The epidemiology and management of postmenopausal osteoporosis: a viewpoint from Brazil

Abstract

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.

Association between osteoporosis, health-related productivity loss and use of hospital services in outpatients of the Brazilian National Health System

“…It is known that osteoporosis is a significant risk factor for several fractures, which can lead to surgical procedures 28 . Treatment of osteoporosis involves a high economic burden, making the disease a public health problem.…”

Osteoporosis and autophagy: What is the relationship?

“…11 The incidence of osteoporotic fractures, associated with morbidity, mortality and the costs of these fractures, has increased substantially and became a public health problem in many countries, [12][13][14] including Brazil. [15][16][17] As life expectancy increases, the number of osteoporotic fractures is expected to increase from 1.7 million in 1990 to 6.3 million in 2050. 18 The cause of osteoporosis is multifactorial and includes genetic, hormonal and nutritional factors, combined with people's lifestyle choices.…”

The effect of osteoporosis on cochlear function in postmenopausal women: An observational study

“…Smoking and alcohol use should also be addressed. Calcium intake should be encouraged, preferably through diet [20,21].…”