OBJECTIVE

To study and evaluate the role of serum optical density in prediction and early diagnosis of osteoporosis in women with risk factors for its development in perimenopause.

MATERIAL AND METHODS

The study was carried out on the basis of Bukhara Regional Perinatal Center in the period from 2019 to 2021 at the Department of Obstetrics and Gynecology No. 2 of Bukhar State Medical Institute. 121 patients in perimenopause were examined. 3 groups of patients were formed to achieve the goal: the 1st group — control group — included 41 perimenopausal women without obvious clinical manifestations of menopause; the 2nd group — 40 women without corrective therapy; the 3rd group — 40 women who underwent corrective therapy. Ultrasound densitometry was used to assess changes in bone tissue state in the patients. The optical density of blood serum was determined by the method of wedge-shaped dehydration.

RESULTS

The mean age of the patients of the 1st group was 45.54±0.84 years, of the 2nd group — 44.53±0.97 years and of the 3rd group — 50.73±0.93 years. The mean age of all examined patients was 46.9 years. In the 1st (control) group there were no obvious clinical manifestations of menopausal syndrome, the manifestations of menopausal syndrome were confirmed by laboratory parameters. The average level of T-criterion in this group was –0.54, Ca — 2.1 mg/dl, alkaline phosphatase (ALP) — 85 units/l, estradiol — 45 pmol/l, Z-criterion was –32.1±0.1%. All these parameters are age normal for the patients. When determining the optical density of blood serum, 30 to 45 radial lines in facies were found, which appear due to drying of serum on a slide at room temperature with sufficient amount of minerals and proteins in the examined patients. In 40 patients of the 2nd group, according to the data of questionnaire survey and clinical examination, clinical manifestations of menopausal syndrome were revealed, and according to the laboratory parameters of blood serum, a decrease in Ca concentration up to 0.14 mg/dL, estradiol — up to 18 pmol/L, and an increase in alkaline phosphorus activity by 27 units/L compared to the reference values for women of this age were found. Accordingly, the value of standard deviations of T-criterion amounted to –2.5±0.01 in ultrasound densitometry, which indicated the development of osteoporosis. In this case, the Z-criterion was –69.9±0.4%. The 3rd group included women who systematically underwent preventive examinations by a gynecologist and were on the dispensary register. According to the questionnaire data, clinical signs of menopausal syndrome were revealed, manifested as periodic rises in blood pressure, headaches, sleep disturbances, sweating, fatigue, and menstrual cycle disorders. Ultrasound examination revealed no pathologic changes in the pelvic organs. According to the ultrasound densitometry data, the values of standard deviations of T-criterion before treatment averaged –2.0±0.03, Z-criterion –75.4±0.2%, which indicated the development of osteopenia; after treatment T-criterion decreased to –1.8±0.02. Blood Ca content was 1.98 mg/dL, alkaline phosphate 266 units/L, and estradiol 14 pmol/L.

CONCLUSION

On the basis of the obtained results, it has been established that prediction of osteopenia and osteoporosis in perimenopausal women can be carried out by studying the structural-optical properties of blood serum, which also makes it possible to evaluate the effectiveness of complex menopausal hormonal therapy. Since the formation of structural facies of blood serum is normally associated with the presence of sufficient amounts of minerals and protein compounds, a decrease in their level in blood serum is reflected as the appearance of a blurred pattern of serum optical density with the number of radial lines less than 20 in the field of view. Taking into account the high importance in gynecological practice of disturbed bone resorption in perimenopause, which leads to a high frequency of osteopenia and osteoporosis, the use of the method of determining the optical density of blood serum and its structural structure allows to identify risk groups for osteoporosis before the appearance of symptoms, at early stages of its development.