Revista de Osteoporosis y Metabolismo Mineral

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The Journal follows the Uniform Requirements standards Manuscripts Submitted to Biomedical for Journals www.icmje.org

The Journal embraces the principles and procedures dictated by the Committee on Publication Ethics (COPE) www.publicationethics.org

Category: Editorial

Farewell

The Journal of Osteoporosis and Mineral Metabolism (ROMM) was created at the end of 2009 and was presented at the Congress of the Spanish Society for Bone Research (SEIOMM) that year, held in Santander. We have participated from the beginning, both in its creation, start-up and later development, until today. It is the SEIOMM associates who should assess our management. For our part, we believe that a cycle has been completed and that the renewal of the management team is appropriate. For this reason and through this editorial, we say farewell, thanking all those who have trusted and collaborated with us: boards of directors, members of the editorial committee and associates, some who have submitted articles and others who have served as reviewers. A special thanks to our collaborators on a day-to-day basis: Jesús and Concha, publishers of Ibáñez y Plaza; Gabriel Plaza, responsible for the website; and David Shea, translator of the journal, with whom it has always been so easy to work, and who with professionalism and dedication have contributed enormously to make this journal where it is right now. Thank you all.

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Hypercalcemia and autoimmune diseases

Hypercalcemia is a very common water-electrolyte imbalance found in daily clinical practice. It is defined as the presence of a serum calcium concentration greater than 2 standard deviations from the mean laboratory value, which is usually 10.6 mg/dL [1].
From the pathophysiological point of view, high levels of calcium in the blood increase the difference in electrical potential between cell membranes, which increases the depolarization threshold. Clinically, hypercalcemia may present a very wide spectrum that can range from a certain muscle weakness to depression and even coma and death, and this depends on several factors such as the severity of hypercalcemia, the speed of its onset and other circumstances specific to the patient, such as age, comorbidity and medication received [1]. Therefore, it is not surprising that two patients with the same high serum calcium values present completely different symptoms.

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Are femoral bone mass measurements symmetrical?

This issue of the journal offers an interesting article on possible differences in femur densitometry related to the dominance of the upper extremities between left and right handed [1].
Dual-energy X-ray absorptiometry (DXA) is based on the measurement of areal bone mineral density centimeter (BMD, g/cm2) in the proximal femur and lumbar spine. Conditions such as osteoarthritis or osteophytic calcifications influence spinal BMD and confer a great value to femoral measurement. Since the DXA technique began being used on the hips, the presumption that there may be a minimal bilateral asymmetry between the proximal femurs has been maintained, but with no clinical relevance. Several research groups have studied this question. It has not been established whether there are systematic differences between the BMD of both hips, and in order to answer the questions: is the bone density in one of the femurs similar to same in the opposite side? which of them to choose?

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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.

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Methodology to improve the efficiency in the migration and detection of mesenchymal stem cells in murine models

Osteoporosis is a generalised disease of the skeletal system characterised by an imbalance between the bone formation and resorption that leads to bone mass loss and to the deterioration of the microarchitecture of the bone tissue, compromising bone resistance and therefore resulting in a higher bone fragility and an increased susceptibility to fractures [1].
Two stem cells coexist in the bone cavity (bone marrow): the hematopoietic stem cell, which generates all the blood and immune system cells, and the mesenchymal stem cell, responsible for the formation of the skeleton. Osteoblasts or bone-forming cells originate from the differentiation of mesenchymal stem cells. These pluripotent cells can create a wide variety of cell types such as osteoblasts, adipocytes, or chondrocytes [2-4]. This characteristic makes them highly interesting candidates for regenerative medicine given their ability to migrate to injured areas to promote the de novo generation of bone [5].

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Bone protection during breast cancer treatment

Few medical areas have changed as much through the last decades as the treatment of breast cancer (BC). From Halsted’s theory of the progression of an initially local disease, with a first loco-regional and then metastatic extension, to the most recent studies in molecular biology that identify the gene personality of each tumor, there have been many advances. Old TNM classification originally designed for solid tumors have been abandoned and all areas related to hormonal dependence and gene expression of each tumor have grown in importance. All this is aimed at better facing a global therapeutic approach.
Almost 20 years ago, an important biological research laboratory provided us with a detailed study of the basal estradiol levels of the patients in the placebo group of the MORE study [1]. An increased risk of breast cancer associated with raised serum estradiol levels was demonstrated, confirming the previous results on the hormonal dependence of this neoplasm. With the introduction of chemotherapy (QMT) in the final decade of the last century, the general mortality of women from breast cancer was reduced in all western countries. At the time, and just a few years later, the implementation of massive early detection programs at the population level facilitated an increase in the diagnosis of tumors in early stages.

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About air pollution and hip fracture

Raised levels of air pollution have recently been been linked to the induction of inflammatory phenomena at both systemic and tissue levels. Chronic inflammatory diseases, such as rheumatoid arthritis or chronic obstructive pulmonary disease, reduce bone mineral density (BMD), which leads to an increase in the release of immune cells from the bone marrow. Particulate matter is associated with oxidative damage and inflammation, which can accelerate bone loss and increase the risk of fractures in older adults. However, the association between air pollution and osteoporosis is not yet well defined in the literature.
It seems that there are other indirect routes, such as vitamin D and PTH, which may also be altered by contamination and are involved in bone remodeling [1-8]. In the first place, air pollution (microparticles and ozone) presents a physical barrier to ultraviolet B solar radiation, thus contributing to a lower cutaneous production of vitamin D [2,4,5]. Similarly, a study conducted in the United States [9] indicated the relationship between low levels of PTH in blood and elevated levels of microparticles and carbon in the air, causing indirect harmful effects on bone mass.

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Osteonecrosis of the jaw: lights and shadows in the knowledge of its pathophysiology

Osteonecrosis of the jaw (ONJ) was described by Marx et al.[1] in 2005. In the following years, both isolated cases and series of patients were published which, over the years, was decreasing, on the one hand, due to the saturation of the journals and the low interest that the description of new cases may cause. Furthermore, knowledge of this disease has lead to the development of preventive measures that may have diminished its incidence.
Regarding ONJ, a whole range of “fears, risks and dangers” have been developed that are largely unjustified. ONJ was indicated as a complication of prolonged bisphosphonate treatment and in this sense it was equalized to the diaphyseal fractures[2], when both processes most certainly have different etiopathogenic mechanisms[3]. Fears concerning ONJ or diaphyseal fractures developed a whole doctrine about the need to suspend treatment with bisphosphonates or denosumab, the so-called “therapeutic vacations” that in reality what it was about was simply to suspend the antiresorptive treatment, before that the possible complications of its use appear[4-6]. This is especially common in the field of dentists, who, in many cases, concerned about the possible development of an ONJ do not perform virtually any dental intervention in patients receiving bisphosphonates or denosumab. With this, what has been observed is an increase in the abandonment of treatment with antiresorptive drugs which produces an increased risk of fragility fractures after discontinuation of bisphosphonate therapy, a risk that has an extreme severity in the case of suspension of denosumab treatment, with the appearance of multiple vertebral fractures[7-11].

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Vitamin D and muscle function

In 1922, at Johns Hopkins University in Baltimore, Professor McCollum discovered a factor, which has since been referred to as vitamin D, following the alphabetical order of the other vitamins identified up to that time. It is capable of curing rickets in children and osteomalacia in adults. Diseases in which, as we know from the first scientific descriptions published in London in the mid-seventeenth century, muscle involvement consisting of weakness and generalized hypotonia is associated with bone involvement, its main characteristic. Therefore, since the discovery of vitamin D, it has been associated not only with bone health but also with muscle health [1]. Paradoxically, at present, there is no consensus on the potential beneficial effects of vitamin D supplementation on muscle function, balance and risk of falls, a situation highlighted in the last meta-analysis published by Bolland et al. [2], who review in 81 randomized clinical trials (RCTs) that include 53,537 participants the effect of vitamin D on fractures and falls as a primary outcome. The pooled analyses showed that vitamin D supplementation had no effect on falls (37 RCTs, n=34,144, RR=0.97, 95% confidence interval -0.93 to 1.02), what the authors concluded that “vitamin D supplementation does not exert significant effects in falls”, affirming that “potential future trials will probably not alter those conclusions, and that, therefore, there is little justification for the use of vitamin D supplements.

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Atypical femoral fractures: a rare complication possibly due to the accumulation of rare genetic variants

Antiresorptive drugs, such as bisphosphonates and denosumab, are very effective in reducing the risk of vertebral and non-vertebral fractures in patients with osteoporosis. They can be administered conveniently, are generally well tolerated and the side effects are mild and infrequent. Occasionally, however, some patients may present complications peculiar to the treatment, such as atypical femoral fractures (FFA) and maxillary osteonecrosis. These complications occur very rarely, but are potentially serious and difficult to manage, so they are a source of concern for some doctors and many patients. This fear seems to have a negative influence, although not justified, on therapeutic compliance. Therefore, it would be extremely useful to identify the rare patients who are at risk of developing these complications.

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Brief Original
Clinical Notes
Committees
Editorial
English
Index of Authors
Index of Communications
Letter to the Director
Letter to the Editor
Oral Communications
Original Articles
Osteology images
Position Paper
Poster Communications
Presentation
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