As fraturas femorais sÃo consideradas um problema de saÃde pÃblica e sÃo responsÃveis por um alto Ãndice de morbidade e mortalidade pela ocorrÃncia de possÃveis complicaÃÃes. Ocorrem nÃo somente em pacientes jovens expostos a grandes traumas como tambÃm na populaÃÃo idosa. A maioria dos pacientes idosos possui determinadas afecÃÃes como, por exemplo, a osteoporose, que aumenta ainda mais o risco dessas fraturas, jà que a tendÃncia à que a idade mÃdia da populaÃÃo aumente, as consequÃncias da osteoporose aumentarÃo na mesma proporÃÃo. Estudos clÃnicos demonstraram que o uso dos bifosfonatos reduzem o risco da ocorrÃncia dessa fraturas em pacientes osteoporÃticos. O Ãcido zoledrÃnico pertence à classe dos bifosfonatos, sendo considerado atualmente o mais potente. Como a dose que esses pacientes utilizam à anual, hà um aumento da aderÃncia e da persistÃncia dos pacientes no tratamento, diminuindo, assim, o risco de fraturas. Este trabalho teve, como objetivo, verificar os efeitos do Ãcido zoledrÃnico no processo de consolidaÃÃo Ãssea nos fÃmures de ratos reduzidos com fio de Kirshner. Foram utilizados 36 ratos machos, adultos, da linhagem Wistar, com peso que variou de 250 a 300g. Todos os animais foram submetidos à cirurgia em que era realizada a fratura da diÃfise femoral com uma guilhotina romba. Os animais foram divididos em dois grupos: o grupo do Ãcido zoledrÃnico, que recebeu, via intraperitoneal, 0,1 mg/Kg do Ãcido e o grupo controle. Os animais foram sacrificados com 7, 14 e 28 dias de pÃs-operatÃrio. Houve duas mortes por causas desconhecidas. Foram realizados estudos radiogrÃficos com filme de mamÃgrafo para analisar a densidade Ãptica e a Ãrea do calo Ãsseo, medida em mm e estudo histolÃgico, utilizando amostras coradas com picrosirius red sob a luz polarizada do microscÃpio, para quantificar a formaÃÃo de colÃgeno tipo I e tipo III na regiÃo cortical prÃxima a fratura e no calo Ãsseo. Em relaÃÃo à densidade Ãptica, nÃo se observou nenhum resultado estatisticamente relevante em relaÃÃo ao uso do Ãcido zoledrÃnico. Ao se realizar uma anÃlise intergrupos, em relaÃÃo à Ãrea do calo Ãsseo, nÃo houve diferenÃa significante (p<0,05) nos tempos de consolidaÃÃo utilizados nessa pesquisa. Apesar do grupo zoledronato no tempo de 28 dias ter um resultado muito prÃximo em relaÃÃo ao nÃvel de significÃncia (p=0,0532). Jà na anÃlise intragrupos, observa-se um aumento considerado natural na Ãrea do calo Ãsseo. A percentagem de colÃgeno tipo III no calo Ãsseo e nas corticais nÃo revelou diferenÃa significativa tanto na anÃlise intragrupos como na anÃlise intergrupos. Em contrapartida, esse trabalho teve resultados significantes em relaÃÃo ao colÃgeno tipo I, havendo um aumento da percentagem do colÃgeno tipo I no calo Ãsseo no tempo de consolidaÃÃo de 28 dias (p=0,0098). Nas corticais do fÃmur prÃximas à fratura, esse aumento foi verificado nos trÃs tempos de consolidaÃÃo considerados nesta pesquisa. Concluindo que o Ãcido zoledrÃnico promoveu uma maior deposiÃÃo de colÃgeno tipo I, sugerindo aceleraÃÃo no processo de consolidaÃÃo Ãssea, sobretudo na fase final da reparaÃÃo. Em relaÃÃo à percentagem de colÃgeno tipo III (no calo Ãsseo e nas corticais prÃximas ao calo), a Ãrea do calo Ãsseo e a densidade Ãptica do calo Ãsseo, nÃo houve resultados estatisticamente significantes. / Femoral fractures are considered a public health problem and account for a high rate of morbidity and mortality by the occurrence of complications. They occur not only in young patients exposed to major trauma but in the elderly population as well. Most elderly patients have certain conditions, eg, osteoporosis, which further increase the risk of such fractures. Since the trend is that the average age of population increase, the consequences of osteoporosis will increase proportionately. Clinical studies have demonstrated that the use of bisphosphonates reduces the risk of occurrence of fractures in osteoporotic patients. Zoledronic acid belongs to the class of bisphosphonates, currently being considered the most potent. Because the dose that these patients use is an annual basis, there is an increased adherence and persistence of patients in treatment, thereby decreasing the risk of fractures. This study aimed to evaluate the effects of zoledronic acid on bone healing in femurs of rats with reduced Kirshner wire. We used 36 adult male rats, Wistar, weights ranged from 250 to 300g. All animals underwent surgery that was performed on the fracture of the femoral shaft with a blunt guillotine. The animals were divided into two groups: the group of zoledronic acid, which received intraperitoneally 0.1 mg / kg of the acid and the control group. The animals were sacrificed 7, 14 and 28 days postoperatively. There were two deaths from unknown causes. We performed a radiographic study with film mammography to analyze the optical density and area of callus, measured in mm  and histological study, using samples stained with picrosirius red under dense microscopic light to quantify the formation of collagen type I and type III in the cortical region near the fracture and callus. No significant statistical results regarding the optical density were observed with the use of the zoledronic acid. When conducting a comparative inter-group analyses, the callus area showed no significant differences (p <0.05) in a time of consolidation (7, 14 and 28 days) used in this study. Despite the zoledronate group in 28 days time to have a result very close to the level of significance (p <0.05). In the intragroup analysis there is considerable increase in the natural area of the callus. The percentage of type III collagen in the cortical and callus did not possess significant differences in intragroup analysis and the analysis groups. By contrast this study had significant results in relation to collagen type I. Concluding that zoledronic acid significantly increased the percentage of type I collagen in the callus in healing time of 28 days. And in the cortical bone three times considered (7,14,28 days).

Orientador: Lúcia Helena Simões da Costa Paiva / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T21:42:31Z (GMT). No. of bitstreams: 1 Bastos-Silva_Yasmin_M.pdf: 1080942 bytes, checksum: 7599dbea7c337dddf84a74226180fc92 (MD5) Previous issue date: 2015 / Resumo: O risco de fratura osteoporótica pode ser avaliado clinicamente baseado em fatores clínicos e pela densidade mineral óssea (DMO), entretanto esses parâmetros não são bons preditores do risco de fratura. Recentemente, o Brasil foi incluído no instrumento fracture risk assessment tool- FRAX-BRASIL, porém seu uso tem sido limitado na prática clínica. OBJETIVO: Avaliar o grau de concordância entre o risco de fratura em 10 anos calculado pelo FRAX-BRASIL com e sem densitometria em mulheres brasileiras na pós-menopausa. MÉTODO: Realizou-se um estudo de corte transversal no período de novembro de 2014 a fevereiro de 2015, com 402 mulheres em acompanhamento no Ambulatório de Menopausa do Hospital da Mulher Prof. Dr. José Aristodemo Pinotti em Campinas-SP. Foram incluídas mulheres com 40 anos ou mais, em amenorreia há pelo menos 12 meses e com exame de densitometria óssea prévio a qualquer tratamento medicamentoso para osteopenia ou osteoporose. As mulheres foram entrevistadas por um pesquisador durante a consulta de rotina, na qual foram coletadas informações sobre fatores de risco necessários para o questionário FRAX-BRASIL e dados da densitometria óssea. Os dados obtidos foram inseridos na plataforma online FRAX-BRASIL, em que foi calculado o risco para uma fratura maior e de quadril, utilizando-se somente os fatores de risco clínicos e o risco incluindo valores de DMO do colo do fêmur em g/cm2. ANÁLISE ESTATÍSTICA: Para análise do grau de concordância entre os riscos de fraturas com e sem densitometria óssea foi utilizado o coeficiente de correlação intraclasse (ICC). O Teste de Mann-whitney foi utilizado para comparação entre as médias do risco de fratura calculado com e sem DMO; para comparação entre as frequências de alto risco calculadas com e sem DMO foi utilizado o Teste de comparação entre duas proporções. Para análise da associação entre as variáveis clinico/demográficas e a variação do risco de fratura foi utilizada a análise de regressão linear. O nível de significância adotado foi <0,05. RESULTADOS: A probabilidade de fratura em 10 anos calculada pelo FRAX-BRASIL para fratura de quadril e para fratura maior somente pelos fatores de risco clínicos foi de 0,84% ±1,92 e 4,03% ±2,98 e com DMO foi de 0,83% ±1,76 e 4,05% ±2,98 respectivamente. O coeficiente de correlação intraclasse entre o FRAX-BRASIL com e sem DMO foi de 0,76 (IC95% 0,716-0,799) para uma fratura maior e de 0,644 (IC95% 0,583-0,698) para fratura de quadril. Ao avaliar as mulheres utilizando o FRAX com DMO 0,75% e 5,22% excederam os limiares de alto risco para fratura maior e de quadril, respectivamente. Sem o acréscimo da densidade óssea 1% e 11,44% apresentaram alto risco para fratura maior e de quadril, respectivamente. Dessa forma a recomendação de tratamento foi concordante entre o FRAX com e sem DMO em 99,75% dos casos de alto risco de fratura maior e de 93,78% para o quadril. Os fatores associados a menor variação FRAX com e sem foram maior idade, menor DMO, menor T-score e ausência de fratura previa tanto para fratura maior como para quadril. O menor IMC esteve associado a menor variação do FRAX apenas para fratura maior. CONCLUSÃO: O risco de fratura maior ou de quadril foi baixo na população estudada. O FRAX-BRASIL apresentou alta concordância para estimar o risco de fratura maior e concordância moderada para fratura de quadril apresentando uma estimativa de risco para fratura semelhante com ou sem DMO em nossa população / Abstract: The risk of osteoporotic fracture can be clinically evaluated based on clinical factors and by the bone mineral density (BMD), but these parameters are not good predictors of fracture risk. Recently, Brazil was included in the fracture risk assessment tool- FRAX-BRAZIL, but its use has been limited in clinical practice. GOAL: To evaluate the degree of correlation between the degree of correlation between the risk of fracture in 10 years calculated by FRAX-BRAZIL with and without densitometry in Brazilian postmenopausal women. METHODS: A cross-sectional study was conducted with 402 women followed up at the Menopause Ambulatory at the Women's Hospital Prof. Dr. José Aristodemo Pinotti in Campinas-SP. Women were included with 40 years or more in amenorrhea for at least 12 months and with bone densitometry exam prior to any drug treatment for osteopenia or osteoporosis. A researcher interviewed the women during a routine visit, where information about risk factors necessary for the FRAX-BRAZIL questionnaire and data of bone densitometry were collected. The collected data were inserted on the online platform FRAX-BRAZIL where the risk for major fractures and of the hip using only clinical risk factors and the risk including femoral neck BMD values in g / cm2. STATISTICAL ANALYSIS: To analyze the degree of correlation between the risk of fractures with and without bone densitometry was used the intraclass correlation coefficient (ICC). The Mann-Whitney test was used to compare the averages of fracture risk calculated with and without BMD; to compare the frequencies of high risk calculated with and without BMD was used the compare Test between two proportions. For analysis of the association between clinical / demographic variables and the change of the fracture risk was used linear regression analysis. The significance level was <0.05. RESULTS: The fracture probability calculated in 10 years by using the FRAX-BRAZIL for hip fracture and major fracture only by clinical risk factors was 0.84% ± 1.92 and 4.03 ± 2.98% and BMD was 0.83% ± 1.76 and 4.05 ± 2.98%, respectively. The intraclass correlation coefficient between the FRAX-BRAZIL with and without BMD was 0.76 (IC95% 0.716-0.799) for a major fracture and 0.644 (IC95% 0.583-0.698) for hip fracture. When evaluating women using FRAX with BMD 0.75% and 5.22% exceeded the high-risk thresholds for major and hip fracture, respectively. Without the increase of the bone density 1% and 11.44% presented high risk for major fractures and of hip, respectively. Then the treatment recommendation was consistent between the FRAX with and without BMD in 99.75% of cases of high risk of major fracture and 93.78% for the hip. Factors associated with less variation FRAX with and without were older, lower BMD, lower T-score, and no previous fracture both for major fracture as to hip fracture. The BMI was associated with lower variation in the FRAX only to major fracture. CONCLUSION: The risk of major fracture or of the hip was low in the study population. The FRAX-BRAZIL presented a high correlation to estimate the risk of major fractures and moderate agreement for hip fracture presenting a risk estimate for similar fracture with or without BMD in our population. The FRAX-BRAZIL presented a high correlation to estimate the risk of major fractures and moderate correlation for hip fracture presenting a risk estimate for similar fracture with or without BMD in our population / Mestrado / Fisiopatologia Ginecológica / Mestra em Ciências da Saúde

Leung Ping-chung. / Thesis (D.Sc.)--Chinese University of Hong Kong, 1994. / Includes bibliographical references.

Background. Diabetes seems to be associated with an increased risk of fractures in the general population. We aimed to determine whether pre-transplant diabetes increases the risk of fractures among patients receiving solid organ transplantation. / Methods. We conducted a nested case-control study in a cohort of subjects 18 years and older who received a first solid organ transplantation in Quebec between January 1st 1986 and July 31st 2005, and who were covered by the RAMQ drug plan at least 1 year before the transplantation and 3 months after the date of discharge from the transplantation hospitalization. Cases were subjects from the cohort who had sustained a fracture between the date of discharge from the hospitalization for transplantation and the end of the study period or the patient's death. The fracture date was the case index date. All incidental fractures were included except fractures of the skull, phalanges of the hand and foot, multiple fractures and pathological fractures, and were identified by medical service claims. Controls were matched to cases on the type of organ transplanted and on the date of the transplantation (+/- 3 months). Crude and adjusted odds ratios (OR) were obtained with univariate and multivariate conditional logistic regression models. / Results. The study included 238 cases and 873 controls. Pre-transplant diabetes was present in 30% of the cases and 22% of the controls (crude OR: 2.16, 95% CI: 1.7--2.8). After adjusting for potential confounders, pre-transplantation diabetes remained a significant risk factor for fractures (adjusted OR: 1.94, 95% CI: 1.5--2.6). / Conclusion. Pre-transplant diabetes appeared to significantly increase post-transplant fractures among adults receiving solid organ transplantation.

Objectives. beta-blockers can alter bone turnover and increase bone formation in animals. It is unknown whether beta-blockers have similar bone protective effects in humans. We aimed to estimate the effects of beta-blockers on bone mineral density (BMD) and fractures using data from the Canadian Multicentre Osteoporosis Study, a large prospective cohort study. / Methods. All medications, including beta-blockers, taken at baseline and after five years of follow-up were recorded. BMD was measured at baseline. During the five years of follow-up, incident minimal trauma fractures were documented by yearly questionnaires. To compare users of beta-blockers to non-users while controlling for possible confounders, multiple linear regression was utilized to estimate between group differences in BMD and multivariate logistic regression was employed to estimate differences in fracture risk. / Results. Of the 9423 participants, 236 of 2884 males (8.2%) and 600 of 6539 females (9.2%) used beta-blockers at some point during the study. In men, beta-blocker users had differences of +1.1% (95% confidence interval [CI] -0.9%, 3.0%) and +1.2% (95% CI -0.5%, 4.0%) in baseline BMD at the total hip and at the lumbar spine, respectively, compared to non-users. In women, beta-blocker users had differences of +0.05% (95% CI -1.2%, 1.3%) and +0.2% (95% CI -1.3%, 1.7%) for the BMD of the total hip and the lumbar spine, respectively, compared to non-users. For users of beta-blockers at baseline, the adjusted odds ratio (OR) for any minimal trauma fracture was 1.23 (95% CI 0.67--2.25) in men and 1.02 (95% CI 0.76--1.35) in women. Chronic use (user at baseline and year 5) in men had an OR for any minimal trauma fracture of 2.1 (95% CI 1.0--4.3). In women who used beta-blockers at baseline but not at year 5, the OR for hip fracture was 6.3 (95% CI 2.0--19.3). The risk of fractures for other sites was inconclusive owing to wide confidence intervals. / Conclusion. Despite relatively large numbers of subjects, wide confidence intervals do not permit strong conclusions with regards to the effect of beta-blockers on BMD in men. Using a 2% limit of clinical importance for BMD, there appears to be no effect of beta-blockers on BMD in women. There is some evidence from our study that beta-blockers may be associated with an increased risk of fractures in certain subsets of users.

Diss. (sammanfattning) Umeå : Umeå universitet, 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2007. / Härtill 5 uppsatser.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-04-07T13:15:48Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Mestrado Verônica Melo CCS.pdf: 1393412 bytes, checksum: ba56180c890511d0089ae952978dcc15 (MD5) / Made available in DSpace on 2017-04-07T13:15:48Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Mestrado Verônica Melo CCS.pdf: 1393412 bytes, checksum: ba56180c890511d0089ae952978dcc15 (MD5) Previous issue date: 2016-07-01 / Introdução: o uso crônico de glicocorticoides é considerado a principal causa de osteoporose secundária e iatrogênica. Existem poucos estudos associando fraturas ao uso de glicocorticoides na faixa etária pediátrica. Eles poderiam ajudar na criação de abordagens preventivas e terapêuticas. Objetivos: avaliar se o uso de glicocorticoides, nos 12 meses precedentes, associou-se à ocorrência de fraturas em crianças e adolescentes; identificar a frequência de asma e outras doenças; comparar o perfil demográfico, o tipo de trauma, o índice de massa corpórea, a prática de exercício físico, a ingesta de leite e o tabagismo passivo domiciliar nos grupos com e sem fratura; verificar a frequência de deficiência de vitamina D. Métodos: no período de abril a outubro de 2015, um estudo tipo caso controle foi conduzido em crianças e adolescentes vitimadas por trauma, com e sem fratura, a partir da análise dos dados coletados. Resultados: foram estudados 104 pacientes, 50 com fratura e 54 com trauma, mas sem fratura. Ao todo, 80,4% eram meninos e 40,4% estavam na faixa etária de 10 a 14 anos. O uso prévio de glicocorticoides ocorreu em 15,4% do total, sem diferença estatisticamente significante entre os dois grupos. Entre 39 pacientes com fratura e que dosaram a vitamina D, 47,2% tinham níveis séricos < 30ng/ml. A prática de exercício físico associou-se a um aumento em 2,2 vezes no risco para fratura. Conclusões: este estudo não mostrou associação entre o uso prévio de glicocorticoides e a ocorrência de fraturas em crianças e adolescentes. A faixa etária de 10 a 14 anos, o trauma grave e o exercício físico associaram-se com um maior risco para fraturas. Cerca de metade de uma amostra dos pacientes com fratura apresentou níveis insuficientes/deficientes de vitamina D, mesmo em região tropical. / Introduction: Osteoporosis is not exclusive to older adults and manifests by fractures. Chronic glucocorticoid use is considered the main cause of secondary and iatrogenic osteoporosis. Few studies have related fractures to the use of glucocorticoids in children and adolescents. Such studies could be useful for the development of preventive and therapeutic strategies. Objectives: To assess whether glucocorticoid use in the past 12 months is associated with the occurrence of fractures in children and adolescents; to identify the frequency of asthma and other diseases; and to compare the demographic profile, type of trauma, body mass index, physical activity, milk intake, and household exposure to cigarette smoke of groups with and without fractures; to verify the frequency of vitamin D insufficiency/deficiency. Methods: A case-control study, conducted from April to October 2015, analyzed the data of trauma children and adolescents with and without fractures. Results: A total of 104 trauma patients were studied, 50 with and 54 without fractures. In all, 80.4% were males, and 40.4% were aged 10 to 14 years. Previous glucocorticoid use occurred in 15.4% of the sample, without significant difference between the groups. Of the 39 fracture patients with measured serum vitamin D levels, 47.2% had levels < 30ng/ml. Physical activity was associated with a 2.2-fold risk of fractures, but without significance in multivariate analysis. Conclusions: This study did not find an association between previous glucocorticoid use and the occurrence of fractures in children and adolescents. In 10- to 14-year-olds, severe trauma and physical activity were associated with higher risk of fractures. About half the fracture sample had insufficient/deficient vitamin D levels, despite residing in a tropical region.

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