The association between low lean mass and osteoporosis increases the risk of weakness, poor physical performance and frailty in Brazilian older adults: data from SARCOS study.

PURPOSE: To characterize the phenotypes of older adults with low lean mass and osteoporosis, concomitantly or isolated, in regards to poor physical performance and frailty status. DESIGN: Cross-sectional analysis of the SARCopenia and OSteoporosis in Older Adults with Cardiovascular Diseases Study (SARCOS). SETTING: Outpatient geriatric cardiology clinic. PARTICIPANTS AND METHOD: 385 older adults underwent DXA analysis. Low lean mass was diagnosed according to FNIH and low BMD by a T-score ≤ -2.5 SD. Subjects were grouped into: I-Low lean mass and Osteoporosis (LLMO); II-Low lean mass (LLM); III-Osteoporosis (OP), and IV-Controls. Poor physical performance was diagnosed by weakness or slow walking speed or impaired mobility. Frailty was diagnosed by CHS criteria. RESULTS: The mean age was 78.22 ± 7.16 years. The prevalence of LLMO, LLM, and OP were 14.8%, 39.5%, and 19.2%, respectively. LLMO subjects were older, predominantly women, with a high percentage of body fat (HTBF). LLM was represented by obese men, while individuals with OP were preferably women, older and leaner. In a regression analyses, LLMO presented an OR: 6.42 (2.63‒15.65; p < 0.001) for weakness, OR: 2.55 (1.09‒5.95; p = 0.030) for impaired mobility, and OR: 14.75 (2.72‒79.94; p = 0.002) for frailty. After adjusting for HTBF, the OR for frailty, decreased to 7.25 (1.11-47.21; p = 0.038). LLM and OP were associated only with weakness with an OR: 3.06 (1.36-6.84; p = 0.006) and OR: 3.14 (1.29-7.62; p = 0.011), respectively. CONCLUSION: In Brazilian older community-dwelling outpatient adults, the phenotype characterized by low lean mass and osteoporosis presents a higher association with impaired mobility, weakness and frailty status compared to the others phenotyeps and controls. A high percentage of body fat presents a synergistic effect with low lean mass and osteoporosis phenotype in regards to frailty.

Terapia gênica em ortopedia / Genetic therapy in orthopaedics

A terapia gênica representa um método recente de tratamento de lesões relacionadas à ortopedia. Embora os estudos publicados na literatura se refiram a pesquisa em animais, eles se concentram na busca de melhora da cicatrização dos tecidos, como cartilagem, ligamentos, tendões ou músculos. Estudos clínicos, bem-sucedidos, já foram publicados compreendendo pacientes com artrite reumatóide. A terapia gênica envolvendo a ortopedia baseia-se na transferência de genes a uma célula-alvo, permitindo que esta codifique proteínas (fatores de crescimento) que atuem em tecidos específicos por tempo superior ao que seria obtido pela injeção direta dos fatores de crescimento, os quais são facilmente degradados. A transferência dos genes pode ser realizada por vetores virais ou não virais ao tecido-alvo. A introdução desse material genético para fins terapêuticos pode ser realizada em laboratório e as células manipuladas, recolocadas em tecido de origem (terapia gênica ex vivo) ou no próprio organismo ou tecido-alvo (terapia gênica in vivo). Algumas limitações têm representado barreira na mudança de protocolos de pesquisa para clínicos. O desconhecimento dos efeitos a longo prazo e a possível integração dos genes introduzidos à cromatina do organismo-alvo representa um risco potencial. Mesmo assim, estudos experimentais em animais avançam em todas as áreas da ortopedia.