[Inhibition of RANK-L in the pathophysiology of osteoporosis. Clinical evidences of its use]. / Inhibición del RANK-L en la fisiopatología de la osteoporosis. Evidencias clínicas de su empleo.

The increase bone turnover is the most important fact at the physiopathology of postmenopausal osteoporosis. At the molecular level it is the increase of the RANK-L the principal mediator who allows the osteoclasts formation, survival and development of them. Multiple models have been in use in preclinical investigations for evaluating the effects of the inhibition of the RANKL, between which it is included on OPG's over-expression in mice and transgenic mouse and by means of other models that include the treatment with recombinant OPG. The results of these studies show that RANKL's inhibition improves the DMO as well as the geometry and resistance of the bone. Several references clinical trials have investigated the potential of denosumab as antiresorptive drug for the prevention and treatment of bone disease. It is a monoclonal antibody, the first fully human, which were recently published results of randomized clinical trials to eight years for increasing BMD in different locations and five years for the prevention of vertebral and hip fractures. We review the fundamentals of the mechanism of inhibition of RANK-L and the results of several clinical trials of Denosumab.

[General recommendations over perimenopausal transition therapy]. / Recomendaciones generales para el tratamiento en la transición perimenopáusica.

BACKGROUND: Medical attention during perimenopause requires different therapeutic strategies. OBJECTIVE: To define strategies for the attention of perimenopause women that can favor a healthy aging. METHODS: Review of influencing factors and lifestyle modifications that can be introduced in perimenopause to prevent pathologies. RESULTS: Diet composition and weight control influence cardiovascular and bone risks. It is difficult to get permanent changes in diet habits and there is a lack of conclusive evidence over the results of these recommendations, however there begin to arise better works that shows cardiovascular and osseous benefits of physical activity and specific exercise schedules. Due to them higher risk, it is necessary to suppress toxic habits. Several studies suggest phytotherapeutic supplements consumption benefit, however there is a lack of well-designed clinical essays to justify them recommendation. CONCLUSIONS: Correct nutritional state, appropriate diet, weight control, a common exercise practice, and suppression of toxic habits are applicable measures during perimenopause transition that could influence woman's health level for them lifespan. Individualized identification of diseases risk can justify the recommendations.