A Monegal

Publications (72)370.61 Total impact

• Article: Patients with cirrhosis and ascites have false values of bone density

  N. Guañabens, A. Monegal, A. Muxi, A. Martinez-Ferrer, R. Reyes, J. Caballería, L. Del Río, P. Peris, F. Pons, A. Parés
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  ABSTRACT: SummaryThe effect of ascites on bone densitometry has been assessed in 25 patients with advanced cirrhosis, and it was concluded that ascites over 4l causes inaccuracy of BMD measurements, particularly at the lumbar spine. This fact must be considered when assessing bone mass in patients with decompensated cirrhosis. IntroductionBone mineral density (BMD) measured by dual-energy x-ray absorptiometry (DXA) is the best procedure for assessment of osteoporosis and fracture risk, but BMD values at the central skeleton may be influenced by changes in soft tissues. Therefore, we have studied the effect of ascites on BMD. MethodsBMD was measured by DXA at the lumbar spine, femoral neck and total hip, just before and shortly after therapeutic paracentesis in 25 patients with advanced liver cirrhosis. Changes in BMD, lean and fat mass, abdominal diameter and weight, as well as the amount of removed ascites were measured. ResultsThe amount of drained ascites was 6.6 ± 0.5l (range: 3.0 to 12.7l). After paracentesis, BMD increased at the lumbar spine (from 0.944 ± 0.035 to 0.997 ± 0.038g/cm2, p < 0.001) and at the total hip (from 0.913 ± 0.036 to 0.926 ± 0.036g/cm2, p < 0.01). Patients with a volume of drained ascites higher than 4l showed a significant increase in lumbar BMD (7.0%), compared with patients with a lower amount (1.5%) (p < 0.03). The decrease in total soft tissue mass correlated with the amount of removed ascites (r = 0.951, p < 0.001). Diagnosis of osteoporosis or osteopenia changed after paracentesis in 12% of patients. ConclusionAscites over 4l causes inaccuracy of BMD measurements, particularly at the lumbar spine. This fact must be considered when assessing bone mass in patients with advanced cirrhosis. KeywordsDensitometry–Liver disease–Liver transplantation–Osteopenia–Paracentesis
  Osteoporosis International 04/2012; 23(4):1481-1487. · 4.58 Impact Factor
• Article: Patients with cirrhosis and ascites have false values of bone density: implications for the diagnosis of osteoporosis.

  N Guañabens, A Monegal, A Muxi, A Martinez-Ferrer, R Reyes, J Caballería, L Del Río, P Peris, F Pons, A Parés
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  ABSTRACT: The effect of ascites on bone densitometry has been assessed in 25 patients with advanced cirrhosis, and it was concluded that ascites over 4 l causes inaccuracy of BMD measurements, particularly at the lumbar spine. This fact must be considered when assessing bone mass in patients with decompensated cirrhosis. Bone mineral density (BMD) measured by dual-energy x-ray absorptiometry (DXA) is the best procedure for assessment of osteoporosis and fracture risk, but BMD values at the central skeleton may be influenced by changes in soft tissues. Therefore, we have studied the effect of ascites on BMD. BMD was measured by DXA at the lumbar spine, femoral neck and total hip, just before and shortly after therapeutic paracentesis in 25 patients with advanced liver cirrhosis. Changes in BMD, lean and fat mass, abdominal diameter and weight, as well as the amount of removed ascites were measured. The amount of drained ascites was 6.6 ± 0.5 l (range: 3.0 to 12.7 l). After paracentesis, BMD increased at the lumbar spine (from 0.944 ± 0.035 to 0.997 ± 0.038 g/cm(2), p < 0.001) and at the total hip (from 0.913 ± 0.036 to 0.926 ± 0.036 g/cm(2), p < 0.01). Patients with a volume of drained ascites higher than 4 l showed a significant increase in lumbar BMD (7.0%), compared with patients with a lower amount (1.5%) (p < 0.03). The decrease in total soft tissue mass correlated with the amount of removed ascites (r = 0.951, p < 0.001). Diagnosis of osteoporosis or osteopenia changed after paracentesis in 12% of patients. Ascites over 4 l causes inaccuracy of BMD measurements, particularly at the lumbar spine. This fact must be considered when assessing bone mass in patients with advanced cirrhosis.
  Osteoporosis International 08/2011; 23(4):1481-7. · 4.58 Impact Factor
• Article: Prolonged bisphosphonate release after treatment in women with osteoporosis. Relationship with bone turnover.

  P Peris, M Torra, V Olivares, R Reyes, A Monegal, A Martínez-Ferrer, N Guañabens
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  ABSTRACT: Bisphosphonates (BP), especially alendronate and risedronate, are the drugs most commonly used for osteoporosis treatment, being incorporated into the skeleton where they inhibit bone resorption and are thereafter slowly released during bone turnover. However, there are few data on the release of BP in patients who have received treatment with these drugs for osteoporosis. This information is essential for evaluating the possibility of BP cyclic therapy in these patients and for controlling their long-term presence in bone tissue. This study evaluated the urinary excretion of alendronate and risedronate in patients treated with these drugs for osteoporosis and analysed its relationship with bone turnover, time of previous drug exposure and time of treatment discontinuation. We included 43 women (aged 65±9.4 years) previously treated with alendronate (36) or risedronate (7) during a mean of 51±3 and 53±3 months, respectively, who had not been treated with other antiosteoporotic treatment and with a median time of discontinuation of 13.5 and 14 months, respectively. Both BP were detected in 24-hour urine by HPLC. In addition, bone formation (PINP) and resorption (NTx) markers were analysed. Both BP were also determined in a control group of women during treatment. Alendronate was detected in 41% of women previously treated with this drug whereas no patient previously treated with risedronate showed detectable urinary values. All control patients showed detectable values of both BP. In patients with detectable alendronate levels, the time of drug cessation was shorter than in patients with undetectable values (12 [6-19] versus 31 [7-72] months, p<0.001). Alendronate was not detected in any patient 19 months after treatment cessation. Alendronate levels were inversely related to time of treatment discontinuation (r=-0.403, p=0.01) and the latter was directly related to NTx (r=0.394, p=0.02). No relationship was observed with age, length of drug exposure, renal function or weight. In conclusion, contrary to risedronate, which was not detected in patients after cessation of treatment, alendronate was frequently detected in women previously treated with this agent up to 19 months after discontinuation of therapy. The relationship between alendronate levels and both bone resorption and time of treatment cessation further indicates a residual effect of this drug in bone, despite treatment discontinuation.
  Bone 06/2011; 49(4):706-9. · 4.02 Impact Factor
• Article: URSODEOXYCHOLIC ACID NEUTRALIZES THE NOXIOUS EFFECTS OF LITHOCHOLIC ACID AND BILIRUBIN ON OSTEOBLASTS

  M Dubreuil, S Ruiz-Gaspa, A Martinez-Ferrer, A Enjuanes, P Peris, M J Martinez de Osaba, L Alvarez, A Monegal, A Combalia, N Guanabens, A Pares
  Journal of Hepatology 03/2011; 54(1}, Meeting Abstract = {1306):S515. · 9.26 Impact Factor
• Article: Ursodeoxycholic acid neutralizes the noxious effects of lithocholic acid and bilirubin on osteoblasts

  M Dubreuil, S Ruiz-Gaspa, A Martinez-Ferrer, A Enjuanes, P Peris, Martinez M J Osaba, L Alvarez, A Monegal, A Combalia, A Pares, N Guanabens
  Bone 01/2011; 48(2):S115. · 4.02 Impact Factor
• Article: Efficacy of low doses of pamidronate in osteopenic patients administered in the early post-renal transplant.

  J-V Torregrosa, D Fuster, A Monegal, M A Gentil, J Bravo, L Guirado, A Muxí, J Cubero
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  ABSTRACT: This study evaluates the efficacy of low doses of pamidronate after renal transplantation to prevent bone loss in osteopenic patients. Results show that pamidronate is safe and significantly reduced spinal bone loss when administered immediately after renal transplantation. The purpose of this work is to evaluate the efficacy of two intravenous infusions of pamidronate in the immediate post-transplant period in a renal transplant (RT) population. In this 12-month, randomized, double-blind, multicenter trial, 39 kidney recipients with diagnosed osteopenia received two doses of 30 mg of disodium pamidronate (n = 24) or placebo (n = 15), at surgery and 3 months post-RT. All patients received calcium and vitamin D. Bone density of the lumbar spine and total femur was measured by dual-energy X-ray absorptiometry (DXA) and X-rays were performed at RT, 6 and 12 months post-RT. Biochemical and hormonal determinations were performed before and after treatment. Pamidronate significantly reduced spinal bone loss, but no significant benefit was found for the incidence of fractures. Elevated baseline intact parathyroid hormone (iPTH) and bone remodeling markers returned to normal levels 3 months post-RT. However, normal procollagen type I N propeptide (PINP) concentrations were only maintained in the pamidronate group. After RT, a comparable graft function was observed in both groups according to creatinine values, 25-hydroxyvitamin-D (25-OH-D) levels were improved, and serum calcium levels normalized after a transient fall during the first 3 months. A low dose of pamidronate prevents bone loss in osteopenic patients when administered immediately after RT.
  Osteoporosis International 03/2010; 22(1):281-7. · 4.58 Impact Factor
• Article: Lithocholic acid downregulates vitamin D effects in human osteoblasts.

  S Ruiz-Gaspà, N Guañabens, A Enjuanes, P Peris, A Martinez-Ferrer, M J Martinez de Osaba, B Gonzalez, L Alvarez, A Monegal, A Combalia, A Parés
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  ABSTRACT: Osteoporosis is a common complication in chronic cholestasis. It has been proposed that retained substances such as bile acids may produce a damaging effect on bone cells. This study analyses the effects of lithocholic acid (LCA) on cell survival and vitamin D metabolism in human osteoblasts (hOB). Human osteoblasts cultures were performed with or without foetal bovine serum (FBS) or human albumin (HA) at different LCA concentrations and times with or without vitamin D. Lithocholic acid at concentrations higher than 10(-5 )M decreased cell survival. This effect was partially prevented by the presence of FBS or HA. Vitamin D stimulated CYP24A, BGLAP and TNFSF11 expression in hOB and these effects were modified by nontoxic LCA concentrations. LCA significantly decreased vitamin D stimulation of CYP24A, BGLAP and TNFSF11 gene expression at 72%, 79% and 56% (respectively). LCA alone has an agonistic effect, as has vitamin D, thus partially increasing CYP24A and BGLAP expression, but with no changes on TNFRSF11B expression. Equivalent effects of the LCA were observed by performing gene reporter assays using MG-63 cells transfected with constructs containing CYP24A1 promoter regions. Lithocholic acid decreases the stimulatory effect of vitamin D on CYP24A, BGLAP and TNFSF11 expression in hOB. This effect is produced through vitamin D response elements (VDREs), located in the promoter regions of these genes, suggesting that LCA acts as a mild analogous of vitamin D, interacting with the vitamin D receptor. These results may explain the potential deleterious effects of retained bile acids on hOB.
  European Journal of Clinical Investigation 01/2010; 40(1):25-34. · 3.02 Impact Factor
• Article: PATIENTS WITH ASCITES HAVE FALSE VALUES OF BONE MINERAL DENSITY AT THE CENTRAL SKELETON. A PROSPECTIVE STUDY

  A Martinez-Ferrer, R Reyes, A Monegal, A Muxi, J Caballeria, P Peris, F Pons, A Pares, N Guanabens
  Journal of Hepatology 01/2010; 52(1):S331. · 9.26 Impact Factor
• Article: MONTHLY IBANDRONATE VS. WEEKLY ALENDRONATE IN THE TREATMENT OF OSTEOPOROSIS ASSOCIATED WITH PRIMARY BILIARY CIRRHOSIS: SIMILAR EFFICACY BUT DIFFERENT ADHERENCE

  A Pares, D Cerda, A Monegal, A Muxi, L Caballeria, P Peris, F Pons, N Guananbens
  Journal of Hepatology 01/2010; 52(1):S79. · 9.26 Impact Factor
• Article: HIGH BILIRUBIN REDUCES CELL SURVIVAL AND DIFFERENTIATION OF PRIMARY HUMAN OSTEOBLASTS. IS THIS EFFECT APPLICABLE TO THE SERUM OF CHRONIC CHOLESTATIC PATIENTS?

  S Ruiz-Gaspa, A Martinez-Ferrer, A Enjuanes, P Peris, M J Mertinez de Osaba, L Alvarez, A Monegal, A Combalia, N Guanabens, A Pares
  Journal of Hepatology 01/2010; 52(1):S214-S215. · 9.26 Impact Factor
• Article: Risk factors for fracture and osteopenia in primary biliary cirrhosis

  N Guanabens, D Cerda, A Monegal, F Pons, L Caballeria, P Peris, A Pares
  Bone 06/2009; 44(2):S387. · 4.02 Impact Factor
• Article: Lithocholic acid decreases cell survival and downregulates the effects of vitamin d3 on primary human osteoblasts

  S Ruiz-Gaspa, A Enjuanes, P Peris, A Martinez-Ferrer, M Martinez de Osaba, L Alvarez, A Monegal, A Combalia, B Gonzalez, A Pares, N Guanabens
  Bone 06/2009; 44(2):S319-S320. · 4.02 Impact Factor
• Article: Lithocholic Acid Downregulates the Effects of Vitamin D-3 on Primary Human Osteoblasts

  S Ruiz-Gaspa, A Enjuanes, P Peris, A Martinez-Ferrer, Martinez M J Osaba, L Alvarez, A Monegal, A Combalia, B Gonzalez, N Guanabens, A Pares
  Journal of Bone and Mineral Research 09/2008; 23(S):S140. · 6.37 Impact Factor
• Article: Fracture Risk In Primary Biliary Cirrhosis: Role of Osteopenia and Severity of Cholestasis.

  N Guanabens, D Cerda, A Monegal, F Pons, L Caballeria, P Peris, A Pares
  Journal of Bone and Mineral Research 09/2008; 23:S486. · 6.37 Impact Factor
• Article: Fracture risk in primary biliary cirrhosis: Role of osteopenia and severity of cholestasis

  A Pares, D Cerda, A Monegal, F Pons, L Caballeria, P Peris, N Guanabens
  Journal of Hepatology 01/2008; 48(2}, Meeting Abstract = {876):S329. · 9.26 Impact Factor
• Article: Progressive paraplegia in a renal transplant patient with normal allograft function.

  D Fuster, A Monegal, J-V Torregrosa
  Kidney International 12/2006; 70(9):1533. · 6.61 Impact Factor
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  Article: Biochemical response to bisphosphonate therapy in pagetic patients with skull involvement.

  P Peris, L Alvarez, S Vidal, D Kasper, D J Leeming, A Monegal, M Angeles Martínez, F Pons, N Guañabens
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  ABSTRACT: The aims of this study were to compare the response to therapy in disease activity in pagetic patients with and without skull involvement and the usefulness of bone markers in the evaluation of these patients. Forty patients with Paget's disease treated with tiludronate and 26 healthy controls were included. Serum total and bone alkaline phosphatases (TAP, BAP), procollagen I N propeptide (PINP), and urinary N- and C-terminal cross-linking telopeptides of collagen I (NTX, alpha-alpha CTX, and beta-beta CTX) were measured at baseline and 6 months after therapy. The extent of the disease was evaluated using the Coutris' index. Pagetic patients were classified into three groups: patients with skull involvement (G-I, n = 12), patients without skull involvement (G-II, n = 28), and a subgroup of patients from G-II without skull involvement but with similar disease extent to G-I (G-III, n = 10). At baseline, patients from G-I showed significantly higher values in most markers compared to G-II. alpha-alpha CTX was the marker with the highest values in all groups. Moreover, monostotic patients with skull involvement showed higher serum baseline values of TAP per unit of affected area than monostotic patients without skull involvement. After therapy, the percentage of patients with markers within the normal range was lower in G-I than in G-II and G-III. In conclusion, pagetic patients with skull involvement showed a marked increase in bone turnover and a lower response to therapy.
  Calcified Tissue International 08/2006; 79(1):22-6. · 2.38 Impact Factor
• Article: Multifocal avascular necrosis after liver transplantation: an unusual presentation of the antiphospholipid syndrome.

  J Mundo, P Peris, A Monegal, M Navasa, R Cervera, N Guañiabens
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  ABSTRACT: We describe the case of a 31-year-old man who presented with an antiphospholipid syndrome (APS), which manifested as multifocal avascular necrosis (AVN) one year after orthotopic liver transplantation. The patient developed multiple AVN affecting hips, left knee, humerus and tarsal bones just after withdrawal of corticosteroid therapy. Three years later when lupus anticoagulant was detected, he began anticoagulant treatment and no further AVN episodes were observed. It is important to be aware of this clinical manifestation of APS, especially in these cases where it can be easily overlooked because of corticosteroid therapy.
  Lupus 02/2006; 15(5):304-7. · 2.34 Impact Factor
• Article: Once-weekly compared with daily alendronate for low bone mass in women with primary biliary cirrhosis

  A Pares, I Vazquez, L Alvarez, L Caballeria, F Pons, D Cerda, P Peris, A Monegal, N Guanabens
  Journal of Hepatology 01/2006; 44(2}, Meeting Abstract = {646):S239-S240. · 9.26 Impact Factor
• Article: Alendronate 70 mg once-weekly is more effective and has a better tolerability than alendronate 10 mg daily in the treatment of osteopenia aassociated with primary biliary cirrhosis.

  N Guanabens, I Vazquez, L Alvarez, F Pons, L Caballeria, D Cerda, P Peris, A Monegal, A Pares
  Journal of Bone and Mineral Research 09/2005; 20(9, 1):S279. · 6.37 Impact Factor