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MENOPAUSAL WOMEN, SUFFERING FROM OSTEOPENIA AND VITAMIN D DEFICIENCY
8th European Congress on Menopause (EMAS) / Maturitas 63, Supplement 1 (2009) S1–S136
S87
337
339
COMPARATIVE TRIAL OF TIBOLONE, CONJUGATED ESTROGEN THERAPY, RALOXIFENE AND ALENDRONATE ON THE OSTEOPOROSIS TRAETMENT OF POSTMENOPAUSAL WOMEN
MENOPAUSAL WOMEN, SUFFERING FROM OSTEOPENIA AND VITAMIN D DEFICIENCY
S. Dimitrakopoulos 1 , S. Koliantzaki 1 , K. Sorras 2 , A. Sidiropoulou 2, A. Saltamavros 2 , E. Papageorgiou 1 , N. Oikonomopoulos 2 , N. Sidiropoulos 1 . 1 General Hospital of Pyrgos, Obstetric- Gynecology, Pyrgos, Greece; 2 Saint Andrew Hospital, Medicine, Patras, Greece Objectives: The purpose of our study is to demonstrate the efficacy of osteoporosis treatment with tibolone, conjugated estrogen therapy, raloxifene and alendronate respectively. Methods: The study included 120 postmenopausal women who were conducted at the outpatient clinic for the years 2001 to 2008. They were separated in four groups. The first group of 30 women was treated with 2.5mg of tibolone per day (peros). The second group of 30 women was treated with 0.625mg conjugated equine estrogen + 5mg Medroxyprogesterone Acetate, for two years. The third group of 30 women were given Raloxifene for two years. The fourth group was treated with alendronate for two years. All women received 1000 mgr of Calcium and 0.5 micrograms of Vitamin D. All women had between 12 months to two years of amenorrhea and had increase of the gonadotropins level in the laboratory findings. The mean bone mineral density in the lumbar spine was measured. The statistic analysis of the results was done by SPSS (p<0.05) was considered as statistically important. Results: After two years of treatment the results were: The first group had a significant increase of 5.9% in the mean bone mineral density, the second group had a 5.8% increase, the third group had a 2.9% increase and the fourth group had a 5.6% increase in the bone marrow density. Conclusions: The osteoporosis treatment with tibolone, conjugated estrogen therapy, raloxifene and alendronate is beneficial to the increase of the mean bone mineral density Keywords: Osteoporosis, tibolone, Raloxifene, alendronate, Vitamin D.
S. Djurica, M. Vuksanovic, B. Zerajic. Internal Clinic of “Zvezdara” University Center, Department for Hormone‘s Induced Osteoporosis, Belgrade, Serbia Vitamin D status of 203 menopausal female, average age of 61±0.7 years (46-73y) were assessed. All measurements, (conducted in Belgrade, Serbia), were performed between september and december in the same year. Serum levels of 25 (OH)D were analysed in serum samples taken after an overnight fast. The values from 75 to 250 nM/l were optimal for the method, which was applied. Osteopenia (L1-L4: T score: -2,1 SD±0.5, X±SD; Z score: - 1,3 SD±0,6) was confirmed in all subjects, included in this study, by DXA (Hologic, Explorer) densitometry. Serum osteocalcin, betacrossLaps and parathormone (PTH) were analysed, also.In this study we found a negative linear correlation (r= -0,2) between vit 25(OH)D mean value 75.8±3.60, X±SD, and elevated PTH (70.62±3,66 pg/ml). Normal serum betacrossLaps values (0,38±0,02; X±SD) negatively correlated to vit 25(OH)D, also (r= -0,18). However, mean osteocalcin value (23,97±1,39) showed the negative correlation (r=-0,24) with vit 25(OH)D. In all osteopenic women normocalcemia were confirmed (Ca2+ : 1,17±0,008 mM/l; X±SD). We found positive correlation between PTH and betacrossLaps (r=0,31). Vitamin D deficiency in the menopausal women is one of the most important factors for development of osteopenia and progression to osteoporosis. The increase in serum PTH, secondary to vit D insufficiency, may afect bone remodeling resulting in high bone turnover, increased bone resorption and contribute to age related reductions in bone density. Keywords: Vitamin D, menopause, osteopenia
340 MODERN OPPORTUNITY OF TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS AT WOMEN WITH DIABETES TYPE 2
338 HOW MUCH MONEY TREATMENT OF OSTEOPOROSIS COST? COSTEFFECTIVENESS ANALYSE K. Jocic-Savic 1 , S. Dimitrijevic 2 . 1 Klinical Health Centar ’Zemun’, Zemun-Belgrade, Serbia; 2 Institute for Public Health of Serbia, Health Economy, Belgrade, Serbia Objective: In this analyse we should prove that the costs of preventive of osteoporosis are lower that the costs of treatment of hip fracture for women in KBC ZEMUN in Belgrade in Serbia, in the period 2006/2007. Methods: Retrospective observe of motion of the hip fracture at women, hospital morbidity.Trends moves of cases and days. Results: Hip fracture at women, during the observed period has the increasing tendency as well as the number of treatment days. Annually, there were approximately 121 cases, with about 20 days of treatment. Implantation of prothesis is oftenly indispensable. The cost of using substitutive hormonal therapy during menopause for this 900 woman in period of 5 years are 689,075€ and the cost of control of bone density are 88,000€. If those 900 women did not use substitutive hormonal therapy during menopause the consequences is hip fracture. The costs of treatmant of hip fracture are 1,770,338€. Conclusions: The costs of preventive of osteoporosis are lower that the costs of treatment of hip fracture for women in KBC Zemun, in the period 2006/2007, for 335,853€. QALY of women from 50 to 59 years are 5300 QALYs. If 58 women use preventive therapy during menopause they will not get osteoporosis and contitue to work. In this case they will earn 2,370,805€ gross salary and increase GDP for this sum of money. Keywords: Osteoporosis, cost for osteoporosis, cost for treatment of hip fracture, QALYs
E. Doskina 1 , A. Ametov 2 , E. Mashenko 2 , I. Kochergina 2 . 1 Russian Medical Academy for Advanced Studies, Ministry of Health, Russian Medical Academy, Moscow, Russian Federation; 2 Russian Medical Academy for Advanced Studies, Ministry of Health Russia, Endocrinology and Diabetology Chair, Moscow, Russian Federation Purpose of the study: To research dynamic of parameters of mineral metabolism, during one year therapy with Strontium ranelate (dose - 2 g/day (SR) at women with postmenopausal osteoporosis (PO) and diabetes type 2 (D2). Materials and methods: 35 women (age 65,9±3,2 years), menopause 46,1±1,5 years) with diabetes type 2 (D2 - longer from 1 to 12 years, all patients have oral therapy with antydiabetes drags) and PO (T-score less -2,5). During one year monitor bone mineral density (DEXA), serum Ctelopeptide cross link, calcium, and alkaline phosphates. Clinical results: 10,3% of patients have dyspeptic phenomena (regress was during 1-3 days. Nobody of the patients finish treatment in early stage of treatment). Bone mineral density at DEXA T - score grow on 21,5±2,86% (p=0,05), lumbar spine L1 - 16,5%, L2 - 18,4%, L3 - 23%, femoral neck 24,87%, Wards - 16,7%, Troch. - 27,3%, Total hip - 23,35% (p=0,05). Serum C- telopeptide cross link before treatment raised at 33%. After one year treatment with SR was note regress on 33,5% (r = 0,05). 89% of women had pain syndrome (in spine or in the hip), after 2 month 1% mark its regress, 5% after 4,28% - 6 & 35% after one year of treatment by SR. Nobody had hypoglycemia, nonvertebral and vertebral fracture risks. Conclusions: Strontium ranelate, being effective in reducing both nonvertebral and vertebral fracture risks. Strontium ranelate is a new first treatment of PO and D2. Keywords: Postmenopaus, diabetes type 2, Strontium ranelate.
S87
337
339
COMPARATIVE TRIAL OF TIBOLONE, CONJUGATED ESTROGEN THERAPY, RALOXIFENE AND ALENDRONATE ON THE OSTEOPOROSIS TRAETMENT OF POSTMENOPAUSAL WOMEN
MENOPAUSAL WOMEN, SUFFERING FROM OSTEOPENIA AND VITAMIN D DEFICIENCY
S. Dimitrakopoulos 1 , S. Koliantzaki 1 , K. Sorras 2 , A. Sidiropoulou 2, A. Saltamavros 2 , E. Papageorgiou 1 , N. Oikonomopoulos 2 , N. Sidiropoulos 1 . 1 General Hospital of Pyrgos, Obstetric- Gynecology, Pyrgos, Greece; 2 Saint Andrew Hospital, Medicine, Patras, Greece Objectives: The purpose of our study is to demonstrate the efficacy of osteoporosis treatment with tibolone, conjugated estrogen therapy, raloxifene and alendronate respectively. Methods: The study included 120 postmenopausal women who were conducted at the outpatient clinic for the years 2001 to 2008. They were separated in four groups. The first group of 30 women was treated with 2.5mg of tibolone per day (peros). The second group of 30 women was treated with 0.625mg conjugated equine estrogen + 5mg Medroxyprogesterone Acetate, for two years. The third group of 30 women were given Raloxifene for two years. The fourth group was treated with alendronate for two years. All women received 1000 mgr of Calcium and 0.5 micrograms of Vitamin D. All women had between 12 months to two years of amenorrhea and had increase of the gonadotropins level in the laboratory findings. The mean bone mineral density in the lumbar spine was measured. The statistic analysis of the results was done by SPSS (p<0.05) was considered as statistically important. Results: After two years of treatment the results were: The first group had a significant increase of 5.9% in the mean bone mineral density, the second group had a 5.8% increase, the third group had a 2.9% increase and the fourth group had a 5.6% increase in the bone marrow density. Conclusions: The osteoporosis treatment with tibolone, conjugated estrogen therapy, raloxifene and alendronate is beneficial to the increase of the mean bone mineral density Keywords: Osteoporosis, tibolone, Raloxifene, alendronate, Vitamin D.
S. Djurica, M. Vuksanovic, B. Zerajic. Internal Clinic of “Zvezdara” University Center, Department for Hormone‘s Induced Osteoporosis, Belgrade, Serbia Vitamin D status of 203 menopausal female, average age of 61±0.7 years (46-73y) were assessed. All measurements, (conducted in Belgrade, Serbia), were performed between september and december in the same year. Serum levels of 25 (OH)D were analysed in serum samples taken after an overnight fast. The values from 75 to 250 nM/l were optimal for the method, which was applied. Osteopenia (L1-L4: T score: -2,1 SD±0.5, X±SD; Z score: - 1,3 SD±0,6) was confirmed in all subjects, included in this study, by DXA (Hologic, Explorer) densitometry. Serum osteocalcin, betacrossLaps and parathormone (PTH) were analysed, also.In this study we found a negative linear correlation (r= -0,2) between vit 25(OH)D mean value 75.8±3.60, X±SD, and elevated PTH (70.62±3,66 pg/ml). Normal serum betacrossLaps values (0,38±0,02; X±SD) negatively correlated to vit 25(OH)D, also (r= -0,18). However, mean osteocalcin value (23,97±1,39) showed the negative correlation (r=-0,24) with vit 25(OH)D. In all osteopenic women normocalcemia were confirmed (Ca2+ : 1,17±0,008 mM/l; X±SD). We found positive correlation between PTH and betacrossLaps (r=0,31). Vitamin D deficiency in the menopausal women is one of the most important factors for development of osteopenia and progression to osteoporosis. The increase in serum PTH, secondary to vit D insufficiency, may afect bone remodeling resulting in high bone turnover, increased bone resorption and contribute to age related reductions in bone density. Keywords: Vitamin D, menopause, osteopenia
340 MODERN OPPORTUNITY OF TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS AT WOMEN WITH DIABETES TYPE 2
338 HOW MUCH MONEY TREATMENT OF OSTEOPOROSIS COST? COSTEFFECTIVENESS ANALYSE K. Jocic-Savic 1 , S. Dimitrijevic 2 . 1 Klinical Health Centar ’Zemun’, Zemun-Belgrade, Serbia; 2 Institute for Public Health of Serbia, Health Economy, Belgrade, Serbia Objective: In this analyse we should prove that the costs of preventive of osteoporosis are lower that the costs of treatment of hip fracture for women in KBC ZEMUN in Belgrade in Serbia, in the period 2006/2007. Methods: Retrospective observe of motion of the hip fracture at women, hospital morbidity.Trends moves of cases and days. Results: Hip fracture at women, during the observed period has the increasing tendency as well as the number of treatment days. Annually, there were approximately 121 cases, with about 20 days of treatment. Implantation of prothesis is oftenly indispensable. The cost of using substitutive hormonal therapy during menopause for this 900 woman in period of 5 years are 689,075€ and the cost of control of bone density are 88,000€. If those 900 women did not use substitutive hormonal therapy during menopause the consequences is hip fracture. The costs of treatmant of hip fracture are 1,770,338€. Conclusions: The costs of preventive of osteoporosis are lower that the costs of treatment of hip fracture for women in KBC Zemun, in the period 2006/2007, for 335,853€. QALY of women from 50 to 59 years are 5300 QALYs. If 58 women use preventive therapy during menopause they will not get osteoporosis and contitue to work. In this case they will earn 2,370,805€ gross salary and increase GDP for this sum of money. Keywords: Osteoporosis, cost for osteoporosis, cost for treatment of hip fracture, QALYs
E. Doskina 1 , A. Ametov 2 , E. Mashenko 2 , I. Kochergina 2 . 1 Russian Medical Academy for Advanced Studies, Ministry of Health, Russian Medical Academy, Moscow, Russian Federation; 2 Russian Medical Academy for Advanced Studies, Ministry of Health Russia, Endocrinology and Diabetology Chair, Moscow, Russian Federation Purpose of the study: To research dynamic of parameters of mineral metabolism, during one year therapy with Strontium ranelate (dose - 2 g/day (SR) at women with postmenopausal osteoporosis (PO) and diabetes type 2 (D2). Materials and methods: 35 women (age 65,9±3,2 years), menopause 46,1±1,5 years) with diabetes type 2 (D2 - longer from 1 to 12 years, all patients have oral therapy with antydiabetes drags) and PO (T-score less -2,5). During one year monitor bone mineral density (DEXA), serum Ctelopeptide cross link, calcium, and alkaline phosphates. Clinical results: 10,3% of patients have dyspeptic phenomena (regress was during 1-3 days. Nobody of the patients finish treatment in early stage of treatment). Bone mineral density at DEXA T - score grow on 21,5±2,86% (p=0,05), lumbar spine L1 - 16,5%, L2 - 18,4%, L3 - 23%, femoral neck 24,87%, Wards - 16,7%, Troch. - 27,3%, Total hip - 23,35% (p=0,05). Serum C- telopeptide cross link before treatment raised at 33%. After one year treatment with SR was note regress on 33,5% (r = 0,05). 89% of women had pain syndrome (in spine or in the hip), after 2 month 1% mark its regress, 5% after 4,28% - 6 & 35% after one year of treatment by SR. Nobody had hypoglycemia, nonvertebral and vertebral fracture risks. Conclusions: Strontium ranelate, being effective in reducing both nonvertebral and vertebral fracture risks. Strontium ranelate is a new first treatment of PO and D2. Keywords: Postmenopaus, diabetes type 2, Strontium ranelate.