R M R Pereira

University of São Paulo, San Paulo, São Paulo, Brazil

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Publications (49)126.12 Total impact

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    ABSTRACT: Premenopausal women with systemic lupus erythematosus (SLE) have a higher prevalence of low bone mineral density and vertebral fractures. Multiple genetic loci for osteoporotic fracture were identified in recent genome-wide association studies. This study provides a novel data demonstrating that receptor activator of NF-κB ligand (RANKL)/osteoprotegerin (OPG) polymorphisms likely plays an important role in the bone remodeling process in SLE premenopausal women. The purpose of this study was to evaluate single-nucleotide polymorphisms (SNPs) of the RANKL, RANK, and OPG genes in premenopausal SLE patients and their association with sRANKL and OPG serum levels, vertebral fractures, and bone mineral density (BMD). A total of 211 premenopausal SLE patients (American College of Rheumatology (ACR) criteria) and 154 healthy controls were enrolled. SNPs of RANKL 290A>G (rs2277438), OPG 1181G>C (rs2073618), 245T>G (rs3134069), 163A>G (rs3102735), and RANK A>G (rs3018362) were obtained by real-time PCR. sRANKL/OPG serum levels were determined by ELISA. BMD and vertebral fractures were evaluated by dual-energy X-ray absorptiometry (DXA). SLE patients and controls had similar frequencies of the RANKL 290 G allele (p = 0.94), OPG 1181 C allele (p = 0.85), OPG 245 G allele (p = 0.85), OPG 163 G allele (p = 0.78), and RANK G allele (p = 0.87). Further analysis of the SLE patients revealed that the frequency of the RANKL 290 G allele was lower in patients with fractures than that in patients without fractures (28.1 vs 46.9 %, p = 0.01). In addition, the frequency of the OPG 245 G allele was higher in patients with low BMD than that in patients with normal BMD (31.4 vs 18.1 %, p = 0.04). No association of OPG 1181 G>C, OPG 163 A>G, and RANK A>G SNPs with BMD/fractures was found. Additionally, no association was observed between RANKL/OPG/RANK SNPs and sRANKL/OPG serum levels. Our study provides novel data demonstrating that RANKL/OPG genetic variations appear to play a role in bone remodeling, particularly in its major complication, fracture, in premenopausal patients with SLE.
    Osteoporosis International 01/2015; 26(5). DOI:10.1007/s00198-015-3029-x · 4.17 Impact Factor
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    ABSTRACT: We performed concomitant evaluation of clinical, laboratory, and bone mineral density (BMD) parameters as potential risk factors for falls in a population-based prospective cohort of older adults, since previous studies have focused mostly in clinical risk factors. Loss of hip BMD and persistent hypovitaminosis D were associated with recurrent falls in community-dwelling elderly. Few studies have performed a concomitant evaluation of clinical data, laboratory bone parameters, and bone mineral density (BMD) to determine more accurately the contribution of each of these variables to risk of falls in elderly persons. We investigated the association between bone parameters and recurrent falls in a population-based prospective cohort of community-dwelling older adults. A total of 705 elderly individuals (448 women, 257 men) were evaluated with clinical data, BMD, and laboratory bone tests at baseline and after a mean follow-up of 4.3 ± 0.8 years. Individuals with recurrent falls (≥2 falls in the previous year from the date of the second evaluation) were considered chronic fallers. Logistic regression models were used to identify independent risk factors for recurrent falls. The frequency of chronic fallers was 16.5 %. In multivariate analyses, risk factors for recurrent falls were visual impairment (odds ratio (OR) = 2.49, 95 % confidence interval (CI) 1.30-4.74, p = 0.006), use of psychotropic drugs (OR = 2.47, 95 % CI 1.37-4.49, p = 0.003), clinical fracture (OR = 2.78, 95 % CI 1.48-5.20, p = 0.001), persistently low 25-hydroxyvitamin D (25OHD) (<20 ng/mL) (OR = 1.71, 95 % CI 1.10-2.64, p = 0.016), and loss of total hip BMD during the study (OR = 1.21, 95 % CI 1.17-1.25, p = 0.035 for each 4 % decrease). In addition to traditional clinical risk factors for falls, loss of hip BMD and hypovitaminosis D were associated with recurrent falls in community-dwelling elderly persons. Thus, recognizing these factors is essential to preventing falls and improving the outcomes of this population.
    Osteoporosis International 01/2015; 26(5). DOI:10.1007/s00198-014-3024-7 · 4.17 Impact Factor
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    ABSTRACT: Summary Evidence suggests that creatine may have some beneficial effects on bone. The study aimed to investigate the effects of exercise alone or combined with creatine on bone health in ovariectomized rats. Findings show that exercise, but not creatine, has an important role in improving bone health. Introduction The aim of this study was to investigate the effects of exercise training alone or combined with creatine supplementation on bone health parameters in ovariectomized rats. Methods Wistar rats were randomly allocated into one of five groups: (i) sham-operated, (ii) ovariectomized non-trained placebo-supplemented, (iii) ovariectomized non-trained creatine-supplemented, (iv) ovariectomized exercise-trained placebo-supplemented, and (v) ovariectomized exercise-trained creatine-supplemented. Downhill running training and/or creatine supplementation (300 mg/kg body weight) were administered for 12 weeks. Bone mineral content (BMC), bone mineral density (BMD), and biomechanical and histomorphometric parameters were assessed. Results No interaction effects were observed for BMC and BMD at whole body, femur, and lumbar spine (p > 0.05). Importantly, a main effect of training was detected for whole body BMC and BMD (p = 0.003 and p p = 0.005 and p p p p p p = 0.046), indicating beneficial effects of exercise training on bone strength. Neither a main effect of supplementation nor an interaction effect was detected for biomechanical parameters (p > 0.05). No main or interaction effects were observed for any of the histomorphometric parameters evaluated (p > 0.05). Conclusions Exercise training, but not creatine supplementation, attenuated ovariectomy-induced bone loss in this rat model.
    Osteoporosis International 01/2015; 26(4). DOI:10.1007/s00198-014-3017-6 · 4.17 Impact Factor
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    ABSTRACT: We ascertained the incidence and predictors of radiographic vertebral fracture in a Brazilian elderly cohort, since no data in this field have been reported in low-income countries. This is the first population-based study to demonstrate the high frequency of vertebral fracture in elderly Latin Americans. Age, prior fracture, BMD, and bone turnover were predictors of fracture.
    Annals of the Rheumatic Diseases 08/2014; 73(Suppl 2). DOI:10.1007/s00198-014-2821-3 · 9.27 Impact Factor
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    ABSTRACT: We evaluated the effects of recreational football training combined with calorie-restricted diet (football + diet) vs calorie-restricted diet alone (diet) on aerobic fitness, lipid profile, and insulin resistance indicators in type 2 diabetes (T2D) patients. Forty-four T2D patients aged 48-68 years (27 females, 17 males) were randomly allocated to the football + diet group (FDG; n = 22) or to the diet group (DG; n = 22), of whom 19 FDG and 15 DG subjects completed the study. The football training was performed for 3 × 40 min/week for 12 weeks. Dual-energy X-ray absorptiometry scanning, treadmill testing, and fasting blood samplings were performed pre and post-intervention. After 12 weeks, maximal oxygen uptake (VO2max ) was elevated (P < 0.05) by 10 ± 4% in FDG but not in DG (-3 ± 4%, P < 0.05). After 12 weeks, reductions in blood triglycerides (0.4 ± 0.1 mmol/L), total cholesterol (0.6 ± 0.2 mmol/L), low-density lipoprotein, and very low-density lipoprotein levels were observed only in FDG. Fat mass decreased (P < 0.05) by 3.4 ± 0.4 kg in FDG and 3.7 ± 0.4 kg in DG. The lower (P < 0.05) glucagon and homeostatic model assessment of insulin resistance indicated an improvement in insulin sensitivity in FDG. In conclusion, football combined with restricted diet was effective in enhancing VO2max , reducing total cholesterol and triglycerides, and increasing insulin sensitivity, potentially providing better tools for the prevention of T2D complications than diet alone.
    Scandinavian Journal of Medicine and Science in Sports 08/2014; 24 Suppl 1:57-65. DOI:10.1111/sms.12258 · 3.17 Impact Factor
  • Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):335-336. DOI:10.1136/annrheumdis-2014-eular.5061 · 9.27 Impact Factor
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    ABSTRACT: Sixty female Wistar rats were submitted to a daily intake of ration doped with uranium from weaning to adulthood. Uranium in bone was quantified by the SSNTD (solid state nuclear track detection) technique, and bone mineral density (BMD) analysis performed. Uranium concentration as a function of age exhibited a sharp rise during the first week of the experiment and a drastic drop of 70% in the following weeks. Data interpretation indicates that uranium mimics calcium. Results from BMD suggest that radiation emitted by the incorporated Uranium could induce death of bone cells.
    Applied radiation and isotopes: including data, instrumentation and methods for use in agriculture, industry and medicine 08/2013; 82C:105-110. DOI:10.1016/j.apradiso.2013.07.033 · 1.06 Impact Factor
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    ABSTRACT: Sarcopenia is an aging syndrome that can be characterized by many criteria adjusted or not by fat mass. This study suggested that the optimal criteria should be selected according to body mass index (BMI) in older men and identified age, BMI, race, smoking, physical activity, hip bone mineral density (BMD) as risk factors for this syndrome. This study aims to analyze the prevalence of sarcopenia and associated risk factors using appendicular skeletal mass (ASM)/height(2) and ASM adjusted for total fat mass criteria in older men from community. Three hundred ninety-nine men were included and answered a questionnaire about lifestyle and medical history. Individuals were classified by their BMI using the classification adjusted by age. Body composition and bone mineral density were measured by dual X-ray absorptiometry. Sarcopenia was classified according to both criteria. Logistic regression models were used to analyze risk factors associated with sarcopenia. The mean BMI was 26.46 kg/m(2): 12.5 % underweight, 43.6 % normal, and 43.9 % overweight/obese. Fifty-four (13.5 %) were considered sarcopenic by ASM/height(2) and 79 (19.8 %) by ASM adjusted for fat (p = 0.001). Fifty-one (12.8 %) individuals had discordant sarcopenia classification: 13 were classified only by ASM/height(2) and 38 only by ASM adjusted for fat. Of the 13 subjects classified as sarcopenic only by ASM/height(2), 84.6 % (11/13) were underweight and solely one (7.7 %) was considered overweight/obese. In contrast, of those 38 older men classified as sarcopenic only by ASM adjusted for fat, none were underweight and 53 % (20/38) were overweight/obese. Subjects classified as sarcopenic according to both criteria had the same risk factors in the final model analyses (age, BMI, race, smoking, physical activity, hip BMD; p < 0.05). This study suggested that the optimal criteria for sarcopenia should be selected according to BMI in community-dwelling older men.
    Osteoporosis International 07/2013; 25(2). DOI:10.1007/s00198-013-2455-x · 4.17 Impact Factor
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    ABSTRACT: Objective: To date no studies have evaluated the effect of osteoporosis condition on response of periodontitis treatment. The aim of the present control clinical trial was to evaluate the effect of non-surgical periodontal therapy on clinical periodontal parameters in post-menopausal women with periodontitis and osteoporosis Method: 35 women diagnosed with slight to moderate periodontitis were divided in two groups: osteoporotic (OST, n=18) and non-osteoporotic (CTRL, n=17) women. The effect of non-surgical periodontal treatment was assessed by measuring the changes in plaque (PI) and bleeding on probing (BOP) scores, probing depth (PD) and clinical attachment level (CAL) during one year (1, 3, 6, 9 and 12 months) Result: Only sites with baseline PD≥ 4mm were used for statistical analysis. The periodontal therapy resulted in significant improvements. At the end of twelve months, the mean PI, BOP, PD and CAL for the OST group were 27.2 ±17.7, 2.6 ±3.0, 2.5 ±0.7, 3.6 ±1.3, respectively, versus 30.2 ±17.0, 8.4 ±10.6, 3.2 ±1.2, 4.3 ±1.5, respectively, for the control group. Using an individual-based analysis and Student ttest for unpaired and paired observations (significance of differences between and within groups, respectively), women in CTRL group showed enhanced in BOP and PD scores (p<0.05) over a period of 12 months compared with those in OST group but no significant difference was found between groups for PD and CAL difference changes (p>0,05) Conclusion: The results of this study indicated that although periodontal therapy was effective and determined a statistically significant PD reduction and CAL gain in women with slight to moderate periodontitis, the effect of osteoporosis condition on changes in clinical parameters could not be observed after one year post non-surgical periodontal treatment.
    IADR/AADR/CADR General Session and Exhibition 2013; 03/2013
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    ABSTRACT: Objective: The aim of this study was to evaluate bone turnover alterations after alendronate withdrawal and its influence on dental implants osseointegration. Method: Seventy female Wistar rats were divided into 2 groups that started receiving on day 0 either saline (control group, CTL, n = 10) or alendronate 1mg/kg (test group, n = 60), once weekly, for 120 days. At day 120 alendronate treatment were suspended in 50 animals. A titanium implant was placed in the left rat tibia on days 0, 7, 14, 28, 45 after alendronate withdrawal (n=10, each period). Moreover on day 120 the implants were placed in CTL group and a group that had not suspended the treatment until the end of the experiment (n=10). Bone mineral density (BMD) of femur, serum concentration of bone turnover markers (BTM) as osteocalcin (OCN), procollagen type 1 amino-terminal propeptide (P1NP) and c-terminal telopeptide (CTX) were assessed for all groups. The bone tissue around implants was evaluated regarding bone to implant contact (BIC) and bone area fraction (BAFO). Result: An increased femur BMD was observed for all groups submitted to alendronate treatment. BTM decreased in test group, but some improvement was observed in the initial periods after treatment withdrawal, although BTM showed another decrease in late periods. There was no statically significant difference for BIC and BAFO among groups. Conclusion: Alendronate suspension showed a progressive increase in BMD of femur. Although no difference was shown in histometric parameters, the relative improvement in BTM due to the residual effect of the drug therapy presents the necessity of the evaluation of bone quality in order to assess the real influence on osseointegration.
    IADR General Session 2012; 06/2012
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    ABSTRACT: Objective: Several risk indicators for tooth loss have been identified. Recent studies suggest that tooth loss may be associated with postmenopausal osteoporosis. The association of postmenopausal women with tooth loss was investigated in this cross-sectional study. Method: One hundred eight subjects were interviewed using a structured written questionnaire and clinically examined. Bone mineral density (BMD) measured using dual-energy X-ray absorptiometry (DXA) was assessed at the lumbar spine, femoral neck, and total femur. No women had other bone diseases, such as cancer and bone metastases; no one was taking any medication that affect bone metabolism (exception oestrogen) and no one had femur or vertebral osteoporotic fractures. Result: The mean of tooth loss of the total sample was 10.25. According to the WHO criteria, the women classified with T-score osteoporosis at the lumbar spine, femoral neck and total femur were 48 (26.67%), 40 (22.22%) and 21 (11.67%), respectively. The bivariate analysis there were significant correlations between tooth loss and age, family income, educational level, dental care, tooth floss and osteoporosis on total femur (p < 0.05). In the multivariate analysis using lumbar spine as independent variable it was found a significant association between tooth loss and age of beginning of smoke of 16-20 years even when it was adjusted by age, educational level, income, years of menopause and hormone therapy, but no significant association was found for 21 years and more. No was significant association between tooth loss for femoral neck, but when total femur was independent variable it was found significantly association between tooth loss and dental care and use tooth floss even when it was adjusted by age, educational level, income, years of menopause and hormone therapy. Conclusion: We have established a significant association between osteoporosis of the lumbar spine and femoral neck and tooth loss.
    IADR General Session 2012; 06/2012
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    ABSTRACT: The criteria most used for the definition of sarcopenia, those based on the ratio between the appendicular skeletal muscle mass (ASM) and the square of the height (h(2)) underestimate prevalence in overweight/obese people whereas another criteria consider ASM adjusted for total fat mass. We have shown that ASM adjusted for fat seems to be more appropriate for sarcopenia diagnosis. INTRODUCTION: Since the prevalence of overweight and obesity is a growing public health issue, the aim of this study was to evaluate the prevalence and risk factors associated with sarcopenia, based on these two criteria, among older women. METHODS: Six hundred eleven community-dwelling women were evaluated by specific questionnaire including clinical data. Body composition and bone mineral density were evaluated by dual X-ray absorptiometry. Logistic regression models were used to identify factors independently related to sarcopenia by ASM/h(2) and ASM adjusted for total fat mass criteria. RESULTS: The prevalence of overweight/obesity was high (74.3 %). The frequency of sarcopenia was lower using the criteria of ASM/h(2) (3.7 %) than ASM adjusted for fat (19.9 %) (P < 0.0001). We also note that less than 5 %(1/23) of sarcopenic women, according to ASM/h(2), had overweight/obesity, whereas 60 % (74/122) of sarcopenic women by ASM adjusted for fat had this complication. Using ASM/h(2), the associated factors observed in regression models were femoral neck T-score (OR = 1.90; 95 % CI 1.06-3.41; P = 0.03) and current alcohol intake (OR = 4.13, 95 % CI 1.18-14.45, P = 0.03). In contrast, we have identified that creatinine (OR = 0.21; 95 % CI 0.07-0.63; P = 0.005) and the White race (OR = 1.81; 95 % CI 1.15-2.84; P = 0.01) showed a significant association with sarcopenia using ASM adjusted for fat. CONCLUSIONS: In women with overweight/obesity, ASM adjusted for fat seems to be the more appropriate criteria for sarcopenia diagnosis. This finding has relevant public health implications, considering the high prevalence of overweight/obesity in older women.
    Osteoporosis International 05/2012; 24(2). DOI:10.1007/s00198-012-2002-1 · 4.17 Impact Factor
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    ABSTRACT: We compared outcomes of alveolar hemorrhage (AH) in juvenile (JSLE) and adult onset SLE (ASLE). From 263 JSLE and 1522 ASLE, the AH occurred in 13 (4.9%) and 15 (1.0%) patients, respectively (p < .001). Both groups had comparable disease duration (2.6 ± 3.0 vs. 5.6 ± 7.0 years, p = .151) and median SLEDAI scores [17.5 (2 to 32) vs. 17.5 (3 to 28), p = 1.000]. At AH onset, a higher frequency of JSLE were already on a high prednisone dose ( > 0.5 mg/kg/day) compared to ASLE (54% vs. 15%, p = .042). The mean drop of hemoglobin was significantly lower in JSLE (2.9 ± 0.9 vs. 5.5 ± 2.9 g/dL, p = .006). Although treatments with methylprednisolone, plasmapheresis, intravenous immunoglobulin and cyclophosphamide were similar in both groups (p > .050), regarding outcomes, there was a trend in high frequency of mechanical ventilation use (85% vs. 47%, p = .055) and also significant mortality (69% vs. 13%, p = .006) in JSLE compared to ASLE. The sepsis frequency was comparable in both groups (50% vs. 27%, p = .433). We have identified that AH in JSLE has a worse outcome most likely related to respiratory failure. The AH onset in JSLE already treated with high-dose steroids raises the concern of inadequate response to this treatment and reinforces the recommendation of early aggressive alternative therapies in this group of patients.
    Lupus 03/2012; 21(8):872-7. DOI:10.1177/0961203312441047 · 2.48 Impact Factor
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    ABSTRACT: Objectives: To determine risk indicators of tooth loss in a post-menopausal Brazilian women sample. Methods: Two hundred and twelve subjects from 50 to 78 years old ( mean 59,18 years) received a full mouth clinical (DFT index) after signing the informed consent form. Moreover, they were interviewed using a structured written questionnaire to collect information on enviromental, biological and demographic variables. Bone mineral density was measured through Dual Energy Absorptiometry X-ray (total hip, femoral neck and lumbar spine) using Hologic QDR-4500 scanner. T-score of ≤ -2.5 SD was adopted for osteoporosis diagnosis (WHO, 1994). Panoramic radiographs were obtained using Kodak 8000 Digital Panoramic System and the mandibular cortical index (Klemetti, 1994) was assessed. Diabetes was determined by plasma glucose concentration (PGC≥ 200 mg/dl) and body mass index was assessed in kg/m2 . Results: Of the 212 subjects (77.09 % response rate), 19 were edentulous (8.96%), 90.57% had lost at least two teeth and 48.11% had lost more than 8 teeth. The mean number of teeth lost was 10.86 ( 8.77). First upper molars were the most commonly missing teeth. In a multiple logistic regression analysis based on theoretical hierarchical model of tooth loss, having more than 8 teeth lost was associated with age (OR=1.69, 95% CI=1.16-2.46), years of study(OR=0.40, 95% CI=0.21-0.74) and income(OR=0.39, 95% CI=0.21-0.73) in the final model. Conclusion: Increased age, limited years of scholarity and lower income were associated to extensive tooth loss. Grant number 2008/10797-5 from State of Sao Paulo Foundation for Research Support
    IADR General Session 2011; 03/2011
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    ABSTRACT: Osteoporosis is characterized by loss of bone mass, leading to an increased bone fragility and risk of fractures. In order to treat this condition, alendronate is used as osteoclastic activity inhibitor, suppressing bone resorption. Objectives: This study investigated the effects of alendronate on bone biomechanical properties in a rat model. Methods: Forty-two female Wistar rats, approximately 90 days old, were randomly divided into 3 groups: sham surgery (SHAM, n=14), ovariectomy (OVX, n=14) and ovariectomy followed by alendronate therapy, 50 g/kg every other day (OVX+ALE, n=14). The animals were euthanized 90 days post-ovariectomy or sham surgery. Femur was then evaluated by Dual Energy X-ray Absorptiometry (DXA) to assess bone mineral density (BMD) and bone mineral content (BMC). Femurs also were tested mechanically for bone stiffness and resistance to fracture induced by traction test. Experimental groups were compared using KruskalWallis and Dunn's post hoc test. Results: Ovariectomized animals treated with alendronate showed a rise for all evaluated properties with statistically significant difference in relation to the other groups of the study. On the other hand, OVX groups presented decreased values for BMC, BMD and the mechanical properties, with statistical significant difference in relation to SHAM and OVX+ALE. Conclusion: Alendronate treatment improved bone properties and decreased bone fragility induced by ovariectomy.
    IADR General Session 2011; 03/2011
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    ABSTRACT: To compare prognosis parameters and arterial site involvement in Takayasu arteritis (TA) patients with disease onset at age ≤ 18 and ≥ 21 years. Sixty-two TA patients [American College of Rheumatology (ACR) and European League Against Rheumatism/Paediatric Rheumatology European Society (EULAR/PreS) criteria] were enrolled consecutively and divided into two groups according to disease onset, and matched for disease duration: juvenile TA patients aged ≤ 18 years (n = 17) and adult TA patients aged ≥ 21 years (n = 45). The protocol evaluated the following prognostic factors: aortic insufficiency, ischaemic retinopathy, severe systemic hypertension, and arterial aneurysms. In addition, death and remission [defined as stable disease > 6 months (no complaints without immunosuppressive and prednisone use) and normal erythrocyte sedimentation rate (ESR)] were also analysed. Stenosis and aneurisms were investigated by magnetic angioresonance or arteriography and angiographic classification was defined according to Hata criteria. Mean disease duration was similar in the juvenile and adult TA groups (13.50 ± 10.73 vs. 13.80 ± 7.17 years, p = 0.092) and a trend to a lower predominance of female gender in the juvenile TA group was observed (64.71% vs. 88.89%, p = 0.056). The prognosis was distinct in the two groups, with juvenile patients having a lower frequency of disease remission (23.53% vs. 55.56%, p = 0.04) and a significantly higher frequency of aneurism (41.0% vs. 11.1%, p = 0.013). Almost half of the juvenile TA patients had left renal stenosis, a frequency significantly higher than in the adult TA group (41.18% vs. 11.10%, p = 0.013), whereas the stenosis frequency was comparable in all other vascular sites evaluated. No differences were observed between the two groups regarding the frequency of aortic insufficiency, ischaemic retinopathy, severe systemic arterial hypertension, vascular procedures, and mortality. Angiographic classification revealed a similar distribution of arterial involvement in both groups (p > 0.05). Juvenile TA patients have distinct characteristics, with a peculiar renal vascular involvement, the presence of aneurism, and a more refractory disease compared with adult TA patients.
    Scandinavian journal of rheumatology 11/2010; 39(6):506-10. DOI:10.3109/03009741003742730 · 2.61 Impact Factor
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    ABSTRACT: The aim of this study was to analyze vitamin D levels and their association with bone mineral density and body composition in primary antiphospholipid syndrome. For this cross-sectional study 23 premenopausal women with primary antiphospholipid syndrome (Sapporo criteria) and 23 age- and race-matched healthy controls were enrolled. Demographic, anthropometric, clinical and laboratorial data were collected using clinical interview and chart review. Serum 25-hydroxyvitamin D levels, parathormone, calcium and 24-hour urinary calcium were evaluated in all subjects. Bone mineral density and body composition were studied by dual X-ray absorptiometry. The mean age of patients and controls was 33 years. Weight (75.61 [20.73] vs. 63.14 [7.34] kg, p = 0.009), body mass index (29.57 [7.17] vs. 25.35 [3.37] kg, p = 0.014) and caloric ingestion (2493 [1005.6] vs. 1990 [384.1] kcal/day, p = 0.03) were higher in PAPS than controls. All PAPS were under oral anticoagulant with INR within therapeutic range. Interestingly, biochemical bone parameters revealed lower levels of 25-hydroxyvitamin D [21.64 (11.26) vs. 28.59 (10.67) mg/dl, p = 0.039], serum calcium [9.04 (0.46) vs. 9.3 (0.46) mg/dl, p = 0.013] and 24-hour urinary calcium [106.55 (83.71) vs. 172.92 (119.05) mg/d, p = 0.027] in patients than in controls. Supporting these findings, parathormone levels were higher in primary antiphospholipid syndrome than in controls [64.82 (37.83) vs. 44.53 (19.62) pg/ml, p = 0.028]. The analysis of osteoporosis risk factors revealed that the two groups were comparable (p > 0.05). Lumbar spine, femoral neck, total femur and whole body bone mineral density were similar in both groups (p > 0.05). Higher fat mass [28.51 (12.93) vs. 20.01 (4.68) kg, p = 0.005] and higher percentage of fat [36.08 (7.37) vs. 31.23 (4.64)%, p = 0.010] were observed in PAPS in comparison with controls; although no difference was seen regarding lean mass. In summary, low vitamin D in primary antiphospholipid syndrome could be secondary to higher weight and fat mass herein observed most likely due to adipocyte sequestration. This weight gain may also justify the maintenance of bone mineral density even with altered biochemical bone parameters.
    Lupus 10/2010; 19(11):1302-6. DOI:10.1177/0961203310372938 · 2.48 Impact Factor
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    ABSTRACT: Magnesium (Mg) deficiency has been associated to increased risk of bone mass loss. Objective: This study evaluated the influence of a dietary magnesium restriction on systemic bone mass loss, bone mechanical characteristics and quantity around osseointegrated implants. Methods: The sample was comprised of 30 rats that received a titanium implant in both tibial metaphysis. After implant osseointegration, period of 60 days, the sample was divided into 2 groups (n=15) according to dietary magnesium content. The control group (CTL) received a standard diet with recommended amount of Mg while the test group (Mg) had a depletion of 90% of the recommended amount of Mg on diet. Serum concentrations of Mg and calcium were measured at sacrifice, 150 days after the implant placement. Systemic bone mass was evaluated by bone densitometry of the lumbar vertebrae and femur. The effect on biomechanical characteristics was verified by the resistance of the bone tissue to the removal torque of the osseointegrated implants. Also, bone histomorphometry for bone to implant contact, total bone area and bone eroded surface between the threads were evaluated in nondecalcified sections. Results: Magnesium deficiency was confirmed by the lower levels of magnesium serum concentrations. Densitometry and implant removal torque analysis showed a statistically significant decrease for Mg group (p<0.05) in relation to CTL group. Histomorphometrical analysis showed no statistically significant difference between groups. Conclusion: Within study limitations, it was concluded that severe dietary Mg restriction showed a negative influence on systemic bone loss and biomechanical characteristics of bone tissue around osseointegrated implants in rats. On the other hand it didn't alter the quantity of bone around titanium implants, suggesting that magnesium deficiency might impair the quality of bone tissue.
    IADR General Session 2010; 07/2010
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    ABSTRACT: The prevalence and risk factors of radiographic vertebral fracture were determined among Brazilian community-dwelling elderly. Vertebral fractures were a common condition in this elderly population, and lower hip bone mineral density was a significant risk factor for vertebral fractures in both genders. The aim of the study was to estimate the prevalence of radiographic vertebral fracture and investigate factors associated with this condition in Brazilian community-dwelling elderly. This cross-sectional study included 943 elderly subjects (561 women and 382 men) living in São Paulo, Brazil. Thoracic and lumbar spine radiographs were obtained, and vertebral fractures were evaluated using Genant's semiquantitative method. Bone mineral density (BMD) was measured by dual X-ray absorptiometry, and bone biochemical markers were also evaluated. Female and male subjects were analyzed independently, and each gender was divided into two groups based on whether vertebral fractures were present. The prevalence of vertebral fracture was 27.5% (95% CI 23.8-31.1) in women and 31.8% in men (95% CI 27.1-36.5) (P = 0.116). Cox regression analyses using variables that were significant in the univariate analysis showed that age (prevalence ratio = 1.03, 95% CI 1.01-1.06; p = 0.019) and total femur BMD (PR = 0.27, 95% CI 0.08-0.98; p = 0.048) were independent factors in predicting vertebral fracture for the female group. In the male group, Cox regression analyses demonstrated that femoral neck BMD (PR = 0.26, 95% CI 0.07-0.98; p = 0.046) was an independent parameter in predicting vertebral fractures. Our results suggest that radiographic vertebral fractures are common in Brazilian community-dwelling elderly and that a low hip BMD was an important risk factor for this condition in both genders. Age was also significantly correlated with the presence of vertebral fractures in women.
    Osteoporosis International 05/2010; 22(2):711-9. DOI:10.1007/s00198-010-1258-6 · 4.17 Impact Factor
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    ABSTRACT: To evaluate age at menarche, menstrual cycles and hormone profile in juvenile dermatomyositis (JDM) patients and controls. Twelve consecutive JDM patients were compared to 24 age-matched healthy subjects. Age at menarche and age of maternal menarche were recorded. Menstrual cycle was evaluated prospectively for 6 consecutive months and the mean cycle length and flow were calculated. The hormone profile was collected on the last menstrual cycle. Demographic data, clinical features, muscle enzymes, JDM scores and treatment were analysed. The median of current age of JDM patients and controls was similar (18 vs. 17 years, p=0.99). The median age at menarche of the JDM patients was higher than in the control group (13 vs. 11 years, p=0.02) whereas the median age of maternal menarche was alike in both groups (12 vs. 13 years, p=0.67). Menstrual disturbances were not observed, except for one patient who had longer length of menstrual cycle. The median of follicle stimulating hormone (FSH) was significantly higher in JDM patients compared to controls (4.5 vs. 3.0 IU/L, p=0.02) and none of them had premature ovarian failure (POF). The median of progesterone was significantly lower in JDM patients (0.3 vs. 0.7 ng/mL, p=0.01) with a higher frequency of decreased progesterone compared to controls (75% vs. 29%, p=0.01). Our study identifies in JDM patients delayed menarche with normal cycles and low follicular reserve. The decreased progesterone levels may suggest an underlying subclinical corpus luteum dysfunction in this disease.
    Clinical and experimental rheumatology 01/2010; 28(4):571-5. · 2.97 Impact Factor