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1.
Z Rheumatol ; 76(3): 274-278, 2017 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-28084543

RESUMO

Pregnancy and lactation-associated osteoporosis (PLO) is a rare form of osteoporosis, which occurs in the last trimester or postpartum. So far 100 cases have been published. The leading symptoms are severe low back pain or less frequently hip pain. Many patients develop postpartum depression due to inability to care for the baby and vertebral fractures. The therapeutic decision has to be made individually but teriparatid and bisphosphonates seem to be the best option. We report the clinical course (16 years) of a 37-year-old patient with PLO, who suffered 6 vertebral fractures. There were severe physical limitations and mental problems caused by the disease. The patient was treated by multimodal therapy including physiotherapy and psychotherapy and bisphosphonates were given. The time between the onset of symptoms and diagnosis was 5 months. No further fractures occurred in the following 16 years. The physical and mental condition significantly improved.


Assuntos
Depressão/terapia , Transtornos da Lactação/terapia , Fraturas por Osteoporose/terapia , Complicações na Gravidez/terapia , Fraturas da Coluna Vertebral/terapia , Adulto , Conservadores da Densidade Óssea/uso terapêutico , Terapia Combinada/métodos , Depressão/diagnóstico , Diagnóstico Diferencial , Difosfonatos/administração & dosagem , Feminino , Humanos , Transtornos da Lactação/diagnóstico , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/terapia , Osteoporose , Fraturas por Osteoporose/diagnóstico , Modalidades de Fisioterapia , Gravidez , Complicações na Gravidez/diagnóstico , Psicoterapia/métodos , Fraturas da Coluna Vertebral/diagnóstico , Resultado do Tratamento
2.
Z Rheumatol ; 70(9): 793-8, 800-2, 2011 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-21956827

RESUMO

OBJECTIVE: The aim of this study was to examine bone mineral density (BMD), frequency of osteopenia and osteoporosis in a representative sample of patients with rheumatoid arthritis (RA) and to describe chemoprophylaxis and treatment of osteoporosis compared to evidence-based guidelines. PATIENTS AND METHODS: In 2005 and 2006, 532 patients with RA (98 men, 434 women) aged 23-87 years were recruited from 9 German rheumatology centers. Clinical examination included a detailed documentation of osteoporosis medication. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD at the lumbar spine and femoral neck. Osteopenia and osteoporosis were defined according to the criteria of the World Health Organization. RESULTS: Of the RA patients 29% had normal BMD at the spine and femoral neck, 49% of the patients had osteopenia and 22% met the criteria for osteoporosis at any site. Of the patients 60% were receiving medication for prophylaxis or therapy of osteoporosis, 38% calcium/vitamin D alone, 20% as combinations mostly of calcium/vitamin D + bisphosphonate, 1% received bisphosphonate only and 1% hormone replacement therapy. Although the frequency of osteoporosis showed no significant differences between male and female patients, women with RA used osteoporosis medication more often than men (63% versus 49%, χ²-test, p <0.05). A total of 101 RA patients (83 menopausal women, 6 premenopausal women, 12 men) received corticosteroids in a daily dose of 7.5 mg or less for at least 3 months and had DXA T-scores below -2.0 at any site. In this patient group 41% of the menopausal women, 17% of the premenopausal women and 42% of the male patients were reported to receive medication with calcium/vitamin D + bisphosphonate. Calcium/vitamin D was used by 35% of the menopausal women, none of the premenopausal women and 50% of the male patients and 18% of the menopausal women, 67% of the premenopausal women and 8% of men received no prophylaxis or treatment for osteoporosis. CONCLUSION: According to the DVO (German Society for Osteoporosis) guidelines for osteoporosis (2009) menopausal women with corticosteroid therapy < 7.5 mg per day for at least 3 months and DXA T-scores below -2.0 should receive treatment with bisphosphonate and calcium/vitamin D. The data show that there were still deficits concerning prophylaxis and treatment of osteoporosis in RA.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Conservadores da Densidade Óssea/uso terapêutico , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/prevenção & controle , Osteoporose/epidemiologia , Osteoporose/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/diagnóstico , Densidade Óssea/efeitos dos fármacos , Doenças Ósseas Metabólicas/diagnóstico , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Prevalência , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
3.
Exp Clin Endocrinol Diabetes ; 109(2): 87-92, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11341304

RESUMO

The aim of this study was to identify factors associated with fractures in patients with postmenopausal osteoporosis. The overall hypothesis was that trunk muscle strength, body sway and hypovitaminosis D would influence daily activities and the likelihood of falls and fractures. - In 237 women (mean age 62.9+/-7.4 years) osteoporosis was defined by a T-score at the femoral neck below -2.5 SD. Trunk muscle strength was determined using isokinetic dynamometry and body sway was measured according to Lord et al. Limitations in everyday life were assessed and the history of falls was documented. A fracture was defined as a vertebral height reduction of more than 20% or at least 4 mm. The assessment was carried out using the Spine Deformity Index (SDI) and was confirmed by an experienced radiologist. Pearson coefficients of correlation were calculated. - After correction for age, significant associations were found for body sway and 25-hydroxyvitamin D (p<0.001), body sway and falls (p<0.001), body sway and rib fractures (p<0.01), trunk muscle strength and limitations in everyday life (p<0.001), trunk muscle strength and SDI (p<0.001), trunk muscle strength and bone density (p<0.001), and bone density and 25-hydroxyvitamin D (p<0.001). No significant correlation was found for trunk muscle strength and 25-hydroxyvitamin D (p=0.712). - Findings suggest that hypovitaminosis D is associated with increased body sway and an elevated risk for falls and falls-related fractures. Musculoskeletal rehabilitation should include strengthening exercises for the trunk muscles and training of neuromuscular co-ordination and balance.


Assuntos
Acidentes por Quedas , Fraturas Ósseas/etiologia , Músculo Esquelético/fisiologia , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/fisiopatologia , Equilíbrio Postural/fisiologia , Vitamina D/análogos & derivados , Vitamina D/metabolismo , Idoso , Densidade Óssea , Feminino , Humanos , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fatores de Risco , Vitamina D/sangue
4.
MMW Fortschr Med ; 144(44): 41-4, 2002 Oct 31.
Artigo em Alemão | MEDLINE | ID: mdl-12494598

RESUMO

In terms of their clinical impact, bone fractures as late sequelae of osteoporosis are still largely ignored in Germany. Up to 80-90% of patients with treatment-requiring osteoporosis are not receiving specific treatment. The consequences for the patient are enormous: weeks of severe pain, subsequent fractures that occur for ever more banal reasons, increasing restriction of daily activities, invalidism and an increasing need for nursing care. All this despite the availability of powerful medications. In concert with an appropriate early diagnosis, not only could the majority of patients be spared such a fate, but also the costs incurred as a direct consequence of such fractures could be drastically lowered.


Assuntos
Pessoas com Deficiência/reabilitação , Ácido Etidrônico/análogos & derivados , Osteoporose/terapia , Dor/etiologia , Fraturas da Coluna Vertebral/prevenção & controle , Atividades Cotidianas , Fatores Etários , Alendronato/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Ácido Etidrônico/uso terapêutico , Feminino , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Osteoporose/reabilitação , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/tratamento farmacológico , Dor/prevenção & controle , Cloridrato de Raloxifeno/uso terapêutico , Ácido Risedrônico , Fatores Sexuais , Fraturas da Coluna Vertebral/etiologia
6.
Radiol Diagn (Berl) ; 31(5): 479-87, 1990.
Artigo em Alemão | MEDLINE | ID: mdl-2277842

RESUMO

From 192 gymnastic athletes and 216 swimmers the spine radiographs were evaluated. The risks for a too early start of high performance training in gymnastics for the spine are shown. Juvenile osteochondroses before the 10 year were found. Requirements for the elimination of spine diseases are pointed out.


Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Ginástica , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Natação , Adolescente , Criança , Feminino , Alemanha , Humanos , Masculino , Radiografia , Traumatismos da Coluna Vertebral/etiologia
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