Brazilian general practitioner's knowledge on osteoporosis prevention and treatment strategies

OBJECTIVES: Brazilian physicians' knowledge on osteoporosis prevention and treatment strategies was investigated in this cross-sectional study. A specific structured questionnaire was designed to evaluate physicians' knowledge regarding osteoporosis prevention and treatment as well as osteoporosis information access. PATIENTS AND METHODS: the questionnaire was made available to around 11,000physicians affiliated to the Brazilian Society of Internal Medicine (BSIM). The questionnaire was initially presented at the BSIM home-page and subsequently sent by e-mail to all BSIM members. RESULTS: a total of 329 answered questionnaires returned to the researchers. Most of the physicians that answered the questionnaire (55.3%) had time since graduation lougher than 10 years and half of them (55%) reported having easy access to bone densitometry. The great majority of the physicians (99%) believe that preventing osteoporosis is important or very important. Accordingly, 73% of the physicians believe that osteoporosis can be prevented and around 63% of them discuss the issue with their patients regularly. On the other hand, most of the physicians that answered the questionnaire do not believe that their patients are able to change life habits or will adhere to the treatment in the long-term. Only 35% of the physicians believe that current osteoporosis treatment is effective. Around 82% of the physicians make use of bone densitometry to evaluate osteoporosis. Physicians with time since graduation higher than 10 years reported using bone densitometry more often than their colleagues with less time since graduation. CONCLUSION: our results demonstrate that educational programs aiming at the general practitioner are needed in order to provide better care in terms of prevention and treatment of skeletal fragility syndromes.OBJETIVOS: investigar o conhecimento de profissionais médicos brasileiros a respeito da osteoporose, estratégias de prevenção e tratamento e o acesso à informação em osteoporose, utilizando-se um questionário desenvolvido para avaliar o conhecimento de profissionais médicos em relação à importância da osteoporose e suas estratégias de tratamento. PACIENTES E MÉTODOS: o questionário foi divulgado a11 mil médicos afiliados à Sociedade Brasileira de Clínica Médica (SBCM). Realizou-se a divulgação da pesquisa e do questionário por meio de anúncios publicados no Jornal do Clínico. Inicialmente, foi disponibilizado na home-page e, em seguida, diretamente enviado via e-mail aos sócios cadastrados da SBCM. RESULTADOS: um total de 329 questionários retornou aos pesquisadores. A maioria dos médicos (55,3%) tinha tempo de graduação superior a 10 anos. Pouco mais que a metade dos profissionais médicos pesquisados (55%) relatou ter fácil acesso à densitometria óssea. A maioria (99%) dos participantes acredita que é importante ou muito importante prevenir a osteoporose. Da mesma forma, 73% dos médicos pesquisados acreditam que a osteoporose possa ser prevenida e 63% deles discutem o assunto com os seus pacientes. Por outro lado, mais da metade dos médicos pesquisados não crê que seus pacientes venham a mudar hábitos de vida e cerca de 50% deles não acreditam que seus pacientes venham a aderir ao tratamento da doença em longo prazo. Apenas 35% dos médicos pesquisados acreditam que os tratamentos para osteoporose sejam efetivos. Cerca de 82% fazem uso da densitometria óssea. Médicos com 10 anos ou mais de graduação utilizam a densitometria óssea mais freqüentemente que seus colegas com menos tempo de graduação. CONCLUSÃO: os autores acreditam que as informações obtidas no presente estudo poderiam ser úteis para o início do desenvolvimento de estratégias educacionais efetivas para a prevenção e o tratamento de pacientes com osteoporose.Universidade Federal de São Paulo (UNIFESP) Departamento de Medicina da Escola Paulista de MedicinaUNIFESP-EPMUNIFESP-EPM Departamento de MedicinaUNIFESP, Depto. de Medicina da Escola Paulista de MedicinaUNIFESP-EPMUNIFESP, EPM Depto. de MedicinaSciEL

Bone Mineral Density Measurements, Bone Markers and Serum Vitamin D Concentrations in Men with Chronic Non-Cirrhotic Untreated Hepatitis C

Introduction: the high prevalence of chronic hepatitis C (CHC) and its consequent cirrhosis has been associated with bone fragility. Whether CHC may cause bone and mineral abnormalities in the absence of hepatocellular dysfunction is still unknown. in this study we aimed to determine the prevalence of osteoporotic vertebral fractures and low BMD measurements in men with non-cirrhotic CHC. Risk factors for low BMD and fractures were also investigated.Methods: Morphometric vertebral fractures and BMD measurements were performed in 60 non-cirrhotic untreated men with CHC and 59 healthy controls, matched for age and gender, weight and current smoking. Serum CTx, calcium, phosphate, intact PTH, alkaline phosphatase and vitamin D (25OHD) concentrations were measured in all participants. Clinical risk factors for low BMD and fractures were evaluated by a structured questionnaire as well as details regarding HCV infection.Results: Trochanter and total femur BMD were significantly lower in CHC patients as compared to healthy men (p = 0.04). in men 50 years and older, the prevalence of osteoporosis was significantly higher among CHC patients (p = 0.01). Lower levels of physical activities and more often report of prolonged immobilization were observed among CHC patients (p<0.05). Liver inflammation and fibrosis, viral load and genotype did not correlate with BMD measurements. Bone markers and 25OHD concentrations were similar in both groups. Only a few vertebral fractures were observed.Conclusions: Our results demonstrate that non-cirrhotic untreated CHC patients have lower BMD at the femur as compared to healthy men in spite of the absence of significant bone and mineral abnormalities.Rheumatology Division at the Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM)Universidade Federal de São Paulo, Escola Paulista Med, Div Rheumatol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Div Gastroenterol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Div Rheumatol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Div Gastroenterol, São Paulo, BrazilWeb of Scienc

Bone mineral density in juvenile systemic lupus erythematosus

We evaluated spine bone mineral density (BMD) in Brazilian children with juvenile systemic lupus erythematosus (JSLE) in order to detect potential predictors of reduction in bone mass. A cross-sectional study of BMD at the lumbar spine level (L2-L4) was conducted on 16 female JSLE patients aged 6-17 years. Thirty-two age-matched healthy girls were used as control. BMD at the lumbar spine was measured by dual-energy X-ray absorptiometry. Weight, height and pubertal Tanner stage were determined in patients and controls. Disease duration, mean daily steroid doses, mean cumulative steroid doses and JSLE activity measured by the systemic lupus erythematosus disease activity index (SLEDAI) were determined for all JSLE patients based on their medical charts. All parameters were used as potential determinant factors for bone loss. Lumbar BMD tended to be lower in the JSLE patients, however, this difference was not statistically significant (P = 0.10). No significant correlation was observed in JSLE girls between BMD and age, height, Tanner stage, disease duration, corticosteroid use or disease activity. We found a weak correlation between BMD and weight (r = 0.672). In the JSLE group we found no significant parameters to correlate with reduced bone mass. Disease activity and mean cumulative steroid doses were not related to BMD values. We did not observe reduced bone mass in female JSLE.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de PediatriaUNIFESP, EPM, Depto. de MedicinaSciEL

Kinin B(1) receptor deficiency leads to leptin hypersensitivity and resistance to obesity

OBJECTIVE-Kinins mediate pathophysiological processes related to hypertension, pain, and inflammation through the activation of two G-protein-coupled receptors, named B(1) and B(2). Although these peptides have been related to glucose homeostasis, their effects on energy balance are still unknown.RESEARCH DESIGN and METHODS-Using genetic and pharmacological strategies to abrogate the kinin B(1) receptor in different animal models of obesity, here we present evidence of a novel role for kinins in the regulation of satiety and adiposity.RESULTS-Kinin B(1) receptor deficiency in mice (B(1)(-/-)) resulted in less fat content, hypoleptinemia, increased leptin sensitivity, and robust protection against high-fat diet-induced weight gain. Under high-fat diet, B(1)(-/-) also exhibited reduced food intake, improved lipid oxidation, and increased energy expenditure. Surprisingly, B(1) receptor deficiency was not able to decrease food intake and adiposity in obese mice lacking leptin (ob/ob-B(1)(-/-)). However, ob/ob-B(1)(-/-) mice were more responsive to the effects of exogenous leptin on body weight and food intake, suggesting that B(1) receptors may be dependent on leptin to display their metabolic roles. Finally, inhibition of weight gain and food intake by B(1) receptor ablation was pharmacologically confirmed by long-term administration of the kinin B(1) receptor antagonist SSR240612 to mice under high-fat diet.CONCLUSIONS-Our data suggest that kinin B(1) receptors participate in the regulation of the energy balance via a mechanism that could involve the modulation of leptin sensitivity.Universidade Federal de São Paulo, Dept Biophys, BR-04023062 São Paulo, BrazilUniv Mogi das Cruzes, Mogi Das Cruzes, BrazilUniversidade Federal de São Paulo, Dept Physiol, BR-04023062 São Paulo, BrazilSanofi Aventis, Montpellier, FranceUniversidade Federal de São Paulo, Dept Med, BR-04023062 São Paulo, BrazilInst Natl Sante & Rech Med, Dept Renal & Cardiac Remodeling, U858 I2MR, Toulouse, FranceUniv Toulouse 3, Inst Med Mol Rangueil, F-31062 Toulouse, FranceInst Natl Rech Agron AgroParisTech, UMR914 Nutr Physiol & Ingest Behav, Paris, FranceMax Delbruck Ctr Mol Med, Berlin, GermanyUniversidade Federal de São Paulo, Dept Biophys, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Physiol, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, BR-04023062 São Paulo, BrazilWeb of Scienc

Osteoblast-specific connexin 43 gene deletion in mice: fenotipic characterization

Os osteoblastos sao altamente acoplados por juncoes gap formadas pela conexina 43 (Cx43). Disturbios da expressao ou funcao da Cx43 in vitro alteram a expressao genica nos osteoblastos, enquanto a defiCiência genetica da Cx43 in vivo causa letalidade perinatal, defeitos do desenvolvimento do esqueleto craniofacial e disfuncao autonoma do osteoblasto. Para determinar o papel da Cx43 no pico de massa ossea e na manutencao da homeostase mineral no esqueleto adulto, nos desenvolvemos um modelo animal (camundongo) de delecao do gene da Cx43 seletivamente em osteoblastos (knock-out condicional), usando o sistema Cre/IOxP, de modo a evitar a letalidade perinatal associada a estrategia convencional de delecao do gene da Cx43 (knock-out convencional). Nesse modelo condicional, a recombinase Cre catalisa um evento de recombinacao genica que resulta na substituicao da regiao codificadora do gene da Cx43 por um cassete codificador da (3-galactosidase, LacZ. Uma linhagem de camundongos portadores da mutacao floxed do alelo da Cx43 (Cx43fl) foi gerada na qual a regiao codificadora do gene da Cx43 e flanqueada por dois sitios P's (IoxP). Camundongos homozigotos para a mutacao floxed (Cx43fl/fl) foram cruzados com camundongos com expressao transgenica da recombinase Cre sob controle do fragmento de 2.3 Kb do promotor do gene do colageno tipo I e heterozigotos para a mutacao nula convencional da Cx43 (Cola([)-Cre;Cx43+/-). Dessa forma, camundongos knockout condicional da Cx43 (Col&#61537;(I)-Cre;Cx43-/fl) e seus respectivos controles (Cx43+/fl, Col&#61537;(I)-Cre;Cx43+fl e Cx43-/fl) foram gerados em numerosa(au)BV UNIFESP: Teses e dissertaçõe