Sarkopenili yaşlı bireylerde kalça kırıklarının öngörülmesinde biyokimyasal belirteçler

Abstract

Amaç: Sarkopeni, yaşlılarda çok sayıda kalça kırığına neden olmaktadır. Bir çalışmada kırık tipinin kalça fonksiyonu, klinik morbidite ve sarkopeni üzerindeki etkisi incelenmiştir. Cerrahi olarak tedavi edilen sarkopenik kalça kırıklarında postoperatif risk değişkenleri ve prognoz değerlendirilmiştir.
Gereç ve yöntem: İskelet Kitle indexi (SMI), total psoas alan indexi (TPAI) ve serum dickkopf-ilişkili protein-1 (DKK-1) ile sklerostin (SOST) düzeyleri karşılaştırılmıştır. Tek merkezli bu çalışmada, 1 Ocak 2020 ile 1 Mart 2021 tarihleri arasında üçüncü basamak bir travma hastanesinde proksimal femur kırığı hastaları incelenmiştir. Prospektif olarak yürütülen çalışmada 26’sı sarkopenik pertrokanterik kırık, 26’sı femur boyun kırığı olmak üzere toplam 52 hasta yer almıştır (yaş ortalaması 76,80±9,96 yıl; 27 erkek, 25 kadın). Preoperatif lomber ve pelvik BT taramaları, TPAI, DKK-1 ve SOST biyokimyasal belirteçleri, postoperatif DEXA ve SMI değerleri değerlendirilmiştir. Klinik takipte yürüme hızı, harris kalça skoru (HHS) ve oksford kalça skoru (OHS) skorları ölçülmüştür.
Bulgular: SMI, grup 1’de 5,65±0,98 kg/m², grup 2’de 4,88±0,79 kg/m² bulunmuştur (p=0,009). Ortalama TPAI, grup 1’de 488,58±39,87 mm²/m², grup 2’de 455,92±44,3 mm²/m²’dir (p=0,007). Toplam DKK-1 ortalaması 776,4286±577,50 pg/mL, ortalama SOST ise 1787,80±1262,01 pg/mL’dir. SOST ile DKK-1 arasında korelasyon saptanmıştır (r=0,27, p=0,054). Postoperatif ortalama OHS, grup 1’de 29,81±4,23, grup 2’de 28,85±3,76’dır (p=0,391). Ortalama HHS, grup 1’de 63,27±10,88, grup 2’de 64,15±7,34’tür (p=0,733). OHS ile HHS arasında anlamlı ilişki bulunmuştur (r=0,79, p<0,001). Yürüme hızı testinde gruplar arasında anlamlı fark saptanmamıştır.
Sonuç: Kas kütlesi eşit olan femur boyun kırıklı hastalarda fonksiyonel sonuçlar daha iyi olabilirken, kas kütlesi düşük olanlar daha fazla risk altındadır. Sarkopenide görülen kalça kırıkları DKK-1 ve SOST düzeylerini yükseltebilir.

Keywords

• Sarkopeni
• kalça kırıkları
• sklerostin
• dickkopf- 1 protein
• kırıklar

Ethical Statement

SBÜ ankara eğitimi ve araştırma hastanesi klinik araştırmalar etik kurulu E-93471371-514.10 saylı 446 -no'lu çalışma olarak etik kurul onayı alınmıştır.

Biochemical markers as predictors of hip fractures in elderly individuals with sarcopenia

Abstract

Purpose: Sarcopenia causes numerous senior hip fractures. The aim of the study is to investigate the effect of fracture type on hip function, clinical morbidity, and sarcopenia. Postoperative risk variables and prognosis were studied for surgically treated sarcopenic hip fractures.
Materials and methods: Skelatal Mass Index (SMI), Total Psoas Area Index (TPAI), and serum dickkopf-related protein-1 (DKK-1) and sclerostin (SOST) were compared. In this single-center study, patients with proximal femur fractures treated at a tertiary trauma hospital between January 1, 2020, and March 1, 2021 were analyzed. Prospective 26-patient sarcopenic pertrochanteric/femoral neck fracture study. Our study included 52 patients (mean age 76.80±9.96 years, 27 males, 25 women). Preoperative lumbar and pelvic CT scans, TPAI, DKK-1, and SOST biochemical markers, postoperative DEXA, and SMI were included. Clinical follow-up assessed walking speed, Harris Hip Score (HHS), and Oxford Hip Score (OHS).
Results: SMI was 5.65±0.98 kg/m² in group 1 and 4.88±0.79 in group 2 (p=0.009). The mean TPAI was 488.58±39.87 mm²/m² for group 1 and 455.92±44.3 for group 2 (p=0.007). Total DKK1 mean: 776.4286±577.50 pg/mL. The mean SOST was 1787.80±1262.01 pg/mL. SOST and DKK1 correlate (r=0.27, p=0.054). Group 1 had a mean OHS value of 29.81±4.23 post-op, while Group 2 had 28.85±3.76 (p=0.391). Group 1 had a mean HHS value of 63.27±10.88, while Group 2 had 64.15±7.34. The difference between groups in HHS was not significant (p=0.733). A link exists between OHS and HHS (r=0.79, p<0.001). Gait speed test showed not significant group differences.
Conclusion: Femoral neck fracture patients with equal muscle mass may have better functional results, while those with less are at danger. Hip fractures in sarcopenia may elevate DKK1 and SOST.

Keywords

• Sarcopenia
• hip fractures
• sclerostin
• dickkopf-1 protein
• fractures

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