Bone mineral density and bone turnover in non-cirrhotic patients with chronic hepatitis C and sustained virological response to antiviral therapy with peginterferon-alfa and ribavirin.

UNLABELLED: Patients with chronic hepatitis C have low bone mineral density and increased bone resorption related to serum transaminase levels. Elevated serum soluble tumor necrosis factor (sTNFR-55) receptor levels may play a role in the bone mass loss in these patients. Bone mass is improved and bone turnover normalized in patients who respond to antiviral therapy with interferon and ribavirin. INTRODUCTION: Low bone mineral density (BMD) has been described in patients with chronic hepatitis C (HCV). The study objective was to evaluate the effect of antiviral therapy on BMD and bone metabolism in non-cirrhotic HCV patients with sustained virological response. METHODS: We conducted a prospective study in 36 consecutive outpatients from the general community with non-cirrhotic HCV and an early and sustained virological response to peginterferon-alfa and ribavirin therapy. Determinations of BMD (dual X-ray absorptiometry at lumbar spine and femoral neck) and biochemical measurements of bone metabolism and sTNFR-55 were made at baseline, after 24 and 48 weeks of antiviral therapy, and at 48 weeks after the end of treatment. RESULTS: Patients had a significantly reduced BMD, which significantly increased during the follow-up. Serum levels of sTNFR-55 and bone turnover markers were increased at baseline and significantly reduced at all subsequent time points. We found an inverse correlation between BMD and both serum aminotransferase levels and urine deoxypyridinoline (D-pyr) and a positive correlation between serum aminotransferases and both urine D-Pyr and serum sTNFR-55. CONCLUSIONS: Patients with chronic hepatitis C have low bone mass associated with increased bone resorption, and some relationship can be expected between serum aminotransferase levels and the degree of bone mass loss. Bone mass may be improved and bone turnover normalized in patients who respond to antiviral therapy. Elevated serum sTRFR-55 levels may play a role in the bone mass loss of these patients.

Impact of a 'school-based' nutrition intervention on anthropometric parameters and the metabolic syndrome in Spanish adolescents.

BACKGROUND/AIMS: In adolescents, overweight and obesity are associated with an increased cardiovascular risk. The aim of this study was to determine the impact of a school-based nutritional education program (NEP) on lifestyle changes in Spanish adolescents. METHODS: We selected 263 secondary school students (127 males) aged 12-16 years from Granada (Spain), who were followed up throughout 1 school year (2009-2010). At the beginning and end of the school year, data were gathered on the food consumption frequency, and anthropometric and biochemical profile. The NEP comprised a class on nutritional recommendations every 15 days, and administration of a daily breakfast of 275-350 kcal. RESULTS: After the intervention, the prevalence of overweight and obesity decreased among both male and female students (p < 0.001) and there was also a global reduction in the prevalence of the metabolic syndrome (MS) from 32.2 to 19.7% (p < 0.001); in addition, body mass index was significantly decreased in normal weight, overweight and obesity groups (p = 0.001 and p = 0.02, respectively), and high-density-lipoprotein cholesterol and lean body mass was increased in all groups (p = 0.001). CONCLUSION: The NEP achieved a medium-term reduction in the prevalence of overweight and obesity and had a significant and positive effect on MS components in all groups.

El polimorfismo K121Q del gen PC-1 no está asociado con alteración del metabolismo de la glucosa ni riesgo cardiovascular en mujeres con diabetes mellitus gestacional previa / The K121Q polymorphism of the PC-1 gene is not associated with abnormal glucose tolerance or cardiovascular risk factors in women with previous gestational diabetes mellitus

Introducción: Las pacientes diagnosticadas de diabetes mellitus gestacional(DMG) son una población de riesgo para desarrollar diabetes a largo plazo. Laresistencia a la insulina se relaciona tanto con factores ambientales como genéticos,entre ellos, el polimorfismo K121Q del gen que codifica la proteínaPC-1, aunque existe controversia en la bibliografía especializada. Objetivos:Examinar si el polimorfismo K121Q se asocia con alteración del metabolismode la glucosa y/o síndrome metabólico en la DMG. Material y métodos: Seestudiaron, en el posparto, 97 mujeres mediante sobrecarga oral de glucosa(SOG) y diferentes variables clínicas, analíticas y genotipos del codón 121 delgen de la proteína PC-1. Resultados: Un 61% presenta una tolerancia normala la glucosa, un 29% prediabetes y un 10% diabetes mellitus. No hubodiferencias significativas para la presencia del alelo 121Q entre las pacientescon y sin tolerancia normal a la glucosa o diabetes, ni con las variables relacionadascon el síndrome metabólico. Conclusiones: Aunque se necesitanmás estudios poblacionales, el polimorfismo K121Q no está relacionado, eneste estudio, con alteración del metabolismo de la glucosa o riesgo cardiovascularen mujeres con DMG previa(AU)

Introduction: Women suffering gestational diabetes mellitus (GDM) are a riskgroup for diabetes at long-term. Insulin resistance is related to environmentaland genetic factors. Controversial data exists about association betweenK121Q PC-1 gene polymorphism and diabetes, obesity and/or insulin resistance.The aim of the study was to investigate the relationship between K121QPC-1 gene polymorphism and the glucose metabolic alterations or metabolicsyndrome variables. Patients and methods: 97 women with previous GDMwere reclassified by means of oral glucose tolerance test in the early postpartum.Anthropometric, biochemical and K121Q genotypes frequencies werestudied. Results: 61% of the patients had normal glucose tolerance, 29%met diagnostic criteria of prediabetes, and 10% diabetes mellitus. No significantdifferences in the 121Q allele have been found between women with andwithout glucose intolerance, diabetes or metabolic parameters associated withmetabolic syndrome. Conclusion: Although further poblational studies arenecessary, in this study, the K121Q PC-1 gene polymorphism is not associatedwith type 2 diabetes, glucose intolerance or cardiovascular risk factors inwomen with previous GDM(AU)

Effects of risedronate on metabolic bone disease in patients with type 1 diabetes and osteoporosis

Evaluar el efecto de un antirresortivo sobre la masa ósea y los marcadores del remodelado óseo en pacientes con diabetes mellitus tipo 1 (DM-1) y osteoporosis(OP). El estudio incluyó 52 pacientes con DM-1 con una duración de 21 a 36 años y OP u osteopenia, con edades comprendidas entre los 26 y los 69 años. Los pacientes con OP recibieron 30 mg/semana de risedronato (n = 35) ycalcio + vitamina D; mientras que los pacientes con osteopenia y los que rechazaron el risedronato (n = 17) sólo recibieron calcio + vitamina D. A los 12meses, el grupo con risedronato demostró una mejora significativa en los niveles de fosfatasa ácida resistente al tartrato (FART) (p < 0,0001), proteína óseaGla (BGP por sus siglas en inglés) (p < 0,0001), fosfatasa alcalina ósea (FAO) (p < 0,0001) y hemoglobina A1c (HbA1c) (p < 0,0001). La densidad mineralósea (DMO) fue aumentada a 6 y 12 meses comparado con el nivel basal en la columna (CL) (p < 0,0001) y el cuello femoral (CF) (p < 0,0001). A los 12 meses, el grupo convencional demostró una mejora significativa en HbA1c (p < 0,012) y una reducción en BGP (p < 0,03) y en FAO (p<0,0001). El grupo con tratamiento convencional no demostró cambios significativos en la DMO en la CLy el CF durante el periodo de 12 meses. El tratamiento con risedronato mejora la DMO en pacientes con DM-1 crónica

To assess the effect of a antiresorptive on bone mass and remodeling markers in patients with type 1 diabetes mellitus (DM-1) and osteoporosis (OP). Studyincluded 52 patients with DM-1 of 21-36 years duration and OP or osteopenia, aged 29-69 years. OP patients received 30 mg/week risedronate (n = 35)and calcium + vitamin D; osteopenic patients and risedronate refusers (n = 17) received only calcium + vitamin D. At 12 months, the risedronate group showedsignificant improvements in tartrate resistant acid phosphatase (p < 0.0001), osteocalcin (BGP) (p < 0.0001), bone alkaline phosphatase (BAP) (p < 0.0001),and hemoglobin A1c (HbA1c) (p < 0.0001); bone mineral density (BMD) was increased at 6 and 12 months versus baseline in lumbar spine (LS) (p < 0.0001) and femoral neck (FN) (p < 0.0001). At 12 months, the conventional group showed a significant improvement in HbA1c (p < 0.012) and reduction in BGP (p < 0.03) and BAP (p < 0.0001). The conventional treatment group showedno significant changes in BMD at LS and FN during the 12-month period. Risedronate treatment improves BMD in long-term DM-1 patients (AU)

Effects of raloxifene therapy on circulating osteoprotegerin and RANK ligand levels in post-menopausal osteoporosis.

Previous in vitro studies suggest that the anti-resorptive effect of raloxifene might be mediated by changes in several cytokines involved in the bone remodeling process. In this context, the osteoprotegerin (OPG)- receptor activator of NF kappa B ligand (RANKL) system is considered a key component in the osteoclastogenesis regulation. The aim of this study was to determine the effects of raloxifene treatment on serum concentrations of OPG, receptor RANKL and its relationship with biochemical markers of bone turnover and bone mineral density (BMD) in previously untreated women with post-menopausal osteoporosis. We selected 47 post-menopausal women (mean age 63+/-7 yr) with densitometric criteria of osteoporosis. We determined at baseline, 3, 6, and 12 months anthropometric parameters, biochemical markers of bone turnover, serum levels of 25(OH) D, serum levels of OPG and RANKL. BMD (dual-energy x-ray absorptiometry) in lumbar spine (LS) femoral neck and total hip was measured at baseline and 12 months after raloxifene (60 mg/day) treatment. Serum levels of OPG decreased in the 3rd and 6th month of treatment (p<0.001) and returned to basal levels in the 12th month. There was a significant decrease of RANKL levels and OPG/RANKL ratio after 1 yr of raloxifene treatment. In addition, BMD in LS increased significantly (2.5%) in the 12th month of treatment (p=0.031). Finally, the biochemical markers of bone turnover (total alkaline phosphatase, bone alkaline phosphatase, osteocalcin, tartrate-resistant acid phosphatase, urine cross-linked carboxi-terminal telopeptide of type I collagen) decreased significantly from the 3rd month of treatment. In conclusion, our results support the hypothesis that raloxifene may inhibit osteoclast activity, at least partly modulating the OPG-RANKL system.

Long-term efficacy and tolerability of flutamide combined with oral contraception in moderate to severe hirsutism: a 12-month, double-blind, parallel clinical trial.

OBJECTIVE: Our objective was to test the efficacy and tolerability of three doses of flutamide (125, 250, and 375 mg) combined with a triphasic oral contraceptive (ethynylestradiol/levonorgestrel) during 12 months to treat moderate to severe hirsutism in patients with polycystic ovary syndrome or idiopathic hirsutism. DESIGN: We conducted a randomized, double-blind, placebo-controlled, parallel clinical trial. PATIENTS: A total of 131 premenopausal women, suffering from moderate to severe hirsutism, were randomized to placebo or 125, 250, or 375 mg flutamide daily associated with a triphasic oral contraceptive pill. Hirsutism (Ferriman-Gallwey), acne and seborrhea (Cremoncini), and hormone serum levels were monitored at baseline and at 3 (except hormone serum levels), 6, and 12 months. Side effects and biochemical, hematological, and hepatic parameters were assessed. METHODS: We used three-way ANOVA (subject, dose, and visit) with Scheffé adjustment for multiple comparisons or nonparametrical Friedman test and least-squares mean (paired data) and Kruskall-Wallis test for unpaired data analyses. We used chi(2) or Fisher's test for categorical data. RESULTS: A total of 119 patients were included in the intention-to-treat analysis. All flutamide doses induced a significant decrease in hirsutism, acne, and seborrhea scores after 12 months compared with placebo without differences among dose levels. Similar related side effects were observed with placebo and 125 mg flutamide (12.5%), and slightly higher with 250 mg (17.3%) and 375 mg (21.2%). No statistically significant differences were observed either among doses or compared with placebo. CONCLUSIONS: Flutamide at 125 mg daily during 12 months was the minimum effective dose to diminish hirsutism in patients with polycystic ovary syndrome or with idiopathic hirsutism.

Entre el hirsutismo y el síndrome del ovario poliquístico: análisis desde una perspectiva histórica / From hirsutism to polycystic ovary syndrome: a historical analysis

Al abordar el perfil histórico del síndrome del ovario poliquístico (SOP), la realidad histórica es el aumento de vello en la mujer, la propia depilación, cuadros famosos o cerámicas y miniaturas, exhibiciones circenses, etc., cuyo origen es una mujer hirsuta. Unos 4.000 años a. C., imágenes sobre barro o seda, así como en los lienzos, destacan el vello en la cara y en las zonas malares, preauriculares o el mentón, y añaden el concepto de ¿mujer recia¿, que puede alcanzar connotaciones mágicas y espirituales o meramente estéticas. Al unirse la depilación, aparece un carácter erótico-sexual, pues ésta puede contener matices afrodisíacos. Muy conocidas es la ¿mujer con barba¿ (Brígida del Río, 1590), exhibida en palacios y ferias e inmortalizada por un monje, Fray Juan Sánchez Cotán, o la Mujer barbuda, pintada por J. Ribera (1595-1652). Añadimos 2 cuadros de J. Carreño de Miranda, en que se refiere a la mujer como una ¿monstrua¿, vestida y desnuda, y donde junto al diagnóstico de hirsutismo se podría incluir el de un síndrome de Cushing o alguna otra endocrinopatía relacionada con el ovario y la obesidad abdominal. Con el tiempo, personajes como Madame Taylor, en Estados Unidos, que deja de afeitarse a los 18 años para exhibirse, o Clementine Delait (1865-1939), que fundará el Café de la Femme à Barbe, iniciarán el acercamiento definitivo al siglo xiX, momento en que se sugiere la existencia de una alteración orgánica en el aumento del vello. El Dr. Cooke, en 1756, en una conferencia describió la coincidencia del hirsutismo y la obesidad. Posteriormente, los Drs. Bérillon, Pinard y Gallis, así como el Dr. G. Marañón, convierten esta enfermedad en algo más. La publicación de Brown (1928) Diabetes of bearded womanañade la insulina a una enfermedad cuya tutoría integral la confirmaría la descripción de Stein y Leventhal, en 1935, que implica el hiperandrogenismo y los ovarios portadores de quistes. Las últimas décadas transforman los hechos en un síndrome, se profundiza en su historia natural, su multifactorialidad, su carácter poligénico y su relación con otras enfermedades. Ahora se abren unas expectativas terapéuticas que cada vez se alejan más de la depilación, la infertilidad y la propia discriminación por causas desconocidas (AU)

The historical profile of polycystic ovary syndrome (PCOS) includes increased hair growth in women, hair removal, famous paintings, ceramics and miniatures, and circus exhibits, etc., the origins of which lie in hirsute women. Some 4,000 years B.C., images on earthenware, silk, and canvas clearly show hair on the face, cheeks, preauricular area, or chin. The concept of the ¿strong woman¿ was born, which could have magic and spiritual connotations, as well as purely esthetic ones. When combined with depilation, an erotic-sexual figure emerges, since this figure could have aphrodisiac qualities. Well known are the ¿woman with a beard¿ (Brígida del Río, 1590), exhibited in palaces and fairs and immortalized by the monk, Fray Juan Sánchez Cotán, and the Bearded lady, painted by J. Ribera (1595-1652). Two paintings by J. Carreño de Miranda portray the woman as a ¿monster¿, dressed and naked, in which, together with hirsutism, Cushing¿s syndrome, other ovarian-related endocrine disorders, and obesity, can be discerned. Figures such as Madame Taylor in the United States, who stopped shaving at the age of 18 to become a circus freak, or Clementine Delait (1865-1939), who founded the Café de la Femme à Barbe, lead up to the xiX century, when the existence of an organic alteration in hirsutism was suggested. At a conference in 1756, Dr. Cooke described the association of hirsutism and obesity. Subsequently, Drs. Bérillon, Pinard and Gallis, as well as Dr. G. Marañón, converted this disease into something else. The publication of ¿Diabetes of bearded women¿ by Brown (1928) added insulin to a disease that would first be described by Stein and Leventhal in 1935, who implicated hyperandrogenism and polycystic ovaries. In the last few decades of the century, these findings were classified into a syndrome, whose natural history, multifactorial and polygenic nature, and association with other diseases would be elucidated in greater depth. Therapeutic possibilities are currently being developed, which are far removed from hair removal, infertility and discrimination due to unknown causes (AU)

Encuesta sobre práctica clínica en el hiperparatiroidismo primario / Survey on clinical practice in primary hyperparathyroidism

Una reciente conferencia de consenso, promovida por los National Institutes of Health y la Endocrine Society, ha establecido un conjunto de recomendaciones para el tratamiento del hiperparatiroidismo primario en la práctica clínica. Sin embargo, no se conoce los grados de conocimiento y de cumplimiento de estas recomendaciones por parte de los endocrinólogos españoles. En este artículo se revisan las recomendaciones del consenso y se presenta una encuesta elaborada por el Grupo de Trabajo de Metabolismo Mineral Óseo de la SEEN

A recent consensus conference, promoted by the National Institutes of Health and the Endocrine Society, has established a set of recommendations for the management of primary hyperparathyroidism in clinical practice. However, the degree of awareness of and compliance with these recommendations by Spanish endocrinologists is unknown. The present article reviews the consensus recommendations and presents a survey designed by the Working Group for Bone Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition

[What is the opinion of Spanish internists on osteoporosis?]. / 'Qué opinan los internistas españoles de la osteoporosis?

OBJECTIVE: To conduct an opinion survey on osteoporosis in Spanish internists. METHOD: Survey sent by mail and by personal visit to members of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment. RESULTS: A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to densitometry. CONCLUSIONS: The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases.

¿Qué opinan los internistas españoles de la osteoporosis? / What is the opinion of Spanish internists on osteoporosis?

Objetivo. Realizar una encuesta de opinión sobre osteoporosis en internistas españoles. Método. Encuesta remitida por correo y por visita personal a miembros de la Sociedad Española de Medicina Interna. Recogida de datos sobre opinión acerca de la enfermedad, actitud diagnóstica y terapéutica y medios disponibles (analítica general, radiología convencional, marcadores bioquímicos de remodelamiento óseo, densitometría y ultrasonidos) y preferencias a la hora de elegir un determinado tratamiento. Resultados. Contestaron un total de 538 internistas. Más del 90% de los encuestados opina que la osteoporosis es una enfermedad que deben tratar los internistas. El 93% considera que la osteoporosis es una patología prevalente. Más del 80% tiene acceso a una densitometría. Conclusiones. Los internistas españoles opinan mayoritariamente que la osteoporosis es una enfermedad que deben tratar los internistas y que entra en su ámbito de actuación. Por lo general disponen de los medios que necesitan para su estudio y tratamiento. Los bifosfonatos constituyen el fármaco de elección y en la práctica totalidad de los casos indican un suplemento de calcio y vitamina D

Objective. To conduct an opinion survey on osteoporosis in Spanish internists. Method. Survey sent by mail and by personal visit to member of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment. Results. A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to a densitometry. Conclusions. The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases

Hueso: tratamiento de la osteoporosis / Bone: osteoporosis therapy?

Hoy día se considera que la osteoporosis es un problema de salud pública que justifica la implementación de medidas preventivas y terapéuticas eficaces. El objetivo primario debe ser prevenir la primera fractura y preservar la integridad ósea, aumentando la masa ósea y mejorando la calidad del hueso. Los suplementos de calcio y vitamina D deben recomendarse en todos los individuos de riesgo, y cuando estén indicados deben administrarse fármacos antiosteoporóticos. La evidencia aporta resultados satisfactorios con los fármacos antirresortivos usados actualmente; además, futuros agentes anabólicos permitirán establecer pautas combinadas de tratamiento (AU)

Performance of quantitative ultrasound in the discrimination of prevalent osteoporotic fractures in a bone metabolic unit.

There is a growing interest in ultrasound evaluation of bone status as an alternative to the measurement with dual X-ray absorptiometry (DXA), due to its low cost, portability, and nonionizing radiation. The aim of our study was to investigate the relation among DXA, QUS, clinical, anthropometric, and lifestyle factors, and to determine QUS cutoff values in order to discriminate fractures in patients referred to the Bone Metabolic Unit at an Endocrinology Service. We studied 300 patients (281 females and 19 males; age 58 +/- 11 years) referred for evaluation of osteoporosis. In all cases we determined basic anthropometric parameters, a clinical history including previous osteoporotic fractures and risk factors for osteoporosis, and QUS parameters in calcaneus (Hologic Sahara), and BMD in lumbar spine (LS) and femoral neck (FN), by DXA (Hologic QDR 1000). Using the WHO densitometric criteria, 37, 46.7, and 16.3% of our population were osteoporotic, osteopenic, and normal, respectively. A QUI T-score

Bone mineral density in hypoparathyroid women on LT4 suppressive therapy. Effect of calcium and 1,25(OH)2 vitamin D3 treatment.

Our aim was to study the bone mineral density (BMD) of patients with chronic hypoparathyroidism (hypoPTH) after longterm calcium and vitamin D treatment. Twenty hypoPTH women (mean-/+SD, aged 50-/+15 years, IPTH 4-/+6 pg/ml) and 20 matched euparathyroid women (euPTH) after near total thyroidectomy for thyroid cancer, completed with I-131 ablation and on suppressive therapy with L-Thyroxine (LT(4)), were studied. In addition eight hypoPTH patients who were receiving LT(4) replacement therapy after surgery for compressive goiter were simultaneously studied. The hypoPTH patients were on calcium and 1,25(OH)(2) vitamin D(3) therapy to normalize serum calcium. Bone mineral density (BMD) (DXA, at the lumbar spine [L(2)- L(4), LS], femoral neck [FN] and Ward triangle [WT]), serum and urine calcium, serum phosphorus, TOTALALP and osteocalcin were measured. Patients with hypoPTH showed greater lumbar BMD than euPTH patients on suppressive therapy (Z-score; 1.01-/+1.34 vs. -0.52-/+0.70, p<0.05). Serum osteocalcin levels were higher in hypoPTH patients on suppressive therapy compared to hypoPTH patients on replacement therapy. The LS BMD from hypoPTH patients correlated with calcium supplements (r=0.439; p=0.02), 1,25(OH)(2)D(3) dose (r=0.382; p=0.04) and LT(4) dose (r=0.374; p=0.05). Our data suggest that long-term treatment with calcium and 1,25(OH)(2) vitamin D3 supplements in hypoPTH patients on suppressive LT4 therapy results in increased BMD when compared with patients with normal PTH levels.

Performance of COLIA1 polymorphism and bone turnover markers to identify postmenopausal women with prevalent vertebral fractures.

Some studies have suggested that bone turnover markers (BTM) and collagen type I alpha 1 gene (COLIA1) may be useful in the prediction of rates of future bone loss, and may therefore provide information about fracture risk. Our study aimed to examine the association of the COLIA1 genotype with the risk of vertebral fracture and to investigate the predictive value of this genetic factor in comparison with bone mineral density (BMD) and BTM, in ambulatory postmenopausal Spanish women. We determined the COLIA1 polymorphism by polymerase chain reaction, BMD by dual-energy X-ray absorptiometry and BTM in 43 postmenopausal women with prevalent vertebral fracture and a control group of 101 postmenopausal women without fracture. There was a significant overrepresentation of the 'T' allele in fractured women ( p = 0.029). BTM exhibited no differences between women with or without fractures or COLIA1 genotype groups. After adjusting for all other variables, the osteoporosis densitometric criteria variable was the most strongly associated with fracture (OR = 5 [1.8-13.3]) followed by COLIA1 (OR = 2.1 [1-4.3] per copy of the 'T' allele). Our study shows that COLIA1 is associated with prevalent vertebral fracture independently of bone mass, and the performance of this genetic factor to assess prevalent vertebral fracture is better than bone turnover markers.

Análisis farmacoeconómico del tratamiento de la osteoporosis postmenopaúsica con risedronato o alendronato / Pharmacoeconomic analysis of the treatment of postmenopausal osteoporosis with risedronate of alendronate

Se realizó un análisis coste-efectividad del tratamiento de la osteoporosis postmenopáusica con risedronato o alendronato semanal, utilizándose un modelo de Markov y costes españoles. La reducción del riesgo de sufrir fractura de cadera fue, en pacientes con o sin fractura vertebral previa, del 60 por ciento y 40 por ciento con risedronato y del 51 por ciento y 21 por ciento con alendronato. La reducción del riesgo de fractura vertebral fue, en pacientes con fractura vertebral previa del 45 por ciento y del 55 por ciento con risedronato y alendronato respectivamente. El coste por fractura de cadera evitada (en mujeres tratadas a partir de los 70 años, con o sin fractura vertebral previa, y después de 10 años de tratamiento) osciló con risedronato entre 54.134 y 84.287 euros; con alendronato los costes fueron mayores: 67.853 y 173.748 euros. El coste por año de vida ajustado por calidad (AVAC) fue, así mismo, menor con risedronato (43.601-61.064 euros) que con alendronato (49.48388.634) en pacientes con o sin fractura vertebral previa. Risedronato es más coste-efectivo que alendronato de administración semanal. (AU)

Bone mineral density at time of clinical diagnosis of adult-onset type 1 diabetes mellitus.

OBJECTIVE: To study bone mineral density (BMD) and bone remodeling factors at the time of diagnosis of adult-onset type 1 diabetes mellitus (DM). METHODS: In 22 men and 10 women, who ranged in age from 20 to 39 years, a study was undertaken promptly after diagnosis of type 1 DM (on the basis of criteria established by the World Health Organization). Before any treatment, the clinical history, glycemia, ketonuria, basal and glucagon-stimulated C-peptide levels, islet cell antibodies (ICA), glutamic acid decarboxylase autoantibodies (GADA), and bone remodeling variables were recorded for all the study subjects. Dual-energy x-ray absorptiometry (Hologic QDR1000) was performed to measure BMD in the lumbar spine (LS), femoral neck (FN), and Ward's triangle. RESULTS: Of the 32 patients, 24 (75%) showed positive levels of ICA or GADA (or both), whereas 8 (25%) tested negative. The BMD values-Z-scores (standard deviation [SD] adjusted for age and sex)-were lower among the patients with DM than in a matched healthy population in both the LS (-0.61 +/- 1.23 SD; P = 0.008) and the FN (-0.38 +/- 1.00 SD; P = 0.003). Twelve patients had a T-score between -2.5 SD and -1 SD in the LS, and 14 had the same scores in the FN and were classified as having osteopenia. A correlation was found between BMD values and C-peptide levels in the LS (r = 0.231; P = 0.02) and the FN (r = 0.27; P = 0.01). The BMD values did not correlate with bone remodeling markers, hemoglobin A1c, or immunologic variables. CONCLUSION: We found reduced bone mass in patients with type 1 DM at the time of the clinical diagnosis. A high percentage of patients with DM have osteopenia, which may not, therefore, be a late complication of type 1 DM. These findings need to be confirmed in larger studies.

Relation between vitamin D insufficiency, bone density, and bone metabolism in healthy postmenopausal women.

Although only few postmenopausal women exhibit biochemical signs of hypovitaminosis D, vitamin D insufficiency has been shown to have adverse effects on bone metabolism and could be an important risk factor for osteoporosis and fracture. We determined serum levels of 25-hydroxyvitamin D [25(OH)D], intact parathyroid hormone (iPTH), bone turnover markers, dietary calcium intake, and bone mineral density (BMD; measured by dual X-ray absorptiometry) in 161 consecutive ambulatory women, healthy except for osteoporosis, referred to a bone metabolic unit. The prevalence of vitamin D insufficiency [25(OH)D < or = 15 ng/ml] was 39.1%. 25(OH)D was lower in the osteoporotic subjects (15.7 +/- 5.3 ng/ml vs. 21.8 +/- 9.7 ng/ml; p < 0.001). After controlling for all other variables, lumbar spine (LS) BMD was found to be significantly associated with 25(OH)D, body mass index (BMI), and years after menopause (YSM) (R2 = 0.253; p < 0.001). For femoral neck (FN), significant independent predictors of BMD were YSM, BMI, iPTH, and 25(OH)D (R2 = 0.368; p < 0.001). The probability of meeting osteoporosis densitometric criteria was higher in the vitamin D insufficiency group (odds ratio [OR], 4.17, 1.83-9.48) after adjusting by YSM, BMI, iPTH, and dietary calcium intake. Our study shows that vitamin D insufficiency in an otherwise healthy postmenopausal population is a common risk factor for osteoporosis associated with increased bone remodeling and low bone mass.

Hiperparatiroidismo subclínico: ¿arte o parte de un dilema clínico, social y económico? / Subclinic hiperparathyroidism:art or part of a clinical, social and economical dilema?

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Actualización clínica de la enfermedad tiroidea autoinmune / Clinical update in autoimmune thyroid disease

El estudio y tratamiento de la enfermedad tiroidea autoinmune (ETAI) ha ido cumpliendo distintas etapas de investigación en nuestro grupo. Los estudios iniciales en pacientes con enfermedad de Graves (EG) evidenciaron la implicación de la inmunidad celular al demostrar, mediante un test in vitro de inhibición de la migración linfocitaria (test MIF), la sensibilización al antígeno tiroglobulina 19S y cómo el tratamiento con antitiroideos de síntesis (ATS) ejercía un efecto inmunosupresor claro en el grupo de pacientes tratados comparados con aquellos que presentaban un hipertiroidismo activo sin tratamiento1,2. Posteriormente estudiamos las tasas de reactivación con las tres terapias utilizadas en la EG (ATS, cirugía y radioyodo) demostrando que el mayor porcentaje corresponde a los ATS (42 por ciento) con una incidencia máxima a los 24 meses3. En la última década se ha avanzado en el conocimiento etiopatogénico de la ETAI de forma espectacular paralelo al desarrollo de las técnicas moleculares. La identificación del antígeno tiroperoxidasa y la medida de anticuerpos antitiroperoxidasa (Ac-TPO) han desplazado en la clínica diaria a los clásicos anticuerpos antimicrosomales (Ac-MIC) como test diagnóstico en ETAI4.Dado que la ETAI es más prevalente en la mujer en edad fértil, no es desdeñable el papel que el embarazo y el posparto añaden a la evolución de la misma5,6. Los estudios epidemiológicos sobre ETAI en una cohorte importante de gestantes antes de la semana 16 de gestación han puesto de manifiesto que un 9 por ciento presentan títulos positivos de Ac-TPO. A pesar del descenso en los títulos en el último trimestre de embarazo, la progresión hacia un hipotiroidismo clínico o subclínico está asociado con los valores de TSH y con la presencia de Ac-TPO en el primer trimestre7,8.El estudio de los mecanismos etiopatogénicos de la tiroiditis autoinmune (TA), que desde un punto de vista clínico aparece con deficiente función tiroidea y necesidad de tratamiento sustitutivo, cobra actualmente gran relevancia. En su patogenia ya conocemos el papel que desempeñan los Ac-TPO y/o anticuerpos bloqueadores de TSH a su receptor (TBII); sin embargo, no está bien establecida la implicación que tienen otros inmunomoduladores como las interleucinas (IL), el factor de necrosis tumoral (TNF) o el interferón (IFN), en el daño de la célula tiroidea. Otro problema aún sin resolver y de máxima actualidad, por las importantes implicaciones pronósticas y terapéuticas, es el de discernir qué pacientes pueden beneficiarse de la retirada del tratamiento sustitutivo con hormona tiroidea que se instaura como una sentencia de por vida. No hay estudios a largo plazo y, sobre todo, no son conocidos los factores pronósticos, de tipo inmune o genéticos, que puedan contestar a esta pregunta. La terapéutica con hormona tiroidea no está exenta de riesgos, fundamentalmente en el ámbito cardiovascular y del sistema óseo9, por lo que habría que evitar tratamientos injustificados (AU)