Influência da obesidade sobre a prevalência de osteoporose e fraturas por baixo impacto em mulheres: análise de dois estudos epidemiológicos brasileiros
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Data
2015-12-06
Autores
Castro, Bruna Aurora Nunes Cavalcante [UNIFESP]
Orientadores
Pinheiro, Marcelo de Medeiros [UNIFESP]
Tipo
Dissertação de mestrado
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Contexto: Diversos estudos têm demonstrado o efeito protetor do peso corporal sobre o risco de osteoporose (OP) e de fraturas (Fx) por baixo impacto. No entanto, mais recentemente, tem sido verificada maior taxa de fraturas por fragilidade óssea, especialmente dos membros inferiores, em indivíduos com sobrepeso e obesidade. Objetivos: Determinar a prevalência de Fx por baixo impacto e OP em mulheres, de acordo com a estratificação pelo IMC. Além disso, verificar a relação entre o elevado IMC, OP e Fx por baixo impacto, bem como o desempenho da ferramenta SAPORI (SAo Paulo Osteoporosis Risk Index) para a identificação de mulheres com baixa massa óssea em cada categoria de IMC. Pacientes e Métodos: Foi analisado um banco de dados que incluiu a população de dois grandes estudos brasileiros, totalizando 6.182 mulheres com idade superior a 40 anos, provenientes de unidades básicas de saúde da área metropolitana de São Paulo. Todas elas responderam questionário detalhado sobre os fatores clínicos de risco (FCR) para OP e Fx, bem como realizaram a densitometria óssea da coluna lombar e fêmur proximal (DPX NT, GE-Lunar). Foi realizada a estratificação pelo IMC, de acordo com as categorias da Organização Mundial de Saúde (OMS), para se avaliar a prevalência dos FCR, OP e Fx na população estudada. Foram criados modelos de regressão logística multivariada para estabelecer a associação entre OP e Fx por baixo impacto com a DMO e os FCR. Além disso, foi verificada a acurácia da ferramenta SAPORI para o rastreamento de baixa massa óssea de acordo com as categorias de IMC. Resultados: A prevalência de OP em mulheres com sobrepeso e obesidade foi de 33,6% e 20,8%, respectivamente. No entanto, não houve diferença na prevalência de Fx por baixo impacto entre as categorias de IMC (baixo peso=13,7%, peso normal=12,3%, sobrepeso=11,8% e obesidade=12,7%; p=0,81). Observou-se que o aumento do IMC desempenhou papel protetor para o diagnóstico de OP densitométrica (OR=0,89; IC95% 0,88-0,90; p<0,001), mas não para a ocorrência de Fx por baixo impacto. A chance de Fx de fêmur foi menor em obesas comparadas a não obesas (OR=0,44; IC95% 0,20-0,97; p=0,03), entretanto não houve diferença nos demais sítios avaliados. Houve comprometimento significativo da sensibilidade da ferramenta SAPORI para identificar mulheres com baixa DMO no grupo de maior IMC. Conclusão: Nossos resultados mostraram que as medidas antropométricas, em particular o IMC, exercem impacto positivo sobre os valores de DMO em mulheres, mas não sobre a frequência de Fx por baixo impacto. Esses achados sugerem que fatores independentes da DMO possam estar implicados na maior fragilidade óssea observada em indivíduos com maior IMC.
Background: Several studies have demonstrated the protective effect of body weight on the risk of osteoporosis and low-impact fractures. However, more recently it has been observed higher rate of fractures due to bone fragility, especially of the lower limbs in overweight and obesity. Objectives: To determine the prevalence of low-impact Fx and OP in women, according to the stratification by BMI. Also, check the relationship between high BMI, OP and low-impact Fx and the performance of SAPORI tool (Sao Paulo Osteoporosis Risk Index) for identifying women with low bone mass in each BMI category. Patients and Methods: A database was analyzed which included the population of two large Brazilian epidemiological studies, totaling 6,182 women over the age of 40 years, from basic health units in the metropolitan area of São Paulo. They all answered detailed questionnaires about clinical risk factors (CRF) to OP and Fx and performed the bone density of the lumbar spine and proximal femur (DPX NT, GE-Lunar). The population stratification by BMI was performed according to the categories proposed by the World Health Organization (WHO) to assess the prevalence of CRF for OP and Fx in the population studied. Multivariate logistic regression models were created to establish the association between OP and low-impact Fx with BMD and CRF. In addition, the accuracy of SAPORI tool for screening low bone mass in accordance with the categories of BMI was verified. Results: The prevalence of OP in women with overweight and obesity was 33.6% and 20.8%, respectively. However, there was no difference in the prevalence of low-impact Fx between BMI categories (low weight = 13.7% = 12.3% normal weight, overweight and obesity = 11.8% = 12.7%; p = 0.81). It was observed that increasing BMI played protective role for the diagnosis of densitometric OP (OR = 0.89; 95% CI 0.88 to 0.90; p <0.001), but not for the occurrence of low impact Fx. The chance of femur Fx was lower in obese compared to non-obese (OR = 0.44, 95% CI 0.20 to 0.97; p = 0.03), however there was no difference in the remaining sites. There was significant impairment of SAPORI tool sensitivity to identify women with low BMD in the higher BMI group. Conclusion: Our results showed that the anthropometric measures, particularly BMI, have a positive impact on BMD values in women, but not on the frequency of low-impact Fx. These findings suggest that factors independent of BMD may be involved in increased bone fragility observed in individuals with higher BMI.
Background: Several studies have demonstrated the protective effect of body weight on the risk of osteoporosis and low-impact fractures. However, more recently it has been observed higher rate of fractures due to bone fragility, especially of the lower limbs in overweight and obesity. Objectives: To determine the prevalence of low-impact Fx and OP in women, according to the stratification by BMI. Also, check the relationship between high BMI, OP and low-impact Fx and the performance of SAPORI tool (Sao Paulo Osteoporosis Risk Index) for identifying women with low bone mass in each BMI category. Patients and Methods: A database was analyzed which included the population of two large Brazilian epidemiological studies, totaling 6,182 women over the age of 40 years, from basic health units in the metropolitan area of São Paulo. They all answered detailed questionnaires about clinical risk factors (CRF) to OP and Fx and performed the bone density of the lumbar spine and proximal femur (DPX NT, GE-Lunar). The population stratification by BMI was performed according to the categories proposed by the World Health Organization (WHO) to assess the prevalence of CRF for OP and Fx in the population studied. Multivariate logistic regression models were created to establish the association between OP and low-impact Fx with BMD and CRF. In addition, the accuracy of SAPORI tool for screening low bone mass in accordance with the categories of BMI was verified. Results: The prevalence of OP in women with overweight and obesity was 33.6% and 20.8%, respectively. However, there was no difference in the prevalence of low-impact Fx between BMI categories (low weight = 13.7% = 12.3% normal weight, overweight and obesity = 11.8% = 12.7%; p = 0.81). It was observed that increasing BMI played protective role for the diagnosis of densitometric OP (OR = 0.89; 95% CI 0.88 to 0.90; p <0.001), but not for the occurrence of low impact Fx. The chance of femur Fx was lower in obese compared to non-obese (OR = 0.44, 95% CI 0.20 to 0.97; p = 0.03), however there was no difference in the remaining sites. There was significant impairment of SAPORI tool sensitivity to identify women with low BMD in the higher BMI group. Conclusion: Our results showed that the anthropometric measures, particularly BMI, have a positive impact on BMD values in women, but not on the frequency of low-impact Fx. These findings suggest that factors independent of BMD may be involved in increased bone fragility observed in individuals with higher BMI.
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Citação
CASTRO, Bruna Aurora Nunes Cavalcante. Influência da obesidade sobre a prevalência de osteoporose e fraturas por baixo impacto em mulheres: análise de dois estudos epidemiológicos brasileiros. 2015. 52 f. Dissertação (Mestrado em Reumatologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.