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ISSN 2320-5407 International Journal of penelitian lanjutan (2016), Volume 4, Terbitan 3, 506-513

Situs web jurnal: http://www.journalijar.com

JURNAL INTERNASIONAL
PENELITIAN LANJUTAN

PENELITIAN PASAL
Penentuan tingkat Serum Estrogen dan hubungannya dengan risiko Osteoporosis kalangan perempuan di
Mangalore.
1.
2.

Dr Fatima D'silva, 1Pinto Mrs Cleeta Aniline. 2

Utama dan Profesor, Departemen dari medis bedah perawatan, Institut Usha Nitte Keperawatan ilmu pengetahuan
alam, Universitas Nitte, Mangalore.
Asisten Profesor, Departemen dari medis bedah perawatan, Institut Usha Nitte Keperawatan ilmu pengetahuan
alam, Universitas Nitte, Mangalore.

Naskah Info

Abstrak

Naskah sejarah:

Tujuan dan sasaran:- Untuk memperkirakan risiko osteoporosis antara pra dan
pasca menopause wanita dan menentukan tingkat estrogen serum dan
hubungan dengan risiko osteoporosis.
Latar belakang:Osteoporosis dianggap salah satu yang paling umum
masalah kesehatan berlaku di India, berpose beban ekonomi yang besar di
negara kita. Menurut sebuah survei yang mengejutkan oleh Yayasan arthritis
India, diperkirakan bahwa 2050, setengah dari patah tulang di dunia akan
terjadi di India dan total terpengaruh populasi dengan osteoporosis dapat
Desain:-Deskriptif
co relasional desain.
sekitar 25 juta.
Metode:- Penelitian dilakukan di rumah sakit perawatan tersier di KSHEMA,
Mangalore di tahun 2015. 50 pra-menopause wanita berusia 25-45 tahun
dan 50 pasca menopause wanita berusia 46-65 tahun dipilih oleh purposive
sampling. Data dasar dan risiko osteoporosis dinilai di kedua kelompok yang
menggunakan alat penilaian risiko osteoporosis dan mereka beresiko dinilai
untuk tingkat estrogen serum.
Hasil:- Mayoritas wanita pasca menopause berada di risiko sedang
osteoporosis dan sempat mengalami penurunan kadar estrogen serum dibandingkan pra
wanita menopause. Hubungan negatif yang ditemukan antara risiko
osteoporosis dan serum tingkat estrogen. Risiko osteoporosis adalah dua kali
lebih antara para wanita dengan kadar estrogen serum < 45pg/ml.
Kesimpulan:-Risiko osteoporosis meningkat dengan penurunan serum
tingkat estrogen. Sehingga menciptakan kesadaran tentang pentingnya
pemeriksaan osteoporosis dan pentingnya diet selama periode
pasca-menopause merupakan langkah penting untuk mencegah komplikasi
lebih lanjut.

Menerima: 18 Januari 2016

Final diterima: 10 Februari 2016
Diterbitkan Online: Maret 2016

Kata kunci:

Risiko osteoporosis, tingkat

estrogen Serum, kesadaran,
pengetahuan, Premenopausal,
wanita postmenopause.

*Sesuai penulis
Dr Fatima D'silva.

Salin kanan, IJAR, 2016. Semua Hak, milik.

Pendahuluan:Sistem muskuloskeletal membentuk bagian penting dari tubuh manusia. Hilangnya kepadatan tulang dapat
menyebabkan tulang kelemahan dan akhirnya menyebabkan patah tulang. Menurut Lane, JM et al.(2006),
Osteoporosis adalah penyakit luas metabolik tulang yang ditandai dengan penurunan tulang tulang massa dan miskin
kualitas. Ini menyebabkan peningkatan frekuensi patah tulang pinggul, tulang belakang, dan pergelangan tangan.
perempuan
diadalah
seluruh
1 masalah
dunia. kesehatan masyarakat global saat ini mempengaruhi lebih dari 200 juta
Osteoporosis
WHO survei menyatakan bahwa Osteoporosis diperkirakan untuk mempengaruhi sekitar sepersepuluh dari wanita
berusia 60, seperlima dari wanita berusia 70, dua-perlima dari wanita berusia 80 dan dua-pertiga dari wanita berusia
90. Untuk tahun 2000, ada sekitar 9 juta yang baru adalah 1,7 juta patah tulang osteoporosis, yang 1,6 juta berada di
pinggul, di lengan dan 1,4 juta klinis patah tulang belakang. Eropa dan Amerika menyumbang 51% dari semua ini

506
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ISSN 2320-5407 International Journal of penelitian lanjutan (2016), Volume 4, Terbitan 3, 506-513
patah tulang, sementara sebagian besar sisanya terjadi di wilayah Pasifik Barat dan Asia Tenggara. Dikatakan bahwa dengan
.
2050, kejadian di seluruh dunia patah tulang pinggul pada pria diproyeksikan meningkat sebesar 310% dan 240%
2
pada wanita
Menurut Organisasi Kesehatan Dunia (WHO) dan Yayasan Osteoporosis internasional (IOF), osteoporosis kedua
hanya untuk penyakit kardiovaskular, sebagai masalah kesehatan global. Sekitar 300 juta orang di India menderita
osteoporosis dan hal ini berspekulasi bahwa dalam dekade berikutnya sebanyak 50% penduduk India akan menjadi
korban untuk kondisi ini. Osteoporosis juga tiga kali yang biasa pada laki-laki India dibandingkan dengan mereka
rekan-rekan di tempat lain di dunia.
3
Penyakit ini disebut sebagai diam penyakit yang sering tetap asimtomatik sampai tulang patah terjadi. Meskipun
prevalensi tinggi dan konsekuensi medis serius osteoporosis, banyak di pasien risiko tidak disaring dan didiagnosis
sebelum gejala terjadi. Meskipun prevalensi dan konsekuensi yang merugikan kehilangan tulang dan patah tulang,
pasien dengan osteoporosis terus di bawah didiagnosis dan di bawah diperlakukan. Hal ini penting untuk para
profesional perawatan kesehatan untuk mengidentifikasi risiko tinggi osteoporosis dan menerapkan strategi
pencegahan. Para profesional perawatan kesehatan berada dalam posisi unik untuk meningkatkan diagnosis dan
manajemen kondisi klinis ketika mereka melaksanakan holistik dan multi faktorial pendekatan ini.

Metode:Belajar desain dan pengaturan:Desain relasional co deskriptif yang dilakukan di rumah sakit pendidikan perawatan tersier 1200 tempat tidur untuk
memperkirakan risiko osteoporosis pra dan pasca menopause wanita dan menentukan tingkat estrogen serum dan
hubungannya dengan risiko osteoporosis. Penelitian telah disetujui oleh Komisi etika kelembagaan (Ref No. NUINS /
CON / NU / IEC/2012-2013 tertanggal 21/09/2011). Ditulis izin Diperoleh dari medis Inspektur rumah sakit dipilih
persetujuan Diperoleh dari peserta setelah tepat penjelasan tentang tujuan dan kegunaan studi. Kerahasiaan terjamin
untuk para peserta.
Studi sampel:Lima puluh premenopause perempuan antara usia 25 - 45 tahun dan lima puluh wanita postmenopause antara 46
tahun-65 dipilih melalui teknik purposive sampel. Kriteria inklusi: Post Menopause wanita berusia lebih dari 45 tahun
dan kurang dari 65 tahun; Wanita premenopause atas 25 tahun dan di bawah 45 tahun; Para wanita yang bersedia
untuk berpartisipasi dalam studi. Kriteria pengecualian adalah sebagai berikut: wanita dengan osteoporosis yang ada;
HRT atau Kontrasepsi Oral; wanita hamil; wanita dengan patah tulang atau osteoporosis yang sudah ada.
Pengumpulan data:St
St
Studi percontohan dilaksanakan dari
tanggal 1 September-31
Oktober 2014
Instrumen berikut digunakan untuk pengumpulan data: LKM tersebut proforma demografis terdiri dari 7 pertanyaan
termasuk usia di tahun, status pendidikan, pekerjaan, pendapatan bulanan, kebiasaan makanan, dan sumber informasi;
Alat penilaian risiko Osteoporosis yang terdiri dari 14 pertanyaan berkaitan dengan faktor-faktor risiko yang dapat
menyebabkan osteoporosis dan total score berkisar antara 0-23. Nilai lebih lanjut sewenang-wenang diklasifikasikan
sebagai: tidak ada risiko-0; Rendah risiko-1-7; Moderat risiko-8-14 dan tinggi risiko-15-23.An Estradiol kit ini
digunakan untuk mengukur kadar serum Estrogen perempuan yang berada pada risiko osteoporosis
Analisis data:Versi SPSS XVI digunakan untuk menganalisis data. Variabel-variabel demografik dan tingkat risiko osteoporosis
dianalisis menggunakan frekuensi dan persentase. Perbandingan tingkat risiko osteoporosis antara pra dan pasca
menopause wanita dianalisis menggunakan 'independen t test'. Hubungan antara tingkat risiko osteoporosis dan
tingkat estrogen dinilai menggunakan Karl Pearson korelasi co efisien. Untuk memastikan keabsahan konten, alat
bersama dengan pernyataan masalah, tujuan, hipotesis, operasional definisi dan daftar kriteria yang diajukan untuk
lima ahli dari bidang perawatan bedah medis dan dokter dari Departemen ortopedi. Data akhir yang diterjemahkan
oleh verbatim dari bahasa Inggris ke Kannada oleh ahli bahasa.

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ISSN 2320-5407 International Journal of penelitian lanjutan (2016), Volume 4, Terbitan 3, 506-513

Hasil :Bagian 1: Deskripsi karakteristik sampel

Frekuensi dan persentase perempuan Menurut karakteristik demografis mereka disajikan dalam
Tabel 1:
Tabel 1: Distribusi frekuensi dan persentase perempuan pra dan Postmenopausal menurut mereka
Karakteristik demografis .
n = 100
SLNo.
Karakteristik sampel
Pra-menopause
Post Menopause
1.

UMUR DI TAHUN

1
7
32
10

2
14
64
20

2.

25-30
31-35
36-40
41-45
STATUS PENDIDIKAN
Buta huruf
Pendidikan tinggi
utama wisuda

4
26
11
6
3

8
52
22
12
6

24
16
2
5
3

48
32
4
10
6

86
14

40
10

80
20

10
90

8
42

16
84

48
30
12
10

28
14
8
0

56
28
16
0

54
18
16

31
4
10

62
8
20

12

10

Lain-lain
3.
4.
5.

6.

PENDUDUKAN
Menetap
43
Aktif
7
KEBIASAAN MAKANAN
Vegetarian
5
Campuran
45
PENDAPATAN (dalam rupiah)
< 5000
24
5001-10,000
15
10001-15.000 >
6
5
15.000
SUMBER
DARI
INFORMASI
Media massa
27
9
pendidikan kontak
dengan Kesehatan
8
personil
Lain-lain
6

UMUR DALAM
f
TAHUN
45-50
16
51-55
9
56-60
14
61-65
11

%
32
18
28
22

-1 Meja di atas menunjukkan bahwa mayoritas pra-menopause wanita 32 (64%) adalah dalam kelompok umur 36 - 40 tahun
dan 16 (32%) wanita pasca menopause dalam kelompok usia 45 - 50 tahun. Distribusi berbasis sampel
pada kebiasaan makanan mengungkapkan bahwa sebagian besar pra dan pasca menopause 45(90%) dan 42(84%)
memakan campuran diet masing-masing sedangkan 5(10%) dan 8(16%) adalah vegetarian.
Bagian 2: Risiko osteoporosis kalangan pra dan pasca menopause wanita
Alat penilaian risiko osteoporosis digunakan untuk menilai risiko status pra dan pasca menopause wanita untuk
osteoporosis) -2 tabel )

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Table-2 Frequency and percentage distribution of Pre and Postmenopausal women based on their risk factors
n=100
Risk factors
Pre menopausal
Post menopausal
f
%
f
%
Age
I am under 40 years old
40
80
I am 40 years old or older
10
20
50
100
Family history of osteoporosis
Yes
14
28
19
38
No
36
72
31
62
Menopause
Not gone through menopause
50
100
Gone through menopause after the age of 35
70
45 years
Gone through menopause before the age 15
30
of 45 years
End of menstruation other than
menopause
I have not stopped menstruating
50
100
I have stopped menstruating normally
38
76
I have stopped menstruating for other
12
24
reasons( removal of ovaries)
Hormonal variations
My periods are / were regular
31
62
40
80
My periods are / were irregular
19
38
10
20
Smoking
I never smoke
49
98
49
98
Yes, I smoke
1
2
1
2
Alcohol
No, I do not drink alcohol
I, Drink alcohol occasionally
I, Drink excessively
Dietary habits
My food includes milk and vegetables
My food dont include milk and
vegetables
Gastro- intestinal disorders
I do not have symptoms of gastritis
I do have symptoms of gastritis
Exercise
I exercise regularly
I exercise occasionally
I get little or no exercise
Immobility
Not had any periods of immobility
Had periods of immobility
Medications
I dont take drugs which would
increase risk of osteoporosis
Yes, I take drugs which would increase
risk of osteoporosis
Chronic disease

45
4
1

90
8
2

48
2
-

96
4
-

37
13

74
26

37
13

74
26

42
8

84
16

40
10

82
18

22
19
9

44
38
18

24
18
8

48
36
16

25
25

50
50

22
28

44
56

40

80

39

78

10

20

11

21

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I dont have any of the chronic diseases

31
62
29
58
Yes, I have chronic disease
19
38
21
42
Hyperthyroidism
I
have
been
diagnosed
with 2
4
4
8
hyperthyroidism
No, I dont have hyperthyroidism
48
96
46
94
Hyperparathyroidism
I
have
been
diagnosed
with 6
12
hyperparathyroidism
No, I dont have hyperparathyroidism
50
100
44
88
Caffeine drink
I mostly drink beverages with no caffeine 37
74
36
72
Yes, I drink lot of caffeine, colas,
13
26
14
28
coffee etc
Height
I have not lost my height after the age of 50
100
47
94
40 years
I have lost my height of 3 cms after the 3
6
age of 40 years
Sunlight exposure
I spend outdoors more than 10 minutes
29
58
30
60
I spend outdoors less than 10 minutes
11
22
12
24
I do not spend time outdoors
10
20
8
16
Table- 2 above shows that 14(28%) of the pre menopausal and 19(38%) of the post menopausal had family history
of osteoporosis. It is also observed that 38(76%) of the post menopausal women attained menopause through normal
process were as 12(24%) of them due to the removal of ovaries. 22 (44%) of the pre menopausal and 24(48%) of the
post menopausal women exercised regularly, 2 (4%) of the pre menopausal and 4(8%) of the post menopausal had
hyperthyroidism. 6(12%) the post menopausal had hyperparathyroidism.
Majority of the pre and post menopausal women 37 (74%) and 36(72%) respectively did not consume excessive
caffeine and beverages nor majority 49(98%) had the habit of smoking.

Percentage

Risk for Osteoporosis

96%

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%

64%

36%

Pre Menopausal
Post Menopausal

4%
High Risk

Moderate Risk

Low Risk

Level of Risk
Fig 1: Bar Diagram depicting distribution of women based on level of risk for osteoporosis

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Fig 1- above shows that out of 100 pre and post menopausal women, majority of the premenopausal 48 (96%) were
at low risk when compared to the post menopausal women where 18(36%) were at moderate risk of getting
osteoporosis.
Table (3a): Comparison of the serum estrogen level in pre and post menopausal women
n =50+50
Group
Mean
S.D
Mean
df
t Value
p value
difference
51.72
16.44
12.23
98
4.321
0.001
Pre-menopausal
39.48
11.43
Post -menopausal
t(tab)(98) = 1.984, p<0.005
Table- 3a) shows that the mean score of the pre menopausal estrogen level is 51.72 pg/ml 16.44 and mean of post
menopausal estrogen level is 39.48 pg/ml 11.43 and the mean difference is 12.23. There was a significant
difference in the estrogen level between the pre and post menopausal women (p<.001)
Table -3b) Comparison of the serum estrogen level with respect to risk of osteoporosis
n=100
Group
Mean
S.D
Mean
df
t Value
p value
difference
46.67
16.18
Low risk
5.361
98
1.772
0.08
41.30
10.84
Moderate risk
t (tab)(98) = 1.984, p>0.05
Table -3b) shows that the mean score of the estrogen level of low risk group of the pre and post-menopausal women
level is 46.67pg/ml16.18 and mean of estrogen level of moderate risk group of pre and post-menopausal women is
41.30pg/ml10.84 and the mean difference is 5.361. There was no significant difference in the estrogen level and the
risk of osteoporosis among the pre and post menopausal women (p>.005).
Table 4a): Correlation between the level of risk and the serum estrogen level
n=50+50
SI No:
Variables
Pearson correlation
p value
1.
Level of risk and serum estrogen levels
- 0.254
0.011
Table 4a) above reveals a negative relation between the level of risk and serum estrogen level.
Table 4(b): Odds ratio for the serum estrogen levels of post-menopausal women with the level of risk

SI No:
1.
2

Categorized scores of serum

estrogen level
<45 pg/ml
>45 pg/ml

Low risk

Moderate risk

OR

95% CI

12
20

6
12

1.5 6

0.3574.038

]
The odds ratio in Table 4b) above shows that though there is no statistical significance the risk of getting
osteoporosis is almost two times more among the women with serum estrogen level <45pg/ml comparable to the
women with serum estrogen level > 45pg/ml. However it can be inferred that as the serum estrogen level decreases
the chance of getting osteoporosis increases.

Discussion:Sample characteristics:In the present study majority of the post menopausal women 16 (32%) were in the age group of 45- 50 years. A
study conducted by Aylin, Ozturk & Merdiye, Sendir (2011) to evaluate the osteoporosis knowledge and selfefficacy of female orthopaedic patients showed the mean age of the patients was596 129 years .4
Similar findings were seen in a study conducted by Allali, F et al (2010) to assess educational level and osteoporosis
risk in postmenopausal Moroccan women. Out of 356 women selected the mean age was 58.97.7 years .5

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Majority of the premenopausal women 27(54%) and31 (62%) of postmenopausal women had information on
osteoporosis through mass media, 9(18%) and4 (8%) through academic education, 8(16%) and 10(20%) from the
health personnels, 6(12%) and5 (10%) through other sources respectively. A study conducted at Malaysia showed
similar findings where, 55.7% obtained information about Osteoporosis from newspapers and 46.4% from
magazines.6
Section 2: Risk of osteoporosis among the pre and post menopausal women:Majority of the premenopausal 48 (96%) were at low risk and 2(4%) were at moderate risk when compared to the
post menopausal women 32 (64%) were at low risk, 18(36%) were at moderate risk of getting osteoporosis.
Considering the risk factors, 14(28%) of the pre menopausal and 19(38%) of the post menopausal had family history
of osteoporosis. In both the groups 13 (26%) of them consumed inadequate milk and vegetables, 9(18%) of pre and
8(16%) of post menopausal women got little or no exercise. 13(26%) of the pre and 14(28%) of the post menopausal
women consumed excessive caffeine and beverages.
A study conducted at Malaysia by Swan, Sim Yeap et al (2010) showed similar finding with the above study, which
identified 97.1% of the samples with low calcium intake, 87.8% with lack of exercise, 80.0% with family history of
Osteoporosis, and 75.8% with postmenopausal status .6
A study conducted among the African-American and Hispanic women by S. E, Geller and R, Derman (2001)
identified behaviors such as inadequate physical activity, inadequate calcium intake, cigarette smoking, and long- term
steroid use as risk factors for osteoporosis.
Section 3: Serum estrogen level in women with and without menopause:The mean score of the pre menopausal estrogen level was 51.72 pg/ml 16.44 and mean of post
menopausal estrogen level was 39.48 pg/ml 11.43. Though there was a significant difference in the estrogen level
between the pre and post menopausal women, statistically there was no significant difference seen with the serum
estrogen levels and risk for osteoporosis. Supportive to this finding a prospective study conducted in a cohort of
150 women by Henry, G. Burger et.al (2013) revealed decreasing estrogen levels and rising FSH levels
(Follicular stimulating hormone) before 1-2 years of achieving menopause. The study concluded that there is no
single reliable hormonal marker of menopausal status for an individual woman.
Section 4: Correlation between the level of risk and the serum estrogen levels:The present study findings revealed a negative relation between the risk of osteoporosis and serum estrogen levels.
Similar findings were found in a study conducted by Bruce,Ettinger et al (2013)to evaluate the skeletal effects of
endogenous serum estradiol, bo ne mineral density (BMD) at the calcaneus and radius (single photon
absorptiometry) and at the hip an d spine (dual x-ray absorptiometry) in 274 women aged 65 yr. Lateral radiographs
of
the thoracic and lumbar spine were also taken, and serum was assayed for estradiol. Those who had estradiol
levels from 1025 pg/mL had 4.9%, 9.6%, 7.3%, and 6.8% greater BMD at total hip, calcaneus, proximal radius, and
spine than those with levels below 5 pg/mL.Vertebral deformities were less prevalent among women whose
estradiol level exceeded 5 pg/mL. The study concluded that physiologically low estradiol has a salutary effect on the
skeleton in elderly women, possib ly by reducing skeletal remodeling.

Conclusion:Osteoporosis is a preventable and treatable condition. Hence, care should be aimed at providing strategies to prevent
the disease and resulting injuries from the disease. The present study has revealed the importance of early screening
and increasing awareness as the key to prevention and early detection of osteoporosis. Many individuals are unaware
of the risk of osteoporosis or are uninformed of the preventive behaviors .Thus nurses who work in almost all
settings like hospital, nursing homes, community etc. play an active role in promotion of health, preventing illness
and disability of both individual and communities.
Acknowledgements:I immensely thank the esteem members of Nitte University for funding this project.
Author contributions:The authors have contributed to the design of the study and the preparation and critical revision of the manuscript
and agree to be accountable for all aspects of the study

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Disclosure:The findings from this study are those of the author and do not reflect the views of the funding body. The authors
reports no conflict of interests in this work

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