Adolfo Díez-Pérez

Instituto de Salud Carlos III, Madrid, Madrid, Spain

Are you Adolfo Díez-Pérez?

Claim your profile

Publications (186)772.59 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The only bone anabolic agent currently available for osteoporosis treatment is parathyroid hormone (PTH)-either its N-terminal 1-34 fragment or the whole molecule of 1-84 aminoacids-whose intermittent administration stimulates new bone formation by targeting osteoblastogenesis and osteoblast survival. PTH-related protein (PTHrP) is an abundant factor in bone which shows N-terminal homology with PTH and thus exhibits high affinity for the same PTH type 1 receptor in osteoblasts. Therefore, it is not surprising that intermittently administered N-terminal PTHrP peptides induce bone anabolism in animals and humans. Furthermore, the C-terminal region of PTHrP also elicits osteogenic features in vitro in osteoblastic cells and in various animal models of osteoporosis. In this review, we discuss the current concepts about the cellular and molecular mechanisms whereby PTHrP may induce anabolic actions in bone. Pre-clinical studies and clinical data using N-terminal PTHrP analogs are also summarized, pointing to PTHrP as a promising alternative to current bone anabolic therapies.
    Calcified Tissue International 08/2015; DOI:10.1007/s00223-015-0050-1 · 3.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although a number of reports suggest very low persistence with oral bisphosphonates, there is limited data on persistence with other anti-osteoporosis medications. We compare rates of early discontinuation (in the first year) with all available outpatient anti-osteoporosis drugs in Catalonia, Spain. We conducted a population-based retrospective cohort study using data from the SIDIAP database. SIDIAP contains computerized primary care records and pharmacy dispensing data for >80 % of the population of Catalonia (>5 million people). All SIDIAP participants starting an anti-osteoporosis drug between 1/1/2007 and 30/06/2011 (with 2 years wash-out) were included. We modelled persistence as the time between first prescription and therapy discontinuation (refill gap of at least 6 months) using Fine and Gray survival models with competing risk for death. We identified 127,722 patients who started any anti-osteoporosis drug in the study period. The most commonly prescribed drug was weekly alendronate (N = 55,399). 1-Year persistence ranges from 40 % with monthly risedronate to 7.7 % with daily risedronate, and discontinuation was very common [from 49.5 % (monthly risedronate) to 84.4 % (daily risedronate)] as was also switching in the first year of therapy [from 2.8 % (weekly alendronate) to 10 % (daily alendronate)]. Multivariable-adjusted models showed that only monthly risedronate had better one-year persistence than weekly alendronate and teriparatide equivalent, whilst all other therapies had worse persistence. Early discontinuation with available anti-osteoporosis oral drugs is very common. Monthly risedronate, weekly alendronate, and daily teriparatide are the drugs with the best persistence, whilst daily oral drugs have 40-60 % higher first-year discontinuation rates compared to weekly alendronate.
    Calcified Tissue International 07/2015; DOI:10.1007/s00223-015-0040-3 · 3.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Oral bisphosphonates (BPs) are highly effective in preventing fractures and are recommended first-line therapies for patients with osteoporosis. We identified the incidence and predictors of oral BP treatment failure, defined as the incidence of ≥2 fractures while on treatment (≥2 FWOT) among users with high adherence. Fractures were considered after six months from treatment initiation and up to six months after discontinuation. Data from computerized records and pharmacy invoices were obtained from Sistema d'Informació per al Desenvolupament de l'Investigació en Atenció Primària (SIDIAP) (Catalonia, Spain) and Danish Health Registries (Denmark) for all incident users of oral BPs in 2006-2007 and 2000-2001 respectively. Fine and Gray survival models using backward-stepwise selection (p-entry 0.049; p-exit 0.10) and accounting for the competing risk of therapy cessation were used to identify predictors of ≥2 FWOT among patients having persisted with treatment ≥6months with overall medication possession ratio (MPR) ≥80%. Incidence of ≥2 FWOT was 2.4 (95% Confidence Interval (CI): 1.8-3.2) and 1.7 (95% CI: 1.2-2.2) per 1000 Person Years (PYs) within Catalonia and Denmark respectively. Older age was predictive of ≥2FWOT in both Catalonian and Danish cohorts: subhazard ratio (SHR) = 2.28 (95% CI: 1.11-4.68) and SHR = 2.61 (95% CI: 0.98-6.95) respectively for 65 to <80 years and SHR = 3.19 (95% CI: 1.33-7.69) and SHR = 4.88 (95% CI: 1.74-13.7) respectively for ≥80 years. Further significant predictors of ≥2 FWOT identified within only one cohort were dementia, SHR = 4.46 (95% CI: 1.02-19.4) (SIDIAP) and history of recent or older fracture, SHR = 3.40 (95% CI: 1.50-7.68) and SHR = 2.08 (95% CI: 1.04-4.15) respectively (Denmark). Even among highly adherent users of oral BP therapy, a minority sustain multiple fractures while on treatment. Older age was predictive of increased risk within both study populations, as was history of recent/old fracture and dementia within one but not both populations. Additional and/or alternative strategies should be investigated for these patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 07/2015; DOI:10.1002/jbmr.2595 · 6.83 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aromatase inhibitors (AIs) used as adjuvant therapy in postmenopausal women with hormone receptor-positive breast cancer cause diverse musculoskeletal side effects that include bone loss and its associated fracture. About half of the 391 patients treated with AIs in the B-ABLE cohort suffered a significant bone loss at lumbar spine (LS) and/or femoral neck (FN) after 2 years on AI-treatment. In contrast, up to one third (19.6% LS, 38.6% FN) showed no decline or even increased bone density. The present study aimed to determine the genetic basis for this variability. SNPs in candidate genes involved in vitamin D and estrogen hormone-response pathways (CYP11A1, CYP17A1, HSD3B2, HSD17B3, CYP19A1, CYP2C19, CYP2C9, ESR1, DHCR7, GC, CYP2R1, CYP27B1, VDR and CYP24A1) were genotyped for association analysis with AI-related bone loss (AIBL). After multiple testing correction, 3 tag-SNPs (rs4077581, s11632698 and rs900798) located in the CYP11A1 gene were significantly associated (p<0.005) with FN AIBL at 2 years of treatment. Next, CYP11A1 expression in human fresh bone tissue and primary osteoblasts was demonstrated by RT-PCR. Both common isoforms of human cholesterol side-chain cleavage enzyme (encoded by CYP11A1 gene) were detected in osteoblasts by western blot. In conclusion, the genetic association of CYP11A1 gene with AIBL and its expression in bone tissue reveals a potential local function of this enzyme in bone metabolism regulation, offering a new vision of the steroidogenic ability of this tissue and new understanding of aromatase inhibitor-induced bone loss.
    Journal of Molecular Endocrinology 06/2015; 55(1). DOI:10.1530/JME-15-0079 · 3.08 Impact Factor
  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):166.3-167. DOI:10.1136/annrheumdis-2015-eular.2291 · 10.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the association between socio-economic status (SES) and risk of hand, hip or knee osteoarthritis at a population level. Retrospective ecological study using the SIDIAP database (primary care anonymized records for > 5 million people in Catalonia (Spain)). Urban residents > 15 years old (2009-2012) were eligible. Validated area-based SES deprivation index MEDEA (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) was estimated for each area based on census data as well as incident diagnoses (ICD-10 codes) of hand, hip or knee osteoarthritis (2009-2012). Zero-inflated Poisson models were fitted to study the association between MEDEA quintiles and the outcomes. Compared to the least deprived, the most deprived areas were younger (43.29 (17.59) versus 46.83 (18.49), years (Mean SD), had fewer women (49.1% versus 54.8 %), a higher percentage of obese (16.2 % versus 8.4 %), smokers (16.9 % versus 11.9%) and high-risk alcohol consumption subjects (1.5% versus 1.3 %). Compared to the least deprived, the most deprived areas had an excess risk of osteoarthritis: age-sex-adjusted IRR 1.26 (1.11-1.42) for hand, 1.23 (1.17-1.29) hip, and 1.51 (1.45-1.57) knee. Adjustment for obesity attenuated this association: 1.06 (0.93 -1.20), 1.04 (0.99-1.09), and 1.23 (1.19-1.28) respectively. Deprived areas have higher rates osteoarthritis (hand, hip, knee). Their increased prevalence of obesity accounts for a 50% of the excess risk of knee osteoarthritis observed. Public health interventions to reduce the prevalence of obesity in this population could reduce health inequalities. Copyright © 2015. Published by Elsevier Ltd.
    Osteoarthritis and Cartilage 03/2015; 23(8). DOI:10.1016/j.joca.2015.03.020 · 4.17 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Glucocorticoids, widely used in inflammatory disorders, rapidly increase bone fragility and, therefore, fracture risk. However, common bone densitometry measurements are not sensitive enough to detect these changes. Moreover, densitometry only partially recognizes treatment-induced fracture reductions in osteoporosis. Here, we tested whether the reference point indentation, technique could detect bone tissue properties changes early after glucocorticoid treatment initiation. After initial laboratory and bone density measurements, patients were allocated into groups receiving calcium + vitamin D (Ca + D) supplements or anti-osteoporotic drugs (risedronate, denosumab, teriparatide). Reference point indentation was performed on the cortical bone layer of the tibia by a handheld device measuring Bone Material Strength index (BMSi). Bone mineral density was measured by dual-energy x-ray absorptiometry (DXA). While Ca + D-treated patients exhibited substantial and significant deterioration, risedronate-treated patients exhibited no significant change, and both denosumab- and teriparatide-treated participants exhibited significantly improved BMSi 7 weeks after initial treatment compared to baseline; these trends remained stable for 20 weeks. In contrast, no densitometry changes were observed during this study period. In conclusion, our study is the first to demonstrate that reference point indentation is sensitive enough to reflect changes in cortical bone indentation following treatment with osteoporosis therapies in patients newly exposed to glucocorticoids. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 03/2015; 30(9). DOI:10.1002/jbmr.2497 · 6.83 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Many studies have shown a correlation between chronic kidney disease (CKD) and fracture. However, an increased mortality in CKD patients is a competing risk scenario, not accounted for in previously. Our aim was to investigate the true impact of CKD on hip fracture after accounting for a competing risk with death. We conducted a population-based cohort study to determine the impact of CKD on hip fractures in individuals aged ≥50years old registered in SIDIAP(Q) database (representative 1.9 million people in Catalonia, Spain). Cox regression was used to estimate Hazard Ratio (HR) for death and hip fracture according to CKD status. A competing risk (Fine and Gray) model was fitted to estimate sub-HR for hip fracture in CKD or CKD-free patients accounting for differential mortality. 873,073 (32,934 (3.8%) CKD) patients were observed for 3years. 4,823 (14.6%) CKD and 36,328 (4.3%) CKD-free participants died during follow-up (HR 1.83 [95%CI 1.78-1.89]), whilst 522 (1.59%) and 6,292 (0.75%) sustained a hip fracture respectively. Adjusted Cox models showed a significantly increased risk of hip fractures for CKD group (HR 1.16 [1.06-1.27]), but this association was attenuated in competing risk models accounting for mortality (SHR 1.14 [1.03-1.27]). Both death and hip fracture rates are increased (by 83% and 16% respectively) in CKD patients. However, the association between CKD and hip fractures is attenuated when an excess mortality is taken into account. A competing risk with death must be considered in future analyses of association between CKD and any health outcomes. Copyright © 2014. Published by Elsevier Inc.
    Bone 12/2014; 73. DOI:10.1016/j.bone.2014.12.020 · 3.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the association between socio-economic deprivation (SES) and hip fracture risk. Retrospective cohort study using a population-based database (primary care records) of over 5 million people. Eligibility: all living subjects registered during the period 2009-2012 and resident in an urban area. Measures: a validated SES composite index (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) estimated for each area based on census data. Outcome: incident hip fracture rates as coded in medical records using ICD-10 codes. Statistics: zero-inflated Poisson models fitted to study the association between SES quintiles and hip fracture risk, adjusted for age, sex, obesity, smoking and alcohol consumption. Compared to the most deprived, wealthy areas had a higher hip fracture incidence (age-sex adjusted incidence 38.57 (37.14-40.00) compared to 34.33 (32.90-35.76) per 10,000 person-years). Similarly, most deprived areas had a crude and age-sex adjusted lower risk of hip fracture, RR of 0.71 (0.65-0.78) and RR of 0.90 (0.85-0.95) respectively compared to wealthiest areas. The association was attenuated and no longer significant after adjustment for obesity: RR 0.96 (0.90-1.01). Further adjustment for smoking and high alcohol consumption did not make a difference. Wealthiest areas have an almost 30% increased risk of hip fracture compared to the most deprived. Differences in age-sex composition and a higher prevalence of obesity in deprived areas could explain this higher risk. Copyright © 2014. Published by Elsevier Inc.
    Bone 12/2014; 73. DOI:10.1016/j.bone.2014.12.019 · 3.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Context. Several fracture prediction models that combine fractures at different sites into a composite outcome are in current use. However, to the extent individual fracture sites have differing risk factor profiles, model discrimination is impaired. Objective. To improve model discrimination by developing a 5-yr composite fracture prediction model for fracture sites that display similar risk profiles. Design. Prospective, observational cohort study. Setting. Primary care practices in 10 countries. Patients. Women aged ≥55 years. Intervention. Self-administered questionnaires collected data on patient characteristics, fracture risk factors and previous fractures. Main Outcome Measure. Main outcome is time to first clinical fracture of hip, pelvis, upper leg, clavicle, or spine, each of which exhibits a strong association with advanced age. Results. Of four composite fracture models considered, model discrimination (c index) is highest for an age-related fracture model (c index 0.75, 47,066 women), and lowest for FRAX major fracture and a 10-site model (c indices 0.67 and 0.65). The unadjusted increase in fracture risk for an additional 10 yr of age ranges from 80% to 180% for the individual bones in the age-associated model. Five other fracture sites not considered for the age-associated model (upper arm/shoulder, rib, wrist, lower leg, and ankle) have age associations for an additional 10 yr of age from a 10% decrease to a 60% increase. Conclusions. After examining results for 10 different bone fracture sites, advanced age appeared the single best possibility for uniting several different sites, resulting in an empirically based composite fracture risk model.
    The Journal of Clinical Endocrinology and Metabolism 12/2014; 99(3):jc20133468. DOI:10.1210/jc.2013-3468 · 6.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Summary There is scarce data on the association between early stages of type 2 diabetes and fracture risk. We report a 20 % excess risk of hip fracture in the first years following disease onset compared to matched non-diabetic patients. Introduction Type 2 diabetes mellitus (T2DM) is a chronic disease that affects several target organs. Data on the association between T2DM and osteoporotic fractures is controversial. We estimated risk of hip fracture in newly diagnosed T2DM patients, compared to matched non-diabetic peers. Methods We conducted a population-based parallel cohort study using data from the Sistema d’Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP) database. Participants were all newly diagnosed T2DM patients registered in SIDIAP in 2006–2011 (T2DM cohort). Up to two diabetes-free controls were matched to each T2DM participant on age, gender, and primary care practice. Main outcome was incident hip fracture in 2006–2011, ascertained using the tenth edition of the International Classification of Diseases (ICD-10) codes. We used Fine and Gray survival modelling to estimate risk of hip fracture according to T2DM status, accounting for competing risk of death. Multivariate models were adjusted for body mass index, previous fracture, and use of oral corticosteroids. Results During the study period (median follow-up 2.63 years), 444/58,483 diabetic patients sustained a hip fracture (incidence rate 2.7/1,000 person-years) compared to 776/113,448 matched controls (2.4/1,000). This is equivalent to an unadjusted (age- and gender-matched) subhazard ratio (SHR) 1.11 [0.99–1.24], and adjusted SHR 1.20 [1.06–1.35]. The adjusted SHR for major osteoporotic and any osteoporotic fractures were 0.95 [0.89–1.01] and 0.97 [0.92–1.02]. Conclusions Newly diagnosed T2DM patients are at a 20 % increased risk of hip fracture even in early stages of disease, but no for all fractures. More data is needed on the causes for an increased fracture risk in T2DM patients as well as on the predictors of osteoporotic fractures among these patients.
    Osteoporosis International 12/2014; 26(2). DOI:10.1007/s00198-014-2986-9 · 4.17 Impact Factor
  • Source
    Raquel Soriano · Sabina Herrera · Xavier Nogués · Adolfo Diez-Perez
    [Show abstract] [Hide abstract]
    ABSTRACT: Osteoporosis is commonly associated with menopause and ageing. It can, however, also be caused by diseases, lifestyle, genetic diseases, drug therapies and other therapeutic interventions. In cases of secondary osteoporosis, a common rule is the management of the underlying condition. Healthy habits and calcium and vitamin D supplementation are also generally advised. In cases of high risk of fracture, specific antiosteoporosis medications should be prescribed. For most conditions, the available evidence is limited. Special attention should be paid to possible contraindications of drugs used for the treatment of postmenopausal or senile osteoporosis. Bisphosphonates are the most widely used drugs in secondary osteoporosis, and denosumab or teriparatide have been also assessed in some cases. Important research is needed to develop more tailored strategies, specific to the peculiarities of the different types of secondary osteoporosis.
    Best Practice & Research: Clinical Endocrinology & Metabolism 12/2014; 28(6). DOI:10.1016/j.beem.2014.09.004 · 4.60 Impact Factor
  • Osteoporosis International 11/2014; 25(11):2531-2531. DOI:10.1007/s00198-014-2830-2 · 4.17 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: From 50 years of age, postmenopausal women are at an increased risk of developing sarcopenia and osteoporosis as a result of deterioration of musculoskeletal health. Both disorders increase the risk of falls and fractures. The risk of developing sarcopenia and osteoporosis may be attenuated through healthy lifestyle changes, which include adequate dietary protein, calcium and vitamin D intakes, and regular physical activity/exercise, besides hormone replacement therapy when appropriate. Protein intake and physical activity are the main anabolic stimuli for muscle protein synthesis. Exercise training leads to increased muscle mass and strength, and the combination of optimal protein intake and exercise produces a greater degree of muscle protein accretion than either intervention alone. Similarly, adequate dietary protein intake and resistance exercise are important contributors to the maintenance of bone strength. Vitamin D helps to maintain muscle mass and strength as well as bone health. These findings suggest that healthy lifestyle measures in women aged >50 years are essential to allow healthy aging. The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) recommends optimal dietary protein intake of 1.0–1.2 g/kg body weight/d with at least 20–25 g of high-quality protein at each main meal, with adequate vitamin D intake at 800 IU/d to maintain serum 25-hydroxyvitamin D levels >50 nmol/L as well as calcium intake of 1000 mg/d, alongside regular physical activity/exercise 3–5 times/week combined with protein intake in close proximity to exercise, in postmenopausal women for prevention of age-related deterioration of musculoskeletal health.
    Maturitas 11/2014; 79(1). DOI:10.1016/j.maturitas.2014.07.005 · 2.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ankylosing spondylitis (AS) leads to osteopenia/osteoporosis and spine rigidity. We conducted a case-control study and found that AS-affected patients have a 5-fold and 50 % increased risk of clinical spine and all clinical fractures, respectively. Excess risk of both is highest in the first years and warrants an early bone health assessment after diagnosis.
    Osteoporosis International 10/2014; 26(1). DOI:10.1007/s00198-014-2939-3 · 4.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Patients with OA use different drugs in their search for relief. We aimed to study the prevalence of use and combinations of different medications for OA in a population-based cohort of OA patients in Catalonia, Spain, while characterizing users of each of the drugs available, with a particular focus on cardiovascular risk factors. Methods: Data were obtained from the Sistema d'Informació per al Desenvolupament de l'Investigació en Atenció Primària (SIDIAP) database, which includes electronic medical records and pharmacy invoice data for >5 million people from Catalonia. Study participants were those with a clinical diagnosis of OA in 2006-10. Drugs studied included oral and topical NSAIDs, analgesics (paracetamol, metamizole), opioids (tramadol, fentanyl), cyclooxygenase 2 (COX-2) inhibitors and symptomatic slow-acting drugs in OA. Drug utilization was described using medication possession ratios (MPRs), equivalent to the proportion of days covered with the drug of interest. The annual incidence of new users in the first year after OA diagnosis from 2006 to 2010 was estimated for all studied drugs among newly diagnosed OA patients using Poisson regression. Results: We identified 238 536 study participants. The most common regimen of treatment consisted of at least three drugs (53.9% of patients). The drugs most frequently used regularly (MPR ≥50%) were chondroitin (21.2%), glucosamine (15.8%) and oral NSAIDs (14.4%). The incidence of the use of opioids, COX-2 inhibitors and chondroitin increased over the 5 year period, whereas all others decreased. Conclusion: Drug combinations are common in the treatment of OA patients, who are thus exposed to potential drug interactions, with unknown impacts on their health. The increasing use of opioids and COX-2 inhibitors is noteworthy because of the potential impact on safety and costs.
    Rheumatology (Oxford, England) 10/2014; 54(5). DOI:10.1093/rheumatology/keu403 · 4.48 Impact Factor
  • Osteoporosis International 09/2014; 26(1). DOI:10.1007/s00198-014-2883-2 · 4.17 Impact Factor
  • H Melero · N Garcia-Giralt · J Fernández · A Díez-Pérez · J M Guilemany
    [Show abstract] [Hide abstract]
    ABSTRACT: Hydroxyapatite coatings obtained by plasma-spraying have been used for many years to improve biological performance of bone implants, but several studies have drawn attention to the problems arising from high temperatures and the lack of mechanical properties.In this study, plasma-spraying is substituted by high velocity oxy-fuel (HVOF) spray, with lower temperatures reached, and TiO2 is added in low amounts to hydroxyapatite in order to improve the mechanical properties. Four conditions have been tested to evaluate which are those with better biological properties. Viability and proliferation tests, as well as differentiation assays and morphology observation, are performed with human osteoblast cultures onto the studied coatings.The hydroxyapatite-TiO2 coatings maintain good cell viability and proliferation, especially the cases with higher amorphous phase amount and specific surface, and promote excellent differentiation, with a higher ALP amount for these cases than for polystyrene controls. Observation by SEM corroborates this excellent behaviour.In conclusion, these coatings are a good alternative to those used industrially, and an interesting issue would be improving biological behaviour of the worst cases, which in turn show the better mechanical properties.
    Bio-medical materials and engineering 09/2014; 24(5):1781-91. DOI:10.3233/BME-140989 · 1.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Fractures in obese older individuals contribute significantly to the overall burden, but data on their impact on mortality are lacking. We studied the association between obesity and mortality following hip and non-hip clinical fractures in a retrospective, population-based cohort study. The SIDIAP(Q) database contains primary care computerized medical records of a representative sample of >2.1 million people (35% of the population) in Catalonia (Spain), linked to hospital admissions data. We included in this analysis anyone aged 40 years and older suffering a hip or non-hip clinical fracture in 2007-2009 in the SIDIAP(Q) database. The main exposure was the most recent body mass index (BMI) measured before fracture, categorized as underweight (<18.5 kg/m(2) ), normal (18.5 to <25 kg/m(2) ), overweight (25 to <30 kg/m(2) ) and obese (≥30 kg/m(2) ). Furthermore, the study outcome was all-cause mortality in 2007-2009 as provided to SIDIAP(Q) by the National Office of Statistics. Time to death after fracture was modelled using Cox regression. Multivariate models were adjusted for age, gender, smoking, alcohol intake, oral glucocorticoid use, and Charlson co-morbidity Index. Within the study period, 6,988 and 29,372 subjects with a hip or non-hip clinical fracture were identified and followed for a median (inter-quartile range) of 1.17(0.53-2.02) and 1.36(0.65-2.15) years, respectively. Compared to subjects of normal weight, adjusted hazard ratios (HR) for mortality in overweight and obese subjects were 0.74 (95%CI 0.62-0.88; p = 0.001) and 0.74 (0.60-0.91; p = 0.004) after hip and 0.50 (0.32-0.77; p = 0.002), 0.56 (0.36-0.87; p = 0.010) after non-hip fracture. In conclusion, the highest mortality was observed in individuals with low BMI, but compared to subjects of normal weight, obese and overweight individuals survived longer following fracture. The latter observation is consistent with data reported in other chronic conditions, but the reasons for reduced mortality in obese and overweight subjects when compared to those of normal weight require further research. © 2014 American Society for Bone and Mineral Research.
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 08/2014; 29(8). DOI:10.1002/jbmr.2209 · 6.83 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This consensus article reviews the diagnosis and treatment of osteoporosis in geriatric populations. Specifically, it reviews the risk assessment and intervention thresholds, the impact of nutritional deficiencies, fall prevention strategies, pharmacological treatments and their safety considerations, the risks of sub-optimal treatment adherence and strategies for its improvement. This consensus article reviews the therapeutic strategies and management options for the treatment of osteoporosis of the oldest old. This vulnerable segment (persons over 80 years of age) stands to gain substantially from effective anti-osteoporosis treatment, but the under-prescription of these treatments is frequent. This report is the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores some of the reasons for this and presents the arguments to counter these beliefs. The risk assessment of older individuals is briefly reviewed along with the differences between some intervention guidelines. The current evidence on the impact of nutritional deficiencies (i.e. calcium, protein and vitamin D) is presented, as are strategies to prevent falls. One possible reason for the under-prescription of pharmacological treatments for osteoporosis in the oldest old is the perception that anti-fracture efficacy requires long-term treatment. However, a review of the data shows convincing anti-fracture efficacy already by 12 months. The safety profiles of these pharmacological agents are generally satisfactory in this patient segment provided a few precautions are followed. These patients should be considered for particular consultation/follow-up procedures in the effort to convince on the benefits of treatment and to allay fears of adverse drug reactions, since poor adherence is a major problem for the success of a strategy for osteoporosis and limits cost-effectiveness.
    Osteoporosis International 07/2014; 25(11). DOI:10.1007/s00198-014-2755-9 · 4.17 Impact Factor

Publication Stats

3k Citations
772.59 Total Impact Points


  • 2010–2015
    • Instituto de Salud Carlos III
      Madrid, Madrid, Spain
  • 2009–2015
    • IMIM Hospital del Mar Medical Research Institute
      Barcino, Catalonia, Spain
  • 2002–2015
    • Autonomous University of Barcelona
      • Department of Medicine
      Cerdanyola del Vallès, Catalonia, Spain
  • 2014
    • Consorci MAR Parc de Salut de Barcelona
      Barcino, Catalonia, Spain
  • 2010–2014
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 2001–2014
    • Parc de Salut Mar
      Barcino, Catalonia, Spain
  • 2012
    • Parc de recerca biomedica de barcelona
      Barcino, Catalonia, Spain
  • 2000–2012
    • University of Barcelona
      • Department of Medicine
      Barcino, Catalonia, Spain
  • 2007–2008
    • Universidad Autónoma de Madrid
      Madrid, Madrid, Spain
  • 2006
    • University of Florence
      Florens, Tuscany, Italy
    • Erasmus MC
      • Department of Internal Medicine
      Rotterdam, South Holland, Netherlands
    • Eli Lilly
      Indianapolis, Indiana, United States