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Id: biblio-1123621
Autor: Fuenzalida P, Magdalena; Purto H, Dalay; Rioseco R, Clara; Kutscher C, Sofía; Amenábar M, María Paz; Tagle V, Rodrigo; Jara C, Aquiles.
Título: Hiperkalemia postoperatoria en síndrome de hueso hambriento post-paratiroidectomía por hiperparatiroidismo secundario en enfermedad renal crónica terminal / Hyperkalemia-associated hungry bone syndrome post-parathyroidectomy in end-stage denal disease
Fonte: Rev. chil. endocrinol. diabetes;13(4):154-158, 2020. ilus, tab.
Idioma: es.
Resumo: Introducción: El hiperparatiroidismo secundario (HPTS) es una complicación de la enfermedad renal crónica terminal (ERCT). A pesar de nuevas terapias médicas como calcimiméticos, en HPTS refractarios la paratiroidectomía (PTX) continúa siendo necesaria. Una complicación frecuente en estos pacientes posterior a la PTX es el síndrome de hueso hambriento (SHH), caracterizado por una profunda y prolongada hipocalcemia asociada a hipofosfatemia, secundaria a un excesivo aumento de su captación ósea. Una complicación menos descrita, pero con consecuencias graves e incluso fatales, es la hiperkalemia. El propósito de este trabajo consiste en enfatizar el riesgo de hiperkalemia por SHH a partir de un caso clínico, señalar los mecanismos fisiopatológicos, factores de riesgo y consideraciones terapéuticas. Caso clínico: Mujer de 35 años, con ERCT de causa desconocida, HPTS refractario con PTX total e implante de glándulas en antebrazo hace 9 años. Ingresa por recurrencia de HPTS. Cintigrama MIBI SPECT/CT® evidenció implante hiperfuncionante, indicándose PTX del injerto. Exámenes preoperatorios: calcemia 8.6 mg/dL, fosfatasas alcalinas 1115 UI/L (VN <100), PTH intacta (PTHi) 3509 pg/ml y kalemia 4.8 mEq/L. Biopsia: hiperplasia paratiroidea nodular. En postoperatorio inmediato presentó hiperkalemia de 7.1 mEq/L con cambios electrocardiográficos, requiriendo hemodiálisis de urgencia. Posteriormente desarrolló hipocalcemia, hipofosfatemia e hipomagnesemia, de difícil control. Discusión: El SHH post HPTS puede coexistir con hiperkalemia postoperatoria inmediata grave, incluso fatal si no se identifica y corrige a tiempo. El mecanismo fisiopatológico aún no está bien dilucidado. Varios factores pudieran intervenir, incluyendo aumento del metabolismo celular, traumatismo tisular, fármacos anestésicos, fluidos perioperatorios y flujo de iones transmembrana. El nivel de potasio previo a la cirugía, menor edad, género masculino, tiempo entre la última hemodiálisis y la cirugía, y duración de la PTX, son factores de riesgo para hiperkalemia postoperatoria. El conocimiento de esta grave complicación permitirá estar preparado para monitorizar y eventualmente tratar.

Introduction: Secondary Hyperparathyroidism (SHPT) is a complication of End-Stage Renal Disease (ESRD). Although new medical therapies (i.e.calcimimetics,) parathyroidectomy (PTX) continues to be necessary in refractory cases. A well-known complication after PTX is an entity called Hungry Bone Syndrome (HBS), characterized by deep and prolonged hypocalcemia associated with hypophosphatemia, secondary to an excessive increase in bone formation. A less reported complication, but with severe or even fatal consequences, is hyperkalemia. The purpose of this work consists of emphasizing the risk of hyperkalemia in HBS, reporting a clinical case that points out the physiopathological mechanisms, risk factors, and therapeutic considerations. Clinical case: 35-year-old woman with ESRD of unknown cause with refractory SHPT with total PTX and forearm gland grafts nine years ago. She presented SHPT recurrency. MIBI SPECT/CT® scan showed a hyperfunctioning implant, indicating graft PTX. Preoperative tests: calcemia 8.6 mg/dL, phosphatemia 7.3 mg/dL, alkaline phosphatases 1115 UI/L (VN<100), intact PTH (iPTH) 3509 pg/ml and kalemia 4.8 mEq/L. Biopsy: parathyroid nodular hyperplasia. In the immediate postoperative period, she presented hyperkalemia at 7.1 mEq/L with electrocardiographic changes, requiring emergency hemodialysis. Later she developed hypocalcemia, hypophosphatemia, and hypomagnesemia of difficult control. Discussion: HBS post PTX can coexist with severe immediate postoperative hyperkalemia, which can be even fatal if not detected and corrected. The physiopathological mechanism is still not entirely elucidated. Various factors could interfere, including an increase in cell metabolism, tissue traumatism, anesthetic drugs, intraoperative fluids, and transmembrane ion flow. Preoperative potassium levels, younger age, male gender, the time elapsed between last hemodialysis and surgery, and duration of PTX are risk factors for post-surgical hyperkalemia. Knowing this severe complication will allow the medical team to be prepared for monitoring and eventually treating it.
Descritores: Doenças Ósseas Metabólicas/etiologia
Paratireoidectomia/efeitos adversos
Hiperpotassemia/etiologia
Hiperparatireoidismo Secundário/cirurgia
-Insuficiência Renal Crônica/complicações
Hiperparatireoidismo Secundário/complicações
Limites: Humanos
Feminino
Adulto
Tipo de Publ: Relatos de Casos
Responsável: CL1.1 - Biblioteca Central


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Id: biblio-974386
Autor: Gargeshwari, Aditi; Jha, Raghav Hira; Singh, Niraj Kumar; Kumar, Prawin.
Título: Behavioural and objective vestibular assessment in persons with osteoporosis and osteopenia: a preliminary investigation / Behavioural and objective vestibular assessment in persons with osteoporosis and osteopenia: a preliminary investigation
Fonte: Braz. j. otorhinolaryngol. (Impr.);84(6):744-753, Nov.-Dec. 2018. tab, graf.
Idioma: en.
Resumo: Abstract Introduction: Calcium is vital for the functioning of the inner ear hair cells as well as for the neurotransmitter release that triggers the generation of a nerve impulse. A reduction in calcium level could therefore impair the peripheric vestibular functioning. However, the outcome of balance assessment has rarely been explored in cases with osteopenia and osteoporosis, the medical conditions associated with reduction in calcium levels. Objective: The present study aimed to investigate the impact of osteopenia and osteoporosis on the outcomes of behavioural and objective vestibular assessment tests. Methods: The study included 12 individuals each in the healthy control group and osteopenia group, and 11 individuals were included in the osteoporosis group. The groups were divided based on the findings of bone mineral density. All the participants underwent behavioural tests (Fukuda stepping, tandem gait and subjective visual vertical) and objective assessment using cervical and ocular vestibular evoked myogenic potentials. Results: A significantly higher proportion of the individuals in the two clinical groups' demonstrated abnormal results on the behavioural balance assessment tests (p < 0.05) than the control group. However, there was no significant difference in latencies or amplitude of cervical vestibular evoked myogenic potential and oVEMP between the groups. The proportion of individuals with absence of ocular vestibular evoked myogenic potential was significantly higher in the osteoporosis group than the other two groups (p < 0.05). Conclusion: The findings of the present study confirm the presence of balance-related deficits in individuals with osteopenia and osteoporosis. Hence the clinical evaluations should include balance assessment as a mandatory aspect of the overall audiological assessment of individuals with osteopenia and osteoporosis.

Resumo: Introdução: O cálcio é vital para o funcionamento das células ciliadas, assim como para a liberação dos neurotransmissores que desencadeiam um impulso nervoso. Uma redução nos níveis de cálcio poderia, portanto, prejudicar o funcionamento vestibular periférico. No entanto, a avaliação do equilíbrio tem sido raramente explorada em casos de osteopenia e osteoporose, condições médicas associadas à redução dos níveis de cálcio. Objetivo: O presente estudo teve como objetivo investigar o impacto da osteopenia e da osteoporose nos resultados dos testes de avaliação comportamental e vestibular objetiva. Método: O estudo incluiu 12 indivíduos nos grupos controle e grupo de osteopenia e 11 indivíduos no grupo da osteoporose. Os grupos foram divididos com base nos achados da densidade mineral óssea. Todos os participantes foram submetidos a testes comportamentais (Prova dos Passos de Fukuda, Marcha em tandem e Vertical Visual Subjetiva) e à avaliação objetiva com o uso de potenciais evocados miogênicos vestibulares cervical e ocular (cVEMP e oVEMP). Resultados: Uma proporção significativamente maior de indivíduos nos dois grupos com condições clínicas mostrou resultados anormais nos testes de avaliação comportamental e do equilíbrio (p < 0,05) do que o grupo controle. Embora não tenha havido diferença significativa nas latências ou na amplitude de cVEMP e oVEMP entre os grupos, a proporção de indivíduos com ausência de oVEMP foi significativamente maior no grupo da osteoporose do que nos outros dois grupos (p < 0,05). Conclusão: Os resultados do presente estudo demonstram a presença de déficits de equilíbrio em indivíduos com osteopenia e osteoporose. Assim, as avaliações clínicas gerais e audiológicas de indivíduos com osteopenia e osteoporose deveriam incluir a avaliação do equilíbrio como um aspecto obrigatório.
Descritores: Osteoporose/fisiopatologia
Doenças Ósseas Metabólicas/fisiopatologia
Vestíbulo do Labirinto/fisiologia
-Osteoporose/metabolismo
Doenças Ósseas Metabólicas/metabolismo
Equilíbrio Postural/fisiologia
Potenciais Evocados Miogênicos Vestibulares/fisiologia
Dados Preliminares
Marcha/fisiologia
Testes Auditivos
Hipocalcemia/metabolismo
Limites: Humanos
Masculino
Feminino
Adulto
Pessoa de Meia-Idade
Idoso
Tipo de Publ: Estudo de Avaliação
Responsável: BR1.1 - BIREME


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Id: biblio-1140035
Autor: Ferretti, José Luis; Pilot, Nicolás; Pisani, Leandro; Lüscher, Sergio; Mackler, Leandro; Cointry, Gustavo Roberto; Capozza, Ricardo Francisco.
Título: ¿A qué pregunta responde "el hueso"?: una cuestión de direccionalidad estructural y organización biológica (hueso y huesos, del big-bang a la osteoporosis) / To which question is 'bone' the answer?: a matter of structural directionality and biological organization (bone and bones, from the big bang to osteoporosis)
Fonte: Actual. osteol;16(1):47-66, Ene - abr. 2020. ilus.
Idioma: es.
Resumo: La "razón de ser" de nuestros huesos y esqueletos constituye un dilema centralizado en los conceptos biológicos de "estructura" y "organización", cuya solución necesitamos comprender para interpretar, diagnosticar, tratar y monitorear correctamente las osteopatías fragilizantes. Últimamente se ha reunido conocimiento suficiente para proponer aproximaciones razonables a ese objetivo. La que exponemos aquí requiere la aplicación de no menos de 6 criterios congruentes: 1) Un criterio cosmológico, que propone un origen común para todas las cosas; 2) Un criterio biológico, que explica el origen común de todos los huesos; 3) Un enfoque epistemológico, que desafía nuestra capacidad de comprensión del concepto concreto de estructura y del concepto abstracto de organización, focalizada en la noción rectora de direccionalidad espacial; 4) Una visión ecológica, que destaca la importancia del entorno mecánico de cada organismo para la adecuación de la calidad mecánica de sus huesos a las "funciones de sostén" que les adjudicamos; 5) Una correlación entre todo ese conocimiento y el necesario para optimizar nuestra aptitud para resolver los problemas clínicos implicados y 6) Una jerarquización del papel celular en el manejo de las interacciones genético-ambientales necesario para asimilar todo el problema a una simple cuestión de organización direccional de la estructura de cada hueso. Solo aplicando estos 6 criterios estaríamos en condiciones de responder a la incógnita planteada por el título. La conclusión de esta interpretación de la conducta y función de los huesos debería afectar el fundamento de la mayoría de las indicaciones farmacológicas destinadas al tratamiento de la fragilidad ósea. (AU)

The nature of the general behavior of our bones as weight-bearing structures is a matter of two biological concepts, namely, structure and organization, which are relevant to properly interpret, diagnose, treat, and monitor all boneweakening diseases. Different approaches can be proposed to trace the corresponding relationships. The one we present here involves six congruent criteria, namely, 1) a cosmological proposal of a common origin for everything; 2) a biological acknowledgement of a common origin for all bones; 3) the epistemological questioning of our understanding of the concrete concept of structure and the abstract notion of organization, focused on the lead idea of directionality; 4) the ecological insight that emphasizes the relevance of the mechanical environment of every organism to the naturally-selected adjustment of the mechanical properties of their mobile bones to act as struts or levers; 5) The clinical aspects of all the alluded associations; 6) The central role of bone cells to control the genetics/ environment interactions of any individual as needed to optimize the directionality of the structure of each of his/her bones to keep their mechanical ability within physiological limits. From our point of view, we could only solve the riddle posed by the title by addressing all of these six criteria. The striking conclusion of our analysis suggests that the structure (not the mass) of every bone would be controlled not only to take care of its mechanical ability, but also to cope with other properties which show a higher priority concerning natural selection. The matter would be that this interpretation of bone behavior and 'function' should affect the rationales for most pharmacological indications currently made to take care of bone fragility. (AU)
Descritores: Osso e Ossos/fisiologia
Doenças Ósseas Metabólicas/diagnóstico
-Osteogênese Imperfeita/diagnóstico
Osteogênese Imperfeita/terapia
Osteoporose/diagnóstico
Osteoporose/terapia
Osso e Ossos/anatomia & histologia
Osso e Ossos/citologia
Osso e Ossos/ultraestrutura
Doenças Ósseas Metabólicas/terapia
Epigênese Genética
Limites: Humanos
Tipo de Publ: Revisão
Responsável: AR2.1 - Biblioteca Central


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Id: biblio-1129981
Autor: Sánchez, Ariel.
Título: Síndrome metabólico y masa ósea / Metabolic syndrome and bone mass
Fonte: Actual. osteol;16(1):7-9, Ene - abr. 2020.
Idioma: es.
Descritores: Doenças Ósseas Metabólicas/etiologia
-Índice de Massa Corporal
Densidade Óssea
Síndrome Metabólica/complicações
Síndrome Metabólica/etiologia
Gordura Abdominal
Fraturas Ósseas/etiologia
Limites: Humanos
Masculino
Feminino
Tipo de Publ: Editorial
Responsável: AR2.1 - Biblioteca Central


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Id: lil-767546
Autor: Moncayo-Bravo, Susan D; López-Gutiérrez, José J.
Título: Evaluación del manejo farmacológico de la osteoporosis y la osteopenia en una institución de régimen especial de Bogotá / Pharmacological evaluation of osteoporosis and osteopenia treatment in an institution under the special health system in Bogotá
Fonte: Rev. salud pública;17(4):565-577, jul.-ago. 2015. ilus, tab.
Idioma: es.
Resumo: Objetivo Evaluar los hábitos de prescripción de medicamentos utilizados en el tratamiento de osteoporosis y osteopenia en una institución de salud de régimen especial de Bogotá, comparados guías de manejo internacional de la osteoporosis. Metodología Se realizó un estudio observacional descriptivo de corte transversal con recolección retrospectiva de la información. Corresponde a un estudio de utilización de medicamentos sobre hábitos de prescripción, para el cual se tomó la información de 332 pacientes tratados con Bifosfonatos, sales de calcio, Ranelato de Estroncio y Teriparatida. Se evaluaron los hábitos de prescripción mediante la comparación con las Guías de manejo de la National Osteoporosis Foundation (NOF) y el National Institute for Health and Clinical Excellence (NICE). Resultados El 89 % de la población corresponde a mujeres con un promedio de edad de 67 años. La dosis y frecuencia de administración corresponde a lo establecido por las guías de manejo; el 32,2 % fue tratado con Bisfosfonatos por más de 3 años, el 94,2 % fue tratado en prevención primaria y el 89,6 % fue tratado sin diagnóstico de Osteoporosis mediante Densitometría Mineral Ósea (DMO). De acuerdo a las recomendaciones de la guía NOF el 67,3 % de los pacientes se trató innecesariamente. Conclusiones Los hábitos de prescripción de medicamentos utilizados en el tratamiento de las osteoporosis no están de acuerdo a las guías de manejo, evidenciándose un uso no adecuado especialmente de bifosfonatos.

Objetive To evaluate habits related to the prescription of drugs used in the treatment of osteoporosis and osteopenia in a health institution in Bogota as compared to two international clinical practice guidelines. Methodology An observation and cross-sectional study with retrospective data collection. It is a study of drug-prescribing habits. Information was taken from 331 patients treated with bisphosphonates, calcium salts, strontium ranelate and teriparatide. The prescription habits were assessed by way of a comparison with the NOF clinician's guide for the prevention and treatment of osteoporosis and the National Institute for Health and Clinical Excellence (NICE) guidelines. Results 89 % of the population were women with an average age of 67 years. The dose and frequency of the administration of drugs was in accordance with established guidelines. 32.2 % of patients were treated with bisphosphonates for over 3 years, 94.2% were treated with primary prevention, and 89.6 % had been treated without any osteoporosis diagnosis by DMO. Compared to the NOF guide, 67.3 % of the patients were treated unnecessarily. Conclusions The drug prescription habits used in the treatment of the osteoporosis do not follow the guidelines, showing non-adequate use, especially of bisphosphonates.
Descritores: Osteoporose/tratamento farmacológico
Doenças Ósseas Metabólicas/tratamento farmacológico
Difosfonatos/farmacologia
-Epidemiologia Descritiva
Estudos Transversais
Limites: Humanos
Tipo de Publ: Estudo Observacional
Responsável: BR1.1 - BIREME


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Id: biblio-1129698
Autor: Kitaigrodsky, Ariela Verónica; Marciano, Sebastián; Jiménez, Graciela Beatriz; Diehl, María; Plantalech, Luisa.
Título: Hipofosfatasemia crónica persistente de causa no determinada y su repercusión músculo-esquelética / Persistent hypophosphatasemia and its musculoskeletal repercussion
Fonte: Actual. osteol;16(2):[104]-[115], mayo.-ago. 2020. graf, tab.
Idioma: es.
Resumo: La fosfatasa alcalina baja o hipofosfatasemia, ya sea debida a causas genéticas (hipofosfatasia) o secundarias, presenta correlato clínico. Nuestro objetivo es estimar la prevalencia de hipofosfatasemia crónica persistente y describir sus hallazgos osteometabólicos. Se realizó una búsqueda electrónica de afiliados adultos al Hospital Italiano de Buenos Aires, entre 2013 y 2017, con al menos 2 determinaciones de fosfatasa alcalina igual a 30 UI/l o menor y ninguna mayor de 30 UI/l (rango de referencia 30-100 UI/l). Se excluyeron aquellos con causas secundarias diagnosticadas y se analizaron los correlatos clínico y bioquímico. Se detectó hipofosfatasemia crónica persistente en 78 de 105.925, 0,07% (0,06-0,09) de los afiliados. Solo uno fue excluido por tener causa secundaria. Eran 61,1% mujeres de 44 (34-56) años, fosfatasa alcalina 24 (20-27) UI/L, fosfatemia 4,1 (3,8-4,6) mg/dl. Se observaron osteoartritis, calcificaciones vasculares y fracturas, menos frecuentemente litiasis renal, calcificación del ligamento longitudinal común anterior, pérdida dental y convulsiones. El 63,6% tenían al menos una de las características clínico-radiológicas evaluadas, pero en solo 5,2% fue mencionado el diagnóstico de hipofosfatasemia en la historia clínica. La densitometría evidenció algún grado de afección (osteopenia u osteoporosis) en 76,2%. Se constataron 19 fracturas, con predominio en radio. La prevalencia de hipofosfatasemia fue similar a lo previamente reportado. El reconocimiento fue bajo; sin embargo, se observaron variadas manifestaciones músculo-esqueléticas, similares a las descriptas en la hipofosfatasia del adulto, por lo cual ­ante una hipofosfatasemia sin causa secundaria­ se sugiere considerar este diagnóstico. (AU)

Low alkaline phosphatase (ALP) or hypophosphatasemia either due to genetic (hypophosphatasia) or secondary causes, presents a clinical correlate. Our objectives are to estimate the prevalence of persistent hypophosphatasemia and to describe the clinical findings. We performed a search using the electronic medical records of the members of the Hospital Italiano de Buenos Aires health care system, between 2013 and 2017. Adult members with ≥ 2 ALP ≤ 30 IU/l, no ALP >30 IU/l (normal range 30-100 UI/l) and without diagnosed secondary causes were analyzed. Persistent hypophosphatasemia was detected in 78 of 105.925, 0.07% (0.06-0.09) of members. Only one was excluded due to a secondary cause, 61.1% were women, 44 (34-56) year-old, ALP 24 (20-27) IU/l and phosphatemia 4.1 (3.8-4.6) mg/dl. Osteoarthritis, vascular calcifications and fractures were detected, and nephrolithiasis, DISH (Diffuse idiopathic skeletal hyperostosis), tooth loss, and seizures were less frequently observed. At least one of the mentioned characteristics were present in 63.6 %, but only 5.2% had hypophosphatasemia registered in their clinical record. Densitometry showed osteopenia or osteoporosis in 76.2%. There were 19 fractures, most of them in radius. The prevalence of hypophosphatasemia was similar to what has been previously reported. Hypophosphatasemia finding in medical records was low, but far from being asymptomatic, clinical manifestations were observed. In the presence of hypophosphatasemia without a secondary cause, adult hypophosphatasia should be uspected. (AU)
Descritores: Músculo Esquelético/patologia
Hipofosfatasia/etiologia
-Osteoporose/etiologia
Doenças Ósseas Metabólicas/etiologia
Densidade Óssea
Prevalência
Estudos Transversais
Hipofosfatemia/diagnóstico
Hipofosfatemia/etiologia
Difosfonatos/uso terapêutico
Fosfatase Alcalina/deficiência
Fosfatase Alcalina/fisiologia
Fosfatase Alcalina/sangue
Fraturas por Osteoporose/etiologia
Hipofosfatasia/diagnóstico
Hipofosfatasia/genética
Limites: Humanos
Masculino
Feminino
Adulto
Pessoa de Meia-Idade
Idoso
Tipo de Publ: Estudo Observacional
Responsável: AR2.1 - Biblioteca Central


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Araújo, F. R
Borges, A. P. B
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Id: biblio-1128494
Autor: Araújo, F. R; Valente, F. L; Reis, E. C. C; Ermita, D. A. C. F; Sepúlveda, R. V; Borges, A. P. B.
Título: Modelo de indução de osteoporose em coelhas - avaliação radiográfica / Rabbit osteoporosis induction model - radiographic evaluation
Fonte: Arq. bras. med. vet. zootec. (Online);72(2):633-636, Mar./Apr. 2020. ilus, graf.
Idioma: pt.
Resumo: In order to establish a bone loss induction model in rabbits to study osteoporosis, 18 rabbits underwent ovariectomy and received methylprednisolone 1mg/kg intramuscularly on alternate days for two weeks. Immediately before ovariectomy up to 42 days after methylprednisolone administration, radiographs of the right olecranon were taken in the mediolateral position to evaluate the radiographic optical density. Before the induction of osteoporosis, rabbits presented mean values of radiographic density of 2.305mm Al and at 42 days of 1.575mm Al. The values obtained were submitted to ANOVA for repeated measures that revealed a significant drop (P< 0.001) in the density over time, proving that the induction was able to trigger bone loss of these animals. With this, it can be affirmed that the adopted protocol was enough to provoke a significant bone loss, characterizing a valid model for the study of new treatments for osteoporosis.(AU)
Descritores: Osteoporose/diagnóstico por imagem
Regeneração Óssea
Densidade Óssea
-Doenças Ósseas Metabólicas/veterinária
Análise de Variância
Modelos Animais
Limites: Animais
Feminino
Coelhos
Responsável: BR68.1 - Biblioteca Virginie Buff D'Ápice


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Id: biblio-1104226
Autor: Pavlov, Sergey; Babenko, Nataliia; Kumetchko, Marina; Litvinova, Olga; Semko, Natalia; Pavlova, Olga.
Título: Intercellular mediators in bone remodeling regulation in the experimental renal pathology / Mediadores intercelulares de la regulación de la remodelación ósea en un modelo experimental de patología renal
Fonte: Actual. osteol;15(3):180-191, Sept-Dic. 2019. ilus.
Idioma: en.
Resumo: Bone metabolism disorders are characterized by an imbalance of bone resorption and formation in the bone remodeling process. Glucocorticoids that are used to treat kidney diseases exacerbate these disorders. P-selectin and galectin-3 are molecules involved in the sclerotic process in kidney, whereas bone resorption is regulated by the interaction between the nuclear factor activator kappa b receptor (RANK), its ligand (RANKL) and the RANKL decoy receptor osteoprotegerin (OPG). The aim of this study was to investigate the cellular and molecular mechanisms of disruption of bone remodeling regulation processes, reflected by intercellular mediators (RANKL, OPG, P-selectin and galectin-3) in chronic kidney disease experimental model treated with glucocorticoids. Rats were divided into four groups of 10 animals each. The first group, the control group, included intact animals. The second group consisted of rats with impaired bone remodeling resulting from chronic kidney disease (experimental group (CKD). The third group was a group of animals with impaired bone remodeling due to exposure to glucocorticoids (experimental group (GCs)). The fourth group consisted of rats with impaired bone remodeling in chronic kidney disease, followed by exposure to glucocorticoids (experimental group (CKD + GCs)). The effects of CKD and glucocorticoid were evaluated biochemically, histologically and by measuring bone density. An enzymelinked immunoassay was used to measure intercellular mediator levels in the serum. The bone density in the experimental groups was reduced compared to the control group. RANKL levels in animals of three experimental groups were higher than in intact animals. Serum levels of OPG were higher in CKD and GCs groups than in intact animals. At the same time, in the animals' blood serum of the CKD + GCs group, the levels of OPG were lower, than those in animals from the control group. The levels of galectin-3 in the serum of the experimental groups GCs and CKD + GCs were lower than in intact animals. The serum levels of galectin-3 in animals of the CKD group were higher than those in animals from the control group. The levels of P-selectin were lower in the serum of the GCs group than in intact animals. At the same time, the levels of P-selectin were higher in the CKD and CKD + GCs groups, than those in animals from the control group. In conclusion, the study of the complex system of bone remodeling regulation, which includes many factors and their interactions, may lead to the development of new methods for treating patients with chronic kidney disease in order to prevent osteoporosis in the future. (AU)

Las enfermedades metabólicas óseas se caracterizan por un desequilibrio en el proceso de remodelación ósea en los que participan mediadores tales como receptor del activador del factor nuclear- kappa- b (RANK), su ligando (RANKL) y la osteoprotegerina (OPG). Los glucocorticoides, recuentemente empleados en el tratamiento de la enfermedad renal crónica, exacerban este desequilibrio. En la enfermedad esclerótica renal, las moléculas de adhesión celular P-selectina and galectina-3 tienen un rol fundamental. El objetivo de esta trabajo fue estudiar las alteraciones en los mediadores de la remodelación ósea (RANKL, OPG, P-selectina and galectina-3) en un modelo de enfermedad renal crónica con tratamiento glucocorticoideo. Ratas Wistar hembras fueron divididos en 4 grupos: control (C); enfermedad renal crónica con afección de la remodelación ósea (ERC); animales con afección de la remodelación ósea expuestos a glucocorticoides (GC); enfermedad renal crónica con afección de la remodelación ósea tratados con glucocorticoides (ERC+GC). Los efectos de la ERC y los GC fueron evaluados bioquímicamente, histológicamente y por medición de la densidad ósea. RANKL, OPG, Pselectina and galectina-3 se cuantificaron en muestras de sangre venosa empleando enzimoinmuno análisis. En los 3 grupos experimentales la densidad ósea se evidenció reducida y los niveles séricos de RANKL elevados respecto al grupo control. Los niveles de OPG en los grupos ERC y GC fueron superiores mientras que en el grupo ERC+GC menores respecto a los animales controles. Galectina 3 plasmática en GC y ERC+GC se encontró reducida y aumentada en los animales ERC, en comparación con los animales controles. La concentración sérica de P-selectina sérica fue mayor en los grupos ERC y ERC+GC, y menor en los animales GC respecto a los niveles plasmáticos de los animales intactos. El avance del conocimiento sobre la regulación de la remodelación ósea a través de la interacción de mediadores sistémicos, en un futuro, puede conducir al desarrollo de nuevas estrategias terapéuticas para la prevención de la osteoporosis en pacientes con enfermedad renal crónica. (AU)
Descritores: Distúrbio Mineral e Ósseo na Doença Renal Crônica/induzido quimicamente
Remodelação Óssea/efeitos dos fármacos
Nefropatias/fisiopatologia
-Osteoporose/prevenção & controle
Doenças Ósseas Metabólicas/diagnóstico
Dexametasona/administração & dosagem
Densidade Óssea/efeitos dos fármacos
Clorofórmio/uso terapêutico
Ratos Wistar
Selectina-P/efeitos dos fármacos
Selectina-P/sangue
Galectina 3/efeitos dos fármacos
Galectina 3/sangue
Ligante RANK/efeitos dos fármacos
Ligante RANK/sangue
Osteoprotegerina/efeitos dos fármacos
Osteoprotegerina/sangue
Glucocorticoides/efeitos adversos
Glicerol/administração & dosagem
Nefropatias/tratamento farmacológico
Limites: Animais
Ratos
Tipo de Publ: Ensaio Clínico Controlado Aleatório Veterinário
Responsável: AR2.1 - Biblioteca Central


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Id: lil-636749
Autor: Calvo Ayala, Enrique; Chalem Choueka, Monique; Ángel Arango, Luis Alberto; Muñoz, Yesid.
Título: Validación de encuestas de tamización para decisión de densitometría ósea en mujeres colombianas / Validity of screening questionnaires for referring bone densitometry in Colombian women
Fonte: Rev. colomb. reumatol;14(1):32-43, ene. 2007. ilus.
Idioma: es.
Resumo: Objetivos: validar diferentes cuestionarios de tamización para decisión de realización de densitometría ósea en un grupo de mujeres colombianas y establecer su correlación con la densidad mineral ósea. Diseño: estudio de concordancia y conformidad con Estándar de Oro y correlación sin puntos de corte. Métodos: en mujeres remitidas para la determinación de la Densidad Mineral Ósea (DMO) por el método DXA en columna lumbar y cadera, se establecieron los diagnósticos de normalidad, osteopenia y osteoporosis, utilizando los criterios establecidos por la Organización Mundial de la Salud. Previo al DXA se aplicaron las encuestas ABONE, NOF, ORAI, OSIRIS, OST y SCORE y se correlacionaron con la DMO de manera independiente. Se construyeron las curvas de características operativas de receptor (COR) de cada una y se compararon entre sí. Se calcularon sus sensibilidades, especificidades, y falsos positivos y negativos. Resultados: se encontró osteopenia en el 46,2% y osteoporosis en el 33,6% de 253 mujeres estudiadas con edad promedio de 57,7 años. El coeficiente de correlación de las escalas con DMO fue significativo entre 0,5 y 0,6. El área bajo las curvas COR fue mayor en OST, ORAI, SCORE y OSIRIS, en todas < 0,8. Todas las escalas tuvieron alta sensibilidad pero baja especificidad, con alta tasa de falsos positivos y negativos. Conclusiones: las escalas de tamización para decisión de DXA tienen buena correlación con la DMO pero con altas tasas de falsos positivos y negativos.

Objectives: to assess in a group of Colombian women the validity of six different screening tools as decision rules for referring them for bone densitometry, and to establish their correlation with bone mineral density (BMD). Design: concordance and agreement with gold standard; correlation without cut points. Methods: women who were referred for BMD determination by DXA examination in lumbar spine and hip were diagnosed as normal, osteopenic and/or osteoporotic according to World Health Organization criteria. Before the DXA was made, the screening tools ABONE, NOF, ORAI, OSIRIS, OST and SCORE were applied, and then their correlation coefficient among them and the BMD was made. Receiver Operating Characteristic (ROC) curves were made for each scale and a comparison was made among them. Sensitivity, specificity, and false positives and negatives of each scale were calculated. Results: osteopenia was found in 46.2% and osteoporosis in 33.6% of the 253 studied women, with an average age of 57 years old. Correlation among scales and BMD was significant between 0.5 and 0.6. The area under the curve (AUC) was higher in OST, ORAI, OSIRIS and SCORE, all of them < 0.8. All the tools had high sensitivity, but low specificity, with a high proportion of false positives and negatives. Conclusions: the screening tools as decision rules for referring subjects to bone densitometry had good correlation with BMD, but they had high proportions of false positives and negatives.
Descritores: Densidade Óssea
Estudo de Validação
-Mulheres
Organização Mundial da Saúde
Doenças Ósseas Metabólicas
Programas de Rastreamento
Sensibilidade e Especificidade
Colômbia
Determinação
Densitometria
Decisões
Métodos
Limites: Humanos
Feminino
Responsável: CO356.9


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Id: lil-636828
Autor: Ochoa, Carlos Darío; Toro, Carlos E; Ramírez, Fabián; Mercado, Jaime; Olivares, Orlando; Restrepo, José Félix; Rondón, Federico; Iglesias-Gamarra, Antonio.
Título: Enfermedades metabólicas óseas: análisis clínico y radiológico en cinco casos / Metabolic bone diseases: clinical and radiologic analysis in five cases
Fonte: Rev. colomb. reumatol;17(2):123-131, Apr.-June 2010. ilus, tab.
Idioma: es.
Resumo: El estudio de la enfermedad metabólica ósea es amplio y complejo. La enfermedad ósea más reconocida por médicos de todas las especialidades es la osteoporosis, probablemente debido a su elevada frecuencia. No obstante, es importante reconocer que existen numerosas entidades que afectan el metabolismo óseo de diferentes formas, llevando a fragilidad ósea, aumento del riesgo de fractura, osteoporosis u osteocondensación, de acuerdo a cada caso particular. Tanto el diagnóstico clínico como el reconocimiento de la alteración metabólica subyacente son importantes porque la identificación de la anormalidad específica se constituye en la base para el tratamiento. Se presentan 5 casos diferentes en los que un trastorno metabólico conlleva a una patología ósea específica; se discute la patogenia de las calcificaciones arteriales y se presenta una entidad mixta que nosotros llamamos osteoporomalacia.

The study of metabolic bone disease is broad and complex. The most widely recognized bone disease by physicians of all specialties is osteoporosis, probably due to its high frequency. However, it is important to recognize that there are numerous entities that affect bone metabolism in different ways, leading to brittle bones, increased risk of fracture, osteoporosis or osteocondensation, according to each particular case. Both the clinical diagnosis and recognition of the underlying metabolic abnormality are important because they identify the specific abnormality that will be the base for treatment. There were 5 different cases in which a metabolic disorder leads to specific bone pathology, we discuss the pathogenesis of arterial calcifications and presents a mixed entity we call osteoporomalacia.
Descritores: Doenças Ósseas Metabólicas
-Osteoporose
Patologia
Terapêutica
Osso e Ossos
Diagnóstico Clínico
Risco
Fraturas Ósseas
Limites: Humanos
Feminino
Adulto
Pessoa de Meia-Idade
Idoso
Tipo de Publ: Relatos de Casos
Responsável: CO356.9



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