The Journal of Clinical Endocrinology and Metabolism, Nov 1, 2013
Context: Bone turnover markers (BTMs) may identify changes in bone remodeling within a relatively... more Context: Bone turnover markers (BTMs) may identify changes in bone remodeling within a relatively short time interval before changes in bone mineral density can be detected. New markers such as osteoprotegerin, receptor activator of nuclear factor-B ligand, and sclerostin have emerged, but there is little information about their potential use in clinical practice. Objectives: The aim of this study was to analyze the ability of several BTMs to predict bone loss in pre-and postmenopausal women and to monitor the efficacy of treatment in osteoporotic women. Design, Patients, and Setting: We performed an observational prospective study in pre-and postmenopausal ambulatory women (n ϭ 72 and n ϭ 152, respectively). Intervention: Postmenopausal women with osteoporosis (n ϭ 18) were treated with risedronate and calcium. Women filled out a questionnaire and underwent bone mineral density measurement using dual-energy x-ray absorptiometry at the time of enrollment and after 1 year of follow-up. BTMs were measured at baseline, at 6 months, and after 1 year. Results: Increased levels of N-terminal propeptide of type 1 procollagen (P1NP) and -type I collagen telopeptides (CTXs) were associated with low bone mineral density in the premenopausal (P ϭ .02 and P ϭ .04, respectively) and postmenopausal (P ϭ .03 and P ϭ .02) groups. The best analytical performance to diagnose osteoporosis was for -CTX, osteocalcin, and P1NP, with areas under the curve of 0.70 (P ϭ .005), 0.64 (P ϭ .048), and 0.71 (P ϭ .003). A significant decrease was found in P1NP, osteocalcin, tartrate-resistant acid phosphatase-5b, -CTX, and bone alkaline phosphatase after 1 year of treatment (all P Ͻ .05). Conclusions: Our data suggest that measurement of -CTX and P1NP shows adequate analytical performance and could potentially be included in algorithms for the screening of osteoporosis. Furthermore, these two markers, along with osteocalcin and tartrate-resistant acid phosphatase-5b, are useful to monitor the response to risedronate.
Background-aim Despite the method-dependence a concept 'Fibrinolysis Shutdown' (SD) is of interes... more Background-aim Despite the method-dependence a concept 'Fibrinolysis Shutdown' (SD) is of interest concept and has no single etiology (Moore, 2017). Because any concept should assume an universality we studied the predictors pattern for Lys30 with consideration on direct and mediated links. Methods The study included 115 patients with myeloproliferative neoplasms (MPNs), 96 patients with CCVD comorbided with Ph-negative MPNs, 174 patients with acute ischemic stroke, and 96 patients followed up within 12 months after acute ischemic stroke. Both standard and rapid thromboelastography were performed together with 98 biomarkers assays reflecting coagulation, anticoagulation, platelets, vascular wall, angiogenesis, inflammation, blood cell count, etc. Fibrinolysis was analyzed with plasminogen, t-PA, PAI-1, alfa-2antiplasmin, TAFI and D-dimer. Results Expected correlations for Lys30 were found with PLG, Alfa-2-AP and t-PA. With middle force Lys30 was bound with RBC, platelet count and ADP-and collagen platelet aggregations. Other independent predictors were fVII, fVIII, fXII, TNF, IL-6. Protein C did not show a value as expected predictor. Revealed predictors having middle force indicates multistep, long nature in regulation of fibrinolysis but not due to short direct links. Seems that all long (mediated) pathways converge to thrombin generation. Additional evidences of this are 1) severe value of inflammation shown by TNF and IL-6, and 2) fXII presence which is transmitter between coagulation and immune response. Conclusions Possibly that inflammation is in fact main regulator of fibrinolysis. Additionally SD concept shows an applicability not only for ICU patients that draws attention in a framework of the issues of thrombosis and re-thrombosis.
Type 2 diabetes mellitus prevalence and morbidity are increasing. Osteoporotic fractures are amon... more Type 2 diabetes mellitus prevalence and morbidity are increasing. Osteoporotic fractures are among the 'non-classical' complications of diabetes and been overlooked for a long time, maybe because of their complex diagnostic and therapeutic approach. The usual tools for preventing fragility fractures (such as the fracture risk assessment tool and bone densitometry) underestimate risk of fractures in type 2 diabetic patients. New techniques, such as trabecular bone score or bone turnover markers, could be useful, but greater scientific evidence is required to recommend their use in clinical practice. The special characteristics of their pathophysiology result in decreased bone remodeling with normal or even increased bone mineral density, but with low quality. These changes lead to the occurrence of osteoporotic fractures without evidence of densitometric changes, which could be called 'the diabetic paradox'.
The Journal of Clinical Endocrinology and Metabolism, Nov 1, 2013
Context: Bone turnover markers (BTMs) may identify changes in bone remodeling within a relatively... more Context: Bone turnover markers (BTMs) may identify changes in bone remodeling within a relatively short time interval before changes in bone mineral density can be detected. New markers such as osteoprotegerin, receptor activator of nuclear factor-B ligand, and sclerostin have emerged, but there is little information about their potential use in clinical practice. Objectives: The aim of this study was to analyze the ability of several BTMs to predict bone loss in pre-and postmenopausal women and to monitor the efficacy of treatment in osteoporotic women. Design, Patients, and Setting: We performed an observational prospective study in pre-and postmenopausal ambulatory women (n ϭ 72 and n ϭ 152, respectively). Intervention: Postmenopausal women with osteoporosis (n ϭ 18) were treated with risedronate and calcium. Women filled out a questionnaire and underwent bone mineral density measurement using dual-energy x-ray absorptiometry at the time of enrollment and after 1 year of follow-up. BTMs were measured at baseline, at 6 months, and after 1 year. Results: Increased levels of N-terminal propeptide of type 1 procollagen (P1NP) and -type I collagen telopeptides (CTXs) were associated with low bone mineral density in the premenopausal (P ϭ .02 and P ϭ .04, respectively) and postmenopausal (P ϭ .03 and P ϭ .02) groups. The best analytical performance to diagnose osteoporosis was for -CTX, osteocalcin, and P1NP, with areas under the curve of 0.70 (P ϭ .005), 0.64 (P ϭ .048), and 0.71 (P ϭ .003). A significant decrease was found in P1NP, osteocalcin, tartrate-resistant acid phosphatase-5b, -CTX, and bone alkaline phosphatase after 1 year of treatment (all P Ͻ .05). Conclusions: Our data suggest that measurement of -CTX and P1NP shows adequate analytical performance and could potentially be included in algorithms for the screening of osteoporosis. Furthermore, these two markers, along with osteocalcin and tartrate-resistant acid phosphatase-5b, are useful to monitor the response to risedronate.
Background-aim Despite the method-dependence a concept 'Fibrinolysis Shutdown' (SD) is of interes... more Background-aim Despite the method-dependence a concept 'Fibrinolysis Shutdown' (SD) is of interest concept and has no single etiology (Moore, 2017). Because any concept should assume an universality we studied the predictors pattern for Lys30 with consideration on direct and mediated links. Methods The study included 115 patients with myeloproliferative neoplasms (MPNs), 96 patients with CCVD comorbided with Ph-negative MPNs, 174 patients with acute ischemic stroke, and 96 patients followed up within 12 months after acute ischemic stroke. Both standard and rapid thromboelastography were performed together with 98 biomarkers assays reflecting coagulation, anticoagulation, platelets, vascular wall, angiogenesis, inflammation, blood cell count, etc. Fibrinolysis was analyzed with plasminogen, t-PA, PAI-1, alfa-2antiplasmin, TAFI and D-dimer. Results Expected correlations for Lys30 were found with PLG, Alfa-2-AP and t-PA. With middle force Lys30 was bound with RBC, platelet count and ADP-and collagen platelet aggregations. Other independent predictors were fVII, fVIII, fXII, TNF, IL-6. Protein C did not show a value as expected predictor. Revealed predictors having middle force indicates multistep, long nature in regulation of fibrinolysis but not due to short direct links. Seems that all long (mediated) pathways converge to thrombin generation. Additional evidences of this are 1) severe value of inflammation shown by TNF and IL-6, and 2) fXII presence which is transmitter between coagulation and immune response. Conclusions Possibly that inflammation is in fact main regulator of fibrinolysis. Additionally SD concept shows an applicability not only for ICU patients that draws attention in a framework of the issues of thrombosis and re-thrombosis.
Type 2 diabetes mellitus prevalence and morbidity are increasing. Osteoporotic fractures are amon... more Type 2 diabetes mellitus prevalence and morbidity are increasing. Osteoporotic fractures are among the 'non-classical' complications of diabetes and been overlooked for a long time, maybe because of their complex diagnostic and therapeutic approach. The usual tools for preventing fragility fractures (such as the fracture risk assessment tool and bone densitometry) underestimate risk of fractures in type 2 diabetic patients. New techniques, such as trabecular bone score or bone turnover markers, could be useful, but greater scientific evidence is required to recommend their use in clinical practice. The special characteristics of their pathophysiology result in decreased bone remodeling with normal or even increased bone mineral density, but with low quality. These changes lead to the occurrence of osteoporotic fractures without evidence of densitometric changes, which could be called 'the diabetic paradox'.
Uploads
Papers by Nerea Varo