Risk of fragility fractures in obesity and diabetes: a retrospective analysis on a nation-wide cohort.

This study aims to investigate the role of obesity and diabetes on bone health in a nation-wide cohort of women with high risk of fracture. INTRODUCTION: The role of obesity and diabetes on fracture risk is yet poorly understood. Body mass index (BMI) and bone mineral density (BMD) are strongly correlated; however, patients with elevated BMI are not protected against fractures, configuring the obesity paradox. A similar controversial association has been also found in diabetic patients. Herein, we present a retrospective analysis on 59,950 women. METHODS: Using a new web-based fracture risk-assessment tool, we have collected demographic (including BMI), densitometric, and clinical data (including history of vertebral or hip and non-vertebral, non-hip fractures, presence of comorbidities). We performed a propensity score generation with 1:1 matching for patients in the obese (BMI ≥ 30) and non-obese (BMI < 30) groups, in the diabetics and non-diabetics. Propensity score estimates were estimated using a logistic regression model derived from the clinical variables: age, lumbar spine T-score, and femoral neck T-score. RESULTS: We found an association between diabetes and fractures of any kind (OR 1.3, 95% CI 1.1-1.4 and 1.3, 95% CI 1.2-1.5 for vertebral or hip fractures and non-vertebral, non-hip fractures, respectively). Obesity, on the other hand, was significantly associated only with non-vertebral, non-hip fractures (OR 1.3, 95% CI 1.1-1.6). To estimate the individual effect of obesity and diabetes on bone health, we ran sensitivity analyses which included obese non-diabetic patients and non-obese diabetic patients, respectively. CONCLUSIONS: Non-obese diabetics had the highest risk of vertebral or hip fracture, whereas obese non-diabetics predominantly had non-vertebral, non-hip fracture's risk. These results should raise awareness in clinical practice when evaluating diabetic and/or obese patients.

[Vitamin C. Its clinical use and state of the art]. / Vitamina C. Revisione delle indicazioni clinico-terapeutiche e stato dell'arte.

This is a review of the most relevant articles on the vitamin C-based therapy with emphasis to high per os and parenteral doses that might be effective on calories utilization, energy production, mythocondrial red-ox function, gene expression and metabolism. Ascorbic acid treatment in tumor bearing patients is a puzzling issue whose rationale is based on low vitamin plasma concentration and cancer uptake and sequestration; furthermore high parenteral dosages should be required to achieve a putative oxidative damage on tumor DNA, by this antioxidant molecule; thus bioavailability and metabolism as well as clinical effectiveness are reviewed on the basis of the evidence based medicine: specific evidence of vitamin C efficacy is quite limited, but areas like diabetic vascular complications and sideropenia might benefit of the treatment; high parenteral doses might be useful, perspectively also in relapsing urinary tract infection, after conventional treatment failure, due to the high output of ascorbic acid and potential saturation of the target tissues.