Osteoporosis (Article Anglais)  Fibromyalgie (Article Français) Agenda des Congrés de Rhumatologie

Osteoporosis, the must of rheumatology.

By The Osteoporosis Department Of Notre-Dame Hospital, Jounieh, Tel 09-644644 email

Many societies are becoming interested in osteoporosis, as prevention, diagnosis and therapy. The lebanese people are now aware of the size of the problem and they are seeking more medical advice and bone mineral density measurement (BMD).

Since the discovery of osteoporosis by rheumatologist in Europe in this mid-century, quantitative evaluation of bone density were found to be practically feasible. It became more developed with the beginning of the era of computer and software systems.

Patients in the past were not beneficially treated and the first aim of physicians was to find the etiology especially of vertebral compressions resulting in back or dorsal pain and reduced height. While developing statistics of bone density, it was found that a curve could be reached demonstrating a decreased value in the period of post-menopause in women. In collaboration with gynecologist in the late seventies, trials had identified women at risk since they are deficient in estrogen during menopause. Estrogen was discovered to prevent decreasing value of BMD. Endocrinologists became interested in the comprehension of osteoporosis as well as Orthopedic surgeons since osteoporotic fractures necessitate orthopedic care or surgery (Colles and hip fractures). Geriatricians have now an important role for making group therapy to enhance prevention of falls.

Defenition of Osteoporosis

It was described in details by the Consensus Conference on Osteoporosis in April 1993 held by the National Institute of Arthritis and Musculoskeletal Diseases, the National Osteoporosis Foundation and the European Foundation for Osteoporosis and Bone diseases. It is a systemic skeletal disease characterized by low bone mass and microarchetectural deterioration of bone tissue.

It is different from osteomalacia where the origin of low bone mass is a deficiency of vitamine D resulting in decreased calcium minerals in Bone Tissue.

Assessing The Patient

The European Vertebral Osteoporosis Study Group had drawn questionnaire to identify patients at risk, this is the first approach to identify patients (See table 1). In recent vertebral compression fracture, Patients consult for acute back or dorsal pain. Physical examination is mandatory to rule out any associated problem which could result in osteoporosis. Taking Height and Weight (Baseline and follow-up), describing patient cyphosis and the stooped posture if exist. Searching for localized pain.

The aim of Laboratory tests is to rule out associated diseases in elderly: multiple myeloma, bone metastasis, osteomalacia and dysthyroidism.

First line laboratory test is important for all osteoporotic patients, X-ray if necessary and BMD measurement.

Preventive measures

Education and Continuous medical support using adequate medications are major concerns that improve quality of life and decrease risk of osteoporosis.

Prevention begins since the age of growth, Calcium intake should be adequate in all ages especially during growth, pregnancy and breast feeding, and during elderly (table 2).

Physical activities are very important in reducing the risk of osteoporosis in all ages, we usually propose what the W.H.O. recommends for prevention of cardiovascular diseases which is walking from 3 to 5 km every day.

In early perimenopause the patient should rapidly start to maintain the level of BMD, many estro-progestatif compound are available. Regular follow-up is mandatory by gynecologist if Hormonal replacement therapy (HRT) is instituted. The effect of estrogen disappeared soon after his withdrawal.

Bisphosphonate derivatives are now studied for their use in preventive dose in patients who do not want to take HRT or when this latter is contraindicated.

Offering professional support is important to prevent fractures, we recommend a safe home environment, using hip pads in the frail elderly and maintaining physical activities, making exercise training for body mechanics together with balance enhancement program, and finally social and psychological support to enhance benefits and outcome.

Conclusion

Therapy is now expanded by combining rehabilitation programs and drugs to inhibit bone loss. By making early prevention, reducing osteoporosis and osteoporotic fractures, quality of life in elderly can now be improved in the coming generation.

Table 1

Risk Factors:

Table 2 : U.S. National Institutes of Health Consensus Conference, 1994

                                                                        Optimum Calcium requirements (mg)

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La Fibromyalgie, C'est Quoi

Par l'unité de rhumatologie, Hôpital Trad, Beyrouth.

On se demande pourquoi existe-t-il une douleur dans la Fibromyalgie? comme son nom l'indique, algie=douleur, fibro=fibre, une douleur sur des points précis au rachis et périphériques aux membres.

Souvent en relation avec un Stress? ou même avec une maladie chronique qui provoque un certain état d'âme particulier. C'est une entité reliée à l aRhumatologie, oui, puisque c'est une découverte rhumatologique, mais aussi c'est relié à une pré-dépression (non pas la dépression).

J'explique souvent aux malades atteints que vous avez quelque chose qui n'existe pas! une manifestation douloureuse sans cause organique. Les études récentes ont démontrées la présence d'un trouble de la sérotonine (un transmetteur) qui serai abaissé chez ces malades ce qui fait une baisse du seuil de la douleur, ce qui explique une sensibilité accrue douloureuse à la simple palpée sur ces points douloureux.

Un traitement qui règle la sérotonine dans le système nerveux (Une classe de médicaments SSRI = serotonine re-uptake inhibitor) améliore la situation des malades souffrants. Mais récemment encore des chercheurs Suédois, ont démontré par une étude ménée sur plusieurs centaines de patients que le groupe soumis à ce traitement est comparable à un autre groupe qui a été traité par la natation et/ou relaxation dans une piscine d'eau chaude une heure par jour. Aprés 6 mois de traitement soit par médicament ou par la relaxation en piscine chaude, les 2 groupes ont eu le même résultat.

En clinique, c'est un peu difficile de convaincre, mais faut-il savoir comment convaicre! Adieu la fibromyalgie.

Agenda des Congrés