Predictores del riesgo de fractura en una población de mujeres postmenopáusicas mediante el procedimiento estadístico binario CART / Fracture risk predictors of a postmenopausal female population by binary statistical procedure

Objetivo: La principal consecuencia de la osteoporosis es la fractura por fragilidad asociada a elevada morbimortalidad. La predicción de la misma puede ayudar a identificar la población de mayor riesgo y establecer medidas de prevención. El objetivo de este estudio fue valorar la utilidad de diversos factores en su prevención comparando la densidad mineral ósea (DMO), el cálculo del riesgo absoluto de fractura con la herramienta FRAX® con y sin DMO, y los datos clínicos. Material y métodos: Se realizó un estudio longitudinal de 8 años de duración en una población de mujeres postmenopáusicas, osteoporóticas y no osteoporóticas. A todas ellas se les realizó una historia clínica protocolizada, DMO de columna y cadera, y el FRAX con y sin DMO. A los 8 años se identificaron las fracturas existentes. Además de realizar una estadística paramétrica y no paramétrica con SPSS 21.1, se realizó un método del árbol de clasificación y regresión (CART) para evaluar las posibles interacciones entre los factores de riesgo de fractura. Resultados: Se incluyeron 276 pacientes postmenopáusicas cuya edad media al inicio del estudio fue de 61,08±8,43 años y un índice de masa corporal (IMC) de 25,67±4,04. El 56,5% de las pacientes (n=156) fueron diagnosticadas de osteoporosis antes del inicio de nuestro estudio, y todas ellas fueron tratadas. Pasados los 8 años de seguimiento, 72 pacientes (24,6%) sufrieron fractura y 17 (6,2%) también sufrieron una segunda fractura. Los resultados del análisis CART nos mostraron que el principal factor de riesgo para sufrir una fractura osteoporótica tras 8 años de seguimiento fue el haber sufrido fracturas previas. Entre las pacientes que habían sufrido una fractura previa, el tener una DMO del cuello femoral menor de 0,67 fue el principal factor de riesgo. (AU)

Objetivo: The main consequences of osteoporosis are fragility fractures, associated with high morbimortality. The prediction of these fractures can help identify the most-at-risk population and implement preventive measures. The aim of this study was to assess the usefulness of multiple factors in their prevention, comparing the bone mineral density (BMD), the calculation of absolute risk of fracture using the tool FRAX® in the presence and absence of BMD, and the clinical data. Material and methods: An eight-year-duration longitudinal study was conducted on a postmenopausal female population, with and without osteoporosis. All of them were taken a standardised clinical history, spinal and hip BMD, and FRAX with and without BMD. Eight years later we identified the existent fractures. In addition to a parametric and non-parametric statistic in SPSS 21.1, we used the classification and regression tree (CART) method to assess possible interactions among fracture risk factors. Results: We studied 276 postmenopausal patients whose average age at the beginning of the study was 61.08±8.43 years-old and had a body mass index (BMI) of 25.67±4.04. 56.5% of the patients (n=156) were diagnosed with osteoporosis before the beginning of our study, and all of them were treated. After eight years of follow-up, 72 patients (24.6%) suffered a fracture and 17 patients (6.2%) also suffered a second one. The results of the CART analysis showed that the main risk factor to suffer an osteoporotic fracture after 8 years of following up is having preceding fractures. Having a femoral neck BMD lower than 0.67 was the main risk factor among those with a previous fracture. Conclusions: The use of a binary statistical procedure (CART) on a cohort of patients allow us identify those most at risk of fractures, according to clinical parameters and simple additional tests, in order to establish more effective therapeutic measures. (AU)

Ankle-brachial index, risk of clinical fractures, mortality and low bone mass in nursing home residents.

OBJECTIVE: To assess whether the ankle-brachial index is related to functional impairment, clinical fractures and mortality in nursing home residents, and whether this effect is associated or not with low bone mass. PATIENTS AND METHODS: Prospective, observational, non-interventional cohort study in non-dependent nursing home residents. The following determinations were made: BUN, creatinine, cholesterol, triglycerides, calcium, phosphorous 25-hydroxyvitamin D, parathyroid hormone and cystatin C in blood and microalbuminuria in urine. Bone mass was determined by measuring the peripheral densitometry of the calcaneus. The Katz Index of independence, the Tinetti Balance and Gait evaluation and functional tests were administered. The ankle-brachial index was measured and patients divided into three groups (ankle-brachial index > 1.40, 1.40-0.90, and < 0.90). Clinical fractures and general and vascular mortality were measured for 20 months. RESULTS: Seventy-two patients were included. There was an inverse relationship between age and the ankle-brachial index (p = 0.022) but no association with bone mass, biochemical tests, clinical fractures and the degree of independence. There was increased mortality in patients with increased or reduced ABI. CONCLUSIONS: An altered ankle-brachial index is a marker of vascular mortality in elderly nursing home residents.

Treatment of osteoporosis and hip fractures in a Spanish health area.

OBJECTIVE: The aim of this longitudinal retrospective ecological study was to evaluate the consumption of anti-osteoporotic medications and the evolution of pertrochanteric and femoral neck (FN), subtrochanteric and diaphyseal hip fractures between 2005 and 2010. MATERIALS AND METHODS: Data were obtained from our Hospital Admissions Service (absolute number of fractures) and the Technical Directorate of Pharmacy (defined daily dose and absolute number of containers consumed of bisphosphonates (BP), raloxifene and strontium ranelate). RESULTS: The overall incidence density of FN in 2005-2010 was 124.8 new cases per 100,000 persons per year. BP consumption increased between 2005 and 2010 to a peak of 70,452 containers consumed in 2010, while consumption of raloxifene declined. The number of subtrochanteric and diaphyseal fractures remained stable, but FN reached a peak in 2008 (N = 350) and fell thereafter (N = 284 in 2010). The percentage reduction in the number of FN in the period studied (2009: -14% and 2010: -11% compared to 2005) corresponds temporally with the increased consumption of BP (2009: +76% and 2010: +84% compared to 2005). CONCLUSIONS: We found an inverse temporal association between the annual consumption of BP and the annual number of FN during 2005-2010. This is probably related to the cumulative effect of BP, although, given the limitations of the study design, other studies are needed to confirm our data.

[Relation of -55CT polymorphism of UCP3 gene with weight loss and metabolic changes after a high polyunsaturated fat diet in obese patients]. / Relación del polimorfismo -55CT del gen UCP3 con la pérdida de peso y los cambios metabólicos tras una dieta hipocalórica rica en ácidos grasos poliinsaturados en pacientes obesos.

BACKGROUND AND OBJECTIVES: The alteration in the protein expression of UCP3 could reduce energy consumption and increase energy storage as fat. The aim of our study was to investigate the influence of -55CT polymorphism of UCP3 gene in the metabolic response, weight loss and serum levels of adipokines following a hypocaloric diet rich in polyunsaturated fat in obese patients. DESIGN: A sample of 133 obese patients were analyzed prospectively for 3 months. The hypocaloric diet was 1459 kcal, 45.7% carbohydrate, 34.4% from 19.9% lipids and proteins. The fat distribution was, a 21.8% saturated fat, 55.5% monounsaturated and 22.7% of polyunsaturated fat (7 g per day of fatty acids w6, 2 g per day of w -3 and a ratio w6/w3 of 3.5). RESULTS: A total of 100 patients (28 males/72 females) (75.2%) had genotype - 55CC (wild genotype group) and 33 patients (8 males/25 females) (24.8%) -55CT genotype (group mutant genotype). In the wild genotype, body mass index (-2.5 ± 5.3 kg/m²), weight (-4.2 ± 3.7 kg), fat mass (-3,7 ± 3.3 kg), waist circumference (-4.1 ± 2.9 cm), systolic blood pressure (-4.9 ± 10.1 mmHg), total cholesterol levels (- 16.1 ± 23.6 mg / dl), LDL cholesterol (-11.1 ± 26.8 mg/dl), triglycerides (-12.0 ± 46.8 mg/dl), insulin (-1.8 ± 4.5 IU/L), HOMA-R (-0.6 ± 1.5) and leptin (-6.2 ± 8.4 ng/ml) decreased. In the mutant genotype anthropometric parameters were significantly decreased without significant changes in biochemical parameters. CONCLUSION: The T allele carriers of -55CT UCP3 polymorphism exhibit no metabolic response to weight loss induced by a hypocaloric diet rich in polyunsaturated fatty acids.

[Relation of the rs9939609 gene variant in FTO with cardiovascular risk factor and serum adipokine levels in morbid obese patients]. / Relación del polimorfismo rs9939609 del gen FTO con factores de riesgo cardiovascular y niveles de adipocitoquinas en pacientes con obesidad mórbida.

BACKGROUND: Common polymorphisms of the fat mass and obesity associated gene (FTO) have been linked to obesity in some populations. The aim of our study was to analyze the relationship of the rs9939609 FTO gene polymorphism on body weight, cardiovascular risk factors and serum adipokine levels in morbid obese patients. MATERIAL AND METHODS: A sample of 129 patients with obesity was analyzed in a cross sectional design. Weight, blood pressure, basal glucose, c-reactive protein (CRP), insulin, insulin resistance (HOMA), total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides blood and adipocytokines (leptin, adiponectin, resistin, TNF alpha, and interleukin 6) levels were measured. A tetrapolar bioimpedance and a prospective serial assessment of nutritional intake with 3 days written food records were realized. Genotype of FTO gene polymorphism (rs9939609) was studied. RESULTS: Forty three patients (31.8%) had TT genotype, 55 patients (42.6%) TA genotype and 33 patients (25.6%) AA genotype. Body mass index (43.6 (2.6) kg/m² vs. 44.1 (2.9) kg/m²; p < 0.05), fat mass (52.0 (12.5) kg vs. 56.3 (11.7) kg: p < 0.05), weight (111.6 (16.2) kg vs. 114.9 (18.9) kg; p < 0.05), levels of C reactive protein (6.1 (4.3) mg/dl vs. 9.8 (7.1) mg/dl; p < 0.05) and levels of leptin (65.9 (52.2) ng/ml vs. 110.9 (74.1); < 0.05) were higher in mutant type group (A allele) than wild genotype group (TT). CONCLUSION: The FTO gene polymorphism, rs9939609, was found to be associated with weight, fat mass, C reactive protein and leptin levels in morbid obese patients with A allele.

Relación del polimorfismo rs9939609 del gen FTO con factores de riesgo cardiovascular y niveles de adipocitoquinas en pacientes con obesidad mórbida / Relation of the rs9939609 gene variant in FTO with cardiovascular risk factor and serum adipokine levels in morbid obese patients

Introducción: Algunos polimorfismos del gen asociado con la masa grasa y la obesidad (FTO) se han relacionado con la obesidad y parámetros bioquímicos. Nuestro objetivo fue analizar la relación del polimorfismo rs9939609 del gen FTO con el peso corporal, factores de riesgo cardiovascular y los niveles séricos de adipocitoquinas en una muestra de pacientes con obesidad mórbida. Material y métodos: Una muestra de 129 pacientes con obesidad mórbida (IMC > 40) se analizó en un diseño de corte transversal. A todos los pacientes se les determinó el peso, presión arterial, glucemia basal, proteína C reactiva (PCR), insulina, resistencia a la insulina (HOMA-R), colesterol total, LDL-colesterol, HDL-colesterol, triglicéridos y adipocitoquinas (adiponectina leptina, resistina, TNF-alfa, y los niveles de interleucina-6). Se evaluó la masa grasa mediante bioimpedancia tetrapolar y registró prospectivamente la ingesta de nutrientes durante tres días. En todos ellos se genotipo el polimorfismo del gen FTO (rs9939609). Resultados: Cuarenta y un pacientes (31,8%) tenían el genotipo TT (grupo genotipo salvaje), 55 pacientes (42,6%) el genotipo TA y 33 pacientes (25,6%) el genotipo AA. El índice de masa corporal (43,6 (2,6) kg/m2 vs. 44,1 (2,9) kg/m2; p < 0,05), masa grasa (52,0 (12,5) kg vs. 56,3 (11,7) kg: p < 0,05), el peso (111,6 (16,2) kg vs. 114,9 (18,9) kg; p < 0,05), niveles de proteína C reactiva (6,1(4,3) mg/dl vs. 9,8 (7,1) mg/dl; p < 0,05) y niveles de leptina (65,9 (52,2) ng/ml vs. 110,9 (74,1); < 0,05) fueron estadísticamente mayores en los pacientes que presentaron el alelo mutado (A). Conclusiones: El polimorfismo del gen FTO, rs9939609, se asocia con un mayor peso, masa grasa y niveles circulantes de leptina y proteína C reactiva en pacientes con obesidad mórbida (AU)

Background: Common polymorphisms of the fat mass and obesity associated gene (FTO) have been linked to obesity in some populations. The aim of our study was to analyze the relationship of the rs9939609 FTO gene polymorphism on body weight, cardiovascular risk factors and serum adipokine levels in morbid obese patients. Material and methods: A sample of 129 patients with obesity was analyzed in a cross sectional design. Weight, blood pressure, basal glucose, creactive protein (CRP), insulin, insulin resistance (HOMA), total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides blood and adipocytokines (leptin, adiponectin, resistin, TNF alpha, and interleukin 6) levels were measured. A tetrapolar bioimpedance and a prospective serial assessment of nutritional intake with 3 days written food records were realized. Genotype of FTO gene polymorphism (rs9939609) was studied. Results: Forty three patients (31.8%) had TT genotype, 55 patients (42.6%) TA genotype and 33 patients (25.6%) AA genotype. Body mass index (43.6 (2.6) kg/m2 vs. 44.1 (2.9) kg/m2; p < 0.05), fat mass (52.0 (12.5) kg vs. 56.3 (11.7) kg: p < 0.05), weight (111.6 (16.2) kg vs. 114.9 (18.9) kg; p < 0.05), levels of C reactive protein (6.1 (4.3) mg/dl vs. 9.8 (7.1) mg/dl; p < 0.05) and levels of leptin (65.9 (52.2) ng/ml vs. 110.9 (74.1); < 0.05) were higher in mutant type group (A allele) than wild genotype group (TT). Conclusion: The FTO gene polymorphism, rs9939609, was found to be associated with weight, fat mass, C reactive protein and leptin levels in morbid obese patients with A allele (AU)

Relación del polimorfismo -55CT del gen UCP3 con la pérdida de peso y los cambios metabólicos tras una dieta hipocalórica rica en ácidos grasos poliinsaturados en pacientes obesos / Relation of -55CT polymorphism of UCP3 gene with weight loss and metabolic changes after a high polyunsaturated fat diet in obese patients

Antecedentes y objetivos: La alteración en la expresión de las proteinas UCP3 podrían reducir el gasto energético y aumentar el almacenamiento de energía en forma de grasa. El objetivo de nuestro estudio fue investigar la influencia del polimorfismo -55CT del gen UCP3 en la respuesta metabólica, pérdida de peso y los niveles séricos de adipocitoquinas tras una dieta hipocalórica rica en grasas poliinsaturadas en pacientes obesos. Diseño: Se estudió una muestra de 133 pacientes obesos de forma prospectiva durante 3 meses. La dieta hipocalórica tenía 1.459 kcal, un 45,7% de hidratos de carbono, un 34,4% de los lípidos y un 19,9% de las proteínas. La distribución de las grasas era; un 21,8% de grasas saturadas, un 55,5% de grasas monoinsaturadas y un 22,7% de las grasas poliinsaturadas (7 g por día de ácidos graso w6, 2 g por díia de w-3 y una ratio w6/w3 de 3,5). Resultados: Un total de 100 pacientes (28 varones/72 mujeres) (75,2%) tenían el genotipo -55CC (grupo con genotipo salvaje) y 33 pacientes (8 varones/25 mujeres) (24,8%) el genotipo -55CT (grupo con genotipo mutante). En el grupo con genotipo salvaje disminuyeron el índice de masa corporal (-2,5 ± 5,3 kg/m2), peso (-4,2 ± 3,7 kg), masa grasa (-3,7 ± 3,3 kg), circunferencia de la cintura (-4,1 ± 2,9 cm), tensión arterial sistólica (-4,9 ± 10,1 mmHg), niveles de colesterol total (-16,1 ± 23,6 mg/dl), colesterol LDL (-11,1 ± 26,8 mg/dl), triglicéridos (-12,0 ± 46,8 mg/dl), insulina (-1,8 ± 4,5 UI/L), HOMA-R (-0,6 ± 1,5) y leptina (-6,2 ± 8,4 ng/ml). En el grupo con genotipo mutante disminuyeron significativamente los parámetros antropométricos sin modificaciones significativas de parámetros bioquímicos. Conclusión: Los pacientes portadores del alelo T del polimorfismo -55CT del gen UCP3, presentan una ausencia respuesta metabólica ante la perdida de peso inducida por una dieta hipocalórica rica en ácidos grasos poliinsaturados (AU)

Background and objectives: The alteration in the protein expression of UCP3 could reduce energy consumption and increase energy storage as fat. The aim of our study was to investigate the influence of -55CT polymorphism of UCP3 gene in the metabolic response, weight loss and serum levels of adipokines following a hypocaloric diet rich in polyunsaturated fat in obese patients. Design: A sample of 133 obese patients were analyzed prospectively for 3 months. The hypocaloric diet was 1459 kcal, 45.7% carbohydrate, 34.4% from 19.9% lipids and proteins. The fat distribution was, a 21.8% saturated fat, 55.5% monounsaturated and 22.7% of polyunsaturated fat (7 g per day of fatty acids w6, 2 g per day of w -3 and a ratio w6/w3 of 3.5). Results: A total of 100 patients (28 males/72 females) (75.2%) had genotype - 55CC (wild genotype group) and 33 patients (8 males/25 females) (24.8%) -55CT genotype (group mutant genotype). In the wild genotype, body mass index (-2.5 ± 5.3 kg/m2), weight (-4.2 ± 3.7 kg), fat mass (-3,7 ± 3.3 kg), waist circumference (-4.1 ± 2.9 cm), systolic blood pressure (-4.9 ± 10.1 mmHg), total cholesterol levels (- 16.1 ± 23.6 mg / dl), LDL cholesterol (-11.1 ± 26.8 mg/dl), triglycerides (-12.0 ± 46.8 mg/dl), insulin (-1.8 ± 4.5 IU/L), HOMA-R (-0.6 ± 1.5) and leptin (-6.2 ± 8.4 ng/ml) decreased. In the mutant genotype anthropome-tric parameters were significantly decreased without significant changes in biochemical parameters. Conclusion: The T allele carriers of -55CT UCP3 polymorphism exhibit no metabolic response to weight loss induced by a hypocaloric diet rich in polyunsaturated fatty acids (AU)

Ausencia del cuerpo calloso,colpocefalia y esquizofrenia / Absence of the corpus callosum, colpocephaly and schizophrenia

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Epidemiology of acute carbon monoxide poisoning in a Spanish region.

BACKGROUND: In Spain, as in most of the world, the incidence of acute carbon monoxide poisoning is probably underestimated. METHODS: During an eighteen-month period we studied, by means of a standardized data collection form, all the cases of acute carbon monoxide poisoning that were diagnosed in 2 university hospitals. RESULTS: During the study, 154 patients were diagnosed with carbon monoxide poisoning. The mean age was 32.2+/-15.5 years. The two principal exposure sites were the kitchen (43%) and bathroom (23%). The majority of the cases related to malfunction of the water heater (30%) and of the central heating (23%) and 68% occurred in the home. Improper combustion of butane (31%), propane (13%), and natural gas (12%) were most frequent. The most prevalent clinical manifestations were headache (94%), dizziness (56%), nausea (45%), loss of consciousness (38%), and weakness (34%). Five patients died. In 14.4%, symptoms suggested delayed neurological syndrome. The largest number of cases of poisoning occurred during the months of December and January. CONCLUSIONS: Compared with previous Spanish series or with the antecedent year, acute carbon monoxide poisoning has a high prevalence in our region. Two factors appear to be essential to the accurate diagnosis of acute carbon monoxide poisoning: 1) the ability of emergency room physicians to recognize the clinical symptoms of carbon monoxide poisoning and 2) access to a carbon monoxide-oximeter.