京都大学 / 新制・課程博士 / 博士(医学) / 甲第23375号 / 医博第4744号 / 新制||医||1051(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中本 裕士, 教授 松田 秀一, 教授 妹尾 浩 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第24094号 / 社医博第125号 / 新制||社医||12(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 佐藤 俊哉, 教授 中山 健夫, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Background: The global burden of osteoporosis includes considerable numbers of fractures, morbidity, mortality and expenses, due mainly to vertebral, hip and forearm fractures. Underdiagnosis and undertreatment are common. Several studies have shown decreased health-related quality of life (HRQOL) after osteoporotic fracture, but there is a lack of data from long-term follow-up studies, particularly regarding vertebral fractures, which are often overlooked despite patients reporting symptoms. Aim: The overall aim of this thesis was to evaluate the usefulness of a recent low-energy fracture as index event in a case-finding strategy for osteoporosis and to describe and analyse long-term HRQOL in postmenopausal women with osteoporotic fracture. The specific aims were to describe bone mineral density and risk factors in women 55-75 years of age with a recent low-energy fracture (I), estimate the impact of osteoporotic fractures on HRQOL in women three months and two years after a forearm, proximal humerus, vertebral or hip fracture (II), investigate the changes and long-term impact of vertebral or hip fracture on HRQOL in women prospectively between two and seven years after the inclusion fracture (III), and describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis (IV). Design and methods: Data were collected from southern Sweden between 1998 and 2008. A total of 303 women were included in Study I, and this group served as the basis for Studies II (n=303), III (n=67), and IV (n=10). A cross-sectional observational, case-control design (I), and a prospective longitudinal observational design (II-III) were used. In Study IV a qualitative inductive approach with interviews was used and data were analysed using a qualitative conventional content analysis. Results: The type of recent fracture and number of previous fractures are important information for finding the most osteoporotic women in terms of severity (I). Hip and vertebral fractures in particular have a significantly larger impact on HRQOL evaluated using the SF-36 than do humerus and forearm fractures, both during the three months after fracture and two years later, compared between the different fracture groups and the reference population (II). Women who had a vertebral fracture as inclusion fracture had remaining pronounced reduction of HRQOL at seven years. At the mean age of 75.5 years (±4.6 SD), the prevalence of vertebral fracture suggests more negative long-term impact on HRQOL, more severe osteoporosis and a poorer prognosis than a hip fracture does, and this effect may have been underestimated in the past (III). Study IV demonstrates that the women’s HRQOL and daily life have been strongly affected by the long-term impact of the vertebral fracture several years after diagnosis. The women strive to maintain their independence by trying to manage different types of symptoms and consequences in different ways. Conclusions and implications: Type and number of fractures should be taken into account in the case-finding strategy for osteoporosis in postmenopausal women between 55 and 75 years of age. The long-term reduction of HRQOL in postmenopausal women (age span 55-75 yr) with vertebral fracture emerged clearly, compared to women with other types of osteoporotic fractures and references in this thesis. The results ought to be taken into consideration when developing guidelines for more effective fracture prevention and treatment, including non-pharmacological intervention for women with osteoporotic fractures, with highest priority placed on vertebral fractures and multiple fractures, to increase or maintain HRQOL.

No description available.

The association between age-related vertebral fractures (VFx) and disc degeneration (DD) is not clear, despite the high prevalence of both conditions. Load is transferred to the vertebra by the adjacent intervertebral discs, and degenerative changes within the disc alter how the net force is distributed over the interface between vertebra and disc, known as the vertebral endplate (EP). The ability of the vertebra to resist fracture depends not only on the magnitude of the net force, but also on the distribution. Multiple lines of evidence suggest that the ability of the vertebra to withstand the distribution of applied force depends on the spatial distribution of bone mineral density (BMD) within the vertebra. First, the strength and stiffness of a region of bone in the vertebra are highly correlated with the BMD of that region. Second, changes in the spatial distribution of regional BMD have been associated with aging and DD. Thirdly, some of these observed changes have been replicated in computer models bone adaption with in the presence of progressive DD, suggesting that bone adaption is occurring in response to the altered force distribution associated with DD, and that maladaptation could elevate the risk of fracture. Notably, the current clinical method of identifying patients at risk of fracture is to use an average measure of BMD for the entire vertebra. The lack of consideration of the spatial distribution of BMD may explain why the clinical method used at present does not adequately identify those at risk of fracture. The possible relationship among spatial distribution of BMD, DD, force distribution across the endplate, and vertebral strength suggests that characterizing the spatial distribution of BMD within a vertebra could add to the understanding of why some vertebra are more likely to fracture. This project sought to determine if an association exists between the spatial distribution of vertebral BMD and disc health in order to provide an improved perspective of the clinical sequelae of DD and to improve the ability of clinicians to identify those who would benefit most from intervention. This study found evidence that the distribution of bone in the vertebral body and EP depend on the health of the adjacent disc. The distribution of pressure in discs favors the anterior most portion of the disc in anteriorly flexed postures and the density in the anterior most portion of the EP appears to respond to this shift, suggesting that bone is adapting to loading patterns associated with certain postures more than others. This study also found association between reduced regional disc height and altered distribution of trabecular density which was positive in the nuclear region and negative in the annular region. In some cases there was a lack of association between disc height and density distribution that may indicate maladaptation and thus increased risk of fracture. This study, being cross-sectional could not identify whether the observed alterations in density and degeneration initiated in the vertebra or the disc. However, this study contributes to the understanding of the relationship between the distribution of vertebral density and the functional properties of the adjacent disc that may ultimately improve the clinician's ability to predict VFx. / 2017-06-21T00:00:00Z

Orientador: Lucia Helena Simões da Costa Paiva / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T15:10:52Z (GMT). No. of bitstreams: 1 Ferreira_NevilledeOliveira_M.pdf: 789783 bytes, checksum: 5dfd61c25cd1bdee8f3b7700bbb2088e (MD5) Previous issue date: 2008 / Resumo: OBJETIVO: avaliar a qualidade de vida (QV) e fatores associados em mulheres com osteoporose pós-menopausa correlacionado QUALEFFO 41 com o SF-36. MÉTODOS: realizou-se um estudo de corte transversal com 220 mulheres pósmenopausa (idade entre 55-80 anos), sendo 110 com osteoporose e 110 sem osteoporose, pareadas por idade (± 3anos). Todas foram entrevistas para avaliação da QV realizada através de dois questionários: Quality of Life Questionary of European Foudation for Osteoporosis 41 (QUALEFFO 41) e o Short Form Health Survey 36 (SF-36). Para análise dos dados foi considerado um nível de significância de 5% (p<0,05). RESULTADOS: as características clínicas entre os grupos foram similares, com diferença estatisticamente significativa apenas em relação ao Índice de Massa Corpórea (IMC), raça, escolaridade, idade da menopausa e uso de Terapia Hormonal (TH) (p<0.001). Mulheres com osteoporose apresentaram pior QV tanto no QUALEFFO 41 quanto SF-36, para todos os domínios estudados sendo os dados ajustados para IMC, raça, escolaridade e uso de TH (p<0.001). Houve correlação significativa entre todos os domínios do QUALEFFO 41 com seus correspondentes do SF-36 (p<0.001) Os únicos fatores relacionados à pior QV foram IMC>25 e sedentarismo, já o trabalho remunerado esteve associado à melhor QV (IC=95%). CONCLUSÃO: Mulheres com osteoporose apresentam comprometimento da qualidade de vida particularmente nos aspectos físicos e psico-sociais. Os fatores associados à QV foram a obesidade, o sedentarismo e o trabalho remunerado. Palavras-chave: osteoporose, qualidade de vida, fratura vertebral, QUALEFFO 41, SF-36 / Abstract: OBJECTIVE: To evaluate quality of life (QoL) and associated factors in women with postmenopausal osteoporosis, correlating QUALEFFO 41 with SF-36. METHODS: A cross-sectional study was conducted in 220 postmenopausal women (ages ranging from 55-80 years). Of the total number, 110 women had osteoporosis and 110 women did not have osteoporosis and these women were paired by age (± 3 years). Two questionnaires were administered to all subjects for evaluation of QoL: the Quality of Life Questionnaire of the European Foundation for Osteoporosis 41 (QUALEFFO 41) and the Short-Form Health Survey 36 (SF-36). For data analysis, a significance level of 5% was set (p<0.05). RESULTS: Clinical characteristics between the groups were similar, with statistically significant differences only in Body Mass Index (BMI), race, school education, age at menopause and use of Hormone Therapy (HT) (p<0.001). Women with osteoporosis had a worse QoL both in the QUALEFFO 41 and in the SF-36, in all domains studied. Data was adjusted for BMI, race, school education and use of HT (p<0.001). There was a significant correlation between all domains in the QUALEFFO 41 questionnaire and their corresponding domains in the SF-36 (p<0.001). The only factors related to worse QoL were BMI>25 and sedentary lifestyle. In contrast, paid work was associated with a better QoL (CI=95%). CONCLUSION: Women with osteoporosis had an impaired quality of life, especially relating to the physical, psychological and social aspects. The factors associated with QoL were obesity, sedentary lifestyle and paid work. Keywords: osteoporosis, quality of life, vertebral fracture, QUALEFFO 41, SF- 36 / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia

<p>Background: Increased physical activity has a modest effect on the spatial distribution of bone mineral. The risks and benefits of exercise for women with osteoporosis at high risk to fracture are not known. The decompression of aquatic exercise is an option to increase exercise compliance. The dual energy absorptiometry (DXA) vertebral fracture assessment (VFA) images 2D bone geometry however measurement properties have not been established for this outcome.</p> <p>Purpose: To determine relative and absolute intra-rater reliability of DXA-based vertebral height (VH) measures and to assess the feasibility of investigating bone outcomes in women with established osteoporosis before and after a 6 month aquatic exercise program.</p> <p>Methods: DXA VFA scans of 32 women over 60 years old were analyzed on 2 occasions, 4 weeks apart. Relative reliability, intraclass correlation coefficient (95% CI) and absolute reliability, standard error of measurement (95% CI) were estimated for visible anterior, middle and posterior VHs from T4 to L4. Women with osteoporosis at high risk to fracture (clinical practice guidelines used) were recruited from two osteoporosis clinics. Feasibility of recruitment, adherence to the exercise, adherence to the assessment protocols (DXA, pQCT, physical performance measures), safety and retention were assessed.</p> <p>Results: Intra-rater reliability ICC >0.87 (0.74, 0.94) and SEM <1.17 from T10 to L4. Recruitment of 9 women in 10 weeks; average adherence 68%; pQCT data loss 46%; 1 fracture after class; retention 89% at 12 months.</p> <p>Conclusion: Further study of measurement properties of VH and protocols for recruitment, data management and safety are required.</p> / Master of Science Rehabilitation Science (MSc)

Objetivo: Estimar a prevalência de fraturas vertebrais investigando os fatores de risco associados com esta última condição em idosos brasileiros da comunidade. Métodos: Este estudo de corte transversal incluiu 769 indivíduos idosos com 65 anos ou mais (462 mulheres e 307 homens) residentes em São Paulo, Brasil. Radiografias de coluna torácica e lombar foram obtidas e fraturas vertebrais foram avaliadas usando o método semiquantitativo de Genant. Densidade mineral óssea (DMO) foi mensurada por DXA e parametros bioquímicos foram também avaliados. Mulheres e homens foram analisados separadamente, e cada gênero foi dividido em 2 grupos com base na presença de fraturas vertebrais. Resultados: A prevalência de fraturas vertebrais foi de 16,7% (95% CI 13,3-20,1) nas mulheres e 21,2% (95% CI 16,6-25,7) nos homens. Análise de regressão logística usando as variáveis significantes na análise univariada no grupo feminino mostrou que a idade (OR=1,12, 95% CI 1,06-1,18; p<0,001) e o Tscore do colo femoral (OR=0,61, 95% CI 0,46-0,88; p=0,006) foram fatores de risco independentes na predição de fraturas vertebrais. No grupo masculino, a análise de regressão logística demonstrou que a condição de caidor crônico (OR=2,54 95% CI 1,1-5,9; p=0,031) e T-score do colo femoral (OR=0,72, 95% CI 0,53-0,96; p=0,025) foram independentes parâmetros na predição de fraturas vertebrais. Conclusão: Nossos resultados sugerem que fraturas vertebrais são comuns em idosos brasileiros e que o T-score do colo femoral baixo foi um importante fator de risco para esta condição em ambos homens e mulheres. Idade também foi significantemente correlacionada com a presença de fraturas vertebrais em mulheres, e a condição de caidor crônico foi correlacionada com fraturas vertebrais em homens. / Purpose: To estimate the prevalence of radiographic vertebral fracture and investigate factors associated with this condition in Brazilian communitydwelling elderly. Methods: This cross sectional study included 769 elderly subjects 65 years old and over (462 women and 307 men) living in São Paulo, Brazil. Thoracic and lumbar spine radiographs were obtained and vertebral fractures were evaluated using Genant´s semi-quantitative method. Bone mineral density (BMD) was measured by DXA and bone biochemical markers were also evaluated. Female and male subjects were analyzed independently, and each gender was divided into 2 groups, based on whether vertebral fractures were present. Results: The prevalence of vertebral fracture was 16.7% (95% CI 13.3-20.1) in women and 21.2% (95% CI 16.6-25.7) in men. Logistic regression analyses using variables that were significant in the univariate analysis, in female group showed that age (OR=1.12, 95% CI 1.06-1.18; p<0.001) and femoral neck T-score (OR=0.61, 95% CI 0.46-0.88; p=0.006) were independently factors in predicting vertebral fracture. In the male group, logistic regression analyzes demonstrated that chronic faller condition (OR=2.54 95% CI 1.1-5.9; p=0.031) and femoral neck T-score (OR=0.72, 95% CI 0.53-0.96; p=0.025) were independent parameters in predicting vertebral fractures. Conclusions: Our results suggest that radiographic vertebral fractures are common in Brazilian community-dwelling elderly and that a low femoral neck T-score was an important risk factor for this condition in both males and females. Age was also significantly correlated with the presence of vertebral fractures in women, and chronic faller was correlated with vertebral fractures in men.

Objetivo: Estimar a prevalência de fraturas vertebrais investigando os fatores de risco associados com esta última condição em idosos brasileiros da comunidade. Métodos: Este estudo de corte transversal incluiu 769 indivíduos idosos com 65 anos ou mais (462 mulheres e 307 homens) residentes em São Paulo, Brasil. Radiografias de coluna torácica e lombar foram obtidas e fraturas vertebrais foram avaliadas usando o método semiquantitativo de Genant. Densidade mineral óssea (DMO) foi mensurada por DXA e parametros bioquímicos foram também avaliados. Mulheres e homens foram analisados separadamente, e cada gênero foi dividido em 2 grupos com base na presença de fraturas vertebrais. Resultados: A prevalência de fraturas vertebrais foi de 16,7% (95% CI 13,3-20,1) nas mulheres e 21,2% (95% CI 16,6-25,7) nos homens. Análise de regressão logística usando as variáveis significantes na análise univariada no grupo feminino mostrou que a idade (OR=1,12, 95% CI 1,06-1,18; p<0,001) e o Tscore do colo femoral (OR=0,61, 95% CI 0,46-0,88; p=0,006) foram fatores de risco independentes na predição de fraturas vertebrais. No grupo masculino, a análise de regressão logística demonstrou que a condição de caidor crônico (OR=2,54 95% CI 1,1-5,9; p=0,031) e T-score do colo femoral (OR=0,72, 95% CI 0,53-0,96; p=0,025) foram independentes parâmetros na predição de fraturas vertebrais. Conclusão: Nossos resultados sugerem que fraturas vertebrais são comuns em idosos brasileiros e que o T-score do colo femoral baixo foi um importante fator de risco para esta condição em ambos homens e mulheres. Idade também foi significantemente correlacionada com a presença de fraturas vertebrais em mulheres, e a condição de caidor crônico foi correlacionada com fraturas vertebrais em homens. / Purpose: To estimate the prevalence of radiographic vertebral fracture and investigate factors associated with this condition in Brazilian communitydwelling elderly. Methods: This cross sectional study included 769 elderly subjects 65 years old and over (462 women and 307 men) living in São Paulo, Brazil. Thoracic and lumbar spine radiographs were obtained and vertebral fractures were evaluated using Genant´s semi-quantitative method. Bone mineral density (BMD) was measured by DXA and bone biochemical markers were also evaluated. Female and male subjects were analyzed independently, and each gender was divided into 2 groups, based on whether vertebral fractures were present. Results: The prevalence of vertebral fracture was 16.7% (95% CI 13.3-20.1) in women and 21.2% (95% CI 16.6-25.7) in men. Logistic regression analyses using variables that were significant in the univariate analysis, in female group showed that age (OR=1.12, 95% CI 1.06-1.18; p<0.001) and femoral neck T-score (OR=0.61, 95% CI 0.46-0.88; p=0.006) were independently factors in predicting vertebral fracture. In the male group, logistic regression analyzes demonstrated that chronic faller condition (OR=2.54 95% CI 1.1-5.9; p=0.031) and femoral neck T-score (OR=0.72, 95% CI 0.53-0.96; p=0.025) were independent parameters in predicting vertebral fractures. Conclusions: Our results suggest that radiographic vertebral fractures are common in Brazilian community-dwelling elderly and that a low femoral neck T-score was an important risk factor for this condition in both males and females. Age was also significantly correlated with the presence of vertebral fractures in women, and chronic faller was correlated with vertebral fractures in men.

L’ostéoporose est une maladie du squelette caractérisée par une dégradation de la qualité osseuse conduisant à une majoration du risque fracturaire. Le seul examen permettant actuellement de prédire ce risque est l’ostéodensitométrie à double rayonnement X (DXA) par la mesure de la densité minérale osseuse (DMO). Cependant, la DMO seule ne rend compte que de 40 à 70% de la variation de la résistance mécanique osseuse. Les 3 buts ce travail étaient : 1/ d’évaluer les rôles respectifs de la microarchitecture corticale et trabéculaire dans le comportement mécanique vertébral, 2/ d’évaluer le rôle propre de l’hétérogénéité de la microarchitecture trabéculaire et 3/ de décrire le comportement mécanique vertébral post-fracturaire et d’en identifier les déterminants. Nous montrons que la mesure de l’épaisseur de la corticale antérieure et de son rayon de courbure ainsi que la détermination de la variation régionale de la microarchitecture trabéculaire améliorent significativement la prédiction du risque fracturaire. Il existe une variation marquée du comportement mécanique vertébral après une fracture de grade 1 de Genant. La microarchitecture osseuse, et non la masse osseuse, explique les propriétés mécaniques vertébrales plastiques et élastiques post-fracturaires. / Osteoporosis is characterized by altered bone quality and compromised bone strength leading to increased fracture risk. Measurement of areal bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) is the most widely used index of bone strength. However, BMD alone can only account for 40 to 70% of the variation of bone strength. This study aimed to determine: 1/ the respective role of cortical and trabecular microarchitecture to vertebral mechanical behavior, 2/ the role of trabecular microarchitecture heterogeneity and 3/ the mechanical behavior of a vertebra after simulated mild fracture and its determinants. Our data imply that measurements of cortical thickness and curvature as well as determination of trabecular microarchitecture heterogeneity enhance prediction of vertebral fragility. We found marked variation in the post-fracture load-bearing capacity following simulated mild vertebral fractures. Bone microarchitecture, but not bone mass, was associated with post-fracture mechanical behavior of vertebrae.