RESUMO
The evolution of pain and quality of life after a symptomatic vertebral fracture differs according to patient gender, with a worse evolution in women independently of the treatment received. PURPOSE: In a previous randomized clinical study comparing the effect of vertebroplasty (VP) vs. conservative therapy (CT) on pain evolution and quality of life (QoL) of patients with symptomatic vertebral fractures (VF), we observed the development of chronic back pain in 23% of subjects, independently of the therapy received. This study analyses the effect of gender on the evolution of pain and QoL in these subjects. METHODS: 118/125 randomized patients (27 males/91 females) with recent symptomatic VFs were evaluated. All received a standardized analgesic and antiosteoporotic format of treatment. Pain and QoL were evaluated by VAS and Qualeffo-41, respectively, at baseline, at 2 weeks and 2 and 6 months. We compared pain evolution and QoL after treatment (CT vs. VP) according to gender, and analysed factors including age, time of evolution, treatment received, baseline VAS, previous VFs (total and recent), incidental VFs, lumbar and femoral T-scores, and analgesic and antiosteoporotic treatment. RESULTS: At baseline, there were no differences in age (males 74.8 ± 11.2 vs. females:73.2 ± 8.7 years), time of evolution, number of VFs (males:3.8 ± 2.4 vs. females: 3.1 ± 2.4), treatment received (VP, males:59%, females:45%), lumbar or femoral T-score, baseline VAS (males:6.8 ± 2.1 vs. females:6.8 ± 2.2) or Qualeffo score (males:52.2 ± 24.4 vs. females:59.7 ± 20.6). Pain and QoL evolution differed according to gender, being better in males. These differences were significant after two months independently of the treatment and the development of incidental VF during follow-up. CONCLUSIONS: Pain and QoL evolution after a symptomatic VF differs according to gender, with a worse evolution in women independently of the treatment received.
Assuntos
Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Masculino , Humanos , Feminino , Qualidade de Vida , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Dor nas Costas , Analgésicos/uso terapêutico , Fraturas por Osteoporose/cirurgiaAssuntos
Adenoma/complicações , Anquilose/diagnóstico por imagem , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Articulação Sacroilíaca/diagnóstico por imagem , Adenoma/terapia , Anquilose/complicações , Calcinose/complicações , Calcinose/diagnóstico por imagem , Adenoma Hipofisário Secretor de Hormônio do Crescimento/terapia , Humanos , Ligamentos Longitudinais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Radiografia , Radioterapia Adjuvante , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION AND OBJECTIVE: Fibrous dysplasia (FD) can be associated with the development of hypophosphatemic osteomalacia, caused by the production of FGF-23 by dysplastic bone tissue. This study analysed FGF-23 levels in patients with FD, and their association with disease activity and serum phosphate values. PATIENTS AND METHODS: Twelve adult patients with FD were included in the study. Clinical history, disease extension and activity and treatments received were reviewed, and the relationship of those values with FGF-23 and serum P levels was analysed. RESULTS: FGF-23 was elevated in 6/12 patients (50%). Patients with high FGF-23 levels had similar age and disease activity and extension than those who did not. No differences were observed in serum phosphate values between both groups (increased FGF-23: 3.9±0.9 mg/dl vs. decreased FGF-23: 3.5±0.6 mg/dl). In fact, none of the patients with increased FGF-23 had low serum phosphate values. CONCLUSION: Adult FD patients frequently present elevated FGF-23 values with no serum phosphate level repercussion, suggesting an alteration in the processing of this protein in the dysplastic bone tissue for this pathology.
Assuntos
Fatores de Crescimento de Fibroblastos/sangue , Displasia Fibrosa Óssea/sangue , Adulto , Idoso , Alendronato/uso terapêutico , Biomarcadores/sangue , Conservadores da Densidade Óssea/uso terapêutico , Feminino , Fator de Crescimento de Fibroblastos 23 , Displasia Fibrosa Óssea/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Osteomalacia/etiologia , Pamidronato/uso terapêutico , Fósforo/sangue , Valores de Referência , Adulto Jovem , Ácido Zoledrônico/uso terapêuticoAssuntos
Cistos Ósseos/diagnóstico por imagem , Condrocalcinose , Hemocromatose , Tálus/diagnóstico por imagem , Idoso , Condrocalcinose/diagnóstico , Condrocalcinose/etiologia , Condrocalcinose/fisiopatologia , Hemocromatose/complicações , Hemocromatose/diagnóstico , Hemocromatose/fisiopatologia , Hemocromatose/terapia , Humanos , Masculino , Articulação Metacarpofalângica/diagnóstico por imagem , Articulação Metacarpofalângica/patologia , Osteoartrite/diagnóstico , Osteoartrite/etiologia , Osteoartrite/fisiopatologia , Flebotomia/métodos , Radiografia/métodosRESUMO
Fibrous dysplasia is a skeletal disorder that is associated with a wide spectrum of clinical manifestations, including localized asymptomatic forms and extensive severe forms with severe bone deformities and endocrinological alterations, depending on age, location, extent and associated processes. Although the treatment of choice is based on bisphosphonates, the therapeutic efficacy of these agents in the control of disease activity remains uncertain. This article reviews the current data available on the treatment of this disease as well as the preliminary data on new therapeutic approaches.