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1.
Orthopade ; 49(4): 363-376, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32193562

RESUMO

Osteoporosis is a very common disease all over the world, in which a reduction in bone density can lead to an increased risk of fractures and a diminished physical height. Osteoporosis is also associated with acute and chronic pain, which especially occurs in the back and can significantly reduce the quality of life. To provide sufficient care for affected patients, it is essential to know the particularities of pain management in osteoporosis, such as pharmacological and nonpharmacological treatment options. This article gives a comprehensive review of pain management in osteoporosis and also explains the underlying pathomechanisms, risk factors, and diagnostic procedures.


Assuntos
Conservadores da Densidade Óssea , Fraturas Ósseas , Osteoporose/terapia , Manejo da Dor , Dor nas Costas/tratamento farmacológico , Densidade Óssea , Cálcio/administração & dosagem , Terapia de Reposição de Estrogênios , Terapia por Exercício , Fraturas Ósseas/prevenção & controle , Humanos , Osteoporose/diagnóstico , Osteoporose/psicologia , Qualidade de Vida , Vitamina D/administração & dosagem
2.
Nurse Pract ; 45(3): 50-55, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32068658

RESUMO

Bisphosphonates have been safely used to treat osteoporosis, effectively reducing fracture risk after 3 to 5 years of treatment. Recent concerns about long-term safety coupled with posttreatment fracture risk reduction have increased support for drug holidays. The decision to start low-risk patients on drug holidays must be based on current fracture risk assessment.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/uso terapêutico , Suspensão de Tratamento , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Esquema de Medicação , Duração da Terapia , Fraturas Ósseas/prevenção & controle , Humanos , Osteoporose/tratamento farmacológico , Medição de Risco
5.
Surgery ; 167(1): 155-159, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31604587

RESUMO

BACKGROUND: Our study seeks to find a cost-saving screening strategy in a primary care population for diagnosing primary hyperparathyroidism based on peak serum total calcium level, age, and patient sex. METHODS: Laboratory data resulting from primary care office visits at our institution between January 2016 through December 2017 to evaluate patients who had at least 1 episode of hypercalcemia (≥10.5 mg/dL). For each serum calcium threshold, we calculated the percentage of patients who were found to have an increased parathyroid hormone level (≥65 pg/mL). We determined whether net cost savings could be achieved by screening hypercalcemic patients given their probability of primary hyperparathyroidism and expected cost savings from fracture risk reduction, given their sex and age. RESULTS: From 155,350 unique patients in the study period, a total of 2,271 had a minimum of 1 hypercalcemic lab value. After exclusion criteria, there were 1,326 patients of whom 27.5% had a parathyroid hormone level checked. Cost savings was established at a screening threshold of 10.5 for all patients until age 66 years for men and 69 years for women. For men aged 67-68 y and women aged 70-71 years, the optimal screening threshold was 10.8 mg/dl. CONCLUSION: Cost savings can be achieved by screening hypercalcemic patients with a life expectancy exceeding 16 years, with varying thresholds based on age and sex.


Assuntos
Redução de Custos , Fraturas Ósseas/prevenção & controle , Hipercalcemia/diagnóstico , Hiperparatireoidismo Primário/diagnóstico , Programas de Rastreamento/economia , Idoso , Doenças Assintomáticas/economia , Cálcio/sangue , Estudos de Coortes , Análise Custo-Benefício , Diagnóstico Tardio , Feminino , Fraturas Ósseas/etiologia , Humanos , Hipercalcemia/economia , Hipercalcemia/etiologia , Hipercalcemia/terapia , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/economia , Hiperparatireoidismo Primário/terapia , Expectativa de Vida , Masculino , Programas de Rastreamento/métodos , Modelos Econômicos , Hormônio Paratireóideo/sangue
7.
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
8.
Artigo em Inglês | MEDLINE | ID: mdl-31652597

RESUMO

The objective of this review is to evaluate the effectiveness of digital health supported targeted patient communication versus usual provision of health information, on the recovery of fragility fractures. The review considered studies including older people, aged 50 and above, with a fragility fracture. The primary outcome was prevention of secondary fractures by diagnosis and treatment of osteoporosis, and its adherence. This review considered both experimental and quasi-experimental study designs. A comprehensive search strategy was built to identify key terms including Medical subject headings (MeSH) and applied to the multiple electronic databases. An intention to treat analysis was applied to those studies included in the meta-analysis and odds ratio was calculated with random effects. Altogether, 15 studies were considered in the final stage for this systematic review. Out of these, 10 studies were Randomised controlled trials (RCT) and five were quasi experimental studies, published between the years 2003 and 2016 with a total of 5037 participants. Five Randomised control trails were included in the meta-analysis suggesting that digital health supported interventions were overall, twice as effective when compared with the usual standard care (OR 2.13, 95% CI 1.30-3.48), despite the population sample not being homogeneous. Findings from the remaining studies were narratively interpreted.


Assuntos
Fraturas Ósseas/reabilitação , Telemedicina , Tecnologia Biomédica , Fraturas Ósseas/prevenção & controle , Comunicação em Saúde , Pessoal de Saúde , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Best Pract Res Clin Rheumatol ; 33(2): 290-300, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31547984

RESUMO

In view of the high imminent risk for subsequent fractures, evaluation as early as possible after the fracture will result in early decisions about drug treatment, fall prevention and nutritional supplements. Drug treatment includes anti-resorptive and bone forming agents. Anti-resorptive therapy with broad spectrum fracture prevention and early anti-fracture effects are the first choice. In patients with multiple or severe VFs, the bone forming agent teriparatide should be considered. Adequate calcium and vitamin D are needed in all patients, together with appropriate nutrition, including adequate protein intake.


Assuntos
Acidentes por Quedas/prevenção & controle , Fraturas Ósseas/prevenção & controle , Necessidades Nutricionais , Prevenção Secundária/métodos , Conservadores da Densidade Óssea/uso terapêutico , Cálcio/administração & dosagem , Suplementos Nutricionais , Feminino , Humanos , Masculino , Vitamina D/administração & dosagem
10.
J Manag Care Spec Pharm ; 25(10): 1089-1095, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556816

RESUMO

Decision tree and Markov models have been the most commonly used modeling methods in health economic evaluations. Both methods are known for their limitations. Discrete-event simulation (DES), an event-driven model in continuous time at the patient level, is a relatively new method in health economic evaluations that addresses some limitations of the common modeling techniques. Specifically, with the advent of personalized medicine, conventional methods for value assessment that are based on population-level measures might not be appropriate. The best treatment would depend on patient characteristics and clinical profiles. Value assessment of health interventions can vary substantially and may lead to different health decision making due to patient heterogeneity. As such, modeling at the patient level is an appropriate approach for value assessment of health interventions. The DES model has several advantages, such as flexibility, ability to reflect patient heterogeneity, increased precision, and better characterization of modeling uncertainty, that may be preferred to decision tree and Markov models. In addition, with increasing health care spending and drug prices, it is important to quantify value of available treatment options for women with postmenopausal osteoporosis (PMO). The purpose of this Viewpoints article was to describe and demonstrate an application of a DES model to evaluate the cost-effectiveness of the current treatment guidelines for women with PMO. In particular, the DES model indicated that the optimal treatment at the common willingness-to-pay thresholds between $100,000 per quality-adjusted life-year (QALY) and $150,000 per QALY was denosumab. Analysis of patient heterogeneity in terms of low, medium, high, and very high risk of fractures resulted in a similar conclusion. DISCLOSURES: Funding for this study was received through the PhRMA Foundation Value Assessment Challenge Award. The author has no conflicts of interest to declare.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Análise Custo-Benefício , Fraturas Ósseas/prevenção & controle , Modelos Econômicos , Osteoporose Pós-Menopausa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Árvores de Decisões , Custos de Medicamentos , Feminino , Fraturas Ósseas/economia , Fraturas Ósseas/epidemiologia , Humanos , Cadeias de Markov , Osteoporose Pós-Menopausa/economia , Osteoporose Pós-Menopausa/genética , Guias de Prática Clínica como Assunto , Medicina de Precisão/economia , Medicina de Precisão/normas , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco
11.
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
12.
Actual. osteol ; 15(2): 94-102, mayo - ago. 2019. tab.
Artigo em Espanhol | LILACS | ID: biblio-1048478

RESUMO

El propósito de la terapia en el desorden del metabolismo óseo mineral asociado a la enfermedad renal crónica (IRC) consiste en restaurar el balance mineral, y, en la osteoporosis, mantener o aumentar la masa ósea. Ambas terapias tratan de evitar la fractura ósea. La mayoría de los osteoactivos están contraindicados en la insuficiencia renal crónica avanzada (estadios 4 y 5), y las terapias son empíricas. Algunos autores opinan que sin anomalías bioquímicas del desorden del metabolismo óseo mineral asociado a la enfermedad renal crónica avanzada se podría intentar el tratamiento estándar para la osteoporosis. Antes de intentar la terapia osteoactiva se debe corregir el desorden mineral óseo que pudiera presentarse asociado a la IRC, y en la indicación del tipo de osteoactivo se sugiere seleccionar al paciente según su estado óseo. Se aconseja que la administración de los antirresortivos se realice a dosis menores con respecto a los que tienen mejor función renal junto con aportes adecuados de calcio y vitamina D, antes y durante el tratamiento para prevenir el riesgo de severas hipocalcemias y un efecto óseo excesivo. Se presenta el caso clínico de una mujer de 65 años, con diagnóstico de osteoporosis de etiología multifactorial, fractura de pelvis, múltiples fracturas vertebrales e insuficiencia renal crónica avanzada, entre otras comorbilidades, y probable enfermedad ósea adinámica. Recibió inicialmente terapia con teriparatide y luego con denosumab, complicándose con hipocalcemia asintomática. (AU)


The purpose of therapy for the bone mineral metabolism disorder associated with chronic kidney disease is to restore the mineral balance; and to maintain or increase bone mass in osteoporosis. The goal of both types of therapy is to avoid bone fractures. Most antiosteoporotic drugs are contraindicated in advanced chronic renal failure (CRF) stages 4 and 5, and the therapies are empirical. Some authors believe that without biochemical abnormalities of the mineral bone metabolism disorder associated with advanced chronic kidney disease, standard treatment for osteoporosis could be attempted. Before attempting antiosteoporotic therapy, the bone mineral disorder that may be associated with CRF must be corrected, and in the indication of the type drug it is suggested that the patient be selected according to their bone status. It is advised that the administration of anti-resorptives be performed at lower doses in individuals with poor renal function compared to those with better renal function together with adequate calcium and vitamin D, before and during treatment to prevent the risk of severe hypocalcemia, and an excessive bone effect. We present the clinical case of a 65-year-old woman with a diagnosis of osteoporosis of multifactorial etiology, pelvic fracture, multiple vertebral fractures and advanced chronic renal failure, among other comorbidities and probable adynamic bone disease. The patient received initial therapy with teriparatide and followed by denosumab administration and exhibited asymptomatic hypocalcemia. (AU)


Assuntos
Humanos , Feminino , Idoso , Distúrbio Mineral e Ósseo na Doença Renal Crônica/tratamento farmacológico , Fraturas Ósseas/prevenção & controle , Osteoporose/terapia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/complicações , Distúrbio Mineral e Ósseo na Doença Renal Crônica/metabolismo , Distúrbio Mineral e Ósseo na Doença Renal Crônica/terapia , Vitamina D/administração & dosagem , Vitamina D/uso terapêutico , Cálcio/administração & dosagem , Cálcio/uso terapêutico , Alendronato/uso terapêutico , Teriparatida/administração & dosagem , Teriparatida/efeitos adversos , Teriparatida/uso terapêutico , Difosfonatos/administração & dosagem , Difosfonatos/efeitos adversos , Difosfonatos/uso terapêutico , Cinacalcete/uso terapêutico , Ácido Risedrônico/uso terapêutico , Denosumab/administração & dosagem , Denosumab/efeitos adversos , Denosumab/uso terapêutico , Hipocalcemia/prevenção & controle
13.
Med J Aust ; 211(5): 224-229, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31318068

RESUMO

INTRODUCTION: Representatives appointed by relevant Australian medical societies used a systematic approach for adaptation of guidelines (ADAPTE) to formulate clinical consensus recommendations on assessment and management of bone health in women with oestrogen receptor-positive early breast cancer receiving endocrine therapy. The current evidence suggests that women receiving adjuvant aromatase inhibitors and pre-menopausal woman treated with tamoxifen have accelerated bone loss and that women receiving adjuvant aromatase inhibitors have increased fracture risk. Both bisphosphonates and denosumab prevent bone loss; additionally, denosumab has proven anti-fracture benefit in post-menopausal women receiving aromatase inhibitors for hormone receptor-positive breast cancer. MAIN RECOMMENDATIONS: Women considering endocrine therapy need fracture risk assessment, including clinical risk factors, biochemistry and bone mineral density measurement, with monitoring based on risk factors. Weight-bearing exercise and vitamin D and calcium sufficiency are recommended routinely. Anti-resorptive treatment is indicated in women with prevalent or incident clinical or morphometric fragility fractures, and should be considered in women with a T score (or Z score in women aged < 50 years) of < - 2.0 at any site, or if annual bone loss is ≥ 5%, considering baseline bone mineral density and other fracture risk factors. Duration of anti-resorptive treatment can be individualised based on absolute fracture risk. Relative to their skeletal benefits, risks of adverse events with anti-resorptive treatments are low. CHANGES IN MANAGEMENT AS RESULT OF THE POSITION STATEMENT: Skeletal health should be considered in the decision-making process regarding choice and duration of endocrine therapy. Before and during endocrine therapy, skeletal health should be assessed regularly, optimised by non-pharmacological intervention and, where indicated, anti-resorptive treatment, in an individualised, multidisciplinary approach.


Assuntos
Densidade Óssea , Neoplasias da Mama/diagnóstico , Receptores Estrogênicos/genética , Inibidores da Aromatase/uso terapêutico , Austrália , Conservadores da Densidade Óssea/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/genética , Feminino , Fraturas Ósseas/prevenção & controle , Humanos , Nova Zelândia , Sociedades Médicas , Vitamina D/uso terapêutico
14.
Nutrients ; 11(7)2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31261978

RESUMO

Type 2 diabetes increases bone fracture risk in postmenopausal women. Usual treatment with anti-resorptive bisphosphonate drugs has some undesirable side effects, which justified our interest in the osteogenic potential of nutrition and exercise. Since meal eating reduces bone resorption, downhill locomotion increases mechanical stress, and brief osteogenic responsiveness to mechanical stress is followed by several hours of refractoriness, we designed a study where 40-min of mechanical stress was manipulated by treadmill walking uphill or downhill. Exercise preceded or followed two daily meals by one hour, and the meals and exercise bouts were 7 hours apart. Fifteen subjects each performed two of five trials: No exercise (SED), uphill exercise before (UBM) or after meals (UAM), and downhill exercise before (DBM) or after meals (DAM). Relative to SED trial, osteogenic response, defined as the ratio of osteogenic C-terminal propeptide of type I collagen (CICP) over bone-resorptive C-terminal telopeptide of type-I collagen (CTX) markers, increased in exercise-after-meal trials, but not in exercise-before-meal trials. CICP/CTX response rose significantly after the first exercise-after-meal bout in DAM, and after the second one in UAM, due to a greater CICP rise, and not a decline in CTX. Post-meal exercise, but not the pre-meal exercise, also significantly lowered serum insulin response and homeostatic model (HOMA-IR) assessment of insulin resistance.


Assuntos
Remodelação Óssea , Diabetes Mellitus Tipo 2/terapia , Terapia por Exercício , Fraturas Ósseas/prevenção & controle , Refeições , Osteogênese , Idoso , Biomarcadores/sangue , Colágeno Tipo I/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Fraturas Ósseas/sangue , Fraturas Ósseas/etiologia , Fraturas Ósseas/fisiopatologia , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/sangue , Resistência à Insulina , Pessoa de Meia-Idade , Valor Nutritivo , Fragmentos de Peptídeos/sangue , Peptídeos/sangue , Pós-Menopausa/sangue , Período Pós-Prandial , Pró-Colágeno/sangue , Fatores de Tempo , Resultado do Tratamento
15.
Dtsch Med Wochenschr ; 144(15): 1018-1021, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31350741

RESUMO

Four meta-analyzes on the effect of vitamin D on fracture prevention were published between 2016 and 2018. Two of these meta-analyzes focused on the primary prevention of fractures in adults aged 50 and over who were not at risk for fractures or vitamin D deficiency. Another meta-analysis focused on the combination of vitamin D plus calcium and the most recently published meta-analysis focused on the individual effect of vitamin D without calcium. In terms of current guidelines, it is important to note that only 1 out of the 3 most recent meta-analyzes were predominantly directed at adults over the age of 65 with an increased risk of falls, fractures, and vitamin D deficiency.What can we recommend now? Based on our critical review of the meta-analyzes on vitamin D and fracture prevention, vitamin D supplementation with or without calcium is still useful in older adults, ages 65 and older, with an increased risk of vitamin D deficiency and an increased risk of fracture.


Assuntos
Vitamina D , Idoso , Suplementos Nutricionais , Fraturas Ósseas/tratamento farmacológico , Fraturas Ósseas/prevenção & controle , Humanos , Metanálise como Assunto , Vitamina D/administração & dosagem , Vitamina D/uso terapêutico , Deficiência de Vitamina D/tratamento farmacológico
16.
Maturitas ; 127: 35-42, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351518

RESUMO

Gonadal sex steroids play a pivotal role in bone health. Medical and surgical therapies for gender dysphoria in both adolescents and adults can lead to skeletal changes. This review evaluates the literature on transgender bone health, and how the data can be translated into clinical practice.


Assuntos
Densidade Óssea , Pessoas Transgênero , Acidentes por Quedas , Animais , Conservadores da Densidade Óssea/uso terapêutico , Reabsorção Óssea/prevenção & controle , Fraturas Ósseas/prevenção & controle , Hormônios Esteroides Gonadais/uso terapêutico , Humanos
17.
Z Gerontol Geriatr ; 52(5): 428-432, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31263959

RESUMO

In consideration and critical review of four recent meta-analyses on vitamin D and fracture prevention, vitamin D supplementation with or without calcium is supported among older adults age 65 years and older at risk of vitamin D deficiency and fractures if given in daily or equivalent weekly or monthly doses of 800 to 1000 IU and with good adherence. Vitamin D supplementation might not be effective in primary prevention among adults age 50 years and older without vitamin D deficiency and osteoporosis; however, clinical trials on primary prevention are limited. Notably, large annual bolus administration of vitamin D is detrimental with regard to falls and fractures among older adults at risk of fractures and should not be continued in clinical care. Larger monthly doses of 100,000 IU need further evaluation with respect to efficacy and safety.


Assuntos
Osso e Ossos/efeitos dos fármacos , Fraturas Ósseas/prevenção & controle , Deficiência de Vitamina D/prevenção & controle , Vitamina D/administração & dosagem , Vitaminas/administração & dosagem , Idoso , Suplementos Nutricionais , Humanos , Vitamina D/uso terapêutico , Deficiência de Vitamina D/tratamento farmacológico
18.
Sports Health ; 11(6): 514-519, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31158326

RESUMO

CONTEXT: Hockey is a skillful contact sport with an elevated injury risk at higher levels of play. An understanding of injury incidence, type, mechanism, and severity at various levels of competition aids the clinician treating these athletes. The purpose of this clinical review is to discuss the epidemiology of hockey injuries at various levels of participation, including youth, high school, junior, college, and professional. EVIDENCE ACQUISITION: A literature search was performed by a review of PubMed, Embase, and Cochrane databases and included articles published from 1988 to 2017. Studies were included in this review if determined to be of high quality and containing injury data relevant to the levels of competition. Pertinent data regarding ice hockey injury epidemiology and prevention at various levels of competition were analyzed. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: Youth, high school, junior, college, and professional hockey players have unique injury patterns. Injuries occur much more often in a game compared with a practice, and injury risk increases with each level of competition. Preventative measures, such as mandatory facial protection and delayed body checking in games until age 13 years, are proven strategies to reduce the risk of facial injury and concussion. CONCLUSION: An understanding of common injury types and mechanisms according to age and level of play aids the clinician in diagnosis and management. This information can also guide preventative strategies in the areas of education, coaching, rule enforcement, rule modifications, equipment improvement, and sportsmanship.


Assuntos
Traumatismos em Atletas/epidemiologia , Hóquei/lesões , Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/epidemiologia , Concussão Encefálica/prevenção & controle , Comportamento Competitivo/fisiologia , Contusões/epidemiologia , Contusões/prevenção & controle , Traumatismos Faciais/epidemiologia , Traumatismos Faciais/prevenção & controle , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/prevenção & controle , Dispositivos de Proteção da Cabeça , Humanos , Incidência , Lacerações/epidemiologia , Lacerações/prevenção & controle , Entorses e Distensões/epidemiologia , Entorses e Distensões/prevenção & controle , Estados Unidos/epidemiologia
19.
Lakartidningen ; 1162019 03 19.
Artigo em Sueco | MEDLINE | ID: mdl-31192412

RESUMO

In the Bunkeflo project, one elementary school increased duration of school physical activity (PA) to 200 minutes/week while 3 control schools continued with 60 minutes/week throughout the nine elementary school years. We then registered fractures in 3534 children, and evaluated the duration of PA, bone mass and muscle strength in a subsample (n=140) during the intervention and 3 years after. The PA intervention was associated with higher duration of PA both during and 3 years after the intervention. With each year of intervention, the fracture incidence rate ratio (IRR) declined in the intervention children so that it was 0.48 (95% CI 0.25, 0.91) the eighth year of intervention. These findings were accompanied by beneficial gain in musculoskeletal traits in both intervention girls and boys (p<0.05). Nine years of daily school-based PA is associated with a progressive reduction in fracture risk, accompanied by beneficial musculoskeletal gains and a more physically active lifestyle.


Assuntos
Exercício Físico , Fraturas Ósseas , Educação Física e Treinamento , Instituições Acadêmicas , Adolescente , Densidade Óssea , Criança , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/prevenção & controle , Estilo de Vida Saudável , Humanos , Masculino , Força Muscular , Estudos Prospectivos , Fatores de Risco , Comportamento Sedentário
20.
PLoS One ; 14(5): e0217223, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150426

RESUMO

BACKGROUND: Although intake of fruits and vegetables seemed to have a protective effect on bone metabolism, its effect on fractures remains uncertain. METHODS: A systematic review of randomized controlled trials (RCTs) and cohort studies (PROSPERO: CRD42016041462) was performed. RCTs and cohort studies that evaluated the combined intake of fruits and vegetables in men and women aged over 50 years were included. We considered fractures as a primary outcome measure. Changes in bone markers were considered as secondary outcomes. The search strategy included the following descriptors: fruit, vegetables, vegetable products, bone and bones, bone fractures, postmenopausal osteoporosis, and osteoporosis. PubMed, Embase, and Cochrane Library were the databases used. The appraisal of the studies was performed by two independent reviewers, and discussed and agreed upon by both examiners. The data extracted from the RCTs and cohort studies were summarized separately. The risks of fractures were combined across studies using random models. Bone resorption marker (CTx) was summarized with standardized mean differences. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to evaluate the strength of recommendations. RESULTS: Of the 1,192 studies screened, 13 articles were included in the systematic review and 10 were included in the pooled analysis (6 cohort studies and 4 RCTs). The six cohort studies included in the meta-analysis included a population of 225,062. The pooled hazard ratio (HR) (95% confidence interval (CI)) of the hip in five studies was 0.92 (0.87, 0.98). Its heterogeneity was moderate (I2 = 55.7%, p = 0.060), GRADE (⊕⊕⊕O). Two cohort studies evaluated the risk of any fracture; the HR was 0.90 (95% CI: 0.86-0.96), with aheterogeneity of 24.9% (p = 0.249, GRADE (⊕⊕⊕O)). There was no association between the bone resorption marker CTx and 3 months of fruit and vegetable intake evaluated by four RCTs, GRADE (⊕⊕O O). CONCLUSION: There was an association between the increase of at least one serving of fruits and vegetables per day and decreases in the risk of fractures. The level of evidence for this association is moderate.


Assuntos
Fraturas Ósseas/prevenção & controle , Frutas , Osteoporose/prevenção & controle , Verduras , Comportamento Alimentar , Fraturas Ósseas/epidemiologia , Humanos , Incidência , Osteoporose/epidemiologia
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