Postmenopozal kadınlarda ürik asit ile kemik mineral yoğunluğu arasındaki ilişkinin değerlendirilmesi: tek merkezli retrospektif çalışma

Yıl 2020, , 415 - 420, 22.10.2020

Erdal Dilekçi , Esra Nur Ademoğlu Dilekçi

https://doi.org/10.32322/jhsm.776446

Öz

Amaç: Osteoporoz, kemik kütlesi kaybı ve kırıklara yatkınlıkla sonuçlanan önemli bir halk sağlığı sorunudur. Pürin metabolizmasının son enzimatik ürünü olan ürik asitin diyabetes mellitus, hipertansiyon ve kardiyovasküler hastalıklar gibi çeşitli kronik hastalıklar üzerinde faydalı antioksidan etkilere sahip olduğunu gösteren çok sayıda kanıt vardır. Bu çalışmada postmenopozal osteoporozda serum ürik asit düzeyleri ile kemik mineral yoğunluğu (KMY) arasındaki ilişkiyi değerlendirmeyi amaçladık.
Gereç ve Yöntem: Bu çalışma Bolu Abant İzzet Baysal Eğitim ve Araştırma Hastanesi, Fizik Tedavi ve Rehabilitasyon Kliniğinde yapıldı. Ocak 2019 ve 2020 yılları arasında çift-enerjili X-ışını absorbsiyometri (DEXA) incelemesi olan ve serum ürik asit düzeyleri kaydedilmiş olan 1200 postmenopozal kadının tıbbi kayıtları retrospektif olarak tarandı. Sistemik hastalıkları olan veya kemik metabolizmasını veya ürik asit düzeylerini etkileyen ilaç alan bireyler dışlandıktan sonra toplamda 92 osteoporozlu ve 399 sağlıklı birey çalışmaya dahil edildi. Tüm bireylerde KMY, femur boynu ve lomber vertebra (L2-4) T skoru, serum glukoz, AST, ALT, kreatinin, alkalen fosfataz, kalsiyum, fosfor, parathormon ve total protein düzeyleri kaydedildi.
Bulgular: Serum ürik asit konsantrasyonları, osteoporoz grubunda kontrol grubuna göre anlamlı derecede düşük bulundu [4.65 (2.40-7.80)-5.20 (3.80-9.40); p <0.001, sırasıyla] (Tablo 1). Korelasyon analizinde ürik asit anlamlı bir şekilde açlık kan şekeri (r=0.129, p= 0.004), kreatinin (r=0.374, p <0.001), kalsiyum (r=0.201, p <0.001), toplam protein (r=0.123, p=0.006) ve tiroid uyarıcı hormon (TSH) (r=0.108, p=0.017) ile ilişkili idi. Korelasyon analizi ürik asit ile L2-L4 KMY arasında anlamlı ve pozitif bir korelasyon olduğunu ortaya koydu (r=0.255, p <0.001) (Tablo 2). Çoklu doğrusal regresyon analizinde karıştırıcı faktörlerin etkisi arındırıldıktan sonra L2-L4 KMY ürik asit ile bağımsız olarak ilişkili bulundu (B=1.619, p <0.001).
Sonuç: Bulgularımız, postmenopozal osteoporozda serum ürik asit düzeyleri ve lomber (L2-L4) KMY’nin bağımsız ilişkili olduğunu ortaya koydu. Ürik asit ile osteoporoz arasındaki ilişkiyi belirlemek ve ürik asidin klinik uygulamadaki kullanımını değerlendirmek için daha fazla çalışmaya ihtiyaç vardır.

Anahtar Kelimeler

Osteoporoz, ürik asit, kemik mineral yoğunluğu, postmenopozal kadın

Evaluation of the relationship between uric acid and bone mineral density in postmenopausal women: a single center retrospective study

Öz

Objectives: Osteoporosis is an important public health problem which is characterized by loss of bone mass resulting in susceptibility to fractures. There is much evidence indicating that uric acid, a final enzymatic product of purine metabolism, has beneficial antioxidant effects on several chronic diseases such as diabetes mellitus, hypertension and cardiovascular diseases. We aimed to evaluate the relationship between serum uric acid levels and bone mineral density (BMD) on postmenopausal osteoporosis in the present study.
Material and Method: This study was carried out at the Bolu İzzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital, Department of Physical Medicine and Rehabilitation.. The medical records of 1200 postmenopausal women between January 2019 and 2020 who had dual energy x-ray absorptiometry (DEXA) examination and serum uric acid levels recorded were screened retrospectively. In total, 92 individuals with osteoporosis and 399 healthy individuals were included in the study after exclusion of subjects with systemic diseases or taking drugs affecting bone metabolism or uric acid levels. Bone mineral density and T scores of femur neck (F neck) and lumbar spine (L2-L4), glucose, AST, ALT, creatinine, alkaline phosphatase, calcium, phosphate, parathormone (PTH), albumin and total protein were all recorded in individuals.
Results: Serum uric acid concentrations were found to be significantly lower in the osteoporosis group compared with the control group [4.65(2.40-7.80) vs 5.20 (3.80-9.40); p<0.001, respectively]. In correlation analysis, uric acid was significantly associated with fasting blood glucose (r=0.129, p=0.004), creatinine (r=0.374, p<0.001), calcium (r=0.201, p<0.001), total protein (r=0.123, p=0.006) and TSH (r=0.108, p=0.017). Correlation analysis also revealed a significant and positive correlation between uric acid and L2-L4 BMD (r=0.255, p<0.001). L2-L4 BMD was found to be independently related with uric acid in multivariate linear regression analysis after adjustment for confounding factors (B=1.619, p<0.001).
Conclusion: Our findings revealed that serum uric acid levels and lumbar (L2-L4) BMD were independently associated with each other in postmenopausal osteoporosis. Further studies are needed to determine the association of uric acid with osteoporosis and to address the utility of uric acid in clinical practice.

Anahtar Kelimeler

osteoporosis, Uric acid, Bone mineral density, postmenopausal women

Kaynakça

• Varacallo MA, Fox EJ. Osteoporosis and its complications. Med Clin North Am 2014; 98: 817-31.
• Charles JF, Aliprantis AO. Osteoclasts: more than ‘bone eaters’. Trends Mol Med 2014; 20: 449-59.
• Ginaldi L, Di Benedetto MC, De Martinis M. Osteoporosis, inflammation and ageing. Immun Ageing 2005; 2: 14.
• Antón FM, García Puig J, Ramos T, González P, Ordás J. Sex differences in uric acid metabolism in adults: evidence for a lack of influence of estradiol-17 beta (E2) on the renal handling of urate. Metabolism 1986; 35: 343-8.
• Sautin YY, Johnson RJ. Uric acid: the oxidant-antioxidant paradox. Nucleosides Nucleotides Nucleic Acids 2008; 27: 608-19.
• Kim SC, Paik JM, Liu J, Curhan GC, Solomon DH. Gout and the risk of non-vertebral fracture. J Bone Miner Res 2017; 32: 230-6.
• Genoni G, Menegon V, Secco GG, et al. Insulin resistance, serum uric acid and metabolic syndrome are linked to cardiovascular dysfunction in pediatric obesity. Int J Cardiol 2017; 249: 366-71.
• Han W, Bai X, Wang N, Han L, Sun X, Chen X. Association between lumbar bone mineral density and serum uric acid in postmenopausal women: a cross-sectional study of healthy Chinese population. Arch Osteoporos 2017; 12: 50.
• Du N, Xu D, Hou X, et al. Inverse association between serum uric acid levels and Alzheimer’s disease risk. Mol Neurobiol 2016; 53: 2594-9.
• Chen L, Peng Y, Fang F, Chen J, Pan L, You L. Correlation of serum uric acid with bone mineral density and fragility fracture in patients with primary osteoporosis: a single-center retrospective of 253 cases. Int J Clin Exp Med 2015; 8: 6291-4.
• Babaei M, Shamsi R, Heidari B, Bijari A. Serum uric acid status and its association with bone mineral density in the elderly people aged 60 years and more. Int J Endocrinol Metab 2019; 17: e80780.
• Kausal N, Vohora D, Jalali RK, Jha S. Raised serum uric acid is associated with higher bone mineral density in a cross-sectional study of a healthy Indian population Ther Clin Risk Manag 2018; 14: 75-82.
• Lin X, Zhao C, Qin A, et al. Association between serum uric acid and bone health in general population: a large and multicentre study. Oncotarget 2015; 6: 35395–403.
• Nabipour I, Sambrook PN, Blyth FM, et al. Serum uric acid is associated with bone health in older men: a cross-sectional population-based study. J Bone Miner Res 2011; 26: 955–64.
• 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: 400–6.
• Kim S, Jung J, Jung JH, Kim SK, Kim RB, Hahm JR. Risk factors of bone mass loss at the lumbar spine: a longitudinal study in healthy korean pre- and perimenopausal women older than 40 years. PLoS One 2015; 10: e0136283.
• Ishii S, Miyao M, Mizuno Y, Tanaka-Ishikawa M, Akishita M, Ouchi Y. Association between serum uric acid and lumbar spine bone mineral density in peri- and postmenopausal Japanese women. Osteoporos Int 2014; 25: 1099–105.
• Lane NE, Parimi N, Lui LY, et al. Osteoporotic fractures in men study group association of serum uric acid and incident nonspine fractures in elderly men: the osteoporotic fractures in men (MrOS) study. J Bone Miner Res 2014; 29: 1701–7.
• Muka T, de Jonge EA, Kiefte-de Jong JC et al. The influence of serum uric acid on bone mineral density, hip geometry, and fracture risk: the rotterdam study. J Clin Endocrinol Metab 2016; 101: 1113–22.
• Veronese N, Bolzetta F, De Rui M, et al. Serum uric acid and incident osteoporotic fractures in old people: The PRO.V.A study. Bone 2015; 79: 183–9.
• Zhang D, Bobulescu IA, Maalouf NM, et al. Relationship between serum uric acid and bone mineral density in the general population and in rats with experimental hyperuricemia. J Bone Miner Res 2015 ; 30: 992–9.
• Hui JY, Choi JWJ, Mount DB, Zhu Y, Zhang Y, Cho HK. The independent association between parathyroid hormone levels and hyperuricemia: a national population study. Arthritis Res Ther 2012; 14: R56.
• Li X, Meng X, Timofeeva M, et al. Serum uric acid levels and multiple health outcomes: Umbrella review of evidence from observational studies, randomised controlled trials, and Mendelian randomisation studies. BMJ 2017; 357: j2376.