Masa ósea en mujeres de edad mediana del Policlínico 19 de abril / Bone Mass in Middle-Aged Women from Policlínico 19 de Abril of Havana

Introducción: La osteoporosis es una enfermedad esquelética difusa caracterizada por una disminución generalizada de la resistencia ósea, que predispone a un mayor riesgo de fracturas por fragilidad y está reconocida como un grave problema de salud. Objetivo: Determinar la masa ósea en mujeres de edad mediana y algunos factores relacionados con ella. Métodos: Se realizó un estudio descriptivo transversal en mujeres de edad mediana del Policlínico 19 de abril. De la planilla de recolección de datos se extrajeron: edad, color de la piel, etapa climatérica, número de partos, meses de lactancia, resultados hormonales. Se realizó densitometría para determinar mujeres con hueso normal, baja masa ósea u osteopenia y osteoporosis, y se asociaron con algunos factores de riesgo. Resultados: Se estudiaron 82 mujeres. El 67,07 por ciento tuvo masa ósea normal en la columna lumbar, un 19,51 por ciento baja masa ósea u osteopenia y un 13,42 por ciento osteoporosis. En la cadera izquierda la mayoría (91,46 por ciento) presentó masa ósea normal. De las perimenopáusicas, una entre 50 y 54 años presentó baja masa ósea; en posmenopáusicas predominó la osteoporosis en el grupo de 50-54 (50 por ciento), en las de 55-59, las que tenían hueso normal y osteopenia (41,2 por ciento cada una). En las posmenopáusicas, las que tenían la piel blanca fueron las que presentaron mayor afectación de la masa ósea. A mayor tiempo de posmenopausia menor masa ósea (p= 0,031*), a niveles más elevados de hormona luteinizante (p= 0,000) y foliculoestimulante (p= 0,000), menor densidad mineral ósea en la columna lumbar y cadera izquierda; a niveles más elevados de estradiol (p= 0,000), mayor densidad mineral ósea en ambas localizaciones. Conclusiones: Se concluye que la mayoría de las mujeres de edad mediana del policlínico 19 de abril tenían hueso normal; la osteoporosis predominó en los grupos de mayor edad y el color de la piel blanca. Mayor tiempo de posmenopausia y niveles elevados de hormona luteinizante y foliculoestimulante se asociaron con mala masa ósea; niveles elevados de estradiol con mejor masa ósea(AU)

Introduction: Osteoporosis is a diffuse skeletal disease characterized by a generalized decrease in bone resistance, which predisposes patients to an increased risk of fragility fractures and is recognized as a serious health problem. Objective: To determine bone mass in middle-aged women and some factors related to it. Methods: A descriptive and cross-sectional study was carried out in middle-aged women from the Policlínico 19 de Abril. The following data were extracted from the data collection form: age, skin color, climacteric stage, number of deliveries, breastfeeding months, hormonal results. Densitometry was performed to determine women with normal bone, low bone mass or osteopenia and osteoporosis, and these were associated with some risk factors. Results: A group of 82 women were studied. Of them, 67.07percent had normal bone mass in the lumbar spine, 19.51percent had low bone mass or osteopenia, and 13.42percent ad osteoporosis. On the left hip, the majority (91.46percent) had normal bone mass. Of the perimenopausal women, one aged 50-54 years had low bone mass; among postmenopausal women, osteoporosis predominated in the 50-54 age group (50percent), as well as in those aged 55-59, those with normal bone mass and osteopenia (41.2percent for each condition). In the postmenopausal women, those with white skin were the most affected in bone mass. The longer the postmenopausal period, the lower the bone mass (p = 0.031*); the higher the levels of luteinizing hormone (p = 0.000) and the follicle stimulating hormone (p = 0.000), the lower bone mineral density on the lumbar spine and left hip; the higher the levels of estradiol (p = 0.000), the higher bone mineral density on both locations. Conclusions: Most middle-aged women from the Policlínico April 19 were concluded to have normal bone; osteoporosis predominated in older age groups and white skin color. Longer postmenopausal time and higher levels of luteinizing hormone and the follicle stimulating hormone were associated with poor bone mass; high levels of estradiol were associated with better bone mass(AU)

Association of bone mineral density with chronic obstructive pulmonary disease in postmenopausal women

Abstract Background Osteoporosis (OP) is common in patients with chronic obstructive pulmonary disease (COPD). The relationship between OP and COPD has been primarily studied in male patients, and few reports are available in postmenopausal women. Objective The purpose of this study was to investigate the association between bone mineral density (BMD) and COPD in postmenopausal women. Methods This cross-sectional study included 133 clinically stable female ex-smokers with confirmed COPD, and 31 age-matched “ex-smoker” female controls. We analyzed groups according to their airway obstruction category. BMD was measured on dual-energy X-ray absorptiometry images of the left femoral neck. Results Patients with COPD had lower T-scores and higher prevalence of osteopenia/OP than the control group. In the COPD group, the airway obstruction category was significantly associated with the T-score after adjustment for confounders. Multivariate logistic regression analysis showed COPD was an independent marker for increased risk of osteopenia/OP in postmenopausal women. Conclusions COPD and airway obstruction category were strongly related to BMD. Postmenopausal women with COPD, especially those with severe airway obstruction, had a higher prevalence rate and a higher risk of osteopenia and OP than female controls without COPD.

Riesgo de fractura osteoporótica y factores de riesgo asociados en mujeres postmenopáusicas en atención primaria de salud / Risk of osteoporotic fracture and associated risk factors in postmenopausal women in primary health care

Resumen Objetivo: Analizar el riesgo de fractura osteoporótica y factores de riesgo asociados en mujeres postmenopáusicas bajo control en un Centro de Atención Primaria de Salud. Material y Método: Estudio cuantitativo de corte transversal, selección de muestra de 197 mujeres entre 50 y 64 años, se calculó su riesgo de fractura mediante FRAX, una herramienta predictiva de fractura que incorpora factores de riesgo, y permite determinar la probabilidad a diez años de sufrir riesgo de fractura osteoporótica mayor y de cadera. Resultados: Un promedio de 3,46% ± 3,18% para riesgo de fractura mayor y de 0,84% ± 1,30% para riesgo de fractura de cadera. La categorización del riesgo indicó un 3% con alto riesgo para fractura mayor y un 11,2% alto riesgo para fractura de cadera. La mayor prevalencia de factores de riesgo fueron la osteoporosis secundaria, fumadora activa y fractura previa. Conclusiones: La situación de riesgo de fractura y los factores de riesgo más prevalentes observados, requiere establecer intervenciones preventivas desde el nivel de atención primaria de salud.

Abstract Objective: To analyze the risk of osteoporotic fracture and associated risk factors in postmenopausal women under control in a Primary Health Care Center. Material and Method: A cross-sectional quantitative study, sample selection of 197 women between 50 and 64 years of age, their risk of fracture was calculated using FRAX, a predictive tool for fracture that incorporates risk factors, and allows the probability to be determined ten years Risk of major osteoporotic fracture and hip fracture. Results: A mean of 3.46% ± 3.18% for greater fracture risk and 0.84% ± 1.30% for hip fracture risk. Risk categorization indicated 3% with high risk for major fracture and 11.2% high risk for hip fracture. The highest prevalence of risk factors was secondary osteoporosis, active smoking, and previous fracture. Conclusions: The situation of risk of fracture and the most prevalent risk factors observed requires establishing preventive interventions from the level of primary health care.

Aterosclerosis subclínica y disminución de la densidad mineral ósea en mujeres de edad mediana / Subclinical atherosclerosis and decreasing in bone´s mineral density in middle-aged women

Introducción: la aterosclerosis y la osteoporosis son enfermedades con una alta incidencia. Diversos estudios epidemiológicos han mostrado una asociación entre ambos procesos. Objetivo: describir la posible asociación entre la aterosclerosis subclínica y la disminución de la densidad mineral ósea, así como la relación de estos procesos con variables de la esfera reproductiva en mujeres de edad mediana. Métodos: se realizó un estudio descriptivo transversal con 103 mujeres que asistieron a la consulta de climaterio y osteoporosis del Instituto Nacional de Endocrinología. La aterosclerosis subclínica se diagnosticó a través del ultrasonido doppler carotídeo, y la densidad mineral ósea mediante la absorciometría dual de rayos x en columna lumbar. El test chi cuadrado de independencia, el coeficiente de correlación lineal de Pearson, la prueba t de comparación de medias y Anova, permitieron realizar el análisis estadístico. Resultados: la aterosclerosis subclínica se diagnosticó en 28 de las mujeres de edad mediana (27 por ciento), y 48 pacientes (46,6 por ciento) presentaron densidad mineral ósea disminuida (osteopenia u osteoporosis). El 57,1 por ciento de las pacientes con aterosclerosis subclínica tuvieron una densidad mineral ósea disminuida. El 70,4 por ciento de las pacientes con aterosclerosis subclínica estaban en posmenopausia; el 66,7 por ciento de las que tenían osteopenia, y el 75 por ciento de las que presentaron osteoporosis, pertenecían a la etapa posmenopáusica. Conclusiones: las mujeres de edad mediana con aterosclerosis subclínica tienen mayor frecuencia de osteopenia u osteoporosis. En aquellas con aterosclerosis subclínica y densidad mineral ósea disminuida predomina la posmenopausia. El tipo de menopausia y el tiempo de vida reproductiva no se relacionan con la aterosclerosis subclínica y la disminución de la densidad mineral ósea. Se evidencia una asociación inversa entre tiempo de posmenopausia y densidad mineral ósea(AU)

Introduction: atherosclerosis and osteoporosis are diseases with a high incidence. Several epidemiological studies have shown a relation among both processes. Objective: to describe the possible relation among subclinical atherosclerosis and the decrease of bone´s mineral density, as well as the relations of these processes with reproductive variables in middle-aged women. Methods: a cross-sectional descriptive study was conducted with 103 women who attended to the Climacteric and Osteoporosis Consultation in the National Institute of Endocrinology. Subclinical atherosclerosis was diagnosed through carotid doppler ultrasound, and bone´s mineral density by performing a dual x-ray absorptiometry in the lumbar spine. The chi square test of independence, the Pearson linear correlation coefficient, the t test for comparison of averages and Anova allowed the performance of the statistical analysis. Results: subclinical atherosclerosis was diagnosed in 28 of the middle-aged women in the study (27 percent), and 48 of them (46.6 percent) had decreased bone´s mineral density (osteopenia or osteoporosis). 57.1 percent of the patients with subclinical atherosclerosis had a decreased bone´s mineral density. 70.4 percent of the patients with subclinical atherosclerosis were in the postmenopause stage; 66.7 percent of those with osteopenia, and 75 percent of those with osteoporosis were in the postmenopausal stage. Conclusions: middle-aged women with subclinical atherosclerosis have more incidence of osteopenia or osteoporosis. In those with subclinical atherosclerosis and low bone´s mineral density, postmenopause is predominant. The type of menopause and the reproductive lifetime are not related to subclinical atherosclerosis and low bone´s mineral density. An inverse association among the postmenopausal time and bone´s mineral density is evidenced(AU)

Association between body mass index and osteoporosis in women from northwestern Rio Grande do Sul / Associação entre o índice de massa corporal e osteoporose em mulheres da região noroeste do Rio Grande do Sul

ABSTRACT Objective: To investigate the association between body mass index (BMI) and bone mineral density (BMD) in postmenopausal women. Methods: Observational study with postmenopausal women who underwent bone densitometry in Palmeira das Missões - RS. Sociodemographic data, risk for osteoporosis and food intake were assessed through a specific form. BMI was calculated according to WHO criteria. The assessment of BMD was performed by dual-energy X-ray absorptiometry (DXA) and classified according to WHO. Statistical analysis was performed using prevalence ratios (PR) and their respective 95% confidence intervals for the factors studied. Variables associated with p < 0.20 with the different outcomes (osteopenia and osteoporosis) were included in a Poisson regression model with robust variance to adjust for potential confounding factors. A 5% significance level was considered. Results: 393 postmenopausal women with a mean age of 59.6 ± 8.2 years participated.After the adjustments, the normal weight women had 1.2 times the prevalence of osteopenia of obese women (PR = 1.2; CI 95% 1.3-1.5). Considering osteoporosis, the PR of euthophic women was twice the PR of obese women (PR = 2; CI 95% 1.4-2.9) and was 1.7 times greater for overweight group compared to obese category (PR = 1.7; CI 95% 1.2-2.5). Conclusion: Obese women had lower prevalence of osteopenia compared with normal weight subjects and also with lower prevalence of osteoporosis as compared to normal- and overweight women.

RESUMO Objetivo: Verificar a associação entre o índice de massa corporal (IMC) e a densidade mineral óssea (DMO) em mulheres pós-menopáusicas. Métodos: Estudo observacional, com mulheres pós-menopáusicas submetidas à densitometria óssea em Palmeira das Missões (RS). Dados sociodemográficos, de risco para a osteoporose e do consumo alimentar foram avaliados por meio de formulário específico. O IMC foi calculado de acordo com a Organização Mundial de Saúde (OMS). A avaliação da DMO foi feita por meio de absorciometria por dupla emissão de raios-X (DXA) e classificada de acordo com a OMS. A análise estatística foi feita por meio de razões de prevalência (RP) e os seus respectivos intervalos de 95% de confiança para os fatores em estudo. Variáveis que se associaram com p < 0,20 com os diferentes desfechos (osteopenia e osteoporose) foram incluídas em um modelo de regressão de Poisson com variância robusta para ajuste para potenciais fatores de confusão. Foi considerado um nível de significância de 5%. Resultados: Participaram 393 mulheres pós-menopáusicas, com média de 59,6 ± 8,2 anos.Após os ajustes, as mulheres eutróficas apresentaram 1,2 vez a prevalência de osteopenia das mulheres obesas (RP = 1,2; IC 95% 1,3-1,5). E em relação à osteoporose, no grupo das eutróficas a RP foi duas vezes a RP das obesas (RP = 2; IC 95% 1,4-2,9) e 1,7 no grupo com sobrepeso em relação à categoria obesidade (RP = 1,7; IC 95% 1,2-2,5). Conclusões: As mulheres obesas apresentaram menor prevalência de osteopenia em comparação com as eutróficas, bem como tiveram menor prevalência de osteoporose em comparação com as mulheres eutróficas e com sobrepeso.

Factores de riesgo para alteraciones de la densidad mineral ósea en mujeres posmenopáusicas / Risk factors for alterations in bone mineral density in postmenopausal women

OBJETIVO: Determinar los factores de riesgo para presentar alteraciones de la densidad mineral ósea (DMO) en mujeres posmenopáusicas atendidas en la consulta de Menopausia y Climaterio de la Maternidad "Dr. Armando Castillo Plaza", de Maracaibo, Venezuela. MÉTODOS: Investigación descriptiva, con diseño no experimental y transeccional, donde se evaluó la DMO y los factores de riesgo para presentar osteoporosis en 60 mujeres posmenopáusicas. RESULTADOS: La medición de la DMO resultó en promedio de 957,45 ± 149,95 y 905,00 ± 151,25 gramos, con índices T de -0,52 ± 1,66 y -0,55 ± 2,67 en columna vertebral y cuello femoral, respectivamente. Se estableció una prevalencia de osteoporosis del 10% y 5%, y de osteopenia del 43,3% y 50% en columna vertebral y fémur, respectivamente. La menopausia quirúrgica (OR [95% CI] = 4,75 [1,58-14,25]; p=0,004), el consumo excesivo de café (OR [95% CI] = 3,20 [1,40-7,10 1]; p=0,000) o gaseosas (OR [95% CI] = 2,50 [1,18-5,60]; p=0,002), tabaquismo (OR [95% CI] = 1,70 [1,102,80]; p=0,013) y la ausencia de suplementación de calcio más vitamina D (OR [95% CI] = 1,70 [1,00-2,80]; p=0,019) resultaron ser factores significativamente asociados al diagnóstico de osteoporosis u osteopenia (p<0,05). CONCLUSIÓN: Las mujeres posmenopáusicas evaluadas presentan una alta prevalencia de alteraciones en la DMO, principalmente osteopenia, y factores de riesgo para presentar Osteoporosis.

AIM: To determine risk factors for presenting alterations in bone mineral density (BMD) in postmenopausal women attending the consultation of Menopause and Menopause Maternity "Dr. Armando Castillo Plaza", Maracaibo, Venezuela. METHODS: A descriptive research with non-experimental and transactional design where was evaluated BMD and risk factors for developing osteoporosis in 60 postmenopausal women. RESULTS: The BMD measurement was averaged in 957.45 ± 149.95 and 905.00 ± 151.25 grams; with T indexes of -0.52 ± 1.66 and -0.55 ± 2.67 in spine and femoral neck, respectively. The prevalence of osteoporosis was 10% and 5%, while osteopenia was 43.3% and 50% in spine and femur, respectively. Surgical menopause (OR [95% CI] = 4.75 [1.58 to 14.25]; p=0.004); excessive coffee consumption (OR [95% CI] = 3.20 [1,40- 7.10 1]; p=0.000) or gaseous beverages (OR [95% CI] = 2.50 [1.18 to 5.60]; p=0.002); smoking (OR [95% CI] = 1.70 [1.10 to 2.80]; p=0.013) and the absence of supplemental calcium plus vitamin D (OR [95% CI] = 1.70 [1.00 to 2.80]; p=0.019) were be factors significantly associated with the diagnosis of osteoporosis or osteopenia (p<0.05). CONCLUSION: The evaluated postmenopausal women have a high prevalence of abnormal BMD, especially osteopenia, and risk factors for developing osteoporosis.

Association between Bone Mineral Density and Clinical Consequences: Cross-Sectional Study of Korean Postmenopausal Women in an Orthopaedic Outpatient Clinic

This study is to identify the characteristics of BMD and the related clinical consequences through a nationwide, consecutive, cross-sectional study. A total of 1,281 postmenopausal women was enrolled nationwide and underwent measurement for BMD using dual energy x-ray absorptiometry. Following the T-spine and L-spine plane radiography, they were evaluated for vertebral fracture by a semi-quantitative method using the Genant's method. Relationship between BMD and osteoporotic fracture and a degree of deformity in vertebral fracture, treatment history in osteoporosis and the EQ-5D was analyzed. The distribution of the normal, osteopenia and osteoporosis group was 25.9%, 37.0%, and 37.2% in lumbar spine, and 31.4%, 45.3%, and 23.3% in femur neck, respectively. BMD in subjects with symptomatic or asymptomatic vertebral fracture was significantly lower than those without fracture. The femur neck and total hip BMDs were significantly lower in hip fracture group (0.646 g/cm2 and 0.643 g/cm2, respectively) and wrist fracture group (0.661 g/cm2 and 0.712 g/cm2, respectively) than in subjects without fracture (0.721 g/cm2 and 0.712 g/cm2, respectively). The BMD was significantly lower with more severe degree of deformity in vertebral fracture and lower scores in mobility, usual activities and pain/discomfort of the EQ-5D. In Korean postmenopausal women, the prevalence of osteoporosis and vertebral, hip and wrist fracture increase and quality of life decreases with lower BMD.

Association between Bone Mineral Density and Clinical Consequences: Cross-Sectional Study of Korean Postmenopausal Women in an Orthopaedic Outpatient Clinic

This study is to identify the characteristics of BMD and the related clinical consequences through a nationwide, consecutive, cross-sectional study. A total of 1,281 postmenopausal women was enrolled nationwide and underwent measurement for BMD using dual energy x-ray absorptiometry. Following the T-spine and L-spine plane radiography, they were evaluated for vertebral fracture by a semi-quantitative method using the Genant's method. Relationship between BMD and osteoporotic fracture and a degree of deformity in vertebral fracture, treatment history in osteoporosis and the EQ-5D was analyzed. The distribution of the normal, osteopenia and osteoporosis group was 25.9%, 37.0%, and 37.2% in lumbar spine, and 31.4%, 45.3%, and 23.3% in femur neck, respectively. BMD in subjects with symptomatic or asymptomatic vertebral fracture was significantly lower than those without fracture. The femur neck and total hip BMDs were significantly lower in hip fracture group (0.646 g/cm2 and 0.643 g/cm2, respectively) and wrist fracture group (0.661 g/cm2 and 0.712 g/cm2, respectively) than in subjects without fracture (0.721 g/cm2 and 0.712 g/cm2, respectively). The BMD was significantly lower with more severe degree of deformity in vertebral fracture and lower scores in mobility, usual activities and pain/discomfort of the EQ-5D. In Korean postmenopausal women, the prevalence of osteoporosis and vertebral, hip and wrist fracture increase and quality of life decreases with lower BMD.

Bone mineral density in Jamaican black women after hysterectomy and bilateral oophorectomy: an observational study / Densidad mineral osea en mujeres negras jamaicanas después de histerectomía y ooforectomía bilateral: un estudio observacional

OBJECTIVE: To see if black Jamaican postmenopausal women who had hysterectomy were at increased risk of osteoporosis. To assess the risk of osteoporosis in hysterectomized Jamaican postmenopausal patients. METHOD: We reviewed 809 women (403 hysterectomized and 406 controls) for cardiovascular disease risk. We did a demographic history and examination looking at blood pressure, waist hip ratio and body mass index and investigations done included fasting blood glucose and total and high density lipoprotein (HDL) cholesterol. We also measured bone density at the heel in all women using the Achilles ultrasound bone densitometer looking at T-score and Z-score. RESULTS: There was a significant association of hysterectomy status and bone mineral density (BMD) status with a smaller than expected proportion of women with osteoporosis in the hysterectomy group (χ2 = 18.4; p = 0.001). The mean T-score was significantly higher in the hysterectomized women, adjusting for age, waist circumference and sociodemographic factors. The relationship between the various predictors and BMD was explored by stepwise regression modelling. The factors that were significantly related to low BMD were hysterectomy status, age, waist circumference and being employed. CONCLUSION: Hysterectomy was not found to be a significant risk factor for osteoporosis. The osteoporosis risk among menopausal women in Jamaica appears to be due to other risk factors which probably existed prior to the operation.

OBJETIVO: Determinar si mujeres negras jamaicanas postmenopáusicas sometidas a histerectomía corrían mayor riesgo de osteoporosis. Evaluar el riesgo de osteoporosis en pacientes jamaicanas postmenopáusicas histerectomizadas. MÉTODO: Se examinaron 809 mujeres (403 histerectomizadas y 406 controles) para evaluar el riesgo de enfermedad cardiovascular. Hicimos una historia demográfica y un examen para obtener información sobre la presión arterial, el índice cintura/cadera ratio, y el índice de masa corporal. Asimismo, realizamos investigaciones que incluyeron pruebas de glucemia en ayunas, colesterol total, y colesterol de lipoproteínas de alta densidad (HDL). También medimos la densidad ósea en el talón de todas las mujeres, usando el densitómetro óseo ultrasónico modelo Achilles para obtener el T-score y el Z-score. RESULTADOS: Hubo una asociación significativa entre el estado de histerectomía y el estado de la densidad mineral ósea (DMO) con una proporción de mujeres con osteoporosis en el grupo de histerectomía (χ2 = 18.4; p = 0,001) más pequeña de lo esperada. El T-score promedio fue significativamente mayor en las mujeres histerectomizadas, ajustando por edad, circunferencia de la cintura y factores sociodemográficos. La relación entre los distintos factores predictivos y DMO fue explorada mediante regresión gradual stepwise modelado. Los factores que estuvieron significativamente relacionados con baja DMO fueron estado histerectomía, edad, circunferencia de la cintura y siendo empleado. CONCLUSIÓN: Se halló que la histerectomía no es un factor de riesgo significativo para la osteoporosis. El riesgo de osteoporosis entre las mujeres menopáusicas de Jamaica parece deberse a otros factores de riesgo que probablemente existían antes de la operación.

Gastos publicos com medicamentos para o tratamento da osteoporose na pos-menopausa / Public spending on drugs for the treatment of osteoporosis in post-menopause / Gastos con medicamentos en el Sistema Unico de Salud para el tratamiento de la osteoporosis en la post-menopausia

OBJETIVO: Analisar os gastos com medicamentos para o tratamento da osteoporose na pós-menopausa e os fatores associados ao gasto médio per capita . MÉTODOS: Pareamento probabilístico-determinístico a partir das bases das Autorizações de Procedimentos de Alta Complexidade com o Sistema de Informação sobre Mortalidade, resultando em coorte histórica de pacientes que utilizaram medicamentos de alto custo para o tratamento da osteoporose na pós-menopausa de 2000 a 2006. O gasto médio mensal com medicamentos foi estratificado por faixas etárias e descrito de acordo com as características demográficas, clínicas e tipo de medicamento utilizado. Foi utilizado modelo de regressão linear para avaliar o impacto de características demográficas e clínicas sobre o gasto médio mensal per capita com os medicamentos. RESULTADOS: Foram identificadas 72.265 mulheres que receberam medicamentos para o tratamento da osteoporose na pós-menopausa. O gasto médio mensal per capita no primeiro ano de tratamento foi de R$ 90,00 (dp R$ 144,49). A maioria das mulheres tinha de 60 a 69 anos de idade, iniciaram tratamento em 2000, eram residentes na região Sudeste, tinham fraturas osteoporóticas prévias e o alendronato de sódio foi o medicamento mais utilizado no início do tratamento. A maioria das pacientes permaneceu em uso do mesmo princípio ativo durante o tratamento. Foram identificados 6.429 óbitos entre as participantes. Mais de um terço das mulheres permaneceram no programa por até 12 meses. Raloxifeno e calcitonina sintética foram as alternativas com maior impacto sobre o gasto médio mensal com medicamentos, tendo como padrão de referência o ...

OBJECTIVE: To analyze expenditure on treatment for postmenopausal osteoporosis and associated factors on mean per capita expenditure. METHODS: A probabilistic-deterministic linkage between the database of Authorizations for Highly Complex Procedures and the mortality information system was constructed, resulting in a historical cohort of patients using high-cost medications for the treatment of postmenopausal osteoporosis, between 2000-2006. Mean monthly spending on medicines was stratified by age group and described according to demographic and clinical characteristics and the type of drug used. A linear regression model was used to assess the impact of demographic and clinical characteristics on per capita mean monthly expenditure on medicines. RESULTS: We identified 72,265 women who received drugs for the treatment of postmenopausal osteoporosis. The average monthly expenditure per capita in the first year of treatment was $ 54.02 (sd $ 86.72). The population was predominantly composed of women aged 60-69 years old, who had started treatment in 2000, resident in the Southeast of Brazil, who had previously suffered osteoporotic fractures, and Alendronate sodium was the drug most commonly used at baseline. For most of the patients, the same active ingredient remained in use throughout the treatment period. During the program, 6,429 deaths were identified among participants. More than a third of women remained in treatment for up to 12 months. Raloxifen and calcitonin were the therapeutic alternatives with the greatest impact on the average monthly expenditure on medicine using alendronate sodium as a reference standard. CONCLUSIONS: Due to the high impact of the type of drug used on expenditure on medication, it is recommended that criteria for prescribing and dispensing ...

OBJETIVO: Analizar los gastos con medicamentos para el tratamiento de la osteoporosis en la post-menopausia y los factores asociados al gasto promedio per cápita. MÉTODOS: Pareamiento probabilístico-deterministico a partir de las bases de las Autorizaciones de Procedimientos de Alta Complejidad con el Sistema de Información sobre Mortalidad, resultando en cohorte histórica de pacientes que utilizaron medicamentos de alto costo para el tratamiento de la osteoporosis en la post-menopausia de 2000 a 2006. El gasto promedio mensual con medicamentos fue estratificado por grupos etarios y descrito de acuerdo con las características demográficas, clínicas y tipo de medicamento usado. Se utilizó modelo de regresión linear para evaluar el impacto de las características socio demográficas y clínicas sobre el gasto promedio mensual per cápita con los medicamentos. RESULTADOS: Se identificaron 72.265 mujeres que recibieron medicamentos para el tratamiento de la osteoporosis en la post-menopausia. El gasto promedio mensual per cápita en el primer año de tratamiento fue de R$ 90,00 (de R$ 144,49). La mayoría de las mujeres tenía de 60 a 69 años de edad, iniciaron tratamiento en 2000, eran residentes en la región Sureste, tenían fracturas osteoporóticas previas, y el alendronato de sodio fue el medicamento más utilizado en el inicio del tratamiento. La mayoría de los pacientes permaneció en uso del mismo principio activo durante el tratamiento. Se identificaron 6.429 óbitos entre las participantes. Más de un tercio de las mujeres permanecieron en el programa por 12 meses. Raloxifeno y calcitonina sintética fueron las alternativas con mayor impacto sobre el gasto promedio mensual con medicamentos, teniendo como patrón de referencia ...

Osteoporose em mulheres na pós-menopausa: perfil epidemiológico e fatores de risco / Osteoporosis in postmenopausal women: epidemiological profile and risk factors

JUSTIFICATIVA E OBJETIVOS: A osteoporose é caracterizada por deteriorização microarquitetural do tecido ósseo; considerando o aumento da expectativa de vida, tornou-se um grande desafio para a saúde pública, causando um alto impacto socioeconômico no mundo. O objetivo deste estudo foi traçar o perfil epidemiológico das pacientes menopausadas que realizaram seus exames de densitometria óssea (DO) em hospital geral de Teresina, PI, no período de novembro de 2008 a maio de 2009, além de calcular a prevalência de osteoporose e sua associação com os fatores de risco pesquisados. MÉTODO: Foi aplicado um questionário por pessoa treinada, antes da realização do exame, que contemplava os seguintes dados: sócio-demográficos, antropométricos, reprodutivos e relativos aos hábitos de vida. A osteoporose foi definida como diminuição da massa óssea de pelo menos 2,5 desvios-padrão, em relação à média de massa óssea do adulto jovem (escore - T). RESULTADOS: A prevalência de osteoporose foi de 31,29%. Mulheres com idade entre 56 e 65 anos tiveram 2,4 vezes mais probabilidade de terem a doença. Sobrepeso e a obesidade mostraram-se como fatores protetores. Quanto às variáveis reprodutivas, o tempo de amenorreia mostrou associação com o desfecho na análise univariada, entretanto, perdeu significância na análise multivariada. Quanto aos fatores comportamentais, o álcool mostrou-se como fator protetor na análise univariada, mas perdeu significância na análise multivariada. CONCLUSÃO: A osteoporose foi mais prevalente em faixa etária maior, na cor branca, nas mulheres com baixo índice de massa corporal (IMC) e naquelas com maior duração da amenorreia. As variáveis reprodutivas e antropométricas foram mais significativas que os fatores comportamentais. Idade avançada, baixo IMC e raça branca foram fatores de risco associados à osteoporose.

BACKGROUND AND OBJECTIVES: Osteoporosis is characterized by microarchitectural deterioration of bone tissue; considering increase in life expectancy, osteoporosis has become a great challenge to public health, causing a high socio-economic impact worldwide. The purpose of this work was to delineate the epidemiological profile of post-menopausal patients who underwent bone densitometry examination in a general hospital in Teresina, Piaui, Brazil, from November 2008 to May 2009, calculate the prevalence of Osteoporosis and its association with risk factors studied. METHOD: A questionnaire was applied by a trained professional, including socio-demographic, anthropometric and reproductive data as well as those related to habits of life. Osteoporosis was defined as a reduction in bone mass for at least 2.5 standard deviations in relation to the average young adult bone mass (T-score). RESULTS: Osteoporosis prevalence was 31%. Women aging between 56 and 65 years old were 2.4 times more likely to have the disease. Overweight and obesity were seen as protective factors. As for reproductive variables, duration of amenorrhea was associated with outcome in univariate analysis; however, lost significance in multivariate analysis. With regard to behavioral factors, alcohol proved to be a protective factor in univariate analysis, but lost significance in multivariate analysis. CONCLUSION: Osteoporosis was prevalent in older age groups, Caucasians and in women with lower body mass index (BMI) and in those with longer amenorrhea. Reproductive and anthropometric variables were more significant than behavioral factors. Older age, lower BMI and Caucasian race were risk factors associated with Osteoporosis.

FRAX TM: construindo uma ideia para o Brasil / FRAX TM: building an idea to Brazil

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.

Genetic and racial background, body composition, bone mineral density (BMD), diet, physical activity and life style help to explain the wide difference observed in the world prevalence and incidence of osteoporosis. Recently, a fracture assessment tool, named FRAX TM, was developed to integrate clinical risk factors (genetic and environmental conditions) and BMD, in order to quantify the ten-year probability of an osteoporotic fracture. Shortly, it will be used to indicate treatment for high risk patients. However, this tool is now available only to those populations with known reliable and prospective epidemiologic data of the osteoporotic fractures - fact that does not include the Brazilian population. The aim of this paper was to review the main national and international epidemiologic studies to better understand the differences between the clinical risk factors, BMD and fracture probability of these populations. The authors concluded that, to use the FRAX TM tool, it is necessary more epidemiological data that could characterize the Brazilian population. The future studies should be prospective, evaluate the quality of life, mortality and morbidity after a fracture, as well the life expectancy of the population and the cost-effectiveness and utility related to the osteoporotic fracture. In fact, it is not recommended to use any of the populations available in the FRAX TM tool, as a substitute for the Brazilian population.

Association of menopause with osteopenia and osteoporosis: results from population based study done in Karachi

To assess the association of osteopenia and osteoporosis with menopause and compare the health seeking behaviour of women related to menopause in different strata of society. A cross-sectional study. Three different socioeconomic strata of Karachi from May till August 2004. A sample of 925 women, over 35 years of age, was selected from 16 clusters of 250 households [50 houses in each cluster]. All apparently healthy women having age between 35 and 50 years were selected in the cluster houses. Those who were not willing to be the part of the study or giving history of taking treatment for any disease for more than 4 weeks were excluded. In-depth interviews were conducted at their houses by the fourth year medical students trained and supervised by the senior faculty of the Medical College. T-scores were calculated to get BMD [Bone Mineral Density] for all the subjects through heel ultrasound. A total of 287 women were found to be experiencing menopause. The mean age of menopause was 47.8 + 4.7 years. Out of those 287 women, 135 [47%] wanted their menses to continue and 235 [82%] had consulted a physician after menopause. There was a significantly lower score of BMD of postmenopausal women [mean = -1.833 + 0.65] compared to pre-menopausal women [mean = -1.597 + 0.60, p=0.016]. Out of the 925 women interviewed, 53% had consulted a physician for various symptoms related to menopause. The symptoms experienced by pre-menopausal women included lack of sleep [25%], fear of becoming sterile [13%] and urinary incontinence [18%]. The average age of menopause was found to be similar to other studies of the country. Lower bone mineral density was found in greater proportion among older females. Majority needed intervention inclusive of awareness through health education and medication

Influência dos níveis de densitometria mineral óssea na perda óssea alveolar e parâmetros clínicos periodontais em mulheres na pós-menopausa / Influence of the bone mineral densitometry's levels in the alveolar bone loss and periodontal clinical parameters in the post menopausal women

Objetivo: Verificar a relação da influência do nível de densitometria mineral óssea (DOM) na perda óssea alveolar e parâmetros clínicos periodontais em mulheres na pósmenopausa. Métodos: Em um estudo seccional, foram avaliadas 23 mulheres na menopausa, com idade variando de 44-61 anos de idade. Densitometria óssea mineral da coluna lombar e do fêmur foram obtidas pela técnica DEXA. Foram incluídos exame clínico (profundidade a sondagem, perda de inserção, profundidade a sondagem e o número de ausência dental) e radiográfico para determinar a gravidade da doença periodontal. Os dados foram comparados pelo teste t Student e correlacionados pelo teste de Pearson (r). Resultados: Das 23 mulheres, duas eram osteoporóticas, 14 osteopênicas e 7 em condi- ção de normalidade. Para as comparações dos parâmetros clínicos periodontais com o perfil da DOM não foram encontradas diferenças significativas em nenhuma das análises. O coeficiente de correlação de Pearson foi fraco e negativo quando comparada a DOM com os parâmetros periodontais. Conclusão: No presente estudo não foi encontrada uma associação entre as modificações estruturais ósseas com os parâmetros periodontais (AU)

Objective: To correlate levels of bone mineral densitometry (BMD) and periodontal clinical parameters, including radiographic alveolar bone loss in postmenopausal women. Methods: This cross-sectional study included 23 postmenopausal women. Their ages ranged from 44 to 61 years-old. BMD of the lumbar vertebra and femur were obtained through the DEXA technique. Periodontal clinical examination (probing depth, clinical attachment level and number of missing teeth) and periapical radiographs were obtained to determine the severity of periodontal disease. The data obtained was analyzed using both student t test and Pearson correlation. Results: BMD revealed that 2 participants were osteoporotic, 14 were osteopenic, and 7 were healthy. Comparisons between periodontal clinical and radiographic parameters and BMD profile, among the distinct groups, showed no statistically significant differences. The coefficient for Pearson correlation was weak and negative when comparing BMD with all periodontal parameters. Conclusion: This study showed no association between bone structural modifications and clinical and radiographic periodontal parameters (AU)

Fracturas vertebrales, osteoporosis y vitamina D en la posmenopausia: Estudio en 555 mujeres en Chile / Vertebral fractures, osteoporosis and vitamin D levels in Chilean postmenopausal women

Background: Approximately one-third of vertebral fractures can be clinically diagnosed. Aim: To study the frequency of vertebral fractures in postmenopausal women. Patients and methods: We recruited 555 postmenopausal women from Santiago, Chile, aged 55-84 years, who manifested interest in their bone health. All were healthy by self-declaration and by general clinical and laboratory tests and had not taken any bone-active therapy. They all underwent a spine and femoral neck (FN) densitometry and a digital lateral spine X-ray from T4 to L4 was obtained. PTH, calcidiol, and other parameters of calcium metabolism were also measured. Results: Overall, 142 of 478 patients with a complete study (29.7 percent) had at least one vertebral fracture. The proportion of women with fractures increased with age. A T score below -2.5 in the spine and hip was found in 32 percent and 14 percent of women, respectively. The proportion of women with spinal opeoporosis doubled between ages 55-70 and remained constant afterwards. In contrast, at the femoral neck, this proportion increased progressively reaching 53.3 percent at age 80-85. However, 56 percent of patients with vertebral fractures did not have densitometric osteoporosis in any location. Calcidiol levels were 16.8±6.8 ng/mL. With a cutoff point of 17 ng/mL, 47.5 percent of the patients had hypovitaminosis D. There was no association between calcidiol levels and vertebral fractures or bone density at the spine or femoral neck. Patients with fractures differed from those without fractures in that they had significantly lower bone density at the spine and hip and were older (p <0.001). However they did not differ in weight, body mass index, or calcidiol levels. Conclusions: Thirty percent of postmenopausal women in this series had a vertebral fractures. Osteoporosis and vitamin D deficiency were also common. Most vertebral fractures were observed in women without osteoporosis by densitometric criteria.

Determination of osteoporosis risk factors using a multiple logistic regression model in postmenopausal Turkish women

To determine the risk factors of osteoporosis using a multiple binary logistic regression method and to assess the risk variables for osteoporosis, which is a major and growing health problem in many countries. We presented a case-control study, consisting of 126 postmenopausal healthy women as control group and 225 postmenopausal osteoporotic women as the case group. The study was carried out in the Department of Physical Medicine and Rehabilitation, Dicle University, Diyarbakir, Turkey between 1999-2002. The data from the 351 participants were collected using a standard questionnaire that contains 43 variables. A multiple logistic regression model was then used to evaluate the data and to find the best regression model. We classified 80.1% [281/351] of the participants using the regression model. Furthermore, the specificity value of the model was 67% [84/126] of the control group while the sensitivity value was 88% [197/225] of the case group. We found the distribution of residual values standardized for final model to be exponential using the Kolmogorow-Smirnow test [p=0.193]. The receiver operating characteristic curve was found successful to predict patients with risk for osteoporosis. This study suggests that low levels of dietary calcium intake, physical activity, education, and longer duration of menopause are independent predictors of the risk of low bone density in our population. Adequate dietary calcium intake in combination with maintaining a daily physical activity, increasing educational level, decreasing birth rate, and duration of breast-feeding may contribute to healthy bones and play a role in practical prevention of osteoporosis in Southeast Anatolia. In addition, the findings of the present study indicate that the use of multivariate statistical method as a multiple logistic regression in osteoporosis, which maybe influenced by many variables, is better than univariate statistical evaluation

Prevalence of osteoperosis among postmenopausal females with diabetes mellitus

To assess the prevalence of osteopenia and osteoporosis among Saudi postmenopausal women with non-insulin dependent type 2 diabetes mellitus [T2DM]. The study was carried out at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from February 2000 to September 2002. Bone mineral density [BMD] of the lumbar spine and femoral neck using dual x-ray absorptiometry [DXA; Lunar Wisconsin], were performed in 104 postmenopausal Saudi women with T2DM, and 101 postmenopausal non-diabetic women [control]. Bone mineral density was measured in gm/cm2 and both T-score and Z-score were measured but only T-score was used for analysis based on World Health Organization criteria. Bone profile, 25[OH] Vitamin D, 1,25[OH]2 Vitamin D, parathyroid hormone and urine deoxypyridinoline [DPD] were measured in most patients and controls. Body fat measurement around the biceps muscles using Futrex [body composition analyzer] were performed in patients and controls. Years postmenopausal, duration of diabetes mellitus, parity, exercise, sun exposure and milk consumption were also recorded. In the diabetic group, the mean spine BMD was 0.928 gm/cm2 [T-score = -2.28 SD] and for femoral neck the mean BMD was 0.817 gm/cm2 [T-score = -1.21 SD]. In control group, the mean spine BMD was 1.036 gm/cm2 [T-score = -1.2] and mean femoral neck BMD was 0.914 gm/cm2 [T-score = -0.608]. In the diabetic group, there was 16 [16.64%] patients with normal BMD of the spine, 42 patients [43.68%] with osteopenia [mean T-score = -1.8 SD] and 45 [46.8%] with osteoporosis [mean T-score = -3.3 SD]. Osteoporosis is more common among Type 2 postmenopausal females in this ethnic group. Since both groups are postmenopausal, having equal percentage of Vitamin D deficiency, multi-parity, non exposure to sun, lack of exercise and negligible milk intake, one can conclude that the low BMD can be attributed to DM in the absence of other causes of osteoporosis

Prevalência de osteoporose, fraturas vertebrais, ingestão de cálcio e deficiência de vitamina D em mulheres pós-menopausa / Prevalence of osteoporosis, vitamin D deficiency, low clacium intake, and vertebral fracture in postmenopausal women

O objetivo deste estudo foi verificar a prevalência de osteoporose, como também de deficiência de vitamina D, de baixa ingestão de cálcio, e de fraturas vertebrais, em mulheres na pós-menopausa. Estudamos 627 mulheres com idade acima de 50 anos, com média de idade foi de 63.9 ± 8.3 anos, tempo de menopausa de 16.2 ± 8.6 anos, e índice de massa corpórea de 26.6 ± 4.3 Kg/m2. A prevalência de osteoporose foi de 28.8 por cento na coluna lombar e de 18.8 por cento no colo do fêmur. A prevalência foi maior nas pacientes que apresentaram história de fraturas quando jovens. Na faixa entre 60 a 69 anos 33.2 por cento tinham osteoporose na coluna lombar e 17.4 por cento no colo do fêmur. Entre 70 e 79 anos, 38.2 por cento na coluna lombar e em 34 por cento no colo do fêmur. Das pacientes com mais de 80 anos 54.5 por cento tinham osteoporose na coluna lombar e 72.7 por cento no colo do fêmur. Em 32 por cento a ingestão de cálcio foi considerada baixa. A média de 25OH-D sérica foi de 31.2 ± 7.4 ng/ml, sendo que 24 por cento tinham níveis abaixo de 20 ng/ml, 19.7 por cento entre 20 e 25 ng/ml, e 56 por cento acima de 25 ng/ml. Trinta e sete por cento tinham fraturas, sendo que 9 por cento tinham fraturas grau I, e 10.9 por cento tinham farturas severas.Em mulheres na pós-menopausa, verificamos uma alta taxa de prevalência de osteoporose, de fraturas vertebrais assintomáticas, de deficiência de vitamina D, e de baixa ingestão de cálcio.

Osteoporosis in postmenopausal Saudi women using dual x-ray bone densitometry

A pilot study to estimate the prevalence of osteopenia and osteoporosis in postmenopausal Saudi women. Lumbar spine bone density was measured in 830 postmenopausal Saudi women 50-80 years of age [average 59 years], using dual x-ray absorptiometry [DXA] at the King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between 1989 and 1999. The results of the bone mineral density [BMD] in gm/cm2 were compared to the peak bone density [PBD] in healthy young women [T-score]. Based on the definition of World Health Organization [WHO], the T-score value was considered for analysis. Accordingly, 248 [29.9%] subjects showed normal result, mean BMD of 1.117 +/- 0.13 and T-score of -0.66 SD; while 254 [30.6%] subjects showed osteopenia, mean BMD of 0.983 +/- 0.11 and T-score of -2.4 SD and 328[39.5%] subject showed osteoporosis, mean BMD of 0.767 +/- 0.11 and T-score of -3.4 SD. When the 830 subjects were analyzed by decades, there were 42.3% normal, 33.4% osteopenia and 24.3% osteoporosis in age 50-59 years; 11% normal, 27% with osteopenia and 62% with osteoporosis in age 60-69 years while in older age 70-79 years only 4.6% had normal BMD, 21.5% had osteopenia and 73.8% had osteoporosis. Osteopenia and osteoporosis are common among postmenopausal Saudi women and should be considered as a matter of public health. Bone densitometry should be used to assess the severity of bone loss, identify those who need therapy and for follow up and early diagnosis of those with osteopenia in order to institute proper therapy and avoid future osteoporosis

La osteoporosis como enfermedad pediátrica / Osteoporosis as a pediatric disease

La osteoporosis es una enfermedad que se caracteriza por una pérdida cuantitativa de masa ósea, deterioro microarquitectural, mayor susceptibilidad a fracturas. La adecuada adquisición del pico de masa ósea en la adolescencia minimiza el riesgo del desarrollo de osteoporosis, por lo que se define a la osteoporosis como enfermedad pediátrica. Si durante esta etapa de crecimiento la ingesta es inadecuada en uno o más nutrientes, una posible consecuencia es el deterioro de ese crecimiento, que puede estar afectado cuantitativamente con disminución de la ganancia de peso o talla, pero también cualitativamente, donde la composición del nuevo tejido puede estar alterada. La ingesta adecuada de lácteos a lo largo de toda la vida ha sido descripta como factor fundamental para el desarrollo de una adecuada masa ósea y más específicamente la ingesta de calcio, dado que los productos lácteos podrían favorecer la adquisición de masa ósea a través de otro de sus componentes como la lactosa que aumenta la absorción de calcio por difusión en el ileon. Se describen dos entidades clínicas en diferentes edades de la infancia y adolescencia que cursan con baja masa ósea: la enfermedad ósea metabólica de la prematurez o desmineralización ósea postnatal en lactantes con muy bajo peso al nacer y los trastornos de la conducta alimentaria. Es la infancia y adolescencia, el período de la vida en que se puede ejercer intervención disminuyendo los factores de riesgo de un inadecuado pico de masa ósea, planificando estrategias para la prevención de la osteoporosis (actividad física, ingesta de calcio, exposición solar), por lo que se considera que el riesgo de desarrollar osteoporosis en la vida futura dependerá de la cantidad y resistencia ósea máxima alcanzada por una persona al llegar a la adultez