Disability prevalent conditions in women.

Women and men can have the same illnesses, but with different prevalence and reactions to symptoms. OBJECTIVE: This study aimed to emphasize that distinct traits between men and women require a different approach for each of them. METHODS: PubMed and Google Scholar were searched using the following terms: Disability Evaluations, Women's health, Osteoporosis, Osteoarthritis, and Lymphedema, Pregnancy. RESULTS/CONCLUSION: Disease management can go beyond the symptoms, assessing the long-term consequences and possibly the disabilities they can generate, compromising the quality of life of the person, his/her family members, and eventually caregivers.

Disability prevalent conditions in women

SUMMARY Women and men can have the same illnesses, but with different prevalence and reactions to symptoms. OBJECTIVE: This study aimed to emphasize that distinct traits between men and women require a different approach for each of them. METHODS: PubMed and Google Scholar were searched using the following terms: Disability Evaluations, Women's health, Osteoporosis, Osteoarthritis, and Lymphedema, Pregnancy. RESULTS/CONCLUSION: Disease management can go beyond the symptoms, assessing the long-term consequences and possibly the disabilities they can generate, compromising the quality of life of the person, his/her family members, and eventually caregivers.

A White Paper on Collagen Hydrolyzates and Ultrahydrolyzates: Potential Supplements to Support Joint Health in Osteoarthritis?

PURPOSE OF REVIEW: Osteoarthritis (OA) is the most common forms of arthritis in the general population, accounting for more pain and functional disability than any other musculoskeletal disease. There are currently no approved disease modifying drugs for OA. In the absence of effective pharmacotherapy, many patients with OA turn to nutritional supplements and nutraceuticals, including collagen derivatives. Collagen hydrolyzates and ultrahydrolyzates are terms used to describe collagens that have been broken down into small peptides and amino acids in the presence of collagenases and high pressure. RECENT FINDINGS: This article reviews the relevant literature and serves as a White Paper on collagen hydrolyzates and ultrahydrolyzates as emerging supplements often advertised to support joint health in OA. Collagen hydrolyzates have demonstrated some evidence of efficacy in a handful of small scale clinical trials, but their ability to treat and reverse advanced joint disease remains highly speculative, as is the case for other nutritional supplements. The aim of this White Paper is to stimulate research and development of collagen-based supplements for patients with OA and other musculoskeletal diseases at academic and industrial levels. This White Paper does not make any treatment recommendations for OA patients in the clinical context, but simply aims to highlight opportunities for scientific innovation and interdisciplinary collaboration, which are crucial for the development of novel products and nutritional interventions based on the best available and published evidence.

Self-Healing: A Concept for Musculoskeletal Body Pain Management - Scientific Evidence and Mode of Action.

Traditionally, musculoskeletal pain management has focused on the use of conventional treatments to relieve pain. However, multi-modal integrative medicine including alternative/complementary treatments is becoming more widely used and integrated into treatment guidelines around the world. The uptake of this approach varies according to country, with generally a higher uptake in developed countries and in females aged more than 40 years. Integral to the concept described here, is that the body has an innate ability to self-heal, which can be optimized by the use of integrative medical strategies. Stress triggers for acute or recurring musculoskeletal pain are diverse and can range from physical to psychological. The mechanism by which the body responds to triggers and initiates the self-healing processes is complex, but five body networks or processes are thought to be integral: the nervous system, microcirculation/vasodilation, immune modulation, muscular relaxation/contraction and psychological balance. Multi-modal integrative medicine approaches include nutritional/dietary modification, postural/muscular training exercises, and cognitive behavioral mind/body techniques. This article will review the self-healing concept and provide plausible scientific evidence where available.

Generating evidence and understanding the treatment of osteoarthritis in Brazil: a study through Delphi methodology.

OBJECTIVES: This study aimed to provide evidence for understanding how to treat osteoarthritis (OA) in our country. Therefore, it was necessary to match information and investigations related to the treatment of the disease from the three main types of specialists involved: physiatrists, orthopedists and rheumatologists. METHODS: The authors acted as a scientific advisory committee. From the initial discussions, a structured questionnaire was developed for use with a group of specialists on OA using the Delphi technique. The questionnaire was sent to 21 experts appointed by the authors, and the results obtained were critically analyzed and validated. RESULTS: The prevalence of OA was 33% in Brazil, corresponding to one-third of the individuals in the reference population, which included individuals over 25 years of age. Another significant finding was that most patients did not receive any form of treatment in the early stages of OA. CONCLUSION: The committee pointed to the need for early intervention and that the available medicinal resources can fulfil this important role, as is the case with SYSADOA treatments. Glucosamine-based medicinal products with or without chondroitin could also fulfill this need for early treatment. The other generated evidence and included investigations were then grouped together and are the subject of this publication.

PROFILE OF PATIENTS WITH OSTEOPOROTIC FRACTURES AND FACTORS THAT DECREASE PREVENTION.

OBJECTIVE: To evaluate the epidemiological profile of patients with osteoporotic fractures compared to patients with osteoarthritis (OA) and identify factors that diminish adherence to secondary prevention. METHODS: A total of 108 patients with osteoporotic fractures (OF) were compared to 86 patients with OA. RESULTS: Patients in the OF group were older (p < 0.001); had a lower body mass index (p < 0.001); were less literate (p = 0.012); were more frequently Caucasian (p = 0.003); were less frequently married (p < 0.001); experienced more falls, cognitive deficiency, previous fractures, old fracture, falls in the last year, and fall fractures; needed more help and took more medicine for osteoporosis (p < 0.05); and showed less pathology in the feet, muscle weakness, less vitamin D intake, and lower Katz & Lawton scores (p < 0.001). Factors that increased the chance of nonadherence included older age (p = 0.020), falls (p = 0.035), cognitive deficiency (p = 0.044), and presence of depression/apathy/confusion (p < 0.001). CONCLUSION: Patient age, ethnicity, marital status, previous falls, foot pathologies, muscle weakness, previous fractures, use of vitamin D, use of osteoporosis drugs, and lower Katz & Lawton scale score defined the OF group. Factors that increased the chance of nonadherence included older age, sedative use, cognitive disorders, and symptoms of depression/apathy/confusion. Level of Evidence III, Case-control.

OBJETIVO: Avaliar o perfil epidemiológico de pacientes com fraturas osteoporóticas, comparando com pacientes com osteoartrite (OA) e identificar fatores que diminuam aderência à prevenção secundária. MÉTODOS: 108 pacientes com FO foram comparados a 86 pacientes com OA. RESULTADOS: Grupo FO era mais velho (p< 0,001), com menor IMC (p<0,001), menos alfabetizado (p = 0,012), com maior frequência de brancos (p = 0,003), menor frequência de casados (p< 0,001). Apresentaram mais quedas, deficiência cognitiva, fraturas prévias, fratura antiga, queda no último ano, fraturas por queda. Necessitam de mais auxílio e tomam mais medicamento para osteoporose (p< 0,05); apresentaram menos patologia nos pés, fraqueza muscular. Tomam menos vitamina D e menor Katz & Lawton (p<0,001). Tem aumento da chance de não aderência: maior idade (p = 0,020), sedativo (p = 0,020), quedas (p = 0,035), deficiência cognitiva (p = 0,044) e presença de depressão/apatia/confusão (p< 0,001). CONCLUSÃO: Idade do paciente, etnia, estado civil, quedas prévias, patologias nos pés, fraqueza muscular, fraturas prévias, uso de vitamina D, uso de medicamentos para osteoporose e a escala Katz & Lawton definem o grupo FO. Aumentam a chance de não aderência: maior idade, sedativos, distúrbios cognitivos e sintomas de depressão/apatia/confusão. Nível de Evidência III, Estudo de caso controle.

Profile of patients with osteoporotic fractures and factors that decrease prevention / Perfil de pacientes com fraturas osteoporóticas e fatoresque diminuem aderência à prevenção

ABSTRACT Objective: To evaluate the epidemiological profile of patients with osteoporotic fractures compared to patients with osteoarthritis (OA) and identify factors that diminish adherence to secondary prevention. Methods: A total of 108 patients with osteoporotic fractures (OF) were compared to 86 patients with OA. Results: Patients in the OF group were older (p < 0.001); had a lower body mass index (p < 0.001); were less literate (p = 0.012); were more frequently Caucasian (p = 0.003); were less frequently married (p < 0.001); experienced more falls, cognitive deficiency, previous fractures, old fracture, falls in the last year, and fall fractures; needed more help and took more medicine for osteoporosis (p < 0.05); and showed less pathology in the feet, muscle weakness, less vitamin D intake, and lower Katz & Lawton scores (p < 0.001). Factors that increased the chance of nonadherence included older age (p = 0.020), falls (p = 0.035), cognitive deficiency (p = 0.044), and presence of depression/apathy/confusion (p < 0.001). Conclusion: Patient age, ethnicity, marital status, previous falls, foot pathologies, muscle weakness, previous fractures, use of vitamin D, use of osteoporosis drugs, and lower Katz & Lawton scale score defined the OF group. Factors that increased the chance of nonadherence included older age, sedative use, cognitive disorders, and symptoms of depression/apathy/confusion. Level of Evidence III, Case-control.

RESUMO Objetivo: Avaliar o perfil epidemiológico de pacientes com fraturas osteoporóticas, comparando com pacientes com osteoartrite (OA) e identificar fatores que diminuam aderência à prevenção secundária. Métodos: 108 pacientes com FO foram comparados a 86 pacientes com OA. Resultados: Grupo FO era mais velho (p< 0,001), com menor IMC (p<0,001), menos alfabetizado (p = 0,012), com maior frequência de brancos (p = 0,003), menor frequência de casados (p< 0,001). Apresentaram mais quedas, deficiência cognitiva, fraturas prévias, fratura antiga, queda no último ano, fraturas por queda. Necessitam de mais auxílio e tomam mais medicamento para osteoporose (p< 0,05); apresentaram menos patologia nos pés, fraqueza muscular. Tomam menos vitamina D e menor Katz & Lawton (p<0,001). Tem aumento da chance de não aderência: maior idade (p = 0,020), sedativo (p = 0,020), quedas (p = 0,035), deficiência cognitiva (p = 0,044) e presença de depressão/apatia/confusão (p< 0,001). Conclusão: Idade do paciente, etnia, estado civil, quedas prévias, patologias nos pés, fraqueza muscular, fraturas prévias, uso de vitamina D, uso de medicamentos para osteoporose e a escala Katz & Lawton definem o grupo FO. Aumentam a chance de não aderência: maior idade, sedativos, distúrbios cognitivos e sintomas de depressão/apatia/confusão. Nível de Evidência III, Estudo de caso controle.

Generating evidence and understanding the treatment of osteoarthritis in Brazil: a study through Delphi methodology

OBJECTIVES: This study aimed to provide evidence for understanding how to treat osteoarthritis (OA) in our country. Therefore, it was necessary to match information and investigations related to the treatment of the disease from the three main types of specialists involved: physiatrists, orthopedists and rheumatologists. METHODS: The authors acted as a scientific advisory committee. From the initial discussions, a structured questionnaire was developed for use with a group of specialists on OA using the Delphi technique. The questionnaire was sent to 21 experts appointed by the authors, and the results obtained were critically analyzed and validated. RESULTS: The prevalence of OA was 33% in Brazil, corresponding to one-third of the individuals in the reference population, which included individuals over 25 years of age. Another significant finding was that most patients did not receive any form of treatment in the early stages of OA. CONCLUSION: The committee pointed to the need for early intervention and that the available medicinal resources can fulfil this important role, as is the case with SYSADOA treatments. Glucosamine-based medicinal products with or without chondroitin could also fulfill this need for early treatment. The other generated evidence and included investigations were then grouped together and are the subject of this publication.

PROFILE OF PATIENTS WITH OSTEOPOROTIC FRACTURES AT A TERTIARY ORTHOPEDIC TRAUMA CENTER.

OBJECTIVE: To evaluate the profile of patients with osteoporotic fractures treated at a tertiary orthopedic hospital. METHODS: Using questionnaires, 70 patients with osteoporotic fractures (OF) were compared with 50 outpatients with multiple osteoarthritis (OA) followed through an outpatient clinic. RESULTS: The OF group was older (p <0.001), less heavy (p=0.003), had lower BMI (p=0.006), was more likely to be white (p=0.011), was less likely to be married (p=0.008), and had previous falls, previous fractures, old fractures (>1 year), falls in the last 12 months, fractures due to falls, and needed more assistance (p<0.05). They also had lower Lawton & Brody Instrumental Activities of Daily Living scores (p <0.05) and reported less lower limb disability, foot pathology, muscle weakness, hypothyroidism, and vitamin D intake than patients in the OA group. White race, previous falls, and previous fractures increase the risk of osteoporotic fractures by 10.5, 11.4, and 4.1 times, respectively. The chance of fracture dropped 29% for each one-unit increase in Lawton & Brody IADL score. Married participants had fewer fractures than participants with other marital status. CONCLUSION: Together, race, marital status, previous falls, foot pathologies, previous fractures, and IADL scores define the profile of patients with osteoporotic fractures. Level of Evidence III; Case control study.

OBJETIVO: Avaliar o perfil dos pacientes com fraturas osteoporóticas atendidos em hospital de atendimento terciário ortopédico. MÉTODOS: Setenta pacientes com fraturas osteoporóticas (FO) foram comparados a 50 pacientes com acompanhamento ambulatorial de osteoartrite (OA) por meio de questionários. RESULTADOS: O grupo FO apresentou média de idade maior (p < 0,001), menor peso (p = 0,003), menor IMC (p = 0,006), maior frequência de pacientes brancos (p = 0,011), menor frequência de casados (p = 0,008), mais quedas prévias, fraturas prévias, fratura antiga (> 1 ano), queda nos últimos 12 meses, fratura por causa da queda e necessitam de mais auxílio (p < 0,05); menor Lawton e Brody AIVD (Atividades instrumentais da vida diária, p < 0,05), reportando menos deficiência de membros inferiores, patologia nos pés, fraqueza muscular, hipotireoidismo e consumo de vitamina D do que pacientes do grupo OA. Raça branca, quedas e fraturas prévias aumentam o risco de fraturas osteoporóticas em 10,5, 11,4 e 4,1 vezes respectivamente. A chance de fratura foi reduzida em 29% a cada aumento de uma unidade no Lawton e Brody AIVD. Casados fraturam menos que outros estados civis. CONCLUSÃO: Conjuntamente, a raça, estado civil, quedas prévias, patologias nos pés, fraturas prévias e AIVD definem o perfil dos pacientes com fraturas osteoporóticas deste centro. Nível de Evidência III; Estudo de caso-controle.

Profile of patients with osteoporotic fractures at a tertiary orthopedic trauma center / Perfil de pacientes com fraturas osteoporóticas num centro terciário de trauma ortopédico

ABSTRACT Objective: To evaluate the profile of patients with osteoporotic fractures treated at a tertiary orthopedic hospital. Methods: Using questionnaires, 70 patients with osteoporotic fractures (OF) were compared with 50 outpatients with multiple osteoarthritis (OA) followed through an outpatient clinic. Results: The OF group was older (p <0.001), less heavy (p=0.003), had lower BMI (p=0.006), was more likely to be white (p=0.011), was less likely to be married (p=0.008), and had previous falls, previous fractures, old fractures (>1 year), falls in the last 12 months, fractures due to falls, and needed more assistance (p<0.05). They also had lower Lawton & Brody Instrumental Activities of Daily Living scores (p <0.05) and reported less lower limb disability, foot pathology, muscle weakness, hypothyroidism, and vitamin D intake than patients in the OA group. White race, previous falls, and previous fractures increase the risk of osteoporotic fractures by 10.5, 11.4, and 4.1 times, respectively. The chance of fracture dropped 29% for each one-unit increase in Lawton & Brody IADL score. Married participants had fewer fractures than participants with other marital status. Conclusion: Together, race, marital status, previous falls, foot pathologies, previous fractures, and IADL scores define the profile of patients with osteoporotic fractures. Level of Evidence III; Case control study.

RESUMO Objetivo: Avaliar o perfil dos pacientes com fraturas osteoporóticas atendidos em hospital de atendimento terciário ortopédico. Métodos: Setenta pacientes com fraturas osteoporóticas (FO) foram comparados a 50 pacientes com acompanhamento ambulatorial de osteoartrite (OA) por meio de questionários. Resultados: O grupo FO apresentou média de idade maior (p < 0,001), menor peso (p = 0,003), menor IMC (p = 0,006), maior frequência de pacientes brancos (p = 0,011), menor frequência de casados (p = 0,008), mais quedas prévias, fraturas prévias, fratura antiga (> 1 ano), queda nos últimos 12 meses, fratura por causa da queda e necessitam de mais auxílio (p < 0,05); menor Lawton e Brody AIVD (Atividades instrumentais da vida diária, p < 0,05), reportando menos deficiência de membros inferiores, patologia nos pés, fraqueza muscular, hipotireoidismo e consumo de vitamina D do que pacientes do grupo OA. Raça branca, quedas e fraturas prévias aumentam o risco de fraturas osteoporóticas em 10,5, 11,4 e 4,1 vezes respectivamente. A chance de fratura foi reduzida em 29% a cada aumento de uma unidade no Lawton e Brody AIVD. Casados fraturam menos que outros estados civis. Conclusão: Conjuntamente, a raça, estado civil, quedas prévias, patologias nos pés, fraturas prévias e AIVD definem o perfil dos pacientes com fraturas osteoporóticas deste centro. Nível de Evidência III; Estudo de caso-controle.

Double-blind, randomized, double-dummy clinical trial comparing the efficacy of ketorolac trometamol and naproxen for acute low back pain.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common type of medication used in the treatment of acute pain. Ketorolac trometamol (KT) is a nonnarcotic, peripherally acting nonsteroidal anti-inflammatory drug with analgesic effects comparable to certain opioids. OBJECTIVE: The aim of this study was to compare the efficacy of KT and naproxen (NA) in the treatment of acute low back pain (LBP) of moderate-to-severe intensity. PATIENTS AND METHODS: In this 10-day, Phase III, randomized, double-blind, double-dummy, noninferiority trial, participants with acute LBP of moderate-to-severe intensity as determined through a visual analog scale (VAS) were randomly assigned in a 1:1 ratio to receive sublingual KT 10 mg three times daily or oral NA 250 mg three times daily. From the second to the fifth day of treatment, if patient had VAS >40 mm, increased dosage to four times per day was allowed. The primary end point was the reduction in LBP as measured by VAS. We also performed a post hoc superiority analysis. RESULTS: KT was not inferior to NA for the reduction in LBP over 5 days of use as measured by VAS scores (P=0.608 for equality of variance; P=0.321 for equality of means) and by the Roland-Morris Disability Questionnaire (P=0.180 for equality of variance test; P=0.446 for equality of means) using 95% confidence intervals. The percentage of participants with improved pain relief 60 minutes after receiving the first dose was higher in the KT group (24.2%) than in the NA group (6.5%; P=0.049). The most common adverse effects were heartburn, nausea, and vomiting. CONCLUSION: KT is not inferior in efficacy and delivers faster pain relief than NA.

Prevalence of osteoporosis in patients awaiting total hip arthroplasty.

OBJECTIVE: To evaluate the prevalence of osteoporosis in patients awaiting total hip arthroplasty. METHOD: Twenty-nine patients diagnosed with hip osteoarthritis awaiting primary total arthroplasty of the hip answered WOMAC questionnaire, VAS and questions about habits, osteoporosis and related diseases. Bone mineral densitometry of the lumbar spine and hips and laboratory tests (complete blood count and examination of calcium metabolism) were performed. Weight and height were measured to calculate body mass index (BMI). The evaluated quantitative characteristics were compared between patients with and without osteoporosis using the Mann-Whitney tests. RESULTS: Thirteen men and 16 women with a mean age of 61.5 years old, WOMAC 51.4; EVA 6.4 and BMI 27.6 were evaluated. The prevalence of osteoporosis was 20.7%, and 37.9% had osteopenia. Patients with osteoporosis were older than patients without osteoporosis (p=0.006). The mean bone mineral density of the femoral neck without hip osteoarthritis was lower than the affected side (p=0.007). Thirty-five percent of patients did not know what osteoporosis is. Of these, 30% had osteopenia or osteoporosis. CONCLUSION: osteoarthritis and osteoporosis may coexist and the population waiting for total hip arthroplasty should be considered at risk for the presence of osteoporosis. Level of Evidence III, Observational Study.

Influência do tratamento por ondas de choque sobre a dor em mulheres portadoras de osteoartrite de joelho / Influence of shockwave therapy on pain in women with knee osteoarthritis

A osteoartrite é a doença articular mais comum causando dores em seus portadores. Diversos tratamentos podem ser usados, dentre eles o de ondas de choque. Objetivo: Observar a influência do tratamento por ondas de choque na intensidade da dor em mulheres idosas com AO de joelho. Método: Participaram do estudo, 40 idosas (69,57 ± 6,42 anos) submetidos a tratamento semanalmente por ondas de choque com 2000 impulsos à de 2,5 a 4,0 bar, na frequência de 8Hz, no local mais doloroso à palpação da interlinha articular medial do joelho, durante três semanas consecutivas. O efeito da aplicação sobre a dor foi avaliado pela escala visual analógica antes e depois do tratamento. Resultados: Houve diminuição significante (p < 0,0001) da intensidade da dor das voluntárias, passando de 7,86 ± 1,07 cm para 5,32 ± 2,26 cm. Conclusão: A aplicação de ondas de choque mostrou-se benéfica para redução da dor em idosas portadoras de osteoatrite

Osteoarthritis is the most common articular disease that causes pain to its sufferers. Shockwave therapy is among the many treatments that can be used. Objective: The objective of this study was to observe the influence of shockwave therapy on the intensity of pain in elderly women with knee OA. Method: In this study, 40 elderly females (69.57 ± 6.42 years) were submitted to weekly shockwave therapy with 2000 impulses at 2.5 to 4.0 bar, at a frequency of 8Hz, at the location most painful to touch in the knee, the medial articular interline, for three consecutive weeks. The effect of its application on the pain was evaluated by the visual analogue scale before and after the treatment. Results: There was a significant reduction (p < 0.0001) of pain intensity in the volunteers, going from 7.86 ± 1.07 cm to 5.32 ± 2.26 cm. Conclusion: The application of shockwave therapy has been shown to reduce pain in elderly females with osteoarthritis

Prevalence of osteoporosis in patients awaiting total hip arthroplasty

Objective: To evaluate the prevalence of osteoporosis in patients awaiting total hip arthroplasty. Method: Twenty-nine patients diagnosed with hip osteoarthritis awaiting primary total arthroplasty of the hip answered WOMAC questionnaire, VAS and questions about habits, osteoporosis and related diseases. Bone mineral densitometry of the lumbar spine and hips and laboratory tests (complete blood count and examination of calcium metabolism) were performed. Weight and height were measured to calculate body mass index (BMI). The evaluated quantitative characteristics were compared between patients with and without osteoporosis using the Mann-Whitney tests. Results: Thirteen men and 16 women with a mean age of 61.5 years old, WOMAC 51.4; EVA 6.4 and BMI 27.6 were evaluated. The prevalence of osteoporosis was 20.7%, and 37.9% had osteopenia. Patients with osteoporosis were older than patients without osteoporosis (p=0.006). The mean bone mineral density of the femoral neck without hip osteoarthritis was lower than the affected side (p=0.007). Thirty-five percent of patients did not know what osteoporosis is. Of these, 30% had osteopenia or osteoporosis. Conclusion: osteoarthritis and osteoporosis may coexist and the population waiting for total hip arthroplasty should be considered at risk for the presence of osteoporosis. Level of Evidence III, Observational Study.

Evaluation of the association between osteoporosis and postural balance in postmenopausal women.

The incidence of osteoporosis has been increasing, as have fractures resulting from falls. Postural balance was evaluated in postmenopausal women with and without lumbar osteoporosis. One hundred and twenty-six postmenopausal women aged 55-65 years were evaluated and separated into two groups according to the bone mineral density values of their lumbar spine: the osteoporosis group and the control group, paired by age (P = 0.219) and physical activity (P = 0.611). There was no difference between the groups (P = 0.139) regarding falls reported in the previous 12 months. Functional mobility was evaluated through the Timed Up and Go Test. Postural balance was evaluated using a portable force platform in standard standing position, with eyes open and closed, for 60s. Muscle strength was evaluated through an isokinetic dynamometer. This study shows that there is no difference in knee muscle strength and functional mobility (P = 0.121), postural balance with eyes open [mediolateral displacement (P = 0.286) and mean velocity of the center of pressure (COP) (P = 0.173)] and with eyes closed [mediolateral displacement (P = 0.163), and the mean velocity of displacement of the COP (P = 0.09)] in both groups. Subjects reporting falls had greater mediolateral displacement (P = 0.028) in both groups. Postmenopausal women aged between 55 and 65 years do not present changes in postural balance irrespective of lumbar osteoporosis. Greater COP mediolateral displacement is related to the occurrence of falls in postmenopausal women in the previous year.

Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis.

Glucocorticoids (GC) are used in almost all medical specialties, and approximately 0.5% of the general population of the United Kingdom receives those medications. With the increased survival of patients with rheumatological diseases, morbidity secondary to the use of those medications represents an important aspect of the management of our patients. The incidences of vertebral and non-vertebral fractures are elevated, ranging from 30% to 50% of the individuals on GC for over three months. Thus, osteoporosis and frailty fractures should be prevented and treated in all patients initiating or already on GC. There are several recommendations on this topic elaborated by several international societies, but consensus still lacks. Recently, the American College of Rheumatology has published new recommendations, but they are based on the WHO Fracture Risk Assessment Tool (FRAX®) to evaluate the risk for each individual, and, thus, cannot be completely used for the Brazilian population. Thus, the Committee for Osteoporosis and Bone Metabolic Disorders of the Brazilian Society of Rheumatology, along with the Brazilian Medical Association and the Brazilian Association of Physical Medicine and Rehabilitation, has elaborated the Brazilian Guidelines for Glucocorticoid-Induced Osteoporosis (GIO), based on the better available scientific evidence and/or expert experience. METHOD OF EVIDENCE COLLECTION: The bibliographic review of scientific articles of this guideline was performed in the MEDLINE database. The search for evidence was based on real clinical scenarios, and used the following keywords (MeSH terms): Osteoporosis, Osteoporosis/ chemically induced*= (Glucocorticoids= Adrenal Cortex Hormones, Steroids), Glucocorticoids, Glucocorticoids/administration and dosage, Glucocorticoids/therapeutic use, Glucocorticoids/adverse effects, Prednisone/adverse effects, Dose-Response Relationship, Drug, Bone Density/drug effects, Bone Density Conservation Agents/pharmacological action, Osteoporosis/prevention & control, Calcium, Vitamin D, Vitamin D deficiency, Calcitriol, Receptors, Calcitriol; 1-hydroxycholecalciferol, Hydroxycholecalciferols, 25-Hydroxyvitamin D3 1-alpha-hydroxylase OR Steroid Hydroxylases, Prevention and Control, Spinal fractures/prevention & control, Fractures, Spontaneous, Lumbar Vertebrae/injuries, Lifestyle, Alcohol Drinking, Smoking OR tobacco use disorder, Movement, Resistance Training, Exercise Therapy, Bone density OR Bone and Bones, Dual-Energy X-Ray Absorptiometry OR Absorptiometry Photon OR DXA, Densitometry, Radiography, (Diphosphonates Alendronate OR Risedronate Pamidronate OR propanolamines OR Ibandronate OR Zoledronic acid, Teriparatide OR PTH 1-34, Men AND premenopause, pregnancy, pregnancy outcome maternal, fetus, lactation, breast-feeding, teratogens, Children (6-12 years), adolescence (13-18 years). GRADE OF RECOMMENDATION AND LEVEL OF EVIDENCE: A) Data derived from more consistent experimental and observational studies; B) Data derived from less consistent experimental and observational studies; C) Case reports (uncontrolled studies); D) Expert opinion without explicit critical appraisal, or based on consensus, physiological studies or animal models. OBJECTIVE: To establish guidelines for the prevention and treatment of GIO.

Diretrizes para prevenção e tratamento da osteoporose induzida por glicocorticoide / Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis

Os glicocorticoides (GC) são prescritos por praticamente todas as especialidades médicas, e cerca de 0,5% da população geral do Reino Unido utiliza esses medicamentos. Com o aumento da sobrevida dos pacientes com doenças reumatológicas, a morbidade secundária ao uso dessa medicação representa um aspecto importante que deve ser considerado no manejo de nossos pacientes. As incidências de fraturas vertebrais e não vertebrais são elevadas, variando de 30%-50% em pessoas que usam GC por mais de três meses. Assim, a osteoporose e as fraturas por fragilidade devem ser prevenidas e tratadas em todos os pacientes que iniciarão ou que já estejam em uso desses esteroides. Diversas recomendações elaboradas por várias sociedades internacionais têm sido descritas na literatura, porém não há consenso entre elas. Recentemente, o Americam College of Rheumatology publicou novas recomendações, porém elas são fundamentadas na FRAX (WHO Fracture Risk Assessment Tool) para analisar o risco de cada indivíduo e, dessa maneira, não podem ser completamente utilizadas pela população brasileira. Dessa forma, a Comissão de Osteoporose e Doenças Osteometabólicas da Sociedade Brasileira de Reumatologia, em conjunto com a Associação Médica Brasileira e a Associação Brasileira de Medicina Física e Reabilitação, implementou as diretrizes brasileiras de osteoporose induzida por glicocorticoide (OPIG), baseando-se na melhor evidência científica disponível e/ou experiência de experts. DESCRIÇÃO DO MÉTODO DE COLETA DE EVIDÊNCIA: A revisão bibliográfica de artigos científicos desta diretriz foi realizada na base de dados MEDLINE. A busca de evidência partiu de cenários clínicos reais, e utilizou as seguintes palavras-chave (MeSH terms): Osteoporosis, Osteoporosis/chemically induced*= (Glucocorticoids= Adrenal Cortex Hormones, Steroids), Glucocorticoids, Glucocorticoids/administration and dosage, Glucocorticoids/therapeutic use, Glucocorticoids/adverse effects, Prednisone/adverse effects, Dose-Response Relationship, Drug, Bone Density/drug effects, Bone Density Conservation Agents/pharmacological action, Osteoporosis/ prevention&control, Calcium, Vitamin D, Vitamin D deficiency, Calcitriol, Receptors, Calcitriol; 1-hydroxycholecalciferol, Hydroxycholecalciferols, 25-Hydroxyvitamin D3 1-alpha-hydroxylase OR Steroid Hydroxylases, Prevention and Control, Spinal fractures/prevention & control, Fractures, Spontaneous, Lumbar Vertebrae/injuries, Lifestyle, Alcohol Drinking, Smoking OR tobacco use disorder, Movement, Resistance Training, Exercise Therapy, Bone density OR Bone and Bones, Dual-Energy X-Ray Absorptiometry OR Absorptiometry Photon OR DXA, Densitometry, Radiography, (Diphosphonates Alendronate OR Risedronate Pamidronate OR propanolamines OR Ibandronate OR Zoledronic acid, Teriparatide OR PTH 1-34, Men AND premenopause, pregnancy, pregnancy outcome maternal, fetus, lactation, breast-feeding, teratogens, Children (6-12 anos), adolescence (13-18 anos). GRAU DE RECOMENDAÇÃO E FORÇA DE EVIDÊNCIA: A) Estudos experimentais e observacionais de melhor consistência; B) Estudos experimentais e observacionais de menor consistência; C) Relatos de casos (estudos não controlados); D) Opinião desprovida de avaliação crítica, com base em consensos, estudos fisiológicos ou modelos animais. OBJETIVO: Estabelecer as diretrizes para a prevenção e o tratamento da OPIG.

Glucocorticoids (GC) are used in almost all medical specialties, and approximately 0.5% of the general population of the United Kingdom receives those medications. With the increased survival of patients with rheumatological diseases, morbidity secondary to the use of those medications represents an important aspect of the management of our patients. The incidences of vertebral and non-vertebral fractures are elevated, ranging from 30% to 50% of the individuals on GC for over three months. Thus, osteoporosis and frailty fractures should be prevented and treated in all patients initiating or already on GC. There are several recommendations on this topic elaborated by several international societies, but consensus still lacks. Recently, the American College of Rheumatology has published new recommendations, but they are based on the WHO Fracture Risk Assessment Tool (FRAX®) to evaluate the risk for each individual, and, thus, cannot be completely used for the Brazilian population. Thus, the Committee for Osteoporosis and Bone Metabolic Disorders of the Brazilian Society of Rheumatology, along with the Brazilian Medical Association and the Brazilian Association of Physical Medicine and Rehabilitation, has elaborated the Brazilian Guidelines for Glucocorticoid-Induced Osteoporosis (GIO), based on the better available scientific evidence and/or expert experience. METHOD OF EVIDENCE COLLECTION: The bibliographic review of scientific articles of this guideline was performed in the MEDLINE database. The search for evidence was based on real clinical scenarios, and used the following keywords (MeSH terms): Osteoporosis, Osteoporosis/ chemically induced*= (Glucocorticoids= Adrenal Cortex Hormones, Steroids), Glucocorticoids, Glucocorticoids/administration and dosage, Glucocorticoids/therapeutic use, Glucocorticoids/adverse effects, Prednisone/adverse effects, Dose-Response Relationship, Drug, Bone Density/drug effects, Bone Density Conservation Agents/pharmacological action, Osteoporosis/prevention & control, Calcium, Vitamin D, Vitamin D deficiency, Calcitriol, Receptors, Calcitriol; 1-hydroxycholecalciferol, Hydroxycholecalciferols, 25-Hydroxyvitamin D3 1-alpha-hydroxylase OR Steroid Hydroxylases, Prevention and Control, Spinal fractures/prevention & control, Fractures, Spontaneous, Lumbar Vertebrae/injuries, Lifestyle, Alcohol Drinking, Smoking OR tobacco use disorder, Movement, Resistance Training, Exercise Therapy, Bone density OR Bone and Bones, Dual-Energy X-Ray Absorptiometry OR Absorptiometry Photon OR DXA, Densitometry, Radiography, (Diphosphonates Alendronate OR Risedronate Pamidronate OR propanolamines OR Ibandronate OR Zoledronic acid, Teriparatide OR PTH 1-34, Men AND premenopause, pregnancy, pregnancy outcome maternal, fetus, lactation, breast-feeding, teratogens, Children (6-12 years), adolescence (13-18 years). GRADE OF RECOMMENDATION AND LEVEL OF EVIDENCE: A) Data derived from more consistent experimental and observational studies; B) Data derived from less consistent experimental and observational studies; C) Case reports (uncontrolled studies); D) Expert opinion without explicit critical appraisal, or based on consensus, physiological studies or animal models. OBJECTIVE: To establish guidelines for the prevention and treatment of GIO.

Osteopenia and osteoporosis in people living with HIV: multiprofessional approach.

Increasing bone mineralization abnormalities observed among people living with HIV (PLWHIV) result from various factors relating to the host, the virus, and the antiretrovirals used. Today, HIV infection is considered to be a risk factor for bone mineralization disorders. The test most recommended for diagnosing osteoporosis is measurement of bone mineral density by means of dual energy X-ray absorptiometry at two sites. Osteoporosis treatment has the aims of bone mass improvement and fracture control. A combination of calcium and vitamin D supplementation may reduce the risk of fractures. Antiresorptive drugs act by blocking osteoclastic activity and reducing bone remodeling. On the other hand, bone-forming drugs stimulate osteoblastogenesis, thereby stimulating the formation of bone matrix. Mixed-action medications are those that are capable of both stimulating bone formation and inhibiting reabsorption. Antiresorptive drugs form the group of medications with the greatest quantity of scientific evidence confirming their efficacy in osteoporosis treatment. Physical activity is a health promotion strategy for the general population, but only preliminary data on its real value and benefit among PLWHIV are available, especially in relation to osteoporosis.