4. Kongres fizijatara BiH


1. Narcisa Vavra - Hadžiahmetović, Federation of Bosnia and Herzegovina , Bosnia and Herzegovina
2. Ksenija Miladinović, Federation of Bosnia and Herzegovina , Bosnia and Herzegovina

Introduction: Parathyroid hormone (PTH) plays an important role in bone metabolism. It is one of the causes of secondary osteoporosis in chronic phase of spinal cord lesion. Objective: To compare levels of serum PTH before and after therapy with alendronate and kinesitherapeutic procedures in patients with chronic spinal cord lesion (SL). Methods: This prospective, longitudinal, clinical, comparative study included 36 patients with chronic SL (24 or 67% males and 12 or 33% females) and secondary osteoporosis diagnosed by DEXA densitometry of lumbar spine and proximal femur. The average patients age were 41.7±10.9 years and median of SL occurrence was 12 years (IQR=11 to 13). Before and after the treatment program for osteoporosis, which consisted of weekly alendronate tablet of 70 mg and kinesitherapeutic procedures, passive standing and exercises, lasting 18 months, levels of serum PTH was measured and compared. After treatment period there were 4 subgroups for statistical analysis: (I) those who performed complete treatment program(n=12); (II) those who were not performing passive standing (n=5); (III) those who took only alendronate(n=14); (IV) those who interrupted program in the last quarter of treatment period (n=5). A P value<0.05 was considered as significant. The following statistical tests were used: Kolmogorov-Smirnov test, Independent-Samples T Test, Wilcoxon Signed Rank Test. Results: Before joining the therapeutic program 33% of patients had increased serum PTH level, average value of 63.16 pg/ml, and after performed program 20% of patients had increased levels of PTH, average value of 49.74 pg /ml; (P0.05). There was statistically significant difference in median PTH level in males before (Me=51.8 pg / ml, IQR 40.1 to 68.9) and after the treatment (Me=39.7 pg/ml, IQR =27.0 to 61.5) (Z=-2.257, P=0.023), and in female before (Me=53.9 pg/ml, IQR=42.6 to 79.3) and after the treatment.(Me=41.0 pg/ml; IQR=28.4 do 61.3) (Z=-2.981; P<0.01). In the age group of 20-44 years (n=22) median PTH level before treatment was 44.7 pg/ml (IQR=35.1 to 63.8), while after the treatment was 31.6 pg / ml (IQR=26.5 to 45.6), and the difference is highly statistically significant (Z=-3.685, P<0.001). In the age group ≥ 45 years (n=14), median levels of serum PTH was 64.3 pg/ml (IQR=50.2 to 99.9) before the treatment, while after the treatment was 64.8 pg/ml (IQR=44.3 to 75.8), and the difference was not statistically significant (Z=-1.287, P=0.217). The significant decreasement of serum PTH level had subgroups I (t=2.27; P=0.04). and IV (t=3.37; P=0.04). Conclusion: Alendronate and kinesitherapeutic procedures led to a significant decreasement of serum PTH levels in patients with chronic SL and induced osteoporosis, especially in the age group of 20-44 years, and in patients who peformed passive standing.

Кључне речи:
Spinal Lesions, Osteoporosis, Parathormone

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4. Kongres fizijatara BiH