Öz
Osteoporoz (OP), kemik kütlesinde azalma ve kemik kırılganlığında artış ile karakterize metabolik bir kemik hastalığıdır. OP’nin en önemli morbidite ve mortalite nedeni osteoporotik kırık oluşumudur. Postmenopozal osteoporozda (PMO) kırık risk faktörlerini tanımlamak amacıyla yapılan birçok çalışma bulunmasına rağmen, bu çalışmalarda kırık oluşumunda gerçekte hangi risk faktörünün ne kadar etkili olduğu konusundaki bilgiler halen çelişkilidir. Bu çalışmada amaç, PMO’lu hastalarda kırık riskinin öngörülüp öngörülemeyeceğini belirlemektir. Fiziksel Tıp ve Rehabilitasyon Polikliniği’ne başvuran PMO tanılı 124 hasta çalışmaya dahil edildi. Bu hastaların kırık varlığı ve kırığa neden olabilecek risk faktörleri geriye yönelik olarak tarandı. Hastalar kırık varlığına göre, kırığı olan ve olmayan PMO’lu hastalar olarak iki gruba ayrılarak karşılaştırıldı. PMO’lu hastaların 50’sinde (%40,3) osteoporotik kırık saptanırken, 74 hastada (%59,7) kırık saptanmadı. İki grup arasında yapılan karşılaştırma sonucunda ileri yaş ile kırık oluşumu arasında istatistiksel olarak anlamlı ilişki saptandı. Vücut kitle indeksi (VKİ), menopoz yaşı, 25(OH) D vitamini düzeyleri, dual-enerji X-ışını absorbsiyometri (DEXA) ile değerlendirilen kemik mineral yoğunluğu (KMY) ölçümü T skorları ile kırık oluşumu arasında anlamlı ilişki saptanmadı. Sonuçlar kırık oluşumunun tam olarak öngörülmesinin zor olduğunu düşündürmekle birlikte, daha fazla sayıda veri ile yapılacak daha geniş hasta popülasyonunun tarandığı çalışmalara ihtiyaç olduğunu düşündürmektedir.
Anahtar Kelimeler
Postmenopozal osteoporoz Kemik mineral yoğunluğu Patolojik kırık
Destekleyen Kurum
yok
Proje Numarası
yok
Teşekkür
Dr. Aytül Coşar Ertem ve Dr. Melike Şeyda Dağdelen'e istatistiksel analizler konusundaki desteklerinden dolayı teşekkür ederiz.
Kaynakça
- 1.TFTR Derneği Osteoporoz Çalışma grubu. Postmenopozal Osteoporoz Tanı ve Tedavisinde Kanıta dayalı öneriler. TFTR Derneği Osteoporoz Çalışma grubu uzlaşı raporu 2017;1:13.
- 2.Odabaşı E, Turan M, Bilgiç S, Kutlu M. Osteoporotik Kırıkların Doğum Sayısı ve Fertil Dönem Süresi ile İlişkisi. TAF Prev Med Bull 2009;8(1):1-4.
- 3.Altunbayrak O. Pasif Sigara İçimi Postmenopozal Osteoporoz İçin Bir Risk Faktörü müdür ? (Uzmanlık Tezi). İstanbul: İstanbul Eğitim ve Araştırma Hastanesi; 2008.
- 4.Bozbey I, Yalçın AP. Postmenopozal Osteoporoz Tedavisinde Stronsiyum Ranelat. Turk J Rheumatol 2009;24:149-55.
- 5.Kanis JA, Borgstrom F, Laet CD, et al. Assessment of fracture risk. Osteoporos Int. 2005;16:581-9.
- 6.Ross PD, Davis JW, Epstein RS, Wasnich RD. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991;114(11):919-23.
- 7.Coughlan T, Dockery F. Osteoporosis and fracture risk in older people. Clin Med (Lond). 2014 Apr;14(2):187-91.
- 8.Hippisley-Cox J, Coupland C. Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores. BMJ. 2009 Nov 19;339:b4229.
- 9.Ogura-Tomamatsu H, Asano K, Tomamatsu K, et al. Predictors of osteoporosis and vertebral fractures in patients presenting with moderate-to-severe chronic obstructive lung disease. COPD. 2012 Aug;9(4):332-7.
- 10.Lai EL, Huang WN, Chen HH, et al. Ten-year fracture risk by FRAX and osteoporotic fractures in patients with systemic autoimmune diseases. Lupus. 2019 Jul;28(8):945-53.
- 11.Crandall CJ, Larson J, LaCroix A, et al. Predicting Fracture Risk in Younger Postmenopausal Women: Comparison of the Garvan and FRAX Risk Calculators in the Women's Health Initiative Study. J Gen Intern Med. 2019 Feb;34(2):235-42.
- 12.Lindsay R, Pack S, Li Z. Longitudinal progression of fracture prevalence through a population of postmenopausal women with osteoporosis. Osteoporos Int. 2005 Mar;16(3):306-12.
- 13.Ma X, Xia H, Wang J, et al. Re-fracture and correlated risk factors in patients with osteoporotic vertebral fractures. J Bone Miner Metab. 2019 Jul;37(4):722-8.
- 14.Yusuf AA, Hu Y, Chandler D, Crittenden DB, Barron RL. Predictors of imminent risk of fracture in Medicare-enrolled men and women. Arch Osteoporos. 2020 Aug 3;15(1):120.
- 15.Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019 Jan;30(1):3-44.
- 16.Çolak Y, Afzal S, Nordestgaard BG. 25-Hydroxyvitamin D and Risk of Osteoporotic Fractures: Mendelian Randomization Analysis in 2 Large Population-Based Cohorts. Clin Chem. 2020 May 1;66(5):676-85.
- 17.Looker AC. Serum 25-hydroxyvitamin D and risk of major osteoporotic fractures in older U.S. adults. J Bone Miner Res. 2013 May;28(5):997-1006.
- 18.Cauley JA, Parimi N, Ensrud KE, et al. Serum 25-hydroxyvitamin D and the risk of hip and nonspine fractures in older men. J Bone Miner Res. 2010 Mar;25(3):545-53.
- 19.Aul AJ, Dudenkov DV, Mara KC, et al. The relationship of 25-hydroxyvitamin D values and risk of fracture: a population-based retrospective cohort study. Osteoporos Int. 2020 Sep;31(9):1787-99.
- 20.Çalış HT, Sütbeyaz ST, Sunkak S, et al. Osteoporotic Fractures and Posture Problem in Association with Vitamin D Level in Patients with Parkinson’s Disease. Turk J Osteoporos 2017;23:16-20.
- 21.Trajanoska K, Morris JA, Oei L, et al. Assessment of the genetic and clinical determinants of fracture risk: genome wide association and mendelian randomisation study. BMJ. 2018 Aug 29;362:k3225.
- 22.Chalhoub D, Orwoll ES, Cawthon PM, et al. Areal and volumetric bone mineral density and risk of multiple types of fracture in older men. Bone. 2016 Nov;92:100-6.
- 23.Holmberg TF, Rubin KH, Brixen K, Tolstrup JS, Bech M. Fracture risk prediction using phalangeal bone mineral density or FRAX(®)? A Danish cohort study on men and women. J Clin Densitom. Jan-Mar 2014;17(1):7-15.
- 24.Hillier TA, Cauley JA, Rizzo JH, et al. WHO absolute fracture risk models (FRAX): do clinical risk factors improve fracture prediction in older women without osteoporosis?. J Bone Miner Res. 2011 Aug;26(8):1774-82.
- 25.Schuit SCE, Klift MVD, Weel AEAM, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004 Jan;34(1):195-202.
- 26.Miller PD, Barlas S, Brenneman SK, et al. An approach to identifying osteopenic women at increased short-term risk of fracture. Arch Intern Med. 2004 May 24;164(10):1113-20.
- 27.Ravn P, Cizza G, Bjarnason NH, et al. Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. J Bone Miner Res. 1999;14(9):1622-7.
- 28.Kaze AD, Rosen HN, Paik JM. A meta-analysis of the association between body mass index and risk of vertebral fracture. Osteoporos Int. 2018 Jan;29(1):31-9.
- 29.Johansson H, Kanis JA, Oden A, et al. A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res. 2014 Jan;29(1):223-33.
- 30.Poiana C, Carsote M, Radoi V, Mihai A, Capatina C. Prevalent osteoporotic fractures in 622 obese and non- obese menopausal women. J Med Life. 2015;8(4):462-6.
- 31.Onat ŞŞ, Delialioğlu SÜ, Özel S. The Relationship Between Osteoporotic Risk Factors and Bone Mineral Density. Turkish Journal of Osteoporosis 2013;19:74-80.
- 32.Anagnostis P, Siolos P, Gkekas NK, et al. Association between age at menopause and fracture risk: a systematic review and meta-analysis. Endocrine. 2019 Feb;63(2):213-24.
- 33.Lips P, Van Schoor NM. Quality of life in patients with osteoporosis. Osteoporos Int. 2005;16:447-55.
Öz
Osteoporosis (OP) is a metabolic bone disease characterized by a decrease in bone mass and an increase in bone fragility. The most important cause of morbidity and mortality of OP is osteoporotic fracture formation. Although there are many studies carried out to define fracture risk factors in postmenopausal osteoporosis (PMO), there is still controversy in these studies about which risk factor is actually effective in fracture formation. The aim of this study is to determine whether fracture risk can be predicted in patients with PMO. 124 patients diagnosed with PMO who admitted to the Physical Medicine and Rehabilitation outpatient department were included in the study. The presence of fractures and risk factors that may cause fractures in these patients were screened retrospectively. The patients were divided into two groups according to the presence of fractures, as patients with PMO with and without fractures and compared. While osteoporotic fractures were found in 50 of the patients with PMO (40,3%), no fractures were found in 74 patients (59,7%). As a result of the comparison between the two groups, a statistically significant relationship was found between advanced age and fracture formation. There was no significant relationship between body mass index (BMI), age at menopause, vitamin 25 (OH) D levels, bone mineral density (BMD) measurement T scores evaluated by dual-energy X-ray absorptiometry (DEXA) and fracture formation. Although the results suggest that it is difficult to accurately predict fracture formation, they suggest that studies that will screen a larger patient population with more data are needed.
Anahtar Kelimeler
Postmenopausal osteoporosis Bone mineral density Pathological fracture
Proje Numarası
yok
Kaynakça
- 1.TFTR Derneği Osteoporoz Çalışma grubu. Postmenopozal Osteoporoz Tanı ve Tedavisinde Kanıta dayalı öneriler. TFTR Derneği Osteoporoz Çalışma grubu uzlaşı raporu 2017;1:13.
- 2.Odabaşı E, Turan M, Bilgiç S, Kutlu M. Osteoporotik Kırıkların Doğum Sayısı ve Fertil Dönem Süresi ile İlişkisi. TAF Prev Med Bull 2009;8(1):1-4.
- 3.Altunbayrak O. Pasif Sigara İçimi Postmenopozal Osteoporoz İçin Bir Risk Faktörü müdür ? (Uzmanlık Tezi). İstanbul: İstanbul Eğitim ve Araştırma Hastanesi; 2008.
- 4.Bozbey I, Yalçın AP. Postmenopozal Osteoporoz Tedavisinde Stronsiyum Ranelat. Turk J Rheumatol 2009;24:149-55.
- 5.Kanis JA, Borgstrom F, Laet CD, et al. Assessment of fracture risk. Osteoporos Int. 2005;16:581-9.
- 6.Ross PD, Davis JW, Epstein RS, Wasnich RD. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991;114(11):919-23.
- 7.Coughlan T, Dockery F. Osteoporosis and fracture risk in older people. Clin Med (Lond). 2014 Apr;14(2):187-91.
- 8.Hippisley-Cox J, Coupland C. Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores. BMJ. 2009 Nov 19;339:b4229.
- 9.Ogura-Tomamatsu H, Asano K, Tomamatsu K, et al. Predictors of osteoporosis and vertebral fractures in patients presenting with moderate-to-severe chronic obstructive lung disease. COPD. 2012 Aug;9(4):332-7.
- 10.Lai EL, Huang WN, Chen HH, et al. Ten-year fracture risk by FRAX and osteoporotic fractures in patients with systemic autoimmune diseases. Lupus. 2019 Jul;28(8):945-53.
- 11.Crandall CJ, Larson J, LaCroix A, et al. Predicting Fracture Risk in Younger Postmenopausal Women: Comparison of the Garvan and FRAX Risk Calculators in the Women's Health Initiative Study. J Gen Intern Med. 2019 Feb;34(2):235-42.
- 12.Lindsay R, Pack S, Li Z. Longitudinal progression of fracture prevalence through a population of postmenopausal women with osteoporosis. Osteoporos Int. 2005 Mar;16(3):306-12.
- 13.Ma X, Xia H, Wang J, et al. Re-fracture and correlated risk factors in patients with osteoporotic vertebral fractures. J Bone Miner Metab. 2019 Jul;37(4):722-8.
- 14.Yusuf AA, Hu Y, Chandler D, Crittenden DB, Barron RL. Predictors of imminent risk of fracture in Medicare-enrolled men and women. Arch Osteoporos. 2020 Aug 3;15(1):120.
- 15.Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019 Jan;30(1):3-44.
- 16.Çolak Y, Afzal S, Nordestgaard BG. 25-Hydroxyvitamin D and Risk of Osteoporotic Fractures: Mendelian Randomization Analysis in 2 Large Population-Based Cohorts. Clin Chem. 2020 May 1;66(5):676-85.
- 17.Looker AC. Serum 25-hydroxyvitamin D and risk of major osteoporotic fractures in older U.S. adults. J Bone Miner Res. 2013 May;28(5):997-1006.
- 18.Cauley JA, Parimi N, Ensrud KE, et al. Serum 25-hydroxyvitamin D and the risk of hip and nonspine fractures in older men. J Bone Miner Res. 2010 Mar;25(3):545-53.
- 19.Aul AJ, Dudenkov DV, Mara KC, et al. The relationship of 25-hydroxyvitamin D values and risk of fracture: a population-based retrospective cohort study. Osteoporos Int. 2020 Sep;31(9):1787-99.
- 20.Çalış HT, Sütbeyaz ST, Sunkak S, et al. Osteoporotic Fractures and Posture Problem in Association with Vitamin D Level in Patients with Parkinson’s Disease. Turk J Osteoporos 2017;23:16-20.
- 21.Trajanoska K, Morris JA, Oei L, et al. Assessment of the genetic and clinical determinants of fracture risk: genome wide association and mendelian randomisation study. BMJ. 2018 Aug 29;362:k3225.
- 22.Chalhoub D, Orwoll ES, Cawthon PM, et al. Areal and volumetric bone mineral density and risk of multiple types of fracture in older men. Bone. 2016 Nov;92:100-6.
- 23.Holmberg TF, Rubin KH, Brixen K, Tolstrup JS, Bech M. Fracture risk prediction using phalangeal bone mineral density or FRAX(®)? A Danish cohort study on men and women. J Clin Densitom. Jan-Mar 2014;17(1):7-15.
- 24.Hillier TA, Cauley JA, Rizzo JH, et al. WHO absolute fracture risk models (FRAX): do clinical risk factors improve fracture prediction in older women without osteoporosis?. J Bone Miner Res. 2011 Aug;26(8):1774-82.
- 25.Schuit SCE, Klift MVD, Weel AEAM, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004 Jan;34(1):195-202.
- 26.Miller PD, Barlas S, Brenneman SK, et al. An approach to identifying osteopenic women at increased short-term risk of fracture. Arch Intern Med. 2004 May 24;164(10):1113-20.
- 27.Ravn P, Cizza G, Bjarnason NH, et al. Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. J Bone Miner Res. 1999;14(9):1622-7.
- 28.Kaze AD, Rosen HN, Paik JM. A meta-analysis of the association between body mass index and risk of vertebral fracture. Osteoporos Int. 2018 Jan;29(1):31-9.
- 29.Johansson H, Kanis JA, Oden A, et al. A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res. 2014 Jan;29(1):223-33.
- 30.Poiana C, Carsote M, Radoi V, Mihai A, Capatina C. Prevalent osteoporotic fractures in 622 obese and non- obese menopausal women. J Med Life. 2015;8(4):462-6.
- 31.Onat ŞŞ, Delialioğlu SÜ, Özel S. The Relationship Between Osteoporotic Risk Factors and Bone Mineral Density. Turkish Journal of Osteoporosis 2013;19:74-80.
- 32.Anagnostis P, Siolos P, Gkekas NK, et al. Association between age at menopause and fracture risk: a systematic review and meta-analysis. Endocrine. 2019 Feb;63(2):213-24.
- 33.Lips P, Van Schoor NM. Quality of life in patients with osteoporosis. Osteoporos Int. 2005;16:447-55.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Halk Sağlığı, Çevre Sağlığı, Rehabilitasyon |
| Bölüm | Özgün Araştırma Makaleleri |
| Yazarlar | |
| Proje Numarası | yok |
| Yayımlanma Tarihi | 1 Nisan 2021 |
| Kabul Tarihi | 17 Mart 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 47 Sayı: 1 |
Kaynak Göster
Journal of Uludag University Medical Faculty is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.