Correlación entre osteocalcina, insulinorresistencia, insulinosensibilidad y metabolismo de la glucosa en adultos mayores con síndrome metabólico / Correlation between Osteocalcin, Insulin Resistance, Insulin Sensitivity and Carbohydrate Metabolism in an Elderly Population with Metabolic Syndrome

Introducción: Recientemente han surgido nuevas evidencias que relacionan el metabolismo óseo con el energético. La osteocalcina es una proteína de la matriz ósea no colágena, sintetizada por los osteoblastos que modula localmente la mineralización ósea, tradicionalmente usada como marcador de formación ósea. Se ha demostrado tanto en modelos "in vitro" como en animales de experimentación que la osteocalcina tiene acción hormonal. Esta proteína tiene la propiedad de regular la insulinosensibilidad, la insulinosecreción y la proliferación de las células beta pancreáticas. Objetivo: Evaluar la existencia de correlación entre los niveles de osteocalcina sérica y marcadores de insulinorresistencia (IR) e insulinosensibilidad en una población de adultos mayores con síndrome metabólico. Material y métodos: En nuestro estudio prospectivo se incluyeron 88 pacientes (68 % mujeres, 32 % hombres, media de edad 73 ± 6 y 74 ± 6 años respectivamente) que concurrieron a los consultorios externos del servicio de Endocrinología y Metabolismo del hospital Dr. César Milstein. Todos cumplían con los criterios diagnósticos de síndrome metabólico del año 2009 de la Federación Internacional de Diabetes (IDF). Se midieron: osteocalcina sérica, hemoglobina glicosilada (HbA1c), HDL y triglicéridos (TG). Se calcularon QUICKI (Quantitative Insulin Sensivity Check Index) y el índice TG/HDL. Resultados: Los niveles de osteocalcina sérica se asociaron positivamente con HDL (r = 0,213, p = 0,05) y QUICKI (r = 0,212, p = 0,05) e inversamente con TG (r = -0,218, p < 0,05), con el índice TG/HDL (r = -0,217, p < 0,05) y con HbA1c (r = -0,253, p < 0,05). Conclusiones: Nuestro estudio mostró que en adultos mayores con sindrome metabólico, los niveles de osteocalcina reducidos se asociaron con un aumento en los índices de insulinorresistencia, una disminución de los de insulinosensibilidad y un peor control metabólico. Rev Argent Endocrinol Metab 52:8-13, 2015 Los autores no poseen conflictos de interés.

Introduction: In recent years there has been increasing evidence about the relationship between bone and energy metabolism. Osteocalcin is a non-collagenous bone matrix protein synthesized by osteoblasts that locally modulates bone mineralization and is traditionally used as a bone formation marker. Osteocalcin has been shown to have hormonal actions both in in vitro models and in experimental animals. This hormone has the property of regulating insulin secretion and insulin sensitivity as well as beta pancreatic cell proliferation. Aim: To evaluate the existence of correlation between serum osteocalcin levels, insulin resistance and insulin sensitivity markers in an elderly population with metabolic syndrome. Material and methods: Eighty-eight elderly patients were included in our prospective study (68 % women, mean age 73 ± 6 ; 32 % men, mean age 74 ± 6). They attended the outpatient Endocrinology and Metabo­lism service at Dr. César Milstein Hospital and met the International Diabetes Federation (IDF) criteria of metabolic syndrome. Serum Osteocalcin, Glycated haemoglobin (HbA1c), HDL and Triglycerides (TG) were measured. QUICKI and TG/HDL index were calculated. Results: Serum osteocalcin levels were positively associated with HDL (r = 0.213, p = 0.05) and QUICKI (r = 0.212, p = 0.05), and inversely associated with TG (r = -0.218, p < 0.05), TG/HDL index (r = -0.217, p < 0.05) and HbA1c (r = -0.253, p < 0.05). Conclusions: Our study showed that in elderly patients with metabolic syndrome, reduced osteocalcin levels were associated with increased insulin sensitivity, decreased insulin resistance indexes and impaired metabolic control. Rev Argent Endocrinol Metab 52:8-13, 2015 No financial conflicts of interest exist.

Correlación entre osteocalcina, insulinorresistencia, insulinosensibilidad y metabolismo de la glucosa en adultos mayores con síndrome metabólico / Correlation between Osteocalcin, Insulin Resistance, Insulin Sensitivity and Carbohydrate Metabolism in an Elderly Population with Metabolic Syndrome

Introducción: Recientemente han surgido nuevas evidencias que relacionan el metabolismo óseo con el energético. La osteocalcina es una proteína de la matriz ósea no colágena, sintetizada por los osteoblastos que modula localmente la mineralización ósea, tradicionalmente usada como marcador de formación ósea. Se ha demostrado tanto en modelos "in vitro" como en animales de experimentación que la osteocalcina tiene acción hormonal. Esta proteína tiene la propiedad de regular la insulinosensibilidad, la insulinosecreción y la proliferación de las células beta pancreáticas. Objetivo: Evaluar la existencia de correlación entre los niveles de osteocalcina sérica y marcadores de insulinorresistencia (IR) e insulinosensibilidad en una población de adultos mayores con síndrome metabólico. Material y métodos: En nuestro estudio prospectivo se incluyeron 88 pacientes (68 % mujeres, 32 % hombres, media de edad 73 ± 6 y 74 ± 6 años respectivamente) que concurrieron a los consultorios externos del servicio de Endocrinología y Metabolismo del hospital Dr. César Milstein. Todos cumplían con los criterios diagnósticos de síndrome metabólico del año 2009 de la Federación Internacional de Diabetes (IDF). Se midieron: osteocalcina sérica, hemoglobina glicosilada (HbA1c), HDL y triglicéridos (TG). Se calcularon QUICKI (Quantitative Insulin Sensivity Check Index) y el índice TG/HDL. Resultados: Los niveles de osteocalcina sérica se asociaron positivamente con HDL (r = 0,213, p = 0,05) y QUICKI (r = 0,212, p = 0,05) e inversamente con TG (r = -0,218, p < 0,05), con el índice TG/HDL (r = -0,217, p < 0,05) y con HbA1c (r = -0,253, p < 0,05). Conclusiones: Nuestro estudio mostró que en adultos mayores con sindrome metabólico, los niveles de osteocalcina reducidos se asociaron con un aumento en los índices de insulinorresistencia, una disminución de los de insulinosensibilidad y un peor control metabólico. Rev Argent Endocrinol Metab 52:8-13, 2015 Los autores no poseen conflictos de interés.(AU)

Introduction: In recent years there has been increasing evidence about the relationship between bone and energy metabolism. Osteocalcin is a non-collagenous bone matrix protein synthesized by osteoblasts that locally modulates bone mineralization and is traditionally used as a bone formation marker. Osteocalcin has been shown to have hormonal actions both in in vitro models and in experimental animals. This hormone has the property of regulating insulin secretion and insulin sensitivity as well as beta pancreatic cell proliferation. Aim: To evaluate the existence of correlation between serum osteocalcin levels, insulin resistance and insulin sensitivity markers in an elderly population with metabolic syndrome. Material and methods: Eighty-eight elderly patients were included in our prospective study (68 % women, mean age 73 ± 6 ; 32 % men, mean age 74 ± 6). They attended the outpatient Endocrinology and Metabo¡lism service at Dr. César Milstein Hospital and met the International Diabetes Federation (IDF) criteria of metabolic syndrome. Serum Osteocalcin, Glycated haemoglobin (HbA1c), HDL and Triglycerides (TG) were measured. QUICKI and TG/HDL index were calculated. Results: Serum osteocalcin levels were positively associated with HDL (r = 0.213, p = 0.05) and QUICKI (r = 0.212, p = 0.05), and inversely associated with TG (r = -0.218, p < 0.05), TG/HDL index (r = -0.217, p < 0.05) and HbA1c (r = -0.253, p < 0.05). Conclusions: Our study showed that in elderly patients with metabolic syndrome, reduced osteocalcin levels were associated with increased insulin sensitivity, decreased insulin resistance indexes and impaired metabolic control. Rev Argent Endocrinol Metab 52:8-13, 2015 No financial conflicts of interest exist.(AU)

Comparative efficacy and side effects of the treatment of euthyroid goiter with levo-thyroxine or triiodothyroacetic acid.

Euthyroid goiter is usually treated with TSH-inhibitory doses of levo-T(4) (L-T(4)). Because triiodothyroacetic acid (TRIAC) decreases TSH levels, the following study was perfomed: 36 euthyroid goitrous female patients (no cancer or chronic thyroiditis) were randomized to TRIAC (19.6 micro g/kg) (n = 19) or L-T4 (1.7 microg/kg) (n = 17) treatment during 11 months. Goiter volume; lumbar and femoral bone mineral density; serum osteocalcin; deoxypyridinoline; TSH; free T(4); total, high-density lipoprotein, and low-density lipoprotein cholesterol; and triglycerides were measured before and after the study period. Student's t test and chi(2) analysis were performed. TSH values (microunits per milliliter) in the TRIAC and L-T(4) groups were: 1.91 +/- 0.6 (basal) and 0.180 +/- 0.1 (after) and 2.1 +/- 2.5 (basal) and 0.180 +/- 0.3 (after), respectively. Thyroid volume decreased 37.9 +/- 35.4% in the TRIAC patients and 14.5 +/- 39.5% in the L-T(4) group (P = 0.069). Forty-two percent of the goiters with TRIAC reduced more than 50% their initial volume vs. 17.7% with L-T(4) (P = 0.15). With TRIAC, patients experienced fewer side effects. No differences in the changes of bone mineral density, serum deoxypyridinoline, osteocalcin, or the lipid profile were observed between both groups. The present results show that TRIAC is more effective than L-T(4) in the reduction of goiter size, with comparable effects on peripheral parameters.