Das gemeinsame Auftreten von Osteoporose und Arthrose und der Nutzen der Knochenstoffwechselmarker

Objective Increasing bone mineral density (BMD) has been found in several studies in patients with osteoarthritis. Therefore, many clinicians deny the simultaneous occurrence of osteoporosis (OP) and osteoarthritis (OA). Because of our clinical impression however, we suggested that we have to consider a common occurrence. Furthermore, the value of markers of bone turn over with a view to early diagnosis of OP and or as an assessment for bone metabolism in OA is still a matter debate and their clinical use has not been clearly defined in the management of the individual patient. Method The BMD of the lumbar spine and the proximal femur of 119 OA patients (83 postmenopausal female patients aged 50-83 and 35 male patients aged 36-86 years) who subsequently required hip or knee replacements, but were otherwise healthy, were measured by dual energy X-ray absorption (DXA), Hologic QDR-2000. We also measured biochemical markers of bone turn over, i.e., CICP, ICTP, DPD, PTH, estrogen, testosterone, bAP, hydroxy vitamin D and the normal blood count. Results There was a high occurrence of a low BMD among the patients. A total of 28.9% of women were affected by OP and 52.9% by osteopoenie. This reflects the normal distribution of OP in the female population. Of the male patients 20% had OP and 38.8% osteopoenie. This is astonishing high. Age proved to be a significant factor in the degree of BMD. An association between disuse osteoporosis and degree of BMD in the OA affected joint could not be proven. The use of the biochemical markers for an earlier diagnosis or to assess bone metabolism in OP and OA was not possible. Conclusion We can not support the hypotheses that OA prevents OP. Moreover, the occurrence of OP in our study reflected the incidence of OP in the average female and the astonishingly high incidence in the male population; however does not mean that the two conditions are mutually exclusive. We did not find that the biochemical markers of bone turn over could deliver additional information with respect to bone metabolism and an earlier diagnosis of OP.