Sapundzhiev Lyubomir, Sapundzhieva Tanya, Mitev Martin, Simitchiev Kiril, Batalov Anastas
Department of Propedeutics of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 4001 Plovdiv, Bulgaria.
Rheumatology Department, University Hospital 'Pulmed' Plovdiv, 4002 Plovdiv, Bulgaria.
Life (Basel). 2023 Feb 2;13(2):421. doi: 10.3390/life13020421.
Changes in clinical presentation, radiographic progression (RP), bone mineral density (BMD), bone turnover (BT), and cartilage turnover (CT) markers were compared in two groups of patients with hip osteoarthritis (HOA) over a period of 7 years. Each group consisted of 150 patients, including a control group on standard-of-care therapy (SC) with simple analgesics and physical exercises, and a study group (SG) on standard-of-care therapy supplemented by vitamin D3 and intravenous administration of zoledronic acid (5 mg) yearly for 3 consecutive years. Patient groups were homogenized regarding the following: (1) radiographic grade (RG), including 75 patients with hip OA RG II according to the Kellgren-Lawrence grading system (K/L), and 75 with RG III on K/L; (2) radiographic model (RM), as each of the K/L grades was subdivided into three subgroups consisting of 25 patients of different RMs: atrophic ('A'), intermediate ('I'), and hypertrophic ('H'); (3) gender-equal ratio of men and women in each subgroup (Female/Male = 15/10). The following parameters were assessed: (1) clinical parameters (CP), pain at walking (WP-VAS 100 mm), functional ability (WOMAC-C), and time to total hip replacement (tTHR); (2) radiographic indicators(RI)-joint space width (JSW) and speed of joint space narrowing (JSN), changes in BMD (DXA), including proximal femur (PF-BMD), lumbar spine (LS-BMD), and total body (TB-BMD); (3) laboratory parameters (LP)-vitamin D3 levels and levels of BT/CT markers. RV were assessed every 12 months, whereas CV/LV were assessed every 6 months. Results: Cross-sectional analysis (CsA) at baseline showed statistically significant differences (SSD) at < 0.05 in CP (WP, WOMAC-C); BMD of all sites and levels of CT/BT markers between the 'A' and 'H' RM groups in all patients. Longitudinal analysis (LtA) showed SSD ( < 0.05) between CG and SG in all CP (WP, WOMAC-C, tTHR) parameters of RP (mJSW, JSN), BMD of all sites, and levels of CT/BT markers for all 'A' models and in 30% of 'I'-RMs (those with elevated markers for BT/CT at baseline and during the observation period). Conclusion: The presence of SSD at baseline ('A' vs. 'H') supported the thesis that at least two different subgroups of HOA exist: one associated with 'A' and the other with 'H' models. D3 supplementation and the intravenous administration of bisphosphonate were the treatment strategies that slowed down RP and postponed tTHR by over 12 months in the 'A' and 'I' RM with elevated BT/CT markers.
在7年的时间里，对两组髋骨关节炎（HOA）患者的临床表现、影像学进展（RP）、骨矿物质密度（BMD）、骨转换（BT）和软骨转换（CT）标志物的变化进行了比较。每组由150名患者组成，包括接受简单镇痛药和体育锻炼的标准护理治疗（SC）对照组，以及连续3年每年补充维生素D3并静脉注射唑来膦酸（5毫克）的标准护理治疗研究组（SG）。患者组在以下方面进行了同质化处理：（1）影像学分级（RG），根据Kellgren-Lawrence分级系统（K/L），包括75例髋骨关节炎RG II级患者和75例K/L分级为III级的患者；（2）影像学模式（RM），因为每个K/L分级又细分为三个亚组，每组25例不同RM的患者：萎缩型（'A'）、中间型（'I'）和肥大型（'H'）；（3）每个亚组中男女比例相等（女性/男性=15/10）。评估了以下参数：（1）临床参数（CP）、行走时疼痛（WP-VAS 100毫米）、功能能力（WOMAC-C）和全髋关节置换时间（tTHR）；（2）影像学指标（RI）——关节间隙宽度（JSW）和关节间隙变窄速度（JSN）、BMD变化（DXA）——包括股骨近端（PF-BMD）、腰椎（LS-BMD）和全身（TB-BMD）；（3）实验室参数（LP）——维生素D3水平以及BT/CT标志物水平。每12个月评估一次RV，而每6个月评估一次CV/LV。结果：基线时的横断面分析（CsA）显示，所有患者中，'A'和'H' RM组在CP（WP、WOMAC-C）、所有部位的BMD以及CT/BT标志物水平方面，差异有统计学意义（SSD），P<0.05。纵向分析（LtA）显示，在所有CP（WP、WOMAC-C、tTHR）参数、RP（mJSW、JSN）、所有部位的BMD以及所有'A'模型和30%的'I'-RMs（基线和观察期内BT/CT标志物升高的那些）的CT/BT标志物水平方面，CG和SG之间存在SSD（P<0.05）。结论：基线时存在SSD（'A'与'H'）支持了以下论点，即至少存在两个不同的HOA亚组：一个与'A'相关，另一个与'H'模型相关。补充D3和静脉注射双膦酸盐是在BT/CT标志物升高的'A'和'I' RM中减缓RP并将tTHR推迟超过12个月的治疗策略。
