How can the orthopedic surgeon ensure optimal vitamin D status in patients operated for an osteoporotic fracture?

In this narrative review, the role of vitamin D deficiency in the pathophysiology, healing of fragility fractures, and rehabilitation is discussed. Vitamin D status can be assessed by measuring serum 25(OH)-vitamin D level with standardized assays. There is a high prevalence of vitamin D insufficiency (25(OH)D < 50 nmol/l (i.e., 20 ng/mL)) or deficiency (25(OH)D < 25 nmol/l (i.e., 10 ng/mL)) in patients with fragility fractures and especially in those with a hip fracture. The evidence on the effects of vitamin D deficiency and/or vitamin D supplementation on fracture healing and material osseointegration is still limited. However, it appears that vitamin D have a rather positive influence on these processes. The fracture liaison service (FLS) model can help to inform orthopedic surgeons, all caregivers, and fractured patients about the importance of optimal vitamin D status in the management of patients with fragility fractures. Therefore, vitamin D status should be included in Capture the Fracture® program as an outcome of FLS in addition to dual-energy X-ray absorptiometry (DXA) and specific antiosteoporosis medication. Vitamin D plays a significant role in the pathophysiology and healing of fragility fractures and in rehabilitation after fracture. Correction of vitamin D deficiency should be one of the main outcomes in fracture liaison services.

Profile of patients who visit medical internists for an osteoporosis assessment: The OSTEOMED registry. / Perfil de los pacientes que acuden al médico internista para valoración de osteoporosis: registro OSTEOMED.

BACKGROUND AND OBJECTIVES: Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients' care more effectively and efficiently. MATERIAL AND METHODS: Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. RESULTS: In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients' mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; P<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; P<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; P<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). CONCLUSIONS: These results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.

Effect of obesity on fragility fractures, BMD and vitamin D levels in postmenopausal women. Influence of type 2 diabetes mellitus.

AIMS: To see the effects of obesity on risk fracture, bone density (BMD), and vitamin D levels in a group of postmenopausal women, and consider how comorbid type 2 diabetes mellitus (T2DM) modifies them. METHODS: 679 postmenopausal women were grouped into obese and non-obese. Obese women were grouped into those with T2DM and those without. 25(OH)-vitamin D, PTH and BMD were measured, and prevalent fragility fractures were gathered. RESULTS: Obese women had higher prevalence of T2DM, than non-obese women. Levels of 25(OH)-vitamin D were lower and those of PTH higher in obese women, BMD values were higher in obese women. Diabetic-obese women had a higher prevalence of non-vertebral fractures than non-diabetic-obese. Multivariate logistic regression model showed association of fragility fractures with age, total hip BMD, BMI and T2DM. Obese women have higher BMD and lower 25(OH)-vitamin D values (and higher PTH) than non-obese, without diabetes. CONCLUSIONS: T2DM confers an increased risk of non-vertebral fractures in postmenopausal obese women.

Hyperuricaemia as a prognostic factor for acute ischaemic stroke. / Uricemia como factor pronóstico del ictus isquémico agudo.

INTRODUCTION: Recent studies on uric acid as a biomarker for the prognosis of acute stroke have found conflicting results. METHODS: We collected blood samples from 600 consecutively admitted patients at our tertiary hospital and analysed the relationship between uric acid levels and functional prognosis (measured using the modified Rankin Scale [mRS]). Patients who had received reperfusion therapy were excluded since this may have influenced uric acid levels. RESULTS: A total of 73% of patients had mRS scores ≤2; the mean uric acid level was 5.22mg/dL. We found a nonlinear relationship between functional prognosis at discharge and serum uric acid levels at admission when the National Institutes of Health Stroke Scale score was excluded from the analysis. CONCLUSIONS: Serum uric acid levels in patients with acute ischaemic stroke are significantly associated with functional prognosis at discharge, although this relationship is nonlinear. In fact, poorer prognosis is associated both with very low and with very high concentrations of uric acid. This suggests a dual role of uric acid in relation to stroke: on the one hand, as an associated risk factor, and on the other, as a possible neuroprotective factor due to its antioxidant effect.

Profile of patients who consult with internists for an osteoporosis assessment: The OSTEOMED registry.

BACKGROUND AND OBJECTIVES: Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients' care more effectively and efficiently. MATERIAL AND METHODS: Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. RESULTS: In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients' mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; p<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; p<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; p<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). CONCLUSIONS: These results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.

[Parathyroid hormone in the treatment of osteoporosis]. / La hormona paratiroidea en el tratamiento de la osteoporosis.

Current treatments available for osteoporosis until recently were active by inhibiting osteoclast activity and, thus, reducing bone remodelling. Intact PTH (PTH 1-84) and its analog, teriparatida (human recombinant PTH 1-34), are a new class of anabolic treatment of osteoporosis. It has been described a positive effect on bone microarchitecture and a reduction of the risk of new fractures due to a bone-forming mechanism.PTH must be considered as an useful alternative in the treatment of severe osteoporosis, both in men and women, in patients with several osteoporosis-related fractures or with a very low bone mineral density (T-score below -3.5) an a high risk for fracture. Other potential uses are glucocorticoid-induced and other secondary osteoporosis. The use of PTH is not recommended for more than 18 months for teriparatida and 24 months for PTH 1-84.

[Influence of the different bisphosphonates dose regimens on its tolerability]. / Influencia de los diferentes regímenes de administración de los bifosfonatos sobre la tolerabilidad.

Osteoporosis is the most prevalent metabolic bone disease and fractures are its clinical complication. We have nowadays some drugs that reduce the incidence of new fractures: Bisphosphonates. Nevertheless, treatment must be taken properly in the long run to reduce the incidence of new fractures and a few months alter starting the treatment, a great number of patients stop it because of different reasons. The introduction of new bisphosphonates that can be taken weekly or even better monthly, has improved notably the adherence and compliance to osteoporosis treatment.

Relationship between vitamin D deficiency and visually evoked potentials in multiple sclerosis. / Asociación entre el déficit de vitamina D y los potenciales evocados visuales en la esclerosis múltiple.

OBJECTIVE: To evaluate the possible relationship between serum 25-OH vitamin D levels and visually evoked potentials (VEP) in patients with multiple sclerosis (MS), residents in the south zone of Gran Canaria. MATERIAL AND METHODS: The study included 49 patients with MS, on whom 25-OH-vitamin D was determined, along with VEP, and a neurological examination to determine incapacity. Clinical variables, such as a history of optic neuritis were recorded. RESULTS: The mean value of 25-OH-vitamin D of the patients was 28.1±9.5ng/ml. The VEP latency was 119.1±23.2ms and the amplitude, 8.5±4.4 µV. Patients with a higher 25-OH-vitamin D had a greater number of outbreaks in the year prior to the study (P=.049), and those with vitamin D deficiency and previous optic neuritis showed no reduction in the amplitude of the VEP (P=.006). CONCLUSION: Patients with vitamin D deficiency have lower clinical activity of the MS and show no axonal involvement in VEP after having suffered optic neuritis. These relationships, although statistically significant, do not seem clinically plausible, thus new studies are needed to try and confirm this possible relationship.

Uricemia como factor pronóstico del ictus isquémico agudo / Hyperuricaemia as a prognostic factor for acute ischaemic stroke

Introducción: En el proceso de búsqueda de biomarcadores para el pronóstico del ictus agudo, en los últimos años los estudios realizados en torno al ácido úrico han mostrado resultados contradictorios.MétodosSe recogieron muestras analíticas de 600 pacientes ingresados de manera consecutiva en un hospital de tercer nivel y se analizó la relación entre los niveles de ácido úrico y el pronóstico funcional de los pacientes medido mediante la escala de Rankin modificada (mRS). Se excluyeron los pacientes que habían recibido terapias de reperfusión, ya que podría existir un efecto diferencial en los mismos respecto a los no tratados.ResultadosEl 73% de los pacientes tuvieron una mRS ≤ 2 y los niveles medios de ácido úrico fueron de 5,22 mg/dl. Se encontró una relación no lineal entre el pronóstico funcional al alta y los niveles de ácido úrico sérico en el momento del ingreso al excluir del análisis la medida de la National Institutes of Health Stroke Scale (NIHSS).ConclusionesLos valores séricos de ácido úrico en pacientes afectos de un ictus isquémico agudo se asocian significativamente con el pronóstico funcional en el momento de su alta, pero esta relación es no lineal. Se asocia un peor pronóstico a las concentraciones extremas, muy bajas o muy elevadas, de ácido úrico. Esto podría revelar un doble papel del ácido úrico en su relación con el ictus, como factor de riesgo asociado y/o como posible neuroprotector dado su papel antioxidante. (AU)

Introduction: Recent studies on uric acid as a biomarker for the prognosis of acute stroke have found conflicting results.MethodsWe collected blood samples from 600 consecutively admitted patients at our tertiary hospital and analysed the relationship between uric acid levels and functional prognosis (measured using the modified Rankin Scale [mRS]). Patients who had received reperfusion therapy were excluded since this may have influenced uric acid levels.ResultsA total of 73% of patients had mRS scores ≤ 2; the mean uric acid level was 5.22 mg/dL. We found a nonlinear relationship between functional prognosis at discharge and serum uric acid levels at admission when the National Institutes of Health Stroke Scale score was excluded from the analysis.ConclusionsSerum uric acid levels in patients with acute ischaemic stroke are significantly associated with functional prognosis at discharge, although this relationship is nonlinear. In fact, poorer prognosis is associated both with very low and with very high concentrations of uric acid. This suggests a dual role of uric acid in relation to stroke: on the one hand, as an associated risk factor, and on the other, as a possible neuroprotective factor due to its antioxidant effect. (AU)

Influencia de la lactancia materna en el metabolismo mineral óseo después de la menopausia / Influence of breastfeeding on bone mineral metabolism after menopause

Objetivo: Los estilos de vida y la historia ginecológica parecen influir en el metabolismo mineral óseo. Existen datos contradictorios sobre los posibles efectos de la lactancia materna en el posterior desarrollo de una osteoporosis densitométrica o la aparición de fracturas por fragilidad. El objetivo de este estudio fue valorar dichos efectos. Material y métodos: Estudio observacional, transversal, abierto, realizado en 758 mujeres postmenopáusicas que fueron clasificadas en dos grupos, dependiendo de que hubieran lactado a sus hijos o no. Se recogieron datos sobre estilos de vida, historia ginecológica y fracturas por fragilidad. Se les realizó una analítica general, con función renal, hepática, lípidos, iones, así como marcadores bioquímicos de remodelado óseo, hormona paratiroidea (PTH) y vitamina D (25HCC). Se les determinó la densidad mineral ósea (DMO) en la columna lumbar y en la extremidad proximal del fémur mediante absorciometría dual de rayos X (DXA). Así mismo se les realizó una medición mediante ultrasonografía cuantitativa (QUS) en el calcáneo del pie dominante. Los datos crudos, después de ser comparados por grupos, fueron ajustados aplicando el método de pareamiento por puntuación de propensión o propensity score matching, realizándose una comparación más precisa de las variables estudiadas. (AU)

Objetive: Lifestyle and gynecological history appear to influence bone mineral metabolism. There are conflicting data on the possible effects of breastfeeding on the subsequent development of densitometric osteoporosis or the development of fragility fractures. The objective of this study was to assess these effects. Material and methods: Observational, cross-sectional, open study, carried out in 758 postmenopausal women who were classified into two groups, depending on whether they had breastfed their children or not. Data were collected on lifestyles, gynecological history and fragility fractures. They underwent a general analysis, with renal and hepatic function, lipids, ions, as well as biochemical markers of bone remodeling, parathyroid hormone (PTH) and vitamin D (25HCC). Bone mineral density (BMD) was determined in the lumbar spine and in the proximal extremity of the femur by dual Xray absorptiometry (DXA). Likewise, a quantitative ultrasound (QUS) measurement was performed on the calcaneus of the dominant foot. The raw data, after being compared by groups, were adjusted by applying the propensity score matching method, making a more precise comparison of the variables studied. (AU)

La suplementación de calcio y vitamina D en el manejo de la osteoporosis. ¿Cuál es la dosis aconsejable de vitamina D? / Calcium and vitamin D supplementation in the management of osteoporosis. What is the advisable dose of vitamin D?

Los fundamentos fisiopatológicos que justifican la suplementación con calcio y vitamina D en la osteoporosis se sustancian en una amplia evidencia científica que se ha obtenido a través de varios ensayos clínicos aleatorizados y posteriores meta-análisis que han demostrado una reducción del riesgo de fracturas osteoporóticas estadísticamente significativa y clínicamente relevante. Esta evidencia ha conducido a su recomendación por parte de varias sociedades científicas interesadas en el manejo de la osteoporosis. Con el fin de optimizar la eficacia y el balance beneficio/riesgo de estos, el calcio y la vitamina D deben administrarse conjuntamente con los fármacos que se prescriban para el tratamiento de la osteoporosis, pues en todos estos estudios de referencia se ha utilizado calcio y vitamina D tanto en la rama que recibe el fármaco como la del placebo. La sal de calcio mayormente utilizada es el carbonato y el metabolito de la vitamina D, el colecalciferol o vitamina D3. No existe consenso ni evidencia científica concluyente sobre cuál es la dosis a emplear en la deficiencia de vitamina D asociada a osteoporosis. No obstante, la tendencia ha sido siempre a ir aumentando estas cantidades, desde las 400 UI que se recomendaban hace unos 30 años a las 2.000 UI diarias de la actualidad. Revisaremos en este artículo cuales son las recomendaciones que se realizan por medio de las guías clínicas, al recoger éstas la evidencia científica disponible. (AU)

The pathophysiological foundations justifying calcium and vitamin D supplements in osteoporosis are supported by extensive scientific evidence that has been obtained through several randomized clinical trials and subsequent meta-analyzes that have shown a statistically significant and clinically relevant reduction in the risk of osteoporotic fractures. This evidence has led to its recommendation by several scientific societies interested in the management of osteoporosis. In order to optimize the efficacy and the benefit/risk balance of these, calcium and vitamin D should be administered together with the drugs that are prescribed for the treatment of osteoporosis, since calcium and vitamin D have been used in all these reference studies, both in the arm that receives the drug and also in the placebo arm. The most commonly used calcium salt is carbonate and the metabolite of vitamin D, cholecalciferol or vitamin D3. There is no consensus or conclusive scientific evidence on the dose to be used in vitamin D deficiency associated with osteoporosis. However, the trend has always been to increase these amounts, from the 400 IU recommended 30 years ago to the 2,000 IU daily today. We will review in this article which recommendations are made by means of the clinical guidelines, as they collect the available scientific evidence. (AU)

[Estimation of vitamin supplements and minerals consumption dispensed through pharmacy offices in the province of Las Palmas]. / Estimación del consumo de suplementos vitamínicos y minerales dispensados a través de las oficinas de farmacia de la provincia de Las Palmas.

BACKGROUND: Vitamin supplements and minerals consumption (SPM) is increasing in occidental societies due to the growing concern about health by the population. OBJECTIVES: To have a initial approaching to the to SPM consumption in the Province of Las Palmas through 2000 and 2001. To identify SPM proportions that are dispensed as pharmaceutical specialities and those who are sold as parapharmacy products. Finally, to describe the evolution of this consumption throughout a year. METHOD: The information was obtained through the list of the whole pharmaceutical specialities and parapharmacy products through 2000 and 2001 who have at least a vitamin in its composition and/or a mineral. RESULTS: Usually, 297 pharmaceutical specialities and 216 parapharmacy products are currently being sold. Pharmaceutical specialities comprised 65.6% of the whole products sold and within them, vitamins were the most dispensed (41.5%). Regarding parapharmacy products, vitamins and minerals compounds were the products more sold (34.6%). Comparing to 2000, during 2001 there was a statistically significant increase in the consumption of parapharmacy products, remaining without changes the use of pharmaceutical specialities. CONCLUSION: On the basis of sold XX SPM consumption seems to be due mainly by pharmaceutical specialities rather than parapharmacy products. Nevertheless through 2001 there was an increase only in the parapharmacy products.

Comparación de los valores densitométricos de la extremidad proximal del fémur en sujetos jóvenes sanos: zurdos vs. diestros / Comparison of the femur proximal extremity’s densitometric values in young and healthy study participants: left-handed vs. right-handed

OBJETIVO: La actividad física es un determinante de la densidad mineral ósea. Las personas zurdas ejercitan más los miembros izquierdos que las diestras, quienes lo hacen con los derechos. El objetivo de este trabajo fue estudiar si los sujetos zurdos tienen valores más elevados de DMO en el miembro inferior izquierdo (fémur proximal) y los diestros en el derecho. MATERIAL Y MÉTODOS: Estudio observacional, transversal realizado en sujetos jóvenes sanos de ambos sexos que no realizaban actividad deportiva, que fueron agrupados en zurdos o diestros según su lateralidad, la cual se estableció aplicando el cuestionario de Edimburgo. A todos ellos se les midió la densidad mineral ósea en la columna lumbar y en la extremidad proximal de ambos fémures por medio de un densitómetro Hologic QDR 4500, Discovery®. RESULTADOS: De los 122 sujetos estudiados, 62 eran diestros y 60 zurdos. No se observaron diferencias estadísticamente significativas entre los casos y controles en la edad, proporción de varones y mujeres, índice de masa corporal y distribución de los estilos de vida: consumo de alcohol, tabaco y actividad física en el tiempo libre. Los zurdos y los diestros mostraron valores similares de densidad mineral ósea en la columna y en todas las localizaciones anatómicas medidas (cuello femoral, total de cadera, trocánter e intertrocánter) de ambos fémures, derecho e izquierdo. Sin embargo, en el fémur izquierdo se obtuvieron valores más bajos de DMO en comparación con el derecho en todas las localizaciones medidas (diferencias que fueron estadísticamente significativas) tanto al considerar a todos los sujetos juntos como al agruparlos según su lateralidad.(AU)

OBJETIVO: Physical activity is a key factor for bone mineral density. Left-handed people exercise more left limbs than right-handed do. The objective of this study was to determine whether left-handed participants have higher values of BMD in the left lower limbs (proximal femur) and right-handed subjects have them higher in the right lower ones. MATERIAL AND METHODS: Cross-sectional observational study performed on young and healthy men and women who do not practice any sport activity, and who were divided into two groups according to their laterality, established by the Edinburgh Handedness Inventory. The bone mineral density in the lumbar spine and the proximal extremity of both femurs was measured in all of the participants using a Hologic QDR 4500 Discovery® densitometer. RESULTS: From the 122 study participants, 62 were right-handed and 60 were left-handed. Statistically significant differences were not perceived among the participants, nor age-related, or in male-female proportion, body mass index or according to the subjects’ lifestyle: alcohol consumption, tobacco use and physical activity practiced during leisure time. Left and right-handed participants showed similar values for bone mineral density in the spine and in all the anatomical regions measured (femoral neck, total hip, trochanter and intertrochanter) in the right and left femurs. However, lower BMD values were obtained in all the measured locations of the left femur, compared to the same measurements in the right femur (these differences being statistically significant) when considered all the participants as a whole or when grouping them according to their laterality. (AU)

Diferencias en el metabolismo mineral óseo hiperparatiroidismo primario normocalcémico respecto al hiperparatiroidismo primario clásico / Differences in bone mineral metabolism normocalcemicprimary hyperparathyroidism with respect to classicalprimary hyperparathyroidism

OBJETIVO: El hiperparatiroidismo primario normocalcémico es una variedad menos conocida del hiperparatiroidismo primario clásico. Presentamos en este estudio sus manifestaciones clínicas y los datos relacionados con el metabolismo mineral óseo, tanto desde el punto de vista analítico como densitométrico, comparando los mismos con un grupo de pacientes afectos de hiperparatiroidismo primario clásico, con hipercalcemia. MATERIAL Y MÉTODOS: Estudio de casos y controles donde consideramos caso a pacientes afectos de hiperparatiroidismo primario normocalcémico (n=25) y control (n=25) a pacientes con hiperpartiroidismo primario con hipercalcemia (hiperparatiroidismo primario clásico). Se les efectuó una evaluación clínica completa con recogida de datos clínicos y realizándose determinaciones analíticas en sangre y orina de 24h, así como la estimación de la densidad mineral ósea y el trabecular bone score por densitometría (absorciometría radiológica dual, DXA) y los parámetros ultrasonográficos en el calcáneo. RESULTADOS: En el estudio clínico, los pacientes afectos de hiperparatiroidismo primario clásico solo muestran una mayor prevalencia de urolitiasis (OR: 9,333; IC 95%: 1,50-82,7) en comparación con los pacientes que sufren un hiperparatiroidismo primario normocalcémico. En todos los demás parámetros clínicos, analíticos, densitométricos y ultrasonográficos, no se aprecian diferencias estadísticamente significativas entre ambos grupos. CONCLUSIONES: Con la excepción de los niveles séricos de calcio y la prevalencia de urolitiasis, el hiperparatiroidismo normocalcémico cursa de manera indistinguible del hiperparatiroidismo clásico

OBJECTIVE: Normocalcemic primary hyperparathyroidism is a less known variety of classical primary hyperparathyroidism. In this paper, we present its clinical expression and data related to bone mineral metabolism, both analytically and densitometrically, comparing them with a group of patients with classic primary hyperparathyroidism, with hypercalcemia. MATERIAL AND METHODS: Study of cases and controls where we consider case of patients with normocalcemic primary hyperparathyroidism (n=25) and control (n=25) of patients with primary hyperpartyroidism with hypercalcemia (classical primary hyperparathyroidism). A complete clinical assessment was carried out with clinical data collection and24h blood and urine analytical determinations were performed, as well as estimating bone mineral density and trabecular bone score by densitometry (dual x‐ray absorptiometry, DXA) and ultrasound parameters in the calcaneus. RESULTS: In this clinical study, patients with classic primary hyperparathyroidism only show a higher prevalence of urolithiasis (OR: 9.333; 95% CI: 1.50‐82.7) compared to patients suffering from a normocalcemic primary hyperparathy‐roidism. In all other clinical, analytical, densitometric and ultrasonographic parameters, there are no statistically significant differences between the two groups. CONCLUSIONS: Apart from serum calcium levels and the prevalence of urolithiasis, normocalcemic hyperparathyroidism is indistinguishable from classical hyperparathyroidism

Prevalence of multiple sclerosis in Lanzarote (Canary Islands)

In the island of Lanzarote of the Province of Las Palmas, which is part of the Spanish archipelago of the Canary Islands, the prevalence of multiple sclerosis is 15 per 100,000. The prevalence of MS in Lanzarote seems related more to ethnic conditions than to geography.

New biochemical markers of bone resorption in the study of postmenopausal osteoporosis.

We performed a comparative study on the sensitivity of the determination of several biochemical markers of bone resorption: urinary calcium/creatinine, free pyridinolines (F-Pyr), free deoxypyridinoline (F-Dpyr), carboxyterminal telopeptide of collagen I (CTX) and aminoterminal crosslinked telopeptides of collagen I (NTX) in the study of postmenopausal osteoporosis. The study included 19 untreated osteoporotic postmenopausal women, aged 59 +/- 6 years, range 46-70 and 16 healthy control postmenopausal women, aged 56 +/- 7 years, range 48-70 years. The following bone markers were determined in 2-h fasting urine samples: calcium/creatinine (atomic absorptiometry), F-Pyr (ELISA, Metra), F-Dpyr (ELISA, Metra), CTX (Crosslaps, Cis bio International) and NTX (ELISA, Osteomark, OSTEX). Values of all markers were expressed as urinary creatinine (Cr) ratios. We found a significant increase in all the studied biochemical markers of bone resorption in osteoporotic patients with respect to control women. Areas under receiver operating characteristic (ROC) curves corresponding to F-Pyr/Cr, Calcium/ Cr, NTX/Cr, CTX/Cr and F-Dpyr/Cr were 74%, 75%, 93.4%, 95.7% and 96% respectively. There were no significant differences among the areas of the ROC curves corresponding to NTX, CTX and F-Dpyr, but areas under urinary calcium and F-Pyr were significantly lower. Among the biochemical markers of bone resorption studied, F-Dpyr, CTX and NTX presented the best discrimination between osteoporotic and control women. F-Dpyr/Cr sensitivity was 79% with a specificity of 100%, CTX/Cr sensitivity was also 79% with a specificity of 100% and NTX/Cr sensitivity was 52% with a specificity of 100%.

[Genetic polymorphism of vitamin D receptor and osteoporosis]. / Polimorfismo genético del receptor de la vitamina D y osteoporosis.

BACKGROUND: Genetic factors condition an important part of bone mass. The role of vitamin D receptor polymorphism (VDR) as genetic marker of osteoporosis is a matter of discussion. We have studied the possible influence of VDR on bone remodelling, calciotropic hormones, on the presence of osteoporosis and osteoporotic bone fractures. PATIENTS, CONTROL POPULATION AND METHODS: A case-control study. We have studied a total of 127 postmenopausal Canarian women from Canary Islands, Spain; 66 healthy controls and 61 with the diagnosis of osteoporosis, which was made by clinical, radiological and densitometric criteria. 17 osteoporotic women have had a fracture: Colles, hip or vertebral (spinal deformity index) fracture. VDR were determined by PCR directed to demonstrate the presence (b) or absence (B) of a restriction target for Bsml in intron 7. We analyzed some biochemical markers of bone remodelling: serum levels of alkaline phosphatase, tartrate resistant acid phosphatase and urine ratios of calcium/creatinine and hydroxyproline/creatinine. We also determined calciotropic hormones: parathyroid hormone and calcitonin. Bone mass was measured by DEXA and TC. RESULTS: There were no significant differences in either biochemical bone remodelling markers or in bone mass between the three genotypes: bb, Bb and BB, either in controls or in osteoporotic women with the exception of alkaline phosphatase which had a significative increase compared to control in women with unfavorable alleles distribution (bB and BB). Distribution of genotypes was similar between controls and osteoporotic women, with or without fractures. CONCLUSIONS: In Canarian women, VDR genotype is not associated with changes in biochemical markers of bone remodelling or in bone mass or with the presence of osteoporosis or osteoporotic fractures.

[Morbidity and mortality of osteoporotic proximal femoral fracture after one year follow-up]. / Morbilidad y mortalidad de la fractura osteoporótica de la extremidad proximal del fémur tras un año de seguimiento.

BACKGROUND: The aim of the present study was to follow for a year all the osteoporotic proximal femoral fractures that happened in the island of Gran Canaria during 1990 and to analyze: a) mortality; b) the degree of functional capacity; c) their destination after being attended from the fracture. METHODS: Personal interviews were performed in almost every patient (68%), either directly to them or the relatives who were at their care (23.5%), after excluding those patients who died during the acute phase (7.6%) a year after the fracture. Two patients were missed (0.9%). We had the collaboration of every public and private center in the island. 209 patients (154 women and 55 men) were interviewed. Age mean of the patients was 77.1 +/- 10.9 years. The degree of functional capacity was determined by Karnofsky scale. RESULTS: Mortality within the acute phase was 7.6%, rising to 20.8% 6 months later and to 30.7% after a year. There was an important disability in 30.7% of the remainder living patients. In the postsurgical period, 18% of the patients were transferred to a center for chronic care and 25% to a rehabilitation center. Although 48.9% of the patients are discharged to their homes from the hospital, surprisingly, when they die, only 15% do so in their homes, while 59% of the patients die in a center for chronic care. CONCLUSIONS: Osteoporotic proximal femoral fracture produces an important mortality within the first year after fracture, and also an important deterioration of functional capacity. Most of the patients are admitted later on and die in a center for chronic care.