I Środkowo Europejski Kongres Osteoporozy i Osteoartrozy oraz XIII Zjazd Polskiego Towarzystwa Osteoartrologii i Polskiej Fundacji Osteoporozy, Kraków 6-8.10.2005

Streszczenia:
Ortopedia Traumatologia Rehabilitacja 2005, vol 7 (Suppl. 1), s124-125.

P06
PROSPEKTYWNE BADANIA STANU KOŚĆCA I STANU FUNKCJONALNEGO U CHORYCH PO UDARZE MÓZGU

Pluskiewicz W.1, Pietraszkiewicz F.2, Drozdowska B.3, Adamczyk P.4
1 Katedra i Klinika Chorób Wewnętrznych, Diabetologii i Nefrologii, Zakład Chorób Metabolicznych Kości, Zabrze, Śląska Akademia Medyczna, Katowice.
2 Oddział Rehabiltacji, Nowa Sól.
3 Katedra i Zakład Patomorfologii, Zabrze, Śląska Akademia Medyczna, Katowice
4 Katedra i Klinika Pediatrii, Nefrologii I Endokrynologii Dzieci, Zabrze, Śląska Akademia Medyczna, Katowice.

Słowa kluczowe: badanie funkcjonalne, gęstość mineralna kości, ilościowa metoda ultradźwiękowa

U chorych po udarze mózgu z powodu unieruchomienia i/lub zaburzeń neurologicznych może dochodzić do zaburzeń stanu kośćca. Celem pracy była ocena stanu funkcjonalnego i stanu szkieletu u 21 chorych po udarze mózgu (10 kobiet i 11 mężczyzn) w średnim wieku 61,8+/-10,1 badanych 35+/-43 i 47+/-43 miesięcy po pierwszym udarze mózgu. Stan szkieletu oceniano badaniami gęstości mineralnej (BMD g/cm2) kości piętowej i przedramienia aparatem PIXI (Lunar, USA) i badając ilościową metodą ultradźwiękową paliczki dłoni (Ad-SoS, m/s) aparatem DBM Sonic 1200, (IGEA, Włochy). Stan funkcjonalny oceniano przy pomocy Wskaźnika Barthel. Średnie wartości BMD przedramienia i Ad-SoS wyjściowo i po roku były istotnie niższe po stronie po udarze względem strony zdrowej (p<0,05), a BMD kości piętowej nie różniły się. BMD przedramienia nie zmieniało się w czasie obserwacji po stronie chorej, a uległo istotnemu obniżeniu po stronie zdrowej (p<0,05), a BMD pięty obniżyło się po stronie chorej (p<0,05). Ad-SoS nie uległ w czasie trwania obserwacji istotnym zmianom. Stosując pojęcie minimalnej znamiennej zmiany (Least Significant Change -LSC) istotny spadek zanotowano u 48% chorych (strona zdrowa), 57% (strona chora) dla pięty, u 38% chorych obustronnie dla Ad-SoS oraz u 28% chorych obustronnie dla przedramienia. Podczas obserwacji Wskaźnik Barthel wzrósł istotnie z 77+/-22 do 87+/-16 (p<0,05), ale nie wykazywał związków z wynikami pomiarów szkieletu. W celu oceny czy prospektywne zmiany zmiany wartości Wskaźnika Barthel (BI) wpływały na zmiany wyników pomiarów szkieletu (BMD, Ad-SoS) przeprowadzono analizę korelacji BI z BMD i Ad-SoS i uzyskano istotną korelację BI z BMD kości piętowej po stronie chorej (r=-0,43, p=0,05). Czas od udaru nie wpływał na Wskaźnik Barthel Index i wyniki pomiarów szkieletu.
Podsumowując, u chorych po udarze mózgu zaburzenia szkieletowe kończyn górnych mają charakter trwały, a roczna obserwacja wykazała obniżenie BMD kości piętowej mimo równoległej poprawy stanu funkcjonalnego.

P06
A LONGITUDINAL ASSESSMENT OF SKELETAL AND FUNCTIONAL STATUS IN PATIENTS WITH LONG-STANDING STROKE

Pluskiewicz W.1, Pietraszkiewicz F.2, Drozdowska B.3, Adamczyk P.4
1 Department and Clinic of Internal Diseases, Diabetology and Nephrology – Metabolic Bone Diseases Unit, Zabrze, Silesian School of Medicine in Katowice, Poland
2 Department of Rehabilitation, Nowa Sól, Poland
3 Department and Chair of Patomorphology, Zabrze, Silesian School of Medicine in Katowice, Poland
4 Department and Clinic of Nephrology, Endocrinology and Metabolic Disorders of Childhood, Zabrze, Silesian School of Medicine in Katowice, Poland

Keywords: functional status, BMD, quantitative ultrasounds

Skeletal status in subjects after stroke may be affected due to immobilization and/or neurological disorders connected with a stroke. The aim of the study was to assess skeletal and functional status in a group of 21 subjects (10 females and 11 males) in mean baseline age of 61.8+/-10.1 years evaluated 35+/-43 and 47+/-43 months after a first stroke. Skeletal status was assessed by densitometric measurements at the forearm and calcaneus using PIXI (Lunar, USA) and quantitative ultrasound measurements at hand phalanges using DBM Sonic 1200 (IGEA, Italy) which measures Amplitude-dependent Speed of Sound (Ad-SoS, m/s). Functional status was evaluated by Barthel Index. The mean values, at the baseline and follow up of forearm and ultrasound variables were significantly lower at affected limb (p<0.05) and no differences were noted for calcaneus measurements. In a longitudinal observation the mean forearm measurements at affected limb did not drop while at the opposite site a significant decrease was observed (p<0.05), calcaneal measurement showed a decrease only at affected limb (p<0.05) and no differences occurred for ultrasound measurements. The values of the least significant change (LSC) for skeletal measurements were used in order to detect longitudinal changes in individual patients. The percentage of subjects with a significant drop in BMD values exceed those with a significant increase and was 48% (non-affected side) and 57% (affected) for calcaneus, 38% (both sides) for ultrasound and 28% (both sides) for forearm. During a period of the study the value of Barthel Index increased significantly from 77+/-22 to 87+/-16 (p<0.05) and did not correlate with skeletal variables at the baseline and follow up. In order to establish weather a longitudinal change in BI (BI) influenced longitudinal changes in skeletal variables (BMD, Ad-SoS) a correlation analysis was performed, and a correlation was noted only betweenBI and BMD for calcaneus at affected side (r=-0.43, p=0.05). A time since stroke did not influence Barthel Index and skeletal variables.
Concluding, in subjects with long-standing stroke a skeletal status was permanently affected within upper limbs, and in a longitudinal observation aggravation was noted mainly for calcaneus despite parallel improvement in functional status expressed by Barthel Index.

II Środkowo Europejski Kongres Osteoporozy i Osteoartrozy oraz XIV Zjazd Polskiego Towarzystwa Osteoartrologii i Polskiej Fundacji Osteoporozy, Kraków 11-13.10.2007
Streszczenia:
Ortopedia Traumatologia Rehabilitacja 2007, vol 9 (Suppl. 2), s151-152

P06
STRUCTURAL-FUNCTIONAL STATE OF BONE IN MEN OF DIFFERENT AGE

Povoroznyuk V. V., Kreslov Y. A.

Department of Clinical Physiology and Pathology of Locomotor Apparatus,
Institute of Gerontology AMSU, Ukrainian Scientific-Medical Centre for the Problems of Osteoporosis, Vyshgorodskaya str. 67, Kiev, 04114, Ukraine

This research was aimed at studying the age-dependent peculiarities of bone mineral density and bone mineral consent in men.
Research object: The total of 210 men 20–89 years old (54,6 ± 1,2) were examined and divided into the following age-dependent groups: 20- 29 years old, 30-39 years old, 40-49 years old, 50-59 years old, 60-69 years old, 70-79 years old, 80-89 years old.
Research methods: The mineral density and mineral consent of bone was determined using dual X-ray densitometry by means of „Prodigy” apparatus (GE Medical systems, Lunar, model 8743, 2005).
Research results: The analysis of variation did not expose any reliable influence of age on the BMD and BMC indexes of lumbar spine.
Bone mineral density was significantly higher in the group of 80-89 year-olds in comparison with other groups that may indicate some “selectivity“of this group. Hip BMD in the group of 70-79 year-olds was significantly lower in comparison with other groups: 20-29 year-olds (p = 0,012), 40-49 year-olds (p = 0,036), 60-69 year-olds (p = 0,039).
Correlation of lumbar spine BMD with height was established (r = 0,16; p = 0,021), weight (r = 0,27; p < 0,0001), BMI (r = 0,22; p = 0,001), BMD hip (r = 0,62; p < 0,001); BMD hip with age (r = – 0,15; p = 0,024), height (r = 0,30; p < 0,0001), weight (r = 0,35; p < 0,0001), BMI (r = 0,23; p < 0,001).
The osteoporosis of lumbar spine was observed by X-ray densitometry in 4,3% of patients in group of 40-49 years, in 7,9% – group of 50-59 years, in 7,5% – group of 60-69 years, in 19,2% – group of 70-79 years, in 9,1% – group of 80-89 years; hip osteoporosis in 2,3%, 5,3%, 2,8%, 7,6% of patients respectively. Osteopaenia of lumbar spine was established in 34,8% of patients in group of 20-29 years, in 36% – 30-39 years, in 31,9% – 40-59 years, in 28,9% – 50-59 years, in 20% – 60-69 years, in 23,1% – 70-79 years, in 13,6% – 80-89 years; hip osteopaenia in 20,0% of patients, in 12,5%, in 15,9%, in 23,7%, in 19,4%, in 26,9% and in 22,7% respectively. Among patients of 80-89 years normal state of bone was observed in 77,3%.
Conclusions: Age in men has a substantial influence on hip BMD: the lowest indexes were observed in group of 70-79 year-olds. The osteoporosis of lumbar spine was observed in 19,2%, hip osteoporosis in 7,6% of patients in this group.

P07
HYPODYNAMIA IN ADOLESCENCE AND OSTEOPOROSIS RISK

Popivanova C. V.
National Center of Public Health Protection, Ministry of Health, Sofia, Bulgaria

Active motion in childhood and adolescence is that very important factor for building up and maturing of the bone-skeletal system. With view to realization of the so called “strategic” (in childhood and adolescence) osteoporosis prevention, the study aimed to establish the level of physical activity in adolescents, hypodynamia signs and other unfavorable phenomena as risk factors for disturbed bone health. The studied group consisted of 773 adolescents, 14 – 18 years of age, from secondary schools. The study used anthropometric, questionnaire and psychological methods. A number of shortcomings are found in the system of physical exercises in the Bulgarian school. The students whose physical activities are restricted to school sports lessons form a large group at risk with marked signs of hypodynamia (50.98%). The processes of growth, maturing and development of the bone and muscle system in this group are disturbed. The physical development and physical capacity are at a statistically significant lower level (p < 0.001), the age annual dynamics of anthropometric indicators is uneven, the peak growth of the bone skeleton is retarded with a year, the rate of kyphoses and kyphoskolioses is higher. The immobilized students, as a result of hypodynamia, form an unfavorable psychosocial pattern – decreased “internal control” and “self-control” with resulting behavior risky for bone health – addiction to harmful habits and styles – tobacco smoking, drinking alcohol etc. The obtained results show that adolescent girls are at greater bone health risk than boys (p < 0.01). The fact that physical development indicators in all studied adolescents groups, with high or low physical activity extent, are significantly lower than those of their mates 15 years ago (Slanchev P. et al, 1992) is alarming and suggests retarded and weaker development of the bone-skeletal system. All adolescents in the conditions of polluted environment with reduced oxygen content in resting conditions use maximally the capacity of their lungs (very large range of the anthropometric parameter – p < 0.001) which significantly restricts the functional capacity of the respiratory system to work adequately at intensive physical efforts necessary for stimulation and maintenance of osteogenesis processes. Hypodynamia together with accompanying negative disturbances in the period of growth, maturing and development of the bone-skeletal system create particularly unfavorable life “start” and potential risk for osteoporosis development.