Volume 7 · Number 2 · June 2015
- Use of bisphosphonates in postmenopausal women with rheumatoid arthritis; results of a multicentre study [49-53]
- Prevention of osteoporotic fracture in Spain: use of drugs before and after a hip fracture [54-62]
- Gitelman syndrome and chondrocalcinosis. A clinical case review [63-66]
- Stress fracture in metatarsals: concerning two cases[67-70]
Fracture of the hip is the most serious complication of osteoporosis, not only due to the morbimortality it entails but due to the social-health costs which it generates . However, in spite of this enormous impact, in practice the identification and treatment of osteoporosis and the adequate monitoring of those who have suffered a hip fracture is highly irregular .
In Spain, the use of antiosteoporotic medication is, in general and in the primary care setting in particular, higher in the group of women with an average age of 65 years. However, it is much lower in those at ages with a greater propensity to hip fracture [3,4]. Furthermore, in spite of the fact that the therapeutic arsenal for osteoporosis has increased notably in the last decade, the use of antiresorptive or osteoforming drugs after a hip fracture occurs is low, and has even reduced in countries such as the US .
Use of bisphosphonates in postmenopausal women with rheumatoid arthritis; results of a multicentre study
Objective: The objective of this study was to analyse the use of bisphosphonates in women with rheumatoid arthritis (RA) in the Canary Islands.
Material and methods: This multicentre observational study included women aged 50 years or over. At a single visit, demographic variables and those relating to the RA, history of fragility fractures, use of corticoids, performance of bone densitometry (DXA) and current treatment with bisphosphonates were recorded. The simplified FRAX ® tool was used and the recommendations of the American College of Rheumatology (ACR) for the prophylaxis of osteoporosis with corticoids were applied.
Results: 192 women were included, with an average age of 62 years. A total of 91 (48%) patients were receiving corticoids; 17 of these (9%) had suffered a fracture; 123 (66%) had had a DXA; and 52 (28%) were taking bisphosphonates (70% of the patients with osteoporosis or fracture and 45% of those with criteria for prophylactic use of corticoids for osteoporosis). Those factors having a significant association with the use of bisphosphonates were age, duration of the disease, the HAQ functional capacity questionnaire, the risk of fracture determined by FRAX®, treatment with corticoids, history of fracture and the previous performance of DXA. In the multivariate study only the DXA (p=0.03) and history of fracture (p=0.02) were significantly associated.
Conclusions: In postmenopausal women from the Canary Islands with RA the prescription of bisphosphonates could conform better to the guidelines, especially in patients receiving treatment with corticoids.
Introduction: Treatment of osteoporosis is focussed on the prevention fragility fractures, fractures of the hip being those which produce the highest rates of morbidity and mortality. The existence of a previous fracture is an important predictor of a new fracture.
Objective: we intend to analyse how treatment for osteoporosis varies before and after a hip fracture.
Material and methods: Using the 4,126,030 clinical records in the database for pharmaco-epidemiological research in primary care (Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria [BIFAP] ) 2011 for the whole of Spain, information was obtained regarding patients who had a first hip fracture recorded between 2005-2011, having been monitored for at least a year before and after. We analyse the previous and subsequent treatment for osteoporosis (including calcium and vitamin D supplements).
Results: 2,763 patients over 60 years of age (average 81 years) had suffered a hip fracture, of whom 81.6% were women. Before the fracture 26.5% (95% confidence interval [CI]: 24.8-28.1%) had received some antiosteoporotic treatment, of which 12% (95% CI: 11.0-13.5%), were bisphosphonates. 38.6% (95%CI: 36.8-40.4%) received treatment after the fracture, 20.4% (95%: 18.9-22%) treated with bisphosphonates. The factors associated with the initiation of treatment after the fracture were being a woman, being younger and having a previous diagnosis of osteoporosis.
Conclusions: Most of the patients studied were not receiving preventative treatment before their hip fracture. After the fracture the prescription of treatment increased a little. The drugs most commonly added were calcium, vitamin D and bisphosphonates.
Gitelman syndrome is a tubulopathy of autosomal recessive inheritance which presents with, among other manifestations, hypomagnesemia and hypocalciuria. We present the case of a woman of 68 years of age who came for a consultation due to arthritis in the large joints, in the absence of other symptomology. The X-ray study showed deposits of calcium pyrophosphate in the knees, pubic symphysis and other joints. Blood tests revealed hypomagnesemia and hypocalciuria compatible with Gitelman syndrome, which was confirmed following a genetic study.
Stress fractures occur when a bone with normal elastic strength is subjected to higher loads than its mechanical strength. Although they may occur in any location they are more frequent in the metatarsals, these being the areas subject to greatest load. The clinical presentation for stress fractures is highly non-specific, which means that a detailed history is key to a suspected diagnosis. X-rays may be normal in the first stages, with gammagraphy and magnetic resonance being the gold standards for diagnosis in the initial stages. It is recommended that a study of possible underlying causes which may have contributed to the fracture is carried out. Generally the treatment is conservative, although in some cases, such as those occurring in the 5th metatarsal, surgical treatment may be necessary.
Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system whose etiology is unknown. Certain environmental factors, such as vitamin D, may have an influence on its pathogenesis, although the optimum threshold for vitamin D necessary to maximise its extraosseous benefits is not known. This article reviews, non-systematically, studies world-wide which relate vitamin D with MS. Overall, there are no significant differences between cases of MS and controls. In the case series, hypovitaminosis D with respect to values considered to be normal is seen in patients with MS, an observation which may also apply to healthy individuals. To be able to clarify the extent of the relationship between vitamin D and MS, further prospective studies are needed.