Health-Related Quality of Life Long-Term Study in Lung Transplant Patients: A Single-Center Experience.

INTRODUCTION: Health-related quality of life (HRQL) assessment plays a crucial role in the follow-up care of lung transplanted (LTx) patients. Previous reports have indicated that the HRQL achieved by these patients is often poorer compared to that of healthy individuals. However, the factors contributing to this lower HRQL remain unclear. This prospective study aimed to assess the effectiveness of using both a generic and a disease-specific HRQL instrument in evaluating the outcomes of patients who have undergone LTx. METHODS: A total of 111 LTx patients were enrolled in the study, with 88 survivors completing the 5-year follow-up and 23 nonsurvivors identified within the first 3 y. Among the participants, 84 underwent double LTx, while 27 received a single LTx. Patients were interviewed before LTx, at 6 mo post-transplantation, and annually thereafter. Two validated instruments were utilized: the Euro quality of life five dimensions, a generic measure, and the St. George's Respiratory Questionnaire (SGRQ), a disease-specific questionnaire. RESULTS: The study showed significant improvements in Euro Quality of Life five Dimensions scores from 6 mo after LTx. Specifically, the percentage of patients without Mobility problems increased from 23% before LTx to 71% at 5 y (P = <0.001), while the ability to self-care improved from 48% to 100% (P = <0.001). The ability to carry out usual activities improved from 13% to 86% (P = <0.001), and the proportion of patients without anxiety and depression increased from 50% to 86% (P > 0.004). However, there was no significant improvement observed in Pain, with only a slight reduction from 57% to 42.8% (P = 0.22). The SGRQ also showed improvements in all dimensions (symptoms, impact, activities) (P < 0.001). However, by the fifth year, the HRQL scores remained below normal reference values. Chronic graft dysfunction was associated with a decline in SGRQ scores. Bilateral LTx patients exhibited better SGRQ scores compared to unilateral LTx patients from the first year post-transplantation. Notably, there were no differences in scores between nonsurvivors and survivors. CONCLUSIONS: The study highlights the long-term improvement in HRQL among LTx patients, with greater improvements observed in physical dimensions compared to psychological dimensions. Bilateral LTx was associated with better SGRQ scores than unilateral LTx, and chronic graft dysfunction primarily affected SGRQ scores. These findings underscore the importance of utilizing both generic and specific HRQL instruments in assessing LTx outcomes.

Comparison of Bone Mineral Density and Trabecular Bone Score in Patients with and without Vertebral Fractures and Differentiated Thyroid Cancer with Long-Term Serum Thyrotrophin-Suppressed Therapy.

INTRODUCTION: The study of BMD provides only partial information on bone health in patients undergoing TSH suppression therapy due to differentiated thyroid cancer (DTC). The trabecular bone score (TBS), a new parameter assessing bone microarchitecture, is proposed for studying bone in this context. This study aimed to analyze their long-term use in patients with DTC. METHODS: Bone mineral density (BMD) was measured by dual X-ray densitometry (DXA) and TBS was assessed with iNsigth software (version 2.0, MediImaps, France) in 145 postmenopausal patients with DTC. Vertebral fractures (VFs) were identified using a semi-quantitative X-ray method. RESULTS: The BMD at the end of this study did not differ from the initial measurement. However, the TBS decreased from 1.35 ± 0.1 to 1.27 ± 0.1 (p = 0.002). Increased levels of PTH, osteocalcin, and bone alkaline phosphatase (BAP) were observed, suggesting enhanced bone remodeling. There was an increase in the prevalence of osteoporosis and osteopenia (40.6% and 16.5% to 46.6% and 18.6%, respectively). The proportion of patients with partially degraded and totally degraded TBS increased from 31% and 15.1% to 48.9% and 24.8% by the end of this study. Among the 30 patients with VFs, there were no significant differences in age, body mass index (BMI), calcium intake, alcohol consumption, smoking, radioiodine, therapy, or thyroid parameters compared to those without VFs. The odds ratio for VFs increased with osteopenia (OR 2.63). Combining TBS with BMD did not improve discrimination. CONCLUSIONS: The TBS decreased while the BMD remained unchanged. The percentage of patients with osteoporosis and osteopenia, whether partially degraded or totally degraded, increased by the end of this study. The predominant discordance was found in partially degraded microarchitectures, with a higher proportion of osteopenic patients compared to those with normal or osteoporotic bone density. The AUC of the combination of TBS and BMD did not enhance discrimination. TBS, radioactive iodine therapy, and sedentary lifestyle emerged as the main distinguishing factors for DTC patients with VFs.

Incidence of type 2 diabetes in the elderly in Central Spain: Association with socioeconomic status, educational level, and other risk factors.

AIMS: To analyze the incidence of type 2 diabetes (T2D) in Central Spain and its association with the socioeconomic status (SES), educational level, and other risk factors (RF) in the elderly population of three communities. METHODS: Data for 5278 elderly participants (≥65 years old) were obtained using a census population-based survey. There was a first and a second survey three years later. The association between SES, educational level, RF, and T2D incidence was analyzed. RESULTS: The incidence rate for T2D was 9.8/1000 person-years without gender differences. Incident T2D was associated with low SES and lower educational levels. Baseline and follow-up BMI were also the main RFs for T2D. Communities' incidence rates were: (1) Margarita, working-class area: 11.3/1000 person-years; (2) Arévalo, agricultural region: 10.1/1000 person-years and; (3) Lista, professional high-income class area: 7.6/1000 person-years. CONCLUSION: We found an incidence rate of 9.8/1000 person-years of T2D in the elderly population. The risk of T2D was associated with a lower income and educational level. An increase in BMI may mediate this association. Our results emphasize the necessity of strategies for the prevention of diabetes that includes an approach to SES, educational levels, and other RF among older individuals in Spanish community settings.

Association of Low Serum 25OHD Levels with Abnormal Bone Microarchitecture in Well-Differentiated Thyroid Cancer.

The association of low levels of 25 hydroxyvitamin D (25OHD) with papillary thyroid cancer (PTC) is being studied, as to whether it is a risk factor or as a coincidental one. This study aimed to evaluate serum levels of deficiency, insufficiency, and sufficiency of 25OHD in PTC and its relationship with the trabecular bone score (TBS) and bone mineral density (BMD). This study includes 134 postmenopausal women with PTC, followed for 10 years. BMD was measured with DXA Hologic QDR 4500, and TBS with Med-Imaps iNsight2.0 Software. Mean serum 25OHD was 23.09 ± 7.9 ng/mL and deficiency, insufficiency, and sufficiency levels were 15.64 ± 2.9, 25.27 ± 2.7, and 34.7 ng/mL, respectively. Parathyroid hormone (PTH) and bone alkaline phosphatase (BAP) were higher in deficiency (57.65 ± 22.6 ng/mL; 29.5 ± 14 U/L) and in insufficiency (45.88 ± 19.8 ng/mL; 23.47 ± 8.8 U/L) compared with sufficiency of 25OHD (47.13 ± 16 and 22.14± 9.7 ng/mL) (p = 0.062 and p = 0.0440, respectively). TBS was lower in patients with 25OHD < 20 ng/mL (1.24 ± 0.13) compared with between 20-29 (1.27 ± 0.13, p < 0.05) and 30 ng/mL (1.31 ± 0.11, p < 0.01). We found low TBS in patients with PTC and long-term follow-up associated with low serum 25OHD levels, not associated with cancer stage, or accumulative iodine radioactive dose. Low 25OHD associated with deleterious bone quality in patients with PTC should be restored for the prevention of fractures.

Trabecular bone deterioration in differentiated thyroid cancer: Impact of long-term TSH suppressive therapy.

BACKGROUND: Conflicting results has been reported regard osteoporosis and fractures in patients with Differentiated Thyroid Cancer (DTC). Our objective was to evaluate the long-term effects of TSH suppression therapy with Levothyroxine (LT4) on trabecular bone score (TBS) and bone mineral density (BMD) in females with DTC after thyroidectomy. METHODS: About 145 women with resected DTC and receiving long-term TSH therapy, were stratified according to the degree of TSH suppression. Mean duration of follow-up was 12.3 ± 6.1 years. BMD and TBS, were assessed using dual-energy X-ray absorptiometry (DXA) and TBS iNsight (Med-Imaps), at baseline (1-3 months after surgery) and at the final study visit. RESULTS: In patients stratified by duration of TSH suppression therapy (Group I, 5-10 years; Group II, >10 years), slight increases from baseline TSH levels were observed. Significant decreases in LS-BMD and FN-BMD were seen in patients after >10 years. TBS values were lower in Groups I (1.289 ± 0.122) and II (1.259 ± 0.129) compared with baseline values (P = .0001, both groups). Regarding the degree of TSH suppression, TBS was significantly reduced in those with TSH < 0.1 µU/mL (P = .0086), and not in patients with TSH suppression of 0.1.-0.5 or >0.5 µU/mL. CONCLUSIONS: We found deterioration of trabecular structure in patients with DTC and TSH suppression therapy below 0.1 µU/mL and after 5-10 years of follow-up. Significant changes in BMD according to TSH levels were not observed. Trabecular Bone Score is a useful technique for identifying thyroid cancer patients with risk of bone deterioration.

Trabecular bone score and bone mineral density in patients with postsurgical hypoparathyroidism after total thyroidectomy for differentiated thyroid carcinoma.

BACKGROUND: Although bone mineral density is reported to be increased in patients with postsurgical hypoparathyroidism (postsurgical HypoPT), the effect of HypoPT on trabecular bone score remains unknown. This study evaluated the long-term effects of HypoPT secondary to total thyroidectomy for differentiated thyroid cancer on trabecular bone score, bone mineral density, and bone turnover markers with a similar group of patients without HypoPT. METHODS: Women with resected differentiated thyroid cancer and either postsurgical HypoPT (n = 25; 8 premenopausal and 17 postmenopausal) or euparathyroid function (n = 98; 14 premenopausal and 84 postmenopausal) were matched for age and body mass index. Patients received thyroid-stimulating hormone suppression during follow-up. The bone mineral density and trabecular bone score were analyzed using dual x-ray densitometry and Med-Imaps software at baseline (1-3 months postsurgery) and at the final study visit. RESULTS: Follow-up duration was similar in studied groups (median 10 years). Baseline bone mineral density and trabecular bone score were similar between HypoPT and non-HypoPT patients, regardless of menopausal status. At study end, postmenopausal HypoPT patients had greater bone mineral density versus the non-HypoPT patients at the lumbar spine, hip, and distal radius (P = .001), and a greater trabecular bone score (1.31 ± 0.09 vs 1.24 ± 0.12, P = .0184). Premenopausal patients with and without HypoPT had similar bone mineral density values at the final evaluation. The bone turnover markers (osteocalcin, bone-specific alkaline phosphatase, and ß-crosslaps) were less in postmenopausal HypoPT patients, reflecting decreased bone turnover. CONCLUSION: Postmenopausal patients who underwent a total thyroidectomy for differentiated thyroid cancer with postsurgical HypoPT have greater trabecular bone score and bone mineral density compared with euparathyroid patients, suggesting that HypoPT protects against the negative effects of long-term thyroid-stimulating hormone suppression treatment on bone.

Low trabecular bone score in postmenopausal women with differentiated thyroid carcinoma after long-term TSH suppressive therapy.

The effect of thyroid suppression therapy (TST) on trabecular bone scores (TBS) and bone mineral density (BMD) in thyroidectomized women with differentiated thyroid carcinoma (DTC) on long-term follow-up is presently not conclusive. PATIENTS AND METHODS: We carried out a study in 61 premenopausal and 84 postmenopausal Caucasian women with DTC. Serum biochemistry, bone markers, TBS, BMD, and bone fractures were evaluated 1-3 months post surgery and after a median follow-up of 10 years. RESULTS: In the final study, patients belonged to Group I Premenopausal (n = 14) who remained in this status; Group II Premenopausal who became postmenopausal (n = 47); Group III patients who were and continued as postmenopausal (n = 84). Baseline premenopausal patients had a normal TBS mean value of 1.39 ± 0.14 significantly higher than that found in postmenopausal 1.31 ± 0.12 (p = 001). In the final study, premenopausal patients continued to have a normal TBS of 1.46 ± 0.08 compared to the significantly lower value of postmenopausal patients 1.25 ± 0.11 (p = 0.0009). Lumbar BMD (L-BMD) loss after the long-term study was significant in Group II (0.99 g/cm2 ± 0.13 vs. 0.91 ± 0.12 g/cm2, p < 0.0001) and there was a slight, but not significant, bone loss in Group I (1.00 ± 0.12 vs. 0.98 ± 0.11, p = 0.1936) and in Group III (0.86 ± 0.12 vs. 0.84 ± 0.15, p = 0.1924) compared with baseline values. CONCLUSION: Longer-term suppression therapy in female patients with DTC did not increase significantly the risk of bone loss, although we found in postmenopausal patients deterioration of bone microarchitecture. TBS study should be considered in the evaluation of postmenopausal DTC patients on long-term DTC for the evaluation of the risk of fractures.

rhIGF-1 Treatment Increases Bone Mineral Density and Trabecular Bone Structure in Children with PAPP-A2 Deficiency.

AIM: Our objective was to determine changes in bone mineral density (BMD), trabecular bone score (TBS), and body composition after 2 years of therapy with recombinant human insulin-like growth factor-1 (rhIGF-1) in 2 prepubertal children with a complete lack of circulating PAPP-A2 due to a homozygous mutation in PAPP-A2 (p.D643fs25*) resulting in a premature stop codon. METHODS: Body composition, BMD, and bone structure were determined by dual-energy X-ray absorptiometry at baseline and after 1 and 2 years of rhIGF-1 treatment. RESULTS: Height increased from 132 to 145.5 cm (patient 1) and from 111.5 to 124.5 cm (patient 2). Bone mineral content increased from 933.40 to 1,057.97 and 1,152.77 g in patient 1, and from 696.12 to 773.26 and 911.51 g in patient 2, after 1 and 2 years, respectively. Whole-body BMD also increased after 2 years of rhIGF-1 from baseline 0.788 to 0.869 g/cm2 in patient 1 and from 0.763 to 0.829 g/cm2 in patient 2. After 2 years of treatment, both children had an improvement in TBS. During therapy, a slight increase in body fat mass was seen, with a concomitant increase in lean mass. No adverse effects were reported. CONCLUSION: Two years of rhIGF-1 improved growth, with a tendency to improve bone mass and bone microstructure and to modulate body composition.

Recalcitrant hypocalcaemia in a patient with post-thyroidectomy hypoparathyroidism and Roux-en-Y gastric bypass.

INTRODUCTION: Roux-en-Y gastric bypass (RYGB) places patients at an increased risk of hypocalcaemia due to the reduction in calcium absorption (because the procedure bypasses the duodenum and jejunum) and vitamin D deficiency. Subsequent thyroid surgery increases the risk of severe hypocalcaemia due to potential post-operative hypoparathyroidism. Only a few cases have been published before of this type of treatment-challenging hypocalcaemia. CLINICAL PRESENTATION: We report the case of a 31-year-old woman with a previous RYGB, who suffered severe and symptomatic chronic hypocalcaemia after total thyroidectomy. She required aggressive therapy with oral calcium and calcitriol and frequent calcium infusions, but there was no improvement in serum calcium level. Due to the lack of response to standard therapy, teriparatide treatment was started (first with subcutaneous injections and thereafter with a multipulse subcutaneous infusor) but the results were disappointing. As there was no response to different medical treatments, reversal of RYGB was performed with no complications and a subsequent sustained increase in serum calcium level. CONCLUSIONS: This case shows that patients with postoperative hypoparathyroidism and RYGB have increased risk of severe recalcitrant symptomatic hypocalcaemia. In our case teriparatide was ineffective but, as this is the first patient reported, more results are needed to evaluate properly the effect of teriparatide in this multifactorial hypocalcaemia. Reversal of RYGB should be considered when medical therapy has failed, because surgery restores an adequate absorption of calcium and vitamin D from previously bypassed duodenum and proximal jejunum.

Hiperparatiroidismo primario normocalcémico: un problema en aumento / Normocalcemic primary hyperparathyroidism: a growing problem

El hiperparatiroidismo primario normocalcémico es en el momento actual uno de los motivos de consulta más frecuentes en las unidades de metabolismo óseo. Se caracteriza por el aumento en los valores de hormona paratiroidea intacta en presencia de calcio sérico normal (total e ionizado) en individuos generalmente asintomáticos. En el diagnóstico diferencial deben contemplarse todas aquellas situaciones que cursan con hiperparatiroidismo secundario. Su historia natural no es bien conocida, ya que no siempre evoluciona a la hipercalcemia. Al ser una entidad reconocida recientemente, no existen todavía recomendaciones específicas para su tratamiento. En esta revisión se discuten algunos aspectos de esta entidad, incidiendo en la importancia de un diagnóstico de laboratorio adecuado, evaluando siempre posibles signos o síntomas asociados como la litiasis renal o la osteoporosis, que pueden ayudar al clínico a tomar una actitud conservadora o más intervencionista (AU)

Normocalcemic primary hyperparathyroidism is at present one of the most common reasons for consultation in bone metabolism units. It is characterized by increased levels of intact parathyroid hormone in the presence of normal serum calcium (total and ionized) in generally asymptomatic individuals. The differential diagnosis should be considered in all situations that occur with secondary hyperparathyroidism. Its natural history is not well known, and it does not always progress to hypercalcemia. As a recently recognized entity, there are still no specific recommendations for its management. In this review we discuss some aspects of this entity, emphasizing the importance of a proper laboratory diagnosis, assessing possible signs or symptoms associated such as kidney stones or osteoporosis, which can help the clinician to take a conservative or interventionist attitude (AU)

[Normocalcemic primary hyperparathyroidism: a growing problem]. / Hiperparatiroidismo primario normocalcémico: un problema en aumento.

Normocalcemic primary hyperparathyroidism is at present one of the most common reasons for consultation in bone metabolism units. It is characterized by increased levels of intact parathyroid hormone in the presence of normal serum calcium (total and ionized) in generally asymptomatic individuals. The differential diagnosis should be considered in all situations that occur with secondary hyperparathyroidism. Its natural history is not well known, and it does not always progress to hypercalcemia. As a recently recognized entity, there are still no specific recommendations for its management. In this review we discuss some aspects of this entity, emphasizing the importance of a proper laboratory diagnosis, assessing possible signs or symptoms associated such as kidney stones or osteoporosis, which can help the clinician to take a conservative or interventionist attitude.

Etiopatogenia y tratamiento de la osteoporosis y fracturas del varón adulto / Etiopathogenesis and treatment of osteoporosis and fractures in adult males

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[Concept, etiology and epidemiology of primary hyperparathyroidism]. / Concepto, etiología y epidemiología del hiperparatiroidismo primario.

Primary hyperparathyroidism (PHPT) is one of the most frequent endocrinological disorders. In PHPT, there is abnormal regulation of parathyroid hormone (PTH) by calcium, which translates into inappropriately high PTH secretion for the level of calcemia. Most patients with PHPT have increased serum PTH levels, with increases in serum calcium, especially ionic calcium. The incidence of PHPT rises with age, the mean age at diagnosis being 55 years. This disorder affects mainly women with a female-to-male ratio of approximately 3:1. Most (80-85%) of cases are produced by chief cell parathyroid adenomas. The factors involved in the genesis of PHPT are largely unknown. Gene mutations affecting oncogenes (cyclin D1, RET) or tumor suppressor genes (MEN1, HRPT2) are found in a minority of cases. These mutations are especially important in familial forms of PHPT, such as multiple endocrine neoplasia syndrome (MEN1, MEN2A). No mutations affecting the calcium-sensing receptor (CaSR) or vitamin D receptor (VDR) gene have been found. In parathyroid adenomas and hyperplasias, there may be abnormal Wnt signalling, with mutations of the coreceptor LRP5 gene and beta-catenin accumulation. Expression of the Klotho protein, which intervenes in serum calcium regulation, is reduced. Low levels of 25(OH) vitamin D frequently coexist, although whether vitamin D deficiency plays a pathogenic role in PHPT is unknown.

Concepto, etiología y epidemiología del hiperparatiroidismo primario / Concept, etiology and epidemiology of primary hyperparathyroidism

El hiperparatiroidismo primario (HP) es uno de los trastornos endocrinológicos más frecuentes. En el HP se produce una regulación anormal de la secreción de parathormona (PTH) por el calcio, que se traduce en una secreción de PTH inapropiadamente alta para el grado de calcemia. La mayoría de pacientes con HP presentan valores aumentados de PTH sérica, con aumento de las concentraciones de calcio sérico, especialmente el calcio iónico. La incidencia aumenta con la edad, y la edad media al diagnóstico es de 55 años. Afecta predominantemente a las mujeres, con una proporción aproximada de 3:1, respecto a los varones. El 80-85% de los casos están producidos por un adenoma paratiroideo de células principales. Los factores implicados en la génesis del HP son en gran parte desconocidos. En una minoría se encuentran mutaciones genéticas que afectan a oncogenes (ciclina D1, RET) o genes supresores tumorales (MEN1, HRPT2). Tienen especial relevancia en las formas de HP familiares, como el síndrome de neoplasia endocrina múltiple (MEN1, MEN2A). No se han encontrado mutaciones que afecten al sensorreceptor de calcio (CaSR) o al gen del receptor de vitamina D (VDR). En los adenomas e hiperplasias paratiroideas puede existir una señalización anormal de la vía Wnt, con mutaciones del gen del correceptor LRP5 y acumulación de β-catenina. La expresión de la proteína Klotho, que interviene en la regulación del calcio sérico, está disminuida. Con frecuencia, pueden coexistir valores bajos de 25(OH) vitamina D, aunque se desconoce si la deficiencia de vitamina D tiene un papel patogénico en el HP (AU)

Primary hyperparathyroidism (PHPT) is one of the most frequent endocrinological disorders. In PHPT, there is abnormal regulation of parathyroid hormone (PTH) by calcium, which translates into inappropriately high PTH secretion for the level of calcemia. Most patients with PHPT have increased serum PTH levels, with increases in serum calcium, especially ionic calcium. The incidence of PHPT rises with age, the mean age at diagnosis being 55 years. This disorder affects mainly women with a female-to-male ratio of approximately 3:1. Most (80-85%) of cases are produced by chief cell parathyroid adenomas. The factors involved in the genesis of PHPT are largely unknown. Gene mutations affecting oncogenes (cyclin D1, RET) or tumor suppressor genes (MEN1, HRPT2) are found in a minority of cases. These mutations are especially important in familial forms of PHPT, such as multiple endocrine neoplasia syndrome (MEN1, MEN2A). No mutations affecting the calcium-sensing receptor (CaSR) or vitamin D receptor (VDR) gene have been found. In parathyroid adenomas and hyperplasias, there may be abnormal Wnt signalling, with mutations of the coreceptor LRP5 gene and β-catenin accumulation. Expression of the Klotho protein, which intervenes in serum calcium regulation, is reduced. Low levels of 25(OH) vitamin D frequently coexist, although whether vitamin D deficiency plays a pathogenic role in PHPT is unknown (AU)

Diabetes mellitus y síndrome diarreico en mujer de edad avanzada / Diabetes mellitus and diarrhea in an elderly woman

Entre un 5 y un 10% de los adultos diagnosticados inicialmente de diabetes mellitus tipo 2 (DM2) en realidad tienen diabetes autoinmunitaria de inicio en la edad adulta. Dado el elevado número de pacientes con diagnóstico de DM2, la entidad que ha sido denominada por algunos autores como LADA (latent autoimmune diabetes in adults) podría suponer la mitad de todos los diabéticos con DM1A. Presentamos el caso de una mujer de 75 años de edad, con antecedentes de diabetes mellitus con labilidad en el control glucémico y síndrome de colon irritable, que finalmente fue diagnosticada de diabetes autoinmunitaria con enfermedad celíaca concomitante (AU)

Between 5 and 10% of adults initially diagnosed with type 2 diabetes mellitus (DM) actually have adult-onset autoimmune diabetes. Given the large number of patients diagnosed with DM type 2, the entity called latent autoimmune diabetes in adults (LADA) by some authors could represent half of all diabetics with type 1A diabetes. We report the case of a 75-year-old woman, with a history of brittle diabetes and irritable bowel syndrome, who was finally diagnosed with autoimmune diabetes and celiac disease (AU)

Diabetes and diarrhea in an elderly woman.

Between 5 and 10% of adults initially diagnosed with type 2 diabetes mellitus.(DM) actually have adult-onset autoimmune diabetes. Given the large number of patients diagnosed with DM type 2, the entity called latent autoimmune diabetes in adults (LADA) by some authors could represent half of all diabetics with type 1A diabetes. We report the case of a 75-year-old woman, with a history of brittle diabetes and irritable bowel syndrome, who was finally diagnosed with autoimmune diabetes and celiac disease.

Nuevas estrategias terapéuticas en la osteoporosis / New strategies in the treatment of osteoporosis

La osteoporosis posmenopáusica es una enfermedad importante por sus repercusiones clínicas en morbilidad y mortalidad, que va en aumento con la mayor longevidad y las modificaciones negativas del estilo de vida de la población. Se revisa tanto su impacto clínico como el epidemiológico en la actualidad, señalando el papel de los factores de riesgo para el diagnóstico de esta afección, cuya definición entraña no sólo la pérdida de densidad mineral ósea, sino también alteraciones en la calidad del hueso. En los últimos años, el arsenal terapéutico para la osteoporosis se ha modificado sustancialmente con fármacos estudiados en ensayos clínicos aleatorizados, a doble ciego y controlados con placebo. Ello permite estudiar su efecto en las fracturas, que constituyen el dato más importante para su utilización. Teniendo en cuenta, por lo tanto, estos nuevos datos y los riesgos porcentuales de fracturas al cabo de 10 años en la población, se puede establecer los criterios terapéuticos que se analiza en esta revisión (AU)

Postmenopausal osteoporosis carries substantial morbidity and mortality. The impact of this disease is currently increasing due to greater longevity and negative lifestyle modifications. We review the clinical and epidemiologic impact of postmenopausal osteoporosis, with special emphasis on the risk factors to be considered in the diagnosis of this disease, which involves not only low bone mineral density, but also alterations in bone quality. In the last few years, the therapeutic arsenal available for the treatment of this disease has changed substantially with drugs that have been tested in randomized, double-blind, placebo-controlled clinical trials. These studies have allowed the effect of these drugs on fractures –the most important data for their use– to be studied. Therefore, taking into account these new reports, as well as the percentage 10-year risk of fracture among the population, therapeutic criteria can be established. These criteria are analyzed in the present review (AU)

La Vitamina D3 y el hueso / Vitamin D3 and the bone

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