Osteoporose e terceira-idade
fatores de risco e prevenção
Palabras clave:
osteoporose, estrógenos, hormônios sexuais, menopausa, envelhecimentoResumen
Os autores apresentam uma revisão do conceito da osteoporose como síndrome multifatorial e de abordagem interdisciplinar, com base na dinâmica celular de osteoclastos e osteoblastos, regendo os principais mecânismos de perda de massa óssea. Revêem a participação de citocinas e fatores locais de crescimento nos procedimentos de reabsorção e neoosteogênese da remodelação óssea. Apresentam também as condições que interferem com os mecanismos que explicam as diferentes velocidades de perda de massa óssea - os chamados fatores de risco ou fatores de remodelação óssea. Tais fatores - locais ou sistêmicos - podem compor um elenco de características, que varia de indivíduo para indivíduo, e permite o delineamento do perfil do paciente osteoporótico. Assim, a raça, o sexo, a hereditariedade, a massa muscular, os níveis de estrógenos circulantes, a preconização de uma suplementação cálcica adequada, seja dietética, seja galênica - a nuliparidade, a menopausa precoce, os hábitos sociais, como fumo, etílismo, ingestão demasiada de café e principalmente o "stress" - representam condições que irifluenciam diretamente os mecanismos de reabsorção óssea. A avaliação de todas essas condições permite a apresentação de um programa educacional e assistencial que permite a prevenção da Síndrome Osteoporótico.
Descargas
Citas
ALOIA,J.F., COHN, S.H., OSTIJNI,].A., CANE, R., EWS. K. Prevention of involutional bone loss by exercise. Annals of Interna! Medicine, Philadelphia, v.89, p.356-358, 1978.
ANDERSEN, F.S., TRANSBOL, 1., CHRlSTIANSEN, C. Is cigarette smoking a promotor of the menopause? Acta Medica Scandinavica, Stockholm, v.212, p.137, 1982.
ARBRECHT, H.]., ZENSER, TV., DAVIS, B.B. Effect of age on the conversion of 25 - hydroxyvitarnn D3 to 1,25 – dyhydroxyvitarnin
D3 by kidney of rat. Journal of Clinica! Investigation, New York, v.66, p.1118-1123, 1980.
BAKER, S.P., HARVEY, A.H. Fali injuries in the elderly: symposium on falis in the elderly; biological aspects and behavioral aspects. Clinicsin GeriatricMedicine,Philadelphia, v.l, p.501-508,1985.
BARAN, D.T., TEITELBAUM, S.L., BERGFELD, M.A., PARKER, G., CRUVANT, E.M., AVIOU, L.V. Effect of alcohol ingestion on bane and mineral metabolism in rats. American fournal of Pbysiology, Bethesda, v.238, p.E507-E510, 1980.
BELL, N.H., GREENE, A., EPSTEIN, S., OEXMANN, M.]., SHAW, S., SHARG, J. Evidence for alteration of the vitamin D: endocrine system in blacks. founarl of Clinicai Investigation, New York, v.76, p.470-473, 1985.
BODY, L.]., HEATH, H. Estimates of circulating monomeric calcitonin: physiological studies in normal and thyroidectomized man. fournal of Clinicai Endocronology and Metabolism, Baltimore, v.57, p. 897-903, 1983.
BULLAMORE, J.R., GALLAGHER, J.C., WILKENSON, R., NORDIN, B.E.C., MARSHALL, D.H., Effect of age on calcium absorption. Lancet, London, v.2, p.535-537, 1970.
CANIGGIA, A., GENNARI, C., BIANCHI, V., GUIDERI, R. Intestinal absorption of Ca in senile osteoporosis. Acta Medica Scandinavica, Stockbolm, v.173, p.613, 1963.
CENTRELLA, M., CAHALIS, E. Local regulators os skeletal growth: a perspective. Endocrine Reviews, Baltimore, v.6, p.544-551, 1985.
COHN, S.H., ABESAMES, C., YASUMURA, S., ALOIA,J.F. SANZI, I., ELIS, K.]. Comparative skeletal mass and radial bane mineral content in black and white women. Metabolism: clinicai and experimental, Duluth, v.26, p.171-178, 1977.
CONSENSOS conference: steoporosis. fama, Chicago, v.252, p. 799-802, 1984.
CURTISS, P.H., CLARK, W.S., HERNDON, C.H. Vertebral fractures resulting from prolonged cortisone and corticotrophin therapy. fama, Chicago, v.156, p.467-470, 1954.
DALEN, N., FELDREICH, A.L.Osteopenia in alcoholism. Clinicai Ortbopaedics and Related Researcb, Philadelphia, v.99, p.201, 1974.
, HALLBEY, D., LAMKE, B. Bone mass in obese subjects.
ActaMedicaScandinavica,Stockholm, v.197, p.353-355, 1975.
DANlELL H.W. Postrnenopausal tooth loss: contributions to edentulism by osteoporosis and cigarette smoking. Arcbives o/Interna/Medicine, Chicago, v.143, p.1678-1682, 1983.
DELMAS,P.D.,STENNER, D., WAHNER, H.W., MANN, K.G., RIGGS, B.L.lncrease in serum bane y - carboxyglutamic acid protein with aging in women: irnplications for the mechanism of age related bane loss. fournal of Clinicai Investigation, New York, v.71, p.1316-1321, 1983.
DRINKWATER, B.L., NILSON, K. CHESNlIT, C.H., BREMMER, W.]., SHAINHOLTZ, S., SOUTHWORTH, M.B. Bane mineral content of amenorrheic and eumenorrheic athletes. New England fournal of Medicine, Boston, v.311, p.277-281, 1984.
ERIKSEN, E.F., BENG,N.]., GRAHAM, M.L. MANN,K.G., SPELSBERT, T.C., RIGGS, B.L. Evidence of estrogen receptors in human bane cells. fournal of Bone and Mineral Researcb, New York, v.2, p.s31, 1987. SupplemenT.
ETTINGER, B., GENANT, H.K. CANN, C.E. Long term estrogen replacement therapy prevents bone loss and fractures. Annals of Internai Medicine, Philadelphia, v.102, p.319-324, 1985.
FALCH, J.A., OFTEBRO, H., HANG, E. Early postrnenopausal bane loss is not associated with a decrease in circulating laveis of 25 - hydroxyvitamin D, 1-25-dihydroxyvitamin D. or vitamin D binding protein. fournal of Clinicai Endocrinology and Metabolism, Baltimore, v.64, p.836-841, 1987.
FARLEY,J.R., FITZSIMMONS, R., TAYLOR, A.K.JORCH, U.M., LAU, K.H.W. Direct effects of ethanol on bane resorption and forrnation in vitro. Arcbives of Biocbemistry and Biopbysics, New York, v.238, p.305-314, 1985.
FORESTA, C., ZANATTA, G.P., BUSNARDO, B., SCANEW, G.S CANDELLARI, C.Testosterone and claciotonin plasma leveis in hypogonadal osteoporotic young men.fournal Endocrino logical Investigation, Milano, v.8, p.377-379, 1985.
FRANCIS, R.M., PEACOCK, M., AARON, J.E. et ai. Osteoporosis in hypogonadal men: role of decreased plasma 1,25 - dihdroxyvitamin D, cacium malabsorption and low bane forrnation. Bone, New York, v.7, p.261-268, 1986.
FROST, H.M. Treatrnent of osteoporosis by manipulation of coherent bane cell populations. Clinicai Ortbopaedics and Related Researcb, Philadelphia, v.143, p.227-244, 1979.
GALLAGHER,J.C.RIGGS, B.L., EISMAN,J.,HAMSTRA, A.,ARNAUD, S.B., DELUCA, H.F. Intestinal calcium absorption and serum vitamin D metabolites in normal subjects and osteoporotic patients: effect of age and dietary calcium. fournal of Clinicai Investigation, New Iork, v.64, p.729-736, 1979.
GENANT, H.K., CANN, C.E, EHINGER, B., GORDON, G.S. Quantitative computed tomography of vertebral spotebral spongiosa: a sensitive methof for detecting early bone loss after oophorectomy. Annals of Internai Medicine, Philadeplphia, v.97, p.699-705, 1982.
GRYFE, C.I., AMIES, A logitudinal study of falis in an elderly population: incidence and morbidity. Age and Ageing, Oxford, v.6, p.201.210, 1977.
HEANEY, R.P., GALLAGNHER, J.C., JOHNSTON, C.C., NEEER, R., PARFITT, A.M., WHEDON, G.D., Calcium nutrition and bane health in the elderly. American fournal of Clinicai Nutrition, Bethesda, v.36, p.986-1013, 1982.
, RECKER, R.R. Effects of nitrogen phosphorus and caffeire on calcium balance in women. Journal of Laboratory and Clinicai Medicine, St. Louis, v.99, p.46-55, 1982.
, SAVILLE, P.D. Menopausa! changes in calcium balance performance. fournal of Laboratory and Clinicai Medicine, St. Louis v.92, p.953-963, 1978.
HURLEY, M.M., KREAM, B.E., RASZ, L.G. Effects of heparin on cultured 21 - day fetal rat clavaris.journal of Bone and Mineral Researcb, New York, v.2, p.S14, 1987. Supplement 1.
NEY, J.L., BAYLINK. D.]. Postmenopausal osteoporosis: proposed roles of defective coupling and estrogen defficiency. Metabolic Bone Disease Related Researcb, v.3, p.3-7, 1981.
JENSEM, G.F., CHRISTIANSEN, C., BOESEN, J. HEGEDIS, V., TRANSBOL, I. Relationship beteween bane mineral content and frequency of postrnenopausal fractures. Acta Medica Scandinavica, Stockholm, v.313, p.61-63, 1983.
JOWSEY, J., GERSHON, C. Effect of dietary calcium leveis on production and reversai of experimental osteoporosis in cats. Proceedings of tbe Society for Experimental Biology and Medicine, New York, v.116, p.437, 1964.
KOMM, B.S., SHEETZ, L., BAKER, M., GALLEGOS, A., O'MALLEY, B.W., HAUSSLER, M.R. Bane related cells in culture express putative estrogen receptor mRNA and 125 I - 17 estradiol binding. Journal of Bone and Mineral Researcb, New York, v.2, p.S31, 1987. Supplement 1.
KROLNER, B., TOFT, B., NIELSEN, P.S., TONDEVOLD, E. Physical exercise as prophylaxis against involutional vertebral bane loss: a controled triai. Clinicai Science, Colchester Essex, v. 64, p.541-546, 1983.
LAMBERT, S.W.J., KIJYN, J.G.M., DEJONG, F.H. BIRKERHANGER, J.C. Honnone secretion in alcohol: induced pseudo-cushing's syndrome]AMA, Chicago, v.242, p.164, 1979.
LINDQUIST, O., BENGTSSON, C. Menopausa] age in relation to smo-king. ActaMedica Scandinavica, Stockholm, v.205, p.73, 1979.
UNDSAY, R., AITKEN, J.M., ANDERSON, J.B. et ai. Long-term prevention of postmenopausal osteoporosis by oestrongen. Lancet, London, v.I, p.1038, 1976.
, HART, D.,., FORREST, C., BAND, C. Prevention of spinal oesteporosis in oophorectomissed women. Lancet, London, v.2, p.1151-1153, 1980.
LlPS, P., COURPRON, P., MEUNIER, P.J. Mean wall thickness of trabecular bone packets in human liac crest: changes with age. Calciforme Tissue Researcb, v. 26, p.13-17, 1978.
MAZESS, R.B. On aging bone loss. Clinicai Ortbopaedics and Related Researcb, Philadelphia, v.165, p. 239-252, 1982.
McKENNA, M.J., FRAME, B. The mast cell and bone. Clinicai ortbopaedics and Related Researcb, Philadelphia, v.200, p.226-233, 1985.
MEENA,S., BUNKER, M.L., MEENA, H.E. Preventive effext of strong on postmenopausal bone loss. Arcbives on Internai Medicine, Chicago, v.135, p.1436, 1975.
MELTON, L.J., RIGGS, B.L. Risk factors for injury after a fali: symposium on falis in the elderly; biological and behavioral aspects. Clinics in Geriatric Medicine, Philadelphia, v.1, p.1- 15, 1985.
MILLER, P.D. Prevention and treatment strategies for reducing the incidence of osteoporotic fractures in older patients. Geriatric Medicine Today, v.7, p.23-29, 1988.
NEWCOMER, A.D., HODGSON, S.F. McGillLL, D.B., THOMAS, PJ Lactase deficiency: prevalence in osteoporosis. Annals of Internai Medicine, Philadelphia, v.89, p.218-220, 1978.
NORDIN, B.E.C. O steomalacia, osteoposis and calcium deficiency. Clinicai Ortbopaedics and Related Researcb, Philadelphia, v.17, p.235, 1960.
, HORSMAN, A., MARSHALL, D.H., SIMPSON, M.,
WATERHOUSE, G.M. Calcium requirement and calcium therapy. Clinicai Ortbopaedics and Related Research, Philadelphia, v.140, p.216-239, 1979.
PAGANINI-HlLL, A., ROSS, R,K., GERKlNS, V.R. HENDERSON, B.E., ARTHUR, M., MACK, T.M. Menopausa! estrogen therapy and hip fractures. Annals of Internai Medicine, Philadelphia, v.95, p.28-31, 1981.
PARFITT, A.M. Quantum concept of bone remodelng and turnover: implications for the pathogenesis of osteoporosis. Calcifield Tisse International, New York, v.28, p.1-5, 1979.
PAUL, T.L. KERRIGON, J., KELLY, M. et ai. Longteim 1 - thyroxine therapy is associated with decreased hip bone density in premenopausal women. fama, Chicago, v.259, p.3137, 1988.
PREGER, L., STEINBACH, H.C., MOSKOWITZ, P. Roentgenographic abnonnalities in phenotypic females with gonadal dysgenesis. American Journal of Roentgenology, v.104, p.899, 1968.
RAITX, L.G. Local and systemic factors in the pathogenesis of osteoporosis. New England Journal of Medicine, Boston, v. 318, p.818-S28, 1988.
RICHELSON, L.S., WAHNER, H.W., MELTON, L.J. RIGGS, B.L. Relative contributions of aging and etrongen deficiency to postmenopausal bone loss. New England Journal of Medicine, Boston, v.311, p.1273-1275, 1984.
RIGGS, B.]. BESSER, G.M.JEFFCOATI, W.]., GOLDIE, D.]. MARKS, V Alcohol-induced pseudo-cushing's syndrome. Lancei, London, v.1, p.726, 1977.
RIGGS, B.L. et ai. Differential changes in bone mineral density of the apprendicular and axial skeleton with aging: relationship tospinal oesteoporis. Journal of Clinicai Investigation, New York, v.67, p.328-335, 1981.
MELTON, L.J. Involutional osteoporosis New England Journal of Medicine, Boston, v.314, p.1676-1687, 1986.
RUDMAN, D., KUTNER, M.H. ROGERS, C.M. LUBIN, M.F., FLEMING, G.A., BAIN, R.P. Implaired growth hormone secretion in the adult population: relation to age and adiposity. Journal of Clinicai Investigation, New York, v.67, p.1361-1369, 1981.
SEEMAN, E. et. ai. Differential effects of endorine dysfuntion on the axial and appendicular skeleton. Journal of Clinicai Investigation, New York, v.69, p.1302-1308, 1982.
SIMONEN, O., LAITINEM, O. Does fluoridation of drinking water prevent bone fragility and oesteoporosis? Lancet, London, v.2, p.432-433, 1985.
SLOVIC, D.M., ADAMS, JS., NEER, R.M. HOUCK, M.F. POTTS JR. J.T. Deficient production of 1,25 - dihydroxytamin D in elderly osteopotic patients. New England Journal of Medicine, Boston, v.305, p.372-374, 1981.
SMITH, D.M., KHAIRI, M.R.A., JOHNSTON JR., C.C. The loss of mineral with aging and its relationship to risk of fracture. Journal of Clinicai Investigation, New York, v.56, p.311-318, 1975.
, NANCE, W.E., KONG, K.W., CHRISTIAN,J.C.,JOHNSTON
]R. , C.C. Genetic factors in determining bone mass. Journal fo Clinicai Investigation, New York, v.52, p.2800-2808, 1973.
SMITHJR., EJ., Reddan, W. SMITH, P.E. Physical activity and calcium modalities for vone mineral incrase in aged women. Medicine and Science in Sports and Exercise, Baltimore, v.13, p.60-64, 1981.
SPENCER,H., LENDER, M. Adverse effects of aluminum containing antacids on mineral metabolism. Gastroenterology, Philadephia, v.76, p.603, 1979.
SUSSMAN, C.B. The roentgenologic appearance of the bones in Cushing syndrome. Radiology, Easton, v.39, p.288.292, 1942.
THOMAS, K.A., GIMENEZ-GALLECO, D. Fibroblast grewth factors: mitogens with potent angiogenic activity. Trends in Biocbemical Sciences, Cambridge, v.11, p.81-84, 1986.
TIDEIKSAAR, R. Geriatric falis: assessing the cause, preveting recurrence. Geriatric, Middleburg, v.44, p.57-61, 1989.
TINETTI, M.E., SPEENCHLEY, M., GINTER, S.F. Risk factor for falls among elderly persons living in the community. New England Journal of Medicine, Boston, v.319, p.1701-1707, 1988.
TSAI, K.S., HEALTH, H., KUMAR, R., RIGGS, B.L. Impaired citamin D metabolism with aging in women: possible role in pathogenisis of sensile osteoporosis. Journal of Clinicai Investigation, New York, v.73, p.1668-1672, 1984.
WASNICK, R.D., BENFORTE, RJ., YANO, K., HEILBRUN, L., VOGEL, J.M. Thiazide effect on the mineral content of bone. New Englandjournal of Medicine, Boston, v.309, p.344-347, 1983.
WEISS, N.S., URE, C.L., BALLARD,J.H., WILLIANS, A.R., DAUNG, J.R. Decreased risk of fractures of the hip and Iower foreann with postmenopausal use of estrongen. New England Journal of Medicine, Boston, v.303, p.1195-1198, 1980.
