Context Pregnancy and lactation-associated osteoporosis (PLO) is a rare condition characterized by fragility fractures, mostly vertebral, during the third trimester of pregnancy or the early postpartum. Objective The aim of this study was to evaluate bone microarchitecture in women with PLO in order to better understand the pathophysiology of this disease. Design and methods In this retrospective study, we included women with PLO referred to our bone center between November 2007 and July 2012. We assessed bone mineral density (BMD) by DXA, bone turnover markers and bone microarchitecture by HR-pQCT. Results were compared with a control group of healthy lactating women. Results Among the seven primiparous patients with PLO, six suffered vertebral fractures and one developed a hip fracture during the seventh month of gestation. Fractures occurred within the eighth month of pregnancy and the fourth month of postpartum; vertebral fractures were multiple in 85.7%. Major or minor risk factors for osteoporosis were present in 86% of our patients. Trabecular density, number and thickness were 34%, 20% and 22% lower than controls, (p < 0.01, p = 0.01 and p = 0.01, respectively). Cortical parameters were also deteriorated but to a lesser extent. Conclusion In comparison with healthy lactating women, patients with PLO presented severe deterioration of bone trabecular and cortical microarchitecture. This significant compromise may explain the occurrence of multiple fractures in these otherwise healthy young women. Further prospective studies are needed in order to determine whether bone microarchitecture might be able to be restored in the future.
Long-term glucocorticoid (GC) therapy is frequently indicated to treat autoimmune and chronic inflammatory diseases in daily clinical practice. Two of the most devastating untoward effects are bone loss and fractures. Doses as low as 2.5 mg of prednisone for more than 3 months can impair bone integrity. Population at risk is defined based on the dose and duration of GC therapy and should be stratified according to FRAX (Fracture Risk Assessment Tool), major osteoporotic fracture, prior fractures, and bone mineral density values (BMD). General measures include to prescribe the lowest dose of GC to control the underlying disease for the shortest possible time, maintain adequate vitamin D levels and calcium intake, maintain mobility, and prescribe a bone acting agent in patients at high risk of fracture. These agents include oral and intravenous bisphosphonates, denosumab, and teriparatide.
In a 5-year-old boy, an early onset psychomotor retardation with non-progressive ataxia and without dysmorphic features, associated with lysosomal storage disease found on ultrastructural examination of the conjunctiva, led to the diagnosis of Salla disease. This was supported by a tenfold excretion of urinary free sialic acid, without abnormal oligosacchariduria or anomaly in lysosomal enzymes. This boy is a native of Southern France. Screening of urinary sialic acid has to be introduced in aetiological investigations of patients with apparently non-progressive psychomotor retardation associated with ataxia or dystonic movements.
ResumenIntroducción: La fibromialgia es una entidad frecuente en la práctica clínica y se ha considerado que está asociada con desórdenes psiquiátricos, en particular con depresión, lo cual podría tener un impacto en el tratamiento de esta entidad. Objetivo: Evaluar la prevalencia de síntomas depresivos en pacientes con fibromialgia. Diseño: Estudio observacional y de tipo transversal. Lugar: Servicio de Reumatología, Hospital Departamental María Auxiliadora. Participantes: Pacientes de ambos sexos con diagnóstico de fibromialgia. Intervenciones: Se utilizó la escala de Hamilton para la depresión (HDRS) y el recuento de puntos dolorosos para fibromialgia. Principales medidas de resultados: Porcentaje de pacientes con síntomas depresivos. Puntaje total de la HDRS en relación al recuento de puntos dolorosos. Resultados: La edad promedio fue 54,9 ± 14 años, 80% fue del sexo femenino y el número promedio de puntos dolorosos, 14,4 ± 1,5. El 32,7% de pacientes no tenía síntomas de ánimo depresivo, en 27,7% los síntomas fueron leves, en 30,9% moderados y solo en 9% severos. Ningún paciente presentó síntomas compatibles con ánimo depresivo muy severo. Encontramos una correlación significativa entre el número de puntos dolorosos y el puntaje de la escala HDRS (r= 0,740), p< 0,001. Conclusiones: Los síntomas depresivos severos se encuentran en una proporción baja en pacientes con fibromialgia y parecen estar directamente asociados con el número de puntos dolorosos. Palabras clave: Fibromialgia; depresión; psiquiatría; dolor. AbstractIntroduction: Fibromyalgia is a common musculoskeletal problem in clinical practice and is associated with psychiatric disorders. The association with major depression potentially has therapeutic implications. Objective: To determine the prevalence of depressive symptoms in a sample of patient with fibromyalgia. Design: Observational and transversal study. Setting: Rheumatology Department, Maria Auxiliadora Hospital, Lima, Peru. Participants: Fifty-five patients of both sexes with fibromyalgia. Interventions: Fibromyalgia tender points count and use of Hamilton Rating Scale for Depression (HDRS). Main outcome measures: Percentage of depressive symptoms. Total HDRS score in relation to tender point count. Results: Average age was 54,9 ± 14 years, 80% were females, and the average tender point score was 14,4 ± 1,5. The HDRS score did not show depression mood symptoms in 32,7%, 27,7% had mild symptoms, 30,9% moderate and 9% severe symptoms. In no patient depression mood symptoms were considered very severe. There was significant correlation between the number of tender points and HDRS score (r= 0,740), p< 0,001. Conclusions: Severe or very depressive symptoms are infrequent in fibromyalgia and depression mood symptoms seem to correlate positively with the number of tender points.
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