Comorbidity and osteoporotic fracture: approach through predictive modeling techniques using the OSTEOMED registry

Purpose To examine the response to anti-osteoporotic treatment, considered as incident fragility fractures after a minimum follow-up of 1 year, according to sex, age, and number of comorbidities of the patients. Methods For this retrospective observational study, data from baseline and follow-up visits on the number of comorbidities, prescribed anti-osteoporotic treatment and vertebral, humerus or hip fractures in 993 patients from the OSTEOMED registry were analyzed using logistic regression and an artificial network model. Results Logistic regression showed that the probability of reducing fractures for each anti-osteoporotic treatment consid- ered was independent of sex, age, and the number of comorbidities, increasing significantly only in males taking vitamin D (OR = 7.918), patients without comorbidities taking vitamin D (OR = 4.197) and patients with ≥ 3 comorbidities taking calcium (OR = 9.412). Logistic regression correctly classified 96% of patients (Hosmer–Lemeshow = 0.492) compared with the artificial neural network model, which correctly classified 95% of patients (AUC = 0.6). Conclusion In general, sex, age and the number of comorbidities did not influence the likelihood that a given anti-osteoporotic treatment improved the risk of incident fragility fractures after 1 year, but this appeared to increase when patients had been treated with risedronate, strontium or teriparatide. The two models used classified patients similarly, but predicted differently in terms of the probability of improvement, with logistic regression being the better fit

Efecto del nivel de proteína en el crecimiento de Goodea atripinnis (Pisces: Goodeidae)

Background. Goodea atripinnis is an omnivorous fish that is only found in the state of Aguascalientes. Its population is being drastically reduced and its survival is considered to be threatened. To avoid its extinction, ex situ breeding programs are being implemented. To implement these programs, however, it is necessary to have feeding plans that allow the nutritional needs of this species to be met. Goals. To evaluate the effects of different protein levels in the diet (25, 30, 35, 40 and 45 % PC) on the growth of G. atripinnis. Methods. A randomized complete-block design with five treatments (protein levels) and 3 aquariums per treatment was used, each aquarium containing 20 fish. The experiment lasted 150 days. Daily feed intake and changes in weight and length of each fish were recorded every 15 days. Results. We found differences in final weight and total weight gain (p <0.05) depended on protein levels. Both the growth rate and the total food intake increased with higher levels of protein. As a result, the feed conversion rate, protein efficiency, and Fulton (K) body condition factor improved. The Gompertz model showed that high protein levels increased standard weight and that the inflection point occurred at the same weight. Conclusions. With higher protein levels, the standard weight is reached at an earlier age, leading to greater development of the fish.  Antecedentes. Goodea atripinnis es un pez omnívoro que sólo se localiza en el estado de Aguascalientes y su población se encuentra en estatus de amenaza. Para evitar su extinción se están implementando programas de reproducción ex situ; sin embargo, para lograrlo es necesario contar con planes de alimentación que permitan satisfacer las necesidades nutricionales de la especie. Objetivos. Evaluar los efectos de 5 niveles de proteína (25, 30, 35, 40 y 45% PC) en la dieta, velocidad de crecimiento y parámetros productivos de G. atripinnis. Métodos. Se utilizó un diseño de bloques al azar con 5 tratamientos (niveles de proteína) y 3 acuarios por tratamiento, cada uno contenía 20 peces (peso medio: 0.47 ± 0.02 g). El experimento duró 150 días, durante los cuales se registraron el consumo de alimento diariamente y los cambios en peso y longitud de cada pez cada 15 días. Resultados. Se encontraron diferencias en peso final y ganancia de peso total (p <0.05) entre los niveles de proteína. Tanto la tasa de crecimiento como la ingesta total de alimento aumentaron con el nivel alto de proteína. La tasa de conversión de alimento, la eficiencia proteínica y el factor de condición corporal de Fulton (K) mejoraron. El modelo de Gompertz mostró que los altos niveles de proteína aumentaron el peso estándar y que el punto de inflexión se produce en el mismo peso. Conclusiones. Con los niveles altos de proteína el peso estándar se alcanza a una edad más temprana y permite un mayor desarrollo de los peces

Análisis de la morfometría ósea en ratas sometidas a diferentes situaciones de hipoxia

El hueso es uno de los tejidos metabólicamente más activos, metabolismo que requiere de un aporte suficiente de oxígeno. En este sentido, se han publicado resultados contradictorios de cómo la hipoxia podría modificar el remodelado óseo y con ello la estructura del hueso. El objetivo del estudio fue valorar el efecto de la hipoxia sobre la morfometría ósea y la densidad mineral ósea medidas por tomografía axil computarizada de alta resolución (HR-pQTc ). Se analizaron 61 ratas wistar a las que se les sometió a diferentes condiciones experimentales: ratas control (sometidas a condiciones de normoxia), ratas sometidas a hipoxia crónica constante y ratas sometidas a hipoxia crónica intermitente. Los animales se sacrificaron por una sobredosis cardiaca de fenobarbital. A continuación, se procedió a la extracción de los huesos, fémur y tibia. Posteriormente se fijaron en etanol al 70% para su posterior análisis. Se utilizó un micro-TAC modelo escáner SKYSCAN 1172 de la marca BRUKER y un software de captación de datos skyscan1172 µCT. La reconstrucción de las imágenes se realizó mediante un software Nrecon utilizándose posterio mente el software de análisis de imagen "CTAN". Se utilizó el SPSS v22 para el análisis estadístico. Nuestros resultados mostraron que las ratas sometidas a condiciones de hipoxia tenían una menor densidad mineral de tejido (TMD) en fémur cortical y un menor grosor trabecular de la tibia. Por otra parte, analizando las ratas sometidas a hipoxia crónica permanente en referencia a las ratas control, se observó que la hipoxia se asoció con un menor espesor cortical de la tibia, menor densidad mineral ósea (BMD) en fémur trabecular y con menor volumen óseo porcentual (BV/TV) del fémur trabecular. Diferenciando por sexos, las ratas hembras sometidas a hipoxia crónica permanente presentaron un menor espesor de la tibia cortical, menor grosor de las trabéculas de la tibia y el fémur y menores valores de BMD en las trabéculas de la tibia y el fémur. Las ratas macho sometidas a hipoxia crónica permanente, tenían un menor número de trabéculas en la tibia. También se observó como las ratas sometidas a hipoxia permanente intermitente, tenían un menor TMD que las ratas control. Nuestros resultados mostraron que en diferentes condiciones de hipoxia se observó un deterioro de la morfometría ósea, probablemente debido a que se produce una alteración del remodelado óseo promovido por la hipoxia tisular

Haplotypes of intron 4 of the estrogen receptor alpha gene and hip fractures: a replication study in Caucasians

<p>Abstract</p> <p>Background</p> <p>Despite their great impact, few genetic association studies have used hip fractures as an endpoint. However, the association of two polymorphisms on intron 4 of estrogen receptor alpha (<it>ESR1</it>) with hip fractures was recently reported in a Chinese population. The aim of this study was to investigate whether such association is also present in Caucasians.</p> <p>Methods</p> <p>We analyzed those two SNPs and another neighbour SNP located on the exon 4 of <it>ESR1 </it>in 787 patients with hip fractures and 953 controls from Spain.</p> <p>Results</p> <p>The allelic frequencies differed markedly from those reported in Asian populations. Nevertheless, haplotypes including the rs3020314 and rs1884051 loci in intron 4 showed a significant association with hip fractures (omnibus test p = 0.006 in the whole group and 0.00005 in women). In the sex-stratified analysis, the association was significant in females, but not in males. In women, the CA haplotype appeared to have a protective influence, being present in 6.5% of the controls, but only in 3% of patients with fractures (odds ratio 0.39; 95% confidence interval 0.26-0.59; estimated population preventive fraction 3.5%). The inclusion of the rs1801132 SNP of exon 4 further increased the statistical significance of the association (odds ratio 0.17; 95% CI 0.08-0.37; p = 0.00001). Each SNP appeared to contribute independently to the association. No genotype-related differences in gene expression were found in 42 femoral bone samples.</p> <p>Conclusions</p> <p>This study confirms the association of some polymorphisms in the region of exon 4/intron 4 of <it>ESR1 </it>and hip fractures in women. However, there are marked differences in allele frequencies between Asian and Caucasian populations.</p

Factores de riesgo para trastornos de la alimentación en los alumnos de la Universidad de Manizales

ResumenObjetivo: Determinar la frecuencia de los factores de riesgo para trastornos de la alimentaci&oacute;n en estudiantes de la Universidad de Manizales. Materiales y m&eacute;todos: De 3,610 estudiantes regulares de la Universidad&nbsp; de Manizales se tom&oacute; una muestra de 165 estudiantes, quienes respondieron un cuestionario integrado compuesto por variables demogr&aacute;ficas, las escalas de Zung para ansiedad o depresi&oacute;n,el Eating Disorderrs Inventory (EDI2) y el Apgar familiar; adem&aacute;s se tomaron las medidas de peso, talla, &iacute;ndice de masa corporal y pliegue en el antebrazo. Resultado: Un12.7% de la poblaci&oacute;n present&oacute; factor de riesgo positivo para trastornos de la conducta alimentar&iacute;a, 17.3% de la poblaci&oacute;n femenina y el 3.8% de la poblaci&oacute;n masculina; las personas con mayor factor de riesgo fueron las mujeres en la facultad de Comunicaci&oacute;n Social y Periodismo (24.1%). Se determin&oacute; una&nbsp; relaci&oacute;n significativa entre la variable impulso por la delgadez con la ansiedad o depresi&oacute;n. El mayor &iacute;ndice de masa corporal y de porcentaje de grasa est&aacute; asociado con un aumentoen la variable impulso por la delgadez. Conclusiones:Se encontraron factores de riesgo asociados con trastornos de la alimentaci&oacute;n. La frecuencia del factor de riesgo seg&uacute;n EDI2 en este estudio fue m&aacute;s baja que la encontrada en estudios realizados en Medell&iacute;n y Bogot&aacute;.[Cano AA, Casta&ntilde;o JJ, Corredor DA, Garc&iacute;a AM, Gonz&aacute;lez M, Lloreda OL, et al. Factores de riesgo para trastornos de la alimentaci&oacute;n en los alumnos de la Universidad de Manizales. MedUNAB 2007; 10:187-194].Palabras claves: Trastornos de la conducta alimentaria, factores de riesgo; Anorexia nerviosa, Bulimia

Brazilian Consensus on Photoprotection

Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of nonmelanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection

Executive summary clinical practice guideline of postmenopausal, glucocortcioid-induced and male osteoporosis (2022 update). Spanish Society for Bone and Mineral Metabolism Investigation (SEIOMM)

Esta versión actualizada de las guías de osteoporosis de la Sociedad Española de Investigación en Osteoporosis y Metabolismo Mineral (SEIOMM) incorpora la información más relevante publicada en los últimos 7 años, desde las guías de 2015, con estudios de imagen, como la valoración de la fractura vertebral y el análisis del índice trabecular óseo. Además, los avances terapéuticos incluyen los nuevos fármacos anabólicos, los estudios comparativos de la eficacia de los fármacos y la terapia secuencial y combinada. Por ello se actualizan también las recomendaciones de los tratamientos.This updated version of the Spanish Society for Research in Osteoporosis and Mineral Metabolism (SEIOMM) osteoporosis guides incorporate the most relevant information published in the last 7 years, since the 2015 guides, with imaging studies, such as vertebral fracture assessment and bone trabecular score analysis. In addition, therapeutic advances include new anabolic agents, comparative studies of drug efficacy, and sequential and combined therapy. Therefore, therapeutic algorithms are also updated

High Frequencies of Genetic Variants in Patients with Atypical Femoral Fractures

This study explores the genetic factors associated with atypical femoral fractures (AFF), rare fractures associated with prolonged anti-resorptive therapy. AFF are fragility fractures that typically appear in the subtrochanteric or diaphyseal regions of the femur. While some cases resemble fractures in rare genetic bone disorders, the exact cause remains unclear. This study investigates 457 genes related to skeletal homeostasis in 13 AFF patients by exome sequencing, comparing the results with osteoporotic patients (n = 27) and Iberian samples from the 1000 Genomes Project (n = 107). Only one AFF case carried a pathogenic variant in the gene set, specifically in the ALPL gene. The study then examined variant accumulation in the gene set, revealing significantly more variants in AFF patients than in osteoporotic patients without AFF (p = 3.7 × 10−5), particularly in ACAN, AKAP13, ARHGEF3, P4HB, PITX2, and SUCO genes, all of them related to osteogenesis. This suggests that variant accumulation in bone-related genes may contribute to AFF risk. The polygenic nature of AFF implies that a complex interplay of genetic factors determines the susceptibility to AFF, with ACAN, SUCO, AKAP13, ARHGEF3, PITX2, and P4HB as potential genetic risk factors. Larger studies are needed to confirm the utility of gene set analysis in identifying patients at high risk of AFF during anti-resorptive therapy