Bone turnover markers in Spanish adult men The Camargo Cohort Study

BACKGROUND. This cross-sectional study was performed to determine the reference ranges for two bone turnover markers -aminoterminal propeptide of type I collagen (P1NP) and C-terminal telopeptide of type I collagen (-CTX)- in normal adult Spanish men as measured in serum by automated methods. METHODS. A community-based population of 660 healthy men ≥ 50 years was evaluated. Fasting serum levels of P1NP, -CTX, 25-hydroxivitamin D, and intact parathyroid hormone were measured on the Elecsys 2010 automated analyzer (Roche). BMD at lumbar spine, femoral neck and total hip was determined by DXA. RESULTS. Mean age of participants was 65±9 yrs. Logarithmic transformation of both markers was performed to allow for normal distribution. Mid-95% ranges for P1NP and -CTX were 15-78 ng/ml and 0.069-0.760 ng/ml, respectively. Median and interquartile range of serum P1NP and -CTX were 33.5 [25.5;44.4] ng/ml and 0.27 [0.19;0.38] ng/ml, respectively. Mean values of P1NP (37.1±16.7 ng/ml) were similar to those previously described. -CTX mean values (0.300±0.171 ng/ml) were also similar to those quoted by the manufacturers in men younger than 70 yrs, but slightly lower than those reported in subjects older than 70 yrs. Both markers were higher among osteoporotic men. After excluding from the analysis those men who were found to have BMD below -2.5 T-score, 25OHD serum level below 30 ng/ml or serum PTH above 65 pg/ml, P1NP and -CTX ranges were 17-71 ng/ml and 0.070- 0.681 ng/ml, again respectively. CONCLUSIONS. Values obtained from this well-characterized population study provide reference ranges for serum automated P1NP and -CTX in normal Spanish adult men

Trabecular bone score and bone turnover markers in men with DISH: Data from the Camargo Cohort study

Objective: Diffuse idiopathic skeletal hyperostosis (DISH) has been associated with an increased risk of vertebral fracture. To date, no studies have investigated the relationship between DISH and bone microstructure assessed by the trabecular bone score (TBS). Methods: Cross-sectional study, nested in a prospective population-based cohort. All men (968) aged?50 years were included. Clinical covariates, DISH, TBS, serum bone turnover markers and bone mineral density (BMD) were analyzed. Results: Mean age of participants was 65 ± 9 years. 207 (21.6%) had DISH. DISH subjects were older, had higher body mass index (BMI) and abdominal perimeter, lower glomerular filtration rate (GFR), and higher prevalence of metabolic syndrome (MetS) than non-DISH (NDISH) subjects. Bone mineral density at the lumbar spine (LS-BMD) was significantly higher in the DISH group. TBS values were 1.317 [1.303-1.331] for DISH and 1.334 [1.327-1.341] for NDISH subjects, after adjusting by age, BMI, abdominal perimeter, arterial hypertension, diabetes mellitus, MetS, GFR, serum alkaline phosphatase (ALP), LS and femoral neck BMD (p = 0.03). Serum ALP levels were higher in DISH subjects, showing an inverse correlation with TBS that remained significant after adjusting by age and BMI. Conclusions: TBS values were significantly lower in men with DISH irrespective of age, BMI and BMD, suggesting that the presence of DISH might be related to a worse trabecular microstructureThe study has been funded by grants from the Instituto de Salud Carlos III (PI18/00762), Ministerio de Ciencia, Innovacion y Universidades, Spain, that included FEDER funds from the EU

Prevalence of vertebral fracture and densitometric osteoporosis in Spanish adult men: The Camargo Cohort Study

The aim of this study was to assess the prevalence of densitometric osteoporosis and vertebral fractures in Spanish men aged ?50 years, and to study how the relationship between them may change depending on how osteoporosis is diagnosed. A community-based population of 1003 men aged ?50 years was studied. Bone mineral density (BMD) was measured by DXA at the lumbar spine, femoral neck and total hip. Vertebral fractures were assessed by lateral thoracic and lumbar spine radiographs. The prevalence of osteoporosis was estimated with both the World Health Organization (WHO) (T-score of 70 years with the WHO criterion, and showed no change using the NOF definition. The prevalence of osteoporosis in Spanish men using the WHO definition is too small to have any meaningful clinical use. Although the figure is higher using the NOF definition, it would seem that population-based studies of BMD in men are of questionable value.Funded by grants from the Instituto de Salud Carlos III (PI15/00521), and the National Network for Aging Studies (RETICEF, Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad) (RD12/0043/0009), that included FEDER funds from the EU, Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Spain

Reliability of the Lane method in X-ray evaluation of spondyloarthritis

Objetivo. La escala de Lane es un método ampliamente utilizado en la evaluación de la espondiloartrosis radiológica. Diseñada para el nivel lumbar, analiza la osteofitosis (OF) y la disminución del espacio intervertebral (DEI). Los escasos datos sobre concordancia interobservador usando este método señalan un acuerdo elevado, que disminuye al evaluar la artrosis torácica. El objetivo ha sido conocer en detalle el grado de fiabilidad que aporta esta escala en la columna torácica (CT) y lumbar (CL). Material y método. 3 observadores evaluaron 110 radiografías laterales de CT y CL de 55 sujetos. En cada par de observadores fueron analizadas 4 imágenes (OF-CT, OF-CL, DEI-CT, DEI-CL); se calcularon 3 coeficientes: el kappa ponderado (KP) y Tau-B de Kendall (ambos, con valor máximo ideal = 1) y la distancia al máximo kappa alcanzable (DMK) (con valor ideal = 0). Se realizó asimismo un análisis de las discrepancias. Resultados. El mayor grado de acuerdo fue observado al evaluar la DEI-CL (KP=0,80- 0,82; Tau-B=0,73-0,77), mientras que el menor acuerdo fue observado al evaluar la DEI-CT (KP=0,60-0,76; Tau-B=0,50-0,72). El valor de DMK osciló entre 0,06 (OF-CT) y 0,43 (DEI-CT). Conclusiones. El método de Lane permite una elevada concordancia entre observadores; es más fiable al aplicarse sobre la CL. La fiabilidad disminuye al evaluar la CT, y especialmente la DEI-CT, en que solo cuando la afectación es moderada-grave el acuerdo es similar al observado con las restantes imágenes. Para mejorar el grado de reproducibilidad sobre la CT se puede considerar la utilización de especificaciones descriptivas o de referencias morfométricas radiológicas.Objective. Lane?s scale is a widely used method in the evaluation of radiological spine osteoarthritis on plain radiographs. It was designed for lumbar spine (LS) and is addressed to evaluate osteophytosis (OPH) and disc space narrowing (DSN). Limited data available on reliability of this method indicate a high interobserver agreement, that significantly decreases when evaluating thoracic spine (TS). Our aim was to get a detailed knowledge about the degree of reliability that Lane?s scale provides at TS and LS. Material and method. 3 raters analyzed 110 lateral thoracic and lumbar spine radiographs from 55 participants. Four images (TS-OPH, TS-DSN, LS-OPH, LS-DSN) were analyzed in each pair of raters, calculating 3 coefficients: Weighted kappa (WK) and Kendall?s Tau-B, with an ideal value of 1, and the difference between kappa and maximum attainable kappa (DMK), with an ideal value of 0. An analysis of discrepancies was also performed. Results. The highest level of agreement was observed in LS-DSN (WK=0.80-0.82; Tau- B=0.73-0.77), whereas the least level of agreement was observed in TS-DSN (WK=0.60-0.76; Tau-B=0.50-0.72). The DMK values ranged from 0.06 (TS-OPH) to 0.43 (TS-DSN). Conclusions. Lane?s method allows a high level of interobserver agreement, being more reliable when evaluating the LS. Reliability decreases when assessing the TS, specially TS-DSN. Only a moderate-severe grade in TS-DSN allows a similar agreement than observed with the other images. Descriptive specifications and morphometric radiological references may be of interest to improve the reliability of this scale when evaluating the TS

Relación entre la espondiloartrosis y la fractura vertebral, en mujeres postmenopáusicas y varones mayores de 50 años

RESUMEN: Algunos estudios biomecánicos han sugerido la implicación de los cambios artrósicos de la columna como factor de riesgo local de la fractura vertebral (FV). Se realizaron dos estudios de casos-controles (varones [N=507] y mujeres [N=441, apareadas 1:2 según la edad]). La espondiloartrosis y la FV fueron evaluadas sobre imágenes radiológicas, y se analizaron asimismo variables antropométricas, clínicas y densitométricas. Se obtuvieron modelos validados de regresión múltiple. La osteofitosis, la disminución del espacio intervertebral (DEI) y la FV mostraron una distribución bifásica, con picos de frecuencia coincidentes en la zona torácica media. La osteofitosis (odds ratio[OR]=1,84, IC95% 1,05-3,17, en los varones, y OR=2,21, IC95% 1,25-3,93 en las mujeres) y la DEI torácicas (OR=2,52, IC95% 1,43-4,46 en los varones, y OR=1,80, IC95% 1,03-3,16 en las mujeres) se asociaron de forma independiente a un mayor riesgo de FV, tras ajustar por la edad, la densidad mineral ósea y el resto de variables analizadas.ABSTRACT: Several biomechanical studies have pointed out the implication of the osteoarthritic changes of the spine as a local risk factor of vertebral fracture (VF). Two studies of cases-controls were conducted (males [N=507] and women [N=441, paired 1:2 according to age]). Osteoarthritis and VF were evaluated on radiological images. Other anthropometric, clinical and densitometric variables were analyzed. We obtained two validated models of multiple regression. The osteophytosis, the disc space narrowing (DSN) and the VF showed a biphasic distribution, with coincident peaks of frequency in the middle-thoracic zone. In the thoracic spine, both osteophytosis (odds ratio [OR] =1,84, CI 95% 1,05-3,17 in men and OR=2,21, CI 95% 1,25-3,93 in women) and DSN (OR=2,52, CI 95% 1,43-4,46 in men and OR=1,80, CI 95% 1,03-3,16 in women) showed an independent relationship to the risk of VF, after adjusting by age, bone mineral density and the other variables

Manejo de grúas en centros de atención a personas dependientes: Relación entre accidentes y formación de los profesionales

Objective: The objective was to determine the training degree of professionals in Dependency Care Centers (DCC) in the use of Lift Systems for patients (LS), and to check if there is a relationship between the degree of training and accidents occurred. Method: Survey study, conducted in 25 care DCC, using an anonymous, self-administered questionnaire with 10 multi-choice closed questions. Descriptive and bivariate analysis with contrast statistics were performed. Results: A total of 635 questionnaires (94% women) were analyzed. 84% handled Lift Systems for patients (LS), and 29.4%> 10 times a day. 22.3% had witnessed or experienced ≥1 accident. 56% had not received formal training. This circumstance was significantly associated with an accident risk in the management of LS [Odds ratio = 1.5 (95% CI: 1.01-2.2); P = 0.045]. Conclusion: It has been observed a high percentage of professionalsObjetivo: Conocer el grado de formación de los profesionales en Centros de Atención a la Dependencia (CAD) en el manejo de grúas de transferencia (GT), y comprobar si existe una relación entre el grado de formación y los accidentes ocurridos. Método: Estudio de encuesta, realizado en 25 CAD mediante un cuestionario, auto-administrado y anónimo, con 10 preguntas cerradas multirrespuesta. Se realizaron análisis descriptivo y bivariante, con estadísticos de contraste. Resultados: Fueron analizados 635 cuestionarios (94% mujeres). 84% manejaba GT, y un 29.4% >10 veces al día. 22.3% había presenciado o sufrido ≥1 accidente. 56% no había recibido formación reglada. Esta circunstancia se asoció de forma significativa con un riesgo de accidente en la manejo de la GT [Odds ratio=1.5 (IC95%:1.01-2.2); p=0.045]. Conclusiones: Se ha observado un elevado porcentaje de profesionales que no ha recibido formación reglada en el manejo de GT, un incremento del riesgo de accidentes en relación con ello, y la ausencia de un profesional de referencia. Los resultados ofrecen una información útil para implementar un futuro programa de formación desde las instituciones

Calidad de vida relacionada con la salud como variable explicativa del consumo de consultas en atención primaria: un análisis por sexo

Background: It is well known the inverse relationship between health-related quality of life (HRQoL) and the use of consultations. However, most studies deal sex as a confounding variable rather than to explicitly investigate sex differences. The study aims to know the influence of HRQoL of the elderly on the use of Primary Care consultations in a sex analysis. Methods: Throughout 2013, 191 women and 155 men aged 65 years or older were enrolled in the study and assessed with interviews and analysis of medical records. We used the EuroQol-5D to assess the HRQoL and several demographic, clinical and social support variables were also analyzed. Two multiple linear regression models were developed. Results: HRQoL showed a negative correlation with the use of consultations (Spearman's rho=-0,22; p=0,0001) and a crude OR value of 1,85 (95% CI:1,2-2,9). The association remained significant after adjusting for demographic [OR=1,99 (95% CI: 1,2-3,2)], clinical [OR=1,79 (95% CI: 1,1-2,9)] or social support covariates [OR=1,83 (95% CI: 1,1-2,9)]. In regression analysis, the values of standardized coefficient (β) related to HRQoL were 0,22 (95% CI:-36,7- -6,9) in females and 0,03 (95% CI:-15,6-23,1) in males. Conclusions: In women ≥65 years, HRQoL shows the greatest explanatory power of use of consultations, after adjusting for demographic, clinical and social support covariates. By contrast, its influence on men is negligible.Fundamentos: Es conocida la asociación inversa que existe entre la calidad de vida relacionada con la salud (CVRS) y el consumo de consultas. Sin embargo, el sexo es considerado habitualmente como variable de confusión, y son escasos los estudios que han analizado explícitamente las diferencias de sexo en esta cuestión. El objetivo fue conocer la influencia de la CVRS sobre el uso de consultas de Atención Primaria en las personas >65 años, en un análisis diferenciado por sexo. Métodos: La selección de participantes se realizó a lo largo de 2013, 191 mujeres y 155 varones de ≥65 años fueron estudiados mediante entrevista y análisis de historias clínicas. Se utilizó el Cuestionario EuroQol-5D y fueron analizadas variables demográficas, clínicas y de apoyo social. Se elaboraron 2 modelos de regresión múltiple, uno dirigido a las mujeres y otro a los varones. Resultados: La CVRS se correlacionó de forma negativa con el consumo de consultas (Rho-Spearman=-0,22; p=0,0001), con una OR cruda de 1,85 (IC95%: 1,2-2,9). La asociación se mantuvo significativa al ajustar tanto por variables demográficas [OR=1,99 (IC95%: 1,2-3,2)], como por variables clínicas [OR=1,79 (IC95%: 1,1-2,9)] o de apoyo social [OR=1,83 (IC95%: 1,1-2,9)]. En el análisis de regresión, los valores del coeficiente estandarizado (β) asociado a la CVRS fueron 0,22 (IC95%: -36,7- -6,9) en las mujeres, y 0,03 (-15,6-23,1) en los varones. Conclusiones: En las mujeres de ≥65 años la CVRS es la variable con mayor capacidad explicativa de consumo de consultas, tras ajustar por variables demográficas, clínicas y de apoyo social. Por el contrario, en los varones su influencia es prácticamente nula

Calidad de vida relacionada con la salud (CVRS) en la hipertensión arterial: Un análisis diferenciado por género sobre población de Cantabria

Background: Hypertension is a major public health problem due to its high prevalence and morbi-mortality. It is associated with a worse health-related quality of life (HRQOL). The aim has been to know the HRQOL of the hypertensive population in a gender-differentiated analysis. Methods: Cross-sectional study. Hypertensive patients attended in Primary Care were enrolled in the study. We evaluated HRQOL (using the EuroQol-5D questionnaire), four covariates related to hypertension (degree of control, duration of disease, use of antihypertensive drugs and target organ damage -TOD-), and sociodemographic, lifestyle and clinical variables. Bivariate analysis was performed and two multivariate models were developed, with the EuroQol-5D index (iEQ) as the dependent variable. Results: We analyzed 198 women (55.7%) and 157 men. Significantly, females had a lower educational level, spent more time alone, consumed more psychotropic medication, their iEQ was lower [0.887 (0.2) vs. 0.914 (0.1); p=0.0001] and scored worse in self-care, usual activities, pain / discomfort and anxiety / depression. In women, no variable related to hypertension presented a significant association with the iEQ after adjusting for confounders, and functional capacity was the most important covariate (β=0.35; p=0.0001). In males, TOD (β=0.18) and duration of the disease (β=0.16) were significantly associated with the iEQ, with the consumption of psychotropic medication being the most relevant covariate in the regression model (β=0.42; p=0.005). Conclusions: Notable differences in HRQOL of women and men with hypertension have been noted. Detecting these differences allows us to know the frailest states of our patients.Fundamentos: La hipertensión arterial (HTA), por su elevada prevalencia y morbimortalidad, es un importante problema de Salud Pública. Se asocia a una peor calidad de vida relacionada con la salud (CVRS). El objetivo de este trabajo fue conocer la CVRS de la población hipertensa en un análisis diferenciado por género. Métodos: Se realizó un estudio transversal. Participaron cinco cupos de Medicina de Familia. Se evaluó la CVRS (mediante el cuestionario EuroQol-5D), cuatro variables relacionadas con la HTA (grado de control, duración de la enfermedad, uso de fármacos antihipertensivos y lesión de órgano diana -LOD-), variables sociodemográficas, de estilo de vida y clínicas. Se realizó análisis bivariado y se elaboraron dos modelos multivariados, con el índice EuroQol-5D (iEQ) como variable dependiente. Resultados: Fueron analizadas 198 mujeres (55,7%) y 157 varones. Las mujeres, significativamente, tenían menor nivel educativo, pasaban más tiempo solas, consumían más psicofármacos, su iEQ fue menor (0,887 [0,2] frente a 0,914 [0,1]; p=0,0001) y puntuaron peor en cuidado personal, actividades cotidianas, dolor/malestar y ansiedad/ depresión. En las mujeres, tras ajustar por confusores, ninguna variable relacionada con la HTA presentó una asociación significativa con el iEQ, y la capacidad funcional fue la variable más importante (β=0,35; p=0,0001). En los varones, la LOD (β=0,18) y la duración de la HTA (β=0,16) se asociaron significativamente con el iEQ, siendo el consumo de psicofármacos la variable más relevante del modelo de regresión (β=0,42; p=0,005). Conclusiones: Se observan notables diferencias en la CVRS de las mujeres y los varones con HTA. Detectar dichas diferencias permite conocer los perfiles más frágiles de nuestros pacientes

Health-related quality of life in hypertension: a gender-differentiated analysis in population of Cantabria

Fundamentos: La hipertensión arterial (HTA), por su elevada prevalencia y morbimortalidad, es un importante problema de Salud Pública. Se asocia a una peor calidad de vida relacionada con la salud (CVRS). El objetivo de este trabajo fue conocer la CVRS de la población hipertensa en un análisis diferenciado por género. Métodos: Se realizó un estudio transversal. Participaron cinco cupos de Medicina de Familia. Se evaluó la CVRS (mediante el cuestionario EuroQol-5D), cuatro variables relacionadas con la HTA (grado de control, duración de la enfermedad, uso de fármacos antihipertensivos y lesión de órgano diana -LOD-), variables sociodemográficas, de estilo de vida y clínicas. Se realizó análisis bivariado y se elaboraron dos modelos multivariados, con el índice EuroQol-5D (iEQ) como variable dependiente. Resultados: Fueron analizadas 198 mujeres (55,7%) y 157 varones. Las mujeres, significativamente, tenían menor nivel educativo, pasaban más tiempo solas, consumían más psicofármacos, su iEQ fue menor (0,887 [0,2] frente a 0,914 [0,1]; p=0,0001) y puntuaron peor en cuidado personal, actividades cotidianas, dolor/malestar y ansiedad/depresión. En las mujeres, tras ajustar por confusores, ninguna variable relacionada con la HTA presentó una asociación significativa con el iEQ, y la capacidad funcional fue la variable más importante (B=0,35; p=0,0001). En los varones, la LOD (B=0,18) y la duración de la HTA (β=0,16) se asociaron significativamente con el iEQ, siendo el consumo de psicofármacos la variable más relevante del modelo de regresión (β=0,42; p=0,005). Conclusiones: Se observan notables diferencias en la CVRS de las mujeres y los varones con HTA. Detectar dichas diferencias permite conocer los perfiles más frágiles de nuestros pacientes.Background: Hypertension is a major public health problem due to its high prevalence and morbi-mortality. It is associated with a worse health-related quality of life (HRQOL). The aim has been to know the HRQOL of the hypertensive population in a gender-differentiated analysis. Methods: Cross-sectional study. Hypertensive patients attended in Primary Care were enrolled in the study. We evaluated HRQOL (using the EuroQol-5D questionnaire), four covariates related to hypertension (degree of control, duration of disease, use of antihypertensive drugs and target organ damage -TOD-), and sociodemographic, lifestyle and clinical variables. Bivariate analysis was performed and two multivariate models were developed, with the EuroQol-5D index (iEQ) as the dependent variable. Results: We analyzed 198 women (55.7%) and 157 men. Significantly, females had a lower educational level, spent more time alone, consumed more psychotropic medication, their iEQ was lower [0.887 (0.2) vs. 0.914 (0.1); p=0.0001] and scored worse in self-care, usual activities, pain / discomfort and anxiety / depression. In women, no variable related to hypertension presented a significant association with the iEQ after adjusting for confounders, and functional capacity was the most important covariate (B=0.35; p=0.0001). In males, TOD (B=0.18) and duration of the disease (B=0.16) were significantly associated with the iEQ, with the consumption of psychotropic medication being the most relevant covariate in the regression model (B=0.42; p=0.005). Conclusions: Notable differences in HRQOL of women and men with hypertension have been noted. Detecting these differences allows us to know the frailest states of our patients