The review discusses the possibility of discontinuation of bisphosphonates (BPs), based on the mechanism of action of the drugs, the duration of their antiresorptive activity, criteria for discontinuation and return to therapy. BPs have a unique feature – maintaining the clinical effect for a long time after their withdrawal. Since BPs therapy is carried out for a long time, their accumulation in bone tissue, on the one hand, and the risk of developing severe adverse events, on the other hand, gave rise to discussion on the concept of temporary withdrawal of drugs and the organization of «drug holidays». The main criteria that are relied upon in the question of discontinuation of BPs and re-prescription at present are: 1) the risk of developing new fractures, 2) changes in bone mineral density (BMD), 3) dynamics of markers of bone metabolism. The conducted studies suggest that the suspension of treatment after 3-5 years of continuous therapy with BPs is possible in women who do not have low BMD indicators at the end of the course of therapy, while with continuing low levels of BMD, additional benefits from continuing therapy are likely. The loss of bone mass in the proximal femur and its preservation in the spine 2 years after discontinuation of BPs treatment is explained by their different localization and longer-term effect on bone metabolism in the spongy bone, i.e. in the spine. Delivery and absorption of BPs in the spine may be more intense than in other parts of the skeleton. Tracking the level of markers during a break in the treatment of BPs can be useful to determine the time of resumption of therapy: if their concentration approaches the baseline (before treatment), the patient’s condition should be reassessed and the issue of resuming therapy should be discussed. It should be noted that the optimal duration of «drug holidays» has not been established and should be selected individually depending on clinical circumstances, taking into account the presence of fractures, a significant decrease in BMD or an increase in markers of bone metabolism, as well as the presence and/or appearance of new clinically significant risk factors.
{"title":"Results of bisphosphonate withdrawal: duration of antiresorptive activity, fractures, changes in BMD and bone turnover markers","authors":"K. Belova, O. Ershova, I. Skripnikova","doi":"10.14341/osteo13145","DOIUrl":"https://doi.org/10.14341/osteo13145","url":null,"abstract":"The review discusses the possibility of discontinuation of bisphosphonates (BPs), based on the mechanism of action of the drugs, the duration of their antiresorptive activity, criteria for discontinuation and return to therapy. BPs have a unique feature – maintaining the clinical effect for a long time after their withdrawal. Since BPs therapy is carried out for a long time, their accumulation in bone tissue, on the one hand, and the risk of developing severe adverse events, on the other hand, gave rise to discussion on the concept of temporary withdrawal of drugs and the organization of «drug holidays». The main criteria that are relied upon in the question of discontinuation of BPs and re-prescription at present are: 1) the risk of developing new fractures, 2) changes in bone mineral density (BMD), 3) dynamics of markers of bone metabolism. The conducted studies suggest that the suspension of treatment after 3-5 years of continuous therapy with BPs is possible in women who do not have low BMD indicators at the end of the course of therapy, while with continuing low levels of BMD, additional benefits from continuing therapy are likely. The loss of bone mass in the proximal femur and its preservation in the spine 2 years after discontinuation of BPs treatment is explained by their different localization and longer-term effect on bone metabolism in the spongy bone, i.e. in the spine. Delivery and absorption of BPs in the spine may be more intense than in other parts of the skeleton. Tracking the level of markers during a break in the treatment of BPs can be useful to determine the time of resumption of therapy: if their concentration approaches the baseline (before treatment), the patient’s condition should be reassessed and the issue of resuming therapy should be discussed. It should be noted that the optimal duration of «drug holidays» has not been established and should be selected individually depending on clinical circumstances, taking into account the presence of fractures, a significant decrease in BMD or an increase in markers of bone metabolism, as well as the presence and/or appearance of new clinically significant risk factors.","PeriodicalId":19700,"journal":{"name":"Osteoporosis and Bone Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140234986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bisphosphonates are the main class of drugs for treatment osteoporosis (OP) and other diseases with increased bone resorption, as bisphosphonates are very effective in reducing risk of fracture. The problem of maintaining the effectiveness and possible loss of effect of bisphosphonates, as well as their safety during long-term use, remains actual Long-them therapy with bisphosphonates and it’s effects has been discussed over the past 20 years, as the risk of osteoporotic fracture may stay hight in patients with presence of irreducible risk factors (continous use of glucocorticoids etc.) despite ongoing antiosteoporotic therapy. Real clinical practice demonstrates very low patient adherence to treatment with bisphosphonates. However, observational studies have showed that treatment with bisphosphonates for more than 10 years without initiating a drug holiday can be effective for patients at high risk of fracture. Moreover, the longer therapy with bisphosphonates is continued and the later the“drug holiday”is initiated, the lower the risks of fractures of the proximal femur and clinical vertebral fractures. However, the duration of continuous bisphosphonate therapy for each patient remains at the decision of the physician and is determined individually in each case, based on the risk-benefit ratio, taking into account the patient’s risk factors for fractures and comorbid diseases.
{"title":"Long-term treatment with bisphosphonates in clinical practice: advantages, main problems and risks","authors":"S. U. Shkireeva, O. M. Lesnyak","doi":"10.14341/osteo13157","DOIUrl":"https://doi.org/10.14341/osteo13157","url":null,"abstract":"Bisphosphonates are the main class of drugs for treatment osteoporosis (OP) and other diseases with increased bone resorption, as bisphosphonates are very effective in reducing risk of fracture. The problem of maintaining the effectiveness and possible loss of effect of bisphosphonates, as well as their safety during long-term use, remains actual Long-them therapy with bisphosphonates and it’s effects has been discussed over the past 20 years, as the risk of osteoporotic fracture may stay hight in patients with presence of irreducible risk factors (continous use of glucocorticoids etc.) despite ongoing antiosteoporotic therapy. Real clinical practice demonstrates very low patient adherence to treatment with bisphosphonates. However, observational studies have showed that treatment with bisphosphonates for more than 10 years without initiating a drug holiday can be effective for patients at high risk of fracture. Moreover, the longer therapy with bisphosphonates is continued and the later the“drug holiday”is initiated, the lower the risks of fractures of the proximal femur and clinical vertebral fractures. However, the duration of continuous bisphosphonate therapy for each patient remains at the decision of the physician and is determined individually in each case, based on the risk-benefit ratio, taking into account the patient’s risk factors for fractures and comorbid diseases.","PeriodicalId":19700,"journal":{"name":"Osteoporosis and Bone Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Parathyroid hormone (PTH) plays a key role in the regulation of calcium-phosphate metabolism. The secretion of PTH is regulated by calcium-sensing receptor (CaSR), which primarily expressed in the parathyroid glands and the renal tubules of the kidney. Increase of calcium concentration in extracellular matrix of cells is causing activation of the CaSR. Activated CaSR inhibits secretion of PTH and increases urinary calcium excretion. All CaSR effects leads to prevent development of hypercalcemia complications. Downregulation of the CASR expression and/or altered CaSR functioning leads to dysregulation of PTH synthesis. It may be the underlying cause of the development of primary and secondary hyperparathyroidism, as well as a number of hereditary diseases associated with loss- and gain-of-function mutations of the CaSR. In this paper we discusses the function of the CaSR in physiology and also the potential mechanisms that can impaired CaSR-induced signaling in various calcitropic diseases.
{"title":"The role of the calcium-sensing receptor in the regulation of parathyroid hormone secretion in physiology and in calcitropic diseases","authors":"D. A. Marmalyuk, G. Runova, V. V. Fadeyev","doi":"10.14341/osteo13142","DOIUrl":"https://doi.org/10.14341/osteo13142","url":null,"abstract":"Parathyroid hormone (PTH) plays a key role in the regulation of calcium-phosphate metabolism. The secretion of PTH is regulated by calcium-sensing receptor (CaSR), which primarily expressed in the parathyroid glands and the renal tubules of the kidney. Increase of calcium concentration in extracellular matrix of cells is causing activation of the CaSR. Activated CaSR inhibits secretion of PTH and increases urinary calcium excretion. All CaSR effects leads to prevent development of hypercalcemia complications. Downregulation of the CASR expression and/or altered CaSR functioning leads to dysregulation of PTH synthesis. It may be the underlying cause of the development of primary and secondary hyperparathyroidism, as well as a number of hereditary diseases associated with loss- and gain-of-function mutations of the CaSR. In this paper we discusses the function of the CaSR in physiology and also the potential mechanisms that can impaired CaSR-induced signaling in various calcitropic diseases.","PeriodicalId":19700,"journal":{"name":"Osteoporosis and Bone Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osteoporosis (OP) is one of the common chronic diseases in the elderly, which requires long–term therapy. Bisphosphonates (BP) belong to the first-line choice medications for the treatment of OP, however, prolonged period of bisphosphonates use has been associated with increased risk of atypical femoral fractures (AFFs), medication-related osteonecrosis of the jaw (MRONJ) and the impact on fracture healing, which attracts increased attention to the current widespread use of them.The article presents the existing classes of BP according to their chemical structure and mechanism of action, differences in their antiresorptive potencies. The data of studies on animal models on the effect of BP on the mechanical properties of bone, fracture repair, as well as the development of MRONJ are presented.
骨质疏松症（OP）是老年人常见的慢性疾病之一，需要长期治疗。双膦酸盐（BP）属于治疗骨质疏松症的一线首选药物，然而，长期使用双膦酸盐与非典型股骨骨折（AFF）、药物性颌骨坏死（MRONJ）风险增加以及对骨折愈合的影响有关，这引起了人们对目前广泛使用双膦酸盐的更多关注。文章介绍了关于 BP 对骨骼机械性能、骨折修复以及 MRONJ 发展的影响的动物模型研究数据。
{"title":"Current vision on mechanism of action of bisphosphonates. The effect of long-term administration of bisphosphonates on bone tissue (preclinical studies)","authors":"N. Toroptsova, I. A. Baranova","doi":"10.14341/osteo13147","DOIUrl":"https://doi.org/10.14341/osteo13147","url":null,"abstract":"Osteoporosis (OP) is one of the common chronic diseases in the elderly, which requires long–term therapy. Bisphosphonates (BP) belong to the first-line choice medications for the treatment of OP, however, prolonged period of bisphosphonates use has been associated with increased risk of atypical femoral fractures (AFFs), medication-related osteonecrosis of the jaw (MRONJ) and the impact on fracture healing, which attracts increased attention to the current widespread use of them.The article presents the existing classes of BP according to their chemical structure and mechanism of action, differences in their antiresorptive potencies. The data of studies on animal models on the effect of BP on the mechanical properties of bone, fracture repair, as well as the development of MRONJ are presented.","PeriodicalId":19700,"journal":{"name":"Osteoporosis and Bone Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Runova, E. Pesheva, A. A. Vastistova, L. Rozhinskaya, I. Poluboyarinova, M. P. Vasilevskaya, O. Gurova, V. Fadeev
One of the rare causes of PTH-independent hypercalcemia can be anabolic oil solution, injected intramuscularly by bodybuilders, along with anabolic hormones, in order to make the muscles more prominent. Here is the clinical report of a 43-year-old patient who used Synthol oil solution at the age of 25–30 years is presented. He had long-term undiagnosed hypercalcemia that manifested with nephrolithiasis and progressing chronic kidney disease (CKD). For the first time hypercalcemia was diagnosed at the age of 37, but left omitted. In 2023 (43 years) the laboratory findings sowed extremely high calcium level (4.26 mmol/l) with decreased PTH and CKD C4. Malignancy hypercalcemia was excluded. With this case, the rare cause of hypercalcemia has been proven – intramuscular oil injection resulting in nephrolithiasis, nephrocalcinosis and CKD. Treatment with glucocorticoids has demonstrated positive effect, similar to the ones of granulomatous diseases and hypercalcemia. The mechanisms of PTH-independent hypercalcemia development and differential diagnosis are currently being discussed. The presented clinical case of a rare cause of hypercalcemia may be useful for doctors of various specialties: endocrinologists, therapists, urologists, dermatologists, etc.
{"title":"Hypercalcemia with the development of chronic kidney disease, nephrolithiasis after intramuscular injection of oil solutions","authors":"G. Runova, E. Pesheva, A. A. Vastistova, L. Rozhinskaya, I. Poluboyarinova, M. P. Vasilevskaya, O. Gurova, V. Fadeev","doi":"10.14341/osteo13141","DOIUrl":"https://doi.org/10.14341/osteo13141","url":null,"abstract":"One of the rare causes of PTH-independent hypercalcemia can be anabolic oil solution, injected intramuscularly by bodybuilders, along with anabolic hormones, in order to make the muscles more prominent. Here is the clinical report of a 43-year-old patient who used Synthol oil solution at the age of 25–30 years is presented. He had long-term undiagnosed hypercalcemia that manifested with nephrolithiasis and progressing chronic kidney disease (CKD). For the first time hypercalcemia was diagnosed at the age of 37, but left omitted. In 2023 (43 years) the laboratory findings sowed extremely high calcium level (4.26 mmol/l) with decreased PTH and CKD C4. Malignancy hypercalcemia was excluded. With this case, the rare cause of hypercalcemia has been proven – intramuscular oil injection resulting in nephrolithiasis, nephrocalcinosis and CKD. Treatment with glucocorticoids has demonstrated positive effect, similar to the ones of granulomatous diseases and hypercalcemia. The mechanisms of PTH-independent hypercalcemia development and differential diagnosis are currently being discussed. The presented clinical case of a rare cause of hypercalcemia may be useful for doctors of various specialties: endocrinologists, therapists, urologists, dermatologists, etc.","PeriodicalId":19700,"journal":{"name":"Osteoporosis and Bone Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Z. Nurlygaianov, T. Minasov, D. R. Nurlygaianova
Ankle fractures are common in older people. However, their association with osteoporosis remains controversial. This systematic review aims to determine the relationship between ankle fracture and bone mineral density (BMD). The article presents an overview of articles that have statistical data on the relationship of bone mineral density with the frequency of ankle fractures in the elderly. The aim of the review is to define ankle fracture associations in the geriatric population. Search was performed in PubMed, Medline, Scopus publications for articles in which a study of elderly patients with ankle fractures was conducted with an assessment of bone mineral density, followed by statistical processing with the presentation of the results. Ankle fractures in the geriatric population are due to generalized bone loss and changes in trabecular bone microarchitectonics, fragility, and therefore should be considered osteoporotic fractures, regardless of BMD. Correlation relationships were established with female sex, overweight, type 2 diabetes mellitus, arterial hypertension, which are characterized by a decrease in the trabecular structure. The FRAX fracture algorithm underestimates the likelihood of fractures in geriatric patients who have a high BMI and comorbid physical pathology, so it is necessary to focus on independent clinical risk factors for BMD in order to optimize fracture prevention.
{"title":"Association of osteoporosis with ankle fractures in the geriatric population","authors":"R. Z. Nurlygaianov, T. Minasov, D. R. Nurlygaianova","doi":"10.14341/osteo13129","DOIUrl":"https://doi.org/10.14341/osteo13129","url":null,"abstract":"Ankle fractures are common in older people. However, their association with osteoporosis remains controversial. This systematic review aims to determine the relationship between ankle fracture and bone mineral density (BMD). The article presents an overview of articles that have statistical data on the relationship of bone mineral density with the frequency of ankle fractures in the elderly. The aim of the review is to define ankle fracture associations in the geriatric population. Search was performed in PubMed, Medline, Scopus publications for articles in which a study of elderly patients with ankle fractures was conducted with an assessment of bone mineral density, followed by statistical processing with the presentation of the results. Ankle fractures in the geriatric population are due to generalized bone loss and changes in trabecular bone microarchitectonics, fragility, and therefore should be considered osteoporotic fractures, regardless of BMD. Correlation relationships were established with female sex, overweight, type 2 diabetes mellitus, arterial hypertension, which are characterized by a decrease in the trabecular structure. The FRAX fracture algorithm underestimates the likelihood of fractures in geriatric patients who have a high BMI and comorbid physical pathology, so it is necessary to focus on independent clinical risk factors for BMD in order to optimize fracture prevention.","PeriodicalId":19700,"journal":{"name":"Osteoporosis and Bone Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139274114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. M. Frolova, O. Golounina, E. Mamedova, E. E. Litvinova, Zhanna Evgen'evna Belaya
Pachydermoperiostosis (primary hypertrophic osteoarthropathy) is an orphan disease, the main clinical manifestations of which include pin-shaped deformity of the fingers according to the type of «drumsticks», periostosis (non-inflammatory changes of the periosteum) of tubular bones, pachydermia of the face (hypertrophy and hyperplasia of all skin layers). Two genes associated with the development of pachydermoperiostosis are known — HPGD and SLCO2A1. Mutations in these genes lead to impaired prostaglandin E2 metabolism. This article describes a clinical case of a patient with pachydermoperiostosis, in which two mutations in the HPGD gene were detected during a molecular genetic study: in 1 exon (chr4-174522451-T-A, NM_000860.6:c.1A>T) and in 2 exon (chr4-174521985-AG-, NM_000860.6:c.175_176del) in compound-heterozygous state, while the c.1A>T mutation was previously described once, and the revealed biallelic combination of mutations in the HPGD gene was not previously found in the literature. This clinical case of pachydermoperiostosis is the second described in the Russian population, and the first with confirmed mutations in the HPGD gene. The article expands the knowledge about the correlation of genotype and phenotype in pachydermoperiostosis, which contributes to a faster and more correct interpretation of genetic information during genetic counseling.
{"title":"Features of the clinical course of pachydermoperiostosis with a verified mutation in the European type gene","authors":"T. M. Frolova, O. Golounina, E. Mamedova, E. E. Litvinova, Zhanna Evgen'evna Belaya","doi":"10.14341/osteo13136","DOIUrl":"https://doi.org/10.14341/osteo13136","url":null,"abstract":"Pachydermoperiostosis (primary hypertrophic osteoarthropathy) is an orphan disease, the main clinical manifestations of which include pin-shaped deformity of the fingers according to the type of «drumsticks», periostosis (non-inflammatory changes of the periosteum) of tubular bones, pachydermia of the face (hypertrophy and hyperplasia of all skin layers). Two genes associated with the development of pachydermoperiostosis are known — HPGD and SLCO2A1. Mutations in these genes lead to impaired prostaglandin E2 metabolism. This article describes a clinical case of a patient with pachydermoperiostosis, in which two mutations in the HPGD gene were detected during a molecular genetic study: in 1 exon (chr4-174522451-T-A, NM_000860.6:c.1A>T) and in 2 exon (chr4-174521985-AG-, NM_000860.6:c.175_176del) in compound-heterozygous state, while the c.1A>T mutation was previously described once, and the revealed biallelic combination of mutations in the HPGD gene was not previously found in the literature. This clinical case of pachydermoperiostosis is the second described in the Russian population, and the first with confirmed mutations in the HPGD gene. The article expands the knowledge about the correlation of genotype and phenotype in pachydermoperiostosis, which contributes to a faster and more correct interpretation of genetic information during genetic counseling.","PeriodicalId":19700,"journal":{"name":"Osteoporosis and Bone Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139274808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A female patient with early surgical menopause and severe S-shaped scoliosis was diagnosed with osteoporosis at the place of residence and treated with a bisphosphonate (zoledronic acid). Despite the deformity of the spine and chest, the patient had no complaints until recently and led an active lifestyle. During X-ray densitometry at the National Medical Research Center for Therapy and Preventive Medicine, in particular when examining the lumbar spine, there were difficulties with positioning the patient for correct scanning of the area of interest and, as a result, obtaining information about the true state of trabecular bone tissue. Bone mineral density (BMD) in the proximal femur was consistent with osteopenia. Additional laboratory and instrumental parameters, such as biochemical markers of bone remodelling (osteocalcin and C-terminal type 1 collagen telopeptide) and trabecular bone score (TBS), also did not allow to precise the risk of fractures and make an unambiguous conclusion about the necessity of continuing antiresorptive therapy. Given the low BMD values in lumbar spine (T-score -4.8 SD) and the possibility of developing vertebral compression fractures as a result of minimal trauma with further chest deformity progression and vital organs failure, it was decided to continue treatment with zoledronic acid. Further therapeutic tactics will be determined after the next scheduled examination in 1 year.
一名女性患者因手术导致更年期提前和严重的 S 型脊柱侧弯，在居住地被诊断为骨质疏松症，并接受了双膦酸盐（唑来膦酸）治疗。尽管脊柱和胸部出现畸形，但患者直到最近才出现不适症状，而且生活方式也很活跃。在国家治疗和预防医学研究中心进行 X 射线骨密度测量时，尤其是在检查腰椎时，很难对患者进行定位，以正确扫描感兴趣的区域，因此也很难获得有关骨小梁组织真实状况的信息。股骨近端的骨矿物质密度（BMD）与骨质疏松症相符。其他实验室和仪器参数，如骨重塑的生化标志物（骨钙素和 C 端 1 型胶原端肽）和骨小梁评分（TBS），也无法精确判断骨折风险，也无法就是否有必要继续进行抗骨吸收治疗得出明确结论。考虑到腰椎的 BMD 值较低（T-score -4.8 SD），以及因轻微外伤导致椎体压缩性骨折的可能性，加上胸部畸形进一步发展和重要器官功能衰竭，决定继续使用唑来膦酸治疗。进一步的治疗策略将在一年后的下一次定期检查后决定。
We would like to present a clinical case of severe primary hyperparathyroidism due to a parathyroid carcinoma of atypical location in a patient with chronic kidney disease of complex etiology and multinodular goiter. Patient S., 59 years old, was followed-up for a long time in tertiary referral hospitals for “chronic tubulointerstitial nephritis with nephrosclerosis”, secondary hyperparathyroidism due to chronic kidney disease (CKD) G3–4, osteoporosis, and a multinodular euthyroid colloid goiter. In July 2021 she was referred to the Endocrinology Research Centre in order to clarify the diagnosis because of the persistence of an extremely high level of parathyroid hormone (PTH) despite cinacalcet treatment. During examination, primary hyperparathyroidism, a left parathyroid gland lesion, multinodular goiter with subclinical thyrotoxicosis, and vitamin D deficiency were diagnosed. After the removal of the left parathyroid gland lesion (histologically confirmed parathyroid carcinoma) and a left-sided hemithyroidectomy, hypocalcemia («hungry bone syndrome») developed, but the level of parathyroid hormone remained elevated. After 3–18 months after surgery, no data for relapse of primary hyperparathyroidism was obtained. The persistent moderate increase in PTH was regarded as secondary hyperparathyroidism in CKD and hypocalcemia. Complex therapy of osteoporosis with the antiresorptive drug denosumab, vitamin D and its active metabolite, calcium preparations, and parathyroidectomy led to a significant increase in bone mineral density (BMD) and no repeated fractures 18 months after surgery.Conclusion. In patients with pre-dialysis CKD and high PTH levels, it is necessary to make a differential diagnosis between primary (PHPT) and secondary hyperparathyroidism (SHPT). Severe manifestations of primary hyperparathyroidism can be suspicious for parathyroid carcinoma.
{"title":"Всероссийская научно-практическая конференция с международным участием «Дни остеопороза в Санкт-Петербурге», 16–17 марта 2023 года, Санкт-Петербург. Сборник тезисов","authors":"Article Editorial","doi":"10.14341/osteo2023261s","DOIUrl":"https://doi.org/10.14341/osteo2023261s","url":null,"abstract":"<jats:p>.</jats:p>","PeriodicalId":19700,"journal":{"name":"Osteoporosis and Bone Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84448688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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