Grażyna Bączyk

Multifactorial analysis of risk factors for reduced bone mineral density among postmenopausal women

Introduction The study aimed to determine the risk factors for reduced bone mineral density (BMD) among postmenopausal women. Material and methods Two hundred and fifty-three postmenopausal women were included to the study. The study group consisted of 85 women with osteoporosis (mean age: 59.9 years) and 168 with osteopenia (mean age: 57.8 years). Patients were assigned to groups according to their BMD measured in the lumbar spine, hip and femoral neck by dual X-ray absorptiometry. Bone formation was assessed by measuring serum osteocalcin and bone resorption by measuring serum C-terminal type I α-collagen chain telopeptide. Results Multiple regression analysis for lumbar spine showed association of age (p = 0.001), parental history of fracture (p = 0.05), use of hormone replacement therapy (p = 0.034), bisphosphonates therapy (p < 0.001), calcium and vitamin D supplements therapy (p = 0.001), oestradiol level (p = 0.007) and body mass index (p < 0.001). Multiple regression analysis for femoral neck and hip total showed association of age (p = 0.001), parental history of fracture (p = 0.049), use of bisphosphonates (p < 0.03)) use of calcium and vitamin D supplements (p = 0.039), oestradiol level (p = 0.047). All the variables together explain 40.4% of variance in BMD for the lumbar spine and 25.6% of variance in BMD for femoral neck and hip total. Conclusions The present study demonstrated correlations between the variables and BMD, which are known and widely described in the literature. Osteoporosis and osteopenia in Polish subjects appear to be associated with several known risk factors that are well described in the literature.

Quality of life in postmenopausal women with reduced bone mineral density: psychometric evaluation of the Polish version of QUALEFFO-41.

Introduction Evaluation of the quality of life of patients with osteoporosis concerns the physical, emotional, social and pain quality of life domains. The aim of the research was to describe the psychometric properties of the Polish version of QUALEFFO-41 in 253 Polish postmenopausal women with osteopenia or osteoporosis and in 132 postmenopausal women with normal BMD. Material and methods The internal reliability of QUALEFFO-41 was studied using Cronbach’s alpha coefficient. The reproducibility of the QUALEFFO-41 scales was assessed using Pearson’s correlation. The capacity of questions to discriminate between women with reduced bone mineral density (BMD) and normal subjects was assessed by conditional logistic regression to derive an odds ratio with 95% confidence intervals. The discriminative power, which measures the ability of the questionnaire to discriminate between patients, was assessed by clinical validity. Additionally, receiver operating characteristic (ROC) curves were constructed to assess the ability of QUALEFFO-41. Results Cronbach’s α coefficient reflecting the reliability and repeatability of the instrument for all domains was satisfactory. Results of scores for domains of QUALEFFO-41 and the score for total QUALEFFO-41 demonstrate a significant difference (p < 0.001) among all groups; only in the case of the pain domain was there a significant difference at the level of p < 0.01 between normal subjects and osteoporotic patients. Receiver operating characteristic curve analysis demonstrated a good discriminating capacity of individual domains and total QUALEFFO-41 score. Conclusions The Polish version of QUALEFFO-41 can be used among patients with reduced BMD compared to normal subjects, independently of vertebral fractures, as it is coherent and discriminates well between women with reduced BMD and normal subjects.

Evaluation of the quality of life of postmenopausal osteoporotic and osteopenic women with or without fractures

Introduction Most studies concerned with the quality of life (QoL) of women with reduced bone mineral density (BMD) focus on patients with vertebral and non-vertebral fractures. Our objective was to evaluate QoL among patients with reduced BMD regardless of their fracture history compared to women with normal BMD. Material and methods Eighty-five patients in the study group were classified as osteoporotic, with BMD results measured by densitometry and expressed by T-score ≤ –2.5 SD, 122 women were osteopenic, with –2.5 < T-score ≤ –1.0 SD, and 97 subjects were assessed as normal, with T-score > –1.0 SD. Mean ages of women according to groups were 59.90, 57.67 and 55.68, respectively. Assessment of life quality was conducted using the Polish version of the QUALEFFO-41 scale. Results The ratings in the assessment (QUALEFFO-41) of QoL were lower for osteoporotic and osteopenic women than for the normal BMD group with regard to pain (p = 0.006), social function (p = 0.001), health perception (p = 0.001), and mental function (p = 0.001). For total QUALEFFO-41 the associated factors were: secondary and higher education (OR = 0.49; 95% CI: 0.29–0.82), self-perceived deformity of the back (OR = 4.09; 95% CI: 1.88–8.93), previous fractures (OR = 2.52; 95% CI: 1.09–5.82), reduced height (OR = 2.48; 95% CI: 1.13–5.39) and anxiety (OR = 1.42; 95% CI: 1.21–1.66). Conclusions It seems necessary to evaluate QoL of women with reduced BMD before fractures occur, to aid development of health education aiming to reduce the incidence of osteoporosis and prevent fractures.

Fatigue and sleep quality in rheumatoid arthritis patients during hospital admission

Objectives Rheumatoid arthritis (RA) is a systemic disease of connective tissue characterised by chronic course with periods of exacerbation and remission. Even in the early stages of the disease patients report the occurrence of fatigue and sleep disorders. Reduced sleep quality and chronic fatigue are common among patients with rheumatoid arthritis. The aim of the research was to evaluate the severity of fatigue and sleep quality assessment among patients hospitalised with rheumatoid arthritis and to determine the relation between the level of symptoms of fatigue and sleep quality and variables such as: age, gender, disease duration, marital status, applied pharmacological treatment, and pain intensity. Materials and methods The study involved 38 patients (12 men and 26 women) hospitalised in the Rheumatologic Ward of the Orthopaedics and Rehabilitation Hospital of the University of Medical Sciences. The average age of the entire group was 56.26 years. Fatigue was evaluated with use of Polish version of Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), while in order to evaluate sleep quality within the examined group of patients the Pittsburgh Sleep Quality Index (PSQI) was used. Results Patients with rheumatoid arthritis in the analysed group have lower sleep quality, and within subjects with such a diagnosis the fatigue is present. The relation was found between fatigue and such variables as: age, illness duration, marital status, applied pharmacological treatment, and severity of pain. Sleep quality within patients with RA is correlated by such variables as: age, gender, applied pharmaceutical treatment, and severity of pain. It was identified that patients with lower sleep quality experience increased levels of fatigue. Conclusions There is a need to clarify which factors determine the level of fatigue and sleep quality in patients suffering from RA in future population-based research and to indicate to doctors, nurses, psychologists, and physiotherapists the significance and importance of the problem, which requires specialised and holistic care.

Health-related quality of life assessment among patients with inflammatory bowel diseases after surgery – review

Aim of the work was to review systematically the published literature addressing whether quality of life (QoL) and health-related QoL (HRQoL) are influenced by surgery among patients with inflammatory bowel disease (IBD). Electronic databases and published articles were searched to identify relevant studies published in the years 1990–2015. Then, a multistep selection was undertaken to identify articles that met specific selection criteria, such us specific key-words (IBD, HRQoL, ulcerative colitis (UC), Crohn’s disease (CD), and surgery), and the population was assessed (studies concerning patients < 18 years old were excluded). The review included 27 studies that were evaluated in the context of the influence of surgery on QoL and HRQoL. Concluding, with the increase in the incidence of IBD, monitoring of QoL is an important indicator of the health effects at each stage of the surgical treatment.

The role of demographic and clinical variables in assessing the quality of life of outpatients with rheumatoid arthritis

Introduction The aim of this study was to assess quality of life among patients with rheumatoid arthritis (RA) treated as outpatients. The specific question was: does the quality of life of RA patients depend on demographic variables and clinical variables? Material and methods The study included 240 patients with RA recruited from outpatients. To assess quality of life, the Arthritis Impact Measurement Scales 2 was applied. Clinical tests: VAS, Morning Stiffness, Grip Strength, Richie Articular Index. Results The analysis of life quality for the total group was carried out in the particular AIMS2 of the mean scores for arthritis pain – 7.37; walking and bending – 6.62; social activity – 5.52; level of tension – 5.17; satisfaction – 5.17; hand and finger function – 4.28; mood – 4.03; physical activity – 3.27; arm function – 3.16; household tasks – 2.67; self-care – 2.18; and support from family and friends – 1.75. The arthritis impact score was 6.01. The analysis of the correlation between clinical variables and individual AIMS2 subscales showed a statistically significant relationship between the VAS Pain, Grip Strength Measurement, Morning Stiffness and quality of life subscales (p < 0.01). VAS Pain, Morning Stiffness, and Grip Strength Measurement were the most important predictors among clinical variables of physical component, affect and symptoms (p < 0.001). Among demographic variables: age over 60 years and low education were the most important predictors of physical component (p < 0.01). Conclusions The study results may be helpful for further health-related studies on quality of life among RA studies and in making therapeutic decisions concerning quality of life improvement.