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

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

  1. 1. NUEVO ENFOQUE EN EL DIAGNOTICO DE LA OSTEOPOROSIS Carlos Cure Cure MD Endocrinologia y Nutricion BIOMELAB Barranquilla 2012
  2. 2. Definición de la Osteoporosis“...Una enfermedad sistémica delesqueleto, la cual se caracteriza poruna reducción de la masa ósea y el deterioro microestructural del tejidodel hueso, seguido de un aumentoen la fragilidad ósea y en la susceptibilidad para fracturas.”
  3. 3. El estudio NHANES III demostró quealrededor del 16 al 17 % de lasmujeres postmenopáusicas e n U.S.Están por debajo de -2.5 SD (-5 a 7millones de mujeres) si se evalúa laDMO en fémur. Utilizando otros sitiosdel esqueleto estas cifras se duplican(3)
  4. 4. Observaciones experimentales.1. La fuerza muscular regional es el principaldeterminante de la calidad osea. (Los huesos sonlo que los músculos quieren que sean).2. El sexo es irrelevante en la determinacion de lamecanostasis de la calidad osea humana. Igualesleyes mecanostaticas para determinar su resistencia ala deformación y la fractura
  5. 5. INTERACCION MECANICO - ENDOCRINA
  6. 6. 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
  7. 7. 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 normalmen pre- and post-menopausal women.Bone; 2004; 35 283-295
  8. 8. 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 normalmen pre- and post-menopausal women.Bone; 2004; 35 283-295
  9. 9. 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 normalmen pre- and post-menopausal women.Bone; 2004; 35 283-295
  10. 10. Ferretti, Capozza, Cointry; 2002
  11. 11. 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 FerrettiOsteoporo Int (2005) 16; 2095-2106
  12. 12. 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 FerrettiOsteoporo Int (2005) 16; 2095-2106
  13. 13. 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 FerrettiOsteoporo Int (2005) 16; 2095-2106
  14. 14. 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 FerrettiOsteoporo Int (2005) 16; 2095-2106
  15. 15. CMO-vs-MM RELATIONSHIP WHOLE BODY Pre-MP Post-MPBMC , kg Lean mass (LM), kg Lean mass (LM), kg Normal reference ANCOVA: Normal reference ANCOVA: r= 0.535, p< 0.0001 Slopes: n.s. r= 0.521, p< 0.0001 Slopes: p<0.001 Type-I Fx Ordinates: n.s. Type-I Fx r= 0.446, p< 0.0001 r= 0.571, p< 0.0001 Type-II Fx Type-II FxI r= 0.595, p< 0.0001 r= 0.528, p< 0.0001
  16. 16. • 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
  17. 17. Factores de riesgo para la osteoporósis Establecidas ProbablesMujeres blancas o asiáticas Baja relación peso/alturaEdad avanzada Antecedentes positivosMenopausia temprana de osteoporósis en la familiaOoforectomía premenopáusica Alto consumo de alcoholAmenorrea premenopáusica Bajo consumo de calcioUso crónico de corticoides Habito de fumarReposo prolongado en cama Alto consumo proteínas/fosfatos Alto consumo de cafeína
  18. 18. Barranquilla, Punta Roca 2005
  19. 19. GRACIAS
  20. 20. 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 FerrettiOsteoporo Int (2005) 16; 2095-2106
  21. 21. Mecanostato oseo (sistema de homeostasis)1. La carga sobre el hueso induce deformacion la cuales sensada y analizada por los osteocitos y células derevestimiento.2. Liberacion de factores locales de interacción célula-célula que determinan las respuestas modeladoras oremodeladoras.3. Con estos mecanismos se modifican la calidad o ladistribución espacial del material oseo (arquitectura),determinantes de la calidad mecánica (rigidez) delhueso.
  22. 22. INTERACCION MECANICO - ENDOCRINA
  23. 23. 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 FerrettiOsteoporo Int (2005) 16; 2095-2106
  24. 24. 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 FerrettiOsteoporo Int (2005) 16; 2095-2106
  25. 25. 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 FerrettiOsteoporo Int (2005) 16; 2095-2106
  26. 26. 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
  27. 27. 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 FerrettiOsteoporo Int (2005) 16; 2095-2106
  28. 28. 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 FerrettiOsteoporo Int (2005) 16; 2095-2106
  29. 29. 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 FerrettiOsteoporo Int (2005) 16; 2095-2106
  30. 30. Calidad Revisión •Remodelado periodica Rigidez del osea material MecanismosResistencia a Arquitectura adaptatorios la •Modelado de la forma ydeformación tamaño de los huesos
  31. 31. CALIDAD OSEAMÉTODO PROPIEDAD EVALUADAEn cuerpos Calidad del Calidad Resistenciavertebrales Masa ósea material arquitectura Mecánica DEXA +++ - - ++ QCT ++++ ++ - +++En huesos largos DEXA ++++ - - + QUS ++ +++ - ++ pQCT +++ ++ ++++ +++

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