Osteoporose juvenil

Antes de abordarmos as causas da osteoporose juvenil, é interessante fazermos um breve comentário em relação à prevenção da osteoporose pós-menopausa e senil já no período da infância e adolescência. A osteoporose é caracterizada por uma redução da massa óssea e esta pode ser determinada durante o crescimento ou adquirida tardiamente durante o envelhecimento. Uma vez que a síndrome osteoporótica é mais facilmente previnida do que tratada, o ideal é identificar indivíduos potencialmente de alto risco e iniciar a prevenção dessa síndrome na infância ou na adolescência

Glucocorticoid-induced osteoporosis in rheumatic diseases

The aim of this article is to review rheumatological diseases that are associated with glucocorticoid-induced osteoporosis or fractures and to perform a critical analysis of the current guidelines and treatment regimens. The electronic database MEDLINE was searched using the date range of July 1986 to June 2009 and the following search terms: osteoporosis, bone mineral density, fractures, systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, vasculitis, juvenile rheumatoid arthritis, juvenile idiopathic arthritis and juvenile dermatomyositis. Osteopenia and osteoporosis respectively account for 1.4 to 68.7% and 5.0 to 61.9% of adult rheumatological diseases. Among juvenile rheumatological disorders, the frequency of low bone mass ranges from 38.7 to 70%. In general, fracture rates vary from 0 to 25%. Although glucocorticoid-induced osteoporosis has a high rate of prevalence among rheumatic diseases, a relatively low number of patients on continuous glucocorticoid treatment receive adequate diagnostic evaluation or preventive therapy. This deficit in patient care may result from a lack of clear understanding of the attributed risks by the patients and physicians, the high complexity of the treatment guidelines and poor patient compliance

Perioperative management of drugs commonly used in patients with rheumatic diseases: a review

Rheumatic diseases are very prevalent, affecting about 7 million people in North America; they affect the musculoskeletal system, often with systemic involvement and potential for serious consequences and limitation on quality of life. Clinical treatment is usually long-term and includes drugs that are considered either simple or complex and are occasionally unknown to many health professionals who do not know how to manage these patients in emergency units and surgical wards. Thus, it is important for clinicians, surgeons and anesthesiologists who are involved with rheumatic patients undergoing surgery to know the basic principles of therapy and perioperative management. This study aims to do a review of the perioperative management of the most commonly used drugs in rheumatologic patients. Manuscripts used in this review were identified by surveying MEDLINE, LILACS, EMBASE, and COCHRANE databases and included studies containing i) the perioperative management of commonly used drugs in patients with rheumatic diseases: and ii) rheumatic diseases. They are didactically discussed according to the mechanism of action and pharmacokinetics; and perioperative management. In total, 259 articles related to the topic were identified. Every medical professional should be aware of the types of drugs that are appropriate for continuous use and should know the various effects of these drugs before indicating surgery or assisting a rheumatic patient postoperatively. This information could prevent possible complications that could affect a wide range of patients

Glucocorticoid‐induced osteoporosis in rheumatic diseases

The aim of this article is to review rheumatological diseases that are associated with glucocorticoid‐induced osteoporosis or fractures and to perform a critical analysis of the current guidelines and treatment regimens. The electronic database MEDLINE was searched using the date range of July 1986 to June 2009 and the following search terms: osteoporosis, bone mineral density, fractures, systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, vasculitis, juvenile rheumatoid arthritis, juvenile idiopathic arthritis and juvenile dermatomyositis. Osteopenia and osteoporosis respectively account for 1.4 to 68.7% and 5.0 to 61.9% of adult rheumatological diseases. Among juvenile rheumatological disorders, the frequency of low bone mass ranges from 38.7 to 70%. In general, fracture rates vary from 0 to 25%. Although glucocorticoid‐induced osteoporosis has a high rate of prevalence among rheumatic diseases, a relatively low number of patients on continuous glucocorticoid treatment receive adequate diagnostic evaluation or preventive therapy. This deficit in patient care may result from a lack of clear understanding of the attributed risks by the patients and physicians, the high complexity of the treatment guidelines and poor patient compliance

Study of input value in rural areas with the creation of proximity circuits, in the municipality of Viseu

Este trabalho teve como objetivo estudar os circuitos de proximidade, que podem ser estabelecidos entre consumidores urbanos da cidade de Viseu, e produtores de produtos de origem animal e vegetal, que habitam as zonas rurais da cidade. Este estudo pretende também contribuir para a abertura de um espaço de debate, onde venham a ser lançadas e discutidas ideias e projetos que tenham como objetivo promover a dinamização destes circuitos de proximidade, no contexto da criação de riqueza e da sua distribuição mais igualitária, no contexto da preservação do mundo rural e da ruralidade do nosso concelho. Para tal, foi eleito o método qualitativo de análise da informação recolhida através de entrevistas a clientes urbanos e a produtores rurais. Estes intervenientes foram escolhidos de uma forma aleatória, apenas respeitando alguns parâmetros para a sua seleção. Demonstrou-se com este estudo que é possível estreitar relações entre o meio urbano e o meio rural do concelho de Viseu, identificando mais-valias que este relacionamento pode trazer a ambas as partes. Esta criação de valor vai para além da vertente meramente económica, que nem por isso deixa de ser determinante, promovendo também a criação e o estreitamento de laços sociais entre as duas comunidades.This work aimed to study the circuits of proximity, that can be established between urban consumers in the municipality of Viseu, and producers of animal and vegetable origin, inhabiting the rural areas of the city. This study also aims to contribute to the opening of a space for debate, where ideas and projects that aim to promote the revitalization of these circuits of proximity can be released and discussed, in the context of wealth creation and its more equal distribution, and in the context of preserving the countryside and the rural life of our county. For this, it was elected a qualitative method of analysis of the information gathered through different interviews with farmers and urban customers. These players were chosen in a random manner, respecting only some parameters for its selection. It was demonstrated with this study that it is possible to strengthen relations between urban and rural areas of the municipality of Viseu, identifying gains that this relationship can bring to both parties. This value creation goes beyond the purely economic aspect, which by no means ceases to be decisive, promoting also the creation and strengthening of social ties between the two communities.info:eu-repo/semantics/publishedVersio

Effects of glucocorticoids on growth and bone mineralization

OBJETIVO: Revisar os mecanismos de ações dos glicocorticoides e sua capacidade de induzir osteoporose e déficits de crescimento. FONTES DOS DADOS: A revisão bibliográfica de artigos científicos foi realizada na base de dados MEDLINE e utilizou as palavras-chave agrupadas nas sintaxes “glicocorticoides”, “mineralização óssea”, “crescimento” e “efeitos colaterais”, nos últimos 10 anos, e das referências destes nos reportamos para as publicações mais antigas, mas com os estudos fundamentais para a compreensão do assunto. SÍNTESE DOS DADOS: Destacam-se ações dos glicocorticoides sobre hormônios e citocinas responsáveis pelo crescimento longitudinal. Os efeitos finais dos glicocorticoides sobre o esqueleto são determinados por ações sistêmicas no metabolismo ósseo e por ações diretas desses esteroides nas células ósseas, levando a mudanças no número e função das mesmas e favorecendo a perda óssea. Discutem-se os mecanismos indutores da recuperação dos canais de crescimento e recuperação da massa óssea após a descontinuação dos glicocorticoides; os métodos diagnósticos do metabolismo e mineralização óssea; assim como medidas terapêuticas e preventivas das alterações óssea induzidas pelos glicocorticoides. CONCLUSÃO: A monitorização de cada paciente é essencial para identificação e potencial reversão dos danos associados ao uso crônico de glicocorticoides.OBJECTIVE: To review the various mechanisms of glucocorticoid action and the ability of these agents to induce osteoporosis and growth deficits. SOURCES: A review of the scientific literature was conducted on the basis of a MEDLINE search using the keywords and descriptors “glucocorticoids,” “bone mineralization,” “growth,” and “side effects” and limited to articles published in the last decade. The references cited by these articles were used to identify relevant older publications, with an emphasis on landmark studies essential to an understanding of the topic. SUMMARY OF THE FINDINGS: Emphasis was placed on the actions of glucocorticoids on the hormones and cytokines that modulate linear growth. The end effects of glucocorticoids on the skeletal system are the result of systemic effects on bone metabolism and of direct actions on bone cells, which alter bone cell counts and predispose to bone loss. The mechanisms underlying catch-up growth and bone mass recovery after discontinuation of glucocorticoid treatment are discussed, followed by a review of diagnostic methods available for assessment of bone metabolism and mineralization and of measures for prevention and management of glucocorticoid-induced bone changes. CONCLUSION: Patient monitoring on a case-by-case basis plays an essential role in detection and, potentially, reversal of the damage associated with chronic glucocorticoid therapy