No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
The burden of fractures in Brazil: A population-based study
Abstract
Introduction:
The elderly population is growing fast worldwide, and therefore, investigation of health outcomes peculiar to these individuals is a public health priority nowadays. The decade between 2000 and 2010 is denominated as the Bone and Joint Decade, and researchers are encouraged to quantity the burden of musculo-skeletal disorders worldwide. This is particularly relevant to developing countries, where the burden of these diseases is not well known. This study aims to evaluate the prevalence of fractures (lifetime and previous year) and its association with socio-demographic variables and medical diagnosis of osteoporosis.
Materials and methods:
Population-based cross-sectional study including a multiple-stage sample of individuals aged 20 years or more living in Pelotas, a southern Brazilian city. Both the lifetime prevalence of fractures and the proportion of fractures in the year prior to the interview were investigated. Sex, age, skin color, socioeconomic level, schooling level and medical diagnosis of osteoporosis were used as independent variables. After descriptive and crude analyses, a Poisson regression was carried out in order to provide prevalence ratios including adjustment for confounding.
Results:
The lifetime prevalence of fractures was 28.3%, and 2.3% of the individuals broke a bone in the year prior to the interview. Among men, most fractures were caused by sports practice and happened in leisure-time outside home. Among women, most fractures occurred inside home and were caused by falls. The lifetime prevalence of fractures was positively associated with male sex and white or mixed skin color. The prevalence of fractures in the year prior to the interview was greater among poor individuals and those with a medical diagnosis of osteoporosis. Among all fractures happened in older adults (60 years or more) in the 12 months prior to the interview, 83.3% were caused by falls.
Conclusions:
Data of this investigation might help policy makers to reduce the burden of fractures, particularly among women and older adults, by stimulating prevention against household falls and osteoporosis. Special attention should be given to the poorest individuals, who have a greater likelihood of developing several negative health outcomes and presented a higher risk of fractures in the present study.
... Foi realizado um estudo transversal de base populacional com amostra de 12.402 adultos e 6.624 idosos de 23 estados brasileiros. A prevalência de autorrelato de DM na população de adultos foi de 3,5% (IC95% 3,2-3,9), enquanto nos idosos foi de 16,9% (IC95% 15,(9)(10)(11)(12)(13)(14)(15)(16)(17)8). Em relação à prática de AF observou-se que entre os indivíduos que relataram ter DM, 82,6% (IC95% 79,0-86,1) dos adultos e 88,2% (IC95% 86,3-90,1) dos idosos foram considerados insuficientemente ativos. ...
... A cross-sectional population-based was conducted with a sample of 12,402 adults and 6,624 elderly individuals from 23 Brazilian states. The prevalence of self-reported DM in the adult population was 3.5% (IC95% 3,(2)(3)9), while in the elderly one was 16.9% (IC95% 15,(9)(10)(11)(12)(13)(14)(15)(16)(17)8). Regarding the PA practice, it was observed that among individuals reporting diabetes, 82.6% (95% CI 79.0-86.1) of adults and 88.2% (95% CI 86.3-90.1) of the elderly were considered insufficiently active. ...
... 9,10,11 Neste sentido, a utilização da estratégia de autorrelato, tem demonstrado alta sensibilidade e especificidade, comprovando a validade de utilização do relato para essa doença e outros acontecimentos em saúde. 16,17 Para a definição de AF foi utilizado à seção 2 da versão longa do Questionário Internacional de Atividade Física (IPAQ) com as questões relacionadas ao domínio do lazer. 18,19 As variáveis independentes incluídas na análise foram: sexo; idade em anos (20 a 29, 30 a 39, 40 a 49, 50 a 59, 60 a 69, 70 a 79, 80 ou mais); cor da pele (branca e não branca), nível socioeconômico (NSE) (A,B,C, D e E), porte dos municípios (<10 mil, 10 a <20 mil, 20 a <100 mil, 100 mil a <1 milhão e 1milhão ou mais), atividade física (sim: ≥ 150min/sem e não: ≤ 149 min/sem), consulta médica no último ano por DM (sim e não), índice de massa corporal (IMC) (14 a 25: normal; 25,1 a 30: sobrepeso; 30,1 ou mais: obesidade) e diagnóstico médico referido de hipertensão arterial sistêmica (HAS) (sim e não). ...
... 00 inhabitants) located near the border with Argentina and Uruguay. Mothers were interviewed soon after delivery on socioeconomic, demographic, behavioral , gestational, and delivery characteristics and newborns were weighed using calibrated pediatric scales. Birth length was also measured, as well as gestational age using the Dubowitz method [11]. In –2005, all cohort members were sought for a follow-up visit. Several strategies were used to guarantee high follow-up rates. A census of all schools in Pelotas was carried out and children born in 1993 were linked with their cohort identification number. In addition, a census of all 100,000 households in the city was carried out in the search ...
... Initially focused on complex chronic disease indicators only, the DOHaD hypothesis has been expanded to mental health [14] and some researchers have suggested that musculoskeletal disorders could also be partially programmed by factors operating in early life [15, 16]. A previous study in Brazil found that 28.3% of the adults interviewed (aged 20 years or more) experienced at least one fracture during lifetime [17]. Consistently with that study, our analysis including adolescents showed that males were more likely than females to experience fractures. ...
... We found no other studies reporting such an association and confirmation by other researchers is essential. A previous study in the same city reported that adults in the lowest socioeconomic position category—based on household assets—were 3.2 times more likely than those in the highest category to have experienced a fracture within the 12 months prior to the interview [17]. Because the socioeconomic classification is based on assets acquired over several years rather than concurrent income, reverse causality is unlikely to explain this finding. ...
In a prospective cohort from Brazil, we evaluated the incidence of fractures from birth to early adolescence and examined risk factors for fractures. The incidence was 14.2% (95%CI 13.2, 15.2). Male sex, birth length, and maternal age at delivery were positively associated with the risk of fractures.
This study aims to evaluate the incidence of fractures from birth to 11 years of age and to explore the effect of early life variables on the risk of fractures.
All children (N = 5,249) born in 1993 in the city of Pelotas, Brazil were enrolled in a prospective birth cohort study. In 2004-2005, 87.5% of the cohort members were sought for a follow-up visit. History of fractures, including anatomic site and age of the fracture were asked to mothers.
The incidence of fractures from birth to 11 years of age was 14.2% (95%CI 13.2, 15.2). Out of the 628 subjects who experienced a fracture, 91 reported two and only 20 reported three or more fractures. Male sex, birth length, and maternal age at delivery were positively associated with the risk of fractures. No consistent associations were found for family income, maternal body mass index, smoking during pregnancy, and birth weight.
Birth length seems to have long-term effect on musculoskeletal health. The higher risk of fractures among children of older mothers needs to be confirmed by other studies. In accordance to the developmental origins of diseases, fractures seem to be, at least in part, programmed in early life.
... Kanis y colaboradores mostraron, con base en el análisis de individuos pertenecientes a tres cohortes (CaMos, DOES y el Rotterdam Study), que no había mayor riesgo para fracturas con ingestas menores a dos unidades diarias (una unidad definida en el reino unido como 8 g de alcohol puro), pero que por sobre este nivel se observa un mayor riesgo significativo para presentar cualquier tipo de fractura (RR = 1. 23 6 encontrando además un mayor riesgo no significativo entre individuos del sexo masculino respecto al femenino, lo que está en línea con nuestros resultados. Respecto a la actividad física, se puede cuestionar que los hábitos recabados por medio de una encuesta transversal no entreguen información respecto de la historia completa del individuo; aun así, estudios prospectivos en Tailandia han demostrado que para el caso de la actividad física, los hábitos respecto a éstos se mantienen relativamente estables a lo largo de la vida (contemplando desde la adultez joven hasta la adultez mayor), 18 por lo que la actividad física reportada en la actualidad es una buena medida de la exposición al riesgo que ha tenido a lo largo de la vida el individuo que reporta seguir practicando deporte en la adultez mayor. ...
... Si bien este podría presentar un sesgo de información importante, estudios prospectivos que han buscado validar el autorreporte de una fractura contra el historial clínico o reportes de radiología han demostrado una buena correlación entre ambas (kappa: 0.77-0.89) y aproximadamente 11% de falsos positivos, 23,24 lo que no descarta la posibilidad de que se recuerden las fracturas más recientes y no las que han ocurrido con mucha anterioridad, junto con un potencial subreporte de las fracturas asintomáticas o que no hayan buscado atención médica. Cabe destacar una posible exclusión de los adultos mayores que no estuvieran en condiciones de responder o se encontraran institucionalizados. ...
Introduction:
Fractures are relevant injuries in the lives of individuals both for the cost of treatment and for the burden on working life. The information in our country about this pathology is scarce, so we set out to review epidemiological data available in the national health survey.
Material and methods:
The prevalence of fracture life was calculated for the entire sample and for adults over 55 years of age, with different logistic regression models estimated by sex for the likelihood of a fracture in life.
Results:
The prevalence of fracture life is 18%, with 25.1% for adults over 55 years of age, with higher prevalence observed in men than in women (22.5% and 13.8% respectively). In the male sex it was associated with fractures: age, smoking, physical activity, alcohol consumption, and BMI, while in the female sex it was associated: age, polypharmacy, marital status, and physical activity.
Conclusion:
An association was found between the occurrence of fractures and multiple known risk factors for chronic diseases, highlighting the relevance of fractures in the population. New evidence aimed at studying this phenomenon becomes imperative given the progressive ageing of the Chilean population.
... Kanis y colaboradores mostraron, con base en el análisis de individuos pertenecientes a tres cohortes (CaMos, DOES y el Rotterdam Study), que no había mayor riesgo para fracturas con ingestas menores a dos unidades diarias (una unidad definida en el reino unido como 8 g de alcohol puro), pero que por sobre este nivel se observa un mayor riesgo significativo para presentar cualquier tipo de fractura (RR = 1. 23 6 encontrando además un mayor riesgo no significativo entre individuos del sexo masculino respecto al femenino, lo que está en línea con nuestros resultados. Respecto a la actividad física, se puede cuestionar que los hábitos recabados por medio de una encuesta transversal no entreguen información respecto de la historia completa del individuo; aun así, estudios prospectivos en Tailandia han demostrado que para el caso de la actividad física, los hábitos respecto a éstos se mantienen relativamente estables a lo largo de la vida (contemplando desde la adultez joven hasta la adultez mayor), 18 por lo que la actividad física reportada en la actualidad es una buena medida de la exposición al riesgo que ha tenido a lo largo de la vida el individuo que reporta seguir practicando deporte en la adultez mayor. ...
... Si bien este podría presentar un sesgo de información importante, estudios prospectivos que han buscado validar el autorreporte de una fractura contra el historial clínico o reportes de radiología han demostrado una buena correlación entre ambas (kappa: 0.77-0.89) y aproximadamente 11% de falsos positivos, 23,24 lo que no descarta la posibilidad de que se recuerden las fracturas más recientes y no las que han ocurrido con mucha anterioridad, junto con un potencial subreporte de las fracturas asintomáticas o que no hayan buscado atención médica. Cabe destacar una posible exclusión de los adultos mayores que no estuvieran en condiciones de responder o se encontraran institucionalizados. ...
Introducción:
Las fracturas son lesiones relevantes en la vida de los individuos tanto por el costo del tratamiento, como por la carga en la vida laboral. La información en nuestro país acerca de esta patología es escasa, por lo que nos propusimos revisar datos epidemiológicos disponibles en la Encuesta Nacional de Salud (ENS).
Material y métodos:
Se calculó la prevalencia de vida de fracturas para la totalidad de la muestra y para los adultos mayores de 55 años, estimándose modelos de regresión logísticos distintos por sexo para la probabilidad de sufrir una fractura en la vida.
Resultados:
La prevalencia de vida de fracturas es de 18%, con 25.1% para los adultos mayores de 55 años, observándose mayor prevalencia en hombres que en mujeres (22.5 y 13.8% respectivamente). En el sexo masculino se asoció con fracturas: edad, tabaquismo, actividad física, consumo de alcohol e IMC, mientras que en el sexo femenino se asoció: edad, polifarmacia, estado civil y actividad física.
Conclusión:
Se encontró asociación entre la ocurrencia de fracturas y múltiples factores de riesgo conocidos para enfermedades crónicas, destacando la relevancia que poseen las fracturas en la población. Nueva evidencia orientada a estudiar este fenómeno se hace imperativa dado el envejecimiento progresivo de la población chilena.
... There are few consistent data on the prevalence and rele vance of risk factors for osteoporotic fracture avail Siqueira and cols. evaluated the prevalence of self reported fractures and its association with sociodemo graphic variables and medical diagnosis of osteoporosis in 3,100 individuals from Pelotas, a Southern Brazilian city (56.6% women) (25). The lifetime prevalence of any type of fracture was 37.5% among men and 21.3% among women (P < 0.001). ...
... While in men most fractures were caused by sports practice and happened in leisure time, most fractures in women were caused by falls and occurred inside the home. The prevalence of fractures throughout life was almost twice as higher (28.3%) than that observed in the BRAZOS study (14.4%) (24,25). It is important to emphasize that individuals aged 20 years or more were included in Siqueira's study, as well as traumarelated and nontraumatic fractures. ...
Osteoporotic fractures impose severe physical, psychosocial, and financial burden both to the patient and the society. Studies on the prevalence of osteoporosis and fragility fractures in Brazil show a wide variation, due to differences in sample size, the population studied, and methodologies. Few studies have been conducted in Brazil about the cost-effectiveness analyses of different intervention options aimed at the diagnosis and treatment of osteoporosis. Investigation and treatment strategies based on cost-effectiveness and scientific evidence are essential in the preparation of public health policies with the ultimate goal of reducing the incidence of fractures and, consequently, the direct and indirect costs associated with them. This article reviews the Brazilian burden of osteoporosis in terms of the prevalence and fractures attributable to the disease, the costs related to the investigation and management, as well as the impact of osteoporosis on the population as a whole and on affected individuals.
... Recent studies have estimated the prevalence of bone fragility fractures in Brazilian women at 11.5-21.3% [5][6][7] , and the annual incidence of hip fracture adjusted for age was estimated to be 199 per 100,000 2 . ...
... These results are similar to those obtained in national studies, which estimated that the prevalence of fragility fractures in older women was 11.5-21.3% [5][6][7] , and the prevalence of femoral/hip fractures was 1.26% 7 . ...
To analyze the prevalence of and factors associated with fragility fractures in Brazilian women aged 50 years and older.
This cross-sectional population survey, conducted between May 10 and October 31, 2011, included 622 women aged >50 years living in a city in southeastern Brazil. A questionnaire was administered to each woman by a trained interviewer. The associations between the occurrence of a fragility fracture after age 50 years and sociodemographic data, health-related habits and problems, self-perception of health and evaluation of functional capacity were determined by the χ2 test and Poisson regression using the backward selection criteria.
The mean age of the 622 women was 64.1 years. The prevalence of fragility fractures was 10.8%, with 1.8% reporting hip fracture. In the final statistical model, a longer time since menopause (PR 1.03; 95%CI 1.01-1.05; p<0.01) and osteoporosis (PR 1.97; 95%CI 1.27-3.08; p<0.01) were associated with a higher prevalence of fractures.
These findings may provide a better understanding of the risk factors associated with fragility fractures in Brazilian women and emphasize the importance of performing bone densitometry.
... 3,4,7 In Europe, the United States and Japan, osteoporosis affects around 75 million people 8 and it is estimated that more than eight million hip fractures will occur over the next 50 years. 8,a In Brazil, Siqueira et al 15 found from a sample of more than 3,000 individuals that the prevalence of fractures among the population of Pelotas (southern region) was 28.3%. 15 Recently, the Brazilian Osteoporosis Study (BRAZOS) 13 showed that around 6% of the Brazilian population over the age of 40 years reported having a medical diagnosis of osteoporosis. ...
... 8,a In Brazil, Siqueira et al 15 found from a sample of more than 3,000 individuals that the prevalence of fractures among the population of Pelotas (southern region) was 28.3%. 15 Recently, the Brazilian Osteoporosis Study (BRAZOS) 13 showed that around 6% of the Brazilian population over the age of 40 years reported having a medical diagnosis of osteoporosis. However, low-impact fractures were reported by 15.1% of the women and 12.8% of the men, thus confi rming that the frequency of reported osteoporosis may have been underestimated. ...
OBJETIVO: Estimar a prevalência de osteoporose auto-referida (com diagnóstico médico prévio) e de fatores de risco e proteção associados. MÉTODOS: Estudo transversal baseado em dados do sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL). Foram entrevistados 54.369 indivíduos com idade >18 anos residentes em domicílios servidos por pelo menos uma linha telefônica fixa nas capitais brasileiras e Distrito Federal em 2006. Estimativas de osteoporose segundo fatores socioeconômicos, comportamentais e índice de massa corporal foram estratificadas por sexo. Foram calculados riscos de ocorrência de osteoporose para cada variável individualmente, e em modelo multivariado, considerando-se odds ratio como proxy da razão de prevalência. RESULTADOS: A prevalência de osteoporose referida foi de 4,4%, predominantemente entre mulheres (7,0%), com idade >45 anos, estado civil não solteiro e ex-fumante. Entre homens, ter mais de 65 anos, ser casado ou viúvo e sedentário associaram-se positivamente ao desfecho. CONCLUSÕES: Dentre os fatores associados à osteoporose, destacam-se aspectos modificáveis relacionados com a prevenção da doença, como a atividade física e tabagismo.
... 3,4,7 In Europe, the United States and Japan, osteoporosis affects around 75 million people 8 and it is estimated that more than eight million hip fractures will occur over the next 50 years. 8,a In Brazil, Siqueira et al 15 found from a sample of more than 3,000 individuals that the prevalence of fractures among the population of Pelotas (southern region) was 28.3%. 15 Recently, the Brazilian Osteoporosis Study (BRAZOS) 13 showed that around 6% of the Brazilian population over the age of 40 years reported having a medical diagnosis of osteoporosis. ...
... 8,a In Brazil, Siqueira et al 15 found from a sample of more than 3,000 individuals that the prevalence of fractures among the population of Pelotas (southern region) was 28.3%. 15 Recently, the Brazilian Osteoporosis Study (BRAZOS) 13 showed that around 6% of the Brazilian population over the age of 40 years reported having a medical diagnosis of osteoporosis. However, low-impact fractures were reported by 15.1% of the women and 12.8% of the men, thus confi rming that the frequency of reported osteoporosis may have been underestimated. ...
To estimate the prevalence of self-reported osteoporosis (with previous medical diagnosis) and the associated risk and protection factors.
A cross-sectional study was carried out, based on data from the system Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--telephone-based surveillance of risk and protective factors for chronic diseases). A total of 54,369 individuals aged > or = 18 years living in homes served by at least one fixed telephone line in Brazilian state capitals and the Federal District in 2006 were interviewed. Estimates of osteoporosis in relation to socioeconomic and behavioral factors and the body mass index were stratified according to sex. The risk of occurrence of osteoporosis was calculated for each variable separately and through a multivariate model, taking the odds ratio to be a proxy for the prevalence ratio.
The reported prevalence of osteoporosis was 4.4%, predominantly among women (7.0%) > or = 45 years of age whose marital status was not single and who were former smokers. Among men, age > 65 years, married or widowed status and sedentarism were positively associated with this outcome.
Among the factors associated with osteoporosis, modifiable characteristics relating to disease prevention were highlighted, such as physical activity and smoking habits.
... Taking into account the expected growth of the elderly population and varying assumptions of the secular trends for HF incidence (a 1-3% per annum increase), between 7.3 and 21.3 million new HFs are modestly projected for the year 2050 [3]. Unfortunately, there is still a significant paucity of epidemiological data regarding osteoporotic fractures and their related mortality in developing regions of the world [3,5,31]. ...
... It is also in those regions where the least is known about HF epidemiology. In Brazil only a few studies have been published about this important subject [31,[36][37][38][39], none of which analyzed HF mortality. ...
The purpose of this study was to assess, by applying probabilistic record linkage (PRL) methodology, the excess mortality and underlying causes of death in a cohort of elderly patients who underwent hip fracture surgical repair during 1995 in Rio de Janeiro, Brazil.
We searched the Brazilian Hospital Admission Information System (HAIS) for the city of Rio de Janeiro, identifying all cases of elderly patients who had hip fracture surgery between January 1 and December 31, 1995, and by means of the PRL methodology and RecLink software, crosslinked those data with the Brazilian Mortality Information System (MIS) for the same region for a follow-up period of 1 year. We calculated age- and gender-adjusted standardized mortality ratios (SMR) for three periods of time-1-30 days, 31-90 days, and 91-365 days after hospital admission-and analyzed the basic cause of death as reported in the death certificates and noted the death occurred at the index admission or after hospital discharge.
We found an overall 21.5% (95% CI 18.2-24.9) mortality rate in 1 year and a statistically significant SMR of 1,080 (95% CI 794-1450) and 512.8 (95% CI 366.4-698.3) for the first two periods, 1-30 days and 31-90 days after hospital admission, respectively. For the last period the SMR displayed a statistically nonsignificant trend of 137 (95% CI 99-183). Even in the first 15 days after the index hospital admission, most deaths (55.1%) occurred after hospital discharge, reinforcing the importance of linking hospital mortality databases with general population mortality information systems. The leading three basic causes of death, as reported in death certificates, were cardiovascular events, falls, and infections. This study represents an example of the application of PRL methodology to produce relevant data on hip fracture, a subject of rising epidemiological importance in developing countries.
... In Latin America, estimates of hip fractures for women and men aged from 50 to 64 years old indicate an increase of 400% between 1990 and 2050; a growth around 700% for the population over 65 years old [1]. In Brazil, over 10 million people have osteoporosis (one in 17 people); however, only a third of patients with osteoporotic hip fracture is diagnosed and a fifth of such patients receives treatment [5,6]. ...
Bones are continuously remodeled (resorbed and regenerated) to allow fracture healing and skeleton adaptation to stress. When excessive resorption occurs, bone microstructure is deteriorated, leading to osteoporosis. At early stages, osteoporosis usually has no symptoms; most people are diagnosed when a fracture occurs due to disease severity. To prevent fractures, technologies have been developed to identify high risk population eligible to treatment. Fracture risk has been assessed by analyzing the interaction of different energy stimulus with bone tissues as well as by statistical models that evaluate multiple clinical risk factors. The most applied methods are Dual-energy X-ray Absorptiometry and Fracture Risk Assessment tool. As they present some limitations, other technologies have been proposed for such purpose. A survey of the currently applied and emerging methods is here presented in order to provide a scenario of the technological challenges and trends to diagnose osteoporosis.
... Sample size was calculated using the population of Maringá at the time of the study (375,596) and an estimated 30% lifetime prevalence of injury (17,18). With a precision of ± 0.02 and a response rate loss of 5%, the resultant sample size was calculated to be 2017 individuals (19). ...
Background: Previous research has corroborated a high burden of alcohol-related injury in Brazil and the presence of socioeconomic disparities among the injured. Yet, individual-level data is scarce. To fill this gap, we examined the association between demographic and socioeconomic characteristics with non-fatal alcohol-related injury in Maringá, Brazil. Methods: We used household survey data collected during a 2015 cross-sectional study. We conducted univariate and multivariate analyses to evaluate associations of demographic (age, gender, race) and socioeconomic characteristics (employment, education, income) with non-fatal alcohol-related injury. Results: Of the 995 participants who reported injuries, 62 (6.26%) were alcohol-related. Fifty-three (85%) alcohol-related injuries were reported by males. Multivariate analysis indicated being male (OR = 5.98 95% CI = 3.02, 13.28), 15–29 years of age (OR = 3.62 95% CI = 1.72, 7.71), and identifying as Black (OR = 2.38 95% CI = 1.09, 4.95) were all significantly associated with increased likelihood of reporting an alcohol-related injury, whereas unemployment was significantly associated with decreased likelihood of reporting an alcohol-related injury (OR = 0.41 95% CI = 0.18, 0.88). Conclusion: Our findings suggest that in Maringá, being male, between the ages of 15 and 29, employed, or identifying as Black were characteristics associated with a higher risk for non-fatal alcohol-related injury. Individual level data, such as ours, should be considered in combination with area-level and country-level data when developing evidence-based public-health policies.
... Studies have shown that the occurrence of an event with adverse repercussions is vivid in the memory of participants 15,33,68 . On the other hand, the prevalence of falls may be underestimated due to falls without repercussions 88 . Therefore, standardizing prevalence measurements and additional care during data collection are strongly recommended in research and clinical practice to obtain more conservative estimates. ...
Falls determine huge epidemiological, clinical, and economic burden in the older population worldwide, presenting high odds of severe disability. The present study aimed to estimate the prevalence of falls and associated factors in older Brazilians using a systematic review with meta-analysis. Searches were performed in SciELO, PubMed, LILACS, Web of Science, Scopus and PsycINFO databases with no date or language restrictions. Studies on community-dwelling older persons aged ≥ 60 years from both sexes and with a sample size of ≥ 300 participants included. Exclusion criteria were studies conducted specifically for older adults diagnosed with chronic disabling diseases that predispose them to falls. Risk of bias of included studies was assessed using a critical appraisal tool focusing on prevalence designs. A random-effects meta-analysis was used to pool the prevalence of falls across studies. Exploratory analysis was conducted examining subgroup estimates, prevalence ratios and meta-regression. Thirty-seven studies involving 58,597 participants were included. Twelve-month prevalence of falls was 27% (95%CI: 24.3-30.0), with significantly higher estimates in female than male (PR = 1.57; 95%CI: 1.32-1.86), in age group ≥ 80 years than age group 60-69 years (PR = 1.46; 95%CI: 1.15-1.84), and in participants from the Central region than participants from the South region (PR = 1.36; 95%CI: 1.10-1.69) of Brazil. Risk of bias scores did not impact heterogeneity in the 12-month meta-analysis. These estimates strongly support evidence-based public interventions to prevent falls in older Brazilians, especially in women and the oldest-old population.
... Women are more likely to develop osteoporosis and, consequently, fractures as observed in the BRAZOS study. 2 Caucasian was the prevalent ethnicity, which was not demonstrated in the national BRAZOS study. 2 We should consider that the population of Paraná is mostly Caucasian, which can cause a bias in the results, the same being observed in Pelotas, Rio Grande do Sul. 12 Femoral fracture is a condition of high mortality during hospitalization and months and years following the fracture. In this study, ...
Objectives:
To evaluate the incidence and economic impact of femur fractures in the state of Paraná, Brazil .
Methods:
This descriptive study included men and women ≥ 60 years of age with hip fractures which were treated by the Public Health System in emergency care from January 2010 to December 2014. Data were collected from the DATASUS public health database using filters to select patients; results were presented descriptively and as proportions. The standardized incidence of femur fracture was calculated by sex and age for 10,000 inhabitants in Paraná state and in Brazil for the year 2012 .
Results:
During the study period, 11,226 fractures were registered, 66.8% in women and 33.2% in men. There was a preponderance of fractures in Caucasians and in older age groups. Mortality during hospitalization was 5.9%, higher in males, in patients aged ≥80 years, and in Blacks and Asians. The total cost was R$ 29,393,442.78 and the average cost per hospitalization was R$ 2,618.34. The eastern region of the state had the highest rate of fractures, predominantly in the capital, Curitiba. The standardized incidence rate was higher in females and in the population of Paraná .
Conclusion:
Femur fractures have a high incidence rate in the elderly population of Paraná and a large economic impact. Level of Evidence II, Prognostic Studies Investigating the effect of a Patient Characterisctic on the Outcome of Disease.
... 39 However, the use of self-reporting has become an important and valuable tool 0in epidemiological studies, with high specificity and sensitivity, due to the technical difficulties and high costs of populational studies. [40][41][42] It should also be highlighted that the cross-sectional design does not allow causal inference of the observed associations to be made, and must be treated with caution ...
Objectives:
To verify the prevalence of a low quality of life and analyze the morbidities associated with such a condition among elderly persons registered with the Family Health Strategy of the municipality of Senador Guiomard.
Method
: A cross-sectional study was performed of elderly persons registered with the Family Health Strategy in the urban area of the municipality of Senador Guiomard in the state of Acre. A comparison between men and women regarding morbidities and quality of life was performed using Pearson's chi-squared test. The associations between the tertiles of quality of life and morbidities were estimated by odds ratio through multivariate logistic regression analysis.
Results
: There were differences between men and women in the reporting of hypertension (p=0.015), diabetes (p=0.033), in the psychological domain (p=0.009) and in total quality of life (<0.001). Elderly people classified in the lower tertile of the physical and social domains of quality of life were more likely to suffer from hypertension, cardiovascular disorders and anemia. Those in the lower tertile of the psychological domain were also more likely to suffer from hypertension, cardiovascular disorders and insomnia, as well as anemia. Elderly individuals in the lower overall tertile were more likely to suffer from hypertension, cardiovascular disorders, insomnia and anemia. No statistically significant associations were found for the environmental domain.
Conclusion
: The total quality of life and the physical, psychological and social domains of quality of life can be considered good indicators of the described morbidities among the elderly. The environmental domain, however, was not a useful indicator.
... 23 Studies evaluating injuries from falls show that hip, wrist, vertebrae, humerus and hand fractures are mainly caused by falls. 24 The relevance of this study is to point out an increased prevalence of falls in patients with RA. Moreover, our paper draws attention to the impact of functional disability, measured by the HAQ score, on the risk of falls in this population. ...
Objetivos
identificar a prevalência de quedas nos últimos 12 meses em pacientes com artrite reumatoide (AR) e verificar a influência da atividade da doença e da capacidade funcional no risco de quedas.
Pacientes e métodos
participaram do estudo quarenta e três pacientes com AR. Foram avaliados os seguintes parâmetros: aspectos clínicos; ocorrência de quedas nos últimos 12 meses; VHS (mm/h); dor, através da escala visual analógica (EVA) com escore de 0 a 10 cm; atividade da doença, medida pelo Índice de Atividade da Doença – 28/VHS (Disease Activity Score 28 – DAS-28/VHS); capacidade funcional, avaliada pelo Questionário de Avaliação da Saúde (Health Assessment Questionnaire – HAQ); e o risco de quedas, avaliado por meio de dois testes, o teste senta-levanta da cadeira cinco vezes (TSL) e o teste get up and go timed test (GUGT).
Resultados
a prevalência de quedas nos últimos 12 meses foi de 30,2% (13/43). O fator independente que influenciou significativamente o desempenho no TSL foi o escore total do HAQ, sendo que as demais variáveis não conseguiram contribuir de forma significativa na explicação da variabilidade no TSL. A variável HAQ foi responsável por explicar 42,9% (P < 0,001, R2 ajustado = 0,429) da variabilidade do TSL. As variáveis HAQ e VHS influenciaram de forma significativa o desempenho no escore do GUGT. Esses dois fatores em conjunto foram capazes de explicar 68,8% da variabilidade do GUGT (R2 ajustado = 0,688).
Conclusões
pacientes com AR têm prevalência de quedas aumentada, sendo a incapacidade funcional o principal fator relacionado ao risco de quedas.
... 23 Estudos avaliando lesões decorrentes de quedas mostram que, principalmente as fraturas de quadril, punhos, vértebras, úmero e mãos, em sua maioria, são decorrentes de quedas. 24 A relevância deste estudo está em apontar uma prevalência aumentada de quedas em pacientes com AR. Além disso, chama a atenção para o impacto da incapacidade funcional, mensurada por meio do escore no HAQ, sobre o risco de quedas nessa população. ...
Objectives
Identify fall prevalence in the last 12 months among patients with rheumatoid arthritis (RA) and verify the influence of disease activity and physical function in the risk of falls.
Methods
Forty‐three patients with RA participated in this study. The following parameters were evaluated: clinical aspects; fall occurrence in the last 12 months; ESR (mm/h); pain on a visual analogue scale (VAS) ranging from 0 to 10 cm; disease activity, measured by the Disease Activity Score 28/ESR (DAS‐28/ESR); physical function, assessed by the Health Assessment Questionnaire (HAQ); and risk of falling, assessed by two tests, the 5‐time sit down‐to‐stand up test (SST5) and the timed get up and go test (GUGT).
Results
The fall prevalence in the last 12 months was 30.2% (13/43). The HAQ total score was the independent risk factor that had significant influence on SST5 performance, and the other variables did not succeeded to explain the SST5 variability. HAQ explained 42.9% of SST5 variability (P < 0.001, adjusted R2 = 0.429). HAQ total score and ESR had a significant influence on GUGT score performance. Together, these two variables explained 68.8% of the total variation in GUGT score (adjusted R2 = 0.688).
Conclusion
Patients with RA have high fall prevalence and the functional disability represents the main factor related to falls risk.
... Although studies of populations of elderly can raise concerns as regards memory bias, the literature has shown that this bias is small in outcomes such as falls and fractures, because these events are strongly remembered when elderly people are asked, even with a 12-month recall period 12,20,21 . ...
We conducted a cross-sectional study of a sample of 6,616 elderly living in urban areas of 100 municipalities in 23 Brazilian states, who responded to questions on the occurrence of falls in the 12 months prior to the interview, and occurrence of fractures due to the falls. The prevalence of falls among the elderly was 27.6% (95%CI: 26.5-28.7). Among those reporting falls, 11% had suffered fractures as a result. Of the elderly, 36% had received guidance about the precautions necessary to prevent falls, and about 1% had required surgery. Falls were associated with female gender, older age, low socioeconomic status, obesity and sedentary lifestyles. The prevalence of falls differed significantly between the North and other regions of Brazil. The study shows a high prevalence of falls, and underlines the need for preventive strategies targeting modifiable risk factors.
... No entanto, o fato de não terem sido avaliado alguns fatores de risco não inviabiliza o estudo e tampouco limita a discussão dos achados. Quanto à possibilidade de viés de memória, estudos têm mostrado que desfechos como quedas, fraturas são fortemente lembrados quando perguntados mesmo para pessoas idosas.3,5,14 O período recordatório de 12 meses utilizado no estudo é o período provavelmente mais utilizado nos estudos sobre quedas em idosos na literatura nacional e internacional. ...
The increase of life expectancy in developing countries has been a source of concern about quality of life and well-being of elderly people, especially regarding falls. The objective of the study was to assess the prevalence of falls in institutionalized elderly and to describe factors associated.
Cross-sectional study carried out in the city of Rio Grande (Southern Brazil). A total of 180 elderly (65 years old or more), living in institutions were included in the study. The elderly were interviewed and a pre-tested instrument with questions on falls was administered. In addition to a bivariate analysis (Wald), Poisson's regression analysis was conducted and prevalence ratios and 95% confidence intervals (95% CI) adjusted for confounders were estimated.
The prevalence of falls among institutionalized elderly was 38.3%. Falls were most frequently seen at the home premises (62.3%) and mostly in the bedroom (23%). In the adjusted analysis, falls remained associated to white color skin, separated and divorced elderly, depression, and higher continuous use of medications.
The study showed that the prevalence of falls among institutionalized elderly is high and that they can be disabling to this population. Although some of the associated factors are preventable, accidental falls still occur in settings that should be safe, such as the elderly's bedroom.
... The authors also demonstrated that the combination of CRF with BMD measurements may improve the identification of patients at a greater risk for fractures. In a recent study including 3,214 individuals from Pelotas-RS (southern region of Brazil), Siqueira et al. [27] found that the risk factors associated with fragility fractures were prior history of osteoporosis, falls in the previous year, male gender, Caucasian or mixed ethnic background and lower level of schooling. The prevalence of fractures throughout life reported in the study was nearly twice as high (28.3%) ...
The Brazilian Osteoporosis Study (BRAZOS) is the first epidemiological study carried out in a representative sample of Brazilian men and women aged 40 years or older. The prevalence of fragility fractures is about 15.1% in the women and 12.8% in the men. Moreover, advanced age, sedentarism, family history of hip fracture, current smoking, recurrent falls, diabetes mellitus and poor quality of life are the main clinical risk factors associated with fragility fractures.
The Brazilian Osteoporosis Study (BRAZOS) is the first epidemiological study carried out in a representative sample of Brazilian men and women aged 40 years or older with the purpose of identifying the prevalence and the main clinical risk factors (CRF) associated with osteoporotic fracture in our population.
A total of 2,420 individuals (women, 70%) from 150 different cities in the five geographic regions in Brazil, and all different socio-economical classes were selected to participate in the present survey. Anthropometrical data as well as life habits, fracture history, food intake, physical activity, falls and quality of life were determined by individual quantitative interviews. The representative sampling was based on Brazilian National data provided by the 2000 and 2003 census. Low trauma fracture was defined as that resulting of a fall from standing height or less in individuals 50 years or older at specific skeletal sites: forearm, femur, ribs, vertebra and humerus. Sampling error was 2.2% with 95% confidence intervals. Logistic regression analysis models were designed having the fragility fracture as the dependent variable and all other parameters as the independent variable. Significance level was set as p < 0.05.
The average of age, height and weight for men and women were 58.4 +/- 12.8 and 60.1 +/- 13.7 years, 1.67 +/- 0.08 and 1.56 +/- 0.07 m and 73.3 +/- 14.7 and 64.7 +/- 13.7 kg, respectively. About 15.1% of the women and 12.8% of the men reported fragility fractures. In the women, the main CRF associated with fractures were advanced age (OR = 1.6; 95% CI 1.06-2.4), family history of hip fracture (OR = 1.7; 95% CI 1.1-2.8), early menopause (OR = 1.7; 95% CI 1.02-2.9), sedentary lifestyle (OR = 1.6; 95% CI 1.02-2.7), poor quality of life (OR = 1.9; 95% CI 1.2-2.9), higher intake of phosphorus (OR = 1.9; 95% CI 1.2-2.9), diabetes mellitus (OR = 2.8; 95% CI 1.01-8.2), use of benzodiazepine drugs (OR = 2.0; 95% CI 1.1-3.6) and recurrent falls (OR = 2.4; 95% CI 1.2-5.0). In the men, the main CRF were poor quality of life (OR = 3.2; 95% CI 1.7-6.1), current smoking (OR = 3.5; 95% CI 1.28-9.77), diabetes mellitus (OR = 4.2; 95% CI 1.27-13.7) and sedentary lifestyle (OR = 6.3; 95% CI 1.1-36.1).
Our findings suggest that CRF may contribute as an important tool to identify men and women with higher risk of osteoporotic fractures and that interventions aiming at specific risk factors (quit smoking, regular physical activity, prevention of falls) may help to manage patients to reduce their risk of fracture.
This was a retrospective observational study to determine the secular trends in osteoporosis hip fractures in Brazil from 2004 to 2013. The fracture rates were stable for both sexes, and there was not a secular trend. Fractures were predominant in the South and Southeast Regions. The hip fracture rate was lower in this study than in other studies. These regional differences may be considered in the FRAX Brazil calibration.
Purpose:
Hip fractures are well-known osteoporotic fractures with high mortality and morbidity. Epidemiological studies in Brazil on hip fractures are scarce, and the great majority have been performed in small populations from a few cities. None of these studies has analyzed the long-term hip fracture secular trends, which are important data for the promotion of public health actions.
Methods:
This was a retrospective observational study with a secular trend analysis in patients over 50 years old who were admitted to the Brazilian Public Health System from 2004 to 2013. We collected hospitalization data according to the ICD-10 for low-trauma hip fractures. The fracture rate was calculated when the patients were stratified by sex, age, and geographic region, and linear regression analysis was performed to evaluate the secular trends.
Results:
The hip fracture rate per 100,000 inhabitants was 59.69; the rate was 74.72 in females and 42.95 in males. The fracture rates were higher in the South and Southeast Regions and steadily increased with age, and the average ratio of women-to-men was 1.74. No secular trend was detected in the overall population. Surprisingly, the secular trend only increased in the South region from 2004 to 2013, and the secular trends were stable in the other regions.
Conclusion:
Although the secular trend was similar to some worldwide studies, the hip fracture rate was lower than that previously observed in regional studies in Brazil. These regional differences may be considered in the FRAX Brazil calibration.
A osteoporose, como doença sistêmica, é caracterizada pela diminuição da massa óssea e deterioração da microarquitetura do tecido ósseo, com consequente aumento da fragilidade do esqueleto e maior susceptibilidade à fratura por pequenos traumas(1). Mais recentemente, recomenda-se a inclusão de outros determinantes esqueléticos para o maior risco de fratura, como aspectos qualitativos (geometria, resistência, remodelação, acúmulo de microdanos, mineralização), enfatizando, assim, o conceito de força óssea na definição da doença. É importante ressaltar que fatores extraesqueléticos, como quedas (energia do impacto, tipo de trauma, entre outros), também devem ser considerados na avaliação da população de risco. Tradicionalmente, é reconhecida como doença multifatorial, na qual aproximadamente 70% dependem de fatores genéticos e 30%, de fatores ambientais. Portanto, um único fator de risco não é capaz de identificar indivíduos com ou sem fratura. Diferenças genéticas, raciais e antropométricas, bem como da composição corporal, densidade óssea, dieta, atividade física e outros hábitos de vida contribuem para explicar as divergências na prevalência de baixa densidade óssea e fratura em diversos países do mundo. De 1994 a março de 2010, mais de 230 estudos nacionais sobre osteoporose foram desenvolvidos e publicados em revistas científicas referenciadas pelo banco de dados do PubMed, Medline, SciELO e Lilacs, dos quais cerca de 70 descreveram especificamente a situação epidemiológica no Brasil.
Introduction
Osteoporosis is a very common disease, and data on its epidemiology is important for health care strategy implementation. Brazil is a developing country; its population is aging, leading to an expected increase in hip fractures and their undesirable consequences.
Objective
Assess the incidence of osteoporotic hip fractures and subsequent mortality in Southern Brazil as part of a large epidemiological study aiming to reinforce the data for FRAX Brazil.
Study design
This study evaluated all admissions for fragility hip fractures between April 1, 2010, and March 31, 2012, in the city of Joinville, including both genders of patients 50 years old or older, which corresponded to 19.2% of the local population. Joinville was chosen because it is the third largest city in the south of Brazil, with a representative population predominantly composed of descendants of European immigrants.
Results
There were 213 cases of hip fractures, predominantly in Caucasians (n = 204, 96.7%) whose mean age was 77.7, ± 10.5, of which 143 (67.1%) were women (79.5 ± 9.6 years) and 70 (32.9%) were men (74 ± 11.3 years). The annual incidence of hip fractures was 268.8 for women and 153.0 for men/100,000 inhabitants. In the 60 to 64-year group, the overall incidence was 92.1/100,000, with an age-related increase of 1410.1/100,000 in the 80 to 84-year group. The mortality rate during hospitalization was 7.5%, and 25% died during the 12 months following their fractures.
Conclusion
The incidence of hip fractures among the oldest in this predominantly Caucasian population living in Southern Brazil was similar to that of European populations from the northern hemisphere. The annual incidence of fragility hip fractures among people in their 80s was 59 times higher than that among people in their 50s. The mortality rate was 4.3 times higher in the first year after hip fracture than in the age-related local population.
This is the protocol for a review and there is no abstract. The objectives are as follows:
To inform healthcare workers of:
1. whether whole body vibration is effective for the prevention and treatment of osteoporosis;
2. if effective, the efficacy and safety of reported protocols in the use of whole body vibration;
3. adverse effects associated with whole body vibration.
Bone quality assessment through the crystalline structure of hydroxyapatite
João Rollo ¹, Reinaldo Cesar ², Ricardo S. Boffa ¹, Danilo C. Schwab ¹, Rogerio Erbereli ³ and Tomaz P. Leivas ⁴
• 1 Universidade de São Paulo, Departamento de Engenharia de Materiais - Escola de Engenharia de São Carlos, Brazil
• 2 UNIARA, Production Engineering, Brazil
• 3 Faculdade Anhanguera - Unidade Matão, Engineering, Brazil
• 4 Universidade de São Paulo, Institute of Orthopedics and Traumatology - HCFM, Brazil
The stoichiometric formula of hydroxyapatite is Ca10(PO4)6(OH)2 and it presents a hexagonal structure. This structure allows for facilitated isomorphic cationic and anionic replacements. The Ca2+ may be replaced by metals; the phosphate groups may be replaced by carbonates and vanadates and the carbonates fluorine and chlorine may replace hydroxyls. With these alterations the crystallinity, network parameters, crystal dimensions, superficial texture, stability and solubility of the hydroxyapatite structure may be altered. Dried trabecular bones of vertebrae L1 columns of nine human cadavers from the São Paulo city morgue were used. Before sample collection, they were pre-divided into three groups: normal, osteopenic or osteoporotic, through quantitative ultrasound of the calcaneus. The characterization of the three types of bones were made by electron microscopy scanning, microanalysis by energy dispersive spectrometry, microhardness and powder X-ray diffraction with application of the Rietveld method. The results showed a decrease of the crystallite size, hardness, ratio of calcium and phosphorus, trabecular number and bone density and an increase in microstrain values suggesting greater fragility and disruption in the crystalline structure of hydroxyapatite in osteopenic and osteoporotic bone. Microstructural characterization of hydroxyapatite crystals in dry trabecular bone could differentiate the three types of bones (normal, osteopenic and osteoporotic) and supplement assessment of osteoporosis, with an emphasis on bone quality.
Keywords: Human bone, Hydroxyapatite, Crystal Structure
Institute of Orthopedics and Traumatology from the Clinical Hospital of São Paulo; FAPESP (protocol n. 2010/51698-0)
Osteoporotic fractures represent a relevant public health problem in worldwide. In Brazil, although there are few studies on socioeconomic burden of these events in representative and population sampling, almost 30-40% of adults are at risk for fracture. This review discusses the recent approaches to early diagnosis and treatment of osteoporosis.
Objective:
To analyze the expenditure of the Ministry of Health with osteoporosis treatment in the Brazilian Public Health System (SUS) in 2008-2010 triennium and estimate the influence of demographic, regional and disease related variables on average expenditure per procedures performed.
Methods:
A cross-sectional, descriptive and analytical study based on secondary data from DATASUS related to procedures for the elderly with a diagnosis of osteoporosis and related fractures. For the statistical analysis and multivariate model, Stata 11.0 was used.
Results:
According to the findings, 3,252,756 procedures related to the osteoporosis treatment among the elderly were carried out in Brazil during the 2008 - 2010 period, totalizing R$ 288,986,335.15. The age group that most had procedures was 60 - 69 years (46.3%); the population of 80 years or older showed the highest spending per procedure, around R$ 106 million in three years. The women were majority in terms of quantity (95.6%) and expense (76%) of procedures. The average cost per procedure showed a large gap between men and women, nearly 7 times (R$ 480.14 versus R$ 70.85, respectively). The ambulatory care procedures predominated in quantity (96.4%) and the hospital procedures predominated in resources (70.4%). It was found that there is no single standard for groups of procedures when these are analyzed separately.
Conclusion:
A disaggregated analysis of expenditure by procedures groups extracted from the SUS Management System of the Table of Procedures, Medicines, Orthotics, Prosthetics and Special Materials allowed a detailed overview of federal spending on the osteoporosis treatment in the elderly from Brazil.
This study analyzes the prevalence of health coun- seling related to physical activity among users of primary health care, and explores the associated variables. This cross-sectional study included a random sample of 4,060 adults and 4,003 older adults living in areas covered by primary health care in 41 cities from seven States of South and Northeast Brazil. Prevalence of counseling for physical activity was 28.9% (95%CI: 27.3-30.4) for adults and 38.9% (95%CI: 37.3-40.6) for elders. Prevalence was consistently higher among older adults, in the Northeast, and in areas covered by the Family Health Program. Gender, socioeco- nomic status, smoking, sedentary lifestyle, self-re- ported chronic non-communicable diseases, and continuous-use medication were also associated with the outcome. Counseling for physical activ- ity at community health centers is under-pro- moted, considering individual needs for healthy living. There is a need to improve participation by health professionals from different fields to promote physical activity and other healthy be-
rESumO Introdução/Objetivos: O BRAZOS (The Brazilian Osteoporosis Study) é um estudo epidemiológico, de base populacional, realizado em amostra representativa de mulheres e homens brasileiros, de idade superior a 40 anos, com o objetivo de identificar os principais fatores clínicos de risco associados com fratura por baixo impacto. Nesse artigo são apresentados os principais resultados do estudo, de acordo com cada região do país. Pacientes e Métodos: Um total de 2.420 indivíduos, provenientes das cinco regiões do país e de todas as classes socioeconô-micas foram incluídos no estudo. Foram avaliados dados antropométricos, bem como aspectos relacionados aos hábitos de vida, fraturas, ingestão alimentar, atividade física, quedas e qualidade de vida por meio de entrevista individual e quantitativa. Fratura por baixo impacto foi definida como aquela decorrente de queda da própria altura ou menos. Valor de P < 0,05 foi considerado como estatisticamente significante. Resultados: Não houve diferença estatisticamente significativa da prevalência de fratura nas cinco regiões do Brasil, de acordo com o sexo ou classe social. No entanto, nas mulheres, houve maior ocorrência de fraturas na região metropolitana do que nos municípios do interior dos estados e tendência a maior frequência de fraturas em homens da região nordeste. Não foi verificada diferença estatisticamente significativa de fraturas se os homens eram provenientes das capitais ou do interior dos estados. Conclusões: De acordo com os nossos resultados, não foi observada diferença significativa da prevalência de fraturas por baixo impacto nem da frequência ou relevância de fatores de risco entre as cinco regiões do Brasil. Palavras-chave: População brasileira, fatores clínicos de risco, epidemiologia, fratura, prevalência regional, osteoporose.
The ageing of the population generates interest among health professionals, because of its importance for health. A cross-sectional study was carried out including institutionalized subjects aged over 65 from Pelotas (RS, Brazil). The aim was to investigate the prevalence of falls and associated factors. The prevalence of falls was 33.5%; the most frequent place in which falls occurred was the bedroom (37%). Of all falls, 16.9% resulted in a fracture. Approximately 70% of the falls took place at the institution in which the subjects live. Ankles and hips were the most frequently anatomic sites fractured (33,3%). The prevalence of falls among the elderly was high and the consequences of such falls are worrying. Prevention strategies by healthcare professionals and managers are urgently needed in order to minimize the burden of falls and thus enhance the quality of life of institutionalized elderly people.
The prevalence of osteoporosis is expected to increase with the ageing of the world's population. This article reviews the epidemiology, risk factors and health burden of osteoporosis. In the Global Burden of Disease (GBD) Study 2005, osteoporosis is studied as a risk factor for fracture by considering the bone-mineral-density (BMD) measurement as the continuous exposure variable. We have performed a systematic review seeking population-based studies with BMD data measured by dual-X-ray absorptiometry (DXA). The femoral neck was selected as the unique location and all values were converted into Hologic(®) to enable inclusion of worldwide data for analysis. Provisional results on mean BMD values for different world regions are shown in age breakdowns for males and females 50 years or over, as well as mean T-scores using the young, white, female reference of National Health and Nutrition Examination Survey (NHANES) III. Results show remarkable geographical differences and a time trend towards improvement of the BMD values in Asian and European populations.
The risk of osteoporotic fractures is known to vary among populations. There are no studies analyzing concomitantly clinical, densitometric, and lab risk factors in miscigenated community-dwelling population of Brazil. A total of 1007 elderly subjects (600 women and 407 men) from São Paulo, were evaluated using a questionnaire that included risk factors for osteoporotic fractures. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the hip and lumbar spine. Laboratory blood tests were also obtained. The prevalence of osteoporotic fractures was 13.2% (133 subjects), and the main fracture sites were distal forearm (6.0%), humerus (2.3%), femur (1.3%), and ribs (1.1%). Women had a higher prevalence (17.5%; 95% confidence interval [CI]: 14.6-20.6) than men (6.9%; 95% CI: 4.4-9.3) (p<0.001). After adjusting for significant variables, logistic regression revealed that female gender (odds ratio [OR]=2.7; 95% CI; 1.6-4.5; p<0.001), current smoking (OR=1.9; 95% CI: 1.2-3.3; p=0.013), and the femoral neck T-score (OR=0.7; 95% CI: 0.5-0.9; p=0.001) remain significant risk factors for osteoporotic fractures in the community-dwelling elderly. Our findings identified that female gender, current smoking, and low hip BMD are independent risk factors for osteoporotic fractures.
The BRAZOS (The Brazilian Osteoporosis Study) study is the first epidemiological and population-based study carried out in a representative sample of Brazilian men and women, 40 years or older, with the objective of identifying the prevalence and main clinical risk factors (CRF) associated with low-impact fractures. This report shows the main results according to each region of the country.
A total of 2,420 subjects (70% women) from 150 different cities in five geographic regions in Brazil, and from all different socio-economical classes were included in this study. Anthropometrical data, as well life style, previous fractures, nutritional status, physical activity, falls, and quality of life were evaluated by a quantitative individual survey. Low-impact fracture was defined as that resulting from a fall no greater than standing height of an individual. A P < 0.05 was considered significant.
Statistically significant differences in the prevalence of fractures among the five Brazilian regions according to gender or social class were not observed. However, in women, a higher incidence of fractures was observed in metropolitan areas than in rural areas, and a tendency for a higher frequency of fractures was observed in men from Northeastern states. Statistically significant differences among men from metropolitan areas or rural areas were not observed.
Significant differences in the prevalence of low-impact fractures among the five different regions of Brazil were not observed, as well as its frequency or relevance of risk factors.
The epidemiology of osteoporotic fractures varies widely among countries and is primarily related to differences in the population and utilization of public healthcare services. Since 1994, over 200 studies about osteoporosis and fractures have been conducted in Brazil, among which 60 have described the current epidemiological status. This work is a compilation of studies published in scientific journals (PubMed, MedLine, Lilacs, SciELO Database) with the respective highlights. Overall, these studies show moderate incidence of hip fracture in subjects over 50 years old. However, the prevalence of all types of bone fragility fracture is higher, ranging from 11% to 23.8%. In addition, there is a high incidence of recurrent falls, which are the main extra-skeletal factor associated with these fractures. According to the national studies, 12 months after femoral fractures, the mortality rate ranged between 21.5% and 30%, and there was also a high rate of physical impairment, deterioration of the quality of life and excessive burden to the healthcare system. Considering its high prevalence and associated mortality and physical impairment, osteoporosis and its main consequence, bone fragility fractures, must be considered a major public health problem in our country.
Genetic and racial background, body composition, bone mineral density (BMD), diet, physical activity and life style help to explain the wide difference observed in the world prevalence and incidence of osteoporosis. Recently, a fracture assessment tool, named FRAX TM, was developed to integrate clinical risk factors (genetic and environmental conditions) and BMD, in order to quantify the ten-year probability of an osteoporotic fracture. Shortly, it will be used to indicate treatment for high risk patients. However, this tool is now available only to those populations with known reliable and prospective epidemiologic data of the osteoporotic fractures - fact that does not include the Brazilian population. The aim of this paper was to review the main national and international epidemiologic studies to better understand the differences between the clinical risk factors, BMD and fracture probability of these populations. The authors concluded that, to use the FRAX TM tool, it is necessary more epidemiological data that could characterize the Brazilian population. The future studies should be prospective, evaluate the quality of life, mortality and morbidity after a fracture, as well the life expectancy of the population and the cost-effectiveness and utility related to the osteoporotic fracture. In fact, it is not recommended to use any of the populations available in the FRAX TM tool, as a substitute for the Brazilian population.
This study analyzes the prevalence of health counseling related to physical activity among users of primary health care, and explores the associated variables. This cross-sectional study included a random sample of 4,060 adults and 4,003 older adults living in areas covered by primary health care in 41 cities from seven States of South and Northeast Brazil. Prevalence of counseling for physical activity was 28.9% (95%CI: 27.3-30.4) for adults and 38.9% (95%CI: 37.3-40.6) for elders. Prevalence was consistently higher among older adults, in the Northeast, and in areas covered by the Family Health Program. Gender, socioeconomic status, smoking, sedentary lifestyle, self-reported chronic non-communicable diseases, and continuous-use medication were also associated with the outcome. Counseling for physical activity at community health centers is under-promoted, considering individual needs for healthy living. There is a need to improve participation by health professionals from different fields to promote physical activity and other healthy behaviors.
This multicenter, open-label study evaluated the effects of short-term risedronate on bone resorption and patient satisfaction in postmenopausal women with osteoporosis in Brazil. Entry requirements included: osteoporosis of the spine/femoral neck diagnosed by a bone mineral density (BMD) T-score<or=-2.5 or radiographic fragility fracture within the last year and no treatment with osteoporosis medication in the preceding 3 mo. Patients were treated with once weekly risedronate of 35 mg for 12 wk. Patients also received 1000 mg calcium carbonate and 400 IU vitamin D. The main outcome was the effect on bone resorption, as assessed by the quantification of serum C-telopeptide of type I collagen (CTX). Of the 556 women screened, 480 women received >or=1 dose of study drug (intent-to-treat [ITT] population), and 390 completed treatment (81%). After 12 wk, CTX decreased in 94% of patients (from 0.419+/-0.234 to 0.158+/-0.171 microg/L, p<0.0001). Mean CTX reduction was 60.6%. Patient satisfaction was good/excellent in 91.7% of patients. A total of 156 adverse events (AEs) were reported by 113 (23.5%) patients in the ITT population. Digestive symptoms emerged or worsened in 7.1% and 3.5%, respectively. Five patients (1.0%) experienced serious AEs, not considered to be related to risedronate. In conclusion, risedronate significantly reduced serum CTX after 12-wk treatment. Almost all patients reported good/excellent satisfaction.
Background
Cross-sectional studies with binary outcomes analyzed by logistic regression are frequent in the epidemiological literature. However, the odds ratio can importantly overestimate the prevalence ratio, the measure of choice in these studies. Also, controlling for confounding is not equivalent for the two measures. In this paper we explore alternatives for modeling data of such studies with techniques that directly estimate the prevalence ratio.
Methods
We compared Cox regression with constant time at risk, Poisson regression and log-binomial regression against the standard Mantel-Haenszel estimators. Models with robust variance estimators in Cox and Poisson regressions and variance corrected by the scale parameter in Poisson regression were also evaluated.
Results
Three outcomes, from a cross-sectional study carried out in Pelotas, Brazil, with different levels of prevalence were explored: weight-for-age deficit (4%), asthma (31%) and mother in a paid job (52%). Unadjusted Cox/Poisson regression and Poisson regression with scale parameter adjusted by deviance performed worst in terms of interval estimates. Poisson regression with scale parameter adjusted by χ2 showed variable performance depending on the outcome prevalence. Cox/Poisson regression with robust variance, and log-binomial regression performed equally well when the model was correctly specified.
Conclusions
Cox or Poisson regression with robust variance and log-binomial regression provide correct estimates and are a better alternative for the analysis of cross-sectional studies with binary outcomes than logistic regression, since the prevalence ratio is more interpretable and easier to communicate to non-specialists than the odds ratio. However, precautions are needed to avoid estimation problems in specific situations.
The National Electronic Injury Surveillance System reports that the fingers and hand are the most frequent body parts injured at work and treated in hospital emergency departments. In this study, we describe the type, location, and severity of occupational hand injuries among 1166 patients recruited from 23 occupational health clinics in five New England states. Subjects ranged in age from 18 to 77 years, with a mean of 37.2 years (SD, 11.4), and approximately 75% were men. In decreasing order of frequency, subjects were employed in machine trades, service work, structural work, and less frequently, in benchwork, professional, technical managerial and clerical, and sales work. The majority of subjects (83.4%) had a single type of injury: 62.6% were lacerations, 13.1% were crush injuries, 8.0% were avulsions, and 6.1% were punctures. Metal items, such as nails, metal stock, and burrs accounted for 38.4% of the injuries, followed by hand tools with blades and powered machinery (24.4% and 12.3%, respectively). Hand tools with blades were least likely to result in multiple types of injuries, whereas powered machines or nonpowered hand tools were more likely to result in multiple types of injuries than other injury sources. The generalizability of these results should be limited to clinic-based patients employed in similar occupations. The results of this study may suggest possible prevention strategies for acute traumatic hand injuries.
Blacks develop a higher peak bone mass than whites which is associated with a reduced risk for bone fracture. The physiological basis for the difference in bone mass was investigated by metabolic balance and calcium kinetic studies in adolescent black and white girls. The hypothesis that the greater peak bone mass in blacks compared with whites is due to suppressed bone resorption was tested. Subjects were housed in a supervised environment for 3 wk during which time they consumed a controlled diet and collected all excreta. Subjects were given stable calcium isotopes orally and intravenously after 1 wk adaptation. Blacks have greater calcium retention (mean +/- SD, 11.5 +/- 6.1 vs. 7.3 +/- 4.1 mmol/d, P < 0.05) consistent with greater bone formation rates (49.4 +/- 13.5 vs. 36.5 +/- 13.6 mmol/d, P < 0.05) relative to bone resorption rates (37.4 +/- 13.2 vs. 29.4 +/- 10.9 mmol/d, P = 0.07), increased calcium absorption efficiency (54 +/- 19 vs. 38 +/- 18%, P < 0.05) and decreased urinary calcium (1.15 +/- 0.95 vs. 2.50 +/- 1.35 mmol/d, P < 0.001), compared with whites. The racial differences in calcium retention in adolescence can account for the racial differences in bone mass of adults.
▪ Objective: To determine which types of fractures have an increased incidence in elderly women with low appendicular bone mass.
▪ Design: Prospective cohort study.
▪ Setting: Four clinical centers in the United States (Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; Monangehela Valley, Pennsylvania); and one coordinating center in San Francisco, California.
▪ Subjects: Ambulatory, nonblack women (9704) aged 65 years or more who were recruited from population-based listings.
▪ Measurements: We measured bone mass at the distal and proximal radius and calcaneus using single-photon absorptiometry. Fractures were verified radiographically. Associations were calculated as age-adjusted hazard ratios (with 95% CIs) per standard deviation decrease in bone mass.
▪ Main Results: During a mean follow-up of 2.23 years, 841 nonspinal fractures occurred in 753 women. The risks for fractures of the wrist, foot, humerus, hip, rib, toe, leg, pelvis, hand, and clavicle were significantly related to reduced bone mass (P < 0.05). These fractures represented 74% of nonspinal fractures. The overall hazard ratio for the occurrence of one or more of these fractures was 1.65 (Cl, 1.49 to 1.82) at the distal radius. In a subsample of the cohort, vertebral fractures were also related to low bone mass. Fractures of the ankle, elbow, finger, and face, however, were not associated with bone mass at any measurement site; the overall hazard ratio for these fractures was 1.12 (Cl, 0.96 to 1.30) at the distal radius.
▪ Conclusion: Most types of fractures have an increased incidence in elderly women with low bone mass.
To analyze age- and sex-specific frequencies of peripheral fractures, we used data from the third MONICA-Augsburg Survey (1994/95).
The study comprises 2404 male and 2450 female participants (age 25 to 74 years) who were questioned regarding fracture history. We investigated fracture prevalence, age-specific incidence rates, and the circumstances under which the fractures occurred. The age-standardized, cumulative fracture prevalence among men (m) 25 to 74 years of age was 45% and among women (w) of the same age 31%. Fracture prevalence among women was more than 10% lower than among men in the younger age groups (age 25 to 64 years), but after an significant increase in the 65 to 74-year-olds the fracture prevalence corresponded to that of men (m: 42%, w: 40%). A peak of incidence rates was found among men at age 15–24 (overall incidence rate: 2017 fractures/100,000 person-years) and at age 45–54 (overall incidence rate: 1640 fractures/100,000 PY), respectively, and among women at age 65–74 (overall incidence rate: 3214 fractures/100,000 PY).
The prevalence of self-reported osteoporosis (age 25 to 74 years) was higher in women (7%) than in men (1%). Falls caused 43% (w: 59%, m: 33%) of all fractures, external violence 40% (m: 47%, w: 29%), and sports activities 15% (m: 18%, w: 10%). Further investigation of risk factors related to fractures can contribute to the development of specific preventive measures in that field. In the future, the prevention and efficient treatment of an existing or an often undiagnosed osteoporosis and also the prevention of falls in elderly persons should be an important public health concern.
The validity and reliability of patient recall of diseases depends on the kind of disease. The validity and reliability of patients' recall of fractures was assessed among the 146 cases of a nested case-control study on independent living following fractures in the elderly. On declaration of a fracture a letter was sent to the general practitioner requesting medical information on the lates fracture receiving treatment. A total of 99 medical discharge letters (68%) could be collected for further evaluation. The information on fracture localisation which was obtained both during the patients interviews 1994/95 and 1998 and through the medical discharge letters were coded with reference to the AO (Arbeitsgemeinschaft für Osteosynthesefragen)-classification and compared. The Kappa-statistic for the reliability of patient information was 0.80–0.89, and 0.77–0.89 for the validity, depending on the degree of specified concordance. Obtaining information on fractures from patients appears as a valid and reliable source of epidemiologic data. Patients who generally are affected physically or had to stay in a hospital due to a fracture or its treatment seem to have a good recall of this event. It appears that it can be remembered years after the event with sufficient reliability and validity.
To determine which types of fractures have an increased incidence in elderly women with low appendicular bone mass.
Prospective cohort study.
Four clinical centers in the United States (Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; Monangehela Valley, Pennsylvania); and one coordinating center in San Francisco, California.
Ambulatory, nonblack women (9704) aged 65 years or more who were recruited from population-based listings.
We measured bone mass at the distal and proximal radius and calcaneus using single-photon absorptiometry. Fractures were verified radiographically. Associations were calculated as age-adjusted hazard ratios (with 95% Cls) per standard deviation decrease in bone mass.
During a mean follow-up of 2.23 years, 841 nonspinal fractures occurred in 753 women. The risks for fractures of the wrist, foot, humerus, hip, rib, toe, leg, pelvis, hand, and clavicle were significantly related to reduced bone mass (P less than 0.05). These fractures represented 74% of nonspinal fractures. The overall hazard ratio for the occurrence of one or more of these fractures was 1.65 (Cl, 1.49 to 1.82) at the distal radius. In a subsample of the cohort, vertebral fractures were also related to low bone mass. Fractures of the ankle, elbow, finger, and face, however, were not associated with bone mass at any measurement site; the overall hazard ratio for these fractures was 1.12 (Cl, 0.96 to 1.30) at the distal radius.
Most types of fractures have an increased incidence in elderly women with low bone mass.
Blacks have a greater bone mass and a lower incidence of osteoporosis and hip fractures than whites. We performed biopsies of the iliac crest in 12 blacks (6 men and 6 women) and 13 whites (8 men and 5 women) who were matched for age (range, 19 to 46 years) and weight, to determine whether histomorphometric differences between blacks and whites could be identified. The static measurements of cortical and cancellous bone architecture were not significantly different in the two groups. In contrast, the dynamic measurements, determined with tetracycline markers, showed that the mean rate of bone formation in the blacks was only 35 percent of that in the whites (P less than 0.001). We conclude that the rate of bone turnover is lower in blacks than in whites, since bone resorption and bone formation are closely coupled in the steady state. If reconstitution of previously resorbed cavities at remodeling sites is incomplete in osteoporosis, a reduction in the rate of skeletal remodeling could provide a means for maintaining and preserving bone mass in blacks.
Osteoporosis is recognized as an important cause of morbidity and mortality in aging women, but there have been few epidemiologic
studies in men. Potential risk factors for osteoporotic fractures were assessed in 820 elderly men aged 60 years or above
in the city of Dubbo (Australia). During the follow-up period of 1989–1994, the overall incidence of fractures (determined
from x-ray reports) was 220 fractures per 10, 000 person-years. Higher risk of fracture was associated with lower femoral
neck bone mineral density (BMD), quadriceps weakness, higher body sway, falls in the preceding 12 months, a history of fractures
in the previous 5 years, lower body weight, and shorter current height. Use of thiazide diuretics, higher physical activity,
and moderate alcohol intake were protective against fracture. In multivariate analysis (Cox's proportional hazards model),
femoral neck BMD (odd ratio (OR) = 1.47, 95% confidence interval (Cl) 1.25–1.73 per 0.12 g/cm2), quadriceps strength (OR = 1.43, 95% Cl 1.18–1.73 per 10 kg), and body sway (OR = 1.25, 95% Cl 1.07–1.45 per 5.15 cm2) were independent risk factors. Preventive measures for bone loss and maintaining a physically active, healthy life-style
and modification of risk factors for falls in the elderly could yield beneficial effects in the reduction of the incidence
of osteoporotic fracture and hence improve the survival among men. Am J Epidemiol 1996; 144: 255–63.
Of the fractures linked with osteoporosis, hip fractures are most important in terms of death, functional dependence, and social cost. Reduction of these adverse outcomes depends on preventing hip fractures, which are caused by falling on a biomechanically compromised proximal femur. Skeletal strength depends on the amount of bone and its structural arrangement, whereas the traumatic load on the proximal femur is dictated by the orientation of the fall and other factors. One or several of these underlying mechanisms account for the various risk factors that have been identified for hip fracture, including greater incidence rates among women than men and among white than nonwhite populations. However, the exponentially increasing incidence of hip fractures with age indicates that a complex interplay of factors determines the risk of fracture in each person. The multifactorial nature of the problem suggests that hip fractures will be difficult to prevent even as the fractures and their associated costs continue to rise with the increased number of older people. However, the variability of hip fracture rates within high risk populations in Europe and North America reflects the existence of other powerful risk factors that, if identified, might provide the basis for more effective interventions.
The validity and reliability of patient recall of diseases depends on the kind of disease. The validity and reliability of patients' recall of fractures was assessed among the 146 cases of a nested case-control study on independent living following fractures in the elderly. On declaration of a fracture a letter was sent to the general practitioner requesting medical information on the latest fracture receiving treatment. A total of 99 medical discharge letters (68%) could be collected for further evaluation. The information on fracture localisation which was obtained both during the patients interviews 1994/95 and 1998 and through the medical discharge letters were coded with reference to the AO (Arbeitsgemeinschaft für Osteosynthesefragen)-classification and compared. The Kappa-statistic for the reliability of patient information was 0.80-0.89, and 0.77-0.89 for the validity, depending on the degree of specified concordance. Obtaining information on fractures from patients appears as a valid and reliable source of epidemiologic data. Patients who generally are affected physically or had to stay in a hospital due to a fracture or its treatment seem to have a good recall of this event. It appears that it can be remembered years after the event with sufficient reliability and validity.
Records from the General Practice Research Database were used to derive age- and gender-specific fracture incidence rates for England and Wales during the period 1988-1998. In total, 103,052 men and 119,317 women in the sample of 5 million adults sustained a fracture over 10.4 million and 11.2 million person-years (py) of follow-up. Among women, the most frequent fracture sites were the radius/ulna (30.2 cases per 10,000 py) and femur/hip (17.0 per 10,000 py). In men, the most common fracture was that of the carpal bones (26.2 per 10,000 py); the incidence of femur/hip fracture was 5.3 per 10,000 py. Varying patterns of fracture incidence were observed with increasing age; whereas some fractures became more common in later life (vertebral, distal forearm, hip, proximal humerus, rib, clavicle, pelvis), others were more frequent in childhood and young adulthood (tibia, fibula, carpus, foot, ankle). The lifetime risk of any fracture was 53.2% at age 50 years among women, and 20.7% at the same age among men. Whereas fractures of the proximal femur and vertebral body were associated with excess mortality over a 5 year period following fracture diagnosis among both men and women, fractures of the distal forearm were associated with only slight excess mortality in men. This study provides robust estimates of fracture incidence that will assist health-care planning and delivery.
To analyze age- and sex-specific frequencies of peripheral fractures, we used data from the third MONICA-Augsburg Survey (1994/95). The study comprises 2404 male and 2450 female participants (age 25 to 74 years) who were questioned regarding fracture history. We investigated fracture prevalence, age-specific incidence rates, and the circumstances under which the fractures occurred. The age-standardized, cumulative fracture prevalence among men (m) 25 to 74 years of age was 45% and among women (w) of the same age 31%. Fracture prevalence among women was more than 10% lower than among men in the younger age groups (age 25 to 64 years), but after an significant increase in the 65 to 74-year-olds the fracture prevalence corresponded to that of men (m: 42%, w: 40%). A peak of incidence rates was found among men at age 15-24 (overall incidence rate: 2017 fractures/100,000 person-years) and at age 45-54 (overall incidence rate: 1640 fractures/100,000 PY), respectively, and among women at age 65-74 (overall incidence rate: 3214 fractures/100,000 PY). The prevalence of self-reported osteoporosis (age 25 to 74 years) was higher in women (7%) than in men (1%). Falls caused 43% (w: 59%, m: 33%) of all fractures, external violence 40% (m: 47%, w: 29%), and sports activities 15% (m: 18%, w: 10%). Further investigation of risk factors related to fractures can contribute to the development of specific preventive measures in that field. In the future, the prevention and efficient treatment of an existing or an often undiagnosed osteoporosis and also the prevention of falls in elderly persons should be an important public health concern.
The present study assesses the association between reproduction and hip fractures.
We used two surveys on elderly Danish twins of both sexes and the Danish National Register of Patients. In a cross-sectional study of 2045 twins aged 75-98 years in 1995, we studied the association between different aspects of reproduction and hip fractures leading to hospitalization between 1977 and 1994. In a prospective study, 3057 twins aged 66-99 years in 1977 were followed for a total of 29,112 years, and the association between number of children and incidence of hip fractures was investigated.
In the cross-sectional study, as well as the prospective study, we found, for both sexes, that having no children was associated with a higher risk of hip fracture compared to having at least one child. When excluding persons without children, we found no effect of number of birth events/children. In the cross-sectional study, we found no effect of birth interval length or age at first birth. For women, we found an effect of age at last birth.
No "cost-of-reproduction" in terms of hip fractures was observed. On the contrary, we found that having one or more children was associated with a lower risk of hip fracture.
Bone mass declines and the risk of fractures increases as people age, especially as women pass through the menopause. Hip fractures, the most serious outcome of osteoporosis, are becoming more frequent than before because the world's population is ageing and because the frequency of hip fractures is increasing by 1-3% per year in most areas of the world. Rates of hip fracture vary more widely from region to region than does the prevalence of vertebral fractures. Low bone density and previous fractures are risk factors for almost all types of fracture, but each type of fracture also has its own unique risk factors. Prevention of fractures with drugs could potentially be as expensive as medical treatment of fractures. Therefore, epidemiological research should be done and used to identify individuals at high-risk of disabling fractures, thereby allowing careful allocation of expensive treatments to individuals most in need.
We conducted a case-control study to identify risk factors for fractures of the distal radius and proximal humerus. Subjects were selected from women aged 45 and over with distal radius and proximal humerus fractures, resulting from minor trauma. Two age- and gender-matched controls for each case were selected from patients who subsequently visited the same clinic for treatment of conditions other than fractures. Questionnaires including anthropometric data, past and current physical activity, and lifestyle were sent by mail to both subjects and controls. A total of 140 women with distal radius fractures (mean age 67.4 years) and 242 controls were analyzed. Falls during the previous year were a significant risk factor, while futon use (instead of bed use) before fracture was a protective factor for distal radius fractures. A total of 37 women with proximal humerus fractures (mean age 76.3 years) and 67 controls were analyzed. Weight loss was a significant risk factor, while greater frequency of going outside significantly decreased the risk of proximal humerus fracture. There was no significant correlation with eating habits, milk and alcohol consumption, or smoking to the risk of either fracture.
Osteoporosis and fragility fractures in men account for substantial health care expenditures and decreased quality of life.
This article reviews the most current information about the epidemiology, diagnosis, prevention, and treatment of osteoporosis in men.
Relevant literature was identified through a search of MEDLINE (1966-June 2003) limited to English-language studies in men. The search terms included fractures, bone density, or osteoporosis plus either epidemiology, diagnosis, prevention, control, or therapy. Additional search terms included specific subtopics (eg, bisphosphonates, calcium, exercise, parathyroid hormone). The authors contributed additional relevant publications.
Morbidity after fragility fracture is at least as high in men as in women, and the rate of fracture-related mortality 1 year hip fracture is approximately double in men compared with women. The bioavailable fraction of testosterone slowly declines into the ninth decade in men. There is evidence that the effect of estrogen on bone is greater than that of testosterone in men. Diagnosing osteoporosis in men is complicated by a lack of consensus on how it should be defined. Significant risk factors for osteoporosis or fracture include low bone mineral density, previous fragility fracture, maternal history of fracture, marked hypogonadism, smoking, heavy alcohol intake or alcoholism, low calcium intake, low body mass or body mass index, low physical activity, use of bone-resorbing medication such as glucocorticoids, and the presence of such conditions as hyperthyroidism, hyperparathyroidism, and hypercalciuria. Prevention is paramount and should begin in childhood. During adulthood, calcium (1000-1500 mg/d), vitamin D (400-800 IU/d), and adequate physical activity play crucial preventive roles. When treatment is indicated, the bisphosphonates are the first choice, whereas there is less support for the use of calcitonin or androgen therapy. Parathyroid hormone (1-34) is a promising anabolic therapy. There is also strong evidence for the use of bisphosphonates for the treatment of glucocorticoid-induced osteoporosis.
Lifestyle factors such as diet and physical activity vary in different social and income groups, and are known to be important influences on the incidence of osteoporotic fractures. Financial and social pressures are a common concern for older people. We set out to study the effect of socioeconomic deprivation on the incidence of fracture in older people and to compare the findings with those for younger groups. The All Wales Injury Surveillance System (AWISS) is a computerized system that collects injury data from most A&E departments throughout Wales. In this population-based study of 1.8 million people living in the 445 electoral tracts covered by AWISS in south, west, and northeastern Wales, we identified all 60,106 residents who presented with a fracture in 1999 and 2000. We linked details of their fracture with published Townsend deprivation scores for the electoral tract in which they were living and calculated fracture rates by fifths of deprivation. We observed the expected pattern of increasing fracture incidence in older age groups. Fracture incidence was significantly higher in electoral wards with poorer Townsend scores, resulting from a marked effect of socioeconomic deprivation on fracture incidence among younger adults with a rate ratio of 1.64 (95% CI, 1.57 to 1.72). This effect diminished with age, and was not observed in older age groups. At ages 85 and over the rate ratio was 0.94 (95% CI, 0.87 to 1.01). Socioeconomic factors clearly play a part in the causation of fracture in younger adults. Lifestyle influences are important in older age groups, but socioeconomic deprivation does not appear to be a risk factor for the development of osteoporotic fractures in elderly people.
Novos e velhos males da saude no Brasil
- Monteiro
Risk factors for osteoporotic fractures in elderly men
- Nguyen