The supervised exercise program attenuated lumbar spine and right hip BMD loss and improved LM in the arms and overall MS but did not affect bone remodeling.

ABE&M todos os direitos reservados RESUMOA deficiência de vitamina D (VD) leva ao raquitismo e à osteomalacia e sua insuficiência, caracterizada pelo hiperparatireoidismo secundário, pode resultar osteoporose. Apesar de amplamente prevalente, a insuficiência de VD ainda é pouco reconhecida e subtratada. Os autores estudaram 180 pacientes atendidos em ambulatório de endocrinologia em Belo Horizonte, que tiveram os níveis de 25(OH)VD mensurados, correlacionando-os com paratormônio (PTH), marcadores de remodelação óssea e densidade mineral óssea. Para caracterização de níveis insuficientes de VD, foram correlacionados os níveis de 25(OH)VD com os de PTH, definindo-se, nesta série, ponto de corte de 25(OH)VD de 32 ng/ml. Foi encontrada correlação inversa e significativa entre 25(OH)VD e PTH e entre 25(OH)VD e C-telopeptídeo. A prevalência de insuficiência de VD na população estudada foi de 42,4%. Conclui-se que a insuficiência de VD tem alta prevalência entre pacientes que freqüentam nossos consultórios, alertando para a importância da sua investigação na prática clínica e na instituição de políticas para sua prevenção. Consequences of VD deficiency include rickets and osteomalacia. However, marginal concentrations of 25-hydroxyvitamin D (25(OH)VD) are associated with secondary hyperparathyroidism and osteoporosis. In this context, levels of 25(OH)VD capable to elevate parathyroid hormone (PTH) could be considered as insufficient. The VD insufficiency, although widely prevalent, is still under-recognized and under-treated. The authors have studied 180 patients followed in a endocrinology clinic in Belo Horizonte, who had 25(OH)VD measured, correlating it with PTH, biochemical bone turnover markers and bone mineral density. To determine the sufficiency of VD, 25(OH)VD was correlated with PTH and the cutoff found was of 32ng/ml. CTX-1 and PTH were significantly negative correlated to 25(OH)VD and the prevalence of VD insufficiency was 42%. One concludes that the VD insufficiency is widely prevalent among patients who frequently come to our offices, alerting us for the importance to assess VD status more often and to practice politics for prevention of VD insufficiency. (Arq Bras Endocrinol Metab 2008; 52/3:482-488)

BackgroundPreserved skeletal muscle is essential for the maintenance of healthy bone. Loss of bone mineral density (BMD) and muscle strength, considered a predictor of BMD, have been demonstrated in patients with cirrhosis, but they are poorly studied in chronic hepatitis C (CHC) without cirrhosis. Thus, we aimed to evaluate the prevalence of low BMD and its association with body composition, muscle strength, and nutritional status in CHC.MethodsOne hundred and four subjects [mean age, 50.5 ± 11.3 years; 75.0% males; 67.3% non‐cirrhotic; and 32.7% with compensated cirrhosis] with CHC, prospectively, underwent scanning of the lean tissue, appendicular skeletal muscle mass (ASM), fat mass, lumbar spine, hip, femoral neck, and whole‐body BMD by dual‐energy X‐ray absorptiometry. Muscle strength was assessed by dynamometry. Sarcopenia was defined by the presence of both low, ASM/height2 (ASMI) and low muscle strength according to the European Working Group on Sarcopenia in Older People criteria. The cut‐off points for low ASMI and low muscle strength, for women and men, were < 5.45 and < 7.26 kg/m2 and < 20 and < 30 kg, respectively. According to the adopted World Health Organization criteria in men aged > 50 years, the T‐score of osteopenia is between −1.0 and −2.49 standard deviation (SD) below the young average value and of osteoporosis is ≥−2.5 SD below the young normal mean for men, and the Z‐score of low bone mass is ≤−2.0 SD below the expected range in men aged < 50 years and women in the menacme. Nutritional status evaluation was based on the Controlling Nutritional Status score.ResultsLow BMD, low muscle strength, pre‐sarcopenia, sarcopenia, and sarcopenic obesity were observed in 34.6% (36/104), 27.9% (29/104), 14.4% (15/104), 8.7% (9/104), and 3.8% (4/104) of the patients, respectively. ASMI was an independent predictor of BMD (P < 0.001). Sarcopenia was independently associated with bone mineral content (P = 0.02) and malnutrition (P = 0.01). In 88.9% of the sarcopenic patients and in all with sarcopenic obesity, BMI was normal. The mid‐arm muscle circumference was positively correlated with ASMI (r = 0.88; P < 0.001).ConclusionsThis is the first study to demonstrate that ASM is an independent predictor of BMD in CHC. Mid‐arm muscle circumference coupled with handgrip strength testing should be incorporated into routine clinical practice to detect low muscle mass, which may be underdiagnosed when only BMI is used. These findings may influence clinical decision‐making and contribute to the development of effective strategies to screen the musculoskeletal abnormalities in CHC patients, independently of the stage of the liver disease.

Osteoporotic fractures impose severe physical, psychosocial, and financial burden both to the patient and the society. Studies on the prevalence of osteoporosis and fragility fractures in Brazil show a wide variation, due to differences in sample size, the population studied, and methodologies. Few studies have been conducted in Brazil about the cost-effectiveness analyses of different intervention options aimed at the diagnosis and treatment of osteoporosis. Investigation and treatment strategies based on cost-effectiveness and scientific evidence are essential in the preparation of public health policies with the ultimate goal of reducing the incidence of fractures and, consequently, the direct and indirect costs associated with them. This article reviews the Brazilian burden of osteoporosis in terms of the prevalence and fractures attributable to the disease, the costs related to the investigation and management, as well as the impact of osteoporosis on the population as a whole and on affected individuals. Arq Bras Endocrinol Metab. 2014;58(5):434-43Keywords Expenses; osteoporosis; Brazil RESUMOFraturas osteoporóticas impõem graves entraves físicos, psicossociais e financeiros, tanto para o paciente quanto para a sociedade. Estudos sobre a prevalência de osteoporose e fraturas por fragilidade no Brasil mostram uma grande variação, em decorrência das diferenças no tamanho das amostras, da população estudada e da metodologia empregada. Poucos estudos têm sido realizados no Brasil sobre a análise de custo-efetividade das diferentes opções de intervenção que visam ao diagnóstico e ao tratamento da osteoporose. Estratégias de investigação e de tratamento com base na relação custo-eficácia e evidências científicas são essenciais para a elaboração de políticas de saúde pública, com o objetivo final de reduzir a incidência de fraturas e, consequentemente, os custos diretos e indiretos associados a elas. Este artigo faz uma revisão sobre o ônus da osteoporose no Brasil em termos de prevalência e fraturas atribuí-veis à doença, de custos relacionados com a investigação, tratamento da osteoporose, bem como seu impacto na população como um todo e em indivíduos afetados. Arq Bras Endocrinol Metab.

Objective: ACTH resistance syndromes are rare, autosomal, and genetically heterogeneous diseases that include familial glucocorticoid deficiency (FGD) and triple A syndrome. FGD has been shown to segregate with mutations in the gene coding for ACTH receptor (MC2R) or melanocortin 2 receptor accessory protein (MRAP), whereas mutations in the triple A syndrome (AAAS, Allgrove syndrome) gene have been found in segregation with triple A syndrome. We describe the clinical findings and molecular analysis of MC2R, MRAP, and AAAS genes in five Brazilian patients with ACTH resistance syndrome. Design and methods: Genomic DNA from patients and their unaffected relatives was extracted from peripheral blood leucocytes and amplified by PCR, followed by automated sequencing. Functional analysis was carried out using Y6 cells expressing wild-type and mutant MC2R. Results: All five patients showed low cortisol and elevated plasma ACTH levels. One patient had achalasia and alacrima, besides the symptoms of adrenal insufficiency. The molecular analysis of FGD patients revealed a novel p.Gly116Val mutation in the MC2R gene in one patient and p.Met1Ile mutation in the MRAP gene in another patient. Expression of p.Gly116Val MC2R mutant in Y6 cells revealed that this variant failed to stimulate cAMP production. The analysis of the AAAS gene in the patient with triple A syndrome showed a novel g.782_783delTG deletion. The molecular analysis of DNA from other two patients showed no mutation in MC2R, MRAP, or AAAS gene. Conclusions: In conclusion, the molecular basis of ACTH resistance syndrome is heterogeneous, segregating with genes coding for proteins involved with ACTH receptor signaling/expression or adrenal gland development and other unknown genes.European Journal of Endocrinology 159 61-68

Background: Psoriasis and obesity are somewhat related to a low-grade systemic inflammatory response. Objectives: To determine leptin and adiponectin levels in psoriasis patients compared to control patients matched for weight. Methods: A case-control study was performed, evaluating 113 psoriasis patients and 41 controls with other dermatologic diseases. Results: The prevalence of obesity was 33% in cases and 21.9% in controls. All evaluated comorbidities were more prevalent among cases. When stratified by weight, the comorbidities were more frequent in overweight patients. We found no correlation between being overweight (p=0.25), leptin (p=0.18) or adiponectin (p=0.762) levels and psoriasis severity. When overweight cases and controls were compared, we found differences in the adiponectin values (p= 0.04). The overweight cases had lower adiponectin levels than the overweight controls. We found no differences in the leptin dosage between cases and controls. The overweight cases had higher leptin values than the normal weight cases (p<0.001). Study limitations: Several patients used systemic anti-inflammatory medication. Conclusions: The prevalence of obesity among psoriasis cases (33%) was higher than in the general population (17.4%). We did not find any correlation between severity of psoriasis and inflammatory cytokines and the condition of being overweight. The overweight cases had lower values of adiponectin than the overweight controls. It seems, therefore, that there is a relationship between adiponectin and psoriasis, but this relationship depends on the presence of obesity.

There is a shortage of studies with representative samples, variety at the NC measurement sites, and the age of the participants, which makes it difficult to establish definitive landmarks.

Objective: Because cirrhotic patients are at high risk of malnutrition and sarcopenia, we evaluated the prevalence of low fat‐free mass index (FFMI) and low phase angle (PhA) among patients with chronic hepatitis C (CHC). Methods: In total, 135 subjects with CHC (50.4% males; mean age, 52.4 ± 11.8 years; 65.9% noncirrhotic and 34.1% compensated cirrhotic patients) were prospectively included and evaluated by bioelectrical impedance analysis. Subjective global assessment was used to evaluate malnutrition. Results: Low FFMI and low PhA were identified in 21.5% and 23.7% of the patients, respectively. Compensated cirrhotic patients had lower PhA values than those without cirrhosis. Low FFMI was associated with male sex (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.00–7.01; P = .04) and malnutrition (OR, 4.27; 95% CI, 1.42–12.90; P = .01). Low PhA was associated with cirrhosis (OR, 3.92; 95% CI, 1.56–9.86; P = .004), malnutrition (OR, 5.52; 95% CI, 1.73–17.62; P = .004), and current alcohol use (OR, 2.77; 95% CI, 1.01–7.58; P = .05). Reactance (Xc) normalized for height (H), an indicator of muscle strength, was independently associated with male sex, age, hypertension, and serum albumin. Conclusion: Host factors, including clinical comorbidities, lifestyle, and nutrition status, are associated with low FFMI and low PhA in noncirrhotic and in compensated cirrhotic patients with CHC. These findings highlight the relevance of evaluating body composition in patients chronically infected by hepatitis C virus independently of the stage of liver disease.