Osteopenia and osteoporosis among treatment-experienced people living with HIV

Abstract Introduction Life expectancy of people living with human immunodeficiency (PLHIV) has increased mainly due to the accessibility and effectiveness of antiretroviral therapy (ART). However, adverse effects from long-term use of antiretrovirals, and the physiological changes associated with aging, may compromise the quality of life of PLHIV, in addition to causing new demands on the healthcare system. Objectives Estimate the frequency of osteoporosis and osteopenia in patients on prolonged ART and to verify their associated factors. Methods A cross-sectional study was conducted in Belo Horizonte, Minas Gerais, Brazil, from August 2017 to June 2018, in a sample of PLHIV (age≥18 years) who started ART between 2001 and 2005. Data were collected through face-to-face interviews, physical evaluation, laboratory tests, and Dual-Energy X-Ray Absorptiometry Screening (DEXA). The outcome of interest was presence of bone alteration, defined as presence of osteopenia or osteoporosis in DEXA. The association between the explanatory variables and the event was assessed through odds ratio (OR) estimate, with 95% confidence interval (CI). Multiple logistic regression was performed to evaluate factors independently associated with bone alteration. Results Among 92 participants, 47.8% presented bone alteration (19.6% osteoporosis and 28.2% osteopenia). The variables that remained in the final logistic regression model were age ≥ 50 years (OR: 12.53; 95% CI: 4.37-35.90) and current alcohol use (OR: 2.63; 95% CI: 0.94-7.37). Conclusions This study showed a high frequency of bone changes, especially in PLHIV older than 50 years. This information is useful to stimulate the screening and timely intervention of this comorbidity of PLHIV on prolonged use of ART in order to prevent or minimize complications and new demands on the healthcare system.

Efeito de um protocolo de exercícios realizado em ambientes domiciliar e clínico para prevenir o risco de quedas em idosos comunitários / Effect of an exercise protocol performed at home and clinical environments to prevent falls in elderly community residents

As quedas estão dentre as principais causas de morbimortalidade na população idosa. As causas são multifatoriais, incluindo fatores intrínsecos e extrínsecos. A probabilidade para queda aumenta à medida que se acumulamos fatores de risco. O objetivo deste estudo foi analisar o efeito de um protocolo de exercícios para treinamento de equilíbrio e fortalecimento muscular no risco de quedas em idosos,em ambiente domiciliar e clínico. Neste estudo quase experimental com abordagem quantitativa, realizado no domicílio dos idosos e nas Clínicas Integradas de Fisioterapia da Universidade de Itaúna, foram incluídos 20 idosos com idade ≥ 70 anos, residentes na comunidade e divididos em dois grupos: IC (Intervenção na Clínica)e ID (Intervenção Domiciliar). Instrumentos utilizados: Escala de Equilíbrio de Berg, Timed Get Up and GO, Mini Mental, Perfil de Saúde de Nottingham, Escala de Depressão Geriátrica e Questionário Clínico e Demográfico. Os resultados mostraram melhora em ambos os grupos no aspecto equilíbrio. O grupo ID melhorou também no aspecto qualidade de vida (p < 0,05). Comparando os dois grupos, foi observado melhora significativa no aspecto risco de quedas no grupo IC. Concluiu-se que o atendimento em ambiente domiciliar e ambulatorial são eficazes se os pacientes forem orientados e estimulados pelo fisioterapeuta.

Falls are among the leading causes of morbimortality in the elderly population. The causes are multifactorial, including intrinsic and extrinsic risk factors. The risk of falling increases with the number of risk factors. The aim of this study was to analyze the effect of balance training and muscle strengthening exercise protocol to prevent risk of falling in older adults at clinical and home environments. In this quasi experimental study with a quantitative approach performed at elderly homes and at Integrated Physical Therapy Clinics at the University of Itaúna/MG were included 20 elderly ≥70 years old, living in the community and divided into two groups:IC (Intervention in the Clinic) and ID (Household Intervention). Instruments used were Berg Balance Scale, Timed Get Up Go, MiniMental Nottingham Health Profile, Geriatric Depression Scale and Clinical and Demographic Questionnaire. The results showed an improvement in both groups in balance aspect. The ID group also improved in quality of life aspects (p < 0.05). Comparing the two groups, we observed significant improvement in risk of falling inthe IC group. It was concluded that the exercise protocol held atout patient clinic and home environments are effective when physical therapist offers a well oriented and stimulating program.