RESUMO
A significant loss of bone mineral density and the appearance of multiple vertebral fractures after discontinuation of denosumab treatment have been described. To date, no hip fractures have been reported. We present three cases of patients who suffered femoral fractures after denosumab suppression.
Assuntos
Densidade Óssea/efeitos dos fármacos , Denosumab/farmacologia , Fraturas do Quadril/etiologia , Osteoporose Pós-Menopausa/tratamento farmacológico , Suspensão de Tratamento , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/farmacologia , Feminino , Fraturas do Quadril/diagnóstico , Humanos , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: First, to study the difference between two groups of postmenopausal women living in different population centres (rural vs urban) in the prevalence of osteoporosis, fragility fractures and factors which may influence them: hypovitaminosis D, bone mineral density, coexistence of other diseases which predispose to their appearance; secondly, to observe the influence of low socioeconomic status, categorised as poverty. STUDY DESIGN: 1229 postmenopausal women were studied, of whom 390 (31.7%), were living in rural areas and 839 (68.3%), in urban areas. Data regarding risk factors related to osteoporosis were obtained, and, among other biochemical measures, 25 hydroxyvitamin D and parathyroid hormone were determined. Bone densitometry was carried out in the lumbar spine and proximal femur, as well as lateral X-rays of the dorsal and lumbar spine. RESULTS: The women who lived in rural areas were older, shorter, heavier and had a higher body mass index than those from urban areas. Among the women from rural areas there was a higher prevalence of poverty, and higher levels of obesity, arterial hypertension and diabetes mellitus were observed, as well as a higher prevalence of densitometric osteoporosis. The rural women had lower values of bone mineral density in the lumbar spine and a higher prevalence of vertebral fractures and hypovitaminosis D. The variables which were associated independently with living in rural areas were poverty, obesity, vertebral fractures, BMD in the lumbar spine and levels of 25 hydroxyvitamin D. CONCLUSIONS: In our study, postmenopausal women who live in rural populations have more poverty, lower values of vitamin D, lower BMD in the lumbar spine and a higher prevalence of vertebral fractures and of osteoporosis. The higher prevalence of obesity, arterial hypertension and diabetes mellitus observed in these women may be adjuvant factors, all fostered by their socioeconomic state of poverty.
Assuntos
Densidade Óssea , Osteoporose Pós-Menopausa/epidemiologia , Pós-Menopausa , Pobreza , População Rural , Fraturas da Coluna Vertebral/epidemiologia , Deficiência de Vitamina D/epidemiologia , Adulto , Idoso , Índice de Massa Corporal , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Vértebras Lombares/metabolismo , Pessoa de Meia-Idade , Obesidade/epidemiologia , Osteoporose Pós-Menopausa/metabolismo , Prevalência , Saúde da População Rural , Fraturas da Coluna Vertebral/metabolismo , População Urbana , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangueRESUMO
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