[Mycophenolate mofetil in the treatment of selected connective tissue diseases]. / Mykofenolan mofetylu w leczeniu wybranych ukladowych chorób tkanki lacznej.

Mycophenolate mofetil (MMF) is an inhibitor of inosine monophosphate dehydrogenase, which affects de novo purine synthesis and T- and B-cell proliferation. So far its efficacy and safety as an immunosuppressive treatment have been proven in organ transplantations and also in various autoimmune diseases. A literature search was conducted by using PubMed and the Cochrane library. This review focuses primarily on current treatment with MMF for systemic lupus erythematosus, systemic sclerosis, vasculitis and idiopathic inflammatory myopathies.

Current understanding of osteoporosis according to the position of the World Health Organization (WHO) and International Osteoporosis Foundation.

The study documents a general change of position on osteoporosis (definition, diagnosis, aim of treatment). Taking into consideration a multifactorial nature of bone fragility in osteoporosis we do not diagnose "osteoporosis" but a total, individual 10-year fracture risk (AR-10) on the basis of independent and self-sufficient risk factors. These are: advanced age, prior fragility fracture, parental history of proximal femur fracture, low BMI, low bone mass, glicocortycosteroids treatment, rheumatoid arthritis, smoking, overuse of alcohol. The treatment should be implemented in persons burdened with a fracture risk higher than a population risk. The intervention threshold is a result of an agreement and a result of work of various working groups of experts. According to Johnell AR-10 below 8% does not require a therapeutical intervention; above 14% justifies the treatment independently of BMD measurement. AR-10 between 8% and 14% is an indication for BMD measurement precising fracture risk. The aim of the treatment is to decrease fracture risk. It combines a limitation of fracture risk factors effects including fall prevention and improvement of bone quality with applying pharmacotherapy. This study highlights that a bone mineral measurement, so far accepted as a criteria for diagnosis of osteoporosis or its exclusion should not be made in aim of diagnosis but to evaluate an absolute fracture risk. Spinal X-rays are performed in aim to diagnose vertebral fractures, which mean a multiple increase of risk of further fractures. The principles of low bone mass differential diagnosis and current possibility of pharmacological treatment are also described. Guidelines for fall avoidance in fracture prevention are described.

Kyphoplasty and vertebroplasty in the treatment of osteoporotic fractures of the spine.

This article presents the problem of spinal fractures and the application of vertebro- and kyphoplasty in their treatment. The techniques, outcomes, and complications involved in these procedures are described on the basis of current literature. The advantages and disadvantages of vertebro- and kyphoplasty are discussed.