Treatment of Paget\u27s Bone Disease with the Bisphosphonate APD

Thirty-two patients with Paget\u27s bone disease have been treated with the bisphosphonate APD. Nineteen had previously received treatment for Paget\u27s disease with EHDP alone or in combination with calcitonin; 13 had not previously received treatment for Paget\u27s disease. APD was given in a mean dose of 6.8 mg/kg of body weight during a period of 6 to 12 months. Bone pain disappeared or diminished in 91% of the patients. A very significant diminution of the biochemical indices of bone turnover was observed in all patients, but the response occurred faster in patients who had not previously received treatment for Paget\u27s disease. In 10 patients, APD therapy was discontinued after biochemical remission of the Paget\u27s disease had been achieved. In most patients, clear signs of reactivation of the disease appeared 9 to 10 months after APD therapy was discontinued

Sarcopenia: clinical approach

La sarcopenia, disminución de la masa y rendimiento muscular, es un importante factor de riesgo para la salud en general e, independientemente de la densidad mineral, aumenta el riesgo de sufrir fracturas no vertebrales, especialmente en el hombre. La masa muscular alcanza su mayor desarrollo alrededor de los 40 años y luego disminuye constantemente. Aun después de los 70 años puede disminuir anualmente alrededor del 1% en el hombre y 0,5% en la mujer. Desde el punto de vista clínico, la mejor valoración es la medición de la masa muscular apendicular por DXA. El estudio debe incluir prueba de fuerza (apriete del puño), potencia (pararse/sentarse, subir escalones) y rendimiento (velocidad de la marcha) muscular. La detección/diagnóstico de la sarcopenia debería efectuarse en los sujetos mayores de 65 años e incluso en los menores de esa edad, si sufren caídas frecuentes, fracturas osteoporóticas o falta de fuerza manifiesta. Las intervenciones destinadas a restaurar o prevenir la pérdida de masa y rendimiento muscular deben incluir ejercicios de resistencia, dieta con contenido proteico de 1,0 a 1,2 g/kg de peso y administración de vitamina D para mantener niveles de 25 HOD mayores de 30 ng/ml. Los agentes terapéuticos en investigación incluyen, entre otros, a los anticuerpos antimiostatina y los SARM (moduladores selectivos de los andrógenos).Sarcopenia, the diminution of muscular mass and performance, is an important risk factor for general health and specifically for bone fractures independently of the bone mineral density. After reaching a maximal development around 40 years of age, the muscular mass (MM) diminishes constantly, even after 70 years of age at a rate of 1% per year in men and 0.5% per year in women. From the clinical approach the best measure of MM is accomplished by DXA measuring the appendicular MM. The study of the patient should include physical test to assess strength (hand grip), power (sit/stand test and climb stairs) and muscular performance (walking speed). Subjects over 65 years of age, or those with frequent fall, osteoporotic fractures or manifest diminution of their physical performance could undergo studies for sarcopenia detection. Medical interventions to restore or prevent MM loss should include resistance exercises, protein content of the diet between 1.0 to 1.2 g/kg and vitamin D administration to keep 25 HOD over 30 ng/ml. Intensive research of new agents include, among others, antibodies anti-miostatin and SARM.Fil: Mastaglia, Silvina Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; ArgentinaFil: Mautalen, Carlos Alfredo. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

The Acute Effect of Piretanide upon Serum and Urinary Calcium in Normal Subjects

We gave piretanide, a new diuretic, at two dose levels to six normal subjects. Sodium excretion increased six to eightfold in the first two hours, and diuresis was completed within four hours. There was a simultaneous increase in the excretion of calcium which exceeded the amount present In the mobilized extracellular fluid. The resulting deficit of calcium produced a small but significant fall in serum calcium corrected for protein. After diuresis ended, calcium was retained but not sodium, when compared to basal values on the previous day. The fall in urinary calcium and the failure to correct the sodium deficit may both have resulted from increased secretion of parathyroid hormone (PTH), which increases calcium reabsorption and decreases sodium reabsorption. The role of PTH in the long-term effects of diuretics on sodium and calcium excretion requires further study

Peripheral bone mass is not affected by winter vitamin D deficiency in children and young adults from Ushuaia

Low vitamin D levels in elderly people are associated with reduced bone mass, secondary hyperparathyroidism, and increased fracture risk. Its effect on the growing skeleton is not well known. The aim of this study was to evaluate the possible influence of chronic winter vitamin D deficiency and higher winter parathyroid hormone (PTH) levels on bone mass in prepubertal children and young adults. The study was carried out in male and female Caucasian subjects. A total of 163 prepubertal children (X age ± 1 SD: 8.9 ± 0.7 years) and 234 young adults (22.9 ± 3.6 years) who had never received vitamin D supplementation were recruited from two areas in Argentina: (1)Ushuaia (55°South latitude), where the population is known to have low winter 25OHD levels and higher levels of PTH in winter than in summer, and (2)Buenos Aires (34°S), where ultraviolet (UV) radiation and vitamin D nutritional status in the population are adequate all year round. Bone mineral content (BMC) and bone mineral density (BMD) of the ultradistal and distal radius were measured in the young adults. Only distal radius measurements were taken in the children. Similar results were obtained in age-sex matched groups from both areas. The only results showing significant difference corresponded to comparison among the Ushuaian women: those whose calcium (Ca) intake was below 800 mg/day presented lower BMD and BMC values than those whose Ca intake was above that level (0.469 ± 0.046 versus 0.498 ± 0.041 g/cm2, P < 0.02; 3.131 ± 0.367 versus 3.339 ± 0.386 g, P < 0.05, respectively). In conclusion, peripheral BMD and BMC were similar in children and young adults from Ushuaia and Buenos Aires in spite of the previously documented difference between both areas regarding UV radiation and winter vitamin D status. BMD of axial skeletal areas as well the concomitant effect of a low Ca diet and vitamin D deficiency on the growing skeleton should be studied further.Fil: Oliveri, María Beatriz. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. División Osteopatías; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; ArgentinaFil: Wittich, A.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. División Osteopatías; ArgentinaFil: Mautalen, Carlos Alfredo. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. División Osteopatías; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Chaperon, Federico. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. División Osteopatías; ArgentinaFil: Kizlansky, A.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. División Osteopatías; Argentin

High Prevalence of Sarcopenia in Women with Osteoporotic Fractures

The aim of the present study was to assess the prevalence of sarcopenia in women with osteopenia/osteoporosiswith or without fragility fractures.Patients and methods: 112 ambulatory women with osteopenia/osteporosis were included. Body composition wasdetermined by DXA. Weight, height, body mass index (BMI), bone mineral density (BMD) of the total skeleton, totallean mass (LM), appendicular lean mass (ALM) and the index: appendicular lean mass/height² (ALM/h²) weredetermined. Grip strength and self-selected gait speed were assessed. Results: Average (X ± SD) results were: age70.9 ± 8.2 years, BMI: 23.1 ± 3.3 kg/h², total skeleton BMD T-Score:-1.7 ± 0.8, total LM 33.3 ± 3.8 kg, ALM 14.4 ±2.1kg and ALM/h²: 5.86 ± 0.68 kg/h². Walking speed 0.96±0.21m/s and handgrip: 18.8 ± 4.8 kg. The prevalence ofsarcopenia was: 24.7% (International Working Group criteria). Values for BMI, LM, ALM, ALM/h², gait speed andhand grip were significantly lower in sarcopenic vs. non-sarcopenic patients. 29 patients, average age: 70.5 ± 8.0years had osteoporotic fragility fractures (Fx). The prevalence of sarcopenia in the group of patients with Fx was41.4% vs. 19.3% in the non-Fx patients (n=83) (p<0.018).Conclusion: The prevalence of sarcopenia in women with osteopenia/osteoporosis was higher compared to thatusually reported in non-selected patients of similar age. Those with bone fractures had a significantly higherprevalence of sarcopenia compared to the non-fracture patients. The assessment of muscle mass and function inpatients with osteopenia/osteoporosis is recommended.Fil: Fernández, Candela. Centro de Osteopatías Médicas Dr Mautalen; ArgentinaFil: Oliveri, María Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; ArgentinaFil: Bagur, Alicia Cristina. Centro de Osteopatías Médicas Dr Mautalen; ArgentinaFil: Gomez Glorioso, Dolores. Centro de Osteopatías Médicas Dr Mautalen; ArgentinaFil: González, Diana. Centro de Osteopatías Médicas Dr Mautalen; ArgentinaFil: Mastaglia, Silvina Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; ArgentinaFil: Mautalen, Carlos Alfredo. Centro de Osteopatías Médicas Dr Mautalen; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Romosozumab Enhances Vertebral Bone Structure in Women With Low Bone Density.

Funder: NIHR Cambridge BRC; Id: http://dx.doi.org/10.13039/501100018956Romosozumab monoclonal antibody treatment works by binding sclerostin and causing rapid stimulation of bone formation while decreasing bone resorption. The location and local magnitude of vertebral bone accrual by romosozumab and how it compares to teriparatide remains to be investigated. Here we analyzed the data from a study collecting lumbar computed tomography (CT) spine scans at enrollment and 12 months post-treatment with romosozumab (210 mg sc monthly, n = 17), open-label daily teriparatide (20 μg sc, n = 19), or placebo (sc monthly, n = 20). For each of the 56 women, cortical thickness (Ct.Th), endocortical thickness (Ec.Th), cortical bone mineral density (Ct.bone mineral density (BMD)), cancellous BMD (Cn.BMD), and cortical mass surface density (CMSD) were measured across the first lumbar vertebral surface. In addition, color maps of the changes in the lumbar vertebrae structure were statistically analyzed and then visualized on the bone surface. At 12 months, romosozumab improved all parameters significantly over placebo and resulted in a mean vertebral Ct.Th increase of 10.3% versus 4.3% for teriparatide, an Ec.Th increase of 137.6% versus 47.5% for teriparatide, a Ct.BMD increase of 2.1% versus a -0.1% decrease for teriparatide, and a CMSD increase of 12.4% versus 3.8% for teriparatide. For all these measurements, the differences between romosozumab and teriparatide were statistically significant (p < 0.05). There was no significant difference between the romosozumab-associated Cn.BMD gains of 22.2% versus 18.1% for teriparatide, but both were significantly greater compared with the change in the placebo group (-4.6%, p < 0.05). Cortical maps showed the topographical locations of the increase in bone in fracture-prone areas of the vertebral shell, walls, and endplates. This study confirms widespread vertebral bone accrual with romosozumab or teriparatide treatment and provides new insights into how the rapid prevention of vertebral fractures is achieved in women with osteoporosis using these anabolic agents. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).This research was funded by Amgen and supported by the NIHR Cambridge BRC. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care

Elevada Incidencia de Insuficiencia de Vitamina D en los Adultos Sanos Mayores de 65 Años en Diferentes Regiones de la Argentina

Con el objetivo de evaluar el estado nutricional de vitamina D en la población urbana clínicamente sana ambulatoria de Argentina se invitó a participar a 386 sujetos mayores de 65 años de 7 ciudades (entre 26 y 55º latitud Sur) entre fines del invierno y principios de la primavera. De ellos, 369 aceptaron, 30 presentaron criterios de exclusión clínicos o bioquímicos. Finalmente, se incluyeron 339 sujetos (226 mujeres y 113 hombres), con edad 71,3± 5,2 años (X ± SD). Los resultados fueron los siguientes: los niveles séricos de 25 hidroxivitamina D (25OHD) fueron menores en el Sur (latitud: 41- 55°S): 14,2± 5,6 ng/ml (p<0,0001 vs. las regiones Norte y Central); mayores en el Norte (26-27°S): 20,7±7,4 ng/ml (p<0,03 vs .Central; p<0,0001 vs. Sur); e intermedio en la región Central (33-34°S): 17,9±8,2 ng/ml. Se encontró una correlación negativa entre los niveles séricos de hormona paratiroidea (PTH) y 25OHD: r = -0,24 (p<0,001). El nivel de corte de 25OHD en el cual comenzaban a elevarse los niveles de PTH fue establecido en 27 ng/ml. En las diferentes regiones se observó una alta incidencia (52 a 87%) de niveles de insuficiencia de vitamina D (25OHD <20ng/ml) y solamente entre el 2 y 17% tenían niveles considerados como mínimos deseables de 25OHD (≥ 30 ng/ml). Conclusión: la deficiencia/insuficiencia de vitamina D en adultos mayores es un problema de escala mundial, incluida la población argentina. La corrección del déficit mencionado tendría un impacto positivo en la salud ósea de este grupo etarioFil: Oliveri, María Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. División Osteopatías; ArgentinaFil: Plantalech, Luisa. Hospital Italiano; ArgentinaFil: Bagur, Alicia Cristina. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. División Osteopatías; ArgentinaFil: Wittich, Ana C.. No especifíca;Fil: Rovai, Gloria. No especifíca;Fil: Pusiol, Eduardo. No especifíca;Fil: Lopez Giovanelli, Jorge. No especifíca;Fil: Ponce, Graciela. Universidad Nacional de la Patagonia "San Juan Bosco"; ArgentinaFil: Nieva, Alfonso. No especifíca;Fil: Chaperon, Adriana. Sanatorio San Jorge; ArgentinaFil: Ladizesky, Marta Graciela. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. División Osteopatías; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Somoza, Julia Isabel. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. División Osteopatías; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; ArgentinaFil: Casco, Cristina. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. División Osteopatías; ArgentinaFil: Zeni, Susana Noemi. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. División Osteopatías; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; ArgentinaFil: Parisi, Muriel Solange. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. División Osteopatías; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mautalen, Carlos Alfredo. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. División Osteopatías; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Regression of an ossifying fibroma of the tibia after a fracture involving the lesion: possible role of the periostina

Ossifying fibroma (OF) of the long bones is a benign fibro-osseous lesion typically seen in the first decade of life. OF usually progresses until the age of 10 years, but is occasionally found to regress spontaneously after puberty. The pathogenesis of OF is unknown; however, it has been suggested that the basic defect is in the periosteum. We present the radiological course of an OF of the tibia in a young patient, showing a rapid almost complete regression of the lesion after a tibial fracture at the lesion site. We postulate that the fracture-induced activation of the periosteum in a growing skeleton was fundamental to the regression of the lesion.Fil: Mastaglia, Silvina Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; ArgentinaFil: Mautalen, Carlos Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Mautalen, Salud e Investigación; Argentin

Underdiagnosis of osteoporosis in different ethnic groups when bone mineral density is measured in a single area

The aim of the present review was to assess the difference in osteoporosis (OP) prevalence, when measuring the DXA bone mineral density (BMD) of the lumbar spine (LS) or the femoral neck (FN). To reach it, 15 reports on the simultaneous determination of both areas were reviewed, including results obtained as of the age of 50, periodically assessed every 5 to 10 years and at least upto 79 years of age. The WHO definition of osteoporosis (T-score ≤ -2.5) was used in all studies. Results from men and women were included in six studies; onlywomen values were reported in eight of them, and only men, in one.Results. The prevalence of OP in women measuring only the LS rose from 12.1% in the 6th decade to 39.7% in the 8th decade, while as regards the FN, it rose from 3.0% to 30.2% among the same age groups. In all studies on the 6th and 7th decades, OP prevalence was greater in the LS compared to the FN. In the 8th decade (70-79 y.o), only in 3 out of 14 studies, prevalence was greater in the FN compared to the LS. Failure to diagnose OP when measuring only the FN was 9.1% in the 6th, 16.2% in the 7th and 9.5% in the 8th decade. In six studies, the authors reported not only the OP prevalence of each area but also the prevalence at any site, allowing to determine underdiagnosis when measuring only the LS or the FN. Underdiagnosis was significantly greater when measuring only the FN than when measuring only the LS. The results in women were: 6thdecade: 76.4 ± 8.3% vs 11.3 ± 9.1% p<0.001; 7th decade: 65.0 ± 6.3% vs 15.9 ± 6.9% p <0.001 and 8th decade: 37.2± 13.1% vs 20.1 ± 5.8% p <0.02. As expected, OP prevalence in men is lower than its prevalence in women. There is a failure to diagnose OP in men when measuring only the FN ranging from 3.2% in the 6th decade to 1.3% in the 8th. There was a great dispersion of the results, and no clear predominance from one area to the other was observed. The underdiagnosis of OP, evaluating only the FN, or the LS calculated in four studiesshowed no significant differences in any of the three decades reported.Conclusion. The present review confirms that, especially in women from different ethnic groups or regions neglecting the measurement of the BMD of the LS, leads to a significant underdiagnosis of osteoporosis. This result reinforces the guidelines of the ISCD about measuring both the lumbar spine and the upper femur for a more accurate assessment of osteoporosis prevalenceFil: Mastaglia, Silvina Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; ArgentinaFil: Bagur, Alicia Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; ArgentinaFil: Mautalen, Carlos Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; Argentin