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POVOROZNYUK V.V., NISHKUMAY O.I., NEKRASOVA N.B. Institute of Gerontology named after D.F. Chebotarev AMS Ukraine, Ukrainian Scientific-Medical Centre for the Problems of Osteoporosis, Kyiv, Ukraine
Pain Syndrome n Postmenopausal Women with Osteoarthritis, Combined with Essential Hypertension
The aim of the research is to conduct a comparative assessment of pain in women with osteoarthritis in combination with hypertension.
Materials and methods. 31 postmenopausal women (average age 61.1 ± 1.2 years, menopause duration 5.4 ± ± 2.2 years) were examined. All respondents were divided into two groups: group I comprised 13 patients diagnosed with osteoarthritis (gonarthritis) Roentgen phase II according to classification of Kellgren & Lawrence (1957), group II comprised 18 patients with gonarthritis of stage II in combination with hypertension of the second degree. Pain syndrome was assessed with the usage of verbal analogue scale (VAS) and the scale of WOMAC. All patients were taken Ultrasound densitometry (BUA, SOS, stiffness index, T-score) with the Lunar Achilles device (Lunar Corporation, Madison, Wisc., USA). Laboratory data included total serum calcium, PTH, vitamin D.
Results. All women surveyed revealed osteopenia, the severity of which is not dependent on the degree of hy-
pertension. Pain intensity on VAS was significantly higher in patients with osteoarthritis, combined with hypertension compared to patients with osteoarthritis (60.1 ± ± 2.3 mm and 51.2 ± 1.2 mm respectively, p < 0.05). Evaluation of functional impairment score WOMAC revealed significantly greater stiffness in patients with co morbidity compared with osteoarthritis (70.3 ± 3.2 and 52.5 ± 2.1 respectively, p < 0.05). Also the greatest severity of functional impairment observed in group II compared with the first group (60.5 ± 1.2 and 52.5 ± 2.1 respectively, p < 0.05). Patients of group II were identified to have secondary hyperparathyroidism and vitamin D deficiency (21.99 ± 1.20 nmol/l) probably caused by the D-hormone-deficiency taking into consideration the increases in serum creatinine and decreased creatinine clearance in this group.
Conclusion. Thus, the more intense the pain and functional impairment in patients of group II were seen against the background of the identified secondary hyperparathy-roidism and vitamin D deficiency probably caused by the D-hormone-deficiency taking into consideration the increase in serum creatinine and decreased creatinine clearance in this group. Secondary hyperparathyroidism enhances bone resorption and exacerbates pain due to the development of osteomalacia. It indicates the necessity to use the active metabolite of vitamin D (alfacalcidol) to correct the violations.
SHYMON V.M., STOYKA V.V., SHEREGIYA.A., SHYMONM.V., SLYVKA R.M.
Uzhgorod National University, Uzhgorod, Ukraine
The Indicators Bone Metabolism in Fractures of Trochanteric Areas of Femur in Patients with Type 2 Diabetes
Introduction. Fractures of the trochanteric area of the femur is an actual problem. There are the peculiarities regeneration of fractures of the trochanteric area of the femur in patients with type 2 diabetes. This is due to the peculiarities of osteoreparation background of type 2 diabetes. In recent decades was conducted a large number of studies to determine changes in bone in patients with type 2 diabetes. The available data are very different. Thus, according to different authors an increase in bone mineral density (BMD), normal density and decrease in BMD compared with controls can be observed. In a me-ta-analysis of the observed experiments-LMa and co-authors (2012) noted that these differences may be related to differences in the design of experiments methodology for determining BMD, samples of patients and the presence of complications. We believe that individual indicator BMD may not fully reflect the osteoreparative processes. Comparison of data ultrasound mineral densi-tometry and hormonal balance will help to understand the changes in bone metabolism in patients with type 2 diabetes and help to find ways to prevent complications in the treatment of fractures.
Aim. To study changes in bone metabolism in fractures of trochanteric area of the femur in patients with type 2 diabetes.
Materials and methods. In the period since 2012 to 2015 were examined 42 patients who were hospitalized in the clinic at the department of general surgery UzhNU about fractures of the trochanteric area of the femur. There were 34 injured women, men — 8. Age composition ranged from 48 to 79 years, average age — 67 years. Before trauma patients had active lifestyle.
The main group consisted of 19 patients with type 2 diabetes. Body mass index (BMI) was 29.4 (25.7-34.2) kg/m2, level of glycosylated hemoglobin (HbA1c) — 9.6 (7.711.3) %. Part of patients (n = 13) took sulfonylurea drugs 10.5 (7-10.5) mg/day, metformin — 1.5 (1-1.5) g/day, and other (n = 5) received combined treatment with insulin. The average duration of the disease diabetes was 8 years old. Newly diagnosed diabetes was 1 case, in 4 patients disease duration was less than 5 years, 7 patients — from 5 to 10 years, 7 patients — more than 10 years. Among the complications of diabetes was more frequent diabetic micro and macro angiopathy limbs — 9 people, diabetic retinop-athy — 5 people, diabetic neuropathy — 4 people. Cardiovascular diseases were observed in 13 people.
The control group consisted of 23 patients with fractures of the trochanteric area of the femur in which rates of sugar of blood serum and glycated hemoglobin does not exceed the norm. BMI was 28.9 (25.3-33.9) kg/m2. Both groups were comparable in age, sex, severity of the
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general condition and the nature and methods of fracture surgery.
On all patients were performed laboratory and instrumental clinical study determined the level of calcium, phosphorus, hydroxyvitamin 25(OH)D, alkaline phosphatase, parathyroid hormone (PTH) and osteocalcin.
To determine BMD ultrasonic densitometry was performed in three standard parts of the skeleton (lumbar, proximal femur, forearm). Were estimated bone mineral density L1-L4 spine, proximal femur and distal forearm. BMD assessment was performed according to WHO recommendations Z- and T-criteria. In women during menopause and men over 50 years using T-test data in accordance with the interpretation of densitometric WHO classification (rate from 2.5 to 1, osteopenia from —1 to —2.5, osteoporosis from —2.5 SD and below).
Results and discussion. In people with diabetes type 2 breach phosphorus-calcium balance may be at different stages of the disease, and many researchers indicate normal or slightly reduced levels of calcium and phosphorus in the blood of patients, which coincides with our data. In the experimental group levels of calcium was 2.13 ± ± 0.03 mmol/l, and phosphorus — 1.05 ± 0.04 mmol/l. In the control group levels of calcium was 2.37 ± 0.03 mmol/l, and phosphorus — 1.28 ± 0.04 mmol/l. The same applies to hydroxyvitamin 25(OH)D, the level of which was in the normal range in both groups. Alkaline phosphates' level in experimental group was 128.70 ± 0.04 IU/l, in the control group — 156.30 ± 0.04 IU/l.
Important role in the regulation of bone formation and osteoreparation pay parathyroid hormone. In the
experimental group was marked higher levels of parathyroid hormone than in the control group, and was 58.08 ± 2.70 pg/ml and 41.55 ± 1.90 pg/ml, respectively.
Nowadays it is admitted that the most informative indicator of bone growth is the level of osteocalcin, which is synthesized by osteoblasts. In patients with type 2 diabetes osteocalcin level was 19.92 ± 0.80 ng/ml, in control group — 32.87 ± 0.90 ng/ml.
In the study of data of densitometry in three locations (lumbar, proximal femur, forearm) reduction in bone mass (T < —1) detected in most patients, with those in the experimental group it was more pronounced than in the control group. In the experimental group prevailed patients with a diagnosis of osteoporosis (T < —2.5) in the control group prevailed patients with osteopenia.
When comparing the densitometric measurements in three standard points were observed that in the experimental group osteopenic syndrome most often seen in the proximal femur (78.9 %), whereas in the control group were most pronounced changes in the lumbar spine (73.9 %).
Conclusion. The severity and duration of type 2 diabetes affect the bone metabolism and cause leakage oste-oreparation in patients with fractures of the trochanteric area of the femur through changes in mineral and hormone balance.
The possibility of less reversible changes in bone tissue on a background of type 2 diabetes poses the need to address the issue of early diagnosis and treatment of abuse of bone metabolism in this group of patients.
SOLYEYKO O., STEPANIUKO., STEPANIUK T., KOROBKO O. Vinnytsia National Medical University named after N.I. Pyrogov, Vinnytsia, Ukraine
The Influence of Sartants on the Gout Course
Introduction. Modern science considers the level of uric acid as a risk factor for cardiovascular pathology. Hyperuricemia is the basis for the gout development. The doubled increase in number of diagnosed gout cases and related complications in the last decade requires finding new aspects of pathogenesis and treatment approaches. Today, the largest percentage of use as antihypertensive agents in the world belongs to sartans group. Special place among numerous of sartans pleiotropic properties belongs to urico-zuric effect of this group of drugs. Multicenter trials that investigated the influence of sartans on the course of arterial hypertension, only stated their influence on the level of uric acid in the blood. But, there is no evidence of sartans influence on the gout course.
Aim. To study the influence of sartans on the gout course.
Materials and methods. During the years of 20132014, we have examined 63 of male patients suffered from gout. Patients were randomized into two groups: the first consisted of patients (30 people) who took convention-
al treatment of gout, the second one (33 people) — those, who took sartans as a part of comprehensive treatment of this disease. The average duration of sartans use for group II of patients was 8.3 ± 0.7 months. Both groups were representative by age, level of uric acid, hyperlipidemia before the treatment, the level of process activity, the number of patients with burdened family heredity. The average age of patients in the first group was 43.4 ± 1.5 years, and group II — 45.6 ± 1.3 years. Uric acid levels before treatment were: 0.53 ± 0.11 mmol/l, 0.54 ± 0.10 mmol/l, respectively, in groups I and II. Hyperlipidemia was determined with 56.6 % of patients in group I and 54.56 % — group II. Process activity of II degree (42.4 and 43.4 %, respectively) was observed in most patients of groups I and II. The percentage of patients with burdened family heredity in group I was 13.3 %, in II — 21.2 %.
Results. Analysis of anamnestic and clinical and instrumental features revealed that the most patients of group I (46.7 %) the beginning of the disease covered live period from 40 to 50 years, the start period of the disease for most patients of group II (45.5 %) covered live time from 50 to 60 years. Group I had big number of patients with disease experience from 5 to 10 years (56.6 %), in group II dominated the percentage of patients with disease experience from 2 to 4 years (54.5 %). Patients were divided under number of injured joints as follows: monoarthritis of traditional localiza-
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Brnb. CyM06u. Xpe6eT, ISSN 2224-1507
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