Régis Levasseur

Energy Requirements in Hospitalized Elderly People

OBJECTIVES: To estimate energy intake and energy expenditure (EE) in elderly hospitalized patients recovering from an acute illness.

High prevalence of vertebral fractures in women with breast cancer starting aromatase inhibitor therapy

BACKGROUNDnThe purpose of this study was to describe bone status in a large cohort of postmenopausal women with nonmetastatic breast cancer, at the initiation of aromatase inhibitor therapy.nnnPATIENTS AND METHODSnA prospective, transversal and clinical study was conducted. Each woman had an extensive medical history, a biological evaluation, a bone mineral density (BMD) measurement and spinal X-rays.nnnRESULTSnFour hundred and ninety-seven women aged 63.8±9.6 years were included in this study. Eighty-five percent of these women had a 25-OH vitamin D concentration <75 nmol/l. One hundred and fifty-six women (31.4%) had a T-score < -2 at one of the three site measurements. Ninety-five women (19.1%) had a history of nonvertebral fracture with a total of 120 fractures. Spine X-rays evaluation revealed that 20% of the women had at least one vertebral fracture. The presence of vertebral fracture was associated with nonvertebral fracture history [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1-2.4] and with spine BMD (OR 1.4, 95% CI 1.1-1.7). The prevalence of vertebral fracture reached 62.9% in women with age above 70 years and femoral T-score < -2.5.nnnCONCLUSIONnBefore starting aromatase inhibitor therapy for breast cancer, a large proportion of women had a vitamin D insufficiency and vertebral fractures.BACKGROUNDnThe purpose of this study was to describe bone status in a large cohort of postmenopausal women with nonmetastatic breast cancer, at the initiation of aromatase inhibitor therapy.nnnPATIENTS AND METHODSnA prospective, transversal and clinical study was conducted. Each woman had an extensive medical history, a biological evaluation, a bone mineral density (BMD) measurement and spinal X-rays.nnnRESULTSnFour hundred and ninety-seven women aged 63.8 ± 9.6 years were included in this study. Eighty-five percent of these women had a 25-OH vitamin D concentration <75 nmol/l. One hundred and fifty-six women (31.4%) had a T-score < -2 at one of the three site measurements. Ninety-five women (19.1%) had a history of nonvertebral fracture with a total of 120 fractures. Spine X-rays evaluation revealed that 20% of the women had at least one vertebral fracture. The presence of vertebral fracture was associated with nonvertebral fracture history [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1-2.4] and with spine BMD (OR 1.4, 95% CI 1.1-1.7). The prevalence of vertebral fracture reached 62.9% in women with age above 70 years and femoral T-score < -2.5.nnnCONCLUSIONnBefore starting aromatase inhibitor therapy for breast cancer, a large proportion of women had a vitamin D insufficiency and vertebral fractures.

Bone tissue and hyperhomocysteinemia.

Bone tissue quality is determined not only by multiple architectural variables, but also by the mechanical properties of collagen type 1. Homocysteinuria is a genetic disease whose manifestations include severe hyperhomocysteinemia and decreased bone strength. The effects of smaller homocysteine elevations on bone tissue are difficult to demonstrate in clinical studies. Studies in animals and in humans suggest that homocysteine may weaken collagen crosslinks and, if present in large amounts, interfere with bone remodeling. Whether routine homocysteine assays should be performed to detect bone frailty remains unclear. In clinical practice, the focus should be on identifying patients with potential causes of homocysteine elevation (e.g., medications), who should then be given vitamin D and folic acid supplementation if needed. This approach may improve not only bone health, but also vascular and general health.

Treatment and management of osteoporosis–pseudoglioma syndrome

Osteoporosis–pseudoglioma syndrome (OPPG; MIM 259770) is a very rare genetic disorder with an autosomal recessive mode of inheritance, characterized by congenital or infancy-onset visual loss and skeletal fragility, diagnosed during childhood. This syndrome can lead to severe disability and chronic bone pain. Low-density lipoprotein receptor-related protein 5 (LRP5) is the gene mutated and inactivated in OPPG, and plays a pivotal role in bone accrual and skeletal remodeling by controlling bone formation through activators, such as Wnt proteins, or inhibitors, such as DKK1. OPPG should be differentiated from osteogenesis imperfecta and child abuse by clinicians. Eye examination, coupled to bone phenotype and research of LRP5 mutation, are key points to diagnose OPPG. Chronic pain should be managed correctly in this syndrome with severe functional disability. Bisphosphonates allows fracture prevention, the catch-up of bone mineral density and improvement in mobility in children with OPPG. New drugs favoring osteoblast function and osteoclast inhibition are potential candidates in the treatment of OPPG.

Catch-Up of Bone Mineral Density in Osteoporosis-Pseudoglioma Syndrome

Skeletal fragility during childhood induces fractures due mainly to a decrease in bone quantity and also an alteration of bone quality. Osteoporosis-pseudoglioma syndrome (OPPG, MIM 259770) was discovered in the last century and is a very rare genetic disorder with an autosomal recessive mode of inheritance, characterized by congenital or infancy-onset visual loss and skeletal fragility diagnosed during childhood due to a severe defect of bone accrual during growth. More than 50 cases have now been described. This syndrome can lead to severe disability and chronic bone pain. The gene mutated and inactivated in OPPG is LRP5 (LDL receptor-related protein 5), a Wnt membrane co-receptor expressed in osteoblasts and many other cell types. LRP5 plays a pivotal role in bone accrual and skeletal remodelling by controlling bone formation through activators such as Wnt proteins or inhibitors such as DKK1. The lack of a functional LRP5 leads to a severe defect of bone formation by osteoblasts, very early in the process of bone growth and bone accrual. The main differential diagnoses of OPPG are osteogenesis imperfecta and child abuse; these should be known to clinicians. Eye examination, coupled to bone phenotype and research of LRP5 mutation, is key to diagnose OPPG. Chronic pains with severe functional disability due to repeated fractures are the main problems to manage. Clinicians should normalize the serum level of 25(OH) vitamin D and calcium diet in parallel to giving bisphosphonates during childhood. Bisphosphonates (the main studies have been done with pamidronate) allow fracture prevention, catch-up of bone mineral density, and improvement in mobility in children with OPPG. New drugs favouring osteoblast function and osteoclast inhibition are potential candidates to treat OPPG.