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"Latar Belakang : lnstabilitas postural I jatuh adalah ketidakmampuan untuk mempertahankan pusat kekuatan anti gravitasi pada dasar penyanggah tubuh (misalnya, kaki saat berdiri), atau memberi respon secara cepat pada setiap perpindahan posisi atan keadaan staffs. Prevalensi instabilitas postural di AS 30% dari penduduk usia lebih 60 tahun pernah jatuh, di RSCM tahun 2003 sebesar 23,3%. Faktor risiko yang melatar belakangi terjadinya jatuh adalah faktor ekstrinsik an faktor intrinsik. Faktor intrinsik terbagi dua sistemik (pneumonia, hipatensi ortostatik, hiponatremi, gagal jantung, infeksi saluran kemih) dan lokal (OA servikal, OA gem, Benign paroxiysmalpositional vertigo (BPPV), gangguan penglihatan, gangguan pendengaran, kelemahan otot tungkai bawah). Jatuh memiliki penyulit yang cukup serius, mulai dari cedera ringan sampai fraktur femur. Dengan mengetahui faktor risiko jatuh sedini mungkin, maka kita dapat mencegah terjadinya jatuh dan penyulitnya.Tujuan : mengetahui sebaran faktor intrinsik lokal serta hubungannya dengan instabilitas postural I jatuh.Metodologi : Studi potong lintang dengan basal-sampel 97 orang usia Lanjut yang memenuhi kriteria inklusi. Waktu : Januari-Juni 2005 di Divisi Geriatri RSCM. Tingkat instabilitas diukur dengan posturografri.Hasil : Dari penelitian ini didapat hasil prevalensi instabilitas postural sebesar 64.9%. Prevalensi perempuan 52,3% dan laki-laki 47,7%. Menurut kelompok umur prevalensi tertinggi pada umur > 80 taken sebesar 75,0%. Pada analisa bivariat osteoariritis servikal merupakan faktor intrinsik lokal yang mempunyai hubungan bermakna terhadap kejadian instabilitas postural dengan OR 3,28 (1K 95% 1,25-8,63) p= 0,02 dan pada analisa multivariat dengan inetode backward regresi logistitik didapatkan nilai OR 3,22 (1K 95% 1,18-89,74) p = 0,02. Gangguan pendengaran merupalcan faktor intrinsik lokal yang mernpunyai hubungan bermalma terhadap instabilitas postural pada analisa bivariat dengan nilai OR : 3,95 (1,29-12,11) p= 0,02 dan pads analisa multivariat dengan ailai OR 3,22 (1,18-89,74) pr= 0,02. Osteoartritis genii, BPPV, gangguan penglffiatan dan kelemaban otot tungkai bawah hell m dapat dibuktilcan mempunyai hubungan bermakna dengan instabilitas postural pada penelitian ini.Simpulan : Prevalensi instabilitas postural pada penelitian ini sebesar 64,9%. Ganggaan pendengaran dan OA servikal menrpakan faktor instrinsik lokal yang mempunyai hubungan yang bermakna terhadap instabilitas postural. OA genii, BPPV, gangguan penglihatan dan kelemahan otot tungkai bawah belum dapat dibuktikan mempunyai hubungan bermakna dengan instabilitas postural pada penelitian ini.

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Backgrounds : Instability/falls is inability to maintain central anti gravity strength of supporting structures of the body (e.g. feet while standing) or to give adequate response to positional changes or static condition Prevalence of postural instability in US reached > 30% in population aged > 60 years old A Study conducted in RSCM by Handayani (2003) found the prevalence as high as 23.3%. -Risk factors that responsible for falls are intrinsic and extrinsic factors. Intrinsic factors consist of systemic (pneumonia, orthostatic hypotension, hyponatresmia, heart failure, urinary tract infection) and local factors (cervical OA, knee OA, BPPV, visual impairment, hearing impairment, lower lambs weakness). Falls may have mild complication like mild trauma to serious complications such as femoral fracture. By identifying risk factors of instability/falls earlier, we may prevent falls and its complications.

Objective = to determine intrinsic local factors and its relationship with instability/falls.

Methods : Cross sectional study on 97 elderly patients who fullfled inclusion criteria was conducted in RSCM from January to June 2005 in outpatient clinic, Geriatric Division FKUI 1 RSCM.

Results : From this study we found the prevalence of instability was 64.9%. The prevalence in female (52.3%) was higher than male (47.7%) patience According to age group, the highest prevalence was found in age group of > 80 years (75%). After bivariat analysis, we found cervical OA was intrinsic local factor which bad significant relation with incidence of postural instability with OR 3.28 (CI 95% 1.25-8.63); Bivariat and multivariate analysis of logistic regression using backward method we found OR 3.22 (Cl 95% 1.18-89.74); p= 0.02. Hearing impairment was local intrinsic factor that had significant relation with postural instability after bivariat analysis with OR 3.95 (Cl 95% 1.29-12_ l 1); p= 0.02 and multivariate analysis with OR. 3.22 (Cl 95% 1.18$9.74); p= 0.02. BPPV, knee OA, visual impairment and lower limb weakness had not been proven yet to have significant relation with postural instability in this study.

Conclusion : Prevalence of instability in thus study is 64.9%. Hearing impairment and cervical OA were intrinsic local factors that showed statistically significant relation with postural instability. Knee OA, BPPV, visual impairment, and lower limb weakness had not been proven to have significant relation with instability in this study."

"Latar Belakang. Densitas tulang yang rendah pada usia lanjut antara lain dipengaruhi oleh gangguan produksi dan metabolisme vitamin D, konsumsi alkohol, aktivitas fisik yang kurang, indeks massa tubuh (IMT) yang rendah, merokok yang berlebihan dan asupan kaisium yang rendah. Asupan kalsium, indeks massa tubuh dan kapasitas fisik diketahui berpengaruh pada densitas massa tulang.Korelasi antara asupan kaisium, IMT dan kapasitas fisik dengan densitas massa tulang masih kontroversi dan di Indonesia masih belum banyak diteliti khususnya di Panti Werda.Tujuan. Mengetahui korelasi asupan kalsium, IMT, kapasitas fisik dengan densitas massa tulang lumbal dan femur wanita usia lanjut serta gambaran densitas massa tulang lumbal dan femur, jumlah asupan kalsium, gambaran IMT,dan kapasitas fisik wanita usia lanjut di Panti Werda.Metodalogi. Studi potong lintang dilakukan pada wanita usia lanjut (?60 tahun) di Panti Werda. Subyek penelitian didapat dengan metode cluster random sampling dan yang sesuai dengan kriteria inklusi. Kriteria inklusinya adalah berusia 60 tahun atau lebih, jenis keiamin perempuan, masih dapat mandiri (ADL Barthel >16), dan bersedia ikut daiam penelitian. Dilakukan uji korelasi Pearson dengan aiternatif uji korelasi Spearman jika sebaran data tidak normal untuk mengetahui korelasi antara asupan kalsium, IMT dan kapasitas fisik dengan densitas massa tulang lumbal dan femur.Hasil. Selama periode Maret-Mei 2005 dilakukan penelitian terhadap 51 wanita usia lanjut di 2 Panti Werda Jakarta dan Bekasi. Median usia 70,5 (7,5) tahun, median asupan kalsium 283 gram/hari, IMT 22,28 (4,2) kg/m2 dan kapasitas fisik sebesar 4,8(1,6) Metz. Sedangkan rerata densitas tulang lumbal 0,842(0,I64) gramlcm2 dan densitas tulang femur 0,652(0,097) grarnlcm2. Didapatkan korelasi bermakna antara IMT dengan densitas massa tulang lumbal dan femur (r = 0,677 ; p = 0,000 dan r = 0, 508 ; p = 0,000), dan tidak didapatkan korelasi antara asupan kalsium dengan densitas massa tulang lumbal dan femur (r = 0,146 ; p = 0,308 dan r = 0,096 ; p = 0,501) dan kapasitas fisik dengan densitas massa tulang lumbal dan femur (r=0,016; p=0,913 dan r=0,143 dan nilai p=0,318).Kesimpulan. Didapatkan korelasi antara IMT dengan densitas massa tulang lumbal dan femur sedangkan korelasi antara asupan kalsium dan kapasitas fisik dengan densitas tulang lumbal dan femur wanita usia lanjut di Panti Werda belum dapat dibuktikan. Prevalensi densitas tulang lumbal dan femur wanita usia lanjut di panti werda Jakarta dan Bekasi berkurang sebesar 100% dan 99,8%., asupan kalsiumnya rendah, indeks massa tubuh normal dan kapasitas fisik tingkat menengah.

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Backgrounds

Low bone density in elderly may be caused by decreased production and metabolic dysfunction of vitamin D metabolism, alcohol consumption, decreased physical activity, low BMI, excessive smoking, and low calcium intake. Calcium intake, BMI and physical capacity had already been known to have influence on BMD. The correlation between calcium intake, BMI and physical capacity with BMD is still controversial and there is not much data in Indonesia regarding of it especially in elderly population.

Objective

To investigate the correlation between calcium intakes, body mass index and physical capacity with lumbar and femoral bone mass density of elderly women in nursing homes.

Methods

A cross sectional study was conducted in elderly women in nursing homes. Subjects were obtained by cluster random sampling method and fulfilled inclusion criteria Inclusion criteria were age more than 60 years old, female, and Barthel index >16. We have done Pearson correlation test with Spearman test as alternative if data distribution was not normal.

Result

A cross sectional study was conducted on 51 elderly women in 2 nursing homes in Bekasi between March and May 2005. Median age was 70.5 years, median calcium intake 283 gram/day, BMI 22.28 ± 42 kg/m2 and physical capacity 4.8 ± 1,6 metz. Mean of lumbar BMD was 0.842 ± 0.164 gram/cm2 and mean femoral BMD was 0.652 ± 0.097 gram/cm2. We found significant correlation between BMI and lumbar and femoral BMD (r).677;p).000 and r =508; p=0.000) and there was no correlation between calcium intake and lumbar and femoral BMD (rO.146;p-0.000 and r=0.096;p=0.50 l ). There were no correlation found between physical capacity and lumbar and femoral BMD (r).016;p 0.913 and r-0.143 and p O.318).

Conclusion

This study showed correlation between BMI and lumbar and femoral BMD. We found no correlation between calcium intake and physical capacity with femoral and lumbar BMD in elderly women in nursing homes in Jakarta and Bekasi. Prevalensi of lumbar BMD and femoral BMD of elderly women in nursing homes in Jakarta was decreased (100% and 99,8%).Calcium intake was low, BMI was normal and physical capacity was moderate level."

"Latar Belakang: Subyek diabetes melitus (DM) tipe 2 mengalami peningkatanrisiko fraktur akibat penurunan kekuatan tulang. Bone mineral density (BMD),sebagai parameter kuantitas tulang, tidak dapat menggambarkan fragilitas tulang pada subyek DM tipe 2 karena menunjukkan hasil yang normal atau meningkat dibandingkan dengan subyek bukan DM, sehingga peningkatan resiko fraktur pada subyek DM tipe 2 lebih disebabkan oleh penurunan kualitas tulang. Salah satu unsur penentu kualitas tulang adalah turnover tulang. Beberapa faktor yang berpengaruh pada turnover tulang, antara lain tumor necrosis factor-α (TNF-α) dan sclerostin. Kajian TNF-α dan sclerostin pada subyek DM perempuan pernah dilaporkan namun melibatkan subyek pascamenopause, sehingga tidak dapat dipisahkan efek TNF-α dan sclerostin terhadap turnover tulang.Tujuan: Penelitian ini bertujuan untuk mendapatkan profil kadar TNF-α dansclerostin serum pada subyek perempuan pramenopause DM tipe 2 dan bukanDM.Metode: Studi potong lintang dilakukan pada 80 subyek perempuanpramenopause yang terdiri dari ini 40 subyek DM Tipe 2 dan 40 subyek bukanDM. Data yang dikumpulkan antara lain: karakteristik subyek, riwayatpenggunaan obat-obatan, HbA1C, SGPT, kreatinin, dan eGFR. PemeriksaanTNF-α dan sclerostin serum dilakukan dengan metode enzyme-linkedimmunosorbent assay (ELISA).Hasil: Median (rentang interkuartil) kadar TNF-α serum pada subyek DM tipe 2[43,0 pg/mL (14,4-101,31)], lebih tinggi dibandingkan subyek bukan DM [23,86pg/mL (11,98-78,54)] namun perbedaan tersebut tidak bermakna (p=0.900).Rerata (simpang baku) kadar sclerostin serum pada subyek DM tipe 2 [132,05pg/mL (SB 41,54)], lebih tinggi bermakna (p<0.001) dibandingkan subyek bukan DM [96,03 pg/mL (SB 43,66)]. Tidak didapatkan hubungan antara kadar TNF-α dan sclerostin serum baik pada subyek DM tipe 2 (p=0,630) maupun subyek bukan DM (p=0,560).Kesimpulan: Subyek perempuan pramenopause DM tipe 2 memiliki kadar TNF-α serum lebih tinggi namun tidak bermakna dibandingkan dengan subyek bukan DM. Subyek perempuan pramenopause DM tipe 2 memiliki kadar sclerostin serum lebih tinggi bermakna dibandingkan dengan subyek bukan DM.

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Background: The subject of type 2 diabetes mellitus (T2DM) has an increased

risk of fracture due to a decrease in bone strength. Bone mineral density (BMD), as a parameter of bone quantity, cannot describe bone fragility in T2DM subjects because it shows normal or increased results compared to non-DM subjects, so an increased risk of fracture in T2DM subjects is due to a decrease in bone quality. One element that determines bone quality is bone turnover. Some factors that influence bone turnover include tumor necrosis factor-α (TNF-α) and sclerostin. TNF-α and sclerostin studies in female DM subjects have been reported but involve postmenopausal subjects, so that the effects of TNF-α and sclerostin cannot be separated from bone turnover.

Objective: This study aims to obtain a profile of serum TNF-α and sclerostin levels in premenopausal women with T2DM and non-DM.

Method: A cross-sectional study was carried out on 80 premenopausal female

subjects consisting of 40 T2DM subjects and 40 non-DM subjects. Data collected included: subject characteristics, history of drug use, HbA1C, SGPT, creatinine, and eGFR. Serum TNF-α and sclerostin examination was carried out by the enzyme-linked immunosorbent assay (ELISA) method.

Results: The median (interquartile range) of serum TNF-α levels in T2DM

subjects [43.0 pg/mL (14.4-101.31)], was higher than non-DM subjects [23.86

pg/mL (11.98 -78.54)] but the difference was not significant (p= 0.900). The mean (standard deviation) of serum sclerostin levels in T2DM subjects [132.05 pg/mL (SD 41.54)], was significantly higher (p< 0.001) than non-DM subjects [96.03 pg/mL (SD 43.66)]. There was no association between serum TNF-α and sclerostin levels in both T2DM subjects (p= 0.630) and non-DM subjects (p= 0.560).

Conclusions: Subjects of premenopausal women with T2DM had higher serum

TNF-α levels but were not significant compared to non-DM subjects. Subjects of premenopausal women with T2DM had significantly higher serum sclerostin

levels compared to non-DM subjects.

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