Baixa massa óssea em crianças e adolescentes

Osteoporosis is a disease characterized by low bone mass and micro architectural alterations of bone tissue leading to enhanced bone fragility and increased fracture risk. Although research in osteoporosis has focused mainly on the role of bone loss in the elderly population, it is becoming increasingly clear that the amount of bone that is gained during growth is also an important determinant of future resistance to fractures. Thus, considerable interest is being placed on defining preventive strategies that optimize the gain of bone mass during childhood and adolescence. Knowledge of the determinants accounting for the physiologic and genetic variations in bone accumulation in children will provide the best means toward the early diagnosis and treatment of osteoporosis. This article reviews the techniques available for bone mass measurements in children and the major determinants and diseases influencing bone accretion during childhood and adolescence.Osteoporose é uma doença caracterizada pela baixa massa óssea e alterações de micro arquitetura do tecido ósseo, levando ao aumento da fragilidade óssea e aumento do risco de fratura. Apesar da pesquisa em osteoporose ter focalizado principalmente no papel da perda óssea na população idosa, está começando a ficar claro que a quantidade de osso que é ganho durante o crescimento é também um determinante importante de resistência futura para fraturas. Portanto, interesse considerável está sendo colocado na definição de estratégias preventivas que otimizam o ganho de massa óssea durante a infância e adolescência. O conhecimento dos determinantes responsáveis pelas variações fisiológicas e genéticas, na acumulação óssea nas crianças, irá levar aos melhores meios para o diagnóstico precoce e tratamento da osteoporose. Este artigo revê as técnicas disponíveis para a medida da massa óssea em crianças e os maiores determinantes e doenças que influenciam a aquisição óssea durante a infância e adolescência.Universidade Catolica de BrasiliaFederal University of São Paulo EPM Division of EndocrinologyFleury - Diagnostic MedicineUNIFESP, EPM, Division of EndocrinologySciEL

Diagnóstico e tratamento da doença de Paget óssea

Objective:To conduct a literature review on the diagnosis and management of Paget’s disease of bone. Materials and methods:This scientific statement was generated by a request from the Brazilian Medical Association (AMB) to the Brazilian Society of Endocrinology and Metabolism (SBEM) as part of its Clinical Practice Guidelines program. Articles were identified by searching in PubMed and Cochrane databases as well as abstracts presented at the Endocrine Society, Brazilian Society for Endocrinology Annual Meetings and the American Society for Bone and Mineral Research Annual Meeting during the last 5 years. Grading quality of evidence and strength of recommendation were adapted from the first report of the Oxford Centre for Evidence-based Medicine. All grades of recommendation, including “D”, are based on scientific evidence. The differences between A, B, C and D, are due exclusively to the methods employed in generating evidence. Conclusion:We present a scientific statement on Paget’s disease of bone providing the level of evidence and the degree of recommendation regarding causes, clinical presentation as well as surgical and medical treatment. Arq Bras Endocrinol Metab. 2014;58(6):587-99Objetivo:Conduzir uma atualização das últimas evidências científicas a respeito da apresentação, diagnóstico e manejo clínico da doença de Paget óssea. Materiais e métodos:Este documento foi concebido pelo Departamento de Metabolismo Ósseo da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) a partir daquele oriundo do Programa de Diretrizes da Associação Médica Brasileira (AMB). Realizamos uma revisão dos artigos mais relevantes obtidos nos bancos de dados PubMed e Cochrane, além de abstracts apresentados nos encontros anuais da Endocrine Society, Sociedade Brasileira de Endocrinologia e da American Society for Bone and Mineral Research dos últimos cinco anos e classificamos as evidências em níveis de recomendações de acordo com a força científica por tipo de estudo, adaptando o primeiro relato do “Oxford Centre for Evidence-based Medicine”. Todos os graus de recomendação, incluindo-se o “D”, foram baseados em evidência científica, sendo as diferenças entre o A, B, C e D devidas exclusivamente ao desenho empregado na geração da evidência. Conclusão:Apresentamos uma atualização científica a respeito da doença de Paget óssea, classificando e graduando em níveis de recomendações as principais evidências científicas sobre as suas causas, as variadas formas de apresentação, seu diagnóstico e tratamento.University of Pernambuco Agamenon Magalhães Hospital Department of Endocrinology, Diabetes and Bone DiseasesFederal University of São Paulo Department of Medicine Division of EndocrinologyFederal University of Paraná Division of Endocrinology and MetabolismCatholic University of Brasilia School of MedicineUNIFESP, Department of Medicine Division of EndocrinologySciEL

Diagnóstico e manejo do hiperparatireoidismo primário: uma posição científica do Departamento de Metabolismo Ósseo, a Sociedade Brasileira de Endocrinologia e Metabolismo

OBJECTIVE: To conduct a literature review on the diagnosis and management of primary hyperparathyroidism including the classical hipercalcemic form as well as the normocalcemic variant. MATERIALS AND METHODS: This scientific statement was generated by a request from the Brazilian Medical Association (AMB) to the Brazilian Society for Endocrinology as part of its Clinical Practice Guidelines program. Articles were identified by searching in PubMed and Cochrane databases as well as abstracts presented at the Endocrine Society, Brazilian Society for Endocrinology Annual Meetings and the American Society for Bone and Mineral Research Annual Meeting during the last 5 years. Grading quality of evidence and strength of recommendation were adapted from the first report of the Oxford Centre for Evidence-based Medicine. All grades of recommendation, including D, are based on scientific evidence. The differences between A, B, C and D, are due exclusively to the methods employed in generating evidence. CONCLUSION: We present a scientific statement on primary hyperparathyroidism providing the level of evidence and the degree of recommendation regarding causes, clinical presentation as well as surgical and medical treatment.OBJETIVO: Conduzir uma atualização das últimas evidências científicas a respeito da apresentação, do diagnóstico e do manejo clínico e cirúrgico do hiperparatireoidismo primário clássico e normocalcêmico. MATERIAIS E MÉTODOS: Este documento foi concebido pelo Departamento de Metabolismo Ósseo da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) a partir daquele oriundo do Programa de Diretrizes da Associação Médica Brasileira (AMB) da SBEM. Realizamos uma revisão dos artigos mais relevantes obtidos nos bancos de dados PubMed e Cochrane, além de abstracts apresentados nos encontros anuais da Endocrine Society, da Sociedade Brasileira de Endocrinologia e da American Society for Bone and Mineral Research dos últimos cinco anos, e classificamos as evidências em níveis de recomendações de acordo com a força científica por tipo de estudo, adaptando o primeiro relato do Oxford Centre for Evidence-based Medicine. Todos os graus de recomendação, incluindo-se o D, foram basea-dos em evidência científica, sendo as diferenças entre o A, B, C e D devidas exclusivamente ao desenho empregado na geração da evidência. CONCLUSÃO: Apresentamos uma atualização científica a respeito do hiperparatireoidismo primário, classificando e graduando em níveis de recomendações as principais evidências científicas sobre as suas causas, as variadas formas de apresentação, seu diagnóstico e tratamento.University of Pernambuco Medical School Ministry of HealthFederal University of São Paulo Medical SchoolFederal University of Parana Medical SchoolUniversity of Brasilia Medical SchoolCatholic University of BrasiliaColumbia University College of Physicians & SurgeonsUNIFESP, Medical SchoolSciEL

Recommendations of the Brazilian Society of Endocrinology and Metabology (SBEM) for the diagnosis and treatment of hypovitaminosis D

ObjectiveThe objective is to present an update on the diagnosis and treatment of hypovitaminosis D, based on the most recent scientific evidence. Materials and methodThe Department of Bone and Mineral Metabolism of the Brazilian Society of Endocrinology and Metabology (SBEM) was invited to generate a document following the rules of the Brazilian Medical Association (AMB) Guidelines Program. Data search was performed using PubMed, Lilacs and SciELO and the evidence was classified in recommendation levels, according to the scientific strength and study type. ConclusionA scientific update regarding hypovitaminosis D was presented to serve as the basis for the diagnosis and treatment of this condition in Brazil.ObjetivoApresentar uma atualização sobre o diagnóstico e tratamento da hipovitaminose D baseada nas mais recentes evidências científicas. Materiais e métodoO Departamento de Metabolismo Ósseo e Mineral da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) foi convidado a conceber um documento seguindo as normas do Programa Diretrizes da Associação Médica Brasileira (AMB). A busca dos dados foi realizada por meio do PubMed, Lilacs e SciELO e foi feita uma classificação das evidências em níveis de recomendação, de acordo com a força científica por tipo de estudo. ConclusãoFoi apresentada uma atualização científica a respeito da hipovitaminose D que servirá de base para o diagnóstico e tratamento dessa condição no Brasil.Escola Paulista de Medicina Universidade Federal de São Paulo (UNIFESP) Disciplina de EndocrinologiaUniversidade Federal do Paraná Departamento de Clínica MédicaFaculdade de Medicina da Univille Departamento de Clínica MédicaUniversidade Católica de Brasília Disciplina de EndocrinologiaUniversidade de Pernambuco Escola de Medicina Hospital Agamenon MagalhãesUNIFESP, EPM, EPM, Disciplina de EndocrinologiaSciEL

Can be the Cement Augmentation an Improvement Method of Preventing Hip Fractures in Osteoporotic Patients?

Introduction: The population around the world is aging. With this, there will be an increased incidence of fractures due to osteoporosis of the hip and this will be a serious global health problem. A World Health Organization (WHO) estimate suggests that the incidence of hip osteoporotic fractures worldwide will triple by 2050. Objective: To present, through a literature review, the main results of the femoral reinforcement, a technique described by scientific articles, with the potential to increase the proximal femoral load for the occurrence of fractures, whether using polymethylmethacrylate (PMMA), phosphate cement calcium (CPC), elastomers and metal implants. Methods: Through electronic search in databases PubMed, Latin American and Caribbean Center of Health Information Information (Bireme), Coordination for the Improvement of Higher Education Personnel (Capes), Scientific Electronic Library Online (SciELO), Google Scholar And Cochrane, using the terms cementoplasty and femororplasty, the studies were selected according to a specific inclusion criterion, describing the main findings of the biomechanical results, type of study and material used to perform the femoral reinforcement. Results: Of the 15 articles analyzed, 14 were experimental analyzes and one was a clinical trial, seven studies used PMMA, two used CPC, four elastomers and two metal implants, 13 of them showed favorable Newton load (N) results for the fracture hip. Conclusion: Most of the studies on femoral reinforcement is experimental, and mostly used the PMMA, presenting an increase in the load in N for fracture occurrence

Resistance training versus weight-bearing aquatic exercise : a cross-sectional analysis of bone mineral density in postmenopausal women

INTRODUÇÃO: Há um grande número de estudos mostrando que o treinamento de força tem um efeito positivo sobre a densidade mineral óssea (DMO). Porém, existem poucos estudos comparando a DMO entre praticantes de hidroginástica e treinamento de força. OBJETIVO: Comparar, em uma análise transversal, a DMO de mulheres praticantes de treinamento de força com mulheres praticantes de hidroginástica, na pós-menopausa. MÉTODOS: A amostra foi composta de 63 mulheres, divididas em três grupos: treinamento de força (FORÇA: n = 15; 51,4 ± 2,7 anos), hidroginástica (HIDRO: n = 22; 54,5 ± 3,3 anos) e controles não treinadas (CONTROLE: n = 26; 52,0 ± 3,3 anos). Todas as voluntárias estavam em terapia de reposição hormonal há no mínimo um ano. Os grupos FORÇA e HIDRO treinavam há pelo menos um ano antes do início do estudo (média de anos de treinamento - FORÇA: 4,5 ± 2,0; HIDRO: 4,2 ± 2,2). RESULTADOS: O grupo FORÇA apresentou maior DMO de corpo total, colo femoral e coluna lombar L2-L4 quando comparado ao grupo-controle (todos P < 0,05). O grupo HIDRO apresentou maior DMO no corpo total, quadril total e coluna lombar L2-L4 quando comparado ao grupo-controle (todos P < 0,05). Entretanto, não foram observadas diferenças entre os grupos FORÇA e HIDRO em nenhum dos sítios avaliados. CONCLUSÕES: Estes achados sugerem que não apenas o treinamento de força, mas também a hidroginástica podem ser estratégias não farmacológicas para prevenção da perda de DMO em mulheres na pós-menopausa.INTRODUCTION: Many studies have shown that resistance training has a positive effect on bone mineral density (BMD). However, few studies have compared the BMD of individuals undergoing resistance training and those training aquatic weight-bearing exercises. OBJECTIVE: To compare, in a cross-sectional study, the BMD of postmenopausal women undergoing resistance training and postmenopausal women training aquatic weight-bearing exercises. METHODS: The sample comprised 63 women divided into the following three groups: resistance training (STRENGTH: n = 15; 51.4 ± 2.7 years); aquatic weight-bearing exercises (WA-TER: n = 22; 54.5 ± 3.3 years); and non-trained controls (CONTROL: n = 26; 52.0 ± 3.3 years). All volunteers were on hormone replacement therapy for at least one year. The STRENGTH and WATER groups were training for at least one year prior to study beginning (mean years of training - STRENGTH: 4.5 ± 2.0; WATER: 4.2 ± 2.2). RESULTS: The STRENGTH group had higher BMD of total body, femoral neck, lumbar spine L2-L4 as compared with the CONTROL group (all P < 0.05). The WATER group had higher BMD of total body, total hip, lumbar spine L2-L4 as compared with the CONTROL group (all P < 0.05). However, no difference was observed between the STRENGTH and WATER groups regarding the sites assessed. CONCLUSIONS: Those findings suggest that not only the resistance training, but also aquatic weight-bearing exercises might be a non-pharmacological strategy to prevent BMD loss in postmenopausal women

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years