Bone metabolism in primary hyperparathyroidismMain theme

Judita Klímová

Clin Osteol 2025; 30(2): 77-81

Primary hyperparathyroidism is a generalized disorder of calcium-phosphate metabolism with an increasing incidence. Long-term overproduction of parathyroid hormone with varying degrees of hypercalcemia and hypercalciuria leads to a wide range of complications, from life-threatening hypercalcemic crisis, through diffuse kidney damage, to neurocognitive, metabolic and cardiovascular abnormalities. Bone damage, caused by the predominance of osteoresorption over new formation, is characterized by reduced bone density, impaired bone microarchitecture and an increased risk of vertebral and non-vertebral fractures. Advanced forms of bone damage with the formation...

Osteoporosis and diabetes mellitusMain theme

Ludmila Brunerová

Clin Osteol 2025; 30(2): 71-76

Diabetes mellitus is associated with increased risk of osteoporotic fractures although pathophysiologic mechanisms may differ. In accordance with recent ADA/IOF updated guidelines, specific assessment of fracture risk and screening of osteoporosis should be involved in standard management of patients with diabetes. In real clinical practice, however, insufficient attention is paid to bone health in patients with diabetes. Entire diagnostic and therapeutic approaches are (with some specifics) similar to those in general population, the main difference being the therapeutic threshold (antiosteoporotic treatment should be considered in T-skóre ≤...

Výber z najnovších vedeckých informácií v osteológiiLiterature

Šteňová Ke Em

Clin Osteol 2025; 30(1): 61-62

Secondary OsteoporosisReview articles

Horák Pavel

Clin Osteol 2025; 30(1): 54-60

Osteoporosis is a major public health problem. Although postmenopausal and involutional osteoporosis are the most common forms, secondary causes account for up to 30 % of osteoporosis in postmenopausal women, 50 % of premenopausal osteoporosis, and 80 % of osteoporosis in men. Causes of secondary osteoporosis include lifestyle and nutritional factors, diseases that contribute to the development of bone metabolic disorders, and iatrogenic causes related to pharmacological or nonpharmacological interventions for various conditions. The need for screening for secondary causes of osteoporosis depends on the severity of osteoporosis, the absence of obvious...

Hypophosphatasia -⁠ Standard Diagnostic and Therapeutic GuidlineReview articles

Kužma Martin, Tichá Ubica, Kokavec Milan, Payer Juraj

Clin Osteol 2025; 30(1): 48-53

Hypophosphatasia (HPP) is a rare hereditary disease with a variable course, caused by mutations in the ALPL gene encoding tissue-nonspecific alkaline phosphatase (TNSALP). It is characterized by impaired bone and tooth mineralization, growth and mobility disorders, premature tooth loss, respiratory issues, and seizures. Diagnosis is based on low ALP activity and elevated levels of its substrates. Early diagnosis is crucial, as improper treatment can worsen the patient's condition. Molecular genetics can confirm the diagnosis, though it is not always necessary. Treatment includes enzyme replacement therapy and symptomatic care to manage complications.

The role of palopegteriparatide in the treatment of hypoparathyroidismReview articles

Králik Roman; Pavúková Simona; Payer Juraj; Kužma Martin

Clin Osteol 2025; 30(1): 42-45

Hypoparathyroidism is a rare endocrine disorder characterized by insufficient secretion of parathyroid hormone, leading to hypocalcemia and its severe clinical consequences. While there are various etiological forms, the most common cause is post-surgical removal of the parathyroid glands, such as after total thyroidectomy. Diagnosis is based on low parathyroid hormone levels combined with hypocalcemia and other biochemical changes. Clinical manifestations range from mild neurological symptoms to life-threatening complications such as laryngospasms and cardiac arrhythmias. Long-term complications include nephrolithiasis, renal insufficiency, and alterations...

Predikcia osteoporotických zlomenín na základe intenzity signálu MR?Original contributions

Mikulová Udmila, Gičová Daša, Špakovská Tatiana, Lorinczová Zuzana, Kalafu-Tová Soňa, Blaščáková Mydlárová Marta

Clin Osteol 2025; 30(1): 36-40

Selected stories from osteonephrology -⁠ an introductionMain theme

Sulková Dusilová Sylvie, Pavlíková Ladislava, Pokorná Anita, Jiráčková Jana, Hudík Filip, Malá Alena, Bílková Lenka, Matysková Michaela, Hyšpler Radomír, Šafránek Roman, Palička Vladimír

Clin Osteol 2025; 30(1): 30-34

Vybrané příběhy z osteonefrologie -⁠ úvod do problematikySo called osteonephrology deals with the interface between metabolic and other consequences of complex bone and cardiovascular disease in renal disease and also with non-renal metabolic osteopathies in kidney patients.The article focuses on problems associated with biologic therapy of osteoporosis in patients with chronic kidney disease, including dialysis as well as kidney transplantation. The attention is paid not only to benefit of this therapy, but also on its possible risk, showing the importance of carefull monitoring in hands of nephrologists.

Vitamin D -⁠ current overview of the issue and specifics in nephrological practiceMain theme

Sulková Dusilová Sylvie, Šafránek Roman, Pavlíková Ladislava, Pokorná Anita, Kadlec Mirko, Hudík Filip, Horáček Jiří, Hyšpler Radomír, Palička Vladimír

Clin Osteol 2025; 30(1): 22-29

Recent randomized placebo-controlled trials did not demonstrate clear clinical benefits of nutritional vitamin D supplementation in non-selected population. Therefore, current recommendations suggest testing vitamin D serum values only in vitamin D deficiency risk groups of patients. Kidney disease patients are at this risk.Target serum calcidiol (25-hydroxyvitamin D) concentrations in kidney disease or failure and also in kidney transplant patients should be higher than 75 nmol/l. The reason for this target is to maintain sufficient calcitriol to suppress early parathyroid gland overactivity. On the contrary, calcidiol values over 50 nmol/l are...

From despair to results: Clinical experience and effective strategies in the treatment of calciphylaxisMain theme

Krošlák Oliver, Sulková Dusilová Sylvie, Šafránek Roman, Halouzka Tomáš, Pokorná Anita, Chrobok Viktor, Horáček Jiří, Pavlíková Ladislava, Palička Vladimír

Clin Osteol 2025; 30(1): 14-20

Calciphylaxis (CUA) represents a rare but serious complication in patients with chronic kidney disease and less frequently in other conditions. The aim of our study is to assess our experiences with the diagnosis and treatment of CUA. We present the clinical characteristics, the prevalence of key risk factors, and the favorable prognosis of patients with calciphylaxis treated at our institution between 2014 and 2021. The cohort consisted of 23 patients who were diagnosed with calciphylaxis based on clinical presentation. In most cases, the lesions were multiple, painful, and led to significant mobility limitations. Important risk factors included the...

A completely now approach to the issue of bone disease in patients with chronic kidney disease -⁠ what KDIGO practice recommendations can we expect? Commentary on the KDIGO 2025 Controversies Conference.Main theme

Palička Vladimír, Sulková Dusilová Sylvie

Clin Osteol 2025; 30(1): 6-12

In 2006, the KDIGO initiative acknowledged the link between cardiovascular damage and bone disorders by incorporating a so called "vascular component" into the CKD-MBD concept. However, renal osteodystrophy continued to be viewed as a distinct and specific bone pathology within nephrology.In recent years, this perspective has begun to shift. Renal osteodystrophy, traditionally the domain of nephrologists, and osteoporosis, the domain of osteologists, are now increasingly converging and overlapping. The impetus for this change came from new insights into the importance of bone densitometry in nephrology and the high fracture risk among nephrology...

Několik slov úvodemEditorial

prof. MUDr. Vladimír Palička, CSc., Dr.h.c.

Clin Osteol 2025; 30(1): 3

Výber z najnovších vedeckých informácií v osteológiiLiterature

Šteňová Ke Em

Clin Osteol 2024; 29(4): 157-158

COVID-19 treatment and glucocorticoid-induced osteoporosis: a case reportCase reports

Štambera Dalibor

Clin Osteol 2024; 29(4): 151-156

This case report describes the case of a patient treated with glucocorticoids in connection with his COVID-19 disease, who was subsequently diagnosed with glucocorticoid-induced osteoporosis (GIOP), the most common type of secondary osteoporosis today, based on densitometric findings and a history of low-strain fracture. The article highlights the need for preventive vitamin D and calcium supplementation during glucocorticoid treatment and also the need to perform whole-body densitometry at prescribed intervals in accordance with relevant recommendations.

Charcot's osteoarthropathy or Sudeck's Syndrome? A case reportCase reports

Novák Vladimír

Clin Osteol 2024; 29(4): 147-150

A patient (born in 1950), was examined for suspicion of Sudeck's syndrome of the left foot. The problems arose after prolonged work in the garden -⁠ significant pain in the instep and sole, sensitivity to touch, swelling and redness up to the ankles. There was no previous fracture or other trauma, in the pre-illness the patient was fully mobile without support. Due to the sixteen-year history of type 2 diabetes mellitus, we considered Charcot's osteoarthro­pathy in the differential diagnosis; Subsequently, three-phase skeletal scintigraphy and MRI of the left foot were compatible with this diagnosis, as they showed pathologically increased activity...

The fragile beauty of bone -⁠ a perspective on fracture risk assessment in clinical practice: a case reportCase reports

Killinger Zdenko

Clin Osteol 2024; 29(4): 143-146

In Blahoš's lecture, the author points out several aspects of bone quality and the possibilities of their use, not only when determining the risk of fracture, but also when deciding on the need for anti-porotic therapy. Briefly documents the development of diagnostic methods and therapeutic approaches in the last 30 years of Slovak osteology. Author focused on the role of bone densitometry in the diagnostic and therapeutic algorithm and progress in the position of DXA in real practice in the Slovak Republic in the given period. In conclusion, the author on a specific case report pointed out how individual bone quality parameters can influence the decision...

What's (new) in the guidelines of the osteological societies of the German-speaking countries published in 2023Comments

Hess Zdeněk

Clin Osteol 2024; 29(4): 136-142

The 2023 guidelines from German-speaking scientific osteological societies offer updated recommendations for osteoporosis prevention, diagnosis, and treatment, focusing on new risk factors, such as humeral fractures, cardiac and renal insufficiency, and chronic hyponatremia. The guidelines also consider additional factors, like immobility and HIV, and newly define bone density thresholds for initiating treatment. Romosozumab has been added as a therapeutic option to reduce the risk of vertebral and non-vertebral fractures. The improved fracture risk calculator now combines the two strongest risk factors with bone density measurements and shortens the...

Hemophilia and bone tissue metabolismReview articles

Palička Vladimír; Horáčková Jana; Pavlíková Ladislava; Hyšpler Radomír

Clin Osteol 2024; 29(4): 132-135

Findings of reduced bone mineral density and osteoporosis in hemophilia patients are gradually increasing and will certainly increase with successful treatment and increasing life expectancy. Older, not very numerous studies are being replaced by large meta-analyses showing significant reduction of bone mineral density in hemophiliacs. However, it is not only the effect of increasing age that is being demonstrated, but also the direct and indirect pathobiochemical links between coagulation factor deficiency and the effect of their therapeutic administration on bone tissue metabolism. A crucial role is played by the influence of the RANK/RANKL/OPG system...

Osteoporosis and liver diseasesReview articles

Košcál Mojmír

Clin Osteol 2024; 29(4): 128-131

Increasing attention to the interaction between liver and bone has stimulated interest in targeted interventions for various forms of osteoporosis. Liver damage induced by various liver diseases can cause imbalances in bone metabolism, suggesting a new regulatory paradigm between liver and bone. However, the role of the liver in the development of osteoporosis is still not well understood. Therefore, investigating the precise regulatory mechanisms (liver-bone) may offer innovative clinical approaches to treat liver and bone-related diseases.

Steroid contraception -⁠ the influence on bone metabolismReview articles

Fait Tomáš

Clin Osteol 2024; 29(4): 122-127

The combined hormonal contraception have positive influence on bone mineral density due to its estrogen component. This effect could have clinical application in group of women with menstrual cycle´s disorders and in perimenopausal women. Extremely low doses of ethinylestradiol could forestall the achievement of bone mineral density peak. Depot medroxyprogesterone acetate is not suitable contraception for women with risk of osteoporosis.

Několik slov úvodemEditorial

prof. MUDr. Vladimír Palička, CSc., dr.h.c.

Clin Osteol 2024; 29(4): 119-120

27. kongres slovenských a českých osteológovAbstracts

Clin Osteol 2024; 29(3): 87-113

Výber z najnovších vedeckých informácií v osteológiiLiterature

Šteňová Ke Em

Clin Osteol 2024; 29(3): 84-86

The EGFR signaling pathway is involved in the regulation of cellular functions of osteoclasts and osteoblasts. Suppression of signaling in this pathway by administration of EGFR-TKIs has been used as an option for anticancer therapy in NSCLC patients with activating mutations of the EGFR gene. We describe the case of an NSCLC patient treated with afacitinib in whom we observed a significant suppression of bone remodeling accompanied by an increase in BMD, which was further potentiated by downstream administration of denosumab. The effect of EGFR-TKI inhibition on bone metabolism has not been sufficiently studied. In vitro data show that EGFR inhibition leads to attenuation of osteoblast and osteoclast activity. Further research is also desirable in view of important overlaps into clinical practice (bone metastases, Skeletal-Related Events, OsteoNecrosis of the Jaw).Case reports

Rosa Jan, Fabrik Ivo, Soukup Ondřej, Palička Vladimír

Clin Osteol 2024; 29(3): 80-83

Kardiovaskulární riziko při léčbě romosozumabemComments

Vrablík Michal

Clin Osteol 2024; 29(3): 77-79

Osteoporosis (OP) is a systemic metabolic disease characterized by reduced bone mass and disturbed bone microarchitecture, which causes increased bone fragility and thus increased risk of fractures even with minimal trauma. The goal of osteoporosis treatment is restitution of thinned bone tissue. The ultimate and main goal is fracture prevention. The effectiveness of treatment can also be judged accordingly. An early, indirect indicator of the success of treatment is an increase in bone density, or at least a slowing of bone loss to the physiological limit. Sclerostin is a protein that in humans is encoded by the SOST gene. Sclerostin is produced mainly by osteocytes and has antianabolic effects on bone formation. Romosozumab is a humanized IgG2 monoclonal antibody against sclerostin. The development of an antibody against sclerostin seemed ideal to affect bone formation precisely because of the almost exclusive expression of the SOST gene in bone. Romosozumab has proven to be extremely effective in increasing bone mineral density (BMD), modulating markers of bone turnover and reducing fracture risk. Treatment with romosozumab results in a rapid and effective reduction in fracture risk in postmenopausal women with osteoporosis. The dual mechanism of action makes romosozumab a unique and effective treatment option for osteoporosis, particularly in cases where rapid increases in bone density are desired. The significant reduction in fracture risk represents a substantial clinical benefit.Review articles

Růžičková Olga

Clin Osteol 2024; 29(3): 55-76

Niekoľko slov na úvodEditorial

Clin Osteol 2024; 29(3): 53

Sborník abstrakt: XV. celostátní konference Sekundární osteoporóza, Plzeň, 10.-11. 5. 2024Abstracts

Clin Osteol 2024; 29(1-2): 31-50

Výber z najnovších vedeckých informácií v osteológiiLiterature

Šteňová Emoke

Clin Osteol 2024; 29(1-2): 29-30

Acetabuloplasty in therapy of severe dysplasia of the hip: case reportCase reports

Rendek Pavol; Halas Matúš; Kubičková Paulína; Bevilaqua Jana; Kokavec Milan

Clin Osteol 2024; 29(1-2): 25-28

Developmental dysplasia of the hip (DDH) is a prearthrotic hip defect requiring therapy from neonatal age. The Slovak population has an above-average incidence of DDH, which is why hip screening using the triple-screen method has been introduced in the Slovak Republic. When the most severe form of dysplasia is detected -⁠ hip luxa­tion and obstructions preventing the reposition of the femoral head into the acetabulum, surgical treatment is indicated. During surgery, evacuation of the acetabulum is performed, i.e. removal of all repositioning obstacles. Subsequently, a Dega acetabuloplasty and capsuloplasty are performed. In some cases, the femur...