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BACKGROUND: Mandibular advancement devices for obstructive sleep apnea treatment are becoming increasingly popular among patients who do not prefer CPAP devices or surgery. Our study aims to evaluate the literature regarding potential dental and skeletal side effects caused by mandibular advancement appliances used for adult OSA treatment. METHODS: Electronic databases were searched for published and unpublished literature along with the reference lists of the eligible studies. Randomized clinical trials and non-randomized trials assessing dental and skeletal changes by comparing cephalometric radiographs were selected. Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate. Fourteen articles were finally selected (two randomized clinical trials and 12 non-randomized trials). RESULTS: The results suggest that mandibular advancement devices used for OSA treatment increase the lower incisor proclination by 1.54 ± 0.16°, decrease overjet by 0.89 ± 0.04 mm and overbite by 0.68 ± 0.04 mm, rotate the mandible downward and forward, and increase the SNA angle by to 0.06 ± 0.03°. The meta-analysis revealed high statistical heterogeneity. CONCLUSIONS: The MADs affect the lower incisor proclination, overjet, overbite, the rotation of the mandible and the SNA angle. More randomized clinical trials providing high-quality evidence are needed to support those findings.
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ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: A comparison of the effects of Forsus appliances with and without temporary anchorage devices for skeletal Class II malocclusion. Liu L, Zhan Q, Zhou J, Kuang Q, Yan X, Zhang X, Shan Y, Lai W, Long H. Angle Orthod. 2020 Dec 30. doi:10.2319/051120-421.1. Epub ahead of print. PMID: 33378419. SOURCE OF FUNDING: National Natural Science Foundation of China (No. 82,071,147, 81,571,004, and 81,500,884). TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.
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Maloclusión Clase II de Angle , Aparatos Ortodóncicos Funcionales , Cefalometría , Humanos , Incisivo , Maloclusión Clase II de Angle/terapia , MandíbulaRESUMEN
AIM: To test the hypothesis that skeletal and dentoalveolar effects are both important in skeletal class II malocclusion corrected with the Forsus fatigue-resistant device (FRD). MATERIALS AND METHODS: A total of 35 patients (16 females and 19 males; age 12.0 ± 0.6 years) with skeletal class II malocclusion treated with the Forsus FRD were included. Lateral cephalometric radiographies before and after treatment were collected. Cephalometric analysis and superimpositions were applied. Pancherz's analysis was performed to discover the skeletal and dentoalveolar effects on all patients and 60% contribution was set as a milestone to classify. Statistical comparisons were performed by paired t testing (p < 0.05). RESULTS: The mean treatment period of the Forsus FRD was 6.4 ± 0.2 months. All patients (AG) have been corrected to class I molar relationship in three mechanisms: 15 patients in the skeletal group (SG), 10 patients in the dentoalveolar group (DG), and 10 patients in the skeletal and dentoalveolar group (SDG). Four groups showed a significant change in skeletal sagittal relationship improvement (p < 0.05). The AG, SG, and SDG showed a significant improvement in the growth of the mandible (Co-Go, Go-Pog, and Co-Gn, p < 0.05). The DG showed a significant improvement in the growth of the mandibular body (Go-Pog, p < 0.05). CONCLUSION: Three mechanisms were found in skeletal class II malocclusion corrected with the Forsus FRD. Skeletal and dentoalveolar effects are both important in skeletal class II malocclusion corrected with the Forsus FRD. And skeletal and dentoalveolar effects played differential roles in different cases. CLINICAL SIGNIFICANCE: The mechanism of skeletal class II correction with Forsus FRD may divide into mandibular growth, dentoalveolar effects, and both.
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Maloclusión Clase II de Angle , Aparatos Ortodóncicos Funcionales , Cefalometría , Femenino , Humanos , Masculino , Mandíbula , RadiografíaRESUMEN
Vitamin D (25OHD) pleiotropic effects are widely recognized and studied. Recently, vitamin D cardiovascular effects are gaining interest, especially in children, although the studies present conflicting data. Some randomized controlled trials (RCTs) have demonstrated that cardiovascular risk markers, such as lipid parameters, inflammation markers, blood pressure, and arterial stiffness, are unaffected by vitamin D supplementation. By contrast, other studies show that low vitamin D levels are associated with higher risk of cardiovascular disease (CVD) and mortality, and support that increased risk of these diseases occurs primarily in people with vitamin D deficiency. An update on these points in pediatric patients is certainly of interest to focus on possible benefits of its supplementation.
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Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/metabolismo , Vitamina D/metabolismo , Enfermedades Cardiovasculares/fisiopatología , Niño , Suplementos Dietéticos , Humanos , Modelos Biológicos , Factores de Riesgo , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/fisiopatologíaRESUMEN
The 2nd International Conference on Controversies in Vitamin D was held in Monteriggioni (Siena), Italy, September 11-14, 2018. The aim of this meeting was to address ongoing controversies and timely topics in vitamin D research, to review available data related to these topics and controversies, to promote discussion to help resolve lingering issues and ultimately to suggest a research agenda to clarify areas of uncertainty. Several issues from the first conference, held in 2017, were revisited, such as assays used to determine serum 25-hydroxyvitamin D [25(OH)D] concentration, which remains a critical and controversial issue for defining vitamin D status. Definitions of vitamin D nutritional status (i.e. sufficiency, insufficiency and deficiency) were also revisited. New areas were reviewed, including vitamin D threshold values and how they should be defined in the context of specific diseases, sources of vitamin D and risk factors associated with vitamin D deficiency. Non-skeletal aspects related to vitamin D were also discussed, including the reproductive system, neurology, chronic kidney disease and falls. The therapeutic role of vitamin D and findings from recent clinical trials were also addressed. The topics were considered by 3 focus groups and divided into three main areas: 1) "Laboratory": assays and threshold values to define vitamin D status; 2) "Clinical": sources of vitamin D and risk factors and role of vitamin D in non-skeletal disease and 3) "Therapeutics": controversial issues on observational studies and recent randomized controlled trials. In this report, we present a summary of our findings.
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Deficiencia de Vitamina D/complicaciones , Vitamina D/sangre , Enfermedad Celíaca , Diabetes Mellitus , Suplementos Dietéticos , Fracturas Óseas , Humanos , Esclerosis Múltiple , Neoplasias , Enfermedades Neurodegenerativas , Obesidad , Osteoporosis , Vitamina D/efectos adversos , Vitamina D/metabolismo , Vitamina D/uso terapéutico , Deficiencia de Vitamina D/tratamiento farmacológicoRESUMEN
OBJECTIVE: The aim of this systematic review was to assess the transverse skeletal effects of rapid maxillary expansion (RME) in pre and post-pubertal subjects. MATERIAL AND METHODS: Five databases were searched till May 2018; Pubmed, Cochrane, Scopus, Lilacs and Web of science in addition to the manual search of other sources. There were no language restrictions. Methodological Index for Non-Randomized Studies MINORS was used to assess the quality and risk of bias of the trials included. RESULTS: Six studies were finally included in the qualitative analysis. A meta-analysis wasn't performed due to the heterogeneity of methodologies and outcomes. All of the included studies showed drawbacks in their structure yielding weak evidence. On the short term, RME caused an increase in the maxillary and lateral-nasal widths in pre-pubertal subjects by 3.4 mm and 3.3 mm, and by 2.8 and 2.2 mm respectively in post-pubertal subjects. Although statistically insignificant, the maxillary width increase was more than that of the post-pubertal subjects by 0.6 mm. Over the long term, expansion produced permanent increases in the transverse dimensions of both the dento-alveolar and skeletal components of the maxilla and circum-maxillary structures in pre-pubertal subjects. The post-pubertal subjects presented with a statistically significant increase only in the later-nasal width by 1.3 mm than the untreated controls with no permanent increase in the skeletal maxillary width. CONCLUSION: The literature is very deficient regarding the use of skeletal age as a reference in the treatment of skeletal crossbites using RME. Only weak evidence exists supporting the increased maxillary and lateral-nasal widths after tooth-tissue borne RME in pre-pubertal subjects, with these effects being less in the post-pubertal ones.
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Vitamin D is currently one of the hottest topics in research and clinics, as well as in everyday life. Over the past decades, scientists gathered overwhelming evidence indicating that the observed global vitamin D deficiency not only has a negative impact on human skeletal system, but also facilitates development and progression of multiple disease of civilization, including cardiovascular diseases, diabetes, autoimmune disease, and cancer. This Special Issue, entitled "Vitamin D and Human Health", summarizes recent advances in our understanding of pleiotropic activity of vitamin D in the form of eight comprehensive reviews. Furthermore, eight research papers provide new insight into vitamin D research and highlight new directions.
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Vitamina D/metabolismo , Inmunidad Adaptativa , Enfermedades Cardiovasculares/metabolismo , Enfermedades Cardiovasculares/patología , Suplementos Dietéticos , Humanos , Neoplasias/metabolismo , Neoplasias/patología , Receptores de Calcitriol/genética , Receptores de Calcitriol/metabolismo , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/metabolismo , Deficiencia de Vitamina D/patologíaRESUMEN
Severe vitamin D deficiency can be defined as the dose of vitamin D or serum 25OHD concentrations needed to prevent nutritional rickets or osteomalacia. There is large international consensus that these diseases can be prevented by 400 IU of vitamin D/d and 25OHD above 30 nmol/l (12 ng/ml). Vitamin D deficiency can also accelerate the risk of fractures and probably also of falls in elderly subjects but there is no consensus on the required daily doses or minimal 25OHD threshold for these endpoints. The majority of experts consider 800 IU/d and serum 25OHD above 50 nmol/l (20 ng/ml) as sufficient, with a minority opinion aiming for 75 nmol/l or even higher. For other extra-skeletal endpoints, no hard evidence is available to define whether or not this is causally related to vitamin D status. Therefore, for these endpoints no minimal dosage or 25OHD threshold can be defined.
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Deficiencia de Vitamina D/diagnóstico , Deficiencia de Vitamina D/terapia , Anciano , Anciano de 80 o más Años , Fracturas Óseas/epidemiología , Fracturas Óseas/prevención & control , Fracturas Óseas/terapia , Humanos , Raquitismo/diagnóstico , Raquitismo/epidemiología , Raquitismo/etiología , Raquitismo/terapia , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/epidemiología , Vitaminas/sangreRESUMEN
Research carried out during the past two-decades extended the understanding of actions of vitamin D, from regulating calcium and phosphate absorption and bone metabolism to many pleiotropic actions in organs and tissues in the body. Most observational and ecological studies report association of higher serum 25-hydroxyvitamin D [25(OH)D] concentrations with improved outcomes for several chronic, communicable and non-communicable diseases. Consequently, numerous agencies and scientific organizations have developed recommendations for vitamin D supplementation and guidance on optimal serum 25(OH)D concentrations. The bone-centric guidelines recommend a target 25(OH)D concentration of 20ng/mL (50nmol/L), and age-dependent daily vitamin D doses of 400-800IU. The guidelines focused on pleiotropic effects of vitamin D recommend a target 25(OH)D concentration of 30ng/mL (75nmol/L), and age-, body weight-, disease-status, and ethnicity dependent vitamin D doses ranging between 400 and 2000IU/day. The wise and balanced choice of the recommendations to follow depends on one's individual health outcome concerns, age, body weight, latitude of residence, dietary and cultural habits, making the regional or nationwide guidelines more applicable in clinical practice. While natural sources of vitamin D can raise 25(OH)D concentrations, relative to dietary preferences and latitude of residence, in the context of general population, these sources are regarded ineffective to maintain the year-round 25(OH)D concentrations in the range of 30-50ng/mL (75-125nmol/L). Vitamin D self-administration related adverse effects, such as hypercalcemia and hypercalciuria are rare, and usually result from taking extremely high doses of vitamin D for a prolonged time.
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Suplementos Dietéticos , Deficiencia de Vitamina D/dietoterapia , Vitamina D/análogos & derivados , Vitamina D/administración & dosificación , Adolescente , Adulto , Factores de Edad , Peso Corporal , Conducta Alimentaria , Femenino , Humanos , Hipercalcemia/sangre , Hipercalcemia/inducido químicamente , Hipercalcemia/patología , Hipercalciuria/sangre , Hipercalciuria/inducido químicamente , Hipercalciuria/patología , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Vitamina D/efectos adversos , Vitamina D/sangre , Deficiencia de Vitamina D/sangreRESUMEN
The facemask is a widely used device in the treatment of Class III malocclusion and is intended to anteriorly displace the superior maxilla or stimulate its growth in that direction. The main goal of this study was to evaluate the effects of treatment using orthopedic maxillary expansion with facemask therapy in patients with Class III malocclusion. Sixty-four patients, with a mean age of 8.14 ± 1.18 years at the start of treatment and a mean age of 9.78 ± 1.19 years at the end, were treated using orthopedic maxillary expansion and associated facemask therapy. The patients were evaluated using lateral head teleradiography before and after treatment, and the differences were analyzed. In addition, binary logistic regression was used as a model for predicting successful treatment. When comparing the changes achieved by treatment, statistically significant favorable changes were found at the skeletal level. Furthermore, an improvement in the airways at all levels was detected. Orthopedic maxillary expansion associated with facemask therapy has proven effective in treating early skeletal Class III malocclusion.
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Introduction: Vitamin D deficiency is common worldwide with adverse effects on skeletal health. In recent years, there has been great interest in non-classical actions of vitamin D. Basic research has uncovered actions in a range of non-skeletal tissues, and observational studies have identified inverse relationships with risk of a number of disease states including sarcopenia, obesity, the metabolic syndrome, cardiovascular disease, cancer and autoimmune diseases. Sources of data: PubMed, Medline and Cochrane Systematic Reviews. Areas of agreement: Current evidence supports the use of vitamin D supplementation in deficiency to improve skeletal outcomes such as falls/fracture risk and bone mineral density. Areas of controversy: There is debate reflected in guidelines on optimal thresholds for circulating levels of vitamin D. Further studies are required to refine dosing regimens and treatment target levels of vitamin D. Growing points: A number of studies have investigated the extra-skeletal effects of vitamin D deficiency but causality in humans has yet to be confirmed. Areas timely for developing research: Large-scale randomized controlled trials incorporating data on vitamin D status at baseline and follow up, adverse events, and comparison of dosing regimens are required. It is imperative that studies are carried out with a diverse range of participants (age, gender and ethnicity), and settings to allow for a more individualized approach. In addition, we would advocate incorporating cutting-edge research tools into human studies to advance our understanding of the mechanisms of vitamin D action in extra-skeletal disease. This may involve multi-metabolite analysis of vitamin D metabolites, or unbiased approaches to assess regulation of gene/protein expression in tissues of interest.
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Países Desarrollados , Deficiencia de Vitamina D/terapia , Vitamina D/administración & dosificación , Vitaminas/administración & dosificación , Suplementos Dietéticos , Humanos , Vitamina D/efectos adversos , Vitamina D/fisiología , Deficiencia de Vitamina D/complicaciones , Vitaminas/efectos adversosRESUMEN
Little is known about the association between vitamin D deficiency and the skeletal phenotypes in primary hyperparathyroidism (PHPT) patients. A low 25-hydroxyvitamin D level was associated with a low bone mineral density and deteriorated hip geometry in women with PHPT in an Asian population where vitamin D deficiency is prevalent. INTRODUCTION: Few studies have examined the effect of vitamin D deficiency on the bone health of primary hyperparathyroidism (PHPT) patients. METHODS: We investigated the skeletal effects of vitamin D deficiency in 79 PHPT patients by assessing bone mineral density (BMD), the trabecular bone score (TBS), and hip geometry, which were measured using dual-energy X-ray absorptiometry (27 men with median age 60 years [53;69]; 52 postmenopausal women with median age of 57 years [53;67]). Cross-sectional data were collected from subjects enrolled in an ongoing PHPT cohort study at Seoul National University Hospital from March 2008 to December 2015. RESULTS: We classified PHPT patients according to 25-hydroxyvitamin D (25(OH)D) levels (<20 vs. ≥20 ng/ml). After adjusting for age and body mass index, women with vitamin D deficiency had lower BMDs at the lumbar spine (LS) and femur neck (FN) than women who had sufficient levels of vitamin D (LS, 0.903 ± 0.138 vs. 0.998 ± 0.184 g/cm2; FN, 0.715 ± 0.084 vs. 0.791 ± 0.113 g/cm2; P < 0.05). However, the total hip BMD and the TBS were not significantly different between the two groups. In the hip geometry analysis, the cross-sectional area, cross-sectional moment of inertia, and section modulus were also significantly lower in women with vitamin D deficiency than in those without. No significant difference was found in the BMD, TBS, or hip geometry according to 25(OH)D levels in men. CONCLUSION: Vitamin D deficiency may be associated with a low BMD and deteriorated hip geometry in postmenopausal women with PHPT.
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Hiperparatiroidismo Primario/complicaciones , Osteoporosis/etiología , Deficiencia de Vitamina D/complicaciones , Absorciometría de Fotón/métodos , Anciano , Antropometría/métodos , Densidad Ósea/fisiología , Estudios Transversales , Femenino , Cuello Femoral/fisiopatología , Articulación de la Cadera/patología , Articulación de la Cadera/fisiopatología , Humanos , Hiperparatiroidismo Primario/sangre , Hiperparatiroidismo Primario/fisiopatología , Vértebras Lumbares/fisiopatología , Masculino , Persona de Mediana Edad , Osteoporosis/sangre , Osteoporosis/fisiopatología , Osteoporosis Posmenopáusica/sangre , Osteoporosis Posmenopáusica/etiología , Osteoporosis Posmenopáusica/patología , Osteoporosis Posmenopáusica/fisiopatología , Factores Sexuales , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/fisiopatologíaRESUMEN
Vitamin D has pleiotropic extra-skeletal effects which have been noted in mouse models of deletion of either the 25-hydroxy vitamin D 1α-hydroxylase enzyme, cyp27b1 (1OHase(-/-) mice) or of the vitamin D receptor (Vdr(-/-) mice); these may be preventable or reversible by either restoring normal signaling of the 1,25(OH)2D/VDR system, or in some cases by restoring normal mineral homeostasis. However, effects on skeletal and mineral homeostasis are clearly the major phenotype observed in humans with loss-of-function mutations in either CYP27B1 or VDR. In mouse phenocopies of these human disorders, correction of hypocalcemia and hypophosphatemia reduce elevated circulating parathyroid hormone concentrations and normalize impaired bone mineralization, but restoration of normal 1,25(OH)2D/VDR signaling may be required for optimal bone formation. Induction of high endogenous 1,25(OH)2D concentrations in genetically modified mouse models may cause increased bone resorption and decreased mineralization. Transgenic Vdr overexpression and conditional Vdr deletion in cells of the osteoblastic lineage have also provided insights into the stages of osteoblast differentiation which may mediate these actions. These anabolic and catabolic effects of the 1,25(OH)2D system on bone may therefore be a function of both the ambient concentration of circulating 1,25(OH)2D and the stage of differentiation of the osteoblast. This article is part of a Special Issue entitled '17th Vitamin D Workshop'.
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25-Hidroxivitamina D3 1-alfa-Hidroxilasa/fisiología , Huesos/metabolismo , Calcificación Fisiológica/fisiología , Receptores de Calcitriol/fisiología , Animales , Humanos , Ratones , Ratones NoqueadosRESUMEN
OBJECTIVE: To determine the effect of oral contraceptive pill (OCP) use during adolescence on peak bone mass. DESIGN: Longitudinal observational study. SETTING: Academic clinical research center. PATIENT(S): Sixty-two non-Hispanic, white females in The Penn State Young Women's Health Study, who were studied for 8 years during ages 12-20. INTERVENTION(S): There were 28 OCP users, who used OCPs for a minimum of 6 months and were still using at age 20, and 34 nonusers who had never used OCPs. MAIN OUTCOME MEASURE(S): Total body bone, dedicated hip bone, and body composition measurements were made by dual-energy roentgenogram absorptiometry. RESULT(S): The OCP users and nonusers did not differ at entry in anthropometric, body composition, or total body bone measurements. By age 20, the average duration of OCP use by the user group was 22 months. At age 20, the groups remained indistinguishable in anthropometric, body composition, total body, and hip bone measures, and in age of menarche and sports exercise scores. CONCLUSION(S): Oral contraceptive pill use by healthy, white, teenage females does not affect acquisition of peak bone mass.
PIP: This longitudinal observational study determined the effect of oral contraceptive (OC) use during adolescence on peak bone mass (PBM). The sample comprised 62 non-Hispanic, White females in The Penn State Young Women's Health Study, who were studied for 8 years between the ages of 12 and 20. There were 28 OC users who used OCs for a minimum of 6 months and were still using them at age 20, and 34 nonusers who had never used the regimen. Total body bone, dedicated hipbone, and body composition measurements were made by dual-energy roentgenogram absorptiometry. There was no difference between OC users and nonusers in the anthropometric, body composition, or total body bone measurements. By age 20, the average duration of OC use by the user group was 22 months. At this age, the groups remained indistinguishable in anthropometric, body composition, total body, and hipbone measurements, and in age of menarche and sports exercise scores. These findings suggest that OC use by healthy, White, teenage females does not affect acquisition of PBM.
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Densidad Ósea/efectos de los fármacos , Anticonceptivos Hormonales Orales/efectos adversos , Adolescente , Adulto , Composición Corporal , Niño , Ejercicio Físico , Femenino , Humanos , Estudios LongitudinalesRESUMEN
Two different groups of women, 23 healthy young adults and 13 women with chronic posterior pelvic pain, were studied before and during use of oral contraceptives (OC). Collagen metabolism markers-here, the amino-terminal propeptide of type I procollagen, the carboxy-terminal telopeptide of type I collagen, and the amino-terminal of procollagen type III-as well as hormones and other endocrine factors indicating the balance between androgen expression/anabolism and catabolism of the subjects (testosterone, sex-hormone binding globulin, and insulin-like growth factor I were measured. Type I procollagen, the carboxy-terminal telopeptide of type I collagen, and the amino-terminal of procollagen type III were all significantly decreased during OC use. These findings implicate OC use-induced changes in collagen type I and III turnover. A shift in the anabolic/catabolic balance was also recorded indicating a less anabolic situation during OC use.
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Biomarcadores , Remodelación Ósea , Colágeno/metabolismo , Anticonceptivos Orales/efectos adversos , Ciclo Menstrual , Adolescente , Adulto , Colágeno/sangre , Colágeno Tipo I , Femenino , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Dolor Pélvico , Fragmentos de Péptidos/sangre , Péptidos/sangre , Procolágeno/sangre , Globulina de Unión a Hormona Sexual/metabolismoRESUMEN
The aim of the study was to evaluate if a pill containing the same dose of the same type of progestin compound (gestodene, GES, 75 microg) but different doses of ethinylestradiol (EE2) (20 or 30 microg) differently influences specific markers of bone resorption (urinary levels of pyridinoline (PYR) and dexoxypyridinoline (D-PYR)). During the 12 months of the study a significant decrease of urinary levels of PYR and D-PYR was found in 2 groups of young post-adolescent women taking the pills with 20 and 30 microg of EE2 in comparison with control women (subjects of the same age group with normal menstrual cycle who did not use contraception). In women taking pills with 20 or 30 microg EE2, the levels of sex hormone-binding globulin (SHBG) significantly increased during treatment in comparison with baseline, whereas in the same time period no changes occurred in control women. These findings suggest that similar to the pill containing 30 microg EE2, the lower dosage of the EE2 pill (20 microg) is also capable of reducing bone resorption. Twenty and 30 microg EE2 pills exert the same biological estrogenic effect. In fact, SHBG levels significantly increased with both pills. However, an additional effect of the progestin compound that could act directly on progestin or estrogen receptors of bone cannot be excluded. Since contraception with a pill containing the lowest estrogen dose is associated with the lowest incidence of side effects, these findings further suggest a pill containing 20 microg EE2 for young post-adolescent women would be the best choice.
PIP: The aim of this study was to evaluate if a pill containing the same dose of the same type of progestin compound (gestodene, GES, 75 mcg) but different doses of ethinyl estradiol (EE2) (20 or 30 mcg) differently influences specific markers of bone resorption (urinary levels of pyridinoline (PYR) and dexoxypyridinoline (D-PYR). During the 12 months of the study a significant decrease of urinary levels of PYR and D-PYR was found in 2 groups of young postadolescent women taking the pills with 20 or 30 mcg EE2 in comparison with control women (subjects of the same age group with normal menstrual cycles who did not use contraception). In women taking pills with 20 or 30 mcg EE2, the levels of sex hormone-binding globulin (SHBG) significantly increased during treatment in comparison with baseline, whereas in the same time period no changes occurred in control women. These findings suggest that similar to the pill containing 30 mcg EE2, the lower dosage of the EE2 pill (20 mcg) is also capable of reducing bone resorption. 20 and 30 mcg EE2 pills exert the same biological estrogenic effect. In fact, SHBG levels significantly increased with both pills. However, an additional effect of the progestin compound that could act directly on progestin or estrogen receptors of bone cannot be excluded. Since contraception with a pill containing the lowest estrogen dose is associated with the lowest incidence of side effects, these findings further suggest that a pill containing 20 mcg EE2 would be the best choice for young postadolescent women.
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Resorción Ósea/prevención & control , Anticonceptivos Orales , Etinilestradiol/administración & dosificación , Norpregnenos/administración & dosificación , Adulto , Aminoácidos/orina , Anticonceptivos Orales/efectos adversos , Etinilestradiol/efectos adversos , Femenino , Humanos , Norpregnenos/efectos adversos , Osteocalcina/sangre , Globulina de Unión a Hormona Sexual/metabolismoRESUMEN
We reviewed studies of the association of oral contraceptive (OC) use and bone mineral density (BMD). We limited the review to studies of women using low-dose oral contraceptives and that measured BMD by bone densitometry. A total of 13 studies met the inclusion criteria. Nine of these showed a positive effect of OC use on BMD, and four did not show an association. However, none of the studies showed a decrease in BMD with OC use. We classified the level of evidence from each study according to the guidelines of the US Preventive Services Task Force. The level of evidence supporting a positive association between OC use and increased BMD is II-1. There is fair evidence (Category B) to support the position that OC use has a favorable effect on BMD. We made suggestions for a study design that could yield Level I evidence.
PIP: The authors reviewed studies of the association of oral contraceptive (OC) use and bone mineral density (BMD). They limited the review to studies of women using low-dose OCs and that measured BMD by bone densitometry. A total of 13 studies met the inclusion criteria; 9 of these showed a positive effect of OC use on BMD, and 4 did not show an association. However, none of the studies showed a decrease in BMD with OC use. They classified the level of evidence from each study according to the guidelines of the US Preventive Services Task Force. There is evidence supporting a positive association between OC use and increased BMD. There is fair evidence to support the position that OC use has a favorable effect on BMD. The authors made suggestions for a study design that could yield level I evidence.
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Densidad Ósea/efectos de los fármacos , Anticonceptivos Hormonales Orales/uso terapéutico , Osteoporosis/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Anticonceptivos Hormonales Orales/administración & dosificación , Anticonceptivos Hormonales Orales/normas , Etinilestradiol/administración & dosificación , Etinilestradiol/normas , Etinilestradiol/uso terapéutico , Femenino , Humanos , MEDLINE , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVE: We sought to test the hypothesis that exposure to oral contraceptives protects the skeleton. STUDY DESIGN: Multiple regression techniques were used to analyze data for a random sample of 710 Australian women (age range, 20-69 years). Bone mineral density was measured at the lumbar spine, proximal femur, whole body, and distal forearm. Oral contraceptive exposure was assessed by a questionnaire. RESULTS: Women exposed to oral contraceptives had a 3.3% greater mean bone mineral density adjusted for body mass index and age at the lumbar spine (partial r (2) = 0.009; P =.014). Adjusted mean vertebral bone mineral density was 3.3% greater for premenopausal women (partial r (2) = 0.008; P <.05), but the effect did not reach significance among postmenopausal women. Higher bone mineral density was associated with increased duration of exposure, with a mean increase of 3.2% associated with the first 5 years and a further 0.2% with >/=5 years of exposure. No association was detected at other sites. CONCLUSION: Exposure to oral contraceptives may be associated with higher lumbar spine bone mineral density.
Asunto(s)
Densidad Ósea/efectos de los fármacos , Resorción Ósea/prevención & control , Huesos/fisiología , Anticonceptivos Orales/farmacología , Absorciometría de Fotón , Adulto , Factores de Edad , Anciano , Consumo de Bebidas Alcohólicas , Australia/epidemiología , Índice de Masa Corporal , Resorción Ósea/epidemiología , Huesos/efectos de los fármacos , Calcio de la Dieta , Anticonceptivos Orales/uso terapéutico , Femenino , Fémur/efectos de los fármacos , Fémur/fisiología , Antebrazo/fisiología , Humanos , Vértebras Lumbares/efectos de los fármacos , Vértebras Lumbares/fisiología , Menopausia/fisiología , Persona de Mediana Edad , Análisis Multivariante , Análisis de Regresión , Fumar , Encuestas y CuestionariosRESUMEN
PIP: According to the National Institutes of Health's Osteoporosis and Related Bone Diseases National Resource Center in Washington, DC, osteoporosis is a major public health threat for 28 million Americans, 80% of whom are women. It is noted that 1 of every 2 women over 50 years of age will have an osteoporosis-related fracture in her lifetime. In a retrospective review of medical literature which examined oral contraceptive (OC) user bone mineral density (BMD), evidence supports the hypothesis that low-dose OCs are associated with favorable effects on BMD. A total of 13 studies were included in the review; 9 of the studies showed a positive effect of OC use on BMD and 4 did not show an association. However, none of the studies indicated a decrease in BMD with OC use. Suggestions for a randomized controlled trial to gain definitive information on the literature are cited. In view of this, experts indicate that OC impact on BMD may best be demonstrated in hypoestrogenic women, including those with eating disorders, hypothalamic amenorrhea, and perimenopausal women.^ieng