State Institution "Kundiiev Institute of Occupational Health of the NAMS of Ukraine", Kyiv
Abstract. In the structure of occupational morbidity in Ukraine, the pathology of the locomotor system takes the second place after diseases of the broncho-pulmonary system, making its 5th part and reaching 601–604 cases per year (2015–2016). Chronic radiculopathy is the most common disease of the musculoskeletal system in the working population of Ukraine, which is mostly recorded in a cohort of miners. The risk of traumatism and development of occupational diseases in coal mining is 5–10 times higher than in other branches of industry. In view of this, the problem of timely diagnosis and prevention of development of chronic radiculopathy in mine workers in conditions of physical activity, forced work posture, unfavorable microclimate, is rather actual. The assessment of the state of the bone tissue is a very important diagnostic criterion for patients with chronic lumbosacral radiculopathy. Recently, the following methods are used to evaluate this indicator: definition of the index of mineral density of the bone tissue (DBT as a quantitative characteristics); determination of the TBS (trabecular bone score), which is its qualitative characteristics; definition of vitamin D level in blood serum; an indicator of a 10-year risk of osteoporotic fractures using a FRAX (fracture risk assessment tool), since these are directly degenerativedystrophic changes in the spine that is one of the main etiological factors in development of chronic radiculopathy.
Purpose. To evaluate the state of the bone tissue in miners of main professions, suffering from lumbar sacchar spinal cord, by analyzing vitamin D level in patients' blood, the TBS index, T- and Z- indices and the FRAX tool.
Materials and methods. Investigations of the state of the bone tissue were conducted in a group of 60 miners of main professions with chronic lumbosacral radiculopathy (slaughterers, mining workers of the clearing face (MWCF), sinkers) in Donbas and Lviv-Volyn regions. There was used the two-photon X-ray absorbtionometry (Prodigy, GE Lunar, Madison, USA) and Prodigy (General Electric) with definition of the TBS index, T- and Z-score indices, FRAX, determination of the level of 25 (OH) of vitamin D in blood serum by electrochemiluminescent method on the Elecsys 2010 device.
Results. It was found that the average level of vitamin D in the blood of patients with chronic lumbosacral radiculopathy was within the normal range and made 37.59 ng/ml, with 6.6 % of patients with deficiency of vitamin, and 20 % – its insufficiency. The average index of TBS in the group was within the normative values (1,364), following the general tendency for men population of Ukraine; however, according to the T-score in 20 % of patients osteopenia was diagnosed (ranging from 1 to -2.5). The lowest level of FRAX was found in workers aged 30–39 and made 0.72, increasing with the age of patients. Conclusion. The most informative indicator in assessing the state of the bone tissue in miners, suffering from chronic lumbosacral radiculopathy, was FRAX. It has been established that the level of vitamin D in miners depends on the experience of work in underground conditions and on the age in all groups of the examined patients.
Key words. Chronic lumbosacral radiculopathy, mineral density of the bone tissue, occupational pathology, locomotor apparatus
ORCID ID of co-authors and their contribution to the preparation and writing of the article:
A. Basanets (ORCID ID: https://orcid.org/0000-0001-8236-4251) - the idea of research, the analysis of individual provisions, generalized conclusions;
Lashko O. M. (ORCID ID: https://orcid.org/0000-0001-7938-5887) - formation of tables, analysis of the results, writing of the article;
Gvozdetsky V.A. (ORCID ID: https://orcid.org/0000-0002-4663-141X) - analysis of the results, writing of the article.