P Peris

Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcino, Catalonia, Spain

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Publications (162)666.27 Total impact

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    ABSTRACT: Background Low bone turnover osteoporosis is common in cholestatic diseases. Ursodeoxycholic acid (UDCA) counteracts the damaging effects of bilirubin or lithocholic acid (LCA) on osteoblast viability, proliferation and mineralization. UDCA is antiapoptotic in various cell lines, but this effect in bone cells is unknown. Therefore, the consequences of bilirubin and LCA on apoptosis, and if UDCA has antiapoptotic effects have been assessed on osteoblasts.Materials and Methods Human osteoblasts (hOB), and osteosarcoma cell line (Saos-2) were treated with camptothecin as a proapoptotic agent, and UDCA, LCA and bilirubin. Apoptosis was determined by DNA fragmentation, flow cytometry, caspase-3 activity, and expression of proapoptotic (Bcl-2–associated X protein BAX), and antiapoptotic (BCL2 and BCL2-like 1 protein, BCL2L) genes.ResultsBoth LCA (10 μM) and bilirubin (50 μM) induced apoptosis as indicated by DNA fragmentation (4.7 and 3.7 fold, respectively, p<0.001), caspase-3 activity and flow cytometry in Saos-2 and hOB. UDCA (10 μM) reduced the apoptotic effects of camptothecin (0.5 μM) by 61%, (p<0.001), and counteracted the apoptotic effects of LCA and bilirubin determined by DNA fragmentation (56% and 60%, respectively, p<0.001), cytometry and caspase-3 activity in Saos-2, with lower effects in hOB. UDCA (10 μM) downregulated BAX (75%), and upregulated BCL2L (10-fold, p<0.01) genes, and neutralized BAX upregulation (p<0.01) and BCL2L downregulation (p<0.01) induced by LCA and bilirubin.Conclusions Bilirubin and LCA induce apoptosis in osteoblastic cells. UDCA counteracts the apoptotic consequences of these two substances and therefore, it may have further beneficial effects on the decreased bone formation in the cholestasis.This article is protected by copyright. All rights reserved.
    European Journal of Clinical Investigation 10/2014; · 3.37 Impact Factor
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    ABSTRACT: The aim of the present study was to analyze the usefulness of the determination of fibroblast growth factor 23 (FGF23), a regulatory hormone of phosphate metabolism, in the evaluation of patients with osteomalacia of different causes. Seventeen patients with osteomalacia were included: 12 hypophosphatemic osteomalacia (by several causes), 4 vitamin D-deficiency osteomalacia and one with hypophosphatasia. Plasma C-terminal FGF23 was determined in all patients. FGF23 levels were increased in 6/12 (50%) of patients with hypophosphatemic osteomalacia (2 X-linked, one autosomal dominant, one related HIV therapy and 2 not elucidated). No patient with vitamin D-deficiency osteomalacia or hypophosphatasia presented increased FGF23 levels. The determination of FGF23 could be useful in the evaluation of the different types of hypophosphatemic osteomalacia and also in the identification of their associated etiopathogenic mechanisms. Thus, depending on the cause, 50% of the patients with hypophosphatemic osteomalacia showed increased FGF23 values, whereas in vitamin D-deficiency osteomalacia and in hypophosphatasia FGF23 levels were normal.
    Medicina Clínica 03/2014; · 1.40 Impact Factor
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    ABSTRACT: Population-based studies performed with vertebral fracture assessment (VFA) morphometric technology are lacking in postmenopausal osteoporosis. In this study, we show a lower than expected prevalence of vertebral fractures, a high prevalence of minor vertebral deformities, and a clear association with clinical and densitometric parameters indicating the usefulness of this approach. Adequate epidemiological data on the prevalence of vertebral fractures (VF) is essential in studies of postmenopausal osteoporosis. Routine DXA-assisted VFA may be useful to determine the presence of VF. However, population-based studies performed with this technology are lacking. We aimed to assess the prevalence of VF and minor deformities in 2,968 postmenopausal women aged 59-70 years from a population-based cohort. VFA and bone mineral density (BMD) measurements were conducted, and McCloskey criteria (vertebral heights under 3 SD from reference values) confirmed with the Genant method were used to define VF. Additionally, minor vertebral deformities (vertebral heights between -2 and -2.99 SD) were evaluated. The prevalence of VF was 4.3 %, and 17 % of the participants had minor vertebral deformities. Low BMD was frequently observed in women with VF, with 48 %, and 42 % of participants showing osteoporosis and osteopenia. Minor vertebral deformities were observed in nearly 40 % of women with VF. Multivariate logistic regression analysis showed that age, history of previous fracture, osteoporotic BMD, receiving anti-osteoporotic treatment, and current use of glucocorticoids were significantly associated with VF. Although the VFA approach showed a lower than expected prevalence of VF in our cohort, its association with clinical and densitometric parameters may be useful to identify women at risk for developing fragility fractures and may therefore justify its use in longitudinal studies. The high prevalence of minor vertebral deformities detected in patients with VF indicates the need to evaluate this type of deformity as a risk factor for further skeletal fractures.
    Osteoporosis International 03/2014; · 4.04 Impact Factor
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    ABSTRACT: Bone formation is suppressed in glucocorticoid-induced osteoporosis. One of the mechanisms by which glucocorticoids depress bone formation is through their effects on the Wnt/β-catenin signaling pathway, a critical regulator of osteoblastogenesis. Thus, Wnt signaling induces the differentiation of osteoblast precursors toward mature osteoblasts and prevents osteoblast and osteocyte apoptosis. Glucocorticoids increase the expression of Wnt signaling antagonists (sclerostin and Dkk-1) in experimental studies in rodents and cell cultures. However, the scarce data of their effects in humans are somewhat contradictory, probably due to the dose and duration of treatment as well as the characteristics of the patients. A progressive decrease in Dkk-1 serum levels and an increase in circulating sclerostin levels at long-term follow-up have recently been reported in patients treated with high doses of glucocorticoids. This review describes the most recent data on the effects of glucocorticoids on the Wnt signaling pathway, especially on their antagonists, sclerostin and Dkk-1.
    Current Osteoporosis Reports 02/2014;
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    ABSTRACT: Background and objective The aim of the present study was to analyze the usefulness of the determination of fibroblast growth factor 23 (FGF23), a regulatory hormone of phosphate metabolism, in the evaluation of patients with osteomalacia of different causes. Patients and method Seventeen patients with osteomalacia were included: 12 hypophosphatemic osteomalacia (by several causes), 4 vitamin D-deficiency osteomalacia and one with hypophosphatasia. Plasma C-terminal FGF23 was determined in all patients. Results FGF23 levels were increased in 6/12 (50%) of patients with hypophosphatemic osteomalacia (2 X-linked, one autosomal dominant, one related HIV therapy and 2 not elucidated). No patient with vitamin D-deficiency osteomalacia or hypophosphatasia presented increased FGF23 levels. Conclusion The determination of FGF23 could be useful in the evaluation of the different types of hypophosphatemic osteomalacia and also in the identification of their associated etiopathogenic mechanisms. Thus, depending on the cause, 50% of the patients with hypophosphatemic osteomalacia showed increased FGF23 values, whereas in vitamin D-deficiency osteomalacia and in hypophosphatasia FGF23 levels were normal.
    Medicina Clínica. 01/2014;
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    ABSTRACT: Multifocal or multiple osteonecrosis (ON), defined by the involvement of 3 or more anatomic sites, is unusual, being observed in only 3%-10% of patients diagnosed with ON. We report the clinical characteristics of a cohort of 29 patients with multifocal ON from a single center and evaluate the prevalence of associated prothrombotic abnormalities in 26 of these patients. We conducted a retrospective study of all patients diagnosed with multifocal ON evaluated in our institution during the last 20 years. We recorded clinical manifestations and underlying diagnoses. A wide thrombophilic profile was performed, including antithrombin, protein C, protein S, lupus anticoagulant, anticardiolipin antibodies, activated protein C resistance, factor V Leiden, mutation G-20210-A of the prothrombin gene, and factor VIII. Coagulation test results were compared with those in a healthy control group and a group of patients with history of lower-extremity deep venous thrombosis.The mean age of the patients was 49.2 ± 15 years (range, 28-81 yr). The mean number of ON localizations per patient was 5.2 ± 2.3 (range, 3-11). Hips were the most commonly affected joint (82%), followed by knees (58%), shoulders (37%), and ankles (13%). Most patients had an underlying disease process, and 12 of 25 (48%) patients had coagulation test abnormalities. The most common alterations were high factor VIII levels and antiphospholipid antibody (aPL) positivity in 24% and 20% of cases, respectively. These abnormalities were more prevalent in patients with multifocal ON compared with patients in the control groups.Sixty-one percent of patients had a history of corticosteroid treatment. Patients with coagulation abnormalities had a higher number of ON localizations per patient (6.5 ± 2.7 vs. 3.88 ± 0.8; p = 0.002) and a higher prevalence of atypical ON localizations (25% vs. 0%; p = 0.05).In conclusion, in the present cohort of patients with multifocal ON, 48% of the patients had at least 1 prothrombotic factor, especially high levels of factor VIII and aPL. These findings have major implications for the diagnosis and treatment of multifocal ON and clearly indicate the need to perform a thrombophilic profile in these patients.
    Medicine 10/2013; · 4.35 Impact Factor
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    ABSTRACT: Hypophosphatasia (HPP) is the inborn-error-of-metabolism that features low serum alkaline phosphatase (ALP) activity caused by loss-of-function mutation(s) within the gene for the tissue nonspecific isoenzyme of ALP (TNSALP). In HPP, extracellular accumulation of inorganic pyrophosphate (PPi), a TNSALP substrate and inhibitor of mineralization, leads frequently to premature tooth loss and often to rickets or osteomalacia. In affected adults, the excess PPi sometimes also causes calcium pyrophosphate dihydrate (CPPD) deposition, PPi arthropathy, or pseudogout, or seemingly paradoxical deposition of hydroxyapatite crystals in ligaments or around joints when the condition is called calcific periarthritis (CP). We report three middle-aged sisters with CP as the only clinical manifestation of HPP. Each presented during early adult life with recurrent episodes of pain principally around the shoulders, elbows, wrists, hips, or Achilles tendon. Otherwise, they were in good health, including no history of unusual dental disease, fractures, or pseudofractures. Calcific deposits were identified in symptomatic areas principally by ultrasonographic assessment, but also confirmed radiographically. All three sisters had low serum levels of total and bone-specific ALP, hyperphosphatemia, and increased serum concentrations of the TNSALP substrate pyridoxal 5'-phosphate together characteristic of HPP. Mutation analysis revealed that each carried a single unique 18-bp duplication within TNSALP (c.188_205dup18, p.Gly63_Thr68dup) as did two of their healthy sons and their mother who was without signs of CPPD deposition or CP but had knee osteoarthritis. We find that CP can be the only complication of HPP in adults. Thus, multiple juxta-articular deposits of hydroxyapatite causing CP may be a useful sign of HPP, especially when the CP is familial. © 2013 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 10/2013; · 6.04 Impact Factor
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    ABSTRACT: Objective:To analyse the incidence and factors related to the development and clinical evolution of fractures in patients with traumatic spinal cord injury.Design:A retrospective 10-year follow-up study.Setting:Neurorehabilitation centre.Subjects:Sixty-three patients (50M/13F) with a mean age of 36 ± 20 years with recent traumatic spinal cord injury attended over a one-year period (January to December 2000).Main measures:Medical reports were reviewed, evaluating risk factors for osteoporosis, fracture incidence during the 10 years following spinal cord injury, severity (ASIA score) and level of spinal cord injury (paraplegia/tetraplegia), type of lesion (spastic/flaccid), weight-bearing standing activity, and the cause, location and evolution of the fracture.Results:Of the 129 patients attending during the study period, 75 had traumatic spinal cord injury (7 died and 5 had no follow-up). Finally, 63 patients were included. Fifty-four per cent had complete motor injury (ASIA A). Twenty-five per cent of these patients developed fractures, with 2.9 fractures per 100 patient-years. The femur was the most frequent location of the fractures. Fractures were observed 6.4 ± 2.4 years after spinal cord injury (range 2-10 years), all in males. Most fractures (70%) were related to low-impact injuries. Fifty per cent presented with associated clinical complications and only 20% of the patients had received anti-osteoporotic treatment. Spinal cord injury severity was the only risk factor for the development of fractures (complete spinal cord injury (ASIA A)) (RR 4.043; 95% confidence interval (CI) 1.081-23.846, P = 0.037).Conclusion:The incidence of fractures after spinal cord injury is high, with severity and time since spinal cord injury being the main determinants for their development. Fractures were frequently associated with clinical complications. However, the use of anti-osteoporotic treatment was uncommon.
    Clinical Rehabilitation 10/2013; · 2.19 Impact Factor
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    ABSTRACT: In recent years, there has been speculation about the possibility of a reduction in the incidence of fractures after liver transplantation (LT) because of changes in the characteristics of candidates and the use of different immunosuppressive therapies. We analyzed the characteristics of LT candidates (CTC) and compared them with historical data from a group of LT candidate patients (HTC). Data from 60 CTC patients consecutively included in a screening program of metabolic bone disease were compared with data from 60 HTC patients prospectively evaluated between 1992 and 1993. In all patients, we analyzed the clinical and laboratory characteristics, bone mineral density (BMD) dual-energy X-ray absorptiometry, and skeletal fractures. Patients in the CTC group were older than patients in the HTC group. The CTC group had lower femoral neck T scores. No differences were observed between groups in the proportion of patients with osteoporosis (22 vs. 30 %, p = ns) or fractures (36 vs. 33 %, p = ns). The percentage of patients with normal BMD decreased from 38 to 20 %. 25(OH)D values were low in both groups. Only 7.5 % of the CTC patients received calcium and/or vitamin D supplementation. The prevalence of fractures among CTC patients was similar to that seen two decades ago. At present, candidates for LT are older and have lower femoral bone mass. Vitamin D deficiency remains frequent; however, calcium and/or vitamin D supplementation is uncommon.
    Calcified Tissue International 09/2013; · 2.75 Impact Factor
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    ABSTRACT: The aim of this study was to analyse the effect of glucocorticoid therapy (GCCT) on Wnt signalling antagonists (sclerostin and Dkk-1) and their relationship with bone turnover. 25 patients (8M/17F, aged 48±19yrs) recently initiating GCCT (≥7.5mg/day, ≤6months) were prospectively included. Bone turnover markers (bone formation: P1NP, osteocalcin [OC], bone ALP; bone resorption: sCTx), Wnt antagonists (serum sclerostin and Dkk-1) were assessed in all patients (short-term and 12months after initiating GCCT). Bone mineral density (BMD) was performed to assess osteoporosis. The results were compared with 60 healthy controls. At short-term patients on GCCT showed a significant decrease in bone formation markers versus controls (P1NP: 19±9 vs. 43±16ng/mL, p<0.001; OC: 7.4±2.4 vs. 18.4±5.2ng/mL, p=0.001) and in Dkk-1 levels (24.5±20.1 vs. 36.8±13.7 pmol/L, p=0.008) with similar sclerostin values (41.8±21.8 vs. 42.1±13.9 pmol/L, p=0.950). Sclerostin correlated positively with GCCT doses (r=0.449, p=0.024) and lumbar BMD (r=0.424, p=0.035), and negatively with bone ALP (r=-0.398, p=0.049). A progressive decrease in Dkk-1 levels was observed at 12months, (19.1±14.9, p=0.001), whereas sclerostin increased compared to controls (48.9±11.6, p=0.045). In conclusion, the effect of GCCT on the serum levels of the Wnt signaling parameters differs depending on the antagonist evaluated. Whereas sclerostin values increased and showed a relationship with the dose and bone AP, Dkk-1 levels decreased throughout the study suggesting a counter-regulatory mechanism of this factor thereby reducing the deleterious effect of GCCT in bone.
    Bone 08/2013; · 4.46 Impact Factor
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    ABSTRACT: Osteoporosis resulting in bone fractures is a complication in patients with primary biliary cirrhosis (PBC). Once-weekly alendronate improves bone mass and is well tolerated in these patients, but there is a concern because of poor compliance. Therefore, the efficacy, adherence and safety of monthly ibandronate (150 mg) with weekly alendronate (70 mg) have been compared in a randomized, two-year study in 42 postmenopausal women with PBC and osteoporosis. Bone mineral density (BMD) of the lumbar spine and proximal femur (DXA), liver function and bone markers were measured at entry and every 6 months over two years. Adherence to therapy was assessed by the Morisky-Green score. At enrollment, the two groups were similar with respect to age, BMD, severity of cholestasis, previous fractures and bone markers. Thirty-three patients, 14 with ibandronate group and 19 in the alendronate group, completed the trial. At two-years, both treatments resulted in a significant increase in BMD at the lumbar spine (from 0.875 ± 0.025 to 0.913 ± 0.026 g/cm(2) , p<0.001 with alendronate, and from 0.898 ± 0.024 to 0.949 ± 0.027 g/cm(2) , p<0.001 with ibandronate). The mean percentage change was 4.5% and 5.7%, respectively (p:n.s.). BMD increased at the total hip by 2.0% and 1.2%, respectively. Changes in bone markers were similar in both groups and one patient with alendronate developed a new vertebral fracture. Adherence to therapy was higher with ibandronate (p=0.009). Neither treatment impaired liver function or cholestasis. Conclusion: Both regimens, weekly alendronate and monthly ibandronate, improve bone mass and are comparable in safety for osteoporosis therapy in patients with PBC, although adherence is higher with the monthly regimen. Further larger studies are needed for assessing fracture prevention. (HEPATOLOGY 2013.).
    Hepatology 05/2013; · 12.00 Impact Factor
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    ABSTRACT: BACKGROUND: Osteoporosis resulting from decreased bone formation is a common complication in patients with chronic cholestasis. Lithocholic acid (LCA) and bilirubin may play a role in osteoporosis given that both substances have detrimental effects on survival of human osteoblasts, the cells involved in bone formation. AIMS: As ursodeoxycholic acid (UDCA) improves cholestasis, we have assessed if this bile acid may neutralize the harmful effects of LCA, bilirubin and sera from jaundiced patients on osteoblastic cells. METHODS: The experiments were performed in primary human osteoblasts and human osteosarcoma cell line (Saos-2) at different times and concentrations of UDCA, LCA, cholic acid (CA), bilirubin and sera from jaundiced patients to assess cell viability, differentiation and mineralization. RESULTS: UDCA significantly decreased cell survival at concentrations 10 times higher (1 mM) than that observed with LCA, whereas CA did not decrease osteoblast survival. UDCA (100 μM) neutralized the damaging effects of bilirubin (50 μM) and sera from jaundiced patients on survival. Moreover, UDCA (1 μM and 10 μM) increased osteoblast differentiation in cells treated with harmful concentrations of LCA or bilirubin. UDCA (100 μM) increased cell differentiation in osteoblasts cultured with a mix of serum from cholestatic patients by 23%. Furthermore, UDCA increased osteoblast mineralization by 35% and neutralized the negative consequences of 50 μM bilirubin. CONCLUSIONS: UDCA increases osteoblast differentiation and mineralization, and neutralizes the detrimental effects of lithocholic acid, bilirubin and sera from jaundiced patients on osteoblastic cells. Therefore, UDCA may exert a favourable effect on bone in patients which chronic cholestasis.
    Liver international: official journal of the International Association for the Study of the Liver 03/2013; · 3.87 Impact Factor
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    ABSTRACT: We have recently observed an increased risk for vertebral fractures (VF) in a randomized controlled trial comparing the analgesic effect of vertebroplasty (VP) versus conservative treatment in symptomatic VF. The aim of the present study was to evaluate the risk factors related to the development of VF after VP in these patients. We evaluated risk factors including age, gender, bone mineral density, the number, type and severity of vertebral deformities at baseline, the number of vertebral bodies treated, the presence and location of disk cement leakage, bone remodeling (determining bone turnover markers) and 25 hydroxyvitamin D (25OHD) levels at baseline in all patients.Twenty-nine radiologically new VF were observed in 17/57 patients undergoing VP, 72% adjacent to the VP. Patients developing VF after VP showed an increased prevalence of 25OHD deficiency (< 20 ng/ml) and higher PINP values. 25OHD levels < 20ng/ml was the principal factor related to the development of VF after VP in multivariate analysis (RR,15.47; 95% CI,2.99-79.86, P<0.0001), whereas age >80 years (RR,3.20;95%CI,1.70-6.03, P=0.0007) and glucocorticoid therapy (RR,3.64;95%CI,1.61-8.26,P=0.0055) constituted the principal factors in the overall study population. Increased risk of VF after VP was also associated with cement leakage into the inferior disk (RR,6.14;95%CI,1.65-22.78, P=0.044) and >1 vertebral body treated during VP (RR,4.19; 95% CI,1.03-34.3, P=0.044). In conclusion, nearly 30% of patients with osteoporotic VF treated with VP had a new VF after the procedure. Age, especially over 80 years, the presence of inferior disk cement leakage after the procedure, the number of cemented vertebrae and low 25OHD serum levels were related to the development of new VF in these patients; the latter indicating the need to correct vitamin D deficiency prior to performing VP. © 2013 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 02/2013; · 6.04 Impact Factor
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    ABSTRACT: This cross-sectional study evaluated the distribution of serum cross-linked C-telopeptides of collagen type I (βCTXs) in postmenopausal women, the characteristics of bone remodeling, and the factors influencing this bone marker, especially the use of anti-osteoporotic drugs. Women (n = 4,175) aged 59-70 years randomly selected from the community were invited to participate, measuring βCTXs and lumbar and femoral bone mineral density at recruitment. Risk factors for osteoporosis and the use of anti-osteoporotic treatment were collected with a structured questionnaire. We evaluated the percentage of women with increased (βCTXs >0.620 ng/mL) and decreased bone turnover (βCTXs <0.100 ng/mL) and those reaching the so-called treatment target (values of βCTXs within the lower half of the reference range for healthy young premenopausal women). Two thousand nine hundred sixty-eight women (70 %) participated (2,405 non-treated and 563 treated). Increased and decreased bone turnover was observed in 16.4 and 1.8 %, respectively, of non-treated women with significant differences compared with treated women (9.7 and 14.2 %, respectively, p < 0.001); 28 % of non-treated osteoporotic individuals had increased bone turnover versus 14 % of osteopenic participants and 8.8 % of women with normal bone density (p < 0.001). Women receiving bisphosphonates presented the highest percentages of decreased bone turnover (27 %) and βCTXs (43 %) within the treatment target. Increased bone turnover is observed in 16.4 % of non-treated postmenopausal women and is more frequent in individuals with osteoporosis, whereas decreased bone turnover is unusual. Most participants taking bisphosphonates had values within the treatment target, but nearly one quarter had decreased bone turnover.
    Journal of Bone and Mineral Metabolism 12/2012; · 2.22 Impact Factor
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    ABSTRACT: BACKGROUND AND OBJECTIVE: Percutaneous vertebroplasty (PVP) has been successfully used in the treatment of pain related to osteoporotic vertebral fractures refractory to medical therapy, especially in the treatment of acute factures. However, the effectiveness of this therapeutic approach in the treatment of painful chronic vertebral fractures is less clear. PATIENTS AND METHODS: In this report we evaluate the short and long-term effectiveness in pain relief of PVP in a group of 5 patients with pain related to chronic osteoporotic vertebral fractures without bone marrow edema (BME) on magnetic resonance imaging (MRI). All patients were followed during one year, assessing analgesic use, pain evolution (on a 10-point visual analog scale [VAS]), new vertebral fractures and other clinical complications. Seven procedures were performed in the 5 patients. RESULTS: All patients reported substantial improvement in back pain 2 weeks after the procedure, with a mean decrease of 53% in the VAS. However, one year after PVP most patients (4 out 5) worsened, achieving similar VAS scores to those obtained at baseline. No additional vertebral fractures or other clinical complications were observed. CONCLUSION: The present cases suggest that the long-term effectiveness of PVP in the treatment of painful chronic vertebral fractures without BME on MRI is scarce.
    Medicina Clínica 11/2012; · 1.40 Impact Factor
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    ABSTRACT: Uncertainty regarding the benefits of vertebroplasty (VP) for the treatment of acute osteoporotic vertebral fractures has recently arisen. A prospective, controlled, randomized single-center trial (ClinicalTrials.gov registration number NCT00994032) was designed to compare the effects of VP versus conservative treatment on the quality of life and pain in patients with painful osteoporotic vertebral fractures, new fractures and secondary adverse effects were also analyzed during a 12-month follow-up period. A total of 125 patients were randomly assigned to receive conservative treatment or VP. The primary end point was to compare the evolution of the quality of life (Quality of Life Questionnaire of the European Foundation for Osteoporosis [Qualeffo-41] and pain (Visual Analogue Scale [VAS]) during a 12 month follow-up. Secondary outcomes included comparison of analgesic consumption, clinical complications, and radiological vertebral fractures at the same time points. Both arms showed significant improvement in VAS scores at all time points, with greater improvement (p = 0.035) in the VP group at the 2-month follow-up. Significant improvement in Qualeffo total score was seen in the VP group throughout the study, whereas this was not seen in the conservative treatment arm until the 6-month follow-up. VP treatment was associated with a significantly increased incidence of vertebral fractures (odds ratio [OR], 2 · 78; 95% confidence interval [CI], 1.02-7.62, p = 0.0462). VP and conservative treatment are both associated with significant improvement in pain and quality of life in patients with painful osteoporotic vertebral fractures over a 1-year follow-up period. VP achieved faster pain relief with significant improvement in the pain score at the 2-month follow-up but was associated with a higher incidence in vertebral fractures.
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 05/2012; 27(5):1159-66. · 6.04 Impact Factor
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    ABSTRACT: It remains unclear whether vitamin D sufficiency optimizes response to bisphosphonate (BP) treatment in postmenopausal osteoporosis. We evaluated the role and possible mechanisms of vitamin D in adequate response to standard BP treatment for postmenopausal osteoporosis. We included 120 postmenopausal osteoporotic women (aged 68 ± 8 years) receiving BP (alendronate or risedronate) at their annual follow-up, performing complete anamnesis, including treatment adherence, use of vitamin D supplements, and previous falls and fractures during the last year. We analyzed the evolution of bone mineral density (BMD) during this period and serum PTH and 25 hydroxyvitamin D (25(OH)D) and urinary NTx levels. Patients were classified as inadequate responders to antiosteoporotic treatment based on BMD loss>2% and/or the presence of fragility fractures during the last year. Thirty percent of patients showed inadequate response to BP treatment, with significantly lower levels of 25(OH)D (22.4 ± 1.3 vs. 26.6 ± 0.3 ng/ml, p=0.01), a higher frequency of 25(OH)D levels<30 ng/ml (91% vs. 69%, p=0.019) and higher urinary NTx values (42.2 ± 3.9 vs. 30.9 ± 2.3 nM/mM, p=0.01). Patients with 25(OH)D>30 ng/ml had a greater significant increase in lumbar BMD than women with values <30 ng/ml (3.6% vs. 0.8%, p<0.05). The probability of inadequate response was 4-fold higher in patients with 25(OH)D<30 (OR, 4.42; 95% CI, 1.22-15.97, p=0.02). Inadequate response to BP treatment is frequent in postmenopausal women with osteoporosis as is vitamin D insufficiency, despite vitamin D supplementation. Maintenance of 25(OH)D levels >30 ng/ml is especially indicated for adequate response to BP treatment.
    Bone 04/2012; 51(1):54-8. · 4.46 Impact Factor
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    ABSTRACT: BACKGROUND AND OBJECTIVE: Vertebral fractures (VF) are a major risk factor for the development of further fractures. Therefore, it is important to identify clinical risk factors and laboratory abnormalities related to VF. We aimed to analyse clinical and biochemical alterations related to the presence of radiological VF in postmenopausal women with osteoporosis. PATIENTS AND METHODS: Two-hundred and four postmenopausal women with osteoporosis (aged 64,9 [10] years) who were referred to an outpatient Rheumatology Unit were prospectively included. Bone mineral density (BMD), spine X-ray, and laboratory tests were performed in all participants before treatment. RESULTS: Twenty-eight per cent of patients had VF. Comparing women with and without VF, those with fractures were older (71.9 [10] vs 61.8 [8,6], P<.001), had lower stature (152 [7.2] vs 155 [6.2], P=.01), lower total hip T-score values (-2.2 [0,9] vs -1.9 [0.8], P=.041), higher prevalence of non-VF (38 vs 30%, P=.04) and a higher prevalence of low serum 25(OH)D levels (69 vs 53%, P<.05). In logistic regression analysis, age and BMD at the total hip were independent predictors of VF. Patients over 65 presented a higher frequency of VF (47 vs 12%, P<.0001). In addition, a T-score lower than -2,5 at the total hip was associated with an increased risk of VF (OR 2.5; 95% CI 1.2-4.9). CONCLUSIONS: Over the age of 65 nearly half of the postmenopausal women with osteoporosis have VF and a higher prevalence of low 25(OH)D serum measurements. Spinal X-ray and 25(OH)D serum measurements are especially indicated in this group of women since it influences the therapeutic approach.
    Medicina Clínica 03/2012; · 1.40 Impact Factor
  • Bone 01/2012; 50(4):1019-20; author reply 1021. · 4.46 Impact Factor
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    ABSTRACT: Due to increasing improvement in the diagnosis, evaluation and management of osteoporosis and the development of new tools and drugs, the Spanish Society of Rheumatology (SER) has promoted the development of recommendations based on the best evidence available. These recommendations should be a reference to rheumatologists and other health professionals involved in the treatment of patients with osteoporosis. Recommendations were developed following a nominal group methodology and based on a systematic review. The level of evidence and degree of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. Evidence from previous consensus and available clinical guidelines was used. We have produced recommendations on diagnosis, evaluation and management of osteoporosis. These recommendations include the glucocorticoid-induced osteoporosis, premenopausal and male osteoporosis. We present the SER recommendations related to the biologic therapy risk management.
    Reumatología clinica. 11/2011; 7(6):357-79.

Publication Stats

2k Citations
666.27 Total Impact Points

Institutions

  • 2011–2014
    • Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas
      Barcino, Catalonia, Spain
    • Hospital Clínico, Maracaibo
      Maracaibo, Estado Zulia, Venezuela
  • 1990–2014
    • Hospital Clínic de Barcelona
      • Servicio de Reumatología
      Barcino, Catalonia, Spain
  • 1992–2013
    • University of Barcelona
      • Department of Medicine
      Barcino, Catalonia, Spain
  • 2012
    • Collegi Oficial de Metges de Barcelona
      Barcino, Catalonia, Spain
  • 2009–2012
    • Granollers General Hospital
      Granollers, Catalonia, Spain
  • 2002–2008
    • The American Society for Bone and Mineral Research
      Mineral Wells, Texas, United States
  • 2003–2007
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain