Papers by Vera L Szejnfeld
Archives of Osteoporosis, Mar 18, 2022
Summary This was a retrospective observational study to determine the secular trends in osteoporo... more Summary 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.
Revista Brasileira De Ortopedia, 1998
Springer eBooks, 1994
The association between idiopathic hypercalciuria and decreased bone content has been recognized ... more The association between idiopathic hypercalciuria and decreased bone content has been recognized by many authors1. It is not very well established whether or not calcium intake plays a critical role in loss of bone mass 2. The purpose of the present study was to evaluate bone mineral density (BMD) of white adult RSF.
Brazilian Journal of Infectious Diseases, Nov 1, 2015
Objective: To evaluate bone mass accrual and determine the influence of clinical, anthropometric,... more Objective: To evaluate bone mass accrual and determine the influence of clinical, anthropometric, dietary and biochemical parameters on bone mass. Methods: A cohort study including 35 prepubertal HIV-infected children, between 7 and 12 years, attended at a referral center. At time 1 (T1) and time 2 (T2), patients were assessed according to clinical, anthropometric, dietary, biochemical parameters and bone mineral density (BMD). At T2, patients were divided into prepubertal and pubertal. Results: Despite the increase in bone mass absolute values, there was no improvement in lumbar spine BMD (LSBMD) Z-score (p = 0.512) and worsening in total body BMD (TBMD) Z-score (p = 0.040). Pubertal patients (n = 19) showed higher bone mineral content (BMC) (p = 0.001), TBMD (p = 0.006) and LSBMD (p = 0.002) compared to prepubertal patients. After multivariate linear regression analysis, the predictors of bone mass in T1 were age, BMI and HA Z-scores for BMC; BMI Z-score, adequate serum magnesium concentration and dietary calcium intake for TBMD; adequate serum concentration of magnesium, BMI and HA Zscores for LSBMD. In T2, age, total body fat and lean body mass (kg) for BMC; BMI Z-score and puberty for TBMD; dietary fat intake, BMI Z-score for BMD and puberty for LSBMD. Conclusion: HIV-infected children have compromised bone mass and the presence of puberty seems to provide suitability of these parameters. Adequate intake of calcium and fat appears to be protective for proper bone mass accumulation factor, as well as monitoring nutritional status and serum magnesium concentration.
Archives of Osteoporosis, Aug 25, 2015
The Brazilian FRAX model is described and used to determine intervention thresholds for the treat... more The Brazilian FRAX model is described and used to determine intervention thresholds for the treatment of osteoporosis. Introduction A FRAX model for Brazil was released May 1, 2013. This paper describes the data used to develop the Brazilian FRAX ® model, illustrates its features and develops intervention thresholds. Methods Age-and sex-stratified hip fracture incidence rates were extracted from four regional estimates from the age of 40 years. For other major fractures, Brazilian incidence rates were estimated using Swedish ratios for hip to other major osteoporotic fracture (humerus, forearm or clinical vertebral fractures). Assessment and intervention thresholds were determined using the approach recommended by the National Osteoporosis Guideline Group (UK) applied to the Brazilian FRAX model. Results Fracture incidence rates increased with increasing age: for hip fracture, incidence rates were higher amongst younger men than women but with a female preponderance from the age of 50 years. Ten-year probability of hip or major fracture was increased in patients with a clinical risk factor, lower BMI, female gender, a higher age and a decreased BMD T-score. Of the clinical risk factors, prior fracture accounted for the greatest increase in 10-year fracture probability at younger ages while a parental hip fracture history was the strongest risk factor at ages 80-90 years. Age-dependent probability-based intervention thresholds were developed equivalent to women with a prior fragility fracture. Conclusions The FRAX tool is the first to provide a countryspecific fracture prediction model for Brazil. It is based on the original FRAX methodology, which has been externally validated in several independent cohorts. Despite some limitations, the strengths make the Brazilian FRAX tool a good candidate for implementation into clinical practice.
Osteoporosis International, Oct 27, 2022
Archives of Osteoporosis, Apr 16, 2019
Background: This study assessed the incidence and excess mortality of hip fractures among inpatie... more Background: This study assessed the incidence and excess mortality of hip fractures among inpatients aged 20-40 years in a nationwide population database in Taiwan. Methods: Subjects were selected from Taiwan's National Health Insurance Research Database for the period 2001-2008 and were followed up until the end of 2010. A total of 4,523 subjects were admitted for the first time with primary diagnosis of hip fracture and treated with operation.
A folha medica, 1996
O methotrexate (MTX) tem sido amplamente ministrado como um agente antineoplasico, principalmente... more O methotrexate (MTX) tem sido amplamente ministrado como um agente antineoplasico, principalmente, em criancas com leucemia aguda. Mais recentemente, o MTX vem sendo utilizado no tratamento de diversas doencas inflamatorias do tecido conjuntivo, com maior interesse, no momento, na artrite reumatoide (AR). Os autores revisaram os artigos da literatura que mencionavam qualquer repercussao do MTX sobre o tecido osseo em modelos animais e em pacientes tratados com esta droga, tendo concluido que o MTX pode afetar a integridade do osso, atuando em diferentes niveis do metabolismo. Entretanto, sao necessarios estudos clinicos bem controlados, nas doses habitualmente usadas em pacientes com AR, para verificar sua toxicidade sobre o esqueleto, visto que o mesmo pode ser mais um fator de risco para o desenvolvimento de osteoporose nesses pacientes
Revista paulista de reumatologia, Dec 31, 2019
Diversas ferramentas para avaliação, mensuração e monitorização da atividade física e capacidade ... more Diversas ferramentas para avaliação, mensuração e monitorização da atividade física e capacidade funcional têm sido utilizadas na prática clínica e em pesquisas sobre condicionamento e desempenho físico, incluindo questionários e métodos para estimar a capacidade aeróbia, uma vez que possuem baixo custo e são de fácil aplicação. No entanto, ainda não existe uma ferramenta única e mais recomendada para estimar o consumo de oxigênio (VO2max), considerado o padrão-ouro para a avaliação do condicionamento físico. Nesta abordagem, os autores fizeram uma ampla e cuidadosa pesquisa científica sobre as ferramentas atualmente disponíveis para esses propósitos, incluindo as principais características dos métodos, bem como vantagens e desvantagens. Unitermos: Atividade física. Ferramentas de avaliação. Questionários. Capacidade funcional. Condicionamento aeróbio.
Revista Brasileira De Reumatologia, 2017
BMC Endocrine Disorders, Jul 3, 2018
Background: Vitamin D deficiency is pandemic while resources available to measure 25-hydroxyvitam... more Background: Vitamin D deficiency is pandemic while resources available to measure 25-hydroxyvitamin D (25OHD) are limited. The present study aimed to verify whether sun exposure measured by a structured questionnaire could predict serum 25OHD concentrations in healthy Caucasian individuals living in a tropical area. Methods: A cross-sectional study was carried out in subjects living in the greater São Paulo area, Brazil. Two groups of 50 young (20 to 40 years old) and 50 older (60 to 80 years old) subjects (N = 200) answered a structured questionnaire on sun exposure and had blood samples drawn for serum 25OHD concentration measurement during both summer and winter. Anthropometric data were also recorded. Correlation between the questionnaire variables (duration of sun exposure, amount of exposed skin, total sun exposure score-TSES and other data) and serum 25OHD concentration was evaluated. Results: Mean serum 25OHD concentration was 17.60 ± 7.3 ng/mL with no difference between age groups (p = 0.293). TSES weakly correlated with serum 25OHD levels (r = 0.264; p < 0.001). Separate analyzes by age groups demonstrated that TSES correlated significantly with serum 25OHD concentration only in the older subjects during summer (r = 0.322; p = 0.023). Using linear regression analyses, TSES and body mass index (BMI) were significantly associated with serum 25OHD levels. On the other hand, Receiver operating characteristic (ROC) analysis for TSES showed no significance as a screening tool for vitamin D deficiency (p = 0.172). Conclusion: Sun exposure questionnaire associated with BMI correlates with serum 25OHD concentration with very low accuracy. The use of the questionnaire does not discriminate between vitamin D sufficient and deficient individuals.
Revista paulista de reumatologia, Jan 31, 2012
A osteoporose, como doença sistêmica, é caracterizada pela diminuição da massa óssea e deterioraç... more 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.
Revista Brasileira De Reumatologia, 1999
Os autores discorrem sobre mais um recurso da densitometria ossea, a geometria femoral. O metodo ... more Os autores discorrem sobre mais um recurso da densitometria ossea, a geometria femoral. O metodo baseia-se na medida do comprimento do eixo do femur (CEF) e informa a respeito de aspectos biomecânicos relacionados com a fratura de femur. As medidas de geometria do femur se correlacionam com risco de faturas, independentes da idade e densidade ossea. Acredita-se que a utilizacao combinada das medidas da DO (densitometria ossea) e do CEF (comprimento do eixo do femur) permite melhor determinacao do risco de fratura do quadril
PLOS ONE, Jan 13, 2017
We aim to evaluate the prevalence of vitamin D deficiency in patients with systemic lupus erythem... more We aim to evaluate the prevalence of vitamin D deficiency in patients with systemic lupus erythematosus (SLE) and investigate the association between total, free and bioavailable vitamin D serum concentrations and disease activity. Patients with SLE (ACR 1997) consecutively seen at UNIFESP's outpatient's clinics had disease activity measured after clinical and laboratory evaluation using SLEDAI (Systemic Lupus Erythematosus Disease Activity Index). 25-hydroxyvitamin D (25(OH)D) serum concentrations measured by chemiluminescence and vitamin D binding protein (DBP) measured by ELISA were used to calculate free and bioavailable vitamin D. Healthy blood donors were used as controls. A total of 142 patients (71.4%) had 25(OH)D serum concentrations below 30 ng/mL. Total 25(OH)D serum concentration was associated with disease activity categorized in 5 continuous groups of SLEDAI. 25(OH)D serum concentrations were higher among patients with SLE-DAI 1-5 and lower in those with severe activity (SLEDAI!20) (p <0.05). On the other hand, no statistically significant difference was observed for DBP, free and bioavailable vitamin D measurements in the disease activity subgroups evaluated. Vitamin D deficiency is highly prevalent among patients with SLE and was associated with higher disease activity. DBP serum level and calculation of free and bioavailable vitamin D were not associated with SLE disease activity.
Revista Brasileira De Reumatologia, 1997
Base de dados : LILACS. Pesquisa : 210189 [Identificador único]. Referências encontradas : 1 [ref... more Base de dados : LILACS. Pesquisa : 210189 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, LILACS, seleciona. para imprimir. Fotocópia. Szejnfeld, Vera Lucia. experimental, Documentos relacionados. ...
Uploads
Papers by Vera L Szejnfeld