Hasil untuk "Osteopathy"

Ichiro Yoshii, Naoya Sawada, Tatsumi Chijiwa

<b>Background</b>: Risk factors, including Joint Index Vector (JIV), a new disease activity indicator based on three-axis coordinates, and a pain score using a visual analog scale (PS-VAS), were evaluated for incident bone fragility fractures (inc-BFF) in patients with rheumatoid arthritis (RA) in a retrospective case–control study. <b>Methods</b>: RA patients who were followed for at least two consecutive years (RA) and a control group consisting of patients without RA but with similar background demographics (non-RA) were recruited and monitored. The prevalence of inc-BFF was compared between the two groups. Common potential risk factors in both groups and RA-specific factors within the RA group regarding inc-BFF were analyzed statistically. <b>Results</b>: A total of 278 patients were studied in each group. There was no significant difference in the prevalence of inc-BFF between the two groups. Presenting RA was not a major factor in developing inc-BFF. Higher Vz in the JIV, which reflects the difference in the involvement ratio between large and small joints, and higher PS-VAS showed significantly higher hazard ratios in a univariate model. Vz > 0.01, PS-VAS ≥ 25.5, and simplified disease activity index ≥ 2.11 at follow-up, along with PS-VAS at baseline > 21.0, are the key cutoff indices for RA-specific risk factors. When two of these factors were combined, the combination of Vz and PS-VAS at follow-up resulted in the highest hazard ratio (4.25; <i>p</i> < 0.001). <b>Conclusions</b>: These results suggest that combining Vz and PS-VAS is the key risk indicator for inc-BFF.

Bana Awad, Shahem Elias, Bezalel Peskin et al.

<b>Background/Objectives:</b> Ochronosis is an uncommon metabolic condition caused by a deficiency of homogentisate 1,2-dioxygenase, leading to the accumulation of homogentisic acid (HGA) in connective tissues. This deposition of HGA in the joints can result in cartilage degeneration and advanced ochronotic arthritis. Although this condition is usually asymptomatic, it can demonstrate devastating articular destruction characterized by dark pigmentation of the tissues. <b>Methods:</b> A 64-year-old female with a medical history consisting of diabetes mellitus type 2, hypertension, and thoracic aortic aneurysm, with no personal or family history of ochronosis or related symptoms, has been diagnosed with progressive knee osteoarthritis, Kellgren and Lawrence grade III, unresponsive to conservative treatment. <b>Results:</b> The patient underwent staged bilateral, bicompartmental, cemented total knee arthroplasty (TKA), during which several pathological changes were incidentally discovered: black-pigmented, weakened articular cartilage and darkened synovial fluid, as well as brittle metaphyseal bone necessitating increased cement application to ensure prosthetic stability. Postoperative recovery was significant for anemia requiring a blood transfusion. Improved knee function was observed in the first month follow-up visit, and the patient was referred for diagnostic confirmation of her condition. <b>Conclusions:</b> This case underscores the importance of recognizing ochronosis as a potential cause of advanced joint degeneration in patients undergoing arthroplasty. Furthermore, the diagnosis might be of clinical relevance, since this case demonstrated postoperative anemia which required blood transfusion. This, combined with the brittleness of bone, highlights the need for meticulous surgical planning and tailored approaches by the unaware surgeon who might encounter such not-so-pleasant findings.

Keisuke Oe, Shinya Hayashi, Tomoaki Fukui et al.

<b>Background/Objectives:</b> The aim of this study was to evaluate changes in bone mineral density (BMD) around the stem in elderly patients with femoral neck fractures who underwent hemiarthroplasty using a collared and full hydroxyapatite coated cementless stem, as assessed using the Dorr classification and with anti-osteoporosis drug intervention. <b>Methods:</b> This study followed 85 older patients with femoral neck fractures classified by Dorr’s classification. We measured their BMD around the stem using dual-energy X-ray absorptiometry according to Gruen 7 zones classification and clinical scores. We compared the rate of BMD change based on Dorr’s classification and clinical scores. We also investigated the effect of osteoporosis treatment interventions on the rate of BMD change. The study followed up with the patients for one year after surgery. <b>Results:</b> After excluding patients with missing data, 40 patients were included in the analysis. The rate of change in BMD in zone 2 was significantly reduced in Dorr type C compared to Dorr type B. Clinical scores did not significantly differ between the three groups. Regarding the association between osteoporosis treatment and the rate of BMD change, the pre-injury intervention group had a significantly suppressed decline in the rate of BMD change in zones 1 and 7 compared to the post-injury intervention and no-intervention groups. <b>Conclusions:</b> Careful follow-up examination is crucial when performing hemiarthroplasty in patients with Dorr type C femoral neck fractures because the rate of BMD change may decline postoperatively. Pre-injury osteoporosis intervention therapy may suppress BMD loss around the stem.

Naabil Khan

Introduction: The lack of ethnic minority representation in the medical community is vital in driving the movement towards proportionate representation in medical education. Skin For All, addresses the challenge within the UK's National Health Service by diversifying clinical descriptions to prevent potential misdiagnoses. With a focus on over 30 prevalent skin conditions, Skin For All employs accessible language and segmented information, tailoring resources for diverse user backgrounds. This initiative aims to reshape medical education and patient awareness by providing an inclusive, comprehensive resource aligned with the NHS's commitment to equitable healthcare [1]. Aim: The website aim is to raise awareness about racial disparities in medical education and clinical practice, encouraging familiarity with inclusive language in clinical skin descriptors. Skin For All also strives to normalise diverse images and language in medical curricula, supporting non-medical personnel in recognising skin conditions on diverse skin tones. Method: The methods involve utilising six diverse platforms to identify prevalent skin conditions, catering to both patients and clinicians globally. The information is sourced from reputable clinical websites and patient-focused platforms, ensuring a well-rounded perspective. Results: Since its inception in June 2023, Skin For All has gained significant traction, accumulating 6,500 page visits by December 2023, with an additional 650 page views from January 2024 to the present date. The website's impact has been acknowledged through media appearances on BBC Spotlight and LBC Radio in October 2023 [2]. Furthermore, Skin For All's integration into the Exeter University Problem Based Learning curriculum in October 2023 signifies progress towards its goal of curriculum integration. Qualitative results include presentations at the University of Osteopathy and the Public Involvement in Medical Education group linked to Exeter Medical School, showcasing increased public and student education surrounding the initiative's ethos. Discussion/conclusion: The discussion emphasises the importance of bottom-up, student-led projects like Skin For All in promoting diversity in medical school curricula. Other methods of change in medical education include calls for cases involving ethnic minority patients, diverse images, and reading lists [3]. For patients, raising awareness through public health groups and media appearances is vital in normalising diversity within the medical sphere [4]. While further research is required to present concrete outcomes, Skin For All's prominence in medical academia is evident through its cross-university presentations, user count, and PBL integration. In conclusion, Skin For All serves as a testament to the importance of inclusive healthcare, actively addressing the underrepresentation of ethnic minorities in medical education. Its multifaceted approach aims to reshape medical education and patient outcomes, aligning with the NHS's commitment to equitable healthcare.

Roger Kerry, Kenneth J. Young, David W. Evans et al.

Abstract Background Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. Purpose The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. Methods A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. Conclusions Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.

Ana Rita Pinheiro, Beatriz Paiva, Bruna Silva et al.

Introdução: A Doença Pulmonar Obstrutiva Crónica (DPOC) é uma doença pulmonar inflamatória crónica, multifatorial, com elevada incidência e prevalência em Portugal e no mundo. A osteopatia tem sido proposta como uma abordagem complementar e segura no tratamento das demais doenças inflamatórias crónicas, inclusive a DPOC. Objetivos: Avaliar os efeitos da intervenção osteopática na sintomatologia, bem-estar e qualidade de vida de indivíduos com DPOC. Material e Métodos: A pesquisa científica foi realizada no dia 23 de abril de 2022 nas bases de dados Pubmed e Web of Science Core Collection. Foram incluídos somente RCT’s publicados desde 2008. Estes estudos incluíram indivíduos de idade superior a 18 anos com diagnóstico de DPOC, que foram submetidos a intervenção osteopática. A análise dos artigos quanto aos critérios de inclusão e elegibilidade, a extração de dados e a avaliação da qualidade metodológica foi realizada por dois revisores independentes, com intervenção de um terceiro revisor em caso de discordância. A qualidade metodológica foi avaliada recorrendo ao Cochrane Risk of Bias Tool. Resultados: Nesta revisão, dos 213 resultados obtidos, foram incluídos 4 estudos. Estes apresentaram uma baixa qualidade metodológica com alto risco ou incerto de viés. Num primeiro estudo, em comparação com o grupo controlo, o grupo experimental apresentou um aumento mais significativo da capacidade de exercício (p=0,04) e uma diminuição substancialmente maior do volume residual (p=0,001). Num segundo estudo, o grupo experimental apresentou diminuição significativa (p≤0,05) do fluxo expiratório forçado, do volume de reserva expiratório e da resistência das vias aéreas, e um aumento significativo (p≤0,05) no volume residual, capacidade pulmonar total e na razão desses valores, em comparação com o grupo controlo. Num terceiro estudo, o grupo experimental obteve melhorias significativos nos testes “CAT Questionnaire” (p<0,0005) e “6MWT” (p<0,0038) avaliados no mesmo dia da 4ª sessão de TMO, comparativamente com o grupo controlo. Num último estudo, verificou-se uma melhoria significativa da perceção de dispneia com intervenção osteopática (p=0,04). Conclusões: A presente revisão sistemática demonstrou evidência frágil quanto à eficácia do tratamento osteopático na melhoria da função pulmonar, porém com relatos de melhorias ao nível da sintomatologia, bem-estar e qualidade de vida dos indivíduos com DPOC.

Zoe McParlin, Francesco Cerritelli, Andrea Manzotti et al.

Therapeutic affective touch has been recognized as essential for survival, nurturing supportive interpersonal interactions, accelerating recovery—including reducing hospitalisations, and promoting overall health and building robust therapeutic alliances. Through the lens of active inference, we present an integrative model, combining therapeutic touch and communication, to achieve biobehavioural synchrony. This model speaks to how the brain develops a generative model required for recovery, developing successful therapeutic alliances, and regulating allostasis within paediatric manual therapy. We apply active inference to explain the neurophysiological and behavioural mechanisms that underwrite the development and maintenance of synchronous relationships through touch. This paper foregrounds the crucial role of therapeutic touch in developing a solid therapeutic alliance, the clinical effectiveness of paediatric care, and triadic synchrony between health care practitioner, caregiver, and infant in a variety of clinical situations. We start by providing a brief overview of the significance and clinical role of touch in the development of social interactions in infants; facilitating a positive therapeutic alliance and restoring homeostasis through touch to allow a more efficient process of allostatic regulation. Moreover, we explain the role of CT tactile afferents in achieving positive clinical outcomes and updating prior beliefs. We then discuss how touch is implemented in treatment sessions to promote cooperative interactions in the clinic and facilitate theory of mind. This underwrites biobehavioural synchrony, epistemic trust, empathy, and the resolution of uncertainty. The ensuing framework is underpinned by a critical application of the active inference framework to the fields of pediatrics and neonatology.

Lopez Gavilanez E, Valdivieso Jara J, Imaicela Naula L et al.

Objetivo: Evaluar el impacto clínico de los umbrales de intervención basados en FRAX en mujeres ecuatorianas. Probar una combinación de umbrales de intervención fijo y específico de la edad para optimizar la selección de mujeres elegibles para intervención. Pacientes y métodos: Estudio transversal. Se seleccionaron 2.283 mujeres de 60 a 94 años. Calculamos el riesgo de fracturas osteoporóticas principales y de cuello de fémur con el modelo FRAX ecuatoriano (versión 4.1), y calculamos la proporción de individuos elegibles para tratamiento y evaluación de la densidad mineral ósea aplicando los umbrales específicos de edad de 60 a 94 años y un umbral fijo a partir de 75 años. Resultados: Aplicando los umbrales específicos de la edad, 2% de las mujeres calificaron para tratamiento y 73,7% para evaluación de la densidad mineral ósea. Según la edad, las mujeres elegibles para tratamiento fluctuaron entre 0,7 a 3,8% y las elegibles para evaluación de la densidad mineral ósea entre 58,3 al 80,5%. Con el umbral fijo, 31% de las mujeres calificaron para tratamiento y 76,3% para evaluación de la densidad mineral ósea. Dependiendo de la edad, las mujeres potencialmente elegibles para tratamiento fluctuaron de 3,8 a 76,5%, y las elegibles para evaluación de la densidad mineral ósea entre 65,2 al 85,4%. Conclusiones: La proporción de mujeres potencialmente elegible para el tratamiento, es baja comparada con países con riesgo alto de fracturas. Utilizar un umbral fijo a partir de los 75 años, optimiza la proporción de mujeres elegibles para tratamiento. En los países con riesgo de fractura bajo a moderado, con recursos limitados, un modelo híbrido puede ser más adecuado.

Ilinka Acimovic

This study assesses the impact of exercise on the health of the Qigong (Jibengong, Health Qigong Ba Duan Jin and Health Qigong Yi Jin Jing) in patients with rheumatoid arthritis, rheumatism, osteoporosis, osteopenia. Through the given questionnaire we have come up with data showing how and how much health qigong affects the patients with rheumatoid arthritis, rheumatism, osteoporosis, osteopenia according to the subjective assessment.

Torregrosa Suau O, Guilló Quiles E, Mora Rufete A

La paniculitis mesentérica se caracterizada por una inflamación crónica inespecífica del tejido adiposo del mesenterio intestinal, y su etiología es desconocida. Se ha relacionado con malignidad, vasculitis, enfermedades reumáticas y con determinados fármacos. Presentamos un caso de paniculitis mesentérica asociada a la toma de bifosfonatos, no descrita previamente en la literatura, apoyando así el concepto de sus potenciales efectos secundarios proinflamatorios.

T L KARONOVA, E P MIKhEEVA, I L NIKITINA et al.

Российская Федерация в силу географического расположения и экономических особенностей имеет все предпосылки для развития недостатка и дефицита витамина D. Цель исследования. Оценить уровень 25(OH)D) крови у жителей Северо-Западного региона РФ для изучения распространенности дефицита витамина D и его вклада в здоровье. Материал и методы. В исследование включено 1690 человек (1349 в возрасте 18-75 лет, включая 221 беременную и 120 детей/подростков в возрасте 3-17 лет). Уровень 25(OH)D крови оценивался хемилюминесцентным методом (AbbottArchitect 8000, USA), у беременных исследование проводилось на 8-14 неделях гестации. Критерии РАОП (2015) были использованы для оценки статуса витамина D. Антропометрическое исследование включало измерение роста, веса, окружности талии (ОТ) и расчет индекса массы тела (ИМТ). У 204 женщин в возрасте 30-52 лет проведена двухэнергетическая рентгеновская абсорбциометрия (ДРА) (Lunar Prodigy, USA). У 310 жителей 25-70 летнего возраста проведена оценка наличия тревоги и депрессии при помощи опросника госпитальной шкалы тревоги и депрессии HADS. За отсутствие тревоги и депрессии принималось суммарное значение баллов 0-7, за субклинические нарушения - 8-10, за клинические - >11. Результаты. Уровень 25(OH)D в сыворотке крови варьировал от 9,8 до 147,5 нмоль/л, у взрослых в среднем был 54,8±0,7нмоль/л, у детей/подростков - 46,8±1,6 нмоль/л. У женщин 25(OH)D крови был ниже чем у мужчин (53,9±0,8 и 67,2±2,2 нмоль/л; p<0,01). Было установлено, что 16,8% популяции имели уровень 25(OH)D более 75 нмоль/л, 37,5% - имели недостаток и 45,7% дефицит витамина D. Среди беременных только 50% женщин имели нормальный уровень обеспеченности витамином D. Не было найдено ассоциации между уровнем 25(ОН)D и возрастом. Лица с нормальным показателем ИМТ имели больший уровень 25(OH)D крови, чем лица с избыточной массой тела и ожирением (52,5±2,8 и 44,8±2,0 нмоль/л, p<0,05). Установлены отрицательные корреляционные связи между уровнем 25(OH)D и ИМТ (r=-0,17, p=0,03), ОТ (r=-0,15, p=0,02). Концентрация 25(OH)D крови у беременных не была ассоциирована ИМТ, приемом препаратов, содержащих витамин D, а также антропометрическими параметрами новорожденных. Результаты проведенной ДРА показали, что 18,6% женщин имели снижение МПК, однако чаще эти изменения были характерны для лиц с нормальной массой тела по сравнению с женщинами, имеющими ожирение. Результаты корреляционного анализа продемонстрировали, что МПК в проксимальном отделе бедра ассоциирована с ИМТ (r=0,43, p=0,008), ОТ (r=0,51, p=0,002). В тоже время, показали МПК находились в корреляционной зависимости с 25(ОН)D только у женщин в возрасте до 40 лет (r=0,48, p=0,04). Наличие тревожного расстройства выявлено у 32,5%, депрессивного синдрома - у 11,0% обследованных. Результаты исследования продемонстрировали наличие отрицательной взаимосвязи между уровнем 25(ОН)D и степенью выраженности тревожных нарушений (r=-0,11, p=0,03). Степень выраженности депрессивных нарушений была ассоциирована с возрастом обследованных (r=0,12, p=0,02), но не зависела от уровня обеспеченности витамином D (r=-0,08, p=0,09). Исключение таких факторов формирования психогенных нарушений как ожирение, артериальная гипертензия, нарушение метаболизма глюкозы, позволило определить самостоятельный вклад низкого уровня 25(ОН)D в сыворотке крови в развитии тревожного расстройства в исследованной популяции (R2=0,02, p=0,01). Выводы. Дефицит и недостаток витамина D широко распространены у жителей Северо-Западного региона РФ независимо от возраста. Наиболее низкий уровень 25(OH) D крови характерен для женщин и лиц с избыточным количеством жировой ткани. Дефицит витамина D вносит вклад в формирование остеопенического синдрома у женщин в возрасте до 40 лет, а также, возможно, является самостоятельным фактором, участвующим в развитии тревожного синдрома.

MM KOSTIK, O L KOPChAK, Ya A GORYShINA et al.

Небактериальный и туберкулезный остеомиелиты (НБО и ТБО соответственно) относятся к группе первично-хронических остеомиелитов, требующих четкого дифференцирования для определения адекватной тактики лечения. При этом клиническая картина и лучевые проявления костной деструкции этих заболеваний схожи, а чувствительность кожных туберкулиновых тестов в настоящее время рассматривается как достаточно низкая для диагностики специфического поражения костей. Цель. Сравнить клинико-лабораторные особенности НБО и ТБО. Материал и методы. В исследование включено данные о 95 пациентах (52 - с НБО и 43 - с ТБО) в возрасте до 18 лет с очаговыми деструкциями костей, выявленными на основании комплекса лучевых методов - рентгенографии, компьютерной и магнитно-резонансной томографии, остеосцинтиграфии. Всем больным выполнена закрытая или отрытая биопсия кости. Пациенты с выделением из зоны костной патологии неспецифической микробиоты в исследование не включались. Диагноз ТБО устанавливали при положительных результатах молекулярно-генетических и бактериологических исследований биоптата на микобактерии туберкулезного комплекса (идентифицированы у 26 из 43 пациентов (60,5%)), а также при выявлении типичной морфологической картины специфического гранулематозно-некротического воспаления. Диагноз НБО устанавливали при обнаружении морфологической картины воспаления (кроме типичной для туберкулеза) и отрицательных результатах всех бактериологических исследований. Сравниваемые параметры: количество костных очагов, время постановки диагноза (диагностическая пауза), лабораторные данные - уровень гемоглобина, число лейкоцитов, тромбоцитов, моноцитов, СОЭ, СРБ. Результаты. При отсутствии каких-либо гендерных преобладаний среди больных НБО, ТБО преимущественно поражал мальчиков - 74,4% (р=0,009). Между пациентами с НБО и ТБО обнаружены достоверные различия по показателям возраста дебюта заболевания - соответственно 8,4 (5,4; 11.0) и 2,2 года (1,3; 3,2) (р=0,0000001) и срокам диагностической паузы - 6,3 (2,0; 17,8) и 2,9 мес (1,7; 7,2) (р=0,06). Не обнаружено статистически достоверных различий в числе лейкоцитов, тромбоцитов, уровне гемоглобина, СОЭ, СРБ, в то время, как достоверно различны относительное - 6,0% (4,0; 8.0) и 4,0% (3,0; 5.5), (р=0,007) и абсолютное число моноцитов в 1 мкл - 462,0 (315,0; 602,5) и 285,0 (144,0; 512,0) (р=0,03). Монофокальное поражение отмечено лишь у 10/52 (19.2%) больных НБО, в то время, как при ТБО - у 35/43 (81,4%) (р=0,0000001) при медиане числа костных поражений равном 3,0 (2,0; 6,0) и 1,0 (1,0; 1,0) соответственно (р=0,0000001). Заболевание сопровождалось симптоматикой артрита в 69,2% и 48,8% случаев НБО и ТБО соответственно (р=0,004). Различия частоты поражения костей осевого и периферического скелета между пациентами с НБО и ТБО подтверждены в отношении позвоночника (34,6% и 7,0%, р=0,001), большеберцовой кости (44,2% и 23,2%, р=0,03), малоберцовой кости (17,3% и 2,3%, р=0,018), костей стопы (42,2% и 11,6%, р=0,001), таза (23,1% и 7,0%, р=0,03), и ключицы (11,5% и 0%, р=0,02). Выводы. Выявленные различия позволяют оптимизировать дифференциальную диагностику НБО и ТБО, что может сократить сроки постановки диагноза и начала выбора адекватных схем терапии.

G. McGivern, Michael Fischer, Tomas Palaima et al.

Díaz Curiel M

Objetivos: Se admite hoy en día que la vitamina K tiene un papel importante en la salud ósea. Es necesaria para la gamma-carboxilación de la osteocalcina (la proteína no colágena más importante en el hueso), consiguiendo que la osteocalcina funcione. Hay dos formas importantes de la vitamina K (vitamina K1 y vitamina K2), que provienen de diferentes fuentes y tienen diferentes actividades biológicas.Estudios epidemiológicos sugieren que una dieta con niveles altos de vitamina K se asocia con un menor riesgo de fracturas de cadera en hombres ancianos y mujeres. Sin embargo, ensayos clínicos controlados y aleatorizados, realizados con suplementos de vitamina K1 o K2 en la población blanca, no muestran un aumento en la densidad mineral ósea (DMO) en la mayoría de las diferentes partes del esqueleto. Los suplementos con vitamina K1 y K2 pueden reducir el riesgo de fractura, pero los ensayos clínicos que incluyen las fracturas como resultado final tienen limitaciones metodológicas, por lo que se necesitarían ensayos clínicos con mayor número de pacientes y mejor diseñados para comprobar la eficacia de la vitamina K1 y K2 en las fracturas.Como conclusión, podríamos decir que actualmente no existe una evidencia suficiente para recomendar el uso rutinario de suplementos de vitamina K para la prevención de la osteoporosis y las fracturas en mujeres postmenopáusicas.

L Ya ROZhINSKAYa, L V EGShATYaN

В статье представлен обзор современной литературы и результаты наших исследований, обобщающие экспериментальные и клинические данные о влиянии цинакалцета на гормонально-биохимические показатели фосфорно-кальциевого обмена, на маркеры костного метаболизма, минеральную плотность костей, также на гистоморфометрические показатели почечной остеодистрофии у гемодиализных пациентов с вторичным гиперпаратиреозом

Olmo JA, Román P, León ML et al.

Objetivos: Los pacientes hemipléjicos son considerados una población de riesgo para padecer fracturas osteoporóticas. El objetivo de este trabajo es conocer el riesgo absoluto de fractura por fragilidad en pacientes con accidente cerebrovascular (ACV) y el estado osteometabólico en pacientes con ictus en fase aguda, así como comprobar si existen diferencias basales con un grupo control de pacientes sin patología cerebrovascular. Pacientes y método: Estudio prospectivo multicéntrico realizado en cinco hospitales españoles. Se establecieron dos grupos: a) pacientes con ictus de menos de tres meses de evolución, y b) un grupo control de una población sin enfermedad cerebrovascular. Se analizaron antecedentes de fracturas por fragilidad, número de caídas en el año anterior, densidad mineral ósea (DMO) de cadera, índice FRAX®, determinaciones bioquímicas y marcadores óseos: calcio, fósforo, fosfatasa alcalina, vitamina D, parathormona (PTH), y telopéptido carboxiterminal del colágeno I (CTX). Resultados: Se han estudiado un total de 82 pacientes: 50 pacientes con ACV y 32 controles. El 12% de los pacientes con ACV presentaron riesgo elevado de sufrir una fractura de cadera y el 8% riesgo elevado de una fractura mayor osteoporótica. En el grupo control el riesgo fue mayor. Los pacientes hemipléjicos presentaron una DMO en cadera menor que el grupo control, aunque las diferencias de ambas variables no fueron estadísticamente significativas. Los niveles de CTX estaban elevados en pacientes con ACV, siendo la única determinación con diferencias significativas entre ambos grupos estudiados. Conclusiones: Los pacientes con ACV presentaron valores de marcadores de reabsorción ósea (CTX) significativamente elevados y una DMO de cadera menor que el grupo control.

A. D. McCarthy, M. S. Molinuevo, A. Cortizo

Type 1 and type 2 Diabetes mellitus are associated with a decrease in bone quality that leads to an increase in low-stress fractures, a condition called diabetic osteopathy. A growing body of evidence strongly indicates that one of the main pathological mechanisms of diabetic osteopathy is an excess accumulation of advanced glycation end products (AGEs) on collagen of bone extracellular matrix. This accumulation increases exponentially during ageing, and is further increased in conditions of substrate carbonyl stress such as chronically uncompensated Diabetes mellitus. AGEs can form covalent crosslinks throughout collagen fibrils, progressively increasing bone fragility and decreasing bone post-yield strain and energy, fracture resistance and toughness. In addition, bone marrow mesenchymal cells, osteoblasts and osteoclasts express receptors such as RAGE that can bind AGEs with high affinity, altering normal cellular homeostasis. Binding of AGEs by RAGE diminishes the osteogenic potential of mesenchymal cells, inhibits osteoblastic bone-forming capacity and induces a long-term decrease in osteoclastic recruitment and bone-resorbing activity. Altogether, these cellular effects of AGEs depress bone turnover, and thus induce an even greater accumulation of AGEs. Recent in vivo, ex vivo and in vitro evidence indicates that anti-diabetic and anti-osteoporotic treatment may prevent the deleterious effects of AGEs on bone cells, providing alternative options for the pharmacological treatment of diabetic osteopathy.

J F Griffith, H K Genant, T M Link

Advances in bone imaging have had a tremendous impact on our knowledge of skeletal anatomy, physiology, and pathophysiology while at the same time generating images of both aesthetic and scientific interest. Bone imaging for assessing bone quality very much lends itself to multidisciplinary input and collaboration across scientific disciplines, helping to drive technological and analytical advances in the assessment of bone quality. This has allowed a much deeper awareness of the changes that occur in bone quality with increasing age and disease, as well as improved fracture risk prediction and better treatment monitoring. Currently, many high-resolution imaging modalities exist to evaluate bone quality, though all have their particular merits and limitations. The ideal imaging modality, which has yet to fully emerge, would allow an accurate prediction of bone strength, discriminate at-risk individuals, identify which aspects of bone strength are faltering, and precisely monitor the effect of treatment. When this day comes, the occurrence of unheralded debilitating osteoporotic fractures in themiddle-aged and elderly will be seen as an unusual, rather than a usual, event. In the meantime, we can look forward to evenmore aesthetically pleasing images of bone structure, images that help linkform to function in the human body and as such administer a helpful dose of science to the art of medicine.

T. Drüeke, M. Lafage-Proust

Lozano D, Trejo CG, Manzano M et al.

Introducción: La proteína relacionada con la parthormona (PTHrP), un factor abundante en el tejido óseo, es un importante modulador de la formación ósea. Se ha demostrado que la PTHrP (107-111), conocida como osteostatina, cargada en el material cerámico mesoporoso SBA-15, ejerce acciones osteogénicas in vitro. Objetivo: Comprobar si dicho material y una versión funcionalizada del mismo (C8-SBA-15) promueven la reparación ósea en un modelo de defecto cavitario en el fémur del conejo. Material y métodos: Para ello se han llevado a cabo estudios histológicos e inmunohistoquímicos y de microtomografía computerizada (µCT). Resultados: Tras la implantación de los biomateriales no se observaron niveles significativos de inflamación ni resorción ósea (4 y 8 semanas). A las 8 semanas las biocerámicas no cargadas con la osteostatina se encontraban separadas de la médula ósea por una cápsula fibrosa, que disminuía de forma significativa en presencia del péptido. Se observó (por µCT) un aumento de la neo-formación ósea a diferentes distancias de los biomateriales, principalmente en los cargados con la osteostatina. Además, estos resultados fueron confirmados por inmunohistoquímica de marcadores osteoblásticos. Conclusión: Nuestros hallazgos sugieren que estas biocerámicas cargadas con la osteostatina son una buena estrategia para acelerar la regeneración ósea.