Summary of the Thai Osteoporosis Foundation (TOPF) Clinical Practice Guideline on the diagnosis and management of osteoporosis 2021

Objectives@#The Thai Osteoporosis Foundation (TOPF) is an academic organization that consists of a multidisciplinary group of healthcare professionals managing osteoporosis. The first clinical practice guideline for diagnosing and managing osteoporosis in Thailand was published by the TOPF in 2010, then updated in 2016 and 2021. This paper presents important updates of the guideline for the diagnosis and management of osteoporosis in Thailand. @*Methods@#A panel of experts in the field of osteoporosis was recruited by the TOPF to review and update the TOPF position statement from 2016. Evidence was searched using the MEDLINE database through PubMed. Primary writers submitted their first drafts, which were reviewed, discussed, and integrated into the final document. Recommendations are based on reviews of the clinical evidence and experts' opinions. The recommendations are classified using the Grading of Recommendations, Assessment, Development, and Evaluation classification system. @*Results@#The updated guideline comprises 90 recommendations divided into 12 main topics. This paper summarizes the recommendations focused on 4 main topics: the diagnosis and evaluation of osteoporosis, fracture risk assessment and indications for bone mineral density measurement, fracture risk categorization, management according to fracture risk, and pharmacological management of osteoporosis. @*Conclusions@#This updated clinical practice guideline is a practical tool to assist healthcare professionals in diagnosing, evaluating, and managing osteoporosis in Thailand.

Menopausal Symptoms among Women Attending of the Menopausal Clinic at Srinagarind Hospital

Blackground : Menopause is the period of life after complete cessation of ovarian function. In this period, many physiologic changes occur as process of aging. Studying about menopausal symptoms in woman attending at  the Menopausal Clinic provides basic information and will be useful in developing appropriate medical and health  care services.Objective : To study menopausal symptoms among women attend at the Menopausal Clinic Srinagarind  Hospital.Design : Descriptive studySetting : Menopausal Clinic, Srinagarind Hospital. Faculty of Medicine  Khon Kaen University.Method ; One thousand and two hundred twenty-one records of menopausal women both natural and surgical menopause, attending the menopausal clinic at Srinagarind hospital during January 1997 to December 2006 were reviewed. Natural menopause was divided into 2 subgroups, peri-menopausal group and post-menopausal group. The results were expressed  as mean value + standard deviation (SD). Chi-Square test were used for statistical comparison. The level of statistical significance was chosen as p\< 0.05. Results  : Mean age of the subjects were 51.53 + 6.05 years, 52.82% were post- menopausal group. Mean age of natural menopause was 48.76 + 4.33 years. The three most menopausal symptoms were forgetfulness (90.90%), muscle/joint pains (87.05%) and tiredness (83.12%). Hot flushes was significant higher in surgical menopausal women (70.7%) than natural menopausal groups. Those in natural menopause, moody and decreasing sexual desire were more  presented in peri-menopausal women (87.6% and 75.5 % repectively) while vaginal dryness were mostly presented in post- menopausal  group (62.8 % ).Conclusion :The three most common menopausal symptoms were forgetfulness, muscle/joint pains and tiredness. Hot flushes was significant higher in surgical menopausal women than those in natural  menopause. Moody and decreasing sexual desire were more presented in peri-menopausal women  while vaginal dryness were mostly presented in post- menopausal  group. Key word  : Menopausal symptoms, hot flush, sexual desire, vaginal dryness. 

The Correlation of Bone Mineral Densities among the Lumbar Spines, Proximal Femur and Distal Forearm

Purpose:  To determine the correlation of bone mineral density (BMD) among the lumbar spines, proximal femur, and distal forearm in women.Design:  Retrospective, descriptive studyMaterials:  and Methods:  We reviewed the results of bone mineral density performed at Srinagarind Hospital from May 1997 to June 1999.  Dual energy X-ray absorptiometry (DEXA) technique was used to determine the bone mineral densities (BMDs) at the lumbar spines, proximal femur, and distal forearm in 230 women of age range from 31 to 87 years (mean age = 53.5 years).  Most cases were healthy, with only 10 cases being osteoporotic.Results:  A significant correlation (p

A Double Blinded Randomized Controlled Trial of K-Y gel and Aloe Vera Gel as a Lubricant for Digital Vaginal Examination

Objective:   To compare severity of pain and determine side effects from digital examination between using Aloe vera gel and K-Y gel as a lubricant.Material and Method: This study included 400 patients who required per vaginal examination from February 1,1999 to June 30, 1999. Aloe vera gel was used as a lubricant in 200 patients and K-Y gel was used in other 200 patients. Visual analogue scale was used to assess the level of pain during digital examination. Mailing questionnaire was used to evaluate side effects during the first week after examination.Results:     There were no significant differences in the level of pain and side effects between using Aloe vera gel and K-Y gel.Conclusion: The level of pain and side effects were not significantly different between using Aloe vera gel and K-Y gel. Therefore, Aloe vera gel should be promoted to be an alternative lubricant for digital examination due to its lower cost.Key words: K-Y gel, Aloe vera gel, lubricant, per vaginal examination

Vitamin D Deficiency and the Risk of Osteoporosis in Elderly Women

Backgroud : Vitamin D deficiency lead to elevations in parathyroid hormone levels, resulting in increased bone resorption and reduced  BMD, especially cortical bone, and caused skeletal osteoporosis.  Up  to now there are very few studies to show the effect of vitamin D deficiency on bone mineral density.  The level of vitamin D deficiency vary considerably with latitude, also the variability in the different vitamin D assays, that varies from 10 – 40 ng/ml. From our previous study about prevalence of vitamin D deficiency, it being found that the level of calcidiol \< 35 ng/ml was th level of vitamin D deficiency.Objective : To determine the risk of osteoporosis in lumbar spine, proximal femur and the distal radius, between the elderly women with and without vitamin D deficiency. Design : Cross – sectional descriptive study.Setting : Municipality  of Khon Kaen province, Thailand.Outcome Measurements : Serum calcidiol and PTH  levels and  bone mineral density of lumbar spine, proximal femur and distal forearm.Results : No any significant difference in age, weight, height, BMI  and  the  alkaline  phosphatase  level  between  both  groups.  There  was  only  PTH  level  that  showed  significant  difference  between  both  groups.  A  calcudiol  level  of 

Prevalence of Vitamin D Deficiency among Postmenopausal Women at Srinagarind Hospital, Khon Kaen Province, Thailand.

Background :Vitamin D is essential for bone strength and development. It enhances intestinal absorption of calcium and its apposition to bone. It also increases muscle strength. In vitamin D deficiency condition, blood calcium is depressed, parathyroid hormone production is stimulated resulting in secondary hyperparathyroidism which promotes bone turnover. Cortical bone is the primary site affected, particularly at the femoral neck.In previous studies, we documented an average calcidiol level of £  35 ng/ml as vitamin D deficiency. A very high (\> 60%) prevalence of vitamin D deficiency was found among urban elderly women in Khon Kaen, in contrast to less than 20% among their rural counterparts. Until now, only limited data has been available on the average level of calcidiol and prevalence of vitamin D deficiency among postmenopausal women in Thailand.ObjectivesPrimary: Ascertain the prevalence of vitamin D deficiency among postmenopausal womenSecondary: 1. Find out the average vitamin D (calcidiol) level in postmenopausal women                   2. Find out the correlation between calcidiol and PTH in the pooled data                 3. Find out the calcidiol level which indicates the level of vitamin D deficiency in the pooled dataDesign : Cross-sectional, descriptive studySetting : Postmenopausal Clinic, Srinagarind Hospital, Khon Kaen, ThailandOutcome measurement Serum calcidiol, PTH, and alkaline phosphataseResults: The pooled data set comprised 332 cases including 98 cases of postmenopausal women, 104 cases of previously cited urban elderly women, and 130 cases of rural elderly women. The mean (SD) calcidiol level among the postmenopausal women was 32.58 (8.93) ng/ml, and calcidiol and PTH had reverse relation with the correlation coefficient (r) = -0.265 (p-value \< 0.001). Calcidiol at £  35 ng/ml was associated with a significant increase in PTH, which indicated the level of vitamin D deficiency. The prevalence of vitamin D deficiency in postmenopausal women was 60.2 percent.Conclusion :The high prevalence of vitamin D deficiency with low average level of calcidiol among postmenopausal women suggests a risk for developing osteoporosis. Outdoor exercise with sunlight exposure, high vitamin D diet intake, or, if necessary, supplementation with vitamin D is advised.