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Редак^я журналу «Б'ть. Суглоби. Хребет» eimae aemopie нижченаведеноi статт'1 з визначною под'кю: на 20-й М'жнароднш конференцн з ожир'1ння (2018:20th International Conference on Obesity), що в1дбулася 14-15 травня 2018 року у Лондон (Велика Бриташя), стаття «Associations between Metabolic Syndrome and Bone Mineral Density, Trabecular Bone Score in Postmenopausal Women with Non-Vertebral Fractures» (автори: Vladyslav Povoroznyuk, Larysa Martynyuk, Iryna Syzonenko, Liliya Martynyuk) була визнана найкращою роботою, про що авторам був виданий в'гдпов'дний еертиф'1кат.
UDK616.71-007.23-001.5-008.6/.9:618.173 DOI: 10.22141/2224-1507.8.3.2018.144643
Vladyslav Povoroznyuk1, Larysa Martynyuk2, Iryna Syzonenko3, Liliya Martynyuk2
'State Institution "D.F. Chebotarev Institute of Gerontology of the NAMS of Ukraine", Kyiv, Ukraine
2 State Institution of Higher Education "I. Horbachevsky Ternopil State Medical University", Ternopil, Ukraine
3Kyiv Municipal Center for Radiation Protection of Citizens Affected by the Chernobyl Disaster, Kyiv, Ukraine
Associations between Metabolic Syndrome and Bone Mineral Density, Trabecular Bone Score in Postmenopausal Women with Non-Vertebral
Fractures
For cite: Bol', sustavy, pozvonocnik. 2018;8(3):117-123. doi: 10.22141/2224-1507.8.3.2018.144643
Abstract. Background. Medical, social and economic relevance of osteoporosis is caused by reducing quality of life, increasing disability and mortality of the patients as a result of fractures due to the low-energy trauma. This study is aimed to examine the associations of metabolic syndrome components, bone mineral density (BMD) and trabecular bone score (TBS) in menopausal women with non-vertebral fractures. Materials and methods. 1161 menopausal women aged 50-79 years were examined and divided into three groups: group A included 419 women with increased body weight (body mass index (BMI) — 25.0-29.9 kg/m2), group B — 442 females with obesity (BMI > 29.9 kg/m2) and group C — 300 women with metabolic syndrome (diagnosis according to International Diabetes Federation criteria, 2005). Dual-energy X-ray absorptiometry (Prodigy, GE Medical systems, Lunar, Madison, WI, USA, 2005) was used for measuring lumbar spine (L,-L4), femoral neck, total body and forearm BMD and bone quality indexes (last using Medimaps software). Data were analyzed using Statistica 6.0 package. Results. A significant increase of lumbar spine (L,-L4), femoral neck, total body and ultradistal radius BMD was found in women with obesity and metabolic syndrome compared to the pre-obese ones (p < 0.001). TBS was significantly higher in women with increased body weight compared to obese and metabolic syndrome patients. Analysis showed a significant positive correlation between waist circumference, triglycerides level and BMD of lumbar spine and femur. Significant negative association was found between serum high-density lipoproteins (HDL) level and BMD of investigated sites. Conclusions. The TBS (L,-L4) indexes positively correlated with HDL level. Despite the fact that BMD indexes were better in women with metabolic syndrome, the frequency of non-vertebral fractures was significantly higher in this group of patients.
Keywords: bone mineral density; trabecular bone score; metabolic syndrome; fracture
боль.
суставы. позвоночник
Introduction
Osteoporosis and metabolic syndrome are important public health problems, due to the decreasing of quality and reducing life expectancy of patients as a result of low-trauma fractures in a case of osteoporosis and the possibility of cardiovascular, endocrine and other complications in a case of metabolic syndrome development [1, 5]. The frequency of both diseases increases with age of patient
and duration of menopausal period as a result of slowdown in metabolism and estrogen deficiency development [8, 11].
Traditionally, osteoporosis is diagnosed according to the history of low-energy fractures or the results of bone mineral density (BMD) (T-score), which determine using X-ray densitometry [10]; however, BMD provides only 70—75 % of bone strength [12]. Other factors that affect it
© «Бшь. Суглоби. Хребет» / «Боль. Суставы. Позвоночник» / «Pain. Joints. Spine» (<ЯоГ, sustavy, pozvonocnik»), 2018 © Видавець Заславський О.Ю. / Издатель Заславский А.Ю. / Publisher Zaslavsky O.Yu., 2018
Для кореспонденци: Поворознюк Владислав Володимирович, доктор медичних наук, професор, ДУ «1нститут геронтологи iменi Д.Ф. Чеботарьова НАМН Укра'1'ни», вул. Вишгородська, 67, м. Ки'в, 04114, Укра'на; e-mail: okfpodac@ukr.net
For correspondence: Vladislav Povoroznyuk, MD, PhD, Professor, State Institution "D.F. Chebotarev Institute of Gerontology of the NAMS of Ukraine'; Vyshgorodska st., 67, Kyiv, 04114, Ukraine; e-mail: okfpodac@ukr.net
include state of cortical bone macro-geometry and trabecular bone micro-architecture, presence damages and cracks in it, which can be calculated by index trabecular bone score (TBS), patented by MED-I maps (m. Bordeaux, France) in 2006 [3]. In our opinion, evaluation of TBS is important to perform this work.
Scientists paid much attention to the study of the relationships between metabolic syndrome and osteoporosis. Abdominal obesity, high glucose (as a result of insulin deficiency or insulin resistance), high triglycerides and low high density lipoproteins which are the main components of metabolic syndrome have significant impact on bone tissue and fractures development but published research results are contradictory [4, 7, 13, 15]. The discrepancy of opinions prompted this investigation.
The purpose of our study was to evaluate the relationships between metabolic syndrome components and BMD, TBS in postmenopausal women with low-trauma non-vertebral fractures.
Materials and methods
The study involved 1161 postmenopausal women aged 50—79 years (mean age — 63.977 ± 7.961 years; mean body mass index — 31.587 ± 4.739 kg/m2; mean waist circumference — 92.524 ± 11.466 cm; mean duration of menopause period — 13.858 ± 8.014). Patients were divided into three groups: A — 419 women with increase body weight (pre-obese) defined on the basis of WHO criteria [14], BMI 25.0-29.9 kg/m2 (mean age — 63.983 ± 8.283 years; mean body mass index — 27.547 ± 1.906 kg/m2; mean waist circumference — 79.995 ± 4.511 cm; mean duration of menopause period — 13.809 ± 8.004), B — 442 women with obesity — BMI > 30.0 kg/m2 (mean age — 63.884 ± 7.619 years; mean body mass index — 34.418 ± 3.864 kg/m2; mean waist circumference — 100.464 ± 6.726 cm; mean duration of menopause period —
13.627 ± 7.847), C — 300 female with metabolic syndrome (diagnosed according to the International Diabetic Federation criteria of 2005) [6] (mean age — 64.163 ± 8.017; mean body mass index — 33.058 ± 4.812 kg/m2; mean waist circumference — 98.323 ± 8.244 cm; mean duration of menopause period — 14.267 ± 8.280). Additionally groups were divided according to the presence of low-trauma non-vertebral fractures (202 female had them in history (NVF) and 959 women were without fractures (WF) in the past).
BMD of lumbar spine (Lt-L4), femoral neck, total body and forearm was measured by the DXA method (Prodigy, GE Medical systems, Lunar, Madison, WI, USA, 2005).
TBS at the Lj-L4 was evaluated by TBS iNsight® software (Med-Imaps, Pessac, France) which was installed on DXA machine.
One-way ANOVA test and correlation analysis were performed with usage of Statistical Package 6.0 ©StatSoft, Inc, results presented as M ± SD. Associations between continuous variables were examined by Pearson correlation coefficient, significance set at p < 0.05.
Results and discussion
We found that women with increased body weight have a significantly lower BMD of lumbar spine (A — 0.986 ± 0.178 g/cm2, B — 1.109 ± 0.181 g/cm2; C — 1.120 ± 0.199 g/cm2; F = 63.814; p < 0.001); femoral neck (A — 0.809 ± 0.126 g/cm2, B — 0.872 ± 0.134 g/cm2; C — 0.880 ± 0.149 g/cm2; F = 32.097; p < 0.001), total body (A — 0.876 ± 0.139 g/cm2, B — 0.968 ± 0.146 g/cm2; C — 0.978 ± 0.160 g/cm2; F = 57.366; p < 0.001) and ultra-distal forearm (A — 0.378 ± 0.076 g/cm2, B — 0.436 ± 0.080 g/cm2; C — 0.435 ± 0.088 g/cm2; F = 67.582; p < 0.001) compared to women with obesity and metabolic syndrome. The bone tissue quality (TBS Lt-L4) was significantly
Table 1. Bone mineral density of lumbar spine (L—L4) in groups of women
Groups of patients Subgroups of patients BMD lumbar spine (Lt-L4), g/cm2 P
A Without fractures (n = 358) 0.992 ± 0.180 > 0.05
With non-vertebral fractures (n = 61) 0.955 ± 0.164
B Without fractures (n = 365) 1.119 ± 0.183 < 0.001
With non-vertebral fractures (n = 77) 1.059 ± 0.163
C Without fractures (n = 236) 1.139 ± 0.199 < 0.001
With non-vertebral fractures (n = 64) 1.052 ± 0.860
Groups of patients Subgroups of patients BMD femoral neck, g/cm2 P
A Without fractures (n = 358) 0.814 ± 0.130 > 0.05
With non-vertebral fractures (n =61) 0.780 ± 0.101
B Without fractures (n = 365) 0.879 ± 0.135 < 0.001
With non-vertebral fractures (n = 77) 0.834 ± 0.119
C Without fractures (n = 236) 0.888 ± 0.153 > 0.05
With non-vertebral fractures (n = 64) 0.852 ± 0.133
Table 2. Bone mineral density of femoral neck in groups of women
higher in women with increased weight in comparison with metabolic syndrome female (A — 1.188 ± 0.151, B — 1.169 ± 0.163; C — 1.157 ± 0.173 g/cm2; F = 3.479; p < 0.05).
BMD of lumbar spine (Lt-L4) was significantly higher in patients of groups B and C without fractures (table 1).
BMD of femoral neck was significantly lower in female with obesity and non-vertebral fractures (table 2). BMD of total body and ultradistal radius significantly better in all groups of women without fractures compared to patients with non-vertebral fractures (table 3, 4). TBS (Lt-L4) was significantly higher in patients without fractures in the groups of
Table 3. Bone mineral density of total body in groups of women
Groups of patients Subgroups of patients BMD total body, g/cm2 P
A Without fractures (n = 358) 0.884 ± 0.140 < 0.001
with non-vertebral fractures (n = 61) 0.832 ± 0.119
B Without fractures (n = 365) 0.977 ± 0.148 < 0.001
With non-vertebral fractures (n = 77) 0.928 ± 0.129
C Without fractures (n = 236) 0.991 ± 0.163 < 0.001
With non-vertebral fractures (n = 64) 0.931 ± 0.140
Table 4. Bone mineral density of ultradistal radius in groups of women
Groups of patients Subgroups of patients BMD ultradistal radius, g/cm2 P
A Without fractures (n = 358) 0.382 ± 0.077 < 0.05
With non-vertebral fractures (n = 61) 0.354 ± 0.071
B Without fractures (n = 365) 0.442 ± 0.079 < 0.001
With non-vertebral fractures (n = 77) 0.410 ± 0.083
C Without fractures (n = 26) 0.442 ± 0.088 < 0.001
With non-vertebral fractures (n = 64) 0.407 ± 0.842
Table 5. Trabecular bone score (L1-L4) in groups of women
Groups of patients Subgroups of patients TBS (L^LJ P
A Without fractures (n = 358) 1.194 ± 0.151 < 0.05
With non-vertebral fractures (n = 61) 1.152 ± 0.439
B Without fractures (n = 365) 1.179 ± 0.150 < 0.001
With non-vertebral fractures (n = 77) 1.119 ± 0.171
C Without fractures (n = 236) 1.156 ± 0.177 > 0.05
With metabolic syndrome (n = 73) 1.158 ± 0.156
Table 6. Triglycerides level in groups of women
Groups of patients Subgroups of patients Triglycerides level, mmol/l P
A Without fractures (n = 358) 1.057 ± 0.393 > 0.05
With non-vertebral fractures (n = 61) 0.996 ± 0.288
B Without fractures (n = 365) 1.035 ± 0.332 > 0.05
With non-vertebral fractures (n = 77) 1.006 ± 0.273
C Without fractures (n = 236) 1.643 ± 0.708 > 0.05
With non-vertebral fractures (n = 64) 1.465 ± 0.668
Table 7. HDL level in groups of women
Groups of patients Subgroups of patients HDL level, mmol/l P
A Without fractures (n = 358) 1.523 ± 0.037 > 0.05
With non-vertebral fractures (n = 61) 1.579 ± 0.327
B Without fractures (n = 365) 1.501 ± 0.319 > 0.05
With non-vertebral fractures (n = 77) 1.546 ± 0.272
C Without fractures (n = 236) 1.148 ± 0.229 < 0.001
With non-vertebral fractures (n = 64) 1.252 ± 0.325
women with increased body weight and obesity (p < 0.05) (table 5).
The analysis of the metabolic syndrome laboratory components (serum triglycerides and HDL indexes) was carried out. We established significantly higher triglycerides level (A — 1.049 ± 0.381 g/cm2, B — 1.030 ± 0.322 g/cm2; C — 1.605 ± 0.703 g/cm2; F = 162.669; p < 0.001) and significantly lower HDL level (A — 1.531 ± 0.372 g/cm2, B —
1.509 ± 0.314 g/cm2; C — 1.170 ± 0.256 g/cm2; F = 126.832; p < 0.001) in patients with metabolic syndrome. There was no difference of triglycerides level in female with non-vertebral fractures and without them in all investigated groups (table 6). The level of HDL was significantly lower in patients with non-vertebral fractures and metabolic syndrome (table 7).
In analysis of metabolic syndrome components, the waist circumference component was positively associated with
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Figure 4. Frequency of low-trauma vertebral fractures in women with increase bode weight (A), obesity (B) and with metabolic syndrome (C)
Low-trauma non-vertebral fractures occurred in 14.6 % female with increased body weight, 17.4 % of women with obesity and 21.3 % of patients with metabolic syndrome.
It was not found significant differences in the frequency of non-vertebral fractures in the groups of women with obesity and increased body weight or metabolic syndrome (X2 = 1.312, p > 0.05 and X2 = 1.780, p > 0.05, respectively), but it was significant in the groups of pre-obese female and patients with metabolic syndrome (X2 = 5.590, p < 0.05). The similar results were found by other investigators [9].
Conclusions
Menopausal women with obesity and metabolic syndrome have a significantly higher BMD at all measured sites compared to females with pre-obesity. TBS is significantly lower in women with non-vertebral fractures and increased body weight or obesity. A significant positive correlation is established between waist circumference, triglycerides level and BMD of lumbar spine and femoral neck. Correlation between HDL level and BMD at all levels is significant and negative. At the same time it is positively associated with TBS indexes. There is no significant difference in frequency of low-trauma non-vertebral fractures in the groups of pre-obese and obese women. At the same time, the incidence of osteoporotic non-vertebral fractures is significantly higher in female with metabolic syndrome in compared to other patients Metabolic syndrome may not protect from any type of fractures but future investigations are necessary.
Conflicts of interests. Authors declare the absence of any conflicts of interests that might be construed to influence the results or interpretation of their manuscript.
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Received 20.08.2018 ■
Поворознюк Владислав1, МартынюкЛариса2, Сизоненко Ирина3, Мартынюк Лилия2 1ГУ«Институт геронтологии им. Д.Ф. Чеботарева НАМН Украины», г. Киев, Украина
2ГВУЗ «Тернопольский государственный медицинский университет имени И.Я. Горбачевского», г. Тернополь, Украина 3Киевский городской центр радиационной защиты граждан, пострадавших вследствие Чернобыльской катастрофы, г. Киев, Украина
Связь метаболического синдрома и минеральной плотности костной ткани, показателя качества трабекулярной костной ткани у женщин в постменопаузальном периоде с невертебральными переломами
Резюме. Актуальность. Медицинская, социальная и экономическая значимость остеопороза обусловлена снижением качества жизни, увеличением инвалидности и смертности пациентов в результате переломов, вызванных низкоэнергетической травмой. Цель исследования: изучить корреляцию компонентов метаболического синдрома, минеральной плотности костной ткани (МПКТ) и показателя качества трабекулярной костной ткани (trabecular bone score — TBS) у женщин в постме-нопаузальном периоде с невертебральными переломами. Материалы и методы. Пациентки в постменопаузальном периоде в возрасте 50—79 лет (n = 1161) были обследованы и разделены на три группы: в группу А вошли 419 женщин с повышенной массой тела (индекс массы тела (ИМТ) — 25,0-29,9 кг/м2), группу Б — 442 женщины с ожирением (ИМТ > 29,9 кг/м2) и в группу В — 300 женщин с метаболическим синдромом (диагноз установлен согласно критериям Международной федерации диабе-
та, 2005). Двухэнергетическая рентгеновская абсорбцио-метрия (Prodigy, GE Medical systems, Lunar, Madison, WI, USA, 2005) использовалась для определения МПКТ поясничного отдела позвоночника (Lj—L4), шейки бедренной кости, всего скелета и предплечья и показателей качества костной ткани (последних — с помощью программного обеспечения Medimaps). Данные анализировались с помощью программы Statistica 6.0. Результаты. Значительное увеличение МПКТ поясничного отдела позвоночника (Lj—L4), шейки бедренной кости, всего скелета и ультрадистального отдела лучевой кости было обнаружено у женщин с ожирением и метаболическим синдромом в отличие от пациенток с предожире-нием (p < 0,001). TBS был значительно выше у женщин с избыточной массой тела по сравнению с пациентками с ожирением и метаболическим синдромом. Анализ показал значительную положительную корреляцию между окружностью талии, уровнем триглицеридов и МПКТ
поясничного отдела позвоночника и бедренной кости. Установлена значительная отрицательная связь между уровнем липопротеинов высокой плотности (ЛПВП) в сыворотке крови и МПКТ исследуемых участков. Выводы. TBS (Lj—L4) положительно коррелирует с уровнем ЛПВП. Несмотря на то что показатели МПКТ были луч-
ше у женщин с метаболическим синдромом, частота не-вертебральных переломов в этой группе была значительно выше.
Ключевые слова: минеральная плотность костной ткани; показатель качества трабекулярной костной ткани; метаболический синдром; перелом
Поворознюк Владислав1, Мартинюк Лариса2, Сизоненко 1рина3, Мартинюк ЛШя2 ДЗ «1нститут геронтологи iM. Д.Ф. Чеботарьова НАМНУкраУни», м. КиУв, УкраУна
2ДВНЗ «Тернопльський державний медичний унiверсиmеm iMern 1.Я. Горбачевського», м. Тернопль, УкраУна 3КиУвський мкький центр радiацiйного захисту громадян, постраждалих внаслiдок ЧернобильськоУ катастрофи, м. КиУв, УкраУна
Зв'язок метаболiчного синдрому i мшеральноТ щмьносп кктковоТ тканини, показника якосп трабекулярноТ кктковоТ тканини в жшок у постменопаузальному
перiодi з невертебральними переломами
Резюме. Актуальшсть. Медична, сощальна й eKOHOMi4-на значимють остеопорозу обумовлена зниженням якоста життя, збшьшенням швалщноста та смертноста пащентав у результат переломiв, викликаних низькоенергетичною травмою. Мета дослдження: вивчити корелящю компо-нентiв метаболiчного синдрому, мшерально! щiльностi шстково! тканини (МЩКТ) i показника якостi трабеку-лярно! кютково! тканини (trabecular bone score — TBS) у жшок у постменопаузальному перiодi з невертебральними переломами. Матерiали та методи. Пацieнтки в постменопаузальному перiодi вiком 50—79 рошв (n = 1161) були обстеженi i розподiленi на три групи: до групи А увь йшли 419 жiнок iз пiдвищеною масою т1ла (iндекс маси тала (1МТ) — 25,0—29,9 кг/м2), групи Б — 442 жшки з ожи-рiнням (1МТ > 29,9 кг/м2) i до групи В — 300 жшок iз ме-таболiчним синдромом ^агноз установлений вiдповiдно до критерив Мгжнародно! федераци дiабету, 2005). Двох-енергетична рентгешвська абсорбцiометрiя (Prodigy, GE Medical systems, Lunar, Madison, WI, USA, 2005) викорис-товувалася для визначення МЩКТ поперекового вщдь лу хребта (L1—L4), шийки стегна, всього скелету i перед-плiччя i показниыв якостi шстково! тканини (останнiх —
за допомогою програмного забезпечення Medimaps). Да-нi аналiзувалися за допомогою програми Statistica 6.0. Ре-зультати. Значне зб1льшення МЩКТ поперекового вщдь лу хребта (Lj—L4), шийки стегново! кiстки, всього скелету i ультрадютального вiддiлу променево! кустки було вияв-лено в жшок з ожиршням i метаболiчним синдромом на вщмшу вiд пацieнток iз предожирiнням (p < 0,001). TBS був значно вищим у жiнок iз тдвищеною масою тiла по-рiвняно з пащентками з ожирiнням i метаболiчним синдромом. Аналiз показав значну позитивну кореляцiю мiж окружнiстю тали, рiвнем триглiцеридiв i МЩКТ поперекового вщдшу хребта i стегново! ыстки. Установлений значний негативний зв'язок м!ж рiвнем лшопроте!шв ви-соко! щiльностi (ЛПВЩ) у сироватцi кровi та МЩКТ до-слiджуваних дшянок. Висновки. TBS (L1—L4) позитивно корелюе з рiвнем ЛПВЩ. Незважаючи на те що показни-ки МЩКТ були кращими в жшок iз метаболiчним синдромом, частота невертебральних переломiв у цiй групi була значно вищою.
K™40ßi слова: мiнеральна щiльнiсть кiстково'í тканини; показник якостi трабекулярно! шстково! тканини; мета-болiчний синдром; перелом
