Korelasi Kadar 25-Hydroxyvitamin D dan Kadar Estradiol Serum dengan Densitas Tulang pada Wanita Menopause

Abstract

Background : Postmenopausal osteoporosis is one of the world’s concern with high morbidity and mortality which is marked by low bone density which makes the bone fragile and increases the risk of fracture. It had be known that estrogen plays a role in women’s bone health, that is to maintain the activity of osteoblasts and osteoclasts. Vitamin D which is reflected by 25 Hydroxyvitamin D (25(OH)D) serum is also known to be important to stimulate the absorbtion of calcium in the small intestine for bone mineralization and in the state of vitamin D deficiency, it increases bone turnover by causing secondary hyperparathyroidism. Aim : To know the correlation between 25(OH)D and estradiole serum level with bone densities in menopausal women. Method : This is an analytic research with cross sectional approach performed on 36 menopaused midwives/nurses in RSUP. H. Adam Malik Medan, from September-October 2015. We measure the level of 25(OH)D and estradiole serum, bone density were measured using Dual energy X-ray Absorbtiometry (DXA) method, and then were analized with multiple correlation test. Result : From the characteristics, it is found that most of them is aged > 50 (80,6%), menopause since 3-4 years ago (55,6%), normoweight BMI (47,2%), 25(OH)D level ≤20ng/ml(69,4%), estradiole level ≤20pg/ml(88,9%), and osteopenia (63,9%). Based on chi-square, from the risk factors, only Body Mass Index shows a significant correlation with bone densitiy and estradiole rate (p=0,015 and p=0,005). According to Spearman correlation test, there is no significant corelations between 25(OH)D serum level and T-score (r = 0,261, p>0,05). There is a significant positive corelations between estradiole serum and T-score (r=0,53, p<0,05) and with multiple corelation test, there is a significant positive corelations between 25(OH)D rate and estradiole serum with Tscore (R=0,0663 and p<0,05). Level of 25(OH)D and Estradiole serum have a contribution value as much as 44% towards bone density (R2=0,44). Conclusion : There is a significant positive corelations between the level of 25(OH)D and estradiole serum towards bone density score (T-score).

Latar Belakang : Osteoporosis postmenopausal merupakan masalah morbiditas dan mortalitas di dunia yang ditandai dengan rendahnya densitas tulang sehingga meningkatkan fragilitas tulang dan risiko fraktur. Telah lama diketahui bahwa estrogen memainkan peranan penting dalam menentukan kesehatan tulang pada wanita, yaitu mempertahankan keseimbangan kerja osteoblas dan osteoklas. Vitamin D yang digambarkan oleh kadar 25 Hydroxyvitamin D (25(OH)D) serum juga penting untuk memicu absorbsi kalsium di usus halus untuk fungsi mineralisasi tulang dan keadaan defisiensi Vitamin D dapat meningkatkan turnover tulang melalui efek hiperparatiroid sekunder. Tujuan : Untuk mengetahui korelasi kadar 25(OH)D dan estradiol serum dengan densitas tulang pada wanita menopause. Metode : Penelitian ini merupakan penelitian analitik dengan pendekatan cross sectional pada 36 bidan/perawat menopause di RSUP. H. Adam Malik Medan, dilakukan mulai September–Oktober 2015. Dilakukan pemeriksaan kadar 25(OH)D, estradiol serum & pengukuran densitas tulang dengan metode Dual energy X-ray Absorbtiometry (DXA), kemudian data dianalisis dengan uji korelasi ganda. Hasil : Berdasarkan karakteristik terbanyak dijumpai adalah usia >50 tahun(80,6%), lama menopause 3-4 tahun(55,6%), IMT normoweight(47,2%), kadar 25(OH)D ≤20 ng/ml(69,4%), kadar estradiol ≤20 pg/ml(88,9%) dan osteopenia(63,9%). Hasil uji chi-square faktor risiko yang diteliti, hanya IMT yang menunjukkan hubungan bermakna terhadap densitas tulang dan kadar estradiol (p=0,015 dan p=0,005). Hasil uji korelasi Spearman, antara kadar 25(OH)D serum dengan T-score tidak terdapat korelasi bermakna (r=0,261, p>0,05). Antara kadar estradiol serum dengan T-skor terdapat korelasi positif bermakna (r=0,53, p<0,05) dan dengan uji korelasi ganda, terdapat korelasi positif bermakna antara kadar 25(OH)D dan estradiol serum terhadap T-score (R=0,663 dan p<0,05). Dan keduanya memiliki kontribusi sebesar 44% terhadap densitas tulang (R2=0,44). Kesimpulan: Terdapat korelasi positif bermakna dengan kekuatan sedang antara kadar 25(OH)D dan estradiol serum terhadap skor densitas tulang (T-score).