Navegando por Palavras-chave "bone mineral density"

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    Alterações de parâmetros relacionados ao metabolismo ósseo em mulheres submetidas à derivação gástrica em Y de Roux
    (Sociedade Brasileira de Endocrinologia e Metabologia, 2012-08-01) Santos, Maria Tereza Amaral dos; Souza, Fabíola Isabel Suano de [UNIFESP]; Fonseca, Fernando Luiz Affonso [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]; Sarni, Roseli Oselka Saccardo [UNIFESP]; Faculdade de Medicina do ABC; Centro Hospitalar do Município de Santo André Serviço de Nutrição e Dietética; Universidade Federal de São Paulo (UNIFESP); FMABC Departamento de Pediatria; Universidade de São Paulo (USP); FMABC Serviço de Nutrologia
    OBJECTIVE: To evaluate bone turnover markers and bone mineral density (BMD) in women after Roux-en-Y (RYGB) gastric bypass. SUBJECTS AND METHODS: In a cross-sectional study, 48 women post-RYGB after three years, and 41 healthy women were evaluated. Evaluations: body mass index (BMI); physical activity; food intake; serum levels of calcium, phosphorus, magnesium, alkaline phosphatase, C-terminal telopeptide (CTX), intact parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), osteocalcin, urinary calcium and BMD. RESULTS: Significantly higher levels were observed for osteocalcin (p < 0.001), CTX (p < 0.001), and PTH (p < 0.001) in the RYGB group when compared with the control group; 25OHD deficiency/insufficiency was more frequent in the RYGB group (p = 0.010), even after adjusted for nutritional status, and it was associated with secondary hyperparathyroidism (p = 0.025); there was no difference in BMD between the groups. Energy (p = 0.036) and protein intake (p = 0.004) were lower in the RYGB group. CONCLUSION: Patients submitted to RYGB showed a significantly higher frequency of vitamin D deficiency, secondary hyperparathyroidism, and increase in bone remodeling markers, with no difference in BMD status.
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    Análise da densidade mineral óssea através da absorciometria por dupla emissão de raios x na avaliação dos efeitos ósseos tardios de pacientes tratados de acordo com os protocolos gbtli lla-93 e lla- 99 do grupo cooperativo brasileiro para tratamento da l
    (Universidade Federal de São Paulo (UNIFESP), 2013-08-28) Molinari, Poliana Cristina Carmona [UNIFESP]; Caran, Eliana Maria Monteiro Caran [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives: To evaluate the impact of therapy on bone mineral density in acute lymphoblastic leukemia survivors treated according to the Brazilian Cooperative Childhood protocols – GBTLI LLA-93 and 99. Methods: Bone mineral density (BMD) by dual energy X-ray absorptiometry was performed in 101 treated patients in a crosssectional study. Bone densitometry were interpreted according to the age group and they were compared with reference population. BMD values were evaluated according to clinical and treatment characteristics and body composition. Correlations between BMD values and all variables were tested using χ2 test , Fisher’s exact test, likelihood ratio and t-Student test with significancy level of 5%. Results: Sixty patients were female and 78% were white, mean age was 17 ± 4,7 years, 94% had common ALL and 8,9% had central nervous system leukemia. The mean initial white blood cells (WBC)was 38.305μ/L and 79% of patient had less than 50.000 μ/L WBC. Fourty-four patients were treated according to GBTLI LLA-93 protocol and 54,5% were classified as low risk. Fifty seven patients were treated according to GBTLI LLA-99 protocol and 54% were classified as low risk. Twenty patients (19,8%) received cranial radiotherapy: 17 received prophylatic dose of 18 Gy and three received therapeutic dose of 24 Gy. The distribuition of nutritional diagnosis was 22,8% overweight and 15,8% obesity. There was no relationship between these diagnosis and radiotherapy exposure. There were 2% of fractures and 2% of osteonecrosis. In group younger than 20 years of age, three patients had low BMD: two patients had low lumbar spine BMD and one had low total body BMD. In the risk group for low BMD (Z-score between -1,1 and -1,9), 20,3% had risk values for lumbar spine BMD and 8,9% had risk values for total body BMD. In the group older than 20 years of age, ten patients (45,5%) had osteopenia: 31,8% in the lumbar spine and 13,6% in the proximal femur. The risk group had lower lumbar spine (p=0,01) and total body (p=0,005) BMD compared to the group wih normal values. Moreover that group had lower lean body mass (p=0,03). Patients with lumbar spine osteopenia had lower BMD compared to patients with normal values (p=0,000) and those with proximal femur osteopenia were older than patients with normal values (p=0,001). Conclusion: Bone late effect were represented by 2% of fracture, 2% of osteonecroses and 2,9% of low BMD in survivors of acute lymphoblastic leukemia treated with Brazilian protocols. It was characterized a risk group for low BMD comprising 15,8% that presented significant low values of BMD. The study suggest that this group needs a better attention in monitoring bone loss and they may be benefit through preventive actions to avoid bone loss and to promote good habits of life. Furthermore it encourages the development of protocols for longitudinal monitoring of these patients.
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    Bone disease in idiopathic hypercalciuria
    (Lippincott Williams & Wilkins, 2006-07-01) Heilberg, Ita P. [UNIFESP]; Weisinger, Jose R.; Cent Univ Venezuela; Universidade Federal de São Paulo (UNIFESP)
    Purpose of reviewDecreased bone mineral density and increased prevalence of bone fractures have been found in patients with idiopathic hypercalciuria. the purpose of this review is to summarize the recent published evidence that supports a potential role of the bone, and its link to the kidney and intestine, in the pathogenesis of idiopathic hypercalciuria. the effects of hypercalciuria on bone and the implications for treatment are also reviewed.Recent findingsEvidence suggests that the incidence of a first fracture in kidney stone patients is fourfold higher than the control population. Support for the role of bone in the pathophysiology of hypercalciuria has been corroborated. New studies have detailed the effects of several cytokines increased number and sensitivity of vitamin D receptors, and increased acid production - upon the bone acting cells. Similarly, recent clinical and experimental studies have suggested that genetic factors confer a predisposition to the formation of renal calcium stones and bone demineralization.SummaryWhether hypercalciuria is the result of a primary bone disorder, a consequence of a persisting negative calcium balance or a combination of both still remains to be determined. Nevertheless, bone status must be evaluated and followed up in patients with idiopathic hypercalciuria.
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    Bone Mass Outcomes in Patients With Osteoporosis Treated With Risedronate After Alendronate Failure: a 12-Month Follow-Up Study
    (Elsevier Science Inc, 2017) Mendonca, Leonardo Teixeira [UNIFESP]; Pinheiro, Marcelo Medeiros [UNIFESP]; Szejnfeld, Vera Lucia [UNIFESP]; Castro, Charlles Heldan de Moura [UNIFESP]
    Oral bisphosphonates are the drugs most frequently used for the treatment of osteoporosis. Clinicians usually switch between these drugs in clinical practice based on differences in efficacy. We aim to investigate the reasons associated with switching between oral bisphosphonates and to evaluate bone mass response and the incidence of fractures 12 mo after the exchange in a cohort of patients with osteoporosis seen at a tertiary hospital. Patients with osteoporosis who switched between oral bisphosphonates between January 2007 and December 2014 were included. Bone mass measured by dual-energy X-ray absorptiometry and the incidence of fracture were evaluated. A total of 112 patients (73.1 yr old on average, 95.5% women, 98% postmenopausal) were included. All patients were taking alendronate at the time of the switch to risedronate. In 91 patients (81.3%), the following reasons for the exchange of medication were identified: bone loss (59.8%), adverse events (11.6%), and recent fragility fracture (10.7%). One year after the switch, bone densitometry revealed bone loss in 51 patients (45.5%), bone mass maintenance in 34 (30.4%), and bone mass gain in 27 (24.1%). No new vertebral fracture was detected and no nonvertebral fracture was reported in 12 mo of follow-up. Bone mass outcomes (gain, loss, or maintenance) were not associated with the reason for switching between oral bisphosphonates. Similarly, none of the parameters evaluated could predict good densitometric response (gain or maintenance) in this scenario. Our findings suggest that the use of risedronate should not be recommended in the scenario of treatment failure or adverse events following the use of alendronate.
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    Bone mineral density and osteoporosis among a predominantly Caucasian elderly population in the city of São Paulo, Brazil
    (Springer, 2005-11-01) Camargo, MBR; Cendoroglo, M. S.; Ramos, L.; Latorre, MDDD; Saraiva, G. L.; Lage, A.; Neto, N. C.; Araujo, LMQ; Vieira, JGH; Lazaretti-Castro, M.; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    This cross-sectional study covered 301 individuals over 70 years of age-207 women (W) and 94 men (M)-living in the city of São Paulo, Brazil. Our aims were to evaluate the prevalence of low bone mineral density (BMD) in this population and the possible factors that influence BMD. the subjects were submitted to a bone densitometry scan (DXA) to evaluate the BMD at lumbar spine (LS), femoral neck (FN), trochanter (T), total femur (TF) and total body composition. At the time, the participants filled in a questionnaire about lifestyle habits, diet and medical history, as well as having blood samples taken to check hormone and biochemical levels. Anthropometric parameters were measured. Osteopenia and osteoporosis were defined in accordance with the criteria suggested by the World Health Organization. in the different sites studied, the prevalence of osteopenia and osteoporosis varied, in men ranging 33.3-57.4% and 6.4-16.1%, respectively, and in women ranging 36.6-56.5% and 22.2-33.2%, respectively. Weight was the variable that most strongly correlated with BMD at the proximal femur in both sexes (men, r =0.44-0.52; women, r =0.48-0.52) and with BMD at LS in women ( r =0.44). Height was the parameter that best correlated with BMD at LS in men ( r =0.34). in men follicle-stimulating hormone, growth hormone and glycemia correlated with BMD at T and TF, while plasma albumin only correlated with BMD at T. in women glycemia correlated with BMD at LS, and follicle-stimulating hormone correlated with BMD at FN, T and TF. in conclusion, we found a high prevalence of osteopenia and osteoporosis in this population, with weight being the best predictor of BMD. the prevalence of osteoporosis and osteopenia at FN was as high in men as that observed in women.
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    Bone mineral density of the lumbar spine in children and adolescents with celiac disease on a gluten-free diet in São Paulo, Brazil
    (Lippincott Williams & Wilkins, 2003-11-01) Sdepanian, Vera Lucia [UNIFESP]; Carvalho, Cecília Noronha de Miranda [UNIFESP]; Morais, Mauro Batista de [UNIFESP]; Colugnati, Fernando Antonio Basile [UNIFESP]; Fagundes Neto, Ulysses [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: To compare bone mineral density (BMD) in children and adolescents with celiac disease (CD) and control subjects and to evaluate diet adequacy and calcium metabolism in patients with CD.Methods: Thirty patients with asymptomatic CD (17 children, 13 adolescents). on a gluten-free diet, and 23 healthy subjects were studied. BMD of the lumbar spine (dual energy x-ray absorptiometry) was performed on all patients and control subjects. in patients. food diaries for nine nonconsecutive days were obtained and analyzed. in patients, laboratory tests pertaining to calcium balance were obtained.Results: the mean weight and height of the adolescents with CD Were lower than those of control subjects (weight: 45.8 +/- 10.5 kg v 55.3 +/- 10.5 kg, P = 0.037; height: 153.0 +/- 11.0 cm v 167 +/- 12.0 cm. P = 0.007). the mean BMD in adolescents With CD was significantly lower than that of the control subjects (0.917 +/- 0.116 g/cm(2) v 1.060 +/- 0.158 g/cm(2), P = 0.015), whereas no significant difference was found between children with CD and control subjects (P = 0.595). A multiple-regression model shows that increases in BMD relative to height were lower in adolescents with CD than in control subjects. the proportion of adolescents who had started a gluten-free diet after 2 years of age was higher than that of children with CD (P < 0.001). High percentages of magnesium, calcium, and phosphorous deficiencies were present in CD patients' diets. the serum levels of ionized and total calcium and parathormone were normal.Conclusions: the BMD of adolescents with CD was lower than that of the control subjects, whereas no difference was found between the BMD of children with CD and that of control subjects.
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    Densidade mineral óssea em crianças talassêmicas: uma experiência brasileira
    (Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular, 2008-12-01) Vicari, Perla [UNIFESP]; Correa, Margarida M. P. [UNIFESP]; Szejnfeld, Vera Lucia [UNIFESP]; Figueiredo, Maria Stella [UNIFESP]; Cavalheiro, Rita de Cassia Rosario [UNIFESP]; Yamamoto, Mihoko [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Osteoporosis is characterized by low bone mass and disruption of bone architecture, resulting in greater bone fragility with increased risk of fractures. Bone disease is an important cause of morbidity in beta thalassemia major patients. Osteoporosis has been described extensively in adult thalassemia. However, there are no studies describing Brazilian thalassemic children. We evaluated eleven patients with beta thalassemia major (median age of 10.0 years, range from 5 to 12 years) and twenty-four healthy children (median age of 9.5 years, range from 6 to 12 years), using dual X-ray absorptiometry to assess bone mineral density (BMD). Analysis of biochemical markers such as serum ferritin concentration, ionized calcium, alkaline phosphatase, phosphorus, albumin, prothrombin time and factor V was performed. The height was very different between the groups, p<0.05. The thalassemic patients showed significantly lower BMD (median 0.61 g/cm²) than control subjects (median 0.69 g/cm²) - p < 0.05. The relevant bone loss in the majority of thalassemic children studied emphasizes the need for identification and appropriate treatment of osteopenia, thereby reducing the morbidity of these patients. This is the first study described in the literature that determined bone mineral loss in Brazilian thalassemic children.
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    Densidade mineral óssea em crianças: associação com dor músculo-esquelética e/ou hipermobilidade articular
    (Sociedade Brasileira de Pediatria, 2002-12-01) Roberto, Adriana Madureira [UNIFESP]; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Szejnfeld, Vera Lucia [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    ABSTRACT Objective: joint hypermobility can be associated with benign musculoskeletal pain. The relation between hypermobility and low bone mineral density is still unknown. Osteoporosis can be observed in some genetic syndromes associated with joint hypermobility. The aim of our study was to detect the possible relation between joint hypermobility, benign musculoskeletal pain and bone mineral density in children. Patients and methods: ninety-three children from 5 to 10 years of age were evaluated concerning the presence of joint hypermobility and the presence of musculoskeletal pain based on a questionnaire directed to parents. We also performed densitometry to measure bone mineral density. All children underwent an L2-L4 lumbar bone densitometry. Results: children were distributed into four groups according to the presence or not of joint hypermobility associated or not with musculoskeletal pain: 29 (31.2%) with hypermobility and pain, 20 (21.5%) with hypermobility and without pain, 22 (23.6%) without hypermobility and with pain and 22 (23.6%) without hypermobility and without pain (control group). Twenty-four children (25.8%) presented reduction in bone mineral density over 10% related to the adequate bone mineral density for age and gender. Bone mineral density was significantly lower in relation to the controls in the following groups: with hypermobility (independently of the presence of pain), with pain (independently of the presence of hypermobility), with hypermobility and without pain and without hypermobility and with pain. Conclusion: bone mineral density may be lower in children with joint hypermobility (independently of musculoskeletal pain) and in children with pain (independently of hypermobility) when compared to controls.
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    Densidade mineral óssea, composição corporal e ingestão alimentar de adolescentes modelos de passarela
    (Sociedade Brasileira de Pediatria, 2009-12-01) Rodrigues, Alexandra Magna [UNIFESP]; Cintra, Isa de Pádua [UNIFESP]; Santos, Luana Caroline; Martini, Ligia Araújo; Mello, Marco Tulio de [UNIFESP]; Fisberg, Mauro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Minas Gerais Escola de Enfermagem; Universidade de São Paulo (USP)
    OBJECTIVE: To evaluate the bone mineral density (BMD) and to relate it to the food intake and body composition of adolescent runway models. METHODS: Cross-sectional study evaluating 33 models and 33 non-models aged from 15 to 18 years, paired by age and body mass index (BMI). BMD of spine (L1-L4) was evaluated using the dual-energy X-ray absorptiometry technique (Lunar® DPX Alpha), and body composition was assessed by means of plethysmography. Food intake was evaluated by a 3-day-food record. RESULTS: The subjects mean age was 16.75±1.04 years, and 24% had BMI below ideal value for their age. BMD values (g/cm2) were similar between models (1.108±0.080) and non-models (1.096±0.102) (p > 0.05), and 6% of the participants had low BMD for age. We found that the mean energy intake was lower among models as compared to non-models (1,480.93±582.95 vs. 1,973.00±557.63 kcal) (p < 0.05) and that most of the adolescents in both groups presented an inadequate consumption of micronutrients, with emphasis to the low calcium intakes. There was only significant correlation between BMD and lean body mass (kg) (r = 0.362 for models and r = 0.618 for non-models) (p < 0.05). CONCLUSION: Although no association was found between BMD, BMI, and intake of nutrients which are important for the bone mineralization process, inadequacies of food intake have an adverse influence on the acquisition of bone mass, which is more effective at this stage of life.
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    Desenvolvimento de ferramenta clínica para identificação de homens com baixa densidade óssea e fratura após os 50 anos de idade
    (Universidade Federal de São Paulo (UNIFESP), 2016-08-31) Lima, Pablo Duarte [UNIFESP]; Pinheiro, Marcelo de Medeiros Pinheiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: Several studies have demonstrated the relevance of identifying clinical risk factors (CRF) related to low-impact fractures (Fx) and osteoporosis in women, but little is known about their role in the male population. Aim: To identify and quantify the impact of the CRF associated with Fx and low bone mineral density (BMD) in men, as well as to develop a screening tool to select higher risk individuals. Patients and Methods: A total of 766 men aged over 50 years-old from general population of São Paulo were enrolled in this cross-sectional cohort. Al of them answered a questionnaire including details about CRF for low BMD and Fx, such as anthropometric data, medical history, and lifestyle habits. Besides, they performed bone densitometry (DXA) at lumbar spine and hip (DPX NT, GE-Lunar). The criteria proposed by WHO were used to classify patients with osteoporosis and osteopenia, based on T-score values. Patients with secondary causes of low BMD were excluded. The main CRF were recognized by frequency, and multivariate and logistic regression analysis. P below 0.05 was set as significant. Results: The mean age, weight, height and BMI were 71.8 ± 9.6 years; 72.1 ± 13.8 kg; 1.65 ± 0.07 m and 26.36 ± 4.37 kg/ m2, respectively. Osteopenia was found in 46.5% and 29.2% of sample had osteoporosis. The rate of Fx after 50 years was 12.1%. No CRF was associated significantly with the spine BMD. The main CRF associated with low hip BMD and Fx were older age, low weight, lower height and body mass index (BMI), smoking and low intake of dairy products. After statistical adjustments for confounding variables, the tool for low femoral neck BMD had sensitivity (S) of 84%, specificity (E) of 50% and area under the curve (AUC) ROC = 0.768 (p <0.001). To identify Fx, the S was 69.2%, and E=50% and ROC AUC = 0.628 (p <0.001). Conclusion: Our results showed the development of a simple and useful tool, the SAPORI-M (Sao Paulo Osteoporosis Risk Index for men), to identify men at higher risk of low hip BMD and Fx in the male Brazilian population.
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    Development of mice with osteoblast-specific connexin43 gene deletion
    (Taylor & Francis Ltd, 2003-07-01) Castro, CHM; Stains, J. P.; Sheikh, S.; Szejnfeld, V. L.; Willecke, K.; Theis, M.; Civitelli, R.; Washington Univ; Universidade Federal de São Paulo (UNIFESP); Univ Bonn; Columbia Univ
    Genetic deficiency of Cx43 in vivo causes skeletal developmental defects, osteoblast dysfunction and perinatal lethality. To determine the role of Cx43 in the adult skeleton, we developed two models of osteoblast-specific Cx43 gene deletion using Cre mediated replacement of a floxed Cx43 allele with a LacZ reporter gene. Cre recombinase expression in osteoblasts was driven by either the osteocalcin OG2 promoter or the 2.3 kb fragment of the Colalpha1(I) promoter. Homozygous Cx43 fl/fl mice, in which the Cx43 coding region is flanked by two loxP sites, were crossed with Cre expressing mice in a heterozygous Cx43-null background [Cx43 +/- ; Colalpha1(I)-Cre or Cx43 +/- ; OG2-Cre]. Cx43 gene ablation was demonstrated in tissues by selective X-gal staining of cells lining the endosteal surface, and in cultured osteoblastic cells from calvaria using different approaches. Although no LacZ expression was observed in proliferating calvaria cells, before osteoblast differentiation begins, post-proliferative cells isolated from conditional knockout mice [Cx43 fl/- ; Colalpha1(I)-Cre or Cx43 fl/- ; OG2-Cre] developed strong LacZ expression as they differentiated, in parallel to a progressive disappearance of Cx43 mRNA and protein abundance relative to controls. Selective Cre mediated Cx43 gene inactivation in bone forming cells will be useful to determine the role of Cx43 in adult skeletal homeostasis and overcome the perinatal lethality of the conventional null model.
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    Discriminatory ability of quantitative ultrasound measurements is similar to dual-energy X-ray absorptiometry in a Brazilian women population with osteoporotic fracture
    (Springer, 2003-12-01) Pinheiro, M. M.; Castro, CHM; Frisoli, A.; Szejnfeld, V. L.; Universidade Federal de São Paulo (UNIFESP)
    The discriminating ability and relevance of clinical risk factors, quantitative ultrasound (QUS) variables, X-ray-based bone mineral density (BMD) and hip axis length (HAL) measurements to evaluate the risk of osteoporotic fracture in elderly Brazilian women were examined in this study. QUS at the calcaneus (Achilles +, Lunar), HAL and BMD measurements (DPX-L, Lunar) at several anatomical sites were performed in 275 postmenopausal Caucasian women. Patients with suspected secondary osteoporosis were excluded. One hundred twenty-two (44.4%) women had had previous osteoporotic fracture. All of the subjects were over 50 years old (range 53-93) and answered a questionnaire that included details concerning aspects of lifestyle, diet, hormonal factors and drug use. Lateral thoracic and lumbar radiographs were taken and an independent radiologist reviewed the X-rays for the presence of vertebral fractures. After adjustments for age, the most relevant risk factors to discriminate patients with osteoporotic fracture from normal non-fracture controls were Stiffness index (OR 2.8 per standard deviation; 95% confidence interval 2.3, 8.7), familial history of hip fracture (OR 2.6 per standard deviation; 95% confidence interval 2.2, 5.4), femoral neck BMD (OR 2.3 per standard deviation; 95% confidence interval 1.9, 4.2), age (OR 2.1 per standard deviation; 95% confidence interval 1.6, 2.8) and weight (OR 1.9 per standard deviation; 95% confidence interval 1.5, 2.6). HAL measurements did not associate significantly with the risk of hip fracture in this population. the ability of QUS measurements discriminate between patients with fractures from those without was similar to, if not better, than X-ray-based BMD measurements. However, a combination of QUS and BMD measurements did not significantly improve fracture discrimination compared with either technique alone. Association of clinical risk factors with QUS or BMD measurements seems, on the other hand, to increase the sensibility to identify patients at risk of osteoporotic fractures.
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    Estrogen receptor (ER) gene polymorphism may predict the bone mineral density response to raloxifene in postmenopausal women on chronic hemodialysis
    (Taylor & Francis Inc, 2005-01-01) Heilberg, I. P.; Hernandez, E.; Alonzo, E.; Valera, R.; Ferreira, L. G.; Gomes, S. A.; Bellorin-Font, E.; Weisinger, JR; Universidade Federal de São Paulo (UNIFESP); Cent Univ Venezuela
    The estrogen receptor (ER) gene has been considered as a candidate genetic marker for osteoporosis, and PvuII and XbaI polymorphisms of the ER alpha gene have been associated with low bone mineral density (BMD). We investigated whether ER polymorphism could predict the response of BMD in 28 postmenopausal women on hemodialysis with marked osteopenia or osteoporosis, randomized to receive raloxifene, a selective estrogen receptor modulator (SERM), or placebo for I year. BMD was assessed by dual X-ray absorptiometry and PvuII and XbaI restriction fragment-length polymorphism of the ER gene was determined using polymerase chain reaction. Baseline lumbar spine or femoral neck BMD parameters were not different between patients presenting either homozygous PP or xx when compared with heterozygous Pp or Xx genotypes. After 1 year, patients on raloxifene, presenting with PP or xx genotypes (but not those with Pp or Xx), showed a significantly higher mean lumbar spine BMD (0.942 +/- 0.18 vs. 0.925 +/- 0.17 2 g/cm(2), p <.01) and lower serum pyridinoline (19.7 +/- 9.7 vs. 30.6 +/- 16.5 nmol/L, p <.02) when compared with baseline values. No changes were detected in the placebo-treated patients or in the femur neck sites. in conclusion, after I year on raloxifene, postmenopausal osteoporotic women on chronic hemodialysis, homozygous for the P or x (PP or xx) alleles of the ER, exhibited a better lumbar spine BMD response and decreased serum pyridinoline values when compared with heterozygous women (Pp or Xx), suggesting that ER alpha allelic variants may explain, at least in part, the different outcomes after treatment of osteoporosis with SERM.
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    High prevalence of low bone mineral density in pre-dialysis chronic kidney disease patients: bone histomorphometric analysis
    (Dustri-verlag Dr Karl Feistle, 2004-12-01) Lobao, R.; Carvalho, A. B.; Cuppari, Lilian [UNIFESP]; Ventura, R.; Lazaretti-Castro, Marise [UNIFESP]; Jorgetti, Vanda [UNIFESP]; Vieira, Jose Gilberto Henriques [UNIFESP]; Cendoroglo, Miguel [UNIFESP]; Draibe, Sergio Antonio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Chronic kidney disease (CKD) leads to reduced bone mineral density (BMD) in pre-dialysis and dialysis patients. A few studies have used dual-energy x-ray absorptiometry (DEXA) to assess BMD in pre-dialysis CKD patients and have shown low BMD to be highly prevalent. Until now there have been no studies reporting the histological features of low BMD in pre-dialysis CKD patients. Aim: To determine the prevalence and histological features of low BMD in pre-dialysis CKD patients. Method: Pre-dialysis CKD patients (n = 103, 46 females/57 males), median creatinine clearance of 29 (10 - 78) ml/min/ 1.73 m(2), were evaluated using biochemical analysis and DEXA. Bone biopsies were obtained from those with low BMD. Results: Fifty (48.5%) out of the 103 patients had low BMD (LBD group) and 53 (51.5%) had normal BMD (NBD group). The risk for low BMD was increased in those patients with alkaline phosphatase levels above 190 U/l and intact-PTH (iPTH) below 70 pg/ml (p < 0.05). Demographic and biochemical parameters from both groups were comparable, except for lower body mass index (BMI) in LBD subjects (p = 0.04). Women who had been post-menopausal for at least I year comprised 65% (13/20) and 50% (13/26) of the LBD and NBD groups, respectively (p = NS). In 40 LBD patients, bone histomorphometry revealed adynamic bone disease (ABD, 52.5%), osteomalacia (OM, 42.5%) and mixed bone disease (MBD, 5%). Trabecular bone volume (BV/TV) was lower in ABD and OM patients. A nearly significant association was found between ABD and iPTH &LE; 150 pg/ml (p = 0.056), whereas higher values of iPTH were associated with OM. Total alkaline phosphatase &LE;190 U/l was significantly associated with ABD, whereas higher values were associated with OM. No correlation was observed between BV/TV and BMD. Conclusion: Low BMD is frequent in pre-dialysis CKD patients, and low turnover bone disease, manifesting as ABD and OM, was the hallmark of this bone loss.
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    Osteopenia in patients with glomerular diseases requiring long-term corticosteroid therapy
    (Karger, 2003-07-01) De Deus, Rogério Barbosa [UNIFESP]; Ferreira, A. C.; Kirsztajn, G. M.; Heilberg, I. P.; Universidade Federal de São Paulo (UNIFESP)
    Background: Chronic corticosteroid (CS) use is associated with bone mass loss. Methods: Bone mineral density (BMD) was assessed in 72 patients (25 males/47 premenopausal females) with glomerular diseases, primary (n=35) or secondary to systemic lupus erythematosus (n=37) with normal renal function, who were taking CS, as prednisone and/or methylprednisolone, in doses greater than or equal to7.5 mg/day, for a period of at least 6 months. Cumulative dose and duration of prior CS therapy, as well as biochemical parameters and other factors contributing to bone loss were evaluated. Results: We found 37 (52%) patients with low BMD (29 with osteopenia and 8 with osteoporosis). the low BMD group presented a lower mean weight and body mass index (BMI) versus the normal BMD group (62+/-15 vs. 70+/-10 kg and 25+/-4 vs. 27+/-5, mean+/-SD, p<0.05). the estimated calcium intake was lower than 400 mg/day in all patients with low BMD, and they had taken furosemide as a concomitant drug for a longer mean period of time when compared to normal BMD patients (30&PLUSMN;29 vs. 16&PLUSMN;27 months, p<0.05). A higher mean number of pulses per patient and mean cumulative dose of methylprednisolone were observed in the low versus normal BMD group (7.7+/-4.0 vs. 5.6+/-4.0 pulses and 6.5+/-3.9 vs. 3.9+/-2.7 g, p<0.05). Conclusions: These findings suggest a high frequency of osteopenia among young and premenopausal patients with glomerular diseases given long-term corticosteroid therapy. the lower BMI and calcium intake, as well as the concomitant furosemide use, might have contributed to such a bone loss. the higher number of pulse therapies leading to higher cumulative intravenous doses of corticosteroid mainly in lupus nephritis patients shows that pulse therapy may be deleterious to bone. Copyright (C) 2003 S. Karger AG, Basel.
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    Osteopenia occurs in a minority of patients with acromegaly and is predominant in the spine
    (Springer, 1997-01-01) Kayath, M. J.; Vieira, JGH; Universidade Federal de São Paulo (UNIFESP)
    Acromegaly may induce abnormalities in bone metabolism; however, there are limited data related to bone mineral density (BMT)) in this condition. To evaluate the effects of an excess of growth hormone/insulin-like growth fractor I(GH/IGF-I) in the skeleton, we measured the BMD in spine and femoral region, total body calcium and body composition in 45 patients (24 females and 21 males) aged 21-77 years (median 43 years) with acromegaly for 11.4 +/- 7.5 years (range 0.5-26 years) using a dual-energy X-ray absorptiometer (Lunar DPX). Thirty-four patients had had hypogonadism fur 8.6 +/- 6.5 years (1-24 years). Mean serum GH and IGF-I levels were respectively 159 +/- 183 mu g/l and 843 +/- 497 mu g/l. Total body calcium was increased in the acromegalics (males: 1272 +/- 217 g, range 916-1816 g; females: 1041 +/- 223 g,range 739-1609 g)when compared with normal individuals (males: 1115 +/- 144 g, range 856-1398 g; females: 909 +/- 144 g, range 511-1311 g; p = 0.01). the lean body mass was significantly higher in acromegalic patients (p<0.001) compared with normal individuals. There was a tendency for a lower fat percentage in the acromegalics; however, this difference was not significant. Osteopenia (I Z-score below the mean) was found in the spine in 20% (n = 9) of the patients, while BMD was decreased in the femoral region in only 8.8% (n = 4). the group with osteopenia had a greater duration of hypogonadism than the normal BMD group (14 +/- 11 years vs 4.4 +/- 4.0 years;p = 0.01). A negative correlation was also found between the duration of hypogonadism and BMT) in spine (r = -0.4; p = 0.003) and femoral region (r = -0.37; p = 0.013), the hypogonadal patients had a lower BMD in spine (p<0.005), but not in other regions analyzed. No correlation was found between duration of hypersomatotropism, GH/IGF-I levels and BMD. We conclude that the majority of patients with acromegaly have preserved BMD despite the presence of hypogonadism.
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    A risk assessment tool (OsteoRisk) for identifying Latin American women with osteoporosis
    (Springer, 2005-03-01) Sen, Shuvayu S.; Rives, Vincent P.; Messina, Osvaldo D.; Morales-Torres, Jorge; Riera, Gregorio; Angulo-Solimano, Juan M.; Marques Neto, João Francisco; Frisoli Junior, Alberto [UNIFESP]; Saenz, Ricardo Castro; Geling, Olga; Ross, Philip D.; Merck & Co Inc; Temple Univ; C Argerich Hosp; Hosp Aranda de la Parra; Univ Carabobo; Hosp Cent Fuerza Aerea; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de São Paulo (UNIFESP); Hosp Dr RA Calderon Guardia; Rutgers State Univ; Merck Res Labs
    OBJECTIVE: To develop a simple and easy-to-use tool for identifying osteoporotic women (femoral neck bone mineral density [BMD] T-scores <=-2.5) in Latin America.DESIGN: Retrospective study involving review of medical records.SETTING: Osteoporosis clinics in 6 Latin American countries.PATIENTS: Postmenopausal women ages >= 50 in Latin America who had femoral neck BMD measurements.MEASUREMENTS and MAIN RESULTS: A risk index was developed from 1,547 patients based on least square regression using age, weight, history of fractures, and other variables as predictors for BMD T-score. the final model was simplified by reducing the number of predictors; sensitivity and specificity were evaluated before and after reducing the number of predictors to assess performance of the index. the final model included age, weight, country, estrogen use, and history of fractures as significant predictors for T-score. the resulting scoring index achieved 91% sensitivity and 47% specificity. Simplifying the index by using only age and weight yielded similar performance (sensitivity, 92%; specificity, 45%). Three risk categories were identified based on OsteoRisk, the index using only age and body weight: high-risk patients (index <=-2; 65.6% were osteoporotic), moderate-risk patients (-2 < index <=1; 26.7% were osteoporotic), and low-risk patients (index > 1; 8% were osteoporotic). Similar results were seen in a validation sample of 279 women in Brazil.CONCLUSION: Age and weight alone performed well for predicting the risk of osteoporosis among postmenopausal women. the OsteoRisk is an easy-to-use tool that effectively targets the vast majority of osteoporotic patients in Latin America for evaluation with BMD.
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    Selective estrogen receptor modulators in chronic renal failure
    (Nature Publishing Group, 2003-06-01) Weisinger, Jose R; Heilberg, Ita Pfeferman [UNIFESP]; Hernandez, Eddy; Carlini, Raul; Bellorin-Font, Ezequiel; Univ Munich; Universidade Federal de São Paulo (UNIFESP); San Carlo Borromeo Hosp
    Background. In addition to renal osteodystrophy, postmenopausal women on dialysis could be at risk of osteoporosis. Hormone replacement therapy (HRT) could have beneficial effects as well as potentially serious risks, especially in uremic women, due to the pharmacokinetics of estradiol in renal failure. Therapeutic alternatives, such as the selective estrogen receptor modulators (SERMs), have shown the benefits of estrogen on bone and serum lipid levels, without its adverse effects on the breast and endometrium, in nonuremic women.Methods. Recent data on the effect of the SERM raloxifene in bone and lipid metabolism in osteoporotic postmenopausal women on dialysis is reviewed. Since the estrogen receptor (ER) gene has been suggested as a candidate marker for osteoporosis, we investigated whether ER polymorphism could have predicted the BMD response to raloxifene.Results. Hemodialyzed women on raloxifene demonstrated increased trabecular bone mineral density (BMD) and decreased bone resorption markers. Similarly, LDL-cholesterol values dropped significantly. ER gene polymorphism analysis of baseline BMD parameters did not differ between PP/xx or Pp/Xx groups. Nevertheless, patients on raloxifene with PP/xx genotypes, but not those with Pp/Xx, showed a higher trabecular BMD after one year on treatment, suggesting that homozygous women for P or x alleles of the ER have a better BMD response to raloxifene.Conclusion. Raloxifene and, most likely, other SERMs, could represent a good alternative to HRT in postmenopausal uremic women.
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    Vitamin D receptor alleles and bone mineral density in a normal premenopausal Brazilian female population
    (Associação Brasileira de Divulgação Científica, 1997-08-01) Lazaretti-Castro, Marise [UNIFESP]; Duarte-de-Oliveira, M.a.; Russo, E.m.k.; Vieira, J.g.h. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Laboratório Fleury
    Studies on the association between vitamin D receptor (VDR) polymorphism and bone mineral density (BMD) in different populations have produced conflicting results probably due to ethnic differences in the populations studied. The Brazilian population is characterized by a very broad genetic background and a high degree of miscegenation. Of an initial group of 164, we studied 127 women from the city of São Paulo, aged 20 to 47 years (median, 31 years), with normal menses, a normal diet and no history of diseases or use of any medication that could alter BMD. VDR genotype was assessed by PCR amplification followed by BsmI digestion of DNA isolated from peripheral leukocytes. BMD was measured using dual energy X-ray absorptiometry (Lunar DPX) at the lumbar site (L2-L4) and femoral neck. Most of the women (77.6%) were considered to be of predominantly European ancestry (20.6% of them reported also native American ancestry), 12.8% were of African-Brazilian ancestry and 9.6% of Asian ancestry, 41.0% (52) were classified as bb, 48.8% (62) as Bb and 10.2% (13) as BB. The BB, Bb and bb groups did not differ in age, height, weight, body mass index or age at menarche. Lumbar spine BMD was significantly higher in the bb group (1.22 ± 0.16 g/cm²) than in the BB group (1.08 ± 0.14; P<0.05), and the Bb group presented an intermediate value (1.17 ± 0.15). Femoral neck BMD was higher in the bb group (0.99 ± 0.11 g/cm²) compared to Bb (0.93 ± 0.12) and BB (0.90 ± 0.09) (P<0.05). These data indicate that there is a significant correlation between the VDR BsmI genotype and BMD in healthy Brazilian premenopausal females.
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    Vitamin D receptor gene polymorphism and bone mineral density in hypercalciuric calcium-stone-forming patients
    (Karger, 2002-01-01) Heilberg, I. P.; Teixeira, S. H.; Martini, L. A.; Boim, M. A.; Universidade Federal de São Paulo (UNIFESP)
    Reduced bone mineral density (BMD) and an increased risk of vertebral fracture have been reported in calcium-stone-forming (CSF) patients presenting with idiopathic hypercalciuria. We investigated the association between Bsml vitamin D receptor (VDR) polymorphism and BMD in 68 hypercalciuric CSF patients (35 males and 33 premenopausal females, mean age +/- SD = 39 +/- 10 years). BMD was measured at lumbar spine (L-2-L-4) and femur neck sites using dual energy X-ray absorptiometry. A 72-hour dietary record and a 24-hour urine sample were obtained from each patient to determine calcium intake and excretion. the allelic frequency found for the sample as a whole was 16% BB, 44% Bb and 40% bb. Mean BMD values did not significantly differ among BB, Bb and bb patients at L2-L4 (1.162 +/- 0.10, 1.133 +/- 0.11 and 1.194 +/- 0.19 g/cm(2), mean SD, respectively) or at neck sites (0.920 +/- 0.11, 0.931 +/- 0.15 and 0.982 +/- 0.15 g/cm(2), respectively). Calcium intake and excretion were also not significantly different among the three genotypes. Patients were then divided into two groups, normal BMD, T-score greater than or equal to -1 (n = 34) and low BMD, T-score <-1 (n = 34), to further evaluate the allele influence on previous bone loss. Despite a trend for a higher mean BMD at spine or neck sites for patients with one or two b alleles when compared to BB patients, the difference did not reach statistical significance. the distribution of BB, Bb and bb genotypes in the low-bone-mass group (15, 47 and 38%, respectively) was similar to that in the normal-bone-mass group (18, 41 and 14%, respectively). These data suggest that Bsml VDR polymorphism does not play an important role in the bone loss seen in hypercalciuric CSF patients. Copyright (C) 2002 S. Karger AG, Basel.