RESUMO
ABSTRACT Several drugs are available for the treatment of osteoporosis in postmenopausal women. Over the last decades, most patients requiring pharmacological intervention were offered antiresorptive drugs as first-line therapy, while anabolic agents were considered a last resource for those with therapeutic failure. However, recent randomized trials in patients with severe osteoporosis have shown that anabolic agents reduce fractures to a greater extent than antiresorptive medications. Additionally, evidence indicates that increases in bone mineral density (BMD) are maximized when patients are treated with anabolic agents first, followed by antiresorptive therapy. This evidence is key, considering that greater increases in BMD during osteoporosis treatment are associated with a more pronounced reduction in fracture risk. Thus, international guidelines have recently proposed an individualized approach to osteoporosis treatment based on fracture risk stratification, in which the stratification risk has been refined to include a category of patients at very high risk of fracture who should be managed with anabolic agents as first-line therapy. In this document, the Brazilian Society of Endocrinology and Metabolism and the Brazilian Association of Bone Assessment and Metabolism propose the definition of very high risk of osteoporotic fracture in postmenopausal women, for whom anabolic agents should be considered as first-line therapy. This document also reviews the factors associated with increased fracture risk, trials comparing anabolic versus antiresorptive agents, efficacy of anabolic agents in patients who are treatment naïve versus those previously treated with antiresorptive agents, and safety of anabolic agents.
RESUMO
The aim of this study was to compare metabolic aspects potentially associated with metabolic syndrome (MetS), in addition to serum leptin levels and sleep, according to exposure to night work among nursing staff. A cross-sectional study involving 60 nursing staff was conducted. Sociodemographic, sleep (Karolinska Sleep Questionnaire), physical activity (International Physical Activity Questionnaire), and nutrition data (16-Food Intake Questionnaire) were collected. Body measurements and blood pressure were taken and blood collected to determine glycemia, total cholesterol and portions of low-density lipoprotein and high-density lipoprotein and triglycerides, and leptin levels. The sample was divided into three groups according to exposure to night work (nonexposed, currently exposed, past exposure). Furthermore, to evaluate the relationship between exposure time and prevalence of MetS, the night-exposed groups (past and current) were divided according to time exposed to night shifts (<10 years and ≥10 years). Mean age of participants was 39.8 ± 10.5 years. The groups were homogenous with regard to sociodemographic characteristics, physical activity, dietary patterns, and health aspects. The prevalence of MetS in the population studied was 32%, above the rate for the general population. However, there were no significant differences among the groups. In addition, a higher proportion of participants with hypertriglyceridemia and diastolic arterial hypertension was observed in the currently exposed group. The currently exposed group also reported less sleep and higher sleep debt than the other groups on workdays. Although no differences were observed among the groups regarding MetS, the currently exposed group had more sleep disturbances than the others, and a higher prevalence of two out of three risk factors for the MetS diagnosis.