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Osteogenesis imperfecta (OI) is an inherited disorder that causes low mineral density and bone fragility. Previous studies have shown the efficacy of bisphosphonates to increase bone mineral density (BMD). This study assessed changes over time in BMD and biochemical markers of bone metabolism in adult patients with osteogenesis imperfecta treated with intravenous zoledronic acid and the safety of this treatment., Patients and Methods: A prospective, observational study in patients with OI, osteoporosis or osteopenia (T score <-2) who were administered zoledronic acid infusions (4mg IV) every 6 months for three years and annually thereafter. Densitometry was performed annually. Acute changes in complete blood count and calcium, phosphate, and creatinine levels, as well as side effects of the infusion, were recorded 24 and 48h after treatment. Calcium, phosphate, parathyroid hormone (iPTH), 25OH-vitamin D and bone turnover markers (bone alkaline phosphatase, ß-crosslaps and urinary deoxypyridinoline) were measured at baseline and every 12 months. Adverse events and new fractures were recorded., Results: Twenty patients (6 men and 14 women) were treated. Median follow-up time was five years. Calcium levels and platelet counts significantly decreased 24 and 48hours after the first infusion, and the red blood cell count decreased at 24hours. These changes were not clinically relevant. Seven patients experienced a flu-like episode after the first dose. Treatment induced significant increases in BMD in the lumbar spine (6.7%) after 12 months of follow-up (0.791±0.178 vs. 0.791±0.140g/cm 2 , p=.003) and at three (5.7%) and five years (9%) of follow-up. Femoral neck BMD significantly increased after 3 years (11.1%): 0.648±0.148 vs. 0.720±0.138g/cm 2 ; p=.01. In total hip, increase in BMD (10.1%) was significant after three years of treatment (0.706±0.118 vs. 0.720±0.138, p=.01). There were no significant differences in calcium and 25OH-vitamin D levels during follow-up, phosphorus significantly decreased after one year, and iPTH increased at three years. ß-crosslaps decreased after one year of treatment. Only one patient sustained new fractures., Conclusions: Zoledronic acid is a convenient, safe, and effective treatment that increases BMD in adult patients with OI., (Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Objective: To assess the effect of the application in routine clinical practice of a proposal of thresholds for the indication of bone densitometry in Spanish postmenopausal women., Patients and Methods: We determined the risk of major fracture (RMF) by FRAX(®) of the patients referred to a bone densitometry unit from Primary Care who were untreated. We calculated how many scans would have been avoided if they had been performed only to women ≥ 65 years with a RMF < 10% or women<65 years with a RMF ≥ 3.6%., Results: We included 643 women with a mean age of 61 (9) years. Twenty-three percent had a normal bone mineral density, 56% had osteopenia, and 21% osteoporosis. The RMF was 5.9 (5.5)%. Eighty of 217 (37%) bone scans in women ≥ 65 years and 273 of 426 (64%) in women<65 years would have been avoided. As a whole, 55% of the scans would have been avoided. The sensitivity of the threshold of 3.6% of RMF for the diagnosis of osteoporosis was 51%, specificity 68%, positive predictive value 20%, and negative predictive value 20%., Conclusions: The application of the proposed thresholds for the indication of bone densitometry in Spanish postmenopausal women, based on age and risk of fracture calculated by FRAX(®) would result in a significant decrease of the activity of the bone densitometry unit., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Background and Objective: The QFRACTURE(®) tool allows to estimate the risk of osteoporotic fractures in 10 years. We have estimated it, both for major and hip fracture, from the data obtained from the National Health Questionnaire. We thus estimated the risk of fragility fractures in the next 10 years in the Spanish population of both genders and calculated its burden., Subjects and Methods: We have used the QFRACTURE(®) tool which estimates the risk of any fracture and hip fracture in the next 10 years., Results: A total of 552.879 women and 161.922 men will suffer a fragility fracture in the next 10 years in Spain. Most of the fractures will happen in people aged 70 years old and more. In 10 years there will be 263.351 hip fractures in women and 84.213 in men. More than half of the hip fractures in women will happen to those aged more than 77 years old. The burden of osteoporotic fractures in Spain could arise to 4.778 millions of euros in the next 10 years with a cut-off of 3% for hip fracture accepting as reference the cost of generic alendronate., Conclusions: We have a first approach to the number of osteoporotic fractures in the next 10 years and its burden. The knowledge of this figures may be useful in order to program strategies to reduce the number of osteoporotic fractures in the future., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Introduction: Fragility fractures are an important public health issue. The aim of this study was to analyze the association of the main osteoporotic risk factors related to fragility fracture in a cohort of women with an indication of bone densitometry (BD)., Methods: A retrospective cohort was followed-up until a fragile fracture occurred, in a population of women aged 40 to 90 years with a first visit for BD between January 1992 and February 2008. We calculated the incidence rate of fracture per 1000 women-years of follow-up, and the hazard ratio (HR) of fragile fracture using a Cox regression model., Results: A total of 49,735 women were studied. The average age of participants was 57.8 years (SD: 8.5). Of these, 3631 women (7.1%) reported a new fragility fracture in post-baseline visits. Risk factors with higher adjusted HR were age ≥ 75 years compared with age < 55 years (HR: 3.8; 95% CI: 3.3-4.4) and having a BC result evaluated as osteoporosis compared to normal (HR: 2.0; 95% CI: 1.8-2.2). A personal history of humerus, hip or vertebral fractures had an adjusted HR of 1.2 (95% CI: 1.1-1.3)., Conclusions: The main risk factors for fragility fracture were advanced age, BD result and a personal history of fracture, although 74% of fractures were detected with a bone mineral density classified as normal or osteopenia. Other relevant factors were rheumatoid arthritis or having received prolonged corticosteroid therapy., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objective: To evaluate the clinical features and outcome of inpatients with hip fracture and to investigate the clinical variables associated with the risk of medical complications., Methods: Prospective study of hip fracture patients aged 65 or more, admitted to the Department of Orthopaedic Surgery of the Xeral-Calde Hospital, in Lugo, Spain, in 2008. The different clinical and biochemical variables as regards the baseline health status and presentation features of the hip fracture and its complications were all recorded. The factors associated with the development of medical inpatient complications, including death, were determined, using univariate and multivariate analyses., Results: A total of 258 patients were studied. The mean age was 82.2 (9.5) years, and 76% were women. The fracture was osteoporotic in 96.8%, and 92.6% were treated surgically. The mean Barthel index was 72.9 (25.7) and the age adjusted Charlson comorbidity index was 5.2 (1.5). A total of 63.9% patients had a major medical complication during their hospital stay. Mortality was 5.8%. The following variables were associated with the development of medical inpatient complications: Barthel index (OR=2.21; 95% CI, 1.1-4.25; p=0,01), age (OR=1.09; 95% CI, 1.02-1.12; p=0.006), haemoglobin at admission (OR=0.76; 95% CI, 0.62-0.93; p=0.01)., Conclusions: Patients with hip fracture are fragile elderly with a high degree of functional dependence and comorbidity. Those with a high risk of developing medical inpatient complications can be identified at admission., (Copyright © 2010 SECA. Published by Elsevier Espana. All rights reserved.)

Objective: To know the characteristics of the postmenopausal women with osteoporosis consulting Rheumatology Hospital Divisions in Spain., Methods: An epidemiologic, observational, transverse and multicentric study was performed from June to September 2008 in 63 rheumatology divisions in Spain. Six hundred and twenty nine osteoporotic postmenopausal women were studied using a questionnaire designed to get demographic, clinical, radiological, bone density, and functional information. Every physician had to choose only one patient per day, usually the first woman to come in and fulfill the inclusion and exclusion criteria., Results: Mean age of included women was 66,6 [9,2) years, weight:64,6[10,1] kg and body mass index: 26,1[4,1] kg/m(2). They were 3,1[2,8] cm shorter than the maximal historical height. 35,7% of them had a family history of fracture and 40,7% had a past history of fracture, of which 54,8% were vertebral fractures. Patients who received calcidiol <20 ng/ml sustained more falls (p=0,033) and fractures (p=0,006) than women receiving calcidiol >20 ng/ml. Risk of falls and fractures increased with advancing age and 51,5% of women who fell, had a fracture. 75% of women had poor calcium intake (≤400 mg/day). The Get up & go test showed a linear trend to an increased probability of >20s in relationship with the age as well as with an increased incidence of fractures. 71,8% of patients had back pain and in 85,3% it went from moderate to severe., In Conclusion: Most osteoporotic postmenopausal Spanish women have a low calcium intake, one out of three has a family history of fractures that increases fracture incidence and this shows a relationship with age and functional capacity; four out of ten have had any type of fractures, one out of three have fallen during the past year and half of these present back pain. Calcidiol levels have been evaluated in a small group of patients., (Copyright © 2009 Elsevier España, S.L. All rights reserved.)

Dialysis patients have bone metabolic disorders and a higher prevalence of fractures, principally peripheral fractures. However, there are few studies focusing on the prevalence of vertebral fractures. Moreover, aortic calcifications are very common and are an independent predictive factor of vascular morbidity and mortality. The objective of this study was to assess the prevalence of vertebral fractures and vascular calcifications in haemodialysis (HD) patients (n = 99), in comparison with a random sample of general population of similar age and from the same geographical area (n = 624) and study their relationship with clinical, biochemical and therapeutical data. The prevalence of vertebral fractures in HD patients and general population was 19.1% and 24.1% respectively (non-significant statistical differences). In both, sexes, the presence of vertebral fractures was positively associated with age, mean maximum Ca, mean maximum CaxP. In women, time in HD was positively associated as well. On the other hand, the prevalence of aortic calcifications was much higher in HD patients (77.9% vs 37.5%, p < 0.001). HD was a risk factor for aortic calcification in women [OR = 7.7 (IC 95% = 2.6-22.9)] as in men [OR = 5 (IC 95% = 1.9-12.9)]. Severe vascular calcifications were more frequent in HD patients, it reached 57.4% compared with 17% of general population (p < 0.001). Both, in women (64.5% vs 13.3% p < 0.001) and in men (51.4% vs 20.9%), respectively (p < 0.001). In conclusion, the prevalence of vertebral fractures was similar in HD patients and in general population. Nevertheless, frequency and severity of aortic calcifications was higher in HD patients.

Background: The aim of the present was to study the long term sequelae of osteoporotic fracture of the femur in a general hospital of 300 beds in Barcelona, analyzing 1) mortality; 2) degree of functional capacity; 3) care requirements; 4) familial repercussion, and 5) psychic repercussion., Methods: Structured telephone interviews were carried out between 1990-1991 with the patients attended for osteoporotic fracture of the femur in our center from 1988-1989. Of a total of 145 patients, 12 died within 1 month. Among the remaining patients the interview was performed with 100 patients--25 of whom were males of 78 +/- 8 years of age and 75 females of 82 +/- 10 years of age. The degree of functional capacity was evaluated by the index of independence in daily activities (DA)., Results: Mortality within one month was 8.3%; at one year 30% and at 2 years 38%. Factors associated with the highest mortality were: age of over 80 years (p less than 0.004), deterioration of post fracture functional capacity (p less than 0.0004) and pre-fracture dementia (p less than 0.01). Important deterioration in post fracture functional capacity was seen in 45% of the cases. Seventeen percent of the patients required transfer to a center for chronic care and 34% resided in a center for chronic care prior to the fracture. Familial repercussion was observed in 43% of the cases and post fracture psychologic repercussion was seen in 28%., Conclusions: Osteoporotic fracture of the femur presents the following sequelae: mortality, intense deterioration of functional capacity and important health care requirements in addition to considerable familial and psychological repercussion.