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2.
Medicine (Baltimore) ; 99(7): e19103, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049818

RESUMO

Bioelectrical impedance analysis (BIA) is currently the most commonly used method in clinical practice to measure body composition. However, the bioelectrical impedance analyzer is not designed according to different countries, races, and elderly populations. Because different races may have different body compositions, a prediction model for the elderly population in Taiwan should be developed to avoid population bias, thereby improving the accuracy of community evaluation surveys.Dual energy X-ray absorptiometry (DXA) was used as a standard method for comparison, and impedance analysis was used for the development of a highly accurate predictive model that is suitable for assessing the body composition of elderly people.This study employed a cross-sectional design and recruited 438 elderly people who were undergoing health examinations at the health management center in the Tri-Service General Hospital as study subjects. Basic demographic variables and impedance analysis values were used in four predictive models, namely, linear regression, random forest, support vector machine (SVM), and eXtreme Gradient Boosting (XGBoost) models, to predict DXA body composition. The data from 354 study subjects were used to develop the predictive model, while the data from 84 study subjects were used to validate the accuracy of the predictive model.The body composition of elderly people as estimated by InBody 720 was highly correlated with that estimated by DXA. The correlation coefficient between InBody 720 and DXA for muscle mass was 0.969, and that for fat mass was 0.935. Consistency analysis results showed that InBody 720 tends to underestimate muscle mass and fat mass. A comparison of the accuracy of the linear regression, random forest, SVM, and XGBoost models showed that the linear regression has the highest accuracy. The correlation coefficient between the new model and DXA for muscle mass and fat mass were 0.977 and 0.978, respectively.The new predictive model can be used to monitor the nutrition status of elderly people and identify people with sarcopenia in the community.


Assuntos
Absorciometria de Fóton/métodos , Composição Corporal , Impedância Elétrica , Idoso , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Valor Preditivo dos Testes , Taiwan
3.
Radiol Med ; 125(3): 313-318, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31883053

RESUMO

OBJECTIVES: Bone strain index (BSI) is a dual-energy X-ray absorptiometry (DXA)-derived index of bone strength obtained from lumbar densitometric scan. We estimated the reproducibility of BSI in healthy women with different body mass index. METHODS: We enrolled postmenopausal women (mean age ± SD: 66 ± 10 years) divided into three groups (A, B and C) according to body mass index (BMI: < 25; 25-29.9; ≥ 30 kg/m2) and two groups (D and E) according to waist circumference (WC: ≤ 88; > 88 cm), each of 30 subjects. They underwent two DXA examinations with in-between repositioning, according to the International Society for Clinical Densitometry guidelines for precision estimation. Bone mineral density (BMD) and BSI were expressed as g/cm2 and absolute value, respectively. The coefficient of variation (CoV) was calculated as the ratio between root-mean-square standard deviation and mean; least significant change percentage (LSC%) as 2.77 × CoV; reproducibility as the complement to 100% LSC. RESULTS: BSI increased proportionally to BMI and WC and significantly in group C compared to B and A (p = 0.032 and 0.006, respectively). BSI was significantly higher in E compared to D (p = 0.017), whereas no differences were observed in BMD. Although BSI reproducibility was slightly lower in group C (89%), the differences were not significant between all groups. BMD reproducibility did not significantly differ between all groups. CONCLUSIONS: BSI reproducibility was significantly lower than that of BMD and decreased proportionally to BMI and WC increase. This reduction of BSI reproducibility was more pronounced in patients with BMI ≥ 30 and WC > 88, as expected, being BSI a parameter sensible to weight.


Assuntos
Absorciometria de Fóton/métodos , Índice de Massa Corporal , Osso e Ossos/diagnóstico por imagem , Circunferência da Cintura , Idoso , Densidade Óssea , Osso e Ossos/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade , Posicionamento do Paciente , Estudos Prospectivos , Reprodutibilidade dos Testes , Coluna Vertebral/diagnóstico por imagem
4.
Vet Clin North Am Exot Anim Pract ; 22(3): 397-417, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395322

RESUMO

Diagnostic imaging relies on interpretation of interactions between the body tissue and various energies, such as x-rays, ultrasound, and magnetic or nuclear energies, to differentiate normal from abnormal tissues. Major technological improvements regarding emission and detection of the energetic waves, as well as reconstruction and interpretation of the images, have occurred. These advances made possible visualization of smaller structures, quantitative evaluation of functional processes, and development of unique imaging-guided procedures. This article reviews the technological advances that allowed development of cone beam computed tomography, dual-energy x-ray absorptiometry, and contrast-enhanced ultrasonography, which all could have applications in exotic pet medicine.


Assuntos
Animais Exóticos , Diagnóstico por Imagem/veterinária , Medicina Veterinária/tendências , Absorciometria de Fóton/instrumentação , Absorciometria de Fóton/métodos , Absorciometria de Fóton/tendências , Absorciometria de Fóton/veterinária , Animais , Tomografia Computadorizada de Feixe Cônico/instrumentação , Tomografia Computadorizada de Feixe Cônico/métodos , Tomografia Computadorizada de Feixe Cônico/tendências , Tomografia Computadorizada de Feixe Cônico/veterinária , Diagnóstico por Imagem/instrumentação , Diagnóstico por Imagem/métodos , Diagnóstico por Imagem/tendências , Humanos , Ultrassonografia/instrumentação , Ultrassonografia/métodos , Ultrassonografia/tendências , Ultrassonografia/veterinária , Medicina Veterinária/instrumentação , Medicina Veterinária/métodos
5.
Acta Neurol Scand ; 140(4): 274-280, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31389003

RESUMO

OBJECTIVES: Vitamin D deficiency is widespread in patients with Parkinson's disease (PD). Our aim was to determine whether serum vitamin D levels correlated with bone mineral density (BMD) and non-motor symptoms in patients with PD. MATERIALS & METHODS: A consecutive series of 182 patients with PD and 185 healthy controls were included. Serum 25-hydroxyvitamin D (25[OH]D) levels were measured by immunoassay, while BMD of the lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry. Associations between serum vitamin D levels and clinical data were evaluated using partial correlation analysis. RESULTS: Patients with PD had significantly lower serum 25(OH)D levels relative to healthy controls (49.75 ± 14.11 vs 43.40 ± 16.51, P < 0.001). Furthermore, PD patients with lower vitamin D levels had a significantly higher frequency of falls (P = 0.033) and insomnia (P = 0.015). They also had significantly higher scores for the Pittsburgh Sleep Quality Index (PSQI; P = 0.014), depression (P = 0.020), and anxiety (P = 0.009). Finally, patients with PD also had a significantly lower mean BMD of the lumbar spine (P = 0.011) and femoral neck (P < 0.001). After adjusting for age, sex, and body mass index, vitamin D levels significantly correlated with falls, insomnia, and scores for the PSQI, depression, and anxiety. CONCLUSIONS: In patients with PD, vitamin D levels significantly correlated with falls and some non-motor symptoms. However, no associations were found between BMD and the serum 25(OH)D levels in patients with PD. Thus, vitamin D supplementation is a potential therapeutic for non-motor PD symptoms.


Assuntos
Densidade Óssea/fisiologia , Doença de Parkinson/sangue , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Absorciometria de Fóton/métodos , Acidentes por Quedas/prevenção & controle , Idoso , Feminino , Colo do Fêmur/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico por imagem , Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico por imagem
6.
Aging Clin Exp Res ; 31(10): 1375-1389, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31422565

RESUMO

PURPOSE: The purpose of this paper was to review the available approaches for bone strength assessment, osteoporosis diagnosis and fracture risk prediction, and to provide insights into radiofrequency echographic multi spectrometry (REMS), a non-ionizing axial skeleton technique. METHODS: A working group convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis met to review the current image-based methods for bone strength assessment and fracture risk estimation, and to discuss the clinical perspectives of REMS. RESULTS: Areal bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is the consolidated indicator for osteoporosis diagnosis and fracture risk assessment. A more reliable fracture risk estimation would actually require an improved assessment of bone strength, integrating also bone quality information. Several different approaches have been proposed, including additional DXA-based parameters, quantitative computed tomography, and quantitative ultrasound. Although each of them showed a somewhat improved clinical performance, none satisfied all the requirements for a widespread routine employment, which was typically hindered by unclear clinical usefulness, radiation doses, limited accessibility, or inapplicability to spine and hip, therefore leaving several clinical needs still unmet. REMS is a clinically available technology for osteoporosis diagnosis and fracture risk assessment through the estimation of BMD on the axial skeleton reference sites. Its automatic processing of unfiltered ultrasound signals provides accurate BMD values in view of fracture risk assessment. CONCLUSIONS: New approaches for improved bone strength and fracture risk estimations are needed for a better management of osteoporotic patients. In this context, REMS represents a valuable approach for osteoporosis diagnosis and fracture risk prediction.


Assuntos
Osteoporose/diagnóstico , Absorciometria de Fóton/métodos , Densidade Óssea , Osso e Ossos , Consenso , Feminino , Fraturas Ósseas , Humanos , Osteoartrite , Medição de Risco , Análise Espectral , Ultrassonografia
7.
J Bone Joint Surg Am ; 101(15): 1413-1419, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31393435

RESUMO

Worldwide, osteoporosis management is in crisis because of inadequate delivery of care, competing guidelines, and confusing recommendations. Additionally, patients are not readily accepting the diagnosis of poor bone health and often are noncompliant with treatment recommendations. Secondary fracture prevention, through a program such as Own the Bone, has improved the diagnosis and medical management after a fragility fracture. In patients who undergo elective orthopaedic procedures, osteoporosis is common and adversely affects outcomes. Bone health optimization is the process of bone status assessment, identification and correction of metabolic deficits, and initiation of treatment, when appropriate, for skeletal structural deficits. The principles of bone health optimization are similar to those of secondary fracture prevention and can be initiated by all orthopaedic surgeons. Patients who are ≥50 years of age should be assessed for osteoporosis risk and, if they are in a high-risk group, bone density should be measured. All patients should be counseled to consume adequate vitamin D and calcium and to discontinue use of any toxins (e.g., tobacco products and excessive alcohol consumption). Patients who meet the criteria for pharmaceutical therapy for osteoporosis should consider delaying surgery for a minimum of 3 months, if feasible, and begin medication treatment. Orthopaedic surgeons need to assume a greater role in the care of bone health for our patients.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Saúde Global , Programas de Rastreamento/organização & administração , Osteoporose/prevenção & controle , Fraturas por Osteoporose/prevenção & controle , Absorciometria de Fóton/métodos , Idoso , Osso e Ossos/fisiologia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Ortopedia/organização & administração , Osteoporose/epidemiologia , Prevenção Secundária/métodos , Sociedades Médicas/organização & administração , Vitamina D/uso terapêutico
9.
Nutr. hosp ; 36(4): 919-925, jul.-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184719

RESUMO

Introducción: el índice de masa corporal (IMC) es una medida subrogada de la adiposidad corporal, por lo que puede infradiagnosticar sobrepeso y obesidad, lo que hace necesario definir variables más adecuadas para su correcto diagnóstico. Objetivo: comparar la categorización de sobrepeso y obesidad según el porcentaje de grasa medido con absorciometría de rayos X de energía dual (DEXA) con el IMC y la fórmula Clínica Universidad de Navarra - Body Adiposity Estimator (CUN-BAE), así como su relación con la adherencia a la dieta mediterránea, la actividad física y la satisfacción con la imagen corporal. Sujetos y métodos: estudio descriptivo transversal llevado a cabo en una muestra de 64 estudiantes de Medicina. Se determinaron peso, talla, perímetro de cintura, porcentaje de grasa medido con DEXA, adherencia a la dieta mediterránea, nivel de actividad física y satisfacción con la imagen corporal. Resultados: el IMC infradiagnostica sobrepeso respecto al porcentaje de grasa medido por DEXA mientras que la ecuación CUN-BAE presenta una buena correlación. El porcentaje de grasa se asocia inversamente con la satisfacción con la imagen corporal con mayor fuerza que el IMC. Conclusión: se necesitan nuevas herramientas capaces de distinguir los casos con IMC normal cuyo porcentaje de grasa corporal está elevado. Sería útil estudiar si el empleo de un cuestionario de satisfacción con la imagen corporal en personas clasificadas como normopeso podría distinguir a aquellas con una mayor probabilidad de exceso de grasa y así emplear estudios más exhaustivos en este colectivo


Introduction: body mass index (BMI) can under-diagnose overweight and obesity as it is a surrogate measure of central adiposity, making it necessary to define more adequate variables for its correct diagnosis. Objective: to compare the categorization of overweight and obesity according to the percentage of fat measured with dual-energy X-ray absorptiometry (DEXA) with the BMI and the Clínica Universidad de Navarra - Body Adiposity Estimator (CUN-BAE) formula, as well as their relationship with adherence to the Mediterranean diet, physical activity and satisfaction with body image. Subjects and methods: cross-sectional study conducted in 64 medical students. We determined weight, height, waist circumference, percentage of fat measured with DEXA, adherence to the Mediterranean diet, level of physical activity and degree of satisfaction with body image. Results: BMI underdiagnoses overweight with respect to the percentage of fat measured by DEXA while CUN-BAE has a good correlation. Percentage of fat is inversely associated with satisfaction with body image more strongly than the BMI. Conclusion: the limitations of BMI to diagnose excess body fat pose the need for new tools to distinguish patients with normal BMI whose percentage of body fat is high. It would be useful to assess whether the use of a questionnaire of satisfaction with body image in people classified as normal weight could distinguish individuals with a higher probability of excess of fat, and thus, employ more accurate study methods in this group


Assuntos
Humanos , Masculino , Feminino , Adulto , Composição Corporal/fisiologia , Estilo de Vida , Imagem Corporal , Estudantes de Medicina/estatística & dados numéricos , Absorciometria de Fóton/métodos , Absorciometria de Fóton/instrumentação , Dieta Mediterrânea , Índice de Massa Corporal , Estudos Transversais , Sobrepeso , Obesidade , Inquéritos e Questionários , Antropometria , Atividade Motora
10.
Acta Orthop ; 90(5): 479-483, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31269876

RESUMO

Background and purpose - Bone remodeling as a response to bone trauma, postoperative immobilization, and device-related bone reactions can lead to loss of bone stock and increase the risk of periprosthetic fracture and aseptic loosening. This study investigates the adaptive bone remodeling of the proximal tibia after uncemented total knee arthroplasty (TKA). Patients and methods - We performed a 2-year follow up of 53 patients (mean age 62 (38-70) years, 27 of whom were men, who received an uncemented TKA in a randomized controlled trial with bone mineral density (BMD) as secondary endpoint. Patients were randomized to 2 groups of either monoblock (A) or modular (B) polyethylene design. The TKAs were performed using the uncemented Zimmer Nexgen trabecular metal. Measurements of BMD were done postoperatively and after 3, 6, 12, and 24 months. BMD was measured in 3 regions of interest (ROI). Results and interpretation - In group A statistically significant changes in BMD were seen after 24 months in both the medial and lateral ROI. BMD decreased medially by 15% (p = 0.004) and laterally by 13% (p = 0.01). In group B the BMD changes were limited and after 24 months returned to the preoperative values. The differences in BMD change between groups were statistically significant in both the medial (p = 0.03) and lateral (p = 0.02) ROI. In the distal ROI we found no significant change in BMD in either group. A significantly different bone remodeling pattern of the proximal tibia was seen in the 2 groups with a higher degree of bone loss in the knees that received the monoblock polyethylene design, indicating that the flexible monoblock implant design, previously shown to improve fixation, does not decrease the bone loss of the proximal tibia.


Assuntos
Artroplastia do Joelho/métodos , Remodelação Óssea/fisiologia , Prótese do Joelho , Tíbia/fisiopatologia , Absorciometria de Fóton/métodos , Adulto , Idoso , Densidade Óssea/fisiologia , Cimentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Desenho de Prótese , Tíbia/diagnóstico por imagem
11.
Osteoporos Int ; 30(9): 1827-1836, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31309239

RESUMO

Treatment effects of combining teriparatide and whole-body vibration exercise (WBV) vs teriparatide alone in twelve months were compared using bone mineral density (BMD), bone microarchitecture, and bone turnover markers. We found an increased effect in lumbar spine BMD by adding WBV to teriparatide in postmenopausal osteoporotic women. INTRODUCTION: The parathyroid hormone (PTH) analogue teriparatide is an effective but expensive anabolic treatment for osteoporosis. Whole-body vibration exercise (WBV) has been found to stimulate muscle and bone strength in some studies. Animal data demonstrate a beneficial effect on bone when combining PTH with mechanical loading. The aim of this study was to investigate if combining WBV exercise and teriparatide treatment gives additional beneficial effects on bone compared to teriparatide alone in postmenopausal women with osteoporosis. METHODS: The PaVOS study is a randomized controlled trial where postmenopausal osteoporotic women starting teriparatide 20 µg/day were randomized to WBV + teriparatide or teriparatide alone. WBV consisted of three sessions a week (12 min, including 1:1 ratio of exercise:rest). Bone mineral density (BMD) and bone microarchitecture, bone turnover markers, and sclerostin measurements were obtained. Data were analyzed using a linear mixed regression model with adjustment for baseline values or robust cluster regression in an intention-to-treat (ITT) analysis. RESULTS: Thirty-five women were randomized (17 in teriparatide + WBV group and 18 in teriparatide group). At 12 months, both groups increased significantly in BMD at the lumbar spine. The teriparatide + WBV group increased by (mean ± SD) 8.90% ± 5.47 and the teriparatide group by 6.65% ± 5.51. The adjusted treatment effect of adding WBV to teriparatide was statistically significant at 2.95% [95% CI = 0.14-5.77; P = 0.040]. Markers of bone turnover increased significantly in both groups at three and six months with no significant difference between groups. No other treatment effects were observed in hip BMD, bone microarchitecture parameters, or sclerostin levels in either group. CONCLUSION: Twelve months of WBV and teriparatide had a significant clinically relevant treatment effect in lumbar spine BMD compared to teriparatide alone in postmenopausal osteoporotic women. ClinicalTrials.gov :(NCT02563353).


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Terapia por Exercício/métodos , Osteoporose Pós-Menopausa/terapia , Teriparatida/uso terapêutico , Vibração , Absorciometria de Fóton/métodos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Densidade Óssea/fisiologia , Remodelação Óssea/fisiologia , Terapia Combinada , Feminino , Articulação do Quadril/fisiopatologia , Humanos , Vértebras Lombares/fisiopatologia , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/fisiopatologia , Tomografia Computadorizada por Raios X/métodos
12.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340943

RESUMO

A 35-year-old man with juvenile idiopathic arthritis since childhood presented with bilateral atypical tibial fractures, followed by a later, single atypical fracture of the femur. The fractures were associated with 6 years of oral alendronate treatment immediately followed by subcutaneous denosumab therapy and later teriparatide therapy for osteoporosis. Atypical fractures are known to occur in the femur following bisphosphonate therapy; however, there are only a few documented cases of atypical fractures in the tibia. Our case highlights a rare but serious complication of a commonly prescribed antiresorptive agent. It also shows that teriparatide, while helpful in increasing bone mass, does not fully prevent the development of atypical fractures. Careful investigation should be considered in patients on long-term antiresorptive therapy presenting with bony tenderness to exclude an atypical fracture.


Assuntos
Alendronato/efeitos adversos , Denosumab/efeitos adversos , Fraturas Espontâneas/induzido quimicamente , Osteoporose/tratamento farmacológico , Teriparatida/efeitos adversos , Absorciometria de Fóton/métodos , Adulto , Alendronato/uso terapêutico , Densidade Óssea/fisiologia , Denosumab/uso terapêutico , Relação Dose-Resposta a Droga , Esquema de Medicação , Fraturas do Fêmur/induzido quimicamente , Fraturas do Fêmur/diagnóstico por imagem , Seguimentos , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Masculino , Osteoporose/diagnóstico por imagem , Medição de Risco , Teriparatida/uso terapêutico , Fraturas da Tíbia/induzido quimicamente , Fraturas da Tíbia/diagnóstico por imagem
13.
Osteoporos Int ; 30(9): 1789-1797, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312863

RESUMO

We evaluated the association between prevalent vertebral fractures and bone micro-architecture and strength measured using HR-pQCT in postmenopausal women with a recent non-vertebral fracture visiting the Fracture Liaison Service. The presence and severity of prevalent vertebral fracture reflect generalized bone deterioration. INTRODUCTION: We evaluated the association between prevalent vertebral fractures (VFs) and bone micro-architecture and strength measured using HR-pQCT in postmenopausal women visiting the Fracture Liaison Service. METHODS: In this cross-sectional study in women aged 50-90 with a recent non-vertebral fracture (NVF), VFs were identified on lateral spine images by dual-energy X-ray absorptiometry. Bone micro-architecture and strength were measured at the non-dominant distal radius and distal tibia using HR-pQCT. Linear regression analyses were used to estimate the association between prevalent VFs and HR-pQCT parameters. RESULTS: We included 338 women of whom 74 (21.9%) women had at least one prevalent VF. After adjustment for femoral neck aBMD (FN aBMD) and other parameters, women with at least one prevalent vertebral fracture had significantly lower total and trabecular vBMD and trabecular number (ß - 16.7, - 11.8, and - 7.8 in the radius and - 21.4, - 16.6, and - 7.2 in the tibia, respectively), higher trabecular separation at the radius and tibia (ß 9.0 and 9.3, respectively), and lower cortical thickness and calculated ultimate failure load and compressive bone strength at the tibia (ß - 5.9, - 0.6, and - 10.9, respectively) as compared with those without prevalent VFs. Furthermore, more severe prevalent VFs were associated with even lower total and trabecular vBMD and lower ultimate failure load and compressive stiffness at the radius and tibia, and lower trabecular number and higher trabecular separation at the radius. CONCLUSION: This study indicates that the presence and severity of prevalent VFs reflect generalized bone deterioration in women with a recent NVF, independently of FN aBMD.


Assuntos
Densidade Óssea/fisiologia , Fraturas por Osteoporose/fisiopatologia , Rádio (Anatomia)/fisiopatologia , Fraturas da Coluna Vertebral/fisiopatologia , Tíbia/fisiopatologia , Absorciometria de Fóton/métodos , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Estudos Transversais , Feminino , Análise de Elementos Finitos , Humanos , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Rádio (Anatomia)/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
14.
Pan Afr Med J ; 32: 169, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303938

RESUMO

A 61-year old female patient who was referred to the endocrine clinic for evaluation of an elevated alkaline phosphatase. She was originally referred to gastroenterology (GI), however no GI causes of elevated alkaline phosphatase was found. Upon fractionation, it was noted that she had elevation in bone specific alkaline phosphatase. Past history was significant for hypertension, atrial fibrillation and menopause 6 years ago. She was also noted to have multiple drug allergies manifesting as urticaria and flushing. Review of the past records revealed a persistently elevated alkaline phosphatase over the last two years. She had no history of falls or fractures. Computed tomography (CT) abdomen done to rule out biliary pathology, revealed osteosclerotic and osteolytic lesion in the pelvis concerning neoplastic disease. Bone marrow biopsy however, was negative for cancer but consistent with systemic mastocytosis (SM). Dual Energy X-ray absorbimetery (DEXA) scan revealed osteoporosis Serum tryptase levels were elevated; further genetic analysis showed a positive CKIT D816 mutation. She was started on bisphosphonates (initially alendronate and then ibandronate). Upon follow up at two years she had not experienced any fractures and her bone mineral density also had improved significantly.


Assuntos
Fosfatase Alcalina/metabolismo , Mastocitose Sistêmica/diagnóstico , Osteoporose/etiologia , Absorciometria de Fóton/métodos , Densidade Óssea , Difosfonatos/administração & dosagem , Feminino , Humanos , Mastocitose Sistêmica/complicações , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico
15.
Biomed Res Int ; 2019: 8010356, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31240225

RESUMO

Objective: The objective of this study was to verify possible associations between bone mineral density (BMD) and breast cancer in recently diagnosed women in the Brazilian Mid-west region, considering the menopausal status of patients. Methods: A case-control study was conducted with 142 cases of breast cancer and 234 controls matched by for age, body mass index (BMI), and menopausal status (pre- and postmenopause), performed in a university hospital in the Brazilian Mid-west. Lumbar spine (L1-L4), femoral neck, and total femur BMD were measured by the dual-energy X-ray absorptiometry (DXA) method. For association, a logistic regression analysis was used. Results: Women in the highest lumbar spine BMD quartile presented had a higher chance of developing breast cancer (OR = 2.31; 1.02-5.25; p = 0.045), after adjusting for the confounding variables. Nonetheless, there were no statistically significant differences in the association between pre- and postmenopause in that quartile and breast cancer. Conclusions: High lumbar spine BMD was positively associated with breast cancer in the total sample. In evaluating the BMD of the femoral neck and total femur, such an association was not observed.


Assuntos
Densidade Óssea , Doenças Ósseas Metabólicas/epidemiologia , Neoplasias da Mama/epidemiologia , Vértebras Lombares , Região Lombossacral , Absorciometria de Fóton/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Índice de Massa Corporal , Brasil/epidemiologia , Estudos de Casos e Controles , Feminino , Fêmur , Colo do Fêmur , Humanos , Pessoa de Meia-Idade , Pós-Menopausa , Fatores de Risco
16.
Nat Rev Endocrinol ; 15(9): 535-547, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31189982

RESUMO

Osteoporosis is associated with increased fragility of bone and a subsequent increased risk of fracture. The diagnosis of osteoporosis is intimately linked with the imaging and quantification of bone and BMD. Scanning modalities, such as dual-energy X-ray absorptiometry or quantitative CT, have been developed and honed over the past half century to provide measures of BMD and bone microarchitecture for the purposes of clinical practice and research. Combined with fracture prediction tools such as Fracture Risk Assessment Tool (FRAX) (which use a combination of clinical risk factors for fracture to provide a measure of risk), these elements have led to a paradigm shift in the ability to diagnose osteoporosis and predict individuals who are at risk of fragility fracture. Despite these developments, a treatment gap exists between individuals who are at risk of osteoporotic fracture and those who are receiving therapy. In this Review, we summarize the epidemiology of osteoporosis, the history of scanning modalities, fracture prediction tools and future directions, including the most recent developments in prediction of fractures.


Assuntos
Absorciometria de Fóton/métodos , Densidade Óssea/fisiologia , Programas de Triagem Diagnóstica , Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico por imagem , Absorciometria de Fóton/tendências , Programas de Triagem Diagnóstica/tendências , Humanos , Osteoporose/complicações , Fraturas por Osteoporose/etiologia , Valor Preditivo dos Testes , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Fatores de Risco
17.
Clin Interv Aging ; 14: 987-996, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213785

RESUMO

Background: Sarcopenia is typically defined as the loss of muscle mass, strength and low physical performance with aging. Ultrasound is a safe and easy method for evaluating muscle mass and quality by muscle thickness (MT) and pennation angle (PA), respectively. Although the positive correlations between MT and muscle mass and handgrip strength were observed, the relationship between MT, PA and physical performance remains unclear. Purpose: This study aimed to investigate the correlation of aforementioned ultrasound parameters with muscle mass, muscle strength and physical performance and explore the utility of ultrasound in predicting sarcopenia. Patients and methods: A total of 265 elderly Chinese community dwellers were included. MT of both forearm and lower leg as well as PA of gastrocnemius was assessed by ultrasound. Muscle mass was assessed by dual-energy X-ray absorptiometry. Muscle strength was measured by a Jamar hand dynamometer. Physical performance was assessed by the Short Physical Performance Battery (SPPB). Results: Anterior radial MT in men and regional MTs except posterior fibula in women were negatively correlated with the age. No significant correlation was observed between PA and the age in both genders. Posterior tibial MT and posterior fibula MT were positively correlated with the relative appendicular skeletal muscle mass in men and women, respectively. Anterior ulnar MT was positively correlated with grip strength in both genders. Moreover, gastrocnemius medialis PA showed a positive association with gait speed and SPPB in women but not in men. Conclusion: A combination of posterior fibula MT, anterior ulnar MT and gastrocnemius medialis PA measured by muscle ultrasound is helpful for the assessment of sarcopenia in Chinese elderly women. In addition, a combination of posterior tibial MT and anterior ulnar MT measured by muscle ultrasound is helpful for the assessment of sarcopenia in Chinese elderly men.


Assuntos
Força da Mão , Força Muscular , Músculo Esquelético , Sarcopenia , Absorciometria de Fóton/métodos , Idoso , China/epidemiologia , Feminino , Humanos , Vida Independente/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia , Sarcopenia/fisiopatologia , Ultrassonografia/métodos
18.
Eur Radiol ; 29(12): 6780-6789, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31119416

RESUMO

OBJECTIVES: To assess whether diagnostic accuracy of morphometric vertebral fracture (VF) diagnosis in children can be improved using AVERT™ (a 33-point semi-automated program developed for VF diagnosis in adults) compared with SpineAnalyzer™ (a 6-point program), which has previously been shown to be of insufficient accuracy. MATERIALS AND METHODS: Lateral spine radiographs (XR) and dual-energy X-ray absorptiometry (DXA) scans of 50 children and young people were analysed by two observers using two different programs (AVERT™ and SpineAnalyzer™). Diagnostic accuracy (sensitivity, specificity, false-negative (FN) and false-positive rates (FP)) was calculated by comparing with a previously established consensus arrived at by three experienced paediatric musculoskeletal radiologists, using a simplified algorithm-based qualitative scoring system. Observer agreement was calculated using Cohen's kappa. RESULTS: For XR, overall sensitivity, specificity, FP and FN rates using AVERT™ were 36%, 95%, 5% and 64% respectively and 26%, 98%, 2% and 75% respectively, using SpineAnalyzer™. For DXA, overall sensitivity, specificity, FP and FN rates using AVERT™ were 41%, 91%, 9% and 59% respectively and 31%, 96%, 4% and 69% respectively, using SpineAnalyzer. Reliability (kappa) ranged from 0.34 to 0.37 (95%CI, 0.26-0.46) for AVERT™ and from 0.26 to 0.31 (95%CI, 0.16-0.44) for SpineAnalyzer™. Inter- and intra-observer agreement ranged from 0.41 to 0.47 for AVERT™ and from 0.50 to 0.79 for SpineAnalyzer™. CONCLUSION: AVERT™ has slightly higher accuracy but lower observer reliability for the representation of vertebral morphometry in children when compared with SpineAnalyzer™. However, neither software program is satisfactorily reliable for VF diagnosis in children. KEY POINTS: • SpineAnalyzer™ and AVERT™ have low diagnostic accuracy and observer agreement when compared to three paediatric radiologists' readings for the diagnosis of vertebral fractures (VF) in children. • Neither AVERT™ nor SpineAnalyzer™ is satisfactorily reliable for VF diagnosis in children. • Development of specific paediatric software and normative values (incorporating age-related physiological variation in children) is required.


Assuntos
Absorciometria de Fóton/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Adolescente , Algoritmos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem
19.
Osteoporos Int ; 30(8): 1581-1589, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31115592

RESUMO

INTRODUCTION: To investigate the effect of zoledronic acid on periprosthetic bone mineral density (BMD) and bone metabolism markers after primary total hip arthroplasty in females with postmenopausal osteoporosis. METHODS: From November 2015 to April 2016, 40 female patients who met the inclusion criteria were randomized into two groups: a control group (calcium + calcitriol) and a zoledronic acid group (calcium + calcitriol + zoledronic acid). At 1 week and 3, 6, and 12 months after operation, BMD was obtained through dual-energy X-ray absorptiometry (DEXA). At pre-operation and at 3, 6, and 12 months after the operation, levels of bone metabolism markers were obtained by serum examination. RESULTS: Loss of BMD was significantly more pronounced in the control group than in the ZOL group in zones 1, 4, 6, and 7 at 6 months and in zones 1, 2, 4, 6, and 7 at 12 months after the operation. The levels of bone-resorption marker (ß-CTX) were significantly lower in the ZOL group than in the control group at 3, 6, and 12 months after operation. The levels of bone-formation marker (TP1NP) performed statistically differences only at 12 months after the operation in these two groups. CONCLUSIONS: Receiving an intravenous infusion of 5 mg zoledronic acid after THA can effectively reduce periprosthetic BMD loss and improve bone remodeling in females with postmenopausal osteoporosis. Zoledronic acid significantly inhibited bone mass loss in zones 1, 2, 4, 6, and 7 after THA and inhibited bone-resorption marker (ß-CTX) to improve bone remodeling. Zoledronic acid treatment is potentially important for patients with osteoporosis after THA.


Assuntos
Artroplastia de Quadril/efeitos adversos , Conservadores da Densidade Óssea/farmacologia , Densidade Óssea/efeitos dos fármacos , Prótese de Quadril , Osteoporose Pós-Menopausa/tratamento farmacológico , Ácido Zoledrônico/farmacologia , Absorciometria de Fóton/métodos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Conservadores da Densidade Óssea/uso terapêutico , Remodelação Óssea/efeitos dos fármacos , Reabsorção Óssea/etiologia , Reabsorção Óssea/fisiopatologia , Reabsorção Óssea/prevenção & controle , Calcitriol/uso terapêutico , Carbonato de Cálcio/uso terapêutico , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/fisiopatologia , Cuidados Pós-Operatórios/métodos , Método Simples-Cego , Ácido Zoledrônico/uso terapêutico
20.
Eur Radiol ; 29(11): 6355-6363, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31115622

RESUMO

OBJECTIVE: To investigate the in vivo applicability of non-contrast-enhanced hydroxyapatite (HA)-specific bone mineral density (BMD) measurements based on dual-layer CT (DLCT). METHODS: A spine phantom containing three artificial vertebral bodies with known HA densities was measured to obtain spectral data using DLCT and quantitative CT (QCT), simulating different patient positions and grades of obesity. BMD was calculated from virtual monoenergetic images at 50 and 200 keV. HA-specific BMD values of 174 vertebrae in 33 patients (66 ± 18 years; 33% women) were determined in non-contrast routine DLCT and compared with corresponding QCT-based BMD values. RESULTS: Examining the phantom, HA-specific BMD measurements were on a par with QCT measurements. In vivo measurements revealed strong correlations between DLCT and QCT (r = 0.987 [95% confidence interval, 0.963-1.000]; p < 0.001) and substantial agreement in a Bland-Altman plot. CONCLUSION: DLCT-based HA-specific BMD measurements were comparable with QCT measurements in in vivo analyses. This suggests that opportunistic DLCT-based BMD measurements are an alternative to QCT, without requiring phantoms and specific protocols. KEY POINTS: • DLCT-based hydroxyapatite-specific BMD measurements show a substantial agreement with QCT-based BMD measurements in vivo. • DLCT-based hydroxyapatite-specific measurements are on a par with QCT in spine phantom measurements. • Opportunistic DLCT-based BMD measurements may be a feasible alternative for QCT, without requiring dedicated examination protocols or a phantom.


Assuntos
Absorciometria de Fóton/métodos , Densidade Óssea/fisiologia , Osteoporose/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Algoritmos , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Osteoporose/fisiopatologia , Imagens de Fantasmas
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