Clinical Management of Women with Newly Diagnosed Osteoporosis: Data from Everyday Practice in Bulgaria.

INTRODUCTION: The real duration of osteoporosis treatment in clinical practice is still not well described. The primary objective is to estimate the proportion of patients who stayed on treatment during a 4-year follow-up, and the secondary objective is to estimate the proportion of patients who switched treatment and the reasons for switch or discontinuation. METHODS: This was a national retrospective chart review, based on routine clinical data. Data were collected electronically from medical records in 33 representative primary care physicians' sites. Inclusion criteria were women with postmenopausal osteoporosis that have received initial treatment prescription following diagnosis by DXA between January 1, 2012 and December 31, 2014, and at least a 12-month database history after the index date. Exclusion criteria were women receiving treatment for osteoporosis and follow-up at secondary care physicians' sites only. All statistical analyses were performed with the R statistical package. RESULTS: A total of 1206 female patients with newly diagnosed osteoporosis and treatment initiation were followed for 4 years. The majority (88.3%) had no history of previous fractures. Bone mineral density data were available in 70.1%. Endocrinology was the most common specialty among prescribing specialists (40.0%), followed by rheumatology (30.3%). Bisphosphonates (BPs) were the most common initial treatment (72.7%), followed by denosumab (20.1%). Ibandronate (70.2%) and alendronate (24.2%) constituted the majority of all prescribed BPs; 731 patients remained on treatment during the second year (60.6%), 524 during the third year (43.4%) and 403 (33.4%)-at study end (fourth year). In all groups, except that on denosumab, the most common reason for switching to another treatment was presumed lack of effect. The main reasons for treatment discontinuation were financial on the patient's part. CONCLUSIONS: The duration of osteoporosis treatment in real-world clinical practice is far from optimal: < 3-4 years irrespective of fracture risk. Factors other than medical considerations are at play, mainly limitations set by the Health Insurance Fund. The health authorities should be aware of this.

The effect of Apium Nodiflorum in experimental osteoporosis.

Treatment of osteoporosis remains a therapeutic challenge. The effect of Apium Nodiflorum extract on development of experimental osteoporosis, pain thresholds and carrageenan-induced inflammation has been studied in ovariectomized osteoporotic Wistar rats. After osteoporosis verification rats were randomized and received vehicle only, HPLC-standardized Apium extract (equal to 2.4 mg/kg Quercetin) or Genistein (2.5 mg/kg) for 8 weeks. To verify the effect of Apium on the development of osteoporosis, bone mineral density (BMD) and bone mineral content (BMC), bone histology and plasma levels of IL-6 and RANKL were measured 6 months after ovariectomy and 8 weeks after treatment with Apium extract or Genistein as comparator. Inflammatory hyperalgesia was induced by intraplantar injection of 1% Carrageenan. Apium extract and Genistein impeded the development of osteoporosis (significant differences were shown for BMC and BMD levels in drug vs. vehicle treated rats) and improved bone histology and histological score. Apium and Genistein decreased IL-6 level. Both treatments alleviated mechanical hyperalgesia, decreased exudative reaction and lowered inflammatory pain threshold. The results suggested that Apium extract could be an alternative therapy for post-menopausal osteoporosis.

Prevalence of low forearm bone mineral density in Bulgarian men: a pilot study.

OBJECTIVE: To determine the prevalence of osteoporosis at the distal forearm in a male cohort referred for bone density testing and to compare it to published data of Bulgarian women. DESIGN AND SUBJECTS: 315 consecutive Bulgarian men aged 20 to 84 years were included (mean age 53.74 +/- 14.67 years). 59% of them were self-referrals. The comparative female group consisted of 8869 Bulgarian women whose forearm bone mineral density (BMD) was measured in another study. MEASUREMENTS: BMD was measured by single X-ray absorptiometry at the distal forearm (distal and ultradistal sites) in all men. T-scores were calculated from manufacturer-provided Danish male reference data. RESULTS: The ratio of female to male patients was 28.2 (8869 to 315). Peak BMD was observed in men aged 30 to 39 years: 0.560 +/- 0.065 g/cm(2) (distal site) and 0.490 +/- 0.070 g/cm(2) (ultradistal site). A steady BMD decline followed reaching 0.492 +/- 0.064 g/cm(2) at the distal and 0.412 +/- 0.069 g/cm(2) at the ultradistal site in age group >70. Age had a rather weak negative impact on forearm BMD described by a linear model. In men aged over 50 years the prevalence of osteoporosis at the distal site was 21.19%, compared to 20.45% in women. Low bone mass was seen in 48.77% of men and 32.50% of women. Normal BMD was more frequent in women (47.05%) than in men (30.04%). CONCLUSIONS: We found a high prevalence of forearm osteoporosis in Bulgarian men which is comparable to that already known in women.

PvuII and XbaI polymorphisms of the estrogen receptor gene and bone mineral density in a Bulgarian population sample.

OBJECTIVE: The aim of this study was to search for a possible association of low bone mineral density (bMD) with the PvuII and XbaI polymorphisms of the estrogen receptor (Er) gene in bulgarian women. DESIGN: 400 bulgarian women participated in this study. bMD was measured at the lumbar spine, femoral neck and at the distal forearm. two groups were identified: women with normal bMD at both central sites (n=180) and women with low bMD at either site (n=220), designated as normal (NbMD) and low bMD (LbMD) groups, respectively. the genotype frequencies of PP, Pp, pp and XX, Xx, xx were investigated by Pcr and enzymatic digestion of the products by PvuII and XbaI. RESULTS: The genotype frequencies were 12% for the PP, 59% for the Pp and 29% for the pp genotypes in the NbMD, and 26%, 50% and 24% in the LbMD groups, respectively. the XX, Xx, xx genotype frequencies were 14%, 63% and 23% in the NbMD, and 33%, 50% and 17% in the LbMD groups, respectively. the various genotypes were significantly associated with bMD. the relative risk for low bMD was higher for the XbaI marker (rr=1.51) than for the PvuII marker (rr=1.35). the association between low bMD and the polymorphisms under study was described by an etiological factor of 0.28 for the XbaI marker and 0.20 for the PvuII marker. CONCLUSIONS: The specific XbaI and PvuII polymorphisms of the Er gene are associated with low bMD at all bMD measurement sites in the bulgarian female population. they might therefore become useful genetic markers in osteoporosis risk assessment in this specific population.