3 results on '"Pezzotto, Stella M."'
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2. Factores de riesgo para osteoporosis y fracturas de cadera. Análisis multivariado
- Author
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Masoni, Ana, Morosano, Mario, Tomat, María Florencia, Pezzotto, Stella M., and Sánchez, Ariel
- Subjects
Factores protectores ,Protective factors ,Risk factors ,Epidemiology ,Hip fractures ,Fracturas de cadera ,Osteoporosis ,Epidemiología ,Ancianos ,Factores de riesgo - Abstract
En este trabajo se analizó la asociación entre factores de riesgo (FR) y fracturas de cadera, se evaluó la influencia de FR relacionados con baja masa ósea o con traumatismos, y se exploró la existencia de factores protectores (FP). Se estudiaron datos de 376 pacientes hospitalizados, de los cuales 151 presentaban fracturas de cadera osteoporóticas (casos; el resto fueron controles), a partir de historias clínicas y un cuestionario sobre FR para osteoporosis. La edad promedio fue 80.6 ± 8.1 años, similar en casos y controles; la relación mujer/varón fue de 3:1 en ambos grupos. Las mujeres fracturadas eran mayores que los varones fracturados (82.5 ± 8.1 versus 79.7 ± 7.2 años; p < 0.01). La actividad física, el consumo de alcohol y tabaco, y la exposición solar de los pacientes fueron bajos. La proporción de pacientes con limitación funcional fue mayor en casos, sin diferencia significativa. La mayoría de caídas de los casos se produjo en domicilio (p < 0.001). En mujeres la actividad doméstica constituyó un FR (p = 0.007) no observado en varones. Las variables significativas en el análisis multivariado fueron los siguientes FR: deterioro cognitivo (p = 0.001) y antecedentes de caídas previas (p < 0.0001). Los FP fueron: ingesta cálcica en la juventud y actual, y asistencia mecánica para deambular (todos, p < 0.0001). La evaluación de FR y FP podría contribuir a disminuir la probabilidad de fracturas de cadera, modificando hábitos personales y previniendo las caídas en adultos mayores. Los datos podrían servir para elaborar estrategias locales y nacionales de prevención. In this observational, case-control study, 376 inpatients were evaluated in order to determine the association of risk factors (RF) and hip fracture; 151 patients had osteoporotic hip fracture (cases); the remaining were controls. Data were obtained from medical charts, and through a standardized questionnaire about RF. Mean age of the sample (± SD) was 80.6 ± 8.1 years, without statistically significant difference between cases and controls; the female:male ratio was 3:1 in both groups. Fractured women were older than men (82.5 ± 8.1 vs. 79.7 ± 7.2 years, respectively; p < 0.01). Physical activity, intake of alcohol and tobacco, and sun exposure were low in all patients. Falls among cases happened predominantly at home (p < 0.001). Among female cases, time spent in household duties was a RF (p = 0.007), which was absent in males. In multivariate analysis, the following RF were significantly more frequent: Cognitive impairment (p = 0.001), and previous falls (p < 0.0001); whereas the following protective factors were significantly different from controls: Calcium intake during youth (p < 0.0001), current calcium intake (p < 0.0001), and mechanical aid for walking (p < 0.0001). Evaluation of RF and protective factors may contribute to diminish the probability of hip fracture, through a modification of personal habits, and measures to prevent falls among elderly adults. Present information can help to develop local and national population-based strategies to diminish the burden of hip fractures for the health system.
- Published
- 2007
3. Construction of two instruments for the presumptive detection of post-menopausal women with low spinal bone mass by means of clinical risk factors
- Author
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Masoni, Ana, Morosano, Mario, Pezzotto, Stella M., Tomat, Florencia, Bentancur, Fabiana, Bocanera, Roberto, Tozzini, Roberto, and Puche, Rodolfo C.
- Subjects
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BONE injuries , *REGRESSION analysis , *BONE fractures , *MULTIVARIATE analysis - Abstract
Abstract: The objective of this investigation was the design of two instruments based on clinical risk factors for the presumptive detection of post-menopausal women with spinal BMD<2.5 S.D. below average (LBMD). We investigated the association of 20 risk factors (RF) with LBMD in a series of 131 women. According to current densitometric criteria, subjects were classified as normals (N =33); osteopenics (N =53) and osteoporotics (N =45). Normals and osteopenics were taken as a single group because only ‘nulliparity’ and ‘personal fractures’ exhibited significant differences between these groups. A logistic regression attempting to identify which factors were associated with osteopenia showed a poor fit (pseudo R 2 =0.289). Univariate unconditional logistic regression analysis was used to calculate odd ratios (ORs) and their 95% CI for all RF. Those with associated P-values <0.100 were included in a multivariate logistic regression analysis to obtain the odds ratios (OR) adjusted by the effects of the others. The variables with not significant β coefficients were eliminated, producing a reduced model. BMI (<25kg/m2), calcium intake (<1.2g/day), menopause (>10 years), and the simultaneous occurrence of kyphosis and personal fractures showed significant association with low bone mass at the lumbar spine and their effect was additive. Fitting of the data to the model was assessed with the Hosmer–Lemeshow test (P =0.926) The area under the ROC curve is 0.833 (95% CI=0.757–0.909). The following equation calculates the probability of having low spinal bone mass: The sensitivity, specificity and area under the ROC curve were defined. The point of maximum specificity and sensitivity derived from the ROC curve, has a probability of 0.409. With such a cut-off point, the equation has a sensitivity of 73%, specificity 79%, positive predictive value 65% and negative predictive value 85%. The second instrument associates very low lumbar bone mass with the number of risk factors accumulated per patient. At baseline, all subjects had four RFs: they were, women, white, post-menopausal, and with no previous exposure to estrogens. With six additional RFs the presumptive diagnosis of LBMD has a specificity of 99%, positive predicting value 94% and false positives 6.5%. The area under the curve in a ROC graph was 0.826 (95% CI=0.747–0.914). Comparing present instruments with others in the literature, it is concluded that each population require its own algorithm for the presumptive detection of subjects with low bone mass. The algorithm should be reassessed periodically if the characteristics of the population or its social-economic conditions change. [Copyright &y& Elsevier]
- Published
- 2005
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