The epidemiology and management of postmenopausal osteoporosis: a viewpoint from Brazil.
The epidemiology and management of postmenopausal osteoporosis: a viewpoint from Brazil.
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DOI：
10.2147/cia.s54614
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发表时间：
2015
影响因子：
3.6
通讯作者：
Pinto-Neto AM
中科院分区：
文献类型：
--
作者：
Baccaro LF;Conde DM;Costa-Paiva L;Pinto-Neto AM
巴西人口老龄化，慢性病患病率随之增加。绝经后骨质疏松症尤其令人担忧，因为它会增加骨折的风险，从而对老年妇女的健康产生负面影响。近年来，巴西努力更好地了解骨质疏松症的流行病学，并管理巴西卫生保健系统的直接和间接成本。巴西报告的绝经后妇女骨质疏松症患病率从15%到33%不等，这取决于研究方法和参与者使用骨密度测量数据或自我报告。骨质疏松症的诊断可以基于骨折的发生而没有明显的创伤，或者基于双能X射线骨密度仪测量的低骨密度。为了减少患骨质疏松症的风险，应该鼓励所有绝经后的女性保持健康的生活方式，其中包括体力活动和均衡的饮食。吸烟和饮酒也应该得到解决。应特别注意减少跌倒风险的干预措施，特别是老年妇女。应该鼓励钙的摄入，最好是通过饮食。推荐补钙的决定应该单独做出，因为人们担心这种治疗可能会增加心血管疾病的风险。巴西女性从饮食中摄取的维生素D含量很低，很少暴露在太阳紫外线B辐射下的女性需要补充维生素D。对于被诊断为骨质疏松症的女性，应该开始某种形式的药物治疗。应监测治疗依从性，并对每个患者的治疗周期进行个体化。巴西政府通过公共卫生系统免费提供治疗骨质疏松症的药物，但在缺乏适当的流行病学知识的情况下，公共卫生计划的实施受到阻碍。
Brazil has an aging population, with an associated increase in the prevalence of chronic diseases. Postmenopausal osteoporosis is of particular concern because it leads to an increased risk of fractures, with subsequent negative impacts on health in older women. In recent years, efforts have been made to better understand the epidemiology of osteoporosis in Brazil, and to manage both direct and indirect costs to the Brazilian health care system. The reported prevalence of osteoporosis among postmenopausal women in Brazil varies from 15% to 33%, depending on the study methodology and the use of bone densitometry data or self-reporting by participants. A diagnosis of osteoporosis can be made on the basis of fractures occurring without significant trauma or on the basis of low bone mineral density measured by dual energy X-ray absorptiometry. To reduce the risk of osteoporosis, all postmenopausal women should be encouraged to maintain a healthy lifestyle, which includes physical activity and a balanced diet. Smoking and alcohol use should also be addressed. Special attention should be given to interventions to reduce the risk of falls, especially among older women. Calcium intake should be encouraged, preferably through diet. The decision to recommend calcium supplementation should be made individually because there is concern about a possible increased risk of cardiovascular disease associated with this treatment. Brazilian women obtain a minimal amount of vitamin D from their diet, and supplementation is warranted in women with little exposure to solar ultraviolet-B radiation. For women diagnosed with osteoporosis, some form of pharmacologic therapy should be initiated. Compliance with treatment should be monitored, and the treatment period should be individualized for each patient. The Brazilian government provides medication for osteoporosis through the public health system free of charge, but without proper epidemiological knowledge, the implementation of public health programs is impaired.