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Barros-Sevillano S, Espinoza-Martinez D, Rubio-Zavaleta L. What is known about osteoporosis research in Latin America?: A bibliometric analysis of three decades. Medicine (Baltimore) 2023; 102:e36103. [PMID: 38050309 PMCID: PMC10695571 DOI: 10.1097/md.0000000000036103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/23/2023] [Indexed: 12/06/2023] Open
Abstract
Identifying the gaps in scientific production in a topic allows directing research in order to make better public investment decisions. Bibliometric data on osteoporosis in Latin America are very limited and unclear and, given the impact of this disease in this region, it is relevant to analyze the latest trends in the subject. The study approach was quantitative, observational-descriptive, cross-sectional. Data were collected from journals indexed in Scopus between 1990 and 2019, using a search strategy that included Medical Subject Headings terms for "Osteoporosis" and other related terms, as well as VOSviewer software to create cooperative and co-occurrence word maps. 3261 documents were analyzed, with an annual scientific production rate of 5% (163 documents), where 73.9% were original articles. The countries with the highest scientific production in osteoporosis were Brazil (55.2%) and Argentina (18%). Extra-regional cooperation was mainly with the United States (16.35%) and Spain (5.18%). Six of the 10 most productive countries had their own government agencies as the main funders. The National Council for Scientific and Technological Development was the institution that funded the most (n = 194). The term "osteoporosis" together with the terms "bone mineral density," "fractures," and "menopause" were the most frequently addressed subjects. Latin American scientific production in osteoporosis has shown a significant increase. However, in the last 3 years it has shown a slight reduction. Greater intraregional collaboration involving universities, institutions and health societies is needed.
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Affiliation(s)
- Shamir Barros-Sevillano
- Facultad de Ciencias de la Salud, Escuela de Medicina, Universidad César Vallejo, Trujillo, Peru
| | - David Espinoza-Martinez
- Facultad de Ciencias de la Salud, Escuela de Medicina, Universidad César Vallejo, Trujillo, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad César Vallejo, Trujillo, Peru
| | - Luis Rubio-Zavaleta
- Facultad de Ciencias de la Salud, Escuela de Medicina, Universidad César Vallejo, Trujillo, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad César Vallejo, Trujillo, Peru
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Perez MO, Pedro PPDA, Lyrio AM, Grizzo FMF, Loures MAADR. Osteoporosis and fracture risk assessment: improving outcomes in postmenopausal women. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e2023S130. [PMID: 37556649 PMCID: PMC10411691 DOI: 10.1590/1806-9282.2023s130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Mariana Ortega Perez
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas, Division of Rheumatology – São Paulo (SP), Brazil
- Instituto de Reumatologia de São Paulo – São Paulo (SP), Brazil
| | | | - André Marun Lyrio
- Pontifícia Universidade Católica de Campinas, Division of Rheumatology – São Paulo (SP), Brazil
| | - Felipe Merchan Ferraz Grizzo
- Universidade Estadual de Maringá, Hospital Universitário Regional de Maringá, Division of Rheumatology – Maringá (PR), Brazil
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Correa RGP, Pivovarsky MLF, da Silva Santos G, Gomes ARS, Borba VZC. Factors that cause women with osteoporosis to fall. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e000578. [PMID: 37252691 PMCID: PMC10665076 DOI: 10.20945/2359-3997000000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/25/2022] [Indexed: 05/31/2023]
Abstract
Objective To analyze and compare intrinsic and extrinsic factors that cause falls among women receiving treatment for osteoporosis. Subjects and methods A cross-sectional study of women ≥50 years receiving treatment for osteoporosis. Participants filled out questionnaires (demographic characteristics), and researchers took anthropometric measurements of bone mineral density, handgrip strength (HGS), ankle range of motion (ROM), and gait speed (GS). We also evaluated the Timed Up and Go Test (TUGT), Five Times Sit-to-Stand Test (SST), and Falls Efficacy Scale-International (FES-I) and investigated the extrinsic factors for falls. Results We included 144 participants (71.6 [8.3 years]), who reported 133 falls. We classified participants into a non-faller group (NFG; 0 falls, n=71, 49.5%), a faller group (FG; 1 fall, n=42, 28.9%), and a recurrent-faller group (RFG; more than 1 fall, n=31, 21.5%). Most patients had an increased risk of falling according to the TUGT, SST, reduced ankle ROM, and GS (P<.005 for all). FES-I was associated with sporadic and recurrent falls. For the multivariate analysis, the number of falls was influenced by the presence of ramps (RR 0.48, 95% CI, 0.26-0.87, P=.015), uneven surfaces (RR 1.6, 95% CI. 1.05-2.43, P=.028), and antislippery adhesive on stairs (RR 2.75, 95% CI, 1.77-4.28, P<.001). Conclusion Patients receiving treatment for osteoporosis are influenced by intrinsic and extrinsic factors that cause falls. Lower-limb strength and power-discriminated participants at a higher risk of falls, but extrinsic factors varied. Only uneven floors and antislippery adhesives on stairs were associated with increased frequency of falls.
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Affiliation(s)
| | | | | | - Anna Raquel Silveira Gomes
- Departamento de Fisioterapia, Programa de Pós-graduação em Educação Física, Universidade Federal do Paraná, Curitiba, PR, Brasil
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Aranha Watanabe PC, Machado LF, Rodrigues GA, Lourenço AG, Bitencourt MA, Zerbato RM. Oblique line contrast: A new radiomorphometric index for assessing bone quality in dental panoramic radiographs. Heliyon 2022; 8:e12266. [PMID: 36582704 PMCID: PMC9792747 DOI: 10.1016/j.heliyon.2022.e12266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/14/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
The present study was carried out to assess the possible changes in mandibular bone density according to age and gender through dental panoramic radiographs (PAN). More specifically, the region of the mandibular oblique line. Materials & methods A group of 374 dental patients previously treated in the Ribeirão Preto Dental School (FORP/USP) was included in the study. The complete dental profiling of all the subjects (including PAN images) was previously available in the archive of the same institution. Those subjects were separated into four groups considering age and gender: Group 1-100 young adult men (21.48 ± 3.34 y. o.), Group 2-100 young adult women (20.66 ± 1.52 y. o.), Group 3-87 postmenopausal women (74.07 ± 9.82 y. o.), and Group 4-87 men over 70 years old (75.92 ± 8.71 y. o.). A new index called "W-index" (WI) was proposed for analyzing the possible difference in mandibular bone density. This new index is the ratio between the average pixel value of the image area of the mandibular ramus (AVMR) and the average pixel value of the image area of the mandibular oblique line (AVOL) (WI = AVMR/AVOL). WI was measured for each subject on each PAN and statistical analysis was performed to search how well WI can characterize each study group. Results The largest difference in WI is observed when we compare older subjects (WI 0.73 ± 0.11) with younger subjects (0.89 ± 0.05). WI also varies significantly with gender but in a smaller amount. Mean WI for old women (0.68 ± 0.11) was found lower than for old men (0.77 ± 0.09), and mean WI for young women (0.89 ± 0.05) was also inferior to young men (0.91 ± 0.05). The differences in WI observed in the subject group were tested for a significance level of α = 0,01. We speculate that WI refers to an aspect of bone mineral density. First, the sharp contrast of the mandibular oblique line may signify the loss of mandibular bone mass. And second, it showed to vary significantly with gender and age, but with higher intensity with age. Clinical significance WI might be used in the future for low bone mineral density risk assessment.
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Affiliation(s)
- Plauto Christopher Aranha Watanabe
- Department of Stomatology, Public Oral Healthy and Forensic Dentistry, Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, Brazil,Corresponding author.
| | - Leonardo Ferreira Machado
- Department of Physics, Faculty of Philosophy Sciences and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Giovani Antonio Rodrigues
- Department of Stomatology, Public Oral Healthy and Forensic Dentistry, Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, Brazil
| | - Alan Grupioni Lourenço
- Department of Basic and Oral Biology, Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, Brazil
| | - Matheus Arazin Bitencourt
- Department of Stomatology, Public Oral Healthy and Forensic Dentistry, Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, Brazil
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Association between Wrist Circumference and Risk of Any Fracture in Adults: Findings from 15 Years of Follow-Up in the Tehran Lipid and Glucose Study. J Clin Med 2022; 11:jcm11237048. [PMID: 36498622 PMCID: PMC9736297 DOI: 10.3390/jcm11237048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022] Open
Abstract
We evaluated whether wrist circumference (WrC), as a novel anthropometric measure, is associated with incidences of any fractures. The study population included 8288 adults (45.3% men) aged ≥30 years, who were followed for incidences of any fractures from 31 January 1999 to 16 March 2016. We used Cox proportional hazard models adjusted for well-known risk factors to evaluate the association of WrC, both as continuous and categorical variables (bottom tertile as reference), with incidences of any fractures and major osteoporotic fractures (MOF). Over 15 years of follow-ups, 348 fractures occurred (men = 162). For a 1 cm increase in WrC, hazard ratios (HRs) were 1.18 (95% CI: 1.03-1.35) for incident any fractures and 1.22 (1.01-1.49) for incident MOF. In addition to WrC, age, female sex, lower BMI, higher WC, current smoking, and usage of steroidal medications were significantly associated with the incidences of any fractures. Moreover, participants in the middle and top tertiles of WrC had a higher risk of incidence for any fractures [HR = 1.62 (1.19-2.20) and 1.70 (1.14-2.55), respectively, p-value for trend = 0.012]. We presented WrC as a strong and independent risk factor for incidences of any fractures that might be considered in the risk prediction of bone fracture in Iranian adults.
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Fernandes-Breitenbach F, Peres-Ueno MJ, Santos LFG, Brito VGB, Castoldi RC, Louzada MJQ, Chaves-Neto AH, Oliveira SHP, Dornelles RCM. Analysis of the femoral neck from rats in the periestropause treated with oxytocin and submitted to strength training. Bone 2022; 162:116452. [PMID: 35654351 DOI: 10.1016/j.bone.2022.116452] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Abstract
Among the interventions used to prevent osteoporosis in female organisms, strength training (ST) and oxytocin (OT) stand out, as a promising hormone with anabolic action on bone. This study aimed to verify whether the combined action of OT and ST, compared to isolated interventions, potentiates the bone remodeling process of the femoral neck of Wistar rats during periestropause. Forty Wistar rats (18 months) with irregular estrous cycle were randomly distributed into groups: 1-Vehicle (Veh; NaCl 0.15 mol/L ip); 2-Oxytocin (Ot; 134 μg/kg/ip); 3-Strength training (St); 4-Ot + St. The animals of the 1, 2 and 4 groups received two intraperitoneal injections with an interval of 12 h every 30 days, totaling 8 injections at the end of the experimental period (18 to 21 months). The animals in the St and Ot + St groups performed ST on a ladder 3 times a week, maximal voluntary carrying capacity (MVCC) test monthly. After 120 days, the animals were euthanized; the femur was collected for analysis of biomechanical testing, densitometry, bone microtomography, Raman spectroscopy, tissue PCR, and blood for analysis of bone biomarkers, liver damage, and oxidative stress. The main effects in the Ot group were observed in the maximum load and energy in the compression testing (femoral head), and stiffness and energy in the three-points bending testing (femur diaphysis). In addition, the main effects occurred on the bone mineral density (BMD), cortical thickness (Ct.Th), number of pores (Po.N), polar moment of inertia (J), trabecular thickness (Tb.Th), and connectivity density (Conn.Dn), Bone alkaline phosphatase (Alp), Tumor necrosis factor receptor superfamily member 11b (Opg), Tumor necrosis factor ligand superfamily member 11 (Rankl) and Cathepsin K (Ctsk) expression. There was an effect in the tartrate-resistant acid phosphatase (TRAP) and alkaline phosphatase (ALP). In the St group, the main effect was observed on the energy (compression and the three-points bending), stiffness, aBMD, BMD, cortical bone area (Ct.Ar), Po.N, trabecular bone volume (BV/TV), Tb.Th and in the mineralization ratio (ѵ1PO4/proline), Runt-related transcription factor 2 (Runx2), Bone morphogenetic protein 2 (Bmp2), Alp, Osteopontin/secreted phosphoprotein 1 (Opn/Spp1), Opg, Tumor necrosis factor receptor superfamily member 11ª (Rank), Rankl, Ctsk expression. There was an effect in the TRAP and ALP. The interaction in the combination of therapies in the Ot + St group was verified in energy to maximum load (compression and three-points bending testing), stiffness, BMD, Ct.Th, J, Tb.Th and ѵ1PO4/proline. In the gene analysis there was interaction in the Runx2, Osterix/Sp7 transcription factor (Osx/Sp7), Bmp2, Alp, Osteocalcin/Bone gamma-carboxyglutamate protein (Ocn/Bglap), Opg, Rankl and Acid phosphatase 5, tartrate resistant (Trap/Acp5) expression. In addition, the combination of OT and ST resulted in a higher maximum load compared to the Veh group, with higher BV/TV than the Ot group, higher Rankl and Ctsk expression than Veh and Ot groups, and lower Po.N and lower activity of TRAP than the other groups. In oxidative stress, total antioxidant capacity (TAC) was lower. These results showed that the combination of interventions is a promising anabolic strategy for the prevention of osteoporosis in the period of periestropause, standing out from the effects of isolated interventions.
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Affiliation(s)
- Fernanda Fernandes-Breitenbach
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, SBFis, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Melise Jacon Peres-Ueno
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, SBFis, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Luís Fernando Gadioli Santos
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, SBFis, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Victor Gustavo Balera Brito
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, SBFis, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Robson Chacon Castoldi
- Postgraduate Program in Movement Sciences, Federal University of Mato Grosso do Sul - UFMS
| | - Mário Jeferson Quirino Louzada
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, SBFis, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Antonio Hernandes Chaves-Neto
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, SBFis, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil; Department of Basic Sciences, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Sandra Helena Penha Oliveira
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, SBFis, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil; Department of Basic Sciences, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Rita Cássia Menegati Dornelles
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, SBFis, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil; Department of Basic Sciences, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil.
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An updated hip fracture incidence rate for Brazil: the Brazilian Validation Osteoporosis Study (BRAVOS). Arch Osteoporos 2022; 17:90. [PMID: 35780201 DOI: 10.1007/s11657-022-01127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/07/2022] [Indexed: 02/03/2023]
Abstract
Hip fracture incidence rates in three representative geographic areas in Brazil over a period of 2 years (2010-2012) were assessed for the first time. Estimated incidence rates varied regionally, and markedly differed from those previously reported. Thus, national guidelines as well as FRAX Brazil should be revised in light of this new data. PURPOSE To determine the annual incidence of hip fractures in individuals aged 50 years and over, living in 3 cities located in different regions of the country. To investigate the age, gender, and regional differences in fracture rates. Based on the obtained data, to estimate the national incidence of hip fractures resulting from osteoporosis, in order to improve prevention strategies. METHODS Retrospective, observational study including all patients aged ≥ 50 years admitted in hospitals because of a hip fracture in three cities (Belem, Joinville, and Vitoria) from representative geographic areas in Brazil from 2010 to 2012. Data were obtained from medical records in those cities. We analyzed incidence rates (crude and age- and gender-standardized rates) for hip fractures. RESULTS There were 1025 (310 in men and 715 in women) hip fractures in the over 50-year-old merged population from the three cities. The crude incidence rate for hip fracture was 103.3/100,000 (95% confidence interval [CI = 97.0; 109.7), in men 77.4/100,000 (95% CI = 68.8; 86.0), and in women 125.2/100,000 (95% CI = 116.0; 134.4). Incidence standardized for age and gender was 105.9 cases per 100,000 persons per year (95% CI = 99.4; 112.4); 78.5 cases per 100,000 (95% CI = 69.8; 87.3) in men and 130.6 cases 100,000 in women (95% CI = 121.0, 140.2) per year. Belem, located in the equatorial region (latitude 1° 27' S), had significantly lower crude and age-adjusted incidence than Joinville (latitude 26° 18' S) and Vitoria (latitude 20° 19' S), which were no different from each other. The incidence of fractures increased exponentially with age, and women had about twice the risk of fractures than men. CONCLUSIONS Hip fracture mainly affects elderly women and presents great variability in incidence between the different regions in Brazil. The incidence of hip fractures in Brazil differed markedly from that reported previously, so that national guidelines and the FRAX model for Brazil should be revised.
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Rojas LGP, Cervantes REL, Almejo LL, Pesciallo CA, Garabano G, Bidolegui F, Giordano V, Belangero WD, Hungria JOS, Triana Q MA, Gómez A. Fragility fracture systems, Latin America perspective. OTA Int 2022; 5:e178. [PMID: 35949494 PMCID: PMC9359007 DOI: 10.1097/oi9.0000000000000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/07/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022]
Abstract
Osteoporosis is a worldwide epidemic, affecting an average of 30% to 50% of those over 50 years of age in Latin America. Resulting from it is another epidemic, that of fragility fractures, which adversely affects morbidity and mortality of this population. Increasing in their incidence, fragility fractures are expected to occur in 1 in 3 women and 1 in 5 men over 50years of age during their lifetimes. Currently, there are diagnostic and management guidelines for fragility fractures in Latin American countries, especially those for hip and spine fractures. In general, in Latin America, the quality indicators and standards for the care of these fractures vary greatly according to the health system, being suboptimal in many situations. The organization of health services is different in the different countries throughout Latin America. Common underlying characteristics, however, include the distinctions that exist in care between public and private medicine and the lack of economic resources directed to public healthcare systems from the national levels. Several important changes have been implemented in recent years, with the collaboration between national organizations and international associations such as the Fragility Fracture Network and the International Osteoporosis Foundation, aimed at improving quality standards in care and rates of morbidity and mortality in patients treated thorough fragility fracture programs. The underregistration in these programs and absence of formal national registries also contribute to a lack of recognition of the size, scope, and severity of the problem.
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Affiliation(s)
| | | | | | | | | | | | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro-Hospital Municipal Miguel Couto
- Clínica São Vicente, Rio de Janeiro
| | - William Dias Belangero
- Departamento de Ortopedia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas
| | | | - Miguel Alvaro Triana Q
- Servicio de Ortopedia Fundación Cardioinfantil, Hospital Infantil de San Jose, Universidad del Bosque, Fundacion Universitaria de Ciencias de la Salud, Universidad del Rosario
| | - Amparo Gómez
- Servicio Ortopedia Hospital Universitario de la Samaritana, Bogota, Colombia
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Decreasing hip fracture rates among older adults in Chile, 2001-2019. Arch Osteoporos 2022; 17:26. [PMID: 35091883 DOI: 10.1007/s11657-022-01067-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/20/2022] [Indexed: 02/03/2023]
Abstract
Our aim was to analyze trends in hip fracture rates in people aged ≥ 65 years, from 2001 to 2019 in Chile. Age-standardized incidence rates decreased significantly in both genders over the study period. PURPOSE To describe and analyze the characteristics and trends of osteoporotic hip fractures in Chile from 2001 to 2019, by age and sex. METHODS We assessed hip fractures in people aged ≥ 65 years using data from the hospital discharge register of Chile's Department of Statistics and Health. The Joinpoint regression analysis software was used to perform a trend analysis. RESULTS From 2001 to 2019, a total of 107.972 patients aged ≥ 65 years were hospitalized in Chile with a diagnosis of hip fracture (S72.0, S72.1, and S72.2). 77.4% of the patients were females, and 63.7% were adults aged ≥ 80 years. The average annual incidence rate over this period was 358.3/100.000 in the whole population (95% CI: ± 12.8), 195.2/100.000 in men (95% CI: ± 9), and 482/100.000 in women (95% CI: ± 15.5). After an adjustment for age, hip fracture rates decreased annually on average by 1.0% (p < 0.001, 95% CI: - 1.4%, - 0.7%), from 358.5/100.000 in 2001 to 331.7/100.000 in 2019. Hip fracture rates decreased annually in both men (- 1.4%, p < 0.001) and women (- 0.9%, p < 0.001). CONCLUSION The incidence of osteoporotic hip fractures has been decreasing annually and significantly in Chile since 2001, both in men and women. This may be caused by increased levels of obesity and a lower risk of falling among older adults. We recommend further studies to assess all factors contributing to this change in hip fracture rates.
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Dixit V, Tripathi RL, Dhanwal DK. Lack of secondary hyperparathyroidism in sub-group of vitamin D deficient postmenopausal women: Is VDR gene polymorphism behind this mystery? Diabetes Metab Syndr 2022; 16:102381. [PMID: 34995987 DOI: 10.1016/j.dsx.2021.102381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS We aimed to determine the cause of non-secondary hyperparathyroidism (Non-SHPT) in Indian postmenopausal women. MATERIALS & METHODS 334 apparently healthy postmenopausal women were assessed for bone mineral homeostaisis including Vitamin D, PTH and VDR polymorphism. RESULTS 83% of the subjects had vitamin D deficiency further associated with VDR gene polymorphism (P 0.000). A sizable number of subjects (N = 83) did evoke SHPT despite low vitamin D levels. We observe that VDR gene polymorphism was strongly associated in the sub-group of non-SHPT. CONCLUSION lack of SHPT warrants researchers to study the pathophysiology of non-SHPT in detail to substantiate our findings.
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Affiliation(s)
- Vivek Dixit
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
| | - R L Tripathi
- Department of Biochemistry, UCMS & GTB Hospitals, Delhi, India
| | - Dinesh Kumar Dhanwal
- Sr. Consultant Endocrinologist, NMC Super-speciality Hospitals, Abu Dhabi, United Arab Emirates
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Copês RM, Comim FV, Barrios NS, Premaor MO. Incidence of fractures in women in the post-menopause: a cohort study in primary care in southern Brazil. Arch Osteoporos 2021; 16:126. [PMID: 34490540 DOI: 10.1007/s11657-021-00972-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/14/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED The incidences of total fracture, major fracture, and hip fractures in primary care in Southern Brazil were 22.3, 15.0, and 3.3 per 1000 person/year. The FRAX algorithm showed an adequate discriminatory capacity for the identification of these fractures. OBEJECTIVE Few studies are evaluating the incidence of fractures in Latin America and Brazil. This study aimed to estimate the incidence of bone fractures in postmenopausal women seen in primary care and evaluate the FRAX algorithm's performance in these women. METHODS A cohort study was carried out in the municipality of Santa Maria, Southern Brazil. Postmenopausal women aged 55 years and over who attended primary health care were included. The recruitment period was from March 1 to August 31, 2013, and the participants were followed for 5 years. The fracture risk was calculated using the FRAX algorithm. The reported incident fractures were confirmed by imaging studies or surgical reports. RESULTS Of the 1057 women recruited for the study, 854 were followed. They contributed to 2732 person/year. The mean follow-up time was 3.2 years (SD 1.05). The incidences of total fractures, major fractures, and hip fractures were 22.3, 15.0, and 3.3 per 1000 person/year. The most frequent fracture sites were the wrist, shoulder, and ribs. The fracture predictors were rheumatoid arthritis, previous fracture, and the use of glucocorticoids. The discriminatory capacity of incident fractures calculated by FRAX without the inclusion of BMD was AUC 0.730 (95% CI 0.570, 0.890) for hip fracture and AUC 0.691 (95% CI 0.598, 0.784) for major fractures. CONCLUSION The FRAX algorithm showed an adequate discriminatory capacity to identify incident fractures in primary care in our study. The incidence of fractures found in our study appears to be lower than that reported in North America and Europe.
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Affiliation(s)
| | - Fabio Vasconcellos Comim
- Department of Clinical Medicine, Medical School, Federal University of Minas Gerais (UFMG), Avenida Professor Alfredo Balena, 190 - sala 246, Belo Horizonte, MG, Brazil
| | | | - Melissa Orlandin Premaor
- Department of Clinical Medicine, Medical School, Federal University of Minas Gerais (UFMG), Avenida Professor Alfredo Balena, 190 - sala 246, Belo Horizonte, MG, Brazil.
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Madeira M, Rocha AC, Moreira CA, Aguiar ÁMM, Maeda SS, Cardoso AS, de Moura Castro CH, D'Alva CB, Silva BCC, Ferraz-de-Souza B, Lazaretti-Castro M, Bandeira F, Torres SR. Prevention and treatment of oral adverse effects of antiresorptive medications for osteoporosis - A position paper of the Brazilian Society of Endocrinology and Metabolism (SBEM), Brazilian Society of Stomatology and Oral Pathology (Sobep), and Brazilian Association for Bone Evaluation and Osteometabolism (Abrasso). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 64:664-672. [PMID: 34033275 PMCID: PMC10528626 DOI: 10.20945/2359-3997000000301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022]
Abstract
Antiresorptive therapy is the main form of prevention of osteoporotic or fragility fractures. Medication-related osteonecrosis of the jaw (MRONJ) is a relatively rare but severe adverse reaction to antiresorptive and antiangiogenic drugs. Physicians and dentists caring for patients taking these drugs and requiring invasive procedures face a difficult decision because of the potential risk of MRONJ. The aim of this study was to discuss the risk factors for the development of MRONJ and prevention of this complication in patients with osteoporosis taking antiresorptive drugs and requiring invasive dental treatment. For this goal, a task force with representatives from three professional associations was appointed to review the pertinent literature and discuss systemic and local risk factors, prevention of MRONJ in patients with osteoporosis, and management of established MRONJ. Although scarce evidence links the use of antiresorptive agents in the context of osteoporosis to the development of MRONJ, these agents are considered a risk factor for this complication. Despite the rare reports of MRONJ in patients with osteoporosis, the severity of symptoms and impact of MRONJ in the patients' quality of life make it imperative for health care professionals to consider this complication when planning invasive dental procedures.
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Affiliation(s)
- Miguel Madeira
- Divisão de Endocrinologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil,
- Divisão de Endocrinologia, Departamento de Clínica Médica, Hospital Federal de Bonsucesso, Rio de Janeiro, RJ, Brasil
| | - André Caroli Rocha
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carolina Aguiar Moreira
- Unidade de Endocrinologia e Metabologia (SEMPR), Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Águida Maria Menezes Aguiar
- Hospital Municipal Souza Aguiar, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Sergio Setsuo Maeda
- Disciplina de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Abel Silveira Cardoso
- Departamento de Patologia e Diagnóstico Oral, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | - Barbara Campolina Carvalho Silva
- Faculdade de Medicina, Centro Universitário de Belo Horizonte, Belo Horizonte, MG, Brasil
- Divisão de Endocrinologia, Hospital Felício Rocho, Belo Horizonte, MG, Brasil
- Divisão de Endocrinologia, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brasil
| | - Bruno Ferraz-de-Souza
- Laboratório de Endocrinologia Celular e Molecular (LIM-25) e Unidade de Doenças Osteometabólicas, Divisão de Endocrinologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marise Lazaretti-Castro
- Disciplina de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Francisco Bandeira
- Divisão de Endocrinologia e Diabetes, Faculdade de Medicina da Universidade de Pernambuco, Recife, PE, Brasil
| | - Sandra R Torres
- Departamento de Patologia e Diagnóstico Oral, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Domiciano DS, Machado LG, Figueiredo CP, Caparbo VF, Oliveira RM, Menezes PR, Pereira RMR. Incidence and risk factors for osteoporotic non-vertebral fracture in low-income community-dwelling elderly: a population-based prospective cohort study in Brazil. The São Paulo Ageing and Health (SPAH) study. Osteoporos Int 2021; 32:747-757. [PMID: 33037462 DOI: 10.1007/s00198-020-05669-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
UNLABELLED We ascertained the incidence of non-vertebral fracture in a low-income Brazilian elderly cohort. To the best of our knowledge, this is the first population-based study to demonstrate the frequency of non-vertebral fracture in elderly Latin Americans. Age, prior fracture, and bone mineral density (BMD) at hip were predictors of fracture. INTRODUCTION No data on incidence of osteoporotic non-vertebral fracture have been reported in low-income countries where the population's aging has been faster. Even in developed countries, currently available prospective data on major fracture rates beyond hip are scarce. The aim of this study is to describe the incidence and risk factors for non-vertebral fracture in a longitudinal prospective Brazilian population-based elderly cohort. METHODS Seven hundred seven older adults (449 women, 258 men) were evaluated at baseline and after a mean follow-up of 4.3 ± 0.8 years. Clinical questionnaire, bone mineral density (BMD), and laboratory tests were performed at baseline. New non-vertebral fracture (hip, proximal humerus, rib, forearm) was determined during the follow-up. Multivariate Poisson regression models were used to identify independent predictors of fracture. RESULTS The age-standardized incidence of non-vertebral fracture was 1562.3/100,000 (1085.7-2248.1/100,000) person-years (pyr) in women and 632.8/100,000 (301.7-1327.3/100,000) in men. Concerning to hip fractures, the incidence was 421.2/100,000 (210.7-842.3/100,000) pyr in women and 89.9/100,000 (12.7-638.5/100,000) in men. In a multivariate analysis, age (RR 2.07, 95% CI 1.13-3.82, p = 0.019, each 10-year increase), prior non-vertebral fracture (RR 3.08, 95% CI 1.36-6.95, p = 0.007), and total hip BMD (RR 1.68, 95% CI 1.11-2.56, p = 0.015, each 1 SD decrease) were predictors of new non-vertebral fracture. In men, fitting a model of risk factors for fracture was prevented by the limited number of events in male sample. CONCLUSION This is the first population-based study to ascertain the incidence of major non-vertebral fractures in elderly Latin Americans, confirming the high frequency of the disorder. Age, prior fracture, and hip BMD were predictors of the short-term incidence of fracture.
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Affiliation(s)
- D S Domiciano
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - L G Machado
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - C P Figueiredo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - V F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | | | - P R Menezes
- Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - R M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil.
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Chen P, Yan P, Wan Q, Zhang Z, Xu Y, Miao Y, Yang J. Association of circulating B-type natriuretic peptide with osteoporosis in a Chinese type 2 diabetic population. BMC Musculoskelet Disord 2021; 22:261. [PMID: 33691659 PMCID: PMC7944612 DOI: 10.1186/s12891-021-04138-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 02/28/2021] [Indexed: 02/05/2023] Open
Abstract
Background Altered circulating levels and genetic variation of B-type natriuretic peptide (BNP), has been associated with lower bone mineral density (BMD) values and incidence of osteoporosis in peritoneal dialysis patients, renal transplant recipients, and postmenopausal women. The potential relationship of circulating BNP with osteoporosis in patients with type 2 diabetes mellitus (T2DM), however, has not yet been studied. Methods Circulating BNP levels were measured in 314 patients with T2DM, and participants were divided into normal BMD group (n = 73), osteopenia group (n = 120), and osteoporosis group (n = 121). The association of circulating BNP with diabetic osteoporosis and other parameters was analyzed. Results Circulating BNP was significantly higher in diabetic osteoporosis subjects than normal and osteopenia groups (P < 0.01 or P < 0.05). Circulating BNP levels correlated significantly and positively with neutrophil to lymphocyte ratio, systolic blood pressure, urinary albumin-to-creatinine ratio, and prevalence of hypertension, peripheral arterial disease, diabetic retinopathy, peripheral neuropathy, and nephropathy, and negatively with triglyceride, fasting blood glucose, lymphocyte count, hemoglobin, estimated glomerular filtration rate, bilirubin, osteoporosis self-assessment tool for Asians, BMD at different skeletal sites and corresponding T scores (P < 0.01 or P < 0.05). After multivariate adjustment, circulating BNP remained independently significantly associated with the presence of osteoporosis (odds ratio, 2.710; 95% confidence interval, 1.690–4.344; P < 0.01). BMD at the femoral neck and total hip and corresponding T scores were progressively decreased, whereas the prevalence of osteoporosis was progressively increased with increasing BNP quartiles (P for trend< 0.01). Moreover, receiver-operating characteristic analysis revealed that the optimal cutoff point of circulating BNP to indicate diabetic osteoporosis was 16.35 pg/ml. Conclusions Circulating BNP level may be associated with the development of osteoporosis, and may be a potential biomarker for diabetic osteoporosis.
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Affiliation(s)
- Pan Chen
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Pijun Yan
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Qin Wan
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Zhihong Zhang
- Department of General Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping street, Luzhou, 646000, Sichuan, China
| | - Yong Xu
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Ying Miao
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Jun Yang
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
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Challenges and opportunities for quality densitometry in Latin America. Arch Osteoporos 2021; 16:23. [PMID: 33528678 DOI: 10.1007/s11657-021-00892-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/06/2021] [Indexed: 02/03/2023]
Abstract
Latin America and the Caribbean region account for 8% of the world's total population. Experts from 18 countries were invited to contribute to this article to provide the best available data on the number, types, and quality of densitometry, DXA experts, the local/national incidence and prevalence of osteoporosis and fragility fractures, and other uses and information on the challenges and opportunities for quality densitometry with examples of local initiatives. Osteoporosis is the primary reason for densitometry in our region, which is not a priority for public health in most countries. Access and quality are major challenges, and there is a clear trend to concentrate on densitometry services in the largest cities. Urgent action is needed to face the rapidly increasing burden of osteoporosis in our region, including robust and up to date epidemiology, access to health professionals, and quality densitometry. Health professionals require better access to training, courses, and other activities at a more local or regional level.
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Association of Circulating Omentin-1 with Osteoporosis in a Chinese Type 2 Diabetic Population. Mediators Inflamm 2020; 2020:9389720. [PMID: 33149724 PMCID: PMC7603618 DOI: 10.1155/2020/9389720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/26/2020] [Accepted: 08/03/2020] [Indexed: 12/30/2022] Open
Abstract
Aims Omentin-1, a newly identified adipokine, has been demonstrated to be associated with bone metabolism, but the results have been inconsistent. Moreover, the potential relationship of circulating omentin-1 with diabetic osteoporosis has never been reported. This study is intended for studying the association between circulating omentin-1, bone mineral density (BMD), prior fragility fractures, and other bone metabolic-related parameters. Methods Circulating omentin-1 levels were measured in 172 patients with type 2 diabetes mellitus (T2DM), and participants were divided into the normal BMD group (n = 52), the osteopenia group (n = 66), and the osteoporosis group (n = 54). The relationship between circulating omentin-1 and diabetic osteoporosis and other parameters was analyzed. Results Circulating omentin-1 was significantly higher in the osteoporosis group than in the normal group and in the osteopenia group (both P < 0.05). Circulating omentin-1 levels were correlated significantly and positively with sex; high-density lipoprotein cholesterol; apolipoprotein A; and prevalence of prior fragility fractures, diabetic nephropathy, and retinopathy; they were correlated negatively with diastolic blood pressure, triglyceride, hemoglobin, atherogenic index of plasma, osteoporosis self-assessment tool for Asians, BMD at different skeletal sites, and corresponding T scores, irrespective of age, sex, and body mass index (P < 0.01 or P < 0.05). Moreover, circulating omentin-1 was an independent decisive factor for the presence of osteoporosis only in women after multivariate adjustment (odds ratio: 1.069; 95% confidence interval: 1.003-1.139; P < 0.05). Lastly, the analysis of receiver operating characteristic curves revealed that the best cutoff value for circulating omentin-1 to predict diabetic osteoporosis was 15.37 ng/mL (sensitivity: 71.7%; specificity: 58.5%) in female subjects. Conclusions High levels of circulating omentin-1 may be associated with the development of osteoporosis in female diabetic subjects and may be a potential biomarker for diabetic osteoporosis in women.
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Hip fractures in the elderly Chilean population: a projection for 2030. Arch Osteoporos 2020; 15:116. [PMID: 32720199 DOI: 10.1007/s11657-020-00794-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/21/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Using national databases, we projected the magnitude of hip fractures among the elderly Chilean population by 2030. Hip fractures will increase by 27.5% from 2018 to 9862 cases (95% CI = 8760 to 10,965). The most substantial growth is expected to occur in patients older than 80 years of age. INTRODUCTION There is scarce information regarding the magnitude of hip fractures that will be observed in Latin American countries in the near future. The aim of this study is to project the volume of hip fractures in the elderly Chilean population by the year 2030. METHODS The database of the Chilean Department of Statistics and Health Information, which includes all hospital discharges within Chile, was employed to evaluate the volume of hip fractures observed from 2012 to 2018 in the elderly population (≥ 65 years old). The annual incidence was determined by combining the volume of fractures with census data. Linear regression analysis was performed to determine the projected volume of hip fractures for 2030. RESULTS For 2030, hip fractures among the elderly population are projected to grow 27.5% (R2 = 0.92) to 9862 cases (95% CI = 8760 to 10,965). In the group from 65 to 79 years old, hip fractures are expected to grow 21.6% (R2 = 0.87) to 3046 cases (95% CI = 2686 to 3405). In patients ≥ 80 years of age, hip fractures are expected to grow 30.1% (R2 = 0.9) to 6817 cases (95% CI = 5889 to 7744). CONCLUSIONS A substantial growth in the volume of hip fractures is expected for the next decade among the elderly Chilean population, especially in patients ≥ 80 years of age. A national healthcare strategy should consider efforts to mitigate the impact of the future burden related to patients' care.
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Sales E, da Silva CER, Letichevsky S, dos Santos R, Teixeira Pinto LA, dos Santos CT, de Oliveira LF, de Avillez RR, Monteiro M, Paciornik S, dos Anjos M. Study of composition and structure of demineralized bone using X-ray techniques. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.04.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mattazio RR, Noritomi PY, Silveira ZC. An In Silico Model for the Prediction of Changes in Mineral Density in Cortical Bone Remodeling. J Biomech Eng 2020; 142:011008. [PMID: 31233121 DOI: 10.1115/1.4044094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Indexed: 11/08/2022]
Abstract
An in silico model for the estimation of volumetric bone mineral density (vBMD) changes at a cortical bone site subjected to mechanobiological bone remodeling is proposed in this manuscript. Mechanisms of cell differentiation, receptor-ligand binding, mechanical signaling, and resorption or deposition of bone matrix were considered, therefore providing a comprehensive description of mechanobiological bone remodeling in the bone microenvironment and enabling the analysis of temporal evolution of disease or therapy scenarios. The proposed model is composed by five modules, namely, bone cells populations, mechanobiology, volume fractions and porosity, mineral density, and structural stiffness. The model is an extension of other models found in the literature because equations for the obtaining of cortical vBMD and the binding of parathyroid hormone (PTH) to parathyroid hormone 1 receptor are included. The proposed model showed a satisfactory agreement with the solutions of other in silico models found in the literature. Simulations of walking and running exercise routines were performed for the evaluation of model capability regarding the control of the numerical error and prediction of vBMD. The computational method used to solve the case study controlled the relative numerical error by less than 1 × 10-7 for approximately 1.7 × 106 time steps. The predicted values correlate with the concept of increasing BMD by vigorous physical activity; however, they contrast with the specific effect of physical activities on cortical vBMD.
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Affiliation(s)
- Rafael R Mattazio
- São Carlos School of Engineering, University of São Paulo, 400 Trabalhador São-carlense Avenue, São Carlos, SP 13566-590, Brazil
| | - Pedro Y Noritomi
- Three-dimensional Technologies, Information Technology Center Renato Archer, 143.6 Km Dom Pedro I Highway (SP-65), Campinas, SP 13069-901, Brazil
| | - Zilda C Silveira
- São Carlos School of Engineering, University of São Paulo, 400 Trabalhador São-carlense Avenue, São Carlos, SP 13566-590, Brazil
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Sakane EN, Vieira MCC, Lazaretti-Castro M, Maeda SS. Predictors of Poor Bone Microarchitecture Assessed by Trabecular Bone Score in Postsurgical Hypoparathyroidism. J Clin Endocrinol Metab 2019; 104:5795-5803. [PMID: 31305931 DOI: 10.1210/jc.2019-00698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/09/2019] [Indexed: 12/17/2022]
Abstract
CONTEXT The effects of PTH deprivation on bone are still unclear. Our objective was to report the characteristics of patients with postsurgical hypoparathyroidism (PsH) at a specialized outpatient service and correlate their trabecular bone score (TBS) values to clinical, densitometric, and laboratory findings. A secondary objective was to evaluate the fracture rates and look for associations between these events and the collected data. RESULTS Eighty-two patients were enrolled, of whom 70 (85.4%) were female and 17 (20.7%) had type 2 diabetes mellitus (T2DM). The median body mass index (BMI) was 27.7 kg/m2 and the median age was 59 years. Of 68 dual-energy x-ray absorptiometry (DXA) scans obtained, osteopenia and osteoporosis were present in 32.4% and 2.9%, respectively. In all, 62 lumbar scans were analyzed by using TBS. The mean TBS value (±SD) was 1.386 ± 0.140, and 32.2% of the results were <1.310. TBS values correlated negatively with BMI (mainly > 30 kg/m2), age (mainly > 60 years), and glycemia, whereas abnormal TBS correlated with osteopenia, T2DM, low-impact fracture, and menopause. Six female patients had low-impact fractures, which were associated with a lower TBS (1.178 ± 0.065 vs. 1.404 ± 0.130 in the group without fractures; P < 0.001), older age, higher BMI, impaired renal function, abnormal glycemia, and osteopenia. CONCLUSION The findings suggests that known risk factors for bone loss compromise the bone microarchitecture of individuals with PsH, regardless of DXA results. Menopausal women with PsH and older patients with PsH who have osteopenia, a higher BMI, or T2DM may be candidates for a more detailed assessment by using, for example, TBS.
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Affiliation(s)
- Eliane Naomi Sakane
- Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Marise Lazaretti-Castro
- Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Setsuo Maeda
- Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo, São Paulo, Brazil
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Cunha-Borges JL, Mier GM, Casas N, Medina A, Molina JF, García ML, Oliveria LG, Caselato MS, Cruz AC, Ippolito V, Flórez S. Baseline characteristics of postmenopausal women with osteoporosis treated with teriparatide in a real-world setting in Latin America: a subregional analysis from the Asia and Latin America Fracture Observational Study (ALAFOS). Adv Rheumatol 2019; 59:46. [PMID: 31703737 DOI: 10.1186/s42358-019-0088-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoporosis is a major healthcare concern in Latin America. Factors such as changing demographics, fragmented healthcare systems, and financial considerations may result in a huge increase in the burden of osteoporosis in this region. The aim of this article is to describe the baseline clinical characteristics and fracture history of patients who are prescribed teriparatide in normal clinical practice in Latin America. METHODS We conducted a prospective, multinational, observational study (the Asia and Latin America Fracture Observational Study [ALAFOS]) in 20 countries worldwide to assess the incidence of fractures in postmenopausal women with osteoporosis receiving teriparatide as a part of routine clinical practice in a real-world setting. In this subregional analysis of the ALAFOS study, we report the clinical characteristics, fracture history, risk factors for osteoporosis, comorbidities, previous osteoporosis therapies and health-related quality of life measures at baseline for patients from the four participant Latin American countries: Argentina, Brazil, Colombia, and Mexico. RESULTS The Latin America subregional cohort included 546 postmenopausal women (mean [SD] age: 71.0 [10.1] years; range: 40-94 years), constituting 18% of the ALAFOS total population. The baseline mean (SD) bone mineral density T-scores were - 3.02 (1.23) at the lumbar spine and - 2.31 (0.96) at the femoral neck; 62.8% of patients had a history of low trauma fracture after the age of 40 years and 39.7% of patients had experienced ≥1 fall in the past year. Osteoporosis medications were used by 70.9% of patients before initiating teriparatide. The median (Q1, Q3) EQ-5D-5 L Visual Analog Scale (VAS) scores for perceived health status at baseline was 70 (50, 80). The mean (SD) worst back pain numeric rating scale score for the overall Latin American cohort was 4.3 (3.4) at baseline. CONCLUSIONS This baseline analysis of the Latin America subregion of the ALAFOS study indicates that patients who are prescribed teriparatide in the four participant countries had severe osteoporosis and high prevalence of fractures. They also had back pain and poor health-related quality of life. The proportions of patients with severe or extreme problems on the EQ-5D-5 L individual domains were lower than those in the overall ALAFOS study population.
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Affiliation(s)
| | | | | | - Adriana Medina
- Sociedad de Cirugía de Bogotá - Hospital Universitario de San José, Bogotá, Colombia
| | | | | | | | | | | | | | - Sandra Flórez
- Eli Lilly Interamerica, Transversal 18 No. 96-41, Piso 6, Bogotá, Colombia. .,Pain and Palliative Care Unit, Universidad de la Sabana, Bogotá, Colombia.
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Silva DMW, Lazaretti-Castro M, Freitas Zerbini CAD, Szejnfeld VL, Eis SR, Borba VZC. Incidence and excess mortality of hip fractures in a predominantly Caucasian population in the South of Brazil. Arch Osteoporos 2019; 14:47. [PMID: 30993406 DOI: 10.1007/s11657-019-0597-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 04/01/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Osteoporosis is a very common disease, and data on its epidemiology is important for health care strategy implementation. Brazil is a developing country; its population is aging, leading to an expected increase in hip fractures and their undesirable consequences. OBJECTIVE Assess the incidence of osteoporotic hip fractures and subsequent mortality in Southern Brazil as part of a large epidemiological study aiming to reinforce the data for FRAX Brazil. STUDY DESIGN This study evaluated all admissions for fragility hip fractures between April 1, 2010, and March 31, 2012, in the city of Joinville, including both genders of patients 50 years old or older, which corresponded to 19.2% of the local population. Joinville was chosen because it is the third largest city in the south of Brazil, with a representative population predominantly composed of descendants of European immigrants. RESULTS There were 213 cases of hip fractures, predominantly in Caucasians (n = 204, 96.7%) whose mean age was 77.7, ± 10.5, of which 143 (67.1%) were women (79.5 ± 9.6 years) and 70 (32.9%) were men (74 ± 11.3 years). The annual incidence of hip fractures was 268.8 for women and 153.0 for men/100,000 inhabitants. In the 60 to 64-year group, the overall incidence was 92.1/100,000, with an age-related increase of 1410.1/100,000 in the 80 to 84-year group. The mortality rate during hospitalization was 7.5%, and 25% died during the 12 months following their fractures. CONCLUSION The incidence of hip fractures among the oldest in this predominantly Caucasian population living in Southern Brazil was similar to that of European populations from the northern hemisphere. The annual incidence of fragility hip fractures among people in their 80s was 59 times higher than that among people in their 50s. The mortality rate was 4.3 times higher in the first year after hip fracture than in the age-related local population.
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Affiliation(s)
- Dalisbor Marcelo Weber Silva
- Medical School of Univille, Universidade da Região de Joinville, 520, Anita Garibaldi, Joinville, SC, 89212-050, Brazil.
| | - Marise Lazaretti-Castro
- Osteometabolic Diseases Service of the Department of Endocrinology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Vera Lúcia Szejnfeld
- Department of Rheumatology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Ragi Eis
- Diagnosis and Research Center in Osteoporosis of Espirito Santo, Vitoria, Brazil
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Morimoto M, Shivappa N, de Souza Genaro P, Martini LA, Schuch NJ, Hebert JR, Pinheiro MM. Lack of association between dietary inflammatory index and low impact fractures in the Brazilian population: the Brazilian Osteoporosis Study (BRAZOS). Adv Rheumatol 2019; 59:16. [PMID: 30971320 DOI: 10.1186/s42358-019-0059-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/25/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Adequate nutrition, including intake of dietary calcium and vitamin D, is important to maintain bone health. Evidence suggests that a deficiency in micronutrients may contribute to bone loss during aging and exert generalized effects on chronic inflammation. Recently, the Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of individual diets. Our aim was to evaluate the DII in a representative sample and verify its association with low-impact fractures. METHODS Individuals from The Brazilian Osteoporosis Study (BRAZOS) database had their DII calculated. BRAZOS is an important cross-sectional epidemiological study carried out with a representative sample of men and women ≥40 years old. The research was conducted through in-home interviews administered by a trained team. Nutrition Database System for Research (NDSR) software was used to analyze data on the intake of nutrients, which were employed to calculate the DII using Statistical Analysis Software (SAS®) and Statistical Package for the Social Sciences (SPSS®) to assess its association with low-impact fractures. RESULTS A total of 2269 subjects had their DII score calculated using information from 24-h recall data. Males had lower DII than females (DII = 1.12 ± 1.04 vs DII = 1.24 ± 0.99, p = 0.012). Women taking statins had lower DII (DII = 0.65 ± 1.14 vs DII + 1.26 ± 0.98, p = 0.002), indicating a greater potential for diet-related anti-inflammatory effects. CONCLUSION Our findings suggest that women might have a pro-inflammatory diet pattern compared to men. However, we did not find any association between DII scores and low-impact fractures.
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Affiliation(s)
- Melissa Morimoto
- Rheumatology Division, Universidade Federal de São Paulo, Unifesp/EPM, Rua Leandro Dupre, 204, conjunto 74, São Paulo, Brazil.
| | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, 29208, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | | | - Lígia Araújo Martini
- Department of Nutrition, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Natielen Jacques Schuch
- Department of Nutrition, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - James R Hebert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, 29208, USA
| | - Marcelo Medeiros Pinheiro
- Rheumatology Division, Universidade Federal de São Paulo, Unifesp/EPM, Rua Leandro Dupre, 204, conjunto 74, São Paulo, Brazil
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Cembranel F, Wagner KJP, González-Chica DA, d'Orsi E. Education and Income Levels are Associated With Energy and Micronutrient Intake. INT J VITAM NUTR RES 2019; 90:228-238. [PMID: 30789806 DOI: 10.1024/0300-9831/a000535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: According to the literature, education and income are determinants factors of diet quality and consequently of micronutrient intake. However, this association is still little known among adults who live in middle-income countries. Objective: To estimate energy and micronutrients intake by men and women living in a capital city in southern Brazil, according to education and income levels, and to identify prevalence of inadequate micronutrient intake according also to education and income levels. Method: This is a second wave cross-sectional analysis of a population-based longitudinal study, the EpiFloripa Adultos, including 1,222 individuals of 22-63 years. Data on food consumption were obtained through applying two 24-hour dietary recalls, and the prevalence of inadequate micronutrient intake, following the recommendations of the Institute of Medicine and from the National Research Council. Results: A tendency of increased intake with an increase in income (calcium, vitamins C, E) and education levels (calcium, vitamins A, C, D) was observed for most of the micronutrients analyzed (p<0.05 in all cases); still, a prevalence of inadequacy according to Estimated Average Requirement (EAR) between 85.5-100% in intake of vitamins A, D and E were found for the whole sample. Iron inadequate intake was associated with education level and among women less than 50 years of age (p=0.018). Conclusion: The results showed an influence of the education and income levels on micronutrient intake, point to the need of daily food consumption, of minimally processed and in natura foods (as fruits, vegetables, whole grains, milk and its derivatives) as a means to reduce the encountered inadequacies.
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Affiliation(s)
- Francieli Cembranel
- Assistant Professor at the Department of Nutrition, Federal University of Santa Catarina, Trindade University Campus, Florianópolis, Santa Catarina, Brazil
| | - Katia Jakovljevic Pudla Wagner
- Assistant Professor at the Center for Rural Sciences, Bioscience and Unique Health Coordination, Federal University of Santa Catarina, Curitibanos University Campus, Curitibanos, Santa Catarina, Brazil
| | - David Alejandro González-Chica
- Senior Lecturer at the discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Eleonora d'Orsi
- Associated Professor at the Department of Public Health, Federal University of Santa Catarina, Trindade University Campus, Florianópolis, Santa Catarina, Brazil.,Bernard Lown Scholar in Cardiovascular Health, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
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Nunes Cavalcante Castro BA, Torres Dos Reis Neto E, Szejnfeld VL, Szejnfeld J, Marvulle V, de Medeiros Pinheiro M. Could obesity be considered as risk factor for non-vertebral low-impact fractures? Adv Rheumatol 2018; 58:42. [PMID: 30657094 DOI: 10.1186/s42358-018-0044-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/03/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND It has long been established that obesity plays a positive role against osteoporosis (OP) and low-impact fractures (Fx). However, more recent data has shown higher fracture risk in obese individuals. The aim of this study was to investigate the association between BMI, particularly obesity, OP and low-impact Fx in Brazilian women, as well as to evaluate the SAPORI (Sao Paulo Osteoporosis Risk Index) tool performance to identify low BMD according BMI category. METHODS A total of 6182 women aged over 40 years were included in this cross-sectional analysis using data from two large Brazilian studies. All participants performed hip and spine bone mineral density (BMD) measurements and answered a detailed questionnaire about the presence of clinical risk factors (CRFs) related to low BMD and risk fractures. The World Health Organization (WHO) criteria were used to define obesity. RESULTS Age-adjusted osteoporosis prevalence was 20.8, 33.6, 47 and 67.1% in obese, overweight, normal and underweight category, respectively. Obesity was present in 29,6% (1.830 women) in the study population and the likelihood of osteoporosis and low-impact Fx compared to a normal BMI in this subgroup was of 0.24 (95% CI 0.20-0.28; p < 0.001) and of 1.68 (95% CI 1.35-2.11; p < 0.001), respectively. However, the hip Fx likelihood was lower in obese compared with non-obese women (OR = 0.44; 95% CI 0.20-0.97). Using an originally validated cut-off, the SAPORI tool sensitivity was significantly hampered in overweight and obese women although the accuracy had remained suitable because of increasing in specificity. CONCLUSIONS The osteoporosis prevalence reduced as BMI increased and obesity was associated with low-impact Fx, regardless of the BMD measurements. Moreover, the SAPORI performance was impaired in obese women.
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Affiliation(s)
- Bruna Aurora Nunes Cavalcante Castro
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), Rua Leandro Dupré, 204, conj. 74, Vila Clementino, São Paulo, São Paulo-SP, CEP 04025-010, Brazil
| | - Edgard Torres Dos Reis Neto
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), Rua Leandro Dupré, 204, conj. 74, Vila Clementino, São Paulo, São Paulo-SP, CEP 04025-010, Brazil
| | - Vera Lucia Szejnfeld
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), Rua Leandro Dupré, 204, conj. 74, Vila Clementino, São Paulo, São Paulo-SP, CEP 04025-010, Brazil
| | - Jacob Szejnfeld
- Radiology Department, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil
| | - Valdecir Marvulle
- Statistics Department, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil
| | - Marcelo de Medeiros Pinheiro
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), Rua Leandro Dupré, 204, conj. 74, Vila Clementino, São Paulo, São Paulo-SP, CEP 04025-010, Brazil.
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Munhoz da Rocha Lemos Costa T, Costa FM, Hoffman Jonasson T, Aguiar Moreira C, Boguszewski CL, Cunha Borges JL, Zeghbi Cochenski Borba V. Bone mineral density and vertebral fractures and their relationship with pulmonary dysfunction in patients with chronic obstructive pulmonary disease. Osteoporos Int 2018; 29:2537-2543. [PMID: 30043107 DOI: 10.1007/s00198-018-4643-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 07/13/2018] [Indexed: 11/24/2022]
Abstract
UNLABELLED To evaluate bone mineral density (BMD) and morphometric vertebral fractures (MVF) in chronic obstructive pulmonary disease (COPD) patients in comparison with two control groups. BMD was lower in the disease group (DG) and was associated with the worst disease severity and prognosis. The prevalence of MVF was high and greater in the DG than in the control groups. INTRODUCTION Chronic obstructive pulmonary disease (COPD) is associated with osteoporosis and vertebral fractures. It is still unclear whether the presence of fractures and changes in bone mineral density (BMD) are associated with disease severity and prognosis. The aim of this study was to evaluate BMD and morphometric vertebral fractures (MVF) in COPD patients in comparison with two control groups and to correlate these parameters with indices of COPD severity (VEF1 and GOLD) and prognosis (BODE). METHODS This was a cross-sectional study in COPD patients (disease group, DG) who underwent BMD and vertebral fracture assessment (VFA). Two control groups were used: smokers without COPD (smoker group, SG) and healthy never-smoker individuals (never-smoker group, NSG). RESULTS The DG comprised 121 patients (65 women, mean age 67.9 ± 8.6 years). Altered BMD was observed in 88.4% of the patients in the DG, which was more prevalent when compared with the control groups (p < 0.001). The BMD values were lower in the DG than in the control groups (p < 0.05). BMD was associated with the worst disease severity and prognosis (p < 0.05). The prevalence of MVF was high (57.8%) and greater than that in the SG (23.8%) and the NSG (14.8%; p < 0.001). The prevalence of fractures was not associated with disease severity and prognosis. CONCLUSIONS COPD patients have a higher prevalence of MVF and low BMD, and the latter was associated with the severity and poor prognosis of the disease.
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Affiliation(s)
- T Munhoz da Rocha Lemos Costa
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Avenida Agostinho Leão Júnior, 285, Curitiba, 80030-110, Brazil.
| | - F M Costa
- Pulmonary Division, Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil
| | - T Hoffman Jonasson
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Avenida Agostinho Leão Júnior, 285, Curitiba, 80030-110, Brazil
| | - C Aguiar Moreira
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Avenida Agostinho Leão Júnior, 285, Curitiba, 80030-110, Brazil
| | - C L Boguszewski
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Avenida Agostinho Leão Júnior, 285, Curitiba, 80030-110, Brazil
| | | | - V Zeghbi Cochenski Borba
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Avenida Agostinho Leão Júnior, 285, Curitiba, 80030-110, Brazil
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Albergaria BH, Chalem M, Clark P, Messina OD, Pereira RMR, Vidal LF. Consensus statement: osteoporosis prevention and treatment in Latin America-current structure and future directions. Arch Osteoporos 2018; 13:90. [PMID: 30143914 PMCID: PMC6132387 DOI: 10.1007/s11657-018-0505-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/09/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Osteoporosis is a common disorder affecting populations worldwide. In Latin America, an aging population combined with limited health care resources result in osteoporosis quickly becoming a condition of considerable magnitude with disproportionate morbidity and mortality. AIM To review the current state of prevention, diagnosis, and treatment of osteoporosis in Latin America and to develop strategies and recommendations that may be adopted in the region, an expert panel of clinicians and scientists was assembled to develop a consensus statement outlining future directions. METHOD The panel conducted a comprehensive literature review of publications mainly related to osteoporosis in Latin America, and at an in-person meeting developed a consensus position to address the relevant issues. RESULTS The epidemiology, burden, diagnosis, and treatment of osteoporosis in the region were discussed with particular attention to issues unique to the region. A series of recommendations were developed encompassing virtually all aspects of the disease, including improved public and health professional awareness, better diagnostic processes, improved access to care, and greater engagement by health policy makers, government, and a wide variety of private organizations. CONCLUSIONS The panel concluded that a comprehensive approach to osteoporosis prevention and treatment in Latin America is urgently needed.
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Affiliation(s)
- Ben-Hur Albergaria
- Diagnosis and Research Center of Osteoporosis (CEDOES), Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | | | - Patricia Clark
- Clinical Epidemiology Unit, Hospital Infantil Federico Gómez, Mexico, D.F., Mexico
- Faculty of Medicine, Universidad Nacional Autonoma De Mexico, Mexico, D.F., Mexico
| | - Osvaldo Daniel Messina
- Rheumatology Service, Cosme Argerich Hospital and IRO Clinical Research Center, Buenos Aires, Argentina.
| | - Rosa Maria R Pereira
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Luis F Vidal
- Rheumatology Service, Centro Diagnóstico de la Osteoporosis y Enfermedades Reumáticas (CEDOR), Lima, Peru
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Graumam RQ, Pinheiro MM, Nery LE, Castro CHM. Increased rate of osteoporosis, low lean mass, and fragility fractures in COPD patients: association with disease severity. Osteoporos Int 2018; 29:1457-1468. [PMID: 29564475 DOI: 10.1007/s00198-018-4483-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/07/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED A very high rate of osteoporosis, fractures, and low lean mass was observed in patients with chronic obstructive pulmonary disease (COPD). Disease severity was associated with bone and muscle adverse outcomes, while age ≥ 63.5 years old, low lean mass, higher iPTH, and a T-score below - 2.5 were all associated with higher risk of fracture. INTRODUCTION Osteoporosis is frequently neglected in patients with COPD. We aimed at evaluating the rate of osteoporosis, fractures, and low lean mass in patients with COPD. METHODS Ninety-nine patients with COPD (53 women, 64.5 ± 9.6 years old, and 46 men, 65.9 ± 8.0 years old) underwent bone densitometry (DXA) with body composition analyses. Healthy individuals (N = 57) not exposed to tobacco matched by sex, age, and body mass index (BMI) were used as controls. Spirometry, routine laboratory workout, and conventional thoracolumbar radiography surveying for vertebral deformities were performed in all patients. RESULTS Osteoporosis was found in 40.4% of the COPD patients against only 13.0% of the healthy controls (p = 0.001). Vertebral fractures were seen in 24.4% of the men and 22.0% of the women with COPD. Disease severity (GOLD 3 and 4) was significantly associated with higher risk of vitamin D deficiency (p = 0.032), lower BMD (both men and women at all sites), higher frequency of osteoporosis (in women at all sites), lower skeletal mass index, and higher rate of low lean mass (in both men and women) than healthy controls and COPD patients with milder disease (GOLD 1 and 2). Age was a main predictor of vertebral fractures (OR = 1.164 (1.078-9.297); p < 0.001), while high plasma iPTH (OR = 1.045 (1.005-1.088); p = 0.029) and low ALM (OR = 0.99965 (0.99933-0.99997); p = 0.031) were predictors of non-vertebral fractures. CONCLUSION Highly prevalent in COPD, osteoporosis and low lean mass were associated with FEV1% < 50%. Age, low lean mass, high iPTH, and low bone mass were all significantly associated with fractures in COPD patients.
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Affiliation(s)
- R Q Graumam
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - M M Pinheiro
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - L E Nery
- Pulmonology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - C H M Castro
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
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Dixit V, Tripathi RL, Dhanwal DK. All 25-hydroxyvitamin D-deficient Indian postmenopausal women do not have secondary hyperparathyroidism. Arch Osteoporos 2018; 13:62. [PMID: 29806069 DOI: 10.1007/s11657-018-0465-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/27/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study shows a high 25-hydroxyvitamin D deficiency among postmenopausal women accompanying secondary hyperparathyroidism. However, a sizable number of subjects did not have secondary hyperparathyroidism despite having low 25-hydroxyvitamin D levels. This condition arises a research question in clinical practice needed to be addressed in the future. PURPOSE The present study was attempted to determine the prevalence of secondary hyperparathyroidism and also to analyze the mean value (cutoff) of 25-hydroxyvitamin D from where the PTH begins to rise in Indian postmenopausal women. METHODS A cross-sectional study including 334 postmenopausal women attending the outpatient department (MOPD) of Lok Nayak Hospital, New Delhi, between July 2008 and June 2010. Institutional ethical approval was obtained for this study. The apparently healthy postmenopausal women and attendees of the patients were included in the study. Post-thyroidectomy, thyroid illness, pregnant women, subjects taking drugs that can affect bone mineral metabolism, such as glucocorticoids, antitubercular therapy, antiepileptic, and 25-hydroxyvitamin D supplement were excluded from the study. BMD parameters such as PTH and 25(OH)D were measured by using commercial kits from DiaSorin, USA, and blood chemistry was evaluated by standard methods from the central facility of the center. Dietary calcium was analyzed by applying a food frequency questionnaire by a trained dietician. RESULTS Mean (SD) age of the subjects was 56.4 ± 7.7 years. The mean BMI was 24.7 ± 5.5 kg/m2. The baseline biochemical investigations such as total bilirubin, liver function test (LFT), kidney function test (KFT), calcium, phosphorous, total protein, and serum albumin were in reference range except alkaline phosphatase (ALP). The mean values of 25(OH)D and PTH were 12.95 ± 8.08 ng/ml and 91.60 ± 75.56 pg/ml respectively. The 24-h dietary calcium intake was 487.06 ± 239.36 mg/24 h. 25-hydroxyvitamin D deficiency was found in 277 subjects (82.93%) and was inversely related to PTH. Forty-three subjects had 25-hydroxyvitamin D levels between 20 and 29 ng/ml (12.87%), and only 14 subjects (4.19%) had optimum 25-hydroxyvitamin D levels. Secondary hyperparathyroidism was found in 235 (70.35%) subjects; however, it was not found in 30%. CONCLUSIONS Majority of postmenopausal women of India had 25-hydroxyvitamin D deficiency with raised PTH levels. The cutoff point of 25-hydroxyvitamin D at which PTH began to rise was found at 25 ng/ml which seems similar to that of the Caucasians.
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Affiliation(s)
- Vivek Dixit
- Department of Medicine, Division of Endocrinology and Metabolism, Maulana Azad Medical College, New Delhi, India
| | - R L Tripathi
- Department of Biochemistry, University College of Medical Sciences, New Delhi, India
| | - Dinesh Kumar Dhanwal
- Department of Medicine, Division of Endocrinology and Metabolism, Maulana Azad Medical College, New Delhi, India.
- NMC Specialty Hospital, Abu Dhabi, United Arab Emirates.
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Age of menopause and fracture risk in postmenopausal women randomized to calcium + vitamin D, hormone therapy, or the combination: results from the Women's Health Initiative Clinical Trials. Menopause 2018; 24:371-378. [PMID: 27801706 DOI: 10.1097/gme.0000000000000775] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We previously reported that in the absence of hormone therapy (HT) or calcium/vitamin D (Ca/D) supplementation, earlier menopause age was associated with decreased bone mineral density and increased fracture risk in healthy postmenopausal women. Treatment with HT and Ca/D is protective against fractures after menopause. In this analysis, we asked if the age of menopause onset alters fracture risk in healthy postmenopausal women receiving HT, Ca/D, or a combination. METHODS Hazard ratios (HRs) for any fracture among 21,711 healthy postmenopausal women enrolled in the Women's Health Initiative Clinical Trial, who were treated with HT, Ca/D, or HT + Ca/D, and who reported age of nonsurgical menopause of <40, 40 to 49, and ≥50 years, were compared. RESULTS Women with menopause <40 years had significantly higher HR for fracture than women with menopause 40 to 49 or ≥50 years, regardless of treatment intervention (HR [95% CI]: menopause <40 y vs ≥50 y, 1.36 [1.11-1.67]; menopause <40 y vs 40-49 y, 1.30 [1.06-1.60]). CONCLUSIONS In the overall Women's Health Initiative Clinical Trial cohort and within each treatment group, women with younger menopause age (<40 y) had a higher risk of any fracture than women reporting older menopause ages. The effect of menopause age on fracture risk was not altered by any of the treatment interventions (HT, Ca/D, HT + Ca/D), suggesting that early age of menopause is an independent contributor to postmenopausal fracture risk.
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Silva DMW, Borba VZC, Kanis JA. Evaluation of clinical risk factors for osteoporosis and applicability of the FRAX tool in Joinville City, Southern Brazil. Arch Osteoporos 2017; 12:111. [PMID: 29224172 DOI: 10.1007/s11657-017-0405-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/24/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Clinical risk factors for fracture in Southern Brazil are similar to those used in Fracture Risk Assessment Tool (FRAX®). Age-dependent intervention thresholds had higher accuracy than a fixed cut-off point. INTRODUCTION Access to bone mineral density testing is wanted for a large part of the Brazilian population. The FRAX® has an option to calculate the risk of fracture without this costly evaluation but relies on the clinical risk factors (CRFs) identified in the source cohorts used to generate FRAX. OBJECTIVE The aims of this study were to determine whether the CRFs used in FRAX are also risk indicators for individuals in Southern Brazil and to evaluate possible intervention thresholds for treatment in Brazil. METHODS We determined the CRFs for hip fractures in women and men aged 50 years and more with a hip fracture and controls in Joinville, Southern Brazil (April 1, 2010, and March 31, 2012). For intervention thresholds, we determined the accuracy of using the fixed thresholds of National Osteoporosis Foundation (NOF), USA, compared with the age-dependent thresholds of the National Osteoporosis Guideline Group (NOGG), UK. RESULTS CRFs that were significant for hip fracture were very similar to FRAX, apart from chronic obstructive pulmonary disease and malabsorptive intestinal disease. FRAX based on the NOGG and NOF models had an accuracy of 64.2 and 58.7%, respectively. CONCLUSION CRFs used in FRAX® were similar to those in the Southern Brazil. The NOGG model seems to be more accurate to discriminate patients with increased fracture risk in this population compared to the NOF model, but not significantly.
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Affiliation(s)
- Dalisbor Marcelo Weber Silva
- Medical School of Univille, Universidade da Região de Joinville, Rua Plácido Gomes, 520, Anita Garibaldi, Joinville, SC, Brazil.
| | | | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia
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Cappelle S, Ramon I, Dekelver C, Rozenberg S, Baleanu F, Karmali R, Rubinstein M, Tondeur M, Moreau M, Paesmans M, Bergmann P, Body JJ. Distribution of clinical risk factors for fracture in a Brussels cohort of postmenopausal women: The FRISBEE study and comparison with other major cohort studies. Maturitas 2017; 106:1-7. [DOI: 10.1016/j.maturitas.2017.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/08/2017] [Accepted: 08/11/2017] [Indexed: 11/15/2022]
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POSSA G, CASTRO MAD, SICHIERI R, FISBERG RM, FISBERG M. Dairy products consumption in Brazil is associated with socioeconomic and demographic factors: Results from the National Dietary Survey 2008-2009. REV NUTR 2017. [DOI: 10.1590/1678-98652017000100008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ABSTRACT Objective: To estimate the consumption of dairy products in the Brazilian population. Methods: Data from two non-consecutive food records from 34,003 individuals (aged ³10 years) in the first Brazilian nationally representative dietary survey (2008-2009) were used to estimate the dairy products intake. Dairy products were divided into four major subgroups: cow's milk, cheese, yogurt and other dairy products. Absolute and relative frequencies of individuals in the population who reported consumption of dairy products in at least one of the two-day food record according to sex, age, geographic region and levels of per capita monthly family income were calculated. Moreover, the mean consumption of dairy products, as well as their nutritional contribution in total energy, protein, calcium, phosphorus and magnesium intake was estimated. Results: It was observed that only 43.0% of the population reported consuming dairy products, being the milk subgroup the most frequently consumed (21.1%). The prevalence of consumption was higher among females, elderly, residents of the South region, and among individuals from higher per capita monthly family income. The nutritional contribution of dairy products was less than 10.0% of total energy intake and for most nutrients and the mean daily consumption are justified was 101.8g. Conclusion: Therefore, in view of the low intake of dairy products by Brazilian population and the nutritional benefits associated with this food group, public health strategies to increase dairy consumption are justified.
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Silva A, Martinez L, Pinheiro M, Szejnfeld V. ESTUDO EPIDEMIOLÓGICO DAS FRATURAS DE TORNOZELO NO BRASIL: BRAZILIAN ANKLE OSTEOPOROSIS STUDY (BRANKOS). REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hatta T, Werthel JD, Wagner ER, Itoi E, Steinmann SP, Cofield RH, Sperling JW. Effect of smoking on complications following primary shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:1-6. [PMID: 27810265 DOI: 10.1016/j.jse.2016.09.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 09/02/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to examine the effect of smoking on the incidence of complications after primary anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA). METHODS All patients who underwent primary TSA or RSA at our institution between 2002 and 2011 and had a minimum 2-year follow-up were included. Smoking status was assessed at the time of surgery. Current smokers, former smokers, and nonsmokers were compared for periprosthetic infection, fractures (intraoperative and postoperative), and loosening after surgery. RESULTS The cohort included 1834 shoulders in 1614 patients (814 in smokers and 1020 in nonsmokers). Complications occurred in 73 patients (75 shoulders; 44 in smokers and 31 in nonsmokers). There were 20 periprosthetic infections (16 in smokers and 4 in nonsmokers), 27 periprosthetic fractures (14 in smokers and 13 in nonsmokers), and 28 loosenings (14 in smokers and 14 in nonsmokers). Smokers had lower periprosthetic infection-free survival rates (95.3%-99.4% at 10 years; P = .001) and overall complication-free survival rates (78.4%-90.2%; P = .012) than nonsmokers. Multivariable analyses showed that both current and former smokers had significantly higher risk of periprosthetic infection in comparison with nonsmokers (hazard ratio [HR], 7.27 and 4.56, respectively). In addition, current smokers showed a higher risk of postoperative fractures than both former smokers (HR, 3.63) and nonsmokers (HR, 6.99). CONCLUSIONS This study demonstrates that smoking is a significant risk factor of complications after TSA and RSA. These findings emphasize the need for preoperative collaborative interventions, including smoking cessation programs.
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Affiliation(s)
- Taku Hatta
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Eric R Wagner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eiji Itoi
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Robert H Cofield
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Chain A, Crivelli M, Faerstein E, Bezerra FF. Association between fat mass and bone mineral density among Brazilian women differs by menopausal status: The Pró-Saúde Study. Nutrition 2017; 33:14-19. [PMID: 27908545 DOI: 10.1016/j.nut.2016.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/08/2016] [Accepted: 08/11/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association between bone mineral density (BMD) and fat mass (FM) in a multiethnic population of Brazilian women and to evaluate the influence of total body mass and lean mass on this association. METHODS This was a cross-sectional study nested within the Pro-Saúde Study, a prospective cohort of university civil servants in Rio de Janeiro. Participants were pre- (n = 100) and postmenopausal (n = 166) women. Total fat, lean mass, and BMD of total body, lumbar spine, and femoral neck were measured using dual energy x-ray absorptiometry. The association of BMD with FM was investigated after adjustment for total body mass (model 1) and lean mass (model 2) and potential confounding variables using multivariate linear regression models. RESULTS In model 1, FM was inversely associated with BMD for total body (B = -0.010; P < 0.01) and for femoral neck (B = -0.009 P < 0.05) in premenopausal women. No association between FM and BMD was observed in postmenopausal women. Model 2 yielded direct associations between FM and BMD (total and specific sites; B = 0.003-0.008; P < 0.01) in postmenopausal women only. CONCLUSIONS Independently of the adjustment used, the results of the present study suggest the absence of an inverse association between FM and BMD in postmenopausal women. Additionally, when adjusted for lean mass, a direct association between FM and bone mass can be observed, suggesting that for postmenopausal women being slightly obese does not confer excessive risk for bone loss and may even result in a bone density advantage.
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Affiliation(s)
- Amina Chain
- Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Instituto de Pesquisa e Capacitação Física do Exército, Rio de Janeiro, Brazil
| | - Marise Crivelli
- Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduardo Faerstein
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávia F Bezerra
- Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
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Mercuri EGF, Daniel AL, Hecke MB, Carvalho L. Influence of different mechanical stimuli in a multi-scale mechanobiological isotropic model for bone remodelling. Med Eng Phys 2016; 38:904-10. [PMID: 27215171 DOI: 10.1016/j.medengphy.2016.04.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/11/2016] [Accepted: 04/23/2016] [Indexed: 11/30/2022]
Abstract
This work represents a study of a mathematical model that describes the biological response to different mechanical stimuli in a cellular dynamics model for bone remodelling. The biological system discussed herein consists of three specialised cellular types, responsive osteoblasts, active osteoblasts and osteoclasts, three types of signalling molecules, transforming growth factor beta (TGF-β), receptor activator of nuclear factor kappa-b ligand (RANKL) and osteoprotegerin (OPG) and the parathyroid hormone (PTH). Three proposals for mechanical stimuli were tested: strain energy density (SED), hydrostatic and deviatoric parts of SED. The model was tested in a two-dimensional geometry of a standard human femur. The spatial discretization was performed by the finite element method while the temporal evolution of the variables was calculated by the 4th order Runge-Kutta method. The obtained results represent the temporal evolution of the apparent density distribution and the mean apparent density and thickness for the cortical bone after 600 days of remodelling simulation. The main contributions of this paper are the coupling of mechanical and biological models and the exploration of how the different mechanical stimuli affect the cellular activity in different types of physical activities. The results revealed that hydrostatic SED stimulus was able to form more cortical bone than deviatoric SED and total SED stimuli. The computational model confirms how different mechanical stimuli can impact in the balance of bone homeostasis.
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Affiliation(s)
- E G F Mercuri
- Department of Environmental Engineering, Federal University of Paraná, Curitiba, Brazil; Bioengineering Group, Post Graduate Program in Numerical Methods in Engineering, Federal University of Parana, Curitiba, Paraná, Brazil
| | - A L Daniel
- Bioengineering Group, Post Graduate Program in Numerical Methods in Engineering, Federal University of Parana, Curitiba, Paraná, Brazil
| | - M B Hecke
- Bioengineering Group, Post Graduate Program in Numerical Methods in Engineering, Federal University of Parana, Curitiba, Paraná, Brazil
| | - L Carvalho
- INESC-TEC and Faculty of Sciences of the University of Porto (FCUP), Rua do Campo Alegre, 687, 4150-179 Porto, Portugal.
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Ma L, Song Y, Li C, Wang E, Zheng D, Qu F, Zhou J. Bone turnover alterations across the menopausal transition in south-eastern Chinese women [corrected]. Climacteric 2016; 19:400-5. [PMID: 27147201 DOI: 10.1080/13697137.2016.1180677] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To explore the serum levels of bone resorption marker C-terminal telopeptide of type I collagen (CTX) and bone formation marker N-amino terminal propeptide of type I collagen (PINP) in Chinese women across the menopausal transition and the correlation between follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol with the bone turnover markers. METHODS A cross-sectional study was conducted on 464 healthy Chinese women, separated into pre-, peri- and postmenopausal groups based on their menstruation changes. The serum levels of CTX, PINP, FSH, LH, and estradiol were measured. RESULTS The serum levels of CTX and PINP were significantly higher in women in the peri- and postmenopausal groups. The serum levels of FSH were significantly correlated with the serum levels of PINP in premenopausal women. Both serum FSH and LH were positively correlated with serum CTX in perimenopausal women and postmenopausal women. Estradiol was inversely correlated with CTX in the perimenopausal group. Multiple linear regression models show the serum FSH levels were independently related to the bone turnover markers CTX and PINP. CONCLUSIONS The elevated serum levels of FSH were independent risk factors for bone loss in peri- and postmenopausal women, and measurement of the serum FSH levels in mid-age women with irregular menses could be used in early diagnosis of postmenopausal osteoporosis.
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Affiliation(s)
- L Ma
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
| | - Y Song
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
| | - C Li
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
| | - E Wang
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
| | - D Zheng
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
| | - F Qu
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
| | - J Zhou
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
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Abstract
Fractures in the elderly are increasing in incidence and becoming a major health issue in many countries. With an increasing number of the elderly living to an older age, the problems associated with fractures will continue to increase. We describe the epidemiology of fractures in the elderly and identify six fracture patterns in the population of patients who are sixty-five years of age or older. We also analyzed multiple fractures and open fractures in the elderly and we show that both increase in incidence with older age. The incidence of open fractures in elderly women is equivalent to that in young men. Many factors, including patient socioeconomic deprivation, increase the incidence of fractures in the elderly. More than 90% of fractures follow low-energy falls and the mortality is considerable. Mortality increases with older age and medical comorbidities, but there is also evidence that it relates to premature discharge from the hospital.
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Identification of Clinical and Functional Falls Risk Factors Among Low Bone Density Older Women. TOPICS IN GERIATRIC REHABILITATION 2016. [DOI: 10.1097/tgr.0000000000000100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abrahin O, Rodrigues RP, Marçal AC, Alves EAC, Figueiredo RC, de Sousa EC. Swimming and cycling do not cause positive effects on bone mineral density: a systematic review. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:345-51. [PMID: 27476628 DOI: 10.1016/j.rbre.2016.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 09/17/2015] [Indexed: 12/23/2022] Open
Abstract
Osteoporosis is considered a common metabolic bone disease and its prevalence is increasing worldwide. In this context, physical activity has been used as a non-pharmacological tool for prevention and auxiliary treatment of this disease. The aim of this systematic review was to evaluate the effects of cycling and swimming practice on bone mineral density (BMD). This research was conducted in accordance with the recommendations outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The studies were consulted in the period from 2004 to 2014, through major electronic databases: PubMed(®), SciELO(®) and LILACS(®). Ten studies evaluated the effects of cycling on BMD, and the results showed that nine studies have linked the practice of professional cycling with low levels of BMD. Another 18 studies have reported that swimming has no positive effects on bone mass. We conclude that cycling and swimming do not cause positive effects on BMD; thus, these are not the most suitable exercises for prevention and treatment of osteoporosis.
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Affiliation(s)
- Odilon Abrahin
- Postgraduate Program in Physical Education, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil; Resistive Exercise and Health Laboratory (Leres), Universidade do Estado do Pará, Belém, PA, Brazil.
| | - Rejane Pequeno Rodrigues
- Postgraduate Program in Physical Education, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil; Resistive Exercise and Health Laboratory (Leres), Universidade do Estado do Pará, Belém, PA, Brazil
| | - Anderson Carlos Marçal
- Postgraduate Program in Physical Education, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil
| | | | - Rosa Costa Figueiredo
- Resistive Exercise and Health Laboratory (Leres), Universidade do Estado do Pará, Belém, PA, Brazil
| | - Evitom Corrêa de Sousa
- Resistive Exercise and Health Laboratory (Leres), Universidade do Estado do Pará, Belém, PA, Brazil
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Paiva A, Yanagihara G, Macedo A, Ramos J, Issa J, Shimano A. Analysis of fracture healing in osteopenic bone caused by disuse: experimental study. Braz J Med Biol Res 2016; 49:S0100-879X2016000300708. [PMID: 26840708 PMCID: PMC4763822 DOI: 10.1590/1414-431x20155076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/09/2015] [Indexed: 12/02/2022] Open
Abstract
Osteoporosis has become a serious global public health issue. Hence, osteoporotic fracture healing has been investigated in several previous studies because there is still controversy over the effect osteoporosis has on the healing process. The current study aimed to analyze two different periods of bone healing in normal and osteopenic rats. Sixty, 7-week-old female Wistar rats were randomly divided into four groups: unrestricted and immobilized for 2 weeks after osteotomy (OU2), suspended and immobilized for 2 weeks after osteotomy (OS2), unrestricted and immobilized for 6 weeks after osteotomy (OU6), and suspended and immobilized for 6 weeks after osteotomy (OS6). Osteotomy was performed in the middle third of the right tibia 21 days after tail suspension, when the osteopenic condition was already set. The fractured limb was then immobilized by orthosis. Tibias were collected 2 and 6 weeks after osteotomy, and were analyzed by bone densitometry, mechanical testing, and histomorphometry. Bone mineral density values from bony calluses were significantly lower in the 2-week post-osteotomy groups compared with the 6-week post-osteotomy groups (multivariate general linear model analysis, P<0.000). Similarly, the mechanical properties showed that animals had stronger bones 6 weeks after osteotomy compared with 2 weeks after osteotomy (multivariate general linear model analysis, P<0.000). Histomorphometry indicated gradual bone healing. Results showed that osteopenia did not influence the bone healing process, and that time was an independent determinant factor regardless of whether the fracture was osteopenic. This suggests that the body is able to compensate for the negative effects of suspension.
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Affiliation(s)
- A.G. Paiva
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho
Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo,
Ribeirão Preto, SP, Brasil
| | - G.R. Yanagihara
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho
Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo,
Ribeirão Preto, SP, Brasil
| | - A.P. Macedo
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho
Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo,
Ribeirão Preto, SP, Brasil
| | - J. Ramos
- Departamento de Morfologia, Fisiologia e Patologia Básica, Faculdade
de Odontologia de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP,
Brasil
| | - J.P.M. Issa
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho
Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo,
Ribeirão Preto, SP, Brasil
| | - A.C. Shimano
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho
Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo,
Ribeirão Preto, SP, Brasil
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44
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Macedo AP, Shimano RC, Ferrari DT, Issa JPM, Jordão AA, Shimano AC. Influence of treadmill training on bone structure under osteometabolic alteration in rats subjected to high-fat diet. Scand J Med Sci Sports 2016; 27:167-176. [PMID: 26923426 DOI: 10.1111/sms.12650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2016] [Indexed: 01/02/2023]
Abstract
Nutrition and physical training have important roles in the accumulation and maintenance of bone mass. The aim of this study was to evaluate, in ovariectomized rats (OVX), the effects of treadmill training (T) with high-fat diet (F) on weight gain and bone tissue properties with eight groups (n = 10) for 12 weeks: OVX SC (OVX, sedentary lifestyle, diet control); OVX SF; OVX TC; OVX TF; SH SC (SHAM, sedentary lifestyle, diet control); SH SF; SH TC; and SH TF. Weekly weight gain and final body composition were assessed. After euthanasia, tibiae were analyzed. The trained animals had higher body weight (P = 0.001), bone mineral density (P < 0.001), and trabecular bone (P < 0.001). The animals with a high-fat diet showed higher global fat (P < 0.001), percentage of global fat (P < 0.001) and deformation at impact (P = 0.031) and reduced tibial bone mineral content (P = 0.036). Physical training improves bone microarchitecture, without presenting an increase in impact resistance, and a high-fat diet increases body fat and impairs bone mineralization.
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Affiliation(s)
- A P Macedo
- Bioengineering Laboratory, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - R C Shimano
- Bioengineering Laboratory, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - D T Ferrari
- Bioengineering Laboratory, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - J P M Issa
- Department of Morphology, Physiology and Basic Pathology, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - A A Jordão
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - A C Shimano
- Bioengineering Laboratory, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Abrahin O, Rodrigues RP, Marçal AC, Alves EAC, Figueiredo RC, Sousa ECD. Swimming and cycling do not cause positive effects on bone mineral density: a systematic review. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:S0482-5004(16)00026-7. [PMID: 26949150 DOI: 10.1016/j.rbr.2015.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 08/06/2015] [Accepted: 09/17/2015] [Indexed: 01/02/2023] Open
Abstract
Osteoporosis is considered a common metabolic bone disease and its prevalence is increasing worldwide. In this context, physical activity has been used as a non-pharmacological tool for prevention and auxiliary treatment of this disease. The aim of this systematic review was to evaluate the effects of cycling and swimming practice on bone mineral density (BMD). This research was conducted in accordance with the recommendations outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The studies were consulted in the period from 2004 to 2014, through major electronic databases: PubMed®, SciELO® and LILACS®. Ten studies evaluated the effects of cycling on BMD, and the results showed that nine studies have linked the practice of professional cycling with low levels of BMD. Another 18 studies have reported that swimming has no positive effects on bone mass. We conclude that cycling and swimming do not cause positive effects on BMD; thus, these are not the most suitable exercises for prevention and treatment of osteoporosis.
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Affiliation(s)
- Odilon Abrahin
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Sergipe, São Cristóvão, SE, Brasil; Laboratório de Exercício Resistido e Saúde (Leres), Universidade do Estado do Pará, Belém, PA, Brasil.
| | - Rejane Pequeno Rodrigues
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Sergipe, São Cristóvão, SE, Brasil; Laboratório de Exercício Resistido e Saúde (Leres), Universidade do Estado do Pará, Belém, PA, Brasil
| | - Anderson Carlos Marçal
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Sergipe, São Cristóvão, SE, Brasil
| | | | - Rosa Costa Figueiredo
- Laboratório de Exercício Resistido e Saúde (Leres), Universidade do Estado do Pará, Belém, PA, Brasil
| | - Evitom Corrêa de Sousa
- Laboratório de Exercício Resistido e Saúde (Leres), Universidade do Estado do Pará, Belém, PA, Brasil
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Yanagihara GR, Paiva AG, Gasparini GA, Macedo AP, Frighetto PD, Volpon JB, Shimano AC. High-impact exercise in rats prior to and during suspension can prevent bone loss. Braz J Med Biol Res 2016; 49:S0100-879X2016000300605. [PMID: 26840705 PMCID: PMC4763823 DOI: 10.1590/1414-431x20155086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/16/2015] [Indexed: 11/22/2022] Open
Abstract
High-impact exercise has been considered an important method for treating bone loss in osteopenic experimental models. In this study, we investigated the effects of osteopenia caused by inactivity in femora and tibiae of rats subjected to jump training using the rat tail suspension model. Eight-week-old female Wistar rats were divided into five groups (n=10 each group): jump training for 2 weeks before suspension and training during 3 weeks of suspension; jump training for 2 weeks before suspension; jump training only during suspension; suspension without any training; and a control group. The exercise protocol consisted of 20 jumps/day, 5 days/week, with a jump height of 40 cm. The bone mineral density of the femora and tibiae was measured by double energy X-ray absorptiometry and the same bones were evaluated by mechanical tests. Bone microarchitecture was evaluated by scanning electron microscopy. One-way ANOVA was used to compare groups. Significance was determined as P<0.05. Regarding bone mineral density, mechanical properties and bone microarchitecture, the beneficial effects were greater in the bones of animals subjected to pre-suspension training and subsequently to training during suspension, compared with the bones of animals subjected to pre-suspension training or to training during suspension. Our results indicate that a period of high impact exercise prior to tail suspension in rats can prevent the installation of osteopenia if there is also training during the tail suspension.
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Affiliation(s)
- G R Yanagihara
- Laboratório de Bioengenharia, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A G Paiva
- Laboratório de Bioengenharia, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - G A Gasparini
- Laboratório de Bioengenharia, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A P Macedo
- Laboratório de Bioengenharia, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - P D Frighetto
- Instituto Federal de Educação, Ciência e Tecnologia de São Paulo, São Paulo, SP, Brasil
| | - J B Volpon
- Laboratório de Bioengenharia, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A C Shimano
- Laboratório de Bioengenharia, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Farfel JM, Accorsi TAD, Franken M, Doudement SP, Moran M, Iervolino M, Bastos Neto AS. Adverse drug events leading to emergency department visits in elderly: the role of inappropriate prescription. EINSTEIN-SAO PAULO 2016; 8:175-9. [PMID: 26759999 DOI: 10.1590/s1679-45082010ao1473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Accepted: 04/12/2010] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Adverse drug reactions are more incident among the elderly and are frequently associated to inappropriate prescription for this group. The objective of the current study was to investigate the incidence and the characteristics of emergency department visits, related to inappropriate prescription, at the Hospital Israelita Albert Einstein. METHODS Patients aged 60 years or older, admitted to the emergency department at Unidade Avançada Ibirapuera of Hospital Israelita Albert Einstein, were included in the study. Potentially inappropriate medication for the elderly was evaluated using updated 2003 Beers criteria. RESULTS Over a period of 6 months, 214 individuals were included in the study, being 53.7% male. The mean age was 70.8 years (60-107). A total of 48 registries of inappropriate prescription were recorded in 42 patients (19.6% of sample). An emergency visit related to adverse drug event was verified in 27 individuals (12.5% of the sample). From these patients, 34.5% were admitted to the emergency department because of an adverse event caused by an inappropriate medication. CONCLUSION Inappropriate prescription is frequent among elderly patients admitted to emergency department. A surveillance system and a program to educate physicians on the most recent criteria of appropriate prescription may help reducing emergency visits and adverse drug events in the elderly population.
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Affiliation(s)
- José Marcelo Farfel
- Advanced Unit Ibirapuera, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | | | - Marcelo Franken
- Advanced Unit Ibirapuera, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | - Sueli Pinto Doudement
- Advanced Unit Ibirapuera, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | - Mariane Moran
- Advanced Unit Ibirapuera, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | - Mauro Iervolino
- Advanced Unit Ibirapuera, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
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Late skeletal effects of early menopause. Menopause 2015; 22:1027-9. [DOI: 10.1097/gme.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Cançado BL, Miranda LC, Madeira M, Farias MLF. Importance of bone assessment and prevention of osteoporotic fracture in patients with prostate cancer in the gonadotropic hormone analogues use. Rev Col Bras Cir 2015; 42:62-6. [PMID: 25992703 DOI: 10.1590/0100-69912015001012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/20/2014] [Indexed: 11/22/2022] Open
Abstract
The antiandrogenic therapy (ADT) for prostate cancer represents an additional risk factor for the development of osteoporosis and fragility fractures. Still, bone health of patients on ADT is often not evaluated. After literature research we found that simple preventive measures can prevent bone loss in these patients, resulting in more cost-effective solutions to the public health system and family when compared to the treatment of fractures.
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Affiliation(s)
| | | | - Miguel Madeira
- Departament of Endocrinology, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Lucia Fleiuss Farias
- Departament of Endocrinology, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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50
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Copês RM, Comim FV, Langer FW, Codevilla AADS, Sartori GR, de Oliveira C, Cocco AR, de Almeida AM, de Almeida LL, Dal Osto LC, Compston JE, Premaor MO. Obesity and Fractures in Postmenopausal Women: A Primary-care Cross-Sectional Study at Santa Maria, Brazil. J Clin Densitom 2015; 18:165-71. [PMID: 25534276 DOI: 10.1016/j.jocd.2014.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 09/26/2014] [Indexed: 01/14/2023]
Abstract
Obesity and osteoporosis are chronic disorders with increasing prevalence worldwide. The aim of this study was to investigate the association between obesity and fracture in postmenopausal women from Santa Maria, Brazil. A cross-sectional study was carried out at Santa Maria (parallel 29° south), Brazil. Postmenopausal women aged ≥55 yr who had at least 1 appointment at the primary care in the 2 years before the study were recruited from March 1, 2013 to August 31, 2013. The Global Longitudinal Study of Osteoporosis in Women study questionnaire was applied with permission of The Center for Outcomes Research, University of Massachusetts Medical School. Height and weight were measured according to the World Health Organization protocol. Bone fractures (excluding hand, feet, and head) that occurred after the age of 45 yr were considered as the outcome. Overall, 1057 women completed the study, of whom 984 had body mass index measured. The mean (standard deviation) age and body mass index of the women included in the study were 67.1 (7.6) yr and 29.2 (5.5) kg/m(2), respectively. The prevalence of fractures in obese and nonobese women was similar (17.3% vs 16.0%); 41.4% of all fractures occurred in obese women. Obese postmenopausal women make a substantial contribution to the overall burden of prevalent fractures in this population. Our results provide further evidence in support of the concept that obesity is not protective against fracture.
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Affiliation(s)
- Rafaela Martinez Copês
- Pós-graduação em Ciências da Saúde, Federal University of Santa Maria, Santa Maria, Brazil; Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Fabio Vasconcellos Comim
- Pós-graduação em Ciências da Saúde, Federal University of Santa Maria, Santa Maria, Brazil; Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Felipe Welter Langer
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Giovani Ruviaro Sartori
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Cristina de Oliveira
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Aline Rubin Cocco
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Adriana Maria de Almeida
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Luciana Leiria de Almeida
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Léo Canterle Dal Osto
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Melissa Orlandin Premaor
- Pós-graduação em Ciências da Saúde, Federal University of Santa Maria, Santa Maria, Brazil; Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil.
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