José-Luis Pérez-Castrillón

Non-insulin-dependent diabetes, bone mineral density, and cardiovascular risk factors

People with Type 2 diabetes have bone mass alterations and may have a higher risk of hip fractures. Moreover, they have increased cardiovascular risk factors. The objective of this paper is to investigate the association among non-insulin-dependent diabetes, bone mineral density (BMD), and cardiovascular risk factors. Ninety-two patients (36 males and 56 females) were studied and cardiovascular risk factors were measured: total cholesterol, triglycerides, lipoprotein(a), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), glucose, HbA1c, and microalbuminuria. The densitometric studies were carried out in the calcaneal region using a DEXA densitometer. The diabetic women had a higher BMD than the control group (0.502 +/- 0.127 vs. 0.408 +/- 0.102, P = .027). The women showed a positive relationship between BMD and triglycerides (r =. 478, P = .0001) and a negative relationship with HDL-C (r = -.322, P = .016). The men had a BMD similar to that of the control group, and there was no relationship with the cardiovascular risk factors. When a multivariate logistic regression analysis was performed with the presence of osteoporosis as a dependent variable and each lipid level, age, sex, and BMI as independent variables, only age and BMI were found to be associated with the presence of osteopososis. The diabetic women had a higher BMD than the controls, and there was no relationship between osteoporosis and cardiovascular risk factors in diabetics.

Celiac Disease and Osteoporosis: A Review

Celiac disease is a highly-prevalent autoimmune disease characterized by chronic intestinal inflammation. Osteoporosis may be a complication of celiac disease in both the classic presentation where digestive symptoms predominate and in subclinical forms where it may be the initial manifestation of the disease. Various etiopathogenic mechanisms have been reported in osteoporosis which may explain its appearance in celiac disease. There are no studies of sufficient quality evaluating the prevalence of osteoporosis in celiac disease in accordance with World Health Organization densitometric criteria. Although an increased risk of osteoporotic fracture has been reported, bone mineral density testing in patients with celiac disease is not cost-effective. A gluten-free diet increases bone mass to nearly-normal levels and specific treatment for patients with a high risk of osteoporotic fracture is required. There are no studies analyzing the efficacy of anabolic and anti-catabolic drugs in patients with celiac disease.

[Telmisartan effect's on remodelling bone markers in hypertensive patients].

INTRODUCTION The telmisartan is an angiotensin II receptor blocker (ARB) with a few own characteristics that it allows us to obtain a few additional benefits. It displays the ability to act as a partial agonist of PPARgamma. On the other hand, PPAR gamma intervenes in the control of bone remodelling though with not concordant results. The objective of this study to value the effect of telmisartan on bone markers in hypertensive patients. SUBJECTS A sample of 31 hypertensive patients with hypertension were included. The dose of telmisartan was of 80 mg/24 h and the period of follow-up was 12 weeks. The control group included 32 hypertensive patients treated before with IECA (enalapril-20 mg/24 h - or quinapril - 40 mg/24 hours). The following parameters were determined P1NP, β-CTX, 25OHD and PTH , osteocalcin, insulin and adiponectin. RESULTS The patients treated with Telmisartan shown a significantly decrease in systolic blood pressure (156 ± 19 mmHg vs 133 ± 15 mmHg, p = 0.001) and diastolic blood pressure (92 ± 9 mmHg vs 82 ± 6 mmHg, p = 0.01) . Changes were not observed in other parameter, PTHi (48 ± 22 pg/ml vs 45 ± 22 pg/ml, p > 0.05) and 25-vitamin D (21 ± 10 ng/ml vs 25 ± 8 ng/ml, p > 0.05), CTX (0.195 ± 0.12 ng/ml vs 0.221 ± 0.13 ng/ml, p > 0.05), PINP (39 ± 20 ng/ml vs 40 ± 19 ng/ml, p > 0.05), osteocalcin (11 ± 9 ng/ml vs 11 ± 5 ng/ml, p > 0.05), glucose, adiponectin, insulin and HOMA. When the patients divided in two groups depending on the levels of vitamin D (insufficient and not insufficient), with a cut of 20 ng/ml, there was changes on bone markers but a decrease of the glucose was observed in patients with levels of vitamin D over 20 ng/ml (135 ± 53 mg/dl vs 119 ± 39 mg/dl, p = 0.01). The patients treated with IECAS decreases the systolic blood pressure but the diastolic blood pressure values of arterial systolic does not show changes. CONCLUSIONS Telmisartan has a neutral effect to level of the bone markers of bone remodelling.

Lipids and Bone Mineral Density in Patients with Vascular Disease

Objective: To evaluate the relationship between cholesterol and triglycerides and bone mineral density in patients with vascular disease (hypertension and acute coronary syndrome). Methods: The study included 217 patients (83 men and 134 women), aged between 36 and 76 (mean age 59 ± 10), with hypertension and acute coronary syndrome. Information obtained included anthropometric measurements, total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides; bone mineral density (BMD) was recorded at the lumbar spine. Results: BMD was signifi cantly lower in patients in the higher tertiles of cholesterol (p = 0.041). The effect was maintained after adjustment for age and Body Mass Index (BMI). However, there was no association between the range of triglycerides, LDL cholesterol, HDL cholesterol and bone mass.

The Effect of Genistein Supplementation on Vitamin D Levels and Bone Turnover Markers during the Summer in Healthy Postmenopausal Women: Role of Genotypes of Isoflavone Metabolism

Aims: The objective of this study was to determine whether vitamin D and genistein supplementation had an additive beneficial effect on levels of vitamin D and bone markers and whether this effect was mediated by genes regulating isoflavone metabolism. Materials and Methods: We carried out a prospective study in postmenopausal women randomized to calcium and vitamin D supplementation or calcium, vitamin D, and genistein supplementation. Vitamin D, parathyroid hormone (PTH), cross-linked C-telopeptide (CTX), and procollagen 1 N-terminal (P1NP) were determined by electrochemiluminescence. Three SNPs - rs2231142 (ABCG2), rs358231 (cytosolic β-glucosidase [CBG]), and rs2273697 (ABCC2) - were determined. Results: We included 102 women. The effects on bone remodeling were similar: rises in vitamin D were significantly associated with reductions in PTH, CTX, and P1NP. Pharmacogenomic analysis of the genotypes showed that, in AT heterozygotes of the CBG1368T>A polymorphism, CTX and P1NP were not reduced. Conclusion: Genistein added to calcium and vitamin D supplementation had no additional effect. The supplementation of individual AT heterozygotes of the CBG1368T>A polymorphism had no effect on markers of bone remodeling.

Relationship between Presarcopenia and Trabecular Bone Score in HIV - Infected People

Life expectancy of HIV-infected people has increased markedly since the use of effective, potent antiretroviral therapy (ART). For now, many people are living longer and healthy live with HIV. But growing older with HIV also has an impact on developing an increasing number of noninfectious HIV-related comorbidities. Bone is one of the organs affected by HIV infection, such that a three-time greater prevalence of osteoporosis has been observed in the HIV-positive population compared with HIV-seronegative people independently of age and gender [1]. Multiple factors appear to be involved in bone loss, fracture risk and frailty in HIVinfected patients, including physical inactivity, low body weight, ART side effects, chronic T-cell immune activation and subsequent accelerated cellular senescence and HIV viral proteins itself [2-5]. T-cell activation have been associated with high production of receptor activator of nuclear factor-kappa-β ligand (RANKL) and pro-inflammatory cytokines, which promote osteoclast activity and bone turnover [2, 3, 6, 7].