Amparo Calleja

Traditional and Novel Bone Remodeling Markers in Premenopausal and Postmenopausal Women

CONTEXT Bone turnover markers (BTMs) may identify changes in bone remodeling within a relatively short time interval before changes in bone mineral density can be detected. New markers such as osteoprotegerin, receptor activator of nuclear factor-κB ligand, and sclerostin have emerged, but there is little information about their potential use in clinical practice. OBJECTIVES The aim of this study was to analyze the ability of several BTMs to predict bone loss in pre- and postmenopausal women and to monitor the efficacy of treatment in osteoporotic women. DESIGN, PATIENTS, AND SETTING We performed an observational prospective study in pre- and postmenopausal ambulatory women (n = 72 and n = 152, respectively). INTERVENTION Postmenopausal women with osteoporosis (n = 18) were treated with risedronate and calcium. Women filled out a questionnaire and underwent bone mineral density measurement using dual-energy x-ray absorptiometry at the time of enrollment and after 1 year of follow-up. BTMs were measured at baseline, at 6 months, and after 1 year. RESULTS Increased levels of N-terminal propeptide of type 1 procollagen (P1NP) and β-type I collagen telopeptides (CTXs) were associated with low bone mineral density in the premenopausal (P = .02 and P = .04, respectively) and postmenopausal (P = .03 and P = .02) groups. The best analytical performance to diagnose osteoporosis was for β-CTX, osteocalcin, and P1NP, with areas under the curve of 0.70 (P = .005), 0.64 (P = .048), and 0.71 (P = .003). A significant decrease was found in P1NP, osteocalcin, tartrate-resistant acid phosphatase-5b, β-CTX, and bone alkaline phosphatase after 1 year of treatment (all P < .05). CONCLUSIONS Our data suggest that measurement of β-CTX and P1NP shows adequate analytical performance and could potentially be included in algorithms for the screening of osteoporosis. Furthermore, these two markers, along with osteocalcin and tartrate-resistant acid phosphatase-5b, are useful to monitor the response to risedronate.

Treatment of thyroid cancer with the new oral agents

Thyroid malignancies have traditionally been under the care of endocrinologists. Thyroid cancer excellent prognosis, its unresponsiveness to conventional chemotherapy, and the specific and peculiar methods in the follow-up are some of the reasons for its particular management. Thyroid Cancer Guidelines have been published by Endocrine Societies both in the United States [1] and in Europe [2]. Furthermore, the adequate skills and knowledge related to running a good practice differ from the customary oncologic management. In fact, thyroid cancer is generally omitted from the oncology curriculum for oncologists’ residence education, whereas thyroid cancer management comprises a fundamental feature in the instruction of future endocrinologists. As a result, the oncologists’ experience and interest in the management of this particular type of cancer is generally scarce. We have read the position statement by the Spanish Society of Medical Oncology (SEOM) on the treatment of cancer with the new oral agents [3]. We agree with the SEOM members that, for the benefit of our patients, ‘cancer treatment involves the participation of multiple medical specialties’. Our aim is to be collaborative rather than start a controversy. However, we remind that endocrinologists have led the introduction of these new oral drugs in the thyroid cancer treatment scenario [4, 5]. Clinical trials with tyrosine kinase inhibitors (TKI) for thyroid cancer patients have been at the beginning, and currently are, in the hands of endocrinologists [6]. Therefore, we understand that endocrinologists must continue coordinating thyroid cancer patients’ management. Besides that, it is well described that TKI produce a number of endocrine side-effects such as hypothyroidism, which are especially relevant in the follow-up of these patients [5]. As a parallel situation, we know that endocrinologists cannot claim for the exclusive use of any hormone-related drug. We fully understand that glucocorticoids, for instance, need to be widely used by oncologists and other specialists. Therefore, in agreement with the Spanish Society of Radiation Oncologist [7], we consider that the statement of the SEOM has gone beyond the limits of desirable good relationship among different specialists. J. C. Galofre*, J. M. Gomez-Saez, C. A. Escola, E. Anda, A. Calleja, S. Donnay, A. Lucas-Martin, E. Menendez-Torre, V. Pereg, B. Perez-Corral, J. Santamaria, G. Riesco-Eizaguirre & C. Zafon; on behalf of the Thyroid Cancer Committee from the Spanish Society of Endocrinology and Nutrition (SEEN)

Comments to SEOM clinical guidelines for the treatment of thyroid cancer

Letter to Editor On behalf of the Thyroid Cancer Committee from the Spanish Society of Endocrinology and Nutrition (SEEN).-- et al.

Uso de nuevas moléculas en el tratamiento del cáncer avanzado de tiroides

Juan Carlos Galofréa,∗, José Manuel Gómez-Sáezb, Cristina Álvarez Escolac, Elías Álvarez Garcíad, Emma Anda Apiñanize, Amparo Callejaa, Sergio Donnayf, Anna Lucas-Marting, Edelmiro Menéndez Torreh, Elena Navarro González i, Vicente Peregj, Begoña Pérez Corralk, Javier Santamaría Sandi l, Garcilaso Riesco Eizaguirrec y Carles Zafón Llopism, Toma de posición del Grupo de Trabajo de Cáncer de Tiroides de la Sociedad Española de Endocrinología y Nutrición

EditorialUso de nuevas moléculas en el tratamiento del cáncer avanzado de tiroidesUse of new molecules in the treatment of advanced thyroid cancer

Juan Carlos Galofréa,∗, José Manuel Gómez-Sáezb, Cristina Álvarez Escolac, Elías Álvarez Garcíad, Emma Anda Apiñanize, Amparo Callejaa, Sergio Donnayf, Anna Lucas-Marting, Edelmiro Menéndez Torreh, Elena Navarro González i, Vicente Peregj, Begoña Pérez Corralk, Javier Santamaría Sandi l, Garcilaso Riesco Eizaguirrec y Carles Zafón Llopism, Toma de posición del Grupo de Trabajo de Cáncer de Tiroides de la Sociedad Española de Endocrinología y Nutrición