Abstract:

In this study the potentialities of quantitative computed tomography (QCT) in bone densitometry is reported. QCT was performed in patients receiving glucocorticoid therapy and in postmenopausal women (55 patients all in all). Special software was used for the mineral density loss assessment: surrounding tissues were automatically subtracted, and calculating of the vertebral body density done in cross-sectional view. QCT allows specifying pathological changes in any vertebral structures and so serves as a good contribution to the diagnosis of osteoporosis. 

Reference

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10.   Benitez С. L., Schneider D. L., Barrett-Connor E., Sartoris D. J. Hand ultrasound for osteoporosis screening in postmenopausal women. Osteoporos. Int. 2000; 11 (3): 203-210.

11.   Krane St. M. Assessment of mineral and matrix turnover. In: B. Frame, J.T. Potts et al. Clinical disorders of bone and mineral metabolism. Excerpta medica. Internat. Congress Series 617. Amsterdam. Oxford, Princeton. 1983; 95-98.

Abstract:

A reduced level of female sex hormones at menopause leads to development of atherosclerotic manifestations as well as to reduction of bone mineral density The total estimation of changes in blood vessels and bone tissue on the basis of comparison of SCORE scale and FRAX® program ir a single two-dimensional coordinate system makes it possible to determine degree of risks of cardiovascular complications and fractures in the near future of each individual patient.

Aim: was to assess risks of cardiovascular complications and fractures in women in the early postmenopausal period based on the data of SCORE scale and FRAX® program.

Materials and methods: research included 25 women in the variable menopause period without a previous cardiovascular disease (CVD) and osteoporosis (OP). A standard clinical examination, laboratory tests of lipid spectrum, determination of pulse wave velocity, doppler ultrasound of main arteries of the head with the definition of the thickness of the intima-media complex (IMC) of common carotid arteries(CCA), dual energy X-ray absorptiometry were carried out, risk calculations on the basis of SCORE scale and FRAX® computer program were studied. Re-examination of 25 patients was carried out not less than 12 months after the cessation of menses.

Results: baseline characteristics: low risk (less than 1%) was observed in 72% of women on SCORE scale, and 100% of women (less than 10%) was observed on FRAX®. An increasing number of risk factors enhances the performance of «early» markers of atherosclerosis (CPV-13,0 + 3,4 m/s; thickness IMA of CCA-0.95+0,11 mm) and statistically significant (p <0,05) decrease of mineral bone density (BMD). In the early stage of menopause, an increase in the total risk of cardiovascular complications and fractures in coming 10 years was observed. So poor performance risk was observed in 64% of women on SCORE scale, and risk of fractures was observed in 96% of patients on FRAX®.

Conclusion: distribution of studied parameters in a two-dimensional table in accordance with results of the SCORE scale and FRAX® program revealed the prevalence of patients with low values. After 12 months, the growth of BMD was noted in the decrease of number of patients (64%) with low risks and the occurrence of women (8%) with moderate risk of fractures and no cardiovascular risk. BMD study in the early postmenopausal period found a slight decrease in BMD in 48% of women, osteopenia - 44%, osteoporosis - 8%. The comparison of results of both methods makes it possible to assess objectively risks of cardiovascular disease and risk of fractures in each individual patient in next 10 years of their lives. 

References

1.     Evropeyskiye rekomendatsii po profilaktike serdechno-sosudistykh zabolevaniy v klinicheskoy praktike. [The European guidelines for prevention of cardiovascular disease in clinical practice]. Rational pharmacotherapy in cardiology. 2008; 4(3):111-128 [ In Russ].

2.     Nikulina N. N., Yakushin S. A., Frumento G. I."Women's health issues and their solutions. Materials of V Russian conference «Sravnitel'nyy analiz smertnosti ot ostrykh form IBS u muzhchin i zhenshchin»[Comparative analysis of mortality from acute forms of CHD in men and women]. Moscow.2011; 13-14 [ In Russ].

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6.     Conroy R.M., Pyorala K., Fitzgerald A.P Estimation of ten-year risk off at al cardiovascular disease in Europe: the SCORE project. Eur.Heart.J. 2003; 24:987-1003.

7.     Assman G., Barter., Bellosta S., et al. Rukovodstvo po profilaktike ishemicheskoy bolezni serdtsa. Mezhdunarodnaya rabochaya gruppa po orofilaktike ishemicheskoy bolezni serdtsa [Guidelines to prevention of coronary heart disease. International working group for prevention of coronary heart disease].  Germany. STADA. Thomson Reuters. 2011; 130.

8.     Skripnikova I. A. Osteoporosis and osteopathy. Abstracts of the IV Russian Congress on osteoporosis «Chto svyazyvaet osteoporoz i serdechno-sosudistyye zabolevaniya, obuslovlennyye aterosklerozom (CCZ-AS)?»[What connects osteoporosis and cardiovascular disease caused by atherosclerosis (CVD-al)?]. Moscow. 2010; (1):66. [In Russ].

9.     Ershova O. B. Kommentarii k prakticheskomu ispol'zovaniyu Rossiyskikh klinicheskikh rekomendaciy po osteoporozu. [Comments to the practical use of the Russian clinical recommendations for osteoporosis]. Osteoporosis and osteopathy. Scientific-practical journal. 2010; (1):34-46 [In Russ].

10.   Skripnikova I. A., Oganov R.G. Osteoporoz i serdechno-sosudistyye zabolevaniya, obuslovlennyye aterosklerozom, u zhenshchin postmenopauzal'nogo perioda: obshchnost' povedencheskikh i social'nykh faktorov riska. [Osteoporosis and cardiovascular diseases caused by atherosclerosis, postmenopausal women: a community behavior al and social risk factors]. Osteoporosis and osteopathy. 2009; (2):5-9 [In Russ].

Abstract:

Aim: was to determine the level of bilateral asymmetry of mineral density of trabecular and cortical bones in lumbar spine in women as an additional diagnostic criterion for osteoporosis, using quantitative computed tomography

Material and methods: the study included 210 women, postmenopausal, who underwent bone densitometry by quantitative computed tomography Estimated total body BMD II-IV of the lumbar vertebrae (separately for trabecular and cortical bone), as well as bilateral asymmetry indices BMD - BMD ratio of the largest one-half of the vertebral BMD to the other half.

Results: with increasing age of the surveyed, noted the growth of bilateral asymmetry index values mineral density of the lumbar vertebrae for both trabecular and cortical bones. Decrease in bone mass of the lumbar vertebrae is associated with an increase in bilateral asymmetry of the BMD. The correlation between the BMD and bilateral asymmetry indices for trabecular bone was r = -0.52 (p=0.001) for cortical bone r = - 0.47 (p=0.001).

Conclusion: the index of bilateral asymmetry in bone mineral density of the vertebral bodies car serve as an additional diagnostic criterion for osteoporosis during bone densitometry by quantitative computed tomography in postmenopausal women.

References

1.    Hernlund E., Svedbom A., Ivergard M. et al. Osteoporosis in the European Union: Medical Management, Epidemiology and Economic Burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch. Osteoporos. 2013; 8: 136.

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3.    Nguyen T., Sambrook P, Kelly P et al. Prediction of osteoporotic fractures by postural instability and bone density. BMJ. 1993; 307: 1111-1115.

4.    Siris E.S. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. Journal of the American Medical Association. 2001; 286 (22): 2815-2822.

5.    ACR-SPR-SSR practice parameter for the performance of quantitative computed tomography (QCT) bone densitometry. Available at: http://www.acr.org/-/media /ACR/Documents/PGTS/guidelines/QCT.pdf Res. 32-2013, Amended 2014 (Res. 39).

6.    These are the Official Positions of the ISCD as updated in 2013. Available at: http://www.iscd.org/official-positions/2013-iscd-official-positions-adult (accessed April 24, 2014).

7.    Zakharov I.S., Kolpinskij G.I., Shkaraburov A.S., Popova O.P. Kolichestvennaja kompjuternaja tomografija i dvuhjenergeticheskaja rentgenovskaja absorbciometrija v diagnostike postmenopauzal'nogo osteoporoza. [Quantitative computed tomography and dual-energy X-ray absorptiometry in the diagnosis of postmenopausal osteoporosis]. Diagnosticheskaja i intervencionnaja radiologija. 2015; 10 (2):19—22. [In Russ].

8.    Bansal S.C., Khandelwal N., Rai D.V. et al. Comparison between the QCT and the DEXA scanners in the evaluation of BMD in the lumbar spine. Journal of Clinical and Diagnostic Research. 2011; 5 (4): 694-699.

9.    Bauer J.S., Virmani S., Mueller D.K. Quantitative CT to assess BMD as a diagnostic tool for osteoporosis and related fractures. Medica Mundi. 2010; 54 (2): 31-37.

10.  Li N., Li X.M., Xu L. et al. Comparison of QCT and DXA: osteoporosis detection rates in post-menopausal women. International Journal of Endocrinology. 2013; March 27. Available at: http://www.ncbi.nlm.nih.gov /pubmed/23606843.

11.  Zaharov I

Abstract:

Aim: was to compare results of bone densitometry techniques, conducted by quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in postmenopausal women.

Material and methods: the study included 210 women in postmenopausal period, who were divided by age into four groups: 50-59 years, 60-69 years, 70-79 years, 80 years and older. All patients underwent densitometry of the lumbar spine by quantitative computed tomography anc dual-energy X-ray absorptiometry in the range of 1-2 weeks.

Results: in the evaluation of bone mineral density by methods of QCT and DXA in the age group 50-59 years, there were no significant differences in results of densitometry During of QCT, osteoporosis was diagnosed in 20.5%, during DXA - 15.1% of patients. Since the age of 60 years and older - incidence of osteoporosis by QCT was higher than in the DXA. Evaluation of correlation indicators QCT and DXA, in all four groups showed a positive association of moderate strength, which decreases with increasing age (I group: r=0.68, p=0.001; II group: r=0.57, p=0.001; III group: r=0.40, p=0.003; IV group: r=0.40, p=0.04).

Conclusion: after 60 years, the incidence of osteoporosis, shown by quantitative computed tomography is higher in comparison with dual-energy X-ray absorptiometry.

Abstract:

Aim: was to compare fabric mineral density in women after bilateral ovarioectomy with hormonal replacement therapy and without it after 10 years of monitoring.

Materials and methods: we have examined 87 women after bilateral ovarioectomy with hysterectomy Patients were divided into 2 groups: 50 women with hormonal replacement therapy (1st group) and 37 patients without it (2nd group). All the patients were comparable by age at the moment of operation. Patients from the 1st group underwent examination twice: before operation and 13,1+5,6 years after the operation. Patients from the first group were examined once -11,4±4,1 yrs after the operation. Bone fabric mineral density was measured in 3 regions: lumbar department of a backbone, in a neck of a hip and in proximal department of a femur.

Results: on the base of obtained data it was found out that decreasement of bone fabric mineral density is different due to region of skeleton. Hormonal replacement therapy can decrease the speed of osteoporosis in women after hysterectomy, and that leads to decreased level of fractures in the postoperative period. 

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8.      Кулаков В.И., Юренева С.В., Майчук Е.Ю. Постовариоэктомический синдром. Клиническая лекция. М.: Орион корпорейшн. 2003; 15.

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13.    Castelo-Branco C., Figueras F., Sanjuan A. et al. Long-term compliance with estrogen replacement therapy in surgical postmenopausal women: benefits to bone and analysis of factors associated with discontinuation. Menopause: The J. of the North Am.Menop.Soc. 1999; 6(4): 307-311.

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15.    Hreshchychyn M., Hopkins A., Zystra S. et al. Effect of natural menopause, hysterectomy and oophorectomy on lumbar spine and femoral neck bone densities. Obstet Gynecol. 1998; 8: 631-638.