Analysis and research on the key factors of sports in maintaining human health / Análise e pesquisa sobre os fatores-chave do esporte na manutenção da saúde humana / Análisis e investigación sobre los factores clave del deporte para mantener la salud humana

ABSTRACT Introduction The research on the promotion of physical fitness of the human body by exercise has also attracted widespread attention in sports and rehabilitation medicine. Object This article uses ultrasound to study the bone density health of the human body, thereby establishing the relationship between sports and bone density health. We hope to use the research results of this article to improve people's awareness of sports health. Method We used ultrasound to test the bone mineral density of two groups of students (exercise group and non-exercise group) to explore the relationship between different sports items and the students' bone mineral density. Results There is a significant difference in bone density between the two groups of students. There is no gender difference in bone density. Conclusion Students need to strengthen physical exercise in the growth and development stage to improve bone density. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução A pesquisa sobre a promoção da aptidão física do corpo humano por meio do exercício também tem atraído atenção generalizada na medicina esportiva e de reabilitação. Objeto este artigo usa o ultrassom para estudar a saúde da densidade óssea do corpo humano, estabelecendo assim a relação entre esportes e saúde da densidade óssea. Esperamos usar os resultados da pesquisa deste artigo para aumentar a conscientização das pessoas sobre a saúde no esporte. Método Usamos ultrassom para testar a densidade mineral óssea de dois grupos de alunos (grupo de exercícios e grupo de não exercícios) para explorar a relação entre diferentes itens esportivos e a densidade mineral óssea dos alunos. Resultados Existe uma diferença significativa na densidade óssea entre os dois grupos de alunos. Não há diferença de gênero na densidade óssea. Conclusão Os alunos precisam fortalecer os exercícios físicos na fase de crescimento e desenvolvimento para melhorar a densidade óssea. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción La investigación sobre la promoción de la aptitud física del cuerpo humano mediante el ejercicio también ha atraído una amplia atención en la medicina deportiva y de rehabilitación. Objeto Este artículo utiliza la ecografía para estudiar la salud de la densidad ósea del cuerpo humano, estableciendo así la relación entre el deporte y la salud de la densidad ósea. Esperamos utilizar los resultados de la investigación de este artículo para mejorar la conciencia de las personas sobre la salud deportiva. Método Utilizamos ultrasonido para probar la densidad mineral ósea de dos grupos de estudiantes (grupo de ejercicio y grupo sin ejercicio) para explorar la relación entre diferentes artículos deportivos y la densidad mineral ósea de los estudiantes. Resultados Existe una diferencia significativa en la densidad ósea entre los dos grupos de estudiantes. No hay diferencia de género en la densidad ósea. Conclusión Los estudiantes necesitan fortalecer el ejercicio físico en la etapa de crecimiento y desarrollo para mejorar la densidad ósea. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Osteoporosis and hearing loss: findings from the Korea National Health and Nutrition Examination Survey 2009-2011 / Osteoporose e perda auditiva: resultados da Pesquisa Nacional do Exame de Saúde e Nutrição da Coreia de 2009 a 2011

Abstract Introduction: Age-related hearing impairment is the most common sensory dysfunction in older adults. In osteoporosis, the mass of the ossicles will be decreased, affecting the bone density of the cochlea, and interfering with the sound transmission to the cochlea. Age related hearing loss might be closely related to osteoporosis. Objective: To determine the relationship between age-related hearing impairment and osteoporosis by investigating the relationship between hearing loss and cortical bone density evaluated from femur neck bone mineral density. Methods: We used data from the Korea National Health and Nutrition Examination Survey to examine the associations between osteoporosis and age-related hearing impairment from 2009 to 2011. Total number of participants was 4861 including 2273 men and 2588 women aged 50 years or older. Osteoporosis was defined as a bone mineral density 2.5 standard deviations below according to the World Health Organization diagnostic classification. Age-related hearing impairment was defined as the pure-tone averages of test frequencies 0.5, 1, 2, and 4 kHz at a threshold of 40 dB or higher on the more impaired hearing side. Results: Total femur T-score (p < 0.001), lumbar-spine T-score (p < 0.001) and, femur neck T-score (p < 0.001) were significantly lower in the osteoporosis group compared to the normal group. Thresholds of pure-tone averages were significantly different in normal compared to osteopenia, and osteoporosis groups. In addition, there were significantly higher pure-tone averages thresholds in the osteoporosis group compared to other groups (p < 0.001). After adjusting for all covariates, the odds ratio for hearing loss was significantly increased by 1.7 fold with reduced femur neck bone mineral density (p < 0.01). However, lumbar spine bone mineral density was not statistically associated with hearing loss (p = 0.22). Conclusion: Our results suggest that osteoporosis is significantly associated with a risk of hearing loss. In addition, femur neck bone mineral density was significantly correlated with hearing loss, but lumbar spine bone mineral density was not.

Resumo Introdução: A perda auditiva associada ao envelhecimento é a disfunção sensorial mais comum em idosos. Na osteoporose, a massa dos ossículos diminui e afeta a densidade óssea da cóclea, o que irá interferir na transmissão do som para a mesma. A perda auditiva associada à idade pode estar intimamente relacionada à osteoporose. Objetivo: Determinar a relação entre deficiência auditiva relacionada à idade e osteoporose, investigar a relação entre perda auditiva e densidade óssea cortical avaliada a partir da densidade mineral óssea do colo do fêmur. Método: Utilizamos dados da Korea National Health and Nutrition Examination Survey para examinar as associações entre osteoporose e perda auditiva associada ao envelhecimento de 2009 a 2011. O número total de participantes foi de 4.861, incluiu 2.273 homens e 2.588 mulheres com 50 anos ou mais. A osteoporose foi definida como densidade mineral óssea com 2,5 desvios-padrão abaixo da média, de acordo com a classificação diagnóstica da Organização Mundial da Saúde. A perda auditiva associada ao envelhecimento foi definida como as médias de tom puro das frequências de teste de 0,5, 1, 2 e 4 kHz a um limiar de 40 dB ou superior no lado da audição mais afetado. Resultados: O T-score total do fêmur (p < 0,001), o T-score da coluna lombar (p < 0,001) e o T-score do colo do fêmur (p < 0,001) foram significantemente menores no grupo com osteoporose em comparação ao grupo normal. Os limiares de médias de tom puro foram significantemente diferentes nos grupos normais em comparação com aqueles com osteopenia e osteoporose. Além disso, houve limiares significantemente maiores de médias de tom puro no grupo com osteoporose em comparação com os outros grupos (p < 0,001). Após o ajuste para todas as covariáveis, a odds ratio da perda auditiva mostrou estar significantemente aumentada em 1,7 vez com densidade mineral óssea reduzida no colo do fêmur (p < 0,01). No entanto, a densidade mineral óssea da coluna L não se associou estatisticamente à perda auditiva (p = 0,22). Conclusão: Nossos resultados sugerem que a osteoporose está significantemente associada ao risco de perda auditiva. Além disso, a densidade mineral óssea da coluna lombar não se correlacionou com a perda auditiva, apenas a densidade mineral óssea do colo do fêmur foi significantemente correlacionada.

Association of bone mineral density with chronic obstructive pulmonary disease in postmenopausal women

Abstract Background Osteoporosis (OP) is common in patients with chronic obstructive pulmonary disease (COPD). The relationship between OP and COPD has been primarily studied in male patients, and few reports are available in postmenopausal women. Objective The purpose of this study was to investigate the association between bone mineral density (BMD) and COPD in postmenopausal women. Methods This cross-sectional study included 133 clinically stable female ex-smokers with confirmed COPD, and 31 age-matched “ex-smoker” female controls. We analyzed groups according to their airway obstruction category. BMD was measured on dual-energy X-ray absorptiometry images of the left femoral neck. Results Patients with COPD had lower T-scores and higher prevalence of osteopenia/OP than the control group. In the COPD group, the airway obstruction category was significantly associated with the T-score after adjustment for confounders. Multivariate logistic regression analysis showed COPD was an independent marker for increased risk of osteopenia/OP in postmenopausal women. Conclusions COPD and airway obstruction category were strongly related to BMD. Postmenopausal women with COPD, especially those with severe airway obstruction, had a higher prevalence rate and a higher risk of osteopenia and OP than female controls without COPD.

Linear growth and bone metabolism in pediatric patients with inflammatory bowel disease / Crescimento linear e metabolismo ósseo em pacientes pediátricos com doença inflamatória intestinal

Abstract Objective: To review the pathophysiology and evaluation methods of linear growth and bone mineral density in children and adolescents diagnosed with inflammatory bowel disease. Source of data: Narrative review carried out in the PubMed and Scopus databases through an active search of the terms: inflammatory bowel disease, growth, failure to thrive, bone health, bone mineral density, and children and adolescents, related to the last ten years, searching in the title, abstract, or keyword fields. Synthesis of findings: Inflammatory bowel diseases of childhood onset may present as part of the clinical picture of delayed linear growth in addition to low bone mineral density. The presence of a chronic inflammatory process with elevated serum levels of inflammatory cytokines negatively interferes with the growth rate and bone metabolism regulation, in addition to increasing energy expenditure, compromising nutrient absorption, and favoring intestinal protein losses. Another important factor is the chronic use of glucocorticoids, which decreases the secretion of growth hormone and the gonadotrophin pulses, causing pubertal and growth spurt delay. In addition to these effects, they inhibit the replication of osteoblastic lineage cells and stimulate osteoclastogenesis. Conclusion: Insufficient growth and low bone mineral density in pediatric patients with inflammatory bowel disease are complex problems that result from multiple factors including chronic inflammation, malnutrition, decreased physical activity, late puberty, genetic susceptibility, and immunosuppressive therapies, such as glucocorticoids.

Resumo Objetivo: Revisar a fisiopatologia e os métodos de avaliação do crescimento linear e densidade mineral óssea em crianças e adolescentes com diagnóstico de doença inflamatória intestinal. Fontes dos dados: Revisão narrativa a partir de pesquisa nas bases de dados PubMed e Scopus por meio de busca ativa dos termos inflammatory bowel disease, growth, failure to thrive, bone health, bone mineral density, children e adolescents nos últimos dez anos e com busca nos campos título, resumo ou palavra-chave. Resumo dos achados: As doenças inflamatórias intestinais com início na infância podem apresentar como parte do quadro clínico atraso do crescimento linear, além de baixa densidade mineral óssea. A presença de processo inflamatório crônico com elevados níveis séricos das citocinas inflamatórias interfere negativamente na velocidade do crescimento e na regulação do metabolismo ósseo, além de aumentar o gasto energético, comprometer a absorção de nutrientes e favorecer perdas proteicas intestinais. Outro fator importante é o uso crônico de glicocorticoides, que diminuem a secreção de hormônio do crescimento e dos pulsos das gonadotrofinas e ocasionam atraso puberal e no estirão do crescimento. Além desses efeitos, inibem a reprodução das células da linhagem osteoblástica e estimulam a osteoclastogênese. Conclusão: A insuficiência do crescimento e a baixa densidade mineral óssea em pacientes pediátricos com doença inflamatória intestinal são problemas complexos e que decorrem de múltiplos fatores, inclusive inflamação crônica, desnutrição, diminuição da atividade física, puberdade tardia, suscetibilidade genética a terapias imunossupressoras, como os glicocorticoides.

FRAX-based intervention and assessment thresholds in seven Latin American countries

Age-specific intervention and assessment thresholds were developed for seven Latin American countries. The intervention threshold ranged from 1.2% (Ecuador) to 27.5% (Argentina) at the age of 50 and 90 years, respectively. In the Latin American countries, FRAX offers a substantial advance for the detection of subjects at high fracture risk.INTRODUCTION:Intervention thresholds are proposed using the Fracture Risk Assessment (FRAX) tool. We recommended their use to calculate the ten-year probability of fragility fracture (FF) in both, men and women with or without the inclusion of bone mineral density (BMD). The purpose of this study is to compute FRAX-based intervention and BMD assessment thresholds for seven Latin American countries in men and women ≥ 40 years.METHODS:The intervention threshold (IT) was set at a 10-year probability of a major osteoporotic fracture (MOF) equivalent to a woman with a prior FF and a body mass index (BMI) equal to 25.0 kg/m2 without BMD or other clinical risk factors. The lower assessment threshold was set at a 10-year probability of a MOF in women with BMI equal to 25.0 kg/m2, no previous fracture and no clinical risk factors. The upper assessment threshold was set at 1.2 times the IT.RESULTS:For the seven LA countries, the age-specific IT varied from 1.5 to 27.5% in Argentina, 3.8 to 25.2% in Brazil, 1.6 up to 20.0% in Chile, 0.6 to 10.2% in Colombia, 0.9 up to 13.6% in Ecuador, 2.6 to 20.0% in Mexico, and 0.7 up to 22.0% in Venezuela at the age of 40 and 90 years, respectively.CONCLUSIONS:In the LA countries, FRAX-based IT offers a substantial advance for the detection of men and women at high fracture risk, particularly in the elderly. The heterogeneity of IT between the LA countries indicates that country-specific FRAX models are appropriate rather than a global LA model (AU)

Lean mass as a determinant of bone mineral density of proximal femur in postmenopausal women

ABSTRACT Objective: To verify which component of body composition (BC) has greater influence on postmenopausal women bone mineral density (BMD). Subjects and methods: Four hundred and thirty women undergoing treatment for osteoporosis and 513 untreated women, except for calcium and vitamin D. Multiple linear regression analysis was performed in order to correlated BMD at lumbar spine (LS), total femur (FT), femoral neck (FN) with body mass (BM), total lean mass (LM) and total fat mass (FM), all determined by DXA. Results: BM significantly correlated with all bone sites in untreated and treated women (r = 0.420 vs 0.277 at LS; r = 0.490 vs 0.418 at FN, r = 0.496 vs 0.414 at FT, respectively). In untreated women, the LM correlated better than FM with all sites, explaining 179% of LS; 32.3% of FN and 30.2% of FT; whereas FM explained 13.2% of LS; 277% of FN, 23.4% of FT In treated women, correlations with BC were less relevant, with the LM explaining 6.7% of BMD at LS; 15.2% of FN, 16% of FT, whereas the FM explained 8.1% of LS; 179% of FN and 176% of FT. Conclusion: LM in untreated women was better predictor of BMD than FM, especialy for distal femur, where it explained more than 30% of the BMD, suggesting that maintaining a healthy muscle mass may contribute to decrease osteoporosis risk. Treatment with anti-osteoporotic drugs seems to mask these relationships. Arch Endocrinol Metab. 2018;62(4):431-7

Relação entre resultados da FRAX-Brasil e de densitometrias ósseas / Relationship between the results of FRAX-Brazil and bone densitometries

OBJETIVO: Comparar resultados de densitometrias ósseas e do risco de fratura pela plataforma Fracture Risk Assessment Tool® (FRAX®). Métodos: Estudo observacional, transversal, de natureza quantitativa, realizado por meio da análise de prontuários de indivíduos que realizaram densitometria óssea e seus respectivos laudos, com cálculo posterior do risco de fratura maior e de quadril nos próximos 10 anos pela FRAX®. RESULTADOS: A média de idade foi de 60,19±9,44 anos, e houve predomínio de mulheres (96,5%). Dos indivíduos, 1,1% foi classificado como com risco de fratura maior e 9,1% com risco de fratura de quadril. A osteoporose foi encontrada em 12,4% da amostra, com predomínio nos pacientes mais idosos, e a coluna foi o sítio mais comum (53,7%). Admitindo-se a densitometria óssea como padrão-ouro para diagnóstico de osteoporose, a sensibilidade da plataforma para detectar risco de fratura maior foi 4,5%. Observou-se correlação positiva entre idade e risco de fratura, e negativa entre idade e T-score. CONCLUSÃO: Foi baixa a sensibilidade da plataforma, e não foi importante a relação entre os resultados da densitometria óssea e da FRAX®, sugerindo que esta ferramenta não se mostrou adequada para ser inserida como método de rastreio para osteoporose na população estudada.(AU)

OBJECTIVES: To compare the results of bone densitometry and fracture risk through the platform Fracture Risk Assessment Tool (FRAX®). METHODS: This is a cross-sectional, observational study of quantitative approach performed through the analyses of medical records of individuals who underwent bone densitometry and their respective reports, with a posterior calculation of the risk of major and hip fracture in the next 10 years through FRAX®. RESULTS: The mean age was 60.19±9.44 years, with a predominance of women (96.5%). Of the individuals, 1.1% were classified as having a major fracture risk, and 9.1% as having a hip fracture risk. Osteoporosis was found in 12.4% of the sample, with predominance in the older patients, and the spine was the most common site (53.7%). Assuming bone densitometry as the gold standard for diagnosis of osteoporosis, the sensitivity of the platform to detect major fracture risk was 4.5%. There was a positive correlation between age and fracture risk, and a negative correlation between age and t-score. CONCLUSION: The platform showed low sensitivity, and the relationship between the results of the bone densitometry and FRAX® was not significant, suggesting that this tool is not adequate to be inserted as a screening method for osteoporosis in the studied population.(AU)

Association of Severity of Coronary Lesions with Bone Mineral Density in Postmenopausal Women / Associação entre Gravidade das Lesões Coronarianas e Densidade Mineral Óssea em Mulheres Pós-Menopausa

Abstract Background: Coronary artery disease (CAD) and osteoporosis (OP) are common diseases in postmenopausal women. In both cross-sectional and longitudinal epidemiologic studies, low bone mass has been related to increased frequency of CAD. However, available data on the relationship between bone mineral density (BMD) and severity of coronary lesions is limited. Objective: To investigate association between the BMD and severity of coronary lesions assessed by Gensini score in postmenopausal women. Methods: This study included 122 postmenopausal women who were diagnosed with CAD. These patients were divided into two groups according to the severity of coronary lesions assessed by the Gensini score - patients with mild coronary lesions (Gensini score < 25) and patients with severe coronary lesions (Gensini score ≥ 25). Femoral neck mineral density was measured with dual energy X-ray absorptiometry (DXA). Results: The study included postmenopausal women aged 64.31 ± 4.71 years, 85 of whom (69.7%) exhibited severe coronary lesions. Participants with severe coronary lesions had a significantly higher T score than did those with mild coronary lesions at the femoral neck (p < 0.05). The mean T-score was −0.84 ± 1.01 in mild coronary lesions group, −1.42 ± 1.39 in severe coronary lesions group (p < 0.05). Multivariable logistic regression analysis showed that osteopenia-osteoporosis at the Femoral neck (odds ratio 2.73; 95% confidence interval 1.06 to 6.13) was associated with an increased risk of developing severe coronary lesions. The multiple regression model showed that T-scores (b = −0.407, SE = 0.151, p=0.007) were the independent predictors of Gensini score. Conclusion: The relationship between severity of coronary lesions and BMD was significant in postmenopausal women. BMD, a low-cost technique involving minimal radiation exposure, widely used for osteoporosis screening, is a promising marker of severity of coronary lesions.

Resumo Fundamento: A doença arterial coronariana (DAC) e a osteoporose são doenças comuns em mulheres pós-menopausa. Tanto em estudos transversais como em estudos epidemiológicos longitudinais, a massa óssea diminuída foi relacionada à frequência aumentada de DAC. No entanto, dados disponíveis sobre a relação entre densidade mineral óssea (DMO) e gravidade das lesões coronarianas são limitados. Objetivo: Investigar a associação entre DMO e gravidade das lesões coronarianas avaliadas pelo escore de Gensini em mulheres pós-menopausa. Métodos: Este estudo incluiu 122 mulheres pós-menopausa diagnosticadas com DAC. As pacientes foram divididas em dois grupos de acordo com a gravidade das lesões coronarianas avaliada pelo escore de Gensini - pacientes com lesões coronarianas leves (escore de Gensini < 25) e pacientes com lesões coronarianas graves (escore de Gensini ≥ 25). A densidade mineral do colo femoral foi medida por absorção de raios-X de dupla energia (DXA). Resultados: O estudo incluiu mulheres pós-menopausa com idade de 64,31 ± 4,71 anos, 85 delas (69,7%) com lesões coronarianas graves. Pacientes com lesões coronarianas graves apresentaram um escore T mais elevado que aquelas com lesões coronarianas leves no colo femoral (p < 0,05). O escore T médio foi -0,84 ± 1,01 no grupo com lesões leves, e -1,42 ± 1,39 no grupo com lesões graves (p < 0,05). A análise de regressão logística multivariada mostrou que a osteopenia-osteoporose no colo femoral (odds ratio 2,73; intervalo de confiança de 95% 1,06 - 6,13) esteve associada com um risco aumentado de se desenvolver lesões coronarianas graves. O modelo de regressão múltipla mostrou que os escores T (b = -0,407; EP= 0,151; p = 0,007) foram preditores independentes do escore de Gensini. Conclusão: Encontrou-se uma relação significativa entre a gravidade das lesões coronarianas e a DMO em mulheres pós-menopausa. DMO, uma técnica de baixo custo que envolve mínima exposição à radiação, e amplamente utilizada no rastreamento de osteoporose, é um marcador promissor da gravidade de lesões coronarianas graves.

Comparative study of oral and salivary parameters in patients with and without loss of bone mass

Abstract Osteoporosis is an insidious and increasingly prevalent disease that can cause fractures and affect patients' quality of life. The current study comparatively evaluates patients with and without loss of bone mass in terms of salivary calcium, viscosity, and pH. A controlled cross-sectional study was conducted in two groups of 32 postmenopausal women subjected to a bone densitometry scan and later referred for dental management at the Federal University of Minas Gerais, Brazil. The patients were assigned to two groups: Group 1 - patients with low bone mineral density (BMD) and Group 2 - patients without bone mineral changes. The following salivary parameters were evaluated: calcium concentration, flow rate, viscosity, pH, and average total protein. An oral examination was performed for assessment of DMFT variables and tongue coating. Data were analyzed using descriptive and inferential statistics, adopting a p-value < 0.05. The patients' mean age was 60 years (± 7.35). Salivary flow, pH, and viscosity were similar among the groups. Average total protein was 14.8 mg/mL and 19.0 mg/mL in Groups 1 and 2, respectively. Tongue coating and salivary calcium levels were significantly higher in Group 1 (p < 0.001). Salivary calcium is an important screening tool and may eventually be used for the diagnosis of bone mineral changes.

The Effect of FRAX on the Prediction of Osteoporotic Fractures in Urban Middle-aged and Elderly Healthy Chinese Adults

OBJECTIVE: We aimed to analyze the applicability of a fracture risk assessment tool for the prediction of osteoporotic fractures in middle-aged and elderly healthy Chinese adults. METHODS: A standard questionnaire was administered, and bone mineral density was measured in residents visiting the Dongliu Street Community Health Service Center. Paired t-tests were used to compare the FRAX-based probabilities of fractures estimated with and without consideration of bone mineral density. Risk stratification and partial correlation analyses were applied to analyze the associations between FRAX-based probabilities and body mass index or bone mineral density at different sites. RESULTS: A total of 444 subjects were included in this study. Of these subjects, 175 (39.59%) were diagnosed as osteoporotic, and 208 (47.06%) were diagnosed as osteopenic. The Kappa value for the detection of osteoporosis at the L1-L4 lumbar spine and femoral neck was 0.314. The FRAX-based 10-year major osteoporotic fracture probability and hip osteoporotic fracture probability estimated without considering bone mineral density were 4.93% and 1.64%, respectively; when estimated while considering bone mineral density, these probabilities were 4.97% and 1.54%, respectively. A significant positive association was observed between the FRAX-based fracture probabilities estimated with and without consideration of bone mineral density, while significant negative associations between body mass index and the estimated FRAX-based fracture probabilities after adjustment for age and the estimated FRAX-based fracture probabilities and femoral neck bone mineral density were identified. These results remained the same after controlling for lumbar spine bone mineral density. CONCLUSIONS: The Chinese FRAX model could predict osteoporotic fracture risk regardless of whether bone mineral density was considered and was especially appropriate for predicting osteoporotic fractures of the femoral neck.

Asymptomatic vertebral fractures in patients with low bone mineral density / Fraturas vertebrais assintomáticas em indivíduos com baixa massa óssea

Summary Objective: Vertebral fracture assessment (VFA) is a test technique that can be used to detect asymptomatic vertebral fractures (AVF). It uses dual energy X-ray bsorptiometry (DXA) and can be performed concurrently with bone densitometry. This study aims to assess the prevalence of AVF in patients with low bone mass. Methods: Cross-sectional study including 135 individuals with low bone mineral density (BMD) with a T-score < -2.0 standard deviation (SD) in a densitometry clinic located in the city of Blumenau (state of Santa Catarina). Anthropometric, clinical and lifestyle variables were obtained from history-taking and physical examination. Densitometric variables were obtained by bone mineral densitometry and VFA (Explorer, Hollogic®). Vertebral fractures were classified according to the Genant criteria. Student's t, chi-square and logistic regression were performed for statistical analysis. Results: AVFs occurred in 24.4% of the subjects. They were older compared to those without AVF (65±9.25 versus 60.1±8.66; p=0.005), and had a history of lowimpact fractures (38.24% versus 19.8%; OR 2.5; p=0.03). Half of the patients that reported steroid therapy had AVFs, compared to one fifth of those who did not use steroids (50% versus 21.49%; OR 3.6; p=0.01). Conclusion: Asymptomatic vertebral fractures were present in approximately one fourth of patients. The risk factors associated were history of low-impact fracture, use of steroids and age > 61 years.

Resumo Objetivos: vertebral fracture assessment (VFA) é uma técnica de exame que pode ser aplicada na detecção de fraturas vertebrais assintomáticas (FVA). Utiliza absorciometria de raios-X de dupla energia (DXA) e pode ser realizada concomitantemente ao exame de densitometria óssea. Este estudo visa a avaliar a prevalência de FVA em indivíduos com baixa massa óssea. Métodos: estudo transversal realizado em 135 indivíduos, com baixa densidade mineral óssea (DMO), com T-score < -2,0 desvio padrão (DP), em uma clínica de densitometria de Blumenau (SC). As variáveis antropométricas, clínicas e referentes ao estilo de vida foram obtidas por anamnese e exame clínico; as variáveis densitométricas foram obtidas por DMO e VFA (aparelho modelo Explorer, marca Hollogic®). As fraturas vertebrais foram classificadas de acordo com os critérios de Genant. Os testes estatísticos foram t de student, qui-quadrado e regressão logística. Resultados: FVA ocorreram em 24,4% dos indivíduos. A idade desses indivíduos foi superior à dos indivíduos sem FVA (65±9,25 vs. 60,1±8,66; p=0,005), assim como o antecedente de fratura por baixo impacto (38,24% vs.19,8%; OR 2,5; p=0,03). A metade dos indivíduos que relataram corticoterapia possuíam FVA, contrastando com um quinto dos indivíduos sem corticoterapia (50% vs. 21,49%; OR 3,6; p=0,01). Conclusão: fraturas vertebrais assintomáticas estiveram presentes em aproximadamente um quarto dos pacientes. Os fatores de risco associados foram história de fratura por baixo impacto, corticoterapia e idade > 61 anos.

Massa óssea em crianças e adolescentes que vivem com vírus da imunodeficiência humana / Bone mass in children and adolescents infected with human immunodeficiency virus

OBJETIVO: Descrever a densidade mineral óssea (DMO) e conteúdo mineral ósseo (CMO) de crianças e adolescentes que vivem com o vírus da imunodeficiência humana e comparar com os dados do National Health and Nutrition Examination Survey IV (NHANES IV). MÉTODO: Participaram do estudo48 crianças e adolescentes (sete a 17 anos de idade) com infecção pelo vírus da imunodeficiência humana adquirida por transmissão vertical. A DMO e o CMO foram mensurados pela absorciometria por dupla emissão de raios-X, calculando-se escores-z com base nos dados do NHANES IV. Nos prontuários médicos foram obtidas as informações dos parâmetros clínicos e laboratoriais da infecção pelo vírus da imunodeficiência humana. Foram ainda avaliada a atividade física, a ingestão de cálcio e a maturação esquelética. Utilizaram-se procedimentos da estatística descritiva e inferencial, estabelecendo níveis de significância de 5%. RESULTADOS :Os pacientes soropositivos demonstraram valores inferiores comparados aos dados do NHANES IV em todos os escores-z da massa óssea (média = -0,52 a -1,22, dp = 0,91 e 0,84, respectivamente). Com base no z-DMOsubtotal, há uma prevalência de 16,7% de crianças e adolescentes com massa óssea reduzida para a idade. Indivíduos que utilizaram inibidores de protease apresentaram um z-DMOtotal inferior, comparado ao grupo que não utilizou (-1,31 vs. -0,79; p = 0,02). Não foram encontradas diferenças na massa óssea em relação ao nível de atividade física e ingestão de cálcio. CONCLUSÕES: Na presente amostra, crianças e adolescentes que vivem com o vírus da imuno deficiência humana possuem baixa massa óssea para idade, e o uso de inibidores de protease parece estar relacionado a tais reduções.

OBJECTIVE: To describe bone mineral density (BMD) and bone mineral content (BMC) in children and adolescents infected with the human immunodeficiency virus (HIV), and to compare them with data from the National Health and Nutrition Examination Survey IV (NHANES IV). METHOD: The study included 48 children and adolescents (7 to 17 years old) infected with HIV through vertical transmission. BMC and BMD were measured by dual energy absorptiometry X-ray, by calculating z-scores based on data from NHANES IV. The information on clinical and laboratory parameters of infection by HIV was obtained from medical records. Physical activity, calcium intake, and skeletal maturation were also assessed. Descriptive and inferential statistical procedures were used, with levels of significance set at 5%. RESULTS: Seropositive patients presented lower values compared to data from NHANES IV in all z-scores of bone mass (mean = -0.52 to -1.22, SD = 0.91 and 0.84, respectively). Based on the subtotal z-BMD, there was a prevalence of 16.7% of children and adolescents with low bone mass for age. Individuals using protease inhibitors presented a lower total z-BMD when compared to the group that did not use (-1.31 vs. -0.79, p = 0.02). There were no bone mass differences in relation to physical activity and calcium intake. CONCLUSIONS: In the present sample children and adolescents living with HIV have low bone mass for age, and the use of protease inhibitors appears to be related to such decreases.

Association between low bone mass and calcium and caffeine intake among perimenopausal women in Southern Brazil: cross-sectional study / Associacao entre baixa massa ossea e ingestao de calcio e cafeina em mulheres climatericas na regiao Sul do Brasil: estudo transversal

CONTEXT AND OBJECTIVE: Osteoporosis is a skeletal abnormality characterized by reduction and alteration of bone microarchitecture that results in increased fragility and greater predisposition to fractures. Age and low bone mass are the main non-modifiable risk factors for osteoporotic fractures. The modifiable factors include sedentary lifestyle, inadequate calcium intake, excessive alcohol and/or caffeine consumption, smoking and low body weight. The aim here was to evaluate the association between low bone mass and calcium and caffeine intake among perimenopausal women in Southern Brazil. DESIGN AND SETTING: Cross-sectional study conducted in Porto Alegre and Canoas, Rio Grande do Sul, Brazil. METHODS: Women (n = 155) of mean age 53.6 ± 9.5 years were evaluated through a cross-sectional study in Southern Brazil. Food frequency questionnaires, bone mass evaluation using calcaneal ultrasound and anthropometric assessment were used. RESULTS: The prevalence of overweight was 67.7%. In the bone mass screening, 30.3% had low bone mass and 4.5% had osteoporosis. The median calcium intake was 574.94 mg/day and the caffeine intake was 108.11 mg/day. No association was found between bone mass and anthropometric parameters, calcium intake or caffeine intake. It was found that 38.4% of the women had low bone mass. CONCLUSIONS: No association was found between calcium and caffeine intake and bone mass. High prevalence of low bone mass was observed. .

CONTEXTO E OBJETIVO: A osteoporose é uma alteração esquelética caracterizada pela redução e pela alteração da microarquitetura óssea, que resultam em aumento da fragilidade e maior predisposição a fraturas. A idade e a baixa massa óssea são os principais fatores de risco não modificáveis para fraturas osteoporóticas. Os fatores modificáveis incluem sedentarismo, inadequada ingestão de cálcio, excessivo consumo de álcool e/ou cafeína, tabagismo e baixo peso corporal. O objetivo foi avaliar associação entre baixa massa óssea e ingestão de cálcio e cafeína por mulheres climatéricas no Sul do Brasil. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado em Porto Alegre e Canoas, Rio Grande do Sul, Brasil. MÉTODOS: Mulheres (n = 155) com idade média de 53,6 ± 9,5 anos foram avaliadas em um estudo transversal na região Sul do Brasil. Foram utilizados questionários de frequência alimentar, avaliação da massa óssea por ultrassonometria de calcâneo e avaliação antropométrica. RESULTADOS: A preval ência de sobrepeso foi de 67,7%. No rastreamento de massa óssea, 30,3% apresentou baixa massa óssea e 4,5%, osteoporose. A ingestão mediana de cálcio foi de 574,94 mg/dia e de cafeína foi de 108,11 mg/dia. Não foi encontrada associação entre massa óssea e os parâmetros antropométricos, ingestão de cálcio ou de cafeína. Verificou-se que 38,4% das mulheres apresentaram perda de massa óssea. CONCLUSÕES: Não foi encontrada associação entre a ingestão de cálcio e cafeína com a massa óssea. Foi observada alta prevalência de baixa massa óssea. .

Bone mineral density in postmenopausal women with and without breast cancer / Densidade mineral óssea em mulheres na pós-menopausa com e sem câncer de mama

OBJECTIVE: The values of bone mineral density (BMD) were compared in postmenopausal women with and without breast cancer. METHODS: A cross-sectional study was conducted, including 51 breast cancer survivors (BCS) and 71 women without breast cancer, who were non-users of hormone therapy, tamoxifen, or aromatase inhibitors. BMD T-scores and measurements in grams per centimeter squared (g/cm²) were obtained at the femoral neck, trochanter, Ward's triangle, and lumbar spine. Osteopenia and osteoporosis were grouped and categorized as abnormal BMD. Unconditional logistic regression analysis was used to estimate the odds ratios (OR) of abnormal BMD values as measures of association, with 95% confidence intervals (CIs), adjusting for age, years since menopause, parity, and body mass index (BMI). RESULTS: The mean age of the women with and without breast cancer was 54.7 ± 5.8 years and 58.2 ± 4.8 years (p < 0.01), respectively. After adjusting for age, parity and BMI, abnormal BMD at the femoral neck (adjusted OR: 4.8; 95% CI: 1.5-15.4), trochanter (adjusted OR: 4.6; 95% CI: 1.4-15.5), and Ward's triangle (adjusted OR: 4.5; 95% CI: 1.5-12.9) were significantly more frequent in postmenopausal BCS than in women without breast cancer. Postmenopausal BCS had a significantly lower mean BMD at the trochanter (0.719 vs. 0.809 g/cm², p < 0.01) and at the Ward's triangle (0.751 vs. 0.805 g/cm², p = 0.03). CONCLUSION: The prevalence of abnormal BMD was higher in postmenopausal BCS than in postmenopausal women without breast cancer. Bone health requires special vigilance and the adoption of interventions should be instituted early to minimize bone loss in BCS.

OBJETIVO: Comparar a densidade mineral óssea (DMO) de mulheres na pós-menopausa com e sem câncer de mama. MÉTODOS: Conduziu-se estudo de corte transversal, incluindo 51 mulheres com câncer de mama e 71 mulheres sem câncer de mama, não usuárias de terapia hormonal, tamoxifeno ou de inibidores da aromatase. Avaliou-se a DMO, em T-score e em gramas por centímetro quadrado (g/cm²), no colo do fêmur, trocânter, triângulo de Wards e na coluna lombar. Osteopenia e osteoporose foram agrupadas e categorizadas como DMO alterada. Utilizou-se a análise de regressão logística não condicional para estimar o odds ratios (OR) de DMO alterada como medida de associação, com intervalo de confiança de 95% (IC 95%), ajustando-se por idade, anos de menopausa, paridade e índice de massa corpórea (IMC). RESULTADOS: A média de idade de mulheres com e sem câncer de mama foi 54,7 ± 5,8 anos e 58,2 ± 4,8 anos (p < 0,01), respectivamente. Após ajustar por idade, paridade e IMC, DMO alterada no colo do fêmur (OR ajustado: 4,8; IC 95%: 1,5-15,4), trocânter (OR ajustado: 4,6; IC 95%: 1,4-15,5) e no triângulo de Wards (OR ajustado: 4,5; IC 95%: 1,5-12,9) foi mais frequente em mulheres com câncer de mama. Mulheres com câncer de mama apresentaram significativamente menor média de DMO no trocânter (0,719 vs. 0,809 g/cm², p < 0,01) e no triângulo de Wards (0,751 vs. 0,805 g/cm², p = 0,03). CONCLUSÃO: A prevalência de DMO alterada foi maior em mulheres na pós-menopausa com câncer de mama. A saúde óssea requer vigilância especial e a adoção precoce de intervenções para minimizar a perda óssea de mulheres com câncer de mama.

Efeitos de um programa de exercícios em grupo sobre a força de preensão manual em idosas com baixa massa óssea / Effects of a group exercise program on handgrip strength of elderly women with low bone mass

OBJETIVOS: Avaliar os efeitos de um programa de exercícios sobre a força de preensão ma­nual (FPM) em idosas com baixa massa óssea. SUJEITOS E MÉTODOS: Trinta e seis idosas foram randomizadas em: grupo intervenção - GI (n = 18) e grupo controle - GC (n = 18), avaliadas pelo teste de FPM, utilizando-se um dinamômetro de mão. O GI realizou exercícios de força muscular, equilíbrio e mobilidade funcional. O GC realizou alongamentos. Ambos os grupos realizaram duas sessões semanais de 50 minutos, durante quatro meses. RESULTADOS: O GI apresentou aumento da FPM em 31,38% (p = 0,00). O GC não mostrou diferença. Houve correlações entre a FPM e a densidade mineral óssea (DMO) do colo do fêmur (r = 0,582, p = 0,003) e do fêmur total (r = 0,485, p = 0,01). CONCLUSÃO: Os resultados sugerem uma tendência ao incremento da FPM de idosas e mostraram correlações significantes entre a FPM e a DMO.

OBJECTIVES: To evaluate the effects of an exercise program on handgrip strength (HS) in elderly women with low bone mass. SUBJECTS AND METHODS: Thirty-six elderly women were randomized to the intervention group - GI (n = 18) and control group - GC (n = 18). Participants were evaluated by means of a HS test, using a handgrip dynamometer. GI performed strength, balance and functional mobility exercises, and GC performed stretching exercises. Both groups had sessions twice a week for 50 minutes, during 4 months. RESULTS: GI had a significant increase in handgrip strength equal to 31.38%. No differences were observed in GC. There were correlations between HS test and bone mineral density (BMD) of the femoral neck (r = 0.582, p = 0.003) and total femur (r = 0.485, p = 0.01). CONCLUSION: Results indicate a propensity to increase elderly HS, and showed significant correlations between HS and BMD.

Crosstalk entre osso e tecido adiposo na doença renal crônica / Crosstalk between bone and adipose tissue in chronic kidney disease

Dentro do conceito de que os hormônios são regulados por um ciclo de reciprocidade, o fato de osteoblastos e adipócitos serem desenvolvidos a partir de células-tronco mesenquimais e da remodelação óssea ser regulada pela leptina, traz a ideia de possíveis participações do osso no metabolismo energético e vice-versa. Estudos recentes têm demonstrado que a diferenciação e as funções das células ósseas são reguladas pela leptina, que parece desencadear uma resposta bimodal central, via sistema nervoso simpático, e uma local, na qual a leptina agiria sobre o osso. De fato, estudos têm revelado complexa interação entre osso, tecido adiposo e cérebro; no entanto, existem poucos estudos sobre esse crosstalk em pacientes com doença renal crônica (DRC). Como tais pacientes têm tendência à diminuição da densidade mineral óssea e elevados níveis de leptina, o presente artigo apresentou uma revisão sobre o possível envolvimento entre tecido adiposo e massa óssea, em pacientes com DRC.

Within the concept that hormones are regulated by a cycle of reciprocity, the fact that osteoblasts and adipocytes are developed from mesenchymal stem cells and that bone remodeling is regulated by leptin brings up the idea of possible bone participation in energy metabolism and vice-versa. Recent studies have shown that the differentiation and function of these bone cells are regulated by leptin, which seems to trigger a bimodal response, via sympathetic nervous system, and a local response, in which leptin acts on the bone. In fact, studies have shown complex interactions between bone, adipose tissue and brain. However, there are few studies on crosstalk in patients with chronic kidney disease (CKD). These patients have a tendency to decreased bone mineral density and high levels of leptin. Then, this article presented a review of potential involvement of adipose tissue and bone mass in patients with CKD.

Evaluacion de la microarquitectura osea mediante tomografia computada periferica de alta resolucion (HR-pQCT): aplicaciones clínicas / Bone microarchitecture assessment by high resolution peripheral computarized tomography: clinical aplications

La pérdida de resistencia osea que caracteriza a la osteoporosis depende de varios factores como la masa osea, la distribucion de esta masa en el espacio y la calidad del material. La tomografia computada periferica de alta resolucion es un nuevo metodo de imagen que permite evaluar in vivo la microarquitectura de los sectores trabecular y cortical del radio y de la tibia con una resolucion de 82 Ìm...

Peak bone mass and bone mineral density correlates for 9 to 24 year-old Mexican women, using corrected BMD / Pico mineral óseo y factores asociados a la densidad mineral ósea en mujeres mexicanas de 9 a 24 años de edad usando densidad mineral ósea corregida

OBJECTIVE: To determine the age of peak bone mass (PBM) in Mexican women and factors associated with both BMDa and corrected BMD (BMDcorr) at the femoral neck and the spine (L2-L4). MATERIAL AND METHODS: Data on 461 women between 9 and 24 years old was used. An interview was performed and height and weight were measured. BMDa was measured by a densitometer and BMDcorr by the method proposed by Krõger et al. (1992). RESULTS: PBM at the spine (L2-L4) was observed later than at the femoral neck. Both BMDa and BMDcorr at the lumbar spine correlate with age, socio-economic status, body fat percentage and height. BMDa at the femoral neck correlates with overweight and obesity, body fat percentage, height and moderate physical activity; the same variables were associated with BMDcorr except for height. CONCLUSIONS: The method proposed by Krõger et al. was more precise at the femoral neck than at the spine.

OBJETIVO: Determinar la edad del pico de masa ósea (PMO) y los factores asociados a DMOa y a DMOcorr del cuello femoral y de la columna vertebral (L2-L4) en mujeres mexicanas. MATERIAL Y MÉTODOS: Se utilizaron datos de 461 mujeres de 9 a 24 años de edad. La DMO se midió mediante un densitómetro y la DMOcorr mediante el método propuesto por Krõger et al. (1992). RESULTADOS: El PMO en la columna vertebral (L2-L4) se observó más tarde que en el cuello femoral. A la DMOa y DMOcorr de la columna se asociaron: edad, estado socio económico, porcentaje de grasa corporal y la talla. A DMOa del cuello femoral se asociaron: sobrepeso y obesidad, porcentaje de grasa corporal, talla y actividad física moderada; las mismas variables se asociaron con la DMOcorr excepto talla. CONCLUSIONES: El método propuesto por Krõger et al. fue más preciso para el cuello femoral que para la columna.

The value of calcaneal bone mass measurement using a dual X-ray laser calscan device in risk screening for osteoporosis

OBJECTIVE: To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL) correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA). MATERIALS AND METHODS: A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score <-2.5 received a referral for DXA of the spine and hip. Besides dual energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis. RESULTS: Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO), dual energy X-ray laser calcaneal measurements showed that 13 percent of the subjects had osteoporosis, while another 56 percent had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT), covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (p<0.05). A significant correlation was observed between the calcaneal dual energy X-ray laser T-score and age (r=-0.465, p=0.001), body mass index (BMI) (r=0.223, p=0.001), number of live births (r=-0.229, p=0.001), breast feeding time (r=-0.064, p=0.001), and age at menarche (r=-0.050, p=0.008). The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001) at the spine, and calcaneal DXL and DXA T- ...