The burden of fractures in Brazil: a population-based study

Secular trends in hip fractures in adults over 50 years old: a retrospective analysis of hospital admissions to the Brazilian Public Health System from 2004 to 2013

This was a retrospective observational study to determine the secular trends in osteoporosis hip fractures in Brazil from 2004 to 2013. The fracture rates were stable for both sexes, and there was not a secular trend. Fractures were predominant in the South and Southeast Regions. The hip fracture rate was lower in this study than in other studies. These regional differences may be considered in the FRAX Brazil calibration.

PURPOSE

Hip fractures are well-known osteoporotic fractures with high mortality and morbidity. Epidemiological studies in Brazil on hip fractures are scarce, and the great majority have been performed in small populations from a few cities. None of these studies has analyzed the long-term hip fracture secular trends, which are important data for the promotion of public health actions.

METHODS

This was a retrospective observational study with a secular trend analysis in patients over 50 years old who were admitted to the Brazilian Public Health System from 2004 to 2013. We collected hospitalization data according to the ICD-10 for low-trauma hip fractures. The fracture rate was calculated when the patients were stratified by sex, age, and geographic region, and linear regression analysis was performed to evaluate the secular trends.

RESULTS

The hip fracture rate per 100,000 inhabitants was 59.69; the rate was 74.72 in females and 42.95 in males. The fracture rates were higher in the South and Southeast Regions and steadily increased with age, and the average ratio of women-to-men was 1.74. No secular trend was detected in the overall population. Surprisingly, the secular trend only increased in the South region from 2004 to 2013, and the secular trends were stable in the other regions.

CONCLUSION

Although the secular trend was similar to some worldwide studies, the hip fracture rate was lower than that previously observed in regional studies in Brazil. These regional differences may be considered in the FRAX Brazil calibration.

Association Between Socioeconomic and Demographic Characteristics and Non-fatal Alcohol-Related Injury in Maringá, Brazil

Background: Previous research has corroborated a high burden of alcohol-related injury in Brazil and the presence of socioeconomic disparities among the injured. Yet, individual-level data is scarce. To fill this gap, we examined the association between demographic and socioeconomic characteristics with non-fatal alcohol-related injury in Maringá, Brazil.

Methods: We used household survey data collected during a 2015 cross-sectional study. We conducted univariate and multivariate analyses to evaluate associations of demographic (age, gender, race) and socioeconomic characteristics (employment, education, income) with non-fatal alcohol-related injury.

Results: Of the 995 participants who reported injuries, 62 (6.26%) were alcohol-related. Fifty-three (85%) alcohol-related injuries were reported by males. Multivariate analysis indicated being male (OR = 5.98 95% CI = 3.02, 13.28), 15–29 years of age (OR = 3.62 95% CI = 1.72, 7.71), and identifying as Black (OR = 2.38 95% CI = 1.09, 4.95) were all significantly associated with increased likelihood of reporting an alcohol-related injury, whereas unemployment was significantly associated with decreased likelihood of reporting an alcohol-related injury (OR = 0.41 95% CI = 0.18, 0.88).

Conclusion: Our findings suggest that in Maringá, being male, between the ages of 15 and 29, employed, or identifying as Black were characteristics associated with a higher risk for non-fatal alcohol-related injury. Individual level data, such as ours, should be considered in combination with area-level and country-level data when developing evidence-based public-health policies.

Prevalence of falls and associated factors in community-dwelling older Brazilians: a systematic review and meta-analysis

Falls determine huge epidemiological, clinical, and economic burden in the older population worldwide, presenting high odds of severe disability. The present study aimed to estimate the prevalence of falls and associated factors in older Brazilians using a systematic review with meta-analysis. Searches were performed in SciELO, PubMed, LILACS, Web of Science, Scopus and PsycINFO databases with no date or language restrictions. Studies on community-dwelling older persons aged ≥ 60 years from both sexes and with a sample size of ≥ 300 participants included. Exclusion criteria were studies conducted specifically for older adults diagnosed with chronic disabling diseases that predispose them to falls. Risk of bias of included studies was assessed using a critical appraisal tool focusing on prevalence designs. A random-effects meta-analysis was used to pool the prevalence of falls across studies. Exploratory analysis was conducted examining subgroup estimates, prevalence ratios and meta-regression. Thirty-seven studies involving 58,597 participants were included. Twelve-month prevalence of falls was 27% (95%CI: 24.3-30.0), with significantly higher estimates in female than male (PR = 1.57; 95%CI: 1.32-1.86), in age group ≥ 80 years than age group 60-69 years (PR = 1.46; 95%CI: 1.15-1.84), and in participants from the Central region than participants from the South region (PR = 1.36; 95%CI: 1.10-1.69) of Brazil. Risk of bias scores did not impact heterogeneity in the 12-month meta-analysis. These estimates strongly support evidence-based public interventions to prevent falls in older Brazilians, especially in women and the oldest-old population.

Incidence and excess mortality of hip fractures in a predominantly Caucasian population in the South of Brazil

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.

EPIDEMIOLOGY OF FEMUR FRACTURES IN THE ELDERLY AND COST TO THE STATE OF PARANÁ, BRAZIL

Objectives:

To evaluate the incidence and economic impact of femur fractures in the state of Paraná, Brazil .

Methods:

This descriptive study included men and women ≥ 60 years of age with hip fractures which were treated by the Public Health System in emergency care from January 2010 to December 2014. Data were collected from the DATASUS public health database using filters to select patients; results were presented descriptively and as proportions. The standardized incidence of femur fracture was calculated by sex and age for 10,000 inhabitants in Paraná state and in Brazil for the year 2012 .

Results:

During the study period, 11,226 fractures were registered, 66.8% in women and 33.2% in men. There was a preponderance of fractures in Caucasians and in older age groups. Mortality during hospitalization was 5.9%, higher in males, in patients aged ≥80 years, and in Blacks and Asians. The total cost was R$ 29,393,442.78 and the average cost per hospitalization was R$ 2,618.34. The eastern region of the state had the highest rate of fractures, predominantly in the capital, Curitiba. The standardized incidence rate was higher in females and in the population of Paraná .

Conclusion:

Femur fractures have a high incidence rate in the elderly population of Paraná and a large economic impact. Level of Evidence II, Prognostic Studies Investigating the effect of a Patient Characterisctic on the Outcome of Disease.

Quality of life and associated morbidities among elderly persons registered with the Family Health Strategy of Senador Guiomard in the state of Acre

Objectives: To verify the prevalence of a low quality of life and analyze the morbidities associated with such a condition among elderly persons registered with the Family Health Strategy of the municipality of Senador Guiomard. Method : A cross-sectional study was performed of elderly persons registered with the Family Health Strategy in the urban area of the municipality of Senador Guiomard in the state of Acre. A comparison between men and women regarding morbidities and quality of life was performed using Pearson's chi-squared test. The associations between the tertiles of quality of life and morbidities were estimated by odds ratio through multivariate logistic regression analysis. Results : There were differences between men and women in the reporting of hypertension (p=0.015), diabetes (p=0.033), in the psychological domain (p=0.009) and in total quality of life (<0.001). Elderly people classified in the lower tertile of the physical and social domains of quality of life were more likely to suffer from hypertension, cardiovascular disorders and anemia. Those in the lower tertile of the psychological domain were also more likely to suffer from hypertension, cardiovascular disorders and insomnia, as well as anemia. Elderly individuals in the lower overall tertile were more likely to suffer from hypertension, cardiovascular disorders, insomnia and anemia. No statistically significant associations were found for the environmental domain. Conclusion : The total quality of life and the physical, psychological and social domains of quality of life can be considered good indicators of the described morbidities among the elderly. The environmental domain, however, was not a useful indicator.

Expenditures on the treatment of osteoporosis in the elderly in Brazil (2008 - 2010): analysis of associated factors

Objective: To analyze the expenditure of the Ministry of Health with osteoporosis treatment in the Brazilian Public Health System (SUS) in 2008-2010 triennium and estimate the influence of demographic, regional and disease related variables on average expenditure per procedures performed. Methods: A cross-sectional, descriptive and analytical study based on secondary data from DATASUS related to procedures for the elderly with a diagnosis of osteoporosis and related fractures. For the statistical analysis and multivariate model, Stata 11.0 was used. Results: According to the findings, 3,252,756 procedures related to the osteoporosis treatment among the elderly were carried out in Brazil during the 2008 - 2010 period, totalizing R$ 288,986,335.15. The age group that most had procedures was 60 - 69 years (46.3%); the population of 80 years or older showed the highest spending per procedure, around R$ 106 million in three years. The women were majority in terms of quantity (95.6%) and expense (76%) of procedures. The average cost per procedure showed a large gap between men and women, nearly 7 times (R$ 480.14 versus R$ 70.85, respectively). The ambulatory care procedures predominated in quantity (96.4%) and the hospital procedures predominated in resources (70.4%). It was found that there is no single standard for groups of procedures when these are analyzed separately. Conclusion: A disaggregated analysis of expenditure by procedures groups extracted from the SUS Management System of the Table of Procedures, Medicines, Orthotics, Prosthetics and Special Materials allowed a detailed overview of federal spending on the osteoporosis treatment in the elderly from Brazil.

The burden of osteoporosis in Brazil

Osteoporotic fractures impose severe physical, psychosocial, and financial burden both to the patient and the society. Studies on the prevalence of osteoporosis and fragility fractures in Brazil show a wide variation, due to differences in sample size, the population studied, and methodologies. Few studies have been conducted in Brazil about the cost-effectiveness analyses of different intervention options aimed at the diagnosis and treatment of osteoporosis. Investigation and treatment strategies based on cost-effectiveness and scientific evidence are essential in the preparation of public health policies with the ultimate goal of reducing the incidence of fractures and, consequently, the direct and indirect costs associated with them. This article reviews the Brazilian burden of osteoporosis in terms of the prevalence and fractures attributable to the disease, the costs related to the investigation and management, as well as the impact of osteoporosis on the population as a whole and on affected individuals.

[Falls and associated factors in institutionalized elderly people in Pelotas (RS, Brazil)]

The ageing of the population generates interest among health professionals, because of its importance for health. A cross-sectional study was carried out including institutionalized subjects aged over 65 from Pelotas (RS, Brazil). The aim was to investigate the prevalence of falls and associated factors. The prevalence of falls was 33.5%; the most frequent place in which falls occurred was the bedroom (37%). Of all falls, 16.9% resulted in a fracture. Approximately 70% of the falls took place at the institution in which the subjects live. Ankles and hips were the most frequently anatomic sites fractured (33,3%). The prevalence of falls among the elderly was high and the consequences of such falls are worrying. Prevention strategies by healthcare professionals and managers are urgently needed in order to minimize the burden of falls and thus enhance the quality of life of institutionalized elderly people.

Osteoporosis and fragility fractures

The prevalence of osteoporosis is expected to increase with the ageing of the world's population. This article reviews the epidemiology, risk factors and health burden of osteoporosis. In the Global Burden of Disease (GBD) Study 2005, osteoporosis is studied as a risk factor for fracture by considering the bone-mineral-density (BMD) measurement as the continuous exposure variable. We have performed a systematic review seeking population-based studies with BMD data measured by dual-X-ray absorptiometry (DXA). The femoral neck was selected as the unique location and all values were converted into Hologic(®) to enable inclusion of worldwide data for analysis. Provisional results on mean BMD values for different world regions are shown in age breakdowns for males and females 50 years or over, as well as mean T-scores using the young, white, female reference of National Health and Nutrition Examination Survey (NHANES) III. Results show remarkable geographical differences and a time trend towards improvement of the BMD values in Asian and European populations.

Prevalence of falls in elderly in Brazil: a countrywide analysis

We conducted a cross-sectional study of a sample of 6,616 elderly living in urban areas of 100 municipalities in 23 Brazilian states, who responded to questions on the occurrence of falls in the 12 months prior to the interview, and occurrence of fractures due to the falls. The prevalence of falls among the elderly was 27.6% (95%CI: 26.5-28.7). Among those reporting falls, 11% had suffered fractures as a result. Of the elderly, 36% had received guidance about the precautions necessary to prevent falls, and about 1% had required surgery. Falls were associated with female gender, older age, low socioeconomic status, obesity and sedentary lifestyles. The prevalence of falls differed significantly between the North and other regions of Brazil. The study shows a high prevalence of falls, and underlines the need for preventive strategies targeting modifiable risk factors.

Osteoporotic fractures in the Brazilian community-dwelling elderly: prevalence and risk factors

The risk of osteoporotic fractures is known to vary among populations. There are no studies analyzing concomitantly clinical, densitometric, and lab risk factors in miscigenated community-dwelling population of Brazil. A total of 1007 elderly subjects (600 women and 407 men) from São Paulo, were evaluated using a questionnaire that included risk factors for osteoporotic fractures. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the hip and lumbar spine. Laboratory blood tests were also obtained. The prevalence of osteoporotic fractures was 13.2% (133 subjects), and the main fracture sites were distal forearm (6.0%), humerus (2.3%), femur (1.3%), and ribs (1.1%). Women had a higher prevalence (17.5%; 95% confidence interval [CI]: 14.6-20.6) than men (6.9%; 95% CI: 4.4-9.3) (p<0.001). After adjusting for significant variables, logistic regression revealed that female gender (odds ratio [OR]=2.7; 95% CI; 1.6-4.5; p<0.001), current smoking (OR=1.9; 95% CI: 1.2-3.3; p=0.013), and the femoral neck T-score (OR=0.7; 95% CI: 0.5-0.9; p=0.001) remain significant risk factors for osteoporotic fractures in the community-dwelling elderly. Our findings identified that female gender, current smoking, and low hip BMD are independent risk factors for osteoporotic fractures.

Epidemiology of osteoporotic fractures in Brazil: what we have and what we need

The epidemiology of osteoporotic fractures varies widely among countries and is primarily related to differences in the population and utilization of public healthcare services. Since 1994, over 200 studies about osteoporosis and fractures have been conducted in Brazil, among which 60 have described the current epidemiological status. This work is a compilation of studies published in scientific journals (PubMed, MedLine, Lilacs, SciELO Database) with the respective highlights. Overall, these studies show moderate incidence of hip fracture in subjects over 50 years old. However, the prevalence of all types of bone fragility fracture is higher, ranging from 11% to 23.8%. In addition, there is a high incidence of recurrent falls, which are the main extra-skeletal factor associated with these fractures. According to the national studies, 12 months after femoral fractures, the mortality rate ranged between 21.5% and 30%, and there was also a high rate of physical impairment, deterioration of the quality of life and excessive burden to the healthcare system. Considering its high prevalence and associated mortality and physical impairment, osteoporosis and its main consequence, bone fragility fractures, must be considered a major public health problem in our country.

Prevalência de diagnóstico auto-referido de osteoporose, Brasil, 2006

OBJETIVO: Estimar a prevalência de osteoporose auto-referida (com diagnóstico médico prévio) e de fatores de risco e proteção associados. MÉTODOS: Estudo transversal baseado em dados do sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL). Foram entrevistados 54.369 indivíduos com idade >18 anos residentes em domicílios servidos por pelo menos uma linha telefônica fixa nas capitais brasileiras e Distrito Federal em 2006. Estimativas de osteoporose segundo fatores socioeconômicos, comportamentais e índice de massa corporal foram estratificadas por sexo. Foram calculados riscos de ocorrência de osteoporose para cada variável individualmente, e em modelo multivariado, considerando-se odds ratio como proxy da razão de prevalência. RESULTADOS: A prevalência de osteoporose referida foi de 4,4%, predominantemente entre mulheres (7,0%), com idade >45 anos, estado civil não solteiro e ex-fumante. Entre homens, ter mais de 65 anos, ser casado ou viúvo e sedentário associaram-se positivamente ao desfecho. CONCLUSÕES: Dentre os fatores associados à osteoporose, destacam-se aspectos modificáveis relacionados com a prevenção da doença, como a atividade física e tabagismo.

The role of early life variables on the risk of fractures from birth to early adolescence: a prospective birth cohort study

In a prospective cohort from Brazil, we evaluated the incidence of fractures from birth to early adolescence and examined risk factors for fractures. The incidence was 14.2% (95%CI 13.2, 15.2). Male sex, birth length, and maternal age at delivery were positively associated with the risk of fractures.

INTRODUCTION

This study aims to evaluate the incidence of fractures from birth to 11 years of age and to explore the effect of early life variables on the risk of fractures.

METHODS

All children (N = 5,249) born in 1993 in the city of Pelotas, Brazil were enrolled in a prospective birth cohort study. In 2004-2005, 87.5% of the cohort members were sought for a follow-up visit. History of fractures, including anatomic site and age of the fracture were asked to mothers.

RESULTS

The incidence of fractures from birth to 11 years of age was 14.2% (95%CI 13.2, 15.2). Out of the 628 subjects who experienced a fracture, 91 reported two and only 20 reported three or more fractures. Male sex, birth length, and maternal age at delivery were positively associated with the risk of fractures. No consistent associations were found for family income, maternal body mass index, smoking during pregnancy, and birth weight.

CONCLUSIONS

Birth length seems to have long-term effect on musculoskeletal health. The higher risk of fractures among children of older mothers needs to be confirmed by other studies. In accordance to the developmental origins of diseases, fractures seem to be, at least in part, programmed in early life.

FRAX TM: construindo uma ideia para o Brasil

Diferenças genéticas, raciais e antropométricas, bem como da composição corporal, densidade óssea, dieta, atividade física e outros hábitos de vida, contribuem para explicar as divergências na incidência e prevalência de baixa densidade óssea e fraturas em diversos países do mundo. Recentemente, foi desenvolvida uma ferramenta, denominada FRAX TM, para aglutinar os fatores clínicos de risco (genéticos e ambientais) e a densidade óssea, a fim de quantificar a probabilidade de fratura osteoporótica nos próximos dez anos. Em breve, ela será utilizada para indicação de tratamento em pacientes de risco. No entanto, atualmente, está disponível somente para uso em algumas populações que possuem banco de dados prospectivos e consistentes - o que não inclui o Brasil. Este estudo teve o objetivo de fazer uma revisão dos estudos epidemiológicos nacionais e internacionais para melhor compreender peculiaridades e diferenças de fatores clínicos de risco, densidade óssea e probabilidade de fratura entre essas populações. Os autores concluíram que se faz necessária a obtenção de mais dados epidemiológicos representativos da população brasileira para utilização da ferramenta FRAX TM. Para isso, os estudos brasileiros deverão possuir características adequadas, como o delineamento prospectivo, avaliação da qualidade de vida, mortalidade e incapacidade física após as fraturas, levando em consideração a expectativa de vida da população brasileira e a análise de custos diretos e indiretos relacionados às fraturas por osteoporose. À luz do conhecimento atual, a utilização de qualquer um dos bancos de dados das populações, disponibilizadas pelo FRAX TM, não é recomendada no Brasil.

Clinical risk factors for osteoporotic fractures in Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS)

The Brazilian Osteoporosis Study (BRAZOS) is the first epidemiological study carried out in a representative sample of Brazilian men and women aged 40 years or older. The prevalence of fragility fractures is about 15.1% in the women and 12.8% in the men. Moreover, advanced age, sedentarism, family history of hip fracture, current smoking, recurrent falls, diabetes mellitus and poor quality of life are the main clinical risk factors associated with fragility fractures.

INTRODUCTION

The Brazilian Osteoporosis Study (BRAZOS) is the first epidemiological study carried out in a representative sample of Brazilian men and women aged 40 years or older with the purpose of identifying the prevalence and the main clinical risk factors (CRF) associated with osteoporotic fracture in our population.

METHODS

A total of 2,420 individuals (women, 70%) from 150 different cities in the five geographic regions in Brazil, and all different socio-economical classes were selected to participate in the present survey. Anthropometrical data as well as life habits, fracture history, food intake, physical activity, falls and quality of life were determined by individual quantitative interviews. The representative sampling was based on Brazilian National data provided by the 2000 and 2003 census. Low trauma fracture was defined as that resulting of a fall from standing height or less in individuals 50 years or older at specific skeletal sites: forearm, femur, ribs, vertebra and humerus. Sampling error was 2.2% with 95% confidence intervals. Logistic regression analysis models were designed having the fragility fracture as the dependent variable and all other parameters as the independent variable. Significance level was set as p < 0.05.

RESULTS

The average of age, height and weight for men and women were 58.4 +/- 12.8 and 60.1 +/- 13.7 years, 1.67 +/- 0.08 and 1.56 +/- 0.07 m and 73.3 +/- 14.7 and 64.7 +/- 13.7 kg, respectively. About 15.1% of the women and 12.8% of the men reported fragility fractures. In the women, the main CRF associated with fractures were advanced age (OR = 1.6; 95% CI 1.06-2.4), family history of hip fracture (OR = 1.7; 95% CI 1.1-2.8), early menopause (OR = 1.7; 95% CI 1.02-2.9), sedentary lifestyle (OR = 1.6; 95% CI 1.02-2.7), poor quality of life (OR = 1.9; 95% CI 1.2-2.9), higher intake of phosphorus (OR = 1.9; 95% CI 1.2-2.9), diabetes mellitus (OR = 2.8; 95% CI 1.01-8.2), use of benzodiazepine drugs (OR = 2.0; 95% CI 1.1-3.6) and recurrent falls (OR = 2.4; 95% CI 1.2-5.0). In the men, the main CRF were poor quality of life (OR = 3.2; 95% CI 1.7-6.1), current smoking (OR = 3.5; 95% CI 1.28-9.77), diabetes mellitus (OR = 4.2; 95% CI 1.27-13.7) and sedentary lifestyle (OR = 6.3; 95% CI 1.1-36.1).

CONCLUSION

Our findings suggest that CRF may contribute as an important tool to identify men and women with higher risk of osteoporotic fractures and that interventions aiming at specific risk factors (quit smoking, regular physical activity, prevention of falls) may help to manage patients to reduce their risk of fracture.

Effects of short-term risedronate on bone resorption and patient satisfaction in postmenopausal osteoporosis patients

This multicenter, open-label study evaluated the effects of short-term risedronate on bone resorption and patient satisfaction in postmenopausal women with osteoporosis in Brazil. Entry requirements included: osteoporosis of the spine/femoral neck diagnosed by a bone mineral density (BMD) T-score<or=-2.5 or radiographic fragility fracture within the last year and no treatment with osteoporosis medication in the preceding 3 mo. Patients were treated with once weekly risedronate of 35 mg for 12 wk. Patients also received 1000 mg calcium carbonate and 400 IU vitamin D. The main outcome was the effect on bone resorption, as assessed by the quantification of serum C-telopeptide of type I collagen (CTX). Of the 556 women screened, 480 women received >or=1 dose of study drug (intent-to-treat [ITT] population), and 390 completed treatment (81%). After 12 wk, CTX decreased in 94% of patients (from 0.419+/-0.234 to 0.158+/-0.171 microg/L, p<0.0001). Mean CTX reduction was 60.6%. Patient satisfaction was good/excellent in 91.7% of patients. A total of 156 adverse events (AEs) were reported by 113 (23.5%) patients in the ITT population. Digestive symptoms emerged or worsened in 7.1% and 3.5%, respectively. Five patients (1.0%) experienced serious AEs, not considered to be related to risedronate. In conclusion, risedronate significantly reduced serum CTX after 12-wk treatment. Almost all patients reported good/excellent satisfaction.

Aconselhamento para a prática de atividade física como estratégia de educação à saúde

O estudo descreve a prevalência de aconselhamento educativo à saúde relacionado à atividade física entre as pessoas que utilizaram alguma vez na vida uma unidade básica de saúde, e verifica alguns fatores associados. Estudo com delineamento transversal e amostra aleatória de indivíduos adultos (N = 4.060) e idosos (N = 4.003), moradores em áreas de abrangência de unidades de saúde, em 41 municípios de sete estados das regiões Sul e Nordeste do Brasil. A prevalência de aconselhamento relacionado à atividade física foi de 28,9% (IC95%: 27,3-30,4) entre os adultos e de 38,9% (IC95%: 37,3-40,6) entre os idosos. A prevalência do desfecho foi sempre maior entre os idosos na região Nordeste, e nos adultos e idosos atendidos pelo Programa Saúde da Família. Sexo, padrão de consumo sócio-econômico, tabagismo, sedentarismo, diagnóstico médico de doenças crônicas e uso de medicação contínua também estiveram associados ao desfecho. O aconselhamento à prática de atividade física nas unidades básicas de saúde foi pouco utilizado frente às necessidades dos indivíduos, principalmente em termos de estimular hábitos de vida saudáveis. É necessário melhorar a participação dos profissionais das diferentes áreas do conhecimento na condução de aconselhamentos em saúde.

Prevalência de quedas em idosos asilados do município de Rio Grande, RS

OBJETIVO: O aumento da expectativa de vida nos países em desenvolvimento tem provocado preocupação com a qualidade de vida e o bem-estar dos idosos, principalmente a ocorrência de quedas. Nesse sentido, o objetivo do estudo foi descrever a prevalência de quedas em idosos que vivem em asilos e fatores associados. MÉTODOS: Estudo de delineamento transversal na cidade de Rio Grande (RS), em 2007. Participaram 180 indivíduos idosos (65 anos ou mais) residentes em asilos para acolhimento. Em entrevista, os idosos responderam a questões de instrumento pré-testado sobre a ocorrência de quedas. Além de análise bivariada (Wald), foi realizada análise por regressão de Poisson com cálculo de razões de prevalência e intervalos de confiança de 95%, ajustada para as variáveis de confusão. RESULTADOS: A prevalência de quedas entre os idosos asilados estudados foi de 38,3%. As quedas foram mais comuns no ambiente do asilo (62,3%), sendo o quarto o ambiente onde ocorreu o maior número de quedas (23%). Na análise ajustada, as quedas se mantiveram associadas com cor da pele branca, com os idosos separados e divorciados, com depressão, e maior quantidade referida de medicamentos para uso contínuo. CONCLUSÕES: O estudo mostra que a prevalência de quedas entre idosos asilados é alta. Embora alguns dos possíveis fatores associados sejam passíveis de prevenção, ainda ocorrem quedas em locais que deveriam ser considerados seguros, como o quarto do idoso.

Mortality within 1 year after hip fracture surgical repair in the elderly according to postoperative period: a probabilistic record linkage study in Brazil

OBJECTIVE

The purpose of this study was to assess, by applying probabilistic record linkage (PRL) methodology, the excess mortality and underlying causes of death in a cohort of elderly patients who underwent hip fracture surgical repair during 1995 in Rio de Janeiro, Brazil.

DISCUSSION

We searched the Brazilian Hospital Admission Information System (HAIS) for the city of Rio de Janeiro, identifying all cases of elderly patients who had hip fracture surgery between January 1 and December 31, 1995, and by means of the PRL methodology and RecLink software, crosslinked those data with the Brazilian Mortality Information System (MIS) for the same region for a follow-up period of 1 year. We calculated age- and gender-adjusted standardized mortality ratios (SMR) for three periods of time-1-30 days, 31-90 days, and 91-365 days after hospital admission-and analyzed the basic cause of death as reported in the death certificates and noted the death occurred at the index admission or after hospital discharge.

RESULTS

We found an overall 21.5% (95% CI 18.2-24.9) mortality rate in 1 year and a statistically significant SMR of 1,080 (95% CI 794-1450) and 512.8 (95% CI 366.4-698.3) for the first two periods, 1-30 days and 31-90 days after hospital admission, respectively. For the last period the SMR displayed a statistically nonsignificant trend of 137 (95% CI 99-183). Even in the first 15 days after the index hospital admission, most deaths (55.1%) occurred after hospital discharge, reinforcing the importance of linking hospital mortality databases with general population mortality information systems. The leading three basic causes of death, as reported in death certificates, were cardiovascular events, falls, and infections. This study represents an example of the application of PRL methodology to produce relevant data on hip fracture, a subject of rising epidemiological importance in developing countries.