Only 10% of Patients Treat Osteoporosis

treat osteoporosisOn the day that worldwide alert for Osteoporosis, António Vilar, rheumatology Service Coordinator Lusíadas Hospital in Lisbon, tells us of a disease that affects 12 percent of the adult Portuguese population and is responsible for the increased number of fractures in the hip, spine and peripheral bones.

We take the October 20 to talk a little more Osteoporosis (OP).

widely spoken and harnessed disease, sometimes for commercial purposes often dubious, when not even immoral.

It is a bone metabolism problem that it loses quantity (density) accompanied by deterioration of its architecture, resulting in an increased risk of fractures of the spine, hip bones and peripherals (cuffs).

With increasing longevity, and taking into account that all live long enough we ALL OP, it is easily understood that quickly became a public health problem.

It is only in Portugal in the last 20 years, life expectancy at birth has increased more than 10 years!

Not being the most frequent diseases, it is a major cause of death in developed countries mainly due to femur fractures.

Often called the invisible threat not give symptoms until the first fracture occurs, the OP has visible and devastating consequences with hip fractures because:

24% of patients die within 1 year;

50% of hip fracture victims lose their autonomy and 33% are totally dependent.

Did you know that die in Portugal, more patients per femur fracture than women with breast cancer?

In this context it is easily understood impact, which is also economic, OP.

Data from the World Health Organization (WHO) estimates, only in hip fractures worldwide, an increase from 1990 of over one million and six hundred thousand cases that reach the astronomical amount of over six million fractures in 2050, however, they are not appropriate preventive strategies.

In Portugal 1 in 3 women will have an osteoporosis fracture lifelong, and half are the femur. And those with more than 50 years, half will undergo an osteoporosis fracture.

The main risk factors for OP are age, sex and hormonal factors (such as low estrogen at menopause or testosterone deficit in men), heredity (which determines the peak bone mass achieved at the end adolescence), food (dairy products), some medications such as corticosteroids and heparin, physical activity and some bad habits such as alcohol and tobacco.

The challenge is in the correct identification of patients at risk on the one hand and lack of medical treatment that occurs in patients who have had an osteoporotic fracture …

Between us only 10 to 15% of those patients are treating your OP!

Although one can measure bone density in various sites (spine, femur, forearm and foot) and classified as normal, low or very low bone mass and with it get a sense of increased risk of fractures, new instruments that rheumatologists and other experts interested in the treatment of OP know and can calculate the risk of fracture 10 years.

In it are questioned in addition to age, sex, weight and height, habits like smoking, drinking more than 3 beers, whiskeys or 0.5 liters of wine per day. Prolonged intake of corticosteroids or the presence of some endocrine diseases or menopause before 45 years.

Rheumatoid arthritis is itself also a risk factor, as well as the occurrence of a previous fracture or low-impact hip fracture in the parents.

Joins finally the femoral neck density leading to fractures estimated to 10 years and thus support the decision to treat the OP that user.

I will not speak today of the drugs used in the treatment of OP, but I will make a mention of the need to take calcium and vitamin D supplement, the latter widely spoken by the benefits it adds, in addition to calcium absorption, reducing the risk of falls in the elderly and also reducing the risk of many other diseases, appearing to be associated with greater longevity.

Non-drug measures remembered the importance of exercise. Even without going to the gym or run, WALK! Walk 30 to 45 minutes a day is a lot for your bone: improves muscle mass and coordination of movements.

But you have to do regularly … you can leave the car further, dismounting from public transport in previous stop, walk the dog or narrow affections with family putting catch up!

Other non-medical care is avoid FALLS.

Even at home, where a third of fractures occur (half of them in the kitchen or bathroom), look for:

  • Do not walk on slippery surfaces.
  • Remove carpets.
  • Be very careful with pets at home.
  • Have adequate lighting.
  • Put handrails in hallways and stairs.
  • Avoid excessida height of the bed.
  • There have scattered electrical wires.
  • Usas bases to shower.
  • Having brackets and supports (seats) in the shower.
  • Do not wear slippers.

lean on a cane or Canadian, if imbalance

Some possible interventions to prevent falls are:

  • Not prescribing sedatives.
  • Avoid polypharmacy.
  • Assess vision periodically.
  • Avoid alcohol.
  • Beware of some medicines for high blood pressure.
  • Turn on the light to get up in the night.
  • Never climb the benches or chairs.
  • Use possibly hip protectors.

Retrieve the Quality of Vision

Primary prevention and early detection are the most effective and instrumental in reducing the incidence and morbidity of vision disorders. To mark World Sight Day, which is celebrated today, Professor Eugenio Leite speaks of cataract, a disease that mainly affects older limiting their quality of life.

Cataract is a disease which appears with age or as a consequence of a systemic disease. Gradually, your vision begins to become blurred and objects no longer seem bright and alive as before. The onset of these symptoms may indicate the development of a cataract. Should consult an ophthalmologist to whether it is advisable to undergo cataract surgery to improve the quality of your vision.

The type of surgical technique is a decision that falls to the ophthalmologist, after clarifying conversation with the patient, which should include the entire procedure that involves undergoing surgery. To make the decision to undergo surgery is important to clarify all your doubts.

Next, we will present some questions that will help you understand the various types and causes of cataracts, so you can take your decision.


What is a cataract and what causes it?

The human eye functions like a camera. The visual rays are focused by the lens onto the retina, the fotorecetores layer that acts as the film of the camera, the back of the eye.

In the normal eye, light rays pass through the transparent lens and are focused on the retina, which will lead to a clear and bright image.

With advancing age, the lens continues to grow, adding to the existing layers on the surface. With the progress of time, the lens hardens and loses transparency, which results in a blurred and imperfect vision.

In this clinical situation, the cataract is age related. It is a normal process and, later or earlier, occurs in all individuals.

If the cataract formation process affects only a small area of the lens and it is not central, your vision can not be achieved or greatly disturbed. If, however, the process is severe, it reaches the central zone or whole lens and vision is greatly affected.

Although cataract usually occurs in both eyes rarely develops simultaneously in both eyes.


What are the other causes of cataracts?

There are other less common types of cataracts that are not related to aging. Let’s highlight some of these types:

Cataracts Congenital – occurs in children and can be hereditary or due to birth trauma. Some occur without any obvious cause.

secondary cataract – is caused by diseases or previous surgery to the eye. The formation of secondary cataracts may be accelerated by chronic diseases such as diabetes or excessive use of steroids.

traumatic cataract – The cause is an eye injury. Its appearance may arise immediately after trauma or slowly develop months or years after the accident.


What are the symptoms of cataracts?

Patients with cataracts may have one or some of the following symptoms:

  • Sensitivity to light or dazzle, especially in bright sunlight or the headlights of other cars while driving.
  • Depth perception Reduction.
  • Increased reading difficulties, which require multiple changes of glasses.
  • Loss of vivid.
  • Distortion or ghost images.
  • Turbidity or darkening images.
  • Decreased visual acuity.


There are some concepts well publicized and that are incorrect and should be fixed.


Cataracts NOT:

  • A membrane to grow over the eye.
  • A tumor, cancer, or infection.
  • An irreversible cause of blindness.
  • A contagious disease that is transmitted from eye to eye and from person to person.

cataract baby

How is the diagnosis of a cataract?

The use of a slit lamp or biomicroscope allows the ophthalmologist three-dimensional and magnified examination of the lens. Through Slit lamp examination can detect the presence of cataracts, as well as any other disease that causes a blurred visual acuity or ocular discomfort.

After the diagnosis of a cataract and to analyze and prepare the surgery, you must perform some additional tests, including:

  • Corneal Topography
  • Microscopy speculate
  • Biometrics in calculating the power of intraocular lens
  • Ocular ultrasound.


When to perform cataract surgery?

Previously, there was the concept that one should not operate cataract when the patient no longer see anything. Today, if the vision is a bit blurred and disrupt daily activities, should be considered the possibility of surgery. Surgery is the only way to remove the cataract. No other treatment can remove the cataract, whether drops, exercises or glasses. It should be noted also that no treatment, drops or glasses will influence the development of cataracts. This will increase according to their own evolution varies from person to person. The cataract surgery should be performed by an ophthalmologist with surgical experience.


The technique that is used in cataract?

Currently, there are two techniques for performing cataract surgery, the conventional technique called phacoemulsification, and the laser, an innovative and cutting-edge surgery. The consultation and preoperative examinations will be decisive for choosing the most appropriate technique.

The phacoemulsification technique involves performing two incisions, greater than 3mm and another 1mm in the cornea through which the surgeon introduces the tip of the phacoemulsifier (the largest), a high-frequency ultrasound device, with which dissolves and aspirates the core (center) of cataracts. The remainder of cataract is sucked with the tip irrigation-aspiration. A smaller incision is to use the handler or aid instrument.

The laser technique is innovative and qualitative step for patients and consists in using a cutting edge equipment, Femtofaco LenSX with high security and accuracy indices.

After removal of cataract, regardless of the technique, an intraocular lens within the cataract is implanted or placed. This new intraocular lens will allow the focusing of the light beam on the retina. The intraocular lens will become a permanent part of the eye, unlike contact lenses are removed and replenished daily.

In most cases, the intraocular lens is placed (IOL) into the capsular bag, so in the case of a subsequent IOL. If the technique used is the focoemulsificação, it uses a folding lens, which comes wrapped and only opens into the eye. If, however, the IOL is placed in front of the iris and the anterior chamber IOL is called the anterior chamber.

Finally, only in some cases it is necessary to suture the incision, because the technique is phacoemulsification and IOL using a roll, no need suturing (give points).


What are the pre-operative care?

As already mentioned, it is necessary to perform tests before the operation to which the setting technique or care type of IOL to have. Some recommendations will be made to the patient by the surgeon to go to the clinic fasting or eating until a certain time. At the clinic will be you put drops before surgery. In the operating room, the eye to operate will be disinfected and sterile surgical field to protect the surgical area will be applied.

What type of anesthesia to use?

The cataract surgery does not require a general anesthetic. Today, surgery is performed with a topical anesthesia (drops) and sedation given systemically. This type of anesthesia allows the patient does not feel any pain and not remember anything.


How long is the clinic?

Today, cataract surgery do not need several days of hospitalization.

Cataract surgery is a surgical procedure that can be performed on an outpatient basis or with short hospitalization (24 hours) depending on the type of patient or technique that is used. With current techniques, the patient can resume immediately afterwards your daily activity.


What is the recovery process?

The current procedure allows there is no need to cover the operated eye and should only rest in peace and then return home. This quiet is essential to avoid complications, including bleeding, infection or other problems.

Some other precautions are as follows:

  1. Apply the drops prescribed correctly.
  2. Wait 3 to 5 minutes between each type of droplets.
  3. Do not rub or press the eye.
  4. Do not perform hazardous tasks while recovering the vision.
  5. Do not start intense activities without authorization from the ophthalmologist.


What postoperative controls?

The patient should perform some post-operative checks, usually 2 to 3 exams in the first 6 to 8 weeks. In these queries will be controlling the process of wound healing and functional recovery of the operated eye view.

Sometimes, when using IOLs later, after some months or years, the posterior capsule in which the lens is supported can “get dirty” or opacify, which cause something blurred vision. The ophthalmologist, using a YAG laser, will open the center of this capsule, a painless and effective procedure without hospitalization and with immediate recovery.


You need to wear glasses after surgery?

Patients who used bifocal / progressive lenses for near or just lenses will still need at least glasses for close, even today there are already progressive intraocular lenses / multifocal and in some cases can be implemented. In addition to the issues that have been exposed, some consider some other parameters, such as compare the potential beneficial and possible risks.


What are the risks of complications?

As with any surgery, a good result can not be guaranteed by anyone. But it is important to note that 95 to 97% of cataract surgeries result without any complications. Although rare, complications can occur during or after surgery, imposing some visual limitations.

What happens if it is not operated?

With some exceptions, the presence of cataracts will evolve without being able to modify their progression with their vision loss. However, the wait, although not jeopardize the recovery of vision, will put some technical problems motivated by hardening of cataracts. Remember that 90-95% of patients are satisfied with the outcome of surgery. But remember that cataract surgery will not improve poor vision caused by other diseases, such as diabetes or stroke.

Finally, the decision is yours, but remember that cataract is a common cause of vision loss in the aging process. The older, the greater the possibility of having a cataract that interferes with their quality of life. Therefore, it is strongly considering the possibility of a surgery that is safe, with good results and almost no complications.

New techniques, such as laser, offer you a new quality of life, safety and accuracy.

World Food Day 2016

world food day climate and agricultureThe World Food Day is celebrated on 16 October, since 1981. Currently, 150 countries mark this day, and every year is assigned a different theme that makes us think about issues related to food security, sustainability practices agricultural and nutrition. This year, the theme chosen by FAO (Food and Agriculture Organization) is: “The climate is changing.” The food and agriculture also “aims to raise awareness and raise awareness of the relationship between climate change, the food we eat and the causes of hunger.

What we eat directly influences not only our health, but also the “health” of the environment and the planet.

In order to preserve ecosystems, agriculture and food systems will be required to adapt to the increase in population and become more resilient to climate change (which tend to be harder with the farmers, herders and poor fishermen and with more difficulties. the FAO estimates that in 2050 agricultural output will have to increase by about 60% to cope with the significant population increase.

The challenge of sustainability is to produce larger quantities of food with fewer resources, using natural resources in the best possible way.


What can we do to contribute to a sustainable and healthier planet?

Opt for fresh food and time. Whenever possible, choose organic food production (it is currently possible to find these foods with a price similar to conventional). Choose food production and local producers. In addition to promoting agriculture and the local economy, these foods have a smaller ecological footprint.

Reduce meat consumption …

Especially in developed countries, meat consumption has increased and it seems that the trend will continue to increase. The high demand has driven rapid and intensive production, making the livestock sector the largest user of agricultural land. These factors contribute to the scarcity and degradation of agricultural land. From a nutritional point of view, the protein intake is above the recommended significantly. In Portugal, the protein consumption is three times higher than desired.

… and fish.

The estimated 40% reduction of major fish species consumed, 2050. A healthy diet should be balanced and varied. Reduce the portions of meat and fish and try to diversify your diet, replacing some meat and fish dishes by legumes and whole grains. Do not forget to enrich the plate with colorful vegetables of the season and local production.


Avoid food waste.

Invest in planning meals and draw up a list of appropriate shopping, avoiding buy and cook more than you need. Use your creativity and enjoy the leftovers to create new dishes and help prevent 1.3 billion tonnes of food will continue to be wasted each year. Do not reject the smaller fruits and crudest aspect. It may not be the most beautiful from an aesthetic point of view, but the taste is also delicious. You may even be surprised with a sweeter flavor, a more intense flavor and a succulent texture.


Do not waste a precious commodity like water.

Water is the drink of choice and a precious commodity that is becoming scarce. Save water by reducing the time of the baths, closing the tap when brushing your teeth or when washing the dishes and reduce the consumption of foods that need to use a lot of water for their production. The footprint is water is precisely the volume of water required to produce certain foods. To produce a kilogram of beef is necessary to spend 15,400 liters of water, and to produce one liter of bottled soda may need about 300 liters of water. Apart from being environmentally friendly due to its extremely high sugar content soft drinks are a vehicle of empty calories and no nutritional value. Prefer water, herbal teas or homemade infusions.


Use less plastic.

Fewer plastic bags, less packaged goods, less plastic boxes. Besides giving a great help to the environment, will be reducing the choice of packaged food, or processed foods which normally have a high energy value and a high content of added sugar, fat, sodium and preservatives. Replace fruit juice and fruit packaging for fresh fruit and when shopping, make sure the shopping cart has cooler than plastic packaging food.



It is a gesture so easy that you can incorporate into your routine. Pour the oil from fried foods and canned goods, for example tuna, in its own container and separate the packaging. Take glass bottles in a position, for example of jam or some yogurts, and reuse them to store dried fruit or cereals bought in bulk. Make healthy food choices, safe, sustainable and conscious. Your body thanks, and the planet too!

Nutrition and Food of the Future

Health and wellness are growing concerns of society. Many go to great lengths to ensure that the body is working well all the time. The fitness centers and public parks receive increasing number of people concerned about maintaining the shape and physical well-being. However, and unfortunately, most of the population remains unhealthy lifestyle. It neglects the fact that the human body is constantly challenged by a multitude of risks – viruses and bacteria to chronic diseases such as obesity, diabetes, arteriosclerosis and myocardial infarction.

Fact complicating factor is that society still more accustomed to healing habit that the logic of prevention. Although essential, medical advances result in a paradigm that no longer holds. The costs rise greatly and few can have adequate health insurance. Public health protection systems face financial crises and often people need to shell out the savings of a lifetime to get the treatments they need.

Despite this concern, it is unclear whether the practice of prevention find unimpeded path to the center of health policy. In most countries the health budget is devoted to consultations, hospitalization and medicine to cure people already sick. But when we think of the potential for reducing costs and suffering, common sense, statistics and several studies indicate that prevention and health promotion are more interesting and sustainable way.

future of foodAmong the important issues related to the well-being of people and the prevention of diseases, the adequate supply of safe and healthy food is very important. Still, malnutrition in all its forms – malnutrition, micronutrient deficiencies, overweight and obesity has increased worldwide. FAO estimates that 26% of children are stunted, 2 billion people suffer from one or more micronutrient deficiencies and 1.4 billion people are overweight, of which 500 million are obese. The estimated cost of the impact of malnutrition reaches 5% of global GDP, equivalent to $ 3.5 trillion a year, or $ 500 / person / year.


Advances in agricultural technology and food science and technology are among the principal means of overcoming this worrying picture. The close relationship that foods have on health and well-being has been treated in depth by science and is already well established for decades. Innovations in diversity, quality and functionality of foods may provide better quality of life for the population, reduce costs with diseases associated with poor diet and also meet the growing consumer demand for healthy food, practical and sensory attractive.

Brazil maintains a large set of actions for the advancement of knowledge on the relationship between food, nutrition and health. The goal is to meet the demands of consumers, producers and industries for more diversified food, biofortified with nutritional qualities and functional differentiated and scientifically proven. Embrapa already available biofortified varieties, with vitamins and minerals, sweet potato, cassava, common beans, maize and cowpea, benefiting about 2500 families in the Northeast, Southeast and South of Brazil. They are in the process of breeding varieties of wheat, pumpkin and rice.

In addition to vitamins and minerals seeks to add various foods and increase in the production of bioactive compounds, proteins and peptides, dietary fibers, fatty acids and components for preventing specific diseases. promising results were recently obtained with the production of lettuce high amounts of vitamin B9, important in the nutrition of pregnant women, to prevent anencephaly, due to a malformation of the neural tube. Other designs seek to improve the pumpkin against diabetes, garlic to reduce cholesterol and watermelon, having substances with the potential to fight hypertension.

Hippocrates, the father of medicine, noted, 2,500 years ago, the diseases arise from the nature and can be avoided when it strikes a balance between the environment, the ingested food and spirit. Therefore, it is always time to reflect on their main teaching – “food is our best medicine.”