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"ABSTRAKLatar Belakang: Penderita Diabetes Melitus (DM) mengalami peningkatan resiko fraktur akibat penurunan kualitas dan kekuatan tulang. Bone Mineral Densitometry tidak dapat menggambarkan fragilitas tulang pada pasien DM tipe 2 (DMT2) karena menunjukkan hasil yang normal atau meningkat. Penelitian sebelumnya menunjukkan terdapat penurunan penanda formasi tulang (P1NP) pada perempuan pramenopause dengan DMT2 dibandingkan dengan bukan DM. IGF-1 dan sclerostin adalah faktor yang mempengaruhi diferensiasi dan maturasi osteoblast dalam formasi tulang dan saat ini belum diketahui profilnya pada perempuan pramenopause dengan DM. Tujuan: Untuk mengetahui dan membandingkan kadar IGF-1 serum dan sclerostin serum perempuan pramenopause dengan DMT2 dan bukan DM. Metode: Studi potong lintang, dilakukan pada Agustus 2018 dan melibatkan 80 perempuan pramenopause yang terdiri dari 40 subjek DMT2 dan 40 bukan DM. Pemeriksaan IGF-1 serum dan Sclerostin serum dilakukan dengan metode enzymelinked immunosorbent assay (ELISA). Hasil penelitian: Median (rentang interkuartal) kadar IGF-1 serum pada pasien DMT2 lebih rendah tidak bermakna dibandingkan dengan kelompok bukan DM (40,6 (11-110) ng/ml vs 42,75 (10-65) ng/ml, p=0.900). Rerata kadar sclerostin serum pada kelompok DMT2 lebih tinggi bermakna dibandingkan kelompok bukan DM (132.05 (SB 41.54) ng/ml vs. 96.03 ng/ml (SB 43.66) (p<0.001). Kesimpulan: Tidak terdapat perbedaan kadar IGF-1 serum antara perempuan pramenopause DMT2 dan bukan DM. Terdapat perbedaan bermakna sclerostin serum antara perempuan pramenopause dengan DMT2 dan bukan DM.

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ABSTRACTBackground: Diabetes mellitus (DM) patients are at increased risk for fracture due to the decrease in bone quality and strength. Bone Mineral Densitometry (BMD) measurement in T2DM cannot depict bone fragility (T2DM) because they are shown to be normal or increased results. Previous studies have shown a decrease in markers of bone formation (P1NP) in premenopausal women with T2DM compered non-DM. IGF-1 and sclerostin are factors that influence the differentiation and maturation of osteoblasts in bone formation and their profiles are not currently known in patients with premenopausal women with diabetes. Objective: To determine and compare serum IGF-1 and serum sclerostin levels between premenopausal women T2DM and non-DM. Method: A cross-sectional study was conducted in August 2018 and involved 80 premenopausal women consisting of 40 DMT2 and 40 non-DM subjects. Serum IGF-1 and serum sclerostin were examined using an enzyme-linked immunosorbent assay (ELISA) method. Results: Median (interquarter range) serum IGF-1 in T2DM is 40.6 ng/ml (11-110 ng/ml) vs. 42.75 ng/ml (10-65 ng/ml) in non-DM (p=0.900). Mean serum sclerostin level in T2DM is 132.05 ng/ml (SB 41.54 ng/ml) vs. 96.03 ng/ml (SB 43.66 ng/ml) in not DM (p<0.001). Conclusion: There was no difference in serum IGF-1 levels between premenopausal women with T2DM and non-DM. There were significant differences in serum sclerostin between premenopausal women with T2DM and non-DM."

"Osteoporosis is a metabolic bone disease and is characterized by low bone mass and microstructur deterioration of the bone which leads to increased risk of fracture. Biomarker of bone metabolism can be seen as beginning of bone loss and first detection before imbalanced bone turnover comes. Biomarker of bone formation as serum bone alkaline fosfatase, osteocalcin (OC), procollagen type I, and biomarker of bone resorption as urine pyridinoline (Pyd) and deoxypyridinoline (Dpd) crosslinks, hydroxyprolin. The simultanious examination of serum OC and urine Pyd or Dpd as a very good screening test for determination of bone imbalanced at the moment of the menopausal of the beginning of the pasca menopausal. Saliva as a potential diagnostic fluid for the assessment of osteoporosis biomarker concentrations. The study found elevated three classic warning signs for osteoporosis as OC, Dpd and II 6 in the saliva of sheep without ovaries, which were similar to the levels of signs found in their blood and urine. Expectations, that the test may become available within five years and one day the test may be able to be performed at home like pregnancy test. Osteoporosis biomarker in saliva suggested detected of bone mass density easier. Beside that can used as a metode of early diagnostic and as a monitor therapy that as salinity of the examinations of bone mass on radiology."

"ABSTRAKLatar belakangOsteoarthritis (OA) adalah salah satu penyakit yang paling tua dalam sejarah manusia. Meskipun demikian, persoalan OA sekarang menjadi jauh lebih banyak, Iebih nyata dan lebih bermakna dengan semakin bertambah panjangnya usia.Hasil pengobatan terhadap penyakit ini sampai sekarang masih belum memuaskan oleh karena patogenesisnya belum dapat dipahami dengan baik. Pendekatan epidemiologik yang biasa untuk mengetahui patogenesis OA sebagai suatu keseluruhan dipandang masih belum cukup. Hal itu masih perlu dilengkapi dengan penelitian patogenesis OA pada populasi tertentu, misalnya pada diabetes melitus.Meskipun OA dan diabetes melitus merupakan penyakit yang sering dijumpai, terutama pada orang lanjut usia, kaitan antara kedua keadaan ini belum banyak terungkap. Berbeda dengan komplikasi mikroangiopati, makroangiopati atau neuropati, komplikasi muskuloskeletal diabetes melitus, khususnya OA, kurang dibicarakan. Tak mengherankan kalau dalam konggres International Diabetes Federation yang terakhir (1991), OA telah digolongkan sebagai "overlooked diabetes complications".OA timbul lebih sering, lebih awal dan menimbulkan keluhan yang lebih nyata pada orang-orang dengan diabetes melitus. Prevalensi DISH (Diffuse Idiopathic Skeletal Hyperostosis), salah satu bentuk simpangan OA, pada penderita diabetes melitus adalah 115-13,5%, yang hampir dua kali dari Prevalensi pada non diabetes. Sebaliknya, intoleransi glukosa juga ditemukan jauh lebih banyak (sampai 23%) diantara penderita-penderita DISH. Dua penelitian radiografi menemukan bahwa frekuensi osteofit pada kaki dan tangan dijumpai Iebih sering pada diabetes daripada non diabetes.Penelitian klinik dan radiografik yang dilakukan di RS.Dr. Saiful Anwar Malang juga menemukan kaitan yang serupa. Tanda-tanda radiografik perubahan degeneratif sendi kaki ditemukan pada 15.1% diantara 172 penderita diabetes melitus (usia 32-55 tahun) dibanding pada 8.7% kontrol non diabetes sesuai jenis kelamin dan umumya. Diantara penderita diabetes melitus yang berobat jalan terdapat 50% penderita dengan artrosis (1eher) dibanding 23% pada kontrol.Hasil penelitian-penelitian klinik tersebut disokong oleh hasil penelitianpenelitian pada binatang percobaan. Diskus intervertebra tikus diabetes terbukti mengalami perubahan-perubahan degeneratif yang lebih cepat daripada tikus non diabetes. Disamping itu, spondilosis deforman timbul lebih berat pada tikus diabetes. Pada tulang rawan sendi tikus diabetes timbul perubahan enzim-enzim penghancuran proteoglikan dan kolagen yang dapat dinormalkan kembali dengan tranplantasi pankreas. Pada jaringan tersebut juga terdapat perubahan komposisi kolagen dan proteoglikan matrik.Adanya kaitan antara diabetes dan OA menyokong konsep tentang peranan faktor metabolik dan hormonal pada patogenesis OA. Hormon pertumbuhan (HP), insulin, estradiol dan faktor pertumbuhan seperti insulin-1 (FPI-1) terbukti mempunyai pengaruh nyata pada metabolisme tulang rawan sendi. Adanya perubahan aktivitas hormon tersebut dapat berkaitan dengan patogenesis OA. Meningkatnya HP pada akromegali merangsang pembentukan tulang baru dan hipertropi tulang rawan sendi yang menyerupai gambaran OA.Bagaimana patogenesis OA sebagai salah satu komplikasi menahun diabetes melitus dapat dijelaskan dengan konsep 2 jalur umum patogenesis OA. kerusakan tulang rawan sendi dan reaktivasi pertumbuhan tulang rawan sendi.

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ABSTRACT

Introduction

It is known that diabetes mellitus (DM) increases the risk of osteoarthritis, however the factors play important role in its pathogenesis has not established yet. Osteoarthritis is characterized by joint cartilage degradation and bone formation.

Many studies reported that the duration of DM and the metabolic control in DM become important factors in the development of chronic diabetic complications. It is suggested that some hormones are increased in diabetics, such as insulin, growth hormone (OH), insulin like growth factor-1 (IGF-1) and estradiol. Those hormones are known to promote metabolic action in bone and cartilage joints.

Therefore, some factors that influence the pathogenesis mechanism in DM increased the risk of OA, of which are the level of insulin, GH, 1GF-1 and estradiol serum concentrations, the duration of diabetes and the severity of hyperglycemia.

It is hypothized that the duration of DM and good metabolic control could increase the risk of QA in diabetics. There is a basic concept that the level of insulin, HP1 FPI-1 and estradiol could be risk factors for OA among the diabetics.

The aim of this research is to determine the role of the duration of suffering DM, metabolic control, concentration of insulin, GH, IGF-1 and estradiol in the occurrence of OA among the diabetics.

Material and methods

This study was conducted in the Metabolic and Endocrine clinic of the Dr. Saiful Anwar Hospital in Malang during 1988 up to 1991. Sampling was "purposive" collected among the diabetics (n= 372) who has non obese non insulin dependent diabetes, average body mass index (BMI) = 22.56 + 4.11, ages more than 44 years old, average age= 59.13 + 7.96 years, and onset of DM is older than 30 years.

A case control study to the duration of DM (more or less than 8 years) and the metabolic control was used on this study. Good metabolic control was determined by the average of fasting blood glucose < 120 mg/dl, the compliance of patients and the blood level of fructosamine (< 3 mmol/l). The role of each risk factor was shown by odds ratio (OR).

Radiography of the knee was taken in all samples, to find out knee osteoarthritis (KOA), using diagnostic criteria and gradation of Kellgreen and Lawrence , besides getting the clinical symptoms among the diabetics based on the ARA criteria.

To evaluate the risk of OA in diabetics, the similar study was conducted among the 172 samples non obese (ages and BMI matched). The exclusion criteria are other joint diseases than KOA, obesity, history joint injury and lower extremities paralyses.

Radio immuno assays was measured among the 30 cases of KOA, 30 cases without KOA, for good and poor metabolic control. The assays included the concentration of blood insulin, GH, IGF-1 and estradiol. The results of concentration of serum hormones are statistically analyzed by ANOVA.

In this study was also observed the possible correlation between KOA and high level of insulin related to the complication of diabetes, such as hypertension, Coronary Heart Disease and lipid disturbance. The clinical finding was determined to see the possible correlation KOA in diabetics and the peripheral neuropathy and also diabetes retinopathy."