Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.234
Filtrar
1.
Medicine (Baltimore) ; 99(11): e19426, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176069

RESUMO

BACKGROUND: Osteoporosis is an important cause of bone fractures and even a cause of threaten to the lives of elderly people. Mind-body exercises are beneficial interventions for improving flexibility, controlling body balance, and reducing pain. To assess the effect of mind-body exercise on osteoporosis in aging people, we will perform this systematic review. METHODS: Randomized controlled trials (RCTs) which carried out about mind-body exercise for osteoporosis will be included. Web of Science, PubMed, Science Direct, Medline, Cochrane Library, China National Knowledge Infrastructure, and Wanfang will be searched from inception to January 2020. The outcomes will include bone mineral density (BMD), bone mineral content (BMC), body balance, function of lower extremity, pain, fearing level, and quality of life. Trial reporting quality will be assessed by 2 reviewers independently and Review Manager 5.3 software will be used for meta-analysis. Trial registration is under PROSPERO (CRD42020165385). RESULTS: Based on the current evidence, the potential rank of the efficacy and safety of mind-body exercises for BMD, BMC, body balance, function of lower extremity, pain, fearing level and quality of life will be assessed, and a prioritization regimen will be summarized. CONCLUSIONS: Evidence from this systematic review could be useful for patients, clinical practitioners, and guideline-makers to select an optimum proposal of mild-body exercises for older adults with osteoporosis.


Assuntos
Terapias Mente-Corpo , Osteoporose/terapia , Idoso , Teorema de Bayes , Humanos , Meta-Análise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Medicine (Baltimore) ; 99(9): e19334, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118767

RESUMO

Primary osteoporosis (PO) is a common disease that was characterized by a systemic impairment of bone mass and microarchitecture that results in fragility fractures and constitutes a pressing public health problem. But the effect of acupuncture or moxibustion treatment for PO is controversial.To provide a comprehensive systematic overview of current evidence from systematic reviews (SR)/Meta-analysis of acupuncture treatment for PO pertaining to risk of bias, quality of evidence and report quality.A total of 9 international and Chinese databases were searched for SR/meta-analysis of randomized controlled trials (RCTs). The risk of bias of SR/meta-analysis was appraised using the risk of bias in systematic reviews (ROBIS) instrument, the quality of the evidence was evaluated via Grading of Recommendations Assessment, Development and Evaluation (GRADE), and the report quality of the included studies are estimated by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).According to ROBIS, only 2 articles were with risk of low bias; according to PRISMA, and most articles were reported incomplete, mainly in Q2, Q7, Q24, and Q27; according to GRADE, a total of 28 outcome indicators were evaluated under 4 different interventions of experimental group and control group: the evidence quality of bone mineral density (BMD) from treatment of acupuncture and moxibustion/acupuncture and moxibustion plus was high or moderate; Visual Analogue Score (VAS) of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was low or very low; clinical effectiveness of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was uncertain.Acupuncture and moxibustion can improve the BMD of PO patients according to high-quality evidence, and may benefit VAS, pain score, clinical efficacy based on moderate or low-quality evidence. Further research that provides higher quality evidence of SR/RCTs of acupuncture and moxibustion treatment for PO is required.


Assuntos
Terapia por Acupuntura/normas , Moxibustão/normas , Osteoporose/terapia , Terapia por Acupuntura/métodos , Humanos , Moxibustão/métodos , Osteoporose/fisiopatologia , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(1): e18549, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895794

RESUMO

BACKGROUND: Physical therapy have an important role in preventing and managing osteoporosis (OP). A number of randomized controlled studies have indicated that eight-section brocade (ESB) could increase bone mass and alleviate pain, particularly in older women. However, there is no systematic review evaluating safety and efficacy of ESB. METHODS: Relevant studies involving eight-section brocade in middle-aged and elderly individuals with osteoporosis were systematically identified from electronic databases, including EMBASE, PubMed, the Cochrane Library Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodicals Database, Chinese BioMedical Database, and Wanfang Data. Inclusion criteria are randomised controlled trials of eight-section brocade that examine function and bone metabolism in middle-aged and elderly individuals with OP. The primary outcome measures will be bone mineral density (BMD), balance capacity, pain score, and adverse event including fracture during exercise. Review Manager (Revman Version 5.3) software will be used for data synthesis, sensitivity analysis, meta regression, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias and Begg and Egger tests will be used to assess funnel plot symmetries. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. RESULTS: This paper will systematically review the existing evidence, assessing the safety and effect of eight-section brocade in middle-aged and elderly individuals with OP. CONCLUSION: The results of this review may help to establish a better approach to prevention of osteoporosis and osteoporotic fractures in high-risk groups and to provide reliableevidence for its further application. ETHICS AND DISSEMINATION: Our aim is to publish this systematic review in a peer-reviewed journal. Our findings will provide information about the safety of ESB exercises and their effect on BMD of middle-aged and elderly individuals. This review will not require ethical approval as there are no issues about participant privacy.


Assuntos
Medicina Tradicional Chinesa/métodos , Osteoporose/terapia , Modalidades de Fisioterapia , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Feminino , Humanos , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisão Sistemática como Assunto , Resultado do Tratamento
4.
Ann Agric Environ Med ; 26(4): 592-599, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31885233

RESUMO

INTRODUCTION: Osteoporosis is a chronic condition with serious sequela, including primarily bone fractures, and impacts on almost all spheres of human life. It is important for patients undergoing treatment to accept their health status and feel satisfied with life. OBJECTIVE: The aim of the study was to determine the relationship between socio-demographic factors, duration of the illness, self-assessment of the patient's knowledge of osteoporosis, and also between illness management support and acceptance of the illness and life satisfaction among females with chronic osteoporosis, resident in rural areas. MATERIAL AND METHODS: The study, conducted from September 2016 - June 2017, involved 207 patients of the Clinic of Orthopaedics and Rehabilitation and the Clinic of Gynaecology at the Independent Public Teaching Hospital No. 4 in Lublin, eastern Poland. The study used the Acceptance of Illness Scale (AIS) and the Satisfaction With Life Scale (SWLS). Statistical analysis was performed with Student's t-test, analysis of variance (ANOVA), Tukey's range test, and chi-squared test. A p-value of <0.05 defined statistical significance of differences. The analysis was performed using commercial SPSS Statistics 19 software (IBM Corp., Armonk, NY, USA). RESULTS: The respondents showed average acceptance of their illness (22.2±6.9) and relatively low satisfaction with life (14.7±5.6). Older age, low level of education, poor living conditions, prolonged illness, and frequent ailments are all associated with lower acceptance of the illness and poorer life satisfaction. CONCLUSIONS: As part of their treatment, chronically ill patients should be provided with appropriate support, in particular from healthcare personnel, health education and improved living conditions.


Assuntos
Osteoporose/psicologia , Satisfação Pessoal , Idoso , Idoso de 80 Anos ou mais , Comportamento , Feminino , Nível de Saúde , Humanos , Pessoa de Meia-Idade , Osteoporose/terapia , Polônia , Qualidade de Vida , População Rural/estatística & dados numéricos , Inquéritos e Questionários
5.
Medicine (Baltimore) ; 98(52): e18226, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876703

RESUMO

BACKGROUND: Primary osteoporosis (POP) is a common disease among elderly, which increase the risk of fracture and impact to the quality of life. As a Chinese traditional therapy, moxibustion has been commonly applied in treating chronic musculoskeletal diseases in China. Many trails have shown that moxibustion therapy is effective in treating primary osteoporosis. The protocol aims to present the methods used to access the effectiveness and safety of moxibustion therapy for patients with primary osteoporosis. METHODS: The following databases will be searched from their inception: the Cochrane Central Register of Controlled Trails(CENTRAL), Pubmed, EMBASE, China National Knowledge Infrastructure(CNKI), Chinese Biomedical Literature Database(CBM), Chinese Scientific Journal Database (VIP database), and Wan-Fang Database. Clinical randomized controlled trials related to moxibustion therapy for treating primary osteoporosis will be included, regardless of publication status and languages. Study selection, data collection, and quality assessment will be independently conducted by 2 researchers. We will select the fixed-effects or random-effects model according to the heterogeneity assessment for data synthesis. Bone mineral density(BMD) will be the primary outcomes. Visual analogue scale(VAS), response rate, TCM Syndrome scale(TCMSS), bone gla protein(BGP), alkaline phosphatase(BALP), blood calcium(Ca), blood phosphate(P), quality of life(QOL) will be the second outcomes. If it is appropriate for meta-analysis, RevMan V.5.3 statistical software will be used. Otherwise, a systematic narrative synthesis will be conducted. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference(WMD) or standard mean difference (SMD) 95% CIs for continuous data. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019129507.


Assuntos
Moxibustão , Osteoporose/terapia , Idoso , Humanos , Moxibustão/efeitos adversos , Moxibustão/métodos , Resultado do Tratamento
6.
J Med Food ; 22(10): 1047-1057, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31566516

RESUMO

Senile osteoporosis increases the risk of skeletal fractures with age. Cheonggukjang (CGJ), a traditional Korean dry fermented soybean product, has numerous therapeutic effects; however, its effects on bone mineral density (BMD) and bone metabolism in senile osteoporosis are unclear. In this study, we treated the senescence-accelerated mouse prone 6 (SAMP6) model of senile osteoporosis with CGJ to determine its potential for ameliorating and preventing osteoporosis progression. High-performance liquid chromatography analysis for isoflavone profiles revealed that short-term fermentation significantly increased the isoflavone aglycone content in soybeans. Thereafter, we fed 6-week-old SAMP6 mice with experimental diets containing 5% or 10% CGJ for 15 weeks. Microcomputed tomography revealed that CGJ supplementation effectively increased the BMD and relative bone length. In vitro, CGJ increased the osteopontin reactivity and upregulated the expression of Alp, Col1a1, Fak, Bmp2/4, Smad1/5/8, and Runx2 in osteoblasts, and decreased Cathepsin K reactivity and downregulated Rankl and Nfatc1 expression in osteoclasts. In addition, CGJ increased the osteoprotegerin/Rankl ratio. Collectively, these results demonstrate that CGJ can ameliorate the detrimental effects of senile osteoporosis by improving osteogenesis and decreasing osteoclast activity.


Assuntos
Densidade Óssea , Osteogênese , Osteoporose/terapia , Soja/química , Animais , Isoflavonas/química , Masculino , Camundongos , Osteoblastos/metabolismo , Osteoclastos/metabolismo
7.
Braz Oral Res ; 33: e079, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31531565

RESUMO

Cell therapy associated with guided bone regeneration (GBR) can be used to treat bone defects under challenging conditions such as osteoporosis. This study aimed to evaluate the effect of mesenchymal stem cells (MSCs) in combination with a poly(vinylidene-trifluoroethylene)/barium titanate (PVDF-TrFE/BT) membrane on bone repair in osteoporotic rats. Osteoporosis was induced in female rats by bilateral removal of the ovaries (OVX) or sham surgery (SHAM), and the osteoporotic condition was characterized after 5 months by microtomographic and morphometric analyses. Calvarial defects were created in osteoporotic rats that immediately received the PVDF-TrFE/BT membrane. After 2 weeks, bone marrow-derived MSCs from healthy rats, characterized by the expression of surface markers using flow cytometry, or phosphate-buffered saline (PBS) (Control) were injected into the defects and bone formation was evaluated 4 weeks post-injection by microtomographic, morphometric, and histological analyses. A reduction in the amount of bone tissue in the femurs of OVX compared with SHAM rats confirmed the osteoporotic condition of the experimental model. More bone formation was observed when the defects were injected with MSCs compared to that with PBS. The modification that we are proposing in this study for the classical GBR approach where cells are locally injected after a membrane implantation may be a promising therapeutic strategy to increase bone formation under osteoporotic condition.


Assuntos
Compostos de Bário/farmacologia , Regeneração Tecidual Guiada/métodos , Células-Tronco Mesenquimais/fisiologia , Osteogênese/efeitos dos fármacos , Osteoporose/terapia , Polivinil/farmacologia , Titânio/farmacologia , Animais , Compostos de Bário/química , Densidade Óssea , Regeneração Óssea/efeitos dos fármacos , Regeneração Óssea/fisiologia , Feminino , Citometria de Fluxo , Imagem Tridimensional , Células-Tronco Mesenquimais/química , Osteogênese/fisiologia , Osteoporose/fisiopatologia , Ovariectomia , Polivinil/química , Distribuição Aleatória , Ratos Wistar , Reprodutibilidade dos Testes , Fatores de Tempo , Titânio/química , Resultado do Tratamento
8.
Maturitas ; 128: 70-80, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31561827

RESUMO

BACKGROUND: Osteoporosis is a key concern of women with premature ovarian insufficiency (POI) but there are gaps in clinicians' knowledge of bone health. OBJECTIVES: 1) To systematically evaluate the quality of clinical practice guidelines (CPGs) related to POI and bone health; 2) to formulate a management algorithm. METHODS: Systematic search for English-language clinical practice guidelines (CPGs) from August 2012 to August 2017 (PROSPERO registration number CRD42017075143). Four reviewers independently evaluated the methodological quality of included CPGs using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument (comprising 23 items across 6 domains) using the My AGREE PLUS platform. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). Individual domain and total percentage scores were calculated for each CPG. Data from high-scoring CPGs were extracted and summarised to develop the algorithm, with subsequent refinement via expert and end-user clinician feedback. RESULTS: The systematic search yielded 16 CPGs for appraisal. ICC values were 0.71 (good) to 0.95 (very good). The quality of the CPGs was appraised as "high" in 4 cases, "average" in 8 and "low" in 4. High-quality CPGs had mean total scores of 82-96%. Recommendations from high-quality CPGs were summarised into 6 categories: screening; risk factors; initial assessment; diagnosis; subsequent assessment; and management. Only "management" had recommendations (moderate-quality to low-quality evidence) from all four high-quality CPGs. Limitations are reflected in the algorithm. CONCLUSIONS: Most CPGs regarding bone health and POI are of average to poor quality. High-quality CPGs have evidence limitations and recommendation gaps indicating the need for further research.


Assuntos
Densidade Óssea/fisiologia , Menopausa Precoce , Osteoporose/terapia , Guias de Prática Clínica como Assunto , Insuficiência Ovariana Primária/complicações , Adulto , Algoritmos , Feminino , Humanos , Osteoporose/etiologia , Reprodutibilidade dos Testes
9.
Eat Disord ; 27(5): 471-481, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31524091

RESUMO

Osteoporosis is a common and very serious complication of anorexia nervosa. It affects these patients, both males and females, at very young ages. This loss of bone mineral density begins quickly, soon after the onset of the eating disorder. It is one of the rare medical complications of anorexia nervosa which may result in irreparable harm, even if there is successful nutritional rehabilitation and weight restoration. Nevertheless, notwithstanding its high importance, there is a paucity of evidence-based medicine to guide the optimal approach to diagnosis, prevention, and treatment. This paper attempts to inform clinicians taking care of these patients about a reasonable and measured approach to this problem, while the field awaits more definitive medical literature.


Assuntos
Anorexia Nervosa/complicações , Densidade Óssea/fisiologia , Educação Continuada , Osteoporose/terapia , Adolescente , Adulto , Fatores Etários , Anorexia Nervosa/terapia , Feminino , Humanos , Masculino
10.
J Med Food ; 22(10): 1022-1031, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31381476

RESUMO

Excessive expression of TNF-α worsens bacterial vaginosis (BV) and osteoporosis. Therefore, to understand whether probiotics could alleviate vaginosis and osteoporosis, we isolated anti-inflammatory Lactobacillus plantarum NK3 and Bifidobacterium longum NK49 from kimchi and human fecal lactic acid bacteria collection and examined their effects on Gardnerella vaginalis (GV)-induced vaginosis and ovariectomy-induced osteoporosis in female mice. Oral gavage of NK3 and/or NK49 significantly alleviated GV-induced vaginosis; these inhibited NF-κB activation and TNF-α expression in the vagina and uterus, and decreased the GV population in the vagina. Furthermore, treatment with NK3 and/or NK49 alleviated ovariectomy-induced osteoporosis and obesity; these increased blood calcium, phosphorus, and osteocalcin levels and suppressed body weight. GV-induced vaginosis and ovariectomy increased colonic myeloperoxidase activity, TNF-α expression, and fecal Proteobacteria population. NK3 and/or NK49 treatments reduced TNF-α expression and NF-κB activation in the colon. NK3 and NK49 treatment also restored GV- or ovariectomy-disrupted gut microbiota composition. In conclusion, NK3 and NK49 may simultaneously alleviate BV and osteoporosis by suppressing NF-κB-linked TNF-α expression through the regulation of gut microbiota population.


Assuntos
Bifidobacterium longum/fisiologia , Lactobacillus plantarum/fisiologia , Osteoporose/terapia , Probióticos/uso terapêutico , Vaginose Bacteriana/terapia , Animais , Células Cultivadas , Fezes/microbiologia , Feminino , Gardnerella vaginalis/patogenicidade , Humanos , Macrófagos/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/metabolismo , Ovariectomia , Fator de Necrose Tumoral alfa/metabolismo
12.
Dtsch Med Wochenschr ; 144(16): 1111-1119, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31416102

RESUMO

In Germany, over six million people suffer from osteoporosis. Nearly half of the women over 70 years and nearly 20 % of men at the same age are affected. The clinical and socioeconomical relevance of the disease lies in osteoporotic fractures leading to extensive bone-associated morbidity, increased mortality and health care costs. Fracture risk algorithms and guidelines for the diagnosis and treatment of osteoporosis help to assess the individual fracture risk. By calculating the individual fracture risk, the indication for specific osteoporosis treatment can objectively be determined. A consequent specific osteoporosis therapy is required for patients with a high fracture risk and is essential to prevent osteoporotic fractures and their consequences. As first-line therapy a drug with a proven fracture-reducing effect should be taken. However, for successful osteoporosis therapy, many individual factors have to be considered. A personalized treatment approach should be established according to the severity of the disease, the patient's sex and comorbidities as well as the possible additive and side effects of the drug.


Assuntos
Osteoporose , Medicina de Precisão , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/terapia
13.
Georgian Med News ; (291): 89-93, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31418738

RESUMO

Treatment criteria based only on bone mineral density do not reflect completely the likelihood of fractures. We reviewed the studies and recommendations on different types of intervention thresholds for the initiation of treatment in patients with osteoporosis. Georgian Association of Skeletal Metabolism Diseases recommends to use age dependent intervention threshold based on 10-year probability of osteoporotic fractures calculated by FRAX algorithm as a diagnostic and treatment criteria for patients with osteoporosis.


Assuntos
Algoritmos , Osteoporose/diagnóstico , Osteoporose/terapia , Densidade Óssea , República da Geórgia , Humanos , Osteoporose/complicações , Osteoporose/metabolismo , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/prevenção & controle , Medição de Risco , Fatores de Risco , Sociedades Médicas
15.
Clin Chim Acta ; 498: 101-107, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31425674

RESUMO

With the aging of society, the number of osteoporosis-related fractures is increasing. Prevention of osteoporosis and maintenance of the quality of life of osteoporosis patients require early diagnosis, effective treatment, and highly precise treatment monitoring. Although bone biopsy is clinically one of the essential techniques for diagnosis of osteoporosis, it is invasive and difficult to perform in general clinical practice. Bone mineral density measurement is another essential technique available in clinical practice that provides good precision. However, it is not effective for determining the appropriate treatment options or evaluating short-term treatment efficacy. On the other hand, bone turnover markers (BTMs) have gained attention because they provide information that is valuable for both the selection of treatment and short-term monitoring. BTMs are now positioned to become a tool for clinically assessing bone turnover outcomes. Since the Japan Osteoporosis Society issued its Guidelines for the Use of Bone Turnover Markers in the Diagnosis and Treatment of Osteoporosis in 2012, new drugs, drug formulations, and combination drug therapies have been approved; therefore, we updated the 2012 guidelines in the Guide for the Use of Bone Turnover Markers in the Diagnosis and Treatment of Osteoporosis (2018 Edition).


Assuntos
Remodelação Óssea , Osteoporose/diagnóstico , Osteoporose/terapia , Guias de Prática Clínica como Assunto , Biomarcadores/análise , Humanos , Japão
16.
Unfallchirurg ; 122(10): 771-777, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31456044

RESUMO

Despite the high incidence of osteoporosis, the high risk of subsequent fractures after an initial fracture and effective treatment options, there is a substantial deficit in the diagnostics and treatment of patients suffering from osteoporosis in Germany and worldwide. The reasons for this are multifactorial and can be attributed to physicians and patients as well as mismanagement inherent to the system. This article provides an overview of the challenges in the treatment of osteoporosis patients and shows the possibilities for improvement of care in the outpatient area. With respect to the exact schedule of the diagnostics and treatment of osteoporosis, reference is made to the pocket-sized edition of the current guidelines of the Governing Body Osteology (DVO).


Assuntos
Osteoporose/terapia , Pacientes Ambulatoriais , Fraturas Ósseas , Alemanha , Humanos , Osteologia
17.
Medicine (Baltimore) ; 98(32): e16735, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393383

RESUMO

BACKGROUND: Acupoint injection has currently received increasing attention as a treatment for primary osteoporosis (POP). A number of randomized controlled trials (RCTs) have reported that acupoint injection have some advantages in treatment of POP. However, no article has summarized the existing evidence. This study will evaluate the efficacy and safety of acupoint injection as a clinical treatment for POP, so as to provide an important reference for clinical decision-making. METHODS: RCTs of acupoint injection compared with conventional non-acupoint injection for POP were identified in searches of 7 databases from their inception to March 2019. All data were assessed and extracted by 2 authors independently. The risk of bias assessment recommended by the Cochrane Collaboration was used to assess the quality of the selected studies. Review Manager 5.3 (Cochrane Collaboration) was used to conduct meta-analysis for the efficacy and safety of acupoint injection. RESULT: The results of this systemic review and meta-analysis will be submitted to a recognized journal for publication. CONCLUSION: This systemic review and meta-analysis will evaluate the efficacy and safety of acupoint injection as a clinical treatment for POP. We hope this study can make a definitive conclusion for acupoint injection in the treatment of POP. REGISTRATION: PROSPERO (registration number CRD42019130890).


Assuntos
Pontos de Acupuntura , Terapia por Acupuntura/métodos , Osteoporose/terapia , Humanos , Medicina Tradicional Chinesa , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
19.
Reumatol. clín. (Barc.) ; 15(4): 188-210, jul.-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184412

RESUMO

Objetivo: Actualizar las recomendaciones sobre osteoporosis (OP) de la Sociedad Española de Reumatología (SER) basadas en la mejor evidencia posible. Métodos: Se creó un panel formado por nueve reumatólogos expertos en OP previamente seleccionados por la SER mediante una convocatoria abierta. Las fases del trabajo fueron: identificación de las áreas claves para la actualización del consenso anterior, análisis y síntesis de la evidencia científica (utilizando los niveles de evidencia del SIGN) y formulación de recomendaciones a partir de esta evidencia y de técnicas de consenso. Resultados: Esta revisión de las recomendaciones comporta una actualización en la evaluación diagnóstica de la OP y de su tratamiento. Propone unos criterios para considerar alto riesgo de fractura y unas indicaciones para iniciar tratamiento. Las recomendaciones abordan también cuestiones relativas a la seguridad de los tratamientos y al manejo de situaciones especiales como las enfermedades inflamatorias y el tratamiento con glucocorticoides. Conclusiones: Se presenta la actualización de las recomendaciones SER sobre OP


Objective: To update the recommendations on osteoporosis (OP) of the Spanish Society of Rheumatology (SER) based on the best possible evidence. Methods: A panel of nine expert rheumatologists in OP was created, previously selected by the SER through an open call. The phases of the work were: identification of the key areas for updating the previous consensus, analysis and synthesis of the scientific evidence (using the SIGN levels of evidence) and formulation of recommendations based on this evidence and consensus techniques. Results: This revision of the recommendations implies an update in the diagnostic evaluation and treatment of OP. It proposes some criteria to consider the high risk of fracture and some indications to start treatment. The recommendations also address issues related to the safety of treatments and the management of special situations such as inflammatory diseases and treatment with glucocorticoids. Conclusions: We present an update of SER recommendations on OP


Assuntos
Humanos , Osteoporose/diagnóstico , Osteoporose/terapia , Fraturas por Osteoporose/prevenção & controle , Conservadores da Densidade Óssea/uso terapêutico , Prática Clínica Baseada em Evidências , Segurança do Paciente , Glucocorticoides/uso terapêutico , Densitometria
20.
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
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA