Revista de Osteoporosis y Metabolismo Mineral

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Author: Romm

What perception do Spanish doctors have of vitamin D?

Introduction

The last few years have seen a notable advance in the understanding of practically all the fields of study related vitamin D, which has resulted in it being considered to be a vitamin which is recognised as a steroid hormone [1-4].

Although vitamin D is classically related with bone mineral metabolism, its effects on practically the whole organism, the so-called “extra-bone” effects of vitamin D, are becoming increasingly better understood [2,3,5-8], and which have been reviewed in another article in this Monograph [9].

In the literature consulted we found scant reference to the opinions of Spanish doctors regarding different aspects of vitamin D in the Spanish population in general or in their patients, their views on desirable levels of vitamin D, and lastly, the dose they would recommend be administered. In this study we would like to make a first approximation of these data, which will allow us to understand what knowledge Spanish doctors have of vitamin D.

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Osteoporosis. Definition. Importance. Physiopathology and Clinical manifestations

There is no totally satisfactory definition of osteoporosis. In the 50s Fuller Albright defined it as: “too little bone”1, a concept which is incomplete, since it only captures the quantitative, and not the qualitative, aspect of the disease. Subsequently, in 1988 the American National Institute of Health (NIH) published its first definition, in which osteoporosis is referred to as “a condition in which the bone mass diminishes, increasing susceptibility of bones to suffer fractures”2. Nowadays, we accept as the definition of osteoporosis that published by the NIH in the year 2001, updating the earlier definition of 1988, which considered it to be “a disease of the whole skeleton characterised by a low bone mass and an alteration in the bone microarchitecture which causes fragile bone, the consequence of which is an increased risk of fractures.”3.
Although the current definition focuses on what is the fundamental problem in osteoporosis: the existence of greater bone fragility which results in an increase in the risk of suffering fractures, and integrates the loss of quantity (bone mass), with changes in the bone quality, the alterations in microarchitecture, this definition does not have a direct clinical application, because with it we cannot identify patients who suffer from the disease. Thus, in day to day care, the definition of osteoporosis most used is that based the finding of a densitometry with a T-score lower than -2.5, although this definition has the limitation of being based exclusively on quantitative criteria.

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Cost of postmenopausal osteoporosis

Osteoporosis (OP) is a common disease, responsible for a great number of the fractures occurring in people over 50 years of age. Through various pathogenic mechanisms a reduction in bone mass occurs, which is accompanied by an increase in bone fragility. Osteoporotic fractures in the vertebrae, the hip, the forearm and the humerus are the most frequent. They are a massive health problem due to their repercussions, not only on the health and quality of life of the patients, but also due to the economic and social costs of their treatment and aftercare.
Form a conceptual point of view, it is necessary to distinguish between OP as a clinical entity and densitometric OP. With respect to the former, this consists of a systematic bone disorder characterised by a deterioration in bone resistance which predisposes it to fracture, in the light of the fact that bone resistance is the result of an integration of bone density and bone quality [1]. The cause may have an influence on the loss of bone mass or on other elements, such as the bone’s microarchitecture, on which the quality of the tissue depends. On the other hand, the latter is an operative definition proposed by the working group of the World Health Organisation (WHO) meeting in 1992 [2]. This took into account a number of levels or cut-off points of bone mineral density (BMD) for postmenopausal white women. Thus, considered as normal are those values of BMD above -1 standard deviation (SD) in relation to the average for young adults (T-score > than -1); osteopenia corresponds to values of BMD between -1 and -2.5 SD (T-score between -1 and 2.5); OP, values of BMD lower than -2.5 SD (T-score lower than -2.5); and established OP, when in addition to the above conditions are combined with one or more osteoporotic fractures [2]. This definition is mainly useful as a epidemiological and diagnostic classification criterion, but should not be used in isolation, with other circumstances having to be taken into account such as age, rapidity of bone loss or the frequency of falls [2], since BMD only explains 70% of bone fragility [3].

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Summary Annual Congress of American Society for Bone and Mineral Research 2015. A subjective overview

Introduction
This past October 2015, the annual congress of the American Society for Bone and Mineral Research (ASBMR) was held in Seattle, USA.
Those in attendance observed a constant through all the conference sessions: research aimed at finding new interrelationships in bone mineral metabolism beyond the bone itself or to better understand the patho-physiology or obtain new therapeutic resources.
SEIOMM and the Journal of Osteoporosis and Mineral Metabolism consider it interesting to provide our readers with a personal overview of the proceedings with a summary of the issues that seem most relevant and representative of current research trends in bone metabolism, as I explain below.

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Osteoporosis. Definition. Epidemiology

Osteoporosis is a global health problem whose importance is going to increase with the aging of the population. It is defined as a systemic disorder of the skeleton characterised by low bone mass and deterioration of the microarchitecture of the bone tissue, with the consequent increase in bone fragility and the greater susceptibility to fractures1. Bone resistance reflects essentially the combination of bone density and bone quality. In turn, the concept of bone quality seeks to integrate all those factors apart from bone mass which determine bone fragility, including the microarchitecture, the degree of turnover, the accumulation of lesions or microfractures, or the degree of mineralisation1,2.
It is a process which is preventable and treatable, but which lacks warning signs prior to the appearance of fractures, leading to the fact of few patients being diagnosed at early stages and treated effectively. Therefore, in some studies it has been confirmed that 95% of patients who presented with a fracture did not have an earlier diagnosis of osteoporosis3.
In 1994 the World Health Organisation (WHO) established some definitions based on measurements of bone mass in the lumbar spine, hip or forearm of white postmenopausal women4. Thus, normal bone mass is considered to be having a bone mineral density (BMD) value higher than -1 standard deviation (SD) in relation to the average for young adults (T-score >-1); osteopenia, having BMD values between -1 and -2.5 SD (T-score between -1 and -2.5); osteoporosis, having BMD values lower than -2.5 SD (T-score lower than -2.5), and osteoporosis is established when, along with the above conditions, are associated one or more fragility fractures (Table 1). It is also possible to consider the Z-score in groups of patients such as children and young adults, which expresses the bone mass in comparison with that expected in those of equal age and sex5.

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Generic selectors
Solo mostrar coincidencias exactas
Buscar en títulos
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920191101-en
920211301-en
920211302-en
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
Reviews
SIBOMM News
Special Article
Special Documents

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