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Muñoz-Torres M, Carazo-Gallego A, Jiménez-López JC, Avilés-Pérez MD, Díaz-Arco S, Lozano-Alonso S, Lima-Cabello E, de Dios-Alché J, Reyes-García R, Morales-Santana S. Entorno inflamatorio diferencial en pacientes con osteoporosis y diabetes mellitus tipo 2. Rev Osteoporos Metab Miner 2022. [DOI: 10.4321/s1889-836x2022000100004] [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: 12/02/2022] Open
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Andújar-Vera F, García-Fontana C, González-Salvatierra S, Martínez-Heredia L, Muñoz-Torres M, García-Fontana B. Relación genética entre las enfermedades pulmonares de origen ambiental u ocupacional y la osteoporosis: un enfoque bioinformático. Rev Osteoporos Metab Miner 2021. [DOI: 10.4321/s1889-836x2021000400005] [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: 12/02/2022] Open
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Muñoz-Torres M, Aguado P, Daudén E, Carrascosa JM, Rivera R. Osteoporosis and Psoriasis. Actas Dermosifiliogr (Engl Ed) 2019; 110:642-652. [PMID: 31151668 DOI: 10.1016/j.ad.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 12/25/2018] [Revised: 01/29/2019] [Accepted: 02/03/2019] [Indexed: 02/08/2023] Open
Abstract
Psoriasis is a chronic inflammatory disease associated with multiple comorbidities, particularly in patients with arthritis or more severe forms of the disease. The link between all these comorbidities is probably systemic inflammation. Several recent studies have indicated that patients with psoriasis may be at an increased risk of pathologic fractures and osteoporosis. Current guidelines on comorbidities in psoriasis do not recommend assessment of bone health. In this article, we review the available evidence on the association between psoriasis and osteoporosis. We first examine the concept of osteoporosis and the role of vitaminD in bone health and then propose an algorithm for managing and treating this condition in patients with psoriasis.
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Affiliation(s)
- M Muñoz-Torres
- Servicio de Endocrinología, Hospital Universitario San Cecilio, Granada, España
| | - P Aguado
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España
| | - E Daudén
- Servicio de Dermatología, Hospital Universitario La Princesa, Madrid, España
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España
| | - R Rivera
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España.
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Andújar-Vera F, García-Fontana C, Lozano-Alonso S, Morales-Santana S, Muñoz-Torres M, García-Fontana B. Identificación de potenciales biomarcadores de calcificación vascular en pacientes con diabetes mellitus tipo 2 mediante el uso de herramientas bioinformáticas de libre acceso. Rev Osteoporos Metab Miner 2018. [DOI: 10.4321/s1889-836x2018000200003] [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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Nogués X, Nolla JM, Casado E, Jódar E, Muñoz-Torres M, Quesada-Gómez JM, Canals L, Balcells M, Lizán L. Spanish consensus on treat to target for osteoporosis. Osteoporos Int 2018; 29:489-499. [PMID: 29177559 PMCID: PMC5818595 DOI: 10.1007/s00198-017-4310-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/08/2017] [Indexed: 01/08/2023]
Abstract
UNLABELLED To reach a Spanish expert consensus on a treat-to-target strategy in osteoporosis, a Delphi Consensus Study has been developed. Most of the experts (59.8%) were rheumatologist with a mean clinical experience of 21.3 years (SD 8.5). Consensus was achieved for 70% of the items. Therapeutic objectives, patient follow-up scheme, treatment failure criteria, and appropriate treatment choice for use in T2T strategy in Spain have been defined. INTRODUCTION The paper aims to achieve a Spanish expert consensus on a treat-to-target (T2T) strategy in osteoporosis. METHODS A scientific committee led the project and was involved in expert panel identification and Delphi questionnaire development. Two Delphi rounds were completed. The first-round questionnaire included 24 items and assessed, using a seven-point Likert scale, the experts' wish (W) and prognosis (P) in 5 years for each topic (applicability, therapeutic objectives, patient follow-up, and possible treatment to be prescribed). Items for which there was no consensus in the first round were included in the second round. Consensus was defined as ≥75% agreement (somewhat/mostly/entirely agree) or disagreement (somewhat/mostly/entirely disagree) responses. RESULTS Of the experts, 112 and 106 completed the first and second rounds, respectively. 59.8% were rheumatologists with a mean clinical experience of 21.3 years (SD 8.5). Consensus was achieved for 70% of the items, and was established regarding the utility of a T2T strategy to define therapeutic objectives, optimal follow-up, and therapeutic algorithm. Participants agreed on the utility of the bone mineral density (BMD) value (T-score >-2.5 SD for spine and >-2.5/-2.0 SD for femoral neck), lack of fractures, and fracture risk (FRAX) as therapeutic objectives. For measuring BMD changes, consensus was achieved on the suitability of hip and femoral neck locations. Experts agreed to consider treatment failure as when a significant BMD gain could not be achieved, or when a new fracture occurs within 2-3 years. There was consensus that all proposed therapies should achieve a therapeutic target through T2T strategy (treatments with the highest consensus scores were denosumab and teriparatide). CONCLUSION The therapeutic objectives, patient follow-up scheme, treatment failure criteria, and appropriate treatment choice for use in T2T strategy in Spain have been established by a panel of experts. Some aspects nevertheless still require further analysis.
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Affiliation(s)
- X Nogués
- Mar Institute of Medical Research (IMIM), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Universitat Autonòma de Barcelona , Barcelona, Spain.
| | - J M Nolla
- IDIBELL-University Hospital Bellvitge, L'Hospitalet de Llobregat, Spain
| | - E Casado
- Parc Taulí Universtiy Hospital, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - E Jódar
- University Hospital Quirón Salud, Universidad Europea de Madrid, Madrid, Spain
| | - M Muñoz-Torres
- Bone Metabolic Unit, UGC Endocrinología y Nutrición, Hospital Universitario Campus de la Salud de Granada, Instituto de Investigación Biosanitaria ibs, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Granada, Spain
| | - J M Quesada-Gómez
- UGC Endocrinología y Nutrición, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), University Hospital Reina Sofía & IMIBIC, Córdoba, Spain
| | | | | | - L Lizán
- Outcomes'10, Department of Medicine, University Jaume I, Castelló de la Plana, Spain
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Webb SM, Puig-Domingo M, Villabona C, Muñoz-Torres M, Marazuela M, Fernández D, Martínez G, Jódar E, Mangas MA, Perulero N, Badia X. Validation of PHPQoL, a Disease-Specific Quality-of-Life Questionnaire for Patients With Primary Hyperparathyroidism. J Clin Endocrinol Metab 2016; 101:1571-8. [PMID: 26771703 DOI: 10.1210/jc.2015-3094] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Health-related quality of life (HRQoL) is impaired in primary hyperparathyroidism (PHPT) but instruments to specifically assess this are scarce. OBJECTIVE Validate the new disease-specific Primary Hyperparathyroidism Quality of Life (PHPQoL) questionnaire in usual clinical practice. DESIGN Observational, prospective, and multicenter. SETTING Public hospital ambulatory care. PATIENTS Patients with PHPT of both sexes, aged more than or equal to 18 years either initiated treatment for PHPT (group A) or had stable PHPT, not requiring therapy (group B). Patients in group A had at least one surgical criterion according to the 2009 Third International Workshop on Management of Asymptomatic PHPT. INTERVENTION Sociodemographic, clinical, and HRQoL data (PHPQol, Short Form-36, Psychological Well-Being Index, and patients' self-perceived health status) were collected. Group A underwent 4 evaluations (baseline, 3 ± 1, 6 ± 1, and 12 ± 2 months after a therapeutic intervention) and group B 2, at baseline and 1 month later to assess test-retest reliability. RESULTS A total of 182 patients were included (104 group A, 78 group B) with a mean age (SD) of 61.4 (12.1) years; 79.7% were women. Group A increased PHPQoL score (SD) (better HRQoL) (52 ± 23 at baseline; 62 ± 24 at 12 months; P < .001). At baseline, symptomatic patients had a lower PHPQoL score (worse) than asymptomatic ones (51 ± 21 vs 68 ± 21; P < .001). Correlations were seen between PHPQoL and Short Form-36, Psychological Well-Being Index, and self-perceived health status (P < .001). PHPQoL had good internal consistency (Cronbach's α = 0.80), test-retest reliability (group B, intraclass correlation coefficient > 0.80), and sensitivity to detect HQRoL changes over time. CONCLUSIONS PHPQoL is a valid HRQoL measure to assess the impact of PHPT on health perception in clinical practice.
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Affiliation(s)
- Susan M Webb
- Endocrinology/Medicine Departments (S.M.W.), Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unidad 747, Instituto de Salud Carlos III, IIB-Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; Endocrinology/Medicine Departments (M.P.-D.), Hospital Universitari Germans Trias i Pujol-Badalona, CIBER-ER, Grupo Clínico Vinculado U14, and CIBER of Diabetes and Associated Metabolic Diseases, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; Hospital Universitari Bellvitge (C.V.), L'Hospitalet de Llobregat, 08907 Spain; Bone Metabolic Unit (RETICEF, Red Temática de Investigación Cooperative en Envejecimiento y Fragilidad) (M.M.-T.), Endocrinology Unit, Instituto de Investigación Biosanitaria de Granada, Hospital Universitario San Cecilio, 18012 Granada, Spain; Hospital Universitario de la Princesa and CIBER-ER Grupo Clínico Vinculado U12 (M.M.), 28006 Madrid, Spain; Hospital Virgen de la Victoria (D.F.), 29010 Málaga, Spain; Hospital 12 de Octubre (G.M.), 28041 Madrid, Spain; Hospital Universitario Quirón (E.J.), 28223 Madrid, Spain; Hospital Virgen del Rocío (M.A.M.), 41013 Sevilla, Spain; and IMS Health S.A. (N.P., X.B.), 08034 Barcelona, Spain
| | - M Puig-Domingo
- Endocrinology/Medicine Departments (S.M.W.), Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unidad 747, Instituto de Salud Carlos III, IIB-Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; Endocrinology/Medicine Departments (M.P.-D.), Hospital Universitari Germans Trias i Pujol-Badalona, CIBER-ER, Grupo Clínico Vinculado U14, and CIBER of Diabetes and Associated Metabolic Diseases, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; Hospital Universitari Bellvitge (C.V.), L'Hospitalet de Llobregat, 08907 Spain; Bone Metabolic Unit (RETICEF, Red Temática de Investigación Cooperative en Envejecimiento y Fragilidad) (M.M.-T.), Endocrinology Unit, Instituto de Investigación Biosanitaria de Granada, Hospital Universitario San Cecilio, 18012 Granada, Spain; Hospital Universitario de la Princesa and CIBER-ER Grupo Clínico Vinculado U12 (M.M.), 28006 Madrid, Spain; Hospital Virgen de la Victoria (D.F.), 29010 Málaga, Spain; Hospital 12 de Octubre (G.M.), 28041 Madrid, Spain; Hospital Universitario Quirón (E.J.), 28223 Madrid, Spain; Hospital Virgen del Rocío (M.A.M.), 41013 Sevilla, Spain; and IMS Health S.A. (N.P., X.B.), 08034 Barcelona, Spain
| | - C Villabona
- Endocrinology/Medicine Departments (S.M.W.), Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unidad 747, Instituto de Salud Carlos III, IIB-Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; Endocrinology/Medicine Departments (M.P.-D.), Hospital Universitari Germans Trias i Pujol-Badalona, CIBER-ER, Grupo Clínico Vinculado U14, and CIBER of Diabetes and Associated Metabolic Diseases, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; Hospital Universitari Bellvitge (C.V.), L'Hospitalet de Llobregat, 08907 Spain; Bone Metabolic Unit (RETICEF, Red Temática de Investigación Cooperative en Envejecimiento y Fragilidad) (M.M.-T.), Endocrinology Unit, Instituto de Investigación Biosanitaria de Granada, Hospital Universitario San Cecilio, 18012 Granada, Spain; Hospital Universitario de la Princesa and CIBER-ER Grupo Clínico Vinculado U12 (M.M.), 28006 Madrid, Spain; Hospital Virgen de la Victoria (D.F.), 29010 Málaga, Spain; Hospital 12 de Octubre (G.M.), 28041 Madrid, Spain; Hospital Universitario Quirón (E.J.), 28223 Madrid, Spain; Hospital Virgen del Rocío (M.A.M.), 41013 Sevilla, Spain; and IMS Health S.A. (N.P., X.B.), 08034 Barcelona, Spain
| | - M Muñoz-Torres
- Endocrinology/Medicine Departments (S.M.W.), Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unidad 747, Instituto de Salud Carlos III, IIB-Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; Endocrinology/Medicine Departments (M.P.-D.), Hospital Universitari Germans Trias i Pujol-Badalona, CIBER-ER, Grupo Clínico Vinculado U14, and CIBER of Diabetes and Associated Metabolic Diseases, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; Hospital Universitari Bellvitge (C.V.), L'Hospitalet de Llobregat, 08907 Spain; Bone Metabolic Unit (RETICEF, Red Temática de Investigación Cooperative en Envejecimiento y Fragilidad) (M.M.-T.), Endocrinology Unit, Instituto de Investigación Biosanitaria de Granada, Hospital Universitario San Cecilio, 18012 Granada, Spain; Hospital Universitario de la Princesa and CIBER-ER Grupo Clínico Vinculado U12 (M.M.), 28006 Madrid, Spain; Hospital Virgen de la Victoria (D.F.), 29010 Málaga, Spain; Hospital 12 de Octubre (G.M.), 28041 Madrid, Spain; Hospital Universitario Quirón (E.J.), 28223 Madrid, Spain; Hospital Virgen del Rocío (M.A.M.), 41013 Sevilla, Spain; and IMS Health S.A. (N.P., X.B.), 08034 Barcelona, Spain
| | - M Marazuela
- Endocrinology/Medicine Departments (S.M.W.), Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unidad 747, Instituto de Salud Carlos III, IIB-Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; Endocrinology/Medicine Departments (M.P.-D.), Hospital Universitari Germans Trias i Pujol-Badalona, CIBER-ER, Grupo Clínico Vinculado U14, and CIBER of Diabetes and Associated Metabolic Diseases, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; Hospital Universitari Bellvitge (C.V.), L'Hospitalet de Llobregat, 08907 Spain; Bone Metabolic Unit (RETICEF, Red Temática de Investigación Cooperative en Envejecimiento y Fragilidad) (M.M.-T.), Endocrinology Unit, Instituto de Investigación Biosanitaria de Granada, Hospital Universitario San Cecilio, 18012 Granada, Spain; Hospital Universitario de la Princesa and CIBER-ER Grupo Clínico Vinculado U12 (M.M.), 28006 Madrid, Spain; Hospital Virgen de la Victoria (D.F.), 29010 Málaga, Spain; Hospital 12 de Octubre (G.M.), 28041 Madrid, Spain; Hospital Universitario Quirón (E.J.), 28223 Madrid, Spain; Hospital Virgen del Rocío (M.A.M.), 41013 Sevilla, Spain; and IMS Health S.A. (N.P., X.B.), 08034 Barcelona, Spain
| | - D Fernández
- Endocrinology/Medicine Departments (S.M.W.), Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unidad 747, Instituto de Salud Carlos III, IIB-Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; Endocrinology/Medicine Departments (M.P.-D.), Hospital Universitari Germans Trias i Pujol-Badalona, CIBER-ER, Grupo Clínico Vinculado U14, and CIBER of Diabetes and Associated Metabolic Diseases, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; Hospital Universitari Bellvitge (C.V.), L'Hospitalet de Llobregat, 08907 Spain; Bone Metabolic Unit (RETICEF, Red Temática de Investigación Cooperative en Envejecimiento y Fragilidad) (M.M.-T.), Endocrinology Unit, Instituto de Investigación Biosanitaria de Granada, Hospital Universitario San Cecilio, 18012 Granada, Spain; Hospital Universitario de la Princesa and CIBER-ER Grupo Clínico Vinculado U12 (M.M.), 28006 Madrid, Spain; Hospital Virgen de la Victoria (D.F.), 29010 Málaga, Spain; Hospital 12 de Octubre (G.M.), 28041 Madrid, Spain; Hospital Universitario Quirón (E.J.), 28223 Madrid, Spain; Hospital Virgen del Rocío (M.A.M.), 41013 Sevilla, Spain; and IMS Health S.A. (N.P., X.B.), 08034 Barcelona, Spain
| | - G Martínez
- Endocrinology/Medicine Departments (S.M.W.), Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unidad 747, Instituto de Salud Carlos III, IIB-Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; Endocrinology/Medicine Departments (M.P.-D.), Hospital Universitari Germans Trias i Pujol-Badalona, CIBER-ER, Grupo Clínico Vinculado U14, and CIBER of Diabetes and Associated Metabolic Diseases, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; Hospital Universitari Bellvitge (C.V.), L'Hospitalet de Llobregat, 08907 Spain; Bone Metabolic Unit (RETICEF, Red Temática de Investigación Cooperative en Envejecimiento y Fragilidad) (M.M.-T.), Endocrinology Unit, Instituto de Investigación Biosanitaria de Granada, Hospital Universitario San Cecilio, 18012 Granada, Spain; Hospital Universitario de la Princesa and CIBER-ER Grupo Clínico Vinculado U12 (M.M.), 28006 Madrid, Spain; Hospital Virgen de la Victoria (D.F.), 29010 Málaga, Spain; Hospital 12 de Octubre (G.M.), 28041 Madrid, Spain; Hospital Universitario Quirón (E.J.), 28223 Madrid, Spain; Hospital Virgen del Rocío (M.A.M.), 41013 Sevilla, Spain; and IMS Health S.A. (N.P., X.B.), 08034 Barcelona, Spain
| | - E Jódar
- Endocrinology/Medicine Departments (S.M.W.), Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unidad 747, Instituto de Salud Carlos III, IIB-Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; Endocrinology/Medicine Departments (M.P.-D.), Hospital Universitari Germans Trias i Pujol-Badalona, CIBER-ER, Grupo Clínico Vinculado U14, and CIBER of Diabetes and Associated Metabolic Diseases, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; Hospital Universitari Bellvitge (C.V.), L'Hospitalet de Llobregat, 08907 Spain; Bone Metabolic Unit (RETICEF, Red Temática de Investigación Cooperative en Envejecimiento y Fragilidad) (M.M.-T.), Endocrinology Unit, Instituto de Investigación Biosanitaria de Granada, Hospital Universitario San Cecilio, 18012 Granada, Spain; Hospital Universitario de la Princesa and CIBER-ER Grupo Clínico Vinculado U12 (M.M.), 28006 Madrid, Spain; Hospital Virgen de la Victoria (D.F.), 29010 Málaga, Spain; Hospital 12 de Octubre (G.M.), 28041 Madrid, Spain; Hospital Universitario Quirón (E.J.), 28223 Madrid, Spain; Hospital Virgen del Rocío (M.A.M.), 41013 Sevilla, Spain; and IMS Health S.A. (N.P., X.B.), 08034 Barcelona, Spain
| | - M A Mangas
- Endocrinology/Medicine Departments (S.M.W.), Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unidad 747, Instituto de Salud Carlos III, IIB-Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; Endocrinology/Medicine Departments (M.P.-D.), Hospital Universitari Germans Trias i Pujol-Badalona, CIBER-ER, Grupo Clínico Vinculado U14, and CIBER of Diabetes and Associated Metabolic Diseases, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; Hospital Universitari Bellvitge (C.V.), L'Hospitalet de Llobregat, 08907 Spain; Bone Metabolic Unit (RETICEF, Red Temática de Investigación Cooperative en Envejecimiento y Fragilidad) (M.M.-T.), Endocrinology Unit, Instituto de Investigación Biosanitaria de Granada, Hospital Universitario San Cecilio, 18012 Granada, Spain; Hospital Universitario de la Princesa and CIBER-ER Grupo Clínico Vinculado U12 (M.M.), 28006 Madrid, Spain; Hospital Virgen de la Victoria (D.F.), 29010 Málaga, Spain; Hospital 12 de Octubre (G.M.), 28041 Madrid, Spain; Hospital Universitario Quirón (E.J.), 28223 Madrid, Spain; Hospital Virgen del Rocío (M.A.M.), 41013 Sevilla, Spain; and IMS Health S.A. (N.P., X.B.), 08034 Barcelona, Spain
| | - N Perulero
- Endocrinology/Medicine Departments (S.M.W.), Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unidad 747, Instituto de Salud Carlos III, IIB-Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; Endocrinology/Medicine Departments (M.P.-D.), Hospital Universitari Germans Trias i Pujol-Badalona, CIBER-ER, Grupo Clínico Vinculado U14, and CIBER of Diabetes and Associated Metabolic Diseases, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; Hospital Universitari Bellvitge (C.V.), L'Hospitalet de Llobregat, 08907 Spain; Bone Metabolic Unit (RETICEF, Red Temática de Investigación Cooperative en Envejecimiento y Fragilidad) (M.M.-T.), Endocrinology Unit, Instituto de Investigación Biosanitaria de Granada, Hospital Universitario San Cecilio, 18012 Granada, Spain; Hospital Universitario de la Princesa and CIBER-ER Grupo Clínico Vinculado U12 (M.M.), 28006 Madrid, Spain; Hospital Virgen de la Victoria (D.F.), 29010 Málaga, Spain; Hospital 12 de Octubre (G.M.), 28041 Madrid, Spain; Hospital Universitario Quirón (E.J.), 28223 Madrid, Spain; Hospital Virgen del Rocío (M.A.M.), 41013 Sevilla, Spain; and IMS Health S.A. (N.P., X.B.), 08034 Barcelona, Spain
| | - X Badia
- Endocrinology/Medicine Departments (S.M.W.), Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unidad 747, Instituto de Salud Carlos III, IIB-Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; Endocrinology/Medicine Departments (M.P.-D.), Hospital Universitari Germans Trias i Pujol-Badalona, CIBER-ER, Grupo Clínico Vinculado U14, and CIBER of Diabetes and Associated Metabolic Diseases, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; Hospital Universitari Bellvitge (C.V.), L'Hospitalet de Llobregat, 08907 Spain; Bone Metabolic Unit (RETICEF, Red Temática de Investigación Cooperative en Envejecimiento y Fragilidad) (M.M.-T.), Endocrinology Unit, Instituto de Investigación Biosanitaria de Granada, Hospital Universitario San Cecilio, 18012 Granada, Spain; Hospital Universitario de la Princesa and CIBER-ER Grupo Clínico Vinculado U12 (M.M.), 28006 Madrid, Spain; Hospital Virgen de la Victoria (D.F.), 29010 Málaga, Spain; Hospital 12 de Octubre (G.M.), 28041 Madrid, Spain; Hospital Universitario Quirón (E.J.), 28223 Madrid, Spain; Hospital Virgen del Rocío (M.A.M.), 41013 Sevilla, Spain; and IMS Health S.A. (N.P., X.B.), 08034 Barcelona, Spain
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Reyes-García R, García-Martín A, Morales-Santana S, Rozas-Moreno P, García-Fontana B, Muñoz-Torres M. Dickkopf1 (DKK1), metabolismo óseo y enfermedad ateroesclerótica en pacientes con diabetes mellitus tipo 2. Rev Osteoporos Metab Miner 2016. [DOI: 10.4321/s1889-836x2016000100004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Reyes García R, Muñoz-Torres M. Trabecular Bone Score y tratamiento quirúrgico del hiperparatiroidismo primario. Rev Osteoporos Metab Miner 2015. [DOI: 10.4321/s1889-836x2015000100001] [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: 11/11/2022] Open
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Hollander P, King AB, Del Prato S, Sreenan S, Balci MK, Muñoz-Torres M, Rosenstock J, Hansen CT, Niemeyer M, Garber AJ. Insulin degludec improves long-term glycaemic control similarly to insulin glargine but with fewer hypoglycaemic episodes in patients with advanced type 2 diabetes on basal-bolus insulin therapy. Diabetes Obes Metab 2015; 17:202-6. [PMID: 25387855 DOI: 10.1111/dom.12411] [Citation(s) in RCA: 18] [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: 08/07/2014] [Revised: 10/31/2014] [Accepted: 11/06/2014] [Indexed: 02/07/2023]
Abstract
The aim of the present study was to compare the long-term safety and efficacy of insulin degludec with those of insulin glargine in patients with advanced type 2 diabetes (T2D) over 78 weeks (the 52-week main trial and a 26-week extension). Patients were randomized to once-daily insulin degludec or insulin glargine, with mealtime insulin aspart ± metformin ± pioglitazone, and titrated to pre-breakfast plasma glucose values of 3.9-4.9 mmol/l (70-88 mg/dl). After 78 weeks, the overall rate of hypoglycaemia was 24% lower (p = 0.011) and the rate of nocturnal hypoglycaemia was 31% lower (p = 0.016) with insulin degludec in the extension trial set, while both groups of patients achieved similar glycaemic control. Rates of adverse events and total insulin doses were similar for both groups in the safety analysis set. During 18 months of treatment, insulin degludec + mealtime insulin aspart ± oral antidiabetic drugs in patients with T2D improves glycaemic control similarly, but confers lower risks of overall and nocturnal hypoglycaemia than with insulin glargine treatment.
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Affiliation(s)
- P Hollander
- Baylor University Medical Center, Dallas, TX, USA
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10
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García-Fontana B, Morales-Santana S, Varsavsky M, García-Martín A, García-Salcedo JA, Reyes-García R, Muñoz-Torres M. Sclerostin serum levels in prostate cancer patients and their relationship with sex steroids. Osteoporos Int 2014; 25:645-51. [PMID: 23903956 DOI: 10.1007/s00198-013-2462-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED The role of sclerostin on bone metabolism and its relation to sex steroids in patients with prostate cancer (PC) is not well known. We found that sclerostin levels are significantly increased in PC patients, particularly in those with androgen deprivation therapy (ADT), and there is an inverse relationship between sclerostin levels and testosterone. INTRODUCTION Recent studies have evaluated sclerostin levels in bone diseases as osteoporosis. However, there are few data in PC patients, particularly in patients with hypogonadism related to ADT. The aim of the present study was to compare serum sclerostin levels in ADT/non-ADT-treated PC patients and healthy controls and to evaluate their relationship with sex steroids and bone metabolism. METHODS We performed a cross-sectional study involving 81 subjects: 25 ADT-treated PC patients, 34 PC patients without ADT treatment, and 22 healthy controls. We measured serum sclerostin levels, bone turnover markers, bone mineral density (BMD) in all individuals, and sex steroids levels in PC patients. RESULTS Serum sclerostin levels were significantly higher in PC patients compared to those in control subjects. ADT-treated patients had significantly higher sclerostin levels than PC patients without ADT treatment: ADT 64.52 ± 27.21 pmol/L, non-ADT 48.24 ± 15.93 pmol/L, healthy controls 38.48 ± 9.19 pmol/L, p < 0.05. In PC patients, we found a negative relationship between serum sclerostin levels and androgens after age adjustment (total testosterone: r = -0.309, p = 0.029; bioavailable testosterone: r = -0.280, p = 0.049; free testosterone: r = -0.299, p = 0.035). We did not observe any relationship between sclerostin levels and bone turnover markers or BMD in any group. CONCLUSIONS Circulating sclerostin levels are significantly increased in patients with PC and particularly in those receiving ADT. The inverse relationship between serum sclerostin and testosterone in these patients suggests that androgens are key regulators of bone metabolism in this population.
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Affiliation(s)
- B García-Fontana
- Bone Metabolic Unit, Endocrinology Division (RETICEF), Hospital Universitario San Cecilio, Avda. Doctor Olóriz 16, 18012, Granada, Spain
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11
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García-Martín A, Reyes-García R, García-Castro JM, Muñoz-Torres M. Diabetes and osteoporosis: Action of gastrointestinal hormones on the bone. Rev Clin Esp 2013; 213:293-7. [PMID: 26530941 DOI: 10.1016/j.rce.2013.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 10/17/2012] [Revised: 01/17/2013] [Accepted: 01/20/2013] [Indexed: 11/26/2022]
Abstract
A 62-year-old woman consulted for evaluation of treatment for her type 2 diabetes diagnosed four years ago. He had been received treatment with metformin 850mg twice, with no chronic associated complications. She had hypertension and dyslipidemia. She was being treated with candesartan/hydrochlorothiazide 32/12.5mg and atorvastatin 40mg. Her weight was 92kg and height 162cm (BMI, 35.1kg/m(2)). The last analysis showed fasting glucose 168mg/dl and glycated hemoglobin 7.5%, Microalbuminuria was negative. Blood pressure and lipid profile were within the therapeutic range. Two years ago she suffered a nontraumatic Colle's fracture in her left arm for which she was taking a daily calcium and vitamin D supplement and weekly alendronate. In summary, this is an obese female patient with type 2 diabetes mellitus and inadequate metabolic control, She also has a history of fragility fracture. How should this patient be evaluated and treated?
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Affiliation(s)
- A García-Martín
- Unidad de Metabolismo Óseo, Servicio de Endocrinología, Hospital Universitario San Cecilio, Granada, España; Sección de Endocrinología, Hospital Comarcal del Noroeste, Murcia, España.
| | - R Reyes-García
- Unidad de Metabolismo Óseo, Servicio de Endocrinología, Hospital Universitario San Cecilio, Granada, España; Unidad de Endocrinología, Hospital General Universitario Rafael Méndez, Murcia, España
| | - J M García-Castro
- Servicio de Medicina Interna, Hospital La Inmaculada, Almería, España
| | - M Muñoz-Torres
- Unidad de Metabolismo Óseo, Servicio de Endocrinología, Hospital Universitario San Cecilio, Granada, España
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Black DM, Bilezikian JP, Greenspan SL, Wüster C, Muñoz-Torres M, Bone HG, Rosen CJ, Andersen HS, Hanley DA. Improved adherence with PTH(1-84) in an extension trial for 24 months results in enhanced BMD gains in the treatment of postmenopausal women with osteoporosis. Osteoporos Int 2013; 24:1503-11. [PMID: 22930240 PMCID: PMC4890154 DOI: 10.1007/s00198-012-2098-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 02/27/2012] [Accepted: 07/20/2012] [Indexed: 11/30/2022]
Abstract
UNLABELLED The purpose of this study is to examine the effect of PTH(1-84) treatment over 24 months followed by 12 months discontinuation on BMD, bone turnover markers, fractures and the impact of adherence on efficacy. INTRODUCTION There is limited information about the effect of PTH(1-84) after 18 months and limited data about the impact of compliance on response to anabolic therapy. METHODS Seven hundred and eighty-one subjects who received active PTH(1-84) in the Treatment of Osteoporosis with Parathyroid hormone trial for approximately 18 months were entered into a 6-month open-label extension. Thereafter, they were followed for 12 additional months after discontinuation of treatment. Endpoints examined included changes in BMD and biochemical markers. RESULTS PTH(1-84) treatment over 24 months increased BMD at the lumbar spine by 6.8% above baseline (p<0.05).The total corresponding BMD increases at the hip and femoral neck were 1.1 and 2.2% above baseline. Larger increases in spine BMD were observed in participants with ≥80% adherence to daily injections of PTH(1-84) (8.3% in adherent vs 4.9% in poorly adherent patients). Total hip BMD gains were 1.7% in adherent vs 0.6% in poorly adherent participants. Markers of bone turnover (BSAP and NTx) peaked 6 months after starting PTH(1-84) treatment and declined slowly but remained above baseline at 24 months. After discontinuation of PTH(1-84) treatment (at 24 months), bone turnover markers returned to near baseline levels by 30 months. The adherent group sustained significantly fewer fractures than the poorly adherent group. CONCLUSIONS PTH(1-84) treatment over 24 months results in continued increases in lumbar spine BMD. Adherence to treatment with PTH(1-84) for up to 24 months is also associated with greater efficacy.
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Affiliation(s)
- D M Black
- Department of Epidemiology and Biostatistics, University of California, San Fransisco, Suite 5700, 185 Berry Street, San Francisco, CA 94107, USA.
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Varsavsky M, Reyes-García R, García-Martín A, González-Ramírez AR, Avilés-Perez MD, Muñoz-Torres M. SHBG levels are associated with bone loss and vertebral fractures in patients with prostate cancer. Osteoporos Int 2013; 24:713-9. [PMID: 22588185 DOI: 10.1007/s00198-012-2012-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/26/2012] [Indexed: 10/28/2022]
Abstract
SUMMARY Fractures are increased among prostate cancer patients. No data have been reported in patients with prostate cancer about the relation between serum sex hormone-binding globulin (SHBG) and bone metabolism. We found that SHBG levels were inversely related to bone mass and vertebral fractures in this population. INTRODUCTION Fractures are increased among prostate cancer patients, especially those on androgen deprivation therapy (ADT), but few data are available on the role of SHBG in their bone status. Our objective was to analyze the relation between serum SHBG and bone metabolism in prostate cancer patients. METHODS This is a cross-sectional study including 91 subjects with prostate cancer (54 % with ADT). We measured serum levels of SHBG and sex steroids, bone mineral density (BMD) by dual-energy X-ray absorptiometry, and prevalent radiographic vertebral fractures. RESULTS SHBG levels were inversely related to BMD (femoral neck: r = -0.299, p = 0.00; total hip: r = -0.259, p = 0.019). Subjects with osteoporosis had higher SHBG concentrations than patients without osteoporosis (60.97 ± 39.56 vs 44.45 ± 23.32 nmol/l, p = 0.022). Patients with SHBG levels in the first quartile (>57.6 nmol/l) had an odds ratio (OR) for osteoporosis of 2.59 (95 % CI, 1.30-5.12; p = 0.009) compared with patients with lower SHBG levels. In patients with SHBG >57.6 nmol/l, the OR for vertebral fractures was 2.34 (95 % CI, 1.15-4.78; p = 0.034). The calculated OR was higher after adjustment for age (OR, 5.16; 95 % CI, 1.09-24.49; p = 0.039), estrogens (OR, 6.45; 95 % CI, 1.44-28.95; p = 0.023), and androgens (OR, 5.51; 95 % CI, 1.36-22.37; p = 0.017). CONCLUSIONS In prostate cancer patients, SHBG levels were inversely related to bone mass and vertebral fractures. Determination of the serum SHBG level may constitute a useful and straightforward marker for predicting the severity of osteoporosis in these patients.
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Affiliation(s)
- M Varsavsky
- Bone Metabolic Unit (RETICEF), Endocrinology Division, Hospital Universitario San Cecilio, Granada, Spain
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14
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Rozas Moreno P, Reyes García R, García-Martín A, Varsavsky M, García-Salcedo JA, Muñoz-Torres M. Serum osteoprotegerin: bone or cardiovascular marker in Type 2 diabetes males? J Endocrinol Invest 2013; 36:16-20. [PMID: 22391059 DOI: 10.3275/8285] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The role of osteoprotegerin (OPG) as a marker of cardiovascular disease (CVD) in Type 2 diabetes (T2DM) is not well established. Moreover, the relationship between OPG, osteoporosis, and vertebral fractures in T2DM remains to be elucidated. AIM To determine the role of serum OPG in the prediction of CVD and bone disease in T2DM males. SUBJECTS AND METHODS Cross-sectional study with 68 males, 43 with T2DM and 25 subjects without diabetes. We measured: serum OPG by inmunoassay, the presence of CVD (coronary heart disease, cerebrovascular and peripheral artery disease), surrogate markers of CVD [intima- media thickness (IMT) and aortic calcification] and bone disease (bone mineral density and prevalent vertebral fractures). RESULTS OPG serum levels (in pmol/l) were significantly higher in T2DM males with abnormal IMT (5.12 ± 1.59 vs 3.76 ± 1.98), carotid plaque (5.46 ± 1.67 vs 4.20 ± 1.81), aortic calcification (5.91 ± 1.39 vs 4.07 ± 1.76), hypertension (5.11 ± 1.86 vs 3.81 ± 1.47), and peripheral artery disease (6.24 ± 1.64 vs 4.21 ± 1.63, p < 0.05 for all comparisons). In the logistic regression analysis (after adjustment for age and main cardiovascular risk factors), serum OPG (per 1 pmol/l increase in OPG) was associated with increased risk of abnormal IMT [odds ratio (OR) 1.84, confidence interval (CI) 1.21-2.79, p = 0.004), carotid plaque (OR 1.71, CI 1.13-2.58, p = 0.012), aortic calcification (OR 2.21, CI 1.27-3.84, p = 0.05) and peripheral artery disease (OR 4.02, CI 1.65-9.8 p = 0.002). However, OPG were not related to bone mass or vertebral fractures. CONCLUSIONS Our results suggest that in T2DM males OPG serum concentrations constitute a marker of CVD, but not a marker of bone disease.
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Affiliation(s)
- P Rozas Moreno
- Bone Metabolic Unit, Endocrinology Division, Hospital Universitario San Cecilio, Granada, Spain
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15
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Reyes-García R, Rozas-Moreno P, Muñoz-Torres M. Enfermedad cardiovascular, osteoporosis y riesgo de fractura. Rev Clin Esp 2012; 212:188-92. [DOI: 10.1016/j.rce.2011.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 05/24/2011] [Accepted: 06/05/2011] [Indexed: 11/28/2022]
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16
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Reyes-Garcia R, Rozas-Moreno P, Jimenez-Moleon JJ, Villoslada MJL, Garcia-Salcedo JA, Santana-Morales S, Muñoz-Torres M. Relationship between serum levels of osteocalcin and atherosclerotic disease in type 2 diabetes. Diabetes Metab 2011; 38:76-81. [PMID: 21996253 DOI: 10.1016/j.diabet.2011.07.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/12/2011] [Accepted: 07/30/2011] [Indexed: 11/25/2022]
Abstract
AIMS To analyze the relationship between serum levels of osteocalcin and parameters of atherosclerosis in patients with type 2 diabetes mellitus (T2DM). METHODS This cross-sectional study of 78 patients with T2DM evaluated intima-media thickness, and the prevalence of coronary heart disease, atherosclerotic plaques and aortic calcifications. Serum osteocalcin levels were also determined by radioimmunoassay. RESULTS The patients' mean age was 57.8±6.4 years (duration of diabetes: 13.4 years; mean HbA(1c) level: 8.01%), and 37.2% had coronary heart disease, 56% had an abnormal intima-media thickness, 26.9% had carotid plaques and 32.1% had aortic calcifications. Coronary heart disease was associated with higher levels of osteocalcin in male vs female patients (1.95±1.36 vs 0.93±0.86 ng/mL, respectively; P=0.006). Also, higher concentrations of osteocalcin were found in female patients with vs without abnormal intima-media thicknesses (2.17±1.84 vs 1.25±0.67 ng/mL, respectively; P=0.042), carotid plaques (2.86±2.10 vs 1.43±1.09 ng/mL, respectively; P=0.03) and aortic calcifications (2.85±1.97 vs 1.26±0.83 ng/mL, respectively; P=0.002). Serum osteocalcin levels were associated with coronary heart disease on multivariate logistic regression (odds ratio: 2.27, 95% confidence interval: 1.21-4.25; P=0.01). CONCLUSION In T2DM patients, serum osteocalcin levels were associated with parameters of atherosclerosis, suggesting that osteocalcin is involved not only in bone metabolism, but also in atherosclerotic disease.
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Affiliation(s)
- R Reyes-Garcia
- Bone Metabolic Unit (RETICEF), Endocrinology Division, Hospital Universitario San Cecilio, Av. Dr. Oloriz 16, 18012 Granada, Spain
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17
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Fernández-García D, Muñoz-Torres M, Mezquita-Raya P, de la Higuera M, Alonso G, Reyes-García R, Ochoa AS, Ruiz-Requena ME, Luna JD, Escobar-Jiménez F. Effects of raloxifene therapy on circulating osteoprotegerin and RANK ligand levels in post-menopausal osteoporosis. J Endocrinol Invest 2008; 31:416-21. [PMID: 18560259 DOI: 10.1007/bf03346385] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Previous in vitro studies suggest that the anti-resorptive effect of raloxifene might be mediated by changes in several cytokines involved in the bone remodeling process. In this context, the osteoprotegerin (OPG)- receptor activator of NF kappa B ligand (RANKL) system is considered a key component in the osteoclastogenesis regulation. The aim of this study was to determine the effects of raloxifene treatment on serum concentrations of OPG, receptor RANKL and its relationship with biochemical markers of bone turnover and bone mineral density (BMD) in previously untreated women with post-menopausal osteoporosis. We selected 47 post-menopausal women (mean age 63+/-7 yr) with densitometric criteria of osteoporosis. We determined at baseline, 3, 6, and 12 months anthropometric parameters, biochemical markers of bone turnover, serum levels of 25(OH) D, serum levels of OPG and RANKL. BMD (dual-energy x-ray absorptiometry) in lumbar spine (LS) femoral neck and total hip was measured at baseline and 12 months after raloxifene (60 mg/day) treatment. Serum levels of OPG decreased in the 3rd and 6th month of treatment (p<0.001) and returned to basal levels in the 12th month. There was a significant decrease of RANKL levels and OPG/RANKL ratio after 1 yr of raloxifene treatment. In addition, BMD in LS increased significantly (2.5%) in the 12th month of treatment (p=0.031). Finally, the biochemical markers of bone turnover (total alkaline phosphatase, bone alkaline phosphatase, osteocalcin, tartrate-resistant acid phosphatase, urine cross-linked carboxi-terminal telopeptide of type I collagen) decreased significantly from the 3rd month of treatment. In conclusion, our results support the hypothesis that raloxifene may inhibit osteoclast activity, at least partly modulating the OPG-RANKL system.
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Affiliation(s)
- D Fernández-García
- Bone Metabolic Unit, Endocrinology Division, University Hospital San Cecilio Granada, RETICEF, Granada, Spain
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18
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Adami S, San Martin J, Muñoz-Torres M, Econs MJ, Xie L, Dalsky GP, McClung M, Felsenberg D, Brown JP, Brandi ML, Sipos A. Effect of raloxifene after recombinant teriparatide [hPTH(1-34)] treatment in postmenopausal women with osteoporosis. Osteoporos Int 2008; 19:87-94. [PMID: 17938984 DOI: 10.1007/s00198-007-0485-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 05/02/2007] [Indexed: 10/22/2022]
Abstract
UNLABELLED Loss of bone mineral density occurs after discontinuation of teriparatide, if no subsequent treatment is given. Sequential raloxifene prevented rapid bone loss at lumbar spine and further increased bone mineral density (BMD) at femoral neck, whether raloxifene was started immediately or after a one-year delay following teriparatide treatment. INTRODUCTION We compared the sequential effects of raloxifene treatment with a placebo on teriparatide-induced increases in bone mineral density (BMD). A year of open-label raloxifene extended the study to assess the response with and without delay after discontinuation of teriparatide. METHODS Following a year of open-label teriparatide 20 mug/day treatment, postmenopausal women with osteoporosis were randomly assigned to raloxifene 60 mg/day (n = 157) or a placebo (n = 172) for year 2, followed by a year of open-label raloxifene. BMD was measured by dual energy x-ray absorptiometry. RESULTS The raloxifene and placebo groups showed a decrease in lumbar spine (LS) BMD in year 2 for raloxifene and placebo groups (-1.0 +/- 0.3%, P = 0.004; and -4.0 +/- 0.3%, P < 0.001, respectively); the decrease was less with raloxifene (P < 0.001). Open-label raloxifene treatment reversed the LS BMD decrease with a placebo, resulting in similar decreases 2 years after randomization (-2.6 +/- 0.4% (raloxifene-raloxifene) and -2.7 +/- 0.4% (placebo-placebo). At study end, LS and femoral neck (FN) BMD were higher than pre-teriparatide levels, with no significant differences between the raloxifene-raloxifene and placebo-raloxifene groups, respectively (LS: 6.1 +/- 0.5% vs. 5.1 +/- 0.5%; FN: 3.4 +/- 0.6% vs. 3.0 +/- 0.5%). CONCLUSION Sequential raloxifene prevented rapid bone loss at the LS and increased FN BMD whether raloxifene was started immediately or after a one-year delay following teriparatide treatment.
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Affiliation(s)
- S Adami
- Riabilitazione Reumatologica, University of Verona, Valeggio s/Mincio, Verona, Italy.
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Sosa M, Saavedra P, Valero C, Guañabens N, Nogués X, del Pino-Montes J, Mosquera J, Alegre J, Gómez-Alonso C, Muñoz-Torres M, Quesada M, Pérez-Cano R, Jódar E, Torrijos A, Lozano-Tonkin C, Díaz-Curiel M. Inhaled steroids do not decrease bone mineral density but increase risk of fractures: data from the GIUMO Study Group. J Clin Densitom 2006; 9:154-8. [PMID: 16785074 DOI: 10.1016/j.jocd.2005.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 10/25/2005] [Accepted: 11/27/2005] [Indexed: 11/17/2022]
Abstract
Although the negative effect of systemic steroids on bone is well documented, there is not clear evidence about possible adverse effects of inhaled steroids on bone metabolism and fractures. A cross-sectional study was performed on 105 women suffering from bronchial asthma treated with inhaled steroids and 133 controls. Bone mineral density (BMD) was measured by quantitative ultrasonography (QUS) at the calcaneus and by dual X-ray absorptiometry (DXA), at both the lumbar spine and proximal femur. Patients suffering from bronchial asthma showed no statistically significant changes in BMD as measured by DXA or QUS, compared with controls. A higher prevalence of fractures was found in the group of women with bronchial asthma, with an age-adjusted odds ratio of 2.79 (95% CI: 1.19-6.54). Inhaled steroids do not appear to decrease BMD, but are associated with an increased risk of fracture in women.
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Affiliation(s)
- M Sosa
- University of Las Palmas de Gran Canria, Hospital University Insular, Bone Metabolic Unit, Apartado 550, 35080 Las Palmas de Gran Canaria, Canary Islands, Spain.
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Muñoz-Torres M, Rozas-Moreno P, Alonso G, Escobar-Jiménez F. Encuesta sobre práctica clínica en el hiperparatiroidismo primario. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1575-0922(06)71062-2] [Citation(s) in RCA: 4] [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] [Indexed: 11/25/2022]
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Sosa M, Saavedra P, Gómez-Alonso C, Mosquera J, Torrijos A, Muñoz-Torres M, Valero Díaz de la Madrid C, Díaz Curiel M, Martínez Díaz Guerra G, Pérez-Cano R, Alegre J, Del Pino J. Postmenopausal women with Colles' fracture have bone mineral density values similar to those of controls when measured with calcaneus quantitative ultrasound. Eur J Intern Med 2005; 16:561-6. [PMID: 16314236 DOI: 10.1016/j.ejim.2005.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Revised: 04/08/2005] [Accepted: 06/02/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- M Sosa
- University of Las Palmas de Gran Canaria, Faculty of Medicine, Department of Medical and Surgery Sciences, Hospital University Insular, Service of Internal Medicine, Bone Metabolic Unit, Spain.
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Sosa M, Saavedra P, del Pino-Montes J, Alegre J, Pérez-Cano R, Guerra GMD, Díaz-Curiel M, Valero C, Muñoz-Torres M, Torrijos A, Mosquera J, Gómez-Alonso C. Postmenopausal women with colles' fracture have lower values of bone mineral density than controls as measured by quantitative ultrasound and densitometry. J Clin Densitom 2005; 8:430-5. [PMID: 16311428 DOI: 10.1385/jcd:8:4:430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 06/02/2005] [Accepted: 06/02/2005] [Indexed: 11/11/2022]
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.
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Affiliation(s)
- Manuel Sosa
- University of Las Palmas de Gran Canaria, Hospital University Insular, Bone Metabolic Unit, Las Palmas de Gran Canaria, Canary Islands, Spain.
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de la Higuera López-Frías M, Fernández García D, Muñoz-Torres M. [Bone densitometry: clinical applications and scientific evidence]. Rev Clin Esp 2004; 204:480-2. [PMID: 15388023 DOI: 10.1157/13065979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- M de la Higuera López-Frías
- Unidad Metabolismo Oseo, Servicio de Endocrinología y Nutrición, Hospital Universitario San Cecilio, Granada
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López-Rodríguez F, Mezquita-Raya P, de Dios Luna J, Escobar-Jiménez F, Muñoz-Torres M. Performance of quantitative ultrasound in the discrimination of prevalent osteoporotic fractures in a bone metabolic unit. Bone 2003; 32:571-8. [PMID: 12753874 DOI: 10.1016/s8756-3282(03)00058-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
There is a growing interest in ultrasound evaluation of bone status as an alternative to the measurement with dual X-ray absorptiometry (DXA), due to its low cost, portability, and nonionizing radiation. The aim of our study was to investigate the relation among DXA, QUS, clinical, anthropometric, and lifestyle factors, and to determine QUS cutoff values in order to discriminate fractures in patients referred to the Bone Metabolic Unit at an Endocrinology Service. We studied 300 patients (281 females and 19 males; age 58 +/- 11 years) referred for evaluation of osteoporosis. In all cases we determined basic anthropometric parameters, a clinical history including previous osteoporotic fractures and risk factors for osteoporosis, and QUS parameters in calcaneus (Hologic Sahara), and BMD in lumbar spine (LS) and femoral neck (FN), by DXA (Hologic QDR 1000). Using the WHO densitometric criteria, 37, 46.7, and 16.3% of our population were osteoporotic, osteopenic, and normal, respectively. A QUI T-score </=-1.5 SD provided a sensitivity of 68.9% and a specificity of 64.7% for osteoporotic fracture discrimination and a sensitivity of 64.9% and a specificity of 74.1% for osteoporosis defined by WHO criteria using DXA. In the logistic regression, the presence of family history of fragility fractures (OR: 3.03; CI 95%: 1.3-7.03), a DXA T-score </=-2.5 (OR: 3.58; CI 95%: 1.66-7.73), and a QUI T-score </=-1.5 (OR: 2.56; CI 95%: 1.15-5.69) were independently associated with prevalent osteoporotic fractures. In conclusion, calcaneus ultrasound appears as a useful technique for the routine clinical practice, as its performance is similar to DXA for the discrimination of subjects with osteoporotic fracture.
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Affiliation(s)
- F López-Rodríguez
- Bone Metabolic Unit, Endocrinology Division, University Hospital San Cecilio, Granada, Spain
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Mezquita-Raya P, Muñoz-Torres M, de Dios Luna J, Lopez-Rodriguez F, Quesada JM, Luque-Recio F, Escobar-Jiménez F. Performance of COLIA1 polymorphism and bone turnover markers to identify postmenopausal women with prevalent vertebral fractures. Osteoporos Int 2002; 13:506-12. [PMID: 12107666 DOI: 10.1007/s001980200062] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Some studies have suggested that bone turnover markers (BTM) and collagen type I alpha 1 gene (COLIA1) may be useful in the prediction of rates of future bone loss, and may therefore provide information about fracture risk. Our study aimed to examine the association of the COLIA1 genotype with the risk of vertebral fracture and to investigate the predictive value of this genetic factor in comparison with bone mineral density (BMD) and BTM, in ambulatory postmenopausal Spanish women. We determined the COLIA1 polymorphism by polymerase chain reaction, BMD by dual-energy X-ray absorptiometry and BTM in 43 postmenopausal women with prevalent vertebral fracture and a control group of 101 postmenopausal women without fracture. There was a significant overrepresentation of the 'T' allele in fractured women ( p = 0.029). BTM exhibited no differences between women with or without fractures or COLIA1 genotype groups. After adjusting for all other variables, the osteoporosis densitometric criteria variable was the most strongly associated with fracture (OR = 5 [1.8-13.3]) followed by COLIA1 (OR = 2.1 [1-4.3] per copy of the 'T' allele). Our study shows that COLIA1 is associated with prevalent vertebral fracture independently of bone mass, and the performance of this genetic factor to assess prevalent vertebral fracture is better than bone turnover markers.
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Affiliation(s)
- P Mezquita-Raya
- Bone Metabolic Unit, Endocrinology Division, University Hospital San Cecilio, Granada, Spain
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30
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Sosa M, Saavedra P, Muñoz-Torres M, Alegre J, Gómez C, González-Macías J, Guañabens N, Hawkins F, Lozano C, Martínez M, Mosquera J, Pérez-Cano R, Quesada M, Salas E. Quantitative ultrasound calcaneus measurements: normative data and precision in the spanish population. Osteoporos Int 2002; 13:487-92. [PMID: 12107663 DOI: 10.1007/s001980200059] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Quantitative ultrasound (QUS) assessment at the calcaneus has been found to be a safe and reliable method for evaluating skeletal status. In this study we have determined the normative QUS data in the Spanish population for the Sahara Clinical Sonometer (Hologic). Broadband ultrasound attenuation (BUA), speed of sound (SOS), quantitative ultrasound index (QUI) and estimated bone mineral density (BMD) were determined. We also studied the precision in vivo and in vitro. The short-term in vivo precision (CV) was 4.88% for BUA, 0.36% for SOS, 3.45% for QUI and 4.15% for BMD, while in vitro precision was 0.40% for SOS and 2.67% for BUA. Our results are comparable to reference population data previously published in other countries and may serve as reference normative data for both genders in Spain.
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Affiliation(s)
- M Sosa
- University of Las Palmas de Gran Canaria Health Sciences Center and Department of Clinical Sciences, Hospital University Insular, Bone Metabolic Unit, Canary Islands, Spain.
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Muñoz-Torres M, Mezquita-Raya P, Lopez-Rodriguez F, Torres-Vela E, de Dios Luna J, Escobar-Jimenez F. The contribution of IGF-I to skeletal integrity in postmenopausal women. Clin Endocrinol (Oxf) 2001; 55:759-66. [PMID: 11895218 DOI: 10.1046/j.1365-2265.2001.01390.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The pathogenic role of the decline in serum concentrations of IGF-I in postmenopausal osteoporosis is not fully elucidated. We investigated the associations among IGF-I, bone mineral density (BMD), ultrasound parameters and prevalence of vertebral fractures in postmenopausal women. DESIGN A cross-sectional study. PATIENTS One hundred and fifty-four ambulatory postmenopausal women (61 +/- 7 years) referred for osteoporosis screening. MEASUREMENTS IGF-I was measured by radioimmunoassay and BMD using dual-energy X-ray absorptiometry. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) at calcaneus were measured by a quantitative ultrasound system. RESULTS IGF-I was significantly lower in osteoporotic subjects and correlated positively with BMD, BUA and SOS. After adjusting for age, years since menopause and body mass index, IGF-I accounted for 8.5% of the variance at lumbar spine BMD, 4.6% at femoral neck and 7.1% at calcaneal BUA. BUA was associated with IGF-I independently of BMD. IGF-I was lower in women with vertebral fractures (91 +/- 39 microg/l vs. 114 +/- 44 microg/l; P = 0.003). The osteoporosis densitometric criteria (t-score < or = -2.5 SD) was the most strongly independent associated variable with prevalent vertebral fractures [odds ratio (OR): 3.3 (1.4-7.6)], followed by IGF-I levels below 75th percentile [OR: 3 (1-8.8)]. CONCLUSIONS Our study shows that IGF-I is strongly associated with bone mineral density and reflects aspects of bone quality. The contribution of IGF-I to skeletal integrity in postmenopausal women is clinically relevant.
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Affiliation(s)
- M Muñoz-Torres
- Endocrinology Division, University Hospital San Cecilio, Granada, Spain.
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Mezquita-Raya P, Muñoz-Torres M, Luna JD, Luna V, Lopez-Rodriguez F, Torres-Vela E, Escobar-Jiménez F. Relation between vitamin D insufficiency, bone density, and bone metabolism in healthy postmenopausal women. J Bone Miner Res 2001; 16:1408-15. [PMID: 11499863 DOI: 10.1359/jbmr.2001.16.8.1408] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although only few postmenopausal women exhibit biochemical signs of hypovitaminosis D, vitamin D insufficiency has been shown to have adverse effects on bone metabolism and could be an important risk factor for osteoporosis and fracture. We determined serum levels of 25-hydroxyvitamin D [25(OH)D], intact parathyroid hormone (iPTH), bone turnover markers, dietary calcium intake, and bone mineral density (BMD; measured by dual X-ray absorptiometry) in 161 consecutive ambulatory women, healthy except for osteoporosis, referred to a bone metabolic unit. The prevalence of vitamin D insufficiency [25(OH)D < or = 15 ng/ml] was 39.1%. 25(OH)D was lower in the osteoporotic subjects (15.7 +/- 5.3 ng/ml vs. 21.8 +/- 9.7 ng/ml; p < 0.001). After controlling for all other variables, lumbar spine (LS) BMD was found to be significantly associated with 25(OH)D, body mass index (BMI), and years after menopause (YSM) (R2 = 0.253; p < 0.001). For femoral neck (FN), significant independent predictors of BMD were YSM, BMI, iPTH, and 25(OH)D (R2 = 0.368; p < 0.001). The probability of meeting osteoporosis densitometric criteria was higher in the vitamin D insufficiency group (odds ratio [OR], 4.17, 1.83-9.48) after adjusting by YSM, BMI, iPTH, and dietary calcium intake. Our study shows that vitamin D insufficiency in an otherwise healthy postmenopausal population is a common risk factor for osteoporosis associated with increased bone remodeling and low bone mass.
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Affiliation(s)
- P Mezquita-Raya
- Endocrinology Division, University Hospital San Cecilio, Granada, Spain
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Muñoz-Torres M, Ventosa Viñas M, Mezquita Raya P, Luna V, López Rodríguez F, Becerra D, Quesada Charneco M, Escobar Jiménez F, Jiménez Moleón J. [Usefulness of bone densitometry in the evaluation of primary hyperparathyroidism]. Med Clin (Barc) 2000; 114:521-4. [PMID: 10846662 DOI: 10.1016/s0025-7753(00)71352-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND In recent years, the clinical profile of primary hyperparathyroidism (PH) is predominantly characterized by mild or asymptomatic forms. In this context, the effects of the PH on bone metabolism reach a growing importance in the adoption of therapeutic decisions. PATIENTS AND METHODS 116 patients with PH were studied, 95 women (25 premenopausal, 70 postmenopausal) and 21 males. In all cases parathyroidectomy criteria were evaluated. Bone mineral density (BMD) was determined in 71 patients in lumbar spine (LS) and femoral neck by dual-X-Ray absorptiometry (DXA) and the influence of this measurement in the decision of surgical treatment was analyzed. RESULTS The patients with PH showed a significant reduction of BMD at all sites (p < 0.001) and 71.8% met osteoporosis densitometric criteria. The most frequent parathyroidectomy criteria was the presence of specific clinical manifestations (51.7%) followed by decrease of the BMD in LS (49.3%). The probability of meeting criteria for surgical treatment was significantly higher in patients in which BMD was measured (odds ratio: 3.09 [1.03-9.22]; p = 0.036). CONCLUSIONS In its current presentation, PH presents a significant decrease of bone mass. The systematic performance of bone densitometry has a decisive influence in its appropriate management.
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Affiliation(s)
- M Muñoz-Torres
- Servicio de Endocrinología y Nutrición (Unidad de Metabolismo Oseo), Hospital Clínico San Cecilio, Granada.
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Muñoz-Torres M, Mezquita Raya P. [New approaches to the role of estrogens in bone metabolism]. Med Clin (Barc) 1999; 113:292-3. [PMID: 10603582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Pols HA, Felsenberg D, Hanley DA, Stepán J, Muñoz-Torres M, Wilkin TJ, Qin-sheng G, Galich AM, Vandormael K, Yates AJ, Stych B. Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Fosamax International Trial Study Group. Osteoporos Int 1999; 9:461-8. [PMID: 10550467 DOI: 10.1007/pl00004171] [Citation(s) in RCA: 363] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This randomized, double-masked, placebo-controlled trial evaluated the safety, tolerability and effects on bone mineral density (BMD) of alendronate in a large, multinational population of postmenopausal women with low bone mass. At 153 centers in 34 countries, 1908 otherwise healthy, postmenopausal women with lumbar spine BMD 2 standard deviations or more below the premenopausal adult mean were randomly assigned to receive oral alendronate 10 mg (n = 950) or placebo (n = 958) once daily for 1 year. All patients received 500 mg elemental calcium daily. Baseline characteristics of patients in the two treatment groups were similar. At 12 months, mean increases in BMD were significantly (p</=0.001) greater in the alendronate than the placebo group by 4.9% (95% confidence interval 4.6% to 5.2%) at the lumbar spine, 2.4% (2.0% to 2.8%) at the femoral neck, 3.6% (3.2% to 4.1%) at the trochanter and 3.0% (2.6% to 3.4%) for the total hip. The incidence of nonvertebral fractures was significantly lower in the alendronate than the placebo group (19 vs 37 patients with fractures), representing a 47% risk reduction for nonvertebral fracture for alendronate-treated patients (95% confidence interval 10% to 70%; p = 0.021). Incidences of adverse events, including upper gastrointestinal adverse events, were similar in the two groups. Therefore, for postmenopausal women with low bone mass, alendronate is well tolerated and produces significant, progressive increases in BMD at the lumbar spine and hip in addition to significant reduction in the risk of nonvertebral fracture.
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Affiliation(s)
- H A Pols
- Erasmus University Medical School, Rotterdam, The Netherlands.
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Mezquita P, Luna V, Muñoz-Torres M, Torres-Vela E, Lopez-Rodriguez F, Callejas JL, Escobar-Jimenez F. Methimazole-induced aplastic anemia in third exposure: successful treatment with recombinant human granulocyte colony-stimulating factor. Thyroid 1998; 8:791-4. [PMID: 9777751 DOI: 10.1089/thy.1998.8.791] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The major adverse reactions of antithyroid drugs are hematologic; aplastic anemia (AA) is one of the rarest and most severe complications. Use of recombinant human hemopoietic colony-stimulating factor was reported to be of benefit in patients who developed agranulocytosis, although there is still some doubt regarding the efficacy in AA. We present a case of a 58-year-old female patient with Graves' disease who developed AA in the third exposure to methimazole (MMI). The withdrawal of MMI and early treatment with 5 microg/kg per day recombinant human granulocyte colony-stimulating factor (G-CSF) for 9 days, allowed a favorable recovery of peripheral blood cell count. We conclude that the use of hemopoietic colony stimulating factors might be a suitable means to achieve the correction of severe thionamide-induced hematologic adverse reactions.
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Affiliation(s)
- P Mezquita
- Endocrine Unit, University Hospital of Granada, Spain
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Gallego-Rojo FJ, Gonzalez-Calvin JL, Muñoz-Torres M, Mundi JL, Fernandez-Perez R, Rodrigo-Moreno D. Bone mineral density, serum insulin-like growth factor I, and bone turnover markers in viral cirrhosis. Hepatology 1998; 28:695-9. [PMID: 9731561 DOI: 10.1002/hep.510280315] [Citation(s) in RCA: 163] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Previous studies suggest that low bone mass is a complication of alcoholic liver disease. Nevertheless, little is known about bone mass and bone metabolism in viral cirrhosis. To evaluate the prevalence and magnitude of hepatic osteopenia in these patients, bone remodeling status, and its relationship with the severity of liver disease and serum levels of insulin-like growth factor I (IGF-I), we studied 32 consecutive patients with viral cirrhosis and no history of alcohol intake. Bone mineral density (BMD) was measured by dual x-ray absorptiometry in the lumbar spine (LS) and femoral neck (FN), and the values were expressed as the z score. Bone metabolism markers and hormone profiles were measured. Patients with viral cirrhosis showed reduced BMD in all sites (LS: -1.27 +/- 1.06, P < .001; FN: -0.48 +/- 0.96; P < .01). Of the 32 patients, 53% met the diagnostic criteria for osteoporosis. In patients, urine deoxypyridinoline (D-Pyr) as a marker of bone resorption and serum bone alkaline phosphatase (b-AP) as a marker of bone formation were significantly higher than in control subjects (P < .001 and P < .01, respectively). Serum IGF-I was lower than in control subjects (P < .001), and significant differences were also found between patients with and without osteoporosis (P < .05). BMD in LS correlated with severity of the disease, with serum levels of IGF-I, and with urine D-Pyr. Our findings show that viral cirrhosis is a major cause of osteoporosis in men, and that low serum IGF-I levels seem to play a role in the bone mass loss in these patients. The biochemical markers of bone remodeling suggest high-turnover osteoporosis in patients with viral cirrhosis.
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Affiliation(s)
- F J Gallego-Rojo
- Department of Gastroenterology, University Hospital of Granada, Spain
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Jódar Gimeno E, Muñoz-Torres M, Escobar-Jiménez F, Quesada Charneco M, Luna del Castillo JD, Oleà N. Identification of metabolic bone disease in patients with endogenous hyperthyroidism: role of biological markers of bone turnover. Calcif Tissue Int 1997; 61:370-6. [PMID: 9351877 DOI: 10.1007/s002239900350] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Active hyperthyroidism is associated with reduced bone mass. Nevertheless, not all patients show the same risk for developing osteoporosis. Our aim was to analyze some clinical and biochemical potential predictors of low bone mass in hyperthyroid patients. We studied 127 consecutive hyperthyroid patients (110 females, 17 males; aged 42 +/- 16 years). Bone mineral density (BMD) was measured by dual X-ray absorptiometry (DXA) at lumbar spine (LS; L2-L4) and femoral neck (FN). Data were expressed as g/cm2 and T-score. Patients were placed into two groups based on recent WHO criteria: Group A, no osteoporosis (n = 98); and group B, lumbar or femoral osteoporosis (n = 29). Study protocol included evaluation of osteoporosis risk factors, anthropometrical variables, thyroid function, and bone turnover markers. Receiver-operating characteristic (ROC) plots for the precision of bone markers and multivariate analysis for the prediction of BMD and osteoporosis were performed. Group B showed greater age and proportion of menopausal females; lower weight, height, and calcium intake; longer duration of menopause; and greater levels of total and bone alkaline phosphatase and of urine hydroxyproline. No differences in thyroid function, osteocalcin, tartrate-resistant acid phosphatase, and type I collagen C-telopeptide (ICTP) were found. The best predictive model accounted for 46% and 62% of the variability of lumbar and femoral BMD respectively and correctly classified 89% of the osteoporotic hyperthyroid patients. No significant difference in ROC plots was observed. It is concluded that hyperthyroid patients with lumbar or femoral osteoporosis show a typical clinical and biochemical profile illustrating that the relationship between BMD and bone markers is better in high turnover states. Classical bone turnover markers show high performance in the evaluation of hyperthyroid bone disease.
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Affiliation(s)
- E Jódar Gimeno
- Service of Endocrinology, University Hospital, 12 de Octubre, Madrid, Spain
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Jódar E, Muñoz-Torres M, Escobar-Jiménez F, Quesada-Charneco M, Lund del Castillo JD. Bone loss in hyperthyroid patients and in former hyperthyroid patients controlled on medical therapy: influence of aetiology and menopause. Clin Endocrinol (Oxf) 1997; 47:279-85. [PMID: 9373448 DOI: 10.1046/j.1365-2265.1997.2261041.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The effect of hyperthyroidism on osteoporosis risk and its reversal after control of hyperthyroidism remains somewhat controversial. We assessed the values of bone mineral density in hyperthyroid patients and in former hyperthyroid patients euthyroid on medical therapy, as well as the influence of aetiology and menopause upon bone mass. DESIGN The values of bone mineral density in hyperthyroid patients (active) and former hyperthyroid patients euthyroid on medical therapy (controlled), were compared, together with data from our control group and from the Spanish reference population. We also compared the values of bone mineral density in patients with Graves' disease with those in patients with toxic nodular goitre and assessed the influence of the menopause. PATIENTS We studied 127 consecutive hyperthyroid patients (age 41 +/- 16 years; 110 females, 17 males; 102 Graves' disease and 25 toxic nodular goitre); 78 were active (group A) and 49 controlled on medical therapy (carbimazole, mean time of euthyroidism 7.5 +/- 9.1 months; group B). We also studied 43 healthy subjects (age 40 +/- 14 years; 41 females, two males; group C). MEASUREMENTS Bone mineral density was assessed by dual X-ray absorptiometry at lumbar spine (L2-L4), femoral neck and Ward's triangle. Data were expressed as g/cm2 and as a Z score (SD vs Spanish reference population adjusted by age and sex). Blood was obtained to measure the levels of free T4, TSH and TSH receptor antibody. RESULTS Patients with active hyperthyroidism showed a generalized reduction in axial bone mineral density in comparison with both the control group and the reference population, whereas former hyperthyroid patients showed partial recovery of bone mass in lumbar spine and Ward's triangle. Mean Z scores at lumbar spine, femoral neck and Ward's triangle were: -0.92, -0.79 and -0.89 in group A; -0.74, -0.23 and -0.44 in group B and 0.18, 0.09 and 0.36 in group C, respectively. No differences were found between bone mineral density values from patients with Graves' disease and those with toxic nodular goitre, nor between pre and postmenopausal hyperthyroid women once adjusted by age and sex. CONCLUSIONS Our data suggest that hyperthyroid patients show a generalized reduction of bone mass in the axial skeleton and that only partial recovery is present in former hyperthyroid patients after a mean of 7.5 months of biochemical euthyroidism. This recovery is insufficient to normalize the bone density in lumbar spine and Ward's triangle, although femoral bone mass was not different from that of the control group. The extent and degree of hyperthyroid bone disease surpass the effects of the menopause on the bone mass. The aetiology of hyperthyroidism does not seem to play any role in the severity of hyperthyroid bone disease.
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Affiliation(s)
- E Jódar
- Endocrinology Division (Medicina Interna I), University Hospital, Granada, Spain
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López-Beltrán A, Calanas AS, Jimena P, Escudero AL, Campello TR, Muñoz-Torres M, Escobar-Jiménez F, Carvia RE, Nogales FF. Virilizing mature ovarian cystic teratomas. Virchows Arch 1997; 431:149-51. [PMID: 9293897 DOI: 10.1007/s004280050081] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Three further cases of mature benign cystic teratomas of the ovary associated with virilization are added to the three previously reported in the literature. They were found in postmenopausal, obese, diabetic women aged 52, 61, and 67 years. The patients presented with hirsutism and voice changes and clitoromegaly was present in one. Testosterone and androstenedione levels were elevated but promptly regressed after removal of the tumours. Histologically, sheets of stromal luteinized cells were found peripherally at the interface between the neoplasm and ovarian tissue. Luteinization of ovarian stroma induced by an unknown factor related to diabetes mellitus is the origin of the virilization.
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Affiliation(s)
- A López-Beltrán
- Department of Pathology, Cordoba University Medical School and Reina Sofia University Hospital, Spain
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41
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Jódar E, Muñoz-Torres M, Escobar-Jiménez F, Quesada M, Luna JD, Olea N. Antiresorptive therapy in hyperthyroid patients: longitudinal changes in bone and mineral metabolism. J Clin Endocrinol Metab 1997; 82:1989-94. [PMID: 9177418 DOI: 10.1210/jcem.82.6.4026] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The effect of antiresorptive therapy with nasal calcitonin (CT) in recently diagnosed hyperthyroid patients on conventional medical therapy as well as the evolution of bone metabolism were assessed. Forty-five patients with recent-onset hyperthyroidism (<12 weeks) were sex and menopause stratified and randomly allocated to treatment with carbimazole (Neotomizol), carbimazole plus low dose CT (Calsynar; 100 IU/day, 2 days/week), or carbimazole plus high dose CT (Calsynar; 100 IU/day, 14 days/month). Bone mineral density was measured by dual x-ray absorptiometry in lumbar spine, femoral neck, and Ward's triangle at 0, 9, and 18 months of treatment. We also determined free T4, free T3, TSH, osteocalcin, total and bone alkaline phosphatases, tartrate-resistant acid phosphatase, type I collagen C telopeptide, and urinary hydroxyproline every 3 months of follow-up. No significant difference was observed among treatments. A euthyroid state was attained at 3 months. Bone mass increased significantly at the 9 month evaluation (P < 0.05), with a 5-10% net gain during follow-up. Nevertheless, final bone mass was 4-8% smaller than expected. Bone formation markers were increased at 0 and 3 months, with reductions at 6-9 months; resorption bone markers showed a significant reduction at the 3 month evaluation. These results indicate that the euthyroid state partially reduces hyperthyroidism-associated osteopenia, with a bone mass recovery period during the 6-9 early months of effective treatment. This recovery phase is characterized by raised bone formation markers and reduced bone resorption markers. The treatment with nasal CT at the doses assayed has no additional effect over that of attainment of the euthyroid state.
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Affiliation(s)
- E Jódar
- Service of Endocrinology (Catedra de Medicina Interna I), University Hospital, Granada University, Spain
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42
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Ortego-Centeno N, Muñoz-Torres M, Jódar E, Hernández-Quero J, Jurado-Duce A, de la Higuera Torres-Puchol J. Effect of tobacco consumption on bone mineral density in healthy young males. Calcif Tissue Int 1997; 60:496-500. [PMID: 9164822 DOI: 10.1007/s002239900270] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Smoking is related to a decreased bone mass and increased risk of osteoporotic fractures. Nevertheless, the effect of smoking in males is poorly understood. The purpose of this study was to assess the repercussion of smoking on bone mass in otherwise healthy male smokers and its relationship with markers of mineral metabolism and hormone profile. We measured bone mineral density (BMD) in 57 healthy males (26 nonsmokers, 31 smokers; aged 20-45 years) by dual X-ray absorptiometry (DXA, Hologic QDR1000) in the lumbar spine and proximal femur. In a subset we measured biochemical markers of bone metabolism and hormonal profile. We found significant differences in BMD between heavy smokers (more than 20 cigarettes/day) and nonsmokers in all skeletal sites. Serum levels of dehydroepiandrosterone sulfate (S-DHEAS) were lower in smokers and correlated with femoral BMD measurements. No significant differences in bone turnover markers were found. Our findings show that smoking by healthy young males is associated with decreased bone mass.
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Affiliation(s)
- N Ortego-Centeno
- Service of Internal Medicine B, Granada University Hospital, E-18012 Granada, Spain
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43
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López JA, Luna V, Muñoz-Torres M, Escobar-Jiménez F. [Intracranial hypertension in postoperative hypoparathyroidism]. Med Clin (Barc) 1997; 108:358-9. [PMID: 9139164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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44
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Muñoz-Torres M, Jódar E, Escobar-Jiménez F, López-Ibarra PJ, Luna JD. Bone mineral density measured by dual X-ray absorptiometry in Spanish patients with insulin-dependent diabetes mellitus. Calcif Tissue Int 1996; 58:316-9. [PMID: 8661964 DOI: 10.1007/bf02509378] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Previous studies suggest that low bone mass is a potential complication of insulin-dependent diabetes mellitus. Nevertheless, the factors that influence diabetic osteopenia are not well established. In order to evaluate the prevalence and magnitude of diabetic osteopenia and its association with clinical and metabolic variables, we studied 94 consecutive patients with insulin-dependent diabetes mellitus. Their age ranged from 20 to 56 years and duration of diabetes varied from 1 to 35 years. Bone mineral density (BMD) was measured by dual X-ray absorptiometry at lumbar spine and proximal femur and the values were expressed as z-score. The presence and extent of microvascular complications, degree of metabolic control, and other risk factors for osteoporosis were recorded and some biochemical markers of bone metabolism were assessed. Diabetic patients showed reduced BMD in all sites (lumbar spine: -0.89 +/- 1.21; femoral neck: -0.99 +/- 1.24; Ward triangle: -1.05 +/- 1.24; P < 0.0001). Of the 94 patients 19.1% met diagnostic criteria for osteoporosis. BMD correlated with body mass index in all sites and with the duration of disease in Ward's triangle. Presence and extent of diabetic complications were associated with lower BMD, as was smoking. No correlation was found between BMD and biochemical markers. In conclusion, osteopenia is a common complication in patients with insulin-dependent diabetes mellitus. Microvascular complications are a critical point in the progression of diabetic osteopenia. Other risk factors for osteoporosis (nutritional status and smoking) must be taken into account.
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Affiliation(s)
- M Muñoz-Torres
- Endocrine Division (Cátedra Medicina Interna I), University Hospital, Granada, Spain
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Abstract
The response of bone mass to long-term treatment with estrogen and progesterone in patients with complete androgen-insensitivity syndrome (AIS) is unknown. We report a 17-year-old female patient (karyotype 46 X, Y) with AIS studied during a 4-year period. Bone mineral density (BMD) measured by dual X-ray absorptiometry in lumbar spine and proximal femur was sharply reduced at the initial visit; and remained unchanged during long-term follow-up on hormone replacement therapy with estrogens and progestin. Bone metabolism markers were all in the normal range. The lack of significant increase in BMD highlights the importance of androgens on bone physiology that cannot be balanced in spite of an appropriate estrogenic milieu.
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Affiliation(s)
- M Muñoz-Torres
- Endocrinology Division (Cátedra de Medicina Interna I), Hospital Universitario, Granada, Spain
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46
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Quesada-Charneco M, Muñoz-Torres M, Jódar E, Escobar-Jiménez F. [Elevation of muscular enzymes and idiopathic hypoparathyroidism]. Med Clin (Barc) 1995; 104:77. [PMID: 7532772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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47
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Ortego-Centeno N, Muñoz-Torres M, Hernandez-Quero J, Jurado-Duce A, de la Higuera Torres-Puchol J. Bone mineral density, sex steroids, and mineral metabolism in premenopausal smokers. Calcif Tissue Int 1994; 55:403-7. [PMID: 7895176 DOI: 10.1007/bf00298551] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Smoking is related to decreased bone mass and increased risk of osteoporotic fractures. However, the harmful effects of smoking on bone have not been well characterized. The purpose of this study was to assess the repercussions of smoking on bone mass in premenopausal women, and the relationship between these effects and parameters of mineral metabolism and hormone profile. We measured bone mineral density (BMD) in 101 premenopausal women (47 smokers, 54 nonsmokers) with dual-energy X-ray absorptiometry (DeXA) of the proximal femur and lumbar spine. In a subgroup of the sample (16 smokers, 15 nonsmokers) we measured biochemical indicators of mineral metabolism and hormone profile. BMD in the femoral neck, Ward's triangle, and the intertrochanter region was significantly lower in smokers (P < 0.05) than in nonsmokers. Concentrations of sex hormone-binding globulin were higher, and free testosterone index (FTI) was lower (P < 0.05) in smokers. We found no significant differences between the groups in parameters of mineral metabolism. Concentrations of dehydroepiandrosterone sulfate and free testosterone index were directly correlated with values of BMD in different sites. Our findings show that smoking by premenopausal women is associated with decreased BMD and characteristic changes in the hormone profile.
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Affiliation(s)
- N Ortego-Centeno
- Servicio de Medicina Interna B, Hospital Universitario de Granada, Spain
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48
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Vidal-Puig A, Muñoz-Torres M, Jodar-Gimeno E, García-Calvente C, Lardelli P, Ruiz-Requena ME, Escobar-Jiménez F. Hyperinsulinemia in polycystic ovary syndrome: relationship to clinical and hormonal factors. Clin Investig 1994; 72:853-7. [PMID: 7894211 DOI: 10.1007/bf00190740] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We analyzed the association between hyperandrogenism and hyperinsulinemia, and their relationship to body mass index, in a large series of patients with polycystic ovary syndrome (PCOS). A characteristic hormonal profile was sought in women with marked hyperinsulinemia. The patient group consisted of 73 women with PCOS, ranging in age from 16 to 29 years. The control group consisted of 34 healthy women with no evidence of hyperandrogenism, aged 19-30 years. None of the patients or control women had a body mass index above 27 kg/m2. Follicle-stimulating hormone, luteinizing hormone, prolactin, testosterone, estradiol, androstenedione, dehydroepiandrosterone sulfate, sex hormone binding globulin, 17-hydroxyprogesterone, and free cortisol were determined by radioimmunoassay. The free testosterone index was calculated. The oral glucose tolerance test was used to analyze basal insulinemia, maximum insulin peak, and the insulinemia/glycemia index. In the group with PCOS body mass index was greater, free testosterone index was higher, and levels of dehydroepiandrosterone sulfate, testosterone, 17-hydroxyprogesterone (P < 0.001) and androstenedione (P < 0.05) were higher than in the control group. Of the insulin parameters, basal insulinemia, maximum insulin peak, and insulinemia/glycemia index were higher in the patient group (P < 0.001). In patients with marked insulinemia, free testosterone index was more markedly elevated, and gonadotrophin levels were normal. Our data confirm that a characteristic pattern of hyperinsulinemia is associated with PCOS. We found no causal relationship between hyperinsulinemia and androgen levels. A characteristic hormonal pattern was found in patients with marked hyperinsulinemia.
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Affiliation(s)
- A Vidal-Puig
- Department of Internal Medicine 1, University of Granada Hospital, Spain
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Vidal-Puig A, Muñoz-Torres M, Garcia-Calvente C, Jodar-Gimeno E, Lardelli P, Ruiz-Requena ME, Escobar-Jiménez F. Reduction of endogenous, ovarian and adrenal androgens with ketoconazole does not alter insulin response in the polycystic ovary syndrome. J Endocrinol Invest 1994; 17:647-52. [PMID: 7868804 DOI: 10.1007/bf03349680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Several different strategies were used to investigate the relationship between hyperandrogenism and hyperinsulinemia associated with polycystic ovary syndrome. Ketoconazole was given orally (400 mg/day) for 9 months to evaluate the effect of reduction in ovarian and adrenal androgens on insulin response (oral glucose tolerance test) in 35 women with polycystic ovary syndrome. Androgenic steroids (testosterone, androstenedione, dehydroepiandrosterone sulphate, and free testosterone index) decreased (p < 0.01), but basal insulinemia, maximum peak insulin, and insulin/glucose ratio showed no significant changes. One month after treatment was stopped, free testosterone index, and serum concentrations of androstenedione and testosterone, increased (p < 0.05), but no alterations were noted in insulin parameters. Body mass index was stable throughout the ten-month study period. Our findings suggest that endogenous androgens, no matter whether they are of ovarian or adrenal origin, do not play a major role in the modulation of hyperinsulinemia in patients with polycystic ovary syndrome.
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Affiliation(s)
- A Vidal-Puig
- Department of Internal Medicine I, University of Granada Hospital, Spain
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50
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Vidal-Puig AJ, Muñoz-Torres M, Jódar-Gimeno E, García-Calvente CJ, Lardelli P, Ruiz-Requena ME, Escobar-Jiménez F. Ketoconazole therapy: hormonal and clinical effects in non-tumoral hyperandrogenism. Eur J Endocrinol 1994; 130:333-8. [PMID: 8162160 DOI: 10.1530/eje.0.1300333] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of this study was to assess the usefulness of ketoconazole as a therapeutic alternative to polycystic ovary syndrome. The study group comprised 37 women with signs of hyperandrogenism (hirsutism, acne) and oligomenorrhea. A low dose (400 mg/day) of ketoconazole was tested in a 9-month prospective clinical study. Clinical response (Ferriman & Gallway score, acne) and modifications in hormone pattern (luteinizing hormone, follicle-stimulating hormone, estradiol, testosterone, prolactin, 17-hydroxy-progesterone, androstenedione, steroid hormone-binding globulin, dehydroepiandrosterone sulfate, cortisol, adrenocorticotropin (ACTH) and free testesterone index) were measured, and ACTH stimulation tests were performed. Tolerance and side-effect also were assessed. After 9 months of ketoconazole treatment, the patients' Ferriman & Gallway scores (18.26 +/- 4.6 vs 12.4 +/- 4.1; p < 0.001) and acne had improved markedly. Hormone patterns also became more favorable, with decreases in androgenic steroids (testosterone, androstenedione, free testosterone index and dehydroepiandrosterone sulfate; p < 0.01) and increases in estradiol (p < 0.01). Basal cortisol levels and cortisol after ACTH stimulation were not changed significantly, remaining within the reference range. Increases in ACTH were observed only in the 3rd month (p < 0.01). Initial levels of androgenic steroids were correlated inversely with their percentage decrease in successive samplings. Decreases in adrenal androgenic steroids were associated with an increase in steroid hormone-binding globulin. The side-effects of treatment, although not severe, caused some discomfort and led to a high drop-out rate (30%).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A J Vidal-Puig
- Department of Internal Medicine I (Endocrine Division), University of Granada Hospital, Spain
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