C. Gómez Alonso

Femoral Bone Mineral Density, Neck-Shaft Angle and Mean Femoral Neck Width as Predictors of Hip Fracture in Men and Women

The effect of femoral bone mineral density (BMD) and several parameters of femoral neck geometry (hip axis length, neck–shaft angle and mean femoral neck width) on hip fracture risk in a Spanish population was assessed in a cross-sectional study. All parameters were determined by dual-energy X-ray absorptiometry. There were 411 patients (116 men, 295 women; aged 60–90 years) with hip fractures in whom measurements were taken in the contralateral hip. Controls were 545 persons (235 men, 310 women; aged 60–90 years) who participated in a previous study on BMD in a healthy Spanish population. Femoral neck BMD was significantly lower, and neck–shaft angle and mean femoral neck width significantly higher, in fracture cases than in controls. The logistic regression analysis adjusted by age, height and weight showed that a decrease of 1 standard deviation (SD) in femoral neck BMD was associated with an odds ratio of hip fracture of 4.52 [95% confidence interval (CI) 2.93 to 6.96] in men and 4.45 (95% CI 3.11 to 6.36) in women; an increase of 1 SD in neck–shaft angle of 2.45 (95% CI 1.73 to 3.45) in men and 3.48 (95% CI 2.61 to 4.65) in women; and an increase of 1 SD in mean femoral neck width of 2.15 (95% CI 1.55 to 2.98) in men and 2.40 (95% CI 1.79 to 3.22) in women. The use of a combination of femoral BMD and geometric parameters of the femoral neck except for hip axis length may improve hip fracture risk prediction allowing a better therapeutic strategy for hip fracture prevention.Abstract: The effect of femoral bone mineral density (BMD) and several parameters of femoral neck geometry (hip axis length, neck–shaft angle and mean femoral neck width) on hip fracture risk in a Spanish population was assessed in a cross-sectional study. All parameters were determined by dual-energy X-ray absorptiometry. There were 411 patients (116 men, 295 women; aged 60–90 years) with hip fractures in whom measurements were taken in the contralateral hip. Controls were 545 persons (235 men, 310 women; aged 60–90 years) who participated in a previous study on BMD in a healthy Spanish population. Femoral neck BMD was significantly lower, and neck–shaft angle and mean femoral neck width significantly higher, in fracture cases than in controls. The logistic regression analysis adjusted by age, height and weight showed that a decrease of 1 standard deviation (SD) in femoral neck BMD was associated with an odds ratio of hip fracture of 4.52 [95% confidence interval (CI) 2.93 to 6.96] in men and 4.45 (95% CI 3.11 to 6.36) in women; an increase of 1 SD in neck–shaft angle of 2.45 (95% CI 1.73 to 3.45) in men and 3.48 (95% CI 2.61 to 4.65) in women; and an increase of 1 SD in mean femoral neck width of 2.15 (95% CI 1.55 to 2.98) in men and 2.40 (95% CI 1.79 to 3.22) in women. The use of a combination of femoral BMD and geometric parameters of the femoral neck except for hip axis length may improve hip fracture risk prediction allowing a better therapeutic strategy for hip fracture prevention.

Guías de práctica clínica en la osteoporosis posmenopáusica, glucocorticoidea y del varón. Sociedad Española de Investigación Ósea y del Metabolismo Mineral

These guidelines update issues covered in previous versions and introduce new ones that have arisen in recent years. The former refer mainly to the therapeutic developments that have been made during this time (zoledronate, denosumab, bazedoxifene), which have led to a change in the drug selection algorithm. The latter deal with therapeutic management, the description of new adverse effects (which have led to changes in therapeutic behaviour patterns, as is the case with atypical fracture of the femur), treatment duration (with consideration for the so-called ‘‘therapeutic holidays’’), the so-called sequential treatment and changes in treatment imposed by certain circumstances. A new algorithm has been introduced for sequential treatment. Attention has also been paid to vertebroplasty and kyphoplasty.

Qué opinan los internistas españoles de la osteoporosis

Objetivo Realizar una encuesta de opinion sobre osteoporosis en internistas espanoles. Metodo Encuesta remitida por correo y por visita personal a miembros de la Sociedad Espanola de Medicina Interna. Recogida de datos sobre opinion acerca de la enfermedad, actitud diagnostica y terapeutica y medios disponibles (analitica general, radiologia convencional, marcadores bioquimicos de remodelamiento oseo, densitometria y ultrasonidos) y preferencias a la hora de elegir un determinado tratamiento. Resultados Contestaron un total de 538 internistas. Mas del 90% de los encuestados opina que la osteoporosis es una enfermedad que deben tratar los internistas. El 93% considera que la osteoporosis es una patologia prevalente. Mas del 80% tiene acceso a una densitometria. Conclusiones Los internistas espanoles opinan mayoritariamente que la osteoporosis es una enfermedad que deben tratar los internistas y que entra en su ambito de actuacion. Por lo general disponen de los medios que necesitan para su estudio y tratamiento. Los bifosfonatos constituyen el farmaco de eleccion y en la practica totalidad de los casos indican un suplemento de calcio y vitamina D.

Los polimorfismos del gen del receptor de la vitamina D (VDR) modulan la respuesta a la vitamina D de forma tejido específica

En los ultimos anos se ha discutido el posible papel de los polimorfismos en el gen del receptor de la vitamina D en diferentes enfermedades. En este trabajo se revisan diferentes estudios realizados para determinar la influencia de varios polimorfismos del receptor de la vitamina D y del colageno tipo I sobre diferentes aspectos relacionados con el metabolismo del hueso y de la glandula paratiroides. Los estudios epidemiologicos mostraron que la combinacion alelica BAt de los polimorfismos BsmI, ApaI y TaqI del receptor de la vitamina D y el genotipo ss del polimorfismo sp1 del colageno tipo I son predictores del riesgo de fracturas osteoporoticas. Los estudios experimentales llevados a cabo en los osteoblastos en cultivo indicaron que la combinacion alelica baT en el receptor de la vitamina D confiere una mayor sensibilidad del osteoblasto ante el estimulo con calcitriol. Por el contrario, en las glandulas paratiroides en cultivo fue la combinacion BAt la que respondio mejor al calcitriol. La combinacion alelica mas favorable en el hueso no lo es en la glandula paratiroides y viceversa, lo que indicaria un efecto tejido especifico del receptor de la vitamina D en la respuesta al calcitriol.

Características clínicas y factores de riesgo de la osteoporosis en mujeres posmenopáusicas afectas de fractura de Colles. El estudio GIUMO

espanolFundamento Se discute si la fractura de Colles es verdaderamente una fractura osteoporotica o si mas bien su etiopatogenia esta relacionada con el traumatismo. Por ello, nos planteamos estudiar las caracteristicas clinicas y la posible asociacion de una serie de factores de riesgo para la osteoporosis en un grupo de mujeres posmenopausicas afectas de fractura de Colles, comparandola con un grupo control. Metodo Estudio transversal de caso-control, en el que se selecciono una muestra de la poblacion espanola de mujeres posmenopausicas que habian sufrido una fractura de Colles dentro de los 6 meses anteriores al estudio y otra de controles sin esta fractura. Estudiamos 121 fracturadas y 348 controles. A todas las participantes en el estudio se les determinaron, entre otras, las variables de edad, peso, indice de masa corporal (IMC), ingesta actual de calcio, edad de la menarquia, anos fertiles, edad de la menopausia, anos desde la menopausia, numero de hijos, estatus de fumadora e ingesta de alcohol. Resultados Las pacientes afectas de fractura de Colles tenian mas edad y menos estatura que las controles, y habian tenido la menarquia algo mas tarde (13,8 ± 1,9 anos frente a 13,2 ± 2,6 anos, p = 0,007). Obtuvimos una asociacion estadisticamente significativa entre la fractura de Colles y la lactancia superior a un ano: (oddsratio: 1,80; IC 95%: 1,07-3,03). Por el contrario, las mujeres con fracturas mostraron una menor proporcion de anexectomias bilaterales como causa de menopausia (oddsratio: 0,31; IC 95%: 0,14-0,71). Se obtuvo una mayor prevalencia de caidas entre la paciente con fractura de Colles (61,9% frente a 29,2%, p EnglishBackground It is a matter of discussion whether or not Colles’ fracture is an osteoporotic fracture, or it is more related to traumatism. We studied the distribution of clinical characteristics and risk factors for osteoporosis in a group of postmenopausal women suffering from Colles’ fracture and compared them to a control group. Method Case-control study. We studied 121 postmenopausal Spanish women who had a forearm fracture (Colles’ fracture) within the 6 months prior to the study. Three hundred and forty eight women who had no Colles’ fracture were the controls. We studied in every woman age, weight, height, actual calcium intake and some gynecological data as age at menarche, age of menopause, fertile years, years since menopause and number of children. We also collected data about some other risk factors for osteoporosis, as consumption of alcohol and tobacco. Results Colles’ patients had more age and less stature than controls and have had the menarche later than controls (13.8 ± 1.9 years vs. 13.2 ± 2.6 years, p = 0.007). We also found an association between Colles’ fracture and lactation for more than one year (odds ratio: 1.80, CI 95%: 1.07-3.03). On the other hand, fractured women had a less proportion of bilateral oophorectomy than controls (odds ratio: 0.31, CI 95%: 0.14-0.71). We found a higher prevalence of falls in patients with Colles’ fracture (61.0% vs. 29.3%, p