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Bone ; 103: 64-69, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28655603


BACKGROUND: Some patients experience fractures while receiving oral bisphosphonates (BPs) treatment. Clinical risk factors, advanced bone density loss, and microarchitecture deterioration have been associated with such fractures but bone tissue properties other than bone mineral density (BMD) have not been assessed. METHODS: In a cross-sectional study of postmenopausal women on bisphosphonates for at least 4years with good adherence to treatment, 21 patients with incident fractures were compared with 18 treated patients without new fractures. Demographic and clinical variables, BMD, laboratory tests, and bone material strength index (BMSi) assessed by impact microindentation at the tibial diaphysis were recorded for all participants. RESULTS: Clinical and laboratory results did not differ between patients taking BPs with incident fractures and those without new fractures. However, BMSi was significantly lower (mean±SD) in those who fractured (73.76±6.49) than in no-fracture patients (81.64±6.26; p=0.001). Lumbar spine (LS) BMD was also lower in fractured patients (p=0.03). Adjusted models including age, body mass index, years on BP treatment, and LS-BMD confirmed an increase in fracture risk per BMSi standard deviation decrease: adjusted OR 23.5 [95% CI 2.16 to 255.66], p=0.01. ROC analyses showed an area under the curve of 0.82 (95% CI 0.68 to 0.95) for BMSi, higher than that for BMD at any location, which ranged from 0.64 (95% CI 0.47 to 0.82) for femoral neck (FN) BMD to 0.71 (95% CI 0.55 to 0.87) for LS-BMD. CONCLUSIONS: Patients who fracture while receiving BPs treatment have worse BMSi scores than BP-treated patients without fractures. The potential for BMSi to provide an additional osteoporosis treatment target should be explored.

Conservadores da Densidade Óssea/uso terapêutico , Osso e Ossos/fisiopatologia , Fraturas por Osteoporose/epidemiologia , Administração Oral , Idoso , Área Sob a Curva , Densidade Óssea , Estudos Transversais , Difosfonatos/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa , Fraturas por Osteoporose/prevenção & controle , Curva ROC , Sensibilidade e Especificidade
J Am Med Dir Assoc ; 15(12): 924-8, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25271193


OBJECTIVES: To examine the incidence of functional or cognitive impairment and its associated factors in a sample of individuals aged 85 years or older with and without diabetes mellitus, who were free of significant impairment at baseline. DESIGN: Longitudinal study. SETTING: Community-based survey study of 7 primary health care centers. PARTICIPANTS: A total of 167 individuals born in 1924 who completed 2 years of follow-up. MEASUREMENTS: Sociodemographic variables, the Barthel Index (BI), the Spanish version of Mini-Mental State Examination (MEC), the Mini Nutritional Assessment (MNA), the Charlson Comorbidity Index, and a list of chronic drug prescriptions. A comparative analysis was performed between diabetic and nondiabetic patients regarding the rate of functional and cognitive impairment. In addition, in older people with diabetes experiencing incident disability, an analysis of the potential factors involved was carried out. RESULTS: The prevalence of diabetes (DM) at baseline in this population was 25.1%. After 2 years of follow-up, 66.8% of patients with DM had developed a new impairment measured as 38.1% for the defined target of loss of BI of 10 or more and 33.3% for the cognitive target (MEC scores lower than 24 or loss >4 points in MEC). In a multivariate analysis, diabetic patients had an increased risk of any new disability (OR 2.05, 95% CI 1.01-4.36; P = .04). Logistic regression showed an association between any new disability and baseline scores of MNA (OR 1.35, 95% CI 1.01-1.82; P = .04) and MEC (OR 1.38, 95% CI 1.02-1.85; P = .003). CONCLUSION: This study has identified that in the oldest old, community-dwelling individuals without evidence of severe functional impairment at baseline, diabetes increases the risk of incident disability in only 2 years.

Atividades Cotidianas , Transtornos Cognitivos/epidemiologia , Complicações do Diabetes/epidemiologia , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica , Humanos , Incidência , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Prevalência , Atenção Primária à Saúde , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Espanha