xx, 229 p. : ill. (some col.) / Reproductive effort is a central element of human biology and ecology. Particularly for females, reproduction is energetically demanding, with elevated metabolic costs during pregnancy and lactation, followed by high child care costs. To satisfy energetic needs, women can adopt various physiological and behavioral strategies. On a physiological level, the energetic requirements of offspring may be met by adjusting metabolic allocation and/or drawing on maternal bodily reserves. On a behavioral level, women may reduce energy expenditure and/or increase energy intake. This study examined reproductive trade-offs in activity and skeletal health among the indigenous Shuar forager-horticulturalists of Ecuadorian Amazonia and had two main objectives. First, this research examined trade-offs in energy use during female reproductive states and behavioral adjustments made by females and males to meet high reproductive demands. Second, this study investigated skeletal health profiles among Shuar, as well non-Shuar Colonos, to identify the relationships between female reproductive factors and skeletal health. Research was conducted among adults in four Morona-Santiago communities. Skeletal health was measured using calcaneal ultrasonometry, and physical activity was measured using accelerometry. Extensive information on sociodemographics and reproduction was assessed through structured interviews. Age-related declines in bone mineral density (BMD) were observed for Shuar and Colonos, while Shuar BMD was significantly higher than that of other populations. These results suggest that normative data from developed countries may reflect suboptimal bone density levels. Regarding reproductive effects on skeletal health, results indicate that earlier menarcheal age and greater stature are associated with better bone health in postmenopausal life. These conclusions suggest the importance of the timing of early developmental stages in establishing bone status in adulthood. Results demonstrate that physical activity levels were similar between pregnant/lactating (P/L) and other women. However, P/L women appear to compensate for elevated energetic demands by relying on a male partner who has increased his energy expenditure, suggesting greater participation in subsistence activities. Overall, this study demonstrates the importance of biocultural strategies among women to meet high reproductive costs. Further, it emphasizes the utility of a life history framework for identifying trade-offs in physiology and behavior. This dissertation contains previously published and unpublished co-authored material. / Committee in charge: Dr. J. Josh Snodgrass, Chair; Dr. Lawrence S. Sugiyama, Member; Dr. John Lukacs, Member; Dr. John Halliwell, Outside Member

A caracterização de tecido ósseo por ultra-som para o diagnóstico de osteoporose tem sido investigada como uma alternativa a densitometria óssea baseada em radiação ionizante. A interação do ultra-som com o tecido ósseo é fundamentalmente diferente da que ocorre com a energia ionizante. O potencial da técnica ultra-sônica baseia-se nos efeitos sobre a propagação do campo acústico causados pela estrutura, composição e massa do tecido que está sendo investigado. Quatro estudos in-vitro e um estudo clínico estão descritos neste trabalho. O primeiro estudo in-vitro compara a correlação entre medidas ultra-sônicas e de densidade mineral óssea (em g/cm3) em tecido trabecular humano e bovino. A velocidade e atenuação ultra-sônicas em amostras ósseas foram determinadas pela técnica de inserção convencional (modo de transmissão) e a medida de densidade mineral óssea foi realizada por absortometria de um fóton (SPA). O mecanismo de interação do ultra-som com osso trabecular é pouco conhecido. O segundo estudo in-vitro investigou como a presença da medula óssea afeta as medidas de velocidade e atenuação. As correlações entre medidas ultrasônicas e de densidade mineral óssea (em g/cm3) por SPA, com e sem a presença da medula óssea, são também determinadas. A medida ultra-sônica de inserção convencional é comparada a medida de inserção por contato. O terceiro estudo in-vitro investigou em amostras de calcâneo as correlações entre medidas ultra-sônicas e de densidade mineral óssea (em g/cm3 e em g/cm2) por SPA. A determinação da densidade mineral Óssea em g/cm2 (BMD) a partir de medidas ultra-sônicas nas amostras foi pela primeira vez investigada, utilizando-se uma técnica de regressão linear univariável e multivariável e uma técnica multivariável não-linear baseada em redes neurais. Um novo parâmetro, baseado na média da frequência instantânea (MIF) do sinal da amostra e de referência, foi proposto para caracterizar o tecido ósseo devido a sua alta correlação com a atenuação. O efeito das corticais ósseas do calcâneo nas medidas ultra-sônicas é pouco conhecido. O quarto estudo in-vitro determinou a correlação entre medidas ultrasônicas e de densidade mineral óssea (em g/cm3) por SPA, com e sem a presença das corticais ósseas. Finalmente, no estudo clínico foram determinadas as correlações entre medidas ultra-sônicas no calcanhar e de densidade mineral óssea por DEXA (em g/cm2) no cólo femoral. A determinação da densidade óssea a partir de medidas ultra-sônicas no calcanhar foi pela primeira vez investigada, utilizando-se uma técnica de regressão linear univariável e multivariável e uma técnica multivariável não-linear baseada em redes neurais. / Ultrasonic assessment of bone for managing osteoporosis has been investigated as an alternative to radition-based bone densitometry technology. In contrast with the ionizing electromagnetic radiation of such clinical bone densitometric technique, ultrasound is a mechanical wave and thus interacts with bone in a fundamentally distinct manner. Ultrasound is viewed as having great potential for assessing bone since its propagation is affected by the structure, composition, and mass of the bone tissue being interrogated. Four in-vitro and one clinical study are reported in this work. In the first in-vitro study a comparison is reported on the ultrasonic assessment of human trabecular and bovine trabecular bone samples. Both ultrasonic velocity and attenuation were evaluated through a standard transmission insertion technique and correlated with bone mineral density (in g/cm3 ) as determined with single photon absorptiometry (SPA). There is a relatively limited understanding of how ultrasound interacts with cancellous bone. One potentially model leads analytically to the demonstration that ultrasound propagation through bone is dependent on several factors, including the properties of the fluid, which saturates the pores of the cancellous bone tissue. The second in-vitro study was carried out to assess how the presence of marrow affects the velocity and attenuation measurements. The correlation between ultrasonic and densitometric measurements (in g/cm3) by SPA, with and without the bone marrow, are also determined. A second part of this study compared the measurements of ultrasonic attenuation and velocity on bovine cancellous bone samples using a standard insertion technique with those obtained using a contac method. The thrid in-vitro study with the calcis trabecular samples investigated the correlations between ultrasonic measurements and bone mineral density (in g/cm3 e em g/cm2) as measured by SPA. A nonlinear multivariate estimation technique based on neural network was the first time investigated to determine the ability of ultrasonic measurements to estimate bone mineral density in g/cm2 (BMD). A linear univariate and multivariate estimation of BMD was compared with the neural network approach. A new parameter to characterize the trabecular bone is been proposed, which is based on the mean instantaneous frequency (MIF) of the sample and reference signals after transmission through the os calcis. It was founded a high correlation between MIF and the attenuation (BUA). Little is known about the effect of the os calcis cortical shell on ultrasonic measurements. The fourth in-vitro study with os calcis samples determined the correlation between ultrasonic and densitometric measurements (in g/cm3) by SPA with and without the cortical shell. Finally, a nonlinear multivariate estimation technique based on neural network was the first time investigated to determine the ability of clinical ultrasonic measurements in the heel to estimate bone mineral density (BMD) in the femoral neck. A linear univariate and multivariate estimation to predict BMD in patients is also compared with the neural network approach.

A dermatite atópica é uma doença de pele de caráter inflamatório crônico que normalmente precisa de tratamento com glicocorticóide tópico. O objetivo deste estudo foi avaliar o impacto da Dermatite atópica no consumo de nutrientes, no estado nutricional e no metabolismo ósseo de crianças com dermatite atópica moderada e grave comparadas à crianças saudáveis. Foram incluídas neste estudo 60 crianças de 4 a 12 anos com AD moderada/grave e 54 controles. O consumo alimentar foi avaliado por três recordatórios de 24 horas. O estado nutricional foi determinado pelo z-escore de altura para idade, peso por idade e do índice de massa corporal. Os marcadores ósseos séricos foram 25OH vitamina D, fosfatase alcalina óssea, cálcio sérico, fósforo, PTH, osteocalcina, CTX e cortisol. Os pacientes e familiares foram questionados quanto à fraturas, exposição solar e escore de atividade física. Por meio de densitometria dupla de Raio-X avaliou-se o conteúdo mineral ósseo (CMO), a densidade mineral óssea (DMO) e o z-score da coluna lombar, do fêmur total e do corpo inteiro. As crianças com dermatite atópica usavam glicocorticóide tópico em média por 3,9 ±1,81 anos. O tempo de exposição solar foi menor nas crianças com dermatite atópica. O consumo alimentar evidenciou um alto consumo de proteínas em ambos os grupos, e a ingestão de gordura foi mais baixo na crianças com DA. A média consumida de cálcio e vitamina D foi abaixo da recomendação nutricional em ambos os grupos. As crianças com DA apresentaram mais casos de rinite, asma e alergia alimentar do que o grupo controle. Segundo o zscore de altura para idade as crianças com DA foi significativamente mais baixas quando comparadas com o grupo controle. O CTX sérico foi menor no grupo DA. O CMO da coluna lombar foi mais baixo nas crianças com DA, e o CMO, a DMO e o z-score do fêmur total também foram significativamente menores no grupo DA do que no grupo controle. Neste grupo de crianças com DA, estudado o uso do glicocorticóide tópico pode ter diminuído a altura para idade, e a massa óssea. / Atopic dermatitis is an inflammatory allergic skin disease that often requires glicocorticosteroids therapy. The aim of this study was to determine the atopic dermatitis impact on food ingestion, nutritional status and bone mass in children with moderate to severe AD compared with a control group. Food ingestion was evaluated with 3 days 24-hour food recordathory. Nutritional status was determined with height to age z-score, weight for age z-score and BMI z-score. Bone markers measured in serum were 25OH vitamin D, bone phosphatase alkaline, CTX, serum calcium, phosphorus, osteocalcin, PTH and cortisol. Information on lifestyle parameters, bone fractures, sun exposure and physical activity were collected by use of a standardized questionnaire. Lumbar spine, total femur and whole body, bone mineral content (BMC), bone mineral density (BMD) and z-score was measured by dual-energy X-ray absorptiometry in 60 children (age 4-12years) with moderate to severe AD and 54 health controls, with the same age. In children, low BMD was defined as a Z-score less than -2. The AD children used topic glicocorticosteroids for a mean of 3,9 ±1,81 years. The sun exposure was lower in the AD group. Food ingestion showed high protein ingestion levels in both groups, and the fat consumption was lower in the AD children. The calcium and vitamin ingestion were bellow the recommendations in the two groups. Children with AD had more riniths, asthma and food allergy then control group. The CTX was lower in the AD group. The children with AD were significantly smaller according to the height for age zscore. There was significant smaller BMC on lumbar spine, and in the BMC, BMD and z-score in the total femur on the AD children. Low BMD occured more frequently in this population of children with moderate to severe AD compared with the control group. Use of topical glicocorticosteroids in the previous could be 5 years associated with the decrease in BMD.

O conceito de densidade mineral óssea alta (DMOAL) é controverso, e valores diferentes de DMO têm sido considerados como limite para essa classificação. Considerando que DMOAL pode estar presente em indivíduos normais e anormais, é importante analisar os possíveis fatores clínicos determinantes desta condição. Estudamos 337 mulheres pós-menopausa (180 com DMOAL e 157 grupo controle). A tecnologia DXA foi usada para medir a DMO e os compartimentos da composição corpórea. O grupo DMOAL tinha que apresentar DMO areal com valores absolutos 1,228 g/cm 2 (L1-L4) e 1,006 g/cm 2 (colo do fêmur). Além disso, o T-score deveria ser 0,1 SD (OMS) e o percentil do índice T > 100% em todos os sítios (L1, L2, L3, L4, L1-L4, DP colo do fêmur (CF) wards, trocanter e fêmur total (FT). As pacientes que não apresentavam estes critérios foram incluídas no grupo controle (GC). Todas as voluntárias realizaram testes laboratoriais e responderam questionário de Baecke para avaliar atividade física. A correlação entre as variáveis foram estimadas (coeficiente de correlação de Pearson, Deviance and Hosmer Lemeshow). Modelos de regressão múltipla foram usados para identificar os preditores independentes determinantes de DMOAL. Resultados: A média de idade no grupo DMOAL foi de 60 anos (DP = 8,3); peso 77,0 kg (DP = 11,7); altura 1,57 cm (DP = 0,05) e IMC 31,1 kg/m 2 (DP = 4,9). O não uso prévio de terapia de reposição hormonal (TRH) mostrou correlação negativa com DMOAL no colo do fêmur (r 2 = - 0,011) e o estado eutireoideo mostrou um possível efeito protetor e mantenedor nos valores de DMO . Pacientes com DMOAL em fêmur total não apresentavam antecedentes de fratura prévia por fragilidade (r 2 = 0,008). Valores normais de VB12 mostraram correlação positiva com DMOAL (r 2 = 0,098). O mesmo aconteceu para valores normais ou elevados de leptina. Pacientes com baixa atividade física apresentaram correlação inversa com DMOAL. Estes resultados sugerem que o uso prévio de TRH, estado eutireóideo, uso atual de sinvastatina, e altos níveis de leptina podem ser importantes para a manutenção de DMOAL. Interessantemente, quando utilizamos o cutoff >1 DP para determinar as mulheres com DMOAL nos sítios já referidos, usando este mesmo banco de dados, observamos que para cada aumento de 1 kg de massa magra, a chance de apresentar DMOAL aumentou em 15%. Além disso, o hábito de não fumar, aumentou em 4,21 vezes a chance de apresentar DMOAL. Finalmente, observamos que a massa magra total manteve sua influência positiva na DMO, mesmo quando usamos um valor de corte (cutoff) 1,5 DP no colo do fêmur e fêmur total, como critério de seleção de DMOAL / The concept of high bone mineral density (HBMD) is controversial and different values of BMD have been considered as threshold for this classification. Whereas HBMD may be present in normal and abnormal, it is important to analyze the possible factors determining this clinical condition. We studied 337 postmenopausal women (180 with HBMD and 157 control group). DXA technology was used to measure BMD and body composition compartments. The group HBMD had to present areal BMD with absolute values 1.228 g/cm 2 (L1-L4) and 1.006 g/cm 2 (femoral neck). Moreover, the T-score should be 0,1 SD (WHO) and the percentile of the index T >100% at all sites (L1, L2, L3, L4, L1-L4, Femoral neck, wards, trochanter and Total femur). The patients without these criteria were included in the control group (CG). All volunteers performed laboratory tests and answered the Baecke Questionnaire to assess physical activity. The correlation between variables were estimated (correlation coefficient of Pearson, Deviance and Hosmer- Lemeshow test). Multiple regression models were used to identify independent predictors determinants HBMD. Results: The mean age in group HBMD was 60 years (SD = 8.3), weight 77.0 kg (SD = 11.7), height 1.57 cm (SD = 0.05) and BMI 31,1 kg/m 2 (SD = 4.9). Non prior using of hormone replacement therapy (HRT) showed negative correlation with HBMD in femoral neck (r 2 = - 0.011) and euthyroid state seemed to favor and to maintain HBMD on this site. Patients with negative history of previous fracture fragility had HBMD in total femur (r 2 = 0.008). Normal values of vitamin B12 showed positive correlation with HBMD (r 2 = 0.098). The same occurred for normal or high levels of leptin. Patients with low physical activity correlated inversely with HBMD. Our results suggest that previous use of HRT, euthyroid state, current use of simvastatin, and high levels of leptin may be important to maintaining HBMD. Interestingly, when we used the cutoff >1 SD to determine HBMD women on the sites already mentioned, using this same database, we found that for each increase of 1 kg of lean body mass, the chance of presenting HBMD increased by 15%. Yet, the habit of not smoking, increased by 4.21 times the chance of having HBMD. Finally, we observed that the total lean mass maintained its positive influence on BMD, even when using a cutoff value 1.5 SD in femoral neck and total femur as a criterion of selection for HBMD

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-06-27T13:42:37Z No. of bitstreams: 1 ledamariliafonsecalucinda.pdf: 4559464 bytes, checksum: 43cecca924dfc2d1ba9044bdebbad60d (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-06-28T13:01:49Z (GMT) No. of bitstreams: 1 ledamariliafonsecalucinda.pdf: 4559464 bytes, checksum: 43cecca924dfc2d1ba9044bdebbad60d (MD5) / Made available in DSpace on 2016-06-28T13:01:49Z (GMT). No. of bitstreams: 1 ledamariliafonsecalucinda.pdf: 4559464 bytes, checksum: 43cecca924dfc2d1ba9044bdebbad60d (MD5) Previous issue date: 2012-05-21 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introdução: Dentre os principais mecanismos que causam a osteoporose está o uso de glicocorticoides. Os glicocorticóides induzem a apoptose nos osteoblastos e levar a diminuição do volume ósseo total. Diversos produtos são usados no tratamento da osteoporose e entre estes, alguns produtos naturais, tais como os fitoestrógenos. Estudos com o extrato de Ginkgo biloba (EGb) demonstraram efeitos promissores no tratamento da osteoporose. Este trabalho se propõe avaliar os efeitos do EGb sobre a apoptose de osteoblastos, densidade mineral óssea e na estrutura óssea de ratas Wistar com osteoporose induzida por glicocorticóide. Métodos: 60 ratas foram distribuídas em 5 grupos: controle, osteoporose, alendronato (alendronato de sódio - 0,2mg/Kg/dia), EGb1 (28 mg EGb/Kg/dia ) e EGb2 (56 mg EGb/Kg/dia). A osteoporose foi induzida através de injeções intramusculares de dexametasona. A fosfatase alcalina óssea foi avaliada no soro e a análise imunohistoquímica das proteínas Bcl-2 e Bax foram avaliadas nos cortes histológicos de mandíbula e fêmur. Na tíbia foram avaliadas a densidade mineral óssea, densidade radiográfica, densidade mineral cortical e parâmetros biomecânicos. O grupo controle foi comparado ao grupo osteoporose (teste “t” Student/Mann Whitney). Os demais grupos, exceto o controle, foram analisados através do teste de ANOVA seguido do teste post hoc de Tukey ou Dunnett T3 (p<0,05). Resultados: No grupo osteoporose houve redução dos níveis de fosfatase alcalina óssea e da expressão da proteína anti-apoptótica Bcl-2 (p<0,05). Redução de DMO, densidade mineral cortical da diáfise distal, rigidez, resiliência e carga máxima da tíbia (p<0,05). Aumento da densidade radiográfica da epífise distal da tíbia e da expressão da proteína próapoptica Bax (p<0,05). No grupo alendronato houve redução da expressão de Bax (20 dias ) (p<0,05), aumento da expressão de Bcl-2 (30 dias) e da DMO da tíbia (20 e 30 dias) (p<0,05). EGb 1 e EGb2 (30 dias) aumentaram os níveis de fosfatase alcalina óssea (p<0,05). EGb2 aumentou a DMO (20 e 30 dias). EGb1 e EGb2 aumentaram a expressão de Bcl-2 (20 e 30 dias) (p<0.05). EGb2 (20 dias), EGb1 e EGb2 (30 dias) reduziram significativamente a expressão de Bax (p<0,05). EGb1 e EGb2 (20 e 30 dias) reduziram a densidade radiográfica (p<00,5). Entretanto os tratamentos com o alendronato de sódio e o EGb não alteraram de forma significativa os parâmetros biomecânicos. Conclusão: O EGb aumentou a DMO, a expressão de proteínas anti-apóptoticas e os níveis de fosfatase alcalina óssea. E ainda reduziu a densidade radiográfica e a expressão de proteínas pró-apoptóticas. Este estudo sugere que o EGb reduz a apoptose de células osteoblásticas e aumenta a formação de tecido ósseo, podendo ser um tratamento efetivo para a osteoporose induzida por glicocorticoides. / Introduction: Among the major mechanisms that lead to osteoporosis is the use of glucocorticoids. Glucocorticoids induce apoptosis in osteoblasts and reduce the total bone volume. Several products are used in the treatment of osteoporosis and among them, some natural products such as phytoestrogens. Studies with Ginkgo biloba extract (EGb) showed promising effects in the treatment of osteoporosis. This study aims to evaluate the effects of EGb on the apoptosis of osteoblasts, bone mineral density and bone structure of Wistar rats with glucocorticoid-induced osteoporosis. Methods: 60 rats were divided into 5 groups: control, osteoporosis, alendronate (alendronate sodium - 0.2 mg/kg/day), EGb1 (EGb 28mg/kg/day) and EGb2 (EGb 56mg/kg/day). Osteoporosis was induced by injections of dexamethasone. The bone alkaline phosphatase was measured in serum and immunohistochemical analysis of the proteins Bcl-2 and Bax were evaluated in histological sections of the mandible and femur. In the tibia were evaluated the bone mineral density (BMD), the radiographic density, the cortical mineral density and the biomechanical parameters. The control group was compared to the osteoporosis group ("t" test/ Mann Whitney). The other groups, except the controls, were analyzed by ANOVA followed by Tukey or Dunnett's T3 post hoc test (p <0.05). Results: In the osteoporosis group the levels of bone alkaline phosphatase and the anti-apoptotic protein Bcl-2 expression were significantly reduced. The BMD, cortical mineral density of the distal diaphysis, stiffness, resilience and load of the tibia reduced (p<0.05). The radiographic density of the distal tibial epiphysis and the expression of the pro-apoptic protein Bax increased (p<0.05). Alendronate group decreased the expression of Bax (20 days), and increased the expression of the Bcl-2 (30 days) and the BMD of the tibia (20 and 30 days) (p<0.05). EGb1 and EGb2 (30 days) increased the levels of bone alkaline phosphatase (p<0.05). EGb2 increased BMD (20 and 30 days) (p<0.05). EGb1 and EGb2 increased the expression of Bcl-2 (20 and 30 days) (p<0.05). EGb2 (20 days), EGb1 and EGb2 (30 days) reduced the expression of Bax (p<0.05). EGb1 and EGb2 (20 and 30 days) reduced radiographic density (p<0.05). However treatment with alendronate sodium and EGb did not increase significantly the biomechanical parameters. Conclusion: EGb increased BMD, the expression of anti-apoptotic proteins and bone alkaline phosphatase. The EGb reduced the radiographic density and the expression of pro-apoptotic proteins. This study suggests that EGb reduces apoptosis of osteoblastic cells and increases the formation of bone tissue. It suggests that the EGb may be effective in the treatment of osteoporosis

Tendineous injuries on distal extremity of members are among the most frequent alterations of the locomotor system in both human and animal clinic-surgical routine and frequently adjuvant therapies are needed for the complete return of the physiological functions. The Therapeutic Ultrasound (TUS) is the most commonly used mode of treating tendineous injuries in rehabilitation clinics. However, due to the lack or the disagreements on specific studies about its effects on bone tissues, the use of TUS on distal regions of members, rich in bone protuberances and areas without muscular covering, always worries the professionals of the medical area. With the intention of clarifying the effects of TUS on bone tissue, 18 dogs were separated randomly into 3 groups, in which they received continuous ultrasonic treatment of 1 MHz for 5 minutes during 20 days on the cranium-distally region of the radio and ulna. According to the pre-determined groups, the frequency of TUS applied was of 0.5 or 1 W/cm2. The serum levels of total proteins, albumin, total calcium, ionic calcium, phosphates, alkaline phosphatase and bone alkaline phosphatase, were measured before the beginning of the therapy and after days 4, 7, 11, 14 and 20 of the treatment. The treated regions were also radiographed for analysis of bone densitometry in radiographic images before the therapy and at the end of the treatment. The laboratory exams detected normal serum levels for the main items researched, excepted for albumin which was inferior to the reference values. The statistic analysis of the results obtained show that the TUS caused alteration on the mineral bone metabolism and on the activity of the osteoblasts, especially on the first 7 days of the application, but did not alter the mineral bone density, no matter what dose was used (0.5 or 1 W/cm2). One can conclude that for the parameters in the experiment, TUS in regions of bone protuberances or deprived of muscular covering can be applied with safety. / As lesões tendíneas nas extremidades distais dos membros, estão entre as mais freqüentes alterações do aparelho locomotor da rotina clínico-cirúrgica humana e animal e, não raro, necessitam de terapias adjuvantes para seu completo retorno às funções fisiológicas. O ultra-som terapêutico (UST) é a modalidade mais utilizada nas clínicas de reabilitação para tratar lesões tendíneas, mas devido à falta ou a divergências de estudos específicos sobre seus efeitos no tecido ósseo, sua utilização sobre as regiões distais dos membros, ricas em protuberâncias ósseas e áreas desprovidas de cobertura muscular, sempre preocuparam os profissionais da área médica. No intuito de esclarecer os efeitos do UST sobre o tecido ósseo, 18 cães foram divididos aleatoriamente em três grupos, onde receberam tratamento ultra-sônico contínuo, de 1MHz, durante 5 minutos diários, por um período de 20 dias sobre a região crânio-distal do rádio e ulna. De acordo com os grupos prédeterminados, a freqüência do UST aplicada foi de 0,5 ou 1 W/cm2. Foram mensurados os níveis séricos de proteínas totais, albumina, cálcio total, cálcio iônico, fósforo, fosfatase alcalina e fosfatase alcalina óssea no momento anterior ao começo da terapia e após 4, 7, 11, 14 e 20 dias de tratamento. Também foram radiografadas as regiões tratadas, para análise de densitometria óssea em imagens radiográficas, antes da terapia e ao final do tratamento. Os exames laboratoriais detectaram níveis séricos normais para os principais itens pesquisados, apenas a albumina foi inferior aos valores de referência. As análises estatísticas dos resultados obtidos evidenciaram que o UST causou alterações no metabolismo mineral ósseo e na atividade dos osteoblastos, principalmente nos primeiros 7 dias de aplicação, porém não alteraram a densidade mineral óssea, não importando a dose utilizada (0,5 ou 1 W/cm2). Conclui-se que dentro dos parâmetros utilizados no experimento, a utilização do UST em regiões ósseas protuberantes ou desprovidas de cobertura muscular pode ser feita com segurança.

Abstract The current benchmark for the assessment of fracture risk is the status of osteoporosis based on the measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA). However, DXA-based BMD has been shown to lack predictive ability for individual fracture risk. More than half of the hip fractures occur among people who are not classified as having osteoporosis. Osteoporosis (i.e. reduced bone mass) is only one risk factor for a fracture. In addition to bone mass, the mechanical strength of a bone is influenced by material and structural factors. However, we have limited information about the combined effects of BMD and bone structural properties in the evaluation of fracture risk, with regard to different types of hip fractures in particular. Therefore, this study investigated the radiograph-based structural factors of the upper femur for the assessment of bone mechanical competence and cervical and trochanteric hip fracture risk. The subjects of the clinical study comprised 74 postmenopausal women with non-pathologic cervical or trochanteric hip fracture and 40 age-matched controls. The impact of bone structure on the bone mechanical competence was studied using the experimental material of 140 cadaver femurs. The femora were mechanically tested in order to determine the failure load in a side impact configuration, simulating a sideways fall. In all study series, standard BMD measurements were performed, and the structural parameters of bone were determined from digitized plain radiographs. The present study showed that the large variation in the mechanical competence of bone is associated with the geometrical and architectural variation of bone. Moreover, the results strongly suggested that the etiopathology of different types of hip fractures significantly differs, and that fracture risk prediction should thus be performed separately for the cervical and trochanteric hip fractures. Furthermore, the study implied that the current clinical procedure can better be used for the assessment of the risk of trochanteric fracture, whereas cervical fracture is more strongly affected by the geometrical factors than by BMD. Finally, radiograph-based structural parameters of trabecular bone and bone geometry predicted in vitro failure loads of the proximal femur with a similar accuracy as DXA, when appropriate image analysis technology was used. Thus, the technology may be suitable for further development and application in clinical fracture risk assessment.

Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) is a systemic disorder which includes abnormal bone chemistry, vascular or soft tissue calcification, and abnormal bone formation. Many of the parameters of CKD-MBD have been associated with an increased mortality risk in renal patients. There were three main facets to this research project. The first aim of this research was to perform two different studies using the Chronic Renal Insufficiency Standards Implementation Study (CRISIS) data. This prospective epidemiological study is designed to identify factors associated with renal progression and survival in the pre-dialysis CKD population. We have shown that for each 0.323mmol/L (1mg/dL) increase in serum phosphate there was a significant stepwise increased risk of death. (HR1.3 (1.1, 1.5) P=0.01). The association of baseline phenotypic data against vascular stiffness measurements was also investigated. Augmentation index measured at the radial artery was associated with a raised systolic blood pressure but no association with biochemical abnormalities was found.We hypothesised that the phosphate effect on survival was related to the effects within the CKD-MBD spectrum and therefore control of secondary hyperparathyroidism would improve bone and cardiovascular parameters. Therefore for the second part of this research we performed a randomised controlled trial to examine the effects of cinacalcet with standard therapy compared to standard therapy alone on bone and cardiovascular parameters in haemodialysis patients with uncontrolled hyperparathyroidism. The change of biochemical parameters and cardiovascular markers were also further explored in secondary analyses alongside survival data. The primary end point of change in vascular calcification at 52 weeks showed no significant difference between arms. As equivalent control of phosphate and iPTH was achieved in both arms secondary analyses were performed. This showed a significant regression of left ventricular hypertrophy and carotid intima-media thickness associated with phosphate but not iPTH reduction. Patients whose phosphate reduced during the study had a survival advantage when followed for 5 years (HR=10.2 (1.1, 104.5) P=0.049). The third part of this research was to investigate iPTH assay variability. We explored the variation in iPTH assays across the North West and paired this with regional audit data. This study showed that despite there being significant variation among iPTH assays across the region the variation in clinical management was still accounting for some variation in achieving PTH targets.In conclusion, serum phosphate, within the normal laboratory range, is associated with an increased mortality in CKD patients. Haemodialysis patients may have improvement of cardiovascular outcomes with tight control of secondary hyperparathyroidism, by whichever therapeutic means. Intact PTH assays variation may alter our clinical management but variation in practice still affects guideline achievement.

Introduction: Multiple sclerosis (MS) is associated with impaired bone health in comparison to an equally healthy population, even already in patients at the onset of this disease. The main risk factors for development of osteoporosis in MS patients are known. The aim of the study was to find the relationship of the decrease in bone mineral density (BMD) to the administered cumulative dose of steroids and to other risk factors in MS, mainly to the degree of motor deficit. Further goal was to evaluate the occurence of the risk of low-trauma fractures in multiple sclerosis patients.. The BMD and muscle mass was compared in MS patients (women and men) and control subjects, to examine the effect of main ones - physical disability and long-term glucocorticoid (GC) therapy on BMD. Clinical values of bone remodeling markers were evaluated in assessment of rate of bone loss in patients with multiple sclerosis long term treated with low dose of GC. Patients and methods: We used dual -energy X-ray absorptiometry for a measurement of BMD in 591 MS patients (455 females and 136 males) in 2004 and in cross-sectional longitudinal study published in 2014 with 474 patients (353 women and 121 men). Out of the whole study group body composition was evaluated in 250 MS females, 104 males and 247 healthy controls (193...

Title: The influence of whole-body electromyostimulation on muscle strength and body composition in healthy individuals Objectives: The aim of the diploma thesis is to collect and give comprehensive theoretical information concerning the whole body electromyostimulation topic. Furthermore, find out what the effect of the whole body electromyostimulation method on body weight, fat-free mass, body fat and other parameters of body composition. The aim of this work is to verify whether it is possible to achieve changes in bone mineral density values by means of the WB-EMS method or to increase maximal isometric muscle strength in healthy individuals. Methods: The diploma thesis is an intragroup experiment. The method of qualitative research was used for data collection. Bioelectric impedance analysis was used to evaluate body composition. DXA (Dual Energy X-Ray Absorptiometry) was used to assess bone mineral density and body composition, and isometric muscle strength was evaluated using isometric dynamometry. The research group consisted of 10 young and healthy probands (average age 23.9 years). Probands completed 10 exercise units using the whole body electromyostimulation method. The frequency of exercise was once a week. Results: We have found that after ten weeks of using the whole-body...