постменопауза (2 тип), которые получали
стандартное
лечение,
3-я
группа
(контрольная) – пациентки без системной
костной патологии.
Результаты:
для
улучшения качества остеоинтеграции
имплантатов у пациенток с остеопорозом
был увеличен период от установки
имплантата до фиксации ортопедической
конструкции. Второй этап выполнялся
через 7-8 месяцев на верхней, через 5-6
месяцев – на нижней. челюсти.
Выводы:
внедрение
патогенетически
обоснованного
подхода
к
лечению
позволит добиться значительных успехов
в лечении больных с первичным
остеопорозом.
Ключевые
слова:
женщины,
постменопаузальный
остеопороз,
внутрикостная имплантация.
Relevance of the topic
. Achievements of
recent years in the study of molecular
pathogenetic
aspects
of
osteoporosis
contributed to the search for the most specific
and informative markers which reflect the
intensity of remodeling processes. Although
these markers are divided into synthesis and
resorption markers, it should be kept in mind
that under pathological conditions, when
bone tissue remodeling processes are coupled
and altered in one direction, any of the above
markers will reflect the total rate of bone
metabolism.
Material and methods:
The
women in the climacteric period were
examined, in whom the operation of
intraosseous implantation was planned.
group 1 - 15 patients diagnosed with
postmenopausal osteoporosis (type 1), to
whom we prescribed myacalcic + vitamin D,
group 2 - 22 patients diagnosed with
postmenopause (type 2), who received
standard treatment, group 3 (control) -
patients without systemic bone pathology.
Results:
To improve the quality of implant
osseointegration
in
patients
with
osteoporosis, the period from implant
placement to fixation of the orthopedic
structure was extended. The second stage
was performed after 7-8 months on the upper
one, after 5-6 months - on the lower one
jaws.
Conclusions:
The introduction of a
pathogenetically sound approach to treatment
will make it possible to achieve significant
success in the treatment of patients with
primary osteoporosis.
Key words:
women, postmenopausal
osteoporosis, intraosseous implantation.
UDK: 616.314-089.843-06]-092-055.2
THE EFFECTIVENESS OF CALCIUM AND VITAMIN D PREPARATIONS IN
THE TREATMENT OF OSTEOPOROSIS IN THE EARLY MENOPAUSAL PERIOD
Pulatova B.Zh., Achilova N.G., Abdukarimov N.M.
Tashkent State Dental Institute, Tashkent Medical Academy, Fergana Institute of Public Health
Medicine
The relevance of the topic
. In recent years,
considerable attention has been paid to
clarifying the relationship between metabolic
diseases of bone tissue and changes in the
bone tissue of the jaws. It would seem that the
systemic processes occurring in the div
cannot but affect the condition of the tissues of
the dental system. However, the association
between osteoporosis and oral health remains a
controversial issue. Normally, the height of the
alveolar ridge is maintained by a physiological
balance
between
bone
formation
and
resorption.
Some studies have found that the treatment
of osteoporosis improves the condition of
periodontal tissues J. Wactawski-Wende et al.
(2022) believe that in postmenopausal women,
the loss of alveolar height and the number of
lost teeth depend on the severity of osteopenia.
According to E.A. Krall (2011), M.S. Reddy;
(2012), a decrease in bone mineral density in
patients with osteoporosis, both in men and
women, is a risk factor for the development of
periodontitis, while drugs used to treat
osteoporosis have a beneficial effect on the
condition of the oral cavity [4,9,10].
The purpose of the work
: To evaluate
changes in the oral cavity caused by
osteoporosis, to diagnose changes in the
tissues of the oral cavity in conditions of
estrogen deficiency, and also to study the
effect of hormone replacement therapy,
calcium and vitamin D preparations on the
condition of the oral cavity [5,6,8].
Material and methods
In the course of the study, a biochemical
analysis was carried out with the determination
of calcium. When studying the hormonal
analysis
of
parathyroid
hormone
and
calcitonin, the level of vitamin D was
determined. Before placing the implants, a
comprehensive examination of patients is
recommended to assess the state of bone tissue
and metabolic disorders. Patients were
examined by an orthopedist, endocrinologist or
gynecologist and, if necessary, received a
course of treatment. During the postoperative
period,
it
was
recommended
to
take
physiological doses of vitamin D and calcium
[1-3]. The planning of the intraosseous
implantation operation was carried out on the
basis
of
data
from
a
comprehensive
examination
of
patients
using
clinical,
radiological,
functional
and
laboratory
methods. For the diagnosis of osteoporosis,
various biochemical parameters are widely
used to determine the type of osteoporosis
(primary,
secondary).
We
carried
out
biochemical analyzes: calcitonin parathormone
and vitamin D. Menopausal women were
examined and pathogenetic treatment was
carri.
The first group (15 people) included
patients
diagnosed
with
postmenopausal
osteoporosis (type 1), we gave them myacalcic
+ vitamin D. The second group included 22
patients diagnosed with postmenopause, we
carried out standard treatment (type 2). The
third group (control) consisted of patients
without systemic pathology of the bone
tissue.ed out with myacalcic + vitamin D
(Table).
Table
Distribution of patients by age, abs, (%)
Type
Age
Total number of
patients
40-44 years old 45-49 years old 50-54 years old 55 years and older
1
15 (25,0)
14 (23,33)
11 (18,33)
7 (11,67)
47 (78,33)
2
-
4 (6,67)
5 (8,33)
4 (6,67)
13 (21,67)
Total
15 (25,0)
18 (30,0)
16 (26,66)
11 (18,34)
60 (100)
Results and discussion
The
main
treatment
programs,
the
effectiveness of which has been confirmed by
extensive
controlled
randomized
trials,
include: for the elderly – calcium preparations
and the active form of vitamin D. Both
preventive and curative programs to combat
osteoporosis have a mandatory component of
the subsidy of calcium and vitamin D.
Moreover, special importance is attached to
sufficient intake of calcium and vitamin D
throughout life, especially during the period of
accumulation of bone tissue and during its
predominant loss. Women also need an
increased amount of calcium during pregnancy
and the postpartum period. The recommended
calcium intake during these periods of life is
1000-1500 mg / day and is indicated
regardless of the presence of risk factors for
osteoporosis and the value of BMD. Most
people have a deficiency of calcium intake
from food, which is aggravated by various
diseases of the stomach and intestines, which
dictates the need to prescribe calcium
medications. The expediency of the joint use
of calcium salts and vitamin D led to the
creation of complex preparations containing
both components. In some cases, they contain
additional mineral elements (magnesium, zinc,
boron, etc.). Multivitamins with calcium salts
cannot be considered as medicines for the
prevention of osteoporosis, since their calcium
content is low.
One of the complex preparations used for
the prevention and included in the treatment
regimens of osteoporosis is Calcivite, which
contains 500 mg of calcium in the form of
citrate and carbonate, vitamin D3 (200 IU), as
well as magnesium, zinc, copper in the form of
oxides, manganese in the form of sulfate,
boron in the form of sodium salt. The drug is
taken twice a day, respectively, daily doses of
calcium 1000 mg and vitamin D3 400 mg are
achieved, sufficient for the prevention of
osteoporosis in most individuals.
Conclusion Adequate intake of calcium and
vitamin D contained in foods or medicines is
an important part of the prevention and
treatment of osteoporosis. In order to improve
the quality of implant osseointegration in
osteoporosis, additional time is needed for
bone mineralization. Calcium and vitamin D
preparations
should
be
a
mandatory
component of any osteoporosis treatment
regimen. The daily dose of elemental calcium
for patients with an established diagnosis of
osteoporosis,
as
well
as
for
taking
glucocorticosteroids and for people over the
age of 65 years should be 1000-1500 mg.
Patients of all three groups underwent
implantation according to the classical two-
stage technique, during which screw implants
were installed. The number of implants
depended on the number of teeth to be
replaced, as well as on the quantity and quality
of bone tissue in the area of implantation. The
choice of the length of the implants was
carried out depending on the height of the
alveolar bone. A total of 103 implants were
installed, including 29 (28.2%) in patients of
group 1, 36 (35.0%) in group 2, 38 (36.8%) in
group 3. Implants of maximum length and
diameter were used, keeping a distance of 2
mm when placed close to such anatomical
structures as the maxillary sinuses, the floor of
the nasal cavity, the mandibular nerve canal,
and the mental foramen. In this case, the
thickness of the bone walls around the implant
was at least 1 mm, and the distance between
the implants or between the implants and
adjacent teeth was at least 2 mm.
Conclusion
Vitamin D contributes significantly to bone
mineralization by promoting calcium and
phosphorus absorption in the intestine, calcium
reabsorption in the kidneys, and calcium and
phosphorus transport to the mineralizable area
of bone tissue. In addition to the direct
regulation of calcium-phosphorus metabolism,
vitamin D also indirectly contributes to the
accumulation of bone mass by stimulating the
development of muscle tissue.
References
1.
Achilova N.G., Pulatova B.J. Medical
correction
in
the
planning
of
dental
implantation in patients with osteoporosis in
the menopausal period // Actual problems of
maxillofacial surgery: Materials of the
International scientific and practical online
conference. – Tashkent, 2021. – №3. – Р. 56-
59.
2.
Achilova N.G., Pulatova B.J. Pre-
operative training of patients with osteoporosis
during premenopause when planning dental
implantation // Сentral Аsian J. Med. – 2021. –
№11. – Р. 47-58.
3.
Achilova N.G., Pulatova B.J. Тo the
question of preparation of patients with
osteoporosis during the premenopause when
planning dental implantation // Orient. J. Med.
Pharmacol. – 2022. – №10. – Р. 82-92.
4.
Adams Hillard P.J., Nelson L.M.
Adolescent girls, the menstrual cycle, and
bone health // J. Pediatr. Endocrinol. Metab. –
2003. – Vol. 16 (Suppl. 3). – P. 673-81.
5.
Davas I., Altintas A., Yoldemir T. et al.
Effect of daily hormone therapy and
alendronate use on bone mineral density in
postmenopausal women // Fertil. Steril. –
2003. – Vol. 80, №3. – P. 536-540.
6.
Devine A., Prince R.I., Dhalival S.S. et
al. Results of a 5year double blind, placebo
controlled trial of calcium supplementation
(CAIFOS): bone density outcomes // J. Bone
Miner. Res. – 2004. – Vol. 327. – P. SA416.
7.
Eisman J.A. Pharmacogenetics of the
vitamin D receptor and osteoporosis // Drug
Metab. Dispos. – 2019. – Vol. 29, №4 (Pt. 2).
– P. 505-512.
8.
Grados F., Brazier M., Kamel S..
Effects on bone mineral density of calcium
and vitamin D supplementation in elderly
women with vitamin D deficiency // Joint
Bone Spine.–2003.–Vol.70,№3 –P.203-208.
9.
Lindsay R., Kleerekoper M. Estrogens
for the prevention of osteoporosis; Ed. by R.
Lindsay // Drugs Osteoporosis.–2005.–P.1-27.
10.
Rizzoli R., Bianchi M.L., Garabédian
M. et al. Maximizing bone mineral mass gain
during growth for the prevention of fractures
in the adolescents and the elderly // Bone. –
2010. – Vol. 46, №2. – P. 294-305.
11.
Smetnik
V.P.
Postmenopausal
osteoporosis // Medicine climacteria; Ed. V.P.
Smetnik. – Yaroslavl: LLC "Publishing House
Litera", 2016. – Р. 656-686.
Цель:
оценка изменений в полости рта,
вызванных остеопорозом в условиях
дефицита
эстрогенов
и
влияния
заместительной гормональной терапии
препаратами кальция и витамина D.
Материал и методы:
в 1-ю группу
включены 15 пациенток с диагнозом
постменопаузальный остеопороз (1-й тип),
которые получали миакальцик + витамин
Д, во 2-ю – 22 пациентки с диагнозом
постменопауза,
(2-й
тип)
которым
проводилось
стандартное
лечение.
Контрольную группу составили женщины
без системной патологии костной ткани,
получавшие миакальцик + витамин Д.
Результаты:
витамин
D
вносит
значительный вклад в минерализацию
костей, способствуя всасыванию кальция и
фосфора
в
кишечнике,
реабсорбции
кальция в почках и транспорту кальция и
фосфора
в
минерализуемые
участки
костной ткани. Помимо непосредственной
регуляции кальциево-фосфорного обмена,
витамин D также косвенно способствует
накоплению костной массы, стимулируя
развитие мышечной ткани.
Выводы:
применяемые препаратов можно сочетать
практически со всеми лекарственными
средствами, применяемыми при лечении
остеопороза.
Ключевые слова:
остеопороз, дефицит
эстрогенов, заместительная гормональная
терапия, препараты кальция, витамин D.
Maqsad:
estrogen
etishmovchiligi
sharoitida
osteoporoz
tufayli
og'iz
bo'shlig'idagi o'zgarishlarni va kaltsiy va D
vitamini
preparatlari
bilan
gormonlarni
almashtirish terapiyasining ta'sirini baholash.
Material
va
usullar:
1-guruhga
postmenopozal osteoporoz tashxisi qo'yilgan
(1-toifa) 15 bemor kiritilgan. miakaltsik +
vitamin D, 2-da - standart davolash o'tkazilgan
postmenopauza tashxisi bilan 22 bemorlar (turi
2). Nazorat guruhi miyakalsik + D vitamini
olgan tizimli suyak kasalligi bo'lmagan
ayollardan iborat edi.
Natijalar:
D vitamini
ichakdagi kaltsiy va fosforning so'rilishini,
buyraklardagi kaltsiyning qayta so'rilishini va
kaltsiy va fosforni tashishni rag'batlantirish
orqali suyak mineralizatsiyasiga sezilarli hissa
qo'shadi. suyak to'qimalarining mineralizatsiya
qilinadigan
joylariga.
Kaltsiy-fosfor
almashinuvini
to'g'ridan-to'g'ri
tartibga
solishdan tashqari, D vitamini mushak
to'qimalarining rivojlanishini rag'batlantirish
orqali
suyak
massasining
to'planishiga
bilvosita
yordam
beradi.
Xulosa:
ishlatiladigan dorilar osteoporozni davolashda
ishlatiladigan deyarli barcha dorilar bilan
birlashtirilishi mumkin.
Kalit
so'zlar:
osteoporoz,
estrogen
etishmovchiligi,
gormonlarni
almashtirish
terapiyasi, kaltsiy preparatlari, D vitamini.
Objective:
To evaluate changes in the oral
cavity caused by osteoporosis in conditions of
estrogen deficiency and the effect of hormone
replacement therapy with calcium and vitamin
D preparations.
Material and methods:
Group 1 included 15 patients diagnosed with
postmenopausal osteoporosis (type 1) who
received miakaltsik + vitamin D, in the 2nd -
22 patients with a diagnosis of postmenopause,
(type 2) who underwent standard treatment.
The control group consisted of women without
systemic bone disease who received myacalcic
+ vitamin D.
Results:
Vitamin D contributes
significantly to bone mineralization by
promoting
absorption
of
calcium
and
phosphorus in the intestine, reabsorption of
calcium in the kidneys, and transport of
calcium and phosphorus to mineralizable areas
of bone tissue. In addition to the direct
regulation of calcium-phosphorus metabolism,
vitamin D also indirectly contributes to the
accumulation of bone mass by stimulating the
development of muscle tissue.
Conclusions:
The drugs used can be combined with almost
all drugs used in the treatment of osteoporosis.
Key
words:
osteoporosis,
estrogen
deficiency, hormone replacement therapy,
calcium preparations, vitamin D.
УДК
616.31-084 (075.8). 56.6.
КИМЁВИЙ САНОАТ ИШЧИЛАРИДА СТОМАТОЛОГИК КАСАЛЛИКЛАРИНИ
КЛИНИК-ЛАБОРАТОР ТЕКШИРИШ КЎРСАТКИЧЛАР ТАҲЛИЛЛАРИ
Ибрагимова Феруза Икромовна
Бухоро давлат тиббиёт институти
“Навоиазот” корхонаси кимёвий воситалар ишлаб чиқарувчи саноати ишчилари
орасида ўтказилган стоматологик тиббий кўрик, оғиз бўшлиғида махсус ва қўшимча
