Bone Metabolic Unit

Santander, Spain

Bone Metabolic Unit

Santander, Spain

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Hernandez J.L.,Bone Metabolic Unit | Olmos J.M.,Bone Metabolic Unit | Nan D.,Bone Metabolic Unit | Martinez J.,Bone Metabolic Unit | And 3 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2013

Objective: The aims of the study were to analyze whether there is an association between serum PTH and the prevalence of vertebral fractures and its possible dependence on vitamin D status, and to assessthe influence of serum 25-hydroxyvitamin D (25OHD) in the relationship between PTH and bone mineral density (BMD) or bone turnover markers (BTMs). Design, Participants, and Setting: A total of 820 postmenopausal women were recruited after excluding those with any known condition that could influence serum PTH levels, except for a possible low serum 25OHD. Serum PTH and 25OHD concentrations, as well as vertebral fracture prevalence, BMD, and BTM (CTX and PINP) values were recorded. Serum PTH levels were divided into tertiles, and women were grouped into those in the highest tertile (>58 pg/ml) and those below. Serum 25OHD levels were stratified in 3 categories (<20, 20-30, and >30 ng/ml). Results: Vertebral fracture prevalence was greater in women with PTH above 58 pg/ml (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.04-2.84). After stratifying by 25OHD, this difference was only significant in women below 20 ng/ml (OR, 2.00; 95% CI, 1.02-3.87), those with 25OHD between 20 and 30 ng/ml showing a trend toward this (OR, 1.99; 95% CI, 0.92-4.36). Differences in BMD or BTM between women above and below 58 pg/ml of PTH were also observed only in those below 20 ng/ml. Conclusion: Elevated PTH levels are associated with increased prevalence of vertebral fractures, low bone mass, or higher BTM only in the presence of hypovitaminosis D. An adequate nutritional status in the vitamin appears to protect the bone from the deleterious effect of a high PTH. Copyright © 2013 by The Endocrine Society.


Bonaccorsi G.,University of Ferrara | Fila E.,University of Ferrara | Messina C.,University of Milan | Maietti E.,University of Ferrara | And 4 more authors.
Aging Clinical and Experimental Research | Year: 2016

Purpose: To evaluate (a) the performance in predicting the presence of bone fractures of trabecular bone score (TBS) and hip structural analysis (HSA) in type 2 diabetic postmenopausal women compared to a control group and (b) the fracture prediction ability of TBS versus Fracture Risk Calculator (FRAX®) as well as whether TBS can improve the fracture prediction ability of FRAX® in diabetic women. Methods: Eighty diabetic postmenopausal women were matched with 88 controls without major diseases for age and body mass index. The individual 10-year fracture risk was assessed by FRAX® tool for Europe–Italy; bone mineral density (BMD) at lumbar spine, femoral neck and total hip was evaluated through dual-energy X-ray absorptiometry; TBS measurements were taken using the same region of interest as the BMD measurements; HSA was performed at proximal femur with the HSA software. Results: Regarding variables of interest, the only significant difference between diabetic and control groups was observed for the value of TBS (median value: 1.215; IQR 1.138–1.285 in controls vs. 1.173; IQR 1.082–1.217 in diabetic; p = 0.002). The prevalence of fractures in diabetic women was almost tripled than in controls (13.8 vs. 3.4 %; p = 0.02). The receiver operator characteristic curve analysis showed that TBS alone (AUC = 0.71) had no significantly lower discriminative power for fracture prediction in diabetic women than FRAX major adjusted for TBS (AUC = 0.74; p = 0.65). Conclusion: In diabetic postmenopausal women TBS is an excellent tool in identifying fragility fractures. © 2016 Springer International Publishing Switzerland


Caudarella R.,Maria Cecilia Hospital GVM Care and Research | Caudarella R.,Casa Of Cura Villalba Gvm Care And Research | Vescini F.,University of Udine | Rizzoli E.,University of Bologna | Ulivieri F.M.,Bone Metabolic Unit
Clinical Reviews in Bone and Mineral Metabolism | Year: 2015

The literature data suggest a positive effect of thiazide diuretic treatment on bone health both by increasing bone mineral density and by decreasing the risk of fracture. The protective effect of thiazides seems to be linked both to the dosage and to the duration of treatment; moreover, the protective effects of thiazides in preserving bone mass and in decreasing the risk of fractures does not last long after discontinuation of treatment. Thiazides influence bone health by means of different mechanisms. In fact, they increase renal calcium reabsorption by inhibiting the sodium chloride cotransporter in the distal tubule, thus increasing sodium urinary excretion and decreasing urinary calcium excretion. Still, thiazides contribute to maintaining calcium homeostasis by increasing calcium intestinal absorption. Moreover, thiazides have a direct effect on bone cells, especially on osteoblast differentiation and bone mineral formation. Finally, it was suggested that thiazides prevent bone loss as they decrease the acid production by means of inhibition of carbonic anhydrase activity in the osteoclasts. The dual action shown by thiazides on both osteoblasts and osteoclasts could explain the reduced bone remodeling observed in patients taking these drugs, in the absence of changes in plasma parathyroid hormone levels. In conclusion, thiazides might play an interesting role in osteoporosis management, particularly in those patients affected by both hypertension and osteoporosis, but efficacy in reducing fractures and the safety of this treatment must still be evaluated by means of further randomized controlled clinical trials which have the reduction in fractures as primary outcomes. © 2015, Springer Science+Business Media New York.


Ulivieri F.M.,Bone Metabolic Unit | Silva B.C.,Columbia University | Sardanelli F.,University of Milan | Hans D.,University of Lausanne | And 2 more authors.
Endocrine | Year: 2014

Altered bone micro-architecture is an important factor in accounting for fragility fractures. Until recently, it has not been possible to gain information about skeletal microstructure in a way that is clinically feasible. Bone biopsy is essentially a research tool. High-resolution peripheral Quantitative Computed Tomography, while non-invasive, is available only sparsely throughout the world. The trabecular bone score (TBS) is an imaging technology adapted directly from the Dual Energy X-Ray Absorptiometry (DXA) image of the lumbar spine. Thus, it is potentially readily and widely available. In recent years, a large number of studies have demonstrated that TBS is significantly associated with direct measurements of bone micro-architecture, predicts current and future fragility fractures in primary osteoporosis, and may be a useful adjunct to BMD for fracture detection and prediction. In this review, we summarize its potential utility in secondary causes of osteoporosis. In some situations, like glucocorticoid-induced osteoporosis and in diabetes mellitus, the TBS appears to out-perform DXA. It also has apparent value in numerous other disorders associated with diminished bone health, including primary hyperparathyroidism, androgen-deficiency, hormone-receptor positive breast cancer treatment, chronic kidney disease, hemochromatosis, and autoimmune disorders like rheumatoid arthritis. Further research is both needed and warranted to more clearly establish the role of TBS in these and other disorders that adversely affect bone. © 2014, Springer Science+Business Media New York.


PubMed | University of Foggia, Maria Cecilia Hospital GVM Care and Research, Bone Metabolic Unit, University of Ferrara and University of Milan
Type: | Journal: Aging clinical and experimental research | Year: 2016

To evaluate (a) the performance in predicting the presence of bone fractures of trabecular bone score (TBS) and hip structural analysis (HSA) in type 2 diabetic postmenopausal women compared to a control group and (b) the fracture prediction ability of TBS versusFracture Risk Calculator (FRAXEighty diabetic postmenopausal women were matched with 88 controls without major diseases for age and body mass index. The individual 10-year fracture risk was assessed by FRAXRegarding variables of interest, the only significant difference between diabetic and control groups was observed for the value of TBS (median value: 1.215; IQR 1.138-1.285 in controls vs. 1.173; IQR 1.082-1.217 in diabetic; p=0.002). The prevalence of fractures in diabetic women was almost tripled than in controls (13.8 vs. 3.4%; p=0.02). The receiver operator characteristic curve analysis showed that TBS alone (AUC=0.71) had no significantly lower discriminative power for fracture prediction in diabetic women than FRAX major adjusted for TBS (AUC=0.74; p=0.65).In diabetic postmenopausal women TBS is an excellent tool in identifying fragility fractures.


Baldini M.,University of Milan | Forti S.,Audiology Unit | Marcon A.,University of Milan | Ulivieri F.M.,Bone Metabolic Unit | And 5 more authors.
Annals of Hematology | Year: 2010

With the optimization of transfusional and chelation regimens, beta-thalassemia has changed from a pediatric disease with poor life expectancy into a chronic disease. Bone demineralization is an important cause of morbidity in older patients; the etiology is multifactorial and partially unknown. We examined, cross-sectionally, 111 adult patients with beta-thalassemia major (66 females and 45 males, 32.6±6 years) who were regularly transfused, sufficiently chelated and replaced for endocrine defects. Bone demineralization was detected in 92.7% of patients with different severity according to gender and site: osteopenia was the prominent finding at the femur, osteoporosis at the lumbar spine (p<0.001), more evident in males. The femoral site was more influenced by biochemical and clinical factors; despite adequate replacement, the femoral T-score was lower in the hypogonadic group than in the eugonadic group (p=0.047). A significant correlation was found between the bone mass and body mass index (BMI), alkaline phosphatase (ALP), and pre-transfusional Hb levels. The multivariate analysis indicated as significant regressors ALP, BMI and hypoparathyroidism (T-score, p=0.005, 0.035, and 0.002; Z-score, 0.002, 0.009, and 0.003, respectively) at the femoral site; whereas, only ALP at the lumbar spine (p=0.008 and 0.045 for T-and Z-scores, respectively). The statistical significance was reached more frequently by the T-score, while the Z-score seemed to be a less sensitive parameter. Despite best care facilities, bone demineralization in thalassemic patients remains a challenge. Further exploration of the relationships between bone loss and endocrine, biochemical and hematologic parameters is warranted to find effective measures to reduce the risk of fracture in this disease. © 2010 Springer-Verlag.


Piodi L.P.,nd Gastroenterology Unit | Poloni A.,University of Milan | Ulivieri F.M.,Bone Metabolic Unit
World Journal of Gastroenterology | Year: 2014

The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX® tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a longterm bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts. © 2014 Baishideng Publishing Group Inc. All rights reserved.


PubMed | Bone Metabolic Unit and University of Milan
Type: | Journal: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA | Year: 2016

Bone status impairment represents a complication of generalized forms of epidermolysis bullosa (EB); however, the prevalence and the main determinants of this event in localized forms remain poorly defined. Birmingham epidermolysis bullosa severity (BEBS) score and 25-hydroxyvitamin D levels are strongly associated with low bone mass, suggesting that vitamin D may play a potential beneficial role in bone health. Further longitudinal studies are needed in order to confirm this hypothesis.Bone status impairment represents a complication of generalized forms of EB; thus, we aimed to estimate the prevalence of low bone mass, to examine mineralization differences in various EB subtypes and to identify the most important determinants of bone impairment in children with either generalized or localized EB.An observational study of 20 children (11 males; mean agestandard deviation, 11.73.9years) with EB was performed. Clinical history, physical examination, laboratory studies, X-ray of the left hand and wrist for bone age, and dual energy X-ray absorptiometry scans of the lumbar spine were obtained. Areal bone mineral density (aBMD Z-scores) and bone mineral apparent density were related to the BEBS score.Areal BMD Z-score (mean -1.822.33, range, -7.6-1.7) was reduced (<-2 SD) in 8 patients (40%), whereas aBMD Z-score adjusted for bone age was low in 7 patients (35%). BEBS score and 25-hydroxyvitamin D serum levels were the most important elements associated with aBMD (P=0.0001 and P=0.016, respectively). A significant correlation between the aBMD Z-score and area of skin damage, insulin-like growth factor-1, C-reactive protein, and sodium serum levels was also found.Low aBMD can be considered a systemic complication of EB, primarily associated with BEBS score and 25-hydroxyvitamin D levels. Therefore, longitudinal evaluation of bone status is ongoing in these patients to define whether vitamin D supplementation would prevent, or at least reduce, bone status impairment.

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