Alterações osteometabólicas em pacientes em tratamento antineoplásico: revisão de escopo / Osteometabolic changes in patients under antineoplastic treatment: scoping review

Objetivo: sintetizar as principais evidências acerca das alterações osteometabólicas presentes nos pacientes em tratamento antineoplásico. Métodos: trata-se de uma revisão de escopo, seguindo a metodologia do Instituto Joanna Briggs, nas bases de dados PubMed/MedLine, Cochrane Library, LILACS, The British Library e Google Scholar. A revisão está protocolada no Open Science Framework. Resultados: muitos antineoplásicos possuem efeito na arquitetura óssea, reduzindo sua densidade, tais como moduladores seletivos de receptores de estrogênio, inibidores da aromatase, terapia de privação androgênica, e glicocorticoides. Para evitar tais desfechos, o tratamento e prevenção podem ser realizados pela suplementação de cálcio e vitamina D, exercícios físicos, uso de bifosfonatos, denosumab, e moduladores seletivos do receptor de estrogênio. Conclusão: pessoas com maior risco de desenvolver câncer também possuem maior risco de osteopenia e osteoporose, quando processo já estabelecido e em tratamento antineoplásico, devido ao compartilhamento de fatores de risco. Torna-se evidente a necessidade da densitometria óssea nos pacientes em tratamento contra o câncer para de prevenção e promoção de saúde óssea nesses pacientes, além de mais pesquisas com alto nivel de evidência para subsidiar tal uso.

Objective: To summarize the main evidence regarding osteometabolic changes in patients undergoing antineoplastic treatment. Methods: This is a scoping review, following the methodology of the Joanna Briggs Institute, using PubMed/MedLine, Cochrane Library, LILACS, The British Library, and Google Scholar. This review is registered in the Open Science Framework. Results: Many antineoplastics affect bone architecture by reducing its density, such as selective estrogen receptor modulators, aromatase inhibitors, androgen deprivation therapy, and glucocorticoids. To avoid such outcomes, treatment and prevention can be achieved by calcium and vitamin D supplementation, physical exercise, use of bisphosphonates, denosumab, and selective estrogen receptor modulators. Conclusion: people at a higher risk of developing cancer also have a higher risk of osteopenia and osteoporosis when the process is already established and undergoing antineoplastic treatment because of the grouping of risk factors. The need for bone densitometry in patients undergoing cancer treatment to prevent and promote bone health in these patients is evident, in addition to more research with a high level of evidence to support such use.

Utilidad del Trabecular Bone Score combinado con la densitometría ósea en la valoración de una serie 194 pacientes / Usefulness of Trabecular Bone Score in combination with bone densitometry to assess a series of 194 patients / Utilidade do Trabecular Bone Score combinado com densitometria óssea na avaliação de uma série de 194 pacientes

Resumen: Introducción: la mayoría de las fracturas por fragilidad ocurren en rango densitométrico de osteopenia, la escala ósea trabecular (TBS) permite valorar aspectos de la microarquitectura que influyen en la resistencia ósea. Objetivo: describir las características clínicas y los hallazgos de la microarquitectura ósea aplicando TBS combinado con densitometría ósea (DXA) en un grupo de pacientes. Material y métodos: estudio descriptivo, de recolección retrospectiva. Se incluyen los pacientes a los que se les realizó DXA con TBS en el INRU en julio y agosto de 2020. Resultados: se analizaron 194 pacientes, 173 (89%) de sexo femenino y 21 (11%) de sexo masculino. El 36,1% (70 pacientes) en rango de osteopenia, 36,1 (70 pacientes) en rango de osteoporosis. El 32,9% (23 pacientes) con osteopenia y el 47,1% (33 pacientes) con osteoporosis tenían microarquitectura degradada. 76,9% de los pacientes con artritis reumatoidea y 45,8% de los que tenían espondiloartritis presentaban microarquitectura alterada. Conclusiones: el TBS permitió reestratificar el riesgo de fractura en un número importante de pacientes, mostrándose como una herramienta muy útil en la valoración complementaria de la salud ósea.

Summary: Introduction: most fractures that result from bone fragility occur in the osteopenia range The trabecular bone score (TBS) enables the assessment of microarchitecture aspects that impact bone resistance. Objective: to describe the clinical characteristics and findings of bone microarchitecture, by applying TBS and bone densitometry in a group of patients. Method: descriptive study of retrospective collection. Patients who were included in the study underwent a Dual-energy X-ray Absorptiometry (DXA) with TBS at the National Rheumatology Service between July and August, 2020. Results: 94 patients were analysed, 173 (89%) were female and 21 (11%) were male. 36.1% (70 patients) lay in the osteopenia range, 36.1 (70 patients) in the osteoporotic range. 32.9% (23 patients) with osteopenia and 47.1% (33 patients) with osteoporosis evidenced a degraded bone microarchitecture. 76.9 % of patients with rheumatoid arthritis and 45.8 % of patients with spondyloarthritis respectively evidenced altered bone microarchitecture. Conclusions: TBS allowed stratification of fracture risk in a significant number of patients, which may suggest it is a useful tool for complementary assessment of bone health.

Resumo: Introdução: a maioria das fraturas por fragilidade ocorre na faixa densitométrica da osteopenia; o escore de osso trabecular (TBS) permite avaliar aspectos da microarquitetura que influenciam a resistência óssea. Objetivo: descrever as características clínicas e os achados da microarquitetura óssea aplicando TBS combinado com densitometria óssea (DMO) em um grupo de pacientes. Material e métodos: estudo descritivo, retrospectivo, incluindo pacientes que realizaram DXA (absorciometria de raios-X de dupla energia) com TBS no INRU em julho e agosto de 2020. Resultados: foram analisados 194 pacientes, 173 (89%) mulheres e 21 (11%) homens. 36,1% (70 pacientes) na faixa de osteopenia, 36,1 (70 pacientes) na faixa de osteoporose. 32,9% (23 pacientes) com osteopenia e 47,1% (33 pacientes) com osteoporose tinham microarquitetura degradada. Nos pacientes com artrite reumatoide 76,9% e nas espondiloartrite 45,8% apresentaram microarquitetura alterada, respectivamente. Conclusões: a TBS permitiu fazer uma nova estratificação do risco de fratura em um número significativo de pacientes, mostrando-se uma ferramenta muito útil na avaliação complementar da saúde óssea.

Além da tríade da mulher atleta: o novo conceito de deficiência relativa de energia no esporte / Beyond the female athlete triad: the new concept of relative energy deficiency in sport

"Tríade da mulher atleta" e "deficiência relativa de energia no esporte" são afecções comuns encontradas em esportistas. Tendo como fisiopatologia a disponibilidade energética negativa, essas síndromes têm impacto negativo na saúde das atletas. Apesar de serem frequentemente discutidas entre especialistas vinculados ao mundo desportivo, ainda são pouco conhecidas entre outras especialidades. Essa revisão da literatura foi proposta com o intuito de expor o problema ao ginecologista e obstetra, considerando esses profissionais importantes aliados na prevenção e diagnóstico precoce. Da mesma maneira, a intervenção terapêutica correta minimiza os diversos prejuízos à saúde e melhora o desempenho esportivo.(AU)

"Female athlete triad" and "relative energy deficiency in sport" are conditions relatively common among women participating in sports. Its pathophysiology based on negative energy availability, these syndromes have a negative impact on the athlete's health. Although they are frequently discussed among specialists linked to the sports all over the world, a little has been known among other physicians. This literature review was proposed in order to expose the problem to the gynecologist and obstetrician, considering these professionals as important allies in prevention and early diagnosis. In the same way, the correct therapeutic intervention allows to minimizes the numerous damages to athlete's health and to improve their sports performance.(AU)

Performance funcional, composição corporal e medo de cair em idosas com desmineralização óssea caidoras e não caidoras. Existem diferenças? / Functional performance, body composition and fear of falling in fallers and non-fallers elderly women with bone demineralization. Are there differences?

Objetivou-se comparar performance funcional, composição corporal e medo de cair em idosas com desmineralização óssea caidoras e não caidoras. Estudo transversal, analítico com 19 idosas com baixa da densidade mineral óssea (DMO), sete apresentaram osteoporose e 12 tinham osteopenia. IMC=28,9 ± 4,3kg.m-2 , idade média de 70 ± 5 anos. As idosas foram alocadas em grupos quanto à queda: Caidoras (n=9) e Não Caidoras (n=10). A avaliação da performance funcional englobou: 1) Capacidade Funcional com a bateria Senior Fitness Test (SFT); 2) Variáveis da marcha captadas com o sensor inercial Wivar® Science durante o Teste de Caminhada de 10 metros (TC10M). Composição corporal: DMO, gordura e massa magra foram analisadas através da Absortometria Radiológica de Dupla Energia (DEXA). Verificou-se o medo de cair com a Falls Efficacy Scale - Internacional ­ Brasil. Testou-se a comparação entre médias com teste t de Student e U de Mann Whitney. Quanto ao medo de cair, o escore total atingiu 28±11 pontos. Não houve diferença estatística entre as médias dos testes de capacidade funcional e marcha, exceto a simetria da marcha (p=0,017). Os grupos alcançaram resultados semelhantes de performance funcional, marcha e medo de cair. O estímulo e manutenção da função devem ser feitos como caráter preventivo no público em questão independente do evento queda ter ocorrido. A simetria da marcha pode ser uma variável complementar na avaliação de quedas em idosas com osteopenia e osteoporose.(AU)

The aim of this study was to compare functional performance, body composition and fear of falling in fallers and non-fallers elderly women with bone demineralization. This is a cross-sectional, analytical study with 19 elderly women with low bone mineral density (BMD), seven had osteoporosis and 12 had osteopenia. BMI = 28.9 ± 4.3 kg.m-2 , mean age 70 ± 5 years. The elderly were allocated by fall reported event in groups: Fallers (n = 9) and Non-fallers (n = 10). Functional performance included: 1) Functional Capacity mesuared by Senior Fitness Test (SFT) battery; 2) Walking variables captured by the inertial sensor Wivar® Science during the 10-meter Walk Test (TC10M). Body composition: BMD, fat and lean mass were mesuared by Dual Energy Radiological Absortometry (DEXA). There fear of falling was acessed by Falls Efficacy Scale - International - Brazil. The comparison between means was made with Student's t test and Mann Whitney U test. As results, the total score for fear of falling reached 28 ± 11 points. There was no statistically significant difference between the means of functional capacity and gait tests. Only gait symmetry differed between groups (p = 0.017). Both groups achieved similar results of functional performance, gait and fear of falling. The stimulus and maintenance of the function must be done as a preventive character in the public in question regardless of the event that occurred. The gait symmetry may be a complementary variable to evaluate falls in elderly women with osteopenia and osteoporosis.(AU)

Ocorrência de doença metabólica óssea em prematuros de muito baixo peso internados em UTI neonatal / Occurrence of metabolic bone disease in very low birth weight preterm infants hospitalized in neonatal ICU

Recém-nascidos (RN) prematuros de muito baixo peso apresentam um risco aumentado de desenvolver doença metabólica óssea (DMO), por isso é necessário realizar suplementação mineral e triagem para DMO nos prematuros internados em UTI Neonatal a fim de prevenir esta condição clínica. O estudo avaliou o prontuário de 34 RN nascidos e internados em UTI Neonatal no Hospital Santo Antônio por um período de 1 ano. Destes, 8 foram submetidos a triagem para DMO, sendo que não houve ocorrência de pesquisa positiva. Conclui-se que maiores estudos e de seguimento são necessários, assim como o estabelecimento de protocolos que visem prevenção e tratamento precoce da DMO.

Very low birth weight infants are at increased risk of developing metabolic bone disease (MBD), so it is necessary to perform mineral supplementation and MBD screening in premature infants in neonatal intensive care units in order to prevent this clinical condition. The study evaluated the charts of 34 newborns who was born and hospitalized in a neonatal ICU at the Santo Antônio Hospital for a period of 1 year. Of these, 8 were submitted to MBD screening, and there was no positive research. It is concluded that further studies and follow-up are necessary, as well as the establishment of protocols aimed at prevention and early treatment of MBD.

"Clinical Application of ""Kidney-Marrow System""" / 世界科学技术-中医药现代化

Through reviewing and summarizing classical literatures of traditional Chinese medicine (TCM) and modern medical research results,TCM kidney-marrow system was presented and initially explained.The kidney marrow system is inseparable in structure,interdependent in physiology and mutually influential in pathology.The kidney-marrow system can be applied to the treatment of major diseases in TCM,which included metabolic bone diseases,brain and neurological disorders,haematological diseases and etc.,with significant clinical effects.The in-depth study on TCM kidney marrow system will improve the clinical curative effect of major TCM clinical diseases and achieve the precision treatment in traditional medicine.It displays unique advantages of TCM holism concept and achieves new breakthrough in TCM clinical diseases.

Clinical application of quantitative computed tomography in osteogenesis imperfecta-suspected cat

One-year-old male Persian cat presented with multiple fractures and no known traumatic history. Marked decrease of bone radiopacity and thin cortices of all long bones were identified on radiography. Tentative diagnosis was osteogenesis imperfecta, a congenital disorder characterized by fragile bone. To determine bone mineral density (BMD), quantitative computed tomography (QCT) was performed. The QCT results revealed a mean trabecular BMD of vertebral bodies of 149.9 ± 86.5 mg/cm³. After bisphosphonate therapy, BMD of the same site increased significantly (218.5 ± 117.1 mg/cm³, p < 0.05). QCT was a useful diagnostic tool to diagnose osteopenia and quantify response to medical treatment.

Evaluation of human milk titratable acidity before and after addition of a nutritional supplement for preterm newborns / Avaliação da acidez titulável do leite humano antes e após adição de um suplemento nutricional para recém-nascido pré-termo

Abstract Objective: To evaluate the initial Dornic acidity in raw human milk, after pasteurization and after heating and dilution of a dietary supplement for preterm infants. Methods: A quantitative, descriptive, and experimental study was carried out with a convenience sample at the human milk bank at a Brazilian public maternity, with specialized care for pregnant women and newborns at risk. The eligibility criteria for the study sample included 93 frozen raw human milk in suitable containers with volumes ≥100 mL and initial Dornic acidity ≤8° Dornic (ºD). Milk acidity of human milk was measured in four stages: in raw human milk (initial); after pasteurization; after the heating of pasteurized milk and dilution of the supplement; and after thirty minutes of supplementation. Results: The initial acidity was 3.8° D ± 1.3 (95% CI: 3.56-4.09) with no significant difference in Dornic acidity in pasteurized milk, which was 3.6° D ± 1.2 (95% CI: 3.36-3.87). The dilution of the supplement in pasteurized milk that was heated significantly increased mean Dornic acidity to 18.6 °D ± 2.2 (95% CI: 18.18-19.11), which remained high after thirty minutes of supplementation at 17.8 °D ± 2.2 (95% CI: 17.36-18.27), considering p < 0.05. Conclusions: The study observed no significant differences in Dornic acidity of raw human milk and pasteurized human milk; however, the dilution of a human milk supplementation caused a significant increase in acidity. Further investigations are necessary on the influence of this finding on the quality of supplemented milk and its consequences on the health of preterm infants.

Resumo Objetivo Avaliar a acidez Dornic inicial no leite humano cru, após pasteurização, e aquecimento e diluição de um suplemento nutricional para recém-nascidos prematuros. Métodos Estudo quantitativo, descritivo, experimental, com amostragem por conveniência, feito no Banco de Leite Humano de uma maternidade pública brasileira, com assistência especializada às gestantes e recém-nascidos de risco. Os critérios de elegibilidade das 93 amostras do estudo incluíram leites humanos crus congelados em embalagens apropriadas, com volumes ≥ 100 mL e acidez Dornic inicial ≤ 8°Dornic (°D). A acidez Dornic dos leites humanos foi mensurada em quatro momentos: no leite humano cru (inicial); após pasteurização; após aquecimento do leite pasteurizado e diluição do suplemento; e após transcorridos 30 minutos de suplementação. Resultados A acidez inicial foi de 3,8°D ± 1,3 (IC 3,56-4,09) e não apresentou diferença significativa em relação à acidez Dornic no leite pasteurizado, que foi de 3,6°D ± 1,2 (IC 3,36-3,87). A diluição do suplemento no leite pasteurizado e aquecido aumentou significativamente a média da acidez Dornic a 18,6°D ± 2,2 (IC 18,18-19,11), a qual se manteve elevada em 17,8°D ± 2,2 (IC 17,36-18,27) após 30 minutos da diluição, considerando p < 0,05. Conclusões O estudo demonstrou que a acidez Dornic do leite humano cru e a do leite humano pasteurizado não apresentaram diferenças significativas, porém a diluição do suplemento de leite humano promoveu elevação significativa da acidez. Maiores investigações da influência desse achado sobre a qualidade do leite suplementado e suas consequências na saúde de prematuros são necessárias.

Physical Activity Level of Post-menopausal Women with Low Bone Mineral Density / Nível de atividade física de mulheres menopausadas com baixa densidade mineral óssea

Abstract Introduction Proper physical activity is related to the prevention and the treatment of osteoporosis. Purpose To assess the level of physical activity (PA) in post-menopausal women with low bone mineral density ( BMD ). Methods This cross-sectional clinical study included 123 post-menopausal women. The inclusion criteria were: age of 45 years with last menses at least 12 months prior to the initiation of the study, and bone density scan (BDS) values measured over the preceding 12 months. Women with severe osteoarthritis were excluded. Women were allocated into three groups, according to BMD measured by BDS [osteoporosis (OP; 54 women), osteopenia (35 women), and normal bone density (NBD; 35 women)], and compared for general, clinical, and anthropometric data, and for PA level. The latter was assessed using the International Physical Activity Questionnaire (IPAQ), in metabolic equivalent of task (MET) units. Participants were classified as sedentary, active or very active. Quantitative variables were compared using ANOVA followed by Tukey's test. Associations between qualitative variables were tested by Chi-square (χ2) or Fisher's exact test. In order to check for differences among groups and IPAQ domains, a generalized linear model with Gamma distribution was adjusted for values in METs. Results The OP group differed from the NBD group regarding age (61.8 10.1 and 52.9 5.4 years), percentage of participants with self-declared white ethnicity (43.9 and 28.0%), body mass index (BMI - 25.7 5.4 and 30.9 5.1 kg/m2), and time since menopause (15.5 7.5 and 5.8 4.5 years). Smoking rates were higher in the OP (55.6%) and NBD groups (33.3%) than in the osteopenia group (11.1%). Within the OP group, the rate of subjects with sedentary lifestyles was higher (42.6%), and time spent sitting was greater (344.3 204.8 METs) than in the groups with osteopenia (20.0 % and 300.9 230.6 METs) and NBD (17.7% and 303.2 187.9 METs). Conclusions The rate of sedentary lifestyles was higher in post-menopausal women with OP than in those with either osteopenia or NBD. In order to change this physical inactivity profile, strategies should be created to address this group of patients.

Resumo Introdução Atividade física adequada está relacionada com a prevenção e o tratamento da osteoporose. Objetivo Avaliar o nível de atividade física em mulheres na pós-menopausa com baixa densidade mineral óssea ( DMO ). Métodos Este estudo clínico transversal incluiu 123 mulheres na pós-menopausa. Os critérios de inclusão foram idade 45 anos, com última menstruação pelo menos 12 meses antes do início do estudo, e DMO medida nos últimos 12 meses. Foram excluídas mulheres com osteoartrite grave. As mulheres foram divididas em três grupos, de acordo com DMO medida por densitometria óssea [osteoporose (OP; 54 mulheres), osteopenia (35 mulheres) e DMO normal (NBD; 35 mulheres)], e comparadas com dados gerais, clínicos e antropométricos, e quanto ao nível de atividade física. Este último foi avaliado pelo International Physical Activity Questionnaire (IPAQ), em unidades de metabolic equivalent of task (METs). As participantes foram classificadas como sedentárias, ativas ou muito ativas. As variáveis quantitativas foram comparadas por ANOVA seguida pelo teste de Tukey. As associações entre as variáveis qualitativas foram testadas por Qui-quadrado (χ2) ou exato de Fisher. Para verificar diferenças entre os grupos e domínios do IPAQ, um modelo linear generalizado com distribuição Gama foi ajustado para os valores em METs. Resultados O grupo OP diferiu do NBD quanto à idade (61,8 10,1 e 52,9 5 , 4 anos), porcentagem de etnia autorrelatada branca (43,9 e 28,0%), índice de massa corporal (25,7 5,4 e 30,9 5,1 kg/m2) e tempo da menopausa (15,5 7,5 e 5,8 4,5 anos). As taxas de tabagismo foram maiores nos grupos com OP (55,6 % ) e NBD (33,3%) do que no com osteopenia (11,1%). No grupo com OP, sedentarismo (42,6%) e tempo gasto sentado foram maiores (344,3 204.8 METs) do que nos com osteopenia (20,0% e 300,9 230,6 METs) e NBD (17,7% e 303,2 187,9 METs). Conclusões O sedentarismo foi maior em mulheres na pós-menopausa com osteoporose do que naquelas com osteopenia ou NBD. Estratégias devem ser criadas para alterar este perfil de inatividade física neste grupo de pacientes.

Utilidad de los marcadores de remodelado óseo teniendo en cuenta el valor de referencia para el cambio / Clinical Utility of Bone Remodeling Markers Taking Into Account the Reference Value Change

La Modelación y el Remodelado de hueso son llevados a cabo a través del proceso de Recambio Óseo en sitios específicos llamados Unidades de Remodelación Ósea (URO). Este proceso puede evaluarse a través de marcadores bioquímicos de Formación y de Resorción que reflejan cambios globales del metabolismo esquelético. Estos marcadores de remodelado óseo son utilizados para investigación de enfermedades óseo-metabólicas, porque proveen información dinámica del metabolismo del hueso y pueden ser cuantificados en suero o en orina. La variación de estos marcadores se deben principalmente a variables preanalíticas, analíticas y biológicas y debe interpretarse teniendo en cuenta el Valor de Referencia para el Cambio significativo (VRC), que resulta de un cálculo en el que intervienen la variabilidad biológica (VB) del analito y el error aleatorio del método utilizado en el laboratorio.

The Modeling and Remodeling processes are conducted through the process of replacement bone at specific sites called Units Bone Remodeling (URO).These can be evaluated by biochemical markers of formation and resorption that reflect changes in skeletal metabolism. These markers of bone turnover are used for research óseo-metabolic diseases because they provide dynamic information of bone metabolism and can be quantified in serum or urine. The variation of these markers is mainly due to preanalytical, analytical and biological variables and should be interpreted taking into account the Reference Value Change (VRC), which results from a calculation in which the biological variability (VB) of the analyte and the random error of the method used in the laboratory are involved.

LOW BONE MINERAL DENSITY IN BRAZILIAN PATIENTS AT DIAGNOSIS OF CELIAC DISEASE / Alterações ósseas em celíacos brasileiros ao diagnóstico

BackgroundLow bone mineral density is considered an extra-intestinal manifestation of celiac disease with reduced bone mass, increased bone fragility, and risk of fractures. Celiac disease is considered a condition at high risk for secondary osteoporosis and the evaluation of bone density is very important in the clinical management of these patients.ObjectiveThe present study aimed to investigate bone alterations in celiac patients from Curitiba, South Region of Brazil at diagnosis, correlating the findings with age and gender.MethodsPatients who were included in the study were attended to in a private office of the same physician from January 2009 to December 2013. The diagnosis of celiac disease was done through clinical, serological and histological findings. All data were collected from the medical charts of the patients. After the diagnosis of celiac disease, evaluation for low bone mineral density was requested by dual-energy X-ray absorptiometry (DEXA). DEXA bone densitometer was used to estimate low bone mineral density at the lumbar spine and femur.ResultsA total of 101 patients, 82 (81.2%) female and 19 (18.8%) male subjects, with mean age of 39.0±3.03 years were included. At celiac disease diagnosis, 36 (35.6%) were younger than 30 years, 41 (40.6%) were between 31 and 50 years, and 24 (23.8%) were older than 50 years. Among the evaluated patients, 69 (68.3%) presented low bone mineral density, being 47% with osteopenia and 32% with osteoporosis. Patients who were older than 51 years and diagnosed with celiac disease presented low bone mineral density in 83.3% (20/24) of the cases. As expected, age influenced significantly the low bone mineral density findings. Among women, low bone mineral density was present with high frequency (60%) from 30 to 50 years. In patients diagnosed older than 60 years (n=8), all the women (n=5) and two of the three men had osteoporosis.ConclusionThis study demonstrated that 69% of Brazilian patients with celiac disease at diagnosis had low bone mineral density, being more frequent in women older than 50 years.

ContextoBaixa densidade mineral óssea é considerada uma manifestação extra-intestinal da doença celíaca com redução da massa óssea, aumento da fragilidade óssea e risco de fraturas. A doença celíaca é considerada uma condição de alto risco para a osteoporose secundária e a avaliação da densidade óssea é muito importante no manejo clínico dos pacientes.ObjetivoO presente estudo teve como objetivo investigar as alterações ósseas presentes em pacientes com doença celíaca de Curitiba-PR, no momento do diagnóstico, correlacionando os achados com a idade e gênero.MétodosOs pacientes incluídos no estudo foram atendidos por um só médico no período de janeiro/2009 a dezembro/2013. O diagnóstico da doença celíaca foi feito através das manifestações clínicas, sorologia específica e achados histológicos da mucosa duodenal. Todos os dados foram coletados a partir dos prontuários dos pacientes. Após o diagnóstico da doença celíaca, foi solicitada a avaliação de densidade mineral óssea por meio de densitometria (dual-energy X-ray absorptiometry DEXA). DEXA foi utilizada para estimar a densidade mineral óssea na coluna lombar e fêmur.ResultadosUm total de 101 pacientes, 82 (81,2%) mulheres e 19 (18,8%) homens, com idade média de 39,0±3,03 anos foram incluídos. No momento do diagnóstico de doença celíaca, 36 (35,6%) tinham menos de 30 anos, 41 (40,6%) tinham entre 31 e 50 anos, e 24 (23,8%) tinham mais de 50 anos. Entre os pacientes avaliados, 69 (68,3%) apresentaram baixa densidade mineral óssea, 47% deles com osteopenia e 32% com a osteoporose. Os pacientes maiores de 51 anos de idade apresentaram baixa densidade mineral óssea em 83,3% (20/24) dos casos. Como esperado, a idade influenciou significativamente os resultados da baixa densidade mineral óssea. Entre as mulheres, baixa densidade mineral óssea foi observada com alta frequência (60%) também na faixa etária entre 30 a 50 anos. Pacientes diagnosticados mais de 60 anos (n=8), todas as mulheres (n=5) e dois dos três homens tinham osteoporose.ConclusãoO presente estudo demonstrou que 69% dos pacientes brasileiros com doença celíaca no momento do diagnóstico apresentaram baixa densidade mineral óssea, sendo mais frequente em mulheres com mais de 50 anos.

Fatores associados à osteopenia e osteoporose em mulheres submetidas à densitometria óssea / Factors associated with osteopenia and osteoporosis in women undergoing bone mineral density test

O objetivo deste estudo foi determinar a prevalência de osteopenia e osteoporose em uma população de mulheres que fizeram exames de densitometria em uma clínica especializada no sul do Brasil. Nós conduzimos um estudo transversal, incluindo 1.871 mulheres que se submeteram à densitometria óssea entre janeiro e dezembro de 2012. Foi feita uma análise de regressão logística com todas as variáveis independentes e os desfechos (osteopenia, osteoporose e risco de fraturas). A densitometria óssea foi diagnosticada como normal em 36,5% das mulheres, 49,8% com osteopenia e 13,7% com osteoporose. Estar na menopausa e ter mais de 50 anos foram fatores de risco para osteopenia e osteoporose, enquanto ter feito histerectomia e apresentar índice de massa corporal (IMC) maior do que 25 foram fatores de proteção. Para o desfecho fratura em qualquer sítio, os fatores associados foram idade acima de 50 anos e osteopenia ou osteoporose, (OR = 2,09, intervalo de confiança [IC]: 1,28-3, 95%, 40) e (OR = 2,49, 95% CI: 1,65-3, 74), respectivamente.

The aim of this study was to determine the prevalence of osteopenia and osteoporosis in a female population, that had bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) in a specialized clinic in the south of Brazil. We conducted a cross-sectional study including 1871 women that performed scans between January and December 2012. We conducted a logistic regression analysis with all independent variables and outcomes (osteopenia, osteoporosis and fracture risk). According to DXA results, 36.5% of women had normal BMD, 49.8% were diagnosed with osteopenia and 13.7% with osteoporosis. Menopause and age over 50 years old were risk factors for osteopenia and osteoporosis while prior hysterectomy and BMI greater than 25 were protective factors. For the outcome of fracture at any site the risk factors were age over 50 years old, osteopenia and osteoporosis (OR = 2.09, 95% CI: 1.28–3.40) and (OR = 2.49, 95% CI: 1.65–3.74), respectively.

Vitamin D Activities for Health Outcomes

Reports describing significant health risks due to inadequate vitamin D status continue to generate considerable interest amongst the medical and lay communities alike. Recent research on the various molecular activities of the vitamin D system, including the nuclear vitamin D receptor and other receptors for 1,25-dihydroxyvitamin D and vitamin D metabolism, provides evidence that the vitamin D system carries out biological activities across a wide range of tissues similar to other nuclear receptor hormones. This knowledge provides physiological plausibility of the various health benefits claimed to be provided by vitamin D and supports the proposals for conducting clinical trials. The vitamin D system plays critical roles in the maintenance of plasma calcium and phosphate and bone mineral homeostasis. Recent evidence confirms that plasma calcium homeostasis is the critical factor modulating vitamin D activity. Vitamin D activities in the skeleton include stimulation or inhibition of bone resorption and inhibition or stimulation of bone formation. The three major bone cell types, which are osteoblasts, osteocytes and osteoclasts, can all respond to vitamin D via the classical nuclear vitamin D receptor and metabolize 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D to activate the vitamin D receptor and modulate gene expression. Dietary calcium intake interacts with vitamin D metabolism at both the renal and bone tissue levels to direct either a catabolic action on the bone through the endocrine system when calcium intake is inadequate or an anabolic action through a bone autocrine or paracrine system when calcium intake is sufficient.

Brittle bone disease: a case report / Doenca dos ossos frageis: relato de caso

We report a case of a female patient, 27 years old, with several episodes of fractures after low energy trauma and the first documented episode only to 18 years of age. Extensive research has not found the exact etiology of the disease. The orthopedic monitoring has targeted prevention and treatment of fractures.

Relata-se caso de paciente feminina, de 27 anos, com diversos episódios de fraturas após traumas de baixa energia, o primeiro documentado aos 18 anos. A extensiva investigação até o momento não concluiu a exata etiologia da doença. O acompanhamento ortopédico tem visado à prevenção e ao tratamento das fraturas.

Analysis of the volume of autogenous cancellous bone grafts with or without the use of PTFE-e membranes in ovariectomized rats / Análise do volume ósseo trabecular de enxertos ósseos autógenos recobertos ou não por membranas de PTFE-e em ratas ovarectomizadas

Objetivo: Avaliar quantitativamente e descrever qualitativamente o processo de reparação óssea da interface leito receptor e enxerto ósseo autógeno em bloco associado ou não a membrana de PTFE-e, em ratas, portadoras de osteopenia induzida. Material e Metodos: 48 ratas Wistar pesando aproximadamente 300 g, receberam um enxerto ósseo do osso parietal o qual foi fixado à parede lateral do ramo mandibular esquerdo. Os animais foram divididos aleatoriamente em quatro grupos: Grupo 1: ovariectomia simulada (SHAM) e enxerto ósseo autógeno; Grupo 2: SHAM e enxerto ósseo autógeno com recobrimento por membrana de PTFE-e; Grupo 3: ovariectomia (OVZ) e enxerto ósseo autógeno; Grupo 4: OVZ e enxerto ósseo autógeno com recobrimento por membrana de PTFE-e. Os animais de cada grupo foram sacrificados nos períodos: 21, 45 e 60 dias, com 4 animais por grupo. As peças foram descalcificadas e incluídas; os cortes corados com HE e submetidos à análise histológica e histomorfométrica em microscopia de luz. Resultados: Os testes ANOVA mostraram que as variáveis referente a condição (OVZ e SHAM) e ao período (21,45 e 60 dias) foram estatisticamente significantes, pode-se estabelecer com o teste de Tukey (5%) que o período de 21 dias difere estatisticamente dos períodos de 45 e 60 dias, que entre si não diferem. A análise histológica descritiva mostrou integração do enxerto em todos os animais.Conclusão: O processo de integração do enxerto ao leito foi negativamente afetado na presença de osteopenia induzida e o uso ou não da membrana de PTFE-e, não interferiu neste processo de integração

Objective: To verify the influence of the osteopeny induced by the bone repairing of the receptor site/autogenous bone graft block interface either associated with or without PTFE-e membrane through the analysis of the trabecular bone volume. Material & Methods: 48 Wistar rats weighing approximately 300 g were submitted to parietal bone graft which was fixed to the lateral wall of the left mandibular ramus. The animals were randomly divided into four groups: Group 1: simulated ovariotomy (SHAM) and autogenous bone graft; Group 2: SHAM and autogenous bone graft through PTFE-e membrane recovering; Group 3: ovariotomy (OVZ) and autogenous bone graft; Group 4: OVZ and autogenous bone graft and PTFE-e membrane recovering. The animals of each group were killed at the following periods: 21, 45 and 60 days, comprising 4 animals per group. The pieces were decalcified and included; the cuts were stained with HE and submitted to histological and histomorphometric analysis through light microscopy. Results: ANOVA test showed that the variables accounting for both the condition (OVZ and SHAM) and the period (21,45 and 60 days) were statistically significant; the Tukey test (5%) showed that the period of 21 days was statistically different from 45 and 60 days; however, they were not statistically different between each other. The descriptive histological analysis showed grafting integration in all animals. Conclusion: the process of graft integration with the receptor site was negatively affected by the induced osteopeny presence and presence or absence of PTFE-e membrane did not interfered in the integration process.

Ruptura bilateral y espontánea del tendón del cuadríceps / Ruptura bilateral y espontánea del tendón del cuadríceps

Estudio retrospectivo, transversal y analítico de 5 pacientes ingresados en el equipo 3 del Servicio de Ortopedia y Traumatología en el Hospital Central de San Cristóbal, estado Táchira. Venezuela, con diagnósticos de Ruptura Bilateral del Tendón del Cuádriceps, en el periodo comprendido entre enero del 2004 a julio del 2007. La ruptura espontánea del tendón del cuádriceps es una patología asociada a enfermedades crónicas metabólicas. La ruptura suele ser unilateral y en raras ocasiones bilateral. Se presentan 5 casos de ruptura bilateral de tendón del cuádriceps en pacientes con insuficiencia renal crónica (IRC). El diagnóstico se hace fundamentalmente por la clínica de dolor súbito, seguido de incapacidad para la extensión de la rodilla y defecto palpable por encima de la patela. El estudio radiológico no aporta mayores datos y la ecografía confirma la lesión en todos los casos, pero con un mal reporte de la extensión de la lesión. Los 5 casos estudiados se resolvieron con tratamiento quirúrgico, con una buena evolución, según la escala de gradación de Lovett(AU)

Retrospective, transversal and analytical histories study of the 5 patients admitted in the team 3 of the trauma service in the Central Hospital, San Cristobal-Táchira State, Venezuela with diagnostic of bilateral rupture of the quadriceps tendon, in the period between january 2004 and july 2007. The spontaneous rupture of the quadriceps tendon is a pathology associated with chronic metabolic diseases. The rupture usually is unilateral and rarely bilateral. There are 5 cases of bilateral rupture of quadriceps tendon in 5 patients with chronic renal failure. The diagnostic is mainly due to the sudden pain clinic, followed by the inability of knee extension and the palpable defect above the patela. The radiological study not provide further details and the ultrasound confirmed the injury in all the cases, but the ultrasound give wrong information about the extent of the injury. The 5 studied cases were solve with surgical treatment, with a Good outcome according to the scale of gradation of Lovett(AU)

Association between Sarcopenia, Bone Density, and Health-Related Quality of Life in Korean Men / 가정의학회지

BACKGROUND: Sarcopenia is the loss of muscle mass leading to decreased muscle strength, physical disability, and increased mortality. The genesis of both sarcopenia and osteoporosis is multifactorial, and several factors that play a role in osteoporosis are thought to contribute to sarcopenia. This study evaluated the association between sarcopenia and bone density and health-related quality of life in Korean men. METHODS: We used the data of 1,397 men over 50 years of age from the 2009 Korean National Health and Nutrition Examination Survey. Sarcopenia was defined as the appendicular skeletal muscle mass divided by height2 (kg/m2) < 2 standard deviations below the sex-specific mean for young adults. Health-related quality of life was measured by the EuroQol-5 dimension (EQ-5D) instrument. Logistic regression analysis was performed to evaluate the relationship between sarcopenia, bone density, and health-related quality of life. RESULTS: The T-score of the lumbar spine, total femur, and femur neck in bone mineral density in subjects with sarcopenia were lower than those in subjects without sarcopenia. The score of the EQ-5D index was significantly lower and the rate of having problems with individual components of health-related quality of life was higher in the sarcopenic group. After adjustment for age and body mass index, the odds ratios (ORs) (95% confidence interval [CI]) for sarcopenia were 2.06 (1.07-3.96) in osteopenic subjects and 3.49 (1.52-8.02) in osteoporotic subjects, respectively. After adjustment, the total score of the EQ-5D index was significantly lower in the sarcopenic subjects. The ORs (95% CI) for having problems of mobility and usual activity of the EQ-5D descriptive system were 1.70 (1.02-2.84) and 1.90 (1.09-3.31), respectively. CONCLUSION: Sarcopenia was associated with decreased bone mineral density in Korean men. In addition, sarcopenia was related to poor quality of life, especially with regard to mobility and usual activity. Greater attention to and evaluation for sarcopenia are needed in subjects showing low bone mineral density to prevent and manage poor quality of life.

Physical Activity in Adolescence Has a Positive Effect on Bone Mineral Density in Young Men / 예방의학회지

OBJECTIVES: Little is yet known about the determinants of bone mineral density (BMD) in young adults. Thus, in this study, we aimed to determine the factors that have an impact on BMD in young men. METHODS: Questionnaires were sent out to 111 male medical students. Information on age, socio-economic status, medical history, lifestyle, physical activity during adolescence, school club participation, current physical activity, and dietary intake were collected by the survey. Height, weight, percent body fat and muscle mass were estimated by bioelectrical impedance, and BMD was obtained using calcaneal quantitative ultrasound. Using the Poisson regression model, prevalence ratios (PRs) were used to estimate the degree of association between risk factors and osteopenia. RESULTS: The height and current physical activity showed a correlation to the Osteoporosis Index. Among the categorized variables, past physical activity during adolescence (p=0.002) showed a positive effect on the bone mineral content. In the multivariate model, past physical activity (> or =1 time/wk) had a protective effect on osteopenia (PR, 0.37; 95% confidence interval [CI], 0.18 to 0.75) and present physical activity (1000 metabolic equivalent of task-min/wk) decreased the risk of osteopenia (PR, 0.64; 95% CI, 0.44 to 0.91). CONCLUSIONS: Past physical activity during adolescence is as important as physical activity in the present for BMD in young men.

Observation of trabecular changes of the mandible after orthognathic surgery using fractal analysis

OBJECTIVES: This study sought to evaluate trabecular changes in the mandible using fractal analysis and to explain the transient osteopenia related to rapid orthodontic tooth movement after orthognathic surgery. MATERIALS AND METHODS: Panoramic radiographs were taken of 26 patients who underwent bilateral sagittal split ramus osteotomy. Radiographs taken before the surgery and 1 month after surgery were overlapped, and 40x40 pixel square regions of interest were selected near the mandibular canines and 1st molars. After the image processing procedure, the fractal dimension was calculated using the box-counting method. RESULTS: Fractal dimension after orthognathic surgery decreased in a statistically significant manner (P<0.05). The change in fractal dimension on the canine side had greater statistical significance as compared to that seen on the 1st molar side. CONCLUSION: This study found that bone density decreases after orthognathic surgery due to transient osteopenia related to the regional acceleratory phenomenon. This result can provide a guide to evaluating orthodontic tooth movement after orthognathic surgery.

Doença de Paget com acometimento sacral: relato de caso / Paget's disease with sacral involvement: a case report

Os autores relatam o caso de um paciente do sexo masculino, 71 anos de idade, com diagnóstico de doença de Paget óssea sacral. Foi realizado estudo com radiografia, cintilografia, tomografia computadorizada e ressonância magnética, e o diagnóstico foi confirmado por análise histopatológica. O paciente evoluiu com boa resposta ao uso de ibandronato 150 mg, mensalmente, com redução significativa dos marcadores bioquímicos da doença.

The authors report a case of a 71-year-old male patient diagnosed with Paget's disease of sacrum. Imaging study was performed with radiography, scintigraphy, computed tomography and magnetic resonance imaging, and the diagnosis was confirmed by biopsy. The patient progressed with a good response to monthly treatment with ibandronate 150 mg, presenting a significant reduction in biochemical markers of disease.