Asian Journal of Healthy and Science
p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol.
2 No. 2 February 2023
CHARACTERISTICS OF OSTEOPOROSIS PATIENTS WITH GALLSTONE
FORMATION IN CHOLELITHIASIS PATIENTS WITH MALIGNANT NEUROLEPTIC SYNDROME
R. Mohamad
Javier1, Dani Pratama Febrianto2, Laksmitha Saktiono Safitri3,
Muhammad Haidar Lutfi4, Badrul Munir5, Andi Abdillah6,
Himawan Wicaksono7, A. Rusli Budi Ansyah8, I Nyoman
Mudana9, Bambang Widiwanto10, Sukirman11, Ika
Nurfarida12
Medical Profession, Faculty of Medicine, University of
Muhammadiyah Malang1,2,3,4
Chairman of the SMF of Internal Medicine at
Bhayangkara Hospital, Kediri5
SPV SMF of Surgery, University of Muhammadiyah Malang
Hospital6
Staff of Cardiology & Vascular Diseases at Mitra
Keluarga Hospital Cikarang7
Head of Sub Education, Services and Education in the
Health Sector of the Indonesian Army Health Center, Gatot Soebroto Army
Hospital, Jakarta8
Head of Nervous and Mental Diseases at Kartika Husada
Kindergarten Hospital II Pontianak9
SPV SMF Orthopedic Traumatology Sub-Surgery,
Muhammadiyah University Hospital10
Wakapuskesad11
Associate Doctor, SPV of Mental Health Sciences,
Mental Hospital Dr. Radjiman Wediodiningrat Lawang12
Email: javierbedah@webmail.umm.ac.id, danipratama4@gmail.com, laksmithas@gmail.com, muhammadhaidarlutfi@gmail.com, badrul@umm.ac.id, abdillah@umm.ac.id, drhimawanw@yahoo.co.id, ruslibudi@gmail.com, nyomanmudana139@gmail.com, dr.sukirman@yahoo.co.id, ikapsikiater@gmail.com
There is a suspected relationship between osteoporosis
and gallstone formation in patients with cholelithiasis with neuroleptic
malignant syndrome. However, the characteristics of osteoporosis that are
related to this problem have not been discussed in previous studies. Knowing
the Characteristics of Osteoporosis Patients with Gallstone Formation in
Patients Suffering from Cholelithiasis With Malignant Neuroleptic Syndrome.
This research is a Systematic Review using the Preferred Reporting Items for
Systematic Reviews and Meta-analyses method or commonly called PRISMA, this
method is carried out systematically by following the correct research steps or
protocols. Sources were taken from the Google Scholar website with journals
published in 2005-2022 and then screening was carried out to obtain the results
of 1,910 journal articles. Journal clustering was carried out and the number of
Scopus indexed journals obtained was 4 journals Q1, 1 journal Q2, and 1 Q4
journal, so that 6 journals were extracted.
Keywords: Osteoporosis,
Gallstones, Cholelithiasis, Malignant Neuroleptics.
INTRODUCTION
Osteoporosis is a bone disease
characterized by microarchitectural degradation of bone tissue and loss of bone
mass. Osteoporosis (literally means "porous bones") will increase
bone fragility and the risk of fractures in sufferers (Clynes et al., 2020). Osteoporosis is characterized by loss of bone mass,
degeneration of bone microarchitecture, increased risk of fractures, and the
latter consequence is associated with severe morbidity and mortality. The
asymptomatic and progressive character of osteoporosis causes the need for
early detection of this osteoporosis (Vidal et al., 2019). To anticipate this disease, it is necessary to carry
out prevention activities by consuming proper calcium and vitamin D, as well as
a healthy lifestyle to maintain bone health. As for the treatment, the drug
given will be specific to the character of the fracture and the severity of the
patient's disease.
Osteoporosis is a disease that is
often experienced by older people, but it is possible for teenagers to experience
it. Apart from osteoporosis, gallstones (cholelithiasis) is also a disease that
is often experienced by older people. Both osteoporosis and gallstones are
common disorders in the elderly worldwide. Both of these disorders are more
common in women and can appear during pregnancy and menopause, indicating that
sex hormones play an important role in their development. Gallstones can occur
without symptoms for years and are often discovered incidentally (when they
recur). Likewise with osteoporosis, many people do not realize they have
osteoporosis until their bones are broken. With all these parallels, it's not
surprising that there is some link between the two diseases. This means that
people with osteoporosis are more susceptible to gallbladder disorders, such as
gallstones. Cholecystectomy is a popular surgical operation, and patients who
have had cholecystectomy are frequently encountered in clinical practice.
Gallstones are the most common reason for cholecystectomy, followed by
cholecystitis (Lee et al., 2021).
One of the most obvious common
causes between the two is inflammation. Studies of osteoporosis conclude that
the disease is the result of various metabolic, endocrine, and mechanical
factors. However, in recent years, evidence has shown that inflammation has a
significant effect on bone formation. This systemic inflammation can inhibit
bone formation and overproduce pro-inflammatory mediators such as prostaglandins,
cytokines, and nitric oxide. Inflammation often occurs in the biliary tree,
including the gallbladder. Excessive and long-term inflammation can damage
tissue and cause cholelithiasis. Scars caused by persistent tissue damage can
impact the liver and bile, alter enterohepatic circulation and possibly cause
gallstones (Klahan et al., 2014); (Lin
et al., 2017). According to previous studies,
there were as many as 114 cases of gallstones occurring in osteoporosis. The
risk of gallstones in osteoporosis results in a likelihood ratio of 1.35 or it
means that osteoporosis patients have a higher chance of developing gallstones
than the general population (Klahan et al., 2014).
Osteopontin (OPN) is a
pro-inflammatory cytokine that is found in various tissues and is involved in
various biological processes including bone mineralization, inflammation, and
cell survival. It is expressed at high levels in the bone matrix, and can
promote autoreactive T cell survival and participate in bone remodeling
processes. One study showed that it stimulated adhesion, migration, and bone
resorption by osteoclasts. Research shows that osteopontin (OPN) is also a core
protein in the formation of cholesterol gallstones (Fodor et al., 2013). Based on these data, osteoporosis patients may have a
higher risk of developing gallstones, but the relationship is not clearly known
(Chellaiah
et al., 2003); (Denhardt
& Noda, 1998); (Ichikawa
et al., 2009); (Mazzali
et al., 2002); (Stromnes
& Goverman, 2007).
Based on the study of (Minamisawa
et al., 1991), in the case of adult men with
alcohol addiction with hematoemesis. The patient experienced a case of rupture
of esophageal varices and was then treated with endoscopic injection
sclerotherapy. On the 3rd day of treatment, the patient showed alcohol
withdrawal syndrome. Then the laboratory results related to the values of CK,
LDH, GOT and GPT showed high results, thus strengthening the suspicion of
neuroleptic malignant syndrome (NMS).
Knowing the characteristics of
osteoporosis sufferers with the formation of gallstones in patients suffering
from cholelithiasis with malignant neuroleptic syndrome.
RESEARCH METHODS
This study is a Systematic Review
using the Preferred Reporting Items for Systematic Review and Meta-analyses
(PRISMA) technique, which is carried out in a systematic and complete manner by
following the required research procedures or protocols. A systematic review is
a procedure that uses the previously generated review, analysis, evaluation,
classification, and categorization of information. The procedure for carrying
out a systematic review is quite planned and structured, making this method
very different from simply submitting a literature study. This systematic
review approach consists of several steps:
1.
Arrange
Background and Purpose
2.
Research
problems
3.
Literature
Search
4.
Selection
Criteria
5.
Training screen
6.
Procedure List
and Quality Check
7.
Data Extraction
Strategy and Data Synthesis Strategy
The data used to search for
literature is through selection based on cervical cancer criteria, which
involves medical research and social health. Furthermore, implementing a
literature review related to Osteoporosis, and gallstones. Articles are
searched using Google Scholar as a database. A search for research articles
relevant to the topic of this research was carried out using the keywords:
osteoporosis, osteoporosis characteristics, and gallstone formation,
cholelithiasis.
Analysis is the decomposition of a
subject into its various parts and the study of the parts themselves and the
relationships between the parts to obtain a proper understanding and
understanding of the meaning of the whole. While synthesis is a blend (mixture)
of various meanings or things so that they form a harmonious whole. Narrative
is the method used in synthesizing this research, this method classifies the
extracted data, analyzes the content contained in the research objectives and
research results. The analysis used is journal content analysis.
RESULT AND DISCUSSION
A. Research result
This chapter will describe
the results and analysis using 3 journals related to osteoporosis and
gallstones, 1 journal related to osteoporosis characteristics, 1 journal
related to gallstones and osteopontin variables, and 1 journal related to
osteoporosis and malginant neuroleptics. .
Journals obtained are
screened and extracted into a table to make it easier to explain the contents
of the journal. Based on the results of journal clustering, the number of
journals indexed by Scopus Q1 was 4 journals, 1 journal Q2, and 1 journal Q4,
so that 6 journals were extracted and used as a reference for our systematic
review work.
B. Data Analysis
Data information regarding
osteoporosis as an independent variable analyzed is presented in tabular form
containing the title of the journal, year of publication, the author of the
purpose in the journal, sample and criteria, research instruments, between data
or research methods and research results in the journal.
C.
Characteristics of Osteoporosis Patients in Patients Suffering from
Cholelithiasis based on age & gender
Osteoporosis is a bone disease caused by microarchitectural degradation
of bone tissue and bone mass. The characteristics of this disease are the
fragility of the bones and the risk of fractures which are generally
asymptomatic. People with osteoporosis are more susceptible to gallbladder
disorders and the formation of gallstones. In osteoporosis patients with
gallstone formation, they will experience inflammation, in which this aspect
influences bone formation factors. Where inflammation will inhibit bone
formation and overproduction of pro-inflammatory mediators such as
prostaglandins, cytokines, and nitric oxide which are characteristic of
osteoporosis sufferers. Inflammation often occurs in the biliary tree.
Inflammation over a long period of time then causes Cholelithiasis (Clynes et al., 2020). Inflammation that occurs in people with
osteoporosis will progressively increase with age. This goes hand in hand with
the occurrence of cholelithiasis, in which pro-inflammatory mediators, namely
prostaglandins, decrease and cause bone density to decrease, at the same time
the biliary system which carries out the physiological circulation of bile is
disrupted resulting in the formation of gallstones (Vidal et al., 2019).
Sustained inflammation then causes tissue damage and causes cholelithiasis.
This damage then triggers the formation of gallstones. In the case of
gallstones, patients will experience systemic inflammation that can inhibit
bone formation and overproduce pro-inflammatory mediators such as
prostaglandins, cytokines, and nitric oxide. According to previous studies,
there were 114 cases of gallstones occurring in elderly adult women (> 45
years) suffering from osteoporosis. Gender plays a major role in the occurrence
of cholelithiasis which is closely related to osteoporosis, one of which is
women, because in women the condition of nitric oxide in the body which plays a
role in the process of bone development is hampered more quickly due to the
influence of female hormones, one of which is LH which causes disruption of the
biliary system and gallstones form. However, because these two diseases are
both triggered by inflammation, studies regarding which factors trigger each
other are still lacking to be explained in detail both in terms of age and
gender (Vidal et al., 2019).
D.
Characteristics of Osteoporosis Patients with Gallstone Formation in
Patients Suffering from Cholelithiasis with Neuroleptic Malignant Syndrome
based on duration of taking medication & type of drug
Gallstones can form if the body has produced too much bilirubin due to a
liver condition or if the body's liver produces too much cholesterol. Pigment
gallstones are the most common form, with cholesterol stones accounting for
around 15% of cases of SNM. In people with cholelithiasis, inflammation will
appear and if it continues to occur it will form gallstones. Where according to
the exposure above it will lead to the formation of pigment gallstones (a
greater probability than cholesterol stones) (Coruch, et al. 2017). In the case
of patients with gallstones, patients will experience systemic inflammation
which can inhibit bone formation and overproduce pro-inflammatory mediators
such as prostaglandins, cytokines, and nitric oxide. So it can be said that
indirectly the characteristic of osteoporosis sufferers with the formation of
gallstones in patients with neuroleptic malignant syndrome is that the patient
will experience inflammation which inhibits the process of bone formation.
Inflammation of the bone microenvironment results in changes that lead to
excessive bone loss and bone formation.
One of the incidences of osteoporosis related to drug withdrawal syndrome
is in patients with a history of schizophrenia and receiving antipsychotic
drugs, one example of which is risperidone. Risperidone is able to erode bone
thickness and strength or in other words bone loss. US. Valproate, codeine, etc
(Vidal. et al. 2019). The duration of treatment related to these conditions
depends on the patient's discontinuation of treatment without advice from the
relevant doctor (Adamopoulus, 2018). It was found in the results of the study,
a number of 80 people in NHS Europe who were both male and female took
antipsychotic treatment for a minimum of 4 months and a maximum of about 1 year
and 3 months which could cause SNM due to their non-compliance with not taking
medication. The drug that most often causes NMS due to the effect of decreasing
dopamine activity is valproate acid by 60%, the rest is risperidone (Coruch,
2017).
CONCLUSION
Based on the results of the study,
the incidence of osteoporosis associated with the formation of gallstones /
cholelithiasis and drug withdrawal syndrome / SNM, one of which is in patients
treated with risperidone, as valproate, in psychotic patients who are able to
erode bone thickness and strength or in other words bone loss. US. Valproate,
codeine, etc. The duration of treatment related to these conditions depends on
stopping the patient's treatment without advice from the doctor concerned. It
was found in the results of the study, a number of 80 people in NHS Europe who
were both male and female took antipsychotic treatment for a minimum of 4
months and a maximum of about 1 year and 3 months which could cause SNM due to
their non-compliance with not taking medication. The drug that most often
causes NMS due to the effect of decreasing dopamine activity is valproate acid
by 60%, the rest is risperidone.
Inflammation that occurs in people
with osteoporosis will progressively increase with age. This goes hand in hand
with the occurrence of cholelithiasis, where pro-inflammatory mediators, namely
prostaglandins, decrease and cause bone density to decrease, along with that
the biliary system which carries out the physiological circulation of bile is
disrupted so that gallstones form. Sustained inflammation then causes tissue
damage and causes cholelithiasis. This damage then triggers the formation of
gallstones. In the case of gallstones, patients will experience systemic
inflammation which can inhibit bone formation and overproduce pro-inflammatory
mediators such as prostaglandins, cytokines, and nitric oxide. According to
previous studies, there were 114 cases of gallstones occurring in elderly adult
women (> 45 years) suffering from osteoporosis. Gender plays a major role in
the occurrence of cholelithiasis which is closely related to osteoporosis, one
of which is women.
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Copyright holders:
R.
Mohamad Javier et.al (2023)
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- Asian Journal of Healthy and Science
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