Revista de Osteoporosis y Metabolismo Mineral

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Volume 3 · Number 2 · June 2011


Osteoporosis in primary care

Osteoporosis (OP) is a highly prevalent chronic disease which constitutes a public health problem, with significant medical and socioeconomic repercussions due, respectively, to the morbid-mortality which it brings and the direct and indirect costs which it generates. It is expected that with demographic changes which are happening, and the aging of the population, if there is no immediate intervention in clinical practice, the number of patients who will suffer at least one fracture will become greater.<

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Appropriate use in primary care of antiresorptive drugs against osteoporosis

Background: To assess the appropriateness of the prescription of antiresorptive drugs according to the Guide to Osteoporosis of the Spanish Society for Family and Community Medicine (SEMFYC).
Material and methods: Descriptive transversal study carried out in two urban primary care centres. Out of all those patients who had taken an antiresorptive drug and/or had a diagnosis of osteoporosis, a sample of 411 patients was studied. Those who took the drug for other reasons (13), with diagnostic errors (8), exitus (3), or lacking clinical history (16) were excluded. Variables were recorded: age, sex, personal and family history of fractures, T and Z densitometric scores, type of antiresorptive drug, calcium and vitamin D supplements, and the specialist who initially indicated treatment. The appropriateness of the prescription was assessed according to whether or not it complied with the criteria in the SEMFYC Guide.
Results: 371 patients complied with the inclusion criteria. Of these, 96.5% were women. The average age was 68 years (standard deviation -SD-: 9.4). In 288 patients (77.6%) the personal antecedence of fractures was assessed, and in 21 (5.7%), that of the family. Densitometry had been carried out in 65.5% of patients. 65.2% had taken biphosphonates, and 14.8%, raloxifene. 72.8% were receiving vitamin D supplements, and 76%, calcium. In 30.5% of cases the treatment was initiated by the family doctor, in 21% by a traumatologist and in 14.3%, by a gynaecologist. In 204 patients (55%) the antiresorptive prescription was appropriate, in 113 cases (30.5%) it was not possible to determine the appropriateness, and in 51 (13.7%) it was inappropriate.
Conclusions: The prescription was inappropriate in fewer than 15% of patients, with biphosphonates the drugs most commonly used. In a third of patients densitometry was not carried out.

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Evaluation of the absolute risk of fracture by means of tool FRAX® in a Spanish cohorte

The FRAX® tool has been developed as an aid to predict the 10-year probability of hip and major osteoporotic fracture using country-specific data. This algorithm combines clinical risk factors with or without the bone mineral density (BMD) measurement to identify subjects in high risk of fragility fracture. The aim of this study was to challenge the Spanish version of the WHO fracture risk assessment tool FRAX® on a cohort of women with BMD measurement indication.
Methods:Clinical and BMD data from a large population cohort taken from metropolitan area of Barcelona were used for this study. Inclusion criteria were: age range 40-90 yrs, clinical risk factors, femoral neck BMD T-score available and follow-up longer than 7 years. Main outcome was: major osteoporotic fracture at least 7 years after the first BMD measurement. The total number of predicted fractures by the FRAX algorithm was compared with the total number of new registered fractures during the follow-up time in the study population and expressed as observed – expected fracture (O/E) ratio. Results were stratified by age; BMD results and number of clinical risk factors were included in the FRAX algorithm.
Results: 8450 women were included, 69% were under 60 years and 14% presented a previous fracture. After follow-up, 10% had a major osteoporotic fracture. Wrist was the most incident fracture site and hip accounted only for 0.9% of the total. The 52% of the main fractures happened in women with none or only one risk factor. The fracture ratio (O/E) was 0.8 [CI 95%: 0.7 ; 1.1] for hip fractures and 3.1 [CI 95%: 2.8 ; 3.5] for the main osteoporotic fractures. The O/E ratio was lower as higher was the age of women (for those older than 70 O/E=1.9 [CI 95%: 1.6 ; 4.3]), longer the follow-up time (for those with more than 10 years O/E=2.7 [CI 95%: 2.2 ; 3.4]) or fewer number of risk factors (O/E=3.2 [CI 95%: 2.7 ; 3.9]).
Conclusions: The Spanish version of the FRAX® algorithm for this population is reasonably well adjusted to predict hip fractures but underestimates the observed main osteoporotic fracture incidence, independently of the T-score, and number of risk factors.

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Structural study using micro-CT of the femur of Goto-Kakizaki rats, experimental model for non-overweight type 2 diabetes

Background: The effects of type 2 diabetes on the microstructure and mass of bone are not clearly defined. The objective of this study has been to assess the microstructural properties and volumetric bone mineral density of Goto-Kazizaki rats, the rat model for non-overweight type 2 diabetes which tries to circumvent the influence of obesity on bone mass.
Material and methods: An experimental study was designed using Goto-Kazizaki rats compared with a control group of non-diabetic Wistar rats of similar weight and with normal glycemia, with densitometric and microstructural studies being carried out on the distal region of the femur using computerised X-ray microtomography (micro-CT).
Results: In the volumetric densitometry no significant differences were found between the two groups. The microstructural study showed that the BV/TV and trabecular connectivity were reduced in the diabetic rats, while the tube-like trabeculae increased to the detriment of plaque-like trabeculae.
Conclusion: The deterioration trabecular bone quality could explain the decrease in biomechanical bone resistance in type 2 diabetes.

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Bone metabolism regulation through RANK-RANKL-OPG system

Osteoporosis is a disorder in which loss of bone strength leads to fragility fractures. The discovery of osteoprotegerin (OPG) and the receptor activator of nuclear factor-kb ligand (RANKL) as final effector in osteoporosis pathogenesis have lead to a better understanding of bone remodelling. When RANKL binds to its natural receptor (RANK), osteoclastic differentiation and activation is initiated. OPG is a decoy receptor that binds to RANKL and prevents its osteoclastogenic effect.

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Fibromyalgia and osteoporosis

Fibromyalgia (FM) is a syndrome characterised by the presence of diffuse chronic body pain which is associated with tenderness at certain sensitive points. Symptoms such as fatigue, altered sleep patterns or depression reduce the quality of life of these patients, reducing their physical activity. This may enhance the risk of osteoporosis. Various works have analysed the bone mass and levels of vitamin D in patients with FM, but the results are not conclusive.

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Evolution of bone mineral density after a 15 year intervention based on progressive force training

Dear Editor,

Osteoporosis is the most common bone disorder in humans, affecting older people at a very high rate. It consists of an imbalance in bone formation-resorption which principally affects its strength and resistance, resulting in an increase in risk of fractures1. This situation is associated with high levels of morbidity and mortality2. One of the many causes which affect this relationship is the history of the mechanical load taken by the bone3, and, according to the law proposed by Dr Wolff, the stress or mechanical load applied to the bone through the tendon and generated by the muscle. Pharmacological intervention for osteoporosis includes drugs of the biphosphonate family, the selective oestrogen receptor modulators, parathyroid hormone, the oestrogens and calcitonin2. In addition, the referent institutions and the specialists agree in including the practice of physical exercise among health-giving habits for people affected, or with possible affectation of bone mineralisation2. However, there is a need to evaluate longitudinal studies of physical exercise3, given that bone improvements happen 4-6 months after the start of intervention, but only after a year will these changes become significant3. Similarly, Beck et al.4 have found that, despite the abundant scientific evidence which relates resistance exercise with oestrogen stimulus, the changes in bone mineral density are usually modest. Therefore, it seems logical to think about the necessity of carrying out long term longitudinal studies to be able to observe changes resulting from the application of a resistance exercise programme

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