Behavioural and objective vestibular assessment in persons with osteoporosis and osteopenia: a preliminary investigation / Behavioural and objective vestibular assessment in persons with osteoporosis and osteopenia: a preliminary investigation

Abstract Introduction: Calcium is vital for the functioning of the inner ear hair cells as well as for the neurotransmitter release that triggers the generation of a nerve impulse. A reduction in calcium level could therefore impair the peripheric vestibular functioning. However, the outcome of balance assessment has rarely been explored in cases with osteopenia and osteoporosis, the medical conditions associated with reduction in calcium levels. Objective: The present study aimed to investigate the impact of osteopenia and osteoporosis on the outcomes of behavioural and objective vestibular assessment tests. Methods: The study included 12 individuals each in the healthy control group and osteopenia group, and 11 individuals were included in the osteoporosis group. The groups were divided based on the findings of bone mineral density. All the participants underwent behavioural tests (Fukuda stepping, tandem gait and subjective visual vertical) and objective assessment using cervical and ocular vestibular evoked myogenic potentials. Results: A significantly higher proportion of the individuals in the two clinical groups' demonstrated abnormal results on the behavioural balance assessment tests (p < 0.05) than the control group. However, there was no significant difference in latencies or amplitude of cervical vestibular evoked myogenic potential and oVEMP between the groups. The proportion of individuals with absence of ocular vestibular evoked myogenic potential was significantly higher in the osteoporosis group than the other two groups (p < 0.05). Conclusion: The findings of the present study confirm the presence of balance-related deficits in individuals with osteopenia and osteoporosis. Hence the clinical evaluations should include balance assessment as a mandatory aspect of the overall audiological assessment of individuals with osteopenia and osteoporosis.

Resumo: Introdução: O cálcio é vital para o funcionamento das células ciliadas, assim como para a liberação dos neurotransmissores que desencadeiam um impulso nervoso. Uma redução nos níveis de cálcio poderia, portanto, prejudicar o funcionamento vestibular periférico. No entanto, a avaliação do equilíbrio tem sido raramente explorada em casos de osteopenia e osteoporose, condições médicas associadas à redução dos níveis de cálcio. Objetivo: O presente estudo teve como objetivo investigar o impacto da osteopenia e da osteoporose nos resultados dos testes de avaliação comportamental e vestibular objetiva. Método: O estudo incluiu 12 indivíduos nos grupos controle e grupo de osteopenia e 11 indivíduos no grupo da osteoporose. Os grupos foram divididos com base nos achados da densidade mineral óssea. Todos os participantes foram submetidos a testes comportamentais (Prova dos Passos de Fukuda, Marcha em tandem e Vertical Visual Subjetiva) e à avaliação objetiva com o uso de potenciais evocados miogênicos vestibulares cervical e ocular (cVEMP e oVEMP). Resultados: Uma proporção significativamente maior de indivíduos nos dois grupos com condições clínicas mostrou resultados anormais nos testes de avaliação comportamental e do equilíbrio (p < 0,05) do que o grupo controle. Embora não tenha havido diferença significativa nas latências ou na amplitude de cVEMP e oVEMP entre os grupos, a proporção de indivíduos com ausência de oVEMP foi significativamente maior no grupo da osteoporose do que nos outros dois grupos (p < 0,05). Conclusão: Os resultados do presente estudo demonstram a presença de déficits de equilíbrio em indivíduos com osteopenia e osteoporose. Assim, as avaliações clínicas gerais e audiológicas de indivíduos com osteopenia e osteoporose deveriam incluir a avaliação do equilíbrio como um aspecto obrigatório.

Osteoporosis: parte II: en enfermedades hepáticas y del tubo digestivo / Osteoporosis: part II: in liver and digestive tract diseases

The present review addresses liver and gastrointestinal diseases that are more frequently associated to osteopenia and osteoporosis. For each disease, we describe the prevalence and physiopathology of these bone metabolism conditions. The purpose is to create awareness of this scenario and prompt early analysis if these patients, and in other cases, to provide prophylaxis and treatment of these disorders.

En esta revisión se abordan las enfermedades hepáticas y del tubo digestivo que con mayor frecuencia se asocian a osteopenia y osteoporosis. En cada patología describimos la prevalencia y fisiopatología de estas afecciones del metabolismo óseo. El objetivo es dar a conocer esta realidad e inducir a que estos pacientes sean estudiados precozmente, en otros casos aplicar la profilaxis y tratar estos desórdenes.

Low-level laser therapy associated to a resistance training protocol on bone tissue in diabetic rats

ABSTRACT Objective The present study aimed to evaluate the in vivo response of a resistance training and low-level laser therapy (LLLT) on tibias and femurs of rats with diabetes mellitus (DM). Materials and methods Forty male Wistar rats were randomly distributed into four experimental groups: control group (CG), diabetic group (DG), diabetic trained group (TG) and diabetic trained and laser irradiated group (TLG). DM was induced by streptozotocin (STZ) and after two weeks laser and resistance training started, performed for 24 sessions, during eight weeks. At the end of the experiment, animals were euthanized and tibias and femurs were removed for analysis. Histological, histomorphometrical, immunohistochemistry and mechanical analyses were performed. Results Trained groups, with or without laser irradiation, showed increased cortical area, bone density and biomechanical properties. The immunohistochemical analysis revealed that TG and TLG demonstrated an increased RUNX2 expression. RANK-L immunoexpression was similar for all experimental groups. Conclusion In conclusion, it can be suggested that the resistance exercise program stimulated bone metabolism, culminating in increased cortical tibial area, bone mineral content, bone mineral density and biomechanical properties. Furthermore, the association of physical exercises and LLLT produced higher values for bone mineral content and stiffness. Consequently, these data highlight the potential of physical exercise in the management of bone loss due to DM and the possible extra osteogenic stimulus offered by lasertherapy. Further long-term studies should be carried out to provide additional information.

Analysis of fracture healing in osteopenic bone caused by disuse: experimental study

Osteoporosis has become a serious global public health issue. Hence, osteoporotic fracture healing has been investigated in several previous studies because there is still controversy over the effect osteoporosis has on the healing process. The current study aimed to analyze two different periods of bone healing in normal and osteopenic rats. Sixty, 7-week-old female Wistar rats were randomly divided into four groups: unrestricted and immobilized for 2 weeks after osteotomy (OU2), suspended and immobilized for 2 weeks after osteotomy (OS2), unrestricted and immobilized for 6 weeks after osteotomy (OU6), and suspended and immobilized for 6 weeks after osteotomy (OS6). Osteotomy was performed in the middle third of the right tibia 21 days after tail suspension, when the osteopenic condition was already set. The fractured limb was then immobilized by orthosis. Tibias were collected 2 and 6 weeks after osteotomy, and were analyzed by bone densitometry, mechanical testing, and histomorphometry. Bone mineral density values from bony calluses were significantly lower in the 2-week post-osteotomy groups compared with the 6-week post-osteotomy groups (multivariate general linear model analysis, P<0.000). Similarly, the mechanical properties showed that animals had stronger bones 6 weeks after osteotomy compared with 2 weeks after osteotomy (multivariate general linear model analysis, P<0.000). Histomorphometry indicated gradual bone healing. Results showed that osteopenia did not influence the bone healing process, and that time was an independent determinant factor regardless of whether the fracture was osteopenic. This suggests that the body is able to compensate for the negative effects of suspension.

Psoriasis: new comorbidities

Abstract Psoriasis is a chronic inflammatory disease associated with several comorbidities. A few decades ago, it was considered an exclusive skin disease but today it is considered a multisystem disease. It is believed that 73% of psoriasis patients have at least one comorbidity. Studies have demonstrated the association of psoriasis with inflammatory bowel disease, uveitis, psychiatric disorders, metabolic syndrome and its components and cardiovascular diseases. The systemic inflammatory state seems to be the common denominator for all these comorbidities. This work aims at presenting a review of the current literature on some new comorbidities that are associated with psoriasis as osteoporosis, obstructive sleep apnea and chronic obstructive pulmonary disease. While there is still controversy, many studies already point to a possible bone involvement in patients with psoriasis, especially in the male group, generally less affected by osteoporosis. Psoriasis and chronic obstructive pulmonary disease present some risk factors in common as obesity, smoking and physical inactivity. Besides, both diseases are associated with the metabolic syndrome. These factors could be potential confounders in the association of the two diseases. Further prospective studies with control of those potential confounders should be developed in an attempt to establish causality. Existing data in the literature suggest that there is an association between obstructive sleep apnea and psoriasis, but studies performed until now have involved few patients and had a short follow-up period. It is, therefore, premature to assert that there is indeed a correlation between these two diseases.

Low bone mass density is associated with hemolysis in brazilian patients with sickle cell disease

OBJECTIVES: To determine whether kidney disease and hemolysis are associated with bone mass density in a population of adult Brazilian patients with sickle cell disease. INTRODUCTION: Bone involvement is a frequent clinical manifestation of sickle cell disease, and it has multiple causes; however, there are few consistent clinical associations between bone involvement and sickle cell disease. METHODS: Patients over 20 years of age with sickle cell disease who were regularly followed at the Hematology and Hemotherapy Center of Campinas, Brazil, were sorted into three groups, including those with normal bone mass density, those with osteopenia, and those with osteoporosis, according to the World Health Organization criteria. The clinical data of the patients were compared using statistical analyses. RESULTS: In total, 65 patients were included in this study: 12 (18.5 percent) with normal bone mass density, 37 (57 percent) with osteopenia and 16 (24.5 percent) with osteoporosis. Overall, 53 patients (81.5 percent) had bone mass densities below normal standards. Osteopenia and osteoporosis patients had increased lactate dehydrogenase levels and reticulocyte counts compared to patients with normal bone mass density (p<0.05). Osteoporosis patients also had decreased hemoglobin levels (p<0.05). Hemolysis was significantly increased in patients with osteoporosis compared with patients with osteopenia, as indicated by increased lactate dehydrogenase levels and reticulocyte counts as well as decreased hemoglobin levels. Osteoporosis patients were older, with lower glomerular filtration rates than patients with osteopenia. There was no significant difference between the groups with regard to gender, body mass index, serum creatinine levels, estimated creatinine clearance, or microalbuminuria. CONCLUSION: A high prevalence of reduced bone mass density that was associated with hemolysis was found in this population, as indicated by the high lactate dehydrogenase levels, increased reticulocyte counts and low hemoglobin levels.

Titanium implants: A removal torque study in osteopenic rabbits.

Context: Osteoporosis is a skeletal disorder characterized by low bone mass and microarchitectural deterioration of bone tissue. It may affect the craniomaxillofacial complex and result in less bone-implant contact. Aims: The objective of this study was to measure the endosseous integration of titanium implants using the removal torque test in low-mineral density experimental animal models. Materials and Methods: Thirty female New Zealand white rabbits were divided into two groups: control (n=14), sham-operated; and test (n=16), ovariectomized. All animals received 2.2 mm Χ 4.0 mm titanium implants in the right tibia, 120 days after ovariectomy or sham surgery. Animals were killed at 7 and 14 weeks of postimplant insertion, when implants were removed by reverse torque rotation using a digital torque meter. Statistical analysis used was Student's t-test. Results and Conclusion: At the 7-week period, the mean torque values for the control and test groups were 11.6 Ncm and 10.4 Ncm, respectively, with no statistical significance. Implant removal torque analysis showed statistically lower values (P<0.05) for the test group at the 14-week period (control=16.7 Ncm and test=9.7 Ncm). The results of this study indicate that hormonal privacy compromise implants biomechanical performance.

25 (OH) vitamin D level in Crohn’s disease: association with sun exposure & disease activity.

Background & objectives: Western studies show that up to 65 per cent of patients with Crohn’s disease have low serum 25-hydroxy vitamin D concentrations, and 45 per cent of these patients have metabolic bone disease. No data are available from India or from any country with comparable climatic conditions or ethnicity. We carried out this study to measure the serum 25 (OH) vitamin D levels of Crohn’s disease patients and compare with matched controls and to assess the consequences of low 25 (OH) vitamin D levels on bone and mineral metabolism in these patients. Methods: Adult patients with Crohn’s disease were compared with age and sex matched patients diagnosed to have irritable bowel syndrome. Serum 25 (OH) vitamin D, the effect of disease characteristics, sunlight exposure and milk consumption on 25 (OH) vitamin D level, and the consequences of low 25 (OH) vitamin D level on bone and mineral metabolism were assessed. Results: Thirty four patients with Crohn’s disease (M:F, 24:10, age 39.2 ± 12.9 yr) and 34 controls (M:F, 24:10, age 38.9 ± 13.4 yr) were studied. 25 (OH) vitamin D levels were significantly lower in patients with Crohn’s disease as compared to controls (Crohn’s disease vs controls: 16.3 ± 10.8 vs 22.8 ± 11.9 ng/ml; P<0.05). The severity of disease activity as assessed by the Harvey Bradshaw score correlated negatively (Correlation coefficient -0.484, significance P<0.004), and the duration of sunlight exposure correlated positively (Correlation coefficient 0.327, significance P=0.007) with the serum 25 (OH) vitamin D level. Interpretation & conclusions: Serum 25 (OH) vitamin D levels were significantly lower among patients with Crohn’s disease as compared to age and sex matched controls. Further, 25 (OH) vitamin D levels in patients with Crohn’s disease were lower in those with severe disease activity and less sun exposure. Further studies need to be done to correlate low 25 (OH) vitamin D level with bone density and assess the effect of vitamin D supplementation in these patients.

Reabsorção no metabolismo ósseo de pacientes HIV-positivos / Reabsorption in bone metabolism of HIV-positive patients

INTRODUÇÃO: Pacientes infectados pelo HIV apresentam osteoporose ou osteopenia densitométrica numa taxa de 28 a 50 por cento. O objetivo deste estudo é verificar alterações na taxa de reabsorção/formação destes pacientes. MATERIAL E MÉTODOS: Realizou-se revisão sistemática com metanálise de estudos controlados que avaliaram a associação entre osteopenia e/ou alterações no metabolismo ósseo com a infecção pelo HIV. Todos os estudos que incluíam osteocalcina ou NTX com marcadores respectivos de formação e reabsorção ósseos foram incuidos. Cinco estudos foram classificados como evidência classe III e envolveram 456 indivíduos HIV positivos e 590 controles. O NTX teve aumento significante (p < 0.00014) no grupo HIV-positivo, enquanto osteocalcina não se mostrou alterada. CONCLUSÃO: O presente estudo permite concluir que, durante a infecção pelo HIV, o marcador NTX está significantemente elevado, refletido alta atividade reabsortiva no tecido ósseo. Isto aponta um papel importante na atividade osteoclástica na perda óssea de pacientes HIV-positivos.

INTRODUCTION: HIV-infected patients show osteoporosis or densitometric osteopenia at a rate of 28-50 percent. The objective of this study is to check the changes on reabsorption/ development rates on these patients. MATERIALS AND METHODS: A systematic review was carried out with meta-analysis of controlled studies assessing the correlation between osteopenia and/ or bone metabolism changes with HIV infection. All studies including osteocalcin or NTX with corresponding markers of bone development and reabsorption were included. Five studies were classified as class-III evidence, and involved 456 HIV-positive individuals and 590 controls. NTX had a significant increase (p < 0.00014) on the HIV-positive group, while osteocalcin has shown to be unchanged. CONCLUSION: This study allows us to conclude that, during HIV infection, the NTX marker is significantly high, reflecting a high reabsorptive activity on the bone tissue. This suggests an important role on osteoclastic activity in bone loss for HIV-positive patients.

Bone and heart abnormalities of subclinical hyperthyroidism in women below the age of 65 years / Anormalidades ósseas e cardíacas do hipertireoidismo subclínico em mulheres com menos de 65 anos

The objective of the present study was to evaluate bone and cardiac abnormalities and symptoms and signs of thyroid hormone excess in women with subclinical hyperthyroidism (SCH) aged < 65 years. Forty-eight women with SCH were evaluated. The control group consisted of 48 euthyroid volunteers. The mean symptom rating scale score was significantly higher in patients. Cardiac involvement, both morphological and affecting systolic and diastolic functions, was also observed in patients. Women with SCH showed a significant increase in serum markers of bone formation and resorption. In addition, bone mineral density (BMD) was lower in the femoral neck but not in the lumbar spine in patients before menopause, whereas a lower BMD was observed at both sites in postmenopausal patients. SCH is not completely asymptomatic in women aged < 65 years, and is associated with heart abnormalities and with increased bone turnover and reduced BMD even before menopause.

O objetivo deste estudo foi avaliar as anormalidades ósseas e cardíacas, sintomas e sinais de excesso de hormônio tireoidiano em mulheres com hipertireoidismo subclínico (HSC) e menos de 65 anos de idade. Quarenta e oito mulheres com HSC foram avaliadas. O grupo-controle consistiu de 48 voluntárias eutireoidianas. A média do escore de sintomas foi significativamente maior em pacientes que em controles. Comprometimento cardíaco, morfológico e afetando as funções sistólica e diastólica, também foi observado. Mulheres com HSC apresentaram significativo aumento dos marcadores séricos de formação e reabsorção óssea. A densidade mineral óssea (DMO) foi menor no colo de fêmur, mas não em coluna lombar em mulheres antes da menopausa; enquanto e em ambos os sítios nas mulheres pós-menopausadas. HSC não é inteiramente assintomático em mulheres com menos de 65 anos, está associado a anormalidades cardíacas morfológicas e funcionais, incremento da remodelação óssea, e menor DMO, mesmo antes da menopausa.

Densidade mineral óssea sistêmica vs situação clínica periodontal: estudo transversal em mulheres na pós-menopausa / Systemic bone mineral density versus clinical periodontal condition: cross-sectional study in postmenopausal women

OBJETIVO: Analisar a densidade mineral óssea sistêmica (DMO) e a situação periodontal em mulheres na pós-menopausa, visando compreender o papel da osteoporose como um fator de risco à doença periodontal. MÉTODOS: A amostra da pesquisa foi constituída por 47 mulheres na pós-menopausa, que foram divididas em três grupos: 14 com osso normal (G1), 17 no grupo com osteopenia (G2) e 16 pacientes com osteoporose (G3), através da avaliação da densidade mineral óssea (DMO), aferida pela absormetria de dupla emissão com raios-X na área lombar (L1-L4). A condição periodontal foi avaliada pelo índice gengival (IG), índice da placa (IP) e o nível de inserção clínica (NIC). Os resultados tabulados foram analisados e submetidos ao tratamento estatístico, através do teste ANOVA a um critério (α=0,05) e o teste de correlação de Pearson (α=0,01). RESULTADOS: Verificou-se não haver diferenças significativas na situação periodontal em mulheres na pós-menopausa, através das variáveis IG, IP e NIC. Observou-se correlação significativa entre os parâmetros periodontais IG, IP e NIC entre si (p<0,001), contudo não foi detectada correlação significativa entre os parâmetros periodontais (IG, IP, NIC) e a condição sistêmica do osso das mulheres na pós-menopausa, avaliada através da DMO (p>0,01). CONCLUSÃO: A situação periodontal em mulheres na pós-menopausa não depende da massa óssea sistêmica, não havendo correlação significativa entre DMO e os parâmetros periodontais, sendo necessárias pesquisas longitudinais para considerar a osteoporose como um fator de risco à doença periodontal.

OBJECITVE: To assess the systemic bone mineral density (BMD) and the periodontal situation in postmenopausal women, to understand the possible role of osteoporosis as a risk factor for periodontal disease. METHODS: The sample was comprised of 47 postmenopausal women, divided into 3 groups: 14 patients with normal bones (G1), 17 with osteopenia (G2) and 16 patients with osteoporosis (G3). Data was obtained using bone mineral density (BMD), obtained by dual energy x-ray absorptiometry (DXA) in the lumbar area (L1-L4). Periodontal condition was evaluated by Gingival Index (GI), Plaque Index (PI) and Clinical Attachment Level (CAL). Results were analyzed and submitted to statistical treatment, through the One Way ANOVA: (α=0.05) test and the Pearson's Correlation test (α=0.01). RESULTS: GI, PI and CAL variables did not disclose a significant difference in the periodontal situation of postmenopausal women A significant correlation between periodontal parameters GI, PI and CAL (p<0,001) was observed, however no significant correlation was detected between periodontal parameters (GI, PI and CAL) and systemic bone condition of postmenopausal women, evaluated by BMD (p>0.01). CONCLUSION: The periodontal situation of postmenopausal women does not depend on the systemic bone mass and there is no significant correlation between BMD and periodontal parameters. However, further longitudinal surveys are required to understand osteoporosis as a risk factor of periodontal disease.

Improvement of adynamic bone disease after renal transplantation

Low bone remodeling and relatively low serum parathyroid hormone (PTH) levels characterize adynamic bone disease (ABD). The impact of renal transplantation (RT) on the course of ABD is unknown. We studied prospectively 13 patients with biopsy-proven ABD after RT. Bone histomorphometry and bone mineral density (BMD) measurements were performed in the 1st and 12th months after RT. Serum PTH, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and osteocalcin were measured regularly throughout the study. Serum PTH levels were slightly elevated at transplantation, normalized at the end of the third month and remained stable thereafter. Bone biopsies performed in the first month after RT revealed low bone turnover in all patients, with positive bone aluminum staining in 5. In the 12th month, second biopsies were performed on 12 patients. Bone histomorphometric dynamic parameters improved in 9 and were completely normalized in 6, whereas no bone mineralization was detected in 3 of these 12 patients. At 12 months post-RT, no bone aluminum was detected in any patient. We also found a decrease in lumbar BMD and an increase in femoral BMD. Patients suffering from ABD, even those with a reduction in PTH levels, may present partial or complete recovery of bone turnover after successful renal transplantation. However, it is not possible to positively identify the mechanisms responsible for the improvement. Identifying these mechanisms should lead to a better understanding of the physiopathology of ABD and to the development of more effective treatments.

Fatores de risco da osteoporose: prevenção e detecção através do monitoramento clínico e genético / Osteoporosis risk factors: prevention and detection through clinical and genetic monitoring

A osteoporose é uma doença sistêmica caracterizada pela baixa massa óssea e deterioração da micro arquitetura do tecido ósseo. Consequentemente existe um aumento na fragilidade do osso e suscetibilidade à fratura, que é considerada o efeito clínico mais importante deste processo. Muitos estudos que se utilizam de modelos em gêmeos ou pais e seus descendentes têm confirmado o papel da herança genética no pico de massa óssea, na verdade o maior fator de risco da fratura. Neste artigo de revisão, são enfocados os prováveis genes envolvidos no processo de osteoporose, ressaltando a importância das interações entre gene- gene e gene-ambiente. Concernente à influência isolada do ambiente, são abordados os hábitos relacionados ao estilo de vida, à nutrição e ao tabagismo envolvidos no aparecimento dessa doença. Durante os próximos anos, o conhecimento baseado na genética molecular elucidará o processo osteoporótico. Do mesmo modo, os estudos clínicos se expandirão, visando contribuir para a detecção precoce da doença, permitindo assim a aplicação de medidas preventivas e terapêuticas adequadas.

Fisiopatologia da osteoporose involutiva / Physiopathology of involutive osteoporosis

A diminuição da densidade mineral óssea (DMO) com a idade é um fenômeno universal, atingindo todas as raças e culturas, não patológico em si, mas que se constitui um substrato para o desenvolvimento da osteoporose (OP). Em 1941, Albright descreveu pela primeira vez a OP, e chamou atenção para deficiência de estrógeno (E2) como causa principal desta patologia. Isso foi confirmado em trabalho posteriores, onde a reposição hormonal preveniu a perda óssea. Posteriormente, Riggs e Melton classificaram a OP involutiva em tipo I e tipo II. A OP tipo I, ou pós-menopáusica, ocorre nos 10 anos que se seguem à menopausa, sendo uma conseqüência da deficiência de E2. Porém, o mecanismo de ação do E2 no osso ainda é desconhecido. Vários trabalhos não evidenciaram receptores de E2 em osteoclastos, sugerindo que o efeito do E2 se faz de forma indireta via osteoblastos ou pelas células do estroma da medula óssea, através da liberação de mediadores. Dados recentes controversos sobre o papel da interleucina 6 como mediadora do efeito estrogênico. A OP tipo II, ou senil, ocorreria após 65 anos. À partir dessa idade, outros fatores também seriam determinantes da OP, dentre eles o hiperparatiroidismo secundário. Recentemente, Riggs e Melton retornaram a teoria unitária do modelo de OP involutiva, colocando o E2 como fator etiológico central para ambas as fases de perda óssea. As discussões sobre as classificações da OP têm objetivos didáticos, mas demonstram também o caráter heterogêneo e multifatorial da doença.

Considerações sobre os marcadores bioquímicos do metabolismo ósseo e sua utilidade prática / Usefulness Considerations about the biochemical markers of bone metabolism its practice usefulness

O uso de marcadores bioquímicos do metabolismo ósseo na prática clínica tem se expandido de maneira considerável. Isto se deve ao surgimento de novos métodos e de um melhor conhecimento sobre a fisiopatologia das doenças ósteo-metabólicas, em especial a osteoporose. Os marcadores podem ser devididos em marcadores de formação, que refletem a atividade dos osteoblastos, e os de reabsorção, que refletem a atividade dos osteoclastos. Dentre os primeiros destacam-se a fosfatase alcalina óssea e a osteocalcina, e dentre os últimos os fragmentos derivados da reabsorção do colágeno, como as piridinolinas e os telopeptídeos carboxi e amino terminais. Além das aplicações já consagradas, como o diagnóstico e acompanhamento de patologias com importantes repercussões ósseas como a doença de Paget, o hiperparatiroidismo primário e outras, novas aplicações têm sido estruturadas. Dentre estas, a que mais parece fundamentada é o acompanhamento do efeito de terapêutica específica no tratamento da osteoporose; a curto prazo, 1 a 3 meses, é possível a verificação da eficácia terapêutica, fato só possível com densitometria óssea após 1 a 2 anos. Novos métodos, em especial para a medida de marcadores de reabsorção no soro, devem tornar ainda mais abrangente a aplicação destes ensaios.

Osteodistrofia hepática: revisão da literatura e relato de experiência pessoal em um grupo de crianças em adolescentes com colestase crônica / Hepatic osteodystrophy: literature review and report of personal experience with children and adolescents with chronic cholestasis

Osteodistrofia hepática é o termo usado para definir a doença óssea metabólica associada à hepatopatia crônica. Estudada principalmente em indivíduos adultos com colestase crônica, é igualmente prevalente em adolescentes e crianças hepatopatas crônicos. A patogênese é desconhecida mas parece ser multifatorial. Na maioria dos pacientes ocorre perda progressiva de densidade óssea, causa de importante fragilidade esquelética. Esta predispõe à perda de estatura, dor óssea e surgimento de fraturas associadas ou não ao trauma. A densidade óssea mineral pode ser medida por densitometria óssea de dupla emissão. Nenhuma medida, farmacológica ou profilática, tem se mostrado efetiva para reduzir a osteopenia da hepatopatia crônica, observando-se porém que aproximadamente um ano após transplante hepático, ocorre aumento de massa óssea em grande parte dos pacientes. Nesta revisão, discutimos a fisiopatologia, diagnóstico e tratamento da osteodistrofia hepática e relatamos nossa experiência com 20 pacientes com colestase crônica acompanhados na Unidade de Gastroenterologia Pediátrica do HCPA

Tratamiento de la Osteoporosis

La osteoporosis es el síndrome más frecuente dentro de la enfermedad metabólica ósea. Su importancia aumenta de forma paralela al aumento de la esperanza de vida de la población y al envejecimieto de ésta; su complicación, la fractura, puede producir un enmpeoramiento severo de la calidad de vida, siendo la de cadera una causa importante de mortalidad en los ancianos. Al diagnosticar la existencia de la osteoporosis es importante caracterizar su etiología y grado de recambio óseo para iniciar el tratamiento, el cual puede dividirse en profiláctico y terapéutico sidno su objetivo final la prevención de complicaciones.Son múltiples los tratamiento propuestos para este proceso, apareciendo cada año nuevos fármacos. Los tratamientos tienden a mantener al paciente con niveles de densidad mineral ósea por encima del riesgo de fracturas, pero debido a que la pérdida de calcio es un fenómeno fisiológico, una vez se suspende el tratamiento, este proceso de pérdida se inicia de nuevo. La elección del fármaco será individualizada, deberá basarse en el tipo de osteoporosis, su remodelado óseo y la tolerancia y respuesta del paciente al fármaco

Enfermedad metabólica ósea del prematuro / Bone metabolic disease in premature

La enfermedad metabólica ósea del prematuro (EMOP) es un desorden comúnmente reconocido, caracterizado por falla en la mineralización ósea en prematuros en crecimiento e incluye una amplia variedad de trastornos que van desde una leve desmineralización (osteopenia) a una enfermedad ósea severa con fracturas (raquitismo)