ABSTRACT
La importante prevalencia y morbimortalidad de la obesidad ha ocasionado un aumento de pacientes sometidos a cirugía bariátrica. Son numerosos los beneficios reportados de la cirugía de la obesidad en distintas esferas de la salud. Sin embargo, no ocurre lo mismo sobre el hueso, donde tiene un impacto negativo. Los mecanismos fisiopatológicos que subyacen en el deterioro del tejido óseo de estos pacientes son complejos y requieren de un estudio en profundidad. El adecuado conocimiento de estos factores permitirá adoptar las herramientas más oportunas para un adecuado abordaje terapéutico
The important prevalence and morbidity of obesity has generated an increase in bariatric surgery. It has a positive effect in obesity-related comorbidities. However, it's detrimental to bone health. The underline pathophysiological mechanisms are complex and heterogeneous. The knowledge of these factors may lead us to develop an adequate therapeutic intervention
Subject(s)
Humans , Bariatric Surgery/methods , Bone and Bones/physiopathology , Obesity/surgery , Bariatric Surgery , Bariatric Surgery/adverse effects , Obesity/epidemiology , Obesity/complications , Fractures, Bone , Dietary Supplements , Combined Modality Therapy/methods , Densitometry , Osteoporosis/drug therapyABSTRACT
The important prevalence and morbidity of obesity has generated an increase in bariatric surgery. It has a positive effect in obesity-related comorbidities. However, it's detrimental to bone health. The underline pathophysiological mechanisms are complex and heterogeneous. The knowledge of these factors may lead us to develop an adequate therapeutic intervention.
Subject(s)
Bariatric Surgery/adverse effects , Bone Diseases/etiology , Postoperative Complications/etiology , Bone Diseases/physiopathology , Bone Diseases/therapy , Humans , Postoperative Complications/physiopathology , Postoperative Complications/therapyABSTRACT
La diabetes mellitus tipo 2 es una patología con una enorme prevalencia y morbilidad, que van en aumento. La fractura osteoporótica se encuentra entre las denominadas complicaciones «no clásicas» de la diabetes y ha sido durante tiempo ignorada, tal vez por su complejo abordaje tanto diagnóstico como terapéutico. Las herramientas habituales para la prevención de la fractura por fragilidad, como el FRAX y la densitometría ósea, no han demostrado la suficiente eficacia en estos pacientes, ya que infraestiman el riesgo. Nuevas técnicas de evaluación ósea, como el trabecular bone score o los marcadores de remodelado óseo, podrían ser de utilidad, aunque requieren una mayor evidencia científica para recomendar su uso en la práctica clínica habitual. Las características especiales de su fisiopatología condicionan la aparición de fracturas sin existir alteraciones densitométricas, en lo que podemos calificar de «paradoja diabética» (AU)
Type 2 diabetes mellitus prevalence and morbidity are increasing. Osteoporotic fractures are among the non-classical complications of diabetes and been overlooked for a long time, maybe because of their complex diagnostic and therapeutic approach. The usual tools for preventing fragility fractures (such as the fracture risk assessment tool and bone densitometry) underestimate risk of fractures in type2 diabetic patients. New techniques, such as trabecular bone score or bone turnover markers, could be useful, but greater scientific evidence is required to recommend their use in clinical practice. The special characteristics of their pathophysiology result in decreased bone remodeling with normal or even increased bone mineral density, but with low quality. These changes lead to the occurrence of osteoporotic fractures without evidence of densitometric changes, which could be called the diabetic paradox (AU)
Subject(s)
Humans , Diabetes Mellitus, Type 2/complications , Osteoporosis/epidemiology , Bone Diseases, Metabolic/epidemiology , Osteoporotic Fractures/epidemiology , Risk Factors , Quality of Life , Sickness Impact Profile , Hyperglycemia/physiopathologyABSTRACT
Type 2 diabetes mellitus prevalence and morbidity are increasing. Osteoporotic fractures are among the 'non-classical' complications of diabetes and been overlooked for a long time, maybe because of their complex diagnostic and therapeutic approach. The usual tools for preventing fragility fractures (such as the fracture risk assessment tool and bone densitometry) underestimate risk of fractures in type2 diabetic patients. New techniques, such as trabecular bone score or bone turnover markers, could be useful, but greater scientific evidence is required to recommend their use in clinical practice. The special characteristics of their pathophysiology result in decreased bone remodeling with normal or even increased bone mineral density, but with low quality. These changes lead to the occurrence of osteoporotic fractures without evidence of densitometric changes, which could be called 'the diabetic paradox'.
