Class of 2009 Abstract / OBJECTIVES: The objective of this study was to determine the effect of an education program in regards to pharmacy students’ knowledge and confidence regarding osteoporosis management. METHODS: This was a pretest/posttest study of data obtained through surveys given to pharmacy students’ at the Phoenix and Tucson campuses. The education program administered was generated by the Arizona Osteoporosis Coalition. RESULTS: A total of 19 pharmacy students were surveyed in Tucson and Phoenix, AZ. When the knowledge questions were analyzed (questions 1 through 7), the t-score obtained was 4.7914 (p<0.05). This score was larger than the t-critical value for a 95% confidence interval. When the confidence questions were analyzed (questions 8 through 10), the t-scores obtained were 0.6849, 0.5945, and 0.2287, respectively. These scores did not reach statistical significance (p>0.05). The intervention proved to increase knowledge but did not increase confidence. CONCLUSIONS: The education program on osteoporosis management increased pharmacy students’ knowledge on this disease state. Other education programs targeting various disease states may also increase students knowledge, further preparing them to provide quality patient care.

Raw acceleration can be used as a proxy measure representing external forces experienced at the hip. Peak vertical acceleration at the hip was measured (ActiGraph GT3X+ - BT) in 30 premenopausal women during common exercises (walking, running, stairs and jumping) and while they went about their normal routine (7 days). Accelerations experienced during running and jumping activities were consistently ≥3.2g, whereas only accelerations during box jumps were greater than the higher recommended threshold of ≥ 4.9g proposed to improve bone mineral density in premenopausal women. Peak jerk experienced during jumping activities was greater than the recommended threshold of 100g/s. The median number of accelerations/day ≥3.2g was 30.4, whereas only 3.5 incidences/day were observed at ≥4.9g. Running and jumping resulted in vertical accelerations that met or exceeded the thresholds proposed to be beneficial for bone, however, participants rarely experienced high magnitude vertical accelerations during daily life. / October 2016

La investigación tuvo por objetivo la correlación que existe entre la pérdida del hueso alveolar y los cambios de densidad mineral ósea en pacientes mujeres. La muestra constituida por noventa mujeres mayores de 35 años de edad, fueron atendidas en el Servicio de Ginecología y Reumatología del Hospital Militar Geriátrico. Las mediciones de pérdida o reabsorción de hueso alveolar (RHA) de los pacientes, fue obtenida de zonas proximales de los premolares superiores, mediante exámenes radiográficos orales con la técnica periapical paralela; y los valores de su densidad mineral ósea (DMO) mediante exámenes del cuello femoral con la técnica de Absorciometría por rayos X de doble energía (DEXA). De acuerdo al criterio de la Organización Mundial de la Salud (OMS) en categorizar los estados óseos; Se conformaron tres grupos de 30 pacientes cada grupo en NORMAL, OSTEOPENIA, OSTEOPOROSIS, con sus variables DMO, Tscore y RHA. El análisis inicial con la media aritmética, resulto que el grupo Normal tenía mayor DMO (ξ= 1.0008) que los grupos de Osteopenia (ξ= 0.7586) y Osteoporosis (ξ= 0.7127); con un Tscore de 0.1610 DS para el grupo normal, -2.0193 DS para Osteopenia y -2.6909 DS para Osteoporosis que confirman los cambios de niveles de DMO en los grupos respectivos. La RHA fue menor en el grupo Normal (ξ= 1.12) con incremento progresivo en los grupos de Osteopenia (ξ= 1.44) y Osteoporosis (ξ=3.60). La prueba F de Levene de homogeneidad, aplicados a las pruebas anteriores, se observó la homogeneidad de la DMO (F= P>0.05) y la heterogeneidad de Tscore y RHA (F= P<0.05). El análisis de varianza (ANOVA), aplicada a la DMO se tuvo un alto nivel de significación (0.0001) y la prueba de Brown – Forsythe, utilizada para Tscore y RHA, un nivel de significación de 0.0001. Para determinar con precisión el nivel de significación entre los tres grupos (Normal, Osteopenia, Osteoporosis) y sus variables (DMO, Tscore y RHA); los resultados de ANOVA y Brown – Forsythe fueron sometidos a la prueba de comparación de Post Hoc de Turkey confirmándose el nivel de significación de 0.0001. Finalmente se aplico el Coeficiente de Correlación de Pearson con resultados concluyentes de correlación altamente significativo (P< 0.01), confirmando nuestra hipótesis: Los valores bajos de la densidad mineral ósea en pacientes mujeres determina valores altos de la reabsorción del hueso alveolar. / The investigation had for objective the correlation that exists between the loss of the alveolar bone and the changes of bony mineral density in patient women. The sample constituted by ninety women bigger than 35 years of age, the were assisted in the Service of Gynecology and Rheumatology of the Hospital Military Geriatric. The mensurations of loss or reabsorption of alveolar bone (RHA) of the patients, it was obtained of areas proximal of the superior premolars, by means of exams oral radiographies with the technical parallel periapical; and the values of their bony mineral density (DMO) by means of exams of the femoral neck with the technique of Absortiometry for rays X of double energy (DEXA). According to the approach of the World Organization of the Health (WHO) in categorizing the bony states; they conformed to three groups of patient each group in NORMAL, OSTEOPENIA, OSTEOPOROSIS, with their variable DMO, tscore and RHA. The initial analysis with the arithmetic stocking, was that the normal group had bigger DMO (AND = 1.0008) that the groups of Osteopenia (AND = 0.7586) and Osteoporosis (AND = 0.7127); with a Tscore of 0.1610 DS) for the Normal group, - 2.0193 DS for osteopenia and -2.6909 DS for Osteoporosis that confirm the changes of levels of DMO in the respective groups. The RHA was smaller in the Normal group (E=1.12) with progressive increment in the groups of Osteopenia (E = 1.44) and Osteoporosis (E=3.60). la F of levene of homogeneity proves, applied to the previous test, the homogeneity of Tscore and RHA (F=P<0.05). The variance analysis (ANOVA), applied the DMO one had a high significance level (0.0001) and the test Brown- Forsythe, used for Tscore and RHA, a level of significance of 0.0001. To determine the significance level accurately among the three groups (Normal, Osteopenia, Osteoporosis) and their variables (DMO, Tscore and RHA); the results of ANOVA and Brown- Forsythe were subjected to the comparison test of Post Hoc of turkey being confirmed the level al significance of 0.0001. Finally the highly significant Coefficient of Correlation was applied (p>0.001), confirming our hypothesis: the values low of the bony mineral density in patient women determine values high the reabsorption of the alveolar bone.

Determina la prevalencia de fractura vertebral según morfometría densitométrica en pacientes con osteoporosis realizados en la Clínica de Especialidades Médicas en el periodo de junio 2014 y febrero del 2015. Realiza un estudio de tipo observacional, descriptivo, retrospectivo y de corte transversal, en el que se revisaron las historias clínicas de 56 pacientes con diagnóstico densitométrico de osteoporosis que presentaron signos y síntomas compatibles con fractura vertebral. Aplica una prueba de morfometría densitométrica a los pacientes. Obtiene los siguientes resultados: La prevalencia de fractura vertebral en pacientes con osteoporosis es del 71,43%, la mayor frecuencia de fractura vertebral es en el género femenino con un 85%, el intervalo de edad entre 81 a 90 años tiene una mayor frecuencia con un 35%, los pacientes con sobrepeso según el IMC tienen una mayor frecuencia con un 62,50%, la fracturas dorsales obtienen una mayor frecuencia con un 52,50%, de las cuales, la vértebra D12 tiene una mayor frecuencia a su vez con un 22,50%, el tipo de deformación con mayor porcentaje es la compresión vertebral con un 40%, la mayor frecuencia según el grado de deformación vertebral es un empate entre cuña moderada y compresión severa con un 16,25% y el mayor porcentaje en la relación entre fractura vertebral con antecedentes familiares de osteoporosis y fractura previa es de 57,50% de pacientes que no contaban con ninguna de las anteriores, pero aun así presentaban fractura vertebral. Concluye que existe una alta prevalencia de fractura vertebral en pacientes con diagnóstico de osteoporosis. El género femenino, el intervalo de edad entre 81 a 90 años, el sobrepeso según IMC tienen una mayor frecuencia en pacientes osteoporóticos con fractura vertebral. Así mismo, las facturas dorsales, la vértebra D12, el tipo de fractura compresión vertebral, los grados de deformación cuña moderada y compresión severa, y la no relación con antecedentes familiares de osteoporosis y fractura previa son las que tienen también el mayor porcentaje en cada uno de sus ítems.

Fragility fractures caused by loss of bone mass due to postmenopausal osteoporosis represent a growing morbidity worldwide. Bisphosphonates are first-line medications for fracture treatment and prevention. In the first phase, we updated a Cochrane systematic review of randomized controlled trials on alendronate, assessing its efficacy for five types of fracture prevention, quality of life, and various safety outcomes. In the second phase, we combined indirect and direct evidence to perform a network meta-analysis including alendronate and nine other bisphosphonates evaluating the comparative efficacy and safety of these treatments. Overall, 58 studies were included in the review and 83 studies in the network. Most evidence was of moderate to high quality. Alendronate and zoledronic acid were effective for preventing the most types of fractures, while off-label and unapproved bisphosphonates showed poor efficacy. More evidence is required to evaluate long-term treatment and rare adverse events.

Or Pui Ching. / Thesis submitted in: December 1999. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaves 174-201). / Abstracts in English and Chinese. / acknowledgement --- p.i / abstract (english version) --- p.ii / abstract (chinese version) --- p.vii / table of contents --- p.xi / abbreviations --- p.xvi / list of tables --- p.xviii / list of figures --- p.xxii / Chapter chapter 1. --- introduction --- p.1 / Chapter chapter 2. --- literature review --- p.3 / Chapter 2.1. --- Bone structure --- p.3 / Chapter 2.1.1. --- Composition --- p.3 / Chapter 2.1.2. --- Cortical and Trabecular bone --- p.3 / Chapter 2.2. --- Bone Remodeling --- p.4 / Chapter 2.3. --- Bone Mass --- p.5 / Chapter 2.3.1. --- Peak Bone Mass --- p.5 / Chapter 2.3.1.1. --- Racial and Genetic Factors --- p.5 / Chapter 2.3.1.2. --- Gonadal Factors --- p.6 / Chapter 2.3.1.3. --- Nutrition Factors --- p.6 / Chapter 2.3.1.4. --- Exercise and Physical Activity --- p.7 / Chapter 2.3.2. --- Bone Loss --- p.7 / Chapter 2.3.2.1. --- Determinants of Osteoporotic Bone Loss --- p.7 / Chapter 2.3.2.2. --- Estrogen Deficiency --- p.8 / Chapter 2.3.2.3. --- Dietary Calcium deficiency and Vitamin D deficiency --- p.8 / Chapter 2.3.2.4. --- Physical Activity --- p.9 / Chapter 2.3.2.5. --- Alcoholism and Smoking --- p.9 / Chapter 2.3.2.6. --- Disease-specific Osteoporosis --- p.9 / Chapter 2.3.2.7. --- Drug-induced Osteoporosis --- p.10 / Chapter 2.3.3. --- Bone Mass and Fracture Risk --- p.11 / Chapter 2.4. --- Clinical Presentation of Osteoporosis --- p.12 / Chapter 2.4.1. --- Vertebral Fractures --- p.12 / Chapter 2.4.1.1. --- Radiological Aspects of Vertebral Fracture --- p.13 / Chapter 2.4.1.1.1. --- Changes in Trabecular Pattern --- p.13 / Chapter 2.4.1.1.2. --- Changes in Shape of the Vertebral bodies --- p.13 / Chapter 2.4.1.1.3. --- Changes of Intervertebral Discs --- p.14 / Chapter 2.4.1.2. --- Back Pain --- p.15 / Chapter 2.4.2. --- Hip Fractures --- p.15 / Chapter 2.4.3. --- Quality of Life --- p.16 / Chapter 2.5. --- Treatment of Established Osteoporosis --- p.18 / Chapter 2.5.1. --- Pain Relief --- p.18 / Chapter 2.5.2. --- Drug Therapy --- p.19 / Chapter 2.5.2.1. --- Calcium Supplement --- p.19 / Chapter 2.5.2.2. --- Vitamin D --- p.20 / Chapter 2.5.2.3. --- Estrogen --- p.21 / Chapter 2.5.2.4. --- Fluorides --- p.22 / Chapter 2.5.2.5. --- Calcitonin --- p.23 / Chapter 2.5.2.6. --- Bisphosphonates --- p.24 / Chapter 2.5.2.6.1. --- Physicochemical effects --- p.27 / Chapter 2.5.2.6.2. --- Mechanisms --- p.27 / Chapter 2.5.2.6.3. --- Therapeutic Use --- p.27 / Chapter 2.5.2.6.4. --- Side effects --- p.29 / Chapter 2.5.2.6.5. --- Alendronate --- p.30 / Chapter 2.5.2.7. --- Summary of drug treatment --- p.33 / Chapter 2.6. --- Diagnostic Methods of Osteoporosis --- p.40 / Chapter 2.6.1. --- Biochemical Markers of Bone Metabolism in Osteoporosis --- p.40 / Chapter 2.6.1.1. --- Bone Formation Markers --- p.41 / Chapter 2.6.1.1.1. --- Bone-specific Alkaline Phosphatase (bALP) --- p.41 / Chapter 2.6.1.2. --- Bone Resorption Markers --- p.42 / Chapter 2.6.1.2.1. --- Deoxypyridinoline (Dpd) --- p.43 / Chapter 2.6.2. --- Bone Densitometry --- p.45 / Chapter 2.6.2.1. --- Dual Energy X-ray Absorptiometry (DEXA) --- p.45 / Chapter 2.6.2.2. --- Peripheral Quatitative Computed Tomography (pQCT) --- p.47 / Chapter 2.6.2.3. --- Quantitative Ultrasound (QUS) --- p.48 / Chapter 2.6.3. --- Summary of Diagnostic Methods --- p.49 / Chapter chapter 3. --- methodology --- p.50 / Chapter 3.1. --- Study on Vertebral Structures --- p.51 / Chapter 3.1.1. --- Procedures --- p.51 / Chapter 3.1.2. --- Data analysis --- p.53 / Chapter 3.2. --- Alendronate Treatment --- p.54 / Chapter 3.2.1. --- Subject Selection --- p.54 / Chapter 3.2.2. --- Study design and drug administration --- p.55 / Chapter 3.2.3. --- Bone Densitometry --- p.56 / Chapter 3.2.3.1. --- Dual Energy X-ray absorptiometry --- p.56 / Chapter 3.2.3.2. --- Peripheral Quantitative Computed Tomography (pQCT) --- p.58 / Chapter 3.2.4. --- Biochemical Markers --- p.63 / Chapter 3.2.4.1. --- Bone formation marker --- p.63 / Chapter 3.2.4.2. --- Bone resorption marker --- p.64 / Chapter 3.2.5. --- Quality of Life --- p.65 / Chapter 3.2.6. --- New fracture assessment --- p.66 / Chapter 3.2.7. --- Statistical analysis --- p.67 / Chapter 3.3. --- Proximal femur fracture study --- p.68 / Chapter 3.3.1. --- Subject and study design --- p.69 / Chapter 3.3.2. --- Statistical analysis --- p.70 / Chapter chapter 4. --- results of study on vertebral structures --- p.71 / Chapter 4.1. --- Results of morphological change of vertebral bodes in osteoporotic patients --- p.71 / Chapter 4.2. --- Morphological changes of intervertebral discs --- p.71 / Chapter 4.3. --- Correlation between morphological changes of vertebrae and bulging ratio --- p.72 / Chapter chapter 5. --- results of alendronate study --- p.76 / Chapter 5.1. --- Baseline measurement --- p.76 / Chapter 5.1.1. --- Demographic characteristics --- p.76 / Chapter 5.1.2. --- Reasons for admission --- p.77 / Chapter 5.1.3. --- Social support --- p.77 / Chapter 5.1.4. --- Number of vertebral fracture(s) --- p.78 / Chapter 5.1.5. --- BMD measurement (Baseline) --- p.79 / Chapter 5.1.5.1. --- BMD of Lumbar spine and Hip (measured by DEXA) --- p.79 / Chapter 5.1.5.2. --- BMD of distal tibia and radius measured by pQCT --- p.80 / Chapter 5.1.6. --- Biochemical Markers (Bone formation and resorption) --- p.86 / Chapter 5.2. --- After treatment --- p.88 / Chapter 5.2.1. --- Bone mineral density measurement (measured by DEXA) --- p.90 / Chapter 5.2.1.1. --- Lumbar spine --- p.90 / Chapter 5.2.1.2. --- Femoral Neck --- p.93 / Chapter 5.2.1.3. --- Trochanter --- p.95 / Chapter 5.2.1.4. --- Ward's Triangle --- p.98 / Chapter 5.2.1.5. --- Summary --- p.101 / Chapter 5.2.2. --- Bone Mineral Density measured by pQCT --- p.103 / Chapter 5.2.2.1. --- Distal Radius (Program 1) --- p.103 / Chapter 5.2.2.1.1. --- BMD change of D50 --- p.103 / Chapter 5.2.2.1.2. --- BMD changes of D100 --- p.106 / Chapter 5.2.2.1.3. --- BMD change of P100 --- p.108 / Chapter 5.2.2.2. --- Distal Radius (Program 2) --- p.111 / Chapter 5.2.2.2.1. --- BMD change of pure trabecular bone --- p.112 / Chapter 5.2.2.2.2. --- BMD changes of pure cortical bone --- p.114 / Chapter 5.2.2.3. --- Distal Tibia (Program 1) --- p.118 / Chapter 5.2.2.3.1. --- BMD changes of D50 --- p.118 / Chapter 5.2.2.3.2. --- BMD changes of D100 --- p.121 / Chapter 5.2.2.3.3. --- BMD changes of P100 --- p.124 / Chapter 5.2.2.4. --- Distal Tibia (Program 2) --- p.128 / Chapter 5.2.2.4.1. --- BMD changes of pure trabecular bone --- p.128 / Chapter 5.2.2.4.2. --- BMD changes of pure cortical bone --- p.131 / Chapter 5.2.3. --- Bone turnover --- p.135 / Chapter 5.2.3.1. --- Bone Resorption Marker (urinary Deoxypyridinoline) --- p.135 / Chapter 5.2.3.2. --- Bone Formation Marker (Bone Specific Alkaline Phosphatase) --- p.137 / Chapter 5.2.4. --- Quality of Life (QOL) --- p.139 / Chapter 5.2.5. --- Oswestry Disability Index (ODI) --- p.139 / Chapter 5.2.6. --- Pain --- p.141 / Chapter 5.2.6.1. --- Pain frequency --- p.141 / Chapter 5.2.6.2. --- Night Pain --- p.142 / Chapter 5.2.6.3. --- Administration of pain relief drugs --- p.143 / Chapter 5.2.7. --- Activity of daily living --- p.144 / Chapter 5.2.8. --- Prevention of new vertebral fracture(s) --- p.146 / Chapter 5.2.9. --- Safety and Tolerability --- p.147 / Chapter chapter 6. --- results on proximal femoral fractures study --- p.149 / Chapter 6.1. --- Epidemiological study on proximal femoral fractures --- p.149 / Chapter 6.2. --- The role of ultrasound equipment in the assessment osteoporosis in patients with proximal femoral fractures --- p.154 / Chapter 6.3. --- Summary --- p.155 / Chapter chapter 7. --- discussion --- p.156 / Chapter 7.1. --- The study on vertebral structures --- p.156 / Chapter 7.1.1. --- Changes in Shape of Vertebral Bodies --- p.156 / Chapter 7.1.2. --- Changes of Interevertbral Discs --- p.157 / Chapter 7.2. --- Alendronate treatment on Chinese elderly women with Osteoporotic vertebral fracture --- p.158 / Chapter 7.2.1. --- The Effect of Alendronate on BMD of Lumbar Spine --- p.159 / Chapter 7.2.2. --- The Effects of Alendronate on BMD of Proximal Femur --- p.159 / Chapter 7.2.3. --- The Effects of Alendronate on the BMD of Trabecular and Cortical Bone in the Distal Radius and Distal Tibia --- p.160 / Chapter 7.2.4. --- The Effects of Calcium Supplementation in the study --- p.162 / Chapter 7.2.5. --- The Effect of alendronate on Biochemical Turnover --- p.162 / Chapter 7.2.6. --- The Efficacy of Alendronate on Prevention of New Fractures --- p.163 / Chapter 7.2.7. --- The Effect of Alendronate on Quality of Life --- p.164 / Chapter 7.2.8. --- Adverse Effects of Alendronate --- p.165 / Chapter 7.3. --- Proximal Femur Fracture Study --- p.165 / Chapter chapter 8. --- conclusion --- p.168 / bibliography --- p.174 / epilogue --- p.202 / appendix --- p.xxv

Bone makes up a framework that provides protection for internal body organs. The homeostasis of bone is maintained by a balanced process involving old bone degradation and new bone formation. However, this balance can be altered in pathophysiological conditions such as in postmenopausal osteoporosis and in patients with rheumatoid arthritis (RA). In recent years, new therapies have been developed to reduce bone resorption. However, there is disparity in patients’ response to these therapies. The reasons are unclear although age, gender, ethnic background and lifestyle have all been suggested to play a part. For patients with chronic inflammatory conditions, treatment was revolutionised by the discovery and application of biologic therapies that target pro-inflammatory proteins and/or pathways. However, whilst the anti-inflammatory effect of these biologic agents is well-established, their effect on bone loss is just emerging. In RA, it is not clear whether the beneficial anti-inflammatory effects of biologic anti-tumour necrosis factor alpha (TNFα) agents are accompanied by parallel improvements in bone erosion/density, whether there are differences between patient groups and what factors influence the response. In order to address these issues, a database on the factors that influence responsiveness of patients with osteoporosis to bisphosphonates, a treatment that suppresses bone resorption, was established. Based on the outcome of this study, the influence of the key factor(s) that affect bone response to treatment in combination with excess pro-inflammatory cytokine production on bone response in RA patients was determined. Significant improvement in bone mineral density (BMD) and plasma levels of bone biomarkers has been shown in this study with biologic anti-TNFα agents. The improvement in BMD was not always consistent with improvement the clinical response to treatment as assessed by changes in disease activity score 28(DAS28). The study also provides a mechanistic explanation for how blockade of TNFα in patients can reverse the balance of bone loss in patients with RA. Thus, the data show that treatment of patients with biologic anti-TNFα agents reduces the number of osteoclast precursors (OCs) in the blood.

Objetivo: O objetivo deste estudo foi investigar se a avaliação da cortical mandibular é um método confiável para predizer a densidade mineral óssea utilizando a Morfologia da Cortical Mandibular e a Espessura da Cortical Mandibular em radiografias panorâmicas. Métodos: Duzentos e doze mulheres na pós-menopausa (59,28 ± 4,99 anos) foram incluídas. Questionários estruturados foram aplicados para identificar fatores demográficos e fatores de risco para a osteoporose. A densidade mineral óssea foi medida por dupla absorção de raios-X. A osteoporose foi classificada de acordo com critérios da Organização Mundial da Saúde (T-score -2,5) e foi o padrão ouro para seu diagnóstico. A Morfologia da Cortical Mandibular e a Espessura da Cortical Mandibular foram avaliadas baseadas em métodos validados para verificar as características radiográficas da mandíbula. Resultados: A sensibilidade, a especificidade, os valores preditivos e a acurácia para a identificação de osteoporose pelos parâmetros radiográficos foram analisadas. Resultados para a Morfologia da Cortical Mandibular e a Espessura da Cortical Mandibular foram os seguintes: sensibilidade de 58,33% e 50,00%; especificidade 91,86 e 91,25% e acurácia de 74,08% e 69,91%, respectivamente. A área sob a curva ROC foi de 0,74. O ponto de corte foi 3,4 mm para identificação de osteoporose por meio da Espessura da Cortical Mandibular. Conclusão: Este estudo demonstrou que radiografias panorâmicas são um procedimento confiável para excluir a osteoporose. / Objective: The aim of this study was to investigate if the assessment of the mandibular cortical is a reliable method to predict bone mineral density using Mandibular Cortical Erosion and Mandibular Cortical Width from panoramic radiographs. Methods: Two hundred and eleven postmenopausal women (59.28 ± 4.99 years) were enrolled, and structured questionnaires were administered to identify demographic and risk factors for osteoporosis. Bone mineral density was measured by Dual-energy X-ray absorptiometry. Osteoporosis was classified according to the World Health Organization criteria (T-score -2.5) and it was reference gold standard for osteoporosis diagnosis. Mandibular Cortical Erosion and Mandibular Cortical Width were assessed based on validated methods for evaluating the radiographic characteristics of the mandible. Results: Sensitivities, specificities, predictive values and accuracies for osteoporosis identification by Mandibular Cortical Erosion and Mandibular Cortical Width were evaluated. Respective results for Mandibular Cortical Erosion and Mandibular Cortical Width were as follows: sensitivity 58.33% and 50.00%; specificity 91.86% and 91.25% and accuracy 74.08% and 69.91%. The area under the ROC curve was 0.74 and the cutoff point was 3,4mm to identify osteoporotic women with Mandibular Cortical Width. Conclusion: This study demonstrated that panoramic radiographs are a reliable procedure to exclude osteoporosis and suggests that this methodology could be used to diagnose normal bone density and exclude large populations from unnecessary Dual-energy X-ray absorptiometry.

Orientador: Lúcia Costa-Paiva / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-07T13:26:46Z (GMT). No. of bitstreams: 1 Gomes_DeboraAlessandradeCastro_M.pdf: 1338368 bytes, checksum: cc6c228fa56317429a0a9698e1c05cdf (MD5) Previous issue date: 2010 / Resumo: A osteoporose é uma desordem esquelética caracterizada pela baixa massa óssea e deterioração da arquitetura óssea, que pode progredir por décadas de forma assintomática ou manifestar-se através de fraturas ósseas, acometendo principalmente mulheres na pós-menopausa. O tratamento envolve uso de bisfosfonatos, raloxifeno, associados à dieta, cálcio, vitamina D e atividade física. Estudos mostraram que o conhecimento e a aderência a esses tratamentos foram baixos, o que pode interferir com a resposta terapêutica. Objetivo: Avaliar em mulheres na pós-menopausa com osteoporose ou osteopenia o conhecimento sobre a doença e a habilidade de seguir o tratamento aos diferentes medicamentos prescritos. Sujeitos e métodos: Foi realizado um estudo de corte transversal com 232 mulheres na pós menopausa com diagnóstico densitométrico de osteopenia ou osteoporose em uso de tratamento medicamentoso, acompanhadas no Ambulatório de Menopausa Hospital da Mulher Professor José Aristodemo Pinotti, no Caism/Unicamp. O conhecimento sobre osteoporose foi avaliado através da aplicação do questionário OPQ (Osteoporosis Questionary) contendo 20 questões sobre informações gerais sobre a doença, fatores de risco, conseqüências e tratamento. A habilidade de seguir o tratamento foi avaliada através do questionário MedTake, onde foi analisado a habilidade de seguir o tratamento em relação ao regime prescrito, dose, indicações e modo de ingestão da medicação. Análise - estatística: foi realizada através de medidas de frequência, médias e desvio padrão, teste qui-quadrado e t de Student. Para analisar os fatores associados ao conhecimento e a habilidade de seguir o tratamento foi utilizada a análise de regressão múltipla realizada pelo programa SAS, versão 9.1. Resultados: A média de idade das mulheres foi de 61,6 anos (+ 8,2 anos) e o tempo médio de menopausa foi 16,8 anos (+7,9). O escore médio de conhecimento obtido através do OPQ foi de 3,78, sendo que a média de respostas corretas foi de 9,8, respostas incorretas 6,0 e não sabia responder 4,1. Na análise bivariada as variáveis que se mostraram associadas ao escore de conhecimento foram: a maior escolaridade (p<0,01), tempo de leitura (p<0,02), maior nível de renda p<0,03) modo de aquisição da medicação (p<0,02) e ausência de comorbidades (p<0,04). Na análise de regressão múltipla os fatores que permaneceram associados ao maior conhecimento foram o maior nível de escolaridade, maior escore de renda e a ausência de comorbidades. A habilidade de seguir o tratamento avaliada pelo MedTake foi abaixo de 80% para a maioria das mulheres, não havendo diferença significativa entre as usuárias de bisfosfonato diário ou semanal e raloxifeno. Na análise bivariada as variáveis significativamente associados ao MedTake foram a escolaridade (p<0,01), nível de leitura (p<0,02), escore de conhecimento OPQ (p<0,02), tipo de medicamento (p<0,01) e tempo de uso para tratamento da osteoporose (p<0,01), presença de outras doenças associadas (p<0,02) e uso de outras medicações concomitantes (p<0,01). Os fatores associados ao tratamento inadequado foram idade acima de 70 anos OR 5,62 (IC 95% 1,23 a 25,64); ser analfabeta OR 10,14 (IC 95% 2,14 a 48,12); uso de outras medicações OR 0,33 (95% 0,15 a 0,76) e menor tempo de uso do tratamento para osteoporose OR 5,67 (IC 95% 2,27 a 14,16). Conclusão: O conhecimento sobre osteoporose em mulheres na pós-menopausa foi baixo, assim como a habilidade de seguir o tratamento proposto. O nivel educacional foi um forte preditor do conhecimento sobre osteoporose. A habilidade de seguir o tratamento para os diferentes medicamentos para osteoporose foi baixa e esteve associado à maior idade, ser analfabeta, não usar outras medicações e menor tempo de tratamento / Abstract: Osteoporosis is a skeletal disorder characterized by low bone mass and deterioration of bone architecture, which may progress for decades to be asymptomatic or manifested by bone fractures, affecting especially postmenopausal women after menopause. Treatment involves bisphosphonates, raloxifene, linked to diet, calcium, vitamin D and physical activity. Studies showed that knowledge and adherence to these treatments are low, which may interfere with the therapeutic response. Objective: To evaluate the knowledge about osteoporosis and the ability to follow the treatment with different drugs prescribed in postmenopausal women with osteoporosis or osteopenia. Subjects and methods: We conducted a cross-sectional study with 232 postmenopausal women with a densitometric diagnosis of osteopenia or osteoporosis in use of drug treatment followed at the Menopause Clinic at Women's Hospital Professor Jose Aristodemo Pinotti in Caism / Unicamp. The knowledge about osteoporosis was assessed by applying the OPQ questionnaire (Osteoporosis Questionnaire) containing 20 questions on general information about the disease, risk factors, consequences and treatment. The ability to follow the treatment was assessed by MedTake questionnaire, in relation to the prescribed regimen, dose, indication and method of ingestion. Analysis - Statistical: was performed by the measures of frequency, mean and standard deviation, chi-square and t Student. To analyze the factors associated with knowledge and ability to follow the treatment was used multiple regression analysis performed by SAS software, version 9.1. Results: The mean age of women was 61.6 years (+ 8.2 years) and mean duration of menopause was 16.8 years (+7.9). The average knowledge score through the OPQ questionnaire was 3.78, while the average was 9.8 correct answers and incorrect answers 6,0 and 4,1 do not answer. In bivariate analysis the variables that were associated with knowledge scores were: higher education (p <0.01), reading (p<0.02), higher income level, p<0.03), mode of acquisition of medication (p<0.02) and ausence of comorbidities (p<0.04). In multiple regression analysis the factors that remained associated with higher knowledge were the highest level of education, higher scores of income and the absence of comobidities. The ability to follow the treatment, evaluated by MedTake was below 80% for almost women and no significant difference among users of daily or weekly bisphosphonate and raloxifene. In bivariate analysis the variables significantly associated with MedTake were schooling (p <0.01), reading level (p<0,02), OPQ knowledge scores (p<0.02), type of drug (p<0.01) and time of use for treatment of osteoporosis (p<0.01), presence of other disorders (p<0.02) and use of other concomitant medications (p<0.01). Factors associated with inadequate treatment were age above 70 years OR 5.62 (95% CI 1.23 to 25.64), illiterate OR 10.14 (95% CI 2.14 to 48.12), use of other medications OR 0.33 (95% 0.15 to 0.76) and shorter duration of treatment for osteoporosis OR 5.67 (95% CI 2.27 to 14.16). Conclusion: The knowledge about osteoporosis in postmenopausal women with osteoporosis was low, as well as the ability to follow the treatment for the different drugs for osteoporosis. The educational level was a strong predictor of knowledge about osteoporosis. The ability to follow the treatment for the different drugs for osteoporosis was low and was associated with older age, illiterate, do not use other drugs and less treatment time / Mestrado / Tocoginecologia / Mestre em Tocoginecologia

Orientador: Roberta Okamoto / Coorientador: Leonardo Perez Faverani / Banca: Idelmo Rangel Garcia Junior / Banca: Ronaldo Célio Mariano / Resumo: Este estudo objetivou avaliar o reparo ósseo alveolar em ratas osteopênicas tratadas com ranelato de estrôncio. Trinta e três ratas fêmeas com 3 meses de idade foram selecionadas e divididas em 3 grupos experimentais: OVX (animais submetidos à ovariectomia sem tratamento medicamentoso); SHAM (animais submetidos à cirurgia fictícia sem tratamento medicamentoso) e OVX-RE (animais submetidos à ovariectomia e tratados com ranelato de estrôncio). Inicialmente, os animais foram submetidos à cirurgia de ovariectomia bilateral para indução de condição osteopênica. O tratamento medicamentoso iniciou 30 dias após o procedimento cirúrgico com duração até o momento de eutanásia. Trinta dias após o início do tratamento, foi realizado a extração do incisivo superior direito dos animais para posterior avaliação do reparo alveolar. Os animais do grupo descalcificado foram submetidos à eutanásia aos 14 dias após a extração dentária, sendo as amostradas destinadas às análises histológica e imunoistoquímica. Os animais do grupo calcificado foram submetidos à eutanásia aos 60 dias após a extração dentária, sendo as amostras destinadas às análises por microscopia confocal e microtomográfica. Os resultados histológicos evidenciaram que o grupo OVX-RE demonstrou melhor aspecto de neoformação óssea, com trabéculas mais espessas e baixa presença de tecido conjuntivo, comaprado ao grupo OVX. Os resultados imunoistoquímicos demonstraram intensa marcação de OPG para o grupo OVX-RE e intensa marcação de... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This study aimed evaluate alveolar bone healing in osteopenic rats treated with strontium ranelate. Thirty-three three months's old female rats were selected and diveded into three groups: OVX (animals underwent to ovariectomy with no drug treatment); SHAM (animals underwent to fake surgery with no drug treatment) and OVXSR (animals underwent to ovariectomy treated with strontium ranelate). Firstly, animals undewent to bilateral ovariectomy to induce osteopenic condition. Drug treatment started at 30 days after, during the all experimental period. Thirty days after, it was performed extraction of the right upper incisor tooth, to further evaluation of alveolar healing. Animals from decalcified group were euthanized at 14 days after tooth extraction, and its samples were destinated to histological and immunohistochemestry analysis. Animals from calcified group were euthanized at 60 days and its samples were destinated to confocal microscopy and micro-tomography analysis. Histological results showed that OVX-SR group had the better aspect of new bone formation, with few number of trabecular bone and poor presence of connective tissue compared to OVX group. Immunohistochemestry results showed an intense labeling of OPG for OVX-SR group and intense labeling of RANKL for OVX group. Regarding confocal microscopy analysis, it was possible observed that OVX-SR group showed a significance greater amount of alizarin precipitation compared to another both groups (Tukey test - P < 0.05).... (Complete abstract click electronic access below) / Mestre