Tendencia de las tasas de fracturas de cadera en 12 años en Chile: ¿aumento independiente del envejecimiento poblacional? / Twelve years tendency of hip fracture rates in Chile: is there an increase independent of population aging?

All hospital discharges that occurred in Chile from 1982 to 1993 were analyzed, looking for the diagnosis of hip fracture. National censuses in the same period were also analyzed searching for possible changes in the age structure of the population. Fracture rates were analyzed for three age groups, and changes along the years were calculated correlating the rates with the number of the year. Results: In the twelve year period, women aged 55-64 years old had a correlation of 0.32 (NS), women aged 65-74 years old had a correlation of 0.58 (NS) and women aged over 75 years old had a correlation of 0.95 (p < 0.001). This age group corresponded to 2.01 percent of the whole population in 1982 and to 2.52 percent in 1993. The mean age of the group increased from 80.7 to 80.9 years in the same lapse. Conclusions: Fracture rates increased in the 12 years period studied, specially among women older than 75 years old. During the same period the proportion of people over 75 years old also increased, but there was only a slight increase in its mean age. Thus, the increase in fracture rates is disproportionate to population againg and could be related to changes in lifestyles

Osteoporosis en hombres menores de 65 años manifestada por aplastamiento vertebrales: ¿idiopática o secundaria? / Osteoporosis in men under 65 years old manifested by vertebral squashing: idiopathic or secondary?

Osteoporosis in young or middle age men is unusual and requires an extensive diagnostic work-up. To report a retrospective review of nine men with osteoporosis aged 27 to 61 years old (mean 39), that presented with primary diagnosis of osteoporosis, were reviewed. Subjects were subjected to a diagnostic work-up 5 years after the onset of symptoms. Their body mass index ranged from 21.7 to 26.3 kg-m2, all had vertebral fractures (crush fractures in 8 and a biconcave deformity in one) between T4 and L4 and all had normal serum calcium, phosphate, alkaline phosphatase and cretinine. Four patients had a history of neprholithiasis and 3 had hypercalciuria. Bone density, measured in 7 patients with a dual photon densitometer, showed a mean Z score of -2.0 in the spine and -2.2 in the femoral neck. The final diagnoses of these patients were Cushing's disease in 2, malabsorption syndrome in 1, use of phenobarbital and hydantoin in 1, over renal hypercalciuria with low calcium intake in 1 and alcoholic liver disease in 1. In 3 patients, osteoporosis was considered idiopathic. Of these, 2 had moderate absorptive hypercalciuria as a presumible risk factor. Six of the 9 studied male patients with osteoporosis had an underlying cause and in three, this condition was considered idiopathic

Determinación de los niveles séricos de 25-hidroxivitamina D y sus variaciones estacionales en una población normal joven / Determination of 25-hydroxyvitamin D serum levels and its seasonal variations in a healthy young population

25-hydroxyvitamin D has a longer half life and its serum levels have less daily variations than calcitrol. Thus, its measurement is a better indicator of vitamin D status. Vitamin D was measured using a competitive protein binding radioassay in 61 subjects (27 males) aged 21 to 57 years old, during july to august (winter) and february and march of the next year (summer). 25-hydroxyvitamin levels were 28.8ñ1.5 and 30.9ñ2.3 ng/ml during winter and summer respectively. No differences were found between men and women. Ninety five percent confidence levels were between 13 and 50 ng/ml. Levels in 1 patient with malabsorption were 9.3 ng/ml, in 2 patients with hypophosphemic osteomalacia were 2.1 and 9.3 ng/ml, in 12 patients with alcoholic cirrhosis were 16.4ñ1.3 ng/ml, in 4 patients with primary osteoporosis were 23.3ñ0.7 and in 3 patients receiving vitamin D were 334ñ33.2 ng/ml. Normal levels of 25-hydroxyvitamin D range from 13 to 50 ng/ml in normal adults, there are no differences between men and women and seasonal variations are minimal

Evaluación del compromiso óseo en alcohólicos intermitentes y continuos, sin daño hepático evidente / Assessment of bone compromised in intermitent and continuing alcoholics without hepatic damage

The effect of chronic alcoholism on bone mass and density has been a subject of considerable controversy. The goal of the present study was to evaluate bone mineral content and density in 2 groups of alcoholic men without evidence of liver damage and determine if the modality of alcohol consumption could cause an alcohol-mediated bone loss. We studied 70 alcoholic non cirrhotic men divided into intermittent (n=38) and continuos (n=32) drinkers. They were compared to 109 normal men. Dual photon densitometry technique using a Gd 153 source was utilized and bone mineral density (BMD) of lumbar spine, femoral neck, Ward's triangle, trochanter, total body bone density (TBBD) and mineral (TBBM) were measured. Hematologic, serum and urinary tests of mineral metabolism were also carried out. No significant differences were found in lumbar spine BMD between normals and alcoholics regardless of the type of alcohol consumption and duration of alcoholism. In the femoral neck, a significant decrease in BMD was found in alcoholics when plotted as regression curves (r=25;p=0,02). In this site duration of alcoholism was significantly correlated to decreased BMD in the total group of alcoholics (r=0,27;p=0,02) and also in the continuous drinker group (r=0,40;p=0,02) when considered duration of alcohol abuse. Total bone mineral was significantly lower in alcoholics (p<0.001) and the subgroups compared to normals and correlated with duration of alcohol abuse (p=0,01). Chemical values revealed normal calcium, phosphorus, alkaline phosphatases, PTH and Ca/Cr concentration. Only serum magnesium was found disminished in 16,6 percent of studied subjects. We conclude that pure alcoholism may affect femoral neck density and total body mineral content, being proportional to the duration of alcohol abuse. Spine density appears unaffected. The type of alcoholic abuse was less important than its duration to cause bone mass abnormalities

Fractura de la cadera: estudio de casos y controles en la región metropolitana I / Hip fracture: study of cases and controls at metropolitan region I

Hip fracture is a preventable cause of disability among elderly people. To study factors associated to hip fractures in Chile. Patients admitted to seven public hospitals in Chile, whith hip fracture not due to major accidents, were considered as cases. To each, at least one age and sex matched hospitalized control, without or neoplasic diseases, was assigned. All patients were subjected to an inquiry, using an instrument devised by the WHO. Two hundred sixty eight cases and 501 controls were studied. Cases and controls has similar educational and labor histories. The right hip was fractures in 47 percent of cases and the left in the rest. Compared with controls, cases had a higher body mass index; loss of height during life, rate of hysterectomy, incidence of smoking and a lower consumption of diary products. Cases had a higher risk of falls inside their homes and controls outside. The obtained information may contribute to the development of preventive measures and reduce the public health impact of hip fracture

Citoquinas, factores de crecimiento y enfermedad ósea metabólica / Cytokines, growth factors and metabolic bone disease

Cytokines are polypeptides that bind to membrane receptors and may act in an endocrine, paracrine or autocrine way. Several cytokines and growth factors may be produced by bone cells, stored in the matrix or act on them. Osteoclast derive from the bone marrow stem cell and, as monocytes, belong to the family of tissue macrophages. Their specific function is bone resorption. Interleukin 1, 6 and 11, transforming growth factor and tumor necrosis factor stimulate osteoclast mediated bone resorption. Interleukin 1 is the most potent bone resorption agent and seems to be identical to osteoclast activation factor, identified in multiple myeloma. The role of interleukin 1, 6 and 11 and tumor necrosis factors in postmenopausal osteoporosis triggered by the fall in estrogen levels, has not been well defined yet. Cytokines that increase bone formation are insulin like growth factors I and II, transforming growth factor, platelet derived growth factor and bone morphogenic proteins. Probably, tumor necrosis factor and interferon-ç have a depressor effect on bone formation. Cytokines and growth factors, liberated from bone cells or from the matrix during osteoclastic work, could be the signals responsible for coupling bone formation and resorption

Nódulo tiroídeo en enfermedad de Basedow Graves y cáncer tiroídeo: experiencia en 6 pacientes / Thyroid nodules in Basedow Graves disease and thyroid cancer: experience in 6 patients

Traditionally, Basedow graves disease was considered a protection against cancer. However, recent reports suggest that cancer occurs with a higher frequency than expected and is more aggressive in this disease. We report six patients with hyperthyroidism due to a Basedow Graves disease that presented a palpable thyroid nodule, which was cold in the scintiscan and solid in the ultrasound examination. Fine needle cytology disclosed cancer in 5 cases (2 with cytological features of greater aggressiveness) and a nodular hyperplasia in one. The diagnosis was confirmed in the surgical piece in all patients. We conclude that Basedow Graves disease and thyroid cancer, which can have an increased aggressiveness, may coexist

Osteopenia en cirrosis biliar primaria: estudio en 20 pacientes / Osteopenia in primary biliary cirrhosis: study in 20 patients

We studied 20 female patients, aged 51 ñ 13.6 years old, with the diagnosis of Primary Biliary Cirrhosis (PBC) to assess osteopenia, main involved sites and its relation to menopause, some parameters of mineral metabolism and the degree of histological liver involvement. The diagnosis of PBC was based in histological, clinical and laboratory features. Bone densitometry was measured with dual-photon densitometer and compared with values of a normal female population from the laboratory. When compared to controls, studied patients had a significantly lower lumbar spine bonedensity and total bone mineral content and a non significantly lower density in femoral neck and total body. Serum calcium, phosphorus, magnesium, PTH and urinary calcium/creatinine ratio were within normal limits. Lumbar spine density was no significantly lower in patients with more severe liver histological involvement and in postmenopausal women. No correlation was found between the duration of postmenopausal period and the degree of osteopenia. It is concluded that patients with PBC have a clear lumbar spine osteopenia and a lower total mineral content and that these parameters worsen in a non significant fashion in subjects along with liver histological involvement and with the length of post menopausal period

La osteoporosis y su incidencia en la rehabilitación protésica / Osteoporosis and it incidence in prosthesis rehabilitation

Se estudió la presencia de áreas radiolúcidas mandibulares en una muestra de 24 pacientes con diagnóstico de osteoporosis, de sexo femenino, mediante una ortopantomografía (RX Panorámica). En estos pacientes es posible apreciar algún grado de rarefacción ósea detectable a la radiografía y que el odontólogo, al pesquizar, debe interconsultar al médico especialista y tomar las medidad pertinentes cuando efectúe la rehabilitación. Se establece el tamaño y la ubicación mas frecuente de las áreas radiolúcidas mandibulares, además de su relación con el grado de densidad ósea lumbar y femoral