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Peris P, Blasco J, Monegal A, Florez H, Guañabens N, Carrasco JL. Effect of gender on the evolution of pain and quality of life after treatment of symptomatic vertebral fragility fractures. Osteoporos Int 2024; 35:515-521. [PMID: 38030857 PMCID: PMC10866778 DOI: 10.1007/s00198-023-06960-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023]
Abstract
The evolution of pain and quality of life after a symptomatic vertebral fracture differs according to patient gender, with a worse evolution in women independently of the treatment received. PURPOSE In a previous randomized clinical study comparing the effect of vertebroplasty (VP) vs. conservative therapy (CT) on pain evolution and quality of life (QoL) of patients with symptomatic vertebral fractures (VF), we observed the development of chronic back pain in 23% of subjects, independently of the therapy received. This study analyses the effect of gender on the evolution of pain and QoL in these subjects. METHODS 118/125 randomized patients (27 males/91 females) with recent symptomatic VFs were evaluated. All received a standardized analgesic and antiosteoporotic format of treatment. Pain and QoL were evaluated by VAS and Qualeffo-41, respectively, at baseline, at 2 weeks and 2 and 6 months. We compared pain evolution and QoL after treatment (CT vs. VP) according to gender, and analysed factors including age, time of evolution, treatment received, baseline VAS, previous VFs (total and recent), incidental VFs, lumbar and femoral T-scores, and analgesic and antiosteoporotic treatment. RESULTS At baseline, there were no differences in age (males 74.8 ± 11.2 vs. females:73.2 ± 8.7 years), time of evolution, number of VFs (males:3.8 ± 2.4 vs. females: 3.1 ± 2.4), treatment received (VP, males:59%, females:45%), lumbar or femoral T-score, baseline VAS (males:6.8 ± 2.1 vs. females:6.8 ± 2.2) or Qualeffo score (males:52.2 ± 24.4 vs. females:59.7 ± 20.6). Pain and QoL evolution differed according to gender, being better in males. These differences were significant after two months independently of the treatment and the development of incidental VF during follow-up. CONCLUSIONS Pain and QoL evolution after a symptomatic VF differs according to gender, with a worse evolution in women independently of the treatment received.
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Affiliation(s)
- Pilar Peris
- Rheumatology and Neurointerventional Departments, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
- Departament de Medicina, Facultad de Medicina i Ciencias de la Salut, Universitat de Barcelona, Barcelona, Spain.
| | - Jordi Blasco
- Rheumatology and Neurointerventional Departments, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Ana Monegal
- Rheumatology and Neurointerventional Departments, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Helena Florez
- Rheumatology and Neurointerventional Departments, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Núria Guañabens
- Rheumatology and Neurointerventional Departments, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Departament de Medicina, Facultad de Medicina i Ciencias de la Salut, Universitat de Barcelona, Barcelona, Spain
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Cajiao K, Tomás X, Larqué AB, Peris P. Chondrosarcoma transformation in hereditary multiple exostosis: When to suspect? Int J Rheum Dis 2023; 26:2095-2097. [PMID: 37313676 DOI: 10.1111/1756-185x.14769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 06/15/2023]
Affiliation(s)
- Katherine Cajiao
- Rheumatology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Xavier Tomás
- Radiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Pilar Peris
- Rheumatology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Peris P, Monegal A, Mäkitie RE, Guañabens N, González-Roca E. Osteoporosis related to WNT1 variants: a not infrequent cause of osteoporosis. Osteoporos Int 2023; 34:405-411. [PMID: 36396825 DOI: 10.1007/s00198-022-06609-2] [Citation(s) in RCA: 2] [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: 07/11/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022]
Abstract
UNLABELLED Nearly 10% of subjects with severe idiopathic osteoporosis present pathogenic WNT1 mutations. Clinical characteristics include a family history of osteoporosis, early adulthood onset, and fragility fractures which may evolve to pseudoarthrosis. WNT1 should be genetically screened in these patients as the phenotype is often variable and therapeutic approaches may differ. INTRODUCTION Recent studies have shown that homozygous WNT1 gene mutations may be related to severe osteoporosis resembling osteogenesis imperfecta (OI). Conversely, heterozygous WNT1 mutations are linked to a milder phenotype of early-onset osteoporosis. Treatment with bisphosphonates is reported to be unsatisfactory. Our aim was to analyze the presence and prevalence of WNT1 mutations and the main associated clinical characteristics in subjects with primary early-onset osteoporosis. METHODS A cohort comprising 56 subjects (aged 19-60 years) with severe, early-onset osteoporosis was screened by massive parallel sequencing with a 23-gene panel. The gene panel included 19 genes known to cause OI (including the WNT1 gene), three genes related to osteoporosis, and the gene related to hypophosphatasia (ALPL). RESULTS We identified five patients (3 men) with heterozygous WNT1 variants. All presented severe osteoporosis with early fracture onset and a family history of fragility fractures. None presented a characteristic phenotype of OI or skeletal deformities. One patient was previously treated with bisphosphonates, presenting inadequate response to treatment and two developed pseudoarthrosis after upper arm fractures. All subjects were diagnosed in adulthood. CONCLUSIONS Nearly 1/10 adult subjects with severe idiopathic osteoporosis may present pathogenic WNT1 mutations. Clinical characteristics commonly include a family history of osteoporosis, onset in early adulthood, marked decrease in bone mass, and prevalent fractures, particularly vertebral. WNT1 should be genetically screened in these subjects as the phenotype is often variable and the therapeutic approach may differ. The role of WNT1 mutations in the development of pseudoarthrosis should also be elucidated.
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Affiliation(s)
- Pilar Peris
- Department of Rheumatology, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Ana Monegal
- Department of Rheumatology, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Riikka E Mäkitie
- Folkhälsan Institute of Genetics, University of Helsinki, P.O. Box 63, FIN-00014, Helsinki, Finland
| | - Nuria Guañabens
- Department of Rheumatology, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Eva González-Roca
- Department of Immunology, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Department of Molecular Biology, CORE Laboratory, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Florez H, Muxi A, González E, Monegal A, Guañabens N, Peris P. Utilidad del trabecular bone score en sujetos adultos con osteogénesis imperfecta. Rev Osteoporos Metab Miner 2022. [DOI: 10.4321/s1889-836x2022000400005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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Trius-Soler M, Tresserra-Rimbau A, Moreno JJ, Peris P, Estruch R, Lamuela-Raventós RM. Effect of moderate beer consumption (with and without ethanol) on osteoporosis in early postmenopausal women: Results of a pilot parallel clinical trial. Front Nutr 2022; 9:1014140. [DOI: 10.3389/fnut.2022.1014140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
IntroductionOsteoporosis is a chronic progressive bone disease characterized by low bone mineral density (BMD) and micro-architectural deterioration of bone tissue, leading to an increase in bone fragility and the risk of fractures. A well-known risk factor for bone loss is postmenopausal status. Beer may have a protective effect against osteoporosis associated with its content of silicon, polyphenols, iso-α-acids and ethanol, and its moderate consumption may therefore help to reduce bone loss in postmenopausal women.MethodsAccordingly, a 2-year controlled clinical intervention study was conducted to evaluate if a moderate daily intake of beer with (AB) or without alcohol (NAB) could have beneficial effects on bone tissue. A total of 31 postmenopausal women were assigned to three study groups: 15 were administered AB (330 mL/day) and six, NAB (660 mL/day), whereas, the 10 in the control group refrained from consuming alcohol, NAB, and hop-related products. At baseline and subsequent assessment visits, samples of plasma and urine were taken to analyze biochemical parameters, and data on medical history, diet, and exercise were collected. BMD and the trabecular bone score (TBS) were determined by dual-energy X-ray absorptiometry. Markers of bone formation (bone alkaline phosphatase [BAP] and N-propeptide of type I collagen [PINP]) and bone resorption (N-telopeptide of type I collagen [NTX] and C-telopeptide of type I collagen [CTX]) were determined annually.ResultsBone formation markers had increased in the AB and NAB groups compared to the control after the 2-year intervention. However, the evolution of BMD and TBS did not differ among the three groups throughout the study period.DiscussionTherefore, according to the findings of this pilot study, moderate beer intake does not seem to have a protective effect against bone loss in early post-menopausal women.
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Jurado S, Parés A, Peris P, Combalia A, Monegal A, Guañabens N. Bilirubin increases viability and decreases osteoclast apoptosis contributing to osteoporosis in advanced liver diseases. Bone 2022; 162:116483. [PMID: 35787483 DOI: 10.1016/j.bone.2022.116483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/19/2022]
Abstract
Bilirubin and bile acids have deleterious effects on osteoblasts, which may explain the low bone formation of liver diseases with cholestasis. Although there is some clinical evidence of increased bone resorption in this condition, the effects of these substances on osteoclasts are unknown. The objective was to analyze the effects of bilirubin and bile acids -lithocholic acid (LCA) and ursodeoxycholic acid (UDCA)- on osteoclast viability and apoptosis, and on the expression of osteoclast-related microRNAs (miRNAs). RAW 264.7 cells and human PBMCs were differentiated into osteoclasts. Success in differentiation was assessed by TRAP stain and osteoclast-specific gene expression; osteoclast activity was detected by the resorption pits in Corning® Osteo Assay Surface Plates. Cells were treated with camptothecin (CAM) or with bilirubin, LCA or UDCA, at several concentrations and combinations, including non-treated cells as control. Cell viability was measured using WST-1 assay and apoptosis assessing Caspase-3 by Western blot. Expression of miR-21a, miR-29b, miR-31, miR-148a, miR-155 and miR-223 were analyzed by Real Time. Viability increased gradually in osteoclasts differentiated from RAW 264.7 cells, as the concentration of bilirubin increased, being particularly high with bilirubin 100 μM (61 %) as compared to the untreated control (p < 0.007). Viability decreased significantly with CAM, LCA and UDCA (80 %, 62 % and 27 %, respectively), effects which were abolished by bilirubin. Moreover, bilirubin increased viability in osteoclasts derived from human PBMCs (p < 0.03). Caspase-3 decreased by 46 % with bilirubin 50 μM and increased 10-fold with LCA 100 μM and CAM (p < 0.01). Bilirubin increased miR-21 and miR-148a expression as compared to controls (115 % and 59 %, respectively; p < 0.007). In conclusion, bilirubin increases viability and decreases apoptosis of osteoclasts, and overexpresses the osteoclastogenic miR-21 and miR-148a. The effects of bilirubin counteract the actions of LCA and UDCA. Therefore, bilirubin may contribute to the increased bone resorption and to the development of osteoporosis in advanced liver diseases.
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Affiliation(s)
- Susana Jurado
- IDIBAPS-Hospital Clinic, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
| | - Albert Parés
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pilar Peris
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Andreu Combalia
- Orthopedics Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ana Monegal
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Núria Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, University of Barcelona, Barcelona, Spain
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González-Lamuño D, Lorente Rodríguez A, Luis Yanes MI, Marín-Del Barrio S, Martínez Díaz-Guerra G, Peris P. Clinical practice recommendations for the diagnosis and treatment of X-linked hypophosphatemia: A consensus based on the ADAPTE method. Med Clin (Barc) 2022; 159:152.e1-152.e12. [PMID: 34953573 DOI: 10.1016/j.medcli.2021.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of this project was to adapt to our setting following a systematic process based on the ADAPTE method the first clinical practice guidelines on X-linked hypophosphatemia (XLH) that were published in 2019. MATERIALS AND METHODS The adaptation of the guidelines to our application and implementation setting was carried out in three phases -start-up, adaptation, and finalization- by a group of experts involved in the management of patients with XLH. RESULTS Following the original guide, the recommendations agreed by the group that elaborated the guidelines for diagnosis, frequency and scope of visits and specific follow-up in children and adults are presented. On the other hand, recommendations are established for both age groups with conventional treatment, as well as with burosumab in children or adults and those related to the controversial use of growth hormone in children. Suggestions are also proposed regarding the monitoring and management of musculoskeletal disorders and orthopedic treatment in children, dental health and hearing, and neurosurgical complications. Finally, a series of questions and areas are raised in order to deepen the possible future investigation. CONCLUSIONS These recommendations constitute the systematic adaptation to our setting of the first evidence-based clinical practice guide for the diagnosis and management of XLH and we hope that they can contribute to the adequate management of the disease.
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Affiliation(s)
- Domingo González-Lamuño
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Cantabria-Hospital Universitario Marqués de Valdecilla, Asociación Española para el Estudio de los Errores Congénitos del Metabolismo (AECOM), Santander, Cantabria, España.
| | - Ana Lorente Rodríguez
- servicio de Cirugía Oral y Maxilofacial, Hospital la Vall d'Hebron, Barcelona, España
| | - María Isabel Luis Yanes
- Servicio de Nefrología, Hospital Universitario Nuestra Señora de Candelaria, Asociación Española de Nefrología Pediátrica (AENP), Santa Cruz de Tenerife, Islas Canarias, España
| | - Silvia Marín-Del Barrio
- Servicio de Endocrinología Pediátrica, Hospital Sant Joan de Déu, Sociedad Española de Endocrinología Pediátrica (SEEP), Esplugues de Llobregat, Barcelona, España
| | - Guillermo Martínez Díaz-Guerra
- Servicio de Endocrinología y Nutrición, Hospital Universitario 12 de Octubre, Sociedad Española de Investigación Ósea y Metabolismo Mineral (SEIOMM), Madrid, España
| | - Pilar Peris
- Servicio de Reumatología, Hospital Clinic, Universidad de Barcelona, Sociedad Española de Investigación Ósea y Metabolismo Mineral (SEIOMM), Barcelona, España
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Riancho JA, Peris P, González-Macías J, Pérez-Castrillón JL. Executive summary clinical practice guideline of postmenopausal, glucocortcioid-induced and male osteoporosis (2022 update). Spanish Society for Bone and Mineral Metabolism Investigation (SEIOMM). Rev Clin Esp 2022; 222:432-439. [PMID: 35676194 DOI: 10.1016/j.rceng.2021.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/30/2021] [Indexed: 10/18/2022]
Abstract
This updated version of the Spanish Society for Research in Osteoporosis and Mineral Metabolism (SEIOMM) osteoporosis guides incorporate the most relevant information published in the last 7 years, since the 2015 guides, with imaging studies, such as vertebral fracture assessment and bone trabecular score analysis. In addition, therapeutic advances include new anabolic agents, comparative studies of drug efficacy, and sequential and combined therapy. Therefore, therapeutic algorithms are also updated.
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Affiliation(s)
- J A Riancho
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Departamento de Medicina y Psiquiatría, Universidad de Cantabria, IDIVAL, Santander, Spain.
| | - P Peris
- Servicio de Reumatología, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - J González-Macías
- Departamento de Medicina y Psiquiatría, Universidad de Cantabria, IDIVAL, Santander, Spain
| | - J L Pérez-Castrillón
- Servicio de Medicina Interna, Hospital Universitario Río Hortega, Departamento de Medicina, Universidad de Valladolid, Valladolid, Spain
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Castañeda S, Gómez-Alonso C, Graña J, Guañabens N, Muñoz-Torres M, Peris P, Naves M, Álvaro-Gracia JM. Position of the Spanish Society of Rheumatology (SER) and the Spanish Society for Bone Research and Mineral Metabolism (SEIOMM) on romosozumab. Reumatol Clin (Engl Ed) 2022; 18:383-386. [PMID: 35504824 DOI: 10.1016/j.reumae.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Santos Castañeda
- Servicio de Reumatología, Hospital de La Princesa, IIS-Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carlos Gómez-Alonso
- UGC de Metabolismo Óseo, Hospital Universitario Central de Asturias, ISPA, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Jenaro Graña
- Servicio de Reumatología, CHU A Coruña, A Coruña, Spain
| | - Núria Guañabens
- Servicio de Reumatología, Hospital Clínic, IDIBAPs, Universidad de Barcelona, Barcelona, Spain.
| | - Manuel Muñoz-Torres
- Departamento de Medicina, Universidad de Granada, UGC Endocrinología y Nutrición Hospital Universitario Clínico San Cecilio, IBS, Granada, Spain
| | - Pilar Peris
- Servicio de Reumatología, Hospital Clínic, IDIBAPs, Universidad de Barcelona, Barcelona, Spain
| | - Manuel Naves
- UGC de Metabolismo Óseo, Hospital Universitario Central de Asturias, ISPA, REDinREN del ISCIII, Oviedo, Asturias, Spain
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Yanes MIL, Diaz-Curiel M, Peris P, Vicente C, Marin S, Ramon-Krauel M, Hernandez J, Broseta JJ, Espinosa L, Mendizabal S, Perez-Sukia L, Martínez V, Palazón C, Piñero JA, Calleja MA, Espin J, Arborio-Pinel R, Ariceta G. Health-related quality of life of X-linked hypophosphatemia in Spain. Orphanet J Rare Dis 2022; 17:298. [PMID: 35906684 PMCID: PMC9336088 DOI: 10.1186/s13023-022-02452-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) of patients with X-linked hypophosphatemia (XLH) is lower than that of both the general population and the patients with other chronic diseases, mainly due to diagnostic delay, treatment difficulties, poor psychosocial support, and problems with social integration. Early diagnosis and optimal treatment are paramount to control the disease in patients with XLH, avoid complications, and maintain or improve their HRQoL. We, therefore, analyzed the HRQoL of pediatric and adult patients with XLH treated with conventional therapy in Spain. RESULTS We used several versions of the EuroQol-5 dimensions (EQ-5D) instrument according to the age of patients with XLH. Then we compared the HRQoL of patients to that of the general Spanish population. Children with XLH (n = 21) had moderate problems in walking about (61.9%), washing or dressing themselves (9.52%), and performing their usual activities (33.33%). They also felt moderate pain or discomfort (61.9%) and were moderately anxious or depressed (23.81%). Adults with XLH (n = 29) had lower HRQoL, with problems in walking (93%, with 3.45% unable to walk independently), some level of pain (86%, with 3.45% experiencing extreme pain), problems with their usual activities (80%) and self-care (> 50%), and reported symptoms of anxiety and/or depression (65%). There were important differences with the general Spanish population. CONCLUSIONS XLH impacts negatively on physical functioning and HRQoL of patients. In Spanish patients with XLH, the HRQoL was reduced despite conventional treatment, clearly indicating the need to improve the therapeutic approach to this disorder.
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Affiliation(s)
- M I Luis Yanes
- Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
| | | | - P Peris
- Hospital Clínic, Barcelona, Spain
| | - C Vicente
- Hospital Virgen de Arrixaca, Murcia, Spain
| | - S Marin
- Hospital Sant Joan de Déu, Esplugues de Llobregat (Barcelona), Spain
| | - M Ramon-Krauel
- Hospital Sant Joan de Déu, Esplugues de Llobregat (Barcelona), Spain
| | | | | | | | | | | | - V Martínez
- Hospital Virgen de Arrixaca, Murcia, Spain
| | - C Palazón
- Hospital Virgen de Arrixaca, Murcia, Spain
| | - J A Piñero
- Hospital Virgen de Arrixaca, Murcia, Spain
| | - M A Calleja
- Hospital Virgen de la Macarena, Seville, Spain
| | - J Espin
- Escuela Andaluza de Salud Pública, Granada, Spain
| | | | - G Ariceta
- Hospital Vall d'Hebron, Barcelona, Spain
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Cajiao K, Florez H, Monegal A, Guañabens N, Peris P. AB1061 THE ROLE OF PROSTAGLANDIN E2 IN HYPERTROPHIC OSTEOARTHROPATHY AND/OR CLUBBING OF DIFFERENT CAUSES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundHypertrophic osteoarthropathy (HOA) is characterized by several clinical findings, including arthralgia/arthritis, periostosis, and digital clubbing. It can occur as a congenital condition called pachydermoperiostosis, and more commonly, as a secondary manifestation of pulmonary or extrapulmonary diseases or malignancy. Genomic studies support the role of prostaglandin E2 (PGE2) in the pathogenesis of primary HOA, with mutations in the 15-hydroxyprostaglandin dehydrogenase encoding gene resulting in increased PGE2 levels.ObjectivesTo analyse the clinical characteristics, comorbidities, and the potential role of PGE2 in primary and secondary forms of HOA and/or clubbing and also evaluate the clinical evolution of these patients.MethodsEighteen patients (10 men/8 women) aged 15 to 78 years (49,9 ± 15,6) diagnosed with clubbing and/or HOA were attended in our Rheumatology Department over an 11-year period. We reviewed the clinical characteristics of the patients, including associated comorbidities, image findings, bone turnover markers (BTM), and serum and urinary levels of PGE2, among others. Additionally, we evaluated the treatment and the clinical evolution of these subjects.ResultsMost patients presented associated clinical conditions for HOA and/or clubbing, with only one, the youngest (15 years old), having primary HOA (pachydermoperiostosis). Pulmonary disorders were the most frequent associated conditions, with interstitial lung disease (4 cases), COPD (3 cases), and lung cancer (4 cases) being the most frequent, followed by liver diseases including primary biliary cirrhosis (1 patient), liver cirrhosis (2 patients) and chronic hepatitis C virus (2 patients). All the subjects evaluated (15/18) presented increased urinary PGE2 levels (the highest being observed in primary HOA), with most also presenting increased serum PGE2 values. BTM were evaluated in most subjects (17/18) showing increased values in most (11/17), particularly in PINP and CTx. 4 patients were treated with selective inhibitors of cyclooxygenase-2 (COX-2) presenting, when evaluated, a small decrease in urinary PGE2 titers and partly improving their symptoms, which clearly improved after treating the associated cause when possible.ConclusionIn the present series, all subjects with primary or secondary HOA and/or clubbing presented markedly increased PGE2values, particularly in urine, supporting the role of this agent in the etiopathogenesis of this disorder. Pulmonary disorders, including malignancy and liver diseases, constituted the most frequent associated conditions. The use of COX-2 seems to be an effective symptomatic therapeutic approach in this entity.Disclosure of InterestsNone declared
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Florez H, Carrasco JL, Barberá M, Hernández-Rodríguez J, Muxi A, Prieto-González S, Cid MC, Monegal A, Guañabens N, Peris P. AB1011 FACTORS RELATED TO GLUCOCORTICOID-INDUCED OSTEOPOROSIS AND FRAGILITY FRACTURES IN YOUNG SUBJECTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGlucocorticoid (GC) treatment is the most frequent cause of osteoporosis (OP) in young subjects. However, the factors related to the development of glucocorticoid-induced osteoporosis (GIOP) and fragility fractures (FF), and consequently, the therapeutic approach to GIOP in young populations is not well established.ObjectivesAnalyze the prevalence of GIOP and FF in GC-treated patients and compare the risk factors related to their development according to age (< and ≥50 years).Methods127 patients (62±18 years) receiving chronic GC treatment were included (≥5 mg/day of prednisone, >3 months). The clinical data collected included: dose and duration of GC treatment, disease activity, previous FF, anthropometric data, bone metabolism parameters (including bone turnover markers and the presence of hypogonadism), bone mineral density (by DXA; defining densitometric OP: T-score ≤-2.5 or Z-score ≤-2, depending on the age of the patient), trabecular bone score (by DXA), and vertebral fractures (X-ray). GIOP was defined as densitometric OP and/or FF. Results were compared between subjects < and ≥50 years old.ResultsThe prevalence of GIOP was similar in both age groups: <50 (n=36) 44.4% vs. 46.1% ≥50 years (n=91). Five subjects <50 (13.8%) and 30 ≥50 years (33%) presented FF (p=0.05). Young subjects with FF tended to be >40 years, have a higher body mass index (BMI) (25.4 vs. 23.3, p=n.s.), and inflammatory disease activity (CRP 0.90 vs. 0.06mg/dL, p=0.06). When analyzing the differential risk factors related to FF depending on age, a higher body mass index (BMI) (29.63 vs. 26.95, p=0.048) and inflammatory disease activity (PCR -0.87 vs. -2.51 [log scale], p=0.03) were observed in young subjects, while low lumbar T-scores (-1.08 vs.-0.06 DE, p=0.003) and higher cumulative GC-doses (9.11 vs. 8.56 g, p=0.03) were differential factors in subjects over 50. Hypogonadism was a risk factor independent of age (OR 4.89; 95%CI 1.36-17.59), being associated with the presence of FF in both age groups.ConclusionMore than 40% of the patients receiving GC developed GIOP, with a similar prevalence in both age groups (< and ≥50 years); however, FF are less common in young subjects. Hypogonadism is a determining risk factor for FF independent of age. In addition, young subjects with FF tend to be older, with a higher BMI and disease activity, and, thus, evaluation of these risk factors can improve the identification of subjects at increased risk of fracture.Disclosure of InterestsNone declared
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Gifre L, Vidal J, Carrasco JL, Muxi A, Portell E, Monegal A, Guañabens N, Peris P. Efecto del tratamiento con denosumab durante 24 meses en individuos con lesión medular reciente con osteoporosis. Rev Osteoporos Metab Miner 2022. [DOI: 10.4321/s1889-836x2022000200005] [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: 12/05/2022] Open
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Florez H, Carrasco JL, Berberá M, Hernández-Rodríguez J, Muxi A, Prieto-González S, Cid MC, Monegal A, Guañabens N, Peris P. Factors related to glucocorticoid-induced osteoporosis and fragility fractures in young subjects. Bone Rep 2022. [DOI: 10.1016/j.bonr.2022.101470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Riancho JA, Peris P, González-Macías J, Pérez-Castrillón JL. Resumen ejecutivo de las Guías de práctica clínica en la osteoporosis postmenopáusica, glucocorticoidea y del varón (actualización 2022). Rev Osteoporos Metab Miner 2022. [DOI: 10.4321/s1889-836x2022000100002] [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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Riancho JA, Peris P, González-Macías J, Pérez-Castrillón JL. Guías de práctica clínica en la osteoporosis postmenopáusica, glucocorticoidea y del varón (actualización 2022). Rev Osteoporos Metab Miner 2022. [DOI: 10.4321/s1889-836x2022000100003] [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: 12/05/2022] Open
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Florez H, Hernández-Rodríguez J, Carrasco JL, Filella X, Prieto-González S, Monegal A, Guañabens N, Peris P. Low serum osteocalcin levels are associated with diabetes mellitus in glucocorticoid treated patients. Osteoporos Int 2022; 33:745-750. [PMID: 34557953 DOI: 10.1007/s00198-021-06167-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
UNLABELLED Bone turnover markers are decreased in GC-treated subjects with DM. Decreased OC levels in GC-treated patients were associated with an increased risk of DM. These results suggest the involvement of OC in glucose homeostasis regulation in DM. INTRODUCTION Osteocalcin (OC) is involved in the regulation of glucose homeostasis. Glucocorticoid (GC) treatment is associated with impaired osteoblast function, decreased OC levels, and the development and/or worsening of pre-existing diabetes mellitus (DM). Whether decreased OC levels in GC-treated subjects contribute to DM is not well known. The aim of this study was to analyse whether OC levels in GC-treated patients are associated with the presence of DM. METHODS One hundred twenty-seven patients (aged 61.5 ± 17.9 years) on GC treatment were included. GC dose, treatment duration, presence of DM and bone formation (OC, bone ALP, PINP) and resorption markers (urinary NTX, serum CTX) were analysed. The cut-offs of each bone turnover marker (BTM) for the presence of DM were evaluated and optimised with the Youden index and included in the logistic regression analysis. RESULTS Among the patients, 17.3% presented DM. No differences were observed in GC dose or duration or the presence of fractures. Diabetics showed lower levels of OC (7.57 ± 1.01 vs. 11.56 ± 1; p < 0.001), PINP (21.48 ± 1.01 vs. 28.39 ± 1; p = 0.0048), NTX (24.91 ± 1.01 vs. 31.7 ± 1; p = 0.036) and CTX (0.2 ± 1.01 vs. 0.3 ± 1; p = 0.0016). The discriminating BTM cut-offs for DM presence were < 9.25 ng/mL for OC, < 24 ng/mL for PINP, < 27.5 nMol/mM for NTX and < 0.25 ng/mL for CTX. In a multivariate logistic regression model adjusted for GC dose, BMI, age and the above four BTMs, only OC remained independently associated with DM presence. Thus, in a model adjusted for GC dose, BMI and age, OC was significantly associated with DM (OR: 6.1; 95%CI 1.87-19.89; p = 0.001). CONCLUSION Decreased OC levels in GC-treated patients are associated with increased odds of DM, and only OC was independently associated with DM in a model including four BTMs.
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Affiliation(s)
- H Florez
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - J Hernández-Rodríguez
- Department of Autoimmune Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J L Carrasco
- Biostatistics, Department of Basic Clinical Practice, University of Barcelona, Barcelona, Spain
| | - X Filella
- Biochemistry and Molecular Genetics Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - S Prieto-González
- Department of Autoimmune Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Monegal
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - N Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - P Peris
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Riancho J, Peris P, González-Macías J, Pérez-Castrillón J. Resumen ejecutivo de las guías de práctica clínica en la osteoporosis posmenopáusica, glucocorticoidea y del varón (actualización 2022). Sociedad Española de Investigación Ósea y del Metabolismo Mineral (SEIOMM). Revista Clínica Española 2022. [DOI: 10.1016/j.rce.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cajiao K, Florez H, Peris P. Sternal Stress Fractures: An Unusual Cause of Chest Pain in Patients With Osteoporosis. J Clin Rheumatol 2022; 28:e286-e288. [PMID: 33337804 DOI: 10.1097/rhu.0000000000001678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Katherine Cajiao
- From the Rheumatology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Cosman F, Libanati C, Deignan C, Yu Z, Wang Z, Ferrari S, Beck Jensen JE, Peris P, Bertoldo F, Lespessailles E, Hesse E, Cummings SR. Romosozumab Followed by Antiresorptive Treatment Increases the Probability of Achieving Bone Mineral Density Treatment Goals. JBMR Plus 2021; 5:e10546. [PMID: 34761149 PMCID: PMC8567484 DOI: 10.1002/jbm4.10546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/28/2021] [Indexed: 11/09/2022] Open
Abstract
Increases in bone mineral density (BMD) with osteoporosis treatment are associated with reduced fracture risk. Increasing BMD is therefore a goal of osteoporosis therapy. Here, we compare the probability of achieving a T-score of > -2.5 over 3 years at the total hip (TH) or lumbar spine (LS) in women with osteoporosis, ≥55 years of age, after the following treatment sequences: 1 year romosozumab followed by 2 years denosumab (FRAME and FRAME extension trials), 1 year romosozumab followed by 2 years alendronate, or alendronate-only for 3 years (ARCH trial). Probabilities of attaining the BMD target within 1 year of treatment were also determined. At both skeletal sites, in women with a baseline Tscore ≥ -2.7, there was >50% probability of achieving the BMD target with any 3-year regimen. The probability of achieving the target BMD in those with a baseline TH Tscore equal to -3.0 was 61% with romosozumab/denosumab, 38% with romosozumab/alendronate, and 9% with alendronate. In those with a baseline LS Tscore equal to -3.0, the probability of achieving a T-score > -2.5 was 93% with romosozumab/denosumab, 81% with romosozumab/alendronate, and 55% with alendronate. With 1 year of treatment, in patients with a baseline TH T-score equal to -2.7, the probability of reaching the target Tscore with romosozumab was 71% to 78% and 38% with alendronate. For patients with an initial LS T-score equal to -3.0, the probability of achieving the target T-score over 1 year was 85% to 86% with romosozumab and 25% for alendronate. Our findings suggest baseline BMD and the probability of achieving BMD T-score goals are factors to consider when selecting initial treatment for patients with osteoporosis. As baseline T-score falls below -2.7 (TH) and -3.0 (LS), alendronate has <50% likelihood of achieving a BMD goal above osteoporosis range, whereas these probabilities remain relatively high for regimens beginning with romosozumab. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
| | | | | | | | | | | | | | - Pilar Peris
- Hospital Clinic, IDIBAPS University of Barcelona Barcelona Spain
| | | | - Eric Lespessailles
- Centre Hospitalier Régional d'Orléans University of Orléans Orleans France
| | - Eric Hesse
- Institute of Molecular Musculoskeletal Research University Hospital, LudwigMaximilians-University Munich Germany
| | - Steven R Cummings
- University of California San Francisco San Francisco Coordinating Center San Francisco CA USA
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Kanterewicz E, Puigoriol E, Peris P. Grade 1 vertebral fractures, bone mineral density, and the risk of fractures. J Bone Miner Res 2021; 36:2275-2276. [PMID: 33877710 DOI: 10.1002/jbmr.4302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/19/2021] [Accepted: 03/03/2021] [Indexed: 11/07/2022]
Affiliation(s)
| | - Emma Puigoriol
- Department of Clinical Epidemiology, Hospital Universitari de Vic, Vic, Spain
| | - Pilar Peris
- Department of Rheumatology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
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Cajiao K, Setoain FJ, Peris P. Multifocal Osteonecrosis: The Usefulness of Bone Scintigraphy. J Clin Rheumatol 2021; 27:e196-e197. [PMID: 32251061 DOI: 10.1097/rhu.0000000000001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gómez-Puerta JA, Peris P. Expanding diagnostic approach in patients with osteonecrosis. Arthritis Res Ther 2021; 23:150. [PMID: 34034809 PMCID: PMC8146658 DOI: 10.1186/s13075-021-02533-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- José A Gómez-Puerta
- Rheumatology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Pilar Peris
- Rheumatology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Abstract
The main well recognized action of bisphosphonates (BPs) is their antiresorptive capacity, making them first-line drugs in the treatment of osteoporosis and other metabolic bone diseases. In this review we have compiled other possible actions of BPs, particularly in the areas of immunomodulation, anti-inflammatory capacity and in the prevention of structural joint damage in inflammatory rheumatic diseases. The immunomodulatory capacity of BPs has been focused on the mechanisms involved in the acute-phase response associated with the administration of nitrogen containing BPs (N-BPs), with the stimulus of pro-inflammatory cytokines, through the mevalonate pathway, activation of T-cells and the decrease in the cytotoxic T-lymphocyte antigen-4 (CTLA-4). In relation to their anti-inflammatory capacity, special attention has been given to their effect on preventing structural damage in inflammatory joint diseases and on the differential immune response in bone lesions of the most common and representative inflammatory rheumatic diseases, i.e. rheumatoid arthritis and spondyloarthropathies. The present data indicate that more studies are needed to improve the knowledge on the effect of BPs on inflammatory-mediated diseases and particularly on the prevention and/or treatment of the structural damage in these disorders, since these agents could be a potential useful concomitant therapy.
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Affiliation(s)
- Pilar Peris
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ana Monegal
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Núria Guañabens
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
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Pérez Castrillón JL, Casado E, Corral Gudino L, Gómez Alonso C, Peris P, Riancho JA. COVID-19 y vitamina D. Documento de posición de la Sociedad Española de Investigación Ósea y del Metabolismo Mineral (SEIOMM). Rev Osteoporos Metab Miner 2020. [DOI: 10.4321/s1889-836x2020000400009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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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Ruiz-Gaspà S, Guañabens N, Jurado S, Combalia A, Peris P, Monegal A, Parés A. Bilirubin and bile acids in osteocytes and bone tissue. Potential role in the cholestatic-induced osteoporosis. Liver Int 2020; 40:2767-2775. [PMID: 32749754 DOI: 10.1111/liv.14630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Osteoporosis is a common complication in patients with primary biliary cholangitis. Both bilirubin and lithocholic acid (LCA) result in detrimental effects on osteoblastic cells, and ursodeoxycholic acid (UDCA) counteracts these outcomes. However, there is no information on the consequences of these retained substances of cholestasis and sera from cholestatic patients in osteocytes. METHODS The impact of bilirubin, LCA, UDCA and serum from jaundiced patients on viability, differentiation, mineralization and apoptosis has been assessed in MLO-Y4 and MLO-A5 osteocyte cell lines. Effects on gene expression were assessed in these cells and in human bone fragments. RESULTS Lithocholic acid 10 μmol/L and bilirubin 50 μmol/L decreased viability in MLO-Y4 and MLO-A5 cells (11% and 53% respectively; P ≤ .01). UDCA alone or combined with LCA or bilirubin increased cell viability. Jaundiced sera decreased cell viability (56%), an effect which was reverted by UDCA. Bilirubin decreased differentiation by 47% in MLO-Y4 (P ≤ .01) and mineralization (87%) after 21 days in MLO-A5 (P ≤ .03). Both bilirubin and LCA increased apoptosis in MLO-Y4, and UDCA diminished the apoptotic effect. Moreover, bilirubin down-regulated RUNX2 and up-regulated RANKL gene expression in bone tissue, MLO-Y4 and MLO-A5 cells, and LCA up-regulated RANKL expression in bone tissue. UDCA 100 μmol/L increased the gene expression of all these genes in bone tissue and MLO-Y4 cells and neutralized the decreased RUNX2 expression induced by bilirubin. CONCLUSION Bilirubin and LCA have damaging consequences in osteocytes by decreasing viability, differentiation and mineralization, increasing apoptosis and modifying gene expression, effects that are neutralized by UDCA.
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Affiliation(s)
- Silvia Ruiz-Gaspà
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Núria Guañabens
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Susana Jurado
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Andreu Combalia
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pilar Peris
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ana Monegal
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Albert Parés
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Florez H, Hernández-Rodríguez J, Muxi A, Carrasco JL, Prieto-González S, Cid MC, Espinosa G, Gómez-Puerta JA, Monegal A, Guañabens N, Peris P. Trabecular bone score improves fracture risk assessment in glucocorticoid-induced osteoporosis. Rheumatology (Oxford) 2020; 59:1574-1580. [PMID: 31628810 DOI: 10.1093/rheumatology/kez464] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/06/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To analyse the clinical utility of trabecular bone score (TBS) evaluation for fracture risk assessment in glucocorticoid (GC)-treated patients compared with BMD assessment. METHODS One hundred and twenty-seven patients on GC treatment were included [mean age 62 (18) years, 63% women] in this cross-sectional study. The medical history, anthropometric data, lumbar and femoral BMD (DXA) [considering osteoporosis (OP): T-score ⩽-2.5], TBS (considering degraded microarchitecture: <1.230) and dorsolumbar X-ray [to assess vertebral fractures (VF)] were evaluated. BMD and TBS sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were evaluated to determine the diagnostic accuracy of the two methods. RESULTS All patients were receiving GC treatment for autoimmune diseases during 47.7 (68.9) months at a mean daily dose of 14.5 mg; 17% had VF, 28% any type of fragility fracture (VF + non-VF), 29% OP and 52% degraded microarchitecture. Degraded microarchitecture was significantly more frequent than densitometric OP in patients with VF (76% vs 38%) and with any fragility fracture (69% vs 36%). For VF, TBS and BMD sensitivity, specificity, PPV, and NPV were 0.76, 0.53, 0.25 and 0.92, and 0.38, 0.72, 0.22 and 0.85, respectively. Specificity increased to 0.89 for VF and 0.9 for any fragility fracture on combining BMD+TBS. TBS had better ability than BMD to discriminate between patients with fracture, especially VF (area under the curve = 0.73). CONCLUSION TBS seems to have greater discriminative power than BMD for fracture risk assessment in GC-treated patients, confirming the utility of this method as a complementary tool in the diagnosis of GC-induced OP.
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Affiliation(s)
- Helena Florez
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona
| | | | - Africa Muxi
- Department of Nuclear Medicine, Hospital Clinic, University of Barcelona
| | | | | | - Maria C Cid
- Department of Autoimmune Diseases, Hospital Clinic, IDIBAPS, University of Barcelona
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, IDIBAPS, University of Barcelona
| | - Jose A Gómez-Puerta
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ana Monegal
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona
| | - Núria Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona
| | - Pilar Peris
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona
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Florez H, Hernández-Rodríguez J, Carrasco JL, Prieto-González S, Muxi A, Filella X, Ruiz-Gaspà S, Gómez-Puerta JA, Cid M, Espinosa G, Monegal A, Guañabens N, Peris P. Vertebral fracture risk in glucocorticoid-induced osteoporosis: the role of hypogonadism and corticosteroid boluses. RMD Open 2020; 6:rmdopen-2020-001355. [PMID: 32917834 PMCID: PMC7520700 DOI: 10.1136/rmdopen-2020-001355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/17/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify the risk factors associated with fragility fracture (FF) development in glucocorticoid (GC)-treated patients. METHODS 127 patients (aged 62±18 years, 63% women) on GC-treatment (mean dose 14.5±14.1 mg/day and duration 47.7±69 months) were included. The clinical data collected included bone metabolism study (including gonadal axis), GC-treatment, disease activity, dual-energy X-ray absorptiometry analysis (evaluating densitometric osteoporosis (OP) and trabecular bone score (TBS) degraded microarchitecture values (DMA)), X-ray (assessing vertebral fractures (VF)), FRAX risk (GC-adjusted) and previous FF. RESULTS 17% of the patients had VF, 28% FF (VF and/or non-VF), 29% OP and 52% DMA. Patients with VF received more GC boluses (57.1% vs 29.5%, p=0.03), were older (68±13 vs 60±19 years, p=0.02), postmenopausal (100% vs 67%, p=0.02), had low testosterone levels (57% vs 11%, p=0.02), lower TBS values (1.119±0.03 vs 1.237±0.013, p<0.001) and higher FRAX risk (17.2±16 vs 9.3±7.6, p=0.003). Patients with FF showed higher accumulated GC doses (16.6±18.4 vs 11.1±12.9 g, p=0.046). On multivariate analysis, hypogonadism (OR 12.38; 95% CI 1.85 to >100, p=0.01) and having received GC boluses (OR 3.45; 95% CI 1.04 to 12.15, p=0.01) were the main factors related to VF. Hypogonadism (OR 7.03; 95% CI 1.47 to 38.37, p=0.01) and FRAX >20 (OR 7.08; 95% CI 1.28 to 53.71, p=0.02) were factors related to FF. CONCLUSION Hypogonadism is the principal risk factor for developing fractures in GC-treated men and women, whereas receiving GC boluses is a major factor for VF. These results indicate the importance of evaluating the gonadal axis in these patients.
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Affiliation(s)
- Helena Florez
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain .,Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Jose Hernández-Rodríguez
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Josep Lluis Carrasco
- Biostatistics, Department of Basic Clinical Practice, University of Barcelona, Spain
| | - Sergio Prieto-González
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Africa Muxi
- Department of Nuclear Medicine, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Xavier Filella
- Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, Spain
| | - Silvia Ruiz-Gaspà
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - José A Gómez-Puerta
- Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Maria Cid
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Ana Monegal
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain.,Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Núria Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain.,Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Pilar Peris
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain.,Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
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Florez H, Hernández-Rodríguez J, Carrasco JL, Prieto-González S, Filella X, Monegal A, Guañabens N, Peris P. SAT0467 LOW SERUM OSTEOCALCIN LEVELS ARE ASSOCIATED WITH THE PRESENCE OF DIABETES MELLITUS IN GLUCOCORTICOID TREATED PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Increasing evidence indicates that osteocalcin (OC) is involved in the regulation of glucose homeostasis. Glucocorticoid (GC) treatment is associated with impaired osteoblast function and decreased OC levels and also with the development of CG-induced diabetes mellitus (GIDM). However, whether decreased OC levels in GC-treated subjects contribute to GIDM is not well known.Objectives:To analyse whether OC levels in GC-treated patients are associated with the presence of GIDM.Methods:127 patients (aged 62±18years, 63% women) on GC treatment for autoimmune diseases (≥5mg/day, >3 months) were included. Clinical and anthropometric data were analysed, including the GC dose and treatment duration, presence of GIDM, fragility fractures, densitometric osteoporosis and bone formation (OC, bone alkaline phosphatase [BAP], PINP) and resorption markers (urinary NTX, serum CTX). The cut-offs of each bone marker for the presence of GIDM were estimated and optimized with the Youden index and included in the logistic regression analysis (adjusted for BMI, age and GC doses).Results:17.3% of patients presented GIDM. Diabetic subjects were older (70.5±12.2 vs. 59.6±18.4, p=0.001) and had a higher BMI than non-diabetics (30±5.2 vs. 26±4.2, p=0.002). No differences were observed in GC dose or duration or in the presence of vertebral fractures. Diabetics showed lower levels of OC (7.57±1.01 vs. 11.56±1; p<0.001), PINP (21.48±1.01 vs. 28.39±1; p=0.0048), NTx (24.91±1.01 vs. 31.7±1; p=0.036) and CTX (0.2±1.01 vs. 0.3±1; p=0.0016) with similar BAP values. The best discriminating cut-offs for GIDM presence were: <9.25ng/mL for OC, <24ng/mL for PINP, <27.5nMol/mM for NTX and <0.25ng/mL for CTX. On multivariate analysis OC (<9.25) was the only marker related to the presence of GIDM (OR 6.1; CI95% 1.87-19.89; p=0.001).Conclusion:Decreased OC levels in GC-treated patients are associated with an increased risk of GIDM, a finding that was not observed with other bone turnover markers, further confirming the involvement of OC in the glucose homeostasis regulation in this entity.Disclosure of Interests:None declared
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Azuaga-Piñango AB, Peris P. Efecto del tratamiento antirresortivo y osteoformador en las erosiones óseas en la artritis reumatoide. Med Clin (Barc) 2020; 154:358-365. [DOI: 10.1016/j.medcli.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/10/2019] [Accepted: 12/19/2019] [Indexed: 01/24/2023]
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Ruiz-Gaspà S, Guañabens N, Jurado S, Dubreuil M, Combalia A, Peris P, Monegal A, Parés A. Bile acids and bilirubin effects on osteoblastic gene profile. Implications in the pathogenesis of osteoporosis in liver diseases. Gene 2019; 725:144167. [PMID: 31639434 DOI: 10.1016/j.gene.2019.144167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 12/16/2022]
Abstract
Osteoporosis in advanced cholestatic and end-stage liver disease is related to low bone formation. Previous studies have demonstrated the deleterious consequences of lithocholic acid (LCA) and bilirubin on osteoblastic cells. These effects are partially or completely neutralized by ursodeoxycholic acid (UDCA). We have assessed the differential gene expression of osteoblastic cells under different culture conditions. The experiments were performed in human osteosarcoma cells (Saos-2) cultured with LCA (10 μM), bilirubin (50 μM) or UDCA (10 and 100 μM) at 2 and 24 h. Expression of 87 genes related to bone metabolism and other signalling pathways were assessed by TaqMan micro fluidic cards. Several genes were up-regulated by LCA, most of them pro-apoptotic (BAX, BCL10, BCL2L13, BCL2L14), but also MGP (matrix Gla protein), BGLAP (osteocalcin), SPP1 (osteopontin) and CYP24A1, and down-regulated bone morphogenic protein genes (BMP3 and BMP4) and DKK1 (Dickkopf-related protein 1). Parallel effects were observed with bilirubin, which up-regulated apoptotic genes and CSF2 (colony-stimulating factor 2) and down-regulated antiapoptotic genes (BCL2 and BCL2L1), BMP3, BMP4 and RUNX2. UDCA 100 μM had specific consequences since differential expression was observed, up-regulating BMP2, BMP4, BMP7, CALCR (calcitonin receptor), SPOCK3 (osteonectin), BGLAP (osteocalcin) and SPP1 (osteopontin), and down-regulating pro-apoptotic genes. Furthermore, most of the differential expression changes induced by both LCA and bilirubin were partially or completely neutralized by UDCA. Conclusion: Our observations reveal novel target genes, whose regulation by retained substances of cholestasis may provide additional insights into the pathogenesis of osteoporosis in cholestatic and end-stage liver diseases.
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Affiliation(s)
- Silvia Ruiz-Gaspà
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Nuria Guañabens
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, IDIBAPS, University of Barcelona, Spain.
| | - Susana Jurado
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Marta Dubreuil
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Andres Combalia
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - Pilar Peris
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - Ana Monegal
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - Albert Parés
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Kanterewicz E, Puigoriol E, Rodríguez Cros JR, Peris P. Prevalent vertebral fractures and minor vertebral deformities analyzed by vertebral fracture assessment (VFA) increases the risk of incident fractures in postmenopausal women: the FRODOS study. Osteoporos Int 2019; 30:2141-2149. [PMID: 31123788 DOI: 10.1007/s00198-019-04962-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/29/2018] [Accepted: 03/28/2019] [Indexed: 11/28/2022]
Abstract
UNLABELLED The incidence of vertebral fractures (VF) by vertebral fracture assessment (VFA) was 6.6% in postmenopausal women (FRODOS cohort) after 4 years of follow-up, increasing with prevalent VF and minor vertebral deformities, age, lower bone mass, glucocorticoid use, and rheumatoid arthritis. This study supports the usefulness of VFA to identify VF. PURPOSE Vertebral fracture assessment (VFA) is increasingly used to identify spine fractures, but few cohort studies have used this method in prevalence and incidence assessment. We previously reported the prevalence of vertebral fractures (VF) and minor vertebral deformities (MVD) by morphometric VFA in a population-based cohort of postmenopausal women (FRODOS study). Therefore, the aim of this study was to analyze the incidence of VF, the associated risk factors, and particularly the role of MVD in this cohort of subjects. METHODS We performed a longitudinal analysis of 2510 women aged 59-70 years participating in the FRODOS prevalence study (2006-2009) with evaluable VFA 4 years later. VFA at baseline and in the present study was assessed by quantitative vertebral morphometry and by visual semiquantitative measurement. The multivariate Poisson regression model was performed, and relative risks with confidence interval of 95% were calculated for the incidence of VF. Bone mineral density (BMD) and an osteoporosis questionnaire were collected. RESULTS Overall, the incidence of VF was 6.6%, increasing with prevalent VF (24.5%) and in women with prevalent MVD (17.7%). Age and low BMD were also associated risk factors as were the presence of rheumatoid arthritis and exposure to glucocorticoids and bisphosphonates. CONCLUSIONS The presence of prevalent VF assessed by VFA is associated with further incident spinal fractures in postmenopausal women. In addition, having MVD confers an increased risk of new VF.
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Affiliation(s)
- E Kanterewicz
- Department of Rheumatology, Hospital Universitari de Vic. TR2Lab Group, Universitat de Vic-UCC, C/ Francesc Pla el Vigatà, n° 1, 08500, Vic, Spain.
| | - E Puigoriol
- Department of Clinical Epidemiology. Hospital Universitari de Vic. TR2Lab Group, Universitat de Vic-UCC, Barcelona, Spain
| | - J R Rodríguez Cros
- Department of Rheumatology, Hospital Universitari de Vic. TR2Lab Group, Universitat de Vic-UCC, C/ Francesc Pla el Vigatà, n° 1, 08500, Vic, Spain
| | - P Peris
- Department of Rheumatology, Hospital Clinic i Provincial, Barcelona, Spain
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Kanterewicz E, Puigoriol E, Rodríguez Cros JR, Peris P. Correction to: Prevalent vertebral fractures and minor vertebral deformities analyzed by vertebral fracture assessment (VFA) increases the risk of incident fractures in postmenopausal women: the FRODOS study. Osteoporos Int 2019; 30:1901-1902. [PMID: 31317247 DOI: 10.1007/s00198-019-05050-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/26/2022]
Abstract
Figure 1 as published in the original version of this article was unfortunately incomplete.
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Affiliation(s)
- E Kanterewicz
- Department of Rheumatology, Hospital Universitari de Vic. TR2Lab Group, Universitat de Vic-UCC, C/ Francesc Pla el Vigatà, n° 1, 08500, Vic, Spain.
| | - E Puigoriol
- Department of Clinical Epidemiology. Hospital Universitari de Vic., TR2Lab Group, Universitat de Vic-UCC, Barcelona, Spain
| | - J R Rodríguez Cros
- Department of Rheumatology, Hospital Universitari de Vic. TR2Lab Group, Universitat de Vic-UCC, C/ Francesc Pla el Vigatà, n° 1, 08500, Vic, Spain
| | - P Peris
- Department of Rheumatology, Hospital Clinic i Provincial, Barcelona, Spain
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Guañabens N, Filella X, Florez H, Ruiz-Gaspá S, Conesa A, Peris P, Monegal A, Torres F. Tartrate-resistant acid phosphatase 5b, but not periostin, is useful for assessing Paget's disease of bone. Bone 2019; 124:132-136. [PMID: 31051316 DOI: 10.1016/j.bone.2019.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Periostin is a matricellular protein with a preferential location in cortical bone and periosteal tissue, and tartrate-resistant acid phosphatase 5b (TRAP5b) is a marker of osteoclast numbers. In Paget's disease of bone (PDB), there is increased cortical thickening and probably increased periosteal apposition, along with increased osteoclast numbers. OBJECTIVES To analyse if circulating periostin is a biomarker for PDB, and if it is associated with disease activity and involvement of long bones that represent major cortical contribution. Also, to analyse whether TRAP5b, a scarcely explored bone resorption marker, is useful in the assessment of PDB. PATIENTS AND METHODS We recruited 42 patients with PDB (13F/29M; 71 ± 11.6 yrs). 71.4% had active disease, 66.6% had polyostotic disease and 54.8% had long bone involvement. Blood and urine samples were taken between 8:00 and 10:00 A.M. after an overnight fast. Periostin and TRAP5b were measured in serum, using commercial ELISA assays (Biomedica and IDS, respectively). Serum total ALP, PINP, CTX, bone ALP and urinary NTX were measured. Reference values for periostin and TRAP5b were obtained from 45 healthy subjects. RESULTS Serum periostin did not differ between patients and controls (989.4 ± 173.2 vs. 966.9 ± 195.4 pMol/L, p = 0.572). No significant differences were observed between patients with and without active disease (964.5 ± 168.8 vs.1051.6 ± 175.6 pMol/L, p = 0.143), involvement or not of long bones (1022.2 ± 145.8 vs 949.7 ± 198.2 pMol/L, p = 0.181) and monostotic or polyostotic disease (963.8 ± 198.7 vs 1002.2 ± 161.4 pMol/L, p = 0.505). There were significant correlations between serum periostin and all bone turnover markers (bone ALP, PINP, uNTX, sCTX and TRAP5b) in PDB patients with active disease, but not in the inactive PDB group. Serum TRAP5b was significantly higher in PDB patients than in controls (4.43 ± 1.76 vs. 3.21 ± 1.02 U/L, p < 0.001), in those with active disease (4.98 ± 1.76 vs. 3.07 ± 0.72 U/L, p < 0.001) and in patients with polyostotic disease than in those with monostotic disease (4.81 ± 1.79 vs 3.68 ± 1.5 U/L, p = 0.005). TRAP5b levels were not influenced by previous bisphosphonate treatment (4.14 ± 1.42 vs. 4.84 ± 2.02 U/L, p = 0.206). CONCLUSIONS Periostin is not useful for assessing PDB, whilst TRAP5b, which has been a scarcely explored bone turnover marker until now, may be useful in the analysis of this disease, providing new information on the resorption process. In addition, periostin levels correlate with all classical BTMs in active PDB, suggesting that this marker may reflect periosteal and cortical metabolism in accelerated bone turnover states.
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Affiliation(s)
- Núria Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, IDIBAPS, CIBERhed, University of Barcelona, Spain.
| | - Xavier Filella
- Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Helena Florez
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, IDIBAPS, CIBERhed, University of Barcelona, Spain
| | | | - Arantxa Conesa
- Department of Rheumatology, University Hospital of Castellón, Spain
| | - Pilar Peris
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, IDIBAPS, CIBERhed, University of Barcelona, Spain
| | - Ana Monegal
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, IDIBAPS, CIBERhed, University of Barcelona, Spain
| | - Ferran Torres
- Medical Statistics Core Facility, IDIBAPS, Hospital Clínic, Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Spain
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Guañabens N, Moro-Álvarez MJ, Casado E, Blanch-Rubió J, Gómez-Alonso C, Díaz-Guerra GM, Del Pino-Montes J, Valero Díaz de Lamadrid C, Peris P, Muñoz-Torres M. The next step after anti-osteoporotic drug discontinuation: an up-to-date review of sequential treatment. Endocrine 2019; 64:441-455. [PMID: 30963388 DOI: 10.1007/s12020-019-01919-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 01/28/2019] [Accepted: 03/29/2019] [Indexed: 12/16/2022]
Abstract
Several antiresorptive drugs, like bisphosphonates and denosumab, are currently available for the treatment of osteoporosis due to their evidenced efficacy in reducing fracture risk at mid-term. Osteoanabolic therapies, like teriparatide, whose treatment duration is limited to 2 years, have also shown efficacy in the reduction of fracture risk. However, depending on the severity of osteoporosis and the presence of other associated risk factors for fracture, some patients may require long-term treatment to preserve optimal bone strength and minimize bone fracture risk. Given the limited duration of some treatments, the fact that most of the antiresorptive drugs have not been assessed beyond 10 years, and the known long-term safety issues of these drugs, including atypical femoral fractures or osteonecrosis of the jaw, the long-term management of these patients may require an approach based on drug discontinuation and/or switching. In this regard, interest in sequential osteoporosis therapy, wherein drugs are initiated and discontinued over time, has grown in recent years, although the establishment of an optimal and individualized order of therapies remains controversial. This review reports the currently available clinical evidence on the discontinuation effects of different anti-osteoporotic drugs, as well as the clinical outcomes of the different sequential treatment regimens. The objective of this article is to present up-to-date practical knowledge on this area in order to provide guidance to the clinicians involved in the management of patients with osteoporosis.
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Affiliation(s)
- Núria Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain.
| | | | - Enrique Casado
- Rheumatology Department, Parc Taulí University Hospital, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Carlos Gómez-Alonso
- Bone and Mineral Metabolism Unit, Central University Hospital of Asturias (HUCA), University of Oviedo, Oviedo, Spain
| | | | | | - Carmen Valero Díaz de Lamadrid
- University Hospital Marqués de Valdecilla, Research Institute Marqués de Valdecilla (IDIVAL), University of Cantabria, Santander, Spain
| | - Pilar Peris
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Manuel Muñoz-Torres
- Endocrinology and Nutrition Unit, Hospital Universitario San Cecilio de Granada, Department of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (Ibs.GRANADA), CIBERFES, Instituto de Salud Carlos III, Granada, Spain
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Florez H, Ramírez J, Monegal A, Guañabens N, Peris P. Spontaneous vertebral fractures after denosumab discontinuation: A case collection and review of the literature. Semin Arthritis Rheum 2019; 49:197-203. [PMID: 30826108 DOI: 10.1016/j.semarthrit.2019.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/23/2019] [Accepted: 02/11/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Denosumab is an antiresorptive drug with demonstrated efficacy in the treatment of osteoporosis. However, discontinuation of this agent is associated with increased bone turnover and rapid bone loss, and more recently, with the development of vertebral fractures (VF) in some patients. Therefore, the aim of the study was to analyze the clinical characteristics, bone metabolism parameters and evolution of a group of patients who developed vertebral fractures after denosumab discontinuation. In addition, we reviewed the literature on this subject. METHODS During a period of 28 months (September 2015-January 2018) 7 women presenting spontaneous vertebral fractures after denosumab discontinuation were attended in the Rheumatology Department of our centre. We analyzed their clinical characteristics, bone metabolism parameters and evolution and reviewed the literature related to this subject. RESULTS The patients had received denosumab during 24-58 months (median 38), and developed a median of 5 VF per patient at 8-20 months (median 10) since the last dose of denosumab. Only 2 patients presented previous VF, and most (5 patients) received previous bisphosphonate treatment. After VF all restarted antiosteoporotic treatment with no further fractures during follow-up (median 19 months). CONCLUSIONS In this short series, previous bisphosphonate treatment does not seem to be a protective factor for the development of VF. The possible development of VF following discontinuation of denosumab must be taken into account in the clinical practice of physicians and dentists. Nonetheless, further studies are needed to improve the identification of patients at risk and the most adequate sequential treatment options.
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Affiliation(s)
- Helena Florez
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | - Julio Ramírez
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Ana Monegal
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Núria Guañabens
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Pilar Peris
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
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Florez H, Mandelikova S, Filella X, Monegal A, Guañabens N, Peris P. Clinical significance of increased serum levels of FGF-23 in fibrous dysplasia. Med Clin (Barc) 2018; 151:65-67. [PMID: 29295788 DOI: 10.1016/j.medcli.2017.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/19/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVE Fibrous dysplasia (FD) can be associated with the development of hypophosphatemic osteomalacia, caused by the production of FGF-23 by dysplastic bone tissue. This study analysed FGF-23 levels in patients with FD, and their association with disease activity and serum phosphate values. PATIENTS AND METHODS Twelve adult patients with FD were included in the study. Clinical history, disease extension and activity and treatments received were reviewed, and the relationship of those values with FGF-23 and serum P levels was analysed. RESULTS FGF-23 was elevated in 6/12 patients (50%). Patients with high FGF-23 levels had similar age and disease activity and extension than those who did not. No differences were observed in serum phosphate values between both groups (increased FGF-23: 3.9±0.9 mg/dl vs. decreased FGF-23: 3.5±0.6 mg/dl). In fact, none of the patients with increased FGF-23 had low serum phosphate values. CONCLUSION Adult FD patients frequently present elevated FGF-23 values with no serum phosphate level repercussion, suggesting an alteration in the processing of this protein in the dysplastic bone tissue for this pathology.
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Affiliation(s)
- Helena Florez
- Servicio de Reumatología, Unidad de Patología Metabólica Ósea, Hospital Clínic de Barcelona, CIBERehd, IDIBAPS. Universidad de Barcelona, Barcelona, España
| | - Stanislava Mandelikova
- Servicio de Reumatología, Unidad de Patología Metabólica Ósea, Hospital Clínic de Barcelona, CIBERehd, IDIBAPS. Universidad de Barcelona, Barcelona, España
| | - Xavier Filella
- Servicio de Bioquímica y Genética Molecular, Hospital Clínic de Barcelona, Barcelona, España
| | - Ana Monegal
- Servicio de Reumatología, Unidad de Patología Metabólica Ósea, Hospital Clínic de Barcelona, CIBERehd, IDIBAPS. Universidad de Barcelona, Barcelona, España
| | - Núria Guañabens
- Servicio de Reumatología, Unidad de Patología Metabólica Ósea, Hospital Clínic de Barcelona, CIBERehd, IDIBAPS. Universidad de Barcelona, Barcelona, España
| | - Pilar Peris
- Servicio de Reumatología, Unidad de Patología Metabólica Ósea, Hospital Clínic de Barcelona, CIBERehd, IDIBAPS. Universidad de Barcelona, Barcelona, España.
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Peris P, González-Roca E, Rodríguez-García SC, Del Mar López-Cobo M, Monegal A, Guañabens N. Incidence of Mutations in the ALPL, GGPS1, and CYP1A1 Genes in Patients With Atypical Femoral Fractures. JBMR Plus 2018; 3:29-36. [PMID: 30680361 PMCID: PMC6339546 DOI: 10.1002/jbm4.10064] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/26/2018] [Accepted: 05/23/2018] [Indexed: 12/22/2022] Open
Abstract
Atypical femoral fractures (AFFs) are uncommon and often related to prolonged bisphosphonate (BP) treatment. Isolated cases have been linked to mutations of tissue nonspecific alkaline phosphatase (ALPL). Moreover, mutations in the geranylgeranyl pyrophosphate synthase (GGPPS) gene, which can be inhibited by BPs, and in the enzyme of the cytochrome P450 superfamily (CYP1A1), related to the metabolism of several drugs, have also been associated with AFF development. Our aim was to analyze the incidence of ALPL, GGPS1, and CYP1A1 gene mutations in patients with AFFs and their clinical characteristics. Seventeen women with AAFs were included. All patients underwent Sanger sequencing of the ALPL, GGPS1, and CYP1A1 genes, analyzing the presence of mutations and polymorphisms in these genes. The clinical characteristics of the patients, previous treatments, ALP substrates (vitamin B6 and phosphoethanolamine), bone turnover markers, and bone mass were also analyzed. Three of 17 patients (17.6%) presented heterozygous mutations in the ALPL (p.Gly288Ala) or CYP1A1 (p.Arg136His, p.Val409Ile) genes. Only the patient with the ALPL mutation presented increased ALP substrates. Patients with CYP1A1 variants had glucocorticoid-induced osteoporosis. All patients were previously treated with BPs during 85.5 ± 38 months, and nearly 50% were also treated with glucocorticoids. The AFF was bilateral in 35% of cases. In conclusion, ALPL and CYP1A1 mutations may be related to the development of AFF in patients treated with BPs. The evaluation of ALP substrates in patients with low ALPL levels allows the identification of patients with hypophosphatasia. The role of CYP1A1 mutations in AFF needs further study. © 2018 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Pilar Peris
- Rheumatology Department Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd) Clínic Foundation for Biomedical Research (FCRB) Hospital Clínic University of Barcelona Barcelona Spain
| | - Eva González-Roca
- Immunology Department IDIBAPS CIBERehd FCRB Hospital Clínic University of Barcelona Barcelona Spain
| | - Sebastian C Rodríguez-García
- Rheumatology Department Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd) Clínic Foundation for Biomedical Research (FCRB) Hospital Clínic University of Barcelona Barcelona Spain
| | - María Del Mar López-Cobo
- Molecular Biology Core Laboratory IDIBAPS CIBERehd FCRB Hospital Clínic University of Barcelona Barcelona Spain
| | - Ana Monegal
- Rheumatology Department Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd) Clínic Foundation for Biomedical Research (FCRB) Hospital Clínic University of Barcelona Barcelona Spain
| | - Núria Guañabens
- Rheumatology Department Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd) Clínic Foundation for Biomedical Research (FCRB) Hospital Clínic University of Barcelona Barcelona Spain
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Redondo L, Puigoriol E, Rodríguez J, Peris P, Kanterewicz E. Usefulness of the trabecular bone score for assessing the risk of osteoporotic fracture. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2017.12.002] [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: 11/29/2022]
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Redondo L, Puigoriol E, Rodríguez JR, Peris P, Kanterewicz E. Usefulness of the Trabecular Bone Score for assessing the risk of osteoporotic fracture. Rev Clin Esp 2018; 218:121-127. [PMID: 29329765 DOI: 10.1016/j.rce.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 09/04/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND OBJECTIVES The trabecular bone score (TBS) is an imaging technique that assesses the condition of the trabecular microarchitecture. Preliminary results suggest that TBS, along with the bone mineral density assessment, could improve the calculation of the osteoporotic fracture risk. The aim of this study was to analyse TBS values and their relationship with the clinical characteristics, bone mineral density and history of fractures of a cohort of posmenopausal women. MATERIAL AND METHODS We analysed 2,257 posmenopausal women from the FRODOS cohort, which was created to determine the risk factors for osteoporotic fracture through a clinical survey and bone densitometry with vertebral morphometry. TBS was applied to the densitometry images. TBS values ≤1230 were considered indicative of degraded microarchitecture. We performed a simple and multiple linear regression to determine the factors associated with this index. RESULTS The mean TBS value in L1-L4 was 1.203±0.121. Some 55.3% of the women showed values indicating degraded microarchitecture. In the multiple linear regression analysis, the factors associated with low TBS values were age, weight, height, spinal T-score, glucocorticoid treatment, presence of type 2 diabetes and a history of fractures due to frailty. CONCLUSIONS TBS showed microarchitecture degradation values in the participants of the FRODOS cohort and was associated with anthropometric factors, low bone mineral density values, the presence of fractures, a history of type 2 diabetes mellitus and the use of glucocorticoids.
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Affiliation(s)
- L Redondo
- Servicio de Urgencias Consorci Hospitalari de Vic, Vic, Barcelona, España; Grupo de investigación TR2LAB, Universitat de Vic, Universitat Central de Catalunya, Vic, Barcelona, España
| | - E Puigoriol
- Unidad de Epidemiología Clínica, Consorci Hospitalari de Vic, Vic, Barcelona, España; Grupo de investigación TR2LAB, Universitat de Vic, Universitat Central de Catalunya, Vic, Barcelona, España
| | - J R Rodríguez
- Servicio de Reumatología, Consorci Hospitalari de Vic, Vic, Barcelona, España; Grupo de investigación TR2LAB, Universitat de Vic, Universitat Central de Catalunya, Vic, Barcelona, España
| | - P Peris
- Unidad de Metabolismo Óseo, Servicio de Reumatología, Hospital Clinic, Barcelona, España
| | - E Kanterewicz
- Servicio de Reumatología, Consorci Hospitalari de Vic, Vic, Barcelona, España; Grupo de investigación TR2LAB, Universitat de Vic, Universitat Central de Catalunya, Vic, Barcelona, España.
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Gifre L, Humbert L, Muxi A, Del Rio L, Vidal J, Portell E, Monegal A, Guañabens N, Peris P. Analysis of the evolution of cortical and trabecular bone compartments in the proximal femur after spinal cord injury by 3D-DXA. Osteoporos Int 2018; 29:201-209. [PMID: 29043391 DOI: 10.1007/s00198-017-4268-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/12/2017] [Accepted: 10/11/2017] [Indexed: 01/18/2023]
Abstract
UNLABELLED Marked trabecular and cortical bone loss was observed at the proximal femur short-term after spinal cord injury (SCI). 3D-DXA provided measurement of vBMD evolution at both femoral compartments and cortical thinning, thereby suggesting that this technique could be useful for bone analysis in these patients. INTRODUCTION SCI is associated with a marked increase in bone loss and risk of osteoporosis development short-term after injury. 3D-DXA is a new imaging analysis technique providing 3D analysis of the cortical and trabecular bone from DXA scans. The aim of this study was to assess the evolution of trabecular macrostructure and cortical bone using 3D-DXA in patients with recent SCI followed over 12 months. METHODS Sixteen males with recent SCI (< 3 months since injury) and without antiosteoporotic treatment were included. Clinical assessment, bone mineral density (BMD) measurements by DXA, and 3D-DXA evaluation at proximal femur (analyzing the integral, trabecular and cortical volumetric BMD [vBMD] and cortical thickness) were performed at baseline and at 6 and 12 months of follow-up. RESULTS vBMD significantly decreased at integral, trabecular, and cortical compartments at 6 months (- 8.8, - 11.6, and - 2.4%), with a further decrease at 12 months, resulting in an overall decrease of - 16.6, - 21.9, and - 5.0%, respectively. Cortical thickness also decreased at 6 and 12 months (- 8.0 and - 11.4%), with the maximal decrease being observed during the first 6 months. The mean BMD losses by DXA at femoral neck and total femur were - 17.7 and - 21.1%, at 12 months, respectively. CONCLUSIONS Marked trabecular and cortical bone loss was observed at the proximal femur short-term after SCI. 3D-DXA measured vBMD evolution at both femoral compartments and cortical thinning, providing better knowledge of their differential contributory role to bone strength and probably of the effect of therapy in these patients.
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Affiliation(s)
- L Gifre
- Rheumatology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Metabolic Bone Diseases Unit, Service of Rheumatology, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Rheumatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - A Muxi
- Nuclear Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | - J Vidal
- Guttmann Neurorehabilitation Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - E Portell
- Guttmann Neurorehabilitation Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - A Monegal
- Rheumatology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Metabolic Bone Diseases Unit, Service of Rheumatology, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - N Guañabens
- Rheumatology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Metabolic Bone Diseases Unit, Service of Rheumatology, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - P Peris
- Rheumatology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Metabolic Bone Diseases Unit, Service of Rheumatology, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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Peris P, Filella X, Monegal A, Guañabens N, Foj L, Bonet M, Boquet D, Casado E, Cerdá D, Erra A, Gómez-Vaquero C, Martínez S, Montalá N, Pittarch C, Kanterewicz E, Sala M, Suris X, Carrasco JL. Concordance between direct and indirect measurements of free 25-OH vitamin D. Clin Chim Acta 2017; 475:169-171. [PMID: 29056531 DOI: 10.1016/j.cca.2017.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
At present, data comparing the quantification methods for measurement of free vitamin D (direct assay [direct 25-OHDF] and estimated by calculation [calculated 25-OHDF]), are scarce. The aim of this study was to analyse the concordance between these two methods of 25-OHDF analysis (direct vs. calculated). METHODS Serum values of total 25-OHD (25-OHDT), vitamin D binding protein (DBP) (by R&D Systems ELISA), calculated 25-OHDF (by DBP, albumin and 25-OHDT) and direct 25-OHDF (by DIAsource ELISA) were analysed in 173 healthy women (aged 35-45years). Assessment of concordance was evaluated by the Bland-Altman plot and the total deviation index (TDI). RESULTS The mean values of calculated and direct 25-OHDF in these subjects were 5.27±2.5 and 3.83±1.01pg/mL, respectively. We found significantly lower values of 25-OHDF on comparing subjects with and without vitamin D deficiency, independently of the method used. The total deviation index evaluated by the Bland-Altman plot showed low concordance for both measurements. Only low 25-OHDF levels were concordant. CONCLUSIONS This study shows that the concordance between these two methods of 25-OHDF analysis is low and has a concentration dependent bias. Further studies are necessary to clarify the reference values and the indications for 25-OHDF measurement.
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Affiliation(s)
- Pilar Peris
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Spain.
| | | | - Ana Monegal
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Spain.
| | | | - Laura Foj
- Servicio de Bioquímica Clínica, Hospital Clinic, Spain.
| | | | | | | | | | - Alba Erra
- Hospital Universitari de Bellvitge, Spain.
| | | | | | | | | | | | | | | | - Josep L Carrasco
- Departament de Fonaments Clínics, Universitat de Barcelona, Spain.
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Gifre L, Ruiz-Gaspà S, Carrasco JL, Portell E, Vidal J, Muxi A, Monegal A, Guañabens N, Peris P. Effect of recent spinal cord injury on the OPG/RANKL system and its relationship with bone loss and the response to denosumab therapy. Osteoporos Int 2017; 28:2707-2715. [PMID: 28580511 DOI: 10.1007/s00198-017-4090-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED There is marked bone loss after spinal cord injury (SCI); however, its pathogenesis and clinical management remain unclear. The increased circulating levels of receptor activator of nuclear factor kB ligand (RANKL) associated with bone loss shortly after SCI and the prevention of bone loss with denosumab treatment suggest a contributory role of RANKL in SCI-induced osteoporosis. INTRODUCTION Bone turnover and bone loss are markedly increased shortly after SCI. However, the pathogenesis and clinical management of this process remain unclear, especially the role of the osteoprotegerin (OPG)/RANKL system in this disorder. The aim of this study was to analyze serum levels of OPG and RANKL in bone loss associated with recent SCI and the effect of denosumab treatment on these mediators. METHODS Twenty-three males with recent complete SCI were prospectively included. Serum OPG and RANKL levels, bone turnover markers (PINP, bone ALP, CTX), and bone mineral density (BMD) were assessed at baseline, at 6 months of follow-up, prior to initiating denosumab, and 6 months after treatment. The results were compared with a healthy control group. RESULTS At baseline, SCI patients showed higher RANKL levels vs. controls which were correlated with days-since-SCI and total hip BMD loss at 6 months. OPG levels were similar to controls at baseline. After denosumab treatment, OPG showed no changes, whereas RANKL levels became undetectable in 67% of patients. Patients with undetectable RANKL during treatment showed better response in femoral BMD and bone markers vs. patients with detectable RANKL at 6 months of denosumab. Increased parathormone (PTH) levels during treatment were negatively correlated with RANKL changes. CONCLUSIONS RANKL levels are increased after SCI and related to BMD loss at the proximal femur, becoming undetectable after denosumab treatment. The effect of denosumab on preventing sublesional bone loss, especially in patients with undetectable levels during treatment, suggests a contributory role of RANKL in this process.
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Affiliation(s)
- L Gifre
- Rheumatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Rheumatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - J L Carrasco
- Public Health Department, University of Barcelona, Barcelona, Spain
| | - E Portell
- Guttmann Neurorehabilitation Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - J Vidal
- Guttmann Neurorehabilitation Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - A Muxi
- Nuclear Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - A Monegal
- Rheumatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - N Guañabens
- Rheumatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- CIBERehd, Barcelona, Spain
| | - P Peris
- Rheumatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
- CIBERehd, Barcelona, Spain.
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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Peris P, Filella X, Monegal A, Guañabens N, Foj L, Bonet M, Boquet D, Casado E, Cerdá D, Erra A, Gómez-Vaquero C, Martínez S, Montalá N, Pittarch C, Kanterewicz E, Sala M, Suris X, Carrasco JL. Comparison of total, free and bioavailable 25-OH vitamin D determinations to evaluate its biological activity in healthy adults: the LabOscat study. Osteoporos Int 2017; 28:2457-2464. [PMID: 28466136 DOI: 10.1007/s00198-017-4062-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/17/2017] [Indexed: 01/07/2023]
Abstract
UNLABELLED Determination of different forms of 25-OHD (total, free and bioavailable) in healthy young women does not offer additional advantages over standard 25-OHDT for evaluating vitamin D deficiency. In these subjects 25-OHDT values <15 ng/ml would be more appropriate for defining this deficiency. INTRODUCTION Determination of 25-OH vitamin D serum levels (25-OHD) constitutes the method of choice for evaluating vitamin D deficiency. However, vitamin D-binding protein (DBP) may modulate its bioavailability thereby affecting correct evaluation of 25-OHD status. We analysed the impact of the determination of 25-OHD (total, free and bioavailable) on the evaluation its biologic activity (estimated by serum PTH determination) in healthy young women. METHODS 173 premenopausal women (aged 35-45 yrs.) were included. We analysed serum values of total 25-OHD (25-OHDT), DBP, albumin, PTH and bone formation (PINP,OC) and resorption (NTx,CTx) markers. Free(25-OHDF) and bioavailable (25-OHDB) serum 25-OHD levels were estimated by DBP and albumin determinations and also directly by ELISA (25-OHDF-2). We analysed threshold PTH values for the different forms of 25-OHD and the correlations and differences according to 25-OHDT levels <20 ng/ml. RESULTS 62% of subjects had 25-OHD values <20 ng/ml and also had significantly lower 25-OHDF and 25-OHDB values, with no significant differences in bone markers and PTH values. The PTH threshold value was similar for all forms of 25-OHD (∼70 pg/ml). Women with PTH values >70 had lower 25-OHDT (15.4 ± 1.4 vs. 18.3 ± 2.7, p < 0.05) and 25OHDB values (1.7 ± 0.2 vs. 2.2 ± 0.09, p < 0.05). The different forms of 25OHD were significantly intercorrelated, with marginal correlations between PTH and 25-OHDT (r = -0.136, p = 0.082). CONCLUSIONS Determination of different forms of 25-OHD in healthy young women does not offer additional advantages over standard 25-OHDT for evaluating vitamin D deficiency. In these subjects 25-OHDT values <15 ng/ml would be more appropriate for defining this deficiency.
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Affiliation(s)
- P Peris
- Hospital Clínic de Barcelona, IDIBAPS. CIBERehd, Barcelona, Spain.
| | - X Filella
- Servicio de Bioquímica Clínica, Hospital Clinic, Barcelona, Spain
| | - A Monegal
- Hospital Clínic de Barcelona, IDIBAPS. CIBERehd, Barcelona, Spain
| | - N Guañabens
- Hospital Clínic de Barcelona, IDIBAPS. CIBERehd, Barcelona, Spain
| | - L Foj
- Servicio de Bioquímica Clínica, Hospital Clinic, Barcelona, Spain
| | - M Bonet
- Hospital de l'Alt Penedés, Barcelona, Spain
| | - D Boquet
- Hospital Arnau de Vilanova, Lleida, Spain
| | - E Casado
- Instituto Universitario Parc Taulí, Barcelona, Spain
| | - D Cerdá
- Hospital Moisés Broggi, Barcelona, Spain
| | - A Erra
- Hospital Universitari de Bellvitge, Barcelona, Spain.
| | | | - S Martínez
- Hospital Mútua de Terrassa, Madrid, Spain
| | - N Montalá
- Hospital Sta María, Barcelona, Spain
| | | | | | - M Sala
- Hospital de Figueres, Barcelona, Spain
| | - X Suris
- Hospital de Ganollers, Catalonia, Spain
| | - J L Carrasco
- Departament de Fonaments Clínics, Universitat de Barcelona, Barcelona, Spain
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Valduvieco I, Biete A, Moreno LA, Gallart X, Rovirosa A, Saez J, Plana C, Peris P. Is anti-inflammatory radiotherapy an effective treatment in trochanteritis? Br J Radiol 2016; 90:20160520. [PMID: 27885851 DOI: 10.1259/bjr.20160520] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the analgesic efficacy of low-dose radiotherapy in refractory cases of trochanteritis. METHODS We evaluated a total of 60 consecutive patients who received low-dose radiotherapy to achieve an anti-inflammatory and analgesic effect for recurrent trochanteritis following scarce response to conventional therapy. All patients were evaluated at baseline (prior to radiotherapy) and at 1 and 4 months after radiotherapy and then yearly thereafter for pain assessment using a visual analogue scale (VAS) and to determine the administration of analgesic treatment. RESULTS An improvement in the symptomatology was observed in 62% of the patients with a significant reduction in the VAS (8 ± 2 vs 4 ± 2; p < 0.0001), which was largely maintained until the second evaluation at 4 months. In the cases responding to radiotherapy, the probability of maintaining improvement beyond 24 months was 70%. CONCLUSION Low-dose anti-inflammatory radiation may be used in the treatment of the recurrent cases of relapse or no response of trochanteritis to conventional treatments, with a high probability of remission of pain. These preliminary results indicate the need for evaluating the use of radiotherapy in patients with trochanteritis refractory to conventional treatment in a long-term controlled study. Advances in knowledge: Radiotherapy provides effective analgesic treatment for patients refractory to standard treatment for trochanteritis.
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Affiliation(s)
- Izaskun Valduvieco
- 1 Department of Radiation Oncology, Hospital Clínic, Institute of Haematology and Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Albert Biete
- 1 Department of Radiation Oncology, Hospital Clínic, Institute of Haematology and Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Luis A Moreno
- 2 Surgical Area, Anesthesia Service, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Xavier Gallart
- 3 Traumatology Service, Hospital Clínic, Institute of Medical and Surgical Specialties, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Angels Rovirosa
- 1 Department of Radiation Oncology, Hospital Clínic, Institute of Haematology and Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jordi Saez
- 2 Surgical Area, Anesthesia Service, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Carlos Plana
- 4 Department of Rheumatology, Hospital Clínic, Institute of Medical and Surgical Specialties, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Pilar Peris
- 4 Department of Rheumatology, Hospital Clínic, Institute of Medical and Surgical Specialties, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Florez H, Peris P, Vidal-Sicart S, Monegal A, Guañabens N. Lack of scintigraphic response of fibrous dysplasia to bisphosphonate treatment. Rheumatology (Oxford) 2016; 55:1735. [DOI: 10.1093/rheumatology/kew284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Guañabens N, Ruiz-Gaspà S, Gifre L, Miquel R, Peris P, Monegal A, Dubrueil M, Arias A, Parés A. Sclerostin Expression in Bile Ducts of Patients With Chronic Cholestasis May Influence the Bone Disease in Primary Biliary Cirrhosis. J Bone Miner Res 2016; 31:1725-33. [PMID: 27019303 DOI: 10.1002/jbmr.2845] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 12/10/2015] [Revised: 03/12/2016] [Accepted: 03/23/2016] [Indexed: 02/06/2023]
Abstract
Sclerostin is involved in the regulation of osteoblastogenesis and little is known about its role in the development of bone disease in primary biliary cirrhosis (PBC), characterized by low bone formation. Therefore, we have assessed the circulating levels and the liver expression of sclerostin in this cholestatic disease. Serum sclerostin levels were measured in 79 women with PBC (mean age 60.6 ± 1.2 years) and in 80 control women. Lumbar and femoral bone mineral density (BMD), as well as parameters of mineral metabolism and bone remodeling, were measured. Moreover, sclerostin gene (SOST) expression in the liver was assessed by real-time PCR in samples of liver tissue taken by biopsy in 11 PBC patients and in 5 normal liver specimens. Presence and distribution of sclerostin was evaluated in liver slices from 11 patients by immunohistochemistry. The severity of histologic lesions was assessed semiquantitatively in the same liver samples. PBC patients had higher sclerostin levels than controls (75.6 ± 3.9 versus 31.7 ± 1.6 pmol/L, p < 0.001). Serum sclerostin correlated inversely with markers of bone formation and resorption. Sclerostin mRNA in the liver was overexpressed compared with control samples (2.7-fold versus healthy liver). Sclerostin was detected by immunohistochemistry in 7 of the 11 liver samples, mainly located in the bile ducts. Liver sclerostin was associated with the severity of cholangitis (p = 0.02) and indirectly with the degree of lobular inflammation (p = 0.03). Sclerostin mRNA expression was higher in samples that tested positive by immunohistochemistry and particularly in those with lobular granuloma (p = 0.02). The increased expression of sclerostin in the liver and the association with histologic cholangitis may explain the high serum levels of this protein in patients with PBC, thus suggesting that sclerostin may influence the decreased bone formation in this cholestatic disease. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Núria Guañabens
- Department of Rheumatology, Metabolic Bone Diseases Unit, Hospital Clínic, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
- Center for Biomedical Research Network in Hepatic and Digestive Diseases (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Silvia Ruiz-Gaspà
- Center for Biomedical Research Network in Hepatic and Digestive Diseases (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Laia Gifre
- Department of Rheumatology, Metabolic Bone Diseases Unit, Hospital Clínic, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Rosa Miquel
- Pathology Department, Hospital Clínic, Barcelona, Spain
| | - Pilar Peris
- Department of Rheumatology, Metabolic Bone Diseases Unit, Hospital Clínic, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
- Center for Biomedical Research Network in Hepatic and Digestive Diseases (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Ana Monegal
- Department of Rheumatology, Metabolic Bone Diseases Unit, Hospital Clínic, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marta Dubrueil
- Center for Biomedical Research Network in Hepatic and Digestive Diseases (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Ana Arias
- Department of Rheumatology, Metabolic Bone Diseases Unit, Hospital Clínic, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Albert Parés
- Center for Biomedical Research Network in Hepatic and Digestive Diseases (CIBERehd), Hospital Clínic, Barcelona, Spain
- Liver Unit, Hospital Clínic, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
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Monegal A, Peris P, Alsina M, Colmenero J, Guañabens N. Development of multiorganic calciphylaxis during teriparatide, vitamin D, and calcium treatment. Osteoporos Int 2016; 27:2631-4. [PMID: 27010647 DOI: 10.1007/s00198-016-3571-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 01/20/2016] [Accepted: 03/14/2016] [Indexed: 12/13/2022]
Abstract
Non-uremic calciphylaxis is a severe rare disorder characterized by ischemic necrosis. Recently, three cases of cutaneous calciphylaxis have been described in the context of teriparatide treatment. We present a 51-year-old woman with alcoholic cirrhosis who developed multiorganic calciphylaxis shortly after starting teriparatide treatment associated with calcium and 25-hydroxyvitamin D supplements for severe osteoporosis. After lengthy care of the infectious complications and treatment with bisphosphonates and sodium thiosulfate progressive improvement was observed over a 3-year period. The time between the initiation of teriparatide and the development of calciphylaxis suggests that this agent may have been the triggering factor of this process. Nevertheless, other non-negligible risk factors for calciphylaxis such as alcoholic liver disease, obesity, and vitamin D treatment must also be considered in this patient. Considering the severity of this extremely rare clinical condition, better knowledge of the risk factors related to calciphylaxis development is mandatory.
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Affiliation(s)
- A Monegal
- Department of Rheumatology, Hospital Clínic. CIBERehd, University of Barcelona, C/Villarroel 170, Barcelona, 08036, Spain.
| | - P Peris
- Department of Rheumatology, Hospital Clínic. CIBERehd, University of Barcelona, C/Villarroel 170, Barcelona, 08036, Spain
| | - M Alsina
- Department Dermatology, Hospital Clínic. CIBERehd, University of Barcelona, Barcelona, Spain
| | - J Colmenero
- Department of Hepatology Unit, Hospital Clínic. CIBERehd, University of Barcelona, Barcelona, Spain
| | - N Guañabens
- Department of Rheumatology, Hospital Clínic. CIBERehd, University of Barcelona, C/Villarroel 170, Barcelona, 08036, Spain
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Gifre L, Vidal J, Ruiz-Gaspà S, Portell E, Monegal A, Muxi A, Guañabens N, Peris P. THU0477 Effect of Recent Spinal Cord Injury on The OPG/RANKL System and Its Relationship with Bone Loss and Antiosteoporotic Response To Denosumab Therapy. Preliminary Results. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4159] [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: 11/04/2022]
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Cuevas P, Rodriguez S, Inciarte J, Peris P, Monegal A, Guañabens N. AB0824 Synovial Fluid Analysis in A Rheumatology Department. Past and Present. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4413] [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: 11/03/2022]
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