Drees P, Decking J, Breijawi N, Delank S, Kreitner K-F, Eckardt A
Orthopädische Klinik und Poliklinik der Johannes-Gutenberg-Universität Mainz.
Z Orthop Ihre Grenzgeb. 2005 Mar-Apr;143(2):161-9. doi: 10.1055/s-2004-832321.
Increasing bone mineral density (BMD) has been found in several studies in patients with osteoarthritis (OA). Therefore, the simultaneous occurrence of osteoporosis (OP) and OA is denied by many clinicians. Because of our clinical impression, however, we suggest that we have to consider a common occurrence. In the present study we have examined the relationship between osteoathritis of the knee or the hip and osteoporosis.
The BMD of the lumbar spine and the proximal femur of 117 OA patients (82 postmenopausal female patients aged 50-83 and 35 male patients aged 36-86 years) who subsequently required hip or knee replacements, but were otherwise healthy, was measured by dual-energy X-ray absorptiometry (DXA; Hologic QDR-2000). The results are given as required by the WHO and the new German guidelines of the DVO. The BMD was measured and categorised in a sex-related manner and the occurrence of disuse osteoporosis on the affected limb was examined. Furthermore, a comparison was made in the level of BMD between the OA of the involved hip or knee.
There was a high occurrence of low BMD among the patients. 23.2 % of the women were affected by OP. This reflects the normal distribution of OP in the female population. 20 % of the male patients had occult OP. This is astonishingly high. Osteopenia was measured for 37.1 % of the male patients and 42.7 % of the female patients. Age proved to be a significant factor in the degree of BMD. Neither a disuse osteoporosis, nor a significance in the OA-affected joint to the degree of BMD, could be proven.
We cannot support the hypotheses that OA prevents OP. Moreover, the occurrence of OP in our study reflected the incidence of OP in the average female and was astonishingly high in the male population; this does not support the hypothesis that the two conditions are mutually exclusive. Also a lower risk of fractures among OA patients cannot be concluded. There is current open discussion whether a known BMD should influence the decision for a cemented or an uncemented prosthesis.
多项针对骨关节炎（OA）患者的研究发现其骨矿物质密度（BMD）有所增加。因此，许多临床医生否认骨质疏松症（OP）与OA会同时出现。然而，基于我们的临床印象，我们认为必须考虑到它们会共同出现。在本研究中，我们调查了膝关节或髋关节骨关节炎与骨质疏松症之间的关系。
对117例需要进行髋关节或膝关节置换手术但其他方面健康的OA患者（82例年龄在50 - 83岁的绝经后女性患者和35例年龄在36 - 86岁的男性患者），采用双能X线吸收法（DXA；Hologic QDR - 2000）测量其腰椎和股骨近端的骨密度。结果按照世界卫生组织（WHO）和德国骨科学会（DVO）的新指南要求给出。根据性别对骨密度进行测量和分类，并检查患侧肢体废用性骨质疏松的发生情况。此外，还对受累髋关节或膝关节OA患者之间的骨密度水平进行了比较。
患者中骨密度低的发生率较高。23.2%的女性患有OP。这反映了OP在女性人群中的正常分布情况。20%的男性患者患有隐匿性OP。这一比例高得惊人。37.1%的男性患者和42.7%的女性患者测量显示骨量减少。年龄被证明是影响骨密度程度的一个重要因素。既未证实存在废用性骨质疏松，也未证实OA受累关节对骨密度程度有显著影响。
我们无法支持OA可预防OP这一假设。此外，我们研究中OP的发生率反映了普通女性人群中OP的发病率，而在男性人群中该发病率高得惊人；这并不支持两种病症相互排斥这一假设。也不能得出OA患者骨折风险较低的结论。目前对于已知的骨密度是否应影响骨水泥型或非骨水泥型假体的选择存在公开讨论。
