Revista de Osteoporosis y Metabolismo Mineral

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Citescore: 0,4 | SCImago Journal Rank : 0,12 | Google Scholar: 0,0172

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Category: 12

The importance of identifying intrinsic and modifiable risk factors for falls in order to act early prevention measures

Falls in the elderly constitute one of the main public health problems, both due to their prevalence and consequences. One of the most serious is the fracture of the femur. The annual prevalence of falls in the over 65 population ranges between 28% and 35%, and these falls are frequently repeated [1]. The factors responsible for a fall are divided into intrinsic (related to the patients themselves) and extrinsic (derived from the activity or the environment), the cause being multifactorial in most cases [1]. When assessing the intrinsic factors of a fall, we must take into account the physiological disorders related to age (including the presence of nutritional alterations, sarcopenia and frailty), acute and chronic diseases and the prescription of certain drugs [1]. For this reason, when faced with a fall, it is essential to have a comprehensive approach to the adult through a global geriatric assessment that includes a complete assessment of gait and balance.

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Effect of frailty and sarcopenia on the risk of falls and osteoporotic fractures in an unselected population

Life expectancy has increased rapidly in the last century due to economic growth. This has led to reduced mortality, improved quality of life, as well as greater availability of health care. In fact, there are more elderly people than at any other time in our history, and it is anticipated that within the next few years there will be more older adults than children. This forecast makes it essential for people to reach this age in good health, to avoid increased healthcare costs due to longer hospital stays, readmissions and demand for healthcare resources. One of the most common disorders associated with aging is osteoporosis, the most fatal consequence of which is fracture. Approximately half of the clinical fractures that occur in postmenopausal women do not present criteria for osteoporosis according to their bone mineral density [1]. In fact, the highest percentage of fractures occur in osteopenic women. Thus, other variables or tools are needed that allow the identification of people at high risk of fractures, a determining factor of morbidity and mortality in the elderly population.

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Persistence to aromatase inhibitors in the SIDIAP cohort: mortality and influence of bisphosphonates

Aromatase inhibitors (AIs) are the recommended adjuvant therapy to treat estrogen receptor-positive breast cancer [1,2]. Its effectiveness in reducing the risk of recurrence and mortality is acknowledged [3]. However, AIs are also associated with various side effects that affect patients’ quality of life and therefore compromise adherence to treatment and associated mortality [4].
Reportedly, 30% of patients prescribed with AI discontinue their treatment due to adverse events [5], mainly musculoskeletal [6,7]. Among them, the most frequent are arthralgias [8] and accelerated loss of bone mass [9] associated with an increase in osteoporotic fracture [10,11]. To prevent the loss of bone mass, treating patients with antiresorptives is recommended, with bisphosphonates (BP) being the most used [12-14].
BP use has been associated with improved mortality associated with reduced bone metastases [13]. Similarly, a study published in a Korean population showed the use of BP was associated with improved adherence [15].

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Biocompatibility and osseointegration study of new prosthetic materials

The generation of functional tissue through tissue engineering has a high impact in various areas of regenerative medicine, among which is skeletal tissue. The first implants were used in the field of medicine, in 1909, when Kirschner wires and Steinman nails were developed for the fixation of bone fractures, where stainless steel was used. Over the years, steel has been improved, making it more resistant to corrosion and not causing harmful effects on the human body. In 1940, the study of titanium (Ti) began as a biomaterial for bone implantation [1].
The phase change determines the change in the crystalline structure of the material when subjected to temperature changes. Titanium’s allotropic transformation occurs at 882ºC and goes from an α phase, which has a compact and hexagonal structure (HCP), little deformable and resistant at room temperature, to a β phase characterized by a cubic structure centered on the body (BCC), which is easily deformable and allows for carrying out heat treatments to optimize the material’s properties [2].

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Study of bone factor expression in murine model in the absence of pleiotrophin and its changes in the inflammatory situation

Pleitropin (PTN) is a cytokine secreted by multiple tissues during embryonic development, and which in adulthood is abundantly expressed in the brain and bone [1,2]. PTN is composed of 136 amino acids and its sequence is very rich in lysine and cysteine. Together with midkine (Mdk), with which it shares 50% homology, this cytokine constitutes the heparin-binding family of growth and differentiation factors, both having affinity for bone extracellular matrix [3-5]. PTN is also known as osteoblast stimulating factor 1 (OSF-1) or heparin-linked growth factor (HB-GAM) [6]. This cytokine was initially isolated from the bone and neuronal tissues of newborn rats [2,7,8] and subsequently its homologues have been found in many species including humans, with 90% homology between the different species [9,10].
PTN reportedly exerts its effects through its binding to glucosamin-glucans of several receptors such as N-syndecan, also called syndecan 3 [11], syndecans 1 and 4 [12], integrin αvβ3 [13] and the receptor protein tyrosine phosphatase beta/zeta (PTRPβ/ζ) [14]. It has also been suggested that nucleolin may be a low-affinity receptor for PTN [15] and that anaplastic lymphoma kinase (ALK) may play a role in PTN signaling [16].

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Fibrous dysplasia mimicking rib metastasis

We present the diagnostic images of a 30-year-old woman, an asymptomatic BRCA1 mutation carrier and undergoing clinical-radiological follow-up for bilateral mammary fibroadenomas. The control MRI (Figure 1) highlighted the appearance of a nodular lesion posterior to the right breast prosthesis, relatively well defined and with lobulated contours. Given the suspicion of metastatic bone disease, a positron emission tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) was carried out to assess its metabolic activity and extent of the disease. This was the only active lesion, with a 2.6 cm diameter and high metabolic activity, located in the fourth right costal arch (Figure 2). In this context, the lesion was excised to rule out neoplastic etiology. Pathology studies showed it was fibrous dysplasia, a benign and slowly progressive pseudotumoral disease, which represents less than 5% of bone tumors.

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Olive oil and bone health

Osteoporosis is the bone disease that most affects humans and predisposes a person to fractures. It constitutes a serious public health problem due to its impact on patients’ quality of life and the economic burden it represents. Osteoporosis reportedly affects more than 200 million people [1]. Therefore, it is extremely important to take all possible measures to mitigate its development.
Along with other factors, bone modeling and remodeling are determined by nutritional status [2]. Nutrition has relevant effects on peak bone mass, bone loss with age, and muscle strength [3]. Of course, the main nutrients for bone are calcium and vitamin D [4], since calcium is the major component of bone and its contribution is regulated by vitamin D, thus optimizing peak bone mass. However, the European Union has indicated the relevance of other nutrients on bone development and the advisability of conducting research into these on bone development [5]. The main advantage of nutrition in assessing its importance for bone health is that it can be modified.
The Mediterranean diet is characterized by a high intake of fruits, vegetables, and olive oil. The incidence of osteoporosis and associated fractures seems to be less in countries where the Mediterranean diet is predominant [6].

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Methodology to improve the efficiency in the migration and detection of mesenchymal stem cells in murine models

Osteoporosis is a generalised disease of the skeletal system characterised by an imbalance between the bone formation and resorption that leads to bone mass loss and to the deterioration of the microarchitecture of the bone tissue, compromising bone resistance and therefore resulting in a higher bone fragility and an increased susceptibility to fractures [1].
Two stem cells coexist in the bone cavity (bone marrow): the hematopoietic stem cell, which generates all the blood and immune system cells, and the mesenchymal stem cell, responsible for the formation of the skeleton. Osteoblasts or bone-forming cells originate from the differentiation of mesenchymal stem cells. These pluripotent cells can create a wide variety of cell types such as osteoblasts, adipocytes, or chondrocytes [2-4]. This characteristic makes them highly interesting candidates for regenerative medicine given their ability to migrate to injured areas to promote the de novo generation of bone [5].

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A sensitive method for monitoring the migration of mesenchymal stem cells from bone marrow in murine models

Osteoporosis is the most frequent bone disease, characterized by low bone mass and alteration of the microstructure. This is due to an imbalance between bone formation and bone resorption that causes loss of connections among the different bone trabeculae, a greater thinning and cortical bone porosity. Consequently, there is greater bone fragility and an increased risk of fractures (Fx) [1,2].
Osteoblasts, cells specialized in bone formation, originate from the differentiation of mesenchymal stem cells (MSCs) [3]. These cells are multipotent and can differentiate into a wide variety of mesoderm cell types, such as osteoblasts, adipocytes, or chondrocytes. MSCs are highly interesting candidates for regenerative medicine, because they migrate to skeletal lesions where they have the capacity to form new bone [4]. The many relevant published studies show the importance of MSCs in tissue engineering and regenerative medicine [5,6]. In addition, there are currently more than 250 clinical trials with MSCs, as reflected in the clinical trial database (clinicaltrials.gov).

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Can 3D measurements obtained by lumbar DXA predict fractures in the dorsal vertebrae?

Every year 8.9 million osteoporosis-related fractures occur worldwide, representing one fracture every 3 seconds [1], with vertebral being the most common osteoporotic fractures [2].
Dual-energy X-ray absorptiometry (DXA) is the standard test for diagnosing osteoporosis and evaluating fracture risk [3,4], as it is a low-radiation, inexpensive technique. The DXA provides two-dimensional (2D) images that measure the bone mineral density of the area (aBMD) projected along the anteroposterior (AP) direction. Various studies show that a low aBMD value, measured in AP DXA explorations, is among the highest fracture risks [3-5]. The decrease of the aBMD standard deviation leads to an increase from 1.5 up to 3.0 times the risk of fracture, depending on its location and its measurement’s location [5]. Nevertheless, a low BMD value is not enough to explain every fracture. Recent studies suggest that the risk of fracture is high when the BMD value is low, but this does not mean that fracture risk is negligible when the BMD value is normal [3-8].
Most osteoporosis-related vertebral fractures are located in the vertebral body [9]. In AP DXA images of the spinal column, the vertebral body overlaps the posterior vertebral elements, so the BMD in the vertebral body cannot be estimated separately. On the other hand, the risk of fracture depends on the architecture of the trabecular bone and the thickness of the cortical bone [10]. However, the trabecular and cortical bone compartments are difficult to assess separately on AP DXA scans.

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Impact of vascular calcification on bone health and mortality in kidney transplant patients

Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD), was defined in 2009 as a set of systemic disorders of the bone and mineral metabolism due to chronic kidney disease, resulting in a combination of the following manifestations [1,2]:
I) Abnormalities of the metabolism of calcium, phosphorus, paratohormone or vitamin D.
II) Anomalies of bone remodeling, mineralization, volume, linear growth or resistance.
III) Vascular and other soft tissue calcifications.
This recently updated definition [3], and the consensus documents of various scientific societies [4], have highlighted the importance of the role of vascular calcification in the morbidity and mortality of patients with chronic kidney disease.

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Relative fragility of osteoporotic femurs assessed with DXA and simulation of finite element falls guided by emergency X-rays

The increase in the elderly population and the growing concern about the consequences of fractures, together with insufficient rates of detection of situations of bone fragility [1,2], has increased the indication of the assessment of fracture risk in people of both sexes older than 64 years [3]. The dual-energy X-ray absorptiometry (DXA) technique is currently the clinical standard for this type of bone measurement.
Nowadays, when evaluating the risk of fracture, different methods are applied, although the most widely used include the presence of clinical risk factors and the measurement of areal bone mineral density (BMD). Bone measurements are made in the proximal femur and lumbar spine using DXA. However, BMD only allows a limited assessment of the mechanical determinants of bone fracture [4,5].
Finite element analysis (FE) has been applied to assess bone resistance in volumetric bone models, based on computed tomography (CT) scans, precisely identifying the subject-specific mechanical determinants of fracture. This type of analysis includes the three-dimensional geometry of the bone, the quantity and distribution of bone tissue, and the loads to which the bone is subjected [6]. With this process, the limitations of the BMDa are overcome. CT-based models of FE have been extensively validated ex vivo [7-12], and have shown better performance compared to a BMD in predicting proximal femur resistance in vitro [6,13]. A significant association between bone fractures and estimated resistance with FE has also been reported in an in vivo study [14].

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Clinical Notes
Committees
Editorial
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Index of Authors
Index of Communications
Letter to the Director
Oral Communications
Original Articles
Osteology images
Poster Communications
Presentation
Reviews
SIBOMM News
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