OPYT PRIMENENIYa PROFILAKTIChESKOY DOZY ALENDRONATA (FOSAMAKS 35 mg) DLYa LEChENIYa OSTEOPOROZA u zhenshchin v postmenopauzes subklinicheskim tireotoksikozom

The aim was to estimate the effects of treatment with alendronate (Fosomax 35 mg) in postmenopausal women with osteoporosis and subclinical hyperthyroidism. Thirty postmenopausal women (64 (60-69) years old) with osteoporosis (T-score ≤ -2,5) and subclinical hyperthyroidism (77% with endogenous subclinical hyperthyroidism and 23% on L-thyroxine suppres-sive therapy after thyroidectomy due to differentiated thyroid cancer) were randomly assigned into two groups: 1-14 women received Fosamax 35 mg a week in combination with 500 mg of calcium and 400 UI of Vitamin D3 (VD) daily; 2-16 women received 1000 mg of calcium and 800 UI of VD daily. Euthyroidism was achieved in all women with endogenous subclinical hyperthyroidism. An increase in physical activity was recommended to all patients and a hypolipidemic diet was given to those who had had high cholesterol level. Biochemical parameters (calcium (Ca), phosphorous (P), creatinine (Cre), alkaline phosphatase (ALP), cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TG), cholesterol/HDL ratio) in fasting serum as well as calcium/creatinine ratio in fasting urine (U-Ca/U-Cre); biochemical markers of bone metabolism: osteocalcin (OC) and C-terminal telopeptide of type I collagen (b-CTx) serum ("ECLIA", Roche Elecsys 1010/2010), BMD (DXA; Prodigy, Lunar) at the lumbar spine (L1-L4), femoral neck (FN), total hip (TH) and radius total (RT) were measured at the baseline visit and after 1 year of treatment. At the baseline visit there were not found any differences between the 1 and the 2 groups. After 12 months of treatment the markers of bone metabolism as well as ALP decreased significantly in both groups, though the decreases were significantly greater (p<0.001 for both OC and b-CTx) in the 1 versus the 2 group. BMD in the 1 group increased by 7,6% at L1-L4 (p=0,003), 2,8% at FN (р=0,013), 3,3 % at TH (p=0,012) and 3,2 % at RT (р=0,047). There was not detected any BMD loss in the 2 group. The changes were not significant between the two groups. The levels of Ca, P, Cre, U-Ca/U-Cre did not change in both groups. Significant improvements in lipid levels were found: HDL increased (р=0.035 1 group p=0,034 2 group), cholesterol/HDL ratio decreased (p=0,011 - 1; p=0,004 - 2). In addition, cholesterol (р=0,003); TG (p=0,016) and LDL (p=0,006) decreased for patients from the 1 group. Conclusion: The achievement of euthyroidism and Fosamax 35 mg a week increase BMD in all regions of the skeleton in postmenopausal women with osteoporosis and subclinical hyperthyroidism and reduce bone resorption significantly more than Calcium and VD supplementation.

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