Показники вітаміну D у жінок з артрозом на тлі низької мінеральної щільності кісткової тканини

Abstract

У 71 жінки зі сполученням артрозу та низької мінеральної щільності кісткової тканини (МЩКТ) досліджено деякі показники мінерального обміну (кальцій загальний, кальцій іонізований, магній, фосфор, паратгормон) та вітамін D (25(ОН)D). Дефіцит вітаміну D на тлі низької МЩКТ мав місце у 10% жінок, недостатність – у 90% жінок з гонартрозом; у разі коксартрозу недостатність було зафіксовано у 96% жінок, нормальні показники – у 4% жінок; у разі поєднання гонартрозу і коксартрозу у 93% жінок була недостатність вітаміну D, нормальні показники відмічено у 7% жінок; У 71 женщины с сочетанием артроза с низкой минеральной плотностью костной ткани (МПКТ) исследованы некоторые показатели минерального обмена (кальций общий, кальций ионизированный, магний, фосфор, паратгормон) и витамин D (25(ОН)D). Дефицит витамина D на фоне низкой МПКТ имел место у 10% женщин, недостаточность – у 90% женщин с гонартрозом; при коксартрозе недостаточность зафиксирована у 96% женщин, нормальные показатели – у 4% женщин; при сочетании гонартроза и коксартроза у 93% женщин выявлена недостаточность витамина D, нормальные показатели зафиксированы у 7% женщин; Osteoarthritis and osteoporosis are prevalent among diseases of the musculoskeletal system in the elderly. Between these pathologies there is a relationship, as well as differences. Both diseases are considered as metabolic, with a high incidence in the population and a risk of fracture, which is characteristic not only for patients with osteoporosis but also with osteoarthritis. According to the literature, the osteoarthritis occurs in a high percentage of cases at low bone mineral density (BMD). Due to the high frequency of combined lesion, common the criteria in patients are constantly being sought to find out the mechanisms for development for to pathogenetic therapy. Particular attention is drawn to vitamin D. The purpose of the investigation: to study the features of the content of vitamin 25 (OH) D in serum in patients with osteoarthritis in the background of low mineral density. Object and methods. The object of the study is vitamin D in women with osteoarthritis, in combination with reduced BMD. BMD studies were performed on the Explorer QDR (Holodgic) bone densitometer on three parts of the skeleton: the lumbar spine, the proximal femor, and the distal part of the forearm. If in one of the investigated sections of the skeleton a decrease in mineral density was found, a diagnosis of osteopenia or osteoporosis was performed, in accordance with the T-criteria of the WHO. The study included 71 women. The criteria for inclusion of patients in the study of vitamin D indices were: osteoarthritis of different localization and BMD, corresponding to osteopenia or osteoporosis. Exclusion criteria – concomitant pathology: rheumatic diseases, glucocorticoid osteoporosis, endocrine pathology and oncological diseases. Investigation into the blood serum of the active metabolite of vitamin D – 25 (OH) D and some mineral metabolism indices (total calcium, calcium ionized, magnesium and phosphorus, parathyroid hormone,) was conducted. Research results. Women included in the study were by age (62.67 ± 0.82) years, with weight (73.54 ± 1.36) kg, height (157.70 ± 0.66) cm, menopause age (48, 84 ± 0,52) years. All women had excess body weight, an index (29.79 ± 0.58), corresponding to the WHO classification of overweight. By localization of osteoarthritis in the segments of the skeleton among patients, the most were women with gonarthrosis 45.07%, coxarthrosis 33.8%, with a combination of gonarthrosis and coxarthrosis – 21.13%. In the examined 71 women with osteoarthritis, osteopenia was prevalent (70.4%), and 29.6% of women found osteoporosis. In the study of women with localization of osteoarthritis in different parts of the skeleton in the group with coxarthrosis – 100% osteopenia was detected, and in the group with gonarthrosis and in combination with gonarthrosis and coxarthrosis, osteoporosis was found 45.5% and 40% of women, osteopenia was found to be 54.5 and 60% of women, respectively. At the first stage of the study, vitamin D and some mineral metabolism indices were studied in all women with a diagnosis of «osteoarthritis» in combination with low BMD. It was found that vitamin D levels were lower and were within the insufficiency (<20 ng/ml). Indicators of ionized calcium, phosphorus, magnesium and parathyroid hormone corresponded to the reference norms. Total calcium was slightly decreased. At the next stage of the study, the level of vitamin D was evaluated serum of blood depending on the localization of osteoarthritis in different segments of the skeleton. It was found that against a background of low BMD, deficiency of 25(OH)D was observed in 10% of women with gonartrosis, insufficient – in 90% of women. In the case of coxarthrosis with a combination of low BMD, insufficient vitamin D levels were in 96% of women, with a combination of gonartrosis and coxarthrosis – 93%. In general, 93.3% of women with osteoarthritis of a different localization on the background of low BMD had vitamin D deficiency and only 2.7% of women had indices of norm. Conclusion. In our study, it was found that in the case of osteoarthritis and low BMD, insufficient vitamin D was found in the examined women. Only 2.7% of women had normal vitamin D levels. When analysing the state of vitamin D in women with gonorrhea, coxarthrosis and in combination with gonarthrosis and coxarthrosis was deficiencies of vitamin D exceeded 90%.