İnmeli hastaların kemik mineral yoğunlukları ve klinikleri arasındaki ilişkiler

KESİKTAŞ ,Nur; KARAN ,Ayşe; YALIMAN ,Ayşe; ESKİYURT ,Nurten

Nur KESİKTAŞ

(İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, İstanbul, Türkiye)

Ayşe KARAN

(İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, İstanbul, Türkiye)

Ayşe YALIMAN

(İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, İstanbul, Türkiye)

Nurten ESKİYURT

(İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, İstanbul, Türkiye)

Osteoporoz Dünyasından

Yıl: 2007Cilt: 13Sayı: 3ISSN: 1300-9141Sayfa Aralığı: 49 - 55Metin Dili: Türkçe

172 1

Türkçe
İngilizce

İnmeli hastaların kemik mineral yoğunlukları ve klinikleri arasındaki ilişkiler

Öz: Amaç: Bu çalışmadaki amacımız, inmeli hastalarda paretik ve nonparetik tarafların kemik mineral yoğunluğu (KMY) değerlerini karşılaştırmak, kemik mineral kaybı varlığı ile demografik, klinik özellikler ve bazı laboratuar bulguları arasındaki ilişkiyi değerlendirmektir. Hastalar ve Yöntem: Yaş ortalaması 61.8±5.8 yıl olan 46 tek taraflı inmeli hasta çalışmaya alındı. Klinik ve demografik özellikler değerlendirildi. Brunnstrom evrelemesi, fonksiyonel bağımsızlık ölçümünün Türkçe versiyonu (FBÖ), Ashworth skalası, Beck Depresyon Ölçeği (BDÖ) değerlendirmelerde kullanıldı. Dual-enerji X-ray absorpsiometri ile KMY biokimyasal veriler toplandı. İstatistikler SPSS versiyon 10.0 ile yapıldı. Bulgular: Paretik tarafın femur boynu KMY/T skorları ve distal radius T skoru paretik olmayan taraftan istatistiksel anlamlı olarak daha düşüktü (p<0.05). Sol hemiplejiklerin femur total ve distal radius KMY/T skorları paretik olmayan taraflarından daha düşüktü, fakat sağ hemiplejiklerde paretik olmayan tarafla anlamlı fark yoktu. Kadınların KMY’leri erkeklerin KMY’lerinden istatistiksel anlamlı olarak daha düşüktü (p<0.05). BDÖ ve mobilite arasında anlamlı korelasyon mevcuttu, r=-0,379 (p<0.05). Düşük FBÖ puanları ile osteoporoz varlığı arasında bir ilişki saptandı. Sonuç: Düşük FBÖ puanları düşük KMY’nin göstergesi olabilir. Erken yürüme ve mobilite inme rehabilitasyonunda hedef alınmalıdır. İnmeli hastalarda depresyonun osteoporoza etkisini gözlemlemek için daha büyük ölçekli, prospektif çalışmalar dizayn edilmelidir. (Osteoporoz Dünyasından 2007;13:49-55)

Anahtar Kelimeler: Demografi Depresyon İnme Kemik yoğunluğu Osteoporoz Absorptiyometri, foton

Konu Alanı: Fen > Tıp > Tıbbi Araştırmalar Deneysel
Fen > Tıp > Rehabilitasyon
Fen > Tıp > Romatoloji

Bone mineral density of stroke patients and it’s clinical relevance

Öz:Aim: The aim of this study were to compare paretic and non- paretic side&#8217;s bone mineral density (BMD) and to investigate whether demographic, clinical and some laboaratory findings were correlated with bone mineral loss or not in stroke patients. Patients and Methods: 46 unilateral stroke patients mean aged 61.8±5.8 were included in the study. Demographic and clinical characteristics of the patients were evaluated. Brunnstrom motor recovery scale, Turkish version of the FIM, Ashworth scale, Beck Depression Inventory (BDI) were used for assessments. Dual-energy X-ray absorptiometry&#8217;s Biochemical&#8217;s data were collected. Statistics were analyzed using SPSS version 10.0. Results: The BMDs of the paretic side were statistically significant lower than the non-paretic side at femoral neck BMD/T scores and distal radius T scores (p<0.05). BMDs and T scores of left sided stroke patients were statistically significant lower than non-paretic side at distal radius and femur, but BMD and T scores of right sided stroke patients were not statistically significant different than their non-paretic side BMD of women were statistically significant lower from than men&#8217;s BMD, (p<0.05) There were a correlation BDI and mobilization, r=-0,379 (p<0.05). Lower functional independence measurements score were found a relationship with osteoporosis. Conclussion: Low FIM scores can predict low BMD. Early walking and mobility must be targeted in stroke rehabilitation. Bigger sample sized, prospective studies must designed for observation of depression effect on osteoporosis in stroke. (From the World of Osteoporosis 2007;13:49-55)

Anahtar Kelimeler: Demography Depression Stroke Bone Density Osteoporosis Absorptiometry, Photon

Konu Alanı: SCIENCE > MEDICINE > MEDICINE, RESEARCH & EXPERIMENTAL
SCIENCE > MEDICINE > REHABILITATION
SCIENCE > MEDICINE > RHEUMATOLOGY

Belge Türü: DergiMakale Türü: Araştırma MakalesiErişim Formatı: Erişime Açık

1 Bonita R. Epidemiology of stroke. Lancet 1992;339:342–4.
2 Hatano S. Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ 1976;54:541-53.
3 Bamford J, Sandercock P, Dennis M et al. A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project 1981-86,
I: methodology, demography and incident cases of first-ever stroke. J Neurol Neurosurg Psychiatry 1988;51:1373-80.
4 Jorgensen L, Engstad T, Jacobsen BK. Bone mineral density in acute stroke patients: low bone mineral density may predict first stroke in women. Stroke 2001;32:47-51.
5 Poole KES, Reeve J, Warburton EA. Falls, fractures, and osteoporosis after stroketime to think about protection?. Stroke 2002;33:1432-6.
6 Ramnemark A, Nilsson M, Borssén B et al. Stroke, a major and increasing risk factor for femoral neck fracture. Stroke 2000;31:1572-7.
7 Kanis J, Oden A, Johnell O. Acute and long-term increase in fracture risk after hospitalization for stroke. Stroke 2001;32:702-6.
8 Jorgensen L, Engstad T, Jacobsen BK. Higher incidence of falls in long-term stroke survivors than in population controls. Depressive symptoms predict falls after stroke. Stroke 2002;33:542-7.
9 Ramnemark A, Nyberg L, Borsse´n B et al. Fractures after stroke. Osteoporos Int 1998;8:92-5.
10 Jorgensen L, Jacobsen BK, Wilsgaard T et al. Walking after stroke: does it matter? Changes in bone mineral density within the first 12 months after stroke. A longitudinal study. Osteoporos Int 2000; 11:381-7.
11 Sato Y, Kuno H, Kaji M et al. Increased bone resorption during the first year after stroke. Stroke 1998;29:1373-7.
12 Prince RL, Price RI, Ho S. Forearm bone loss in hemiplegia: a model for the study of immobilization osteoporosis. J Bone MinerRes 1988;3:305-10.
13 Sato Y, Maruoka H, Oizumi K et al. Vitamin D deficiency and osteopenia in the hemiplegic limbs of stroke patients. Stroke 1996;27:2183-7.
14 Finestone HM, Greene Finestone LS, Wilson ES et al. Malnutrition in stroke patients on the rehabilitation service and at follow-up: prevalence and predictors. Arch Phys Med Rehabil 1995;76:310-6.
15 del Puente A, PapponeN, Mandes MG et al. Determinants of bone mineral density in immobilization: a study on hemiplegic patients. Osteoporos Int. 1996;6:50-4.
16 Ramnemark A, Nyberg L, Lorentzon R et al. Hemiosteoporosis after severe stroke, independent of changes in body composition and weight. Stroke 1999;30:755-60.
17 Ramnemark A, Nyberg L, Lorentzon R et al. Progressive hemiosteoporosis on the paretic side and increased bone mineral density in the non-paretic arm the first year after severe stroke. Osteoporos Int 1999;9:269-75.
18 Poole KES, Warburton E A, Reeve J. Rapid long-term bone loss following stroke in a man with osteoporosis and atherosclerosis. Osteoporos Int 2005;16:302-5.
19 Jorgensen L and Jacobsen BK. Changes in Muscle Mass, Fat Mass, and Bone Mineral Content in the Legs After Stroke: A 1 Year Prospective Study. Bone 2001;28: 655-9.
20 Sato Y. Abnormal bone and calcium metabolism in patients after stroke. Arch Phys Med Rehabil 2000;81:117-21.
21 Runge M, Rehfeld G, Schiessl H. Skeletal adaptations in hemiplegic patients J Musculoskel Neuron Interact 2004;4:191-6.
22 Sato Y, Honda Y, Iwamoto J et al. Homocysteine as a predictive factor for hip fracture in stroke patients. Bone 2005;36:721-6.
23 Sato Y, Fujimatsu Y, Honda Y et al. Accelerated bone remodeling in the patients with poststroke hemiplegia. J Stroke Cerebrovascular Dis 1998;7:58-62.
24 Sato Y, Fuiimatsu Y, Kikuvama M et al. Influence of immobilization on bone mass and bone metabolism in hemiplegic elderly patients with a long-standing stroke. J Neural Sci 1998;156:205-10.
25 Iwamoto J, Tsukimura T and Takeda T. Bone mineral density of metatarsus in hemiplegic subjects. Am J Phys Med Rehab 78, 202–7.
26 Watanabe Y. An assessment of osteoporosis in stroke patients on rehabilitation admission. Int J Rehab Res 2004;27:163-6.
27 Yavuzer G, Ataman S, Süldür N et al. Bone mineral density in patients with stroke Int J Rehab Res 2002;25: 235-9.
28 Ikai T, Uematsu M, Eun SS et al. Prevention of secondary osteoporosis postmenopause in hemiplegia. Am J Phys Med Rehabil 2001;80:169-74.
29 Morris PLP, Raphael B, Robinson RG. Clinical depression is associated with impaired recovery from stroke. Med J Aust 1992;157:239-42.
30 Jonkman EJ, de Weerd AW and Vrijens NL. Quality of life after a first ischemic stroke. Long-term developments and correlations with changes in neurological deficit, mood and cognitive impairment. Acta Neurol Scand 1998;98:169-75.
31 Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the state of patients for the clinician. J Psychiat Res 1975;12:189-98
32 Brunstrom S. Motor testing procedures in hemiplegia based on sequential recovery stages. Am J Phys Ther. 1966; 46:357-75.
33 Küçükdeveci A, Yavuzer G, Elhan A et al. Adaptation of the Functional Independence Measure for use in Turkey. Clinical Rehabilitation 2001;15:311-9.
34 Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67:206-7.
35 Beck AT, Steer RA, Brown GK. BDI-II manual. San Antonio, TX: The psychological Corporation, 1996.
36 Orwoll, ES, Oviatt SK and Biddle JA. Precision of dual-energy X-ray absorptiometry, development of quality control rules and their application in longitudinal studies. J Bone Min Res, 1993;8:693.
37 Compston JE, Cooper C, Kanis JA. Bone densitometry in clinical practice. BMJ 1995; 310:1507-10.
38 Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet 2002;359:1929-36.
39 Takamato S, Masuyama T, Nakajima M et al. Alterations of BMD of the femurs in hemiplegia. Calcif Tissue Int 1995;56:256-62.
40 Jorgensen L, Crabtree NJ, Reeve J, et al. Ambulatory level and asymmetrical weight bearing after stroke affects bone loss in the upper and lower part of the femoral neck differently: bone adaptation after decreased mechanical loading. Bone 2000;27:701-7.
41 Ensrud KE, Ewing SK, Stone K L et al. Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women. JAGS 2003;51:1740-7.
42 Giangregorio L, Blimkie CJR Skeletal adaptations to alterations in weight-bearing activity. A comparison of models of disuse osteoporosis. Sports Med 2002;32:459-76.
43 Kim CM, Eng JJ. Symmetry in vertical ground reaction force is accompanied by symmetry in temporal but not distance variables of gait in persons with stroke. Gait Posture 2003;8:23-8.
44 Liu M, Tsuji T, Higuchi Y et al. Osteoporosis in hemiplegic stroke patients as studied with dual-energy x-ray absorptiometry. Arch Phys Med Rehabil 1999;80:1219-26.
45 L. Jørgensen, Jacobsen BK. Functional status of the paretic arm affects the loss of bone mineral in the proximal humerus after stroke: a 1-year prospective study. Calcif Tissue Int 2001;68:11-5.
46 Iversen E, Hassager C, Christiansen C. The effect of hemiplegia on bone mass and soft tissue body composition. Acta Neurol Scand. 1989;79:155-9.
47 Pang MYC, Eng JJ. Muscle strength is a determinant of bone mineral content in the hemiparetic upper extremity: Implications for stroke rehabilitation. Bone 2005;37:103-11.
48 Pang MY C, Eng JJ, McKay HA et al. Reduced hip bone mineral density is related to physical fitness and leg lean mass in ambulatory individuals with chronic stroke. Osteoporos Int 2005;16:1769-79.
49 Browner WS, Pressman AR, Nevitt MC et al. Association between low bone density and stroke in elderly women: the study of osteoporotic fractures. Stroke. 1993; 24:940-6.
50 Özdurak RH, Düz S, Arsal G, et al. Quantitative forearm muscle strength influences radial bone mineral density in osteoporotic and healthy males. Technol and Health Care 2003;11:253-61.
51 Sahin L, Ozoran K, Gunduz OH et al. Bone mineral density in patients with stroke. Am J Phys Med Rehabil 2001;80:592-6.
52 Garrett NA, Brasure M, Schmitz KH, Physical Inactivity Direct Cost to a Health Plan. Am J Prev Med 2004; 27:304-9.
53 Bean JF, Vora A, Frontera WR. Benefits of exercise for community-dwelling older adults. Arch Phys Med Rehabil 2004;85 (Suppl 3):S31-42.
54 Astrom M, Adolfsson R, Asplund K. Major depression in stroke patients: a 3-year longitudinal study. Stroke 1993;24:976-82.
55 Herrmann N, Black SE, Lawrence J et al. The Sunnybrook Stroke Study: a prospective study of depressive symptoms and functional outcome. Stroke. 1998;29:618-24.
56 Dam H, Pedersen HE, Ahlgren P. Depression among patients with stroke. Acta Psychiatr Scand 1989;80:118- 24.