Faculty of Medicine

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RESULTS FROM POST - MARKETING OBSERVATIONAL STUDY FOR THE ASSESSMENT OF SAFETY OF INTRAVENOUS IBANDRONIC ACID IN POSTMENOPAUSAL WOMEN
(SHMSHM - AAMD, 2020-12-23)
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Stefanovska, Dushica
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Our study was non interventional, observational, open, uncontrolled and prospective- retrospective study, multicentre and one branch - during 2009-2011 at secondary and tertiary medical level. 5 medical centres and two clinics from N. Macedonia were included. The study entered 611 pts, but finished 153 pts. 146 were bisphosphonate naive, 7 had previous received peroral bisphosphonate therapy. In our group of patients 36 side effects were registered in 31 patients. 35/36 appeared during first 7 days of application,15/36 did not appeared after first application, 28/36 were with mild intensity and 5 were with moderate intensity and 2 were SAERS. We analyzed review database (2009 to 2011), from the perspective of recent studies. And to point out, that DXA results, together with CMAJ guidelines and FRAX questionnaire, were not changed during last 10 years. Both of them (CMAJ and FRAX), together or without DXA, are solid foundation to begin antiresorbtive bisphosphonate therapy. DXA finding of osteoporosis, sex, and presence of one major or two minor risk factors was the basis of initiating the therapy. All of our patients were female. With the major risk factors 2,1 present in 129 (84%) from 153 patients. In 123 (80,09%) we have registered more than 1 minor risk factors (1,7). Intravenous bisphosphonate therapy, is still most useful steadily in the last decade. It is due to the simple dosing regimens, the adherence, excellent compliance and persistence accurate for certain group of patients. This therapy have few adverse effects.
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Assessement of bone health in adults with cystic fibrosis in the Republic of North Macedonia
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2022-11)
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The term Cystic Fibrosis Bone Disease (CFBD) is used to describe low BMD and /or fragility fractures in CF patients. Objective: We decided to carry out a bone health screening of adult patients with CF in the Republic of North Macedonia and establish their current status. Material and Methods: We conducted a prospective study which comprised a sample of 30 individuals with CF above the age of 18, of the population of ~50 adults with CF in North Macedonia. The sex, age, height and weight (later converted to BMI kg/m2) were recorded, blood sample analysed for serum levels of calcium, free calcium, phosphate, parathyroid hormone (PTH) and 25(OH)D. We conducted an interview with all subjects regarding additional risk factors. All subjects underwent DXA scan, by measuring the BMD at the lumbar spine and proximal hip. Results: approximately half of the adults with CF have low BMD and about a quarter of them also have osteoporosis. 33,3% of the patients had history of fragility fractures, the mean BMI was lower than the recommended values, vitamin D deficiency was found in 60% and continuous use of glucocorticoids was recorded in 30% of the subjects. Conclusion: Our findings align with those of other studies. The most effective method for evaluating BMD in adult CF patients is DXA scanning and monitoring regularly.
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Bone mineralization disorders in patients with cystic fibrosis in Republic of Macedonia
(Faculty of Medicine, University Ss. Cyril and Methodius in Skopje, 2018)
Spirevska, L
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Deterioration of mineral bone density (BMD) is common in patients with cystic fibrosis (CF). It is a result of several reasons such as poor nutritional status, chronic inflammation, use of glucocorticoid therapy and others. The aim of the study was to determinate the prevalence of deterioration of mineral bone density in patients with CF by the method of absorption of X-ray dual-wavelenght (dual-energy X-ray absorptiometry-DXA) and the impact of clinical factors age, nutritional status and severity lung disease on its appearance. The study included 80 patients with CF aged 5 to 36 years who are treated at the University Children's Hospital in Skopje. Patients with CF were devided into 3 age groups: pre-puberty, from 5-11 years, puberty and adolescence 12-18 years and adults 19-36 years. All patients underwent examination of bone mineral density by DXA of the lumbal spine and some clinical parameters (body weight and height) and functional lung tests (forced expiratory volume in the first second-FEV1 and forced vital capacity-FVC). Most CF patients (68,75%) had normal mineral density (BMD); 21.25% were with osteopenia and 10% had osteoporosis. Patients with CF who have osteoporosis and osteopenia had statistically significant worse clinical parameters compared to these with normal BMD. Early detection of bone disease and prompt treatment is important in order to prevent fractures and other complications.
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INDEX OF THE OSTEOPOROTIC RISK IN THE EVALUATION OF THE DENOSUMAB TREATMENT
(SHMSHM - AAMD, 2022)
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Snezana Markovic Temelkova
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Jasmina Meceska Jovcevska
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Objective. Predomination of bone resorption compared to bone formation in postmenopausal (PM) osteoporotic women and inversion of this relation during denosumab treatment (DT), indicated the need to discover their relationship as an index of the osteoporotic risk (IOR). Osteocalcin and β-CrossLaps (CTX) reduction and IOR increase were determined during one year of DT in order to discover its efficacy. Material and methods. Bone turnover markers N-MID osteocalcin (O) and CTX, expressed in ng/ml, and their ratio IOR=O/CTX were determined during DT in 18 PM women with osteoporosis. The mean value of the percentage of O and CTX reduction and IOR increase from the basal levels during one year of DT were determined. Results. Pretreatment O levels as well as the correspondent CTX levels lowered and IOR levels increased significantly during one year of denosumab treatment (p<0.0001). O% reduction for 12 months was 46.88±22%, CTX% reduction was 78.6±17% and mean IOR% increase was 166.24±118%, confirming bone formation predomination compared to bone resorption that will enable BMD increase. Conclusions. Significant O and O% decrease, highly significant CTX and CTX% decrease, as well as IOR and IOR% significant increase confirmed predominance of bone formation compared to bone resorption, decreased bone turnover, which indicated reduced osteoporotic risk and fracture risk in postmenopausal women as a result of DT. Determination of the relation of the two processes, bone formation and bone resorption through IOR enabled follow up of the osteoporotic risk and the efficacy of the antiresorptive treatment and confirmed very high efficacy of DT in PM osteoporosis.
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BONE MARKERS IN PERIMENOPAUSAL AND POSTMENOPAUSAL WOMEN WITH ABNORMAL UTERINE BLEEDING
(International Osteoporosis Foundation, 2022-03-24)
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Biljana Jovanoska Todorova
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Bashkim Ismaili
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Pranvera Izairi
Objectives: To determine the histopathological changes of the endometrium that occur during the period of perimenopause and postmenopause and to determine their association with the presence of obesity and the levels of bone markers for bone resorpition and bone formation, serum parathormone, vitamin D and calcium levels. Material and methods: This study involved 120 patients with fractionated explorative curettage due to abnormal uterine bleeding. The examined group was divided in two subgroups: 60 women in perimenopausis and 60 women in postmenopausis. Anamnestic data were taken from from all respondents. Body height and weight were measured. This laboratory analyses were performed: Serum Osteocalcin, beta CTX, parathormone, Vitamin D and calcium levels. Results: The most common pathological change of the endometrium was an endometrial polyp. History of previous bone fractures was significantly more common in postmenopausal women than in perimenopausal women. Postmenopausal women were older than perimenopausal and had significantly higher Body Mass Index, higher levels of serum osteocalcin and beta CTX in serum. Postmenopausal duration significantly positively correlated with Osteocalcin and β Cross Laps serum values. Higher serum Osteocalcin and β Cross Laps values were measured in patients with longer postmenopause duration. There was not significant difference in the levels of vitamin D and calcium between the groups. Conclusions: In the period of perimenopause and postmenopause, there are changes in the genital organs, but also there are internal disorders (obesity, metabolic syndrome, diabetes, thyroid disorders, cardiovascular disease, osteoporosis), which should be timely prevented, diagnosed and treated. Estrogen deficiency in postmenopausis is the most common cause of postmenopausal osteoporosis.
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Influence of interferential currents, pulsed low-frequency electromagnetic field and exercises for pain in postmenopausal osteoporotic patients
(Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, 2019)
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Introduction: Osteoporosis causes chronic back pain that leads to diminished functional capability and quality of life. Aim: To examine the influence of physical modalities and exercises on pain in patients with postmenopausal osteoporosis. Material and methods: This was a prospective study comprising 92 patients with postmenopausal osteoporosis randomly selected and followed for one year at the Institute of Physical Medicine and Rehabilitation in Skopje. Patients were assigned to three groups: the first group of 32 patients underwent physical procedures, the second group of 30 patients did not undergo physical modalities, and the third control group comprised 30 patients. Physical therapy consisted of physical modalities and exercises. Physical modalities included interferential currents and pulsed low-frequency electromagnetic field conducted each day for 21 days with weekend breaks. Patients from the first and the second group performed exercises 3 times per week during the entire follow-up period. The third group of patients did not practice exercises. Two check-ups were made, on day 21 and at the end of the twelfth month. Assessment of pain intensity was made by the use of a numeric pain rating scale. Results: No significant difference among the groups was observed regarding the mean age of patients (p<0.21). The first check-up showed а significantly higher pain score in the third group of patients (p=0.0003). At the end of the twelfth month the number of patients with pain was significantly reduced as compared to the control group of patients (p=0.0029). Conclusion: Physical therapy modalities and exercises influence on pain in patients with osteoporosis.
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PREVENTION OF BONE MINERAL LOSS IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES
(Македонско лекарско друштво = Macedonian Medical Association, 2020)
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Filip Guchev
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Mimoza Nicolovska-Kotevska
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Dubravka Antova
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Introduction. Corticosteroids are therapeutic support for many medical conditions including systemic inflammatory rheumatic diseases. Secondary osteoporosis is one of the major complications from this therapy. Bisphosphonates are indicated for prevention and treatment of corticosteroid-induced osteoporosis. Aim. In a retrospective cross-sectional study to assess the effect of the early use of bisphosphonates on bone mineral density in patients with inflammatory rheumatic diseases treated with corticosteroids. Methods. We compared bone mineral density in an examined group of 75 posmenopausal women with inflammatory rheumatic diseases on a corticosteroid therapy who were treated early with bisphosphonates, with a control group of 80 postmenopausal women with osteoarthritis who have never been treated with corticosteroids. Bone mineral density was measured at the lumbar spine and left femur using Dual X-Ray absorptimetry in both groups of subjects. Results. Patients with inflammatory rheumatic diseases had an average T-score at the lumbar spine of -2.19, and -1.41 at the left hip. The average T-score for the control group was -2.24 at the lumbar spine and -1.53 at the hip. Difference in T-score at the lumbar spine and the left hip between the two groups was 0.073 and 0.300 (P=0.639 and P=0.048), respectively. There was no statistically significant difference in the T-scores for both groups. Conclusion. Osteoporosis is more prevalent in patients with inlammatory rheumatic diseases, both at the hips and the spine. The early use of bisphosphonates in patients with inflammatory rheumatic diseases, especially in those who are on corticosteroids, can prevent the loss of bone mineral density
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АSSESSMENT OF OSTEOPOROSIS AND OCCURRENCE OF VERTEBRAL FRACTURES IN POSTMENOPAUSAL PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH SMALL DOSES OF GLUCOCORTICOIDS
(Институт за јавното здравје на Република Македонија = Institute of public health of the Republic of Macedonia, 2020-12-11)
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Nikolovska-Kotevska, Mimoza
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Karadzova-Stojanoska, Andzelika
<jats:p>Osteoporosis (OP) is a serious extracorporeal manifestation that occurs in patients with rheumatoid arthritis (RA). One of the risk factors is long-term use of glucocorticoids (GC). Osteoporosis together with the increased risk of vertebral (VF) and non-vertebral fractures (non-VF) in particular has a negative impact on quality of life in patients with rheumatoid arthritis. The aim of the study was to detect the occurrence of OP and VF in postmenopausal patients with RA and their association with long-term use of small doses of glucocorticoids. Material and methods: A total of 46 patients were analyzed. All respondents underwent imaging for osteoporosis evaluation with a DXA scanner (Lunar iDXA, GE) and VF with incorporated Vertebral Fracture Assessment (VFA). Results: The values of bone mineral densities (BMD) were significantly smaller in the group that received glucocorticoids. According to VFA, 37,0% of patients were registered to have a fracture of middle degree, a mild fracture was registered in 19.6% of patients, and severe fractures were registered in 3 patients (6.5%). Conclusion: In postmenopausal patients with RA receiving GC therapy, a more common occurrence of osteoporosis and vertebral fractures was reported compared with the remaining group of RA patients. All patients with RA in menopause need to be screened for timely detection and treatment of osteoporosis and prevention of its complications.</jats:p>

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