Globally, one in 11 adults has diabetes mellitus of which 90% have type 2 diabetes. The numbers for osteoporosis are no less staggering: 1 in 3 women has a fracture after menopause, and the same is true for 1 in 5 men after the age of 50 years. Aging is associated with several physiological changes that cause insulin resistance and impaired insulin secretion, which in turn lead to hyperglycemia. The negative balance between bone resorption and formation is a natural process that appears after the fourth decade of life and lasts for the following decades, eroding the bone structure and increasing the risk of fractures. Not incidentally, it has been acknowledged that diabetes mellitus, regardless of whether type 1 or 2, is associated with an increased risk of fracture. The nuances that differentiate bone damage in the two main forms of diabetes are part of the intrinsic heterogeneity of diabetes, which is enhanced when associated with a condition as complex as osteoporosis. This narrative review addresses the main parameters related to the increased risk of fractures in individuals with diabetes, and the mutual factors affecting the treatment of diabetes mellitus and osteoporosis. Arch

A relevância e a abordagem consistente dos temas reunidos no Guia Prático em Osteometabolismo asseguraram a publicação dessa nova edição. Preparada pelos membros do Departamento de Metabolismo Ósseo e Mineral da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) e por seus colaboradores, oferece uma visão ainda mais detalhada sobre condições enfrentadas diariamente por clínicos e especialistas, como diabetes mellitus, osteoporose, hipertireoidismo e hipoparatireoidismo. Com isso, o guia mantém a sua condição como material de consulta e referência para profissionais da Endocrinologia e áreas relacionadas.

The occurrence of fractures in young individuals is frequently overlooked by physicians, especially when associated with exercise or trauma. Nevertheless, multiple fractures should always be investigated since underlying conditions can predispose to such events. We describe here the case of a young, healthy woman who sustained multiple fractures in the lower limbs, which were initially considered to be "stress fractures" . Further investigation, including a panel of genes associated with osteogenesis imperfecta, revealed that the patient is a heterozygous carrier of a SERPINF1 variant. According to criteria recommended by the American College of Medical Genetics and Genomics and the Association for Molecular Pathology, this variant is classified as likely benign (PM2, PP3, PP4, BP1, and BP4). The patient's mother and brother were also asymptomatic carriers of the variant and had sustained previous minor fractures. The patient had normal biochemical profile and bone density. This condition has been rarely described and is not associated with low bone mineral density or altered bone turnover markers. This case highlights the importance of investigating multiple fractures in young patients who are otherwise healthy since these may be a warning sign of rare genetic conditions associated with fragility fractures.

Rev Bras Ginecol Obstet 2017;39:585-586. Vitamin D is included, along with thyroid and steroid hormones, within the unique category of endocrine molecules that act through nuclear receptors. Differently from its partners, until recently vitamin D was thought to be a specialized hormone with an action limited to the control of mineral and bone metabolism. 1 The misconception has been recently reviewed after the recognition that the vitamin D receptor (VDR) as well as the cell machinery to synthesize the active hormone 1,25(OH) 2 D are largely distributed among most tissues and cells. Therefore, vitamin D can potentially modulate an ample diversity of systems and functions, including the cardiovascular system, energy metabolism, immune modulation and cell proliferation. 2 The new knowledge reinvigorated the interest to unveil the ideal levels of vitamin D to obtain osteomineral, as well as non-mineral health.The biochemical measurement of 25-hydroxivitamin D (25-OHD) is considered the best surrogate parameter to assess the status of vitamin D sufficiency. Until 2010, the cut-off point for 25-OHD serum levels was set at 15 ng/mL, and it was an uncommon laboratory parameter, seldom requested by a specialist. Since then, a passionate discussion emerged regarding one key point: what are the ideal serum levels of 25-OHD? Some authors have stated that they are the serum levels that are able to promote the intestinal absorption of calcium, stabilize parathyroid (PTH) serum levels and enable porper bone mineralization. However, this point is still a conundrum.In a perfect world, the new knowledge would stimulate clinical investigation through long prospective studies, as well as randomized double-blinded studies to establish the ideal levels of vitamin D. Conversely, a new proposal was made based on previously published studies, most small and observational investigations, and the ideal serum levels of 25-OHD were set at 30 ng/mL. 3 Curiously, most healthy individuals (70%), independently of age, sex and country, do not have 25-OHD serum levels above 30 ng/mL. A different position was held by the Institute of Medicine (IOM), 4 which estimated that 20 ng/mL were the appropriate levels. The passionate debate about vitamin D deficiency went beyond the realm of science and migrated to the lay media, and patients are currently pressuring physicians to know their vitamin D status, with the hope of preventing diseases simply by taking vitamin D supplementation. 5 The discussion about the appropriate levels of vitamin D goes beyond the focus of the present editorial. Recently published and ongoing well-designed studies aiming at evaluating the effect of vitamin D supplementation on the prevention of diseases will give appropriate scientific support to the query about the role of vitamin D on health maintenance. For instance, in a recent study, vitamin D supplementation (3,750 IU versus 600 IU/day during 1 year) did not ameliorate insulin resistance in overweight individuals. 6 Moreover, The Vitamin D Assessment Study, a random...