Revista de Osteoporosis y Metabolismo Mineral

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Citescore: 0,14 | SCImago Journal Rank : 0,12 | Google Scholar: 0,0172

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Category: Osteology images

Metastatic transverse vertebral fracture due to lung cancer

A 58-year-old patient with rheumatoid arthritis in remission with methotrexate at a dose of 10 mg/week. He goes to hospital emergencies several times for acute lower back pain over one month. In the lumbar X-ray, an L4 transverse fracture with posterior wall retropulsion (Figure 1) goes unnoticed. This lower back pain becomes disabling with loss of left leg function. Lumbar MRI is carried out on T2 and STIR sequence (Figures 2a and 2b), showing acute-subacute fracture of the L4 vertebral soma with pedicles edema and moderate intra-canal displacement of the lower half of the posterior wall that compresses the efferent nerve root. Left and partially takes up the side recess. With suspicion of tumor etiology, enter for study. In the thoracic CT scan, a large, right-lobed, upper-cavity tumor is reported with ipsilateral main bronchus associated with perilesional pneumonitis and bronchiectasis (Figure 3). The pulmonary lesion histology was of large cell lung carcinoma PD-L1 80% positive. Vertebroplasty was carried out. The patient underwent pembrolizumab treatment with good response to date. Rheumatoid arthritis is maintained in remission despite treatment with anti-PDL [1].

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Vitamin D and heart failure. Pathophysiology, prevalence, and prognostic association

Heart failure (HF) is a major public health problem characterized by high mortality, frequent hospitalizations and deterioration in the quality of life, with a prevalence and incidence that is increasing worldwide [1,2]. Although the prognosis has improved in recent decades thanks to the diagnostic and therapeutic improvement of cardiovascular diseases, the morbidity and mortality of these patients remains high [3]. All this implies that new objectives and treatment options are still needed.
Vitamin D had traditionally been associated only with bone health, accepting that vitamin D deficiency caused osteomalacia and osteoporosis in adults and rickets in children [4,5]. However, data obtained in recent years indicate that vitamin D is an important micronutrient for optimal function of many organs and tissues throughout the body, including the cardiovascular system [6,7]. It has been suggested that vitamin D deficiency may be an important factor both in the genesis of risk factors and cardiovascular disease [7] as a prognostic marker in HF. Pathophysiological data indicate that vitamin D deficiency may be very harmful for patients with HF and that vitamin D supplementation can be potentially beneficial, although all this is not without controversy [8].

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