Socioeconomic status, osteoporosis and fragility fractures. / Estatus socioeconómico, osteoporosis y fracturas por fragilidad.

Low socioeconomic status (SES) is associated with a higher risk of fragility fractures, as well as higher mortality in the first year post-fracture. The SES variables that have the greatest impact are educational level, income level, and cohabitation status. Significant disparities exist among racial and ethnic minorities in access to osteoporosis screening and treatment. In Spain, a higher risk of fractures has been described in people with a low income level, residence in rural areas during childhood and low educational level. The Civil War cohort effect is a significant risk factor for hip fracture. There is significant geographic variability in hip fracture care, although the possible impact of socioeconomic factors has not been analyzed. It would be desirable to act on socioeconomic inequalities to improve the prevention and treatment of osteoporotic fractures.

Diferente evolución de la esclerostina sérica respecto de otros marcadores de remodelado óseo en el primer año tras un trasplante hepático / Different development of serum sclerostincompared to other bone remodeling markersin the first year after a liver transplant

Objetivo: Nuestro estudio tiene como objetivo principal valorar la evolución de los niveles de esclerostina en pacientes con trasplante hepático, e investigar su relación con otros marcadores de remodelado óseo. Material y método: Estudio observacional prospectivo. Se incluyeron 83 pacientes con trasplante hepático. Se determinaron los valores de esclerostina, β-crosslaps, fosfatasa alcalina ósea, osteocalcina y proteína C reactiva la semana anterior al trasplante y posteriormente, a los 1, 3, 6 y 12 meses. Se determinaron basalmente la 25 hidroxi-vitamina D y la paratohormona. En cada revisión se evaluó la existencia de fracturas. La evolución de los marcadores respecto del valor basal se determinó mediante la prueba t-Student. Un valor de p inferior a 0,05 se consideró estadísticamente significativo. Resultados: 56 varones y 27 mujeres (edad media: 56,2±10,4 años). Los niveles basales de esclerostina (0,76±0,35 ng/ml) disminuyeron de forma significativa precozmente (0,55±0,22 ng/ml en el primer mes, p=0,034), tendencia que se mantuvo hasta los 12 meses (0,62±0,22 ng/ml, p=0,047). Al contrario, los niveles basales de osteocalcina (17±10,3 ng/ml) y β-crosslaps (0,44±0,3 ng/ml) se incrementaron significativamente a los largo del estudio; en el caso de la osteocalcina, hasta los 12 meses (37,27±26,84 ng/ml, p<0,01) y el β-crosslaps, hasta los 6 meses (0,62±0,34 ng/ml, p<0,01), con un descenso posterior (0,47±0,31 ng/ml, p=0,2). Conclusiones: Tras el trasplante hepático existe un descenso de los niveles de esclerostina, opuesto a la elevación de otros marcadores de remodelado, β-crosslaps y osteocalcina. Son necesarios más estudios para determinar si estos cambios tienen un impacto en la aparición de osteoporosis en pacientes sometidos a trasplante

Objetive:Our main objective was to evaluate the development of sclerostin levels in patients with liver transplantation,and to investigate their relationship with other bone remodeling markers.Material and method:Prospective observational study of 83 patients with liver transplantation. Sclerostin, β‐crosslaps,bone alkaline phosphatase, osteocalcin and C‐reactive protein values were determined the week before the transplantand subsequently, at 1, 3, 6 and 12 months. The hydroxy‐vitamin D and the paratohormone were determined basally. Ineach revision, the existence of fractures was evaluated. The development of the markers compared to the baseline valuewas determined by the t‐Student test. A p‐value less than 0.05 was considered statistically significant.Results:56 men and 27 women (mean age: 56.2±10.4 years). Baseline sclerostin levels (0.76±0.35 ng/ml) decreasedsignificantly early (0.55±0.22 ng/ml in the first month, p=0.034), a trend that remained until 12 months (0.62±0.22ng/ml, p=0.047). On the contrary, the basal levels of osteocalcin (17±10.3 ng/ml) and β‐crosslaps (0.44±0.3 ng/ml) in‐creased significantly throughout the study; in the case of osteocalcin, up to 12 months (37.27±26.84 ng/ml, p<0.01) andβ‐crosslaps, up to 6 months (0.62±0.34 ng/ml, p<0.01), with a subsequent decrease (0.47±0.31 ng/ml, p=0.2).Conclusions:There is a decrease in the levels of sclerostin after liver transplantation, as opposed to the elevation ofother markers of remodeling, β‐crosslaps and osteocalcin. More studies are needed to determine if these changes havean impact on the occurrence of osteoporosis in patients undergoing transplantation

Serum Levels of Osteocalcin and Insulin Resistance in Patients with Impaired Glucose Tolerance or New-Onset Diabetes Mellitus After Liver Transplantation.

Liver transplantation (LT) patients are at high risk of developing new-onset diabetes after transplantation (NODAT). Osteocalcin has been proposed as a mediator between bone tissue and glucose metabolism, but its role in the pathogenesis of diabetes is not defined yet. Our objective was to assess the relationship between serum osteocalcin and glucose metabolism parameters in liver transplantation recipients. A total of 187 liver transplantation patients were cross-sectionally studied, 54 of them developed NODAT. None had been diagnosed of diabetes mellitus prior to transplant. In 133 nondiabetic patients, a 75 g oral glucose tolerance test (OGTT) was performed to assess blood glucose, insulin, and C-peptide levels at baseline and 120 min. Serum total osteocalcin was measured at baseline in all patients.After OGTT, 10.5% of LT patients had NODAT criteria, 51.9% showed impaired glucose tolerance, and 37.6% had normal glucose tolerance. Overall, NODAT prevalence was 36.3%. HOMA-IR was significantly higher in NODAT compared with impaired glucose tolerance and normal glucose tolerance groups (p<0.001). Osteocalcin was inversely correlated to HOMA-IR (r=- 0.16, p=0.05), BMI (r=- 0.27, p=0.000) and waist circumference (r=- 0.21, p=0.005). Patients in the lowest osteocalcin tertile (< 16.5 ng/ml) had significantly higher fasting plasma glucose and HOMA-IR index (p=0.029 and 0.037, respectively) than those in medium or highest tertiles. In multiple linear regression analysis, osteocalcin was negatively associated with fasting plasma glucose (standardized ß coefficient-0.16; p=0.041) and 2-h insulin (standardized ß coefficient-0.21; p=0.028). Prevalence of NODAT/impaired glucose tolerance is high in liver transplantation patients and is associated with insulin resistance. In these patients total osteocalcin is inversely associated with plasma glucose level and insulin resistance indexes.

The health of older women.

The emerging profile of a healthy older woman in the community is that of an active, independent, and positive person. Data from in-depth interviews are presented to illustrate the value of research in assessing health status. Nurses are encouraged to use research to accurately portray older women and their nursing care requirements.