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NUEVO ENFOQUE EN EL DIAGNOTICO DE LA
OSTEOPOROSIS
Carlos Cure Cure MD
Endocrinologia y Nutricion
BIOMELAB Barranquilla 2012
Definición de la Osteoporosis
“...Una enfermedad sistémica del
esqueleto, la cual se caracteriza por
una reducción de la masa ósea y el
deterioro microestructural del tejido
del hueso, seguido de un aumento
en la fragilidad ósea y en la
susceptibilidad para fracturas.”
El estudio NHANES III demostró que
alrededor del 16 al 17 % de las
mujeres postmenopáusicas e n U.S.
Están por debajo de -2.5 SD (-5 a 7
millones de mujeres) si se evalúa la
DMO en fémur. Utilizando otros sitios
del esqueleto estas cifras se duplican(3)
Observaciones experimentales.
2. El sexo es irrelevante en la determinacion de la
mecanostasis de la calidad osea humana. Iguales
leyes mecanostaticas para determinar su resistencia a
la deformación y la fractura
1. La fuerza muscular regional es el principal
determinante de la calidad osea. (Los huesos son
lo que los músculos quieren que sean).
INTERACCION MECANICO - ENDOCRINA
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
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
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
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
Ferretti, Capozza, Cointry; 2002
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.
Osteoporo Int (2005) 16; 2095-2106
Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti
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
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
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
ANCOVA:
Slopes: n.s.
Ordinates: n.s.
ANCOVA:
Slopes: p<0.001
CMO-vs-MM RELATIONSHIP WHOLE BODY
Pre-MP Post-MP
Normal reference
r= 0.535, p< 0.0001
Type-I Fx
r= 0.446, p< 0.0001
Type-II Fx
r= 0.595, p< 0.0001
Normal reference
r= 0.521, p< 0.0001
Type-I Fx
r= 0.571, p< 0.0001
Type-II FxI
r= 0.528, p< 0.0001
Lean mass (LM), kg Lean mass (LM), kg
BM
C , k
g
• 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
Factores de riesgo para la osteoporósis
Establecidas Probables
Mujeres blancas o asiáticas Baja relación peso/altura
Edad avanzada Antecedentes positivos
Menopausia temprana de osteoporósis en la familia
Ooforectomía premenopáusica Alto consumo de alcohol
Amenorrea premenopáusica Bajo consumo de calcio
Uso crónico de corticoides Habito de fumar
Reposo prolongado en cama Alto consumo proteínas/fosfatos
Alto consumo de cafeína
Barranquilla, Punta Roca 2005
GRACIAS
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.
Osteoporo Int (2005) 16; 2095-2106
Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti
2. Liberacion de factores locales de interacción célula-
célula que determinan las respuestas modeladoras o
remodeladoras.
1. La carga sobre el hueso induce deformacion la cual
es sensada y analizada por los osteocitos y células de
revestimiento.
3. Con estos mecanismos se modifican la calidad o la
distribución espacial del material oseo (arquitectura),
determinantes de la calidad mecánica (rigidez) del
hueso.
Mecanostato oseo
(sistema de homeostasis)
INTERACCION MECANICO - ENDOCRINA
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.
Osteoporo Int (2005) 16; 2095-2106
Carlos Cure, Ricardo Capozza, Gustavo Cointry, Margarita Meta, Pablo Cure, Jose Ferretti
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
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
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
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
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
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
Rigidez
osea
•Remodelado Calidad
del
material
Arquitectura •Modelado Resistencia a
la
deformación
Revisión
periodica
Mecanismos
adaptatorios
de la forma y
tamaño de
los huesos
CALIDAD OSEA
MÉTODO PROPIEDAD EVALUADA
En cuerpos Calidad del Calidad Resistencia
vertebrales Masa ósea material arquitectura Mecánica
DEXA +++ - - ++
QCT ++++ ++ - +++
En huesos
largos
DEXA ++++ - - +
QUS ++ +++ - ++
pQCT +++ ++ ++++ +++
