[Prediction of changes in bone density during alendronate treatment in postmenopausal women]. / Predikcia zmien kostnej denzity pri liecbe alendronátom u postmenopauzálnych zien.

Alendronate is an aminobisphosphonate, a selective inhibitor of osteoclast-mediated bone resorption. Due to its influence a decline of markers of bone turnover occurs. The latter react much sooner than it is possible to detect significant changes of bone density. In the submitted trial the authors investigated changes of selected markers: total alkaline phosphatase (ALP), osteocalcin (OC), N-terminal telopeptide fragment of collagen type I (NTx) after 3 months' treatment with alendronate, the influence on bone density after one year's treatment in 50 postmenopausal women with densitometrically verified osteoporosis. After one-year treatment in the whole group a significant increase of bone density occurred in the area L2-L4 by 4.52% (SD = 3.9), neck of the femur by 2.24% (SD = 3.6), trochanter by 2.81% (SD = 3.0) and total by 1.89% (SD = 2.7). Total ALP and OC in serum, similarly as NTx in urine declined significantly already after 3 months treatment and the decline persisted also after one year of treatment. With the change of bone density after one year correlated significantly only NTx. A decline of NTx after 3 months by more than 30% as compared with the baseline value was recorded in 81% patients and this change predicted a significant rise of the bone density in the area of the neck of the femur, on average by 30. Urinary NTx is a promising predictor of the effect of alendronate treatment. Its drop by more than 30% after 3 months justifies the assumption that bone density increased after one year's treatment.

Coexistence of ochronosis and rheumatoid arthritis: a cause of delay in diagnosis and treatment.

Two rheumatic diseases can often coexist despite the interesting fact that gout and rheumatoid arthritis (RA) are infrequently associated. We describe a patient with familial history of alkaptonuria and rheumatoid arthritis who developed both diseases. The exact time of onset of the RA was difficult to ascertain. The RA seemed to be rapidly progressive, possibly because of the delayed recognition, overly cautious drug treatment, or additive effects of the two diseases. Physicians should keep in mind the possible coexistence of two joint diseases in patients who are not doing well.