Oral antikoagülan alan hastalarda kemik mineral dansitesi
Küçük Resim Yok
Tarih
1998
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Oral antikoagülanların kemik (5-karboksi glutamik asit (gla) protein (BGP, osteocalsin) sentezi ile ilgili olarak kemik metabolizmasını etkiledikleri, az sayıdaki yeni çalışmalarla vurgulanmaktadır. Kemikte en çok bulunan nonkollagen protein olan osteokalsin, osteo-blast tarafından sentezlenir ve Ki vitaminine bağımlı (5-karboksi glutamik asit içerir. Glutamik asitin karboksillenmesi, osteokalsinin kemikte birikimi ve hidroksiapatite bağlanması için önemlidir. Oral antikoagülanlar, Ki vitamininin etkisini antogonize ettiği için, glutamatın (5-karboksi glutamata dönüşümü gerçekleşemez ve böylece karboksillenmemiş osteokalsin kemik formasyonunda yer alamaz. Bu nedenle uzun dönem oral antikogülan tedavi yapılan hastalarda, tedavinin kemik mineral dansitesine etkisini araştırmak amacıyla yapılması planlanan bu çalışmaya; New York Kalp Derneğinin fonksiyonel sınıflamasına göre 2. Evreye dahil olan, kalp kapak replasmanı yapılıp en az bir yıldır Coumadin tedavisi alan 25 hasta ve kontrol grubu olarak da; antikoagülan tedavi yapılmayan, yaş, BMİ (body mass index), kardiak durumu uyumlu 25 kişi alınmıştır. Tüm hastalarda rutin kan tetkikleri, serum Ca, P, ALP, kemik ALP, osteokalsin, PTH, üriner pridinolin, hidroksipirolin ve Ca atılımına bakılmış olup, kişiler fiziksel aktivite, kırık öyküsü, menapozyaşı konusunda da sorgulanmışlardır. Kemik dansite ölçümleri hem femoral hem de lomber bölgede DEXA (Dual Enerji X Ray Absorbsiyometre) ile yapılmıştır. Oral antikoagülan alan hastalarda, kemik dansite değerleri kontrol grubuna göre anlamlı ölçüde daha düşük saptanmıştır. Kemik mineral dansitesi ve tedavi süresi arasında istatistiksel anlamlı korelasyon gözlenmemiştir. Tedavi dozu ile lomber bölge kemik dansite değerleri arasında ise istatistiksel anlamlı negatif korelasyon saptanmıştır. Bu gözlemlerle, oral antikoagülanlann kemik mineral dansitesini azaltarak osteoporoza yol açan bir risk faktörü olduğu ve oral antikoagülan alan hastalarda düzenli kemik dansite kontrolünün gerektiği sonucuna varılmıştır.
It is considered that the oral anticoagulants affect bone metabolism by means of bone $\delta$-carboxyglutamic acid (gla) protein (BGP, osteocalcin) synthesis. BGP, one of the most abundant noncollagenous proteins in bone, is synthesized by osteoblast and contains vit K dependent $\delta$-carboxyglutamic acid (gla). Gla is important for the binding of osteocalcin to hydroxyapatite and its acumulation in bone. Since oral anticoagulants antagonize the effect of vit Kl (phytanadion), conversion of glutamate to $\delta$-carboxyglutamate can not occur and thus non-carboxylated osteocalcin can not take a role in regulation of bone formation. This study is planned to investigate the effect of oral anticoagulant treatment on bone mineral density in patients taking long term coumadin. A group of 25 patients who were using coumadin at least for one year, with a past heart valve replacement operation and accepted as class 2 according to New York Heart Association criteria (NYHA) is compared with the control group of 25 age, BMI (body mass index), cardiac status matched patients not treated with oral anticoagulants. In all patients serum levels of Ca, P, ALP, bone ALP, osteocalcin, PTH, creatinin and urinary Ca, hydroxypiroline, piridinolin were analyzed. In addition each patient was interviewed to determine levels of physical activity, diatary intake, history of fracture and date onset of menopause. DEXA is used fot both femoral and lomber region's bone densitometric measurements. The bone density values in the patients using coumadin were significantly lower than those of the control group. No correlation were observed between bone mineral density and the duration of coumadin treatment. According to this observations, oral anticoagulants are a risk factor for osteoporosis and thepatients taking long term oral anticoagulant should have regular bone density measurements.
It is considered that the oral anticoagulants affect bone metabolism by means of bone $\delta$-carboxyglutamic acid (gla) protein (BGP, osteocalcin) synthesis. BGP, one of the most abundant noncollagenous proteins in bone, is synthesized by osteoblast and contains vit K dependent $\delta$-carboxyglutamic acid (gla). Gla is important for the binding of osteocalcin to hydroxyapatite and its acumulation in bone. Since oral anticoagulants antagonize the effect of vit Kl (phytanadion), conversion of glutamate to $\delta$-carboxyglutamate can not occur and thus non-carboxylated osteocalcin can not take a role in regulation of bone formation. This study is planned to investigate the effect of oral anticoagulant treatment on bone mineral density in patients taking long term coumadin. A group of 25 patients who were using coumadin at least for one year, with a past heart valve replacement operation and accepted as class 2 according to New York Heart Association criteria (NYHA) is compared with the control group of 25 age, BMI (body mass index), cardiac status matched patients not treated with oral anticoagulants. In all patients serum levels of Ca, P, ALP, bone ALP, osteocalcin, PTH, creatinin and urinary Ca, hydroxypiroline, piridinolin were analyzed. In addition each patient was interviewed to determine levels of physical activity, diatary intake, history of fracture and date onset of menopause. DEXA is used fot both femoral and lomber region's bone densitometric measurements. The bone density values in the patients using coumadin were significantly lower than those of the control group. No correlation were observed between bone mineral density and the duration of coumadin treatment. According to this observations, oral anticoagulants are a risk factor for osteoporosis and thepatients taking long term oral anticoagulant should have regular bone density measurements.
Açıklama
Anahtar Kelimeler
Rehabilitasyon, Romatoloji
Kaynak
Romatoloji ve Tıbbi Rehabilitasyon Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
9
Sayı
3
