Manuel Sosa Henríquez

New biochemical markers of bone resorption in the study of postmenopausal osteoporosis

We performed a comparative study on the sensitivity of the determination of several biochemical markers of bone resorption: urinary calcium/creatinine, free pyridinolines (F-Pyr), free deoxypyridinoline (F-Dpyr), carboxyterminal telopeptide of collagen I (CTX) and aminoterminal crosslinked telopeptides of collagen I (NTX) in the study of postmenopausal osteoporosis. The study included 19 untreated osteoporotic postmenopausal women, aged 59 +/- 6 years, range 46-70 and 16 healthy control postmenopausal women, aged 56 +/- 7 years, range 48-70 years. The following bone markers were determined in 2-h fasting urine samples: calcium/creatinine (atomic absorptiometry), F-Pyr (ELISA, Metra), F-Dpyr (ELISA, Metra), CTX (Crosslaps, Cis bio International) and NTX (ELISA, Osteomark, OSTEX). Values of all markers were expressed as urinary creatinine (Cr) ratios. We found a significant increase in all the studied biochemical markers of bone resorption in osteoporotic patients with respect to control women. Areas under receiver operating characteristic (ROC) curves corresponding to F-Pyr/Cr, Calcium/ Cr, NTX/Cr, CTX/Cr and F-Dpyr/Cr were 74%, 75%, 93.4%, 95.7% and 96% respectively. There were no significant differences among the areas of the ROC curves corresponding to NTX, CTX and F-Dpyr, but areas under urinary calcium and F-Pyr were significantly lower. Among the biochemical markers of bone resorption studied, F-Dpyr, CTX and NTX presented the best discrimination between osteoporotic and control women. F-Dpyr/Cr sensitivity was 79% with a specificity of 100%, CTX/Cr sensitivity was also 79% with a specificity of 100% and NTX/Cr sensitivity was 52% with a specificity of 100%.

Estilo de vida, nivel socioeconómico y morbilidad en mujeres posmenopáusicas con obesidad de grados II y III

Objetivos: Conocer que proporcion de las mujeres canarias posmenopausicas con obesidad de grados II y III (indice de masa corporal [IMC] = 35) se encuentra por debajo del umbral de la pobreza y estudiar en esa misma poblacion la prevalencia de diabetes mellitus, enfermedad tiroidea, obesidad, hipertension arterial, enfermedad reumatica inflamatoria, urolitiasis y fracturas oseas por fragilidad (totales, vertebrales y no vertebrales), la distribucion de una serie de estilos de vida (consumos de tabaco, de alcohol y de cafeina y actividad fisica realizada durante el tiempo libre), y el nivel socioeconomico. Metodo: Estudio observacional transversal. Se entrevisto personalmente a todas las pacientes y se les aplico un cuestionario dirigido a conocer su estilo de vida. Asimismo se reviso su historia clinica para documentar la prevalencia de las enfermedades. Tambien se les efectuo una exploracion fisica detenida y se las tallo y peso con ropa ligera. Asimismo se les extrajo sangre en ayunas para realizar una analitica general. El criterio de pobreza aplicado fue el establecido por el Instituto Nacional de Estadistica. Resultados: Las mujeres con obesidad morbida tenian mayor edad (56,8 ± 11 frente a 53,9 ± 11,6 anos; p = 0,02), menor talla (153,7 ± 6,3 frente a 156,9 ± 36,1 cm; p = 0,001), mayor peso (89,6 ± 9,3 frente a 66,6 ± 10,4 kg; p = 0,001) y mayor superficie corporal que las controles (1,73 ± 0,13 frente a 1,54 ± 0,13 m2; p = 0,001). Estas mujeres consumian menos alcohol y tabaco y mas cafe, y eran mas sedentarias que las mujeres del grupo control. Tambien tenian mayor prevalencia de hipertension arterial (el 36 frente al 17,9%; p = 0,001; odds ratio [OR] = 2,57; intervalo de confianza [IC] del 95%, 1,56-4,24), diabetes mellitus (el 24,4 frente al 11,3%; p = 0,001; OR = 2,52; IC del 95%, 1,47-1,05) e hipotiroidismo (el 14,3 frente al 8%; p = 0,04; OR = 1,91; IC del 95%, 0,99-3,68). Mas de la mitad de las mujeres con obesidad morbida vivian en un habitat rural y se encontraban por debajo del umbral de la pobreza. Conclusiones: Mas de la mitad de las mujeres posmenopausicas con obesidad morbida estan por debajo del umbral de la pobreza y viven en un habitat rural. Consumen menos alcohol y tabaco, son mas sedentarias y presentan una mayor prevalencia de diabetes mellitus, hipertension e hipotiroidismo.Background Obesity has become a major public health problem in all western countries, and its prevalence is increasing. This condition is associated with a higher prevalence of diabetes mellitus, hypertension, and coronary heart disease; furthermore, obesity is a risk factor for mortality. Objective To study the association of some prevalent diseases (diabetes mellitus, thyroid disease, obesity, hypertension, inflammatory rheumatic disease, urolithiasis), the distribution of some lifestyle factors (tobacco, alcohol and caffeine consumption and physical activity during leisure time) and the prevalence of poverty in a population of postmenopausal women in the Canary Islands with obesity class II or III (BMI>35). Method A personal interview was performed in all patients. A questionnaire was administered to assess their lifestyles and current medication use. The womens medical records were reviewed to confirm the existence of certain diseases. A complete physical examination was performed in all patients. Weight and height were measured with the patient dressed in light clothing. Blood samples were obtained with the patient in a fasting state for subsequent analysis. Poverty was defined according to the criteria of the Spanish National Institute of Statistics. Results Women with obesity class II or III were older (56.8+/-11 vs 53.9+/-11.6 years, p=0.02), shorter (153.7+/-6.3 vs 156.9+/-36.1 cm, p=0.001), heavier (89.6+/-9.3 vs 66.6+/-10.4 kg, p=0.001) and had a greater body surface than controls (1.73+/-0.13 vs 1.54+/-0.13 m2, p=0.001). Alcohol and tobacco consumption were lower in obese women than in controls. Obese women drank more coffee and took less physical activity during leisure time than controls. The prevalence of hypertension -36% vs 17.9%, p=0.001, odds ratio [OR] [95% confidence interval (IC)]=2.57 (1.56-4.24)-, diabetes mellitus -24.4% vs 11.3%, p=0.001, OR=2.52 (1.47-1.05)-and hypothyroidism -14.3% vs 8%, p=0.04; OR=1.91 (0.99-3.68)-was higher in obese women than in controls. More than half lived in rural areas and were below the poverty threshold. Conclusions More than half of postmenopausal women with obesity class II or III were below the poverty threshold and lived in a rural area. In these women there was a lower consumption of alcohol and tobacco, lesser physical activity during leisure time, and a higher prevalence of diabetes mellitus, hypertension and hypothyroidism than in control postmenopausal women.BACKGROUND Obesity has become a major public health problem in all western countries, and its prevalence is increasing. This condition is associated with a higher prevalence of diabetes mellitus, hypertension, and coronary heart disease; furthermore, obesity is a risk factor for mortality. OBJECTIVE To study the association of some prevalent diseases (diabetes mellitus, thyroid disease, obesity, hypertension, inflammatory rheumatic disease, urolithiasis), the distribution of some lifestyle factors (tobacco, alcohol and caffeine consumption and physical activity during leisure time) and the prevalence of poverty in a population of postmenopausal women in the Canary Islands with obesity class II or III (BMI>35). METHOD A personal interview was performed in all patients. A questionnaire was administered to assess their lifestyles and current medication use. The womens medical records were reviewed to confirm the existence of certain diseases. A complete physical examination was performed in all patients. Weight and height were measured with the patient dressed in light clothing. Blood samples were obtained with the patient in a fasting state for subsequent analysis. Poverty was defined according to the criteria of the Spanish National Institute of Statistics. RESULTS Women with obesity class II or III were older (56.8+/-11 vs 53.9+/-11.6 years, p=0.02), shorter (153.7+/-6.3 vs 156.9+/-36.1 cm, p=0.001), heavier (89.6+/-9.3 vs 66.6+/-10.4 kg, p=0.001) and had a greater body surface than controls (1.73+/-0.13 vs 1.54+/-0.13 m2, p=0.001). Alcohol and tobacco consumption were lower in obese women than in controls. Obese women drank more coffee and took less physical activity during leisure time than controls. The prevalence of hypertension -36% vs 17.9%, p=0.001, odds ratio [OR] [95% confidence interval (IC)]=2.57 (1.56-4.24)-, diabetes mellitus -24.4% vs 11.3%, p=0.001, OR=2.52 (1.47-1.05)-and hypothyroidism -14.3% vs 8%, p=0.04; OR=1.91 (0.99-3.68)-was higher in obese women than in controls. More than half lived in rural areas and were below the poverty threshold. CONCLUSIONS More than half of postmenopausal women with obesity class II or III were below the poverty threshold and lived in a rural area. In these women there was a lower consumption of alcohol and tobacco, lesser physical activity during leisure time, and a higher prevalence of diabetes mellitus, hypertension and hypothyroidism than in control postmenopausal women.

Hay vida más allá de la densitometría ósea

La osteoporosis es una enfermedad muy frecuente que afecta a un amplio segmento de la población, sobre todo a mujeres de edad avanzada. La definición más utilizada de osteoporosis fue publicada por el NIH (National Institutes of Health) en el año 2000, que la considera «una enfermedad de todo el esqueleto, caracterizada por una masa ósea baja y una alteración en la microarquitectura ósea que condiciona la presencia de un hueso más frágil, con el consecuente incremento en el riesgo de fractura»; y esta definición integra todo lo que es necesario conocer sobre la osteoporosis para su diagnóstico y tratamiento: masa ósea baja (trastorno cuantitativo), alteración microestructural (trastorno cualitativo), mayor fragilidad y la fractura como complicación y única manifestación clı́nica, que es lo que debe tratar de evitarse, idealmente la primera y, si no es posible, las sucesivas. Sin embargo, desde un punto de vista clı́nico esta definición no es práctica, ya que, aunque identifiquemos y aceptemos todos estos elementos como componentes necesarios para la definición de la enfermedad, no disponemos de una herramienta única, sencilla y reproducible que permita aplicar medidas preventivas o terapéuticas. Desde luego, no es la fractura la que define la existencia de la osteoporosis (es su complicación), y tampoco lo es exclusivamente una densidad mineral ósea baja, pues con ésta, medida habitualmente por densitometrı́a, solo se valora uno de los aspectos de la osteoporosis: la alteración cuantitativa. Y aún con estas limitaciones, el desarrollo de la densitometrı́a en los años 1980-1990 y la aceptación casi universal de los criterios diagnósticos densitométricos de la Organización Mundial de la Salud (OMS) publicados en 1994 generaron entre los clı́nicos una