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

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

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

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

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

Trabecular bone score and bone turnover markers in men with DISH: Data from the Camargo Cohort study.

OBJECTIVE: Diffuse idiopathic skeletal hyperostosis (DISH) has been associated with an increased risk of vertebral fracture. To date, no studies have investigated the relationship between DISH and bone microstructure assessed by the trabecular bone score (TBS). METHODS: Cross-sectional study, nested in a prospective population-based cohort. All men (968) aged≥50 years were included. Clinical covariates, DISH, TBS, serum bone turnover markers and bone mineral density (BMD) were analyzed. RESULTS: Mean age of participants was 65 ± 9 years. 207 (21.6%) had DISH. DISH subjects were older, had higher body mass index (BMI) and abdominal perimeter, lower glomerular filtration rate (GFR), and higher prevalence of metabolic syndrome (MetS) than non-DISH (NDISH) subjects. Bone mineral density at the lumbar spine (LS-BMD) was significantly higher in the DISH group. TBS values were 1.317 [1.303-1.331] for DISH and 1.334 [1.327-1.341] for NDISH subjects, after adjusting by age, BMI, abdominal perimeter, arterial hypertension, diabetes mellitus, MetS, GFR, serum alkaline phosphatase (ALP), LS and femoral neck BMD (p = 0.03). Serum ALP levels were higher in DISH subjects, showing an inverse correlation with TBS that remained significant after adjusting by age and BMI. CONCLUSIONS: TBS values were significantly lower in men with DISH irrespective of age, BMI and BMD, suggesting that the presence of DISH might be related to a worse trabecular microstructure.

Calidad de vida relacionada con la salud (CVRS) en la hipertensión arterial: un análisis diferenciado por género sobre población de cantabria / Health-related quality of life in hypertension: a gender-differentiated analysis in population of Cantabria

OBJETIVO: La hipertensión arterial (HTA), por su elevada prevalencia y morbimortalidad, es un importante problema de Salud Pública. Se asocia a una peor calidad de vida relacionada con la salud (CVRS). El objetivo de este trabajo fue conocer la CVRS de la población hipertensa en un análisis diferenciado por género. MÉTODOS: Se realizó un estudio transversal. Participaron cinco cupos de Medicina de Familia. Se evaluó la CVRS (mediante el cuestionario EuroQol-5D), cuatro variables relacionadas con la HTA (grado de control, duración de la enfermedad, uso de fármacos antihipertensivos y lesión de órgano diana -LOD-), variables sociodemográficas, de estilo de vida y clínicas. Se realizó análisis bivariado y se elaboraron dos modelos multivariados, con el índice EuroQol-5D (iEQ) como variable dependiente. RESULTADOS: Fueron analizadas 198 mujeres (55,7%) y 157 varones. Las mujeres, significativamente, tenían menor nivel educativo, pasaban más tiempo solas, consumían más psicofármacos, su iEQ fue menor (0,887 [0,2] frente a 0,914 [0,1]; p = 0,0001) y puntuaron peor en cuidado personal, actividades cotidianas, dolor/malestar y ansiedad/depresión. En las mujeres, tras ajustar por confusores, ninguna variable relacionada con la HTA presentó una asociación significativa con el iEQ, y la capacidad funcional fue la variable más importante (beta=0,35; p = 0,0001). En los varones, la LOD (beta=0,18) y la duración de la HTA (beta=0,16) se asociaron significativamente con el iEQ, siendo el consumo de psicofármacos la variable más relevante del modelo de regresión (beta=0,42; p = 0,005). CONCLUSIONES: Se observan notables diferencias en la CVRS de las mujeres y los varones con HTA. Detectar dichas diferencias permite conocer los perfiles más frágiles de nuestros pacientes

OBJECTIVE: Hypertension is a major public health problem due to its high prevalence and morbi-mortality. It is associated with a worse health-related quality of life (HRQOL). The aim has been to know the HRQOL of the hypertensive population in a gender-differentiated analysis. METHODS: Cross-sectional study. Hypertensive patients attended in Primary Care were enrolled in the study. We evaluated HRQOL (using the EuroQol-5D questionnaire), four covariates related to hypertension (degree of control, duration of disease, use of antihypertensive drugs and target organ damage -TOD-), and sociodemographic, lifestyle and clinical variables. Bivariate analysis was performed and two multivariate models were developed, with the EuroQol-5D index (iEQ) as the dependent variable. RESULTS: We analyzed 198 women (55.7%) and 157 men. Significantly, females had a lower educational level, spent more time alone, consumed more psychotropic medication, their iEQ was lower [0.887 (0.2) vs. 0.914 (0.1); p = 0.0001] and scored worse in self-care, usual activities, pain / discomfort and anxiety / depression. In women, no variable related to hypertension presented a significant association with the iEQ after adjusting for confounders, and functional capacity was the most important covariate (Beta=0.35; p = 0.0001). In males, TOD (Beta=0.18) and duration of the disease (Beta=0.16) were significantly associated with the iEQ, with the consumption of psychotropic medication being the most relevant covariate in the regression model (Beta=0.42; p = 0.005). CONCLUSIONS: Notable differences in HRQOL of women and men with hypertension have been noted. Detecting these differences allows us to know the frailest states of our patients