<p>Physical activity is known to benefit many physiological processes, including bone turnover. There are; however, currently no clinical guidelines regarding the most appropriate type, intensity and duration of activity to prevent bone loss. To address this gap in the literature, we performed a retrospective analysis of data from the Canadian Multicentre Osteoporosis Study (CaMos), a prospective cohort of 10,000 adult patients. Female participants aged 75 and over provided information regarding their daily activity levels, including the amount of time spent each week performing moderate physical activity (e.g. housework, brisk walking). Outcome measures included bone mineral density and fracture rate. Multiple and linear regression analysis was used to determine the effect of increasing amounts of moderate physical activity on the outcome measures. The results indicate that a step increase in the amount of physical activity performed each day resulted in a positive effect on bone mineral density at the hip, Ward's triangle, trochanter and femoral neck (B=0.006 to 0.008, p</p> / Master of Science (MSc)

No description available.

No / Summary We have produced paediatric reference data for forearm sites using the Stratec XCT-2000 peripheral quantitative computed tomography scanner. These data are intended for clinical and research use and will assist in the interpretation of bone mineral density and bone geometric parameters at the distal and mid-shaft radius in children and young adults aged between 6–19 years. Introduction Peripheral quantitative computed tomography (pQCT) provides measurements of bone mineral content (BMC), density (BMD) and bone geometry. There is a lack of reference data available for the interpretation of pQCT measurements in children and young adults. The aim of this study was to provide reference data at the distal and midshaft radius. Methods pQCT was used to measure the 4% and 50% sites of the non-dominant radius in a cohort of healthy white Caucasian children and young adults aged between 5 and 25 years. The lambda, mu, sigma (LMS) technique was used to produce gender-specific reference centile curves and LMS tables for calculating individual standard deviations scores. Results The study population consisted of 629 participants (380 males). Reference centile curves were produced; total and trabecular BMD for age (distal radius) and for age and height, bone area (distal and mid-shaft radius), cortical area, cortical thickness, BMC, axial moment of inertia, stress– strain index and muscle area (mid-shaft radius). Conclusions We present gender-specific databases for the assessment of the distal and mid-shaft radius by pQCT. These data can be used as control data for research studies and allow the clinical interpretation of pQCT measurements in children and young adults by age and height. / Central Manchester and Manchester Children’s University Hospital NHS Research Endowment Fund and the support of the National Osteoporosis Society (Camerton, Bath, UK), which awarded Rebecca Ashby a Linda Edwards Memorial Studentship in 2003 and funded the initial part of the study (1997–1998).

by Chan Kwai Foon May. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaves 103-114). / Abstracts in English and Chinese. / Declaration --- p.2 / Abstract --- p.3 / Abstract in Chinese --- p.6 / Acknowledgements --- p.8 / Chapter Chapter 1. --- Introduction --- p.15 / Chapter Chapter 2. --- Osteoporosis : The relationship between aging and skeletal organization between men and women --- p.17 / Chapter 2.1. --- Skeletal organization --- p.17 / Chapter 2.1.1. --- Bone structure --- p.17 / Chapter 2.1.2. --- Bone metabolism --- p.17 / Chapter 2.1.3. --- Peak bone mass --- p.18 / Chapter 2.2. --- Bone loss between men and women --- p.20 / Chapter 2.2.1. --- Aging and bone loss --- p.20 / Chapter 2.2.2. --- Clinical aspects of bone loss in men and women --- p.21 / Chapter Chapter 3. --- Vertebral deformity : Bone Mineral Density and Body Composition --- p.23 / Chapter 3.1. --- Bone mineral density --- p.23 / Chapter 3.1.1. --- Types of vertebral deformity --- p.23 / Chapter 3.1.2. --- Clinical diagnosis in vertebral deformity --- p.24 / Chapter 3.1.3. --- Bone mineral density measurements --- p.25 / Chapter 3.1.4. --- Vertebral deformity and bone mineral density --- p.28 / Chapter 3.2. --- Bone composition --- p.33 / Chapter Chapter 4. --- Literature Review on Health Consequences of Vertebral Deformity --- p.36 / Chapter 4.1. --- Back pain --- p.36 / Chapter 4.1.1. --- Back pain and vertebral deformity --- p.36 / Chapter 4.1.2. --- Back pain in men and women with vertebral deformity --- p.38 / Chapter 4.2. --- Morale and functional limitation and vertebral deformities --- p.39 / Chapter 4.2.1. --- Function evaluation : The Barthel Index --- p.40 / Chapter 4.2.2. --- Philadelphia Geriatric Morale Scale --- p.41 / Chapter Chapter 5. --- Objectives --- p.43 / Chapter Chapter 6. --- "Subjects and methods for phase I: anthropometric measurement, body composition and bone mineral density measurement in vertebral deformity patients and controls" --- p.44 / Chapter 6.1. --- Study subjects --- p.44 / Chapter 6.2. --- Radiology and digitization protocol for diagnosis vertebral deformity --- p.46 / Chapter 6.3. --- Diagnosis of vertebral deformity --- p.48 / Chapter 6.4. --- Body composition and bone mineral density measurements --- p.54 / Chapter 6.4.1. --- Body composition analysis --- p.54 / Chapter 6.4.2. --- Lumbar spine and hip bone mineral analysis --- p.54 / Chapter 6.5. --- Quality control --- p.56 / Chapter 6.5.1. --- Routine quality control of measurements --- p.56 / Chapter 6.5.2. --- Precision on patient repositioning --- p.56 / Chapter Chapter 7. --- Subjects and methods for phase II: health consequences of vertebral deformity patients and controls --- p.57 / Chapter 7.1. --- Questionnaire on health consequences --- p.57 / Chapter 7.1.1 --- Back pain and disability --- p.57 / Chapter 7.1.2 --- Activities of daily living --- p.59 / Chapter 7.1.3 --- Morale --- p.59 / Chapter 7.2. --- Statistical methods --- p.60 / Chapter 7.2.1. --- Bone mineral density and body composition --- p.60 / Chapter 7.2.2. --- Back pain and disability --- p.60 / Chapter 7.2.3. --- Activities of daily living and morale --- p.61 / Chapter Chapter 8. --- "Results for phase I: anthropometric measurement, body composition and bone mineral density measurement in vertebral deformity patients and controls" --- p.62 / Chapter 8.1. --- Demographic characteristics of study population --- p.62 / Chapter 8.2. --- Anthropometric measurements : Body composition and bone mineral density --- p.64 / Chapter Chapter 9. --- Results for phase II: Health Consequences of vertebral deformity patients and control --- p.76 / Chapter 9.1. --- Back pain --- p.76 / Chapter 9.2. --- Disability --- p.78 / Chapter 9.3. --- Activities of daily living --- p.81 / Chapter 9.4. --- Morale --- p.82 / Chapter Chapter 10. --- Discussion I --- p.83 / Chapter 10.1. --- Study Sample --- p.83 / Chapter 10.2. --- Digitization method and definition of vertebral deformity --- p.84 / Chapter 10.3. --- Methods for bone mineral density measurement --- p.87 / Chapter 10.4. --- Questionnaire validity --- p.88 / Chapter 10.4.1. --- Back pain and disability --- p.88 / Chapter 10.4.2. --- Barthel Index --- p.88 / Chapter 10.4.3. --- Philadelphia Geriatric Morale Scale --- p.89 / Chapter Chapter 11. --- Discussion II --- p.92 / Chapter 11.1 . --- Body composition and bone mineral density --- p.92 / Chapter 11.2. --- Differences of vertebral deformity between Chinese men and Caucasian men --- p.93 / Chapter 11.3. --- Health consequences in Chinese men --- p.96 / Chapter 11.4. --- Comparison of health consequences between Chinese men and Caucasian men --- p.98 / Chapter 11.5. --- Variation of health consequences between Chinese men and Chinese women --- p.101 / Chapter 11.5.1. --- Back pain and disability --- p.101 / Chapter 11.5.2. --- Morale --- p.102 / Chapter Chapter 12. --- Conclusion --- p.103 / Reference --- p.104 / Appendix I --- p.115 / Appendix II Publication

Breast cancer, osteoporosis, and coronary heart disease (CHD) are three major threats to women’s health. Postmenopausal women with breast cancer are also at high risk for osteoporosis and CHD. Adjuvant tamoxifen therapy is not only an effective treatment for breast cancer, but has been shown to have a beneficial effect on bone and the cardiovascular system. Although tamoxifen has been convincingly demonstrated to be able to preserve bone mineral density (BMD), an unexpected increase of risk of fractures in patients treated with tamoxifen has been reported. The findings of the association of tamoxifen and CHD from previous studies were either borderline or inconsistent. To clarify the discrepancy between BMD and fractures and test the potential beneficial effect of tamoxifen on CHD, I conducted a series of retrospective studies in postmenopausal women with breast cancer who participated in the Cancer Surveillance in HMO Administrative Data (IMPACT study) or the Study of Osteoporotic Fractures (SOF). In patients who participated in the IMPACT study, I demonstrated that the association of tamoxifen and fracture incidence varied at different skeletal sites. Although the association of tamoxifen and fractures in the spine (HR=0.40, 95% CI: 0.09-1.85), wrist (HR=2.49, 95% CI: 0.88-7.06), and total body (HR=0.87, 95% CI: 0.49-1.55) was inconclusive, tamoxifen was associated with an apparent reduction of the risk of hip fracture (HR=0.41, 95% CI: 0.17-1.03, p=0.0565). Importantly, the pattern of observed association of tamoxifen with the risks of fractures among postmenopausal women with breast cancer is consistent with its widely reported preserving effect on bone mineral density. Using SOF data, I found that the association between BMD and fractures in women with breast cancer varied at different skeletal sites, and type of BMD measured. Non-specific BMD was not associated with hip fracture (HR=1.12; 95% CI: 0.78, 1.59). Site-specific BMD was more likely linked with hip fracture (HR=1.43, 95% CI: 0.99, 2.08) while change in BMD did not predict hip fracture (HR=1.05; 95% CI: 0.63, 1.72). The association of spine morphometric fracture with either non-specific or spine-specific BMD was similar (OR=1.40; 95% CI: 1.04, 1.90; OR=1.35, 95% CI: 0.99, 1.85, respectively). Overall, the association of BMD and fracture in elderly women with breast cancer is weak. Only site-specific BMD appears to have a consistently modest association with fractures in the corresponding skeletal sites. In the IMPACT study population, compared to patients without tamoxifen, the overall incidence of CHD in tamoxifen-treated patients was lower (adjusted HR=0.60, 95% CI: 0.40-0.88). For each year of tamoxifen use, there was a statistically significant decrease in the risk of CHD (HR=0.90, 95% CI: 0.82-0.98). Further analyses categorized by length of tamoxifen use showed that an apparent association with a decreased CHD risk was found in patients who received tamoxifen for two to five years (HR=0.54, 95% CI: 0.33-0.86). No association was detected after the discontinuation of tamoxifen therapy. In summary, I detected a possible benefit associated with tamoxifen on fractures in the hip, the most common fracture site. I also found that BMD did not predict osteoporotic fractures well in postmenopausal women with breast cancer. In addition, I demonstrated that tamoxifen was associated with a reduced risk of CHD in postmenopausal women with breast cancer in a dose-dependent manner. An apparent benefit was found in those patients who received tamoxifen therapy for at least two years.

A qualidade óssea, bem como a estabilidade inicial dos implantes, está diretamente relacionada com o sucesso das reabilitações na implantodontia. O presente estudo teve como objetivo analisar a correlação entre índices radiomorfométricos de densidade óssea por meio de radiografias panorâmicas, perfil de qualidade óssea com o auxílio de Tomografia Computadorizada de Feixe Cônico (TCFC) com o uso do software de imagens OsiriX, Análise da Frequência de Ressonância (RFA) e Torque de Inserção do implante. Foram avaliados 160 implantes de 72 indivíduos, com média etária de 55,5 (±10,5) anos. Nas radiografias panorâmicas foram obtidos os índices IM, IPM e ICM, e nas tomografias computadorizadas de feixe cônico, os valores de pixels e a espessura da cortical da crista óssea alveolar, além da estabilidade primária por meio do torque de inserção e análise da frequência de ressonância. Os resultados foram analisados pelo coeficiente de correlação de Spearman, para p<= 0,01 foi obtido entre o torque de inserção e valores de pixels (0.330), o torque de inserção e a espessura da cortical da crista alveolar (0.339), o torque de inserção e o ISQ vestibulo-lingual (0.193), os valores de pixels e espessura da cortical da crista alveolar (0.377), as duas direções vestíbulo-lingual e mesio-distal do ISQ (0.674), o ISQ vestíbulo-lingual e a espessura da cortical da crista alveolar (0.270); os índices radiomorfométricos foram correlacionados entre eles e para p<= 0,05 foi obtido entre torque de inserção e ISQ mesio-distal (0.131), entre o ISQ vestibulo-lingual e os valores de pixels (0.156) e ISQ mesio-distal e IPMI esquerdo (0.149) e ISQ mesio-distal e IPMS esquerdo (0.145). Existe correlação entre a TCFC, o torque de inserção e a RFA na avaliação da qualidade óssea. É possível utilizar, pré-cirurgicamente, os exames de TCFC para avaliar a qualidade e quantidade óssea, tendo em vista as correlações obtidas neste estudo. / The bone quality and initial stability of implants are directly related to the success of rehabilitation in implantology. The aim of this study was to analyze the correlation between radiomorphometric indexes of bone density through panoramic radiographic images, bone quality profile using the Cone-Beam Computed Tomography (CBCT) and the OsiriX imaging software, Resonance Frequency Analysis (RFA) and insertion torque implant. One hundred and sixty implants were evaluated in 72 individuals with a mean age of 55.5 (± 10.5) years. In the panoramic radiographic images, the IM, IPM and ICM indexes were assessed. For the cone beam computed tomography, the analyses included pixel values, thickness of cortical bone crest, as well as the primary stability through the insertion torque and resonance frequency. The results were analyzed by Spearman correlation coefficient for p <= 0.01. The values between insertion torque and pixel were (0.330), the insertion torque and cortical thickness of the alveolar crest were (0.339), for torque insertion and ISQ vestibule-lingual (0.193), and for pixel values and cortical thickness of the alveolar crest (0.377). Considering both directions bucco-lingual and mesial-distal ISQ the values were (0.674), the bucco-lingual ISQ and cortical thickness of the alveolar ridge were (0.270); the radiomorphometric indexes were correlated between themselves. Values of p <= 0.05 were obtained between insertion torque and mesio-distal ISQ (0.131), as well as the ISQ vestibule-lingual and the pixel values (0.156) and also mesial-distal ISQ and left IPMI (0.149) and mesial-distal ISQ and left IPMS (0.145). There is a correlation between the CBCT, the insertion torque and RFA in the evaluation of bone quality. CBCT scans can be used prior to surgery, in order to assess bone quality and quantity, considering the correlations obtained in this study.

A fundamentação de métodos diagnósticos precoces na ortopedia de eqüinos é de extrema importância clínica, cirúrgica e econômica. O presente estudo teve como objetivo estudar a correlação da densidade mineral óssea do terceiro metacarpiano de eqüinos, obtida pelo método de absorciometria radiográfica, com a resistência dos mesmos quando submetidos a ensaios biomecânicos de compressão e flexão. Utilizaram-se trinta pares de osso terceiro metacarpiano de eqüinos adultos, os quais foram dissecados, radiografados, analisados pelo método de absorciometria radiográfica, submetidos ao estudo tomográfico e a ensaios biomecânicos. Através dos dados obtidos não se observou correlação significativa entre os valores de densidade óptica radiográfica e as propriedades biomecânicas do osso terceiro metacarpiano. Concluiu-se que não se pode inferir que os valores de densidade óssea obtidos pela absorciometria radiográfica do osso terceiro metacarpiano de um eqüino tenha correlação com a capacidade deste osso de absorver cargas de compressão e flexão. / The complete knowledge about non-invasive methods for early disgnostics in equine orthopedy is economicaly important. This experiment has studied the correlation between bone mineral density determined by radiographic absorptiometry and bone resistance of equine third metacarpal bone submitted to both compression and flexion testings. Thirty pairs of third metacarpal bone of adult horses were collected, dissected, radiographed, analysed by the radiographic absorptiometry technique, and submitted to tomographic study and biomechanical testings. The results have shown there is no significant correlation between radiographic bone density values and biomechanical properties of the third metacarpal bone. Therefore, it has been concluded bone mineral density of the third metacarpal bone determined by radiographic absorptiometry do not predict bone capacity to resist compression and flexion loads.

Redução da densidade mineral óssea tem sido descrita como uma complicação clínica entre as pessoas vivendo com HIV/AIDS. Entretanto não há dados descrevendo essa alteração entre os pacientes brasileiros. Nosso objetivo foi investigar a prevalência de baixa densidade mineral óssea entre pessoas vivendo com HIV/AIDS na cidade de São Paulo. Nós estudamos108 pacientes infectados pelo HIV (78 homens e 30 mulheres). Foram utilizados neste estudo dados secundários. Os dados foram originalmente coletados com o objetivo de acompanhamento de rotina dos pacientes na clínica e para este estudo estes dados foram coletados dos prontuários médicos. Todos os pacientes foram submetidos ao exame de densitometria óssea, que é uma técnica radiológica que mensura a densidade mineral óssea. Os pacientes foram classificados como tendo baixa densidade mineral óssea de acordo com a classificação da organização mundial da saúde que define osteopenia quando o T-score a partir de -1,1 e osteoporose quando T-score abaixo de -2,5 quando se tratava de homens e mulheres com idade acima de 50 anos. Quando homens e mulheres tinham idade até 50 anos, utilizamos a classificação da ISCO, neste grupo baixa densidade mineral óssea foi definida quando os pacientes apresentavam um Z-score abaixo de -2. Entretanto para este estudo ambas as classificações foram definidas como baixa densidade mineral óssea. A mediana de idade, tempo de infecção pelo HIV a partir da data do diagnóstico, tempo sob terapia antiretroviral, número de células linfócitos TCD4+ no momento da avaliação e Nadir foram similares entre homens e mulheres. A mediana de idade foi de 43 anos (intervalo interquartílico [li] 43-48 anos) e mediana de tempo de infecção pelo HIV foi de 3,66 anos (intervalo interquartílico [li] 1,72- 10,91 anos). Os pacientes tinham adquirido o HIV principalmente pela via sexual (homens que fazem sexo com home 46% e 50% eram heterossexuais). A mediana de células linfócitos TCD4+ foi de 399céls/mm 3(intervalo interquartílico [li] 275 - 566,5). Vinte e cinco pacientes foram classificados como tendo baixa DMO (23,15%). Não houve associação estatisticamente significante entre sexo, IMC, nadir e baixa DMO. Os fatores de risco associados à baixa DMO foram células linfócitos TCD4+ <350 céls/mm3 idade acima de 502 anos e tabagismo (p=0,003; p= 0,001; p=0,002) respectivamente. Quando avaliamos HAART VS baixa DMO encontramos 14,28% de baixa DMO entre os que usavam HAART e 26,25% entre os que não usavam e essa diferença não foi estatisticamente significante. Uma limitação de nosso estudo foi o tamanho de nossa amostra, coortes maiores talvez encontrem resultados diferentes. Contudo, nossos achados fortemente sugerem que a identificação de fatores de risco para baixa DMO e que são modificáveis são um importante componente no manejo desses pacientes para prevenção da baixa DMO e do risco de fratura atribuído a essa alteração. Portanto nossos resultados sugerem que esforços no sentido de encorajamento de cessação do tabagismo devem ser realizados e considerados um importante componente de qualquer programa de saúde dos indivíduos com HIV/AIDS. Identificar fatores de risco modificáveis pode contribuir para formulação de melhores políticas de saúde. / Reductions in bone mineral density (BMD) has been reported as a complication among people living with HIV/AIDS. However, no data describing this complication in Brazilian HIV infected patients have been reported . To investigate the prevalence of osteopenia/osteoporosi s among HIV-infected persons living in Sao Paulo City. We studied 108 HIV-infected patients (78 men and 30 women). We abstracted data from medical charts. All subjects enrolled in this study were submitted to Bone densitometry or dual-X-ray absorptiometry , a radiological technique using low-intensity X-ray . lt measures the bone mineral density content. lf the patients were postmenopausal woman and men aged 50 or above , they were classified as having low bone mineral dens ity when a T-score < -1 at the lumbar spine or femoral neck was detected. lf it was from -1,.1 to -2,5 osteopenia was defined and if it was < -2.5 osteoporosis was defined , using the WHO organization definition. Premenopausal woman and men younger than 50years are classified according to the current ISCO criteria, using Z-score <- 2,0 SD at the lumbar spine or femoral neck. For the propose of this study we combined both classification as Low Bone Mienral Density. Median age was 43 years (IQR 43 - 48 years). and the emdian time since HIV diagnosis was 3,66 years (IQR 1.72 - 10.91). Patients had acquired HIV primarily sexually (men who hasve sex with men 46%, heterosexual 50%). Plasma virai load was undetectable in 53 patients (40.09%) The CD4 T cell count was 399 cells/µ (IQR 275 - 566.5). Twenty-five patients (23.15%) had LBMD. There was no statiscally significant amng gender , body mass índex, nadir and LBMD. The risk factores associetaed were related to having CD4 T cells count <350 mm3 , being older than 50 years and being smoker (p=0.003; p= 0.001; p= 0.002) respectively. Low Bone Mineral Density was encountred 14.28% of patients with HAART, and in 26.25% with no haart. There, HAART was not statistically associated with LBMD. Our study was limited by its small sample. Larger cohort may have different results. Nonetheless, ou finding are compelling and suggesting that addressing modifiable risk factors for low bone mineral density and fragility fractures is an important component of both apporachs. Therefore ou data also suggest that efforts should be directed towards appropriate enouragment of lifestyle change alterations . Specifically , smoking cessation should be a major component of any health program within the HIV/AIDS population. Assessing such risk factors can contribute to the formulation of health policies to address this issue.

O tecido ósseo tem como característica estar constantemente em plena absorção e recomposição celular, sendo controlado pela interação de RANKL e OPG. No caso da perda de sua continuidade, ou seja, quando ocorre algum defeito ósseo, sua remodelação leva à restauração e consequente integridade do esqueleto, sendo o seu metabolismo influenciado por fatores hormonais, locais, comportamentais, ambientais e nutricionais; e seu desequilíbrio é um dos maiores obstáculos para a eficácia da remodelação óssea, podendo interferir negativamente na consolidação de fraturas. A ingestão crônica de álcool pode contribuir para esse desequilíbrio, e embora correlações significativas venham sendo relatadas entre o consumo excessivo de álcool e a consolidação óssea, novos estudos devem ser desenvolvidos haja vista a grande disparidade entre o tempo de submissão e a quantidade de ingestão do álcool englobando os diferentes protocolos. Os objetivos desse estudo foram avaliar quantitativamente os efeitos do consumo crônico de álcool no peso, reparo ósseo e densidade óssea em ratos Wistar, além de observarmos qualitativamente as fibras colágenas e a expressão de OPG e RANKL. Para isso, separamos aleatoriamente 30 ratos Wistar em dois grupos , sendo (G1) 15 ratos consumindo solução de aguardente diluída em água por 100 dias com concentração progressiva e controlada (10ºGL, 15ºGL, 20ºGL, 25ºGL e 30ºGL) e 15 ratos não alcoólatras consumindo como dieta líquida somente água (G2). Após o 92º dia do período de indução do alcoolismo, ambos os grupos foram submetidos a um defeito ósseo realizado na tíbia com um motor rotacional contendo uma broca com tamanho de 3 mm de diâmetro. Após 8 dias após o procedimento cirúrgico os animais foram eutanasiados em câmara de C02, as tíbias foram removidas e aparadas nas proximidades do defeito ósseo para que fossem processadas através de secções histológicas descalcificadas. A porcentagem de osso neoformado e a densidade óssea foram avaliadas histometricamente. Através da imunohistoquimica observamos a expressão de OPG e RANKL e através de reação histoquímica pelo método Picro-sirius Red, estudamos o padrão de birrefringência das fibras colágenas. Como resultados, pudemos observar que o peso dos animais, a densidade e remodelação ósseas foram menores no grupo alcoólico. Encontramos também efeitos negativos em relação à qualidade e organização das fibras colágenas, bem como diferenciação na expressão de RANKL e OPG nos diferentes grupos. Nossos resultados demonstram que o protocolo proposto de ingestão de álcool exerce efeitos negativos no ganho de peso e qualidade óssea quando comparado ao grupo controle. / The osseous tissue features the continuous cellular absorption and recomposition regulated by the interaction of the Receptor activator of nuclear factor kappa- &beta; ligand (RANKL) and Osteoprotegerin (OPG). In case its continuity is lost, that is, any kind of bone injury, its remodeling leads to restoration and consequent skeletal integrity and its metabolism is influenced by hormonal, local, behavioral, environmental and nutritional factors; its imbalance is one of the biggest obstacles to the efficiency of bone remodeling, and it might interfere negatively with fracture healing. The chronic consumption of alcohol may contribute to this imbalance, and, although significant correlations between the excessive alcohol intake and bone consolidation have been reported, new studies must be developed considering the great variety of protocols which approach the time of exposure and quantity of alcohol intake. The objective of this study was to verify quantitatively the effects of chronic alcohol consumption on body weight, bone healing and density in rats. It was also observed quantitatively the collagenous fibers and the expression of OPG and RANKL. For this purpose, 30 Wistar rats were randomly divided into two groups: G1 (group 1) consisted in 15 rats which had, for 100 days, a liquid diet of liquor diluted in water with a progressive and controlled concentration (10°GL, 15°GL, 20°GL, 25°GL and 30°GL); G2 (group 2) consisted in 15 rats on a liquid diet of only water and free of alcohol. After the 92nd day of the induction period of alcoholism, tibial defects of 3 mm in diameter were created in both groups and after 8 days from this surgery procedure the animals were euthanized in a CO2 chamber. The tibiae were removed and cut next to the bone defect in order to be processed through decalcified histological sections. The percentage of renovated bone and osseous density were submitted to histometric analysis. Through immunohistochemistry, the expression of OPG and RANKL were analyzed and using Picrosirius red staining method, the birefringence pattern of the collagen fibers was studied. As a result, it was verified that the body weight of the animals, the osseous density and bone remodeling were smaller in G1; negative effects regarding to the collagen fibers quality and organization and a differentiation in the expression of OPG and RANKL were also found in both groups. Conclusion: these results show that the proposed protocol of alcohol intake produces negative effects in the gain of body weight and bone quality when compared to the control group.

INTRODUÇÃO: A perda óssea acelerada é uma das reconhecidas complicações da hemiplegia pós-acidente vascular encefálico (AVE), mas pouco se sabe sobre o ritmo de perda na fase crônica e seus determinantes. O objetivo deste estudo foi avaliar a evolução tardia da densidade mineral óssea (DMO) em pacientes hemiplégicos crônicos, bem como identificar possíveis fatores associados. MÉTODOS: Foi realizado um estudo longitudinal envolvendo pacientes ambulatoriais com hemiplegia há mais de 12 meses. Pacientes com doenças e outras condições associadas à perda óssea foram excluídos. Avaliações clínica e densitométrica foram realizadas no início e após aproximadamente 16 meses, e foram analisados fatores de risco para perda óssea. RESULTADOS: Cinquenta e sete pacientes foram estudados, sendo 40 do sexo masculino, com média de 59,3 anos e tempo médio de hemiplegia de 33,4 meses. Ao comparar os hemicorpos acometido e não acometido, foi observada perda óssea mais acentuada em antebraço acometido (p=0,001), mas não em fêmur acometido. Foi observada perda óssea significativa em 56% dos pacientes em antebraço e 22,6% em fêmur, no lado acometido. Maior tempo de AVE foi protetor para a perda óssea em antebraço (OR = 0,96, IC 95%: 0,92 0,99; p=0,015), e o uso de anticoagulantes e/ou anticonvulsivantes (OR = 5,83, IC 95%:1,25 27,3; p=0,025) e espasticidade moderada/intensa (OR = 8,29, IC 95%:1,10 62,4; p=0,040) foram determinantes para perda óssea em fêmur. CONCLUSÕES: O presente estudo evidenciou que a perda óssea é comum e frequente em antebraço acometido em pacientes com hemiplegia crônica, com tendência à estabilização da perda com o passar do tempo. Espasticidade mais intensa e uso de anticoagulantes e/ou anticonvulsivantes foram associados à perda óssea em fêmur. Estes achados indicam que pacientes hemiplégicos crônicos devem ser monitorados e tratados para perda óssea, com atenção para os determinantes identificados, e que o membro superior acometido deve ser incluído na avaliação da DMO / INTRODUCTION: Accelerated bone loss is a well-known early complication of hemiplegia. However, less is known about chronicphase bone loss and its determinants. The objective of this study was to evaluate long-term changes in bone mineral density (BMD) in chronic hemiplegic patients, and investigate possible related factors. METHODS: A longitudinal study involving chronic stroke-related hemiplegic patients was conducted. Clinical and densitometric evaluations were performed at baseline and after approximately 16 months, and risk factors for bone loss were analyzed. RESULTS: Fiftyseven patients were studied (40 males) with a mean of 59.3 years and with mean time since hemiplegia of 33.4 months. Decrease in BMD was more pronounced in affected forearms compared to the nonaffected forearms (p=0.001). No difference was found between affected and non-affected femurs. Bone loss was observed in 56% of the affected forearms and 22.6% of the affected femurs. Longer time since stroke was protective for bone loss in the forearm (OR = 0.96, 95% CI: 0.92 0.99; p=0.015), and the use of anticoagulation/antiepileptic drugs (OR = 5.83, 95% CI: 1.25 27.3; p=0.025) and moderate/severe spasticity (OR = 8.29, 95% CI: 1.10 62.4; p=0.040) were associated to bone loss in the femur. CONCLUSIONS: Bone loss is common and more frequent in the affected forearm in chronic hemiplegic patients with tendency to stabilize over time. Greater spasticity and use of anticoagulation and/or antiepileptic drugs were proved to be associated with bone loss at the femur. Our findings indicate that chronic hemiplegic patients should be monitored and treated for bone loss, with attention to the identified determinants, and that the upper paretic limb should be included in BMD evaluation