Decrease in Bone Mass in Women After Liver Transplantation: Associated Factors

AbstractBackgroundIn the future, an increasing number of female liver transplant recipients will reach the climacteric with osteoporosis as a common complication. We evaluated the factors associated with decreased bone mass among women after liver transplantation.MethodsA prospective, cross-sectional study of 23 outpatient transplant recipients followed from February 2009 to March 2010 included women of age ≥35 years after liver transplantations ≥1 year prior. We recorded patient histories, liver enzyme levels, as well as bone mineral densities measured at the lumbar spine and femur. Statistical analysis used Fisher's exact test, simple odds ratio (OR), and Spearman's rank correlation coefficient.ResultsThe mean patient age was 52.5 ± 11 years with 30.4% premenopausal, and 69.6% perimenopausal or postmenopausal. Approximately 21% showed osteoporosis and 35%, a low bone mass. Postmenopausal women: OR 69.0 (95% CI 2.89–1647.18; P < .0001), aged ≥49 years: OR 13.33 (95% CI 1.78–100.15; P = .0123) and receiving a transplant after 44 years of age: OR 49.50 (95% CI 3.84–638.43; P < .0001) were associated with a lower bone mass. Having undergone transplantation for more than 5.8 years lowered the risk of bone mass change: OR 0.11 (95% CI 0.02–0.78; P = .0361). Clinical and laboratory variables, including corticosteroid use, were not associated with decreased bone mass.ConclusionUnderstanding the prevalence and factors associated with osteoporosis among female liver transplant recipients is important to enhance the strategies to diagnose and treat these women, seeking to improve their quality of life

Quality Of Life And Menopausal Symptoms In Women With Liver Transplants [qualidade De Vida E Sintomas Da Menopausa Em Mulheres Transplantadas Hepáticas]

PURPOSE: To assess quality of life and climacteric symptoms in women with and without liver transplants. METHODS: This was a cross-sectional study of 52 women undergoing follow-up at a university hospital in southeastern Brazil from February 4th, 2009 to January 5th, 2011. Twenty-four of these women were 35 years old or older and had undergone liver transplantation at least one year before study entry. The remaining 28 women had no liver disease and were matched by age and menstrual patterns to the patients with transplants. The abbreviated version of the World Health Organization (WHOQOL-BREF) questionnaire was used to assess quality of life. Menopausal symptoms were assessed using the Menopause Rating Scale (MRS). Statistical analysis was carried out by Student's I{stroke} -test, Mann-Whitney test and analysis of variance. Correlations between MRS and the WHOQOL-BREF were established by correlation coefficients. RESULTS: The mean age of the women included in the study was 52.2 (±10.4) years and the mean time since transplantation was 6.1 (±3.3) years. Women with liver transplants had better quality of life scores in the environment domain (p=0.01). No difference was noted between the two groups in any domain of the MRS. For women in the comparison group, there was a strongly negative correlation between somatic symptoms in the MRS and the physical domain of the WHOQOL-BREF (p&lt;0.01; r=-0.8). In contrast, there was only a moderate association for women with liver transplants (p&lt;0.01; r=-0.5). CONCLUSIONS: Women with liver transplants had better quality of life scores in the domain related to environment and did not exhibit more intense climacteric symptoms than did those with no liver disease. Climacteric symptoms negatively influenced quality of life in liver transplant recipients, although less intensely than in women without a history of liver disease.353103110Saab, S., Ng, V., Landaverde, C., Lee, S.J., Comulada, W.S., Arevalo, J., Development of a disease-specific questionnaire to measure health-related quality of life in liver transplant recipients (2011) Liver Transpl, 17 (5), pp. 567-579Lim, K.B., Schiano, T.D., Long-term outcome after liver transplantation (2012) Mt Sinai J Med, 79 (2), pp. 169-189van Ginneken, B.T., van den Berg-Emons, R.J., van der Windt, A., Tilanus, H.W., Metselaar, H.J., Stam, H.J., Persistent fatigue in liver transplant recipients: A two-year follow-up study (2010) Clin Transplant, 24 (1), pp. E10-E16Bryan, S., Ratcliffe, J., Neuberger, J.M., Burroughs, A.K., Gunson, B.K., Buxton, M.J., Health-related quality of life following liver transplantation (1998) Qual Life Res, 7 (2), pp. 115-120Nickel, R., Wunsch, A., Egle, U.T., Lohse, A.W., Otto, G., The relevance of anxiety, depression, and coping in patients after liver transplantation (2002) Liver Transpl, 8 (1), pp. 63-71Masala, D., Mannocci, A., Unim, B., Del Cimmuto, A., Turchetta, F., Gatto, G., Quality of life and physical activity in liver transplantation patients: Results of a case-control study in Italy (2012) Transplant Proc, 44 (5), pp. 1346-1350Sirivatanauksorn, Y., Dumronggittigule, W., Limsrichamrern, S., Iramaneerat, C., Kolladarungkri, T., Kositamongkol, P., Quality of life among liver transplantation patients (2012) Transplant Proc, 44 (2), pp. 532-538Wang, G.S., Yang, Y., Li, H., Jiang, N., Fu, B.S., Jin, H., Health-related quality of life after liver transplantation: The experience from a single Chinese center (2012) Hepatobiliary Pancreat Dis Int, 11 (3), pp. 262-266de Bona, M., Ponton, P., Ermani, M., Iemmolo, R.M., Feltrin, A., Boccagni, P., The impact of liver disease and medical complications on quality of life and psychological distress before and after liver transplantation (2000) J Hepatol, 33 (4), pp. 609-615Jabiry-Zienjewicz, Z., Kaminski, P., Bobrowska, K., Pietrzak, B., Wielgos, M., Zieniewicz, K., Menstrual cycle and sex hormone profile in perimenopausal women after liver transplantation (2006) Transplant Proc, 38 (9), pp. 2909-2912Boin, I.F., Ataide, E.C., Leonardi, M.I., Stucchi, R., Sevá-Pereira, T., Pereira, I.W., Elderly donors for HCV(+) versus non-HCV recipients: Patient survival following liver transplantation (2008) Transplant Proc, 40 (3), pp. 792-796Guyton, A.C., Hall, J.E., (1996) Textbook of Medical Physiology, , Philadelphia, SaundersParolin, M.B., Rabinovitch, I., Urbanetz, A.A., Scheidemantel, C., Cat, M.L., Coelho, J.C., Impact of successful liver transplantation on reproductive function and sexuality in women with advanced liver disease (2004) Transplant Proc, 36 (4), pp. 943-944Mass, K., Quint, E.H., Punch, M.R., Merion, R.M., Gynecological and reproductive function after liver transplantation (1996) Transplantation, 62 (4), pp. 476-479Cundy, T.F., O'Grady, J.G., Williams, R., Recovery of menstruation and pregnancy after liver transplantation (1990) Gut, 31 (3), pp. 337-338Hickey, M., Davis, S.R., Sturdee, D.W., Treatment of menopausal symptoms: What shall we do now? (2005) Lancet, 366 (9483), pp. 409-421Hess, R., Thurston, R.C., Hays, R.D., Chang, C.C., Dillon, S.N., Ness, R.B., The impact of menopause on health-related quality of life: Results from the STRIDE longitudinal study (2012) Qual Life Res, 21 (3), pp. 535-544Ozkan, S., Alatas, E.S., Zencir, M., Women ́s quality of life in the premenopausal and postmenopausal periods (2005) Qual Life Res, 14 (8), pp. 1795-1801Dennerstein, L., Lehert, P., Guthrie, J., The effects of the menopausal transition and biopsychosocial factors on well-being (2002) Arch Womens Ment Health, 5 (1), pp. 15-22Mishra, G.D., Brown, W.J., Dobson, A.J., Physical and mental health: Changes during menopause transition (2003) Qual Life Res, 12 (4), pp. 405-412Kumari, M., Stafford, M., Marmot, M., The menopausal transition was associated in a prospective study with decreased health functioning in women who report menopausal symptoms (2005) J Clin Epidemiol, 58 (7), pp. 719-727Cheng, M.H., Lee, S.J., Wang, S.J., Wang, P.H., Fuh, J.L., Does menopausal transition affect the quality of life? A longitudinal study of middle-aged women in Kinmen (2007) Menopause, 14 (5), pp. 885-890Avis, N.E., Colvin, A., Bromberger, J.T., Hess, R., Matthews, K.A., Ory, M., Change in health-related quality of life over the menopausal transition in a multiethnic cohort of middle-aged women: Study of Women ́s Health Across the Nation (2009) Menopause, 16 (5), pp. 860-869Birkhauser, M.H., Barlow, D.H., Notelovitz, M., Rees, M.C., (2005) Management Handbook: Health Plan For the Adult Woman, , London, Taylor & FrancisHeinemann, L.A., Potthoff, P., Schneider, H.P., International versions of the Menopause Rating Scale (MRS) (2003) Health Qual Life Outcomes, 1, p. 28Fleck, M.P., Louzada, S., Xavier, M., Chachamovich, E., Vieira, G., Santos, L., Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida WHOQOL-bref (2000) Rev Saúde Pública, 34 (2), pp. 178-183Santos, C., (2007) Estatística Descritiva - Manual De Auto-aprendizagem, , Lisboa, Edições SílaboTelles-Correia, D., Barbosa, A., Mega, I., Mateus, E., Monteiro, E., When does quality of life improve after liver transplantation? A longitudinal prospective study (2009) Transplant Proc, 41 (3), pp. 904-905Aadahl, M., Hansen, B.A., Kirkegaard, P., Groenvold, M., Fatigue and physical function after orthotopic liver transplantation (2002) Liver Transpl, 8 (3), pp. 251-259Goetzmann, L., Klaghofer, R., Wagner-Huber, R., Halter, J., Boehler, A., Muellhaupt, B., Quality of life and psychosocial situation before and after a lung, liver or an allogeneic bone marrow transplant (2006) Swiss Med Wkly, 136 (17-18), pp. 281-290Schwartz, C.E., Rapkin, B.D., Reconsidering the psychometrics of quality of life assessment in light of response shift and appraisal (2004) Health Qual Life Outcomes, 2, p. 16Dennerstein, L., Dudley, E., Guthrie, J., Barrett-Connor, E., Life satisfaction, symptoms, and the menopausal transition (2000) Medscape Womens Health, 5 (4), pp. E4Brzyski, R.G., Medrano, M.A., Hyatt-Santos, J.M., Ross, J.S., Quality of life in low-income menopausal women attending primary care clinics (2001) Fertil Steril, 76 (1), pp. 44-50Ekström, H., Hovelius, B., Quality of life and hormone therapy in women before and after menopause (2000) Scand J Prim Health Care, 18 (2), pp. 115-12

Factors Associated With Fragility Fractures In Women Over 50 Years Of Age: A Population-based Household Survey [fatores Associados A Fraturas Por Fragilidade óssea Em Mulheres Acima De 50 Anos De Idade: Um Estudo De Base Populacional]

Purpose: To analyze the prevalence of and factors associated with fragility fractures in Brazilian women aged 50 years and older. Methods: This cross-sectional population survey, conducted between May 10 and October 31, 2011, included 622 women aged ≥50 years living in a city in southeastern Brazil. A questionnaire was administered to each woman by a trained interviewer. The associations between the occurrence of a fragility fracture after age 50 years and sociodemographic data, health-related habits and problems, self-perception of health and evaluation of functional capacity were determined by the χ2 test and Poisson regression using the backward selection criteria. Results: The mean age of the 622 women was 64.1 years. The prevalence of fragility fractures was 10.8%, with 1.8% reporting hip fracture. In the final statistical model, a longer time since menopause (PR 1.03; 95%CI 1.01-1.05; p&lt;0.01) and osteoporosis (PR 1.97; 95%CI 1.27-3.08; p&lt;0.01) were associated with a higher prevalence of fractures. Conclusion: These findings may provide a better understanding of the risk factors associated with fragility fractures in Brazilian women and emphasize the importance of performing bone densitometry.3511497502Instituto Brasileiro de Geografia e Estatística (IBGE) [Internet]., , http://censo2010.ibge.gov.br/resultados, Censo 2010: resultados [citado 2013 Fev 14]. Disponível emKanis, J.A., Odén, A., McCloskey, E.V., Johansson, H., Wahl, D.A., Cooper, C., A systematic review of hip fracture incidence and probability of fracture worldwide (2012) Osteoporos Int., 23 (9), pp. 2239-2256Hughson, J., Newman, J., Pendleton, R.C., Hip fracture management for the hospital-based clinician: A review of the evidence and best practices (2011) Hosp Pract (1995)., 39 (1), pp. 52-61Auron-Gomez, M., Michota, F., Medical management of hip fracture (2008) Clin Geriatr Med., 24 (4), pp. 701-719+ixPinheiro, M.M., Ciconelli, R.M., Martini, L.A., Ferraz, M.B., Clinical risk factors for osteoporotic fractures in Brazilian women and men: The Brazilian Osteoporosis Study (BRAZOS) (2009) Osteoporos Int., 20 (3), pp. 399-408Siqueira, F.V., Facchini, L.A., Hallal, P.C., The burden of fractures in Brazil: A population-based study (2005) Bone., 37 (2), pp. 261-266Pinheiro, M.M., Reis Neto, E.T., McHado, F.S., Omura, F., Yang, J.H.K., Szejnfeld, J., Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women (2010) Rev Saúde Pública., 44 (3), pp. 479-485Kanis, J.A., Johnell, O., Oden, A., Johansson, H., McCloskey, E., FRAX and the assessment of fracture probability in men and women from the UK (2008) Osteoporos Int., 19 (4), pp. 385-397Pinheiro, M.M., Eis, S.R., Epidemiology of osteoporotic fractures in Brazil: What we have and what we need (2010) Arq Bras Endocrinol Metabol., 54 (2), pp. 164-170FRAX: WHO Fracture Risk Assessment Tool [Internet]., , http://www.shef.ac.uk/FRAX/tool.aspx?country=55, Calculation tool [cited 2013 May 7]. Available fromLebrão, M.L., Duarte, Y.A.O., (2003) SABE-Saúde, bem-estar e envelhecimento-O projeto SABE no município de São Paulo: Uma abordagem inicial, , Brasília (DF): Organização Pan-Americana de Saúde(2008) Vigilância de fatores de risco e proteção para doenças crônicas não transmissíveis por entrevistas telefônicas (VIGITEL)., , http://portal.saude.gov.br/portal/arquivos/pdf/167_Q2008.pdf, Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde [Internet]. [citado 2013 Fev 14]. Disponível emGuralnik, J.M., Fried, L.P., Simonsick, E.M., Kasper, J.D., Lafferty, M.E., (1995) The women's health and aging study: Health and social characteristics of older women with disability., , editors. Bethesda: National Institute on Aging(NIH Pub. No. 95-4009)Altman, D.G., (1999) Practical statistics for medical research, , Boca Raton: Chapman & Hall/CRCBarros, A.J.D., Hirakata, V.N., Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio (2003) BMC Med Res Methodol., 3, p. 21Baim, S., Leslie, W.D., Assessment of fracture risk (2012) Curr Osteoporos Rep., 10 (1), pp. 28-41(2010) Clinician's guide to prevention and treatment of osteoporosis, , National Osteoporosis Foundation. Washington, DC: National Osteoporosis FoundationBaccaro, L.F., McHado, V.S.S., Costa-Paiva, L., Sousa, M.H., Osis, M.J., Pinto-Neto, A.M., Treatment for menopausal symptoms and having health insurance were associated with a lower prevalence of falls among Brazilian women (2013) Maturitas., 75 (4), pp. 367-372Baccaro, L.F., McHado, V.S.S., Costa-Paiva, L., Souza, M.H., Osis, M.J., Pinto-Neto, A.M., Factors associated with osteoporosis in Brazilian women: A population-based household survey (2013) Arch Osteoporos., 8 (1-2), p. 138Kärkkäinen, M., Rikkonen, T., Kröger, H., Sirola, J., Tuppurainen, M., Salovaara, K., Association between functional capacity tests and fractures: An eight-year prospective population-based cohort study (2008) Osteoporos Int., 19 (8), pp. 1203-1210Recker, R., Lappe, J., Davies, K., Heaney, R., Characterization of perimenopausal bone loss: A prospective study (2000) J Bone Miner Res., 15 (10), pp. 1965-1973Ohta, H., Sugimoto, I., Masuda, A., Komukai, S., Suda, Y., Makita, K., Decreased bone mineral density associated with early menopause progresses for at least ten years: Cross-sectional comparisons between early and normal menopausal women (1996) Bone., 18 (3), pp. 227-231Gerdhem, P., Obrant, K.J., Bone mineral density in old age: The influence of age at menarche and menopause (2004) J Bone Miner Metab., 22 (4), pp. 372-375Portaria no 1101/GM, 12 junho 2002, , http://dtr2001.saude.gov.br/sas/PORTARIAS/Port2002/Gm/GM-1101.htm, Brasil. 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Fine roots stimulate nutrient release during early stages of leaf litter decomposition in a Central Amazon rainforest

Purpose Large parts of the Amazon rainforest grow on weathered soils depleted in phosphorus and rock-derived cations. We tested the hypothesis that in this ecosystem, fine roots stimulate decomposition and nutrient release from leaf litter biochemically by releasing enzymes, and by exuding labile carbon stimulating microbial decomposers. Methods We monitored leaf litter decomposition in a Central Amazon tropical rainforest, where fine roots were either present or excluded, over 188 days and added labile carbon substrates (glucose and citric acid) in a fully factorial design. We tracked litter mass loss, remaining carbon, nitrogen, phosphorus and cation concentrations, extracellular enzyme activity and microbial carbon and nutrient concentrations. Results Fine root presence did not affect litter mass loss but significantly increased the loss of phosphorus and cations from leaf litter. In the presence of fine roots, acid phosphatase activity was 43.2% higher, while neither microbial stoichiometry, nor extracellular enzyme activities targeting carbon- and nitrogen-containing compounds changed. Glucose additions increased phosphorus loss from litter when fine roots were present, and enhanced phosphatase activity in root exclusions. Citric acid additions reduced litter mass loss, microbial biomass nitrogen and phosphorus, regardless of fine root presence or exclusion. Conclusions We conclude that plant roots release significant amounts of acid phosphatases into the litter layer and mobilize phosphorus without affecting litter mass loss. Our results further indicate that added labile carbon inputs (i.e. glucose) can stimulate acid phosphatase production by microbial decomposers, highlighting the potential importance of plant-microbial feedbacks in tropical forest ecosystems

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time, and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space. While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes, vast areas of the tropics remain understudied. In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity, but it remains among the least known forests in America and is often underrepresented in biodiversity databases. To worsen this situation, human-induced modifications may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge, it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Is Liver Transplantation Associated With Decreased Bone Mass In Climacteric Women? [o Transplante Hepático Está Associado A Menor Massa óssea Em Mulheres Climatéricas?]

PURPOSE: To evaluate whether climacteric women undergoing liver transplantation had higher prevalence of decreased bone mass than those without any liver disease. METHODS: A cross-sectional study with 48 women receiving follow-up care at a university hospital in Southeastern Brazil, from February 4th 2009 to January 5th 2011, was conducted. Of these women, 24 were 35 years or older and had undergone liver transplantation at least one year before study entry. The remaining 24 women had no liver disease and their ages and menstrual patterns were similar to those of transplanted patients. Laboratorial tests (follicle-stimulating hormone and estradiol) and bone density measurements of the lumbar spine and femur (equipment Hologic, Discovery WI) were performed. Statistical analysis was carried out by Fisher's exact test, simple Odds Ratio (OR), and multiple logistic regression. RESULTS: Mean age of the women included in the study was 52.8 (±10.7) years-old, 27.1% were premenopausal and 72.9% were peri/postmenopausal. Approximately 14.6% of these women exhibited osteoporosis and 35.4% had low bone mass. The following items were associated with decreased bone mass: being postmenopausal (OR=71.4; 95%CI 3.8-1,339.7; p&lt;0.0001), current age over 49 years-old (OR=11.4; 95%CI 2.9-44.0; p=0.0002), and serum estradiol levels lower than 44.5 pg/mL (OR=18.3; 95%CI 3.4-97.0; p&lt;0.0001). Having a history of liver transplantation was not associated with decreased bone mass (OR=1.4; 95%CI 0.4-4.3; p=0.56). CONCLUSION: Liver transplantation was not associated with decreased bone mass in this group of climacteric women.347335342Baccaro, L.F., Boin, I.F., Pedro, A.O., Costa-Paiva, L., Leal, A.G., Ramos, C.D., Decrease in bone mass in women after liver transplantation: Associated factors (2011) Transplant Proc, 43 (4), pp. 1351-1356Hommann, M., Kammerer, D., Lehmann, G., Kornberg, A., Kupper, B., Daffner, W., Prevention of early loss of bone mineral density after liver transplantation by prostaglandin E1 (2007) Transplant Proc, 39 (2), pp. 540-543Monegal, A., Navasa, M., Guañabens, N., Peris, P., Pons, F., de Martinez, O.M.J., Osteoporosis and bone mineral metabolism disorders in cirrhotic patients referred for orthotopic liver transplantation (1997) Calcif Tissue Int, 60 (2), pp. 148-154Newton, J., Francis, R., Prince, M., James, O., Bassendine, M., Rawlings, D., Osteoporosis in primary biliary cirrhosis revisited (2001) Gut, 49 (2), pp. 282-287Preamor, M.O., Das, T.K., Debiram, I., Parker, R.A., Ninkovic, M., Alexander, G.T., Fracture incidence after liver transplantation: Results of a 10-year audit (2011) QJM, 104 (7), pp. 599-606Jabiry-Zienjewicz, Z., Kaminski, P., Bobrowska, K., Pietrzak, B., Wielgos, M., Zieniewicz, K., Menstrual cycle and sex hormone profile in perimenopausal women after liver transplantation (2006) Transplant Proc, 38 (9), pp. 2909-2912Boin, I.F., Ataide, E.C., Leonardi, M.I., Stucchi, R., Sevá-Pereira, T., Pereira, I.W., Elderly donors for HCV(+) versus non-HCV recipients: Patient survival following liver transplantation (2008) Transplant Proc, 40 (3), pp. 792-796Guañabens, N., Parés, A., Ros, I., Caballeria, L., Pons, F., Vidal, S., Severity of cholestasis and advanced histological stage but not menopausal status are the major risk factors for osteoporosis in primary biliary cirrhosis (2005) J Hepatol, 42 (4), pp. 573-577Lim, K.B., Schiano, T.D., Long-term outcome after liver transplantation (2012) Mt Sinai J Med, 79 (2), pp. 169-189Compston, J.E., Osteoporosis after liver transplantation (2003) Liver Transpl, 9 (4), pp. 321-330Birkhauser, M.H., Barlow, D.H., Notelovitz, M., Rees, M.C., (2005) Management Handbook: Health Plan For the Adult Woman, , London: Taylor & FrancisBaim, S., Binkley, N., Bilezikian, J.P., Kendler, D.L., Hans, D.B., Lewiecki, E.M., Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference (2008) J Clin Densitom, 11 (1), pp. 75-91Assessment of fracture risk and its application to screening for postmenopausal osteoporosis (1994) World Health Organ Tech Rep Ser, 843, pp. 1-129. , World Health Organization, Report of a WHO Study GroupSegal, E., Baruch, Y., Kramsky, R., Raz, B., Tamir, A., Ish-Shalom, S., Predominant factors associated with bone loss in liver transplant patients - after prolonged post-transplantation period (2003) Clin Transplant, 17 (1), pp. 13-19Giannini, S., Nobile, M., Dalle, C.L., Ciuffreda, M., Germoni, V., Iemmolo, R.M., Vertebral morphometry by X-ray absorptiometry before and after liver transplant: A crosssectional study (2001) Eur J Gastroenterol Hepatol, 13 (10), pp. 1201-1207Isoniemi, H., Appelberg, J., Nilsson, C.G., Makela, P., Risteli, J., Hockerstedt, K., Transdermal oestrogen therapy protects postmenopausal liver transplant women from osteoporosis. A 2-year follow-up study (2001) J Hepatol, 34 (2), pp. 299-305Sokhi, R.P., Anantharaju, A., Kondaveeti, R., Creech, S.D., Islam, K.K., van Thiel, D.H., Bone mineral density among cirrhotic patients awaiting liver transplantation (2004) Liver Transpl, 10 (5), pp. 648-653Monegal, A., Navasa, M., Guañabens, N., Peris, P., Pons, F., de Martinez, O.M.J., Bone disease after liver transplantation: A long-term prospective study of bone mass changes, hormonal status and histomorphometric characteristics (2001) Osteoporos Int, 12 (6), pp. 484-492Guichelaar, M.M., Kendall, R., Malinchoc, M., Hay, J.E., Bone mineral densitiy before and after OLT: Long-term follow-up and predictive factors (2006) Liver Transpl, 12 (9), pp. 1390-1402Hay, J.E., Osteoporosis in liver diseases and after liver transplantation (2003) J Hepatol, 38 (6), pp. 856-865Torregrosa, J.V., Campistol, J.M., Montesinos, M., Fenollosa, B., Pons, F., de Martinez, O.M.J., Factors involved in the loss of bone mineral density after renal transplantation (1995) Transplant Proc, 27 (4), pp. 2224-2225Goldstein, M.F., Fallon Jr., J.J., Harning, R., Chronic glucocorticoid therapy-induced osteoporosis in patients with obstructive lung disease (1999) Chest, 116 (6), pp. 1773-1789Weinstein, R.S., Jilka, R.L., Parfitt, A.M., Manolagas, S.C., Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids. Potential mechanisms of their deleterious effects on bone (1998) J Clin Invest, 102 (2), pp. 274-282Weinstein, R.S., Chen, J.R., Powers, C.C., Stewart, S.A., Landes, R.D., Bellido, T., Promotion of osteoclast survival and antagonism of bisphosphonate-induced osteoclast apoptosis by glucocorticoids (2002) J Clin Invest, 109 (8), pp. 1041-1048Morris, H.A., Need, A.G., O'Loughlin, P.D., Horowitz, M., Bridges, A., Nordin, B.E., Malabsortion of calcium in corticosteroid-induced osteoporosis (1990) Calcif Tissue Int, 46 (5), pp. 305-308Sambrook, P., Birmingham, J., Kempler, S., Kelly, P., Eberl, S., Pocock, N., Corticosteroid effects on proximal femur bone loss (1990) J Bone Miner Res, 5 (12), pp. 1211-1216van Staa, T.P., Leufkens, H.G., Abenhaim, L., Zhang, B., Cooper, C., Use of oral corticosteroids and risk of fractures (2000) J Bone Miner Res, 15 (6), pp. 993-1000Monegal, A., Navasa, M., Guañabens, N., Peris, P., Pons, F., de Martínez, O.M.J., Bone mass and mineral metabolism in liver transplant patients treated with FK506 or cyclosporine A (2001) Calcif Tissue Int, 68 (2), pp. 83-86Diaz-Guerra, G.M., Gómez, R., Jódar, E., Loinaz, C., Moreno, E., Hawkins, F., Long-term follow-up of bone mass after orthotopic liver transplantation: Effect of steroid withdrawal from the immunosuppressive regimen (2002) Osteoporos Int, 13 (2), pp. 147-150Stein, E., Ebeling, P., Shane, E., Post-transplantation osteoporosis (2007) Endocrinol Metab Clin North Am, 36 (4), pp. 937-96

Factors Associated With Osteoporosis In Brazilian Women: A Population-based Household Survey

The aging of Brazilian population has been well-documented. A longer time since menopause, poor self-perception of health, and having arthrosis and balance problems are factors associated with postmenopausal osteoporosis. Poor self-perception of health, menopausal treatment with natural remedies, smoking, and decreased functional capacity are associated with early onset of the disease. Purpose: This study aims to evaluate the prevalence of osteoporosis and its associated factors in Brazilian women over 50 years of age and to obtain information on factors related to the early onset of the disease. Methods: A cross-sectional study with 622 women over 50 years of age residing in Campinas/Brazil was conducted between May 10 and October 31, 2011 in the form of a population survey. A questionnaire was applied by trained interviewers. Osteoporosis was classified either as self-reported or as osteoporosis diagnosed by bone densitometry. Statistical analysis was carried out by chi-square test, Poisson regression analysis, and Cox multiple regression model. Results: The mean age of the women was 64.1 years. The prevalence of self-reported osteoporosis was 21.3 %. A longer time since menopause (prevalence ratios (PR), 1.04; 95 % CI, 1.03-1.05; p 20 cigarettes/day (coefficient, 1.02; p = 0.003), and problems in running/lifting something heavy/practicing sports/doing heavy work (coefficient, 0.60; p = 0.029). Conclusions: The results of this study have improved understanding of the factors associated with osteoporosis in the Brazilian population and may help identify those women who should undergo bone densitometry. © 2013 International Osteoporosis Foundation and National Osteoporosis Foundation.81/Fev(2008) Síntese de Indicadores Sociais, , http://www.ibge.gov.br/home/estatistica/populacao/condicaodevida/ indicadoresminimos/sinteseindicsociais2008/indic_sociais2008.pdf, Instituto Brasileiro de Geografia e Estatística (IBGE) Estudos e pesquisas Accessed 26 June 2012Parahyba, M.I., Veras, R., Melzer, D., Disability among elderly women in Brazil (2005) Rev Saúde Pública, 39, pp. 383-391. , 15997313 10.1590/S0034-89102005000300008Johnell, O., Kanis, J., Epidemiology of osteoporotic fractures (2005) Osteoporos Int, 16 (SUPPL. 2), pp. 3-S7. , 15365697 10.1007/s00198-004-1702-6Abrahamsen, B., Rejnmark, L., Nielsen, S.P., Ten-year prediction of osteoporosis from baseline bone mineral density: Development of prognostic thresholds in healthy postmenopausal women. 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