RT info:eu-repo/semantics/doctoralThesis
T1 Nuevas aproximaciones en la evaluación de factores predictores de fractura osteoporótica en mujeres postmenopaúsicas
A1 Campilllo Sánchez, Francisco de Asis
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Menopausia
K1 Ginecología
K1 Osteoporosis
K1 Fracture
K1 Fractura
K1 CART analysis
K1 Análisis CART
K1 3201.08 Ginecología
AB Introduction: Osteoporosis is a prevalent disease that particularly affects postmenopausal women due to factors such as age and declining estrogen levels. The main problem with this disease is that it often remains asymptomatic until a fracture occurs, significantly impacting patient morbidity and mortality. Therefore, identifying patients at risk of fractures and implementing therapies and preventive measures, both pharmacological and lifestyle modifications, to prevent or at least delay the occurrence of these complications is crucial.Hypothesis and Objectives: The identification of the specific risk factors associated with the risk of fractures in a postmenopausal women population could aid in their prevention, utilizing the available diagnostic tools in medical practice. The objectives of our study were to identify analytical parameters associated with bone quality and fracture risk in postmenopausal women. Additionally, we aimed to identify densitometric parameters using 3D densitometry and TBS technologies associated with the risk of osteoporotic fractures. Overall, we sought to test the predictive capacity of available diagnostic tools for fracture risk in the postmenopausal women population.Materials and Methods: We conducted an 8-year longitudinal study in a population of postmenopausal women, including those with and without osteoporosis. A standardized clinical history, blood analysis, DXA scans of the spine and hip, and FRAX with and without DXA were performed for all participants. Fractures that occurred during the 8-year follow-up period were identified. Statistical analysis, both parametric and non-parametric, was conducted using SPSS 21.1. Additionally, a Classification and Regression Tree (CART) method was employed to assess potential interactions between fracture risk factors.Results: The study included 276 postmenopausal patients. After the 8-year follow-up, 72 patients (24.6%) experienced fractures, and 17 (6.2%) suffered a second fracture. Women in quartile 4 (Q4) of HOMA-IR had higher values of volumetric bone mineral density (vBMD) but not TBS. The increase was higher in the trabecular compartment than in the cortical compartment. Similar results were observed for insulin. Women in Q4 of uric acid also had higher vBMD values. After adjusting for body mass index (BMI), statistical significance was maintained for TBS, insulin, HOMA-IR, HbA1c, and uric acid. CART analysis results indicated that the main risk factor for osteoporotic fracture after 8 years of follow-up was a history of previous fractures. Among patients with previous fractures, having a femoral neck BMD less than 0.67 was the main risk factor.Conclusions: Among analytical parameters, a significant relationship was found between HOMA-IR, insulin, HbA1C, uric acid, and various densitometric parameters. These findings underscore the importance of considering these parameters as indicators of fracture risk and bone quality evaluation in postmenopausal women in our population. The combination of FRAX with analytical and densitometric parameters allowed for a more precise and personalized assessment of fracture risk. These tools are valuable for the early identification of postmenopausal women at higher fracture risk based on clinical parameters and simple complementary tests, enabling the implementation of more effective therapeutic measures.
YR 2023
FD 2023
LK https://uvadoc.uva.es/handle/10324/67840
UL https://uvadoc.uva.es/handle/10324/67840
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 16-jul-2024