ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
FİZİKSEL TIP VE REHABİLİTASYON
BİLİMLERİ DERGİSİ
www.jpmrs.com
Kayıtlı İndexler


ORIJINAL ARAŞTIRMA

Fibromiyalji Tanılı Hastalarda B12 Vitamini, D Vitamini, Magnezyum Düzeyleri ile Düşme Riski İlişkisi
The Relationship Between Vitamin B12, Vitamin D, Magnesium Levels and Fall Risk in Patients with Fibromyalgia
Received Date : 04 Aug 2022
Accepted Date : 06 Sep 2023
Available Online : 11 Sep 2023
Doi: 10.31609/jpmrs.2022-92756 - Makale Dili: TR
J PMR Sci 2024;27(1):1-10.
ÖZET
Amaç: Fibromiyalji sendromu (FMS) hastalarında fonksiyonelliği etkileyen semptomlardan biri de denge kaybıdır. Bu çalışmada, FMS tanılı kadın hastalarda düşme riski ile B12 vitamini, D vitamini, magnezyum düzeyleri ve bazı klinik özelliklerin ilişkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya FMS tanılı, 18-60 yaş arası, ardışık 60 kadın hasta ve 60 sağlıklı kadın gönüllü alındı. Katılımcılara ağrı için görsel analog skala, hastalık aktivitesi için Fibromiyalji Etki Anketi, düşmenin etkisi için Düşme Etkinlik Ölçeği ve depresyon için Beck Depresyon Anketi uygulandı. Postürografi cihazı ile kantitatif olarak düşme riskleri belirlendi. Son olarak; fibromiyalji tanılı grup ile kontrol grubu arasında ve ilaveten fibromiyaljili grubun kendi içinde alt gruplar oluşturularak düşme riski, etkisi, sayısı, B12, D vitamini ve magnezyum düzeyleri ve çeşitli klinik özellikler açısından istatistiksel karşılaştırmalar yapıldı. Bulgular: Çalışmamızda FMS olan kadınların, kontrol grubuna göre düşme risk indekslerinin (medyan; %44-%28), düşme sayısı (medyan; 2-1) ve etkisinin (medyan; 22-11,5) anlamlı olarak yüksek olduğu tespit edildi. FMS grubunda parestezi mevcudiyeti ve FMS için ilaç kullanımı daha yüksek düşme riski (p: 0,029) ve etkisi (p: 0,012) ile ilişkili bulundu. Yine FMS grubunda beden kitle indeksi artışı daha yüksek düşme riski (p: 0,019) ile ve yaşın ileri olması ise daha yüksek Düşme Etkinlik Ölçeği skoru (p<0,001) ile ilişkili bulundu. Sonuç: FMS hastalarında düşme riskinin topluma göre daha yüksek olduğu, ilaç kullanımının riski daha da artırdığı ve B12 vitamini, D vitamini ve magnezyum düzeylerinin düşme riski ile direkt ilişkili olmadığı tespit edildi. Bu sonuçlar ile FMS hastalarında denge fonksiyonları için egzersiz programları dâhil ek önlemlerin alınması ve denge ile ilgili çalışma sayısının artırılması gerektiği ortaya konuldu.
ABSTRACT
Objective: One of the symptoms affecting functionality in patients with fibromyalgia syndrome (FMS) is loss of balance. In this study, it was aimed to evaluate the relationship between fall risk and vitamin B12, vitamin D, magnesium levels and some clinical features in female patients with FMS. Material and Methods: Sixty consecutive female patients diagnosed with FMS, aged 18-60 years, and 60 healthy female volunteers were included in the study. Participants were administered the visual analog scale for pain, the Fibromyalgia Impact Questionnaire for disease activity, the Fall Activity Scale for the effectiveness of falling, and the Beck Depression Questionnaire for depression. The risk of falling was determined quantitatively with the posturography device. Finally; Statistical comparisons were made between the fibromyalgia group and the control group, as well as within the fibromyalgia group, in terms of fall risk, effectiveness, number, B12, vitamin D and magnesium levels, and various clinical features. Results: In our study, it was determined that the fall risk indexes (median; 44%-28%), number of falls (median; 2-1) and effectiveness (median; 22- 11,5) of women with FMS were significantly higher than the control group. Presence of paresthesia and drug use for FMS were associated with higher fall risk (p: 0,029) and efficacy (p: 0,012) in the FMS group. Again, in the FMS group, an increase in body mass index was associated with a higher risk of falling (p: 0,019), and older age was associated with a higher fall efficiency scale score (p<0,001). Conclusion: It was determined that the risk of falling is higher in FMS patients than in the general population, drug use increases the risk even more, and vitamin B12, vitamin D and magnesium levels are not directly related to the risk of falling. With these results, it was revealed that additional measures, including exercise programs, should be taken for balance functions in FMS patients and the number of studies on balance should be increased.
REFERENCES
  1. Çelenay ŞT, Külünkoğlu BA, Küçükşahin O. [Evaluation of balance, endurance and flexibility in women with fibromyalgia syndrome]. Türk Fizyoterapi ve Rehabilitasyon Dergisi. 2017;28:125-31. [Link] 
  2. Ozgocmen S, Ozyurt H, Sogut S, et al. Current concepts in the pathophysiology of fibromyalgia: the potential role of oxidative stress and nitric oxide. Rheumatol Int. 2006;26:585-97. [Crossref]  [PubMed] 
  3. Bagcıer F, Tufanoglu FH, Kadıçeşme Ö. Is there any relationship between serum endocan levels and carotid intima-media thickness in patients with fibromyalgia? Turk J Osteoporos. 2019;25:49-52. [Crossref] 
  4. Tinetti ME, Williams TF, Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. Am J Med. 1986;80:429-34. [Crossref]  [PubMed] 
  5. Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing. 2006;35 Suppl 2:ii7-ii11. [Crossref]  [PubMed] 
  6. Peinado-Rubia AB, Osuna-Pérez MC, Cortés-Pérez I, et al. Effectiveness of Vestibular Rehabilitation in Improving Health Status and Balance in Patients with Fibromyalgia Syndrome: A Single-Blind Randomized Controlled Trial. Biomedicines. 2023 Apr 27;11(5):1297. [Crossref]  [PubMed]  [PMC] 
  7. Núñez-Fuentes D, Obrero-Gaitán E, Zagalaz-Anula N, et al. Alteration of postural balance in patients with fibromyalgia syndrome-a systematic review and meta-analysis. Diagnostics (Basel). 2021;11:127. [Crossref]  [PubMed]  [PMC] 
  8. Kasapoğlu Aksoy M, Altan L, Ökmen Metin B. The relationship between balance and vitamin 25(OH)D in fibromyalgia patients. Mod Rheumatol. 2017;27:868-74. [Crossref]  [PubMed] 
  9. Hartikainen S, Lönnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci. 2007;62:1172-81. [Crossref]  [PubMed] 
  10. Muto LH, Sauer JF, Yuan SL, et al. Postural control and balance self-efficacy in women with fibromyalgia: are there differences? Eur J Phys Rehabil Med. 2015;51:149-54. [PubMed] 
  11. Gucmen B, Kocyigit BF, Nacitarhan V, et al. The relationship between cervical proprioception and balance in patients with fibromyalgia syndrome. Rheumatol Int. 2022;42:311-8. [Crossref]  [PubMed] 
  12. Wolfe F, Clauw DJ, Fitzcharles MA, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016;46:319-29. [Crossref]  [PubMed] 
  13. Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. J Gerontol. 1990;45:P239-43. [Crossref]  [PubMed] 
  14. Bennett R. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol. 2005;23:S154-62. [PubMed] 
  15. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71. [Crossref]  [PubMed] 
  16. Tetrax Hekim Rehberi, Yazılım Versiyonu 5.0/15.0 DUM 0062 Revision 01. Available At: [Link] 
  17. Sarıhan K, Uzkeser H, Erdal A. Evaluation of balance, fall risk, and related factors in patients with fibromyalgia syndrome. Turk J Phys Med Rehabil. 2021;67:409-15. [Crossref]  [PubMed]  [PMC] 
  18. Kul A, Uzkeser H, Sarihan K, et al. Postural Stability and Fall Risk in Adult Familial Mediterranean Fever Patients. Van Tıp Derg. 2020; 27(2): 125-33. [Crossref] 
  19. Jones KD, King LA, Mist SD, et al. Postural control deficits in people with fibromyalgia: a pilot study. Arthritis Res Ther. 2011;13:R127. [Crossref]  [PubMed]  [PMC] 
  20. Ulus Y, Akyol Y, Tander B, et al. Is there a balance problem in hypermobile patients with fibromyalgia? Turk J Rheumatol. 2013;28:10-5. [Crossref] 
  21. Bennett RM, Jones J, Turk DC, et al. An internet survey of 2,596 people with fibromyalgia. BMC Musculoskelet Disord. 2007;8:27. [Crossref]  [PubMed]  [PMC] 
  22. Collado-Mateo D, Gallego-Diaz JM, Adsuar JC, et al. Fear of Falling in Women with Fibromyalgia and Its Relation with Number of Falls and Balance Performance. Biomed Res Int. 2015;2015:589014. [Crossref]  [PubMed]  [PMC] 
  23. Meireles SA, Antero DC, Kulczycki MM, et al. Prevalence of falls in fibromyalgia patients. Acta Ortop Bras. 2014;22:163-6. [Crossref]  [PubMed]  [PMC] 
  24. Akkaya N, Akkaya S, Atalay NS, et al. Assessment of the relationship between postural stability and sleep quality in patients with fibromyalgia. Clin Rheumatol. 2013;32:325-31. [Crossref]  [PubMed] 
  25. Jones KD, Horak FB, Winters-Stone K, et al. Fibromyalgia is associated with impaired balance and falls. J Clin Rheumatol. 2009;15:16-21. [Crossref]  [PubMed]  [PMC] 
  26. Pérez-de-Heredia-Torres M, Huertas-Hoyas E, Martínez-Piédrola R, et al. Balance deficiencies in women with fibromyalgia assessed using computerised dynamic posturography: a cross-sectional study in Spain. BMJ Open. 2017;7:e016239. [Crossref]  [PubMed]  [PMC] 
  27. Watson NF, Buchwald D, Goldberg J, et al. Neurologic signs and symptoms in fibromyalgia. Arthritis Rheum. 2009;60:2839-44. [Crossref]  [PubMed]  [PMC] 
  28. Hayashibara M, Hagino H, Katagiri H, et al. Incidence and risk factors of falling in ambulatory patients with rheumatoid arthritis: a prospective 1-year study. Osteoporos Int. 2010;21:1825-33. [Crossref]  [PubMed] 
  29. Alkan Melikoğlu M, Bağcier F. Fall risk and related factors in systemic lupus erythematosus. Arch Rheumatol. 2017;32:216-20. [Crossref]  [PubMed]  [PMC] 
  30. Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med. 2003;348:42-9. [Crossref]  [PubMed] 
  31. Brenton-Rule A, Dalbeth N, Bassett S, et al. The incidence and risk factors for falls in adults with rheumatoid arthritis: a systematic review. Semin Arthritis Rheum. 2015;44:389-98. [Crossref]  [PubMed] 
  32. McKay C, Anderson KE. How to manage falls in community dwelling older adults: a review of the evidence. Postgrad Med J. 2010;86:299-306. [Crossref]  [PubMed] 
  33. Russek LN, Fulk GD. Pilot study assessing balance in women with fibromyalgia syndrome. Physiother Theory Pract. 2009;25:555-65. [Crossref]  [PubMed] 
  34. Boyle N, Naganathan V, Cumming RG. Medication and falls: risk and optimization. Clin Geriatr Med. 2010;26:583-605. [Crossref]  [PubMed] 
  35. Rutledge DN, Cherry BJ, Rose DJ, et al. Do fall predictors in middle aged and older adults predict fall status in persons 50+ with fibromyalgia? An exploratory study. Res Nurs Health. 2010;33:192-206. [Crossref]  [PubMed] 
  36. Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B. Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. Arch Intern Med. 2006;166:424-30. [Crossref]  [PubMed] 
  37. Akdeniz S, Hepguler S, Öztürk C, et al. The relation between vitamin D and postural balance according to clinical tests and tetrax posturography. J Phys Ther Sci. 2016;28:1272-7. [Crossref]  [PubMed]  [PMC] 
  38. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of Vitamin D on falls: a meta-analysis. JAMA. 2004;291:1999-2006. [Crossref]  [PubMed] 
  39. Boersma D, Demontiero O, Mohtasham Amiri Z, et al. Vitamin D status in relation to postural stability in the elderly. J Nutr Health Aging. 2012;16:270-5. [Crossref]  [PubMed] 
  40. Boland R. Role of vitamin D in skeletal muscle function. Endocr Rev. 1986;7:434-48. [Crossref]  [PubMed] 
  41. Janssen HC, Samson MM, Verhaar HJ. Muscle strength and mobility in vitamin D-insufficient female geriatric patients: a randomized controlled trial on vitamin D and calcium supplementation. Aging Clin Exp Res. 2010;22:78-84. [Crossref]  [PubMed] 
  42. Sendur OF, Tastaban E, Turan Y, et al. The relationship between serum trace element levels and clinical parameters in patients with fibromyalgia. Rheumatol Int. 2008;28:1117-21. [Crossref]  [PubMed] 
  43. Bagis S, Karabiber M, As I, et al. Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia? Rheumatol Int. 2013;33:167-72. [Crossref]  [PubMed] 
  44. Andretta A, Dias Batista E, Madalozzo Schieferdecker ME, et al. Relation between magnesium and calcium and parameters of pain, quality of life and depression in women with fibromyalgia. Adv Rheumatol. 2019;59:55. [Crossref]  [PubMed] 
  45. Magaldi M, Moltoni L, Biasi G, et al. Modificazioni degli ioni calcio e magnesio intracellulari nella fisiopatologia della sindrome fibromialgica [Changes in intracellular calcium and magnesium ions in the physiopathology of the fybromyalgia syndrome]. Minerva Med. 2000;91:137-40. Italian. [PubMed] 
  46. Dominguez LJ, Barbagallo M, Lauretani F, et al. Magnesium and muscle performance in older persons: the InCHIANTI study. Am J Clin Nutr. 2006;84:419-26. [Crossref]  [PubMed] 
  47. Kucuk A, Baykara RA, Tuzcu A, et al. Could ferritin, vitamin B12, and vitamin D play a role in the etiopathogenesis of fibromyalgia syndrome? Rom J Intern Med. 2021;59:384-93. [Crossref]  [PubMed] 
  48. Ortancil O, Sanli A, Eryuksel R, et al. Association between serum ferritin level and fibromyalgia syndrome. Eur J Clin Nutr. 2010;64:308-12. [Crossref]  [PubMed] 
  49. Özkuk K, Uysal B. [Comparison of neutrophil / lymphocyte ratio, vitamin b12 and vitamin d levels in patients with fibromyalgia and myofascial pain syndrome]. Kocaeli Med J. 2021;10:1-6. [Crossref] 
  50. de Carvalho JF, Silva DN. Serum levels of vitamin B12 (cobalamin) in fibromyalgia. Rheumatol Int. 2016;36:741-2. [Crossref]  [PubMed] 
  51. Kul A, Bilge N, Uzkeser H, et al. Postural stability and risk of fall in vitamin B12 deficiency. J PMR Sci. 2020;23:144-51. [Crossref] 
  52. Dursun N, Sarkaya S, Ozdolap S, et al. Risk of falls in patients with ankylosing spondylitis. J Clin Rheumatol. 2015;21:76-80. [Crossref]  [PubMed] 
  53. Fessel KD, Nevitt MC. Correlates of fear of falling and activity limitation among persons with rheumatoid arthritis. Arthritis Care Res. 1997;10:222-8. [Crossref]  [PubMed]