Argentine Guidelines for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Postmenopausal Women and Men Aged 50 Years and Older.

OBJECTIVE: The aim of this study was to provide an evidence-based framework to guide health care professionals treating patients under glucocorticoid (GC) therapy and develop guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis (GIO) in postmenopausal women and men aged ≥50 years. METHODS: An expert panel on bone diseases designed a series of clinically meaningful questions following the PICO (Population, Intervention, Comparator, and Outcome) structure. Using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology, we made a systematic literature review, extracted and summarized the effect estimates, and graded the quality of the evidence. The expert panel voted each PICO question and made recommendations after reaching an agreement of at least 70%. RESULTS: Seventeen recommendations (9 strong and 8 conditional) and 8 general principles were developed for postmenopausal women and men aged ≥50 years under GC treatment. Bone mineral density (BMD), occurrence of fragility fractures, probability of fracture at 10 years by Fracture Risk Assessment Tool, and other screening factors for low BMD are recommended for patient evaluation and stratification according to fragility fracture risk. The treatment of patients under GC therapy should include counseling on lifestyle habits and strict control of comorbidities. The goal of GIO treatment is the nonoccurrence of new fragility fractures as well as to increase or maintain BMD in certain clinical situations. This was considered for the therapeutic approach in different clinical scenarios. CONCLUSIONS: This GIO guideline provides evidence-based guidance for health care providers treating patients.

Vitamina D en pediatria, embarazo y lactancia / Vitamin D in pediatrics, pregnancy and lactation

La principal fuente de vitamina D se produce en la piel ante la exposición al sol. Su déficit es frecuente y también ocurre en embarazadas. El nivel de vitamina D en la leche materna depende del nivel que posee la madre. Si tiene déficit, la leche tendrá poca vitamina y los bebés tendrán déficit. Posibles consecuencias son raquitismo y convulsiones, pero se han descrito infecciones de vías respiratorias bajas o mayor riesgo de diabetes tipo 1. Se han publicado sugerencias diversas sobre aportes. Para embarazo y lactancia, el Institute of Medicine (IOM) sugiere 600 unidades internacionales (UI)/día a la madre, y la Endocrine Society, 1500-2000 UI/día. La Federación Argentina de Sociedades de Endocrinología sugiere 800-1200 UI/día. La nueva sugerencia del IOM y la Academia Americana de Pediatría para los niños entre el nacimiento y un año es 400 UI/día y 600 UI/día entre 1 y 18 años.

The main source of vitamin D is produced by the exposure of sunlight on the skin. It has been proven that the deficit is frequent and also occurs in pregnant women. Possible consequences may be preeclampsia and others. The level of vitamin D in breast milk depends on the level of the mother, so that deficient mothers produce milk with low concentration. Possible consequences for the baby are rickets and seizures, but also lower respiratory tract infections or risk of type 1 diabetes. Various suggestions have been published. For pregnancy and lactation the Institute of Medicine (IOM) suggests 600 international units (IU)/day for the mother, whereas the Endocrine Society considers 15002000 IU/day. The Federación Argentina de Sociedades de Endocrinología suggests 800-1200 IU/day. The new suggestion of the IOM and the American Academy of Pediatrics for children between birth and one year is 400 IU/day, while it is 600 IU/day between 1 and 18 years.

[Vitamin D in pediatrics, pregnancy and lactation]. / Vitamina D en pediatría, embarazo y lactancia.

The main source of vitamin D is produced by the exposure of sunlight on the skin. It has been proven that the deficit is frequent and also occurs in pregnant women. Possible consequences may be preeclampsia and others. The level of vitamin D in breast milk depends on the level of the mother, so that deficient mothers produce milk with low concentration. Possible consequences for the baby are rickets and seizures, but also lower respiratory tract infections or risk of type 1 diabetes. Various suggestions have been published. For pregnancy and lactation the Institute of Medicine (IOM) suggests 600 international units (IU)/day for the mother, whereas the Endocrine Society considers 1500- 2000 IU/day. The Federación Argentina de Sociedades de Endocrinología suggests 800-1200 IU/day. The new suggestion of the IOM and the American Academy of Pediatrics for children between birth and one year is 400 IU/day, while it is 600 IU/day between 1 and 18 years.

La principal fuente de vitamina D se produce en la piel ante la exposición al sol. Su déficit es frecuente y también ocurre en embarazadas. El nivel de vitamina D en la leche materna depende del nivel que posee la madre. Si tiene déficit, la leche tendrá poca vitamina y los bebés tendrán déficit. Posibles consecuencias son raquitismo y convulsiones, pero se han descrito infecciones de vías respiratorias bajas o mayor riesgo de diabetes tipo 1. Se han publicado sugerencias diversas sobre aportes. Para embarazo y lactancia, el Institute of Medicine (IOM) sugiere 600 unidades internacionales (UI)/día a la madre, y la Endocrine Society, 1500-2000 UI/ día. La Federación Argentina de Sociedades de Endocrinología sugiere 800-1200 UI/día. La nueva sugerencia del IOM y la Academia Americana de Pediatría para los niños entre el nacimiento y un año es 400 UI/día y 600 UI/día entre 1 y 18 años.

Calcium supplementation, bone mineral density and bone mineral content. Predictors of bone mass changes in adolescent mothers during the 6-month postpartum period

We determined the effect of calcium supplementation on bone mineral density (BMD) and bone mineral content (BMC) and identified predictors of bone mass changes in adolescent mothers 6 months postpartum. A prospective, analytical, clinical study was performed in adolescent mothers (≤19 years old; n=37) from La Plata, Argentina. At 15 days postpartum, mothers were randomly assigned into one of two groups and started with calcium supplementation; one group received dairy products (932 mg Ca; n=19) and the other calcium citrate tablets (1000 mg calcium/day; n=18). Weight, height and dietary intake were measured and BMD was determined by DEXA at 15 days (baseline) and 6 months postpartum. BMC, total body BMD and BMD were assessed in lumbar spine, femoral neck, trochanter and total hip. Regression models were used to identify the relationship of total body BMD and BMC with independent variables (calcium supplementation, months of lactation, weight at 6 months, percent weight change, lean mass at 6 months, percent lean mass change, total calcium intake). Results showed that changes in BMD and BMC at the different sites were similar in both groups, and changes in percent body weight and total calcium intake were the main predictive factors. In conclusion, the effect of calcium was similar with either form of supplementation, i.e., dairy products or tablets, and changes in percent body weight and total calcium intake were predictors of total body BMD and BMC changes.

Suplementación con calcio, densidad mineral ósea y contenido mineral óseo. Predictores de cambios en la masa ósea en madres adolescentes a los 6 meses postparto. El objetivo del estudio fue determinar el efecto de dos formas de suplementare calcio sobre la densidad mineral ósea (DMO) y el contenido mineral óseo (CMO), e identificar predictores de cambios en la masa ósea en madres adolescentes a los 6 meses postparto. Se realizó un estudio prospectivo, analítico y clínico en madres adolescentes (≤19 años; n=37) de la ciudad de La Plata, Argentina. A partir de los 15 días postparto, las adolescentes fueron distribuidas al azar en 2 grupos y comenzaron con la suplementación con calcio; un grupo recibió productos lácteos (932 mg Ca; n=19) y el otro citrato de calcio (1000 mg calcio/día; n=18). Se midió peso, altura y consumo de alimentos y se determinó la DMO por DEXA a los 15 días (línea de base) y a los 6 meses postparto. También se determinó CMO, DMO corporal total y DMO de columna lumbar, cuello femoral, trocánter y cadera total. Se usaron modelos de regresión para identificar relaciones entre DMO corporal total y CMO con variables independientes (tipo de suplementación, meses de lactancia, peso a los 6 meses, porcentaje de cambio de peso, masa magra a los 6 meses, porcentaje de cambio de masa magra, consumo total de calcio). Los resultados muestran que los cambios en DMO y CMO en los distintos sitios fueron similares en ambos grupos, y que los cambios en los porcentajes de peso corporal e ingesta total de calcio fueron los principales factores predictivos. En conclusión, el efecto del calcio fue similar tanto con productos lácteos como con comprimidos. Los cambios porcentuales en peso corporal e ingesta total de calcio resultaron factores predictivos de los cambios de la DMO corporal total y el CMO.

Calcium supplementation, bone mineral density and bone mineral content. Predictors of bone mass changes in adolescent mothers during the 6-month postpartum period.

We determined the effect of calcium supplementation on bone mineral density (BMD) and bone mineral content (BMC) and identified predictors of bone mass changes in adolescent mothers 6 months postpartum. A prospective, analytical, clinical study was performed in adolescent mothers (< or = 19 years old; n = 37) from La Plata, Argentina. At 15 days postpartum, mothers were randomly assigned into one of two groups and started with calcium supplementation; one group received dairy products (932 mg Ca; n = 19) and the other calcium citrate tablets (1000 mg calcium/day; n = 18). Weight, height and dietary intake were measured and BMD was determined by DEXA at 15 days (baseline) and 6 months postpartum. BMC, total body BMD and BMD were assessed in lumbar spine, femoral neck, trochanter and total hip. Regression models were used to identify the relationship of total body BMD and BMC with independent variables (calcium supplementation, months of lactation, weight at 6 months, percent weight change, lean mass at 6 months, percent lean mass change, total calcium intake). Results showed that changes in BMD and BMC at the different sites were similar in both groups, and changes in percent body weight and total calcium intake were the main predictive factors. In conclusion, the effect of calcium was similar with either form of supplementation, i.e., dairy products or tablets, and changes in percent body weight and total calcium intake were predictors of total body BMD and BMC changes.

Changes in bone mineral density of adolescent mothers during the 12-month postpartum period.

OBJECTIVE: Bone mineral density (BMD) loss has been described in adult women in the 12-month postpartum period. However, little is known about the precise BMD pattern in adolescent mothers. The present study aimed to evaluate BMD in Argentinean adolescent mothers followed up during the 12-month postpartum period. DESIGN: Analytical, prospective clinical trial. BMD and body composition were determined by dual-energy X-ray absorptiometry; bone mineral content (BMC) and BMD were measured in the lumbar spine (L2-L4), femoral neck (FN), femur trochanter (TR), total hip (TH) and total body. Changes in BMD and BMC were analysed using ANOVA for pairwise comparisons. Other comparisons were performed with the paired-sample t test and Wilcoxon test; Pearson's correlation coefficient was used to analyse the relationship among continuous variables. SETTING: La Plata, Argentina. SUBJECTS: Adolescent mothers (n 35; 17 years old or less) were recruited within 15 d after delivery. Studies and follow-up were performed at 15 d and 3, 6 and 12 months postpartum. RESULTS: BMD and BMC losses at 3 and 6 months and recovery at 12 months fitted a quadratic curve (ANOVA) at the three sites studied (FN, TH, TR), in total-body BMD (P = 0.000) and BMC (P = 0.038). At hip sites, BMD loss occurred at 3 months (FN, P = 0.000; TR, P = 0.000; TH, P = 0.000) and 6 months (FN, P = 0.000; TR, P = 0.000; TH, P = 0.000) compared with basal values. Percentage BMD loss immediately after delivery up to 6 months was about 5 %. CONCLUSIONS: Adolescents showed significant BMD and BMC losses at 6 months postpartum, with an almost total recovery at 12 months in all sites studied.

Changes in body composition in lactating adolescent mothers.

We assessed changes in body composition in lactating adolescent mothers living under unfavorable socioeconomic and sanitary conditions. A total of 17 healthy primiparous adolescents under 17 years of age attending the Maternity Hospital of the city of La Plata, Argentina, were followed at 4 time points (15 days and 3, 6 and 12 months postpartum) to assess, a) dietary intake, b) practice of physical activity, c) nutritional condition (weight, height, body mass index [BMI] according to age, and body composition by the sum of skinfold measurements), d) characteristics of lactation, and e) growth parameters of the child. The mean age of adolescents was 15.06 +/- 0.66 years (mean menarchal age, 11.59 +/- 0.80 years). All adolescents breastfed up to 12 months postpartum, and maternal milk covered above 80% the baby intake (mean 7.06 +/- 2.54 breast feeds/day). While the daily intake of nutrients by adolescent mothers was constant up to 6 months postpartum, there was a modest decrease in that of proteins, carbohydrates and lipids 15 days and 12 months postpartum. The decrease in energetic intake during the same period was significant (p < 0.05). The practice of physical activity was classified as moderate during the follow-up period. Whereas mean basal percent of fat body mass (FBM) was 29.85 +/- 2.87, and decreased significantly at 6 (27.2% +/- 3.9%; p = 0.02) and 12 (26.1% +/- 3.9%; p = 0.002) months postpartum, changes in lean body mass (LBM) were not significant. In conclusion, lactating adolescents maintained LBM, whereas weight, FBM and BMI decreased markedly from 3 months postpartum.

Evaluacion clinica, humoral y centellografica de un bisfosfonato como posible tratamiento en dos casos de displasias diafisarias: las enfermedades de Ribbing y Camurati-Engelmann / Clinical, humoral and centellographic assessment of pamidronate as potential treatment of diaphyseal dysplasia: Ribbing and Cammurati-Engelmann diseases

Se presenta la evolución a corto plazo de 2 casos de displasias diafisarias, uno de enfermedad de Ribbing y el otro de Camurati-Engelman, tratados con pamidronato disódico, por vía oral. El diagnóstico se verificó por el cuadro clínico, bioquímico y radiológico, este último mostrando el típico engrosamiento de las corticales diafisarias. Aunque tratándose de patologías condensantes, la medicación se administró porque ambos casos presentaban recambio óseo acelerado, evidenciado por los marcadores bioquímicos del metabolismo fosfo-cálcico y la hipercaptación en la centellografía esquelética. El bisfosfonato produjo mejorías clínicas, reduciendo el dolor óseo, mejorándo la deambulación de las pacientes y normalizando la actividad metabólica. Se consideran a estos efectos como francamente positivos en estas displasias, carentes de tratamiento específico.

Evaluacion clinica, humoral y centellografica de un bisfosfonato como posible tratamiento en dos casos de displasias diafisarias: las enfermedades de Ribbing y Camurati-Engelmann / Clinical, humoral and centellographic assessment of pamidronate as potential treatment of diaphyseal dysplasia: Ribbing and Cammurati-Engelmann diseases

Se presenta la evolución a corto plazo de 2 casos de displasias diafisarias, uno de enfermedad de Ribbing y el otro de Camurati-Engelman, tratados con pamidronato disódico, por vía oral. El diagnóstico se verificó por el cuadro clínico, bioquímico y radiológico, este último mostrando el típico engrosamiento de las corticales diafisarias. Aunque tratándose de patologías condensantes, la medicación se administró porque ambos casos presentaban recambio óseo acelerado, evidenciado por los marcadores bioquímicos del metabolismo fosfo-cálcico y la hipercaptación en la centellografía esquelética. El bisfosfonato produjo mejorías clínicas, reduciendo el dolor óseo, mejorándo la deambulación de las pacientes y normalizando la actividad metabólica. Se consideran a estos efectos como francamente positivos en estas displasias, carentes de tratamiento específico. (AU)