Prevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario Nacional
Prevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario Nacional Introducción: La osteoporosis posmenopáusica de muy alto riesgo (OPMAR) incluye las pacientes que tienen una mayor probabilidad de tener fracturas a corto plazo. Se define como la presencia de 1 o más...
- Autores:
-
Mejía Sandoval, Harvey Julián
- Tipo de recurso:
- Fecha de publicación:
- 2023
- Institución:
- Universidad Nacional de Colombia
- Repositorio:
- Universidad Nacional de Colombia
- Idioma:
- spa
- OAI Identifier:
- oai:repositorio.unal.edu.co:unal/83147
- Palabra clave:
- 610 - Medicina y salud
Osteoporosis
Enfermedad de los huesos
Bones - diseases
osteoporosis posmenopáusica
Factores de riesgo
Muy alto riesgo
Fracturas vertebrales
Agentes anabólicos
Postmenopausal osteoporosis
Risk factors
Very high risk
Vertebral fractures
Anabolic agents
- Rights
- openAccess
- License
- Atribución-NoComercial-SinDerivadas 4.0 Internacional
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Prevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario Nacional |
| dc.title.translated.eng.fl_str_mv |
Prevalence of very high risk postmenopausal osteoporosis in the National University Hospital |
| title |
Prevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario Nacional |
| spellingShingle |
Prevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario Nacional 610 - Medicina y salud Osteoporosis Enfermedad de los huesos Bones - diseases osteoporosis posmenopáusica Factores de riesgo Muy alto riesgo Fracturas vertebrales Agentes anabólicos Postmenopausal osteoporosis Risk factors Very high risk Vertebral fractures Anabolic agents |
| title_short |
Prevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario Nacional |
| title_full |
Prevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario Nacional |
| title_fullStr |
Prevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario Nacional |
| title_full_unstemmed |
Prevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario Nacional |
| title_sort |
Prevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario Nacional |
| dc.creator.fl_str_mv |
Mejía Sandoval, Harvey Julián |
| dc.contributor.advisor.none.fl_str_mv |
Arteaga Díaz, Juan Manuel Martínez Peñaloza, Daniela |
| dc.contributor.author.none.fl_str_mv |
Mejía Sandoval, Harvey Julián |
| dc.contributor.orcid.spa.fl_str_mv |
Mejia, Harvey [0000000176595379] |
| dc.subject.ddc.spa.fl_str_mv |
610 - Medicina y salud |
| topic |
610 - Medicina y salud Osteoporosis Enfermedad de los huesos Bones - diseases osteoporosis posmenopáusica Factores de riesgo Muy alto riesgo Fracturas vertebrales Agentes anabólicos Postmenopausal osteoporosis Risk factors Very high risk Vertebral fractures Anabolic agents |
| dc.subject.lemb.spa.fl_str_mv |
Osteoporosis Enfermedad de los huesos |
| dc.subject.lemb.eng.fl_str_mv |
Bones - diseases |
| dc.subject.proposal.spa.fl_str_mv |
osteoporosis posmenopáusica Factores de riesgo Muy alto riesgo Fracturas vertebrales Agentes anabólicos |
| dc.subject.proposal.eng.fl_str_mv |
Postmenopausal osteoporosis Risk factors Very high risk Vertebral fractures Anabolic agents |
| description |
Prevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario Nacional Introducción: La osteoporosis posmenopáusica de muy alto riesgo (OPMAR) incluye las pacientes que tienen una mayor probabilidad de tener fracturas a corto plazo. Se define como la presencia de 1 o más de: fracturas en los últimos 12 meses, durante el tratamiento, asociada a fármaco lesivo, más de una, T-score < -3, alto riesgo de caídas, FRAX de muy alta probabilidad. Hasta el momento ningún estudio ha determinado su frecuencia y caracterización. Objetivos: determinar la frecuencia de OPMAR en el HUN, caracterizar este grupo de pacientes, identificar la distribución de los factores de riesgo, complicaciones y tratamiento recibido. Metodología: estudio observacional, descriptivo de corte transversal. Se realizó búsqueda en sistema HOSVITAL de códigos CIE10 relacionados con osteoporosis (OP) durante 2020 - 2021. Se seleccionaron las pacientes con OP posmenopáusica atendidas en consulta externa de endocrinología. Se determinó frecuencia y caracterización del grupo de muy alto riesgo. Resultados: de 502 pacientes, 221 clasificaron como OPMAR (44%), con media de edad 72. Las comorbilidades más frecuentes fueron hipertensión arterial (32,2%), diabetes tipo 2 (11,8%), insuficiencia cardiaca (10,4%) e hiperparatiroidismo secundario (7,7%). Hubo antecedente de tabaquismo en 8,6%, consumo de inhibidores de bomba de protones en 19,5%, glucocorticoides en 12,2%. El 21,3% presentaron deficiencia de vitamina D, 10,8% reportaron caídas en el último año. 43,4% tuvieron fracturas, 20,3% en columna dorsal. 30,8% recibieron manejo con teriparatida, 14,5% como terapia inicial. Conclusiones: La OPMAR es una condición de elevada frecuencia. La edad avanzada y múltiples factores contribuyen a su aparición. El principal sitio afectado fue columna dorsal. Existe un bajo uso de terapia anabólica, la cual debe preferirse en estos casos. (Texto tomado de l a fuente) |
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2023 |
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2023-01-26T19:55:01Z |
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2023-01-26T19:55:01Z |
| dc.date.issued.none.fl_str_mv |
2023-01-25 |
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Trabajo de grado - Especialidad Médica |
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info:eu-repo/semantics/masterThesis |
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Universidad Nacional de Colombia |
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Repositorio Institucional Universidad Nacional de Colombia |
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Universidad Nacional de Colombia Repositorio Institucional Universidad Nacional de Colombia |
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1. Kanis JA, Harvey NC, McCloskey E, Bruyère O, Veronese N, Lorentzon M, et al. Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures. Osteoporos Int [Internet]. 2020 Jan 13;31(1):1–12. Available from: http://link.springer.com/10.1007/s00198-019-05176-3 2. Camacho PM, Petak SM, Binkley N, Diab DL, Eldeiry LS, Farooki A, et al. American association of clinical endocrinologists/American college of endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update. Endocr Pract. 2020;26(s1):1–46. 3. Shoback D, Rosen CJ, Black DM, Cheung AM, Murad MH, Eastell R. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Guideline Update. J Clin Endocrinol Metab. 2020;105(3):1–8. 4. Kendler DL, Marin F, Zerbini CAF, Russo LA, Greenspan SL, Zikan V, et al. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2018;391(10117):230–40. 5. Saag KG, Petersen J, Brandi ML, Karaplis AC, Lorentzon M, Thomas T, et al. Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis. N Engl J Med. 2017;377(15):1417–27. 6. Carmona F. Osteoporosis en Santa Fe de Bogotá. St Fe Bogotá Inst Nac Salud. 1999 7. Páez A. Densitometria ósea: utilidad diagnóstica. Rev del Hosp Cent la Policía Nac. 1999;2:27–32. 8. Cooper C, Ferrari S. IOF Compendium of Osteoporosis. Int Osteoporos Found [Internet]. 2019;2nd Editio:1–76. Available from: https://www.iofbonehealth.org/compendium-of-osteoporosis 9. Garcia, Javier. Guerrero, Edgar Arturo. Terront, Alexandra. Molina, Jose Fernando. Pérez C, Jannaut, María José. Pineda, Gustavo. Pérez, Javier. Páez, Bernardo. Chalem M. Costos de las Fracturas en mujeres con Osteoporosis en Colombia. Acta Médica Colomb [Internet]. 2014;1–11. Available from: http://www.actamedicacolombiana.com/ojs/index.php/actamed/article/view/89 10. Medina A, Rosero Ó, Nel P, Plata R, Sánchez F, Chalem M, et al. II Consenso Colombiano para el Manejo de la Osteoporosis Posmenopáusica. Rev Colomb Reumatol. 2018;5(3):184–210. 11. Odén A, McCloskey E V., Johansson H, Kanis JA. Assessing the impact of osteoporosis on the burden of hip fractures. Calcif Tissue Int. 2013;92(1):42–9. 12. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–33. 13. Salari N, Ghasemi H, Mohammadi L, Behzadi M hasan, Rabieenia E, Shohaimi S, et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. J Orthop Surg Res [Internet]. 2021;16(1). Available from: https://doi.org/10.1186/s13018-021-02772-0 14. Ballane G, Cauley JA, Luckey MM, El-Hajj Fuleihan G. Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int. 2017;28(5):1531–42. 15. Clark P, Cons-Molina F, Deleze M, Ragi S, Haddock L, Zanchetta JR, et al. The prevalence of radiographic vertebral fractures in Latin American countries: The Latin American Vertebral Osteoporosis Study (LAVOS). Osteoporos Int. 2009;20(2):275–82. 16. Fernández-Ávila DG, Bernal-Macías S, Parra MJ, Rincón DN, Gutiérrez JM, Rosselli D. Prevalence of osteoporosis in Colombia: Data from the National Health Registry from 2012 to 2018. Reumatol Clin [Internet]. 2020;(xx):8–12. Available from: https://doi.org/10.1016/j.reuma.2020.07.008 17. Jaller-Raad JJ, Jaller-Char JJ, Lechuga-Ortiz JA, Navarro-Lechuga E, Johansson H, Kanis JA. Incidence of hip fracture in barranquilla, colombia, and the development of a colombian FRAX model. Calcif Tissue Int. 2013;93(1):15–22. 18. Aziziyeh R, Amin M, Habib M, Garcia Perlaza J, Szafranski K, McTavish RK, et al. The burden of osteoporosis in four Latin American countries: Brazil, Mexico, Colombia, and Argentina. J Med Econ [Internet]. 2019;22(7):638–44. Available from: https://doi.org/10.1080/13696998.2019.1590843 19. Van Geel TACM, Van Helden S, Geusens PP, Winkens B, Dinant GJ. Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis. 2009;68(1):99–102. 20. Johansson H, Siggeirsdóttir K, Harvey NC, Odén A, Gudnason V, McCloskey E, et al. Imminent risk of fracture after fracture. Osteoporos Int [Internet]. 2017;28(3):775–80. Available from: http://dx.doi.org/10.1007/s00198-016-3868-0 21. Roux C, Briot K. Imminent fracture risk. Osteoporos Int. 2017;28(6):1765–9. 22. Gehlbach S, Saag KG, Adachi JD, Hooven FH, Boonen S, Chapurlat RD, et al. Previous Fractures at Multiple Sites Increase the Risk for Osteoporosis in Women: The Global Longitudinal Study of Osteoporosis in Women. J Bone Miner Res. 2016;27(3):645–53. 23. Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological management of osteoporosis in postmenopausal women: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2019;104(5):1595–622. 24. Whittier X, Saag KG. Glucocorticoid-induced Osteoporosis. Rheum Dis Clin North Am [Internet]. 2016;42(1):177–89. Available from: http://dx.doi.org/10.1016/j.rdc.2015.08.005 25. Saag KG, Shane E, Boonen S, Marín F, Donley DW, Taylor KA, et al. Teriparatide or alendronate in glucocorticoid-induced osteoporosis. Obstet Gynecol Surv. 2008;63(4):232–3. 26. Ferrari S, Libanati C, Lin CJF, Brown JP, Cosman F, Czerwiński E, et al. Relationship Between Bone Mineral Density T-Score and Nonvertebral Fracture Risk Over 10 Years of Denosumab Treatment. J Bone Miner Res. 2019;34(6):1033–40. 27. Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, et al. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int. 2016;27(1):367–76. 28. Curtis EM, Reginster J-Y, Al-Daghri N, Biver E, Brandi ML, Cavalier E, et al. Management of patients at very high risk of osteoporotic fractures through sequential treatments. Aging Clin Exp Res [Internet]. 2022 Apr 24;34(4):695–714. Available from: https://doi.org/10.1007/s40520-022-02100-4 29. Ebeling PR, Nguyen HH, Aleksova J, Vincent AJ, Wong P, Milat F. Secondary Osteoporosis. Endocr Rev [Internet]. 2022 Mar 9;43(2):240–313. Available from: https://academic.oup.com/edrv/article/43/2/240/6363556 30. Hálfdánarson ÓÖ, Pottegård A, Björnsson ES, Lund SH, Ogmundsdottir MH, Steingrímsson E, et al. Proton-pump inhibitors among adults: a nationwide drug-utilization study. Therap Adv Gastroenterol [Internet]. 2018 Jan 1;11(6):175628481877794. Available from: http://journals.sagepub.com/doi/10.1177/1756284818777943 31. da Maia TF, de Camargo BG, Pereira ME, de Oliveira CS, Guiloski IC. Increased Risk of Fractures and Use of Proton Pump Inhibitors in Menopausal Women: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health [Internet]. 2022 Oct 19;19(20):13501. Available from: https://www.mdpi.com/1660-4601/19/20/13501 32. O’Connell MB, Madden DM, Murray AM, Heaney RP, Kerzner LJ. Effects of proton pump inhibitors on calcium carbonate absorption in women: A randomized crossover trial. Am J Med [Internet]. 2005 Jul;118(7):778–81. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002934305000938 33. Release notice – Osteoporosis and related fractures in Canada: Report from the Canadian Chronic Disease Surveillance System 2020. Heal Promot Chronic Dis Prev Canada [Internet]. 2021 Feb;41(2):68–68. Available from: https://www.canada.ca/en/public-health/services/reports-publications/health- promotion-chronic-disease-prevention-canada-research-policy-practice/vol-41-no-2-2021/release-notice-osteoporosis-fractures-canadian-chronic-disease-surveillance-system.html 34. Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A. The Burden of Osteoporotic Fractures: A Method for Setting Intervention Thresholds. Osteoporos Int [Internet]. 2001 May 1;12(5):417–27. Available from: http://link.springer.com/10.1007/s001980170112 35. Hoyt D, Urits I, Orhurhu V, Orhurhu MS, Callan J, Powell J, et al. Current Concepts in the Management of Vertebral Compression Fractures. Curr Pain Headache Rep [Internet]. 2020 May 20;24(5):16. Available from: http://link.springer.com/10.1007/s11916-020-00849-9 36. Habibi Ghahfarrokhi S, Mohammadian-Hafshejani A, Sherwin CMT, Heidari-Soureshjani S. Relationship between serum vitamin D and hip fracture in the elderly: a systematic review and meta-analysis. J Bone Miner Metab [Internet]. 2022 Jul 31;40(4):541–53. Available from: https://doi.org/10.1007/s00774-022-01333-7 37. Chakhtoura M, Bacha DS, Gharios C, Ajjour S, Assaad M, Jabbour Y, et al. Vitamin D Supplementation and Fractures in Adults: A Systematic Umbrella Review of Meta-Analyses of Controlled Trials. J Clin Endocrinol Metab [Internet]. 2022 Feb 17;107(3):882–98. Available from: https://academic.oup.com/jcem/article/107/3/882/6409080 38. Force T, Bloom JM, Cromer SJ, Tsai JN. Vitamin D and Incident Fractures. N Engl J Med [Internet]. 2022 Oct 27;387(17):1625–8. Available from: http://www.nejm.org/doi/10.1056/NEJMc2211434 39. Manoj P, Derwin R, George S. What is the impact of daily oral supplementation of vitamin D3 (cholecalciferol) plus calcium on the incidence of hip fracture in older people? A systematic review and meta‐analysis. Int J Older People Nurs [Internet]. 2022 Jul 17;(December 2020):1–20. Available from: https://onlinelibrary.wiley.com/doi/10.1111/opn.12492 40. Barrera P, Lancheros L, Vargas M. Consumo de calcio: Evolución y situación actual The evolution and current situation of calcium consumption. Rev la Fac Med. 2012;60(Supl):s50–61. 41. Söreskog E, Lindberg I, Kanis JA, Åkesson KE, Willems D, Lorentzon M, et al. Cost-effectiveness of romosozumab for the treatment of postmenopausal women with severe osteoporosis at high risk of fracture in Sweden. Osteoporos Int [Internet]. 2021 Mar 6;32(3):585–94. Available from: https://link.springer.com/10.1007/s11657-022-01106-9 |
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Universidad Nacional de Colombia |
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Bogotá - Medicina - Especialidad en Endocrinología |
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Facultad de Medicina |
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Bogotá, Colombia |
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Universidad Nacional de Colombia - Sede Bogotá |
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Atribución-NoComercial-SinDerivadas 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Arteaga Díaz, Juan Manuel94dc81b65ec1751214d1bcb414397204Martínez Peñaloza, Danielac3ac78a758bff0df6103ae5cdafca809Mejía Sandoval, Harvey Julián37e5019af8807c5fa63439c7af094928Mejia, Harvey [0000000176595379]2023-01-26T19:55:01Z2023-01-26T19:55:01Z2023-01-25https://repositorio.unal.edu.co/handle/unal/83147Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/Prevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario Nacional Introducción: La osteoporosis posmenopáusica de muy alto riesgo (OPMAR) incluye las pacientes que tienen una mayor probabilidad de tener fracturas a corto plazo. Se define como la presencia de 1 o más de: fracturas en los últimos 12 meses, durante el tratamiento, asociada a fármaco lesivo, más de una, T-score < -3, alto riesgo de caídas, FRAX de muy alta probabilidad. Hasta el momento ningún estudio ha determinado su frecuencia y caracterización. Objetivos: determinar la frecuencia de OPMAR en el HUN, caracterizar este grupo de pacientes, identificar la distribución de los factores de riesgo, complicaciones y tratamiento recibido. Metodología: estudio observacional, descriptivo de corte transversal. Se realizó búsqueda en sistema HOSVITAL de códigos CIE10 relacionados con osteoporosis (OP) durante 2020 - 2021. Se seleccionaron las pacientes con OP posmenopáusica atendidas en consulta externa de endocrinología. Se determinó frecuencia y caracterización del grupo de muy alto riesgo. Resultados: de 502 pacientes, 221 clasificaron como OPMAR (44%), con media de edad 72. Las comorbilidades más frecuentes fueron hipertensión arterial (32,2%), diabetes tipo 2 (11,8%), insuficiencia cardiaca (10,4%) e hiperparatiroidismo secundario (7,7%). Hubo antecedente de tabaquismo en 8,6%, consumo de inhibidores de bomba de protones en 19,5%, glucocorticoides en 12,2%. El 21,3% presentaron deficiencia de vitamina D, 10,8% reportaron caídas en el último año. 43,4% tuvieron fracturas, 20,3% en columna dorsal. 30,8% recibieron manejo con teriparatida, 14,5% como terapia inicial. Conclusiones: La OPMAR es una condición de elevada frecuencia. La edad avanzada y múltiples factores contribuyen a su aparición. El principal sitio afectado fue columna dorsal. Existe un bajo uso de terapia anabólica, la cual debe preferirse en estos casos. (Texto tomado de l a fuente)Prevalence of very high risk postmenopausal osteoporosis in the national university hospital Introduction: Very high-risk postmenopausal osteoporosis (OPMAR) includes patients who have a higher probability of having fractures in the short term. It is defined as the presence of 1 or more of: fractures in the last 12 months, during treatment, associated with an injurious drug, more than one, T-score < -3, high risk of falls, FRAX with a very high probability. To date, no study has determined its frequency and characterization. Objectives: to determine the frequency of OPMAR in the HUN, to characterize this group of patients, to identify the distribution of risk factors, complications and treatment received. Methodology: observational, descriptive cross-sectional study. A search was made in the HOSVITAL system for ICD10 codes related to osteoporosis (OP) during 2020 - 2021. Patients with postmenopausal OP seen in an endocrinology outpatient clinic were selected. Frequency and characterization of the very high risk group was determined. Results: Of 502 patients, 221 were classified as OPMAR (44%), with a mean age of 72. The most frequent comorbidities were arterial hypertension (32.2%), type 2 diabetes (11.8%), heart failure (10, 4%) and secondary hyperparathyroidism (7.7%). There was a history of smoking in 8.6%, consumption of proton pump inhibitors in 19.5%, glucocorticoids in 12.2%. 21.3% presented vitamin D deficiency, 10.8% reported falls in the last year. 43.4% had fractures, 20.3% in the thoracic column. 30.8% received management with teriparatide, 14.5% as initial therapy. Conclusions: OPMAR is a condition of high frequency. Advanced age and multiple factors contribute to its appearance. The main affected site was the dorsal column. There is a low use of anabolic therapy, which should be preferred in these casesEspecialidades MédicasEspecialista en EndocrinologíaDiseño del estudio Estudio observacional descriptivo de corte transversal. Marco muestral Población a estudio: Pacientes con diagnóstico de osteoporosis atendidas en el HUN, en el servicio de consulta externa de endocrinología, registradas en el sistema HOSVITAL. Población blanco: Pacientes con diagnóstico de osteoporosis atendidas en el HUN, durante los años 2020 a 2021, en el servicio de consulta externa de endocrinología y registradas en el sistema HOSVITAL. Se obtendrá este dato a partir de la revisión de todos los diagnósticos CIE10 registrados, relacionados con osteoporosis (M800, M801, M802, M803, M804, M805, M808, M809, M810, M811, M812, M813, M814, M815, M816, M818, M819, M820, M821, M828) en el sistema HOSVITAL, durante los años 2020 a 2021. De este grupo se seleccionarán, a través de la revisión de historias clínicas las pacientes con OPMAR, se determinará la frecuencia y se realizará su caracterización. Tipo de muestreo: Se realizará un muestreo por conveniencia donde se seleccionarán solo los pacientes con diagnóstico de osteoporosis registrados en el sistema HOSVITAL, durante los años 2020 a 2021, atendidos en el HUN.Endocrinología75 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Especialidad en EndocrinologíaFacultad de MedicinaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y saludOsteoporosisEnfermedad de los huesosBones - diseasesosteoporosis posmenopáusicaFactores de riesgoMuy alto riesgoFracturas vertebralesAgentes anabólicosPostmenopausal osteoporosisRisk factorsVery high riskVertebral fracturesAnabolic agentsPrevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario NacionalPrevalence of very high risk postmenopausal osteoporosis in the National University HospitalTrabajo de grado - Especialidad Médicainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TM1. 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Available from: https://link.springer.com/10.1007/s11657-022-01106-9Prevalencia de osteoporosis posmenopáusica de muy alto riesgo en el Hospital Universitario NacionalEstudiantesInvestigadoresMaestrosPúblico generalLICENSElicense.txtlicense.txttext/plain; charset=utf-85879https://repositorio.unal.edu.co/bitstream/unal/83147/1/license.txteb34b1cf90b7e1103fc9dfd26be24b4aMD51ORIGINAL1098704113.2023.pdf1098704113.2023.pdfTrabajo de grado - Especialidad Médica en Endocrinologíaapplication/pdf689348https://repositorio.unal.edu.co/bitstream/unal/83147/2/1098704113.2023.pdf08a2806680d9cc1987598516257035a3MD52THUMBNAIL1098704113.2023.pdf.jpg1098704113.2023.pdf.jpgGenerated Thumbnailimage/jpeg4706https://repositorio.unal.edu.co/bitstream/unal/83147/3/1098704113.2023.pdf.jpge2cd14e4fbbaa7463989d85162aef609MD53unal/83147oai:repositorio.unal.edu.co:unal/831472023-08-14 23:04:14.378Repositorio Institucional Universidad Nacional de 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