Revista de Osteoporosis y Metabolismo Mineral

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Category: English

Bone protection during breast cancer treatment

Few medical areas have changed as much through the last decades as the treatment of breast cancer (BC). From Halsted’s theory of the progression of an initially local disease, with a first loco-regional and then metastatic extension, to the most recent studies in molecular biology that identify the gene personality of each tumor, there have been many advances. Old TNM classification originally designed for solid tumors have been abandoned and all areas related to hormonal dependence and gene expression of each tumor have grown in importance. All this is aimed at better facing a global therapeutic approach.
Almost 20 years ago, an important biological research laboratory provided us with a detailed study of the basal estradiol levels of the patients in the placebo group of the MORE study [1]. An increased risk of breast cancer associated with raised serum estradiol levels was demonstrated, confirming the previous results on the hormonal dependence of this neoplasm. With the introduction of chemotherapy (QMT) in the final decade of the last century, the general mortality of women from breast cancer was reduced in all western countries. At the time, and just a few years later, the implementation of massive early detection programs at the population level facilitated an increase in the diagnosis of tumors in early stages.

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Risk factors for incident fracture in patients with breast cancer treated with aromatase inhibitors: B-ABLE cohort

Currently, aromatase inhibitors (AI) are used as first-line adjuvant therapy for women diagnosed with breast cancer with positive hormonal receptors. Although its effectiveness in reducing the risk of recurrence and mortality is well known [1], AIs have also been associated with side effects that can negatively affect the patient’s quality of life, adherence to treatment and associated mortality [2].
In AI treatment, there is a marked reduction in circulating estrogens in postmenopausal women by blocking the conversion by the enzyme aromatase from androgens to estrogens. This action leaves the woman without residual estrogens, such as estradiol and estrone, after menopause. One of the most common side effects is accelerated bone loss, which is associated with an increased risk of osteoporotic fractures [3,4]. Along these lines, there are different meta-analyzes that include randomized controlled clinical trials that have shown an association between prolonged treatment with AI and an increased risk of bone fractures, with an increase between 34% and 59% [5,6].

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Differences in bone mineral metabolism normocalcemic primary hyperparathyroidism with respect to classical primary hyperparathyroidism

Primary hyperparathyroidism (HPT) is a very common bone mineral metabolic disease consisting of autonomous overproduction of parathyroid hormone (PTH), which leads to an increase in serum calcium [1]. It is the most frequent cause of hypercalcemia.
A lesser known clinical variant of HPT is the so-called “normocalcemic primary hyperparathyroidism” (NHPT), which has normal blood calcium levels and elevated parathyroid hormone (PTH) values, not knowing the mechanism by which this differential fact occurs [2-4]. These patients do not have clear causes that justify secondary elevations of PTH such as chronic renal damage [5], vitamin D deficiency (less than 30 ng/ml) [6], renal hypercalciuria or drugs [7]. Although NHPT was first formally recognized in the Third International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism in 2008 [8], all clinical features are not yet known, particularly with regard to its epidemiology, natural history, management and prognosis [9,10]. Therefore, this clinical variety of the disease is less studied [11] and there is less bibliography. All of which has motivated us to carry out this study.

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Effects of bazedoxifene treatment on the bone quality of ovariectomized rats

Selective estrogen-receptor modulators (SERMs) are synthetic, nonsteroidal agents with estrogenic agonist-antagonist activity in different target tissues [1]. Their estrogenic responses are mediated by estrogen receptors (α and β). SERMs may present agonistic or antagonistic behavior depending on the tissue type [2,3]. In general, SERMs exhibit agonist activity in the liver, the digestive tube, the skeleton and the heart, but antagonist activity in the breast. In the uterus some SERMs manifest agonist activity while others show an antagonist behavior [1]. Several co-regulatory proteins modify the behavior of the SERMs on gene expression and contribute to their tissue-selective pharmacology.
Tamoxifen is a SERM used as a mammary antiestrogen for preventing and treating breast cancer with estrogen agonistic activity in the uterus. Raloxifene has been used for the prevention and treatment of osteoporosis and prevents breast cancer but presents some estrogenic activity [4]. Bazedoxifene is a 3rd generation SERM with agonistic effects on the bone and additional positive effects on lipids, the uterus and the breast tissue [5,6].

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Influence of high-concentration hyperbaric oxygen therapy on bone metabolism

Oxygen is required to produce cellular energy and is involved in numerous processes, such as enzymatic activation, molecular signaling and regulation of gene expression [1]. Also in angiogenesis, the maintenance of hematopoietic stem cells and bone formation [2]. In fact, changes in the partial pressure of oxygen can influence the function of osteoblasts and osteoclasts [3]. In hypoxia, bone formation and mineralization decreases, while resorption increases [4-6]. In the opposite direction, hyperoxia could have a beneficial effect on the bone. Treatment with high concentration of oxygen in the hyperbaric chamber has proven useful in osteomyelitis and osteonecrosis of the jaw caused by radiotherapy or by the use of bisphosphonates [7-9]. HC accelerates osteogenic differentiation of mesenchymal cells and decreases the activation of osteoclasts [10-12].
In this work we wanted to analyze the actions of oxygen at high concentration in HBO on the expression of genes related to bone metabolism in osteoblastic cell lines and human bone [5,6,13,14].

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Assessment of bone mass density in the surgical indication. New tool

To the Editor:

Current scientific evidence and practical clinical guidelines recommend primary and secondary prevention of fragility fractures in geriatric patients [1,2]. A personal history of fragility fractures significantly increases the risk of new fractures. Up to 33% of patients with a femur fracture had suffered a previous fracture. Among the various fractures due to fragility, the femur is the most prevalent and presents the most repercussions (clinical, functional and social) in patients over 65 years of age, with the resulting depletion of health resources [3]. The worldwide trend is estimated to rise from 1.7 million femoral fractures in 1990 to 6 million in 2050 [4].
In 2011, the Fractures Working Group of the Scientific Advisory Committee of the International Osteoporosis Foundation stressed the importance of coordination between orthopedics, osteoporosis services, fall units, patient, family, geriatrician and Primary Care physician. This multidisciplinary action was consolidated in the so-called “coordinated services for the treatment of fractures” or Fracture Liaison Services (FLS) that were initially implemented in the United Kingdom, Europe, Australia, Canada and the USA [5], with very good results.

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About air pollution and hip fracture

Raised levels of air pollution have recently been been linked to the induction of inflammatory phenomena at both systemic and tissue levels. Chronic inflammatory diseases, such as rheumatoid arthritis or chronic obstructive pulmonary disease, reduce bone mineral density (BMD), which leads to an increase in the release of immune cells from the bone marrow. Particulate matter is associated with oxidative damage and inflammation, which can accelerate bone loss and increase the risk of fractures in older adults. However, the association between air pollution and osteoporosis is not yet well defined in the literature.
It seems that there are other indirect routes, such as vitamin D and PTH, which may also be altered by contamination and are involved in bone remodeling [1-8]. In the first place, air pollution (microparticles and ozone) presents a physical barrier to ultraviolet B solar radiation, thus contributing to a lower cutaneous production of vitamin D [2,4,5]. Similarly, a study conducted in the United States [9] indicated the relationship between low levels of PTH in blood and elevated levels of microparticles and carbon in the air, causing indirect harmful effects on bone mass.

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Long-term efficacy and safety of polymethylmethacrylate (PMMA) in osteoporotic patients treated by percutaneous vertebroplasty

Without a doubt, vertebral fracture (VF) is the most prevalent type of bone rupture in patients with low bone mass [1]. The most recent epidemiological data in the Spanish population indicate about 35% VF prevalence in women over 45 years of age [2]. In men, the prevalence at 50 years is estimated 5 times lower than that of the female population, although this increases beyond 70 years of age [3].
Osteoporotic VFs (OVF) are conservatively treated, usually including rest, analgesia (in combination with muscle relaxants), orthotics and rehabilitation. This treatment is crucial in the first weeks post-fracture, so that proper follow-up usually resolves OVFs effectively. However, in 10-35% of patients, complications may arise from the fracture itself, such as delayed bone union, increased kyphosis, appearance of neurological disorders or the appearance of pseudo-arthrosis (Kümmell’s disease). In these cases, patients frequently do not respond well to conservative treatment, complicating the management of their symptoms. This tends to worsen over time [4].

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Functional impact of sclerostin gene polymorphisms on DNA methylation and gene expression

Genome-wide association studies (GWAS) and candidate gene studies have found some single nucleotide polymorphisms (SNPs) in the SOST gene, which encodes sclerostin, associated with bone mineral density (BMD) and predisposition to fractures [1-4]. However, the mechanism responsible for this association is unknown. Among the general mechanisms by which genetic variants predispose to complex diseases are epigenetic mechanisms, such as DNA methylation, that modulate gene transcription directly (locally) or indirectly (remotely) [5]. In this sense, it should be noted that the DNA methylation of the SOST promoter is inversely related to the gene expression levels of the gene [6].
DNA methylation is an epigenetic mark that consists in the addition of a methyl group at the 5 ’position of the cytosine ring, usually in cytosines that precede guanine, forming the so-called CpG sites. They are distributed throughout the genome and abundant in some specific regions, such as promoters, called CpG islands. Methylation levels of CpG sites and/or islands have specific profiles according to the tissue of origin and modulate gene expression in many tissues, including bone [7-10].

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Factors that influence the results of bone ultra-microindentation tests. An experimental study in rats

Fragility fractures are the relevant hallmark of osteoporosis [1]. The risk of fracture is closely related to bone strength, which, in turn, depends on bone mass, geometry and material quality [2-6]. Bone mass and geometry can be evaluated clinically using bone densitometry and high resolution imaging techniques. However, the mechanical properties of bone tissue are more difficult to explore. These properties determine bone quality, a concept that represents the intrinsic capacity of tissue to resist tension states, regardless of the amount of material (bone density) or its spatial distribution (bone architecture). Bone quality depends on the chemical composition and organization of the bone matrix [7].
In an indentation or hardness test, a sample is subjected to quasi-static loading by means of a small indenter, recording the size of the resulting footprint; Sometimes the curve that relates the applied load and the displacement experienced by the indenter during the test is also determined. Hardness is defined as the maximum force applied divided by the area of the footprint that remains in the material after the test. Hardness is the property of the material that characterizes its resistance to permanent/plastic deformation [8].

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How to merge Orthogeriatrics Units with Fracture Coordination Units (FCU). Experience in the Joan XXIII Health Complex of Tarragona

Current scientific evidence and practical clinical guidelines recommend primary and secondary prevention of fragility fractures in geriatric patients [1,2]. A personal history of fragility fractures significantly increases the risk of new fractures. Up to 33% of patients with a femur fracture had suffered a previous fracture. Among the various fractures due to fragility, the femur is the most prevalent and presents the most repercussions (clinical, functional and social) in patients over 65 years of age, with the resulting depletion of health resources [3]. The worldwide trend is estimated to rise from 1.7 million femoral fractures in 1990 to 6 million in 2050 [4].
In 2011, the Fractures Working Group of the Scientific Advisory Committee of the International Osteoporosis Foundation stressed the importance of coordination between orthopedics, osteoporosis services, fall units, patient, family, geriatrician and Primary Care physician. This multidisciplinary action was consolidated in the so-called “coordinated services for the treatment of fractures” or Fracture Liaison Services (FLS) that were initially implemented in the United Kingdom, Europe, Australia, Canada and the USA [5], with very good results.

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Clinical Notes
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Editorial
English
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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Special Documents

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