Bone effects of epidural and intra-articular glucocorticoids: a systematic literature review / Efectos óseos de los glucocorticoides epidurales e intraarticulares: revisión sistemática de la literatura

Osteoporosis and vertebral and non-vertebral fractures are common in glucocorticoids (GC) treated patients. Oral GC treatment leads to bone loss, particularly of trabecular bone. The benefits of GC used in rheumatological and traumatological disorders are known but they would have possible negative effects on bone. This systematic review aimed to evaluate the effects of epidural steroid injections (ESI), and intra-articular and intramuscular GC administration on bone mineral density (BMD) and fragility fractures. A systematic review of Medline/PubMed, Cochrane, and LILACS up to November 2020 was conducted. Meta-analyses, systematic reviews, randomized and non-randomized controlled trials, and prospective and retrospective studies comparing the effect of ESI, intra-articular or intramuscular GC used compared to a control group or baseline measurements were included. Results: A total of 8272 individuals were included among the 13 selected articles (10 about ESI and 3 about intra-articular GC; no article was found evaluating intramuscular GC). Only a few studies showed a negative effect of ESI on bone in the qualitative analysis considering osteopenia and osteoporosis in lumbar spine, femoral neck and total hip and BMD as surrogate outcomes. On the other hand, the qualitative analysis showed that most studies found an increased risk of fragility fracture. However, only two studies could be included in the quantitative analysis, in which there were no differences between patients exposed to ESI versus controls in all evaluated regions. In conclusion, there was insufficient evidence to suggest that ESI and intra-articular GC, unlike oral GC, negatively affect bone mass. Longitudinal studies are needed to obtain more knowledge regarding the effect of ESI or intra-articular GC on BMD and fragility fractures. (AU)

La osteoporosis y las fracturas vertebrales y no vertebrales son comunes en pacientes tratados con glucocorticoides (GC). El tratamiento oral con GC conduce a la pérdida ósea, particularmente del hueso trabecular. Los beneficios de los GC utilizados en patologías reumatológicas y traumatológicas son conocidos, pero tendrían posibles efectos negativos sobre el hueso. Esta revisión sistemática tuvo como objetivo evaluar los efectos de las inyecciones epidurales de esteroides (ESI), GC intraarticulares e intramusculares sobre la densidad mineral ósea (DMO) y las fracturas por fragilidad. Se realizó una revisión sistemática de Medline/PubMed, Cochrane y LILACS hasta noviembre de 2020. Se incluyeron metanálisis, revisiones sistemáticas, ensayos controlados aleatorizados y no aleatorizados, estudios prospectivos y retrospectivos que compararon el efecto de ESI, GC intraarticular o intramuscular utilizado en comparación con un grupo de control o mediciones iniciales. Resultados: Se incluyeron un total de 8272 individuos entre los 13 artículos seleccionados (10 sobre ESI y 3 sobre GC intraarticular; no se encontró ningún artículo que evaluara GC intramuscular). Solo unos pocos estudios mostraron un efecto negativo del ESI sobre el hueso en el análisis cualitativo considerando la osteopenia y la osteoporosis en la columna lumbar, el cuello femoral y la cadera total y la DMO como un resultado indirecto. Por otro lado, el análisis cualitativo mostró que la mayoría de los estudios encontraron un mayor riesgo de fractura por fragilidad. Sin embargo, solo dos estudios pudieron incluirse en el análisis cuantitativo, en los que no hubo diferencias entre los pacientes expuestos a ESI versus los controles en todas las regiones evaluadas. En conclusión, no hallamos datos suficientes para sugerir que la ESI y los GC intraarticulares, a diferencia de los GC orales, afectan negativamente a la pérdida ósea. Se necesitan estudios longitudinales para obtener más conocimiento sobre el efecto de ESI o GC intraarticular en la DMO y las fracturas por fragilidad. (AU)

The bone densitometry is normal in Turner syndrome prepubertal patients after height age correction / A densitometria óssea é normal em pacientes pré-púberes com síndrome de turner quando corrigida pela idade estatura

Abstract Objectives: to evaluate the bone mass in prepubertal patients with Turner Syndrome (TS) according to height age (HA) and verify the influence of karyotype and adiposity. Methods: retrospective and analytical study of prepubertal TS patients. The variables analyzed were: karyotype, age at bone densitometry (BD), height, body mass index (BMI) and BD result. The result of the BD was corrected using HA. BMI and BD were calculated on Z score for chronological age (CA) and for HA. Results: thirty-seven prepubertal patients were selected and after exclusion criteria, 13 cases between 10 and 13 years old were included in the study. The BD for HA was significantly higher than for CA (0.39 ± 1.18 x −1.62 ± 1.32), without karyotype (p=0.369) and BMI (p=0.697) influence. Conclusion: prepubertal TS patients present normal BD when corrected for HA, without influence of karyotype and BMI.

Resumo Objetivos: avaliar a massa óssea de pacientes pré-púberes com Síndrome de Turner (ST) de acordo com a idade estatura (IE) e verificar a influência do cariótipo e da adiposidade. Métodos: estudo retrospectivo e analítico de pacientes pré-púberes com ST. As variáveis analisadas foram: cariótipo, idade na realização da densitometria óssea (DO); estatura, índice de massa corporal (IMC) e resultado da DO. Realizou-se a correção do resultado da DO utilizando a IE. O IMC e a DO foram calculados em Z score para idade cronológica (IC) e para IE. Resultados: foram selecionadas 37 pacientes pré-púberes e após critério de exclusão foram incluídas no estudo 13 casos entre 10 e 13 anos de idade. A DO para IE foi significativamente maior que para IC (0,39 ± 1,18 × −1,62 ± 1,32), sem influência do cariótipo (p=0,369) e do IMC (p=0,697). Conclusão: pacientes pré-púberes com ST apresentam DO normal quando corrigida para IE, sem influência do cariótipo e do IMC.

Quantitative evaluation of the regenerated dura mater in a decompressive skull trepanation model in rats / Evaluación cuantitativa de la duramadre regenerada en un modelo de perforación cranial descompresiva en ratas

SUMMARY: Regeneration of the dura mater following duraplasty using a collagen film, a chitosan film, or a combination of both with gelatin, was studied in a craniotomy and penetrating brain injury model in rats. Collagen autofluorescence in the regenerated dura mater was evaluated using confocal microscopy with excitation at λem = 488 nm and λem = 543 nm. An increase in regeneration of the extracellular matrix of connective tissue and an increase in matrix fluorescence were detected at 6 weeks after duraplasty. The major contributors to dura mater regeneration were collagen films, chitosan plus gelatin-based films, and, to a much lesser extent, chitosan-based films. By using autofluorescence densitometry of extracellular matrix, the authors were able to quantify the degree of connective tissue regeneration in the dura mater following duraplasty.

RESUMEN: Se estudió la regeneración de la duramadre después de una duraplastía utilizando una lámina de colágeno, una lamina de quitosano o una combinación de ambas con gelatina en un modelo de craneotomía y lesión cerebral en ratas. La autofluorescencia del colágeno en la duramadre regenerada se evaluó mediante microscopía confocal con excitación a λem = 488 nm y λem = 543 nm. Se observó un aumento en la regeneración de la matriz extracelular del tejido conectivo y un aumento en la fluorescencia de la matriz a las 6 semanas después de la duraplastía. Se observe un efecto significativo en la regeneración de la duramadre con las láminas de colágeno, las láminas en base de quitosano más gelatina y, en un menor grado, las láminas a base de quitosano. Mediante el uso de densitometría de autofluorescencia de la matriz extracelular, los autores lograron cuantificar el grado de regenera- ción del tejido conectivo en la duramadre después de la duraplastía.

Integrated optical density analysis of the immunohistochemical expression of the progesterone receptor in the uterine endometrium of prepubertal araucana sheep / Análisis por densidad óptica integrada de la expresión inmunohistoquímica del receptor de progesterona en el endometrio uterino de ovejas prepúberes de raza araucana

SUMMARY: Progesterone receptors are expressed in the reproductive organs of adult sheep, where they regulate morphofunctional and reproductive development. However, various studies have shown the presence of these receptors in the uterus of prepubertal females. It is not clear what role these receptors have at this level of development in uterine tissue. Therefore, it is relevant as a first step in the investigation, to determine the expression and histological distribution of the progesterone receptor in prepubertal sheep in order to determine possible functions at this level of reproductive development. Immunohistochemical analysis allows visualizing the specific presence of a protein in the cellular and histological context, however, the results displayed through digital images are qualitative data and subject to the observer's criteria. In this work, a quantitative analysis method of immunohistochemical expression of the progesterone receptor in ovine endometrium is presented, using digital analysis of images, by means of integrated optical density of digital photographs of histological sections processed with immunohistochemical methods. The results show the possibility of quantitatively evaluating the expression of progesterone receptors in the endometrial stroma and prepubertal endometrial glands by applying the integrated optical density analysis of digital images.

RESUMEN: Los receptores de progesterona se expresan en los órganos reproductores de ovejas adultas, donde regulan el desarrollo morfofuncional y reproductivo. Sin embargo, diversos estudios han demostrado la presencia de estos receptores en útero de hembras prepúberes. No está claro, el papel que estos receptores tienen en este nivel de desarrollo en tejido uterino. Por lo que, es relevante como primer paso en la investigación, determinar la expresión y distribución histológica del receptor de progesterona en ovejas prepúberes con el fin determinar posibles funciones en este nivel de desarrollo reproductivo. El análisis inmuno- histoquímico permite visualizar la presencia específica de una proteína en el contexto celular e histológico, sin embargo, los resultados visualizados a través de imágenes digitales, son datos cualitativos y sujeto al criterio del observador. En este trabajo se presenta un método de análisis cuantitativo de expresión inmunohistoquímica del receptor de progesterona en endometrio ovino, utilizando análisis digital de imágenes, mediante densidad óptica integrada de fotografías digitales de cortes histológicos procesados con métodos inmunohistoquímicos. Los resultados muestran la posibilidad de evaluar cuantitativamente la expresión de los receptores de progesterona en el estroma endometrial y las glándulas endometriales prepúberes aplicando el análisis de densidad óptica integrado de imágenes digitales.

Frequency of osteopenia and osteoporosis in men and women living with HIV/Aids: an observational study / Frequência de osteopenia e osteoporose em homens e mulheres vivendo com HIV/Aids: um estudo observacional

ABSTRACT: Aims: To identify the frequency in changes of bone metabolism, including below the average value for age, osteopenia, and osteoporosis, in people living with HIV/AIDS (PLWHA) and to compare the frequency of factors associated with bone mineral density (BMD) and body composition between sex. Methods: This observational study assessed 106 PLWHA (65 male) recruited from the University Hospital of Ribeirão Preto Medical School from 2013 to 2014. BMD was measured using Dual Energy X-ray Absorptiometry (DXA). Standard deviation values for Z- and T-score proposed by the International Society for Clinical Densitometry were adopted to classify participants below the average value for age, osteopenia, and osteoporosis. Qui-square and Fischer's exact tests were employed to compare males and females based on their factors associated with BMD reduction. Results: Fifty-two (49%) PLWHA presented at least one diagnosis for below the average value for age, osteopenia, and osteoporosis, being 37 (57%) and 15 (37%) male and female, respec-tively. Frequency of alcohol consumption was higher in males (n=20; 30.8%) than females (n=05; 12.2%) (p=0.028).Conclusions: A high rate of PLWHA showed changes in bone metabolism, with a higher frequency in males. The fre-quency of alcohol consumption was higher in males, and it may partially explain the possible causes of the increased rates of bone metabolism changes observed in this group. This information may help develop strategies for reducing the frequency of diagnosis for below the average value for age, osteopenia, osteoporosis improving quality of life in PLWHA. (AU)

RESUMO: Objetivos: Identificar a frequência de alterações no metabolismo ósseo, incluindo valores abaixo do estimado para idade, osteopenia e osteoporose, em pessoas vivendo com HIV/Aids (PVHA) e comparar a frequência de fatores associados à redução da densidade mineral óssea (DMO) e composição corporal entre sexos. Métodos: Estudo observacional que ava-liou 106 PVHA (65 do sexo masculino) recrutadas do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo entre os anos 2013 e 2014. A DMO foi medida utilizando a Absorciometria Radiológica de Dupla Energia (DXA). Valores de desvio padrão Z- e T- scores propostos pela Sociedade Internacional para Densitometria Clí-nica foram adotados para classificar os participantes em abaixo do valor estimado para idade, osteopenia e osteoporose. Os testes do qui-quadrado e exato de Fischer foram empregados na comparação entre os sexos baseado em seus respec-tivos fatores associados à redução da densidade mineral óssea. Resultados: Cinquenta e dois (49%) PVHA apresentaram ao menos um diagnóstico para abaixo do valor estimado para idade, osteopenia e osteoporose, sendo 37 (57%) do sexo masculino e 15 (37%) feminino. A frequência de consumo de álcool foi maior no sexo masculino (n=20; 30,8%) compara-do ao feminino (n=5; 12,2%) (p=0,028). Conclusões: Uma alta taxa de PVHA apresentaram alterações no metabolismo ósseo, com maior frequência no sexo masculino. A frequência no consumo de álcool foi maior no sexo masculino, podendo explicar parcialmente as possíveis causas para taxa aumentada de alterações no metabolismo ósseo observada nesse grupo. Essa informação pode contribuir no desenvolvimento de estratégias para redução da frequência do diagnóstico para valores abaixo do estimado para idade, osteopenia e osteoporose, melhorando a qualidade de vida em PVHA

Valores de referencia de la densidad mineral ósea por densitometría tipo DXA en una población adulta sana de Bogotá / Bone mineral density reference values by densitometry (DXA) in a healthy adult population of Bogota

RESUMEN Introducción: La actual definición de osteoporosis es basada en la absorciometría de energía dual de Rx (DXA, por sus siglas en inglés), lo cual representa la principal técnica para la cuantificación de la densidad mineral ósea (DMO) y la evaluación del riesgo de fractura. El objetivo de este estudio fue determinar la DMO en columna lumbar y cuello femoral de adultos sanos desde el punto de vista metabólico óseo en una población de Bogotá-Colombia. Métodos: Se realizó un estudio observacional, analítico, de corte transversal, basado en un cuestionario aplicado a la población de estudio. Las medidas densitométricas fueron realizadas con un equipo compacto de alto rendimiento de la General Electric, modelo iDXA, por el mismo tecnólogo en los sitios esqueléticos de interés, columna lumbar L1, L2, L3, L4 y L1-4 en proyección anteroposterior y en cuello femoral. El cálculo del tamaño de muestra se realizó teniendo en cuenta la estratificación por sexo y 2 grupos de edad: 20 a 29 años y 30 a 39 años. Se encuestó a 805 individuos y 432 se realizaron la densitometría ósea. Resultados: Los valores encontrados en columna lumbar para cada uno de los grupos de nuestra población, fueron: 1,150 g/cm2 (DE: 0,11), 1,180 g/cm2 (DE: 0,10), para mujeres y hombres de 20 a 29 años, y 1,169 g/cm2 (DE: 0,10), 1,209 g/cm2 (DE: 0,10) para mujeres y hombres de 30 a 39 años, respectivamente. A nivel del cuello femoral, 0,991 g/cm2 (DE: 0,10), 1,119 g/cm2 (DE: 0,13), para mujeres y hombres de 20 a 29 años, y 0,970 g/cm2 (DE: 0,11), 1,079 g/cm2 (DE: 0,13) para mujeres y hombres de 30 a 39 años, respectivamente. Conclusión: Este estudio pudo demostrar el comportamiento de la DMO en nuestra población, la cual es inferior a la detectada en otras latitudes y a las utilizadas como valores de referencia en nuestros equipos. Adicionalmente, se determinó el valor máximo de masa ósea en cada una de las regiones de interés para los rangos de edad de la población de nuestro estudio.

ABSTRACT Introduction: The current definition of osteoporosis is based on the dual energy X-ray absorptiometry (DXA), which represents the main technique for the quantification of bone mineral density (BMD) and the evaluation of fracture risk. The objective of this study was to determine the BMD in the lumbar spine and femoral neck of healthy adults from a bone metabolism point of view in a population of Bogotá-Colombia. Method: An observational, analytical, cross-sectional study was conducted based on a questionnaire completed by the study population. The densitometric measurements were carried out using a high-performance compact equipment of the General Electric, iDXA model, by the same technologist at the skeletal sites of interest, lumbar spine L1, L2, L3, L4 and L1-4 in anteroposterior projection, and in femoral neck. The sample size calculation was performed taking into account stratification by gender and 2 age groups: 20 to 29 years, and 30 to 39 years. A total of 805 individuals were surveyed, and 432 bone densitometries were performed. Results: The values found in the lumbar spine for each of the groups in our population were: 1.150 g/cm2 (SD: 0.11), 1.180 g/cm2 (SD: 0.10), for women and men aged 20 to 29 years, and 1.169 g/cm2 (SD: 0.10), 1.209 g/cm2 (SD: 0.10) for women and men aged 30 to 39, respectively. At the level of the femoral neck, 0.991 g/cm2 (SD: 0.10), 1.119 g/cm2 (SD: 0.13), for women and men aged 20 to 29 years, respectively, and 0.970 g/cm2 (SD: 0.11), 1.079 g/cm2 (SD: 0.13) for women and men aged 30 to 39, respectively. Conclusion: This study was able to demonstrate the behaviour of BMD in our population, which is lower than that detected in other latitudes and those used as reference values in our equipment. Additionally, the maximum bone mass value was determined in each of the locations of interest for the age ranges of the population in our study.

Vitamina D, magnesio y parámetros seleccionados de laboratorio en hombres uruguayos / Vitamin D, magnesium, and selected laboratory parameters in Uruguayan men / Vitamina D, magnésio e parâmetros selecionados de laboratório em homens uruguaios

Resumen: Introducción: los niveles de vitamina D (VD) plasmática se han investigado sobre todo en mujeres, no obstante también son relevantes en hombres, y no sólo en relación al estado de salud ósea. Un estudio previo realizado hace dos décadas en una pequeña muestra de hombres y mujeres uruguayos reveló serias deficiencias de VD. Por otra parte, el magnesio posee importantes efectos no solo relacionados a los niveles de VD, también afecta el hueso directa e indirectamente. Objetivos: analizar posibles interrelaciones entre valores de VD plasmática, testosterona plasmática, densitometría ósea, y otros parámetros en una población de jóvenes varones uruguayos. Métodos: durante julio-agosto de 2015, cien hombres uruguayos afiliados al sistema prepago de salud fueron invitados a participar en nuestra Unidad de Metabolismo Fosfocálcico, para ser estudiados con técnicas de antropometría, laboratorio y densitométricas. Los datos colectados fueron analizados estadísticamente. Resultados: los hombres estudiados mostraron bajos niveles de VD plasmática (96% insuficientes-deficientes), que no mostraron correlaciones significativas con ninguno de los parámetros estudiados. El magnesio plasmático se correlacionó significativa e inversamente con los z-scores densitométricos, lo que fue más intenso en hombres con sobrepeso y con VD ≥15 ng/ml. Conclusiones: a pesar de lo pequeño de la muestra, los resultados confirman la presencia de bajos niveles de VD en hombres aparentemente saludables. Los hallazgos dan razones para pensar en posibles recomendaciones para mejorar el espectro preventivo enfocado en osteoporosis y cáncer colorrectal.

Summary: Background: serum vitamin D (VD) levels have been mainly studied in women, but they are relevant also among men, not only regarding bone health status. A previous small-size study performed two decades ago in Uruguayan women and men revealed serious deficiencies of VD. On the other hand, magnesium has important effects not only related to vitamin D levels but directly and indirectly affect bone. Purpose: to analyze possible interrelationships among values of serum VD, magnesium, testosterone, bone densitometry and other parameters in young Uruguayan male population. Methods: during July-August 2015, one hundred Uruguayan men affiliated to the prepaid healthcare system, invited to participate by our Unit of Bone Metabolism, were studied with anthropometry, laboratory and, densitometry techniques. Collected data were statistically analyzed. Results: the studied men showed low serum VD levels (96% insufficient-deficient), which did not show significant correlations with any of the studied parameters. Serum magnesium was significantly and inversely correlated with densitometric z-scores, even stronger among men with overweight and with VD≥15 ng/ml. Conclusions: despite the sample size, results confirm the presence of low serum VD levels in apparently healthy men. Findings give reasons to think about possible recommendations to improve the preventive scope regarding osteoporosis and colorectal cancer.

Resumo: Introdução: os níveis plasmáticos de vitamina D (DV) têm sido investigados principalmente em mulheres, porém também são relevantes em homens, e não apenas em relação à saúde óssea. Um estudo anterior realizado há duas décadas em uma pequena amostra de homens e mulheres uruguaios revelou graves deficiências de VD. Por outro lado, o magnésio tem efeitos importantes não apenas relacionados aos níveis de VD, mas também afeta o osso direta e indiretamente. Objetivos: analisar as possíveis relações entre os valores plasmáticos de VD, testosterona plasmática, densitometria óssea e outros parâmetros em uma população de jovens uruguaios. Métodos: durante o período de julho a agosto de 2015, cem uruguaios filiados ao sistema de saúde pré-pago foram convidados a participar de nossa Unidade de Metabolismo Fosfocálcico, para serem estudados com técnicas antropométricas, laboratoriais e densitométricas. Os dados coletados foram analisados estatisticamente. Resultados: os homens estudados apresentaram baixos níveis de VD plasmático (96% insuficiente-deficiente), que não apresentou correlações significativas com nenhum dos parâmetros estudados. O magnésio plasmático foi significativa e inversamente correlacionado com os escores z densitométricos, que foi mais intenso em homens com sobrepeso e VR ≥15 ng / ml. Conclusões: porém, na pequena amostra, os resultados confirmam a presença de baixos níveis de VD em homens aparentemente saudáveis. Estes achados propõem pensar sobre possíveis recomendações para melhorar o espectro preventivo com foco na osteoporose e no câncer colorretal.

Rol de la densitometría ósea como herramienta diagnóstica y de control en el síndrome de dolor regional complejo: reporte de un caso / Role of bone densitometry as a diagnostic and monitoring tool in complex regional pain syndrome: report of a case

El síndrome de dolor regional complejo (SDRC) es una patología poco frecuente, caracterizada por dolor crónico y cambios locales del sitio afectado. Ocurre en forma posterior a un traumatismo, o, menos frecuentemente, sin desencadenante claro. El diagnóstico se realiza de forma clínica, evaluando la presencia de hallazgos típicos detallados en los criterios de Budapest, como el dolor continuo y desproporcionado, y síntomas y signos típicos, como edema, asimetría térmica y disminución del rango de movilidad. Los estudios por imágenes, así como la radiografía, la resonancia magnética o el centellograma óseo de 3 fases, también brindan información valiosa, sobre todo en los casos que se presentan con más dudas, y para realizar diagnóstico diferencial de otras patologías. En este sentido, la medición de la densidad mineral ósea por absorciometría dual de rayos X (DXA) se presenta también como herramienta de utilidad, no solo en la fase diagnóstica, al evidenciar la mayor desmineralización del miembro afectado, sino también en la evaluación de la respuesta terapéutica a bifosfonatos. Presentamos el caso de una paciente con SDRC del miembro inferior, donde la densitometría ósea resultó de gran utilidad en su manejo clínico. (AU)

Complex regional pain syndrome (CRPS) is a rare pathology, characterized by chronic pain and local changes of the affected site. It occurs after trauma or, less frequently, without a clear trigger. The diagnosis is made clinically, evaluating the presence of typical findings detailed in the Budapest criteria, such as continuous and disproportionate pain, and typical signs and symptoms, like edema, thermal asymmetry, and decreased range of motion. Imaging studies, such as radiography, magnetic resonance imaging, or 3-phase bone scintigraphy also provide valuable information, especially in cases that present with more doubts, and to make a differential diagnosis with other pathologies. In this regard, the measurement of bone mineral density by dual X-ray absorptiometry (DXA) is also a useful tool, not only in the diagnostic phase, by showing the greater demineralization of the affected limb, but also in the evaluation of the therapeutic response to bisphosphonates. We present the case of a patient with CRPS of the lower limb, where bone densitometry was very useful in her clinical management. (AU)

Avaliação da saúde óssea em pacientes com anorexia nervosa e bulimia nervosa / Bone health assessment in patients with anorexia nervosa and bulimia nervosa

Introdução: Anorexia nervosa (AN) e bulimia nervosa (BN) são transtornos alimentares (TA), cujos sintomas típicos de restrição alimentar, exercícios físicos excessivos, vômitos auto-induzidos e abuso de laxantes e diuréticos podem resultar em severas complicações clínicas. Mulheres com AN e BN apresentam risco elevado para osteoporose, osteopenia e fraturas, associado com baixo peso, atividade física excessiva, história e duração da doença, amenorreia, perda de força muscular e insuficiência de vitamina D. Objetivo: Avaliar a saúde óssea e a composição corporal de mulheres adultas com diagnóstico de AN e BN atual ou prévio. Métodos: estudo transversal incluindo 53 mulheres adultas (18-49 anos) com diagnóstico atual ou pregresso de AN (n=25) ou BN (n=28). Foi realizada absorciometria com raios-X de dupla energia (DXA) para mensuração da densidade mineral óssea (DMO) (total, coluna lombar e colo do fêmur), massa gorda e massa magra e seus índices ajustados pela estatura; administração de diluição isotópica de deutério (D2O) para determinação de água corporal total e massa magra, e teste de prensão palmar para avaliação da força muscular. A determinação sérica das concentrações de glicose, insulina (cálculo de HOMA-IR), colesterol total e frações (LDL-c, HDL-c e VLDL-C), triglicérides e 25-hydroxyvitamin D (25(OD)D) foram realizadas em amostra de sangue obtida após jejum de 12 horas. Foram aplicados questionários sobre história da doença, uso de suplementos, atividade física habitual e sintomas do TA. Análises estatísticas incluíram testes T Independente, ANOVA, Qui Quadrado, correlação linear de Pearson, modelos de regressão linear univariados e múltiplos e análise de Bland-Altman. Resultados estão apresentados em média, desvio-padrão, frequências e intervalo de confiança de 95%. Revisão sistemática e meta-análise da DMO em indivíduos com TA em comparação a controles saudáveis foi realizada de acordo com o PRISMA guidelines. Resultados: Mulheres com AN apresentaram menor DMO de corpo total [1.09 g/cm2 (0.07) vs BN: 1.18 g/cm2 (0.12); p<0.01] e do colo do fêmur [0.95 g/cm2 (0.13) vs BN: 1.05 g/cm2 (0.16); p<0.01] em comparação com BN. Mulheres com AN apresentaram menor gordura corporal, razão androide/ginoide, tecido adiposo visceral, massa magra e maior percentual de massa magra em comparação àquelas com BN. Comparação entre DXA e D2O mostrou nenhuma diferença significante para gordura corporal (massa, percentual e índice de massa/estatura2) e massa magra (massa e índice de massa/estatura2). Possível viés sistemático do DXA em superestimar gordura corporal e massa magra, exceto para o índice de massa livre de gordura (IMLG), foi relacionado com o diagnóstico de BN, estado de hidratação e atividade física. DMO total foi positivamente associada com gordura corporal (Modelo DXA: ß=0.59; p=0.007; Modelo D2O: ß=0.59; p<0.001) e força muscular (Modelo DXA: ß=0.32; p=0.013). DMO da coluna foi negativamente associada com duração da amenorreia (Modelo DXA: ß=-0.32; p=0.027; Modelo D2O: ß=-0.38; p=0.024). A DMO do colo do fêmur foi associada com gordura corporal (Modelo D2O: ß=0.37; p=0.038) e massa magra (Modelo D2O: ß=0.43; p=0.025). Não houve efeito da duração da doença e atividade física na DMO. Foram observadas diferenças entre os TA nos valores de HOMA-IR [AN: 1.3 (0.8) vs BN: 2.0 (1.2); p<0.05] e HDL-c [AN: 76.6mg/dL (13.2) vs BN: 61.9 mg/dL (16.3); p<0.05]. Inadequação de 25(OH)D (<30ng/mL) foi observada na AN (100%) e na BN (72%). Destacam-se as associações independentes de HOMA-IR e LDL-c com a DMO do colo do fêmur em mulheres com AN (R2=0.45; p<0.00; HOMA ß=0.503; LDL-c: ß=0.398). Na meta-análise (n=42 estudos), a DMO (total, coluna, quadril e fêmur) foi menor na AN e a DMO (total e coluna) foi menor BN (principalmente com história de AN) em comparação aos controles saudáveis. Conclusão: mulheres com AN e BN com história de AN são mais susceptíveis às perdas de massa óssea. É importante que indivíduos com AN ou história de AN tenham sua saúde óssea avaliada, independente do diagnóstico atual. Recomenda-se a utilização do IMLG e o desenvolvimento de protocolos específicos para realização da avaliação da composição corporal pelo DXA nessa população. A avaliação da saúde óssea deve considerar composição corporal, história da doença, função menstrual e estado de hidratação. A inclusão de teste de força e análise de parâmetros bioquímicos pode auxiliar na identificação de indivíduos que apresentam maior necessidade de exames específicos.

Background: Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders (ED) whose typical symptoms of food restriction, excessive exercise, self-vomit and misuse of laxatives and diuretics can lead to severe clinical complications. Women with AN and BN have increased risk of developing osteopenia, osteoporosis and fractures, associated with low weight, low physical activity, history and duration of the disease, amenorrhea, lack of muscle strength and vitamin D insufficiency. Aim: to assess bone health and body composition of women with current or previous AN and BN. Methods: cross-sectional study including 53 adult (18-49 years) with current or previous diagnosis of AN (n=25) or BN (n=28). Dual-energy x-ray absorptiometry (DXA) was performed to measure total, lumbar spine and femoral neck BMD, fat mass and lean mass; and administration of deuterium oxide (D2O) solution to determine total body water and lean mass. Serum determinations of glucose, insulin (HOMA-IR calculation), total cholesterol and fractions (LDL-c, HDL-c and VLDL-C), triglycerides, and 25-hydroxyvitamin D (25(OD)D were obtained after a 12-hour fasting blood test. Questionnaires about lifestyle, clinical history of the disease, use of supplements, physical activity and ED symptoms were applied. Statistical analyses included Independent T, ANOVA, chi-Square, Pearson's linear correlation tests, univariate and multivariate linear regressions and Bland-Altman analysis. Results are presented in means, standard deviation, frequencies, and 95% confidence interval. Systematic review and meta-analysis of BMD in individuals with ED in comparison to healthy controls was performed according to PRISMA guidelines. Results: Women with AN had lower total DMO [1.09 g/cm2 (0.07) vs BN: 1.18 g/cm2 (0.12); p<0.01] and femoral neck BMD [0.95 g/cm2 (0.13) vs BN: 1.05 g/cm2 (0.16); p<0.01] than women with BN. Compared to BN, women with AN presented less fat mass, android/gynoid ratio, visceral adipose tissue, lean mass and higher lean mass percentage. DXA and D2O dilution comparison showed absence significant difference for body fat (mass, percentage and index) and lean mass (mass and index). Possible bias of DXA in overestimating fat and lean mass, except for lean mass index (LMI) was related to BN diagnosis, hydration status and physical activity. Total BMD was positively associated with body fat (Model DXA: ß=0.59; p=0.007; Model D2O: ß=0.59; p<0.001) and muscle strength (Model DXA: ß=0.32; p=0.013). Lumbar spine BMD was negatively associated with duration of amenorrhea (Model DXA: ß=-0.32; p=0.027; Model D2O: ß=-0.38; p=0.024). Femoral neck BMD associated with body fat (Model D2O: ß=0.37; p=0.038) and lean mass (Model D2O: ß=0.43; p=0.025). Illness duration and physical activity did not present effect on BMD. Differences were observed for HOMA-IR [AN: 1.3 (0.8) vs BN: 2.0 (1.2); p<0.05] e HDL-c [AN: 76.6mg/dL (13.2) vs BN: 2.0 mg/dL (1.2); p<0.05]. 25(OH)D (<30ng/mL) inadequacy was observed in AN (100%) and BN (72%). HOMA-IR and LDL-c were independently associated with femoral neck BMD in women with AN (R2=0.45; p<0.00; HOMA ß=0.503; LDL-c: ß=0.398). In the meta-analysis (n=42 studies), BMD (total, spine, hip and femur) were lower in AN and BMD (total and spine) lower in BN than in healthy controls. Conclusion: Women with AN and BN and a history of AN are prone to bone loss. It is important that individuals with AN or a history of AN have their bone health assessed, irrespective of the current diagnosis. The use of the LMI and the development of specific protocols to carry out the assessment of body composition by DXA are recommended for this population. Bone health assessment should consider body composition, disease history, menstrual function, and hydration status. The inclusion of grip strength test and analysis of biochemical parameters can help identify individuals who have a greater need for specific tests.

Comparison between infrared and hot-blade beak trimming methods in white and brown pullets: performance, organ and bone development / [Comparativo entre debicagem infravermelha e por lâmina-quente em linhagens de frangas leves e semi-pesadas: desempenho, desenvolvimento ósseo e de órgãos]

The purpose of this study was to evaluate infrared beak trimming versus hot-blade beak trimming on performance, organ and bone development of laying pullets, using 240 birds, at 0-16 weeks of age, from two strains (white layer - Hy-Line W36 and brown layer - Hy-Line Brown). Infrared debeaking was performed on the first day of life in the hatchery, whereas hot-blade beak trimming was performed at eight days of age. Zootechnical performance at 6, 9, 12 and 15 weeks of age was analyzed. At the end of the trial, one Bird per experimental unit was euthanized for liver, gizzard, proventriculus, heart and small intestine relative weight evaluation. Both tibiotarsus were collected to measure bone breaking resistance, bone mineral content and bone densitometry. There was higher body weight and feed intake in both bird strains submitted to infrared beak trimming. Additionally, hot-blade white layers presented lower body development and feed intake. The debeaking methods did not influence relative organ weights or tibiotarsus parameters evaluated. We conclude that the infrared beak trimming method promotes better pullet body development than the conventional hot-blade method, improving feed intake, without compromising organ and bone development, being a more adequate debeaking method to be used in layer production.(AU)

Para avaliar a debicagem infravermelha versus a debicagem pelo método da lâmina quente no desempenho, no desenvolvimento de órgãos e na qualidade óssea de poedeiras em recria, foram utilizadas 240 aves, entre zero e 16 semanas de idade, em duas linhagens (branca - Hy-Line W36 e vermelha - Hy-Line Brown). A debicagem por infravermelho foi realizada no primeiro dia de vida no incubatório, enquanto a debicagem com lâmina quente foi realizada aos oito dias de idade. Analisou-se o desempenho zootécnico na sexta, nona, 12ª e 15ª semanas de idade. No final do estudo, uma ave por unidade experimental foi eutanasiada para avaliação do peso relativo do fígado, da moela, do proventrículo, do coração e do intestino delgado, e ossos do tibiotarso foram coletados para avaliação da resistência à ruptura, do conteúdo mineral e da densitometria óssea. Houve maior peso corporal e consumo alimentar nas aves pertencentes às duas linhagens quando submetidas à debicagem por infravermelho, sem haver influência sobre o peso relativo dos órgãos e a qualidade óssea. Conclui-se que o método de debicagem por radiação infravermelha promove melhor desenvolvimento corporal das frangas em relação à debicagem por lâmina quente, melhorando consumo de ração, sem comprometer o desenvolvimento de órgãos e ossos, sendo mais adequada para utilização na avicultura de postura comercial.(AU)

Caracterización clínico-epidemiológica de pacientes con fracturas por fragilidad ¿Estamos haciendo las cosas bien? / Clinical and epidemiological characteristics of patients with fragility fractures: Are we doing things right?

Resumen Introducción: la osteoporosis es una enfermedad que se incrementa conforme nuestra población envejece; ésta se asocia a mayor riesgo de fracturas por fragilidad, conllevando a pérdida de la independencia, dolor crónico e incluso la muerte. Con el fin de evitar dichas complicaciones, es importante caracterizar la población con diagnóstico de fractura por fragilidad e identificar si se está realizando un adecuado tamizaje y abordaje del paciente con riesgo o diagnóstico de osteoporosis. Material y métodos: estudio prospectivo realizado en pacientes ingresados con fractura por fragilidad en un hospital de alta complejidad, en el periodo entre marzo-septiembre del 2018. Se realizó una caracterización según variables clínico-sociodemográficas y se aplicó criterios de tamización según diferentes guías con el fin de determinar si se está realizando un adecuado tamizaje y abordaje del paciente con fractura por fragilidad. Resultados: se identificaron 70 pacientes con fracturas por fragilidad, la edad promedio fue de 80.01 ± 10.73 años. Se encontró que 81.43% de los pacientes había sido evaluado por médico general, pero tan sólo 50% había sido educado sobre prevención de caídas. Además, el 97.14%, 95.71% y 90.0% de los pacientes cumplían criterios de tamización para osteoporosis según las guías NOF, ISCD y OSC respectivamente y sólo 11.43% habían sido tamizados. Conclusión: las fracturas por fragilidad son frecuentes en nuestro medio; sin embargo, los tiempos de atención e intervención son lentos y los esfuerzos en prevención tanto primaria como secundaria están siendo insuficientes.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1319).

Abstract Introduction: Osteoporosis is a disease which increases as our population ages. It is associated with a greater risk of fragility fractures, leading to a loss of independence, chronic pain and even death. In order to avoid these complications, it is important to describe the population diagnosed with fragility fractures and determine if patients at risk for or diagnosed with osteoporosis are being screened and managed appropriately. Materials and methods: A prospective study of patients hospitalized due to fragility fractures in a tertiary care hospital from March-September 2018. The patients were described according to clinical and sociodemographic variables, and screening criteria from various guidelines were applied to determine if patients with fragility fractures are being adequately screened and managed. Results: Seventy patients with fragility fractures were identified, with an average age of 80.01 ± 10.73 years. Of these, 81.43% had been seen by a general practitioner, but only 50% had been educated on fall prevention. In addition, 97.14%, 95.71% and 90.0% of these patients met the osteoporosis screening criteria according to the NOF, ISCD and OSC guidelines, respectively, and only 11.43% had been screened. Conclusion: Fragility fractures are common in our setting. However, turnaround times for care and intervention are long and both primary and secondary prevention efforts are currently insufficient.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1319).

Parâmetros ósseos de codornas de corte suplementadas com diferentes níveis de vitamina A, de 15 a 35 dias de idade / [Parameters of bone of meat-type quail supplemented with different levels of vitamin A from 15 to 35 days of age]

Avaliou-se o efeito da utilização de níveis crescentes de vitamina A sobre os parâmetros ósseos de codornas de corte de 15 a 35 dias de idade. Foram utilizadas 1520 codornas, não sexadas, com peso médio inicial de 85±4,25g, distribuídas em um delineamento inteiramente ao acaso, totalizando oito tratamentos com cinco repetições e 38 codornas por unidade experimental. Os tratamentos consistiram de oito níveis de suplementação de vitamina A (0; 4.500; 6.000; 7.500; 9.000; 10.500; 12.000 e 13.500UI/kg da dieta). O período experimental foi de 15 a 35 dias de idade. Os ossos analisados apresentaram uma redução linear para o índice de Seedor, resistência óssea e teor de cinzas do fêmur e da tíbia de acordo com os níveis de suplementação de vitamina A. A suplementação de vitamina A para codornas de corte de 15 a 35 dias de idade mostrou resultados negativos para a qualidade óssea, com a necessidade de mais estudos sobre seu antagonismo com a vitamina D.(AU)

This study evaluated the effect of using increasing levels of vitamin A on bone parameters in meat-type quails from 15 to 35 days old. A total of 1520 unsexed quail with an average initial weight of 85g distributed in a completely randomized design, totaling eight treatments with five replicates and 38 quails per experimental unit were used. The treatments consisted of eight vitamin supplementation levels A (0; 4,500; 6,000; 7,500; 9,000; 10,500; 12,000 and 13,500IU / kg diet). The experimental period was 15 to 35 days of age. The bones analyzed showed a linear reduction to the Seedor index, bone strength and ash content of the femur and tibia according to vitamin supplementation levels Vitamin A supplementation for cutting quails from 15 to 35 days of age showed negative results for bone quality, with the need for more studies on its antagonism to vitamin D.(AU)

Factores biológicos relacionados con la masa ósea en hombres de edad mediana / Biological Factors Associated to Bone Mass in Middle-Aged Men

RESUMEN Introducción: La osteoporosis masculina es una enfermedad clínica heterogénea y subdiagnosticada, con múltiples factores de riesgo. Requiere un proceso de diagnóstico en ocasiones más complejo que en las mujeres. Objetivo: Identificar factores biológicos relacionados con la masa ósea en hombres de edad mediana. Métodos: Se realizó estudio descriptivo, transversal, en 43 hombres de edad mediana (40-59 años) entre abril de 2017 y mayo de 2018, que fueron atendidos en el Policlínico Universitario Vedado. Se estudiaron los antecedentes patológicos familiares (APF) de osteoporosis masculina o fracturas por fragilidad, índice de masa corporal (IMC), circunferencia de la cintura (CC), presión arterial (PA), glucemia, colesterol, triglicéridos, creatinina, hormona luteinizante, folículo estimulante, estradiol, testosterona (T), prolactina y paratohormona (PTH) y densitometría dual de Rx (DXA). Según edad y resultado de la DXA, se crearon 4 grupos (de 40-49 y de 50-59 años, en L1-L4 y fémur). Se identificaron hombres con hueso normal y mala masa ósea (MMO). Se determinaron distribuciones de frecuencia (variables cualitativas), y mediana y rango (cuantitativas). Se empleó chi cuadrado para determinar relación entre variables cualitativas y Mann-Whitney para cuantitativas. Para establecer correlación entre variables cuantitativas, se calculó el test de Pearson. Resultados: En hombres de 50-59 años, con antecedentes patológicos familiares de fracturas por fragilidad, predominó la mala masa ósea (75 por ciento). La mediana del índice de masa corporal en hombres de 40-49 años fue mayor (26,7 Kg/m2sc) en los que tenían hueso normal en L1-L4; en los de 50-59 años con aumento de la circunferencia de la cintura predominó la mala masa ósea (3; 75 por ciento). La presión arterial sistólica y diastólica se correlacionaron positivamente con la densidad mineral ósea en L1-L4 ([r = 0,225; p = 0,009], [r = 0,263; p = 0,002]). Hubo correlación positiva entre colesterol y contenido mineral óseo en fémur (r = 0,164; p = 0,002). La testosterona resultó más baja en hombres con hueso normal (40-49 años: 15,3 nmol/L; 50-59 años: 12,5 nmol/L). Se observó correlación negativa entre paratohormona y contenido mineral óseo en fémur (r = -0,324; p = 0,000). Conclusiones: Se puede concluir que, de los factores biológicos estudiados en los hombres de edad mediana del Policlínico Universitario Vedado, los niveles más elevados de presión arterial y colesterol, y más bajos de paratohormona, se asociaron con mejor masa ósea(AU)

ABSTRACT Introduction: Male osteoporosis is a heterogeneous and underdiagnosed clinical condition and with multiple risk factors, which requires a diagnostic process that is sometimes more complex than for women. Objective: To identify biological factors related to bone mass in middle-aged men from "Vedado" University Polyclinic. Methods: A cross-sectional and descriptive study was carried out with 43 middle-aged (40-59 years old) men, between April 2017 and May 2018. The variables were family pathological history of osteoporosis or fragility fractures, body mass index, waist circumference, blood pressure, glycemia, cholesterol, triglycerides, creatinine, luteinizing hormone, stimulating follicle, estradiol, testosterone, prolactin and parathyroid hormone, and dual x-ray densitometry. According to age and results of the dual x-ray densitometry, four groups were created (40-49 and 50-59 years old, in L1-L4 and femur). The men with normal bone and poor bone mass were identified. Frequency distributions (qualitative variables), as well as median and range (quantitative variables) were determined. The chi-square test was used to determine the relationship between qualitative variables, and the Mann-Whitney test was used for quantitative variables. To establish correlation between quantitative variables, the Pearson test was used. Results: Among men aged 50-59 years and with a family pathological history of fragility fractures, poor bone mass prevailed (75 percent). The median body mass index among men aged 40-49 years was higher (26.7 kg/m2sc) in those with normal bone in L1-L4; among those aged 50-59 years and with increased waist circumference, poor bone mass predominated (3; 75 percent). Systolic and diastolic blood pressure were correlated positively with bone mineral density in L1-L4 [(r = 0.225, p = 0.009), (r = 0.263, p = 0.002)]. There was a positive correlation between cholesterol and bone mineral content in the femur (r = 0.164, p = 0.002). T was lower among men with normal bone (15.3 nmol/L for the group 40-49 years old, and 12.5 nmol/L for the group 50-59 years old). A negative correlation was observed between the parathyroid hormone and bone mineral content values in the femur (r = -0.324, p = 0.000). Conclusions: Among the biological factors studied in middle-aged men from "Vedado" University Polyclinic, higher levels of blood pressure and cholesterol, as well as lower levels of the parathyroid hormone were concluded to be associated with better bone mass(AU)

Posición oficial ISCD 2019: Densitometría ósea en adultos. Puesta al día sobre las nuevas recomendaciones / ISCD 2019 Official Position: Bone Densitometry in Adults. Update on new recommendations

La Sociedad Internacional de Densitometría Clínica convoca una Conferencia de Desarrollo de Posición para hacer recomendaciones sobre los estándares en el campo de la densitometría ósea. Este año 2019 fueron publicadas las nuevas posiciones oficiales en adultos sobre salud ósea. Los temas considerados incluyeron cuestiones técnicas y clínicas relevantes para la absorciometría de rayos X de energía dual (DXA), otras tecnologías para evaluación ósea que no son DXA central, la evaluación de fracturas vertebrales, regiones de interés, mediciones seriales densitométricas, evaluación de imágenes en perfil, trabecular bone score. Este año agregan la utilidad de DXA para detectar anormalidades en el espectro de las fracturas atípicas de fémur, en pacientes con injuria en médula espinal, y la posición en pacientes transgénero e individuos no conforme a su género. Otros temas abordados son la realización de calibración cruzada con DXA, mínimo cambio significativo y la evaluación de la salud ósea en ortopedia y evaluación periprotésica.

The International Society for Clinical Densitometry (ISCD) convenes a Position Development Conference (PDC) to make recommendations for standards in the field of bone densitometry. This year the new official positions in pediatric bone health were published. Topics considered included relevant technical and clinical issues for dual energy X-ray absorptiometry (DXA), other bone evaluation technologies other than central DXA and the evaluation of vertebral fractures, interest of regions, serial densitometric scan, DXA utility in evaluation of atypical femur fractures, evaluation in patients with spinal cord injury, and the official position in transgender and gender non-conforming individuals. Other topics are DXA cross-calibration and least significant change, and peri-prosthetic and orthopedic bone health.

Riesgo de fracturas osteoporóticas en adultos mayores / Risk for Osteoporotic Fractures in Aged Adults

Introducción: La medición del Fracture Risk Assessment Tool - FRAX® es útil en Atención Primaria de Salud para evaluar el riesgo de fractura. Objetivo: Determinar el riesgo de fractura osteoporótica en adultos mayores. Métodos: Se realizó un estudio descriptivo de corte transversal, con una muestra de 54 adultos pertenecientes al grupo Club Nueva Vida de la Ciudad de Tunja, primer semestre de 2018, seleccionados por medio de un muestreo no probabilístico a conveniencia. Se empleó la herramienta FRAX®, propuesta por la Organización Mundial de la Salud y se realizó un análisis estadístico con el Chi2 de Pearson y la Razón de Prevalencia. Resultados: El factor de riesgo con mayor presencia fue la osteoporosis secundaria en 51,9 por ciento, donde 13 por ciento reporta FRAX®+ para probabilidad a 10 años de fractura mayor osteoporótica y 14,8 por ciento obtuvo FRAX®+ para probabilidad a 10 años de fractura de cadera sin densitometría ósea. Conclusiones: El FRAX®, es una herramienta útil en la prevención de problemas de salud resultado de fracturas que conllevan a alteraciones en la capacidad funcional y el movimiento(AU)

Introduction: The measurement of the Fracture Risk Assessment Tool - FRAX® is useful in primary healthcare for assessing the risk of fracture. Objective: To determine the risk of osteoporotic fracture in older adults. Methods: A descriptive and cross-sectional study was carried out, with a sample of 54 adults belonging to the Club Nueva Vida group of the City of Tunja, first semester of 2018, selected by means of a nonprobabilistic sampling at convenience. The FRAX® tool, proposed by the World Health Organization, was used, and statistical analysis was performed with Pearson's Chi2 and the prevalence ratio. Results: The risk factor with the highest presence was secondary osteoporosis in 51.9 percent, where 13 percent reported FRAX® + for a 10-year probability of major osteoporotic fracture and 14.8 percent obtained FRAX®+ for a 10-year probability of hip fracture without bone densitometry. Conclusions: FRAX® is a useful tool in the prevention of health problems resulting from fractures that lead to alterations in functional capacity and movement(AU)

Salud ósea en personas transgénero / Bone health in transgender subjects

Una persona transgénero es aquella en la cual el género autopercibido difiere del asignado al nacer, mientras que el término cisgénero es utilizado en aquellos individuos no trans. El tratamiento hormonal cruzado (THC) constituye una opción para lograr caracteres sexuales secundarios deseados. Es conocido que los esteroides sexuales desempeñan un rol fundamental en la adquisición de la densidad mineral ósea (DMO) durante la pubertad. Por lo tanto, el impacto del THC sobre la masa ósea se ha convertido en materia de estudio. En estadios puberales tempranos, los análogos de la hormona liberadora de gonadotrofinas (GnRH) son utilizados con un efecto reversible. Si bien la DMO parece mantenerse estable, cuando se compara con una población de referencia del mismo sexo biológico y edad, el Z-score se encuentra por debajo de lo esperado. En adultos, durante el THC no se informaron disminuciones en la DMO. Está reportado que las mujeres trans antes del inicio del TH presentan características densitométricas diferentes de los hombres cisgénero. Hasta el momento, la carga de datos para los calculadores del riesgo de fractura y el software del equipo DXA se basan en el sexo biológico y no en identidad de género. Recientemente, la International Society for Clinical Densitometry (ISCD) emitió sus recomendaciones para la evaluación de la masa ósea en personas transgénero y en aquellos individuos no conformes con el género. Si bien la ISCD sugiere realizar la evaluación únicamente en aquellos pacientes con factores de riesgo, es de importancia realizar DXA basal, sobre todo en mujeres transgénero, para determinar el riesgo inicial de dicha población. En este artículo se revisa la evidencia disponible sobre el impacto del THC en la salud ósea de personas transgénero. (AU)

Cross sex hormone therapy (CSHT) in transgender women (TW) it is an option to achieve desired secondary sexual characteristics. It is known that sex steroids play a fundamental role in the acquisition of bone mineral density during puberty, in addition to determining a different characteristic bone pattern between both biological sexes. So the impact of affirming HT on bone is it has become in subject of study. In early pubertal stages, GnRH analogs are used with a reversible effect. Although bone mineral density (BMD) seems to remain stable, when compared with a reference population of the same biological sex and age, the Z-score is lower than expected. In adults, during CSHT no decreases in BMD were reported. However, it was reported that TW prior to starting CSHT present different densitometric characteristics than cisgender men. So far, the data load for the fracture risk calculators and DXA software is based on biological sex and not gender identity. Recently the ISCD issued its recommendations for the evaluation of bone mass in transgender subjects and in those non-conforming to gender. Although the ISCD suggests performing the evaluation only in those patients with risk factors, our group recognizes that baseline DXA, especially in TW, constitutes a useful tool to determine the initial risk of this population. Our proposal arises from our own experience and from that compiled in the international literature, where it is observed that even without starting CSHT, transgender women have lower BMD. DXA. This article reviews the available evidence regarding the effect of CSHT on health bone in transgender people. (AU)

Diabetes mellitus tipo 2: cambios densitométricos del cristalino / Type 2 diabetes mellitus: lens densitometric changes

La diabetes mellitus es la responsable de la quinta parte de todas las cataratas, el sistema de cámara rotatoria scheimpflug permite estudiar a profundidad los primeros cambios en la densidad de estos cristalinos, estableciendo valores densitométricos en pacientes con Diabetes Mellitus tipo 2, con buena agudeza visual sin retinopatía diabética, y comparar dichos valores con un grupo control sin la enfermedad, desde junio de 2017 hasta marzo de 2018. Métodos: se realizó un estudio comparativo, exploratorio y prospectivo, la población y muestra estuvo compuesta por pacientes que acudieron a la consulta oftalmológica del Hospital Domingo Luciani. Resultados: todos los valores densitométricos fueron mayores en los pacientes con diabetes que en los normales. La mayor diferencia se produce en los valores del núcleo, seguido de la cápsula anterior acercándose a la significancia estadística (p=0,02) y (p=0,01) respectivamente. El 75% de los pacientes con diabetes presentaron cambios importantes en densitometría de la cápsula anterior y el 40% en el núcleo. Conclusiones: la cápsula anterior en pacientes con diabetes de menor edad (50 a 60 años) presentó valores más elevados de densitometría con relación a los controles. En los grupos de 61 a 70 y 71 a 80 los valores fueron menores; se concluye que los cambios tempranos en la cápsula anterior se deben a la diabetes. En cuanto al núcleo se observó en el grupo control un incremento progresivo de la densidad a medida que iba aumentando la edad, pero al agregarse el factor diabetes, aumentaron notablemente los valores, acentuando de esta manera la evolución de la catarata senil. La diabetes altera precozmente la densidad de la capsula anterior y núcleo(AU)

Diabetes mellitus is responsible for one fih of all cataracts, the scheimpflug rotary chamber system allows to study in depth the first changes in the density of these lenses, establishing densitometric values in patients with Type 2 Diabetes Mellitus, with good visual acuity without diabetic retinopathy, and compare these values with a control group without the disease, from June 2017 to March 2018. Methods: a comparative, exploratory and prospective study was carried out, the population and sample was composed of patients who attended the ophthalmological consultation of the Domingo Luciani Hospital. Results: all densitometric values were higher in diabetic patients than in normal patients. The greatest difference occurs in the nucleus values, followed by the anterior capsule approaching the statistical significance (p = 0.02) and (p = 0.01) respectively. 75% of diabetic patients presented significant changes in densitometry of the anterior capsule and 40% in the nucleus. Conclusions: the anterior capsule in diabetic patients with younger age (50 to 60 years) presented higher values of densitometry compared to non-diabetics. In the groups of 61 to 70 and 71 to 80 the values were lower; We conclude that the early changes in the anterior capsule are due to diabetes. As for the nucleus, a progressive increase in density was observed in the control group as the age increased, but when the diabetes factor was added, the values increased markedly, thus accentuating the evolution of the senile cataract. Diabetes precociously alters the density of the anterior capsule and nucleus(AU)

Posición oficial ISCD 2019. Densitometría Ósea en pediatría. Puesta al día sobre las nuevas recomendaciones / ISCD 2019 official position. Bone Densitometry in pediatrics. Update on new recommendations

La Sociedad Internacional de Densitometría Clínica convoca una Conferencia de Desarrollo de Posición para hacer recomendaciones sobre los estándares en el campo de la densitometría ósea. Este año 2019 fueron publicadas las nuevas posiciones oficiales en pediatría sobre salud ósea. Los temas considerados incluyeron cuestiones técnicas y clínicas relevantes para la absorciometría de rayos X de energía dual (DXA), otras tecnologías para evaluación ósea que no son DXA central y la evaluación de fracturas vertebrales. Además de la utilidad de columna lumbar y cuerpo entero excluyendo cabeza, este año agregan la utilidad de DXA en sitios periféricos en niños y adolescentes.

The International Society for Clinical Densitometry (ISCD) convenes a Position Development Conference (PDC) to make recommendations for standards in the field of bone densitometry. This year 2019 the new official positions in pediatric bone health were published. Topics considered included relevant technical and clinical issues for dual energy X-ray absorptiometry (DXA), other bone evaluation technologies other than central DXA and the evaluation of vertebral fractures. In addition to the utility of the lumbar spine and total body less head, this year the recommendations add the utility of DXA in peripheral sites in children and adolescents

Factores relacionados con la masa ósea en hombres de edad mediana / Factors related to bone mass in middle-aged men

RESUMEN Introducción: La osteoporosis representa un problema de salud debido al impacto en la morbilidad, mortalidad, calidad de vida y altos costos. Los factores de riesgo asociados a la osteoporosis han sido poco abordados en hombres cubanos. Objetivo: Determinar la masa ósea y su posible relación con factores sociodemográficos y del estilo de vida en hombres de edad mediana del Policlínico Universitario "Vedado". Métodos: Se realizó un estudio descriptivo transversal que incluyó hombres de edad mediana. De la planilla de recolección de datos se extrajeron: sociodemográficos, estilo de vida y elementos del examen físico. Se realizó densitometría para determinar la masa ósea. Se crearon 4 grupos (de 40-49 y de 50-59 años en L1-L4 y fémur, solo se analizó L1-L4), se determinaron las personas con hueso normal y mala masa ósea (MMO) y se asociaron con los factores de riesgo. Resultados: En los hombres estudiados predominó el hueso normal: L1-L4 (27 = 62,8 por ciento) y fémur (38 = 88,4 por ciento). En los hombres entre 50-59 años, el 85,7 por ciento de los que tenían piel mestiza presentaron MMO, el 100 de los que tenían piel blanca y el 83,3 por ciento de los de piel negra, tuvieron hueso normal (p = 0,017). En los dos grupos, se observó un predominio del hueso normal, en los que tenían alimentación adecuada (100 por ciento) y aceptable (66,6 por ciento). En los de 40-49 años que realizaban actividad física, predominó el hueso normal; de 50-59 la mala masa ósea (6 = 60 por ciento). En ambos grupos, los que consumían bebidas alcohólicas y fumaban, predominaron en el grupo con hueso normal. Conclusiones: La mayoría de los hombres estudiados tenían masa ósea normal, la afectación fue mayor en L1-L4. La mayor edad y el color de piel mestiza, en hombres de 50-59 años, se asociaron con mayor daño óseo; factores del estilo de vida no se relacionaron con la masa ósea(AU)

ABSTRACT Introduction: Osteoporosis represents a health problem due to the impact on morbidity, mortality, quality of life and high costs. The risk factors associated with osteoporosis have been poorly addressed in Cuban men. Objective: To determine the bone mass and its possible relationship with sociodemographic and lifestyle factors in middle-aged men at Vedado University Polyclinic. Methods: A descriptive cross-sectional study was carried out in middle-aged men. From the data collection form were extracted sociodemographic, lifestyle and physical examination elements. Densitometry was performed to determine bone mass. Four groups (40-49 and 50-59 years in L1-L4 and femur were created, only L1-L4 was analyzed). People with normal bone and poor bone mass were identified and associated with risk factors. Results: Normal bone predominated in the studied men, L1-L4 (27 = 62.8 percent) and femur (38 = 88.4 percent). 85.7 percent between 50-99 years with meztizo skin color presented poor bone mass. Normal bone was evidenced in white and black skin subjects (100 and 83.3 percent) (p = 0.017). In both groups, predominance of normal bone was observed in those with adequate (100 percent) and acceptable diet (66.6 percent). In those 40-49 year-old subjects who had physical activity, normal bone predominated; but in those 50-59 year-old subjects, bad bone mass predominated (6 = 60 percent). In both groups, normal bone predominated in those who consumed alcoholic beverages and smoked in both groups. Conclusions: Most of the men studied had normal bone mass, the affectation was greater in L1-L4. Older age and mestizo skin color in 50-59 year-old men were associated with greater bone damage. Lifestyle factors were not related to bone mass(AU)

Incidencia de diagnóstico y tratamiento de la osteoporosis en pacientes con fractura de radio distal / Diagnosis and treatment incidence of osteoporosis in patients with distal radius fracture

Introducción: Las fracturas de radio distal en pacientes mayores son un indicador de osteoporosis. El objetivo de este estudio fue determinar el diagnóstico y el tratamiento de la osteoporosis en pacientes con fractura de radio distal, operados en nuestra institución, entre 2012 y 2014. Materiales y Métodos: Los datos se obtuvieron de entrevistas telefónicas a 41 pacientes mayores, operados por fracturas de radio distal. Las variables evaluadas fueron: sexo, edad, enfermedades asociadas, tabaquismo, fracturas previas, tratamiento antiosteoporótico previo o posterior a la fractura en cuestión, especialidad del médico que solicitó el tratamiento y realización o no de densitometría mineral ósea. Resultados: La muestra incluyó a 41 pacientes (32 mujeres). Veintiséis contaban con una densitometría antes de la fractura (15 con osteoporosis), 11 habían sufrido una fractura por osteoporosis, y sólo 7 recibían tratamiento antiosteoporótico cuando ocurrió la fractura. Luego de la cirugía, solo 4 de ellos continuó con el tratamiento. Se encontró cierta asociación entre una densitometría patológica y la presencia de diabetes tipo 2, no así con otras comorbilidades. La tasa de incidencia anual de osteoporosis, calculada entre todos los pacientes que se atendieron en nuestra institución, en 2014, fue alrededor del 1%. Los traumatólogos solicitaron el 1,5% de todas las densitometrías prescritas dicho año. Conclusiones: Este estudio sugiere que los traumatólogos que se desempeñan en nuestra institución tienen nula o poca participación en la prevención secundaria de la osteoporosis; por esta razón, se consideraría necesario un protocolo de prevención de fracturas secundarias a la osteoporosis. Nivel de Evidencia: IV

Introduction: Distal radius fractures in elderly patients are an indicator of osteoporosis. The aim of this study was to determine osteoporosis diagnosis and treatment rates in patients with distal radius fractures treated surgically at our institution between 2012 and 2014. Methods:Information of 41 patients who underwent surgical intervention for distal radius fracture was obtained through telephone interviews. There were several variables evaluated-age, sex, smoking, comorbidities, previous fractures, preoperative and postoperative osteoporosis treatments, specialty of the physicians prescribing osteoporosis treatment, and a DEXA scan performed. Results: The study included 41 patients (32 women). Twenty-six of them had a DEXA scan performed before the fracture (15 patients evidenced osteoporosis), 11 had suffered previous fractures secondary to osteoporosis. Only 7 patients were under osteoporosis treatment at the moment of the fracture. After surgery, only 4 patients continued treatment. Pathological DEXA scan results had certain degree of association with the presence of type 2 diabetes, but not with other comorbidities. The annual incidence rate of osteoporosis, calculated using all patients served at our institution in 2014, was about 1%. Orthopedic surgeons accounted for only 1.5% of the total number of DEXA scans prescribed that year. Conclusions: Our study suggests that there is poor prevention by orthopedic surgeons of secondary osteoporotic fractures, which is why a national prevention protocol for fractures secondary to osteoporosis would be necessary. Level of Evidence: IV