髋关节置换术等待期老年男性骨质减少和骨质疏松发生率研究

Incidence of osteopenia and osteoporosis in oldermen with hip osteoarthritis scheduled for total joint replacement

目的研究等待全髋置换术的髋关节炎老年男性患者骨质减少和骨质疏松发生情况。方法共有52例患者纳入研究组,平均年龄64.7岁,研究对象行单侧或者双侧双能X线检查以及实验室检查,记录研究对象椎体、股骨近端以及前臂远端的骨密度值,检测外周血钙离子浓度、25(OH)D、甲状旁腺激素浓度以及骨吸收和骨生成标志物水平。结果有29%的研究对象骨质疏松,44%出现骨质减少,骨质疏松与年龄具有相关性,其中4例(8%)患者实验室检查异常,1例患者诊断为甲状旁腺腺瘤,19例患者出现维生素D缺乏,骨密度较低的研究对象与其他的骨钙素、I型原胶原N端前肽以及I型胶原N末端肽的水平比较,差异有统计学意义(P=0.001、0.010和0.048)。骨关节炎患侧股骨颈骨矿盐含量高于健侧,差异有统计学意义(P=0.000),粗隆骨矿盐含量低于健侧,差异有统计学意义(P=0.005)。结论 73%患者出现骨质减少以及骨质疏松,呈骨转换表现,部分患者存在继发性骨质疏松,骨关节炎侧股骨近端骨密度分布异常。

Objective To investigate the incidence of osteopenia and osteoporosis in oldermen selected for cementless total hip arthroplasty （THA）. Methods A subgroup of fifty-two male patients （average age, 64.7 years） with advanced primary hip OA scheduled for eementless 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 boneresorption and formation were determined to exclude secondary OP. Results The prevalence of OP （T score 〈 2.5） and osteopenia （1.0 〉 T score 〉 2.5） were 29% and 44%, respectively. Statistically, OP was related to patient＇s age, and 4 patients （8%） had abnormal laboratory findings. One was found to have a parathyroid adenoma. The prevalence of vitamin D insufficiency [S 25 （OH） D levels ≤ 50 nmol/l] was 37% （n = 19）. As a sign of high bone turnover, the patients with reduced BMD values showed significantly increased serum levels of osteocalcin （P = 0.001）, intact procollagen type I N propeptide （P = 0.010） and N-terminal crosslinking telopeptide of type I collagen （P = 0.048）. The BMC of the femoral necks of the osteoarthritic hips were significantly higher （P = 0.000） and the BMC of the trochanter regions were significantly lower （P = 0.005） compared to the contralateral hips. Conclusions The majority （73%） of the male hipOA patients are osteopenic or osteoporotic with signs of increased bone turnover.An unexpectedly high number of patients require preoperative consultation with anendocrinologist. 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.