Evidence for increased bone resorption in patients with progressive knee osteoarthritis - Longitudinal results from the Chingford study
Evidence for increased bone resorption in patients with progressive knee osteoarthritis - Longitudinal results from the Chingford study
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DOI：
10.1002/art.10630
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发表时间：
2002-12-01
影响因子：
--
通讯作者：
Spector, TD
中科院分区：
文献类型：
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作者：
Bettica, P;Cline, G;Spector, TD
Objective.一些研究表明，增加软骨下骨转换是骨关节炎（OA）进展的决定因素。为了验证这一假设，在Chingford研究的一个患者亚组中，在3个不同的时间点测量了尿N-末端I型胶原端肽（NTx）和C-末端I型胶原端肽（CTx）的水平，这两种蛋白是经验证的骨吸收标志物。最初的Chingford研究人群包括1，003名女性。从该组中，确定未接受任何骨修饰药物的绝经后女性，这些女性具有基线膝关节X线片和4年后的重复X线片，并且其基线腰椎骨矿物质密度（BMD）测量结果可用，并分为4组，如下所示：对照组（n = 50）、进展性OA（n = 71）、非进展性OA（n = 36）和骨质疏松症（n = 59）。分别于基线、第1年和第2年采集尿液，测定NTx和CTx。基线时各组患者的年龄和绝经后年数相似。正如预期的那样，骨质疏松症患者的体重指数（BMI）和骨密度均最低。进展性OA或骨质疏松患者3个时间点的中位吸收标志物水平比对照组和非进展性OA患者高31-87%（P < 0.01，进展性OA患者与非进展性OA患者的CTx水平除外）。NTx和CTx水平在进展性OA（定义为骨赘或关节间隙狭窄）和骨质疏松症患者之间或对照组和非进展性OA患者之间无显著差异。校正年龄、BMI、BMD和既往激素替代治疗后，或单独分析每个时间点的NTx和CTx值后，结果基本不变。我们的数据表明，进行性膝关节OA患者的骨吸收增加，而非进行性膝关节OA患者的骨吸收没有增加。在进行性膝关节OA患者中观察到的骨吸收增加与骨质疏松症患者中观察到的相似。骨转换改变可能是进行性OA患者的诊断或治疗目标。
Objective. Several studies have suggested that increased subchondral bone turnover is a determinant of progression of osteoarthritis (OA). To test this hypothesis, the level of urinary N-terminal type I collagen telopeptides (NTx) and C-terminal type I collagen telopeptides (CTx), which are validated markers of bone resorption, was measured at 3 different time points in a subset of patients from the Chingford study.Methods. The original Chingford study population comprised 1,003 women. From this group, postmenopausal women not receiving any bone-modifying medication who had a baseline knee radiograph and a repeat radiograph 4 years later, and for whom a baseline lumbar spine bone mineral density (BMD) measurement was available, were identified and separated into 4 groups as follows: controls (n = 50), progressive OA (n = 71), nonprogressive OA (n = 36), and osteoporosis (n = 59). NTx and CTx were measured in urine samples collected at baseline, year 1, and year 2.Results. Patient age and years since menopause were similar among groups at baseline. As expected, both body mass index (BMI) and BMD were lowest in patients with osteoporosis. Median resorption marker levels over the 3 time points were 31-87% higher in patients with either progressive OA or osteoporosis than in controls and patients with nonprogressive OA (P < 0.01, except for levels of CTx in patients with progressive OA versus nonprogressive OA). Levels of NTx and CTx did not differ significantly between women with progressive OA (defined either by the presence of osteophytes or by joint space narrowing) and those with osteoporosis or between controls and women with nonprogressive OA. Results were essentially unchanged after adjustment for age, BMI, BMD, and past use of hormone replacement therapy, or when NTx and CTx values at each time point were analyzed separately.Conclusion. Our data demonstrate that bone resorption is increased in patients with progressive knee OA and is not increased in those with nonprogressive knee OA. The increase in bone resorption seen in patients with progressive knee OA is similar to that observed in patients with osteoporosis. Altered bone turnover may be a diagnostic or therapeutic target in patients with progressive OA.