Epidemiologia de fraturas pela osteoporose no Brasil: o que temos e o que precisamos

The epidemiology of osteoporotic fractures varies widely among countries and is primarily related to differences in the population and utilization of public healthcare services. Since 1994, over 200 studies about osteoporosis and fractures have been conducted in Brazil, among which 60 have described the current epidemiological status. This work is a compilation of studies published in scientific journals (PubMed, MedLine, Lilacs, SciELO Database) with the respective highlights. Overall, these studies show moderate incidence of hip fracture in subjects over 50 years old. However, the prevalence of all types of bone fragility fracture is higher, ranging from 11% to 23.8%. In addition, there is a high incidence of recurrent falls, which are the main extra-skeletal factor associated with these fractures. According to the national studies, 12 months after femoral fractures, the mortality rate ranged between 21.5% and 30%, and there was also a high rate of physical impairment, deterioration of the quality of life and excessive burden to the healthcare system. Considering its high prevalence and associated mortality and physical impairment, osteoporosis and its main consequence, bone fragility fractures, must be considered a major public health problem in our country.A epidemiologia das fraturas por osteoporose varia amplamente entre os países, principalmente em decorrência das diferenças entre as populações e da utilização de recursos públicos de saúde. Desde 1994, mais de 200 estudos sobre osteoporose e fraturas foram feitos no Brasil, dos quais 60 descreveram a situação epidemiológica atual. Esse manuscrito é a compilação de estudos publicados em revistas científicas (PubMed, MedLine, Lilacs, SciELO Database) com seus principais achados. Em geral, esses trabalhos mostram moderada incidência de fratura de quadril em indivíduos acima de 50 anos de idade. No entanto, a prevalência de todos os tipos de fratura por fragilidade óssea é elevada, variando de 11% a 23,8%. Além disso, é observada alta incidência de quedas recorrentes, um dos principais aspectos extraesqueléticos associados com essas fraturas. De acordo com os estudos nacionais, 12 meses após a fratura de fêmur, a taxa de mortalidade variou de 21,5% a 30%, com elevada taxa de incapacidade física, deterioração da qualidade de vida e grande impacto sobre o sistema de saúde. Diante da elevada prevalência, associação com mortalidade e incapacidade física, a osteoporose e sua principal consequência, a fratura por fragilidade óssea, deveriam ser consideradas um problema de saúde pública em nosso país.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Serviço de Densitometria ÓsseaCEDOESUNIFESP, EPM, Serviço de Densitometria ÓsseaSciEL

Uso de risedronato na consolidação e formação do calo na fratura de Colles em mulheres na pós‐menopausa – Estudo Solid

ResumoObjetivoEste estudo multicêntrico, randomizado, aberto, grupo paralelo avaliou a eficácia de Actonel® 35 mg mais cálcio/vitamina D versus cálcio/vitamina D isoladamente na preservação da densidade mineral óssea (DMO) em mulheres pós‐menopausadas com fratura de Colles.MétodosPacientes com fratura de Colles em sete dias foram aleatoriamente designadas para receber Actonel® 35 mg semanalmente mais cálcio/vitamina D (Grupo AO [GAO]) ou cálcio/vitamina D (grupo O [GO]) isoladamente. As pacientes foram avaliadas após 90 e 180 dias de tratamento.ResultadosCompletaram as avaliações 59 pacientes no GAO e 56 no OG. No fim do estudo, a DMO do rádio no local da fratura mostrou variação negativa no GO (32,8%) que foi discretamente menor no GAO (20,8%), assim como uma perda menor na DMO no GAO comparado com o OG. Houve diferença na proporção de paciente com perda da DMO no fim do estudo nos dois grupos de tratamento em favor do GAO, apesar de não estatisticamente significante. Não houve diferença significativa na identificação radiológica da formação do calo entre os grupos de tratamento. Na maioria das pacientes a identificação radiológica do calo ocorreu depois de 90 dias.ConclusãoMulheres pós‐menopausadas com fratura de Colles que receberam risedronato sódico, além do cálcio/vitamina D, comparado com cálcio/vitamina D não mostraram diferença significativa na perda da DMO na fratura do antebraço, com tendência de efeito protetor do risedronato na perda da DMO devido à imobilização. O tempo até a consolidação da fratura não foi afetado.AbstractObjectiveThis open, randomized and blinded parallel‐group multicenter study evaluated the efficacy of Actonel® (35mg) plus calcium/vitamin D versus calcium/vitamin D alone for preserving bone mineral density (BMD) in postmenopausal women with Colles fractures.MethodsPatients with a Colles fracture for seven days were randomized to receive either Actonel® (35mg) once a week plus calcium/vitamin D (ACD group) or calcium/vitamin D alone (CD group). The patients were evaluated after 90 and 180 days of treatment.ResultsCompleted all the evaluations 59 ACD patients and 56 CD patients. At the end of the study, the BMD of the radius at the fracture location showed a negative change in the CD group (32.8%). The loss of BMD in the ACD group (20.8%) was slightly less than in the CD group. There was a difference in the proportions of patients with BMD losses at the end of the study period in the two treatment groups, in favor of the ACD group, although this was not statistically significant. There was no significant difference in radiological identification of callus formation between the treatment groups. In the majority of the patients, the callus could be radiologically identified after 90 days.ConclusionPostmenopausal women with Colles fractures who received risedronate sodium plus calcium/vitamin D did not show any significant difference in BMD loss in forearm fractures, in comparison with those who received calcium/vitamin D alone. Risedronate presented a tendency towards a protective effect regarding BMD loss due to immobilization. The time taken for fracture consolidation to be achieved was unaffected

Vitamin K Supplementation Modulates Bone Metabolism and Ultra-Structure of Ovariectomized Mice

Background/Aims: Osteoporosis is a bone metabolic disease that affects mostly post-menopausal women. There has been shown that vitamin K (VK) supplementation during menopause may decrease bone loss as well as risk of bone breaking. Aiming to clarify the beneficial role of VK in bone metabolism during menopause, we investigated mineral metabolism and bone ultrastructure of ovariectomized (OVX) mice. Methods: To determine the effects chronic use of VK in bone structure and mineral metabolism in OVX mice, we used several methods, such as DXA, µCTScan, and SEM as well as biomolecular techniques, such as ELISA and qRT-PCR. In addition, complete analysis of serum hormonal and other molecules associated to bone and lipid metabolism were evaluated overview the effects of VK in menopause murine model. Results: VK treatment significantly affects Pi metabolism independently of OVX, changing Pi plasma, urinary output, balance, and Pi bone mass. Interestingly, VK also increased VLDL in mice independently of castration. In addition, VK increased compact bone mass in OVX mice when we evaluated it by DXA, histomorphometry, µCTScanning. VK increased bone formation markers, osteocalcin, HYP- osteocalcin, and AP whereas it decreased bone resorption markers, such as urinary DPD/creatinine ratio and plasmatic TRAP. Surprisingly, SEM images revealed that VK treatment led to amelioration of microfractures observed in OVX untreated controls. In addition, SHAM operated VK treated mice exhibited higher number of migrating osteoblasts and in situ secretion of AP. OVX led to decreased to in situ secretion of AP that was restored by VK treatment. Moreover, VK treatment increased mRNA expression of bone Calbindin 28KDa independently of OVX. Conclusion: VK treatment in OVX mice exhibited beneficial effects on bone ultrastructure, mostly by altering osteoblastic function and secretion of organic bone matrix. Therefore, VK could be useful to treat osteopenic/osteoporotic patients

Use of risedronate for consolidation and callus formation in Colles fractures in postmenopausal women: SOLID study

OBJECTIVE: This open, randomized and blinded parallel-group multicenter study evaluated the efficacy of Actonel(r) (35 mg) plus calcium/vitamin D versus calcium/vitamin D alone for preserving bone mineral density (BMD) in postmenopausal women with Colles fractures.METHODS: Patients with a Colles fracture for seven days were randomized to receive either Actonel(r) (35 mg) once a week plus calcium/vitamin D (ACD group) or calcium/vitamin D alone (CD group). The patients were evaluated after 90 and 180 days of treatment.RESULTS: 59 ACD patients and 56 CD patients completed all the evaluations. At the end of the study, the BMD of the radius at the fracture location showed a negative change in the CD group (32.8%). The loss of BMD in the ACD group (20.8%) was slightly less than that in the CD group. There was a difference in the proportions of patients with BMD losses at the end of the study period in the two treatment groups, in favor of the ACD group, although this was not statistically significant. There was no significant difference in radiological identification of callus formation between the treatment groups. In the majority of the patients, the callus could be radiologically identified after 90 days.CONCLUSION: Postmenopausal women with Colles fractures who received risedronate sodium plus calcium/vitamin D did not show any significant difference in BMD loss in forearm fractures, in comparison with those who received calcium/vitamin D alone. Risedronate presented a tendency toward a protective effect regarding BMD loss due to immobilization. The time taken for fracture consolidation to be achieved was unaffected

Association of PvuII and XbaI polymorphisms on estrogen receptor alpha (ESR1) gene to changes into serum lipid profile of post-menopausal women: Effects of aging, body mass index and breast cancer incidence - Fig 2

<p>A: Linear regression graph comparing serum Total Lipids and age. Each lines slopes are significantly different (p = 0.015). Goodness of fit (r²): XX = 0.097; Xx = 0.007. B: Linear regression graph comparing serum Triglycerides and age. Each lines slopes are significantly different (p<0.05). Goodness of fit (r²): XX = 0.060; Xx = 0.002. C: Linear regression graph comparing serum Total Lipid and BMI. Each lines slopes are not significantly different (p>0.05). Goodness of fit (r²): XX = 0.072; Xx = 0.004. D: Linear regression graph comparing serum triglycerides and BMI. Each lines slopes are significantly different (p<0.05). Goodness of fit (r²): XX = 0.106; Xx = 0.017.</p

Serum lipid profile for each genotype.

<p>Serum lipid profile for each genotype.</p

Population characteristics.

<p>Population characteristics.</p