Efectividad y seguridad de los bisfosfonatos en el tratamiento de la osteoporosis infantil secundaria

Bisfosfonatos; Efectividad; NiñoBisfosfonats; Efectivitat; NenBisphosphonates; Effectiveness; ChildIntroduction There are few studies on effectiveness and safety of bisphosphonate therapy in secondary osteoporosis in children. The aim of this research was to analyse effectiveness and safety of bisphosphonates in secondary osteoporosis in children. Patients and methods Multicentre retrospective study in patients younger than 18 suffering from secondary osteoporosis and who have received bisphosphonates. Clinical data were recorded. Bone mineral density (BMD) was assessed in terms of BMD Z-score in lumbar spine (ZBMDls) measured by dual-energy X-ray absorptiometry (DXA). Effectiveness was valued at changes in ZBMDls one and two years after the onset of bisphosphonates and at the decrese in the number of fractures a year. Adverse events reported were recorded. Descriptive and bivariant analysis was performed. Results 32 patients were recruited. ZBMDls increased one year after the onset of treatment ((−2.46 ± 0.96) vs. (−1.54 ± 1.38); p < .001). Fractures a year dicreased significantly (1 (1–2) vs. 0 (0–0.61); p < .001). ZBMDls increase was higher in patients who were able to walk (1.88 ± 0.72 vs. 0.55 ± 0.82; p = .07) and correlated positively with body mass index (BMI)- for- age percentile (rho: 0.564; p < .001). The decrease in the number of fractures a year was higher in patients with lower initial fracture rate (rho: −0,47; p = .006) and with higher initial ZBMDls (rho: −0.47; p = .07). 10 adverse events were reported in 7 patients (22%), all of them intravenous bisphosphonates related. No association was found between adverse events and studied variables. Conclusions Bisphosphonates are effective in secondary osteoporosis in children. Response seems to be better in patients who are able to walk, well-nourished and in the early stages of the disease. Adverse events were frequent but mild.Introducción Los estudios sobre efectividad y seguridad de los bisfosfonatos en osteoporosis infantil secundaria (OIS) son escasos. El objetivo fue analizar efectividad y seguridad de los bisfosfonatos en OIS. Pacientes y métodos Estudio multicéntrico retrospectivo en <18 años afectos de OIS tratados con bisfosfonatos. Se recogieron variables clínicas. Se valoró densidad mineral ósea (DMO) mediante el Z-score de DMO en columna lumbar (ZDMOcl) medido por absorciometría de rayos X de doble energía (DXA). Valoramos efectividad en función del cambio del ZDMOcl al año y a los dos años de su inicio y del descenso del número de fracturas/año. Los eventos adversos reportados fueron recogidos. Se realizó análisis descriptivo y bivariante. Resultados Se reclutaron 32 pacientes. El ZDMOcl se incrementó al año del inicio del tratamiento ((−2,46 ± 0,96) vs. (−1,54 ± 1,38); p < 0,001). El número de fracturas/año disminuyó significativamente (1 (1–2) vs. 0 (0–0,61); p < 0,001). El cambio en el ZDMOcl fue mayor en los pacientes deambulantes (1,88 ± 0,72 vs. 0,55 ± 0,82; p = 0,07) y se correlacionó positivamente con el percentil del IMC (rho: 0,564; p < 0,001). El descenso del número de fracturas/año fue mayor en los pacientes con menor tasa inicial de fracturas (rho: −0,47; p = 0,006) y cuanto mayor era el Z-score inicial (rho: −0,47; p = 0,07). Se reportaron 10 eventos adversos leves en 7 pacientes (22%), todos con bisfosfonatos intravenosos. No se halló relación entre eventos adversos y las variables estudiadas. Conclusiones Los bisfosfonatos son efectivos en OIS. La respuesta parece ser mejor en pacientes deambulantes, bien nutridos y en estadios precoces de la enfermedad. Resultan seguros, siendo los efectos adversos leves, aunque frecuentes

Expert panel consensus recommendations for diagnosis and treatment of secondary osteoporosis in children

Background: Osteoporosis incidence in children is increasing due to the increased survival rate of patients suffering from chronic diseases and the increased use of drugs that can damage bones. Recent changes made to the definition of childhood osteoporosis, along with the lack of guidelines or national consensuses regarding its diagnosis and treatment, have resulted in a wide variability in the approaches used to treat this disease. For these reasons, the Osteogenesis Imperfecta and Childhood Osteoporosis Working Group of the Spanish Society of Pediatric Rheumatology has sounded the need for developing guidelines to standardize clinical practice with regard to this pathology. Methods: An expert panel comprised of 6 pediatricians and 5 rheumatologists carried out a qualitative literature review and provided recommendations based on evidence, when that was available, or on their own experience. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A Delphi survey was conducted for those recommendations with an evidence level of IV or V. This survey was sent to all members of the SERPE. All recommendations that had a level of agreement higher or equal to 70% were included. Results: Fifty-one recommendations, categorized into eight sections, were obtained. Twenty-four of them presented an evidence level 4 or 5, and therefore a Delphi survey was conducted. This was submitted electronically and received a response rate of 40%. All recommendations submitted to the Delphi round obtained a level of agreement of 70% or higher and were therefore accepted. Conclusion: In summary, we present herein guidelines for the prevention, diagnosis and treatment of secondary childhood osteoporosis based on the available evidence and expert clinical experience. We believe it can serve as a useful tool that will contribute to the standardization of clinical practice for this pathology. Prophylactic measures, early diagnosis and a proper therapeutic approach are essential to improving bone health, not only in children and adolescents, but also in the adults they will become in the future

Estudio de la variabilidad de los parámetros de riesgo de cristalización en orina de 12 horas diurna y nocturna

[spa] El análisis de la composición urinaria es esencial para el estudio de la litiasis renal y depende de una correcta recogida y procesamiento de la muestra. Este estudio descriptivo está diseñado para comparar los parámetros urinarios en dos períodos consecutivos de 12 horas en sujetos sanos y litiásicos, con el objetivo de ver si existen diferencias en la excreción de sustancias promotoras e inhibidoras de la cristalización entre ambos períodos, que indiquen un patrón circadiano de eliminación. Los resultados revelan que la composición de la orina no es constante a lo largo del día y que dicha variabilidad afecta a la mayoría de parámetros implicados en el proceso de cristalización. Así, en la muestra de orina de 12 horas nocturna, se observa una excreción urinaria mayor de fósforo y magnesio, y menor de citrato y ácido úrico, así como niveles más bajos de pH y de volumen urinario, en comparación con el día. Los resultados del estudio revelan también que existe un patrón circadiano de diferencias en la eliminación de ciertos solutos entre el día y la noche, y que este patrón se cumple en niños y en adultos, así como en sujetos sanos y litiásicos. La orina recogida durante el período nocturno presenta una combinación de parámetros que le confieren un mayor riesgo de cristalización urinaria. Con el objetivo de implementar un protocolo simplificado de diagnóstico y seguimiento de la litiasis renal basado en la utilización de la muestra de orina nocturna, se evalúa la concordancia de diagnósticos de las alteraciones metabólicas urinarias entre este tipo de muestra y la de 24 horas de uso habitual. A pesar de las limitaciones del estudio, los resultados revelan que la muestra de orina de 12 horas nocturna tiene una capacidad de detección similar de dichas alteraciones y, por consiguiente, tendría interés seguir profundizando en su posible utilidad para el estudio de la litiasis. Finalmente, el estudio pone de manifiesto la necesidad de contar con valores de referencia adaptados a este tipo de muestra para una correcta interpretación de los resultados.[cat] L’estudi de la composició urinària és fonamental per l’avaluació de la litiasi renal i depèn d’una adequada recollida i processament de les mostres d’orina. Aquest estudi descriptiu és dissenyat per comparar els paràmetres urinaris en dos períodes consecutius de 12 hores, en subjectes sans i litiàsics, amb l’objectiu de veure si existeixen diferències en la excreció de substàncies promotores i inhibidores entre ambdós períodes, que indiquin un patró circadià d’eliminació. Els resultats revelen que la composició urinària no es constant al llarg del dia i que aquesta variabilitat afecta la majoria de paràmetres implicats en el procés de cristal·lització. Així, en la mostra d’orina de 12 hores nocturna, s’observa una major eliminació de fòsfor i magnesi, i menor de citrat i àcid úric, així com nivells inferiors de pH i diüresi, en comparació en la mostra diürna. Per altra banda, l’estudi mostra que existeix un patró circadià de diferències en l’eliminació de determinats soluts entre el dia i la nit, que es produeix tant en nins com en adults i tant en subjectes sans com litiàsics. L’orina recollida durant el període nocturn presenta una combinació de paràmetres que li confereixen un risc de cristal·lització urinària incrementat. Amb l’objectiu d’implementar un protocol simplificar de diagnòstic i seguiment de la litiasi renal, s’avalua la concordança de diagnòstics de les principals alteracions metabòliques urinàries entre les mostres d’orina de 24 hores i de 12 hores nocturna. Malgrat les limitacions de l’estudi, els resultats mostren que la mostra de 12 hores nocturna té una capacitat de detecció similar d’aquestes alteracions urinàries i resultaria de gran interès profunditzar en la utilitat d’aquesta mostra d’orina per l’estudi de la litiasi renal. Finalment, l’estudi posa de manifest la necessitat de disposar de valors de referencia adaptats a aquest tipus de mostra per a la correcta interpretació dels resultats.[eng] The analysis of the urinary composition is essential to the evaluation of renal lithiasis and depends on an adequate sample collection and processing. The aim of this study is to examine circadian variations of stone-promoting and stone-inhibiting factors in urine using split 24-h samples from healthy and stone-forming children and adults. This study indicates that urine composition changes throughout the day, with daily variability in most of the parameters related to kidney stone formation. Thus, the overnight urine samples in all groups had higher levels of phosphorous and magnesium, lower volume, lower pH, and less citrate and uric acid. Furthermore, this circadian pattern in solutes excretion seems to be fulfilled in healthy and stone-forming subjects. Urine collected during the night period presents a greater risk of urinary crystallization. In order to evaluate a simplified metabolic urinary stone study, we compared the metabolic alterations detected in the 12-h overnight urine and 24-h urine. Despite the limitations of our study, the 12- hour night-time urine sample seems to be useful in the metabolic evaluation of kidney stone disease and it would be of great interest to provide of adapted reference values

Effectiveness and safety of bisphosphonates therapy in secondary osteoporosis in children Efectividad y seguridad de los bisfosfonatos en el tratamiento de la osteoporosis infantil secundaria

Introduction: There are few studies on effectiveness and safety of bisphosphonate therapy in secondary osteoporosis in children. The aim of this research was to analyse effectiveness and safety of bisphosphonates in secondary osteoporosis in children. Patients and methods: Multicentre retrospective study in patients younger than 18 suffering from secondary osteoporosis and who had received bisphosphonates. Clinical data were recorded. Bone mineral density was assessed in terms of bone mineral density Z-score in lumbar spine (ZBMDls) measured by dual-energy X-ray absorptiometry (DXA). Effectiveness was valued at changes in ZBMDls one and two years after the onset of bisphosphonates and at the decrease in the number of fractures a year. Adverse events reported were recorded. Descriptive and bivariant analysis were performed. Results: 32 patients were recruited. ZBMDls increased one year after the onset of treatment ([−2.46 ± 0.96] vs. [−1.54 ± 1.38]; p <.001). Fractures a year decreased significantly (1 [1-2] vs. 0 [0-0.61]; p <, 001). ZBMDls increase was higher in patients who were able to walk (1.88 ± 0.72 vs. 0.55 ± 0.82; p =.07) and correlated positively with body mass index (BMI) for age percentile (rho: 0.564; p <.001). The decrease in the number of fractures a year was higher in patients with lower initial fracture rate (rho: −0.47; p =.006) and with higher initial ZBMDls (rho: −0.47; p =.07). 10 adverse events were reported in 7 patients (22%), all of them intravenous bisphosphonates related. No association was found between adverse events and studied variables. Conclusions: Bisphosphonates are effective in secondary osteoporosis in children. Response seems to be better in patients who are able to walk, well-nourished and in the early stages of the disease. Adverse events were frequent but mild

Prevention and early diagnosis of childhood osteoporosis: are we doing the right thing?

[eng] Objectives: To assess prevention, early diagnosis and training received regarding osteoporosis among the pediatrics professionals in our area. Material and methods: Survey directed to physicians of pediatricians of Primary Care (PC) and Specialized Care (SC) in order to evaluate their activity in prevention, detection and training received in osteoporosis. The survey was disseminated through the relevant scientific societies. Results: 420 pediatricians participated (324 from PC and 96 from SC). 93.5% of PC pediatricians and 89.6% of SC pediatricians valued the physical activity of the patients; 85.19% and 35.4% of them, respectively, the intake of dairy products. 45.68% of PC and 70.2% of SC recommended calcium and vitamin D supplements in the case of low nutritional intake, whereas 39.2% of PC and 47.2% of SC favored follow-up. 39.6% of SC pediatricians requested bone densitometry for this disease or risk treatment, and 47.9% measured the levels of 25-OH-vitamin D. 25.93% of PC and 45.3% of SC asked about the existence of fractures, 90.4% and 96.8% requested etiopathogenic mechanism. 40% of PC and 86.2% of SC requested a bone densitometry or referred to the specialist for fractures due to low trauma energy, with specific criteria in 13.7% and 5.86%, respectively. 92% of PC and 82.3% of SC had not received recent training in childhood osteoporosis. Conclusion: Detection, derivation circuits and the training of pediatricians regarding bone health in our country can be improved. Optimizing these aspects is essential to favor the peak of bone mass in our population

Effectiveness and safety of bisphosphonates therapy in secondary osteoporosis in children.

There are few studies on effectiveness and safety of bisphosphonate therapy in secondary osteoporosis in children. The aim of this research was to analyse effectiveness and safety of bisphosphonates in secondary osteoporosis in children. Multicentre retrospective study in patients younger than 18 suffering from secondary osteoporosis and who have received bisphosphonates. Clinical data were recorded. Bone mineral density (BMD) was assessed in terms of BMD Z-score in lumbar spine (ZBMDls) measured by dual-energy X-ray absorptiometry (DXA). Effectiveness was valued at changes in ZBMDls one and two years after the onset of bisphosphonates and at the decrese in the number of fractures a year. Adverse events reported were recorded. Descriptive and bivariant analysis was performed. 32 patients were recruited. ZBMDls increased one year after the onset of treatment ((-2.46 ± 0.96) vs. (-1.54 ± 1.38); p Bisphosphonates are effective in secondary osteoporosis in children. Response seems to be better in patients who are able to walk, well-nourished and in the early stages of the disease. Adverse events were frequent but mild