BMD Changes Following 2-Year Treatment of Osteoporosis by using BMK to Monitor the Dose of Bisphosphonates.

Reasons for using BMK to adjust dose for Osteoporosis patients: 1) To keep balance between bone formation and bone resorption, 2) To set balance ofboneformation to be higher than bone resorption (+10%), 3) To slightly lengthen bone life cycle. Only 127 out of 197 patients who joined the program ofusingBMKto monitor Bisphosphonate dose could complete the 2-year follow-up. The measurement ofBMK used before the treatment was compared with that ofthe 2-year follow-up by using both T-score and PR. As a result, the adjustment of the Bishosphonates given period by using BMK can better reinforce both spine and hip T-scores and PR summaries, more increasing and steadier than decreasing. It can be said that usingBMK to monitor the dose of bisphosphonates can offer balance between bone formation and bone resorption (balanced with plus and steadiness than minus). Moreover it can lengthen the bone cell life cycle more than usual (CTx = 80-100% of normal value, 0.31, in women or CTx 0.25-0.31). Besides, it helps the patients to reduce the cost oftreatment of bisphosphonate by lengthening the time of administration by up to 3-6 times.

Effects of the treadmill walking exercise on the biochemical bone markers.

OBJECTIVE: To study the effects of moderate-intensity treadmill walking exercise on the biochemical bone markers in the menstruating and menopausal women. STUDY DESIGN: Experimental study. SETTING: Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: Twenty-two healthy volunteer women at the age of 30-70 were recruited: 11 menstruating women and 11 menopausal women. The exercise consisted of the treadmill walking exercise, intensity of 50% of heart rate reserve, for the duration of 30 minutes, at the frequency of 3 times a week, over a 3-month period. Serum beta CTx, PINP and NMID osteocalcin were measured at the baseline and in the 1st, 2nd, and 3rd months. RESULTS: Twenty women: 11 menstruating women and 9 menopauses completed the exercise protocol. The baseline characteristics including age, body mass index, serum beta CTx, PINP and NMID were statistically different. The serum beta CTx and NMID levels were decreased from the baseline from Month 1 to 3 in both menstruating and menopausal groups. Serum PINP was not significantly changed in the 1st and 2nd months except the significant decreasing in the 3rd month in the menstruating women. There were no significant differences of bone marker changes between the menstruating women and the menopauses. The biochemical bone markers' levels (beta CTx, PINP and NMID) had the strong correlations analyzed by Pearson's correlation coefficients (> 0.8 with p-value < 0.001). CONCLUSION: The present study clearly demonstrates that the moderate intensity treadmill walking exercise for 30 minutes, 3 times a week reduces bone resorption and bone turnover markers in both the menstruating women and the menopauses after the first month until the third month of the experiment. Although the bone formation markers had a tendency of decreasing after exercising, the significant changes showed only in the 3rd month in the menstruating group. All of the bone markers including beta CTx, NMID osteocalcin and PINP were highly correlated.

Observation: application and advantages of BMK in osteoporosis by monitoring the dose of antiresorptive drugs with CTx.

One of the potential applications of BMK is the dynamic measure of bone metabolism. The present study aimed to observe the dynamic response of patients' bone toward the antiresorptive drugs by using BMK in the prospective procedure. The subjects were 309 Thai women. They were divided by age into 3 groups: A) 56 participants at 50-60 years old, B) 116 participants at 61-70 years old and C) 137 participants at over 71 years old. They had the blood BMK tests based on these conditions: 1) prior to the prescription of antiresorptive drugs, 2) every month for following up the administration of the drugs until the proper doses were obtained, 3) every 3 month after the proper doses were obtained. The patients were observed on the 5-category criteria resulting in as follows: Category 1: No previous history of antiresorptive drugs adminitration and the CTx level was lower than normal. The antiresorptive drugs were not required during this 2-year observation. There were 7 cases aged 50-60, 13 cases aged 61-70 and 16 cases aged 71 up. Category 2: No previous history of antiresorptive drugs administration but the CTx was higher than normal. Then the antiresorptive drugs were prescribed and the CTx later became lower than normal. Thereafter, the antiresorptive drugs were not required any more through this 2-year study. There were 5 cases aged 50-60, 22 cases aged 61-70 and 22 cases aged 71 up. Category 3: No previous history of antiresorptive drugs administration but the CTx was higher than normal. The antiresorptive drugs were prescribed until the CTx became normal or lower than normal, but the values were not stable. So the drugs were prescribed intermittently. There were 10 cases aged 50-60, 28 cases aged 61-70 and 18 cases aged 71 up. Category 4: Having the previous history of antiresorptive drugs administration for more than 1 year, and the CTx was lower than normal. The patients did not take any antiresorptive drugs during this 2-year study. There were 15 cases aged 50-60, 37 cases aged 61-70 and 55 cases aged 71 up. Category 5: Having the previous history of antiresorptive drugs administration for more than 1 year and the CTx was lower than normal. Later, the values became higher and the antiresorptive drugs were continued intermittently during the 2-year study. There were 19 cases aged 50-60, 16 cases aged 61-70 and 25 cases aged 71 up. In conclusion, the change of bone turn over rate after the antiresorptive therapy for individual patients is very independent and varied. The up and down changes depend on many factors such as environments, genes, etc. Besides, the time of drugs response evaluated by BMK needed to be assigned within 1 month. The patients' BMK is suggested to be observed regularly. The observation is the justifying key not only to determine the suitable amount of antiresorptive drugs as well as the effective time response on the individual patients but also to help reduce patients' medical cost.

Uropathogens and empiric antibiotics for the treatment of urinary tract infections in spinal cord injured patients at rehabilitation center, Thai Red Cross Society during 2001 to 2005.

BACKGROUND: Urinary tract infection (UTI) is common in spinal cord injured patients. The authors investigated the epidemiology of bacteria associated with UTI to select an appropriate antibiotic for empirical treatment of UTI before obtaining a bacterial culture. OBJECTIVE: To determine the prevalence, as well as the causative bacteria and their susceptibility pattern of urinary tract infection in spinal cord injured patients hospitalized to the Rehabilitation Center, Thai Red Cross Society, Samutprakarn, Thailand from January 2001 to December 2005. MATERIAL AND METHOD: A retrospective chart review of 76 spinal cord injured patients. RESULTS: Of all spinal cord injured patients, there were 50 males and 26 females, with the average age of 44.70 years. The average length of hospitalization was 104.5 days. 71.2% of the patients needed intermittent catheterization for bladder drainage, and only 2.7% had suprapubic cystostomy. None of patient had indwelling catheterization. Forty-six patients had 68 episodes of UTI (60.52%). Eighteen patients had recurrent UTI (14 patients had two episodes and four patients had three episodes). E. coli was the most common isolated pathogen (74.36%) followed by K. pneumoniae (12.82%), E. faecalis (5%) and P. mirabilis (5%). Most gram-negative pathogens were susceptible to amikacin and third generation cephalosporins. The susceptibility of these organisms to cotrimoxazole, amoxicillin/clavulanate, and ciprofloxacin were in the range of 34.6-60.0%, 44.0-50.0% and 25.9-50.0%, respectively. CONCLUSION: Urinary tract infections were commonly observed among spinal cord injured patients in the presented institution. E. coli was the most common isolated pathogen. Surprisingly, most gram-negative pathogens were resistant to cotrimoxazole, amoxicillin/clavulanate, and ciprofloxacin. An antibiotic of choice for UTI in our patients should be aminoglycoside or third generation cephalosporins.

Effects of imagery-weight exercise.

OBJECTIVE: To study the effects of imagery-weight exercise on muscle strength. MATERIAL AND METHOD: Preliminary study of a before and after designed experiment was conducted at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok, from June to September 2004. Fifteen healthy sedentary volunteers: 5 males, 10 females, mean age 28.7 +/- 3.5 years were enrolled The participants were instructed to perform imagery-weight exercise training with their non-dominant arms. The program consisted of 3 sets of 10 repetitions of elbow flexion, 3 days/week, for 8 weeks. The arm muscles strength were assessed with computerized isotonic machine. One-Repetition Maximum (1-RM) at before and after the training program, was compared RESULTS: The mean 1-RM of elbow flexors increased by 44.9% (from 6.78 +/- 2.10 kg to 9.83 +/- 2.32 kg, p = 0.000). The mean 1-RM of elbow extensors increased by 32.0% (from 4.03 +/- 1.98 kg to 5.33 +/- 2.32 kg, p = 0.000). CONCLUSION: Imagery-weight exercise is another effective technique of low impact strength training.

Age and gender effects on postural stability and static balance in Thai community dwelling adults.

BACKGROUND: A study of postural stability was undertaken to identify the effects of age and gender as a preliminary study in one Thai community dwelling adults. It will be useful to prevent falls in the future. METHOD: The authors measured the postural stability in 120 males and females aged 30-40, 60-70 years using a Balance Master 8.0, Neurocom, OR to perform the modified Clinical Test for the Sensory Integration of Balance (mCTSIB) and the Unilateral Test protocols. RESULTS: The authors found that the females aged 60-70 were more stable than the males at the same age. CONCLUSION: Age and gender were significant variables that influence postural stability and static balance.