthy women. An improvement of bone mineral density is possible after substantial body mass increase. Weight loss, in conjunction with a well-balanced, controlled diet, is the key to correct peak bone mass levels, and diminishes the risk of osteoporosis with its consequence of low energy bone fractures. (Pol J Endocrinol 2011; 62 (1): 45-47).

Alendronate 70 therapy in elderly women with post-menopausal osteoporosis: the problem of compliance.

INTRODUCTION: More than half of those with chronic diseases, including osteoporosis, discontinue treatment during the first year of its administration. This problem increases over the course of continued follow-up. Additionally, it has been observed that 13% of women, prescribed oral daily alendronate, do not even start the treatment, while 20% of patients discontinue the therapy during the first four months. On the other hand, those patients who are compliant achieve increased bone mass density with a simultaneous decrease of fracture risk. The aim of our study was to assess the adherence to the recommended alendronate 70 administration protocol over the course of 12 months by women with post-menopausal osteoporosis. MATERIAL AND METHODS: Adherence (compliance plus persistence) to alendronate 70 therapy was assessed in a prospective study of 153 post-menopausal women, followed up for one year with monitoring every two months. RESULTS: Adherence to therapy of all the study participants was high during the entire study period, the patients remaining compliant after a year in 95.08 ± 1.39% (mean ± SEM) of cases, and the mean persistence with medication was 347.05 ± 5.07 days. In the group of patients who interrupted treatment, the mean persistence was 212.44 days. One of the study participants did not start the treatment, and another two discontinued the therapy within 30-60 days of the study onset (between the first two visits). Facilitated contacts with the doctor, continuous access to prescribed treatment and frequent visits significantly improved patient compliance. The common reason for discontinuation was side effects, while age (but not education) affected the rate of compliance with therapy. The worst results were obtained in the group of patients with osteoporosis diagnosed more than five years before the study, particularly in the subgroup where alendronate was being used for the first time or where treatment resumed after a substantial break. CONCLUSIONS: The obtained results indicate that better adherence to alendronate 70 therapy, administered once a week, depends on more frequent monitoring of treated patients.

A discussion of the intervention thresholds in osteoporosis treatment in Poland.

INTRODUCTION: Epidemiological prognoses regarding the global spread of post-menopausal osteoporosis can prove somewhat nebulous. But it is clear that low-energy fractures and their consequences will become an increasingly serious health problem. Therefore it is crucial to implement prognostic procedures which could more effectively predict the incidence of osteoporosis and its complications. MATERIAL AND METHODS: The study involved 378 female patients aged 40-86 years for whom clinical risk factors of osteoporotic fracture were analysed. Densitometry (DPX) was performed at femoral neck. The 10-year risk of fracture was assessed according to the British model of FRAX calculator. RESULTS: The study group was divided into two, depending on the history of low-energy fractures. Previous osteoporotic fractures were confirmed in 128 patients. In this group, the mean bone mineral density (BMD) values (0.717 g/cm(2)) were lower than in the group without fracture history (0.735 g/cm(2)). In 33.3% of patients aged 50-59 years and 17% of women aged 60-79 who required medical treatment for their clinical status (previous fracture), the FRAX value did not meet the criterion of pharmacotherapy administration. Considering BMD in the calculation of FRAX produced an even higher underestimation of the fracture risk. Of women aged 40-49, 25% were qualified for pharmacotherapy of osteoporosis. In that particular age category, BMD did not affect the FRAX value. BMD measurement had a higher discriminatory value among patients aged 50-79, increasing the number of patients requiring therapy by more than 50%. CONCLUSIONS: 1. The FRAX calculator does not always consider the history of low-energy fractures as a criterion sufficient for therapy implementation. 2. Designing a FRAX calculator specifically for the Polish population would be advisable.

[Pregnancy, lactation and bone mineral density]. / Ciaza, laktacja a gestosc mineralna kosci.

Evidence shows that pregnancy and lactation lead to the decrease of bone mineral density (BMD), which is related to mobilization of skeletal calcium. Numeorous mechanisms are involved in maternal adaptation to the increased demand for calcium. BMD has been proved to return to the baseline level after weaning. Pregnancies and long or repeated periods of feeding do not seem to determine the diagnosis of osteoporosis in later life. In fact, women with multiple pregnancies have been shown to have the same or higher BMD and lower fracture risk compared with nulliparous women. Pregnancy and lactation-associated osteoporosis (PLO) is a rare disease entity. It manifests itself as low back pain, and often leads to a number of vertebral compression fractures and, therefore, to potentially serious health consequences.

Vitamin D supplementation in adults - guidelines.

Vitamin D is necessary in maintaining appropriate calcium and phosphate homeostasis in the body (classical function) and ensuring appropriate functioning of many tissues, organs and cells, unrelated to mineral economy (non-classical function). Vitamin D deficiency in adults may cause osteomalacia, increase fracture risk in osteoporosis, induce cardiovascular diseases, diabetes type 1 and 2, multiple sclerosis, Lesniowski-Crohn disease, and cancer, including colon, breast, and prostate cancer. Possible causes of vitamin D deficiency in a healthy population include decreased cutaneous synthesis and an inadequate intake of vitamin D, both in food and in supplements. Vitamin D deficiency level (25(OH) D. 〈 20 ng/mL), is fairly widespread, being found in a substantial percentage of healthy subjects around the world, regardless of race, gender and age. Daily vitamin D dose, as determined by the Food and Nutrition Board in 1997, is now rather insufficient, the biggest problem being associated with maximal vitamin D levels (50 µg/day) in actually available food supplements. Nowadays, it is recommended that adults need a minimum of 800-1,000 U/day when their exposure to the sun is inadequate (in Poland from October to April). This dosage should be provided to all subjects who avoid sunlight, as well as to those aged over 65 because of their slower skin synthesis of vitamin D and for its proven anti-fracture and anti-fall effects.

Correlation of vitamin D receptor gene (VDR) polymorphism with osteoporotic changes in Polish postmenopausal women.

OBJECTIVE: Recently the significance of genetic traits, influencing hormonal and environmental factors, in susceptibility to osteopenia and osteoporosis development has been indicated. Much attention to the polymorphic variants of vitamin D receptor (VDR) gene was paid. The restriction polymorphisms in VDR gene could be involved in the modulation of vitamin D action and modulate the level of bone mineral density (BMD) and the risk to develop osteopenia and osteoporosis. MATERIALS AND METHODS: Total 321 postmenopausal women (mean age 63.26 +/- 8.90 years), including women with osteoporosis (163 patients) and osteopenia (95) have been compared to 63 women with normal t-score value. For detection of VDR polymorphisms PCR/RFLP (polymerase chain reaction/restriction fragment length polymorphism) assay have been used. RESULTS: The frequency of BsmI, ApaI, and TaqI polymorphic variants of VDR gene detected in investigated groups was not statistically different. The slight, not significant tendency to prevalence of a allele (ApaI polymorphism) in the controls comparing to women with osteoporosis and osteopenia have been noted. Higher prevalence of homozygous TT genotype (TaqI polymorphism) the in the both groups with lower BMD value (47.9 : 49.5 vs. 34.9% in the controls) and higher prevalence of T allele in these both groups (65.9 : 68.4 vs. 57.9) was been also observed. CONCLUSIONS: The presence of T allele of TaqI polymorphism could predict the higher risk to develop osteoporosis in postmenopausal woman; consequently t allele could have protective effect. The presence of A allele (ApaI polymprphism) seems to be weakly connected with osteoporosis susceptibility.

Gender makes the difference: the influence of patients' gender on the delivery of preventive services in primary care in Poland.

OBJECTIVE: General practitioners' (GPs') time and resources for preventive services needs to be delivered equitably. We aimed to study the effect of patients' gender on the delivery of preventive procedures to adult patients aged 40 years and over. METHOD: An observational study was performed in primary care surgeries in Wielkopolska (Poland) as a part of the Improving Quality in Primary Care (PIUPOZ) programme carried out by Family Medicine Department of the University of Medical Sciences, Poznan. Trained observers directly observed GPs in their office, to register preventive procedures performed during the consultation and in the previous year (via the medical record) in patients aged 40 years and over. RESULTS: A total of 1073 preventive procedures were registered among 450 patients (267 women and 183 men) by 113 doctors in one year. The most common were serum glucose, blood pressure and total cholesterol measurements. Six procedures were offered to less than 10% of patients: dietary advice, tobacco use and alcohol screening, exercise counselling, body mass index (BMI) recording, and waist measurement. Men were more likely to receive tobacco use and alcohol screening and BMI measurement, while more women were offered a total cholesterol screen. CONCLUSIONS: The annual delivery rate of preventive procedures in patients aged 40 years and above is below the recommended level set by the Polish Ministry of Health. Procedures based on clinical examinations or laboratory tests were offered and performed more frequently than lifestyle advice. More men than women received preventive services for tobacco use or alcohol screening and BMI measurements. Patients' gender and physicians' engagement may influence GPs' preventive attitude and performance. These elements should be incorporated in the development of guidelines concerning prevention in primary care.

[Efficacy of densitometry and fracture risk assessment tool FRAX in making therapeutic decisions in osteoporosis--a study on female patients of university of medical sciences endocrinology outpatient clinic]. / Znaczenie densytometrii oraz zastosowania metody szacowania ryzyka zlamania osteoporotycznego za pomoca algorytmu FRAX dla podejmowania decyzji terapeutycznych w osteoporozie na przykladzie pacjentek Poradni Endokrynologicznej Uniwersytetu Medycznego w Poznaniu.

INTRODUCTION: Contemporary understanding of osteoporosis is based on the assessment of fracture risk. Evaluation of clinical risk factors of fracture with or without densitometry (DEXA) allows to identify patients requiring pharmacological treatment. AIM: The aim of the study was to estimate the usefulness of DEXA in assessment of fracture risk in women >50 years old. MATERIALS AND METHODS: In 296 previously untreated for osteoporosis women of Endocrinology Outpatient Clinic aged 50 to 85 years (mean 68.8+/-7.8) 10-year fracture risk using FRAX tool was computed from clinical risk factors alone (FRAX, FRAX hip) and after measurement of BMD (FRAX BMD). Then FRAX parameters were compared in 4 age categories. Fracture risk was confronted with therapeutic thresholds proposed in Poland. RESULTS: 10-year fracture risk by FRAX increased with age. The most frequent risk factors were: previous fracture and family history of fractures. FRAX and FRAX BMD were significantly different in the 50-59 year-olds and 60-69 year-olds. Statistically significant difference was found for FRAX hip and FRAX hip BMD in 50-59 year old women. FRAX and FRAXhip were better predictors of fractures than FRAX BMD in patients >80 years old. In 50-79 year old women qualification for treatment was more effective when risk was assessed according to FRAX BMD. DEXA performance did not change the number of women over 80 who were eligible for treatment according to FRAX. CONCLUSIONS: BMD is crucial for the 10-year risk assessment in 50-69 year-olds without previous fracture, as an increasing number of patients need therapy. In >80 year old women clinical risk factors alone are sufficient to make therapeutic decisions. DEXA in these women has no influence on the risk of future fractures, including hip fracture. In 60-69 women with previous fracture DEXA is a good predictor for future fractures but has no value as far as therapeutic decisions are concerned.

[Metabolic syndrome and bone]. / Zespól metaboliczny a kosc.

In recent years an increasing socioeconomic burden of two pressing problems has been observed: enormous prevalence of obesity and - along with aging of populations - great number of people affected with osteoporosis. Visceral obesity, expressed by increased waist circumference, is according to the latest guidelines a crucial component of metabolic syndrome (MS). So far the two entities have not been linked, as studies have proven beneficial effect of increased body weight on bone mineral density (BMD). It has been shown however, that adipose tissue is actually an endocrine tissue, secreting numerous biologically active substances that influence also bone. Moreover, an adipocyte and osteoblast derive from a common precursor cell. There is also increasing number of evidence showing common genetic determination of the diseases. Data from experimental and epidemiological studies proves that obesity itself as well as remaining components of MS might have negative influence on bone. BMD as well as fracture risk have been shown to be raised in patients diagnosed with MS. The same has been observed for high blood pressure. What's more, contradiction between high BMD and - simultaneously - high fracture risk in subjects with type 2 diabetes has not been convincingly explained. The paper discusses reports and controversies on coexistence and interactions between MS and osteoporosis and its complications.

Association analysis of vitamin D receptor gene polymorphisms with bone mineral density in young women with Graves' disease.

UNLABELLED: Graves' (GD) hyperthyroidism induces accelerated bone turnover that leads to decreased bone mineral density (BMD). The role of the VDR gene in predisposition to primary osteoporosis has been recognized. Recent studies show associations between the VDR gene polymorphisms and susceptibility to autoimmune diseases. Here we analyzed if VDR gene polymorphisms: BsmI, ApaI, TaqI, and FokI may predispose women with Graves' hyperthyroidism to BMD reduction or to disease development. The subjects were 75 premenopausal female Polish patients with GD and 163 healthy women. The genotyping was performed by the use of the restriction fragment length polymorphism analysis (RFLP). We studied the association of the VDR polymorphisms and their haplotypes with patients' BMD and also SNPs and haplotypes association with Graves' disease. We found a strong linkage disequilibrium for the BsmI, ApaI, and TaqI polymorphims that formed three most frequent haplotypes in Graves' women: baT (47.9%), BAt (34.9%), and bAT (16.4%). We did not show statistically significant association of analyzed VDR polymorphisms or haplotypes with decreased bone mineral density in Graves' patients. However, the presence of F allele had a weak tendency to be associated with Graves' disease (with OR=1.93; 95% CI: 0.97-3.84; p=0.058). IN CONCLUSION: VDR gene polymorphisms do not predict the risk of decreased BMD in Polish women with Graves'. It may be speculated that the F allele carriers of the VDR-FokI polymorphism are predisposed to Graves' disease development.

The TP53 codon 72 polymorphism and predisposition to adrenocortical cancer in Polish patients.

The TP53 polymorphism occurs at codon 72 of exon 4 with two alleles encoding either arginine or proline. The association between this common polymorphism and risk of different cancers has been extensive studied, however various reports are controversial. We have analyzed the 72Pro polymorphic variant in patients with adrenocortical tumors to evaluate whether 72G--> C substitution at codon 72 of TP53 gene may be associated with increased risk for malignancy in adrenal cortex in comparison to the control group. DNA extracted from peripheral leucocytes of 46 Polish patients with adrenocortical tumors (17 malignant and 29 benign) and 50 controls was examined by PCR-HD method followed by direct sequencing. TP53 polymorphism in codon 72 was found in 47% of ACC cases, in 28% of patients with adenomas and in 24% of controls. The genotype Arg/Arg, Arg/Pro and Pro/Pro distribution was respectively 53%/35%/12% for cancers, 72%/28%/0% for benign tumors and 76%/24%/0% for controls. High frequency of 72Pro allele in patients with carcinoma (29%) in comparison to the benign tumors (14%) and controls (12%) was statistically analyzed. We found that 72Pro variant of TP53 gene was associated with a significantly increased risk of ACC (OR = 3.05; 95% CI = 1.17-7.91, p=0.03). Our results suggest that the TP53 codon 72 polymorphism could be associated with susceptibility for adrenocortical cancer in the examined Polish patients.

[Quality of life in patients with hip bone fractures]. / Jakosc zycia chorych po zlamaniu szyjki kosci udowej.

UNLABELLED: The aim of the study was to evaluate quality of life in patients who received surgical treatment of hip fracture. MATERIAL AND METHODS: Fifty patients (mean age: 77,5) including 37 women and 13 men participated in the study. All patients filled in a questionnaire constructed specially for the study. Patients were investigated three times: first time during hospitalization after surgery, second time within one month, and the last time after one year since surgery. Patients were not diagnosed as osteoporotic, before fracture had occurred. The diagnosis of osteoporosis was done on the basis of risk factors analysis and occurrence of low-energy fracture. RESULTS: Eight percent of patients assesed their economical status as very good before the hip fracture has occurred. There were no such assessments after the hip fracture. Before hip fracture 28% of patients' assessed their economical status as low, after hip fracture there were 50% of low economical status assessments. Twenty two percent of patients need continuous care after one year since hip fracture in comparison to 16% of patients before hip fracture. Twenty eight percent of patients who suffered from hip fracture assessed their health condition as bad, in comparison to 16% of such assessments before hip fracture. Eight percent of patients stated that their quality of life is low, in comparison to 40% of such assessments after one year since hip fracture. All patients declared that pain ailments increased during last year. Mortality rate in investigated group, despite immediate treatment, was 40%. In investigated group 40% of patients died within one year since hip fracture, despite immediate treatment. In group of patients who died within one year 54% assessed their quality of life as low. CONCLUSION: Quality of life assessment is important indicator of overall health condition and treatment efficiency.

The prognostic value of quality of life parameters in patients recovering from osteoporotic fractures of the proximal femur.

Background. Improving the quality of life is the aim of treatment in elderly patients with hip fracture. Different outcomes are often achieved using similar therapy methods. On the basis of own observations we tested the hypothesis that different parameters of quality of life (QOL) before hip fracture can be important prognostic factors. The aim of the study was to evaluate the association between selected QOL parameters and mortality after osteoporotic hip fracture at 2- and 12-month follow-up. Material and methods. We examined 55 patients ranging in age from 48 to 92 years (mean age 77 years) with hip fracture resulting from falls, who were treated in our surgery department. All patients answered a questionnaire constructed especially for this research. The patients were examined three times: first during hospitalization after surgery, the second time within 8 weeks, and the last time at follow-up one year after surgery. Results. 63% of those patients who died within 2 months lived alone, in comparison to 37% of patients living together with their families. 63% of the patients who needed continuous care died within the 8-week observation period. During this same time no patients who had been independent before hip fracture died. The one-year mortality rate among patients who did not leave their home before and after the fracture was 100%. A lack of social activity was associated with 82% mortality within 12 months. Conclusions. Quality of life parameters are important predictive factors for mortality in patients after hip fracture. High subjective quality of life assessment predicts better chances of recovery.

Association analysis of the COL1A1 polymorphism with bone mineral density and prevalent fractures in Polish postmenopausal women with osteoporosis.

INTRODUCTION: Polymorphism in the promoter region of collagen type 1α (COL1A1) +1245G/T (Sp1, rs1800012) was in some studies shown to be relevant for bone mineral density (BMD) and low-energy fracture prediction. The aim of the study was to confirm this finding in a group of postmenopausal women diagnosed with osteoporosis. MATERIAL AND METHODS: We investigated 311 Caucasian women (mean age: 65.2 ±9.39 years) either after low-energy fractures (regardless of the location) or meeting World Health Organization (WHO) criteria for osteoporosis. All patients underwent clinical examination in order to exclude secondary osteoporosis; hip and lumbar spine DEXA was performed (Lunar). The three genotypes of Sp1 polymorphism were determined by RFLP (restriction fragment length polymorphism). RESULTS: Distribution of COL1A1 genotypes (SS/Ss/ss) agreed with Hardy-Weinberg equilibrium. No relation between COL1A1 genotypes and hip/L1-L4 BMD was found. Fractures were reported in 26.3% of women. Prevalence of low-energy fractures, regardless of the type, was 50.0% in ss genotype carriers, 26.4% in SS homozygotes and 23.7% in Ss heterozygotes. There was no statistically significant recessive or dominant effect of any Sp1 genotype on fracture prevalence (p = 0.613). CONCLUSIONS: We failed to observe that COL1A1 Sp 1 genotypes contribute to BMD determination or are associated with prevalent low-energy fractures in a Polish cohort of postmenopausal osteoporotic women.

Osteoprotegerin, s-RANKL, and selected interleukins in the pathology of bone metabolism in patients with Crohn's disease.

INTRODUCTION: Crohn's disease (CD) promotes the development of osteopaenia/osteoporosis, the cytokine background of which is not fully known. AIM: Evaluation of bone mineral density (BMD), the prevalence of osteopaenia and osteoporosis, and the determination of the levels of selected interleukins (IL), osteoprotegerin (OPG), and s-RANKL proteins in patients with CD in relation to a control group and assessment of the relationship between the tested cytokines, OPG, s-RANKL, and BMD. MATERIAL AND METHODS: Thirty-seven CD patients and 37 healthy volunteers (control group) were enrolled into the study. Densitometry of the lumbar spine (L2-L4) and of the femoral neck using the DXA technique was carried out. Serum levels of: IL-13, IL-4, IL-17, IL-1ß, OPG, and s-RANKL were determined using the ELISA method. Progression-of-disease questionnaires were collected. RESULTS: The prevalence of osteoporosis and osteopaenia in the CD group was: 18.92% and 32.43% in L2-L4; 13.51% and 35.13% in the neck, respectively. The IL-13 and IL-1ß concentrations were significantly higher and OPG was significantly lower in CD patients when compared to controls. In the case of all subjects: IL-13 correlated negatively with the BMD of the neck, IL-17 correlated negatively with the Z-score of L2-L4, and OPG correlated negatively with the IL-13. In the case of CD patients, IL-4 correlated negatively with the BMD of L2-L4. CONCLUSIONS: The incidence of osteopaenia and osteoporosis in Polish CD patients is high. IL-13, IL-1ß, and IL-4 seem to be connected with the pathology of decreased BMD in CD. It can be hypothesised that IL-13 may lower BMD by modulating OPG.