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MANASOVA G.S.1, ZELINSKYA.A.2, DMITRIEVA V.V.3, KAZARENKO O.N.3, GLOBA S.S.3
Health Department of the Odessa City Council, Ukraine
2Оdessa State Medical University, Ukraine
3Municipal establishment «Maternity № 5» Odessa, Ukraine
State of the Bone Tissue in the Premenopausal Women: the Frequency of athology, Risk Factors
Introduction. The problem of the osteoporosis continues to be one of the most important medical and social problems of the modern society. It is known that every third woman after 65 years there is at minimum one fracture due to osteoporosis.
Most studies have focused on the study of the osteoporosis in the postmenopausal age when the clinical manifestations of the disease become apparent. In recent years, there is growing evidence of the prevalence of the osteoporosis in the young people.
The aim of the study. The study of the prevalence of the osteopenia and osteoporosis in the premenopausal women, the characteristic of the risk factors of the bone tissue diseases.
Materials and methods. The premenopausal women were asked to complete the questionnaire, which contained the data on the somatic and obstetric-gynecological history, the lifestyle, nutrition, on the bad habits, the number of births, the nature of the menstrual function and others.
Subsequently, the patients were determined the parameters of the bone mineral density (BMD) of the calcane-us by ultrasound densitometry. The diagnosis of the osteo-penia and osteoporosis, according to the recommendations ICSD, by the basis of the Z-criterion — the standard deviation of age bone mass is determined.
The study 589 women in the one district of the Odessa city examined, the middle age was 41.90 ± 1.89 years. All of the women had normal body type with an the average body mass index 22.96 ± 2.32, the average growth 166.80 ± 5.09 cm, average weight — 63.17 ± 5.61 kg.
The results of the study. In the analysis of the questionnaires established the following. The active lifestyle, including the exercise, were 46.67 % of the women; abused the coffee and carbonated drinks — 47.04 %, smoking — 40.00 % of the women. Menarche occurred before the age of 12 years at 13.70 %, later becoming the menstrual cycle was observed in 7.41 %.
In the 53.33 % of the women had of the one birth, at 33.33 % — 2, at 6.67 % — 3 birth, did not give birth at all 6.67 % of women. At 6.67 % of the women had no one birth.
Every fifth the patient (18.15 %) were of the reproductive organs chronic inflammatory diseases, one in ten (12.22 %) had the pathology of the cervix (pseudoerosion, cervici-tis).
On the gastrointestinal diseases identified 15.93 % of the women, of the kidneys — 12.96 %, rheumatoid arthritis — 7.78 %, hyperthyroidism — 7.04 %, diabetes — 7.41 % of the women. Only 7.04 % of the premenopausal women had no somatic and gynecological diseases.
According to the ultrasound densitometry, parameters of the bone mineral density were normal in only 54.16 % (319) of the women, osteopenia was found in 42.78 % (252) and at the 3.06 % (18) women osteoporosis diagnosed.
The indicators of the standard deviation of the age bone mass (Z-criterion) in the women with the osteopenia was —1.48 ± 0.22 SD, with the osteoporosis — -2.62 ± 0.06 SD.
Conclusion. Only 7 % of the premenopausal women in one district of the Odessa city have chronic diseases; the most frequently reported diseases of the gastrointestinal tract (15.93 %), kidney disease (12.96 %), and 7 % of the women suffer from rheumatoid arthritis, hyperthyroidism, diabetes mellitus. Every third of the premenopausal woman (30.37 %) are diseases of the reproductive sphere. In addition, almost half of the women abused coffee, smoke.
Every second of the premenopausal women (45.84 %) revealed the osteopenia, 3.06 % in the parameters of the bone mineral density evidence of osteoporosis.
MASIK N.P.
A chair of Internal Medicine № 2, Vinnitsa National Medical University named after Pirogov, Vinnitsa, Ukraine
Systemic Disturbances of Bone Metabolism in Patients of Different Age Groups with Chronic Obstructive Pulmonary Disease and Ways of Their Correction
Introduction. The pathogenesis of osteoporosis in patients with chronic obstructive diseases of lungs (COPD) is associated with pathophysiological features of the disease, exactly with the development of systemic inflammation.
The aim of this study is devoted to studying a problem of bone metabolism as one of systemic manifestations of COPD, the role of endogenous intoxication, systemic inflammation, general adaptation syndrome as major pre-
dictors of disease progression and their impact on clinical course and quality of life of patients.
Materials and methods. A comprehensive clinical examination and the study of structural and functional condition of the bone tissue and calcium-phosphorus homeostasis were performed in 696 COPD patients.
Results. The investigation of systemic inflammation markers in COPD patients made possible to predict a development of systemic effects of the disease and to establish early diagnosis of an imbalance in bone metabolism, which may lead to the development and progression of osteoporosis. We suggested using some indices of bone metabolism (osteocalcin, vitamin D, P-terminal telopeptides), blood serum cytokine profile (IL-ip, TNF-a), and endogenous intoxication markers (middle-molecular peptides, fibrinogen) as diagnostic criteria of systemic disorders of bone metabolism in COPD patients.
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Results. It was revealed that with increasing severity of disease and patient's age COPD inflammation activity increases with increasing levels of markers of systemic inflammation. It has been determined significant inverse correlations between markers of systemic inflammation and bone formation, and direct correlations between markers of bone resorption, which confirm the adverse effect of active inflammation in the metabolic processes in the bone tissue. It has been determined significant (p < 0.05) negative correlation between COPD stage and axial skeleton BMD of the lumbar spine (r = —0.80), radius (r = —0.73), femur (r = —0.75), all skeletal sites (r = -0.73); trunk (r = -0.71); pelvis (r = -0.71); limbs (r = -0.62).
We determined the frequency of osteopenic syndrome, osteoporosis and osteoporotic fractures in COPD patients according to age, sex, severity and duration of illness. Risk factors of osteoporosis for patients with chronic obstructive pulmonary disease were also determined. A lumbar spine was found the most vulnerable area for osteoporosis in COPD patients, as evidenced by a significant decrease of bone mineral density in this area in patients with at least stage II of the disease.
The study established the relationship of bone metabolism with bad habits of patients, severity of COPD, age, systemic inflammation, and formation of negative adaptive responses.
We found new aspects of pathogenesis of osteoporosis in COPD patients. Hypoxia and acidosis, chronic inflammation and hyperinflation, frequent exacerbations, accompanied with intoxication syndrome, stress reactions of nonspecific resistance of organism, vitamin D deficiency/insufficiency, deterioration of microcirculation and nutritional status were found disturbances arising from development of systemic inflammation syndrome and drivers of osteo-deficiency conditions in COPD patients.
Conclusions. We developed an algorithm of COPD patients' supervision that served as a basis for reducing a period of diagnostic process and definition of ultimate risk group in terms of development of systemic osteoporosis and its complications. The particular attention should be paid to such osteoporosis risk factors as severity of bronchial obstruction, low BMI values, smoking experience and age of COPD patients as the most important ones.
OSYPENKO I., SOLYEYKO O., SOLEYKO L.
Vinnytsia National PyrogovMedical University, Vinnytsia,
Ukraine
Injury of Musculoskeletal System in Young Patients with Undifferentiated Connective Tissue Dysplasia
Introduction. Problem of undifferentiated connective tissue dysplasia (UCTD) as pathology of collagen, is a significant problem of modern medicine because of the high prevalence, multiorgans injury and serious affects. Congenital defects of connective tissue can be diagnosed at the stage of physical examination of the patient at combined rating of phenotypic markers. Thus, a big numbers of external markers of dysplasia are founded at UCTD. Prevalence of some external phenotypes according to various sources is extremely high: single external markers detected in 94 % of young people, numerous (more than 6 features) ones are found in 42 % of patients. The most studied and dangerous for the complications at the syndrome of UCTD is idiopathic mitral valve prolapse (MVP), which often occurred with cardiac arrhythmias. At the same time, injury of the thoracic spine at UCTD causes to arrhythmic complications of verte-brogenic character.
The aim of our study was to find external (phenotypic) markers of UCTD from the side of musculoskeletal system in patients with idiopathic MVP and detect prog-nostically important parameters for further formation of risk groups.
Materials and methods. We examined 120 patients of age 16 to 35 years with idiopathic MVP (average age — 25.1 ± 0.4 years). All patients had a complex clinical and instrumental examination (general clinical, biochemi-
cal, ECG, Holter ECG monitoring, Doppler echocardiography examination, X-ray examination). Somato-metric examination of the patients conducted by the method of V.V. Bunaka (1939, 1941) in modification of P.P. Shaparenko (1989).
Results. By the study results 100 % of patients had the skeletal system injury regardless of the degree of MVP. However, the evidences of a musculoskeletal system injury differed depending on the degree of MVP. Thus, the phenotypic markers of the spine (scoliotic curvature, kyphoscoliosis, straight back and hollowed chest) significantly more often detected in patients with II degree of MVP (p < 0.05). Phenotypic stigmas of the upper and lower extremities (short and crooked little finger, «like sandal» cleft foot, flat feet, dolichostenomielia) were founded in the same number of patients regardless of the degree of MVP (64.1 %). Changes of the oral cavity (abnormalities of dentition structure, high palate) were found in 52.1 % of patients with idiopathic MVP. Hypotrophy (61.4 %) often was observed among stigmas muscle in patients with idiopathic mitral valve prolapse, incidence of which was increased significantly with the degree of MVP (p < 0.05).
Cardiac rhythm disorder was observed in 51 patients (42.5 %). Supraventricular extrasystole, sinus tachycardia, ventricular arrhythmia dominated among the patients with I degree of MVP. Supraventricular extrasystole, paroxysmal supraventricular tachycardia, ventricular extrasystole, sinus tachycardia, fibrillation were registered in patients with II-III degree of MVP more often. Correlation analysis revealed a strong direct connection between the degree of MVP and the numbers of musculoskeletal stigmas (r = +0.72). Risk assessment in the form of calculating the odds ratio (OR) in patients with II—III
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