Índice trabecular óseo y niveles de 25-hidroxivitamina D en las complicaciones microvasculares de la diabetes mellitus tipo 2 / Trabecular bone score and 25-hydroxyvitamin D levels in microvascular complications of type 2 diabetes mellitus

Antecedentes y objetivo:La enfermedad microvascular (EMV) diabética ha sido asociada con una fragilidad ósea incrementada. El objetivo fue analizar la relación entre la EMV y la microestructura trabecular -evaluada mediante el índice trabecular óseo (trabecular bone score, TBS)- en pacientes diabéticos tipo 2 (DM2). Adicionalmente, conocer la relación entre la vitamina D y la EMV.Pacientes y métodos:Diseño transversal analítico, que incluyó varones > 50 años y mujeres postmenopáusicas con DM2, participantes en una cohorte poblacional. Se clasificó como EMV+ la presencia de nefropatía, neuropatía y/o retinopatía. Fueron analizadas variables clínicas, de laboratorio, el TBS, la 25-hidroxivitamina D [25(OH)D] y la densidad mineral ósea (DMO). Se realizaron análisis bivariable y multivariable.Resultados:Fueron evaluados 361 pacientes (51,1% mujeres), de 63,8 (9) años. De ellos, 92 tenían EMV, con un peor control metabólico, mayor duración de la DM2, menor TBS (1,235 [0,1] vs. 1,287 [0,1]; p=0,003) y menores niveles de 25(OH)D (18,3 [7] vs. 21,6 [8] ng/mL; p=0,0001). No hubo diferencias entre EMV+ y EMV- en la DMO ni en los marcadores P1NP y β-CTX. Tras ajustar por confusores, incluyendo HbA1c y duración de la DM2, el TBS en EMV+ fue 1,252 (IC 95% 1,230-1,274) vs. 1,281 (IC 95% 1,267-1,295) en EMV- (p=0,034). La EMV se asoció a un nivel de 25(OH)D < 20 ng/mL con una OR ajustada=1,88 (IC 95% 1,06-3,31; p=0,028).Conclusiones:Los pacientes con EMV presentaron un TBS significativamente menor, tras ajustar por confusores. El análisis multivariable mostró asimismo una asociación significativa entre un nivel bajo de 25(OH)D y la EMV prevalente. (AU)

Background and objective:Diabetic microvascular disease (MVD) has been associated with increased bone fragility. The objective was to analyse the relationship between MVD and trabecular microstructure -assessed by the trabecular bone score (TBS)- in type 2 diabetic (T2D) patients. A second aim was to know the relationship between vitamin D and MVD.Patients and methods:Cross-sectional study, which included men >50 years and postmenopausal women participating in a population-based cohort, diagnosed with T2D. The presence of nephropathy, neuropathy and/or retinopathy was classified as MVD+. Clinical and laboratory variables, TBS, 25(OH)D and BMD by DXA, were evaluated. Bivariate and multivariate analysis were performed.Results:We evaluated 361 patients (51.1% women), 63.8 (9) years old. Of them, 92 were MVD+ and presented poorer metabolic control, longer duration of T2D, lower TBS [1.235 (.1) vs. 1.287 (.1); p=.007] and lower levels of 25(OH)D [18.3 (7) vs. 21.6 (8) ng/ml; p=.0001). There were no differences between MVD+ and MVD- with regard to BMD or P1NP and β-CTX markers. After adjusting for confounders, including HbA1c and duration of T2D, the TBS value in MVD+ was 1.252 (95% CI 1.230-1.274) vs. 1.281 (95% CI 1.267-1.295) in MVD- (p=.034). MVD was associated with a 25(OH)D level <20 ng ml with an adjusted OR of 1.88 (95% CI 1.06-3.31; p=.028).Conclusions:The MVD+ patients presented a significantly lower TBS, after adjusting for confounders. Furthermore, multivariable analysis showed a significant relationship between a low 25(OH)D level and a prevalent MVD. (AU)

Trabecular bone score and 25-hydroxyvitamin D levels in microvascular complications of type 2 diabetes mellitus. / Índice trabecular óseo y niveles de 25-hidroxivitamina D en las complicaciones microvasculares de la diabetes mellitus tipo 2.

BACKGROUND AND OBJECTIVE: Diabetic microvascular disease (MVD) has been associated with increased bone fragility. The objective was to analyse the relationship between MVD and trabecular microstructure -assessed by the trabecular bone score (TBS)- in type 2 diabetic (T2D) patients. A second aim was to know the relationship between vitamin D and MVD. PATIENTS AND METHODS: Cross-sectional study, which included men >50 years and postmenopausal women participating in a population-based cohort, diagnosed with T2D. The presence of nephropathy, neuropathy and/or retinopathy was classified as MVD+. Clinical and laboratory variables, TBS, 25(OH)D and BMD by DXA, were evaluated. Bivariate and multivariate analysis were performed. RESULTS: We evaluated 361 patients (51.1% women), 63.8 (9) years old. Of them, 92 were MVD+ and presented poorer metabolic control, longer duration of T2D, lower TBS [1.235 (.1) vs. 1.287 (.1); p=.007] and lower levels of 25(OH)D [18.3 (7) vs. 21.6 (8) ng/ml; p=.0001). There were no differences between MVD+ and MVD- with regard to BMD or P1NP and ß-CTX markers. After adjusting for confounders, including HbA1c and duration of T2D, the TBS value in MVD+ was 1.252 (95% CI 1.230-1.274) vs. 1.281 (95% CI 1.267-1.295) in MVD- (p=.034). MVD was associated with a 25(OH)D level <20 ng ml with an adjusted OR of 1.88 (95% CI 1.06-3.31; p=.028). CONCLUSIONS: The MVD+ patients presented a significantly lower TBS, after adjusting for confounders. Furthermore, multivariable analysis showed a significant relationship between a low 25(OH)D level and a prevalent MVD.

Relación entre hiperostosis esquelética idiopática difusa, calcificación de la aorta abdominal y las alteraciones metabólicas asociadas: datos de la Cohorte Camargo / Relationship between diffuse idiopathic skeletal hyperostosis, abdominal aortic calcification and associated metabolic disorders: Data from the Camargo Cohort

Antecedentes y objetivo: La hiperostosis esquelética idiopática difusa (DISH, del inglés diffuse idiopathic skeletal hyperostosis) y la calcificación aórtica abdominal (CAA) se asocian a un incremento del riesgo cardiovascular. El objetivo fue analizar una posible relación entre ambas, así como las alteraciones metabólicas asociadas a la DISH. Pacientes y método: Estudio transversal-analítico, incluido en una cohorte poblacional. La DISH (criterios de Resnick-Niwayama) y la CAA (mediante la escala AAC-24) fueron evaluadas sobre imágenes de radiología simple. Se evaluaron asimismo otras 40 variables clínicas mediante correlaciones y regresión multivariante. Resultados: Fueron analizados 987 varones ≥ 50 años, con una edad media = 65, 5±9 años. Las prevalencias de DISH y CAA fueron del 21,6% y del 58,7%, respectivamente. El sujeto con DISH tenía mayor edad (68,1±9 vs. 63,8±9 años; p=0,0001) y con mayor frecuencia presentaba síndrome metabólico (SM) (55,6 vs. 36,6%; p=0,0001). La CAA fue de 3,7±5 puntos en sujetos con DISH frente a 3,3±5 en sujetos sin DISH (p=0,25), y se asoció a un riesgo incrementado de DISH prevalente (OR cruda=1,4 [IC95%: 1,01-1,9]; p=0,04), que desapareció al ajustar por edad (OR ajustada=1,1 [IC95%: 0,8-1,5]; p=0,47). No se observó asociación de la DISH con la hipertensión arterial, diabetes mellitus o dislipidemia, pero mantuvieron una relación significativa tras ajustar por confusores la edad (OR=2,2 [IC95%: 1,6-3]; p=0,0001), el IMC (OR=1,5 [IC95%: 1,1-2]; p=0,007), el perímetro abdominal (OR=1,5 [IC95%: 1,04-2,3]; p=0,03) y el SM (OR=1,7 [IC95%: 1,1-2,4]; p=0,005). Conclusiones: No se ha podido demostrar una asociación consistente entre la DISH y la CAA, presentando ambas una débil relación dependiente de la edad. La DISH ha mostrado unas asociaciones significativas con la edad, el IMC, el perímetro abdominal y el SM (AU)

Background and objective: Diffuse idiopathic skeletal hyperostosis (DISH) and abdominal aortic calcification (AAC) are related to an increased cardiovascular risk. The aim of this study was to analyse a possible relationship between both entities and also the association between metabolic disorders and DISH. Patients and method: Analytic cross-sectional study in a population-based cohort. DISH (with Resnick-Niwayama criteria) and AAC (with AAC-24 scale) were assessed on plain x-ray images. Interaction terms between DISH and forty clinical covariates were also investigated, through correlation analysis and multivariate regression. Results: Nine hundred eighty-seven males aged≥50 years, with a mean age=65,5±9 years, were evaluated. Prevalence rates of DISH and AAC were 21.6% and 58.7%, respectively. DISH+ subjects were older (68.1±9 vs. 63.8±9 years; P=.0001) and more likely to be affected by metabolic syndrome (MS) (55.6% vs. 36.6%; P=.0001). In DISH+ subjects, the AAC was 3.7±5 points, whereas in DISH− subjects it was 3.3±5 (P=.25). AAC was associated with an increased risk of prevalent DISH (unadjusted OR=1.4 [CI95%: 1.01-1.9]; P=.04), that disappeared when it was adjusted for age (adjusted OR=1.1 [CI95%: 0.8-1.5];P=.47]. No association was found between DISH and hypertension, diabetes or dyslipidaemia; however, age (OR=2.2 [CI95%: 1.6-3]; P=.0001), BMI (OR=1.5 [CI95%: 1.1-2]; P=.007), waist circumference (OR=1.5 [CI95%: 1.04-2,3]; P=.03) and MS (OR=1.7 [CI95%: 1.1-2.4]; P=.005) showed a significant relationship with DISH after adjusting for confounders. Conclusions: The study was not able to demonstrate a consistent association between DISH and AAC, proving only a weak and age-dependent relationship between them. DISH proved to be significantly associated with age, BMI, waist circumference and MS (AU)

Relationship between diffuse idiopathic skeletal hyperostosis, abdominal aortic calcification and associated metabolic disorders: Data from the Camargo Cohort. / Relación entre hiperostosis esquelética idiopática difusa, calcificación de la aorta abdominal y las alteraciones metabólicas asociadas: datos de la Cohorte Camargo.

BACKGROUND AND OBJECTIVE: Diffuse idiopathic skeletal hyperostosis (DISH) and abdominal aortic calcification (AAC) are related to an increased cardiovascular risk. The aim of this study was to analyse a possible relationship between both entities and also the association between metabolic disorders and DISH. PATIENTS AND METHOD: Analytic cross-sectional study in a population-based cohort. DISH (with Resnick-Niwayama criteria) and AAC (with AAC-24 scale) were assessed on plain x-ray images. Interaction terms between DISH and forty clinical covariates were also investigated, through correlation analysis and multivariate regression. RESULTS: Nine hundred eighty-seven males aged≥50 years, with a mean age=65,5±9 years, were evaluated. Prevalence rates of DISH and AAC were 21.6% and 58.7%, respectively. DISH+ subjects were older (68.1±9 vs. 63.8±9 years; P=.0001) and more likely to be affected by metabolic syndrome (MS) (55.6% vs. 36.6%; P=.0001). In DISH+ subjects, the AAC was 3.7±5 points, whereas in DISH- subjects it was 3.3±5 (P=.25). AAC was associated with an increased risk of prevalent DISH (unadjusted OR=1.4 [CI95%: 1.01-1.9]; P=.04), that disappeared when it was adjusted for age (adjusted OR=1.1 [CI95%: 0.8-1.5];P=.47]. No association was found between DISH and hypertension, diabetes or dyslipidaemia; however, age (OR=2.2 [CI95%: 1.6-3]; P=.0001), BMI (OR=1.5 [CI95%: 1.1-2]; P=.007), waist circumference (OR=1.5 [CI95%: 1.04-2,3]; P=.03) and MS (OR=1.7 [CI95%: 1.1-2.4]; P=.005) showed a significant relationship with DISH after adjusting for confounders. CONCLUSIONS: The study was not able to demonstrate a consistent association between DISH and AAC, proving only a weak and age-dependent relationship between them. DISH proved to be significantly associated with age, BMI, waist circumference and MS.