Diferente evolución de la esclerostina sérica respecto de otros marcadores de remodelado óseo en el primer año tras un trasplante hepático / Different development of serum sclerostincompared to other bone remodeling markersin the first year after a liver transplant

Objetivo: Nuestro estudio tiene como objetivo principal valorar la evolución de los niveles de esclerostina en pacientes con trasplante hepático, e investigar su relación con otros marcadores de remodelado óseo. Material y método: Estudio observacional prospectivo. Se incluyeron 83 pacientes con trasplante hepático. Se determinaron los valores de esclerostina, β-crosslaps, fosfatasa alcalina ósea, osteocalcina y proteína C reactiva la semana anterior al trasplante y posteriormente, a los 1, 3, 6 y 12 meses. Se determinaron basalmente la 25 hidroxi-vitamina D y la paratohormona. En cada revisión se evaluó la existencia de fracturas. La evolución de los marcadores respecto del valor basal se determinó mediante la prueba t-Student. Un valor de p inferior a 0,05 se consideró estadísticamente significativo. Resultados: 56 varones y 27 mujeres (edad media: 56,2±10,4 años). Los niveles basales de esclerostina (0,76±0,35 ng/ml) disminuyeron de forma significativa precozmente (0,55±0,22 ng/ml en el primer mes, p=0,034), tendencia que se mantuvo hasta los 12 meses (0,62±0,22 ng/ml, p=0,047). Al contrario, los niveles basales de osteocalcina (17±10,3 ng/ml) y β-crosslaps (0,44±0,3 ng/ml) se incrementaron significativamente a los largo del estudio; en el caso de la osteocalcina, hasta los 12 meses (37,27±26,84 ng/ml, p<0,01) y el β-crosslaps, hasta los 6 meses (0,62±0,34 ng/ml, p<0,01), con un descenso posterior (0,47±0,31 ng/ml, p=0,2). Conclusiones: Tras el trasplante hepático existe un descenso de los niveles de esclerostina, opuesto a la elevación de otros marcadores de remodelado, β-crosslaps y osteocalcina. Son necesarios más estudios para determinar si estos cambios tienen un impacto en la aparición de osteoporosis en pacientes sometidos a trasplante

Objetive:Our main objective was to evaluate the development of sclerostin levels in patients with liver transplantation,and to investigate their relationship with other bone remodeling markers.Material and method:Prospective observational study of 83 patients with liver transplantation. Sclerostin, β‐crosslaps,bone alkaline phosphatase, osteocalcin and C‐reactive protein values were determined the week before the transplantand subsequently, at 1, 3, 6 and 12 months. The hydroxy‐vitamin D and the paratohormone were determined basally. Ineach revision, the existence of fractures was evaluated. The development of the markers compared to the baseline valuewas determined by the t‐Student test. A p‐value less than 0.05 was considered statistically significant.Results:56 men and 27 women (mean age: 56.2±10.4 years). Baseline sclerostin levels (0.76±0.35 ng/ml) decreasedsignificantly early (0.55±0.22 ng/ml in the first month, p=0.034), a trend that remained until 12 months (0.62±0.22ng/ml, p=0.047). On the contrary, the basal levels of osteocalcin (17±10.3 ng/ml) and β‐crosslaps (0.44±0.3 ng/ml) in‐creased significantly throughout the study; in the case of osteocalcin, up to 12 months (37.27±26.84 ng/ml, p<0.01) andβ‐crosslaps, up to 6 months (0.62±0.34 ng/ml, p<0.01), with a subsequent decrease (0.47±0.31 ng/ml, p=0.2).Conclusions:There is a decrease in the levels of sclerostin after liver transplantation, as opposed to the elevation ofother markers of remodeling, β‐crosslaps and osteocalcin. More studies are needed to determine if these changes havean impact on the occurrence of osteoporosis in patients undergoing transplantation

Hormonas tiroideas, TSH, cáncer de tiroides y hueso en mujeres pre y postmenopáusicas / Thyroid hormones, TSH, thyroid cancer and bones in pre- and postmenopausal women

En los últimos años se han realizado progresos en el conocimiento de la regulación del desarrollo del esqueleto y del mantenimiento de la masa ósea del adulto por el eje hipotálamo-hipófisis-tiroides. Se han hecho estudios sobre el efecto de las hormonas tiroideas sobre el osteoblasto, osteoclasto y el condrocito, que han implicado un mejor conocimiento genético y fisiológico de la acción celular de estas hormonas. Recientemente se han propuesto posibles intervenciones de las deiodinasas D2 en la osteoporosis, e incluso se ha señalado la relación entre la densidad mineral ósea, la calidad del hueso y el riesgo de fracturas con las hormonas tiroideas en mujeres postmenopáusicas normales, lo que sugiere un papel de estas hormonas, incluso dentro del rango de la normalidad tiroidea, en estas patologías. Por otro lado, la incidencia del cáncer diferenciado de tiroides, modelo experimental in vivo de la supresión de la hormona tiroidea por la terapia preventiva de recidivas, ha aumentado significativamente. Existen guías clínicas para su manejo, pero es evidente que los posibles efectos secundarios derivados requieren una precisa indicación ajustada al balance riesgo-beneficio de la dosificación de las hormonas tiroideas, prescritas a largo plazo, especialmente en los casos de baja agresividad tumoral, edad avanzada e incluso en pacientes frágiles. Las pacientes con elevado riesgo, deben ser referidas para una densitometría ósea, para considerar el tratamiento de futuras fracturas. La prevención de osteoporosis, en particular en la mujer postmenopáusica, es altamente conveniente y debe incluir dieta adecuada en calcio y suplementación de vitamina D si es necesario. No existe aún un consenso sobre el tratamiento de la osteoporosis en la paciente con cáncer de tiroides y tratamiento supresor, pero los criterios indicados para la osteoporosis postmenopáusica en general parecen aplicables (AU)

In recent years, progress has been made in regulating skeletal development and maintenance of bone mass of the adult by the hypothalamus-pituitary-thyroid axis. Studies have been carried out into the effect of thyroid hormones on the osteoblasts, osteoclast and the chondrocyte. This research has led to better genetic knowledge into the physiology of the cellular action of these hormones. Recently, possible D2 deodinase interventions in osteoporosis have been proposed. The link between bone mineral dignity, bone quality and the risk of fractures with thyroid hormones in normal postmenopausal women suggest a role for these hormones, even within the range of normal thyroid, in these diseases. On the other hand, the incidence of differentiated thyroid cancer, experimental in vivo thyroid hormone suppression by therapy, recurrent disease, has increased significantly. There are management guides, but it is clear that the secondary derivatives require a precise balance-adjusted indication, risk-benefit ratio of thyroid hormone dosage, prescribed long term, especially in cases of low tumor aggressiveness, advanced age and even in fragile patients. High risk patients should be referred for a bone densitometry, to consider treating future fractures. Prevention of osteoporosis, particularly in postmenopausal women, is highly desirable and should include adequate diet in calcium and vitamin D supplementation if necessary. There is still no consensus on osteoporosis treatment in the patient with thyroid cancer and suppressive treatment, but the indicated criteria for postmenopausal osteoporosis seem to be applicable in general (AU)

Deficiencia de vitamina D: ¿la estamos identificando bien? / Vitamin D deficiency: are we identifying it properly?

No disponible

Serum Levels of Osteocalcin and Insulin Resistance in Patients with Impaired Glucose Tolerance or New-Onset Diabetes Mellitus After Liver Transplantation.

Liver transplantation (LT) patients are at high risk of developing new-onset diabetes after transplantation (NODAT). Osteocalcin has been proposed as a mediator between bone tissue and glucose metabolism, but its role in the pathogenesis of diabetes is not defined yet. Our objective was to assess the relationship between serum osteocalcin and glucose metabolism parameters in liver transplantation recipients. A total of 187 liver transplantation patients were cross-sectionally studied, 54 of them developed NODAT. None had been diagnosed of diabetes mellitus prior to transplant. In 133 nondiabetic patients, a 75 g oral glucose tolerance test (OGTT) was performed to assess blood glucose, insulin, and C-peptide levels at baseline and 120 min. Serum total osteocalcin was measured at baseline in all patients.After OGTT, 10.5% of LT patients had NODAT criteria, 51.9% showed impaired glucose tolerance, and 37.6% had normal glucose tolerance. Overall, NODAT prevalence was 36.3%. HOMA-IR was significantly higher in NODAT compared with impaired glucose tolerance and normal glucose tolerance groups (p<0.001). Osteocalcin was inversely correlated to HOMA-IR (r=- 0.16, p=0.05), BMI (r=- 0.27, p=0.000) and waist circumference (r=- 0.21, p=0.005). Patients in the lowest osteocalcin tertile (< 16.5 ng/ml) had significantly higher fasting plasma glucose and HOMA-IR index (p=0.029 and 0.037, respectively) than those in medium or highest tertiles. In multiple linear regression analysis, osteocalcin was negatively associated with fasting plasma glucose (standardized ß coefficient-0.16; p=0.041) and 2-h insulin (standardized ß coefficient-0.21; p=0.028). Prevalence of NODAT/impaired glucose tolerance is high in liver transplantation patients and is associated with insulin resistance. In these patients total osteocalcin is inversely associated with plasma glucose level and insulin resistance indexes.

Results from a national survey on the management of primary hyperparathyroidism.

BACKGROUND: Management of primary hyperparathyroidism (PHPT) continues to be challenging. At the Third International Workshop on PHPT, recent data on this disease were reviewed and new clinical recommendations were developed. There are few data on the influence of new guidelines in clinical practice. AIM: We designed an online survey that was sent to all Spanish hospital endocrinology services. METHODS: The questionnaire included 28 questions about diagnosis and management of PHPT. Ninety-nine of 131 sites (76%), giving health coverage to 70% of Spanish population, completed the survey. RESULTS: The reported incidence of PHPT was 9.95/100,000 person-years. Heighty percent of patients were asymptomatic. Each center performed a median (Q1, Q3) of 12 (6, 20) parathyroidectomies/year. The median (Q1, Q3) percentage of curative interventions (at first trial) was 90% (80, 95). The main reasons for not performing surgery were, by decreasing frequency: surgery contraindication, patient's refusal, loss of monitoring, limited surgery experience. Localization techniques were used in 83% of cases. The main criteria for parathyroidectomy in asymptomatic patients were Ca≥2.875 mmol/l (79%), Tscore ≤-2.5 SD at any site (91%), age <50 yr (80%) and glomerular filtration rate <60 ml/min/1.73 m 2 (82%). Minimally invasive surgery was performed in 42% of centers. Frequency of biochemistry and bone density determinations for non-surgically managed patients was in accordance with international guidelines. CONCLUSIONS: The clinical practice of Spanish endocrinologists is consistent with the recommendations of the guidelines from the Third International Workshop for the management of PHPT.

Densidad mineral ósea y composición corporal en la anorexia nerviosa / Bone mineral density and body composition in anorexia nervosa

La anorexia nerviosa (AN) es una enfermedad relativamente frecuente, asociada con pérdida ósea en un elevado número de pacientes y un notable incremento del riesgo de fracturas. En la adolescente con AN puede haber un fallo en alcanzar el pico de masa ósea normal, originando un déficit permanente. Diferentes factores pueden intervenir en esta osteopenia asociada a la AN, incluyendo deprivaciones en calcio y otros macronutrientes, alteraciones en la composición corporal, bajo peso corporal, deficiencia de estrógenos y en algunos casos excesiva actividad física. El objetivo de este trabajo ha sido revisar los factores que intervienen en el desencadenamiento de la pérdida ósea en pacientes con AN

Anorexia nervosa (AN) is a relatively frequent disease, associated with bone loss in a high number of patients and also with increased fracture risk. Adolescent patients can have a failure to achieve bone mass peak with a permanent bone deficit. Different factors can be involved in this AN associated osteopenia, including lack of calcium and other macronutrients, body mass composition alterations, low body weight, estrogen deficiency and in some cases excess physical activity. The objective of this paper has been to review the factors involved in the development of bone loss in patients with AN

Postmenopausal women with Colles' fracture have bone mineral density values similar to those of controls when measured with calcaneus quantitative ultrasound.

BACKGROUND: It is a matter of controversy whether or not Colles' fracture is an osteoporotic fracture. Indeed, the usefulness of quantitative ultrasound in distinguishing Colles' fracture from normal fractures is also unclear. METHODS: A cross-sectional case-control study was done on 469 postmenopausal Spanish women, 121 with Colles' fracture and 348 controls. Assessment of risk factors for osteoporosis and measurement of calcaneus quantitative ultrasound were carried out using a Sahara, Hologic device. RESULTS: Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls, and no statistically significant differences were found. We estimated ROC curves for SOS and a score based on a linear combination of height and SOS (SH-Score). The areas under both curves were 0.56 and 0.61, respectively, which was statistically significant. To obtain 5% false-negative and 10% false-positive figures, the T-score cut-off for SOS was -2.45 and -0.045, respectively. Of these, only 9.2% were classified as high risk and 11% as low risk with 79.8% undetermined. CONCLUSIONS: Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls. Nevertheless, ROC curves calculated by a combination of height and SOS showed that quantitative calcaneus ultrasound may be a useful tool for identifying postmenopausal women with Colles' fracture. These results indicate that measuring bone mineral density with ultrasound only captures limited aspects of the pathophysiology of Colles' fractures.

Escalas de riesgo de Osteoporosis / Risk scales of Osteoporosis

La valoración de los factores de riesgo de osteoporosis está adquiriendo una importancia creciente para el cribado y la identificación de los sujetos con mayor riesgo de presentar baja masa ósea o fracturas osteoporóticas. Por otra parte, las propuestas más recientes de valoración del riesgo de fractura en los pacientes con osteoporosis ­y por lo tanto, de selección del tratamiento más adecuado­ incluyen además de la medida de la masa ósea, la detección de factores de riesgo clínicos que han mostrado capacidad de predecir el desarrollo de fracturas de forma independiente de la masa ósea. En el presente artículo se revisan tanto los factores de riesgo clínicos mayores, como algunas de las escalas de riesgo de osteopenia y de fractura osteoporótica, debiendo señalarse que cualquiera de estas escalas debe ser validada en la población local antes de proceder a su implantación y utilización

La osteoporosis (OP) es una enfermedad prevalente ­tanto o más que la enfermedad pulmonar obstructiva crónica o la diabetes­ y grave, con un importante impacto sobre la mortalidad, la morbilidad y el deterioro de la calidad de vida, comparable a otras enfermedades crónicas consideradas graves como la cardiopatía isquémica o los accidentes cerebrovasculares. Por lo tanto, se hace imprescindible desarrollar estrategias encaminadas a la detección de la población en riesgo dado que, como ha puesto de manifiesto la Organización Mundial de la Salud (OMS), existen medidas diagnósticas, preventivas y terapéuticas eficaces.Por otra parte, parece claro que el cribaje universal de la OP mediante densitometría no es factible por su desfavorable relación coste-beneficio. En los últimos años se ha propuesto que el diagnóstico, e incluso la indicación de tratamiento de la osteoporosis, debería establecerse sobre una valoración integral del riesgo de fractura más que sobre la medida aislada de la densidad mineral ósea (DMO)1 . Aunque no existen pruebas de que esta aproximación sea más beneficiosa desde el punto de vista de coste-efectividad, resulta evidente que en la valoración del perfil de riesgo individual del paciente con OP debe considerarse

Tratamiento anabólico de la osteoporosis. Influencia de los tratamientos antirresortivos / Anabolic treatment of osteoporosis. Influence of anti-resorptive treatments

La reciente aparición de teriparatida (TRPT) para el tratamiento anabólico dela osteoporosis grave reabre la necesidad de esclarecer algunos puntos en relacióncon su uso asociado con fármacos antirresortivos.Las mujeres osteoporóticas tratadas con alendronato (ALN) o raloxifeno (RLX)mantienen su capacidad para responder al tratamiento con TRPT, aunque las pretratadascon RLX tienen ganancias de densidad mineral ósea (DMO) similaresa las esperadas en mujeres sin tratamiento previo, mientras que la respuesta delas pretratadas con ALN fue más retrasada y limitada, aunque no abolida.El tratamiento combinado con ALN y hormona paratiroidea (PTH) (en mujeres)o TRPT (en varones) no presenta ningún efecto sinérgico, aunque la respuestasobre la DMO lumbar es mayor que el de ALN solo. Sobre el cuellofemoral, el uso combinado de ALN reduce la pérdida aparente de DMO evaluadapor DXA. Por el contrario, el uso combinado con ALN atenúa el efectodel tratamiento anabólico sobre los marcadores de remodelado y la DMO volumétrica.En varones previamente tratados con TRPT durante 18 meses, la suspensióndel tratamiento produce una pérdida de DMO lumbar cercana al 4% en un año,mientras que el tratamiento inmediato con ALN induce en el mismo períodouna ganancia adicional del 5%. En mujeres osteoporóticas tratadas durante unaño con PTH, el tratamiento posterior e inmediato con ALN diario produjouna importante ganancia adicional de DMO que casi duplica la conseguida conPTH.Sea como fuere, la ausencia de datos sobre fracturas hace que las dudas en cuantoa la eficacia de la asociación de tratamientos antirresortivos y anabólicos nopuedan aclararse aún de forma definitiva

The recent appearance of teriparatide (TRPT) for the anabolic treatment of severeosteoporosis reopens the need to explain some points in relatinship with itsuse associated with antirresorptive drugs.Osteoporotic women treated with alendronate (ALN) or raloxifene (RLX) maintaintheir capacity to respond to treatment with TRPT, although those pretreatedwith RLX have BMD gains similar to those expected in women withoutprevious treatment, while the response of those pre-treated with ALN ismore delayed and limited, although not abolished.Combined treatment with ALN and PTH (in women) or TRPT (in men) doesnot have any synergic effect, although the response on the lumbar BMD isgreater than that of ALN alone. On the femoral neck, the combined use of ALNreduces the apparent loss of BMD evaluated by DXA. On the contrary, thecombined use of ALN lessens the effect of anabolic treatment on the remodelingmarkers and volumetric BMD.In men previously treated with TRPT for 18 months, discontinuation oftreatment causes loss of lumbar BMD close to 4% in one year, while immediatetreatment with ALN induces an additional gain of 5% in the same period.In osteoporotic women treated with PTH for one year, later and immediatetreatment with daily ALN causes an important additional gain of BMD thatalmost doubles that obtained with PTH.One way or the other, absence of data on fractures makes it impossible to clarifydefinitively the doubts regarding the efficacy of the association of antiresorptiveand anabolic treatments

Densidad mineral ósea local (tibial) y axial en mujeres menopáusicas con artrosis leve a moderada / Local (tibial) and axial bone mineral density in menopausal women with mild to moderate arthrosis

Objetivo. La osteoporosis (OP) y la artrosis (A) suelen considerarse extremosopuestos dentro del espectro de la enfermedad ósea metabólica. Nuestro objetivofue valorar mediante densitometría dual de rayos-X (DXA) la densidadmineral ósea (DMO) axial (columna lumbar y cuello femoral, CL y CF respectivamente)y local tibial (adyacente a la espina tibial y al cóndilo interno, ET yCI, respectivamente) en mujeres menopáusicas con artrosis de rodilla (AR) levea moderada.Métodos. Estudiamos 77 mujeres menopáusicas atendidas de forma consecutivaen una consulta especializada (edad 61 ± 5 años, índice de masa corporal [IMC]27,7 ± 3,8 kg/m2). El 81,8% mostraba artrosis de columna (AC) leve a moderada,mientras que el 51,9% tenía AR leve o moderada valorada mediante laescala radiográfica de Kellgren-Lawrence (eKL). Diez mujeres sin artrosis seutilizaron para calcular z-scores locales de la tibia.Resultados. El grupo control y el de artrosis resultaron comparables. La DMOlocal de la tibia fue mayor en pacientes con AR (Z score; ET: 0,73 ± 1,14 g/cm2,p = 0,001; CI: 0,79 ± 2,17 g/cm2, p = 0,027) y correlacionó tanto con los valoresde la escala radiográfica (eKL) como con los de DMO axial. El 44,1% delas pacientes reunían criterios densitométricos de OP. Los pacientes con ARmostraron mayor edad (62 ± 5 frente a 60 ± 5 años; p = 0,02) y peso (71,4 ±10,9 frente a 66,0 ± 8,9 kg; p = 0,02) frente a los pacientes sin AR.Conclusiones. La DMO local de la tibia está incrementada en mujeres menopáusicascon AR leve a moderada, correlacionándose con la puntuación radiológica.La DMO local de la tibia y la DMO axial muestran una correlación estrecha.La prevalencia de OP en mujeres con A leve a moderada es alta

Objective. To assess axial (lumbar spine [LS] and femoral neck [FN]) and localtibial BMD by DXA (tibial spine [TS] and internal condylus [IC]) in menopausalwomen with mild knee OA (kOA).Methods. Seventy seven consecutive postmenopausal women (aged 61 ± 5years, bone mineral indez [BMI] 27.7 ± 3.8 kg/m2) were studied; 81.8% hadmild to moderate spine OA (sOA) and 51.9% mild to moderate kOA (Kellgren-Lawrence scale, KLs). Ten women without OA were used to calculate localtibial Z scores.Results. Control and OA groups were comparable. Local tibial BMD was increasedin kOA patients (Z score; TS: 0.73 ± 1.14 g/cm2, p = 0.001; IC: 0.79± 2.17 g/cm2, p = 0.027), correlating with radiographic rating scale of OA andwith axial BMD. 44.1% of patients had densitometric OP. Patients with kOAwere older (62 ± 5 vs 60 ± 5 years; p = 0.02) and heavier (71.4 ± 10.9 vs 66.0± 8.9 kg; p = 0.02) versus non-kOA patients.Conclusions. Local tibial BMD is increased in menopausal women with mildkOA and this increase is related to radiological score. Local tibial and axialBMD are closely related. The prevalence of OP in these women is very high

Alteraciones del metabolismo mineral y óseo en los pacientes con infección por el virus de la inmunodeficiencia humana / Mineral and bone metabolism abnormalities in patients with human immunodeficiency virus infection

Recientemente, se ha descrito en sujetos con infección por el virus de la inmunodeficiencia humana (VIH) una elevada incidencia de osteopenia y osteoporosis. En los pacientes con infección por VIH tratados con el tratamiento antirretrovírico de gran actividad (TARGA) se ha objetivado una mayor frecuencia de baja masa ósea que en la población general. Pero también se ha documentado una desmineralización ósea mayor de la esperada en pacientes sin tratamiento antirretrovírico, lo que sugiere que la propia infección vírica puede ser el origen de la osteopenia, mediada por la activación inmune y las citocinas. La variedad y la complejidad de los cambios del metabolismo óseo en estos pacientes y los diferentes mecanismos posibles desencadenantes de la pérdida de masa ósea pueden haber contribuido, entre otros factores, al amplio rango de frecuencias de esta complicación metabólica y a los datos contradictorios sobre el papel que desempeña la terapia antirretrovírica. El conocimiento de la etiopatogenia de estas alteraciones óseas, hasta ahora desconocida, permitirá aplicar las medidas preventivas y terapéuticas más idóneas en la población con VIH. (AU)

Factores predictivos de osteoporosis densitométrica en varones sanos de edad avanzada / Predictive factors of densitometric osteoporosis in healthy elderly males

La osteoporosis masculina es un problema clínicamente significativo, aunque los factores predictivos de baja masa ósea no son bien conocidos. Nuestro objetivo fue conocer la prevalencia de osteoporosis densitométrica en varones sanos de edad avanzada, caracterizar el remodelado óseo en estos sujetos e investigar la capacidad predictiva de distintos parámetros antropométricos y hormonales para identificar a los sujetos con baja masa ósea (osteoporosis). Cien voluntarios mayores de 55 años fueron evaluados transversalmente. Se midió la densidad mineral ósea mediante absorciometría con doble haz de rayos X en columna lumbar y cadera y se evaluaron los siguientes parámetros antropométricos: peso, talla, índice de masa corporal, índice cintura-cadera y volumen testicular. Los parámetros hormonales evaluados fueron testosterona total, libre y biodisponible, estradiol, SHBG, IGF-1, IGFBP-1, iPTH y 1,25 vitamina D3. Los marcadores del turnover óseo que se midieron fueron osteocalcina y telopéptido carboxiterminal del colágeno I en suero (ICTP). Un sujeto fue excluido por hipogonadismo primario. El 28,2 por ciento presentaban criterios densitométricos de osteoporosis (T-score lumbar y/o femoral < -2,5). Con la edad se produce un descenso significativo en los niveles de testosterona biodisponible e IGF-1, con un aumento paralelo de la IGFBP-1. En el 25 por ciento de los sujetos los niveles de osteocalcina estaban disminuidos, y el 8 por ciento presentaban hiperparatiroidismo secundario. El remodelado óseo se mantiene estable hasta la 6.ª década en que se acelera a expensas de un aumento en la resorción ósea, como indica la correlación positiva entre ICTP y edad. Los factores predictivos de baja masa ósea fueron el peso corporal, y los niveles de SHBG e iPTH: peso (odds ratio, OR = 0,92, intervalo de confianza al 95 por ciento, 95 por ciento CI = 0,87-0,98), SHBG (OR = 1,03; 95 por ciento CI = 1,005-1,065), iPTH (OR = 1,04; 95 por ciento CI = 1,009-1,089). La sensibilidad del modelo para identificar a los sujetos con criterios densitométricos de osteoporosis es del 73 por ciento (AU)

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.

Receptor sensible a calcio y parathormona / Calcium-sensing receptor and parathormone

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Bone mineral density in male patients with L-thyroxine suppressive therapy and Graves disease.

Little is known about the effects of thyroid hormone excess in male patients. Our aim was to evaluate bone mineral density (BMD), bone turnover markers, and thyroid function in male patients with treated thyroid cancer on long-term suppressive L-T4 therapy (TC) and in male patients with Graves' disease (GD). We studied 49 male patients (aged 45+/-12 years), 17 with TC (29-288 months on L-T4 suppressive therapy; free T4: 1.9+/-0.6 ng/dl [normal< or =2.0]; TSH: 0.2+/-0.3 microU/ml [Normal 0.5-5.0]) and 32 with recent onset GD (<12 weeks, free T4: 2.0+/-1.4 ng/dl; TSH: 1.07+/-1.8 microU/ml; TSHRAb 53+/-45% [normal < 15]). BMD was measured by dual X-ray absorptiometry (DXA, Hologic QDR1000w) at the lumbar spine (L2-L4, LS), femoral neck (FN), and Ward's triangle (WT). Results were expressed as Z-score (SD compared to national controls). Total alkaline phosphatase (ALP), osteocalcin (BGP), iPTH, serum phosphorus, serum, and 24 h urine calcium were measured as bone markers. Age, weight, and body mass index were comparable in both groups. Patients with TC and with GD showed reduced axial BMD (95% confidence interval: LS: TC (-1.27-0.01)(P = 0.046), GD (-1.06 to-0.38)(P < 0.001); FN: TC (-0.82 to-0.16)(P = 0.007), GD (-0.95 to-0.15)(P = 0.008); WT: TC (-0.82 to -0.18)(P = 0.004), GD (-0.97 to -0.08)(P = 0.024). No significant differences in BMD were found between the groups. Among bone markers, total ALP and osteocalcin levels showed higher levels in Graves' disease (ALP: 139+/-76 vs. 88+/-34, P < 0.01; BGP: 7.5+/-3.7 vs. 4.6+/-1.6; P < 0.001). Our data suggest a mild deleterious effect of thyroid hormone excess in the axial bone mass from male subjects. A skeletal status assessed by BMD in male patients with chronic TSH suppression by L-T4 or history of hyperthyroidism is recommended.

Calcificaciones y osificaciones ectópicas / Ectopic calcifications and ossifications

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Alteraciones tiroideas y paratiroideas asociadas al tratamiento crónico con litio. A propósito de un caso / Thyroid and parathyroid disirders associated to chronic lithium treatment. A new case

La hipercalcemia y el hipotiroidismo constituyen complicaciones endocrinas secundarias al tratamiento con litio. Presentamos el caso clínico de una mujer con trastorno bipolar en tratamiento crónico con litio que desarrolló un hipotiroidismo subclínico y un hiperparatiroidismo primario. A propósito de este caso, hemos revisado los mecanismos fisiopatológicos de estas alteraciones endocrinas inducidas por el litio (AU)

Hormonal and anthropometric predictors of bone mass in healthy elderly men: major effect of sex hormone binding globulin, parathyroid hormone and body weight.

Osteoporosis in men is a significant health problem, and factors associated with bone mass are being investigated. Although osteoporosis is a typical feature of hypogonadism, the influence of testosterone levels and other hormonal factors on bone mass of eugonadal males is unknown. Our aim was to identify several anthropometric and hormonal predictors that could be responsible for the variability in bone mineral density (BMD) in healthy men. One hundred elderly men (age 68 +/- 7 years) were investigated in this cross-sectional study. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral sites (femoral neck, Ward's triangle, trochanter, intertrochanter and total femur). Anthropometric measures were obtained including: weight, height, body mass index (BMI), waist-hip ratio and testicular volume. Hormonal data measures were total, free and bioavailable testosterone, dihidrotestosterone, estradiol, sex hormone binding globulin (SHBG), insulin-like growth factor I (IGF-I), intact parathyroid hormone (iPTH) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3). One subject was excluded because primary hypogonadism was found. SHBG levels were increased in 53.5% of men, and 8% showed a mild increase in iPTH levels. Twenty-eight subjects had densitometric criteria of osteoporosis (T-score < or = -2.5). All BMD sites were positively correlated with body weight (r = 0.29-0.48, p < 0.001) and BMI (r = 0.24-0.47, p < 0.001). A negative correlation between SHBG levels and intertrochanter (IT) and total femur (TL) BMD was found (r = -0.24 and r = -0.22, p < 0.05). After adjusting for age and BMI, SHBG and IGF-I levels were negatively correlated (r = -0.33, p < 0.001). In multiple linear regression analysis independent predictors of bone mass were body weight, SHBG and iPTH levels. The best predictive model accounted for 24-40% of the observed variability of BMD. However, most of the BMD variability was explained by body weight. In conclusion, in our study body weight, SHBG and iPTH levels were predictors of BMD in healthy elderly men.

Indicaciones del tratamiento hormonal sustitutivo en la mujer postmenopáusica / Indications for hormonal replacement therapy in the postmenopausal woman

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