A＆R：萎缩型髋部OA患者发生骨质疏松性骨折的风险高
2013-03-15 Arthritis Rheum 丁香园
萎缩型髋部OA患者发生骨质疏松性骨折的风险更高 萎缩型髋骨关节炎（OA）的特征是关节软骨退化而无骨赘形成。萎缩型OA患者尚未被深入研究，这类OA与其他类别OA相比，在骨组织方面是否具有不同的骨赘形式尚不明确。为此，来自荷兰鹿特丹伊拉兹马斯医学中心的Martha C. Casta?o-Betancourt等研究者进行了一项研究。研究者将萎缩型OA患者与其他骨赘形式的OA患者（正常型/肥大型）及
萎缩型髋部OA患者发生骨质疏松性骨折的风险更高
萎缩型髋骨关节炎（OA）的特征是关节软骨退化而无骨赘形成。萎缩型OA患者尚未被深入研究，这类OA与其他类别OA相比，在骨组织方面是否具有不同的骨赘形式尚不明确。为此，来自荷兰鹿特丹伊拉兹马斯医学中心的Martha C. Castaño-Betancourt等研究者进行了一项研究。研究者将萎缩型OA患者与其他骨赘形式的OA患者（正常型/肥大型）及无OA的个体进行比较，以检测其骨矿物密度（BMD）、髋关节结构性质及骨折风险的不同。研究结果发表于2013年3月的《关节炎与风湿病》（ARTHRITIS & RHEUMATISM）杂志上。研究者发现，萎缩型髋部OA患者发生骨质疏松性骨折的风险增高，但该风险不能完全用其较低的总BMD值进行解释。
本研究是大型人口前瞻性队列研究——鹿特丹研究的一部分。研究者共收集了5006例参与者的数据，评估了各参与者在基线时的OA状况、BMD值、骨几何结构，以及此后偶发的非脊柱骨质疏松性骨折的病史（平均随访期为9.6年）。研究者评估了OA患者组与对照组（无关节间隙狭窄或骨赘的个体）在骨特征方面的不同点。使用Cox相对危险回归法预测骨质疏松性骨折的发生风险。
萎缩型OA患者与正常型OA患者及对照组个体相比，其总BMD值更低（全身BMD值分别降低了6.5%及9%，头盖骨BMD值分别降低了4%和5%）。具有骨赘的OA患者相比于对照组个体或萎缩型OA患者，其全身BMD值升高了4%、头盖骨BMD值升高了5%，并具有更宽的股骨颈、更好的骨强度（剖面系数分别升高了12%和5%）。萎缩型OA患者与对照组个体相比，其骨质疏松性骨折的发生风险升高了50%（HR 1.48，P=0.008）。这项差别不能通过BMD值、摔倒次数、伤残程度及糖皮质激素用药史等因素的差异来进行解释。
研究发现，与对照组相比，萎缩型髋部OA患者发生骨质疏松性骨折的风险增高，但该风险不能完全用其较低的总BMD值进行解释。
与骨折相关的拓展阅读：
Objective
The atrophic type of hip osteoarthritis (OA) is characterized by cartilage degradation without the formation of osteophytes. Individuals with atrophic OA have been less well studied, and it is unknown whether this OA type differs from the osteophytic types with regard to bone tissue. The purpose of this study was to examine bone mineral density (BMD), hip structural properties, and fracture risk in individuals with the atrophic type of OA as compared to those with the osteophytic types (normotrophic/hypertrophic) as well as individuals without OA.
Methods
This study is part of the Rotterdam Study, a large prospective population-based cohort study. We examined 5,006 participants who had been assessed for OA, BMD, and geometric measures at baseline and for incident nonvertebral osteoporotic fractures (mean followup 9.6 years). We estimated the differences in bone characteristics between the OA groups and the controls (no joint space narrowing or osteophytes). Cox proportional hazards regression was used to calculate osteoporotic fracture risk.
Results
Participants with atrophic OA had systemically lower BMD as compared to those with normotrophic OA and as compared to the controls (6.5% and 9% for total body BMD; 4% and 5% for skull BMD, respectively). Participants with osteophytic OA had ∼4% and ∼5% higher total body and skull BMD, respectively, a wider femoral neck, and greater bone strength (12% and 5% higher section modulus, respectively) as compared to the controls or to those with atrophic OA. The risk of osteoporotic fractures was almost 50% higher in those with atrophic OA as compared to the controls (hazard risk 1.48, P = 0.008). This difference was not explained by differences in the BMD, number of falls, degree of disability, or use of corticosteroids.
Conclusion
Individuals with atrophic hip OA have an increased risk of osteoporotic fractures that is not fully explained by systemically lower BMD as compared to controls.
作者：Arthritis Rheum
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#萎缩#
33
#骨质疏松性骨折#
38
#髋部#
0
#骨质#
35