Hasan ATBİNİCİ, Serkan SİPAHİOGLU, Nurten AKSOY, İslam BAYKARA, Ugur ISİKAN

Osteoporoz hastalarında salmon kalsitonin tedavisinin serum ve sinovyal sıvı kemik yapım ve yıkım belirteçleri üzerine etkisi

Amaç: Salmon kalsitonin, kalsiyum ve D vitamin tedavisinin osteoporoz hastalarında kemik mineral yoğunluğu, sinovyal sıvı ve serumda kemik yapım ve yıkım belirteçleri üzerine etkisini değerlendirmek amaçlandı.Çalışma planı: Kemik mineral yoğunluğu ölçümü T skoru -2,5 altında 50–85 yaş arası daha önceden osteoporoz tedavisi almamış 25 hasta çalışmaya dâhil edildi. Hastalar iki gruba ayrıldı. Kalsitonin alan Grup1’de 15 (E/K = 1 /14, ortalama yaş 67) ve kalsitonin almayan Grup 2’de 10 (E/K=3/7, ortalama yaş 68) hasta değerlendirildi. Çalışma başlangıcında ve 1 yıl tedavi sonrasında kan ve sinovyal sıvıdaki fosfor, alkalen fosfataz, kalsiyum, kalsitonin, C-telopeptit (CTx), N-telopeptit (NTx), siyaloprotein ile birlikte kemik mineral yoğunluğu değerlerine bakıldı.Bulgular: Kalsitonin alan grupta tedavi sonrasında femur boyun kemik mineral yoğunluğu değerinde azalma ve vertebra kemik mineral yoğunluğu değerinde artma olduğu görüldü. Kalsitonin almayan grupta her iki değerde artma vardı. Tedavi sonrası kalsitonin alan hastaların sinovyal sıvısında, kalsitonin, siyaloprotein ve NTx değerlerinde azalma, CTx değerinde değişim saptanmadı. Kalsitonin değerindeki azalma istatiksel olarak anlamlı bulundu. CTx, Siyaloprotein değerinde değişim saptanmadı. Bu değişimler istatiksel olarak anlamlı bulunmadı. Kalsitonin almayan Grup 2’de tedavi sonrası sinovyal sıvısında, kalsitonin değerinde azalma, CTx değerinde artma, NTx, Siyaloprotein değerinde değişim saptanmadı. Bu değişimler istatiksel olarak anlamlı bulunmadı. Her iki grupta da tedavi sonrası parametrelerin serum değerlerindeki değişimler anlamlı bulunmadı.Çıkarımlar: Osteoporoz hastalarında sinovial sıvı kemik yapım ve yıkım belirteç düzeyleri kalsitonin tedavisinden etkilenmektedir. Bu etkileşimin hangi mekanizmalarla gerçekleştiğini ve osteoporoz eklem kıkırdağı metabolizması arasındaki ilişkiyi açıklayacak daha ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

CTx; dansitometre; NTx; osteoporoz; solmon kalsitonin; sinovyal sıvı.

Effects of salmon calcitonin treatment on serum and synovial fluid bone formation and resorption markers in osteoporosis patients

Objective: This study aimed to evaluate the effects of salmon calcitonin, and calcium and vitamin Dtreatment on bone mineral density, serum and synovial fluid bone formation and resorption markers in patients with osteoporosis.Methods: The study was completed with twenty-five osteoporosis patients divided into two groups: The 15 patients comprising Group I (1 male and 14 females; mean age: 67.0±12.0) were administered calcitonin treatment in addition to calcium and vitamin D. The 10 patients in Group II (3 males and 7 females; mean age 68.0±16.0) were administered calcium and vitamin D only. Serum and synovial fluid calcium phosphorus, alkaline phosphatase, calcitonin, C-telopeptide (CTx), N-telopeptide (NTx) and sialoprotein levels, and bone densitometries were determined at the beginning and at the end of one year of treatment.Results: In the calcitonin and calcium and vitamin D treatment group (Group I), femoral neck density scores were decreased and vertebrae scores were increased after one-year treatment. Both scores were increased in the non-calcitonin group (Group II). In Group I, synovial fluid levels of calcitonin, sialoprotein and NTx were decreased, and synovial fluid CTx levels showed no change. The only decrease that was statistically significant was that in calcitonin levels. In Group II, synovial fluid calcitonin levels were decreased, synovial fluid CTx levels were increased and synovial fluid NTx and sialoprotein level were unchanged. These changes were not statistically significant. Serum changes in the parameters were not statistically significant in either group.Conclusion: In osteoporosis, salmon calcitonin treatment affects synovial fluid bone formation and absorption marker levels. Advanced studies are needed to evaluate the mechanisms by which this takes place, and to explain the relationship between osteoporosis and articular cartilage metabolism.

Keywords:

CTx, densitometry, NTx, osteoporosis, salmon calcitonin synovial fluid,

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