Revista de Osteoporosis y Metabolismo Mineral

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Category: English

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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Hypercalcemia in patients with rheumatoid arthritis: a retrospective study

Hypercalcemia is a relatively common clinical problem and a frequent laboratory finding, both in hospital and out-of-hospital practice. Calcium ions play a critical role in many cellular functions. Parathyroid hormone (PTH) and vitamin D are the most important hormones for regulating calcium. The main sources of serum calcium are intestinal absorption, stimulated by active vitamin D metabolites, and bone resorption, usually stimulated by PTH. Therefore, hypercalcemia can be classified as PTH-dependent (due to increased secretion of PTH by the parathyroid glands) and independent of PTH. The latter cases are attributable to increased bone resorption and/or increased intestinal absorption of calcium, induced by factors other than PTH. Among them, PTH-related protein (PTHrP) and locally produced cytokines are factors that often cause hypercalcemia in cancer patients [1]. Unregulated extrarenal synthesis of 1,25-dihydroxyvitamin D can also cause hypercalcemia, particularly in patients with chronic granulomatous disorders and in some patients with lymphoma [2].

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Association of biochemical parameters of bone metabolism with progression and/or development of new aortic calcifications

Atherosclerosis, arteriosclerosis, vascular calcification and osteoporosis are common age-related disorders associated with high morbidity and mortality [1,2]. Due to the increased life expectancy in the Spanish population, these disorders are expected to become more and more frequent in the coming decades. Although recent work has been carried out on the development of non-invasive techniques for the early detection of vascular calcifications, such as pulse wave velocity and non-contrast carotid ultrasound, serum biochemical parameters continue to be the most widely used option for monitoring patients with bone metabolic disorders [3-5].

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Search for variants of the LRP4 gene in women with high bone mass and in patients with Chiari type I malformation

The Wnt signalling pathway is involved in a wide range of processes, including bone development and homeostasis [1]. In accordance with this, mutations have been identified in various components of the Wnt pathway that cause different musculoskeletal diseases [2]. The canonical Wnt pathway begins with the formation of a heterotrimeric complex between a co-receptor, LRP5/6, a ligand, WNT, and a receptor, FZD, which produces an accumulation of β-catenin that, once in the nucleus will activate the transcription of numerous important target genes for bone [1]. This activation is finely regulated by a series of extracellular inhibitors such as DKK1 and sclerostin that bind to LRP5/6, preventing the formation of the heterotrimeric complex. For DKK1 and sclerostin to exert their inhibitory activity, they must form another heterotrimeric complex with LRP5 and KREMEN1/2 or LRP4, respectively. Although in the case of DKK1 the presence of KREMEN does not seem to be necessary to carry out a correct inhibition, the presence of LRP4 is essential for the inhibitory function of sclerostin [3,4].

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The cut-out phenomenon in intertrochanteric femur fracture: analysis using a finite element model

Proximal extremity fractures of the femur are a very common problem in today’s society and of great importance as there has been an increased incidence in the population. This increase is explained by the longer life expectancy in recent years, thus increasing the elderly population and, therefore, related diseases. This is particularly relevant in Spain which has, of late, seen a severe aging of the population [1].
Several epidemiological studies describe the incidence of hip fracture in Spain. In most cases these are local studies and carried out over short periods of time. National studies have been carried out, although to a lesser extent [2]. According to the Ministry of Health and Social Policy’s 2010 report “Hip fracture care in the hospitals of the National Health System” [3], a total of 487,973 cases of fracture were recorded between 1997 and 2008. In these figures and in those carried out in various local studies2, a predominance of cases in the female sex and an increase in the incidence in age over the years has been found.

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Pathophysiology of osteoporosis in chronic inflammatory joint diseases

Chronic inflammation is a nonspecific response against aggressor agents mediated by the body’s immune system. In such a scenario, an infiltrate of predominantly mononuclear cells, such as lymphocytes, macrophages and plasma cells, is produced. Under certain conditions or when the aggressor agent persists, a sustainable accumulation and activation of immune cells occurs. Then, the secretion of cytokines, agents that prolong the life of lymphocytes and macrophages, is increased, what leads to chronic inflammation.
Inflammation is the main mechanism involved in bone destruction in chronic inflammatory diseases (CIDs) [1], such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), multiple sclerosis and/or inflammatory bowel disease (IBD). These diseases show a chronic systemic inflammation that can affect different organs, caused by an alteration of the immune system [2].

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Unusual case of bone proliferation: Nora’s lesion

We present the case of a 43-year-old man who presents pain and functional impotence in the left wrist of one year of evolution. Upon examination, an indurated tumor adhered to deep planes is found in this location. Following findings on computerized axial tomography (CT) of images consistent with osteochondroma versus peripheral chondrosarcoma (Figure 1), a bone scan was requested. This bone scintigraphic study in three phases of the upper limbs and a subsequent full-body image (Figure 2), showed the early arrival of the tracer with an increase in the vascular pool of slight-moderate intensity in the distal portion of the left radius (arrow), which persisted with greater intensity in late images. No other diseased findings were observed in the rest of the skeleton. These findings revealed increased vascularity and osteoblastic activity at the distal end of the left radius.
A biopsy was carry out, with a pathological result of osteochondromatous proliferation compatible with Nora’s lesion, confirming this diagnosis after surgical resection.

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Care profile of susceptible patients with osteoporosis by telemedicine visits in the post-COVID-19 era

Osteoporotic fractures represent a growing public health problem worldwide. At present, we lack adequate procedures for prevention, diagnosis, assessment, intervention and patient follow-up.
New technologies have provided new communication tools and have changed our mentality, with the possibility of carrying out, virtually, actions or procedures in our daily lives that until now required our physical presence, either for technical, cultural or social reasons [1].
The COVID-19 pandemic, caused by the SARS-COV-2 virus, has triggered a global public health emergency with rapid evolution and tragic consequences. The fight against this disease is forcing to modify the forms of care, which includes transforming some face-to-face consultations into remote ones [2].
Prior to the COVID-19 pandemic, telemedicine, in its different forms, was used in exceptional situations. One of the first uses was the tele-nursing practice that emerged in the UK and Canada at a primary care level.

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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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Comparison of the femur proximal extremity’s densitometric values in young and healthy study participants: left-handed vs. right-handed

Dual-energy X-ray absorptiometry, commonly known as bone densitometry [1], is a technic broadly used in daily clinical practice and is considered the gold standard to estimate the bone mineral density (BMD) [1-4]. When performing a densitometry, the values obtained, usually in the lumbar spine and in the proximal extremity of the femur, are compared with the reference values for the population of each country, so the T-score and Z-score values can be calculated [3-5]. By consensus, the World Health Organization recommended the osteoporosis densitometric diagnosis to be carried out in the presence of a T-score value lower than -2.5 of the typical deviation of the peak BMD [2]. Although this criterion has been a topic for controversy, it has also become a world reference that has allowed the homogenisation of the randomized trials, among other advantages [1-6].

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Fracture risk predictors of a postmenopausal female population by binary statistical procedure CART

The osteoporosis is an illness linked to a high morbimortality that increases as the population grows older. It has been defined as a systemic skeletal disease characterized by a deterioration of bone micro-architecture and a decrease of bone tissue, with a consequent increase in bone fragility and a higher susceptibility to fracture [1]. It is a clinically silent disease that is not manifested by other signs but for its complications, fractures.
The main consequences of osteoporosis are fragility fractures that can appear in different locations, though they typically happen on the vertebrae, distal radius and proximal extremity of the femur [2,3]. They are fractures with a high economic cost and are associated with a higher morbimortality, specifically those on the vertebrae and the proximal femur. Hip fracture mortality, the most serious manifestation of osteoporosis, is 8% during the first month after the fracture (acute mortality). It rises to 30% after a year [4]. Furthermore, the recovery of patients who do not pass away is poor. Only 30% of patients suffering a hip fracture return to the baseline situation [5]. The vertebral fracture shows a higher incidence than the hip fracture. While the hip fracture shows a yearly incidence of 1.3-1.9 cases/1,000 inhabitants/year, the incidence of vertebral fractures is 13.6/1,000 inhabitants/year in males and 29.3/1,000 inhabitants/year in females [2]. Although its mortality is lower than that of hip fracture, it is not despicable, especially in patients also presenting a respiratory disease [6,7]. Therefore treatments are designed to prevent its appearance through adequate therapeutic measures. In order to establish the most appropriate treatment it is necessary to dispose of stand-alone diagnostic factors that help identify the every patient’s individual risk through additional tests or risk scales.

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Evaluation of bone mineral density and 3D-Shaper parameters in congenital hypophosphatasia of the adult

Hypophosphatasia (HPP) is a rare metabolic disease characterized by low enzymatic activity of non-tissue-specific alkaline phosphatase (TNSALP), which causes an accumulation of its natural substrates: inorganic pyrophosphate (PPi), pyridoxal-5′-phosphate (PLP) and phosphoethanolamine (PEA) [1]. PPi acts as a potent inhibitor of hydroxyapatite crystal formation and its high extracellular levels can induce skeletal alterations, such as decreased bone mineralization [2,3]. In general, the more severe forms are associated with earlier symptoms and diagnosis, even perinatal, while the milder forms often present later in childhood or adulthood [4]. The importance of an early diagnosis lies in the potential severity of the disease and the alteration of the quality of life, as well as in the possible iatrogenesis derived from a wrong diagnosis and treatment [5]. Previous studies have analyzed the symptoms that characterize adult HPP, which usually shows a wide range of clinical manifestations, sometimes nonspecific, such as the presence of musculoskeletal pain, weakness, dental pathology or early loss of teeth, and the presence of of recurrent stress fractures and pseudofractures [6,7]. In a pediatric age cohort, the analysis of bone mineral density (BMD) in these patients has detected low values in the most severe cases [8].

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English
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