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1.
Calcif Tissue Int ; 115(2): 160-168, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38864922

RESUMO

Diabetic osteopathy is a frequent complication in patients with type 2 diabetes mellitus (T2DM). The association between T2DM and increased fracture risk has led to study the impact of new antidiabetic drugs on bone metabolism. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are incretin mimetic drugs which have many pleiotropic properties. The relationship between GLP-1RAs and bone is very complex: while in vitro and animal studies have demonstrated a protective effect on bone, human studies are scarce. We led a 12 months longitudinal study evaluating bone changes in 65 patients withT2DM for whom a therapy with GLP-1RAs had been planned. Fifty-four T2DM patients completed the 12-month study period; of them, 30 had been treated with weekly dulaglutide and 24 with weekly semaglutide. One-year therapy with GLP-1RAs resulted in a significant reduction in weight and BMI. Bone mineral density (BMD), bone metabolism, trabecular bone score (TBS), adiponectin, and myostatin were evaluated before and after 12 months of GLP-1RAs therapy. After 12 months of therapy bone turnover markers and adiponectin showed a significant increase, while myostatin values showed a modest but significant reduction. BMD-LS by DXA presented a significant reduction while the reduction in BMD-LS by REMS was not significant and TBS values showed a marginal increase. Both DXA and REMS techniques showed a modest but significant reduction in femoral BMD. In conclusion, the use of GLP-1RAs for 12 months preserves bone quality and reactivates bone turnover. Further studies are needed to confirm whether GLP-1RAs could represent a useful therapeutic option for patients with T2DM and osteoporosis.


Assuntos
Densidade Óssea , Diabetes Mellitus Tipo 2 , Receptor do Peptídeo Semelhante ao Glucagon 1 , Peptídeos Semelhantes ao Glucagon , Hipoglicemiantes , Fragmentos Fc das Imunoglobulinas , Incretinas , Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Estudos Longitudinais , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Feminino , Pessoa de Meia-Idade , Peptídeos Semelhantes ao Glucagon/uso terapêutico , Peptídeos Semelhantes ao Glucagon/análogos & derivados , Peptídeos Semelhantes ao Glucagon/farmacologia , Masculino , Densidade Óssea/efeitos dos fármacos , Hipoglicemiantes/uso terapêutico , Hipoglicemiantes/farmacologia , Idoso , Fragmentos Fc das Imunoglobulinas/uso terapêutico , Incretinas/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Proteínas Recombinantes de Fusão/farmacologia , Doenças Ósseas Metabólicas/tratamento farmacológico , Agonistas do Receptor do Peptídeo 1 Semelhante ao Glucagon
2.
Aging Clin Exp Res ; 35(12): 3015-3022, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37924469

RESUMO

BACKGROUND: The reports on bone mineral loss or major osteoporosis fracture (MOF) in sarcoidosis are scarce and have conflicting outcomes. This study aimed to evaluate the prevalence and risk factors of MOF in sarcoidosis patients. METHODS: In a single-center cohort of 382 patients with sarcoidosis (55.8 ± 11.6 years) we evaluated bone mineral density at lumbar spine, at femoral neck and at total hip and the presence of MOF. Lung function measurements including diffusion capacity for carbon monoxide (DLCO) were assessed. Chest X-rays were performed and radiological staging was done by Scadding score. RESULTS: Ninety patients (23.6%) with sarcoidosis have history of a MOF. BMD T-scores were lower in sarcoidosis with MOF with respect to those without MOF, but the difference was statistically significant only for BMD at femoral neck (p < 0.05). Moreover, BMD values at total hip was positively correlated with DLCO (%) (p < 0.001). Prevalence of MOF was higher in patients with sarcoidosis with lung parenchymal involvement (radiological stages 2-4) than in patients with sarcoidosis in chest X-ray stages 0 and 1 (28.3 vs 19.2% respectively, p < 0.05). Moreover, multiple regression analyses showed that X-ray Scadding score was positively associated with MOF. CONCLUSIONS: This study shows that MOF represent a common and important complication in patients with moderate/severe sarcoidosis. The chest X-ray evaluation and the pulmonary function test could allow to define the risk of MOF in sarcoidosis patients.


Assuntos
Osteoporose , Fraturas por Osteoporose , Sarcoidose , Humanos , Absorciometria de Fóton/métodos , Osteoporose/complicações , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Densidade Óssea , Fatores de Risco , Vértebras Lombares , Sarcoidose/complicações , Sarcoidose/epidemiologia , Gravidade do Paciente
3.
Aging Clin Exp Res ; 35(5): 1097-1105, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36988828

RESUMO

BACKGROUND: Cardiovascular disease, osteoporosis and sarcopenia are very common age-related conditions. This study aimed at investigating the relationships of cardiac calcifications, as assessed by using GCCS with BMD, fragility fractures and sarcopenia in elderly subjects. METHODS: In a cohort of 106 subjects (age 70.4 ± 5.8 yrs) we measured lumbar (BMD-LS), femoral BMD (femoral neck: BMD-FN, total femur: BMD-TH) and body composition (BMD-WB) with Dual-energy X-ray Absorptiometry (DXA) method. We also evaluated the presence of sarcopenia on the basis of the EWGSOP Consensus. All subjects, simultaneously, underwent to a transthoracic color doppler echocardiography exam to assess the presence of cardiac calcifications. The degree of non coronaric cardiac calcifications was evaluated using the Global Cardiac Calcium Score (GCCS). RESULTS: The degree of cardiac calcification assessed by GCCS was significantly higher in osteoporotic patients (p < 0.001). Furthermore, an inverse correlation emerged between BMD and GCCS, statistical significance was found at lumbar spine and femoral sub-regions in female population (p < 0.01). Moreover by dividing population according to the presence of fragility fractures, we observed that GCCS values were significantly higher in subjects with fractures in respect of non-fractured ones (p < 0.05). Multiple regression models showed that BMD-LS and BMD-FT were independently associated with cardiac calcification. GCCS values were significantly associated with BMI and ASMM in women (p < 0.01 and p < 0.05, respectively) and with handgrip strength in men (p < 0.05). CONCLUSIONS: Our data confirm the presence of a relationship between cardiac calcifications and decreased BMD values. It's also the first study that relates sarcopenia and valvular calcifications.


Assuntos
Fraturas Ósseas , Osteoporose , Sarcopenia , Masculino , Humanos , Feminino , Idoso , Densidade Óssea , Sarcopenia/diagnóstico por imagem , Sarcopenia/complicações , Força da Mão , Osteoporose/complicações , Absorciometria de Fóton/métodos , Fraturas Ósseas/complicações , Colo do Fêmur/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem
4.
Aging Clin Exp Res ; 35(4): 763-773, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36752950

RESUMO

BACKGROUND: Accurate estimation of the imminent fragility fracture risk currently represents a challenging task. The novel Fragility Score (FS) parameter, obtained during a Radiofrequency Echographic Multi Spectrometry (REMS) scan of lumbar or femoral regions, has been developed for the non-ionizing estimation of skeletal fragility. AIMS: The aim of this study was to assess the performance of FS in the early identification of patients at risk for incident fragility fractures with respect to bone mineral density (BMD) measurements. METHODS: Data from 1989 Caucasians of both genders were analysed and the incidence of fractures was assessed during a follow-up period up to 5 years. The diagnostic performance of FS to discriminate between patients with and without incident fragility fracture in comparison to that of the BMD T-scores measured by both Dual X-ray Absorptiometry (DXA) and REMS was assessed through ROC analysis. RESULTS: Concerning the prediction of generic osteoporotic fractures, FS provided AUC = 0.811 for women and AUC = 0.780 for men, which resulted in AUC = 0.715 and AUC = 0.758, respectively, when adjusted for age and body mass index (BMI). For the prediction of hip fractures, the corresponding values were AUC = 0.780 for women and AUC = 0.809 for men, which became AUC = 0.735 and AUC = 0.758, respectively, after age- and BMI-adjustment. Overall, FS showed the highest prediction ability for any considered fracture type in both genders, resulting always being significantly higher than either T-scores, whose AUC values were in the range 0.472-0.709. CONCLUSION: FS displayed a superior performance in fracture prediction, representing a valuable diagnostic tool to accurately detect a short-term fracture risk.


Assuntos
Fraturas do Quadril , Fraturas por Osteoporose , Feminino , Humanos , Masculino , Densidade Óssea , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Absorciometria de Fóton/métodos , Fraturas do Quadril/epidemiologia , Análise Espectral
5.
Nutr Metab Cardiovasc Dis ; 32(11): 2638-2646, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36064689

RESUMO

BACKGROUND AND AIMS: ODYSSEY APPRISE trial evaluated efficacy and safety of alirocumab in 994 patients with hypercholesterolemia and high CV risk in a real-life setting. The aim of the present report is to detail on the Italian cohort enrolled and treated in the trial. METHODS AND RESULTS: The methodology of the of the multinational, single-arm, Phase 3b open-label ODYSSEY APPRISE (Clinicaltrials.gov: NCT02476006) has been previously reported. 255 Italian patients were enrolled and treated according to the trial protocol. Overall mean exposure to alirocumab was 83.3 ± 27.7 weeks. At week 12, LDL-C decreased by 51.3 ± 23.1% and this reduction was overall maintained for the duration of the study. A similar reduction was observed in patients with and without heterozygous familial hypercholesterolemia (HeFH 50.7% ± 23.9 vs. non-FH, 53.6% ± 19.6). LDL-C was reduced below 1.8 mmol/L and/or by ≥ 50% reduction from baseline in 62% of patients overall (61% in HeFH and 67% in non-FH). Alirocumab was similarly well tolerated in the Italian cohort as in the entire study population and the more common treatment emergent adverse events (TEAEs) were influenza, myalgia and nasopharyngitis. The incidence LDL-C levels <25 mg/dl and <15 mg/dl, was 8.2% and 2.9% respectively. CONCLUSION: The efficacy and safety of alirocumab in a real-life setting, in the Italian subgroup of patients are consistent with findings in the entire study population and confirm that alirocumab is a beneficial approach to further reduce LDL-C levels in patients at high CV risk on maximally tolerated conventional lipid lowering treatment. GOV IDENTIFIER: NCT02476006.


Assuntos
Anticorpos Monoclonais Humanizados , Hiperlipoproteinemia Tipo II , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticolesterolemiantes/efeitos adversos , LDL-Colesterol/metabolismo , Humanos , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Resultado do Tratamento
6.
Aging Clin Exp Res ; 34(1): 121-127, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34050917

RESUMO

BACKGROUND: Patients with type 2 diabetes (T2DM) have an increased or normal BMD; however fragility fractures represent one of the most important complications of T2DM. AIMS: This study aimed to evaluate whether the use of the Radiofrequency Echographic multi spectrometry (REMS) technique may improve the identification of osteoporosis in T2DM patients. METHODS: In a cohort of 90 consecutive postmenopausal elderly (70.5 ± 7.6 years) women with T2DM and in 90 healthy controls we measured BMD at the lumbar spine (LS-BMD), at femoral neck (FN-BMD) and total hip (TH-BMD) using a dual-energy X-ray absorptiometry device; moreover, REMS scans were also carried out at the same axial sites. RESULTS: DXA measurements were all higher in T2DM than in non-T2DM women; instead, all REMS measurements were lower in T2DM than in non T2DM women. Moreover, the percentage of T2DM women classified as "osteoporotic", on the basis of BMD by REMS was markedly higher with respect to those classified by DXA (47.0% vs 28.0%, respectively). On the contrary, the percentage of T2DM women classified as osteopenic or normal by DXA was higher with respect to that by REMS (48.8% and 23.2% vs 38.6% and 14.5%, respectively). T2DM women with fragility fractures presented lower values of both BMD-LS by DXA and BMD-LS by REMS with respect to those without fractures; however, the difference was significant only for BMD-LS by REMS (p < 0.05). CONCLUSIONS: Our data suggest that REMS technology may represent a useful approach to enhance the diagnosis of osteoporosis in patients with T2DM.


Assuntos
Diabetes Mellitus Tipo 2 , Osteoporose , Absorciometria de Fóton , Idoso , Densidade Óssea , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Osteoporose/diagnóstico por imagem , Ultrassonografia
7.
BMC Musculoskelet Disord ; 23(1): 469, 2022 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-35590362

RESUMO

BACKGROUND: Osteoarthritis (OA) and vertebral fractures at the lumbar spine lead to an overestimation of bone mineral density (BMD). Recently, a new approach for osteoporosis diagnosis, defined as radiofrequency echographic multi-spectrometry (REMS), represents an innovative diagnostic tool that seems to be able to investigate bone quality and provide an estimation of fracture risk independent of BMD. The aim of this paper was to evaluate whether the use of REMS technology can favor the diagnosis of osteoporosis in subjects with an apparent increase in BMD. METHODS: In a cohort of 159 postmenopausal (66.2 ± 11.6 yrs) women with overestimated BMD by DXA at the lumbar spine, we performed an echographic scan with the REMS technique. RESULTS: The mean values of BMD at different skeletal sites obtained by the DXA and REMS techniques showed that the BMD T-scores by REMS were significantly lower than those obtained by the DXA technique both at the lumbar spine (p < 0.01) and at all femoral subregions (p < 0.05). In OA subjects, the percentage of women classified as "osteoporotic" on the basis of BMD by REMS was markedly higher with respect to those classified by DXA (35.1% vs 9.3%, respectively). Similarly, the REMS allows a greater number of fractured patients to be classified as osteoporotic than DXA (58.7% vs 23.3%, respectively). CONCLUSIONS: REMS technology by the analysis of native raw unfiltered ultrasound signals appears to be able to overcome the most common artifacts, such as OA and vertebral fracture of the lumbar spine, which affect the value of BMD by DXA.


Assuntos
Fraturas Ósseas , Osteoartrite , Osteoporose , Fraturas da Coluna Vertebral , Absorciometria de Fóton/métodos , Densidade Óssea , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Osteoporose/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem
8.
Isr Med Assoc J ; 24(7): 433-438, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35819208

RESUMO

BACKGROUND: Some studies have shown that patients who are hospitalized with severe COVID-19 also have low levels of vitamin D. It is known that vitamin D can reduce the risk of infections and down regulate the immune/inflammatory reaction. OBJECTIVES: To investigate the association between vitamin D status and lymphocyte subpopulations in hospitalized pneumonia COVID-19 patients. METHODS: In 33 positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with radiologic evidence of interstitial pneumonia and in 16 healthy control subjects matched for age, sex, and seasonality lymphocyte subpopulations and vitamin D levels were evaluated. RESULTS: The majority of patients with COVID-19 pneumonia (70.8%) presented vitamin D deficiency. The percentages of neutrophils presented a negative correlation (r = -0.74; P < 0.001), whereas the percentages of lymphocytes presented a positive correlation (r = 0.43; P < 0.01) with 25(OH)D. Moreover, vitamin D levels were positively correlated with CD3+ (r = 0.37, P < 0.05), CD4+ (r = 0.41, P < 0.05), CD8+ (r = 0.32, P < 0.07), and CD19+ (r = 0.38, P < 0.05). CONCLUSIONS: This preliminary study confirms the high prevalence of vitamin D deficiency in patients with COVID-19 pneumonia and that vitamin D deficiency is associated with a reduction of lymphocyte subsets and altered T-lymphocyte activation. This finding may contribute to clarify the mechanisms by which vitamin D influences the course and outcome of COVID-19 pneumonia.


Assuntos
COVID-19 , Pneumonia , Deficiência de Vitamina D , Humanos , Contagem de Linfócitos , Subpopulações de Linfócitos , Pneumonia/complicações , SARS-CoV-2 , Vitamina D , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia
9.
Eat Weight Disord ; 27(8): 3207-3213, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35896857

RESUMO

PURPOSE: Reduced bone mineral density (BMD) and increase risk of fragility fracture are common complication of anorexia nervosa (AN). BMD by dual-energy X-ray absorptiometry (DXA) present several limits in subjects with AN. This study aimed to evaluate the usefulness of the new Radiofrequency echographic multispectrometry (REMS) technique in the assessment of bone status in young women with AN. METHODS: In a cohort of 50 subjects with restrictive AN and in 30 healthy controls, we measured BMD at the lumbar spine (LS-BMD), at femoral neck (FN-BMD) and total hip (TH-BMD) using both DXA and REMS technique. RESULTS: BMD evaluated by DXA and REMS technique at all measurement sites were all significantly (p < 0.01) lower in subjects suffering from AN subjects than in controls. Good correlations were detected between BMD by DXA and BMD by REMS measurements at LS (r = 0.64, p < 0.01) at FN (r = 0.86, p < 0.01) and at TH (r = 0.84, p < 0.01) in subjects suffering from AN. Moreover, Bland-Altman analysis confirmed the good agreement between the two techniques. The subjects suffering from AN with previous vertebral fragility fractures presented lower values of both BMD-LS and BMD-TH by DXA and by REMS with respect to those without fractures; however, the difference was significant only for BMD-TH by REMS (p < 0.05). CONCLUSIONS: Our data suggest that REMS technique due to its characteristic of precision and reproducibility may represent an important tool for the evaluation of the changes in bone status in AN young women, especially during the fertile age and in case of pregnancy and breastfeeding. LEVEL OF EVIDENCE: Level of evidence: level III cohort study.


Assuntos
Anorexia Nervosa , Fraturas Ósseas , Fraturas da Coluna Vertebral , Humanos , Feminino , Densidade Óssea , Anorexia Nervosa/diagnóstico por imagem , Anorexia Nervosa/complicações , Estudos de Coortes , Reprodutibilidade dos Testes , Fraturas Ósseas/complicações , Absorciometria de Fóton/efeitos adversos , Absorciometria de Fóton/métodos , Fraturas da Coluna Vertebral/etiologia , Colo do Fêmur/diagnóstico por imagem
10.
Nutr Metab Cardiovasc Dis ; 31(8): 2210-2233, 2021 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-34059385

RESUMO

AIM: Bone fragility is increasingly recognized as a relevant complication of type 2 diabetes (T2D) and diabetic patients with fragility fractures have higher mortality rates than non diabetic individuals or diabetic patients without fractures. However, current diagnostic approaches for fracture risk stratification, such as bone mineral density measurement or the use of risk assessment algorithms, largely underestimate fracture risk in T2D patients. A multidisciplinary expert panel was established in order to in order to formulate clinical consensus recommendations on bone health assessment and management of fracture risk in patients with T2D. DATA SYNTHESIS: The following key questions were addressed: a) which are the risk factors for bone fragility in T2D?, b) which diagnostic procedures can be currently used to stratify fracture risk in T2D patients?, c) which are the effects of antidiabetic treatments on bone?, and d) how to prevent and treat bone fragility in T2D patients? Based on the available data members of this panel suggest that the stratification of fracture risk in patients with diabetes should firstly rely on the presence of a previous fragility fracture and on the individual risk profile, with the inclusion of T2D-specific risk factors (namely T2D duration above 10 yrs, presence of chronic T2D complications, use of insulin or thiazolidinediones and persistent HbA1c levels above 8% for at least 1 year). Two independent diagnostic approaches were then suggested in the presence or the absence of a prevalent fragility fracture, respectively. CONCLUSIONS: Clinical trials in T2D patients at risk for fragility fractures are needed to determine the efficacy and safety of available antiresorptive and anabolic agents in this specific setting.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Fraturas Ósseas/prevenção & controle , Hipoglicemiantes/uso terapêutico , Osteoporose/tratamento farmacológico , Conservadores da Densidade Óssea/efeitos adversos , Consenso , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Medicina Baseada em Evidências , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/etiologia , Fraturas Ósseas/mortalidade , Humanos , Hipoglicemiantes/efeitos adversos , Osteoporose/diagnóstico , Osteoporose/etiologia , Osteoporose/mortalidade , Fatores de Proteção , Medição de Risco , Fatores de Risco , Resultado do Tratamento
11.
J Ultrasound Med ; 40(12): 2773-2777, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33615539

RESUMO

Dual-energy X-ray absorptiometry (DXA) is considered the gold standard in the evaluation of bone mineral density (BMD) and in the diagnosis of osteoporosis.The diagnostic sensitivity of BMD at lumbar spine is frequently reduced by the presence of artifacts. This study aimed to show the usefulness of radiofrequency echographic multi-spectrometry (REMS) in determining lumbar BMD in the presence of artifacts with DXA measurements. We present 3 cases in which REMS technology, by the analysis of native raw unfiltered ultrasound signals, appears to be able to recognize and overcome the most common artifacts that affect the value of the BMD by DXA, thus allowing a better assessment of fracture risk.


Assuntos
Artefatos , Densidade Óssea , Absorciometria de Fóton , Humanos , Vértebras Lombares , Análise Espectral
12.
Aging Clin Exp Res ; 33(9): 2539-2547, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33506314

RESUMO

BACKGROUND: At present, although cholecalciferol represents the form of vitamin D of choice for the treatment of vitamin D deficiency, there is a growing interest in calcifediol. AIMS: This study aimed to evaluate the efficacy and the safety of two different daily doses of calcifediol. METHODS: Fifty osteopenic/osteoporotic women with serum levels of 25-hydroxyvitamin D (25OHD) between 10 and 20 ng/ml were randomized to a 6-month treatment with oral calcifediol 20 µg/day (n = 25) or oral calcifediol 30 µg/day (n = 25). In all, we measured the time course of the levels of 25OHD and other biochemical parameters. Moreover, we evaluated handgrip strength and serum levels of myostatin. RESULTS: The peak increase in 25OHD levels was reached after 90 days of treatment in group 1 (59.3 ng/ml) and after only 60 days in group 2 (72.3 ng/ml); thereafter in both groups, the levels of 25OHD showed a tendency towards stabilization. After 30 days, all the patients treated with 30 µg/day had values of 25OHD > 30 ng/ml. Handgrip strength showed a modest but progressive increase which reached the statistical significance in the 30 µg/day group. This latter group also presented a modest and non-significant decrease in serum levels of myostatin. CONCLUSIONS: Calcifediol is able to rapidly normalize the vitamin D deficiency, and the 30 µg daily dosage could be suggested in those patients who need to rapidly reach optimal 25OHD levels. Moreover, the 6-month treatment with calcifediol at a dose of 30 µg results in a modest but significant increase in upper limb strength.


Assuntos
Calcifediol , Deficiência de Vitamina D , Colecalciferol , Suplementos Nutricionais , Feminino , Força da Mão , Humanos , Força Muscular , Pós-Menopausa , Vitamina D , Deficiência de Vitamina D/tratamento farmacológico
13.
Aging Clin Exp Res ; 33(12): 3223-3235, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33909280

RESUMO

BACKGROUND: A low calcium intake is a well-known factor that influences the bone mineral density (BMD) maintenance. In the presence of inadequate calcium intake, secondary hyperparathyroidism develops, leading to an increased bone turnover and fracture risk. AIMS: To assess the dietary calcium intake in relation with osteoporosis and fragility fracture in a cohort of Italian individuals evaluated for low BMD. METHODS: A 7-day food-frequency questionnaire was administered to 1793 individuals, who were consecutively referred at the Centers of the Italian Society for Osteoporosis, Mineral Metabolism and Skeletal Diseases (SIOMMMS) for low BMD. RESULTS: In 30.3% and 20.9% of subjects, the calcium intake was inadequate (< 700 mg/day) and adequate (> 1200 mg/day), respectively. As compared with patients with adequate calcium intake, those with inadequate calcium intake were younger (65.5 ± 10.8 vs 63.9 ± 11.5 years, p = 0.03) and they more frequently reported adverse reactions to food (3.2% vs 7.2% p = 0.01) and previous major fragility fractures (20.8% vs 27.0%, p = 0.03). Patients with calcium intake < 700 mg/day showed a higher prevalence of diabetes mellitus, idiopathic hypercalciuria and food allergy/intolerance (8.1%, 5.1%, 7.2%, respectively) than patients with calcium intake > 700 mg/day (5.3%, 3.0%, 4.1%, respectively, p < 0.04 for all comparisons), also after adjusting for age, gender and body mass index. In 30.3% of fractured subjects, the calcium intake was < 700 mg/day. DISCUSSION: In Italy, a low calcium intake is highly prevalent in individuals at risk for low BMD. Importantly, an inadequate calcium intake is highly prevalent even in patients with history of fragility fractures. CONCLUSIONS: Only about a fifth of patients being assessed for low BMD in an Italian SIOMMMS referral Centre have an adequate calcium intake.


Assuntos
Doenças Ósseas Metabólicas , Cálcio da Dieta/administração & dosagem , Fraturas Ósseas , Osteoporose , Densidade Óssea , Fraturas Ósseas/epidemiologia , Humanos , Itália , Osteoporose/epidemiologia
14.
BMC Med Genet ; 21(1): 21, 2020 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005172

RESUMO

BACKGROUND: More than 95% of individuals with RTT have mutations in methyl-CpG-binding protein 2 (MECP2), whose protein product modulates gene transcription. The disorder is caused by mutations in a single gene and the disease severity in affected individuals can be quite variable. Specific MECP2 mutations may lead phenotypic variability and different degrees of disease severity. It is known that low bone mass is a frequent and early complication of subjects with Rett syndrome. As a consequence of the low bone mass Rett girls are at an increased risk of fragility fractures. This study aimed to investigate if specific MECP2 mutations may affects the degree of involvement of the bone status in Rett subjects. METHODS: In 232 women with Rett syndrome (mean age 13.8 ± 8.3 yrs) we measured bone mineral density at whole body and at femur (BMD-FN and BMD-TH) by using a DXA machine (Hologic QDR 4500). QUS parameters were assessed at phalanxes by Bone Profiler-IGEA (amplitude dependent speed of sound: AD-SoS and bone transmission time: BTT). Moreover, ambulation capacity (independent or assisted), fracture history and presence of scoliosis were assessed. We divided the subjects with the most common point mutations in two group based on genotype-phenotype severity; in particular, there has been consensus in recognising that the mutations R106T, R168X, R255X, R270X are considered more severe. RESULTS: As aspect, BMD-WB, BMD-FN and BMD-TH were lower in subjects with Rett syndrome that present the most severe mutations with respect to subjects with Rett syndrome with less severe mutations, but the difference was statistically significant only for BMD-FN and BMD-TH (p < 0.05). Also both AD-SoS and BTT values were lower in subjects that present the most severe mutations with respect to less severe mutations but the difference was not statistically significant. Moreover, subjects with Rett syndrome with more severe mutations present a higher prevalence of scoliosis (p < 0.05) and of inability to walk (p < 0.05). CONCLUSION: This study confirms that MECP2 mutation type is a strong predictor of disease severity in subjects with Rett syndrome. In particular, the subjects with more severe mutation present a greater deterioration of bone status, and a higher prevalence of scoliosis and inability to walk.


Assuntos
Doenças Ósseas/genética , Proteína 2 de Ligação a Metil-CpG/genética , Osteoporose/genética , Síndrome de Rett/genética , Adolescente , Adulto , Densidade Óssea/genética , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/fisiopatologia , Criança , Pré-Escolar , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/genética , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Mutação , Osteoporose/diagnóstico por imagem , Osteoporose/fisiopatologia , Síndrome de Rett/diagnóstico por imagem , Síndrome de Rett/fisiopatologia , Escoliose/diagnóstico por imagem , Escoliose/genética , Escoliose/fisiopatologia , Índice de Gravidade de Doença , Adulto Jovem
15.
Respiration ; 99(3): 207-212, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32114588

RESUMO

BACKGROUND: Calcium metabolism alterations are quite common in sarcoidosis and have been correlated with disease activity. OBJECTIVES: The aim of the study was to investigate the clinical significance of calcium metabolism alterations in patients with chronic sarcoidosis. We paid particular attention to associations with specific disease phenotypes and chitotriosidase (CTO) expression. METHODS: 212 chronic sarcoidosis patients (mean age 56.07 ± 12 years; 97 males) were retrospectively recruited. Demographic, clinical, functional, and radiological data, and serum-urinary calcium metabolism were entered into an electronical database for analysis. Levels of CTO and angiotensin-converting enzyme (ACE) were measured and bone mineral density and lung function tests were conducted. RESULTS: Hypercalciuria and hypercalcemia were observed in 18.8 and 1.8% of patients, respectively. Urinary calcium levels correlated with CTO activity (r = 0.33, p = 0.0042). Patients with worsening persistent disease showed the highest levels of urinary calcium. Diffusing capacity of the lung for carbon monoxide (DLCO) percentage correlated inversely with urinary calcium (r = 0.1482; p = 0.0397). CONCLUSIONS: Calcium metabolism alteration, particularly hypercalciuria, was observed in a significant percentage of patients of sarcoidosis. Urinary calcium was correlated with clinical status, DLCO, and serum CTO activity, suggesting its potential role as a biomarker of the activity and severity of sarcoidosis.


Assuntos
Cálcio/metabolismo , Hexosaminidases/sangue , Hipercalcemia/metabolismo , Hipercalciúria/metabolismo , Peptidil Dipeptidase A/sangue , Sarcoidose Pulmonar/metabolismo , Absorciometria de Fóton , Adulto , Idoso , Densidade Óssea , Creatinina/metabolismo , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Fosfatos/metabolismo , Capacidade de Difusão Pulmonar , Radiografia Torácica , Testes de Função Respiratória , Estudos Retrospectivos , Sarcoidose/metabolismo , Sarcoidose/fisiopatologia , Sarcoidose Pulmonar/diagnóstico por imagem , Sarcoidose Pulmonar/fisiopatologia , Capacidade Vital
16.
Pediatr Res ; 85(5): 639-643, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30188498

RESUMO

BACKGROUND: Low bone mass is a frequent and early complication of girls with Rett syndrome. As a consequence of the low bone mass, Rett patients are at an increased risk of fragility fractures. This study aimed to investigate the long-term influences of mobility on bone status in girls with Rett syndrome. METHODS: In 58 girls with Rett syndrome, biochemical parameters and quantitative ultrasound parameters at phalanges (amplitude-dependent speed of sound: AD-SoS and bone transmission time: BTT) were measured at baseline and after 5 and 10 years. The subjects were divided into two groups: nonambulatory (n = 28) and ambulatory (n = 30). RESULTS: In nonambulatory Rett subjects, the values of AD-SoS and BTT were significantly lower than in ambulatory Rett subjects at each time point. However, during the 10-year follow-up both ambulatory and nonambulatory Rett patients showed a similar worsening in their bone status. CONCLUSION: This longitudinal study suggests that both ambulatory and nonambulatory Rett subjects present a progressive deterioration of bone status as assessed by quantitative ultrasound parameters, and the ambulatory impairment and the nutritional status seem to play a key role in the deterioration of bone status.


Assuntos
Densidade Óssea , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/fisiologia , Síndrome de Rett/diagnóstico por imagem , Síndrome de Rett/fisiopatologia , Caminhada , Absorciometria de Fóton , Adolescente , Criança , Ciências da Nutrição Infantil , Pré-Escolar , Colecalciferol/administração & dosagem , Pessoas com Deficiência , Feminino , Falanges dos Dedos da Mão/diagnóstico por imagem , Seguimentos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Lactente , Estudos Longitudinais , Estado Nutricional , Inquéritos e Questionários , Ultrassonografia , Vitamina D/sangue
17.
J Am Coll Nutr ; 38(3): 197-208, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30247998

RESUMO

The most recent scientific evidence supports the consumption of cow's milk and dairy products as part of a balanced diet. However, these days, the public and practicing physicans are exposed to a stream of inconsistent (and often misleading) information regarding the relationship between cow's milk intake and health in the lay press and in the media. The purpose of this article, in this context, is to facilitate doctor-patient communication on this topic, providing physicians with a series of structured answers to frequently asked patient questions. The answers range from milk and milk-derived products' nutritional function across the life span, to their relationship with diseases such as osteoporosis and cancer, to lactose intolerance and milk allergy, and have been prepared by a panel of experts from the Italian medical and nutritional scientific community. When consumed according to appropriate national guidelines, milk and its derivatives contribute essential micro- and macronutrients to the diet, especially in infancy and childhood where bone mass growth is in a critical phase. Furthermore, preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes, and cardiovascular disease, while no clear data suggest a significant association between milk intake and cancer. Overall, current scientific literature suggests that an appropriate consumption of milk and its derivatives, according to available nutritional guidelines, may be beneficial across all age groups, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy. Key teaching points: Milk and its derivatives contribute essential micro and macronutrients to the diet, when consumed according to appropriate national guidelines, especially in infancy and childhood where bone mass growth is in a critical phase. Preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes and cardiovascular disease No clear data are available about the association between milk intake and cancer. Current scientific literature suggests that an appropriate consumption of milk and its derivatives may be beneficial at all ages, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy.


Assuntos
Dieta , Leite , Valor Nutritivo , Animais , Bovinos , Hipersensibilidade Alimentar , Humanos
18.
Aging Clin Exp Res ; 31(11): 1541-1547, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31030419

RESUMO

The patients' persistence with osteoporosis treatments is low. This retrospective, multicenter survey showed that almost 30% of osteoporotic patients discontinued the treatment within the first 6 months and that those taking drinkable bisphosphonates were less likely to interrupt the therapy; instead, the use of generic bisphosphonates was associated to a more precocious interruption. PURPOSE: Low persistence with osteoporosis medications is associated with higher fracture risk. This study aimed to assess the persistence to treatment with oral bisphosphonates among Italian osteoporotic patients under treatment for at least 6 months and to evaluate whether the different oral formulations of bisphosphonates may influence the interruption of the therapy. METHODS: 723 consecutive osteoporotic patients, aged 50 years or over, referred as outpatients for a follow-up visit after receiving a prescription of an oral bisphosphonate for the first time for at least 6 months were enrolled in this retrospective, multicenter survey carried out under conditions of usual clinical practice. All the patients enrolled were submitted to a standardized interview. RESULTS: 191 patients turned out to have discontinued treatment (28.7%), the more common causes for interruption being the adverse events (43.9%), fear of adverse events (23.3%) and perceived absence of efficacy of the treatment (15.8%). The osteoporotic patients taking drinkable bisphosphonate or on treatment with aromatase inhibitors or under the age of 70 years were less likely to interrupt the treatment. However, these associations were no longer significant when the pharmaceutical formulation (generic vs branded) was included into the multivariate logistic regression model. CONCLUSION: This study suggests that the new drinkable formulations of bisphosphonates could be an interesting option able to reduce upper GI adverse events, thus increasing persistence; whereas the generic formulations of bisphosphonates were associated to a premature discontinuation.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Difosfonatos/administração & dosagem , Adesão à Medicação/estatística & dados numéricos , Osteoporose/tratamento farmacológico , Administração Oral , Idoso , Conservadores da Densidade Óssea/efeitos adversos , Estudos de Casos e Controles , Difosfonatos/efeitos adversos , Feminino , Fraturas Ósseas/etiologia , Humanos , Itália/epidemiologia , Modelos Logísticos , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Osteoporose/psicologia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Estudos Retrospectivos
19.
Aging Clin Exp Res ; 31(10): 1375-1389, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31422565

RESUMO

PURPOSE: The purpose of this paper was to review the available approaches for bone strength assessment, osteoporosis diagnosis and fracture risk prediction, and to provide insights into radiofrequency echographic multi spectrometry (REMS), a non-ionizing axial skeleton technique. METHODS: A working group convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis met to review the current image-based methods for bone strength assessment and fracture risk estimation, and to discuss the clinical perspectives of REMS. RESULTS: Areal bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is the consolidated indicator for osteoporosis diagnosis and fracture risk assessment. A more reliable fracture risk estimation would actually require an improved assessment of bone strength, integrating also bone quality information. Several different approaches have been proposed, including additional DXA-based parameters, quantitative computed tomography, and quantitative ultrasound. Although each of them showed a somewhat improved clinical performance, none satisfied all the requirements for a widespread routine employment, which was typically hindered by unclear clinical usefulness, radiation doses, limited accessibility, or inapplicability to spine and hip, therefore leaving several clinical needs still unmet. REMS is a clinically available technology for osteoporosis diagnosis and fracture risk assessment through the estimation of BMD on the axial skeleton reference sites. Its automatic processing of unfiltered ultrasound signals provides accurate BMD values in view of fracture risk assessment. CONCLUSIONS: New approaches for improved bone strength and fracture risk estimations are needed for a better management of osteoporotic patients. In this context, REMS represents a valuable approach for osteoporosis diagnosis and fracture risk prediction.


Assuntos
Osteoporose/diagnóstico , Absorciometria de Fóton/métodos , Densidade Óssea , Osso e Ossos , Consenso , Feminino , Fraturas Ósseas , Humanos , Osteoartrite , Medição de Risco , Análise Espectral , Ultrassonografia
20.
Calcif Tissue Int ; 101(4): 404-411, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28664329

RESUMO

Literature data reported that in elderly subjects, carotid intima-media thickness (IMT) was negatively associated with bone mineral density (BMD). Paradoxically, type-2 diabetes (T2DM) patients, despite having higher BMD, present an increased risk of fragility fractures and cardiovascular complications. Some studies have reported trabecular bone score (TBS), an index of trabecular bone quality, as possibly being reduced in T2DM. This study aimed to evaluate whether in T2DM subjects TBS was better associated with IMT with respect to BMD. In 131 consecutive T2DM subjects (55 men and 76 women; mean age: 60.0 ± 7.3 years) and 265 consecutive non-T2DM subjects (107 men and 158 women; mean age: 58.9 ± 7.8 years) we measured carotid IMT by high-resolution ultrasonography and BMD at lumbar spine (LS-BMD), at femoral neck FN-BMD and total hip TH-BMD; TBS was calculated using TBS iNsight software. LS-BMD, FN-BMD, and TH-BMD were all significantly higher in T2DM than in non-T2DM subjects, whereas TBS was significantly lower in T2DM subjects than in controls and inversely correlated with diabetes duration. In T2DM subjects multiple regression analysis showed that IMT was positively associated with age (b = 0.017; p < 0.001) and inversely associated with TBS (b = -0.473; p = 0.038). In non-T2DM subjects, only age was positively associated with IMT. To sum up, T2DM subjects present higher values of BMD and lower values of TBS with respect to non-diabetic controls. Moreover, in T2DM subjects TBS was found to be independently associated with carotid IMT. These findings suggest that TBS may not only capture bone fragility-related factors, but also some information associated with greater risk of developing cardiovascular diseases.


Assuntos
Densidade Óssea/fisiologia , Osso Esponjoso/diagnóstico por imagem , Osso Esponjoso/patologia , Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 2/complicações , Absorciometria de Fóton , Estudos Transversais , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade
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