Perspectivas diagnósticas e terapêuticas da osteoporose após lesão medular
DOI:
https://doi.org/10.11606/issn.2317-0190.v11i1a102471Palavras-chave:
Traumatismos da Medula Espinal, Osteoporose, Densidade Mineral Óssea, Paraplegia, QuadriplegiaResumo
A osteoporose é uma das reconhecidas complicações da lesão medular, mas restam dúvidas quanto à totalidade de mecanismos fisiopatológicos envolvidos e tratamento efetivo. Grande parte da perda óssea ocorre na fase aguda, com estabilização cerca de doze a dezesseis meses após. A perda óssea afeta todos os segmentos, mas é mais intensa naqueles paralisados e em áreas ricas em osso trabecular. Mecanismos envolvidos não são totalmente esclarecidos, mas englobam não só a perda da tensão mecânica, mas também fatores neurovasculares e alterações estruturais do colágeno. Tanto marcadores bioquímicos quanto estudos com o uso da histomorfometria óssea evidenciam aumento da reabsorção óssea em detrimento da formação óssea. Estudos com o uso da densitometria óssea evidenciam dissociação entre a perda a nível da coluna e quadril, com maior perda a nível do quadril e de membros inferiores, achado considerado típico e marcante deste grupo de pacientes. Como conseqüência, o aumento da incidência de fraturas que se situa entre 1 e 7%, sendo muitas vezes decorrentes de traumas mínimos. Trabalhos com ortostatismo e cinesioterapia não demonstraram benefício significativo no que diz respeito à redução da perda de massa óssea e trabalhos com estimulação elétrica funcional apresentam resultados divergentes, parecendo resultar em algum benefício local. O uso de medicação anti-reabsortiva parece constituir opção promissora, sobretudo na fase aguda, mas estudos são ainda necessários para avaliar a sua efetividade, ou seja, a redução da incidência de fraturas.
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