Erdal DİLEKÇİ, Esra Nur ADEMOĞLU DİLEKÇİ

Postmenopozal kadınlarda ürik asit ile kemik mineral yoğunluğu arasındaki ilişkinin değerlendirilmesi: tek merkezli retrospektif çalışma

Amaç: Osteoporoz, kemik kütlesi kaybı ve kırıklara yatkınlıkla sonuçlanan önemli bir halk sağlığı sorunudur. Pürin metabolizmasının son enzimatik ürünü olan ürik asitin diyabetes mellitus, hipertansiyon ve kardiyovasküler hastalıklar gibi çeşitli kronik hastalıklar üzerinde faydalı antioksidan etkilere sahip olduğunu gösteren çok sayıda kanıt vardır. Bu çalışmada postmenopozal osteoporozda serum ürik asit düzeyleri ile kemik mineral yoğunluğu (KMY) arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu çalışma Bolu Abant İzzet Baysal Eğitim ve Araştırma Hastanesi, Fizik Tedavi ve Rehabilitasyon Kliniğinde yapıldı. Ocak 2019 ve 2020 yılları arasında çift-enerjili X-ışını absorbsiyometri (DEXA) incelemesi olan ve serum ürik asit düzeyleri kaydedilmiş olan 1200 postmenopozal kadının tıbbi kayıtları retrospektif olarak tarandı. Sistemik hastalıkları olan veya kemik metabolizmasını veya ürik asit düzeylerini etkileyen ilaç alan bireyler dışlandıktan sonra toplamda 92 osteoporozlu ve 399 sağlıklı birey çalışmaya dahil edildi. Tüm bireylerde KMY, femur boynu ve lomber vertebra (L2-4) T skoru, serum glukoz, AST, ALT, kreatinin, alkalen fosfataz, kalsiyum, fosfor, parathormon ve total protein düzeyleri kaydedildi. Bulgular: Serum ürik asit konsantrasyonları, osteoporoz grubunda kontrol grubuna göre anlamlı derecede düşük bulundu [4.65 (2.40-7.80)-5.20 (3.80-9.40); p <0.001, sırasıyla] (Tablo 1). Korelasyon analizinde ürik asit anlamlı bir şekilde açlık kan şekeri (r=0.129, p= 0.004), kreatinin (r=0.374, p <0.001), kalsiyum (r=0.201, p <0.001), toplam protein (r=0.123, p=0.006) ve tiroid uyarıcı hormon (TSH) (r=0.108, p=0.017) ile ilişkili idi. Korelasyon analizi ürik asit ile L2-L4 KMY arasında anlamlı ve pozitif bir korelasyon olduğunu ortaya koydu (r=0.255, p <0.001) (Tablo 2). Çoklu doğrusal regresyon analizinde karıştırıcı faktörlerin etkisi arındırıldıktan sonra L2-L4 KMY ürik asit ile bağımsız olarak ilişkili bulundu (B=1.619, p <0.001). Sonuç: Bulgularımız, postmenopozal osteoporozda serum ürik asit düzeyleri ve lomber (L2-L4) KMY’nin bağımsız ilişkili olduğunu ortaya koydu. Ürik asit ile osteoporoz arasındaki ilişkiyi belirlemek ve ürik asidin klinik uygulamadaki kullanımını değerlendirmek için daha fazla çalışmaya ihtiyaç vardır.

Anahtar Kelimeler:

Osteoporoz, ürik asit, kemik mineral yoğunluğu, postmenopozal kadın

Evaluation of the relationship between uric acid and bone mineral density in postmenopausal women: a single center retrospective study

Objectives: Osteoporosis is an important public health problem which is characterized by loss of bone mass resulting in susceptibility to fractures. There is much evidence indicating that uric acid, a final enzymatic product of purine metabolism, has beneficial antioxidant effects on several chronic diseases such as diabetes mellitus, hypertension and cardiovascular diseases. We aimed to evaluate the relationship between serum uric acid levels and bone mineral density (BMD) on postmenopausal osteoporosis in the present study. Material and Method: This study was carried out at the Bolu İzzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital, Department of Physical Medicine and Rehabilitation.. The medical records of 1200 postmenopausal women between January 2019 and 2020 who had dual energy x-ray absorptiometry (DEXA) examination and serum uric acid levels recorded were screened retrospectively. In total, 92 individuals with osteoporosis and 399 healthy individuals were included in the study after exclusion of subjects with systemic diseases or taking drugs affecting bone metabolism or uric acid levels. Bone mineral density and T scores of femur neck (F neck) and lumbar spine (L2-L4), glucose, AST, ALT, creatinine, alkaline phosphatase, calcium, phosphate, parathormone (PTH), albumin and total protein were all recorded in individuals. Results: Serum uric acid concentrations were found to be significantly lower in the osteoporosis group compared with the control group [4.65(2.40-7.80) vs 5.20 (3.80-9.40); p<0.001, respectively]. In correlation analysis, uric acid was significantly associated with fasting blood glucose (r=0.129, p=0.004), creatinine (r=0.374, p<0.001), calcium (r=0.201, p<0.001), total protein (r=0.123, p=0.006) and TSH (r=0.108, p=0.017). Correlation analysis also revealed a significant and positive correlation between uric acid and L2-L4 BMD (r=0.255, p<0.001). L2-L4 BMD was found to be independently related with uric acid in multivariate linear regression analysis after adjustment for confounding factors (B=1.619, p<0.001). Conclusion: Our findings revealed that serum uric acid levels and lumbar (L2-L4) BMD were independently associated with each other in postmenopausal osteoporosis. Further studies are needed to determine the association of uric acid with osteoporosis and to address the utility of uric acid in clinical practice.

Keywords:

osteoporosis, Uric acid, Bone mineral density, postmenopausal women,

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