Cortet B, Flipo R M, Pigny P, Duquesnoy B, Boersma A, Marchandise X, Delcambre B
Department of Rheumatology, CHRU Lille, Hôpital R. Salengro, France.
J Rheumatol. 1998 Dec;25(12):2339-44.
To study the relationship between bone turnover markers and bone mineral density in patients with rheumatoid arthritis.
We studied 54 patients, 24 of whom were receiving low dose steroids, and compared them to 54 age and sex matched controls.
An 8.2% decrease of femoral neck bone mineral density (BMD) was found in patients not taking steroids compared with controls (confidence interval 1.2-15.3%). Serum markers of bone turnover -- namely, procollagen type I C-terminal propeptide (PICP) and procollagen type I N-terminal propeptide (PINP), which reflect bone formation, and procollagen type I C-terminal telopeptide, which reflects bone resorption -- were significantly increased compared with controls (p < 0.05, p < 0.01, p < 0.01, respectively). Both PINP levels and PICP levels were correlated with the femoral neck BMD as well as osteocalcin levels: R = -0.32 (p < 0.05), R = -0.29 (p < 0.05), and R = -0.42 (p < 0.01), respectively. The best independent predictors of bone mass (stepwise multiple regression analysis) at the femoral neck were steroid use, osteocalcin levels, age, height, the presence of rheumatoid factor, and the Health Assessment Questionnaire score, which explained 61.6% of the variance in femoral neck BMD.
Elderly patients with RA using steroids with severe disease and high levels of osteocalcin have marked osteoporosis at the hip.
研究类风湿关节炎患者骨转换标志物与骨密度之间的关系。
我们对54例患者进行了研究，其中24例正在接受低剂量类固醇治疗，并将他们与54例年龄和性别相匹配的对照者进行比较。
未服用类固醇的患者与对照者相比，股骨颈骨密度（BMD）下降了8.2%（置信区间为1.2 - 15.3%）。反映骨形成的骨转换血清标志物，即I型前胶原C末端前肽（PICP）和I型前胶原N末端前肽（PINP），以及反映骨吸收的I型前胶原C末端端肽，与对照者相比均显著升高（分别为p < 0.05，p < 0.01，p < 0.01）。PINP水平和PICP水平均与股骨颈BMD以及骨钙素水平相关：相关系数分别为R = -0.32（p < 0.05），R = -0.29（p < 0.05），R = -0.42（p < 0.01）。股骨颈骨量的最佳独立预测因素（逐步多元回归分析）为类固醇使用情况、骨钙素水平、年龄、身高、类风湿因子的存在以及健康评估问卷评分，这些因素解释了股骨颈BMD变异的61.6%。
患有严重疾病且骨钙素水平高的老年类风湿关节炎患者使用类固醇时，髋部存在明显骨质疏松。
