RESUMO
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.
Assuntos
Conservadores da Densidade Óssea , Densidade Óssea , Osteoporose , Humanos , Osteoporose/tratamento farmacológico , Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Fraturas por Osteoporose/prevenção & controle , Anabolizantes/uso terapêutico , Teriparatida/uso terapêutico , Análise Custo-BenefícioRESUMO
Objective: To analyze the amount of muscle and the presence of sarcopenia in postmenopausal women using different methods, verifying the agreement between them as to skeletal muscle mass (SMM). Methods: This cross-sectional observational study was conducted with postmenopausal women aged ≥ 50 years. SMM was obtained from a predictive equation, Bioelectrical Impedance (BIA), and Dual Energy X-Ray Absorptiometry (DXA). The skeletal muscle mass index (SMI) and the appendicular skeletal muscle mass index (ASMI) were calculated. The cut-off point of SMI was determined for the population itself. The agreement between the SMI obtained using the different methods was verified. Sarcopenia was diagnosed according to the criteria proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). The significance level adopted for all tests was 5.0%. Results: A total of 112 women were evaluated, with an average age of 66.1 ± 5.65 years. Among them, 51.8% were sufficiently active and 43.8% were overweight and obese. The SMI cut-offs were 6.46 kg/m2 for the predictive equation and 7.66 kg/m2 for BIA, with high sensitivity and specificity. There was an excellent agreement in the identification of SMM by the predictive equation (0.89 [0.824-0.917], p < 0.001) and BIA (0.92 [0.883-0.945], p < 0.001), in reference to DXA. The prevalence of sarcopenia was 0.9%, 1.8%, and 2.7% according to BIA, DXA, and the predictive equation, respectively. Conclusion: The predictive equation showed the expected agreement in estimating skeletal muscle mass in postmenopausal women, offering a viable and accurate alternative.
Assuntos
Absorciometria de Fóton , Músculo Esquelético , Pós-Menopausa , Sarcopenia , Humanos , Feminino , Sarcopenia/epidemiologia , Sarcopenia/diagnóstico por imagem , Sarcopenia/diagnóstico , Estudos Transversais , Pós-Menopausa/fisiologia , Idoso , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/anatomia & histologia , Pessoa de Meia-Idade , Impedância Elétrica , AntropometriaRESUMO
Abdominal adiposity is associated with tumor development and poor clinical outcomes in breast cancer (BC) and can be identified by the measurement of waist circumference (WC) and visceral adipose tissue (VAT). This study aimed to evaluate the association between waist circumference (WC) and imaging measurement of central adiposity according to age group in women with BC. Abdominal adiposity was assessed by WC and VAT, obtained by dual-energy X-ray absorptiometry (DXA). Body mass index (BMI) was assessed. The presence of inflammation was investigated by measuring C-Reactive Protein (CRP) levels. Multivariate linear regression models were applied to verify the association between WC and VAT. The significance level adopted for all tests was 5%. This study included 112 women with a mean age of 55.5 ± 11.4 years. After adjusted models, WC remained associated with VAT and for every centimeter increase in WC, there was an increase of 3.12 cm2 (CI: 2.40 - 3.85; p < 0.001) in VAT. WC was associated with VAT in women with breast cancer, proving to be a simple, fast, and noninvasive approach that can be used as a proxy to identify visceral fat.
Assuntos
Neoplasias da Mama , Gordura Intra-Abdominal , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Circunferência da Cintura , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/metabolismo , Gordura Intra-Abdominal/patologia , Neoplasias da Mama/patologia , Obesidade/metabolismo , Índice de Massa Corporal , Obesidade AbdominalRESUMO
Abstract Objective: To analyze the amount of muscle and the presence of sarcopenia in postmenopausal women using different methods, verifying the agreement between them as to skeletal muscle mass (SMM). Methods: This cross-sectional observational study was conducted with postmenopausal women aged ≥ 50 years. SMM was obtained from a predictive equation, Bioelectrical Impedance (BIA), and Dual Energy X-Ray Absorptiometry (DXA). The skeletal muscle mass index (SMI) and the appendicular skeletal muscle mass index (ASMI) were calculated. The cut-off point of SMI was determined for the population itself. The agreement between the SMI obtained using the different methods was verified. Sarcopenia was diagnosed according to the criteria proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). The significance level adopted for all tests was 5.0%. Results: A total of 112 women were evaluated, with an average age of 66.1 ± 5.65 years. Among them, 51.8% were sufficiently active and 43.8% were overweight and obese. The SMI cut-offs were 6.46 kg/m2 for the predictive equation and 7.66 kg/m2 for BIA, with high sensitivity and specificity. There was an excellent agreement in the identification of SMM by the predictive equation (0.89 [0.824-0.917], p < 0.001) and BIA (0.92 [0.883-0.945], p < 0.001), in reference to DXA. The prevalence of sarcopenia was 0.9%, 1.8%, and 2.7% according to BIA, DXA, and the predictive equation, respectively. Conclusion: The predictive equation showed the expected agreement in estimating skeletal muscle mass in postmenopausal women, offering a viable and accurate alternative.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Composição Corporal , Antropometria , Impedância Elétrica , Pós-Menopausa , Músculo Esquelético , Sobrepeso , Sarcopenia , ObesidadeRESUMO
Abstract Introduction Osteoporosis is a metabolic disease characterized by reduced bone mineral density, often accompanied by loss of quality of trabecular bone microarchitecture. Objective To assess the quality or degradation of trabecular bone microarchitecture in digital panoramic radiography to better predict the risk of fragility fractures. Material and method The sample included 68 female patients, age-matched, and divided into three groups according to densitometric results. Trabecular Bone Score values were measured and digital panoramic radiographs were taken. Fractal analysis with box counting was conducted in the region of premolars and angle of the mandible, with regions of interest measuring 64×64 and 80×120 pixels. In the statistical analysis, Pearson's correlation was applied between the Trabecular Bone Score and fractal analysis results obtained in each group, using age as a control variable and assigning individualized age ranges within groups. Result A moderate correlation was identified in the regions of interest of 64×64 and 80×120 pixels at the angle of the mandible in the osteoporosis group and in the normal group. A moderate correlation was also obtained using age as a control variable in the 64x64 pixel regions of interest in the premolar region. Considering age range, the within-group analysis presented a strong correlation in the osteoporosis group and moderate correlation in the osteopenia and normal groups. Conclusion Fractal analysis in digital panoramic radiographs was shown to be a promising predictive instrument of bone microarchitecture quality.
Resumo Introdução A osteoporose é uma doença metabólica caracterizada pela redução da densidade mineral óssea, muitas vezes acompanhada da perda de qualidade da microarquitetura óssea trabecular. Objetivo Avaliar a qualidade da microarquitetura óssea trabecular em radiografia panorâmica digital a fim de identificar precocemente a sua degradação, possibilitando melhor predição do risco de fraturas por fragilidade. Material e método A amostra consistiu de 68 pacientes do sexo feminino, pareadas por idade, e divididas em 3 grupos conforme resultado densitométrico. Foram aferidos os valores de Trabecular Bone Score e realizadas radiografias panorâmicas digitais. A análise fractal com box counting foi feita na região de pré-molares e ângulo da mandíbula, com regiões de interesse medindo 64x64 e 80x120 pixels. Na análise estatística utilizou-se a correlação de Pearson entre os resultados de Trabecular Bone Score e de análise fractal obtidos em cada grupo, utilizando-se a idade como variável de controle e através de atribuição de grupos etários individualizados intragrupos. Resultado Identificou-se correlação moderada nas regiões de interesse de 64x64 e 80x120 pixels, em ângulo da mandíbula no grupo Osteoporose e no grupo normal. Também se obteve correlação moderada utilizando a idade como variável de controle nas regiões de interesse de 64x64 pixels, em região de pré-molares. A análise intragrupos, considerando a faixa etária, resultou em correlação forte, no grupo osteoporose e moderada nos grupos osteopenia e normal. Conclusão A análise fractal em radiografias panorâmicas digitais se mostrou promissora como instrumento preditivo da qualidade de microarquitetura óssea.
Assuntos
Humanos , Feminino , Osteoporose , Osso e Ossos , Doenças Ósseas Metabólicas , Radiografia Panorâmica , MandíbulaRESUMO
Abstract Objective: To present an updated and evidence-based guideline for the use of dual-energy x-ray absorptiometry (DXA) to assess body composition in clinical practice. Materials and methods: This Official Position was developed by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism ( Associação Brasileira de Avaliação Óssea e Osteometabolismo , ABRASSO) and experts in the field who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications in the area of body composition assessment. In this second part of the Official Position, the authors discuss the interpretation and reporting of body composition parameters assessed by DXA and the use of DXA for body composition evaluation in special situations, including evaluation of children, persons with HIV, and animals. Conclusion: This document offers recommendations for the use of DXA in body composition evaluation, including indications, interpretation, and applications, to serve as a guiding tool in clinical practice and research for health care professionals in Brazil.
Assuntos
Humanos , Masculino , Feminino , Osteoporose/diagnóstico , Osteoporose/fisiopatologia , Osteoporose/prevenção & controle , Densidade Óssea/fisiologia , Medição de Risco/métodos , Brasil , Fatores de Risco , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/fisiopatologia , Fraturas por Osteoporose/prevenção & controle , Pessoa de Meia-IdadeRESUMO
Abstract Osteoporosis is the leading cause of fractures in the population older than 50 years. This silent disease affects primarily postmenopausal women and the elderly, and the morbidity and mortality rates are high. The main goal of treating osteoporosis is the prevention of fractures. The identification of populations at risk through early diagnosis and treatment is essential. The last Brazilian guideline for the treatment of postmenopausal osteoporosis was elaborated in 2002. Since then, new strategies for diagnosis and risk stratification have been developed, and drugs with novel action mechanisms have been added to the therapeutic arsenal. The Osteoporosis and Osteometabolic Diseases Committee of the Brazilian Society of Rheumatology, in conjunction with the Brazilian Medical Association and other Societies, has developed this update of the guidelines for the treatment of postmenopausal osteoporosis according to the best scientific evidence available. This update is intended for professionals in many medical and health specialties involved in the treatment of osteoporosis, for physicians in general and for health-related organizations.
Resumo A osteoporose é a principal causa de fraturas na população acima de 50 anos. É uma doença silenciosa que afeta especialmente as mulheres na pós-menopausa e idosos e tem elevada taxa de morbimortalidade. O principal objetivo do tratamento da osteoporose é a prevenção das fraturas. A identificação dessa população de risco através do diagnóstico e tratamento precoces é de fundamental importância. A última diretriz brasileira para tratamento da osteoporose em mulheres na pós-menopausa foi elaborada em 2002. Desde então foram desenvolvidas novas estratégias de diagnóstico da osteoporose, bem como fármacos com novos mecanismos de ação foram adicionados ao arsenal terapêutico. A Comissão de Osteoporose e Doenças Osteometabólicas da Sociedade Brasileira de Reumatologia em conjunto com a Associação Médica Brasileira e sociedades afins desenvolveu esta atualização da diretriz do tratamento da osteoporose em mulheres na pós-menopausa de acordo com as melhores evidências científicas disponíveis. Esta atualização é destinada aos profissionais das várias especialidades médicas e da área da saúde envolvidos no tratamento da osteoporose, médicos em geral e organizações relacionadas à saúde.
Assuntos
Humanos , Idoso , Osteoporose Pós-Menopausa/diagnóstico , Osteoporose Pós-Menopausa/terapia , Conservadores da Densidade Óssea/uso terapêutico , Reumatologia , Sociedades Médicas , Acidentes por Quedas/prevenção & controle , Brasil , Exercício Físico , Absorciometria de Fóton , Osteoporose Pós-Menopausa/prevenção & controle , Pessoa de Meia-IdadeRESUMO
Introdução: Os bifosfonatos têm sido indicados para o tratamento de doenças do metabolismo ósseo. Atualmente, seu emprego terapêutico aumentou e, com ele, os efeitos adversos, dos quais um dos mais importantes é a indução da osteonecrose dos maxilares (BRONJ), uma complicação de difícil tratamento e solução. Objetivo: Identificar a prevalência e os possíveis fatores de risco para o desenvolvimento de osteonecrose em pacientes tratados com bifosfonatos no HUCAM/UFES. Métodos: Foram realizados exames clínicos e análises de radiografias panorâmicas de pacientes em tratamento com bifosfonatos no HUCAM/UFES. Resultados: Foram examinadas 16 pacientes do gênero feminino, com idade entre 55 e 84 anos. Todas as pacientes tinham osteoporose, sendo que 87,5% ainda tinham outro comprometimento sistêmico. A doença periodontal foi o fator de risco de osteonecrose mais comum, presente em 56,25% pacientes. O bifosfonato mais utilizado pelas pacientes foi o alendronato sódico 70 mg, sendo utilizado por 87,5%. A administração do medicamento foi semanal e por via oral em todas as pacientes, com tempo de uso variável de 2 meses a 5,5 anos. Conclusão: Com o envelhecimento populacional e aumento do uso de bifosfonatos no tratamento de osteoporose é fundamental a identificação de usuários e fatores de risco existentes, para o tratamento não se constituir como risco em lugar do benefício. Mas não se observa esta conduta e para que seja estabelecida precisará haver a conscientização de todos os indivíduos envolvidos: médicos, dentistas e pacientes (AU)
Introduction: Bisphosphonates have been indicated for treating diseases of bone metabolism. Currently, its therapeutic use has increased and with it, the adverse effects, of which the most important is the induction of osteonecrosis of the jaw, is a complication of difficult treatment and solution. Objective: To identify the prevalence and possible risk factors for the development of osteonecrosis in patients treated with bisphosphonates in HUCAM/UFES. Methods: Clinical examinations were performed and analysis of panoramic radiographs of patients in treatment with bisphosphonates in HUCAM/UFES. Results: 16 female patients were examined, aged between 55 and 84 years old. All patients have osteoporosis, and 87.5% have other systemic involvement. Periodontal disease is a risk factor for osteonecrosis most commonly presented in patients 56.25%. The bisphosphonate used by most patients was 70 mg alendronate sodium, being used by 87.5%. Drug administration is weekly and is made for all patients orally. The bisphosphonate usage time ranged from 2 months to 5.5 years. Conclusion: Risk factors for development are found in most users patients. It is therefore important to drug users to identify and existing risk factors, especially in postmenopausal women for the treatment does not constitute a risk rather than benefit. (AU)
Assuntos
Humanos , Osteonecrose , Osteoporose , Difosfonatos , Mandíbula , MaxilaRESUMO
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.
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.