FRAX TM: building an idea to Brazil

Genetic and racial background, body composition, bone mineral density (BMD), diet, physical activity and life style help to explain the wide difference observed in the world prevalence and incidence of osteoporosis. Recently, a fracture assessment tool, named FRAX TM, was developed to integrate clinical risk factors (genetic and environmental conditions) and BMD, in order to quantify the ten-year probability of an osteoporotic fracture. Shortly, it will be used to indicate treatment for high risk patients. However, this tool is now available only to those populations with known reliable and prospective epidemiologic data of the osteoporotic fractures - fact that does not include the Brazilian population. The aim of this paper was to review the main national and international epidemiologic studies to better understand the differences between the clinical risk factors, BMD and fracture probability of these populations. The authors concluded that, to use the FRAX TM tool, it is necessary more epidemiological data that could characterize the Brazilian population. The future studies should be prospective, evaluate the quality of life, mortality and morbidity after a fracture, as well the life expectancy of the population and the cost-effectiveness and utility related to the osteoporotic fracture. In fact, it is not recommended to use any of the populations available in the FRAX TM tool, as a substitute for the Brazilian population.Diferenças genéticas, raciais e antropométricas, bem como da composição corporal, densidade óssea, dieta, atividade física e outros hábitos de vida, contribuem para explicar as divergências na incidência e prevalência de baixa densidade óssea e fraturas em diversos países do mundo. Recentemente, foi desenvolvida uma ferramenta, denominada FRAX TM, para aglutinar os fatores clínicos de risco (genéticos e ambientais) e a densidade óssea, a fim de quantificar a probabilidade de fratura osteoporótica nos próximos dez anos. Em breve, ela será utilizada para indicação de tratamento em pacientes de risco. No entanto, atualmente, está disponível somente para uso em algumas populações que possuem banco de dados prospectivos e consistentes - o que não inclui o Brasil. Este estudo teve o objetivo de fazer uma revisão dos estudos epidemiológicos nacionais e internacionais para melhor compreender peculiaridades e diferenças de fatores clínicos de risco, densidade óssea e probabilidade de fratura entre essas populações. Os autores concluíram que se faz necessária a obtenção de mais dados epidemiológicos representativos da população brasileira para utilização da ferramenta FRAX TM. Para isso, os estudos brasileiros deverão possuir características adequadas, como o delineamento prospectivo, avaliação da qualidade de vida, mortalidade e incapacidade física após as fraturas, levando em consideração a expectativa de vida da população brasileira e a análise de custos diretos e indiretos relacionados às fraturas por osteoporose. À luz do conhecimento atual, a utilização de qualquer um dos bancos de dados das populações, disponibilizadas pelo FRAX TM, não é recomendada no Brasil.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de Minas Gerais Centro de Pós-GraduaçãoUniversidade Federal do Paraná Hospital de ClínicasSociedade Brasileira para o Estudo do Metabolismo Ósseo e MineralUNIFESP-EPMSociedade Brasileira de Endocrinologia e MetabologiaUNIFESP, EPMSciEL

2008 official positions of the Brazilian Society for Clinical Densitometry - SBDens

With the evolution of bone densitometry, differences in technologies, acquisition techniques, reference databases, reporting methods, diagnostic criteria and terminology have developed and the International Society for Clinical Densitometry (ISCD) periodically holds Position Development Conferences, the latest in 2007. The Brazilian Society for Clinical Densitometry (SBDens), with support from many Brazilian societies interested in bone health, gathered numerous specialists to discuss the ISCD proposals and to evaluate the validity of the extension of those norms to Brazilian population. The SBDens reunion of consensus made a very utile document to help the understanding and interpretation of bone densitometry and other methods of bone assessment.A evolução dos métodos de avaliação da massa óssea trouxe diferentes tecnologias, modos de aquisição de imagens, bancos de dados de referência, terminologias, critérios diagnósticos fez com que a International Society for Bone Densitometry (ISCD) tomasse a iniciativa de promover reuniões periódicas de consenso, a última em 2007. A Sociedade Brasileira de Densitometria Clínica (SBDens), com apoio de várias sociedades brasileiras ligadas ao estudo da saúde óssea, reuniu diversos especialistas para discutir as propostas da ISCD e validar a aplicação destas normas à população brasileira. A reunião de Posições Oficiais da SBDens produziu um documento extremamente útil para a compreensão e interpretação da densitometria e de outros métodos de avaliação da massa óssea.Sociedade Brasileira de Densitometria ClínicaSociedade Brasileira para o Estudo do Metabolismo Ósseo e MineralUniversidade Federal de São Paulo (UNIFESP)Universidade Federal de Minas Gerais Hospital Mater DeiSociedade Brasileira de ReumatologiaSociedade Brasileira de OsteoporoseUniversidade de São Paulo Faculdade de Medicina Hospital das ClínicasAssociação Brasileira de Medicina Física e ReabilitaçãoUniversidade Federal do Espírito SantoUNIFESPColégio Brasileiro de RadiologiaSociedade Brasileira de Ortopedia e TraumatologiaUNIFESPSciEL

Expressão de ativina A em células-tronco embrionárias de camundongo durante o processo de diferenciação em osteoblastos

Exportado OPUSMade available in DSpace on 2019-08-10T21:10:02Z (GMT). No. of bitstreams: 1 doutorado_bruno_muzzi_versao_01_mar_2014.pdf: 15913079 bytes, checksum: c494c6e163f8d3cafef11273042524a8 (MD5) Previous issue date: 1A busca de agentes anabolizantes tem sido alvo da pesquisa na terapia da osteoporose. As células-tronco embrionárias (CTE), diferenciadas em osteoblastos, têm sido utilizadas para o estudo da fisiologia celular. Protocolos de diferenciação celular em osteoblastos têm sendo utilizados com sucesso. Um estímulo comum aos protocolos de diferenciação osteoblástica é a proteína morfogenética óssea (BMP). Ativina A, um fator de crescimento que tem estrutura e função parcialmente homólogas ao BMP, apresenta efeitos importantes sobre a proliferação de osteoblastos e a remodelação óssea. Contudo, a definição do momento em que Ativina A passa a agir sobre a minealização óssea demanda maiores estudos. OBJETIVO: avaliar a expressão de Ativina A em CTE de camundongo durante protocolo de diferenciação celular para osteoblastos. MATERIAL e MÉTODOS: adaptamos técnicas de cultivo celular adotadas em protocolo de diferenciação de CTE em osteoblastos (Kawaguchi, 2006) e acompanhamos a diferenciação fenotípica in vitro de uma linhagem de células-tronco embrionárias (CT-4), isolada no Laboratório de Reprodução Humana Prof. Aroldo Fernando Camargos do Hospital das Clínicas da UFMG. Aplicamos o método de reação da cadeia de polimerase (PCR) em tempo real em diferentes fases do processo para evidenciar a expressão gênica de marcadores de indiferenciação celular (Oct-4 e Nanog), marcadores de diferenciação osteoblástica (osteocalcina, fosfatase alcalina óssea e RUNX-2 e da Ativina A. Correlacionamos a expressão de todos esses genes-alvo em diferentes fases do processo de diferenciação. RESULTADOS: constatamos que a expressão de marcadores de diferenciação para a linhagem osteoblástica aumentou à medida em que a cultura avançou no sentido da diferenciação terminal em osteoblastos. A expressão da Ativina A acompanhou, num relação direta, o padrão de expressão verificado nesses marcadores de formação e diferenciação óssea. O protocolo favoreceu a diferenciação de precursores celulares de osteoblastos. CONCLUSÃO: a Ativina A foi expressa em cultivos celulares de CTE de camundongos em estágio intermediário de diferenciação em osteoblastos, acompanhando o padrão de expressão celular verificado para outros marcadores de formação óssea como a osteocalcina.The search for anabolic agents has been widely researched for osteoporosis therapy. Embryonic stem cells (ESC), differentiated into osteoblasts, have been used for the study of cell physiology. Protocols osteoblastic cell differentiation have been successfully performed. A common stimulus used on most osteoblastic differentiation protocols is bone morphogenetic protein (BMP) . Activin A, a growth factor with structure and function homologous to BMP, has important effects on the proliferation of osteoblasts and bone remodeling. However, the definition of the exact moment when activin A acts on bone mineralization demand studies. OBJECTIVE: To evaluate the expression of activin A on a mouse ESC protocol used to differentiate them into osteoblasts. MATERIAL AND METHODS: Adopt a technical modification to an osteoblastic ESC culture differentiation protocol (Kawaguchi, 2006), isolated at the Laboratory of Human Reproduction Prof. Aroldo Fernando Camargos - Hospital das Clínicas / UFMG. Real time polymerase chain reaction (PCR) evaluated genic expression at different stages during the protocol for markers of celular indifferentiation (Oct -4, Nanog), markers of osteoblastic differentiation (osteocalcin, bone alkaline phosphatase, RUNX2) and Activin A at different stages of differentiation protocol. RESULTS: Markers of osteoblast differentiation increased as the culture moved towards osteoblastic differentiation. Activin A expression showed a direct association to the markers of bone formation. The protocol favored the differentiation of osteoblasts precursor cells. CONCLUSION: Activin A was expressed in cell cultures of mice ESC since an intermediate stage of differentiation into osteoblasts, following the pattern of cellular expression observed for other markers of bone formation, such as osteocalcin, during the differentiation protocol

Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF)

Purpose: trabecular bone score (TBS) is a grey-level textural measurement acquired from dual-energy X-ray absorptiometry lumbar spine images and is a validated index of bone microarchitecture. In 2015, a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) published a review of the TBS literature, concluding that TBS predicts hip and major osteoporotic fracture, at least partly independent of bone mineral density (BMD) and clinical risk factors. It was also concluded that TBS is potentially amenable to change as a result of pharmacological therapy. Further evidence on the utility of TBS has since accumulated in both primary and secondary osteoporosis, and the introduction of FRAX and BMD T-score adjustments for TBS have accelerated adoption. This position paper therefore presents a review of the updated scientific literature, and provides expert consensus statements and corresponding operational guidelines for the use of TBS.Methods: an Expert Working Group was convened by the ESCEO and a systematic review of the evidence was undertaken, with defined search strategies for four key topics with respect to the potential use of TBS: 1) fracture prediction in men and women; 2) initiating and monitoring treatment in postmenopausal osteoporosis; 3) fracture prediction in secondary osteoporosis; and 4) treatment monitoring in secondary osteoporosis. Statements to guide the clinical use of TBS were derived from the review and graded by consensus using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results: a total of 96 articles were reviewed and included data on the use of TBS for fracture prediction in men and women, from over 20 countries. The updated evidence shows that TBS enhances fracture risk prediction in both primary and secondary osteoporosis, and can, when taken with BMD and clinical risk factors, inform treatment initiation and the choice of antiosteoporosis treatment. Evidence also indicates that TBS provides useful adjunctive information in monitoring treatment with long-term denosumab and for anabolic agents. All expert consensus statements were voted as strongly recommended.Conclusion: the addition of TBS assessment to FRAX and/or BMD enhances fracture risk prediction in primary and secondary osteoporosis, and is useful in treatment decision-making and monitoring. The expert consensus statements provided in this paper can be used to guide the integration of TBS in clinical practice for the assessment and management of osteoporosis. An example of an operational approach is provided in the appendix.<br/

Recommendations for the optimal use of bone forming agents in osteoporosis

Bone forming agents, also known as anabolic therapies, are essential in managing osteoporosis, particularly for patients at very high-risk of fractures. Identifying candidates who will benefit the most from these treatments is crucial. For example, this group might include individuals with severe osteoporosis, multiple vertebral fractures, a recent fragility fracture or those unresponsive to antiresorptive treatments. Definitions of patients with a very high fracture risk vary across nations, are often based on fracture history, bone mineral density (BMD), and/or fracture risk calculated by FRAX® or other algorithms. However, for very high-risk patients, anabolic agents such as teriparatide, abaloparatide, or romosozumab are commonly recommended as first-line therapies due to their ability to stimulate new bone formation and improve bone microarchitecture, offering significant benefits in rapid fracture reduction over antiresorptive therapies. The cost-effectiveness of these agents is a critical consideration for decision-makers. Despite their higher costs, their effectiveness in significantly reducing fracture risk and improving quality of life can justify the investment, especially when long-term savings from reduced fracture rates and associated healthcare costs are considered. Additionally, after completing a course of anabolic therapy, transitioning to antiresorptive agents like bisphosphonates or denosumab is crucial to maintain the gains in bone density and minimize subsequent fracture risks. This sequential treatment approach ensures sustained protection and optimal resource utilization. In summary, the effective use of bone forming agents in osteoporosis requires a comprehensive strategy that includes accurate patient identification, consideration of cost-effectiveness, and implementation of appropriate sequential treatments, ultimately maximizing patient outcomes and healthcare efficiency.</p