RESUMO
The aim of the study was to report values for osteoporosis (OP) prevalence in Buenos Aires. Bone mineral density (BMD) at different skeletal sites was measured from November 2012 to July 2014. Participants were recruited through a newspaper advertisement inviting women at least 50 yr of age to receive free BMD measurement. After signing an informed consent form, 5448 women living in Buenos Aires and surrounding districts were studied. Lumbar spine (L1-L4), femur neck, and total hip BMDs were measured (Lunar Prodigy, software version 12.3 GE, Madison, WI, USA). OP was defined as a T-score ≤-2.5 at the lumbar spine or the femoral neck. Results showed that 1021 out of 5448 studied subjects (18.7%) had OP at the lumbar spine or the femoral neck. Comparison of age of the population sample with reference data for the general population showed a moderate (+0.6%) increase in prevalence. Prevalence of OP was low, up to the age of 70 yr when based on femoral neck BMD only. Conversely, the prevalence of OP at the lumbar spine, which was reportedly high in women up to the age of 70 yr, tended to level off over that age. The results of the total femur only added a slight (+0.7%) nonsignificant increase to the OP prevalence. A total 346,500 out of 1,853,000 women aged 50+ yr in Buenos Aires had OP at the lumbar spine or femoral neck, whereas only 163,500 had OP at the upper femur, reducing the number by 53%. The present study assessed OP prevalence in the most densely populated urban area in Argentina. The results are similar to those reported for Caucasian populations in the United States and Canada. As measurement of only the BMD of femoral neck overlooks the diagnosis in half of the women, future studies should include measurement of the lumbar spine in combination with the femoral neck for a more accurate estimation of OP prevalence.
Assuntos
Osteoporose/epidemiologia , População Urbana/estatística & dados numéricos , Absorciometria de Fóton , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Densidade Óssea , Feminino , Colo do Fêmur/diagnóstico por imagem , Quadril/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Osteoporose Pós-Menopausa/diagnóstico por imagem , Osteoporose Pós-Menopausa/epidemiologia , PrevalênciaRESUMO
Existe discrepancia en la elección de las áreas esqueléticas a evaluar para determinar la prevalencia de osteoporosis (OP). La International Society for Clinical Densitometry sugiere evaluar la columna lumbar (CL) y el fémur proximal (FT), mientras que la International Osteoporosis Foundation (IOF) sugiere medir solo el cuello femoral (CF). La estimación de la prevalencia de OP evaluada solo por CF en mujeres mayores de 50 años de Buenos Aires mostró un sub-diagnóstico del 53%. Objetivo: analizar la discrepancia en la prevalencia de OP, según el área esquelética evaluada por DXA, en los estudios internacionales disponibles. Materiales y Métodos: Se incluyeron los trabajos publicados en la literatura internacional, en idioma inglés que contenían: 1. Medición simultánea de CL y CF. 2. Análisis por décadas a partir de los 50 años y hasta por lo menos la década 70-79. 3. Diagnóstico densitométrico de osteoporosis con el criterio de la OMS: T-score ≤-2.5. Resultados: fueron incluidos doce estudios. La evaluación de estos estudios arrojó un sub-diagnóstico global del 52 % si la prevalencia de OP fuera estimada solo por la densidad mineral ósea (DMO) de CF. Cuando analizamos por décadas la sub-estimación fue del 75% en la 6a década, 58% en la 7a década y del 22% en 8a década, mostrando claramente que el subdiagnóstico disminuye a medida que aumenta la edad y desaparece después de los 80 años. Conclusión: Estos resultados señalan que la prevalencia de OP debe ser determinada a través de la evaluación de la DMO de ambas áreas esqueléticas: CL y CF. (AU)
There is discrepancy in the election of skeletal areas to be measured to determine the prevalence of osteoporosis.The International Society for Clinical Densitometry suggests evaluating the lumbar spine and proximal femur, while the International Osteoporosis Foundation (IOF) suggests measuring only the femoral neck.The estimate of the prevalence of osteoporosis (OP) evaluated only for femoral neck (FN) in women over 50 years of Buenos Aires showed underdiagnosis of 53%. Objective: To analyze the discrepancy on the prevalence of OP, according to the skeletal area evaluated by DXA, in international studies. Material and Methods: We included the works published in the international English literature that contained: 1- Simultaneous measurement of lumbar spine (LS) and femoral neck (FN). 2- Analysis for decades from 50 years and up to at least the decade 70-79. 3- Densitometric diagnosis of osteoporosis according to WHO: T-score ≤-2.5. Results: Twelve studies were included. The evaluation of these studies showed an overall underdiagnosis of 52% if the prevalence of OP was estimated only for bone mineral density of the femoral neck.When we analyzed for decades the underestimation was 75% in the sixth decade, 58% in the seventh and 22% in the eighth decade, clearly showing that the underdiagnosis decreases as age increases and disappears after 80 years. Conclusion: This over-all review of 12 studies indicates that lumbar spine as well as femoral neck should be assessed by DXA to determine the prevalence of osteoporosis. (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Densidade Óssea , Densitometria/estatística & dados numéricos , Prevalência , Fêmur , Colo do Fêmur , Região LombossacralRESUMO
Ossifying fibroma (OF) of the long bones is a benign fibro-osseous lesion typically seen in the first decade of life. OF usually progresses until the age of 10 years, but is occasionally found to regress spontaneously after puberty. The pathogenesis of OF is unknown; however, it has been suggested that the basic defect is in the periosteum. We present the radiological course of an OF of the tibia in a young patient, showing a rapid almost complete regression of the lesion after a tibial fracture at the lesion site. We postulate that the fracture-induced activation of the periosteum in a growing skeleton was fundamental to the regression of the lesion.
RESUMO
Body fat distribution is gender specific: men tend to accumulate adipose tissue in the android region, whereas women tend to do so in the gynoid region. The aim of the study was to assess total fat mass (TFM), android fat (AF), and gynoid fat (GF) mass in a selected group of healthy adult women with normal body mass index (BMI) to evaluate variations in fat distribution. Seventy-seven women (20--69yr of age) with BMI values between ≥18.5 and ≤24.9kg/m(2) were included. TMF, AF, GF, and the AF to GF ratio (A:G) were assessed using dual-energy X-ray absorptiometry. Results showed an increase in AF after the fifth decade of life (D), which reached statistical significance in the sixth and seventh decades (p<0.05--0.008), a 33% increase in kg of AF between the fourth and seventh and a 20% increase in A:G between the third and the seventh, with no significant changes in TFM and GF. In normal BMI women, age appears to be associated with changes in fat mass distribution with an increase in AF, which might have potential deleterious health consequences, after the fifth D.
Assuntos
Absorciometria de Fóton , Tecido Adiposo/diagnóstico por imagem , Envelhecimento/fisiologia , Composição Corporal/fisiologia , Distribuição da Gordura Corporal , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Feminino , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
Chronic idiopathic hyperphosphatasia (CIH), or juvenile Paget disease, is a rare disorder characterized by increased bone turnover and progressive enlargement of bones. We report a girl, 6 1/2 years old, with a history of three fractures, short stature, delayed eruption of teeth, and poor hair growth. She had a waddling gait, bone deformities, kyphoscoliosis, hyperlordosis, genu valgum and curvature of her limbs. She also had progressive hearing loss but other cranial nerves were unaffected. Laboratory studies indicated high bone turnover: serum alkaline phosphatase: 4047 IU/l (normal value: 150-550), urinary hydroxyproline: 1205 mg/g creatinine (n.v.: 60-160), and urinary CrossLaps: 4360 microg/mmol creatinine (n.v.: 450-2100). Radiographs demonstrated generalized skeletal involvement with osteoectasia (expansion) of long bones, diffuse sclerosis, cotton wool appearance of the skull, absence of mastoid pneumatization, and crushed dorsal and lumbar vertebrae. Iliac crest biopsy was compatible with CIH. Cyclical intravenous pamidronate (1 mg/kg/day during 3 h, 3 consecutive days at 2- to 3-month intervals) was administered during 2 years with oral calcium 500 mg and vitamin D 1000 IU/day. Oral pamidronate was added after 11 months of i.v. therapy. Treatment-induced remarkable clinical and radiographic improvement with normalization of bone markers of osteoblastic and osteoclastic activity, including bone alkaline phosphatase, urinary hydroxyproline, and urinary CrossLaps.
Assuntos
Remodelação Óssea/efeitos dos fármacos , Difosfonatos/uso terapêutico , Osteíte Deformante/tratamento farmacológico , Administração Oral , Fosfatase Alcalina/sangue , Biomarcadores/sangue , Biomarcadores/urina , Osso e Ossos/metabolismo , Criança , Difosfonatos/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Hidroxiprolina/urina , Injeções Intravenosas , PamidronatoAssuntos
Densidade Óssea/fisiologia , Cálcio/metabolismo , Lactação/metabolismo , Necessidades Nutricionais , Gravidez/metabolismo , Adaptação Fisiológica , Cálcio da Dieta/administração & dosagem , Suplementos Nutricionais , Feminino , Humanos , Lactação/fisiologia , Osteoporose/prevenção & controle , Gravidez/fisiologia , DesmameRESUMO
Bisphosphonates have proven to be effective in patients with fibrous dysplasia of the bone (FD) as shown by their effect on bone pain, markers of bone turnover, or radiological changes. The aim of this study was to evaluate the usefulness of measuring bone mineral density (BMD) of affected bones to assess the efficacy of bisphosphonate treatment. Seven patients (mean age 26 years) received courses of 180 mg intravenous infusion of pamidronate every 6 months (60 mg/day during 3 days). Clinical symptoms, serum alkaline phosphatase, and urinary C-terminal cross-linking telopeptide of type I collagen were assessed every 3 months. BMD of total skeleton and X-rays of FD areas (FDa) were performed at baseline and at 12 months. BMD of FDa was compared with the contralateral side (CL) using the region of interest program on the total skeleton scan. BMD of total skeleton was normal at baseline. Average BMD of FDa was -11.4% compared with CL, a significantly greater difference than that observed between the left and right sides in healthy controls, -0.7% (P < 0.02). At 12 months bone pain diminished in all patients. Bone turnover markers decreased. Mean total skeleton BMD increased 3.3% (P < 0.02). Subregions of the total skeleton scan presenting FD lesions augmented: arms +9.6% (P < 0.02), legs +4.2%, and pelvis +3.5% (P < 0.05). The increase in mean BMD of FDa was +6.8% compared with +2.6% in CL. No changes were observed on the X-ray. These results indicate that simultaneous determination of markers of bone turnover and BMD of FDa is useful in short-term follow-up to determine the efficacy of intravenous pamidronate.
Assuntos
Densidade Óssea/efeitos dos fármacos , Difosfonatos/administração & dosagem , Displasia Fibrosa Óssea/tratamento farmacológico , Displasia Fibrosa Óssea/metabolismo , Adolescente , Adulto , Fosfatase Alcalina/sangue , Estudos de Casos e Controles , Colágeno/urina , Colágeno Tipo I , Difosfonatos/efeitos adversos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pamidronato , Peptídeos/urinaRESUMO
A 30-yr-old Caucasian man with a history of dorsal and lumbar back pain, which responded partially to antiinflammatory agents, was seen at our Unit. The biochemical bone markers showed an increment in bone alkaline phosphatase and urinary CTX. Serum phosphate tended to be low. Radiographic abnormalities were marked osteosclerosis in the pelvis and vertebral bodies without changes in size. Bone scintigraphy results were normal. The increase in bone mineral density (BMD) was greater in L2-L4 (+ 3.9 SDs) than in total skeleton (+ 1.4 SDs). Analysis of skeletal subareas showed a marked increase in axial skeleton BMD: trunk, +4.0 SDs; spine, +2.5 SDs and pelvis, +4.5 SDs. BMD of the remaining subareas was found to be normal: skull, +0.04 SDs; arms, -0.3 SDs and legs, -0.05 SDs. The patient refused to have a bone biopsy. The radiologic, densitometric, and biochemical findings in the patient presented herein are compatible with axial osteomalacia. Evaluation of total skeleton BMD, and especially skeletal subareas, clearly indicated that the abnormal BMD was restricted to the spine and pelvis whereas the rest of the skeleton was not affected.
Assuntos
Densidade Óssea , Osteosclerose/metabolismo , Absorciometria de Fóton , Adulto , Fosfatase Alcalina/metabolismo , Osso e Ossos/metabolismo , Humanos , Masculino , Osteosclerose/diagnóstico por imagem , Fosfatos/sangueRESUMO
Corticosteroid treatment diminishes bone mass and alters bone quality. The objective was to evaluate bone in corticosteroid-treated patients and controls and in fractured and non-fractured patients treated with corticosteroids using both X-ray densitometry (DEXA) and ultrasound. We evaluated 34 women aged 58 +/- 14 years (X +/- SD), who had been on long-term low dose prednisone therapy for at least 6 months, and who had never received specific treatment for osteoporosis. Bone mineral density of total skeleton (TS), lumbar spine (LS), femoral neck (FN), and vertebral morphometry (MXA) were measured by DEXA. Speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness were measured using an Achilles Plus system. Forty-two healthy women served as controls. Both densitometric and ultrasound parameters in the patients were significantly diminished compared with controls: TS: P < 0.002, LS: P < 0.025, FS: P < 0.005, Stiffness: P < 0.001, BUA: P < 0.002 and SOS: P < 0.002. The percentage of patients with a Z score below -2 was higher in Stiffness and BUA: 38% and 47%, respectively, compared with a range of 16-24% in the other parameters (P < 0.05 BUA vs. DEXA measurements). Eleven patients with previous bone fracture had values lower than the non-fractured patients, both according to DEXA and ultrasound measurements, but the difference was only significant for BUA (P < 0.02). BUA of the calcaneus was more effective in detecting the specific skeletal alterations and fracture risk of the group of patients receiving chronic corticosteroid treatment.
Assuntos
Absorciometria de Fóton/métodos , Densidade Óssea , Osso e Ossos , Osteoporose Pós-Menopausa/diagnóstico , Prednisona/efeitos adversos , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea/efeitos dos fármacos , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Calcâneo/diagnóstico por imagem , Calcâneo/fisiopatologia , Relação Dose-Resposta a Droga , Feminino , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/metabolismo , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/induzido quimicamente , Osteoporose Pós-Menopausa/complicações , Reprodutibilidade dos Testes , Índice de Gravidade de DoençaRESUMO
Bone formation proceeds through a remodeling process that runs continuously, involving the resorption of old bone by osteoclasts, and the subsequent formation of new bone by osteoblasts. This is controlled by growth factors and cytokines produced in bone marrow microenvironment and by the action of systemic hormones, like parathyroid hormone, estradiol or growth hormone (GH). One candidate for hormonal modulation of osteoblast and osteoclast formation is melatonin. Because circulating melatonin declines with age, its possible involvement in post-menopausal and senescence osteoporosis is considered. This review article discusses early studies on melatonin-bone relationships and recent data that suggest a direct effect of melatonin on bone. Melatonin could act as an autacoid in bone cells as it is present in high quantities in bone marrow, where precursors of bone cells are located. Melatonin dose-dependently augmented proteins that are incorporated into the bone matrix, like procollagen type I c-peptide. Osteoprotegerin, an osteoblastic protein that inhibits the differentiation of osteoclasts is also augmented by melatonin in vitro. Another possible target cell for melatonin is the osteoclast, which degrades bone partly by generating free radicals. Melatonin through its free radical scavenger and antioxidant properties may impair osteoclast activity and bone resorption. At least in one study melatonin was both inhibitory to osteoclastic and osteoblastic cells. Therefore, the documented bone-protecting effect of melatonin in ovariectomized rats can depend in part on the free radical scavenging properties of melatonin. Additionally, melatonin may impair development of osteopenia associated with senescence by improving non-rapid eye movement sleep and restoring GH secretion. Whether melatonin can be used as a novel mode of therapy for augmenting bone mass in diseases deserves to be studied.
Assuntos
Desenvolvimento Ósseo/fisiologia , Melatonina/fisiologia , Idoso , Animais , Feminino , Hormônio do Crescimento/fisiologia , Humanos , Osteoporose/fisiopatologiaRESUMO
To assess the effect of melatonin on bone metabolism in ovariectomized rats, receiving oestradiol therapy or not, melatonin was administered in the drinking water (25 microg/mL water) and oestradiol (10 microg/kg body weight) or vehicle was given subcutaneously 5 days/week for up to 60 days after surgery. Urinary deoxypyridinoline (a marker of bone resorption) and circulating levels of bone alkaline phosphatase activity (a marker of bone formation), as well as serum calcium and phosphorus levels, were measured every 15 days. Bone area (BA), bone mineral content (BMC), bone mineral density (BMD) and total body fat (expressed as 100 g body weight) were measured by dual-energy X-ray absorptiometry at the end of the experiment. Body weight and total body fat were augmented after ovariectomy, and decreased after melatonin or oestradiol treatment. The effect of melatonin on body weight was seen in sham-operated rats only. Ovariectomy augmented, and melatonin or oestradiol lowered, urinary deoxypyridinoline excretion. This effect of melatonin and oestradiol was seen mainly in ovariectomized rats. The efficacy of oestradiol to counteract ovariectomy-induced bone resorption was increased by melatonin. Melatonin or oestradiol lowered serum bone alkaline phosphatase activity. Melatonin inhibition was seen mainly on the increase of bone alkaline phosphatase activity that followed ovariectomy. Serum phosphorus levels decreased after melatonin administration and were augmented after oestradiol injection; overall, melatonin impaired the increase of serum phosphorus caused by oestradiol. Ovariectomy decreased, and oestradiol increased, serum calcium levels while melatonin augmented serum calcium in sham-operated rats only. On day 60 after surgery, BMD and content decreased after ovariectomy and were increased after oestradiol injection. Melatonin augmented BA of spine and BMC of whole of the skeleton and tibia. The highest values observed were those of rats treated concurrently with oestradiol and melatonin. The present results indicate that: (i) melatonin treatment restrained bone remodelling after ovariectomy; (ii) the effect of melatonin required adequate concentrations of oestradiol; (iii) melatonin augmented oestradiol effects on bone in ovariectomized rats; (iv) a counter-regulation by melatonin of the increase in body fat caused by ovariectomy was uncovered. The melatonin doses employed were pharmacological in terms of circulating melatonin levels but not necessarily for some other fluids or tissues.
Assuntos
Desenvolvimento Ósseo/efeitos dos fármacos , Estradiol/farmacologia , Melatonina/farmacologia , Ovariectomia , Animais , Peso Corporal , Feminino , Ratos , Ratos WistarRESUMO
Se describe una familia, en la cual todos sus miembros mujeres, madre postmenopáusica (caso índice) y sus tres hijas premenopáusicas presentan osteoporosis. La madre (60 años) presentó fracturas axiales y periféricas, con una densidad mineral ósea (DMO) muy baja para su edad. Su abuela había sufrido una fractura de cadera. La hija mayor (30 años) sufrió múltiples fracturas vertebrales durante el embarazo y lactancia asociadas a una DMO muy baja. En consecuencia se estudiaron las dos hijas menores (29 y 27 años). En ellas se observó que la DMO estaba severamente disminuida (valores densitométricos de osteoporosis según la definición de la OMS) pero sin antecedentes de fracturas óseas. Es probable que la alta heredabilidad de la masa ósea sea la causa de la severa disminución de la DMO observada en todas las mujeres de esta familia, y responsable de fracturas óseas en dos de ellas. No hemos encontrado en la literatura descripciones de una familia similar, que muestre la importancia del estudio de la masa ósea de los descendientes de un individuo con osteoporosis severa, permitiendo la detección de familiares con baja masa ósea y alto riesgo de desarrollo de fracturas óseas
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Gravidez , Fraturas Espontâneas/etiologia , Osteoporose/genética , Densidade Óssea , Traumatismo Múltiplo/etiologia , Osteoporose/complicações , Osteoporose/diagnóstico , Fatores de RiscoRESUMO
Se describe una familia, en la cual todos sus miembros mujeres, madre postmenopáusica (caso índice) y sus tres hijas premenopáusicas presentan osteoporosis. La madre (60 años) presentó fracturas axiales y periféricas, con una densidad mineral ósea (DMO) muy baja para su edad. Su abuela había sufrido una fractura de cadera. La hija mayor (30 años) sufrió múltiples fracturas vertebrales durante el embarazo y lactancia asociadas a una DMO muy baja. En consecuencia se estudiaron las dos hijas menores (29 y 27 años). En ellas se observó que la DMO estaba severamente disminuida (valores densitométricos de osteoporosis según la definición de la OMS) pero sin antecedentes de fracturas óseas. Es probable que la alta heredabilidad de la masa ósea sea la causa de la severa disminución de la DMO observada en todas las mujeres de esta familia, y responsable de fracturas óseas en dos de ellas. No hemos encontrado en la literatura descripciones de una familia similar, que muestre la importancia del estudio de la masa ósea de los descendientes de un individuo con osteoporosis severa, permitiendo la detección de familiares con baja masa ósea y alto riesgo de desarrollo de fracturas óseas
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Gravidez , Osteoporose/genética , Fraturas Espontâneas/etiologia , Osteoporose/diagnóstico , Osteoporose/complicações , Traumatismo Múltiplo/etiologia , Densidade Óssea , Fatores de RiscoRESUMO
Se estudió la eficacia del olpadronato, un nuevo bisfosfonato producto de la dimetilación del pamidronato, en 37 pacientes con enfermedad de Paget de (X + 1DS) 68 + 8 anos de edad. La población estaba constituida por: 12 pacientes sin tratamiento específico previo (STP) y 25 pacientes que habían recibido tratamientos anteriores (CTP) hasta (X + 1DS) 11+8 meses previos al inicio del estudio. La fosfatasa alcalina (FA) inicial en ambos grupos fue: 36 + 20 UKA y 43 + 30 UKA, respectivamente (rango normal: 5 a 15 IKA). La dosis diaria utilizada fue: 127 + 34mg por vía oral durante 3.5 + 2.4 meses (rango: 0.5 a 13 meses). Siete pacientes recibieron 2 ciclos de tratamiento. Todos los pacientes STP y 21 pacientes CTP normalizaron los valores de FA e hidroxiprolina urinaria (remisión completa). En 1 paciente CTP el olpadronato no fue efectivo y en 3 pacientes CTP la hidroxiprolina se normalizó pero no la FA aunque descendió en un 60 por ciento de los valores iniciales (remisión parcial). Se comparó la eficacia del olpadronato respecto del pamidronato en 14 pacientes CTP que habían sido previamente tratados con varios ciclos de pamidronato durante un período de 6.6 + 4.2 años y que no habían conseguido normalizar la FA. Doce de los 14 pacientes normalizaron la FA con el tratamiento con olpadronato y todos alcanzaron valores de hidroxiprolina normales. Conclusión: El olpadronato en dosis de 100 a 200 mg/día por vía oral es bien tolerado y eficaz en el tratamiento de la enfermedad de Paget aún en aquellos pacientes parcialmente respondedores al pamidronato.
Assuntos
Idoso , Feminino , Humanos , Fosfatase Alcalina/sangue , Difosfonatos/uso terapêutico , Hidroxiprolina/sangue , Osteíte Deformante/tratamento farmacológico , Difosfonatos , Tolerância a Medicamentos , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Humanos , Masculino , Adolescente , Adulto , Composição Corporal , Densidade Óssea , Esqueleto , Futebol , Educação Física e Treinamento , Medicina EsportivaRESUMO
Se estudió la eficacia del olpadronato, un nuevo bisfosfonato producto de la dimetilación del pamidronato, en 37 pacientes con enfermedad de Paget de (X + 1DS) 68 + 8 anos de edad. La población estaba constituida por: 12 pacientes sin tratamiento específico previo (STP) y 25 pacientes que habían recibido tratamientos anteriores (CTP) hasta (X + 1DS) 11+8 meses previos al inicio del estudio. La fosfatasa alcalina (FA) inicial en ambos grupos fue: 36 + 20 UKA y 43 + 30 UKA, respectivamente (rango normal: 5 a 15 IKA). La dosis diaria utilizada fue: 127 + 34mg por vía oral durante 3.5 + 2.4 meses (rango: 0.5 a 13 meses). Siete pacientes recibieron 2 ciclos de tratamiento. Todos los pacientes STP y 21 pacientes CTP normalizaron los valores de FA e hidroxiprolina urinaria (remisión completa). En 1 paciente CTP el olpadronato no fue efectivo y en 3 pacientes CTP la hidroxiprolina se normalizó pero no la FA aunque descendió en un 60 por ciento de los valores iniciales (remisión parcial). Se comparó la eficacia del olpadronato respecto del pamidronato en 14 pacientes CTP que habían sido previamente tratados con varios ciclos de pamidronato durante un período de 6.6 + 4.2 años y que no habían conseguido normalizar la FA. Doce de los 14 pacientes normalizaron la FA con el tratamiento con olpadronato y todos alcanzaron valores de hidroxiprolina normales. Conclusión: El olpadronato en dosis de 100 a 200 mg/día por vía oral es bien tolerado y eficaz en el tratamiento de la enfermedad de Paget aún en aquellos pacientes parcialmente respondedores al pamidronato. (AU)