CAMILLE PINTO FIGUEIREDO

(Fonte: Lattes)
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina

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  • conferenceObject
  • conferenceObject
    VERTEBRAL FRACTURE ASSESSMENT (VFA): A VALID TOOL TO DETECT VERTEBRAL FRACTURES IN COMMUNITY-DWELLING OLDER INDIVIDUALS - THE SAO PAULO AGEING & HEALTH STUDY (SPAH)
    (2012) DOMICIANO, D.; LOPES, J. B.; FIGUEIREDO, C. P.; CAPARBO, V.; TAKAYAMA, L.; BONFA, E.; PEREIRA, R. M. R.
    Aims: Vertebral fractures (VFx) are associated with higher morbidity and mortality in the general population. Since 70 % of the VFx are clinically silent, radiologic image of spine has to be acquired for the diagnosis. Vertebral Fracture Assessment (VFA) has emerged as possible alternative for the gold standard radiologic image to detect prevalent VFx. Previous studies evaluating this method are hampered by the limited sample size, selection of women with specific indication for spine X-ray and inclusion of patients under 70 years. Thus, the aim of this study was to compare the performance of VFA with X-ray to identify VFx in healthy community-dwelling older men and women. Methods: 429 noninstitutionalized subjects (60 % women), aged over 65 years, from community, were enrolled in this cohort. VFA by DXA measurements was evaluated by two expert rheumatologists by consensus and spine X-ray (T4 to L4) were analyzed according to semiquantitative method (Genant HK, 1993) by an expert radiologist. The correlation between VFA and spine X-ray to identify VFx was analyzed by kappa ( κ ) scores. P<0.05 was set as significant. Results: The average age ofsubjects was 73.1±5.1 years.The prevalence of VFx in VFA and X-ray were 29.7 and 28.6 % in women (p= 0.69), and 28.2 and 30.6 % in men (p=0.50), respectively. The frequency of unavailable vertebrae was significantly lower in spine X-ray than VFA (0.9 % and 5.6 %, respectively, p<0.001), particularly along with T4-T6. According to VFA, 5013 (96 %) vertebrae were identified as normal, 144 (2.7 %) had grade 1 fractures, 58 (1.1 %) grade 2 fractures and 12 (0.2) grade 3 fractures. The sensitivity of VFA was 72.93 % and the specificity was 99.1 % to identify VFx. The sensitivity increased to 92 % and specificity to 99.9 % excluding deformities grade 1. A good correlation between VFA and X-ray (κ=0.74) was observed and the exclusion of grade 1 resulted in an even better agreement(κ=0.84). The correlation vertebrae by vertebrae between VFA and spine X-ray was lower for T4-T7 (0.61-0.67). Correlations between the two methods were comparable in both gender (κ=0.73 in men,κ=0.75 in women). Conclusion: In elderly community, VFA and X-ray had comparable performances to identify VFx, particularly if mild deformities are excluded. Thus, this methodology is an easy and feasible promising alternative to improve the identification and management of patients with high risk of osteoporotic fractures.
  • conferenceObject
    The Impact of Asymptomatic Vertebral Fractures On Quality of Life in Community-Dwelling Older Women: The Sao Paulo Ageing & Health Study (SPAH)
    (2012) LOPES, Jaqueline B.; FUNG, Leandro; CHA, Carolina C.; FIGUEIREDO, Camille P.; TAKAYAMA, Liliam; CAPARBO, Valeria; PEREIRA, Rosa M. R.
    Background/Purpose: Health-related Quality of life (HRQL) has been used as a complementary measure of bone mineral density to evaluate the burden of osteoporosis on a patient’s daily life. There are few epidemiological studies evaluate HRQL and vertebral fractures in non-ambulatory or non-institutionalized elderly individuals. The aim of this study was to investigate the impact of asymptomatic vertebral fractures on quality of life in community-dwelling older women. Methods: This cross-sectional study is nested within the larger epidemiological project of prevalence vertebral fractures in older living in Sao Paulo, Brazil. A random sample of 180 women with 65 years of age or over was evaluated. The Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) was applied to all subjects. The QUALEFFO is a specific questionnaire designed to be used by patients with vertebral fractures attributed to osteoporosis. A low domain score indicates worse health and a high score indicates better health. Anthropometric data was obtained by physical examination and body mass index (BMI) was calculated. A lateral thoracic and lumbar spine X-ray was performed to identify asymptomatic vertebral fractures using Genant semi-quantitative method. A generalized linear model (GLM) with gamma distribution and logarithmic link function was used in the final statistical analysis. Results: Women with asymptomatic vertebral fractures had lower QUALEFFO total score [61.4(15.3) vs. 67.1(14.2), p=0.03] and worse QUALEFFO-physical-function domain [69.5(20.1) vs. 77.3(17.1), p=0.02] compared to those without fractures. QUALEFFO total score was also worse in women classified as obese, compare those classified as overweight and normal. High physical activity was related with better QUALEFFO total score (p=0.01). Likewise, lower QUALEFFO-physical-function score was observed in women with higher BMI (p<0.05) and lower physical activity (p< 0.05). GLM with gamma distribution and logarithmic link function, adjusted to age, showed that impair QUALLEFFO-total score and QUALEFFO-physical-function domain was related with high BMI, lower physical activity and vertebral fractures (p<0.05). Conclusion: Vertebral fractures are associated to decrease QOL in community-dwelling older women regardless of age, BMI, and physical activity. Therefore, our results highlight the importance of preventing and controlling asymptomatic vertebral fractures in order to reduce their impact on QOL among older women.
  • article 15 Citação(ões) na Scopus
    The impact of asymptomatic vertebral fractures on quality of life in older community-dwelling women: the Sao Paulo Ageing & Health Study
    (2012) LOPES, Jaqueline B.; FUNG, Leandro K.; CHA, Caroline C.; GABRIEL, Gustavo M.; TAKAYAMA, Liliam; FIGUEIREDO, Camille P.; PEREIRA, Rosa Maria R.
    OBJECTIVES: The aim of this study was to investigate the impact of asymptomatic vertebral fractures on the quality of life in older women as part of the Sao Paulo Ageing & Health Study. METHODS: This study was a cross-sectional study with a random sample of 180 women 65 years of age or older with or without vertebral fractures. The Quality of Life Questionnaire of the European Foundation for Osteoporosis was administered to all subjects. Anthropometric data were obtained by physical examination, and the body mass index was calculated. Lateral thoracic and lumbar spine X-ray scans were obtained to identify asymptomatic vertebral fractures using a semi-quantitative method. RESULTS: Women with asymptomatic vertebral fractures had lower total scores [61.4(15.3) vs. 67.1(14.2), p = 0.03] and worse physical function domain scores [69.5(20.1) vs. 77.3(17.1), p = 0.02] for the Quality of Life Questionnaire of the European Foundation for Osteoporosis compared with women without fractures. The total score of this questionnaire was also worse in women classified as obese than in women classified as overweight or normal. High physical activity was related to a better total score for this questionnaire (p = 0.01). Likewise, lower physical function scores were observed in women with higher body mass index values (p < 0.05) and lower physical activity levels (p < 0.05). Generalized linear models with gamma distributions and logarithmic link functions, adjusted for age, showed that lower total scores and physical function domain scores for the Quality of Life Questionnaire of the European Foundation for Osteoporosis were related to a high body mass index, lower physical activity, and the presence of vertebral fractures (p < 0.05). CONCLUSION: Vertebral fractures are associated with decreased quality of life mainly physical functioning in older community-dwelling women regardless of age, body mass index, and physical activity. Therefore, the results highlight the importance of preventing and controlling asymptomatic vertebral fractures to reduce their impact on quality of life among older women.
  • conferenceObject
    SERUM PHOSPHATE AND HIP BONE MINERAL DENSITY AS ADDITIONAL FACTORS IN VASCULAR CALCIFICATION IN A COMMUNITY-DWELLING: SAO PAULO AGEING HEALTHY STUDY (SPAH)
    (2012) FIGUEIREDO, C. P.; LOPES, J. B.; CAPARBO, V. F.; TAKAYAMA, L.; BONFA, E. D.; PEREIRA, R. M.
    Aims: To analyze abdominal aortic calcification (AAC) and its possible association with bone metabolism parameters as well as others clinical and laboratory data in a São Paulo community-dwelling elderly (SPAH). Methods: This cross-sectional study included 815 subjects ≥ 65 years old. The risk factors for osteoporosis and cardiovascular disease as well as a wide array of demographic and lifestyle characteristics were collected using a standardized questionnaire. BMD was measured by DXA. Kauppila’ s method was used to quantify the AAC score (AACS) by spine X-rays. Laboratory analyses were also performed. Results: AAC was observed in 63.2 % of subjects with a mean AACS of 4.68±5.88. AACS was directly correlated with age, phosphorus, LDL-cholesterol, triglycerides, and inversely correlated with BMI, femoral neck BMD and total femur BMD (p<0.05). Regarding binary variables, the AACS was associated with previous fragility fractures, current smoking, low physical activity, falls and arterial hypertension (p<0.05). Multiple lin-ear regression analysis demonstrated that the AACS was positively associated with phosphate (p=0.005) and negatively associated with total femur BMD (p<0.001) after adjusting by age, triglycerides, current smoking, arterial hypertension and LDL-cholesterol. An increased of AACS was observed with the elevation of serum phosphorus levels [£ 2.4 mg/dL: AACS 01.9 (SD:3.9); 2.5-3.5 mg/dL: AACS04.5 (SD:5.6)and >3.5 mg/dL: AACS05.3 (SD:6.3), p=0.003]. Conclusion: Our study identified serum phosphate and hip BMD as additional players in the complex process of vascular calcification outside the setting of kidney failure in a community-dwelling elderly and extended the previous observations of well-known risk factors for cardiovascular disease.
  • conferenceObject
    THE IMPACT OF ASYMPTOMATIC VERTEBRAL FRACTURES ON QUALITY OF LIFE IN COMMUNITY-DWELLING OLDER WOMEN: SAO PAULO AGEING & HEALTH STUDY (SPAH)
    (2012) LOPES, J. B.; FUNG, L.; CHA, C. C.; FIGUEIREDO, C. P.; TAKAYAMA, L.; PEREIRA, R. M. R.
    Aims: To investigate the impact of asymptomatic vertebral fractures on community-dwelling older women’s quality of life (QOL) from the Sao Paulo Ageing & Health Study (SPAH). Methods: This cross-sectional study is nested within the larger epidemiological project of prevalence vertebral fractures in older living in Sao Paulo, Brazil. 180 women with 65 years of age or over were evaluated. The Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) was administered to all subjects. The QUALEFFO is a specific questionnaire designed to be used by patients with vertebral fractures attributed to osteoporosis. This questionnaire has 41 questions, covering five domains: pain, physical function, social function, general health perception and mental function. Each domain score was computed by summing the scores of all questions and submitting the sum to a linear transformation to a scale of 100. A low score indicates worse health and a high score indicates better health. Anthropometric data was obtained by physical examination and BMI was calculated. The participants underwent a lateral thoracic and lumbar spine X-ray to identify asymptomatic vertebral fractures using semiquantitative method (Genant-1993). Results: Women with asymptomatic vertebral fractures had lower QUALEFFO-Total [61.4 (15.3) vs. 67.1 (14.2), p=0.03] and worse QUALEFFO-physical-function domain [69.5 (20.1) vs. 77.3 (17.1), p=0.02] compared to those without fractures. QUALEFFO-Total was also worse in women classified as obese, compared to those classified as overweight and normal [61.7(15.4) vs. 66.4(13.8) vs. 70.8 (13.5), p=0.008]. Lower QUALEFFO-Total was found in women with low physical activity compared to those with moderate or high activity [51.8(19.1) vs. 64.8(14.3) vs. 70.3 (13.2), p=0.010]. The analysis each domain showed that lower QUALEFFO-physical-function domain was also observed in women with higher BMI and lower physical activity. The final statistical analysis using generalized linear models with gamma distribution and logarithmic link function showed that impair QUALEFFO-Total was associated with vertebral fractures regardless of age (p<0.05). Lower QUALEFFO-physical-function domain remain associated with high BMI (p=0.004), lower physical activity (<0.001) and vertebral fractures (p=0.041). Conclusion: Vertebral fractures are associated to decreased QOL and physical function in community-dwelling older women. Therefore, the results highlight the importance of preventing and controlling asymptomatic vertebral fractures in order to reduce their impact on QOL among older women.