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2011, vol. 17, br. 1-2, str. 28-35
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Faktori rizika koji su povezani sa smanjenjem mineralne gustine kosti
The risk factors associated with the reduction bone mineral density
Sažetak
Uvod. Osteoporoza (OR) je progresivno sistemsko oboljenje, koje se karakteriše smanjenjem mineralne gustine kosti (engl. Bone Mineral Density - VMD) i mikroarhitekturnim oštećenjem kosti, što doprinosi nastanaku preloma. Svetska zdravstvena organizacija definiše OR kao sniženje VMD na 2,5 SD (standardne devijacije) ili više, mereno dvostrukom apsorpciometrijom X zraka, u odnosu na srednju vrednost gustine kosti mlade žene bele rase. Brojni su faktori koji mogu uticati na razvoj osteoporoze: pol, životno doba, rasa, rana menopauza, pozitivna porodična anamneza, mala telesna masa, nedovoljna fizička aktivnost, zloupotreba alkohola, kofeina, pušenje, hronične bolesti i upotreba određenih lekova. Cilj rada. Utvrditi uticaj faktora rizika na razvoj smanjene mineralne gustine kosti kod osoba ženskog pola. Metod. Ispitivanje je sprovedeno prospektivno od 1. juna do 31. decembra 2009. u Domu zdravlja (DZ) u Novom Sadu i DZ u Rumi, a uključeno je 120 osoba ženskog pola, starosti preko 50 godina. Korišćen je Upitnik za procenu faktora rizika za razvoj smanjene gustine kosti. Svim pacijentima je određivana mineralna gustina kosti (VMD). Podeljeni su u dve grupe: prva grupa - smanjena gustina kosti (osteopenija/osteoporoza) i druga grupa - normalna gustina kosti. Podaci su analizirani primenom statističkih metoda χ² test i relativni rizik (RR). Rezultati. U prvoj grupi bila su 52 (43,3%) ispitanika, 22 (18,3%) sa osteoporozom i 30 (25%) sa osteopenijom, u drugoj grupi (normalna mineralna gustina) 68 (56,7%). U prvoj grupi cigarete puši 19,2%, kortikosteroide koristi 11,5%, reumatoidni artritis ima 11,5%, pozitivnu porodičnu istoriju 11,5%, prethodne prelome 46,2%. U drugoj grupi cigarete puši 13,2%, kortikosteroide upotrebljava 7,4%, reumatoidni artritis ima 7,4%, pozitivnu porodičnu istoriju 5,8%, istoriju prethodnih preloma 7,4%. Postoji statistički značajna razlika u pojavi preloma kod pacijenata sa osteoporozom u odnosu na normalnu gustinu kosti (÷²=39,9; p<0,01). Ne postoji statistički značajna razlika u učestalosti preloma kod osoba sa osteopenijom u odnosu na normalnu gustinu kosti (÷²=3,46; r>0,05). Upotreba kortikosteroida je povezana sa smanjenjem mineralne gustine kosti (RR=1,2). Osobe sa reumatoidnim artritisom imaju češće smanjenu gustinu kosti (RR=1,2). Pušenje cigareta je povezano sa osteoporozom (RR=1,3). Zaključak. Faktori rizika igraju ulogu u razvoju osteoporoze, a lekar opšte medicine ima značajnu ulogu u njihovom otkrivanju. Za prevenciju osteoporoze i njenih posledica treba se usmeriti na žene s visokim faktorima rizika, kao što su: godine starosti, porodična anamneza, prethodne frakture u odraslom dobu, rani nedostatak estrogena (pre 45. godine), lečenje glikokortikoidnom terapijom duže od tri meseca, nedovoljan unos kalcijuma i vitamina E, smanjena fizička aktivnost, niska telesna težina (BMI<18), pušenje, oštećen vid, demencija, zloupotreba alkohola i kofeina.
Abstract
Introduction. Osteoporosis (OP) is a systemic progressive disease, characterized by low bone mineral density (BMD) and a deterioration in the microarchitecture of bone, resulting in increased susceptibility to fracture. It is the most common in women after menopause. The World Health Organization defines OP as a BMD that is 2.5 standard deviations or more (as measured by dual-energy Xray absorptiometry) below the reference mean for healthy, young white women. There are numerous factors that may affect the development of osteoporosis: gender, age, race, early menopause, positive family history, low body weight, physical inactivity, alcohol abuse, caffeine, chronic diseases and use of certain drugs. Objective. To determine the impact of risk factors on the development of reduced bone mineral density in females. Method. In this prospective study participated 120 women, older then 50 years, in period between 01.06.2009. and 31.12.2009. in Health Center Novi Sad and Health Center Ruma. Instrument of the study was the osteoporosis risk-assessment questionnaire. All patients were submitted to bone scan test (DEXA) and according to results divided into two groups. Group I-reduced bone density (osteopenia/osteoporosis) and Group II-normal bone density. The collected data were statistically processed using χ² test and RR. Results. Group I comprised 52 (43.3%) subjects, 22 (18.3%) with osteoporosis and 30 (25%) with osteopenia. Group II with normal mineral density included 68 subjects (56.7%). In Group I- 19.2%, were smokers, 11.5% used cortiosteroids, 11.5% suffered from Rheumatoid arthritis, 11.5 had positive family history, and 46.2% positive history of the previous bone fractures. In Group II 13.2% were smokers, 7.4% used corticosteroids, 7.4% had rheumatoid arthritis, 5.8 a positive family history, and 7.4 history of previous fractures. The difference in the occurrence of fractures in patients with osteoporosis compared to normal bone density subjects was statistically significant (χ²=39.9, p<0.01). Rheumatoid arthritis and the use of corticosteroids were associated with reduced bone mineral density (RR = 1.2). Cigarette smoking was associated with osteoporosis (RR = 1.3). Conclusion. Risk factors play important role in the development of osteoporosis. General practitioner's role is to recognize these factors. Prevention of osteoporosis and its sequelae should be targeted at women with high risk factors for osteoporosis, i.e.: age, family history, personal history of previous fractures in adult age, early oestrogen deficiency (<45 years), administration of oral glucocorticoids >3 months, low calcium and vitamin D intake, low physical activity, low body mass index (BMD<18), cigarette smoking, impaired vision, dementia, abuse of alcohol and coffe.
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