RESUMO
BACKGROUND: To explore the anti-osteoporosis and anti-diabetes effects and potential underlying mechanisms of treatment with metformin and alendronate in diabetes mellitus mice. METHODS: Eight-week-old C57 BL/KS db/db and db/+ female mice were evaluated according to the following treatment group for 12 weeks: control group, diabetes mellitus group, diabetes mellitus with metformin group, diabetes mellitus with Alendronate group, diabetes mellitus with metformin plus alendronate group. Glucose level, glucose tolerance test, bone mineral density, bone microarchitecture, bone histomorphometry, serum biomarkers, and qPCR analysis. RESULTS: Combined metformin and alendronate can improve progression in glucose metabolism and bone metabolism, including blood glucose levels, blood glucose levels after 4 and 16 hours fasting, glucose tolerance test results, insulin sensitivity and reduces bone loss than the diabetes group. The use of alendronate alone can increase significantly serum glucagon-like peptide-1 levels than the diabetes group. The use of metformin alone can improve bone microstructure such as Tb.Sp and Tb.N of spine in diabetic mice. CONCLUSION: The combined use of alendronate and metformin has an anti-diabetes and anti-osteoporotic effect compared with diabetic mice, but they appear to act no obvious synergistically between alendronate and metformin.
Assuntos
Alendronato/uso terapêutico , Desmineralização Patológica Óssea/prevenção & controle , Diabetes Mellitus/patologia , Glucose/metabolismo , Metformina/uso terapêutico , Alendronato/administração & dosagem , Animais , Glicemia/efeitos dos fármacos , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/administração & dosagem , Conservadores da Densidade Óssea/uso terapêutico , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/metabolismo , Quimioterapia Combinada , Feminino , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Metformina/administração & dosagem , Camundongos , Camundongos Endogâmicos NODRESUMO
This study aimed to assess the influence of glycosaminoglycan (chondroitin and glucosamine sulfates) supplementation in the diet on the performance and incidence of locomotor problems in broiler chickens. A completely randomized design was carried out in a 3 × 3 factorial scheme (3 levels of chondroitin sulfate -0, 0.05, and 0.10%; and 3 levels of glucosamine sulfate -0, 0.15, and 0.30%). Each treatment was composed of 6 replications of 30 broilers each. The performance of broilers (average weight, weight gain, feed intake, feed conversion, and productive viability) was assessed at 7, 21, 35, and 42 d of age, whereas the gait score, valgus and varus deviations, femoral degeneration, and tibial dyschondroplasia were assessed at 21 and 42 d of age. Increasing levels of glucosamine sulfate inclusion linearly increased the weight gain from 1 to 35 and from 1 to 42 d of age of broilers (P = 0.047 and P = 0.039, respectively), frequency of broilers with no femoral degeneration in the right and left femurs, and the proliferating cartilage area of proximal epiphysis at 42 d of age (P = 0.014, P < 0.0001, and P = 0.028, respectively). The increasing inclusion of chondroitin and glucosamine sulfates led to an increase in the frequency of broilers on the gait score scale 0 (P = 0.007 and P = 0.0001, respectively) and frequency of broilers with no valgus and varus deviations (P = 0.014 and P = 0.0002, respectively) also at 42 d of age. Thus, chondroitin and glucosamine sulfates can be used in the diet of broiler chickens to reduce their locomotor problems.
Assuntos
Galinhas , Suplementos Nutricionais , Glicosaminoglicanos , Ração Animal/análise , Fenômenos Fisiológicos da Nutrição Animal/efeitos dos fármacos , Animais , Desmineralização Patológica Óssea/prevenção & controle , Desmineralização Patológica Óssea/terapia , Desmineralização Patológica Óssea/veterinária , Dieta/veterinária , Glicosaminoglicanos/farmacologia , Osteocondrodisplasias/prevenção & controle , Osteocondrodisplasias/terapia , Osteocondrodisplasias/veterinária , Distribuição AleatóriaRESUMO
Abnormal calcium metabolism in sarcoidosis patients can lead to hypercalcemia, hypercalciuria, and kidney stones. Hypercalcemia in sarcoidosis is usually due to increased activity of 1α-hydroxylase in macrophages of pulmonary granulomata, resulting in low levels of 25-hydroxyvitamin D and high levels of calcitriol. Vitamin D supplementation may be dangerous for some sarcoidosis patients and is recommended only for those with decreased 25-hydroxyvitamin D and reduced or normal calcitriol level. Diagnosis, treatment of osteoporosis, and maintenance of bone health are complex issues for sarcoidosis patients. An approach to diagnosis and treatment of bone fragility is presented.
Assuntos
Desmineralização Patológica Óssea/metabolismo , Cálcio/metabolismo , Suplementos Nutricionais/efeitos adversos , Sarcoidose/metabolismo , Vitamina D/farmacologia , Fatores Etários , Desmineralização Patológica Óssea/etiologia , Desmineralização Patológica Óssea/prevenção & controle , Calcitriol/sangue , Fraturas Ósseas/prevenção & controle , Humanos , Conduta do Tratamento Medicamentoso , Ensaios Clínicos Pragmáticos como Assunto , Fatores de Risco , Sarcoidose/complicações , Sarcoidose/terapia , Fatores Sexuais , Vitamina D/metabolismoRESUMO
OBJECTIVES: This study aims to investigate the effectivity of cement combined demineralized bone matrix (DBM) treatment on new bone formation in the cortical window as well as to evaluate the effect of new bone formation on functional outcomes. PATIENTS AND METHODS: Thirty-two benign bone tumor patients (15 males, 17 females; median age 38 years; range, 12 to 68 years), who were treated with cement combined DBM between February 2010 and December 2014, were evaluated retrospectively. Patient characteristics were recorded as age, gender, tumor localization, histological diagnosis, Enneking stage, tumor size, size of the cortical window, usage of prophylactic fixation, time to return to work, Musculoskeletal Tumor Society (MSTS) functional score, tumor relapse, and new bone formation on the cortical window in the computed tomography scans after one year of surgery. RESULTS: Median tumor volume was 17.2 cm3 (range, 2.8 to 139.6 cm3), median area of the cortical window was 8.3 cm2 (range, 1.6 to 28.4 cm2), and median postoperative one-year MSTS score was 84.5 (range, 66 to 97). MSTS scores were significantly worse with the usage of prophylactic fixation (p<0.001). There was a statistically significant difference between the usage of prophylactic fixation and cortical window size (p=0.013). There was a low-level negative correlation in terms of age and bone formation on the cortical window (p=0.046, r= -0.356) and mid-level negative correlation between cortical window size and functional scores (p=0.001, r= -0.577). CONCLUSION: Application of cement combined with DBM procedure is an effective, alternative, and biological treatment in bone tumors that provides immediate stability and stimulates new bone formation on the cortical window.
Assuntos
Cimentos Ósseos/uso terapêutico , Desmineralização Patológica Óssea/terapia , Neoplasias Ósseas , Transplante Ósseo/métodos , Extremidade Inferior , Neoplasias , Extremidade Superior , Adulto , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Regeneração Óssea , Feminino , Humanos , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Masculino , Neoplasias/patologia , Neoplasias/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Resultado do Tratamento , Extremidade Superior/patologia , Extremidade Superior/cirurgiaRESUMO
BACKGROUND: Vascular calcification progression has been associated with the loss of trabecular bone in chronic kidney disease (CKD) patients. There are few data evaluating the relationship between cortical bone loss and vascular calcification in this population. The aim of this study was to prospectively evaluate the association between changes in cortical bone density and coronary artery calcification (CAC) progression in non-dialyzed CKD patients. METHODS: Changes of cortical and trabecular bone, and changes of calcium score, were analyzed using vertebral tomographic images from a prospective study. Automatic delineation of the cortical bone layer was performed by Image J software, and trabecular bone was determined by selecting a region of interest using Vitrea 2® software. Cortical and trabecular bone density (BD) were expressed in Hounsfield Units (HU), and coronary artery calcium score in Agatston Units (AU). RESULTS: Seventy asymptomatic patients [57.8 ± 10.2 years, 63% males, 20% diabetic, estimated glomerular filtration rate (eGFR) = 37.3 (24.8-51.3) mL/min/1.73m2] were followed for 24 months. The mean cortical and trabecular BD did not change over time. While 49 patients lost either bone, 29 (41%) patients lost cortical [- 4.4%/year (ranging from - 7.15 to - 0.5)] and 39 (56%) lost trabecular bone [- 3.15%/year (- 13.7 to - 0.25)]. There was no association between cortical and trabecular BD changes (p = 0.12). CAC was observed in 33 (46%) patients at baseline, and 30 (91%) of them showed CAC progression. While an inverse correlation between trabecular bone and calcium score changes was observed (p = 0.001), there was no correlation between cortical bone and calcium score changes (p = 0.34). CONCLUSION: CKD patients experience either cortical or trabecular bone loss over time, but these changes do not take place simultaneously in all patients. Cortical, unlike trabecular bone loss, is not associated with vascular calcification progression in these patients.
Assuntos
Desmineralização Patológica Óssea , Osso Esponjoso , Insuficiência Renal Crônica/complicações , Calcificação Vascular/diagnóstico , Doenças Assintomáticas , Desmineralização Patológica Óssea/diagnóstico , Desmineralização Patológica Óssea/etiologia , Densidade Óssea , Brasil/epidemiologia , Osso Esponjoso/irrigação sanguínea , Osso Esponjoso/diagnóstico por imagem , Osso Esponjoso/patologia , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/metabolismo , Tomografia Computadorizada por Raios X/métodos , Calcificação Vascular/epidemiologiaRESUMO
PURPOSE: Incomplete partition III (IP-III) characterized by congenital mixed or sensorineural hearing loss is a rare genetic disease transmitted through X-linked inheritance. Incomplete partition III can be easily achieved based on pathognomonic computed tomography findings. The aims of this study were to investigate the otic capsule abnormalities in IP-III and to report irregular contour of membranous labyrinth and hypomineralized areas at otic capsule, which have not previously been described. MATERIALS AND METHODS: The otic capsule features of 10 subjects (8 affected patients, 1 of whom is a female; 2 carrier mothers), who were diagnosed on clinical and typical radiologic findings, were analyzed. RESULTS: All patients had typical IP-III as described in the literature. Seven of 10 patients had irregular contour. Seven of 10 patients demonstrated hypomineralized areas, which were very hypodense to normally develop otic capsule areas. One affected patients and 2 carrier mothers had a normal-looking membranous labyrinth contour and normal mineralization at otic capsule. CONCLUSIONS: We report for the first time the irregular contour of inner ear structures and hypodense otic capsule areas in patients with IP-III. We think that though speculative, abnormal development of the inner endosteal layer results in irregular contour of inner ear structures. Hypomineralized areas at otic capsule could be explained by abnormal development of middle enchondral layer due to reduced or absent vascular supply from middle ear mucosa during fetal life. These findings may be accepted as additional criteria of IP-III.
Assuntos
Orelha Interna , Perda Auditiva Neurossensorial , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Desmineralização Patológica Óssea/diagnóstico por imagem , Desmineralização Patológica Óssea/patologia , Criança , Pré-Escolar , Orelha Interna/anormalidades , Orelha Interna/diagnóstico por imagem , Feminino , Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Neurossensorial/genética , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Masculino , Adulto JovemRESUMO
The goal is to clarify the epidemiology of hearing loss in patients with osteogenesis imperfecta (OI), so as to improve management. A literature review analyzed data from 15 patient series. Hearing loss prevalence in OI varied widely, from 2% to 94.1%. Typically, hearing loss was conductive in young patients and sensorineural in older patients. Prevalence increased with age, but after 50 years the increase was slight, and seldom became total. Hearing loss was usually bilateral, but not necessarily symmetrical. There were no correlations between type of mutation (COL1A1 or COL1A2), prevalence, type or severity of hearing loss, or age of symptom onset; there was intra-familial variability. There was also no correlation between mutated gene, type of mutation and auditory phenotype. Frequency, type and severity of hearing loss were unrelated to other clinical parameters. Hearing loss prevalence depended on type of OI: higher in type I and lower in type IV. Incidence of otitis media was higher in children with OI, related to the associated craniofacial dysmorphia. Hearing screening before 5 years of age with long-term follow-up are recommended.
Assuntos
Perda Auditiva Condutiva/etiologia , Perda Auditiva Neurossensorial/etiologia , Osteogênese Imperfeita/complicações , Envelhecimento , Desmineralização Patológica Óssea/diagnóstico por imagem , Humanos , Osteogênese Imperfeita/classificação , Osso Temporal/diagnóstico por imagemRESUMO
Previous studies have shown substances capable of similar effects of demineralization, accelerating the process of bone remodeling. This study investigated preosteoblasts behavior in cell culture after bone demineralization with citric acid and tetracycline. Seventy-four Wistar rats provided 144 calvarial bone samples, 126 of which were randomly divided in seven groups according to the treatment given to the surface: no demineralization (C), citric acid (CA), tetracycline (TCN) during 15, 30, and 60 s. Each group received preosteoblasts cultured for 24, 48, and 72 hr. Eighteen remaining samples were analyzed for the atomic percentage (A%) by energy dispersive spectroscopy (EDS) before and after demineralization. The average percentage of bone area covered by cells increased with time and it was significantly higher after 24 and 48 hr of culture in groups CA15s, CA30s, CA60s, TCN15s, and TCN30s than in groups TCN60 and C (p < 0.05). The cell morphology in all CA and TCN groups was shown to be compatible with more advanced stages of differentiation than in C group. The A% changed after demineralization. We conclude that demineralization with citric acid or tetracycline for 15-30 s increased the area of bone surface covered by preosteoblasts. The A% changes were not sufficient to impair the cells spreading and morphology. Bone demineralization may promote potential benefits in bone regenerative procedures. HIGHLIGHTS: Low pH effects did not interfere on cell growth. Bone demineralization favored the preosteoblasts growth. A possible alternative to improve graft consolidation.
Assuntos
Desmineralização Patológica Óssea , Ácido Cítrico/farmacologia , Osteoblastos/efeitos dos fármacos , Crânio/efeitos dos fármacos , Crânio/patologia , Tetraciclina/farmacologia , Animais , Diferenciação Celular/efeitos dos fármacos , Células Cultivadas , Concentração de Íons de Hidrogênio , Masculino , Microscopia Eletrônica de Varredura , Osteoblastos/citologia , Osteoblastos/ultraestrutura , Ratos Wistar , Crânio/ultraestruturaRESUMO
Bone volume, microstructure and its material composition are maintained by bone remodelling, a cellular activity carried out by bone multicellular units (BMUs). BMUs are focally transient teams of osteoclasts and osteoblasts that respectively resorb a volume of old bone and then deposit an equal volume of new bone at the same location. Around the time of menopause, bone remodelling becomes unbalanced and rapid, and an increased number of BMUs deposit less bone than they resorb, resulting in bone loss, a reduction in bone volume and microstructural deterioration. Cortices become porous and thin, and trabeculae become thin, perforated and disconnected, causing bone fragility. Antiresorptive agents reduce fracture risk by reducing the rate of bone remodelling so that fewer BMUs are available to remodel bone. Bone fragility is not abolished by these drugs because existing microstructural deterioration is not reversed, unsuppressed remodelling continues producing microstructural deterioration and unremodelled bone that becomes more mineralized can become brittle. Anabolic agents reduce fracture risk by stimulating new bone formation, which partly restores bone volume and microstructure. To guide fracture prevention, this Review provides an overview of the structural basis of bone fragility, the mechanisms of remodelling and how anabolic and antiresorptive agents target remodelling defects.
Assuntos
Anabolizantes/uso terapêutico , Desmineralização Patológica Óssea/prevenção & controle , Conservadores da Densidade Óssea/uso terapêutico , Animais , Desmineralização Patológica Óssea/terapia , Remodelação Óssea/efeitos dos fármacos , Reabsorção Óssea/tratamento farmacológico , HumanosAssuntos
Ciclosporina/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Imunossupressores/administração & dosagem , Fototerapia/métodos , Dermatopatias/tratamento farmacológico , Administração Oral , Desmineralização Patológica Óssea/induzido quimicamente , Criança , Contraindicações de Medicamentos , Aconselhamento , Ciclosporina/efeitos adversos , Ciclosporina/farmacologia , Fármacos Dermatológicos/efeitos adversos , Fármacos Dermatológicos/farmacologia , Vias de Administração de Medicamentos , Esquema de Medicação , Toxidermias/etiologia , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Humanos , Hiperlipidemias/induzido quimicamente , Hipertensão/induzido quimicamente , Imunossupressores/efeitos adversos , Imunossupressores/farmacologia , Anamnese , Uso Off-Label , Infecções Oportunistas/induzido quimicamente , Exame Físico , Gravidez , VacinaçãoRESUMO
Bone is now considered as a particular endocrine organ. Its endocrine function is not yet fully understood and has been the subject of several conferences at the European Society of Endocrinology Congress 2018. Bone regulates phosphate metabolism by secreting fibroblast growth factor 23; it also regulates glucose metabolism via osteocalcin and energy metabolism, thanks to lipocalin 2, a new hormone acting on the brain. In addition, the incidence of diabetes continues to grow, and its impact on bone has been demonstrated, with an increased risk of fractures regardless the type of diabetes. The mechanism of bone fragility in this disease is not fully known but it involves a decrease in bone turnover and bone demineralization. Recent findings on the role of bone on glucose and mineral metabolism could open therapeutic perspectives, especially for the treatment of diabetes or obesity.
Assuntos
Osso e Ossos/fisiologia , Metabolismo/fisiologia , Desmineralização Patológica Óssea/etiologia , Remodelação Óssea , Complicações do Diabetes , Diabetes Mellitus/epidemiologia , Glândulas Endócrinas/fisiologia , Metabolismo Energético , Fator de Crescimento de Fibroblastos 23 , Fatores de Crescimento de Fibroblastos/fisiologia , Fraturas Ósseas/etiologia , Glucose/metabolismo , Humanos , Lipocalina-2/fisiologia , Minerais/metabolismo , Osteocalcina/fisiologia , Fosfatos/metabolismo , Fatores de RiscoAssuntos
Doença Hepática Induzida por Substâncias e Drogas/enzimologia , Gastroenterologia/educação , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hepatopatias/enzimologia , Idoso , Autoanticorpos/análise , Desmineralização Patológica Óssea/etiologia , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Feminino , Ferritinas/análise , Ferritinas/metabolismo , Hemocromatose/diagnóstico , Hemocromatose/metabolismo , Hemocromatose/patologia , Hepatite B/diagnóstico , Hepatite B/tratamento farmacológico , Hepatite B/imunologia , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/genética , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/tratamento farmacológico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Cirrose Hepática Biliar/complicações , Hepatopatias/diagnóstico por imagem , Hepatopatias/imunologia , Hepatopatias/patologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/enzimologia , Hepatopatia Gordurosa não Alcoólica/metabolismo , Adulto JovemRESUMO
PURPOSE: To examine the prevalence and risk factors for hypercalcemia among non-dialysis chronic kidney disease (CKD) patients with mineral and bone disorder (MBD). METHODS: A retrospective cohort study was conducted in Singapore General Hospital, involving all CKD stage 4 and 5 pre-dialysis patients who were on treatment for MBD in June 2016. Each patient was followed up for 1 year and screened for hypercalcemia episodes. Mild, moderate and severe hypercalcemia were defined as corrected calcium of 2.47-3.00, 3.01-3.50 and ≥ 3.51 mmol/l respectively. Patients who were on dialysis, post-renal transplant, post-parathyroidectomy or had no calcium levels taken during the study period were excluded. Details related to patients' clinical information and hypercalcemia episodes were collected. Multivariate logistic regression analysis was performed to evaluate risk factors for hypercalcemia. RESULTS: Of 557 patients, 75 (13.4%) patients developed hypercalcemia. There were 120 (97.6%) mild and 3 (2.4%) moderate hypercalcemia episodes. The daily elemental calcium intake from phosphate binders and usage of vitamin D analogues did not differ between patients with and without hypercalcemia (p > 0.05). After adjusting for covariates, lower baseline iPTH level [odds ratio (OR) 0.96, 95% CI 0.93-0.99], history of hypercalcemia in past 1 year (OR 11.11, 95% CI 3.36-36.75) and immobility (OR 3.34, 95% CI 1.34-8.40) were associated with increased hypercalcemia risk. CONCLUSION: Hypercalcemia affects a significant proportion of pre-dialysis patients with MBD. More studies should be undertaken to evaluate other risk factors associated with hypercalcemia.
Assuntos
Desmineralização Patológica Óssea , Cálcio , Hipercalcemia , Insuficiência Renal Crônica , Vitamina D , Idoso , Desmineralização Patológica Óssea/sangue , Desmineralização Patológica Óssea/etiologia , Densidade Óssea , Conservadores da Densidade Óssea/uso terapêutico , Cálcio/sangue , Cálcio/uso terapêutico , Feminino , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/epidemiologia , Hipercalcemia/etiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/tratamento farmacológico , Insuficiência Renal Crônica/metabolismo , Estudos Retrospectivos , Fatores de Risco , Singapura/epidemiologia , Vitamina D/sangue , Vitamina D/uso terapêuticoAssuntos
Desmineralização Patológica Óssea/induzido quimicamente , Fatores de Crescimento de Fibroblastos/sangue , Fraturas Ósseas/induzido quimicamente , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Densidade Óssea/efeitos dos fármacos , Canagliflozina/efeitos adversos , Fator de Crescimento de Fibroblastos 23 , Humanos , Hormônio Paratireóideo/sangue , Fósforo/sangue , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Vitamina D/análogos & derivados , Vitamina D/sangueRESUMO
Guidelines for the assessment, diagnosis and therapy of the alterations that characterize the CKD-MBD are an important support in the clinical practice of the nephrologist. Compared to the KDIGO guidelines published in 2009, the 2017 update made changes on some topics on which there was previously no strong evidence both in terms of diagnosis and therapy. The recommendations include the diagnosis of bone anomalies in CKD-MBD and the treatment of mineral metabolism abnormalities with particular regard to hyperphosphataemia, calcium levels, secondary hyperparathyroidism and anti-resorptive therapies. The Italian Study Group on Mineral Metabolism, in reviewing the 2017 recommendations, aimed to assess the weight of the evidence that led to this update. In fact, on some topics there has not been a substantial difference on the degree of evidence compared to the previous guidelines. The Italian Study Group emphasizes the points that may still reserve critical issues, including interpretation, and invites an evaluation that is articulated and personalized for each patient.
Assuntos
Distúrbio Mineral e Ósseo na Doença Renal Crônica , Corticosteroides/efeitos adversos , Biópsia , Desmineralização Patológica Óssea/etiologia , Desmineralização Patológica Óssea/fisiopatologia , Desmineralização Patológica Óssea/terapia , Densidade Óssea , Conservadores da Densidade Óssea/uso terapêutico , Reabsorção Óssea/etiologia , Reabsorção Óssea/prevenção & controle , Osso e Ossos/patologia , Cálcio/análise , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico por imagem , Distúrbio Mineral e Ósseo na Doença Renal Crônica/fisiopatologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/terapia , Contraindicações de Medicamentos , Soluções para Diálise/química , Humanos , Hipercalcemia/etiologia , Hipercalcemia/prevenção & controle , Hipercalcemia/terapia , Hiperparatireoidismo Secundário/tratamento farmacológico , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/fisiopatologia , Hiperfosfatemia/dietoterapia , Hiperfosfatemia/tratamento farmacológico , Hiperfosfatemia/etiologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/metabolismo , Vitamina D/uso terapêuticoRESUMO
BACKGROUND: The discovery of Jewish babies who were born in Nazi concentration camps and survived seems miraculous, but this phenomenon did occur toward the end of World War II. The lives of a small group of mothers and surviving children are of both historical and medical interests. Their survival shows additional support for the hypothesis that maternal nutrition can induce metabolic syndrome and bone demineralization in their offspring. Information obtained through direct contact with some of the surviving children is the basis for this article.
Assuntos
Campos de Concentração/história , Holocausto/história , Judeus/história , Sobrevida/fisiologia , Sobreviventes/história , Desmineralização Patológica Óssea/epidemiologia , Criança , Feminino , História do Século XX , Humanos , Masculino , Fenômenos Fisiológicos da Nutrição Materna/fisiologia , Síndrome Metabólica/epidemiologia , Gravidez , II Guerra MundialRESUMO
BACKGROUND: Coronary artery disease (CAD) and osteoporosis (OP) are common diseases in postmenopausal women. In both cross-sectional and longitudinal epidemiologic studies, low bone mass has been related to increased frequency of CAD. However, available data on the relationship between bone mineral density (BMD) and severity of coronary lesions is limited. OBJECTIVE: To investigate association between the BMD and severity of coronary lesions assessed by Gensini score in postmenopausal women. METHODS: This study included 122 postmenopausal women who were diagnosed with CAD. These patients were divided into two groups according to the severity of coronary lesions assessed by the Gensini score - patients with mild coronary lesions (Gensini score < 25) and patients with severe coronary lesions (Gensini score ≥ 25). Femoral neck mineral density was measured with dual energy X-ray absorptiometry (DXA). RESULTS: The study included postmenopausal women aged 64.31 ± 4.71 years, 85 of whom (69.7%) exhibited severe coronary lesions. Participants with severe coronary lesions had a significantly higher T score than did those with mild coronary lesions at the femoral neck (p < 0.05). The mean T-score was -0.84 ± 1.01 in mild coronary lesions group, -1.42 ± 1.39 in severe coronary lesions group (p < 0.05). Multivariable logistic regression analysis showed that osteopenia-osteoporosis at the Femoral neck (odds ratio 2.73; 95% confidence interval 1.06 to 6.13) was associated with an increased risk of developing severe coronary lesions. The multiple regression model showed that T-scores (b = -0.407, SE = 0.151, p=0.007) were the independent predictors of Gensini score. CONCLUSION: The relationship between severity of coronary lesions and BMD was significant in postmenopausal women. BMD, a low-cost technique involving minimal radiation exposure, widely used for osteoporosis screening, is a promising marker of severity of coronary lesions.
Assuntos
Desmineralização Patológica Óssea/fisiopatologia , Densidade Óssea/fisiologia , Doença da Artéria Coronariana/fisiopatologia , Osteoporose Pós-Menopausa/fisiopatologia , Pós-Menopausa/fisiologia , Absorciometria de Fóton/métodos , Fatores Etários , Idoso , Desmineralização Patológica Óssea/complicações , Doença da Artéria Coronariana/etiologia , Estudos Transversais , Feminino , Colo do Fêmur/diagnóstico por imagem , Humanos , Hiperlipidemias/complicações , Modelos Logísticos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Valores de Referência , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Estatísticas não ParamétricasRESUMO
The aim of this study was to investigate if grape or apple juices are able to protect bone tissue of rats exposed to cadmium. For this purpose, histopathological analysis and immunohistochemistry for RUNX-2 and RANK-L were investigated in this setting. A total of 20 adult Wistar rats were distributed into four groups (n = 5), as follows: control group, cadmium group, cadmium and grape juice group, and Cadmium and apple juice group. Control group received a single intraperitoneal (i.p.) water injection. Cadmium group received a single i.p. injection of cadmium chloride (1.2 mg/kg body weight) diluted in water. Cadmium and grape juice and cadmium and apple juice groups received a single i.p. injection of cadmium chloride (1.2 mg/kg body), and after 15 days, the rats were treated with grape or apple juices for 15 days, by gavage. All animals were euthanized 30 days after the beginning of experiment. Histopathological analysis in rat femur revealed extensive bone loss in rats intoxicated with cadmium. Grape or apple juices were able to increase bone formation. Cadmium inhibited RUNX-2 immunoexpression whereas cadmium increased RANK-L immunoexpression in rat bone cells. Grape or apple juices increased RUNX-2 and decreased RANK-L immunoexpression after cadmium intoxication. Taken together, our results demonstrate that grape or apple juices are able to exert therapeutic activity following cadmium intoxication in rat bone tissue as result of stimulatory effect of bone formation by RUNX-2 upregulation and RANK-L downregulation.
Assuntos
Desmineralização Patológica Óssea/prevenção & controle , Subunidade alfa 1 de Fator de Ligação ao Core/genética , Fêmur/efeitos dos fármacos , Sucos de Frutas e Vegetais , Osteogênese/efeitos dos fármacos , Substâncias Protetoras/farmacologia , Receptor Ativador de Fator Nuclear kappa-B/genética , Animais , Subunidade alfa 1 de Fator de Ligação ao Core/metabolismo , Fêmur/patologia , Imuno-Histoquímica , Masculino , Malus/química , Ratos , Ratos Wistar , Receptor Ativador de Fator Nuclear kappa-B/metabolismo , Vitis/químicaRESUMO
Abstract Background: Coronary artery disease (CAD) and osteoporosis (OP) are common diseases in postmenopausal women. In both cross-sectional and longitudinal epidemiologic studies, low bone mass has been related to increased frequency of CAD. However, available data on the relationship between bone mineral density (BMD) and severity of coronary lesions is limited. Objective: To investigate association between the BMD and severity of coronary lesions assessed by Gensini score in postmenopausal women. Methods: This study included 122 postmenopausal women who were diagnosed with CAD. These patients were divided into two groups according to the severity of coronary lesions assessed by the Gensini score - patients with mild coronary lesions (Gensini score < 25) and patients with severe coronary lesions (Gensini score ≥ 25). Femoral neck mineral density was measured with dual energy X-ray absorptiometry (DXA). Results: The study included postmenopausal women aged 64.31 ± 4.71 years, 85 of whom (69.7%) exhibited severe coronary lesions. Participants with severe coronary lesions had a significantly higher T score than did those with mild coronary lesions at the femoral neck (p < 0.05). The mean T-score was −0.84 ± 1.01 in mild coronary lesions group, −1.42 ± 1.39 in severe coronary lesions group (p < 0.05). Multivariable logistic regression analysis showed that osteopenia-osteoporosis at the Femoral neck (odds ratio 2.73; 95% confidence interval 1.06 to 6.13) was associated with an increased risk of developing severe coronary lesions. The multiple regression model showed that T-scores (b = −0.407, SE = 0.151, p=0.007) were the independent predictors of Gensini score. Conclusion: The relationship between severity of coronary lesions and BMD was significant in postmenopausal women. BMD, a low-cost technique involving minimal radiation exposure, widely used for osteoporosis screening, is a promising marker of severity of coronary lesions.
Resumo Fundamento: A doença arterial coronariana (DAC) e a osteoporose são doenças comuns em mulheres pós-menopausa. Tanto em estudos transversais como em estudos epidemiológicos longitudinais, a massa óssea diminuída foi relacionada à frequência aumentada de DAC. No entanto, dados disponíveis sobre a relação entre densidade mineral óssea (DMO) e gravidade das lesões coronarianas são limitados. Objetivo: Investigar a associação entre DMO e gravidade das lesões coronarianas avaliadas pelo escore de Gensini em mulheres pós-menopausa. Métodos: Este estudo incluiu 122 mulheres pós-menopausa diagnosticadas com DAC. As pacientes foram divididas em dois grupos de acordo com a gravidade das lesões coronarianas avaliada pelo escore de Gensini - pacientes com lesões coronarianas leves (escore de Gensini < 25) e pacientes com lesões coronarianas graves (escore de Gensini ≥ 25). A densidade mineral do colo femoral foi medida por absorção de raios-X de dupla energia (DXA). Resultados: O estudo incluiu mulheres pós-menopausa com idade de 64,31 ± 4,71 anos, 85 delas (69,7%) com lesões coronarianas graves. Pacientes com lesões coronarianas graves apresentaram um escore T mais elevado que aquelas com lesões coronarianas leves no colo femoral (p < 0,05). O escore T médio foi -0,84 ± 1,01 no grupo com lesões leves, e -1,42 ± 1,39 no grupo com lesões graves (p < 0,05). A análise de regressão logística multivariada mostrou que a osteopenia-osteoporose no colo femoral (odds ratio 2,73; intervalo de confiança de 95% 1,06 - 6,13) esteve associada com um risco aumentado de se desenvolver lesões coronarianas graves. O modelo de regressão múltipla mostrou que os escores T (b = -0,407; EP= 0,151; p = 0,007) foram preditores independentes do escore de Gensini. Conclusão: Encontrou-se uma relação significativa entre a gravidade das lesões coronarianas e a DMO em mulheres pós-menopausa. DMO, uma técnica de baixo custo que envolve mínima exposição à radiação, e amplamente utilizada no rastreamento de osteoporose, é um marcador promissor da gravidade de lesões coronarianas graves.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Doença da Artéria Coronariana/fisiopatologia , Densidade Óssea/fisiologia , Osteoporose Pós-Menopausa/fisiopatologia , Pós-Menopausa/fisiologia , Desmineralização Patológica Óssea/fisiopatologia , Valores de Referência , Índice de Gravidade de Doença , Doença da Artéria Coronariana/etiologia , Absorciometria de Fóton/métodos , Modelos Logísticos , Osteoporose Pós-Menopausa/complicações , Estudos Transversais , Fatores de Risco , Fatores Etários , Estatísticas não Paramétricas , Medição de Risco , Desmineralização Patológica Óssea/complicações , Colo do Fêmur/diagnóstico por imagem , Hiperlipidemias/complicaçõesRESUMO
Metabolic acidosis is not uncommon in CKD and is linked with bone demineralization, muscle catabolism, and higher risks of CKD progression and mortality. Clinical practice guidelines recommend maintaining serum total CO2 at ≥22 mEq/L to help prevent these complications. Although a definitive trial testing whether correcting metabolic acidosis improves clinical outcomes has not been conducted, results from small, single-center studies support this notion. Furthermore, biologic plausibility supports the notion that a subset of patients with CKD have acid-mediated organ injury despite having a normal serum total CO2 and might benefit from oral alkali before overt acidosis develops. Identifying these individuals with subclinical metabolic acidosis is challenging, but recent results suggest that urinary acid excretion measurements may be helpful. The dose of alkali to provide in this setting is unknown as well. The review discusses these topics and the prevalence and risk factors of metabolic acidosis, mechanisms of acid-mediated organ injury, results from interventional studies, and potential harms of alkali therapy in CKD.