ÖZET

Amaç:

Bu çalışmada, obez ve obez olmayan yaşlı hastalarda Vizüel Analog skala (VAS) ağrı skalasını değerlendirmeyi ve ayrıca VAS ağrı skorunun osteoporozlu hastalarda obezite ile ilişkili olup olmadığını belirlemeyi amaçladık.

Gereç ve Yöntem:

Çalışmaya toplam yüz doksan iki hasta dahil edildi [vücut kitle indeksi (VKİ) <30 olan 69 hasta ve VKİ ≥30 olan 99 hasta]. kemik mineral yoğunluğu (KMY) değerleri, dual-enerjili X-ışını absorpsiyometrisi yöntemi ile belirlenmiştir. VAS ağrı skoru “ağrısız” (skor=0) ve “en kötü ağrı” (skor=10) olarak değerlendirildi ve Dünya Sağlık Örgütü’nün ağrı şiddeti ölçeğine göre 3 gruba ayrıldı: skor <3 hafif ağrı, 3-6 hafif-orta derecede ağrı ve >6 orta-şiddetli ağrı. Osteoporoz hastalarında VAS ağrı skorunun bağımsız risk faktörlerini belirlemek için çok değişkenli bir lojistik regresyon modeli kullanıldı.

Bulgular:

Obez hastalarda VAS ağrı skoru obez olmayan hastalardan daha yüksekti (4,49±2,76 ve 3,49±2,42, p=0,014). Osteoporoz hastalarında ileri yaş [Olasılık oranı (OR)=1,094, %95 güven aralığı (GA)=1,018-1,175, p=0,014] ve obezite (OR=0,225, %95 GA=0,055-0,928, p=0,039), VAS ağrı skoru ile ilişkili idi. Normal KMY olan hastalarda sadece ileri yaş VAS ağrı skoru ile ilişkili idi (OR=1,157, %95 GA=1,045-1,280, p=0,005). Tüm hastalarda ileri yaş (OR=1,141, %95 GA=1,093-1,192, p=<0,001) ve osteoporoz (OR=0,001, %95 GA=0,00-0,014, p=<0,001) VAS ağrı skoru ile ilişkiliydi.

Sonuç:

Değişken bir risk faktörü olan obezitenin azaltılmasının, ağrı ve sedanter yaşam tarzını azaltacağını ve osteoporozu olan hastalarda KMY’yi iyileştireceğini düşünüyoruz.

References

Schulman RC, Weiss AJ, Mechanick JI. Nutrition.Bone and aging: an integrative physiology approach. Curr Osteoporos Rep 2011;9:184-95.

Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: Medical Management, Epidemiology, and Economic Burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2013;8:136.

https.//www.sheffields.ac.uk/NOGG/NOGG%20Guideline%20202017.

Okifuji A, Hare BD. The association between chronic pain and obesity. J Pain Res 2015;8:399-408.

Hu Y, Tan LJ, Chen XD, Liu Z, Min SS, Zeng Q, et al. Identification of Novel Potentially Pleiotropic Variants Associated With Osteoporosis and Obesity Using the cFDR Method. J Clin Endocrinol Metab 2018;103:125-38.

Neglia C, Argentiero A, Chitano G, Agnello N, Ciccarese R, Vigilanza A, et al. Diabetes and Obesity as Independent Risk Factors for Osteoporosis: Updated Results from the ROIS/EMEROS Registry in a Population of Five Thousand Post-Menopausal Women Living in a Region Characterized by Heavy Environmental Pressure. Int J Environ Res Public Health 2016;13:1067.

Fassio A, Idolazzi L, Rossini M, Gatti D, Adami G, Giollo A, et al. The obesity paradox and osteoporosis. Eat Weight Disord 2018;23:293-302.

Iwamoto J, Takeda T, Sato Y, Uzawa M. Comparison of the effect of treatment with etidronate and alendronate on lumbar bone mineral density in elderly women with osteoporosis. Yonsei Med J 2005;46:750-8.

Ohtori S, Akazawa T, Murata Y, Kinoshita T, Yamashita M, Nakagawa K, et al. Risedronate decreases bone resorption and improves low back pain in postmenopausal osteoporosis patients without vertebral fractures. J Clin Neurosci 2010;17:209-13.

Sahin N, Karahan AY, Atik A, Dogan E, Gezer IA, Ugurlu H. Assessment of the relationship between pain, psychological status, quality of life, and body mass index. Aristotle Univ Med J 2016;42:13-21.

Mohd Sallehuddin S, Mohamad Nor NS, Ambak R, Abdul Aziz NS, Mohd Zaki NA, Omar MA, et al. Changes in body pain among overweight and obese housewives living in Klang Valley, Malaysia: findings from the MyBFF@home study. BMC Womens Health 2018;18:101.

Kanis JA, Cooper C, Rizzoli R, Reginster JY; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF). Executive summary of the European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Calcif Tissue Int 2019;104:235-23.

Medical Advisory Secretariat. Utilization of DXA Bone Mineral Densitometry in Ontario: An Evidence-Based Analysis. Ont Health Technol Assess Ser 2006;6:1-180.

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain. Arthritis Care Res 2011;63:240-52.

Macdonald N. World Health Organization Cancer Pain Relief. Geneva: Worl Health Organization. J Palliat Care 1986;1:31.

Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39:175-91.

Williams EP, Mesidor M, Winters K, Dubbert PM, Wyatt SB. Overweight and Obesity: Prevalence, Consequences, and Causes of a Growing Public Health Problem. Curr Obes Rep 2015;4:363-70.

Black DM, Rosen CJ. Clinical Practice. Postmenopausal Osteoporosis. N Engl J Med 2016;374:254-62.

Chen YY, Fang WH, Wang CC, Kao TW, Chang YW, Wu CJ, et al. Body fat has stronger associations with bone mass density than body mass index in metabolically healthy obesity. PLoS One 2018;13:e0206812.

Ilich JZ, Inglis JE, Kelly OJ, McGee DL. Osteosarcopenic obesity is associated with reduced handgrip strength, walking abilities, and balance in postmenopausal women. Osteoporos Int 2015;26:2587-95.

Santos VRD, Christofaro DGD, Gomes IC, Júnior IFF, Gobbo LA.The relationship between obesity, sarcopenia, sarcopenic obesity, and bone mineral density in elderly subjects aged 80 years and over. Rev Bras Ortop 2017;53:300-5.

Taylor R Jr, Pergolizzi JV, Raffa RB, Nalamachu S, Balestrieri PJ. Pain and obesity in older adult. Curr Pharm Des 2014;20:6037-41.

Leveille SG, Bean J, Bandeen-Roche K, Jones R, Hochberg M, Guralnik JM. Musculoskeletal pain and risk for falls in older disabled women living in the community. J Am Geriatr Soc 2002;50:671-8.

Stubbs B, Binnekade TT, Soundy A, Schofield P, Huijnen IP, Eggermont LH. Are older adults with chronic musculoskeletal painless active than older adults without chronic pain? A systematic review and meta-analysis. Pain Med 2013;14:1316-31.

Stubbs B, Binnekade T, Eggermont L, Patchay S, Sepehry A, Eggermont L. Pain and the risk for falls in community-dwelling older adults: a systematic review and meta-analysis. Arch Phys Med Rehabil 2014;95:175-87.

Tanaka S, Yoshida A, Kono S, Oguma T, Hasegawa K, Ito M. Effectiveness of elcatonin for alleviating pain and inhibiting bone resorption in patients with osteoporotic vertebral fractures. J Bone Miner Metab 2017;35:544-53.

Kemik Mineral Dansitesinin Vizüel Analog Skala Ağrı Skoruna Etkisi Var mıdır?

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References