Rano otkrivanje osteoporoze u ordinaciji lekara opšte medicine

Milena Kostić; Olga Radosavljević; Maja Vučković

doi:10.5937/opmed0-51897

Milena Kostić Health Center "Dr Đorđe Kovačević"
Olga Radosavljević
Maja Vučković

DOI: https://doi.org/10.5937/opmed0-51897

Ključne reči: Ključne reči: osteoporoza, faktori rizika, rana dijagnoza

Sažetak

Uvod. U nastanku osteoporoze značajnu ulogu imaju određeni faktori rizika, čije rano prepoznavanje može uticati na pojavu, tok i ishod bolesti.

Cilj. Ispitati mogućnosti i značaj ranog otkrivanja pacijenata u povećanom riziku za nastanak osteoporoze u ordinaciji lekara opšte medicine.

Metod. Istraživanje je sprovedeno u jednoj ambulanti Doma zdravlja u Lazarevcu, u periodu septembar-decembar 2016.godine. Prikupljeni su podaci o faktorima rizika za osteoporozu, dobijeni prilikom posete izabranom lekaru i korišćenjem medicinske dokumentacije. Ispitanice sa jednim ili više faktora rizika su upućivane na merenje mineralne gustine kosti (Bone Mineral Density, BMD) primenom DEXA, a prema nalazu BMD i faktorima rizika reumatologu. Podaci su analizirani deskriptivnom statistikom i metodama za testiranje statističkih hipoteza, analizirani korišćenjem SPSS 20.

Rezultati. U istraživanju je učestvovalo 58 postmenopauzalnih žena starijih od 45 godina, prosečne starosti 65,62 godine. Najzastupljeniji faktori rizika bili su: rana menopauza (32,8%), pušenje cigareta (31,0%) i prisustvo hronične bolesti (25,9%). 51,7% imalo je 1 ili 2 faktora rizika, 22,4% 3 i više faktora rizika. Na DEXA je upućeno 72,4% ispitanica, kod 35,7% je dijagnostikovana osteoporoza i započeto lečenje.

Zaključak. U ordinaciji lekara opšte medicine mogu se na jednostavan način otkriti osobe u povećanom riziku za osteoporozu, ispitivanjem faktora rizika za njen nastanak. Daljom zdravstvenom intervencijom obezbeđuju se prevencija, blagovremena dijagnoza i lečenje ove bolesti.

Reference

Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 1993; 94(6): 646‒50.

Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R; National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014 Oct;25(10):2359-81. doi: 10.1007/s00198-014-2794-2. Epub 2014 Aug 15. Erratum in: Osteoporos Int. 2015 Jul;26(7):2045-7. PMID: 25182228; PMCID: PMC4176573.

Schürer C, Wallaschofski H, Nauck M, Völzke H, Schober HC, Hannemann A. Fracture risk and risk factors for osteoporosis. Dtsch Arztebl Int. 2015;112(21-22):365-71. Ova ne mora

Lewieski EM. Baim S.Bilezikian PJ. Eastell R, Le Boff RM, Miller DP.2008 Santa Fe Bone Symposium: Update of Osteoporosis. Jurnal of Clinical densitometry 2009; 12:135-157.

Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA. Osteoporosis in the European Union: medical management, epidemiology and economic burden : A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA) Arch Osteoporos. 2013;8:136.

International Osteoporosis Foundation. SCOPE 2021. Available at Infographic General.pdf (osteoporosis.foundation)

Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis Int. 2013;24(1):23-57. doi:10.1007/s00198-012-2074-y.

Murray CJ, Vos T, Lozano R et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380:2197–2223.

Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15: 767–778.

Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD. Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum. 2006; 35:293–305.

Albaum JM, Youn S, Levesque LE, Gershon AS, Cadarette SM. Osteoporosis management among chronic glucocorticoid users: a systematic review. J Popul Ther Clin Pharmacol. 2014;21:e486–504.

Vujasinović-Stupar N, Radojčić L, Tadić I, Pavlov-Dolijanović S. Znanje o osteoporozi kod žena u postmenopauzi u Srbiji. Vojnosanitetski pregled. 2017;74(5):445-9. doi: 10.2298/VSP150716107V.

Lazarević H, Milovanović DR. Znanje o osteoporozi žena u postmenopauzi koje posećuju ustanovu primarne zdravstvene zaštite. PONS - medicinski časopis. 2019;16(1):14-8. doi: 10.5937/pomc16-20259.

Kanis JA, Cooper C, Rizzoli R, Reginster JY; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women [published correction appears in Osteoporos Int. 2020 Jan;31(1):209] [published correction appears in Osteoporos Int. 2020 Apr;31(4):801]. Osteoporos Int. 2019;30(1):3-44. doi:10.1007/s00198-018-4704-5.

Bijelic R, Milicevic S, Balaban J. Risk Factors for Osteoporosis in Postmenopausal Women. Med Arch. 2017;71(1):25-28. doi: 10.5455/medarh.2017.71.25-28. Epub 2017 Feb 5. PMID: 28428669; PMCID: PMC5364787.

Ratajczak AE, Szymczak-Tomczak A, Rychter AM, Zawada A, Dobrowolska A, Krela-Kaźmierczak I. Impact of Cigarette Smoking on the Risk of Osteoporosis in Inflammatory Bowel Diseases. J Clin Med. 2021 Apr 5;10(7):1515. doi: 10.3390/jcm10071515. PMID: 33916465; PMCID: PMC8038608.

Министарство здравља Републике Србије. Републички завод за статистику. Институт за јавно здравље Србије „Др Милан Јовановић Батут“. Истраживање здравља становништва Србије 2019.године. Београд, 2021. Available at: https://www.batut.org.rs/download/publikacije/ZdravljeStanovnistva2019.pdf.

Kundu S, Acharya SS. Exploring the triggers of premature and early menopause in India: a comprehensive analysis based on National Family Health Survey, 2019-2021. Sci Rep. 2024 Feb 6;14(1):3040. doi: 10.1038/s41598-024-53536-9. PMID: 38321073; PMCID: PMC10847426.

Minaković I, Zvekić-Svorcan J, Janković T, Vuksanović M, Mikić D, Bošković K. Early Menopause and Risk of Fractures-A Preventable Gap. Iran J Public Health. 2023 Mar;52(3):534-541. doi: 10.18502/ijph.v52i3.12136. PMID: 37124898; PMCID: PMC10135509.

Stajic D, Zivanovic S, Miric A, Sekulic M, Djonovic N. Prevalence of Risk Factors Among Women With Osteoporosis. Experimental and Applied Biomedical Research (EABR). 2017;18(3): 239-243. https://doi.org/10.1515/sjecr-2016-0080.

Zhang W, Gao R, Rong X, Zhu S, Cui Y, Liu H, Li M. Immunoporosis: Role of immune system in the pathophysiology of different types of osteoporosis. Front Endocrinol (Lausanne). 2022 Sep 6;13:965258. doi: 10.3389/fendo.2022.965258. PMID: 36147571; PMCID: PMC9487180.

Stajić D, Živanović S, Mirić A, Sekulić M, Đonović N. Prevalenca faktora rizika kod žena sa osteoporozom. Serbian Journal of Experimental and Clinical Research. 2017;18(3):239-43. doi: 10.1515/SJECR-2016-0080.

Marković A, Popović T. Najčešći faktori rizika za nastanak osteoporoze. Zdravstvena zaštita. 2017;46(3):33-8. doi: 10.5937/ZZ1703033M.

Ivanović S, Trgovčević S, Kocić B, Tomašević Todorović S, Jeremić Knežević M, Knežević A. Identifikacija starih osoba sa rizikom za pad i faktora rizika za pad u opštoj populaciji. Srpski arhiv za celokupno lekarstvo. 2018;146(7-8):396-402. doi: 10.2298/SARH170529171I.

Borgström F, Karlsson L, Ortsäter G, Norton N, Halbout P, Cooper C, Lorentzon M, McCloskey EV, Harvey NC, Javaid MK, Kanis JA; International Osteoporosis Foundation. Fragility fractures in Europe: burden, management and opportunities. Arch Osteoporos. 2020 Apr 19;15(1):59. doi: 10.1007/s11657-020-0706-y. PMID: 32306163; PMCID: PMC7166207.

Gates M, Pillay J, Nuspl M, Wingert A, Vandermeer B, Hartling L. Screening for the primary prevention of fragility fractures among adults aged 40 years and older in primary care: systematic reviews of the effects and acceptability of screening and treatment, and the accuracy of risk prediction tools. Syst Rev. 2023;12(1):51. https://doi.org/10.1186/s13643-023-02181-w.

Gregson CL, Armstrong DJ, Bowden J, Cooper C, Edwards J, Gittoes NJL, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. 2022 Apr 5;17(1):58. doi: 10.1007/s11657-022-01061-5. Erratum in: Arch Osteoporos. 2022 May 19;17(1):80. doi: 10.1007/s11657-022-01115-8. PMID: 35378630; PMCID: PMC8979902.