The interest of biochemical markers of bone turnover for monitoring treatment of postmenopausal osteoporosis

BACKGROUND: Postmenopausal osteoporosis is especially female pathology, whose incidence increases with age. AIM: The purposes of this study are to evaluate the level of bone turnover by the determination of markers of bone formation (PAL, BAP) and marker of bone resorption (CTX) in the osteoporotic women, to study the correlations between bone biochemical markers, clinical parameters and radiological measurements and to assess the interest of biochemical markers therapeutic monitoring after 6 months of antiresorptive treatment. METHODS: The authors report a prospective study of 134 osteoporotic women classified in two groups according to the presence of osteoporotic fracture. Patients of the first group G1 (n=102) with fractures, were treated by the bisphosphonates (risedronate), whereas the ones of the second group G2 (n=32) without fractures, were submited to calcic supplementation and vitamin D. RESULTS: The analyses showed that the femoral and lumbar BMD were statistically lower in the presence of osteoporotic fractures. However, the values of CTX were statistically higher in the patients of G1 group compared to those of the G2 group (0,708 +/- 0,332 ng/ml versus 0,514 +/- 0,225 ng/ml). The CTX were statistically correlated with the femoral and lumbar BMD (r = -0,21, p<0,05 and r= -0,348, p<0,001). The hypovitminosis were observed in 50,98% (52/102) of women with ostéoporotic fractures, whereas it was only 25% (8/32) in women without fractures. After 6 months of treatment by the bisphosphonates, the PAL, the BAP and the CTX have decreased with an average of, respectively, 19%, 46,5% and 62,9%. These variations were significantly more important in G1 group. CONCLUSION: The biochemical markers of bone turnover, in particular those of the resorption (CTX), can predict the postmenopausal woman's bone loss evaluated by BMD, the risk of fractures and the efficiency of the bone treatments.     

Idiopathic pulmonary hemosiderosis in adults

Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of diffuse alveolar hemorrhage characterized by abnormal deposition of hemosiderin iron in the macrophages of alveoli. Most cases occur in children. In adults, IPH is rare: almost 10 cases reported during the late 10 years. We report the case of a 20-year-old-girl with IPH. There was no evidence of pulmonary vasculitis or capillaritis. Long-term treatment with systemic corticosteroids was followed by clinical remission lasting 4 years.     

Gastrointestinal stromal tumors. A study of 5 cases

GI stromal tumors are mesenchymatal tumors arising primarily from the digestive tract or from the omentum. Despite their rarity (less than 1% of digestive tumors). These tumors have become of current interest since the discovery of a treatment for metastatic and locally advanced tumors, the imatinib (Glivec). In this study we report 5 cases of stromal tumors. Patients were 42 years old an average. Abdominal mass was the revealing signal in 80% of cases, localisation- was obtained by endoscopy and ultrasonography in 60% cases. Total resection of the tumor was performed in all patients. Immuno-histochemical examination confirmed the diagnosis of stromal tumors. Based on these cases and on a review of literature, we insist on the diagnostic difficulties of this rare pathology, while trying to determine the histological prognostic parameters and the latest therapeutic methods.     

Treatment compliance in asthma: a Tunisian transversal study

As a chronic disease, asthma requires a continued treatment and poses the problem of compliance with medication. To study in a Tunisian population of asthmatics, the level of compliance and the factors affecting it, we included 190 adults with persistent asthma in a transversal study using a self-questionnaire. The mean age was 38.56 years. 2/3 of patients had medium or poor socioeconomic status. 1/3 had severe persistent asthma, progressing for 5 years in 68 % of case. All patients received inhaled corticosteroids; only 44 had high dosed corticosteroids. 29.5 % of patients were compliant with medication in our study. Omission and intentional negligence were the two main reasons for non-compliance. Level of compliance was positively related to socioeconomic status, urban way of life, hystory of hospitalization, high dosed corticosteroids and knowledge of their indication. We conclude that treatment compliance in asthma is very low. Further efforts should be made to improve compliance: by increasing the accessibility of medication and by the educational programs which should be a priority in the management of asthma.     

Left main coronary stenosis: clinical and paraclinical aspects

The authors report a retrospective study about 20 cases of left main coronary disease admitted during 7 years. The mean age is 60 years with a large predilection for men (65% cases). The left main coronary stenosis generally presented as instable angina in 45% cases, myocardial infarct in 40% cases and left ventricular dysfunction in 10% cases. The left main coronary disease was associated with three vessel disease in 45% cases, two vessel disease in 20% cases and one vessel disease in 15% cases. The left main stenosis is frequently distal (60% cases), severe left myocardial dysfunction (EF < 40%) is found in 25% cases. 13 patients had coronary artery by pass graft with favourables outcome in all patients. The mortality was evaluated at 20% cases, only in medical group.     

Biochemical markers of bone remodeling: recent data of their applications in managing postmenopausal osteoporosis

The recent development of new biochemical markers has considerably improved the non invasive exploration of bone turnover. Currently, the most sensitive markers to access bone formation are osteocalcin, bone alkaline phosphatase and N-terminal propeptide of type I procollagen. Blood or urinary immunoassays of pyridinoline, deoxy-pyridinoline and terminal telopeptides type I of collagen are currently the best indices to evaluate the bone resorption. The principal application fields of biochemical markers in postmenopausal osteoporosis, in combination with the measurement of the bone mineral mass, are primarily the monitoring of anti-resorptive therapy response and prediction of bone loss and risk of fractures. In fact, treatment with anti-resorptive drugs is followed by rapid decrease of bone markers levels (3 months for the markers of resorption and 6 months for those of osteo-formation ), whereas the bone mineral density measurements requires at least two years to change significantly.     

Chronic pancreatitis in the ventral pancreas in pancreas divisum

Pancreas divisum, partial or non fusion of the dorsal and ventral pancreatic ductal system, affects up to 10 percent of the population. Approximately 25 percent of patients with pancreas divisum will develop complications such as recurrent pancreatitis. Surgical and endoscopic therapy usually include minor papilla sphincterotomy or sphincteroplasty to facilitate drainage of the dorsal ductal system. The following case represents an unusual complication of the pancreas divisum with primarily ventral duct disease and pancreaticolithiasis.     

Biventricular resynchronization in the management of severe cardiac insufficiency

Heart failure is a major problem of public health, it represents a frequent status among patients with heart disease, and its implications in term of mortality and cost are high. Non Pharmacological treatment of heart failure most commonly designed as cardiac resynchronization therapy (CRT) has demonstrate efficacy to improve functional class, exertion capacity, left ventricular ejection fraction, reduction of mitral regurgitation, and probably mortality at midterm. The most recent studies emphasize on the role of implantable cardioverter defibrillate or (ICD) combined with CRT to reduce mortality. More trials are needed to valid this concept.