Digital vertebral morphometry performed by DXA: a valuable opportunity for identifying fractures during bone mass assessment.

OBJECTIVES: To evaluate the usefulness of vertebral morphometry in identifying unreferred vertebral fractures and correlate potential risk factors. SUBJECTS AND METHODS: Female patients above 45 years, postmenopausal for at least 2 years, diagnosed with osteoporosis and undergoing treatment for at least three months were considered eligible. All of them underwent bone densitometry and vertebral morphometry performed by concomitant DXA. The presence of fractures was defined between T7 and L4; only moderate and severe fractures were considered for analysis. All volunteers were submitted to laboratory tests, anthropometry and responded a questionnaire on their lifestyle habits and medical history. RESULTS: Thirty two (17%) out of the 188 female patients presented with at least one vertebral fracture, among whom only 4 (12.5%) were previously aware of the fracture. The fractures were mainly located on the thoracic spine. Nine patients had severe fractures (28.1%), whereas 23 had moderate fractures (71.9%). On average, patients with fractures were 5 years older and weighed 5 kilograms less than those without fractures. The creatinine clearance was on average 9 mL/min less in patients with vertebral fracture. The assessment of vertebral fractures by morphometry is a fast, accurate and complementary method associated with low radiation exposure for identifying moderate and severe vertebral fractures. Predisposition to vertebral fractures does not depend solely on BMD.

Digital vertebral morphometry performed by DXA: a valuable opportunity for identifying fractures during bone mass assessment

Objectives To evaluate the usefulness of vertebral morphometry in identifying unreferred vertebral fractures and correlate potential risk factors. Subjects and methods Female patients above 45 years, postmenopausal for at least 2 years, diagnosed with osteoporosis and undergoing treatment for at least three months were considered eligible. All of them underwent bone densitometry and vertebral morphometry performed by concomitant DXA. The presence of fractures was defined between T7 and L4; only moderate and severe fractures were considered for analysis. All volunteers were submitted to laboratory tests, anthropometry and responded a questionnaire on their lifestyle habits and medical history. Results Thirty two (17%) out of the 188 female patients presented with at least one vertebral fracture, among whom only 4 (12.5%) were previously aware of the fracture. The fractures were mainly located on the thoracic spine. Nine patients had severe fractures (28.1%), whereas 23 had moderate fractures (71.9%). On average, patients with fractures were 5 years older and weighed 5 kilograms less than those without fractures. The creatinine clearance was on average 9 mL/min less in patients with vertebral fracture. The assessment of vertebral fractures by morphometry is a fast, accurate and complementary method associated with low radiation exposure for identifying moderate and severe vertebral fractures. Predisposition to vertebral fractures does not depend solely on BMD. .

25-Hydroxyvitamin D level does not reflect intestinal calcium absorption: an assay using strontium as a surrogate marker.

There is conflicting evidence as to the optimal serum 25-hydroxyvitamin D [25(OH)D] concentration for intestinal calcium absorption (Abs-Ca). Our purpose was to assess the relationship between vitamin D status and Abs-Ca in postmenopausal women. Fifty volunteers with low bone mass were grouped according to their serum 25(OH)D concentration as follows: mild deficient, <50 nmol/L (DEF) and sufficient, ≥75 nmol/L (SUF). The subjects were submitted to an oral strontium overload test to assess their Abs-Ca. Fasting blood samples were obtained to perform the relevant hormonal and biochemical tests. After the subjects received the test solution, blood samples were drawn at 30, 60, 120, and 240 min to determine the strontium concentrations. Abs-Ca was indirectly expressed as the area under the serum strontium concentration curve (AUC). A repeated measures ANOVA was performed to determine the differences among the groups. Pearson's correlation and multiple linear regression analysis were used to study the associations between the variables. The mean 25(OH)D and 1,25-dihydroxyvitamin D [1,25(OH)2D] concentrations differed between the groups (SUF vs. DEF) as follows: 98.7 ± 18.2 vs. 38.4 ± 8.5 nmol/L (p < 0.001) and 36.2 ± 10.2 vs. 24.9 ± 4.6 pg/mL (p < 0.001), respectively. There was no statistically significant difference between the groups for parathyroid hormone and AUC. Only 1,25(OH)2D influenced the strontium absorption in the last 2 h of the test. In the studied population, no correlation between levels of 25(OH)D and Abs-Ca was found. Only 1,25(OH)2D influenced Abs-Ca as measured by a strontium absorption test.

Recommendations of the Brazilian Society of Endocrinology and Metabology (SBEM) for the diagnosis and treatment of hypovitaminosis D.

OBJECTIVE: The objective is to present an update on the diagnosis and treatment of hypovitaminosis D, based on the most recent scientific evidence. MATERIALS AND METHODS: The Department of Bone and Mineral Metabolism of the Brazilian Society of Endocrinology and Metabology (SBEM) was invited to generate a document following the rules of the Brazilian Medical Association (AMB) Guidelines Program. Data search was performed using PubMed, Lilacs and SciELO and the evidence was classified in recommendation levels, according to the scientific strength and study type. CONCLUSION: A scientific update regarding hypovitaminosis D was presented to serve as the basis for the diagnosis and treatment of this condition in Brazil.

Modifiable factors of vitamin D status among a Brazilian osteoporotic population attended a public outpatient clinic.

Objectives To evaluate the serum 25-hydroxyvitamin D [25(OH)D] concentration in Brazilian osteoporotic patients and the modifiable factors of vitamin D status in this population. Subjects and methods In a cross-sectional study, 363 community-dwelling patients who sought specialized medical care were evaluated between autumn and spring in São Paulo, Brazil. Serum levels of 25(OH)D and parathormone (PTH), biochemical and anthropometric measurements, and bone density scans were obtained. The group was assessed using two questionnaires: one questionnaire covered lifestyle and dietary habits, skin phototype, sun exposure, medical conditions, and levels of vitamin D supplementation (cholecalciferol); the other questionnaire assessed health-related quality-of-life. Logistic regression and a decision tree were used to assess the association between the variables and the adequacy of vitamin D status. Results The mean age of the overall sample was 67.9 ± 8.6 years, and the mean 25(OH)D concentration was 24.8 ng/mL. The prevalence of inadequate vitamin D status was high (73.3%), although 81.5% of the subjects were receiving cholecalciferol (mean dose of 8,169 IU/week). 25(OH)D was positively correlated with femoral neck bone mineral density and negatively correlated with PTH. In the multivariate analysis, the dose of cholecalciferol, engagement in physical activity and the month of the year (September) were associated with improvement in vitamin D status. Conclusions In this osteoporotic population, vitamin D supplementation of 7,000 IU/week is not enough to reach the desired 25(OH)D concentration (≥ 30 ng/mL). Engagement in physical activity and the month of the year are modifiable factors of the vitamin D status in this population.

Modifiable factors of vitamin D status among a Brazilian osteoporotic population attended a public outpatient clinic / Fatores modificáveis do status de vitamina D em uma população brasileira de osteoporóticos assistidos em um ambulatório público

Objectives To evaluate the serum 25-hydroxyvitamin D [25(OH)D] concentration in Brazilian osteoporotic patients and the modifiable factors of vitamin D status in this population. Subjects and methods In a cross-sectional study, 363 community-dwelling patients who sought specialized medical care were evaluated between autumn and spring in São Paulo, Brazil. Serum levels of 25(OH)D and parathormone (PTH), biochemical and anthropometric measurements, and bone density scans were obtained. The group was assessed using two questionnaires: one questionnaire covered lifestyle and dietary habits, skin phototype, sun exposure, medical conditions, and levels of vitamin D supplementation (cholecalciferol); the other questionnaire assessed health-related quality-of-life. Logistic regression and a decision tree were used to assess the association between the variables and the adequacy of vitamin D status. Results The mean age of the overall sample was 67.9 ± 8.6 years, and the mean 25(OH)D concentration was 24.8 ng/mL. The prevalence of inadequate vitamin D status was high (73.3%), although 81.5% of the subjects were receiving cholecalciferol (mean dose of 8,169 IU/week). 25(OH)D was positively correlated with femoral neck bone mineral density and negatively correlated with PTH. In the multivariate analysis, the dose of cholecalciferol, engagement in physical activity and the month of the year (September) were associated with improvement in vitamin D status. Conclusions In this osteoporotic population, vitamin D supplementation of 7,000 IU/week is not enough to reach the desired 25(OH)D concentration (≥ 30 ng/mL). Engagement in physical activity and the month of the year are modifiable factors of the vitamin D status in this population. .

Objetivos Avaliar a concentração sérica de 25-hidroxivitamina D [25(OH)D] em pacientes osteoporóticos brasileiros e os fatores modificáveis do status de vitamina D nesta população. Sujeitos e métodos Em um estudo transversal, 363 pacientes, residentes na comunidade, que procuravam atendimento médico especializado, foram avaliados entre o outono e a primavera, em São Paulo, Brasil. Níveis séricos de 25(OH)D e paratormônio (PTH), avaliações bioquímicas e antropométricas e exames de densitometria óssea foram obtidos. O grupo foi avaliado por meio de dois questionários: um questionário abordou estilo de vida e hábitos alimentares, fototipo de pele, exposição solar, problemas médicos e os níveis de suplementação de vitamina D (colecalciferol); o outro questionário avaliou a qualidade de vida relacionada à saúde. Regressão logística e árvore de decisão foram utilizadas para avaliar a associação entre as variáveis e a adequação do status de vitamina D. Resultados A idade média da amostra foi de 67,9 ± 8,6 anos e a concentração média de 25(OH)D foi de 24,8 ng/mL. A prevalência de um status de vitamina D inadequado foi elevada (73,3%), apesar de 81,5% dos indivíduos receberem colecalciferol (dose média de 8.169 UI/semana). 25(OH)D correlacionou-se positivamente com a densidade mineral óssea do colo de fêmur e negativamente com PTH. Nas análises multivariadas, a dose de colecalciferol, a prática de exercícios físicos e o mês do ano (setembro) foram associados com a melhora do status de vitamina D. Conclusões Nesta população osteoporótica, a suplementação de 7.000 UI/semana não é suficiente para atingir a concentração desejada ...

Recomendações da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) para o diagnóstico e tratamento da hipovitaminose D / Recommendations of the Brazilian Society of Endocrinology and Metabology (SBEM) for the diagnosis and treatment of hypovitaminosis D

Objetivo Apresentar uma atualização sobre o diagnóstico e tratamento da hipovitaminose D baseada nas mais recentes evidências científicas. Materiais e métodos O Departamento de Metabolismo Ósseo e Mineral da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) foi convidado a conceber um documento seguindo as normas do Programa Diretrizes da Associação Médica Brasileira (AMB). A busca dos dados foi realizada por meio do PubMed, Lilacs e SciELO e foi feita uma classificação das evidências em níveis de recomendação, de acordo com a força científica por tipo de estudo. Conclusão Foi apresentada uma atualização científica a respeito da hipovitaminose D que servirá de base para o diagnóstico e tratamento dessa condição no Brasil. .

Objective The objective is to present an update on the diagnosis and treatment of hypovitaminosis D, based on the most recent scientific evidence. Materials and methods The Department of Bone and Mineral Metabolism of the Brazilian Society of Endocrinology and Metabology (SBEM) was invited to generate a document following the rules of the Brazilian Medical Association (AMB) Guidelines Program. Data search was performed using PubMed, Lilacs and SciELO and the evidence was classified in recommendation levels, according to the scientific strength and study type. Conclusion A scientific update regarding hypovitaminosis D was presented to serve as the basis for the diagnosis and treatment of this condition in Brazil. .

Vitamin D supplementation and strontium ranelate absorption in postmenopausal women with low bone mass.

BACKGROUND: Strontium ranelate is used to treat osteoporosis. Calcium (Ca) and strontium (Sr) have common chemical features and are absorbed by the same pathways. Vitamin D has a main role in calcium intestinal absorption. The aim of this study was to investigate whether vitamin D status is a determinant of strontium ranelate absorption. METHODS: Twenty-five patients with vitamin D deficiency (25(OH)D<50 nmol/l) and 25 with vitamin D sufficiency (25(OH)D>75 nmol/l) underwent a 4-h oral Sr overload test. Sr absorption was evaluated as the fraction of absorbed dose and the area under the curve. After the baseline overload test, the deficient patients were treated until reaching sufficient vitamin D levels (25(OH)D>75 nmol/l) and the test was repeated. RESULTS: Changing vitamin D status from deficient to sufficient resulted in a significant increase in 1,25(OH)2D (24.97±4.64×34.62±9.14 pg/ml, P<0.001) and a reduction in parathyroid hormone (73.87±37.50×58.24±20.13 pg/ml, P=0.006). Nevertheless, no differences were found in the parameters used to evaluate Sr absorption between the vitamin D deficient and sufficient groups. In addition, vitamin D3 replacement in the deficient group did not result in enhanced Sr absorption. CONCLUSION: Vitamin D status did not interfere with strontium ranelate absorption. Taking into account the benefits of adequate vitamin D status in osteoporotic patients, we strongly recommend the treatment of vitamin D deficiency. However, the data demonstrate that such treatment does not enhance strontium ranelate absorption in patients with mild deficiency.

Evidence-based non-skeletal actions of vitamin D.

Vitamin D is a major regulator of mineral homeostasis through its action in the kidney, intestine, bone and parathyroid glands. On these tissues, its active form, calcitriol, acts by binding to a specific nuclear receptor that belongs to the steroid/thyroid hormone receptor family. This receptor, however, has also been identified in several additional human tissues. So, apart from its traditional actions related to calcium, vitamin D and its synthetic analogs are being increasingly recognized for their anti-proliferative, pro-differentiative and immunomodulatory activities. Low levels of vitamin D have been linked to many chronic diseases. Decreased muscle function and increased fall risk in elderly people; prostate, breast and colorectal cancers; diabetes mellitus; and other health problems have been associated to low circulating levels of 25-hydroxyvitamin D. This paper presents an overview of the available scientific evidence for the non-calcemic actions of vitamin D in humans.

Evidence-based non-skeletal actions of vitamin D / Evidências das ações não esqueléticas da vitamina D

Vitamin D is a major regulator of mineral homeostasis through its action in the kidney, intestine, bone and parathyroid glands. On these tissues, its active form, calcitriol, acts by binding to a specific nuclear receptor that belongs to the steroid/thyroid hormone receptor family. This receptor, however, has also been identified in several additional human tissues. So, apart from its traditional actions related to calcium, vitamin D and its synthetic analogs are being increasingly recognized for their anti-proliferative, pro-differentiative and immunomodulatory activities. Low levels of vitamin D have been linked to many chronic diseases. Decreased muscle function and increased fall risk in elderly people; prostate, breast and colorectal cancers; diabetes mellitus; and other health problems have been associated to low circulating levels of 25-hydroxyvitamin D. This paper presents an overview of the available scientific evidence for the non-calcemic actions of vitamin D in humans.

A vitamina D é um importante regulador da homeostase mineral por meio de sua ação nos rins, no intestino, nos ossos e nas glândulas paratireoides. Nesses tecidos, sua forma ativa, o calcitriol, atua ligando-se a um receptor nuclear específico, pertencente à família de receptores dos hormônios esteroides e tireoidianos. Contudo, esse receptor também foi identificado em outros tecidos humanos. Assim, além de suas ações tradicionais, relacionadas ao metabolismo do cálcio, a vitamina D e análogos sintéticos estão, cada vez mais, sendo reconhecidos por seus efeitos antiproliferativos, pró-diferenciação e imunomodulatórios. Baixas concentrações séricas de vitamina D têm sido associadas a várias doenças crônicas. Redução da função muscular e aumento do risco de quedas em idosos; câncer de próstata, mama e colorretal; diabetes melito; e outros problemas de saúde têm sido associados a concentrações circulantes baixas de 25-hidroxivitamina D. Este trabalho apresenta uma visão geral sobre as evidências científicas disponíveis das ações não calcêmicas da vitamina D em humanos.

Bone mineral density and osteoporosis among a predominantly Caucasian elderly population in the city of São Paulo, Brazil.

This cross-sectional study covered 301 individuals over 70 years of age--207 women (W) and 94 men (M)--living in the city of São Paulo, Brazil. Our aims were to evaluate the prevalence of low bone mineral density (BMD) in this population and the possible factors that influence BMD. The subjects were submitted to a bone densitometry scan (DXA) to evaluate the BMD at lumbar spine (LS), femoral neck (FN), trochanter (T), total femur (TF) and total body composition. At the time, the participants filled in a questionnaire about lifestyle habits, diet and medical history, as well as having blood samples taken to check hormone and biochemical levels. Anthropometric parameters were measured. Osteopenia and osteoporosis were defined in accordance with the criteria suggested by the World Health Organization. In the different sites studied, the prevalence of osteopenia and osteoporosis varied, in men ranging 33.3-57.4% and 6.4-16.1%, respectively, and in women ranging 36.6-56.5% and 22.2-33.2%, respectively. Weight was the variable that most strongly correlated with BMD at the proximal femur in both sexes (men, r =0.44-0.52; women, r =0.48-0.52) and with BMD at LS in women (r =0.44). Height was the parameter that best correlated with BMD at LS in men (r =0.34). In men follicle-stimulating hormone, growth hormone and glycemia correlated with BMD at T and TF, while plasma albumin only correlated with BMD at T. In women glycemia correlated with BMD at LS, and follicle-stimulating hormone correlated with BMD at FN, T and TF. In conclusion, we found a high prevalence of osteopenia and osteoporosis in this population, with weight being the best predictor of BMD. The prevalence of osteoporosis and osteopenia at FN was as high in men as that observed in women.

Refluxo vesicoureteral na infância: estudo clínico de 42 casos / Vesicoureteral reflux in childhood: clincial study of 42 cases

Foram observados, durante cinco anos, os aspectos clínicos da evoluçäo e dos exames subsidiários de 42 crianças com RVU e ITU. Em todos os casos foram realizados os exames de urina tipo I, urocultura com contagem de bactérias e antibiograma, urografia excretora, cistouretrografia miccional e, em 25 urografia excretora, cistouretrografia miccional e, em 25 crianças, o DMSA. Houve predominância do sexo feminino e da faixa etária de 0 a 2 anos. Em 28 casos, o RVU foi unilateral, com maior incidência à esquerda. Nos bilaterais, a maior incidência foi nos graus III e II. Nos RVU à direita ocorreu normalizaçäo radiológica em 58,3//, enquanto que nos à esquerda em 37,5//. Nos bilaterais, a normalizaçäo radiológica foi de 57,8//. O DMSA feito em 25 crianças foi normal em 24//. Em todas as 42 crianças foi realizado tratamento contra ITU. Houve indicaçöes de ciruriga anti-refluxo em três casos (7,1//). Os autores recomendam a feitura do cistouretrograma em todos os casos de RVU