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Polikistik Over Sendromu Olan Hastaların Kemik Mineral Yoğunluğunun Değerlendirilmesi

Year 2022, , 71 - 77, 18.03.2022
https://doi.org/10.31832/smj.1004039

Abstract

Amaç: Polikistik over sendromu (PKOS) üreme çağındaki kadınlarda en sık rastlanan endokrinolojik bozukluktur. Metabolik ve kardiyovasküler ek hastalıklara zemin oluşturması yanı sıra kemik metabolizmasını da etkilemektedir. Çalışmamızda PKOS olgularının kemik mineral yoğunluğunu değerlendirmek ve bunu etkileyen faktörleri belirlemeyi amaçladık.
Gereç ve yöntem: Araştırmaya Ocak 2019 ve Ocak 2021 tarihleri arasında poliklinik başvurusu olan 17-44 yaş arası 109 PKOS tanısı alan kadın dahil edilmiştir. PKOS tanısı Rotterdam kriterleri baz alınarak konulmuştur. Olguların kemik mineral yoğunluğu (KMY) dual enerji X ray absorbsiyometri (DEXA) ile ölçüldü. Ayrıca katılımcıların biyokimyasal ve hormonal değerlendirmeleri de yapılarak sol femur boynu ve lumbal 2,3 ve 4. vertebra bölgelerinden alınan DEXA ölçümlerinin Z ve T skorları, katılımcılar vücut kitle indeksine (VKİ) göre gruplandırılarak karşılaştırıldı.
Bulgular: Fazla kilolu olan olguların insülin (p=0,006), homeaostatic model assessment –insulin resistance (HOMA-IR) (p=0,006) ve kortizol (p=0,009) ölçüm ortalamaları normal kilolu olgulara göre istatistiksel açıdan anlamlı olarak daha yüksek iken, tiroid stimülan hormon (TSH) ölçüm ortalamaları normal kilolu olgulara göre anlamlı olarak daha düşüktü (p=0,030). Fazla kilolu olan olguların femur boynu T skoru (FBTS) (p=0.038) ve femur boynu Z skoru (p=0.022) ölçüm ortalamaları normal kilolu olgulara göre daha yüksek olarak saptandı. Olgulara ait VKİ ölçümleri ile FBTS ölçümleri arasında pozitif bir (r=0.238) korelasyon saptanmıştır (p=0.013) ve bel çevresi/boy oranı ölçümleri ile FBZS ölçümleri arasında anlamlı, düşük düzeyde (r=0.198) ilişki saptanmıştır (p=0.039). Olguların FBZS (r=-0.212, p=0.028), lumbal 2-4 vertebra T skoru (L2L4TS)(r=-0.217, p=0.024) ve lumbal 2-4 vertebra Z skoru (L2L4ZS) (r=-0.277, p=0.004) ile dehidroepiandrosteron sülfat (DHEAS) arasında anlamlı negatif bir korelasyon saptanmıştır.
Sonuç: Sonuç olarak VKİ ve bel çevresi/boy oranı PKOS olgularında KMY’i olumlu yönde etkilerken, DHEAS’nin olumsuz yönde etkilediği kanaatine vardık. Ancak mekanizmayı ortaya koymak için prospektif ve moleküler çalışmalara ihtiyaç vardır.

References

  • 1. Centers for disease control and prevention. Policyctic ovary syndrome and diabetes. https://www.cdc.gov/diabetes/basics/pcos.html#text Erişim 12.04.2021.
  • 2. Azziz R, Legro R, Dewailly D, Franks S, Tarlatzis R, Fauser B, et al. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81(1):19–25.
  • 3. Livadas S, Pappas C, Karachalios A, Marinakis E, Tolia N, Drakou M, et al. Prevalence and impact of hyperandrogenemia in 1,218 women with polycystic ovary syndrome. Endocrine 2014;47(2):631–8.
  • 4. Echiburú B, Crisosto N, Maliqueo M, Perez-Bravo-F, Ladron de Guevara A, Hernandez P, et al. Metabolic profile in women with polycystic ovary syndrome across adult life. Metabolism [Internet] 2016;65(5):776–82.
  • 5. Kudesia R, Illions EH, Lieman HJ. Elevated Prevalence of polycystic ovary syndrome and cardiometabolic disease in South Asian ınfertility patients. J Immigr Minor Heal 2017;19(6):1338–42.
  • 6. Krishnan A, Muthusami S, Hormonal alterations in PCOS and its influence on bone metabolism. J Endocrinol 2017;232:99–113.
  • 7. Kassanos D, Trakakis E, Baltas CS, Papakonstantinou O, Simenoidis G, Salamelakis G, et al. Augmentation of cortical bone mineral density in women with polycystic ovary syndrome : a peripheral quantitative computed tomography ( pQCT ) study. Hum Reprod 2010;25(8):2107–14.
  • 8. Rubin KH, Glintborg D, Nybo M, Andersen M, Abrahamsen B. Fracture risk is decreased in women with population-based cohort study. J Bone Miner Res 2016;31(4):709–17.
  • 9. Baillargeon J-P. Use of insulin sensitizers in polycystic ovarian syndrome. Curr Opin Invest Drugs 2005;6(10):1011–22.
  • 10. Clemens TL, Karsenty G. The Osteoblast : an insulin target cell controlling glucose homeostasis. J Bone Miner Res 2011;26(4):677–80.
  • 11. Abu EO, Horner A, Kusec V, Triffitt JT, Compston JE. The localization of androgen receptors in human bone. J Clin Endocrinol Metab 1997;82(10):3493–7.
  • 12. Ganie MA, Chakraborty S, Sehgal A, Sreejith M, Kandasami D, Jana M, et al. Bone mineral density is unaltered in women with polycystic ovary syndrome. Horm Metab Res 2018;50(10):754–60.
  • 13. Katulski K, Slawek S, Czyzyk A, Podfigurna-Stop A, Paczkowska K, Ignaszak N, et al. Bone mineral density in women with polycystic ovary syndrome. J Endocrinol Invest 2014;37:1219–24.
  • 14. To WWK, Wong MWN. A comparison of bone mineral density in normal weight and obese adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol [Internet] 2012;25(4):248–53.
  • 15. Good C, Tulchinsky M, Mauger D, Demers LM, Legro RS. Bone mineral density and body composition in lean women with polycystic ovary syndrome. Fertil Steril 1999;72(1):21–5.
  • 16. Karadağ C, Yoldemir T, Yavuz DG. Determinants of low bone mineral density in premenopausal polycystic ovary syndrome patients. Gynecol Endocrinol [Internet] 2016;33(3):234–7.
  • 17. Chen J-F, Lin P-W, Tsai Y-R, Yang Y-C, Kang H-Y. Androgens and androgen receptor actions on bone health and disease : from androgen deficiency to androgen therapy. Cells 2019;8(11):1318.
  • 18. Zborowski J V, Talbott E, Cauley JA. Polycystıc ovary syndrome , androgen excess , and the ımpact on bone, Obstet Gynecol Clin North Am 2001;28(1):135–51.
  • 19. Notelovitz M. Androgen effects on bone and muscle. Fertil Steril 2002;77(4):34–41.
  • 20. Behboudi-gandevani S, Ramezani F, Cheraghi L. Could “ a body shape index ” and “ waist to height ratio ” predict insulin resistance and metabolic syndrome in polycystic ovary syndrome ? Eur J Obstet Gynecol [Internet] 2016;205:110–4.
  • 21. Kalyan S, Patel MS, Kingwell E, Côté HCF, Liu D. Competing factors link to bone health in polycystic ovary syndrome : chronic low-grade inflammation takes a toll Sci Rep 2017;7:3432.
Year 2022, , 71 - 77, 18.03.2022
https://doi.org/10.31832/smj.1004039

Abstract

References

  • 1. Centers for disease control and prevention. Policyctic ovary syndrome and diabetes. https://www.cdc.gov/diabetes/basics/pcos.html#text Erişim 12.04.2021.
  • 2. Azziz R, Legro R, Dewailly D, Franks S, Tarlatzis R, Fauser B, et al. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81(1):19–25.
  • 3. Livadas S, Pappas C, Karachalios A, Marinakis E, Tolia N, Drakou M, et al. Prevalence and impact of hyperandrogenemia in 1,218 women with polycystic ovary syndrome. Endocrine 2014;47(2):631–8.
  • 4. Echiburú B, Crisosto N, Maliqueo M, Perez-Bravo-F, Ladron de Guevara A, Hernandez P, et al. Metabolic profile in women with polycystic ovary syndrome across adult life. Metabolism [Internet] 2016;65(5):776–82.
  • 5. Kudesia R, Illions EH, Lieman HJ. Elevated Prevalence of polycystic ovary syndrome and cardiometabolic disease in South Asian ınfertility patients. J Immigr Minor Heal 2017;19(6):1338–42.
  • 6. Krishnan A, Muthusami S, Hormonal alterations in PCOS and its influence on bone metabolism. J Endocrinol 2017;232:99–113.
  • 7. Kassanos D, Trakakis E, Baltas CS, Papakonstantinou O, Simenoidis G, Salamelakis G, et al. Augmentation of cortical bone mineral density in women with polycystic ovary syndrome : a peripheral quantitative computed tomography ( pQCT ) study. Hum Reprod 2010;25(8):2107–14.
  • 8. Rubin KH, Glintborg D, Nybo M, Andersen M, Abrahamsen B. Fracture risk is decreased in women with population-based cohort study. J Bone Miner Res 2016;31(4):709–17.
  • 9. Baillargeon J-P. Use of insulin sensitizers in polycystic ovarian syndrome. Curr Opin Invest Drugs 2005;6(10):1011–22.
  • 10. Clemens TL, Karsenty G. The Osteoblast : an insulin target cell controlling glucose homeostasis. J Bone Miner Res 2011;26(4):677–80.
  • 11. Abu EO, Horner A, Kusec V, Triffitt JT, Compston JE. The localization of androgen receptors in human bone. J Clin Endocrinol Metab 1997;82(10):3493–7.
  • 12. Ganie MA, Chakraborty S, Sehgal A, Sreejith M, Kandasami D, Jana M, et al. Bone mineral density is unaltered in women with polycystic ovary syndrome. Horm Metab Res 2018;50(10):754–60.
  • 13. Katulski K, Slawek S, Czyzyk A, Podfigurna-Stop A, Paczkowska K, Ignaszak N, et al. Bone mineral density in women with polycystic ovary syndrome. J Endocrinol Invest 2014;37:1219–24.
  • 14. To WWK, Wong MWN. A comparison of bone mineral density in normal weight and obese adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol [Internet] 2012;25(4):248–53.
  • 15. Good C, Tulchinsky M, Mauger D, Demers LM, Legro RS. Bone mineral density and body composition in lean women with polycystic ovary syndrome. Fertil Steril 1999;72(1):21–5.
  • 16. Karadağ C, Yoldemir T, Yavuz DG. Determinants of low bone mineral density in premenopausal polycystic ovary syndrome patients. Gynecol Endocrinol [Internet] 2016;33(3):234–7.
  • 17. Chen J-F, Lin P-W, Tsai Y-R, Yang Y-C, Kang H-Y. Androgens and androgen receptor actions on bone health and disease : from androgen deficiency to androgen therapy. Cells 2019;8(11):1318.
  • 18. Zborowski J V, Talbott E, Cauley JA. Polycystıc ovary syndrome , androgen excess , and the ımpact on bone, Obstet Gynecol Clin North Am 2001;28(1):135–51.
  • 19. Notelovitz M. Androgen effects on bone and muscle. Fertil Steril 2002;77(4):34–41.
  • 20. Behboudi-gandevani S, Ramezani F, Cheraghi L. Could “ a body shape index ” and “ waist to height ratio ” predict insulin resistance and metabolic syndrome in polycystic ovary syndrome ? Eur J Obstet Gynecol [Internet] 2016;205:110–4.
  • 21. Kalyan S, Patel MS, Kingwell E, Côté HCF, Liu D. Competing factors link to bone health in polycystic ovary syndrome : chronic low-grade inflammation takes a toll Sci Rep 2017;7:3432.
There are 21 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Huri Güvey 0000-0002-8603-6981

Canan Soyer Çalışkan 0000-0002-9889-5249

Samettin Çelik 0000-0002-6407-1129

Merve Yılmaz 0000-0002-3421-8548

Publication Date March 18, 2022
Submission Date October 3, 2021
Published in Issue Year 2022

Cite

AMA Güvey H, Soyer Çalışkan C, Çelik S, Yılmaz M. Polikistik Over Sendromu Olan Hastaların Kemik Mineral Yoğunluğunun Değerlendirilmesi. Sakarya Tıp Dergisi. March 2022;12(1):71-77. doi:10.31832/smj.1004039

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