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1.
Med. clín (Ed. impr.) ; 154(5): 163-170, mar. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186628

RESUMO

Objetivos: Analizar el riesgo de fractura calculado por FRAX(R) y la frecuencia de alto riesgo de fractura en la población general en España. Métodos: EPISER2016 es un estudio transversal multicéntrico de base poblacional de la prevalencia de las enfermedades reumáticas en población adulta en España. Un total de 3.154 sujetos de edad igual o superior a 40 años (1.184 hombres y 1.970 mujeres) se seleccionaron mediante muestreo aleatorio estratificado. Las preguntas relacionadas con los factores de riesgo de fractura se realizaron mediante encuesta telefónica. El riesgo de fractura principal (RFP) y de cadera (RFC) se calcularon con la versión española de la herramienta FRAX(R), sin la inclusión de la densidad mineral ósea. Para definir alto riesgo de fractura, se utilizaron los umbrales RFP≥20%, RFP≥10%, RFP≥7,5% y RFC≥3%. Resultados: La mediana (rango intercuartílico) del RFP fue 2,61% (1,55-6,34%) en mujeres y 1,67% (1,15-2,87%) en hombres; la del RFC fue 0,39% (0,14-1,86%) y 0,18% (0,07-0,77%). El 3,83% de las mujeres y ningún hombre tenían un RFP≥20%; el 15,71% y el 1,14% tenían un RFP≥10%; el 20,62% y el 2,21%, un RFP≥7,5%; y el 19,27% y el 8,05%, un RFC≥3%. En las mujeres de 65 años o más, el RFC fue alto en el 58,09%. Conclusiones: EPISER2016 nos ha permitido conocer el riesgo de fractura calculado por FRAX(R) y la prevalencia de alto riesgo de fractura en la población general según los diversos umbrales utilizados en España


Objectives: To analyse the risk of fracture calculated by FRAX(R) and the frequency of high risk of fracture in the general population in Spain. Methods: EPISER2016 is a multicentre cross-sectional population-based study of the prevalence of rheumatic diseases in the adult population in Spain. 3,154 subjects aged ≥40 years (1,184 men and 1,970 women) were selected by stratified random sampling. The questions related to fracture risk factors were asked by telephone survey. The risk of major osteoporotic fracture (MOFR) and hip fracture (HFR) were calculated with the Spanish version of the FRAX(R) tool, without the inclusion of bone mineral density. To define high fracture risk, the MOFR≥20%, MOFR≥10%, MOFR≥7.5% and HFR≥3% thresholds were used. Results: The median (interquartile range) of the MOFR was 2.61% (1.55-6.34%) in women and 1.67% (1.15-2.87%) in men, whereas that of the HFR was 0.39% (0.14-1.86%) and 0.18% (0.07-0.77%); 3.83% of women and no men had a MOFR≥20%; 15.71% and 1.14% had a MOFR≥10%; 20.62% and 2.21%, a MOFR≥7.5%; and 19.27% and 8.05%, an HFR≥3%. In women aged 65 and over, the HFR was high in 58.09%. Conclusions: EPISER2016 enabled us to establish the risk of fracture calculated by FRAX(R) and the prevalence of high risk of fracture in the general population according to the different thresholds used in Spain


Assuntos
Humanos , Masculino , Feminino , Adulto , Fraturas Ósseas/diagnóstico , Algoritmos , Fatores de Risco , Medição de Risco/métodos , Fraturas Ósseas/etiologia , Espanha , Estudos Transversais , Inquéritos e Questionários
2.
Medicine (Baltimore) ; 99(8): e19120, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080087

RESUMO

Osteoporosis (OP) is a disease characterized by bone mass loss, bone microstructure damage, increased bone fragility, and easy fracture. The molecular mechanism underlying OP remains unclear.In this study, we identified 217 genes associated with OP, and formed a gene set [OP-related genes gene set (OPgset)].The highly enriched GOs and pathways showed OPgset genes were significantly involved in multiple biological processes (skeletal system development, ossification, and osteoblast differentiation), and several OP-related pathways (Wnt signaling pathway, osteoclast differentiation, steroid hormone biosynthesis, and adipocytokine signaling pathway). Besides, pathway crosstalk analysis indicated three major modules, with first module consisted of pathways mainly involved in bone development-related signaling pathways, second module in Wnt-related signaling pathway and third module in metabolic pathways. Further, we calculated degree centrality of a node and selected ten key genes/proteins, including TGFB1, IL6, WNT3A, TNF, PTH, TP53, WNT1, IGF1, IL10, and SERPINE1. We analyze the K-core and construct three k-core sub-networks of OPgset genes.In summary, we for the first time explored the molecular mechanism underlying OP via network- and pathway-based methods, results from our study will improve our understanding of the pathogenesis of OP. In addition, these methods performed in this study can be used to explore pathogenesis and genes related to a specific disease.


Assuntos
Osso e Ossos/patologia , Fraturas Ósseas/etiologia , Osteoporose/genética , Adipocinas/genética , Densidade Óssea/genética , Osso e Ossos/metabolismo , Osso e Ossos/ultraestrutura , Diferenciação Celular/genética , Biologia Computacional/métodos , Regulação da Expressão Gênica/genética , Redes Reguladoras de Genes/genética , Humanos , Osteoblastos/fisiologia , Osteoclastos/fisiologia , Osteogênese/genética , Osteoporose/complicações , Osteoporose/epidemiologia , Prevalência , Via de Sinalização Wnt/genética
3.
Medicine (Baltimore) ; 99(4): e18789, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977870

RESUMO

Clinical features of extremity fractures (EFs) in patients presenting with traumatic spinal fractures (TSFs) and spinal cord injury (SCI) have not been investigated. To investigate the clinical features and risk factors for EFs in patients presenting with TSFs and SCI.Data from 1392 patients presenting with TSFs and SCI in our hospitals between 2001 and 2010 were retrospectively reviewed, among which 165 patients (129 males and 36 females, 37.5 ±â€Š10.6 years old) presented with EFs. The clinical features of EFs have been investigated.The frequencies of upper limb fractures were significantly higher in the motor vehicle collisions (MVCs) group than in the high-fall group (P = .012) and the struck-by-object group (P = .002). The frequencies of lower limb fractures were significantly higher in the struck-by-object group (P = .019) and the high-fall group (P = .011) than the MVCs group. Univariate logistic regression analysis show that being in the 19 to 39 age group (P = .001), having a lumbar spinal fracture (P < .001) and experiencing a high fall (P < .001) were risk factors for EFs. Multivariate logistic regression analysis showed that we should focus on the factors that having a lumbar spinal fracture and experiencing a high fall.High fall and MVCs were the most common aetiologies for EFs. Having a lumbar spinal fracture and experiencing a high fall were significant risk factors for EFs. We should make early diagnoses and initiate timely treatment according to different patterns of extremity fractures in patients with TSFs and SCI.


Assuntos
Fraturas Ósseas/epidemiologia , Extremidade Inferior/lesões , Fraturas da Coluna Vertebral/epidemiologia , Extremidade Superior/lesões , Acidentes/estatística & dados numéricos , Adulto , Fatores Etários , Feminino , Fraturas Ósseas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia
4.
Int J Radiat Oncol Biol Phys ; 106(3): 485-492, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31610251

RESUMO

PURPOSE: Older patients undergoing radiation therapy (RT) for pelvic malignancies are at increased risk for pelvic fracture, which is associated with significant morbidity and mortality. RT techniques such as brachytherapy or intensity modulated RT (IMRT) allow for more conformal dose distributions, but it is not known whether the risk for pelvic fracture varies by RT modality. METHODS AND MATERIALS: This observational cohort study involved 28,354 patients ≥65 years old, treated with RT for pelvic malignancies. We evaluated the relative risk of pelvic fracture by type of RT when accounting for baseline factors. To test for nonspecific effects, we also evaluated risk of nonpelvic fractures in the same population. RESULTS: The 5-year incidence of pelvic fractures was 12.7% (95% confidence interval [CI], 11.6%-13.8%), 11.8% (10.8%-12.8%), and 3.7% (3.4%-4.0%) for patients with gastrointestinal, gynecologic, and prostate cancer, respectively. On multivariable analysis, being treated with IMRT (hazard ratio, 0.85; 95% CI, 0.73-0.99) or brachytherapy therapy alone (hazard ratio, 0.43; 95% CI, 0.34-0.54) was associated with a reduced hazard for pelvic fractures compared with 3D conformal radiation therapy in female patients. In contrast, there was no association with RT modality and the hazard for nonpelvic fractures among females. There was no significant association between pelvic fractures and IMRT or brachytherapy for male patients. White race, advanced age, and higher comorbidity were associated with an increased hazard for pelvic fracture. CONCLUSIONS: IMRT and brachytherapy were associated with a reduced risk of pelvic fractures in older women undergoing RT for pelvic malignancies. Pelvic insufficiency fracture risk should be considered when treating with pelvic RT.


Assuntos
Braquiterapia/efeitos adversos , Fraturas Ósseas/etiologia , Ossos Pélvicos/lesões , Neoplasias Pélvicas/radioterapia , Radioterapia Conformacional/efeitos adversos , Fatores Etários , Idoso , Estudos de Coortes , Intervalos de Confiança , Grupo com Ancestrais do Continente Europeu , Feminino , Fraturas Ósseas/epidemiologia , Neoplasias Gastrointestinais/radioterapia , Neoplasias dos Genitais Femininos/radioterapia , Humanos , Incidência , Masculino , Ossos Pélvicos/efeitos da radiação , Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada/efeitos adversos , Análise de Regressão , Risco , Fatores Sexuais
5.
Int J Radiat Oncol Biol Phys ; 106(3): 475-484, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31580930

RESUMO

PURPOSE: To estimate the overall rate, symptomatic proportion, and most common sites of pelvic insufficiency fracture (PIF) after external beam radiation therapy for gynecologic cancers based on posttreatment computed tomography, magnetic resonance imaging, positron emission tomography, or bone scintigraphy. METHODS AND MATERIALS: A systematic search of databases (PubMed and EMBASE) was performed (CRD42019125679). The pooled summary of overall PIF and the proportion of symptomatic cases were calculated using the random-effects model weighted by the inverse variance. A multivariate meta-regression was performed to evaluate potential sources of heterogeneity regarding PIF fractures. RESULTS: Twenty-one studies met the inclusion criteria (total 3929 patients). Five hundred four patients developed PIF, translating to an overall rate of 14% (95% confidence interval, 10%-18%, based on 21 studies). Among these cases with PIF, the proportion of symptomatic patients was 61% (95% confidence interval, 52%-69%, based on 14 studies). The total number of PIFs was 704 (mean, 1.72 PIFs per each patient to develop PIF, based on 14 studies). More recent series (P = .0074) and the use of intensity modulated radiation therapy (P = .0299) were associated with lower fracture rates. The most common fracture sites were sacroiliac joint (39.7%), body of the sacrum (33.9%), pubis (13%), lumbar vertebra (7%), iliac bone (2.8%), acetabulum (2.1%), and femoral head/neck (1.5%). The median time to fracture was 7.1 to 19 months after radiation therapy. CONCLUSIONS: The incidence of PIF after radiation therapy for gynecologic cancers is high (14%), with the majority affecting the sacral bone or joint (73.6%), although this risk appears to be lower with intensity modulated radiation therapy. Posttreatment bone surveillance is warranted in this population because nearly 40% of patients were asymptomatic at the time of PIF diagnosis.


Assuntos
Fraturas Ósseas/epidemiologia , Fraturas Espontâneas/epidemiologia , Neoplasias dos Genitais Femininos/radioterapia , Ossos Pélvicos/lesões , Intervalos de Confiança , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Neoplasias dos Genitais Femininos/diagnóstico por imagem , Humanos , Ossos Pélvicos/efeitos da radiação , Radioterapia de Intensidade Modulada , Análise de Regressão
6.
Acta Neurol Scand ; 141(1): 47-55, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550049

RESUMO

OBJECTIVES: To estimate the incidence of fractures, possibly caused by falls, in patients aged 65 and older with first episode of stroke, and to estimate the incidence of fracture types for this group of patients. Another objective was to investigate stroke severity and marital status, as risk factors for fractures. MATERIALS AND METHODS: A large retrospective dataset of 116 519 patients with first episode of stroke was extracted from the Danish Stroke Registry between January 2003 and December 2017. The occurrence of fractures was identified in the Danish National Patient Registry. A univariate analysis was conducted and a multivariate analysis was conducted to determine the relationship between stroke severity and fractures, and marital status and fractures, adjusting for multiple confounders. Cox regression with time-varying covariates was used, taking time-dependent variables into account. RESULTS: The incidence rate of fractures post-stroke was 41.07 per 1000 person-years between 2003 and 2017 in Denmark. A total of 15 872 (14.86%) sustained a fracture and the mean time at risk until outcome was 3.67 years post-stroke. Femur fracture was the most common fracture type. Mild, moderate, severe, and unknown stroke severity are associated with fractures after stroke compared to very severe stroke, and living alone at the time of stroke is associated with fractures after stroke compared to living with someone. CONCLUSIONS: The incidence rate of fractures in Denmark was 41.07 per 1000 person-years. Moreover, mild, moderate, and severe stroke severity, and living alone at the time of stroke were found to be risk factors for fracture.


Assuntos
Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Acidente Vascular Cerebral/complicações , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Feminino , Humanos , Incidência , Masculino , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco
8.
Maturitas ; 130: 41-49, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31706435

RESUMO

Turner syndrome is one of the most common sex chromosomal anomalies, characterized by the complete or partial loss of one X chromosome. Females with Turner syndrome are characterized by skeletal abnormalities, short stature and primary ovarian insufficiency. The aim of this narrative review was to identify the underlying mechanisms of osteoporosis in Turner syndrome, summarize its clinical manifestations and provide suggestions regarding the management of osteoporosis. Girls and women with Turner syndrome have lower bone mineral density and a higher fracture rate than healthy individuals. The most important risk factors for osteoporosis are inadequately treated primary ovarian insufficiency, followed by intrinsic bone abnormalities. Comorbidities that further increase the risk of osteoporosis include vitamin D deficiency, celiac disease and inflammatory bowel disease. In addition, hearing problems can predispose to falls. Early initiation of hormone replacement therapy (HRT) at the age of 11-13 years, prompt titration to the adult dose after 2 years and long-term follow-up to ensure compliance with HRT are the cornerstones of osteoporosis prevention in women with Turner syndrome.


Assuntos
Terapia de Reposição Hormonal , Osteoporose/etiologia , Osteoporose/prevenção & controle , Síndrome de Turner/complicações , Densidade Óssea , Osso e Ossos/anormalidades , Doença Celíaca/complicações , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Humanos , Doenças Inflamatórias Intestinais/complicações , Menopausa Precoce , Insuficiência Ovariana Primária/complicações , Síndrome de Turner/diagnóstico , Síndrome de Turner/tratamento farmacológico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/tratamento farmacológico
9.
Am Surg ; 85(10): 1089-1093, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657300

RESUMO

Older adults undergoing nonelective surgery are at risk for geriatric events (GEs: delirium, dehydration, falls/fractures, failure to thrive, and pressure ulcers), but the impact of GEs on postoperative outcomes is unclear. Using the 2013 to 2014 National Inpatient Sample, we analyzed nonelective hospital admissions for five common operations (laparoscopic cholecystectomy, colectomy, soft tissue debridement, small bowel resection, and laparoscopic appendectomy) in older adults (aged ≥65 years) and a younger referent group (aged 55-64 years). Nationally weighted descriptive statistics were generated for GEs. Logistic regression controlling for patient, procedure, and hospital characteristics estimated the association of 1) age with GEs and 2) GEs with outcomes. Of 471,325 overall admissions, 64.7 per cent were aged ≥65 years. The rate of any GE in older adults was 26.9 per cent; GEs varied by age and procedure (P < 0.001). After adjustment, the probability of any GE increased with age category (P < 0.001); having any GE was associated with higher probability of all outcomes (P < 0.001): mortality (4.5% vs 0.8%), postoperative complications (61.7% vs 24.9%), prolonged length of stay (24.3% vs 7.9%), and skilled nursing facility discharge (46.6% vs 10.3%). In addition, there was a dose-response relationship between GEs and negative outcomes. GEs are prevalent in the nonelective surgery setting and associated with worse clinical outcomes. Quality improvement efforts should focus on addressing GEs.


Assuntos
Apendicectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Colectomia/efeitos adversos , Desbridamento/efeitos adversos , Intestino Delgado/cirurgia , Complicações Pós-Operatórias/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Fatores Etários , Idoso , Apendicectomia/estatística & dados numéricos , Colecistectomia Laparoscópica/estatística & dados numéricos , Colectomia/estatística & dados numéricos , Desbridamento/estatística & dados numéricos , Desidratação/epidemiologia , Desidratação/etiologia , Delírio/epidemiologia , Delírio/etiologia , Insuficiência de Crescimento/epidemiologia , Insuficiência de Crescimento/etiologia , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Resultado do Tratamento
10.
J S Afr Vet Assoc ; 90(0): e1-e7, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31588759

RESUMO

A definitive diagnosis of extensive suture line exostoses affecting the nasofrontal, nasolacrimal, nasomaxillary, frontolacrimal, lacrimozygomatic and lacrimomaxillary suture lines in a 7-year-old Thoroughbred mare with chronic bilateral epiphora and facial deformation was achieved using standing computed tomography (CT) examinations. Positive contrast dacryocystorhinography using CT revealed partial bilateral obstruction of the nasolacrimal ducts. Minimally displaced depression fractures of the right nasal bone, the right maxillary bone and right frontal bone were also demonstrated. The cosmetic appearance of the periosteal reaction associated with the suture line exostosis and epiphora significantly improved within 3 months of diagnosis and treatment.


Assuntos
Exostose/veterinária , Fraturas Ósseas/veterinária , Traumatismos Cranianos Fechados/veterinária , Doenças dos Cavalos/etiologia , Cavalos/lesões , Obstrução dos Ductos Lacrimais/veterinária , Animais , Exostose/etiologia , Exostose/terapia , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Traumatismos Cranianos Fechados/complicações , Doenças dos Cavalos/diagnóstico por imagem , Doenças dos Cavalos/terapia , Obstrução dos Ductos Lacrimais/complicações , Obstrução dos Ductos Lacrimais/diagnóstico por imagem , Ducto Nasolacrimal/lesões , África do Sul , Resultado do Tratamento
11.
Eur J Radiol ; 120: 108694, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31593844

RESUMO

PURPOSE: To evaluate the clinical, radiological and periprocedural features associated with the occurrence or worsening of acetabular fracture (OWAF) following percutaneous cementoplasty of the acetabulum (PCA) in cancer patients. METHOD: All patients who underwent PCA in our comprehensive cancer center for an acetabular metastasis between January 2008 and December 2015 were included. Clinical features, characteristics of the metastasis on computed tomography (CT-scan) (location [roof, quadrilateral surface, anterior and posterior columns], number of locations, matrix, extra/intra-articular fractures, extra-osseous or subchondral extensions) and of the procedure (extra- or intra-articular cement leakage (IACL), percentage of filling of each location, complications) were reported as well as prior, concomitant or post-PCA treatments. The endpoint was OWAF on CT-scan during post-PCA follow-up. Log-rank tests and Cox models were used to identify prognostic factors. RESULTS: 140 PCA were identified in 129 patients (11 bilateral procedures, median age: 66.6). Eighteen (18/140, 12.9%) had an initial articular fracture. IACL was seen in 12/140 (8.6%) PCA. The only feature associated with IACL was a pre-existing articular fracture (p = 0.009). Of the 111 patients with imaging follow-ups, 18 (16.2%) showed OWAF. In multivariate analysis, the presence of cement filling (even partial) of all acetabular metastatic locations was the only feature predictive of OWAF-free survival (hazard ratio = 3.8, p = 0.031). CONCLUSIONS: Injecting cement in all areas affected by acetabular metastases could prevent OWAF. Because survival following PCA is not negligible, completing an insufficient first PCA could help preserve patients' quality of life.


Assuntos
Acetábulo/lesões , Neoplasias Ósseas/complicações , Neoplasias Ósseas/terapia , Cementoplastia/efeitos adversos , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Acetábulo/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico por imagem , Cementoplastia/métodos , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Transplant Proc ; 51(8): 2704-2709, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31477421

RESUMO

BACKGROUND: There is a high risk of fracture after kidney transplantation (KT). Recipients of KT are susceptible to persistent hyperparathyroidism and other disorders of bone and mineral metabolism. However, the risk factors for fractures after KT remain uncertain. The aim of the present study was to investigate the risk factors for fracture after KT. METHODS: A total of 941 recipients of KT were enrolled from a multicenter observational cohort study in Korea from 2012 to 2016. The biochemical markers were measured at the time of KT, then annually for 5 years following KT. All fracture events were recorded. A Cox proportional hazards analysis was performed to calculate hazard ratios (HR) for the association of risk factors with fractures. RESULTS: Twenty-two fractures had occurred in 20 patients during the study period. Baseline and serial changes of mineral and bone biochemical markers were similar between fracture and nonfracture patient groups. Among the total study population, 104 patients were diagnosed with osteoporosis and 422 patients were diagnosed with osteopenia in a pretransplant bone mineral density test. In a multivariate Cox analysis, pretransplant osteoporosis (HR = 11.76; 95% confidence interval [CI], 2.28-60.69; P = .003) and pretransplant osteopenia (HR = 5.21; 95% CI, 1.15-23.57; P = .032) were independent risk factors for fracture in recipients of KT. CONCLUSIONS: Pretransplant osteoporosis and osteopenia were independent risk factors for fracture after KT. More careful monitoring of bone mineral density before and after KT might be beneficial to predict the risk for fracture after KT.


Assuntos
Doenças Ósseas Metabólicas/complicações , Fraturas Ósseas/etiologia , Transplante de Rim , Osteoporose/complicações , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Doenças Ósseas Metabólicas/epidemiologia , Estudos de Coortes , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Modelos de Riscos Proporcionais , República da Coreia , Fatores de Risco
13.
BMJ ; 366: l4892, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481394

RESUMO

OBJECTIVE: To explore whether thyroid stimulating hormone (TSH) concentration in patients with a diagnosis of hypothyroidism is associated with increased all cause mortality and a higher risk of cardiovascular disease and fractures. DESIGN: Retrospective cohort study. SETTING: The Health Improvement Network (THIN), a database of electronic patient records from UK primary care. PARTICIPANTS: Adult patients with incident hypothyroidism from 1 January 1995 to 31 December 2017. EXPOSURE: TSH concentration in patients with hypothyroidism. MAIN OUTCOME MEASURES: Ischaemic heart disease, heart failure, stroke/transient ischaemic attack, atrial fibrillation, any fractures, fragility fractures, and mortality. Longitudinal TSH measurements from diagnosis to outcomes, study end, or loss to follow-up were collected. An extended Cox proportional hazards model with TSH considered as a time varying covariate was fitted for each outcome. RESULTS: 162 369 patients with hypothyroidism and 863 072 TSH measurements were included in the analysis. Compared with the reference TSH category (2-2.5 mIU/L), risk of ischaemic heart disease and heart failure increased at high TSH concentrations (>10 mIU/L) (hazard ratio 1.18 (95% confidence interval 1.02 to 1.38; P=0.03) and 1.42 (1.21 to 1.67; P<0.001), respectively). A protective effect for heart failure was seen at low TSH concentrations (hazard ratio 0.79 (0.64 to 0.99; P=0.04) for TSH <0.1 mIU/L and 0.76 (0.62 to 0.92; P=0.006) for 0.1-0.4 mIU/L). Increased mortality was observed in both the lowest and highest TSH categories (hazard ratio 1.18 (1.08 to 1.28; P<0.001), 1.29 (1.22 to 1.36; P<0.001), and 2.21 (2.07 to 2.36; P<0.001) for TSH <0.1 mIU/L, 4-10 mIU/L, and >10 mIU/L. An increase in the risk of fragility fractures was observed in patients in the highest TSH category (>10 mIU/L) (hazard ratio 1.15 (1.01 to 1.31; P=0.03)). CONCLUSIONS: In patients with a diagnosis of hypothyroidism, no evidence was found to suggest a clinically meaningful difference in the pattern of long term health outcomes (all cause mortality, atrial fibrillation, ischaemic heart disease, heart failure, stroke/transient ischaemic attack, fractures) when TSH concentrations were within recommended normal limits. Evidence was found for adverse health outcomes when TSH concentration is outside this range, particularly above the upper reference value.


Assuntos
Doenças Cardiovasculares/epidemiologia , Fraturas Ósseas/epidemiologia , Hipotireoidismo/tratamento farmacológico , Tireotropina/sangue , Tiroxina/administração & dosagem , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/complicações , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Glândula Tireoide/metabolismo , Tireotropina/metabolismo , Tireotropina/normas
14.
J Korean Med Sci ; 34(35): e224, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31496139

RESUMO

BACKGROUND: There have been equivocal results in studies of the effects of dipeptidyl peptidase-4 inhibitors (DPP-4i) on fractures. In this study, we analyzed the effect of DPP-4i on bone fracture risk in a Korean population. METHODS: We extracted subjects (n = 11,164) aged 50 years or older from the National Health Insurance Service-National Sample Cohort 2.0 from 2009 to 2014. Our control group included subjects without diabetes (n = 5,582), and our treatment groups with diabetes included DPP-4i users (n = 1,410) and DPP-4i non-users (n = 4,172). The primary endpoint was the incidence of a composite outcome consisting of osteoporosis diagnosis, osteoporotic fractures, vertebral fractures, non-vertebral fractures, and femoral fractures. The secondary endpoint was the incidence of each individual component of the composite outcome. Survival analysis was performed with adjustment for age, gender, diabetes complications severity index, Charlson comorbidity index, hypertension medication, and dyslipidemia treatment. RESULTS: The incidence of the composite outcome per 1,000 person-years was 0.089 in DPP-4i users, 0.099 in DPP-4i non-users, and 0.095 in controls. There was no significant difference in fracture risk between DPP-4i users and DPP-4i non-users or controls after the adjustments (P > 0.05). The incidences of osteoporosis diagnosis, osteoporotic fractures, vertebral fractures, non-vertebral fractures, and femoral fractures were not significantly different between DPP-4i users and non-users. The results of subgroup analyses by gender and age were consistent. CONCLUSION: DPP-4i had no significant effect on the risk of fractures in a Korean population.


Assuntos
Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Fraturas Ósseas/diagnóstico , Hipoglicemiantes/efeitos adversos , Idoso , Estudos de Coortes , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Humanos , Hipoglicemiantes/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/etiologia , República da Coreia/epidemiologia , Fatores de Risco
15.
Eur J Endocrinol ; 181(5): 509-517, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31484162

RESUMO

Introduction: The role of vitamin D on bone microarchitecture and fragility is not clear. Objective: To investigate whether vitamin D deficiency (25(OH)D <20 ng/mL) increases cortical bone loss and the severity of fractures. Design: Cross-sectional study of 287 elderly women with at least one prevalent low-impact fracture. Methods: Biochemistry, X-rays to identify vertebral fractures (VFs) and to confirm non-vertebral fractures (NonVFs), and high-resolution peripheral quantitative computed tomography (HR-pQCT) to evaluate bone microstructure. Results: Serum 25(OH)D levels were associated with body mass index (BMI: r = -0.161, P = 0.006), PTH (r = -0.165; P = 0.005), CTX (r = -0.119; P = 0.043) and vBMD at cortical bone (Dcomp: r = 0.132; P = 0.033) and entire bone (D100: r = 0.162 P = 0.009) at the distal radius, but not at the tibia. Age and PTH levels were potential confounding variables, but in the multiple linear regressions only BMI (95% CI: 0.11-4.16; P < 0.01), 25(OH)D (95% CI: -0.007 to 1.70; P = 0.05) and CTX (95% CI: -149.04 to 21.80; P < 0.01) predicted Dcomp, while BMI (95% CI: 1.13-4.18; P < 0.01) and 25(OH)D (95% CI: 0.24-1.52; P < 0.01) predicted D100. NonVFs predominated in patients with 25(OH)D <20 ng/mL (P = 0.013). Logistic regression analysis showed a decrease in the likelihood of presenting grade 2-3 VFs/NonVFs for every increase in 25(OH)D (OR = 0.962, 95% CI: 0.940-0.984; P = 0.001), BMI (OR = 0.932, 95% CI: 0.885-0.981; P = 0.007) and D100 at radius (OR = 0.994, 95% CI: 0.990-0.998; P = 0.005). Conclusion: In elderly patients with prevalent fractures, vitamin D deficiency was associated with cortical bone loss and severity of fractures.


Assuntos
Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Osteoporose/epidemiologia , Osteoporose/etiologia , Deficiência de Vitamina D/complicações , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Hormônio Paratireóideo/sangue , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia
16.
BMC Musculoskelet Disord ; 20(1): 404, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484522

RESUMO

BACKGROUND: Areal bone mineral density (aBMD) estimated by dual-energy X-ray absorptiometry (DXA) is used to estimate peak bone mass, define osteoporosis and predict fracture. However, as aBMD is calculated as bone mineral content (BMC) divided by the scanned area, aBMD displays an inverse relationship with bone size. In a skeleton that is increasing in size, this is a problem, as bone size is an independent factor that determines bone strength. It could therefore be questioned whether peak aBMD is the period with greatest bone strength, a period that in the hip then would occur in ages 16-19. The aim of this study was to evaluate whether there are changes in bone size in men after age 18 that may influence peak bone strength. Another aim was to provide updated normative DXA data. METHODS: We scanned left femoral neck by DXA in a cross-sectional study with a population-based selection of 1052 men aged 18-28, and then registered bone mineral content (BMC, gram), aBMD (gram/cm2) and bone area (cm2) in each one-year age group. We performed analyses of variance (ANOVA) to evaluate whether there were differences in these traits between the age groups. We then used Pearson's correlation analyses to test for trends with ageing after peak bone mass was reached. RESULTS: We found the highest absolute femoral neck aBMD at age 19, with statistically significant differences between the one-year age groups in BMC, aBMD, and bone area (all p < 0.05). From peak bone mass onwards (n = 962), there are negative correlations between age and BMC (r = - 0.07; p < 0.05) and age and aBMD (r = - 0.12; p < 0.001), and positive correlation between age and bone area (r = 0.06; p < 0.05). CONCLUSION: As femoral neck bone size in young adult men becomes larger after peak bone mass, it could be questioned whether DXA estimated peak aBMD correlates with peak bone strength. We infer that aBMD must be interpreted with care in individuals with a growing skeleton, since skeletal strength may then increase, in spite of decreasing aBMD. This should be taken into account when performing DXA measurements in these ages.


Assuntos
Absorciometria de Fóton , Envelhecimento/fisiologia , Densidade Óssea/fisiologia , Colo do Fêmur/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Análise de Variância , Estudos Transversais , Estudos de Viabilidade , Colo do Fêmur/crescimento & desenvolvimento , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Humanos , Incidência , Masculino , Osteoporose/complicações , Osteoporose/diagnóstico , Medição de Risco/métodos , Suécia/epidemiologia , Adulto Jovem
17.
Medicine (Baltimore) ; 98(33): e16900, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415435

RESUMO

RATIONALE: Spontaneous closed extensor tendon rupture is a rare complication of Kienböck disease with only 23 cases reported in the English literature. PATIENT CONCERNS: We present a case of painless attritional rupture of the extensor tendons of the right fourth finger in a 69-year-old woman with Kienböck disease and review reported cases of Kienböck disease with subcutaneous closed tendon rupture. DIAGNOSES: Physical examination had shown mild painless swelling of the dorsum of the right hand. Plain radiographs showed a dorsally displaced fragment of collapsed lunate bone fracture (Lichtman grade IIIb). Although surgery was recommended, the patient did not desire surgery because she had no pain and no interference with the activities of daily living. Six months later, however, the patient returned to our hospital with complaints of loss of spontaneous extension of the fourth finger. CT and MRI showed aseptic necrosis and large dorsally displaced fragments of the lunate under the extensor tendons of the fingers, suggesting a subcutaneous fourth extensor tendon rupture. INTERVENTIONS: Surgery was performed to achieve functional recovery of the ring extensor and to prevent further subcutaneous tendon rupture. The extensor digitorum communis (EDC) of the ring finger was found to be ruptured and the EDCs to the third and fifth fingers were frayed due to attrition from the protrusion of the dorsal fragmented lunate bone. Inspection of the floor of the compartment revealed that the dorsally displaced fragment of the lunate bone had perforated the wrist capsule and protruded into the fourth compartment. The dorsal and volar fragments of the lunate bone were excised completely and scaphocapitate arthrodesis followed by the reconstruction of the fourth extensor tendon was performed. OUTCOMES: A year after the surgery, radiography showed complete union of the scaphocapitate arthrodesis. The joint motion reached 45% of normal without any pain and there was full active extension of the fourth finger. LESSONS: Because dorsally displacement of collapsed lunate bone fragments is a risk factor for attritional closed rupture of tendons, radiography, and MRI are essential to diagnose and to treat any closed tendon rupture.


Assuntos
Fraturas Ósseas/etiologia , Osso Semilunar/lesões , Osteonecrose/complicações , Ruptura Espontânea/etiologia , Idoso , Doenças Assintomáticas , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/cirurgia , Osteonecrose/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Tendões/cirurgia , Tomografia Computadorizada por Raios X
18.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439552

RESUMO

Bilateral acetabular fractures following epileptic seizures are a rare but known occurrence in adults, with an 18.5% mortality rate. These fractures occurring post epileptic seizures have not been previously documented in children. We report a case of a 13-year-old boy who presented to hospital via ambulance following two violent generalised tonic-clonic seizures in a postictal state, metabolically acidotic and a low haemoglobin. Acute abdomen was suspected and the patient underwent a CT scan which showed bilateral acetabular fractures with central dislocations of both femoral heads and free fluid in the abdomen. The patient underwent initial damage control intervention with insertion of bilateral distal femur skeletal traction. Definitive fixation of the acetabular fractures occurred 1 week later with an open reduction internal fixation with novel supra-pectineal plates using a Pfannenstiel incision. We use this report to increase awareness of significant pelvic injuries in paediatric patients post epileptic seizures.


Assuntos
Acetábulo/lesões , Fraturas Ósseas/diagnóstico , Convulsões/complicações , Adolescente , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Humanos , Masculino , Tomografia Computadorizada por Raios X
19.
Injury ; 50(8): 1423-1428, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31256910

RESUMO

There has been very limited analysis of the relationship between obesity and fractures in the orthopaedic literature. It has been established for some years that underweight individuals are at greater risk of proximal femoral fractures but recently there has been interest in the susceptibility of obese post-menopausal females to fracture. We have undertaken an analysis of 4886 adult patients who presented with a fracture and had their BMI assessed. Analysis has confirmed the relationship between underweight individuals and proximal femoral fractures but there is also a negative association between obesity and clavicle fractures in males and females and with calcaneal fractures in females. There is a positive relationship between obesity and proximal humeral, finger phalangeal and ankle fractures in males and with humeral diaphyseal, carpal and ankle fractures in females. There was no relationship found between open or multiple fractures and obesity.


Assuntos
Densidade Óssea/fisiologia , Fraturas Ósseas/epidemiologia , Obesidade/epidemiologia , Fraturas por Osteoporose/epidemiologia , Magreza/epidemiologia , Adulto , Índice de Massa Corporal , Calcâneo/lesões , Clavícula/lesões , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/fisiopatologia , Inquéritos Epidemiológicos , Humanos , Úmero/lesões , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/fisiopatologia , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/fisiopatologia , Prevalência , Escócia/epidemiologia , Fatores Sexuais , Ossos do Tarso/lesões , Magreza/complicações , Magreza/fisiopatologia
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