-
" "
1998 .
:
,
,
,
-
,
.
. .
-
( )
. . , . . , . . , . . ,
. . , . . , . . ,
.. , . .
8
:
..
..
..
..
..
..
(. )
..
( )
..
..
B.C.
. .
..
..
( )
..
:
.. ()
.. ()
.. ()
.. ()
. . ()
.. ()
.. ()
.. (-)
.. ()
.. (-)
.. ()
.. ()
.. ()
.. ()
55 ,
. . , . .
12
, -
. .
16
. . , . . , . . ,
. . , . . , . . ,
. .
20
()
()
. . , . .
24
( )
. . , . .
28
, D ,
J.D. Ringe
33
:
17036, , . . , . 11. .
. ..
... ..
. 016589 10.09.97. 60x90/8. 5000 . 856
. ISBN 5-7886-0002-5. - , . .
-.
1/200:
..
,
( - . . )
(),
,
. ,
, ().
1.
() , (70%
47%; <0,001). ( ) ()
- ,
(,
) () [7].
, [1,2,7],
, (, ,
), -
(, , ).
-
( ), [4,6].
I
|
|
|
/./.
(),
,
. , , 333 69% , 2
, [10].
, -, ,
(set-point)
,
, -,
.
: ) - ) . ( ) - -
(/2),
, /,0
[2,11]. /2 ,
,
( ) - [1,2,6].
: , , , [10].
16%
11% [1,7].
.
.
, , , ,
[1,2,7].
.
[1,6],
, . , , (.1). (3 . ( ) , ( .)
. . , .
.
,
( ) [6], , :
1) , (=0,46; <0,05)
( .)
./ 2) , (=0,53;<0,02)
. ./.
. -
1/2002
(2)
, ,
. ,
,
;
, . ( ) ,
( (3 . ). , -, - , , , , - ( ).
1.2.
in vitro
- .
, - [3].
-,
, (36%; <0,001).
(63%;
<0,01),
, (75%) [3].
, , (.
2).
(33% 41% ) [3,5,7].
N, 80% .
-, CaP/alb Bsp, -,
CaPr/alb Bsp (. 3).
: , N
[3,5,7].
, 71% ,
- 62%, - 74%, .
,
, ;
,
CaPr/alb, .
-
1
(MSD)
.1 (/-1)
0,380,09
(14)
. 2 (/ 1 )
0,360,09
(14)
1 3 (/'/' 1 )
1,170,33
(13)
2 (/'/" 1 )
-0,120,11
(13)
0,290,09*
(11)
0,350,13
()
0,880,23*
(7)
0,430,15
(13)
0,45+0,09*
(12)
1,130,32
(8)
2,5
+0,040,12*
(9)
* - .
ft . - .
Me . -
3
- 1 2 - .
1
-0,050,15
(13)
1/2002
N -
, , , , , [7].
. ,
.
,
[12]. ,
, ,
. [7],
, - N .
-
++ [1,7]: ++ , , , -
. ,
(
)
. /2 ,
(,
). , -
.
, ,
,
;
, .
, ,
, .
,
, -
.
, , .
,
.
- ,
. ,
, .
-
2
( )
28
psp.
CaPr/alb
++ CaPr/alb=0
1,070,29
2,680,23
1,760,24
1,380,25
0,230,13
CaPr/alb
2,050,34
4 .
40
15
++ 1,0 /
0,900,41
0,790,38*
3,161,13
2,720,53
2,471,80
1,740,66
1,37+0,56
1,130,36*
0,330,24
0,310,19*
+ + 1,4 /
1,920,58
.
.
4 .
42
0,700,40*
3,311,04* **
2,290,96* **
1,170,36*
0,420,23* **
2,020,61
1/2002
3
( )
26
0,270,
7,97+2,11
*
4 *
24
19
2,191,79**
0,860,31***
3,021,18**
3,401,38**
36
l,80,26
l,380,25
++ 1,0 /
22
16
7
0,650,32**
0,8710,28***
1,670.48**
1,5510,43
0,890,26**
1,840,34**
45
1,050,19
2,050,34
++ 1,4 /
14
19
0,460,28**
0,590,24**
1,940,50
1,720,49****
15
0,690,26***
2,270,52
Psp.
CaPr/alb
psp.
CaPr/alb
4 *
15
1,130,61***
4,081,34***
* - () ; ** -
; *** - ; **** - .
. ,
,
[6]. , ,
. , , , . ,
.
2.
3 : (1)
; (2) ; (3) , .
,
, : ()
( , ,
,
); () (
, ); () ( -
). , ,
, - ,
. (), . 126 , ,
, ,
,
[13,14].
[7,8].
( 4-10 ), ,
(osteitis fibrosa cystica),
. , , -
1/2002
. ,
810 2 . , , 7 ,
.
[8].
, . ,
. , , ,
[7].
, , ,
, . , .
1. .. : . ... - . . ., 1990. 88 .
2. .., .., ..,
.. //
- . : , 1987. . 161-171.
3. .., .., ..
// . 1990. 11. .
493-495.
4. .., .., ..,
., .., ..
// . 1991. 6. . 7578.
5. .., .., ..
// . 1991. 9. . 256-258.
6. .., .., ..,
.., .. ,
.
// . 1994. 4.
. . 39-43.
.. 7. .., .. , //
[9]. / . .. . : .,
1998.
8. .., .., ..,
.., .., .. , ,
,
. //
. 2000. 4. . 23-28.
9. .., .., .,
.
.., ..
.
, ,
//
. 1993. 12. . 591-593.
[7].
10. .., .., ..,
.. // : / . .. . .: SUMMARY
, : ., 1995.
Author summarized results of the longitudinal study in
. 1. . 183-211.
mechanisms of calcium homeostasis disorders in patients with
11. Nordin ... Ed. Calcium, Phosphate and
terminal renal failure and following successful kidney trans- Magnesium Metabolism. Churchill Livingstone. New-York.
plantation. Hormonal regulated paths and physico-chemical 1976. P. 683.
1/2002
- (
)
1
.. , .. , .. , .. , .. ,
4
5
.. , .. , .. ,..
' ,
'-- ,
3
,
5
,
( 6, 12 24 )
50 , 1997 ., .
647 (438 209 ): (172 .), (133 .), (193 .), (37 .), (112 .).
6 21,5% (27,1% 19,8% ), 33,6%.
2 274 607 , 45,1% (49% 36,9% ).
. 2 ,
, 31,6% (); 32,6% (); 33,4% (); 53,8% (); 63,4%
(). .
59,3% (384 647 ). - 31,2%,
17,3%, - 7,1% . .
6 93,5%; - 78%; 2 - 65,5% .
, .
: , , , .
, .
. , 12
24% , 50% , 25% [16,17].
[3,13,16].
, [4]. ,
, , , .
50
.
( ).
( 6,12 24 ) 50 , 1997 .
, ( )
.
, ,
, .
6 :
(172 ), (133 ), (193 ), (37 ), (112 ). 647 (438
209 ).
1/2002
(67,7%), .
607 , 40 , .
, ,
8,1% (14 172 ), 5,3% (7 133 ). - 10,2% 7,1%
, - 7,1% 4,4% , . :
, - , , , , , .
. 1. 6 139
647 ,
21,5%. - 27,1%
19,8%, .
33,6% (
213 633 ) 29,9%
42,7% (<0,01). 274 607 , ,
45,1% (36,9%
49% ; <0,01).
(. 2). 6
(9%) (12,8%),
24,3%,
- 28,6% 32,2% (<0,001).
- 15,1%, 23,3% 27% , 43,7%
- 51,8%.
.
(32,6%)
(31,6%), (43,1%),
(54%)
(63,4%). 3 ,
, .
,
, .
(84,2% 72,7% ).
(. 3).
384 647 (59,3%).
() - 31,2%, () 17,3%, () - 7,1%
. ()
.
, ( ), , .
- , .
(. 4). 6 ,
. . 3% . ,
,
, .
.
13,7% ,
, .
. 6
93,5% , - 78%, 2 - 65,5% .
-
. 6 , -
2 -
(45%).
. 2 :
- 23,3% [2) [5] - 25,5% - , -
1/2002
. 1.
50
(1997 .)
.3.
1997 .
. 4.
-
, . , [8]. , 30,8%
35,1%; 2 - 36,2% 48,5%,
[9, 10, 11, 14, 15].
,
. , ,
, . , , , ,
.
, .
, [1,6,7].
, / . , .
,
,
. .
1/2002
2. .., .., ..
// . 2000. 1.
. 9-10.
3. .. //
. ., 2000.
. 76-77.
4. .., ..,
.. .
// . 1999. 3. . 2-6.
5. .., .., .., ..
- // . .,
2000. . 76.
6. .., ..
Elite plus // : . .,
2000. .177178.
7. . , ..,
.. . //
. .,
2000. .182-184.
SUMMARY
8. ., , . Aim of study: to investigate the near and remout outcomes . of hip fractures in 6,12 and 24 months and social consequenc- : . . .: , 1998. 352 .
es in people of urban population elder 50 years in different
9. Altadill Arregui A., Gomez Alonso , Virgys
Socriano M.J. et al. Epidemology of hip fracture in
region of Russia.
Asturias // Med. Clin. (Bare). 1995. V. 105, 8. P.
There were investigated 647 patients with hip fractures
281-286.
(438 females and 209 males) in Irkutsk-city (172 pts), in
lO.Baudoin C, Fardellone P., Bean K. et al. Clinical
Jaroslavl (133 pts), in Ekaterinburg (193 pts), in Electrostal
outcomes and mortality after hip fracture: 2-year follow
- city ofMoscowsky region (37pts) and in Khabarovsk - city
up study // Bone 1996. V. 18, 3 (Suppl). P. 149-157.
(112 pts). In 6 months 139 of 607pts died, the mortality (in
11.Browner W.S., Pressman A.R., Nevit M.C.,
Cummings S.R. Mortality following fractures in older
pts of both sexes) amounted to 21,5%. In one year mortality
increased to 33,6%. To the end of the second year 274 of 607 women. The study of osteoporotic fractures // Arch.
Intern. Med. 1996. V. 156, 14. P. 1521-1525.
pts died and mortality amounted to 45,1% (36,9% in males
12.Harris ., Kovar M.G., Suzman R. et al.
and 49% in females). The indices of mortality considerably
Longitudinal study of physical ability in the oldest old //
differed in different cities. The surgical treatment was conAm. J. Public Health 1989. V. 79. P. 698-702.
ducted in 59,3% (384 Of 647pts), skeletal extension - 31,2%,
13.Hernandez-Berian J.A., Segura-Garcia C, Cuevas
osteosynthesis was conducted in 17,3%; arthroplasty was car- F. et al. Economic burden of osteoporotic hip fracture//
ried out only in 7,1% of cases. Low functional possibilities and Rheumtology in Europe. 1997. V. 26, 2 (Suppl.). P.
51.
daily activity of pts, their poor self-attendance were revealed.
14.Meyer H.E., Tverdal A., Falch J,A., Pedersen J.I.
In 6 months outsider's attendance was required for 93,5% of
Factors associated with mortality after 'hip fracture //
pts, in one year - 78% and two year - 65,5% patients.
Osteoporosis Int. 2000. V. 11, 3. P. 228-232.
15.Parker M.J., Pryor G.A., Myles J. 11-year results
Key words: hip fracture, mortality, surgical treatment,
in
2846
patients of the Peterborough Hip Fracture Project:
functional possibilities.
recuced morbidity, mortality and hospital stay // Acta
Orthop. Scand. 2000. V. 71, 1. P. 34-8.
1/2002
55 ,
.. , ..
, (. - . P.M. )
, . ( - .. )
55 , , 67 ,
.
, (DEXA) , ; - ,
.
. , .
(), () [1-4].
. ()
(),
, [12].
(DEXA).
.
(-) (. 1).
. 1, ,
, . - () - . - , , , [511].
. (-) [-2,5] , -
. , - [-1,0]
[-2,5], .
, , :
1. DEXA , .
2.
.
3.
.
1990 2000 -
() 207
(118 - 57%, 89 43%). 2000 143, 64 . (28%, =58), (26,5%, =55),
1
( )
[01 - ]
[--1-2,5]
[-2,5]
[-2,5]
1/2002
2
-
I
(=38)
II
(=29)
24
-2,10,3
18
-2,40,2
14 -2,60,5
11
-3,40,3
<0,05
>0,05
3
, , ,
**
,
/
,
/
[.]
,
/
0,460,02
-1,960,21
2,60,2
1,530,03
3,750,28
235,010,2
0,4170,021
-2,00,1
2,350,2
1,720,03
4,050,09
239,052,0
0,393+0,011
-2,50,2
2,2+0,1
1,90,1
4,180,22
369,343,5
0,348+0,015
-3,40,2
2,20,2
2,10,2
4,620,31
817,579,8
5,3+0,5, /;
* 32,43,2 . (=12)
15,0+3,2, /;
36,24,1 . (=28)
32,6+3,6, /;
43,94,0 . (=39)
82,7+5,8, /;
55,85,0 . (=26)
1/2002
,
/2
Z- (%)
.,
/
,
/
++,
/
[.]
(=5)
0,2890,021
55,01,9
-3,70,2
2,450,09
1,80,4
42956,2
0,940,03
4,430,23
,
95,1+0,7 /
(=3)
0,2940,063
50,311,1
-4,80,8
2,570,24
2,10,2
1905,7385
1,10,07
5,390,30
>0,05
>0,05
>0,05
>0,05
>0,05
<0,05
>0,05
<0,05
,
5,23+13,2 /
-
(OCTEIA intact PTH IEMA kit).
() DEXA
PIXI "Lunar" [5-7, 11,12]. , -.
(-
[~3,5])
Lunar News [9,10].
-
. .
-,
(. 2).
. 2 , II
. - I II
20%, , ,
. 7 II -
,
%
,
88,9+12,0 . (=6)
44,94,5
2,9
42,0+6,3 . (=2)
58,52,5
2,0
[-3,4+0,3]
II .
5565 (=22,
42,0+6,0 ) - [-2,20,2]. 65
(=7) [-2,80,3] 33%. I (" " 40,64,9 ,
36,34,4 /)
- ([3,0+0,4] [-2,50,3] ).
DEXA
.
(
).
,
(. 3).
. 3, - [-2,0]
18 /.
() , -,
, .
,
, . - [-2,0] , , .
- [-2,0].
1/2002
8 (3 5 )
3,9% , . 40%
. 2 , - 2 .
2 .
. 4,
, ,
[] .
0,2920,023 /2 Z- 53,33,9.
- [-3,5],
- [-4,0]. -,
,
.
" " II
( 55 ), , (. 5). ,
, ,
.
D
DEXA.
20
,
( 46,6+0,4 ,
2
1,68~0,02 , " " - 43,84,8
). (=10, [-2,40,2])
-3- () 0,25
2,5+0,5 . 1 1,5 .
(=10, - [3,70,2])
50
ME 1,50,5
1,5 .
. -3- 1920% ( [-2,5] [
2,0]; 0,3960,024
0,4250,014 /2).
- [-3,7] [3];
0,315+0,014 0,3570,019 /2.
,
. , ,
.
1. () ,
.
2.
.
3.
.
1. .. -
// : / .
.. // . 2000. . 62-76.
2. ..; .., .., .. // . 2000. 3.
. 1619.
3. .., . D. EULAR Publ., Basle 1996. P. 140.
4. .., P.P. //
. 2001. . 82, 1.
. 61-64.
5. El-Haj 3., Fuleihan G., Stock ., Saifi G., Me Clung
M.R. Bone mineral density reporting in the US: a national random
survey // Bone Miner Reg, 1999, 14 (Suppl 1), 52-53.
6. Faulkner K.G. Bone densitometry-choosing in proper
skeletal site to measure // J Clin Densitometry, 1998, 1:
279-285.
7. Faulkner K.G., von Stetten E., Steiger P., Miller P.
Discrepancies in osteoporosis prevalence at different skeletal sites:
impact on the WHO criteria // Bone 23 1998'.(Suppl): P. 194.
8. Greenspan S.L., Maitland-Ramsey L, Myers E.
Classification of osteoporosis in the elderly is dependent on sitespecific analysis // Calcif Tissue Int, 1996, 58: 409-414.
9. Lunar News. T-score. Contention is increasing // Lunar
News Winter, 1. 2000. P.I 1-12.
10. Lunar News. Bone Densitometry. Reimbursement in
US. Expanded//Lunar News. Autumn, 4. 1998. P. 6.
11. Mazess RB. T-scores differ among skeletal sites // Calcif
Tissue Int, 1999, 64: P. 104.
12. Rix M., Andreassen H., Eskildsen P., Langdahl .,
Olgaard K. Bone mineral density and biochemical markers of
bone turnover in patients with predialysis chronic renal failure /
/ Kidney Int, 1999, 56: 1084-1093.
1/2002
..
( - . . .
Achilles+ (Lunar, USA) - 41 23 67. , . ,
, , , , , . 1 .
D3 .
.
[4]. [3,9].
,
,
.
[1,7].
[2,6].
,
- ,
.
41 2-3
23 67 ,
. , -
. ,
45 , 2 : 23 44
45 67 . 22
, - 19.
, 123 . : 69
54 . -
. .
Stiffness-
Achilles+ (Lunar, USA), - (SD) Z-
.
1 SD, <1SD,
>2,5 SD , -2,5 SD - .
: (), ; (), , ; (%),
: =0,5*(-
1/2002
-
, ( )
()
()
44
37,822,04
<0,01
=11
2,32 1,04
-0,39 0,13
<0,01
-0,360,11
>0,05
122,272,09
>0,05
1541.093,57
<0,01
92,931,71
<0,01
44
35,64 2,01
<0,05
=11
2,620,96
-2,090,24
<0,01
-1,420,18
<0,01
103,823,23
<0,01
15128,12
<0,01
72,83,1
<0,01
45
54,82.31
>0,05
=8
5,182,66
-0,28+0,54
>0,05
-1,750,57
>0,05
1376,82
>0,05
154410,32
>0,05
103,567,13
>0,05
45
55,731,98
>0,05
=11
1,970,73
-3,120,83
<0,01
-1,610,85
<0,01
101,274,06
<0,01
1507,4518,86
<0,01
69,64,08
<0,01
44
29,91,7
=10
-0,410,26
-0,670,24
129,23,08
1569,38,29
105,43,35
45
52,91,3
=17
-0,210,2
-1,490,2
1312,3
1557,15,26
103,22,74
- ; - .
+), =(-50/75).100;
=-1380/180* 100.
- () () ,
.
| () .
Screen master
plus (Hospitex Diagnostics S.A., ) Hospitex Diagnostics.
(), (.)
CIS
International (). OK ,
/ -
. 31 1
. ,
,
D3 6 .
Microsoft Excel Windows
( ) ,
t- , .
,
44
( ) 23,2%
, - 38,9%,
- 50% 57,9% ,
,
(<0,05).
1/2002
2
-
( )
44
2,030,01
<0,05
=11
0,920,03
<0,05
=11
0,070,006
<0,05
=11
0,460,03
<0,05
=
52,11,62
<0,05
=10
23,922,54
<0,05
=10
15,051,78
<0,05
=9
44
1,90,02
<0,01
=9
1,120,07
<0,01
=10
0,140,01
<0,01
=10
0,450,03
>0,05
=10
63,784,18
<0,01
=10
42,254,25
<0,01
=7
28,914.8
<0,05
=6
45
2,170,1
>0,05
=8
0,810,02
>0,05
=8
0,050,01
>0,05
=8
,530,02
>0,05
=8
48,82,58
>0,05
=8
19,342,37
>0,05
=8
17,671,26
>0,05
=8
45
1,880,03
<0,01
=11
1.110,04
<0,01
=11
0,20,03
<0,01
=11
0,460,06
>0,05
=11
77,646,7
<0,01
=11
26,282,99
>0,05
=9
13,212,48
>0,05
=10
44
2,070,02
=10
0,830,03
=10
0,070,004
=10
0,520,04
=10
49,30,67
=10
19,70,71
=6
16,231,78
=6
45
2,1 0,02
=16
0,80,03
=16
0,080,01
=14
0,470,03
=14
51,350,86
=11
19,622,69
=7
16,560,78
=14
- ; - .
. 1,
, Z, , , (<0,01), , ,
.
, , ,
,
, .
.
(=0,99; <0,001)
.
.
. 2.
(<0,01) .
.
(<0,01) .
,
-,
[8].
(<0,01)
,
(<0,01) , Krolner [5].
(=0,44; <0,01), -
1/2002
/ (=0,7; <0,001),
.
, , 44
.
(=-0,66; <0,001).
. Rosen R. Adler (9) , . 1 , Z, , , ,
(>0,05). D3
(<0,05) (<0,05)
, Z, ,
(>0,05).
emia, hyperphosphatemia, hypercalciuria, and elevated levels of parathyroid hormone, alkaline phosphatase and osteocalcin. The results of the study shows
that hyperthyroidism is associated with increased rate
of bone formation and bone resorption. Restoration of
BMD was not observed 1 year after the achievement of
euthyroid state in patients with hyperthyroidism. Calcium and vitamin Z), intake should be recommended to
the patients with hyperthyroidism.
1. .., ..,
.., .., ..,
.., .. - //
. 1997. .43, 5. . 12-16.
2. .., A.M.
- - // : /
. . .. . .: .
.. , 1989. .202.
3. Diamond ., Vine 3., Smart R., Butler P.
:
// Ann.Intern.
Med. 1994. 120. P. 8-11.
1.
4. Gomez Acotto C, Schott A.M., Hans D.,
. Nipomniszeze H., Mautalen C.A., Meunier P.J.
, Hyperthyroidism influences ultrasound bone
.
measurement on the os calcis // Osteoporos Int. 1998,
8. P. 455-459.
2. -
5. Krolner ., Vesterdae Jorgensen J., Pors
, ,
Niesen S. Spinal bone mineral content in myxoedema
, and thyrotoxicosis: effects of thyroid hormone and
, antithyroid treatment // J. Clin. Endocrinol. 1983,
18. P. 439-446.
.
6. Lalau J., Sebert J., Marie A. et al. Effects of
thyrotoxicosis
and its treatment on mineral and bone
3. metabolism // J. Endocrinol. Invest. 1986. V. 9.
P. 491-496.
.
4. 1
7. Mosekilde L, Eriksen E., Charles P. // J.
Endocrinol. Metab. Clin. 1990. V. 19. P. 35-63.
.
8. Peerenboom H., Keck E., Kruskemper H.L,
5. Stronhemeyer G. The defect of intestinal calcium
transport in hyperthyroidism and its response to therapy
D3.
// J. Clin. Endocrinol. Metab. 1984, 59. P. 936940.
SUMMARY
9. Rosen C.J., Adler R.A. Longitudinal changes
Osteoporosis was detected more frequently in wom- in Lumbar Bone Density among Thyrotoxic Patients
en with hyperthyroidism compared to the control group. after Attainment of Euthyroidism // J .Clin.
The decrease of BMD was associated with hypocalciEndocrinol. Metab. 1992, 75. P. 1531-1534.
1/2002
.. , .. , .. , .. , .. ,
2
2
.. , ..
'
2
,
30 , 8216+1926 / .
(DEXA)
(L2-L4) .
(SD) (-).
() ; - (), ELISA.
, 24%
-1 -2,5 -, 3%
2,5 . 18% ; 3% ; 6%
.
(=0,725) .
. 80%
(=0,511) . .
()
.
.
() -
, [1,2,3]. 45% ,
() [13].
[14]. ,
[5,6].
.
, ,
()
[1,3,5].
2-5%.
, ,
.
( , , , )
, () - [3,13,7]. , (
30%
) [3,5]. ( ) [4].
,
,
[10,15,14].
I .
,
.
30 ( 20 40 ) 1200 /
1/2002
50 000 / (82161926 /). .
2700 /, 540 /,
- 1880134,7 / (=10). 2700 50 000 /,
11 3842625 / (=20).
1000 /;
; ,
( 100
5 ); , ; , , D
, ; ; ;
; .
() DEXA (L2-L4)
( - Neck.,
- Total hip). (SD)
(-).
-
.
.
() ( 1-35 /)
(36 92 /). Elecses 1010 ().
- 1 ().
, (90%) [12].
- 1 .
1 .
- . 1 2 -1- 1 -2-,
- [11].
1 : (N- -)
(-- -N 1 ). ,
. , -
, N- , - (- - -
117 , 6-8 ).
, - N-
, 1 . ,
. ELISA
-
1 ( 0-0,28 /).
,
- , .
Microsoft Exel . .
, 24% -1
-2,5 -, ..
. 3% 2,5
(SD) .
73% , ,
, 1 SD , L2-L4
-1SD. .
: 18% ; 3%
; 6%
.
, .
0,725.
.
2
. -
1/2002
1
, /
, /
1872,5291,41
0,240,08
II
112013828
0,590,07
<0,05
<0,001
,
/
,
/
1872,52914
262,8
0,240,05
3211437,3
231,8
0,390,06
4182823,5
230,7
0,5080,09
178874404
282,6
0,4950,08
20%
80%
. 1.
. 2.
(-)
()
,
,
. , , (),
.
, ,
.
.
- . 80%
(. 1).
A. Colao . [7]
N- (NTx) 20
20 .
NTx
.
.
, Di Somma . .
[9]. ,
. Shaarawy . [15], , , .
(. 1).
2700
/ ( 1872,5) .
2700 / 50 000
/ 0,101 1 /.
- 0,511 (<0,05).
(. 2) , , (. 2).
3 : 1
;
-1SD; (. 2).
. , , , ,
,
,
.
- :
,
.
,
, .
1. T.C., ..,
.. //
. 2000. 4. . 16-18.
2. .., .., ..
. , , : , .
., 1999. 63 .
3. .. - : . ... . . . ., 1993.
19 .
4. .. . .:
. , 2002. 195 .
5. .., .., ..
. //
1. 27%
. 1992. . 38, 6. . 17-19.
, L2-L4.
6. .., .. 2. : .
// .
3. 2000. 6. . 24-29.
7. Colao A., Ferone D., Lastoria S. et al.
,
Prolactinomas in adolescents: persistent bone loss after 2
. years of prolactin normalization. Clin Endocrinol. Oxford
, 2000 Mar. V. 52(3). P. 319-27.
8. Consensus Development Conference: Diagnosis,
.
prophylaxis and treatment of osteoporosis. Am. J.Med.
4.
1993. V. 94. P. 646-650.
.
9. Di Somma C, Colao A., Di Sarno A., Klain
M., Landi M.L., Faccciolli G., Pivonello R., Panza
SUMMARY
In purpose to estimate influence of the elevated PRL levels N., Saivatore M., Lombardi G. Bone marker and bone
density responses lo dopamine agonist therapy in
on metabolic processes in the human body, we studied bone
hyperprolactinemic males. J Clin Endocrinol Metab. 1998
turnover in women with sustained hyperprolactinemia.
Mar. V. 83 (3). P. 807-13.
Thirty female patients of reproductive age (from 20 to 40
10. Eriksen E.F., Brixen K. and Charles P. New
. .) with various disorders of menstrual cycle were examined.
markers of bone metabolism: clinical use in metabolic bone
Prolactin levels accounted 82161926 fU/L.
Dual-energy x-ray absorptiometry (DEXA) was used for disease. Eur. J. Endocrinol. 1995. V. 251-263.
ll.Garnero P., Hausherr E., Chapuy M.C., Marcelli
analysis of the bone tissue condition on the ground of score in
C, Grandjean H., Muller C, Cormier C, Breart G.,
the hip and spine. Serum osteocalcin () and alkaline
Meunier P.J., Delmas P.D. Markers of bone resorption
phosphatase (ALP), as markers of bone formation and Ctelopeptide of type I collagen (CTx) levels as markers of bone predict hip fracture in elderly women: the EP1DOS
Prospective Study. J Bone Miner Res. 1996 Oct. V.
resorption, were measured using direct immunoassays.
11(10). P. 1531-8.
Bone mineral density (BMD) from - 1 to - 2,5 SD was
12. Calvo M.S., Eyre D.R., Gundenberg C M .
observed in 24% of patients, lower that -2,5 SD - in 3% of
patients. In 18% of patients loss of BMD was found in different Molecular Basis and Clinical Application of Biological.
Markers of bone Turnover // Endocrine reviews, 1996.
spine segments, in 3% of women - in the hip, and in 6% of
V. 17. P. 333-363.
patients - both in hip and vertebra. In most of these patients,
BMD loss correlated with the duration ofamenorrhea (r=0,725) 13. Sanfilippo JS. Implications of not treating
hyperprolactinemia. J Reprod Med 1999 Dec: V. 44 (12
and did not correlate with a level of prolactin.
Biochemical changes reflecting bone formation were not Suppl.). P. 1111-5.
14. Seibel M., Lang M., Geilenkeuser W.J.
found in our servey.
CTx levels were increased in 80% of patients and signifi- Interlaboratory variation of biochemical markers of bone
cantly correlated with prolactin levels (r=0,511) and avail- turnover. Clin Chem 2001 Aug; V. 47(8). P. 1347-9.
15. Shaarawy M., El-Dawakhly A. S., Mosaad M.,
ability, but not with duration of amenorrhea. CTx increase
was associated with more significant decrease of BMD. These El-Sadek M.M. Biomarkers of bone turnover and bone
changes demonstrate that patients with sustained hyperpro- mineral density in hyperprolactinemic amenorrheic women.
Clin Chem Lab Med. 1999 Apr. V. 37(4). P. 433-8.
lactinemia are at the high risk of the development of osteoporosis.
1/2002
()
()
.. , ..
,
(. - . P.M. ),
, . ( - .. )
10 - 207
189 .
,
,
.
, ,
, ( 40 ), ,
. - ,
, . (), [] - (
, ..).
, , .
.
,
[3].
, [4].
: . , 45-50 - , [1,2].
, (),
( )*.
, , , .
,
.
, (), ++ , , , , ,
( , -
D, , ..) [1,9,10].
-
,
(), , ,
[2,5].
. 6,9 / 18 / (
0,8-3,9 /) [4,10].
- ,
. ,
.
- .
[4,5].
, , : , -
1/2002
,
.
1990 2000 - 207 (118 - 57%,
89 - 43%). 2000 143 ,
64 . (28%, =58), (26,5%, =55), (14,5%, =30), (10,2%, =21),
(10,8%, =22). ( , ..)
(5,3%, =11) (4,8%, =10).
( )
23,8% , .
55
(24,5%, =12). 40
15,6% (=12),
, .
3
210+30 4008 (, )
(F6HPS), , AF-72 BI-84; 500 /, 26510 /, kt/v - 1,470,06.
.
Hitachi-902 () ( -
, /; ++, /;
, /; ,
/; /).
- (1
intact PTH IEMA kit).
() PIXI "Lunar"B
[8,9].
, -. (- |~3,5))
Lunar News |6,7|.
-
. .
4,0 10,0 /,
,
,
(. 1).
. 1, . , , 4 , ,
.
()
- [5]. 71,4%
,
25,4+3,2 .
(=16)
51,24,2
(=6)
,
/
,
/2
Z-
(%)
- +SD
.,
/
,
/
,
/
[.]
5,30,5
0,48910,015
83,2+3,1
-1,65+0,29
2,6+0,2
1,490,03
234+10,2
3,840,29
5,2+1,2
0.385+0,020
70.4+2,4
-2.8+0,2
2,2+0,1
1,650,05
239+11,2
3,550,27
>0,05
<0,05
<0,05
<0,05
>0,05
>0,05
>0,05
>0.05
1/2002
2
( 34,0+4,1 .)
,
/
,
2
/
.,
/
, /
++,
/
(=6)
(0,70,03)
14,83,2
0,4230,021
-1,60,4
2,450,15
306,052,0
1,020,02
(73,2%).
( 0,7 /)
6,9 18 / (. 2).
. 2,
,
, 2-3 (- [-2,0]).
.
,
, 4 [10].
(),
- (. 3).
[*] , , - , -
[10].
.
: , ,
,
[5].
, , ,
[2]. ,
, .
D,.
- ++. ,
.
, , , , . ,
[5].
,
/
,
/2
,
/
,
/
++,
/
[.]
, 3,30,2,
/, "
" 37,03,2 . (=9)
4,81,0
0,5120,031
-1,60,4
1,530,03
23510,2
1,10,1
4,980,22
0,3230,062
-3,720,3
2,00,2
1108385
, 2,9+0,3,
/,, "
" 68,8+8,9 . (=8) 64,610,7
0,820,08 5,690,45
1/2002
4
, /
Mg, /
9-18 / (=12)
2,350,05
1,340,03
50 / (= 15)
2,170,05
1,150,03
<0,05
<0,05
[1].
.
,
. 20% ; , [5].
: . , ,
. .
.
, ,
[5]. (. 4).
. 4
.
, 4,0 10,0 / . 2,7 /,
1,5 /, , D3.
1. , , ( 40 ),
,
. - , , -
.
2. (), [|
- ( , ..).
3. , , .
1. .. -
// : /
. .. . : , 2000. . 62~76.
2. .., .. . .: , 1999. . 270
273.
3. Consensus development conference: diagnosis,
prophylaxis and treatment of osteoporosis // Am J Med
1993; 94: 646-650.
4. Matluche H.H., Monier-Faugere M.C.: Risk of
adynamic bone disease in dialyzed patients // Kidney (Suppl
38); 1992, s 62.
5. Llach F. Rental osteodystrophy. In: Replacement
of renal function by dialysis/ Fourth edition, ed by
Winchester J.F. // Kluwer academic publishers. 1996.
P. 1159-1235.
6. Lunar News. T-score. Contention is increasing //
Lunar News Winter, 1. 2000. P. 11-12.
7. Lunar News. Bone Densitometry. Reimbursement
in US. Expanded // Lunar News. Autumn, 4. 1998. P.
6.
8. Mazess R.B. T-scores differ among skeletal sites //
Calcif Tissue Int 1999. 64. S. 104.
9. Rix M., Andreassen H., Eskildsen P., Langdahl
., Olgaaard K. Bone mineral density and biochemical
markers of bone turnover in patients with predialysis chronic
renal failure // Kidney Int 1999. 56: 1084-1093.
10. Sherrard D.J. Renal osteodystrophy. In: Principles
and Practice of dialysis. Ed by William L. Henrich.
Williams & Willkins, Baltimore. 1994. P. 234-246.
1/2002
( )
.. , ..
( - . . ) ,
. ,
, , [25).
() ( ), ( ). .
( ) 25 , , ().
. , .
, .
, .
[30]. [30]. (
)
[1].
(). "" -1, .
, ,
[39]. , -
-1 [17]. Green
. " " ,
- , -1
[16]. ,
. , , , ,
[9].
[5] -1 . -1 [34].
: 3 , & [23]. ,
. ,
[16].
,
, in vitro [7].
. . [19]. , .
in vitro [3]. , , ,
.
[31].
.
.
[28, 35].
()
1/2002
.
,
, .
.
30-100%
100%
( , 20% ) [1]. : , ,
[32]. D.A. Bailey, : 26% ,
, 2 , - 12 15,9 (14,01,0
.) 10,5 14,6 - (12,50,9 .) [4].
,
,
2 11 17 ,
. Mora . [26] . Nichino [29],
, ,
[29]. 9- [15].
, , - (
). . Fricke [13] . Tommasi
[38],
10 15 . ,
( , - I , ,
I
)
, [14, 26, 29, 32]. ,
,
4-5 , [37]. .. Sen
.
[33].
,
Tanner PI 2.
4 Tanner 5 Tanner.
R. Sorva . [36].
A. Conti 4-5
2-3 Tanner - [10].
.
[22].
. [6, 12, 27, 21].
.
, ,
.
, , Finkelstein . [12[, S. Bertelloni . [6]. .
, ,
.
.
,
[21]. ,
.
. , ,
,
,
[8].
,
, . - [11]. M.N. Moreira-Anres . [27]
, , , 10 ,
.
, .
, , . , -
1/2002
. , ,
[24]. ,
.
, ,
,
, , , ,
, .
.
.
1. .. . .:
, 1999. . 378-395.
2. .., .., .. : , , : . ,
1999. 63 .
3. Abu E.O., Horner A., Kusec J.T. et al. The localization
of androgen receptors in human bone. J Clin Endocrinol Metab.
1997. 82. P. 3493-3497.
4. Bailey D.A., Martin A.D., McKay H.A. Calcium
accretion in girls and boys during puberty: a longitudinal analysis.
Bone Miner Res 2000. 11. P. 2245-2250.
5. Barnard R., Ng K.W., Martin T.J. et al. Growth
hormone (GH) receptors in clonal osteoblast-like cells mediate
a mitogenic response to GH. Endocrinology. 1991. 128. P.
1459-1464.
6. Bertellorii S., Baroncelli G.L., Battini R. et al. Shortterm effect of testosterone treatment on reduced bone density in
boys with constitutional delay of pubertv. Bone Miner Res.
1995. 10. P. 1485-95.
7. Blanchard O., Tsagris ., Rappaport R. et al. Agedependent responsiveness or rabbit and human cartilage cells to
sex steroids in vitro. J Steroid Biochem Mol Biol. 1991. 40. P.
711-716.
8. Bonjour J.P. Delay puberty and peak bone mass. Europ
J of Endocrinol. 1998. 139. P. 257-259.
9. Bouillon R. Growth hormone and bone. Horm Res.
1991. 36. P. 49-55.
10. Conti A., Ferrero S., Giambona S. et al. Urinary free
deoxypyridinoline levels during childhood. J Endocrinol Invest,
1998. 21. P. 318-322.
11. Ferrari S., Rizzoli R., Slosman D. Familial resemblance
for bone mineral mass is expressed before puberty. J Clin
Endocrinol Metab. 1998. 83. P. 358-361.
12. Finkelstein J.S., Kibanski A., Neer R.M. A longitudinal
evaluation of bone mineral density in adult men with histories of
delayed puberty. Clin Endocrinol Metab. 1996. 81. P. 1152
1155.
13. Fricke O., Stabrey A., Schoma E. Chemiluminescence
immunometric assay for measuring osteocalcin in healthy
children. Clin Lab. 2000.46. P. 281-284.
14. Fujimoto S., Kubo ., Tanaka H. et al. Urinary
pyridinoline and deoxypyridinoline in healthy children with
growth hormone deficiency. Clin Endocrinol Metab. 1995. 80.
P. 1922-1928.
15. Goslings W.R., Cole T.J., Prentice A. Rate of radial
bone mineral accretion in healthy children. Acta Paediatr. 1995.
84. P. 383-387.
16. Green H., Moricawa M., Nixon T. A dual effector
theory of growth hormone action. Differentiation. 1985. 29.
P. 195-198.
1/2002
, D
,
J.D. RINGE
Cologne,
( , .)
I
,
() , 10% , , . , , .
:
(), , ,
/ ,
.
,
,
, . ,
D
,
( ).
.
[1].
[2].
.
, , ,
D, , ,
.
13
, 15 ,
1000 [3]. ,
,
,
.
,
.
,
. Sambrook
[4], , 29 ,
1000 , 4,3%, - 2,9%
. , 1 , ,
, ,
(4 14 )
(500 76 ).
, , , , 3,2% 1,7% [5]. , ,
2,8 2,6% [6].
,
[3], , 500-1000
,
.
Hahn [7,8]
D 25- . , . ,
, , , , . 50 000 ME 3
[7]. 40100 25- D [8]. 500 .
D [9-12].
, D, .
500 400 ME D
.
-
, 62 , 1
. 50 000 ME D 1000 ,
31 . . 1.
,
D
[16]. ,
D
1/2002
D.
,
D
, [17].
, 11 , D, - .
,
, D ( .
: 50 000 ME 7143 ME ) 500-1000
[18]. , ,
25- D
- D.
D
(25- D) 1 1,25- D (), ,
. -
, , , . , , , , .
0,5 ,
- 1,0 .
D
D
. -, . 20 , 5-15 ,
[19].
. [20]. -, 1 D
[21].
1,25- D. -
D-
.
, D :
1. D , .
2. D ,
.
3. , , .
23 1984 . 0,4
500 ,
.
18 [24]. ,
, .
Sambrook
[4] 92 .
0,6 ,
1000 . 1
.
, , -
, .
.
90 , ,
0,5 500 [25]. 0,50-0,75 58 [26].
1
, , 50 000 ME D
1000 ( ) ( ) [16]
, %
12 .
-2,6
-4,1
24 .
-3,7
-3,8
36 .
-2,2
-1,5
1/2002
,
. 1980
[27-32] , , .
.
:
. 41 ( , , ),
0,25-1,0 ,
, 4,4% , ,
0,5% .
- ,
[34|. 145
, 30
15 . , 1 , 12 . 405 . 57 , : 39:61%. 46,6 43,6 /. .
107 , , (38, , 33,
)
, 3, 6 12 . 6 2,11% 4%
. . I 12 .
1 1 .
, -
, . ,
, .
. ,
D,
D.
Francis |36| 0,5 5001000 ME D,
" 49 (
- 69 ). 3 45
(<0,05) ,
D. , ,
.
D [37]. , , 1
500
( , 43 ), 1000 ME D, 500 ( , 42 ). , , ,
,
(= -3,28 -3,25 ) ,
.
(+2,0%) (0,5%).
, (+1,47 +0,45% ) (. 2).
, . 12 10
21 17 (
).
, D.
,
D.
-5,67
, 0,39
D
D
,
: D D. D
. . D - , .
D
, 25- - D
1,25-(), - D
. 1.
,
. 2.
(<0,0001 24 36 )
D
D
[37]
, D
, :
1. 500-1000 ,
, .
2. D
(
D).
3. D (0,5
) (1,0 ) . .
4. D , (, , , , ).
11. Bernstein C.N., Seeger L.L., Anton P.A. A randomized, placebocontrolled trial of calcium supplementation for decreased bone density in
corticosteroid-using patients with inflammatory bowel disease: A pilot study.
Aliment Pharmacol Ther 1996; 10:777-786.
12. Buckley L.M., Leib E.S., Catularo K.S., Vacek P.M., Cooper S.M.
Calcium and vitamin D5 supplementation prevents bone loss in the spine
secondary to low-dose corticosteroids in patients with rheumatoid arthritis.
Ann Intern Med 1996; 125:961968.
13. Lane N.E., Genant H.K., Kinney J.H., Englemann E. Effect of
intermittent cyclic etidronate therapy for glucocorticoid-induced osteoporosis
in rheumatoid arthritis: Interim analysis. J Bone Miner Res 1993;8:S262.
14. Pitt P., Li F., Macintosh A double-blind, placebo-controlled
study to determine the effects of intermittent cyclical etidronate on bone mineral
density in patients on long-term corticosteroid treatment. J Bone Miner Res
1997;12:S510.
15.Poubelle P.E., Adachi O. Hawkins F.: Alendronate increases bone
mineral density in patients on glucocorticoid therapy: Results of the multinational
study. Arthritis Rheum 1997;40:S327.
16. Adachi J.D., Bensen W.G.. Bianchi F., Cividino A., Pillersdorf F..
Sebaldt R.J., Tugwell P. Gordon M., Steel M., Webber Goldsmith CH:
Vitamin D and calcium in the prevention oicorticoid-induced osteoporosis: A
3-year follow-up. J Rheumatol 1996;23:995-1000.
17,Amin S., La Valley M.P., Simms R.W., Felson D.T. The role of
vitamin D in corticosteroid-induced osteoporosis. Arthritis Rheum
1999:42:1740-1751.
18.Adachi J.D., loannidis G. Calcium and vitamin D therapy in
corticosteroid-induced bone loss: What is the evidence? CalcifTtssue Int
1999:65:332-336.
19. Lund ., Andersen R.B., Friis ., Hjorth L., Jorgensen F.S.,
Norman A.W., Sorensen O.H. Effect of 1 a-hydroxyvitamin D} and 1,25dihydroxyvitamin D. on intestine and bone in glucocorticoid-treated patients.
Clin Endocrinol 1977;7:177S-181S.
20. Ringe J.D. Active vitamin D metabolites in glucocorticoid-induced
osteoporosis. CalcifTtssue Int 1997;60:124127.
21.Tsurukami H., Nakamura ., Suzuki K., Sato K., Higuchi Y.,
Nishii Y. A novel synthetic vitamin D analogue, 2(J-(3-hydroxypropoxy)l,25dihydroxyvitamin D. (ED-71). increases bone mass by stimulating the bone formation
in normal and ovanectomized rats. Calcif Tissue Int 1994;54: 142-149.
22. Nielsen H.K., Brixen K., Kassem M., Mosekilde L. Acute effect of
1,25-dihydroxyvitamin D,, prednisone and 1,25-dihydroxyvitamin D, plus
prednisone on serum osteocalcin in normal individuals. J Bone Miner Res
1991:6:435-440.
23.Mathieu C, Waer M., Laureys J., Rutgeerts O., Bouillon R.
Activated form of vitamin D (1,25-(OH),-D,) and its analogues are dosereducing agents for cyclosporine in vitro and in vivo. Transplant Proc
1994:26.3048-3049.
24. Dykman T.R., Haralson K.M., Gluck O.S., Murphy W.A., Teitelbaum
S.L., Hahn T.J., Hahn B.H. Effect of oral 1,25-dihydroxyvitamin D and
calcium on glucocorticoid-induced osteopenia in patients with rheumatic
diseases. Arthritis Rheum 1984:27:13361343.
25.Neuhaus R., Lohmann R., Platz K.P., Guckelberger O., Schon
M., Hierholzer J., Neuhaus P. Treatment of osteoporosis after liver
transplantation. Transplant Proc 1995;27:12261227.
26. Sambrook P., Marshall G., Henderson K., Keogh A., MacDonald
P., Spratt P. Effects of calcitriol in the prevention of bone loss after cardiac
or lung transplantation. J Bone Mine; Res 1997; 12 (suppl l):S400.
27. Graf H., Stummvoll H.K., Kovarik J., Bergmann H. Aktive VitaminD-Metabolite in der Therapie der Cortisonosteoporose. Wien Klin
Wochenschr 1980;92:776777.
28.Braun J.J., Birkenhager-Frenkel D.H., Rietveld A.H., Juttmann J.R.,
Visser T.J., Birkennager J.C. Influence of la-(OH)D. administration on bone
and bone mineral metabolism in patients on chronic glucocorticoid treatment:
A double-blind controlled study. Clin Endocrinol 1983;18: 265-273.
29.Schaadt O.P., Bohr H.H. Alfacalcidol in prednisone treatment - A
controlled study of effect on bone mineral content in lumbar spine, femoral
neck and shaft. CalcifTissue Int 1986:39(suppl):A58.
3O.Verstraeten A., Dequeker J., Nijs J., Geusens P. Prevention of
postmenopausal bone loss in rheumatoid arthritis patients. A two-year
prospective study. Clin Exp Rheumatol 1989;7:351358.
31.Yamada H.: Long-term effect of 1 a-hydroxyvitamin D, calcium and
thiazide administration on glucocorticoid-induced osteoporosis. Nippon
Naibunpi Gakkai Zasshi 1989;65:603-614.
32.Van Cleemput J., Daenen W., Geusens P., Dequeker J., van de
Werf F., Vanhaecke J. Prevention of bone loss'm cardiac transplant recipients.
Transplantation 1996;61:1495 1499.
33.Lakatos P., Kiss L., Horvath C, Takacs I., Foldes J., Bossanyi A.
Prevention of corticosteroid-induced osteoporosis with alfacalcidol. Lege Art
Med 1996;6:624-629.
34. Reginster J.Y., Kuntz D.. Verdickt W., Wouters M.. Guillevi L..
Menkes C.J., Nielsen K. Prophylactic use of alfacalcidol in corticosteroidinduced osteoporosis. Osteoporos Int 1999:9:75-81.
35.Chapuy M.C., Arlot M.E., DuBoef F.. Brun J., Crouzet ., Arnaud
S., Delmas P.D. Meunier P.J. Vitamin D and calcium (o prevent hip
fractures in elderly women. N Engl J Med 1992:327:16371642.
36. Francis R.M., Boyle I.T., Moniz C, Sutcliffe A.M., Davis B.S.,
Beastall G.H., Cowan R.A., Downes N. A comparison of the effects of
alfacalcidol treatment and vitamin D, supplementation on calcium absorption
in elderly women with vertebral fractures. Osteoporos Int 1996;6:284290.
37. Ringe J.D., Coster A., Meng ., Schacht E., Umbach R. Treatment
of glucocorticoid-induced osteoporosis with alfacalcidol/calcium versus vitamin
D/calcium. CalcifTissue Int 1999:63: 337-340.