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PURPOSE: Osteoporosis in pregnancy is an uncommon disease and there is little information regarding its pathogenesis and its effects on the skeleton. This review aims to describe changes in mineral metabolism during pregnancy and lactation as well as their clinical impact. METHODS: We performed a narrative review of the literature using the PubMed and Google Scholar databases for articles published from 1955 to 2021. RESULTS: Mineral metabolism in the mother must adapt to the demand created by the fetus and the placenta, which together absorb calcium and other minerals from the mother to mineralize the developing fetal skeleton; analyses of iliac bone biopsies at the beginning and end of pregnancy have shown that pregnancy significantly modifies maternal bone status. The greatest demand for calcium for the maternal skeleton occurs during lactation; women who breastfeed have an even greater loss of calcium to produce milk. However, it is controversial whether breastfeeding can increase the risk of osteoporotic fractures, and the possible mechanism is considerably complicated. Osteoporosis in pregnancy is an uncommon disease characterized by the occurrence of fragility fractures, most commonly in the vertebral column, in the third trimester of pregnancy, or early postpartum. The pathogenesis of PLO remains unclear owing to its rarity; DXA provides a sensitive and specific method for diagnosing osteoporosis by measuring BMD, one of the parameters that allow a better understanding of fracture risk. One limitation is the controversy in using radiation in pregnant women and the risk to the embryo/fetus; a safe alternative can be MRI. CONCLUSION: Pregnancy and lactation alter the maternal bone status; without a balance in metabolism, this may cause an increased risk of fracture due to changes in BMD. There is little information on BMD during pregnancy; more clinical studies are required to elucidate if this represents a risk factor for osteoporosis.
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Osteoporose , Fraturas por Osteoporose , Densidade Óssea , Aleitamento Materno , Feminino , Humanos , Lactação , Osteoporose/etiologia , Fraturas por Osteoporose/complicações , GravidezRESUMO
Resumen OBJETIVO: Establecer si existe asociación entre el hiperparatiroidismo secundario a una deficiencia de vitamina D en el embarazo y la frecuencia de preeclampsia. MATERIALES Y MÉTODOS: Estudio de casos y controles, prospectivo y longitudinal efectuado en pacientes con y sin preeclampsia que entre el 1 de enero y el 30 de junio del 2021 acudieron al Hospital Universitario de la Universidad Autónoma de Nuevo León para la atención del parto. Criterios de inclusión: pacientes embarazadas con diagnóstico de preeclampsia en el último trimestre de la gestación con tensión arterial igual o mayor a 140-90 mmHg y proteinuria igual o mayor a 30 mg/dL. Para el grupo control: embarazadas sanas, sin diagnóstico de preeclampsia en el último trimestre de la gestación. Criterios de exclusión: tabaquismo, alcoholismo y drogadicción y quienes no aceptaron entrar al estudio o tuvieran diagnóstico de enfermedades médicas crónicas. RESULTADOS: Se estudiaron 90 pacientes divididas en dos grupos: con preeclampsia (n = 45) y sin ésta (control, n = 45). Se encontró una relación entre la deficiencia de vitamina D, la hipocalcemia y la preeclampsia; no así entre la paratohormona y la preeclampsia en los rangos internacionales de la primera. La preeclampsia se encontró con mayor frecuencia en pacientes de 12 a 15 años. CONCLUSIONES: El hiperparatiroidismo secundario a la deficiencia de vitamina D en el embarazo no se observó en pacientes con preeclampsia, quienes sí la padecieron tuvieron concentraciones de paratohormona en límites normales. Se encontró una relación entre la deficiencia de vitamina D, la hipocalcemia y la preeclampsia.
Abstract OBJECTIVE: To establish whether there is an association between hyperparathyroidism secondary to vitamin D deficiency in pregnancy and the frequency of preeclampsia. MATERIALSAND METHODS: Case-control, prospective, longitudinal study performed in patients with and without preeclampsia who between January 1 and June 30, 2021 attended the Hospital Universitario of the Universidad Autónoma de Nuevo Leon for delivery care. Inclusion criteria: pregnant patients with a diagnosis of preeclampsia in the last trimester of gestation with blood pressure equal to or greater than 140-90 mmHg and proteinuria equal to or greater than 30 mg/dL. For the control group: healthy pregnant women without a diagnosis of preeclampsia in the last trimester of gestation. Exclusion criteria: smoking, alcoholism and drug addiction and those who did not agree to enter the study or had a diagnosis of chronic medical diseases. RESULTS: We studied 90 patients divided into two groups: with preeclampsia (n = 45) and without preeclampsia (control, n = 45). A relationship was found between vitamin D deficiency, hypocalcemia, and preeclampsia; a relationship was not found between parathormone and preeclampsia in the international parathormone ranges. Preeclampsia was found more frequently in patients aged 12 to 15 years. CONCLUSIONS: Hyperparathyroidism secondary to vitamin D deficiency in pregnancy was not observed in patients with preeclampsia; those who had it had parathormone concentrations in normal limits. A relationship was found between vitamin D deficiency, hypocalcemia, and preeclampsia.
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Objective: The purpose of this study is to establish the prevalence of vitamin D deficiency and their newborns and analyze the risk factors related to this deficiency. Methods: This is an observational, transversal, and prospective study. It included 191 puerperal women and their full-term newborns. Serum 25 hydroxyvitamin D values were analyzes by enzyme immunoassay. Results: 61% of the puerperal presented deficiency and 26% insufficiency of vitamin D. In the newborn group 98% showed deficiency and 66% of them presented severe deficiency. There is a positive correlation between the values of vitamin D in mothers and their newborns (r2 = 0.173 ng/ml; p = 0.017). The lowest levels were in autumn. (15.75 ng/mL mothers, 6 ng/mL newborns). There was no correlation between vitamin D levels in mothers and their dietary intake, maternal skin type, sun time exposure and prenatal body mass index. Conclusions: This is the first study that shows the existence of a high deficiency of vitamin D in Mexican mothers and their newborns.
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Mães/estatística & dados numéricos , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Técnicas Imunoenzimáticas , Recém-Nascido , Prevalência , Estudos Prospectivos , Fatores de Risco , Estações do Ano , Índice de Gravidade de Doença , Vitamina D/sangue , Deficiência de Vitamina D/etnologia , Adulto JovemRESUMO
INTRODUCTION: There are few studies integrating the common causes of osteoporosis and obesity (disorders of body composition). A first step is to investigate correlations between their biological phenotypes to determine their common integrative physiology. OBJECTIVE: To correlate the variation of bone mineral density with phenotypes of body composition and biomarkers of bone physiology, insulin-glucose axis, and adipose tissue. METHODS: Cross-sectional study of 75 women (aged 18-45 years). MEASUREMENTS: Body mass index, waist, fat mass, lean mass (dual-energy X-ray absorptiometry), glucose, insulin, osteocalcin, leptin, tumor necrosis factor alpha. STATISTICAL ANALYSIS: multivariate general linear model, SPSS v.22, p<0.05. RESULTS: Age: 32.08±7.33. Bone mineral content multivariate general linear model 1 with two phenotypes excluded (glucose, insulin): osteocalcin (ß=-0.228, p=0.011), lean mass (ß=0.606, p=0.001) and fat mass (ß=1.237, p=0.001) in 62.0%. The bone mineral density multivariate general linear model 2 with three phenotypes excluded (body mass index, glucose, tumor necrosis factor alpha): insulin (ß=0.250, p=0.024), osteocalcin (ß=-0.362, p=0.001), lean mass (ß=0.512, p=0.001) and fat mass (ß=0.701, p=0.001) in 46.3%. CONCLUSIONS: Results show that body composition with an increased lean mass is beneficial to bone. This study reaffirms the importance of performing regular exercise to prevent muscle loss.
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Tecido Adiposo/fisiologia , Composição Corporal/fisiologia , Densidade Óssea/fisiologia , Absorciometria de Fóton/métodos , Adolescente , Adulto , Biomarcadores/metabolismo , Índice de Massa Corporal , Estudos Transversais , Feminino , Glucose/metabolismo , Humanos , Insulina/metabolismo , Modelos Lineares , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Osteoporosis affects 1 in 3 postmenopausal women and is associated with significant morbidity and mortality. The utility of bisphosphonates is often affected by lack of attachment and acceptance of treatment. OBJECTIVE: To analyze the impact of biofeedback in the adherence to once-monthly oral ibandronate treatment. PATIENTS AND METHOD: We designed an open-label, prospective, randomized, multicenter clinical study to investigate the impact of biofeedback with bone turnover markers on adherence to once-monthly oral ibandronate treatment in 781 Mexican and Chilean patients with postmenopausal osteoporosis (BOHEMIA study). They were enrolled at 25 centers in Mexico (700 patients) and 24 centers in Chile (81 patients). All patients received once-monthly oral ibandronate 150 mg for 6 months. Patients without previous bisphosphonate treatment, previous bisphosphonate users, or current bisphosphonate users were included. Patients were randomly divided into two arms at baseline, either to receive biofeedback or not. RESULTS: A statistically significant improvement in adherence was found in patients who received biofeedback when compared with those who did not (98.8 to 99.8% [95% CI] and 95.5 to 97.5%, respectively [p < 0.001]). CONCLUSIONS: Even though biofeedback with bone turnover markers was associated with a significantly greater adherence, it was not great enough to recommend biofeedback as a strategy to achieve optimal adherence. Once-monthly ibandronate by itself can achieve an adequate therapeutic adherence.
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Biorretroalimentação Psicológica , Conservadores da Densidade Óssea/administração & dosagem , Difosfonatos/administração & dosagem , Osteoporose Pós-Menopausa/tratamento farmacológico , Cooperação do Paciente , Administração Oral , Idoso , Biomarcadores , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Cálcio/uso terapêutico , Chile , Colágeno Tipo I/sangue , Difosfonatos/efeitos adversos , Difosfonatos/uso terapêutico , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Ácido Ibandrônico , México , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/psicologia , Dor/induzido quimicamente , Satisfação do Paciente , Peptídeos/sangue , Estudos Prospectivos , Vitamina D/uso terapêuticoRESUMO
OBJECTIVE: To compare the efficacy of liraglutide monotherapy with glimepiride monotherapy in subjects with DM2 inadequately controlled by previous treatment of diet/exercise or oral antidiabetic drug. METHODS: A 52-week, double-blinded, active-controlled, parallel-group, multi-centre, prospective trial, involving 746 subjects was conducted in the USA and Mexico. In Mexico, 171 subjects were rando-mised (1:1:1) to once daily liraglutide (either 1.2, or 1.8 mg/day injected subcutaneously) or glimepiride (8 mg/day orally). RESULTS: Hb1Ac reduced by 0.64%, 1.31% and 0.30% with glimepiride, liraglutide 1.8 mg and 1.2 mg, respectively. Body weight decreased with both liraglutide doses while a weight gain of 0.94 kg was observed with glimepiride. FPG reduced by 27.9 mg/dL with liraglutide 1.8 mg, whereas a FPG increase of 9.54 mg/dL was shown with glimepiride. No major hypoglycaemic episodes were reported in this trial. CONCLUSIONS: in Mexican subjects with DM2, liraglutide monotherapy can provide greater reduction in HbA1c, weight loss and lower risk of hypoglycaemia in comparison with glimepiride.
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Diabetes Mellitus Tipo 2/tratamento farmacológico , Peptídeo 1 Semelhante ao Glucagon/análogos & derivados , Hipoglicemiantes/uso terapêutico , Compostos de Sulfonilureia/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia , Diabetes Mellitus Tipo 2/sangue , Método Duplo-Cego , Feminino , Peptídeo 1 Semelhante ao Glucagon/uso terapêutico , Humanos , Liraglutida , Masculino , México , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
Osteoporosis is recognized worldwide as a major public health problem since many decades ago, mainly due to the cost of treatment for related fragility fractures. Fortunately, WHO has provided new strategies for identifying populations with a high ten-year fracture risk, which together with increasingly sensitive diagnostic methods make it feasible for decision makers in this field to design cost effective fracture prevention strategies. These strategies are aimed at preventing falls and improving bone strength and therefore diminishing the prevalence and incidence of new or recurrent osteoporosis related fractures. Herein we review the content of these new strategies, and the medical treatments available, as well as their efficacy in the Mexican context. Several countries are now reporting a decreasing incidence and prevalence of osteoporosis related fractures, after 30 years of clinical and population-based interventions. Mexico has several effective anti-fracture drug treatments available. Such drugs can be classified according to the mechanism that makes them effective as: 1) antidestructive or anticatabolic, 2) bone forming or anabolic, and 3) those with both actions or mixed drugs. The authors argue that treatment strategies that use drugs to strengthen bone tissue must assure normal mineralization of the already formed, remnant bone tissue and/or the newly formed bone tissue in order to encourage biochemical outcomes like formation of mature hydroxyapatite crystals with complete biomechanical and biochemical properties and therefore long term benefits. The present review includes some perspectives that will surely enhance osteoporosis management in the near future and which will bring about a decrease in the impact of the problems in Mexico.
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Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea , Protocolos Clínicos , Fraturas Ósseas/prevenção & controle , Osteoporose/tratamento farmacológico , Acidentes por Quedas/prevenção & controle , Densidade Óssea/efeitos dos fármacos , Densidade Óssea/fisiologia , Conservadores da Densidade Óssea/classificação , Conservadores da Densidade Óssea/provisão & distribuição , Remodelação Óssea/fisiologia , Tomada de Decisões , Feminino , Humanos , México , Osteoporose/diagnósticoRESUMO
Osteoporosis is recognized worldwide as a major public health problem since many decades ago, mainly due to the cost of treatment for related fragility fractures. Fortunately, WHO has provided new strategies for identifying populations with a high ten-year fracture risk, which together with increasingly sensitive diagnostic methods make it feasible for decision makers in this field to design cost effective fracture prevention strategies. These strategies are aimed at preventing falls and improving bone strength and therefore diminishing the prevalence and incidence of new or recurrent osteoporosis related fractures. Herein we review the content of these new strategies, and the medical treatments available, as well as their efficacy in the Mexican context. Several countries are now reporting a decreasing incidence and prevalence of osteoporosis related fractures, after 30 years of clinical and population-based interventions. Mexico has several effective anti-fracture drug treatments available. Such drugs can be classified according to the mechanism that makes them effective as: 1) antidestuctive or anticatabolic, 2) bone forming or anabolic, and 3) those with both actions or mixed drugs. The authors argue that treatment strategies that use drugs to strengthen bone tissue must assure normal mineralization of the already formed, remnant bone tissue and/or the newly formed bone tissue in order to encourage biochemical outcomes like formation of mature hydroxyapatite crystals with complete biomechanical and biochemical properties and therefore long term benefits. The present review includes some perspectives that will surely enhance osteoporosis management in the near future and which will bring about a decrease in the impact of the problems in Mexico.
La osteoporosis se reconoce mundialmente como un problema de salud pública desde hace muchas décadas, principalmente por el impacto global implícito en la atención de las fracturas que ocasiona. Afortunadamente, cada vez contamos con más y mejores estrategias desarrolladas por la OMS para identificar oportunamente a las personas en riesgo de sufrir una fractura; actualmente es posible definir este riesgo para los siguientes diez años. Lo cual, aunado a métodos cada vez más sensibles para establecer diagnósticos definitivos y opciones de tratamiento costo-eficaces para evitar caídas y disminuir significativamente la presentación de fracturas, permite a quien toma decisiones en este problema diseñar y poner en práctica planes de atención sustentados en la mejor evidencia científica, que son motivo de esta revisión. Varios países empiezan a informar un abatimiento del número de fracturas, después de haber establecido programas dirigidos a este fin desde hace 30 años. Contamos con medicamentos que han demostrado su eficacia para abatir la presentación de la primera fractura o de fracturas recurrentes de manera costo-eficiente, estos se pueden dividir para su estudio de acuerdo al mecanismo de acción que los vuelve eficaces. Así, aquellos que frenan la destrucción del tejido óseo se clasifican como anti-catabólicos, los que estimulan la formación de tejido óseo nuevo son anabólicos, los que tienen ambas acciones se conocen como de acción mixta. En todos los casos, el tejido remanente, previamente formado o en vías de destrucción, que se fortalecerá o el tejido de nueva formación, requieren medidas para garantizar que el proceso de mineralización suceda normalmente y se genere hidroxiapatita o un compuesto con características similares para que la eficiencia biomecánica del tejido realmente mejore a largo plazo. Esta revisión incluye algunas perspectivas que seguramente mejorarán nuestro manejo de la osteoporosis en el futuro inmediato y que...
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Feminino , Humanos , Densidade Óssea , Conservadores da Densidade Óssea/uso terapêutico , Protocolos Clínicos , Fraturas Ósseas/prevenção & controle , Osteoporose/tratamento farmacológico , Acidentes por Quedas/prevenção & controle , Conservadores da Densidade Óssea/classificação , Conservadores da Densidade Óssea/provisão & distribuição , Densidade Óssea/efeitos dos fármacos , Densidade Óssea/fisiologia , Remodelação Óssea/fisiologia , Tomada de Decisões , México , Osteoporose/diagnósticoRESUMO
El hipertiroidismo en la infancia ocurre con una frecuencia relativa del 5 por ciento. La presencia de epilepsia y tirotoxicosis es poco frecuente. De acuerdo a la revisión de la literatura no existen reportes de esta asociación en niños. Descubrimos un paciente de cuatro años de edad con enfermedad de Graves que desarrolló crisis convulsiva tónico-clónica generalizada seguida de estado epiléptico parcial motor en hemicuerpo izquierdo. El EEG mostró actividad epileptiforme y la TC e IRM de cráneo resultaron normales. El EEG se normalizó al controlar el hipertiroidismo. De acuerdo a la revisión de la literatura, este es el primer caso reportado de epilepsia y tirotoxicosis en nuestro país. Se comentan los posibles mecanismos fisiopatológicos de las convulsiones en nuestro paciente con tirotoxicosis