Risk Factors of Muscle Wasting in Women with Rheumatoid Arthritis: Relevance of the Persistent Failure of Conventional Combination Therapy.

Background: Muscle wasting, also known as myopenia, is frequent in rheumatoid arthritis (RA). To date, it is still unknown if the failure of pharmacologic therapies increases the risk of myopenia in RA. Objective: To identify if treatment failure with conventional synthetic DMARDs (csDMARDs) constitutes an independent risk factor of muscle wasting in women with RA. Methods: This was a cross-sectional study. We included 277 women with RA. Assessments in RA patients included: clinical, epidemiological, and therapeutic variables. The skeletal muscle index (SMI) was estimated by DXA, and myopenia was diagnosed if they had an SMI < 5.45 kg/m2. Multivariable logistic regression models identified risk factors of myopenia. Results: Muscle wasting was observed in 28.2% of patients with RA. The risk factors of myopenia in RA were menopausal (OR: 4.45, 95% CI: 1.86 to 10.64) and failure of combined therapy with csDMARDs (OR: 2.42, 95% CI: 1.15 to 5.07). The increased body mass index was protective (OR:0.81, 95% CI: 0.75 to 0.87). Conclusions: Around one of four patients with RA presented muscle wasting. Muscle wasting is related to treatment failure of combined csDMARDs; other factors influencing the presence of muscle wasting is being postmenopausal, whereas, the body mass index was a protective factor.

Serum irisin concentrations and osteoporotic vertebral fractures in women with rheumatoid arthritis: A cross-sectional study.

ABSTRACT: Irisin stimulates osteoblast differentiation increasing bone mass a decreasing in irisin levels might contribute to osteoporotic fractures in inflammatory diseases. To date, there is controverted whether irisin levels are associated with osteoporotic fractures in rheumatoid arthritis (RA). Therefore, we evaluate the association of serum irisin with osteoporotic Vertebral Fractures (VFs) in women with RA.A total of 148 women with RA was included in the study.Clinical characteristics and risk factors of VFs was evaluated. For measurement of bone mineral density we included the assessment of lumbar spine (AP L1-L4) and Femoral Neck by dual-energy X-ray absorptiometry (DXA). VFs were evaluated by lateral vertebral assessment (LVA) of the dorsal and lumbar regions using X-ray and digital vertebral morphometry by DXA, using the Genant scale. Serum irisin levels were measured by ELISA. A reference group of 97 women with non-rheumatic diseases were included to compare irisin levels.RA patients had a median age of 59 years and 41% had osteoporosis. Seventy three (49%) had VFs. Lower irisin levels were observed in RA patients compared to controls (94 ±â€Š74 vs 135 ±â€Š103, P < .001). Irisin concentrations were lower in RA + VFs than RA non-VFs (74 ±â€Š42 vs 113 ±â€Š92 ng/mL, P = .001). In the multivariable logistic regression analysis the low 50 percentile irisin levels < 73 ng/mL (OR:3.1, 95% CI:1.55-6.2, P = .001), and disease duration of RA (OR:1.04, 95% CI:1.001-1.08, P = .04) were associated with an increase in the risk of VFs.A decrease of irisin levels is associated to VFs in RA. These results are valuable to consider that RA patients with low levels of irisin are in a potential risk of VFs.

Description of Normative Spine TBS Data for Men and Women in Mexican Population.

Trabecular Bone Score (TBS) has proven its usefulness to improve areal Bone Mineral Density in diagnosing fracture risk and bone status evaluation. For it to be better interpreted, local reference values are recommended to account for population differences and, if possible, both in women and men, the former being scarcer. Using TBS, we reanalyzed data obtained from the Mexican population included in the Latin American Vertebral Osteoporosis Study and the Mexican Vertebral Study in men that included a random probability sample of 408 women and 414 men aged 50 and older without fractures. Data was used to obtain reference curves in such a population. Mean TBS in women ranged from an average of 1.359 ± 0.118 standard deviation (SD) 50 to 59 and decreased down to 1.211 ± 0.128 SD in women 80 and above. In men ranged from 1.382 ± 0.116 SD in the first group down to 1.315 ± 0.118 SD in the latter with little differences in age groups. Mean values in women are lower than previously suggested cutoff points to establish microarchitecture status using TBS: 1.350 and above normal, 1.200 to 1.349 partially degraded and 1.199 and below, degraded. Our TBS data have the strength of being a random sample drawn from the population, although limited in its extent to one city in Mexico. The means and curves may be used to diagnose bone status with better sensibility and specificity, although these values are yet to be evaluated.

Impact of osteoporosis-associated vertebral fractures on health-related quality of life in the Mexican population.

OBJECTIVE: To measure the impact on the health-related quality of life (HRQoL) of a sample of Mexicans with vertebral fractures. MATERIAL AND METHODS: One hundred fifteen subjects with vertebral fractures were interviewed and compared with 135 subjects similar in age without the fracture. Subjects were men and women > 50 years of age with osteoporosis confirmed by bone mineral densitometry and with at least 1 vertebral fracture verified by vertebral morphometry and Xrays. The sample was recruited from two sources: The Clínica de Osteoporosis at the Instituto Nacional de Rehabilitación and a random sample from the Latin American Osteoporosis Study. The Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) validated in Spanish for the Mexican population was applied. Descriptive statistics were used for demographic and clinical aspects of the sample, as well as χ2 for categorical variables and Student t test for independent samples for continuous variables. A multiple linear regression (LR) was conducted to characterize predictive variables related to quality of life. RESULTS: Two hundred fifty subjects were interviewed; 64% of them were women. The average age of those interviewed was 73.4 ± 11.4 years; 46% of the sample had vertebral fractures; of them 43% of were lumbar and 57% thoracic; the most frequent site was L1-T12. Significant changes were found in the group with fractures in pain, physical function, social function, and mental function (p < 0.05); in women, pain and social function were different between groups (p < 0.05); and those over 70 years also presented differences in physical, social, and mental function (p < 0.05); differences were found associated with the place of recruitment being worse in their quality of life those coming from the Clínica de Osteoporosis. Two or more fractures, age, being female and widowed were significant predictors for greater deterioration of HRQoL with the LR. CONCLUSION: This is the first study looking at the HRQoL in osteoporosis related fractures in Mexicans were quality of life deterioration on physical, social, and emotional functioning was demonstrated in subjects with two vertebral fractures. Age is a determining factor for greater deterioration in all studied domains. Differences between the samples obtained at the Clínica de Osteoporosis at the Instituto Nacional de Rehabilitación and the random population exemplifying that asymptomatic fractures are common and not diagnosed. It is important to scrutinize vertebral fractures at the first level because their timely detection allows for their evaluation and treatment and diminishes the probability of a second fracture. Our results can be generalized to men and women over 50 who live in the central megalopolis and in other states of the Valley of México.

Fracture risk assessment in Latin America: is Frax an adaptable instrument for the region?

Osteoporosis is a generalized disease of bone that increases fracture risk. Multiple factors influence this risk, besides low bone mass. To decrease osteoporotic fractures, those patients who require preventive management should be readily identified. This paper aims to review current information on the use of the fracture risk assessment tool (FRAX) in Latin America. Bone mineral density measurement is currently the method of reference for evaluating the fracture risk and opting for treatment; but, it misses a notable proportion of individuals who have clinical risk factors for osteoporosis and fractures. FRAX was designed to predict the 10-year absolute risk of sustaining a major osteoporotic fracture or a hip fracture. Although data is available for several countries, from Latin America, only Argentina appears in the current version of the tool. Its present use in other Latin American countries is possible with some adaptations based in similarities of epidemiological information of each country with some of the existing databases. The cutoff value beyond which treatment should be initiated needs to be determined, based not only on clinical criteria, but also on economic considerations.

The prevalence of vertebral fractures in San Juan, Puerto Rico: a population-based study among females aged 50 years and over.

OBJECTIVE: The participation of Puerto Rico in the Latin American Vertebral Osteoporosis Study (LAVOS) has allowed us to study the magnitude of the problem of osteoporosis in the female population residing in San Juan. The objective of LAVOS was to estimate the prevalence of vertebral fractures in Latin American women using a random sample of females selected from cities across five Latin American countries. METHODS: A probability cluster design was employed to select a random sample of households in San Juan, Puerto Rico, in order to interview 400 females aged 50 years and over. A 30-minute face-to-face interview gathered data on demographics, risk factors, and life styles. Data regarding bone mineral densities of the spine and hip by DXA and lateral dorsolumbar X-rays were obtained using international protocols; digital morphometry was used to determine vertebral deformities, with the results being classified according to Eastell criteria. This article summarizes the main findings observed in San Juan, Puerto Rico. RESULTS: Overall weighted prevalence of vertebral fractures was 11.2% (95% CI: 8.5%, 14.7%). Age-specific prevalence of vertebral fractures was as follows: 5.4% (95% CI: 2.7%, 10.7%) in the 50-59 years age group, 8.3% (95% CI: 4.4%, 15.1%) in the 60-69 years group, 16.2% (95% CI: 10.5%, 25.0%) in the 70-79 years group, and 22.4% (95% CI: 13.3%, 35.1%) in participants > or = 80 years. Factors significantly associated with vertebral fractures were being 70-79 years old (adjusted POR70-79 vs. 50-59 = 2.9; 95% CI: 1.1, 7.4), being > or = 80 years old (adjusted POR > or = 80 vs .50-59 = 3.3; 95% CI: 1.2, 9.4), and a T-score < or = -2.5 in the lumbar spine (adjusted POR = 2.5; 95% CI: 1.5, 5.7) and in the femoral neck (adjusted POR = 3.5; 95% CI: 1.5, 8.0). Personal history of fractures was marginally associated with vertebral fractures after adjusting for the remaining risk factors (adjusted POR = 2.0; 95% CI: 1.0, 4.0). Nearly 94% of the women with vertebral fractures were not aware of their bone status. Using the WHO classification, we determined that 71% had osteoporosis, 21%, osteopenia, and 8%, normal bone mineral densities. Bone mineral densities in the lumbar spine and femoral neck were significantly lower in women with vertebral fractures. Non-vertebral fractures were more common in women with a personal history of prior vertebral fractures. The prevalence of the most common non-vertebral fractures were hip, 1% (95% CI: 0.4%, 2.7%), and wrist, 5.9% (95% CI: 4.0%, 8.7%), respectively. CONCLUSION: This is the first population-based study of osteoporotic fractures in Puerto Rico and should serve as a guide to health providers and policy makers in the prevention and treatment of this disease.

Morfometría vertebral radiológica: valores de índices, alturas y áreas vertebrales en columnas dorsal y lumbar de mujeres mexicanas: estudio multicéntrico / Radiological vertebral morphometry: vertebral indices, heights and areas in thoracic and lumbar spine in Mexican women: multicentric study

La morfolometría vertebral (MV) es un método empleado para la medición de contornos vertebrales en placas radiográficas de columna. Nuestro objetivo fue establecer valores normales de alturas, áreas e índices de deformidad vertebral en mujeres mexicanas sanas para poder ser empleados en estudios de MV. Evaluamos los cambios producidos por el envejecimiento en alturas y áreas vertebrales entre mujeres jóvenes (40-59 años) y mujeres ancianas (60-79 años). Se evaluaron 130 MV de columna dorsal y lumbar; se midieron alturas y áreas vertebrales T4-L5 y se calcularon índices de deformidad vertebral. Se encontró un aumento en la altura anterior (Aa) y posterior (Ap) de las vértebras T4-L3 pero en L4-L5 Ap fue inferior que Aa. El aumento promedio en Aa de T4-T8 fue de 1.1 mm mientras que de T8 a L3 fue de 10.9 mm. El aumento progresivo en el tamaño de los cuerpos vertebrales condiciona un aumento en el área vertebral. El aumento promedio del área vertebral T4-L3 fue 8.2 cm. La comparación entre mujeres jóvenes y ancianas indican que no hay diferencias en los valores absolutos de alturas vertebrales; sin embargo, los índices de contorno vertebrales (ICV) muestran: el índice por ciento Acuñamiento y el índice por ciento Concavidad aumentan con la edad de T8-T10 mientras que el Indice por ciento Compresión Específica es mayor en todos los niveles vertebrales en las mujeres de mayor edad

Validación en español de un instrumento de pre-escrutinio para la detección de masa ósea baja en mujeres posmenopáusicas: índice SCORE / SCORE Index ia pre-screening questionary used in post-menopausal women in risk of low bone mass

El índice SCORE es un cuestionario que se utiliza como pre-escrutinio de mujeres posmenopáusicas en riesgo de masa ósea baja, en las cuales se puede optimiza el recurso de la densitometría ósea, que tiene un costo elevado. Se validó en español el índice SCORE y se aplicó en 1280 mujeres posmenopáusicas mayores de 45 años de edad que fueron evaludas por densitometría dual de rayos "X" (DXA) en columna lumbar y cuello femoral. El análisis del balance entre sensibilidad/especificidad del índice SCORE en la identificación de mujeres con osteopenia y osteoporosis, muestra que las mujeres posmenopáusicas mestizas mexicanas requieren un punto de corte menor que el utilizado en mujeres posmenopáusicas blancas caucásicas, donde se desarrolló originalmente el índice SCORE siendo este punto de corte muy semejante a las mujeres posmenopáusicas de origen asiático. El índice SCORE es capaz de identificar, entre mujeres mexicanas, osteopenia en columna lumbar con 4 puntos y osteopenia en cuello femoral con 5 puntos. Identifica osteoporosis en columna lumbar con 6 puntos y osteoporosis en cuello femoral con 8 puntos

Métodos diagnósticos en osteoporosis / Diagnostic methods in osteoporosis

Se describen aquí los principales métodos de diagnóstico de osteoporosis. Los rayos X (RX) simples no permiten medir la masa ósea, sólo pueden detectar osteopenia y tienen un alto grado de error para pacientes con osteoporosis. La radiogrametría metacarpiana es un procedimiento sencillo y barato, útil en el escrutinio de osteoporosis. La radioabsorciometría emplea una placa simple de mano tomada junto a una cuña de aluminio, tiene buena precisión y exactitud. La Absorciometría Dual de RX (DXA) es actualmente el método estándar para la medición de la masa ósea, permite realizar mediciones del esqueleto entero y de segementos como columna lumbar anteroposterior y lateral, antebrazo, cuello femoral y mano. La absorciometría dual de RX Morfométrica (MXA) tiene además la ventaja de analizar la morfometría de los cuerpos vertebrales así como una mejor calidad en las imágenes gracias a su tecnología de RX en abanico. La Tomografía Cuantitativa Computarizada (QCT) es el único método que proporciona medidas del contenido mineral en 3 dimensiones y puede determinar la densidad del hueso cortical y trabecular en forma separada. El Ultrasonido Cuantitativo (QUS) es un procedimiento sencillo no invasivo útil en el escrutinio de pacientes con osteoporosis y permite además evaluar la calidad del hueso