Several factors are involved in determining bone quality including bone density, bone turnover, the extent of trabecular bone connectivity, cortical porosity and geometry. Metabolically active and in a continuous process of remodeling, approximately 20% of bone tissue is renewed annually. Bone turn over markers (BTM) are frequently used in clinical trials and to provide valid information about the effectiveness of osteoporosis treatment, reflecting the state of bone metabolism and its response to treatment, although they are not useful alone to estimate bone loss. In this review the behavior of BTM from different clinical trials or different osteoporotic drugs will be addressed. Arq Bras Endocrinol Metab. 2014;58(5):504-13 Keywords Bone markers; osteoporosis; bone density ReSumoDiversos fatores estão envolvidos na determinação da qualidade óssea, incluindo a densidade óssea, a remodelação óssea, a extensão da conectividade do osso trabecular, porosidade cortical e geometria. Metabolicamente ativo e, em um processo contínuo de remodelação, cerca de 20% do tecido ósseo é renovado anualmente. Por sua vez, marcadores de turnover ósseo (BTM) são frequentemente utilizados em estudos clínicos e fornecem informações válidas sobre a eficácia do tratamento da osteoporose, o que reflete o metabolismo ósseo e sua resposta ao tratamento, embora eles não sejam úteis somente para estimar a perda óssea. Nesta revisão, o comportamento dos BTM em ensaios clínicos diferentes e com diferentes drogas osteoporóticas será abordado. one is a specific type of tissue composed primarily of type I collagen impregnated with minerals in the form of hydroxyapatite crystals. Several factors are involved in determining bone quality including bone density, bone turnover, the extent of trabecular bone connectivity, cortical porosity and geometry (Figure 1) (1). Metabolically active and in a continuous process of remodeling, approximately 20% of bone tissue is renewed annually (2). This complex process begins at birth and is maintained throughout life. The active cellular participants in this process, often configured as multiple multicellular units, are osteoclasts, osteoblasts and osteocytes.The system is highly regulated by many factors. For example, osteoprotegerin (OPG) (osteoprotegerin), receptor activator of NF-kappaB (RANK) and its cognate ligand, (RANKL), form a metabolic regulatory system focused upon bone resorption (3). Additionally there are other factors that influence bone turnover, such as parathyroid hormone (PTH), 1,25-dihydroxyvitamin D (calcitriol), prostaglandin E2 and interleukins (4). The process of bone turnover leads to the release of factors that give highly relevant information on rates of bone formation and resorption (Figure 2).

SUMMARYNormocalcemic primary hyperparathyroidism (NPHPT) is a condition characterized by elevation of the parathyroid hormone (PTH) in the presence of normal serum calcium and the absence of secondary causes. The case described illustrates the long-term follow-up of a postmenopausal woman with NPHPT patient who progressed with multiple adenomas. This case reports a 77-year-old female who has chronic generalized pain and osteoporosis. Her initial serum PTH was 105 pg/mL, with total serum calcium of 9.6 mg/dL, albumin 4.79 g/dL, phosphorus 2.8 mg/dL, and 25OHD after supplementation was 34.6 ng/mL. The bone densitometry (BMD) results were as follows: lumbar spine: T-score -3.0, femoral neck: T-score -2.6 and distal radius: -4.2. Other causes of secondary hyperparathyroidism were ruled out and cervical ultrasound and Tc-99-Sestamibi scan were negative. She used oral alendronate and three infusions of zoledronic acid for treatment of osteoporosis. In the 10 th year of follow-up, after successive negative cervical imaging, ultrasound showed a nodule suggestive of an enlarged right inferior parathyroid gland. PTH levels in fluid which was obtained during fine-needle aspiration (FNA) were over 5,000 pg/mL and a Sestamibi scan was negative. The patient underwent parathyroidectomy, and a histological examination confirmed parathyroid adenoma. Post-operatively serum PTH remained elevated in the presence of normal serum calcium levels. A follow-up cervical ultrasound showed a new solid nodule suggestive of an enlarged right superior parathyroid gland. PTH levels in the aspiration fluid were remarkably high. A second parathyroidectomy was performed, with the excision of a histologically confirmed parathyroid adenoma. In conclusion, this is an unusual presentation of NPHPT and highlights the long-term complications. Arq Bras Endocrinol Metab. 2014;58(5):583-6 SUMáRioHiperparatiroidismo primário normocalcêmico (NPHPT) caracteriza-se pela elevação do hormô-nio da paratiroide (PTH), na ausência da elevação dos níveis séricos de cálcio e exclusão de causas secundárias. O caso descrito ilustra o seguimento de uma mulher na pós-menopausa com NPHPT que evoluiu com múltiplos adenomas. Este caso relata uma paciente de 77 anos de idade que tem dor generalizada crônica e osteoporose. O PTH inicial foi elevado com níveis séricos de cálcio, albumina, fósforo e 25OH vitamina D normais. A densitometria óssea (DMO) evidenciou um T-SCORE da coluna lombar: -3.0, colo do fêmur: -2.6 e rádio distal: -4.2. Outras causas de hiperparatireoidismo secundário foram descartadas e a ultrassonografia cervical e varredura com Sestamibi foram negativos. Fez uso de alendronato e três infusões de ácido zoledrônico para o tratamento da osteoporose. No décimo ano de seguimento, depois de sucessivas imagens negativas, a ultrassonografia evidenciou um nódulo sugestivo de adenoma de paratireoide inferior direita. A paciente foi submetida à paratireoidectomia, e um exame histológico confirmou a hipótese. A elevação dos níveis séricos de PTH no pós-operatório se ma...

Diabetes mellitus (DM) is a metabolic disease defined by hyperglycemia, which is associated with periodontal disease and exerts an effect on bone metabolism. The aim of this study was to determine serum levels of sclerostin in postmenopausal women with diabetes and determine a possible association with periodontal disease. Sixty-one postmenopausal women (32 with diabetes and 29 without diabetes) were evaluated. Blood was collected for biochemical analysis and the determination of serum sclerostin. The participants were also submitted to a clinical examination for the evaluation of periodontal status. A total of 75.4% of the volunteers had periodontal disease and levels serum sclerostin were altered in 48.7% of the patients with diabetes. In the diabetic population, mean levels of LDL (p = 0.035) and urea (p = 0.032) were higher in the patients without periodontal disease and the plaque index was higher in those with periodontal disease (p = 0.039). The prevalence of periodontal disease and the levels serum sclerostin were high in the postmenopausal women analyzed, but the data do not allow the determination of whether periodontal disease is related to high levels of this peptide.

Backgound: Sclerostin (SCL), produced mainly by osteocytes, inhibits the Wnt pathway and bone formation, and may be influenced by skeletal muscle mass. Objective: To evaluate serum sclerostin levels, body composition and physical function in postmenopausal women (PMW) with T2DM. Methods: We studied 250 PMW (125 with T2DM and 125 PMW without diabetes) with HbA1c below 10%, estimated GFR above 60 ml/min/1.73m2, and compared body composition analysis by multifrequency-bioelectrical impedance, gait speed (GS) and serum sclerostin with metabolic parameters. Results: Although there were no differences between cases and controls regarding age and years since menopause (62.9±8.3 vs. 61.8±7.5 years, p=0.11; 14.3 ± 12.1 vs. 12.1±8.2 years, p=0.12, respectively), high circulating SCL and sarcopenia (low GS and fat free mass index) were found in 76% / 89.6% of T2DM vs. 61.6% / 72.8% of controls; p=0.014 and p=0.001, respectively. T2DM had more adiposity than controls: BMI 31.0± 29.5 vs. 29.4±29 kg/m2, p=0.04; WC 102.2±12.8 vs. 95.5±11.6 cm, p<0.001; fat mass 29.3±7.6 vs. 26.7±7.1% body weight, p=0.008; and serum triglycerides 153.8±74 vs. 128.3±50.0 mg/dl, p=0.004. Conclusion: Serum sclerostin is high in PMW with T2DM, as well as the presence of sarcopenia. Since SCL is also involved in vascular endothelial remodeling and inflammation, adiposopathy may also be related to high SCL in T2DM. Disclosure F. Bandeira: Consultant; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Boehringer Ingelheim Pharmaceuticals, Inc.. Consultant; Self; Novo Nordisk Inc.. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Sanofi. C.D. Chaves: None. M. Bandeira Farias: None. L.B. Pimentel: None. L. Farias: None.

The use of antipsychotics (AP) is associated with the development of metabolic disorders, such as diabetic ketoacidosis (DKA) and acute dysregulation of glucose metabolism. Hyperglycemic complications from drug use, although rare, are potentially life-threatening, so appropriate follow-up and risk assessment during treatment are necessary. This study reports the case of a patient with bipolar affective disorder using olanzapine who developed severe DKA and reviews the current literature on this association. The research was done in PubMed, Cochrane Database, Scopus, Web of Science, Embase, and Google Scholar databases using the keywords: diabetes mellitus, diabetic ketoacidosis, psychotic disorders, antipsychotics, olanzapine, adverse drug event. Upon analysis of the included epidemiological studies, it was observed that most patients who developed DKA were undergoing treatment with olanzapine and clozapine alone or in combination with other antipsychotics. It was seen that the DKA picture usually occurs between six to twelve months of AP use, similar to the case presented. Before insulin resistance, male gender, and middle age favor the disorder in AP users.