New considerations on the management of osteoporosis in Central and Eastern Europe (CEE): summary of the "3rd Summit on Osteoporosis-CEE", November 2009, Budapest, Hungary.

INTRODUCTION: In November 2009, the "3rd Summit on Osteoporosis-Central and Eastern Europe (CEE)" was held in Budapest, Hungary. The conference aimed to tackle issues regarding osteoporosis management in CEE identified during the second CEE summit in 2008 and to agree on approaches that allow most efficient and cost-effective diagnosis and therapy of osteoporosis in CEE countries in the future. DISCUSSION: The following topics were covered: past year experience from FRAX® implementation into local diagnostic algorithms; causes of secondary osteoporosis as a FRAX® risk factor; bone turnover markers to estimate bone loss, fracture risk, or monitor therapies; role of quantitative ultrasound in osteoporosis management; compliance and economical aspects of osteoporosis; and osteoporosis and genetics. Consensus and recommendations developed on these topics are summarised in the present progress report. CONCLUSION: Lectures on up-to-date data of topical interest, the distinct regional provenances of the participants, a special focus on practical aspects, intense mutual exchange of individual experiences, strong interest in cross-border cooperations, as well as the readiness to learn from each other considerably contributed to the establishment of these recommendations. The "4th Summit on Osteoporosis-CEE" held in Prague, Czech Republic, in December 2010 will reveal whether these recommendations prove of value when implemented in the clinical routine or whether further improvements are still required.

Indications to teriparatide treatment in patients with osteoporosis.

To prevent osteoporotic fracture occurrence, a variety of treatment regimens with different mechanisms of action is available. The antiresorptive bisphosphonate drugs are currently the most commonly prescribed agents in the management of patients with osteoporosis. The recombinant amino-terminal fragment of human parathyroid hormone (Teriparatide) is a bone anabolic agent which reduces fracture risk by increasing bone mass and improving bone microarchitecture. Teriparatide treatment reduces vertebral and non-vertebral fracture risk markedly in women and men with idiopathic osteoporosis, or with glucocorticoid-induced osteoporosis. Teriparatide should thus be considered as first line treatment for postmenopausal women and for men with severe osteoporosis.

Directorio de expertos en el tratamiento de la información (EXIT). Análisis de uso

Descripción y características del Directorio EXIT (Expertos en el tratamiento de la información), puesto en marcha oficialmente en junio de 2005. A los dos años (julio de 2007) se ha evaluado y analizado su funcionamiento, implantación, visibilidad y aceptación por parte de la comunidad profesional de bibliotecarios, documentalistas, archiveros y especialistas en información a la que sirve, y en especial su uso. Técnicamente, EXIT está considerado un directorio estado-del-arte a nivel mundial, siendo además un genuino producto de la web 2.0 ya que son los propios interesados los que rellenan y mantienen al día sus fichas, bajo la supervisión de sus creadores-gestores y de un Comité Evaluador internacional.

Evaluation of the potential use of trabecular bone score to complement bone mineral density in the diagnosis of osteoporosis: a preliminary spine BMD-matched, case-control study.

The trabecular bone score (TBS) is a new parameter that is determined from gray-level analysis of dual-energy X-ray absorptiometry (DXA) images. It relies on the mean thickness and volume fraction of trabecular bone microarchitecture. This was a preliminary case-control study to evaluate the potential diagnostic value of TBS as a complement to bone mineral density (BMD), by comparing postmenopausal women with and without fractures. The sample consisted of 45 women with osteoporotic fractures (5 hip fractures, 20 vertebral fractures, and 20 other types of fracture) and 155 women without a fracture. Stratification was performed, taking into account each type of fracture (except hip), and women with and without fractures were matched for age and spine BMD. BMD and TBS were measured at the total spine. TBS measured at the total spine revealed a significant difference between the fracture and age- and spine BMD-matched nonfracture group, when considering all types of fractures and vertebral fractures. In these cases, the diagnostic value of the combination of BMD and TBS likely will be higher compared with that of BMD alone. TBS, as evaluated from standard DXA scans directly, potentially complements BMD in the detection of osteoporotic fractures. Prospective studies are necessary to fully evaluate the potential role of TBS as a complementary risk factor for fracture.

Tratamiento ambulatorio involuntario

Discusión de las implicaciones bioéticas del tratamiento ambulatorio involuntario

Variacion del modulo de 'Young' con el tratamiento termico en aceros al carbono hipoeutectoides

En trabajos anteriores se ha constatado que varios aceros al carbono hipoeutectoides, en estado de temple, presentan valores del módulo de Young inferiores a los correspondientes en estado de revenido. En todos los casos la determinación se ha realizado mediante ultrasonidos. En concreto, para el acero C22E (EN 10083), el módulo se incrementa ligeramente desde 209 GPa (material templado) hasta 211 GPa (revenido a 650 °C), para el acero C45E el módulo aumenta desde 199 GPa hasta 211 GPa (revenido a 500 °C) y para el acero C55E el módulo varía desde 202 GPa hasta 209 GPa para el acero revenido a 650 °C. El presente trabajo se centra en la caracterización estructural de los tres aceros mencionados a los distintos estados de tratamiento térmico, utilizando las técnicas de microscopía óptica de reflexión y microscopía electrónica de barrido, y se propone una explicación de la variación del módulo a partir del comportamiento de las dislocaciones y su interacción con átomos de soluto y con otras dislocaciones.

Tratamiento farmacológico del juego patológico

El tratamiento farmacológico del juego patológico conlleva una serie de dificultades que se pueden relacionar con la ausencia de un sustrato neurobiológico universalmente aceptado, altas tasas de abandonos y no cumplimentación del tratamiento, y ausencia de ensayos controlados que comparen diferentes modalidades de tratamiento en la misma población. El abordaje farmacológico del juego patológico se puede reaiizar desde diferentes perspectivas: desde un punto de vista etiopatonénico, desde el tiatumiento de-las patologías asociadas al juego patológico e incluso tratatando esta conducta como un síntoma de otra patología, como la mania. En las siguientes páginas 10s autores intentan revisar 10s diferentes fármacos propuestos en varios estudios. Los autores no recomiendan un tratamiento especifico para el juego patológico ya que existen diferentes posibilidades según las características del paciente.

Tratamiento del estrés docente y prevención del burnout con musicoterapia autorrealizadora

El presente trabajo describe la investigación realizada con maestros de Primaria de la provincia de Barcelona, que asistieron a un Taller de Musicoterapia Autorrealizadora (MTA) para tratar el estrés docente y prevenir el burnout. El estudio se realizó con un grupo de maestros que recibieron el tratamiento. Paralelamente se constituyó un Grupo Control, que no recibió ningún tratamiento. El método usado fue la Musicoterapia Autorrealizadora, mi propio sistema de aplicar los beneficios terapéuticos de la música de manera activa y creativa, a través de la interpretación e improvisación musical. Los objetivos planteados fueron comprobarla eficacia de la MTA para disminuir la tensión física, mental y emocional, relajarse, centrarse en el momento presente y adquirir estrategias para disminuir el propio estrés.

El tratamiento numérico de la realidad. Reflexiones sobre la importancia actual de la estadística en la Sociedad de la Información.

La estadística se ha convertido en un método práctico para describir los valores de datos económicos, políticos, sociales, psicológicos, médicos, biológicos y físicos, como herramienta para relacionar y analizar dichos datos. El trabajo del estadístico no consiste sólo en obtener, reunir o tabular los datos, sino sobre todo el proceso de interpretación de esa información solo o en colaboración con los expertos en cada ámbito. A pesar de que es imposible entender la Sociedad de la Información sin la estadística, es preocupante la situación actual de las ciencias matemáticas y más concretamente de la estadística, ya que a pesar de su imprescindibilidad existe una falta de vocación entre los jóvenes por su estudio y uso, ya sea por su dificultad matemática, desconocimiento u otros motivos. Este artículo pretende reflexionar sobre la importancia de la misma en la sociedad actual que permite tratar numéricamente la realidad.

High prevalence of osteoporosis in Swiss women aged 60 and older: a 2-year pilot screening campaign.

Background: Osteoporosis (OP) is frequent in postmenopausal women, but remains underdiagnosed and undertreated. In Switzerland, DXA is not reimbursed by the insurances for screening, even if it is recommended to test women's Bone Mineral Density (BMD) at the age of 65. Methods: To assess the feasibility of a screening program for OP, the Bone diseases center of Lausanne has been mandated to perform a 2-year information and screening campaign (3 days per months) for women age 60 and older through the state of Vaud using a mobile unit for bone assessment. This project is still ongoing. Women are informed by media for dates and screening locations. Appointments are taken by phone. Women known for osteoporosis or already treated are excluded. During the evaluation every women is assessed by a questionnaire for risk factors, by a DXA measurement (Discovery C, Hololgic), and by Vertebral Fracture Assessment (VFA) for Genant's grades 2 and 3 prevalent vertebral fractures (VF). Women are considered at high risk of fracture if they have a hip fracture, a VF, another fragility fracture with a BMD T-score ≤-2 or a BMD T-score ≤-2.5. Results: After 17 months (50 days of screening), 752 women were assessed, mean age 66±6 yrs, mean BMI 26±5 kg/m2, mean lowest T-score -1.6±1.0 SD. 215 women (29%) were considered at high risk, 92 of them (12%) having established OP and 50 (7%) having one or more fragility VF. VF were unknown for 83% of the women and discovered by VFA. The number needed to screen (NNS) were 3.5 for high risk women, 8.2 for established OP and 15 for VF. Conclusions: After near ¾ of the project, prevalence of women at high risk of fracture was high, with a NNS below 4. Knowing the global cost of OP and that current treatment have a high efficacy for fracture risk reduction, such a screening program could have a positive economic impact. VFA allowed discovering many women with unknown VF, who were at very high risk of further fractures. A systematic screening for VF should be added to BMD measurements after the age of 60.

Les traitements de l'ostéoporose (à l'exception de la substitution hormonale et de ses dérivés) [Treatment of osteoporosis (with the exception of hormone replacement and its derivates]

Calcium and vitamin D supplementation are warranted for the treatment of osteoporosis, when other specific drugs are used. Vitamin D supplementation is necessary when the plasma level of 25-hydroxy-vitamin D is below 30 nmol/l (12 pg/l) in order to avoid any increase of the plasma parathyroid hormone level. Bisphosphonates are the most widely drugs used. Recent advances will provide patients with a more convenient therapeutically equivalent alternative: the once-weekly oral dosing regimen and probably the possibility to give infusions at intervals of up to one year. Parathyroid hormone administered subcutaneously daily produced a dramatic increase of trabecular and cortical bone mineral density, and an important decrease of vertebral and nonvertebral fracture risk. Strontium is a new original drug, which stimulates bone formation, and inhibits bone resorption. It significantly improves trabecular and cortical bone mass. Calcitonin not only prevents the recurrence of vertebral fractures, but possibly could decrease hip fractures risk. Hydrochlorothiazide preserves the bone mineral density, and decreases nonvertebral fracture risk, as showed in epidemiological studies. Large clinical trials with statins therapy in appropriate populations are required to find out whether these drugs have any role in preventing fractures.

Cost effectiveness and cost utility of risedronate for osteoporosis treatment and fracture prevention in women: a Swiss perspective.

OBJECTIVES: To assess the incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) of risedronate compared to no intervention in postmenopausal osteoporotic women in a Swiss perspective. METHODS: A previously validated Markov model was populated with epidemiological and cost data specific to Switzerland and published utility values, and run on a population of 1,000 women of 70 years with established osteoporosis and previous vertebral fracture, treated over 5 years with risedronate 35 mg weekly or no intervention (base case), and five cohorts (according to age at therapy start) with eight risk factor distributions and three lengths of residual effects. RESULTS: In the base case population, the ICER of averting a hip fracture and the ICUR per quality-adjusted life year gained were both dominant. In the presence of a previous vertebral fracture, the ICUR was below euro45,000 (pound30,000) in all the scenarios. For all osteoporotic women>or=70 years of age with at least one risk factor, the ICUR was below euro45,000 or the intervention may even be cost saving. Age at the start of therapy and the fracture risk profile had a significant impact on results. CONCLUSION: Assuming a 2-year residual effect, that ICUR of risedronate in women with postmenopausal osteoporosis is below accepted thresholds from the age of 65 and even cost saving above the age of 70 with at least one risk factor.