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1.
Aging (Albany NY) ; 12(20): 19923-19937, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33080571

RESUMO

Coronavirus disease 19 (COVID-19) is currently a global pandemic that affects patients with other pathologies. Here, we investigated the influence of treatments for osteoporosis and other non-inflammatory rheumatic conditions, such as osteoarthritis and fibromyalgia, on COVID-19 incidence. To this end, we conducted a cross-sectional study of 2,102 patients being treated at the Rheumatology Service of Hospital del Mar (Barcelona, Spain). In our cohort, COVID-19 cumulative incidence from March 1 to May 3, 2020 was compared to population estimates for the same city. We used Poisson regression models to determine the adjusted relative risk ratios for COVID-19 associated with different treatments and comorbidities. Denosumab, zoledronate and calcium were negatively associated with COVID-19 incidence. Some analgesics, particularly pregabalin and most of the studied antidepressants, were positively associated with COVID-19 incidence, whereas duloxetine presented a negative association. Oral bisphosphonates, vitamin D, thiazide diuretics, anti-hypertensive drugs and chronic non-steroidal anti-inflammatory drugs had no effect on COVID-19 incidence in the studied population. Our results provide novel evidence to support the maintenance of the main anti-osteoporosis treatments in COVID-19 patients, which may be of particular relevance to elderly patients affected by the SARS-CoV-2 pandemic.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Cálcio/uso terapêutico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Doenças Reumáticas/complicações , Vitamina D/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/induzido quimicamente , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/induzido quimicamente , Doenças Reumáticas/tratamento farmacológico , Espanha/epidemiologia
2.
Maturitas ; 140: 55-63, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32972636

RESUMO

Supplementation with calcium (Ca) and/or vitamin D (vitD) is key to the management of osteoporosis. Other supplements like vitamin K2 (VitK2) and magnesium (Mg) could contribute to the maintenance of skeletal health. This narrative review summarizes the most recent data on Ca, vitD, vitK2 and Mg supplementation and age-related bone and muscle loss. Ca supplementation alone is not recommended for fracture prevention in the general postmenopausal population. Patients at risk of fracture with insufficient dietary intake and absorption could benefit from calcium supplementation, but it needs to be customized, taking into account possible side-effects and degree of adherence. VitD supplementation is essential in patients at risk of fracture and/or vitD deficiency. VitK2 and Mg both appear to be involved in bone metabolism. Data suggest that VitK2 supplementation might improve bone quality and reduce fracture risk in osteoporotic patients, potentially enhancing the efficacy of Ca ± vitD. Mg deficiency could negatively influence bone and muscle health. However, data regarding the efficacy of vitK2 and Mg supplementation on bone are inconclusive.


Assuntos
Cálcio/uso terapêutico , Fraturas Ósseas/prevenção & controle , Magnésio/uso terapêutico , Osteoporose/prevenção & controle , Vitamina D/uso terapêutico , Vitamina K 2/uso terapêutico , Vitaminas/uso terapêutico , Animais , Suplementos Nutricionais , Humanos
3.
Arch Osteoporos ; 15(1): 137, 2020 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-32860546

RESUMO

As a result of the current demographics, increased projections of osteoporosis (OP) and prevalence of the disease in Turkey, a panel of multidisciplinary experts developed a thorough review to assist clinicians in identifying OP and associated fracture risk patients, diagnosing the disease with the appropriate available diagnostic methods, classifying the disease, and initiating appropriate treatment. The panel expects to increase the awareness of this prevalent disease, decrease consequences of OP with corresponding cost savings and, ultimately, decrease the overall burden of OP and related fractures in Turkey. BACKGROUND: OP is not officially accepted as a chronic disease in Turkey despite the high prevalence and predicted increase in the following years. However, there are areas where the country is performing well, such as having a country-specific fracture risk assessment model, DXA access, and the uptake of FRAX. Additional efforts are required to decrease the existing treatment gap estimating 75-90% of patients do not receive pharmacological intervention for secondary prevention, and the diagnosis rate is around 25%. METHODS: A selected panel of Turkish experts in fields related to osteoporosis was provided with a series of relevant questions to address prior to the multi-day conference. Within this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion until a consensus was achieved. Represented in the panel were a number of societies including The Turkish Osteoporosis Society, The Society of Endocrinology and Metabolism of Turkey (SEMT), and The Turkish Society of Physical Medicine and Rehabilitation. RESULTS: Standardized general guidelines to identify OP and related fractures and at-risk population in Turkey, which will enable clinicians to accurately and effectively diagnose the disease, treat the appropriate patients with available pharmacological and non-pharmacological treatments and decrease the burden of the disease. CONCLUSIONS: This manuscript provides a review of the current state of OP and related fractures in Turkey. Moreover, this manuscript reviews current international guidelines and national studies and proposes a number of helpful country-specific classifications that can be used by healthcare providers caring for the at-risk population. Additionally, the panel proposes practical recommendations that should be implemented nationally in order to decrease the burden of OP and related fractures and effectively preventing the burden in future generations.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Cálcio/uso terapêutico , Osteoporose/diagnóstico por imagem , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/tratamento farmacológico , Vitamina D/uso terapêutico , Consenso , Suplementos Nutricionais , Fraturas Ósseas/etiologia , Humanos , Masculino , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Guias de Prática Clínica como Assunto , Prevalência , Medição de Risco , Sociedades Médicas , Resultado do Tratamento , Turquia/epidemiologia
4.
Cochrane Database Syst Rev ; 4: CD012581, 2020 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-32303107

RESUMO

BACKGROUND: Nutritional rickets is a disease which affects children, especially in low- and middle-income countries. It causes problems such as skeletal deformities and impaired growth. The most common cause of nutritional rickets is vitamin D deficiency. Vitamin D administered with or without calcium is commonly regarded as the mainstay of treatment. In some sunny countries, however, where children are believed to have adequate vitamin D production from exposure to ultraviolet light, but who are deficient in calcium due to low dietary intake, calcium alone has also been used in the treatment of nutritional rickets. Therefore, it is important to compare the effects of vitamin D, calcium or a combination of vitamin D and calcium for the treatment of nutritional rickets in children living in different settings. OBJECTIVES: To assess the effects of vitamin D, calcium or a combination of vitamin D and calcium for the treatment of nutritional rickets in children. SEARCH METHODS: We searched CENTRAL, MEDLINE, LILACS, WHO ICTRP Search Portal and ClinicalTrials.gov. The date of the last search of all databases was 25 July 2019. We applied no language restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCT) involving children aged 0 to 18 years with nutritional rickets which compared treatment with vitamin D, calcium or a combination of vitamin D and calcium. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the title and abstracts of all studies, extracted data and assessed the risk of bias of included studies. We resolved any disagreements by consensus or recourse to a third review author. We conducted meta-analyses for the outcomes reported by study authors. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (CI) and, for continuous outcomes, we calculated mean differences (MD) with 95% CIs. We assessed the certainty of the evidence of the included studies using GRADE. MAIN RESULTS: We identified 4562 studies; of these, we included four RCTs with 286 participants. The studies compared two or more of the following: vitamin D, calcium or vitamin D plus calcium. The number of participants randomised to receive vitamin D was 64, calcium was 102 and vitamin D plus calcium was 120. Two studies were conducted in India and two were conducted in Nigeria. None of the included studies had a low risk of bias in all domains. Three studies had a high risk of bias in at least one domain. The age of the participants ranged between six months and 14 years. The duration of follow-up ranged between 12 weeks and 24 weeks. Two studies compared vitamin D to calcium. There is low-certainty evidence that, at 24 weeks' follow-up, calcium alone improved the healing of rickets compared to vitamin D alone (RR 3.26, 95% CI 1.59 to 6.69; P = 0.001; 1 study, 71 participants). Comparing vitamin D to calcium showed no firm evidence of an advantage or disadvantage in reducing morbidity (fractures) (RR 0.27, 95% CI 0.03 to 2.32; P = 0.23; 1 study, 71 participants; very low-certainty evidence). Adverse events were not reported. Two studies compared vitamin D plus calcium to vitamin D at 12 or 24 weeks. Vitamin D plus calcium improved healing of rickets compared to vitamin D alone at 24 weeks' follow-up (RR 3.06, 95% CI 1.49 to 6.29; P = 0.002; 1 study, 75 participants; low-certainty evidence). There is no conclusive evidence in favour of either intervention for reducing morbidity (fractures) (RR 0.24, 95% CI 0.03 to 2.08; P = 0.20; 1 study, 71 participants; very low-certainty evidence) or adverse events (RR 4.76, 95% CI 0.24 to 93.19; P = 0.30; 1 study, 39 participants; very low-certainty evidence). All four included studies compared vitamin D plus calcium to calcium at different follow-up times. There is no conclusive evidence on whether vitamin D plus calcium in comparison to calcium alone improved healing of rickets at 24 weeks' follow-up (RR 1.17, 95% CI 0.72 to 1.90; P = 0.53; 2 studies, 140 participants; very low-certainty evidence). Evidence is also inconclusive for morbidity (fractures) (RR 0.89, 95% CI 0.06 to 13.76; P = 0.94; 1 study, 72 participants; very low-certainty evidence) and adverse events (RR 4.29, 0.22 to 83.57; P = 0.34; 1 study, 37 participants; very low-certainty evidence). Most of the evidence in the review is low or very low certainty due to risk of bias, imprecision or both. None of the included studies assessed all-cause mortality, health-related quality of life or socioeconomic effects. One study assessed growth pattern but this was not measured at the time-point stipulated in the protocol of our review (one or more years after commencement of therapy). AUTHORS' CONCLUSIONS: This review provides low-certainty evidence that vitamin D plus calcium or calcium alone improve healing in children with nutritional rickets compared to vitamin D alone. We are unable to make conclusions on the effects of the interventions on adverse events or morbidity (fractures).


Assuntos
Cálcio/uso terapêutico , Raquitismo/terapia , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Adolescente , Criança , Pré-Escolar , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/prevenção & controle , Humanos , Lactente , Ensaios Clínicos Controlados Aleatórios como Assunto , Raquitismo/etiologia , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/terapia
5.
Expert Opin Pharmacother ; 21(7): 811-821, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32151211

RESUMO

INTRODUCTION: Osteoporosis and subsequent fractures are well-recognized complications of stroke. However, drug treatment strategies for osteoporosis after stroke have been rarely discussed in the current guidelines for the management of stroke or osteoporosis. AREAS COVERED: The authors review the epidemiology, characteristics, pathophysiology, and risk prediction of post-stroke osteoporosis and fractures. Then they provide an overview of existing evidence regarding drug treatment strategies for osteoporosis in stroke patients. They also review the effects on bone mineral density (BMD) and fractures for those drugs commonly used in stroke patients. EXPERT OPINION: Currently, there is scarce evidence. A small randomized control trial suggested that a single use of 4 mg of intravenous zoledronate within 5 weeks of stroke onset was beneficial for preserving BMD, while simultaneous use of calcium and vitamin D supplements may be effective in preventing hypocalcemia. Further studies are needed to address several important issues of post-stroke osteoporosis, including who (the eligibility for treatment), when (the best timing of treatment), what (which drug), and how long (the best duration of treatment). On the other hand, physicians should bear in mind that drugs commonly used for stroke, such as statins or warfarin, may have beneficial or adverse effects on BMD and fracture risks.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Fraturas Ósseas/prevenção & controle , Osteoporose/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Cálcio/uso terapêutico , Suplementos Nutricionais , Feminino , Humanos , Osteoporose/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/complicações , Vitamina D/uso terapêutico , Ácido Zoledrônico/uso terapêutico
7.
Artigo em Russo | MEDLINE | ID: mdl-32207705

RESUMO

AIM: Study of the effect of taking a complex biologically active food supplement with calcium and vitamins D3 and B6 to the effectiveness and duration of medical rehabilitation effect at patients with osteoporosis and with a high risk of fractures. MATERIAL AND METHODS: We examined 119 men and women with osteoporosis and (or) with a high risk of fractures, beginning a course of medical rehabilitation. The 1st study group (SG1) included 41 patients who had already received antiresorptive therapy. In SG2 and SG3, 39 patients who did not receive pathogenetic therapy of osteoporosis were included by the randomization method. For patients SG1 and SG2, a complex biologically active food supplement Osteomed forte was prescribed to use within 12 months. The dynamics of tensodynamometry, stabilometry and functional tests were evaluated in 20 days, 6 and 12 months after the start of the study. RESULTS: The muscle strength indicators achieved during the 20-day training session compared to the initial level were maintained for 12 months in extensor and flexor of the back at patients within SG1 and SG2, as well as up to 6 months in the lateral flexor of the back at patients of SG1. At patients within SG3, the effect of medical rehabilitation completely regressed after 6 months. Higher stabilization parameters after 6 and 12 months in comparison with the initial level were observed only in patients within SG1 and SG2. The effect achieved during rehabilitation was supported for 12 months in the 'stand on one leg' test within SG1, comparing in contrast to SG3, where a deterioration in the average value of the test indicator was noted. CONCLUSION: Long-term use of food supplements containing calcium salts with vitamins D3 and B6can be recommended to maintain the effect of rehabilitation measures at patients with osteoporosis and with a high risk of fractures, more preferably in combination with antiresorptive therapy.


Assuntos
Cálcio/uso terapêutico , Movimento/efeitos dos fármacos , Força Muscular/efeitos dos fármacos , Osteoporose/tratamento farmacológico , Equilíbrio Postural/efeitos dos fármacos , Vitaminas/uso terapêutico , Feminino , Humanos , Masculino , Osteoporose/reabilitação , Resultado do Tratamento
8.
Clín. investig. arterioscler. (Ed. impr.) ; 32(1): 33-42, ene.-feb. 2020. graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-187006

RESUMO

La osteoporosis es una enfermedad esquelética sistémica, caracterizada por baja masa ósea y deterioro en la microarquitectura del tejido óseo, que origina un aumento de la fragilidad ósea y, en consecuencia, mayor susceptibilidad a fracturas. Es la enfermedad metabólica ósea más frecuente en nuestra población, y las fracturas resultantes de la osteoporosis son cada vez más comunes. Por otro lado, la calcificación vascular es un factor de riesgo reconocido de morbimortalidad cardiovascular, que históricamente era considerada como un proceso pasivo y degenerativo. Sin embargo, en la actualidad se reconoce como un proceso activo que tiene características histopatológicas, de composición mineral y de mecanismos de iniciación y desarrollo propias de la formación del hueso. Paradójicamente, los pacientes con osteoporosis muestran con frecuencia calcificaciones vasculares. Tradicionalmente se han considerado como procesos independientes relacionados con la edad, aunque estudios epidemiológicos recientes han evidenciado que existe una estrecha relación entre la pérdida de masa ósea y la calcificación vascular, independiente de la edad. De hecho, ambas entidades comparten factores de riesgo y mecanismos fisiopatológicos. Entre ellos destacan la relación entre proteínas de origen óseo, como la osteopontina y la osteoprotegerina, con la patología vascular, y el sistema intercelular proteico RANK/RANKL/OPG y la vía de señalización Wnt. Los mecanismos vinculados en ambas patologías deben considerarse en las decisiones clínicas, dado que los tratamientos para la osteoporosis podrían tener efectos imprevistos en la calcificación vascular, y a la inversa. En definitiva, una mejor comprensión de la relación entre ambas entidades puede contribuir a plantear estrategias para disminuir la prevalencia creciente de calcificación vascular y osteoporosis en la población que envejece


Osteoporosis is a systemic skeletal disease, characterised by low bone mass and deterioration in the micro-architecture of bone tissue, which causes increased bone fragility and consequently greater susceptibility to fractures. It is the most frequent metabolic bone disease in our population, and fractures resulting from osteoporosis are becoming more common. Furthermore, vascular calcification is a recognised risk factor of cardiovascular morbidity and mortality that historically has been considered a passive and degenerative process. However, it is currently recognised as an active process, which has histopathological characteristics, mineral composition and initiation and development mechanisms characteristic of bone formation. Paradoxically, patients with osteoporosis frequently show vascular calcifications. Traditionally, they have been considered as independent processes related to age, although more recent epidemiological studies have shown that there is a close relationship between the loss of bone mass and vascular calcification, regardless of age. In fact, both conditions share risk factors and pathophysiological mechanisms. These include the relationship between proteins of bone origin, such as osteopontin and osteoprotegerin (OPG), with vascular pathology, and the intercellular protein system RANK/RANKL/OPG and the Wnt signalling pathway. The mechanisms linked in both pathologies should be considered in clinical decisions, given that treatments for osteoporosis could have unforeseen effects on vascular calcification, and viceversa. In short, a better understanding of the relationship between both entities can help in proposing strategies to reduce the increasing prevalence of vascular calcification and osteoporosis in the aging population


Assuntos
Humanos , Osteoporose/etiologia , Calcificação Vascular/etiologia , Fatores de Risco , Doenças Cardiovasculares/epidemiologia , Osteoporose/fisiopatologia , Calcificação Vascular/fisiopatologia , Calcificação Vascular/classificação , Cálcio/uso terapêutico , Osteoclastos/metabolismo , beta Catenina
10.
Arch Dis Child ; 105(4): 399-405, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31900251

RESUMO

Hypocalcaemia is a common clinical scenario in children with a range of aetiological causes. It will often present with common symptoms but may occasionally be identified in an asymptomatic child. An understanding of the physiological regulation of plasma calcium is important in understanding the potential cause of hypocalcaemia and its appropriate management. The age of presentation will influence the likely differential diagnosis. We have presented a stepwise approach to the investigation of hypocalcaemia dependent on the circulating serum parathyroid hormone level at the time of presentation. The acute and long-term management of the underlying condition is also reviewed.


Assuntos
Hipocalcemia/sangue , Hormônio Paratireóideo/sangue , Complicações Pós-Operatórias/sangue , Doenças da Glândula Tireoide/terapia , Deficiência de Vitamina D/tratamento farmacológico , Cálcio/sangue , Cálcio/uso terapêutico , Criança , Humanos , Hipocalcemia/tratamento farmacológico , Hipocalcemia/terapia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Guias de Prática Clínica como Assunto , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/fisiopatologia , Tireoidectomia , Vitamina D/sangue , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações
11.
BMJ Case Rep ; 13(1)2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31969415

RESUMO

Rickets other than those associated with advanced kidney disease, isolated distal renal tubular acidosis (dRTA) and hypophosphatasia (defective tissue non-specific alkaline phosphatase) are associated with hypophosphatemia due to abnormal proximal tubular reabsorption of phosphate. dRTA, however, at times is associated with completely reversible proximal tubular dysfunction. On the other hand, severe hypophosphatemia of different aetiologies may also interfere with both distal tubular acid excretion and proximal tubular functions giving rise to transient secondary renal tubular acidosis (distal and/or proximal). Hypophosphatemia and non-anion gap metabolic acidosis thus pose a diagnostic challenge occasionally. A definitive diagnosis and an appropriate management of the primary defect results in complete reversal of the secondary abnormality. A child with vitamin D resistant rickets was thoroughly evaluated and found to have primary dRTA with secondary proximal tubular dysfunction in the form of phosphaturia and low molecular weight proteinuria. The child was treated only with oral potassium citrate. A complete clinical, biochemical and radiological improvement was noticed in follow-up.


Assuntos
Cálcio/uso terapêutico , Hipopotassemia/tratamento farmacológico , Hipofosfatemia/tratamento farmacológico , Citrato de Potássio/uso terapêutico , Raquitismo/tratamento farmacológico , Vitamina D/uso terapêutico , Criança , Ácido Cítrico/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos
12.
Ginebra; World Health Organization; 20200000. 48 p.
Monografia em Inglês | BIGG - guias GRADE | ID: biblio-1116755

RESUMO

The primary goal of this recommendation is to improve the quality of care and outcomes for pregnant women and women intending to become pregnant, particularly those related to prevention of pre-eclampsia, eclampsia and resulting complications. This recommendation may be of interest to professional societies involved in the care of pregnant women, nongovernmental organizations concerned with promoting people-centred pre-conception and maternal care, and implementers of maternal and child health and nutrition programmes. It aims to help in increasing capacity in the countries to respond to their needs on interventions before and/or early in pregnancy to prevent the risk of pre-eclampsia during pregnancy, and to prioritize essential actions in national health policies, strategies and plans.


Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Pré-Eclâmpsia/prevenção & controle , Pré-Eclâmpsia/tratamento farmacológico , Complicações na Gravidez/prevenção & controle , Cálcio/deficiência , Cálcio/uso terapêutico , Pessoal de Saúde/organização & administração , Serviços de Saúde Materno-Infantil/organização & administração , Prática Clínica Baseada em Evidências/métodos
14.
Med J Aust ; 211(10): 468-473, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31680267

RESUMO

Vitamin D is made in the skin when exposed to sunlight, so deficiency is usually the result of low sunlight exposure (eg, in frail older people and in individuals who are veiled). Calcium and/or vitamin D supplements have been used for the prevention and treatment of osteoporosis. The major trials in community-dwelling individuals have not demonstrated fracture prevention with either calcium, vitamin D, or their combination, but the results of a large study in vitamin D-deficient nursing home residents indicated a reduced fracture incidence. Trials show that vitamin D increases bone density when winter 25-hydroxyvitamin D levels are below 25-30 nmol/L. However, assay expense and variability suggest that supplements are better targeted based on clinical status to frail older people and possibly to people with dark skin living at higher latitudes. A daily dose of 400-800 units (10-20 µg) is usually adequate. Parenteral antiresorptive drugs can cause hypocalcaemia in severe vitamin D deficiency (< 25 nmol/L), which should therefore be corrected before treatment. Clinical trials have not demonstrated benefits of vitamin D on non-skeletal endpoints. Calcium supplements in healthy individuals are not needed, nor are they required in most people receiving treatment for osteoporosis, where they have not been shown to affect treatment efficacy. Calcium supplements cause constipation, bloating and kidney stones, and some evidence suggests they may cause a small increase in the risk of myocardial infarction. Low dose vitamin D is safe, but high doses result in more falls and fractures. Current evidence does not support the use of these supplements in healthy community-dwelling adults.


Assuntos
Cálcio , Vitamina D , Idoso , Densidade Óssea , Cálcio/administração & dosagem , Cálcio/efeitos adversos , Cálcio/deficiência , Cálcio/uso terapêutico , Fraturas Ósseas , Humanos , Vitamina D/administração & dosagem , Vitamina D/efeitos adversos , Vitamina D/uso terapêutico , Deficiência de Vitamina D
15.
Methodist Debakey Cardiovasc J ; 15(3): 207-213, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687100

RESUMO

Vitamin D has traditionally been known as the "bone vitamin". However, a large body of observational data has also linked low concentrations of serum 25-hydroxyvitamin D (25[OH]D), the primary storage form of vitamin D, to an increased risk of incident cardiovascular disease (CVD) and mortality, garnering public excitement about the purported nonskeletal benefits of vitamin D. Despite this, more recent meta-analyses and randomized clinical trials have failed to find a beneficial effect of vitamin D supplements on CVD and cancer outcomes. These findings, along with the lack of consensus on optimal serum 25(OH)D concentrations, have dampened some of the initial enthusiasm for vitamin D supplements. Residual confounding or reverse causation may explain some of the discrepancy between the observational and trial results. At this time, vitamin D supplements should not be prescribed for the primary purpose of CVD prevention. Adding to this complexity is the fact that many adults take vitamin D and calcium supplements together for bone health, and there is some concern (albeit inconclusive) related to calcium use and increased CVD risk. In this light, it may be best to achieve the recommended daily allowances of calcium intake through food and reserve calcium supplementation only for those at risk for calcium intake deficiency, with the smallest dosage needed after dietary modifications have been exhausted. In this review, we discuss vitamin D and calcium supplementation and how they may affect cardiovascular health.


Assuntos
Cálcio/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Suplementos Nutricionais , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/uso terapêutico , Animais , Biomarcadores/sangue , Cálcio/efeitos adversos , Cálcio/deficiência , Cálcio na Dieta/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Suplementos Nutricionais/efeitos adversos , Humanos , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Vitamina D/efeitos adversos , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia
16.
Bone Joint J ; 101-B(11): 1402-1407, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674239

RESUMO

AIMS: Bone health assessment and the prescription of medication for secondary fracture prevention have become an integral part of the acute management of patients with hip fracture. However, there is little evidence regarding compliance with prescription guidelines and subsequent adherence to medication in this patient group. PATIENTS AND METHODS: The World Hip Trauma Evaluation (WHiTE) is a multicentre, prospective cohort of hip fracture patients in NHS hospitals in England and Wales. Patients aged 60 years and older who received operative treatment for a hip fracture were eligible for inclusion in WHiTE. The prescription of bone protection medications was recorded from participants' discharge summaries, and participant-reported use of bone protection medications was recorded at 120 days following surgery. RESULTS: Of 5456 recruited patients with baseline data, 2853 patients (52%) were prescribed bone protection medication at discharge, of which oral bisphosphonates were the most common, 4109 patients (75%) were prescribed vitamin D or calcium, and 606 patients (11%) were not prescribed anything. Of those prescribed a bone protection medication, only 932 patients (33%) reported still taking their medication 120 days later. CONCLUSION: These data provide a reference for current prescription and adherence rates. Adherence with oral medication remains poor in patients with hip fracture. Cite this article: Bone Joint J 2019;101-B:1402-1407.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Fraturas do Quadril/cirurgia , Idoso , Cálcio/uso terapêutico , Estudos de Coortes , Denosumab/uso terapêutico , Difosfonatos/uso terapêutico , Humanos , Hidroxicolecalciferóis/uso terapêutico , Adesão à Medicação , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Teriparatida/uso terapêutico , Reino Unido , Vitamina D/uso terapêutico
17.
Bratisl Lek Listy ; 120(10): 789-793, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31663356

RESUMO

AIM: Lipid emulsions are promising with regard to the treatment of toxicity by agents of high lipophilic nature. Our objective is to investigate the efficacy of intralipid 20% and calcium administration at different times when symptoms of cardiac toxicity occur during verapamil infusion. METHOD: 24 adult male Spraque-Dawley rats were randomly divided into 4 different groups, the control group, calcium group, calcium following 20% intralipid group and concomitant 20% intralipid and calcium group. Following monitoring under ketamine anesthesia, all groups were administered 37.5 mg kg-1 h-1 verapamil infusion until a 50% decrease occurred in MAPb. At the end of the infusion, verapamil infusion was decreased down to 15 mg kg-1h-1 and the treatment agents predetermined for the groups were administered concomitantly. RESULTS: There is no statistically significant difference between the administration of 20% intralipid synchronized with calcium or as a pretreatment, but both groups provided a higher survival rate when compared to the other groups. CONCLUSIONS: The administration of calcium alone in verapamil toxicity is not sufficient; when calcium and 20% intralipid are administered together, there is no difference between the administration of lipid and calcium concomitantly and the administration of lipid prior to calcium (Tab. 1, Fig. 2, Ref. 23).


Assuntos
Cálcio/uso terapêutico , Fosfolipídeos/administração & dosagem , Óleo de Soja/administração & dosagem , Verapamil/toxicidade , Animais , Emulsões/administração & dosagem , Emulsões Gordurosas Intravenosas , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley
18.
BMJ Case Rep ; 12(10)2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31604721

RESUMO

A 39-year-old man was admitted to our hospital with the diagnosis of thyroid storm due to Graves' disease. Near-total thyroidectomy was performed after 1 month's pharmacological treatment, and he presented with tetany next morning. Serum corrected calcium value was 5.7 mg/dL. Procollagen type 1 N-terminal propeptide increased considerably, while tartrate-resistant acid phosphatase 5b decreased. These changes indicated that bone formation exceeded bone resorption in reverse after thyroidectomy. Calcium gluconate was administered intravenously for 14 days, before the patient was discharged. Oral administration of calcium and active forms of vitamin D was continued for 4 months. Rapid skeletal uptake of calcium from blood caused severe and persistent hypocalcaemia, which is called hungry bone syndrome. When patients with Graves' disease have severe thyrotoxicosis, high serum alkaline phosphatase levels and low bone mineral densities, they are at high risk for hungry bone syndrome after thyroidectomy, and should be educated for the symptoms of hypocalcaemia.


Assuntos
Doenças Ósseas Metabólicas/etiologia , Doença de Graves/complicações , Hipocalcemia/etiologia , Tireoidectomia/efeitos adversos , Tireotoxicose/complicações , Adulto , Doenças Ósseas Metabólicas/tratamento farmacológico , Cálcio/uso terapêutico , Doença de Graves/cirurgia , Humanos , Hipocalcemia/tratamento farmacológico , Masculino , Tireotoxicose/cirurgia , Vitamina D/uso terapêutico
19.
Acta otorrinolaringol. esp ; 70(5): 301-305, sept.-oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186374

RESUMO

El hipoparatiroidismo es la complicación más frecuente tras la tiroidectomía total. Se define por la presencia de hipocalcemia con unos niveles de hormona paratiroidea (PTH) bajos o inadecuadamente normales. La hipocalcemia aguda es una complicación potencialmente grave. Su tratamiento se basa, según la gravedad del cuadro, en la administración de calcio por vía oral o intravenosa, pudiendo requerir asimismo calcitriol oral. El riesgo de hipocalcemia sintomática tras una tiroidectomía es muy bajo si la PTH postoperatoria desciende menos del 80% respecto de la preoperatoria. Estos pacientes podrían ser dados de alta sin tratamiento, aunque los umbrales son variables entre laboratorios y recomendamos extremar la vigilancia en los casos de riesgo aumentado (enfermedad de Graves, grandes bocios, reintervenciones o constancia de la extirpación de alguna paratiroides). El tratamiento a largo plazo busca controlar los síntomas manteniendo la calcemia en el límite bajo de la normalidad, vigilando el producto calcio-fósforo y la aparición de hipercalciuria


Hypoparathyroidism is the most common complication after total or completion thyroidectomy. It is defined as the presence of hypocalcemia accompanied by low or inappropriately normal parathyroid hormone (PTH) levels. Acute hypocalcemia is a potential lethal complication. Hypocalcemia treatment is based on endovenous or oral calcium supplements as well as oral calcitriol, depending on the severity of the symptoms. The risk of clinical hypocalcemia after bilateral thyroidectomy is considered very low if postoperative intact PTH decrease less than 80% with respect to preoperative levels. These patients could be discharged home without treatment, although this threshold may vary between institutions, and we recommend close surveillance in cases with increased risk (Graves disease, large goiters, reinterventions or evidence of parathyroid gland removal). Long-term treatment objectives are to control the symptoms and to keep serum calcium levels at the lower limit of the normal range, while preserving the calcium phosphate product and avoiding hypercalciuria


Assuntos
Humanos , Hipoparatireoidismo/etiologia , Tireoidectomia/efeitos adversos , Calcitriol/uso terapêutico , Cálcio/sangue , Cálcio/uso terapêutico , Doença de Graves/cirurgia , Hipercalciúria/prevenção & controle , Hipercalciúria/terapia , Hiperfosfatemia/tratamento farmacológico , Hiperfosfatemia/etiologia , Hipocalcemia/etiologia , Hipoparatireoidismo/tratamento farmacológico , Hipoparatireoidismo/prevenção & controle , Cuidados Intraoperatórios , Glândulas Paratireoides/cirurgia , Glândulas Paratireoides/transplante , Hormônio Paratireóideo/sangue , Cuidados Pós-Operatórios , Reimplante
20.
Dtsch Med Wochenschr ; 144(16): 1120-1124, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31416103

RESUMO

Adequate intake of vitamin D and calcium are fundamental for the treatment of osteoporosis. A normal vitamin D status is required for optimal intestinal calcium absorption. However, general calcium and vitamin D supplementation is not sufficient for prevention of osteoporotic fractures in persons older than 50 years. Nevertheless, vitamin D deficiency should be avoided and corrected. In particular, parts of the population with increased risk for vitamin D deficiency (immobilized or older individuals, swarthy, migrants) should be tested. Secondary causes of vitamin D deficiency should be identified and treated.


Assuntos
Conservadores da Densidade Óssea , Osteoporose , Vitamina D , Conservadores da Densidade Óssea/administração & dosagem , Conservadores da Densidade Óssea/uso terapêutico , Cálcio/administração & dosagem , Cálcio/uso terapêutico , Suplementos Nutricionais , Humanos , Osteoporose/tratamento farmacológico , Osteoporose/fisiopatologia , Vitamina D/administração & dosagem , Vitamina D/uso terapêutico , Deficiência de Vitamina D
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