Prevalence of osteoporosis and related factors in postmenopausal women aged 40 and above in China / 中华流行病学杂志

Objective: To understand the prevalence of osteoporosis and related factors in postmenopausal women aged ≥40 years in China and provide scientific evidence for osteoporosis prevention and control. Methods: Data of this study were from the 2018 China Osteoporosis Epidemiological Survey, covering 44 counties (districts) in 11 provinces in China. Related variables were collected by questionnaire survey and physical measurement, and the BMD of lumbar spine and proximal femur was measured by dual-energy X-ray absorption method. The prevalence of osteoporosis and its 95%CI in postmenopausal women aged ≥40 years were estimated with complex sampling weights. Results: A total of 5 728 postmenopausal women aged ≥40 years were included in the analysis and the prevalence of osteoporosis was 32.5% (95%CI: 30.3%-34.7%). The prevalence of osteoporosis in postmenopausal women aged 40-49 years, 50-59 years, 60-69 years, 70-79 years, and ≥80 years were 16.0% (95%CI:4.5%-27.5%), 18.4% (95%CI:15.9%-20.8%), 37.5% (95%CI:34.5%-40.4%), 52.9% (95%CI: 47.5%-58.3%), and 68.0% (95%CI:55.9%-80.1%) respectively. The prevalence of osteoporosis was higher (P<0.001) in those with education level of primary school or below (47.2%, 95%CI: 43.0%-51.3%) and in those with individual annual income less than 10 000 Yuan, (40.3%, 95%CI: 36.9%-43.7%). The prevalence of osteoporosis was 35.1% in rural areas (95%CI: 32.0%-38.1%), which was higher than that in urban areas (P<0.001). The prevalence of osteoporosis in low weight, normal weight, overweight and obese groups were 69.9% (95%CI: 59.0%-80.8%), 42.2% (95%CI: 38.7%-45.7%), 24.2% (95%CI: 21.3%-27.1%) and 14.6% (95%CI: 11.1%-18.0%), respectively. The prevalence of osteoporosis in those with menstrual maintenance years ≤30 years and in those with menopause years ≥11 years were 46.1% (95%CI:40.8%-51.3%) and 48.2% (95%CI:45.0%-51.3%), respectively. Multivariate logistic analysis showed that age ≥60 years, education level of primary school or below, annual household income per capita less than 10 000 Yuan, low body weight, menstrual maintenance years ≤30 years, menopause years ≥11 years were risk factors of osteoporosis in postmenopausal women in China. Conclusions: The prevalence of osteoporosis was high in postmenopausal women aged ≥40 years in China, and there were differences in osteoporosis prevalence among different socioeconomic groups. Effective interventions should be taken for the prevention and control of osteoporosis in key groups in the future.

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.

Effect of multiparity on bone mineral density, evaluated with bone turnover markers / Efeito da multiparidade sobre a densidade mineral óssea, avaliada por marcadores de remodelação óssea

Abstract Objective: Our aim was to investigate the effect of parity on osteoporosis by evaluating bone mineral density, markers of bone turn-over and other factors that are effective in osteoporosis in multiparous (five deliveries or more) and nulliparous women in the post-menopausal period. Methods: A total of 91 multiparous (five deliveries or more) and 31 nulliparous postmenopausal women were included in this study. All patients were interviewed on sociodemographic characteristics, gynecologic history, personal habits, levels of physical activity, and life-long intake of calcium. Bone mineral density was measured at lumbar (L1-4) and femoral neck regions with Dexa. Results: The mean age of multiparous women was 58.79 ± 7.85 years, and the mean age of nulliparous women was 55.84 ± 7.51. The femoral BMD was 0.94 ± 0.16 and lumbar BMD 1.01 ± 0.16 in multiparous women, femoral BMD was 0.99 ± 0.16 and lumbar BMD 1.07 ± 0.14 in nulliparous women. There were no statistical differences between the femoral and lumbar T scores and BMD values of the two groups. Lumbar T scores and lumbar BMD showed a decrease with increasing total duration of breast-feeding in multiparous women. The independent risk factors for osteoporosis in the regression analysis of multiparous women were found to be the duration of menopause and body weight of 65 kg and less. Conclusion: There is no difference between the bone mineral densities of multiparous and nulliparous women. Females with lower body-weight and longer duration of menopause should be followed-up more carefully for development of osteoporosis.

Resumo Objetivo: Investigar o efeito da paridade sobre a osteoporose por meio da avaliação da densidade mineral óssea, marcadores de remodelação óssea e outros fatores eficazes na avaliação da osteoporose em multíparas (cinco partos ou mais) e nulíparas no período pós-menopausa. Métodos: Foram incluídas neste estudo 91 multíparas (cinco partos ou mais) e 31 nulíparas, todas na pós-menopausa. As pacientes foram entrevistadas para a determinação das características sociodemográficas, história ginecológica, hábitos pessoais, níveis de atividade física e ingestão de cálcio ao longo da vida. A densidade mineral óssea foi medida na região lombar (L1-4) e do colo femoral com a Dexa. Resultados: A média de idade das multíparas e nulíparas foi de 58,79 ± 7,85 anos e 55,84 ± 7,51, respectivamente. Nas multíparas, a DMO femoral e lombar foi de 0,94 ± 0,16 e 1,01 ± 0,16, respectivamente; nas nulíparas, a DMO femoral e lombar foi de 0,99 ± 0,16 e 1,07 ± 0,14, respectivamente. Não houve diferença estatisticamente significativa entre os T-escores femoral e lombar e os valores de DMO dos dois grupos. O T-escore e a DMO lombar mostraram uma diminuição em caso de aumento na duração total da lactação materna em multíparas. Encontrou-se que os fatores de risco independentes para a osteoporose na análise de regressão das multíparas são a duração da menopausa e o peso corporal menor ou igual a 65 kg. Conclusão: Não há diferença entre a densidade mineral óssea de multíparas e nulíparas. As mulheres com menor peso corporal e maior duração da menopausa devem ser acompanhadas com mais atenção para determinar se há desenvolvimento de osteoporose.

Comparación entre score de frax sin densidad mineral ósea y los criterios propuestos por la sociedad Argentina de osteoporosis para el uso de tratamiento antirresortivo en mujeres postmenopáusicas

Identificar pacientes con alto riesgo de fractura utilizando factores de riesgo clínicos podría reducir los gastos en salud derivados de la realización de una densitometría ósea. El objetivo de este estudio fue comparar el score de FRAX sin determinación de densidad mineral ósea (DMO) con los criterios propuestos por la Sociedad Argentina de Osteoporosis (SAO), para considerar el inicio de tratamiento antirresortivo. Realizamos un estudio observacional, transversal. Se incluyeron 330 mujeres postmenopáusicas entre 40 y 90 años de edad. Se determinó la cantidad de tratamientos indicados según se utilice la herramienta FRAX sin DMO, o los criterios de la SAO. Utilizando los criterios de la SAO, 85 (25.8%) pacientes recibirían tratamiento, mientras que si se utilizara la herramienta FRAX sin DMO, lo harían 15 (4.5%) pacientes (p = 0.0019). De los 67 pacientes con diagnóstico de osteoporosis por densitometría ósea, todas recibirían tratamiento utilizando los criterios de la SAO y solo 10 (15%) lo harían si utilizáramos el score de FRAX sin DMO (p = 0.011). La utilización del score de FRAX sin DMO reduce en forma significativa la cantidad de pacientes tratables en comparación con los criterios actuales de la SAO. En pacientes con diagnóstico de osteoporosis por DMO, el score de FRAX subestima los pacientes a tratar.

To identify patients at high risk of fracture using clinical risk factors could reduce health costs arising from the realization of a bone densitometry. The aim of this study was to compare the FRAX score without bone mineral density (BMD) with the criteria proposed by the Argentine Society of Osteoporosis (SAO) to consider starting antiresorptive treatment. We conducted an observational, cross-sectional study where 330 postmenopausal women between 40 and 90 years of age were included. The number of treatments given if the FRAX tool without BMD had been followed was compared with the number of treatments indicated using the SAO criteria. Using the SAO criteria, 85 (25.8%) patients would initiate antiresorptive treatment compared with 15 (4.5%) using the FRAX without BMD (p = 0.0019). Among the 67 patients with a diagnosis of osteoporosis by BMD determination, all of them (100%) would have received treatment by using the SAO criteria compared with 10 (15%) using the FRAX score (p = 0.011). The use of FRAX without BMD significantly underestimates the number of patients who should receive antiresorptive treatment. In patients diagnosed with osteoporosis by BMD, the FRAX score underestimates the number of patients to be treated.

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.

Caracterización de la asociación aterosclerosis-osteoporosis en hombres y mujeres: estudio en fallecidos / Caracterization of the aterosclerosis-osteoporosis asociation in men and women: patient death study

Objetivos: Caracterizar la asociación entre las lesiones ateroscleróticas de las arterias coronarias con la osteoporosis de la columna lumbar y de fémur proximal en hombres y mujeres. Métodos: Se estudiaron 79 necropsias, realizando densitometría postmorten de columna lumbar y fémur proximal, clasificando los niveles de densidad mineral ósea (DMO) según T score en: normal, osteopenia y osteoporosis; seguido del examen patomorfológico y morfométrico de las tres coronarias epicárdicas principales aplicando el sistema aterométrico, clasificando las lesiones ateroscleróticas como: estría adiposa, placa fibrosa y placa grave. Resultados: La asociación aterosclerosis-osteoporosis mostró características especiales para cada sexo, con predominio significativo de osteoporosis en hombres y de osteopenia en mujeres. Tras remover el efecto del tabaquismo, las diferencias entre los géneros se modificaron, observándose que los fumadores, de ambos sexos, presentaron una DMO y una asociación aterosclerosis-osteoporosis similares. Conclusiones: La interferencia ejercida por sexo sobre la asociación aterosclerosis-osteoporosis resultó despreciable

Objective: characterize the association between coronary atherosclerotic lesions and osteoporosis of lumbar spine and hip in men and women. Methods: We study 79 necropsies, doing lumbar spine and hip bone densitometry, classifying bone mineral density (BMD) by T score in: normal, osteopenia and osteoporosis. Then we carry out morphological and morphometric characterization of the three principal coronary arteries using the atherometric system, classifying atherosclerotic lesions like: fatty streak, fibrous plaques and severe plaques. Results: The atherosclerosis-osteoporosis association show special characteristics for each sex, with significantly predominance of osteoporosis in men and osteopenia in women. After smoking adjustment, the differences between sexes were modified, finding similar BMD and atherosclerosis-osteoporosis association between smoker patients of both sexes. Conclusions: The sex interference about atherosclerosis-osteoporosis association resulting contemptible

Women with primary ovarian insufficiency have lower bone mineral density

The aim of the present study was to assess the prevalence of osteoporosis in a sample of 32 patients with spontaneous primary ovarian insufficiency (POI) in comparison to reference groups of 25 pre- and 55 postmenopausal women. Hip (lumbar) and spinal bone mineral density (BMD) measurements were performed by dual-energy X-ray absorptiometry in the three groups. The median age of POI patients at the time of diagnosis was 35 years (interquartile range: 27-37 years). The mean ± SD age of postmenopausal reference women (52.16 ± 3.65 years) was higher than that of POI (46.28 ± 10.38 years) and premenopausal women (43.96 ± 7.08; P = 0.001) at the time of BMD measurement. Twenty-seven (84.4 percent) POI women were receiving hormone replacement therapy (HRT) at the time of the study. In the postmenopausal reference group, 30.4 percent were current users of HRT. Lumbar BMD was significantly lower in the POI group (1.050 ± 0.17 g/cm²) compared to the age-matched premenopausal reference group (1.136 ± 0.12 g/cm²; P = 0.040). Moreover, 22 (68.7 percent) POI women had low bone density (osteopenia/osteoporosis by World Health Organization criteria) versus 47.3 percent of the postmenopausal reference group (P = 0.042). In conclusion, the present data indicate that BMD is significantly lower in patients with POI than in age-matched premenopausal women. Also, the prevalence of osteopenia/osteoporosis is higher in POI women than in women after natural menopause. Early medical interventions are necessary to ensure that women with POI will maintain their bonemass.

[Evaluation of osteoporosis preventive factors in menopausal women referred to the health care centers of Ilam university of medical sciences in 2004]

Osteoporosis is a common metabolic bone disease that cause bone fracture. Menopause is the most important risk factors for osteoporosis. This disease is prevalent in menopausal women [50%] because of estrogen deficiency and less bone mass in menopausal period. The aim of this study was to determine the osteoporosis preventive factors in menopausal women referred to the health care centers of Ilam University of Medical Sciences. This research was an analytical-descriptive study, in which 150 menopausal women were selected by random sampling method as population of the study. The data were collected by interview, observation and physical examinations, using specific questionnaires and check lists. The data were analyzed by Chi-square and Fisher tests using SPSS software. The result of this study showed that%90 of the samples did not exercise,%92.7 have not consumed enough calcium and just%45.3 of the samples used to exposed in sunlight. These women also suffered from joint pain [%76.7], back pain [%47.3], and muscular weakness [%42.7]. In addition, our results showed that age [P<0.05], amount of calcium intakes in 24 hour [P<0.05], previous history of bone fracture in family [P<0.01], amount of vitamin D intakes [P<0.01] and steroid drugs [P<0.05] could have influences on osteoporosis intensity, but other variables did not show an influence on osteoporosis intensity [P>0.05]. The finding of this study showed a weak performance of menopausal women for preventing the risk factors causing osteoporosis. Thus, more training should be in considered for menopausal women to reduce osteoporosis among them

The association of dietary calcium, bone mineral density and biochemical bone turnover markers in rural Thai women.

OBJECTIVE: To investigate the relative contribution of dietary calcium intake on bone mineral density (BMD) and biochemical bone turnover markers in rural Thai women. MATERIAL AND METHOD: A cross-sectional investigation was designed in 255 rural Thai women. Usual dietary calcium intake was determined by 3-day food records and quantitative food-frequency questionnaire. BMD was measured by DXA. The three markers for bone turnover event: serum total alkaline phosphatase, serum N-mid osteocalcin and type I collagen C-telopeptide, including serum calcium and were determined in 125 women in the present study. RESULTS: An average daily calcium intake in the present study was 265 mg/day. Two hundred and thirty three out of 255 women (87%) consumed dietary calcium less than half of the recommended value and only 3% of women (n = 7) had calcium intake > 800 mg/day. After controlling certain parameters: age and body mass index, women who consumed higher amount of dietary calcium had significantly higher BMD at all sites. Moreover highly increased bone turnover markers were observed in those with lowest quartile calcium intake. Women with osteopenia and osteoporosis were older, lower BMI, consumed less calcium and had significantly higher values of all biochemical bone turnover markers than those who had normal BMD. CONCLUSION: The present study showed that a habitual diet of the rural Thai population might not provide enough calcium as needed for bone retention and for prevention of bone loss in the following years. Modification of eating pattern by promotion of increased consumption of locally available calcium rich food may be beneficial for prevention of osteoporosis among this population.

The presence of Helicobacter Pylori in postmenopausal women is not a factor to the decrease of bone mineral density

BACKGROUND: Osteoporosis affects approximately 30 percent of postmenopausal women. Gastrectomy, pernicious anemia, and more recently Helicobacter pylori infection, have all been implicated in the pathogenesis of osteoporosis. A reduced parietal cell mass is a common feature in these conditions. AIM: To study a possible relationship between chronic gastritis, parietal cell density of the oxyntic mucosa and bone mineral density in postmenopausal women, as chronic gastritis, Helicobacter pylori infection and osteoporosis are frequently observed in the elderly. METHODS: Fifty postmenopausal women (61.7 ± 7 years) were submitted to gastroduodenal endoscopy and bone densitometry by dual energy X-ray absorptiometry. Glandular atrophy was evaluated objectively by the determination of parietal cell density. Helicobacter pylori infection was evaluated by histology, urease test and breath test with 13C. RESULTS: Thirty-two patients (64 percent) presented chronic multifocal gastritis, and 20 of them (40 percent) showed signs of gastric mucosa atrophy. Lumbar spine osteoporosis was found in 18 patients (36 percent). The parietal cell density in patients with and without osteoporosis was 948 ± 188 and 804 ± 203 cells/mm², respectively. Ten osteoporotic patients (55 percent) and 24 non-osteoporotic patients (75 percent) were infected by Helicobacter pylori. CONCLUSION: Postmenopausal women with osteoporosis presented a well-preserved parietal cell density in comparison with their counterparts without osteoporosis. Helicobacter pylori infection was not different between the two groups. We concluded that neither atrophic chronic gastritis nor Helicobacter pylori seem to be a reliable risk factor to osteoporosis in postmenopausal women.

RACIONAL: A osteoporose afeta aproximadamente 30 por cento das mulheres na pós-menopausa. Gastrectomia, anemia perniciosa e mais recentemente, a infecção pelo H. pylori, têm sido implicados na patogênese da osteoporose. A diminuição da massa de células parietais constitui aspecto comum a estas condições. OBJETIVOS: Estudar possível relação entre gastrite crônica, densidade de células parietais da mucosa oxíntica e a densidade mineral óssea em mulheres na pós-menopausa. MÉTODOS: Cinqüenta mulheres na pós-menopausa (média de idade 61.7 ± 7 anos) foram submetidas a endoscopia digestiva alta e a densitometria óssea pela absorciometria com raio-X de dupla energia. A atrofia glandular foi avaliada, histologicamente e pela determinação da densidade das células parietais na mucosa do corpo gástrico. A infecção pelo H. pylori foi avaliada através da histologia, teste da urease e teste respiratório com C13. RESULTADOS: Trinta e dois pacientes (64 por cento) apresentaram gastrite crônica e 20 (40 por cento) deles apresentaram sinais de atrofia de mucosa gástrica através da análise histopatológica rotineira. Osteoporose da coluna lombar foi encontrada em 18 (36 por cento) pacientes. A densidade de células parietais em pacientes com e sem osteoporose foi 948 ± 188 e 804 ± 2003 células/mm², respectivamente. Dez pacientes (55 por cento) com osteoporose e 24 por cento (75 por cento) pacientes sem osteoporose estavam infectados pelo H. pylori. CONCLUSÃO:Mulheres na pós-menopausa com osteoporose apresentaram mucosa gástrica e população de células parietais mais conservadas em relação àquelas sem osteoporose. A infecção pelo H.pylori não foi estatisticamente diferente entre mulheres com e sem osteoporose, indicando que a infecção por esta bactéria, com ou sem atrofia da mucosa gástrica, não se constitui em fator de risco para osteoporose em mulheres na pós-menopausa.

Leptin and postmenopausal osteoporosis

To investigate plasma leptin concentrations in postmenopausal women to improve the understanding of the role of leptin in determining bone mass. A prospective observational cross-sectional study. Departments of Obstetrics and Gynecology, Rheumatology and Chemical Pathology at Kasr El-Aini Hospital, Cairo University. Thirty postmenopausal women with osteoporosis [ages range 45-73 years and body mass index [BM1] range 23.31-39.37Kg/m[2]], and 30 age- and BMI-matched healthy postmenopausal women. Bone mineral densities were measured by dual energy X-ray absorptiometry [DEXA]. Plasma leptin concentrations were measured using enzyme-linked immunosorbent assay [ELIZA]. The correlation of plasma leptin concentrations and bone mineral density [BMD]. Plasma leptin concentrations were significantly higher in the osteoporotic group than the control group [67.44 +/- 48.60 Vs. 38.10 +/- 19.58, p=0.004]. No correlation was observed between plasma leptin and BMD values in the osteoporotic group [r=0.2462, p=0.198; r=0.3452, p=0.067 and r=0.1898, p=0.324 for T score spine, Rt. hip and Lt. hip, respectively] and the control group [r=0.0050, p=0.980; r=0.2564, p=0.188 and r=-0.0967, p=0.624 for T score spine, Rt. hip and Lt. hip, respectively], but there was a significant positive correlation between plasma leptin and BMI in the osteoporotic group [r=0.4911, p=0.007] and the control group [r=0.8205, p<0.001]. Circulating plasma leptin does not have a significant direct influence on bone mass in postmenopausal women

Estudio preliminar de indicadores del estrés oxidativo y los síntomas que aquejan con mayor frecuencia a las mujeres climatéricas: Ciudad de Matanzas / Preliminary study of hints of oxidative stress and the symptoms of more frequency in climacteric women: Matanzas city

Se considera hoy en el mundo que más del 90 por ciento de las mujeres de países desarrollados pasan por la etapa del climaterio en algún momento de sus vidas. En virtud de los logros alcanzados por nuestra Salud Pública, se espera que cerca de cuatro millones de mujeres cubanas alcancen esta edad y padezcan invariablemente las consecuencias del déficit estrogénico. Como es conocido, a partir de la menopausia se manifiestan cambios neuroendocrinos que afectan el estado psicológico de la mujer y se incrementa la morbimortalidad femenina por afecciones como la aterosclerosis, la osteoporosis y el cáncer. Estudios recientes relacionan la etiología de muchos de estas afecciones con alteraciones en el estrés oxidativo, mientras otros demuestran el poder antioxidante de los estrógenos. Con el propósito de estudiar el comportamiento de estos indicadores en mujeres climatéricas y a su vez de evaluar la incidencia de las diferentes manifestaciones clínicas que caracterizan al Síndrome Climatérico, se realizó un estudio descriptivo que incluía a 60 mujeres matanceras de más de 40 años, 30 premenopáusicas y el resto postmenopáusicas, analizándose la presencia de algunos síntomas que generalmente acompañan al climaterio y las concentraciones de indicadores de estrés oxidativo y defensa antioxidante. Se encontró como síntoma más frecuente a los calores, seguidos por la ansiedad en las mujeres premenopáusicas, el insomnio y la cefalea en ambos grupos. Los indicadores del estrés oxidático mostraban cierto incremento, siendo éste más notable en el caso de la Superóxido Dismutasa (SOD) para ambos grupos...

Terapia hormonal y calidad del hueso / Hormone therapy and bone quality

La osteoporosis se reconoce como uno de los problemas de salud de la población femenina posmenopáusica, y la terapia hormonal de reemplazo (THR) como una de las medidas terapéuticas efectivas para evitar la fractura. Nos propusimos mostrar la experiencia acumulada en relación con el efecto de la terapia hormonal de reemplazo sobre la calidad del hueso. En un estudio retrospectivo realizado en 42 mujeres con edades entre 40 y 59 años que asistieron a la Clínica de Climaterio y Osteoporosis y a la consulta multidisciplinaria de climaterio del Hospital Ginecoobstétrico Ramón González Coro entre enero de 1997 y diciembre del año 2003, se determinó la calidad ósea mediante absorciometría dual de rayos X en región lumbar (L2-L4) o por ultrasonido del calcáneo (USCAL) y recibieron tratamiento continuado con terapia estrogénica (E) o con estrógenos progestagenos (EP) durante no menos de un año (n = 30). Las mujeres que no pudieron recibir THR fueron agrupadas y evaluadas como grupo control (n =12). Durante el tiempo de observación promedio de 2 años, las mujeres que recibieron THR mejoraron su calidad ósea en el 16,8(por ciento), mientras que las del grupo control empeoraron en el 8(por ciento) de los casos. Estos resultados iniciales, aunque son modestos, muestran la utilidad de la THR para mejorar la calidad del hueso y la necesidad de continuar estudios que permitan definir en nuestro medio la persistencia de la mejoría ósea, así como la magnitud de la osteoporosis posmenopáusica(AU)

Parâmetro biológico para avaliação do risco de osteoporose e fratura no menacme e climatério / A Biological parameter of the risc for osteoporosis and fracture during menacme and climateric

A Importância do estudo sobre o remodelamento ósseo ao longo do climatério sempre foi justificada por grande perda de massa óssea, o elevado risco de fratura, os custos dispendiosos para o diagnóstico, tratamento clínico-cirúrgico, atendimento para-médico e assistência social contínua. Em 1999, nos EUA, as despesas gerais com o tratamento da osteoporose atingiram US$ 21 bilhões, valor que inviabiliza qualquer programa de assistência médica para os países em desenvolvimento. A magnitude monetária obtida nos dados do IBGE em 2002, em que 27,6 por cento das mulheres brasileiras encontram-se acima de 40 anos, justificam per se a busca incessante por metodologias com compromisso social para serem aplicadas a partir do menacme. A nova definição de Osteopose, ao relacionar a deterioração da micro-arquitetura óssea (colágeno tipo I), com o risco de fratura, impõe nos estudos a utilização de tecnologias que avaliam simultaneamente a qualidade e a quantidade óssea. Portanto, para estudar o remodelamento ósseo no menacme e no climatério, quando devemos nos preocupar em prevenir a osteopenia e a osteoporose, a metodologia utilizada deverá obrigatoriamente retratar o perfil ósteo-sonográfico. Atualmente essa análise rigorosa só é possível quando realizada na metáfise distal das falanges proximais dos dedos II a V

Osteoporose: questão nutricional / Osteoporosis: nutritional question

A osteoporose torna-se cada vez mais freqüente, na medida em que os erros alimentares se tornam mais intensos e a prática de esportes, menos valorizada. A grande quantidade de vitaminas e sais minerais presentes na alimentação vegetariana amplamente diversificada favorece o bom funcionamento ósseo, enquanto que a acidez de uma dieta não-vegetariana induz a desmineralização óssea. Os alimentos fritos e (ou) picantes, oleosos, e o excessivo uso de comidas refinadas, como doces, produtos de confeitaria, pães e outros produtos do trigo refinado, são importantes fatores incriminados nas doenças articulares. Neste contexto, o uso da soja tem-se demonstrado de importância crítica no trabalho preventivo e curativo da oesteoporose em todas as faixas etárias. Diante do exposto, há uma necessidade premente de se desenvolver estratégias efetivas na prevenção e controle da osteoporose, visto que atualmente o risco de morte por uma fratura relacionada à osteoporose supera as taxas de mortalidade dos cânceres de mama e ovário em conjunto.

The osteoporosis becomes more frequent because the mistakes related to our nutrition are more intense today, and the practice of sports less often. The great amount of vitamins and mineral salts present in the vegetarian foods amply diversified favors the good bone metabolism, while the acidity of a no vegetarian diet induces the bone demineralization. The fried and(or) spicy foods, the fatty ones, and the excessive use of those refined items as candies and bakery products are important factors incriminated in the diseases of the articulations. In this context the use of soy has being of critical importance for the control of the osteoporosis in the postmenopausal women. In face of the above exposed, it is urgent to develop effective strategies for the prevention and control of the osteoporosis, because nowadays the risk os death related to a osteoporotic fracture overcomes the breast and ovary's cancer mortality together.

The diagnostic value of combined risk factor analysis and radiological imaging in determining osteoporosis in post-menopausal women.

AIM: To determine the diagnostic value of risk factor analysis (age, duration of menopause, body mass index and physical activities) and radiological imaging (Singh index and cortical index of the femoral neck) in diagnosing osteoporosis in post-menopausal women. METHODS: The study was cross sectional on 64 post-menopausal women without secondary risk factor for osteoporosis. They were classified proportionally using the Singh index. Bone density was measured using DEXA (dual x-ray absorptiometry) on the femoral neck and lumbal 2-4 spine areas. The Singh index and cortical index of the femoral neck were evaluated using femoral neck antero-posterior x-ray. Physical activities were measured using a Historical leisure activity questionnaire. Bivariat statistical analysis was conducted using the t-test and chi-square, whereas multivariate analysis was conducted using multinomial logistic regression. RESULTS: There was a significant association (p<0.05) between bone density and age, body weight, height, body mass index, duration of menopause and Singh index. With multinomial logistic regression analysis, it was demonstrated that only Singh index, the duration of menopause and body mass index had the highest sensitivity and specificity. The score system algorithm could be utilized in two steps, the first was to diagnose osteoporosis and the second was to distinguish between osteopenia and normal bone. This score system had a sensitivity of 91.4% and a specificity of 89.6%, a positive prediction value of 91.4% in determining osteoporosis, and a sensitivity of 66.7%, a specificity of 89.1% and a positive prediction value of 70.6% in determining osteopenia, whereas the negative prediction value was 75%. CONCLUSION: The score system algorithm is the best method for determining osteoporosis in post-menopausal women. If there is osteopenia, evaluation using DEXA is then required. The score system algorithm cannot be used to follow up the therapy.

Osteoporose em mulheres na pós-menopausa, cálcio dietético e outros fatores de risco / Osteoporosis in postmenopausal women, dietary calcium and other risk factors

O objetivo deste trabalho foi examinar os principais fatores de risco associados ao desenvolvimento de osteoporose primária em mulheres na pós-menopausa com osteopenia. Setenta e seis pacientes entre 46 e 85 anos foram selecionadas; 56,6 por cento apresentaram diagnóstico de osteopenia e 43,4 por cento, de osteoporose, de acordo com o critério da Organização Mundial da Saúde. Os fatores de risco foram pesquisados por meio de registro clínico e questionário de freqüência alimentar. O odds ratio foi calculado por meio do aplicativo Statistica. Oitenta e seis por cento das mulheres com osteopenia e 84,8 por cento das com osteoporose apresentaram baixa ingestão de cálcio através de produtos lácteos. O teste "t" para amostras independentes foi aplicado e não inferiu diferença significativa (p= 0,99) entre os dois grupos. No grupo com osteopenia, os fatores de risco assumiram a seguinte forma hierárquica: ausência de terapia de reposição hormonal (2,000), não-exposição ao sol (1,516), consumo de bebidas alcoólicas na juventude (1,346), consumo atual inadequado de cálcio (1,163), ausência de atividade física atual (1,145), história familiar de osteoporose (1,101), ausência de atividade física na juventude (1,006), tabagismo (0,851) e consumo atual de bebidas alcoólicas (0,827). Em conclusão, a ausência de terapia de reposição hormonal foi o fator de risco que indicou maior probabilidade de ocorrência de osteoporose entre as mulheres com osteopenia.

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

Fatores locais envolvidos na etiopatogênese da osteoporose pós-menopausa / Local factors involved in the etiopathogenesis of postmenopausal osteoporosis

A osteoporose representa uma das principais causas de morbidade na populaçäo idosa e inúmeros fatores de risco estäo envolvidos na sua patogênese, acreditando-se que em todos os casos exista uma alteraçäo no mecanismo de remodelaçäo óssea, em que a reabsorçäo excede a formaçäo de osso novo. Uma variedade de compostos, incluindo hormônios e nutrientes, modulam a remodelaçäo óssea e em adiçäo a essas substâncias bem caracterizadas, o sistema imune desempenha um papel importante através da açäo de citocinas, especialmente interleucinas e fatores de crescimento. Durante os últimos anos, estudos tem sido feitos visando a esclarecer os mecanismos fisiológicos envolvidos na regulaçäo local da remodelaçäo óssea, com ênfase especial na fisiopatologia da osteoporose. Este artigo realiza uma exaustiva revisäo acerca de alguns desses mecanismos e espera contribuir para o entendimento das alteraçöes da reabsorçäo óssea relacionadas à osteoporose.

Hipovitaminosis D en mujeres postmenopáusicas con masa ósea baja en la Región Metropolitana / Vitamin D levels in postmenopausal women with low bone mineral density from Región Metropolitana

Background: Low vitamin D levels are a risk factor for osteoporosis. In the Northern hemisphere, a high frequency of low vitamin D levels has been detected. The correction of this deficit is associated with a lower fracture risk. Aim: To measure serum vitamin D levels in postmenopausal women with low bone mineral density. Material and methods: 25-hydroxyvitamin D levels were measured in 40 postmenopausal women aged 50 to 74 years old, with a spine bone mineral density of less than 2 standard deviation of the values for young individuals. Serum calcium, phosphorus and calcium dietary intake were also measured. Results: Mean serum 25-hydroxyvitamin D levels were 32.2 ñ 12.5 ng/ml. No correlation between vitamin D levels and other measured variables was observed. Using a cutoff value of 15 ng/ml, two women had low 25-hydroxyvitamin D levels. Conclusion: In this sample of postmenopausal women, vitamin D deficiency was infrequent