© Borgis - Postępy Nauk Medycznych 3/2012, s. 288-290
This issue of “Postępy Nauk Medycznych” focuses on various aspects of osteoarthritis (OA), osteoporosis (OP) and pleiotropic influence of Vitamin D. We present conceptual papers and empirical studies with the aim of passing knowledge to doctors, who in their daily practice deal with results of bone and joints dysfunction due to OP, OA, and general deficiency of Vitamin D.
In the article on genetically determined and acquired factors predisposing to osteoarthritis or osteoporosis, the authors present new arguments for the genetic influences on OA or OP as well as show various factors that predispose for the development of OA or OP. Those arguments arise from the epidemiological studies of OA and osteoporotic fractures, studies on the bone and articular cartilage metabolism, the role of kind and location of adipose tissue, the role of muscle tissue, especially the role of subchondral bone in pathogenesis of OA and the results of antiresporption treatment in OA. It is important to remember that even with the differences in bone characteristic in patients with OA and OP, antiresorption treatment is beneficial. In case of OP it is related to the imbalance of making and resorption (more resorption), and the anticatabolic influence on articular cartilage (shown in the publication “Antiosteoarthritic effect of estrogen β-receptor modulator in postmenopausal women with knee osteoarthritis and osteopenia”) begins a new understanding of the role of bone in pathology of articular cartilage.
Epidemiology of osteoporotic fractures in Europe and in Poland is discussed, pointing attention of the readers to the fact that difference in prevalence of osteoporotic fractures in various populations may be related to age, gender, region of the world and socioeconomic conditions. The authors stress the fact of increased fractures of proximal femur in majority of countries, which is related to the process of aging of population across the world. It is important to know the epidemiological data because those data show the necessity of effective prophylactics of osteoporotic fractures.
In one of the articles, an important issue of glucocorticoid-induced osteoporosis was raised. The authors stress the fact that glucocirticosteroid (GS) intake is the main cause of secondary osteoporosis and write that the prevalence of chronic GS use is over 0,5% in general population, but only 15% of these patients are receiving treatment of osteoporosis. These data show that glucocorticoid-induced osteoporosis (GIOP) is an underestimated and undertreated condition. The authors present a systemic literature review on pathophysiology, clinical picture and treatment of GIOP, and describe recent guidelines for GIOP management. The article can be a good source of guidelines for doctors dealing on every day basis with patients on corticoid therapy.
In another article, the authors point out that bone complications, including periarticular erosions as well as local and generalized osteoporosis, are typical symptoms of chronic inflammatory joint diseases and can lead to increased fracture risk. Recent findings show that good control of generalized inflammatory process is the main target for management of osteoporosis.
The issue of falls has also been raised. In 2007 WHO recognized falls to be one of the most important health and social issues of the aging populations. Falls are one of the main causes of disability and the fifth most frequent causes of death above the age of 75. The authors write that reports regarding a protective influence of vitamin D on falls and fractures are diverse. They conclude that, in case of severe vitamin D deficiency, calcium and vitamin D supplementation reduces fall risk and the frequency of fractures, whereas in case of normal vitamin D levels in serum these effects are insignificant.
In the articles regarding Vitamin D, the authors present a review of literature which led them to write that Vitamin D is necessary not only for maintaining appropriate metabolism of calcium and phosphorous, function of bone in the organism, but also for appropriate functioning of various tissues and organs not related to mineral metabolism.
In the first paper the authors focused on Vitamin D as a factor responsible for appropriate functioning of bone. They discuss the influence of 1,25(OH)2D which is a steroid hormone encouraging the metabolism of calcium and phosphorous. Numerous direct and indirect effects of 1,25(OH)2D have been demonstrated on a range of critical bone proteins and 1,25(OH)2D appears to be involved in their regulation at all stages of osteoblast differentiation and, indeed, bone remodeling. 1,25(OH)2D uses VDR to regulate calcium absorption leading to increased capacity of the intestine to absorb calcium and acts on the PTH gene to decrease its transcription. This information is important for understanding why for individuals with low bone mass, when diagnosing its etiology, one should pay attention to vitamin D deficiency.
The immunomodulating effects of vitamin D were discussed with respect to rheumatoid arthritis (RA) showing that in patients with RA are related to a decrease in the number of Th1 and Th17 lymphocytes, to an increase in the number of Th2 and T-reg cells as well as to diminishing the production of proinflammatory cytokines together with increasing the secretion of antyinflammatory cytokines. An inverse relationship between serum level of 25-OH vitamin D and early onset polyarthritis, severity of the disease as well as a degree of disability of the patients with RA were reported and this is a reason for Vitamin D supplementation for this pathology.
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