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ABSTRACT: In this prospective study, we found a positive relationship between the prevalence of aortic calcifications and age. Aortic calcifications at baseline were positively associated with osteoporotic fractures. In addition, progression of aortic calcifications was also positively associated with the rate of decline in BMD at lumbar spine.
The aim of this study was to analyze the relationship between the progression of abdominal aortic calcification and osteoporosis in a Spanish cohort of men and women older than 50.
Men and women (n=624) aged 50 and over underwent two lateral X-rays of thoracic and lumbar spine and a dual X-ray absorptiometry (DXA) study at lumbar spine and hip, and were followed during 4 years. Abdominal aortic calcifications were classified as absent, mild-moderate and severe.
There was a positive relationship between the prevalence of aortic calcifications and age. In both sexes, prevalent severe aortic calcifications were positively associated with prevalent osteoporotic fractures [odds ratio (OR)=1.93 (1.02-3.65)]. The association was stronger when only vertebral fracture was considered [OR=2.45 (1.23-4.87)]. In addition, progression of aortic calcifications showed a positive association with the rate of decline in bone mineral density (BMD) at lumbar spine.
Aortic calcifications at baseline were positively associated with osteoporotic fractures. The progression of aortic calcifications was also positively associated with the rate of decline in BMD at lumbar spine.
Osteoporosis International 09/2008; 19(8):1161-6. · 4.58 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 Clínica Española 02/2008; 208(1):33-45. · 2.01 Impact Factor
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M Sosa,
P Saavedra, C Gómez-Alonso,
J Mosquera,
A Torrijos,
M Muñoz-Torres,
C Valero Díaz de la Madrid,
M Díaz Curiel,
G Martínez Díaz Guerra,
R Pérez-Cano,
J Alegre,
J Del Pino
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ABSTRACT: It is a matter of controversy whether or not Colles' fracture is an osteoporotic fracture. Indeed, the usefulness of quantitative ultrasound in distinguishing Colles' fracture from normal fractures is also unclear.
A cross-sectional case-control study was done on 469 postmenopausal Spanish women, 121 with Colles' fracture and 348 controls. Assessment of risk factors for osteoporosis and measurement of calcaneus quantitative ultrasound were carried out using a Sahara, Hologic device.
Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls, and no statistically significant differences were found. We estimated ROC curves for SOS and a score based on a linear combination of height and SOS (SH-Score). The areas under both curves were 0.56 and 0.61, respectively, which was statistically significant. To obtain 5% false-negative and 10% false-positive figures, the T-score cut-off for SOS was -2.45 and -0.045, respectively. Of these, only 9.2% were classified as high risk and 11% as low risk with 79.8% undetermined.
Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls. Nevertheless, ROC curves calculated by a combination of height and SOS showed that quantitative calcaneus ultrasound may be a useful tool for identifying postmenopausal women with Colles' fracture. These results indicate that measuring bone mineral density with ultrasound only captures limited aspects of the pathophysiology of Colles' fractures.
European Journal of Internal Medicine 01/2006; 16(8):561-6. · 2.00 Impact Factor
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M Sosa Henríquez,
J Filgueira Rubio,
J A López-Harce Cid,
M Díaz Curiel,
C Lozano Tonkin,
A del Castillo Rueda,
P Sánchez Molini,
J Montes Santiago,
C Serrano Fernández,
B Díaz López, [......],
J A Blázquez,
N Ortego Centeno,
R Tirado Miranda,
J R Sánchez Linares,
X Nogués Solán,
J Farrerons Minguela,
F Escobar Jiménez,
J del Pino del Montes,
J González-Macías, C Gómez Alonso
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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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Manuel Sosa,
P Saavedra,
J del Pino-Montes,
J Alegre,
R Pérez-Cano,
G Martínez Díaz Guerra,
M Díaz-Curiel,
C Valero,
M Muñoz-Torres,
A Torrijos,
J Mosquera, C Gómez-Alonso
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ABSTRACT: Measurement of ultrasonographic parameters provides information concerning not only bone density but also bone architecture. We investigated the usefulness of ultrasonographic parameters and bone mineral density (BMD) to evaluate the probability of Colles' fracture. Two-hundred eighty-nine postmenopausal women (62.3 +/- 8.7 yr) with (n = 76) and without (n = 213) Colles' fracture were studied. BMD of lumbar spine and proximal femur was evaluated in all women by dual-energy X-ray absorptiometry (DXA) and speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness in the calcaneus were measured by a Sahara ultrasonometer (Hologic). Patients suffering from Colles' fracture had lower values of BMD adjusted by height at the lumbar spine, L2-L4 (0.797 g/cm2 vs 0.860 g/cm2), femoral neck (0.685 g/cm2 vs 0.712 g/cm2 ), SOS (1518 m/sg vs 1525 m/sg), and stiffness (74.6 vs 77.7) (p < 0.05). Nevertheless, BUA values were similar in both groups. After stepwise logistic regression analysis, the area found under receiver operating characteristic (ROC) curves was 0.60 for L2L4 and 0.63 for a formula combining L2L4 and height. Our data suggest that patients suffering from Colles' fracture have lower values of BMD by DXA, SOS, and stiffness. However, the ability of these techniques to discriminate is low because the values for the area under ROC curve are 0.60 for L2-L4 and 0.63 for a formula derived of the combination of L2-L4 and height.
Journal of Clinical Densitometry 01/2005; 8(4):430-5. · 1.29 Impact Factor
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M Sosa Henríquez,
P Saavedra Santana,
J Alegre López, C Gómez Alonso,
J González Macías,
N Guañabens Gay,
F Hawkins Carranza,
C Lozano Tonkin,
M T Martínez Izquierdo,
J Mosquera Martínez,
M Muñoz Torres,
R Pérez Cano,
J M Quesada Gómez,
E Salas Heredia
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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
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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. · 1.00 Impact Factor
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L Reyes,
M Rodríguez García, C Gómez Alonso,
J Megido,
P Ruiz de Alegría,
A Fonseca,
M Gorostidi,
E Gago,
R Forascepi,
J Guerediaga,
J B Cannata Andía
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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. · 1.00 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. · 1.00 Impact Factor
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ABSTRACT: Effect of vertebral fracture on the perceived health using the SF-36 Health Questionnaire in a representative population older than 54 years.
Randomly cohort from the register of the city Hall of Oviedo. All the 299 subjects (147 men and 152 women) completed the traduced and validated Spanish SF-36 questionnaire four years after radiologic studies were performed to evaluate prevalent vertebral fractures.
Vertebral fracture decreased the health related quality of life, particularly in physical function dimension in males and in mental health dimension in women. This effect was increased when osteopenia was present.
This first study performed in both sexes shows worse perceived health in people with fractures.
Medicina Clínica 05/2001; 116(14):533-5. · 1.38 Impact Factor
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Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2001; 21 Suppl 1:45-50. · 1.00 Impact Factor
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ABSTRACT: 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.
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.
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.
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 12/2000; 115(17):650-3. · 1.38 Impact Factor
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ABSTRACT: 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.
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).
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.
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 10/2000; 115(9):326-31. · 1.38 Impact Factor
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Revista Clínica Española 07/2000; 200(6):327-9. · 2.01 Impact Factor
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ABSTRACT: The effect of femoral bone mineral density (BMD) and several parameters of femoral neck geometry (hip axis length, neck–shaft
angle and mean femoral neck width) on hip fracture risk in a Spanish population was assessed in a cross-sectional study. All
parameters were determined by dual-energy X-ray absorptiometry. There were 411 patients (116 men, 295 women; aged 60–90 years)
with hip fractures in whom measurements were taken in the contralateral hip. Controls were 545 persons (235 men, 310 women;
aged 60–90 years) who participated in a previous study on BMD in a healthy Spanish population. Femoral neck BMD was significantly
lower, and neck–shaft angle and mean femoral neck width significantly higher, in fracture cases than in controls. The logistic
regression analysis adjusted by age, height and weight showed that a decrease of 1 standard deviation (SD) in femoral neck
BMD was associated with an odds ratio of hip fracture of 4.52 [95% confidence interval (CI) 2.93 to 6.96] in men and 4.45
(95% CI 3.11 to 6.36) in women; an increase of 1 SD in neck–shaft angle of 2.45 (95% CI 1.73 to 3.45) in men and 3.48 (95%
CI 2.61 to 4.65) in women; and an increase of 1 SD in mean femoral neck width of 2.15 (95% CI 1.55 to 2.98) in men and 2.40
(95% CI 1.79 to 3.22) in women. The use of a combination of femoral BMD and geometric parameters of the femoral neck except
for hip axis length may improve hip fracture risk prediction allowing a better therapeutic strategy for hip fracture prevention.
Osteoporosis International 01/2000; 11(8):714-720. · 4.58 Impact Factor
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ABSTRACT: Previous studies have shown a different effect of aluminum (Al) on bone metabolism in animals with chronic renal failure and conversely, positive osteogenic effects in animals with normal renal function. The aim of this study was to evaluate the effect of aluminum on bone metabolism in osteopenic rats. We studied male Wistar rats with severe osteopenia induced by adding NH4Cl (2%) to the drinking water over a 6-month period. The rats were divided into two groups and followed for 4 months. The Aluminum group (G1) received AlC13 intraperitoneally (10 mg/kg/5 days/week) (n = 8); the Control group (G2) did not receive any treatment after stopping the administration of NH4Cl (n = 5). In all animals we measured biochemical markers (serum Ca, P, Cr, Al, osteocalcin, hydroxyproline) as well as bone mineral density and bone histomorphometry (BV/TV, CTh, ObS/BS, OTh, and NOc/TV). Bone aluminum content, measured by atomic absorption spectrometry, was 101.6 +/- 13 microg/g in the Al overloaded group and 1.31 +/- 0.14 in controls. Bone mineral density, evaluated by dual X-ray absorptiometry (DXA) at the proximal extremity of the tibia was significantly higher in G1 (0.292 +/- 0.01 g/cm2 versus 0. 267 +/- 0.02 g/cm2). No significant differences were found between the biochemical markers. In the histomorphometric parameters we observed significant differences in G1 compared with G2: an increase in BV/TV (18.59 +/- 5.6 versus 7.69 +/- 3.08%) and in CTh (0.52 +/- 0.06 versus 0.36 +/- 0.07 mm) with a moderate increment of the osteoid thickness (14.05 +/- 4.72 versus 5.25 +/- 0.9 microm) (P < 0. 05). Changes in others parameters and the relationship between biochemical parameters of bone remodeling, Al, and histology were analyzed. These findings indicate that in rats with normal renal function, Al is able to induce bone formation even when osteopenia is present.
Calcified Tissue International 06/1999; 64(6):534-41. · 2.38 Impact Factor
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Nephrology Dialysis Transplantation 02/1998; 13 Suppl 3:73-7. · 3.40 Impact Factor
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ABSTRACT: Prevention, diagnosis and treatment of renal osteodystrophy are continually evolving. We submitted a postal questionnaire to all Spanish dialysis centres, comprising 30 questions, with the aim of obtaining information about the current management of this entity in Spain. The answers from 171 centres, 63% of the total registered (10,724 patients), were analysed. The centres performed an annual average of nine calcium and phosphorus determinations, three for parathyroid hormone (PTH), 1.5 for aluminium and one for bone radiology. For these parameters, nephrologists consider ideal levels to be 10-10.5 mg/dl for calcium (53% of centres), 4.5-5.5 mg/dl for phosphorus (77%) and 120-150 pg/ml for iPTH (75%). The calcium concentration used in the dialysis fluids was found to be variable: 2% of the centres used 2 mEq/l, 44% used 2.5 mEq/l, 28% used 3 mEq/l and 26% used 3.5 mEq/l. When using oral calcitriol, 82% of the centres do not change the calcium concentration in the dialysis fluids; this percentage falls to 51% when calcitriol administration is parenteral. In 78% of centres, vitamin D treatment was started when PTH was high, without taking into consideration the plasma calcium level. The dose varies; in 28% of the centres calcitriol pulse therapy was started when iPTH was >250 pg/ml; 52% when >500 pg/ml and 16% when >750 pg/ml. Seventy one percent of the centres claim to use calcitriol in doses proportional to the severity of hyperparathyroidism. With regard to response to treatment, 78% of the centres wait for 6 months before considering a patient as a 'non-responder' and 80% of the centres would carry out parathyroidectomy only when iPTH is >750 pg/ml. The data collected from the enquiry show that there are important variations in some aspects related to current patient management in the different units in Spain. Diagnostic criteria are relatively homogeneous whereas the therapeutic guidelines are less uniform.
Nephrology Dialysis Transplantation 01/1998; 13 Suppl 3:51-6. · 3.40 Impact Factor
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Revista Clínica Española 07/1992; 191(1):59-60. · 2.01 Impact Factor
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Medicina Clínica 04/1991; 96(10):396. · 1.38 Impact Factor
