Acta Medica Medianae (Apr 2009)
HYPERTENSION AND OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN
Abstract
Hypertension is a frequent, chronic cardiovascular disease both in industrially developed and developing countries; its frequency ranges between 20 and 40 %. Although the prevalence of hypertension in women is lower than that in men, it reaches 70% to 80% in women above 70 years of age, and is a strong predictor of cardiovascular risk. Osteoporosis (OP) is systematic skeletal disorder with lower bone mass and damages of bone tissue microarchitecture. The aim of this study was to ascertain the association between hypertension and osteoporosis as two mass noninfectious deceases.The examination involved three hundred postmenopausal women who came for densitometry inspection; none of them had some major cardiovascular event (myocardial infarction, cerebrovascular stroke) and ischemic heart disease. From all of them were taken personal data, personal and familial case histories. The parameters used in the further analysis were: body mass, body height, waist circumference, blood pressure; laboratory analysis: cholesterol, HDL, LDL, glycemia, Ca and P in serum and Ca in urine. In addition, there was calculated a ten-year risk of cardiovascular event according to SCORE system, using tables for high risk; bone mineral density on Hologic Discovery QDR-C was shown as T score on the lumbar part of the spinal column. The patients were divided into tree groups based on the measures of bone density: the patients with osteoporosis - bone density with T score lower than 2.5 SD (100 patients); patients with osteopenia - T score from -1 to -2,5 SD (100), and control group of patients with normal bone density T score from +1 to -1 SD (100).The mean age of postmenopausal women (control group) with normal bone density was 54.10±3.90 years; 56.63±4.76 years in the group with osteopenia (group II); and 60.14±3.55 years in the group of postmenopausal women with osteoporosis.The analysis of variance (ANOVA) and post hoc Dunett`s test showed that there were statistically significant age differences between groups (p<0.001). In the control group, hypertension was reported in 27 (27.0%) patients, in the group with osteopenia in 61 (61.0%) patients, and in group with osteoporosis in 98 (98.0%) patients. Hi-square test confirmed that differences in the presence of AH among the examined groups were statistically significant (p<0.001). Average value of SKP in the control group was 121.30±9.81 mmHg, in the group with osteopenia it was 136.40±13.37 mmHg, and in the group of postmenopausal women with osteoporosis it reached 151.20±8.68 mmHg. There were high statistically significant differences among these values (p<0.001), determined by ANOVA and post hoc test test. The mean value of DKP in the patients with normal bone density was 76.00±5.50 mmHg, in the group with osteopenia 80.90±8.05 mmHg, and in the group with osteoporosis 89.00±6.74 mmHg; there were high statistically significant differences among these values (ANOVA and post hoc test test: p<0.001)Univariate linear regression analysis showed that evry year of age, menopause duration and hypertension (0.012 g/cm2, 0.012 g/cm2, 0.014 g/cm2, respectively) had signitificant influence on the fall of bone density among patients. Elevation of values of SKP and DKP for one unit caused significant decrease of bone density: SKP by 0.005 g/cm2(0.005 - 0.006 g/cm2), DKP by 0.008 g/cm2 (0.007 to 0.010 g/cm2). The patients with hypertension had reduced bone density by 0.138 g/cm2 (0.111 to 0.164 g/cm2).Univariate linear regression analysis showed that every year of age, menopause duration, hypertension and dislipidemia significantly influenced the increase in risk for osteopenia or ostoporosis among patients; every year of age by 25% (17 to 33%), every year of menopause duration by 42% (30 to 54%), every year of hypertension by 62% (41 to 86%).Elevation of SKP and DKP values for one unit significantly influenced the increase in the risk for osteopenia or ostoporosis among patients: SKP by 15% (12 to 19%), DKP by 20% (14 to 25%).Osteoporosis and hypertension are two mass noninfectious diseases, the incidence of which increases with aging of the population. Early menopause, estrogen deficit, age, smoking and physical inactivity are important risk factors. Based on these results, it is appropriate to consider preventive strategy for early detection and management of these diseases.
