Vascular Calcification in Chronic Kidney Disease

Cardiovascular disease (CVD) is the major cause of death in chronic kidney disease (CKD). Of the various risk factors, vascular calcification has only recently come into prominence. CKD is associated with an increased risk of vascular calcification. In routine practice, clinicians usually overlook this finding. Screening for vascular calcification is often missed during first contact with nephrologists. With this article, we would like to reiterate the importance of preventing vascular calcification in early stages of CKD and once it starts appearing, its progression needs to be halted early with individualized treatment. The prevalence, sites of involvement, detection, quantification, pathogenesis, risk factors, clinical manifestations and management options have been discussed.

Doença metabólica óssea em prematuros de muito baixo peso internados em UTI neonatal: ocorrência e fatores associados / Metabolic bone disease in extremely low birth weight premature infants admitted to a neonatal ICU: prevalence and associated factors

Introdução: Recém-nascidos (RN) prematuros de muito baixo peso (MBP) apresentam um risco aumentado de desenvolver doença metabólica óssea (DMO). A realização de suplementação mineral e de triagem para DMO em UTI Neonatal auxilia na prevenção, no diagnóstico e no tratamento desta condição clínica. Objetivos: Avaliar a ocorrência de DMO, a realização de suplementação mineral e de investigação para DMO em prematuros de MBP internados em UTI Neonatal de um Serviço Hospitalar Materno-Infantil de alto risco, vinculado ao SUS. Métodos: Estudo transversal, a partir de dados secundários coletados de prontuários eletrônicos. Foram avaliados os recém-nascidos prematuros de muito baixo peso internados em UTI neonatal. Estudaram-se perfil do recém-nascido, realização da triagem para DMO, ocorrência de DMO, regime alimentar, intercorrências clínicas, uso de suplementação de vitaminas e minerais, idade, peso, sexo, via de parto e Apgar. Resultados: Foram incluídos 112 participantes. A triagem para DMO foi feita em 56 pacientes (50%), com dosagem sérica de fosfatase alcalina, cálcio, fósforo e magnésio séricos. A ocorrência de DMO foi de 8,9% (5 casos). Todos os participantes com DMO apresentaram doença respiratória, quadro infeccioso e estavam recebendo nutrição parenteral. Conclusão: A ocorrência de DMO em recém-nascidos de muito baixo peso internados em UTI neonatal foi de 8,9%, inferior à descrita na literatura. Identificamos como fatores associados à DMO a ocorrência concomitante de doença respiratória, a sepse e o uso de nutrição parenteral.

Introduction: Extremely low birth weight (ELBW) premature infants have an increased risk of developing metabolic bone disease (MBD). The use of mineral supplementation and MBD screening in the neonatal ICU helps prevent, diagnose, and treat this clinical condition. Objectives: To evaluate the occurrence of MBD, as well as the presence of mineral supplementation and MBD screening in premature infants with MBD admitted to the neonatal ICU of a high-risk maternal-child hospital associated with the Brazilian Unified Health System. Methods: This was a cross-sectional study based on secondary data from electronic medical records. We evaluated ELBW premature infants admitted to a neonatal ICU. Infant profile, MBD screening, MBD occurrence, diet, clinical complications, vitamin and mineral supplementation use, age, weight, sex, delivery method, and Apgar score were assessed. Results: We included 112 participants in the study. MBD screening was conducted in 56 patients (50%) with serum levels of alkaline phosphatase, calcium, phosphorus, and magnesium. The rate of MBD occurrence was 8.9% (5 cases). All participants with MBD had respiratory disease, infection, and were receiving parenteral nutrition. Conclusions: The occurrence rate of MBD in ELBW infants admitted to a neonatal ICU was 8,9%, lower than that found in the literature. Factors associated with MBD were the concomitant occurrence of respiratory disease, sepsis, and parenteral nutrition.

Risk factors of metabolic bone disease associated fracture in very low birth weight infants / 中国新生儿科杂志

Objective:To study the risk factors of metabolic bone disease (MBD) associated fracture in very low birth weight premature infants.Methods:From January 2012 to December 2019, premature infants (gestational age <32 weeks, birth weight <1 500 g) were admitted to our hospital and followed-up regularly for 1.5 years (once every month within first 6 months, then once every 3 months). The infants were assigned into two groups according to X-ray diagnosis: the fracture group and the non-fracture group. The clinical data of the two groups were compared and the risk factors of fracture were analyzed.Results:A total of 62 preterm infants with MBD were included in this study, including 11 in the fracture group and 51 in the non-fracture group. The risk factors of MBD associated fracture included intrauterine growth restriction (IUGR), birth weight <1 000 g, gestational age, respiratory support duration and total parenteral nutrition (TPN) duration ( P<0.05). Logistic regression analysis showed that IUGR ( P<0.05, OR=2.159, 95% CI 1.536~2.759) and TPN duration ( P<0.05, OR=1.143, 95% CI 1.042~1.270) were independent risk factors for fracture. Serum alkaline phosphatase (ALP) in the fracture group was significantly higher than the non-fracture group and 25(OH)VitD was significantly lower than the non-fracture group ( P<0.05). Conclusions:IUGR and TPN duration are risk factors for MBD associated fracture in preterm infants. As biochemical markers of bone metabolism, ALP and 25(OH)VitD levels have clinical value predicting MBD associated fracture.

Expert consensus on clinical management of metabolic bone disease of prematurity (2021) / 中国当代儿科杂志

Metabolic bone disease of prematurity (MBDP) is a systemic bone disease with a reduction in bone mineral content due to disorder of calcium and phosphorus metabolism. There is still a lack of in-depth research and systematic understanding of MBDP in China, and there are many irregularities in clinical management of this disease. Based on relevant studies in China and overseas, Grading of Recommendations Assessment, Development and Evaluation was used to develop the expert consensus on the clinical management of MBDP, which provides recommendations from the following five aspects: high-risk factors, screening/diagnosis, prevention, treatment, and post-discharge follow-up of MBDP, so as to provide relevant practitioners with recommendations on the clinical management of MBDP to reduce the incidence rate of MBDP and improve its short- and long-term prognosis.

Rickets in white-eared opossums (Didelphis albiventris) / Raquitismo em gambás-de-orelha-branca (Didelphis albiventris)

Two young opossums were necropsied and diagnosed with rickets. This study aims to describe the clinical-pathological aspects of rickets in Didelphis albiventris. Macroscopically, the opossums presented kyphosis and scoliosis, lateral deviation of the limbs in varus, locomotion difficulty, and enlargement with softening of costochondral junctions (rickety rosary). Samples of bones and joints were processed for hematoxylin and eosin staining and Masson's trichrome. Microscopically, we observed thickening of the epiphyseal plate, characterized by irregular and multifocal proliferation of serialized and hypertrophic cartilage zones, which formed circular groups of large, dysplastic chondrocytes towards the spongy zone, often surrounded by non-mineralized osteoid tissue. In the cortical bone, there were pale eosinophilic zones around the Havers channels consistent with non-mineralized osteoid. The staining of Masson's trichrome evidenced the accumulation of osteoid tissue in cortical and trabecular bones. It is possible that a mixed cause of absorption deficiency of vitamin D3 associated with an unbalanced Ca:P diet based on lactose-free milk and fruits may have triggered the disease.(AU)

Dois gambás jovens foram necropsiados e diagnosticados com raquitismo. O objetivo do trabalho é descrever os aspectos clínico-patológicos de raquitismo em Didelphis albiventris. Macroscopicamente os gambás apresentaram cifose e escoliose, desvio lateral dos membros em varus, dificuldade de locomoção e alargamento com amolecimento das junções costocondrais (rosário raquítico). Amostras dos ossos e articulações foram processadas para coloração de hematoxilina e eosina e Tricrômico de Masson. Microscopicamente havia espessamento da placa epifisária, caracterizada pela proliferação irregular e multifocal das zonas de cartilagem seriada e hipertrófica, que formavam grupos circulares de condrócitos grandes, displásicos em direção a zona esponjosa frequentemente cercados por tecido osteoide não mineralizado. No osso cortical haviam zonas eosinofílicas pálidas ao redor dos canais de Havers consistentes com osteoide não mineralizado. A coloração de Tricrômico de Masson evidenciou o acúmulo de tecido osteoide no nosso cortical e trabecular. Acredita-se que uma causa mista de déficit de absorção de vitamina D3 associada a uma dieta desbalanceada em Ca:P a base de leite sem lactose e frutas tenha desencadeado a doença.(AU)

Extrapulmonary complications of bronchopulmonary dysplasia in premature infants / 中国小儿急救医学

Bronchopulmonary dysplasia(BPD)is a common chronic lung disease that occurs in preterm infants.The infant who with BPD has the feature of small gestational age, low birth weight and immature development of various organ systems.During hospitalization, it is easy to combine with brain injury in premature infant, metabolic bone disease of prematurity, retinopathy of prematurity and cholestasis syndrome, which seriously affect the survival rate and life quality of premature infants.This article reviewed the extrapulmonary complications of BPD in premature infants.

Clinical high-risk factors of metabolic bone disease in very low birth weight infants / 中华临床营养杂志

Objective To explore the high-risk factors of metabolic bone disease (MBD) in premature infants by retrospective analysis of the clinical data so as to provide evidence for optimal clinical management. Methods Clinical data of premature infants with birth weight<1500 g admitted in our hospital from January 2016 to December 2017 were retrospectively analyzed. Infants with serum alkaline phosphatase ( ALP )>500 IU/L and blood phosphorus <1. 5 mmol/L were selected as MBD group and premature infants with birth weight <1500 g were selected randomly as non-MBD group. General data, pulmonary surfactant, continuous positive airway pressure, mechanical ventilation, start time of enteral nutrition, parenteral nutrition ( PN) time, breast feeding time and breast milk fortifier adding, drug usage, hospitalization time and complications were re-corded and compared between the two groups. Results A total of 440 premature infants with birth weight<1500 g were admitted to the hospital during the study period. 58 [ 13. 2％ ( 58/440) ] infants were enrolled in the MBD group, among which infants with birth weight<1000 g accounting for 56. 9％ ( 33/58) . High birth weight (OR=0. 62, 95％ CI:0. 389-0. 990) was an independent protective factor of MBD in premature in-fants. The higher the birth weight, the lower the risk of MBD in premature infants. The longer duration of breast feeding time ( OR= 2. 191, 95％ CI:1. 628-2. 950) , later initial time of enteral feeding ( OR=2. 695, 95％CI:1. 710-4. 248), longer duration of PN (OR=6. 205, 95％ CI:3. 359-11. 463) time, longer duration of respiratory supporting time ( OR=1. 046, 95％ CI:1. 026-. 067) , longer hospital stay time ( OR=1. 703, 95％ CI:1. 109-2. 615) and small for gestational age ( OR=2. 965, 95％ CI:1. 163-5. 658) were inde-pendent risk factors of MBD in premature infants. The duration of PN was the most important independent risk factor of MBD in premature infants (OR=6.205, 95％ CI: 3.359-11.463). Conclusion Multiple factors can lead to MBD of premature infants. The high birth weight is an independent protective factor of MBD and the duration of PN is the most important independent risk factor of MBD in premature infants.

Significance of fibroblast growth factor 23 in metabolic bone disease of prematurity / 实用医学杂志

Objective To investigate the significance of fibroblast growth factor 23 in metabolic bone disease of prematuriy.Methods 60 patients who had been treated in our hospital from March 2016 to March 2017 were included in this study.Blood biochemistry was examined two weeks after birth,and values of blood phosphorus, serum calcium and alkaline phosphatase were recorded. Serum levels of 25 hydroxyvitamin D3,parathyroid hormone and fibroblast growth factor 23 were detected two weeks after birth. 20 premature infants with metabolic bone disease were selected as a study group. 40 infants without metabolic bone disease were treated as a control group. Two weeks after treatment,the above indicators were measured and compared in the study group. Results Serum levels of 25 hydroxyvitamin D3,parathyroid hormone and fibroblast growth factor 23 were compared between the two groups 2 weeks after birth,the difference was statistically significant(P<0.05).Levels of serum parathyroid hormone and fibroblast growth factor 23 in the study group were not statistically significant after treat-ment(P > 0.05). Levels of 25 hydroxy vitamin D3 in the study group had statistically significant after treatment (P<0.05).Conclusions Early detection of fibroblast growth factor 23 can reflect metabolic bone disease in pre-term infants.It suggests that vitamin D should be adequately supplemented in early.

Factores de riesgo y marcadores bioquímicos de la enfermedad metabólica ósea del recién nacido prematuro / Risk factors and biochemical markers in metabolic bone disease of premature newborns

Introducción: La enfermedad metabólica ósea (EMO) del recién nacido prematuro (RNPT) es una complicación de origen multifactorial, que ha ido en aumento, consecuencia de la disminución progresiva de la mortalidad. El objetivo del estudio fue analizar los factores de riesgo (FR) pre y postnatales relacionados con la EMO severa y sus marcadores analíticos. Pacientes y Métodos: Estudio retrospectivo observacional, descriptivo y analítico, que incluyó RNPT nacidos con menos de 32 semanas y/o peso menor de 1.500 g entre enero de 2012 y diciembre de 2014. Se analizó la muestra en función del desarrollo de EMO severa. Resultados: 139 pacientes, con 25(OH)D3 media de 70,68 ± 25,20 nmol/l, mayor en los nacidos en primavera-verano que en otoño-invierno (80,94 ± 25,33 vs 61,13±21,07; p = 0,000). Los pacientes con EMO severa presentaron valores de 25(OH)D3 similares al resto de pacientes (65,61 ± 26,49 vs 72,07 ± 24,89; p = 0,283), y superiores de fosfatasa alcalina (FA) (1314,19 ± 506,67 vs 476,56 ± 188,85; p = 0,000). Mediante curva ROC se calculó un punto de corte de FA de 796,5 IU/l (S 95,2%, E 92,4%). Los FR más asociados al desarrollo de EMO severa fueron el crecimiento intrauterino restringido, el peso al nacimiento y la duración de ventiloterapia y nutrición parenteral. Conclusiones: Las cifras de FA son las que mejor se relacionan con el desarrollo de EMO severa. El riesgo de ésta aumenta a mayor número de factores de riesgo y menores cifras de vitamina D3. Niveles de 25(OH)D3 por encima de 70 nmol/l parecen proteger del desarrollo de EMO, incluso en pacientes con múltiples factores de riesgo.

Background: Metabolic bone disease (MBD) of prematurity is a complication of multifactorial aetiology, which has been increasing, due to progressive decrease in mortality of preterm newborns. The aim of the study was to analyze risk factors of severe MBD and its analytical markers. Patients and Method: Retrospective study involving preterm infants less than 32 weeks gestational age and/or weight less tan 1,500 g born between january 2012 and december 2014. Comparison was made according to the presence of severe MBD. Results: 139 patients were recruited. Mean value of 25(OH)D3 was 70.68 ± 25.20 nmol/L, being higher in patients born in spring-summer than in autumn-winter (80.94 ± 25.33 vs 61.13 ± 21.07; p = 0.000). Levels of 25(OH)D3 were similar in patients with severe MBD compared with the rest of patients (65.61 ± 26.49 vs 72.07 ± 24.89, P = 0.283). Higher levels of alkaline phosphatase (AP, IU/L ) (1314.19 ± 506.67 vs 476.56 ± 188.85; p = 0.000) were found in these patients. Cutoff point of AP 796.5 IU/L (S 95.2%, specificity 92.4%) was calculated by ROC curve. The risk factors most associated to severe EMO were restricted fetal growth, birth weight, duration of ventilation therapy and parenteral nutrition. Conclusions: AP levels were the best marker of severe MBD development. EMO risk increases with the number of risk factors and lower levels of 25(OH)D3. Levels of 25(OH)D3 higher than 70nmol/L appear to protect from the development of severe MBD, even in patients with multiple risk factors.

Clinical analysis of the early extrapulmonary complications in preterm infants with bronchopulmonary dysplasia / 中国小儿急救医学

Objective To clinically analyze the incidence of early extrapulmonary complications in premature infants with bronchopulmonary dysplasia(BPD),including periventricular intraventricular hemorrhage(PVH-IVH),white matter injury(WMI),parenteral nutrition associated cholestasis(PNAC) and metabolic bone disease(MBD),in order to direct the prevention and monitoring of these complications in BPD patients.Methods The clinical data of premature infants who were admitted to the neonatal department between September 2014 and December 2015 was retrospectively analyzed.A total of 87 premature infants diagnosed with BPD were studied as BPD group,while other 90 premature infants without BPD who were hospitalized at the same time were randomly selected as non BPD group.The occurrence of several common extrapulmonary complications was compared between two groups,including PVH-IVH,WMI,PNAC and MBD.Results The incidence of PVH-IVH in BPD group increased compared with non BPD group[(26.4%(23/87) vs 11.1%(10/90)] (P＜0.01),grade Ⅰ-Ⅱ PVH-IVH was more often seen in the BPD group too[24.1%(21/87) vs.11.1%(10/90)](P＜0.05),although the difference between two groups regarding the incidence of grade Ⅲ-Ⅳ PVH-IVH was not significant (P＞0.05).The incidence of WMI in BPD group was much higher than that in non BPD group[33.3%(29/87) vs 16.7%(15/90)] (P＜0.05),especially periventricular leukomalacia,the severe type of WMI,was more often found in BPD group than that in non BPD group[13.7%(12/87) vs 2.2%(2/90)](P＜0.05).The incidences of PNAC[22.9%(20/87) vs 5.5%(5/90)],MBD[17.2%(15/87) vs 3.3%(3/90)] and MBD with imaging changes[6.9%(6/87) vs 0] were all higher in BPD group compared with non BPD group,with significant differences between the two groups (P＜0.05).Conclusion BPD patients are more likely to have early extrapulmonary complications like PVH-IVH,WMI,PNAC and MBD than other preterm infants.It is crucial to prevent these complications reasonably and monitor them regularly for the BPD patients in order to improve the quality of life.

The Effect of Bariatric Surgery on Bone Health.

The prevalence of obesity, with its associated co-morbidities, is on the rise, and bariatric surgery is proving to be an effective means of allowing sustained weight loss as compared to alternative strategies. Follow up data is starting to accumulate showing evidence of the impact on bone metabolism, with associated clinical implications, including pathological fracture at a relatively young age. Furthermore this effect is seen to be different with regards to what type of procedure is performed. This review provides a summary on this topic, including an overview of the background science of bone metabolism and relates this to the nutritional sequelae of bariatric surgery. Follow up data on each procedure is reviewed, and recommended management and monitoring strategies discussed.

Prevention and treatment of nephrotic syndrome associated bone metabolic abnormality in children / 中华实用儿科临床杂志

Metabolic bone disease in nephrotic syndrome(NS) are increasingly being renal physician's attention.As calcium binding protein and VitD binding protein losing with a large number of protenuria, the bone metabolic biochemical abnormalities had happened at the beginning of the onset of the nephrotic syndrome, and is further exacerbated by therapeutic high-dose or long course of glucocorticoids (GC) application.The main mechanism of the glucocorticoid-induced osteoporosis (GIOP) is for GC to inhibit the activity of osteoblasts and promote apoptosis of osteoblasts and formation of osteoclasts, resulting in secondary hyperparathyroidism,leading to increasing the risk of osteoporosis,slow growth and fracture,seriously harm to children's physical and mental health.The biomarkers of bone transform can prompt the NS with bone metabolic abnormalities early;vertebral body bone dual-energy X-ray absorptiometry bone mineral density detection is the best method and position to determine GIOP.As the most commonly used and effective means to prevent and control metabolic bone disease, calcium supplements and VitD were always taken when GC was treated for NS, even the dosage of GC was very low.So far, it is still lack of guideline of prevention and treatment of bone metabolic abnormalities in NS in children.

Hiperparatiroidismo primario con tumor pardo mimetizando enfermedad ósea maligna

Objetivo: Los tumores pardos son una manifestación infrecuente del hiperparatiroidismo primario (HPTP). Se presenta la evaluación diagnóstica en una paciente con lesión ósea e imágenes osteolíticas extensas que confunden y orientan a tumor óseo metastásico. Caso clínico: Paciente femenina de 49 años de edad, con dolor lumbosacro irradiado a cresta ilíaca izquierda y limitación para la marcha de dos años de evolución, con episodios de pancreatitis aguda e hipertrigliceridemia; en el último episodio se le realiza TAC abdómino-pélvica, con hallazgo incidental de lesión sacro ilíaca izquierda, que sugiere tumor óseo; se realizan estudios de extensión en pesquisa de metástasis. La biopsia ósea muestra células gigantes con proliferación fibroblástica y formación de hueso reactivo, sugestivo de tumor de células gigantes, el USG tiroideo muestra imagen hipoecoica, hipervascularizada, USG renal con nefrolitiasis renal. Laboratorio: PTH 1250 pg/mL y otra en 986,7 pg/mL. Calcio 9,8 mg/mL, Fosfatasa alcalina 570 U/L, Marcadores tumorales negativos. La Rx de cráneo muestra imágenes líticas en región frontal en “sal y pimienta”. DXA: osteoporosis cortical, T-score antebrazo izquierdo -3,1. TAC de cadera: lesión osteolítica expansiva con irrupción de la cortical, de 7 x 3.5 cm en cresta ilíaca izquierda y múltiples imágenes osteolíticas sacroilíacas y vertebrales (L4-L5). El CT-PET con áreas múltiples de hipercaptación que sugieren infiltración ósea por enfermedad metastásica, sin captación en cuello. Se realiza Gammagrama 99mTc-MIBI que revela imagen sugestiva de adenoma de paratiroides en el lóbulo izquierdo. Se realiza extirpación del mismo. Conclusiones: Las lesiones óseas múltiples son enfocadas en el contexto metastásico y pueden confundir el diagnóstico de HPTP. Los tumores pardos son causa potencial de falsos positivos con CT/PET en la evaluación de pacientes con tumor primario desconocido o metástasis esqueléticas. Análisis básicos de metabolismo cálcico y gammagrama paratiroideo con 99mTc-MIBI, son herramientas diagnósticas en estos pacientes.

Objective: Brown tumors are an uncommon manifestation of Primary Hyperparathyroisim (PHPT). We provide diagnostic evaluation in a patient with bone lesion and extensive osteolytic images that suggesting metastatic bone tumor. Case report: Female patient 49 years old with lumbosacral pain radiating to the left iliac crest and walking limitation of two years of evolution with episodes of acute pancreatitis and hypertriglyceridemia; in the last episode, abdominal and pelvic CT images were performed, with incidental finding of left sacroiliac bone lesion, that suggests a bone tumor. Extension studies on screening for metastases were performed. Bone biopsy showed giant cells with fibroblastic proliferation and reactive bone formation, suggestive of giant cell tumors; thyroid USG showed hypoechoic image, hypervascularized; renal USG showed nephrolithiasis. Laboratory: PTH 1250 pg/mL and another at 986.7 pg/mL, calcium 9.8 mg/mL, alkaline phosphatase 570 U/L and tumor markers negatives. X ray of skull showed multiple lytic lesions in the frontal region, like “salt and pepper”. DXA: cortical osteoporosis, with a left forearm T-score of -3.1. Computed tomographic of pelvis showed expansive osteolytic lesion with cortical irruption of 7 cm x 3.5 cm in the left iliac crest and multiple osteolytic vertebral and sacroiliac images (L4-L5). The CT-PET showed multiple areas of increased uptake suggesting infiltration by metastatic bone disease, no neck pickup. A 99mTc-MIBI scintigraphy revealed an image suggestive of parathyroid adenoma in the left lobe, which is excised. Conclusion: Multiple bone lesions are focused as metastasis and may confuse the diagnosis of PHPT. Brown tumors are potential causes of false positives with CT / PET in the evaluation of patients with unknown primary tumor or skeletal metastases. Basic analysis of calcium metabolism and parathyroid scintigraphy 99mTc.MIBI are diagnostic tools in these patients.

Metabolic bone disease in the preterm newborn:an update on prevention and treatment / 国际儿科学杂志

Metabolic bone disease is one of the common complications in preterm neonates,which has important influence on the quality of life,even increases the risk of adulthood osteoporosis. Early diagnosis and therapy are important for the improvement of outcome of preterm neonates. This article reviews the progress of prevention and treatment of metabolic bone disease in preterm neonates.

Enfermedad metabólica ósea del prematuro: informe de un caso y revisión de la literatura / Metabolic bone disease of prematurity: Case report and review

Se comunica el caso de una paciente con enfermedad metabólica ósea del prematuro, que nació luego de 26 semanas de gestación y de 62 días de vida extrauterina, que estuvo internada desde su nacimiento en un hospital de 3er nivel en la ciudad de Oruro, donde estuvo conectada a presión positiva nasal (CPAP) por varios días, además de recibir tratamiento antibiótico con varios esquemas de amplio espectro por haber cursado con sepsis neonatal y enterocolitis necrosante (ECN) grado II; además recibió metilxantinas por presentar periodos de apnea y hasta su ingreso a nuestro hospital permanecía dependiente de oxígeno, con muy poca ganancia de peso e hipoactividad. Fue transferida para valoración oftalmológica por sospecha de retinopatía del prematuro. A su ingreso se hizo un examen clínico minucioso y se realizaron varios exámenes de laboratorio y gabinete con los cuales se demostró una osteopenia del prematuro, que respondió en forma favorable al tratamiento.

We describe a 26 weeks old premature baby with metabolic bone disease. She was transferred to our hospital at 62 days of age for ophthalmologic evaluation. She was treated in the primary hospital with CPAP, different antibiotics for sepsis and NEC. She also received methylxanthines for neonatal apnea. When she arrived to our hospital she was oxygen dependent and with little weight increase. During her stay at our neonatal unit we performed a complete physical exam and several diagnostic tests, showing metabolic bone disease which favorable response to specific treatment.

Efeito do treinamento resistido na densidade mineral óssea e no conteúdo de GLUT4 em ratos diabéticos (tipo 2) osteopênicos / Effect of resistance training on bone mineral density and GLUT4 content in osteopenic rats with type 2 diabetes

O diabetes melittus (DM) é considerado um importante problema na saúde pública em vários países do mundo, pois além de estar em ascendente prevalência, compromete tanto a produtividade quanto a qualidade de vida e sobrevida dos seus portadores. Sua principal característica é a presença de hiperglicemia crônica decorrente de defeitos na secreção e/ou ação da insulina. A literatura tem mostrado uma associação de DM com redução da massa óssea. Contudo, os mecanismos de mudanças da densidade mineral óssea (DMO) nesses pacientes diabéticos ainda não estão claros. Portanto, o objetivo deste estudo foi investigar o efeito do treinamento resistido (TR) sobre a DMO, as propriedades biomecânicas do osso, glicemia, calcemia, fosfatemia, a sensibilidade à insulina e a expressão de GLUT4 em ratos osteopênicos com diabetes tipo 2 (DM2). Para tanto, foram utilizados 64 ratos machos (5 dias de idade) divididos em dois grandes grupos: grupo controle (CN), que recebeu injeção de veículo (tampão citrato 10 mmol/L, pH 4.5 i.p.) e grupo diabético (DM), que recebeu injeção de estreptozotocina (150 mg/kg i.p.). Após 55 dias, foi mensurada a glicose de cada animal utilizando o monitor (Accu-Chek Advantage, Roche Diagnostics, Indianapolis, IN) para verificar se os animais do grupo DM estavam diabéticos. Apenas os ratos do grupo DM com glicose acima de 200mg/dl foram utilizados no experimento. Logo em seguida, todos os animais foram anestesiados com cloridrato de quetamina (80 mg/kg de peso corporal, i.m) e xilazina (10 mg/kg de peso corporal, i.m) para realizar a primeira análise densitométrica (AD) (pré-suspensão) da tíbia direita por emissões de absorciometria de raios-X (DXA), do aparelho DPX (Lunar DPX Alpha, WI, USA). Em seguida, esses grupos foram subdivididos em quatro grupos: CN, controle osteopênicos (CO), DM e diabéticos osteopênicos (DO). Os animais dos grupos CO e DO foram suspensos pela cauda por um período de 21 dias para promover osteopenia nos membros traseiros...

Diabetes mellitus (DM) is considered an important public health problem in many countries of the world, because, besides being in ascending prevalence, it commits the productivity, the quality of life and survival of their bearers. Its main characteristic is the presence of chronic hyperglycemia due to defects in secretion and/or insulin action. The literature has shown an association between DM and reduced bone mass. However, the mechanisms of change in bone mineral density (BMD) in these diabetic patients are still unclear. Therefore, the aim of this study was to investigate the effect of resistance training (RT) on BMD, bone biomechanical properties, glycemia, calcemia and phosphatemia, insulin sensitivity and GLUT4 expression in osteopenic rats with type 2 diabetes (DM2). Thus, we used 64 male rats (5 days old) divided into two groups: control (CN), which received an injection of vehicle (citrate buffer 10 mmol/L, pH 4.5 i.p.) and diabetic (DM), which received an injection of streptozotocin (150 mg/kg i.p). After 55 days, glucose was measured in each animal using the monitor (Accu-Chek Advantage, Roche Diagnostics, Indianapolis, IN) to verify if animals of DM group were diabetic. Only diabetic group rats with glucose above 200mg/dl were used in the experiment. After that all animals were anesthetized with ketamine (80 mg/kg body weight, i.m) and xylazine (10 mg/kg bodyweight i.m) so that the first densitometric analysis (DA) (pre-suspension) of the right tibia by dual X-ray absorptiometry emissions (DXA), from apparatus DPX (Lunar DPX Alpha, WI, USA) was performed. Then, these groups were subdivided into four groups: CN, osteopenic control (OC), DM and osteopenic diabetic (OD). Animals in groups OC and OD were suspended by their tails for a period of 21 days to promote osteopenia in hindlimb. Thereafter, the second DA (post-suspension) was performed. After this analysis, these osteopenic groups were removed from suspension and stayed with free movement...

Determination of normative bone mineral density values in Filipino women

OBJECTIVE: To obtain reference values of bone mineral density (BMD) for Filipino women in order to make a population-specific diagnosis of osteoporosis.SETTING: Osteoporosis Unit, Joint and Bone Center, Section of Rheumatology and Clinical Immunology, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines. PARTICIPANTS: 442 healthy Filipino women volunteers recruited from the outpatient department, Rheumatology and Clinical Immunology Clinic of the University of Santo Tomas Hospital and from within the University of Santo Tomas campus. Subjects with known underlying illness or conditions or intake of drugs that predispose to osteoporosis were excluded from the study. INTERVENTION: Bone mineral density (BMD) measurements, expressed in grams per square centimenter of the lumbar spine, non-dominant femur and non-dominant forearm were done in 442 consecutive healthy Filipino women using the LUNAR DPX-IQ machine. RESULTS: Means and standard deviations of BMD measurements at each site were calculated using Kwikstat software Version 3.6, Release 7. Results were grouped in decades to serve as reference per decade. CONCLUSION: BMD of these 442 healthy Filipino women may serve as an initial reference guide for the diagnosis of osteoporosis in Filipino women.

Supplementation of calcium and phosphorus in parenteral nutrition for extremely low-birth-weight infants / 中华临床营养杂志

Objective To investigate the usefulness of calcium and phosphorus supplementation in parenteral nutrition for extremely low-birth-weight (ELBW) infants.Methods According to the inclusion criteria,66 ELBW infants hospitalized after birth in neonatal ward of Tongji Hospital from June 2009 to December 2012 were divided into three groups with random number table:28 infants in the first group were treated with parenteral nutrition without calcium and phosphorus supplementation,21 infants in the second group were treated with parenteral nutrition with calcium supplementation only,and 17 infants in the third group was treated with parenteral nutrition with calcium and phosphorus supplementation.The blood levels of ionic calcium,blood phosphorus,and urine calcium and creatinine were determined once a week (total of 4 times).The speed of sound (SOS) was detected for shin bones by quantitative ultrasound at the date of admitting and the end of 4weeks.Results After administrations of supplementation,the blood levels of ionic calcium in the second group were significantly higher than those in the first group [on the 14th day,(1.82 ± 0.35) mmol/L vs.(1.14 ±0.47) mmol/L,t=5.800,P=0.005;onthe21stday,(1.77±0.45) mmol/Lvs.(1.07±0.43) mmol/L,t=5.492,P=0.004; on the 28th day,(1.61±0.58) mmol/Lvs.(0.92±0.44) mmol/L,t=4.556,P=0.025].The blood levels of ionic calcium in the third group were also significantly higher than those in the first group [on the 14th day,(1.55 ± 0.30) mmol/L vs.(1.14 ± 0.47) mmol/L,t =3.570,P =0.001 ; on the 21st day,(1.58 ±0.38) mmol/L vs.(1.07 ±0.43) mmol/L,t =4.151,P=0.000; on the 28th day,(1.55 ±0.35) mmol/L vs.(0.92 ±0.44) mmol/L,t =5.302,P =0.003].The blood levels of phosphorus were significantly elevated in the third group compared with those in the first group [on the 14th day,(1.86 ±0.10) mmol/L vs.(1.65 ±0.17) mmol/L,t=5.217,P=0.012; on the21st day,(1.88 ±0.14) mmol/Lvs.(1.61 ±0.13) mmol/L,t =6.442,P=0.003; on the 28th day,(1.89 ±0.15) mmol/L vs.(1.58 ±0.14) mmol/L,t =6.891,P =0.000] and the second group [on the 14th day,(1.86 ± 0.10) mmol/L vs.(1.53 ±0.15) mmol/L,t =8.100,P=0.000; on 21st day,(1.88 ±0.14) mmo/Lvs.(1.57 ±0.14) mmol/L,t =6.787,P =0.000; on the 28th day,(1.89 ± 0.15) mmol/L vs.(1.62 ± 0.18) mmol/L,t =5.043,P =0.000].The calcium-to-phosphorus ratios markedly increased in the second group compared with those in the first group (on the 14th day,0.69 ±0.18 vs.0.33 ±0.14,t =7.601,P =0.000; on the 21st day,0.66±0.16 vs.0.37 ±0.14,t =6.62,P=0.001 ; on the 28th day,0.62 ±0.15 vs.0.39 ±0.12,t =5.776,P =0.005) while declined in the third group (on the 14th day,0.14 ± 0.10 vs.0.33 ± 0.14,t =5.294,P =0.010; on the 21st day,0.13 ± 0.12 vs.0.37 ± 0.14,t =6.102,P =0.002; on the 28th day,0.12 ± 0.11 vs.0.39 ± 0.12,t =7.711,P =0.000).The third group showed significantly increased SOS values than those in the first and second groups [(381 ± 87) m/s vs.(135 ± 87) m/s,t =9.815,P =0.000;(381 ±87) m/s vs.(146 ±68) m/s,t =9.774,P=0.000].Conclusions Proper supplementation of calcium and phosphorus via parenteral nutrition can achieve increased bone mineral contents and stable blood ionic calcium and phosphorus levels,and avoid hypercalciuria in ELBW infants.PN therapy with calcium and phosphorus supplementation in ELBW infants needs further studies.

Long-term anti-epileptic drug therapy and metabolic bone disase in children / 国际儿科学杂志

Epilepsy is a common chronic brain dysfunction in children.Studies have showed that antiepileptic drugs (AED) affect the hydroxylation of vitamin D in liver and kidney and inhibit the calcification of bone,mainly by up-regulating cytochrome oxidase P450 and promoting the resolution of vitamin D,and then increasing serum parathyroid hormone compensatory.Long-term use can cause children metabolic bone disease occurrence,clinical manifestations include bone pain,short stature,rickets,teeth agenesis,fracture,etc.AED firstly affect the hormones related to bone metabolism in vivo,so that the present researches focus on biochemical tests and measurement of sclerotin and bone density.In the children's long-term use of antiepileptic drug treatment at the same time,the application of Vitamin D,calcium and exercise can prevent the occurrence of metabolic bone disease.

Enfermedades metabólicas óseas: análisis clínico y radiológico en cinco casos / Metabolic bone diseases: clinical and radiologic analysis in five cases

El estudio de la enfermedad metabólica ósea es amplio y complejo. La enfermedad ósea más reconocida por médicos de todas las especialidades es la osteoporosis, probablemente debido a su elevada frecuencia. No obstante, es importante reconocer que existen numerosas entidades que afectan el metabolismo óseo de diferentes formas, llevando a fragilidad ósea, aumento del riesgo de fractura, osteoporosis u osteocondensación, de acuerdo a cada caso particular. Tanto el diagnóstico clínico como el reconocimiento de la alteración metabólica subyacente son importantes porque la identificación de la anormalidad específica se constituye en la base para el tratamiento. Se presentan 5 casos diferentes en los que un trastorno metabólico conlleva a una patología ósea específica; se discute la patogenia de las calcificaciones arteriales y se presenta una entidad mixta que nosotros llamamos osteoporomalacia.

The study of metabolic bone disease is broad and complex. The most widely recognized bone disease by physicians of all specialties is osteoporosis, probably due to its high frequency. However, it is important to recognize that there are numerous entities that affect bone metabolism in different ways, leading to brittle bones, increased risk of fracture, osteoporosis or osteocondensation, according to each particular case. Both the clinical diagnosis and recognition of the underlying metabolic abnormality are important because they identify the specific abnormality that will be the base for treatment. There were 5 different cases in which a metabolic disorder leads to specific bone pathology, we discuss the pathogenesis of arterial calcifications and presents a mixed entity we call osteoporomalacia.