Vitamin D deficiency and high serum levels of vitamin A increase the risk of osteoporosis evaluated by Quantitative Ultrasound Measurements (QUS) in postmenopausal Spanish women.

OBJECTIVES: Association between vitamin D deficiency and excess of vitamin A as a potential risk factor of osteoporosis and fracture has been evaluated. DESIGN AND METHODS: 232 healthy postmenopausal women were studied. Serum parameters were analyzed by standard methods and fat-soluble vitamins by an own HPLC method. QUS measurement of the calcaneal bone was carried out by Sahara. RESULTS: 124 patients were considered non-osteoporotic and 101 (44.9%) were osteoporotic. The prevalence of high serum levels of retinol was 36.4% and vitamin D deficiency was 70.1%. 60.4% of women with vitamin D deficiency have high serum levels of retinol. In the whole population, the increased risk of osteoporosis was up to three times higher for the highest retinol quintile, as compared with the lowest retinol quintile. Whereas in women with vitamin D deficiency the risk of osteoporosis increased was up 5 times higher than women in the lowest quintile of retinol. CONCLUSIONS: Our results show that high retinol levels together with vitamin D deficiency are hitherto an overlooked risk factor for osteoporosis.

Actualización en Medicina de Familia. Condicionantes de la efectividad de un tratamiento farmacológico en la osteoporosis. Adherencia y cumplimiento / Up-date in Family Medicine. Conditioning factors of the effectiveness of a drug treatment in osteoporosis. Adherence and complicance

El riesgo de fractura osteoporótica en lo que le queda de vida para una mujer de raza blanca de 50 años de edad se estima aproximadamente en un 50% y en un 20% para el varón. La alta morbilidad y mortalidad, y los costes económicos resultantes, han estimulado el desarrollo de intervenciones eficaces para reducir el riesgo de fractura. Identificar a pacientes con un mayor riesgo de fractura y garantizar la adherencia (cumplimiento y persistencia) del tratamiento instaurado, son fundamentales en el cuidado de la osteoporosis. Datos de estudios longitudinales, retrospectivos, o prospectivos demuestran que el cumplimiento y la persistencia en el tratamiento de la osteoporosis es muy pobre. En una encuesta llevada a cabo en 9.859 mujeres se observa que más de la mitad abandonan el tratamiento en los primeros 6 meses. Abandono que aumenta con el paso del tiempo. Sólo un 20% de los pacientes continúan con el tratamiento de manera ininterrumpida. El incumplimiento terapéutico, con una pobre adherencia y mínima persistencia en el tratamiento de la osteoporosis, constituye un grave problema de salud pública, que afecta negativamente al objetivo de disminución de la fractura osteoporótica. La posología de los fármacos para el tratamiento de la osteoporosis desempeña un papel importante en la adheren-cia al mismo. Cuanto más sencilla sea su administración y cuanto menor sea la frecuencia de la toma mejor será la adherencia (asumiendo que la adherencia a un tratamiento preventivo es siempre baja). La administración semanal de bifosfonatos se asocia con una mejor adherencia que la administración diaria. La administración mensual aumenta el cumplimiento y es tan eficaz como la diaria en el incremento de masa ósea y reducción de los marcadores de remodelado. Además, junto a una fácil administración del fármaco, es necesaria una información detallada al paciente, para que asuma parte de la responsabilidad de su enfermedad y en unión con el facultativo aumente la adherencia al tratamiento instaurado, incrementando la masa ósea y reduciendo el riesgo de fractura, que en definitiva, es el objetivo que perseguimos con el tratamiento de la osteoporosis

The risk of osteoporotic fracture in the remaining life time of a white 50-year-old woman is estimated to be approximately 50%, this being 20% for the man. The higher morbidity and mortality and resulting economic costs have encouraged the development of effective interventions to reduce the risk of fracture. Identifying patients with a greater risk of fracture and guaranteeing adherence (compliance and persistence) of the established treatment are essential in the treatment of osteoporosis. Data from longitudinal, retrospective or prospective studies show that compliance and persistence in the treatment of osteoporosis is very poor. In a survey conducted in 9,859 women, it was observed that more than half of the women dropped out of the treatment in the first six months. This dropout increases over time. Only 20% of the patients continue with the treatment without interrupting it. Therapeutic noncompliance, with poor adherence, and minimum persistence in the treatment of osteoporosis is a serious problem of public health that negatively affects the goal of decreasing osteoporotic fracture. The drug dosage for the treatment of osteoporosis plays an important role in its adherence. The easier its administration and the less frequent the dosage, the better the adherence, (assuming that adherence to a preventive treatment is always low). The weekly administration of biphosphonates is associated with better appearance then the daily administration. Monthly administration increases compliance and is as effective as the daily one in the increase of bone mass and reduction of remodeling markers. Furthermore, together with the easy administration of the drug, detailed information must be given to the patient in order for the patient to assume part of the responsibility for his/her disease and together with the professional increase inherence to the established treatment, increasing bone mass and reducing the risk of fracture, which is, finally, the goal we pursue with the treatment of osteoporosis

Allele-frequency determination of BsmI and FokI polymorphisms of the VDR gene by quantitative real-time PCR (QRT-PCR) in pooled genomic DNA samples.

The vdr gene is a candidate for osteoporosis susceptibility, with conflicting results in association studies. We have designed and optimized an individual allele-specific and DNA pooling PCR-based methodology to quantitate BsmI and FokI polymorphisms of the vdr gene and studied single-nucleotide polymorphisms (SNPs) from pooled DNA samples. The allele frequency in DNA pooling experiments has been analyzed by kinetic PCR: quantitative real-time PCR (QRT-PCR). A Spanish cohort of 225 healthy postmenopausal women was studied. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DEXA) and quantitative ultrasound calcaneous densitometry. Allele-specific PCR amplification of BsmI and FokI genes showed full concordance with the PCR-RFLP approach. The prevalence of the three BsmI VDR genotypes was 19.1, 44.9 and 36.0% for BB, Bb and bb, respectively. In the case of the FokI locus, the prevalence of genotypes was 40.4, 48.0 and 11.6% for FF, Ff and ff, respectively. No positive correlation was found between polymorphism and BMD. The DNA pooling procedure was validated. No differences were found in allele frequencies and T-score data obtained using the high throughput DNA pooling approach, as compared to known individual frequencies. In our hands, this is a very useful approach to study quantitative (thus polygenic) traits like osteoporosis susceptibility.