Description of Normative Spine TBS Data for Men and Women in Mexican Population.

Trabecular Bone Score (TBS) has proven its usefulness to improve areal Bone Mineral Density in diagnosing fracture risk and bone status evaluation. For it to be better interpreted, local reference values are recommended to account for population differences and, if possible, both in women and men, the former being scarcer. Using TBS, we reanalyzed data obtained from the Mexican population included in the Latin American Vertebral Osteoporosis Study and the Mexican Vertebral Study in men that included a random probability sample of 408 women and 414 men aged 50 and older without fractures. Data was used to obtain reference curves in such a population. Mean TBS in women ranged from an average of 1.359 ± 0.118 standard deviation (SD) 50 to 59 and decreased down to 1.211 ± 0.128 SD in women 80 and above. In men ranged from 1.382 ± 0.116 SD in the first group down to 1.315 ± 0.118 SD in the latter with little differences in age groups. Mean values in women are lower than previously suggested cutoff points to establish microarchitecture status using TBS: 1.350 and above normal, 1.200 to 1.349 partially degraded and 1.199 and below, degraded. Our TBS data have the strength of being a random sample drawn from the population, although limited in its extent to one city in Mexico. The means and curves may be used to diagnose bone status with better sensibility and specificity, although these values are yet to be evaluated.

Impact of osteoporosis-associated vertebral fractures on health-related quality of life in the Mexican population.

OBJECTIVE: To measure the impact on the health-related quality of life (HRQoL) of a sample of Mexicans with vertebral fractures. MATERIAL AND METHODS: One hundred fifteen subjects with vertebral fractures were interviewed and compared with 135 subjects similar in age without the fracture. Subjects were men and women > 50 years of age with osteoporosis confirmed by bone mineral densitometry and with at least 1 vertebral fracture verified by vertebral morphometry and Xrays. The sample was recruited from two sources: The Clínica de Osteoporosis at the Instituto Nacional de Rehabilitación and a random sample from the Latin American Osteoporosis Study. The Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) validated in Spanish for the Mexican population was applied. Descriptive statistics were used for demographic and clinical aspects of the sample, as well as χ2 for categorical variables and Student t test for independent samples for continuous variables. A multiple linear regression (LR) was conducted to characterize predictive variables related to quality of life. RESULTS: Two hundred fifty subjects were interviewed; 64% of them were women. The average age of those interviewed was 73.4 ± 11.4 years; 46% of the sample had vertebral fractures; of them 43% of were lumbar and 57% thoracic; the most frequent site was L1-T12. Significant changes were found in the group with fractures in pain, physical function, social function, and mental function (p < 0.05); in women, pain and social function were different between groups (p < 0.05); and those over 70 years also presented differences in physical, social, and mental function (p < 0.05); differences were found associated with the place of recruitment being worse in their quality of life those coming from the Clínica de Osteoporosis. Two or more fractures, age, being female and widowed were significant predictors for greater deterioration of HRQoL with the LR. CONCLUSION: This is the first study looking at the HRQoL in osteoporosis related fractures in Mexicans were quality of life deterioration on physical, social, and emotional functioning was demonstrated in subjects with two vertebral fractures. Age is a determining factor for greater deterioration in all studied domains. Differences between the samples obtained at the Clínica de Osteoporosis at the Instituto Nacional de Rehabilitación and the random population exemplifying that asymptomatic fractures are common and not diagnosed. It is important to scrutinize vertebral fractures at the first level because their timely detection allows for their evaluation and treatment and diminishes the probability of a second fracture. Our results can be generalized to men and women over 50 who live in the central megalopolis and in other states of the Valley of México.

Osteoporosis in patients with systemic lupus erythematosus.

In recent years the survival of patients with systemic lupus erythematosus has increased markedly. Consequently, long-term complications, such as osteoporosis, are currently of paramount importance. SLE is known to increase the risk of bone fractures, and numerous studies have found that SLE patients have osteoporosis. Of the various risk factors associated with osteoporosis in SLE, disease duration, the use of corticosteroids and chronic disease-related damage are consistently reported, with differences between studies probably due to the different populations studied. The role of chronic inflammation in osteoporosis is also important. On the other hand, little attention has been paid to osteoporotic fractures, especially of the vertebra, which are associated with reduced quality of life, increased mortality rates and increased risk of new vertebral and non-vertebral fractures in the general population.

Osteoporosis: una área dinámica de la medicina: recomendaciones internacionales en el año 2000 para diagnóstico y tratamiento / Osteoporosis: a dynamic area from medicine: international recomendation at 2000 to diagnosis and treatment

En los últimos 20 años ha habido grandes avances en el conocimiento de la patogenia, manifestaciones clínicas, factores de riesgo, diagnóstico temprano (antes de que aparezcan las fracturas), prevención y tratamiento de la osteoporosis. En 1994 la OMS propuso criterios diagnósticos en base a la medición de la masa ósea y reconoció la utilidad de la densitometría ósea para evaluar "riesgo de fractura" en la mujer posmenopaúsica de raza blanca caucásica. Estos han sido utilizados mundialmente con fines epidemiológicos, de investigación clínica y estrategias de tratamiento, sin embargo no han sido universalmente aceptados por la comunidad científica internacional ya que se reconoce que tienen ciertas limitaciones: I) podrían no ser aplicables a mujeres postmenopaúsicas de otras razas o al diagnóstico de osteoporosis en hombres. II) el criterio diagnóstico de osteoporosis valor ü T ñ 2.5 desviación estándar (DS) con respecto a la densidad ósea promedio de la población joven ha sido validado para predecir fractura de cadera de mujeres postmenopaúsicas caucásicas, sin embargo podría no ser aplicable a otros sitios anatómicos (antebrazo, columna, calcáneo, etc) ni aplicarse a otras técnicas de medición de la masa ósea que no sea absorciometría dual de rayos X (DXA) como ultrasonido o tomografía axial cuantitativa. Recientemente el comité científico de la "International Osteoporosis Foundation" revisó éstos criterios diagnósticos de la OMS, propuso algunos cambios y hace énfasis en que estos criterios diagnósticos por densitometría ósea no deben ser utilizados necesariamente como niveles de intervención terapéutica. La decisión por parte del médico en cuanto a la administración de tratamiento para osteoporosis debe basarse no solo en el estado de la masa ósea sino también en otros factores de riesgo para presentar fracturas por osteoporosis y un análisis cuidadoso individual del riesgo y costo-beneficio de los distintos agentes terapéuticos, algunos de ellos con un alto costo y no exentos de efectos indeseables.