At a time when we have advanced enormously in the knowledge of the natural history of osteoporosis and of the drugs which we use in its treatment, it is necessary to identify those patients at greatest risk in order to focus on them diagnostic therapeutic resources before the final complication, the fracture, appears. This is especially important in the context of finite resources which should be located in the population which would most benefit from them. It is the case, also, that we now know more about the potential risks and limitations of some treatments – for example, the powerful anti-catabolics about which we lack data on their safety beyond 10 years of treatment, or the anabolics, which are considered to be indicated for a maximum of two years – for which reason we need to know at what moment in the natural history of the disease the global risk to the patient is sufficiently important to initiate appropriate treatment.Read More
In the last few years there has been a notable interest in vitamin D, not only due to its crucial importance in bone mineral metabolism, but also for its effects outside the bone, which, every day, are becoming better known.
Similarly, the existence of low blood levels of vitamin D, lower than what is desirable, has been found in different populations, both healthy and sick, and there is a discussion as to what would be the optimum levels of vitamin D in the blood.
For all these reasons, the Spanish Society of Bone and Mineral Metabolism Research (Sociedad Española de Investigación Ósea y Metabolismo Mineral – SEIOMM), jointly with all the scientific societies involved in the study of bone metabolism, have produced this position document on the requirements and optimum levels of vitamin D.
Material and method
The content of this document was developed in the following stages:
a) Meeting of a group of experts in osteoporosis to discuss and agree the relevant clinical questions related to vitamin D (Table1).
b) Creation of a systematic review team, formed by two experts in bone mineral metabolism who carried out the search, a standardised review, critical analysis and tabulation of the articles which had been published in Spanish and English between January 2000 and May 2010. The search was carried out using the MeSH (Medical Subject Headings) terms of the National Library of Medicine of the US National Institutes of Health, related to the topic. Using these terms, the following databases were consulted: PubMed, Medline Plus, Cochrane Library, Up to Date and OVID. Similarly, an ascending search was made of the previously published guides to clinical practice relevant to the topic, as well as articles suggested by the group of experts.
c) Those articles which provided the best level of evidence for each of the questions raised were included (Table 2).
d) Subsequently, following on from the results obtain in the search, a draft of the position document was put together by the group of clinical experts to respond to the questions previously formulated and to provide a consensus on recommendations, taking into account social, economic and health repercussions. In cases of disagreement, a majority opinion was formed, leaving the absence of unanimity on record.
Osteoporosis is a common disease, responsible for most of the fractures which occur after the age of 50 years. It is a worldwide health problem of great magnitude which increases with the aging and the lifestyles of the population, especially in Western countries. The main complication is fracture which carries with it a high health and social cost1. In spite of the fact that it is a preventable and treatable disease, to date, policies developed to deal with it so far have not managed to reduce the problem. Osteoporosis is defined as a general disorder of the skeleton characterised by low bone mass and deterioration in the microarchitecture of the bone tissue, which is translated into a diminution of bone resistance which predisposes it to fracture2. Bone resistance is made up of two components – bone density and bone quality. In turn, the concept of quality attempts to integrate all those factors, apart from bone mass, which contribute to bone fragility, and which include among others, the microarchitecture, the degree of bone turnover, the accumulation of lesions or microfractures and degree of mineralisation2,3.
According to the definition, the most significant clinical fact is fragility fracture. The absence of manifestations of osteoporosis without fracture make diagnosis difficult. Without methods of evaluating quality, or its components, the diagnosis is based on the confirmation of low bone mineral density (BMD). Thus, in 1994 the WHO agreed an operative definition based on levels or cut-off points of BMD for white postmenopausal women4. Thus, it was proposed that normal levels for BMD be set at a value higher than a -1 standard deviation (SD) in relation to the average for young adults (T-Score > -1); for osteopenia, values of BMD between -1 and -2.5 SD (T-Score between -1 and -2.5); for osteoporosis, values of BMD lower than -2.5 SD (T-Score lower than -2.5) and established osteoporosis, when, along with these conditions, are associated one or more osteoporotic fractures (Table 1). It has recently been recommended that these same cut-off points be used for osteoporosis in males5.
Several data support the concept that skeletal homeostasis, repair and adaptation to daily life depend on mechanically-induced signals that promote appropriate responses of bone cells. This review considers the cells that are responsive to mechanical signals within the bone environment, and the molecular mechanisms involved in mechanotransduction, the process by which cells convert mechanical stimuli in biochemical signals and subsequently modify biological activity. Understanding the cellular and molecular mechanisms underlying bone responses to mechanical loads will positively impact current knowledge on basic bone biology and pathophysiology and will likely contribute to the development of new interventions to improve bone strength.Read More
Since it was discovered by McCollum in 1922 how vitamin D was involved in bone mineralisation and was responsible for rickets , much new knowledge has come to light. From being a vitamin it has become considered to be a hormone , and with parathormone and calcitonin makes up the calciotropic hormone group. Its important role in the homeostasis of calcium and its direct action on bone tissue have made it the object of continual research in the study of mineral metabolism.
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