| spelling |
Maria Marta Sarquis Soareshttp://lattes.cnpq.br/6821363733372088Maria Marta Sarquis SoaresEli Iola Gurgel AndradeBeatriz Santana Soares Rochahttp://lattes.cnpq.br/6592729742855089Bruna Coelho Galvão Marinho2021-07-08T14:57:50Z2021-07-08T14:57:50Z2010-08-27http://hdl.handle.net/1843/36696A osteoporose (OP) é a doença osteometabólica mais comum. É caracterizada por redução de massa óssea e qualidade óssea alterada com consequente fragilidade óssea e aumento do risco de fraturas. Vários fatores podem contribuir para perda de massa óssea e eles devem ser identificados e corrigidos para que o tratamento da osteoporose seja eficaz. Este estudo tem o objetivo de avaliar a frequência das alterações laboratoriais e o custo-efetividade de exames na investigação de OP. Estudo quantitativo transversal em que foram analisados 185 prontuários de pacientes do sexo feminino, na pós-menopausa, atendidas no ambulatório de endocrinologia geral do Hospital Felício Rocho, em Belo Horizonte, Brasil, com diagnóstico de OP realizado através de densitometria mineral óssea de coluna lombar e/ou fêmur proximal. Foram excluídos pacientes com insuficiência renal ou hepática ou sabidamente com doença ou em uso de medicamento que resulte em perda de massa óssea. O cálcio foi o exame mais solicitado (100% das pacientes) na investigação laboratorial da OP, mas esteve alterado em apenas 8,65% das pacientes. O hormônio tireoestimulante (TSH) foi o segundo exame mais solicitado, estando alterado em 12,57% dos casos. O paratormônio (PTH) foi solicitado para 82,16% das pacientes e esteve alterado em 35,53% delas, enquanto a calciúria foi solicitada para 67,03% e esteve alterada em 18,55%. A 25 hidroxi-vitamina D (25OHD) foi o exame mais alterado (42,11%) nesta população, sendo solicitado para 82,16% das pacientes. O exame de fator de crescimento insulina-like 1 (IGF1) foi solicitado apenas em 2,7% das pacientes, mas estava alterado em 40,0%, por ter sido solicitado apenas em pacientes com alta suspeita diagnóstica. A eletroforese de proteína foi realizada em 23,78% das pacientes, com alteração em 13,64% dos exames. Nenhuma paciente teve cortisol ou anticorpos para triagem de doença celíaca alterados. Para a avaliação de custo-efetividade da investigação laboratorial de OP foi avaliado o grupo de pacientes (n=62) sem tratamento para OP que realizou todos os exames da “propedêutica mínima” completa, que são: cálcio, calciúria, PTH, 25OHD e TSH. Estratégias com estes exames foram montadas com objetivo de avaliar o custo e a eficácia de cada estratégia em diagnosticar desordens que alteram a massa óssea. A estratégia que solicita PTH, calciúria e 25OHD para todas as pacientes e TSH para aquelas usuárias de levotiroxina realiza 100% dos diagnósticos a um custo de R$123,34 por paciente e R$149,94 por diagnóstico. Já a estratégia que solicita PTH e calciúria para todas as pacientes, 25OH para aquelas em que um dos exames anteriores esteja alterado e TSH para as usuárias de levotiroxina diagnostica 84,31% das desordens a um custo menor, de R$98,42 por paciente e R$141,91 por diagnóstico. Não há consenso sobre qual a propedêutica mínima a ser solicitada na avaliação de pacientes com OP. Várias desordens que alteram massa óssea são comuns e de fácil diagnóstico e tratamento. Na população deste estudo, os exames de calciúria, PTH, 25OHD e TSH foram custo-efetivos na investigação das principais desordens que contribuem para baixa massa óssea.Osteoporosis (OP) is the most common osteometabolic disease. It is characterized by reduced bone mass and bone quality deterioration with consequent increase in bone fragility and fracture risk. Several factors may contribute to bone loss and they should be identified and corrected so that OP treatment can be effective. This study aims to assess the frequency of laboratory abnormalities and cost-effectiveness of tests used in OP investigation. Cross-sectional quantitative study analyzed 185 charts of, postmenopausal women attending the general outpatient clinic of Endocrinology at Felicio Rocho, Hospital - Belo Horizonte, Brazil; OP diagnois was made by lumbar spine and / or proximal femur bone mineral densitometries. Patients with renal or hepatic or other diseases or in use of medication that could result in loss of bone mass were excluded. Calcium was the most requested test (100% of patients) in the laboratory investigation of the OP, but was altered in only 8.65% of patients. The thyroid-stimulating hormone (TSH) was the second most requested test and was amended in 12.57% of cases. The parathyroid hormone (PTH) was requested for 82.16% of patients and was abnormal in 35.53% of them, while calciuria was requested for 67.03% and was abnormal in 18.55%. The 25-hydroxy vitamin D (25OHD) was the more frequently amended (42.11%) test in this population, being asked to 82.16% of patients. The examination of insulin growth factor-like 1 (IGF1) was requested in only 2.7% of patients, but was changed in 40.0%, having been asked only in patients with high clinical suspicion. Protein electrophoresis was performed in 23.78% of patients and was abnormal in 13.64% of patients. No patient had cortisol or screen antibodies for celiac disease changed. To assess the cost-effectiveness of laboratory investigation of OP we used the group of patients without treatment for OP who performed all examinations of the “minimal complete workup” (n = 62), which are: calcium, urine calcium, PTH, and 25OHD TSH. Strategies on these tests were assembled to evaluate the cost and effectiveness in diagnosing disorders that affect bone mass. The strategy using PTH, urine calcium and 25OHD for all women and TSH for those users of levothyroxine performs 100% of diagnoses at a cost of R$ 123.34 per patient and R$ 149.94 per diagnosis. The strategy using PTH and urinary calcium for all patients, 25OH for those with abnormalities in one of the previous tests and TSH for users of levothyroxine identified 84.31% of the disorders at a lower cost of R$ 98.42 per patient and R$ 141.91 per diagnosis. There is no consensus on the minimum workup to evaluate patients with OP. A number of disorders that affect bone mass are common and easily diagnosed and treated. In this study population, calciuria, PTH, 25OHD and TSH were cost-effectiveness in the investigation of major disorders that contribute to low bone mass.porUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em Ciências Aplicadas à Saúde do AdultoUFMGBrasilMEDICINA - FACULDADE DE MEDICINACálcioHipercalciúriaVitamina DTeriparatidaRemodelação ÓsseaDensidade ÓsseaOsteoporoseCálcioHipercalciúriaVitamina DTeriparatidaRemodelação ÓsseaDensidade mineral ósseaOsteoporoseFrequência das alterações laboratoriais e custo-efetividade de exames na investigação de osteoporoseinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSElicense.txtlicense.txttext/plain; charset=utf-82119https://repositorio.ufmg.br/bitstream/1843/36696/2/license.txt34badce4be7e31e3adb4575ae96af679MD52ORIGINALDissertação Bruna final.pdfDissertação Bruna final.pdfapplication/pdf1726474https://repositorio.ufmg.br/bitstream/1843/36696/1/Dissertac%cc%a7a%cc%83o%20Bruna%20final.pdf5308998aa8c69e4b1f75949c0c420cd9MD511843/366962021-07-08 11:57:51.224oai:repositorio.ufmg.br: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Repositório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2021-07-08T14:57:51Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
|