Fatores associados a fraturas de fêmur em uma coorte de mulheres idosas

Introdução: Fraturas de fêmur em mulheres idosas estão associadas à elevada morbimortalidade. O objetivo do estudo foi identificar os fatores associados a fraturas de fêmur em mulheres com idade igual ou superior a 60 anos. Metodologia: Estudo de coorte em grupo de mulheres idosas que foram submetidas à intervenção cirúrgica entre 2000 e 2015. Utilizou-se instrumento para coleta dos dados sociodemográficos/clínicos e o the European Vertebral Osteoporosis Study Group (EVOS). Os dados foram analisados por meio da estatística descritiva, do teste t de Student e do teste Qui-quadrado com nível de significância de p<0,05. A investigação foi aprovada pelo Comitê de Ética em Pesquisa com Seres Humanos da Instituição. Resultados: Dezoito mulheres foram incluídas na análise. A média de idade na época da fratura foi de 74,43±2,35 anos. O principal mecanismo de fratura foi de baixo impacto (77,8%). A maioria das participantes não fazia uso de tratamento farmacológico para osteoporose pós-fratura. Conclusão: Nossos achados sugerem vulnerabilidade das participantes a novas fraturas, o que indica a necessidade de maior atenção ao processo saúde-adoecimento.

Raloxifene retards the progression of adjacent segmental intervertebral disc degeneration by inhibiting apoptosis of nucleus pulposus in ovariectomized rats

Background Adjacent segmental intervertebral disk degeneration (ASDD) is a major complication secondary to lumbar fusion. Although ASSD pathogenesis remains unclear, the primary cause of intervertebral disk degeneration (IVDD) development is apoptosis of nucleus pulposus (NP). Raloxifene (RAL) could delay ASDD by inhibiting NP apoptosis. Methods An ASDD rat model was established by ovariectomy (OVX) and posterolateral spinal fusion (PLF) on levels 4–5 of the lumbar vertebrae. Rats in the treatment groups were administered 1 mg/kg/d RAL by gavage for 12 weeks, following which, all animals were euthanized. Lumbar fusion, apoptosis, ASDD, and vertebrae micro-architecture were evaluated. Results RAL maintained intervertebral disk height (DHI), delayed vertebral osteoporosis, reduced histological score, and inhibited apoptosis. The OVX+PLF+RAL group revealed upregulated expression of aggrecan and B-cell lymphoma-2 (bcl2), as well as significantly downregulated expression of a disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS-4), metalloproteinase-13 (MMP-13), caspase-3, BCL2-associated X (bax), and transferase dUTP nick end labeling (TUNEL) staining. Micro-computed tomography (Micro-CT) analysis revealed higher bone volume fraction (BV/TV), bone mineral density (BMD), and trabecular number (Tb.N), and lower trabecular separation (Tb.Sp) in OVX+PLF+RAL group than in the OVX+PLF group. Conclusions RAL can postpone ASDD development in OVX rats through inhibiting extracellular matrix metabolic imbalance, NP cell apoptosis, and vertebral osteoporosis. These findings showed RAL as a potential therapeutic target for ASDD.

AB0614 DENSITOMETRIC VERTEBRAL FRACTURE ASSESSMENT: FACTORS LIMITING GOOD VISIBILITY OF THE VERTEBRA

Background:The radiograph of the spine is the gold standard for identifying vertebral fractures (VF). Vertebral Fracture Assessment (VFA) is a new feature available on modern densitometers that could assess VF. This technique offers the advantage of low irradiation over standard radiography but at the cost of lower image quality.Objectives:The aim of this study was to assess factors associated with good vertebra visibility when using VFA.Methods:This is a cross-sectional study including patients referred by their physicians for bone mineral density (BMD) measurement. Anthropometric data were recorded. BMD was measured using standard methods over the lumbar spine L1-L4, the total proximal femur. Results were expressed as T-scores using Dual-energy X-ray absorptiometry (DEXA). The screening for VF was performed by VFA. A professional operator analyses VFA scans and assessed the good visibility of the vertebra.Results:The study included 100 patients. The mean age was 61.7 ±12.6 years [18-83].The average body mass index (BMI) was 28.9 ± 24.2 kg/m2 [14.2-45.3]. The mean T-score at the vertebral site was -1.5 DS [-4.9-1.5] with a mean mass of 0.95g/cm2 [0.58-1.371]. Osteoporosis was found in 27.7 % of patients. A vertebral fracture was diagnosed in 25% of cases. The visualization of the vertebra was impaired in the upper thoracic region in 60% of cases. Poor visibility was observed in 19% of cases in the mid-thoracic spine and only in 2% of cases in the lumbar spine. No statistically significant correlation was found between good vertebral visibility and age (p=0.2), weight (p=0.5), or BMI (p=0.7). However, good visibility of the vertebra was associated with a lower height (1.7 m vs 1.5 m, p=0.03). A better vertebrae visualization was correlated neither to the BMD of the right hip (0.84 vs 0.87, p=0.4) nor to the left hip (0.85 vs 0.89, p= 0.3). Similarly, the absence of vertebral osteoporosis was not correlated with a better vertebral visualization (p=0.6).Conclusion:Visibility of the vertebra on VFA does not appear to be altered by the BMD and vertebral osteoporosis, suggesting safe use in the elderly. However, precautions may be taken when interpreting VFA in patients with high heights.Disclosure of Interests:None declared.

Body weight, BMI, and stature have a protective effect on bone mineral density in women with postmenopausal vertebral osteoporosis, whereas greater age at menarche and years after menopause have a negative effect

Background Osteoporosis is a metabolic bone disease with a risk factor of being female, particularly after the onset of menopause. Objectives To evaluate the influence of age, anthropometric, and reproductive variables on spinal bone mineral density (BMD) in women with postmenopausal vertebral osteoporosis. Methods The study was retrospective and included data from 171 patients with postmenopausal vertebral osteoporosis. We performed both simple and multiple regressions considering BMD in spine as the dependent variable. Coefficients of correlation (r), coefficients of determination (r2), and their level of significance were calculated. Results The associations between spinal BMD and each of the following variables were extremely significant: age at menarche (P = 0.0003), weight (P < 0.0001), stature (P = 0.0004), and BMI (P < 0.0001). The associations between spinal BMD and age (P = 0.004), and between spinal BMD and number of years after menopause were very significant (P = 0.0093). BMD was not associated with age at menopause or number of reproductive years. For multiple regressions there was an increasing trend of r2 with increasing number of independent variables included in the analysis: r2 = 21.84% (2 variables), r2 = 24.93% (3 variables), 26.45% (4 variables), and r2 = 27% (5 variables). Conclusion BMD is positively associated with weight, BMI, and stature, and is negatively associated with age, time of menarche, and years after menopause. BMD is not associated with age at menopause and reproductive period.