Patricia Clark

The prevalence of radiographic vertebral fractures in Latin American countries: the Latin American Vertebral Osteoporosis Study (LAVOS)

SummaryIn the first population-based study of vertebral fractures in Latin America, we found a 11.18 (95% CI 9.23–13.4) prevalence of radiographically ascertained vertebral fractures in a random sample of 1,922 women from cities within five different countries. These figures are similar to findings from studies in Beijing, China, some regions of Europe, and slightly lower than those found in the USA using the same standardized methodology.IntroductionWe report the first study of radiographic vertebral fractures in Latin America.MethodsAn age-stratified random sample of 1,922 women aged 50xa0years and older from Argentina, Brazil, Colombia, Mexico, and Puerto Rico were included. In all cases a standardized questionnaire and lateral X-rays of the lumbar and thoracic spine were obtained after informed consent.ResultsA standardized prevalence of 11.18 (95% CI 9.23–13.4) was found. The prevalence was similar in all five countries, increasing from 6.9% (95% CI 4.6–9.1) in women aged 50–59xa0years to 27.8% (95% CI 23.1–32.4) in those 80xa0years and older (p for trend <xa00.001). Among different risk factors, self-reported height loss ORu2009=u20091.63 (95% CI: 1.18–2.25), and previous history of fracture ORu2009=u20091.52 (95% CI: 1.14–2.03) were significantly (pu2009<u20090.003 and pu2009<u20090.04 respectably) associated with the presence of radiographic vertebral fractures in the multivariate analysis. In the bivariate analyses HRT was associated with a 35% lower risk ORu2009=u20090.65 (95% CI: 0.46–0.93) and physical activity with a 27% lower risk of having a vertebral fracture ORu2009=u20090.73 (95% CI: 0.55–0.98), but were not statistically significant in multivariate analysesConclusionWe conclude that radiographically ascertained vertebral fractures are common in Latin America. Health authorities in the region should be aware and consider implementing measures to prevent vertebral fractures.

Leptin predicts BMD and bone resorption in older women but not older men: the Rancho Bernardo study.

We studied the relation of leptin to bone, bone loss, and bone turnover in community‐dwelling men and women. Leptin predicted higher BMD and lower bone turnover only in women. Leptin was not associated with 4‐year bone loss in either sex.

Incidence rates and life-time risk of hip fractures in Mexicans over 50 years of age: a population-based study

The vast majority of hip fractures in the 21st century will occur in the developing countries. The rates and life-time hip fracture risk are not known for Mexico, and for this reason, we studied the incidence of hip fractures, and the remaining life-time probability of having a hip fracture at the age of 50xa0years in Mexican men and women. All hip fracture cases registered during the year 2000 were collected at all the main tertiary-care hospitals in the two major health systems in México City, Instituto Mexicano del Seguro Social (IMSS) and Ministry of Health (SS), and the diagnosis was validated by chart review in all cases. The annual rates of hip fracture were 169 in women and 98 in men per 100,000 person-years. The life-time probability of having a hip fracture at 50xa0years of age was 8.5% in Mexican women and 3.8% in Mexican men. We conclude that hip fractures are an important health problem in Mexico and that Mexican health authorities should consider public health programs to prevent hip fractures.

Increasing age- and sex-specific rates of hip fracture in Mexico: a survey of the Mexican institute of social security

SummaryThis study, characterising the incidence of hip fracture in Mexico, showed that age- and sex-specific rates increased between 2000 and 2006. The demographic changes estimated for Mexico indicate that the annual number of hip fractures will rise from 29,732 in 2005 to 155,874 in 2050. If the age-specific incidence of hip fracture continues, the number of hip fractures would increase by a further 46%.IntroductionThe aim of the present study was to determine time trends, if any, in hip fracture rates for Mexico and to forecast the number of hip fractures expected in Mexico over the coming years up to 2050.MethodsAll hip fracture cases registered during the years 2000–2006 were collected at all the second and tertiary-care hospitals across the country from one of the largest health systems in Mexico, The Instituto Mexicano del Seguro Social (IMSS).ResultsBetween the years 2000 and 2006, the age-specific incidence of hip fracture increased significantly both for men and women by 1% per year (pu2009=u20090.016 and pu2009<u20090.001, respectively). In 2005, there were there were 29,732 hip fractures estimated in Mexico, 68% of which were found in women. Assuming no change in the age- and sex-specific incidence of hip fracture, the number of hip fractures was expected to increase markedly with time to 155,874 in 2050. Assuming that the age-specific incidence continues, the number of hip fractures in men and women would increase by a further 46% to 226,886 in 2050.ConclusionDemographic changes estimated for Mexico indicate that the annual number of hip fractures will rise from 29,732 in 2005 to 155,874 expected in 2050. If the age-specific incidence of hip fracture continues to rise, the number of hip fractures would increase by a further 46%.

Direct costs of osteoporosis and hip fracture: an analysis for the Mexican healthcare system

SummaryThis study reports the direct costs related to osteoporosis and hip fractures paid for governmental and private institutions in the Mexican health system and estimates the impact of these entities on Mexico. We conclude that the economic burden due to the direct costs of hip fracture justifies wide-scale prevention programs for osteoporosis (OP).Methods To estimate the total direct costs of OP and hip fractures in the Mexican Health care system, a sample of governmental and private institutions were studied. Information was gathered through direct questionnaires in 275 OP patients and 218 hip fracture cases. Additionally, a chart review was conducted and experts’ opinions obtained to get accurate protocol scenarios for diagnoses and treatment of OP with no fracture. Microcosting and activity-based costing techniques were used to yield unit costs. ResultsThe total direct costs for OP and hip fracture were estimated for 2006 based on the projected annual incidence of hip fractures in Mexico. A total of 22,233 hip fracture cases were estimated for 2006 with a total cost to the healthcare system of US

Reference Values of Total Lean Mass, Appendicular Lean Mass, and Fat Mass Measured with Dual-Energy X-ray Absorptiometry in a Healthy Mexican Population

97,058,159 for the acute treatment alone (

25 hydroxyvitamin D and nutritional parameters correlation in adults with stage 4 chronic kidney disease

4,365.50 per case). We found considerable differences in costs and the way the patients were treated across the different health sectors within the country. ConclusionCosts of the acute treatment of hip fractures in Mexico are high and are expected to increase with the predicted increment of life expectancy and the number of elderly in our population.

Prevention of low bone mass to achieve high bone density in Mexico: position of the Mexican Association for Bone and Mineral Metabolism

The aim of this study was to develop age- and gender-specific reference values of total lean body mass (LBM), appendicular lean body mass (ALBM), and fat mass (FM) by dual-energy X-ray absorptiometry (DXA) data in a healthy Mexican population. A cross-sectional analysis was conducted on 9518 healthy subjects 7–89xa0years of age participating in the baseline measurement of the Health Workers Cohort Study. Using DXA, LBM, ALBM, and FM were measured. Using these data, LBM index (LBMI), ALBM index (ALBMI), and fat mass index (FMI) were calculated. LMI, ALMI, and FMI were calculated as the LBM, ALBM, and FM kg divided by the height in meters squared. Males and females were analyzed separately; sex-specific means and standard deviations for LBM, ALBM, FM, LBMI, ALBMI, and FMI were calculated. A total of 2829 males and 6694 females were included in the final analysis. Strong sex gaps were observed after 12xa0years in LBM, ALBM, LBMI, and ALBMI (Pxa0<xa00.01). LBM and ALBM values continue to increase for males up to age 20; females plateaued approximately after age 15. Significant sex differences were also observed for FM and FMI. Significant sex- and age-related differences exist in LBM, ALBM, and FM in the Mexican population. In addition, given the null data available in this area, these reference values may be useful in the evaluation of a variety of childhood and adult abnormalities involving lean body mass deficits, mainly in the assessment of muscle wasting, with important medical and epidemiological uses.

Learning from pain scales: patient perspective.

BACKGROUND AND AIMSnSerum concentrations of 25-hydroxyvitamin D (abbreviated 25(OH)D) and parameters of nutritional status both decline as chronic kidney disease (CKD) progresses. The objective of this study was to measure and correlate 25(OH)D concentrations with alterations in the nutritional status of adult patients with stage 4 CKD.nnnMETHODSnThe study was cross-sectional, included patients with stage 4 CKD (CKD-Epi between 15 and 30xa0ml/min/1.73xa0m2), between the ages of 18 and 65, who sought services at the Department of Nephrology between April 2016 and April 2017.nnnRESULTSnseventy participants were evaluated; the median age was 47 years old (interquartile range [IQR] of 33-53 years), and 54% of the participants were women. All of the participants presented 25(OH)D serum concentrations below 30xa0ng/ml. According to a Subjective Global Assessment, 32.6% of the study population was malnourished and 14% presented protein energy wasting. An inverse and proportional correlation was found between levels of 25(OH)D and urea (rxa0=xa0-0.342), cholesterol (rxa0=xa0-0.383), triglycerides (rxa0=xa0-0.316), and extracellular water (rxa0=xa0-0.399). In contrast, levels of 25(OH)D were directly proportional with serum albumin (rxa0=xa00.388), serum hemoglobin (rxa0=xa00.331), phase angle (rxa0=xa00.355), resistance (rxa0=xa00.518), and reactance (rxa0=xa00.580) in a statistically significant manner (pxa0<xa00.05).nnnCONCLUSIONSnAll the participants in this study presented levels of 25(OH)D considered to be deficient. Levels of 25(OH)D were shown to be significantly correlated with alterations in nutritional status. It is necessary to implement effective interventions to help correct these deficiencies in patients with CKD.

Risk factors for osteoporotic hip fractures in mexicans

SummaryIn Mexico, osteoporosis is a public health problem. In this document, the Mexican Association for Bone and Mineral Metabolism defines its position on calcium, vitamin D supplement use, and physical activity as an effective, safe, and cost-effective initiatives to prevent low bone mass.IntroductionIn Mexico, osteoporosis is a public health problem that is expected to increase in the decades ahead. Generally, modifiable risk factors for bone health are related with lifestyles, especially nutrition and physical activity.MethodsIn this position paper, the Mexican Association for Bone and Mineral Metabolism (AMMOM, by its acronym in Spanish), which is a multidisciplinary group of researchers, dietitians, epidemiologists, nurses, and physicians who study bone and related tissues and communicate the best strategies for diagnosis, treatment, and prevention of bone problems, aims to analyze the association between nutrition and bone health, risk behaviors for low bone mass, and the economic impact that prevention of low bone mass represents for the health care system.ResultsAddressing therapeutic management with pharmacological and non-pharmacological approaches, we emphasize the important role the patient plays in the doctor–patient relationship, both in the consulting room and in daily life. Furthermore, the AMMOM defines its position on calcium and vitamin D supplement use as an effective, safe, and cost-effective initiative to prevent low bone mass.ConclusionsIn summary, most research and clinical practice related to osteoporosis have focused on diagnosis and treatment, but general measures for primary prevention based on addressing modifiable risk factors as a public health priority to delay the onset of loss of bone mass have not been considered by Mexican authorities. Consequently, the AMMOM task force also seeks to provide information on concrete actions to prevent low bone mass.