İnvolusyonel osteoporoz hastalarında kemik mineral yoğunluğu ve risk faktörlerinin vertebra kırığı ile ilişkisinin değerlendirilmesi
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Date
2006
Authors
Aslan, Mahmut
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Çalışmanın amacı, involusyonel osteoporoz (postmenopozal ve senil osteoporoz) hastalarında kemik mineral yoğunluğu (KMY) ve risk faktörlerinin vertebra kırığı ile ilişkisini değerlendirmektir. Çalışmaya, 1997-2005 yılları arasında Uludağ Üniversitesi Tıp Fakültesi (U.Ü.T.F) Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı polikliniğine başvuran ve ilk olarak postmenopozal veya senil osteoporoz (OP) tanısı konmuş kadın hastalar alındı. Tüm olguların risk faktörlerini içeren OP sorgulama formu retrospektif olarak incelendi. Sekonder osteoporoza neden olabilecek sistemik hastalığı olanlar ile kemik metabolizmasını etkileyebilecek ilaç kullananlar çalışmaya dahil edilmedi. Olguların lateral torakal ve lomber grafileri U.Ü.T.F. Radyoloji Anabilim Dalı’nda görevli aynı radyolog tarafından değerlendirildi. T4-L4 arası vertebra kırıklarının değerlendirilmesinde semikantitatif metod olan Genant yöntemi kullanıldı. Tüm olguların DEXA ile ölçülen lomber total, femur boyun, trokanter ve total kalça KMY (gr/cm2) ile t skoru ve osteoporoz risk faktörlerinin vertebra kırığı ile ilişkisi değerlendirildi. Yaş ortalaması 62.13 ± 8.58 olan toplam 382 olgu çalışmaya alındı. 65 olguda vertebra kırığı saptanırken, 317 olguda ise vertebra kırığı yoktu. Risk faktörleri açısından karşılaştırıldığında vertebra kırığı olan olgularda yaşın oldukça yüksek, eğitimin belirgin derecede düşük, giyim tarzı olarak geleneksel giyimin fazla ve menopoz süresinin daha uzun olduğu bulunurken, kırık oranının yaş ile birlikte artış gösterdiği saptandı (p<0,05). Güneşlenme, vertebra kırığı olanlarda daha az olmasına rağmen istatistiksel olarak anlamsızdı (p>0,05). Oral kontraseptif kullanımı ise vertebra kırığı olmayanlarda daha yüksekti (p<0,05). KMY ve t skoru değerleri açısından lomber bölgede bir farklılık saptanmazken, total kalça KMY ve t skorları vertebra kırığı olan grupta daha düşüktü (p<0,05). Risk faktörlerinden 65 yaş üstü (>65 yaş) ve sigara kullanımı için yapılan logistik regresyon analizi sonucunda sigara kullanımı anlamsız bulunurken, 65 yaş üstü kadınlarda ise %28,7 oranında vertebra kırığı saptandı (p<0,05). Çalışmanın sonucunda; yaş ve menopoz süresinin uzun olmasıyla OP’a bağlı vertebra kırığının arttığı, risk altındaki birçok hastayı gelecekte oluşabilecek kırıklardan korumak amacıyla OP tanısının erken konulabilmesi, OP risk faktörlerinin değiştirilebilir olanları konusunda hastanın bilinçlendirilmesi ve korunma prensiplerinin verilmesi, vertebra kırığının lomber bölgedeki KMY düşüklüğü ile her zaman uyumlu olmadığı, yaşın osteoporotik kırık oluşumunda KMY’dan bağımsız olarak rol oynadığı, kırığı olan hastaların KMY ölçümü yanında klinik ve radyografik görüntüleme yöntemlerinin birlikte değerlendirilmesi gerektiği sonucuna varıldı.
The aim of this study is to assess relationship between bone mineral density (BMD) and risk factors with vertebral fractures in women with involutional osteoporosis (postmenopausal and senile osteoporosis). Women with first diagnosis of postmenopausal and senile osteoporosis who came to Uludag University Medical Faculty Physical Treatment and Rehabilitation Department between 1997-2005 included to the study. Questionnaire including all risk factors for osteoporosis of each subject searched retrospectively. Patients with systemic medical problems can cause to secondary osteoporosis and patients using drugs that can interact with bone metabolism excluded from the study. Lumbar and thoracic lateral plain radiographs are assessed by same radiologist working in radiology department. Vertebral fractures on levels T4-L4 assessed with semiquantitative Genant method. Association between lumbar total, femur neck, trochanter and total femur BMD (gr/cm2) and t scores measured with DEXA and osteoporosis risk factors assessed. 382 women with average age of 62.13±8.58 included to the study. İn 317 women there were no vertebral fracture, in 65 women vertebral fracture was present. When compared according to the risk factors, subjects with vertebral fracture have older age, worse educational history, more common traditional clothing, and longer menopause period than subjects with no fracture. Presence of vertebral fracture was increasing with age (p<0, 05). Sunbathing was lower in subjects with fracture but association was statistically insignificant (p>0, 05). Use of oral contraceptive drugs was higher in subjects who have no fracture (p<0, 05). Lumbar BMD and t scores was similar in both groups, total hip BMD and t score was lower in subjects with fracture (p<0, 05). By logistic regression analysis smoking was an insignificant factor but women at an age over 65 have 28.7% vertebral fractures (p<0, 05). At the end of this study when age and menopause period increases vertebral fractures connected with osteporosis increases; for protecting women with higher risk from vertebral fractures can occur in future, early diagnosis is important; some risk factors of osteoporosis can be changed and patient must be educated about this factors; vertebral fractures in lumbar vertebra is not always associated with BMD; age is a risk factor for formation of vertebral fractures indepent from BMD, patients who have fracture must be assessed with clinic and radiographic methods in addition to BMD is concluded.
The aim of this study is to assess relationship between bone mineral density (BMD) and risk factors with vertebral fractures in women with involutional osteoporosis (postmenopausal and senile osteoporosis). Women with first diagnosis of postmenopausal and senile osteoporosis who came to Uludag University Medical Faculty Physical Treatment and Rehabilitation Department between 1997-2005 included to the study. Questionnaire including all risk factors for osteoporosis of each subject searched retrospectively. Patients with systemic medical problems can cause to secondary osteoporosis and patients using drugs that can interact with bone metabolism excluded from the study. Lumbar and thoracic lateral plain radiographs are assessed by same radiologist working in radiology department. Vertebral fractures on levels T4-L4 assessed with semiquantitative Genant method. Association between lumbar total, femur neck, trochanter and total femur BMD (gr/cm2) and t scores measured with DEXA and osteoporosis risk factors assessed. 382 women with average age of 62.13±8.58 included to the study. İn 317 women there were no vertebral fracture, in 65 women vertebral fracture was present. When compared according to the risk factors, subjects with vertebral fracture have older age, worse educational history, more common traditional clothing, and longer menopause period than subjects with no fracture. Presence of vertebral fracture was increasing with age (p<0, 05). Sunbathing was lower in subjects with fracture but association was statistically insignificant (p>0, 05). Use of oral contraceptive drugs was higher in subjects who have no fracture (p<0, 05). Lumbar BMD and t scores was similar in both groups, total hip BMD and t score was lower in subjects with fracture (p<0, 05). By logistic regression analysis smoking was an insignificant factor but women at an age over 65 have 28.7% vertebral fractures (p<0, 05). At the end of this study when age and menopause period increases vertebral fractures connected with osteporosis increases; for protecting women with higher risk from vertebral fractures can occur in future, early diagnosis is important; some risk factors of osteoporosis can be changed and patient must be educated about this factors; vertebral fractures in lumbar vertebra is not always associated with BMD; age is a risk factor for formation of vertebral fractures indepent from BMD, patients who have fracture must be assessed with clinic and radiographic methods in addition to BMD is concluded.
Description
Keywords
Primer involusyonel osteoporoz, Vertebra kırığı, DEXA, Risk faktörleri, Primary involutional osteoporosis, Vertebral fracture, Risk factors
Citation
Aslan, M. (2006). İnvolusyonel osteoporoz hastalarında kemik mineral yoğunluğu ve risk faktörlerinin vertebra kırığı ile ilişkisinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.