Volume 12 · Number 3 · October 2020
PDF EspañolEDITORIAL
- Effect of frailty and sarcopenia on the risk of falls and osteoporotic fractures in an unselected population [81-86]
- Persistence to aromatase inhibitors in the SIDIAP cohort: mortality and influence of bisphosphonates [87-91]
- Biocompatibility and osseointegration study of new prosthetic materials [92-97]
- Study of bone factor expression in murine model in the absence of pleiotrophin and its changes in the inflammatory situation [98-104]
- Olive oil and bone health [107-110]
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.
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.
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].
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].
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].
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.
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].
