Entorno inflamatorio diferencial en pacientes con osteoporosis y diabetes mellitus tipo 2 / Differential inflammatory environment in patients with osteoporosis and type 2 diabetes mellitus

Objetivo: La diabetes mellitus tipo 2 (DM2) y la osteoporosis son enfermedades asociadas con un entorno pro-inflamatorio, cuya prevención mediante nuevas estrategias terapéuticas podría evitar su desarrollo. Sin embargo, existe un escaso número de estudios que evalúen el perfil inflamatorio de la osteoporosis en pacientes con DM2.El objetivo de este estudio se centró en evaluar la respuesta inflamatoria inmunitaria mediante concentraciones séricas de nueve citocinas, dos de ellas de carácter anti-inflamatorio (IL-10, IL-5) y seis pro-inflamatorias (IL-2, IL-6, IL-12 (p70), IL-17A, TNFα e IFNɣ) en 163 individuos con DM2 y 47 controles. Una subpoblación, formada por 43 pacientes DM2 sin osteoporosis, y 33 con osteoporosis, fue analizada en más profundidad a nivel de parámetros óseos. Además, hemos evaluado las hormonas calciotropas, los marcadores de remodelado óseo, densidad mineral ósea y fracturas vertebrales en la población, y hemos analizado la relación de las citocinas ensayadas con la DM2, la osteoporosis y las fracturas vertebrales prevalentes.Los pacientes con DM2 tenían concentraciones séricas significativamente más altas de IL-10 en comparación con el grupo control (0,5±1 vs. 0,14±0,3 pg/ml; p=0,016) y los niveles de IL-12 p70 se mostraron más bajos en pacientes con DM2 respecto a los controles (2,9±1,6 vs. 3,9±3,1 pg/ml; p=0,027).En el grupo de pacientes con DM2 y osteoporosis, los niveles de la citocina IL-6 resultaron elevados respecto al grupo de DM2 sin osteoporosis (10,9±14,6 vs. 4,5±7,0; p=0,017). También se observó una asociación de IL-5, siendo sus niveles más bajos en el grupo DM2 con osteoporosis (1,7±0,2 vs. 3,8±0,6; p=0,032). Además, la IL-5 mostró una correlación directa con los niveles del biomarcador de formación ósea fosfatasa alcalina ósea (r=0,277, p=0,004) en la subpoblación de pacientes con DM2. El resto de citocinas no mostraron diferencias significativas. (AU)

Resumen ejecutivo: Documento de posicionamiento: evaluación y manejo de la hipoglucemia en el paciente con diabetes mellitus 2020. Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición / Executive summary: Position document: Evaluation and management of hypoglycemia in the patient with diabetes mellitus 2020. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition

Proporcionar unas recomendaciones prácticas para la evaluación y el manejo de la hipoglucemia en pacientes con diabetes mellitus. Miembros del Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición (SEEN). Las recomendaciones se formularon según el sistema Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Se realizó una búsqueda sistemática en MEDLINE (PubMed) de la evidencia disponible para cada tema, y se revisaron artículos escritos en inglés y castellano con fecha de inclusión hasta el 28 de febrero de 2020. En este resumen ejecutivo incluimos la evidencia reciente incorporada desde 2013. El documento establece unas recomendaciones prácticas basadas en la evidencia acerca de la evaluación y manejo de la hipoglucemia en pacientes con diabetes mellitus.

To provide practical recommendations for the evaluation and management of hypoglycemia in patients with diabetes mellitus. Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN). The recommendations were made based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to establish both the strength of the recommendations and the level of evidence. A systematic search was made in MEDLINE (PubMed) for the available evidence on each subject, and articles written in English and Spanish with an inclusion date up to 28 February 2020 were reviewed. This executive summary takes account of the evidence incorporated since 2013. The document establishes practical evidence-based recommendations regarding the evaluation and management of hypoglycemia in patients with diabetes mellitus.

¿Es útil la puntuación de hueso trabecular en la valoración de la calidad ósea en pacientes con espondiloartritis axial y sindesmofitos? / Is the trabecular bone score useful for assessing bone quality in patients with axial spondyloarthritis and syndesmophytes?

Introducción y objetivos: Los sindesmofitos parecen elevar falsamente los valores de densidad mineral ósea lumbar, lo que limita el diagnóstico de osteoporosis por absorciometría de rayosX de doble energía en pacientes con espondiloartritis axial. Por este motivo, el objetivo del estudio fue analizar la influencia de sindesmofitos a nivel lumbar en los valores de puntuación de hueso trabecular y densidad mineral ósea lumbar y cuello femoral, y evaluar los factores clínicos y analíticos asociados a puntuación de hueso trabecular en la espondiloartritis axial. Material y métodos: Estudio transversal en el que se incluyeron, de manera consecutiva desde enero de 2017 a junio de 2018, pacientes con espondiloartritis axial según los criterios ASAS. Se evaluaron los valores de puntuación de hueso trabecular y densidad mineral ósea. Se recogieron variables clínico-demográficas, relativas a la enfermedad y analíticas. Resultados: Se incluyeron 82 sujetos con espondiloartritis axial (38 con sindesmofitos y 44 sin sindesmofitos). La edad media fue de 44,36+/-11,85años en espondiloartritis axial sin sindesmofitos y de 55,7+/-10,27años con sindesmofitos (p<0,001). El valor de puntuación de hueso trabecular medio fue de 1,345+/-0,14 en pacientes con sindesmofitos y de 1,41+/-0,11 sin sindesmofitos (p=0,05). Se encontró asociación entre un mayor índice de masa corporal, velocidad de sedimentación globular, duración de la enfermedad y número de niveles afectados por sindesmofitos y un mayor riesgo de fractura por puntuación de hueso trabecular. Conclusión: Los valores de puntuación de hueso trabecular no parecen estar enmascarados por la presencia de sindesmofitos

Introduction and objectives: Syndesmophytes appear to falsely raise lumbar bone mineral density values, thereby hindering the diagnosis of osteoporosis by dual-energy X-ray absorptiometry in patients with axial spondyloarthritis. The objective of the study was therefore to analyse the influence of syndesmophytes at the lumbar level on trabecular bone scores and lumbar and femoral neck bone mineral density values and to assess the clinical and analytical factors associated with trabecular bone scores in axial spondyloarthritis. Material and methods: From January 2017 to June 2018, a cross-sectional study consecutively included patients with axial spondyloarthritis according to Assessment in Ankylosing Spondylitis criteria. We assessed the trabecular bone scores and bone mineral density values and recorded clinical, demographic, disease-related and laboratory variables. Results: The study included 82 patients with axial spondyloarthritis (38 with syndesmophytes and 44 without syndesmophytes). The mean age of the patients with and without syndesmophytes was 55.7+/-10.27years and 44.36+/-11.85years, respectively (P<.001). The mean trabecular bone score for the patients with and without syndesmophytes was 1.345+/-0.14 and 1.41+/-0.11, respectively (p < 0.05). There was an association between higher body mass index, erythrocyte sedimentation rate, disease duration and the number of levels affected by syndesmophytes and a greater risk of fracture as measured by the trabecular bone score. Conclusion: Trabecular bone scores do not appear to be masked by the presence of syndesmophytes

Is the trabecular bone score useful for assessing bone quality in patients with axial spondyloarthritis and syndesmophytes? / ¿Es útil la puntuación de hueso trabecular en la valoración de la calidad ósea en pacientes con espondiloartritis axial y sindesmofitos?

INTRODUCTION AND OBJECTIVES: Syndesmophytes appear to falsely raise lumbar bone mineral density values, thereby hindering the diagnosis of osteoporosis by dual-energy X-ray absorptiometry in patients with axial spondyloarthritis. The objective of the study was therefore to analyse the influence of syndesmophytes at the lumbar level on trabecular bone scores and lumbar and femoral neck bone mineral density values and to assess the clinical and analytical factors associated with trabecular bone scores in axial spondyloarthritis. MATERIAL AND METHODS: From January 2017 to June 2018, a cross-sectional study consecutively included patients with axial spondyloarthritis according to Assessment in Ankylosing Spondylitis criteria. We assessed the trabecular bone scores and bone mineral density values and recorded clinical, demographic, disease-related and laboratory variables. RESULTS: The study included 82 patients with axial spondyloarthritis (38 with syndesmophytes and 44 without syndesmophytes). The mean age of the patients with and without syndesmophytes was 55.7±10.27years and 44.36±11.85years, respectively (P<.001). The mean trabecular bone score for the patients with and without syndesmophytes was 1.345±0.14 and 1.41±0.11, respectively (p < 0.05). There was an association between higher body mass index, erythrocyte sedimentation rate, disease duration and the number of levels affected by syndesmophytes and a greater risk of fracture as measured by the trabecular bone score. CONCLUSION: Trabecular bone scores do not appear to be masked by the presence of syndesmophytes.

Efecto de la terapia biológica en las concentraciones de DKK1 y esclerostina, riesgo cardiovascular y metabolismo óseo en pacientes con artritis reumatoide / Effect of biological therapy on concentrations of DKK1 and sclerostin, cardiovascular risk and bone metabolism in patients with rheumatoid arthritis

Introducción: Estudios previos han relacionado la vía Wnt con la alteración del metabolismo óseo y la patología cardiovascular. Así mismo, el control de la inflamación con terapia biológica tiene un efecto positivo sobre la densidad mineral ósea (DMO) y el riesgo cardiovascular. El objetivo de este estudio fue, por tanto, evaluar el efecto de la terapia biológica en pacientes con artritis reumatoide (AR) que no habían recibido previamente terapia biológica sobre la carga inflamatoria, y su relación con el riesgo cardiovascular y el metabolismo óseo. Pacientes y métodos: Estudio de cohortes prospectivo en pacientes con diagnóstico de AR activa que iniciaban terapia biológica. Los pacientes fueron seleccionados de forma consecutiva no seleccionada. Se recogieron: las concentraciones séricas de proteína Dickkopf-1 (DKK1) y esclerostina, ambas mediante el método ELISA (Biomedica Medizinprodukte GmbH and Co. KG, Viena, Austria); características sociodemográficas y clínicas; marcadores de remodelado óseo; la DMO en columna lumbar y en cadera mediante absorciometría de rayos X de energía dual (DXA); el grosor íntima-media carotídea (c-IMT); y la evaluación de riesgo cardiovascular mediante el modelo Systematic Coronary Risk Evaluation (SCORE). Resultados: El 46,7% de los pacientes presentaron respuesta EULAR al tratamiento a los 12 meses. Sólo en este subgrupo de pacientes encontramos un aumento en las concentraciones de DKK1 tras el inicio de la terapia biológica (basal: 20,55±8,13 pg/ml vs. 12 meses: 31,20±4,88 pg/ml, p=0,03). En cuanto a los marcadores de remodelado óseo, se detectó un aumento en los niveles de osteocalcina (basal: 11,25±3,28 ng/ml vs. 12 meses: 15,78,±4,11 ng/ml, p=0,01). No se encontraron cambios estadísticamente significativos en el c-IMT ni en el SCORE tras 12 meses de tratamiento. Conclusiones: En pacientes con AR tratados con terapia biológica y con respuesta al tratamiento hemos observado un aumento significativo de las concentraciones séricas de DKK1 a los 12 meses de tratamiento, no asociado a cambios en el metabolismo óseo o al riesgo cardiovascular

Introduction: Previous studies have linked the Wnt pathway in the alteration of bone metabolism and cardiovascular pathology. Also, the control of inflammation with biological therapy has a positive effect on bone mineral density (BMD) and cardiovascular risk. The aim of the study was to evaluate the effect of biological therapy in patients with rheumatoid arthritis, naïve to these therapy, on the inflammatory load and its relation with cardiovascular risk and bone metabolism. Patients and methods: Prospective cohort study performed in patients diagnosed with active rheumatoid arthritis (RA) initiating biological therapy. Patients were selected consecutively not selected. The serum concentrations of Dickkopf-1 protein (DKK1) and sclerostin were collected, both by means of the ELISA method (Biomedica Medizinprodukte GmbH and Co. KG, Vienna, Austria); demographic and clinical variables, markers of bone remodeling, hip and lumbar spine BMDs were measured by dual energy X-ray absorptiometry (DXA), measurement of intima-media thickness (IMT), evaluation cardiovascular risk by Systematic Coronary Risk Evaluation (SCORE). Results: 46.7% of patients presented EULAR response to treatment at 12 months. Only in this subgroup of patients, we found in the subgroup of patients an increase in the concentrations of DKK1 following the initiation of biological therapy (baseline 20.55±8.13 pg/ml vs 12 months 31.20±4.88 pg/ml, p=0.03). Regarding markers of bone remodeling, an increase in osteocalcin levels (baseline: 11.25±3.28 ng/ml vs 12 months 15.78±4.11 ng/ml, p=0.01). There was no change in IMT or SCORE at 12 months of treatment. Conclusions: In patients with RA treated with biological therapy who presented EULAR response we observed a significant increase in serum concentrations of DKK1 at 12 months of treatment not associated with changes in bone metabolism and cardiovascular risk

Dickkopf1 (DKK1), metabolismo óseo y enfermedad ateroesclerótica en pacientes con diabetes mellitus tipo 2 / Serum dickkopf1 (DKK1), bone metabolism and atherosclerotic disease in patients with type 2 diabetes

Objetivos: La diabetes mellitus tipo 2 (DM2) se asocia a un incremento del riesgo de fracturas y de enfermedades cardiovasculares. Los objetivos de nuestro estudio fueron evaluar los niveles séricos de Dickkopf-1 (DKK1) en una cohorte de pacientes con DM2 y analizar su relación con el metabolismo óseo y la enfermedad ateroesclerótica (EA). Pacientes y métodos: Se estudiaron 126 sujetos: 72 pacientes con DM2 (edad media de 58,2±6 años) y 54 sujetos no diabéticos (edad media de 55,4±7 años). Se midió DKK1 mediante ensayo de inmunoabsorción ligado a enzimas (ELISA, Biomedica Gruppe), se determinó la densidad mineral ósea (DMO) mediante absorciometría dual de rayos X (DXA), se registró la presencia de EA (enfermedad cerebrovascular, enfermedad arterial periférica, cardiopatía isquémica) y se evaluó el grosor de la íntima-media (GIM, ultrasonografía doppler) y la calcificación aórtica (radiología simple). Resultados: No se encontraron diferencias significativas en DKK1 entre diabéticos y no diabéticos. Las concentraciones séricas de DKK1 fueron significativamente mayores en las mujeres de la muestra total (24,3±15,2 vs. 19,6±10,2 pmol/L, p=0,046) y del grupo DM2 (27,5±17,2 vs. 19,8±8,9 pmol/L, p=0,025). Hubo una correlación positiva entre DKK1 y DMO lumbar en la muestra total (r=0,183, p=0,048). Sin embargo, no se encontraron diferencias en función del diagnóstico de osteoporosis o presencia de fracturas vertebrales morfométricas. Los valores de DKK1 fueron significativamente mayores en los pacientes con DM2 y EA (26,4±14,5 pmol/L vs. 19,1±11,6 pmol/L, p=0,026) y también en pacientes con GIM anormal (26,4±15,1 pmol/L vs. 19,8±11,3 pmol/L, p=0,038). En el análisis de la curva ROC para evaluar la utilidad de DKK1 como un marcador de alto riesgo de EA, el área bajo la curva fue de 0,667 (intervalo de confianza -IC- del 95%: 0,538-0,795; p=0,016). Una concentración de 17,3 pmol/L o superior mostró una sensibilidad del 71,4% y una especificidad del 60% para identificar un mayor riesgo de EA. Conclusiones: Los niveles circulantes DKK1 son más altos en los diabéticos con EA y se asocian con un GIM patológico. Por tanto, consideramos que DKK1 puede estar implicado en la enfermedad vascular de los pacientes con DM2 (AU)

Background and objectives: Type 2 diabetes (T2DM) is a risk factor for osteoporotic fractures and cardiovascular disease. The aims of our study were to evaluate serum Dickkopf-1(DKK1) levels in a cohort of T2DM patients and to analyze its relationships with bone metabolism and atheroesclerotic disease (AD). Patients and methods: We studied 126 subjects: T2DM patients (n: 72, mean age 58,2±6 years) and non-diabetic subjects (n: 54, mean age 55,4±7 years). DKK-1 was measured by enzyme-linked immunosorbent assay (ELISA, Biomedica Gruppe). Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA). The presence of AD (cerebrovascular disease, peripheral arterial disease, ischemic heart disease) was recorded. Intima-media thickness (IMT) was determined by doppler ultra- sonography and aortic calcification by evaluation of lateral view conventional X-rays. Results: We did not find significant differences in DKK1 between groups. Serum DKK1 concentrations were significantly higher in females in total sample (24,3±15,2 vs 19,6±10,2 pmol/L, p=0,046) and in T2DM group (27,5±17,2 vs 19,8±8,9 pmol/L, p=0,025). There was a positive correlation between serum DKK1 and LS BMD in total sample (r=0,183, p=0,048). However, we did not find a significant relationship with osteoporosis diagnosis or morphometric vertebral fractures. Serum DKK1 was significantly higher in T2DM patients with AD (26,4±14,5 pmol/L vs 19,1±11,6 pmol/L, p=0,026) and also in patients with abnormal IMT (26,4±15,1 pmol/L vs 19,8±11,3 pmol/L, p=0,038). In the ROC curve analysis to evaluate the usefulness of DKK-1 as a marker for high risk of AD, the area under the curve was 0,667 (95% confidence interval: 0,538-0,795; p=0,016). A concentration of 17,3 pmol/L or higher showed a sensitivity of 71,4% and a specificity of 60% to identify an increased risk of AD. Conclusions: Circulating DKK1 levels are higher in T2DM with AD and are associated with an abnormal IMT in this cross-sectional study. DKK1 may be involved in vascular disease of T2DM patients (AU)

Cambios inducidos en DKK1 en pacientes con artritis reumatoide que inician tratamiento con terapia biológica / Changes induced by DKK1 in rheumatoid arthritis patients who commence biologic therapy treatment

Introducción: El objetivo del estudio es evaluar la relación entre la carga inflamatoria, el riesgo cardiovascular y el metabolismo óseo en pacientes con artritis reumatoide que inician tratamiento con terapia biológica. Pacientes y métodos: Se trata de un estudio de cohortes prospectivo realizado en pacientes con diagnóstico de artritis reumatoide (AR) activa evaluados en la Unidad de Reumatología y que inician terapia biológica. Los pacientes serán seleccionados de forma consecutiva. Presentamos los datos preliminares de 14 pacientes. Resultados: Encontramos una reducción en las concentraciones de Dickkopf-1 (DKK1) tras el inicio de la terapia biológica (basal: 53,12±60,43 pg/ml vs. 6 meses 23,2±13,5 pg/ml, p=0,307) pero no se alcanzó la significación estadística. Se encontraron cambios en los marcadores de remodelado con aumento en los niveles de osteocalcina y CTX que no alcanzó la significación estadística. Conclusiones: En pacientes con AR activa tratados con terapia biológica hemos observado un descenso no significativo de las concentraciones séricas de DKK1. La ampliación tanto de los sujetos de estudio como de las determinaciones bioquímicas pendientes nos permitirán en un futuro próximo establecer de forma más precisa esta asociación, así como la relación entre DKK1, remodelado óseo, terapia biológica y enfermedad cardiovascular en pacientes con AR (AU)

Introduction: The aim of this study is to assess the relationship among inflammatory charge, cardiovascular risk and bone metabolism in patients with rheumatoid arthritis initiating biological therapy treatment. Patients and methods: This is a prospective cohort study conducted in patients diagnosed with active rheumatoid arthritis (RA) assessed in the Rheumatology Unit and initiating biological therapy. Patients will be selected consecutively, with preliminary data on 14 patients. We present preliminary data from 14 patients. Results: Reduced Dickkopf-1 (DKK1) concentrations after commencing biological therapy were detected (baseline: 53.12±60.43 pg/ml vs 6 months 13.5±23.2 pg/ml, p=0.307) but without statistical significance. Changes were found in markers for bone remodeling with increased osteocalcin levels and CTX which were not statistically significant either. Conclusions: We observed a nonsignificant decrease in DKK1 serum in patients with active RA treated with biologic therapy. Expanding the scope of study subjects and pending biochemical determinations will allow us, in the near future, to establish more precisely this link and the relationship of DKK1, bone remodeling, biological therapy and cardiovascular disease in RA patients (AU)

Metabolismo fosfocálcico y factores litogénicos en pacientes con fractura osteoporótica / Calcium and phosphorus metabolism and lithogenic factors in patients with osteoporotic fracture

Objetivos: Demostrar la presencia de alteraciones del metabolismo del fósforo y calcio y la presencia de factores litogénicos en orina de pacientes con fractura osteoporótica sin litiasis previamente conocida. Material y métodos: Se incluyen 67 pacientes con fractura osteoporótica tratados quirúrgicamente en un servicio de traumatología. Se incluyen pacientes con fractura osteoporótica demostrada por la zona de la fractura, mecanismo de fractura y presencia de osteoporosis en la densitometría ósea. Se analiza el metabolismo fosfocálcico, el estudio de calciuria, la oxaluria, la citraturia y la uricosuria de 24 h. Se compara entre los pacientes con hipercalciuria versus normocalciuria la presencia de alteraciones del metabolismo fosfocálcico. Resultados: Doce hombres y 55 mujeres incluidos con edad media de 68,8 ± 14,5 años. El IMC medio fue de 27,4 ± 4,1 kg/m2. Presentan hipercalciuria el 42% de los pacientes, hiperoxaluria el 34% de los pacientes, hipocitraturia el 34% de los pacientes e hiperuricosuria el 7% de los pacientes. Al comparar los pacientes con hipercalciuria versus normocalciuria únicamente hay diferencias estadísticamente significativas en el calcio/creatinina en ayunas (0,17 versus 0,08; p < 0,0001). Conclusión: Los pacientes con fractura osteoporótica presentan diversos factores litogénicos en la orina, fundamentalmente hipercalciuria, siendo siempre de ayunas

Objectives: To demonstrate the attendance of mineral metabolism disorders and lithogenic factors in patients’ urine with osteoporotic fracture without previously known stones Material and methods: 67 patients with osteoporotic fractures surgically treated in trauma service are included. The area of the fracture site, fracture mechanism and the presence of osteoporosis were the factors taken into account to diagnose osteoporotic fracture. Mineral metabolism, calciuria, oxaluria, uricosuria and citraturia in 24 hours urine were analyzed. The presence of abnormal calcium and phosphorus metabolism was proved comparing hypercalciuria patients with normocalciuria ones. Results: 12 men and 55 women with mean age 68.8 ± 14.5 years old were included. Mean Body Mass Index (BMI) was 27.4 ± 4.1 kg/m2. 42% of patients showed hypercalciuria, 34% hyperoxaluria, 34% hypocitraturia and 7% hyperuricosuria. Statistically significant differences were observed only in fasting calcium/creatinine ratio (0.17 vs. 0.08; P < .0001) when comparing patients with hypercalciuria with those with normocalciuria. Conclusions: Patients with osteoporotic fractures show different lithogenic factors in urine, mainly hypercalciuria, always in fasting conditions

Actualización de las recomendaciones para la evaluación y tratamiento de la osteoporosis asociada a enfermedades endocrinas y nutricionales. Grupo de trabajo de osteoporosis y metabolismo mineral de la SEEN / Update of recommendations for evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions. Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology

Objetivo: Actualizar las recomendaciones previas formuladas por el Grupo de trabajo de osteoporosis y metabolismo mineral de la Sociedad Española de Endocrinología y Nutrición (SEEN) para la evaluación y el tratamiento de la osteoporosis asociada a diferentes enfermedades endocrinas y alteraciones nutricionales. Participantes: Miembros del Grupo de trabajo de osteoporosis y metabolismo mineral de la SEEN. Métodos: Las recomendaciones se formularon de acuerdo al sistema Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Se realizó una búsqueda sistemática en PubMed de las nuevas acerca de cada enfermedad usando las siguientes palabras clave asociadas al nombre de cada proceso patológico: AND osteoporosis, fractures, bone mineral density, bone markers y treatment. Se revisaron artículos escritos en inglés con fechas de inclusión comprendidas entre el 18 de octubre de 2011 y el 30 de octubre de 2014. Tras la formulación de las recomendaciones estas se discutieron de forma conjunta por el Grupo de trabajo.Conclusiones: Esta actualización resume los nuevos datos acerca de la evaluación y tratamiento de la osteoporosis en las enfermedades endocrinas y nutricionales que se asocian a baja masa ósea o a un aumento del riesgo de fractura.(AU)

Objective: To update previous recommendations developed by the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition for the evaluation and treatment of osteoporosis associated to different endocrine and nutritional diseases. Participants: Members of the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition. Methods: Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed) using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date between 18 October 2011 and 30 October 2014 were included. The recommendations were discussed and approved by all members of the Working Group. Conclusions: This update summarizes the new data regarding evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions.(AU)

Trabecular Bone Score y tratamiento quirúrgico del hiperparatiroidismo primario / No disponible

No disponible

Calcium and phosphorus metabolism and lithogenic factors in patients with osteoporotic fracture.

OBJECTIVES: To demonstrate the attendance of mineral metabolism disorders and lithogenic factors in patients' urine with osteoporotic fracture without previously known stones MATERIAL AND METHODS: 67 patients with osteoporotic fractures surgically treated in trauma service are included. The area of the fracture site, fracture mechanism and the presence of osteoporosis were the factors taken into account to diagnose osteoporotic fracture. Mineral metabolism, calciuria, oxaluria, uricosuria and citraturia in 24hours urine were analyzed. The presence of abnormal calcium and phosphorus metabolism was proved comparing hypercalciuria patients with normocalciuria ones. RESULTS: 12 men and 55 women with mean age 68.8±14.5 years old were included. Mean Body Mass Index (BMI) was 27.4±4.1kg/m2. 42% of patients showed hypercalciuria, 34% hyperoxaluria, 34% hypocitraturia and 7% hyperuricosuria. Statistically significant differences were observed only in fasting calcium/creatinine ratio (0.17 vs. 0.08; P<.0001) when comparing patients with hypercalciuria with those with normocalciuria. CONCLUSIONS: Patients with osteoporotic fractures show different lithogenic factors in urine, mainly hypercalciuria, always in fasting conditions.

Como prevenir y tratar las hipoglucemias farmacológicas / How to prevent and treat pharmacological hypoglycemias

Mujer de 58 años con diabetes tipo 2 diagnosticada hace 3 años, en tratamiento con metformina 850mg cada 12h y glimepirida 4mg cada 24h. Tras iniciar glimepirida hace 9 meses ha incrementado 5kg su peso habitual, y presenta hipoglucemias frecuentes que han afectado a su capacidad para conducir. Su índice de masa corporal es 35,5kg/m2. Presenta además hipertensión arterial en tratamiento con telmisartán e hidroclorotiazida con adecuado control, e hipercolesterolemia en tratamiento con atorvastatina 40mg/día. Acude a consulta para revisión, aporta fondo de ojo, con resultado normal y resultados de la analítica que muestra una HbA1c de 7,0%, microalbuminuria negativa, colesterol total 149mg/dl, HDL colesterol 52mg/dl, LDL colesterol 98mg/dl y triglicéridos 123mg/dl. La tensión arterial es de 129/81mmHg, no presenta hipotensión ortostática, y la exploración neurológica periférica en miembros inferiores es normal. En resumen, se trata de una paciente joven, con una diabetes tipo 2 y obesidad, sin complicaciones crónicas, y con hipoglucemias frecuentes ¿Cómo deber ser evaluada y tratada esta paciente? (AU)

A 58 year-old woman with type 2 diabetes diagnosed 3 years before came to our clinic. Her treatment was metformin 850mg every 12hours and glimepiride 4mg every 24hours. After the initiation of glimepiride 9 months before her weight has increased 5kg, and she suffers frequent hypoglycemias which have affected her while driving. Her BMI is 35.5kg/m2. She has a normal eye fund exam. She has hypertension treated with telmisartán and hidroclorotiazide with adequate control, and also hypercholesterolemia treated with atorvastatine 40mg every 24hours. Her blood test shows an HbA1c of 7.0%, normal values of microalbuminuria, total cholesterol 149mg/dl, HDL cholesterol 52mg/dl, LDL cholesterol 98mg/dl and triglycerides 123mg/dl. Her blood pressure is 129/81mmHg, there was no orthostatic hypotension, and her peripheral neurological examination shows normal results. In summary, our case is a young woman with type 2 diabetes and obesity, without chronic complications and which has frequent hypoglycaemia. How must this woman be evaluated and treated? (AU)

Consensus statement: recommendations for the management of metabolic bone disease in human immunodeficiency virus patients / Documento de consenso: Recomendaciones para el manejo de la enfermedad ósea metabólica en pacientes con virus de la inmunodeficiencia humana

"OBJECTIVE: To provide practical recommendations for the evaluation and treatment of metabolic bone disease in human immunodeficiency virus (HIV) patients. PARTICIPANTS: Members of scientific societies related to bone metabolism and HIV: Grupo de Estudio de Sida (GeSIDA), Sociedad Española de Endocrinología y Nutrición (SEEN), Sociedad Española de Investigación Ósea y del Metabolismo Mineral (SEIOMM), and Sociedad Española de Fractura Osteoporótica (SEFRAOS). METHODS: A systematic search was carried out in PubMed, and papers in English and Spanish with a publication date before 28 May 2013 were included. Recommendations were formulated according to GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) setting both their strength and the quality of supporting evidence. Working groups were established for each major part, and the final resulting document was later discussed in a face-to-face meeting. All the authors reviewed the final written document and agreed with its content. CONCLUSIONS: The document provides evidence-based practical recommendations on the detection and treatment of bone disease in HIV-infected patients"

"Objetivo Proporcionar unas recomendaciones prácticas para el manejo de la enfermedad metabólica ósea en pacientes con virus de la inmunodeficiencia humana (VIH). Participantes Miembros de diferentes sociedades científicas relacionadas con el metabolismo óseo y con la enfermedad VIH: Grupo de Estudio de Sida (GeSIDA), Sociedad Española de Endocrinología y Nutrición (SEEN), Sociedad Española de Investigación Ósea y del Metabolismo Mineral (SEIOMM) y Sociedad Española de Fractura Osteoporótica (SEFRAOS). Métodos Se realizó una búsqueda sistemática en PubMed de la evidencia disponible para cada aspecto, y se revisaron artículos escritos en inglés y en castellano con fecha de inclusión hasta 28 de mayo de 2013. Las recomendaciones se formularon según el sistema GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Los autores trabajaron por grupos en la formulación de cada apartado de las recomendaciones y posteriormente el documento global se discutió en una reunión conjunta. Todos los autores revisaron el documento escrito final y lo consensuaron. Conclusiones El documento establece unas recomendaciones prácticas basadas en la evidencia acerca de la evaluación y el tratamiento de la enfermedad metabólica ósea en pacientes con VIH"

How to prevent and treat pharmacological hypoglycemias.

A 58 year-old woman with type 2 diabetes diagnosed 3 years before came to our clinic. Her treatment was metformin 850 mg every 12 hours and glimepiride 4 mg every 24 hours. After the initiation of glimepiride 9 months before her weight has increased 5 kg, and she suffers frequent hypoglycemias which have affected her while driving. Her BMI is 35.5 kg/m². She has a normal eye fund exam. She has hypertension treated with telmisartán and hidroclorotiazide with adequate control, and also hypercholesterolemia treated with atorvastatine 40 mg every 24 hours. Her blood test shows an HbA1c of 7.0%, normal values of microalbuminuria, total cholesterol 149 mg/dl, HDL cholesterol 52 mg/dl, LDL cholesterol 98 mg/dl and triglycerides 123 mg/dl. Her blood pressure is 129/81 mmHg, there was no orthostatic hypotension, and her peripheral neurological examination shows normal results. In summary, our case is a young woman with type 2 diabetes and obesity, without chronic complications and which has frequent hypoglycaemia. How must this woman be evaluated and treated?

Sclerostin serum levels in prostate cancer patients and their relationship with sex steroids.

UNLABELLED: The role of sclerostin on bone metabolism and its relation to sex steroids in patients with prostate cancer (PC) is not well known. We found that sclerostin levels are significantly increased in PC patients, particularly in those with androgen deprivation therapy (ADT), and there is an inverse relationship between sclerostin levels and testosterone. INTRODUCTION: Recent studies have evaluated sclerostin levels in bone diseases as osteoporosis. However, there are few data in PC patients, particularly in patients with hypogonadism related to ADT. The aim of the present study was to compare serum sclerostin levels in ADT/non-ADT-treated PC patients and healthy controls and to evaluate their relationship with sex steroids and bone metabolism. METHODS: We performed a cross-sectional study involving 81 subjects: 25 ADT-treated PC patients, 34 PC patients without ADT treatment, and 22 healthy controls. We measured serum sclerostin levels, bone turnover markers, bone mineral density (BMD) in all individuals, and sex steroids levels in PC patients. RESULTS: Serum sclerostin levels were significantly higher in PC patients compared to those in control subjects. ADT-treated patients had significantly higher sclerostin levels than PC patients without ADT treatment: ADT 64.52 ± 27.21 pmol/L, non-ADT 48.24 ± 15.93 pmol/L, healthy controls 38.48 ± 9.19 pmol/L, p < 0.05. In PC patients, we found a negative relationship between serum sclerostin levels and androgens after age adjustment (total testosterone: r = -0.309, p = 0.029; bioavailable testosterone: r = -0.280, p = 0.049; free testosterone: r = -0.299, p = 0.035). We did not observe any relationship between sclerostin levels and bone turnover markers or BMD in any group. CONCLUSIONS: Circulating sclerostin levels are significantly increased in patients with PC and particularly in those receiving ADT. The inverse relationship between serum sclerostin and testosterone in these patients suggests that androgens are key regulators of bone metabolism in this population.

Diabetes y osteoporosis: acción de las hormonas gastrointestinales sobre el hueso / Diabetes and osteoporosis: action of gastrointestinal hormones on the bone

Mujer de 62 años, que consulta para valoración de tratamiento de diabetes mellitus tipo 2 (DM2) de 4 años de evolución, en tratamiento con metformina 850mg/12h, sin complicaciones crónicas asociadas. Presenta hipertensión y dislipemia. Tratada con candesartán/hidroclorotiazida 32/12,5mg/día y atorvastatina 40mg/día. Pesaba 92kg y medía 162cm (IMC:35,1kg/m2). En el último control analítico, glucemia basal 168mg/dl y HbA1c 7,5%. La microalbuminuria era negativa. Las cifras de presión arterial y el perfil lipídico se encontraban dentro de los objetivos terapéuticos. Hace 2 años tuvo una fractura de Colles no traumática en la muñeca izquierda motivo por el que toma un suplemento de calcio y vitamina D diariamente y bifosfonato alendronato una vez por semana. En resumen, nos encontramos ante una mujer con obesidad y DM2, con un control metabólico inadecuado, que además presenta antecedentes de fractura por fragilidad. ¿Cómo debe ser evaluada y tratada esta paciente?(AU)

A 62-year-old woman consulted for evaluation of treatment for her type 2 diabetes diagnosed four years ago. He had been received treatment with metformin 850mg twice, with no chronic associated complications. She had hypertension and dyslipidemia. She was being treated with candesartan/hydrochlorothiazide 32/12.5mg and atorvastatin 40mg. Her weight was 92kg and height 162cm (BMI, 35.1kg/m2). The last analysis showed fasting glucose 168mg/dl and glycated hemoglobin 7.5%, Microalbuminuria was negative. Blood pressure and lipid profile were within the therapeutic range. Two years ago she suffered a nontraumatic Colle's fracture in her left arm for which she was taking a daily calcium and vitamin D supplement and weekly alendronate. In summary, this is an obese female patient with type 2 diabetes mellitus and inadequate metabolic control, She also has a history of fragility fracture. How should this patient be evaluated and treated?(AU)

Diabetes and osteoporosis: Action of gastrointestinal hormones on the bone. / Diabetes y osteoporosis: acción de las hormonas gastrointestinales sobre el hueso.

A 62-year-old woman consulted for evaluation of treatment for her type 2 diabetes diagnosed four years ago. He had been received treatment with metformin 850mg twice, with no chronic associated complications. She had hypertension and dyslipidemia. She was being treated with candesartan/hydrochlorothiazide 32/12.5mg and atorvastatin 40mg. Her weight was 92kg and height 162cm (BMI, 35.1kg/m(2)). The last analysis showed fasting glucose 168mg/dl and glycated hemoglobin 7.5%, Microalbuminuria was negative. Blood pressure and lipid profile were within the therapeutic range. Two years ago she suffered a nontraumatic Colle's fracture in her left arm for which she was taking a daily calcium and vitamin D supplement and weekly alendronate. In summary, this is an obese female patient with type 2 diabetes mellitus and inadequate metabolic control, She also has a history of fragility fracture. How should this patient be evaluated and treated?

SHBG levels are associated with bone loss and vertebral fractures in patients with prostate cancer.

SUMMARY: Fractures are increased among prostate cancer patients. No data have been reported in patients with prostate cancer about the relation between serum sex hormone-binding globulin (SHBG) and bone metabolism. We found that SHBG levels were inversely related to bone mass and vertebral fractures in this population. INTRODUCTION: Fractures are increased among prostate cancer patients, especially those on androgen deprivation therapy (ADT), but few data are available on the role of SHBG in their bone status. Our objective was to analyze the relation between serum SHBG and bone metabolism in prostate cancer patients. METHODS: This is a cross-sectional study including 91 subjects with prostate cancer (54 % with ADT). We measured serum levels of SHBG and sex steroids, bone mineral density (BMD) by dual-energy X-ray absorptiometry, and prevalent radiographic vertebral fractures. RESULTS: SHBG levels were inversely related to BMD (femoral neck: r = -0.299, p = 0.00; total hip: r = -0.259, p = 0.019). Subjects with osteoporosis had higher SHBG concentrations than patients without osteoporosis (60.97 ± 39.56 vs 44.45 ± 23.32 nmol/l, p = 0.022). Patients with SHBG levels in the first quartile (>57.6 nmol/l) had an odds ratio (OR) for osteoporosis of 2.59 (95 % CI, 1.30-5.12; p = 0.009) compared with patients with lower SHBG levels. In patients with SHBG >57.6 nmol/l, the OR for vertebral fractures was 2.34 (95 % CI, 1.15-4.78; p = 0.034). The calculated OR was higher after adjustment for age (OR, 5.16; 95 % CI, 1.09-24.49; p = 0.039), estrogens (OR, 6.45; 95 % CI, 1.44-28.95; p = 0.023), and androgens (OR, 5.51; 95 % CI, 1.36-22.37; p = 0.017). CONCLUSIONS: In prostate cancer patients, SHBG levels were inversely related to bone mass and vertebral fractures. Determination of the serum SHBG level may constitute a useful and straightforward marker for predicting the severity of osteoporosis in these patients.

Serum osteoprotegerin: bone or cardiovascular marker in Type 2 diabetes males?

BACKGROUND: The role of osteoprotegerin (OPG) as a marker of cardiovascular disease (CVD) in Type 2 diabetes (T2DM) is not well established. Moreover, the relationship between OPG, osteoporosis, and vertebral fractures in T2DM remains to be elucidated. AIM: To determine the role of serum OPG in the prediction of CVD and bone disease in T2DM males. SUBJECTS AND METHODS: Cross-sectional study with 68 males, 43 with T2DM and 25 subjects without diabetes. We measured: serum OPG by inmunoassay, the presence of CVD (coronary heart disease, cerebrovascular and peripheral artery disease), surrogate markers of CVD [intima- media thickness (IMT) and aortic calcification] and bone disease (bone mineral density and prevalent vertebral fractures). RESULTS: OPG serum levels (in pmol/l) were significantly higher in T2DM males with abnormal IMT (5.12 ± 1.59 vs 3.76 ± 1.98), carotid plaque (5.46 ± 1.67 vs 4.20 ± 1.81), aortic calcification (5.91 ± 1.39 vs 4.07 ± 1.76), hypertension (5.11 ± 1.86 vs 3.81 ± 1.47), and peripheral artery disease (6.24 ± 1.64 vs 4.21 ± 1.63, p < 0.05 for all comparisons). In the logistic regression analysis (after adjustment for age and main cardiovascular risk factors), serum OPG (per 1 pmol/l increase in OPG) was associated with increased risk of abnormal IMT [odds ratio (OR) 1.84, confidence interval (CI) 1.21-2.79, p = 0.004), carotid plaque (OR 1.71, CI 1.13-2.58, p = 0.012), aortic calcification (OR 2.21, CI 1.27-3.84, p = 0.05) and peripheral artery disease (OR 4.02, CI 1.65-9.8 p = 0.002). However, OPG were not related to bone mass or vertebral fractures. CONCLUSIONS: Our results suggest that in T2DM males OPG serum concentrations constitute a marker of CVD, but not a marker of bone disease.

Enfermedad cardiovascular, osteoporosis y riesgo de fractura / Cardiovascular disease, osteoporosis and risk of fracture

Hombre de 60 años, administrativo, que consulta para valoración de posible osteoporosis. Fumador de 10 cigarrillos/día y bebedor esporádico. A los 52 años y tras una caída accidental presentó una fractura de Colles en muñeca derecha, que curó sin complicaciones. Su madre padeció a los 78 años una fractura de cadera. El enfermo pesaba 89,4 kg y medía 165cm (IMC: 32,8 kg/m2). La densitometría ósea mostró en columna lumbar T-score -2,4 (CL) y en fémur T-score -1,9. Hace un año tuvo un infarto agudo de miocardio, por lo que sigue tratamiento con una estatina, beta-bloqueante y enalapril. En resumen, se trata de un varón con antecedente de fractura por fragilidad, con valores de densidad mineral ósea (DMO) lumbar cercanos a los establecidos como diagnósticos de osteoporosis y que además presenta enfermedad cardiovascular. ¿Cómo debe ser evaluado y tratado este enfermo?(AU)

A 60-year-old man, who did administrative work, consulted for evaluation of the presence of osteoporosis. He smoked ten cigarettes a day and drank alcohol occasionally. Eight years ago he suffered a Colle's fracture in his right arm after an incidental fall, which resolved without complications. His mother had a hip fracture when she was 78 years old. The patient weighed 89.4 kg and his height was 165cm (BMI 38 kg/m2). The DXA showed a T-score -2.4 at lumbar spine and -1.9 at femoral neck. He had suffered a myocardial infarction one year ago and is presently taking statin, a beta-blocker and enalapril. In summary, this is a male with a background of fracture due to fragility, with lumbar BMD close to those established as diagnostic of osteoporosis and he also has cardiovascular disease. How should this patient be evaluated and treated?(AU)