骨代谢指标与骨关节炎及绝经后骨质疏松症的关系

背景：研究显示，在绝经后骨质疏松症及骨关节炎状态下，原本正常的骨转换平衡状态被破坏，血清、尿液中一些特异性指标可以较敏感地反映出骨转换的具体变化过程。 目的：测量绝经后原发性膝骨关节炎及绝经后骨质疏松症患者的骨密度及骨代谢指标，分析两疾病骨密度及骨代谢指标的变化特点。 方法：选取248例绝经女性受试者，行骨密度、膝关节X射线片检查，最终选出180例进入试验，分为骨关节炎组、骨质疏松组及对照组。对比分析各组观察对象的骨代谢指标：骨碱性磷酸酶、骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b。通过二元Logistic回归分析判断两疾病发病与各项指标间的相关性。 结果与结论：与对照组比较，骨关节炎组腰椎骨密度升高，Ⅰ型胶原交联C末端肽值降低；骨质疏松组腰椎及全髋部骨密度降低，骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b升高。血清Ⅰ型胶原交联C末端肽水平的降低与骨关节炎发病具有显著相关性；血清骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b水平的升高与骨质疏松发病具有显著相关性。提示绝经女性骨关节炎患者骨吸收速率减低，骨质疏松患者骨转换率加快，骨代谢水平的差异导致两疾病患者骨密度呈现出负相关趋势。监测Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b、骨钙素，特别是Ⅰ型胶原交联C末端肽血清水平对骨关节炎及骨质疏松的早期诊断及治疗有一定的参考价值。

Correlation of bone metabolic index with osteoarthritis and postmenopausal osteoporosis

BACKGROUND： Increasingly studies report that the normal balance of bone metabolism may be destroyed in the case of postmenopausal osteoporosis or osteoarthritis. The concrete metabolic process of bone turnover could be revealed sensitively by measuring the bone turnover markers in the serum or urine.
OBJECTIVE： To study the bone density and bone metabolic index of knee osteoarthritis （KOA） and postmenopausal osteoporosis （PMO）, and to discuss the characteristics of bone density and bone metabolic index in KOA and PMO.
METHODS： A total of 248 postmenopausal women were detected for bone mineral density and knee X-ray. Finally 180 patients were included in this study and were divided into three groups： KOA group, PMO group, and control group. The levels of bone turnover markers （bone alkaline phosphatase, bone gla protein, collagen type I cross-linked C-telopeptide, and tartrate-resistant acid phosphatase 5b） in serum from the participants were measured. The correlation between bone turnover markers and the disease progression was analyzed by Logistic regression analysis.
RESULTS AND CONCLUSION： The bone mineral density in the KOA group was higher than the control group but collagen type I cross-linked C-telopeptide was lower. The levels of bone gla protein, collagen type I cross-linked C-telopeptide, and tartrate-resistant acid phosphatase 5b in serum from PMO group were higher than the control group. The decrease of collagen type I cross-linked C-telopeptide was associated with the incidence of KOA, and the increases of bone gla protein, collagen type I cross-linked C-telopeptide, and tartrate-resistant acid phosphatase 5b were associated with the incidence of PMO. The lower bone absorption can be seen in postmenopausal women with KOA. PMO patients showed a higher bone turnover rate. The difference of bone metabolism between patients with KOA and PMO led to negative relationship of bone mineral density. The serum levels of bone gla protein, collagen type I cross-linked C-telopeptide, and tartrate-resistant acid phosphatase 5b can assist clinical diagnose and therapeutic effect detection of both KOA and PMO.