http___medlib.mef.hr_1681__1.xml
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Turk, Nikša and Kaštelan, Darko and Čuković-Čavka, Silvija and Kraljević, Ivana and Koršić, Mirko and Vucelić, Boris (2007) Discriminatory Ability of Calcaneal Quantitative Ultrasound in the Assessment of Bone Status in Patients with Inflammatory Bowel Disease. Ultrasound in medicine & biology, 33 (6). Abstract A high incidence of bone disease in patients with inflammatory bowel disease (IBD) requires frequent monitoring of skeletal status and, for that reason, evaluation of radiation-free technology is an issue of interest. Our objective was to appraise the parameters of calcaneal quantitative ultrasound (QUS): broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (QUI), and establish their t-score values to investigate discriminatory ability of QUS in IBD patients with metabolic bone disease. The study included 126 patients (Crohn's disease [n = 94] and ulcerative colitis [n = 32]), and 228 age- and sex-matched healthy volunteers. Bone status was evaluated on the same day by calcaneal QUS and dual-energy x-ray absorptiometry (DXA) at spine (L1-L4) and total hip. All QUS measurements were lower in patients compared with healthy controls (BUA p < 0.001; SOS p < 0.001; QUI p < 0.001) and correlated significantly but inversely with disease duration (r = -0.3, p = 0.002). There was no difference with respect to type of disease (Crohn's disease or ulcerative colitis) or corticosteroid therapy. All three QUS t-scores were significantly lower in patients who had previously sustained fragile fractures (n = 28) than in those without fracture in their history (n = 98) (t-scores: BUA -2.0 vs. -1.3, p = 0.008; SOS -2.1 vs. -1.4, p = 0.02: QUI -2.3 vs. -1.5, p = 0.009). Axial DXA was not significantly different between the fracture and nonfracture patients (-1.7 vs. -1.2, p = 0.1), whereas total hip DXA showed a discriminatory power between the two (-1.6 vs. -0.7, p = 0.001). Patients with t-score < -1.0 scanned by DXA were classified as bone disease. The sensitivity of QUS to identify bone disease was 93% and specificity 63%. The sensitivity of QUS to detect osteopenia was 84% and 72% for osteoporosis. Alternatively, lower negative QUS t-score cutoff </= -1.8 identified 83% of osteoporosis at lumbar spine and 100% at total hip. All three QUS variables had t-scores less than -1.8 when osteoporosis was detected at both spine and hip. However, the subgroup of IBD patients with QUI t-score cutoff </= -1.8 still included 26% of individuals with normal bone status. Calcaneal QUS measurements may identify patients with IBD who are at a higher risk of fracture independently of DXA measurements. However, QUS showed poor agreement with bone status scanned by DXA and a low discriminatory power between osteopenia and osteoporosis. Actions (login required) Downloads Downloads per month over past year
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Turk, Nikša (2008) Metabolička bolest kostiju u Crohnovoj bolesti [Metabolic bone disease and Crohn's disease]. PhD thesis, Sveučilište u Zagrebu. Croatian abstract Svrha/Ciljevi Metabolička bolest kostiju je učestala ekstraintestinalna manifestacija Crohnove bolesti. Patogeneza nije u potpunosti jasna, no kako se javlja u bolesnika koji jesu, ali i u onih koji nisu liječeni kortikosteroidima, prepostavlja se da sam upalni proces ima značajnog upliva na koštani metabolizam. Stoga je cilj ovog istraživanja bio komparativno evaluirati proupalne citokine, biljege koštane izgradnje i razgradnje, te regulatorne molekule u biogenezi osteoklasta RANKL i osteoprotegerin (OPG), u skupinama bolesnika s Crohnovom bolesti sa i bez metaboličke bolesti kostiju. Bolesnici i metode Ispitivanu skupinu od 95 bolesnika činilo je njih 80 s dugogodišnjim trajanjem Crohnove bolesti i 15 bolesnika u kojih je bolest tek dijagnosticirana. Koncentracije sRANKL, OPG, TNF-a, IL-1B, IL-6, osteokalcina i C-telopeptida u serumu, odreñivane su imunološkim metodama. Koštani je status mjeren metodom dvostruke apsorpciometrije X-zraka (DXA) odreñivanjem mineralne gustoće kostiju (BMD) lumbalne kralješnice i kuka, te uporedo, metodom kvantitativnog ultrazvuka petne kosti (QUS). Rezultati U skupini s tek dijagnosticiranom Crohnovom bolesti 53% bolesnika ima sniženu mineralnu koštanu gustoću, dok je u bolesnika s dugogodišnjim trajanjem bolesti osteoporoza prisutna u njih 26%. U naïvnih je bolesnika zabilježena vrlo dobra korelacija izmeñu središnjeg proupalnog citokina TNF-a i osteoklastičnog posrednika sRANKL (r=0.6; p=0.027), a ta je pozitivna korelacija ostala nepromjenjenom i u skupini bolesnika s višegodišnjim trajanjem bolesti (r=0.3; p=0.009). Koncentracije slobodnog RANKL-a i njegovog receptora OPG koreliraju negativno u bolesnika sa sniženom mineralnom gustoćom kostiju (r=- Sažetak 77 0.36; p=0.003), dok u bolesnika sa zdravim skeletom nema meñusobne povezanosti. U naïvnih bolesnika s reduciranom mineralnom gustoćom kostiju (T-vrijednost ≤-1.0), korelacija izmeñu RANKL-a i OPG je izrazito visoka, ali s negativnim predzakom (r=-0.8; p=0.02). Tu podskupinu bolesnika ujedno karakterizira niži indeks tjelesne mase, značajno viša koncentracija proupalnih citokina, visoka razina CRP i pojačane aktivnosti RANKL i OPG. Nalazi kvantitativnog ultrazvuka petne kosti nisu pokazali dobru podudarnost s DXA mjerenjima (specifičnost 63%). Osjetljivost QUS metode u detekciji osteopenije je 84%, a 72% za osteoporozu. Meñutim QUS petne kosti je uspješnija metoda u identificiraju bolesnika s rizikom koštanih prijeloma. Zaključci Rezultati ove studije snažno podupiru hipotezu da upalni proces per se u Crohnovoj bolesti ima primarnu ulogu u razvijanju i napredovanju metaboličke bolesti kostiju. U prilog izrečenom govori podatak da središnji proupalni citokin TNF-a vrlo pozitivno korelira s osteoklasičnim posrednikom RANKL, a negativno s mineralnom koštanom gustoćom. Klinički se to ogleda u činjenici da 50% naïvnih bolesnika već pri dijagnozi ima nižu koštanu gustoću. Kvantitativni ultrazvuk petne kosti prema rezultatima prikazanog istraživanja nije pouzdana zamjena za metodu klasične denzitometrije, no može poslužiti kao komplementarna opcija jer se pokazalo da je dobar prediktivni parametar za rizik na koštane prijelome. English abstract Objective The high incidence of bone disease and increasing evidence for Crohn´s disease (CD) affecting bone status in corticosteroid users and non-users suggest that bone metabolism is affected by inflammatory process. This study aimed to determine comparative serum levels of proinflammatory cytokines, markers of bone formation and resorption, and regulatory molecules of osteoclast biogenesis RANKL and osteoprotegerin (OPG), in CD patients with and without metabolic bone disease. Patients and Methods The study included 95 patients; 15 of them newly diagnosed and untreated, and 80 patients with long-standing Crohn´s disease. Serum sRANKL, OPG, TNF-a, IL-1B, IL-6, osteocalcin and C-telopeptide I were measured by immunoassay. Bone status was evaluated, in parallel, by calcaneal quantitative ultrasound (QUS), and dual-energy x-ray absorptiometry (DXA) scanned spine (L1-L4) and hip bone mineral density (BMD). Results Decreased BMD at diagnosis was found in 53% and low bone mass in 72% of the study population. The newly diagnosed, untreated patients showed correlation between TNF-a and sRANKL (r=0.6; p=0.027), and this positive relationship also persists in the unselected study population of long-standing CD patients (n=80) (r=0.3; p=0.009). Multiple regression identified TNF-a as the best predictor of sRANKL (p<0.001). Analysis of the OPG and sRANKL relationship according to subgroups showed absence of correlation in patients with healthy skeleton, and an inverse relationship in those with decreased BMD (r=-0.36; p=0.003). In naïve patients with reduced BMD t-score≤-1.0, the correlation between sRANKL and OPG was highly inverse (r=-0.8; p=0.02) and Abstract 79 these patients were characterized by lower BMI, significantly higher level of proinflammatory cytokines, elevated CRP and increased activity of free sRANKL and OPG. The sensitivity of QUS to identify bone disease was 93%; indicating 7% of patients with verified bone disease to be misclassify as false negative. The specificity of 63% showed that 37% of individuals with normal bone status were QUS classified as false positive. The sensitivity of QUS to detect osteopenia was 84% and 72% for osteoporosis. Conclusions Bone disease that accompanies CD at diagnosis suggests that bone metabolism is affected by the underlying inflammatory process per se, as probably confirmed by our finding of the central proinflammatory cytokine TNF-a being strongly associated with the osteoclastogenic mediator RANKL, and inversely with bone density. Calcaneal QUS showed poor agreement with bone status scanned by DXA and a low discriminatory power between osteopenia and osteoporosis. However, QUS successfully identified patients with previous fragile fractures. Actions (login required)