There is a need to identify patients with osteopenia who are at high risk of sustaining fractures and who would benefit from treatment, since many patients with osteopenia do not sustain fractures, in 2008, the WHO unveiled the fracture risk-assessment-tool (FRAX®), which calculates the 10-year probability of a patient sustaining a fracture. It is available on the internet free of charge, and represents a major step forward since it takes into account a number of risk factors and allows clinicians to focus on those patients at high risk of sustaining fractures, in whom the benefits of treating a silent disease outweigh the potential adverse effects and cost. In the USA, the National Osteoporosis Foundation has suggested a fracture threshold to recommend treatment. In this article, the various risk factors included in the FRAX tool are briefly reviewed, and the advantages, potential limitations and possible future developments are discussed.

Long-term exposure to pharmacological doses of glucocorticoids has been associated with the development of osteopenia and avascular necrosis. Bone loss may be partially attributed to a steroid-induced decrease in the osteoblastic differentiation of multipotent progenitor cells found in the bone marrow. In order to determine if there is a change in the osteogenic potential of the bone marrow stroma following glucocorticoid treatment, Sprague-Dawley rats were administered methylprednisolone for up to six weeks, then sacrificed at 0, 2, 4, or 6 weeks during treatment or 4 weeks after cessation of treatment. Femurs were collected and analyzed for evidence of steroid-induced osteopenia and bone marrow adipogenesis. Although glucocorticoid treatment did inhibit bone growth, differences in ultimate shear stress and mineral content were not detected. The volume of marrow fat increased with increasing duration of treatment, but returned to near control levels after cessation of treatment. Marrow stromal cells were isolated from tibias, cultured in the presence of osteogenic supplements, and analyzed for their capacity to differentiate into osteoblast-like cells in vitro. Glucocorticoid treatment diminished the absolute number of isolated stromal cells, but did not inhibit the relative levels of bone-like mineral deposition or osteocalcin expression and secretion. Although pharmacological glucocorticoid levels induce bone loss in vivo, physiologically equivalent concentrations have been shown to enhance the formation of bone-like tissue in vitro. However, glucocorticoids have also been reported to inhibit proliferation and type I collagen synthesis in marrow stromal cell cultures. In order to assess the effects of intermittent dexamethasone treatment on the progression of osteogenesis in rat marrow stromal cell culture, this synthetic glucocorticoid was removed from the culture medium after a variable period of initial supplementation. Cell layers were analyzed for total cell number, collagen synthesis, phenotypic marker expression, and matrix mineralization. Prolonged supplementation with dexamethasone decreased proliferation, but did not significantly affect collagen synthesis. Furthermore, increased treatment duration was found to increase bone sialoprotein expression and mineral deposition. The duration of glucocorticoid treatment may be a key factor for controlling the extent of differentiation in vitro. / Master of Science

Low trauma hip fractures, due to bone fragility, are a major healthcare burden with serious consequences for individuals in terms of long-term morbidity and mortality; and also for society due to the high medical and care costs associated with these injuries. Because of the association with low bone mass, these fractures are particularly prevalent in elderly populations and are likely to become more common as longevity increases globally. Avoidance of these fractures is therefore an extremely important goal. Low bone mass, manifested in the conditions of osteopenia and osteoporosis, is the primary cause of bone fragility, and reductions in bone mass are the inevitable corollary of aging and menopause. Bone loss may be exacerbated by immobilisation and reduced weight-bearing activity, giving rise to the condition of disuse osteopenia. Immobilisation may itself be the result of low trauma leg fragility fractures that potentially causes further bone density loss. If this loss occurs at the hip, there is an increased risk for hip fracture as a sequela to the original injury. Osteoarthritis is also a condition strongly associated with aging that may necessitate knee arthroplasty as a last stage treatment, potentially causing a period of reduced mobility and weight-bearing activity following surgery. Leg fracture and knee replacement both present additional risk factors for hip fracture due to changes in muscle mass, gait and postural stability that may increase the risk of falls. This study aims primarily to investigate the effects of immobilisation on leg fracture and knee replacement patients, immediately following injury or surgery, in order to quantify bone and muscle loss and to monitor recovery over a one year period. A postmenopausal population were studied as they are already losing bone density systemically and may be at greater risk of further bone loss following immobilisation. Factors of activity, function, weight-bearing, pain, treatments, therapies, health perceptions and mental wellbeing, that potentially contribute to bone loss and recovery, were also investigated. Results from the study may provide information relating to increased future hip fracture risk and lead to treatment options to alleviate bone loss in these groups.

Por ser a osteoporose um grande problema de saúde pública e sua ocorrência aumentar os índices de morbidade e mortalidade proporcionados por fraturas geradas pela maior fragilidade óssea é importante o estudo de novos tratamentos para este quadro clínico. Tratamentos alternativos são opções para pessoas com alto risco de desenvolver osteoporose mas que possuem restrições aos tratamentos convencionais já existentes. Assim, este estudo tem o objetivo de analisar a ação do ultra-som de baixa intensidade (30mW/cm 2, freqüência de repetição de 1 KHz e ciclo de trabalho de 20%), como método não invasivo, em modelo de ratas osteopênicas. O modelo experimental foi obtido através da realização de ovarectomia e histerectomia em ratas da raça Holstman, com aproximadamente 200 gramas. Para obtenção do quadro de osteopenia foram aguardados 30 dias. Os animais foram divididos dois grupos: grupo placebo e grupo tratado. O tratamento começou no 31º dia após o procedimento cirúrgico, com duração de 20 dias consecutivos por 20 minutos diários. No grupo placebo, as ratas não foram submetidas ao tratamento ultra-sônico mas foram submetidas ao mesmo estresse causado às do grupo tratado. A emissão do campo ultra-sônico, no grupo tratado, foi na região do colo de fêmur. As propriedades mecânicas da diáfise femoral não se alteraram nos ossos osteopênicos comparados com ossos normais, assim como também não se alteraram nos ossos tratados comparados com os não tratados. Os resultados quantitativos de cálcio e fósforo não mostraram diferenças significativas entre os grupos placebo e tratado. No entanto, os achados qualitativos obtidos através da microscopia eletrônica de varredura indicaram uma microarquitetura óssea mais preservada nos ossos do grupo tratado. / As osteoporosis has become a major public health problem and its occurrence increases the rates of morbidity and mortality caused by fractures originated from bone fragility, it is important to study new treatments for this disease. Alternative treatments are options for those people with increased risk of osteoporosis development but with restrictions for the ordinary treatments already existent. This study aims at analyzing the low intensity ultrasound action (30mW/cm2 , 200ms burst of 1.5 MHz sine waves repeated at 1.0kHz) as a non invasive method, in the osteopenic rat model. Mature Holstman rats were subjected to bilateral ovariectomy. In order to obtain osteopenic rats, a 30 day period was allowed. The animals were separated in 2 groups: non-treated and treated. The treatment began in the 31 st day after the surgery, lasting twenty days, 20 minutes/day, in the femural neck site. The non treated group was subjected to the same stress caused to the treated group. The bone mineral matrix content of the femural neck (calcium and phosphorus) showed no significant differences among the groups. However, the analyzes using scanning electron micrographs indicated the smaller microarchitectural deterioration of trabecular bone present in the treated rats groups.

Individuals with intellectual and developmental disabilities (IDD) are prone to certain diseases in their lifetime, such as osteoporosis. Absorption of calcium is essential to maintaining good bone health and preventing osteoporosis. This study examined primary care providers’ (PCPs) choice of calcium supplementation, as well as type of calcium supplementation, and the relationship between variables in the IDD population. Ten PCPs were asked to complete a 14-question web-based survey, with five surveys completed. Calcium citrate was the preferred supplement among respondents at 50%. Retrospective data was collected from patient records and included type of calcium supplement prescribed, bone density test results, and other variable factors. The type of calcium supplement prescribed did not affect bone density results in subjects with IDD. There was a weak significance between calcium supplement type and gender and vitamin D. It is of modest benefit to include vitamin D with calcium supplementation to enhance calcium absorption.

Submitted by Mario BC (mario@bc.ufrpe.br) on 2016-06-15T12:23:12Z No. of bitstreams: 1 Nicholas Novack.pdf: 1065518 bytes, checksum: 960193b642c76d9c5d7a0f4e56572f4f (MD5) / Made available in DSpace on 2016-06-15T12:23:12Z (GMT). No. of bitstreams: 1 Nicholas Novack.pdf: 1065518 bytes, checksum: 960193b642c76d9c5d7a0f4e56572f4f (MD5) Previous issue date: 2015-06-15 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Quantitative computerized tomography (QCT) is a highly sensitive technique, applied accurately diagnose loss of bone mass, bone mineral densitometry call with great advantages over plain radiography, but the lack of it limiting values for its clinical application. This study had the following objectives: establishing mean values of radiodensity the vertebral body of the second lumbar vertebra through the TCQ in cats, aspects involved in the pathophysiology of osteopenia induced by castration; study effects of depletion of estrogens radiodensity evaluate the characteristics of the female feline species of each experimental group, between the entire young cats and castrated adult cats spayed and not more than 6 years in a total of 22 animals. Comparing the degree of normality for young adult cats, and related. Statistically diseases was proven to be a reduction of bone mass in castrated cats over 6 years second lumbar vertebra L2. / A tomografia computadorizada quantitativa (TCQ) é uma técnica de alta sensibilidade, aplicada com precisão no diagnóstico de perda de massa óssea, chamada de densitometria mineral óssea, com grandes vantagens em relação à radiografia simples, porém a falta de valores de normalidade é limitante para a sua aplicação clínica. O presente trabalho teve os seguintes objetivos: estabelecer valores médios da radiodensidade do corpo vertebral da segunda vértebra lombar, através da TCQ, em gatas, aspectos envolvidos na fisiopatologia da osteopenia induzida pela castração; estudar efeitos da depleção dos estrógenos e avaliar as características da radiodensidade das fêmeas da espécie felina de cada grupo experimental, entre as gatas jovens inteiras e as gatas adultas castradas e não castradas acima de 6 anos, em um total de 22 animais. Comparando o grau de normalidade para as gatas adultas jovens e as patologias relacionadas. Estatisticamente comprovou-se uma redução de massa óssea em gatas castrada com mais de 6 anos na segunda vértebra lombar L2.

Por ser a osteoporose um grande problema de saúde pública e sua ocorrência aumentar os índices de morbidade e mortalidade proporcionados por fraturas geradas pela maior fragilidade óssea é importante o estudo de novos tratamentos para este quadro clínico. Tratamentos alternativos são opções para pessoas com alto risco de desenvolver osteoporose mas que possuem restrições aos tratamentos convencionais já existentes. Assim, este estudo tem o objetivo de analisar a ação do ultra-som de baixa intensidade (30mW/cm 2, freqüência de repetição de 1 KHz e ciclo de trabalho de 20%), como método não invasivo, em modelo de ratas osteopênicas. O modelo experimental foi obtido através da realização de ovarectomia e histerectomia em ratas da raça Holstman, com aproximadamente 200 gramas. Para obtenção do quadro de osteopenia foram aguardados 30 dias. Os animais foram divididos dois grupos: grupo placebo e grupo tratado. O tratamento começou no 31º dia após o procedimento cirúrgico, com duração de 20 dias consecutivos por 20 minutos diários. No grupo placebo, as ratas não foram submetidas ao tratamento ultra-sônico mas foram submetidas ao mesmo estresse causado às do grupo tratado. A emissão do campo ultra-sônico, no grupo tratado, foi na região do colo de fêmur. As propriedades mecânicas da diáfise femoral não se alteraram nos ossos osteopênicos comparados com ossos normais, assim como também não se alteraram nos ossos tratados comparados com os não tratados. Os resultados quantitativos de cálcio e fósforo não mostraram diferenças significativas entre os grupos placebo e tratado. No entanto, os achados qualitativos obtidos através da microscopia eletrônica de varredura indicaram uma microarquitetura óssea mais preservada nos ossos do grupo tratado. / As osteoporosis has become a major public health problem and its occurrence increases the rates of morbidity and mortality caused by fractures originated from bone fragility, it is important to study new treatments for this disease. Alternative treatments are options for those people with increased risk of osteoporosis development but with restrictions for the ordinary treatments already existent. This study aims at analyzing the low intensity ultrasound action (30mW/cm2 , 200ms burst of 1.5 MHz sine waves repeated at 1.0kHz) as a non invasive method, in the osteopenic rat model. Mature Holstman rats were subjected to bilateral ovariectomy. In order to obtain osteopenic rats, a 30 day period was allowed. The animals were separated in 2 groups: non-treated and treated. The treatment began in the 31 st day after the surgery, lasting twenty days, 20 minutes/day, in the femural neck site. The non treated group was subjected to the same stress caused to the treated group. The bone mineral matrix content of the femural neck (calcium and phosphorus) showed no significant differences among the groups. However, the analyzes using scanning electron micrographs indicated the smaller microarchitectural deterioration of trabecular bone present in the treated rats groups.

Thesis (MScMedSc) -- Stellenbosch University, 2001. / ENGLISH ABSTRACT: Osteopenia is a well documented complication of anorexia nervosa (AN). The pathogenesis of this bone loss is presently poorly defined in the literature. Pathogenetic mechanisms that have been implicated include certain nutritional factors, exercise abuse, hypogonadism, hypercortisolism and/or vitamin 0 deficiency. We studied, 59 Caucasian eating disorder patients aged 15-45yr. The eating disorder was classified by a single, qualified psychiatrist according to OSM IV R criteria as either anorexia nervosa (AN: n =25), bulimia nervosa (BN: n = 17) or eating disorder not otherwise specified (EONOS: n = 17). All patients were subjected to a detailed dietary and general history. We assessed the prevalence and severity (OEXA), the nature (osteocalcin, deoxypyridinoline) and site (vertebral versus hip) of osteopenla in these patients. he role of nutritional factors (energy intake, weight, height, BMI, plasma albumin, lipids), physical activity, hypercortisolemia (plasma and urinary free cortisol), vitamin 0 deficiency (plasma 250HD) and hypogonadism (amenorrhoea, E2, LH, FSH) in the pathogenesis of bone loss were also evaluated. Mild osteopenia (BMO decreased by more than 1SO below age-matched controls) was documented in 46% of the total study population, with more marked osteopenia (Z-Score < -2 SO) present in 15%. Both vertebral and hip osteopenia were documented. In the study population those patients with AN (Lumbar BMO (q/cm") = 0.869 ± 0.121) were most likely to develop osteoporosis, although a significant percentage of patients with BN (Lumbar BMO (q/crn") = 0.975 ± 0.16) and EONOS (Lumbar BMO (g/cm2) = 0.936 ± 0.10) were also osteopenic (29% and 35% respectively). Twenty four percent (24%) of the total patient population had a history of fragility fractures. These fractures were reported more commonly amongst patients with AN and EONOS (28% and29.4%). Fracture prevalence was however similar in patients with normal and low bone mass. Conventional risk factors were similar in patients with normal and low bone mass, except for a significantly longer duration of amenorrhoea (p = 0.009), a lower BMI (p = 0.0001) and greater alcohol consumption (p = 0.05) in the osteopenic patients. Nutritional parameters (S-albumin, protein, Ca, and P04 intakes), physical activity, as well as 25(OH) vitamin D levels were similar in AN and BN subjects, as well as in patients with a low versus normal BMD. Plasma and urine cortisol levels were also similar in these subgroups. With the exception of two patients with borderline osteopenia, significant bone loss was only documented in those patients with a past or current history of amenorrhoea. In the total patient population the duration of amenorrhoea was significantly (p<0.009) longer in patients with osteopenia versus those with a normal bone mass. A significant negative correlation between BMD (Z-Score) and duration of amenorrhoea was also documented in the total patient population (r = -0.4, P = 0.001) as well as in all three eating disorder groups (AN r - -0.4, P = 0.03; BN r = - 0.6, P = 0.008; EDNOS r = -0.6, P = 0.005). In the total patient population, those patients with amenorrhoea, had lower BMD and BMI values and lower estrogen levels compared to those with a normal menstrual cycle. We conclude that osteopenia commonly attends AN, as well as BN and EDNOS. Nutritional (with the exception of alcohol consumption) and mechanical factors as well as hypercortisolemia did not appear to contribute significantly to bone loss in this study population. Hypogonadism appeared to be the main cause of the bone loss observed in these patients. / AFRIKAANSE OPSOMMING: Osteopenie is In welbekende komplikasie van anorexia nervosa (AN). Die patogenese van hierdie beenverlies is swak in die huidige literatuur omskryf en nutrisiele faktore, 'n vita mien 0 gebrek, oormatige oefening, hiperkortisolemie en hipogonadisme word onder andere qeimpliseer. Vir die doel van die studie is In totaal van 59 Kaukasier eetsteurnis pasiente patients volledig ondersoek. Die tipe eetsteurnis is deur In enkel gekwalifiseerde psigiater volgens die DSM IV R kriteria geklassifiseer as anorexia nervosa (AN: n =25) of bulimia nervosa (BN: n = 17) of eetsteurnis nie anders gespesifiseer (EDNOS: n = 17). Elke pasient is ook aan In gedetailleerde dieet en algemene risikofaktor vraelys vir osteoporose onderwerp. Die voorkoms en graad (DEXA), die aard (osteokalsien, deoksipiridinolien) asook die tipe (werwelkolom/heup) osteopenie is ondersoek. Die rol van nutrisiele faktore (totale kalorie-inmame, gewig ,Iente LMI, plasma albumien, lipiede) en vitamien 0 gebrek, oefening, hiperkortisolemie (plasma en urinere kortisol) en hipogonadisme (amenoree, plasma E2, LH,FSH) in die patogenese van die beenverlies is ook evalueer. Matige osteopenie (BMD meer as 1 SO onder die van ouderdomskontrole) is in 46% van die totale pasientpopulasie gedokumenteer, met erge osteopenie (Z-Telling < -2) in 15%. Aantasting van beide werwelkolom en heup is aangetoon. In hierdie studiepopulasie kom osteopenie meer algemeen voor in die AN (Lumbaal BMD (g/cm2) = 0.869 ± 0.121) groep (64%) in vergelyking met BN (Lumbaal BMD (g/cm2) = 0.975 ± 0.16) (29%) en (EDNOS) (Lumbaal BMD (g/cm2) = 0.936 ± 0.10) (32%). Vier-en-twintig persent van die totale pasientpopulasie het In geskiedenis van frakture gehad. Frakture het meer algemeen in AN en EDNOS pasiente voorgekom (28% en 29%). Pasiente met 'n lae beenmassa was gekenmerk deur In betekenisvolle laer LMI (p = 0.0001), hoer alkolholverbruik (p = 0.05) en langer duurte van amenoree(p = 0.009). Nutrisiele parameters (s-albumien, protetene, Ca, P04 inname) oefening, asook 25(OH) vitamien 0 vlakke was soortgelyk in AN en BN pasiente. Hierdie parameters het ook nie verskil tussen pasiente met osteopenie en die met In normale BMD nie. Plasma en urinere vry kortisolvlakke was ook soortgelyk in hierdie twee groepe. Betekenisvolle beenverlies (met die uitsondering van twee pasiente met grenslyn osteopenie) het slegs voorgekom in pasiete met 'n huidige of In vorige geskiedenis van amenoree. In die totale pasientpopulasie was die duurte van amenoree (p< 0.009) betekenisvollanger in die pasiente met osteopenie. In Betekenisvolle negatiewe korrelasie tussen BMD (Z-Telling) en die duurte van amenoree in die toale pasient populasie (r = -0.4; P = 0.001) asook in al drie eetsteurnis groepe (AN: r = -0.4; P = 0.03; BN: r = -0.06; P = 0.008; EDNOS: r = - 0.6, P = 0.005) is aangetoon. In die groep as 'n geheel, het die amenoree pasiente In laer LMI, E2vlakke en BMD gehad in vergelyking met die pasiente met normale menses. Opsommend dus, kom osteopenie algemeen in pasiente met AN, asook BN en EDNOS voor. In Betekenisvolle bydrae van nutrisiele (met die uitsondering van alkoholinname) en meganiese faktore asook hiperkortisolemie tot been verlies, kon nie in hierdie tudie populasie gedemonstreer word nie. Hipogonadisme is as die hoofoorsaak van osteopenie in die pasiente qefdentifiseer.

Made available in DSpace on 2016-08-19T18:15:55Z (GMT). No. of bitstreams: 1 Fernanda Rachel Melo Vidigal do O.pdf: 137536 bytes, checksum: 43d4b9f8aac5eef0fa525346d044dd09 (MD5) Previous issue date: 2007-10-26 / Purpose: To study vertebral deformities of Osteopeny/Osteoporosis among over 40 years old women, São Luís, Maranhão. To verify frequency of vertebral deformities in lumbar column. Methods: A prospective transversal study, peri-postmenopausal women period, selected by spontaneous demand, with recent bone densitometry (last 12 months) showing osteopeny/osteoporosis, at Centro de Densitometria Óssea do Maranhão, São Luís, between March and December, 2006. A questionnaire was aplicated, solicitated sacral column radiography at Centro de Diagnóstico Médico do Maranhão. Results: In 222, with 109 osteopeny and 113 osteoporosis, according with bone densitometry results. Higher osteoporosis frequency among women with more than three gestations and deliveries, postmenopausics, diabetics, users of alcoholics drinks, not user of milk and derivates, not obese and sedentary. Vertebral deformities by the lumbar-sacral column radiography, associated with osteoporosis reduced vertebral discus spaces (52%), vertebral fractures (12%), flatten vertebral bodies (8%), vertebral collapses (4%). Vertebral deformities before osteoporosis higher frequency, like osteophytes (75%), scoliosis (69%), artrosis (35%). Conclusions: White women, low escolarity and retired, more frequent. Age between 40 and 59 years old with osteopeny, over 60 years old osteoporosis. User of Sodic Alendronate for more time than a year, initiated at perimenopause, higher osteopeny frequency. Vertebral factures and vertebral collapses were the most important osteoporosis complications in lumbar-sacral column. / Objetivos: Avaliar a presença de deformidades vertebrais, na coluna lombar, em mulheres com osteopenia/osteoporose, a partir dos 40 anos, em São Luís, Maranhão. Métodos: Estudo prospectivo, transversal, mulheres climatéricas, demanda espontânea, densitometria óssea recente (últimos 12 meses), apresentando osteopenia/osteoporose, realizado no Centro de Densitometria Óssea do Maranhão, São Luís, de março a dezembro, 2006. Foi aplicado questionário, e as pacientes submetidas à radiografia de coluna lombosacra no Centro de Diagnóstico Médico do Maranhão. Resultados: A densitometria óssea revelou nas 222 mulheres, osteopenia em 109 e osteoporose em 113. Maior freqüência de osteoporose em mulheres com mais de três gestações e partos, pós-menopáusicas, diabéticas, não obesas, sedentárias, usuárias de bebida alcoólica, não usuárias de leite e derivados. Deformidades vertebrais à radiografia de coluna lombo-sacra, associadas à osteoporose: redução de espaços discais 52%, fraturas vertebrais 12%, achatamento de corpos vertebrais 8%, colapsos vertebrais 4%. Maior freqüência de deformidades vertebrais anteriores à osteoporose: osteofitos 75%, escoliose 69%, artrose 35%. Conclusões: Cor branca, baixa escolaridade, aposentadas, faixa etária de 40 a 59 anos de idade, predominando osteopenia, e acima de 60 anos, osteoporose. Alendronato de sódio por mais de 12 meses demonstrou efeito protetor contra osteoporose. Maior freqüência de deformidades vertebrais anteriores e associadas à osteoporose. Principais complicações da osteoporose na coluna lombar: fraturas e colapsos vertebrais.

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