An updated hip fracture incidence rate for Brazil: the Brazilian Validation Osteoporosis Study (BRAVOS).

Hip fracture incidence rates in three representative geographic areas in Brazil over a period of 2 years (2010-2012) were assessed for the first time. Estimated incidence rates varied regionally, and markedly differed from those previously reported. Thus, national guidelines as well as FRAX Brazil should be revised in light of this new data. PURPOSE: To determine the annual incidence of hip fractures in individuals aged 50 years and over, living in 3 cities located in different regions of the country. To investigate the age, gender, and regional differences in fracture rates. Based on the obtained data, to estimate the national incidence of hip fractures resulting from osteoporosis, in order to improve prevention strategies. METHODS: Retrospective, observational study including all patients aged ≥ 50 years admitted in hospitals because of a hip fracture in three cities (Belem, Joinville, and Vitoria) from representative geographic areas in Brazil from 2010 to 2012. Data were obtained from medical records in those cities. We analyzed incidence rates (crude and age- and gender-standardized rates) for hip fractures. RESULTS: There were 1025 (310 in men and 715 in women) hip fractures in the over 50-year-old merged population from the three cities. The crude incidence rate for hip fracture was 103.3/100,000 (95% confidence interval [CI = 97.0; 109.7), in men 77.4/100,000 (95% CI = 68.8; 86.0), and in women 125.2/100,000 (95% CI = 116.0; 134.4). Incidence standardized for age and gender was 105.9 cases per 100,000 persons per year (95% CI = 99.4; 112.4); 78.5 cases per 100,000 (95% CI = 69.8; 87.3) in men and 130.6 cases 100,000 in women (95% CI = 121.0, 140.2) per year. Belem, located in the equatorial region (latitude 1° 27' S), had significantly lower crude and age-adjusted incidence than Joinville (latitude 26° 18' S) and Vitoria (latitude 20° 19' S), which were no different from each other. The incidence of fractures increased exponentially with age, and women had about twice the risk of fractures than men. CONCLUSIONS: Hip fracture mainly affects elderly women and presents great variability in incidence between the different regions in Brazil. The incidence of hip fractures in Brazil differed markedly from that reported previously, so that national guidelines and the FRAX model for Brazil should be revised.

Incidence and excess mortality of hip fractures in a predominantly Caucasian population in the South of Brazil.

INTRODUCTION: Osteoporosis is a very common disease, and data on its epidemiology is important for health care strategy implementation. Brazil is a developing country; its population is aging, leading to an expected increase in hip fractures and their undesirable consequences. OBJECTIVE: Assess the incidence of osteoporotic hip fractures and subsequent mortality in Southern Brazil as part of a large epidemiological study aiming to reinforce the data for FRAX Brazil. STUDY DESIGN: This study evaluated all admissions for fragility hip fractures between April 1, 2010, and March 31, 2012, in the city of Joinville, including both genders of patients 50 years old or older, which corresponded to 19.2% of the local population. Joinville was chosen because it is the third largest city in the south of Brazil, with a representative population predominantly composed of descendants of European immigrants. RESULTS: There were 213 cases of hip fractures, predominantly in Caucasians (n = 204, 96.7%) whose mean age was 77.7, ± 10.5, of which 143 (67.1%) were women (79.5 ± 9.6 years) and 70 (32.9%) were men (74 ± 11.3 years). The annual incidence of hip fractures was 268.8 for women and 153.0 for men/100,000 inhabitants. In the 60 to 64-year group, the overall incidence was 92.1/100,000, with an age-related increase of 1410.1/100,000 in the 80 to 84-year group. The mortality rate during hospitalization was 7.5%, and 25% died during the 12 months following their fractures. CONCLUSION: The incidence of hip fractures among the oldest in this predominantly Caucasian population living in Southern Brazil was similar to that of European populations from the northern hemisphere. The annual incidence of fragility hip fractures among people in their 80s was 59 times higher than that among people in their 50s. The mortality rate was 4.3 times higher in the first year after hip fracture than in the age-related local population.

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.

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.

Estrogen is a steroidal hormone involved in several physiological functions in the female body including regulation of serum lipid metabolism and breast cancer (BC). Estrogen actions on serum lipids mostly occur through its binding to intracellular Estrogen Receptor alpha (ERalpha) isoform, expressed in most of tissues. This gene (ESR1) exhibit many polymorphic sites (SNPs) located either on translated and non-translated regions that regulate ERalpha protein expression and function. This paper aimed to investigate the association of two intronic SNPs of ESR1 gene, namely c454-397T>C (PvuII) and c454-351A>G (XbaI) to alterations in serum levels of total cholesterol (T-chol), total lipid (TL), low density lipoprotein cholesterol (LDL), high density lipoprotein (HDL), and triglycerides (TG) in a cohort of post-menopausal women. In addition, we aimed to associate presence of these SNPs to development of BC along 5 years period. To do so, a group of healthy 499, highly miscigenated, post-menopausal Brazilian women, were carried using PCR-FRLP technique and further confirmed by automatic sequence analysis as well followed through 5 years for BC incidence. Measurements of serum lipid profile by standard commercial methods were carried individually whereas Dual Energy X-ray Absorciometry (DXA) measured Body Mass Indexes (BMI), Fat Mass (FM), Lean Body Mass (LBM), and Body Water Content (BWC). No effects of PvuII SNP on ESR1 gene were observed on patient´s serum T-chol, TL, LDL, HDL, and TG. However, c454-397T>C PvuII SNP is associated to lower body fat and higher levels of lean mass and body water and lower incidence of BC. On the other hand, statistically significant effect of XbaI c454-351A>G SNP on serum TG and TL levels. Patients homozygous for X allele were followed up from 2010-2015. They showed higher incidence of breast cancer (BC) when compared to either heterozygous and any P allele combination. Moreover, the increasing of TG and TL serum concentrations associated to SNP XbaI c454-351A>G on ESR1 gene is enhanced in both obese (higher BMI) and elder women. Taken together, these results suggested that XbaI c454-351A>G SNP is associated to changes in lipid profile, particularly in serum TG and TL, in this cohort of post-menopausal woman. Also, this paper shows another link between obesity and BC corroborating the current thesis that both diseases are interlinked.

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(®) (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(®) (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.

OBJETIVO: Este 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. MÉTODOS: Pacientes 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. RESULTADOS: Completaram 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. CONCLUSÃO: Mulheres 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.

Uso de risedronato na consolidação e formação do calo na fratura de Colles em mulheres na pós-menopausa - estudo solid / Use of risedronate for consolidation and callus formation in Colles fractures in postmenopausal women: solid study

OBJETIVO: Este estudo multicêntrico, randomizado, aberto, grupo paralelo avaliou a eficácia de Actonel(r) 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. MÉTODOS: Pacientes com fratura de Colles em sete dias foram aleatoriamente designadas para receber Actonel(r) 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. RESULTADOS: Completaram 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. CONCLUSÃO: Mulheres 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.

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.

Spontaneous supracondylar femoral fracture in an HIV patient in lotus position.

Bone disorders have been described in patients chronically infected with human immunodeficiency virus (HIV). A case of spontaneous supracondylar femoral fracture that occurred in a 58-year-old monk during meditation is reported. His AIDS disease was controlled with combination antiretroviral therapy. Vitamin D and calcium had been added 3yr before since osteoporosis was detected by dual-energy X-ray absorptiometry (DXA). At the time of the fracture, the patient was on treatment with 35mg every week of sodium risedronate, 1000mg of calcium, and 400IU of Vitamin D every day. Clinical use of DXA for HIV patients should be considered as a routine measure to help reducing risk for fractures.

Epidemiology of osteoporotic fractures in Brazil: what we have and what we need.

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.

Epidemiology of osteoporotic fractures in Brazil: what we have and what we need: [review] / Epidemiologia de fraturas pela osteoporose no Brasil: o que temos e o que precisamos: [revisão]

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 percent to 23.8 percent. 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 percent and 30 percent, 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 por cento a 23,8 por cento. 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 por cento a 30 por cento, 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.

[2008 official positions of the Brazilian Society for Clinical Densitometry--SBDens]. / Posições oficiais 2008 da Sociedade Brasileira de Densitometria Clínica (SBDens).

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 useful document to help the understanding and interpretation of bone densitometry and other methods of bone assessment.

Posições oficiais 2008 da Sociedade Brasileira de Densitometria Clínica (SBDens) / 2008 official positions of the Brazilian Society for Clinical Densitometry - SBDens

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.

Dual-Energy X-Ray Absorptiometry Technical issues: the 2007 ISCD Official Positions.

At the 2007 Position Development Conference, the Dual-Energy X-ray Absorptiometry Technical Task Force investigated three major areas of bone density testing. Although bone mineral density (BMD) testing in men had previously been reviewed at the 2005 Position Development Conference, we reviewed the most recent data in men to develop appropriate indications for bone density testing in men. We continue to recommend screening at age 70 and discuss the clinical risk factors that may be an appropriate indication for earlier BMD testing. Menopausal transition (perimenopause) was considered an important time to consider BMD evaluation because bone loss may be significant prior to menopause. However, because fracture risk is inherently low in women of this age without other risk factors, screening BMD testing is not appropriate. We discuss the risk factors that are strong indicators of fracture risk that may be increased during the menopause transition. The presence of these risk factors are appropriate indications for BMD testing with applicability of WHO diagnostic categorization. The issue of establishing a high threshold for BMD was investigated thoroughly and the current literature was reviewed. Despite the fact there is agreement that all BMD values greater than T-score -1.0 are not normal, it was felt that because of the paucity of sensitivity data and confounding factors such as high body mass index, an upper threshold could not be established or recommended at this time. This was felt to be an important area for further research.

Densitometria clínica: posições oficiais 2006 / Clinical densitometry: official positions 2006

Descrevemos as posições oficiais da Sociedade Brasileira de Densitometria Clínica (SBDens) para a realização e o relato do exame de densitometria óssea. Essas posições foram obtidas por consenso em encontro realizado em São Paulo no ano de 2006. A SBDens contou com o apoio de várias sociedades científicas descritas no texto.

We describe the official positions of the Brazilian Society for Clinical Densitometry (SBDens) for the performance and report of the bone mineral density testing. These positions were obtained by consensus in a meeting at São Paulo in 2006. SBDens positions were supported by other scientific societies described in the text.

Peripheral bone densitometry: Clinical applications.

Technologies for the measurement of bone mineral density and other parameters of bone strength at peripheral skeletal sites have been studied since the 1960s. Single-energy Photon Absorptiometry (SPA), Radiographic Absorptiometry (RA), Radiogrametry (RG), Single-energy X-ray Absorptiometry (SXA), Peripheral Dual-energy X-ray Absorptiometry (pDXA), and Quantitative Ultrasonometry (QUS) have been successively evaluated. These technologies and their clinical applications are discussed in this article. The available scientific evidence supports the clinical use of these technologies at peripheral skeletal for assessment of fracture risk. Peripheral measurements other than the 33% (one-third) radius by DXA cannot be used to diagnose osteoporosis according to current standards. Peripheral skeletal sites are not clinically useful for monitoring changes in BMD with natural evolution of the disease and its treatment. Peripheral BMD measurement can theoretically be used to screen patients for selection to central DXA testing, although device-specific cut-points should be developed before this is implemented. When central DXA testing is not available, peripheral BMD testing may be considered to identify individuals who might benefit from pharmacological intervention.

Peripheral bone densitometry: clinical applications / Densitometria periférica: aplicabilidade clínica e uso atual

Technologies for the measurement of bone mineral density and other parameters of bone strength at peripheral skeletal sites have been studied since the 1960s. Single-energy Photon Absorptiometry (SPA), Radiographic Absorptiometry (RA), Radiogrametry (RG), Single-energy X-ray Absorptiometry (SXA), Peripheral Dual-energy X-ray Absorptiometry (pDXA), and Quantitative Ultrasonometry (QUS) have been successively evaluated. These technologies and their clinical applications are discussed in this article. The available scientific evidence supports the clinical use of these technologies at peripheral skeletal for assessment of fracture risk. Peripheral measurements other than the 33 percent (one-third) radius by DXA cannot be used to diagnose osteoporosis according to current standards. Peripheral skeletal sites are not clinically useful for monitoring changes in BMD with natural evolution of the disease and its treatment. Peripheral BMD measurement can theoretically be used to screen patients for selection to central DXA testing, although device-specific cut-points should be developed before this is implemented. When central DXA testing is not available, peripheral BMD testing may be considered to identify individuals who might benefit from pharmacological intervention.

Tecnologias para medidas de densidade (DMO) e outros parâmetros determinantes da resistência óssea no esqueleto periférico vêm sendo estudados desde os anos 60. Absorciometria Fotônica de Energia Unica (SPA), Absorciometria Radiográfica (AR), Radiogrametria (RG), Absorciometria por Raios-X de Energia Unica (SXA), Absorciometria por Raios-X de Dupla Energia (pDXA), e Ultrassonometria Quantitativa (QUS) têm sido sucessivamente avaliados. Tais tecnologias e suas aplicabilidades clínicas são discutidas neste artigo. As evidências científicas disponíveis apóiam o emprego clínico dessas tecnologias em sítios esqueléticos periféricos para avaliação prognóstica do risco de fraturas. Medidas periféricas além do radio 33 por cento (um terço) medido por DXA não podem ser utilizadas para diagnóstico da osteoporose de acordo com os padrões atuais. Sítios esqueléticos não são úteis clinicamente para o monitoramento de mudanças na DMO com a evolução natural da doença e seu tratamento. Medidas de DMO periférica podem, teoricamente, ser utilizadas no rastreio de pacientes, para seleção daqueles que necessitem realizar exames DXA centrais, embora critérios de corte específicos para cada um desses equipamentos necessitem ainda ser desenvolvidos antes que isso seja incorporado à prática clínica. Em locais onde exames DXA centrais não sejam disponíveis, avaliações de DMO do esqueleto periférico podem ser consideradas para identificar indivíduos que poderão se beneficiar de intervenções farmacológicas.

Consenso brasileiro de osteoporose 2002 / Brazilian consensus on osteoporosis 2002

Objetivo: estabelecer diretrizes para o diagnóstico precoce, prevenção e tratamento da osteoporose. Métodos: representantes das diferentes especialidades que estudam e trabalham com os diferentes aspectos da osteoporose participaram deste consenso, no qual estabeleceram estas diretrizes baseados em uma revisão sistemática da literatura buscando evidências científicas consistentes. Os trabalhos foram selecionados pela sua metodologia, desenho, medidas adequadas e validade dos resultados contemplando procedimentos diagnósticos, preventivos e terapêuticos. Resultados: Após extensa discussão os participantes produziram um texto básico sujeito a correções posteriores, e revisões até a aprovação final