Sobre osteoporose, divulgou-se depoimento oficial de um dos membros do painel de peritos que criou os critérios diagnósticos:
“... durante dois ou três dias os peritos presentes andaram para trás e para a frente… tentando decidir com precisão onde é que, num gráfico de diminuição da densidade óssea, se devia traçar a linha… ao fim e ao cabo, foi uma questão de… ‘Bom... Temos que traçar a linha em algum sítio... e lembro-me que estava muito calor, e as pessoas estavam em mangas de camisa, sabem, tínhamos que andar para a frente, vocês compreendem... e, francamente, não me recordo quem é que se levantou e traçou a linha dizendo, ‘Bom, vamos lá fazer isto ”
Cerca de 2/3 dos grupos de pacientes, como a National Osteoporosis Foundation*, recebe fundos provenientes da indústria.A seguir um resumo de alguns dos artigos trabalhados nos pequenos grupos:
* National Osteoporosis Foundation (patrocinada pela “Merck & Company”), desenha campanhas visando “… chamar a atenção para a importância de testar para a osteoporose…”
- Bone densitometry is not a good predictor of hip fracture
Bisphosphonates are considered first-line treatment for postmenopausal osteoporosis. They are prescribed for millions of geriatric patients. Bisphosphonates – alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronic acid (Zometa, Reclast) – inhibit bone resorption by decreasing the activity of osteoclasts. Extensive studies have shown that therapy with bisphosphonates improves bone density and decreases fracture risk.
The reports of multiple cases of low-impact femoral fractures in patients who were taking alendronate for several years, a previously rare event, have therefore called for further study of the possible connection between alendronate and such fractures, as has been suggested by several authors.
The odds ratio for this pattern was 139.33 for alendronate users, and was 98% specific to identifying alendronate users. The patients with this pattern had been using alendronate for a mean of 6.9 years.
The evolution of our understanding of the relationship between alendronate and femoral fractures parallels the growing understanding of the relationship between use of bisphosphonates and osteonecrosis of the jaw (ONJ), which may reflect a similar mechanism of bone injury. After numerous publications of multiple case reports, a population-based analysis of IV bisphosphonate therapy concluded that the hazard ratio of being diagnosed with inflammatory conditions or osteomyelitis of the jaw was 11.48 for recipients of IV bisphosphonates as compared with non-recipients. No randomized, controlled, doubleblind studies have been done regarding bisphosphonates and ONJ, and they are unlikely to be done in the future. Nonetheless, the case reports and population studies have led to the creation of a new syndrome in the dental world, bisphosphonate-associated osteonecrosis of the jaw (BON), and position papers on trying to prevent this disorder have been published by several organizations concerned with dental surgery.
Although most cases of ONJ have occurred in patients treated with IV bisphosphonates (pamidronate, zoledronic acid), the finding of some cases related to oral bisphosphonates resulted in the recent publication by the American Dental Association of “Dental management of patients receiving oral bisphosphonate therapy.” This document suggests that “because there is no validated diagnostic technique currently available to determine if patients are at increased risk for developing BON, it may be prudent to proceed conservatively in some cases.”