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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.

Niska masa kostna byla dotychczas tradycyjnie lączona z cukrzycą typu 1. Ostatnie badania potwierdzily, ze chorzy na cukrzyce typu 2 doznają zlaman niskoenergetycznych cześciej niz osoby zdrowe, tymczasem gestośc masy kostnej jest u nich podwyzszona lub taka sama jak u osob zdrowych. Wydaje sie, ze ocena gestości masy kostnej za pomocą badania densytometrycznego nie oddaje zlozoności patologii tkanki kostnej u chorych na cukrzyce, co wspolcześnie jest przedmiotem wielu badan. Wzrost ryzyka zlamania uwarunkowany jest prawdopodobnie m.in. dlugością trwania choroby, jej wyrownaniem metabolicznym, obecnością powiklan, rodzajem stosowanego leczenia, zwiekszoną podatnością na upadki. Upośledzona jest prawdopodobnie tzw. jakośc kości, co jest efektem nagromadzenia w kości zaawansowanych produktow glikacji, nieprawidlowego usieciowania kolagenu oraz niskiego tempa obrotu kostnego. Wykazano takze, ze u chorych na cukrzyce parametry strukturalne i geometryczne kości są gorsze. W świetle wzrastającego zagrozenia zlamaniami wśrod kobiet po menopauzie wskazana jest kalkulacja ryzyka zlamania takze wśrod starszych chorych z cukrzycą typu 2.

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.

Background Observational studies on osteoporotic fractures in patients with type 2 diabetes indicate their increased incidence compared to those without diabetes, but results are inconsistent. Currently, type 2 diabetes is not considered as an independent risk factor for low-energy fractures in elder subjects. The aim of the study was to assess the association between type 2 diabetes and risk for hip and vertebral fractures in postmenopausal women. Materials and methods We searched Medline, Web of Science and Cochrane databases for articles published before September 2013. Studies assessing fractures in women aged >50 diagnosed with type 2 diabetes, regardless of the diabetes treatment, were deemed eligible. To estimate fracture risk meta-analysis in a random effect model was performed. The results were shown by the odds ratio (OR) and 95 % confidence interval (CI). Heterogeneity was tested using a Q-Cochrane test (significance was analyzed with p

Objectives: Aim of the study was to evaluate general practitioners’ opinions on barriers in the delivery of preventive procedures and ways of solving the problem. 100s of physicians working in Primary Care Practices in Wielkopolska Region (Poland), during a period in 2010, filled questionnaires. Results: The most common barrier was lack of time and inadequate finances identified by 90% and 78% of doctors. Doctors’ or patients’ negative attitude to prevention was noted by 12% and 16% respondents. Insufficient skills and difficulties in updating knowledge were recognized by 9% of the doctors. As a solution 76% respondents pointed at increasing consultation time and 66% - to additional financial incentives. Some of surveyed doctors suggested the need for improvement of the national health programs and increasing their number. Workshops for medical staff were chosen by 48% of questioned doctors. Conclusions: 1. Lack of time is the main barrier in the delivery of preventive procedures in primary care. 2. According to the asked doctors financial incentives would increase the amount of health promotion in primary care.

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.

Introduction: Educational meetings are one of the most frequently used strategies to change doctors' professional behavior; however, their effectiveness as a single intervention is limited. This study evaluated the effect of a multifactorial intervention, based on interactive workshops, on the GPs' knowledge and the delivery rates of preventive procedures in primary care. Material and methods: The study population comprised 106 GPs working in the Wielkopolska region recruited to the PIUPOZ program (Improving Quality in Primary Care). The intervention in the program consisted of lectures, interactive workshops and an audit, before and three months after the training. Trained medical students directly observed GPs to register which of 12 studied preventive procedures were performed during the consultation in patients aged 40+. Results: A total of 1060 consultations were recorded, during which 4899 preventive procedures were delivered: 2115 before and 2784 after workshops. The mean number of preventive procedures per patient before and after workshops was 3.84 and 5.25 respectively (p < 0.0001). The most commonly performed preventive procedures were blood pressure, blood glucose and lipid profile measurement. Mean number of correct answers for 16 questions in the initial knowledge test was 8.7 and 12.7 in the final test (p < 0.0001). Conclusions: The observed number of delivered preventive procedures was below the recommended range. Preventive procedures based on laboratory tests were performed more often than lifestyle counseling.

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.

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.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.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%.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.

Despite known positive association between body mass and bone mineral density (BMD), relative contribution of fat and lean tissue to BMD remains under debate. We aimed at investigating the effect of selected anthropometric parameters, including fat content and lean body mass (LBM) on BMD in postmenopausal, osteoporotic women with body mass index (BMI)20 kg/m(2). The study involved 92 never-treated women (mean age 69.5 ± 7.3). L1-L4 and femoral neck (FN) BMD were measured by dual energy X-ray absorptiometry (DEXA). Absolute (kg) and relative (%) fat and LBM were assessed by means of electric bioimpedance method. We showed both FN and L1-L4 BMD were positively correlated with body mass, waist circumference (WC), hip circumference (HC) and LBM (kg). Fat content correlated with FN BMD (r = 0.36, p0.001). Regression analysis revealed the only predictor of L1-L4 BMD was LBM (R(2) = 0.18, p0.05), for FN--both LBM and fat (R(2) = 0.18, p0.05 and p0.001, respectively). Of the women, 44.5% were overweight, 18.4% obese. Obese women displayed the highest BMD. Both L1-L4 and FN BMD were higher in women with WC80 cm. In postmenopausal osteoporotic women with BMI20 kg/m(2) both fat and lean tissue might contribute to BMD. Positive association between body mass and BMD does not make obesity and osteoporosis mutually exclusive.

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.

Objective Leukocyte migration to the subendothelial space is considered crucial in the initiation of atherosclerosis. There is increasing evidence that overexpression of chemokine receptors contribute to this process. CCR5 is one of the receptors present on peripheral T lymphocytes, monocytes and macrophages. We decided to evaluate the expression of CCR5 on monocytes and macrophages in peripheral blood and selected inflammatory markers in patients with type 2 diabetes mellitus before and after the initiation of insulin therapy. Material and methods A total of 10 patients with newly diagnosed type 2 diabetes and 6 healthy control subjects were studied. Assessment of CCR5 expression on the surface of monocytes and macrophages in peripheral blood was performed using flow cytometry before the initiation of insulin therapy and after 5-week treatment. Serum concentrations of RANTES, TNF-alpha, IL-6 and hsCRP were assessed. Results When compared to control subjects, we observed higher densities of CCR5 on the surface of peripheral blood monocytes and macrophages and higher concentrations of RANTES, TNF-alpha, IL-6 and hsCRP before insulin therapy. After 5-week insulin therapy, there was a significant decrease in the expression of CCR5 on the surface of these cells and a significant fall in serum levels of RANTES, IL-6, TNF-alpha and hsCRP. Conclusions Type 2 diabetes leads to an increase in the inflammatory process, and insulin therapy inhibits the early stages of this process.

Chronic sub-clinical inflammation observed in hypertension plays a prominent role in the progression of atherosclerosis. Accumulating evidence suggests that homocysteine (Hcy) can cause inflammation. The aim of this study was to compare the predictive utility of Hcy and lipid measures as determinants of inflammation in hypertensive patients. We studied a group of 100 patients (45.0+/-12.2 years old) with essential hypertension and a control group of 40 healthy volunteers (44.0+/-8.7 years old). We found that plasma total Hcy (tHcy), tumor necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), and C-reactive protein (CRP) were significantly higher in hypertensive patients compared with the control group. The subgroup of hypertensive patients with obesity had higher levels of TNF-alpha (p

Overexpression of chemokine receptors might contribute to the initiation of atherosclerosis, due to promotion of monocyte migration to the subendothelial space which is considered as an initiating mechanism in the natural history of atherosclerosis. The CCR5 receptor is one of the chemokine receptors present on peripheral T lymphocytes, monocytes and macrophages.The aim of the study was to determine the expression of CCR5 receptor on peripheral blood mononuclear cells (PBMC) in patients with type 2 diabetes.14 patients with type 2 diabetes and 6 healthy subjects as a control were included to the study. We evaluated the density of the CCR5 receptor on peripheral blood mononuclear cells by flow cytometric analysis by use of LSR Cytofluorograf System (Becton Dickinson Co.).There was significantly higher density of the CCR5 receptor on PMBC in diabetic subjects when compared to the controls.(1) Patients with type 2 diabetes present overexpression of the CCR5 receptor on peripheral blood mononuclear cells. (2). Overexpression of the CCR5 receptor should be considered as a factor that promotes the development of atherosclerosis in diabetic patients.

Background: Vertebral fractures often are undiagnosed, while we identify patients with osteoporosis. Their incidences increase with age. Height loss is a frequent manifestation of vertebral fractures and is simple to assess. Vitamin D (VD) has good evidence for fall prevention and reduction of fracture risk. Data are inconclusive for men. The aims of study were: 1. to determine the association between serum 25(OH)D concentration and the degree of height loss, previous fractures and risk of falling in Polish men with osteoporosis and 2. to test the efficacy of vitamin D supplementation in preventing falls. Material and methods: The study group comprised 88 men aged 60–87 years (average age 70 yrs) with BMD T-score at the femoral neck or lumbar spine =4 cm that suggests clinically silent vertebral fractures in 60% of patients. Only 15 incidents were symptomatic, confirmed by Xray. 20 men experienced other clinical low energy fractures at different locations and 21 fell at least 1 time. 29% patients took regularly VD (200–800 IU daily). In 98% men 25(OH)D was =5 cm may be an indicator of vitamin D deficiency in men. 2. Vitamin D deficiency had no relation to previous fractures and falls in men. 3. Daily intake of vitamin D

Graves' (GD) hyperthyroidism leads to reduced bone mineral density (BMD) accompanied by accelerated bone turnover. Ample studies have identified association between estrogen receptor (ESR1) gene polymorphism and decreased BMD and osteoporosis. In contrast, number of publications that link ESR1, BMD and Graves' disease is limited. The purpose of this study was to identify the association between ESR1 polymorphisms and BMD in premenopausal women with GD and to determine whether ESR1 polymorphic variants can predispose to GD. The study included 75 women aged 23-46 years with GD and 163 healthy controls. BMD was measured at lumbar spine and femoral neck. We investigated two SNPs in the ESR1 gene and analyzed genetic variants in the form of haplotypes reconstructed by statistical method. Three out of four possible haplotypes of the PvuII and XbaI restriction fragment length polymorphisms were found in GD patients: px (55.3 %), PX (33.3 %) and Px (11.4 %). Women homozygous for xx of XbaI and for pp of PvuII had the lowest BMD at lumbar spine. Moreover, the px haplotype predisposed to reduced lumbar BMD. No associations were observed for femoral neck BMD. No statistically significant relationship were found between ESR1 polymorphisms or their haplotypes and GD. These results indicate that the PvuII and the XbaI polymorphisms of ESR1 gene are associated with bone mineral density in premenopausal women with GD and may help to estimate the risk of bone loss particularly at lumbar spine. However, none of the ESR1 gene alleles predict the risk of GD in Polish female patients.