1. NUEVO ENFOQUE EN EL
DIAGNOTICO DE LA
OSTEOPOROSIS
Carlos Cure Cure MD
Endocrinologia y Nutricion
BIOMELAB Barranquilla 2012

2. 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.”

3. 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)

12. Observaciones experimentales.
1. La fuerza muscular regional es el principal
determinante de la calidad osea. (Los huesos son
lo que los músculos quieren que sean).
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

13. INTERACCION MECANICO - ENDOCRINA

15. 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

16. 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

17. 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

18. 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

19. Ferretti, Capozza, Cointry; 2002

21. 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

22. 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

23. 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

24. 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

25. CMO-vs-MM RELATIONSHIP
WHOLE BODY
Pre-MP Post-MP
BMC , kg
Lean mass (LM), kg Lean mass (LM), kg
Normal reference ANCOVA: Normal reference ANCOVA:
r= 0.535, p< 0.0001 Slopes: n.s. r= 0.521, p< 0.0001 Slopes: p<0.001
Type-I Fx Ordinates: n.s. Type-I Fx
r= 0.446, p< 0.0001 r= 0.571, p< 0.0001
Type-II Fx Type-II FxI
r= 0.595, p< 0.0001 r= 0.528, p< 0.0001

26. • 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

33. 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

42. Barranquilla, Punta Roca 2005

43. GRACIAS

46. 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

47. Mecanostato oseo
(sistema de homeostasis)
1. La carga sobre el hueso induce deformacion la cual
es sensada y analizada por los osteocitos y células de
revestimiento.
2. Liberacion de factores locales de interacción célula-
célula que determinan las respuestas modeladoras o
remodeladoras.
3. Con estos mecanismos se modifican la calidad o la
distribución espacial del material oseo (arquitectura),
determinantes de la calidad mecánica (rigidez) del
hueso.

48. INTERACCION MECANICO - ENDOCRINA

49. 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

50. 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

51. 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

52. 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

54. 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

55. 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

56. 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

58. Calidad Revisión
•Remodelado periodica
Rigidez del
osea material
Mecanismos
Resistencia a Arquitectura adaptatorios
la •Modelado de la forma y
deformación tamaño de
los huesos

59. 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 +++ ++ ++++ +++