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Sosa-Henríquez M, de Tejada-Romero MJG. Effect of obesity on fragility fractures, BMD and vitamin D levels in postmenopausal women. Influence of type 2 diabetes mellitus. Acta Diabetol 2023; 60:1597. [PMID: 37537280 DOI: 10.1007/s00592-023-02161-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/15/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Manuel Sosa-Henríquez
- Investigation Group On Osteoporosis and Mineral Metabolism, University of Las Palmas de Gran Canaria, Canary Islands, Las Palmas, Spain.
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Coco-Martín MB, Leal-Vega L, Blázquez-Cabrera JA, Navarro A, Moro MJ, Arranz-García F, Amérigo MJ, Sosa-Henríquez M, Vázquez MÁ, Montoya MJ, Díaz-Curiel M, Olmos JM, Ruiz-Mambrilla M, Filgueira-Rubio J, Pérez-Castrillón JL. Influence of non-osteoporotic treatments in patients on active anti-osteoporotic therapy: evidence from the OSTEOMED registry. Eur J Clin Pharmacol 2023; 79:1333-1339. [PMID: 37515605 PMCID: PMC10501932 DOI: 10.1007/s00228-023-03544-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE To evaluate the effect of different non-osteoporotic drugs on the increase or decrease in the risk of incident fragility fractures (vertebral, humerus or hip) in a cohort of patients diagnosed with osteoporosis on active anti-osteoporotic therapy. METHODS For this retrospective longitudinal study, baseline and follow-up data on prescribed non-osteoporotic treatments and the occurrence of vertebral, humerus or hip fractures in 993 patients from the OSTEOMED registry were analyzed using logistic regression models. The drugs evaluated with a possible beneficial effect were thiazides and statins, while the drugs evaluated with a possible harmful effect were antiandrogens, aromatase inhibitors, proton pump inhibitors, selective serotonin reuptake inhibitors, benzodiazepines, GnRH agonists, thyroid hormones, and oral and inhaled corticosteroids. RESULTS Logistic regression analyses indicated that no treatment significantly improved fracture risk, with the only treatments that significantly worsened fracture risk being letrozole (OR = 0.18, p-value = 0.03) and oral corticosteroids at doses ≤ 5 mg/day (OR = 0.16, p-value = 0.03) and > 5 mg/day (OR = 0.27, p-value = 0.04). CONCLUSION The potential beneficial or detrimental effects of the different drugs evaluated on fracture risk are masked by treatment with anabolic or antiresorptive drugs that have a more potent action on bone metabolism, with two exceptions: letrozole and oral corticosteroids. These findings may have important clinical implications, as patients receiving these treatments are not fully protected by bisphosphonates, which may imply the need for more potent anti-osteoporotic drugs such as denosumab or teriparatide.
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Affiliation(s)
- María Begoña Coco-Martín
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Valladolid, Spain
| | - Luis Leal-Vega
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Valladolid, Spain.
| | | | - Amalia Navarro
- Department of Internal Medicine, Hospital General Universitario de Albacete, Albacete, Spain
| | - María Jesús Moro
- Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - María José Amérigo
- Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Sosa-Henríquez
- Department of Internal Medicine, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | | | | | - José Manuel Olmos
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain
| | - Marta Ruiz-Mambrilla
- Unit of Speech and Language Therapy, Department of Surgery, Ophthalmology, Otorhinolaryngology and Physical Therapy, University of Valladolid, Valladolid, Spain
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de Tejada-Romero MJG, Saavedra-Santana P, de la Rosa-Fernández F, Suárez-Ramírez N, Martín-Martínez A, Del Rosario FM, Sosa-Henríquez M. Effect of obesity on fragility fractures, BMD and vitamin D levels in postmenopausal women. Influence of type 2 diabetes mellitus. Acta Diabetol 2022; 59:1201-1208. [PMID: 35789433 PMCID: PMC9329389 DOI: 10.1007/s00592-022-01923-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022]
Abstract
AIMS To see the effects of obesity on risk fracture, bone density (BMD), and vitamin D levels in a group of postmenopausal women, and consider how comorbid type 2 diabetes mellitus (T2DM) modifies them. METHODS 679 postmenopausal women were grouped into obese and non-obese. Obese women were grouped into those with T2DM and those without. 25(OH)-vitamin D, PTH and BMD were measured, and prevalent fragility fractures were gathered. RESULTS Obese women had higher prevalence of T2DM, than non-obese women. Levels of 25(OH)-vitamin D were lower and those of PTH higher in obese women, BMD values were higher in obese women. Diabetic-obese women had a higher prevalence of non-vertebral fractures than non-diabetic-obese. Multivariate logistic regression model showed association of fragility fractures with age, total hip BMD, BMI and T2DM. Obese women have higher BMD and lower 25(OH)-vitamin D values (and higher PTH) than non-obese, without diabetes. CONCLUSIONS T2DM confers an increased risk of non-vertebral fractures in postmenopausal obese women.
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Affiliation(s)
- M J Gómez de Tejada-Romero
- Research Group On Osteoporosis and Mineral Metabolism, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Department of Medicine, University of Seville, Seville, Spain
| | - P Saavedra-Santana
- Department of Mathematics, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - F de la Rosa-Fernández
- Research Group On Osteoporosis and Mineral Metabolism, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - N Suárez-Ramírez
- Research Group On Osteoporosis and Mineral Metabolism, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - A Martín-Martínez
- Research Group On Osteoporosis and Mineral Metabolism, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Gynecology and Obstetrics Service, Maternal-Infant Insular University Hospital Complex, Las Palmas de Gran Canaria, Spain
| | - F Martín Del Rosario
- Research Group On Osteoporosis and Mineral Metabolism, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - M Sosa-Henríquez
- Research Group On Osteoporosis and Mineral Metabolism, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
- Bone Metabolic Unit, Maternal-Infant Insular University Hospital Complex, Las Palmas de Gran Canaria, Spain.
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Sosa-Henríquez M, de Tejada-Romero MAJG, Cancelo-Hidalgo MAJ, Díaz-Guerra GM, Etxebarría Foronda Í, Tarazona-Santabalbina FJ, Torregrosa-Suau Ó, Valdés-Llorca C. Calcifediol Is Not Superior to Cholecalciferol in Improving Vitamin D Status in Postmenopausal Women. J Bone Miner Res 2022; 37:1411-1412. [PMID: 35451531 PMCID: PMC9545200 DOI: 10.1002/jbmr.4560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/05/2022] [Accepted: 03/13/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Manuel Sosa-Henríquez
- University of Las Palmas de Gran Canaria, Investigation Group on Osteoporosis and Bone and Mineral Diseases, Las Palmas de Gran Canaria, Spain.,Bone Metabolic Unit, Hospital University Insular, Las Palmas de Gran Canaria, Spain
| | | | | | | | | | | | - Óscar Torregrosa-Suau
- Bone Metabolic Unit. Service of Internal Medicine, University General Hospital, Elche, Spain
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Sosa-Henríquez M, Torregrosa O, Déniz A, Saavedra P, Ortego N, Turrión A, Pérez Castrillón JL, Díaz-Curiel M, Gómez-Alonso C, Martínez G, Antonio Blázquez J, Olmos-Martínez JM, Etxebarria Í, Caeiro JR, Mora-Peña D. Multiple vertebral fractures after suspension of denosumab. A series of 56 cases. Int J Clin Pract 2021; 75:e14550. [PMID: 34145944 DOI: 10.1111/ijcp.14550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 06/10/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Denosumab is a monoclonal antibody approved for the treatment of postmenopausal osteoporosis. The withdrawal of denosumab produces an abrupt loss of bone mineral density and may cause multiple vertebral fractures (MVF). OBJECTIVE The objective of this study is to study the clinical, biochemical, and densitometric characteristics in a large series of postmenopausal women who suffered MVF after denosumab withdrawal. Likewise, we try to identify those factors related to the presence of a greater number of vertebral fractures (VF). PATIENTS AND METHODS Fifty-six patients (54 women) who suffered MVF after receiving denosumab at least for three consecutive years and abruptly suspended it. A clinical examination was carried out. Biochemical bone remodelling markers (BBRM) and bone densitometry at the lumbar spine and proximal femur were measured. VF were diagnosed by magnetic resonance imaging MRI, X-ray, or both at dorsal and lumbar spine. RESULTS Fifty-six patients presented a total of 192 VF. 41 patients (73.2%) had not previously suffered VF. After discontinuation of the drug, a statistically significant increase in the BBRM was observed. In the multivariate analysis, only the time that denosumab was previously received was associated with the presence of a greater number of VF (P = .04). CONCLUSIONS We present the series with the largest number of patients collected to date. 56 patients accumulated 192 new VF. After the suspension of denosumab and the production of MVF, there was an increase in the serum values of the BBRM. The time of denosumab use was the only parameter associated with a greater number of fractures.
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Affiliation(s)
- Manuel Sosa-Henríquez
- University of Las Palmas de Gran Canaria, Investigation Group on Osteoporosis and Bone Mineral Metabolism, Hospital University Insular, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Oscar Torregrosa
- Internal Medicine Service, Hospital General University Elche, Elche, Alicante, Spain
| | - Alejandro Déniz
- Endocrinology Section, Hospital University Insular, Las Palmas de Gran Canaria, Spain
| | - Pedro Saavedra
- Mathematics Department, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Norberto Ortego
- Internal Medicine, Hospital University San Cecilio, Granada, Spain
| | - Ana Turrión
- Rheumatology Service, Hospital University Salamanca, Salamanca, Spain
| | | | - Manuel Díaz-Curiel
- Internal Medicine Service, Hospital University Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Gómez-Alonso
- Internal Medicine Service, Hospital University Central Asturias, Oviedo, Spain
| | | | | | | | | | - José Ramón Caeiro
- Orthopaedic Surgery Department, University Hospital of Santiago de Compostela, La Coruña, Spain
| | - Damián Mora-Peña
- Internal Medicine Service, Hospital Virgen de la Luz, Cuenca, Spain
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Chevalley T, Brandi ML, Cavalier E, Harvey NC, Iolascon G, Cooper C, Hannouche D, Kaux JF, Kurth A, Maggi S, Maier G, Papavasiliou K, Al-Daghri N, Sosa-Henríquez M, Suhm N, Tarantino U, Reginster JY, Rizzoli R. How can the orthopedic surgeon ensure optimal vitamin D status in patients operated for an osteoporotic fracture? Osteoporos Int 2021; 32:1921-1935. [PMID: 34013461 PMCID: PMC8134831 DOI: 10.1007/s00198-021-05957-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022]
Abstract
In this narrative review, the role of vitamin D deficiency in the pathophysiology, healing of fragility fractures, and rehabilitation is discussed. Vitamin D status can be assessed by measuring serum 25(OH)-vitamin D level with standardized assays. There is a high prevalence of vitamin D insufficiency (25(OH)D < 50 nmol/l (i.e., 20 ng/mL)) or deficiency (25(OH)D < 25 nmol/l (i.e., 10 ng/mL)) in patients with fragility fractures and especially in those with a hip fracture. The evidence on the effects of vitamin D deficiency and/or vitamin D supplementation on fracture healing and material osseointegration is still limited. However, it appears that vitamin D have a rather positive influence on these processes. The fracture liaison service (FLS) model can help to inform orthopedic surgeons, all caregivers, and fractured patients about the importance of optimal vitamin D status in the management of patients with fragility fractures. Therefore, vitamin D status should be included in Capture the Fracture® program as an outcome of FLS in addition to dual-energy X-ray absorptiometry (DXA) and specific antiosteoporosis medication. Vitamin D plays a significant role in the pathophysiology and healing of fragility fractures and in rehabilitation after fracture. Correction of vitamin D deficiency should be one of the main outcomes in fracture liaison services.
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Affiliation(s)
- T Chevalley
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - M L Brandi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - E Cavalier
- Department of Clinical Chemistry, University of Liege, CHU de Liege, Liege, Belgium
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- UKNIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - D Hannouche
- Service of Orthopaedics and Trauma Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - J-F Kaux
- Department of Physical Medicine and Rehabilitation, University and University Hospital of Liège, Liège, Belgium
| | - A Kurth
- Department of Orthopaedic and Trauma Surgery, Campus Kemperhof, Community Clinics Middle Rhine, Koblenz, Germany
| | - S Maggi
- CNR Aging Branch-IN, Padua, Italy
| | - G Maier
- Department of Orthopaedic and Rheumatological Rehabilitation, Rehazentrum am Meer, Bad Zwischenahn, Germany
| | - K Papavasiliou
- 3rd Orthopaedic Department, Aristotle University of Thessaloniki Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - N Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science King Saud University, Riyadh, 11451, Saudi Arabia
| | - M Sosa-Henríquez
- University Institute of Investigation on Biomedical Sciences (IUIBMS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain
- Bone Metabolic Unit, Hospital University Insular, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - N Suhm
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - U Tarantino
- Department of Clinical Sciences and Translational Medicine, Faculty of Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - R Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Carreras-Díaz R, Saavedra-Santana P, Gómez de Tejada-Romero MJ, Martín-Martínez A, Sosa-Henríquez M. Influencia de la lactancia materna en el metabolismo mineral óseo después de la menopausia. Rev Osteoporos Metab Miner 2021. [DOI: 10.4321/s1889-836x2021000200003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Affiliation(s)
- M Sosa-Henríquez
- University of Las Palmas de Gran Canaria, University Institute of Investigation on Biomedical Sciences (IUIBMS), Las Palmas de Gran Canaria, Canary Islands, Spain.
- Bone Metabolic Unit, Hospital University Insular, Las Palmas de Gran Canaria, Canary Islands, Spain.
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Bárbara-Bataller E, Méndez-Suárez JL, Alemán-Sánchez C, Sánchez-Enríquez J, Miranda-Calderín G, Sosa-Henríquez M. [How does the new spinal-cord-injured patient profile influence bladder management?]. ARCH ESP UROL 2019; 72:662-669. [PMID: 31475677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To describe the bladder management in spinal cord injury and to verify if the increase in the age of the patient who is suffering a spinal cord injury in recent years is conditioning a change in its treatment. METHODS We performed a retrospective review of all acute traumatic spinal cord injured patients in Canary Islands between 2001-2015. Data were collected from the hospital records of a regional referral Spinal Cord Unit. RESULTS The sample included 250 patients. Patients' mean age was observed to increase from 38 to 47 years during the study (p<0.05). Clean Intermittent Catheterization (CIC) was the most used bladder emptying method (42.4%), followed by normal voiding (NV) (26.4%) and permanent derivation (PD) (23.6%). There was a decrease in CIC use (48.1% to 40.3%) and an increase in PD use (13.5% to 32.5%) ( p<0.05 ). Cervical injuries were associated with NV (35.8%), while thoracic and lumbar injuries were associated with IC (67% and 41.7% respectively). Patients discharged to a health care residence were associated with IC (81.8%) (p<0.05). CONCLUSIONS CIC is currently the most frequently used bladder emptying method in spinal cord injured patients in our population. The mean age of new spinal cord injury patients is progressively increasing and it promotes the use of indwelling catheter with an increased risk of urologic complications.
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Affiliation(s)
- Enrique Bárbara-Bataller
- Unidad de Lesionados Medulares. Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria. Las Palmas de Gran Canaria. España
| | - José Luis Méndez-Suárez
- Unidad de Lesionados Medulares. Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria. Las Palmas de Gran Canaria. España
| | - Carolina Alemán-Sánchez
- Unidad de Lesionados Medulares. Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria. Las Palmas de Gran Canaria. España
| | - Jesús Sánchez-Enríquez
- Unidad de Lesionados Medulares. Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria. Las Palmas de Gran Canaria. España
| | - Guillermo Miranda-Calderín
- Unidad de Lesionados Medulares. Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria. Las Palmas de Gran Canaria. España
| | - Manuel Sosa-Henríquez
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias. Grupo de Investigación en osteoporosis y metabolismo mineral. Universidad de Las Palmas de Gran Canaria. España. Hospital Universitario Insular. Unidad Metabólica Ósea. Las Palmas de Gran Canaria. España
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Quintana-González M, Quintana-Montesdeoca P, Gómez de Tejada-Romero MJ, Saavedra-Santana P, Vicente-Barrero M, Bocanegra-Pérez S, Sosa-Henríquez M. Estado cualitativo y cuantitativo óseo generalizado en la osteonecrosis de maxilares. Efecto de los bifosfonatos. Rev Osteoporos Metab Miner 2019. [DOI: 10.4321/s1889-836x2019000200004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Navarro-Valverde C, Caballero-Villarraso J, Mata-Granados JM, Casado-Díaz A, Sosa-Henríquez M, Malouf-Sierra J, Nogués-Solán X, Rodríguez-Mañas L, Cortés-Gil X, Delgadillo-Duarte J, Quesada-Gómez JM. High Serum Retinol as a Relevant Contributor to Low Bone Mineral Density in Postmenopausal Osteoporotic Women. Calcif Tissue Int 2018; 102:651-656. [PMID: 29294148 DOI: 10.1007/s00223-017-0379-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
There is controversial information about the impact of vitamin A on bone. Some epidemiological studies show that excessive intake of vitamin A, or an excess of serum vitamin A, has related with adverse impact on bone mass; however, other studies did not find these links, and some authors have proposed that this vitamin might promote a better bone health. The present work aims to contribute to clarify the real role of vitamin A in bone tissue. For this purpose, a cross-sectional study of 154 osteoporotic non-treated postmenopausal women (> 65 years old) was carried out. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. We assessed concentrations of serum retinol, osteocalcin, parathyroid hormone, alkaline phosphatase, calcium, and phosphorus. We also studied demographic and anthropometric parameters. Spearman's correlations between retinol levels and other variables found negative correlations with BMD in both lumbar spine (R = - 0.162, P < 0.01) and femoral neck (R = - 0.182, P < 0.01), as well as alkaline phosphatase (R = - 0.110; P < 0.05) and phosphorus (R = - 0.110; P < 0.05). A positive correlation between retinol and fertile window was observed (R = 0.158; P < 0.01). After multivariable adjustment, we still found a negative correlation between serum retinol and BMD, both at the lumbar spine (R = - 0.210; P < 0.01) and at the femoral neck (R = - 0.324, P < 0.001). It is concluded that elevated serum-retinol levels are associated with an increased risk of low bone mass and thus with osteoporotic fractures. Therefore, osteoporosis-risk assessment should include quantification of serum metabolite of vitamin A.
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Affiliation(s)
| | - Javier Caballero-Villarraso
- IMIBIC (Instituto Maimónides de Investigación Biomédica de Córdoba)/Hospital Universitario Reina Sofía/ Universidad de Córdoba & RETICEF, CIBERFES (ISCIII), Córdoba, Spain.
| | - José M Mata-Granados
- IMIBIC (Instituto Maimónides de Investigación Biomédica de Córdoba)/Hospital Universitario Reina Sofía/ Universidad de Córdoba & RETICEF, CIBERFES (ISCIII), Córdoba, Spain
| | - Antonio Casado-Díaz
- IMIBIC (Instituto Maimónides de Investigación Biomédica de Córdoba)/Hospital Universitario Reina Sofía/ Universidad de Córdoba & RETICEF, CIBERFES (ISCIII), Córdoba, Spain
| | | | - Jorge Malouf-Sierra
- Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau & RETICEF (ISCIII), Barcelona, Spain
| | - Xavier Nogués-Solán
- Servicio de Medicina Interna (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona & RETICEF, CIBERFES (ISCIII), Barcelona, Spain
| | - Leocadio Rodríguez-Mañas
- Fundación para la Investigación Biomédica, Servicio de Geriatría, Hospital Universitario de Getafe & RETICEF, CIBERFES (ISCIII), Madrid, Spain
| | | | - Joaquín Delgadillo-Duarte
- Departament de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Quesada-Gómez
- IMIBIC (Instituto Maimónides de Investigación Biomédica de Córdoba)/Hospital Universitario Reina Sofía/ Universidad de Córdoba & RETICEF, CIBERFES (ISCIII), Córdoba, Spain
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Bárbara-Bataller E, Méndez-Suárez JL, Alemán-Sánchez C, Sánchez-Enríquez J, Sosa-Henríquez M. Change in the profile of traumatic spinal cord injury over 15 years in Spain. Scand J Trauma Resusc Emerg Med 2018; 26:27. [PMID: 29622032 PMCID: PMC5887209 DOI: 10.1186/s13049-018-0491-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic spinal cord injury remains a serious public health and social problem. Although incidence rates are decreasing in our environment, it is a high cost condition that is associated with great disability. The objective of this study was to describe the epidemiological and demographic characteristics of traumatic spinal cord injury and to analyse its epidemiological changes. METHODS This study was an observational study with prospective monitoring of all traumatic spinal cord injury patients in the Canary Islands, Spain (2.1 million inhabitants) between 2001 and 2015. RESULTS Over the specified period of the study, 282 patients suffered a traumatic spinal cord injury. The crude incidence rate was 9.3 cases per million people/year. The patients' mean age increased from 38 years (2001-2005) to 48 years (2011-2015) (p < 0.05). Overall, 80.1% of patients were males. The trauma mechanisms of spinal cord injury were falls in 44%, traffic accidents in 36.5%, diving accidents in 8.9% and others in 10.7%. While traffic accidents decreased, falls increased, particularly in the elderly (p < 0.05). The most frequently affected level was the cervical spine (50.9%), and incomplete tetraplegia was the most prevalent group (29.8%). A total of 76.6% of all patients suffered a vertebral fracture, and 91.6% of these required surgery. Among 282 patients, 12.5% were transferred to residences. The patients transferred increased from 8.5% in the first period to 20.0% (p < 0.05) in the last period. Such cases were related to age, cervical level injuries and injuries associated with poor functionality (p < 0.05). CONCLUSIONS The rise in the number of falls among the older population, as well as the reduction in traffic accidents, decreased the incidence of traumatic spinal cord injury in our environment. This change in the profile of new traumatic spinal cord injuries led us to reformulate the functional objectives planned for these patients upon admission to specialized units, to plan destination-upon-discharge in advance and to promote campaigns to prevent spinal cord injury in older adults.
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Affiliation(s)
- Enrique Bárbara-Bataller
- Unit of Spinal Cord Injury, Rehabilitation Service of the University Insular Hospital of Gran Canaria, Avenida Maritima S/N, 350016 Las Palmas de Gran Canaria, Spain
| | - José Luis Méndez-Suárez
- Unit of Spinal Cord Injury, Rehabilitation Service of the University Insular Hospital of Gran Canaria, Avenida Maritima S/N, 350016 Las Palmas de Gran Canaria, Spain
| | - Carolina Alemán-Sánchez
- Unit of Spinal Cord Injury, Rehabilitation Service of the University Insular Hospital of Gran Canaria, Avenida Maritima S/N, 350016 Las Palmas de Gran Canaria, Spain
| | - Jesús Sánchez-Enríquez
- Unit of Spinal Cord Injury, Rehabilitation Service of the University Insular Hospital of Gran Canaria, Avenida Maritima S/N, 350016 Las Palmas de Gran Canaria, Spain
| | - Manuel Sosa-Henríquez
- University Institute for Biomedical and Health Research, Osteoporosis and Mineral Metabolism Research Group, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Cabrera Naranjo FH, Saavedra Santana P, González Hernández A, Fabre Pi O, Sosa-Henríquez M. Hyperuricaemia as a prognostic factor for acute ischaemic stroke. Neurologia 2018. [PMID: 29526317 DOI: 10.1016/j.nrl.2018.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION Recent studies on uric acid as a biomarker for the prognosis of acute stroke have found conflicting results. METHODS We collected blood samples from 600 consecutively admitted patients at our tertiary hospital and analysed the relationship between uric acid levels and functional prognosis (measured using the modified Rankin Scale [mRS]). Patients who had received reperfusion therapy were excluded since this may have influenced uric acid levels. RESULTS A total of 73% of patients had mRS scores ≤2; the mean uric acid level was 5.22mg/dL. We found a nonlinear relationship between functional prognosis at discharge and serum uric acid levels at admission when the National Institutes of Health Stroke Scale score was excluded from the analysis. CONCLUSIONS Serum uric acid levels in patients with acute ischaemic stroke are significantly associated with functional prognosis at discharge, although this relationship is nonlinear. In fact, poorer prognosis is associated both with very low and with very high concentrations of uric acid. This suggests a dual role of uric acid in relation to stroke: on the one hand, as an associated risk factor, and on the other, as a possible neuroprotective factor due to its antioxidant effect.
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Affiliation(s)
- F H Cabrera Naranjo
- Servicio de Neurología, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, España.
| | - P Saavedra Santana
- Departamento de Matemáticas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | | | - O Fabre Pi
- Servicio de Neurología, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, España
| | - M Sosa-Henríquez
- Universidad de Las Palmas de Gran Canaria, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Las Palmas de Gran Canaria, España
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Bárbara-Bataller E, Méndez-Suárez JL, Alemán-Sánchez C, Sánchez-Enríquez J, Sosa-Henríquez M. [Spinal cord injuries resulting from diving accidents in the Canary Islands]. Neurocirugia (Astur) 2017; 28:183-189. [PMID: 28343903 DOI: 10.1016/j.neucir.2017.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Diving accidents is one of the leading causes of spinal cord injury after falls and car accidents. The objective of this study was to determine the epidemiological and clinical characteristics of these patients in our setting to better prevent these injuries. MATERIAL AND METHODS We performed a retrospective, descriptive study of patients who have suffered from a traumatic spinal cord injury after a diving accident in the Canary Islands, Spain from 2000 to 2014. These patients were admitted to the Spinal Cord Unit of Hospital Universitario Insular de Gran Canaria. RESULTS Of the 264 patients admitted to our unit for acute traumatic spinal cord injury, 23 (8.7%) cases were due to diving. Grouping the patients into 5years periods, 56% of the injuries occurred in 2000-2005, 17% in 2006-2010 and 26% in 2011-2014. All patients were male, with a mean age of 29years. Approximately 65% were under 30years. A total of 22/23 patients had a fracture and injury most commonly occurred to the C5 vertebra. Burst fractures were the most common. A total of 86% of cases underwent surgery. All the spinal cord injuries were cervical, with C6 being the neurological level most often affected. A total of 65% of spinal cord injuries were complete injuries. CONCLUSIONS Spinal cord injury secondary to diving accidents is the third leading cause of traumatic spinal cord injury in our setting. It affects young males and the most common clinical presentation is a complete cervical spinal cord injury. Given the irreversible nature of the injury, prevention, aimed mainly at young people, is of great importance.
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Affiliation(s)
- Enrique Bárbara-Bataller
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España.
| | - José Luis Méndez-Suárez
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Carolina Alemán-Sánchez
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Jesús Sánchez-Enríquez
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Manuel Sosa-Henríquez
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Grupo de Investigación en Osteoporosis y Metabolismo Mineral, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
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15
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Navarro-Valverde C, Sosa-Henríquez M, Alhambra-Expósito MR, Quesada-Gómez JM. Vitamin D 3 and calcidiol are not equipotent. J Steroid Biochem Mol Biol 2016; 164:205-208. [PMID: 26829558 DOI: 10.1016/j.jsbmb.2016.01.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 01/22/2016] [Accepted: 01/26/2016] [Indexed: 11/16/2022]
Abstract
Despite the discussion on the optimal threshold of 25-hydroxyvitamin D serum level continues, there is now consensus on the fact that post-menopausal and elderly populations have inadequate Vitamin D serum levels worldwide. The adjustment of these levels is necessary to improve both bone and general health, as it is to optimize bone response to antiresortive treatments. It is recommended, as endorsed by international clinical guides, to use Vitamin D3, the physiological form of Vitamin D, in a dose range between 600-2000IU. It should be administered on a daily basis or on its weekly or monthly equivalents. In Spain, the use of calcidiol (25(OH)D3) at the same dose than Vitamin D3 is the most extended prescription, notwithstanding the available evidence stating that they are not equipotent. This may lead to over-dosage. In order to provide evidence on this circumstance, a convenience study was performed. Four groups of ten post-menopausal osteoporotic women each (average age 67), deficient in Vitamin D ((25(OH)D 37.5±10 nmol/L)) were enrolled. Each group followed a different treatment regimen: (G1) vitamin D3 20μg/day [800IU/day]; (G2) 25 (OH)D3 20μg/day; (G3) 25(OH)D3 266μg/week and (G4) 25(OH)D3 0.266mg every two weeks. 25(OH)D levels were measured for each group at 0, 6 and 12 months, with the following results: G1 (40.5±4.7;80.0±2; 86.2±23.7), G2 (37,2±4.2; 161±21.7;188.0±24.0), G3 (38±3.7;213.5±80.0; 233.0±81.2), G4 (39.5±4;164.5±41,7;210.5±22.2). These data reveal that both metabolites are not equipotent. Calcidiol is faster and 3-6 times more potent to obtain serum levels of 25(OH)D in the medium to long term. This circumstance must be assessed and included in the therapeutic prescription guides for Osteoporosis, since it should be of concern when planning and prescribing treatments to normalize serum levels of 25(OH)D3 and avoid potential adverse impacts.
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Affiliation(s)
| | - Manuel Sosa-Henríquez
- Grupo de investigación en Osteoporosis y Metabolismo Mineral, Unidad Metabólica Ósea, Servicio de Medicina Interna, Hospital Universitario Insular de Las Palmas de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Spain
| | - Maria Rosa Alhambra-Expósito
- UGC Endocrinología y Nutrición HU Reina Sofía, Instituto Maimónides de Investigación Biomédica, Universidad de Córdoba, RETICEF, Spain
| | - José Manuel Quesada-Gómez
- UGC Endocrinología y Nutrición HU Reina Sofía, Instituto Maimónides de Investigación Biomédica, Universidad de Córdoba, RETICEF, Spain.
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16
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Bárbara-Bataller E, Méndez-Suárez JL, Alemán-Sánchez C, Ramírez-Lorenzo T, Sosa-Henríquez M. [Epidemiology of traumatic spinal cord injury in Gran Canaria]. Neurocirugia (Astur) 2016; 28:15-21. [PMID: 27756531 DOI: 10.1016/j.neucir.2016.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/26/2016] [Accepted: 08/29/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the epidemiological and clinical trends in acute traumatic spinal cord injuries. MATERIAL AND METHODS A retrospective study was conducted of traumatic spinal cord injury patients in Gran Canaria (Canary Islands, Spain) from 2000 to 2014. Demographic and spinal injury severity trends were analysed by year of injury grouped into 3 periods: 2000-2005, 2006-2010, and 2011-2014. RESULTS The sample included 141 patients. The mean incidence for the entire period was 12 cases/million/year. There was a decrease in cases in the second and third period. While the male/female ratio was 3.8/1 and was maintained in all periods, the mean patient age increased from 38.8 in 2000-5 to 54.5 years in 2011-4 (P<.05). Falls have been the leading cause of spinal cord injury (48.2%), followed by traffic accidents (37.6%). Falls have increased, especially in the older population. Incomplete tetraplegia has been the most prevalent group (30.5%). A vertebral fracture was suffered by 70.3% of all patients, with 93.2% of them requiring surgery. CONCLUSIONS There has been a decrease in the incidence of traumatic spinal cord injury in recent years. The target population has changed, and the older population is currently the most affected. This reality suggests the need to change the local prevention campaigns for spinal cord injury in the elderly.
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Affiliation(s)
- Enrique Bárbara-Bataller
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España.
| | - José Luis Méndez-Suárez
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Carolina Alemán-Sánchez
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Teresa Ramírez-Lorenzo
- Unidad de Investigación, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Manuel Sosa-Henríquez
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Grupo de Investigación en osteoporosis y metabolismo mineral, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
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17
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López-Méndez P, Sosa-Henríquez M, Ruiz-Pérez Á. Relationship between vitamin D deficiency and visually evoked potentials in multiple sclerosis. ACTA ACUST UNITED AC 2016; 91:217-22. [PMID: 26896059 DOI: 10.1016/j.oftal.2016.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 01/01/2016] [Accepted: 01/04/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the possible relationship between serum 25-OH vitamin D levels and visually evoked potentials (VEP) in patients with multiple sclerosis (MS), residents in the south zone of Gran Canaria. MATERIAL AND METHODS The study included 49 patients with MS, on whom 25-OH-vitamin D was determined, along with VEP, and a neurological examination to determine incapacity. Clinical variables, such as a history of optic neuritis were recorded. RESULTS The mean value of 25-OH-vitamin D of the patients was 28.1±9.5ng/ml. The VEP latency was 119.1±23.2ms and the amplitude, 8.5±4.4 μV. Patients with a higher 25-OH-vitamin D had a greater number of outbreaks in the year prior to the study (P=.049), and those with vitamin D deficiency and previous optic neuritis showed no reduction in the amplitude of the VEP (P=.006). CONCLUSION Patients with vitamin D deficiency have lower clinical activity of the MS and show no axonal involvement in VEP after having suffered optic neuritis. These relationships, although statistically significant, do not seem clinically plausible, thus new studies are needed to try and confirm this possible relationship.
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Affiliation(s)
- P López-Méndez
- Unidad de Neurooftalmología, Servicio de Neurología, Hospital Universitario Insular de Gran Canaria, Complejo Hospitalario Insular Materno-Infantil, Las Palmas de Gran Canaria, España.
| | - M Sosa-Henríquez
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España; Hospital Universitario Insular de Gran Canaria. Unidad Metabólica Ósea. Complejo Hospitalario Insular Materno-Infantil, Las Palmas de Gran Canaria, España
| | - Á Ruiz-Pérez
- Unidad de Neurooftalmología, Servicio de Oftalmología, Hospital Universitario Insular de Gran Canaria, Complejo Hospitalario Insular Materno-Infantil, Las Palmas de Gran Canaria, España
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Bocanegra-Pérez MS, Vicente-Barrero M, Sosa-Henríquez M, Rodríguez-Bocanegra E, Limiñana-Cañal JM, López-Márquez A, Pérez-Plasencia D, Ramos-Macías A. Bone metabolism and clinical study of 44 patients with bisphosphonate-related osteonecrosis of the jaws. Med Oral Patol Oral Cir Bucal 2012; 17:e948-55. [PMID: 22926469 PMCID: PMC3505715 DOI: 10.4317/medoral.17946] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 03/08/2012] [Indexed: 11/28/2022] Open
Abstract
Osteonecrosis of the jaws is a clinical entity described and linked to treatment with bisphosphonates in 2003. Its real incidence is unknown and it could increase due to the large number of patients treated with these drugs, and its cumulative effect on the bone. State of the art knowledge regarding its etiopathogeny, clinical course and suitable treatments is limited.
Objectives: To study the clinical characteristics of 44 patients with bisphosphonate-related osteonecrosis of the jaws and the state of their bone mineral metabolism: bone remodeling state, prevalence of fractures, bone mineral density study, and assessment of the different treatment strategies.
Design of the Study: Observational. Information was gathered prospectively through interviews, clinical examinations, additional tests and review of medical records.
Results: We studied 16 men and 28 women with a mean age of 64.7 years. Breast cancer was the most frequent underlying disease. Zoledronate was used in 82% of the cases and in the non-oncology group of patients; alendronate was the most frequently used bisphosphonate. The mean duration of the zoledronate and alendronate treatments was 25 months and 88 months respectively. The lower jaw was the most frequent location, and previous exodontias—among the triggering factors known—were the most closely linked to its onset. We found considerable osteoblastic activity in patients suffering from neoplasia, with artifacts present in their bone densitometry and a high percentage of vertebral fractures.
Conclusions: According to our results, osteonecrosis of the jaws affects elderly patients. We found a direct relationship between the duration of exposure and the accumulated dose. Other relevant factors are: Poor oral and dental health, corticoids, diabetes and teeth extractions. In essence, it is a clinical diagnosis. Prevention is the best strategy to handle this clinical entity.
Key words:Alendronate, bisphosphonate, jaw, maxilla, osteonecrosis, osteoporosis, prevention, zoledronate.
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Affiliation(s)
- María-Sacramento Bocanegra-Pérez
- Insular Maternal and Child University Hospital Complex of Las Palmas of Gran Canaria, Stomatology Department, Bone Metabolism Unit and Research Unit, Las Palmas of Gran Canaria, Spain
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Bocanegra-Pérez S, Vicente-Barrero M, Sosa-Henríquez M, Gebaguer Blanco A, Knezevic M, Castellano-Navarro JM. [Osteonecrosis of the jaw secondary to oral alendronate: Report of three cases]. Rev Med Chil 2009; 137:275-279. [PMID: 19543652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Osteonecrosis of the jaw associated to biphosphonate use is more common in cancer patients with bone metastases, that are using intravenous diphosphonates. When these drugs are used orally the risk of the complication is lower. We report 3 diabetic women aged 69, 76 and 82 years, receiving alendronate 70 mg every one week. The unveiling event was the extraction of several teeth without the use of antibiotics. All had bone pain, purulent discharge, loss of bone and halitosis. All improved five months after discontinuing alendronate.
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Bocanegra-Pérez S, Vicente-Barrero M, Sosa-Henríquez M, Gebaguer Blanco A, Knezevic M, Castellano-Navarro JM. Osteonecrosis maxilar secundaria al uso de bisfosfonatos por vía oral: Exposición de tres casos clínicos relacionados con alendronato. Rev Med Chil 2009. [DOI: 10.4067/s0034-98872009000200014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Santana-Rodríguez A, Sosa-Henríquez M, de Pablos-Velasco P. [New prospects in genetics of obesity]. Rev Clin Esp 1999; 199:740-7. [PMID: 10638239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- A Santana-Rodríguez
- Servicio de Endocrinología, Hospital Nuestra Señora del Pino, Facultad de Medicina, Universidad de Las Palmas de Gran Canaria
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