ABSTRACT:

Introduction:

Osteoporosis is a multifactorial disease that predisposes individuals to suffer falls and fractures, causing functional impairment and a consequent reduction in quality of life.

Objective:

To assess the prevalence and factors associated with self-reported osteoporosis in the elderly population living in Campinas, São Paulo, Brazil (ISACAMP 2008).

Methods:

Cross-sectional study with a random sample taken by conglomerates in 2 stages totaling 1,419 elderly people living in the urban area. The self-reported prevalence of osteoporosis was estimated according to socioeconomic and demographic variables, morbidity, health behaviors and problems. Crude prevalence ratios were estimated and adjusted by means of simple and multiple regressions using the Poisson svy commands in Stata 11.0 software.

Results:

We found a prevalence of osteoporosis of 14.8%, and significantly higher in females, in individuals who reported white skin, those who reported less than 7 hours of sleep/day, in patients with rheumatism/arthritis/arthrosis, asthma/bronchitis/emphysema, tendinitis, dizziness, insomnia, common mental disorders, BMI < 27, health self-related as bad and very bad, and reporting falls occurring in the last 12 months.

Conclusion:

The present study, by identifying the factors associated with osteoporosis, identified segments of older people with a higher prevalence of the disease; to this information may contribute to the planning of public health policies and programs aimed at controlling the disease and its consequences.

Keywords:
Osteoporosis; Aged; Aging; Health surveys; Cross-sectional studies; Risk factors

INTRODUCTION

The aged population growth is a worldwide phenomenon, and modifications in the age structure are happening very quickly owing to this growth in Brazil. In less than 40 years, Brazil migrated from a demographic profile that is typical of a young population to a population in which growth happens, mainly, in the most advanced age ranges¹1. Gordilho A, Sérgio J, Silvestre J, Ramos LR, Freire MPA, Espindola N, et al. Desafios a serem enfrentados no terceiro milênio pelo setor saúde na atenção integral ao idoso. Rio de Janeiro: UERJ/UnATI; 2000.^,22. Veras R. Em busca de uma assistência adequada à saúde do idoso: revisão da literatura e aplicação de um instrumento de detecção precoce e de previsibilidade de agravos. Cad Saúde Pública2003; 19(3): 705-15.. Thus, a change in the population epidemiological profile has occurred with a significant increase of chronic and multiple illnesses. Diseases of the circulatory system, neoplasms, and metabolic bone diseases such as osteoporosis (OP) are known in the scenario of illnesses related to aging, which create high costs for the health system and that cause impairments and deaths³3. Nunes A. O envelhecimento populacional e as despesas do Sistema Único de Saúde. In: Camarano AA (org.). Os novos idosos brasileiros: muito além dos 60? Rio de Janeiro: IPEA; 2004. p. 427-49..

OP is defined as a metabolic bone disorder of multifactorial origin, characterized by the decrease of bone mineral density with deterioration of the microarchitecture, which results in a higher risk of fractures⁴4. World Health Organization. Assessment of fracture risk and its application to screening of postmenopausal osteoporosis: report of a WHO Study Group. World Health Organ Tech Rep Ser 1994; 843: 1-129.. OP can be classified as primary, and it is subdivided into types I and II and secondary. In the type I primary OP, also known as postmenopausal type, there is a fast bone loss that happens in the recently menopaused woman. Type II or senile OP is associated with aging and is developed through calcium chronic impairment, increase of the parathormone activity, and decrease of bone formation⁵5. Riggs BL, Melton LJ 3rd. Evidence for two distinct syndromes of involutional osteoporosis. Am J Med 1983; 75(6): 899-901..

The secondary OP can occur owing to inflammatory processes such as those produced by the rheumatoid arthritis, to endocrine alterations such as those present in hyperthyroidism, and in adrenal disorders; it can also be caused owing to the use of drugs such as heparin, alcohol, vitamin A, and use of corticoids, among other causes⁵5. Riggs BL, Melton LJ 3rd. Evidence for two distinct syndromes of involutional osteoporosis. Am J Med 1983; 75(6): 899-901..

OP is a multifactorial disease with high prevalence that predisposes the subject to suffering falls and fractures, thus provoking functional impairment and a consequent reduction in the quality of life. This disease has become an important public health issue, especially after the increase of population's life expectation⁶6. Martini LA, Moura EC, Santos LC, Malta DC, Pinheiro MM. Prevalência de diagnostico auto-referido de osteoporose, Brasil, 2006. Rev Saúde Pública 2009; 43(Suppl 2): 107-16.. It is estimated that around 200 million people in the world have OP⁷7. Reginster JY, Burlet N. Osteoporosis: a still increasing prevalence. Bone2006; 38(2 Suppl 1): S4-9.. In the United States, 10 million people aged 50 years or older have OP⁸8. Bonjour J, Guéguen L, Palacios C, et al. Minerals and vitamins in bone health: the potential value of dietary enhancement. Brit J Nutr. 2009;1-16.. In Spain, there is a 31.8% prevalence⁹9. Sanfélix-Genovés J, Reig-Molla B, Sanfélix-Gimeno G, Peiró S, Graells-Ferrer M, Vega-Matrínez M, et al. The population-based prevalence of osteoporotic vertebral fracture and densitometric osteoporosis in postmenopausal women over 50 in Valencia, Spain (The FRAVO Study). Bone2010; 47(3): 610-6.. According to estimations from the WHO for 2020, more than 270 million people only in India and China will suffer from OP¹⁰10. Jha R, Mithal A, Malhotra N, Brown EM. Pilot case-control investigation of risk factors for hip fractures in the urban Indian population. BMC Musculoskelet Disord 2010; 11: 49..

Brazilian population-based studies point out a prevalence that varies from 4.4 to 27.4%, depending on the investigated methodology and age range⁶6. Martini LA, Moura EC, Santos LC, Malta DC, Pinheiro MM. Prevalência de diagnostico auto-referido de osteoporose, Brasil, 2006. Rev Saúde Pública 2009; 43(Suppl 2): 107-16.^,1111. Pinheiro MM, Ciconelli RM, Martini LA, Ferraz MB. Risk factors for recurrent falls among Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS). Cad Saúde Publica 2010; 26(1): 89-96.^,1212. Baccaro LF, de Sousa Santos Machado V, Costa-Paiva L, Souza MH, Osis MJ, PInto Neto AM. Factors associated with osteoporosis in Brazilian women: a population-based household survey. Arch Osteoporos 2013; 8(1-2): 138.. Research developed in other countries has showed factors associated with OP such as OP history in the family, low schooling level, sedentary lifestyle, alcoholic beverage consumption, and diet with poor amount of calcium¹³13. Tatsuno I, Terano T, Nakamura M, Suzuki K, Kubota K, Yamaguchi J, et al. Lifestyle and osteoporosis in middle-aged and elderly women: Chiba bone survey. Endocr J 2013; 60(5): 643-50.. In Brazil, few population-based studies have analyzed the factors associated with OP. The factors identified in national studies included, among others: longer time of menopause, bad self-perception of health, arthrosis, problems in balance maintenance, advanced age, and current smoking habit¹¹11. Pinheiro MM, Ciconelli RM, Martini LA, Ferraz MB. Risk factors for recurrent falls among Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS). Cad Saúde Publica 2010; 26(1): 89-96.^,1212. Baccaro LF, de Sousa Santos Machado V, Costa-Paiva L, Souza MH, Osis MJ, PInto Neto AM. Factors associated with osteoporosis in Brazilian women: a population-based household survey. Arch Osteoporos 2013; 8(1-2): 138.. However, Martini et al.⁶6. Martini LA, Moura EC, Santos LC, Malta DC, Pinheiro MM. Prevalência de diagnostico auto-referido de osteoporose, Brasil, 2006. Rev Saúde Pública 2009; 43(Suppl 2): 107-16. assessed that the prevalence and factors associated with OP have not yet been enough elucidated in the Brazilian population.

Given the increasing prevalence of OP together with the fast aging of the population, the serious implications the disease causes to quality of life, the increased risk of fractures, and the lack of Brazilian population-based studies on this disease, this study aimed at analyzing the prevalence and factors associated with self-reported OP in the population of aged subjects who lived in Campinas city, São Paulo state, Brazil, through assessment of the disease association with demographic, socioeconomic, health behavioral, and morbidity factors.

METHODS

This is a cross-sectional and population-based study that was developed in a sample with noninstitutionalized aged subjects (≥ 60 years), who lived in the urban area of Campinas city, in São Paulo. Data were taken from the Health Household Survey (ISACAMP 2008) that aimed at obtaining information from several health dimensions related to three age domains: adolescents (10 - 19 years), adults (20 - 50 years), and aged (≥ 60 years) subjects.

The minimum amount of people to constitute the sample of each domain was defined considering the situation that was related to the maximum variability for the frequency of studied events (p = 0.50), a 95% confidence coefficient in the determination of the confidence intervals (z = 1.96), sampling error between 4 and 5 percentage points, and outlining effect equals to 2. Thus, a minimum number of a thousand interviews was established for each age domain.

The survey sample was obtained by means of probabilistic sampling procedures, by conglomerates, and in two stages: censor sector and household. In the first stage, 50 censor sectors were sorted with a probability in the same proportion to the size (number of households). In the second stage, in order to achieve the necessary size of the sample, 2,150; 700 and 3,900 households were independently sorted to obtain the minimum desired number of adolescents, adults, and aged subjects, respectively.

Information was obtained through a structured questionnaire that was composed of several thematic blocks that included information regarding: morbidity, emotional problems, accidents and violence, quality of life, use of services, preventive practices, use of medications, health-related behaviors, and socioeconomic characteristics. The questionnaires were applied by qualified interviewers through readings, content discussions, and training of questionnaire use with friends and relatives. Activities were monitored throughout the entire period of field research.

Only data from the survey regarding people aged ≥ 60 years were used in this study.

The dependent variable that was used in this study was OP self-reported diagnosis, which was achieved through the question: "Has any physician or other health professional told you have OP?" (Yes or no).

The following independent variables were chosen based on the literature and on the ISACAMP 2008 checklist:

Data from the survey were typed in a database that was developed with the use of the software EpiData, version 3.1 (Epidata Assoc., Odense, Denmark) and submitted to consistence assessment. Estimations of prevalence and of 95% confidence intervals (95%CI) were produced for the analyses of this study. Associations between the independent variables and OP were analyzed through the χ²-test. Poisson simple and multiple regression analyses were also applied to estimate the gross and adjusted prevalence ratios (PRs).

The analyses were conducted with the software Stata 11.0 (Stata Corp, Colégio Station, United States) using the svy commands that incorporate the needed ponderations owing to the sampling design.

The project of this study received approval of the Ethics Committee from the School of Medical Sciences of Universidade Estadual de Campinas , in an addendum to protocol number 079/2007.

RESULTS

Among the households sorted to obtain the sample of aged subjects, there was a loss of 6.5% owing to the impossibility of finding a resident or the refusal of such resident in enrolling the subjects who lived in the household. Of the aged subjects enrolled in the sorted households and whom should be interviewed, 2.3% refused in participating. Thus, data from 1,419 aged subjects were analyzed in this study.

Of the studied population, 14.8% referred diagnosis of OP, with a pretty higher prevalence of women (22.8%) compared with men (4.4%). Subjects who self-reported black skin color presented lower prevalence of the disease, even after adjustment by gender and age. In subjects aged 80 years or older, OP prevalence was about two times higher than in the age range of 60 to 69 years. The first associations found with marital status, schooling, and paid job lost significance after the adjustment by gender and age (Table 1).

In Table 2, the variable of sleeping hours was associated with OP, presenting a significantly higher prevalence in the segment of less than 7 sleeping hours per day. The frequency of alcohol consumption and dependence, assessed through AUDIT, also presented p ≤ 0.05; however, the associations lost significance after the adjustments. Table 3 presents the OP prevalence according to morbidity, health problems, fall occurrence, and health self-assessment. Among the analyzed diseases, we found a significantly higher prevalence for those subjects diagnosed with rheumatism/arthritis/arthrosis, asthma/bronchitis/emphysema, and tendinitis even after adjustment by age and gender.

With regard to the reported health problems, significant associations were seen for dizziness and insomnia, even after adjustments. The CMD, which is also presented in this Table, and the BMI > 27 kg/m² category presented a PR = 1.61 (95%CI 1.25 - 2.06) and PR = 1.27 (95%CI 1.00 - 1.61) after adjustments by age and gender (Table 3.

The occurrence of falls in the last 12 months and health self-assessment also presented significant associations after adjustments. Subjects who assessed health as bad/very bad presented a PR = 3.43 (95%CI 2.40 - 4.90), and, in those who reported falls, the PR = 1.53 (95%CI 1.14 - 2.05) (Table 3.

Another analyzed aspect was the total amount of chronic morbidity and of reported health problems. It was seen that the OP prevalence increases based on the higher number of reported morbidity and health problems (Table 3.

DISCUSSION

Results showed in this study are based on the self-report of an aged subject, who claims being diagnosed with OP by a physician or other health professional. The highest prevalence of the disease was found in older female subjects who self-reported being white-skinned, on aged subjects with rheumatism/arthritis/arthrosis, asthma/bronchitis/emphysema, tendinitis, dizziness, insomnia, CMD, and overweight (BMI > 27 kg/m²⁾, and in those who reported sleeping less than 7 hours per day.

The growing increase of OP prevalence with aging found in this study was also seen in the investigations of Martini et al.⁶6. Martini LA, Moura EC, Santos LC, Malta DC, Pinheiro MM. Prevalência de diagnostico auto-referido de osteoporose, Brasil, 2006. Rev Saúde Pública 2009; 43(Suppl 2): 107-16. and Baccaro et al.¹²12. Baccaro LF, de Sousa Santos Machado V, Costa-Paiva L, Souza MH, Osis MJ, PInto Neto AM. Factors associated with osteoporosis in Brazilian women: a population-based household survey. Arch Osteoporos 2013; 8(1-2): 138.. It is known that, throughout life, the human skeleton suffers a continuous process of reabsorption and renovation of the bone tissue called bone remodeling, which is directly related to homeostasis of calcium and phosphorus¹⁹19. National Osteoporosis Foundation (NOF). [homepage na Internet] Are you at risk? Disponível em: Disponível em: http://www.nof.org/articles/2 (Acessado em: 13 de outubro de 2015).
http://www.nof.org/articles/2... . Children and adolescents present a gradual increase of the bone tissue with predominance of bone formation regarding reabsorption. Around 20 years old, swaying between bone loss and formation changes, people start to lose more bone mass than to form it. In the midlife, this speed of bone loss becomes even higher, thus contributing to the OP development¹⁹19. National Osteoporosis Foundation (NOF). [homepage na Internet] Are you at risk? Disponível em: Disponível em: http://www.nof.org/articles/2 (Acessado em: 13 de outubro de 2015).
http://www.nof.org/articles/2... .

Women presented an OP prevalence much higher compared with men. It is known that menopause is a determining factor. After menopause, the circulating estrogen hormone levels decrease, which lead to an activation of bone remodeling cycles, with predominance in the phases of reabsorption regarding formation, with consequent decrease of bone mass²⁰20. Van Geel TA, Geusens PP, Winkens B, Sels JP, Dinant GJ. Measures of bioavailable testosterone and estradiol and their relationships with muscle mass, muscle strength and bone mineral density in postmenopausal women: a cross sectional study. Eur J Endocrinol 2009; 160(4): 681-7..

Another association was between self-reported skin color and OP. Black-colored subjects presented a lower prevalence of the disease compared with white-colored ones. This fact might be associated with a higher renal reabsorption of calcium and a higher resistance to the reabsorption action of the parathyroid hormone (PTH) that is present in black-colored subjects, which contributes to a higher accumulation of bone mass²¹21. Kleerekoper M, Nelson DA, Peterson EL, Flynn MJ, Pawluszka AS, Jacobsen G, et al. Reference data for bone mass, calciotropic hormones, and biochemical markers of bone remodeling in older (55-75) post-menopausal white and black women. J Bone Miner Res 1994; 9(8): 1267-76.. Some studies also point out that factors related to bone geometry and muscle strength could also be associated with lower occurrence of OP²²22. Kannus P, Parkkari J, Sievanen H, Sievänen H, Heinonen A, Vuori I, et al. Epidemiology of hip fractures. Bone1996; 18(1 Suppl): 57S-63S.^,2323. Nelson DA, Barondess DA, Hendrix SL, Beck TJ. Cross-sectional geometry, bone strength, and bone mass in the proximal femur in black and white postmenopausal women. J Bone Miner Res 2000; 15(10): 1992-7.. Nelson et al.²³23. Nelson DA, Barondess DA, Hendrix SL, Beck TJ. Cross-sectional geometry, bone strength, and bone mass in the proximal femur in black and white postmenopausal women. J Bone Miner Res 2000; 15(10): 1992-7. report that black women in general have a longer and narrower femur and smaller medullary cavities than white women, which contributes to higher bone mineral deposition and higher mechanic resistance.

Among the analyzed diseases, higher OP prevalence was found among subjects diagnosed with rheumatism/arthritis/arthrosis²⁴24. Lee SG, Parke YE, Parke SH, Kim TK, Choi HJ, Lee SJ, et al. Increased frequency of osteoporosis and BMD below the expected range for age among South Korean women with rheumatoid arthritis. Int J Rheum Dis 2012; 15(3): 289-96.. About 30 to 50% of the patients with rheumatoid arthritis develop OP, thus the result is an important increase in the number of fractures. The OP pathogenesis in the rheumatoid arthritis is multifactorial, and the factors that cause its appearance include the reduced mobility that these patients commonly present, time of disease, use of corticosteroids, and the lack of estrogen in women or of testosterone in men of older ages²⁵25. Huusko TM, Korpela M, Karppi P, Avikainen V, Kautiainen H, Sulkava R. Threefold increased risk of hip fractures with rheumatoid arthritis in Central Finland. Ann Rheum Dis 2001; 60(5): 521-2.. The persistent inflammatory activity also causes a higher bone reabsorption secondarily to the effects of IL-1 and IL-6, and TNF-α proinflammatory cytokines present in larger amounts in arthritis patients²⁶26. Pereira IA, Pereira RMR. Osteoporose e erosões ósseas focais na artrite reumatóide: da patogênese ao tratamento. Rev Bras Reumatol 2004; 44(5): 347-54..

Subjects with asthma/bronchitis/emphysema also showed a higher significant prevalence of OP in this study. Clinical and population-based studies also evidenced this association²⁷27. Sin DD, Man JP, Man SF. The risk of osteoporosis in Caucasian men and women with obstructive airways disease. Am J Med 2003; 114(1): 10-4.^,2828. Lekamwasam S, Trivedi DP, Khaw KT. An association between respiratory function and hip bone mineral density in older men: a cross-sectional study. Osteoporos Int 2005; 16(2): 204-7.. However, OP causative factor in patients with chronic obstructive pulmonary disease is complex, and many factors, such as low pulmonary function and use of corticosteroids, might contribute to its pathogenesis²⁹29. Gluck O, Colice G. Recognizing and treating glucocorticoid-induced osteoporosis in patients with pulmonary diseases. Chest 2004; 125(5): 1859-76..

The association between CMD and OP was also confirmed in other population-based studies³⁰30. Robbins J, Hirsch C, Whitmer R, Cauley J, Harris T. The association of bone mineral density and depression in an older population. J Am Soc Geriatr Soc 2001; 49(6): 732-6.^,3131. Diem SJ, Blackwell TL, Stone KL, Yaffe K, Haney EM, Biziotes MM, et al. The use of antidepressants and rates of hip bone loss in older women: study of osteoporotic fractures. Arch Intern Med 2007; 167(12): 1240-5.. Cizza et al.³²32. Cizza G, Primma S, Csako G. Depression as a risk factor for osteoporosis. Trends Endocrinol Metab 2009; 20(8): 367-73. suggest that many endocrine alterations that were seen during the depressive condition induce to bone loss. Schweiger et al.³³33. Schweiger U, Deuschle M, Körner A, Lammers CH, Schmider J, Gotthardt U, et al. Low lumbar bone mineral density in patients major depression. Am J Psychiatry 1994; 151(11): 1691-3. emphasize this association might be owing to a hormone dysregulation of the hypothalamic-pituitary adrenergic system.

Subjects with sleeping disorders such as insomnia and short sleep (less than 7 hours a day) also showed a higher prevalence of OP in this study, even after adjustments by gender and age. Fu et al.³⁴34. Fu X, Zhao X, Lu H, Jiang F, Ma X, Zhu S. Association between sleep duration and bone mineral density in Chinese women. Bone 2011; 49(5): 1062-6., in their study on the association between sleep duration and bone mineral density in Chinese women, also proved this association. It is known that an inappropriate sleep affects a healthy aging; however, the specific effects of this kind of sleep regarding bone metabolism are still unknown and limited³⁴34. Fu X, Zhao X, Lu H, Jiang F, Ma X, Zhu S. Association between sleep duration and bone mineral density in Chinese women. Bone 2011; 49(5): 1062-6.^,3535. Everson CA, Folley AE, Toth JM. Chronically inadequate sleep results in abnormal bone formation and abnormal bone marrow in rats. Exp Biol Med (Maywood) 2012; 237(9): 1101-9..

Dizziness as an isolated factor was also analyzed in this study. It was associated with OP, similarly to what was seen in other studies³⁶36. Jeong SH, Choi SH, Kim JY, Koo JW, Kim HJ, Kim JS. Osteopenia and osteoporosis in idiopathic benign positional vertigo. Neurology2009; 72(12): 1069-76.^,3737. De Moraes SA, Soares WJ, Ferriolli E, Perracini MR. Prevalence and correlates of dizziness in community-dwelling older people: a cross sectional population based study. BMC Geriatr 2013; 13: 4.. According to Jeong et al.³⁶36. Jeong SH, Choi SH, Kim JY, Koo JW, Kim HJ, Kim JS. Osteopenia and osteoporosis in idiopathic benign positional vertigo. Neurology2009; 72(12): 1069-76., the cause might be related to the decrease in the absorption of calcium, which is a nutrient used to form calcium carbonate crystals that move sensors inside the internal ear and are responsible for balance perception.

Overweight (BMI > 27 kg/m²⁾, traditionally seen as an OP protective factor³⁸38. Kopelman PG. Obesity as a medical problem. Nature2000; 404(6778): 635-43.^,3939. Villareal DT, Apovian CM, Kushner RF, Klein S. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Am J Clin Nutr 2005; 82(5): 923-34., showed to be associated with higher OP prevalence in this study. Recent studies indicate that excessive fat might not protect human beings from OP, and it is indeed associated with low bone mineral density⁴⁰40. Nielson CM, Marshall LM, Adams AL, LeBlanc ES, Cawthon PM, Ensrud K, et al. BMI and fracture risk in older men: the osteoporotic fractures in men study (MrOs). J Bone Miner Res 2011; 26(3): 496-502.^,4141. Moon SS, Lee YS, Kim SW. Association of nonalcoholic fatty liver disease with low bone mass in postmenopausal women. Endocrine2012; 42(2): 423-9. and increases the risk of fractures⁴⁰40. Nielson CM, Marshall LM, Adams AL, LeBlanc ES, Cawthon PM, Ensrud K, et al. BMI and fracture risk in older men: the osteoporotic fractures in men study (MrOs). J Bone Miner Res 2011; 26(3): 496-502.^,4242. Goulding A, Jones IE, Taylor RW, Williams SM, Manning PJ. Bone mineral density and body composition in boys with distal forearm fractures: a dual-energy x-ray absorptiometry study. J Pediatr 2001; 139(4): 509-15.. Researchers report that a possible explanation for this association is the fact of derivation of osteoblasts (bone-making cells) and adipocytes (energy storage cells) being from the same mesenchymal staminal cell⁴³43. Gregoire FM, Smas CM, Sul HS. Understanding adipocyte differentiation. Physiol Rev 1998; 78(3): 783-809. and that the increase of fat content in the bone medulla would make the bone weaker⁴⁴44. Schellinger D, Lin CS, Hatipoglu HG, Fertikh D. Potential value of vertebral proton MR spectroscopy in determining bone weakness. AJNR Am J Neuroradiol 2001; 22(8): 1620-7.. Bredella et al.⁴⁵45. Bredella MA, Gill MC, Gerweck AV, Landa MG, Kumar V, Daley SM, et al. Ectopic and serum lipid levels are positively associated with bone marrow fat in obesity. Radiology 2013; 269(2): 534-41. investigated the associations between the ectopic lipid levels, the serum lipid levels, and the bone medulla fat in obese men and women and found a positive correlation regardless the BMI, age, insulin resistance, and exercise status (number of hours of vigorous exercise per week).

Another studied association was health self-assessment. It was seen that those who considered health as bad and very bad presented a higher prevalence of OP. It is worth mentioning that health self-assessment is a valid and relevant indicator of the health condition of subjects and populations. It produces a global self-classification of the subject, considering signals and symptoms of diseases (diagnosed or not by health professionals), besides assessing the impact of such conditions on the physical, mental, and social wellfare⁴⁶46. Ratner PA, Johnson JL, Jeffery B. Examining emotional, physical, social and spiritual health as determinants of self-rated health status. Am J Health Promot 1998; 12(4): 275-82..

The association seen among subjects with OP and the occurrence of falls was also observed in this study and in another research¹¹11. Pinheiro MM, Ciconelli RM, Martini LA, Ferraz MB. Risk factors for recurrent falls among Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS). Cad Saúde Publica 2010; 26(1): 89-96.^,4747. Da Silva RB, Costa-Paiva L, Morais SS, Mezzalira R, Ferreira NO, Pinto-Neto AM. Predictors of falls in women with and without osteoporosis. J Orthop Sports Phys Ther 2010; 40(9): 582-8.. According to Arnold et al.⁴⁸48. Arnold CM, Busch AJ, Schachter CL, Harrison L, Olszynski W. The relationship of intrinsic fall risk factors to a recent history of falling in older women with osteoporosis. J Orthop Sports Phys Ther 2005; 35(7): 452-60., this association is associated with the consequences created by OP, such as decrease of trunk musculature strength, kyphosis, alteration of movement amplitude and motor coordination, situations that favor falls, fractures⁴⁹49. Pinheiro MM, Szejnfeld VL. Epidemiologia da osteoporose no Brasil. Rev Paul Reumatol 2011; 10(Suppl 1): 9-19., and limitation of everyday activities.

The results of this study showed the high prevalence of OP in aged subjects from Campinas, São Paulo and the association of the disease with several health morbidities, problems, and conditions. Comprehension and discussion of results should consider some limitations.

The first one refers to the information about the presence of OP being referred without confirmation of bone densitometry examination diagnosis, which might have underestimated the disease prevalence. Another limitation lies on the fact that this is a cross-sectional study, which does not allow inferring about the association causality.

We should also consider that this study used data from a health survey with wide thematic scope, which is not specifically directed to the OP theme; therefore, there are not more details regarding the disease and some factors such as sun exposure and fractures. Brazilian population-based studies involving prevalence and associated factors with OP in aged subjects are still rare in literature; thus, it does not enable better discussions.

CONCLUSION

This study, through the identification of OP-associated factors, points some segments of aged subjects who are more susceptible to the disease. Among them, some stand out, such as: female gender, white-colored skin, older subjects, those with rheumatism/arthritis/arthrosis, asthma/bronchitis/emphysema, tendinitis, dizziness, CMD, and other less studied and seen in this study such as short sleep, insomnia, and overweight (BMI > 27 kg/m²⁾.

The presence of these characteristics should warn health professionals, caregivers, and relatives to give a special attention to control OP and its consequences. It is worth mentioning that, by identifying these factors associated with OP, this study contributes to a better planning of public policies and health programs to the aged population.

References

Publication Dates

History