The dissertationis aimed at improving the diagnosticsandprophylaxis of osteoporosis and its complications. Its findings arebased on the study of the 10-year probability of osteoporotic fractures, bone mineral density and quality, body composition, Vitamin D level in postmenopausal women with/out rheumatoid arthritis.
The study findings reveal that bone quality decreases significantly with the extended duration of postmenopausal period (р<0.000001). The bone mineral density at the spinal level did not change (р<0.004) in a remarkable manner, which may be attributed to the osteophyte presence at this skeletal site in those subjects suffering from the degenerative diseasesof the spine. The bone mineral density at the femoral neck level decreased significantly with age (р<0.000001). The alterations of total fat and lean mass indexes in patients with various spans of postmenopausal period were statistically unreliable (р=0.013 and р=0.048 respectively). A significant positive correlation was found between the total fat mass and bone mineral density of the spine and femoral neck in the medium and late postmenopausal period. The accumulated fat mass plays an osteoprotective role against osteoporotic fractures for the postmenopausal women during those periods.
While studying the 25(OH)D level in relation to the body mass index, it was revealed that 34.4% postmenopausal women had Vitamin D deficiency, 31.4% postmenopausal women had Vitamin D insufficiency and 34.4 % postmenopausal women had a normal Vitamin D level. 25(OH)D was much lower in women with Grade 1 overweight (23.6±10.2 ng/ml) and Grade 2 overweight (22.4±10.3 ng/ml) compared to women with a normal body weight (28.2±12.9 ng/ml). In postmenopausal women with obesity, the body mass index (BMI) significantly affected the 25(OH)D level, irrespective of the season. The presented findings should be taken into consideration in order to ensure an optimum prophylaxis and treatment of Vitamin D deficiency in the obese women.
Analysis of the 10-year probability of major osteoporotic fractures according to the Ukrainian version of the FRAX model confirmed that the 10-year probability was significantly higher in women with rheumatoid arthritis (RA) compared to the control group (р=0.0000001). The frequency analysis of fragility fractures across the groups found a significantly higher number of those in the RA women (24.5%), while within the control group they were diagnosed only in 6.7% examined women (χ2=14.2; р<0.001). The evaluation of glucocorticoid treatment also revealed their more frequent use in the RA women (62.7%) compared to the control group (1.7%; р< 0.001).While determining the women’s need for further examination or antiosteoporotic treatment, we found that within the control group only 5% women had the 10-year probability of major osteoporotic fractures above the upper intervention threshold, i.e. required treatment even without dual-energy X-ray absorptiometry (DXA) corroboration, while for the RA subjects this index was much higher and attributed for 33.6% (χ2=31.0; р<0.0001). The abovementioned findings should be taken into account while managing this group of patients in order to reduce their risk of osteoporotic fractures.
The RA women’s bone mineral density (BMD) of the femoral neck was significantly lower (р=0.002) than the one of the control group’s, while the BMD at the spinal level did not differ substantially (р=0.3). The total body lean mass, appendicular lean mass and appendicular lean mass index were noticeably lower than the ones of the control group women. The reduced lean mass frequency in the RA women was remarkably higher (49%) compared to the control group (18%). The RA patients had the confirmed appendicular lean mass reduction associated with the duration of their condition. While performing the correlation analysis, we didn’t find any reliable correlations amongthe activity markers (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), visual analogue pain scale DAS28), life quality and lean mass indices in the RA patients. With that, there was a significant correlation between the number of swollen joints and lean mass of the upper limbs (r=0.67; р=0.02).
While studying the cholecalciferol’s efficacy and safety (1000 IU as 1 capsule 3 times a day during 3 months) for Vitamin D deficiency’s correction in the postmenopausal women, as well as for studying the Vitamin D level’sinfluence on the pain syndrome acuity and life quality, we found the highest accretion of 25(OH)D level during the three months of therapy in those patients who had the lowest 25(OH)D levels before the treatment. It was found that cholecalciferol results in a diminishment of the maximum pronounced pain syndrome at the lower spine level, improvement of the spine’s functional state, amelioration of daily activity indices and life quality of postmenopausal women.
