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Peris P, Blasco J, Monegal A, Florez H, Guañabens N, Carrasco JL. Effect of gender on the evolution of pain and quality of life after treatment of symptomatic vertebral fragility fractures. Osteoporos Int 2024; 35:515-521. [PMID: 38030857 PMCID: PMC10866778 DOI: 10.1007/s00198-023-06960-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023]
Abstract
The evolution of pain and quality of life after a symptomatic vertebral fracture differs according to patient gender, with a worse evolution in women independently of the treatment received. PURPOSE In a previous randomized clinical study comparing the effect of vertebroplasty (VP) vs. conservative therapy (CT) on pain evolution and quality of life (QoL) of patients with symptomatic vertebral fractures (VF), we observed the development of chronic back pain in 23% of subjects, independently of the therapy received. This study analyses the effect of gender on the evolution of pain and QoL in these subjects. METHODS 118/125 randomized patients (27 males/91 females) with recent symptomatic VFs were evaluated. All received a standardized analgesic and antiosteoporotic format of treatment. Pain and QoL were evaluated by VAS and Qualeffo-41, respectively, at baseline, at 2 weeks and 2 and 6 months. We compared pain evolution and QoL after treatment (CT vs. VP) according to gender, and analysed factors including age, time of evolution, treatment received, baseline VAS, previous VFs (total and recent), incidental VFs, lumbar and femoral T-scores, and analgesic and antiosteoporotic treatment. RESULTS At baseline, there were no differences in age (males 74.8 ± 11.2 vs. females:73.2 ± 8.7 years), time of evolution, number of VFs (males:3.8 ± 2.4 vs. females: 3.1 ± 2.4), treatment received (VP, males:59%, females:45%), lumbar or femoral T-score, baseline VAS (males:6.8 ± 2.1 vs. females:6.8 ± 2.2) or Qualeffo score (males:52.2 ± 24.4 vs. females:59.7 ± 20.6). Pain and QoL evolution differed according to gender, being better in males. These differences were significant after two months independently of the treatment and the development of incidental VF during follow-up. CONCLUSIONS Pain and QoL evolution after a symptomatic VF differs according to gender, with a worse evolution in women independently of the treatment received.
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Affiliation(s)
- Pilar Peris
- Rheumatology and Neurointerventional Departments, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
- Departament de Medicina, Facultad de Medicina i Ciencias de la Salut, Universitat de Barcelona, Barcelona, Spain.
| | - Jordi Blasco
- Rheumatology and Neurointerventional Departments, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Ana Monegal
- Rheumatology and Neurointerventional Departments, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Helena Florez
- Rheumatology and Neurointerventional Departments, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Núria Guañabens
- Rheumatology and Neurointerventional Departments, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Departament de Medicina, Facultad de Medicina i Ciencias de la Salut, Universitat de Barcelona, Barcelona, Spain
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Gómez-Vaquero C, Hernández JL, Olmos JM, Cerdà D, Calleja CH, López JAM, Arboleya L, Del Rey FJA, Pardo SM, Vilamajó IR, Armangué XS, Grados D, Audera CB, Suero-Rosario E, Gracia IG, Chamizo AS, Martín-Esteve I, Florez H, Naranjo A, Castañeda S, Bruno SO, Carazo SG, Garcia-Vadillo A, Vives LL, Martínez-Ferrer À, Paños HB, Acín PA, Castellanos-Moreira R, Satorra P, Tebé C, Guañabens N. High incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis. A case-control study. Bone 2023; 168:116654. [PMID: 36584785 DOI: 10.1016/j.bone.2022.116654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To estimate the incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis (RA) and analyze risk factors for fracture. METHODS Incidence of clinical fragility fractures in 330 postmenopausal women with RA was compared to that of a control population of 660 age-matched postmenopausal Spanish women. Clinical fractures during the previous five years were recorded. We analyzed associations with risk factors for fracture in both populations and with disease-related variables in RA patients. RESULTS Median age of RA patients was 64 years; median RA duration was eight years. Sixty-nine percent were in remission or on low activity. Eighty-five percent had received glucocorticoids (GCs); 85 %, methotrexate; and 40 %, ≥1 biologic DMARD. Fifty-four patients and 47 controls had ≥1 major osteoporotic fracture (MOF). Incidence of MOFs was 3.55 per 100 patient-year in patients and 0.72 in controls (HR: 2.6). Risk factors for MOFs in RA patients were age, previous fracture, parental hip fracture, years since menopause, BMD, erosions, disease activity and disability, and cumulative dose of GCs. Previous fracture in RA patients was a strong risk for MOFs (HR: 10.37). CONCLUSION Of every 100 postmenopausal Spanish women with RA, 3-4 have a MOF per year. This is more than double that of the general population. A previous fracture poses a high risk for a new fracture. Other classic risk factors for fracture, RA disease activity and disability, and the cumulative dose of GCs are associated with fracture development.
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Affiliation(s)
- Carmen Gómez-Vaquero
- Department of Rheumatology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain.
| | - José Luis Hernández
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - José Manuel Olmos
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Dacia Cerdà
- Department of Rheumatology, Hospital Moisès Broggi, Sant Joan Despí, University of Barcelona, Barcelona, Spain
| | | | | | - Luis Arboleya
- Department of Rheumatology, University Hospital Central de Asturias, Oviedo, Spain
| | | | | | | | - Xavier Surís Armangué
- Department of Rheumatology, Hospital General de Granollers, Granollers, International University of Catalunya, Barcelona, Spain
| | - Dolors Grados
- Department of Rheumatology, Hospital d'Igualada, Igualada, Barcelona, Spain
| | | | | | | | | | | | - Helena Florez
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antonio Naranjo
- Department of Rheumatology, University Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Santos Castañeda
- Department of Rheumatology, University Hospital La Princesa IIS-, IP, Madrid, Spain
| | - Soledad Ojeda Bruno
- Department of Rheumatology, University Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | | | | | | | - Pilar Aguado Acín
- Department of Rheumatology, University Hospital La Paz, Madrid, Spain
| | - Raul Castellanos-Moreira
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pau Satorra
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristian Tebé
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain
| | - Núria Guañabens
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
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Florez H, Muxi A, González E, Monegal A, Guañabens N, Peris P. Utilidad del trabecular bone score en sujetos adultos con osteogénesis imperfecta. Rev Osteoporos Metab Miner 2022. [DOI: 10.4321/s1889-836x2022000400005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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Cajiao K, Florez H, Monegal A, Guañabens N, Peris P. AB1061 THE ROLE OF PROSTAGLANDIN E2 IN HYPERTROPHIC OSTEOARTHROPATHY AND/OR CLUBBING OF DIFFERENT CAUSES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundHypertrophic osteoarthropathy (HOA) is characterized by several clinical findings, including arthralgia/arthritis, periostosis, and digital clubbing. It can occur as a congenital condition called pachydermoperiostosis, and more commonly, as a secondary manifestation of pulmonary or extrapulmonary diseases or malignancy. Genomic studies support the role of prostaglandin E2 (PGE2) in the pathogenesis of primary HOA, with mutations in the 15-hydroxyprostaglandin dehydrogenase encoding gene resulting in increased PGE2 levels.ObjectivesTo analyse the clinical characteristics, comorbidities, and the potential role of PGE2 in primary and secondary forms of HOA and/or clubbing and also evaluate the clinical evolution of these patients.MethodsEighteen patients (10 men/8 women) aged 15 to 78 years (49,9 ± 15,6) diagnosed with clubbing and/or HOA were attended in our Rheumatology Department over an 11-year period. We reviewed the clinical characteristics of the patients, including associated comorbidities, image findings, bone turnover markers (BTM), and serum and urinary levels of PGE2, among others. Additionally, we evaluated the treatment and the clinical evolution of these subjects.ResultsMost patients presented associated clinical conditions for HOA and/or clubbing, with only one, the youngest (15 years old), having primary HOA (pachydermoperiostosis). Pulmonary disorders were the most frequent associated conditions, with interstitial lung disease (4 cases), COPD (3 cases), and lung cancer (4 cases) being the most frequent, followed by liver diseases including primary biliary cirrhosis (1 patient), liver cirrhosis (2 patients) and chronic hepatitis C virus (2 patients). All the subjects evaluated (15/18) presented increased urinary PGE2 levels (the highest being observed in primary HOA), with most also presenting increased serum PGE2 values. BTM were evaluated in most subjects (17/18) showing increased values in most (11/17), particularly in PINP and CTx. 4 patients were treated with selective inhibitors of cyclooxygenase-2 (COX-2) presenting, when evaluated, a small decrease in urinary PGE2 titers and partly improving their symptoms, which clearly improved after treating the associated cause when possible.ConclusionIn the present series, all subjects with primary or secondary HOA and/or clubbing presented markedly increased PGE2values, particularly in urine, supporting the role of this agent in the etiopathogenesis of this disorder. Pulmonary disorders, including malignancy and liver diseases, constituted the most frequent associated conditions. The use of COX-2 seems to be an effective symptomatic therapeutic approach in this entity.Disclosure of InterestsNone declared
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Florez H, Carrasco JL, Barberá M, Hernández-Rodríguez J, Muxi A, Prieto-González S, Cid MC, Monegal A, Guañabens N, Peris P. AB1011 FACTORS RELATED TO GLUCOCORTICOID-INDUCED OSTEOPOROSIS AND FRAGILITY FRACTURES IN YOUNG SUBJECTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGlucocorticoid (GC) treatment is the most frequent cause of osteoporosis (OP) in young subjects. However, the factors related to the development of glucocorticoid-induced osteoporosis (GIOP) and fragility fractures (FF), and consequently, the therapeutic approach to GIOP in young populations is not well established.ObjectivesAnalyze the prevalence of GIOP and FF in GC-treated patients and compare the risk factors related to their development according to age (< and ≥50 years).Methods127 patients (62±18 years) receiving chronic GC treatment were included (≥5 mg/day of prednisone, >3 months). The clinical data collected included: dose and duration of GC treatment, disease activity, previous FF, anthropometric data, bone metabolism parameters (including bone turnover markers and the presence of hypogonadism), bone mineral density (by DXA; defining densitometric OP: T-score ≤-2.5 or Z-score ≤-2, depending on the age of the patient), trabecular bone score (by DXA), and vertebral fractures (X-ray). GIOP was defined as densitometric OP and/or FF. Results were compared between subjects < and ≥50 years old.ResultsThe prevalence of GIOP was similar in both age groups: <50 (n=36) 44.4% vs. 46.1% ≥50 years (n=91). Five subjects <50 (13.8%) and 30 ≥50 years (33%) presented FF (p=0.05). Young subjects with FF tended to be >40 years, have a higher body mass index (BMI) (25.4 vs. 23.3, p=n.s.), and inflammatory disease activity (CRP 0.90 vs. 0.06mg/dL, p=0.06). When analyzing the differential risk factors related to FF depending on age, a higher body mass index (BMI) (29.63 vs. 26.95, p=0.048) and inflammatory disease activity (PCR -0.87 vs. -2.51 [log scale], p=0.03) were observed in young subjects, while low lumbar T-scores (-1.08 vs.-0.06 DE, p=0.003) and higher cumulative GC-doses (9.11 vs. 8.56 g, p=0.03) were differential factors in subjects over 50. Hypogonadism was a risk factor independent of age (OR 4.89; 95%CI 1.36-17.59), being associated with the presence of FF in both age groups.ConclusionMore than 40% of the patients receiving GC developed GIOP, with a similar prevalence in both age groups (< and ≥50 years); however, FF are less common in young subjects. Hypogonadism is a determining risk factor for FF independent of age. In addition, young subjects with FF tend to be older, with a higher BMI and disease activity, and, thus, evaluation of these risk factors can improve the identification of subjects at increased risk of fracture.Disclosure of InterestsNone declared
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Florez H, Carrasco JL, Berberá M, Hernández-Rodríguez J, Muxi A, Prieto-González S, Cid MC, Monegal A, Guañabens N, Peris P. Factors related to glucocorticoid-induced osteoporosis and fragility fractures in young subjects. Bone Rep 2022. [DOI: 10.1016/j.bonr.2022.101470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Florez H, Hernández-Rodríguez J, Carrasco JL, Filella X, Prieto-González S, Monegal A, Guañabens N, Peris P. Low serum osteocalcin levels are associated with diabetes mellitus in glucocorticoid treated patients. Osteoporos Int 2022; 33:745-750. [PMID: 34557953 DOI: 10.1007/s00198-021-06167-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
UNLABELLED Bone turnover markers are decreased in GC-treated subjects with DM. Decreased OC levels in GC-treated patients were associated with an increased risk of DM. These results suggest the involvement of OC in glucose homeostasis regulation in DM. INTRODUCTION Osteocalcin (OC) is involved in the regulation of glucose homeostasis. Glucocorticoid (GC) treatment is associated with impaired osteoblast function, decreased OC levels, and the development and/or worsening of pre-existing diabetes mellitus (DM). Whether decreased OC levels in GC-treated subjects contribute to DM is not well known. The aim of this study was to analyse whether OC levels in GC-treated patients are associated with the presence of DM. METHODS One hundred twenty-seven patients (aged 61.5 ± 17.9 years) on GC treatment were included. GC dose, treatment duration, presence of DM and bone formation (OC, bone ALP, PINP) and resorption markers (urinary NTX, serum CTX) were analysed. The cut-offs of each bone turnover marker (BTM) for the presence of DM were evaluated and optimised with the Youden index and included in the logistic regression analysis. RESULTS Among the patients, 17.3% presented DM. No differences were observed in GC dose or duration or the presence of fractures. Diabetics showed lower levels of OC (7.57 ± 1.01 vs. 11.56 ± 1; p < 0.001), PINP (21.48 ± 1.01 vs. 28.39 ± 1; p = 0.0048), NTX (24.91 ± 1.01 vs. 31.7 ± 1; p = 0.036) and CTX (0.2 ± 1.01 vs. 0.3 ± 1; p = 0.0016). The discriminating BTM cut-offs for DM presence were < 9.25 ng/mL for OC, < 24 ng/mL for PINP, < 27.5 nMol/mM for NTX and < 0.25 ng/mL for CTX. In a multivariate logistic regression model adjusted for GC dose, BMI, age and the above four BTMs, only OC remained independently associated with DM presence. Thus, in a model adjusted for GC dose, BMI and age, OC was significantly associated with DM (OR: 6.1; 95%CI 1.87-19.89; p = 0.001). CONCLUSION Decreased OC levels in GC-treated patients are associated with increased odds of DM, and only OC was independently associated with DM in a model including four BTMs.
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Affiliation(s)
- H Florez
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - J Hernández-Rodríguez
- Department of Autoimmune Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J L Carrasco
- Biostatistics, Department of Basic Clinical Practice, University of Barcelona, Barcelona, Spain
| | - X Filella
- Biochemistry and Molecular Genetics Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - S Prieto-González
- Department of Autoimmune Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Monegal
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - N Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - P Peris
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Cajiao K, Florez H, Peris P. Sternal Stress Fractures: An Unusual Cause of Chest Pain in Patients With Osteoporosis. J Clin Rheumatol 2022; 28:e286-e288. [PMID: 33337804 DOI: 10.1097/rhu.0000000000001678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Katherine Cajiao
- From the Rheumatology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Schwartz AV, Pan Q, Aroda VR, Crandall JP, Kriska A, Piromalli C, Wallia A, Temprosa M, Florez H. Long-term effects of lifestyle and metformin interventions in DPP on bone density. Osteoporos Int 2021; 32:2279-2287. [PMID: 34086101 PMCID: PMC10088864 DOI: 10.1007/s00198-021-05989-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/03/2021] [Indexed: 12/19/2022]
Abstract
UNLABELLED In the Diabetes Prevention Program Outcome Study (DPPOS), a cohort at high risk of diabetes, randomization to intensive lifestyle intervention or metformin, both associated with weight loss, did not have long-term negative effects on BMD compared with the placebo group. Potential positive effects of metformin on bone warrant further investigation. INTRODUCTION Randomization to lifestyle intervention (ILS) or metformin in the Diabetes Prevention Program (DPP) resulted in weight loss and reduced progression to diabetes. Weight loss is associated with reduced bone mineral density (BMD), but the long-term effects of these interventions on BMD are unknown. In the DPP Outcome Study (DPPOS), we determined if randomization to ILS or metformin, compared with placebo, was associated with differences in BMD approximately 16 years later. METHODS Of 3234 DPP participants, 2779 continued in DPPOS and were offered ILS in group format. Those randomized to metformin were offered unmasked metformin. At DPPOS year 12, 1367 participants had dual-energy X-ray absorptiometry scans. BMD in metformin and ILS groups was compared to placebo using sex-specific linear regression models, adjusted for age, race/ethnicity, and weight and weight-bearing activity at DPP baseline. RESULTS At DPPOS year 12, mean age was 66.5 (±9.5) years. Femoral neck BMD was similar in the ILS and placebo groups in men (difference = -0.021 g/cm2, 95%CI (-0.063, 0.021)) and in women (+0.014 g/cm2, 95%CI (-0.014, 0.042)). Femoral neck BMD was higher in the metformin compared to placebo group although not statistically different in men (+0.017 g/cm2, 95% CI (-0.023, 0.058)) and in women (+0.019 g/cm2, 95% CI (-0.009, 0.047)). Prevalence of osteoporosis was low and similar across treatment groups in men (0.9%; p=0.745) and women (2.4%; p=0.466). CONCLUSION In a cohort at high risk of diabetes, lifestyle intervention or metformin did not appear to have long-term negative effects on BMD. Potential positive effects of metformin on bone warrant further research.
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Affiliation(s)
- A V Schwartz
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
| | - Q Pan
- Department of Statistics and The Biostatistics Center, George Washington University, Washington, D.C., USA
| | - V R Aroda
- MedStar Health Research Institute, Hyattsville, MD, USA
- Brigham Women's Hospital, Boston, MA, USA
| | - J P Crandall
- Albert Einstein College of Medicine, New York City, NY, USA
| | - A Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - A Wallia
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - M Temprosa
- Department of Biostatistics and Bioinformatics and The Biostatistics Center, George Washington University, Washington, D.C., USA
| | - H Florez
- Department of Public Health Sciences and Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Guañabens N, Olmos JM, Hernández JL, Cerdà D, Hidalgo Calleja C, Martinez López JA, Arboleya L, Aguilar Del Rey FJ, Martinez Pardo S, Ros Vilamajó I, Suris Armangué X, Grados D, Beltrán Audera C, Suero-Rosario E, Gómez Gracia I, Salmoral Chamizo A, Martín-Esteve I, Florez H, Naranjo A, Castañeda S, Ojeda Bruno S, García Carazo S, García Vadillo A, López Vives L, Martínez-Ferrer À, Borrell Paños H, Aguado Acín P, Castellanos-Moreira R, Tebé C, Gómez-Vaquero C. Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study. Osteoporos Int 2021; 32:1333-1342. [PMID: 33459805 DOI: 10.1007/s00198-021-05824-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
UNLABELLED Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.
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Affiliation(s)
- N Guañabens
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - J M Olmos
- Departament of Internal Medicine, University Hospital Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - J L Hernández
- Departament of Internal Medicine, University Hospital Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - D Cerdà
- Department of Rheumatology, Hospital Moisès Broggi, Sant Joan Despí, University of Barcelona, Barcelona, Spain
| | - C Hidalgo Calleja
- Department of Rheumatology, University Hospital de Salamanca, Salamanca, Spain
| | - J A Martinez López
- Department of Rheumatology, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - L Arboleya
- Department of Rheumatology, University Hospital Central de Asturias, Oviedo, Spain
| | - F J Aguilar Del Rey
- Department of Rheumatology, University Hospital Virgen de la Victoria, Malaga, Spain
| | - S Martinez Pardo
- Department of Rheumatology, University Hospital Mutua Terrassa, Barcelona, Spain
| | - I Ros Vilamajó
- Department of Rheumatology, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - X Suris Armangué
- Department of Rheumatology, Hospital General de Granollers, Granollers, International University of Catalunya, Barcelona, Spain
| | - D Grados
- Department of Rheumatology, Hospital d'Igualada, Igualada, Barcelona, Spain
| | - C Beltrán Audera
- Department of Rheumatology, University Hospital Miguel Servet, Zaragoza, Spain
| | - E Suero-Rosario
- Department of Rheumatology, Hospital General Mateu Orfila, Maó, Spain
| | - I Gómez Gracia
- Department of Rheumatology, University Hospital Reina Sofía, Cordoba, Spain
| | - A Salmoral Chamizo
- Department of Rheumatology, University Hospital Reina Sofía, Cordoba, Spain
| | - I Martín-Esteve
- Department of Rheumatology, Hospital General Mateu Orfila, Maó, Spain
| | - H Florez
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Naranjo
- Department of Rheumatology, University Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - S Castañeda
- Department of Rheumatology, University Hospital La Princesa IIS-IP, Madrid, Spain
| | - S Ojeda Bruno
- Department of Rheumatology, University Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - S García Carazo
- Department of Rheumatology, University Hospital La Paz, Madrid, Spain
| | - A García Vadillo
- Department of Rheumatology, University Hospital La Princesa IIS-IP, Madrid, Spain
| | - L López Vives
- Department of Rheumatology, Hospital Sant Rafael, Barcelona, Spain
| | - À Martínez-Ferrer
- Department of Rheumatology, University Hospital Doctor Peset, Valencia, Spain
| | - H Borrell Paños
- Department of Rheumatology, Hospital Sant Rafael, Barcelona, Spain
| | - P Aguado Acín
- Department of Rheumatology, University Hospital La Paz, Madrid, Spain
| | - R Castellanos-Moreira
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C Tebé
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL) L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Gómez-Vaquero
- Department of Rheumatology, University Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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11
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Florez H, Hernández-Rodríguez J, Muxi A, Carrasco JL, Prieto-González S, Cid MC, Espinosa G, Gómez-Puerta JA, Monegal A, Guañabens N, Peris P. Trabecular bone score improves fracture risk assessment in glucocorticoid-induced osteoporosis. Rheumatology (Oxford) 2020; 59:1574-1580. [PMID: 31628810 DOI: 10.1093/rheumatology/kez464] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/06/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To analyse the clinical utility of trabecular bone score (TBS) evaluation for fracture risk assessment in glucocorticoid (GC)-treated patients compared with BMD assessment. METHODS One hundred and twenty-seven patients on GC treatment were included [mean age 62 (18) years, 63% women] in this cross-sectional study. The medical history, anthropometric data, lumbar and femoral BMD (DXA) [considering osteoporosis (OP): T-score ⩽-2.5], TBS (considering degraded microarchitecture: <1.230) and dorsolumbar X-ray [to assess vertebral fractures (VF)] were evaluated. BMD and TBS sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were evaluated to determine the diagnostic accuracy of the two methods. RESULTS All patients were receiving GC treatment for autoimmune diseases during 47.7 (68.9) months at a mean daily dose of 14.5 mg; 17% had VF, 28% any type of fragility fracture (VF + non-VF), 29% OP and 52% degraded microarchitecture. Degraded microarchitecture was significantly more frequent than densitometric OP in patients with VF (76% vs 38%) and with any fragility fracture (69% vs 36%). For VF, TBS and BMD sensitivity, specificity, PPV, and NPV were 0.76, 0.53, 0.25 and 0.92, and 0.38, 0.72, 0.22 and 0.85, respectively. Specificity increased to 0.89 for VF and 0.9 for any fragility fracture on combining BMD+TBS. TBS had better ability than BMD to discriminate between patients with fracture, especially VF (area under the curve = 0.73). CONCLUSION TBS seems to have greater discriminative power than BMD for fracture risk assessment in GC-treated patients, confirming the utility of this method as a complementary tool in the diagnosis of GC-induced OP.
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Affiliation(s)
- Helena Florez
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona
| | | | - Africa Muxi
- Department of Nuclear Medicine, Hospital Clinic, University of Barcelona
| | | | | | - Maria C Cid
- Department of Autoimmune Diseases, Hospital Clinic, IDIBAPS, University of Barcelona
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, IDIBAPS, University of Barcelona
| | - Jose A Gómez-Puerta
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ana Monegal
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona
| | - Núria Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona
| | - Pilar Peris
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona
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12
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Florez H, Hernández-Rodríguez J, Carrasco JL, Prieto-González S, Muxi A, Filella X, Ruiz-Gaspà S, Gómez-Puerta JA, Cid M, Espinosa G, Monegal A, Guañabens N, Peris P. Vertebral fracture risk in glucocorticoid-induced osteoporosis: the role of hypogonadism and corticosteroid boluses. RMD Open 2020; 6:rmdopen-2020-001355. [PMID: 32917834 PMCID: PMC7520700 DOI: 10.1136/rmdopen-2020-001355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/17/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify the risk factors associated with fragility fracture (FF) development in glucocorticoid (GC)-treated patients. METHODS 127 patients (aged 62±18 years, 63% women) on GC-treatment (mean dose 14.5±14.1 mg/day and duration 47.7±69 months) were included. The clinical data collected included bone metabolism study (including gonadal axis), GC-treatment, disease activity, dual-energy X-ray absorptiometry analysis (evaluating densitometric osteoporosis (OP) and trabecular bone score (TBS) degraded microarchitecture values (DMA)), X-ray (assessing vertebral fractures (VF)), FRAX risk (GC-adjusted) and previous FF. RESULTS 17% of the patients had VF, 28% FF (VF and/or non-VF), 29% OP and 52% DMA. Patients with VF received more GC boluses (57.1% vs 29.5%, p=0.03), were older (68±13 vs 60±19 years, p=0.02), postmenopausal (100% vs 67%, p=0.02), had low testosterone levels (57% vs 11%, p=0.02), lower TBS values (1.119±0.03 vs 1.237±0.013, p<0.001) and higher FRAX risk (17.2±16 vs 9.3±7.6, p=0.003). Patients with FF showed higher accumulated GC doses (16.6±18.4 vs 11.1±12.9 g, p=0.046). On multivariate analysis, hypogonadism (OR 12.38; 95% CI 1.85 to >100, p=0.01) and having received GC boluses (OR 3.45; 95% CI 1.04 to 12.15, p=0.01) were the main factors related to VF. Hypogonadism (OR 7.03; 95% CI 1.47 to 38.37, p=0.01) and FRAX >20 (OR 7.08; 95% CI 1.28 to 53.71, p=0.02) were factors related to FF. CONCLUSION Hypogonadism is the principal risk factor for developing fractures in GC-treated men and women, whereas receiving GC boluses is a major factor for VF. These results indicate the importance of evaluating the gonadal axis in these patients.
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Affiliation(s)
- Helena Florez
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain .,Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Jose Hernández-Rodríguez
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Josep Lluis Carrasco
- Biostatistics, Department of Basic Clinical Practice, University of Barcelona, Spain
| | - Sergio Prieto-González
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Africa Muxi
- Department of Nuclear Medicine, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Xavier Filella
- Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, Spain
| | - Silvia Ruiz-Gaspà
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - José A Gómez-Puerta
- Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Maria Cid
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Ana Monegal
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain.,Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Núria Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain.,Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Pilar Peris
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain.,Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
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13
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Gomez-Vaquero C, Valencia L, Nolla JM, Boquet D, Martínez Pardo S, Mihaylov Grigorov M, Lafont A, Segalés N, Roig Vilaseca D, Cerdà D, Casado E, Oncins X, Sallés M, Mínguez S, García Mira Y, Holgado S, López Louzao A, Pitarch C, Castellanos Moreira R, Florez H, Tebé C. The incidence of clinical fractures in adults aged 50 years and older in Spain. Rheumatol Adv Pract 2020. [DOI: 10.1093/rap/rkaa050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
The aim of this study was to quantify the incidence of all clinical fractures, including traumatic and fragility fractures, in patients aged 50 years and older, and to describe their distribution by fracture location, sex and age.
Methods
The incidence of clinical fractures at 10 hospitals in Catalonia, with a reference population of 3 155 000 inhabitants, was studied. For 1 week, from 30 May to 5 June 2016, we reviewed the discharge reports of the Traumatology section of the Emergency Department to identify all fractures diagnosed in patients ≥50 years of age. As a validation technique, data collection was carried out for 1 year at one of the centres, from 1 December 2015 to 30 November 2016. The fracture incidence, including the 95% CI, was estimated for the entire sample and grouped by fracture type, location, sex and age.
Results
A total of 283 fractures were identified. Seventy per cent were in women, with a mean age of 72 years. The overall fracture incidence was 11.28 per 1000 person-years (95% CI: 11.10, 11.46), with an incidence of traumatic and fragility fractures of 4.15 (95% CI: 4.04, 4.26) and 7.13 per 1000 person-years (95% CI: 6.99, 7.28), respectively. The incidence of fractures observed in the validation sample coincided with that estimated for the whole of Catalonia. The most common fragility fractures were of the hip, forearm, humerus and vertebrae.
Conclusion
The results of this study are the first to estimate the incidence of clinical fragility fractures in Spain, grouped by location, age and sex.
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Affiliation(s)
- Carmen Gomez-Vaquero
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari de Bellvitge, L’Hospitalet
| | - Lidia Valencia
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari de Bellvitge, L’Hospitalet
| | - Joan M Nolla
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari de Bellvitge, L’Hospitalet
| | - Dolors Boquet
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Arnau de Vilanova, Lleida
| | - Silvia Martínez Pardo
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Mútua Terrassa, Terrassa
| | - Mihail Mihaylov Grigorov
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Mútua Terrassa, Terrassa
| | - Anna Lafont
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital de Mataró, Mataró
| | - Nuria Segalés
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital de Mataró, Mataró
| | - Daniel Roig Vilaseca
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí
| | - Dacia Cerdà
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí
| | - Enrique Casado
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology and Orthopedics Departments, Parc Taulí Hospital Universitari, Sabadell
| | - Xavier Oncins
- Rheumatology and Orthopedics Departments, Parc Taulí Hospital Universitari, Sabadell
| | - Meritxell Sallés
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Sant Joan de Déu de Manresa, Manresa
| | - Sonia Mínguez
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Sant Joan de Déu de Manresa, Manresa
| | - Yaiza García Mira
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Germans Trias i Pujol, Badalona
| | - Susana Holgado
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Germans Trias i Pujol, Badalona
| | - Ana López Louzao
- Rheumatology and Orthopedics Departments, Hospital de l’Esperit Sant, Santa Coloma de Gramenet
| | - Conxita Pitarch
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology and Orthopedics Departments, Hospital de l’Esperit Sant, Santa Coloma de Gramenet
| | - Raúl Castellanos Moreira
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Clínic de Barcelona, Barcelona
| | - Helena Florez
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Clínic de Barcelona, Barcelona
| | - Cristian Tebé
- Statistical Advisory Service, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet, Spain
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Florez H, Hernández-Rodríguez J, Carrasco JL, Prieto-González S, Filella X, Monegal A, Guañabens N, Peris P. SAT0467 LOW SERUM OSTEOCALCIN LEVELS ARE ASSOCIATED WITH THE PRESENCE OF DIABETES MELLITUS IN GLUCOCORTICOID TREATED PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Increasing evidence indicates that osteocalcin (OC) is involved in the regulation of glucose homeostasis. Glucocorticoid (GC) treatment is associated with impaired osteoblast function and decreased OC levels and also with the development of CG-induced diabetes mellitus (GIDM). However, whether decreased OC levels in GC-treated subjects contribute to GIDM is not well known.Objectives:To analyse whether OC levels in GC-treated patients are associated with the presence of GIDM.Methods:127 patients (aged 62±18years, 63% women) on GC treatment for autoimmune diseases (≥5mg/day, >3 months) were included. Clinical and anthropometric data were analysed, including the GC dose and treatment duration, presence of GIDM, fragility fractures, densitometric osteoporosis and bone formation (OC, bone alkaline phosphatase [BAP], PINP) and resorption markers (urinary NTX, serum CTX). The cut-offs of each bone marker for the presence of GIDM were estimated and optimized with the Youden index and included in the logistic regression analysis (adjusted for BMI, age and GC doses).Results:17.3% of patients presented GIDM. Diabetic subjects were older (70.5±12.2 vs. 59.6±18.4, p=0.001) and had a higher BMI than non-diabetics (30±5.2 vs. 26±4.2, p=0.002). No differences were observed in GC dose or duration or in the presence of vertebral fractures. Diabetics showed lower levels of OC (7.57±1.01 vs. 11.56±1; p<0.001), PINP (21.48±1.01 vs. 28.39±1; p=0.0048), NTx (24.91±1.01 vs. 31.7±1; p=0.036) and CTX (0.2±1.01 vs. 0.3±1; p=0.0016) with similar BAP values. The best discriminating cut-offs for GIDM presence were: <9.25ng/mL for OC, <24ng/mL for PINP, <27.5nMol/mM for NTX and <0.25ng/mL for CTX. On multivariate analysis OC (<9.25) was the only marker related to the presence of GIDM (OR 6.1; CI95% 1.87-19.89; p=0.001).Conclusion:Decreased OC levels in GC-treated patients are associated with an increased risk of GIDM, a finding that was not observed with other bone turnover markers, further confirming the involvement of OC in the glucose homeostasis regulation in this entity.Disclosure of Interests:None declared
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Gómez Vaquero C, Olmos JM, Hernández JL, Cerda D, Hidalgo C, Martínez López J, Arboleya Rodríguez LM, Aguilar del Rey J, Martinez Pardo S, Ros I, Surís X, Grados Canovas D, Beltrán Audera C, Suero-Rosario E, Gómez Gracia I, Salmoral A, Martín-Esteve I, Florez H, Naranjo A, Castañeda S, Ojeda S, García Carazo S, García-Vadillo A, López Vives L, Martínez-Ferrer À, Borrell Paños H, Aguado P, Castellanos-Moreira R, Tebé C, Guañabens N. OP0323 INCIDENCE OF CLINICAL FRAGILITY FRACTURES IN POSTMENOPAUSAL WOMEN WITH RHEUMATOID ARTHRITIS. A MULTICENTRIC CASE-CONTROL STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Incidence of clinical fractures in rheumatoid arthritis (RA) is not as well-known as hip or vertebral fracture incidence.Objectives:1. To estimate the incidence of clinical fragility fractures in a population of postmenopausal women diagnosed with RA and compare it with that of the general population; 2. To analyze the risk factors for fracture.Methods:330 postmenopausal women with RA from 19 Spanish Rheumatology Departments, randomly selected from the registry of RA patients in each center. The control group consisted of 660 Spanish postmenopausal women from the Camargo Cohort. Clinical fractures during the previous 5 years were recorded. Assessed risk factors for fracture were: sociodemographic characteristics, BMD and variables related to RA.Results:Median age of RA patients was 64 yrs. vs. 63 yrs. in controls (ns). Evolution of the disease was 8 yrs. 78% and 76% had RF and ACPA+, respectively. 69% of patients were in remission or low activity. 85% had received glucocorticoids and methotrexate and 40% at least one biological DMARD. We identified 105 fractures (87 fragility and 18 traumatic) in 75 patients. Fifty-four patients and 47 controls had at least one major fracture (MF) (p< 0.001). Incidence of MF was 3.55 per 100 patient-year in patients and 0.72 in controls. Risk factors for MF in RA patients were age, previous fracture, parental hip fracture, postmenopausal period, hip BMD and cumulative dose of glucocorticoids. In controls, risk factors were age, age at menopause and lumbar BMD.Among RA-associated factors, MFs were associated with erosions, disease activity and disability. Previous fracture in RA patients was a strong risk for MF (HR: 10.37 [95% CI: 2.95-36.41]).Conclusion:Between 3 and 4 of every 100 postmenopausal women with RA have a major fracture per year, four times more than the general population. Disease activity and disability associated with RA, the cumulative dose of glucocorticoids and mainly previous fracture are associated with the development of fragility fractures.References:NoneAcknowledgments:Funded in part by ISCIII (PI18/00762) that included FEDER funds from the EU.Disclosure of Interests:Carmen Gómez Vaquero: None declared, Jose Manuel Olmos: None declared, J. Luis Hernández: None declared, Dacia Cerda: None declared, Cristina Hidalgo: None declared, JA Martínez López: None declared, Luis Marcelino Arboleya Rodríguez: None declared, Javier Aguilar del Rey: None declared, Silvia Martinez Pardo: None declared, Inmaculada Ros: None declared, Xavier Surís: None declared, Dolors Grados Canovas: None declared, Chesús Beltrán Audera: None declared, Evelyn Suero-Rosario: None declared, Inmaculada Gómez Gracia: None declared, Asunción Salmoral: None declared, Irene Martín-Esteve: None declared, Helena Florez: None declared, Antonio Naranjo Grant/research support from: amgen, Consultant of: UCB, Speakers bureau: AMGEN, Santos Castañeda: None declared, Soledad Ojeda Speakers bureau: AMGEN, LILLY, GEBRO, S García Carazo: None declared, Alberto García-Vadillo: None declared, Laura López Vives: None declared, À Martínez-Ferrer: None declared, Helena Borrell Paños: None declared, Pilar Aguado: None declared, Raul Castellanos-Moreira: None declared, Cristian Tebé: None declared, Núria Guañabens: None declared
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16
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Ferri-Guerra J, Aparicio-Ugarriza R, Salguero D, Baskaran D, Mohammed YN, Florez H, Ruiz JG. The Association of Frailty with Hospitalizations and Mortality among Community Dwelling Older Adults with Diabetes. J Frailty Aging 2020; 9:94-100. [PMID: 32259183 DOI: 10.14283/jfa.2019.31] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Diabetes (DM) is associated with an accelerated aging that promotes frailty, a state of vulnerability to stressors, characterized by multisystem decline that results in diminished intrinsic reserve and is associated with morbidity, mortality and utilization. Research suggests a bidirectional relationship between frailty and diabetes. Frailty is associated with mortality in patients with diabetes, but its prevalence and impact on hospitalizations are not well known. OBJECTIVES Determine the association of frailty with all-cause hospitalizations and mortality in older Veterans with diabetes. DESIGN Retrospective cohort. SETTING Outpatient. PARTICIPANTS Veterans 65 years and older with diabetes who were identified as frail through calculation of a 44-item frailty index. MEASUREMENTS The FI was constructed as a proportion of healthcare variables (demographics, comorbidities, medications, laboratory tests, and ADLs) at the time of the screening. At the end of follow up, data was aggregated on all-cause hospitalizations and mortality and compared non-frail (robust, FI≤ .10 and prefrail FI=>.10, <.21) and frail (FI≥.21) patients. After adjusting for age, race, ethnicity, median income, history of hospitalizations, comorbidities, duration of DM and glycemic control, the association of frailty with all-cause hospitalizations was carried out according to the Andersen-Gill model, accounting for repeated hospitalizations and the association with all-cause mortality using a multivariate Cox proportional hazards regression model. RESULTS We identified 763 patients with diabetes, mean age 72.9 (SD=6.8) years, 50.5% were frail. After a median follow-up of 561 days (IQR=172), 37.0% they had 673 hospitalizations. After adjustment for covariates, frailty was associated with higher all-cause hospitalizations, hazard ratio (HR)=1.71 (95%CI:1.31-2.24), p<.0001, and greater mortality, HR=2.05 (95%CI:1.16-3.64), p=.014. CONCLUSIONS Frailty was independently associated with all-cause hospitalizations and mortality in older Veterans with diabetes. Interventions to reduce the burden of frailty may be helpful to improve outcomes in older patients with diabetes.
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Affiliation(s)
- J Ferri-Guerra
- Jorge G. Ruiz, MD, VA GRECC Associate Director for Clinical Affairs, Bruce W. Carter Miami VAMC, GRECC (11GRC), 1201 NW 16th Street, Miami, Florida 33125, Telephone: (305) 575-3388 /Fax: (305) 575-3365, Mail: , ORCID: 0000-0003-3069-8502
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Frade-Sosa B, Florez H, Isern-Kebschull J, Halperin I, Guañabens N. Fusion of sacroiliac joints in acromegaly: a challenging finding. Rheumatology (Oxford) 2020; 59:898. [PMID: 31613960 DOI: 10.1093/rheumatology/kez468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Helena Florez
- Department of Rheumatology, Hospital Clinic, Barcelona, Spain
| | - Jaime Isern-Kebschull
- Department of Radiology, Hospital Clinic, Musculoskeletal Imaging Unit, Barcelona, Spain
| | - Irene Halperin
- Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain.,IDIBAPS, Group of Endocrine Disorders, Barcelona, Spain
| | - Núria Guañabens
- Department of Rheumatology, Hospital Clinic, Barcelona, Spain.,IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
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Guañabens N, Filella X, Florez H, Ruiz-Gaspá S, Conesa A, Peris P, Monegal A, Torres F. Tartrate-resistant acid phosphatase 5b, but not periostin, is useful for assessing Paget's disease of bone. Bone 2019; 124:132-136. [PMID: 31051316 DOI: 10.1016/j.bone.2019.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Periostin is a matricellular protein with a preferential location in cortical bone and periosteal tissue, and tartrate-resistant acid phosphatase 5b (TRAP5b) is a marker of osteoclast numbers. In Paget's disease of bone (PDB), there is increased cortical thickening and probably increased periosteal apposition, along with increased osteoclast numbers. OBJECTIVES To analyse if circulating periostin is a biomarker for PDB, and if it is associated with disease activity and involvement of long bones that represent major cortical contribution. Also, to analyse whether TRAP5b, a scarcely explored bone resorption marker, is useful in the assessment of PDB. PATIENTS AND METHODS We recruited 42 patients with PDB (13F/29M; 71 ± 11.6 yrs). 71.4% had active disease, 66.6% had polyostotic disease and 54.8% had long bone involvement. Blood and urine samples were taken between 8:00 and 10:00 A.M. after an overnight fast. Periostin and TRAP5b were measured in serum, using commercial ELISA assays (Biomedica and IDS, respectively). Serum total ALP, PINP, CTX, bone ALP and urinary NTX were measured. Reference values for periostin and TRAP5b were obtained from 45 healthy subjects. RESULTS Serum periostin did not differ between patients and controls (989.4 ± 173.2 vs. 966.9 ± 195.4 pMol/L, p = 0.572). No significant differences were observed between patients with and without active disease (964.5 ± 168.8 vs.1051.6 ± 175.6 pMol/L, p = 0.143), involvement or not of long bones (1022.2 ± 145.8 vs 949.7 ± 198.2 pMol/L, p = 0.181) and monostotic or polyostotic disease (963.8 ± 198.7 vs 1002.2 ± 161.4 pMol/L, p = 0.505). There were significant correlations between serum periostin and all bone turnover markers (bone ALP, PINP, uNTX, sCTX and TRAP5b) in PDB patients with active disease, but not in the inactive PDB group. Serum TRAP5b was significantly higher in PDB patients than in controls (4.43 ± 1.76 vs. 3.21 ± 1.02 U/L, p < 0.001), in those with active disease (4.98 ± 1.76 vs. 3.07 ± 0.72 U/L, p < 0.001) and in patients with polyostotic disease than in those with monostotic disease (4.81 ± 1.79 vs 3.68 ± 1.5 U/L, p = 0.005). TRAP5b levels were not influenced by previous bisphosphonate treatment (4.14 ± 1.42 vs. 4.84 ± 2.02 U/L, p = 0.206). CONCLUSIONS Periostin is not useful for assessing PDB, whilst TRAP5b, which has been a scarcely explored bone turnover marker until now, may be useful in the analysis of this disease, providing new information on the resorption process. In addition, periostin levels correlate with all classical BTMs in active PDB, suggesting that this marker may reflect periosteal and cortical metabolism in accelerated bone turnover states.
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Affiliation(s)
- Núria Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, IDIBAPS, CIBERhed, University of Barcelona, Spain.
| | - Xavier Filella
- Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Helena Florez
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, IDIBAPS, CIBERhed, University of Barcelona, Spain
| | | | - Arantxa Conesa
- Department of Rheumatology, University Hospital of Castellón, Spain
| | - Pilar Peris
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, IDIBAPS, CIBERhed, University of Barcelona, Spain
| | - Ana Monegal
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, IDIBAPS, CIBERhed, University of Barcelona, Spain
| | - Ferran Torres
- Medical Statistics Core Facility, IDIBAPS, Hospital Clínic, Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Spain
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Florez H, Ramírez J, Monegal A, Guañabens N, Peris P. Spontaneous vertebral fractures after denosumab discontinuation: A case collection and review of the literature. Semin Arthritis Rheum 2019; 49:197-203. [PMID: 30826108 DOI: 10.1016/j.semarthrit.2019.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/23/2019] [Accepted: 02/11/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Denosumab is an antiresorptive drug with demonstrated efficacy in the treatment of osteoporosis. However, discontinuation of this agent is associated with increased bone turnover and rapid bone loss, and more recently, with the development of vertebral fractures (VF) in some patients. Therefore, the aim of the study was to analyze the clinical characteristics, bone metabolism parameters and evolution of a group of patients who developed vertebral fractures after denosumab discontinuation. In addition, we reviewed the literature on this subject. METHODS During a period of 28 months (September 2015-January 2018) 7 women presenting spontaneous vertebral fractures after denosumab discontinuation were attended in the Rheumatology Department of our centre. We analyzed their clinical characteristics, bone metabolism parameters and evolution and reviewed the literature related to this subject. RESULTS The patients had received denosumab during 24-58 months (median 38), and developed a median of 5 VF per patient at 8-20 months (median 10) since the last dose of denosumab. Only 2 patients presented previous VF, and most (5 patients) received previous bisphosphonate treatment. After VF all restarted antiosteoporotic treatment with no further fractures during follow-up (median 19 months). CONCLUSIONS In this short series, previous bisphosphonate treatment does not seem to be a protective factor for the development of VF. The possible development of VF following discontinuation of denosumab must be taken into account in the clinical practice of physicians and dentists. Nonetheless, further studies are needed to improve the identification of patients at risk and the most adequate sequential treatment options.
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Affiliation(s)
- Helena Florez
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | - Julio Ramírez
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Ana Monegal
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Núria Guañabens
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Pilar Peris
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
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Guardiola M, Salvatierra K, Florez H. Computer analysis of resistance mutations to HCV NS5A antivirals. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.4280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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21
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Florez H, Mandelikova S, Filella X, Monegal A, Guañabens N, Peris P. Clinical significance of increased serum levels of FGF-23 in fibrous dysplasia. Med Clin (Barc) 2018; 151:65-67. [PMID: 29295788 DOI: 10.1016/j.medcli.2017.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/19/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVE Fibrous dysplasia (FD) can be associated with the development of hypophosphatemic osteomalacia, caused by the production of FGF-23 by dysplastic bone tissue. This study analysed FGF-23 levels in patients with FD, and their association with disease activity and serum phosphate values. PATIENTS AND METHODS Twelve adult patients with FD were included in the study. Clinical history, disease extension and activity and treatments received were reviewed, and the relationship of those values with FGF-23 and serum P levels was analysed. RESULTS FGF-23 was elevated in 6/12 patients (50%). Patients with high FGF-23 levels had similar age and disease activity and extension than those who did not. No differences were observed in serum phosphate values between both groups (increased FGF-23: 3.9±0.9 mg/dl vs. decreased FGF-23: 3.5±0.6 mg/dl). In fact, none of the patients with increased FGF-23 had low serum phosphate values. CONCLUSION Adult FD patients frequently present elevated FGF-23 values with no serum phosphate level repercussion, suggesting an alteration in the processing of this protein in the dysplastic bone tissue for this pathology.
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Affiliation(s)
- Helena Florez
- Servicio de Reumatología, Unidad de Patología Metabólica Ósea, Hospital Clínic de Barcelona, CIBERehd, IDIBAPS. Universidad de Barcelona, Barcelona, España
| | - Stanislava Mandelikova
- Servicio de Reumatología, Unidad de Patología Metabólica Ósea, Hospital Clínic de Barcelona, CIBERehd, IDIBAPS. Universidad de Barcelona, Barcelona, España
| | - Xavier Filella
- Servicio de Bioquímica y Genética Molecular, Hospital Clínic de Barcelona, Barcelona, España
| | - Ana Monegal
- Servicio de Reumatología, Unidad de Patología Metabólica Ósea, Hospital Clínic de Barcelona, CIBERehd, IDIBAPS. Universidad de Barcelona, Barcelona, España
| | - Núria Guañabens
- Servicio de Reumatología, Unidad de Patología Metabólica Ósea, Hospital Clínic de Barcelona, CIBERehd, IDIBAPS. Universidad de Barcelona, Barcelona, España
| | - Pilar Peris
- Servicio de Reumatología, Unidad de Patología Metabólica Ósea, Hospital Clínic de Barcelona, CIBERehd, IDIBAPS. Universidad de Barcelona, Barcelona, España.
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Florez H, Morlà R, Castellanos-Moreira R, Sanmartí R. Sustained response to rituximab in a TNFi-induced ANCA-vasculitis developed in a patient with rheumatoid arthritis. Semin Arthritis Rheum 2018; 47:e15-e16. [DOI: 10.1016/j.semarthrit.2017.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/10/2017] [Indexed: 12/15/2022]
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23
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Valencia Rodrigo W, Botros D, Pendlebury D, Florez H, Lee C, Oursler K, Katzel L, Morey M. PROACTIVE REACH AND TELEHEALTH MONITORING (GEROFIT) ENHANCE RESISTANCE EXERCISE AT RURAL SETTINGS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- W. Valencia Rodrigo
- Miami VA Geriatrics Research, Education and Clinical Center (GRECC), Miami, Florida,
- University of Miami School of Medicine Department of Public Health Sciences, Miami, Florida,
| | - D. Botros
- Miami VA Geriatrics Research, Education and Clinical Center (GRECC), Miami, Florida,
- Jackson Memorial Hospital, Miami, Florida,
| | - D. Pendlebury
- Miami VA Geriatrics Research, Education and Clinical Center (GRECC), Miami, Florida,
| | - H. Florez
- Miami VA Geriatrics Research, Education and Clinical Center (GRECC), Miami, Florida,
- University of Miami School of Medicine Department of Public Health Sciences, Miami, Florida,
| | - C. Lee
- Greater LA VA Geriatrics Research, Education and Clinical Center (GRECC), Los Angeles, California,
- UCLA David Geffen School of Medicine, Los Angeles, California,
| | - K. Oursler
- Salem VA Geriatrics Research and Education, Salem, New York,
- University of Maryland School of Medicine - Department of Medicine,
Baltimore, Maryland,
| | - L.I. Katzel
- Baltimore VA Geriatrics Research, Education and Clinical Center (GRECC), Baltimore, Maryland,
- University of Maryland School of Medicine - Department of Medicine,
Baltimore, Maryland,
| | - M.C. Morey
- Durham VA Geriatrics Research, Education and Clinical Center (GRECC), Durham, North Carolina,
- Duke University School of Medicine - Department of Medicine, Durham, North Carolina
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Florez H, Peris P, Vidal-Sicart S, Monegal A, Guañabens N. Lack of scintigraphic response of fibrous dysplasia to bisphosphonate treatment. Rheumatology (Oxford) 2016; 55:1735. [DOI: 10.1093/rheumatology/kew284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Florez H, Reaven PD, Bahn G, Moritz T, Warren S, Marks J, Reda D, Duckworth W, Abraira C, Hayward R, Emanuele N. Rosiglitazone treatment and cardiovascular disease in the Veterans Affairs Diabetes Trial. Diabetes Obes Metab 2015; 17:949-55. [PMID: 25964070 PMCID: PMC4676911 DOI: 10.1111/dom.12487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/31/2015] [Accepted: 05/02/2015] [Indexed: 01/17/2023]
Abstract
AIMS To evaluate the relationship between patterns of rosiglitazone use and cardiovascular (CV) outcomes in the Veterans Affairs Diabetes Trial (VADT). METHODS Time-dependent survival analyses, case-control and 1 : 1 propensity matching approaches were used to examine the relationship between patterns of rosiglitazone use and CV outcomes in the VADT, a randomized controlled study that assessed the effect of intensive glycaemic control on CV outcomes in 1791 patients with type 2 diabetes (T2D) whose mean age was 60.4 ± 9 years. Participants were recruited between 1 December 2000 and 31 May 2003, and were followed for 5-7.5 years (median 5.6) with a final visit by 31 May 2008. Rosiglitazone (4 mg and 8 mg daily) was initiated per protocol in both the intensive-therapy and standard-therapy groups. Main outcomes included a composite CV outcome, CV death and myocardial infarction (MI). RESULTS Both daily doses of rosiglitazone were associated with lower risk for the primary composite CV outcome [4 mg: hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.49-0.81 and 8 mg: HR 0.60, 95% CI 0.49-0.75] after adjusting for demographic and clinical covariates. A reduction in CV death was also observed (HR 0.25, p < 0.001, for both 4 and 8 mg/day rosiglitazone); however, the effect on MI was less evident for 8 mg/day and not significant for 4 mg/day. CONCLUSIONS In older patients with T2D the use of rosiglitazone was associated with decreased risk of the primary CV composite outcome and CV death. Rosiglitazone use did not lead to a higher risk of MI.
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Affiliation(s)
- H Florez
- Miami VA Healthcare System, GRECC, University of Miami, Miami, FL, USA
| | - P D Reaven
- Phoenix VA Health Care Center, Department of Medicine, Phoenix, AZ, USA
| | - G Bahn
- Hines VA Cooperative Studies Program, Coordinating Center, Hines VA Hospital, Hines, IL, USA
| | - T Moritz
- Hines VA Cooperative Studies Program, Coordinating Center, Hines VA Hospital, Hines, IL, USA
| | - S Warren
- VA Cooperative Studies Program, Clinical Research Pharmacy Coordinating Center, University of New Mexico, Albuquerque, NM, USA
| | - J Marks
- Miami VA Healthcare System, GRECC, University of Miami, Miami, FL, USA
| | - D Reda
- Hines VA Cooperative Studies Program, Coordinating Center, Hines VA Hospital, Hines, IL, USA
| | - W Duckworth
- Phoenix VA Health Care Center, Department of Medicine, Phoenix, AZ, USA
| | - C Abraira
- Miami VA Healthcare System, GRECC, University of Miami, Miami, FL, USA
| | - R Hayward
- VA Center for Practice Management & Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - N Emanuele
- Hines VA Cooperative Studies Program, Coordinating Center, Hines VA Hospital, Hines, IL, USA
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Abstract
The pharmacological management of diabetes in older people is complex and challenging. It requires a comprehensive understanding of the individual beyond the diabetes itself. Through the ageing years, the older individual presents with diabetes-related and non-related comorbidities and complications, develops functional limitations and psychological issues, and may lack social support and access to care. A disturbance in these categories, known as the four geriatric domains, will negatively affect diabetes self-management and self-efficacy, leading to poor outcomes and complications. Furthermore, older people with diabetes may be more interested in the management of other chronic conditions such as pain or impaired mobility, and diabetes may be lower in their list of priorities. Proper education must be provided to the older individual and caregivers, with continuous monitoring and counselling, especially when pharmacological interventions offer risks of side effects, adverse reactions and interactions with other medications. Informed shared medical decisions will help to improve adherence to the regimen; however, such discussions ought to be based on the best evidence available, which is unfortunately limited in this age group. We performed a review focused on pharmacological agents and summarize current evidence on their use for the treatment of diabetes in older people. We encourage clinicians to investigate and incorporate the four geriatrics domains in the selection and monitoring of these agents.
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Affiliation(s)
- W M Valencia
- Geriatrics Research, Education and Clinical Center, Miami Bruce W. Carter VA Medical Center, Miami, FL, USA; Department of Public Health Sciences, Division of Epidemiology, University of Miami Miller School of Medicine, Miami, FL, USA
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Marrero D, Pan Q, Barrett-Connor E, de Groot M, Zhang P, Percy C, Florez H, Ackermann R, Montez M, Rubin RR. Impact of diagnosis of diabetes on health-related quality of life among high risk individuals: the Diabetes Prevention Program outcomes study. Qual Life Res 2013; 23:75-88. [PMID: 23709097 DOI: 10.1007/s11136-013-0436-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 01/24/2023]
Abstract
PURPOSE The purpose of this study is to assess if diagnosis of type 2 diabetes affected health-related quality of life (HRQoL) among participants in the Diabetes Prevention Program/Diabetes Prevention Program Outcome Study and changes with treatment or diabetes duration. METHODS 3,210 participants with pre-diabetes were randomized to metformin (MET), intensive lifestyle intervention (ILS), or placebo (PLB). HRQoL was assessed using the SF-36 including: (1) 8 SF-36 subscales; (2) the physical component (PCS) and mental component summary (MCS) scores; and (3) the SF-6D. The sample was categorized by diabetes free versus diagnosed. For diagnosed subgroup, mean scores in the diabetes-free period, at 6 months, 2, 4 and 6 years post-diagnosis, were compared. RESULTS PCS and SF-6D scores declined in all participants in all treatment arms (P < .001). MCS scores did not change significantly in any treatment arm regardless of diagnosis. ILS participants reported a greater decrease in PCS scores at 6 months post-diagnosis (P < .001) and a more rapid decline immediately post-diagnosis in SF-6D scores (P = .003) than the MET or PLB arms. ILS participants reported a significant decrease in the social functioning subscale at 6 months (P < .001) and two years (P < .001) post-diagnosis. CONCLUSIONS Participants reported a decline in measures of overall health state (SF-6D) and overall physical HRQoL, whether or not they were diagnosed with diabetes during the study. There was no change in overall mental HRQoL. Participants in the ILS arm with diabetes reported a more significant decline in some HRQoL measures than those in the MET and PLB arms that developed diabetes.
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Affiliation(s)
- D Marrero
- Indiana University School of Medicine, Indianapolis, IN, USA,
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28
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Kapila N, Florez H, Dang S, Oropesa L. Group exercise improves chronic pain in South Florida older adults. BMC Proc 2012. [PMCID: PMC3425999 DOI: 10.1186/1753-6561-6-s4-o51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- N Kapila
- Royal College of Surgeons in Ireland
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29
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Andrieu S, Barberger-Gateau P, Raffaitin C, Berr C, Tzourio C, Dartigues JF, Gin H, Fitten LJ, Ortiz F, Fairbanks L, Bartzokis G, Lu P, Ringman J, Heyn PC, Locher JL, Salvà A, Andrieu S, Fernández E, Vellas B, van de Rest O, Geleijnse JM, Kok FJ, van Staveren WA, Beekman ATF, Hoefnagels WHL, de Groot CPGM, Angevaren M, Aufdemkampe G, Verhaar HJJ, Aleman A, Vannees L, Arkin S, Florez H, Gerstein H, Sheridan P, Bosch J, Goldberg R, Kaspar KM, Drawert SM, Marcus RL, Kidde J, Dibble L, Addison O, LaStayo PC, Scarmeas N, Stern Y, Schupf N, Luchsinger JA, Sharkey JR, Laditka JN, Laditka SB, Liu R, Hochhalter A, Robare JF, Türner N, Judge M, Foster TC, Erdos B, Cudykier I, Scarpace PJ, Weiss LA, Bergstrom J, Kritz-Silverstein D, Barrett-Connor E, Yurko-Mauro K, Nelson E, Quinn J, Sattler FR, Castaneda-Sceppa C, Binder EF, Schroeder ET, Wang Y, Bhasin S, Kawakubo M, Stewart Y, Hahn C, Colletti P, Roubenoff R, Yarasheski KE, Azen SP, Aoki Y, Yamamoto T, Otuka T, Blanc-Bisson C, Bourdel-Marchasson I, Bocock MA, Keller HH, Bowman G, Baxter J, Oken B, Frei B, Traber M, Leonard S, Kaye J, Shannon J, Quinn J, Carlsson M, Gustafson Y, Eriksson S, Littbrand H, Håglin L, Danthiir V, Wilson C, Nettelbeck T, Burns N, Wittert G, Noakes M, Clifton P, DiMaria-Ghalili RA, Grieger JA, Nowson CA, Wattanapenpaiboon NT, Holstein J, Robinson C, Hartmann C, Rueb S, Heffel L, Dintaman S, Reynolds J, Fleming L, Crull M, Goldey J, Serper LL, Hubbard R, Westengard J, Horning M, Ishige Y, Aoki Y, Keller HH, Keller HH, LaStayo PC, Marcus RL, Smith S, Kidde J, Dibble L, Butler C, Hill M, LaStayo PC, Marcus RL, Dibble L, Kidde J, Peters C, Meier W, Laughlin GA, Kritz-Silverstein D, von Muhlen D, Barrett-Connor E, Olariu L, Petcu M, Tulcan C, Pup M, Otilingam P, Gate M, Pasinetti GM, Ray B, Chauhan NB, Bailey JA, Lahiri DK, Shatenstein B, Kergoat MJ, Reid I, Chicoine ME, Vaz L, Stewart R, Sabbah W, Tsakos G, D’Aiuto F, Watt RG, Sturman M, Kelly J, Fleischman D, Leurgans S, Bennett D, Morris MC, Suominen MH, Muurinen S, Soini H, Pitkälä KH, Yamamoto T, Fujinoki C, Aoki Y. 3rd IANA (International Academy on Nutrition and Aging) Meeting Nutrition, Exercise & Alzheimer and Clinical Trials on Sarcopenia August 1–2, 2008 Hyatt Regency Tamaya Resort 1300 Tuyuna Trail Santa Ana Pueblo, NM USA. J Nutr Health Aging 2008. [DOI: 10.1007/bf02982702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Affiliation(s)
- E P Cherniack
- Geriatric Research, Education and Clinical Center and Research Service, Miami Veterans Affairs Healthcare System, Miami, FL 33125, USA.
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31
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Florez H, Ryder E, Campos G, Fernandez V, Morales LM, Valbuena H, Rincón E, Gómez ME, Raleigh X. Women relatives of Hispanic patients with type 2 diabetes are more prone to exhibit metabolic disturbances. Invest Clin 1999; 40:127-42. [PMID: 10390951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Hyperinsulinemia and impaired insulin action are familial and predictive of Type 2 diabetes onset. Since high levels of insulin are characteristic of our general (venezuelan)hispanic population, the purpose of this investigation was to identify early metabolic defects in a group of healthy first degree relatives of Type 2 diabetic patients. We studied 46 (29 women and 17 men; ages ranging 18-66 y) first degree relatives of Type 2 diabetic patients comparing them with 22 (12 women and 10 men; ages ranging 22-60 y) subjects who had no family history of diabetes. All subjects underwent resting blood pressure and anthropometric measurements; a 75 g oral glucose tolerance test with determination of glucose and insulin and a fasting lipid profile. The relatives of Type 2 diabetic patients had higher tricipital (TC) and subscapular (SC) skinfolds, and elevated DBP in relation to the control group. The skinfolds elevation was more evident in women, while in men the elevation in DBP predominates. None of the relatives had glucose intolerance, however, the glucose-stimulated insulin response was elevated at all points in men as well as in women. No difference was observed in the HOMA values for IR and beta cell function, or in the delta I30/delta G30 ratio. The lipid profile showed a marked elevation in TG levels in men as well as in women, with low HDL-C values in men. No other lipid abnormalities were observed. Correlation analysis revealed strong association between BMI and WHR with skinfolds and several parameters of the carbohydrate metabolism in women, but not in men. IR in women was possitively associated with skinfolds, SBP and lipid parameters and beta cell function with VLDL-C. Adult relatives of Type 2 diabetic venezuelan patients from hispanic origin had, early in their lives, several parameters of the metabolic syndrome as hyperinsulinemia, obesity, dyslipidemia and high blood pressure. These alterations were more prominent in women, group in which the association among BMI, WHR and IR were statistically significant respect to SBP, DBP, basal insulin, insulin/glucose ratio, TG and HDL-C.
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Affiliation(s)
- H Florez
- Institute of Clinical Research, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela
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32
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Florez H, Valbuena H, Ryder E, Rincón E, Campos G, Castillo S, González J, Fernández V, Raleigh X, Gómez ME. [Dyslipidemia and hyperinsulinemia in normoglycemic-obese relatives of patients with non-insulin dependent diabetes mellitus]. Invest Clin 1995; 36:131-47. [PMID: 7548306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To determine the most frequent dyslipidemias among first-degree relatives of NIDDM patients, and its association with their glucose-tolerance status and hyperinsulinemia, we have started to examine members of NIDDM pedigrees, according to American Diabetes Association guidelines for nuclear family studies. In a large family with 2 NIDDM siblings in the 2nd generation, and 4 siblings with NIDDM in the 3rd generation, we have evaluated 14 first degree relatives and also 15 sex and aged matched healthy control subjects without family history of diabetes. The NIDDM relative group presented BMI = 31.8 +/- 3.9 kg/m2, SBP = 128 +/- 18.2 mmHg, DBP = 84 +/- 12.7 mmHg. Both relatives and controls were subjected to a 2h 75g OGTT for glucose and insulin determinations. Although none of NIDDM relatives has IGT, both Glycemic Area (GA) and Insulin Area (IA) were greater (p < 0.01) in the NIDDM relative group. The Insulin/Glucose ratio was also higher (p < 0.01) at 0 and 120 min of OGTT, this might be indirect evidence of Insulin- Resistance. Fasting serum lipids in the NIDDM relatives were TG = 148 +/- 24mg/dl, T-Chol = 244 +/- 10.7mg/dl, HDL-C = 34.2 +/- 2.5mg/dl; lipids in the control group were TG = 84.8 +/- 10.1mg/dl, T-Chol = 167 +/- 10.2mg/dl, HDL-C = 44.4 +/- 2.6mg/dl. Electrophoretic pattern showed type IIa (30.7%) and IIb (61.5%) hyperlipidemias in the NIDDM relatives. In this group, there was a positive and significant association between basal insulin and DBP (r = 0.67; p < 0.01), and between DBP and both TG (r = 0.74; p < 0.01)) and VLDL-C (r = 0.58; p < 0.05). It was also obtained a negative association between basal insulin and HDL-C (r = -0.89; p < 0.001). These data suggest that hyperinsulinemia in association with lipid abnormalities could appear early (before the development of Impaired Glucose Tolerance and Diabetes) in first degree relatives of NIDDM patients.
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Affiliation(s)
- H Florez
- Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad del Zulia, Maracaibo, Venezuela
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