[The implementation of personalized treatment for osteoporosis].

AIM: To establish personalized treatment of osteoporosis. METHODS: A T869-->C polymorphism in exon 1 of the transforming growth factor-beta1 gene, which results in a Leu-->Pro substitution at amino acid 10, is reported to be associated with the rate of bone loss as well as the response to active vitamin D treatment. Therefore, we determined this single nucleotide polymorphism (SNP) to estimate the need of active vitamin D treatment. We also determined serum level of 25 hydroxy-vitamin D to evaluate a degree of vitamin D fulfillment. Based on these data, we categorized postmenopausal patients into four groups; C homozygote with vitamin D deficiency patients to whom 1 microg/day active vitamin D was administered, C homozygote without vitamin D deficiency patients or those who bore at least one T-allele with vitamin D deficiency to whom 0.5 microg/day active vitamin D was administered, and patients who bore at least one T-allele without vitamin D deficiency to whom no drug was given. The patients were checked up every 6 months with regard to changes in bone mineral density and occurrence of fresh fractures. RESULTS: The SNP was associated with prevalent vertebral fractures; the frequency of the T allele was significantly greater in patients with vertebral fractures. Furthermore, the serum level of 25 hydroxy-vitamin D was significantly lower in patients with vertebral fractures, which were observed in 17 out of 34 patients who bore at least one T-allele as well as vitamin D deficiency, while only 2 of 15 homozygous C-allele carriers without vitamin D deficiency suffered from fractures. CONCLUSION: These findings suggest that the SNP in combination with the serum level of 25 hydroxy-vitamin D can predict fracture risk in postmenopausal osteoporosis.

[A case of Plummer disease that appeared in older old age after 10-year course of subclinical hyperthyroidism].

A 81-year-old woman with a thyroid tumor and subclinical hyperthyroidism since ten years ago was admitted to our hospital for palpitations and hyperthyroidism (FT(4) 1.75 ng/dl, FT(3) 5.37 pg/ml, TSH<0.03 microIU/ml). Although thyroid stimulating antibody (TSAb) was transiently and mildly positive, anti-TSH receptor antibody (TRAb), microsome test, and thyroid test were negative. Thyroid echogram showed an isoechoic nodule in the left lobe (33 x 42 x 22 mm) and a small nodule (10 x 15 x 9 mm) in right lobe. Thyroid scintiscan showed a hyperfunctional (hot) nodule in left thyroid lobe with suppressed uptake in the remainder of the gland. The uptake rate of thyroidal radioiodine ((123)I) in 24 hours was within the normal range (7.3%). Based on the above findings, a diagnosis of Plummer disease was made. Since she refused invasive surgical or radioiodine treatment, she was treated with 10 mg thiamazole daily. After treatment with propranolol and thiamazole, the thyrotoxic symptoms disappeared and thyroid function returned to normal level. She had osteoporosis but she had neither atrial fibrillation nor cardiac symptoms. This was a rare case of Plummer disease that appeared in extremely old age after a long course of subclinical hyperthyroidism.

Low well-being is an independent predictor for stroke in elderly patients with diabetes mellitus.

OBJECTIVES: To examine whether psychological factors are risk factors for the development of stroke in elderly diabetic patients. DESIGN: Prospective cohort study. SETTING: Outpatient clinic. PARTICIPANTS: Three hundred seventy-six diabetic outpatients free of stroke; mean age 75. METHODS: Well-being and diabetes-specific burden were assessed at baseline using the Philadelphia Geriatric Center morale scale and the Elderly Diabetes Burden Scale (EDBS), respectively. Symptomatic stroke was defined as a focal neurological deficit with rapid onset that persists for more than 24 hours, supported by brain computed tomography or magnetic resonance imaging. RESULTS: During the 3-year follow-up period, 25 symptomatic strokes (24 ischemic strokes and 1 cerebral hemorrhage) occurred. Low scores on the morale scale (