Manuel Muñoz Torres

Elevada prevalencia de déficit de vitamina D en poblaciones con riesgo de osteoporosis: Un factor relevante en la integridad Ósea

Fundamento En la actualidad, la deficiencia grave de vitamina D es infrecuente en la mayoria de los paises desarrollados. Sin embargo, la prevalencia del deficit subclinico de vitamina D (insuficiencia de vitamina D [IVD]) es mas elevada y puede contribuir al descenso de la masa osea en poblaciones con riesgo de osteoporosis. El objetivo de nuestro estudio fue evaluar la prevalencia de IVD en mujeres posmenopausicas (MPM), pacientes diagnosticados de enfermedad inflamatoria intestinal (EII) y pacientes asmaticos en tratamiento con glucocorticoides (PAC) y analizar su relacion con la densidad mineral osea (DMO) y hormonas calciotropas. Pacientes y metodo Estudiamos a 299 sujetos (MPM 161; EII 61; PAC 77). En todos los casos determinamos los valores sericos de hormona paratiroidea (PTH), 25-hidroxivitamina D (25OHD) y la DMO (DXA, Hologic QDR1000) en columna lumbar y cuello femoral. Resultados La prevalencia de IVD (25OHD Conclusiones En poblaciones con riesgo de osteoporosis, el deficit de vitamina D tiene una elevada prevalencia y un efecto significativo en el deterioro de la integridad osea.

Polimorfismos en los genes cistationina β-sintasa y metilentetrahidrofolato reductasa como factores de riesgo de enfermedad vascular cerebral

BACKGROUND AND OBJECTIVE: High plasma total homocysteine (tHcy), low dietary intake of folate and other B vitamins, and genetic polymorphisms related to the metabolism of homocysteine may interactively contribute to the risk of cerebral vascular disease (CVD). We explored interrelations between total homocysteine levels and mutations in genes for the two key enzymes in methionine-homocysteine metabolism. PATIENTS AND METHOD: We analyzed two polymorphisms, C677T in the MTHFR gene and 844ins68 in the CBS gene. We assessed their association with fasting homocysteine in 64 patients with CVD, and in 159 controls. RESULTS: No differences in CBS and MTHFR genotype frequencies between cases and controls were found (C677T p = 0.87 and 844ins68 p = 0.63), nor was a particular CBS and MTHFR genotype associated with an elevated risk of CVD. None of the genotypes defined by the CBS and MTHFR variants studied showed an association with elevated fasting homocysteine concentrations (C677T p = 0.07 and 844ins68 p = 0.47). CONCLUSIONS: We did not find any indication that genetic variation in the CBS and MTHFR genes are associated with homocysteine-related risk of CVD, hence needing further investigation. The contributions to total plasma homocysteine levels of the common mutations of genes coding for the enzymes controlling homocysteine metabolism are modest.

Hiperparatiroidismo secundario en el cancer de prostata avanzado

BACKGROUND AND OBJECTIVE High parathyroid hormone (PTH) concentrations are associated with increased bone resorption and bone matrix degradation. Some studies show elevated PTH concentrations and hypocalcemia in patients with advanced prostate carcinoma, although the pathophysiological significance of these findings is not well defined. MATERIALS AND METHODS We performed a retrospective study of 60 patients diagnosed with advanced prostate cancer (44 nonmetastatic and 16 metastatic) treated with androgen deprivation. In all patients, PTH, calcium, phosphorus, 25 (OH) vitamin D and prostate-specific antigen (PSA) were determined. Bone scintigraphy had previously been performed. RESULTS In patients with bone metastases, mean concentrations were as follows: calcium 9.19 mg/dl, phosphorus 3.47 mg/dl, 25 (OH) vitamin D 13.85 ng/ml, PTH 66.8 pg/ml and total PSA 101.27 ng/ml. For those without bone metastases, the results were calcium 9.39 mg/dl, phosphorus 3.38 mg/dl, 25 (OH) vitamin D 20.50 ng/ml, PTH 52.23 pg/ml and total PSA 2.52 ng/ml. PTH levels were significantly higher in patients with prostate cancer and bone metastases than in those without metastases (p=0.03). Vitamin D levels were also significantly lower in this group (p=0.03). There were no differences in other values. CONCLUSIONS The present study found increased PTH concentrations in patients with advanced prostate cancer. This finding could be useful to predict disease progression.

Documento de consenso de osteoporosis del varón

OBJECTIVE To provide practical recommendations to assess and treat osteoporosis in males. PARTICIPANTS Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology. METHODS Recommendations were formulated using the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in Medline (PubMed) using the following associated terms: «osteoporosis», «men», «fractures», «bone mineral density», «treatment», «hypogonadism», and «prostate cancer». Papers in English and Spanish with publication date before 30 August 2017 were included. Current evidence for each disease was reviewed by 2group members. Finally, recommendations were discussed in a meeting of the working group. CONCLUSIONS The document provides evidence-based practical recommendations for diagnosis, assessment, and management of osteoporosis in men and special situations such as hypogonadism and prostate cancer.

Mieloma múltiple como causa de osteoporosis secundaria con evolución rápidamente progresiva

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Ensayos clínicos de resultados de enfermedad cardiovascular en diabetes

Los pacientes con diabetes mellitus tipo 2 (DM2) tienen un riesgo de enfermedad cardiovascular (ECV) elevado tanto por la hiperglucemia como por otros factores de riesgo vascular asociados y, además, un peor pronóstico ante los eventos cardiovasculares. La diabetes acentúa la gravedad de todas las fases de la aterosclerosis, su desarrollo y sus complicaciones. En los pacientes con diabetes existe un exceso de mortalidad atribuida a causas cardiovasculares frente a la población no diabética (HR: 2,32; IC 95%: 2,112,56) y el infarto de miocardio y el ictus explican el 80% de las muertes en los pacientes con DM2. En este contexto se ha estimado que los pacientes con diabetes tienen un riesgo de presentar un evento cardiovascular unos 15 años antes que los no diabéticos. Así, la intervención integral sobre los factores de riesgo de ECV en esta población es recomendada para mejorar el pronóstico. Un aspecto singular es la importancia del control de la glucemia en esta aproximación integral. Sin embargo, el efecto sobre el desarrollo y la progresión de la ECV de los fármacos antidiabéticos es, en la actualidad, insuficientemente conocido. En los años previos, una serie de ensayos clínicos (ADVANCE, ACCORD, VADT) han evaluado el efecto del control estricto de la

Degludec, una nueva insulina basal de acción ultra-lenta para el tratamiento de la diabetes tipo 1 y 2: avances en investigación clínica

Degludec is the most recent molecule of the ultra-long-acting basal insulin analogues approved for human use. It forms soluble multihexamers which after subcutaneous injection are converted into monomers, and are thus slowly and continuously absorbed into the bloodstream. This absorption mechanism confers degludec an ultra-long and stable action profile, with no concentration peaks. This paper discusses the most recent studies in patients with type 1 and 2 diabetes mellitus, which showed degludec to be non inferior in decreasing HbA1c, ensuring optimum glycemic control similar to that achieved with insulin glargine or detemir. Degludec also had an improved safety profile, as it was associated to a significantly lower rate of nocturnal hypoglycemia in both types of diabetes and to a potentially lower overall hypoglycemia rate in type 2 DM. Degludec also opens the possibility to use more flexible regimens.