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Abstract Introduction: Complex regional pain syndrome (CRPS), also known as Sudeck syndrome, is a chronic painful condition usually affecting the limbs after trauma or surgery. Its presentation is heterogeneous and its physio pathology, diagnosis and treatment remain controversial. The objective of this study was to analyze a group of patients with this rare syndrome, describing in detail the results of the dual energy X-ray absorptiometry (DXA) and the response to bisphosphonate treatment. Method: We retrospectively analyzed 54 patients with CRPS, taking into account their demographic features, inciting events and diagnostic tests. As regards treat ment, we analyzed the results and adverse events of the use of bisphosphonates Results: We found a female predominance (74%), with 55 ± 13 years. The most common inciting event was trauma (59%), followed by surgery. The difference in bone mineral density between the affected limb and the healthy one was 12 to 15%. Forty-four patients were treated with bisphosphonates (pamidronate, iban dronate, zoledronic acid) and showed a clinical im provement, mainly in terms of pain intensity. Only six patients presented with adverse events, like pseudoflu syndrome and acute phase symptoms. Conclusion: In our cohort, lower limbs CRPS pre dominantly affects middle aged women. DXA scans are tests used to quantify bone loss and the response to treatment. The use of bisphosphonates is an interest ing therapeutic option to improve clinical symptoms in most patients. Future prospective randomized studies will be needed to confirm our results.

Resumen Introducción: El síndrome doloroso regional complejo (SDRC), también conocido como síndrome de Sudeck, es una enfermedad dolorosa crónica que generalmente afecta a las extremidades luego de un trauma o cirugía. Su presentación es heterogénea y existen controversias sobre su fisiopatología, adecuado diagnóstico y trata miento. El objetivo de este trabajo es describir un grupo de pacientes con SDRC en miembros inferiores, describi endo los resultados de la densitometría mineral ósea (DMO) y la respuesta al tratamiento con bifosfonatos. Método: Analizamos retrospectivamente 54 pacientes con SDRC, teniendo en cuenta características demográ ficas, factores desencadenantes y estudios diagnósticos. En relación al tratamiento, analizamos los resultados y efectos adversos del uso de bifosfonatos. Resultados: Encontramos un predominio femenino (74%), con una edad de 55 ± 13 años. Los factores des encadenantes más comunes fueron los traumatismos (59%) y la cirugía. La diferencia de densidad mineral ósea entre el miembro comprometido y el sano fue 12 a 15%. En los 44 pacientes fueron tratados con bifosfona tos (pamidronato, ibandronato y ácido zoledrónico), su uso se asoció a mejoría clínica, especialmente del dolor. Seis pacientes tuvieron efectos adversos como sindrome pseudogripal y síntomas de fase aguda. Conclusión: En nuestra población, el SDRC de miem bros inferiores predomina en mujeres de edad media. La DMO es un método que permite cuantificar la pérdida ósea y la respuesta al tratamiento. Los bifosfonatos son una buena opción terapéutica para el control de síntomas. Son necesarios futuros estudios de naturaleza prospectiva y aleatorizada para confirmar nuestros resultados.

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INTRODUCTION: Complex regional pain syndrome (CRPS), also known as Sudeck syndrome, is a chronic painful condition usually affecting the limbs after trauma or surgery. Its presentation is heterogeneous and its physiopathology, diagnosis and treatment remain controversial. The objective of this study was to analyze a group of patients with this rare syndrome, describing in detail the results of the dual energy X-ray absorptiometry (DXA) and the response to bisphosphonate treatment. METHOD: We retrospectively analyzed 54 patients with CRPS, taking into account their demographic features, inciting events and diagnostic tests. As regards treatment, we analyzed the results and adverse events of the use of bisphosphonates Results: We found a female predominance (74%), with 55 ± 13 years. The most common inciting event was trauma (59%), followed by surgery. The difference in bone mineral density between the affected limb and the healthy one was 12 to 15%. Forty-four patients were treated with bisphosphonates (pamidronate, ibandronate, zoledronic acid) and showed a clinical improvement, mainly in terms of pain intensity. Only six patients presented with adverse events, like pseudoflu syndrome and acute phase symptoms. CONCLUSION: In our cohort, lower limbs CRPS predominantly affects middle aged women. DXA scans are tests used to quantify bone loss and the response to treatment. The use of bisphosphonates is an interesting therapeutic option to improve clinical symptoms in most patients. Future prospective randomized studies will be needed to confirm our results.

Introducción: El síndrome doloroso regional complejo (SDRC), también conocido como síndrome de Sudeck, es una enfermedad dolorosa crónica que generalmente afecta a las extremidades luego de un trauma o cirugía. Su presentación es heterogénea y existen controversias sobre su fisiopatología, adecuado diagnóstico y tratamiento. El objetivo de este trabajo es describir un grupo de pacientes con SDRC en miembros inferiores, describiendo los resultados de la densitometría mineral ósea (DMO) y la respuesta al tratamiento con bifosfonatos. Método: Analizamos retrospectivamente 54 pacientes con SDRC, teniendo en cuenta características demográficas, factores desencadenantes y estudios diagnósticos. En relación al tratamiento, analizamos los resultados y efectos adversos del uso de bifosfonatos. Resultados: Encontramos un predominio femenino (74%), con una edad de 55 ± 13 años. Los factores desencadenantes más comunes fueron los traumatismos (59%) y la cirugía. La diferencia de densidad mineral ósea entre el miembro comprometido y el sano fue 12 a 15%. En los 44 pacientes fueron tratados con bifosfonatos (pamidronato, ibandronato y ácido zoledrónico), su uso se asoció a mejoría clínica, especialmente del dolor. Seis pacientes tuvieron efectos adversos como sindrome pseudogripal y síntomas de fase aguda. Conclusión: En nuestra población, el SDRC de miembros inferiores predomina en mujeres de edad media. La DMO es un método que permite cuantificar la pérdida ósea y la respuesta al tratamiento. Los bifosfonatos son una buena opción terapéutica para el control de síntomas. Son necesarios futuros estudios de naturaleza prospectiva y aleatorizada para confirmar nuestros resultados.

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Existe discrepancia en la elección de las áreas esqueléticas a evaluar para determinar la prevalencia de osteoporosis (OP). La International Society for Clinical Densitometry sugiere evaluar la columna lumbar (CL) y el fémur proximal (FT), mientras que la International Osteoporosis Foundation (IOF) sugiere medir solo el cuello femoral (CF). La estimación de la prevalencia de OP evaluada solo por CF en mujeres mayores de 50 años de Buenos Aires mostró un sub-diagnóstico del 53%. Objetivo: analizar la discrepancia en la prevalencia de OP, según el área esquelética evaluada por DXA, en los estudios internacionales disponibles. Materiales y Métodos: Se incluyeron los trabajos publicados en la literatura internacional, en idioma inglés que contenían: 1. Medición simultánea de CL y CF. 2. Análisis por décadas a partir de los 50 años y hasta por lo menos la década 70-79. 3. Diagnóstico densitométrico de osteoporosis con el criterio de la OMS: T-score ≤-2.5. Resultados: fueron incluidos doce estudios. La evaluación de estos estudios arrojó un sub-diagnóstico global del 52 % si la prevalencia de OP fuera estimada solo por la densidad mineral ósea (DMO) de CF. Cuando analizamos por décadas la sub-estimación fue del 75% en la 6a década, 58% en la 7a década y del 22% en 8a década, mostrando claramente que el subdiagnóstico disminuye a medida que aumenta la edad y desaparece después de los 80 años. Conclusión: Estos resultados señalan que la prevalencia de OP debe ser determinada a través de la evaluación de la DMO de ambas áreas esqueléticas: CL y CF. (AU)

There is discrepancy in the election of skeletal areas to be measured to determine the prevalence of osteoporosis.The International Society for Clinical Densitometry suggests evaluating the lumbar spine and proximal femur, while the International Osteoporosis Foundation (IOF) suggests measuring only the femoral neck.The estimate of the prevalence of osteoporosis (OP) evaluated only for femoral neck (FN) in women over 50 years of Buenos Aires showed underdiagnosis of 53%. Objective: To analyze the discrepancy on the prevalence of OP, according to the skeletal area evaluated by DXA, in international studies. Material and Methods: We included the works published in the international English literature that contained: 1- Simultaneous measurement of lumbar spine (LS) and femoral neck (FN). 2- Analysis for decades from 50 years and up to at least the decade 70-79. 3- Densitometric diagnosis of osteoporosis according to WHO: T-score ≤-2.5. Results: Twelve studies were included. The evaluation of these studies showed an overall underdiagnosis of 52% if the prevalence of OP was estimated only for bone mineral density of the femoral neck.When we analyzed for decades the underestimation was 75% in the sixth decade, 58% in the seventh and 22% in the eighth decade, clearly showing that the underdiagnosis decreases as age increases and disappears after 80 years. Conclusion: This over-all review of 12 studies indicates that lumbar spine as well as femoral neck should be assessed by DXA to determine the prevalence of osteoporosis. (AU)

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OBJECTIVES: The etiology of osteoporosis in asthma is complex as various factors contribute to its pathogenesis. The purpose of our study was to investigate the effects of obesity and inhaled steroids, as well as the severity and duration of asthma, on osteoporosis in postmenopausal asthma patients as compared to healthy controls. METHODS: A total of 46 patients with asthma and 60 healthy female controls, all postmenopausal, were enrolled in our study. Bone mineral density was assessed at the lumbar spine and hip using a Lunar DPX-L densitometer. RESULTS: Bone mineral density (BMD) scores were comparable between the asthmatic and control groups, with average scores of 0.95 ± 0.29 and 0.88 ± 0.14 g/cm², respectively. Likewise, osteoporosis was diagnosed in a similar percentage of patients in the asthmatic (39.1 percent) and control (43.3 percent) groups. Bone fracture was identified in four patients with asthma (8.6 percent) and in six patients from the control group (10 percent). We could not detect any relationship between BMD and duration of asthma, asthma severity, inhaled steroids or body mass index (BMI). There was no difference between the two groups with respect to age or years since menopause. Although asthma patients were more likely to be overweight and presented higher BMD scores on average than the control subjects, these differences were not statistically significant. CONCLUSIONS: There is a slight positive protective effect of high BMI against osteoporosis in asthma patients, but this effect is overcome by time and menopause status. Therefore, the protective effect of obesity against osteoporosis in asthma patients seems to not be significant.

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Objetivo: Verificar a relação da influência do nível de densitometria mineral óssea (DOM) na perda óssea alveolar e parâmetros clínicos periodontais em mulheres na pósmenopausa. Métodos: Em um estudo seccional, foram avaliadas 23 mulheres na menopausa, com idade variando de 44-61 anos de idade. Densitometria óssea mineral da coluna lombar e do fêmur foram obtidas pela técnica DEXA. Foram incluídos exame clínico (profundidade a sondagem, perda de inserção, profundidade a sondagem e o número de ausência dental) e radiográfico para determinar a gravidade da doença periodontal. Os dados foram comparados pelo teste t Student e correlacionados pelo teste de Pearson (r). Resultados: Das 23 mulheres, duas eram osteoporóticas, 14 osteopênicas e 7 em condi- ção de normalidade. Para as comparações dos parâmetros clínicos periodontais com o perfil da DOM não foram encontradas diferenças significativas em nenhuma das análises. O coeficiente de correlação de Pearson foi fraco e negativo quando comparada a DOM com os parâmetros periodontais. Conclusão: No presente estudo não foi encontrada uma associação entre as modificações estruturais ósseas com os parâmetros periodontais (AU)

Objective: To correlate levels of bone mineral densitometry (BMD) and periodontal clinical parameters, including radiographic alveolar bone loss in postmenopausal women. Methods: This cross-sectional study included 23 postmenopausal women. Their ages ranged from 44 to 61 years-old. BMD of the lumbar vertebra and femur were obtained through the DEXA technique. Periodontal clinical examination (probing depth, clinical attachment level and number of missing teeth) and periapical radiographs were obtained to determine the severity of periodontal disease. The data obtained was analyzed using both student t test and Pearson correlation. Results: BMD revealed that 2 participants were osteoporotic, 14 were osteopenic, and 7 were healthy. Comparisons between periodontal clinical and radiographic parameters and BMD profile, among the distinct groups, showed no statistically significant differences. The coefficient for Pearson correlation was weak and negative when comparing BMD with all periodontal parameters. Conclusion: This study showed no association between bone structural modifications and clinical and radiographic periodontal parameters (AU)

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En la actualidad la osteoporosis se considera solamente como un riesgo de fractura y por lo tanto se debe analizar en compañía de otros riesgos para decidir la conveniencia del tratamiento. Es más importante considerar la calidad ósea que confiere la resistencia, en la que la densidad ósea es uno de los varios componentes junto con la microarquitectura, la matriz y el recambio óseo. El tratamiento de la osteoporosis se hace en forma individual, considerando la edad y el antecedente de fractura, para así seleccionar varios recursos que se pueden agrupar en antiresortivos y anabólicos. Entre los primeros están los estrógenos, los bisfosfonatos y los moduladores selectivos del receptor de estrógenos como los principales; los anabólicos aún se encuentran en estudio y el más adelantado es la parathormona sintética. La administración de calcio y vitamina D no es suficiente para el tratamiento de la osteoporosis. El principal problema del tratamiento, que ha provocado una baja adherencia es el costo de los medicamentos y la falta de información sobre la necesidad de que el tratamiento sea a muy largo plazo.

Osteoporosis has to be considered only as a risk factor for bone fractures and its measurement by the bone mass index has some limitations. The aim of treatment of osteoporosis is to reduce the frequency of fractures (especially at the vertebral and the hip) which are responsible for morbidity and mortality with the osteoporosis. It has been demonstrated that antiresorptive drugs (bisphosphonates, estrogens, raloxifen) as well as anabolic agents (synthetic parathormone) are useful for preventing fractures. Calcium and vitamin D supplementation is not sufficient to treat persons with osteoporosis. Choice of treatment depends of age, the presence or absence of prevalent fractures, and the degree of bone mineral density measured at the spine and hip. The main inconvenient for the adherence of treatment is the high cost of the medicaments and agents as well as the poor information given to the patients.

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