Diagnostic, treatment, and follow-up of osteoporosis-position statement of the Latin American Federation of Endocrinology.

The Latin American Federation of Endocrinology position statement on osteoporosis was developed by endocrinologists from 9 countries. It encompasses the definition, diagnosis, treatment, and follow-up of the disease, the identification of barriers to healthcare, and proposals to improve the disease care in the region. INTRODUCTION: There is a gap in the understanding of osteoporosis in Latin America. The objective of this work is to state the position of the Latin American Federation of Endocrinology on osteoporosis care in postmenopausal women to better bridge this gap. METHODS: An experts' panel was formed comprising of 11 endocrinologists from 9 countries. A data search was conducted with a conceptual approach and data selection was based on the hierarchy of the EBHC pyramid. Unpublished data was considered for local epidemiological data and expert opinion for the identification of barriers to healthcare. An expert consensus based on the Delphi methodology was carried out. Experts were asked to respond on a 5-point Likert Scale to two provided answers to guiding questions. RESULTS: Consensus was agreed on the answer for the questions with the higher median on the Likert scale and synthetized on 16 statements covering the definition of osteoporosis, diagnostic approach, treatment options, and follow-up. Besides clinical topics, unmet needs in osteoporosis were identified in relation to local epidemiological data, barriers to treatment, and misclassification of programs within health systems. CONCLUSIONS: Through a process based on recognized methodological tools, FELAEN's position on osteoporosis was developed. This made it possible to state an optimum scenario for the care of the disease and helped to identify knowledge gaps. There is great variability in the approach to osteoporosis in Latin America and barriers in all the stages of healthcare persist.

FRAX-based intervention and assessment thresholds in seven Latin American countries

Age-specific intervention and assessment thresholds were developed for seven Latin American countries. The intervention threshold ranged from 1.2% (Ecuador) to 27.5% (Argentina) at the age of 50 and 90 years, respectively. In the Latin American countries, FRAX offers a substantial advance for the detection of subjects at high fracture risk.INTRODUCTION:Intervention thresholds are proposed using the Fracture Risk Assessment (FRAX) tool. We recommended their use to calculate the ten-year probability of fragility fracture (FF) in both, men and women with or without the inclusion of bone mineral density (BMD). The purpose of this study is to compute FRAX-based intervention and BMD assessment thresholds for seven Latin American countries in men and women ≥ 40 years.METHODS:The intervention threshold (IT) was set at a 10-year probability of a major osteoporotic fracture (MOF) equivalent to a woman with a prior FF and a body mass index (BMI) equal to 25.0 kg/m2 without BMD or other clinical risk factors. The lower assessment threshold was set at a 10-year probability of a MOF in women with BMI equal to 25.0 kg/m2, no previous fracture and no clinical risk factors. The upper assessment threshold was set at 1.2 times the IT.RESULTS:For the seven LA countries, the age-specific IT varied from 1.5 to 27.5% in Argentina, 3.8 to 25.2% in Brazil, 1.6 up to 20.0% in Chile, 0.6 to 10.2% in Colombia, 0.9 up to 13.6% in Ecuador, 2.6 to 20.0% in Mexico, and 0.7 up to 22.0% in Venezuela at the age of 40 and 90 years, respectively.CONCLUSIONS:In the LA countries, FRAX-based IT offers a substantial advance for the detection of men and women at high fracture risk, particularly in the elderly. The heterogeneity of IT between the LA countries indicates that country-specific FRAX models are appropriate rather than a global LA model (AU)

Menopausia y terapia hormonal de la menopausia. Las recomendaciones 2018 de la Unidad de Endocrinología Ginecológica de Clínica Alemana de Santiago -Sociedad Italiana de la Menopausia y la Sociedad Chilena de Endocrinología Ginecológica / Menopause and menopausal hormone therapy. The 2018 recommendations of the Gynecological Endocrinology Unit of Clínica Alemana de Santiago -Italian Society of Menopause and the Chilean Society of Gynecological Endocrinology

ABSTRACT In the last decade, the risk benefits ratio of MHT has been evaluated mainly in terms of cardiovascular risk. Present Consensus Statement is largely inspired by the Global Consensus on Menopausal Hormone Therapy in 2013 and 2016 by leading global menopause societies (The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society). The aim of these Recommendations is to provide a simple and updated reference on postmenopausal MHT. The term MHT typically includes estrogen replacement therapy (ERT) and estrogen-progestogen therapy (EPT). EPT can be sequential (Seq) when progestogen is added to ERT for 10-14 days a month, or continuous combined (CC) when progestogen is administered continuously every day along with a fixed amount of estrogen. MHT also includes Tibolone and the Tissue Selective Estrogen Complex (TSEC).

FRAX-based intervention and assessment thresholds in seven Latin American countries.

Age-specific intervention and assessment thresholds were developed for seven Latin American countries. The intervention threshold ranged from 1.2% (Ecuador) to 27.5% (Argentina) at the age of 50 and 90 years, respectively. In the Latin American countries, FRAX offers a substantial advance for the detection of subjects at high fracture risk. INTRODUCTION: Intervention thresholds are proposed using the Fracture Risk Assessment (FRAX) tool. We recommended their use to calculate the ten-year probability of fragility fracture (FF) in both, men and women with or without the inclusion of bone mineral density (BMD). The purpose of this study is to compute FRAX-based intervention and BMD assessment thresholds for seven Latin American countries in men and women ≥ 40 years. METHODS: The intervention threshold (IT) was set at a 10-year probability of a major osteoporotic fracture (MOF) equivalent to a woman with a prior FF and a body mass index (BMI) equal to 25.0 kg/m2 without BMD or other clinical risk factors. The lower assessment threshold was set at a 10-year probability of a MOF in women with BMI equal to 25.0 kg/m2, no previous fracture and no clinical risk factors. The upper assessment threshold was set at 1.2 times the IT. RESULTS: For the seven LA countries, the age-specific IT varied from 1.5 to 27.5% in Argentina, 3.8 to 25.2% in Brazil, 1.6 up to 20.0% in Chile, 0.6 to 10.2% in Colombia, 0.9 up to 13.6% in Ecuador, 2.6 to 20.0% in Mexico, and 0.7 up to 22.0% in Venezuela at the age of 40 and 90 years, respectively. CONCLUSIONS: In the LA countries, FRAX-based IT offers a substantial advance for the detection of men and women at high fracture risk, particularly in the elderly. The heterogeneity of IT between the LA countries indicates that country-specific FRAX models are appropriate rather than a global LA model.

Diagnóstico citogenético prenatal: experiencia de 10 años en el Hospital Regional Rancagua / Prenatal diagnosis and cytogenetics: 10 year experience in a regional hospital

Objective: To present a 10-year experience with prenatal karyiotyping in cases of fetal malformations in a Regional NHS hospital. Methods: Pregnancies complicated with congenital abnormalities detected prenatally by ultrasonography and undergoing an invasive procedure for fetal Karyotyping were reviewed. Information on maternal demographics, number and type of procedure, indications, complications, and cytogenetic results was obtained by reviewing the ultrasound reports and medical records. Results: In the 10- year period from January 1997 to December 2006, 1.139 pregnancies complicated by a fetal structural anomaly were evaluated in our unit. In 270 cases, an invasive procedure for fetal karyotyping was carried out, including 212 (78 percent) fetal blood sampling procedures, 43 (16 percent) amniocenteses, 8 ( 3 percent) chronic villus sampling procedures. In 178 (66 percent) the karyotype result was reported as normal, in 68 (25 percent) as abnormal, in 22 (8 percent) there was a culture failure, and in 2 (1 percent) a failed procedure. Among the 68 chromosomal abnormalities, 32 percent were trisomy 21 (n=22), 32 percent trisomy 18 (n=22), and 25 percent a monosomy X(n=17). In the remaining cases there was a trisomy 13, trisomy 14, triploidy, or a chromosomal structural defect. In the first 4 years, the detection rate of a chromosomal defect was approximately 15 percent, which increased to 35 percent in the last 6 years, without a significant increase in the number of procedures. Conclusions: Our unit deals with more than 100 cases of fetal malformations per year. The implementation of a cytogenetic laboratory allows the provision of critical information for the subsequent management of the pregnancy and future genetic counseling. Overall, 25 percent of the procedures yielded an abnormal result. With increasing experience, the efficiency is improving considerable without a concomitant increase in the number of procedures.

Objetivo: Presentar la experiencia acumulada de 10 años con el diagnóstico citogenético prenatal en fetos con malformaciones congénitas detectados por ultrasonografía en un hospital base del sector público. Métodos : Se revisó nuestra base de datos seleccionando aquellas pacientes evaluadas exclusivamente por malformaciones fetales únicas o múltiples que fueron sometidas a estudio citogenético prenatal. Se recolectó la información demográfica y clínica, evaluando el número total de procedimientos por año, la relación normales/anormales, el rendimiento por tipo de muestra, el porcentaje de procedimientos frustros en la toma de muestra y la fallas del cultivo. Resultados: En el período entre enero de 1997 y diciembre del 2006, se evaluaron 1.139 embarazos complicados con malformaciones congénitas, en los cuales se realizaron 270 procedimientos invasivos prenatales. De ellos 212 (78 por ciento) fueron cordocentesis, 43 (16 por ciento) amniocentesis, 8 (3 por ciento) biopsias placentarias y 7 (3 por ciento) biopsia de vellosidades coriales. En 178 (66 por ciento) casos el cariograma fue informado como normal en 68 (25 por ciento) como anormal, en 22 (8 por ciento) no hubo crecimiento de cultivo celular y en 2 (1 por ciento) hubo una punción frustra. De los 68 resultados anormales, un 32 por ciento corresponden a trisomías 21 (n=22), un 32 por ciento a trisomías 18 (n= 22) y un 25 por ciento a monosomía del cromosoma X (n=17). El 10 por ciento restante corresponde a anomalías del cromosoma 13 ó 14, triploidías o defectos estructurales rearreglos cromosómicos. De un promedio de resultados anormales de un 15 por ciento en los primeros 4 años del estudio, se mejoró la detección a un 35 por ciento en los últimos 6 años, sin un aumento significativo en el número de procedimientos. Conclusiones: Nuestra Unidad de Ultrasonografía maneja un volumen superior a los 100 casos de anomalías fetales anuales...

Completa recuperación de grave síndrome de hueso hambriento usando infusión crónica ambulatoria de calcio intravenoso. Caso clínico / Complete recovery of hungry bone syndrome using intravenous calcium infusion. Report of one case

We report a 29 years old woman with a highly symptomatic primary hyperparathyroidism. After parathyroid adenoma excision, she presented a prolonged and life threatening hypocalcemia, due to a severe hungry bone syndrome. Conventional treatment with oral and intravenous calcium and calcitriol supplementation failed to raise serum and urinary calcium or to relief symptoms. After one month, we indicated a continuous intravenous calcium infusion allowing, during 6 months, an adequate outpatient management. Initial T scores for bone density were markedly low (L2-L4: -3.14; femoral neck: -3.07) and they increased 17 per cent after 18 days of calcium infusion. After 147 days of treatment bone density was normal, increasing by 61 per cent. The present case shows that the hungry bone syndrome can be a real risk for patients and a complex therapeutic challenge. With an appropriate calcium supply an early, fast and complete recovery of bone mass can be achieved.

[Familial and isolated primary hyperparathyroidism. Case report]. / Hiperparatiroidismo primario, aislado y de carácter familiar. Caso clínico.

Familial hyperparathyroidism can be a part of a type 1 or 2 multiple endocrine neoplasia syndrome, can be associated to mandibular fibromas or can appear as an isolated disease. We report a family with 11 members affected by a primary hyperparathyroidism, all with a history of kidney stones and without evidences of other endocrine tumors. Not knowing the familial history of the disease, only one adenoma was resected in four cases and in all, the disease recidivated. Two were operated again, performing a total parathyroidectomy and heterologous autotransplantation of parathyroid tissue in the forearm. The presentation form of primary hyperparathyroidism in this family, is similar to other reported cases. It is more aggressive, is diagnosed at a lower age has a higher incidence of recurrence and multiglandular involvement than the sporadic disease.

[Effect of low calcitonin doses on bone remodeling in postmenopausal women with high bone turnover rate]. / Efecto de dosis bajas de calcitonina sobre la remodelación ósea en mujeres postmenopáusicas con alto recambio.

BACKGROUND: Calcitonin is specially indicated for the treatment of osteoporosis in women that cannot receive estrogen replacement therapy or that have a high bone turnover rate. AIM: To study the effects of low intranasal calcitonin doses on bone remodeling in postmenopausal women with a high bone turnover. PATIENTS AND METHODS: Forty one healthy women aged 56 +/- 6 years old, with a mean lapse after menopause of 7.6 +/- 6.5 years and with a high bone turnover rate, evidenced by an urinary hydroxyproline (mg/dl)/creatinine (g/dl) ratio of 52.4 +/- 7.2, were studied. They were randomly assigned to receive 100 or 50 U/calcitonin thrice a week during 3 months or to a control group that received placebo. All received 500 mg/day calcium carbonate. Urinary hydroxyproline/creatinine ratio was measured a 0, 15, 30, 60 and 90 days. Plasma bone fraction of alkanine phosphatases was measured at 0, 30 and 90 days. RESULTS: Initial urinary hydroxyproline/creatinine ratio and plasma bone fraction of alkanine phosphatases were similar in all study groups and there was no change in these parameters during the study period. CONCLUSIONS: Intranasal calcitonin in doses of 100 U thrice a week or less, does not modify accelerated bone turnover in postmenopausal women.

[Cushing syndrome by ectopic ACTH secretion: analysis of the physiopathologic mechanism of hypokalemia. Report of two cases]. / Síndrome de Cushing por secreción ectópica de ACTH: análisis del mecanismo fisiopatológico de la hipokalemia. Comunicación de dos casos.

We report a 42 years old male and a 66 years old female with a Cushing syndrome caused by ectopic ACTH secretion secondary to a carcinoid tumor. These patients had both severe hypokalemia, resistant to medical treatment and that subsided with bilateral adrenalectomy and supplementation with dexametasone. Cushing syndrome caused by ectopic ACTH secretion is characterized by a severe and rapidly evolving hypercortisolism. Hypokalemia is present in 90% of cases and is probably caused by a defect in 11 beta hydroxysteroid dehydrogenase, that limits the binding of cortisol to aldosterone receptor, metabolizing it to cortisone. Therefore, this alteration will increase the mineralocorticoid action of cortisol.

Persistent hypokalemia after successful adrenalectomy in a patient with Cushing's syndrome due to ectopic ACTH secretion: possible role of 11beta-hydroxysteroid dehydrogenase inhibition.

Ectopic ACTH secretion is characterized by a high incidence of hypokalemia. The pathophysiology of hypokalemia has not been totally clarified, although it has been postulated that excessive amounts of adrenal steroids may play a role, as well as a possible role of the inhibition of the enzyme 11beta-hydroxysteroid dehydrogenase (11beta-OHSD). This enzyme normally converts cortisol to cortisone avoiding the mineralocorticoid action of cortisol. We present a patient with ectopic ACTH secretion due to a metastatic carcinoid tumor. The clinical picture was characterized by maintained hypokalemia (1.4 mmol/l) resistant to potassium, spironolactone and ketoconazole administration. A bilateral adrenalectomy was performed but the hypokalemia persisted while he was receiving a physiological dose of cortisol. Eight days after adrenalectomy cortisol was replaced by an equivalent dose of dexamethasone. This change was followed by a rapid and persistent normalization of hypokalemia suggesting a mineralocorticoid effect of cortisol. In conclusion, the origin of hypokalemia in our patient with ectopic ACTH secretion was secondary to cortisol. We postulate that this peculiar effect of cortisol could have happened if an inhibition of 11beta-OHSD occurred.

[Growth hormone deficiency in patients with chronic heart failure]. / Déficit de hormona de crecimiento en pacientes con insuficiencia cardíaca crónica.

BACKGROUND: Experimental and preliminary clinical data in patients with dilated cardiomyopathy show that growth hormone has a positive inotropic effect and contributes to peripheral vasodilatation. However, there is little information about the activity of growth hormone-IGF-1 axis in patients with chronic heart failure. AIM: To measure growth hormone and IGF-1 levels in patients with chronic heart failure. PATIENTS AND METHODS: Nine patients, aged 49 to 76 years old, 7 male, were studied. Seven had an idiopathic dilated cardiomyopathy and 2 a coronary heart disease. All had a stable cardiac failure, in functional capacity II or III and were receiving digoxin, furosemide and potassium supplements. Thyroid hormone levels, basal and exercise growth hormone and IGF-1 levels were measured and compared with reference values for American populations. Left ventricular ejection fraction was measured with an isotopic technique and nutritional status using anthropometry and indirect calorimetry. RESULTS: Anthropometric measures, basal and post-prandial oxygen consumption were within normal limits. Thyroid hormone levels were normal. During maximal exercise, growth hormone levels were 2.56 +/- 4.1 ng/ml and IGF-1 levels were 0.56 +/- 0.61 mU/ml. These values were significantly lower than expected for age and sex. CONCLUSIONS: These patients with chronic cardiac failure have lower than normal growth hormone and IGF-1 levels.

[Effects of hormone replacement therapy in bone resorption, in post-menopausal women]. / Modificación de la reabsorción ósea con terapia hormonal de reemplazo en la postmenopausia.

BACKGROUND: The effects of different therapies on bone loss rate can be measured using biochemical markers of bone resorption such as urinary hydroxyproline. AIM: To study the effects of hormone replacement therapy on urinary hydroxyproline in postmenopausal women. PATIENTS AND METHODS: Eighty three postmenopausal women without hormone replacement therapy, 54 postmenopausal women receiving hormone replacement therapy and 16 premenopausal women (considered as the control group) were studied. Hydroxyproline was measured in an early morning urine sample, after one day of diet without meat or gelatin. RESULTS: Urinary hydroxyproline in premenopausal women was 33.7 +/- 7.9 mg/g creatinine. The figure for postmenopausal women with hormonal replacement therapy was 33.7 +/- 5.9 mg/g creatinine. Postmenopausal women without replacement therapy had an urinary hydroxyproline of 47.4 +/- 8.5 mg/g creatinine, significantly higher than that of premenopausal and supplemented women. In 21 postmenopausal women, hydroxyproline was measured before and after three months of replacement therapy, values decreased 35.5 +/- 11% in this period and there was a direct correlation between initial values and the degree of reduction (r = 0.69, p < 0.001). CONCLUSIONS: Postmenopausal women receiving hormone replacement therapy have a urinary hydroxyproline excretion similar to that of premenopausal women.

ACP and PGM1 polymorphisms in a Chilean population.

A random sample of 140 individuals from the population of Valparaíso, Chile, was studied for 2 polymorphic genetic markers. The gene frequency estimates were: ACP*A = 0.246 +/- 0.026 and PGM1*2 = 0.235 +/- 0.025. The comparison of ACP with data obtained from other populations indicates a similarity with Mongoloid groups whereas for PGM1, the comparison with the data obtained shows no significant difference from Caucasoid populations. These results indicate that the Valparaíso population is the result of genetic admixture of various populations.

[Comparative yield of fine needle biopsy and cytology of solid thyroid nodules]. / Rendimiento comparativo entre biopsia y citología obtenidas por aspiración con aguja fina en nódulos sólidos del tiroides.

BACKGROUND: The correct management of thyroid nodules requires an accurate histological diagnosis to discard carcinoma. AIM: To assess the diagnostic value of fine needle aspiration biopsy of thyroid nodules as compared to cytology of the same sample and surgical biopsy. PATIENTS AND METHODS: One hundred and forty three thyroid nodules were punctured with a 21 G needle under continuous aspiration obtaining a sample for cytological and histological diagnosis. Fifty patients were subjected to a thyroidectomy. RESULTS: The age of studied patients ranged from 12 to 78 years old and 94% were female. Mean nodule diameter was 2.7 +/- 1.4 cm. Two percent of procedures were complicated with local hematomas, that subsided spontaneously. A diagnosis of cancer was reached in 16% of all patients and 46% of operated patients. Cytology had a 50% sensitivity, 87.5% specificity, a 89.4% positive predictive value and a 87.5% negative predictive value. The figures for fine needle aspiration biopsy were 82.6, 100, 100 and 87% respectively. CONCLUSIONS: Fine needle aspiration biopsy has a better diagnostic accuracy than cytology and is a simple and safe procedure.

[Multiple endocrine neoplasia type 2A. Report of a case with an unusually aggressive outcome]. / Neoplasia endocrina múltiple tipo 2A. Presentación de un caso de evolución inhabitualmente agresiva.

We report a 28 years old woman who consulted for diarrhea of two years and a thyroid nodule. A medullary thyroid carcinoma was diagnosed and a thyroidectomy performed. There was a local relapse two months later and distant metastases were found five months later. A MIBG-1131 scintigraphic image of the adrenals lead to the suspicion of a bilateral pheochromocytoma. The surgical resection of the adrenals confirmed the diagnosis. There was no response to chemotherapy and the patient continued with severe hypercalcemia, repeated infections, persistent diarrhea and cachexia, dying one year after the diagnosis. There was no family history of the disease. We conclude that this is a particularly aggressive presentation of a multiple endocrine neoplasia type 2A.

[Analysis of consanguinity in some populations of the V Region, Valparaiso, Chile, from 1880 to 1969]. / Análisis de la consaguinidad en poblaciones de la V Región, Valparaíso, Chile, de 1880 a 1969.

The population structure of 10 populations ("comunas") in Valparaíso, V Region Chile, was studied through the frequency of consanguineous marriages (%CM) and the coefficient of consanguinity (alpha), in order to know their dynamics, and gather information for clinical and genetic epidemiological studies as well as for isonymy studies. The comunas were grouped according to density: Group I, high density, more than 100 inhabitants/km2; Group II, intermediate, between 25 and 99 inhabitants/km2; and Group III, low, less than 25 inhabitants/km2. Data were obtained from parochial archives and national census, from 1880 to 1969. CM's were divided in: uncle-aunt/nephew-niece (12), first cousins (22), first cousins one removed (23), second cousins (33) and multiple consanguinity (M), and the four subtypes of 12 and 22. Percentage of CM and alpha diminish in time. Groups I and II show similar values, but lower in I, and show a constant decrease. Group III has higher values and considerable fluactuations. Types 12 and 22 contribute mostly to %CM and alpha in the 3 groups. Subtypes of 12 and 22 do not occur at random. This temporary and spatial behavior can be explained because of sociocultural and socioeconomical factors in each group, being density an indicator of endogamy. This behavior is consistent with current coefficients of endogamy obtained by isonymy.

Cáncer de mama en el hombre / Male breast cancer

El cáncer de mama en el hombre es una enfermedad rara. Entre 1979 y 1993, 4 hombres han sido tratados en el Hospital Clínico Guillermo Grant Benavente, representando el 0,52 por ciento del total de cánceres de mama. La edad promedio al momento del diagnóstico fue de 68 años. El tiempo de evolución promedio antes de la primera consulta fue de 9 meses. Un paciente estaba en estadio II y 3 pacientes en estadio III. La mastectomía radical modificada seguida por radioterapia fue el tratamiento de elección. El tipo de tumor más frecuente fue el carcinoma ductal infiltrante

[Multiple organ failure syndrome in fulminant hepatic failure]. / Síndrome de falla orgánica múltiple en el curso de la insuficiencia hepática fulminante.

BACKGROUND: in fulminant hepatic failure, different organs systems become involved and a multiple systems organic failure may ensure. AIM: to perform a retrospective analysis of patients with fulminant hepatic failure admitted to UC Hospital Intensive Care Unit. PATIENTS AND METHODS: the charts of fourteen patients (8 male) were analyzed. Multiple systems organic failure was defined as the presence of 2 or more organic dysfunctions. The evolution and mortality of these patients was analyzed. RESULTS: patient's ages ranged from 30 to 74 years. The etiology of hepatic failure was B hepatitis in 4, non A non B hepatitis in 5, acute fatty liver of pregnancy in 3 and use of halothane and HIN in 2. ICU stay ranged from 1 to 44 days and 2 patients survived (one with drug induced liver failure and one with acute fatty live of pregnancy). Mean prothrombin time was 19 +/- 9.5%, total bilirrubin was 24 +/- 8.9 mg/dl and 12 patients reached grade IV encephalopathy. Mean admission APACHE II score was 21.5 +/- 6. Twelve patients developed multiple systems organic failure, that appeared 1.5 days after or was already present at ICU admission; it lasted a mean of 2.5 days and all these 12 patients died. Neurologic involvement occurred in 13 patients, renal in 10, cardiovascular in 9, respiratory in 5 and hematological involvement in 1. CONCLUSIONS: multiple systems organic failure is frequent in fulminant hepatic failure and is associated with a high mortality.

[Frequency of lumbar spine osteopenia in an asymptomatic postmenopausal Chilean population]. / Frecuencia de osteopenia en columna lumbar en una población Chilena postmenopáusica asintomática.

The aim of this study was to assess lumbar spine bone density in a group of chilean postmenopausal females and to estimate the frequency of vertebral osteopenia in the national urban female population. A clinical assessment and lumbar spine bone density measurement were performed to 171 healthy women over 40 years of age and not receiving medications that modify bone turnover. Calcium ingestion was recalled in 77 of these. Fifty women (29.2%) had osteopenia, defined as a bone density of less than 0.92 g/cm2. Extrapolating this figure to the national urban population, an osteopenia frequency of 21.7% was estimated. Body mass index was 25.5 +/- 3.8 and 57% of the sample was overweight. Calcium ingestion was 740.3 +/- 331.7. These two parameters did not correlative with bone density. Women with osteopenia were older and had a longer postmenopausal lapse than those with normal bone density. The completion of further clinical an epidemiological studies is recommended to know the real magnitude of osteoporosis in Chile.

[Basedow-Graves disease development in 2 patients with primary hypothyroidism: exceptional development of the autoimmune thyroid disease]. / Desarrollo de enfermedad de Basedow-Graves en 2 pacientes con hipotiroidismo primario. Evolución excepcional de la enfermedad tiroídea autoinmune.

Autoimmune thyroid disease has multiple manifestations and its presentation may change with time. We report two patients with primary hypothyroidism due to Hashimoto's disease that unexpectedly, developed a hyperthyroidism due to Basedow-Graves disease. This phenomenon may be explained by variations in the types and proportions of anti TSH receptor antibodies, that can stimulate or block thyroid gland function and growth. It is deducted that the hypothyroidism of these patients was not due to a definitive gland destruction, but to the action of function blocking antibodies.