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"Perawatan gigi tiruan pada lansia terutama lansia perempuan usia 50-75 tahun sering mengalami kegagalan, karena adanya resorpsi tulang alveolar berlebihan yang menyebabkan gigi tiruan longgar dan tidak stabil. Berbagai penelitian penyebab terjadinya resorpsi tulang telah banyak dipublikasi, di antaranya yang terkait faktor sosiodemografis, klinis, dan lingkungan, namun penelitian terkait dengan hormon (PTH, FSH) dan faktor genetik (polimorfisme gen PTH dan PTHR1) belum banyak diteliti.Tujuan: Memperoleh indeks tingkat keparahan resorpsi tulang alveolar mandibula untuk memprakirakan tingkat keparahan resorpsi tulang alveolar mandibula pada pascamenopause yang memerlukan perawatan gigi tiruan. Subjek penelitian adalah perempuan pascamenopause usia 50-75 tahun yang bertempat tinggal di kelurahan Kenari dan Paseban Jakarta Pusat.Metode: Menggunakan alat ukur kuesioner indeks kepadatan tulang mandibula tervalidasi, pemeriksaan klinis, pemeriksaan serum darah dengan ELISA, dan teknik PCR RFLP untuk menganalisis gen, dan evaluasi radiograf panoramik untuk menilai kualitas tulang kortikal mandibular. Selanjutnya dilakukan penelitian potong lintang untuk mencari faktor-faktor risiko yang paling berperan terhadap keparahan resorpsi tulang alveolar mandibula.Hasil: Penelitian ini menunjukkan tidak terdapat hubungan antara faktor sosiodemografis, klinis, dan lingkungan, serta ditemukan sebanyak 87,25% subjek dengan kadar PTH <65pg/mL, dan adanya korelasi yang signifikan antara kadar PTH dengan resorpsi tulang alveolar mandibula (p<0,05). Kadar PTH ≥65pg/ml bertendensi terhadap tingkat keparahan resorpsi tulang alveolar. Tidak ditemukan adanya korelasi antara kadar PTH dengan genotip dan alel polimorfisme gen PTH pada posisi rs6254 di intron dua (p>0,05). Tidak terbukti adanya korelasi antara polimorfisme gen PTH dengan keparahan resorpsi tulang alveolar mandibula (p>0,05), sedangkan pada polimorfisme gen PTHR1 pada posisi promoter tiga ditemukan bahwa pada pengulangan (AAAG)6 memiliki kualitas tulang yang lebih rendah dan resorpsi tulang tinggi walaupun tidak ditemukan adanya korelasi antara polimorfisme gen PTHR1 dengan keparahan resorpsi tulang (p>0,05). Hasil uji multivariat memperlihatkan kadar FSH, PTH dan kualitas tulang alveolar mandibula berperan terhadap terjadinya keparahan resorpsi tulang alveolar mandibula (p<0,05). Penelitian ini memperoleh dua model penskoran indeks prediksi keparahan resorpsi tulang alveolar mandibula. Model satu dengan faktor PTH, FSH dan kualitas tulang mandibula mempunyai sensitifitas 68,29%, spesifisitas 56,48%, dengan daerah di bawah kurva (AUC) 0,675 dapat digunakan jika pada penerapan model dua tidak terlihat faktor yang berperan. Model dua terdiri dari FSH dan kualitas tulang, dengan sensitivitas 68,29% dan spesifisitas 58,33% serta area daerah di bawah kurva (AUC) 0,649.Kesimpulan: indeks prediksi resorpsi tulang alveolar mandibula yang terdiri atas analisis kualitas tulang mandibula, kadar FSH dan PTH dapat digunakan untuk memprediksi tingkat keparahan resorpsi tulang alveolar mandibula. Dengan demikian diharapkan kegagalan perawatan gigi tiruan pada perempuan kelompok usia 50-75 tahun yang berisiko osteoporosis dapat diatasi.

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Denture treatment in the elderly, especially in women aged 50-75 years, often experience failure, due to excessive alveolar bone resorption which causes loose and unstable dentures. Various studies have been published on the causes of bone resorption, including those related to sociodemographic, clinical, and environmental factors, but research related to hormones (PTH, FSH) as well as genetic factors (PTH and PTHR1 gene polymorphisms) have not been much studied.Purpose: This study aims to obtain a mandibular alveolar bone resorption severity index to predict the severity of mandibular alveolar bone resorption in the postmenopausal period that requires denture treatment. The subjects of the study were postmenopausal women aged 50-75 years who lived in the villages of Kenari and Paseban, Central Jakarta.Methods: The first step this study were conducted by using a validated mandibular bone density index questionnaire, clinical examination, blood serum examination by ELISA, and PCR- RFLP techniques to analyze genes, and panoramic radiographs evaluation to assess the quality of mandibular cortical bone. A cross-sectional study to look for the risk factors that most contribute to the severity of mandibular bone resorption were then conducted at the second step of this study.Results: This study showed no relationship between sociodemographic, clinical, and environmental factors, and found as many as 87.25% of subjects with PTH levels <65pg / ml, as well as a significant correlation between PTH levels with resorption of the mandibular alveolar bone (p <0.05 ). The PTH level ≥65pg / ml has a tendency towards the severity of alveolar bone resorption, however, there was no correlation between PTH levels with genotype and PTH gene polymorphism alleles at position rs6254 in intron two (p> 0.05). There is no proven correlation between PTH gene polymorphism with the severity of mandibular alveolar bone resorption (p> 0.05). In the PTHR1 gene polymorphism of the promoter position three it was found that the repetition (AAAG)6 had lower bone quality and higher bone resorption although no correlation was found between PTHR1 gene polymorphisms and the severity of bone resorption (p> 0.05). Multivariate analysis showed that the levels of FSH, PTH and mandibular alveolar bone quality were contributed to the severity of mandibular alveolar bone resorption (p <0.05). From this study two predictive index scoring models of the severity of mandibular alveolar bone resorption were obtained. The model one with factors of PTH, FSH and quality of mandibular bone, has 68.29%sensitivity and 56.48% specificity, with the area under the curve (AUC) 0.675. Model two has a sensitivity of 68.29%, and specificity of 58.33% with the area under the curve (AUC) is 0.649. The model one could be used if in the application of model two does not show factors that play a role.Conclusion: the predictive index of mandibular alveolar bone resorption consisting of analysis of mandibular bone quality, FSH and PTH levels can be used to predict the severity of mandibular bone resorption. It is hoped that the failure of denture treatment in women aged 50-75 years at risk of osteoporosis can be overcome."

"TujuanMengetahui hubungan antara asupan energi, protein, kalsium, vitamin D dan aktivitas fisik dengan resorpsi tulangTempatMalang, Jawa TimurMetodologiStudi potong lintang terhadap 109 lansia sehai. Data yang dikumpulkan meliputi karakteristik subyek penelitian berdasarkan umur, jenis kelamin, data antropometri (berat badan, tinggi badan, indeks massa tubuh), analisis asupan zat gizi derigan FFQ semikuantitatif dan recall 1 x 24 jam, analisis aktivitas fisik dengan kuesioner aktivitas fisik, dan data laboratorium (CTx serum dan rasio kalsium kreatinin dalam urin 24 jam). Data dianalisis dengan uji korelasi Pearson dan analisis multivariat regresi multiple.HasilSubyek penelitian terdiri dari 49 laki-laki dan 60 perempuan dengan rerata usia 68,19 ± 5,91 tahun. Sebagian besar subyek penelitian berpendidikan sedang sampai tinggi, dan berpenghasilan menengah rendah. Rerata IM£ subyek penelitian ialah 23,86 ± 3,08 kglm2. Rcrata asupan energi ialah 1548 ± 416,23 kkal; rerata asupan protein 59,14 + 11,37 g; rerata asupan kalsium 928,62+ 360,79 mg, dan rerata asupan vitamin D 9,85 ± 5,09 pg. Indeks aktivitas fisik sebagian besar subyek penclitian mencngah sampai tinggi. Didapatkan korelasi negatif yang berrnakna anlara CTx dengan asupan energi, protein, kalsium, dan aktivitas fisik. Korelasi negatif berrnakna juga didapatkan antara rasio kalsium kreatinin dengan asupan energi, protein dan kalsium, sedangkan korelasi positif bermakna didapatkan dengan variabel umur. Pada analisis multivariat, CTx berhubungan secara negatif bcrrnakna dengan protein, kalsium dan aktivitas fisik. Sedangkan rasio kalsium kreatinin berhubungan secara positif bermakna dengan umur dan kalsium.KesimpulanRerata asupan energi subyek penelitian lebih rendah daripada AKG VIII, narnun dengan tingkat asupan tersebut, IMT dalam batasan normal sampai obes. Rerata asupan protein, kalsium dan vitamin D subyek penelitian lebih besar dibandingkan dengan AKG VIII. Didapatkan hubungan yang bermalma antara asupan protein, kalsium dan aktivitas fisik dengan resorpsi tulang. Didapatkannya hubungan yang bermakna, namun dengan derajat rendah, menunjukkan adanya pcngaruh faktor lain dalam bahan makanan.

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Objective

To determine the relationship between nutritional intake and physical activity with bone resorption of Indonesian elderly

Place

Malang, East Java

Method

A cross-sectional study in 109 community dwelling elderly (>60 y) free of medication know to affect bone. Semiquantitative FFQ, validated with 1x24 hour food recall was used to assess energy, protein, calcium, and vitamin D. Assessment of physical activity was done with a questionnaire based on the Dutch questionnaire modified by Josten. Bone resorption were measured by its collagen degradation product, C-telopeptide in serum. Bivariate and multivariate analysis was done to assess relationship between nutrients and physical activity with biomarker of bone resorption.

Results

Subject were 49 men and 60 women with mean age of 68,19 +/- 5,91 years old. Most subject had moderate high education, and a middle low income. Based on the Physical Acticity Index, most subjects has moderate to highphysical activity. The body mass index of most subjects were normal to obese. Mean intake of energy in subjects were 1548 +/- 416,23 kcal. Mean intake of protein were 59,14 +/- 11,37 g/d, mean Calcium intake were 928,62 mg/d and mean vitamin D intake were 9,85 +/- 5,09 µg. There were significant negative correlation between intakes of energy, protein, calcium, and physical activity with CTx. Significant negative correlation were also found between intakes of energy, protein, calcium with calcium creatinine ratio, while positive significant correlation were found with age. Multiple regression analysis showed significant relationship between protein and calcium intakes and physical activity with CTx and between calcium intake and age with calcium creatinine ratio.

Conclusion

Mean intake of energy were lower than the Indonesian RDA. But at this level BMI were normal to obese. Mean intakes of protein, calcium and vitamin D were well above the Indonesian RDA. Significant relationship were found between intakes of protein and calcium and physical activity with bone resorption. The rather low but statistically significant relationship, shows that the other factors in food sources, that may play role in bone resorption, such as osteoprotegerin/OPG, IGF-1, potassium, vitamin K, zinc and magnesium."

"Recent research, which Bone- Metabolic Function and Modulators expands on, has added new support to the idea that bone not only serves as a support system, but also functions as an integrating organ, with a significant regulatory role for lipid and energy metabolism. Links between physical activity and the skeleton are also becoming increasingly clear. This fully illustrated volume contains up-to-date information on the metabolic role of the skeleton and what this can mean for the treatment of metabolic as well as skeletal and auditory diseases."

"Beban penyakit akibat pajanan timbel terus meningkat. Timbel mengganggu hidroksilasi 25(OH)D dan transportasi kalsium sehingga aktivitas osteoklastik dan resorpsi tulang meningkat. Pyridinoline crosslinks (PYD) sebagai indikator kerusakan tulang lebih dini dari pencitraan. Penelitian ini merupakan penelitian sekunder dari penelitian primer yang berjudul Korelasi Kadar Serum 25(OH)D dengan Penanda Biologis Kardiovaskular pada Pekerja Terpajan Timbel. Penelitian berdesain potong lintang ini dilakukan untuk mengetahui hubungan kadar 25(OH)D serum dengan rasio PYD/kreatinin urin pada pekerja terpajan timbel. Penelitian berlokasi di Kabupaten Tegal, Kabupaten Tangerang, Kota Surabaya, dan Kabupaten Bogor. Subjek adalah bagian dari seluruh pekerja terpajan timbel yang terdaftar sebagai responden dalam penelitian primer dan memenuhi kriteria, didapatkan total 104 subjek. Instrumen yang digunakan adalah formulir karakteristik subjek, pemeriksaan fisik, Global Physical Activity Questionnaire, Semi-Quantitative Food Frequency Questionnaire, hasil pemeriksaan fungsi ginjal dan hepar, kadar timbel dalam darah, kadar 25(OH)D serum, dan sampel urin pagi. Median kadar timbel dalam darah 6,3 (1,2-35,5) µg/dL, indeks pajanan timbel kronik 35,3 (1,2-535,8) tahun µg/dL, kadar 25(OH)D serum 22 (8-52) ng/mL, dan rasio PYD/kreatinin urin 5,3 (3,6-28,1).10^-6. Sebagian besar (86,5%) subjek memiliki kadar 25(OH)D serum yang tidak adekuat. Studi menunjukkan terdapat hubungan negatif yang signifikan antara kadar 25(OH)D serum dengan rasio PYD/kreatinin urin pada pekerja terpajan timbel (r = -0,39, p < 0,001), dan terdapat hubungan positif yang signifikan antara indeks pajanan timbel kronik dengan rasio PYD/kreatinin urin (r = 0,21, p = 0,036).......The burden of disease due to lead exposure continues to increase. Lead interferes with 25(OH)D hydroxylation and calcium transport, increasing osteoclastic activity and bone resorption. Pyridinoline crosslinks (PYD) as an indicator of bone damage that can be seen earlier than imaging. This study is a secondary study of the primary study entitled Correlation of Serum 25(OH)D Levels with Cardiovascular Biological Markers in Workers Exposed to Lead. This cross-sectional study was conducted to determine the correlation between serum 25(OH)D levels and the urinary PYD/creatinine ratio in workers exposed to lead. The study was located in Tegal Regency, Tangerang Regency, Surabaya City, and Bogor Regency. The subjects were part of all lead-exposed workers who were registered as respondents in the primary study and met the criteria, resulting in a total of 104 subjects. The instruments used were subject characteristic form, physical examinations, Global Physical Activity Questionnaire, Semi-Quantitative Food Frequency Questionnaire, kidney and liver function test results, blood lead levels, serum 25(OH)D levels, and morning urine samples. Median blood lead levels were 6.3 (1.2-35.5) µg/dL, chronic lead exposure index 35,3 (1,2-535,8) years µg/dL, serum 25(OH)D levels were 22 (8-52) ng/mL, and urinary PYD/creatinine ratio was 5.3 (3.6-28.1).10^-6. Among the most population (86.5% of subjects) had inadequate serum 25(OH)D  the study showed a significant negative correlation between serum 25(OH)D levels and urinary PYD/creatinine ratio in workers exposed to lead (r = -0.39, p < 0.001). There was also a significant positive correlation between chronic lead exposure index and the urinary PYD/creatinine ratio (r = 0.21, p = 0.036)."