26. nuevo(completo) enfoque en el diagnotico de la osteoporosis

NUEVO ENFOQUE EN EL DIAGNOTICO DE LA

OSTEOPOROSIS

Carlos Cure Cure MD

Endocrinologia y Nutricion

BIOMELAB Barranquilla 2012

Definición de la Osteoporosis

“...Una enfermedad sistémica del

esqueleto, la cual se caracteriza por

una reducción de la masa ósea y el

deterioro microestructural del tejido

del hueso, seguido de un aumento

en la fragilidad ósea y en la

susceptibilidad para fracturas.”

El estudio NHANES III demostró que

alrededor del 16 al 17 % de las

mujeres postmenopáusicas e n U.S.

Están por debajo de -2.5 SD (-5 a 7

millones de mujeres) si se evalúa la

DMO en fémur. Utilizando otros sitios

del esqueleto estas cifras se duplican(3)

Observaciones experimentales.

2. El sexo es irrelevante en la determinacion de la

mecanostasis de la calidad osea humana. Iguales

leyes mecanostaticas para determinar su resistencia a

la deformación y la fractura

1. La fuerza muscular regional es el principal

determinante de la calidad osea. (Los huesos son

lo que los músculos quieren que sean).

INTERACCION MECANICO - ENDOCRINA

Capozza R.F., Cointry G.R., Cure Ramirez P.,

Ferretti J.L., Cure Cure Carlos.

A DEXA study of muscle-bone relationships

in the whole body and limbs of 2512 normal

men pre- and post-menopausal women.

Bone; 2004; 35 283-295

Capozza R.F., Cointry G.R., Cure Ramirez P., Ferretti J.L., Cure Cure Carlos.

A DEXA study of muscle-bone relationships in the whole body and limbs of 2512 normal

men pre- and post-menopausal women.

Bone; 2004; 35 283-295

Capozza R.F., Cointry G.R., Cure Ramirez P., Ferretti J.L., Cure Cure Carlos.

A DEXA study of muscle-bone relationships in the whole body and limbs of 2512 normal

men pre- and post-menopausal women.

Bone; 2004; 35 283-295

Capozza R.F., Cointry G.R., Cure Ramirez P., Ferretti J.L., Cure Cure Carlos.

A DEXA study of muscle-bone relationships in the whole body and limbs of 2512 normal

men pre- and post-menopausal women.

Bone; 2004; 35 283-295

Ferretti, Capozza, Cointry; 2002

REFERENCE CHARTS FOR THE RELATIONSHIP BETWEEN DUAL-ENERGY X-RAY ABSORPTIOMETRY-ASSESSED BONE MINERAL CONTENT AND

LEAN MASS IN 3,063 HEALTHY MEN AND PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN.

Osteoporo Int (2005) 16; 2095-2106

Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti

REFERENCE CHARTS FOR THE RELATIONSHIP BETWEEN DUAL-ENERGY X-RAY ABSORPTIOMETRY-ASSESSED BONE MINERAL CONTENT AND

LEAN MASS IN 3,063 HEALTHY MEN AND PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN.

Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti

Osteoporo Int (2005) 16; 2095-2106

REFERENCE CHARTS FOR THE RELATIONSHIP BETWEEN DUAL-ENERGY X-RAY ABSORPTIOMETRY-ASSESSED BONE MINERAL CONTENT AND

LEAN MASS IN 3,063 HEALTHY MEN AND PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN.

Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti

Osteoporo Int (2005) 16; 2095-2106

REFERENCE CHARTS FOR THE RELATIONSHIP BETWEEN DUAL-ENERGY X-RAY ABSORPTIOMETRY-ASSESSED BONE MINERAL CONTENT AND

LEAN MASS IN 3,063 HEALTHY MEN AND PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN.

Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti

Osteoporo Int (2005) 16; 2095-2106

ANCOVA:

Slopes: n.s.

Ordinates: n.s.

ANCOVA:

Slopes: p<0.001

CMO-vs-MM RELATIONSHIP WHOLE BODY

Pre-MP Post-MP

Normal reference

r= 0.535, p< 0.0001

Type-I Fx

r= 0.446, p< 0.0001

Type-II Fx

r= 0.595, p< 0.0001

Normal reference

r= 0.521, p< 0.0001

Type-I Fx

r= 0.571, p< 0.0001

Type-II FxI

r= 0.528, p< 0.0001

Lean mass (LM), kg Lean mass (LM), kg

BM

C , k

g

• Association between low lean body mass and osteoporotic fractures after menopause.

• Ricardo Capozza, Carlos Cure Cure y cols.

• Menopause, vol !5, No 5 pp 1-9

Factores de riesgo para la osteoporósis

Establecidas Probables

Mujeres blancas o asiáticas Baja relación peso/altura

Edad avanzada Antecedentes positivos

Menopausia temprana de osteoporósis en la familia

Ooforectomía premenopáusica Alto consumo de alcohol

Amenorrea premenopáusica Bajo consumo de calcio

Uso crónico de corticoides Habito de fumar

Reposo prolongado en cama Alto consumo proteínas/fosfatos

Alto consumo de cafeína

Barranquilla, Punta Roca 2005

GRACIAS

REFERENCE CHARTS FOR THE RELATIONSHIP BETWEEN DUAL-ENERGY X-RAY ABSORPTIOMETRY-ASSESSED BONE MINERAL CONTENT AND

LEAN MASS IN 3,063 HEALTHY MEN AND PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN.

Osteoporo Int (2005) 16; 2095-2106

Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti

2. Liberacion de factores locales de interacción célula-

célula que determinan las respuestas modeladoras o

remodeladoras.

1. La carga sobre el hueso induce deformacion la cual

es sensada y analizada por los osteocitos y células de

revestimiento.

3. Con estos mecanismos se modifican la calidad o la

distribución espacial del material oseo (arquitectura),

determinantes de la calidad mecánica (rigidez) del

hueso.

Mecanostato oseo

(sistema de homeostasis)

INTERACCION MECANICO - ENDOCRINA

REFERENCE CHARTS FOR THE RELATIONSHIP BETWEEN DUAL-ENERGY X-RAY ABSORPTIOMETRY-ASSESSED BONE MINERAL CONTENT AND

LEAN MASS IN 3,063 HEALTHY MEN AND PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN.

Osteoporo Int (2005) 16; 2095-2106

Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti

REFERENCE CHARTS FOR THE RELATIONSHIP BETWEEN DUAL-ENERGY X-RAY ABSORPTIOMETRY-ASSESSED BONE MINERAL CONTENT AND

LEAN MASS IN 3,063 HEALTHY MEN AND PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN.

Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti

Osteoporo Int (2005) 16; 2095-2106

REFERENCE CHARTS FOR THE RELATIONSHIP BETWEEN DUAL-ENERGY X-RAY ABSORPTIOMETRY-ASSESSED BONE MINERAL CONTENT AND

LEAN MASS IN 3,063 HEALTHY MEN AND PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN.

Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti

Osteoporo Int (2005) 16; 2095-2106

REFERENCE CHARTS FOR THE RELATIONSHIP BETWEEN DUAL-ENERGY X-RAY ABSORPTIOMETRY-ASSESSED BONE MINERAL CONTENT AND

LEAN MASS IN 3,063 HEALTHY MEN AND PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN.

Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti

Osteoporo Int (2005) 16; 2095-2106

REFERENCE CHARTS FOR THE RELATIONSHIP BETWEEN DUAL-ENERGY X-RAY ABSORPTIOMETRY-ASSESSED BONE MINERAL CONTENT AND

LEAN MASS IN 3,063 HEALTHY MEN AND PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN.

Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti

Osteoporo Int (2005) 16; 2095-2106

REFERENCE CHARTS FOR THE RELATIONSHIP BETWEEN DUAL-ENERGY X-RAY ABSORPTIOMETRY-ASSESSED BONE MINERAL CONTENT AND

LEAN MASS IN 3,063 HEALTHY MEN AND PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN.

Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti

Osteoporo Int (2005) 16; 2095-2106

REFERENCE CHARTS FOR THE RELATIONSHIP BETWEEN DUAL-ENERGY X-RAY ABSORPTIOMETRY-ASSESSED BONE MINERAL CONTENT AND

LEAN MASS IN 3,063 HEALTHY MEN AND PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN.

Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti

Osteoporo Int (2005) 16; 2095-2106

Rigidez

osea

•Remodelado Calidad

del

material

Arquitectura •Modelado Resistencia a

la

deformación

Revisión

periodica

Mecanismos

adaptatorios

de la forma y

tamaño de

los huesos

CALIDAD OSEA

MÉTODO PROPIEDAD EVALUADA

En cuerpos Calidad del Calidad Resistencia

vertebrales Masa ósea material arquitectura Mecánica

DEXA +++ - - ++

QCT ++++ ++ - +++

En huesos

largos

DEXA ++++ - - +

QUS ++ +++ - ++

pQCT +++ ++ ++++ +++