Official Position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry—part II (clinical aspects): interpretation, reporting, and special situations

Abstract Objective: To present an updated and evidence-based guideline for the use of dual-energy x-ray absorptiometry (DXA) to assess body composition in clinical practice. Materials and methods: This Official Position was developed by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism ( Associação Brasileira de Avaliação Óssea e Osteometabolismo , ABRASSO) and experts in the field who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications in the area of body composition assessment. In this second part of the Official Position, the authors discuss the interpretation and reporting of body composition parameters assessed by DXA and the use of DXA for body composition evaluation in special situations, including evaluation of children, persons with HIV, and animals. Conclusion: This document offers recommendations for the use of DXA in body composition evaluation, including indications, interpretation, and applications, to serve as a guiding tool in clinical practice and research for health care professionals in Brazil.

Use of aromatase inhibitors in patients with breast cancer is associated with deterioration of bone microarchitecture and density

ABSTRACT Objective: To evaluate changes in bone density and architecture in postmenopausal women with breast cancer (BC) and use of aromatase inhibitor (AI). Subjects and methods: Thirty-four postmenopausal women with BC, without bone metastasis, renal function impairment and who were not receiving bone-active drugs were selected from a population of 523 outpatients treated for BC. According to the presence of hormonal receptors, HER2 and Ki67, seventeen had positive hormonal receptors and received anastrozole (AI group), and seventeen were triple-negative receptors (non-AI group), previously treated with chemotherapy. Areal bone mineral density (aBMD) and vertebral fracture assessment (VFA) analyses were performed by DXA; vBMD and bone microarchitecture were evaluated by HR-pQCT. Fracture risk was estimated using the FRAX tool. Results: No patient referred previous low-impact fracture, and VFA detected one moderate vertebral fracture in a non-AI patient. AI patients showed lower aBMD and BMD T-scores at the hip and 33% radius and a higher proportion of osteoporosis diagnosis on DXA (47%) vs non-AI (17.6%). AI group had significantly lower values for vBMD at the entire, cortical and trabecular bone compartments, cortical and trabecular thickness and BV/TV. They also had a higher risk for major fractures and for hip fractures estimated by FRAX. Several HR-pQCT parameters evaluated at distal radius and distal tibia were significantly associated with fracture risk. Conclusion: AI is associated with alterations in bone density and microarchitecture of both the cortical and trabecular compartments. These findings explain the overall increase in fracture risk in this specific population.

Performance of quality of life and functional capacity in women with knee osteoarthritis treated with viscosupplementation and strength training

The viscosupplementation and strength training are interventions accepted in the treatment of knee osteoarthritis. Objective: The study describes the effect of two interventions in quality of life and functional capacity. Method: Thirty women diagnosed with bilateral knee osteoarthritis of grade II and III by radiological criteria of Kellgren & Lawrence, were randomized into three groups with ten patients each: VSTF group submitted to viscosupplementation and strength training, TF group submitted only to strength training and VS group submitted only to viscossuplementation. Moments of the study were defined as pre-procedure (PRE), after 48 hours of VS (POS-VS) after 12 weeks of training (POS T) and after eight weeks of detraining (POS D). Quality of life was assessed by the SF-36 BRAZIL, functional capacity by Lequesne index. Intraarticular infiltrations were carried out with a single dose of 6 ml / 48 mg with 6,000,000 kDa Hylan GF-20 and strength training sessions were held for twelve weeks. Results: Strength training and viscosupplementation were effective in the treatment of knee osteoarthritis. Both interventions promoted improvements in quality of life and in functional capacity (p < 0.001), with advantage to the groups that trained force. Conclusion: Strength training is a possible replacement of viscosupplementation in the treatment of osteoarthritis of women's knees. However, the beneficial effect of viscosupplementation in pain reduction suggests better efficiency in the strength training execution which may be an advantage of the association of both

Análise de idosos ambulatoriais quanto ao estado nutricional, sarcopenia, função renal e densidade óssea / Analysis of elderly outpatients in relation to nutritional status, sarcopenia, renal function, and bone density

Objetivo : Avaliar relações entre estado nutricional, sarcopenia e osteoporose em idosas.Sujeitos e métodos : Estudamos 44 mulheres, 67-94 anos, mediante miniavaliação nutricional (MAN), filtração glomerular (FG) corr. 1,73 m2, índice de massa corporal (IMC), circunferência da panturrilha e braquial (CP e CB), densidade mineral óssea e composição corporal, DXA (massa gorda – MG; massa magra – MM). Aferimos sarcopenia: IMM = MM MSS + MIS/altura2. Utilizamos o coeficiente de correlação de Pearson, e p < 0,05 como significativo.Resultados : MNA e IMM se correlacionaram positivamente com IMC, CP, CB e MG. A idade influenciou negativamente FG corr., IMC, MG, IMM e CP. Quatorze tinham história de fraturas osteoporóticas. O mais baixo T-score foi diretamente relacionado a MAN e MG.Conclusões : O envelhecimento acarretou o declínio da FG, MG e massa muscular; a circunferência da panturrilha e braquial refletiu estado nutricional e composição corporal; e as grandes influências na DMO foram estado nutricional e MG. Arq Bras Endocrinol Metab. 2014;58(3):226-31.

Objectives : To evaluate relationships between nutritional status, sarcopenia and osteoporosis in older women.Subjects and methods : We studied 44 women, 67-94 years, by mini-nutritional assessment (MAN), glomerular filtration corr. 1.73 m2, body mass index (BMI), arm circumference and calf (CP and CB), bone mineral density and body composition, DXA (fat mass MG; lean MM). We gauge sarcopenia: IMM MM = MSS + MIS/height2. We used the Pearson correlation coefficient, p < 0.05 as significant.Results : MNA and IMM were positively correlated with BMI, CP, CB and MG. Age influenced negatively FG corr., BMI, FM, IMM and CP. Fourteen had a history of osteoporotic fractures. The lowest T-score was directly related to MAN and MG.Conclusions The aging caused the decline of FG, fat mass and muscle; the calf circumference, and brachial reflected nutritional status and body composition; and major influences on BMD were nutritional status and fat mass.Arq Bras Endocrinol Metab. 2014;58(3):226-31.

Osteoporose x osteoartrose: um estudo radiológico e densitométrico / Osteoporosis x osteoarthritis: a radiologic and densitometric study

Objetivo: Verificar se há associaçao negativa entre osteoporose e osteoartrose como tem sido relatada. Método: Foi empregada técnica de absorçao de fótons com dupla emissao de raios X, utilizando-se o aparelho Dexalunar, para avaliar a densidade mineral óssea de 42 mulheres com osteoartrose de coluna lombar. Quarenta e duas mulheres saudáveis, sem sintomas de osteoartrose e/ou osteoporose, também foram avaliadas como grupo controle. Em todas foram determinados peso, altura e idade de início da menopausa e realizadas radiografias simples da coluna lombar. A densidade óssea foi aferida na coluna lombar, nas incidências ântero-posterior e perfil, e no fêmur proximal. Resultados: Nao foi observada diferença significativa da densidade óssea entre os indivíduos portadores de osteoartroses e os normais. Embora em pequena percentagem, havia osteopenia em pacientes osteoartrósicos. O aumento do índice de massa corporal acompanhou-se de densidade cortical óssea elevada. O mesmo nao foi observado em relaçao ao osso trabecular. Conclusao: Apesar de osteartrose e osteoporose apresentarem nítidas diferenças etiopatogênicas, este estudo parece demonstrar que elas sao total mente excludentes em todos os sítios do esqueleto