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We have recently identified a significant deterioration of bone microarchitecture in premenopausal women with newly diagnosed celiac disease (CD) using high-resolution peripheral quantitative computed tomography (HRpQCT). The aim of this work was to assess changes in bone microarchitecture after 1 year on a gluten-free diet (GFD) in a cohort of premenopausal women. We prospectively enrolled 31 consecutive females at diagnosis of CD; 26 of them were reassessed 1 year after GFD. They all underwent HRpQCT scans of distal radius and tibia, areal BMD by DXA, and biochemical tests (bone-specific parameters and CD serology) at both time points. Secondary, we compared 1-year results with those of a control group of healthy premenopausal women of similar age and BMI in order to assess whether the microarchitectural parameters of treated CD patients had reached the values expected for their age. Compared with baseline, the trabecular compartment in the distal radius and tibia improved significantly (trabecular density, trabecular/bone volume fraction [BV/TV] [p < 0.0001], and trabecular thickness [p = 0.0004]). Trabecular number remained stable in both regions. Cortical density increased only in the tibia (p = 0.0004). Cortical thickness decreased significantly in both sites (radius: p = 0.03; tibia: p = 0.05). DXA increased in all regions (lumbar spine [LS], p = 0.01; femoral neck [FN], p = 0.009; ultradistal [UD] radius, p = 0.001). Most parameters continued to be significantly lower than those of healthy controls. This prospective HRpQCT study showed that most trabecular parameters altered at CD diagnosis improved significantly by specific treatment (GFD) and calcium and vitamin D supplementation. However, there were still significant differences with a control group of women of similar age and BMI. In the prospective follow-up of this group of patients we expect to be able to assess whether bone microarchitecture attains levels expected for their age. © 2016 American Society for Bone and Mineral Research.
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Osso e Ossos/patologia , Doença Celíaca/dietoterapia , Doença Celíaca/patologia , Dieta Livre de Glúten , Absorciometria de Fóton , Adulto , Densidade Óssea , Osso e Ossos/diagnóstico por imagem , Cálcio/metabolismo , Estudos de Casos e Controles , Demografia , Suplementos Nutricionais , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Vitamina D/uso terapêutico , Adulto JovemRESUMO
CONTEXT: Abaloparatide is a novel synthetic peptide analog of parathyroid hormone-related protein (PTHrP) that is currently being developed as a potential anabolic agent in the treatment of postmenopausal osteoporosis. OBJECTIVE: This study sought to assess the effects of abaloparatide on bone mineral density (BMD) at the lumbar spine, total hip, and femoral neck in postmenopausal women with osteoporosis. DESIGN: Multi-center, multi-national, double-blind placebo controlled trial in which postmenopausal women were randomly assigned to receive 24 weeks of treatment with daily sc injections of placebo, abaloparatide, 20, 40, or 80 µg, or teriparatide, 20 µg. A 24-week extension was also performed in a subset of subjects. PARTICIPANTS: Postmenopausal women with osteoporosis (n = 222). MAIN OUTCOME MEASURES: BMD by dual-x-ray absorptiometry and biochemical markers of bone turnover. RESULTS: At 24 weeks, lumbar spine BMD increased by 2.9, 5.2, and 6.7% in the abaloparatide, 20-, 40-, and 80-µg groups, respectively, and 5.5% in the teriparatide group. The increases in the 40- and 80-µg abaloparatide groups and the teriparatide group were significantly greater than placebo (1.6%). Femoral neck BMD increased by 2.7, 2.2, and 3.1% in abaloparatide, 20-, 40-, and 80-µg groups, respectively, and 1.1% in the teriparatide group. The increase in femoral neck BMD with abaloparatide, 80 µg was significantly greater than placebo (0.8%). Total hip BMD increased by 1.4, 2.0, and 2.6% in the abaloparatide, 20-, 40-, and 80-µg groups, respectively. The total hip increases in the 40- and 80-µg abaloparatide groups were greater than both placebo (0.4%) and teriparatide (0.5%). CONCLUSIONS: Compared with placebo, 24 weeks of daily sc abaloparatide increases BMD of the lumbar spine, femoral neck, and total hip in a dose-dependent fashion. Moreover, the abaloparatide-induced BMD increases at the total hip are greater than with the marketed dose of teriparatide. These results support the further investigation of abaloparatide as an anabolic therapy in postmenopausal osteoporosis.
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Conservadores da Densidade Óssea/farmacologia , Densidade Óssea/efeitos dos fármacos , Osteoporose Pós-Menopausa/tratamento farmacológico , Proteína Relacionada ao Hormônio Paratireóideo/farmacologia , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/uso terapêutico , Método Duplo-Cego , Feminino , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/efeitos dos fármacos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/efeitos dos fármacos , Pessoa de Meia-Idade , Proteína Relacionada ao Hormônio Paratireóideo/uso terapêutico , Radiografia , Teriparatida/farmacologia , Teriparatida/uso terapêutico , Resultado do TratamentoRESUMO
Denosumab is the first fully human monoclonal antibody that inhibits the formation, function, and survival of osteoclasts by blocking the interaction of receptor activator of nuclear factor-κB (RANK) ligand with its osteoclastic receptor RANK. Clinical studies have shown that the decreased bone resorption and increased bone mineral density resulting from the use of denosumab 60 mg twice yearly entail significant risk reduction of vertebral, hip, and nonvertebral fractures in women with postmenopausal osteoporosis, with an acceptable rate of side effects so far. Following its approval by the US Food and Drug Administration and the European Medicines Agency, a number of clinical trials with denosumab are ongoing to demonstrate its value for other indications and to further characterize its effects on immunomodulation. Denosumab offers a new choice for the treatment of postmenopausal osteoporosis in patients at high risk for fracture.
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Anticorpos Monoclonais/farmacologia , Densidade Óssea/efeitos dos fármacos , Fraturas Ósseas/prevenção & controle , Osteoporose Pós-Menopausa/tratamento farmacológico , Ligante RANK/farmacologia , Anticorpos Monoclonais Humanizados , Ensaios Clínicos como Assunto , Denosumab , Feminino , Fraturas Ósseas/etiologia , Humanos , Masculino , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/fisiopatologia , Neoplasias da Próstata/complicações , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: To determine the safety and efficacy of full-length parathyroid hormone, PTH(1-84), treatment for up to 36 months by evaluating bone mineral density (BMD) changes, bone histomorphometric indices, and clinical fracture incidence in postmenopausal women with osteoporosis. BACKGROUND: The TOP trial demonstrated increased lumbar spine BMD (6.9%) versus placebo after 18 months of PTH(1-84) treatment and reduced the incidence of new vertebral fractures (61%; p = 0.001). The therapeutic benefits of long-term treatment of postmenopausal women with PTH(1-84) are unknown. METHODS: The safety and efficacy of 36 months of once-daily dosing with 100 µg PTH(1-84) in postmenopausal women with osteoporosis were assessed. Women receiving placebo during the TOP trial were eligible for PTH(1-84) in the extension study. CLINICAL TRIAL REGISTRATION: NCT00172120. RESULTS: Lumbar spine BMD increased by 8.5% above baseline (p < 0.001) at 36 months of PTH(1-84) treatment, remaining stable during the last 12 months of treatment. Increases in total hip and femoral neck BMD occurred more slowly, reaching 3.2% and 3.4%, respectively above baseline at 36 months (p < 0.001). The total hip BMD showed no signs of reaching a limiting value although the femoral neck plateaued from months 24 to 36. Seven patients had vertebral fractures during the placebo phase of the TOP trial and before entering the extension study, but this rate decreased with the introduction of PTH(1-84) therapy, resulting in a single worsened vertebral fracture in the first 6 months and no further vertebral fractures from months 6 to 36. Treatment over 36 months with PTH(1-84) was well-tolerated and iliac crest biopsies showed no adverse effects on bone. LIMITATIONS: There was no placebo group for BMD comparisons. The number of patients assessed for fracture incidence was small. CONCLUSIONS: PTH(1-84) treatment for 36 months resulted in significant increases in BMD at the lumbar spine and hip, was associated with a lower incidence of vertebral fracture when compared to before therapy initiation, and was well-tolerated. The continuous increases in total hip BMD suggest that prolonged PTH(1-84) treatment may be beneficial for postmenopausal osteoporosis. Increased BMD at the femoral neck and lumbar spine also showed favourable changes but plateaued between 24 and 36 months. Long-term treatment was not associated with abnormalities in bone biopsies.
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Osteoporose Pós-Menopausa/tratamento farmacológico , Hormônio Paratireóideo/uso terapêutico , Idoso , Densidade Óssea/efeitos dos fármacos , Feminino , Fraturas Ósseas/prevenção & controle , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Hormônio Paratireóideo/efeitos adversos , Coluna Vertebral/fisiopatologia , Fatores de TempoRESUMO
INTRODUCTION: The most frequent urine metabolic risk factor in adults is idiopathic hypercalciuria while in children is hypocitraturia. If there is really a change of metabolic abnormalities with age it would be interesting to study risk factors in the intermediate population: young adults. OBJECTIVE: We evaluated metabolic risk factors, clinical presentation and family history of stone formers between 17 and 27 years old. METHODS: A total of 160 patients (87 males and 73 females) were studied with a standard protocol. RESULTS: A single urine metabolic risk factor was present in 64% of the patients, and multiple risk factors were present in 27% of them. No metabolic abnormalities were found in the remaining 9%. The most common urine risk factor was idiopathic hypercalciuria (alone or in combination), which was identified in 42.5% followed by hypocitraturia (alone or in combination) found in 32.9% of the patients. In the subgroup of patients of 17-20 years (n = 75; mean age of 18.8 + or - 1.0 years), hypocitraturia (alone or in combination) was as frequent as idiopathic hypercalciuria (alone or in combination), which was identified in 38% (n = 30) and 36.7% (n = 29), respectively. The most frequent form of presentation was renal colic (72%). A positive family history of stone disease in first degree and second-degree relatives was found in 32.9 and 34.1%, respectively. CONCLUSIONS: Metabolic abnormalities were found in 91% of young adults with renal lithiasis, similar to our adult series. Hypercalciuria was the most frequent metabolic abnormality found. Yet, hypocitraturia (alone or in combination) was very frequent, and in the subgroup of patients of 17-20 years, it was as frequent as idiopathic hypercalciuria, similar to what we found in children.
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Cálculos Renais/diagnóstico , Cálculos Renais/metabolismo , Adolescente , Adulto , Feminino , Humanos , Cálculos Renais/epidemiologia , Masculino , Medição de Risco , Fatores de Risco , Adulto JovemRESUMO
Glucocorticoid use is a leading cause of secondary osteoporosis. This post hoc analysis compared teriparatide vs alendronate on bone mineral density (BMD) in Hispanic and non-Hispanic patients with glucocorticoid-induced osteoporosis. The 18-mo results from all patients (N=428) in a double-blind trial of teriparatide (20 microg/d) and alendronate (10 mg/d) who had taken glucocorticoids for >or=3 mo were reported (Saag et al. N Engl J Med 2007). The present study analyzed results from the Hispanic (n=61) and non-Hispanic (n=367) cohorts. The BMD was measured by dual-energy X-ray absorptiometry (DXA). In the Hispanic cohort at 18 mo, there were significantly greater increases from baseline in the teriparatide vs alendronate group in lumbar spine BMD (9.8%+/-1.7% vs 4.2%+/-1.4%; p<0.001; mean+/-SE) and total hip BMD (5.9%+/-1.6% vs 1.3%+/-1.3%, p<0.001), with no significant difference between groups at the femoral neck (4.3%+/-2.2% vs 2.0%+/-1.8%, p=0.228). Within each treatment group, the BMD responses were not significantly different in the Hispanic vs non-Hispanic cohort. The number of patients reporting >or=1 adverse event was not significantly different between treatments in either cohort, with more patients reporting nausea in the teriparatide group. In summary, teriparatide was more efficacious than alendronate in increasing BMD in Hispanic and non-Hispanic patients with glucocorticoid-induced osteoporosis. Both treatments were generally well tolerated.
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Alendronato/farmacologia , Conservadores da Densidade Óssea/farmacologia , Densidade Óssea/efeitos dos fármacos , Osteoporose/tratamento farmacológico , Osteoporose/etnologia , Teriparatida/farmacologia , Argentina , Brasil , Estudos de Coortes , Colômbia , Método Duplo-Cego , Feminino , Glucocorticoides/efeitos adversos , Hispânico ou Latino , Humanos , Masculino , México , Pessoa de Meia-Idade , Osteoporose/induzido quimicamente , VenezuelaRESUMO
The evaluation of metabolic risk factor in children with renal stone disease is the basis of medical treatment aimed at preventing recurrent stone events and the growth of preexisting calculi. In this retrospective study, we evaluated the metabolic risk factors and clinical and family histories of 90 children with kidney stone disease who had been referred to our institution and subjected to clinical tests using a standardized protocol. The mean age of our pediatric patients was 10.7 years, and the male:female ratio was 1.14:1.0. Biochemical abnormalities were found in 84.4% of all cases. A single urine metabolic risk factor was present in 52.2% (n = 47) of the patients, and multiple risk factors were present in the remaining 31.1% (n = 28). Idiopathic hypercalciuria (alone or in combination) and hypocitraturia (alone or in combination) were the most frequent risk factors identified in 40 and 37.8% of these patients, respectively. Renal colic or unspecified abdominal pain were the most frequent forms of presentation (76.9%), with 97.5% of stones located in the upper urinary tract. In most patients, stone disease was confirmed by renal ultrasonography (77%). A positive family history in first-degree and second-degree relatives was found in 46.2 and 32.5% of the cases, respectively. We conclude that specific urine metabolic risk factors are found in most children with kidney stones and that hypocitraturia is as frequent as hypercalciuria. Very often there is a positive family history of renal stone disease in first- and second-degree relatives.
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Cálculos Renais/etiologia , Dor Abdominal/etiologia , Adolescente , Argentina , Criança , Pré-Escolar , Citratos/urina , Feminino , Predisposição Genética para Doença , Hematúria/etiologia , Humanos , Hipercalciúria/complicações , Hipercalciúria/urina , Hiperoxalúria/complicações , Hiperoxalúria/urina , Cálculos Renais/complicações , Cálculos Renais/patologia , Cálculos Renais/urina , Magnésio/urina , Masculino , Linhagem , Estudos Retrospectivos , Fatores de Risco , Ácido Úrico/urinaRESUMO
Little is known about the magnitude of vitamin D deficiency in patients with stage 5 chronic kidney disease (CKD-5) on hemodialysis (HD). In the present study, we examined the prevalence of vitamin D deficiency in patients with CKD-5 undergoing HD, evaluating the relationship between calcidiol levels with other parameters of mineral metabolism, nutrition/inflammation, functional capacity (FC), and sunlight exposure. Serum 25(OH) vitamin D levels were evaluated in 84 stable patients on chronic HD not receiving vitamin D supplements, with a mean age 58.9+/-16.6 years, during the month of September (end of winter in the southern hemisphere). 25(OH) vitamin D serum levels, intact PTH (iPTH), as well as serum albumin, calcium, phosphorus, and alkaline phosphatase were analyzed in fasting samples. Similarly, protein catabolic rate (PCR) and body mass index (BMI) were determined as nutritional parameters. Functional capacity according to the Karnofsky index, and sunlight exposure were also analyzed. In this study, we considered adequate vitamin D levels those above 30 ng/mL (U.S.A. National Kidney Foundation DOQI Guidelines), vitamin D insufficiency when levels were between 15 and 30 ng/mL, and vitamin D deficiency when levels were below 15 ng/mL. The mean 25(OH) D levels were significantly higher in men than in women (28.6 vs. 18.9 ng/mL; p=0.001). Vitamin D insufficiency was found in 53.5% of the patients (n=45) and vitamin D deficiency in 22.6% (n=19). In the univariate analysis, there were no correlations between 25(OH) D levels with age, iPTH, calcium, or phosphorus. There were positive correlations between serum 25(OH) D levels and degrees of sunlight exposure (R=0.55; p<0.0001), serum creatinine (r=0.38; p<0.001), serum albumin (r=0.22; p=0.04), and a negative correlation with BMI (r=-0.26; p=0.01). In the multiple regression analysis, only sunlight exposure (B=0.361), BMI (B=-0.23), and gender (B=-0.27) were significantly associated with 25(OH) D levels. Patients with FC 1 to FC 2 (n: 70%, 83.3%) had significantly higher 25(OH) D serum levels compared with FC 3 to FC 4 patients (n: 14%, 16.6%): 25.9 vs. 17.1 ng/mL (p=0.03). These results indicate that vitamin D insufficiency/deficiency is highly prevalent (76.1%) at the end of winter, in stage 5 CKD patients on HD, and lower values seem to be related to decreased sunlight exposure, female gender, increased BMI, and worse functional class.
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Calcifediol/sangue , Diálise Renal , Insuficiência Renal Crônica/sangue , Deficiência de Vitamina D/sangue , Adulto , Idoso , Índice de Massa Corporal , Jejum/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minerais/sangue , Guias de Prática Clínica como Assunto , Prevalência , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Estações do Ano , Índice de Gravidade de Doença , Fatores Sexuais , Luz Solar , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/etiologiaRESUMO
BACKGROUND: Intravenous disodium pamidronate has been described in the treatment of several osteopathies. Although tolerability has been found to be good in clinical trials, some mild to serious adverse events (AEs) have been reported. OBJECTIVES: The aims of this study were to analyze the toelrability of IV pamidronate in patients being treated for osteoporosis and other metabolic osteopathies and to describe particular patients with relative contraindications, because such cases are not commonly seen in daily clinical practice. METHODS: We performed a retrospective analysis of patients with different osteopathies who were administered IV infusions of pamidronate at doses ranging from 15 to 90 mg/infusion and 15 to 900 mg/year. The study was conducted in patients who had received treatment at the Institute of Metabolic Investigations, University of Salvador, Buenos Aires, Argentina, between January 1995 and December 2003. To rule out dose-related AEs, a comparison was made between patients who received fewer IV infusions and had cumulative doses of 120 to 180 mg/y (less frequent administration [LFA] group) and those patients who received regular infusions and had cumulative doses of >180 mg/year (frequent administration [FA] group). To confirm data obtained from medical records and to assess the occurrence of AEs, attempts were made to interview all patients by phone. The following information was verified for each patient included in the study: the reason for treatment, documented evidence of current diagnostic criteria, and whether the dose administered was adequate to treat the patient's condition. RESULTS: Six hundred eight patients (464 [76.3%]women, 144 [23.7%]men; mean [SD] age, 69 [10] years) with various osteopathies (osteoporosis, 367 [60.4%] of the patients; Paget's disease, 172 [28.3%]; Sudeck's disease, 63 [10.4%]; multiple myeloma, 3 [0.5%]; and bone metastases, 3 [0.5%]) were administered a total of 2933 IV infusions of pamidronate during the study period. We were able to confirm the clinical records of 69.4% (422/608) of the patients by telephone survey; 29.9% (124/415) of those patients experienced extraskeletal AEs (most commonly fever and flu-like symptoms [eg, headache, malaise, fatigue, chills, and asthenia]). The percentage of patients reporting AEs was significantly higher for the LFA group than that of the FA group (91.2 vs 19.5; P < 0.001), although factors other than the frequency of treatment might have had a bearing on this finding. All AEs were mild and transient in both groups of patients, and there were no reports of jaw osteonecrosis in either group. It should be noted that although LFA patients received lower doses of pamidronate per infusion than the FA group, they had higher cumulative doses/year. Biochemical variables for the entire study population were compared with baseline measurements, and no significant changes in mean values were observed. Both serum calcium and 25-hydroxy vitamin D levels remained within normal ranges. On the other hand, there was a transient decrease in white blood cell count (WBCC) in 73 (12.0%) patients, and leukopenia was observed in 8 (1.3%) patients. However, 5 of the 6 patients who were leukopenic at the beginning of treatment had normal WBCCs during follow-up. Platelet count decreased significantly in 20 (3.3%) patients, and 5 (0.8%) patients developed thrombocytopenia. Serum creatinine (sCreat) levels increased significantly in 91 (15.0%) patients. This increase was transient and within normal limits (0.6-1.2 mg/dL) in 79 (86.8%) of those patients but persistent in the other 12 (13.2%), all of whom received higher doses of pamidronate or had other risk factors for renal failure such as advanced age, diabetes, multiple myeloma, or an obstructor disease. Baseline sCreat level for 7 of these 12 patients was >1.20 mg/dL. CONCLUSIONS: Pamidronate administered IV was well tolerated when used for treating osteoporosis or other metabolic osteopathies in our study population. The clinical AEs observed with IV pamidronate administration were not serious and hematologic changes were mild, transient, and not associated with dose, time of treatment, or any particular underlying disease. An increase in sCreat level was the most frequent biochemical complication and was found in patients with additional risk factors for renal failure and particular diseases. Whether certain patients with risk factors for osteoporosis may require even fewer IV administrations of the drug is an issue that remains to be elucidated.
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Osteoporosis-related fractures are a major public health problem worldwide. Antiresorptive drugs, which work principally by suppressing bone resorption, are the established therapeutic approach for the prevention of fragility fractures in patients with osteoporosis. Parathyroid hormone and its analogs represent a new class of agents with anabolic effects on the skeleton. The results of double-blind, randomized, placebo-controlled trials have shown that both the full length, 84 amino acid parathyroid hormone and teriparatide, the parathyroid hormone fragment (1-34) increase bone mineral density and reduce the risk of fracture when administered intermittently to postmenopausal osteoporotic women. Therefore, these drugs should be considered an alternative therapy in postmenopausal osteoporosis.
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A 60-year-old Caucasian woman with a 1-year history of pain at the ribs, spine, and pelvis consulted at our Institute in March 1999. She brought a bone densitometry performed using a Lunar DPX densitometer that showed bone mineral density (BMD) measurements in the osteoporotic range at both the lumbar spine and the femoral neck. As a child she had had bowed legs and had been treated with ultraviolet radiation. Results of the laboratory test performed at our institute showed normal total serum calcium, repeated low serum P levels, and a low renal phosphate threshold with elevated total and bone fraction of alkaline phosphatase with normal intact parathyroid hormone (PTH). A diagnosis of hypophosphatemic osteomalacia due to renal phosphate leak was made. She began treatment with neutral sodium phosphate at 1.5 g/day and calcitriol 0.5 microg/day. Her serum P levels normalized, and there was a progressive decrease in alkaline phosphatase levels. The densitometry showed a very rapid increase in BMD values with normalization at the lumbar spine after 10 months of treatment. This case shows the importance of bone densitometry in the follow-up of patients with suspected osteomalacia.
Assuntos
Densidade Óssea/efeitos dos fármacos , Hipofosfatemia/fisiopatologia , Osteomalacia/diagnóstico , Fosfatase Alcalina/sangue , Fosfatase Alcalina/efeitos dos fármacos , Cálcio/farmacologia , Colecalciferol/uso terapêutico , Feminino , Humanos , Hipofosfatemia/complicações , Hipofosfatemia/tratamento farmacológico , Pessoa de Meia-Idade , Osteomalacia/tratamento farmacológico , Osteomalacia/etiologia , Endopeptidase Neutra Reguladora de Fosfato PHEX , Fosfatos/uso terapêutico , Fósforo/sangue , Proteínas/genéticaRESUMO
BACKGROUND: The usefulness of bone mass measurements and bone turnover markers to estimate the risk of fracture and the type of underlying renal osteodystrophy are not well established in patients on peritoneal dialysis (PD). OBJECTIVE: To assess bone mass using total and regional bone densitometry in a group of patients on PD and to determine if serum markers of bone turnover identify patients with low bone mass. METHODS: Bone densitometry was studied by dual-energy x-ray absorptiometry (DEXA), and bone turnover using several serum markers, in 65 patients on PD. Bone mass was classified as normal, osteopenic, or osteoporotic according to World Health Organization criteria based on bone mineral density (BMD) T scores. RESULTS: T scores in the osteopenia range were present at the lumbar spine (LS) in 44.6% (45% of men and 44.4% of women) of patients and at the femoral neck (FN) in 56.9% (55% of men and 58% of women). T scores in the osteoporosis range were present at the LS in 13.8% of patients (10% of men and 15.5% of women) and at the FN in 21.5% (30% of men and 17.7% of women). Patients with BMD T scores in the osteoporosis range at both regions had increased serum intact parathyroid hormone (iPTH) levels compared to patients in the osteopenic/normal range. Bone mineral content in the whole skeleton (TBMC) correlated negatively with iPTH (r = -0.34) and with total time on dialysis (r = -0.26); in multivariate analysis, only iPTH correlated negatively with TBMC (B = -0.26, p = 0.03). No correlations were found between the other bone markers and BMD T scores at the FN or LS. There were no significant differences in absolute BMD or BMD T scores at the LS or FN between patients with and patients without fractures. CONCLUSIONS: BMD T scores in the osteopenia/osteoporosis range were observed at the LS in 58.4% of these patients on PD and at the FN in 78.4%. TBMC correlated negatively with iPTH. There were no correlations between markers of bone turnover and bone mass measurements at the two skeletal regions, although patients with BMD T scores in the osteoporosis range had increased serum iPTH levels. Bone mass measurements were not different between patients with and patients without fractures.
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Densidade Óssea/fisiologia , Remodelação Óssea/fisiologia , Falência Renal Crônica/sangue , Diálise Peritoneal , Adulto , Idoso , Fosfatase Alcalina/sangue , Biomarcadores/sangue , Colágeno/sangue , Colágeno Tipo I , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fragmentos de Peptídeos/sangue , Peptídeos/sangue , Pró-Colágeno/sangueRESUMO
UNLABELLED: Abstract. BACKGROUND: Medical practitioners face the challenge of noncompliance with prescriptions, particularly in chronic, asymptomatic, diseases such as osteoporosis. OBJECTIVE: The aim of this study was to assess the raloxifene compliance and continuance rates and adverse effects over 24 months in clinical practice. METHODS: Using a retrospective study of clinical histories obtained from a database at the Metabolic Research Institute, University of El Salvador School of Medicine, Buenos Aires, Argentina, as well as telephone interviews, we assessed compliance and continuance with raloxifene therapy in post-menopausal patients who had received prescriptions for raloxifene to prevent or treat osteoporosis. Patients were contacted by telephone 24 months after they had received a prescription for raloxifene. Compliance and continuance rates were calculated based on the data provided by the patients. RESULTS: Data from 419 patients (mean [SD] age, 61.4 [7.4] years [range, 42-90 years]) were included in the study. At the time of the telephone interview, 225 (53.7%) were still receiving raloxifene, 105 (25.1%) had stopped treatment at their own discretion, 59 (14.1%) had not started treatment, and 30 (7.2%) had discontinued treatment as a result of advice from a physician. The reasons for not starting treatment were fear of thrombolytic events (21 patients [35.6%]); lack of interest in starting treatment (12 [20.3%]); other physician's advice (11 [18.6%]); family problems (3 [5.1%]); dissatisfaction with the prescribing physician, treatment cost, health problems unrelated to osteoporosis, and mistrust in the prescription (each, 2 [3.4%]); and advice from family/friends, fear of breast cancer, belief that raloxifene is hormonal, and that the patient was already polymedicated (each, 1 [1.7%]). Eleven of the 59 patients (18.6%) who had not started therapy were advised by a physician other than the prescribing physician not to start treatment and were excluded from the compliance analysis. Thus, the compliance analysis included 408 patients. The 2 most common reasons for discontinuing treatment at the patient's own discretion were health problems unrelated to osteoporosis (25 [23.8%]) and digestive problems not considered treatment related (16 [15.2%]). The compliance rates were 75.0%, 71.1%, 65.0%, 57.1%, and 52.0% at 3, 6, 12, 18, and 24 months, respectively. In patients who started raloxifene treatment, the continuance rates were 85.0%, 80.6%, 73.6%, 64.7%, and 58.9% at 3, 6, 12, 18, and 24 months, respectively. Sixty-two of the 135 patients who discontinued treatment did so within 3 months of receiving the prescription, accounting for 45.9% of all discontinuations. CONCLUSIONS: In the present study of raloxifene compliance and continuance in clinical practice, the compliance rate appeared to be relatively high compared with those of hormone-replacement therapy (HRT) and other non-HRT treatments. Almost half of patients who discontinued treatment did so in the first 3 months.
RESUMO
BACKGROUND: Malnutrition is widely prevalent in dialysis. Malnourished patients present depletion of somatic protein stores and a decrease in lean body mass (LBM) that can be measured by different techniques. AIMS: (1) To assess the reliability of lean mass measurements obtained by creatinine kinetics (CrK) in a group of stable peritoneal dialysis (PD) patients, using dual-energy x-ray absorptiometry (DEXA) measurements as the reference method; (2) to establish the reproducibility of LBM estimated by CrK in individual patients analyzing repeated measurement in the short term, and (3) to correlate measurements of LBM with laboratory determinations that assess nutritional status. METHODS: We performed a cross-sectional evaluation of LBM by DEXA and CrK in 39 PD patients. In 14 patients we performed repeated measurements of LBM by CrK in the short term. RESULTS: No significant difference was found in mean lean mass values estimated by both methods: mean DEXA LBM was 41.7 kg, 36.1 +/- 4.5 kg in females and 52.7 +/- 6.4 kg in males and mean CrK LBM was 41.08 kg, 37.5 +/- 6.1 kg in females and 48.1 +/- 8.4 kg in males. A good correlation was found between both techniques (r = 0.71; p < 0.003). The mean difference between the two methods was 0.638 +/- 6.95 kg (95% confidence limits: -12.98 and +14.26). A wide scatter of the differences between both methods was seen throughout the range of measurements of LBM. When LBM by CrK was repeatedly (2-3 times) measured in a period of 3-4 months in 14 patients, it had a coefficient of variation (CV) of 15.39% (range 2.89-42.88%), while body weight CV in the same period was 0.69% (range 0-1.9%). CONCLUSIONS: CrK is an unsatisfactory method for the assessment of LBM in PD patients.
Assuntos
Composição Corporal , Creatinina/metabolismo , Estado Nutricional , Diálise Peritoneal , Absorciometria de Fóton , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesAssuntos
Osteoporose/classificação , Osteoporose/diagnóstico , Osteoporose/fisiopatologia , Osteoporose/terapia , Osteoporose , Osteoporose/prevenção & controle , Osteoporose/epidemiologia , Fatores de Risco , Densidade Óssea , Doenças Ósseas Metabólicas , Fraturas do Quadril , Descalcificação Patológica , Densitometria , Homeostase , Tomografia Computadorizada por Raios X , Doenças Reumáticas , Ciências da Nutrição , Exercício FísicoAssuntos
Ciências da Nutrição , Densidade Óssea , Densitometria , Descalcificação Patológica , Doenças Reumáticas , Doenças Ósseas Metabólicas , Exercício Físico , Fatores de Risco , Fraturas do Quadril , Homeostase , Osteoporose , Osteoporose/classificação , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/fisiopatologia , Osteoporose/prevenção & controle , Osteoporose/terapia , Tomografia Computadorizada por Raios XRESUMO
La litiasis renal constituye por su frecuencia la 3ra alteración de las vías urinarias. La prevalencia en la Ciudad de Buenos Aires es del 4 por ciento, según estudios recientes. Se presentan los resultados metabólicos de 2612 pacientes estudiados con un mismo protocolo ambulatorio para estudio bioquímico de litiasis renal. Se encontraron alteraciones en 2423 pacientes (92.8 por ciento). El 61.5 por ciento como única alteración y 31.2 por ciento en forma asociada. No pudimos obtener diagnóstico en 189 pacientes (7.2 por ciento). Los diagnósticos más frecuentes como única alteración fueron la hipercalciuria idiopática en el 31.2 por ciento, la hiperuricosuria y diátesis gotosa en el 9.4 y 5.4 por ciento respectivamente. Otros diagnósticos fueron hipomagnesuria (6.7 por ciento), hiperparatiroidismo primario (2.6 por ciento), hiperoxaluria (1.3 por ciento) y cistinuria (0.45 por ciento). La hipercalciuria asociada a otros diagnósticos se observó en el 58.1 por ciento y los trastornos del ácido úrico en el 36.8 por ciento. Además de los trastornos metabólicos descriptos observamos un 12 por ciento de pacientes com bajo volumen urinario. Estos datos están en concordancia con la mayoría de las series publicadas y resaltan la importancia de encontrar un diagnóstico bioquímico en estos pacientes que permita el tratamiento específico que evite la recurrencia.
Assuntos
Humanos , Masculino , Feminino , Adulto , Nefropatias/metabolismo , Litíase/metabolismoRESUMO
La pérdida ósea tiene componentes relacionados con la edad y la menopausia. La pérdida ósea asociada con el progreso de la edad se debe a múltiples factores. Con el fin de evaluar el estado nutricional de vitamina D de mujeres de nuestra ciudad (34ºS), se midió la concentración sérica de calcidiol en 357 mujeres ambulatorias con rango de edad 40-90 años. Ciento ochenta fueran evaluadas en meses de verano y 177 en meses de invierno. También evaluamos niveles de parathormona intacta (PTH) en un subgrupo de 231 mujeres, lo que nos permitió documentar la prevalencia de hiperparatiroidismo secundario. Los valores de calcidiol en verano fueron significativamente más altos que en invierno: 25.3 + 8.5 vs 21.3 + 7.4 ng/ml (p<0.001). Hallamos un 4.4 por ciento de déficit de vitamina D, 2.2 por ciento en verano y 6.6 por ciento en invierno. La prevalencia de calcidiol entre 10-20 ng/ml fue de 67 por ciento en invierno y de 25 por ciento en verano. Un 5.2 por ciento de la mujeres presentó hiperparatiroidismo secundario. Si bien la prevalencia de déficit de vitamina D fue baja comparada con otras series, una gran proporción de mujeres presentó valores entre 10 y 20 ng/ml. Estos valores podrían no ser suficientes para la población adulta y añosa, y resultar en aumento de movilización de calcio y posterior pérdida ósea.