RESUMO
Although rickets and osteomalacia posed a serious health problem in industrialised countries a hundred years ago, these diseases are now rarely found, and when, usually in certain risk groups. In underdeveloped countries, rickets is still a major public health problem due to inadequate calcium intake by children. In our highly developed countries, elderly people--especially when institutionalised in nursing homes--are at a very high risk of developing osteomalacia, often combined with pre-existing osteoporosis, with its high impact on mobility and life expectancy in this section of the population. In this review, the common mechanisms involved in developing rickets or osteomalacia are identified and therapeutic measures are reported. Rare causes of osteomalacia due to congenital errors in metabolism or genetic defects are also discussed.
Assuntos
Osteomalacia/diagnóstico , Raquitismo/diagnóstico , Idoso , Cálcio da Dieta/administração & dosagem , Criança , Estudos Transversais , Países Desenvolvidos , Países em Desenvolvimento , Humanos , Incidência , Necessidades Nutricionais , Osteomalacia/tratamento farmacológico , Osteomalacia/epidemiologia , Osteomalacia/etiologia , Raquitismo/tratamento farmacológico , Raquitismo/epidemiologia , Raquitismo/etiologia , Fatores de Risco , Vitamina D/administração & dosagemRESUMO
OBJECTIVE: To test if markers of bone metabolism are altered in patients with seronegative spondyloarthropathies (SSpA). METHODS: We studied biochemical markers of bone resorption and bone formation, osteoprotegerin (OPG), and bone mineral density (BMD) in patients with psoriatic arthritis (PsA), ankylosing spondylitis (AS), and reactive arthritis (ReA) and healthy volunteers. RESULTS: The bone resorption markers urinary deoxypyridinoline and crosslinked telopeptide of collagen-I were significantly increased in patients with AS, PsA, and ReA; in PsA they correlated with the acute phase response (C-reactive protein and erythrocyte sedimentation rate). The bone formation markers were divergent: bone-specific alkaline phosphatase was increased in PsA, but not in AS or ReA. Osteocalcin levels were only elevated in AS. Serum levels of OPG were significantly increased in both AS and PsA. Dual energy x-ray absorptiometry (DEXA) measurements of lumbar spine and femoral neck revealed osteopenia in patients with AS, whereas the DEXA distribution was within normal range in PsA. CONCLUSION: Our data indicate high and, particularly in AS, unbalanced bone turnover in SSpA, consistent with the decrease in BMD found in patients with AS.
