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1.
Acta Med Port ; 32(7-8): 536-541, 2019 Aug 01.
Artigo em Português | MEDLINE | ID: mdl-31445534

RESUMO

INTRODUCTION: Metabolic bone disease of prematurity consists in a decrease of bone matrix mineral content, in comparison with the level expected for gestational age. Screening of this condition is based on serum alkaline phosphatase and phosphate levels. The aim of this study is to evaluate the prevalence of metabolic bone disease of prematurity, to assess the aspects associated with a higher risk of this disease and to describe the growth of newborns with birth weight below 1500 g and metabolic bone disease of prematurity. MATERIAL AND METHODS: Observational, retrospective, multicenter and descriptive study in three neonatal intensive care units in Portugal, from May 1st 2016 to April 30th 2017. A convenience sample of very low birthweight newborns was obtained. Demographic, clinical, and laboratory variables were described in newborns with and without metabolic bone disease of prematurity. RESULTS: A total of 53 newborns were included in this study: 30 males, 16 with gestational age ≤ 28 weeks. Five cases of metabolic bone disease of prematurity were diagnosed. In this group, the majority of patients was male and presented a lower gestational age and birth weight, in comparison with the group without metabolic bone disease of prematurity. The average duration of parenteral nutrition was higher in newborns with metabolic bone disease of prematurity and the calcium/phosphate ratio was lower than the recommended values. Growth was similar in both groups. No patient with metabolic bone disease of prematurity underwent physical rehabilitation. DISCUSSION: The prevalence of metabolic bone disease of prematurity was 9.43%, which is lower than what is described in the literature. However, only 50% of newborns completed the screening according to the recommendations. The main risk factors identified concur with the literature. CONCLUSION: Metabolic bone disease of prematurity is a frequent but underdiagnosed comorbidity in very low birthweight newborns. It is essential to screen newborns at risk for this condition, using biochemical markers, as well as structure nutritional interventions and physical stimulation in order to avoid short and long-term consequences of this disease.


Assuntos
Doenças Ósseas Metabólicas/epidemiologia , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Fosfatase Alcalina/sangue , Doenças Ósseas Metabólicas/diagnóstico , Cálcio/sangue , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Nutrição Parenteral/estatística & dados numéricos , Fosfatos/sangue , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
2.
Nutrients ; 11(6)2019 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-31234587

RESUMO

The diurnal rhythm of bone remodeling suggests nocturnal dietary intervention to be most effective. This study investigated the effect of bedtime ingestion of a calcium-fortified, milk-derived protein matrix (MBPM) or maltodextrin (CON) on acute (0-4 h) blood and 24-h urinary change in biomarkers of bone remodeling in postmenopausal women with osteopenia. In CON, participants received 804 ± 52 mg calcium, 8.2 ± 3.2 µg vitamin D and 1.3 ± 0.2 g/kg BM protein per day. MBPM increased calcium intake to 1679 ± 196 mg, vitamin D to 9.2 ± 3.1 µg and protein to 1.6 ± 0.2 g/kg BM. Serum C-terminal cross-linked telopeptide of type I collagen (CTX) and procollagen type 1 amino-terminal propeptide (P1NP), and urinary N-telopeptide cross-links of type I collagen (NTX), pyridinoline (PYD) and deoxypyridinoline (DPD) was measured. Analyzed by AUC and compared to CON, a -32% lower CTX (p = 0.011, d = 0.83) and 24% (p = 0.52, d = 0.2) increase in P1NP was observed for MBPM. Mean total 24 h NTX excreted in MBPM was -10% (p = 0.035) lower than CON. Urinary PYD and DPD were unaffected by treatment. This study demonstrates the acute effects of bedtime ingestion of a calcium-fortified, milk-based protein matrix on bone remodeling.


Assuntos
Doenças Ósseas Metabólicas/dietoterapia , Remodelação Óssea , Cálcio na Dieta/administração & dosagem , Ritmo Circadiano , Suplementos Nutricionais , Alimentos Fortificados , Proteínas do Leite/administração & dosagem , Pós-Menopausa/sangue , Idoso , Biomarcadores/sangue , Doenças Ósseas Metabólicas/sangue , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/fisiopatologia , Cálcio na Dieta/efeitos adversos , Colágeno Tipo I/sangue , Suplementos Nutricionais/efeitos adversos , Feminino , Alimentos Fortificados/efeitos adversos , Humanos , Irlanda , Pessoa de Meia-Idade , Proteínas do Leite/efeitos adversos , Hormônio Paratireóideo/sangue , Fragmentos de Peptídeos/sangue , Peptídeos/sangue , Pró-Colágeno/sangue , Fatores de Tempo , Resultado do Tratamento , Vitamina D/administração & dosagem
3.
Osteoporos Int ; 30(9): 1893-1896, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31147735

RESUMO

We describe a novel disease of diffuse skeletal histiocytosis associated with multiple fragility fractures and high osteoclast activity. Clinical, radiographic, biochemical, genetic, and histopathological investigations were performed to characterize the diagnosis of an Asian man who presented with hip fracture and diffuse skeletal lytic lesions. After excluding malignancy and other common metabolic bone diseases, open bone biopsy yielded several pathological samples all showing extensive skeletal histiocytosis likely to explain the diffuse axial and appendicular lytic lesions. Rare disorders such as Langerhans histiocytosis, Erdheim-Chester disease, and diffuse cystic skeletal angiomatosis were excluded through careful pathological examination and lack of CD1a and S-100 staining. Whole exome sequencing did not yield diagnostic findings to explain this likely acquired disease. High markers of osteoclast activity suggested excessive focal bone resorption but normalized after zoledronic acid treatment. A novel disease of skeletal histiocytosis with high bone turnover is differentiated from other histiocytic and lytic skeletal diseases.


Assuntos
Doenças Ósseas Metabólicas/diagnóstico , Fraturas Espontâneas/diagnóstico , Histiocitose/diagnóstico , Doenças Ósseas Metabólicas/patologia , Diagnóstico Diferencial , Fraturas Espontâneas/patologia , Histiocitose/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Recidiva
4.
Arch Dis Child Fetal Neonatal Ed ; 104(5): F560-F566, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31079069

RESUMO

Metabolic bone disease of prematurity (MBDP) is characterised by skeletal demineralisation, and in severe cases it can result in fragility fractures of long bones and ribs during routine handling. MBDP arises from prenatal and postnatal factors. Infants who are born preterm are deprived of fetal mineral accumulation, 80% of which occurs in the third trimester. Postnatally, it is difficult to maintain a comparable intake of minerals, and medications, such as corticosteroids and diuretic therapy, lead to bone resorption. With improvements in neonatal care and nutrition, the incidence of MBDP in preterm infants appears to have decreased, although the recent practice of administering phosphate supplements alone will result in secondary hyperparathyroidism and associated bone loss, worsening MBDP. Postnatal immobilisation and loss of placental supply of oestrogen also contribute to skeletal demineralisation. There is no single diagnostic or screening test for MBDP, with pitfalls existing for most radiological and biochemical investigations. By reviewing the pathophysiology of calcium and phosphate homeostasis, one can establish that plasma parathyroid hormone is important in determining the aetiology of MBDP - primarily calcipaenia or phosphopaenia. This will then direct treatment with the appropriate supplements while considering optimal physiological calcium to phosphate ratios.


Assuntos
Doenças Ósseas Metabólicas , Recém-Nascido Prematuro/metabolismo , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/metabolismo , Doenças Ósseas Metabólicas/terapia , Cálcio/metabolismo , Gerenciamento Clínico , Humanos , Recém-Nascido , Hormônio Paratireóideo/metabolismo , Fosfatos/metabolismo
5.
PLoS One ; 14(5): e0217348, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141566

RESUMO

This is a report on how 1H NMR-based metabonomics was employed to discriminate osteopenia from osteoporosis in postmenopausal women, identifying the main metabolites associated to the separation between the groups. The Assays were performed using seventy-eight samples, being twenty-eight healthy volunteers, twenty-six osteopenia patients and twenty-four osteoporosis patients. PCA, LDA, PLS-DA and OPLS-DA formalisms were used. PCA discriminated the samples from healthy volunteers from diseased patient samples. Osteopenia-osteoporosis discrimination was only obtained using Analysis Discriminants formalisms, as LDA, PLS-DA and OPLS-DA. The metabonomics model using LDA formalism presented 88.0% accuracy, 88.5% specificity and 88.0% sensitivity. Cross-Validation, however, presented some problems as the accuracy of modeling decreased. LOOCV resulted in 78.0% accuracy. The OPLS-DA based model was better: R2Y and Q2 values equal to 0.871 (p<0.001) and 0.415 (p<0.001). LDA and OPLS-DA indicated the important spectral regions for discrimination, making possible to assign the metabolites involved in the skeletal system homeostasis, as follows: VLDL, LDL, leucine, isoleucine, allantoin, taurine and unsaturated lipids. These results indicate that 1H NMR-based metabonomics can be used as a diagnosis tool to discriminate osteoporosis from osteopenia using a single serum sample.


Assuntos
Doenças Ósseas Metabólicas/diagnóstico , Metabolômica/métodos , Osteoporose/diagnóstico , Idoso , Estudos de Casos e Controles , Diagnóstico Diferencial , Análise Discriminante , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/métodos , Pessoa de Meia-Idade , Pós-Menopausa/metabolismo , Análise de Componente Principal , Sensibilidade e Especificidade
6.
Paediatr Respir Rev ; 31: 12-14, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30962150

RESUMO

NICE produced a guideline for the diagnosis and management of CF (NG78) in October 2017. This paper describes the process of producing the guideline and highlights some of the areas covered by it, including ideas for further research and tools that can be used by purchasers to help improve CF care.


Assuntos
Fibrose Cística/diagnóstico , Fibrose Cística/terapia , Guias de Prática Clínica como Assunto , Antibacterianos/uso terapêutico , Doenças Ósseas Metabólicas/diagnóstico , Infecção Hospitalar/prevenção & controle , Diabetes Mellitus/diagnóstico , Expectorantes/uso terapêutico , Teste de Tolerância a Glucose , Humanos , Programas de Rastreamento , Modalidades de Fisioterapia , Terapia Respiratória , Reino Unido
8.
Front Horm Res ; 51: 147-159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641531

RESUMO

Pseudohypoparathyroidism (PHP), pseudo-PHP, acrodysostosis, and progressive osseous heteroplasia are heterogeneous disorders characterized by physical findings, differently associated in each subtype, including short bones, short stature, a stocky build, ectopic ossifications (features associated with Albright's hereditary osteodystrophy), as well as laboratory abnormalities consistent with hormone resistance, such as hypocalcemia, hyperphosphatemia, and elevated parathyroid hormone (PTH) and thyroid-stimulating hormone levels. All these disorders are caused by impairments in the cAMP-mediated signal transduction pathway and, in particular, in the PTH/PTHrP signaling pathway: the main subtypes of PHP and related disorders are caused by de novo or autosomal dominantly inherited inactivating genetic mutations, and/or epigenetic, sporadic, or genetic-based alterations within or upstream of GNAS, PRKAR1A, PDE4D, and PDE3A. Here we will review the impressive progress that has been made over the past 30 years on the pathophysiology of these diseases and will describe the recently proposed novel nomenclature and classification. The new term "inactivating PTH/PTHrP signaling disorder," iPPSD: (1) defines the common mechanism responsible for all diseases, (2) does not require a confirmed genetic defect, (3) avoids ambiguous terms like "pseudo," and (4) eliminates the clinical or molecular overlap between diseases.


Assuntos
Doenças Ósseas Metabólicas , Disostoses , Deficiência Intelectual , Ossificação Heterotópica , Osteocondrodisplasias , Proteína Relacionada ao Hormônio Paratireóideo/metabolismo , Hormônio Paratireóideo/metabolismo , Pseudo-Hipoparatireoidismo , Transdução de Sinais/fisiologia , Dermatopatias Genéticas , Doenças Ósseas Metabólicas/classificação , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/metabolismo , Doenças Ósseas Metabólicas/terapia , Disostoses/classificação , Disostoses/diagnóstico , Disostoses/metabolismo , Disostoses/terapia , Humanos , Deficiência Intelectual/classificação , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/metabolismo , Deficiência Intelectual/terapia , Ossificação Heterotópica/classificação , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/metabolismo , Ossificação Heterotópica/terapia , Osteocondrodisplasias/classificação , Osteocondrodisplasias/diagnóstico , Osteocondrodisplasias/metabolismo , Osteocondrodisplasias/terapia , Pseudo-Hipoparatireoidismo/classificação , Pseudo-Hipoparatireoidismo/diagnóstico , Pseudo-Hipoparatireoidismo/metabolismo , Pseudo-Hipoparatireoidismo/terapia , Dermatopatias Genéticas/classificação , Dermatopatias Genéticas/diagnóstico , Dermatopatias Genéticas/metabolismo , Dermatopatias Genéticas/terapia
9.
Mult Scler Relat Disord ; 28: 305-308, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30641355

RESUMO

BACKGROUND: Accidental falls and fall-related injuries are common among people with multiple sclerosis (MS). Fractures are the most common injury, pointing to the need to understand current practices related to bone health management in this population. We sought to identify factors associated with bone mineral density (BMD) screening, using dual-energy X-ray absorptiometry, among people with MS. METHODS: Using population-based databases from Manitoba, Canada, we identified all people with MS. Through linkage to the Manitoba Bone Mineral Density Database we subsequently determined which of these individuals underwent BMD screening following their MS diagnosis. We used Cox proportional hazards regression analysis to identify factors associated with time to BMD screening after MS diagnosis. RESULTS: Of the 5729 eligible persons with MS, most were females (n = 4032, 70.4%) and were living in an urban centre (n = 3601, 62.9%). Ten percent (n = 584) had suffered a recent fracture and nearly one-third used anticonvulsants. BMD screening occurred in 783 (13.7%). Factors associated with BMD screening were female sex (hazard ratio [HR] 5.34; 95%CI: 4.10-6.95), prolonged glucocorticoid therapy (HR 3.73; 95%CI: 2.64-5.25), breast cancer (HR 3.54; 95%CI: 2.37-5.30), recent fracture (HR 3.44; 95%CI: 2.39-4.90), continuity of care (HR 1.69; 95%CI: 1.17-2.44), greater disability (HR 1.49; 95%CI: 1.19-1.86), older age (HR/decade 1.34; 95%CI: 1.22-1.34), anticonvulsant use (HR 1.32; 95%CI: 1.06-1.63) and urban (versus rural) residence (HR 1.17; 95%CI: 1.00-1.36). CONCLUSION: Factors known to be associated with low BMD were associated with BMD screening in people with MS, but overall BMD screening rates are relatively low, suggesting that a clinically meaningful proportion of individuals with MS who have low bone mass may be missed.


Assuntos
Absorciometria de Fóton , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/epidemiologia , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/terapia , Adulto Jovem
10.
J Matern Fetal Neonatal Med ; 32(17): 2860-2867, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29562766

RESUMO

Purpose: The aim of this pilot study was to estimate physiological parathyroid hormone (PTH) levels and their relationship with bone metabolism parameters in otherwise healthy preterm newborns with birth weight 1000-1500 g. Methods: PTH, 25(OH)D, S-Ca, S-P, and ALP were analysed from blood samples obtained from 20 preterm infants once a week up to the 36th gestational week. Results: Of the total 134 examined serum samples for PTH levels, the estimated range was 1.6-9.3 pmol/l (15.1-87.7 pg/ml). No statistically significant correlation of PTH level with that of S-Ca, S-P, or ALP was observed, except for the 56th day of life (p = .03; Rho = 0.76; n = 8). From the second month of life, there was a statistically significant relationship only between PTH and 25(OH)D (Rho = -0.71, p ≤ .0001). In our cohort, vitamin D deficiency (20 ng/ml) occurred in 75% at birth and at 30% in the 36th gestational week. Conclusions: The physiological range indicated by the measurements was close to the reference limits for adults (1-7 pmol/l; 9.4-66 pg/ml). PTH level above this range can be considered as hyperparathyroidism in preterm neonates.


Assuntos
Densidade Óssea , Doenças Ósseas Metabólicas/diagnóstico , Calcitriol/sangue , Hormônio Paratireóideo/sangue , Deficiência de Vitamina D/sangue , Biomarcadores/sangue , Doenças Ósseas Metabólicas/sangue , Cordocentese , Feminino , Idade Gestacional , Humanos , Hiperparatireoidismo/diagnóstico , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Projetos Piloto , Estudos Prospectivos , Deficiência de Vitamina D/diagnóstico
11.
Physiother Theory Pract ; 35(6): 577-585, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29589776

RESUMO

Various methods are used to measure hip and knee joint motion angles; however, their use is often limited by cost or inability to measure dynamic movements. The assessment of movement patterns is clinically useful in individuals with osteoporosis (OP) and osteopenia (OPe) through its potential to optimize fracture risk assessment. This study evaluates the inter-rater reliability of using DartfishTM 2-D Motion Analysis Software to measure maximum flexion and extension angles at the hip and knee in individuals with OP or OPe while performing five tasks of the Safe Functional Motion test. Twelve participants were videotaped performing the pour, footwear, newspaper, sweep, and sit-to-floor tasks. Five raters used DartfishTM to analyze maximum flexion and extension angles at the hip and knee, and an intra-class correlation coefficients (ICC) and SEM were calculated for each measurement. In all five tasks, ICC and SEM values ranged from 0.23 to 0.95, and 1.75 to 11.54 degrees, respectively, with maximum knee flexion angles generally having higher ICC, and lower SEM point estimates. The results indicate that DartfishTM measurements of maximum knee flexion angles in uniplanar tasks demonstrate a moderate to excellent degree of inter-rater reliability, while measurements at the hip joint should be used with caution. Given that the results of this study display moderate to excellent reliability, they lay the groundwork for future research aimed at determining the validity of these measurements. Such research would help to further develop the base of evidence surrounding the usefulness of DartfishTM Motion Analysis in fracture risk analysis among individuals with OP.


Assuntos
Doenças Ósseas Metabólicas/diagnóstico , Articulação do Quadril/fisiopatologia , Interpretação de Imagem Assistida por Computador/métodos , Articulação do Joelho/fisiopatologia , Osteoporose/diagnóstico , Exame Físico/métodos , Software , Gravação em Vídeo , Idoso , Fenômenos Biomecânicos , Doenças Ósseas Metabólicas/fisiopatologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Osteoporose/fisiopatologia , Valor Preditivo dos Testes , Amplitude de Movimento Articular , Reprodutibilidade dos Testes
13.
Adv Clin Exp Med ; 28(2): 179-184, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29963786

RESUMO

BACKGROUND: Postmenopausal osteoporosis is the most common metabolic bone disease among women. The Wnt signaling pathway has been known to be the critical regulator of osteoblastogenesis. Alterations in this mechanism may have consequences for bone remodeling in humans. OBJECTIVES: The aim of the study was to evaluate the frequency of genotypes and alleles of single nucleotide polymorphism (SNP) rs4988321 and rs312009 of LRP5 in Polish postmenopausal women with osteopenia (n = 109) and osteoporosis (n = 333). Potential correlations between genetic polymorphisms, bone mineral density (BMD), risk for bone fractures, and other clinical parameters were analyzed. MATERIAL AND METHODS: Genomic DNA was extracted from the blood samples and the sequence polymorphisms of LRP5 gene were detected using real-time polymerase chain reaction (RT-PCR) methods with melting curve analysis. We also calculated the odds ratio (OR) for the LRP5 genotypes and the alleles. Then, we evaluated the effect of the LRP5 polymorphism on T-score, Z-score, L2L4AM, L2L4YA, L2L4BMD, body mass index (BMI), and other clinical parameters. RESULTS: No statistically significant differences in the distribution of LRP5 rs312009 genotypes between the groups were observed. Furthermore, our findings indicate that there is no correlation between LRP5 genotypes and the clinical characteristics of women with osteopenia/osteoporosis. In contrast, there was an increased value of OR in heterozygotes for rs4988321, both in patients with osteopenia (OR = 1.47) and in those with osteoporosis (OR = 1.33). In our study, we were not able to calculate the OR parameter for the AA genotype due to its low prevalence in the population. CONCLUSIONS: Our results suggest that the Val667Met LRP5 (rs312009) polymorphism may contribute to an elevated risk for fractures in postmenopausal Polish women.


Assuntos
Densidade Óssea/genética , Doenças Ósseas Metabólicas/genética , Proteína-5 Relacionada a Receptor de Lipoproteína de Baixa Densidade/genética , Osteoporose Pós-Menopausa/genética , beta Catenina , Índice de Massa Corporal , Doenças Ósseas Metabólicas/diagnóstico , Feminino , Genótipo , Humanos , Proteína-5 Relacionada a Receptor de Lipoproteína de Baixa Densidade/metabolismo , Osteoporose Pós-Menopausa/diagnóstico , Polônia , Polimorfismo de Nucleotídeo Único/genética , Pós-Menopausa , Reação em Cadeia da Polimerase em Tempo Real , Via de Sinalização Wnt
14.
Indian J Dermatol Venereol Leprol ; 85(2): 153-159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30226478

RESUMO

Background/Purpose: Psoriasis is a multisystem disease which has been related to vitamin-D deficiency through chronic inflammation. This psoriasis-related inflammatory state and vitamin-D deficiency may induce bone mineral density loss. The purpose of this study is to assess the relationship of psoriasis with bone mineral density, by comparing psoriatic patients with healthy controls and patients with osteopenia/osteoporosis. Methods: A total of 185 subjects were studied; 58 psoriatic patients who had not been under systemic or biological treatment were included. Age, gender, body mass index, phosphocalcic metabolic parameters and hip and lumbar (L4) bone mineral density data were collected. These variables were compared with those collected in 61 healthy controls and 67 patients with osteopenia/osteoporosis. Results: Psoriatic patients showed worse hip and lumbar spine bone mineral density levels than healthy controls (P = 0.001) and better levels than osteoporotic patients (P < 0.001). Multivariate analysis demonstrated a negative association of age and a positive association of body mass index in hip bone mineral density in psoriatic patients. Limitations: The main limitations are those of cross-sectional studies, such as a lack of follow up period, and a male predominance in the psoriatic group, which is corrected employing a multivariate analysis with an adjusted model for confounding factors. Conclusions: Bone mineral density levels in psoriatic patients are situated halfway between healthy controls and patients with osteopenia/osteoporosis. In addition, the higher body mass index in patients with psoriasis appears to confer a protective effect against further development of lower bone mineral density.


Assuntos
Densidade Óssea , Doenças Ósseas Metabólicas/epidemiologia , Osteoporose/epidemiologia , Psoríase/epidemiologia , Adulto , Distribuição por Idade , Doenças Ósseas Metabólicas/diagnóstico , Comorbidade , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Osteoporose/diagnóstico , Prevalência , Prognóstico , Psoríase/diagnóstico , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo
15.
J Microbiol Immunol Infect ; 52(5): 693-699, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30293926

RESUMO

BACKGROUND/PURPOSE: HIV-infected patients have a high prevalence of low bone mineral density (BMD), but BMD changes remain unclear. This cross-sectional retrospective observational study aimed to characterize the prevalence and associated factors of low BMD in HIV patients. METHODS: Between 1 January 2015 and 31 December 2016, all patients aged 20 years or greater who sought for HIV care were included. BMD was measured by dual-energy X-ray absorptiometry. Multivariable analyses of the association with HIV disease status, treatment and anthropometric parameters were performed. Circulating fibroblast growth factor 23 and intact parathyroid hormone were measured. RESULTS: A total of 137 patients was included; their median age was 39 years old; 97.8% were treated with combination antiretroviral therapy (cART); Body mass index (BMI) was 21.97 kg/m2. Sixty-one patients (44.5%) showed low BMD (osteopenia and osteoporosis) based on the WHO criteria. The median BMD was -0.80 g/cm2 (IQR, -1.5 to -0.2). The prevalence rate of low BMD was 37% in those who were aged 20-29 years, 45.2% in those who were aged 30-39 years, 45.2% in those who were aged 40-49 years, 45.8% in those who were aged 50-59 years, and 53.8% in those who were aged ≧60 years. More than half of patients (50.4%, 69/137) were younger than 40 years. Compared with normal BMD group, the low BMD group has a higher proportion of secondary hyperparathyroidism (18.0% vs 5.3%, p: 0.026) and a lower median C-terminal FGF23 level (48.92 vs 62.61 pg/ml, p: 0.008). Univariate and multivariate analyses of the factors associated with low BMD. We found that only serum intact-parathyroid hormone (iPTH) > 69 pg/ml (OR, 3.86; 95% CI, 1.14-13.09) was statistically significant associated with low BMD in multivariate analysis. CONCLUSIONS: This cohort-based survey showed a high prevalence of low BMD among HIV-infected adults which included young-age patient in an university hospital. Secondary hyperparathyroidism was significantly associated with low BMD. There was no association between FGF23 and low BMD.


Assuntos
Doenças Ósseas Metabólicas/complicações , Fatores de Crescimento de Fibroblastos/metabolismo , Infecções por HIV/complicações , Hormônio Paratireóideo/metabolismo , Absorciometria de Fóton , Adulto , Antirreumáticos/uso terapêutico , Densidade Óssea , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Hiperparatireoidismo , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Osteoporose , Pacientes , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
16.
Clin Interv Aging ; 14: 2281-2293, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31908438

RESUMO

Purpose: To evaluate the effectiveness of a combined balance-, strength-, and jumping-exercise intervention on a mini-trampoline performed by older women with osteopenia on static balance and functional mobility, gait speed, strength of the upper and lower limbs, fear of falling, as well as to investigate its influence on bone mineral density (BMD). Patient and methods: Using a randomized controlled study design, participants (range: 56-83 years) were assigned either to the intervention group (IG; n=20, mean age 69.6 ± 5.3 years) performing a specifically tailored intervention on a mini-trampoline or to the control group (CG; n=20, 67.4 ± 6.8 years), that did not undertake any intervention beyond regular osteopenia treatment. The intervention was performed twice a week for 12 weeks, each session lasting 45-60 mins and consisted of balance, strength and jumping exercises. Static balance and functional mobility was measured by one-leg stance (OLS) and timed up and go test (TUG). Upper and lower limb strength was evaluated by the arm curl test (ACT) and the 30-s chair stand test (CST) whereas gait speed was measured by the 6 m walking test (WT). Fear of falling was measured using the Falls Efficacy Scale - International (FES-I). BMD was measured at the lumbar spine and femoral neck using Dual-energy X-ray absorptiometry (DXA). Results: Significant interactions (group x time) were found for all parameters (p<0.001) except for BMD, measured at the lumbar spine (p=0.064) and femoral neck (p=0.073). All test parameters of balance and functional mobility tests (OLS, TUG), strength tests (ACT, CST), WT, FES-I and BMD (femoral neck) showed significant improvement in the IG (p<0.05). Conclusion: The combined 12-week intervention was highly effective in improving balance and functional mobility, strength, gait performance and fear of falling in patients with osteopenia.


Assuntos
Acidentes por Quedas/prevenção & controle , Densidade Óssea/fisiologia , Doenças Ósseas Metabólicas/reabilitação , Terapia por Exercício/métodos , Medo/psicologia , Equilíbrio Postural/fisiologia , Velocidade de Caminhada/fisiologia , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/fisiopatologia , Exercício , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
17.
Best Pract Res Clin Endocrinol Metab ; 32(5): 725-738, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30449551

RESUMO

Bone turnover includes two processes: resorption (removal of old bone) and formation (laying down of new bone). N-terminal propeptide of type I procollagen (PINP) and C-telopeptide of type I collagen (CTX-I) are markers of bone formation and resorption, respectively, that the International Osteoporosis Foundation and the International Federation of Clinical Chemistry recommend for clinical use. Bone turnover markers (BTM) are subject to sources of variability, including feeding (lower resorption) and recent fracture (increased levels of all markers). Controllable patient-related factors should be adapted as much as possible (eg blood collection after an overnight fast) to minimize pre-analytical variability. Uncontrollable factors should be considered in the interpretation of the BTM measurements. BTM do not improve prediction of bone loss or fracture within an individual. In osteoporotic patients, BTM may help to assess the response to anabolic and antiresorptive therapies, to assess compliance to the treatment, or to indicate possible secondary causes of osteoporosis. BTM reflect changes in bone metabolism induced by anti-osteoporotic treatment. Anti-resorptive drugs induce a rapid dose-dependent decrease in bone resorption, whereas bone formation stimulating medications increase the levels of bone formations markers. BTM may be used for monitoring anti-osteoporosis therapy. The expected effect during the anti-resorptive therapy is to decrease the PINP by at least 10 ng/mL and to attain the target level of less than 35 ng/mL. The expected effect during the bone formation-stimulating therapy is to increase the PINP by at least 10 ng/mL and to attain the target level of more than 69 ng/mL.


Assuntos
Doenças Ósseas Metabólicas/diagnóstico , Remodelação Óssea/fisiologia , Animais , Biomarcadores/sangue , Densidade Óssea/fisiologia , Doenças Ósseas Metabólicas/metabolismo , Doenças Ósseas Metabólicas/patologia , Reabsorção Óssea/sangue , Reabsorção Óssea/diagnóstico , Reabsorção Óssea/terapia , Osso e Ossos/metabolismo , Colágeno Tipo I/sangue , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Humanos , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Osteoporose/etiologia , Osteoporose/terapia , Peptídeos/sangue
18.
Eur J Dermatol ; 28(4): 434-439, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30325330

RESUMO

Multiple miliary osteoma cutis consists of heterotopic foci of bone tissue in the dermis and subcutaneous tissue. Patients usually present with multiple, asymptomatic facial papules of several millimetres in diameter which cause distress regarding their cosmetic appearance. The condition is described as rare, as only a few cases have been reported since its first description in 1864 by Virchow. We therefore carried out a comprehensive literature search and review, in which 102 published cases were retrieved and analysed. The demographic and clinical aspects, as well as current therapy solutions, of this probably overlooked condition are discussed.


Assuntos
Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/terapia , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/terapia , Dermatopatias Genéticas/diagnóstico , Dermatopatias Genéticas/terapia , Conservadores da Densidade Óssea/uso terapêutico , Doenças Ósseas Metabólicas/epidemiologia , Procedimentos Cirúrgicos Dermatológicos , Diagnóstico Diferencial , Humanos , Ossificação Heterotópica/epidemiologia , Retinoides/uso terapêutico , Dermatopatias Genéticas/epidemiologia
20.
J Pediatr ; 202: 171-178.e3, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30268401

RESUMO

OBJECTIVE: We sought to assess worldwide differences among pediatric patients undergoing hemodialysis. Because practices differ widely regarding nutritional resources, treatment practice, and access to renal replacement therapy, investigators from the Pediatric Investigation and Close Collaboration to examine Ongoing Life Outcomes, the pediatric subset of the MONitoring Dialysis Outcomes Cohort (PICCOLO MONDO) performed this cross-sectional study. We hypothesized that growth would be better in developed countries, possibly at the expense of bone mineral disease. STUDY DESIGN: In this cross-sectional study, we analyzed growth by height z score and recommended age-specific bone mineral metabolism markers from 225 patients <18 years of age maintained on hemodialysis, between the years of 2000 to 2012 from 21 countries in different regions. RESULTS: The patients' median age was 16 (IQR 14-17) years, and 45% were females. A height z score less than the third percentile was noted in 34% of the cohort, whereas >66% of patients reported normal heights, with patients from North America having the greatest proportion (>80%). More than 70% of the entire cohort had greater than the age-recommended levels of phosphorus, particularly in the Asia-Pacific and North America, where we also observed the greatest body mass index z score (0.99 ± 1.6) and parathyroid hormone levels (557.1 [268.4-740.5]). Below-recommended parathyroid hormone levels were noted in 26% and elevated levels in 61% of the entire sample, particularly in the Asia Pacific region. Lower-than-recommended calcium levels were noted in 36% of the entire cohort, particularly in Latin America. CONCLUSIONS: We found regional differences in growth- and age-adjusted bone mineral metabolism markers. Children from North America had the best growth, received the most dialysis, but also had the worst phosphate control and body mass index z scores.


Assuntos
Estatura , Doenças Ósseas Metabólicas/epidemiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/epidemiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Diálise Renal/métodos , Adolescente , Antropometria , Biomarcadores/sangue , Índice de Massa Corporal , Doenças Ósseas Metabólicas/diagnóstico , Criança , Pré-Escolar , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico , Estudos Transversais , Feminino , Saúde Global , Humanos , Internacionalidade , Falência Renal Crônica/diagnóstico , Masculino , Prognóstico , Medição de Risco , Taxa de Sobrevida
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