Bone turnover markers in relation to menopause in rhematoid arthritis patients

Biochemical markers of bone turnover are extremely useful for the management of generalized osteoporosis associated with rheumatoid arthritis [RA]. They provide information that is different and complementary to bone mass measurements. We assessed the effect of menopause and disease activity on bone turnover markers in RA patients by measuring two bone formation markers ;Bone Alkaline Phosphatase [BAP] and Osteocalcin [OC] as well as two bone resorption markers by measuring urinary pyridinoline [PYD] and deoxypyridinoline [D-PYD]. The present work was done on 80 females aged between 35-65 years. They were divided into two groups: Group I normal controls [NC] constituted 20 females; 10 premenopausal [Pre NC] and 10 postmenopausal [Post NC]. Group II RA patients: 30 premenopausal RA [Pre RA] and 30 postmenopausal RA [Post RA]. Among bone formation markers, both BAP and OC were significantly lowered in RA than in NC [p<0. 05 each] particularly in postmenopausal period. On the other hand bone resorption markers urinary PYD and D -PYD were increased in RA in comparison to NC during both premenopause and postmenopause [p<0. 05 each] and menopause exaggerated this condition. Meanwhile, RA activity altered bone formation markers with increased OC in premenopausal [p<0. 05] and decreased BAP in postmenopausal period [p<0. 05]. On the other hand, RA activity exaggerated the increased bone resorption markers PYD and D-PYD especially in the postmenopausal period [p<0. 05 each]. Both RA and menopause accelerated osteporosis by inducing a disequilibrium between bone formation markers [BAP and OC] and bone resorption markers [PYD and D-PYD]. While bone formation markers were reduced, bone resorption markers were exaggerated. RA activity further altered bone formation markers and exaggerated bone resorption markers which should be considered during management of osteoporosis. Furthermore, biochemical markers of bone turnover are simple, cost effective, non-invasive methods that offer an alternative to bone imaging techniques

Glycemic control and cardiopulmonary dysfunction in asymptomatic patients with insulin dependent diabetes mellitus

The study was undertaken to evaluate the cardiopulmonary functions in asymptomatic patients insulin dependent diabetes Mellitus [IDDM] and also to investigate the relationship of cardiopulmonary dysfunction to chronic glycemic control and the duration of diabetes. Thirty-three diabetic patients with mean age 26 +/- 7 years, with no history or physical findings of ardiovascular or respiratory disease, were compared with fifteen healthy non diabetic control subjects. According to the level of glycosylated hemoglobin [HBA1c], patients were classified into hyperglycemic [group A n=17] with elevated HbA1c levels and normoglycemic [group B n=16] who had near normal HbA1c levels. Pulmonary function via spirometry and Doppler echocardiogram were performed in all patients and control subjects. The results revealed significant reduction in forced vital capacity [FVC] in patients versus control and in hyperglycemic than normoglycemic patients [58.9 +/- 8.6% vs 67.0 +/- 2.8% respectively'; forced expiratory volume in the first second [FEV1] was also significantly diminished in patients versus control and in hyperglycemic than normoglycemic patients [60.9 +/- 11.0% vs 72.1 +/- 2.9% respectively. Ejection fraction [EF] was significantly diminished in patients versus control and in hyperglycemic patients versus normoglycemics [64.3 +/- 2.4% vs 65.9 +/- 3.0%, respectively. Also fractional shortening [FS] was significantly diminished in hyperglycemic than normoglycemic patients [32.9 +/- 6.1% vs 33.4 +/- 5.6% respectively]