CC BY
14
Практична медицина / Practical Medicine
БШЬ.
СуГЛОБИ. JOINTS. I ХРЕБЕТ SPINE I
УДК616.153.857-008.61 DOI: 10.22141/2224-1507.10.1.2020.199725
G.S. Dubetska
State Institution D.F. Chebotarev Institute of Gerontology by the NAMS of Ukraine, Kyiv, Ukraine
Bone mineral density and trabecular bone score, hyperuricemia and metabolic syndrome in postmenopausal women
For citation: Bol', sustavy, pozvonocnik. 2020;10(1):57-60. doi: 10.22141/2224-1507.10.1.2020.199725_
Abstract. The article presents the results of independent study of hyperuricemia peculiarities among the women in postmenopausal period, taking into account indicators of body mass index, lipid metabolism and bone mineral density. The higher level of uric acid was found among women in postmenopausal period with maximal body mass index (BMI > 35), with the highest degree of obesity. Significant correlation was determined between uric acid and triglyceride (r = 0.26, p < 0.05), atherogenic coefficient (r = 0.24, p < 0.05) among women in postmenopausal period. The incidence of osteoporosis in women with hyperuricemia was lower than the one of women who had a normal rate of uric acid: 19 % and 34 % at the level of lumbar spine, and 17 % and 21 % at the level of femoral neck.
Keywords: hyperuricemia; uric acid; obesity; body mass index; lipid metabolism; metabolic syndrome; bone mineral density; trabecular bone score
Introduction
According to the European League against Rheumatism (EULAR)'s recommendation, hyperuricemia is an uric acid level increase over 360 mcmol/l in women and 420 mcmol/l in men [1]. The prevalence of this pathology among the world's population is 5-12% [2, 3]. Taking into account a large number of references on the uricosuric estrogen properties preventing hyperuricemia in women, studies of uric acid level in the postmenopausal individuals gains more prominence each year [2, 4]. Gout is known to develop in women during menopause, accompanied by the diuretic use (in order to treat the arterial hypertension or to achieve weight loss). The prevalence of uric acid metabolism disorders in women over 50 is 35% [5]. There is a well-documented association of hyperuricemia and endothelial dysfunction (promoting atherosclerosis) and oxidative stress (promoting atherosclerotic plaques) [6, 7, 8, 9]. According to the National Collaborating Center for Primary Care (2006), obesity with a body mass index (BMI) > 30 results in hyperuricemia's risk rising by 2-3 times in adults [1, 10]. Despite the fact that the uric acid is referred to as a risk factor of various diseases, namely a metabolic syndrome, scien-
tific findings reveal a positive influence of hyperuricemia on bone metabolism [11, 12]. For instance, it is stated that uric acid has antioxidant properties while oxidative stress is often blamed for its negative impact on bone tissue.
As of today, in Ukraine there are few studies documenting BMD values of patients with various uric acid rates. The US and Australian scientists proved a lower fracture frequency and higher BMD in patients with elevated uric acid rates; they also claim oxidative stress as a key pathogenic factor explaining this fact. Thus, knowing an individual uric acid rate, one may predict a likelihood of osteopenia, osteoporosis and fractures, performing a primary diagnostics of these conditions in the localities where there are no accessible diagnostic tools for osteoporosis.
Our aim is to study the structural-functional bone state (bone mineral density, bone quality) and components of metabolic syndrome in postmenopausal women with various uric acid rates.
Materials and methods
The study was held at the Department of Clinical Physiology and Pathology of Locomotor Apparatus, State Insti-
© 2020. The Authors. This is an open access article under the terms of the Creative Commons Attribution 4.0 International License, CC BY, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
Для кореспонденци: Дубецька Г.С., кандидат медичних наук, вщдш шшчно!' фЫологй та патологи опорно-рухового апарату, ДУ «1нститут геронтологи' ¡м. Д.Ф. Чеботарьова НАМН Укра'ни», вул. Вишгородська, 67, м. Ки'в, 04114, Укра'на. e-mail: [email protected]
For correspondence: G.S. Dubetska, PhD, Department of clinical physiology and pathology of locomotor apparatus, State Institution "D.F. Chebotarev Institute of Gerontology by the NAMS of Ukraine'; Vyshgorodska st., 67, Kyiv, 04114, Ukraine. e-mail: [email protected] Full list of author information is available at the end of the article.
tution "D.F Chebotaryov Institute of Gerontology" by the NAMS of Ukraine and the Ukrainian Scientific-Medical Center of Osteoporosis. 412 postmenopausal women were examined, among whom 4 groups were determined depending on their BMI: I group (BMI=18.5-24.9) - normal, II group (BMI=25.0-29.9) — pre-obesity, III group (BMI=30.0-34.9) — obesity of Type I, IV group (BMI>35) - obesity of Type II. According to the uric acid blood serum rate, 4 groups were further outlined by quartile method: Q1 < 235 mcmol/l, Q2 = 235-281 mcmol/l, Q3 = 282-329 mcmol/l, Q4 > 329 mcmol/l.
Determining the uric acid blood serum rate required (uricase-peroxidase) enzymatic method and spectrophoto-metric analysis.
Determining the total spine BMD, lumber spine BMD, femoral BMD, Ward triangle, hip and radius BMD was performed by means of «Prodigy» mechine (CE Medical systems, model 8743, 2005).
Trabecular bone quality (TBS (L1-L4)) was measured by the installed TBS iNsight® software and X-ray densitometer (Med-Imaps, Pessac, France).
Statistical analysis included parametric and non- parametric criteria and required Statistica 6.0 software and Microsoft Office Excel.
Results and discussion
Our results show the highest uric acid blood serum rates in postmenopausal women with the highest BMI (BMI>35), i.e. the highest obesity rate. Furthermore, in the I group this parameter was 277.52 ± 8.40 mcmol/l; in the II group — 286.81 ± 7.79 mcmol/l; in the III group — 291.81 ± 7.56 mcmol/l; in the IV group — 327.17 ± 12.17 mcmol/l. The frequency of hyperuricemia among the postmenopausal women was: in the I group — 10.2 %; in the II group — 15.9 %; in the III group — 21.2 %; in the IV group — 34.2 %.
A significant dependence between the uric acid rate and body mass was determined in postmenopausal women (r=0.21, p<0.05) (Fig. 1).
It was found that postmenopausal women manifest a significant dependence between some lipid metabo-
lism parameters, namely very-low-density lipopro-teins (VLDLs) (r=0.40, p<0.05), triglycerides (r=0.26, p<0.05) and atherogenicity coefficient (r=0.24, p<0.05) (Fig. 2,3,4).
It was revealed that the osteoporosis frequency was lower in the group of patients with hyperuricemia compared to patients with normal uricemia. Thus, in the hyperuricemia group it was 19 % while in the normal uricemia group it was 34 % at the lumbar spine level, 17 and 21 % at the femoral neck level, respectively. The osteopenia frequency in the hyperuricemia group was 37 % at the lumbar spine level and 49 % at the femoral neck level, while in the normal uricemia group it was 30 % and 53 % respectively.
When the quartile analysis was used to distribute the uric acid rates, 4 groups of patients were determined (Q1 < 235 mcmol/l; Q2 = 235-281 mcmol/l; Q3 = 282329 mcmol/l; Q4 > 329 mcmol/l). A significant difference of femoral neck BMD values and ultradistal BMD levels was found between Q1 and Q4 groups (BMD Q1 = 0.789 g/cm2 and BMD Q4 = 0.842 g/cm2; BMD Q1 = 0.711 g/cm2 and BMD Q4 = 0.773 g/cm2, p < 0.05, respectively) (Fig.5).
The quartile analysis did not reveal any significant uric acid rate difference depending on bone quality between Q1 and Q4 groups (p > 0.05).
Our results point out the fact that patients with a high uric acid rate have a lower osteoporosis frequency, while the BMD values, namely at the femoral neck and ultradistal radius levels are significantly higher in those patients with higher uric acid rates in blood serum.
Postmenopausal age may be considered one of the risk factors for hyperuricemia's development. It is proved that postmenopausal women have a significant dependence of age, body mass and some lipid metabolism parameters. This is why, a conventional test for the uric acid rate may be considered an obligatory component of examination if a woman is over 50, in order to prevent cardiovascular pathologies, metabolic syndrome and other somatic disorders associated with a protracted hyperuricemia. There is a reliable correlation among the uric acid rate, body mass index, very-low-density lipoproteins (VLDLs), triglycerides and atherogenicity coefficient.
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Fig. 3. Association of uric acid rate and triglyceride rate in postmenopausal women
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Fig.5. Bone mineral density of femoral neck (A) and ultradistal radius (B) in post menopausal afe according to the quartile analysis
of uric acid levels
Notes: Q1 < 235 mcmol/l; Q2 = 235-281 mcmol/l; Q3 = 282-329 mcmol/l; Q4 > 329 mcmol/l; * - p < 0.05 - significant difference between Q1 and Q4 groups.
Conflicts of interests. Author declares the absence of any conflicts of interests and their own financial interest that might be construed to influence the results or interpretation of their manuscript.
References
1. Zhang W, Doherty M, Pascual E, et al. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65(10):1301—1311. https://doi.org/10.1136/ ard.2006.055251.
2. Maksudova AN, Salikhov IG, Khabirov RA, Khalfina TN, authors. Podagra [Gout]. 3th ed. Moskow: MEDpress-in-form; 2017. 112 p. (In Russian).
3. Lai SW, Tan CK, Ng KC. Epidemiology of hyperuricemia in the elderly. Yale J Biol Med. 2001;74(3):151—157.
4. Koga M, Saito H, Mukai M, Kasayama S, Yamamoto T. Factors contributing to increased serum urate in postmenopausal Japanese females. Climacteric. 2009;12(2):146—152. https://doi.org/10.1080/13697130802607719.
5. Dzyak GV, Khomazyuk TA. Podagra: «Kapkan» met-abolichnyh problem [Gout: "Trap" of metabolic problems]. Dnepropetrovsk: Royal Print; 2010. 112 p. (in Ukrainian).
6. Zhang M, Chang H, Gao Y, et al. Major dietary patterns and risk of asymptomatic hyperuricemia in Chinese adults. J Nutr Sci Vitaminol (Tokyo). 2012;58(5):339-345. https://doi. org/10.3177/jnsv.58.339.
7. Zoccali C, Mallamaci F. Uric acid, hypertension, and cardiovascular and renal complications. Curr Hypertens Rep. 2013;15(6):531—537. https://doi.org/10.1007/s11906-013-0391-y.
8. Ziaee A, Esmailzadehha N, Ghorbani A, Asefzadeh S. Association between Uric Acid and Metabolic Syndrome in Qazvin Metabolic Diseases Study (QMDS), Iran. Glob J Health Sci. 2012;5(1):155-165. https://doi.org/10.5539/gjhs. v5n1p155.
9. Zhang X, Lu Q, Zhang Z, et al. Value of three-dimensional speckle tracking echocardiography to assess left ventricular function in hyperuricemia patients. Clin Rheumatol. 2018;37(9):2539-2545. https://doi.org/10.1007/s10067-018-4132-0.
10. Yue JR, Huang CQ, Dong BR. Association of serum uric acid with body mass index among long-lived Chinese. Exp Gerontol. 2012;47(8):595-600. https://doi.org/10.1016/). exger.2012.05.008.
11. Ahn SH, Lee SH, Kim BJ, et al. Higher serum uric acid is associated with higher bone mass, lower bone turnover, and lower prevalence of vertebral fracture in healthy postmenopausal women. Osteoporos Int. 2013;24(12):2961-2970. https:// doi.org/10.1007/s00198-013-2377-7.
12. Makovey J, Macara M, Chen JS, et al. Serum uric acid plays a protective role for bone loss in peri- and postmenopausal women: a longitudinal study. Bone. 2013;52(1):400—406. https://doi.org/10.1016/j.bone.2012.10.025.
Received 03.02.2020 Revised 14.02.2020 Accepted 02.03.2020 ■
Information about author
G.S. Dubetska, PhD, Rheumatologist, Department of clinical physiology and pathology of locomotor apparatus, State Institution "D.F. Chebotarev Institute of Gerontology of the NAMS of Ukraine', Kyiv, Ukraine
Дубецька Г.С.
ДУ «1нститут геронтологи теш Д.Ф. Чеботарьова» НАМН Украши, м. Кив, Украша
Структурно-функцюнальний стан кктковоУ тканини, гiперурикемiя та компоненти метаболiчного синдрому в жшок у постменопаузальному nep^i
Резюме. У статп подано результати дослщжень щодо ви-вчення piBM сечово'1 кислоти в жшок у постменопаузальному nep^i з урахуванням показнишв шдексу маси тша, лшщно-го обмiну та мшерально'! щшьносп юстково'! тканини. Най-вищий piвeнь сечово'1 кислоти у сиpоватцi плазми кpовi вияв-лено в жшок у постменопаузальному rop^i iз найвищим ш-дексом маси т1ла (1МТ > 35 ум.од.). У жшок у постменопаузальному перюда юнуе вipогiIдна залeжнiсть м1ж piвнeм сечо-во'1 кислоти та показниками лшопротещв дуже низько'1 щшь-ностi (г = 0,401, p < 0,05), триглщеридами (г = 0,26, p < 0,05),
коефЩентом aтеpогенностi (r = 0,24, p < 0,05). Чaстотa осте-опоpозy бyлa нижчою в гpyпi пaцieнток iз riпеpypикемieю по-piвняно з особaми з ноpмоypикемieю. Тaк, у гpyпi тщентш з гiпеpypикемieю вонa стaновилa 19 %, a в тащенйв iз ноpмо-ypикемiею — 34 % m piвнi попеpекового вщдшу хpебтa, 17 i 21 % — та piвнi шийки стегново'1 шстки вщповщно. Ключовi слова: гiпеpypикемiя; сечовa кислотa; ожиpiння; iндекс мaси тгга; лiпiIдний обмiн; метaболiчний синдpом; мь неpaльнa щiльнiсть юстково'! ткaнини; яюсть кiстковоï ткa-нини
Дубецкая Г.С.
ГУ «Институт геронтологии имени Д.Ф. Чеботарева» НАМН Украины, г. Киев, Украина
Структурно-функциональное состояние костной ткани, гиперурикемия и компоненты метаболического синдрома у женщин в постменопаузальном
периоде
Резюме. В статье представлены результаты исследований по изучению уровня мочевой кислоты у женщин в постменопаузальном периоде с учетом показателей индекса массы тела, липидного обмена и минеральной плотности костной ткани. Самый высокий уровень мочевой кислоты в сыворотке плазмы крови выявлен у женщин в постменопаузальном периоде с наибольшим индексом массы тела (ИМТ > 35 усл.ед.). У женщин в постменопаузальном периоде существует достоверная зависимость между уровнем мочевой кислоты и показателями липопротеидов очень низкой плотности (г = 0,401, р < 0,05), триглицеридами (г = 0,26, р < 0,05), коэффициен-
том атерогенности (г = 0,24, р < 0,05). Частота остеопороза была ниже в группе пациенток с гиперурикемией по сравнению с лицами с нормоурикемией. Так, в группе пациентов с гиперурикемией она составляла 19 %, а у пациентов с нормо-урикемией — 34 % на уровне поясничного отдела позвоночника, 17 и 21 % — на уровне шейки бедренной кости соответственно.
Ключевые слова: гиперурикемия; мочевая кислота; ожирение; индекс массы тела; липидный обмен; метаболический синдром; минеральная плотность костной ткани; качество костной ткани
