| Abstract | Cilj istraživanja
Cilj istraživanja bio je usporediti vrijednosti pokazatelja tjelesne sposobnosti s koncentracijom vitamina D u krvi i s vrijednostima mineralne gustoće kosti u žena u postmenopauzi.
Ispitanici i metode
Istraživanjem su obuhvaćene ukupno 194 ispitanice u postmenopauzi dobi 50 i više godina. Iz istraživanja su isključene žene koje su do sada liječene lijekovima za osteoporozu i glukokortikoidima, kao i žene koje su imale bolesti koje značajno utječu na metabolizam kosti. Svim ispitanicama izmjerena je tjelesna sposobnost pomoću kratkog testa (SPPB), određena snaga stiska dominantne šake hidrauličkim dinamometrom, određena serumska koncentracija 25-hidroksivitamina D (25(OH)D) i izmjerena mineralna gustoća kosti (BMD) denzitometrijom kosti pomoću X zraka dvostruke prodornosti (DXA).
Rezultati
Prosječna dob ispitanica iznosila je 60,6 godina, prosječno trajanje menopauze iznosilo je 11,4 godine, a prosječan indeks tjelesne mase iznosio je 29,0 kg/m2. U samo 13,9% ispitanica denzitometrijski je utvrđena osteoporoza. Prosječna koncentracija vitamina D iznosila je 49,1 nmol/L (±17,1 SD). Prevalencija insuficijencije, deficita i teškog deficita vitamina D iznosila je kako slijedi 90,7%, 59,3% i 14,4% (granične vrijednosti 25(OH)D <75, <50, <30 nmol/L). Koncentracija vitamina D značajno se smanjivala s porastom dobi ispitanica (r=-0,25; p<0,001). Prevalencija teškog deficita vitamina D (<30 nmol/L) u ispitanica dobi 70 i više godina iznosila je čak 36,7%. Utvrđene su sezonske varijacije u koncentraciji vitamina D uz najveću izmjerenu prosječnu koncentraciju tijekom ljeta, a najmanju u rano proljeće (p=0,030). Prevalencija teškog deficita vitamina D bila je veća u ispitanica s osteoporozom u odnosu na ispitanice s urednom mineralnom gustoćom kosti (<30 nmol/L; 29,6% vs. 9,8 %). Koncentracija vitamina D bila je statistički značajno i pozitivno povezana s mineralnom gustoćom kosti (g/cm2) izmjerenom ukupno na kuku (r=0,18; p=0,026) i na vratu bedrene kosti (r=0,20; p<0,001). Prosječna tjelesna sposobnost ispitanica bila je osrednja (SPPB 7,77±2,37). U 28,3% ispitanica izmjerena je loša, u 28,9% osrednja i u 42,8% dobra tjelesna sposobnost. Najbolje su ispitanice izvele standardizirani test za procjenu uobičajene brzine hoda (79,9% dobro do izvrsno), nešto lošije test za procjenu ravnoteže (59,3% dobro do izvrsno), a najlošije test za procjenu snage mišića nogu (35% dobro do izvrsno). Tjelesna sposobnost smanjivala se s dobi ispitanica (r=-0,49; p<0,001) i bila je pozitivno povezana s koncentracijom vitamina D (r=0,59; p<0,001). Od pojedinačnih testova tjelesne sposobnosti najsnažniju povezanost s koncentracijom vitamina D pokazao je test najveće brzine hoda (r=0,60; p<0,001) i snaga stiska dominantne šake (r=0,53; p<0,001). Tjelesna sposobnost bila je veća što je bila veća tjelesna aktivnost, odnosno manji broj sati proveden sedentarno u toku dana (korelacija SPPB-a i tjelesne aktivnosti: r=-0,34; p<0,001). Ukupna razina tjelesne sposobnosti (mjerena SPPB-om) bila je statistički značajno povezana s mineralnom gustoćom kosti izmjerenom ukupno na kuku (r=0,19; p=0,031) kao i na vratu bedrene kosti (r=0,24; p=0,011). Ovim istraživanjem potvrđena je statistički značajna povezanost dobi, trajanja menopauze i indeksa tjelesne mase s mineralnom gustoćom kosti na slabinskoj kralješnici i kuku. Zaključak
Rezultati ovog istraživanja ukazuju na vrlo visoku prevalenciju nedostatka vitamina D u hrvatskih žena u postmenopauzi. Ta utvrđena visoka prevalencija nedostatka vitamina D uz rastuću spoznaju o važnosti vitamina D u brojnim skeletnim i ne-skeletnim funkcijama u organizmu ukazuje na potrebu provođenja javno-zdravstvenih mjera za poboljšanje statusa vitamina D u navedenoj populaciji. Utvrđena je osrednja prosječna tjelesna sposobnost u žena u postmenopazi, a iz rezultata se nameće zaključak kako bi se ona najučinkovitije mogla povećati upravo programima koji bi omogućili povećanje snage mišića nogu i poboljšanje ravnoteže, kao i poboljšanjem statusa vitamina D. Utvrđena je značajna i pozitivna povezanost koncentracije vitamina D i tjelesne sposobnosti s mineralnom gustoćom kosti izmjerenom na kuku i vratu bedrene kosti. Navedeni rezultati upućuju na zaključak da se mineralna gustoća kosti, a time i čvrstoća kosti, u žena u postmenopauzi može povećati poboljšanjem statusa vitamina D i povećanjem razine tjelesne sposobnosti. Za ostvarenje tih ciljeva neophodno je osmišljavanje i provođenje javno-zdravstvenih mjera od edukacije pa do različitih rekreacijskih programa. Također rezultati istraživanja opravdavaju uvođenje mjerenja tjelesne sposobnosti u svakodnevnoj kliničkoj praksi dijagnostike i liječenja osteoporoze. |
| Abstract (english) | Objectives
The aim of the study was to investigate physical performance in Croatian postmenopausal women and to correlate it with vitamin D concentrations and bone mineral density.
Patients and methods
This study was based on the sample of 194 adult, postmenopausal women aged 50 years or over from Croatia. Women who previously received therapy for osteoporosis or glucocorticoids, and women with uncontrolled diseases with substantial potential to influence bone metabolism were excluded from the study. Short physical performance battery test (SPPB) was used for assessment of physical function. Hydraulic hand dynamometer was used for measuring grip strength. Assessment of 25-hydoxyvitamin D (25(OH)D) concentration and bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) was performed to all participants.
Results
The average age of the participants in this study was 60.6 years. The average menopause duration was 11.4 years. The average BMI was 29.0 kg/m2. Among the included participants only 13.9 % of women complied with diagnostic criteria for osteoporosis. Mean serum concentration of 25(OH)D was 49.1 nmol/L (±17.1 SD). The prevalence of three cut-off levels of vitamin D inadequacy was as follows 90.7% for vitamin D insufficiency (<75 nmol/L), 59.3% for vitamin D deficiency (<50 nmol/L), and 14.4 for severe vitamin D deficiency (<30 nmol/L). Vitamin D was exhibiting declining values with increasing age (r=-0.25; p<0.001). The prevalence of severe vitamin D deficiency (<30 nmol/L) in participants aged 70 years or over was 36.7%. Seasonal variations in vitamin D concentration were detected. The highest level of vitamin D was detected in summer and the lowest in early spring with significant statistical difference between summer and spring (p=0.030). The prevalence of severe vitamin D deficiency was significantly higher in participants with osteoporosis compared with participants with normal BMD (<30 nmol/L; 29.6% vs. 9.8 %). Correlation between serum 25(OH)D concentration and BMD was significant and positive at the proximal femur (r=0.18; p=0.026), and at the femoral neck (r=0.20; p<0.001).
The average value of SPPB was 7.77 (±2.37 SD) indicating medium level of physical performance in Croatian postmenopausal women. In 28.3% of participants average physical performance was bad. In 28.9% of participants average physical performance was medium and in 42.8% average physical performance was good. The best scored was the test for gait speed (79.9% of participants scored good or excellent), followed by balance test (59.3% scored good or excellent), and the worst scored was the test for lower leg muscle strength (35% scored good or excellent). Physical performance was exhibiting declining values with increasing age (r=-0.49; p<0.001). The strongest correlation with vitamin D concentration showed maximum gait speed (r=0.60; p<0.001) followed by grip strength (r=0.53; p<0.001). Physical performance was better in participants with higher physical activity. Physical activity measured by number of hours spend during the day in sedentary activity correlated negatively with physical performance (r=-0.34; p<0.001).
Correlation between physical performance and BMD was significant and positive at the proximal femur (r=0.19; p=0.031), and at the femoral neck (r=0.24; p=0.011). The results of this study confirmed previously detected strong correlation between age, menopause duration and body mass index with BMD measured both at the lumbar spine and et the proximal femur.
Conclusion
The results of this study indicate a high prevalence of vitamin D inadequacy in Croatian postmenopausal women. High prevalence coupled with the rising recognition of potential clinical significance of the vitamin D inadequacy in skeletal and non-skeletal functions in the human organism make this highly interesting intervention target, suggesting that the attempts to increase the awareness on this issue are needed. Medium level physical performance was determinated in postmenopausal women. Results of this study suggest that it can be enhanced by programs aimed at enhancement of lower extremity muscle strength and balance and by the enhancement of vitamin D status in postmenopausal women. Based on the finding of significant and positive correlation between serum 25(OH)D concentration and BMD, and between physical performance and BMD measured at the proximal femur and at the femoral neck we can speculate that BMD can be enhanced trough optimizing vitamin D status and physical performance in postmenopausal women. For implementation of these goals broad and various health programs are needed. The results of this study implicate that physical performance measures should be included in everyday clinical praxis for management of osteoporosis. |
