Full length parathyroid hormone (1–84) in the treatment of osteoporosis in postmenopausal women

Esteban Jódar-GimenoEndocrinology and Metabolism Service, University Hospital “12 de Octubre”, Madrid, Spain. Associate Professor of Medicine Universidad Complutense, Madrid, SpainObjective: To review the pharmacological properties and the available clinical data of full length parathyroid hormone (PTH) in post-menopausal osteoporosis.Sources: A MEDLINE search was completed, together with a review of information obtained from the manufacturer and from the medicine regulatory agencies.Study and data selection: Studies were selected according to relevance and availability. Relevant information (design, objectives, patients’ characteristics, outcomes, adverse events, dosing, etc) was analyzed.Results: Different studies have shown that, when administered intermittently as a subcutaneous injection in the abdomen, PTH increases bone mineral density (BMD) and prevents vertebral fractures. On completion of PTH therapy (up to 24 months), there is evidence that sequential treatment with alendronate is associated with a therapeutic benefit in terms of increase in BMD. Further trials are necessary to determine long-term safety and the role of PTH in combination with other treatments for osteoporosis and the effect of repeated cycles of PTH followed by an anti-catabolic agent. There are currently no completed comparative trials with other osteoporosis treatments.Conclusions: Full length PTH, given intermittently as an abdominal subcutaneous injection, appears to be a safe and efficacious treatment option for high risk osteoporosis. More data are needed to determine its specific role in osteoporosis treatment.Keywords: postmenopausal osteoporosis, anabolic therapy, PTH (1–84

Valoración de la capacidad predictiva de la calculadora Garvan del riesgo de fractura a 10 años en una población española

Introduction: Several calculation tools or scales have been developed in recent years to assess the risk of fracture due to long-term fragility. The Garvan calculator has not been validated in the Spanish population. This study aims to observe their predictive capacity in a population sample of the Canary Islands and, therefore, of the Spanish population. Material and Methods: We included 121 patients who were followed up for 10 years in our consultations. All were assessed the risk of fracture using the Garvan calculator and based on the data obtained in the first visit. Results: Of the 121 patients, 30 suffered at least one osteoporotic fracture over the 10-year follow-up period. The group of patients with fractures had on the Garvan scale an average risk value to suffer any fracturing fracture of 27%, compared to 13% of those who did not suffer fracture (p<0.001). The area under the corresponding ROC curve was 0.718 (CI-95% = 0.613 ; 0.824). Based on this, the estimated optimal cut-off point to consider a high risk fracture was 18.5%. This value corresponded to a sensitivity of 0.67 (CI-95% = 0.47 ; 0.83) and a specificity of 0.67 (CI-95% = 0.56 ; 0.77). Conclusions: Our results show that the Garvan scale adequately predicts the risk of 10-year osteoporotic fracture in our population. A value lower than 18.5% would allow us to establish a low fracture risk and could be used as a screening tool.Introducción: En los últimos años se han desarrollado varias herramientas de cálculo o escalas para valorar el riesgo de fractura por fragilidad a largo plazo. La calculadora Garvan no ha sido validada en la población española. El objetivo de este estudio fue observar su capacidad predictiva en una muestra de la población canaria y, por tanto, de la española. Material y métodos: Se incluyó a 121 pacientes a los que se les realizó un seguimiento de 10 años en nuestras consultas. A todos se les valoró el riesgo de fractura usando la calculadora Garvan y basándonos en los datos obtenidos en la primera visita realizada. Resultados: De los 121 pacientes, 30 sufrieron al menos una fractura osteoporótica a lo largo de los 10 años de seguimiento. El grupo de pacientes fracturados tenían en la escala Garvan un valor medio de riesgo de sufrir cualquier fractura por fragilidad de 27%, frente al 13% de aquellos que no sufrieron fractura (p<0,001). El área bajo la correspondiente curva ROC fue de 0,718 (IC-95% = 0,613 ; 0,824). En base a ella, se estimó que el punto de corte óptimo para considerar un alto riesgo de fractura por fragilidad fue 18,5%. A este valor le correspondió una sensibilidad de 0,67 (IC-95% = 0,47 ; 0,83) y una especificidad de 0,67 (IC-95% = 0,56 ; 0,77). Conclusiones: Nuestros resultados muestran que la escala Garvan predice adecuadamente el riesgo de fractura osteoporótica a 10 años en nuestra población. Un valor inferior a 18,5% permitiría establecer un riesgo de fractura bajo, pudiendo ser utilizada como herramienta de cribado

Comprehensive approach to people with type 2 diabetes. Diabetes Knowledge Area of the Spanish Society of Endocrinology and Nutrition

[ES] Objetivo: Proporcionar recomendaciones prácticas para el abordaje integral de las personas con diabetes tipo 2 según la medicina basada en la evidencia. Participantes: Miembros del Área de Conocimiento de Diabetes de la Sociedad Española de Endocrinología y Nutrición. Métodos: Las recomendaciones se formularon según los grados de evidencia de los Standards of Medical Care in Diabetes—2022. Tras la revisión de la evidencia disponible y la formulación de recomendaciones por los autores de cada apartado, se desarrollaron varias rondas de comentarios con incorporación de las aportaciones y votación de los puntos controvertidos. Por último, el documento final se remitió al resto de los miembros del área para revisión e incorporación de aportaciones, para, finalmente, realizar el mismo proceso con los miembros de la Junta Directiva de la Sociedad Española de Endocrinología y Nutrición. Conclusiones: El documento establece unas recomendaciones prácticas basadas en la última evidencia disponible para el manejo de las personas con diabetes tipo 2.[EN] Objective. To provide practical recommendations for the comprehensive approach of people with type 2 diabetes according to evidence-based medicine. Participants. Members of the Diabetes Knowledge Area of the Spanish Society of Endocrinology and Nutrition. Methods. The recommendations were formulated according to the degrees of evidence of the Standards of Medical Care in Diabetes—2022. After reviewing the available evidence and formulating recommendations by the authors of each section, several rounds of comments were developed incorporating the contributions and voting on controversial points. Finally, the final document was sent to the rest of the members of the area for review and incorporation of contributions, to finally carry out the same process with the members of the Spanish Society of Endocrinology and Nutrition Board of Directors. Conclusions. The document establishes practical recommendations based on the latest available evidence for the management of people with type 2 diabetes.Peer reviewe

Diabetes and bone: An unexpected but intense relationship

Sin financiación0.121 SJR (2017) Q4, 197/232 Endocrinology, Diabetes and MetabolismUE

Hypertension and vascular risk: editorial for «Control of the major cardiovascular risk factors for ischemic cardiopathy in secondary prevention in Aragon: COCINA study». Impact of diabetes mellitus and its metabolic control with regards to cardiovascular risk

En este número de Hipertensión y riesgo vascular se publican los resultados del estudio COCINA, que estudió el grado de control de los diferentes factores de riesgo cardiovascular (FRCV) en la población aragonesa en prevención secundaria de enfermedad coronaria arterial isquémica1. Es bien conocido el impacto beneficioso del control estricto de estos factores de riesgo en sujetos en prevención secundaria; no obstante, su grado de control en general es claramente mejorable, como pone de manifiesto el artículo que comentamos, en este caso, en la comunidad de Aragón, en la que apenas un 17% de los sujetos tienen sus FRCV modificables farmacológicamente controlados. Es especialmente relevante que el sobrepeso, la presión arterial y el control de la dislipidemia son, junto a la diabetes, los factores peor controlados.Sin financiación0.104 SJR (2016) Q4, 324/344 Cardiology and Cardiovascular Medicine, 119/126 Internal MedicineUE

Secondary osteoporosis

Las osteoporosis secundarias se deben a diversas causas relacionadas con enfermedades, medicaciones y hábitos que reducen la masa ósea y aumentan el riesgo de fractura osteoporótica con independencia de la edad y del déficit estrogénico. Están presentes en una de cada cinco de las mujeres diagnosticadas de osteoporosis y hasta en la mitad de los varones con fracturas osteoporóticas. Una importante cantidad de enfermedades endocrinológicas, digestivas, hematológicas, reumatológicas, infecciosas y tumorales, así como el uso de múltiples fármacos, se ha asociado a pérdida de masa ósea y a un riesgo incrementado de fractura. En la presente actualización se revisan sus causas, fisiopatología, evaluación y tratamiento recomendado.0.103 SJR (2014) Q4, 1647/1811 Medicine (miscellaneous)UE

Characteristics and types of GLP-1 receptor agonists. An opportunity for individualized therapy

El péptido similar al glucagón-1 (GLP-1) es secretado por células L entero-endocrinas tras la ingestión oral de nutrientes y potencia la secreción de insulina estimulada por glucosa mientras suprime la secreción de glucagón. Además, retrasa el vaciamiento gástrico –reduciendo la hiperglucemia posprandial–, reduce el peso corporal, la presión arterial sistólica y tiene otros beneficios tanto en el sistema nervioso central como en el cardiovascular. Desde la década de 1990 se conoce su efecto hipoglucemiante en la diabetes mellitus tipo 2 (DM2), aunque precisa de infusión subcutánea continua por su corta vida media por efecto de la enzima dipeptidil-peptidasa 4 (DPP-4). Además de los inhibidores de la DPP-4 que elevan pseudofisiológicamente el GLP-1 endógeno, se han desarrollado diversos agonistas del receptor de GLP-1 de acción corta, larga y prolongada con diferencias estructurales, farmacodinámicas y clínicas que pueden administrarse en diferentes combinaciones terapéuticas. Estas diferencias pueden permitir individualizar el tratamiento en la DM2.1.417 JCR (2014) Q2, 70/153 medicine, general & internalUE

Vitamina D y enfermedades endocrinas

Sin financiación0.121 SJR (2017) Q4, 197/232 Endocrinology, Diabetes and MetabolismUE

Once-Weekly Semaglutide Reduces HbA 1c and Body Weight in Patients with Type 2 Diabetes Regardless of Background Common OAD: a Subgroup Analysis from SUSTAIN 2-4 and 10

Introduction: Despite treatment with oral antidiabetic drugs (OADs), achieving effective glycaemic control in type 2 diabetes (T2D) remains a challenge. The objective of this post hoc analysis of data from the SUSTAIN 2, 3, 4 and 10 active-controlled trials was to assess the efficacy and safety of the once-weekly glucagon-like peptide 1 receptor agonist (GLP-1RA) semaglutide in patients on background treatment with metformin (MET), with or without a sulphonylurea (SU). Methods: Data from the randomised phase 3 trials SUSTAIN 2, 3, 4 and 10 for subjects who received background MET alone or MET + SU were analysed. Change from baseline in HbA1c and body weight at the end of treatment visit (week 30 in SUSTAIN 4 and 10, week 56 in SUSTAIN 2 and 3), and rates of hypoglycaemia and adverse events leading to premature treatment discontinuation were assessed. Results: In total, 3411 subjects were included in the full analysis set (3410 in the safety analysis set). Across the four trials, semaglutide significantly reduced HbA1c (estimated treatment difference [ETD] - 0.32 to - 0.79%-points for semaglutide 0.5 mg, and - 0.38 to - 1.07%-points for semaglutide 1.0 mg vs comparators; p < 0.01) in subjects receiving both MET and MET + SU. Regardless of background OAD, semaglutide significantly reduced body weight (ETD - 2.35 to - 4.72 kg for semaglutide 0.5 mg, and - 2.96 to - 6.76 kg for semaglutide 1.0 mg vs comparators; p < 0.0001). Across the trials, hypoglycaemic events were more common with background MET + SU than MET alone, in subjects receiving either semaglutide or a comparator. The rate of adverse events (AEs) leading to premature treatment discontinuations in subjects treated with semaglutide were generally consistent regardless of background therapy. Conclusion: Semaglutide 0.5 mg and 1.0 mg significantly improve glycaemic control (HbA1c) and body weight in subjects with T2D, with a similar tolerability profile, regardless of whether they receive background MET or MET + SU.Novo Nordisk A/S2.945 JCR (2020) Q3, 103/146 Endocrinology & Metabolism – 0.907 SJR (2020) Q2, 89/2320.907 SJR (2020) Q2, 89/232No data IDR 2020UE

Coexistence of dyschondrosteosis associated to SHOX deficiency, pseudohypoparathyroidism 1B, and chronic autoimmune thyroiditis: a case report

We present an unusual case of SHOX deficiency associated with Léri-Weill dyschondrosteosis (LWD), Hashimoto’s thyroiditis and pseudohypoparathyroidism 1B in a young woman. To our knowledge, this is the first ever report of these disorders coexisting. At the age of nine years, the proband was diagnosed of hypothyroidism due to Hashimoto’s thyroiditis, and developed biochemical abnormalities consistent with hyperphosphatemia, mild hypocalcemia and elevated parathyroid hormone without any clinical symptoms except short stature. Replacement therapy with levothyroxine, calcium and alphacalcidol was initiated. The diagnosis of pseudohypoparathyroidism 1B was confirmed at the age of 17.5 years with the demonstration of methylation alteration at the GNAS locus. At the age of 16 years, 3.5 years after her menarche, she presented clear features of LWD. A large deletion of the SHOX gene was confirmed. Family genetic tests were not doable since she was adopted. We discuss the diagnostic challenges of these coexisting rare endocrinopathies.Sin financiación1.634 JCR (2020) Q3, 95/129 Pediatrics0.411 SJR (2021) Q2, 149/320 Pediatrics, Perinatology and Child HealthUE