Gabriela Luporini Saraiva

Aerobic exercise capacity in normal adolescents and those with type 1 diabetes mellitus.

Objective:  To compare the aerobic exercise capacity between normal adolescents and those with type 1 diabetes mellitus (T1DM).

Safety and efficacy of a 1-year treatment with zoledronic acid compared with pamidronate in children with osteogenesis imperfecta.

Abstract Pamidronate (PAM) infusion is the standard treatment in children with osteogenesis imperfecta (OI). Zoledronic acid (ZOL) is a bisphosphonate with higher potency and faster intravenous infusion, but its efficacy and safety has not been established for OI patients. We report an open-label, prospective, and randomized clinical analysis to study the safety and efficacy of ZOL compared with PAM in 23 children with OI. They were selected to receive PAM (PAM group), 1 mg/kg/day, over 2 days or ZOL (ZOL group), 0.025–0.05 mg/kg/day, over 2 days every 3–4 months according to their ages, during a 1-year follow-up. They were observed for clinical and biochemical parameters, side effects, bone mineral density (BMD), and fracture rate. After treatment, the PAM and ZOL groups average lumbar spine (LS) BMD increased by 51.8% (p=0.053) and 67.6% (p=0.003), respectively. Parallel improvement was seen in LS Z-score in the PAM and ZOL groups, with scores of –5.3 to –3.8 (p=0.032) and –4.8 to –2.3 (p=0.007), respectively. LS Z-score for the ZOL group at the end of treatment was higher compared with the PAM group but only a borderline significance (p=0.053). The total alkaline phosphatase (AP) in the ZOL group significantly decreased from baseline at third and fourth infusion (p=0.032). Mild side effects were similar in both groups, but no severe clinical symptoms were reported. In conclusion, the present study shows that the use of ZOL in the dosage and period studied was safe and efficient to promote a clinical and densitometric improvement, similarly to PAM. Further studies are needed to establish optimal dosing and long-term safety.

Marcadores Bioquímicos da Remodelação Óssea na Prática Clínica

In physiological circumstances, bone resorption and formation are coupled processes. When, however, one predominates over the other the result is a gain or a loss of bone mass. To study this dynamic process, biochemical bone markers have been developed. Osteocalcin and bone alkaline phosphatase better represent bone formation, while pyridinoline, deoxypyridinoline and collagen type I cross-linking (amino and carboxi-terminal) telopeptides, the bone resorption. In the follow up of osteoporosis treatment, the bone resorption markers are more specific and sensitive than the formation markers. During the treatment of post-menopausal osteoporosis with anti-reabsortive therapy, the rate of fall from basal values of resorption markers at 3 or 6 months are related to the increase on bone mass after long-term treatment. The bone markers have applications in a number of diseases of the skeleton including osteoporosis, and helped to understand the pathophysiological mechanisms of many diseases that affect bone tissue. Although they still need better sensibility and specificity to be strongly recommended in the clinical routine, their use should be encouraged to assess risk of fractures in special cases, to aid treatment decisions, and to monitor treatment.

Seasonal variation in the serum 25-hydroxyvitamin D levels of young and elderly active and inactive adults in Sao Paulo, Brazil: The Sao PAulo Vitamin D Evaluation Study (SPADES).

Objective: To evaluate the 25-hydroxyvitamin D [25(OH)D] concentrations in individuals in the city of São Paulo belonging to different age groups and exhibiting specific behavioral characteristics and to correlate the 25(OH)D concentration with the level of UV radiation (UVR). Patients and Methods: A total of 591 individuals were included, distributed as follows: 177 were living in institutions (NURSING, 76.2 ± 9.0 y old), 243 were part of the community elderly (COMMUNITY, 79.6 ± 5.3 y old), 99 were enrolled in a physical activity program targeting the elderly (ACTIVE, 67.6 ± 5.4 y old) and 72 were young (YOUNG, 23.9 ± 2.8 y old). Blood samples from all individuals were collected throughout the year. UVR measurements were taken by an official meteorology institution. Results: The UVR values varied throughout the year, following a sinusoidal-like pattern. Because of the Earth’s orbit, we hypothesized that there would be cyclic patterns for the 25(OH)D and UVR values that repeat every 12 mo. The general formula is represented by the equation P1+P2⋅sin(−2⋅π12⋅(t−P3)) The mean 25(OH)D concentration and the amplitude of the variation were significantly higher for the YOUNG and ACTIVE groups than for the COMMUNITY and NURSING groups. The nadir for UVR was in June, whereas the nadir for the 25(OH)D concentration was in the spring, corresponding to a delay of one season. Conclusions: There was seasonal variation in the 25(OH)D concentration for all the groups studied; however, the amplitude of the variation was higher for the groups of young and physically active people, possibly due to the higher level of sunlight exposure for these groups. The lowest 25(OH)D concentration was detected in the spring.