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Osteoporosis is considered as a lifestyle disease with high prevalence in the developed countries. Its appearance with number of related fractures has increasing tendency. In the Czech Republic approximately 7 % of the population is affected, which is 700,000 people, 50,000 osteoporosis fractures a year are documented. Most frequent type of osteoporosis is postmenopausal osteoporosis which is classified in the group of primary osteoporosis similarly as a senile osteoporosis (involutive). Secondary osteoporosis is a line of causal risk factors. Osteoporosis at men is usually part of primary or secondary hypogonadism. Idiopathic juvenile osteoporosis is a rare type of the disease, appearing before the puberty and disappearing in the adulthood. Generally exists a list of osteoporosis risk factors analyzed in this article.Key words: epidemiology - idiopathic osteoporosis - primary osteoporosis - secondary osteoporosis - risk factors.

Long-term estrogen deficiency after menopause is responsible for different disorders, which not only make the quality of life in the older age worse but also are the major causes of womens mortality. It is especially the case for cardiovascular disease and osteoporosis. Aim of this review is to point at efficacy of raloxifene (a selective estrogen receptor modulator) in the long-term care of the women in their non-reproductive period of life, and namely in prevention and treatment of postmenopausal osteoporosis.Key words: bone turnover - breast cancer - postmenopausal osteoporosis - prevention - raloxifene.

All existing recommendations sign hormone replacement therapy (HRT) as first therapy for acute climacteric syndrome. The low dose vaginal therapy is the first choice for prevention and therapy of urogenital atrophy and its complications. Early start of HRT has neutral or slightly beneficial influence on ischaemic heart disease. It is sure that HRT is effective in prevention and therapy of postmenopausal osteoporosis. Long term therapy must be individualized on base of benefits to risks ratio with differences by type of HRT.

The author describes actual and perspective treatment ofosteoporosis. Basic treatment consists in calcium, vitamin D, physical activity, restriction of risk factors and prevention of falls. Actual treatment includes antiresorptive drugs (calcitonin, bisphosphonates, estrogens and SERM) and denosumab. Perspective emerging drugs are also mentioned.

The comparation of two possibilities of bone mineral density measurement--ultrasound and dual energy x-ray absorptiometry.Open nonrandomized observation study.Department of Obstetrics and Gynecology, 1st Faculty of Medicine Charles University and General Faculty Hospital Prague.We examined 190 women with mean age 56 years by both methods--Lunar PIXI (dual energy x-ray absorptiometry) on forearm and CUBA Clinical (broadband ultrasound attenuation) on heel. We took personal history for menopause status, hormone replacement therapy, smoking, sport activity and age.The incidence of T-scores was the same for both methods, there were differences in Z-scores. In both methods we have seen the same tendencies of interaction with risk factors. Bone mineral density (BMD) respective T-score significantly decreased with age. There were no significant connections between BMD and body mass index (lineary regression test), hormone replacement therapy (paired t-test), smoking and physical exercise (Mann-Whitney U test). T-score was significantly (p0.003) lower in women with history of fracture (Mann-Whitney U test).In spite of totally different principles of measurement both methods are able to screen BMD.

Osteoporosis is a disease causing higher bone fragility and bone ruptures occurring even in minimal traumas. Good patient compliance is the prerequisite for long-term efficacy of osteoporosis treatment. Compliance data from randomised clinical studies may not provide reliable information about compliance in clinical practice which is usually lower. CORAL (COmpliance with RALoxifene therapy) is a local, Slovak, non-interventional, open, prospective, uncontrolled and multicentre study of woman patients on raloxifen therapy in current clinical practice. Raloxifen is a selective estrogen receptor modulator (SERM) indicated for the treatment and prevention of postmenopausal osteoporosis.The primary objective of the study was to assess compliance with raloxifen therapy in the conditions of current clinical practice. The secondary objectives were the assessment of the impact of therapy on the quality of life, of treatment satisfaction and treatment safety.A total of 1497 patients with proven postmenopausal osteoporosis were enrolled in the 18-month study performed in 40 centres. Compliance was evaluated on the basis of the number of omissions in the use of the evaluated drug. Treatment satisfaction was evaluated by the patients who used a 0-100 visual analogue scale (VAS). Quality of life was evaluated by means of an EQ-5D quality of life questionnaire. In order to measure treatment safety, all adverse events were recorded by the supervising physician in a dedicated questionnaire at every visit. Statistical methods used: The non-parametrical Mann-Whitney test was used to assess the relation between raloxifen treatment compliance and the selected parametres (quality of life, treatment satisfaction, changes in health condition, premature discontinuation of therapy). The maximum likelihood ratio chi2 test and Fisher's exact test (for 2 x 2 tables) were used to analyse the ratio between compliance and reasons for enrolment in the study. Changes in treatment satisfaction in the course of the study were analysed using the Wilcoxon test. All the used tests were bilateral and data was assessed at a 5 % level of significance.The mean age of the patients enrolled in the study was 63.4 +/- 8.0 years. 58 % of patients were enrolled on the basis ofdensitometric evidence of osteoporosis, 74% of patients were enrolled for proven osteoporosis which had been manifested by a fracture, and osteoporotic fracture as such was the reason to start therapy in 10 % of patients. The majority of patients enrolled in the study (77%) had natural menopause. The mean period from menopause to the study was 15 years. Acceptable cooperation (or =80% of medication used) was recorded for more than 90% of patients during the study, and total dosing adherence was recorded more than 58 % of patients. A significantly higher satisfaction with pharmacotherapy was observed in the patients who adhered to the prescribed dosing schedule. Adherence to the prescribed dosing schedule was also associated with a considerable better health condition and a higher quality of life. In a total of 1,497 evaluated patients, treatment was prematurely discontinued in 87 (5.8 %) women. The attending physician's decision, adverse events or the patient's request were relatively evenly distributed among the reasons for the discontinuation of therapy. Premature discontinuation of therapy was mostly recorded in patients who were not satisfied with the pharmacotherapy of osteoporosis as such, in women who were less satisfied with their overall health condition and who had a lower quality of life.The study showed very good patient compliance with raloxifen. The above findings associate with a significant correlation between the degree of adherence to therapy, treatment satisfaction and the overall health condition and quality of life. Premature discontinuation of therapy was observed in a very low number of women. It can be concluded that raloxifen therapy provides effective treatment of osteoporosis based on long-term cooperation of patients.Effective treatment of postmenopausal osteoporosis with raloxifen is related to excellent cooperation of patients on a long-term basis.

The most common cause of compressive spinal fractures in older women is undoubtedly senile osteoporosis, while less common causes are malignant diseases which metastase into the skeleton and multiple myeloma focally or diffusely infiltrating the skeleton. Targeted biopsy in the hands of an experienced radiologist is the fastest diagnostic method which has the potential to detect the exact cause of the compressive fracture. We describe a case of monoclonal gammopathy in which only a biopsy using CT-guided puncture of the compressed vertebra showed a symptomatic multiple myeloma requiring overall treatment. Up to the time of the targeted biopsy, the patient had wrongly been classified as a case of monoclonal gammopathy of undetermined significance, and later as a case of stage IA asymptomatic multiple myeloma. The aim of the paper is to draw attention to the need for early invasive diagnostic intervention in unclear cases.

Generalised use of statins in primary and secondary prevention of ischemic heart disease has led in recent years to the discovery ofa number of other "pleiotropic" effects ofstatins. One of them is the effect ofstatins on bone metabolism. The objective of the study was to monitor bone density, bone turnover markers and basic biochemical parameters in a group of postmenopausal women at regular intervals for a period of 2 years. The monitoring allowed for an assessment of the effect of statin therapy on those parameters. Statin therapy safety was also monitored. According to expectations, the group receiving active treatment recorded a decrease in the levels of total cholesterol, as well as LDL-cholesterol, and a mild decrease in the level of triacylglycerols. However, no significant difference in bone density in any of the measured regions (NECK, TROCH, SHAFT) was found when the trends in bone density parameters were compared for the two groups, nor there was a significant change in the respective T-scores. There was no significant difference with respect to the markers of bone formation or the markers of bone resorption between the group with active treatment and the control group. The results correspond to inconsistent data from the performed and quoted retrospective and prospective studies.

Apart from other factors, the treatment of osteoporosis is limited by a narrow range of applicable drugs. Ibandronate, forming part of the aminobisphosphonate group, which was launched in clinical practice in 2005, has extended the range of treatment options. It allows for intermittent dosage in 1-month (oral form) or 3-month (intravenous form) intervals, whilst the high efficiency of treatment and good safety profile are preserved. Intermittent dosage significantly improves the adherence of patients to treatment, which has, apart from other advantages, a positive effect on cost efficiency of treatment. In addition, oscillation in bone remodelation in the course of intermittent ibandronate treatment might have a positive effect on the physiology of bone tissue, thus reducing some risks associated with bisphosphonate treatment.

The aim of this article is to justify a need for evaluation of the absolute risk of fractures, to compare efficacy of antiresorptive therapies as indicated by large clinical trials, and to review currently available methods to assess efficacy of therapies in individual patients. It is emphasized that adherence to therapies is influenced not only by the individual bone efficacy and safety of the drug but also by beneficial impacts of the treatment on tissues other than bone.

Stress (insufficient) sacral bone fracture is a seriously painful disease with discussed and disunited therapy. Older women sufferig from osteoporosis create the main group in which this fracture occurs. Clinically, serious pain in sacral area is the most common symptome. This pain may last for a long time when treated conservatively and it can lead to pacient's immobilization with related comorbidity. In 2% of patients, neurological complications can be observed. Authors present summary of published studies and demonstrate an own case treated using percutaneous sacroplasty.

Osteoporosis is a chronic progressive disease, characterized by higher bone resorption than bone mass accumulation. This leads to reduction of the bone mass, to microarchitectural deterioration of the bone tissue and to the increased risk of bone fracture. Osteoporosis affects predominately postmenopausal females, but it is also diagnosed at elderly males. Although osteoporosis is influenced by various environmental factors (mainly by dietary habits and physical activity), analysis of results obtained from studies with different designs (population-, family-, association- studies) confirmed, that risk of osteoporosis development and risk of osteoporotic fractures are significantly influenced by genetic predispositions. The genetic determination of osteoporosis is not yet completely understood. However, it is clear, that although there are mutations in some genes causing rare form of osteoporosis, osteoporosis is a polygenic disease--it is influenced by common variants (polymorphisms) of several different genes. For example genes for vitamin D receptor, estrogen receptor alpha, collagen type I alpha1, transforming growth factor beta-1 and some others are indicated to play a role in genetic determination of osteoporosis. In this review we summarize our recent knowledge about the genetic determination of osteoporosis.

The aim of the study was to review health state in postmenopausal women with long-term hormone replacement therapy and compare it with health state of control group without hormone replacement therapy. We focused on metabolic estrogen-deficiency syndrome and its influence on risk of cardiovascular disease, risk of osteoporosis and memory dysfunction.Epidemiology study.Department of Obstetrics and Gynecology, University Hospital, Hradec Králové.Pursuant to clinic and laboratory investigation we evaluated blood pressure, BMI, lipid profile, blood sugar, CRP and homocysteine in women with EPT, ET and compared the data it with controls. Due to dual X-ray absorptiometry we determined bone mineral density and by the memory quiz we evaluated memory function in examined postmenopausal women.Our results indicate that use of hormone replacement therapy in postmenopausal women may be of benefit in cardiovascular risk factors, especially with better plasma lipid profile, blood sugar, atherogenity index, BMI and diastolic blood pressure. We found protective role of HT on decrease of bone mineral density in lumbal spine. We didn't prove this influence in hip. There is no evidence of HT influence on memory dysfunction, but we found, that culture and social life of older women in East Bohemia region is at low level. We did not register any heart attack, stroke and breast cancer under long-term treatment.Women with hormone replacement therapy have less of cardiovascular risk factors and better status of mineral bone density than women in control group.

Hormone replacement therapy (HRT) is not a homogenous group of pharmacological agents. The dose and the way of application can influence the different effects of pure estrogens, combination of estrogens and gestagens and selective tissue estrogenic activity regulators (STEARs). This should be taken into account when results of clinical trials are applied in practice. Conclusions from observational studies demonstrated a positive effect of HRT in both the primary and secondary prevention of ischaemic heart disease. But all randomised trials (HERS, HERS II, WHI, PHOREA, PHASE, WAVE) failed to prove this positive effect; on the contrary, the cardiovascular risk was increased in the beginning of therapy. The ongoing arm of WHI with estrogens only and the EPAT trial indicate possible positive effects of some HRT regimens. There are no new contraindications to HRT after the new results of clinical trials were published. The new results only underline the necessity of clear indication to HRT and confirm already well known risks: increased incidence of breast cancer with long-term use of HRT, increased risk of tromboembolic disease and stroke. The prevention of ischaemic heart disease was excluded from the possible indications of HRT. Many questions regarding optimal choice in the individual treatment strategies have been raised. HRT in its individualised form remains the first choice therapy for the acute climacteric syndrome, for the prevention and the therapy of urogenital atrophy. HRT is highly effective way of the prevention of osteoporosis and as such can be considered as the second line choice if the calcium and vitamin D represent the first line. Other beneficial long-term effects of HRT cannot be considered as the indication but as a possible positive of the individually long usage.

Evaluation of positive properties and side effects of raloxifene treatment with respect to its potential use as agent to improve women's health and quality of life in postmenopausal years.A review article.Obstetrics and Gynaecology Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague.Estrogen use may protect against osteoporosis and cardiovascular disease, but may increase the risk of breast cancer in long-term treated women and also may increase the risk of irregular uterine bleeding (in combination with gestagen in non-hysterectomized women) in perimenopause and postmenopause. Drugs with tissue-specific estrogenic effects are termed selective estrogen receptor modulators (SERM). Tamoxifen is the first SERM successfully used in the prevention and treatment of breast cancer. Another SERM raloxifene is widely used in the prevention and treatment of postmenopausal osteoporosis, especially in women without climacteric complaints. Therapy with raloxifene increases bone mineral density, lowers serum concentrations of total and low-density lipoprotein cholesterol, and does not stimulate endometrium and breast. Evaluation of another potential positive effects (reducing size of uterine leiomyomas, etc.) warrants further investigation.Raloxifene can be used in postmenopausal women free of climacteric symptoms for the prevention and treatment of postmenopausal osteoporosis with no increased risk of thrombosis and with the advantage of positive side effects during the treatment.

To analyse the influence of the contraceptive treatment on bone mass.Literary review.Department of Gynaecology and Obstetrics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.Informations were collected from full-texts which were taken from database Medline.The lowering of bone turnover under combined oral contraception was shown in all studies. It is favourable for bone mineral density after 30 years when bone loss starts. The positive influence is significantly dependent on the length of treatment. Only gestagen drugs have no positive effect on bone mass. The influence of contraception on mineral density in term of physiological bone density increasing before 20-25 year is not clear. Some of studies informed us about adverse effects of extremely-low dose oral contraception on mineral density in this group.

The aim of this study was to find the prevalence of osteopenia and osteoporosis in postmenopausal diabetic females and its association with the diabetic compensation and angiopathic complications.Bone mineral density was measured in 156 diabetic females, 44 of them had type 1 diabetes mellitus (mean age 53 +/- 8.9 years) and 112 type 2 (mean age 60 +/- 9.2 years). In the lumbar spine and proximal femur the prevalence of osteoporosis varied between 9-11% and 18-20% respectively. The respective prevalence of osteopenia amounted 30-36% and 34-48%. No statistically significant differences were found between type 1 and type 2 diabetes. Any association with diabetic compensation and the diabetic microangiopathic complications was not found. Only in females with osteoporosis the prevalence of cardiovascular heart disease was higher than in those with normal bone mineral density.The prevalence of osteoporosis and osteopenia in postmenopausal diabetic women is similar to those in the common population of the respective age.

Evidence has been accumulated that some phytoestrogens act as protective factors against development of cancer and also cardiovascular diseases. These are phytoestrogens of isoflavone and lignane series, found especially in soy. Beneficial effect of these compounds may be explained by a complexity of their actions at various levels: they interact with estrogen receptors, some of them are inhibitors of the key enzymes responsible in the final effect for cell growth and proliferation, and, due to their chemical nature they are scavengers of free radicals. In the presented work the authors, in collaboration with Finnish partners from the University of Helsinki, developed original immunoassays for determination of main phytoestrogens of isoflavone series--daidzein, genistein, formononoetin, biochanin A, their metabolite equal and lignane enterolactone. The methods are sensitive enough for follow-up of actual levels of phytoestrogens in serum. By using these methods, the levels of phytoestrogens in Czech population have been established. The group of patients suffering from osteoporosis has been investigated, too. Significantly lower levels of isoflavonoids in comparison with sex- and age-matched healthy subject have been found in the patients. The methods have also enabled us to follow up the dynamics of these compounds in the organism, as well as to determine their content in food and its sources. The original detection and quantification of four above mentioned isoflavonoids in beer is an example.

After the initial enthusiasm for fluorides in the treatment of osteoporosis there was a regression after some time and a "campaign" against fluorides. Recently in particular after the introduction of monofluorophosphate instead of NaF there is a revival of the use of fluorides in the treatment of osteoporosis, along with Ca, vitamin D and exercise as the classical combination of four. This can be supplemented by HRT in women, thyrocalcitonin, alendronate and other drugs with individual consideration of the optimal combination of these drugs. Also in future fluorides remain the foremost representative of the group of agents stimulating new formation of bone.

The objective of this study was to evaluate expenditures and efficacy of osteoporosis treatment in the Czech Republic (CZ) (1.38 million women and 0.99 million men55 years of age).Demographic data, incidence of hip fractures and prevalence of osteoporosis and osteopenia in Czech women and men, cost burden to healthcare agencies due to hip fractures and costs of diagnostic procedures, preventive measures and therapies of osteoporosis were obtained from published data and from database of the main health insurance agency (VZP) and the State Institute for Drug Control. The direct costs for treatment of hip fractures in the CZ in 1997 averaged Kc (Czech Crown) 2.5 billion, diagnosis of osteoporosis, Kc 150 million, prevention of osteoporosis using hormone replacement therapy, Kc 66 million, and treatments of osteoporosis which has been applied to less than 5% of osteoporosis patients, 482 million. However, despite the continuously increasing expenditures for treatments of osteoporosis, the incidence of hip fractures doubled in the last 10 years. This is mainly due to increased life expectancy in Czech women and men.The results of this first economic evaluation of diagnosis, treatment and consequences of osteoporosis in the CZ indicate a need for conceptual decisions in both treatment and prevention of osteoporosis.

Long-term estrogen deficiency after menopause is responsible for different disorders, which not only make the quality of life in the older age worse but also are the major causes of women's mortality. It is especially the case for cardiovascular disease, osteoporosis and dementia. The risk for these disorders can significantly be reduced by hormone replacement therapy (HRT). Unfortunately, the mean duration of the postmenopausal administration of HRT is too short to demonstrate its efficacy in preventing the mentioned diseases. In this review the new therapeutic possibilities are discussed, called selective estrogen receptor modulators (SERMs). These structurally heterogeneous compounds interact with estrogen receptors and act as either estrogen-agonists or--antagonists according to the type of organ and physiological context (i.e., dose, target tissue and hormone concentration in the tissue). The evaluation of the effects of these compounds led to the better understanding of both antiestrogens and the whole steroid signaling system. The research of the clinical properties of SERM showed their potential benefit in the long-term care of the women in their non-reproductive period of life and demonstrated the possibility to overcome some drawbacks of HRT.

The decline of the production of several hormones with age has been recently linked to several degenerative processes related to aging including osteoporosis. The aim of our study was to confirm the observations published in 1994 suggesting that postmenopausal women with DHEAS levels below a certain limit have a much higher risk of osteoporosis than those with the levels above this limit. The DHEAS levels were measured by RIA and compared to our own age-adjusted reference ranges. The values lower than 25th quantile were considered "subnormal". More than 500 postmenopausal subjects were included in our study. In those with "subnormal" levels bone mineral density (BMD) was measured on DEXA (Lunar or Hologic). Decreased BMD ranging from osteopenia to severe osteoporosis was found in 86% of 74 women with "subnormal" DHEAS, while the expected frequency in our postmenopausal population may be about 30%. In the following period the serum DHEAS levels were compared with DEXA findings in another 134 postmenopausal women. The DHEAS levels in all stages of decreased BMD were significantly lower than those in the group with normal BMD. The clinical sensitivity and specificity of DHEAS as a marker of increased risk of osteoporosis has been calculated for a cut-off limit of 0.5 MoM. In the light of these findings we believe that the robust and relatively cheap DHEAS determination could help us to identify women who are at higher risk of osteoporosis. Also, in the future, only the women with evidently deficient DHEA production might possibly become candidates for eventual DHEA substitution.

The objective of this study was to evaluate the prevalence of osteoporosis and osteopenia in Czech women and men aged 50 to 75 years.Bone mineral density was assessed in an age-stratified random sample of 713 women and 429 men from two cities (Prague and Litomĕrice) in the lumbar spine, proximal femur and total body by dual X-ray absorptiometry and in the distal forearm by single X-ray absorptiometry. The proportion of women and men in each age group with bone density below specified levels at any of these skeletal sites was projected to the population structure of the Czech Republic. With advancing age, in women at 55 years and in men at 65 years of age the population with normal bone mineral density becomes smaller, and a greater proportion has osteopenia or osteoporosis. Overall, an estimated 428,000 women and 195,000 men over age 50 have osteoporosis and another 680,000 women and 435,000 men have osteopenia.The results of this first population-based cross sectional study in the Czech Republic document a high prevalence of osteoporosis and osteopenia which is comparable with that published for the Netherlands and the United States. The results offer a basis for economical considerations in diagnosis, treatment and consequences of osteoporosis.

Bisphosphonates are chemical substances which are used in medicine for the diagnosis of bone diseases, for the treatment of bone metastases of various tumours and in recent years also for the treatment of osteoporosis, in particular postmenopausal or corticoid induced osteoporosis. The administration of biphosphonates is based on the idea that ideal treatment of an enhanced bone turnover is creation of a greater bone mass by de novo bone formation with concurrent inhibition of bone absorption (possibility of dismantling the remodelling cycle). This idea of the action of biphosphonates is based on the finding that they reduce the absorption activity of osteoclasts or enhance the osteoforming activity of osteoblasts. Biphosphonates thus create a positive balance of the remodelling cycle, i.e. they increase the density of bone mass and reduce the frequency of fractures. In the submitted paper the authors present a summary of results and possible use of these biphosphonate groups which were used in the treatment of involutional or corticoid induced osteoporosis.

Fluorides began to be used in the treatment of osteoporosis in the sixties when it was found that in areas with a high fluoride content of drinking water the prevalence of this disease is low. Fluorides stimulate osteoblasts to form more osteoid, and moreover larger crystals of bone mineral are formed which are more resistant to resorption by osteoclasts. Fluorides must be, however, administered always in combination with calcium and vitamin D. In the eighties a certain group of osteologists started a "campaign" against fluorides and maintained that after fluorides bone is of poor quality and there in a greater risk of fractures. All was explained by the fact that these authors administered fluorides alone in large doses. Recently with the introduction of monofluorophosphate into treatment instead of NaF there was a revival of fluorides which in combination with calcium and vitamin D are among the best stimulators of new formation of bone; after fluorides the bone density improves and they are used also in osteoporosis and preventively to avoid fractures.

The diagnostic significance of biochemical markers of bone remodelling is limited and it should always be evaluated together with results of other methods. Unlike bone densitometry, biochemical markers do not reflect bone mass and cannot be therefore used in diagnosis of osteoporosis. Markers enable for differential diagnostics of metabolic and neoplastic bone diseases and can be used for assessment of activity of bone disease and its monitoring. Different markers reflect aspects of bone remodelling. The sensitivity and specificity of the markers differ according to the type of bone disease and its treatment. The application of markers in monitoring treatment in individual patients requires an acceptable long-term biological variability of the marker (C.V.12%). In postmenopausal osteoporosis, osteocalcin measurements suffice in assessment of activity of the disease and for monitoring treatment. Lack of improvement in the marker can indicate poor compliance of the patient, a diagnostic error or an and-organ resistance to treatment. The biochemical measurement predicts changes in bone mass about one year prior to bone densitometry, thus enabling for decision concerning urgency of therapeutic intervention. In individual patients, however, a single measurement of a biochemical marker cannot be used to predict long-term changes in bone mass. Osteokalcin is cleared from the circulation by kidney and cannot be used to assess bone remodelling in chronic renal failure patients. This is not true with bone-specific alkaline or acid phosphatase isoenzymes. Low serum osteocalcin concentrations have special significance in hypercortisolism. Considering their high cost, the markers should be clinically applied under specified indications and only when standardised.

The objective of this study was to compare effects of 17 beta-estradiol and intranasal salmon calcitonin on bone mass and biochemical markers of bone turnover in postmenopausal women with an accelerated bone loss and osteopenia or osteoporosis.72 women with significantly increased bone resorption were evaluated (urinary hydroxyproline/creatinineor = 21.9 mmol/mol, mean age, 53.7 +/- 6.3 years, time since menopause 6.1 +/- 2.6 years). All patients received daily 500 mg Ca2+ and 400 IU vitamin D supplement. 48 patients with osteopenia and 24 patients with osteoporosis were randomly allocated to treatment with open-label 17 beta-estradiol (50 micrograms transdermally or 2 mg orally) or calcitonin (200 IU every other day). Bone mass was measured by dual-energy x-ray absorptiometry (DPX-L, Lunar, C.V., 1.10 +/- 0.55% and 1.41 +/- 0.55%, lumbar spine and femoral neck, respectively) every six month for 2.5 year, bone stiffness was measured by ultrasound (Achilles, Lunar, C.V., 3.88 +/- 1.95%). Biochemical markers of bone turnover (plasma osteocalcin and tartrate-resistant acid phosphatase, serum bone specific alkaline phosphatase and urinary hydroxyproline) were measured before and after 6, 12 and 24 month of treatment. Patients who received 17 beta-estradiol experienced significant increases (p0.05) in bone mass on the first and second year (by 2.6% and 2.1% at lumbar spine, 1.1% and 1.0%, at femoral neck, and 2.3% and 2% at the heel). A significant positive correlation was found between rates of bone mass change in all sites (p0.001). No statistically significant bone changes were found in calcitonin treated patients. In 17 beta-estradiol treated patients, biochemical markers of bone turnover decreased by 40-50% to the mean values in premenopausal women. In calcitonin treated patients, biochemical markers reached the upper normal limit.Estrogen replacement therapy increases bone mass in lumbar spine as well as in femoral neck. It is efficient for both prevention and treatment of postmenopausal osteoporosis. Salmon calcitonin effectively prevents bone loss. Efficacy of both the treatment can be assessed after 6 months using a biochemical marker of bone resorption and after 2 years using dual-energy x-ray densitometry.

Drug used to treatment osteoporosis can be grouped in two main categories: those that decrease bone resorption and those that increase bone formation. Long-term estrogen therapy as antiresorptive drugs are most effective when bone turnover is increased at time of menopause. Further antiresorptive drugs include oral calcium, calcitonin, bisphosphonates. Drugs that act by increasing bone formation produce an increase in bone mass, these agents are good candidates for the treatment of osteoporosis. Intermittent slow-release sodium fluoride administered for osteoporotic patients inhibits new vertebral fractures, increases the mean spinal bone mass and is safe to use. Calcium supplementation, and vitamin D supplementation have a beneficial effect in retardation of bone loss with very good tolerance. As to new preparations, the most promising ones seem to be drugs, which act on the level of cytokines and growth local factors in bone. In the conclusion authors present therapeutic possibility of postmenopausal women, the most risk group of osteoporotic patients.

In the pharmacotherapy of osteoporosis administration of calcium, small amounts of vitamin D and fluorides still is the basic treatment. Thyrocalcitonin can be also administered, recently also in the form of a nasal spray. It does not only prevent reabsorption of bone but has also an analgetic effect. In the treatment of postmenopausal osteoporosis we use conjugated oestrogens in cyclic preparations with gestagens. Biphosphonates prevent bone resorption but also apposition of the mineral. As to new preparations, Ipriflavone and TGF-beta seem most promising, moreover, there is the perspective of the use of other preparations: small doses of PTH, tamoxifen and raloxifen, promethazine and vitamin K. The author emphasizes the comprehensive character of therapy and the urgent necessity to initiate it early.

The author reviews contemporary drugs and procedures used in the treatment of osteoporosis. Long time known substances such as calcium, vitamin D and fluorides are enlarged by the use of thyrocalcitonin, combined treatment with oestrogens and gestagens in post-climacteric women, biphosphonates, and an essential prerequisite remains burdening of the bones by exercise. As to new preparations, the most promising ones seem to be Ipriflavone and TGF-beta; the use of anabolics is tested again, as well as small doses of parathormone and tamoxifen. In the conclusion the author emphasizes the comprehensive character and prolonged period of treatment of osteoporosis and the necessity of perfect cooperation between patient and physician.

In 25 women with ovariectomy made before the menopause and in a control group of 11 women after the menopause the authors examined laboratory values of the calcium phosphate metabolism and bone density. They repeated the examinations 6 and 12 months after treatment with a combined sequence oestrogen and gestagen preparation--Presomen 0.6 comb. of KaliChemie (Solvay), FRG. After one year of treatment the calcium and phosphate blood levels did not change substantially nor the alkaline phosphatase activity or its bone isoenzyme (although an insignificant increase occurred after six months). On the other hand, the originally elevated calciuria suggesting enhanced resorption of bone mineral, declined in the group of ovariectomized women on average by 3.02 mmol/d, i.e. the women lost by 120 mg less Ca, and the density increased by 6.80%! In a group of postmenopausal women the calciuria declined on average by 2.80 mmol (urinary Ca losses were by 113 mg lower) and the density increased by 4.18%. The results of this investigation support unequivocally not only the benefit but also the necessity of combined hormonal treatment after ovariectomy made before the menopause and provide also evidence of its importance in the prevention of osteoporosis in postmenopausal women.

The author investigated parameters of the calcium phosphate metabolism and level of bone mineralization in 82 women with ovariectomy performed before the natural menopause and compared them with a group of women with ovariectomy after the menopause. In the first group calciuria was significantly elevated and their bone mineralization is highly significantly lower than in women with ovariectomy after the menopause low values were reached that the number of fractures of vertebral bodies or other bones was increased. The values of calciuria and bone mineralization in women ovariectomized after the menopause does not differ essentially from values recorded in women of similar age without ovariectomy. From the investigation ensues that early hormonal prevention is essential in women subjected to ovariectomy before the menopause.

The prevalence of osteoporosis and its complications, in particular fractures of the femur, are rising and at present special attention is devoted to osteoporosis from the scientific, health and socio-economic aspect. The authors deal with factors of civilization which are involved in the aetiopathogenesis of osteoporosis and its complications and which can be influenced by preventive provisions. These factors which are part of the modern lifestyle comprise physical load, nutritional influences, the influence of toxic substances and drugs. As to nutritional factors the authors pay attention to an adequate calcium intake. They deal in detail also with aluminium intoxications. Attention is also drawn to the possible pathogenetic importance of stress and the authors contemplate on the inclusion of osteoporosis among diseases of civilization.

The beneficial effects of combined estrogen-progestin-containing oral contraceptives (OCs) include prevention of pregnancy (less than 1 failure out of 100 regular users); the prevention of ectopic pregnancy; the reduction of preeclampsia (2.4 times lower risk compared with barrier methods); and reduction of pelvic inflammation to about one-half. The effects on menstruation include the reduction of sideropenic anemia (by lowering the incidence and duration of menstruation, OCs reduce the loss of iron to 50% or to as much as 33%); dysmenorrhea by 40% (symptoms receded in 90% of users); and premenstrual syndrome by 30%. OCs exert a favorable effect on menstrual epilepsy; reduce sports-related accidents in the premenstrual and menstrual periods; and reduce intermenstrual bleeding. The protection from cancer includes the lowering of endometrial cancer risk (every 2 years of use reduces the risk by 38%, 12 years of use by 70%, and the beneficial effects last 3-15 years); reduction of the risk of the ovarian cancer (already 3-6 months of use reduces the risk by 30%, and more than 5 years by 50% in women under 50 years of age with a longterm effect of 10 years or more, which drops sharply in women over 60 who are mostly at risk). Among other beneficial effects, they reduce benign mastopathy by 50-75%; reduce the risk of follicular ovarian cysts to 50% and the risk of corpus luteal ovarian cysts to 1/5; and they lessen bone loss which favorably affects osteoporosis. Low-dose OCs minimize the well-known risks of thrombotic and cerebrovascular accidents, myocardial infarction, hypertension, altered carbohydrate metabolism, gallbladder diseases, and liver cancer. A new OC with 30 mcg of ethinyl estradiol was tested with daily doses of 150 mcg of desogestrel. The high density lipoprotein (HDL) either increased or did not change with desogestrel: the HDL2 subfraction that protects from atherosclerosis did not change, and probably the HDL3 raised the HDL level.

The authors examined 33 cases of senile, 18 cases of postmenopausal and 9 cases of medicamentous osteoporosis and assessed serum and red cell zinc content. The mean blood levels of zinc were highest in the group of medicamentous osteoporosis. In all three groups the zinc level was reduced more frequently in serum than in red cells.

In the introduction of the paper the authors explain that it is essential to adopt effective preventive provisions to prevent the loss of osseous tissue in women after the menopause and to prevent osteoporotic fractures. In Bohemia and Moravia during the last 20 years the incidence of these frequently fatal or invalidating fractures of the proximal femur has increased substantially and in view of the ageing of the population it may be assumed that this trend will proceed further. Among possible preventive provisions, in order to eliminate undesirable metabolic side-effects of long-term hormonal substitution treatment, it seems best to administer by the parenteral route natural oestradiol by using the transdermal therapeutic Estraderm TTS system. Its effectiveness in suppressing menopause-induced enhanced bone resorption was tested in 11 women where on average within three months after bilateral ovariectomy increased bone resorption was found. In all women in the course of four months treatment all biochemical indicators of bone remodelling became normal - urinary excretion of hydroxyproline, acid plasma phosphatase activity, serum alkaline phosphatase isoenzyme, and serum osteocalcin. The dynamics of indicators of osteoresorption were similar as in women treated with oral synthetic oestrogen, which may produce, however, serious metabolic side-effects. Substitution treatment with Estraderm improves significantly also other manifestations of the climacteric oestrogen deficiency syndrome. Its safety is further enhanced by combination with progesterone.

The authors investigated in three experiments the blood flow (by retention of 85Sr microparticles), the 85Sr retention and state of mineralization of the tibia in female rats after oophorectomy (OOX). In the first experiment one month after OOX the retention of 85Sr microparticles is increased significantly to 158.6%, as compared with controls, the blood flow is increased insignificantly to 131.3%. In the second experiment the retention of microparticles is increased maximally 4 weeks after OOX to 152.9%, the blood flow after two weeks to 150.0%, as compared with controls; the weight of the ash per unit of bone volume of the tibia is significantly reduced after 8 weeks following OOX--to 90.8%. The two-hour retention of radioactive strontium 85Sr in the third experiment after OOX rises--significantly after 8 weeks to 133.4%. The results of the experiments are consistent with the idea on an increased metabolic activity of osseous tissue in the initial stage of the demineralization process following OOX.