RESUMEN
The role of dietary patterns in the development of osteoporosis is unclear. The heel quantitative ultrasound (QUS) is a potential alternative to Dual X-Ray Absorptiometry. Nutrients, foods, dietary patterns and compliance to dietary guidelines were compared between the lowest and the highest tertiles of QUS parameters [Broadband Ultrasound Attenuation (BUA), Speed of Sound (SOS), Stiffness Index (SI)], using data from the OsteoLaus cohort. Participants in the highest tertiles of QUS parameters (385 for BUA, 397 for SOS, 386 for SI) were younger, of higher body weight, and had less major osteoporotic fractures. Women in the highest tertiles of SI and BUA consumed more fat (35.1 ± 0.4 vs 33.9 ± 0.4 and 34.9 ± 0.4 vs 33.8 ± 0.4 gr/day for SI and BUA, respectively, p < 0.05), and complied less frequently with dairy intake guidelines [odds ratio (95% confidence interval): 0.70 (0.53-0.92) and 0.72 (0.55-0.95) for SI and BUA, respectively, p < 0.05] than women in the lowest tertile. No differences were found regarding dietary patterns, healthy dietary scores, or compliance to dietary guidelines. Postmenopausal women in the highest QUS tertiles were younger, of higher weight and BMI, consumed more monounsaturated fatty acids and less dairy and calcium than women in the lowest tertiles. No differences were found between QUS tertiles regarding dietary patterns.
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Calcáneo , Osteoporosis Posmenopáusica , Osteoporosis , Humanos , Femenino , Talón/diagnóstico por imagen , Densidad Ósea , Posmenopausia , Absorciometría de Fotón , Ultrasonografía , Calcáneo/diagnóstico por imagenRESUMEN
A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. INTRODUCTION: The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD). METHODS: We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted ß-coefficients. RESULTS: A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72-2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69-2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63-2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62-2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination. CONCLUSION: A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.
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Fracturas de Cadera , Osteoporosis , Fracturas Osteoporóticas , Masculino , Humanos , Femenino , Fracturas Osteoporóticas/etiología , Fracturas Osteoporóticas/complicaciones , Osteoporosis/complicaciones , Fracturas de Cadera/etiología , Fracturas de Cadera/complicaciones , Densidad Ósea , Factores de Riesgo , Medición de RiesgoRESUMEN
We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. INTRODUCTION: The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors. METHODS: A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible. RESULTS: Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed. CONCLUSIONS: These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)).
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Fracturas de Cadera , Osteoporosis , Fracturas Osteoporóticas , Densidad Ósea , Fracturas de Cadera/complicaciones , Fracturas de Cadera/etiología , Humanos , Osteoporosis/complicaciones , Osteoporosis/epidemiología , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/etiología , Estudios Prospectivos , Medición de Riesgo/métodos , Factores de RiesgoRESUMEN
Thyroid-stimulating hormone (TSH) excess or deficiency influences bone density and fracture risk. Nevertheless, does TSH in the reference range influence bone health? In euthyroid postmenopausal women, TSH levels in the reference range were positively associated with trabecular bone score and negatively with incident fractures, without affecting BMD. PURPOSE: Subclinical hyperthyroidism is associated with low bone mineral density (BMD) and increased fracture risk. In healthy postmenopausal women, association between thyroid-stimulating hormone (TSH) in the normal range and BMD is contradictory. Trabecular bone score (TBS), an index of bone micro-architecture, is often decreased in secondary osteoporosis (OP). The aim was to determine the association between thyroid hormones (TSH, fT4) and BMD, TBS, and the incident 5-year OP fractures, in euthyroid post-menopausal women. METHODS: We assessed 1475 women of the CoLaus/OsteoLaus cohort. We evaluated BMD at lumbar spine, femoral neck and total hip, lumbar spine TBS, and vertebral fracture with DXA. Incident major OP fractures were evaluated 5 years later by questionnaire and DXA. Women with anti-osteoporotic, antidiabetic, thyroid-modifying, hormone replacement, or systemic corticoid treatment were excluded. RESULTS: Five hundred thirty-three women (age 68.4 ± 7.3 years, BMI 25.9 ± 4.6 kg/m2, TSH 2.03 ± 0.87 mU/l, fT4 15.51 ± 1.85 pmol/l) met the inclusion criteria. There was no significant association between TSH or fT4 and BMD measures at any site. A positive association was found between TSH and TBS (ß = 0.138, p < 0.01), even after adjusting for age, BMI, and duration of menopause (ß = 0.086, p < 0.05). After a 5-year follow-up, women with incident major OP fractures had lower TSH levels (1.77 ± 0.13 vs. 2.05 ± 0.04 mU/l, p < 0.05) than women without fractures, while no difference was found for fT4. CONCLUSION: In euthyroid postmenopausal women, TSH levels were positively associated with TBS and negatively with incident fractures, without affecting BMD. Further studies are needed to evaluate the influence of thyroid hormones on TBS.
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Hueso Esponjoso , Fracturas Osteoporóticas , Absorciometría de Fotón , Anciano , Densidad Ósea , Hueso Esponjoso/diagnóstico por imagen , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Persona de Mediana Edad , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/etiología , Posmenopausia , TirotropinaRESUMEN
Q fever, caused by Coxiella burnetii, is a poorly recognized zoonotic infection given its polymorphic clinical presentation. The diagnosis should not be missed to treat in the acute phase and thus prevent major complications of the chronic phase. We describe a case of acute Q fever with pancreatitis, hypereosinophilia and pulmonary infiltrates.
RESUMEN
Denosumab discontinuation is associated with a rapid increase in bone resorption and a decrease in bone mineral density. Spontaneous vertebral fractures may occur as a side effect of the rebound of bone resorption. Cases of rebound-linked hypercalcemia have also been described, moderate in women with osteoporosis and breast cancer and severe in children receiving oncological doses of denosumab. We report the case of an adult woman with primary hyperparathyroidism and moderate hypercalcemia, treated with denosumab for osteoporosis, who developed severe hypercalcemia and spontaneous vertebral fractures (SVFs) after denosumab discontinuation. An 86-year-old woman with densitometric osteoporosis was treated for 3 years with 60 mg of subcutaneous denosumab every 6 months. She was known to have primary hyperparathyroidism, with a serum albumin-corrected calcium of 2.82 mmol/l (NV 2.15-2.5) at the end of denosumab effect. Nine months after the last denosumab injection, she was hospitalized due to worsening overall health. Clinical evaluation revealed severe hypercalcemia (calcium 3.35 mmol/l). Very high values of bone turnover markers (BTMs) suggested a rebound effect due to denosumab discontinuation. An X-ray showed multiple new SVFs. After injection of denosumab 60 mg, serum calcium rapidly decreased and BTMs were dramatically reduced. A surgical approach by minimally invasive parathyroidectomy allowed for definite resolution of hyperparathyroidism and hypercalcemia. This case suggests that hypercalcemia can be a side consequence of denosumab discontinuation, which can become severe when other causes of hypercalcemia, such as primary hyperparathyroidism, are present.
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Conservadores de la Densidad Ósea , Denosumab/uso terapéutico , Hipercalcemia , Hiperparatiroidismo Primario , Osteoporosis , Anciano de 80 o más Años , Conservadores de la Densidad Ósea/efectos adversos , Conservadores de la Densidad Ósea/uso terapéutico , Niño , Denosumab/efectos adversos , Femenino , Humanos , Hipercalcemia/inducido químicamente , Hiperparatiroidismo Primario/inducido químicamente , Hiperparatiroidismo Primario/complicaciones , Síndrome de Abstinencia a SustanciasRESUMEN
We evaluated the associations between nutrients, dietary patterns or compliance to dietary guidelines and bone health among postmenopausal women from the CoLaus/OsteoLaus cohort. Postmenopausal women with osteoporosis consume a high amount of vegetables but insufficient amount of dairy products and calcium to benefit from their adherence to dietary guidelines. INTRODUCTION: Diet plays a significant role in the prevention of osteoporosis (OP). We evaluated the associations between nutrients, dietary patterns or compliance (expressed in odds of meeting) to dietary Swiss guidelines and bone health (T score < - 2.5 SD, TBS < 1230) among postmenopausal women. METHODS: One thousand two hundred fifteen women (64.3 ± 7.5 years) from the CoLaus/OsteoLaus cohort (Lausanne, Switzerland) had their dietary intake assessed using a validated food frequency questionnaire. Bone mineral density (BMD), trabecular bone score (TBS) and vertebral fractures were evaluated with DXA. OP risk factors, calcium supplements (> 500 mg) and prevalent major OP fractures were assessed by questionnaire. RESULTS: One hundred eighty of 1195 women had OP according to BMD, 87/1185 a low TBS and 141/1215 prevalent major OP fractures. In multivariate analysis (adjusted for total energy intake, age, antiosteoporotic treatment, educational level, BMI, sedentary status and diabetes), OP women consumed more vegetable proteins (21.3 ± 0.4 vs 19.6 ± 0.2 g/day), more fibres (18.2 ± 0.5 vs 16.5 ± 0.2 g/day), less animal proteins (40.0 ± 1.1 vs 42.8 ± 0.4 g/day), less calcium (928 ± 30 vs 1010 ± 12 mg/day) and less dairy products (175 ± 12 vs 215 ± 5 g/day), all p ≤ 0.02. According to guidelines, OP women had a tendency to higher compliance for vegetables (OR (95% CI) 1.50 (0.99-2.26)) and a lower compliance for dairy (OR (95% CI) 0.44 (0.22-0.86)) than those without OP. Women taking calcium supplements consumed significantly higher amounts of dairy products. No association was found between TBS values or prevalent OP fractures and any dietary components. CONCLUSION: Postmenopausal women with OP consume a high amount of vegetables but insufficient amount of dairy products and calcium. TBS does not seem to be influenced by diet.
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Osteoporosis Posmenopáusica , Osteoporosis , Densidad Ósea , Calcio , Productos Lácteos , Femenino , Humanos , Osteoporosis Posmenopáusica/epidemiología , Osteoporosis Posmenopáusica/prevención & control , Posmenopausia , Suiza , Verduras , VirtudesRESUMEN
Life expectancy of people living with HIV (PLWH) is reaching similar length as in the general population. Accordingly, age-related comorbidities, including osteoporosis, are increasing. Fracture risk is higher and increases approximately 10 years earlier in PLWH. Classical risk factors of bone fragility are highly prevalent in PLWH but factors specific for HIV infection itself and the type of antiretroviral therapy (ART) (triple combination antiretroviral therapy) regimen (especially tenofovir and protease inhibitors) also contribute to bone loss. The majority of bone loss occurs during virus activity and at initiation of ART (immune reconstitution) and is associated with an increase of bone resorption (upregulation RANKL). Recent data indicate that calcium and vitamin D supplements as ART initiation lower BMD loss. The reduction of tenofovir plasma concentrations with tenofovir alafenamide attenuates BMD loss but it remains unknown whether it will contribute to reduce fracture risk. Hence, special considerations for the management of bone fragility in PLWH are warranted. Based on the current state of epidemiology and pathophysiology of osteoporosis in PLWH, we provide the consensus of the Swiss Association against Osteoporosis on best practice for diagnosis, prevention, and management of osteoporosis in this population. Periodic assessment of fracture risk is indicated in all HIV patients and general preventive measures should be implemented. All postmenopausal women, men above 50 years of age, and patients with other clinical risk for fragility fractures qualify for BMD measurement. An algorithm clarifies when treatment with bisphosphonates and review of ART regimen in favour of more bone-friendly options are indicated.
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Infecciones por VIH/complicaciones , Osteoporosis/etiología , Fármacos Anti-VIH/efectos adversos , Densidad Ósea/efectos de los fármacos , Conservadores de la Densidad Ósea/uso terapéutico , Infecciones por VIH/epidemiología , Humanos , Osteoporosis/diagnóstico , Osteoporosis/epidemiología , Osteoporosis/terapia , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/fisiopatología , Fracturas Osteoporóticas/prevención & control , Medición de Riesgo/métodos , Factores de Riesgo , Suiza/epidemiologíaRESUMEN
At denosumab discontinuation, an antiresorptive agent is indicated to reduce the high bone turnover, the rapid bone loss, and the risk of spontaneous vertebral fractures. We report two cases of postmenopausal women, previously exposed to bisphosphonates, treated with alendronate at denosumab discontinuation. Alendronate was ineffective to avoid spontaneous clinical vertebral fractures. They presented three and nine spontaneous vertebral fractures 8 and 12 months after denosumab discontinuation, respectively. Ineffectiveness of alendronate was attributed to insufficient control of the rebound as assessed by B-crosslaps measures in the first case, and partially to the high risk of fractures in the later. In both situations, the increased fracture risk may have favoured these new fractures. It is urgent to define effective therapeutic strategies to avoid spontaneous vertebral fractures after denosumab discontinuation.
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Alendronato/uso terapéutico , Conservadores de la Densidad Ósea/uso terapéutico , Denosumab/uso terapéutico , Fracturas Osteoporóticas/prevención & control , Fracturas de la Columna Vertebral/prevención & control , Anciano , Alendronato/administración & dosificación , Conservadores de la Densidad Ósea/administración & dosificación , Denosumab/administración & dosificación , Esquema de Medicación , Sustitución de Medicamentos , Femenino , Humanos , Imagen por Resonancia Magnética , Osteoporosis Posmenopáusica/tratamiento farmacológico , Fracturas Osteoporóticas/diagnóstico por imagen , Radiografía , Fracturas de la Columna Vertebral/diagnóstico por imagen , Insuficiencia del TratamientoRESUMEN
The present study tested if the accuracy of the VFA reading reproducibility is more affected by the statistical tool used or by the reader's level of expertise in 50 VFA from a population-based cohort, the OstéoLaus study. We found that uniform kappa and instruction reading with the ISCD/IOF VFA reading course both increased the accuracy of the reproducibility. INTRODUCTION: Vertebral fractures (VF) due to osteoporosis are under diagnosed. Screening osteoporosis in the general population allows improving management of fragility fracture. It consists to perform a dual X-ray absorptiometry and a spine X-ray to look at a VF. To reduce the dosage of radiation, prevalent or incident VF could be detected by DXA image. The aim of the present study was to test the reproducibility of vertebral fracture assessment (VFA) readings in a population-based cohort and to explore if the accuracy of the reproducibility is more affected by the statistical tool used or by the reader's level of expertise. METHODS: We calculated the reproducibility of VFA reading by uniform and Cohen's kappa, comparing one expert and one non-expert, before and after an instructional on-line International Society of Clinical Densitometry (ISCD) /International Osteoporosis Foundation (IOF) course on VFA reading. We performed the analysis on 50 VFA from a population-based cohort, the OstéoLaus study. RESULTS: Before the VFA reading course, reproducibility with Cohen's kappa was moderate to poor (0 to 0.520), good with the uniform kappa (0.796 to 0.958). After the course, both Cohen's kappa and uniform kappa statistically increased, ranging from 0.524 to 1.000. CONCLUSIONS: For female population-based cohort studies, we recommend using the uniform kappa and instructing a non-expert reader using the ISCD/IOF VFA reading course to correctly read and evaluate the reproducibility of the VFA reading.
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Competencia Clínica , Fracturas Osteoporóticas/diagnóstico por imagen , Fracturas de la Columna Vertebral/diagnóstico por imagen , Absorciometría de Fotón/métodos , Absorciometría de Fotón/normas , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Interpretación de Imagen Asistida por Computador/normas , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/lesiones , Persona de Mediana Edad , Modelos Estadísticos , Reproducibilidad de los Resultados , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/lesionesRESUMEN
The association of trabecular bone score (TBS) with fracture risk and its added predictive value to FRAX® for clinical use have never been independently evaluated in a Chinese population. TBS may improve the predictive power of FRAX® for clinical use in older Chinese men. INTRODUCTION: Trabecular bone score (TBS) of lumbar spine on Dual X-ray densitometry provides information on bone architecture. We therefore examined the additive value of TBS to FRAX® in predicting major osteoporotic fractures (MOFs) in older Chinese people. METHODS: Four thousand community-dwelling Chinese men and women aged ≥65 years were followed up for fracture incidence for an average period of 9.94 and 8.82 years, respectively. At baseline, areal BMD of hip and lumbar spine were measured by DXA, TBS was estimated for the lumbar spine, and FRAX® for 10-year risk of MOFs (hip, clinical spine, shoulder, and wrist) was estimated. Cox regression model was used to evaluate the associations between TBS and FRAX® with the MOFs risk. The area under receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI), and category-based net reclassification improvement (NRI) were applied to evaluate the improved prediction ability. RESULTS: During the follow-up, 126 men and 215 women had at least one incident MOF. Each SD decrease in TBS was significantly associated with incident MOFs, with HR (95%CI) of 1.53 (1.30-1.80) and 1.40 (1.22-1.61) in men and women, respectively. TBS-adjusted FRAX® predicts better than FRAX® with a significantly increased AUC and IDI in men. Using specific intervention thresholds, TBS-adjusted FRAX® brings about 5 % overall correct reclassification for MOFs prediction than FRAX® in men. The increased correct MOFs risk classifications were not significant in older women. CONCLUSIONS: TBS-adjusted FRAX® may improve the predictive power of FRAX® on MOFs for clinical use in older Chinese men.
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Vértebras Lumbares/fisiopatología , Fracturas Osteoporóticas/etiología , Absorciometría de Fotón/métodos , Anciano , Estudios de Cohortes , Femenino , Cuello Femoral/fisiopatología , Estudios de Seguimiento , Hong Kong/epidemiología , Humanos , Incidencia , Vértebras Lumbares/diagnóstico por imagen , Masculino , Osteoporosis/diagnóstico por imagen , Osteoporosis/epidemiología , Osteoporosis/fisiopatología , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/fisiopatología , Valor Predictivo de las Pruebas , Pronóstico , Medición de Riesgo/métodos , Factores de RiesgoRESUMEN
We evaluated the influence of degenerative disease and fractured vertebra on lumbar spine bone mineral density (BMD) and trabecular bone score (TBS) in 1500 women aged 50-80 years. TBS was not affected by a degenerative disease. While BMD increases after 62.5 years, TBS continues to decline. TBS should play a leading role in lumbar spine evaluation. INTRODUCTION: After menopause, lumbar spine (LS) BMD and TBS values decrease. Degenerative disease (DD) increases with age and affect LS BMD. The aim of this study was to measure changes in LS BMD and TBS in women 50 to 80 years old, taking into account the impact of fractured vertebrae and DD. METHODS: LS BMD, TBS, and vertebral fracture assessment were evaluated in the OsteoLaus cohort (1500 women, 50-80 years old). The exams were analyzed following ISCD guidelines to identify vertebrae with fractures or DD (Vex). RESULTS: 1443 women were enrolled: mean age 66.7 ± 11.7 years, BMI 25.7 ± 4.4. LS BMD and TBS were weakly correlated (r2 = 0.16). The correlation (Vex excluded) between age and BMD was +0.03, between age and TBS -0.34. According to age group, LS BMD was 1.2 to 3.2% higher before excluding Vex (p < 0.001). TBS had an insignificant change of <1% after excluding Vex. LS BMD (Vex) decreased by 4.6% between 52.5 and 62.5 years, and increased by 2.6% between 62.5 and 77.5 years. TBS (Vex excluded) values decreased steadily with age with an overall loss of 8.99% between 52.5 and 77.5 years. Spine TBS, femoral neck, and total hip BMD gradually decreased with age, reaching one SD between the oldest and youngest group. CONCLUSIONS: TBS is not affected by DD. While BMD increases after 62.5 years, TBS continues to decline. For lumbar spine evaluation, in view of its independence from DD, TBS should play a leading role in the diagnosis in complement to BMD.
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Densidad Ósea/fisiología , Hueso Esponjoso/fisiopatología , Vértebras Lumbares/fisiopatología , Osteoporosis Posmenopáusica/fisiopatología , Enfermedades de la Columna Vertebral/fisiopatología , Absorciometría de Fotón , Distribución por Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Cuello Femoral/fisiopatología , Humanos , Persona de Mediana Edad , Osteoporosis Posmenopáusica/diagnóstico , Fracturas Osteoporóticas/diagnóstico , Fracturas Osteoporóticas/fisiopatología , Fracturas de la Columna Vertebral/fisiopatologíaRESUMEN
UNLABELLED: Trabecular bone score (TBS) seems to provide additive value on BMD to identify individuals with prevalent fractures in T1D. TBS did not significantly differ between T1D patients and healthy controls, but TBS and HbA1c were independently associated with prevalent fractures in T1D. A TBS cutoff <1.42 reflected prevalent fractures with 91.7 % sensitivity and 43.2 % specificity. INTRODUCTION: Type 1 diabetes (T1D) increases the risk of osteoporotic fractures. TBS was recently proposed as an indirect measure of bone microarchitecture. This study aimed at investigating the TBS in T1D patients and healthy controls. Associations with prevalent fractures were tested. METHODS: One hundred nineteen T1D patients (59 males, 60 premenopausal females; mean age 43.4 ± 8.9 years) and 68 healthy controls matched for gender, age, and body mass index (BMI) were analyzed. The TBS was calculated in the lumbar region, based on two-dimensional (2D) projections of DXA assessments. RESULTS: TBS was 1.357 ± 0.129 in T1D patients and 1.389 ± 0.085 in controls (p = 0.075). T1D patients with prevalent fractures (n = 24) had a significantly lower TBS than T1D patients without fractures (1.309 ± 0.125 versus 1.370 ± 0.127, p = 0.04). The presence of fractures in T1D was associated with lower TBS (odds ratio = 0.024, 95 % confidence interval (CI) = 0.001-0.875; p = 0.042) but not with age or BMI. TBS and HbA1c were independently associated with fractures. The area-under-the curve (AUC) of TBS was similar to that of total hip BMD in discriminating T1D patients with or without prevalent fractures. In this set-up, a TBS cutoff <1.42 discriminated the presence of fractures with a sensitivity of 91.7 % and a specificity of 43.2 %. CONCLUSIONS: TBS values are lower in T1D patients with prevalent fractures, suggesting an alteration of bone strength in this subgroup of patients. Reliable TBS cutoffs for the prediction of fracture risk in T1D need to be determined in larger prospective studies.
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Diabetes Mellitus Tipo 1/complicaciones , Vértebras Lumbares/diagnóstico por imagen , Fracturas Osteoporóticas/diagnóstico por imagen , Fracturas Osteoporóticas/etiología , Absorciometría de Fotón/métodos , Adulto , Anciano , Índice de Masa Corporal , Densidad Ósea/fisiología , Estudios de Casos y Controles , Estudios Transversales , Diabetes Mellitus Tipo 1/fisiopatología , Femenino , Cuello Femoral/fisiopatología , Hemoglobina Glucada/metabolismo , Articulación de la Cadera/fisiopatología , Humanos , Vértebras Lumbares/fisiopatología , Masculino , Persona de Mediana Edad , Fracturas Osteoporóticas/fisiopatología , Sensibilidad y Especificidad , Adulto JovenRESUMEN
Osteoporosis treatments are usually given for a limited period of time in order to balance benefits and risks. We report three cases of postmenopausal women without any previous fragility fracture who presented severe spontaneous vertebral fractures after denosumab discontinuation. We think that the occurrence of these fractures could be explained by the severe rebound effect observed after denosumab discontinuation and that a consensus regarding the end of treatment with denosumab has to be defined.
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Conservadores de la Densidad Ósea/administración & dosificación , Denosumab/administración & dosificación , Fracturas Espontáneas/etiología , Fracturas Osteoporóticas/etiología , Fracturas de la Columna Vertebral/etiología , Anciano , Conservadores de la Densidad Ósea/uso terapéutico , Denosumab/uso terapéutico , Esquema de Medicación , Femenino , Fracturas Espontáneas/prevención & control , Humanos , Persona de Mediana Edad , Osteoporosis Posmenopáusica/complicaciones , Osteoporosis Posmenopáusica/tratamiento farmacológico , Fracturas Osteoporóticas/prevención & control , Fracturas de la Columna Vertebral/prevención & control , Privación de TratamientoRESUMEN
Early readmission is the major success indicator of the transition between hospital and home. Patients admitted with heart failure reach a 20% rate. Potentially avoidable readmissions, defined as unpredictable and related to a known condition during index hospitalization, represent the improvement margin. For these latter, implementation of specific interventions can be effective. Complex interventions on transition, including several modalities and seeking to encourage patient autonomy seem more effective than others. We describe two models: a pragmatic one developed in a regional hospital, and a more complex one developed in a university hospital during the LEAR-HF study. In both cases, it is imperative to work on "medical liability": should it extend beyond discharge up to the threshold of the private practice?
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Continuidad de la Atención al Paciente/normas , Hospitales/normas , Modelos Teóricos , Alta del Paciente , Insuficiencia Cardíaca/terapia , Hospitalización/estadística & datos numéricos , Humanos , Readmisión del Paciente/estadística & datos numéricosAsunto(s)
Osteoporosis/epidemiología , Fracturas Osteoporóticas/epidemiología , Conservadores de la Densidad Ósea/administración & dosificación , Conservadores de la Densidad Ósea/uso terapéutico , Difosfonatos/administración & dosificación , Difosfonatos/uso terapéutico , Femenino , Humanos , Masculino , Osteoporosis/complicaciones , Osteoporosis/terapia , Fracturas Osteoporóticas/prevención & control , Suiza/epidemiologíaRESUMEN
The significant progress on the quality and resolution of the images obtained by "Dual X-ray Absorptiometry" or DXA has permitted on one hand to improve some existing features and on the other to develop new ones, significantly refining the care of our patients in various pathologies. For example, by improving the prediction of fracture risk by indirect analysis of micro- and macro-architecture of the bone, by looking for markers of associated bone diseases (research vertebral fractures or atypical femoral fractures), or by assessing the metabolic status by the measurement of body composition. With the best performing DXA devices we will soon be able, in clinical routine, to determine bone age, to estimate cardiovascular risk (by measuring the calcification of the abdominal aorta) or to predict the progression of joint osteoarthritis and its evolution after surgical management.
Asunto(s)
Absorciometría de Fotón/métodos , Densidad Ósea/fisiología , Enfermedades Óseas/diagnóstico , Enfermedades Óseas/patología , Huesos/patología , Huesos/fisiología , Fracturas Óseas/diagnóstico , Fracturas Óseas/patología , HumanosRESUMEN
Pseudoarthrosis is defined as a non healing fracture 9 months after trauma and without radiological progression within the last three months. Osteoporotic fractures have a greater risk of chirurgical complications. The question of giving a medical treatment in the purpose of accelerating fracture healing is an increasing concern. There are data showing that with teriparatide (bone anabolic treatment derived from the parathyroid hormone) bone healing and functional status are improved, with or without surgery, in the case of either typical or atypical fractures. The risks of this treatment are low but health insurance agreement is needed in this indication. We report our experience with the use of this molecule, out of the official indication, in complex situations of non healing fractures.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Curación de Fractura/efectos de los fármacos , Seudoartrosis/tratamiento farmacológico , Teriparatido/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas Óseas/tratamiento farmacológico , Fracturas Óseas/patología , Humanos , Masculino , Persona de Mediana Edad , Fracturas Osteoporóticas/tratamiento farmacológico , Fracturas Osteoporóticas/patología , Seudoartrosis/patologíaRESUMEN
Trabecular bone score (TBS) is a recently-developed analytical tool that performs novel grey-level texture measurements on lumbar spine dual X-ray absorptiometry (DXA) images, and thereby captures information relating to trabecular microarchitecture. In order for TBS to usefully add to bone mineral density (BMD) and clinical risk factors in osteoporosis risk stratification, it must be independently associated with fracture risk, readily obtainable, and ideally, present a risk which is amenable to osteoporosis treatment. This paper summarizes a review of the scientific literature performed by a Working Group of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. Low TBS is consistently associated with an increase in both prevalent and incident fractures that is partly independent of both clinical risk factors and areal BMD (aBMD) at the lumbar spine and proximal femur. More recently, TBS has been shown to have predictive value for fracture independent of fracture probabilities using the FRAX® algorithm. Although TBS changes with osteoporosis treatment, the magnitude is less than that of aBMD of the spine, and it is not clear how change in TBS relates to fracture risk reduction. TBS may also have a role in the assessment of fracture risk in some causes of secondary osteoporosis (e.g., diabetes, hyperparathyroidism and glucocorticoid-induced osteoporosis). In conclusion, there is a role for TBS in fracture risk assessment in combination with both aBMD and FRAX.
Asunto(s)
Absorciometría de Fotón , Huesos/diagnóstico por imagen , Osteoporosis Posmenopáusica/diagnóstico , Osteoporosis/diagnóstico , Adulto , Anciano , Algoritmos , Densidad Ósea , Huesos/fisiopatología , Estudios Transversales , Síndrome de Cushing/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Fémur/patología , Curación de Fractura , Humanos , Hiperparatiroidismo Primario/complicaciones , Vértebras Lumbares/patología , Masculino , Persona de Mediana Edad , Osteoartritis/complicaciones , Osteoporosis/fisiopatología , Osteoporosis Posmenopáusica/fisiopatología , Fracturas Osteoporóticas/diagnóstico , Fracturas Osteoporóticas/fisiopatología , Probabilidad , Medición de Riesgo , Factores de RiesgoRESUMEN
The year 2014 was rich in significant advances in all areas of internal medicine. Many of them have an impact on our daily practice and on the way we manage one problem or another. From the use of the ultrasound for the diagnosis of pneumonia to the choice of the site of venous access and the type of line, and the increasing complexity of choosing an oral anticoagulant agent, this selection offers to the readers a brief overview of the major advances. The chief residents in the Service of internal medicine of the Lausanne University hospital are pleased to share their readings.