[Utility of biochemical markers of bone turnover in diagnosis of osteoporosis and fracture risk prediction]

Currently, for the diagnosis of osteoporosis, we search risk factors and measure bone mineral density [BMD] by DXA. However, bone turnover markers, unused still in practice, have shown an interest especially in the prediction of fracture risk. To determine the relationship between bone markers, BMD and osteoporotic fracture. Prospective study of 65 women referred for measure of BMD during the period between May and August 2010. Each patient had a dosage of serum bone formation markers: osteocalcin [OC] and N-terminal propeptide of type I collagen [P1NP] and bone resorption markers: serum and urinary C-terminal telopeptide of type I collagen [beta-CTX or CrossLaps] as well as parathyroid hormone and calcium. Risk factors of osteoporosis were identified in each case. Our 65 women had a mean age of 58.6 +/- 12.1 years. The majority [83%] were menopausal women. Osteoporosis was found in 52%, osteopenia 26% and normal BMD 22% of cases. An increase in bone turnover markers was correlated with menopause [p = 0. 001 for the OC, p = 0.016 for urinary CTX], a low body mass index [p = 0.015 for OC, p = 0.042 for serum CTX] and osteoporosis [p <0.001 for P1NP, p <0.001 for serum and urinary CTX]. Corticosteroid therapy was correlated with a decrease in bone formation markers [p = 0.002 for P1NP]. The presence of fracture was only associated with increased urinary CTX [p = 0.05]. Bone turnover markers increase in menopausal women and in case of low BMD. However, their contribution in the diagnosis of osteoporosis is low. They are rather an interest in the prediction of fracture risk

[Survival prognosis factors in multiple myeloma]

Outcome in multiple myeloma [MM] is very heterogeneous in survival and therapeutic response, constantly fatale despite her therapy progress. To determine the prognostic factors and survival in MM. We carried out a transversal study of 100 patients in the rheumatology department of hospital Monastir between 1991 and 2010. In each case we determinate the survival delay and also the clinical, laboratory, radiological data at diagnosis and therapeutic response. The mean age was 64.4 years and sex ratio H/F=1.27. MM is IgG type in 57%, IgA in 28% and light chain in 11% of cases. The survival mean is 34 months and the survival median is 26 months. Univariate analysis showed five prognostic factors: age [p = 0.016], anaemia [p=0.033], beta 2 microglobulin [p < 0.0001], CRP [p = 0.0001], albumin [p = 0.002], LDH [p=0.001], plasmocyte proliferation rate [p=0.003] and rapidly therapeutic response [p <0.001]. beta 2 microgrobulin-CRP classification and the international staging system [ISS] presented a high prognosis signification [p < 0.0001]. Multivariate analysis demonstrated two prognostic factors: beta 2 microglobulin and CRP. Our study showed that MM presented many prognostic factors, which easily realized in daily practice. These prognostic factors are essentially to evaluate prognosis and select patients for appropriate therapeutic indication. beta 2 microgrobulin- CRP classification and the international staging system [ISS] are more predictive than Durie Salmon classification in MM survival

[Quality of life in ankylosing spondylitis]

Ankylosing Spondylarthritis [AS] involves by its frequency and its repercussion on the functional capacity an important handicap and deterioration of the patients quality of life. To evaluate the handicap and the quality of life during the AS and to seek the predictive factors of the deterioration of this quality of life. A prospective study relating to 50 patients recruited in the Department of Rheumatology of F. B. Hospital of Monastir during 6 months period [Mars to September 2008]. The studied parameters were the quality of life evaluated by a specific sore [ASQOL] and a generic score [SF-12]. Also the physical, social and economic felt handicap was evaluated using a qualitative scale. Predictive factors [clinical, biological and radiological] of the quality of life were carried out. Our patients are divided in 42 men and 8 women with an average age of 38.9 +/- 10.7 years. The average duration of AS is of 11.9 +/- 7.6 years. The average of ASQOL is of 11.9 +/- 4 [extremes: 0-17]. The average of physical SF12 is of 29.8 +/- 6 [21.7-53.2] and of mental SF-12 of 35.3 +/- 6.6 [22.5-55.8]. The physical, social and economic felt handicap was considered to be average or important in respectively 88%, 72% and 86% of the cases. The predictive factors of a high ASQOL [faded quality of life] are absence of occupation, high BASMI, a high number of painful articulations and high BASFI, BASDAI, BASG, BASRI and EVA total pain. The factors associated to the alteration of the quality of life according to SF-12'S are male sex, professional statute, high number of painful articulations and high BASDAI, BASFI and BASRI. Our study shows the important deterioration of the quality of life in AS patients. The existence of the predictive factors of quality of life primarily related to the functional capacity of the patients and to the disease activity implicates an early and adequate disease management in order to decrease this repercussion

fracture risk assessment tool [FRAXTM], where one is in Tunisia?

The fracture risk assessment tool [FRAXTM], published in February 2008, is developed based on the use of clinical risk factors with or without bone mineral density tests. To calculate the FRAX tool in a cohort of Tunisian patients in whom bone mineral density [BMD] was assessed by dual X ray absorptiometry [DXA]; to correlate this score to osteoporotic fracture and to BMD assessment and to propose a threshold for therapeutic intervention. In a cross sectional study of 582 patients older than 40 years, in whom a BMD measurement by DXA has been performed between January 2006 and December 2009, clinical risk factor for osteoporotic fracture and the occurrence of a prior fragility fracture were assessed. The French version of the FRAX tool was used. Threshold for pharmacological intervention was evaluated by ROC curve. Patients were aged 62.3 +/- 10.4 years. They were female in 91.2% of cases. BMD measurement was under 2.5 standard deviation in 53.2%. Osteopenia was noted in 29.2% of cases and BMD was normal in 17.4% of cases. Osteoporotic fractures were observed in 38.2% of cases. Major osteoporotic fractures [FOM] [hip, vertebra, radius] occurred in 82% of cases. The FRAX score calculated with T-score was 8.55 +/- 8.54% for the FOM and 3.02 +/- 6.37% for femoral neck [FN], while it was 7.81 +/- 6.45% for the FOM and 2.58 +/- 3.97% for the FN if calculated without T-score with a significant difference [p <10[3]]. For the patients having T-score under 2.5 SD, FRAX score was 11.39 +/- 10.32% for the FOM and 4.74 +/- 8.13% for the FN if calculated with T-score and it was 9.18 +/- 6.95% for the FOM and 3.19 +/- 4.11% if calculated without T-score. The score FRAX was correlated to BMD [r=0, 53, p <10-3] and to fracture prevalence [p < 10[3]]. The threshold of therapeutic intervention was fixed to 30% for the FOM and 7% for the FN. Our study confirms the usefulness of the FRAX score in the prediction of fracture risk in Tunisian population. The determination of therapeutic threshold intervention requires other prospective and larger studies with medico-economic analyses