ÖZET
Amaç:
Bu çalışmada osteopenili hastalarda vertebra bütünlüğünün ne ölçüde etkilendiği araştırıldı.
Gereç ve Yöntem:
Çalışmaya ikinci basamak bir sağlık kuruluşunun iç hastalıkları polikliniğinde tedavi gören 40-74 yaş arası 304 kadın hasta dahil edildi. Total lomber T ve Z-skorları ile femur boyun T ve Z-skorları çift enerjili X-ışını absorbsiyometri ile analiz edildi. T-skoru -1 ile -2,4 arasında olan hastaları dahil edildi ve dorsal ve ventral X-ışını görüntüleme ile hastaların torasik ve lomber vertebraları değerlendirildi. Hastalarda vertebra kırığı olup olmadığı incelendi ve varsa kırık şiddeti belirlendi.
Bulgular:
Hastaların %30,6’sında vertebra kırığı saptandı ve bu hastalarda skolyoz sıklığı kırık olmayanlara göre daha yüksek bulundu (p<0,001). Omurga kırıklarının sıklığı ile menopozdan sonra geçen yıl sayısı arasında anlamlı bir ilişki vardı (p<0,001). Premenopozal ve postmenopozal dönemler karşılaştırıldığında menopoz eşiğinde ve kırık sıklığında anlamlı artış görüldü (p=0,036). Vücut kitle indeksi (VKİ) düzeyleri kırıklı hastalarda anlamlı olarak yüksek bulundu (p=0,001). Lomber T-skoru ile vertebral kırık sıklığı (p=0,469) ve skolyoz sıklığı (p=0,116) arasında anlamlı bir ilişki bulunmadı.
Sonuç:
Menopoz sonrası geçen süre kırık sıklığını artırmaktadır. Genel literatürün aksine, çalışmamız obezite ve artmış VKİ ile kırık sıklığında artış göstermiştir. Üç yüz dört osteopenik hastayı direkt radyografi ile taradığımızda, önemli bir kırık sıklığı bulduk, ancak çoğu hastanın kırıkları “sessiz” idi. Toplumda osteopeni sık görülmekle birlikte literatürde olduğu gibi çalışmamız da bu hastaların herhangi bir semptomu olmasa bile vertebra kırığı açısından incelenmesi gerektiğini göstermektedir.
References
1
Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, Johansson H, et al. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int 2012;23:949-55.
2
Carlson BB, Salzmann SN, Shirahata T, Ortiz Miller C, Carrino JA, Yang J, et al. Prevalence of osteoporosis and osteopenia diagnosed using quantitative CT in 296 consecutive lumbar fusion patients. Neurosurg Focus 2020;49:E5.
3
Watts NB, Bilezikian JP, Camacho PM, Greenspan SL, Harris ST, Hodgson SF, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of postmenopausal osteoporosis. Endocr Pract 2010;16 Suppl 3:1-37.
4
Sornay-Rendu E, Munoz F, Garnero P, Duboeuf F, Delmas PD. Identification of osteopenic women at high risk of fracture: the OFELY study. J Bone Miner Res 2005;20:1813-9.
5
Burr DB, Stafford T. Validity of the bulk-staining technique to separate artifactual from in vivo bone microdamage. Clin Orthop Relat Res 1990;(260):305-8.
6
Hasegawa K, Takahashi HE, Koga Y, Kawashima T, Hara T, Tanabe Y, et al. Mechanical properties of osteopenic vertebral bodies monitored by acoustic emission. Bone 1993;14:737-43.
7
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 2007;22:465-75.
8
Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 2010;182:1864-73.
9
Khosla S, Melton LJ 3rd. Clinical practice. Osteopenia. N Engl J Med 2007;356:2293-300.
10
Pasco JA, Seeman E, Henry MJ, Merriman EN, Nicholson GC, Kotowicz MA. The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int 2006;17:1404-9.
11
Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002;359:1761-7.
12
Gambacciani M, Spinetti A, de Simone L, Cappagli B, Maffei S, Taponeco F, et al. The relative contributions of menopause and aging to postmenopausal vertebral osteopenia. J Clin Endocrinol Metab 1993;77:1148-51.
13
Gallagher JC. Effect of early menopause on bone mineral density and fractures. Menopause 2007;14:567-71.
14
Kanis JA, Black D, Cooper C, Dargent P, Dawson-Hughes B, De Laet C, et al. A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int 2002;13:527-36.
15
Sornay-Rendu E, Munoz F, Garnero P, Duboeuf F, Delmas PD. Identification of osteopenic women at high risk of fracture: the OFELY study. J Bone Miner Res 2005;20:1813-9.
16
Kobayashi T, Atsuta Y, Takemitsu M, Matsuno T, Takeda N. A prospective study of de novo scoliosis in a community based cohort. Spine (Phila Pa 1976) 2006;31:178-82.
17
Ploumis A, Transfledt EE, Denis F. Degenerative lumbar scoliosis associated with spinal stenosis. Spine J 2007;7:428-36.
18
Robin GC, Span Y, Steinberg R, Makin M, Menczel J. Scoliosis in the elderly: a follow-up study. Spine (Phila Pa 1976) 1982;7:355-9.
19
Riseborough EJ. Scoliosis in adults. Curr Pract Orthop Surg 1977;7:36-55.
20
Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993;8:1137-48.
21
Siris ES, Chen YT, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 2004;164:1108-12.
22
Melton LJ 3rd, Kan SH, Frye MA, Wahner HW, O’Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol 1989;129:1000-11.
23
Ballane G, Cauley JA, Luckey MM, El-Hajj Fuleihan G. Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int 2017;28:1531-42.
24
Ho-Pham LT, Mai LD, Pham HN, Nguyen ND, Nguyen TV. Reference ranges for vertebral heights and prevalence of asymptomatic (undiagnosed) vertebral fracture in Vietnamese men and women. Arch Osteoporos 2012;7:257-66.
25
Fujiwara S, Kasagi F, Masunari N, Naito K, Suzuki G, Fukunaga M. Fracture prediction from bone mineral density in Japanese men and women. J Bone Miner Res 2003;18:1547-53.
26
Wattanachanya L, Pongchaiyakul C. Prevalence and risk factors of morphometric vertebral fracture in apparently healthy osteopenic postmenopausal Thai women. Menopause 2020;28:12-7.
27
Shuhart CR, Yeap SS, Anderson PA, Jankowski LG, Lewiecki EM, Morse LR, et al. Executive Summary of the 2019 ISCD Position Development Conference on Monitoring Treatment, DXA Cross-calibration and Least Significant Change, Spinal Cord Injury, Peri-prosthetic and Orthopedic Bone Health, Transgender Medicine, and Pediatrics. J Clin Densitom 2019;22:453-71.
28
Urrutia J, Diaz-Ledezma C, Espinosa J, Berven SH. Lumbar scoliosis in postmenopausal women: prevalence and relationship with bone density, age, and body mass index. Spine (Phila Pa 1976) 2011;36:737-40.
29
Rozenberg S, Vandromme J, Aguillera A, Peretz A, Ham H. Clinical significance of heterogeneity of vertebral mineral density. Maturitas 1995;21:147-51.
30
Spencer RP, Hosain F, Yoosufani KA. Bone density variation within lumbar vertebrae in apparently normal women. Int J Rad Appl Instrum B 1992;19:83-5.
31
Sahota O, Pearson D, Cawte SW, San P, Hosking DJ. Site-specific variation in the classification of osteoporosis, and the diagnostic reclassification using the lowest individual lumbar vertebra T-score compared with the L1-L4 mean, in early postmenopausal women. Osteoporos Int 2000;11:852-7.
32
Ström O, Borgström F, Kanis JA, Compston J, Cooper C, McCloskey EV, et al. Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2011;6:59-155.
33
Francucci CM, Romagni P, Camilletti A, Fiscaletti P, Amoroso L, Cenci G, et al. Effect of natural early menopause on bone mineral density. Maturitas 2008;59:323-8.
34
Türkiye Endokrinoloji ve Metabolizma Derneği Osteoporoz ve Kemik Hastalıkları Tanı ve Tedavi Klavuzu. 2020. s. 6.
35
Casado Burgos E. Guias de practica clinica sobre osteoporosis. Rev Osteoporosis Metab Miner 2018;10 Suplemento:9-12.
36
Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 2010;182:1864-73.
37
Yeung HY, Qin L, Hung VW, Lee KM, Guo X, Ng BW, et al. Lower degree of mineralization found in cortical bone of adolescent idiopathic scoliosis (AIS). Stud Health Technol Inform 2006;123:599-604.
38
Yung PS, Lai YM, Tung PY, Tsui HT, Wong CK, Hung VW, et al. Effects of weight bearing and non-weight bearing exercises on bone properties using calcaneal quantitative ultrasound. Br J Sports Med 2005;39:547-51.
39
Arboleya L, Díaz-Curiel M, Del Río L, Blanch J, Díez-Pérez A, Guañabens N, et al. Prevalence of vertebral fracture in postmenopausal women with lumbar osteopenia using MorphoXpress® (OSTEOXPRESS Study). Aging Clin Exp Res 2010;22:419-26.
40
Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR. Recognition of vertebral fracture in a clinical setting. Osteoporos Int 2000;11:577-82.
41
Songpatanasilp T, Sritara C, Kittisomprayoonkul W, Chaiumnuay S, Nimitphong H, Charatcharoenwitthaya N, et al. Thai Osteoporosis Foundation (TOPF) position statements on management of osteoporosis. Osteoporos Sarcopenia 2016;2:191-207.
42
Delmas PD, van de Langerijt L, Watts NB, Eastell R, Genant H, Grauer A, et al. Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res 2005;20:557-63.
43
Yang J, Mao Y, Nieves JW. Identification of prevalent vertebral fractures using Vertebral Fracture Assessment (VFA) in asymptomatic postmenopausal women: A systematic review and meta-analysis. Bone 2020;136:115358.
44
Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 2014;25:2359-81.
45
Liew D, Chapurlat RD, Sornay-Rendu E, Lespessailles E, Peng Y, Seeman E. Cost-effectiveness of treatment of women aged 70 years and older with both osteopenia and microstructural deterioration. Bone 2021;142:115682.
