老年男性骨关节炎骨密度变化相关研究

目的探讨老年男性骨关节炎（osteoarthritis,OA）患者骨密度（Bone mineral density,BMD）变化相关因素。方法选择老年男性膝骨关节炎（Knee osteoarthritis,KOA）患者72例（男性组）、老年女性KOA患者60例（女性组）,检测两组的BMD及男性组生活方式情况、血生化指标、骨代谢指标、双膝数值化X射线、KOA WOMAC（Western Ontario and McMaster Uni-versities）评分等临床资料,应用SPSS 13.0软件包进行统计学分析。结果①男性组BMD高于女性组（P=0.002）,骨量变少率低于女性组（P〈0.001）;②男性组腰椎、股骨颈、Wards三角、大转子、股骨干BMD差异有统计学意义（P〈0.001）,其中Wards三角BMD值最低,腰椎BMD值最高;③喝牛奶、户外运动在男性骨量正常组高于骨量变少组（P=0.031,0.002）;④骨量正常组低密度脂蛋白胆固醇（LDL-C）低于骨量减少组和骨质疏松（osteoporosis,OP）组（P〈0.05）,而碱性磷酸酶（ALP）高于骨量减少组和OP组（P〈0.01）,骨钙素（OC）高于OP组（P=0.01）;⑤老年男性KOA的BMD与体质量指数（BMI）、OC呈正相关,与年龄、LDL-C呈负相关。结论老年男性OA较老年女性OA患者更少伴发OP,老年男性OA患者喝牛奶、户外运动者更不易伴发OP,LDL-C越高、年龄越大越易患OP,老年男性OA伴发的OP主要是成骨细胞活性减低所致,属低转换型,在诊治男性OA过程中更应关注OP。

Factors influencing changes in bone mineral density in elderly men patients with osteoarthritis

Objective To explore relative factors of bone mineral density change in elderly men osteoarthritis(osteoarthritis,OA) patients.Methods Our study involved 72 elderly men knee osteoarthritis,and 60 age-matched elderly women knee osteoarthritis controls.Bone mineral density(BMD) was assessed at the hip and lumbar spine by dual-energy x-ray absorptiometry.The way of life situation,the blood biochemical index,bone metabolism index,knees of numerical value X-ray,KOA WOMAC score and clinical data of male group were also measured.Results ①The BMD of male group was higher than women controls(P = 0.002),bone mass less rate of the male group is lower than women controls(P < 0.001).②The BMD of femoral neck,lumbar Wards triangle,big rotor,and femoral BMD in male group were significantly different(P < 0.001).BMD of Wards triangle was the lowest,while lumbar BMD value was the highest.③When the men patients were divided into two groups of normal bone mass and less bone mass,the frequencies of milk drinking and outdoor activities in normal bone mass group were higher than in less bone mass group(P = 0.031,P = 0.002,respectively);④LDL-C levels both in slowdown group and OP group were significantly higher than in normal bone mass group(P < 0.05),while ALP and OC levels were lower(P < 0.01,P = 0.01,respectively).⑤BMI and OC were both positively correlated with BMD in elderly patients with knee OA,while age and LDL-C levels were negatively correlated with BMD.Conclusion Elderly men OA comorbid OP were less frequent than elderly women OA patients.Milk-drinking and outdoor sports seemed to prevent OP in elderly men OA patients.Osteoarthritis patients with higher LDL-C levels,or greater age were more likely to develop into OP.Elderly men OA patients with comorbid OP were mainly caused by reduced activity of osteoblasts,which was defined as low transformation.OP should be more focused on in diagnosis and treatment of male OA.