Abstract
Giriş: Toplumların giderek yaşlanması sonucu
osteoporoz önemli bir halk sağlığı sorunu olarak karşımıza çıkmaktadır. Yapılan çalışmalarda inflamasyonun
osteoporozun patogenezinde kritik bir rol oynadığı gösterilmiştir. NLR (neutrophil
to lyphocyte ratio )
ve PLR (platelet to lyphocyte ratio
) maligniteler ve inflamatuar hastalıklarda basit, invazif
olmayan ve uygun maliyetli bir inflamasyon belirtecidir. Bu çalışmanın
amacı bilinen başka ek hastalığı ve ilaç kullanım öyküsü olmayan osteopenik,
osteoporotik ve kontrol deneklerinde NLR ve PLR düzeylerini karşılaştırmak ve
NLR, PLR düzeyleri ile KMY arasındaki ilişkiyi değerlendirmektir.
Yöntem: Bu kesitsel
çalışmaya 65 yaş ve üzeri toplam 308 hasta dahil edildi. Tüm vücut BMD (bone
mineral densıty) çift enerjili X ışını absorpsiyometrisi (DEXA) ile
ölçülmüştür. Tam kan sayımı (CBC), inflamasyonun biyobelirteçleri C-reaktif
protein (CRP), eritrosit sedimantasyon hızı (ESR), glukoz / lipid
metabolizması, tiroid fonksiyon testleri kayıt altına alınmıştır.
Bulgular: Osteoporoz
grubunda, NLR düzeylerinin osteopenik ve kontrol grubuna göre yüksek olduğu
bulundu (sırasıyla 3,58 ± 4,22, 2,64 ±
1,99 ve 2,36 ± 1,39) ve gruplar arasındaki bu ilişki istatistiksel olarak
anlamlı saptandı ( p = 0,025). Elde ettiğimiz verilerde sedimantasyon değerleri
osteoporoz grubunda osteopenik ve sağlıklı kontrol grubuna göre yüksek saptanmış
olup istatistiksel olarakta anlamlıydı (p=0,011).
Sonuç: Yaşlı osteoporozu olan bireylerde NLR seviyelerinin yükselmesi ve bu yüksekliğin
sedimantasyonda da olması kemik remodellinginde iltihaplanmanın önemli bir rol
oynayabileceğini düşündürmektedir.
References
- 1. Cosman F, De Beur S, Le Boff M, Lewiecki EM, Tanner B, Randall S, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014; 25(10):2359–81. http://dx.doi.org/10.1007/s00198-015-3037-x
- 2. Jeremiah MP, Unwin BK, Greenawald MH, Casiano VE. Diagnosis and management of osteoporosis. Am Fam Physician 2015; 92(4):261–8. https://www.ncbi.nlm.nih.gov/pubmed/26280231
- 3. Burge R, Dawson-Hughes B, Solomon D, Wong JB, King A, Tosteson A. Incidence and economic burden or osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007; 22(3):465–75. https://doi.org/10.1359/jbmr.061113
- 4. World Health Organization. WHO Scientific Group on the assessment of osteoporosis at primary health care level: summary meeting report. May 5–7, 2004. [Accessed December 27, 2017]. Available at: https://www.who.int/chp/topics/Osteoporosis.pdf.
- 5. NIH Osteoporosis and Related Bone Diseases National Resource Center. The Surgeon General’s report on bone health and osteoporosis: what it means to you. [Accessed June 6, 2017]. Available at: https://www.bones.nih.gov/health-info/bone/SGR/surgeon-generals-report.
- 6. Arron JR, Choi Y. Bone versus immune system. Nature 2000;408(6812):535-6. https://doi.org/10.1038/35046196
- 7. Mundy GR. Osteoporosis and inflammation. Nutr Rev 2007;65(12 Pt 2): 147-51. https://doi.org/10.1111/j.1753-4887.2007.tb00353.x
- 8. Yun AJ, Lee PY. Maldaptation of the link between inflammation and bone turnover may be a key determinant of osteoporosis. Med Hypotheses 2004;63: 532-7. https://doi.org/10.1016/S0306-9877(03)00326-8
- 9. Ferrari SL, Ahn-Luong L, Garnero P, Humphries SE, Greenspan SL. Two promoter polymorphisms regulating interleukin-6 gene expression are associated with circulating levels of C-reactive protein and markers of bone resorption in postmenopausal women. J Clin Endocrinol Metab 2003;88(1):255-9. https://doi.org/10.1210/jc.2002-020092
- 10. Kimble RB, Matayoshi AB, Vannice JL, Kung VT, Williams C, Pacifici R. Simultaneous block of interleukin-1 and tumor necrosis factor is required to completely prevent bone loss in the early postovariectomy period. Endocrinology 1995;136(7):3054-61. https://doi.org/10.1210/endo.136.7.7789332
- 11. Barbour KE, Boudreau R, Danielson ME, Youk AO, Wactawski-Wende J, Greep NC, et al. Inflammatory markers and the risk of hip fracture: The Women’s Health Initiative. J Bone Miner Res 2012;27:1167–76. https://doi.org/10.1002/jbmr.1559
- 12. Azab B, Bhatt VR, Phookan J, Murukutla S, Kohn N, Terjanian T, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol 2012;19(1):217-24. https://doi.org/10.1245/s10434-011-1814-0.
- 13. Gomez D, Farid S, Malik HZ, Young AL, Toogood GJ, Lodge JP, et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. World J Surg 2008;32(8):1757-62. https://doi.org/10.1007/s00268-008-9552-6.
- 14. Motomura T, Shirabe K, Mano Y, Muto J, Toshima T, Umemoto Y, et al. The neutrophil-lymphocyte ratio reflects recurrence of hepatocellular carcinoma after liver transplantation via inflammatory micro-medium. J Hepatol 2013;58(1):58-64. https://doi.org/10.1016/j.jhep.2012.08.017
- 15. Balta S, Aparcı M, Ozturk C, Demirkol S, Celik T. [Clinical importance of neutrophil/lymphocyte ratio in differential diagnosis of acute cholecystitis and cholelithiasis]. (in Turkish) Kocaeli Med J 2016;5(3);6-11. Available at: https://www.journalagent.com/kocaelitip/pdfs/KTD-02525-RESEARCH_ARTICLE-ERTOK.pdf
- 16. Hu ZD, Sun Y, Guo J, Huang YL, Qin BD, Gao Q, et al. Red blood cell distribution width and neutrophil / lymphocyte ratio are positively correlated with disease activity in primary Sjögren syndrome. Clin Biochem 2014;47(18):287-90. https://doi.org/10.1016/j.clinbiochem.2014.08.022
- 17. Feng JF, Huang Y, Chen QX. Preoperative platelet lymphocyte ratio (PLR) is a predictive factor for neutrophil lymphocyte ratio (NLR) in patients with esophageal squamous cell carcinoma. World J Surg Oncol 2014;12:58. https://doi.org/10.1186/1477-7819-12-58
- 18. Ozturk ZA, Yesil Y, Kuyumcu ME, Bilici M, Ozturk N, Yesil NK, et al. Inverse relationship between neutrophil lymphocyte ratio (NLR) and bone mineral density (BMD) in elderly people. Arch Gerontol Geriatr 2013;57:81–5. https://doi.org/10.1016/j.archger.2013.02.005
The relationship between bone mineral density and hematological parameters in the geriatric age group
Abstract
Introduction: As populations gradually become older, osteoporosis manifests itself as
an important public health problem. Studies have shown that inflammation plays
a critical role in the pathogenesis of osteoporosis. NLR (neutrophil to
lymphocyte ratio) and PLR (platelet to lymphocyte ratio) are simple,
non-invasive, and inexpensive markers of inflammation in malignancies and
inflammatory diseases. This study aims to compare osteopenic, osteoporotic, and
control subjects, who do not have other known diseases or a history of
medication use, in terms of their NLR and PLR levels and evaluate the
relationship between NLR, PLR levels and BMD.
Methods: This cross-sectional study included a total of 308 patients aged 65 or
above. Total bone mineral density (BMD) was measured using dual energy X-ray
absorptiometry (DEXA). Complete blood count (CBC), biomarkers of inflammation
(C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), glucose/lipid
metabolism, and thyroid function test results were recorded.
Results: The osteoporosis group demonstrated higher NLR levels compared to the
osteopenic and control groups (respectively 3.58 ± 4.22,
2.64 ± 1.99, and 2.36 ± 1.39), and this
relationship between the groups was found to be statistically significant
(p=0.025). Our data revealed higher sedimentation values for the osteoporosis
group than for the osteopenic and healthy control groups with statistical
significance (p=0.011).
Conclusions: The fact that individuals with geriatric osteoporosis demonstrate
elevated NLR levels and that this elevation is also seen in sedimentation
suggests that inflammation plays an important role in bone remodelling.
Keywords
Bone mineral density neutrophil to lymphocyte ratio platelet to lymphocyte ratio inflammation
References
- 1. Cosman F, De Beur S, Le Boff M, Lewiecki EM, Tanner B, Randall S, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014; 25(10):2359–81. http://dx.doi.org/10.1007/s00198-015-3037-x
- 2. Jeremiah MP, Unwin BK, Greenawald MH, Casiano VE. Diagnosis and management of osteoporosis. Am Fam Physician 2015; 92(4):261–8. https://www.ncbi.nlm.nih.gov/pubmed/26280231
- 3. Burge R, Dawson-Hughes B, Solomon D, Wong JB, King A, Tosteson A. Incidence and economic burden or osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007; 22(3):465–75. https://doi.org/10.1359/jbmr.061113
- 4. World Health Organization. WHO Scientific Group on the assessment of osteoporosis at primary health care level: summary meeting report. May 5–7, 2004. [Accessed December 27, 2017]. Available at: https://www.who.int/chp/topics/Osteoporosis.pdf.
- 5. NIH Osteoporosis and Related Bone Diseases National Resource Center. The Surgeon General’s report on bone health and osteoporosis: what it means to you. [Accessed June 6, 2017]. Available at: https://www.bones.nih.gov/health-info/bone/SGR/surgeon-generals-report.
- 6. Arron JR, Choi Y. Bone versus immune system. Nature 2000;408(6812):535-6. https://doi.org/10.1038/35046196
- 7. Mundy GR. Osteoporosis and inflammation. Nutr Rev 2007;65(12 Pt 2): 147-51. https://doi.org/10.1111/j.1753-4887.2007.tb00353.x
- 8. Yun AJ, Lee PY. Maldaptation of the link between inflammation and bone turnover may be a key determinant of osteoporosis. Med Hypotheses 2004;63: 532-7. https://doi.org/10.1016/S0306-9877(03)00326-8
- 9. Ferrari SL, Ahn-Luong L, Garnero P, Humphries SE, Greenspan SL. Two promoter polymorphisms regulating interleukin-6 gene expression are associated with circulating levels of C-reactive protein and markers of bone resorption in postmenopausal women. J Clin Endocrinol Metab 2003;88(1):255-9. https://doi.org/10.1210/jc.2002-020092
- 10. Kimble RB, Matayoshi AB, Vannice JL, Kung VT, Williams C, Pacifici R. Simultaneous block of interleukin-1 and tumor necrosis factor is required to completely prevent bone loss in the early postovariectomy period. Endocrinology 1995;136(7):3054-61. https://doi.org/10.1210/endo.136.7.7789332
- 11. Barbour KE, Boudreau R, Danielson ME, Youk AO, Wactawski-Wende J, Greep NC, et al. Inflammatory markers and the risk of hip fracture: The Women’s Health Initiative. J Bone Miner Res 2012;27:1167–76. https://doi.org/10.1002/jbmr.1559
- 12. Azab B, Bhatt VR, Phookan J, Murukutla S, Kohn N, Terjanian T, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol 2012;19(1):217-24. https://doi.org/10.1245/s10434-011-1814-0.
- 13. Gomez D, Farid S, Malik HZ, Young AL, Toogood GJ, Lodge JP, et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. World J Surg 2008;32(8):1757-62. https://doi.org/10.1007/s00268-008-9552-6.
- 14. Motomura T, Shirabe K, Mano Y, Muto J, Toshima T, Umemoto Y, et al. The neutrophil-lymphocyte ratio reflects recurrence of hepatocellular carcinoma after liver transplantation via inflammatory micro-medium. J Hepatol 2013;58(1):58-64. https://doi.org/10.1016/j.jhep.2012.08.017
- 15. Balta S, Aparcı M, Ozturk C, Demirkol S, Celik T. [Clinical importance of neutrophil/lymphocyte ratio in differential diagnosis of acute cholecystitis and cholelithiasis]. (in Turkish) Kocaeli Med J 2016;5(3);6-11. Available at: https://www.journalagent.com/kocaelitip/pdfs/KTD-02525-RESEARCH_ARTICLE-ERTOK.pdf
- 16. Hu ZD, Sun Y, Guo J, Huang YL, Qin BD, Gao Q, et al. Red blood cell distribution width and neutrophil / lymphocyte ratio are positively correlated with disease activity in primary Sjögren syndrome. Clin Biochem 2014;47(18):287-90. https://doi.org/10.1016/j.clinbiochem.2014.08.022
- 17. Feng JF, Huang Y, Chen QX. Preoperative platelet lymphocyte ratio (PLR) is a predictive factor for neutrophil lymphocyte ratio (NLR) in patients with esophageal squamous cell carcinoma. World J Surg Oncol 2014;12:58. https://doi.org/10.1186/1477-7819-12-58
- 18. Ozturk ZA, Yesil Y, Kuyumcu ME, Bilici M, Ozturk N, Yesil NK, et al. Inverse relationship between neutrophil lymphocyte ratio (NLR) and bone mineral density (BMD) in elderly people. Arch Gerontol Geriatr 2013;57:81–5. https://doi.org/10.1016/j.archger.2013.02.005
Details
| Primary Language | English |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | Original Research |
| Authors | |
| Publication Date | January 22, 2020 |
| Submission Date | October 17, 2019 |
| Acceptance Date | November 25, 2019 |
| Published in Issue | Year 2020Volume: 5 Issue: 1 |