D vitamini eksikliğinin yaşlı hastalarda osteoartrit ve kemik mineral dansitesi üzerine etkisi.

Yıl 2019, Cilt: 44 Sayı: Ek 1, 375 - 382, 29.12.2019

Kenan Özler

https://doi.org/10.17826/cumj.568656

Öz

Amaç: Farklı kemik mineral yoğunluğu (KMY) olan kadın ve erkek erken ve geç evre osteoartritli (OA) yaşlılarda, vitamin D düzeyinin OA ve KMY üzerine etkisini ve ayrıca D vitamini ve diz fonksiyon skorları arasındaki ilişkiyi belirlemeyi amaçladık.

Gereç ve Yöntem: Çalışmaya diz OA olan yüz kırk iki kadın ve yüz otuz beş erkek hasta alındı. Diz OA erken ve geç evre olarak sınıflandırıldı. Western Ontario ve McMaster Universities Osteoarthritis indexi (WOMAC) indeksi, Knee Injury ve Osteoarthritis Outcome Skoru (KOOS) hesaplandı ayrıca KMY ve D vitamini düzeyleri ölçüldü. 

Bulgular: Kadın OA de D vitamini düzeyleri erkek OA grubuna göre istatistiksel olarak anlamlı derecede düşüktü. Kadın OA hastalarında kalsiyum ve fosfor düzeyleri erkek OA grubuna göre anlamlı olarak daha yüksekti. Osteoporoz, osteopeni ve normal KMY olan erken ve geç dönem OA hastalarında vitamin D, vitamin B12, kalsiyum, fosfor, WOMAC indeksi ve KOOS skorları arasında fark yoktu. Osteoporozlu erken evre ve geç evre OA olan erkek hastalarda osteopenisi ve normal KMY olanlara göre WOMAC indexi anlamlı olarak daha yüksekti. Kadın OA olan hastalarda yaş odds oranı (OR) 1,047 (% 95 CI = 1,009-1,086), erkek OA olan hastalarda OR = 1.090 (% 95 CI = 1,021-1,163) idi.

Sonuç: D vitamini takviyesinin, osteoporozun ilerlemesini yavaşlattığı, ağrıyı azalttığı, KMY arttırdığı söylenebilir, ancak OA progresyonu ve diz fonksiyon skorları üzerinde hiçbir etkisi yoktur.

Anahtar Kelimeler

Vitamin D eksikliği, Osteoartrit, Kemik Mineral Yoğunluğu, WOMAC indeksi, KOOS skoru

Destekleyen Kurum

KONYA BEYŞEHİR DEVLET HASTANESİ

Proje Numarası

local ethics committee: approval date/number:05.04.2019/86

Teşekkür

KONYA BEYŞEHİR DEVLET HASTANESİ, KONYA SAĞLIK İL MÜDÜRLÜĞÜ

Effect of vitamin D deficiency on osteoarthritis and bone mineral density in elderly patients

Öz

Purpose: We aimed to determine the effect of inadequate vitamin D level on osteoartritis (OA) and bone mineral density (BMD) in female and male elderly patients with early and late stage OA with different BMD, and also the relationship between vitamin D and knee function scores in female and male OA patients.

Materials and Methods: One hundred and fortytwo female and one hundred thirty-five male knee OA patients were enrolled in the study. The knee OA was classified as early and late stage. WOMAC score, KOOS score, BMD and Vitamin D levels were measured.  

Results: Vitamin D levels patients were statistically significantly lower in female OA than male OA group. Calcium and phosphorus levels were significantly higher in female OA patients than male OA group. There was no difference between vitamin D, vitamin B12, calcium, phosphorus, WOMAC score and KOOS scores in early and late stage OA patients with osteoporosis, osteopenia and normal BMD.  WOMAC score was significantly higher in male patients with osteoporosis early stage and late stage OA than patients with osteopenia and normal BMD. The age odds ratio (OR) was 1,047 (95% CI = 1,009-1,086) in female OA patients, and OR was 1.090 (95% CI = 1,021-1,163) in male OA patients.

Conclusion: Vitamin D supplementation may be said increase BMD, slow down the progression of osteoporosis, reduce pain, but have no effect on OA progression and knee function scores.

Anahtar Kelimeler

Vitamine D deficiency, Osteoartritis, Bone Mineral Density, WOMAC score, KOOS score

Proje Numarası

local ethics committee: approval date/number:05.04.2019/86

Kaynakça

• 1. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med 2010; 26(3):355–69.2. Lane NE, Gore LR, Cummings SR, Hochberg MC, Scott JC, Williams EN, et al. Serum vitamin D levels and incident changes of radiographic hip osteoarthritis: a longitudinal study. Arthritis Rheum. 1999;42(5):854-60.3. Heidari B, Heidari P, Hajian-Tilaki K. Association between serum vitamin D deficiency and knee osteoarthritis. Int Orthop. 2011;35:1627–31.4. Dequeker J. Inverse relationship of the interface between osteoporosis and osteoarthritis. J Rheumatol 1997;24:795e8.5. Lips P, Hosking D, Lippuner K, Norquist JM, Wehren L, Maalouf G, et al. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. Journal of Internal Medicine 2006;260(3):245–54.6. Bergink AP, Uitterlinden AG, Van Leeuwen JP, Buurman CJ, Hofman A, Verhaar JA, et al. Vitamin D status, bone mineral density, and the development of radiographic osteoarthritis of the knee: The Rotterdam Study. J Clin Rheumatol. 2009;15:230–7.7. McAlindon T, LaValley M, Schneider E, Nuite M, Lee JY, Price LL, et al. Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial. JAMA. 2013;309:155–62.8. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis 1957;16:494e5029. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1-129.10. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–40. 11. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)-- the development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28:88–96. 12. Weinstein SL: 2000–2010: the bone and joint decade (editorial). J Bone Joint Surg Am 2000;2:1 –3. 13. Hart DJ, Cronin C, Daniels M, Worthy T, Doyle DV, Spector TD.The relationship of bone density and fracture to incident and progressive radiographic osteoarthritis of the knee: the Chingford Study. Arthr Rheum 2002;46(1):92-9.14. Zhang Y, Hannan MT, Chaisson CE, McAlindon TE, Evans SR, Aliabadi P, et al. Bone mineral density and risk of incident and progressive radiographic knee osteoarthritis in women: the Framingham study. J Rheumatol. 2000;27(4):1032-7.15. Burger H, van Daele PLA, Odding E, Valkenburg HA, Hofman A, Grobbee DE, et al. Association of radiographically evident osteoarthritis with higher bone mineral density and increased bone loss with age. The Rotterdam Study. Arthritis Rheum. 1996;39:81–86.16. Lethbridge-Cejku M, Tobin JD, Scott WW Jr, Reichle R, Roy TA, Plato CC, et al. Axial and hip bone mineral density and radiographic changes of osteoarthritis of the knee: data from the Baltimore Longitudinal Study of Aging. J Rheumatol 1996;23:1943–7.17. Goula T, Kouskoukis A, Drosos G, Tselepis AS, Ververidis A, Valkanis C, et al. Vitamin D status in patients with knee or hip osteoarthritis in a Mediterranean country. J Orthop Traumatol J Orthop Traumatol. 2015;16(1):35-9. 18. Breijawi N, Eckardt A, Pitton MB, Hoelzl AJ, Giesa M, von Stechow D, et al. Bone Mineral Density and Vitamin D Status in Female and Male Patients with Osteoarthritis of the Knee or Hip. Eur Surg Res 2009;42:1–10. 19. Corvol MT, Dumontier MF, Tsagris L, Lang F, Bourguignon J. Cartilage and vitamin D in vitro. Ann Endocrinol. 1981;142:482e7.20. Linde KN, Puhakka KB, Langdahl BL, Søballe K, Krog-Mikkelsen I, Madsen F, et al. Bone Mineral Density is Lower in Patients with Severe Knee Osteoarthritis and Attrition. Calcif Tissue Int. 2017;101(6):593-601. 21. Hunter DJ, Hart D, Snieder H, Bettica P, Swaminathan R, Spector TD. Evidence of altered bone turnover, vitamin D and calcium regulation with knee osteoarthritis in female twins. Rheumatology (Oxford) 2003;42:1311e6.22. Arden NK, Cro S, Sheard S, Doré CJ, Bara A, Tebbs SA, et al. The effect of vitamin D supplementation on knee osteoarthritis, the VIDEO study: a randomized controlled trial. Osteoarthritis Cartilage. 2016 Nov;24(11):1858-66. 23. Felson DT, Niu J, Clancy M, Aliabadi P, Sack B, Guermazi A, et al. Low levels of vitamin D and worsening of knee osteoarthritis: results of two longitudinal studies. Arthritis Rheum 2007;56: 129e36.24. Ding C, Cicuttini F, Parameswaran V, Burgess J, Quinn S, Jones G. Serum levels of vitamin D, sunlight exposure, and knee cartilage loss in older adults. Arthritis Rheum 2009; 60:1381e9.25. Mabey T, Honsawek S. Role of Vitamin D in osteoarthritis: molecular, Cellular, and Clinical Perspectives. Int J Endocrinol. 2015;2015:383918. 26. Divya S, Abhishek M, Amar Chandra S, Ajai S, Natu SM, Sarita Agarwal, et al. Does Vitamin D Improve Osteoarthritis of the Knee: A Randomized Controlled Pilot Trial. Clin Orthop Relat Res. 2013; 471:3556–62 27. Muraki S, Dennison E, Jameson K, Boucher BJ, Akune T, Yoshimura N, et al. Association of vitamin D status with knee pain and radiographic knee osteoarthritis. Osteoarthritis Cartilage. 2011;19(11):1301-6. 28. Hannan MT, Felson DT, Pincus T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol. 2000;27:1513e7. 29. Miranda H, Viikari-Juntura E, Martikainen R, Riihimaki H. A prospective study on knee pain and its risk factors. Osteoarthritis Cartilage 2002;10:623e30. 30. Andersen RE, Crespo CJ, Ling SM, Bathon JM, Bartlett SJ. Prevalence of significant knee pain among older Americans: results from the Third National Health and Nutrition Examination Survey. J Am Geriatr Soc 1999;47:1435e8. 31. O’Reilly SC, Muir KR, Doherty M. Occupation and knee pain: a community study. Osteoarthritis Cartilage. 2000;8:78e81.32. Muraki S, Akune T, Oka H, Mabuchi A, En-yo Y, Yoshida M, et al. Association of occupational activity with radiographic knee osteoarthritis and lumbar spondylosis in elderly patients of population-based cohorts: a large-scale population-based study. Arthritis Rheum. 2009;61:779e86.