Volume 4 · Number 2 · June 2012
- Pregnancy-associated osteoporosis. Presentation of 5 cases and long term monitoring [57-62]
- Seasonal variation in vitamin D levels in patients attending in Basic Healthcare Center[63-68]
- Prevalence of vertebral fractures in patients with Chronic Obstructive Pulmonary Disease admitted to a University Hospital [69-75]
- Role of DNA methylation in the regulation of osteogenesis [77-81]
- Action of beer on the bone [83-87]
Both generalised and regional osteoporosis are diseases which, exceptionally, are associated with pregnancy and breastfeeding, although, undoubtedly, diseases that are underdiagnosed.
Compensatory physiological mechanisms allow, in the majority of cases, those requirements necessary for the formation and mineralisation of the foetal skeleton and the nutrition of the new born to be met, overcoming this period without major difficulties 1. However, some mothers experience bone demineralisation which may become complicated with fractures2, and a small group suffers regional demineralisation which temporarily disables them3v.
The fundamental problem in these situations is the diagnosis since, on the one hand, some of the associated symptoms may be attributed to ”normal” problems related to gestation, such as pelvic pain, which are frequently seen in the typical clinical picture during the third quarter of pregnancy, while on the other, there is the impossibility of carrying out diagnostic procedures such as DXA during pregnancy.
Background: Pregnancy-associated osteoporosis (PAO) is a clearly described and relatively frequent entity, although there are few studies which have carried out long term monitoring of the disease.
Material and methods: 5 women affected by osteoporosis who were monitored over the long term, between 4 and 16 years. In all the patients a questionnaire on lifestyle and risk factors was completed and a physical examination carried out, as well as densitometry after the pregnancy and subsequently every year during the follow up period. At the end of this period, a lateral X-ray of the dorsal and lumbar spine was performed.
Results: In 3 cases there was a spontaneous fracture as the first manifestation of PAO, while in 2 cases a very low densitometric value was observed, without fractures, in the immediate postpartum period. All the patients received calcium and vitamin D supplements, and in 3 cases a biphosphonate (risedronate) was indicated. No new fractures were observed in any of the cases over the follow up period. The bone mineral density (BMD) increased in the lumbar spine in all the patients, but in one a decreased measurement was observed in the hip, both in the femoral neck and the total hip. None of the patients became pregnant again in the period of the study.
Conclusions: While none of the patients with PAO studied over the long term suffered a new fracture, and in all an increase in the bone mineral density in the lumbar spine was observed, which makes us think that there is a recovery of DMO over time, in one case there was a considerable decrease in bone mineral density in the proximal femur, for which reason we believe that it is advisable to carry out long term monitoring of these patients.
Background: Previous reports have shown a high prevalence of vitamin D deficiency among different populations in our country. However fewer longitudinal studies about seasonal changes in serum vitamin D have been published. The aim of the present study was to determinate seasonal variation in serum vitamin D in patients attending in Basic Healthcare Center.
Patients and method: Prospective longitudinal cohort study of 82 patients attending in Basic Healthcare Center. In all cases, serum levels of calcium, 25OHD and PTH were determined during January, February and March (Period 1) and September and Octuber (Period 2).
Results: Serum calcium levels did not differ between Period 1 and Period 2. During Period 1, 50.6% presented 25OHD levels < 15 ng/ml and 3.65% presented 25OHD levels > 30 ng/ml. During Period 2, 25OHD levels increased (31.88 vs 15.75 ng/ml, p < 0,001). Prevalence of patients with 25OHD levels < 15 ng/ml decreased (2.7 vs 50.6%, p < 0,001) and prevalence of patients with 25OHD levels > 30 ng/ml increased (50.68 vs 3.65%, p< 0,001). Negative correlation between 25OHD and PTH concentrations during both periods was observed.
Conclusions: These results show vitamin D deficiency during winter months in the majority of patients attending in Basic Healthcare Center. The prevalence of patients with vitamin D deficiency decreased after summer, however only half of the patients reached optimal vitamin D levels. Based on our results, to guarantee optimum vitamin D levels in the general population, the promotion of sanitary policies is recommended.
Prevalence of vertebral fractures in patients with Chronic Obstructive Pulmonary Disease admitted to a University Hospital
Objective: Chronic obstructive pulmonary disease (COPD) is a widely distributed disease with high morbimortality, associated with important pathologies, among which is included osteoporosis. The objective of this study was to evaluate the prevalence of vertebral fractures in those patients with chronic obstructive pulmonary disease and to determine some factors which heighten the risk of fracture in these patients, especially the severity of the COPD and the use and dosage of inhaled corticoids.
Material and method: Retrospective, observational transversal study, in which were included patients admitted to the Rio Hortega University Hospital during the year 2006 diagnosed with COPD who had a lateral thoracic X-ray. A control group was included, without COPD, of similar age and sex, admitted to the internal medicine service over the same period. The vertebral fracture was determined using Morphoxpress®.
Results: 115 patients with COPD and 87 control patients were included, with a higher prevalence of vertebral fractures in being observed in patients with COPD, although without there being a statistically significant difference with respect to the control group. However, if we consider only the moderate-severe fractures (Gennant Type II and III), there is a greater prevalence, which is related to the severity of the disease, measured by the decrease in FEV1 (Forced expiratory volume in one second). We found no relationship between the prevalence of fractures, the different types of treatment and the morbidity determined by the number of admissions.
Conclusions: Our study shows the tendency of patients with COPD to have an increased prevalence of vertebral fractures which are associated with the severity of the COPD and the seriousness of the fractures themselves. We found no relationship between the different inhaled corticoids, individually or grouped, and the presence of fractures. Nor did we find a relationship between the number of vertebral fractures and the number of flare-ups, treatment with broncodilators, corticoids, home oxygen therapy, or the diagnosis of, or previous treatment for, osteoporosis.
Recent studies suggest that epigenetic mechanisms, such as the methylation of DNA, play a critical role in cellular differentiation. Osteoclasts are cells with the capability of reabsorbing bone. Their differentiation is strictly regulated by the RANKL-OPG-RANK signalling pathway. Recently, our group has reported that the expression of RANKL and OPG by cells of the osteoblastic lineage is regulated by the methylation of the promoter regions of those genes. This review summarizes current knowledge about the influence of DNA methylation on the regulation of osteoclastogenesis.
Although it has been shown that excess alcohol is a significant risk factor for osteoporosis, the moderate consumption of beer appears to have beneficial effects on the bone. This review comments on the scientific evidence regarding the possible beneficial effects of beer on bone metabolism, describes which of its elements may be responsible for these positive effects, and reports that both the polyphenols and the flavonoids, among them lignane, and above all silicon, all of which are components of beer, act positively on bone metabolism and bone mass.
The bisphosphonates are widely and very safely used both for the prevention and the management of metastatic bone disease in tumoral processes. In spite of this, its use if not free of complications, of which hypocalcaemia, which is usually light, is one of the most frequent. There are various factors which increase the risk of this occurring, some of which are not yet well known, but which should be taken into account in all patients before the administration of these drugs to avoid serious cases of symptomatic hypocalcaemia.