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[PMID]:28449657
[Au] Autor:Adachi JD; Bone HG; Daizadeh NS; Dakin P; Papapoulos S; Hadji P; Recknor C; Bolognese MA; Wang A; Lin CJF; Wagman RB; Ferrari S
[Ad] Endereço:McMaster University, 501-25 Charlton Ave E., Hamilton, ON, L8N 1Y2, Canada. jd.adachi@sympatico.ca.
[Ti] Título:Influence of subject discontinuation on long-term nonvertebral fracture rate in the denosumab FREEDOM Extension study.
[So] Source:BMC Musculoskelet Disord;18(1):174, 2017 04 27.
[Is] ISSN:1471-2474
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Denosumab treatment for up to 8 years in the FREEDOM study and Extension was associated with low fracture incidence. It was not clear whether subjects who discontinued during the study conduct had a higher risk of fracture than those who remained enrolled, thereby underestimating the true fracture risk for the entire trial cohort. Thus, we explored the influence of early withdrawals on nonvertebral fracture incidence during the Extension study. METHODS: To understand the potential effect of depletion of susceptible subjects on fracture incidence, we first evaluated subject characteristics in patients who were enrolled in the Extension vs those who were not. We subsequently employed a Kaplan-Meier multiple imputation (KMMI) approach to consider subjects who discontinued as if they remained enrolled with a 0%, 20%, 50%, and 100% increase in fracture risk compared with participants remaining on study. RESULTS: Extension enrollees were generally similar to nonparticipants in median age (71.9 and 73.1 years, respectively), mean total hip bone mineral density T-score (-1.9 and -2.0, respectively), and probability of fracture risk by Fracture Risk Assessment Tool (FRAX ) at FREEDOM baseline (16.9% and 17.7% for major osteoporotic fracture and 6.7% and 7.4% for hip fracture, respectively). When we assumed a doubled fracture risk (100% increase) after discontinuation in KMMI analyses, nonvertebral fracture rate estimates were only marginally higher than the observed rates for both the crossover group (10.32% vs 9.16%, respectively) and the long-term group (7.63% vs 6.63%, respectively). CONCLUSION: The observation of continued denosumab efficacy over 8 years of treatment was robust and does not seem to be explained by depletion of susceptible subjects. TRIAL REGISTRATION: ClincalTrials.gov registration number NCT00523341 ; registered August 30, 2007.
[Mh] Termos MeSH primário: Conservadores da Densidade Óssea/uso terapêutico
Denosumab/uso terapêutico
Fraturas do Quadril/tratamento farmacológico
Fraturas por Osteoporose/tratamento farmacológico
Pacientes Desistentes do Tratamento
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Fraturas do Quadril/diagnóstico por imagem
Fraturas do Quadril/epidemiologia
Seres Humanos
Masculino
Meia-Idade
Fraturas por Osteoporose/diagnóstico por imagem
Fraturas por Osteoporose/epidemiologia
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Bone Density Conservation Agents); 4EQZ6YO2HI (Denosumab)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1186/s12891-017-1520-6


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[PMID]:29390346
[Au] Autor:Zhao B; Li H; Yan J; Han LR; Yang XF
[Ad] Endereço:Department of Orthopaedics, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, China.
[Ti] Título:Pipkin type III femoral head fracture-dislocation combined with complicated acetabular fracture: A rare case report and literature review.
[So] Source:Medicine (Baltimore);96(50):e9214, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Pipkin III fracture, which is characterized by high risk of avascular necrosis of the femoral head, is extremely rare. It is more difficult to treat and has a worse prognosis when accompanied with severe acetabular fractures. Few studies show that both Pipkin type III femoral head fracture-dislocation and complicated acetabular fracture presented in one patient. PATIENT CONCERNS: A 34-year-old male suffered a terrible traffic accident with a serious damage to the left side when he was sitting in the car's cockpit. Pelvic radiograph and 3-dimensional reconstruction of computed tomography revealed characteristics of fractures before the emergency operation. DIAGNOSIS: Pipkin III fractures combined with complicated acetabular fracture. INTERVENTIONS: Firstly, we used combined anterior and posterior approach for treatment to fix the femoral head fractures. Then, we completed anatomical reduction of fractures with countersunk head screw, hollow screw, and reconstruction plate. OUTCOMES: At the 12-months follow-up, the patient could walk freely and perform activities of daily living without necrosis of femoral head and heterotopic ossification. LESSONS: Although there are serious complications in Pipkin III fractures combined with complicated acetabular fracture, early surgical treatment with appropriate approach and fixation could get satisfactory results.
[Mh] Termos MeSH primário: Fraturas do Colo Femoral/cirurgia
Fratura-Luxação/cirurgia
Fixação Interna de Fraturas/métodos
Fraturas do Quadril/cirurgia
[Mh] Termos MeSH secundário: Acidentes de Trânsito
Adulto
Fraturas do Colo Femoral/classificação
Fraturas do Colo Femoral/diagnóstico por imagem
Fraturas do Colo Femoral/etiologia
Fratura-Luxação/classificação
Fratura-Luxação/diagnóstico por imagem
Fratura-Luxação/etiologia
Fixação Interna de Fraturas/instrumentação
Fraturas do Quadril/diagnóstico por imagem
Fraturas do Quadril/etiologia
Seres Humanos
Fixadores Internos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009214


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[PMID]:29390254
[Au] Autor:Zhang M; Li XM; Wang GS; Tao JH; Chen Z; Ma Y; Li XP
[Ad] Endereço:Department of Rheumatology and Immunology, Anhui Provincial Hospital, Anhui Medical University, Hefei, PR China.
[Ti] Título:The association between ankylosing spondylitis and the risk of any, hip, or vertebral fracture: A meta-analysis.
[So] Source:Medicine (Baltimore);96(50):e8458, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease and strongly associated with an increased risk of fractures. A great proportion of patients with AS are suffering from sustaining fractures and the aim of this study is to evaluate and quantify the association between the site of the fracture and AS by performing a meta-analysis. METHODS: A systematic literature search was performed on Medline database from 1966 to August 15, 2016 and Embase database from 1980 to August 15, 2016. Studies were evaluated by 2 independent reviewers and quantitative estimates regarding the association between ankylosing spondylitis and the risk of any, hip, or vertebral fracture were presented. After the heterogeneity of selected studies was assessed by using Cochran I statistics, the random effect model was used to combine effect size. Publication bias was measured by Egger and Begg's regression tests. RESULTS: A total of 6 articles were involved in our study. The results of meta-analysis revealed that AS was strongly associated with the risk of vertebral fracture (odds ratio [OR] = 4.25, 95% confidence interval [CI] = 1.07-7.42) and was not significantly associated with the risk of any fracture (OR=2.00, 95%CI = 0.94-3.06) or hip fracture (OR=1.28, 95%CI =0.16-2.40). CONCLUSION: In the present study, a general knowledge of the association between AS and the risk of 3 kinds of fractures were presented, which could improve the ways of prevention of fracture in the patients with AS.
[Mh] Termos MeSH primário: Fraturas Ósseas/etiologia
Fraturas do Quadril/etiologia
Fraturas da Coluna Vertebral/etiologia
Espondilite Anquilosante/complicações
[Mh] Termos MeSH secundário: Seres Humanos
Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008458


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[PMID]:29279934
[Au] Autor:Zhao JG; Zeng XT; Wang J; Liu L
[Ad] Endereço:Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China.
[Ti] Título:Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis.
[So] Source:JAMA;318(24):2466-2482, 2017 12 26.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The increased social and economic burdens for osteoporosis-related fractures worldwide make the prevention of such injuries a major public health goal. Previous studies have reached mixed conclusions regarding the association between calcium, vitamin D, or combined calcium and vitamin D supplements and fracture incidence in older adults. Objective: To investigate whether calcium, vitamin D, or combined calcium and vitamin D supplements are associated with a lower fracture incidence in community-dwelling older adults. Data Sources: The PubMed, Cochrane library, and EMBASE databases were systematically searched from the inception dates to December 24, 2016, using the keywords calcium, vitamin D, and fracture to identify systematic reviews or meta-analyses. The primary randomized clinical trials included in systematic reviews or meta-analyses were identified, and an additional search for recently published randomized trials was performed from July 16, 2012, to July 16, 2017. Study Selection: Randomized clinical trials comparing calcium, vitamin D, or combined calcium and vitamin D supplements with a placebo or no treatment for fracture incidence in community-dwelling adults older than 50 years. Data Extraction and Synthesis: Two independent reviewers performed the data extraction and assessed study quality. A meta-analysis was performed to calculate risk ratios (RRs), absolute risk differences (ARDs), and 95% CIs using random-effects models. Main Outcomes and Measures: Hip fracture was defined as the primary outcome. Secondary outcomes were nonvertebral fracture, vertebral fracture, and total fracture. Results: A total of 33 randomized trials involving 51 145 participants fulfilled the inclusion criteria. There was no significant association of calcium or vitamin D with risk of hip fracture compared with placebo or no treatment (calcium: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01 [95% CI, 0.00 to 0.01]; vitamin D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00 [95% CI, -0.00 to 0.01]. There was no significant association of combined calcium and vitamin D with hip fracture compared with placebo or no treatment (RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00 [95% CI, -0.00 to 0.00]). No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of nonvertebral, vertebral, or total fractures. Subgroup analyses showed that these results were generally consistent regardless of the calcium or vitamin D dose, sex, fracture history, dietary calcium intake, and baseline serum 25-hydroxyvitamin D concentration. Conclusions and Relevance: In this meta-analysis of randomized clinical trials, the use of supplements that included calcium, vitamin D, or both compared with placebo or no treatment was not associated with a lower risk of fractures among community-dwelling older adults. These findings do not support the routine use of these supplements in community-dwelling older people.
[Mh] Termos MeSH primário: Cálcio/uso terapêutico
Suplementos Nutricionais
Fraturas Ósseas/prevenção & controle
Fraturas do Quadril/prevenção & controle
Vitamina D/uso terapêutico
Vitaminas/uso terapêutico
[Mh] Termos MeSH secundário: Idoso
Quimioterapia Combinada
Fraturas Ósseas/epidemiologia
Fraturas do Quadril/epidemiologia
Seres Humanos
Incidência
Vida Independente
Meia-Idade
Ensaios Clínicos Controlados Aleatórios como Assunto
Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Vitamins); 1406-16-2 (Vitamin D); SY7Q814VUP (Calcium)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.19344


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[PMID]:29183076
[Au] Autor:Pincus D; Ravi B; Wasserstein D; Huang A; Paterson JM; Nathens AB; Kreder HJ; Jenkinson RJ; Wodchis WP
[Ad] Endereço:Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
[Ti] Título:Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery.
[So] Source:JAMA;318(20):1994-2003, 2017 11 28.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Although wait times for hip fracture surgery have been linked to mortality and are being used as quality-of-care indicators worldwide, controversy exists about the duration of the wait that leads to complications. Objective: To use population-based wait-time data to identify the optimal time window in which to conduct hip fracture surgery before the risk of complications increases. Design, Setting, and Participants: Population-based, retrospective cohort study of adults undergoing hip fracture surgery between April 1, 2009, and March 31, 2014, at 72 hospitals in Ontario, Canada. Risk-adjusted restricted cubic splines modeled the probability of each complication according to wait time. The inflection point (in hours) when complications began to increase was used to define early and delayed surgery. To evaluate the robustness of this definition, outcomes among propensity-score matched early and delayed surgical patients were compared using percent absolute risk differences (RDs, with 95% CIs). Exposure: Time elapsed from hospital arrival to surgery (in hours). Main Outcomes and Measures: Mortality within 30 days. Secondary outcomes included a composite of mortality or other medical complications (myocardial infarction, deep vein thrombosis, pulmonary embolism, and pneumonia). Results: Among 42 230 patients with hip fracture (mean [SD] age, 80.1 years [10.7], 70.5% women) who met study entry criteria, overall mortality at 30 days was 7.0%. The risk of complications increased when wait times were greater than 24 hours, irrespective of the complication considered. Compared with 13 731 propensity-score matched patients who received surgery earlier, 13 731 patients who received surgery after 24 hours had a significantly higher risk of 30-day mortality (898 [6.5%] vs 790 [5.8%]; % absolute RD, 0.79; 95% CI, 0.23-1.35) and the composite outcome (1680 [12.2%]) vs 1383 [10.1%]; % absolute RD, 2.16; 95% CI, 1.43-2.89). Conclusions and Relevance: Among adults undergoing hip fracture surgery, increased wait time was associated with a greater risk of 30-day mortality and other complications. A wait time of 24 hours may represent a threshold defining higher risk.
[Mh] Termos MeSH primário: Fraturas do Quadril/mortalidade
Fraturas do Quadril/cirurgia
Complicações Pós-Operatórias/epidemiologia
Tempo para o Tratamento
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seguimentos
Fixação Interna de Fraturas
Seres Humanos
Masculino
Complicações Pós-Operatórias/mortalidade
Pontuação de Propensão
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.17606


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[PMID]:29385235
[Au] Autor:Eamer G; Taheri A; Chen SS; Daviduck Q; Chambers T; Shi X; Khadaroo RG
[Ad] Endereço:Department of Surgery, University of Alberta, Edmonton, Canada.
[Ti] Título:Comprehensive geriatric assessment for older people admitted to a surgical service.
[So] Source:Cochrane Database Syst Rev;1:CD012485, 2018 Jan 31.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Aging populations are at increased risk of postoperative complications. New methods to provide care for older people recovering from surgery may reduce surgery-related complications. Comprehensive geriatric assessment (CGA) has been shown to improve some outcomes for medical patients, such as enabling them to continue living at home, and has been proposed to have positive impacts for surgical patients. CGA is a coordinated, multidisciplinary collaboration that assesses the medical, psychosocial and functional capabilities and limitations of an older person, with the goal of establishing a treatment plan and long-term follow-up. OBJECTIVES: To assess the effectiveness of CGA interventions compared to standard care on the postoperative outcomes of older people admitted to hospital for surgical care. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two clinical trials registers on 13 January 2017. We also searched grey literature for additional citations. SELECTION CRITERIA: Randomized trials of people undergoing surgery aged 65 years and over comparing CGA with usual surgical care and reporting any of our primary (mortality and discharge to an increased level of care) or secondary (length of stay, re-admission, total cost and postoperative complication) outcomes. We excluded studies if the participants did not receive a complete CGA, did not undergo surgery, and if the study recruited participants aged less than 65 years or from a setting other than an acute care hospital. DATA COLLECTION AND ANALYSIS: Two review authors independently screened, assessed risk of bias, extracted data and assessed certainty of evidence from identified articles. We expressed dichotomous treatment effects as risk ratio (RR) with 95% confidence intervals and continuous outcomes as mean difference (MD). MAIN RESULTS: We included eight randomised trials, seven recruited people recovering from a hip fracture (N = 1583) and one elective surgical oncology trial (N = 260), conducted in North America and Europe. For two trials CGA was done pre-operatively and postoperatively for the remaining. Six trials had adequate randomization, five had low risk of performance bias and four had low risk of detection bias. Blinding of participants was not possible. All eight trials had low attrition rates and seven reported all expected outcomes.CGA probably reduces mortality in older people with hip fracture (RR 0.85, 95% CI 0.68 to 1.05; 5 trials, 1316 participants, I² = 0%; moderate-certainty evidence). The intervention reduces discharge to an increased level of care (RR 0.71, 95% CI 0.55 to 0.92; 5 trials, 941 participants, I² = 0%; high-certainty evidence).Length of stay was highly heterogeneous, with mean difference between participants allocated to the intervention and the control groups ranging between -12.8 and 8.3 days. CGA probably leads to slightly reduced length of stay (4 trials, 841 participants, moderate-certainty evidence). The intervention probably makes little or no difference in re-admission rates (RR 1.00, 95% CI 0.76 to 1.32; 3 trials, 741 participants, I² = 37%; moderate-certainty evidence).CGA probably slightly reduces total cost (1 trial, 397 participants, moderate-certainty evidence). The intervention may make little or no difference for major postoperative complications (2 trials, 579 participants, low-certainty evidence) and delirium rates (RR 0.75, 95% CI 0.60 to 0.94, 3 trials, 705 participants, I² = 0%; low-certainty evidence). AUTHORS' CONCLUSIONS: There is evidence that CGA can improve outcomes in people with hip fracture. There are not enough studies to determine when CGA is most effective in relation to surgical intervention or if CGA is effective in surgical patients presenting with conditions other than hip fracture.
[Mh] Termos MeSH primário: Avaliação Geriátrica
Fraturas do Quadril/cirurgia
Tempo de Internação
Neoplasias/cirurgia
[Mh] Termos MeSH secundário: Idoso
Delírio/epidemiologia
Procedimentos Cirúrgicos Eletivos/mortalidade
Fraturas do Quadril/mortalidade
Seres Humanos
Neoplasias/mortalidade
Readmissão do Paciente/estatística & dados numéricos
Complicações Pós-Operatórias/epidemiologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012485.pub2


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[PMID]:28460645
[Au] Autor:Vangala C; Lenihan CR; Montez-Rath ME; Nair SS; Navaneethan SD; Ramanathan V; Winkelmayer WC
[Ad] Endereço:Baylor College of Medicine, Section of Nephrology, One Baylor Plaza, BCM 620 - 11D32.5, Houston, TX, 77030, USA.
[Ti] Título:Statin use and hip fractures in U.S. kidney transplant recipients.
[So] Source:BMC Nephrol;18(1):145, 2017 May 01.
[Is] ISSN:1471-2369
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Basic and translational research supports beneficial effects of statins on bone metabolism. Clinical studies suggest that statin use may reduce the risk of hip fractures in the general population. Whether statin use is associated with hip fracture risk in kidney transplant recipients, a particularly high-risk group for this outcome, is unknown. METHODS: From the U.S. Renal Data System (2007-2011), we identified all hip fracture events recorded in Medicare billing claims of first-time kidney transplant recipients. We then matched all cases to an unlimited number of controls on age (±3 years), sex, race (black vs. non-black), and time since transplant. Cases and controls were required to have >1 year of Medicare Parts A + B + D coverage and be without a recorded history of hip fracture. We ascertained any statin use in the previous year and defined adherent statin use as those who had filled prescriptions for statins to cover >80% of days in that year (proportion of days covered, PDC). We ascertained several potential confounders (demographics, comorbidities, BMI, transplant-related factors) and applied conditional logistic regression with multiple imputation for missing data to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: We identified 231 hip fracture cases (mean age 51.8 years; 53% female; 11.3% black; 6.9 years from transplant, and 9.9 years from ESRD) and 15,575 matched controls. Any prior statin use was present in 64.1% of cases and 60.3% of controls with 37.2% of cases and 33.9% of controls being found adherent. Unadjusted conditional logistic regression showed an OR of 1.17 (0.89-1.54) for any statin use, and a fully-adjusted OR of 0.89 (0.67-1.19). Compared with statin non-users, the adjusted OR for patients with lesser adherence (PDC ≤80%) and those with greater adherence (PDC >80%) were 0.93 (0.66-1.31) and 0.87 (0.63-1.20), respectively. CONCLUSION: Statin use was not associated with hip fracture risk in first-time kidney transplant recipients.
[Mh] Termos MeSH primário: Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia
Fraturas do Quadril/epidemiologia
Fraturas do Quadril/prevenção & controle
Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico
Falência Renal Crônica/epidemiologia
Falência Renal Crônica/reabilitação
Transplante de Rim/utilização
[Mh] Termos MeSH secundário: Conservadores da Densidade Óssea/uso terapêutico
Causalidade
Comorbidade
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico
Feminino
Fraturas do Quadril/diagnóstico
Seres Humanos
Incidência
Falência Renal Crônica/diagnóstico
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Bone Density Conservation Agents); 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1186/s12882-017-0559-9


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[PMID]:29390448
[Au] Autor:Weidung B; Toots A; Nordström P; Carlberg B; Gustafson Y
[Ad] Endereço:Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå.
[Ti] Título:Systolic blood pressure decline in very old individuals is explained by deteriorating health: Longitudinal changes from Umeå85+/GERDA.
[So] Source:Medicine (Baltimore);96(51):e9161, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Declining systolic blood pressure (SBP) is common in very old age and is associated with adverse events, such as dementia. Knowledge of factors associated with SBP changes could explain the etiology of this decline in SBP. This study investigated longitudinal changes in socioeconomic factors, medical conditions, drug prescriptions, and assessments and their associations with SBP changes among very old followed individuals.The study was based on data from the Umeå85+/Gerontological Regional Database (GERDA) cohort study, which provided cross-sectional and longitudinal data on participants aged 85, 90, and ≥95 years from 2000 to 2015. Follow-up assessments were conducted after 5 years. The main outcome was a change in SBP. Factors associated with SBP changes were assessed using multivariate linear regression models.In the Umeå85+/GERDA study, 454 surviving individuals underwent follow-up assessment after 5 years. Of these, 297 had SBP measured at baseline and follow-up. The mean change ±â€Šstandard deviation in SBP was -12 ±â€Š25 mm Hg. SBP decline was associated independently with later investigation year (P = .009), higher baseline SBP (P < .001), baseline antidepressant prescription (P = .011), incident acute myocardial infarction during follow-up (P = .003), new diuretic prescription during follow-up (P = .044), and a decline in the Barthel Activities of Daily Living index at follow-up (P < .001).In conclusion, SBP declines among very old individuals. This decline seems to be associated with initial SBP level, investigation year, and health-related factors.
[Mh] Termos MeSH primário: Pressão Sanguínea
Nível de Saúde
Sístole
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Antidepressivos/uso terapêutico
Doenças Cardiovasculares/epidemiologia
Estudos Transversais
Demência/epidemiologia
Depressão/epidemiologia
Diabetes Mellitus/epidemiologia
Avaliação da Deficiência
Diuréticos/uso terapêutico
Feminino
Finlândia/epidemiologia
Fraturas do Quadril/epidemiologia
Seres Humanos
Estudos Longitudinais
Masculino
Suécia/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antidepressive Agents); 0 (Diuretics)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009161


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[PMID]:28740372
[Au] Autor:Vandenbroucke A; Luyten FP; Flamaing J; Gielen E
[Ad] Endereço:Clinical Department of Internal Medicine, UZ Leuven.
[Ti] Título:Pharmacological treatment of osteoporosis in the oldest old.
[So] Source:Clin Interv Aging;12:1065-1077, 2017.
[Is] ISSN:1178-1998
[Cp] País de publicação:New Zealand
[La] Idioma:eng
[Ab] Resumo:The incidence of osteoporotic fractures increases with age. Consequently, the global prevalence of osteoporotic fractures will increase with the aging of the population. In old age, osteoporosis is associated with a substantial burden in terms of morbidity and mortality. Nevertheless, osteoporosis in old age continues to be underdiagnosed and undertreated. This may, at least partly, be explained by the fact that evidence of the antifracture efficacy of osteoporosis treatments comes mainly from randomized controlled trials in postmenopausal women with a mean age of 70-75 years. However, in the last years, subgroup analyses of these landmark trials have been published investigating the efficacy and safety of osteoporosis treatment in the very elderly. Based on this evidence, this narrative review discusses the pharmacological management of osteoporosis in the oldest old (≥80 years). Because of the high prevalence of calcium and/or vitamin D deficiency in old age, these supplements are essential in the management of osteoporosis in the elderly people. Adding antiresorptive or anabolic treatments or combinations, thereof, reduces the risk of vertebral fractures even more, at least in the elderly with documented osteoporosis. The reduction of hip fracture risk by antiresorptive treatments is less convincing, which may be explained by insufficient statistical power in some subanalyses and/or a higher impact of nonskeletal risk factors in the occurrence of hip fractures. Compared with younger individuals, a larger absolute risk reduction is observed in the elderly because of the higher baseline fracture risk. Therefore, the elderly will benefit more of treatment. In addition, current osteoporosis therapies also appear to be safe in the elderly. Although more research is required to further clarify the effect of osteoporosis drugs in the elderly, especially with respect to hip fractures, there is currently sufficient evidence to initiate appropriate treatment in the elderly with osteoporosis and osteoporotic fractures.
[Mh] Termos MeSH primário: Conservadores da Densidade Óssea/uso terapêutico
Osteoporose/tratamento farmacológico
Osteoporose/epidemiologia
Fraturas por Osteoporose/prevenção & controle
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Conservadores da Densidade Óssea/administração & dosagem
Conservadores da Densidade Óssea/efeitos adversos
Cálcio/deficiência
Cálcio na Dieta
Suplementos Nutricionais
Difosfonatos/uso terapêutico
Feminino
Fraturas do Quadril/prevenção & controle
Seres Humanos
Osteoporose Pós-Menopausa/tratamento farmacológico
Fatores de Risco
Fraturas da Coluna Vertebral/prevenção & controle
Deficiência de Vitamina D/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Bone Density Conservation Agents); 0 (Calcium, Dietary); 0 (Diphosphonates); SY7Q814VUP (Calcium)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE
[do] DOI:10.2147/CIA.S131023


  10 / 12924 MEDLINE  
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[PMID]:29437066
[Au] Autor:Basques BA; McLynn RP; Lukasiewicz AM; Samuel AM; Bohl DD; Grauer JN
[Ad] Endereço:Yale School of Medicine, 47 College Street, 2nd Floor, New Haven, Connecticut 06510, USA.
[Ti] Título:Missing data may lead to changes in hip fracture database studies: a study of the American College of Surgeons National Surgical Quality Improvement Program.
[So] Source:Bone Joint J;100-B(2):226-232, 2018 Feb.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: The aims of this study were to characterize the frequency of missing data in the National Surgical Quality Improvement Program (NSQIP) database and to determine how missing data can influence the results of studies dealing with elderly patients with a fracture of the hip. PATIENTS AND METHODS: Patients who underwent surgery for a fracture of the hip between 2005 and 2013 were identified from the NSQIP database and the percentage of missing data was noted for demographics, comorbidities and laboratory values. These variables were tested for association with 'any adverse event' using multivariate regressions based on common ways of handling missing data. RESULTS: A total of 26 066 patients were identified. The rate of missing data was up to 77.9% for many variables. Multivariate regressions comparing three methods of handling missing data found different risk factors for postoperative adverse events. Only seven of 35 identified risk factors (20%) were common to all three analyses. CONCLUSION: Missing data is an important issue in national database studies that researchers must consider when evaluating such investigations. Cite this article: 2018;100-B:226-32.
[Mh] Termos MeSH primário: Acurácia dos Dados
Bases de Dados Factuais
Fraturas do Quadril/cirurgia
Melhoria de Qualidade
[Mh] Termos MeSH secundário: Idoso
Comorbidade
Demografia
Feminino
Seres Humanos
Tempo de Internação
Masculino
Duração da Cirurgia
Procedimentos Ortopédicos
Complicações Pós-Operatórias
Medição de Risco
Fatores de Risco
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180214
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B2.BJJ-2017-0791.R1



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