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1.
Nutrients ; 13(7)2021 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-34371870

RESUMO

Kidney transplant recipients are at high risk of progressive bone loss and low-energy fractures in the years following transplantation. Marine n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation may have beneficial effects on bone strength. The Omega-3 fatty acids in Renal Transplantation (ORENTRA) trial was an investigator initiated, randomized, placebo-controlled trial investigating the effects of marine n-3 PUFA supplementation after kidney transplantation. Effects of supplementation on bone mineral density (BMD) and calcium metabolism were pre-defined secondary endpoints. Adult kidney transplant recipients (n = 132) were randomized to 2.6 g marine n-3 PUFA supplement or olive oil (control) from 8 to 52 weeks post-transplant. Dual energy X-ray absorptiometry was performed to assess changes in bone mineral density of hip, spine, and forearm, as well as trabecular bone score (TBS) of the lumbar spine. Student's t test was used to assess between-group differences. There were no differences in ΔBMD between the two groups (intervention vs. control) at lumbar spine (-0.020 ± 0.08 vs. -0.007 ± 0.07 g/cm², p = 0.34), total hip (0.001 ± 0.03 vs. -0.005 ± 0.04, p = 0.38), or other skeletal sites in the intention-to-treat analyses. There was no difference in the change in TBS score (0.001 ± 0.096 vs. 0.009 ± 0.102, p = 0.62). Finally, no effect on biochemical parameters of mineral metabolism was seen. Results were similar when analyzed per protocol. In conclusion, we found no significant effect of 44 weeks of supplementation with 2.6 g of marine n-3 PUFA on BMD in kidney transplant recipients.


Assuntos
Densidade Óssea/efeitos dos fármacos , Suplementos Nutricionais , Ácidos Docosa-Hexaenoicos/administração & dosagem , Ácido Eicosapentaenoico/administração & dosagem , Transplante de Rim , Osteoporose/prevenção & controle , Fraturas por Osteoporose/prevenção & controle , Absorciometria de Fóton , Adulto , Idoso , Biomarcadores/sangue , Cálcio/sangue , Dinamarca , Suplementos Nutricionais/efeitos adversos , Ácidos Docosa-Hexaenoicos/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Ácido Eicosapentaenoico/efeitos adversos , Feminino , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Osteoporose/etiologia , Osteoporose/fisiopatologia , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
2.
Nutrients ; 13(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34371899

RESUMO

Introduction: Chronic pancreatitis (CP) can lead to malnutrition, an established risk factor for low bone mineral density (BMD) and fractures. This study aims to determine the prevalence of low BMD, assess fracture incidence and explore risk factors for fractures in patients with CP. Patients and methods: We performed a retrospective analysis of all patients treated for CP at Karolinska University Hospital between January 1999 and December 2020. Electronic medical records were retrieved to assess demographic, laboratory and clinical data. Patients subjected to dual-energy X-ray absorptiometry (DXA) were categorised as either low BMD or normal BMD. We investigated whether the rate of fractures, defined by chart review, differed between these groups using Cox regression, adjusting the model for age, sex and body mass index (BMI). Additional within-group survival analysis was conducted to identify potential risk factors. Results: DXA was performed in 23% of patients with definite CP. Some 118 patients were included in the final analysis. Low BMD was present in 63 (53.4%) patients. Mean age at CP diagnosis in the total cohort was 53.1 years and was significantly lower in patients with normal BMD than in patients with low BMD (45.5 vs. 59.8, p < 0.001). Significant differences were observed in smoking status and disease aetiology, i.e., a higher proportion of patients with low BMD were current or former smokers, with nicotine or alcohol being a more common cause of CP (p < 0.05). Total follow-up time was 898 person-years. Fractures were found in 33 (28.0%) patients: in 5 of 55 patients (16.7%) with normal DXA and in 28 of 63 patients (44.4%) with low BMD (adjusted hazard ratio = 3.4, 95% confidence interval (CI) = 1.2-9.6). Patients with at least 3 months of consecutive pancreatic enzyme replacement therapy (PERT) or vitamin D treatment had a longer median time to fracture after CP diagnosis. Conclusion: DXA was only performed in 23% of patients with definite CP in this study, indicating a low adherence to current European guidelines. A low BMD was found in 53.4% of patients with CP, and 44% of the patients with a low BMD experienced a fracture during follow-up. Moreover, the fracture rate in patients with low BMD increased compared to those with normal BMD.


Assuntos
Densidade Óssea , Insuficiência Pancreática Exócrina/epidemiologia , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Pancreatite Crônica/epidemiologia , Absorciometria de Fóton , Adulto , Idoso , Insuficiência Pancreática Exócrina/diagnóstico por imagem , Insuficiência Pancreática Exócrina/fisiopatologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Osteoporose/fisiopatologia , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/fisiopatologia , Pancreatite Crônica/diagnóstico por imagem , Pancreatite Crônica/fisiopatologia , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Suécia/epidemiologia
3.
Biomed Res Int ; 2021: 4650057, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34327227

RESUMO

Background: Postoperative pain, dysfunction, and significant bone loss may occur after vertebral fractures, which will lead to the occurrence of refractures and shorten the survival time, so postoperative rehabilitation is very important. Pulsed electromagnetic field therapy is noninvasive, pain-relieving, and beneficial to reduce bone loss and is an important treatment for patients to recover after surgery. Therefore, this study analyzed the effect of postmenopausal women's vertebral fracture rehabilitation after pulsed electromagnetic field treatment. Method: This study uses a randomized controlled study, respectively, in the pulsed electromagnetic field treatment group (40 cases) and the control group (42 cases), respectively. We studied the results of health-related quality of life scores (HRQOL), back pain, body function, hip bone density, bone microstructure of tibia, and radius after 1 month and 3 months after surgery. Results: Compared with the control group, the pulsed electromagnetic field treatment group (PEMF) can improve significantly the psychological score, 6-minute walk test, and Chair Sit-and-Reach one month after the operation. And at 3 months after surgery, the pulsed electromagnetic field treatment group can improve significantly in health-related quality of life scores (HRQOL), back pain, and body function. Regarding the effect of changes in bone mass, compared with the control group, pulsed electromagnetic field treatment had no significant effect on changes in hip bone density. As a result of changes in bone microstructure, pulsed electromagnetic field treatment can significantly improve the bone microstructure of the radius and tibia three months after vertebral fractures. Conclusion: Pulsed electromagnetic field therapy has positive significance for improving pain, body functional changes, and bone loss after vertebral fracture surgery.


Assuntos
Campos Eletromagnéticos , Fraturas por Osteoporose/terapia , Pós-Menopausa/fisiologia , Fraturas da Coluna Vertebral/terapia , Densidade Óssea , Osso e Ossos/patologia , Osso e Ossos/fisiopatologia , Humanos , Pessoa de Meia-Idade , Tamanho do Órgão , Fraturas por Osteoporose/fisiopatologia , Qualidade de Vida , Fraturas da Coluna Vertebral/fisiopatologia
4.
Medicine (Baltimore) ; 100(18): e25606, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950937

RESUMO

BACKGROUND: Osteoporosis (OP) is an age-related disease characterized by reduced bone mass and increased bone fragility. It is more common in older people and postmenopausal women. As a new type of exercise training for OP, whole-body vibration (WBV) exercise has been proved to have a good effect on postmenopausal women with OP. It can increase bone density and improve strength and balance in postmenopausal population, which has certain clinical value, but lacks evidence-based medicine evidence. This study aims to systematically study the effectiveness of WBV exercise on postmenopausal women with OP. METHODS: The English databases (PubMed, Embase, Web of Science, The Cochrane Library) and Chinese databases (China National Knowledge Network, Wanfang, Weipu, China Biomedical Database) were searched by computer. From the establishment of the database to February 2021, the randomized controlled clinical studies on WBV exercise on postmenopausal women with OP were conducted. The quality of the included studies was independently extracted by 2 researchers and literature quality was evaluated. Meta-analysis of the included studies was performed using RevMan5.3 software. RESULTS: In this study, the efficacy and safety of WBV exercise on postmenopausal women with OP were evaluated by lumbar spine bone density, femoral neck bone density, pain, incidence of falls, incidence of fractures, and quality of life scale score, etc. CONCLUSION: This study will provide reliable evidences for the clinical application of WBV exercise on postmenopausal women with OP. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/WPYT9.


Assuntos
Terapia por Exercício/métodos , Osteoporose Pós-Menopausa/terapia , Fraturas por Osteoporose/epidemiologia , Vibração/uso terapêutico , Densidade Óssea/fisiologia , Medicina Baseada em Evidências/métodos , Terapia por Exercício/efeitos adversos , Feminino , Humanos , Incidência , Metanálise como Assunto , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/fisiopatologia , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/fisiopatologia , Fraturas por Osteoporose/prevenção & controle , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
5.
J Clin Endocrinol Metab ; 106(7): e2527-e2534, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-33780545

RESUMO

CONTEXT: In primary hyperparathyroidism (PHPT) bone mineral density (BMD) is typically decreased in cortical bone and relatively preserved in trabecular bone. An increased fracture rate is observed however not only at peripheral sites but also at the spine, and fractures occur at higher BMD values than expected. We hypothesized that components of bone quality other than BMD are affected in PHPT as well. OBJECTIVE: To evaluate bone material properties using impact microindentation (IMI) in PHPT patients. METHODS: In this cross-sectional study, the Bone Material Strength index (BMSi) was measured by IMI at the midshaft of the tibia in 37 patients with PHPT (28 women), 11 of whom had prevalent fragility fractures, and 37 euparathyroid controls (28 women) matched for age, gender, and fragility fracture status. RESULTS: Mean age of PHPT patients and controls was 61.8 ±â€…13.3 and 61.0 ±â€…11.8 years, respectively, P = .77. Calcium and PTH levels were significantly higher in PHPT patients but BMD at the lumbar spine (0.92 ±â€…0.15 vs 0.89 ±â€…0.11, P = .37) and the femoral neck (0.70 ±â€…0.11 vs 0.67 ±â€…0.07, P = .15) were comparable between groups. BMSi however was significantly lower in PHPT patients than in controls (78.2 ±â€…5.7 vs 82.8 ±â€…4.5, P < .001). In addition, BMSi was significantly lower in 11 PHPT patients with fragility fractures than in the 26 PHPT patients without fragility fractures (74.7 ±â€…6.0 vs 79.6 ±â€…5.0, P = .015). CONCLUSION: Our data indicate that bone material properties are altered in PHPT patients and most affected in those with prevalent fractures. IMI might be a valuable additional tool in the evaluation of bone fragility in patients with PHPT.


Assuntos
Pesos e Medidas Corporais/métodos , Indicadores Básicos de Saúde , Hiperparatireoidismo Primário/fisiopatologia , Fraturas por Osteoporose/etiologia , Fraturas da Tíbia/etiologia , Absorciometria de Fóton , Pesos e Medidas Corporais/instrumentação , Densidade Óssea , Cálcio/sangue , Osso Esponjoso/fisiopatologia , Osso Cortical/fisiopatologia , Estudos Transversais , Feminino , Colo do Fêmur/diagnóstico por imagem , Humanos , Hiperparatireoidismo Primário/complicações , Vértebras Lombares/diagnóstico por imagem , Masculino , Microtecnologia/instrumentação , Microtecnologia/métodos , Pessoa de Meia-Idade , Fraturas por Osteoporose/fisiopatologia , Hormônio Paratireóideo/sangue , Tíbia/fisiopatologia , Fraturas da Tíbia/fisiopatologia
6.
South Med J ; 114(4): 252-259, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33787941

RESUMO

OBJECTIVES: This study aimed to identify factors, including physical functions and activities that affect quality of life (QOL) at discharge among patients with osteoporotic vertebral fractures. METHODS: Patients with osteoporotic vertebral fractures were included in our prospective cohort study. Multiple regression analysis was performed to determine the predictors of QOL at discharge using two models: model 1, basic medical information and physical functions at admission, and model 2, basic medical information, physical function, and activity after 4 weeks of admission. RESULTS: Multiple regression analysis (standard partial regression coefficients) using model 1 identified L2 to L4 bone mineral density (-0.2), Visual Analog Scale for pain during activity at admission (-0.31), and Revised Hasegawa Dementia Scale (HDS-R) score at admission (0.64) as factors affecting QOL at discharge. Multiple regression analysis using model 2 identified HDS-R at admission (0.64), Pain Catastrophizing Scale score at 4 weeks (-0.34), and knee extension muscle strength at 4 weeks (0.28) as factors affecting QOL at discharge. CONCLUSIONS: Our results suggest that if patients have high bone mineral density, intense pain, and low cognitive function at admission, then low QOL at discharge will be predicted; however, improvement of pain catastrophizing and knee extension muscle strength during first the 4 weeks of admission may be able to improve QOL at discharge. Because patients in this study were Japanese only, it is important to exercise caution when applying our results to other populations.


Assuntos
Regras de Decisão Clínica , Fraturas por Osteoporose , Alta do Paciente , Qualidade de Vida , Fraturas da Coluna Vertebral , Idoso , Idoso de 80 Anos ou mais , Demência/complicações , Demência/diagnóstico , Feminino , Seguimentos , Fixação de Fratura , Humanos , Masculino , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/fisiopatologia , Fraturas por Osteoporose/psicologia , Fraturas por Osteoporose/cirurgia , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/psicologia , Prognóstico , Estudos Prospectivos , Qualidade de Vida/psicologia , Recuperação de Função Fisiológica , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/psicologia , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral , Escala Visual Analógica
8.
PLoS One ; 16(2): e0245967, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33556061

RESUMO

BACKGROUND: Osteoporosis is an asymptomatic disease of high prevalence and incidence, leading to bone fractures burdened by high mortality and disability, mainly when several subsequent fractures occur. A fragility fracture predictive model, Artificial Intelligence-based, to identify dual X-ray absorptiometry (DXA) variables able to characterise those patients who are prone to further fractures called Bone Strain Index, was evaluated in this study. METHODS: In a prospective, longitudinal, multicentric study 172 female outpatients with at least one vertebral fracture at the first observation were enrolled. They performed a spine X-ray to calculate spine deformity index (SDI) and a lumbar and femoral DXA scan to assess bone mineral density (BMD) and bone strain index (BSI) at baseline and after a follow-up period of 3 years in average. At the end of the follow-up, 93 women developed a further vertebral fracture. The further vertebral fracture was considered as one unit increase of SDI. We assessed the predictive capacity of supervised Artificial Neural Networks (ANNs) to distinguish women who developed a further fracture from those without it, and to detect those variables providing the maximal amount of relevant information to discriminate the two groups. ANNs choose appropriate input data automatically (TWIST-system, Training With Input Selection and Testing). Moreover, we built a semantic connectivity map usingthe Auto Contractive Map to provide further insights about the convoluted connections between the osteoporotic variables under consideration and the two scenarios (further fracture vs no further fracture). RESULTS: TWIST system selected 5 out of 13 available variables: age, menopause age, BMI, FTot BMC, FTot BSI. With training testing procedure, ANNs reached predictive accuracy of 79.36%, with a sensitivity of 75% and a specificity of 83.72%. The semantic connectivity map highlighted the role of BSI in predicting the risk of a further fracture. CONCLUSIONS: Artificial Intelligence is a useful method to analyse a complex system like that regarding osteoporosis, able to identify patients prone to a further fragility fracture. BSI appears to be a useful DXA index in identifying those patients who are at risk of further vertebral fractures.


Assuntos
Absorciometria de Fóton , Redes Neurais de Computação , Fraturas por Osteoporose/fisiopatologia , Traumatismos da Coluna Vertebral/fisiopatologia , Coluna Vertebral/fisiopatologia , Estresse Mecânico , Fenômenos Biomecânicos , Densidade Óssea , Feminino , Humanos , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico , Prognóstico , Traumatismos da Coluna Vertebral/diagnóstico
9.
J Orthop Surg Res ; 16(1): 138, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33588890

RESUMO

PURPOSE: Biomechanical comparison of wedge and biconcave deformity of different height restoration after augmentation of osteoporotic vertebral compression fractures was analyzed by three-dimensional finite element analysis (FEA). METHODS: Three-dimensional finite element model (FEM) of T11-L2 segment was constructed from CT scan of elderly osteoporosis patient. The von Mises stresses of vertebrae, intervertebral disc, facet joints, displacement, and range of motion (ROM) of wedge and biconcave deformity were compared at four different heights (Genant 0-3 grade) after T12 vertebral augmentation. RESULTS: In wedge deformity, the stress of T12 decreased as the vertebral height in neutral position, flexion, extension, and left axial rotation, whereas increased sharply in bending at Genant 0; L1 and L2 decreased in all positions excluding flexion of L2, and T11 increased in neutral position, flexion, extension, and right axial rotation at Genant 0. No significant changes in biconcave deformity. The stress of T11-T12, T12-L1, and L1-L2 intervertebral disc gradually increased or decreased under other positions in wedge fracture, whereas L1-L2 no significant change in biconcave fracture. The utmost overall facet joint stress is at Genant 3, whereas there is no significant change under the same position in biconcave fracture. The displacement and ROM of the wedge fracture had ups and downs, while a decline in all positions excluding extension in biconcave fracture. CONCLUSIONS: The vertebral restoration height after augmentation to Genant 0 affects the von Mises stress, displacement, and ROM in wedge deformity, which may increase the risk of fracture, whereas restored or not in biconcave deformity.


Assuntos
Análise de Elementos Finitos , Fraturas por Compressão/cirurgia , Osteoporose/complicações , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral/anormalidades , Vertebroplastia/métodos , Idoso , Fenômenos Biomecânicos , Feminino , Fraturas por Compressão/etiologia , Fraturas por Compressão/fisiopatologia , Humanos , Fraturas por Osteoporose/fisiopatologia , Amplitude de Movimento Articular , Fraturas da Coluna Vertebral/fisiopatologia , Estresse Mecânico , Vertebroplastia/efeitos adversos
10.
Med Sci Monit ; 27: e929853, 2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33597390

RESUMO

BACKGROUND The incidence of unspecific back pain and osteoporotic vertebral compression fractures increases significantly with age. Considering the difficulties in the diagnosis of spontaneous osteoporotic vertebral fractures, this retrospective study aimed to compare the characteristics of back pain in women with postmenopausal osteoporosis with and without vertebral compression fractures. MATERIAL AND METHODS This study enrolled 334 women with postmenopausal osteoporosis; 150 had vertebral fractures, and 184 had no vertebral fractures. Densitometric vertebral fracture assessment and bone mineral density measurements in the central skeleton were performed for each patient. The participants completed a survey about features of their back pain. RESULTS Patients with vertebral fractures had more severe back pain based on the numeric rating scale: 6.14 vs. 4.33 (P<0.001, odds ratio [OR]=1.43, 95% confidence interval [CI]: 1.29-1.59). Among these individuals, back pain caused reduction in normal activity during the day (P<0.001, OR=4.68, 95% CI: 2.86-7.68), and pain occurred more often (P<0.001, OR=1.77, 95% CI: 1.47-2.13), lasted longer (P<0.001, OR=2.01, 95% CI: 1.65-2.46), predominantly occurred in the lumbar spine (P<0.001, OR=4.70, 95% CI: 1.96-11.29), and intensified during normal everyday activities (P<0.001). Based on these results, a new survey was created. It demonstrated a sensitivity of 70.67% and a specificity of 67.37% in predicting a current compression fracture. CONCLUSIONS Patients with vertebral compression fractures experience higher pain intensity and exhibit specific features of back pain. The new survey can be considered a supportive tool in assessing the possibility of vertebral compression fractures.


Assuntos
Dor nas Costas/etiologia , Osteoporose Pós-Menopausa/fisiopatologia , Fraturas por Osteoporose/etiologia , Idoso , Dor nas Costas/fisiopatologia , Densidade Óssea/fisiologia , Doenças Ósseas Metabólicas , Feminino , Fraturas por Compressão/etiologia , Humanos , Vértebras Lombares/fisiopatologia , Pessoa de Meia-Idade , Osteoporose/fisiopatologia , Fraturas por Osteoporose/fisiopatologia , Polônia/epidemiologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/fisiopatologia
11.
Sci Rep ; 11(1): 122, 2021 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-33420234

RESUMO

Sarcopenia has been associated with poor clinical outcomes in several diseases. Herein, the clinical results of balloon kyphoplasty (BKP) for acute osteoporotic vertebral fracture (OVF) treatment were assessed and compared between sarcopenia and non-sarcopenia patients. Sixty patients who underwent BKP for treatment of acute OVF with poor prognostic factors between April 2016 and September 2017 and were assessed for sarcopenia were enrolled. Clinical results (back pain on visual analogue scale [VAS]; short-form [SF] 36; vertebral deformity; activities of daily living levels; and incidence of adjacent vertebral fractures) were compared between the two groups at 6 months post-BKP. Data analysis revealed that back pain on VAS, SF-36 scores, and vertebral deformity improved from baseline to 6 months after BKP. Thirty-nine patients (65.0%) were diagnosed with sarcopenia and demonstrated a lower body mass index (21.2 vs. 23.3 kg/m2, p = 0.02), skeletal muscle mass index (5.32 vs. 6.55 kg/m2, p < 0.01), hand-grip strength (14.7 vs. 19.2 kg, p = 0.01), and bone mineral density of the femoral neck (0.57 vs. 0.76 g/cm2, p < 0.01) than those of patients without sarcopenia. However, no significant differences were observed in the clinical results between these groups. Therefore, BKP's clinical results for the treatment of acute OVF are not associated with sarcopenia.


Assuntos
Cifoplastia , Fraturas por Osteoporose/cirurgia , Sarcopenia/complicações , Fraturas da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Animais , Humanos , Masculino , Força Muscular , Músculo Esquelético/crescimento & desenvolvimento , Fraturas por Osteoporose/complicações , Fraturas por Osteoporose/fisiopatologia , Estudos Prospectivos , Sarcopenia/fisiopatologia , Sarcopenia/cirurgia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/fisiopatologia , Resultado do Tratamento , Vertebrados/cirurgia
12.
J Bone Miner Metab ; 39(3): 463-473, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33387064

RESUMO

INTRODUCTION: Denosumab is a humanized IgG2 monoclonal antibody that was approved for the treatment of osteoporosis in Japan in 2013. This study aimed to investigate the long-term safety and effectiveness of denosumab in Japanese patients with osteoporosis in daily clinical practice. MATERIALS AND METHODS: This 3-year, prospective, observational, post-marketing study included patients who initiated treatment with denosumab (60 mg/6 months) for osteoporosis. Data were assessed at baseline, 3, 6, 12, 24 and 36 months. Key endpoints were adverse events (AEs), adverse drug reactions (ADRs), occurrence of osteoporotic fractures, bone mineral density (BMD), and bone turnover markers. Multivariate analyses were conducted to identify predictors of hypocalcaemia and percent change in BMD. RESULTS: Overall, 3534 patients were assessed (mean 75.7 years; 89.8% women). In total, 298 patients (8.4%) developed ADRs; the most common was hypocalcaemia (3.9%). Hypocalcaemia risk was significantly increased in patients with creatinine clearance < 30 mL/min, no prior use of bisphosphonates, prior use of calcium and vitamin D preparations, baseline serum calcium < 8.5 mg/dL, and no concomitant use of calcium or vitamin D preparations. Six patients had adjudicated osteonecrosis of the jaw. Lumbar spine BMD increased significantly from baseline (mean percent change: 11.4% at 36 months). All bone turnover markers decreased significantly from baseline. Over 3 years, 3.3% of patients developed a new osteoporotic fracture. CONCLUSIONS: This study confirmed the long-term safety and effectiveness of denosumab in Japanese patients with osteoporosis in daily clinical practice. No new safety signals were identified.


Assuntos
Grupo com Ancestrais do Continente Asiático , Denosumab/efeitos adversos , Denosumab/uso terapêutico , Osteoporose/tratamento farmacológico , Vigilância de Produtos Comercializados , Idoso , Biomarcadores/metabolismo , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/farmacologia , Conservadores da Densidade Óssea/uso terapêutico , Remodelação Óssea/efeitos dos fármacos , Feminino , Humanos , Hipocalcemia/epidemiologia , Incidência , Japão , Masculino , Análise Multivariada , Osteoporose/fisiopatologia , Fraturas por Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/fisiopatologia , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
13.
J Bone Miner Metab ; 39(3): 332-340, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33206222

RESUMO

Skeletal integrity is maintained by a meticulous balance between bone resorption and bone formation, and recent studies have revealed the essential role of canonical Wnt signaling pathways in maintaining skeletal homeostasis. The SOST gene, which encodes sclerostin, a member of Dan family glycoproteins, was originally identified as the gene responsible for two sclerosing bone dysplasias, sclerosteosis and van Buchem disease. Sclerostin is highly expressed by osteocytes, negatively regulates canonical Wnt signaling pathways by binding to low-density lipoprotein receptor-related protein (LRP) 5/6, and suppresses osteoblast differentiation and/or function. Romosozumab, a specific anti-sclerostin antibody, inhibits sclerostin-LRP5/6 interactions and indirectly activates canonical Wnt signaling pathways and bone formation. This review focuses on the mechanism of action of sclerostin and summarizes clinical studies that demonstrated the efficacy of romosozumab to increase bone mineral density and reduce osteoporotic fractures, as well as its cardiovascular safety.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Pesquisa Médica Translacional , Animais , Anticorpos Monoclonais/farmacologia , Anticorpos Monoclonais/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Humanos , Fraturas por Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/fisiopatologia , Via de Sinalização Wnt/efeitos dos fármacos
14.
J Nucl Med ; 62(4): 446-454, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33310738

RESUMO

Bone mineral density (BMD) measurement by dual-energy x-ray absorptiometry (DXA) is an internationally accepted standard-of-care screening tool used to assess fragility-fracture risk. Society guidelines have recommended which populations may benefit from DXA screening and the use of the fracture risk assessment tool (FRAX) to guide decisions regarding pharmacologic treatment for osteoporosis. According to the U.S. National Osteoporosis Foundation guidelines, postmenopausal women and men at least 50 y old with osteopenic BMD warrant pharmacologic treatment if they have a FRAX-calculated 10-y probability of at least 3% for hip fracture or at least 20% for major osteoporotic fracture. Patients with osteoporosis defined by a clinical event, namely a fragility fracture, or with an osteoporotic BMD should also be treated. Patients who are treated for osteoporosis should be monitored regularly to track expected gains in BMD by serial DXA scans. With some drug therapies, BMD targets can be reached whereby further improvements in BMD are not associated with further reductions in fracture risk. Although reaching this target might suggest a stopping point for therapy, the reversibility of most treatments for osteoporosis, except for the bisphosphonates, has dampened enthusiasm for this approach. In the case of denosumab, it is now apparent that stopping therapy at any point can lead to an increase in multiple-fracture risk. For patients who do not respond to antiosteoporosis pharmacologic therapy with an improvement in BMD, or who have an incident fragility fracture on therapy, secondary causes of osteoporosis or non-compliance with medical therapy should be considered.


Assuntos
Densidade Óssea , Humanos , Osteoporose/fisiopatologia , Osteoporose/terapia , Fraturas por Osteoporose/fisiopatologia , Fraturas por Osteoporose/terapia , Medição de Risco
15.
Artigo em Inglês | MEDLINE | ID: mdl-32903642

RESUMO

Introduction: Serum phosphate plays an important role in bone mineralization and might be a risk factor for many bone diseases. Patients with T2D usually have low serum phosphate level due to diet control, osmotic diuresis, and insulin stimulation. Current studies have discussed the linear association between serum phosphate and bone mineral density (BMD). Objective: We aimed to analyze both the linear and non-linear correlations between serum phosphate and BMD in patients with type 2 diabetes (T2D). Methods: We included 1,469 patients with T2D and obtained their basic information, laboratory measurements, and BMD data. Multivariate adjusted linear regression was used to analyze the linear associations, and we applied a two-piecewise linear regression model using a smoothing function to examine the non-linear association. Results: No linear correlation was found between serum phosphate and BMD in patients with T2D. In women with T2D, we found a non-linear correlation between serum phosphate level and femur neck or total hip BMD. When serum phosphate was <1.3 mmol/L, it was positively associated with femur neck and total hip BMD, whereas when phosphate was >1.3 mmol/L, it was negatively associated with femur neck BMD. Conclusions: In men with T2D, serum phosphate level was not associated with BMD. However, in women with T2D, we found a non-linear correlation between serum phosphate and femur neck or total hip BMD.


Assuntos
Densidade Óssea , Diabetes Mellitus Tipo 2/fisiopatologia , Fraturas por Osteoporose/fisiopatologia , Fosfatos/sangue , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/sangue , Fraturas por Osteoporose/etiologia , Estudos Retrospectivos , Fatores de Risco
16.
Artigo em Inglês | MEDLINE | ID: mdl-32849289

RESUMO

Background and Purpose: Muscle weakness and bone fragility are both associated with hip fracture. In general, muscle contractions create forces to the bone, and bone strength adapts to mechanical loading through changes in bone architecture and mass. However, the relationship between impairment of muscle and bone function remain unclear. In particular, the associations of muscle with properties of proximal femur cortical and trabecular bone are still not well understood. The aim of this study was to explore the associations of hip/thigh muscle density (CT attenuation value in Hounsfield units) and size with cortical and trabecular bone mineral density (BMD) of the proximal femur. Materials and Methods: Three-dimensional quantitative computed tomography (QCT) imaging of the lumber, hip and mid-thigh was performed in a total of 301 participants (mean age 68.4 ± 6.1 years, 194 women and 107 men) to derive areal BMD (aBMD) and volumetric BMD (vBMD). Handgrip strength (HGS) and the Timed Up and Go (TUG) test were also performed. From the CT images, cross-sectional area (CSA), and density were determined for the gluteus maximus muscle (G.MaxM), trunk muscle at the vertebrae L2 level, and mid-thigh muscle. Multivariate generalized linear models were applied to assess associations. Results: Total hip (TH) aBMD was associated significantly with G.MaxM CSA (men: P = 0.042; women: P < 0.001) and density (men: P = 0.012; women: P = 0.043). In women, 0.035 cm2 of mid-thigh CSA (95% CI, 0.014-0.057; P = 0.002) increased per SD increase in TH aBMD, but this significance was not observed in men (P = 0.095). Trunk muscle density and CSA were not associated with proximal femur BMD. The associations of hip/thigh muscle parameters with femoral neck BMD were weaker than those with trochanter and intertrochanter BMD. Furthermore, compared to muscle density, muscle CSA showed better associations with vBMD. G.MaxM CSA was associated with trochanter (TR) Cort. vBMD in men (ß, 19.898; 95% CI, 0.924-38.871; P = 0.040) and in women (ß, 15.426; 95% CI, 0.893-29.958; P = 0.038). Handgrip strength was only associated with TR aBMD (ß, 0.038; 95% CI, 0.006-0.070; P = 0.019) and intertrochanter aBMD (ß, 0.049; 95% CI, 0.009-0.090; P = 0.016) in men. Conclusions: We observed positive associations of the gluteus and thigh muscle size with proximal femur volumetric BMD. Specifically, the gluteus maximus muscle CSA was associated with trochanter cortical vBMD in both men and women.


Assuntos
Densidade Óssea , Fêmur/fisiopatologia , Força da Mão , Vida Independente/estatística & dados numéricos , Músculos/fisiopatologia , Fraturas por Osteoporose/fisiopatologia , Absorciometria de Fóton , Idoso , Feminino , Fêmur/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Músculos/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico por imagem , Tomografia Computadorizada por Raios X
17.
Genes (Basel) ; 11(6)2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32498429

RESUMO

As life expectancy increases, the prevalence of osteoporosis is increasing. In addition to vitamin D which is well established to have an association with osteoporosis, B vitamins, such as thiamine, folate (vitamin B9), and cobalamin (vitamin B12), could affect bone metabolism, bone quality, and fracture risk in humans by influencing homocysteine/folate metabolism. Despite the crucial role of B vitamins in bone metabolism, there are few studies regarding associations between B vitamin-related genes and osteoporosis. In this study, we investigated the genetic association of four single nucleotide polymorphisms (SNPs) within the 3'-untranslated regions of vitamin B-related genes, including TCN2 (encodes transcobalamin II), CD320 (encodes transcobalamin II receptor), SLC19A1 (encodes reduced folate carrier protein 1), and SLC19A2 (encodes thiamine carrier 1), with osteoporosis and osteoporotic vertebral compression fracture (OVCF). We recruited 301 postmenopausal women and performed genotyping of CD320 rs9426 C>T, TCN2 rs10418 C>T, SLC19A1 rs1051296 G>T, and SLC19A2 rs16862199 C>T using a polymerization chain reaction-restriction fragment length polymorphism assay. There was a significantly higher incidence of both osteoporosis (AOR 5.019; 95% CI, 1.533-16.430, p < 0.05) and OVCF (AOR, 5.760; 95% CI, 1.480-22.417, p < 0.05) in individuals with genotype CD320 CT+TT and high homocysteine concentrations. Allele combination analysis revealed that two combinations, namely CD320 C-TCN2 T-SLC19A1 T-SLC19A2 C (OR, 3.244; 95% CI, 1.478-7.120, p < 0.05) and CD320 T-TCN2 C-SLC19A1 G-SLC19A2 C (OR, 2.287; 95% CI, 1.094-4.782, p < 0.05), were significantly more frequent among the osteoporosis group. Our findings suggest that SNPs within the CD320 gene in 3´-UTR may contribute to osteoporosis and OVCF occurrences in some individuals. Furthermore, specific allele combinations of CD320, TCN2, SLC19A1, and SLC19A2 may contribute to increased susceptibility to osteoporosis and OVCF.


Assuntos
Antígenos CD/genética , Proteínas de Membrana Transportadoras/genética , Osteoporose/genética , Receptores de Superfície Celular/genética , Proteína Carregadora de Folato Reduzido/genética , Transcobalaminas/genética , Complexo Vitamínico B/genética , Regiões 3' não Traduzidas/genética , Alelos , Feminino , Ácido Fólico/genética , Ácido Fólico/metabolismo , Fraturas por Compressão/fisiopatologia , Estudos de Associação Genética , Predisposição Genética para Doença , Genótipo , Humanos , Osteoporose/fisiopatologia , Fraturas por Osteoporose/fisiopatologia , Pós-Menopausa/genética , Pós-Menopausa/metabolismo , Vitamina B 12/genética , Vitamina B 12/metabolismo , Complexo Vitamínico B/metabolismo
18.
Panminerva Med ; 62(2): 83-92, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32515572

RESUMO

BACKGROUND: Obesity has been regarded to be protective against fracture in spite of its association with low levels of vitamin D. Vitamin D is the key regulator of bone metabolism and its deficiency contributes to higher level of parathyroid hormone (PTH), leading to the activation of bone turnover. METHODS: We studied 161 subjects of which 65 were young healthy subjects and 96 were elderly subjects. We measured creatinine, 25(OH)D, 1,25(OH)2D, PTH, albumin, and calcium plasma levels, we evaluated physical activity, and we calculated BMI. A sub-cohort of elderly subjects also underwent DXA scans. RESULTS: Overweight and obese subjects, as well as underweight ones, had lower levels of vitamin D but normal serum concentrations of 1,25(OH)2D and PTH was higher in underweight and obese subjects. Moreover, we found a nonlinear relationship between body mass index (BMI) and PTH with a significant U-shaped exponential regression. Regardless of BMI, 25(OH)D mean levels were higher in subjects who practice physical activity. CONCLUSIONS: These findings suggest that physical activity and BMI had a significant effect on the metabolism of bone and vitamin D, but the effect of BMI was different in underweight, normal weight or obese subjects. In obesity the real vitamin D deficiency could be estimate by serum 1,25(OH)2D concentrations whose lower levels contribute to the higher PTH production and consequently to bone loss and to a greater fracture risk.


Assuntos
Exercício Físico , Obesidade/sangue , Fraturas por Osteoporose/sangue , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Adiposidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Índice de Massa Corporal , Densidade Óssea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/fisiopatologia , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/fisiopatologia , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Cidade de Roma/epidemiologia , Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/fisiopatologia
19.
J Clin Endocrinol Metab ; 105(10)2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32556277

RESUMO

CONTEXT: Reduced bone material strength index (BMSi) and increased cortical porosity (CtPo) have emerged as potentially contributing to fracture risk in type 2 diabetes mellitus (T2DM) patients. OBJECTIVE: To determine whether BMSi or CtPo are related to other diabetic complications. DESIGN: Cross-sectional observational study. SETTING: Subjects recruited from a random sample of southeast Minnesota residents. PARTICIPANTS: A total of 171 T2DM patients (mean age, 68.8 years) and 108 age-matched nondiabetic controls (mean age, 67.3 years). MAIN MEASURES: Bone material strength index was measured using microindentation, skin advanced glycation end-products (AGEs) measured using autofluorescence, high-resolution peripheral quantitative computed tomography at the distal radius and tibia, assessment of diabetic microvascular complications including urine microalbuminuria, retinopathy, neuropathy, and vascular disease (ankle brachial index and transcutaneous oxygen tension [TcPO2]). All analyses were adjusted for age, sex, and body mass index. RESULTS: Skin AGEs were negatively correlated with the BMSi in both T2DM (r = -0.30, P < 0.001) and control (r = -0.23, P = 0.020) subjects. In relating diabetic complications to CtPo, we found that T2DM patients with clinically significant peripheral vascular disease (TcPO2 ≤ 40 mm Hg) had higher (+21.0%, P = 0.031) CtPo at the distal tibia as compared to controls; in these subjects, CtPo was negatively correlated with TcPO2 at both the distal tibia (r = -0.39, P = 0.041) and radius (r = -0.41, P = 0.029). CONCLUSIONS: Our findings demonstrate that bone material properties are related to AGE accumulation regardless of diabetes status, while CtPo in T2DM patients is linked to TcPO2, a measure of microvascular blood flow.


Assuntos
Densidade Óssea/fisiologia , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/epidemiologia , Produtos Finais de Glicação Avançada/metabolismo , Fraturas por Osteoporose/epidemiologia , Idoso , Índice Tornozelo-Braço , Estudos Transversais , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/fisiopatologia , Feminino , Produtos Finais de Glicação Avançada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/fisiopatologia , Porosidade , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/fisiopatologia , Fatores de Risco , Pele/química , Pele/metabolismo , Tíbia/diagnóstico por imagem , Tíbia/fisiopatologia , Tomografia Computadorizada por Raios X
20.
Injury ; 51 Suppl 2: S118-S122, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32448467

RESUMO

Fractures in the elderly population are increasing in incidence and represent a rising burden of disease. It is difficult for the elderly population to adhere to restricted weight bearing, and immobility poses significant risks and increased morbidity. Therefore, a primary goal of fracture management in the elderly population is early post-operative weight bearing. This review examines published literature regarding lower extremity fracture management in the elderly, with a focus on post-operative rehabilitation. While extensive literature supports early weight bearing after hip fractures in the elderly, further research is warranted to provide guidelines for management of other lower extremity fractures in this population.


Assuntos
Fraturas do Quadril/reabilitação , Traumatismos da Perna/reabilitação , Fraturas por Osteoporose/reabilitação , Suporte de Carga/fisiologia , Idoso , Fraturas do Quadril/fisiopatologia , Fraturas do Quadril/cirurgia , Humanos , Traumatismos da Perna/fisiopatologia , Traumatismos da Perna/cirurgia , Fraturas por Osteoporose/fisiopatologia , Fraturas por Osteoporose/cirurgia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Resultado do Tratamento
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