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"Pain. Joints. Spine." Том 8, №3, 2018

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Associations between Metabolic Syndrome and Bone Mineral Density, Trabecular Bone Score in Postmenopausal Women with Non-Vertebral Fractures

Authors: Vladyslav Povoroznyuk (1), Larysa Martynyuk (2), Iryna Syzonenko (3), Liliya Martynyuk (2)
(1) — State Institution “D.F. Chebotarev Institute of Gerontology of the NAMS of Ukraine”, Kyiv, Ukraine
(2) — State Institution of Higher Education “I. Horbachevsky Ternopil State Medical University”, Ternopil, Ukraine
(3) — Kyiv Municipal Center for Radiation Protection of Citizens Affected by the Chernobyl Disaster, Kyiv, Ukraine

Categories: Rheumatology, Traumatology and orthopedics

Sections: Clinical researches

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Summary

Актуальність. Медична, соціальна й економічна значимість остеопорозу обумовлена зниженням якості життя, збільшенням інвалідності та смертності пацієнтів у результаті переломів, викликаних низькоенергетичною травмою. Мета дослідження: вивчити кореляцію компонентів метаболічного синдрому, мінеральної щільності кісткової тканини (МЩКТ) і показника якості трабекулярної кісткової тканини (trabecular bone score — TBS) у жінок у постменопаузальному періоді з невертебральними переломами. Матеріали та методи. Пацієнтки в постменопаузальному періоді віком 50–79 років (n = 1161) були обстежені і розподілені на три групи: до групи А увійшли 419 жінок із підвищеною масою тіла (індекс маси тіла (ІМТ) — 25,0–29,9 кг/м2), групи Б — 442 жінки з ожирінням (ІМТ > 29,9 кг/м2) і до групи В — 300 жінок із метаболічним синдромом (діагноз установлений відповідно до критеріїв Міжнародної федерації діабету, 2005). Двохенергетична рентгенівська абсорбціометрія (Prodigy, GE Medical systems, Lunar, Madison, WI, USA, 2005) використовувалася для визначення МЩКТ поперекового відділу хребта (L1–L4), шийки стегна, всього скелету і передпліччя і показників якості кісткової тканини (останніх — за допомогою програмного забезпечення Medimaps). Дані аналізувалися за допомогою програми Statistica 6.0. Результати. Значне збільшення МЩКТ поперекового відділу хребта (L1–L4), шийки стегнової кістки, всього скелету і ультрадістального відділу променевої кістки було виявлено в жінок з ожирінням і метаболічним синдромом на відміну від пацієнток із предожирінням (p < 0,001). TBS був значно вищим у жінок із підвищеною масою тіла порівняно з пацієнтками з ожирінням і метаболічним синдромом. Аналіз показав значну позитивну кореляцію між окружністю талії, рівнем тригліцеридів і МЩКТ поперекового відділу хребта і стегнової кістки. Установлений значний негативний зв’язок між рівнем ліпопротеїнів високої щільності (ЛПВЩ) у сироватці крові та МЩКТ досліджуваних ділянок. Висновки. TBS (L1–L4) позитивно корелює з рівнем ЛПВЩ. Незважаючи на те що показники МЩКТ були кращими в жінок із метаболічним синдромом, частота невертебральних переломів у цій групі була значно вищою.

Актуальность. Медицинская, социальная и экономическая значимость остеопороза обусловлена снижением качества жизни, увеличением инвалидности и смертности пациентов в результате переломов, вызванных низкоэнергетической травмой. Цель исследования: изучить корреляцию компонентов метаболического синдрома, минеральной плотности костной ткани (МПКТ) и показателя качества трабекулярной костной ткани (trabecular bone score — TBS) у женщин в постменопаузальном периоде с невертебральными переломами. Материалы и методы. Пациентки в постменопаузальном периоде в возрасте 50–79 лет (n = 1161) были обследованы и разделены на три группы: в группу А вошли 419 женщин с повышенной массой тела (индекс массы тела (ИМТ) — 25,0–29,9 кг/м2), группу Б — 442 женщины с ожирением (ИМТ > 29,9 кг/м2) и в группу В — 300 женщин с метаболическим синдромом (диагноз установлен согласно критериям Международной федерации диабета, 2005). Двухэнергетическая рентгеновская абсорбциометрия (Prodigy, GE Medical systems, Lunar, Madison, WI, USA, 2005) использовалась для определения МПКТ поясничного отдела позвоночника (L1–L4), шейки бедренной кости, всего скелета и предплечья и показателей качества костной ткани (последних — с помощью программного обеспечения Medimaps). Данные анализировались с помощью программы Statistica 6.0. Результаты. Значительное увеличение МПКТ поясничного отдела позвоночника (L1–L4), шейки бедренной кости, всего скелета и ультрадистального отдела лучевой кости было обнаружено у женщин с ожирением и метаболическим синдромом в отличие от пациенток с предожирением (p < 0,001). TBS был значительно выше у женщин с избыточной массой тела по сравнению с пациентками с ожирением и метаболическим синдромом. Анализ показал значительную положительную корреляцию между окружностью талии, уровнем триглицеридов и МПКТ поясничного отдела позвоночника и бедренной кости. Установлена значительная отрицательная связь между уровнем липопротеинов высокой плотности (ЛПВП) в сыворотке крови и МПКТ исследуемых участков. Выводы. TBS (L1–L4) положительно коррелирует с уровнем ЛПВП. Несмотря на то что показатели МПКТ были лучше у женщин с метаболическим синдромом, частота невертебральных переломов в этой группе была значительно выше.

Background. Medical, social and economic relevance of osteoporosis is caused by reducing quality of life, increasing disability and mortality of the patients as a result of fractures due to the low-energy trauma. This study is aimed to examine the associations of metabolic syndrome components, bone mineral density (BMD) and trabecular bone score (TBS) in menopausal women with non-vertebral fractures. Materials and methods. 1161 menopausal women aged 50–79 years were examined and divided into three groups: group A included 419 women with increased body weight (body mass index (BMI) — 25.0–29.9 kg/m2), group B — 442 females with obesity (BMI > 29.9 kg/m2) and group C — 300 women with metabolic syndrome (diagnosis according to International Diabetes Federation criteria, 2005). Dual-energy X-ray absorptiometry (Prodigy, GE Medical systems, Lunar, Madison, WI, USA, 2005) was used for measuring lumbar spine (L1-L4), femoral neck, total body and forearm BMD and bone quality indexes (last using Medimaps software). Data were analyzed using Statistica 6.0 package. Results. A significant increase of lumbar spine (L1-L4), femoral neck, total body and ultradistal radius BMD was found in women with obesity and metabolic syndrome compared to the pre-obese ones (p < 0.001). TBS was significantly higher in women with increased body weight compared to obese and metabolic syndrome patients. Analysis showed a significant positive correlation between waist circumference, triglycerides level and BMD of lumbar spine and femur. Significant negative association was found between serum high-density lipoproteins (HDL) level and BMD of investigated sites. Conclusions. The TBS (L1-L4) indexes positively correlated with HDL level. Despite the fact that BMD indexes were better in women with metabolic syndrome, the frequency of non-vertebral fractures was significantly higher in this group of patients.


Keywords

мінеральна щільність кісткової тканини; показник якості трабекулярної кісткової тканини; метаболічний синдром; перелом

минеральная плотность костной ткани; показатель качества трабекулярной костной ткани; метаболический синдром; перелом

bone mineral density; trabecular bone score; metabolic syndrome; fracture

Introduction

Osteoporosis and metabolic syndrome are important public health problems, due to the decreasing of quality and reducing life expectancy of patients as a result of low-trauma fractures in a case of osteoporosis and the possibility of cardiovascular, endocrine and other complications in a case of metabolic syndrome development [1, 5]. The frequency of both diseases increases with age of patient and duration of menopausal period as a result of slowdown in metabolism and estrogen deficiency development [8, 11]. 
Traditionally, osteoporosis is diagnosed according to the history of low-energy fractures or the results of bone mineral density (BMD) (T-score), which determine using X-ray densitometry [10]; however, BMD provides only 70–75 % of bone strength [12]. Other factors that affect it include state of cortical bone macro-geometry and trabecular bone micro-architecture, presence damages and cracks in it, which can be calculated by index trabecular bone score (TBS), patented by MED-I maps (m. Bordeaux, France) in 2006 [3]. In our opinion, evaluation of TBS is important to perform this work. 
Scientists paid much attention to the study of the relationships between metabolic syndrome and osteoporosis. Abdominal obesity, high glucose (as a result of insulin deficiency or insulin resistance), high triglycerides and low high density lipoproteins which are the main components of metabolic syndrome have significant impact on bone tissue and fractures development but published research results are contradictory [4, 7, 13, 15]. The discrepancy of opinions prompted this investigation.
The purpose of our study was to evaluate the relationships between metabolic syndrome components and BMD, TBS in postmenopausal women with low-trauma non-vertebral fractures.

Materials and methods

The study involved 1161 postmenopausal women aged 50–79 years (mean age — 63.977 ± 7.961 years; mean body mass index — 31.587 ± 4.739 kg/m2; mean waist circumference — 92.524 ± 11.466 cm; mean duration of menopause period — 13.858 ± 8.014). Patients were divided into three groups: A — 419 women with increase body weight (pre-obese) defined on the basis of WHO criteria [14], BMI 25.0–29.9 kg/m2 (mean age — 63.983 ± 8.283 years; mean body mass index — 27.547 ± 1.906 kg/m2; mean waist circumference — 79.995 ± 4.511 cm; mean duration of menopause period — 13.809 ± 8.004), B — 442 women with obesity — BMI ≥ 30.0 kg/m2 (mean age — 63.884 ± 7.619 years; mean body mass index — 34.418 ± 3.864 kg/m2; mean waist circumference — 100.464 ± 6.726 cm; mean duration of menopause period — 13.627 ± 7.847), C — 300 female with metabolic syndrome (diagnosed according to the International Diabetic Federation criteria of 2005) [6] (mean age — 64.163 ± 8.017; mean body mass index — 33.058 ± 4.812 kg/m2; mean waist circumference — 98.323 ± 8.244 cm; mean duration of menopause period — 14.267 ± 8.280). Additionally groups were divided according to the presence of low-trauma non-vertebral fractures (202 female had them in history (NVF) and 959 women were without fractures (WF) in the past).
BMD of lumbar spine (L1–L4), femoral neck, total body and forearm was measured by the DXA method (Prodigy, GE Medical systems, Lunar, Madison, WI, USA, 2005). 
TBS at the L1–L4 was evaluated by TBS iNsight® software (Med-Imaps, Pessac, France) which was installed on DXA machine.
One-way ANOVA test and correlation analysis were performed with usage of Statistical Package 6.0 ©StatSoft, Inc, results presented as M ± SD. Associations between continuous variables were examined by Pearson correlation coefficient, significance set at p < 0.05.

Results and discussion

We found that women with increased body weight have a significantly lower BMD of lumbar spine (A — 0.986 ± 0.178 g/cm2, B — 1.109 ± 0.181 g/cm2; C — 1.120 ± 0.199 g/cm2; F = 63.814; p < 0.001); femoral neck (A — 0.809 ± 0.126 g/cm2, B — 0.872 ± 0.134 g/cm2; C — 0.880 ± 0.149 g/cm2; F = 32.097; p < 0.001), total body (A — 0.876 ± 0.139 g/cm2, B — 0.968 ± 0.146 g/cm2; C — 0.978 ± 0.160 g/cm2; F = 57.366; p < 0.001) and ultra-distal forearm (A — 0.378 ± 0.076 g/cm2, B — 0.436 ± 0.080 g/cm2; C — 0.435 ± 0.088 g/cm2; F = 67.582; p < 0.001) compared to women with obesity and metabolic syndrome. The bone tissue quality (TBS L1–L4) was significantly higher in women with increased weight in comparison with metabolic syndrome female (A — 1.188 ± 0.151, B — 1.169 ± 0.163; C — 1.157 ± 0.173 g/cm2; F = 3.479; p < 0.05).
BMD of lumbar spine (L1–L4) was significantly higher in patients of groups B and C without fractures (table 1). BMD of femoral neck was significantly lower in female with obesity and non-vertebral fractures (table 2). BMD of total body and ultradistal radius significantly better in all groups of women without fractures compared to patients with non-vertebral fractures (table 3, 4). TBS (L1–L4) was significantly higher in patients without fractures in the groups of women with increased body weight and obesity (p < 0.05) (table 5).
The analysis of the metabolic syndrome laboratory components (serum triglycerides and HDL indexes) was carried out. We established significantly higher triglycerides level (A — 1.049 ± 0.381 g/cm2, B — 1.030 ± 0.322 g/cm2; C — 1.605 ± 0.703 g/cm2; F = 162.669; p < 0.001) and significantly lower HDL level (A — 1.531 ± 0.372 g/cm2, B — 1.509 ± 0.314 g/cm2; C — 1.170 ± 0.256 g/cm2; F = 126.832; p < 0.001) in patients with metabolic syndrome. There was no difference of triglycerides level in female with non-vertebral fractures and without them in all investigated groups (table 6). The level of HDL was significantly lower in patients with non-vertebral fractures and metabolic syndrome (table 7).
In analysis of metabolic syndrome components, the waist circumference component was positively associated with BMD of lumbar spine and femur (fig. 1). The study reveals significant positive correlation between serum triglycerides level and both investigated BMD sites (fig. 2). A number of investigators have suggested relationship in accordance with our own findings [2]. It was found a significant positive correlation between HDL serum level and TBS and inversely association with BMD of lumbar spine and femur (fig. 3).
 
We calculated the percentage of non-vertebral fractures in anamnesis (fig. 4). 
Low-trauma non-vertebral fractures occurred in 14.6 % female with increased body weight, 17.4 % of women with obesity and 21.3 % of patients with metabolic syndrome. 
It was not found significant differences in the frequency of non-vertebral fractures in the groups of women with obesity and increased body weight or metabolic syndrome (X2 = 1.312, p > 0.05 and X2 = 1.780, p > 0.05, respectively), but it was significant in the groups of pre-obese female and patients with metabolic syndrome (X2 = 5.590, p < 0.05). The similar results were found by other investigators [9].

Conclusions

Menopausal women with obesity and metabolic syndrome have a significantly higher BMD at all measured sites compared to females with pre-obesity. TBS is significantly lower in women with non-vertebral fractures and increased body weight or obesity. A significant positive correlation is established between waist circumference, triglycerides level and BMD of lumbar spine and femoral neck. Correlation between HDL level and BMD at all levels is significant and negative. At the same time it is positively associated with TBS indexes. There is no significant difference in frequency of low-trauma non-vertebral fractures in the groups of pre-obese and obese women. At the same time, the incidence of osteoporotic non-vertebral fractures is significantly higher in female with metabolic syndrome in compared to other patients Metabolic syndrome may not protect from any type of fractures but future investigations are necessary.
Conflicts of interests. Authors declare the absence of any conflicts of interests that might be construed to influence the results or interpretation of their manuscript.

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