Efecto de la fragilidad y la sarcopenia sobre el riesgo de caídas y de fracturas osteoporóticas en población no seleccionada / Effect of frailty and sarcopenia on the risk of falls and osteoporotic fractures in an unselected population

OBJETIVOS: Valorar si la fuerza de agarre y la dificultad para realizar actividades cotidianas podrían ser predictores de caídas y fracturas osteoporóticas. MATERIAL Y MÉTODOS: Se seleccionaron aleatoriamente 624 hombres y mujeres mayores de 50 años, que fueron seguidos durante 8 años para conocer la incidencia de caídas y fracturas osteoporóticas no vertebrales. Al inicio se midió la fuerza de agarre en manos y se cumplimentó un cuestionario con variables clínicas, factores de riesgo relacionados con la osteoporosis y cuestiones relativas a la dificultad o incapacidad para realizar actividades cotidianas. RESULTADOS: La fuerza de agarre en manos no se asoció con la incidencia de caídas y fracturas. Sin embargo, la imposibilidad o dificultad de "estar sentado más de 1 hora en silla dura", "quitarse los calcetines o las medias" e "inclinarse desde una silla para coger un objeto del suelo" se asoció con caídas: 1,83 (1,16-2,89); 1,85 (1,14-3,00) y 1,68 (1,04-2,70), respectivamente. Del mismo modo, la imposibilidad o dificultad de "llevar durante 10 metros un objeto de 10 kilos" y "levantar una caja con 6 botellas y ponerlas sobre una mesa" se asoció con fractura: 2,82 (1,21-6,59) y 2,54 (1,12-5,81) respectivamente. CONCLUSIONES: No se encontró asociación entre la fuerza de agarre e incidencia de caídas y fracturas osteporóticas, pero sí con dificultad o incapacidad para realizar actividades cotidianas. Las relacionadas con mayor fuerza se asociaron con fractura, mientras que las relacionadas con capacidad funcional se asociaron con caídas. Realizar cuestionarios sencillos podría ayudar a predecir eventos antes de que ocurran

OBJECTIVE: Assess whether grip strength and difficulty in carrying out daily activities could be predictors of falls and osteoporotic fractures. MATERIAL AND METHODS: 624 men and women over 50 years of age were randomly selected and followed for 8 years to determine the incidence of falls and non-vertebral osteoporotic fractures. At the beginning, the grip strength in the hands was measured and a questionnaire was filled out with clinical variables, risk factors related to osteoporosis, and questions related to difficulty or inability to perform daily activities. RESULTS: Grip strength in the hands was not associated with the incidence of falls and fractures. However, the impossibility or difficulty of "sitting for more than 1 hour in a hard chair", "taking off socks or stockings" and "leaning from a chair to pick up an object from the floor" were associated with falls: 1.83 (1.16-2.89); 1.85 (1.14-3.00) and 1.68 (1.04-2.70), respectively. Similarly, the impossibility or difficulty of "carrying a 10-kilogram object for 10 meters" and "lifting a box with 6 bottles and putting them on a table" was associated with fracture: 2.82 (1.21-6.59) and 2.54 (1.12-5.81) respectively. CONCLUSIONS: No association was found between grip strength and incidence of falls and osteoporotic fractures, but it was found with difficulty or inability to perform daily activities. Those related to greater strength were associated with fracture, while those related to functional capacity were associated with falls. Taking simple questionnaires could help predict events before they happen

Impacto de la calcificación vascular en la mortalidad y salud ósea en pacientes con trasplante renal / Impact of vascular calcification on bone health andmortality in kidney transplant patients

OBJETIVOS: Evaluar la prevalencia de calcificación vascular y fracturas vertebrales en una cohorte de pacientes sometidos a trasplante renal, y su asociación con mortalidad por todas las causas y disfunción del injerto, así como la relación con parámetros bioquímicos del metabolismo óseo y mineral. MATERIAL Y MÉTODOS: Estudio prospectivo, observacional, unicéntrico, en el que se incluyeron 405 pacientes sometidos a trasplante renal, con recogida de parámetros clínicos, bioquímicos, epidemiológicos y de calcificación vascular radiológica y fracturas vertebrales mediante radiografía simple en el momento del trasplante, con un seguimiento mínimo de dos años, evaluando mortalidad cardiovascular y por todas las causas y descenso del filtrado glomerular. Se dispuso además de 39 estudios de densitometría ósea realizados en los meses previos al trasplante. RESULTADOS: La supervivencia de los pacientes fue significativamente menor en el grupo de pacientes con calcificación vascular (131 ± 1,5 meses sin calcificación frente a 110 ± 3,5 meses con calcificación vascular, p < 0,001). Se observó un mayor descenso del filtrado glomerular estimado (FGE) mediante la fórmula CKD-EPI en todos los pacientes que presentaban calcificación vascular, siendo esta un factor de riesgo independiente (OR = 2,7; IC 95%: 1,6-4,4; p < 0,001). La prevalencia de fracturas vertebrales fue significativamente mayor en el grupo de calcificación vascular (12%), independientemente de otros factores de riesgo (OR = 9,2; IC 95%: 1,2-73,4; p = 0,036). Se ha asociado la prevalencia de fracturas vertebrales con menor masa ósea en cadera evaluada mediante densitometría ósea (T-score -1,2 vs. -2,4, p = 0,02) CONCLUSIONES: La calcificación vascular previa al trasplante, evaluada mediante un método sencillo, barato y accesible como la radiografía simple, condiciona la morbimortalidad del paciente sometido a trasplante renal y tiene un gran impacto sobre la evolución de la función del injerto, independientemente de otros factores de riesgo tradicionales. La asociación entre la fragilidad ósea, la calcificación vascular y el pronóstico del paciente y del injerto renal nos debe hacer pensar en añadir la densitometría ósea en el protocolo de inclusión en lista de espera de trasplante. Es relevante promover no sólo la mejor salud vascular posible sino también promover el menor impacto en el tejido óseo en la progresión de la enfermedad renal crónica antes del momento del trasplante

OBJETIVE: To assess the prevalence of vascular calcification and vertebral fractures in a cohort of patients undergoing kidney transplantation and its association with all graft-related causes of mortality and dysfunction, as well as the relationship with biochemical parameters of bone and mineral metabolism. MATERIAL AND METHODS: Prospective, observational, single-center study, which included 405 patients undergoing kidney transplants, with collection of clinical, biochemical, epidemiological parameters, and of radiological vascular calcification and vertebral fractures by simple radiography at the time of transplantation, with a minimum follow-up of two years. We assessed cardiovascular mortality and all causes and decreased glomerular filtration. In addition, 39 bone densitometry studies carried out in the months prior to transplantation were reported. RESULTS: Patient survival was significantly lower in the group of patients with vascular calcification (131 ± 1.5 months without calcification compared to 110 ± 3.5 months with vascular calcification, p < 0.001). A greater decrease in the estimated glomerular filtration rate (GFR) was observed using the CKD-EPI formula in all patients who presented vascular calcification, this being an independent risk factor (OR = 2.7; 95% CI: 1.6-4, 4; p < 0.001). The prevalence of vertebral fractures was significantly higher in the vascular calcification group (12%), independently of other risk factors (OR = 9.2; 95% CI: 1.2-73.4; p = 0.036). The prevalence of vertebral fractures has been associated with lower hip bone mass assessed by bone densitometry (T-score -1.2 vs. -2.4, p = 0.02) CONCLUSIONS: Vascular calcification prior to transplantation, evaluated using a simple, cheap and accessible method such as plain radiography, determines the morbidity and mortality of the patient undergoing a kidney transplant and has a great impact on the evolution of graft function, regardless of other risk factors. traditional. The association between bone fragility, vascular calcification and the prognosis of the patient and the renal graft should make us think about adding bone densitometry to the protocol for inclusion in the transplant waiting list. It is relevant to promote not only the best possible vascular health but also to promote the least impact on bone tissue in the progression of chronic kidney disease before the time of transplantation

Niveles de calcidiol y mantenimiento de la función muscular, capacidad funcional y densidad mineral ósea en población española no seleccionada / Calcidiol levels and muscle function maintenance, functional capacityand bone mineral bone density in non-selected Spanish population

Introducción: La vitamina D posee efectos beneficiosos que supuestamente contribuirian a mantener la funcion musculo‐esqueletica. Objetivo: Analizar en una poblacion no seleccionada el efecto de los niveles de calcidiol sobre la funcion muscular en ambas manos, sobre actividades de la vida cotidiana y sobre los cambios en la densidad mineral osea (DMO). Material y métodos: Se utilizo la cohorte del estudio EVOS que realizo, entre otros, medidas de fuerza muscular de agarre en ambas manos, preguntas relativas a la dificultad para realizar actividades cotidianas, estudio densitometrico en columna lumbar y cadera, y bioquimica para determinar los niveles de calcidiol. Resultados: Valores de calcidiol ≥20 ng/mL se asociaron con mayor fuerza muscular de agarre en ambas manos. Tras ajuste por edad, sexo, IMC y estacionalidad, niveles de calcidiol <20 ng/mL se asociaron independientemente con menor fuerza muscular de agarre solo en la mano izquierda (OR=2,35; IC 95%: 1,03‐5,38). Del mismo modo, la incapacidad o tener dificultades para "coger un libro u objeto de una estanteria alta" e "incorporarse de la cama" se asociaron significativamente con niveles de calcidiol <20 ng/mL. Niveles de calcidiol <20 ng/mL se asociaron con mayores perdidas de DMO en cuello femoral y cadera total. Estas asociaciones se mantuvieron en el analisis multivariante. Conclusiones: Mantener niveles de calcidiol ≥20 ng/mL se asociaron con mayor fuerza muscular de agarre en las manos, mantenimiento de actividades cotidianas y menores perdidas de DMO en cadera. Este estudio corrobora la utilidad de mantener niveles adecuados de vitamina D para mantener la funcion musculo‐esqueletica

Introduction:Vitamin D offers beneficial effects that reportedly help maintain musculoskeletal function. Aim:To analyze the effect of calcidiol levels on muscle function in both hands, on activities of daily life and on changesin bone mineral density (BMD) in an unselected population.Material and methods:The EVOS study cohort was used, which carried out, among others, measures of muscularstrength of grip in both hands, questions related to difficulty in performing daily activities, densitometric study in thelumbar and hip spine, and biochemistry to determine the levels of calcidiol.Results: Calcidiol values ≥20 ng/mL were associated with greater grip strength in both hands. After adjusting for age,sex, BMI and seasonality, calcidiol levels <20 ng/mL were independently associated with lower grip strength only inthe left hand (OR=2.35; 95% CI: 1.03‐5.38). Likewise, the inability or difficulty to "pick up a book or object from a highshelf" and "get up from the bed" were significantly associated with calcidiol levels <20 ng/mL. Levels of calcidiol <20ng/mL were associated with greater BMD losses in the femoral neck and total hip. These associations were maintainedin the multivariate analysis.Conclusions:Maintaining levels of calcidiol ≥20 ng/mL was associated with greater muscular strength of grip in thehands, maintenance of daily activities and lower BMD losses in the hip. This study corroborates the utility of maintainingadequate levels of vitamin D to maintain musculoskeletal function

Caloric restriction attenuates aging-induced cardiac insulin resistance in male Wistar rats through activation of PI3K/Akt pathway.

BACKGROUND AND AIM: Caloric restriction (CR) improves insulin sensitivity and is one of the dietetic strategies most commonly used to enlarge life and to prevent aging-induced cardiovascular alterations. The aim of this study was to analyze the possible beneficial effects of caloric restriction (CR) preventing the aging-induced insulin resistance in the heart of male Wistar rats. METHODS AND RESULTS: Three experimental groups were used: 3 months old rats (3m), 24 months old rats (24m) and 24 months old rats subjected to 20% CR during their three last months of life (24m-CR). After sacrifice hearts were mounted in a perfusion system (Langendorff) and heart function in basal conditions and in response to accumulative doses of insulin (10-9-10-7 M), in the presence or absence of Wortmannin (10-6 M), was recorded. CR did not attenuate the aging-induced decrease in coronary artery vasodilation in response to insulin administration, but it prevented the aging-induced downregulation of cardiac contractility (dp/dt) through activation of the PI3K/Akt intracellular pathway. Insulin stimulated in a greater extent the PI3K/Akt pathway vs the activation of the MAPK pathway and increased the protein expression of IR, GLUT-4 and eNOS in the hearts of 3m and 24m-CR rats, but not in the hearts of 24m rats. Furthermore, CR prevented the aging induced increase in endothelin-1 protein expression in myocardial tissue. CONCLUSION: In conclusion CR partially improves cardiac insulin sensitivity and prevents the aging induced decrease in myocardial contractility in response to insulin administration through activation of PI3K/Akt pathway.

Study of insulin vascular sensitivity in aortic rings and endothelial cells from aged rats subjected to caloric restriction: Role of perivascular adipose tissue.

The prevalence of metabolic syndrome is dramatically increasing among elderly population. Metabolic syndrome in aged individuals is associated with hyperinsulinemia and insulin resistance both in metabolic tissues and in the cardiovascular system, with this fact being associated with the cardiometabolic alterations associated to this condition. Caloric restriction (CR) improves insulin sensitivity and is one of the dietetic strategies most commonly used to enlarge life and to prevent aging induced cardiovascular alterations. The aim of this study was to analyze the possible beneficial effects of CR in aging-induced vascular insulin resistance both in aortic rings and in primary culture of endothelial cells. In addition, the inflammatory profile of perivascular adipose tissue (PVAT) and its possible role in the impairment of vascular insulin sensitivity associated with aging was also assessed. Three experimental groups of male Wistar rats were used: 3 (3m), 24 (24m) fed ad libitum and 24months old rats subjected to 20% CR during their three last months of life (24m-CR). Aorta rings surrounded or not by PVAT were mounted in an organ bath and precontracted with phenylephrine (10-7.5M). Changes in isometric tension were recorded in response to cumulative insulin concentrations (10-8-10-5.5M) in the presence or absence of L-NAME (10-4M). Aortic rings and primary aortic endothelial cells were incubated in presence/absence of insulin (10-7M) and the activation of the PI3K/Akt and MAPK pathways as well as nitrite and nitrates concentrations and the mRNA levels of eNOS, insulin receptor, and GLUT-4 were assessed. CR prevented the aging-induced decrease in the vasodilator response to insulin and the aging-induced increase in the vasoconstrictor response to high insulin concentrations. Changes between 24m and 24m-CR aorta rings were abolished in the presence of L-NAME. CR induced-improvement in insulin vascular sensitivity was related with activation of the PI3K/Akt both in aortic rings and in aortic endothelial cells in response to insulin. CR attenuated the overexpression of iNOS, TNF-α and IL-1ß in the PVAT of aged rats although aortic rings surrounded by PVAT from 24m rats showed and increased vasorelaxation in response to insulin compared to aortic rings from 3m and 24m-CR rats. In conclusion, a moderate protocol of CR improves insulin vascular sensitivity and prevents the aging induced overexpression of pro-inflammatory cytokines in PVAT.

Effects of early overnutrition on the renal response to Ang II and expression of RAAS components in rat renal tissue.

BACKGROUND AND AIMS: The aim of this study was to analyze the effects of early overnutrition (EON) on the expression of the renin angiotensin aldosterone system (RAAS) components in renal cortex, renal arteries and renal perivascular adipose tissue (PVAT), as well as the vascular response of renal arteries to Angiotensin II (Ang II). METHODS AND RESULTS: On birth day litters were adjusted to twelve (L12-control) or three (L3-overfed) pups per mother. Half of the animals were sacrificed at weaning (21 days old) and the other half at 5 months of age. Ang II-induced vasoconstriction of renal artery segments increased in young overfed rats and decreased in adult overfed rats. EON decreased the gene expression of angiotensinogen (Agt), Ang II receptors AT1 and AT2 and eNOS in renal arteries of young rats, while it increased the mRNA levels of AT-2 and ET-1 in adult rats. In renal PVAT EON up-regulated the gene expression of COX-2 and TNF-α in young rats and the mRNA levels of renin receptor both in young and in adult rats. On the contrary, Ang II receptors mRNA levels were downregulated at both ages. Renal cortex of overfed rats showed increased gene expression of Agt in adult rats and of AT1 in young rats. However the mRNA levels of AT1 were decreased in the renal cortex of overfed adult rats. CONCLUSION: EON is associated with alterations in the vascular response of renal arteries to Ang II and changes in the gene expression of RAAS components in renal tissue.