artigo dE rEvisão rEviEw articlE RESUMO A prevalência de incapacidade e dependência funcional é maior em idosos e está intimamente associada à redução da massa muscular, que ocorre, até mesmo, em indivíduos saudáveis. A sarcopenia parece decorrer da interação complexa de distúrbios da inervação, diminuição de hormônios, aumento de mediadores inflamatórios e alterações da ingestão protéico-calórica que ocorrem durante o envelhecimento. A perda de massa e força muscular é responsável pela redução de mobilidade e aumento da incapacidade funcional e dependência. Quando associada à fragilidade, esta perda gera custos econômicos e sociais. Neste artigo, pretende-se avaliar aspectos relacionados à gênese da sarcopenia, bem como analisar possíveis opções terapêuticas e de prevenção.

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OBJECTIVE: To develop a simple and easy-to-use tool for identifying osteoporotic women (femoral neck bone mineral density [BMD] Tscores À 2.5) in Latin America. DESIGN:Retrospective study involving review of medical records.SETTING: Osteoporosis clinics in 6 Latin American countries. PATIENTS:Postmenopausal women ages ! 50 in Latin America who had femoral neck BMD measurements. MEASUREMENTS AND MAIN RESULTS:A risk index was developed from 1,547 patients based on least square regression using age, weight, history of fractures, and other variables as predictors for BMD T-score. The final model was simplified by reducing the number of predictors; sensitivity and specificity were evaluated before and after reducing the number of predictors to assess performance of the index. The final model included age, weight, country, estrogen use, and history of fractures as significant predictors for T-score. The resulting scoring index achieved 91% sensitivity and 47% specificity. Simplifying the index by using only age and weight yielded similar performance (sensitivity, 92%; specificity, 45%). Three risk categories were identified based on OsteoRisk, the index using only age and body weight: high-risk patients (index o =À 2; 65.6% were osteoporotic), moderate-risk patients ( À 2o index o =1; 26.7% were osteoporotic), and low-risk patients (index41; 8% were osteoporotic). Similar results were seen in a validation sample of 279 women in Brazil.CONCLUSION: Age and weight alone performed well for predicting the risk of osteoporosis among postmenopausal women. The OsteoRisk is an easy-to-use tool that effectively targets the vast majority of osteoporotic patients in Latin America for evaluation with BMD. Although patients with fracture should automatically be considered for treatment for osteoporosis, and assessment of bone mineral density (BMD) using dual energy x-ray absorptiometry (DXA) is the standard for diagnosing osteoporosis prior to fracture, facilities for DXA measurements remain limited in Latin America and certain other parts of the world, and this poses a serious challenge for diagnosing osteoporosis in patients without prior fracture.Some researchers have examined the relationship between clinical variables and bone mass in the hope of targeting BMD measurements to patients who are more likely to have osteoporosis.14-20 Lydick et al. 17 developed a model that accurately identifies 90% of subjects with low bone mass and 40% of subjects with normal bone mass. Recently, Koh et al. 18 developed an index, the Osteoporosis Self-assessment Tool for Asians (OSTA), for identifying women at increased risk of osteoporosis in a population of Asian patients other than Japanese. The OSTA is based only on age and weight and achieved a sensitivity of 91% for identifying women with osteoporosis; it was further validated in a cohort of Japanese women, with a sensitivity of 98%. 19 The Osteoporosis Self-assessment Tool (OST) was derived from the OSTA by altering the risk category ranges, and performed well in identifying women at...

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ND increased BMD, hemoglobin levels, and muscle mass, and reduced the vertebral fracture rate of elderly osteoporotic women.