COMPLEX TREATMENT OF CHILDREN WITH A COMBINATION OF UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA AND A DECREASE IN BONE MINERAL DENSITY
Inadequate bone formation, including its lack of mineralization during childhood, has many mechanisms in common with undifferentiated connective tissue dysplasia (UCTD). To date, the greatest occurrence of combinations of connective tissue dysplasia with osteoporosis and osteopenia is revealed, which necessitates a systematic approach to the treatment of such combined manifestations. The study aims to analyze the effectiveness and create a systematic approach for treating undifferentiated connective tissue dysplasia and osteopenic syndrome in children. Materials and methods. Examination of 160 patients aged 3-16 years was conducted. The contingent of children participating in the study is represented by two equal groups of 80 children each. The age and sex composition of the study groups were the same. The criterion for the inclusion of patients in the study was the presence of UCTD against the background of a decrease in bone mineral density. The laboratory blood test included measuring the concentration of 25-hydroxyvitamin D, calcium, and magnesium, and the level of glycosaminoglycans (GAGs) in the urine. All patients underwent ultrasound densitometry of the calcaneus. Children were under dispensary supervision for two years. In the first (comparison) group, patients were offered to undergo a six-month course of treatment with vitamin D3 and calcium preparations (in standard doses, considering age). After a period of mandatory treatment (6 months), prophylactic doses were recommended. The second (main) group of patients received sodium chondroitin sulfate, calcium, vitamin D3 and magnesium - the treatment period was 3 months, a break of 6 months, then a repeated course for 3 months, then a maintenance dose for the entire observation period. Research results. The results of densitometry showed that the value of the t-criterion significantly increased rapidly in the main group than in the first group. No significant differences in the control group were observed after 18 and 24 months of therapy. In the frequency of normalization of the content of bone mineral density (BMD), statistically significant differences (χ2 = 11.90, p = 0.015) were observed after 24 months in the main group of patients. It was impossible to identify significant differences in blood levels of calcium and vitamin D metabolite. Nevertheless, according to the content of magnesium in the blood after 6 months in patients of the second group, compared with the first group, significant differences were established, which were traced throughout the stage of observation. The GAG release rate was reduced only in children of the second group during the entire follow-up period (24 months) compared with the control group. Conclusions: 1) The use of a systemic approach for treating patients with UCTD against the background of a decrease in bone mineral density contributes to an increase in bone mineral density in more than 20% of children and a complete restoration of bone mineral composition within 2 years. 2) A systematic approach to therapy contributes to the stabilization of the pathogenetic mechanisms of the severity of UCTD, has a positive effect on the state of the connective tissue and its normal formation if appropriate treatment is prescribed.