C Gómez Alonso

Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

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Publications (42)63.05 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background The present work, performed as follow-up of the prevalence study of vertebral fractures (EVOS Study), evaluates in a 6 year period the incidence of vertebral fractures and other osteoporotic fractures in Oviedo (Asturias, Spain) in people older than 50 years. Patients and method The study was performed in a cohort from the Oviedo's local registry in 1986. 624 men and women were followed by 3 postal questionnaires. The first questionnaire referred to the history of falls and fractures that happened during the follow-up period performed. Between the 2nd and 3rd follow-up subjects were invited to repeat the X-rays previously performed in the initial study. Results The incidence of osteoporotic fractures was higher in women than in men. In both sexes, vertebral fracture was the one which reached the highest incidence. Compared with men, Colles fracture in women occurred earlier, with 5 times higher incidence. The incidence of hip fracture was twice higher in women than in men. A prevalent vertebral fractures increased until 5 times the incidence of vertebral and hip fracture. Conclusions Among the osteoporotic fractures, vertebral fracture had a highest incidence values in both sexes. Although vertebral and hip fractures were twice incident in women compared with men, the incidence of Colles fracture was five times higher in women. A pre-existing vertebral fracture is an important risk factor to develop a new vertebral or hip fracture.
    Medicina Clínica. 07/2013; 115(17):650–653.
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    ABSTRACT: Background In spite of vertebral fracture is one of the most frequent osteoporotic fracture, the epidemiology of this entity remains unknown. The aim of this study was to know the prevalence of vertebral fracture in Oviedo (Spain), according to the most used radiologic criteria in research Subjects And Methods A random sample of 624 men and women older than 50 years from the Oviedo's municipality took part in this analysis. All participants performed two thoracic and lumbar spinal lateral radiographs. In 615 subjects the presence of vertebral fracture was performed using a semicuantitative radiological criteria (Genant) and two morphometric criteria (Eastell and McCloskey) Results Prevalence of vertebral fracture varies between 17.4 and 24.6%, according to the radiological criteria used. The prevalence was higher in women than in men, but the differences were lower than expected, and there was a relative high frequency of vertebral fractures in men from 50 to 65 years old. In both sexes, prevalence of vertebral fracture increased with age, although in a steeper manner in women. The incidence of vertebral fracture in women was almost twice than in men. The incidence increased with age. Every ten years the prevalence of vertebral fracture increased two times. Conclusions Prevalence of vertebral fracture was high in women and men older than 50 years, mainly in women older than 70 years, independently of the radiological criteria used. The average prevalence of vertebral fracture in Oviedo (Spain) has been similar to that observed in studies of American, European and Asian populations
    Medicina Clínica. 07/2013; 115(9):326–331.
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    ABSTRACT: An observational cross-sectional study was conducted to assess calcium intake and vitamin D status by measurement of 25-hydroxyvitamin D (25(OH)D), in postmenopausal osteoporotic women (PMOW) treated and untreated for osteoporosis. To assess the influence of sunlight exposure on vitamin D status, the study group was categorized on the basis of sunlight exposure (above or below 2,500 sunlight hours/year). A group of 336 PMOW older than 65 years was identified (190 [56.5%] treated and 146 [43.5%] untreated for osteoporosis). The demographic and clinical data of the PMO women included history of prior fractures, pharmacological treatments and dietary calcium intake. BMD was measured by DEXA and 25(OH)D was determined by an HPLC method. Results: vitamin D serum levels were lower in the untreated group as compared with the treated group (58 ±27 vs. 67 ±27 nmol/l; p=0.006). Prevalence of vitamin D deficiency (cut-off point set at <50 nmol/l) was higher in the non-treated group (43.8% vs. 29.5%; p=0.009). Nearly all PMOW, whether treated or not for osteoporosis had a total calcium intake of less than 1,200mg. Sunlight exposure did not influence the vitamin D status. Conclusions: Vitamin D deficiency and an insufficient calcium intake are highly prevalent in both treated and untreated Spanish PMOW older than 65 years. This can be related to low therapeutic adherence and/or insufficient prescription. Therefore physician's and patient's knowledge regarding the optimization of vitamin D status and calcium intake should be improved and implemented.
    The Journal of steroid biochemistry and molecular biology 11/2012; · 3.98 Impact Factor
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    ABSTRACT: Among the chronic kidney disease-mineral bone disease (CKD-MBD) disorders, osteoporosis and adynamic bone are highly prevalent, and they have been consistently associated with low bone mass, bone fractures, vascular calcifications and greater mortality in general and CKD populations. Despite the fact that osteoporosis and adynamic bone have similar clinical outcomes, they have different pathogeneses and clinical management. In osteoporosis, there is a lack of balance between bone formation and bone resorption, and less new bone is formed to replace bone losses. Osteoporosis is defined by the World Health Organization as "a disease characterized by low bone mineral density and micro architectural deterioration leading to low bone strength and increased risk of fractures." In the general population, there is a good correlation between dual-energy X-ray absorptiometry measurements and bone fractures, but this is not the case with CKD patients. Despite the fact that we have a great number of active antiosteoporotic drugs, the experience in CKD patients is limited. Adynamic bone is suspected based on biochemical parameters, mainly parathyroid hormone (PTH) and bone alkaline phosphatase, but it needs to be proven using a bone biopsy, where a low or zero bone formation rate and a reduction or absence of osteoblasts and osteoclasts should be found. The clinical management of adynamic bone has important limitations and currently does not allow taking many active measures. Treatment is mainly based on the prevention of risk factors known to induce PTH oversuppression, such as aluminium and calcium load and very high doses of vitamin D receptor activators. Due to the limitations in the treatment of both conditions, prevention plays a key role in the management of these disorders.
    Journal of nephrology 09/2012; · 2.02 Impact Factor
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    ABSTRACT: The aim of the study was to analyse the risk of fracture calculated using the FRAX® tool and its determinants in patients who have received a kid-ney transplant referred to us for control of bone repercussions. A total of 113 patients were studied, 42 men and 71 women with a functioning transplanted kidney, who completed a general survey. A bone densitometry test of the PA lumbar spine (L2 - L4) and hip (femoral neck and total hip) was carried out on all patients using a Hologic QDR 1000® densitometer. With the data obtained from the survey, the risk of fracture was calculated using the FRAX® tool. The average age of the patients was 57±9 years and the average time since the transplant was 4.6±4.4 years. The risk of presenting major osteoporotic frac-ture after 10 years was 6.54±4.9% and the risk of hip fracture was 2.06±2.67%. When we analyse the risk according to sex, we observe that in women the probability of presenting major osteoporotic fracture after 10 years was signifi cantly higher than in men (7.6±5.2% compared to 4.8±3.7%, p=0.001). The risk of hip fracture after 10 years was also slightly higher in women than in men, but not signifi cantly (2.3±2.8% compared to1.6±2.4%).
    Revista de la Sociedad Espanola de Enfermeria Nefrologica 01/2010; 13(2).
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    C. Gómez Alonso, J. B. Díaz López
    Revista Clinica Espanola - REV CLIN ESPAN. 01/2009; 209:15-22.
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    ABSTRACT: Our objective has been to elaborate an updated Clinical Guide of the Spanish Society of Internal Medicine (SEMI) for the prevention and treatment of glucocorticoids-induced osteoporosis (GIO), identifying and measuring the grade of evidence that supports the given recommendations. For this, we reviewed studies performed on pathophysiology, diagnosis, prevention and treatment of GIO and after analyzing them we elaborated the present recommendations. This was done after a pre-specified and reproducible process that included an accepted model for the evaluation, and the reference of the evidence that supported it. Once the Scientific Committee elaborated the draft of the Clinical Guide, it was reviewed by all the members of the Working Group on Osteoporosis of the SEMI, and by an External Committee who included experts of many different specialities. Pathophysiology of GIO is complex and yet unknown. Bone effects of glucocorticoids are determined by multiple factors although accumulated doses seems to be the most important one. The best method to diagnose GIO is Dual X-Ray Absorptiometry (DXA), although WHO criteria defined for the diagnosis of postmenopausal osteoporosis are not applicable in GIO. The presence of a T-score lower than -1.5 Tscore indicates the necessity of treatment in any patient who receives or is going to receive more than 3 months treatment with glucocorticoids at a dose higher than 2.5 mg/day (in postmenopausal women) and 5 mg/day (in premenopausal women and men). DXA is also useful to follow up the patients, who can be done annually. Treatment must be prescribed to any patient who is receiving glucocorticoids or is going to receive them at doses higher than 7.5 mg/day for more than 3 months and 5 mg/day if the patient is a postmenopausal woman or has suffered from previous fragility fractures. Risedronate and alendronate are the drugs of election, always together with calcium and vitamin D supplements and general measurements usually prescribed in the treatment of osteoporosis. In very ill patients, parathyroid hormone can be used. The treatment for GIO should be maintained while glucocorticoid therapy is used.
    Revista Clínica Española 02/2008; 208(1):33-45. · 2.01 Impact Factor
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    ABSTRACT: Our objective has been to elaborate an updated Clinical Guide of the Spanish Society of Internal Medicine (SEMI) for the prevention and treatment of glucocorticoids-induced osteoporosis (GIO), identifying and measuring the grade of evidence that supports the given recommendations. For this, we reviewed studies performed on pathophysiology, diagnosis, prevention and treatment of GIO and after analyzing them we elaborated the present recommendations. This was done after a pre-specified and reproducible process that included an accepted model for the evaluation, and the reference of the evidence that supported it. Once the Scientific Committee elaborated the draft of the Clinical Guide, it was reviewed by all the members of the Working Group on Osteoporosis of the SEMI, and by an External Committee who included experts of many different specialities. Pathophysiology of GIO is complex and yet unknown. Bone effects of glucocorticoids are determined by multiple factors although accumulated doses seems to be the most important one. The best method to diagnose GIO is Dual X-Ray Absorptiometry (DXA), although WHO criteria defined for the diagnosis of postmenopausal osteoporosis are not applicable in GIO. The presence of a T-score lower than -1.5 Tscore indicates the necessity of treatment in any patient who receives or is going to receive more than 3 months treatment with glucocorticoids at a dose higher than 2.5 mg/day (in postmenopausal women) and 5 mg/day (in premenopausal women and men). DXA is also useful to follow up the patients, who can be done annually. Treatment must be prescribed to any patient who is receiving glucocorticoids or is going to receive them at doses higher than 7.5 mg/day for more than 3 months and 5 mg/day if the patient is a postmenopausal woman or has suffered from previous fragility fractures. Risedronate and alendronate are the drugs of election, always together with calcium and vitamin D supplements and general measurements usually prescribed in the treatment of osteoporosis. In very ill patients, parathyroid hormone can be used. The treatment for GIO should be maintained while glucocorticoid therapy is used.
    Revista Clinica Espanola - REV CLIN ESPAN. 01/2008; 208(1):33-45.
  • Revista Clinica Espanola - REV CLIN ESPAN. 01/2008; 208:1-24.
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    Endocrinología y Nutrición. 08/2007; 54(7).
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    ABSTRACT: In the last years, the likely role of the vitamin D receptor polymorphisms in different diseases has been discussed. In this work we review several studies performed to investigate the influence of the vitamin D receptor polymorphisms and type I collagen in different aspects of bone and parathyroid gland metabolism. On one hand, the epidemiological studies showed that BAt haplotype from BsmI, ApaI and TaqI polymorphisms in the vitamin D receptor and SS genotype in sp1 polymorphism in type I collagen gene predicted the risk for osteoporotic fractures. On the other hand, experimental studies carried out in both human primary osteoblasts and parathyroid glands showed that while baT haplotype responded better to calcitriol in osteoblasts, BAt haplotype showed the best response in parathyroid glands. The most favorable allele combination in the bone is not in the parathyroid gland and vice versa. These findings are indicative of a tissue specific effect of the vitamin D receptor in the response to calcitriol.
    Revista Española de Enfermedades Metabólicas Óseas. 01/2007; 16(1).
  • J. B. Díaz López, C. Gómez Alonso
    Medicine - Programa de Formación Médica Continuada Acreditado. 06/2006; 9(60).
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    ABSTRACT: To conduct an opinion survey on osteoporosis in Spanish internists. Survey sent by mail and by personal visit to members of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment. A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to densitometry. The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases.
    Revista Clínica Española 09/2005; 205(8):379-82. · 2.01 Impact Factor
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    ABSTRACT: Background It is a matter of discussion whether or not Colles’ fracture is an osteoporotic fracture, or it is more related to traumatism. We studied the distribution of clinical characteristics and risk factors for osteoporosis in a group of postmenopausal women suffering from Colles’ fracture and compared them to a control group. Method Case-control study. We studied 121 postmenopausal Spanish women who had a forearm fracture (Colles’ fracture) within the 6 months prior to the study. Three hundred and forty eight women who had no Colles’ fracture were the controls. We studied in every woman age, weight, height, actual calcium intake and some gynecological data as age at menarche, age of menopause, fertile years, years since menopause and number of children. We also collected data about some other risk factors for osteoporosis, as consumption of alcohol and tobacco. Results Colles’ patients had more age and less stature than controls and have had the menarche later than controls (13.8 ± 1.9 years vs. 13.2 ± 2.6 years, p = 0.007). We also found an association between Colles’ fracture and lactation for more than one year (odds ratio: 1.80, CI 95%: 1.07-3.03). On the other hand, fractured women had a less proportion of bilateral oophorectomy than controls (odds ratio: 0.31, CI 95%: 0.14-0.71). We found a higher prevalence of falls in patients with Colles’ fracture (61.0% vs. 29.3%, p < 0.001, odds ratio 3.81 CI 95%: 2.42-5.99), an a lower proportion of treatments for osteoporosis (14.9% vs. 27%, p = 0.007, odds ratio 0.40, CI 95% 0.22-0.74). A family history of fractures almost reached statistically significance. Conclusion Postmenopausal women suffering from Colles’ fracture have less height than controls and had the menarche earlier than them. We found an association between Colles’ fracture and lactation during more than a year, and also between Colles’ fracture and falls in the last year. Curiously, postmenopausal women with Colles’ fracture received less treatment for osteoporosis than controls. A family history of fracture could be another risk factor for Colles’ fracture, although the statistical significance was unclear.
    Revista Española de Enfermedades Metabólicas Óseas. 03/2005; 14(2).
  • Carlos Gómez Alonso, Carme Mallofré, Xavier Tomás
    Medicina Clínica 07/2003; 121(3):109-16. · 1.40 Impact Factor
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    ABSTRACT: In recent years, a large number of techniques have been developed to estimate the bone mineral density for the diagnosis of osteoporosis. However, diagnostic criteria established by WHO are invariably applied for the interpretation of dual radiological densitometry (DEXA), which could not be correct in the case of the interpretation of ultrasound. We studied 2,589 randomly chosen people of both sexes, 1,138 males and 1,451 women from 10 to 99 years, in 11 spanish provinces. We carried out a measurement of the following calcaneous ultrasound parameters with the Sahara and Hologic devices: speed of the sound (SOS), coefficient of attenuation of wide band (BUA), index of consistency (QUI) and estimated bone mineral density (est. BMD). The prevalence of osteopenia and osteoporosis was calculated by applying the WHO criteria (osteopenia Tscore < or = 1 and osteoporosis Tscore < or = 2.5) and the prevalence of osteoporosis by applying a Tscore 1.8 as threshold. According to the WHO criteria, osteoporosis (Tscore < or = 2.5) is seen in 1.5 % males and 5.9 % females from 51 to 70 years, and in 2.6% males and 22.1% females over 70 years. Using a Tscore 1.8 as threshold, osteoporosis prevalence increases to 8.2% males and 21.9% females from 51 to 70 years, and to 8.4% males and 40.9% females over 70 years. Osteoporosis prevalence in spanish people of both sexes differs notably when applying the cut off point in a Tscore of 2.5, as WHO recommends, or in a Tscore of 1.8 as is suggested by other authors. Consensus is necessary to establish the appropriate cut off point or threshold for the diagnosis of osteoporosis with quantitative ultrasonography of calcaneum.
    Revista Clínica Española 07/2003; 203(7):329-33. · 2.01 Impact Factor
  • Carlos Gómez Alonso, Carme Mallofré, Xavier Tomás
    Medicina Clinica - MED CLIN. 01/2003; 121(3):109-116.
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    ABSTRACT: There has been a poor consensus in defining normal levels of 25(OH) D. It has been traditionally recognized that 25(OH)D serum levels below 5-7 ng/ml induce osteomalacia, serum levels below 10-12 ng/ml induce secondary hyperparathyroidism and osteoporosis, and serum levels above 18-20 ng/ml are usually considered normal or adequate. Due to the results obtained in several studies, a more functional classification has recently been proposed defining serum 25(OH)D levels > 40 ng/ml or > 100 nmol/l as "desirable", serum levels between 20 and 40 ng/ml or 50 and 100 nmol/l as hypovitaminosis D, levels between 10 and 20 ng/ml or 25 and 50 mmol/l as vitamin D insufficiency and 25(OH)D levels below 10 ng/ml or 25 nmol/l as deficient. These new cut-off levels, suggest that, in the past, we had been using a wrong statistical approach for defining "normal serum 25(OH)D levels". In agreement with this new classification, in a recent study conducted in a random sample of our population, a high prevalence of low levels of 25(OH)D and secondary hyperparathyroidism was found. In our study, only in those people having "excellent" renal function, representing only 15% of the sample (serum creatinine < 1 mg/dl in men and < 0.8 in women, mean age of 68 years) hyperparathyroidism was not diagnosed despite observing 25(OH)D serum levels around 18-30 ng/ml or 45-75 nmol/l). In the remaining people (85% of the sample), who showed the expected serum creatinine increments according to their age, secondary hyperparathyroidism was avoided only if the serum 25(OH)D levels were higher than 30 ng/ml or 75 nmol/l. These remarkable findings demonstrate the importance of maintaining higher 25(OH)D levels--in addition to normal calcitriol levels--in order to avoid stimulation of the parathyroid gland. In 87 patients with a functioning renal transplantation only a 11.5% of they had levels of 25(OH)D higher than 30 ng/ml and it was correlated with PTH. These remarkable findings demonstrate the importance of maintaining higher 25(OH)D levels--in addition to normal calcitriol levels--in order to avoid stimulation of the parathyroid gland in aged people. Thus, the deficiency or even "subtle deficiency" of 25(OH)D, currently neglected in the daily management of patients with chronic renal failure, may play an important role in the maintenance of hormonal and mineral homeostasis.
    Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 01/2003; 23 Suppl 2:73-7. · 1.27 Impact Factor
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    ABSTRACT: Bone mass (BMD) may be evaluated by digital X-ray radiogrammetry (DXR) which it is estimated from multiple cortical measures carried out on five regions of interest over a simple hand-forearm X-ray film. We included 168 HD patients (108 men and 60 women; 63 +/- 14 and 66 +/- 12 years old respectively--p < 0.05-) coming from seven HD units in Asturias. We performed a hand-forearm X-ray, an epidemiologic questionnaire and we revised their medical and analytical records. As the normative data we used the measurements of a random sample of 247 subjects from our own population. The prevalence of osteoporosis was 7% and 40% in men and women respectively. BMD was correlated with weight (r = 0.346), time on HD (r = -0.188), time on treatment (r = -0.235). The porosity was correlated with PTH levels.
    Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 01/2003; 23 Suppl 2:100-5. · 1.27 Impact Factor
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    ABSTRACT: Dialysis patients have bone metabolic disorders and a higher prevalence of fractures, principally peripheral fractures. However, there are few studies focusing on the prevalence of vertebral fractures. Moreover, aortic calcifications are very common and are an independent predictive factor of vascular morbidity and mortality. The objective of this study was to assess the prevalence of vertebral fractures and vascular calcifications in haemodialysis (HD) patients (n = 99), in comparison with a random sample of general population of similar age and from the same geographical area (n = 624) and study their relationship with clinical, biochemical and therapeutical data. The prevalence of vertebral fractures in HD patients and general population was 19.1% and 24.1% respectively (non-significant statistical differences). In both, sexes, the presence of vertebral fractures was positively associated with age, mean maximum Ca, mean maximum CaxP. In women, time in HD was positively associated as well. On the other hand, the prevalence of aortic calcifications was much higher in HD patients (77.9% vs 37.5%, p < 0.001). HD was a risk factor for aortic calcification in women [OR = 7.7 (IC 95% = 2.6-22.9)] as in men [OR = 5 (IC 95% = 1.9-12.9)]. Severe vascular calcifications were more frequent in HD patients, it reached 57.4% compared with 17% of general population (p < 0.001). Both, in women (64.5% vs 13.3% p < 0.001) and in men (51.4% vs 20.9%), respectively (p < 0.001). In conclusion, the prevalence of vertebral fractures was similar in HD patients and in general population. Nevertheless, frequency and severity of aortic calcifications was higher in HD patients.
    Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 01/2003; 23 Suppl 2:106-11. · 1.27 Impact Factor

Publication Stats

251 Citations
63.05 Total Impact Points

Institutions

  • 2007–2012
    • Hospital Universitario Central de Asturias
      Oviedo, Asturias, Spain
  • 2003–2012
    • University of Oviedo
      Oviedo, Asturias, Spain
  • 2005
    • Universidad de Las Palmas de Gran Canaria
      Las Palmas, Canary Islands, Spain
  • 1995–2001
    • Hospital Central de Asturias
      Oviedo, Asturias, Spain
  • 2000
    • Parc de Salut Mar
      Barcino, Catalonia, Spain