Cambios en la masa ósea en una población infantil con diabetes mellitus tipo 1. Estudio longitudinal / Changes in bone mass in a paediatric population with type 1 diabetes mellitus. Longitudinal study

Objetivo: Evaluar, a lo largo de un seguimiento de 79,2 meses, el comportamiento de la densidad mineral ósea (DMO) determinada mediante Densitometría Axial Computarizada (DXA), la densidad mineral ósea volumétrica (DMOvol) y su relación con los datos antropométricos, junto con los parámetros relativos al metabolismo óseo (calcio, fósforo, fosfatasa alcalina, parathormona (PTH) y vitamina D (25-OH-D3)) en una población infantil con Diabetes Mellitus Tipo 1 (DM1) sin complicaciones microvasculares y un grupo control de referencia de similares características.Material y métodos: Inicialmente, se realizó un estudio transversal en 40 niños diabéticos (edad media 9,4±2,8 años) y 108 controles (9,3±1,5 años) para valorar las posibles diferencias entre ambas poblaciones. 26 pacientes del grupo diabético inicial, fueron reevaluados tras 79,2 meses de seguimiento.Resultados: Se observó que, al inicio, la masa ósea fue similar en los diabéticos y controles. Después del seguimiento, la DMO de los niños diabéticos era muy inferior a la esperada en población infantil no diabética.El peso, la altura y el Índice de Masa Corporal (IMC) siguieron el mismo patrón que la DMO. Los valores de calcio, fósforo, fosfatasa alcalina, PTH y vitamina D, aunque en rango de normalidad, fueron más bajos que en los controles. La fosfatasa alcalina no se incrementó en el periodo puberal.Conclusiones: El presente estudio demuestra que los niños y adolescentes con un diagnóstico reciente de DM1 tienen una DMO normal. Sin embargo, con el paso del tiempo, y sobre todo durante la adolescencia, muestran una menor ganancia de masa ósea y alteraciones en los parámetros de recambio óseo. (AU)

Does the Antitumor Necrosis Factor-α Therapy Decrease the Vertebral Fractures Occurrence in Inflammatory Bowel Disease?

BACKGROUND/OBJECTIVE: Osteoporosis and osteoporotic fracture risk are extraintestinal manifestations of the inflammatory bowel disease, whose etiopathogenic mechanisms have not been determined yet. Anti-tumor necrosis factor (TNF)-α are used in treatment of inflammatory bowel disease (IBD), but it is unknown if they play a role in osteoporotic fracture prevention. The objective of this study was to know if anti-TNF decreases fracture risk or modifies bone mineral density. To determine the possible risk factors associated with fractures, and assess the incidence of vertebral fractures in IBD patients. METHODS: Longitudinal prospective cohort study (7 yr of follow-up); which included 71 IBD patients, 23 received anti-TNF-α; the remaining 48 received conventional treatment, constituted the control group. Patients participated in a questionnaire which gathered risk factors associated with the development of osteoporosis and fractures. Radiographs of the dorsolumbar-spine were performed and also a bone density measurement. Their biochemical and bone remodeling parameters were determined. RESULTS: Although patients who did not receive anti-TNF-α, suffered more fractures but biologic therapy did not reduce the risk of new vertebral fractures. The increase of bone mass was significantly higher the group treated with anti-TNF-α. The increase in the lumbar spine was of 8% and in the femoral neck was of 6.7%. The only determinant factor for the incidence of vertebral fractures was a history of previous fractures (odds ratio of 12.8; confidence interval 95% 2.37-69.9; p = 0.003). The incidence of vertebral fractures in IBD patients was considerably high: 26.7/700 patient-yr. CONCLUSIONS: Anti-TNF-α, although increased bone mass in these patients, did not reduce the risk of new vertebral fractures. In this study, patients with IBD have a considerably high incidence of fractures. Only the existence of previous vertebral fractures was a predictive factor for consistent fractures.

¿Se fracturan la cadera los hombres y las mujeres ante los mismos factores de riesgo? / Do men and women have the same risk factors for hip fractures?

Fundamento y objetivo. La osteoporosis ha sido considerada una enfermedad de la mujer, sin embargo hoy se sabe que también tiene gran importancia en el sexo masculino. Es una enfermedad multifactorial, cuyo principal factor de riesgo independiente para padecer fracturas, en general, y de cadera en particular, es la masa ósea, aunque otras circunstancias, independientes de ésta, también son relevantes. Este estudio pretende conocer si los hombres y las mujeres presentan fractura de cadera con un mismo nivel de masa ósea y si cuentan con los mismos factores de riesgo asociados a la enfermedad. Pacientes y métodos. Se estudiaron 105 pacientes con fractura de cadera no traumática y 68 controles, en los que se analizan distintos factores de riesgo incluyendo datos clínicos, estilo de vida, analíticos, relacionados con el metabolismo óseo y hormonas sexuales, así como valoración de masa ósea. Resultados y conclusiones. Los valores de densidad mineral ósea (DMO) determinados a nivel de cadera constituyen el principal factor de riesgo de fractura osteoporótica de cadera en ambos géneros, que son comparables cuando se expresan en términos de densidad volumétrica. En las mujeres los factores de riesgo determinantes de la aparición de fractura son el antecedente de fractura no traumática a edad mayor de 50 años, la DMO de cadera total, los niveles de calcio sérico y la toma o no de tiazidas; mientras que en los varones, sólo alcanza significación estadística la DMO de cadera total(AU)

Background and aims. Osteoporosis has been traditionally considered as a disease in women. However, it is now known that this condition is also important in men. It is a multifactor condition whose main independent risk factor to suffer fractures, in general, and those of the hip, specifically, is bone mass. Nonetheless, there are other independent risk factors of importance. This study has aimed to study if men and women suffer hip fractures with the same bone mass and if they have the same risk factors associated to this condition. Patients and methods. We studied 105 patients with non-traumatic hip fracture and 68 healthy controls. The different risk factors were analyzed, including clinical data, lifestyle, analytic data, data related to bone metabolism and sex hormones as well as a complete bone evaluation. Results and conclusions. Hip bone mass density (BMD) values are the main risk factor for osteoporotic fractures in both genders. These values are comparable when expressed in terms of volumetric density. In women, risk factors that determine the appearance of fractures are previous non-traumatic fractures when they are older than 50 years, total hip BMD, serum calcium levels and thiazide intake while in men only total hip BMD reaches statistical significance(AU)

[Do men and women have the same risk factors for hip fractures?]. / ¿Se fracturan la cadera los hombres y las mujeres ante los mismos factores de riesgo?

BACKGROUND AND AIMS: Osteoporosis has been traditionally considered as a disease in women. However, it is now known that this condition is also important in men. It is a multifactor condition whose main independent risk factor to suffer fractures, in general, and those of the hip, specifically, is bone mass. Nonetheless, there are other independent risk factors of importance. This study has aimed to study if men and women suffer hip fractures with the same bone mass and if they have the same risk factors associated to this condition. PATIENTS AND METHODS: We studied 105 patients with non-traumatic hip fracture and 68 healthy controls. The different risk factors were analyzed, including clinical data, lifestyle, analytic data, data related to bone metabolism and sex hormones as well as a complete bone evaluation. RESULTS AND CONCLUSIONS: Hip bone mass density (BMD) values are the main risk factor for osteoporotic fractures in both genders. These values are comparable when expressed in terms of volumetric density. In women, risk factors that determine the appearance of fractures are previous non-traumatic fractures when they are older than 50 years, total hip BMD, serum calcium levels and thiazide intake while in men only total hip BMD reaches statistical significance.