There are convincing data on the association of psycho-emotional disorders with the degree of bone mineral density (BMD) loss and the risk of fractures on the basis of osteoporosis (OP) but the nature of the causal relationship has not yet been clearly established. The study of this issue is important to substantiate the need and nature of psychological correction within the framework of comprehensive rehabilitation programs in patients with osteoporotic fractures.
OBJECTIVE
Study of the severity of symptoms of depression and anxiety in patients who have suffered compression fractures of the vertebrae (VF) of osteoporotic genesis who entered the II stage of medical rehabilitation, as well as the contribution to the development of psycho-emotional age disorders, the severity of OP, pain syndrome and the use of orthotics.
MATERIAL AND METHODS
The study sample consisted of 120 women 50 to 80 years old with an established diagnosis of OP based on the results of bone densitometry. The main group included 60 patients with OP complicated by at least one VF. The control group included 60 patients with OP without a history of osteoporotic fractures comparable in age, body mass index and BMD in the spine with the main group. The complex of examination included the collection of complaints, anamnesis of OP, previous fractures, assessment of pain syndrome according to VAS, BMD study and verification of VF by X-ray methods. To assess the level of depression (DL) we used the Tsung depression scale modified by T.I. Balashova, situational (SA) and personal anxiety (PA) — Spielberger—Khanin questionnaire.
RESULTS
In the main group in comparison with the control group the proportion of patients without symptoms of depression was lower (66.7 and 88.3%, respectively; p=0.042), as well as the frequency of detection of high degree of SA was higher (85.0 and 73.4%, respectively; p=0.039). In patients with VF it was higher than in the control, DL — 46.0 [42.0; 54.5] (27—70) and 43.0 [38.0; 47.5] (25—65) points, respectively (p=0.0009), as well as the SA degree — 61.5 [54.0; 71.0] (20—75) and 52.5 [43.5; 64.0] (20—68) points, respectively (p=0.0006). Statistically significant direct correlation dependences of DL on age (r=0.317; p=0.00042), the duration of the postmenopausal period (r=0.325; p=0.0003), the number of VFs (g= –0.245; p=0.00013) were established. Moreover, the intensity of pain syndrome (g= –0.234; p=0.00034), as well as feedbacks of this indicator with BMD in the spine (r= –0.342; p=0.00017) and the duration of the use of thoracolumbar orthoses (r = −0.504; p = 0.00016). There were direct dependence of the SA degree on age (r=0.281; p=0.0019) and the intensity of pain syndrome (g=0.258; p=0.0044). Negative correlation of SA with body weight (r= –0.183; p=0.045), BMD in the spine (r= –0.207; p=0.026), duration of orthosis application (r= –0.327; p=0.0095) and the amount of VF in the lumbar spine (g= –0.214; p=0.044) were detected. There was a significant correlation between the degree of PA and BMD in the lumbar vertebrae (r= –0.18; p=0.046) and the intensity of pain syndrome (g=0.137; p=0.039).
CONCLUSION
The results obtained indicate the need for psychological correction in the framework of the complex rehabilitation of women who underwent VF based on OP due to increased DL and SA especially in older age groups.
