Osteoporoz Hastalarında Ağrı Düzeyi ve Uyku Kalitesinin Yaşam Kalitesi Üzerine Etkisi

Öz

Osteoporoz (OP), kemik yoğunluğunun azalması, kemik mikroyapısının bozulması ve kırık riskinin artmasıyla karakterize ilerleyici metabolik bir kemik hastalığıdır. Bu çalışma, osteoporoz tanısı almış postmenopozal kadınlarda ağrı düzeyi, uyku kalitesi ve yaşam kalitesi arasındaki ilişkiyi araştırmayı amaçlamıştır. Çalışmaya, osteoporoz tanılı 38 postmenopozal kadın dahil edilmiştir. Lomber vertebralar (L1–L4), femur boynu ve total femur için Kemik Mineral Yoğunluğu (KMY) ve T-skorları DEXA yöntemi ile ölçülmüştür. Katılımcıların yaş, eğitim durumu, medeni hali gibi demografik verileri ile klinik öyküleri kaydedilmiştir. Yaşam kalitesi QUALEFFO-41 anketi ile, uyku kalitesi Pittsburgh Uyku Kalitesi İndeksi (PUKİ) ile ve ağrı düzeyi Görsel Analog Skala (VAS) ile değerlendirilmiştir. Katılımcıların yaş ortalaması 59,13 ± 10,24 yıldır. Katılımcıların 22’sinde kötü uyku kalitesi (PUKİ < 5), 16’sında ise iyi uyku kalitesi (PUKİ ≥ 5) saptanmıştır. PUKİ skoru ile QUALEFFO-41 parametrelerinden Ruh Hali alt boyutu arasında anlamlı negatif korelasyon (r=-0.411, p=0.010) saptandı. VAS skoru ile QUALEFFO-41 parametrelerinden Ağrı alt boyutu (r=0.688, p<0.001) ve Fiziksel Aktivite alt boyutu (r=0.343, p=0.035) arasında anlamlı pozitif korelasyon saptandı. Postmenopozal osteoporozlu kadınlarda hem ağrı hem de kötü uyku kalitesi yaşam kalitesini olumsuz etkilemektedir. Bu faktörlerin klinik yönetimde dikkate alınması, tedavi sonuçlarını ve hasta iyilik halini artırabilir.

Anahtar Kelimeler

• osteoporoz
• uyku kalitesi
• ağrı
• yaşam kalitesi

The Impact of Pain Intensity and Sleep Quality on Quality of Life in Patients with Osteoporosis

Öz

Osteoporosis (OP) is a progressive metabolic bone disease characterized by decreased bone density, impaired bone microarchitecture, and increased fracture risk. This study aimed to investigate the relationship between pain intensity, sleep quality, and quality of life in postmenopausal women diagnosed with osteoporosis. A total of 38 postmenopausal women with osteoporosis were included in the study. Bone Mineral Density (BMD) and T-scores of the lumbar vertebrae (L1–L4), femoral neck, and total femur were measured using the DEXA method. Demographic data such as age, educational status, and marital status, as well as clinical history, were recorded. Quality of life was assessed using the QUALEFFO-41 questionnaire, sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and pain intensity using the Visual Analogue Scale (VAS). The mean age of participants was 59.13 ± 10.24 years. Poor sleep quality (PSQI ≥ 5) was observed in 22 participants, while good sleep quality (PSQI < 5) was found in 16 participants. A significant negative correlation was identified between PSQI score and the Mood subscale of QUALEFFO-41 (r = -0.411, p = 0.010). Significant positive correlations were found between VAS score and the Pain (r = 0.688, p < 0.001) and Physical Activity (r = 0.343, p = 0.035) subscales of QUALEFFO-41. In postmenopausal women with osteoporosis, both pain and poor sleep quality negatively affect quality of life. Considering these factors in clinical management may improve treatment outcomes and patient well-being.

Anahtar Kelimeler

• osteoporosis
• sleep quality
• pain
• quality of life

Kaynakça

1. Ağargün, M.Y., Kara, H., & Anlar, O. (1996). Validity and reliability of the Pittsburgh Sleep Quality Index. Turkish Journal of Psychiatry; 7: 107-115.
2. Aktaş, Ö., Kaplan, S., & Sezer, N. (2018). An assessment of the relation between bone mineral density and clinic-demographic properties and life quality during postmenopausal period. Journal of Back and Musculoskeletal Rehabilitation. 31(5); 803-810. 62.
3. Akyüz Gülseren. (2010)."Pain and Quality of Life in Osteoporosis." The Journal of Turkish Family Physician.; 1.4: 11-15.
4. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. (1994). World Health Organization technical report series, 843, 1–129.
5. Bleicher,, Ma. (1995).Bone pain. 9-13. Basle, Sandoz Pharma Ltd;
6. Buysse, D. J., Reynolds, C. F., 3rd, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research, 28(2), 193–213. https://doi.org/10.1016/0165-1781(89)90047-4
7. Chapman, C.R., & Syrjala, K.L. (1990). Measurement of pain. In: "The management of pain" (ed) Bonica JJ, Philadelphia and London, Lea and Febiger. 580-594.
8. Dequeker, J., Raspe, H,, Sambrook, P. (1994). Metabolic Bone Disease. In Rheumatology, Eds: Klippel HJ. Mosby, Chapter: 7-31.

9. Ertüngealp, E., & Seyisoğlu, H. (2000). History of Menopause and Osteoporosis. In: Menopause and Osteoporosis. Istanbul: National Menopause and Osteoporosis Association Publication, 1-10.
10. Eskiyurt, N. (2005). Exercise and physical activity in osteoporosis rehabilitation. Eryavuz Sarıdoğan M, Gökçe Kutsal Y, editors. Osteoporosis diagnosis and treatment guide. 1st ed. Istanbul, Deamed Medical Publishing; p. 245-253.
11. Goldt, DT.(1996).The clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone Mar; 18 Suppl 3: 185-189.
12. Hsu, H.C., Tsao, L.I., & Lin M.H. (2015). Improving sleep quality interventions among menopausal women with sleep disturbances in Taiwan: a preliminary study. Appl Nurs Res. 28(4); 374–380.
13. Hübscher, M., Vogt, L., Schmidt, K., Fink, M., & Banzer, W. (2010). Perceived pain, fear of falling and physical function in women with osteoporosis. Gait & posture, 32(3), 383–385. https://doi.org/10.1016/j.gaitpost.2010.06.018
14. Kalkan, B., Nasibova, A., Erol, M.F.,Boyraz, M.,Ok, M.O., Musabalievi, T. (2018). Ankara Üniversitesi Tıp Fakültesi Cebeci Eğitim ve Araştırma Hastanesi Nükleer Tıp Anabilim Dalında Kemik dansitometre ölçümü yaptıran hastaların test sonuçlarının osteoporoz risk faktörleri ile ilişkilendirme. http://kdt.medicine.ankara.edu.tr/wp-content/uploads/sites/815/2023/02/2018-2019-PROJE_Grup_25.pdf (Erişim Tarihi: 22.11.2023)..
15. Kutlu, R., Çivi, S., Pamuk, G. (2012). Osteoporosis prevalence in postmenopausal women and 10-year fracture risk calculation using the FRAXTM scale. Turkish J Phys Med Rehabil.; 58: 126-135.
16. Lips, P., Cooper, C., Agnusdei, D., Caulin, F., Egger, P., Johnell, O., Kanis, J. A., Kellingray, S., Leplege, A., Liberman, U. A., McCloskey, E., Minne, H., Reeve, J., Reginster, J. Y., Scholz, M., Todd, C., de Vernejoul, M. C., & Wiklund, I. (1999). Quality of life in patients with vertebral fractures: validation of the Quality of Life Questionnaire of the
17. European Foundation for Osteoporosis (QUALEFFO). Working Party for Quality of Life of the European Foundation for Osteoporosis. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 10(2), 150–160. https://doi.org/10.1007/s001980050210
18. Liu-Ambrose, T., Eng, J. J., Khan, K. M., Mallinson, A., Carter, N. D., & McKay, H. A. (2002). The influence of back pain on balance and functional mobility in 65- to 75-year-old women with osteoporosis. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 13(11), 868–873. https://doi.org/10.1007/s001980200119
19. Mediati, R. D., Vellucci, R., & Dodaro, L. (2014). Pathogenesis and clinical aspects of pain in patients with osteoporosis. Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases, 11(3), 169–172.
20. Onat, Ş,Ş., Delialioğlu, S.Ü., Biçer, S., Özel, S. (2013). Depression and Quality of Life in Osteoporosis. Turkish Journal of Osteoporosis; 19: 58-64.
21. Özcan H, & Oskay Ü. (2013). Evidence-based applications in symptom management during menopause. Göztepe Medical Journal, 28(4), 157-163.
22. Rosen N. H. M, & Drezner M. K. (2020). Overview of the management of osteoporosis in postmenopausal women. UptoDate, Access Address: https://www.uptodate.com/contents/overview-of-the-management-of-osteoporosis-inpostmenopausal.
23. Sangkomkamhang, T., Sangkomkamhang, U. S., & Ngamjarus, C. (2013). Vitamin K for the prevention and treatment of osteoporosis in post‐menopausal women. Cochrane Database of Systematic Reviews (1). Santoro, N., Epperson, C.N., & Mathews S.B. (2015). Menopausal symptoms and their management. Endocrinol Metab Clin North Am.; 44: 497-515.
24. Santos, L., Elliott-Sale, K. J., & Sale, C. (2017). Exercise and bone health across the lifespan. Biogerontology, 18(6), 931–946. https://doi.org/10.1007/s10522-017-9732-6
25. Simpson, N., & Dinges, D.F. (2007). Sleep and Inflammation. Nutrition Reviews, 7(12), 244-252.
26. Sürücü, G.D., Teker, S., & Eken-Gedik. (2022). Effects of neuropathic pain on sleep quality, quality of life, and depression in postmenopausal osteoporosis patients. Turk J Osteoporos. 28(3): 173-179.
27. Tong I. L. (2013). Nonpharmacological treatment of postmenopausal symptoms. The Obstetrician & Gynaecologist, 15(1), 19-25.
28. Turhanoğlu, A.D., Güler ,H., Özer, C., (2008). The Impact of Osteoporosis Treatment on the Quality of Life in Elderly Women. Osteoporosis World, 14, 7-11.
29. Tuzun, S., Eskiyurt, N., Akarirmak, U., Saridogan, M., Senocak, M., Johansson, H., Kanis, J. A., & Turkish Osteoporosis Society (2012). Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 23(3), 949–955. https://doi.org/10.1007/s00198-011-1655-5
30. Vellucci, R., Terenzi, R., Kanis, J. A., Kress, H. G., Mediati, R. D., Reginster, J. Y., Rizzoli, R., & Brandi, M. L. (2018). Understanding osteoporotic pain and its pharmacological treatment. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 29(7), 1477–1491. https://doi.org/10.1007/s00198-018-4476-y