Faktori rizika za poremećaje homeostaze koštanog tkiva kod bolesnika sa psihotičnim poremećajima

Abstract

Izvod: Bolesnici sa shizofrenijom i drugim psihozama predstavljaju populaciju osoba kod koje postoji povećani rizik za nastanak poremećaja homeostaze koštanog tkiva i posledično, osteoporoze i fraktura. Mogući mehanizmi narušavanja koštane homeostaze kod pacijenata sa shizofrenijom su : hiperprolaktinemija, hipogonadizam, povećana aktivnost interleukina, polidipsija, disbalans kalcijuma, pušenje duvana, deficit vitamina, neadekvatna ishrana, smanjena fizička aktivnost i smanjeno izlaganje svetlosti. Upotreba antipsihotičnih lekova je verovatno nezavisni faktor rizika za razvoj osteoporoze kod bolesnika sa psihozama. Svaki od ovih faktora pojedinačno, kao i njihova kombinacija mogu biti razlog smanjenja mineralne koštane gustine. Merenje mineralne koštane gustine (bone mineral density-BMD) metodom osteodenzitometrije danas je najvažnija procedura u dijagnostici osteoporoze. A praćenjem biohemijskih markera koštanog prometa može se steći bliži uvid u metabolizam koštanog tkiva i proceniti nivo ukupnog formiranja ili razgradnje koštanog tkiva u datom trenutku. Cilj: Osnovni cilj ovog istraživanja je identifikacija i kvantifikacija faktora koji su udruženi sa poremećajima ispitivanih biohemijskih markera homeostaze kostiju kod lečenih bolesnika sa psihotičnim poremećajima.

Patients with schizophrenia and other psychoses represent a population of individuals with an increased risk of bone homeostasis disorders and, consequently, osteoporosis and fractures. Possible mechanisms of disturbance of bone homeostasis in patients with schizophrenia are: hyperprolactinemia, hypogonadism, increased activity of interleukins, polydipsia, calcium imbalance, smoking, vitamin deficiency, inadequate nutrition, physical activity and reduced exposure to sunlight. The use of antipsychotic drugs is probably an independent risk factor for osteoporosis in patients with psychosis. Each of these factors individually, and their combination may be the reason for decrease in bone mineral density. Measurement of bone mineral density (bone mineral density-BMD) by densitometry is today the most important procedures in the diagnosis of osteoporosis. A monitoring of biochemical markers of bone turnover can gain a closer insight into the metabolism of bone tissue and to assess the overall level of formation or resorption of bone tissue at the time. The Objective: The main objective of this research is to identify and quantify the factors that are associated with disorders studied biochemical markers of bone homeostasis in treated patients with psychotic disorders. The procedure: The study was designed as a prospective, interventional, non-therapeutic research for a period of 4 weeks. The study involved patients treated for psychotic disorders at the Department of Psychiatry, Clinical Center Kragujevac. The blood samples of patients were determined: ions (calcium, phosphorus and magnesium), enzymes (alkaline phosphatase), serum proteins (albumin), hormones (PTH, vitamin D3, calcitonin, troksin and thyroid-stimulating hormone) and biochemical markers of bone turnover (osteocalcin, PINP and β-cross laps). All study subjects were measured and bone mineral density using densitometry to assess the level of osteoporosis or osteopenia.