VALERIA DE FALCO CAPARBO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
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 PREVALENCE OF SARCOPENIA AND ASSOCIATED RISK FACTORS BY TWO DIAGNOSTIC CRITERIA IN COMMUNITY-DWELLING OLDER WOMEN: THE SAO PAULO AGEING & HEALTH STUDY (SPAH)(2016) DOMICIANO, D. S.; FIGUEIREDO, C. P.; LOPES, J. B.; CAPARBO, V. F.; TAKAYAMA, L.; MENEZES, P. R.; PEREIRA, R. M.conferenceObject DISCRIMINATING SARCOPENIA IN COMMUNITY-DWELLING OLDER WOMEN WITH HIGH FREQUENCY OF OVERWEIGHT/OBESITY: PREVALENCE AND ASSOCIATED RISK FACTORS - 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.- Prevalence of sarcopenia and associated risk factors by two diagnostic criteria in community-dwelling older men: the So Paulo Ageing & Health Study (SPAH)(2014) FIGUEIREDO, C. P.; DOMICIANO, D. S.; LOPES, J. B.; CAPARBO, V. F.; SCAZUFCA, M.; BONFA, E.; PEREIRA, R. M. R.Sarcopenia is an aging syndrome that can be characterized by many criteria adjusted or not by fat mass. This study suggested that the optimal criteria should be selected according to body mass index (BMI) in older men and identified age, BMI, race, smoking, physical activity, hip bone mineral density (BMD) as risk factors for this syndrome. This study aims to analyze the prevalence of sarcopenia and associated risk factors using appendicular skeletal mass (ASM)/height(2) and ASM adjusted for total fat mass criteria in older men from community. Three hundred ninety-nine men were included and answered a questionnaire about lifestyle and medical history. Individuals were classified by their BMI using the classification adjusted by age. Body composition and bone mineral density were measured by dual X-ray absorptiometry. Sarcopenia was classified according to both criteria. Logistic regression models were used to analyze risk factors associated with sarcopenia. The mean BMI was 26.46 kg/m(2): 12.5 % underweight, 43.6 % normal, and 43.9 % overweight/obese. Fifty-four (13.5 %) were considered sarcopenic by ASM/height(2) and 79 (19.8 %) by ASM adjusted for fat (p = 0.001). Fifty-one (12.8 %) individuals had discordant sarcopenia classification: 13 were classified only by ASM/height(2) and 38 only by ASM adjusted for fat. Of the 13 subjects classified as sarcopenic only by ASM/height(2), 84.6 % (11/13) were underweight and solely one (7.7 %) was considered overweight/obese. In contrast, of those 38 older men classified as sarcopenic only by ASM adjusted for fat, none were underweight and 53 % (20/38) were overweight/obese. Subjects classified as sarcopenic according to both criteria had the same risk factors in the final model analyses (age, BMI, race, smoking, physical activity, hip BMD; p < 0.05). This study suggested that the optimal criteria for sarcopenia should be selected according to BMI in community-dwelling older men.
conferenceObject BONE MINERAL DENSITY AND PARATHYROID HORMONE AS INDEPENDENT RISK FACTORS FOR MORTALITY IN COMMUNITY-DWELLING OLDER ADULTS: A POPULATION-BASED PROSPECTIVE COHORT STUDY IN BRAZIL. THE SAO PAULO AGEING & HEALTH (SPAH) STUDY(2016) DOMICIANO, D.; MACHADO, L.; LOPES, J.; FIGUEIREDO, C.; CAPARBO, V.; TAKAYAMA, L.; OLIVEIRA, R.; SCAZUFCA, M.; MCCLUNG, M.; PEREIRA, R.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.- Lower P1NP serum levels: a predictive marker of bone loss after 1 year follow-up in premenopausal systemic lupus erythematosus patients(2015) SEGURO, L. P. C.; CASELLA, C. B.; CAPARBO, V. F.; OLIVEIRA, R. M.; BONFA, A.; BONFA, E.; PEREIRA, R. M. R.Predictors of bone mineral density (BMD) loss are additional tools in the management of osteoporosis in premenopausal women with systemic lupus erythematosus (SLE). This study provides original evidence that N-terminal propeptide of type 1 collagen (P1NP), the most specific bone formation marker, is a predictor of BMD loss in this group of women. SLE is associated with a high risk of low bone mass/fractures but this risk is still controversial in premenopausal women. Our aim was to determine the 1 year incidence of BMD loss in premenopausal SLE women and the value of bone turnover markers as predictors of this complication. This study enrolled a convenience sample of 63 premenopausal SLE patients. BMD was evaluated by dual X-ray absorptiometry at lumbar spine and hip at baseline and after 12 months. BMD changes above the least significant change were considered significant. Serum levels of P1NP and CTX (electrochemiluminescence), OPG, and RANKL (ELISA) were determined at baseline. Mean age was 31.1 +/- 6.8 years, and disease duration was 5.25 +/- 3.8 years. 36.5 % of patients presented BMD loss and 17.5 % BMD gain at lumbar spine and/or hip. Patients were divided in three groups: BMD loss (BL), no BMD change (NC), and BMD gain (BG). Patients with BL and NC received similar cumulative/mean/maximum glucocorticoid doses during the study, but patients with BG received lower doses (p < 0.05). Baseline P1NP levels were different in the groups (BL: 36.95 +/- 23.37 vs. NC: 54.63 +/- 30.82 vs. BG: 84.09 +/- 43.85 ng/mL; p = 0.031 BL vs. NC, p < 0.001 BL vs. BG, and p = 0.039 NC vs. BG). There was no difference in CTX, OPG, or RANKL levels. After multivariate analysis, P1NP remained as an independent risk factor for BMD loss (p < 0.03). This study provides original evidence that lower levels of P1NP, the most specific bone formation marker, are predictive of BMD loss over 12 months in premenopausal SLE patients.
conferenceObject EXERCISE AS A TREATMENT TO ATTENUATE BONE LOSS IN WOMEN AFTER ROUX-EN-Y GASTRIC BY PASS : A RANDOMIZED CONTROLLED TRIAL(2019) MURAI, I. H.; ROSCHEL, H.; DANTAS, W. S.; GIL, S.; MEREGE-FILHO, C. A.; CAPARBO, V.; TAKAYAMA, L.; SA-PINTO, A. L.; CLEVA, R.; SANTO, M. A.; KIRWAN, J.; PEREIRA, R. M.; GUALANO, B.conferenceObject VISCERAL FAT MEASURED BY DXA IS ASSOCIATED WITH INCREASED RISK OF NONSPINE FRACTURES IN NONOBESE ELDERLY WOMEN: A POPULATION-BASED PROSPECTIVE COHORT ANALYSIS FROM THE SAO PAULO AGEING & HEATHY (SPAH) STUDY(2016) MACHADO, L.; PEREIRA, R. M.; DOMICIANO, D.; FIGUEIREDO, C.; LOPES, J.; CAPARBO, V.; TAKAYAMA, L.; OLIVEIRA, R.; MENEZES, P.- Prevalence and risk factors of radiographic vertebral fracture in Brazilian community-dwelling elderly(2011) LOPES, J. B.; DANILEVICIUS, C. F.; TAKAYAMA, L.; CAPARBO, V. F.; MENEZES, P. R.; SCAZUFCA, M.; KUROISHI, M. E.; PEREIRA, R. M. R.The prevalence and risk factors of radiographic vertebral fracture were determined among Brazilian community-dwelling elderly. Vertebral fractures were a common condition in this elderly population, and lower hip bone mineral density was a significant risk factor for vertebral fractures in both genders. The aim of the study was to estimate the prevalence of radiographic vertebral fracture and investigate factors associated with this condition in Brazilian community-dwelling elderly. This cross-sectional study included 943 elderly subjects (561 women and 382 men) living in So Paulo, Brazil. Thoracic and lumbar spine radiographs were obtained, and vertebral fractures were evaluated using Genant's semiquantitative method. Bone mineral density (BMD) was measured by dual X-ray absorptiometry, and bone biochemical markers were also evaluated. Female and male subjects were analyzed independently, and each gender was divided into two groups based on whether vertebral fractures were present. The prevalence of vertebral fracture was 27.5% (95% CI 23.8-31.1) in women and 31.8% in men (95% CI 27.1-36.5) (P = 0.116). Cox regression analyses using variables that were significant in the univariate analysis showed that age (prevalence ratio = 1.03, 95% CI 1.01-1.06; p = 0.019) and total femur BMD (PR = 0.27, 95% CI 0.08-0.98; p = 0.048) were independent factors in predicting vertebral fracture for the female group. In the male group, Cox regression analyses demonstrated that femoral neck BMD (PR = 0.26, 95% CI 0.07-0.98; p = 0.046) was an independent parameter in predicting vertebral fractures. Our results suggest that radiographic vertebral fractures are common in Brazilian community-dwelling elderly and that a low hip BMD was an important risk factor for this condition in both genders. Age was also significantly correlated with the presence of vertebral fractures in women.
conferenceObject ASSOCIATION BETWEEN METABOLIC SYNDROME AND BONE MINERAL DENSITY IN COMMUNITY-DWELLING OLDER WOMEN: THE SAO PAULO AGEING AND HEALTH STUDY (SPAH)(2017) MACHADO, L. G.; DOMICIANO, D. S.; FIGUEIREDO, C. P.; LOPES, J. B.; CAPARBO, V. F.; TAKAYAMA, L.; OLIVEIRA, R.; PEREIRA, R. M.