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Although the negative effect of systemic steroids on bone is well documented, there is not clear evidence about possible adverse effects of inhaled steroids on bone metabolism and fractures. A cross-sectional study was performed on 105 women suffering from bronchial asthma treated with inhaled steroids and 133 controls. Bone mineral density (BMD) was measured by quantitative ultrasonography (QUS) at the calcaneus and by dual X-ray absorptiometry (DXA), at both the lumbar spine and proximal femur. Patients suffering from bronchial asthma showed no statistically significant changes in BMD as measured by DXA or QUS, compared with controls. A higher prevalence of fractures was found in the group of women with bronchial asthma, with an age-adjusted odds ratio of 2.79 (95% CI: 1.19−6.54). Inhaled steroids do not appear to decrease BMD, but are associated with an increased risk of fracture in women.

Objetivo Realizar una encuesta de opinion sobre osteoporosis en internistas espanoles. Metodo Encuesta remitida por correo y por visita personal a miembros de la Sociedad Espanola de Medicina Interna. Recogida de datos sobre opinion acerca de la enfermedad, actitud diagnostica y terapeutica y medios disponibles (analitica general, radiologia convencional, marcadores bioquimicos de remodelamiento oseo, densitometria y ultrasonidos) y preferencias a la hora de elegir un determinado tratamiento. Resultados Contestaron un total de 538 internistas. Mas del 90% de los encuestados opina que la osteoporosis es una enfermedad que deben tratar los internistas. El 93% considera que la osteoporosis es una patologia prevalente. Mas del 80% tiene acceso a una densitometria. Conclusiones Los internistas espanoles opinan mayoritariamente que la osteoporosis es una enfermedad que deben tratar los internistas y que entra en su ambito de actuacion. Por lo general disponen de los medios que necesitan para su estudio y tratamiento. Los bifosfonatos constituyen el farmaco de eleccion y en la practica totalidad de los casos indican un suplemento de calcio y vitamina D.

Introduccion La insuficiencia cardiaca tiene una elevada incidencia y prevalencia en nuestra poblacion. Los objetivos marcados en nuestro estudio son describirel perfil del paciente que ingresa en los servicios de Medicina Interna de nuestro hospital con objeto de analizar los aspectos terapeuticos y conocer el grado de utilizacion de los distintos grupos farmacologicos. Material y metodos Se realiza un estudio transversal recogiendo datos de las historias clinicas de los pacientes ingresados en el ano 2002 en los sevicios de Medicina Interna del Hospital Clinico San Carlos de Madrid con el diagnostico de insuficiencia cardiaca. El total de pacientes con dichas caracteristicas es de 1.338. Calculando el tamano muestral con una precision del 5% y un intervalo de confianza del 95%, el numero de historias analizadas es de 130 escogidas de un modo aleatorio. Los datos se recogen mediante un cuestionario que analiza diferentes variables clinicas y terapeuticas. Resultados La media de edad es de 80,3 (desviacion estandar: 9,64) anos, siendo en su mayoria mujeres. La patologia asociada mas frecuente es la hipertension arterial, existiendo en un 70,2% de los pacientes alguna enfermedad. Los diureticos son los farmacos mas utlizados y su prescripcion aumenta al alta (p Discusion y conclusiones En nuestro medio los pacientes con IC tienen una edad avanzada, presentanuna importante comorbilidad y una clase functional avanzada, siendo los diureticos su tratamiento de base. Observamos que no existe homogeneizacion en cuanto al tratamiento con respecto a las ultimas recomendaciones y que hay una escasa utilizacion de los farmacos que, como los bloqueadores beta, han demostrado un aumento de la supervivencia en la insuficiencia cardiaca.

Objetivo: Determinar la densidad mineral ósea (DMO) en hueso axial y apendicular en un grupo de niños y adolescentes con diabetes tipo 1 y relacionarla con parámetros de control metabólico y con el tiempo de evolución de la enfermedad Pacientes y método: Se realizó una densitometría de columna lumbar (L 1-L 4) y de antebrazo mediante el densitómetro de doble energía de rayos X Hologic QDR;1000 a 246 niños y adolescentes sanos (111 varones y 135 mujeres, de 2,8 a 20,8 años) y a 45 diabéticos (18 varones y 27 mujeres, de 5,2 a 19,4 años). Los resultados se expresaron en forma de media y desviación estándar. Las diferencias entre ambas poblaciones se determinaron mediante el t-test y análisis de la variancia. La relación entre DMO y el resto de las variables se midió mediante el coeficiente de correlación de Pearson y el coeficiente de correlación parcial. Se definió significación estadística a un valor de p < 0,05. Resultados: La DMO aumenta desde la infancia a la vida adulta en ambas poblaciones. La DMO de los pacientes diabéticos fue inferior a la del grupo no diabético, tanto en la columna lumbar como en el antebrazo, sobre todo durante el brote puberal. Las diferencias de masa ósea más llamativas se encontraron en el hueso trabecular de la pobla-ción masculina. No se encontró ninguna relación estadísticamente significativa entre la DMO de las diferentes regiones analizadas y los parámetros de control metabólico (hemoglobina glucosilada media, dosis de insulina) o el tiempo de evolución de la enfermedad (p > 0,05). Conclusiones: La diabetes tipo 1 debe considerarse una población de riesgo de padecer osteoporosis en la vida adulta. El diagnóstico debe establecerse a partir de criterios densitomé-tricos, ya que en este estudio el grado de control metabólico o el tiempo de evolución de la enfermedad no per-mitieron predecir qué grupo de diabéticos va a estar os-teopénico. : Objective: To determine bone mineral density (BMD) at axial and appendicular sites in patients with type 1 diabetes melli-tus and evaluate its relationship with metabolic control and disease duration. Patients and method: BMD was measured by dual-energy X-ray absorptio-metry (Hologic QDR-1000) in the lumbar spine (L 1-L 4) and at the distal third forearm in 246 healthy non-diabetic children and adolescents (111 boys, 135 girls, aged 2.820.8 years) and in 45 diabetic patients (18 boys, 27 girls, aged 5.2-19.4 years). The results were expressed as the mean and standard deviation. The differences were tested by analysis of variance or Student's t-test, as appropriate. The relationship between BMD and the remaining variables was studied by simple Pearson's coefficient and partial correlation coefficient. Significance was defined as p < 0.05. Results: BMD increased progressively from infancy to adulthood in both populations. Lumbar spine and forearm BMD were significantly lower in diabetic patients than in the healthy non-diabetic children, mainly during pubertal spurt. The greatest differences were found in males and in the trabecular bone. No relationship was found between metabolic control (mean glycosylated hemoglobin, insulin requirement) and duration of diabetes and the BMD in any region studied (p > 0.05). Conclusions: Pediatric patients with type 1 diabetes mellitus appear to constitute a population at risk of osteoporosis in adulthood. Diagnosis of osteopenia diagnosis should be established according to densitometric criteria. In this study, metabolic control parameters and duration of diabetes did not enable predetermination of diabetic patients at risk of osteoporosis in adulthood.

To conduct an opinion survey on osteoporosis in Spanish internists.Survey sent by mail and by personal visit to members of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment.A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to densitometry.The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases.

In recent years, a large number of techniques have been developed to estimate the bone mineral density for the diagnosis of osteoporosis. However, diagnostic criteria established by WHO are invariably applied for the interpretation of dual radiological densitometry (DEXA), which could not be correct in the case of the interpretation of ultrasound.We studied 2,589 randomly chosen people of both sexes, 1,138 males and 1,451 women from 10 to 99 years, in 11 spanish provinces. We carried out a measurement of the following calcaneous ultrasound parameters with the Sahara and Hologic devices: speed of the sound (SOS), coefficient of attenuation of wide band (BUA), index of consistency (QUI) and estimated bone mineral density (est. BMD). The prevalence of osteopenia and osteoporosis was calculated by applying the WHO criteria (osteopenia Tscoreor = 1 and osteoporosis Tscoreor = 2.5) and the prevalence of osteoporosis by applying a Tscore 1.8 as threshold.According to the WHO criteria, osteoporosis (Tscoreor = 2.5) is seen in 1.5 % males and 5.9 % females from 51 to 70 years, and in 2.6% males and 22.1% females over 70 years. Using a Tscore 1.8 as threshold, osteoporosis prevalence increases to 8.2% males and 21.9% females from 51 to 70 years, and to 8.4% males and 40.9% females over 70 years.Osteoporosis prevalence in spanish people of both sexes differs notably when applying the cut off point in a Tscore of 2.5, as WHO recommends, or in a Tscore of 1.8 as is suggested by other authors. Consensus is necessary to establish the appropriate cut off point or threshold for the diagnosis of osteoporosis with quantitative ultrasonography of calcaneum.

Continuous treatment with calcitonin (CT) has caused an increase of bone mineral density for the first 18 months, followed by a partial decrease of it. In order to obtain a better result in a two year follow-up, it is proposed a schedule treatment during 50% to 66% of the time in recent postmenopausal women.Pilot, double-blind, randomised, two years follow-up study. 60 women with osteopenia less than 5 years from menopause received 40 U of intranasal elcatonin (ELC) or placebo (PL) 2 months ON, one month OFF. Compliance, safety, pain and the degree of incapacity were evaluated at baseline and every 3 months. At the start and every six months lumbar and femoral BMD were assessed with DXA.41 patients completed the study (21 ELC and 20 PL). There were no basal differences. The treatment was actually used during 59% of the follow-up time in the ELC group and during 58% of the time in the PL group. Basal T-scores were -2.29 SD in the PL group and -2.42 SD in the ELC group. Bone densitometry showed an increase of BMD in the group of patients treated with ELC up to 18 months (lumbar and femoral) but a loss in those patients that received PL.40 U of nasal elcatonin for more than 50% of the observation time prevents in the long-term (2 years) the progressive loss of bone mineral density in recent postmenopausal women.

To determine bone mineral density (BMD) at axial and appendicular sites in patients with type 1 diabetes mellitus and evaluate its relationship with metabolic control and disease duration.BMD was measured by dual-energy X-ray absorptiometry (Hologic QDR-1000) in the lumbar spine (L1-L4) and at the distal third forearm in 246 healthy non-diabetic children and adolescents (111 boys, 135 girls, aged 2.8-20.8 years) and in 45 diabetic patients (18 boys, 27 girls, aged 5.2-19.4 years). The results were expressed as the mean and standard deviation. The differences were tested by analysis of variance or Students t-test, as appropriate. The relationship between BMD and the remaining variables was studied by simple Pearsons coefficient and partial correlation coefficient. Significance was defined as p0.05.BMD Increased progressively from infancy to adulthood In both populations. Lumbar spine and forearm BMD were significantly lower in diabetic patients than in the healthy non-diabetic children, mainly during pubertal spurt. The greatest differences were found in males and in the trabecular bone. No relationship was found between metabolic control (mean glycosylated hemoglobin, insulin requirement) and duration of diabetes and the BMD in any region studied (p0.05).Pediatric patients with type 1 diabetes mellitus appear to constitute a population at risk of osteoporosis in adult-hood. Diagnosis of osteopenia diagnosis should be established according to densitometric criteria. In this study, metabolic control parameters and duration of diabetes did not enable predetermination of diabetic patients at risk of osteoporosis in adulthood.

In order to establish the normal patterns of forearm bone mineral density (BMD), BMD in the cortical and trabecular parts of the distal forearm were studied in a normal pediatric population.BMD was measured by dual-energy X-ray absorptiometry (HOLOGIC QDR-1000) in the distal third forearm of 246 normal children and adolescents (111 boys and 135 girls) ranging from 2.8 to 20.8 years of age. BMD was correlated by multiple regression analysis with age, weight, body mass index (BMI), sex and pubertal Tanner stage.Forearm BMD increased progressively with age, weight, height, BMI and maturity, with the maximal increase in all forearm bone sites occurring at the onset of puberty in girls and boys. A statistically significant correlation was found between forearm BMD and all of these variables (r = 0.65 to 0.92). Mean BMD was higher in boys than in girls in cortical, trabecular and cortical-trabecular sites of the distal forearm. Maximal differences in BMD between boys and girls occurred at 17-18 years of age, especially the trabecular-dominated (ultradistal) part of the distal forearm (0.446 vs 0.384 g/cm2).Forearm BMD studies permit information of both cortical and trabecular bone mineralization to be obtained at the same time. This study reports normative data for forearm BMD in a healthy pediatric population. The values obtained may be used as a reference of normality when evaluating bone density in situations where skeletal mineralization may be compromised.

Radiogrametric values of the second right metacarpal and data obtained by radiographic densitometry in the lumbar cord and the neck of the right femur have been studied comparatively in sixty two women and 6 men, with ages within 24 and 82 years and suspicion of suffering osteoporosis. Cases have been divided into four groups depending on the presence of vertebral fractures (Group I) and the densitometric results at the level of the lumbar cord. The comparison has shown a poor correlation between lumbar densitometric values and the radiogrametry, both in the cases considered normal and pathogenic. We conclude that the radiogrametry has a small discriminant value in the diagnosis of the post-menopause osteoporosis. On the contrary, absorptiometry in the neck of the femur has a significant correlation with radiogrametry in healthy individuals.

Unter chronischer Hamodialyse-Behandlung wurden 13 Falle auf Knochenveranderungen unter Berucksichtigung des Calcium-Phosphat-Stoffwechsels untersucht. Die Knochenveranderungen wurden histomorphometrisch definiert. Bestimmt wurden die prozentualen Anteile der neutralen Oberflachen, des Osteoids, der aktivierten Osteoblasten, der Resorptionslacunen und der mehrkernigen Osteoclasten an den endostalen Oberflachen, sowie die mittlere Breite der Osteoidsaume. Auserdem wurden Formation und Resorption des Knochens mittels quantitativer Mikroradiographie sowie die volumetrische Dichte der Spongiosa gemessen.

Auf der Suche nach Verfahren, um eine Osteoporose zu objektivieren, wurden zwei Untersuchungsmethoden gegenubergestellt: die rontgenologische Indexbestimmung nachBarnett undNordin und eine histologisch-morphometrische Methode am Beckenkammcylinder. Hierbei zeigte sich, das das erste Verfahren in 2 von 17 Fallen mit einer Osteoporose mit sehr ausgepragtem Befund (Nr. 7 und 10) versagte. Bei vier weiteren Fallen (Nr. 8, 4, 11 und 12) wurde es zweifelhaft, ob die Osteoporose wirklich bestand. Bei der morphometrischen Methode wurden viermal (Nr. 5, 9, 13 und 20) falsch-negative Ergebnisse gewonnen, d. h. eine Osteoporose wurde mit diesem Verfahren nicht erfast, die in Wirklichkeit bestand. Zwei weitere Falle (Nr. 4 und 12) waren vermutlich falsch-positiv, d. h. bei hochgradig pathologischen Werten lag keine so starke Osteoporose vor, wie sie danach zu vermuten gewesen ware. Beim hypoplastischen Skelet ohne Krankheitswert wurden Werte erhoben, wie sie einer Osteoporose entsprechen. Insofern ist durch die letztgenannte Methode die Gefahr einer Fehldeutung gegeben.

Die Abnahme der Knochenmasse ist zwar in der Regel einer der atrophischen Prozesse, die das Alter begleiten; es gibt aber auch Knochenatrophien oder Osteoporosen bei jungen Menschen, die ohne erkennbare Ursache auftreten und die man als idiopathische Osteoporose bezeichnet. Man findet bei diesen Patienten keine genetische, keine hormonale, keine alimentare, keine gastrointestinale Storung, d. h. man findet keine Veranderung, die diese Form der juvenilen Osteoporose als symptomatisch charakterisieren wurde.