Минеральная плотность кости и уровень кальцитриола у больных остеохондрозом

Abstract

В останні роки увага дослідників звернена на метаболізм вітамін D в організмі пацієнтів при різній патології. Метою дослідження було: вивчити мінеральну щільність кістки і рівень в сироватці крові активного метаболіту вітаміну D – кальцитріолу у жінок постменопаузального періоду хворих на остеохондроз в поєднанні з остеопорозом. У 44 обстежених жінок в проекції тіл хребців спостерігали остеопенію (нижня межа) на тлі вираженого дефіциту кальцитріолу. У 33 жінок (перша група) зафіксований дефіцит кальцитріолу, у 11 жінок – нижня межа недостатності вітаміну D в харчуванні (друга група). Клінічна симптоматика остеохондрозу у пацієнтів з низькою МПК і дефіцитом або недостатністю в харчуванні вітаміну Д3 погіршувалася.

В последние годы внимание исследователей обращено на метаболизм витамин D в организме пациентов при различной патологии. Целью исследования явилось: изучить минеральную плотностью кости и уровень в сыворотке крови активного метаболита витамина D – кальцитриола у женщин постменопаузального периода больных остеохондрозом в сочетании с остеопорозом. У 44 обследованных женщин в проекции тел позвонков наблюдали остеопению (нижняя граница) на фоне выраженного дефицита кальцитриола. У 33 женщин (первая группа) зафиксирован дефицит кальцитриола, у 11 женщин – нижняя граница недостаточности витамина D в питании (вторая группа). Клиническая симптоматика остеохондроза у пациентов с низкой МПК и дефицитом или недостаточностью в питании витамина Д3 усугублялась.

Osteoporosis, a common metabolic disease, is often combined with orthopedic pathology. The search for factors leading to osteoporosis is an actual problem. In recent years, the attention of researchers has been turned to the metabolism of vitamin D in osteoporosis, as in the conditions of its deficiency the regulation of mineral ion homeostasis is disrupted, calcium absorption in the intestine and bone mineralization are reduced, myogenesis is disturbed, which leads to muscle weakness, cognitive impairment, increased risk of falls and fractures. In a previous study in postmenopausal women with a combination of osteochondrosis and osteoporosis, the state of total vitamin D (calciferol, D2 + D3) and 25-hydroxycholecalciferol (25 (OH) D3, calcidol) was studied. The aim of the study was to study the bone mineral density (BMD) and serum level of the active metabolite of vitamin D-calcitriol in postmenopausal women with osteochondrosis combined with osteoporosis. Verification of osteochondrosis was carried out taking into account patients’ complaints, data of anamnesis, clinical and radiological examination. The growth and weight of the patients were measured, the body mass index was calculated. An active metabolite of vitamin D – calcitriol, as well as mineral metabolism indices – total and ionized calcium, phosphorus, magnesium – was studied in the blood serum. All 44 women examined in the projections of vertebral bodies were observed osteopenia (lower limit) against the background of a pronounced deficiency of calcitriol. In 33 women (the first group) there was a deficiency of calcitriol, in 11 women – the lower limit of vitamin D deficiency in the diet (the second group). In terms of the ВМD of the vertebral bodies, osteopenia was revealed in the examined patients of the first group, the initial group of osteoporosis was revealed in the second group. Mineral calcium metabolism in the patients of the two groups was within the reference norm (2.15-2.5 mmol/l), and in ionized calcium – increased in women of the second group (reference norm -0.5-1.3 mmol/l). Magnesium and phosphorus indices were increased in patients of the first group. Clinical symptomatology of osteochondrosis in patients with low BMD and deficiency or deficiency in nutrition of vitamin D3 was aggravated. The duration of the disease according to the history was from 6 to 10 years. VAS of pain was estimated at 5.4 points. Movement in the lumbar spine was limited, the paravertebral zones of the thoracic and lumbar regions were tense and painful. Patients complained of rapid fatigue, decreased muscle tone, diffuse myalgia. In 81.8% of patients we recorded deformations of the vertebral bodies in the lumbar and thoracic spine. The combination of a decrease in bone mineral density with vitamin D deficiency is a stable factor present in elderly patients with osteoporosis combined with osteochondrosis. Many effects of vitamin D are known – effects on the cardiovascular and immune system, muscle, nerve and bone tissues. In this regard, the underreceipt of this vitamin leads to a disruption in the metabolism of the body, and its sufficient intake is an important part of the treatment regimen for elderly and senile patients.