RESUMEN
Vertebral fractures are the hallmark of osteoporosis, responsible for increased morbidity and mortality in post-menopausal women. However, two-thirds of vertebral fractures do not come to clinical attention. The aim of this study was to compare the identification of vertebral fractures on spine X-rays among rheumatologists. Study subjects were women aged 60-80 years having potential signs of vertebral fracture and visiting a rheumatologist. X-rays were performed according to standardized procedures. In 629 patients (among 824 included) at least one vertebral fracture was diagnosed, and the X-rays were then sent to a central facility where a semi-quantitative assessment of vertebral fracture was performed by a single rheumatologist trained for this evaluation. According to the vertebral level, kappa scores were between 0.20 to 0.77, i.e., below 0.6 from T4 to T7, and between 0.6 and 0.77 from T8 to L4. The false-negative fractures rate was 25.8% (and 15.7% of them were related to a numbering discrepancy). The rate of false positive fractures was 6.3%. At the patient level 6.8% had actually no fracture. This study shows that 25% of overall vertebral fractures are not diagnosed among patients considered as having at least one fracture. As a consequence, patients who require treatment to reduce fracture risk are not being properly identified.
Asunto(s)
Fracturas de la Columna Vertebral/diagnóstico por imagen , Columna Vertebral/diagnóstico por imagen , Anciano , Errores Diagnósticos , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/lesiones , Persona de Mediana Edad , Osteoporosis Posmenopáusica/complicaciones , Osteoporosis Posmenopáusica/diagnóstico por imagen , Radiografía , Sensibilidad y Especificidad , Fracturas de la Columna Vertebral/etiología , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/lesionesRESUMEN
OBJECTIVE: To compare bone mass loss due to deflazacort versus prednisone in longterm treatment of patients with giant cell arteritis (GCA) in a randomized double blind comparative trial. METHODS: Seventy-four patients were included in a prospective multicenter study. Half received deflazacort (DFZ) and the other half prednisone (PR) for a minimum of 12 months. Calcium and vitamin D supplements were also provided to all subjects. Our intent was (1) to evaluate bone mineral density, using dual energy x-ray absorptiometry, at baseline and comparatively at 3, 6, and 12 mo; vertebral fractures by Meunier score and size variations after 12 mo treatments were also analyzed; (2) to assess calcium/phosphate metabolism modifications in both groups at baseline and after 12 mo. RESULTS: No significant difference was observed between the 2 groups in terms of treatment efficacy. Patients taking PR were slightly older on average versus the DFZ group (74 vs 70 yrs). Bone mass loss between entry and month 12 was not statistically different in the PR group (-0.026 +/- 0.007 g/cm2) compared to the DFZ group (-0.03 +/- 0.005 g/cm2). No significant difference was found in Meunier score variations (0.77 and 1.18 in the PR and DFZ groups, respectively; p = 0.3), nor in vertebral size variations (-0.4 and -0.2 in the PR and DFZ groups, respectively; p = 0.4). There was no difference in calcium/phosphate metabolism evaluations at month 12. CONCLUSION: In older patients taking longterm glucocorticoids who are at risk of osteoporosis, deflazacort did not result in less bone loss than prednisone.
Asunto(s)
Antiinflamatorios/efectos adversos , Enfermedades Óseas Metabólicas/inducido químicamente , Arteritis de Células Gigantes/tratamiento farmacológico , Glucocorticoides/efectos adversos , Prednisona/efectos adversos , Pregnenodionas/efectos adversos , Absorciometría de Fotón , Adulto , Anciano , Anciano de 80 o más Años , Densidad Ósea/efectos de los fármacos , Enfermedades Óseas Metabólicas/prevención & control , Calcio/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Estudios Prospectivos , Fracturas de la Columna Vertebral/etiología , Resultado del Tratamiento , Vitamina D/administración & dosificaciónRESUMEN
UNLABELLED: The significant psychosocial and occupational impact of low back pain is a risk factor for chronicization but remains difficult to be evaluated. METHODS: A cross-sectional study of acute and chronic low back pain patients managed by 1282 physicians was conducted using an 85-item questionnaire. Most items were composed of multiple or binary clauses. A semi quantitative six-point scale was used to evaluate effects of the pain on family and personal life. A total of 2741 completed questionnaires were sent in. The present study was conducted on the 1072 questionnaires completed for "active" (as opposed to retired) patients with chronic low back pain. Mean age was 44 years. RESULTS AND DISCUSSION: As compared to the general population, there were fewer blue-collar workers, executives, and skilled professionals and more intermediate professions (34% versus 19% according to an INSEE survey, p < 0.001). Twelve per cent of patients were able either to change jobs or to find lighter duties in their current job, but a similar proportion were completely incapacitated or awaiting a job modification. Significant negative effects on everyday life were reported by 80% of patients, on emotional life by 58%, and on sexual activity by 46%. Most patients had reduced their leisure and household activities. Psychological disorders were noted in 75% of patients. On the day of the visit, two-thirds of patients were given a prescription for analgesics, nonsteroidal antiinflammatory drugs, and/or muscle relaxants, whereas only 34% received advice regarding their diet and life style and only 4% were sent to a back school. Despite significant effects on everyday and personal experiences associated with an increased risk of chronicization, treatments given to low back pain patients consist mainly of symptomatic medication.