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No 3/2005

1. .. - : . . - . . , 1989.
2. .. (, , )
// : .
.:: , 1997. . 28-29.
3. .., .., .. . .: , 1987. 272 .
4. .. .. . .:
, 1980. 320 .
5. ..., .. . .,, 2001. 269 .
6. .., .., .
. ..
. 20-22 2003 - .37.
7. .. // . 1998. No 1. . 13-17.
8. .. //
/ . ... .: , 2003. . 21. .
442-468.
9. .., .., .. . ,
120-
// . . : . 1997. . 63-65.
10. .., .., .. . 120 // .
. . 1997. T. 31. No 5. C. 59-63.
11. .., .., ..,
.., . . .
. 2004. -No4 . ( ).
12. B.C., .., .. .

4, 5, 6
// . . . 1992. . 26. No 5/6. . 2024.
13. .., .., .. .
// . .
. . // . 1988. . 33. No 1. C. 30-33.
14. .., .., .. .

//
. 1989. T. 23. No 5. C. 4-46.
15. .., .. //
:
. . 3. . 1. .: , 1997. . 421-460.
16. .., ..

// . . . .
1983. T. 17. No 1. C. 86-88.
17. ..
. .: , 1959. 536 .
18. .. . .: , 1993. 386 .
19. .., ..
// . . 63. .,
1989. 185 .
20. Arnaud S.B., Morey-Holton E. Gravity, calcium,
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(Suppl.). P. 65-68.
21. Arnaud S.B., Sherrard D.J., Maloney N. et al. Effect of
1-week head-down tilt bed rest on bone formation and calcium
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1. P. 14-20.

10

22. Cann Ch., Genant H. Precise measurement of vertebral

mineral content using computed tomography // J. Comp. Ass.
Tomogr. 1980. V. 4. No 4. P. 493-500.
23. Cann Ch. Studies of bone mineral loss and recovery
as a result of exposure to flight and weightlessness simulation
// Report on the 12-th Meeting of US/USSR Joint Working
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24. Deitrick J. E., Whedon E., Shorr E. Effects of immobilization upon various metabolic and physiologic functions of
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26. Fukuoka H., Nishimura Y., Haruna M. et al. Effect of
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No 3/2005

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No 3/2005
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25- D .

, ,
(<300 /.)
(>1500 /.) [7].
,
D {2,2}

,
.
(22 ,
70,24,2 ) {2,2}
,
(36,6% 21,7% , p=0,048),
(p=0,008).
(p=0,0004) Z-
{2,2} (. 3) , -,
.
VDR
, .
TaqI ( T1055-C
), [11].

.
, ,
- [15].
, , ApaI ( BsmI),
ApaI 8,
.
--, 3-
VDR, [8,14].
, L ( - 17 )
b [14], , T.
3-
-, , D
--,
BsmI TaqI VDR.

No 3/2005

1. -
{2,2} VDR
(21,7%, 23,6%, 18% ).
2. Z- {2,2} (p=0,0004) ( )
(36,6%, p=0,008)
(70,24,2 ).
3.
25- D {2}
50%, {2,2} 35,7%, , .
- .
4. {2,2} VDR
(2=118,5, p=0,045).
{2,2} .
5.
, ,
, .

SUMMARY

Osteoporosis is a multifactor disease with a strong

genetic component. The aim of this work was to investigate
distribution of polymorphisms of VDR gene associated
with osteoporosis, regarding to mineral metabolism
and hormone status of patients. Cohort patients (106
patients) includes patients having severe osteoporosis with
compression fractures. Cohort families (72 patients)
includes immediate relatives of the patients and patients
themselves. The TaqI, BsmI, and ApaI polymorphisms
of VDR gene were studied by the PCR-RFLP method.
The frequencies of the osteoporosis associated BAtBAt
genotype in the families cohort and in patients one
are close to the population values (23,6%, 21.7% and
18.0, respectively, p>0.05). Among the elderly patients the
frequency of this BAtBAt genotype (36,6%) is twice higher
than in population (p=0,008). A correlation between the
osteoporosis bone loss and VDR polymorphisms was
observed for women (2=118,5, p=0,045), but there is no
correlation for men. We have established six familiar cases
of reduced vitamin D content in the blood serum and the
frequency of the osteoporosis associated BAtBAt genotype
in this group is higher than in both cohorts. 89% of the
tested relatives have disorders of mineral homeostasis
and 60,7% of them have a low serum Mg level. The data
indicate that mineral disorders (especially Mg-related)
and genetic predispose must be considered together for
early recognition of osteoporosis.

1. .., .., ..,

.., .., .., .. VDR3 COL1A1
// . 2002; No 2: 2-6.
2. .., .. . . .; .
.; , , 2000 .; 560 .
3. Colin E.M., Uitterlinden A.G., Meurs J.B.J., Bergink A.P., Van
De Klift M., Fang Y. et al. Interaction between vitamin D receptor genotype and estrogen receptor genotype influences vertebral fracture risk // J
Clin Endocrinol Metab. 2003; 88(8): 3777-3784.
4. Fleet J.C., Harris S.S., Wood R.J. et al. The BsmI vitamin D receptor restriction fragment length polymorphism () predicts low bone
density in premenopausal black and white women // J Bone Miner Res.
1995; 10: 985-990.
5. Gamero P., Borel O., Sornay-Rendu E., Arlot V.E., Delmas P.D.
// Vitamin D receptor gene polymorphisms are not related to bone turnover, rate of bone loss, and bone mass in postmenopausal women: the
OFELY Study // J Bone Min Res. 1996; 11: 827-834.
6. Gennari L., Becherini I., Masi L. et al. Vitamin D and estrogen
receptor allelic variants in Italian postmenopausal women: evidence of
multiple gene contribution to bone mineral density // J Clin Endocrinol
Metab. 1998; 83: 939-944.
7. Gennari L., Becherini L., Masi L., Gonnelli S. et al. Vitamin D
receptor genotypes and intestinal calcium absorption in postmenopausal
women. Calcif Tissue Int 1997;61(6):460-463.
8. Grundberg E, Brandstrom H, Ribom EL, Ljunggren O, Kindmark A, Mallmin H. A poly adenosine repeat in the human vitamin D
receptor gene is associated with bone mineral density in young Swedish
women // Calcif Tissue Int. 2003; 73(5): 455-462.
9. Hansen T.S., Abrahamsen B., Henriksen F.L., Hermann A.P. et.
al. Vitamin D receptor alleles do not predict bone mineral density or bone
loss in Danish perimenopausal women // Bone. 1998; 22: 571-575.
10. Harvey N., Cooper C. Determinants of fracture risk in osteoporosis // Curr. Rheumatol. Rep. 2003. V. 5. P. 75-81.
11. http://www.ncbi.nim.gov/omim601769/
12. Kanis J.A. and WHO Study Group. Assessment of fracture risk
and its application to screening for postmenopausal osteoporosis synopsis of WHO report // Osteoporosis int. 1994; 4: 368-381.
13. Kikuchi R., Uemura T., Gorai I. et al. Early and late postmenopausal bone loss is associated with BsmI vitamin D receptor gene polymorphism in Japanese women // Calcif Tissue Int. 1999; 64: 102-106.
14. Kim JG, Kwon JH, Kim SH, Choi YM, Moon SY, Lee JY. Association between vitamin D receptor gene haplotypes and bone mass in
postmenopausal Korean women // Am J Obstet Gynecol. 2003, 189(5):
1234-1240.
15. Langdahl B.L., Gravholt C.H., Brixen K., Eriksen E.F. Polymorphisms in the vitamin D receptor gene and bone mass, bone turnover
and osteoporotic fractures // Eur J Clin Invest. 2000; 30(7): 608-617.
16. Morrison N.A., Qi G.C., Tokita A., Kelly P.J., Crofts L., Nguen
T.V. Prediction of bone density from vitamin D receptor alleles. Nature.
1994; 367: 284-287.
17. Rizzoli R., Bonjour J.-P., Ferrari S.L. Osteoporosis, genetics and
hormones // J Mol Endocrinology. 2001. V. 26. P. 79-94.
18. Seeman E. Pathogenesis of bone fragility in women and men.
Lancet. 2002; 359: 1841-1850.
19. Tokita ., Matsumoto ., Morrison N.A. et al. Vitainin D receptor alleles, bone mineral density and turnover in premenopausal Japanese
women // J Bone Miner Res. 1996; 11: 1003-1009.
20. Uitterlinden A.G., Pols H.A.P., Burger H., Huang Q., Van Daele
P.L.A. et.al. F A large-scale population-based study of the association of
vitamin D receptor gene polymorphisms with bone mineral density // J
Bone Min Res. 1996; 11(9): 1241-1248.
21. Uitterlinden AG, Weel AE, Burger H, Fang Y, van Duijn CM,
Hofman A, van Leeuwen JP, Pols HA. Interaction between the vitamin D
receptor gene and collagen type Ialpha1 gene in susceptibility for fracture. J Bone Miner Res. 2001; 16(2): 379-85.
22. Viitanen ., kkaunen M., Laitinen . et al. Common polymorphism of the vitamin D receptor gene is associated with variation of
peak hone mass in young Finns // Calcif Tissue Int. 1996; 59: 231-234.

No03-04-49460.

15

No 3/2005

.. *, .. *, .. **, .. *, .. *, .. **
* , ,
** ,

D3 , , 86 () .
, 75% .
D3 . , ,
.
.

(),
.
,
, ,
612%
[15,16,17]. [4,14].
()
:
, D, , ,
, .

,

.

84 ,

. 68 (),
16
().
23 78 ,
.
.
30
, 5 . 14
, 9 .

(
). -

16

D 25OHD3 1,25 (OH)2D3 (

),
- ,
, .

64 (75%)
, 17
(27%). , ,
. , .
44
(69%) ,
26
(59%) .
20 (31%) .
16
(80,0%), 4 (20,0%)
.
.
,
,
.

, 48 (75%) . , (39,32,7 ),

(39,57,4 ).

, ,
54,25,3 ,

44,54,3 .
,

No 3/2005
1

250
200

r=0,67; p>0,05

150
100
50
0
-3

-2

-1

,
21,20,5 20,70,7 .
19 /2
100% ,

71,4%.

.

.

,
. , 79,2%
37,5%
(<0,05).
(20,8%
0%),
3 (8,91,9 2,41,2 , <0,01).
, 3

.
,
; r=0,67, <0,05 (. .).
16 (42%)
5 (28%) .
88,2%,
60,0% .

,
.
, , ,
1,7 ,
1,45 .

.
, , , 74% ,
, , 78% .

70

56
4655


10




410

8,00
5,00
3,03
1,82
1,72
1,67
1,67
1,47
1,45
1,45
1,22
1,18

2
- ,
D3

n=68

.
n=18

2,22,7

2,30,04

2,30,05

(/)

0,811,62

1,090,02

1,250,061

(/24 )

2,57,5

5,10,3

3,290,61

(/24 )

12,942,0

11,60,4

8,650,72

25-D3 (/)

1460

12,21,9

23,32,31

(/)

1,25()2D3
1665
14,51,8
51,418,42
(/)
1

<0,05;
2

p<0,001.

, , ,
, 6 , , ,
30%. ,

.
, ,
, ,
.
,
(. 1).

--

17

No 3/2005
,
D3 , 25D3
1,25()2D3.

, ,
25D3 1,25()2D3 (. 2).
,
,
,
.
,

.
:
, , ,
.
D3
. ,
D3
,
D3

.

D3 .

1,25()2D3.
(r=0,79; p<0,05) ,
(r=0,53; p<0,1). ,
,
.
25D3.
:
25D3, r=0,58; >0,1,
25D3, r=0,48; p>0,1.
48 ( 39,82,9 ) :
(21 )
(13 ) 14 . (26 ),
(16 ) (6 ) . ( 3)
0,5 1 /. + 1,0
6 , .

2,250,06 /
2,620,12 / (<0,01),
4,730,51 / 2,920,41 / (<0,01).
-
0,560,09 0,310,04,
.
1,170,05
/ 1,480,18 /
(=0,01).

18

1,25()2D3.
66,9012,72 / 139,9062,63 /, -
.
. 1,5610,202, 6 1,4250,022.
, 0,119, 7,6%,
, 36 (75%) 48 .
.
24 (50%) .

, (, , , ).

,

.

25 [8].


. , (Z-
2 2,5)
1842% [4,14].
12% [15,16] 26% [10,17]. ,
. ,
[3,19],
,
.
,

[1, 6, 11,
21], [5,19]. , ,
. ,
,
.
, [12],
[9]. ,

[14].
.
- Z-

No 3/2005
- [2,18],
[16].
,
50 .
, ,
, 5 ,
515%.
, ,
.
,
.
,

, , [2, 6, 16].

D3,
.
,
.
,

[7,17], [4,19].
.

.
, ,
, . ,
,
, , , . ,
,
, .

,
.

D3
.
.

SUMMARY

Research a condition of a metabolism of vitamin

D3, activity proinflammatory cytokines and BMD, at 84
patients inflammatory bowel disease (IBD). Results of research have shown, that steopenia was found in at 75%
of patients. BMD reduction was associated with disorder
of metabolism of vitamin D3 and high activity TNF. The
group of risk was represented by patients with long current of disease, total defeat of a gut, heavy attacks and
extraenteric symptoms of disease. Treatment with alfacalcidol patients IBD positively influences on BMD.

1.Andreassen H., Hylander E., Rix M. Gender, age, and body

weight are the major predictive factors for bone mineral density
in Crohns disease: a case-control cross-sectional study of 113
patients. Am J Gastroenterol 1999; 94: 824828.
2.Ardizzone S., Bollani S., Bettica P. et al. Altered bone
metabolism in inflammatory bowel disease: there is a difference
between Crohns disease and ulcerative colitis. J Intern Med
2000; 247: 6370.
3.Bernstein C.N., Seeger L.L., Sayre J.W. et al. Decreased
bone density in inflammatory bowel disease is related to
corticosteroid use and not disease diagnosis. J Bone Miner Res
1995; 10: 250256.
4.Bjarnason I., Macpherson A., Mackintosh C. et al. Reduced
bone density in patients with inflammatory bowel disease. Gut
1997; 40: 228233.
5.Dinca M., Fries W., Luisetto G. et al. Evolution of
osteopenia in inflammatory bowel disease. Am J Gastroenterol
1999; 94: 12921297.
6.Dresner-Pollak R., Karmeli F., Eliakim R. et al. Increased
urinary N-telopeptide cross-linked type 1 collagen predicts
bone loss in patients with inflammatory bowel disease. Am J
Gastroenterol 2000; 95: 699704.
7.Fries W., Dinca M., Luisetto G. et al. Calcaneal ultrasound
bone densitometry in inflammatory bowel disease: a comparison
with double X-ray densitometry of the lumbar spine. Am J
Gastroenterol 1998; 93: 23392344.
8.Genant H.K., Mall J.C., Wagonfeld J.B. et al. Skeletal
demineralization and growth retardation in inflammatory bowel
disease. Invest Radiol 1976; 11: 541549.
9.Hyams J.S., Wyzga N., Kreutzer D.L. et al. Alterations in
bone metabolism in children with inflammatory bowel disease: an
in vitro study. J Pediatr Gastroenterol Nutr 1997; 24: 289295.
10.Jahnsen J., Falch J.A., Aadland E., Mowinckel P. Bone
mineral density is reduced in patients with Crohns disease but
not in patients with ulcerative colitis: a population based study.
Gut 1997; 40: 313319.
11.Lee S.H., Kim H.J., Yang S.K. et al. Decreased trabecular
bone mineral density in newly diagnosed inflammatory bowel
disease patients in Korea. J Gastroenterol Hepatol 2000; 15:
512518.
12.Lin C.L., Moniz C., Chambers T.J., Chow J.W. Colitis
causes bone loss in rats through suppression of bone formation.
Gastroenterology 1996; 111: 12631271.
13.Meys E., Fontanges E., Fourcade N. et al. Bone loss after
orthotopic liver transplantation. Am J Med 1994; 97: 445450.
14.Pollak R.D., Karmeli F., Eliakim R. et al. Femoral neck
osteopenia in patients with inflammatory bowel disease. Am J
Gastroenterol 1998; 93: 14831490.
15.Robinson R.J., Al Azzawi F., Iqbal S.J. et al. Osteoporosis
and determinants of bone density in patients with Crohns
disease. Dig Dis Sci 1998; 43: 25002506.
16.Schoon E.J., van Nunen A.B., Wouters R.S. et al.
Osteopenia and osteoporosis in Crohns disease: prevalence in a
Dutch population-based cohort. Scand J Gastroenterol 2000; 35:
43-47.
17.Schulte C., Dignass A.U., Mann K., Goebell H. Reduced
bone mineral density and unbalanced bone metabolism in
patients with inflammatory bowel disease. Inflam Bowel Dis
1998; 4: 268275.
18.Silvennoinen J.A., Lamberg-Allardt C., Karkkainen M.
et al. Dietary calcium intake and its relation to bone mineral
density in patients with inflammatory bowel disease. J Intern
Med 1996; 240: 285292.
19.Staun M., Tjellesen L., Thale M. et al. Bone mineral
content in patients with Crohns disease: a longitudinal study in
patients with bowel resections. Scand J Gastroenterol 1997; 32:
226232.
20.Svendsen O.L., Hassager C., Skodt V., Christiansen
C. Impact of soft tissue on in vivo accuracy of bone mineral
measurements in the spine, hip, and forearm: a human cadaver
study. J Bone Miner Res 1995; 10: 868873.
21.Ulivieri F.M., Lisciandrano D., Ranzi T. et al. Bone
mineral density and body composition in patients with ulcerative
colitis. Am J Gastroenterol 2000; 95: 14911494.

19

No 3/2005

.. 1, .. 2, .. 2
(. )
2

() .
. 64 () 23 37
( 28,54,7 ). ,
. 30 . (DEXA).
. 40% . , , . .
. .
. , , , DEXA.
() ,
(,
) [9].

, [6].
,
[8].
.
. , , ,
.

6,

. ,

,
,
.
, .

(DEXA).

64 (
28,54,7 ). (
, 24,9 / ),
(, , ), (
) [4].
,
(/) (, /)
120 (75 ).
-

20

Caro,
HOMA = ( , /) (/
) / 22,5.
HOMA 3,0
Caro 0,33 [2, 5]. () 25,0
/.
, .
(, . . .) (
140/90 . . .).
13
( 25 40 /).
12,42,6 . 49 (52,6%)
. 60 (94%)
.

31,61,96 /.
53 (82%) 150 . .
., 90 . . .,
, .
6,10,5 . 57 (89%) ( 6,30,15 /,
0,90,08 /) (
1,480,1 /).

3
( ) .
I 15 (23%) ( , , , , 2 );
II 38 (59%)
, , ;
III 12 (18%) , , , 2
(. 1).
, 23 .

(, 2 ).
:
(

No 3/2005

21

No 3/2005

);
;
.
, , ,
-

.
(DEXA) Lunar (). (L2L4),
( (neck),
,
Total hip
total body.
/ BMD (Bone Mineral Density) (SD)
(-) .
- 1 SD 1
SD , 1 SD 2,5 SD, 2,5 SD.
30 ,
,
.

Statistika 5,0.
.
p<0,05.

, 40% 1,0 1,8 SD -,
.

,
.
, ,
, .

,
(L2L4),
, , .
,

. , 24 (37,5%)
26 (40,6%) ,
4 (6,25%) (. 2).


. ( total =
1,20,1 SD). , 37%

( total hip =
1,760,4 SD; p<0,001), 11% (total hip = 1,450,12 SD; p<0,01),

22

()

(I )

II

III

15 (23%)

38 (59%)

12 (18%)

38+1,6

25+1,8

37+1,6

(. . .)

163,1+2,9
93,4+2,7

167,2+3,2
95,2+2,9

159,1+2,9
94,4+2,7

(,
/)

36,8+0,8

37,3+0,8

25,3+0,6

, /

39,2+2,1

12+1,7

29,3+1,8

()

15,8+1,2

10,1+0,9

12,5+1,9

2
()

2,4+0,3

1,4+0,1

6,84+0,15

6,4+0,13

5,12+0,11

,
/

(n=64)

total
total

1,1880,2
0,40,09

>0,05
>0,05

L2L4
L2L4

1,0580,1
0,650,09

<0,05
<0,05

total hip
total hip

0,9290,18
1,20,12

<0,05
<0,05

neck
neck

0,8790,1
1,20,12

<0,01
<0,01

0,8210,1
1,41,12

<0,01
<0,01

15%
.
(T total = 0,60,09
SD; p<0,05). 33%
(Ttotal hip
= 1,10,12 SD, p<0,01). 16%
( L2
L4 = 0,510,08 SD, p<0,05) ,
.

(BMDneck =
0,8480,12 /; p<0,05), (BMDneck =
0,6740,09 /; p<0,05).

- , (r=0,55;
p<0,05) (r=0,63;
p<0,01) -
.

No 3/2005
- . (r=0,54; p<0,05), (r= 0,65; p<0,05) (r= 0,53; p<0,05).
-
(r= 0,63; p<0,01), (r= 0,58; p<0,01).

, (100,413,4 89,212,8 ).
- :
total hip = 0,9 0,09 SD; p<0,05, L2L4 = 0,50,05 SD;
p<0,05, T neck = 1,70,3 SD; p<0,01.
(4,60,6 /; p<0,01) (1,410,2
/; p<0,01).
,

. 2325
;
2530 20% ;
3035 36% .
DEXA Z-, 0,10,05 SD. (Z =1,20,12
SD, p<0,01)
.
- Z-.
, (r=0,98; p<0,001).

,
.

, 40% ,
.
,
,

, .

,

.
,

,
DEXA.
,
, . , ,
,
, ,

:
, ,
.

SUMMARY

Condition of bone mineral density in patients wish metabolic

syndrome.
Aim: the estimation of bone mineral densitys (BMD)
condition in young woman this metabolic syndrome.
Materials and methods: 64 patients this metabolic syndrome
(from 23 to 37 years) was inspected. BMD is estimated DEXA.
All patients got treatment, including normal of body mass and
therapy off metformin and Orlistat. Control group was consisted
by 30 women. All patients were estimated bone mineral density.
Results. 40% women wish metabolic syndromes were
diagnosing the osteopenic syndrome. Mark that the decrease
BMD depends from glycemia, insulin and lipid in blades. The
figures of BMD in metabolic syndrome significant decrease in
full metabolic syndrome.
Conclusion. Patients wish metabolic syndrome were marked
decrease BMD to osteopenia in the neck and trochanter.
Key words: metabolic syndrome, hyperinsulinemia, and
osteoporosis, DEXA.

1. .., .. // . . .
1996. No10. . 511.
2. .. //
. . 1999. No7.
. 336.
3. .. // : ,
, , . . 2001. .9, No2. . 5660.
4. .. .
, .
: , 2000. 160 .
5. .., .., .. //
. . 2001. .7, No4. . 5361.
6. ., .. .
// . 1997. No3. .
797802.
7. .. : . .
- . . --, 2000. 38 .
8. .. ,

(- ). // . .
. . , 2002. 320 .
9. ., .. : . . 1997.
10. .. ,
, : . // . 1999. .64, No6. .
725734.
11. Brunner L., Levens N. // Curr Clin. Nutr. Metab. Care.
1998. Vol.1, N6. . 565571.
12. Chan J.M., Rimm E.B., Colditz G.A. et al. // Diabetes
Care. 1994. N17. . 961969.
13. Jensen L., Kollerup G., Quaade F., Sorensen O. // J. Bone
miner. Res. 2001. V. 16, N1. . 141147.
14. Kopf D., Muhlen I., Kroning G., Sendzik I. et al. //
etabolism. 2001. V. 50, N8. . 929935.
15. McCarty M.F. // Med. Hypotheses. 1995. Vol.45, N3. .
241246.
16. Schindler R., Mancilla J., Endres S. et. al. // Blood. 1990.
V. 75. . 740.
17. Tsigos ., Papanicolaou D.A., Defensor R. et. al. // Neuroendocrinology. 1997. V. 66. . 5462.
18. Walder K., FillipsS, Clarc S. // J. Endocrinol. 1997.
V.155. P. 57.

23

No 3/2005

L CALSCAN

.. *, .. *, .. **, .. *, . *
* - . .. ,
** No29

.
.
10% .
2050 , , 312 .
,
[8,10].

,

. ,
.
()
().



[2, 9].

, . 90-
,
[3]:
.

.
[10]

,
(bone mineral mass).


. ,
, .

24

- ,
[7]. ,
CALSCAN,
, ,

.


. , [1]
,
-
CALSCAN
.
[3, 6, 7, 9, 11], , . , ,
, ,
. , [2],
,

. , ,

.
CALSCAN , .

150
20 80 .
Calscan Demetech,
( )
PRODIGY Lunar,
D.

No 3/2005
1

2040

4150

5160

6170

>70

. (-Neck)

0,70

0,53

0,55

0,40

0,54

0,63

. (-Spine )

0,85

0,61

0,43

0,35

0,31

0.47

. (-Spine L)

0,65

0,43

0,40

0,26

0,33

0,47

(Spine -Neck)

0,76

0,75

0,74

0.48

0,54

0,59

. (Spine L-Neck)

0,58

0,60

0,65

0,14

0,47

0,52

. (Spine L)

0,80

0,70

0,59

0,53

0,38

0,54

29,5

45,9

55,9

65,9

76,6

60,8

12

24

31

39

44

150

n=
Spine AP .
Spine L .

2
, , -

Sap-Sl*

+A
n

A
n

A
n

Max

4,5

1,18

63

56

32

25

31

2,5

0,94

57

50

30

23

27

2,0

0,77

61

45

27

21

24

1,5

0,64

46

41

25

20

21

1,0

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(%)
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25

No 3/2005

26

45,0
40,0
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,
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70 .

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No 3/2005
( ) ,
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40%

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100% (. 2).

,

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Kanis J.A. et al. [4] ,

0,6, (SEE)
0,14 /2 17%. ,
5,3%,
6,5%,
0,85. ,

(accuracy)
. ,
,
. -
50% [4].
,
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,
[4,5].

, - ,
.

27

No 3/2005
70
,
,

. ,
-
.


.

.

accuracy ()

, ,

.

(accuracy), ,
,
2, . ,
,
4%. 4% - 2,5
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, 4% -2,5 0,1.

0,2
, 0,2 0,5 , 0,5, .
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.


, , , ,
.

28

,
Calscan ,
.
.

, , Kanis et al. [5],
, ,

, 71,2% 33,8% .
,
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Calscan
, , ,

.

1. .. :
.
. 2004, No 2,
.11-13
2. .., ..

. 2005, No 1,
.41-45
3. Hakulinen M., Saarakkala S., Toyras J., Kroger H., Jurvelin J.S.
Dual Energy X-ray & Laser Measurement of Calcaneal Bone Mineral
Density. Physics in Medicine and Biology 2003; 48:1741-1752.
4. Kanis J.A., Gluer C.C. An update on the Diagnosis and
assessment of osteoporosis with densitometry. Osteoporosis Int. 2000,
11: 192-202
5. Kanis J.A., Johnell O. Requirements for DXA for the
management of osteoporosis in Europe // Osteoporosis Int. 2005.
Vol. 16. No. 3. P. 229-238.
6. Kullenberg R. A new accurate technology for the determination
of bone mineral areal density - Dual X-ray and Laser (DXL). Proc.
Fifth Symposium on Clinical Advances in Osteoporosis, National
Osteoporosis Foundation, USA 2002;
7. Kullenberg R. Falch J. The prevalence of osteoporosis using
bone mineral measurements at the Calcauneus by Dual X-ray and
Laser (DXL). Osteoporosis International 2003, 14, 823-827.
8. Larijani B., Hossein-Nezhad A., Mojtahedi A., Pajouhi M.,
Bastanhagh M.H., Soltani A., Mirfezi S.Z., Dashti R. Normative data of
bone Mineral Density in healthy population of Tehran, Iran: a cross sectional study // BMC Musculoskelet. Disord. 2005. Vol. 6. No. 1.
P. 38.
9. Martini G., Valenti R., Giovani S., Gennari L., Salvadori S.,
Galli ., Nuti R. Assessment of Bone Mineral density of the Calcaneus in healthy and Osteoporotic Women by a new DXA device. J Bone
Min Res 2002; 17, suppl. 1, S280;
10. Michael GJ, Henderson CJ. Monte Carlo modeling of an
extended DXA technique. Phys. Med Biol. 1998, Sep; 43 (9), 2583-96.
11. Waern E., Johnell O., Jutberger H., Karlsson J, Nyman C,
Mellstrom. Patients with forearm fracture should be diagnosed for
osteoporosis. J Bone Min Res 2001:16, Suppl 1, S515;

No 3/2005

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SUMMARY

At admittance to the hospital of 285 elderly and old

people aged 6585, with osteoporosis and fractures
there was a high level of anxiety, there were some
signs of desadaptation, manifestations of frustration
and depression, evident emotions like sadness, distress
and mazement. Psychological condition improved due
to the work of psychologist with the patients, and also
development of individual verbal schemes of psychological
activity and training of patients to use them. Even at the
age of 6070 year the level of uneasiness and depression
decreased, the number and brightness of emotions
increased, activity and work capability increased.
Systematic talks to psychologist decreased the level of
uneasiness and symptoms of depression de to the skill
to transfer the uneasiness to the sphere of interpersonal
relations and communicative connections, and also to
switch patients attention to other problems. It helped
to maintain the achieved effect, improved the psychophysiological condition of body functions, decreased the
negative emotions and their consequences.

1. , .. , /
.. // 1 : . .-. . - , . 2003.- ..
180-185.
2. , .. / ... // : . , ,
2002. - . 119-124.
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7. , ..
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8. /
.., .., .., .. //
. 2001.- No 3. .98-104.

35

No 3/2005

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No 3/2005
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37

No 3/2005
Microsoft Windows 95.

.
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. 1, 6
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10 /., 5,4 % [8].
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No 3/2005

[18].
,
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3 45
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70 1
.

1. 70 1 1000 /.

.
2. , , ,
.
3. .
4. .
5.
.

SUMMARY

We studied the effect of once-weekly alendronat

treatment 70 mg on bone mineral density, bone turnover
and tolerability in 45 women with postmenopausal
osteoporosis. They also received calcium in total dose
1000 mg and vitamin D 400 U per day for the whole
treatment duration..
19 patients were treated with alendronate for 6 and
24 patients for 12 months. Having treated 19 women we
discovered a significant increase of bone mineral density
(BMD) of spine (+5,2%, p=0,01) and 24 women had

significant increase BMD of spine (+7,4%, p=0,01) after

12 months. At the same time there were no significant
increase of BMD of hip within 6 months (+2,12%) in 19
women and significant increase BMD (+3,6%, p<0,05)
within 12 months (n=24). It was founded a significant
decrease of bone turnover markers: Cterminal telopeptide
(bone resorption marker) on 43% and osteokalcine (bone
formation marker) on 42%. Significant increase of PTH
level was revealed after 6 and 12 months. After onceweekly alendronat treatment 70 mg gastrointestinal side
effects were discovered in 7% cases.

1.
. . ,
. -. 2005. . 66.
2.
.. , .., .. . .// 1998 No 2: 28-32.
3.
.. , .. . .// .2004;1:16-19.
4.
.. , .. . .// .1998;1:24-26.
5.
Devogelaer J.P., Broll H., Correa-Rotter R. et al. Oral
alendronate induces progressive increases in bone mass of the spine,
hip, and total body over 3 years in postmenopausal women with
osteoporosis.// J. Bone 1996. vol. 18:141-150.
6.
Tucci J.R., Tonino R.P., Emkey R.D., Peverly C.A., Kher U.,
Santora A.C.II. Effect of three years of oral alendronate treatment in
postmenopausal women with osteoporosis.// American J Medicine 1996.
Vol 101:488-501.
7.
Sambrook P.N., Rodrigues J.P., Wasnish R.D. et al. Alendronat
in the prevention of osteoporosis: 7-year follow-up.// J Osteoporos Int.
2004. Vol.15:483-488.
8.
Black D.M., Cummings S.R., Karpf D.B., et al. Randomized
trial of effect of alendronate of risk of fracture in women existing
vertebral fractures.// J. Lancet 1996. Vol. 348:1535-1541.
9.
Hochberg M. Preventing fractures in postmenopausal women
with osteoporosis Review article.// Drugs/Aging.2000; 4:317-330.
10. Pols H.A., Felsenberg D., Hanley D.A. et al. Multinational,
placebocontrolled, randomized trial of the effects of Alendronate on
bone density and fracture risk in postmenopausal women with low Bone
mass: Results of the FOSIT study.// Osteoporosis Int. 1999.V9;5:461468.
11. Rizzoli R et al. Two year results of once-weekly administration of alendronate 70 mg for the treatment of postmenopausal
osteoporosis.// J. Bone Miner. Res.2002; 11:1988-1996.
12. Black D.M., Cummings S.R., Karpf D.B. et al. Randomized
trial of effect alendronate on risk of fracture in women with existing
vertebral fractures. Fracture Intervention Trial Research Group.//Lancet
1996. V.348:1535-1541.
13. Chestnut C.N.Mc Elung M.R., Ensrud K.E. et al. Alendronate
treatment of the postmenopausal osteoporotic women effect of multiple
dosages on bone mass and bone remodeling.// Am. J. Med. 1995;99:144152.
14. GarneroP, Shit W.J. Gineyts E. Comparison of new biochemical
markers of bone turnover in the late postmenopausal osteoporotic
women in response to alendronate treatment.//J Clin Endocrinol Metab.
1994; 79:1693-700.
15. Massari F, Zanchetta S.R. PTH levels in postmenopausal
women with osteoporosis treated with alendronate.// J Bone miner. Res.
1997; 12 (Suppl 1): 470.
16. Greenspan S.L., Holland S, Maitland-Ramsey L., et al.
Alendronate stimulation of nocturnal parathyroid hormone secretion:
a mechanism to explain the continued improvement in bone mineral.
//Proc. Assoc. Am. Physicians 1996; 108 (3):230-238.
17. Vasikaran S.D., Khan S., McClasky E.V. et al. Sustained
response to intravenous alendronate in postmenopausal osteoporosis.//
Bone 1995; 17(6):517-520.
18. Balena R., Toolan B.C., Shea M. et al. The effect of 2-year
treatment with aminobisphosphonate alendronate on bone metabolism,
bone histomorphometry and bone strength in ovariectomized nonhuman
primates. //J. Clin. Invest. 1993; 92:2577-2586.
19. Bone H.G., Hosking D., Devogelaer J-P. et al. Ten years
experience with alendronate for osteoporosis in postmenopausal women.
N Engl J Med 2004; 350: 1189- 99.

39

No 3/2005

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