Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION: There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS: We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS: Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION: The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

Risk of acute myocardial infarction among new users of bisphosphonates: a nested case-control study.

OBJECTIVE: To test the hypothesis that bisphosphonates reduce AMI risk among new users and to assess whether the effect depends on the duration of treatment. METHODS: Case-control study nested in a primary cohort composed of patients aged 40 to 99 years, with at least 1-year registry in the BIFAP database throughout the study period 2002-2015. Out of this cohort, incident AMI cases were identified and five controls per case were randomly selected, matched by exact age, sex, and index date. The association of AMI with current, recent and past use of bisphosphonates was assessed by computing adjusted odds ratios (AOR) and their corresponding 95% confidence interval (CI) through an unconditional logistic regression. Only initiators of bisphosphonates were considered. RESULTS: A total of 23,590 cases of AMI and 117,612 controls were included. The mean age was 66.8 (SD 13.4) years, and 72.52% was male, in both groups. About 276 (1.17%) cases and 1458 (1.24%) controls were current users of bisphosphonates yielding an AOR of 0.98 (95% CI 0.854-1.14). Recent and past use were not associated with a reduced risk, either, nor was it found a reduction with treatment duration (AOR less than 1 year = 0.92; 95% CI 0.73-1.15; AOR more than 1 year = 1.03; 95% CI 0.86-1.23). Stratified analysis by age, sex and background cardiovascular risk did not show an effect modification by these variables. CONCLUSION: The results do not support a cardioprotective effect of bisphosphonates regardless of the duration of treatment, age, sex or background cardiovascular risk. However, a small protective effect could have been masked if patients with osteoporosis have had a background higher risk of AMI.

Short-term association between outdoor air pollution and osteoporotic hip fracture.

This study examines the association of the levels of different airborne pollutants on the incidence of osteoporotic hip fracture in a southern European region. Association was detected between SO2 and NO2 and hospital admissions due to hip fracture. INTRODUCTION: To examine the short-term effects of outdoor air pollution on the incidence of osteoporotic hip fracture in a southern European region. METHODS: This is an ecological retrospective cohort study based on data obtained from three databases. In a time-series analysis, we examined the association between hip fracture incidence and different outdoor air pollutants (sulfur dioxide (SO2), monoxide (NO), nitrogen dioxide (NO2), ozone (O3), and particulate matter in suspension < 2.5 (PM2.5) and < 10-µm (PM10) conditions by using general additive models (Poisson distribution). The incidence rate ratio (IRR), crude and adjusted by season and different weather conditions, was estimated for all parameters. Hip incidence was later analyzed by sex and age (under or over age 75) subgroups. The main outcome measure was daily hospital admissions due to fracture. RESULTS: Hip fracture incidence showed association with SO2 (IRR 1.11 (95% CI 1.04-1.18)), NO (IRR 1.01 (95% CI 1.01-1.02)), and NO2 (IRR 1.02 (95% CI 1.01-1.04)). For O3 levels, this association was negative (IRR 0.97 (95% CI 0.95-0.99)). The association persisted for SO2 and NO2 when the models were adjusted by season. After adjusting by season and weather conditions, the association persisted for NO2. When participants were stratified by age and sex, associations persisted only in women older than 75 years. CONCLUSIONS: A short-term association was observed with several indicators of air pollution on hip fracture incidence. This is the first study that shows these associations.

Afectación pulmonar que simula un tumor como manifestación inicial de polimiositis / Pulmonary affection mimicking a tumor as initial manifestation of polymyositis

La polimiositis se manifiesta por debilidad muscular proximal acompañada en muchos casos de artralgias, Raynaud y síntomas constitucionales. Es una enfermedad multisistémica que con frecuencia afecta a otros órganos. La afección pulmonar es de las más frecuentes. Se presenta el caso de un varón de 62 años que acudió a consulta por un cuadro de infección respiratoria que empeoró progresivamente a pesar del tratamiento. Se le diagnosticó lesión pulmonar con alta sospecha de carcinoma no microcítico, por lo que se realizó lobectomía inferior derecha. El resultado histológico del lóbulo extirpado fue una lesión sin signos de transformación tumoral. Unos meses después la disnea había desaparecido, pero persistía importante astenia; además aparecieron poliartralgias, mialgias y debilidad muscular proximal de las cuatro extremidades. En el estudio ulterior se le diagnosticó polimiositis. Con todo esto, podemos concluir que la afección pulmonar, que inicialmente parecía un tumor, había sido la primera manifestación de esta enfermedad (AU)

Polymyositis is characterized by proximal muscle weakness, in most cases with arthralgias, Raynaud phenomenon and systemic symptoms. This is a multisystemic disorder that frequently affects other organs, pulmonary affection being one of the most frequent. We present the case of a 62-year old man who came to the consulting room with a respiratory infection that progressively worsened in spite of treatment. He was diagnosed of pulmonary affection with high suspicion of non-small cell lung cancer, so that a lower right lobectomy was performed. The histology of the extirpated lobe showed a lesion without any tumoral transformation. A few months later, the dyspnea had disappeared but he manifested important asthenia, polyarthalgias, myalgias and proximal muscle weakness in the four limbs. The subsequent study was consistent with polymyositis. Based on the above, we can conclude that the pulmonary affection that initially mimicked a cancer had been the first manifestation of this disease (AU)

Eficacia del tratamiento con alendronato en una población española de mujeres posmenopáusicas con masa ósea baja. Resultados en España del ensayo multinacional fosit / Efficacy of alendronate in treatment of a Spanish population of postmenopausal women with low bone mass. Spanish results in the international fosit trial

Fundamento. El alendronato es un potente inhibidor de la resorción ósea que normaliza la tasa de recambio óseo a niveles premenopáusicos. El objetivo del estudio fue evaluar la eficacia sobre la densidad mineral ósea y la tolerabilidad de alendronato en mujeres posmenopáusicas con baja masa ósea en España. Métodos. Ensayo clínico controlado y doble ciego del tratamiento con alendronato (10 mg/ día) frente a placebo durante un año con una fase de extensión de un año de duración en la que todas las pacientes recibieron alendronato. Resultados. En las pacientes tratadas con alendronato se comprobó un aumento significativo y progresivo de la densidad mineral ósea en todas las localizaciones y en todos los tiempos estudiados. A los 12 meses de tratamiento, la diferencia entre los grupos de alendronato y placebo en el porcentaje medio de aumento de la densidad mineral ósea fue de 4,75 por ciento en la columna lumbar, de 1,12 por ciento en el cuello femoral, 3,95 por ciento en el trocánter y 3,09 por ciento en cadera total. En las pacientes que recibieron placebo en el primer año y alendronato en el segundo, la diferencia en el segundo año fue de 4,54 por ciento en la columna lumbar; 1,92 por ciento en cuello femoral; 3,41 por ciento en trocánter y 2,43 por ciento en cadera total, todas ellas significativas. Conclusiones. Este estudio muestra que en una población española de mujeres postmenopáusicas con masa ósea baja, el tratamiento durante dos años con alendronato incrementa la densidad mineral ósea de forma rápida en el primer año y que continúa sin alcanzar una meseta en el segundo. La consistencia del efecto de alendronato se evidencia al comparar los incrementos de masa ósea después de un año de tratamiento con alendronato entre aquellos pacientes asignados al brazo tratado y los que inicialmente recibieron placebo y posteriormente alendronato (AU)

Variabilidad en el manejo de la osteoporosis en pacientes con artritis reumatoide en España / Variability in the management of osteoporosis in patients with rheumatoid arthritis in Spain

Objetivo: Estudiar en España la variabilidad regional en el diagnóstico y tratamiento de la osteoporosis en los pacientes con artritis reumatoide (AR).Pacientes y métodos: El estudio emAR se realizó mediante la revisión de las historias clínicas de 1.379 sujetos seleccionados de forma aleatoria en 48 servicios clínicos de 15 comunidades autónomas españolas. Entre otros, se recogieron datos relacionados con el diagnóstico de osteoporosis, la prescripción de fármacos para el tratamiento o prevención de esta enfermedad, así como la presencia de tratamiento glucocorticoideo. Resultados: Se habían realizado estudios densitométricos en el 10,8 por ciento de los pacientes. En 549 pacientes (39,8 por ciento) se había prescrito algún tipo de tratamiento para la osteoporosis, con una gran variabilidad que osciló del 8,3 al 66,6 por ciento según la comunidad autónoma. El fármaco empleado con más frecuencia fue el calcio con o sin vitamina D (de 8,3 a 58,3 por ciento), seguido de bifosfonatos (de 0 a 23,1 por ciento) y calcitonina (de 0 a 16,7 por ciento). Todos los fármacos mostraron una marcada variabilidad regional en su uso, incluso en las poblaciones con mayor riesgo de osteoporosis: sexo femenino, tratamiento con glucocorticoides y edad superior a 65 años. Conclusión: Existe una escasa búsqueda activa del diagnóstico de osteoporosis en los pacientes con AR, y una baja prescripción de fármacos antirresortivos, incluso en aquellas subpoblaciones de mayor riesgo (AU)

Reduction of bone mass in women after bone marrow transplantation.

Osteoporosis is a common disease among patients undergoing transplantation. Its prevalence and complications have been well described in solid organ recipients, especially kidney, liver, and heart. However, studies in bone marrow transplantation (BMT) are scarce. Among the mechanisms invoked in the pathogenesis of BMT osteoporosis are the baseline disease, the use of immunosuppressive drugs and, more remarkably, secondary hypogonadism. We present a study of 27 women who underwent BMT, all of them suffering ovarian failure. We studied different biochemical markers of bone formation/resorption and also evaluated the presence of osteopenia/osteoporosis by dual energy X-ray absorptiometry (DXA) of the lumbar spine. Osteopenia was observed in nine patients (33%) and osteoporosis in another five (18%), according to the World Health Organization criteria. We also detected a subgroup showing elevation of several bone turnover biochemical markers, indicating high osseous remodeling. A remarkable increase in urine hydroxyproline/creatinine was detected in 95% of cases, although an explanation is lacking. We outline a reasonable therapeutic approach for osteoporosis in BMT emphasizing the need to monitor these patients after transplantation.

[Features of Paget's disease of bone in a new high-prevalence focus]. / Características de la enfermedad de Paget del hueso en un nuevo foco de elevada prevalencia.

We report the features of a group of 41 patients with Paget's disease (PD) who were identified in a cross sectional study in the "Sierra de la Cabrera" (Madrid). As the screening test, we used serum alkaline phosphatase quantification, and the diagnosis was confirmed by radiological study. This biochemical parameter shows an excellent diagnostic performance, with a sensitivity of 98% and a specificity of 85%. The prevalence in the population over 40 years of age is 6.37% (95% CI 4.79-7.95) which, comparing it with that from other areas, suggests that this region is a "focus" of PD. 51% of cases had the characteristic symptoms of the disease, bone pain being the most common (44%). We compared the abnormalities in the patients with those of a control group with strictly comparable features, and we found that bone deformity (34%) and a localized increase in skin temperature (27%) were the most discriminative data, while cranial symptoms (26%) were nonspecific. Cataracts and actinic keratosis were associated with PD in the crude analysis (p less than or equal to 0.01). When age was controlled for, the statistical significance of cataracts disappeared, whereas that of actinic keratosis was maintained (odds ratio 4.08, p less than or equal to 0.01). A high family incidence was found, with 15 proven cases (36.5%) in 6 families. Apart from a marked increase in alkaline phosphatase (mean: 407 mU/ml), other abnormalities or biochemical differences with the control were not found. These results suggest an interaction of genetic and environmental factors, and is wholly consistent with the multifactorial etiological hypothesis of PD.

Systemic lupus erythematosus and tetrasomy-X.

An 18-year-old woman with tetrasomy-X (48,XXXX karyotype) who developed systemic lupus erythematosus is described. This is, to our knowledge, the first recorded case of this association. The occurrence of autoimmune disorders in patients with chromosomal aberrations is discussed.