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PURPOSE: Osteoporosis is a pressing public health concern among older adults, contributing to substantial mortality and morbidity rates. Low- to middle-income countries (LMICs) often grapple with limited access to dual-energy X-ray absorptiometry (DXA), the gold standard for early osteoporosis detection. This study aims to assess the performance of the FRAX® score as a population-wide screening tool for predicting osteoporosis risk, rather than fracture, in individuals aged 50 and above within an LMIC context. METHODS: This retrospective cohort study (n=864) assessed the performance of the FRAX® score for predicting osteoporosis risk using comparative c-statistics from Receiver Operating Characteristic (ROC) curves. Hazard ratios (HR) and 95â¯% confidence intervals (CI) were calculated, with p-values <0.05 indicating statistically significant. RESULTS: The 10-year FRAX® probability for hip fracture, calculated without bone mass density (BMD), exhibited significantly superior performance compared to the 10-year FRAX® probability for major fracture in predicting osteoporosis risk (AUROC: 0.71 versus 0.67, p<0.001). Within 2 to 10 years of follow-up, the 10-year FRAX® probability for hip fracture showed both greater predictive performance and net benefit in the decision curve compared to the FRAX® 10-year probability for major fracture. A newly established cutoff of 1.9â¯% yielded a negative predictive value of 92.9â¯% (95â¯%CI: 90.4-94.8â¯%) for the 10-year FRAX® probability for hip fracture. CONCLUSION: The 10-year FRAX® probability for hip fracture estimated without BMD emerges as an effective 10-year screening tool for identifying osteoporosis risk in aged 50 and older, especially when confronted with limited access to DXA scans in LMICs. MINI ABSTRACT: The Fracture Risk Assessment Tool score performance as an osteoporosis screening tool was assessed in areas with limited dual-energy X-ray access. The hip fracture probability showed better performance than major fracture probability within 2 to 10 years. The tool emerges as effective for screening osteoporosis risk in individuals over 50.
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Absorciometria de Fóton , Densidade Óssea , Programas de Rastreamento , Osteoporose , Fraturas por Osteoporose , Humanos , Medição de Risco/métodos , Idoso , Feminino , Masculino , Estudos Retrospectivos , Osteoporose/diagnóstico por imagem , Osteoporose/complicações , Pessoa de Meia-Idade , Fraturas por Osteoporose/epidemiologia , Programas de Rastreamento/métodos , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/epidemiologia , Curva ROC , Países em Desenvolvimento , Idoso de 80 Anos ou mais , Região de Recursos LimitadosRESUMO
Abstract Objective: The main growth hormone action is to promote linear growth increasing protein synthesis stimulation and osteoblastic activity. Peak bone mass extends from adolescence to 30 years of age. Several factors may influence this acquisition and prevent fracture risk in adulthood, such as genetic potential, GH, ethnicity, and lifestyle factors. This study aims to compare bone mass and osteometabolic profile of white and Afro-descendant Brazilian adolescents in the transition phase, who were treated with human recombinant growth hormone in childhood. Methods: The authors selected 38 adolescents from the Transition Outpatient Clinic of the University of São Paulo. Lumbar spine and total body bone mineral density (BMD) and bone mineral content (BMC), serum calcium, 25-OH-vitamin D and bone markers were analyzed at the rhGH withdrawal. Results: The mean age was 16.8 ± 1.6 years. There were 21 Afro-descendant and 17 whites. Thirty-four percent of the sample presented vitamin D insufficiency, 66% inadequate calcium intake and 44.7% physical inactivity. The Afro-descendants showed a lower lumbar spine and total body Z scores than those of the whites (p = 0.04 and p = 0.03, respectively), as well as their mean body weight (p = 0.03). There were no differences in the remaining osteometabolic parameters. Conclusion: As most adolescents had vitamin D insufficiency, low calcium intake, and physical inactivity, calcium, and cholecalciferol supplementation and lifestyle changes should be encouraged. The Brazilian Afro-descendant may be a vulnerable group for low bone mass, requiring
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OBJECTIVE: The main growth hormone action is to promote linear growth increasing protein synthesis stimulation and osteoblastic activity. Peak bone mass extends from adolescence to 30 years of age. Several factors may influence this acquisition and prevent fracture risk in adulthood, such as genetic potential, GH, ethnicity, and lifestyle factors. This study aims to compare bone mass and osteometabolic profile of white and Afro-descendant Brazilian adolescents in the transition phase, who were treated with human recombinant growth hormone in childhood. METHODS: The authors selected 38 adolescents from the Transition Outpatient Clinic of the University of São Paulo. Lumbar spine and total body bone mineral density (BMD) and bone mineral content (BMC), serum calcium, 25-OH-vitamin D and bone markers were analyzed at the rhGH withdrawal. RESULTS: The mean age was 16.8 ± 1.6 years. There were 21 Afro-descendant and 17 whites. Thirty-four percent of the sample presented vitamin D insufficiency, 66% inadequate calcium intake and 44.7% physical inactivity. The Afro-descendants showed a lower lumbar spine and total body Z scores than those of the whites (p = 0.04 and p = 0.03, respectively), as well as their mean body weight (p = 0.03). There were no differences in the remaining osteometabolic parameters. CONCLUSION: As most adolescents had vitamin D insufficiency, low calcium intake, and physical inactivity, calcium, and cholecalciferol supplementation and lifestyle changes should be encouraged. The Brazilian Afro-descendant may be a vulnerable group for low bone mass, requiring special strategies to increase bone accrual and body weight. More studies are necessary to compare ethnic differences in this population.
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Hormônio do Crescimento Humano , Deficiência de Vitamina D , Adolescente , Humanos , Densidade Óssea/fisiologia , Cálcio , Brasil , Vitamina D , VitaminasRESUMO
Abstract Introduction Osteoporosis is a metabolic disease characterized by reduced bone mineral density, often accompanied by loss of quality of trabecular bone microarchitecture. Objective To assess the quality or degradation of trabecular bone microarchitecture in digital panoramic radiography to better predict the risk of fragility fractures. Material and method The sample included 68 female patients, age-matched, and divided into three groups according to densitometric results. Trabecular Bone Score values were measured and digital panoramic radiographs were taken. Fractal analysis with box counting was conducted in the region of premolars and angle of the mandible, with regions of interest measuring 64×64 and 80×120 pixels. In the statistical analysis, Pearson's correlation was applied between the Trabecular Bone Score and fractal analysis results obtained in each group, using age as a control variable and assigning individualized age ranges within groups. Result A moderate correlation was identified in the regions of interest of 64×64 and 80×120 pixels at the angle of the mandible in the osteoporosis group and in the normal group. A moderate correlation was also obtained using age as a control variable in the 64x64 pixel regions of interest in the premolar region. Considering age range, the within-group analysis presented a strong correlation in the osteoporosis group and moderate correlation in the osteopenia and normal groups. Conclusion Fractal analysis in digital panoramic radiographs was shown to be a promising predictive instrument of bone microarchitecture quality.
Resumo Introdução A osteoporose é uma doença metabólica caracterizada pela redução da densidade mineral óssea, muitas vezes acompanhada da perda de qualidade da microarquitetura óssea trabecular. Objetivo Avaliar a qualidade da microarquitetura óssea trabecular em radiografia panorâmica digital a fim de identificar precocemente a sua degradação, possibilitando melhor predição do risco de fraturas por fragilidade. Material e método A amostra consistiu de 68 pacientes do sexo feminino, pareadas por idade, e divididas em 3 grupos conforme resultado densitométrico. Foram aferidos os valores de Trabecular Bone Score e realizadas radiografias panorâmicas digitais. A análise fractal com box counting foi feita na região de pré-molares e ângulo da mandíbula, com regiões de interesse medindo 64x64 e 80x120 pixels. Na análise estatística utilizou-se a correlação de Pearson entre os resultados de Trabecular Bone Score e de análise fractal obtidos em cada grupo, utilizando-se a idade como variável de controle e através de atribuição de grupos etários individualizados intragrupos. Resultado Identificou-se correlação moderada nas regiões de interesse de 64x64 e 80x120 pixels, em ângulo da mandíbula no grupo Osteoporose e no grupo normal. Também se obteve correlação moderada utilizando a idade como variável de controle nas regiões de interesse de 64x64 pixels, em região de pré-molares. A análise intragrupos, considerando a faixa etária, resultou em correlação forte, no grupo osteoporose e moderada nos grupos osteopenia e normal. Conclusão A análise fractal em radiografias panorâmicas digitais se mostrou promissora como instrumento preditivo da qualidade de microarquitetura óssea.
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Humanos , Feminino , Osteoporose , Osso e Ossos , Doenças Ósseas Metabólicas , Radiografia Panorâmica , MandíbulaRESUMO
Some studies based on bone biopsy have demonstrated that in patients with tumor-induced osteomalacia (TIO) the mineralization process of the bone matrix is profoundly disturbed. However, the interrelationship between clinical and biochemical features and bone microarchitecture in this disease needs further analysis. With this purpose in mind, we set out three objectives: (i) to determine bone microarchitecture and estimated bone strength in a group of patients with tumor-induced osteomalacia using high-resolution peripheral quantitative computed tomography (HR-pQCT) and finite element analysis (FEA), (ii) to investigate correlations between duration of disease, biochemical features, bone density, HR-pQCT and FEA parameters, and (iii) to compare HR-pQCT and FEA parameters with a healthy control group. Ten patients with TIO were included. All patients had non-resolved disease. At the distal radius, all bone microarchitecture parameters were significantly affected in patients with TIO in comparison with healthy controls. At the distal tibia, all parameters were significantly impaired, except for trabecular thickness. All the parameters were more affected in the distal tibia than in the distal radius. Women with TIO (n = 7) had significantly lower bone strength parameters than healthy controls. In men (n = 3), bone strength parameters were significantly lower than in the control group at the distal tibia. Alkaline phosphatase levels exhibited a negative correlation with microarchitecture parameters, failure load, and stiffness. Higher levels of parathyroid hormone correlated with poorer microarchitecture parameters. We believe that in TIO, hormonal disturbances and the lack of mechanical stimulus specially converge to generate an extremely harmful combination for bone health. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Densidade Óssea , Rádio (Anatomia) , Osso e Ossos/diagnóstico por imagem , Feminino , Humanos , Masculino , Osteomalacia , Síndromes Paraneoplásicas , Rádio (Anatomia)/diagnóstico por imagem , TíbiaRESUMO
RESUMEN Introducción: La actual definición de osteoporosis es basada en la absorciometría de energía dual de Rx (DXA, por sus siglas en inglés), lo cual representa la principal técnica para la cuantificación de la densidad mineral ósea (DMO) y la evaluación del riesgo de fractura. El objetivo de este estudio fue determinar la DMO en columna lumbar y cuello femoral de adultos sanos desde el punto de vista metabólico óseo en una población de Bogotá-Colombia. Métodos: Se realizó un estudio observacional, analítico, de corte transversal, basado en un cuestionario aplicado a la población de estudio. Las medidas densitométricas fueron realizadas con un equipo compacto de alto rendimiento de la General Electric, modelo iDXA, por el mismo tecnólogo en los sitios esqueléticos de interés, columna lumbar L1, L2, L3, L4 y L1-4 en proyección anteroposterior y en cuello femoral. El cálculo del tamaño de muestra se realizó teniendo en cuenta la estratificación por sexo y 2 grupos de edad: 20 a 29 años y 30 a 39 años. Se encuestó a 805 individuos y 432 se realizaron la densitometría ósea. Resultados: Los valores encontrados en columna lumbar para cada uno de los grupos de nuestra población, fueron: 1,150 g/cm2 (DE: 0,11), 1,180 g/cm2 (DE: 0,10), para mujeres y hombres de 20 a 29 años, y 1,169 g/cm2 (DE: 0,10), 1,209 g/cm2 (DE: 0,10) para mujeres y hombres de 30 a 39 años, respectivamente. A nivel del cuello femoral, 0,991 g/cm2 (DE: 0,10), 1,119 g/cm2 (DE: 0,13), para mujeres y hombres de 20 a 29 años, y 0,970 g/cm2 (DE: 0,11), 1,079 g/cm2 (DE: 0,13) para mujeres y hombres de 30 a 39 años, respectivamente. Conclusión: Este estudio pudo demostrar el comportamiento de la DMO en nuestra población, la cual es inferior a la detectada en otras latitudes y a las utilizadas como valores de referencia en nuestros equipos. Adicionalmente, se determinó el valor máximo de masa ósea en cada una de las regiones de interés para los rangos de edad de la población de nuestro estudio.
ABSTRACT Introduction: The current definition of osteoporosis is based on the dual energy X-ray absorptiometry (DXA), which represents the main technique for the quantification of bone mineral density (BMD) and the evaluation of fracture risk. The objective of this study was to determine the BMD in the lumbar spine and femoral neck of healthy adults from a bone metabolism point of view in a population of Bogotá-Colombia. Method: An observational, analytical, cross-sectional study was conducted based on a questionnaire completed by the study population. The densitometric measurements were carried out using a high-performance compact equipment of the General Electric, iDXA model, by the same technologist at the skeletal sites of interest, lumbar spine L1, L2, L3, L4 and L1-4 in anteroposterior projection, and in femoral neck. The sample size calculation was performed taking into account stratification by gender and 2 age groups: 20 to 29 years, and 30 to 39 years. A total of 805 individuals were surveyed, and 432 bone densitometries were performed. Results: The values found in the lumbar spine for each of the groups in our population were: 1.150 g/cm2 (SD: 0.11), 1.180 g/cm2 (SD: 0.10), for women and men aged 20 to 29 years, and 1.169 g/cm2 (SD: 0.10), 1.209 g/cm2 (SD: 0.10) for women and men aged 30 to 39, respectively. At the level of the femoral neck, 0.991 g/cm2 (SD: 0.10), 1.119 g/cm2 (SD: 0.13), for women and men aged 20 to 29 years, respectively, and 0.970 g/cm2 (SD: 0.11), 1.079 g/cm2 (SD: 0.13) for women and men aged 30 to 39, respectively. Conclusion: This study was able to demonstrate the behaviour of BMD in our population, which is lower than that detected in other latitudes and those used as reference values in our equipment. Additionally, the maximum bone mass value was determined in each of the locations of interest for the age ranges of the population in our study.
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Humanos , Adulto , Densidade Óssea , Colômbia , Densitometria , Coluna Vertebral , Pesos e Medidas , Estudos Transversais , Colo do FêmurRESUMO
Avaliou-se o efeito da utilização de níveis crescentes de vitamina A sobre os parâmetros ósseos de codornas de corte de 15 a 35 dias de idade. Foram utilizadas 1520 codornas, não sexadas, com peso médio inicial de 85±4,25g, distribuídas em um delineamento inteiramente ao acaso, totalizando oito tratamentos com cinco repetições e 38 codornas por unidade experimental. Os tratamentos consistiram de oito níveis de suplementação de vitamina A (0; 4.500; 6.000; 7.500; 9.000; 10.500; 12.000 e 13.500UI/kg da dieta). O período experimental foi de 15 a 35 dias de idade. Os ossos analisados apresentaram uma redução linear para o índice de Seedor, resistência óssea e teor de cinzas do fêmur e da tíbia de acordo com os níveis de suplementação de vitamina A. A suplementação de vitamina A para codornas de corte de 15 a 35 dias de idade mostrou resultados negativos para a qualidade óssea, com a necessidade de mais estudos sobre seu antagonismo com a vitamina D.(AU)
This study evaluated the effect of using increasing levels of vitamin A on bone parameters in meat-type quails from 15 to 35 days old. A total of 1520 unsexed quail with an average initial weight of 85g distributed in a completely randomized design, totaling eight treatments with five replicates and 38 quails per experimental unit were used. The treatments consisted of eight vitamin supplementation levels A (0; 4,500; 6,000; 7,500; 9,000; 10,500; 12,000 and 13,500IU / kg diet). The experimental period was 15 to 35 days of age. The bones analyzed showed a linear reduction to the Seedor index, bone strength and ash content of the femur and tibia according to vitamin supplementation levels Vitamin A supplementation for cutting quails from 15 to 35 days of age showed negative results for bone quality, with the need for more studies on its antagonism to vitamin D.(AU)
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Animais , Tíbia/crescimento & desenvolvimento , Vitamina A/administração & dosagem , Osso e Ossos/anatomia & histologia , Coturnix/crescimento & desenvolvimento , Dieta/veterinária , Suplementos Nutricionais/análise , Densitometria/veterináriaRESUMO
Avaliou-se o efeito da utilização de níveis crescentes de vitamina A sobre os parâmetros ósseos de codornas de corte de 15 a 35 dias de idade. Foram utilizadas 1520 codornas, não sexadas, com peso médio inicial de 85±4,25g, distribuídas em um delineamento inteiramente ao acaso, totalizando oito tratamentos com cinco repetições e 38 codornas por unidade experimental. Os tratamentos consistiram de oito níveis de suplementação de vitamina A (0; 4.500; 6.000; 7.500; 9.000; 10.500; 12.000 e 13.500UI/kg da dieta). O período experimental foi de 15 a 35 dias de idade. Os ossos analisados apresentaram uma redução linear para o índice de Seedor, resistência óssea e teor de cinzas do fêmur e da tíbia de acordo com os níveis de suplementação de vitamina A. A suplementação de vitamina A para codornas de corte de 15 a 35 dias de idade mostrou resultados negativos para a qualidade óssea, com a necessidade de mais estudos sobre seu antagonismo com a vitamina D.(AU)
This study evaluated the effect of using increasing levels of vitamin A on bone parameters in meat-type quails from 15 to 35 days old. A total of 1520 unsexed quail with an average initial weight of 85g distributed in a completely randomized design, totaling eight treatments with five replicates and 38 quails per experimental unit were used. The treatments consisted of eight vitamin supplementation levels A (0; 4,500; 6,000; 7,500; 9,000; 10,500; 12,000 and 13,500IU / kg diet). The experimental period was 15 to 35 days of age. The bones analyzed showed a linear reduction to the Seedor index, bone strength and ash content of the femur and tibia according to vitamin supplementation levels Vitamin A supplementation for cutting quails from 15 to 35 days of age showed negative results for bone quality, with the need for more studies on its antagonism to vitamin D.(AU)
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Animais , Tíbia/crescimento & desenvolvimento , Vitamina A/administração & dosagem , Osso e Ossos/anatomia & histologia , Coturnix/crescimento & desenvolvimento , Dieta/veterinária , Suplementos Nutricionais/análise , Densitometria/veterináriaRESUMO
RESUMEN Fundamento: la osteoporosis en el climaterio es una enfermedad prevenible, al evitar los factores de riesgos que llevan a su aparición, mediante la realización de la densitometría ósea para su diagnóstico, tratamiento y prevención. Objetivo: analizar la prevalencia de osteoporosis producida por el climaterio en mujeres de 45 a 60 años. Métodos: se desarrolló una investigación cuantitativa con alcance descriptivo y diseño transversal y retrospectivo. La población estuvo constituida por 50 mujeres del barrio La Propicia, cuatro en la ciudad de Esmeraldas, Ecuador. Para la recolección de datos se realizó una revisión de las historias clínicas de todas las mujeres en etapa menopaúsica. Resultados: el 50 % de la población estudiada estaban en un rango entre 51 a 60 años, el 34 % del total de mujeres padeció osteoporosis, el 60 % de las participantes discontinuaron su menstruación de dos a cinco años y el 76 % no llevaban terapia hormonal sustitutiva. Solo el 16 % del total de mujeres con diagnóstico de osteoporosis se había realizado la densitometría ósea y el 47,05 % sufrió algún tipo de fractura producto de la enfermedad. Conclusiones: existe una alta prevalencia de osteoporosis en mujeres mayores de 60 años, el tiempo más frecuente de la última menstruación fue de dos a cinco años y en su gran mayoría no llevan tratamiento con terapia hormonal. Se observó que muy pocas de ellas se realizaron la densitometría ósea para el diagnóstico de osteoporosis y muchas presentaron fracturas.
ABSTRACT Background: Informed Consent is the acceptance of a medical intervention by a patient, in a free, voluntary and conscious way, after the doctor has informed him of the nature of the intervention, risks, benefits and alternatives. Objective: to assess the quality of structure and content of the informed consent forms in severe patients. Methods: cross-sectional retrospective descriptive study was carried out with 335 IC written forms applied to family members and / or patients admitted to the Intensive Care Unit of the Joaquín Albarrán Domínguez Hospital, Havana, Cuba, from September 30, 2017 to September 22, 2018. The Chi-square test was performed the frequencies of compliance. A value of p ≤ 0.05 was significant. Results: predominantly, the written formats in patients with a clinical profile complied with the completion of the document and the best were those of surgical profile. In compliance with the general data in the IC written format, there was an adequate compliance, in the forms of the clinical profile, they did not comply with writing the name and description of medical procedures. There was no consent forms to authorize medical researches and it was not delivered a copy of the written document to the interested persons. Conclusions: the quality of the formats was bad, we still have to improve the information offered, clarify the doubts, as well as the request for authorization for medical research and implement mechanisms that facilitate the delivery of a copy of the written document.
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INTRODUCTION: Intermittent 1-34 parathyroid hormone (iPTH) administration, a bone-forming treatment, is widely used as a therapy for severe osteoporosis. It can only be used for a maximum of 24 mo and must be followed by an antiresorptive drug to retain the new formed tissue. Mechanical load, in the form of low-intensity and high-frequency vibration, has received considerable attention due to its ability to prevent bone loss. AIM: To investigate the ability of whole body mechanical vibration (MV) to potentiate the anabolic effects of iPTH and to inhibit bone resorption following discontinuation of iPTH treatment in estrogen-deficient rats. METHODOLOGY: Fifty-four 6-month-old female Wistar rats were ovariectomized (OVX) or sham-operated. After 5 mo, they were divided into 7 groups: Sham - non-OVX; Control - OVX, vehicle for 60 d; MV - OVX, submitted to MV for 60 d; PTH60d - OVX, injected with iPTH for 60 d; PTH+MV - OVX, injected with iPTH combined with MV for 60 d; PTH30d - OVX, injected with iPTH for 30 d, and untreated for 30 d; PTH30d/MV30d - OVX, injected with iPTH for 30 d, followed by MV for 30 d. Bone mineral density (BMD) and body composition (lean mass and fat) were evaluated at OVX (T0), the beginning (T1), and at the end (T2) of treatments by dual X-ray absorptiometry (DXA). Femurs were processed for histomorphometry (bone volume - BV/TV and cortical thickness - Ct.Th) and tibias for biomechanical test. RESULTS: Body composition and BMD were similar among the groups at T0. In T2, MV presented higher fat than other groups (except PTH60d) and PTH30d/MV30d showed greater lean mass than Control. At T1, Sham presented the highest BMD, but between T1 vs T2 there was an increase in all iPTH-treated groups. At T2, BMD was higher in PTH60d and PTH+MV than in the Control and MV groups. The highest BV/TV was observed in the PTH+MV group, followed by PTH60d. Cortical thickness was increased in PTH60d and PTH+MV compared to Sham. Vibration applied post-iPTH (PTH30d/MV30d) improved the force at failure in tibias when compared to Sham and Control groups. CONCLUSION: MV potentiated iPTH anabolic effects in cancellous bone; however, MV was unable to maintain bone mass after stopping iPTH in ovariectomized rats.
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Conservadores da Densidade Óssea/farmacologia , Densidade Óssea/efeitos dos fármacos , Osso Esponjoso/efeitos dos fármacos , Fêmur/efeitos dos fármacos , Teriparatida/farmacologia , Vibração , Absorciometria de Fóton , Animais , Fenômenos Biomecânicos , Composição Corporal/efeitos dos fármacos , Osso Esponjoso/patologia , Feminino , Fêmur/patologia , Ovariectomia , Ratos , Suporte de CargaRESUMO
Giant South American turtles (Podocnemis expansa) are at a risk of extinction because of the rapid decline in their population over the last few decades. Metabolic bone disease (MBD) is common in captive testudines, but is often not diagnosed until a later stage. The authors present the cases of four captive giant South American turtles with carapace deformity secondary to MBD that underwent computed tomography (CT) scans of the carapace bones and vertebral column. Findings indicative of changes in geometry were found in both. The cancellous bone pattern was characterized by varying degrees of increased trabecular spacing and cortical thinning of the pleural bones. Bone densitometry analysis of the pleural and neural bones and at the level of the body of the third, fourth, and fifth dorsal vertebrae showed mean density values much lower than those found in two adult specimens of the same species that were considered healthy. In conclusion, CT contributed important information on the degree of demineralization and possible structural changes due to MBD and should be considered a relevant tool for diagnosis of this condition.
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Densidade Óssea/fisiologia , Doenças Ósseas Metabólicas/veterinária , Tomografia Computadorizada por Raios X/veterinária , Tartarugas , Animais , Doenças Ósseas Metabólicas/diagnóstico por imagem , Doenças Ósseas Metabólicas/patologia , Feminino , MasculinoRESUMO
An experiment was conducted to evaluate the effects of phytase (PHY), alone or in combination with citric acid (CA), on growing Japanese quails under moderate and severe phosphorus (P) restriction. For this, 504 one-day-old female quails were distributed in a completely randomised design with seven treatments and six replications. Treatments consisted of the following diets: (a) positive control (PC): formulated according to quails nutritional requirements; (b) negative control 40% (NC40 ): PC with 40% less aP; (c) NC40 +PHY; (d) NC40 +PHY+CA; (e) negative control 65% (NC65 ): PC with 65% less aP; (f) NC65 +PHY; (g) NC65 +PHY+CA. Phytase and CA were included at 300 FTU/kg and 40 g/kg, respectively. Performance, bone mineralization and plasma mineral concentration were evaluated at day 35; calcium (Ca) and P metabolism, between days 36 and 39. No significant differences in performance, plasma Ca and P were detected between quails fed PC or NC40 ; however, NC40 decreased tibia ash (p < 0.01). Treatment NC65 impaired daily weight gain (p = 0.01), tibia ash (p < 0.01), and tibia optical densitometry (p = 0.03), as well as modified plasma Ca (p < 0.01) and P (p = 0.03) concentrations when compared to PC. Both NC40 and NC65 reduced P excretion (p < 0.01). Phytase alone restored tibia ash of NC40 quails to regular rates. Nevertheless, only PHY and CA combined returned plasma P, tibia ash, tibia optical densitometry, and daily weight gain of quails fed NC65 to similar values as those observed in PC. In conclusion, PHY alone suppresses the negative effects of moderate P restriction in growing Japanese quails, but fails in this task under severe P restriction. In such a situation, only the combination of PHY and CA ensures regular rates of growth and bone mineralization. This concept should be better explored by producers in order to take full advantage of the reduction in P excretion achieved by lowering dietary P concentrations.
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6-Fitase/farmacologia , Densidade Óssea/efeitos dos fármacos , Desenvolvimento Ósseo/efeitos dos fármacos , Ácido Cítrico/farmacologia , Fósforo na Dieta/administração & dosagem , Codorniz , Ração Animal/análise , Fenômenos Fisiológicos da Nutrição Animal , Animais , Ácido Cítrico/administração & dosagem , Dieta/veterinária , Feminino , Fósforo/deficiência , Distribuição AleatóriaAssuntos
Humanos , Esqueleto , Osso e Ossos , Tomografia , Densidade Óssea , Densitometria , Desenvolvimento MusculoesqueléticoRESUMO
En consonancia con la orientación tradicional de nuestras investigaciones, la Osteología está incorporando progresivamente el análisis estructural-biomecánico óseo y las interacciones músculo-esqueléticas. En este artículo se sintetizan los aportes originales del CEMFoC a la Osteología moderna en el terreno biomecánico en forma didáctica, para que el lector aprecie sus posibles aplicaciones clínicas. Los hallazgos aportaron evidencias sucesivas en apoyo de dos proposiciones fundamentales: a) los huesos deben interpretarse como estructuras resistivas, biológicamente servocontroladas ("Los huesos tienden siempre a mantener un factor de seguridad que permite al cuerpo trabajar normalmente sin fracturarse" Paradigma de Utah) y b) los huesos interactúan con su entorno mecánico, determinado principalmente por las contracciones musculares, en forma subordinada al entorno metabólico ("Los huesos son lo que los músculos quieren que sean, siempre que las hormonas lo permitan"). Los avances producidos se refieren, tanto cronológica como didácticamente, al conocimiento osteológico en general y al desarrollo de recursos novedosos para el diagnóstico no invasivo de fragilidad ósea, para distinguir entre osteopenias y osteoporosis, y para discriminar entre sus etiologías 'mecánica' y 'sistémica'. Finalmente, el nuevo conocimiento se integra en la proposición de un algoritmo diagnóstico para osteopenias y osteoporosis. El espíritu general de la presentación destaca que la evaluación osteomuscular dinámicamente integrada genera un nuevo espacio de análisis personalizado de los pacientes para la atención de cualquier osteopatía fragilizante con criterio biomecánico. (AU)
In consonance with the traditional spirit of our studies, skeletal research is being progressively focused on the structural-biomechanical analysis of bone and the muscle-bone interactions. In this article, the CEMFoC's members summarize their original findings in bone biomechanics and their potential clinical applications. These findings provided evidence supporting two fundamental hypotheses, namely, A. bones constitute resistive structures, which are biologically servo-controlled ('Bones tend to maintain a safety factor which allows the body to function normally avoiding fractures' the 'Utah paradigm'), and B. the interactions of bones with their mechanical environment mainly are determined by the contraction of local muscles - 'bone-muscle units'), and are subordinated to the control of the metabolic environment ('Bones are what muscles wish them to be, provided that hormones allow for it'). The achievements in the field are presented in a chronological and didactical sequence concerning the general knowledge in Osteology and the development of novel resources for non-invasive diagnosis of bone fragility, aiming to distinguish between osteopenias and osteoporosis and the 'mechanical' and 'metabolic' etiology of these conditions. Finally, the integrated new knowledge is presented as supporting for a proposed diagnostic algorithm for osteopenias and osteoporosis. In general terms, the article highlights the dynamic evaluation of the musculoskeletal system as a whole, opening a new diagnostic field for a personalized evaluation of the patients affected by a boneweakening disease, based on functional and biomechanical criteria. (AU)
Assuntos
Humanos , Animais , Ratos , Osso e Ossos/diagnóstico por imagem , Osteologia/tendências , Sistema Musculoesquelético/diagnóstico por imagem , Osteogênese Imperfeita/diagnóstico por imagem , Osteoporose/etiologia , Osteoporose/diagnóstico por imagem , Hormônio Paratireóideo/administração & dosagem , Hormônio Paratireóideo/uso terapêutico , Fenômenos Biomecânicos , Osso e Ossos/anatomia & histologia , Osso e Ossos/metabolismo , Doenças Ósseas Metabólicas/etiologia , Doenças Ósseas Metabólicas/diagnóstico por imagem , Algoritmos , Calcitonina/uso terapêutico , Colecalciferol/farmacologia , Hormônio do Crescimento Humano/uso terapêutico , Difosfonatos/farmacologia , Glucocorticoides/efeitos adversos , Glucocorticoides/farmacologia , Sistema Musculoesquelético/anatomia & histologia , Sistema Musculoesquelético/metabolismoRESUMO
Chia seeds (Salvia hispanica) provide an unusually high content of α-linolenic acid with several potential health benefits, but few studies have examined the long-term intake of n-3 fatty acid-rich plant foods such as chia. In this work, we investigated some of the effects of a diet containing 10% chia seeds versus a conventional isocaloric diet for 10 and 13 months on body measurements, musculoskeletal system, the liver, and the intestines of 20 male Sprague-Dawley rats assigned into two groups. The n-6/n-3 ratios for the control and chia diets were 7.46 and 1.07, respectively. For the first 10 months of the diet, the body parameters and weights were similar, but at 13 months, the bone mineral content (BMC) of the chia-fed rats was significantly higher than that of the controls whether in total or proximal areas of the left tibia. Also, significant positive correlations were found between the age of the chia group and the bone mineral density, BMC, weight of the musculoskeletal system, final body weight, and skin weight. Liver and intestinal examinations showed improved morphology associated with lower lipid deposit in hepatocytes and increased intestinal muscle layers and crypt size in the chia group. This study provides new data suggesting the potential benefits associated with the long-term intake of chia seeds.
Assuntos
Dieta , Ácidos Graxos Ômega-3/uso terapêutico , Enteropatias/prevenção & controle , Hepatopatias/prevenção & controle , Osteoporose/prevenção & controle , Salvia , Sementes , Absorciometria de Fóton , Animais , Densidade Óssea , Desenvolvimento Ósseo , Osso e Ossos/diagnóstico por imagem , Ácidos Graxos Ômega-3/administração & dosagem , Ácidos Graxos Ômega-3/análise , Enteropatias/patologia , Mucosa Intestinal/citologia , Mucosa Intestinal/crescimento & desenvolvimento , Mucosa Intestinal/patologia , Intestino Delgado/citologia , Intestino Delgado/crescimento & desenvolvimento , Intestino Delgado/patologia , Fígado/citologia , Fígado/crescimento & desenvolvimento , Fígado/patologia , Hepatopatias/patologia , Masculino , Valor Nutritivo , Osteoporose/diagnóstico por imagem , Distribuição Aleatória , Ratos Sprague-Dawley , Salvia/química , Sementes/química , Fatores de TempoRESUMO
Resumen La osteoporosis es una enfermedad esquelétita caracterizada por compromiso en la fuerza ósea, que predispone a fracturas de fragilidad. El diagnóstico de la osteoporosis se establece tanto por fracturas de bajo impacto, así como por medio de la densitometría ósea.
Abstract Osteoporosis is a skeletal disorder characterized by compromised bone strenght, which predisposes to the development of fragility fractures. The diagnosis of osteoporosis is established by the presence of a true fragility or, in patients who have never sustained a fragility fracture, by measurement of bone mineral density.
Assuntos
Humanos , Osteoporose/diagnóstico por imagem , Densidade Óssea , Osteoporose Pós-Menopausa , Densitometria , Fraturas por OsteoporoseRESUMO
La osteoporosis es un desorden esquelético que afecta aproximadamente al 21% de las mujeres entre 50 y 84 años. Su importancia radica en que se asocia a un aumento en el riesgo de fractura, y por lo tanto, a un incremento en la morbimortalidad. El diagnóstico puede ser realizado mediante historia clínica o densitometría mineral ósea. Teniendo en cuenta que el sobrediagnóstico y sobretratamiento de osteoporosis en la práctica ginecológica es frecuente, es esencial conocer tanto las indicaciones para realizar densitometría como los criterios diagnósticos de la patología. El primer pilar para la prevención y tratamiento de osteoporosis es el ejercicio y el aporte adecuado de calcio y vitamina D. Los bifosfonatos son la terapia médica de primera línea, sin embargo, existen otras alternativas que han ha demostrado disminuir el riesgo de fractura osteoporótica como la terapia hormonal de la menopausia y el denosumab.
Osteoporosis is a skeletal disorder that affects approximately 21% of women between 50 and 84 years. It's an important public health issue because low bone mass leads to an increased risk of fracture, having negative consequences in morbidity and mortality in this population. Diagnosis is based in clinical history and bone densitometry. Over diagnosis and over treatment of osteoporosis is common in gynecologic practice. The knowledge of diagnostic criteria and indications to perform bone densitometry is relevant. Treatment of osteoporosis consists in lifestyle measures like exercise and adequate consumption of calcium and vitamin D. Bisphosphonates are first-line medical therapy, but alternative treatments including hormone replacement therapy and denosumab have also shown to decrease risk of fracture.
Assuntos
Humanos , Feminino , Osteoporose/diagnóstico , Osteoporose/terapia , Osteoporose/fisiopatologia , Vitamina D/uso terapêutico , Exercício Físico , Cálcio/uso terapêutico , Remodelação Óssea , Terapia de Reposição Hormonal , Densitometria , Difosfonatos/uso terapêutico , Fraturas Ósseas/prevenção & controleRESUMO
ABSTRACT Introduction: Standard anthropometric measures used to diagnose obesity in the general population may not have the same performance in patients with rheumatoid arthritis. Objective: To determine cutoff points for body mass index (BMI) and waist circumference (WC) for detecting obesity in women with rheumatoid arthritis (RA) by comparing these standard anthropometric measures to a dual-energy X-ray absorptiometry (DXA)-based obesity criterion. Patients and method: Adult female patients with more than six months of diagnosis of RA underwent clinical evaluation, with anthropometric measures and body composition with DXA. Results: Eighty two patients were included, mean age 55 ± 10.7 years. The diagnosis of obesity in the sample was about 31.7% by BMI, 86.6% by WC and 59.8% by DXA. Considering DXA as golden standard, cutoff points were identified for anthropometric measures to better approximate DXA estimates of percent body fat: for BMI value ≥ 25 kg/m2 was the best for definition of obesity in female patients with RA, with sensitivity of 80% and specificity of 60%. For WC, with 80% of sensitivity and 35% of specificity, the best value to detect obesity was 86 cm. Conclusion: A large percentage of patients were obese. The traditional cutoff points used for obesity were not suitable for our sample. For this female population with established RA, BMI cutoff point of 25 kg/m2 and WC cutoff point of 86 cm were the most appropriate to detect obesity.
RESUMO Introdução: Medidas antropométricas universalmente usadas para diagnosticar obesidade na população geral podem não apresentar a mesma performance em pacientes com artrite reumatoide. Objetivos: Determinar pontos de corte do índice de massa corporal (IMC) e da circunferência de cintura (CC) para detecção de obesidade em mulheres com artrite reumatoide (AR) por meio da comparação dessas medidas antropométricas habituais com os índices de adiposidade obtidos pela densitometria óssea por dupla emissão de raios X (DXA). Pacientes e método: Mulheres adultas com mais de seis meses de diagnóstico de AR foram submetidas a avaliação clínica com medidas antropométricas e à DXA com exame da composição corporal. Resultados: Foram incluídas 82 pacientes, média de 55± 10,7 anos. O diagnóstico de obesidade na amostra foi de 31,7% pelo IMC, 86,6% pela circunferência de cintura e 59,8% pela DXA. Considerando a DXA o padrão-ouro, o valor de IMC acima de 25 kg/m2 foi o mais adequado para definição de obesidade nas pacientes com AR, apresentou sensibilidade de 80% e especificidade de 60%. Da mesma forma, para a CC, com 80% de sensibilidade e de 35% de especificidade, o valor encontrado foi de 86 cm para se detectar a obesidade. Conclusão: Foi elevado o porcentual de pacientes obesas. Os pontos de corte tradicionalmente usados para obesidade não foram adequados para nossa amostra. Para essa população de pacientes femininas com diagnóstico de AR, o ponto de corte de 25 kg/m2 para IMC e de 86 cm para CC foi o mais adequado para definir obesidade.
Assuntos
Humanos , Feminino , Idoso , Artrite Reumatoide/complicações , Absorciometria de Fóton , Índice de Massa Corporal , Circunferência da Cintura , Obesidade/diagnóstico , Estudos de Coortes , Sensibilidade e Especificidade , Pessoa de Meia-Idade , Obesidade/complicaçõesRESUMO
INTRODUCTION: Standard anthropometric measures used to diagnose obesity in the general population may not have the same performance in patients with rheumatoid arthritis. OBJECTIVE: To determine cutoff points for body mass index (BMI) and waist circumference (WC) for detecting obesity in women with rheumatoid arthritis (RA) by comparing these standard anthropometric measures to a dual-energy X-ray absorptiometry (DXA)-based obesity criterion. PATIENTS AND METHOD: Adult female patients with more than six months of diagnosis of RA underwent clinical evaluation, with anthropometric measures and body composition with DXA. RESULTS: Eighty two patients were included, mean age 55±10.7 years. The diagnosis of obesity in the sample was about 31.7% by BMI, 86.6% by WC and 59.8% by DXA. Considering DXA as golden standard, cutoff points were identified for anthropometric measures to better approximate DXA estimates of percent body fat: for BMI value≥25kg/m2 was the best for definition of obesity in female patients with RA, with sensitivity of 80% and specificity of 60%. For WC, with 80% of sensitivity and 35% of specificity, the best value to detect obesity was 86cm. CONCLUSION: A large percentage of patients were obese. The traditional cutoff points used for obesity were not suitable for our sample. For this female population with established RA, BMI cutoff point of 25kg/m2 and WC cutoff point of 86cm were the most appropriate to detect obesity.
Assuntos
Absorciometria de Fóton , Artrite Reumatoide/complicações , Índice de Massa Corporal , Obesidade/diagnóstico , Circunferência da Cintura , Idoso , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/complicações , Sensibilidade e EspecificidadeRESUMO
We developed and evaluated a fast and simple method to obtain suitable bone samples for densitometry and chemical analysis through biopsies of the 12th rib of cattle. The postoperative recovery, dry matter intake (DMI) and average daily weight gain (ADG) was evaluated in 36 Nellore steers, nine of which were randomly selected for the control group and 27 others were rib biopsied. Every 30 days, rib biopsy was performed in nine steers, using a corded-electric pistol-grip drill coupled with a hole saw of a 3mm diameter pilot drill bit. This rib biopsy technique provided a suitable sample obtained in a fast way and allowed the surgeon to work alone with the animal slightly sedated and restrained in the crush. Dry matter intake (DMI) was not affected in biopsied animals. At the end of the experimental period (116 days) the average daily weight gain (ADG) was similar in the steers biopsied or not. The described method provided rib samples from cattle suitable for densitometry and chemical analysis of bone tissue without effects on health and performance. This information could greatly increase the accuracy for the diagnosis of phosphorus deficiency in cattle raised on pasture and allow the evaluation of bone metabolism in experimental animals.(AU)
No presente estudo foi desenvolvida uma técnica para se obter, de forma rápida e simples, amostras da 12a costela bovina por meio de biópsias. Avaliou-se a recuperação pós-operatória (durante 15 dias), o consumo de matéria seca (CMS) e o ganho de peso diário (GMD) de 36 novilhos Nelores, sendo nove animais controles e 27 submetidos à biópsia. A cada 30 dias biópsias de costelas foram realizadas em nove animais, usando uma furadeira elétrica acoplada a uma serra-copo com uma broca-guia de 3mm de diâmetro. Esta técnica de biópsia permitiu obter amostras ósseas de forma rápida, com o cirurgião operando sozinho e com os animais levemente sedados e em estação. Ao término do experimento (116 dias) o CMS e o GMD não foram afetados pelo procedimento cirúrgico. As amostras obtidas foram adequadas para exames radiográficos e subsequentes análises químicas. O conjunto de informações adquiridas com a técnica de biópsia de costelas permite aumentar a exatidão no diagnóstico da deficiência de fósforo em bovinos criados em pastagens e também realizar estudos sobre metabolismo ósseo em animais experimentais.(AU)