RESUMEN
Osteoporosis (OP) is a chronic disease that affects older adults' quality of life, with fragility fractures (FF) being its most significant consequence due to their impact on healthcare systems in terms of morbidity, and economic and caregiving burden. FF are defined as fractures resulting from low-energy trauma, defined as falls from a standing height or less, and are usually considered osteoporotic (1). World demographic projections warn of a significant increase in adults aged 65 and older by 2050. These demographic changes mean that OP and FF will soon become an even greater challenge for healthcare systems, where prevention programs should be a priority. In Mexico, FF is also a public health challenge, with an initial reported incidence of nearly 2,000 cases per 100,000 population, and a projected seven-fold increase by 2050. Given this scenario, there is an urgent need for policy- and decision-makers to change their approach and formulate health policies that guarantee that people aged 65 and older are screened for fractures and have access to appropriate care. These policies should be part of a strategy to minimize FF and ensure active and healthy aging according to the WHO's Decade of Healthy Ageing. In this context, a group of Mexican experts representing different health organizations interested in the burden of OP and FF met to discuss possible strategies to reduce their burden for the next decade and summarize them in this Call to Action to promote public policies that prioritize an evidence-based approach to the prevention and treatment of OP and FF.
RESUMEN
The role of leukotrienes (LTs) in the pathogenesis of systemic sclerosis (SSc) needs clarification. We analyzed the association of salivary (sa) and plasma (p) levels (pg/mL) of cysteinyl-leukotrienes (CysLT) and LTB4 with SSc vascular manifestations and nailfold capillaroscopy (NFC) in a cross-sectional study. Patients and healthy controls were evaluated for vascular manifestations and NFC. LTs were compared between groups as follows: SSc with or SSc without vascular features and controls, and by NFC parameters. Twenty SSc patients and 16 volunteers were recruited; Raynaud's phenomenon (RP) history (SSc: saCysLT 99.4 ± 21.8 vs. controls: 23.05 ± 23.7, p = 0.01), RP at examination (SSc: saCysLT 129.3 ± 24.6 vs. controls: 23.05 ± 22.46, p = 0.01; pCysLT SSc: 87.5 ± 11.2 vs. controls: 32.37 ± 10.75, p = 0.002), capillary loss (saCysLT 138.6 ± 26.7 vs. 23.05 ± 21.6, p = 0.0007; saLTB4 3380.9 ± 426.6 vs. 1216.33 ± 346.1, p = 0.0005), "late" scleroderma pattern vs. controls (saCysLT 205.6 ± 32 vs. 23 ± 19.6, p = 0.0002; saLTB4 4564.9 ± 503.6 vs. 1216.3 ± 308.3; p < 0.0001) were all significant. Late patterns had higher levels (saCysLT, p = 0.002; LTB4 p = 0.0006) compared to active and early patterns (LTB4, p = 0.0006), and giant capillaries (p = 0.01) showed higher levels of LTs. Levels of pCysLT were higher in patients with RP at examination vs. patients without RP; saCysLT and LTB4 were higher in SSc group with vs. without capillary loss. LTs could be involved in the pathophysiology of vascular abnormalities. Further research is required to determine if blocking LTs could be a therapeutic target for SSc vascular manifestations.