Parametri koštane strukture i snage u proceni rizika za prelom kod žena u postmenopauzalnom periodu

Abstract

Postoji više parametara koštane strukture i snage koji mogu da utiču na rizik za prelom kod žena u postmenopauzalnom periodu. Procena mikroarhitekture kosti, na osnovu DXA (dvostruko-energetska x-zračna apsorpciometrija), je jedan od novijih parametara sagledavanja kvaliteta kosti i frakturnog rizika. Naš cilj je bio ispitati povezanost prisutnih kliničkih faktora rizika za prelom i preloma na malu traumu sa vrednošću skora koštane mikroarhitekture (SKM), kao i da odredimo prediktore (iz domena kliničkih faktora i parametara koštane snage i strukture) za prelome. METOD: Istraživanje je sprovedeno kao studija preseka, koja je obuhvatila 515 žena u postmenopauzalnom periodu, starosne dobi od 43 do 80 godina. Uključene su samo žene koje su prvi put došle na snimanje koštane gustine DXA metodom. Procenjivani su: demografske i socioekonomske karakteristike, mineralna koštana gustina, skor koštane mikroarhitekture, parametri snage femura, klinički faktori rizika za prelom, desetogodišnji rizik za prelome pomoću FRAX alatke, prelomi, prisustvo drugih hroničnih bolesti, nivo fizičke aktivnosti, prisustvo faktora rizika za pad i strah od pada. REZULTATI: Samo polovina ispitanica, sa prelomom na malu traumu, ima DXA nalaz u okviru osteoporoze na kičmi (51,3%), a trećina nalaz osteoporoze na kuku (32,9%). Najbolju senzitivnost u izdvajanju postmenopauzalnih žena sa prelomom je pokazala kombinacija nalaza DXA i SKM (89,5%), dok je najviša specifičnost FRAX alatke (83,6%). Multivarijantna analiza je pokazala da žene u postmenopauzalnom periodu sa SKM nižim od 1.200 imaju 5 puta veću šansu da dožive prelom u odnosu na one sa višim vrednostima (OR=4,99; p  0,001; 95% CI (2,99-8,33)), zatim one sa sa visokim FRAX indeksom imaju 4,2 puta veću šansu za prelomom od onih sa niskim (OR=4,15; p  0,001; 95% CI (2,53-6,83)), one koje po rezultatima testa “Ustani i idi” su riziku za pad, imaju 2,2 puta veću šansu da dožive prelom (OR=2,12; p = 0,016; 95% CI (1,15-3,91)), zatim koje na Modifikovanom upitniku za procenu rizika od pada (MFES) pokažu izražen strah od pada imaju 1,7 puta veću šansu za prelomom u odnosu na one bez straha od pada (OR=1,68; p = 0,046; 95% CI (1,01-2,78)). ZAKLJUČAK: SKM se pokazao kao značajan dodatni parametar koštane snage koji se može koristiti u proceni rizika za prelom kod žena u postmenopauzalnom periodu.

There are several parameters of bone structure and bone strength that can affect risk for fractures in women who are in the postmenopausal period. The evaluation of the bone microarchitecture, based on the DXA (Dual-Energy Absorptionometry X-ray) image, is one of the recent parameters of bone quality and fracture risk assessment. Our goal was to investigate the correlation of the clinical risk factors for fracture and low trauma fractures with Trabecular Bone Score (TBS), as well as to determine the predictors (from the domain of clinical factors and parameters of bone strength and structure) for fractures. METHODS: Study was conducted as a cross-sectional study, which included 515 women in the postmenopausal period, aged 43 to 80 years. Only women, who came to bone density measurement by DXA for the first time, were included. In the study, we evaluated: mineral bone density, Trabecular Bone Score, parameters of femoral strength, clinical risk factors for fracture, the ten-year probability of fracture assessment by FRAX (Fracture Risk Assessment Tool) tool, fractures, presence of other chronic diseases, the level of physical activity, presence of risk factors for the fall and fear of falling. RESULTS: Only half participants with small-traumatic fracture had DXA finding on the spine in osteoporosis range (51.3%), and a third of them had result of osteoporosis on the hip (32.9%). The best sensitivity, in the allocation of postmenopausal women with a fracture, was shown by a combination of DXA and SKM findings (89.5%), while the highest specificity showed the FRAX tool (83.6%). A multivariate analysis showed that women in the postmenopausal period with a TBS lower than 1,200 had 5 times greater chance of experiencing a fracture than those with higher values (OR=4,99; p  0,001; 95% CI (2,99-8,33)); those with a high values of FRAX index had a 4.2 times higher chance for fracture than those with lower values (OR=4,15; p  0,001; 95% CI (2,53- 6,83)); participants who, according to the results of the "Stand Up and Go" test, are at risk for a fall, have a 2.2 times higher chance of experiencing a fracture (OR=2,12; p = 0,016; 95% CI (1,15-3,91)), and participants who showed a marked fear of a fall on the MFES test, have a 1.7 times higher chance of breaking a bone than those without fear of falling (OR=1,68; p = 0,046; 95% CI (1,01-2,78)).TBS proved to be a significant additional parameter of bone strenght that can be used in the assessment for risk, in women in the postmenopausal period.