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1.
BMC Geriatr ; 21(1): 69, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468069

RESUMO

BACKGROUND: The purpose of this study was to investigate the prevalence of osteosarcopenia in the over 60-year-old community and to evaluate whether osteosarcopenia is associated with disability, frailty and depression. METHODS: This study was performed using the baseline data of Namgaram-2, among the 1010 surveyed subjects, 885 study subjects who were 60 years or older and had all necessary tests performed were selected. The Kaigo-Yobo checklist (frailty), World Health Organization Disability Assessment Schedule (WHODAS) and Geriatric Depression Scale-Short Form-Korean (GDSSF-K) were used. The Asian Working Group for Sarcopenia (AWGS 2019) were applied in this study. Osteopenia was measured using data from dual energy X-ray absorptiometry (DEXA) and osteopenia was diagnosed when the T-score was less than - 1.0. The study subjects were divided into four groups: the normal group, in which both sarcopenia and osteopenia were undiagnosed, osteopenia only, sarcopenia only and the osteosarcopenia group, which was diagnosed with both sarcopenia and osteopenia. RESULTS: Of the 885 subjects over 60 years old evaluated, the normal group comprised 34.0%, the only osteopenia group 33.7%, the only sarcopenia group 13.1%, and the osteosarcopenia group 19.2%. WHODAS (17.5, 95% CI: 14.8-20.1), Kaigo-Yobo (3.0, 95% CI: 2.6-3.4), and GDSSF mean score (4.6, 95% CI: 3.9-5.4) were statistically significantly higher in the osteosarcopenia group compared the other groups. Partial eta squared (ηp2) of WHODAS (0.199) and Kaigo-Yobo (0.148) values ​​according to Osteosarcopenia were large, and GDSSF (0.096) was medium CONCLUSIONS: Osteosarcopenia is a relatively common disease group in the older adults community that may cause deterioration of health outcomes. Therefore, when evaluating osteopenia or sarcopenia in the older adults, management of those in both disease groups should occur together.


Assuntos
Doenças Ósseas Metabólicas , Fragilidade , Sarcopenia , Idoso , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/epidemiologia , Depressão/diagnóstico , Depressão/epidemiologia , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Humanos , Vida Independente , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia
2.
Clin Interv Aging ; 16: 83-96, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33469276

RESUMO

The menopausal transition is a critical period in women's lives. Exercise might be the most promising non-pharmaceutic intervention to address the large variety of risk factors related to the pronounced estradiol decline during peri- and early-postmenopause. The aim of this study was to determine the effect of an 18-month multipurpose exercise program on risk factors and symptoms related to the menopausal transition. Fifty-four women 1-5 years postmenopause with osteopenia or osteoporosis were randomly assigned 1) to a high impact weight-bearing/high-intensity/velocity resistance training group (EG: n=27) exercising three times a week or 2) to an attendance control group (CG: n=27) that performed low-intensity exercise once a week. Both groups were supplemented with cholecalciferol and calcium. The primary study endpoint was bone mineral density (BMD) at lumbar spine (LS) and total hip, secondary outcomes were lean body mass (LBM), total and abdominal body percentage, metabolic syndrome Z-Score (MetS-Z), menopausal symptoms and muscle strength and power. Due to COVID-19, the study was stopped after 13 months. We observed significant effects for BMD-LS (EG: 0.002±.018 versus CG: -.009±0.018 mg/cm2, p=0.027) but not for BMD total hip (EG: -0.01±.016 versus CG: -.009±0.020 mg/cm2, p=0.129). LBM improved significantly in the EG and decreased in the CG (0.39±1.08 vs -0.37±1.34 kg, p=0.026). Total and abdominal body fat improved significantly in the EG and was maintained in the CG (-1.44±1.49 vs -0.02±1.55 kg, p=0.002 and -1.50±2.33 vs 0.08±2.07 kg, p=0.011). Significant effects in favor of the EG were also determined for menopausal symptoms (p=0.029), hip/leg extension strength (p<0.001) and power (p<0.001). However, changes of the MetS-Z did not differ significantly (p=0.149) between EG and CG. In summary, with minor exceptions, we demonstrated the effectiveness of a multipurpose exercise protocol dedicated to early-postmenopausal women on various risk factors and complaints related to the menopausal transition.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Doenças Ósseas Metabólicas , Treinamento Intervalado de Alta Intensidade/métodos , Síndrome Metabólica/prevenção & controle , Osteoporose Pós-Menopausa , Pós-Menopausa , Densidade Óssea , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/terapia , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/diagnóstico , Osteoporose Pós-Menopausa/terapia , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco , Comportamento de Redução do Risco
3.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431459

RESUMO

Primary Sjögren's syndrome (pSS) is a chronic slowly progressive autoimmune disease characterised by lymphocytic infiltration of salivary and lacrimal glands with varying degree of systemic involvement. Renal involvement, a recognised extraglandular manifestation of pSS, is commonly related to tubular dysfunction and generally manifests as distal renal tubular acidosis (RTA), proximal RTA, tubular proteinuria and nephrogenic diabetes insipidus. Untreated long-standing RTA is known to cause metabolic bone disease. Here, we present the report of a patient with sclerotic metabolic bone disease related to pSS with combined distal and proximal RTA and negative workup for other causes of sclerotic bone disease. A significant clinical and biochemical improvement, including recovery of proximal tubular dysfunction, was noted with alkali therapy. This case suggests the need to consider pSS in the diagnostic algorithm of a patient presenting with sclerotic bone disease.


Assuntos
Acidose Tubular Renal/diagnóstico , Dor nas Costas/imunologia , Doenças Ósseas Metabólicas/diagnóstico , Síndrome de Sjogren/diagnóstico , Absorciometria de Fóton , Acidose Tubular Renal/sangue , Acidose Tubular Renal/tratamento farmacológico , Acidose Tubular Renal/imunologia , Adulto , Fosfatase Alcalina/sangue , Dor nas Costas/sangue , Densidade Óssea/imunologia , Doenças Ósseas Metabólicas/sangue , Doenças Ósseas Metabólicas/tratamento farmacológico , Doenças Ósseas Metabólicas/imunologia , Feminino , Humanos , Citrato de Potássio/uso terapêutico , Cintilografia , Síndrome de Sjogren/sangue , Síndrome de Sjogren/complicações , Síndrome de Sjogren/imunologia , Esqueleto/diagnóstico por imagem , Bicarbonato de Sódio/uso terapêutico
4.
Nutrients ; 12(12)2020 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-33321828

RESUMO

Despite the importance of early recognition of metabolic bone disease (MBD) of prematurity, there is still significant variability in screening practices across institutions. We conducted an observational study of infants born at ≤32 weeks of gestation with a birth weight of ≤1500 g (n = 218) to identify clinical factors associated with biochemical indicators of MBD. Bone mineral status was assessed by measuring alkaline phosphatase and phosphate levels between weeks 3 and 5 of life. Two comparisons were performed after classifying infants as either MBD (cases) or non-MBD (controls), and as either high or low risk for MBD, as determined based on the results of MBD screening. In total, 27 infants (12.3%) were classified as cases and 96 (44%) as high-risk. Compared with controls, MBD infants had a significantly lower gestational age and birth weight, and a longer duration of parenteral nutrition and hospital stay. Respiratory outcomes were significantly poorer in high- versus low-risk infants. Multivariate logistic regression showed that birth weight was the only independent risk factor for MBD (odds ratio [OR]/100 g, 0.811; confidence interval [CI95%], 0.656-0.992; p = 0.045) and that birth weight (OR/100 g, 0.853; CI95%, 0.731-0.991; p = 0.039) and red blood cell transfusion (OR, 2.661; CI95%, 1.308-5.467; p = 0.007) were independent risk factors for high risk of MBD. Our findings provide evidence of risk factors for MBD that could help clinicians to individualize perinatal management. The association of red blood cell transfusion with MBD is a novel finding that may be related to iron overload and that merits further study.


Assuntos
Doenças Ósseas Metabólicas/diagnóstico , Doenças do Prematuro/diagnóstico , Recém-Nascido Prematuro/sangue , Triagem Neonatal/métodos , Fosfatase Alcalina/sangue , Peso ao Nascer , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Razão de Chances , Avaliação de Resultados em Cuidados de Saúde , Nutrição Parenteral/estatística & dados numéricos , Fosfatos/sangue , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
5.
Medicine (Baltimore) ; 99(28): e20906, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664083

RESUMO

Osteoporosis (OP) is a metabolic bone disease that can cause structural changes in bone marrow cavity. Bone marrow is the hematopoietic organ of adults. Accumulating evidence has shown a close connection between bone marrow hematopoietic function and bone formation. Some studies have revealed that OP is associated with hematopoiesis. However, the relationship is not definite.This study aimed to evaluate the association between peripheral blood cell counts (white blood cells [WBC], red blood cells [RBC], platelets [PLT]), hemoglobin [HGB], and bone mineral density [BMD]) in a sample of Chinese postmenopausal women. This is a retrospective study involving 673 postmenopausal women cases. The BMD of lumbar spine and left hip joint were measured by dual-energy X-ray absorptiometry. The levels of blood cell counts and HGB were measured and analyzed.The study results showed the WBC, RBC, PLT, and HGB levels of postmenopausal women in the OP group were all higher than those in the non-osteoporosis group. Spearman linear trend analysis and partial correlation analysis demonstrated that BMD was negatively correlated with WBC, RBC, PLT, and HGB in postmenopausal women.Due to the differences between different countries and races, and there are few studies on the association of BMD with peripheral blood cell counts and HGB in Chinese Postmenopausal Women. Therefore, more large sample studies are needed.


Assuntos
Grupo com Ancestrais do Continente Asiático/etnologia , Contagem de Células Sanguíneas/métodos , Densidade Óssea/fisiologia , Hemoglobinas/análise , Pós-Menopausa/sangue , Absorciometria de Fóton/métodos , Idoso , Contagem de Células Sanguíneas/tendências , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/fisiopatologia , Estudos de Casos e Controles , Feminino , Hematopoese/fisiologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Pessoa de Meia-Idade , Osteogênese/fisiologia , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/fisiopatologia , Estudos Retrospectivos
7.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(5): 310-316, mayo 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-191306

RESUMO

INTRODUCCIÓN: El síndrome del hueso hambriento (SHH) es una complicación tras la cirugía paratiroidea que puede causar una hipocalcemia grave y prolongada. El objetivo fue conocer los factores de riesgo de SHH después de la cirugía por hiperparatiroidismo primario y su relación con los niveles de calcio sérico y de hormona paratiroidea (PTH). MATERIALES Y MÉTODOS: Se realizó un estudio analítico observacional de casos y controles en pacientes operados por hiperparatiroidismo primario en los últimos 10 años (2008-2017). Se estudió la evolución analítica del calcio, la PTH y las características generales de los pacientes. RESULTADOS: La incidencia de SHH en nuestra serie fue del 12,2%. Se encontró una asociación significativa de SHH con la cirugía tiroidea en el mismo acto quirúrgico (odds ratio ajustada [ORa] = 17,241), con la edad mayor de 68 años (Ora = 6,666) y con el tamaño de la lesión mayor a 1,7cm (Ora = 7.165). Observamos una relación estadísticamente significativa entre presentar SHH con un valor mayor a la media de calcio sérico corregido el día después de la cirugía, a la semana y a los 3 meses, así como con un valor mayor de la media de PTH preoperatoria, en la cirugía y un día después de la cirugía. CONCLUSIÓN: Los factores de riesgo independientes para el desarrollo de SHH en nuestra serie fueron la edad del paciente, el tamaño de la lesión y si la intervención se acompaña de cirugía tiroidea, lo que obliga a una monitorización más estrecha del metabolismo mineral durante el perioperatorio


INTRODUCTION: Hungry bone syndrome (HBS) is a complication occurring after parathyroid surgery that can cause severe and prolonged hypocalcemia. The study objective was to know the risk factors for HBS after surgery for primary hyperparathyroidism and its relationship with serum calcium and parathyroid hormone levels. MATERIAL AND METHODS: A case-control, observational, analytical study was conducted in patients who had undergone surgery for primary hyperparathyroidism in the past 10 years (2007-2016). Changes over time in serum calcium and PTH levels and the general characteristics of patients were analyzed. RESULTS: The incidence rate of HBS in our series was 12.2%. HBS was found to be significantly associated to thyroid surgery during the surgical procedure itself (adjusted odds ratio [aOR] = 17.241), to age older than 68 years (aOR = 6.666), and to lesions greater than 1.7cm (aOR = 7.165). A statistically significant relationship was seen between presence of HBS and corrected serum calcium levels higher than the mean the day after surgery and one week and 3 months later, and also with PTH levels higher than the mean before, during, and one day after surgery. CONCLUSIÓN: In our series, independent risk factors for development of HBS included patient age, lesion size, and whether or not the procedure was accompanied by thyroid surgery, which requires closer monitoring of mineral metabolism during the perioperative period


Assuntos
Humanos , Masculino , Feminino , Idoso , Hormônio Paratireóideo/metabolismo , Paratireoidectomia , Hiperparatireoidismo/cirurgia , Hiperparatireoidismo Primário , Doenças Ósseas Metabólicas/diagnóstico , Complicações Pós-Operatórias/terapia , Cálcio/sangue , Fatores de Risco , Hiperparatireoidismo Primário/etiologia , Complicações Pós-Operatórias/diagnóstico , Estudos de Casos e Controles , Cálcio/administração & dosagem , Cálcio/metabolismo , Modelos Logísticos
8.
Actual. osteol ; 16(1): 47-66, Ene - abr. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1140035

RESUMO

La "razón de ser" de nuestros huesos y esqueletos constituye un dilema centralizado en los conceptos biológicos de "estructura" y "organización", cuya solución necesitamos comprender para interpretar, diagnosticar, tratar y monitorear correctamente las osteopatías fragilizantes. Últimamente se ha reunido conocimiento suficiente para proponer aproximaciones razonables a ese objetivo. La que exponemos aquí requiere la aplicación de no menos de 6 criterios congruentes: 1) Un criterio cosmológico, que propone un origen común para todas las cosas; 2) Un criterio biológico, que explica el origen común de todos los huesos; 3) Un enfoque epistemológico, que desafía nuestra capacidad de comprensión del concepto concreto de estructura y del concepto abstracto de organización, focalizada en la noción rectora de direccionalidad espacial; 4) Una visión ecológica, que destaca la importancia del entorno mecánico de cada organismo para la adecuación de la calidad mecánica de sus huesos a las "funciones de sostén" que les adjudicamos; 5) Una correlación entre todo ese conocimiento y el necesario para optimizar nuestra aptitud para resolver los problemas clínicos implicados y 6) Una jerarquización del papel celular en el manejo de las interacciones genético-ambientales necesario para asimilar todo el problema a una simple cuestión de organización direccional de la estructura de cada hueso. Solo aplicando estos 6 criterios estaríamos en condiciones de responder a la incógnita planteada por el título. La conclusión de esta interpretación de la conducta y función de los huesos debería afectar el fundamento de la mayoría de las indicaciones farmacológicas destinadas al tratamiento de la fragilidad ósea. (AU)


The nature of the general behavior of our bones as weight-bearing structures is a matter of two biological concepts, namely, structure and organization, which are relevant to properly interpret, diagnose, treat, and monitor all boneweakening diseases. Different approaches can be proposed to trace the corresponding relationships. The one we present here involves six congruent criteria, namely, 1) a cosmological proposal of a common origin for everything; 2) a biological acknowledgement of a common origin for all bones; 3) the epistemological questioning of our understanding of the concrete concept of structure and the abstract notion of organization, focused on the lead idea of directionality; 4) the ecological insight that emphasizes the relevance of the mechanical environment of every organism to the naturally-selected adjustment of the mechanical properties of their mobile bones to act as struts or levers; 5) The clinical aspects of all the alluded associations; 6) The central role of bone cells to control the genetics/ environment interactions of any individual as needed to optimize the directionality of the structure of each of his/her bones to keep their mechanical ability within physiological limits. From our point of view, we could only solve the riddle posed by the title by addressing all of these six criteria. The striking conclusion of our analysis suggests that the structure (not the mass) of every bone would be controlled not only to take care of its mechanical ability, but also to cope with other properties which show a higher priority concerning natural selection. The matter would be that this interpretation of bone behavior and 'function' should affect the rationales for most pharmacological indications currently made to take care of bone fragility. (AU)


Assuntos
Humanos , Osso e Ossos/fisiologia , Doenças Ósseas Metabólicas/diagnóstico , Osteogênese Imperfeita/diagnóstico , Osteogênese Imperfeita/terapia , Osteoporose/diagnóstico , Osteoporose/terapia , Osso e Ossos/anatomia & histologia , Osso e Ossos/citologia , Osso e Ossos/ultraestrutura , Doenças Ósseas Metabólicas/terapia , Epigênese Genética
9.
Nephrol Dial Transplant ; 35(1): 147-154, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30053139

RESUMO

BACKGROUND: Few studies have examined the association between hepcidin, iron indices and bone mineral metabolism in non-dialysis chronic kidney disease (CKD) patients. METHODS: We reviewed the data of 2238 patients from a large-scale multicenter prospective Korean study (2011-16) and excluded 214 patients with missing data on markers and related medications of iron and bone mineral metabolism, hemoglobin, blood pressure and causes of CKD. Multivariate linear regression analysis was used to identify the association between iron and bone mineral metabolism. RESULTS: The proportion of CKD Stages 1-5 were 16.2, 18.7, 37.1, 21.6 and 6.4%, respectively. Per each 10% increase in transferrin saturation (TSAT), there was a 0.013 mmol/L decrease in phosphorus [95% confidence interval (CI) -0.021 to -0.004; P = 0.003] and a 0.022 nmol/L increase in logarithmic 25-hydroxyvitamin D (Ln-25OHD) levels (95% CI 0.005-0.040; P = 0.019). A 1 pmol/L increase in Ln-ferritin was associated with a 0.080 ng/L decrease in Ln-intact parathyroid hormone (Ln-iPTH; 95% CI -0.122 to -0.039; P < 0.001). Meanwhile, beta (95% CI) per 1 unit increase in phosphorus, Ln-25OHD and Ln-iPTH for the square root of the serum hepcidin were 0.594 (0.257-0.932; P = 0.001), -0.270 (-0.431 to -0.108; P = 0.001) and 0.115 (0.004-0.226; P = 0.042), respectively. In subgroup analysis, the relationship between phosphorus, 25OHD and hepcidin was strongest in the positive-inflammation group. CONCLUSIONS: Markers of bone mineral metabolism and iron status, including hepcidin, were closely correlated to each other. Potential mechanisms of the relationship warrant further studies.


Assuntos
Anemia/diagnóstico , Biomarcadores/sangue , Doenças Ósseas Metabólicas/diagnóstico , Hepcidinas/sangue , Inflamação/diagnóstico , Ferro/sangue , Insuficiência Renal Crônica/complicações , Anemia/sangue , Anemia/etiologia , Doenças Ósseas Metabólicas/sangue , Doenças Ósseas Metabólicas/etiologia , Feminino , Ferritinas/sangue , Hemoglobinas/análise , Humanos , Inflamação/sangue , Inflamação/etiologia , Masculino , Pessoa de Meia-Idade , Minerais/análise , Estudos Prospectivos
10.
J Clin Endocrinol Metab ; 105(1)2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31588503

RESUMO

CONTEXT: Primary hyperparathyroidism (PHPT) has been related to bone loss. Dual-energy x-ray absorptiometry (DXA) cannot distinguish between trabecular and cortical bone compartments but the recently developed three-dimensional (3D)-DXA software might overcome this issue. OBJECTIVE: To examine the differences in DXA-derived areal bone mineral density (aBMD) and 3D-DXA parameters at the hip site between patients with PHPT and a healthy control group. DESIGN: Cross-sectional pilot study. SETTING: Hospital. PATIENTS: 80 adults (59.5 ± 9.1 yrs), 40 with PHPT and 40 age- and sex-matched healthy controls. MEASURES: aBMD (g/cm2) of the femoral neck, trochanter, shaft, and total hip was assessed using DXA. Cortical surface (sBMD, mg/cm2), cortical volumetric BMD (vBMD, mg/cm3), trabecular vBMD (mg/cm3), integral vBMD (mg/cm3) and cortical thickness (mm) was assessed using 3D-DXA software. RESULTS: Mean-adjusted values showed lower aBMD (7.5%-12.2%, effect size: 0.51-1.01) in the PHPT group compared with the control group (all P < 0.05). 3D-DXA revealed bone impairment (3.7%-8.5%, effect size: 0.47-0.65) in patients with PHPT, mainly in cortical parameters (all P < 0.05). However, differences in trabecular vBMD were not statistically significant (P = 0.055). The 3D mapping showed lower cortical sBMD, cortical vBMD, and cortical thickness at the trochanter and diaphysis in the PHPT group (P < 0.05) compared with the control group. In both groups, the presence of osteopenia or osteoporosis is related to lower cortical bone. CONCLUSIONS: aBMD and cortical 3D parameters are impaired in patients with PHPT versus healthy controls. The vBMD of the trabecular compartment seems to be affected, although to a lesser extent.


Assuntos
Absorciometria de Fóton/métodos , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/etiologia , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Ossos Pélvicos/diagnóstico por imagem , Idoso , Densidade Óssea , Doenças Ósseas Metabólicas/epidemiologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Hiperparatireoidismo Primário/epidemiologia , Hiperparatireoidismo Primário/metabolismo , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Espanha/epidemiologia
11.
BMJ Open ; 9(12): e032891, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31796490

RESUMO

INTRODUCTION: Haemophilia A is an X linked inherited bleeding disorder, caused by a decrease in coagulation factor VIII. Persons with haemophilia experience repeated musculoskeletal bleeding, which can lead to decreased range of motion, irreversible joint damage, low bone mineral density (BMD), and are at greater risk for osteoporosis. Women heterozygous for this mutation, also known as haemophilia A carriers, can have bleeding symptoms and even experience joint bleeding evidenced by radiological soft tissue and osteochondral changes. The prevalence of low BMD as a risk factor for osteoporosis has never been evaluated in carriers of haemophilia, and given the recent findings which suggest subclinical musculoskeletal bleeding in carrier women, we hypothesise that they too are at risk of impaired bone health. METHODS AND ANALYSIS: This is a national multicentre prospective matched-cohort study to compare BMD T-scores among symptomatic haemophilia A carriers, 50 years of age or older, with age-matched and body mass index-matched non-carriers (1:1). A total of 40 symptomatic carriers and 40 matched non-carriers will be recruited from St. Michael's Hospital, Kingston General Hospital in Ontario, Canada and Foothills Medical Centre in Alberta, Canada. Multivariable linear regression models will be used to estimate the effect of haemophilia carriership on BMD T-scores, adjusting for age, body mass index and other relevant covariates. ETHICS AND DISSEMINATION: The protocol was designed and will be conducted in compliance with applicable laws, rules and regulations. Research ethics approval was obtained from St. Michael's Hospital, Foothills Medical Centre, and Kingston General Hospital. Findings will be presented at international venues such as the American Society of Haematology and the World Federation of Haemophilia World Congress. The authors of this study will seek publication in journals such as Blood, Journal of Thrombosis and Haemostasis, American Journal of Hematology and British Journal of Haematology.


Assuntos
Doenças Ósseas Metabólicas , Hemofilia A , Hemorragia , Osteoporose , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/etiologia , Estudos de Coortes , Fator VIII/genética , Feminino , Hemofilia A/diagnóstico , Hemofilia A/epidemiologia , Hemofilia A/genética , Hemofilia A/fisiopatologia , Hemorragia/complicações , Hemorragia/epidemiologia , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/etiologia , Projetos de Pesquisa , Medição de Risco/métodos , Fatores de Risco , Fatores Sexuais , Avaliação de Sintomas/métodos
12.
Dis Markers ; 2019: 3189520, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31814858

RESUMO

Background: Osteoporosis is the most common metabolic bone disease in the world. Since osteoporosis is clinically symptomless until the first fracture occurs, early diagnosis is critical. Calcium, along with calcium-binding and calcium-associated proteins, plays an important role in homeostasis, maintaining healthy bone metabolism. This study is aimed at investigating the level of calcium-binding/associated proteins, annexin A1, S100A4, and TMEM64, in peripheral blood mononuclear cells associated with osteoporosis and its clinical significance. Methods: The levels of mRNAs of annexin A1, S100A4, and TMEM64 in human peripheral blood mononuclear cells were evaluated among 48 osteopenia and 23 osteoporosis patients compared to 17 nonosteoporotic controls. Total RNAs were isolated from clinical samples, and quantitation of mRNA levels was performed using real-time quantitative PCR. Results: The levels of mRNAs for calcium-binding proteins, annexin A1 and S100A4, and calcium-associated protein, TMEM64, in human peripheral blood mononuclear cells were significantly reduced in osteopenia and osteoporosis patients compared with nonosteoporotic controls (one-way ANOVA, P < 0.0001, P = 0.039, and P = 0.0195, respectively). Annexin A1 and TMEM64 mRNAs were also significantly reduced in female osteoporosis patients over the age of 50 years compared to nonosteoporotic controls (one-way ANOVA, P = 0.004 and P = 0.0037, respectively). ROC analysis showed that the reduction in the level of mRNA for annexin A1, S100A4, or TMEM64 in the patients' peripheral blood mononuclear cells has a good diagnostic value for osteoporosis. Conclusions: The results show for the first time that calcium-binding/associated proteins, annexin A1 and TMEM64, could be future diagnostic biomarkers for osteoporosis.


Assuntos
Anexina A1/genética , Biomarcadores/sangue , Doenças Ósseas Metabólicas/diagnóstico , Proteínas de Membrana/genética , Osteoporose/diagnóstico , RNA Mensageiro/genética , Proteína A4 de Ligação a Cálcio da Família S100/genética , Anexina A1/sangue , Doenças Ósseas Metabólicas/sangue , Doenças Ósseas Metabólicas/genética , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Leucócitos Mononucleares/metabolismo , Masculino , Proteínas de Membrana/sangue , Pessoa de Meia-Idade , Osteoporose/sangue , Osteoporose/genética , Prognóstico , RNA Mensageiro/sangue , Proteína A4 de Ligação a Cálcio da Família S100/sangue
13.
Actual. osteol ; 15(3): 180-191, Sept-Dic. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-1104226

RESUMO

Bone metabolism disorders are characterized by an imbalance of bone resorption and formation in the bone remodeling process. Glucocorticoids that are used to treat kidney diseases exacerbate these disorders. P-selectin and galectin-3 are molecules involved in the sclerotic process in kidney, whereas bone resorption is regulated by the interaction between the nuclear factor activator kappa b receptor (RANK), its ligand (RANKL) and the RANKL decoy receptor osteoprotegerin (OPG). The aim of this study was to investigate the cellular and molecular mechanisms of disruption of bone remodeling regulation processes, reflected by intercellular mediators (RANKL, OPG, P-selectin and galectin-3) in chronic kidney disease experimental model treated with glucocorticoids. Rats were divided into four groups of 10 animals each. The first group, the control group, included intact animals. The second group consisted of rats with impaired bone remodeling resulting from chronic kidney disease (experimental group (CKD). The third group was a group of animals with impaired bone remodeling due to exposure to glucocorticoids (experimental group (GCs)). The fourth group consisted of rats with impaired bone remodeling in chronic kidney disease, followed by exposure to glucocorticoids (experimental group (CKD + GCs)). The effects of CKD and glucocorticoid were evaluated biochemically, histologically and by measuring bone density. An enzymelinked immunoassay was used to measure intercellular mediator levels in the serum. The bone density in the experimental groups was reduced compared to the control group. RANKL levels in animals of three experimental groups were higher than in intact animals. Serum levels of OPG were higher in CKD and GCs groups than in intact animals. At the same time, in the animals' blood serum of the CKD + GCs group, the levels of OPG were lower, than those in animals from the control group. The levels of galectin-3 in the serum of the experimental groups GCs and CKD + GCs were lower than in intact animals. The serum levels of galectin-3 in animals of the CKD group were higher than those in animals from the control group. The levels of P-selectin were lower in the serum of the GCs group than in intact animals. At the same time, the levels of P-selectin were higher in the CKD and CKD + GCs groups, than those in animals from the control group. In conclusion, the study of the complex system of bone remodeling regulation, which includes many factors and their interactions, may lead to the development of new methods for treating patients with chronic kidney disease in order to prevent osteoporosis in the future. (AU)


Las enfermedades metabólicas óseas se caracterizan por un desequilibrio en el proceso de remodelación ósea en los que participan mediadores tales como receptor del activador del factor nuclear- kappa- b (RANK), su ligando (RANKL) y la osteoprotegerina (OPG). Los glucocorticoides, recuentemente empleados en el tratamiento de la enfermedad renal crónica, exacerban este desequilibrio. En la enfermedad esclerótica renal, las moléculas de adhesión celular P-selectina and galectina-3 tienen un rol fundamental. El objetivo de esta trabajo fue estudiar las alteraciones en los mediadores de la remodelación ósea (RANKL, OPG, P-selectina and galectina-3) en un modelo de enfermedad renal crónica con tratamiento glucocorticoideo. Ratas Wistar hembras fueron divididos en 4 grupos: control (C); enfermedad renal crónica con afección de la remodelación ósea (ERC); animales con afección de la remodelación ósea expuestos a glucocorticoides (GC); enfermedad renal crónica con afección de la remodelación ósea tratados con glucocorticoides (ERC+GC). Los efectos de la ERC y los GC fueron evaluados bioquímicamente, histológicamente y por medición de la densidad ósea. RANKL, OPG, Pselectina and galectina-3 se cuantificaron en muestras de sangre venosa empleando enzimoinmuno análisis. En los 3 grupos experimentales la densidad ósea se evidenció reducida y los niveles séricos de RANKL elevados respecto al grupo control. Los niveles de OPG en los grupos ERC y GC fueron superiores mientras que en el grupo ERC+GC menores respecto a los animales controles. Galectina 3 plasmática en GC y ERC+GC se encontró reducida y aumentada en los animales ERC, en comparación con los animales controles. La concentración sérica de P-selectina sérica fue mayor en los grupos ERC y ERC+GC, y menor en los animales GC respecto a los niveles plasmáticos de los animales intactos. El avance del conocimiento sobre la regulación de la remodelación ósea a través de la interacción de mediadores sistémicos, en un futuro, puede conducir al desarrollo de nuevas estrategias terapéuticas para la prevención de la osteoporosis en pacientes con enfermedad renal crónica. (AU)


Assuntos
Animais , Ratos , Distúrbio Mineral e Ósseo na Doença Renal Crônica/induzido quimicamente , Remodelação Óssea/efeitos dos fármacos , Nefropatias/fisiopatologia , Osteoporose/prevenção & controle , Doenças Ósseas Metabólicas/diagnóstico , Dexametasona/administração & dosagem , Densidade Óssea/efeitos dos fármacos , Clorofórmio/uso terapêutico , Ratos Wistar , Selectina-P/efeitos dos fármacos , Selectina-P/sangue , Galectina 3/efeitos dos fármacos , Galectina 3/sangue , Ligante RANK/efeitos dos fármacos , Ligante RANK/sangue , Osteoprotegerina/efeitos dos fármacos , Osteoprotegerina/sangue , Glucocorticoides/efeitos adversos , Glicerol/administração & dosagem , Nefropatias/tratamento farmacológico
14.
Nutr. hosp ; 36(6): 1241-1247, nov.-dic. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-191140

RESUMO

Introduction: neurologically impaired children frequently experience nutritional disorders and bone health complications. Our aim was firstly to analyze a method to interpret bone mineral density (BMD) accurately in neurologically impaired children. Secondly, to determine its relationship with the nutritional status and micronutrient levels in order to identify which factors are associated with low BMD. Methods: a observational multicenter study was conducted in children with moderate-to-severe neurological impairment. Data collected included: medical records, anthropometric measures, hematologic and biochemical evaluation. BMD was measured with Dual-energy X-ray absorptiometry and z-scores were calculated adjusting for sex and chronological age. Secondly, BMD z-scores were calculated applying height age (age at which the child's height would be in 2nd percentile) instead of chronological age. Results: fifty-two children were included (aged 4-16 years). Seventeen patients (32.7%) received feeding by gastrostomy tube. Height and BMI z-score were below 2SD in 64% and 31% of patients respectively, with normal mid upper arm circumference and skinfold thickness measurements. Low vitamin-D levels were found in 42% of cases. 50% of patients evidenced low BMD when calculated for chronological age, whereas only 34.5% showed BMD z-score <-2 when calculated for height age. No correlation was observed between BMD and vitamin-D levels, weight and height z-scores or age when BMD was calculated applying height age. Conclusions: the prevalence of low BMD is high in neurologically impaired children, and it is probably multifactorial. In these children, we suggest adjusting BMD for height age, in order not to over diagnose low BMD


Introducción: los niños con afectación neurológica con frecuencia presentan trastornos nutricionales y complicaciones óseas. Nuestro objetivo fue, en primer lugar, analizar un método para interpretar la densidad mineral ósea (DMO) de forma adecuada en estos pacientes. En segundo lugar, determinar la relación de la DMO con el estado nutricional y los niveles de micronutrientes, para determinar qué factores se asocian con baja DMO. Métodos: estudio observacional multicéntrico, se incluyeron niños con afectación neurológica moderada-severa. Se recogieron datos clínicos, medidas antropométricas y una evaluación hematológica y bioquímica. La DMO fue evaluada mediante densitometría, y se calcularon los z-scores según la edad y sexo. En segundo lugar, se recalcularon los z-scores de DMO para la edad talla (edad en la cual la talla del niño se encontraría en el percentil 2) en vez de la edad cronológica. Resultados: se incluyeron 52 niños (4-16 años). Diecisiete pacientes (32,7%) recibían alimentación por gastrostomía. Los z-scores de peso y talla estaban por debajo de 2 desviaciones estándar (DE) en el 64% y 31% de los pacientes respectivamente, con normalidad de las mediciones de perímetro braquial y pliegues tricipital y subescapular. Los niveles de vitamina D estaban bajos en el 42% de los casos. La mitad de los pacientes tenían baja DMO cuando se calculó para la edad cronológica, mientras que solo el 34,5% presentaron DMO por debajo de 2 DE cuando se calculó para la edad talla. No observamos correlación entre z-scores de DMO calculados para la edad talla y los niveles de vitamina D, la edad o los z-scores de peso y talla. Conclusiones: la prevalencia de baja DMO es alta en niños con discapacidad neurológica, y probablemente es multifactorial. En estos niños, sugerimos ajustar DMO para la edad talla, para evitar sobrediagnosticar baja DMO


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/etiologia , Doenças do Sistema Nervoso/complicações , Transtornos Nutricionais/diagnóstico , Transtornos Nutricionais/etiologia , Estado Nutricional
15.
Semin Respir Crit Care Med ; 40(6): 810-824, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31679155

RESUMO

Cystic fibrosis (CF) is one of the most common life-limiting genetic disorders. Although CF is typically considered primarily as a pulmonary disease, the CF conductance transmembrane regulator is present throughout the body. From an endocrine perspective, this multisystem disease manifests primarily in the pancreas as a unique form of diabetes (CF-related diabetes mellitus), as bone disease, and as reproductive health issues in people with CF. These complications have become ever more concerning to people with CF as treatment for pulmonary disease improves and lifespans lengthen, increasing the impact of nonpulmonary complications. Our understanding of the management of these concerns continues to evolve, and, although there are some effective treatments, there is great opportunity for continued investigation into the pathophysiology of the endocrine complications of CF and their treatment.


Assuntos
Doenças Ósseas Metabólicas/etiologia , Fibrose Cística/complicações , Diabetes Mellitus/etiologia , Hipogonadismo/etiologia , Infertilidade/etiologia , Densidade Óssea , Doenças Ósseas Metabólicas/diagnóstico , Fibrose Cística/metabolismo , Diabetes Mellitus/diagnóstico , Humanos , Hipogonadismo/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
J Pediatr Endocrinol Metab ; 32(10): 1103-1120, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31600139

RESUMO

Background Infants who present with multiple unexplained fractures (MUF) are often diagnosed as victims of child abuse when parents deny wrongdoing and cannot provide a plausible alternative explanation. Herein we describe evidence of specific and commonly overlooked radiographic abnormalities and risk factors that suggest a medical explanation in such cases. Methods We evaluated such infants in which we reviewed the radiographs for signs of poor bone mineralization. We reviewed medical, pregnancy and family histories. Results Seventy-five of 78 cases showed poor bone mineralization with findings of healing rickets indicating susceptibility to fragility fractures that could result from a wide variety of causes other than child abuse. We found risk factors that could explain the poor bone mineralization: maternal and infant vitamin D deficiency (VDD), decreased fetal bone loading, prematurity and others. Most infants had more than one risk factor indicating that this bone disorder is a multifactorial disorder that we term metabolic bone disease of infancy (MBDI). Maternal and infant VDD were common. When tested, 1,25-dihydroxyvitamin D levels were often elevated, indicating metabolic bone disease. Conclusions Child abuse is sometimes incorrectly diagnosed in infants with MUF. Appreciation of the radiographic signs of MBDI (healing rickets), risk factors for MBDI and appropriate laboratory testing will improve diagnostic accuracy in these cases.


Assuntos
Doenças Ósseas Metabólicas/diagnóstico , Calcificação Fisiológica , Maus-Tratos Infantis/estatística & dados numéricos , Diabetes Gestacional/fisiopatologia , Fraturas Ósseas/diagnóstico , Deficiência de Vitamina D/complicações , Doenças Ósseas Metabólicas/etiologia , Feminino , Seguimentos , Fraturas Ósseas/etiologia , Idade Gestacional , Humanos , Lactente , Masculino , Gravidez , Prognóstico , Fatores de Risco
18.
Pediatr Int ; 61(10): 1015-1019, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31486579

RESUMO

BACKGROUND: The aim of this study was to assess the performance of a score-based diagnostic approach (SBDA) proposed in the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) 2012 guideline, and the usefulness of bone mineral density (BMD) measurement in SBDA as an objective finding in the diagnosis of celiac disease (CD). METHODS: The SBDA scores of 153 biopsy-proven celiac diagnosed children (derived from symptomatology, serology, human leukocyte antigen [HLA] analysis, histology) were calculated. Additionally, BMD Z scores obtained at diagnosis were also investigated. The diagnostic sensitivity of SBDA was tested in different scenarios in which low BMD was scored as a diagnostic finding. RESULTS: The mean age of children was 9.48 ± 3.59 years and 54.2% were female. All patients scored ≥4, which is the minimum score to diagnose CD in SBDA. Mean BMD Z score in 142 of 153 patients was -2.70 ± 1.16, and 73.9% of them were below -2. Moreover, different diagnostic scenarios without histology were tested. In one of them, BMD and HLA were not included and the sensitivity was 85.2%. In another one, low BMD was scored as an equivalent of malabsorption, HLA was not included and sensitivity was 97.2%. The sensitivities of these scenarios were significantly different (P = 0.001). CONCLUSION: In the absence of both HLA and histology, accepting low BMD as an equivalent of malabsorption drastically increased the diagnostic sensitivity, while SBDA had limited success. Therefore, BMD might be useful when HLA and biopsy are not available.


Assuntos
Doenças Ósseas Metabólicas/diagnóstico , Doença Celíaca/diagnóstico , Indicadores Básicos de Saúde , Algoritmos , Doenças Ósseas Metabólicas/etiologia , Doença Celíaca/complicações , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade
19.
Clin Otolaryngol ; 44(6): 1011-1016, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31529761

RESUMO

OBJECTIVES: We aimed to investigate the bone mineral density (BMD) in a group of Swedish patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) with or without asthma, as well as to evaluate whether the treatment of this patient group is in accordance with the EPOS recommendations. DESIGN, SETTINGS AND PARTICIPANTS: Adult patients with a diagnosis of CRSwNP, and a history of at least two courses of oral corticosteroids (OCS) during the last year, were consecutively included in this study at five centres. MAIN OUTCOME MEASURES: The BMD of the patients was measured by Dual-energy X-ray absorptiometry (DXA), which is the only technology for classifying BMD according to the criteria established by WHO. RESULTS: A total of 51 patients, with an average number of 7 years with OCS treatment, were enrolled. During the last 12 months, the mean number of OCS courses was 2.76, and the total mean intake was 891 mg of Prednisone equivalents. According to the T-scores, 17 patients were measured to have ≤-1 SD T-score lumbar spine, which is considered to be osteopenia, and five patients had <-2.5 SD T-score, considered as osteoporosis. However, when taking age and gender into account and analysing the Z-scores, only 2 patients had a reduced density of the spine and none in the hip, which is no difference compared to a matched Swedish population. CONCLUSIONS: This prospective study shows that 2-3 moderate courses of OCS annually may be used without high risk of causing osteopenia/osteoporosis in patients with CRSwNP.


Assuntos
Corticosteroides/efeitos adversos , Doenças Ósseas Metabólicas/induzido quimicamente , Pólipos Nasais/tratamento farmacológico , Osteoporose/induzido quimicamente , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Absorciometria de Fóton , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Doenças Ósseas Metabólicas/diagnóstico , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Osteoporose/diagnóstico , Estudos Prospectivos , Rinite/complicações , Sinusite/complicações , Suécia
20.
Nutr Hosp ; 36(6): 1241-1247, 2019 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-31545064

RESUMO

Introduction: Introduction: neurologically impaired children frequently experience nutritional disorders and bone health complications. Our aim was firstly to analyze a method to interpret bone mineral density (BMD) accurately in neurologically impaired children. Secondly, to determine its relationship with the nutritional status and micronutrient levels in order to identify which factors are associated with low BMD. Methods: a observational multicenter study was conducted in children with moderate-to-severe neurological impairment. Data collected included: medical records, anthropometric measures, hematologic and biochemical evaluation. BMD was measured with Dual-energy X-ray absorptiometry and z-scores were calculated adjusting for sex and chronological age. Secondly, BMD z-scores were calculated applying height age (age at which the child's height would be in 2nd percentile) instead of chronological age. Results: fifty-two children were included (aged 4-16 years). Seventeen patients (32.7%) received feeding by gastrostomy tube. Height and BMI z-score were below 2SD in 64% and 31% of patients respectively, with normal mid upper arm circumference and skinfold thickness measurements. Low vitamin-D levels were found in 42% of cases. 50% of patients evidenced low BMD when calculated for chronological age, whereas only 34.5% showed BMD z-score <-2 when calculated for height age. No correlation was observed between BMD and vitamin-D levels, weight and height z-scores or age when BMD was calculated applying height age. Conclusions: the prevalence of low BMD is high in neurologically impaired children, and it is probably multifactorial. In these children, we suggest adjusting BMD for height age, in order not to over diagnose low BMD.


Assuntos
Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/etiologia , Doenças do Sistema Nervoso/complicações , Transtornos Nutricionais/diagnóstico , Transtornos Nutricionais/etiologia , Estado Nutricional , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino
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