Резюме
Поворознюк В.В., Гаркуша М.А. Остеопороз хребта у жінок в постменопаузальному періоді з переломами Коліса в анамнезі.
В статті представлені результати визначення мінеральної щільності кісткової тканини на рівні поперекового відділу хребта у 72 пацієнток з переломом дистального відділу кісток передпліччя в анамнезі. Доведено, що МЩКТ на рівні поперекового відділу хребця вірогідно нижче у обстежених хворих в порівнянні з практично здоровими жінками відповідного віку. Частота остеопорозу у пацієнток з переломом кісток дистального відділу достовірно вища в порівнянні з особами контрольної групи.
Ключові слова: мінеральна щільність кісткової тканини, перелом кісток дистального відділу передпліччя, поперековий відділ хребта.

Резюме
Поворознюк В.В., Гаркуша М.А. Остеопороз позвоночника у женщин в постменопаузальном периоде с переломами Колиса в анамнезе.
В статье представлены результаты определения минеральной плотности костной ткани на уровне проксимального отдела бедренной кости у 72 пациенток с переломом дистального отдела костей предплечья в анамнезе. Доказано, что МПКТ поясничного отдела позвоночника достоверно ниже у обследованных больных по сравнению с практически здоровыми женщинами соответствующего возраста. Частота остеопороза у пациенток с переломом костей дистального отдела достоверно выше по сравнению с лицами контрольной группы.
Ключевые слова: минеральная плотность костной ткани, перелом костей дистального отдела предплечья, поясничный отдел позвоночника.

Summary
Povoroznуuk V.V., Garkusha M.A. Osteoporosis spine in postmenopausal women with Colles’ fractures.
The article presents the results of the determination of bone mineral density at the level of proximal region of thigh bone in 72 patients with a fracture of the distal forearm in history. Proved that the bone mineral density of the spine were significantly lower in the patients examined, compared to healthy women of the same age. The frequency of osteoporosis in patients with fractures of the distal forearm was significantly higher compared with those of control group.
Key words: bone mineral density, fracture of the distal forearm, the lumbar region of spine.

Рецензент: д.мед.н. О.І. Нішкумай

УДК 616:71-007.234-053.8/9

ДУ «Інститут геронтології АМН України», Український науково-медичний центр проблем остеопорозу (Київ)

D.F.Chebotarev State Institute of Gerontology NAMS of Ukraine, Ukrainian scientific medical center of osteoporosis

okfpoda @ ukr.net

 Osteoporosis harms from the third to the half of all postmenopausal women. Nowadays in the world it is diagnosed in approximately 200 million women, in 20-25% of women after age 50 there is one or more fractures of bodies of vertebra.

The direct reason of postmenopausal osteoporosis development is the deficit of oestrogens, which develops for women after menopause, which results in the substantial loss of bone tissue. From data of dual-energy X-ray absorptiometry for women of Ukrainian population osteoporosis appears at the level of spine in 20 % and at the level of forearm in 24% examined women. (Povoroznyuk V.V., 2009). In four from 10 women after age 50 one or more osteoporotic fractures develop during all life.

 Colles’ fracture is the most widespread osteoporotic fracture for postmenopausal women. Prospective researches showed that patients with substantial fracture in the future for certain have higher risk of vertebral fractures and fractures of thigh bone (Povoroznyuk V.V., 2009; Cummings S.R. et al., 1985; Kanis J., 2004). Up to now in the world there are only isolated researches concerning the learning of the role of bone tissue structure functional state as a predicator of distal forearm fractures. (Myers T.A., Briffa N.K., 2003; Blake G.M. et al., 2003; Melton J.I. et al., 2007) and, in the future, more threatening vertebral fractures and fractures of proximal part of the thigh bone. However, the majority of them are executed with the use of peripheral densitometers (Wigderowitz C.A. et al., 2003; Povoroznyuk V.V. with co-author., 1998) which do not give possibility to estimate the mineral density of axial skeleton. The above mentioned stipulated the implementation of this research.

 Purpose of work is to learn the bone mineral density of axial skeleton (at the level of the lumbar region of the spout for postmenopausal women with Colles’ fracture and its connection with age and anthropometric characteristics of the examined.

 Research object and research methods. In the department of clinical physiology and pathology of locomotor apparatus of State Institution « D.F. Chebotarev Institute of gerontology of National Academy Of Medical Science of Ukraine» the research of the bone mineral density at the level of lumbar region of spine (L₁-L₄ ) is done for 144 postmenopausal women (72 are women without fractures in history; 72 are women with low-energy Colles’ fractures with the fractures no more than 3 years). During the examination of the women using the questionnaire of WHO the anamnestic data in relation to the character of the fracture, the presence of other diseases and factors of risk of osteoporosis were collected. From the examination we\they eliminated the women who during a post fracture period took drugs which substantially influence on the metabolism of bone tissue (hormone replacement therapy, bisphosphonates, calcitonin, strontium ranelate) or medicines which influence on the metabolism of bone tissue, patients with heavy concomitant pathology.

 The examination of the state of bone tissue, the diagnostics of osteoporosis for all women was conducted using dual-energy X-ray densitometer «Prodigy» (GE Medical systems, model 8743, 2005). The bone mineral density at the level of lumbar region of spine (L₁-L₄) was determined.

 Statistical analysis was conducted with the use of packages of softwares «Microsoft Exсel 2000» та « Statistiсa 6,0».

 Results of research and their discussion.

 Clinical and demographic characteristics of patients, included in the research, are shown in table. 1. Mass of a body and Body Mass Index in the examined with Colles’ fractures in history were for certain higher as compared to the representatives of control group (CG). Groups did not differ in age and in anthropometric information.

Table 1. Clinical description of the examined women subject to the presence of Colles’ fractures in history.

         Notes: results are presented as M±m;

 The bone mineral density, indexes of T and Z were for certain higher for the women with Colles’ fractures in history (table. 2).

Yes, for patients with Colles’ fractures the bone mineral density was lower as compared to the patients without fractures by 12,7%.

 Table 2. Indexes of the bone mineral density in the lumbar region of spine depending on the presence of Colles’ fractures in history.      

Notes: results are presented as M±m; possible differences comparing with the patients of control group are set off in a bold face.

 The connection between the bone mineral density of the lumbar region of spine and age, growth and mass of a body of the examined was determined (Picture. 1, 2). Unlike previous researches (Povoroznyuk V.V. and others., 1999) for the patients of control group without fractures it was found possible connection between the index of the bone mineral density of the lumbar region of spine and age (the bone mineral density =1,37 - 0,0036 × years; r = - 0.287; t = 2,797; p = 0,006) and mass of a body (the bone mineral density =0,9424 + 0,0028 × mass(kg); r = 0,21; t = 2,045; p = 0,043). Contrariwise, for postmenopausal women with Colles’ fractures possible correlation between the index of the bone mineral density of lumbar region of spine and age were not found (the bone mineral density =1,15 - 0,0024 ×years; r = - 0,21; t = 1,982; p = 0,051), mass of a body (the bone mineral density =0,8573±0,0022 ×mass (kg); r = 0,199; t = 1.876; p = 0,064). Possible connections between the bone mineral density and height in both groups of the examined were not found.

Figure. 1. Correlation between the indexes of the bone mineral density of the lumbar region of spine (L₁-L₄ ) and age for the examined patients in a postmenopausal period with Colles’ fracture and without osteoporotic fractures in history.

 Figure. 2. Correlation between the indexes of the bone mineral density of the lumbar region of spine (L₁-L₄ ) and age for the examined patients in a postmenopausal period with Colles’ fracture and without osteoporotic fractures in history.

 Among all the examined we distinguished groups of patients with normal bone tissue, osteopenia and postmenopausal osteoporosis, in accordance with the diagnostic criteria of WHO. The results of this distribution are presented in figure 3.

 Figure 3. The distribution of patients in the bone mineral density of the lumbar region of spine (L₁-L₄ ) (norm, osteopenia, osteoporosis) for the examined postmenopausal women with Colles’ fracture and without them.

Notes: 1. normal bone mineral density; 2. osteopenia; 3. osteoporosis.

 Among patients with Colles’ fractures in a postmenopausal period osteoporosis of the lumbar region of spine was found in 17 examined women (17,2%), osteopenia in 32 women (36,8%), normal bone mineral density in 40 women (46%). For patients without fractures osteoporosis at the level of lumbar region of spine was found only in 7 persons(6,8%), osteopenia in 23 women (26,1%), normal bone mineral density in 59 examined women (67,1%).

 Conclusion. Thus the bone mineral density of the lumbar region of spine (L₁-L₄ ) for the examined postmenopausal women with Colles’ fractures is for certain lower (by 12,8%) comparing to the women without fractures. The frequency of osteoporosis of spine is 17,2% for patients with Colles’ fractures and 6,8% without fractures. These results confirm the importance of monitoring of the state of bone tissue and preventive medical measures for this contingent for the purpose of warning of osteoporotic vertebral fractures.

Література

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