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      Fuerza muscular como predictora de fragilidad ósea en pacientes con diabetes mellitus tipo 2 Translated title: Muscle strength as a predictor of bone fragility in patients with type 2 diabetes mellitus

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          Abstract

          Resumen Introducción: La mayoría de estudios han puesto de manifiesto una disminución de la función y fuerza muscular en pacientes con diabetes mellitus tipo 2 (DM2). Sin embargo, la relación entre la función muscular y la salud ósea en los pacientes con DM2 no está bien definida. Objetivo: El objetivo del estudio fue analizar la relación entre la fuerza muscular y la fragilidad ósea en pacientes con DM2. Material y métodos: Estudio observacional transversal. Se incluyeron un total de 60 pacientes con DM2 (60% varones y 40% mujeres postmenopáusicas) con una edad entre 49-85 años. Se estudiaron variables demográficas, antropométricas, clínicas y bioquímicas. Se determinó la densidad mineral ósea (DMO) en columna lumbar (CL), cuello femoral y cadera total mediante DXA (Hologic QDR 4500), y los valores de TBS (TBS iNsight Software, versión 3.0.2.0, Medimaps, Merignac, France). La fuerza de la mano (kg/cm2) se midió con un dinamómetro hidráulico manual Jamar® (5030j1; jackson, MI). Para evaluar el nivel de movilidad y el riesgo de caídas, se realizó el test Time Up and Go. El análisis estadístico se realizó mediante el programa SPSS (SPSS, inc, v 25.0). Resultados: La edad media de los pacientes fue de 66,3±8,3 años. La HbA1c media fue de 7,7±1,1%, observándose un inadecuado control glucémico (HbA1c >7,5%) en el 73,3% de los pacientes. El 91,7% de las mujeres y el 77,8% de los varones presentaron baja fuerza muscular. El 41,7% de mujeres y el 25% de varones presentaron un riesgo elevado de caídas. Los sujetos con baja fuerza de prensión manual y los que tenían riesgo de caídas elevado presentaron valores significativamente menores de TBS que los que tenían mayor fuerza de la mano (0,99±0,17 vs 1,12±0,15; p=0,03) y bajo riesgo de caídas (0,94±0,13 vs 1,04±0,19; p=0,02). Los pacientes con TBS normal y parcialmente degradado tenían mayor fuerza de agarre manual que los sujetos con TBS degradado (p=0,031). La fuerza de la mano se asoció positivamente con TBS (p<0,05) independientemente de la edad, perímetro de cintura, niveles de 25OH vitamina D y DMO en CL. No hubo diferencias significativas en la fuerza de agarre manual en función de los valores de DMO. Conclusiones: Nuestro estudio muestra que la reducción de la fuerza muscular puede estar relacionada con el deterioro de la microarquitectura ósea determinada por TBS en pacientes con DM2.

          Translated abstract

          Summary Introduction: Most studies have shown a decrease in muscle function and strength in patients with type 2 diabetes mellitus (DM2). However, the relationship between muscle function and bone health in patients with DM2 is not well defined. Objetives: The objective of this study was to analyze the relationship between muscle strength and bone fragility in patients with DM2. Methods: This observational cross-sectional study included 60 patients with DM2 (60% men and 40% postmenopausal women) ranging in age from 49 to 85 years. Demographic, anthropometric, clinical and biochemical variables were studied. Bone mineral density (BMD) in the lumbar spine (LS), femoral neck and total hip was determined using DXA (Hologic QDR 4500), and TBS values (TBS iNsight Software, version 3.0.2.0, Medimaps, Merignac, France). Hand grip (kg/cm2) was measured with a Jamar® manual hydraulic dynamometer (5030j1; Jackson, MI). To assess the level of mobility and the risk of falls, the Time Up and Go test was carried out. Statistical analysis was performed using the SPSS program (SPSS, inc, v 25.0). Results: The mean age of the patients was 66.3±8.3 years. The mean HbA1c was 7.7±1.1%, with inadequate glycemic control (HbA1c >7.5%) observed in 73.3% of the patients. 91.7% of the women and 77.8% of the men had low muscle strength. 41.7% of women and 25% of men presented a high risk of falls. Subjects with low hand grip strength and those with high risk of falls had significantly lower TBS values than those with greater hand grip strength (0.99±0.17 vs 1.12±0.15; p=0.03) and low risk of falls (0.94±0.13 vs 1.04±0.19; p=0.02). Patients with normal and partially degraded TBS had greater hand grip strength than subjects with degraded TBS (p=0.031). Hand grip strength was positively associated with TBS (p<0.05) regardless of age, waist circumference, 25OH vitamin D levels, and BMD in LS. There were no significant differences in hand grip strength as a function of BMD values. Conclusions: Our study shows that the reduction in muscle strength may be related to bone microarchitecture deterioration determined by TBS in patients with DM2.

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          Most cited references39

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          Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia.

          Sarcopenia, a newly recognized geriatric syndrome, is characterized by age-related decline of skeletal muscle plus low muscle strength and/or physical performance. Previous studies have confirmed the association of sarcopenia and adverse health outcomes, such as falls, disability, hospital admission, long term care placement, poorer quality of life, and mortality, which denotes the importance of sarcopenia in the health care for older people. Despite the clinical significance of sarcopenia, the operational definition of sarcopenia and standardized intervention programs are still lacking. It is generally agreed by the different working groups for sarcopenia in the world that sarcopenia should be defined through a combined approach of muscle mass and muscle quality, however, selecting appropriate diagnostic cutoff values for all the measurements in Asian populations is challenging. Asia is a rapidly aging region with a huge population, so the impact of sarcopenia to this region is estimated to be huge as well. Asian Working Group for Sarcopenia (AWGS) aimed to promote sarcopenia research in Asia, and we collected the best available evidences of sarcopenia researches from Asian countries to establish the consensus for sarcopenia diagnosis. AWGS has agreed with the previous reports that sarcopenia should be described as low muscle mass plus low muscle strength and/or low physical performance, and we also recommend outcome indicators for further researches, as well as the conditions that sarcopenia should be assessed. In addition to sarcopenia screening for community-dwelling older people, AWGS recommends sarcopenia assessment in certain clinical conditions and healthcare settings to facilitate implementing sarcopenia in clinical practice. Moreover, we also recommend cutoff values for muscle mass measurements (7.0 kg/m(2) for men and 5.4 kg/m(2) for women by using dual X-ray absorptiometry, and 7.0 kg/m(2) for men and 5.7 kg/m(2) for women by using bioimpedance analysis), handgrip strength (<26 kg for men and <18 kg for women), and usual gait speed (<0.8 m/s). However, a number of challenges remained to be solved in the future. Asia is made up of a great number of ethnicities. The majority of currently available studies have been published from eastern Asia, therefore, more studies of sarcopenia in south, southeastern, and western Asia should be promoted. On the other hand, most Asian studies have been conducted in a cross-sectional design and few longitudinal studies have not necessarily collected the commonly used outcome indicators as other reports from Western countries. Nevertheless, the AWGS consensus report is believed to promote more Asian sarcopenia research, and most important of all, to focus on sarcopenia intervention studies and the implementation of sarcopenia in clinical practice to improve health care outcomes of older people in the communities and the healthcare settings in Asia. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
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            Sarcopenia: revised European consensus on definition and diagnosis

            doi: 10.1093/ageing/afy169 In the original version of the above paper there was an error in Table 3, which shows the recommended cut-off points for ASM/height2 in women. The cut-off point was given as <6.0 kg/m2, but the correct value is <5.5 kg/m2. This has now been corrected online. The authors wish to apologise for this error.
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              Clinician’s Guide to Prevention and Treatment of Osteoporosis

              The Clinician’s Guide to Prevention and Treatment of Osteoporosis was developed by an expert committee of the National Osteoporosis Foundation (NOF) in collaboration with a multispecialty council of medical experts in the field of bone health convened by NOF. Readers are urged to consult current prescribing information on any drug, device, or procedure discussed in this publication.
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                Author and article information

                Journal
                romm
                Revista de Osteoporosis y Metabolismo Mineral
                Rev Osteoporos Metab Miner
                Sociedad Española de Investigaciones Óseas y Metabolismo Mineral (Madrid, Madrid, Spain )
                1889-836X
                2173-2345
                December 2021
                : 13
                : 4
                : 137-144
                Affiliations
                [03] Madrid orgnameCIBERFES orgdiv1Instituto de Salud Carlos III España
                [06] Granada Andalucía orgnameUniversidad de Granada orgdiv1Departamento de Medicina Spain
                [05] Granada orgnameHospital Universitario Clínico San Cecilio orgdiv1Medicina Nuclear España
                [02] Granada orgnameInstituto de Investigación Biosanitaria de Granada España
                [01] Granada orgnameHospital Universitario Clínico San Cecilio orgdiv1Unidad de Metabolismo Óseo, Endocrinología y Nutrición España
                [04] Granada orgnameFundación para la Investigación Biosanitaria de Andalucía Oriental España
                Article
                S1889-836X2021000400006 S1889-836X(21)01300400006
                10.4321/s1889-836x2021000300006
                909d1e5d-48a6-4499-a1d3-61d379dbe4f0

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

                History
                : 06 September 2021
                : 20 October 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 39, Pages: 8
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                SciELO Spain

                Categories
                Originales

                bone densitometry,diabetes mellitus tipo 2,fuerza de la mano,fragilidad ósea,Trabecular bone score,densitometría ósea,ype 2 diabetes mellitus,hand strength,bone fragility

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