md-medicaldata


Go to content

PROCENA RIZIKA NASTANKA OSTEOPOROZE KOD OBOLELIH OD MULTIPLE SKLEROZE /
ASSESSMENT OF RISKS THAT LEAD TO THE OCCURENCE OF OSTEOPOROSIS IN PATIENTS WITH MULTIPLE SCLEROSIS

Authors

 

Atila Klimo

Specijalna bolnica za rehabilitaciju „Banja Kanjiža“ Kanjiža

 

UDK: 616.832-004.2
616.71-007.233


The paper recieved / Rad primljen:15.02.2018.

Accepted / Rad prihvaćen: 20.03.2018.

 


Corresponding to:


Spec. dr med. Atila Klimo, prim.
fizijatar-balneoklimatolog
Specijalna bolnica za rehabilitaciju „Banja Kanjiža“ Kanjiža
24420 Kanjiža, Narodni park b.b,
tel: +38124875163,
e-mail: petik@stcable.net

 

 

Sažetak

 

Uvod: Smanjena gustina koštane mase može se povezati sa kumulativnim efektom različitih faktora, a najčešće je to fizička neaktivnost, umanjen unos D vitamina i upotreba lekova kao što su glukokortikoidi. Oboleli od multiple skleroze (MS) mogu imati povećan rizik za nastanak osteoporoze.
Cilj: Cilj ovog istraživanja je bio da se ispita procena rizika nastanka osteoporoze/osteopenije kod obolelih od multiple skleroze koji su prvi put lečeni u Specijalnoj bolnici za rehabilitaciju “Banja Kanjiža”.
Materijal i metode: Opservaciona analitička studija preseka je obuhvatila 366 pacijenta od multiple skleroze koji su prvi put primljeni na stacionarno lečenje u Specijalnu bolnicu za rehabilitaciju “Banja Kanjiža” u Kanjiži u trajanju od 21 dan od januara 2013. – decembra 2017. godine. U studiju su uvršteni pacijenti stariji od 18 godina sa postavljenom dijagnozom na osnovu revidiranih Mekdonaldovih kriterijuma. Praćeni su sledeći parametri: pol, starosna dob, dužina trajanja i forma osnovne bolesti, stepen funkcionalne onesposobljenosti prema Kurtzkeovoj EDS skali, upotreba medikamenata i suplemenata za lečenje osteoporoze/osteopenije, prethodni patološki prelom, saznanje o DXA merenju.
Rezultati: U navedenom periodu lečeno je 639 obolelih od multiple skleroze. Po prvi put je lečeno 366 bolesnika sa MS od kojih je 62,3 % imalo relapsno - remitentni oblik bolest. U datom vremenu rehabilitovano je dva puta više žena nego muškaraca. Praćenjem ovih pacijenata tokom petogodišnjeg vremenskog perioda samo je 9% bolesnika podvrgnuto centralnoj DXA osteodenzitometriji, kod kojih je utvrđen različiti stepen poremećaja koštanog metabolizma. Patološki prelom na malu traumu je zadobilo 6,8% (25 od 366) pacijenata. Od gore navedenih parametara samo je ženski pol (p<0.001) i starosna dob (p=0.036) statistički značajno udružena sa pojavom niske mineralizacije kosti.
Zaključak: Neophodno je povećati nivo zdravstvene edukacije obolelima od multiple skleroze o posledicama niske mineralizacije kostiju. Žene starije životne dobi obolele od multiple skleroze imaju statistički značajan rizik za nastanak smanjene gustine koštane mase.

 

 

Ključne reči:

mineralna gustina kosti, osteodenzitometrija, multipla skleroza.

 

 

Abstract

 

Introduction: Reduced bone mass density can be related to a cumulative effect of different factors, most common ones being physical inactivity, reduced intake of vitamin D and use of medications such as glucocorticoids. Multiple sclerosis patients can have a higher risk from occurrence of osteoporosis. Objective: The study sought to assess the risk of osteoporosis in patients with multiple sclerosis who had been treated for the first time in the Specialized hospital of rehabilitation “Banja Kanjiža” in Kanjiža. Material and methods: The observational analytical cross-section study included 366 patients with multiple sclerosis on the first stationary treatment at the Specialized hospital of rehabilitation "Banja Kanjiža" in Kanjiža in the period of 21 days between January 2013 and December 2017. In the study are included patients who are more than 18 years old who have been diagnosed on the basis of McDonald’s revised criteria. The following parameters were observed in patients: sex, age, duration and form of basic disease, the level on the Kurtzke Expanded Disability Status Scale, use of medication and supplements for the treatment of osteoporosis/osteopenia, previous pathological fracture, and knowledge on DXA scale. Results: During the given period 639 patients with multiple sclerosis were treated. For the first time treated 366 patients with multiple sclerosis, out of those 62.3% with relapsing-remitting type of disease. Within the given period, twice as many women were rehabilitated than men. During the five-year long period of observation of said patients, only 9% of patients with different levels of bone metabolic disorders established underwent central DXA bone densitometry. Pathological fracture on a small trauma was suffered in 6.8% patients. Of the abovementioned parameters, only the female sex (p<0.001) and age (p=0.036) statistically significantly influenced the occurrence of low bone mineral density. Conclusion: It is necessary to increase the level of health education of multiple sclerosis patients on the consequences of low bone mineral density. The highest risk of osteoporotic fracture is in older women suffering from multiple sclerosis.

 

 

Key words:

bone mineral density, central DXA devices, multiple sclerosis

 

 

References:

 

  1. Republička stručna komisija za izradu i implementaciju vodiča dobre kliničke prakse; Nacionalni vodič dobre kliničke prakse za dijagnostikovanje i lečenje multiple skleroze. Klinički vodič 19/13, Ministarstvo zdravlja Republike Srbije, Beograd 2013.
  2. Marrie RA, Cutter G, Tyry T, Vollmer T. A cross-sectional study of bone health in multiple sclerosis. Neurology 2009; 73 (17): 1394–8.
  3. Bazelier MT, van Staa TP, Uitdehaag BMJ, Cooper C, Leufkens HGM, Vestergaard P. et al. Risk of fractures in patients with multiple sclerosis A population-based cohort study. Neurology 2012; 78 (24): 1967–1973.
  4. Dobson R, Ramagopalan S, Giovannoni G. Bone health and multiple sclerosis. Mult Scler  2012; 18: 1522–8.
  5. Dong G, Zhang N, Wu Z, Liu Y, Wang L. Multiple Sclerosis Increases Fracture Risk: A Meta-Analysis. Biomed Res Int. 2015; 2015: 650138.
  6. Gupta S, Ahsan I, Mahfooz N, Abdelhamid N, Ramanathan M, Weinstock G. B. Osteoporosis and Multiple Sclerosis: Risk Factors, Pathophysiology, and Therapeutic Interventions. CNS Drugs 2014; 28 (8): 731.
  7. Zorzon M, Zivadinov R, Locatelli L, Giuntini D, Toncic M, Bosco A. et al. Long-term effects of intravenous high dose methylprednisolone pulses on bone mineral density in patients with multiple sclerosis. EAN 2005; 12 (7): 550-6.
  8. Josyula S, Mehta B.K, Karmon Y, Teter B, Batista S, Ostroff J. et al. The nervous system's potential role in multiple sclerosis associated bone loss. JNS 2012; 319 (1-2): 8–14.
  9. Zhao W, Liu Y, Cahill C.M, Yang W, Rogers J.T, Huang X. The Role of T Cells in Osteoporosis, an Update. Int J Clin Exp Pathol. 2009; 2 (6): 544–52.
  10. Dionyssiotis Y. Bone loss and fractures in multiple sclerosis: focus on epidemiologic and physiopathological features. Int J Gen Med. 2011; 4: 505–9.
  11. Simonsen C.S, Gulowsen C.E, Brunborg C, Tallaksen Ch, Eriksen E.F, Holmøy T, Moen S.M. Bone mineral density in patients with multiple sclerosis, hereditary ataxia or hereditary spastic paraplegia after at least 10 years of disease - a case control study. BMC Neurol. 2016; 16: 252.
  12. Kanis J. A, McCloskey E. V, Johansson H, Cooper C, Rizzoli R, Reginster J.-Y, and on behalf of the Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013; 24 (1): 23–57.
  13. Kurtzke JF. Historical and clinical perspectives of the expanded disability status scale. Neuroepidemiology 2008; 31 (1): 1-9.
  14. Huang ZQi YDu SChen GYan W. BMI levels with MS Bone mineral density levels in adults with multiple sclerosis: a meta-analysis. Int J Neurosci. 2015; 125 (12): 904-12.
  15. Di Somma CScarano EBarrea LZhukouskaya VVSavastano SMele C. et al. Vitamin D and Neurological Diseases: An Endocrine View. Int J Mol Sci. 2017; 18 (11): 2482. 
  16. Karahan SZ, Boz C, Kilic S, Usta NC, Ozmenoglu M, Cakmak AV. et al.  Lack of Association between Pulse Steroid Therapy and Bone Mineral Density in Patients with Multiple Sclerosis. Mult Scler Int. 2016; Epub 2016 Feb 4.
  17. Terzi TTerzi MTander BCantürk FOnar M. Changes in bone mineral density and bone metabolism markers in premenopausal women with multiple sclerosis and the relationship to clinical variables. J Clin Neurosci. 2010; 17 (10): 1260-4.
  18. Steffensen LH, Jørgensen L, Straume B, Mellgren SI, Kampman MT. Can vitamin D3 supplementation prevent bone loss in persons with MS? A placebo-controlled trial. Journal of Neurology 2011; 258 (9): 1624–31.
  19. Weinstein RS. Glucocorticoid-Induced Osteoporosis and Osteonecrosis. Endocrinol Metab Clin North Am. 2012; 41 (3): 595–611.
  20. De Vries FBracke MLeufkens HGLammers JWCooper CVan Staa TP. Fracture risk with intermittent high-dose oral glucocorticoid therapy. Arthritis Rheum. 2007; 56 (1): 208-14.
  21. Córdoba-L.D, de Castro L. Metabolomics: A potential way to know the role of vitamin D on multiple sclerosis. J Pharm Biomed Anal. 2017; 136 :22-31.
  22. Ramagopalan  S.V,  Dyment D.A, Cader M.Z, Morrison K.M, Disanto G, Morahan J.M. et al. Rare variants in the CYP27B1 gene are associated with multiple sclerosis. Annals of Neurology. 2011; 70 (6): 881-86.
  23. Hearn AP, Silber E. Osteoporosis in multiple sclerosis. Mult Scler. 2010; 16 (9): 1031-43.
  24. Kampman MT, Eriksen EF, Holmoy T. Multiple sclerosis, a cause of secondary osteoporosis? What is the evidence and what are the clinical implications? Acta Neurol Scand 2011; 124 (191): 44–9.

PDF Klimo A. • MD-Medical Data 2018;10(2): 091-095

 

 

 

Naslovna | Revija | Galerija | Dešavanja | Instrukcije | Redakcija | Izdavač | Prijatelji sajta | Saradnja | Kontakt | Site Map


Back to content | Back to main menu