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En los últimos años ha crecido el interés por el conocimiento y manejo de las complicaciones del pie diabético. El aumento de la incidencia de la diabetes mellitus y las nuevas terapias nos llevan a buscar un abordaje multidisciplinar de excelencia que nos permita reducir el número de amputaciones. El cirujano ortopédico debe conocer los procesos patológicos y tratar sus complicaciones (úlceras, infecciones, deformidades y neuroartropatía de Charcot), ya que un 15% de los pacientes diabéticos presentarán una úlcera en el pie, porcentaje similar al de los pacientes que presentarán una enfermedad de Charcot si su diabetes tiene más de 10 años de evolución.In recent years there has been increasing interest in the knowledge and management of diabetic foot complications. The highest incidence of diabetes mellitus and new therapies lead us to look for a multidisciplinary approach to excellence, allowing us to reduce the number of amputations. The orthopedic surgeon should know the pathological processes and treat its complications: ulcerations, infections, deformities and Charcot neuroarthropathy. Approximately 15% of diabetic patients will develop an ulcer on the foot, similar to the percentage of patients that present a Charcot in the case of more than 10 years of evolution diabetes.

The primary goal of osteoporosis treatment is to prevent the occurrence of fragility fractures, and thereby reduce morbidity and mortality. Among the various approaches to the treatment of this disease include ensuring proper calcium intake and to obtain adequate levels of vitamin D. Virtually all clinical trials with drugs used to treat osteoporosis systematically include calcium and vitamin D supplements. In light of the recent publication of clinical trials and meta-analyses, a possible increase in cardiovascular risk, particularly in the form of a myocrdial infarction, is hypothesised in patients taking calcium supplements. However, data published to date are inconclusive. Until the development of new scientific evidence, it seems reasonable to recommend, whenever practicable and individualized for each patient, increasing calcium intake with food and reserve supplements for patients with very low calcium intake in the diet. It would also be advisable for the administration of total daily dose to be fractionated throughout the day and with meals, and to obtain appropriate levels of vitamin D (25-hydroxycholecalciferol or calcidiol), along with the basic treatment for osteoporosis that is decided to be prescribed to patients.

Objetivo Describir las caracteristicas generales de una serie de enfermos con osteomielitis vertebral hematogena (OVH) desde la perspectiva de un hospital comarcal y comparar nuestros resultados con los de otras series nacionales y extranjeras. Pacientes y metodos Analisis retrospectivo de las historias clinicas de los pacientes con OVH diagnosticados en el Hospital de Viladecans en el periodo comprendido entre 1993 y 2008. Se han incluido solo los pacientes con demostracion microbiologica de infeccion y adquiridos por via hematica. Resultados Veintiseis pacientes cumplian los criterios de inclusion, nueve mujeres y diecisiete varones, con una edad media de 61 anos (limites 36�83). La mayoria de estos tenian algun factor predisponente de base, predominando la diabetes mellitus, y estaban causados por germenes piogenos (77%). La presentacion clinica habitual fue el dolor vertebral de caracteristicas inflamatorias, observado en 23 enfermos (88,4%). La artritis septica de articulaciones perifericas fue la forma de inicio en dos pacientes (7,6%) y el abdomen agudo en un paciente. La fiebre se detecto en 22 casos (84,6%). La mortalidad fue nula, aunque las complicaciones y secuelas resultaron frecuentes y a menudo graves. Conclusiones Las caracteristicas clinicas generales de nuestra serie no difieren esencialmente de otras, tanto nacionales como extranjeras, aunque como hecho diferencial hemos detectado una incidencia predominante de etiologia estreptococica sobre la estafilococica habitual. Es resenable la nula mortalidad observada. Aunque se trata de una enfermedad infrecuente, parece que esta aumentando su incidencia, lo que unido a su potencial capacidad para ocasionar complicaciones y secuelas graves obliga a sensibilizar al colectivo medico a fin de conseguir un diagnostico mas precoz y mejorar con ello el pronostico.

Objectives To describe a series of patients with haematogenous vertebral osteomyelitis (HVO) in a primary care hospital. The results were compared with other Spanish and foreign series. Patients and methods The files of patients with HVO diagnosed in the Viladecans hospital from 1993 through 2008, were retrospectively reviewed. Only patients with microbiological demonstration of infection were included. Patients with HVO after surgical procedures were excluded. Results Twenty six patients had inclusion criteria, 9 females and 17 males, with a mean age of 61 years (range 36ndash;83). The most patients had any predisposing factor, generally diabetes mellitus. Pyogenic microorganisms were the most frequent aetiological agents (77%). Back pain was by far the most common presenting symptom (88.4%), followed by peripheral septic arthritis in two patients (7.6%), and acute abdominal pain in one. Fever was found in 22 cases (84.6%). None of our patients died, but the sequelae were non rare. Conclusion We did not find difference between our series and others. It is noteworthy that the streptococcal species represents the most frequently isolated organism, followed by Staphylococcus aureus, more common in other series. Remarkably, none of our patients died. HVO is an infrequent disease. However, evidence suggests that the incidence is increasing. Early diagnosis can avoid potential serious sequelae.

The primary goal of osteoporosis treatment is to prevent the occurrence of fragility fractures, and thereby reduce morbidity and mortality. Among the various approaches to the treatment of this disease include ensuring proper calcium intake and to obtain adequate levels of vitamin D. Virtually all clinical trials with drugs used to treat osteoporosis systematically include calcium and vitamin D supplements. In light of the recent publication of clinical trials and meta-analyses, a possible increase in cardiovascular risk, particularly in the form of a myocrdial infarction, is hypothesised in patients taking calcium supplements. However, data published to date are inconclusive. Until the development of new scientific evidence, it seems reasonable to recommend, whenever practicable and individualized for each patient, increasing calcium intake with food and reserve supplements for patients with very low calcium intake in the diet. It would also be advisable for the administration of total daily dose to be fractionated throughout the day and with meals, and to obtain appropriate levels of vitamin D (25-hydroxycholecalciferol or calcidiol), along with the basic treatment for osteoporosis that is decided to be prescribed to patients.