Osteoporosis is a systemic metabolic disease of the skeleton characterized by low bone strength that results in an increased risk of fracture. Fractures are associated with serious clinical consequences, including pain, disability, loss of independence, and death, as well as high healthcare costs. Early identification and intervention with patients at high risk for fracture is needed to reduce the burden of osteoporotic fractures. The identification of a patient at high risk of fracture should be followed by evaluation for factors contributing to low bone mineral density (BMD) and/or low bone quality, falls, and fractures. Components of the osteological evaluation include an assessment of BMD by dual-energy X-ray absorptiometry, osteoporosis-directed medical history and physical exam, laboratory studies, and possibly skeletal imaging. Disorders other than osteoporosis, requiring other types of treatment, may be found. This overview summarizes the basic procedures for the diagnosis and differential diagnosis of osteoporosis, which are necessary before starting treatment.

• Klíčová slova
• diagnosis, differential diagnosis, fractures, osteoporosis, type 2 diabetes mellitus,
• MeSH
• absorpční fotometrie škodlivé účinky   metody   MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• kostní denzita MeSH
• lidé MeSH
• osteoporotické fraktury * diagnóza   etiologie   MeSH
• osteoporóza * komplikace   diagnóza   MeSH
• rizikové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: The aim of the study was the evaluation of the rs1107946 polymorphism of the COLIA1 gene impact on bone mineral density and fracture risk in Slovak postmenopausal women. METHODS: One hundred and twenty-seven postmenopausal Slovak women with a diagnosis of osteopenia/osteoporosis were genotyped for rs1107946 polymorphism of the COLIA1 gene. Clinical and anthropometric data were obtained. DNA isolation was performed using a standard protocol. Genetic analyses of the rs1107946 polymorphism of the COLIA1 gene were performed by the TaqMan SNP genotyping assays. RESULTS: The study confirmed a statistically significant relationship using an association analysis between the rs1107946 polymorphism of the COLIA1 gene genotypes and body weight of the Slovak postmenopausal women with osteopenia/osteoporosis (p = 0.03). The study revealed a significant association of the risk T allele of the rs1107946 polymorphism of the COLIA1 gene with osteoporotic fractures (p = 0.038). The odds ratio confirmed 2.060 times higher risk of osteoporotic fractures in Slovak postmenopausal women with the presence of risk T allele of the rs1107946 COLIA1 gene polymorphism (OR = 2.060; 95% CI: 1.024-4.144). CONCLUSION: The results of this study revealed an association of T allele of the rs1107946 COLIA1 gene polymorphism with osteoporotic fractures in Slovak postmenopausal women with osteopenia/osteoporosis and suggest that the rs1107946 polymorphism of the COLIA1 gene may be a molecular biomarker usable in the management of osteoporosis.

• Klíčová slova
• COLIA1 gene - rs1107946 polymorphism, fracture risk, osteoporosis, postmenopausal women,
• MeSH
• genotyp MeSH
• kostní denzita genetika   MeSH
• lidé MeSH
• osteoporotické fraktury * komplikace   MeSH
• osteoporóza * komplikace   genetika   MeSH
• polymorfismus genetický MeSH
• postmenopauza MeSH
• postmenopauzální osteoporóza * genetika   komplikace   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Slovenská republika epidemiologie   MeSH

Osteoporotic fractures of the vertebrae and the proximal end of the femur dramatically impair quality of life and increase morbidity and mortality. Although up to 40% of all osteoporotic fractures occur in men, physicians tend to underestimate the osteoporosis in men, and it remains underdiagnosed and undertreated. Though, there is no evidence that current approved osteoporosis medications work any less well in men than in women, insufficient awareness of the risk of fractures, fear of side effects of drugs and other barriers have made management challenging in men at risk for fracture. Our review provides updates on pathophysiology and current options for diagnosis and treatment of male osteoporosis.

• Klíčová slova
• Pathogenesis, fractures, male osteoporosis, management, pathogenesis, type 2 diabetes mellitus,
• MeSH
• kvalita života MeSH
• lidé MeSH
• osteoporotické fraktury * etiologie   prevence a kontrola   MeSH
• osteoporóza * komplikace   diagnóza   terapie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Diabetes mellitus (DM) is currently a pandemic problem, and the number of diabetic patients is constantly increasing. There are known and established diabetic complication but it is also comorbidities associated with DM cannot be forgotten. One of these is osteoporosis and osteoporotic fractures. In diabetic patients, the fractures are usually 2 to 6 times higher. In management of diabetes we should screen also the risk of osteoporosis and fractures. From a diabetic point of view, optimum glycaemic control should be achieved, however, we should take into account the effect of antidiabetic agents on bone. In this summary data on the diagnosis and treatment of osteoporosis in patients with DM as well as on the effect of antidiabetic agents on bone are presented.

• Klíčová slova
• cardiovascular disease, cardiovascular diseases, diabetes mellitus, diagnosis, osteoporosis, treatment,
• MeSH
• diabetes mellitus 2. typu * komplikace   MeSH
• diabetes mellitus * MeSH
• hypoglykemika terapeutické užití   MeSH
• komplikace diabetu * MeSH
• kostní denzita MeSH
• lidé MeSH
• osteoporotické fraktury * etiologie   MeSH
• osteoporóza * komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• hypoglykemika MeSH

BACKGROUND: Low bone mineral density (BMD) and trabecular bone score (TBS) are established risk factors for fractures even in hemodialysis population and they seem to be significantly lower in comparison with general population. The aim of our study was to describe 2-year loss of BMD and TBS and their predictors in hemodialysis patients. METHODS: From 59 non-selected patients (mean age 67.6 ± 13.1 years) from one dialysis centre, treated with hemodiafiltration (HDF), clinical and laboratory characteristics were obtained and densitometry examinations (with BMD and TBS results) were performed initially and at the end of 2-year follow-up. RESULTS: Two-year decrease in BMD of lumbar spine reached 4.1% (ns), of proximal femur 9.1% (p = 0.004), and of femoral neck 1.3% (ns). In the co-educated cohort, BMD decrease in all the sites correlated significantly with age and only the change of BMD of lumbar spine was negatively associated with serum calcium (r = - 0.39; p = 0.04) and dialysis vintage (r = - 0.387; p = 0.062), no other predictors of BMD loss were identified. Some predictors of BMD loss were identified with regard to gender. TBS decrease was 0.05 (3.9%; p = 0.03), and similarly, it was not predicted by any of selected parameters. No differences in BMD changes or TBS were observed between the patients with and without fractures. CONCLUSIONS: In patients with HDF, significant BMD and TBS annual losses were observed, and they were associated only with age and (in BMD of lumbar spine) with serum calcium and dialysis vintage.

• Klíčová slova
• BMD, Follow-up, Hemodialysis, Loss, TBS,
• MeSH
• absorpční fotometrie MeSH
• bederní obratle diagnostické zobrazování   patofyziologie   MeSH
• chronické selhání ledvin komplikace   patofyziologie   terapie   MeSH
• dospělí MeSH
• hemodiafiltrace MeSH
• kostní denzita * MeSH
• krček femuru diagnostické zobrazování   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• osteoporotické fraktury etiologie   MeSH
• osteoporóza komplikace   diagnostické zobrazování   patofyziologie   MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sexuální faktory MeSH
• trabekulární kostní tkáň patofyziologie   MeSH
• vápník krev   MeSH
• věkové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• vápník MeSH

Patients with diabetes mellitus are at an increased risk of bone fractures. Several groups of effective antidiabetic drugs are available, which are very often given in combination. The effects of these medications on bone metabolism and fracture risk must not be neglected. Commonly used antidiabetic drugs might have a positive, neutral or negative impact on skeletal health. Increased risk of fracture has been identified with use of thiazolidinediones, most definitively in women. Also treatment with sulfonylureas can have adverse effects on bone. One consequence of these findings has been greater attention to fracture outcomes in trails of new diabetes medication (incretins and SGLT-2 inhibitors). The effect of insulin on bone is discussed and the risk of fractures in patients using insulin seems to be unrelated to insulin as itself. The aim of the review is to summarize effects of antidiabetic treatment on bone - bone mineral density, fractures and bone turnover markers. The authors also try to recommend a strategy how to treat patients with diabetes mellitus regarding the risk of osteoporotic fractures. In this review the problem of how to treat osteoporosis in patient with diabetes is also discussed.

• MeSH
• diabetes mellitus 2. typu komplikace   farmakoterapie   MeSH
• hypoglykemika škodlivé účinky   MeSH
• inhibitory kostní resorpce terapeutické užití   MeSH
• inkretiny farmakologie   MeSH
• inzulin farmakologie   MeSH
• kosti a kostní tkáň účinky léků   MeSH
• lidé MeSH
• metformin farmakologie   MeSH
• osteoporóza komplikace   diagnóza   farmakoterapie   MeSH
• sulfonylmočovinové sloučeniny škodlivé účinky   MeSH
• thiazolidindiony škodlivé účinky   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• hypoglykemika MeSH
• inhibitory kostní resorpce MeSH
• inkretiny MeSH
• inzulin MeSH
• metformin MeSH
• sulfonylmočovinové sloučeniny MeSH
• thiazolidindiony MeSH

Osteoporosis in chronic diseases is very frequent and pathogenetically varied. It complicates the course of the underlying disease by the occurrence of fractures, which aggravate the quality of life and increase the mortality of patients from the underlying disease. The secondary deterioration of bone quality in chronic diseases, such as diabetes of type 1 and type 2 and/or other endocrine and metabolic disorders, as well as inflammatory diseases, including rheumatoid arthritis - are mostly associated with structural changes to collagen, altered bone turnover, increased cortical porosity and damage to the trabecular and cortical microarchitecture. Mechanisms of development of osteoporosis in some inborn or acquired disorders are discussed.

• MeSH
• celiakie komplikace   genetika   metabolismus   MeSH
• Crohnova nemoc komplikace   genetika   metabolismus   MeSH
• diabetes mellitus genetika   metabolismus   MeSH
• lidé MeSH
• metabolické nemoci komplikace   genetika   metabolismus   MeSH
• osteoporóza komplikace   genetika   metabolismus   MeSH
• remodelace kosti fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

The risk of osteoporotic fracture is determined collectively by bone mineral density, bone mass, architecture and properties of the mineral and organic matrix composite. Changes in these distinct aspects of quality of bone with age, estrogen deficiency, diseases leading to increased risk of fracture and differential mode of action of antiresorptive and bone anabolic treatments have to be considered in clinical therapeutic strategies. In patients at high risk of low impact fracture, sequential therapy switching to antiresorptives after patients have an adequate response to 2 years teriparatide may be the optimal strategy of long term therapy.Key words: aging - bone quality - osteoporosis - prevention - therapy.

• MeSH
• inhibitory kostní resorpce * terapeutické užití   MeSH
• kostní denzita MeSH
• lidé MeSH
• osteoporotické fraktury * etiologie   prevence a kontrola   MeSH
• osteoporóza * komplikace   MeSH
• teriparatid terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• inhibitory kostní resorpce * MeSH
• teriparatid MeSH

UNLABELLED: Despite individual recommendations on osteoporosis management in patients after hip fracture surgery, addressed by orthopedic surgeons to Czech general practitioners, the patients remained undiagnosed and untreated because of provider-level barriers to post-fracture secondary prevention. PURPOSE: The goal of the study was to assess whether an individual recommendation on osteoporosis treatment addressed to a hip fracture patient's GP would lead to better osteoporosis management. METHODS: Two groups of patients who suffered hip fractures and were treated at the Orthopedic Department were evaluated. In 111 patients, general recommendations on osteoporosis treatment and fracture prevention were provided in a discharge report addressed to the GP. In the second group, 96 patients were provided individually with a detailed written set of recommendations on osteoporosis examination, treatment, and fracture prevention, which was also provided in the discharge report. A questionnaire to assess the provided care was mailed to the patients 5.3 ± 1.2 months of discharge. Those patients who did not return the questionnaires were contacted by phone. RESULTS: The questionnaires were received from 44% and 49% of patients from the general and detailed recommendation groups, respectively. Along with the phone call, we were able to contact 78 (70.3%) and 68 (70.8%) patients from the general and detailed recommendation groups, respectively. GPs secured osteoporosis evaluation in 14.6% of the patients. Calcium supplementation and vitamin D supplementation were newly provided in 42.7 and 36.4% of the patients, respectively. Anti-resorptive therapy was newly provided in 8.3% of the patients. No significant differences between the groups were observed in osteoporosis evaluation, calcium and vitamin D supplementation, and anti-osteoporosis treatments. Out of 207 patients, further examination or treatment was requested by 45 patients (21.7%); 75 patients (36.2%) declared no interest in further care. CONCLUSION: Recommendations on osteoporosis management addressed to Czech GPs after surgical fracture management had little effect on treatment. As the anti-osteoporotic preparations can only be prescribed by specialists, the availability of necessary examinations and treatment is limited by the motivation of GPs. Consequently, the implementation of Fracture Liaison Services to help close the care gap may be limited in the absence of participation by Czech GPs.

• Klíčová slova
• Fracture Liaison Services, Hip fracture, Osteoporosis,
• MeSH
• fraktury kyčle prevence a kontrola   chirurgie   MeSH
• kooperační chování MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteoporotické fraktury prevence a kontrola   MeSH
• osteoporóza komplikace   terapie   MeSH
• pooperační období MeSH
• potravní doplňky statistika a číselné údaje   MeSH
• praktické lékařství metody   MeSH
• průzkumy a dotazníky MeSH
• sekundární prevence metody   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Hip fractures are mainly caused by accidental falls and trips, which magnify forces in well-defined areas of the proximal femur. Unfortunately, the same areas are at risk of rapid bone loss with ageing, since they are relatively stress-shielded during walking and sitting. Focal osteoporosis in those areas may contribute to fracture, and targeted 3D measurements might enhance hip fracture prediction. In the FEMCO case-control clinical study, Cortical Bone Mapping (CBM) was applied to clinical computed tomography (CT) scans to define 3D cortical and trabecular bone defects in patients with acute hip fracture compared to controls. Direct measurements of trabecular bone volume were then made in biopsies of target regions removed at operation. METHODS: The sample consisted of CT scans from 313 female and 40 male volunteers (158 with proximal femoral fracture, 145 age-matched controls and 50 fallers without hip fracture). Detailed Cortical Bone Maps (c.5580 measurement points on the unfractured hip) were created before registering each hip to an average femur shape to facilitate statistical parametric mapping (SPM). Areas where cortical and trabecular bone differed from controls were visualised in 3D for location, magnitude and statistical significance. Measures from the novel regions created by the SPM process were then tested for their ability to classify fracture versus control by comparison with traditional CT measures of areal Bone Mineral Density (aBMD). In women we used the surgical classification of fracture location ('femoral neck' or 'trochanteric') to discover whether focal osteoporosis was specific to fracture type. To explore whether the focal areas were osteoporotic by histological criteria, we used micro CT to measure trabecular bone parameters in targeted biopsies taken from the femoral heads of 14 cases. RESULTS: Hip fracture patients had distinct patterns of focal osteoporosis that determined fracture type, and CBM measures classified fracture type better than aBMD parameters. CBM measures however improved only minimally on aBMD for predicting any hip fracture and depended on the inclusion of trabecular bone measures alongside cortical regions. Focal osteoporosis was confirmed on biopsy as reduced sub-cortical trabecular bone volume. CONCLUSION: Using 3D imaging methods and targeted bone biopsy, we discovered focal osteoporosis affecting trabecular and cortical bone of the proximal femur, among men and women with hip fracture.

• Klíčová slova
• Fracture prediction, Hip fracture, Osteoporosis, Pathogenesis,
• MeSH
• biopsie MeSH
• fraktury kyčle etiologie   patologie   MeSH
• kortikální kost patologie   MeSH
• krček femuru patologie   MeSH
• lidé MeSH
• odds ratio MeSH
• osteoporóza komplikace   patologie   MeSH
• plocha pod křivkou MeSH
• ROC křivka MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH