Randomized, double-blind, controlled trial, phase III, to evaluate the use of platelet-rich plasma versus hyaluronic acid in hip coxarthrosis. / Ensayo clínico fase III para evaluar la eficacia y seguridad del uso de plasma rico en plaquetas frente a ácido hialurónico en coxartrosis.

AIMS OF THE STUDY: To compare efficacy and safety of a home-made platelet-rich plasma (PRP) solution versus hyaluronic acid in patients with hip osteoarthritis not responding to conservative treatment and to correlate cellular composition of PRP to clinical outcomes. MATERIAL AND METHODS: This is a phase III clinical trial, double-blinded, controlled and randomised into two treatment groups (PRP and hyaluronic acid). Patients received one hip ultrasound-guided injection. Follow up was 12 months. Pain was assessed using VAS score, HHS and WOMAC were used as functional scores, analgesia, adverse events, cellular components (PRP group) in peripheral blood and in PRP were recorded. Clinical response was assessed using OARSI criteria. RESULTS: Seventy-four patients were included. Both groups improved in VAS, WOMAC and HHS score and reduced the amount of analgesia (p<.05). Significant differences were seen at 1 year post-treatment in HHS score (PRP 70.9 [3.7-58], hyaluronic acid 60.2[43-74.2] p<.05). No adverse events were observed in none of the groups. Platelet concentration was different between responders and non-responders (at 1 month, non-responders 449[438-578] x103 platelets/µl versus responders 565 [481-666] x103 platelets/µl, p<.044). There was a correlation between leukocytes concentration and clinical scores (VAS at six months, r=0.748, p<.013, WOMAC at 6 months r=0.748, p <.013). Patients with early stage hip OA showed higher response rate to PRP compared with late stage (11.51 OR, 95%CI 2.34-50.65, p<.03). CONCLUSIONS: Platelet-rich plasma injection improved hip function, reduced pain and the use of analgesia. It is important to bear in mind the cellular composition in order to achieve a better clinical response.

Guía SECOT-GEIOS en osteoporosis y fractura por fragilidad. Actualización / SECOT-GEIOS guidelines in osteoporosis and fragility fracture. An update

No disponible

Factores determinantes de la resistencia ósea / Bone strength determinants

Hoy en día se considera que la resistencia ósea, entendiendo como tal la fuerza necesaria para desencadenar el fracaso biomecánico de un hueso, es el resultado de la integración de dos variables, la cantidad y la calidad ósea, factores dependientes a su vez del remodelado óseo. Mientras la cantidad de hueso depende directamente de su densidad mineral, la calidad del mismo depende de variables tales como la estructuración jerárquica y la composición química del material que lo forma. Cada uno de estos determinantes primarios de la resistencia ósea comprende a su vez una serie de determinantes secundarios, responsables directos de alguna de las propiedades biomecánicas óseas específicas. En conjunto, determinantes primarios y secundarios ayudan a establecer un hueso sano, resistente y biomecánicamente competente, mientras que sus alteraciones son responsables del desarrollo de osteopatías fragilizantes, procesos fisiopatológicos que incrementan el riesgo de fractura

Nowadays it is considered that bone strength, understanding as so the necessary load to cause a biomechanical failure of bone, it is the result of the integration of two variables, bone mass and bone quality, both related with bone remodelling. While bone mass depends directly on its mineral density, quality of bone depends on variables such as the hierarchic structure and chemical composition of its material. Each one of these bone strength primary determinants include a serial of secondary ones related with some of the specific biomechanical properties of bone. Altogether, primary and secondary determinants, help to establish a healthy, resistant and mechanical competent bone, whereas their alterations produce weakening osteopathies that increase fracture risk