A epidemiologia das fraturas por fragilidade óssea em uma população de mulheres brasileiras na pósmenopausa residentes na cidade de Chapecó/SC

Abstract

Introduction: Osteoporosis and fractures have become one of the most public health problems in the world, affecting mostly women after menopause. Bone densitometry (BD) was established as the gold standard for diagnosis and monitoring of osteoporosis, but the quantitative ultrasound of the calcaneus (QUS) is able to estimate the risk for fractures in a similar way.Objectives: 1) To compare the recommendations in the international and national guidelines; 2) To verify the prevalence of vertebral fracture by bone fragility in the Chapecó city and relate it to clinical factors; 3) To verify the prevalence of women with fracture risk estimated by the QUS and its association with risk factors. 4) To check the power discrimination of this kind of QUC to discriminate vertebral fractures. Methodology: To achieve the first objective was to elaborate an article with critical analysis on the recommendations of international and national consensus for BD. For the other three objectives was developed one cross-sectional study. The population was selectioned by random sampling of white elderly post-menopausal women living in Chapecó. All answered a structured questionnaire between May and December 2007, and have done spine radiography (SR) and/or QUS. Results: The critical analysis about different consensus, we observed that in recent years there has been an effort to improve the referral recommendations and analysis of results of BD, and to unify them. In the cross-sectional studies, we observed: a) about the prevalence of vertebral fractures, the sample consisted of 186 women. Of these, 48.9% had asymptomatic vertebral fractures, with higher prevalence in T11-12 and L4-5. Sedentary lifestyle (OR 2.59, IC 1,18-5,67) and age (OR 3.14, CI 1,47-6,71 for women between 70 and 79 years, and OR 19.89 IC 2,35-168,58 for women aged over 80 years) were risk factors for fracture; b) about the prevalence of fracture risk estimated by the QUS, we studied 168 women with a mean age of 69.56 ± 6.27 years; 81% of the study population had abnormal test, 41% considered higher risk. Women with abnormal tests had lower weight, height and BMI, and had lower values of SOS, BUA, BQI and T-score. After adjustment, BMI remained significant for QUS changed (OR = 3.37, CI 1,199,56, p = 0.02) and previous history of fractures of the QUC to the greatest risk (OR = 4.44 CI 1,16-16,96, p = 0.03); c) about the QUS we observed 87.8% of sensitivity and 28% of specificity if abnormal QUS, and 80% and 45% for the largest range of risk of QUS, respectively. The AUC was more significant for SOS and BUA. Conclusions: Our study shows good sensitivity of the equipment of QUC Sonost 2000 to screen elderly female population. The prevalence of risk for fractures by QUS and vertebral fractures by SR was higher than other Brazilian studies. This shows the need for adaptive public policies for each region of this country. So, we suggest the realization of SR and/or QUS for screening and prevention of fractures because this methods are more affordable and accessible than the BD. In the analysis of the consensus about BD we observed effort toward the improvement and unification them. Despite the changes, the technological advancement of machines that are used in this way and the studies about osteoporosis give us hope to more changes in coming years.