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Primary osteoporosis is a common age-related disease characterized by an imbalance in bone homeostasis, increasing the risk of fractures. Twin and family studies have shown that bone mineral density (BMD) variance is in part genetically determined and osteoporotic fractures have also a heritable component. Over the last years, a series of genome-wide association studies (GWAS) and meta-analysises evidenced several loci associated with BMD at genome-wide significance, clustering within the RANK-RANKL-OPG and WNT signaling pathways but also in the mesenchymal stem cell differentiation or endochondral ossification systems. Some of these BMDassociated loci were also significantly associated with risk of fracture, including 17q21.31 (SOST), 11q13.2 (LRP5), 10q21.1 (DKK1), 1p36.12 (WNT4) and 7q31.31 (WNT16), whereas SNPs in genes of the RANK-RANKLOPG pathway (TNFRSF11A, TNFSF11, TNFRSF11B) were associated with BMD only. These data provide key insights into the pathophysiological mechanisms of the disease and may contribute to the identification of new drug targets for the treatment of osteoporosis, beyond previously available therapy. [ABSTRACT FROM AUTHOR]

The forearm DXA is additional in current practice, except for primary hyperparathyroidism cases. A transversal, observational study was performed between 2010 and 2013, including women in menopause. The excluding criteria were previous anti-osteoporosis drugs or diagnosis of primary hyperparathyroidism. The bone turnover markers were assessed, as well as central DXA of the 4 central sites. The absolute risk of fracture based on Romanian FRAX was calculated. The age at evaluation was 61.25 years. The bone markers were: alkaline phosphatase 60.89 +/- 40.29 U/l, CrossLaps 0.48 +/- 0.25 ng/ml, osteocalcin 18.45 +/- 7.27 ng/ml. The bone mineral density varies with DXA site. The FRAX probability of major fractures for 10 years is higher than for hip (4.11 versus 0.98%). The WHO groups based on minimum T score were: osteoporosis - 18.75%, osteopenia - 37.5% and normal DXA - 43.75%. The forearm DXA identified the diagnosis as well as central DXA groups (the WHO groups) in 100% of cases with osteoporosis; 66.66% of cases with osteopenia, and 100% of cases with DXA normal. The forearm evaluation is useful in cases when central DXA is not availed, under normal values of the parathormon. [ABSTRACT FROM AUTHOR]

Silent disease, less known than in women, osteoporosis in men is an important public health problem which is increasing in significance. The pathogenesis of this entity is extremely heterogeneous. The gold standard for osteoporosis diagnosis is the DXA scan which measure BMD in the spine or hip. Treatment consists both of non-pharmacological (lifestyle factors, calcium and vitamin D supplementation) and pharmacological (most commonly bisphosphonates) approaches. This article analyses the risk factors in the development of osteoporosis in men, the means of diagnosis and treatment of this clinical entity that is often underdiagnosed, undertreated or insufficiently search. [ABSTRACT FROM AUTHOR]

Osteoporosis is a systemic bone disease în which both a reduction în bone mass and an alteration of the normal architecture occur, the combined result being an increased risk of fracture, particularly at the spine, hip and forearm. Primarily affecting postmenopausal women and elderly men, osteoporosis has gained epidemic proportions and with increasing life expectancy în developed countries the incidence of fragility fractures is exceeding that of breast cancer and is coming close to that of cardiovascular diseases. Since the recognition of this disease many treatment options have been found, some of which are currently widely used, with demonstrated effects on reducing the incidence of fractures. Bisphosphonates are currently the most widely used class of drugs worldwide. It has been shown that their antiresorbtive effect is protective against fractures, which exceeds the strict increase în DMO as assessed by DXA. However, the mechanism of action, which involves significant suppression of bone metabolism, given the prolonged duration of treatment, raises concerns about patient safety with such drugs. Increased risk for atypical fractures (subtrochanteric) and dental complications (osteonecrosis of the jaw) are additional arguments that we haven't found yet the ideal drug for the treatment of osteoporosis. Therefore, new therapies for treatment of osteoporosis should bring us closer to this goal. Strontium ranelate's presumtive mechanism of action involves decoupling bone formation from bone resorbtion, with the possibility of net bone accumulation Anabolic therapies, unlike antiresorbtive ones, have the effect of active accumulation of bone mass by stimulating osteoblasts. Teriparatide, the only approved drug în this group, proved to be effective în the prevention of new fractures in high-risk patients. Denosumab, a human monoclonal antibody which inhibits osteoclast activation mediated through RANK-ligand, became first biologic therapy approved for the treatment of osteoporosis. In addition, current research that evaluates the effectiveness of modulators of calcium sensor on stimulation of endogenous pulsatile secretion of PTH, of anti-sclerostin and anti-dikkopf1 antibodies and of integrin antagonists and cathepsin-K inhibitors open up the possibility of new therapeutic approaches. The role of intracellular VEGF in osteoblast differentiation from mesenchymal stem cell to osteoblast is also currently being investigated. [ABSTRACT FROM AUTHOR]

Introduction. Type 2 Diabetes Mellitus (T2DM) induces changes in bone health by increasing the fracture risk but not throughout currently measurable anomalies as Bone Mineral Density (BMD) changes but throughout qualitative disturbances of the cortical bone structure, the glycosylation of bone matrix proteins and consecutive decreased bone turnover markers. Aim. We analyzed the bone parameters in menopausal women with or without T2DM. Material and methods. This is a transversal study in menopausal women (for at least 1 year post-menopause), aged between 40 and 80 years who were not previously treated with anti-resorbtives or hormonal replacement therapy. Body Mass Index (BMI), central DXA, 25-OH vitamin D levels, and bone turnover markers were performed. Results. 310 women were included: group 1 with T2DM - 64p and group 2 (control) without T2DM -- 246p. Mean age and BMI were not statistically significant (SS) different between groups (59 yrs, respectiv 31.42 kg/m2 vs. 30.19 kg/m2 in control group). Fractures percent was 6.25% in group 1 and 9,7% in group 2. Lumbar and femoral neck BMD (higher in diabetics) were not SS different unlike total hip BMD (1.9 g/cm2 vs. 0.95 g/cm2, p=0.01). Mean 25-OH vitamin D was low but similar between the two groups. Bone turnover markers were SS lower in diabetics: osteocalcin 19.29 ng/ml vs. 23.24 ng/mL (p=0.01) and CrossLaps: 0.36 ng/mL vs. 0.48 ng/mL (p=0.04). Conclusions. Based on our observations BMD is higher in menopausal women with diabetes with statistically significant results in hip while the bone turnover markers are statistically significant lower in diabetics. No differences were found in 25-OH vitamin D levels and overall prevalence of fractures was lower in diabetic patients. The relationship between type 2 diabetes mellitus and bone is .complex, many of the observations being provided during the last years but there are still a lot of aspects incompletely known. [ABSTRACT FROM AUTHOR]

We present a transversal study in 306 anti-osteoporotic free medication, postmenopausal women, who were analyzed based on DXA. The 153 patients with osteopenia were statistically significant different from those 103 with normal DXA by following parameters: body mass index, bone formation marker serum osteocalcin, bone resorbtion marker serum CrossLaps. The heel quantitative ultrasound (QUS) analyze by two devices Achilles and Sonost Chrono 3000 revealed differences between the Stiffness index values between osteopenia and each of the other two groups. [ABSTRACT FROM AUTHOR]