Influencia de la obesidad sobre la microarquitectura y las propiedades biomecánicas en pacientes con fractura de cadera

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Abstract

Resumen Introducción: La obesidad y la osteoporosis (OP) son dos patologías muy prevalentes en nuestra sociedad actual. El efecto de la obesidad sobre la calidad ósea se encuentra en debate en la actualidad. Objetivo: Valorar el efecto del peso corporal sobre la microestructura y las propiedades biomecánicas de hueso trabecular procedente de biopsias de extremidad proximal de fémur de pacientes con fractura de cadera por fragilidad. Material y método: Estudio transversal de 16 pacientes con fractura de cadera. 2 grupos según su IMC: (A) sujetos normopeso y (B) con obesidad. Recogimos biopsias de hueso trabecular de cabeza femoral. Valoramos determinaciones bioquímicas (PTH, 25(OH) vitamina D e IGF-1), marcadores de remodelado óseo (PINP,CTX), masa ósea (DMO cuello y cadera total), microestructura ósea y estudio biomecánico (µCt). El análisis estadístico: t-Student (SPSS 22.0) significación p<0,05. Resultados: Todos los pacientes presentaron DMO de cadera en rango osteoporótico. El grupo de obesos presentó niveles superiores de PTH e inferiores de IGF-1, vitamina D y PINP. No encontramos diferencias en los parámetros relacionados con el metabolismo óseo. El grupo de obesos presentó mejores índices microestructurales alcanzando la significación: mayor volumen óseo (BV/TV: 36,6±12,7 vs. 19,4±11,4%, BS/TV: 5,5±1,1 vs. 3,9±1,3%), mayor número de trabéculas (Tb.N: 1,6±0,4 vs. 1,01±0,4), mayor anchura de trabéculas (Tb.Th: 0,22±0,003 vs. 0,17±0,05) y menor separación trabecular (Tb.Sp: 0,51±0,12 vs. 0,66±0,16). Los parámetros biomecánicos confirman una mayor resistencia del hueso trabecular en pacientes obesos. Conclusión: La obesidad puede ser un factor protector de la calidad ósea en la región femoral y tiene menos efecto sobre la densidad mineral ósea.

Translated abstract

Abstract Introduction: Obesity and osteoporosis (OP) are two very prevalent diseases in our society today. The effect of obesity on bone quality is currently a subject under discussion. Objective: To assess the effect of body weight on the microstructure and biomechanical properties of trabecular bone biopsies from the proximal end of the femur in patients with hip fracture fragility. Material and Methods: Cross-sectional study of 16 patients with hip fracture. The 2 groups are divided according to their BMI: (A) normal weight individuals and (B) those with obesity. We collected biopsies of cancellous bone from the femoral head and assessed biochemical determinations (PTH, 25 (OH) vitamin D and IGF-1), bone remodeling markers (PINP, CTX), bone mass (BMD neck and total hip), bone microstructure and biomechanical study (µCt). Statistical analysis: Student's t test (SPSS 22.0) significance p<0.05. Results: All patients had hip BMD in osteoporotic range. The obese group had higher levels of PTH and lower IGF-1, vitamin D and PINP. We found no differences in the parameters related to bone metabolism. The obese group showed better indices reaching microstructural significance: increased bone volume (BV/TV: 36.6±12.7 vs 19.4±11.4%, BS/TV: 5.5±1.1 vs 3.9±1.3%), higher trabecular number (Tb.N: 1.6±0.4 vs 1,01±0,4), greater trabecular width (Tb.Th: 0.22±0.003 vs 0.17±0.05) and lower trabecular separation (Tb.Sp: 0.51±0.12 vs 0.66±0.16). Biomechanical parameters confirm greater strength of trabecular bone in obese patients. Conclusion: Obesity may be a protective factor of bone quality in the femoral region and has less effect on bone mineral density.

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Most cited references 23

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Nia Mitchell, Victoria A Catenacci, Holly Wyatt … (2011)

The obesity epidemic in the United States has proven difficult to reverse. We have not been successful in helping people sustain the eating and physical activity patterns that are needed to maintain a healthy body weight. There is growing recognition that we will not be able to sustain healthy lifestyles until we are able to address the environment and culture that currently support unhealthy lifestyles. Addressing obesity requires an understanding of energy balance. From an energy balance approach it should be easier to prevent obesity than to reverse it. Further, from an energy balance point of view, it may not be possible to solve the problem by focusing on food alone. Currently, energy requirements of much of the population may be below the level of energy intake than can reasonably be maintained over time. Many initiatives are underway to revise how we build our communities, the ways we produce and market our foods, and the ways we inadvertently promote sedentary behavior. Efforts are underway to prevent obesity in schools, worksites, and communities. It is probably too early to evaluate these efforts, but there have been no large-scale successes in preventing obesity to date. There is reason to be optimistic about dealing with obesity. We have successfully addressed many previous threats to public health. It was probably inconceivable in the 1950s to think that major public health initiatives could have such a dramatic effect on reducing the prevalence of smoking in the United States. Yet, this serious problem was addressed via a combination of strategies involving public health, economics, political advocacy, behavioral change, and environmental change. Similarly, Americans have been persuaded to use seat belts and recycle, addressing two other challenges to public health. But, there is also reason to be pessimistic. Certainly, we can learn from our previous efforts for social change, but we must realize that our challenge with obesity may be greater. In the other examples cited, we had clear goals in mind. Our goals were to stop smoking, increase the use of seatbelts, and increase recycling. The difficulty of achieving these goals should not be minimized, but they were clear and simple goals. In the case of obesity, there is no clear agreement about goals. Moreover, experts do not agree on which strategies should be implemented on a widespread basis to achieve the behavioral changes in the population needed to reverse the high prevalence rates of obesity. We need a successful model that will help us understand what to do to address obesity. A good example is the recent HEALTHY study. This comprehensive intervention was implemented in several schools and aimed to reduce obesity by concentrating on behavior and environment. This intervention delivered most of the strategies we believe to be effective in schools. Although the program produced a reduction in obesity, this reduction was not greater than the reduction seen in the control schools that did not receive the intervention. This does not mean we should not be intervening in schools, but rather that it may require concerted efforts across behavioral settings to reduce obesity. Although we need successful models, there is a great deal of urgency in responding to the obesity epidemic. An excellent example is the effort to get menu labeling in restaurants, which is moving rapidly toward being national policy. The evaluation of this strategy is still ongoing, and it is not clear what impact it will have on obesity rates. We should be encouraging efforts like this, but we must evaluate them rigorously. Once we become serious about addressing obesity, it will likely take decades to reverse obesity rates to levels seen 30 years ago. Meanwhile, the prevalence of overweight and obesity remains high and quite likely will continue to increase.

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Thinness (low percentage of body fat, low body mass index [BMI], or low body weight) was evaluated as a risk factor for low bone mineral density (BMD) or increased bone loss in a randomized trial of alendronate for prevention of osteoporosis in recently postmenopausal women with normal bone mass (n = 1609). The 2-year data from the placebo group were used (n = 417). Percentage of body fat, BMI, and body weight were correlated with baseline BMD (r = -0. 13 to -0.43, p < 0.01) and 2-year bone loss (r = -0.14 to -0.19, p < 0.01). Women in the lowest tertiles of percentage of body fat or BMI had up to 12% lower BMD at baseline and a more than 2-fold higher 2-year bone loss as compared with women in the highest tertiles (p

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Low body mass index (BMI) is a well-established risk factor for fracture in postmenopausal women. Height and obesity have also been associated with increased fracture risk at some sites. We investigated the relationships of weight, BMI, and height with incident clinical fracture in a practice-based cohort of postmenopausal women participating in the Global Longitudinal study of Osteoporosis in Women (GLOW). Data were collected at baseline and at 1, 2, and 3 years. For hip, spine, wrist, pelvis, rib, upper arm/shoulder, clavicle, ankle, lower leg, and upper leg fractures, we modeled the time to incident self-reported fracture over a 3-year period using the Cox proportional hazards model and fitted the best linear or nonlinear models containing height, weight, and BMI. Of 52,939 women, 3628 (6.9%) reported an incident clinical fracture during the 3-year follow-up period. Linear BMI showed a significant inverse association with hip, clinical spine, and wrist fractures: adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) per increase of 5 kg/m(2) were 0.80 (0.71-0.90), 0.83 (0.76-0.92), and 0.88 (0.83-0.94), respectively (all p < 0.001). For ankle fractures, linear weight showed a significant positive association: adjusted HR per 5-kg increase 1.05 (1.02-1.07) (p < 0.001). For upper arm/shoulder and clavicle fractures, only linear height was significantly associated: adjusted HRs per 10-cm increase were 0.85 (0.75-0.97) (p = 0.02) and 0.73 (0.57-0.92) (p = 0.009), respectively. For pelvic and rib fractures, the best models were for nonlinear BMI or weight (p = 0.05 and 0.03, respectively), with inverse associations at low BMI/body weight and positive associations at high values. These data demonstrate that the relationships between fracture and weight, BMI, and height are site-specific. The different associations may be mediated, at least in part, by effects on bone mineral density, bone structure and geometry, and patterns of falling. © 2014 American Society for Bone and Mineral Research.

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Author and article information

Contributors

M Giner: Role: ND

MJ Montoya: Role: ND

C Miranda: Role: ND

MA Vázquez: Role: ND

MJ Miranda: Role: ND

R Pérez-Cano: Role: ND

Journal

Journal ID (publisher-id): romm

Title: Revista de Osteoporosis y Metabolismo Mineral

Abbreviated Title: Rev Osteoporos Metab Miner

Publisher: Sociedad Española de Investigaciones Óseas y Metabolismo Mineral (Madrid, Madrid, Spain )

ISSN (Print): 1889-836X

ISSN (Electronic): 2173-2345

Publication date (Print and electronic): March 2017

Volume: 9

Issue: 1

Pages: 20-27

Affiliations

[4] Sevilla Andalucía orgnameUniversidad de Sevilla orgdiv1Facultad de Medicina orgdiv2Departamento de Medicina Spain

[7] Sevilla Andalucía orgnameUniversidad de Sevilla orgdiv1Facultad de Medicina orgdiv2Departamento de Citología Normal y Patológica Spain

[1] Sevilla orgnameHospital Universitario Virgen Macarena orgdiv1Servicio Medicina Interna orgdiv2Unidad de Osteoporosis España

[3] Sevilla orgnameHospital Universitario Virgen Macarena orgdiv1Servicio Medicina Interna orgdiv2Unidad de Osteoporosis España

[6] Sevilla orgnameHospital Universitario Virgen Macarena orgdiv1Servicio Medicina Interna orgdiv2Unidad de Osteoporosis España

[2] Sevilla Andalucía orgnameUniversidad de Sevilla orgdiv1Facultad de Medicina orgdiv2Departamento de Medicina Spain

[8] Sevilla Andalucía orgnameUniversidad de Sevilla orgdiv1Facultad de Medicina orgdiv2Departamento de Medicina Spain

[5] Sevilla orgnameHospital Universitario Virgen Macarena orgdiv1Servicio Medicina Interna orgdiv2Unidad de Osteoporosis España

Article

Publisher ID: S1889-836X2017000100020

DOI: 10.4321/s1889-836x2017000100004

SO-VID: 48d1ecc3-050e-4042-b0bf-d8f8f802f948

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This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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Keywords: osteoporosis,obesidad,microestructura hueso trabecular,biomecánica,densidad mineral ósea,marcadores remodelado óseo,obesity,microstructure trabecular bone,biomechanics,bone mineral density,bone turnover markers

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Keywords: osteoporosis, obesidad, microestructura hueso trabecular, biomecánica, densidad mineral ósea, marcadores remodelado óseo, obesity, microstructure trabecular bone, biomechanics, bone mineral density, bone turnover markers

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Non-Pharmacological Interventions towards Preventing the Triad Osteoporosis-Falls Risk-Hip Fracture, in Population Older than 65. Scoping Review
Authors: Alba Peraza-Delgado, María Sánchez-Gómez, Juan Gómez-Salgado …

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