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Bone remodeling, crucial for maintaining the balance between bone resorption and formation, relies on the coordinated activity of osteoclasts and osteoblasts. During osteoclastogenesis, hematopoietic stem cells (HSCs) differentiate into the osteoclast lineage through the signaling pathways OPG/RANK/RANKL. On the other hand, during osteoblastogenesis, mesenchymal stem cells (MSCs) differentiate into the osteoblast lineage through activation of the signaling pathways TGF-ß/BMP/Wnt. Recent studies have shown that bone remodeling is regulated by post-transcriptional mechanisms including microRNAs (miRNAs). miRNAs are small, single-stranded, noncoding RNAs approximately 22 nucleotides in length. miRNAs can regulate virtually all cellular processes through binding to miRNA-response elements (MRE) at the 3' untranslated region (3'UTR) of the target mRNA. miRNAs are involved in controlling gene expression during osteogenic differentiation through the regulation of key signaling cascades during bone formation and resorption. Alterations of miRNA expression could favor the development of bone disorders, including osteoporosis. This review provides a general description of the miRNAs involved in bone remodeling and their significance in osteoporosis development.
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Roux-en-Y gastric bypass (RYGB) and gastric sleeve (GS) have been associated with significant reductions in bone mineral density (BMD) and fluctuations in serum levels of calciotropic hormones. These changes pose a risk to bone health. The study assessed the short-term (12 and 24 months) effects of RYGB and GS on BMD and calciotropic hormones. PubMed, Embase, and Cochrane Library databases were searched. Analyses considered follow-up (12 and 24 months) with BMD as main outcome at three sites (femoral neck, total hip, and lumbar spine) and one for each calciotropic hormone (25 OH vitamin D and parathyroid hormone [PTH]). Estimated effect sizes were calculated as standardized mean differences (SMD), confidence interval of 95%, and P value. Nine studies totaling 473 participants (RYGB = 261 and GS = 212) were included. RYGB resulted in lower BMD than GS at 12 months for femoral neck (SMD = -0.485, 95% CI [-0.768, -0.202], P = .001), lumbar spine (SMD = -0.471, 95% CI [-0.851, -0.092], P = .015), and total hip (SMD = -0.616, 95% CI [-0.972, -0.259], P = .001), and at 24 months for total hip (SMD = -0.572, 95% CI [-0.907, -0.238], P = .001). At 24 months, 25 OH vitamin D was lower in RYGB than GS (SMD = -0.958 [-1.670, -0.245], P = .008) and PTH levels were higher in RYGB than in GS (SMD = 0.968 [0.132, 1.804, P = .023]). RYGB demonstrated significant reduction in regional BMD. It also induces lower serum 25 OH vitamin D and higher PTH levels than GS. The results support the need for preventive bone health measures in the short-term postoperative period, especially in the case of RYGB.
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Densidade Óssea , Derivação Gástrica , Obesidade Mórbida , Hormônio Paratireóideo , Humanos , Densidade Óssea/fisiologia , Gastrectomia/métodos , Derivação Gástrica/efeitos adversos , Gastroplastia/efeitos adversos , Gastroplastia/métodos , Obesidade Mórbida/cirurgia , Obesidade Mórbida/sangue , Hormônio Paratireóideo/sangue , Vitamina D/sangueRESUMO
BACKGROUND: The impact of treatments, suppressing the immune system, persistent hyperparathyroidism, and other risk factors on mineral and bone disorder (MBD) after kidney transplantation is well-known. However, there is limited knowledge about their effect on bone metabolism biomarkers. This study aimed to investigate the influence of kidney transplant on these markers, comparing them to patients undergoing hemodialysis and healthy individuals. METHODS: In this cross-sectional study, three groups were included: kidney transplant patients (n = 57), hemodialysis patients (n = 26), and healthy controls (n = 31). Plasma concentrations of various bone metabolism biomarkers, including Dickkopf-related protein 1, osteoprotegerin, osteocalcin, osteopontin, sclerostin, and fibroblast growth factor 23, were measured. Associations between these biomarkers and clinical and laboratory data were evaluated. RESULTS: A total of 114 patients participated. Transplant recipients had significantly lower levels of Dickkopf-related protein 1, osteoprotegerin, osteocalcin, osteopontin, sclerostin, and fibroblast growth factor 23 compared to hemodialysis patients. Alkaline phosphatase levels positively correlated with osteopontin (r = 0.572, p < 0.001), while fibroblast growth factor 23 negatively correlated with 25-hydroxyvitamin D (r = -0.531, p = 0.019). The panel of bone biomarkers successfully predicted hypercalcemia (area under the curve [AUC] = 0.852, 95% confidence interval [CI] = 0.679-1.000) and dyslipidemia (AUC = 0.811, 95% CI 0.640-0.982) in transplant recipients. CONCLUSION: Kidney transplantation significantly improves mineral and bone disorders associated with end-stage kidney disease by modulating MBD markers and reducing bone metabolism markers, such as Dickkopf-related protein 1, osteoprotegerin, osteocalcin, osteopontin, and sclerostin. Moreover, the panel of bone biomarkers effectively predicted hypercalcemia and dyslipidemia in transplant recipients.
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Biomarcadores , Osso e Ossos , Fator de Crescimento de Fibroblastos 23 , Transplante de Rim , Osteocalcina , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Biomarcadores/sangue , Estudos Transversais , Adulto , Osso e Ossos/metabolismo , Osteocalcina/sangue , Osteoprotegerina/sangue , Diálise Renal , Fatores de Crescimento de Fibroblastos/sangue , Osteopontina/sangue , Peptídeos e Proteínas de Sinalização Intercelular/sangue , Proteínas Adaptadoras de Transdução de SinalRESUMO
INTRODUCTION: X-linked hypophosphatemia is an orphan disease of genetic origin and multisystem involvement. It is characterized by a mutation of the PHEX gene which results in excess FGF23 production, with abnormal renal and intestinal phosphorus metabolism, hypophosphatemia and osteomalacia secondary to chronic renal excretion of phosphate. Clinical manifestations include hypophosphatemic rickets leading to growth abnormalities and osteomalacia, myopathy, bone pain and dental abscesses. The transition of these patients to adult life continues to pose challenges to health systems, medical practitioners, patients and families. For this reason, the aim of this consensus is to provide a set of recommendations to facilitate this process and ensure adequate management and follow-up, as well as the quality of life for patients with X-linked hypophosphatemia as they transition to adult life. MATERIALS AND METHODS: Eight Latin American experts on the subject participated in the consensus and two of them were appointed as coordinators. The consensus work was done in accordance with the nominal group technique in 6 phases: (1) question standardization, (2) definition of the maximum number of choices, (3) production of individual solutions or answers, (4) individual question review, (5) analysis and synthesis of the information and (6) synchronic meetings for clarification and voting. An agreement was determined to exist with 80% votes in favor in three voting cycles. RESULTS AND DISCUSSION: Transition to adult life in patients with hypophosphatemia is a complex process that requires a comprehensive approach, taking into consideration medical interventions and associated care, but also the psychosocial components of adult life and the participation of multiple stakeholders to ensure a successful process. The consensus proposes a total of 33 recommendations based on the evidence and the knowledge and experience of the experts. The goal of the recommendations is to optimize the management of these patients during their transition to adulthood, bearing in mind the need for multidisciplinary management, as well as the most relevant medical and psychosocial factors in the region.
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Raquitismo Hipofosfatêmico Familiar , Hipofosfatemia , Osteomalacia , Adulto , Humanos , Raquitismo Hipofosfatêmico Familiar/genética , Osteomalacia/genética , Osteomalacia/metabolismo , Consenso , Qualidade de Vida , Hipofosfatemia/genética , Hipofosfatemia/metabolismo , Fatores de Crescimento de Fibroblastos/genéticaRESUMO
Patients with systemic mastocytosis (SM) are at high risk of bone deterioration. However, the evaluation of bone microarchitecture in this disease remains unclear. We aimed to assess bone microarchitecture in patients with SM. This was a cross-sectional study of 21 adult patients with SM conducted in a quaternary referral hospital in Sao Paulo, Brazil. A healthy, age-, weight-, and sex-matched cohort of 63 participants was used to provide reference values for bone microarchitecture, assessed by high resolution peripheral quantitative computed tomography (HR-pQCT). Total volumetric bone mineral density (vBMD), cortical vBMD, and cortical thickness at the radius were significantly lower in the control group compared with the SM group (all P < 0.001). Patients with aggressive SM had significantly lower trabecular number (Tb.N) (P = 0.035) and estimated failure load (F.load) (P = 0.032) at the tibia compared with those with indolent SM. Handgrip strength was significantly higher in patients who had more Tb.N at the radius (ρ, 0.46; P = 0.036) and tibia (ρ, 0.49; P = 0.002), and lower who had more trabecular separation at the radius (ρ, -0.46; P = 0.035) and tibia (ρ, -0.52; P = 0.016). Strong and positive associations between F.load (ρ, 0.75; P < 0.001) and stiffness (ρ, 0.70; P < 0.001) at the radius, and between F.load at the tibia (ρ, 0.45; P = 0.038) were observed with handgrip strength. In this cross-sectional study, aggressive SM was more susceptible to bone deterioration compared with indolent SM. In addition, the findings demonstrated that handgrip strength was associated with bone microarchitecture and bone strength.
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Mastocitose Sistêmica , Adulto , Humanos , Estudos Transversais , Força da Mão , Brasil , Osso e Ossos , Densidade Óssea , Rádio (Anatomia)/diagnóstico por imagem , Tíbia , Absorciometria de FótonRESUMO
Collagen is one of the main components of the extracellular matrix of the dermis and articular cartilage and influences the body's mechanical, organizational, and tissue formation properties. Produced from food industry by-products, it is considered a nutraceutical product widely used as an ingredient or supplement in food, pharmaceutical, and cosmetic industries. This study aimed to conduct a literature review on the scientific evidence regarding the beneficial effects of collagen consumption in the treatment of skin and orthopedic diseases. Literature data have shown that hydrolyzed collagen supplementation promotes skin changes, such as decreased wrinkle formation; increased skin elasticity; increased hydration; increased collagen content, density, and synthesis, which are factors closely associated with aging-related skin damage. Regarding orthopedic changes, collagen supplementation increases bone strength, density, and mass; improves joint stiffness/mobility, and functionality; and reduces pain. These aspects are associated with bone loss due to aging and damage caused by strenuous physical activity. Thus, this review addresses the economic and health potential of this source of amino acids and bioactive peptides extracted from food industry by-products.
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Osteoporosis (OP) is the most common bone disease affecting elderly individuals. The diagnosis of this pathology is most commonly made on the basis of bone fractures. Several microRNAs (miRNAs/miRs) have been identified as possible biomarkers for the diagnosis and treatment of OP. miRNAs can regulate gene expression, and determining their functions can provide potential pharmacological targets for treating OP. A previous study showed that miR-1270 was upregulated in monocytes derived from postmenopausal women with OP. Therefore, the present study aimed to uncover the role of miR-1270 in regulating bone metabolism. To reveal the mechanism underlying the regulatory effect of miR-1270 on interferon regulatory factor 8 (IRF8) expression, luciferase assay, reverse transcription-quantitative PCR, and Western blot analysis were performed. The results suggest that miR-1270 could regulate the mRNA and protein expression levels of IRF8 by directly binding to its 3'-untranslated region. The effects of miR-1270 overexpression and IRF8 silencing on cell proliferation, migration, and invasion were also evaluated. To the best of our knowledge, the current study was the first to support the crucial role of miR-1270 in bone metabolism via modulation of IRF8 expression. In addition, miR-1270 overexpression could attenuate human osteoblast-like cells' proliferation and migration ability.
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Background: The present study analyzed the acute responses of parathyroid hormone (PTH) and bone-specific alkaline phosphatase (BSAP) to the low-intensity resistance exercise with blood flow restriction using different occlusion pressures. Methods: Twelve women completed the three protocols of this crossover study: resistance exercise without blood flow restriction (RE), resistance exercise with blood flow restriction and occlusion pressure corresponding to 70% of systolic blood pressure (RE + BFR70), and resistance exercise with blood flow restriction and occlusion pressure corresponding 130% of systolic blood pressure (RE + BFR130). All exercises were performed in a guided squat apparatus with load corresponded to 30% of one-repetition maximum test. Results: Relative to resting levels, PTH concentrations decreased significantly (p = .000) post-exercise in all groups and increased significantly (p = .000) 15 min post-exercise in RE + BFR70 and RE + BFR130 groups; PTH concentrations returned to resting levels after the 30-min recovery period in all groups. There was no significant difference (p >.05) between BSAP values at rest and 30 min post-exercise. Conclusion: In conclusion, our results showed that protocols with blood flow restriction using occlusion pressures equivalent to 70% and 130% of systolic blood pressure were more effective than RE alone to induce PTH peaks, and to promote a metabolic condition favorable to bone anabolism.
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OBJECTIVE: To assess the condylar bone metabolic activity in patients with temporomandibular joint health by measuring 99m Tc-MDP uptake using a single-photon emission computed tomography (SPECT) to establish reference values of the uptake difference between condyles and the ratio with respect to the clivus. SETTING AND SAMPLE POPULATION: Eighty consecutive patients of both sexes who were admitted to a Nuclear Medicine Centre between 2017 and 2019 were included in the study. METHOD: This was an observational cross-sectional study in patients with SPECT indications to evaluate pathologies other than those of the temporomandibular joint. The values of the total and normalized counts in a fixed region of interest of five trans-axial slides were obtained to assess the percentage difference between the sides and the uptake ratio. The reference values are expressed as median and 5th and 95th percentiles. RESULTS: The sample included 53 women (66.25%) and 27 men (33.75%) aged 15-55 years. The percentage of uptake difference between condyles was 5.04% (0.46-14.78) for men and 5.17% (0.27-13.21) for women (difference not significant, P = .9). The uptake difference was below 10% in 85% of the subjects (n = 68). The ratio values for total counts in women (0.87, 0.46-1.33) were significantly different (P = .0030) from those in men (1.08, 0.61-2.09). No significant correlation with age was found. CONCLUSIONS: These new reference ranges are applicable to the diagnosis of unilateral and bilateral condylar hyperplasia.
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Côndilo Mandibular , Medronato de Tecnécio Tc 99m , Estudos Transversais , Feminino , Humanos , Masculino , Côndilo Mandibular/diagnóstico por imagem , Valores de Referência , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
Periodontal disease (PD) is a prevalent inflammatory disease with the most severe consequence being the loss of the alveolar bone and teeth. We therefore aimed to evaluate the effects of telmisartan (TELM), an angiotensin II type 1 receptor (Agtr1) antagonist, on the PD-induced alveolar bone loss, in Wistar (W) and Spontaneous Hypertensive Rats (SHRs). PD was induced by ligating the lower first molars with silk, and 10 mg/kg TELM was concomitantly administered for 15 days. The hemimandibles were subjected to microtomography, ELISA was used for detecting tumor necrosis factor (TNF-α), interleukin-1ß (IL-1ß), interleukin-6 (IL-6), CXCL3, and CCL2, while qRT-PCR was used for analyzing expression of components of renin-angiotensin system (RAS) (Agt, Ace, Agt1r, Agt2r, Ace2, and Masr), and bone markers (Runx2, Osx, Catnb, Alp, Col1a1, Opn, Ocn, Bsp, Bmp2, Trap, Rank, Rankl, CtsK, Mmp-2, Mmp-9, and osteoclast-associated receptor (Oscar)). The SHR + PD group showed greater alveolar bone loss than the W + PD group, what was significantly inhibited by treatment with TELM, especially in the SHR group. Additionally, TELM reduced the production of TNF-α, IL-1ß, and CXCL3 in the SHR group. The expression of Agt increased in the groups with PD, while Agtr2 reduced, and TELM reduced the expression of Agtr1 and increased the expression of Agtr2, in W and SHRs. PD did not induce major changes in the expression of bone formation markers, except for the expression of Alp, which decreased in the PD groups. The bone resorption markers expression, Mmp9, Ctsk, and Vtn, was higher in the SHR + PD group, compared to the respective control and W + PD group. However, TELM attenuated these changes and increased the expression of Runx2 and Alp. Our study suggested that TELM has a protective effect on the progression of PD, especially in hypertensive animals, as evaluated by the resorption of the lower alveolar bone. This can be partly explained by the modulation in the expression of Angiotensin II receptors (AT1R and AT2R), reduced production of inflammatory mediators, the reduced expression of resorption markers, and the increased expression of the bone formation markers.
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In diabetes, metabolic, inflammatory, and stress-associated alterations conduce to ß-cell failure and tissue damage. Osteocalcin is a bone protein with several endocrine functions in different tissues. In this review, we gathered scientific evidence of how osteocalcin could modulate functional disorders that are altered in diabetes in an integrative way. We include adipose tissue, pancreatic function, and oxidative stress aspects. In the first section, we focus on the role of inflammatory mediators and adiponectin in energy homeostasis and insulin sensitivity. In the following section, we discuss the effect of osteocalcin in metabolic and pancreatic function and its association in insulin signaling and in ß-cell proliferation. Finally, we focus on osteocalcin action in oxidative and endoplasmic reticulum stress, and in antioxidant regulation, since ß-cells are well known by its vulnerability to stress damage. These evidences support the notion that osteocalcin could have an important role in diabetes treatment.
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Diabetes Mellitus/metabolismo , Osteocalcina/metabolismo , Substâncias Protetoras/metabolismo , Tecido Adiposo/patologia , Animais , Homeostase , Humanos , Estresse OxidativoRESUMO
We aimed to evaluate the impact of non-surgical periodontal treatment on the salivary expression of leptin, TNF-α, sclerostin, parathyroid hormone, osteoprotegerin, osteopontin, osteocalcin, IL-6, IL-1ß and fibroblast growth factor 23 in patients with chronic periodontitis after 1 year of follow-up. Fifteen patients with chronic periodontitis (56.0 ± SD 9.6 years) and 15 subjects with gingivitis (39.7 ± SD 4.4 years) were included in the study. Clinical periodontal parameters, such as probing pocket depth (PPD), clinical attachment level (CAL), % of plaque and bleeding on probing (BOP) were evaluated, and non-stimulated whole saliva was collected from all patients before periodontal treatment and after 1 year of follow-up. A bead-based multiplex assay measured cytokines. In the chronic periodontitis group, periodontal treatment significantly improved clinical parameters and reduced the salivary levels of IL-1ß, leptin and TNF-α (p = 0.002, 0.007 and 0.015, respectively). In the gingivitis group, there were also significant improvements in the mean patient %BOP, % Plaque, CAL and PPD. However, there were no significant changes in the cytokine's salivary levels. In conclusion, chronic periodontitis patients showed a significant reduction in the salivary levels of leptin, TNF-α and IL-1ß 1 year after periodontal treatment and a significant improvement in their clinical periodontal parameters suggesting that periodontal treatment alone can downregulate important cytokines associated with bone metabolism.
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Periodontite Crônica , Gengivite , Citocinas , Humanos , Perda da Inserção Periodontal , Índice Periodontal , SalivaRESUMO
[This corrects the article DOI: 10.3389/fphar.2020.579926.].
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Os receptores ativados por proliferadores de peroxissoma de isoforma gama (PPARgama) são fatores de transcrição que se encontram no entrelaçamento de várias vias metabólicas e determinam a gênese da obesidade e doenças associadas. Estudos recentes têm relatado o potencial dos medicamentos agonistas PPARs, usados no tratamento de doenças cardiovasculares e diabetes tipo 2, de afetar a função das células ósseas e o risco de fratura. O objetivo deste estudo foi avaliar os efeitos da ativação do PPAR-gama no processo de reparo ósseo e osseointegração de implantes dentários. Foram utilizados 42 ratos Wistar alimentados com ração sólida padrão para roedores e água "ad Libitum". A administração do agonista PPAR-gama(durante 4 semanas) foi realizada incorporada à dieta perfazendo dois grupos experimentais: Grupo Controle (SC) e Grupo PPAR-gama (SC-gama). Os animais, em seguida, foram submetidos a procedimento cirúrgico para instalação de implantes dentários e confecção de defeitos ósseos nas tíbias direita e esquerda, respectivamente. Após períodos de 7, 15 e 45 dias os animais foram eutanasiados e as tíbias removidas seguiram para processamento e posterior análise histológica descritiva e histomorfometria. Em relação aos defeitos, no aspecto histológico descritivo, em todos os períodos analisados, há atraso no reparo ósseo do grupo SC-gama em relação ao SC. A histomorfometria apresenta diferença comparando os grupos teste e controle nos parâmetros ossoneoformado (ON) em 7 dias (P=0,0374) e 15 dias (P=0,0134) e osso maduro (OM) em 15 dias (P=0,0009). Em 45 dias, os valores tanto de OM quanto de ON não apresentam significância. Já as tíbias onde o implante foi instalado, nas áreas de roscas os dois grupos apresentam-se muito semelhantes tanto aos eventos celulares quanto à maturação óssea exceto no período de 15 dias onde o grupo teste apresentou atraso no reparo peri-implantar. Conclui-se que, em relação ao reparo ósseo o processo de diferenciação e remodelação é lento no grupo tratado; e em relação ao reparo peri-implantar o comportamento biológico demonstra atraso do grupo tratado apenas no período intermediário(AU)
The peroxisome proliferator-activated receptor-gamma isoform (PPARgamma) are transcription factors found in the interlacing of several metabolic pathways that determine the genesis of obesity and associated diseases. Recent studies have reported the potential of PPAR agonist drugs, used to treat cardiovascular disease and type 2 diabetes, to affect bone cell function and fracture risk. This study aimed to evaluate the effects of PPAR-gamma activation on the process of bone repair and osseointegration of dental implants. Thirty-six Wistar rats received standard rodent solid chow and "ad Libitum" water. The administration of the PPAR-gamma agonist (during four weeks) was performed incorporated into the diet, making two experimental groups: Control Group (SC) and PPAR gamma Group (SC-gama). The animals were then submitted to a surgical procedure to install dental implants and make bone defects in the right and left tibias, respectively. After periods of 7, 15, and 45 days the animals were euthanized, the tibiae were removed for histological protocols and subsequent descriptive histological analysis and histomorphometry. Concerning the defects, the descriptive histological aspect revealed a slight delay in bone repair in the SC-gamma group in comparison with the SC for all parameters. Conversely, the histomorphometry showed difference between the groups regarding neoformed bone (NB) in 7 days (P = 0.0374) and 15 days (P = 0.0134) and mature bone (MB) in 15 days (P = 0.0009). At 45 days, there were no differences between the groups regarding MB and NB. As for tibiae, where the implant was placed, the two groups were similar to both cellular events and bone maturation in the areas of threads, except at 15 days where the test group showed delay in peri-implant repair. In conclusion, regarding the bone defect, the process of differentiation and remodeling is slow in the treated group. Regarding the implant, a descriptive histological analysis showed biological behavior delay in the treated group only in the intermediate period(AU)
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Animais , Ratos , Regeneração Óssea , Implantes Dentários , Osseointegração , PPAR gama , Células , Agonistas PPAR-gama , ObesidadeRESUMO
Ao tratar pacientes em crescimento, especialmente os portadores de más-oclusões esqueléticas de classes II e III, onde espera-se redirecioná-lo, é fundamental a determinação do estágio de crescimento do indivíduo. Para tal, existem diversas técnicas, como as radiográficas e as enzimáticas. O objetivo deste estudo determinar a fase de crescimento através dos níveis e da correlação dos valores de um biomarcador ósseo (fosfatase alcalina óssea) e duas técnicas radiográfica. Foram selecionados 65 pacientes de ambos os sexos, com idade média de 12,7 anos, em busca de tratamento ortodôntico nos setores de Ortodontia e Odontopediatria da Universidade do Estado do Rio de Janeiro e que se enquadraram nos critérios de inclusão/exclusão. Os indicadores de crescimento ósseo radiográficos escolhidos foram os estágios de maturação das vértebras cervicais, avaliados através da radiografia cefalométrica lateral, e os da maturação da falange média do terceiro dedo, obtida em exame da área de interesse, na mão direita. Após a obtenção e o devido processamento das radiografias, estas foram avaliadas por dois avaliadores previamente calibrados, utilizando os métodos de Bacetti e Perinetti para as radiografias cefalométrica e do terceiro dedo, respectivamente. O índice de concordância kappa demonstrou boa reprodutibilidade intra e inter-examinadores. Na avaliação intra-examinador, o resultado de kappa foi de 0,711 para a maturação vertebral e 0,893 para a maturação da falange. Quanto a correlação inter-examinador, a avaliação da maturação da falange média, o valor de kappa ponderado foi de 0,923 enquanto para o da maturação das vértebras cervicais foi de 0,864. O terceiro indicador de crescimento avaliado neste trabalho foi a quantificação da fosfatase alcalina óssea na saliva. A coleta da saliva foi realizada entre 9 e 11 horas da manhã, sem estímulo químico ou mecânico. O processamento da saliva foi feito através de um ensaio de imunoabsorção enzimática, com posterior determinação da densidade óptica através de um espectrofotômetro. Os valores obtidos neste ensaio foram então correlacionados aos estágios de crescimento pré-pico, pico e pós-pico de crescimento puberal, determinados por ambas as radiografias. Após a aplicação do teste ANOVA, não foi encontrada diferença estatisticamente significativa entre os estágios de crescimento puberal. Como não houve variação dos níveis da fosfatase alcalina entre os diferentes estágios maturacionais, pode-se inferir que a avaliação desta enzima na saliva pode não ser um indicador confiável do crescimento ósseo. A quantificação desta enzima pode ser avaliada em outros fluidos corpóreos, como sangue ou fluido gengival(AU)
When treating growing patients, especially those who have a skeletal class II or III condition, where the willing is to redirect growth, it is indispensable to determine the individual's growing stage. For this determination, there are different methods, radiographic or enzymatic. The aim of this study was to assess the levels of a bone biomarker (bone-alkaline phosphatase) and its correlation to two different radiographic techniques. Sixty-five patients of both sex and mean age of 12.7 years old looking for treatment at Orthodontics and Pediatric Dentistry sectors in the State University of Rio de Janeiro were selected for filling the inclusion/exclusion criteria. The radiographic growing indicators chosen for this study were the maturational stages of cervical vertebrae (CVM), assessed in lateral cephalometric radiograph, and maturational stages of the middle phalanx of the third finger (MP3), acquired in a radiograph taken from the interested area on the right hand. After obtaining and processing the X-rays, those were assessed by two calibrated examiners. They have used the methods proposed by Baccetti and Perinetti to assess lateral and third finger X-rays, respectively. The Cohen's kappa index of agreement showed a good reproducibility intra and inter-examiner. The intra-observer rater, the result was a kappa of 0,711 to cervical vertebrae maturation and 0,893 to third finger middle phalanx maturation. Inter-observer weighted and unweighted kappa values were 0.864 and 0.693 for and 0.923 and 0.868, respectively, for MP3 method. The third maturational growth indicator analyzed in this study was the quantification of salivary bone-alkaline phosphatase, a biomarker of bone metabolism. The patients were asked to expel unstimulated whole saliva between nine and eleven in the morning. Those samples were collected and stored according to the orientations of the analysis kit. Saliva were processed through an immunosorbent assay, with posterior determination of optical density by spectrophotometry. The resulting values of this assay were then correlated to the three stages of pubertal growth: pre-, pubertal and post-pubertal. An ANOVA test was used to correlate that information and as a result, it was not found a statistically significant correlation between bone alkaline phosphatase levels and maturational stages. As no difference was found, quantification of this enzyme in saliva may not be a reliable maturational growth indicator. The assessment of bone alkaline phosphatase should be done in other body fluids, as blood serum or gingival fluid(AU)
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Humanos , Masculino , Feminino , Criança , Adolescente , Osso e Ossos/metabolismo , Desenvolvimento Ósseo , Desenvolvimento Maxilofacial , Saliva , Radiografia Dentária , Estudos Transversais , Fosfatase AlcalinaRESUMO
Obesity negatively affects the relationship between markers and micronutrients of bone metabolism. Testing the hypothesis that the metabolically healthy obese phenotype might be protected by those alterations was the aim of this study. A cross-sectional study was carried out in adults with class III obesity classified in Metabolically Healthy Obese (MHO) and Metabolically Unhealthy Obese (MUHO), according to the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP ATP III) criteria. Anthropometric, biochemical, and clinical variables were analyzed for sample characterization. To evaluate bone metabolism, markers (alkaline phosphatase and parathyroid hormone-PTH) and related nutrients (vitamin D, vitamin B12, calcium, phosphorus, magnesium, potassium and zinc) were analyzed. A total of 223 adults with class III obesity aged 41.20 ± 10.15 years were included. The MHO phenotype was identified in 32.73% of the sample. After logistic regression, it was observed that inadequacies of calcium (OR: 4.11; 95% CI: 2.33-6.66), phosphorus (OR: 3.03; 95% CI: 1.98-5.79), vitamin D (OR: 5.01; 95% CI: 2.92-6.71) and PTH (OR: 5.45; 95% CI: 4.49-6.74) were significantly higher in the MUHO group compared to the MHO Group. This study showed that the MHO phenotype does not protect adults from alterations in markers and micronutrients of bone metabolism. However, the MUHO phenotype presents a higher risk for alterations related to bone metabolism, which can favor the emergence of metabolic bone diseases.
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Fosfatase Alcalina/sangue , Remodelação Óssea , Micronutrientes/sangue , Obesidade Metabolicamente Benigna/sangue , Hormônio Paratireóideo/sangue , Adulto , Antropometria , Biomarcadores/sangue , Cálcio/sangue , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade Metabolicamente Benigna/fisiopatologia , Fenótipo , Fósforo/sangue , Vitamina D/sangueRESUMO
Giant South American turtles (Podocnemis expansa) are at a risk of extinction because of the rapid decline in their population over the last few decades. Metabolic bone disease (MBD) is common in captive testudines, but is often not diagnosed until a later stage. The authors present the cases of four captive giant South American turtles with carapace deformity secondary to MBD that underwent computed tomography (CT) scans of the carapace bones and vertebral column. Findings indicative of changes in geometry were found in both. The cancellous bone pattern was characterized by varying degrees of increased trabecular spacing and cortical thinning of the pleural bones. Bone densitometry analysis of the pleural and neural bones and at the level of the body of the third, fourth, and fifth dorsal vertebrae showed mean density values much lower than those found in two adult specimens of the same species that were considered healthy. In conclusion, CT contributed important information on the degree of demineralization and possible structural changes due to MBD and should be considered a relevant tool for diagnosis of this condition.
Assuntos
Densidade Óssea/fisiologia , Doenças Ósseas Metabólicas/veterinária , Tomografia Computadorizada por Raios X/veterinária , Tartarugas , Animais , Doenças Ósseas Metabólicas/diagnóstico por imagem , Doenças Ósseas Metabólicas/patologia , Feminino , MasculinoRESUMO
Resumen Introducción: la hiperfosfatemia es una complicación común de la enfermedad renal crónica (ERC) y empeora progresivamente a medida que disminuye la función renal. Actualmente disponemos de diversas moléculas farmacéuticas para su tratamiento. Dentro de ellas, existen quelantes que contienen hierro, como es el caso del oxihidróxido sucroférrico. Su uso se ha extendido fundamentalmente entre pacientes en hemodiálisis, en sustitución de otros quelantes. Objetivo: describir la tolerabilidad, la aparición de efectos secundarios, la adherencia terapéutica y las cifras de fósforo sérico en pacientes en tratamiento con oxihidróxido sucroférrico en nuestro centro. Materiales y métodos: se analizaron 5 pacientes de la unidad de hemodiálisis del Servicio de Nefrologia del Hospital Universitario de Burgos, España, en el periodo comprendido entre enero de 2017 a mayo de 2018, todos ellos en tratamiento con oxihidróxido sucroférrico. Se evaluaron las concentraciones plasmáticas de fósforo, calcio y hormona paratiroidea durante el tratamiento con oxihidróxido sucroférrico, además de los efectos secundarios y las causas de abandono. El análisis de los datos se realizó mediante el software estadístico IBM SPSS 22 con un intervalo de confianza del 95 %. Se evaluaron las posibles diferencias con el análisis de la t-Student. Resultados: se evidenció una reducción media del 12,27 % de la hiperfosforemia y una reducción en el número de comprimidos diarios del 15,79 %, con buena tolerancia del fármaco en todos los casos. No se evidenció reducción estadísticamente significativa en los niveles plasmáticos de calcio, ni de hormona paratiroidea (PTH). Conclusiones: el oxihidróxido sucroférrico es un fármaco bien tolerado, que generó una disminución de los niveles séricos de fósforo en la población estudiada. Sin embargo, dado el bajo número de casos analizados, no es posible recomendar el uso terapéutico de este fármaco como primera línea de tratamiento de la hiperfosforemia.
Abstract Introduction: Hyperphosphatemia is a common complication of CKD and progressively worsens as renal function decreases. Currently we have several pharmaceutical molecules for its treatment. Among them, there are chelators that contain iron, as is the case of sucroferric oxyhydroxide. Its use has been extended mainly among those on hemodialysis, replacing other chelators. Objective: Describe the tolerability, the appearance of side effects, therapeutic adherence and serum phosphorus levels in patients undergoing treatment with sucroferric oxyhydroxide in our center. Materials and methods: Five patients were analyzed from the hemodialysis unit of the Nephrology Service of the University Hospital of Burgos, from January 2017 to May 2018, all of them under treatment with sucroferric oxyhydroxide. Plasma concentrations of phosphorus, calcium and parathyroid hormone were evaluated during treatment with sucroferric oxyhydroxide, in addition to side effects and causes of abandonment. For the analysis of the data, they were processed using the IBM SPSS 22 statistical software with a confidence interval of 95%. Possible differences were evaluated with the t-Student analysis. Results: There was an average reduction of 12.27% in hyperphosphataemia and a reduction in the number of daily tablets of 15.79%, with good tolerance of the drug in all cases. There was no statistically significant reduction in plasma levels of calcium or parathyroid hormone (PTH). Conclusions: Sucroferric oxyhydroxide is a well-tolerated drug, which generated a decrease in serum phosphorus levels in the population studied. However, given the low number of cases analyzed, it is not possible to recommend the therapeutic use of this drug as the first line of treatment for hyperphosphatemia.
Assuntos
Humanos , Masculino , Feminino , Distúrbio Mineral e Ósseo na Doença Renal Crônica , Evolução Clínica , Diálise Renal , Espanha , Terapêutica , QuelantesRESUMO
OBJECTIVE: To compare the bone metabolism of adolescents and adults with obesity before undergoing a Roux-en-Y gastric bypass (RYGB) and 6 and 12 months after the surgery. MATERIALS AND METHODS: Adolescents (G1) and adults (G2) with obesity assessed before (T0), six (T1), and 12 months after (T2) RYGB. Sun exposure, serum concentrations of 25(OH)D, calcium, phosphorous, magnesium, zinc, alkaline phosphatase, parathyroid hormone (PTH), and bone mineral density (BMD) were evaluated. RESULTS: Sixty adolescents and 60 adults were assessed. At T0, there was no significant difference between the groups' serum 25(OH)D levels (G1 21.87 + 7.52 ng/mL, G2 21.73 + 7.60 ng/mL, p = 0.94) or sun exposure (G1 17 ± 2.0 min/day, G2 13.2 ± 5.2 min/day, p = 0.85). G1 had high levels of inadequacy of calcium (66.7%), phosphorous (80.0%), and zinc (18.3%) at T0 and had a significant fall in their 25(OH)D (p < 0.01) and magnesium (p < 0.01) levels from T1 to T2. G2 saw a significant lowering of their serum zinc levels from T0 to T1 and T2 (T1 p < 0.01; T2 p < 0.01). In both groups, there was a significant rise in PTH from T1 to T2 (G1 p = 0.04, G2 p = 0.02) and from T0 to T2 (G1 and G2 p < 0.01). In G2, 40.4% of individuals with osteopenia and osteoporosis presented inadequacy of 25(OH)D. CONCLUSION: RYGB was found to worsen the inadequacy of micronutrients related to bone metabolism and was associated with secondary hyperparathyroidism and low BMD values, especially among the adolescents. The irreversible damaging effects of obesity on bone metabolism can occur in adolescence.
Assuntos
Osso e Ossos/metabolismo , Derivação Gástrica , Obesidade Mórbida/cirurgia , Obesidade Infantil/cirurgia , Adolescente , Adulto , Fatores Etários , Fosfatase Alcalina/sangue , Densidade Óssea/fisiologia , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/etiologia , Doenças Ósseas Metabólicas/metabolismo , Cálcio/sangue , Feminino , Seguimentos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Humanos , Hiperparatireoidismo Secundário/epidemiologia , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/metabolismo , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/metabolismo , Hormônio Paratireóideo/sangue , Obesidade Infantil/epidemiologia , Obesidade Infantil/metabolismo , Adulto JovemRESUMO
Anthropomorphic measures among type 1 diabetic patients are changing as the obesity epidemic continues. Excess fat mass may impact bone density and ultimately fracture risk. We studied the interaction between bone and adipose tissue in type 1 diabetes subjects submitted to two different clinical managements: (I) conventional insulin therapy or (II) autologous nonmyeloablative hematopoietic stem-cell transplantation (AHST). The study comprised 3 groups matched by age, gender, height and weight: control (C = 24), type 1 diabetes (T1D = 23) and type 1 diabetes treated with AHST (T1D-AHST = 9). Bone mineral density (BMD) and trabecular bone score (TBS) were assessed by dual X-ray absorptiometry (DXA). 1H Magnetic resonance spectroscopy was used to assess bone marrow adipose tissue (BMAT) in the L3 vertebra, and abdominal magnetic resonance imaging was used to assess intrahepatic lipids (IHL), visceral (VAT) and subcutaneous adipose tissue (SAT). Individuals conventionally treated for T1D were more likely to be overweight (C = 23.8 ± 3.7; T1D = 25.3 ± 3.4; T1D-AHST = 22.5 ± 2.2 Kg/m2; p > 0.05), but there was no excessive lipid accumulation in VAT or liver. Areal BMD of the three groups were similar at all sites; lumbar spine TBS (L3) was lower in type 1 diabetes (p < 0.05). Neither SAT nor VAT had any association with bone parameters. Bone marrow adipose tissue (BMAT) lipid profiles were similar among groups. BMAT saturated lipids were associated with cholesterol, whereas unsaturated lipids had an association with IGF1. Overweight and normal weight subjects with type 1 diabetes have normal areal bone density, but lower trabecular bone scores. Adipose distribution is normal and BMAT volume is similar to controls, irrespective of clinical treatment.