Hasil untuk "Osteopathy"

E. Silva, D. Madsen

This article investigates the popularity of Integrative and Complementary Health Practices by analyzing internet search behavior during distinct periods. The objective was to examine the public’s interest in searching for these practices before and during the covid-19 pandemic in Brazil, using data from Google Trends. Quantitative digital analysis methods were applied to assess the relative volume of searches in 2019 and 2020. Subsequently, a paired t-test was conducted to identify significant differences in search activity. The practices that showed an increase in average search volume were ayurveda, phytotherapy, medicinal plants, chiropractic, and yoga. In contrast, acupuncture, homeopathy, meditation, osteopathy, ozone therapy, and reiki showed a decrease. The study reveals that internet users expressed interest in these approaches, with variations depending on the specific modality. Among them, yoga stood out with a significant increase, suggesting heightened relevance during the pandemic period.

Christopher R. Stephenson, Jayawant N. Mandrekar, Thomas J. Beckman et al.

Abstract Background The U.S. News & World Report has used the Doximity social networking site to determine rankings for 27 medical specialties, which influence medical students' choices. Despite concerns about the validity of these rankings, few studies have explored whether Doximity rankings correlate with program characteristics. We aim to determine associations between Doximity internal medicine reputation rank and publicly available program characteristics. Methods We performed a cross-sectional study of the 566 internal medicine residencies with a Doximity reputation rank from 2020. Doximity rankings were linked with publicly available sources, including the American Medical Association’s FREIDA, the American Board of Internal Medicine, the Accreditation Council for Graduate Medical Education, the Centers for Medicare and Medicaid Services Quality System, and U.S. News Best Hospitals Ranking. Variables included resident demographics, faculty characteristics, and program features. Statistical analyses involved univariable and multivariable linear regression. Results In multivariable analysis (parameter estimate ± standard error), higher ABIM pass rates (-1.30 ± 0.41), higher physician faculty-to-resident ratios (-14.10 ± 4.45), older programs (-1.07 ± 0.25), availability of research rotations (-38.56 ± 16.23), and larger program sizes (-1.09 ± 0.16) were associated with better Doximity ranks. Conversely, a higher percentage of international medical graduates (1.07 ± 0.19) and Doctors of Osteopathy (1.12 ± 0.27) were linked to lower rankings. Variables had an adjusted R2 of 0.53. Conclusions Doximity rankings were positively associated with publicly available characteristics of residency programs including higher ABIM pass rates, lower physician faculty-to-resident ratio, older program age, availability of a research rotation, and larger program size. Doximity rankings were negatively associated with a higher percentage of IMG and DO residents. These findings suggest that while Doximity rankings may be influenced by larger program sizes and higher self-reporting rates, they may also reflect meaningful indicators of program quality. The findings highlight the importance of research productivity and faculty ratios in enhancing program reputation and underscore potential disadvantages for community-based programs.

Julie Ellwood, Kesava Kovanur Sampath, Iryna Rund et al.

Abstract Background Infantile asymmetries of posture, movement and/or shape are common. Coincidence in the presentation of asymmetrical features can lead to a broad spectrum of descriptors. Published guidelines on prevention strategies are not currently available. The objective of this systematic review was to find, evaluate, and synthesise the available evidence regarding the effectiveness of prevention strategies for infantile asymmetries, specifically strategies involving paediatric screening and/or guidance to parents. Methods This review has been reported based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the review protocol was prospectively registered on the Open Science Framework, ( https://osf.io/rgzev/ ). Searches were conducted on Ovid Medline, Ovid AMED, and PEDro. Inclusion criteria of articles were infants < 28 weeks old who had received either an early musculoskeletal screen and/or education to parents on home care guidance/exercises to prevent asymmetry development. Any primary research was included. There was no limit placed upon date of publication. Data were screened, extracted and appraised in duplicate by at least two blinded reviewers. The Cochrane Collaboration's tool for assessing risk of bias available as part of Covidence was used by two reviewers independently. Results Of the 878 papers retrieved, 19 studies were included: 9 randomised controlled trials, 6 cohort studies and 4 non-randomised experimental studies. The presenting conditions included head shape asymmetry in 16/19 studies, cervical range of motion in 10 studies and positional preference in 3. Due to a lack of homogeneity between all the studies, it was not possible to pool the data and conduct meta-analysis. Guidance strategies show better outcomes in asymmetry prevention when provided early (< 3 months) and under supervision of a healthcare professional. The overall risk of bias for cohort and non-randomised experimental studies was considered to be ‘low’, and ‘adequate’ or ‘low’ for randomised controlled trials. The GRADE level of evidence was found to be ‘very low’. Conclusion Early parental guidance may prevent infantile asymmetry when supervised by a trained healthcare professional and with good adherence from parents. Further studies with a higher methodological rigour are needed to identify and perform comparative interventions. Clinical Trial Number Not applicable. OSF number https://doi.org/10.17605/OSF.IO/RGZEV .

Carla Vanti, Matteo Golfari, Giacomo Pellegrini et al.

Background: Osteopathic manual procedures called pump techniques include thoracic, abdominal, and pedal pumps. Similar techniques, called pompages, are also addressed to joints and muscles. Despite their widespread use, no systematic review has been published on their effectiveness. (2) Methods: CINAHL, Cochrane Controlled Trials Register, ISI Web of Science, PEDro, PubMed, and Scopus databases were searched until July 2020. Randomized Controlled Trials (RCTs) on adults were included. Subjective (e.g., pain, physical function) and objective (e.g., pulmonary function, blood collection) outcomes were considered. The Risk of Bias tool (RoB 2) and the GRADE instrument were used to evaluate the quality of evidence. (3) Results: 25 RCTs were included: 20 concerning the pump techniques and five concerning pompages. Due to the extensive heterogeneity of such studies, it was not possible to perform a meta-analysis. The risk of bias resulted from moderate to high and the quality of the evidence was from very low to high. Singular studies suggested some effectiveness of pump techniques on pain and length of hospitalization. Pompage seems also to help improve walking distance and balance. (4) Conclusions: Although several studies have been published on manual pump techniques, the differences for population, modalities, dosage, and outcome measures do not allow definite conclusions of their effectiveness.

Olga O. Golounina, Valentin V. Fadeev, Zhanna E. Belaya

Aging is a multi-factor biological process that inevitably affects everyone. Degenerative processes, starting at the cellular and molecular levels, gradually influence the change in the functional capabilities of all organs and systems. Progeroid syndromes (from Greek. progērōs prematurely old), or premature aging syndromes, represent clinically and genetically heterogeneous group of rare hereditary diseases characterized by accelerated aging of the body. Progeria and segmental progeroid syndromes include more than a dozen diseases, but the most clear signs of premature aging are evident in Hutchinson-Guilford Progeria Syndrome and Werner Syndrome. This review summarizes the latest scientific data reflecting the etiology and clinical picture of progeria and segmental progeroid syndromes in humans. Molecular mechanisms of aging are considered, using the example of progeroid syndromes. Modern possibilities and potential ways of influencing the mechanisms of the development of age-related changes are discussed. Further study of genetic causes, as well as the development of treatment for progeria and segmental progeroid syndromes, may be a promising direction for correcting age-related changes and increasing life expectancy.

Torrubia B, Martín Fernández M, Rubert M et al.

Objetivo: El bazedoxifeno es un SERM de 3ª generación con efectos agonistas sobre el hueso y sobre el útero y el tejido mamario. Nuestro objetivo ha sido estudiar los efectos del bazedoxifeno sobre la calidad ósea en un modelo experimental de ratas ovariectomizadas. Material y métodos: Se utilizaron 3 grupos de 15 ratas Wistar hembras de 6 meses de edad: uno control; otro de ratas ovariectomizadas; y un tercer grupo de ratas ovariectomizadas tratadas con bazedoxifeno (0,33 mg/kg/día). Tras 8 meses se estudiaron la densitometría ósea lumbar y femoral, los parámetros microtomográficos, los marcadores bioquímicos de remodelado y los parámetros biomecánicos del hueso. Resultados: La ovariectomía descendió la densidad ósea femoral y lumbar. La última se recuperó parcialmente con bazedoxifeno. El remodelado óseo aumentó, recuperando el bazedoxifeno los niveles de formación. El bazedoxifeno recuperó la fracción volumétrica ósea (BV/TV), la densidad de superficie ósea (BS/TV), el aumento en la separación trabecular (Tb.Sp), la disminución en el número de trabéculas (Tb.N), el aumento del factor de patrón trabecular (Tb.Pf) y el índice de modelo estructural (SMI). La superficie relativa cortical aumentó tras la ovariectomía, normalizándose con bazedoxifeno. También recuperó la deformación máxima antes de la rotura producida por la ovariectomía, y amortiguó parcialmente la ganancia de peso de las ratas ovariectomizadas. Conclusiones: Nuestro estudio muestra resultados positivos del bazedoxifeno sobre la calidad ósea. Este fármaco podría estar especialmente indicado para mujeres jóvenes postmenopáusicas con osteoporosis o en riesgo de padecerla.

Elham HASSAN, Faisal TORAD, Ashraf ABU-SEIDA et al.

Hypertrophic osteodystrophy is a developmental disease of unknown etiology and affects primarily young rapidly growing large and giant breed dogs. The present study reports a case of mandibular hypertrophic osteodystrophy fibrosa in a 6-month-old male German shepherd puppy admitted with a history of one month decreased appetite, difficulty in chewing, and open mouth with continuous drooling. Clinical examination revealed thickened mandible and filling of the intermandibular space with hard tissue. Radiography revealed bone-like material filling the intermandibular space. Biopsy from the thickened mandibular mass demonstrated marked osteoclastic activity and resorption of bone trabeculae that were replaced by fibrous connective tissue. The marrow cavity was filled with massive fibrous tissue mixed with hemorrhage and osteoclasts. Hypertrophic osteodystrophy fibrosa should be taken into consideration in dogs with mandibular masses. Radiography and histologic evaluation are suitable tools to differentiate hypertrophic osteodystrophy. fibrosa from mandibular neoplasms and cranio-mandibular osteopathy.

Alexandra A. Petrushkina, Ekaterina A. Pigarova, Liudmila Y. Rozhinskaya

In this review, we discuss the main reasons for the vitamin D insufficiency in Russian Federation, as well as data on the prevalence of vitamin D deficiency among various population groups and regions, which confirm the widespread prevalence of vitamin D deficiency in the country. The discussed data suggest that the current vitamin D insufficiency in Russian population (reduced levels of 25(OH)D occurs in 50 - 94% of general population) is due to both a low level of its endogenous synthesis and insufficient intake from food : the territory of the country is located in a zone of low insolation, and at the same time, the main natural sources of vitamin D (sea fish of fatty varieties) and fortified with vitamin D products are very limited in the diet of the population. Taking measures to improve the status of vitamin D and maintaining the optimal serum levels of 25(OH)D in children and adults, adequate vitamin D intake will improve the condition of the musculoskeletal system, as well as reduce the risk of development and improve the control of some chronic diseases.

R Hurtado García, E Nortes Cañizares, JA Ruiz Maciá et al.

Brett Vaughan

Abstract Background Clinical teaching evaluations are common in health profession education programs to ensure students are receiving a quality clinical education experience. Questionnaires students use to evaluate their clinical teachers have been developed in professions such as medicine and nursing. The development of a questionnaire that is specifically for the osteopathy on-campus, student-led clinic environment is warranted. Previous work developed the 30-item Osteopathy Clinical Teaching Questionnaire. The current study utilised Rasch analysis to investigate the construct validity of the Osteopathy Clinical Teaching Questionnaire and provide evidence for the validity argument through fit to the Rasch model. Methods Senior osteopathy students at four institutions in Australia, New Zealand and the United Kingdom rated their clinical teachers using the Osteopathy Clinical Teaching Questionnaire. Three hundred and ninety-nine valid responses were received and the data were evaluated for fit to the Rasch model. Reliability estimations (Cronbach’s alpha and McDonald’s omega) were also evaluated for the final model. Results The initial analysis demonstrated the data did not fit the Rasch model. Accordingly, modifications to the questionnaire were made including removing items, removing person responses, and rescoring one item. The final model contained 12 items and fit to the Rasch model was adequate. Support for unidimensionality was demonstrated through both the Principal Components Analysis/t-test, and the Cronbach’s alpha and McDonald’s omega reliability estimates. Analysis of the questionnaire using McDonald’s omega hierarchical supported a general factor (quality of clinical teaching in osteopathy). Conclusion The evidence for unidimensionality and the presence of a general factor support the calculation of a total score for the questionnaire as a sufficient statistic. Further work is now required to investigate the reliability of the 12-item Osteopathy Clinical Teaching Questionnaire to provide evidence for the validity argument.

Roca-Ayats N, Cozar Morillo M, Gerousi M et al.

FLJ42280 es un posible gen de susceptibilidad a la osteoporosis. Distintos estudios de GWAs han identificado 4 SNPs no-codificantes en este gen que se asocian a la densidad mineral ósea (DMO) y el riesgo de fractura. Para descubrir la causa de la asociación entre estos SNPs y la osteoporosis, se realizó una búsqueda de variantes genéticas mediante resecuenciación de 28 kb que contienen el gen, en una selección truncada de mujeres con DMO muy baja (n=50) o muy alta (n=50) de la cohorte BARCOS (Barcelona Cohorte Osteoporosis, cohorte de mujeres postmenopáusicas de Barcelona). Las variantes encontradas se filtraron y se analizó su frecuencia en cada grupo. Se analizó el solapamiento de las variantes con elementos funcionales del proyecto ENCODE y también se calculó el desequilibrio de ligamiento entre los SNPs de la región. Finalmente, se hizo un análisis de eQTL de los 4 SNPs no-codificantes respecto a los niveles de expresión de genes cercanos a FLJ42280 en linfoblastos. Se seleccionaron 110 variantes. Las diferencias de sus frecuencias entre los dos grupos estuvieron por debajo del poder estadístico del diseño experimental. Sin embargo, 3 variantes solaparon con posibles enhancers y una solapó con un enhancer activo en osteoblastos (rs4613908). Se observó un fuerte desequilibrio de ligamiento entre los 4 SNPs no-codificantes y el SNP rs4613908, que pertenecen a un bloque que abarca el gen casi por completo. Ninguno de los SNPs no-codificantes mostró asociación con los niveles de expresión de genes cercanos a FLJ42280. En conclusión, el SNP rs4613908 podría estar implicado funcionalmente en la determinación de la DMO. Serán necesarios experimentos concretos para confirmarlo.

E R FARShATOVA, I A MEN'ShIKOVA, T I GANEEV et al.

Исследование содержания ряда элементов в волосах горняков ОАО «Учалинский ГОК», добывающих медно-цинковую руду подземным способом, выявило статистически значимое увеличение содержания ряда тяжелых металлов [Кудашева, 2005; Аглетдинов и др., 2011] характеризуя их поступление и накопление в тканях. При длительном введении порошка руды экспериментальным животным также установлено значительное увеличение содержания этой группы элементов в костях [Нургалеев и др., 2013], что сопровождалось усилением оксидативных процессов. Клетки дифферона мононуклеарных фагоцитов костной ткани -остеокласты чувствительно реагируют на воздействие химических соединений и в процессе активного функционирования высвобождают ряд ферментов, которые генерируют в зоне резорбции супероксидный анион-радикал [Vääräniemi et al., 2004], и усиление свободно-радикального окисления в костной ткани может быть отражением интенсификации резорбтивных процессов при действии полиэлементов руды цветных металлов. Цель. Изучение уровня маркеров остеобластогенеза и остеокластогенеза при действии полиэлементов медно-цинковой колчеданной руды. Материал и методы. 20 белым половозрелым самцам крыс опытной группы в течение трех месяцев ежедневно внутрижелудочно вводили суспензию порошка руды в 2% растворе крахмала из расчета 60 мг/100г массы, 12 крыс идентичной массы (220-240г) получали ежедневно раствор крахмала. В трубчатых костях (бедренная, большеберцовая и плечевая) через 1,2 и 3 месяца интоксикации рудой определяли содержание Fe, Mg, Mn, Hg, Sr, Cr методом атомно-абсорбционной спектрометрии и Cu, Zn, Cd b Pb вольтамперометрическим методом. В плазме крови на 3-й месяц эксперимента изучили содержание растворимого лиганда ядерного фактора транскрипции каппа Б (s RANKL), остеопротегерина (OPG) - ложного рецептора RANKL и склеростина, используя соответствующие наборы реагентов (Biomedica, Medizinproducte Gmb), костной щелочной фосфатазы (КЩФ, «Quidel Corporation»)). В группах рассчитывали медиану, межквартальные интервалы, достоверность межгрупповых различий оценивали по U-критерию Манна-Уитни. Результаты. Определение ряда элементов в кости выявило, что содержание Mn, Sr, Fe, Cu, Zn, Cd, Pb и Hg повышается к концу 3-го месяца эксперимента у опытной группы крыс значительно (от 1,5 до 5 раз), Cr увеличивается незначительно, а Mg снижается. При этом уровень Fe и Mn увеличивается уже через 1 месяц интоксикации, а затем не подвергается статистически значимым изменениям. Другие элементы накапливаются, достигая максимального уровня лишь к концу третьего месяца. Содержание s RANKL в плазме крови животных при действии полиэлементов руды практически не изменялось, составляя 0,6 [0,12;1,29] пмоль/л в контроле и 0,63 [0,45; 0,75] пмоль/л в опытной группе. Аналогичная динамика выявилась и при определении КЩФ: 4,5 [1,6;6,9] Е/л и 5,0 [3,8;6,3] Е/л соответственно, р=0,42, а содержание OPG снижалось с 0,41 [0,4;0,44] пмоль/л до 0,3 [0,26;0,38] пмоль/л, р=0,043. Коэффициент sRANKL/OPG, характеризующий общее «конвергентное» соотношение про- и антирезорбтивных регуляторов остеокластной дифференцировки и активации остеокластов [Hobauer, 2009], повышается. У животных контрольной группы он составляет 1,46 [1,2;1,51], у опытной группы - 2,1 [1,84;2,33], р=0,041, что отражает интенсификацию процессов остеокластогенеза и резорбции. Уровень склеростина у опытной группы животных повышался с 12,3 [12,0;12,6] пмоль/л до 14,2 [12,5;14,7], р=0,046. Склеростин, вырабатываемый остеоцитами и гипертрофированными хондроцитами, является негативным регулятором остеобластогенеза [Bernardes et al., 2013], и его повышение свидетельствует об ингибировании костного дифферона. Выводы. Полиэлементы медно-цинковой колчеданной руды, накапливаясь в костной ткани, приводят к активации остеокластического дифферона на фоне некоторого подавления костного дифферона (остеобластогенеза).

L A MARChENKOVA, IV KRYuKOVA, M Yu GERASIMENKO

Цель исследования: сравнение частоты остеопоротических переломов проксимального отдела бедра и дистального отдела предплечья среди мужского и женского населения Московской области в возрасте 50 лет и старше за периоды 1998-2002 гг. и 2009-2013 гг. Материал и методы: проведено ретроспективно-проспективное сравнительное исследование частоты переломов среди населения Коломенского района в возрасте 50 лет и старше, расположенного на юго-востоке Московской области, общая численность которого составляет около 190 000 человек. Анализировалась вся медицинская документация травматологического отделения и травматологического пункта Коломенской центральной районной больницы, оказывающей медицинскую помощь всему населению Коломенского района, за два пятилетних периода: исходно в 19982002 гг. и далее в динамике в 2009-2013 гг. Регистрировались все случаи переломов проксимального отдела бедра и дистального отдела предплечья, случившиеся в периоды исследования. Частота переломов рассчитывалась на 100 000 мужского и женского населения района. Результаты: в 1998-2002 гг. было зарегистрировано 527 переломов проксимального отдела бедра (142 у мужчин и 385 у женщин) и 2420 переломов дистального отдела предплечья (325 у мужчин и 2095 у женщин). В период сравнения 2009-2013 гг. - 630 переломов проксимального отдела бедра (227 у мужчин и 403 у женщин) и 5204 переломов дистального отдела предплечья (2019 у мужчин и 3185 у женщин). У мужчин отмечалась тенденция к снижению частоты перелома проксимального отдела бедра в период с 20092013 гг. с 248,2 в 2009 г. до 123,0 на 100000 населения в 2013г (p>0,05). При этом, средняя частота перелома проксимального отдела бедра у мужчин в 2009-2013 гг. составила 170,8/100000 и имела четкую тенденцию к росту в сравнении с частотой в 1998-2002 гг. - 120,6/100000. При оценке динамики частоты перелома дистального отдела предплечья у мужчин выявлен существенный рост за последние 11 лет в среднем 5,5 раза с 276,1/100000 в 1998-2002 гг. до 1520,8/100000 в 2009-2013 гг. (p<0,05). Средняя частота перелома проксимального бедра у женщин за период 2009-2013 гг. была несколько ниже, чем в ранее оцениваемый временной интервал 1998-2002 гг. и составила соответственно 184,5 против 201,1 на 100 000 населения (p>0,05). Статистически значимых различий средней частоты перелома предплечья среди женского населения за два периода исследования также выявлено не было: в 2009 2013 гг. частота перелома предплечья у женщин составила 1458,5/100 000 населения против 1094,4/100000 в период 1998-2002 гг. (p>0,05). Каких-либо значимых тенденций изменения частоты как перелома проксимального отдела бедра, так и перелома предплечья у женщин в течение периода 2009-2013 гг. не наблюдалось. Выводы: сравнительное ретроспективно-проспективное исследование частоты остеопоротических переломов проксимального отдела бедра и дистального отдела предплечья среди населения Коломенского района Московской области в возрасте 50 лет и старше выявило выраженный рост в 5,5 раза распространенности перелома дистального отдела предплечья у мужчин в 2009-2013 гг. по сравнению с 1998-2002 гг. и отсутствие значимых изменений частоты исследуемых переломов среди женского населения. Полученные данные свидетельствуют о срочной необходимости широкого внедрения комплексных мероприятий по профилактике остеопороза и переломов среди мужского населения старшей возрастной группы.

I A SKRIPNIKOVA, K E SOBChENKO, E S ABIROVA et al.

Objective: To investigate the effect of treatment with betablockers (β-AB), inhibitors of angiotensin converting enzyme (ACEI) on bone mineral density (BMD) depending on the risk factors (RF) of osteoporosis. Material and methods. In a retrospective study included 1129 outpatients (1093 women) aged over 40 years, who had the first DXA examination prior to start of the treatment for osteoporosis. Baseline characteristics of pts including data on osteoporosis risk factors (RF) and medication were obtained at the initial visit which had taken place between 2001 and 2011. BMD at the lumbar spine (LS), femoral neck (FN) and total hip (TH) were measured by DXA (Hologic Delphi W). 384 pts have been taking β-AB, ACEI and their combination not less than 6 months before the DXA examination ("users group”), 745 pts. have not been receiving any therapy ("non-users group”). Results. In the "users group” risk of reduction of BMD was lower than in the non-users [RR=1,6 (95 % CI 1.25-2,022) p<0.001], osteoporosis was diagnosed 1,3 times less frequently, and the BMD in LS, FN and TH were significantly higher than these parameters in "non-users group”. The highest BMD were noted in pts on combined therapy. The risk of BMD reduction not depends in both groups on RF such as age, postmenopause duration, presense of early or surgical menopause, low body weight, physical inactivity, previous fractures, fractures in relatives, rheumatoid arthritis, glucocorticoid use or alcohol abuse. In multivariate regression analysis after adjustment with these RF, BMD at all measured locations in users group maintained significantly higher than in non-users. There was no correlation between BMD and duration of β-AB and ACEI therapy. Conclusion Prolonged use of β-AB, ACEI in combination as well as monotherapy could has a protective effect on bone mass regardless of osteoporosis risk factors.

L A MARChENKOVA, A V DREVAL', M A DOBRITsYNA

Despite high prevalence and severity of complications, osteoporosis (OP) in Russia is still not recognized as a socially significant disease and there are no common standards for prevention of OP and associated fractures. The aim of the study was to investigate the adherence of healthy females to prevention measures of OP and the affecting it factors to develop the principles governing the preventive strategy of OP. Methods. The study is performed in Moscow Region (MR) in a form of a questionnaire survey in the population of adult healthy women aged >20 years. The data are obtained using "Questionnaires on osteoporosis prevention" and "The test of knowledge in the field of osteoporosis" developed in Clinical Research Institution of Moscow Region named after M.F. Vladimirsky. Study comprised 1712 female aged from 20 till 87 years (median 55,0 years [45,0; 44,0]) living in 16 districts and 11 cities of MR. Taking into account the quality of the filling of questionnaires, data provided by 1631 women were included in the statistical analysis. Results. It is established that 31% of female inhabitants of MR are engaged in OP prevention, using for this purpose mainly calcium-containing drugs (64,3%) and increased consumption of calcium in food (59,8%). 93% of these women get preventive therapy at their own expense, spending on them on the average 200 rub a month, and preventive medication has appeared more saving than non-pharmacological preventive measures. Socially active working women at the age of 50-69 years are motivated on prevention of OP better than others. Level of the OP awareness and undertaking densitometry screening also directly influence adherence to OP prevention.

Martínez-Laguna D, Nogués-Solán X, Díez-Pérez A et al.

Fundamento: En fases previas al diagnóstico de diabetes mellitus tipo 2 existe riesgo aumentado de enfermedad cardiovascular, pero se desconoce si esto sucede en lo relativo al riesgo de fracturas. Objetivo: Comparar la prevalencia de fractura en casos incidentes de diabetes mellitus y en controles apareados. Material y método: Estudio de casos-controles anidados en una cohorte de base poblacional. Se incluyó a todos los pacientes diabéticos tipo 2 diagnosticados en el periodo 2006-2011 y, por cada uno, a dos sujetos controles sin diabetes de igual edad, género y centro de salud. Se identificaron en ellos fracturas, accidentes cerebro-vascular y cardiopatía isquémica prevalentes utilizando códigos CIE10. Se calculó la prevalencia de fracturas osteoporóticas, mayores y de cadera, y de enfermedad cardiovascular en el momento del diagnóstico para los sujetos diabéticos, y en esa misma fecha índice para los controles apareados. Mediante regresión logística condicional se calcularon las odds ratios (OR) ajustadas por índice masa corporal, tabaquismo, enolismo, uso de estatinas, enfermedad cardiovascular y complicaciones diabéticas. Resultados: Se identificaron 58.931 pacientes diabéticos y 117.862 controles. En la fecha del diagnóstico, los pacientes diabéticos presentaban mayor prevalencia de accidente cerebro-vascular (4,9% vs. 3,5%; p<0,001) y de cardiopatía isquémica (8,1% vs. 4,7%; p<0,001). Por el contrario, la prevalencia de fractura osteoporótica (2,8% vs. 2,7%; p=0,22), fractura de cadera (0,4% vs. 0,4%; p=0,63) y fractura mayor (1,5% vs. 1,5%; p=0,97) fue similar en ambos grupos. Las OR ajustadas fueron: 1,02 (IC 95%: 0,96-1,09), 1,08 (IC 95%: 0,90-1,28), y 0,99 (IC 95%: 0,91-1,09), respectivamente. Conclusiones: Los pacientes diabéticos tipo 2 presentan mayor prevalencia de enfermedad cardiovascular en el momento del diagnóstico. Sin embargo, su riesgo de fractura es similar al de los sujetos controles no diabéticos.

Fernández-Murga ML, Serna E, Sanz-Salvador L et al.

Fundamento: Los mecanismos que desencadenan la osteogénesis todavía no están aclarados. El objetivo de este estudio fue valorar el papel de estroncio y calcio, aportados en distinto soporte molecular, como inductores de distintos mecanismos de estímulo osteoblástico, incluyendo proliferación, diferenciación y mineralización de células preosteoblásticas. Se investigó también la respuesta global genómica con la técnica de microarray. Métodos: Se diseñó un estudio experimental con células pre-osteoblásticas murinas MC3T3-E1, que fueron estimuladas durante 3 horas y 7 días. Se realizaron estudios bioquímicos y de expresión génica del genoma de ratón (Affymetrix). Resultados: El estroncio unido a ranelato (SrRn) fue el más potente inductor de la capacidad de mineralización, en comparación con los otros compuestos utilizados (2,55 veces respecto al control). Los estudios de expresión génica global mostraron que a las 3 horas cambian 2.030 genes de los cuales 1.644 genes son específicos de esta fase. Por el contrario, a 7 días de tratamiento sólo cambian 329 genes siendo específicos 147 genes. Los procesos biológicos más enriquecidos a las 3 horas fueron los involucrados en la regulación transcripcional (147 genes), procesos metabólicos (140 genes) y la fosforilación de proteínas (44 genes) entre otros, mientras que a 7 días hubo cambios relacionados con el ciclo celular (18 genes) y con el metabolismo de carbohidratos en general (12 genes). Conclusión: El estroncio unido al anión ranelato se comportó como el más potente inductor de la osteogénesis comparado con otros aniones como cloruro o hidróxidos. El estímulo a 3 horas presentó mayores cambios de expresión de genes en comparación a 7 días. Los procesos biológicos afectados pueden ser útiles para especular sobre cascadas de señalización involucradas en la activación osteoblástica y sobre nuevas dianas moleculares con fines terapéuticos.

Zh E Belaya, L Ya Rozhinskaya

Обзор литературы посвящён патогенетической обоснованности, эффективности и безопасности применения деносумаба в терапии постменопаузального остеопороза. Обсуждается механизм действия препарата, сходства и отличия по отношению к другим препаратам для лечения остеопороза. Подробно представлены результаты II и III фаз клинических исследований деносумаба, в том числе в сравнении с алендроновой кислотой и возможности назначения деносумаба после лечения бисфосфонатами. Отдельное внимание уделяется безопасности и практическим аспектам терапии деносумабом

Muñoz-Torres M, Varsavsky M, Avilés Pérez MD

López-Herce Cid JA