Vertebral fractures associated with osteoporosis: patient management.

With the growing interest in new treatments aimed at preventing bone loss and conserving bone mass, insufficient attention has been given to symptomatic treatment of patients with vertebral fractures. Patients often believe that the pain and impaired mobility associated with these fractures are permanent and that little can be done to help. This is a serious misconception. Prompt intervention using a multidisciplinary approach can hasten recovery from pain; improve mobility, flexibility, and speed of movement; and restore independence. Individualized care is needed because clinical features and degree of physical disability vary widely. Asymptomatic patients with vertebral fractures require evaluation and a management plan aimed at maintaining bone mass, improving functional status of the affected region, and preventing pain and new fractures. For patients with acute or chronic pain, treatment of pain and functional limitations is the first priority, followed by functional rehabilitation and preservation of bone mass. A multidisciplinary approach to long-term care is recommended and includes lifestyle re-education, physical therapy, physical fitness training, neurologic and orthopedic evaluation, and, for some patients, use of an orthosis. After 4-6 weeks, those patients for whom pain is persistent require detailed study to detect neurologic, myofascial, or orthopedic complications that can lead to chronic impairment of mobility. Vertebroplasty, surgery using different modalities, new exercise programs, and lifestyle modifications, together with more potent and effective medications to improve bone quality, are options to be used in the individual patient. Well-designed studies are needed that specifically examine the management of these patients, particularly in the areas of pain relief and functional rehabilitation.

[Reproducibility of a questionnaire for studying climacteric]. / Reproducibilidad de un cuestionario para el estudio del climaterio.

OBJECTIVE: This study evaluated the reproducibility of a questionnaire concerned with the clinical and epidemiological aspects of menopause. MATERIAL AND METHODS: The study population consisted of a hundred perimenopausal Mexican women seeking care at gynecology and obstetric health care services. Their participation was voluntary and they answered the same questionnaire two times with a 15-30 day lag between each application. RESULTS: The Kappa coefficient was high (0.81-1.0) for categorical variables such as: type of menstrual cycles, type of menopause, breast-feeding, use of estrogen during menopause and use of hormonal contraceptives. The Kappa coefficient was moderate (0.7-0.8) for symptoms related to menopause such as hot flashes, sweating, painful coitus, vaginal dryness and a decrease in libido. Mean differences were calculated for continuous variables such as age at menarche, age at menopause, time using estrogen and the duration of breast-feeding, the majority had a value of zero and 95% confidence intervals for these mean differences included the null value. The questionnaire also included other characteristics such as tobacco consumption and a short food frequency questionnaire, which showed high concordance (Kappa 0.7-1.0). CONCLUSIONS: The results of this study show that this questionnaire has a high level of reproducibility and can be useful as a research tool to explore menopause in Mexican women.

[Risk factors in osteoporosis: clinical and epidemiologic evidence]. / Factores de riesgo en la osteoporosis: evidencias clínicas y epidemiológicas.

The mechanisms of bone loss involve a predominance of osteodestructive cell activity over bone repair. Age and gender are the most significant biological risk factors; perimenopausal women constitute the most susceptible population group. Hormone-related phenomena, such as pregnancies and lactational performance, as well as heredity and ethnic origin, are also associated with osteoporosis. Alcohol and caffeine have been linked with progressive bone demineralization. A reduced body mass increases the probability of fractures. Dietary factors, such as adequate intakes of calcium, phosphates, and vitamin D, exert a protective action while the effect of fluoride and dietary fiber is still controversial. A constant physical activity promotes an appropriate development and maintenance of bone mass and architecture.