Sociedad Española de Investigacion Ósea y Metabolismo Mineral

Revista de Osteoporosis y Metabolismo Mineral

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Volume 14 · Number 1 · March 2022


Towards an individualised approach to management of osteoporosis

The treatment and management of osteoporosis, like any other disease, should be evidence-based in order to give the patients the best chance of limiting the consequences of the disease. Osteoporosis is a very common condition, affecting more women than men, and often overlooked and undertreated. The updated clinical practice guideline on postmenopausal, glucocorticoid induced, and male osteoporosis from the Spanish Society for Bone and Mineral Metabolism Investigation (SEIOMM) [1] is an important tool for clinicians with respect to diagnosis, future fracture risk assessment, and treatment of osteoporosis.
The diagnostic criteria are based on DXA and the presence of fractures, the criteria are not new, but the emphasis on recent fractures is new and worth noticing. A patient with a prior major osteoporotic fracture has a higher risk of fracture than a person at the same age without a fracture for up to 10 years following the first fracture, however, the risk in the 2 years immediately following the fracture is several times higher [2]. Therefore, the period following a fracture is a window of opportunity for prevention of the next fracture. The Fracture Liaison Service concept was developed to reduce the worldwide gap in fracture patients being assessed for osteoporosis.

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Executive summary clinical practice guideline of postmenopausal, glucocorticoid-induced, and male osteoporosis (2022 update)*. Spanish Society for Bone and Mineral Metabolism Investigation (SEIOMM)

Seven years have passed since the most recent version of the Osteoporosis Guidelines of the Spanish Society for Bone Research and Mineral Metabolism (SEIOMM) was drawn up, using the standard methodology of evidence‐based medicine [1]. This update incorporates information released since then. The full text is available in the Guide.

2. Methods
A group of experts (see annexe) reviewed each section to incorporate the new findings published in recent years. The new text was disseminated to other interested entities (including SEIOMM partners, patient associations, the Spanish Agency for Medicines and Health Products, and pharmaceutical industries) to provide input to the document, which was subsequently analysed by the group of experts. Osteoporosis in postmenopausal women was analysed first, followed by osteoporosis in men and glucocorticoid‐induced osteoporosis.

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Clinical practice guidelines for postmenopausal, glucocorticoid-induced and male osteoporosis: 2022 update. Spanish Society for Bone and Mineral Metabolism Research (SEIOMM)

Seven years have passed since the publication of the previous version of the Osteoporosis Guidelines of the Spanish Society for Bone Research and Mineral Metabolism (SEIOMM) that was created in accordance with the standard methodology of evidence‐based medicine [1]. This update incorporates the most essential information that has appeared since the publication of the previous version, with particular reference to new diagnostic procedures and therapeutic options. Novel diagnostic modalities discussed in these guidelines include the Trabecular Bone Score (TBS) and the detection of vertebral fractures by densitometry. Among the therapeutic options, we discuss the use of novel anabolic drugs (abaloparatide and romosozumab). Studies that compare the efficacy of various drug regimens for the treatment of severe osteoporosis are also considered. Likewise, the guidelines for action after the withdrawal of antiresorptive drugs and other sequential and combined treatment schemes are assessed.

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Differential inflammatory environment in patients with osteoporosis and type 2 diabetes mellitus

Diabetes mellitus (DM2) and osteoporosis are increasing prevalence diseases due to the aging of the population, and gender, genetic and environmental factors, such as an unbalanced diet, obesity and a sedentary life. DM2 increased alarmingly in 2014, affecting more than 420 million people worldwide [1]. Patients with DM2 present a higher risk of falls and increased prevalence and incidence of fragility fractures have been observed in these patients [2-5], causing significant mortality, morbidity and increased healthcare costs.
DM2 affects bone homeostasis [6,7], and is associated with a higher risk of fractures [8], despite the fact that patients exhibit higher bone mineral density (BMD) [4,9-12]. Furthermore, reduced circulating levels of bone turnover markers have been observed in DM2 [13], which should influence the high fracture risk in patients with DM2.

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25-OH-vitamin D and reversal of metabolic comorbidities associated with obesity after bariatric surgery

Obesity is a chronic metabolic disease with an increasing incidence that is associated with the development of multiple metabolic and mechanical comorbidities, it has also been associated with a higher incidence of tumors, a worse evolution of autoimmune diseases (SEEDO/WHO) [1,2] and a increase in all-cause mortality [3,4]. According to Spain’s Ministry of Health data, the prevalence of obesity in the adult population (25-65 years) is 14.5% (17.5% in women; 13.2% in men), with a parallel increase with people’s age (21.6% and 33.6% in women and men over 65 years of age, respectively). This situation is a public health challenge, not only because of its prevalence, but also due to the increase in morbidity and mortality, accelerated aging, the economic costs and associated social implications [5,6].
To date, intensive medical treatment and lifestyle modifications in obese patients have not shown a significant decrease in the development of complications during follow-up (10-20 years) [7-9]. In contrast, bariatric surgery (BS) is an intervention that entails significant weight loss (25-58% at 10 years), associated with a significant improvement in comorbidities directly and indirectly related to the disease [7,10]. Additionally, BS reduces the risk of mortality by 51% [10]. Different meta-analyzes suggest reductions in cardiovascular mortality (OR, 0.58, 95% CI, 0.46-0.73), all-cause mortality (OR: 0.70, 95% CI, 0.59-0 ,84) and increased life expectancy of up to 7 years in patients with underlying cardiovascular disease [11].

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Effect of a calcium-rich diet on mineral and bone metabolism in rats

The body’s main reservoir of calcium is bone, where about 99% of total calcium is stored in the form of hydroxyapatite. Thus, the calcium content present in extracellular fluids only represents a small fraction of total calcium.
In healthy individuals, the concentration of calcium in the blood varies between 8.6 and 10.4 mg/dl, with around 40% being bound to proteins and 6% to phosphate, citrate or bicarbonate salts. The metabolic activity of calcium is attributed to ionic calcium, which represents 54% of total calcium in the blood and is very precisely regulated so that plasma values remain in a range between 4.4 and 5.4 mg/dl (1.1-1.35 mM) [1].
With regard to bone health, the benefits of a diet rich in calcium on bone homeostasis are under debate [2]. Thus, for example, the calcium supplement has been commonly recommended for the maintenance of bone health and for preventing osteoporosis. Nevertheless, meta-analysis studies have shown that this calcium supplement does not always have a positive effect. In a general adult population, it has been observed that neither the supplement with vitamin D, calcium nor the combination of both are associated with a decrease in the risk of fracture [3]. Thus the controversy concerning the effectiveness of these supplements has increased. In the same sense, in a prospective longitudinal study carried out in Sweden in which the incidence of fractures and osteoporosis in adult women was studied over 19 years, calcium intake was estimated by means of a questionnaire, it concluded that a higher intake was not associated with a reduced risk of fracture or osteoporosis [4].

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Knowledge and clinical decisions of Colombian dentists about the risk of osteonecrosis of the jaws in patients receiving treatment for osteoporosis

Maxillary osteonecrosis (ONJ) is a rare severe adverse reaction to drugs used to treat osteoporosis and cancer, such as bisphosphonates and denosumab. This complication consists of the progressive destruction of the mandibular and/or maxillary bone, with exposure of the necrotic bone in the oral cavity, which occurs more frequently with the use of antiresorptive agents in cancer and multiple myeloma [1,2].
The risk of ONJ with bisphosphonates and denosumab in osteoporosis therapy is very low, close to 0.01%, as it is a low-dose and short-exposure therapy, unlike when they are used in cancer patients, with a risk of around 1.3% [3,4]. The prevalence of ONJ in patients receiving long-term oral bisphosphonate therapy was reported to be 0.1% (10 cases per 10,000), which increased to 0.21% (21 cases per 10,000) in patients older than 4 years. bisphosphonate exposure [5].
Although the risk of ONJ is very low with the use of bisphosphonates and denosumab in osteoporosis, dental professionals still perceive a high risk of presenting this complication. They frequently request authorization for dental procedures to the prescribing physician, leading to dental complications due to delays in carrying out the procedures or associated with the suspension of treatment for osteoporosis [6,7].

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