[Guide for the prevention and treatment of glucocorticoid-induced osteoporosis of the Spanish Society of Internal Medicine]. / Guía de prevención y tratamiento de la osteoporosis inducida por glucocorticoides de la Sociedad Española de Medicina Interna.

Our objective has been to elaborate an updated Clinical Guide of the Spanish Society of Internal Medicine (SEMI) for the prevention and treatment of glucocorticoids-induced osteoporosis (GIO), identifying and measuring the grade of evidence that supports the given recommendations. For this, we reviewed studies performed on pathophysiology, diagnosis, prevention and treatment of GIO and after analyzing them we elaborated the present recommendations. This was done after a pre-specified and reproducible process that included an accepted model for the evaluation, and the reference of the evidence that supported it. Once the Scientific Committee elaborated the draft of the Clinical Guide, it was reviewed by all the members of the Working Group on Osteoporosis of the SEMI, and by an External Committee who included experts of many different specialities. Pathophysiology of GIO is complex and yet unknown. Bone effects of glucocorticoids are determined by multiple factors although accumulated doses seems to be the most important one. The best method to diagnose GIO is Dual X-Ray Absorptiometry (DXA), although WHO criteria defined for the diagnosis of postmenopausal osteoporosis are not applicable in GIO. The presence of a T-score lower than -1.5 Tscore indicates the necessity of treatment in any patient who receives or is going to receive more than 3 months treatment with glucocorticoids at a dose higher than 2.5 mg/day (in postmenopausal women) and 5 mg/day (in premenopausal women and men). DXA is also useful to follow up the patients, who can be done annually. Treatment must be prescribed to any patient who is receiving glucocorticoids or is going to receive them at doses higher than 7.5 mg/day for more than 3 months and 5 mg/day if the patient is a postmenopausal woman or has suffered from previous fragility fractures. Risedronate and alendronate are the drugs of election, always together with calcium and vitamin D supplements and general measurements usually prescribed in the treatment of osteoporosis. In very ill patients, parathyroid hormone can be used. The treatment for GIO should be maintained while glucocorticoid therapy is used.

[The endobronchial metastases of a prostatic neoplasm with normal radiology]. / Metástasis endobronquiales de neoplasia prostática con radiología normal.

Prostatic cancer is the most frequent neoplasm in man, usually it is revealed in the course of study of unknown origin bone metastasis. Pulmonary involvement is normally detected through clinical symptoms or an chest X-ray altered showing intraparenchymatous nodules or a carcinomatous lymphangitis pattern. We present a case of a patient with prostatic cancer and bone metastasis in whom during the extension study we detected endobronchial metastasis. Endobronchial involvement is exceptional in prostatic cancer; through bibliographical review we have only found 12 similar cases published.

[Estimate of the costs of osteoporotic fractures of the femur in Spain]. / Aproximación a los costes de la fractura osteoporótica de fémur en España.

To evaluate the economic impact of osteoporosis, the cost of acute attention to the osteoporotic hip fractures recorded in Barcelona during one year was investigated. The hospital records of 8637 beds (85.64% of the overall number in the city) were reviewed and the cases seen in inhabitants aged 45 years or more during 1984 were included. The cost, days of hospital admission, operations and orthopedic material were recorded. Data from 870 fractures were recovered. During the study period 1358 hip fractures took place in Barcelona, with 1269 +/- 21 (mean +/- SEM) operations, 31219 +/- 1550 (mean +/- SEM) days of hospital admission, and 408 +/- 40 (mean +/- SEM) prostheses. Their attention generated a cost amounting to 662.5 +/- 29.5 (mean +/- SEM) million pesetas. The cost of each fracture was 488200 +/- 331700 (mean +/- SD) pesetas, with a hospital stay of 23 +/- 17 (mean +/- SD) days. This represents, for the whole of Spain, 33298 +/- 1769 (mean +/- SEM) fractures, 31160 +/- 2154 (mean +/- SEM) operations, 767853 +/- 78314 (mean +/- SEM) hospital admission days and 10042 +/- 1530 (mean +/- SEM) prostheses every year. The yearly expenditure is 16295 +/- 1598 (mean +/-SEM) million pesetas (confidence interval of the estimation 95%). Thus, osteoporotic hip fracture results in a significant expenditure in this country. The enormous cost of the attention to osteoporosis and its complications warrants a greater effort for its prevention and care.