Mäkinen Tatu J, Alm Jessica J, Laine Hanna, Svedström Erkki, Aro Hannu T
Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku, Medisiina B4, Kiinamyllynkatu 10, FIN-20520 Turku, Finland.
Bone. 2007 Apr;40(4):1041-7. doi: 10.1016/j.bone.2006.11.013. Epub 2007 Jan 17.
The co-existence of osteoporosis (OP) and osteoarthritis (OA) remains obscure. No systematic studies have been carried out to exclude the possibility that especially female osteoarthritic patients selected for cementless total hip arthroplasty (THA) suffer from primary or secondary OP.
A subgroup of fifty-three female patients (average age, 64.7 years) with advanced primary hip OA scheduled for cementless THA were recruited for DXA and laboratory screening. Before surgery, bone mineral density (BMD) of the lumbar spine, the proximal femurs and the distal forearm were measured. The serum concentrations of calcium, 25-hydroxyvitamin D, parathyroid hormone and biochemical markers of bone resorption and formation were determined to exclude secondary OP.
The prevalence of OP (T score <-2.5) and osteopenia (-1.0 >T score >-2.5) were 28% and 45%, respectively. Statistically, OP was related to patient's age, low BMI, postmenopausal status and not having estrogen replacement therapy. Five patients (9%) had laboratory findings of secondary OP. Two of them were found to have a parathyroid adenoma. The prevalence of vitamin D insufficiency [S-25(OH)D levels <or=50 nmol/l] was 36% (n=19). As a sign of high bone turnover, the patients with reduced BMD values showed significantly increased serum levels of osteocalcin (p=0.049), intact procollagen type I N propeptide (p=0.040) and N-terminal crosslinking telopeptide of type I collagen (p=0.046). The BMC of the femoral necks of the osteoarthritic hips were significantly higher (p<0.001) and the BMC of the trochanter regions significantly lower (p=0.005) compared to the contralateral hips.
Against a general belief, OA does not seem to protect a patient from generalized primary OP. The majority (74%) of the female hip OA patients were osteopenic or osteoporotic with signs of increased bone turnover. The observed prevalence of reduced BMD corresponds with the published data of age-matched population. An unexpectedly high number of patients required preoperative consultation with an endocrinologist. The altered distribution of BMD observed in the proximal femurs may explain the lower prevalence of fractures reported in the femoral necks of osteoarthritic hips.
骨质疏松症（OP）与骨关节炎（OA）并存的情况仍不明确。尚未开展系统研究以排除这样一种可能性，即尤其那些被选来接受非骨水泥型全髋关节置换术（THA）的女性骨关节炎患者患有原发性或继发性OP。
招募了一组53名计划接受非骨水泥型THA的晚期原发性髋关节OA女性患者（平均年龄64.7岁）进行双能X线吸收法（DXA）和实验室筛查。术前，测量腰椎、股骨近端和远端前臂的骨矿物质密度（BMD）。测定血清钙、25-羟基维生素D、甲状旁腺激素以及骨吸收和形成的生化标志物，以排除继发性OP。
OP（T值＜-2.5）和骨质减少（-1.0＞T值＞-2.5）的患病率分别为28%和45%。从统计学角度看，OP与患者年龄、低体重指数、绝经后状态以及未接受雌激素替代治疗有关。5名患者（9%）有继发性OP的实验室检查结果。其中2名被发现患有甲状旁腺腺瘤。维生素D不足[S-25(OH)D水平≤50 nmol/l]的患病率为36%（n = 19）。作为高骨转换的一个标志，BMD值降低的患者血清骨钙素（p = 0.049）、I型原胶原N端前肽（p = 0.040）和I型胶原N端交联肽（p = 0.046）水平显著升高。与对侧髋关节相比，骨关节炎髋关节的股骨颈骨密度（BMC）显著更高（p＜0.001），转子区的BMC显著更低（p = 0.005）。
与普遍看法相反，OA似乎并不能保护患者免受全身性原发性OP的影响。大多数（74%）女性髋关节OA患者存在骨质减少或骨质疏松，并有骨转换增加的迹象。观察到的BMD降低患病率与年龄匹配人群的已发表数据相符。数量出乎意料多的患者需要术前咨询内分泌科医生。在股骨近端观察到的BMD分布改变可能解释了骨关节炎髋关节股骨颈骨折报告患病率较低的原因。
