Yakovenchuk N. N.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

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%.

women, osteoarthritis, osteopenia, osteoporosis, vitamin D

1. Povoroznyuk VV. Sostoyanie problemyi osteoporoza i drugih metabolicheskih zabolevaniy skeleta v Ukraine. Novosti meditsinyi i farmatsii. 2014;3(487):10-3.[in Russiаn].
2. Povoroznyuk VV. Grigoreva NV. Menopauza i kostno-myishechnaya sistema. Kiev, Ekspres. 2004. 512 s. [in Russiаn].
3. Povoroznyuk VV. Pludovskі P. redaktori. Defіtsit ta nedostatnіst vіtamіnu D: epіdemiologiya, dіagnostika, profіlaktika ta lіkuvannya. Donetsk: Vidavets Zaslavskiy OYu. 2014. 262 s. [in Ukrainian].
4. Romanov GN. Rudenko EV. Sovremennyie problemyi vozrast-assotsiirovannyih zabolevaniy: osteoartroz i osteoporoz. Meditsinskie novosti. 2012;8:26-9. [in Russiаn].
5. Toroptsova NV. Vzaimosvyaz osteoporoza i osteoartroza. Lechaschiy vrach. Nauchno-prakticheskiy zhurnal. [Internet]. 2006;2. Dostupno: https://www.lvrach.ru/2006/02/4533438[in Russiаn].
6. Abu E, Maaty MA, Hanafi RS, El-Badawy S, Gad MZ. Interplay of vitamin D and nitric oxide in post-menopausal knee osteoarthritis. Aging Clin Exp Res. 2014;26:363-8. DOI:10.1007/s40520-013-0192-9
7. Bogunovic L, Kim AD, Beamer BS, Nguyen J, Lane JM. Hypovitaminosis D in patients scheduled to undergo orthopaedic surgery: a single-center analysis. J Bone Joint Surg Am. 2010 Oct 6;92(13):2300-4. DOI: 10.2106/JBJS.I.01231
8. Chin KF, Keen RW, Haddad FS. Vitamin D deficiency in patients with osteoarthritis undergoing total hip replacement: A cause for concern? J Bone Joint Surg Br. 2010 Apr;92(4):496-9. DOI: 10.1302/0301-620X.92B3.23535
9. EFFO and NOF (1997) Who are candidates for prevention and treatment for osteoporosis? Osteoporos Int. 1997;7(1):1-6.
10. Francis RM, Boyle IT, Moniz C, Sutcliffe AM, Davis BS, Beastall GH,et al. A comparison of the effects of alfacalcidol treatment and vitamin D2 supplementation on calcium absorption in elderly women with vertebral fractures. Osteoporosis International. 1996 July;6(4):284-90.
11. Kanis JA.WHO Technical Report, University of Sheffield. UK. 2007;66. Available from: https://www.sheffield.ac.uk/FRAX/pdfs/WHO_Technical_Report.pdf
12. Konstari S, Kaila-Kangas L, Jддskelдinen T, Heliцvaara M, Rissanen H, Marniemi J,et al. Serum 25-hydroxyvitamin D and the risk of knee and hip osteoarthritis leading to hospitalization: a cohort study of 5274 Finns. Rheumatology (Oxford). 2014 Oct;53(10):1778-82. DOI: 10.1093/rheumatology/keu178
13. Mabey T, Honsawek S. Role of Vitamin D in Osteoarthritis: Molecular, Cellular, and Clinical Perspectives. International Journal of Endocrinology.Volume 2015, Article ID 383918:14. Available from: http://dx.doi.org/10.1155/2015/383918
14. Marks R. Vitamin D and Cartilage: Does Vitamin D Influence Cartilage Integrity. Austin J. Musculoskelet. Disord. 2016;3(2):1-7. 
15. WHO: Global Database on Body Mass Index. Available from: http://www.assessmentpsychology.com/icbmi.htm
16. Yoshimura N, Muraki S, Oka H, Nakamura K, Kawaguchi H, Tanaka S, Akune T. Serum levels of 25-hydroxyvitamin D and the occurrence of musculoskeletal diseases: a 3-year follow-up to the road study. Osteoporos Int. 2015 Jan;26(1):151-61. DOI: 10.1007/s00198-014-2844-9

«Bulletin of problems biology and medicine» Issue 1 Part 1 (142), 2018 year, 222-226 pages, index UDK 616.71-007.234-616.72-008.1

10.29254/2077-4214-2018-1-1-142-222-226