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Osteoporosis and osteoarthrosis in women of uzbek nationality of old age based on digital x-ray and densitometry research
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Rustamova Umida Mukhtarovna, MD, senior scientific researcher, Head of X-ray Department of Scientific Research institute Of Traumatology and Orthopaedics under the Ministry
of Healthcare of The Republic of Uzbekistan [email protected]
Osteoporosis and osteoarthrosis in women of uzbek nationality of old age based on digital x-ray and densitometry research
Abstract: Based on the analysis of the association of the two diseases in the age aspect, data, and digital X-ray densitometry studies it was revealed a positive dependence between osteoartrozis and osteoporosis. The results show that the incidence of osteoarthritis and osteoporosis is mainly observed after 40 years, but most often after age 50, whereas the expressed structural radiographic changes of the knee joint bones epimetaphysis are observed more after 60 years old.
Keywords: Osteoporosis, osteoarthrosis, women, menopause, knee, digital radiography, densitometry.
Introduction. Problem of osteoporosis and osteoarthritis is currently very topical. This pathology is very common and is increasing as the population ages [2; 5]. In recent years particular attention is paid to the relationship between these two pathologies [4; 6]. Since osteoporosis is a common systemic metabolic disease of the skeleton, except for changes microarchitectonics bone may be affected all the components of the knee joint — the articular cartilage, capsule and periarticular tissues. Osteoporosis and osteoarthritis according to some authors may be interconnected or mutually complementary disease [1].
The first reports about it appeared about 40 years ago. In the beginning there were conflicting views on diseases and eventually began to appear information about the relationship ofbone mineral density of the peripheral skeleton with the risk of osteoarthritis [7]. According to research of M. C. Hochberg et al. (2004), increased risk of osteoartrosis of knee is associated with high bone mineral density [3].
Purpose — to identify connection of osteoporosis and osteoarthrosis in women in menopausal age by interpreting the results of digital radiographic and densitometric studies.
Material for the study — 280 women of Uzbek nationality were treated in the sports injury department, orthopedics and adult outpatients who came for counseling to clinic of SRI of Traumatology and Orthopaedics of Ministry of Health of the Republic of
Uzbekistan.
Methods of research is Digital X-ray and densitometry. Radiological studies were conducted on the digital X-ray machine Flexavision Company Shimadzu (made in Japan). Densitometric studies were conducted by using a densitometer Stratos Campaign DMS (made in France) under the "whole body" and standard programmes. It was studied bone structural changes of epimetaphysis bone and joint status of mineral density bones. Received research results are compared.
The main results and their discussion. All of the surveyed women were divided into two groups: the first group of women (168 women — 60%) with osteoarthritis of the knee and a second
group were women (112 women — 40%) without osteoarthritis. Surveyed from 45 to 85 years of age, 168 (60% of all amount of patients) women of the main group were distributed in the following age aspect: from 45 to 55 years — 22 women (13% of the number of main group), 56-65 years — 49 women (29,2%), 66-75 years — 55 women (32.8%), 76-85 years — 42 women (25%).
112 surveyed (40% of total patients) in the control group were women aged 45 to 55 years — 76 women (67.9 among the control group), 56-65 years — 35 women (31.2%), 66 -75 years — female 1 (0.9%) there were not any patients aged 76-85 years. The average age of a main group of women = 64.2 years, in the control group = 53.3 years. As digital radiographs the condition of the knee was evaluated in patients in both groups: joint space, the contours of the articular surfaces, X-ray angles, the structure of the bones of the joint.
To determine the radiological stage of osteoarthritis of the knee we use a classification J. Kellgren and I. Lawrence (1957), M. Le-quesne improved in 1982, based on an assessment of the severity of narrowing of the X-ray joint space, subchondral osteosclerosis and edge magnitude bone growths, where 4 stage are divided: 0 — absence of radiographic signs; I — doubtful; II — minimal; III — average; IV — expressed. Using this classification, we divided the surveyed women into 5 groups, depending on the severity of the disease: Group 1 — Stage 0, i.e, the formation of arthrosis, Group 2 — Stage 1, Group 3 — Stage 2, Group 4 — Stage 3, Group 5 — Stage 4 osteoarthrosis.
In women of a main group X-ray changes were minimal at the first stage. At this stage — the stage of formation of osteoarthri-tis — pain and inflammation are clinically observed. In the second stage unevenness moderate joint space narrowing was found. When the third and fourth stages of osteoarthritis of the knee it is defined noticeable uneven contraction and deformation of the X-ray joint space. It was marked deformation and uneven narrowing (medial segment) of joint space. It was mentioned that seal subchondral cortical layer inside ofwhich there were visible portions dilution — cortical and subchondral cysts ofvarious shapes and sizes.
Section 6. Medical science
In some cases, these cysts are big enough, and can take a condyle, a digital radiograph picture of such changes are identified more clearly.
Structural changes areas are observed equally in the medial and lateral segments; in some cases, changes are accompanied with seal meniscus and medial and lateral ligaments, which often occurs at the level of the medial ligament. The contours of the articular surfaces are unevenly sealed, and joint contours are clear, and inner contours are rough, fuzzy, distorted. X-ray corners are pointed with the presence ofvarious forms of osteophytes. During the study of the structure of the bones of the joint we took into account the imposition of shade on the center of the patella epimetaphysis distal femur, where there is a sealed portion of bones shade. These changes were more pronounced depending on the stage of the disease.
There is a clear image of trabecular bone structure at epimetaphysis level where subchondral cysts in the third and fourth stages of osteoarthritis are differentiated. There are perichondral osteophytes, often with a beak-shaped formations that pointed more in the medial segment. Degenerative changes were more pronounced in the medial segment of the bone joint (predominant localization in the medial segment) — in 112 patients, in the lateral segment — 15, in all segments — 2. Among the 15 patients with primary localization of degenerative changes in the lateral segment in 11 it was revealed that they had injury before.
Based on the above criteria (primary and often advantageous changes of the knee joint medial segment of the medial joint space narrowing, more pronounced medial osteophytosis and many more.) We can assume not only damage of the articular cartilage, but also of the medial meniscus — at this period already meniscopathy. Changes associated with a particular X-ray angles in the intercondylar eminences, they can beconnected not just a degenerative process of the articular surface, but also a partial cruciate ligament calcification. Changes in the form of osteophytosis at base level and apex of the patella indicate not only the damage to the articular surface of the patella-femoral, and partial calcification of the tendon of the quadriceps muscles and the patellar tendon.
It is also possible to note changes in the knee joint axis ofvarus or valgus deformity, which increases depending on the stage of gon-arthrosis; violation of the ratio of the bones of the joint, which is more common in the outer segment; hondrome body, which are often observed at the posterior segment of the joint.
Osteoarthritis at the surveyed women has been identified mainly in the age 50-60 years — in menopause period. The first group of women of the main group (total of 168 women — 100%) during the densitometric studies in 105 (62%) it showed a decrease in bone mineral density of the skeleton, and in 63 patients (38%), bone
mineral density of the skeleton was within the age norm. Out of 105 female patients osteoporosis was diagnosed in 34 patients, and 69 patients had osteopenia.
In the second group of women in the control group out of 112 (100%) women mineral density of bones was within the age norm in 69 (62%), and decrease in bone mineral density ofthe skeleton was found in 43 (38%) patients. From them 12 patients are with osteoporosis and 31 patients had osteopenia. Women with osteoarthritis there is a decrease bone density varying degrees of frequency.
Among the methods of densitometry studies the most revealing were the results of the program «total body» and standard program in the projections of the lumbar spine and femur. Under the program «total body» decrease in bone mineral density was more pronounced in the bones of the spine, ribs and bones of the lower extremities. With standard study hip mineral density decrease was more pronounced in the trochanteric region of the femur, and lumbar spine mineral density decline was most pronounced at the level of the body VL 4. Among patients with osteoarthritis of the knee combined pathology was more common over the age of 50 years.
Reduced mineral density in women of the main group was noted in the majority of cases in the older age groups of patients: in 40-49 years in 14% of cases; 50-59-20%; 60-69-28% and in the 70-85 year — 38% of cases of osteopenia or osteoporosis.
Based on the analysis of the association of the two diseases in the age aspect, data, and digital X-ray densitometry studies it was revealed a positive dependence between osteoartrozis and osteoporosis. The results show that the incidence of osteoarthritis and osteoporosis is mainly observed after 40 years, but most often after age 50, whereas the expressed structural radiographic changes of the knee joint bones epimetaphysis are observed more after 60 years old.
Conclusions:
1) The women of Uzbek nationality in menopausal age after 45 years we can see more frequent decline in bone mineral density and in the presence of osteoarthritis in these patients frequency of osteoporosis is increased mainly after 50 years of age.
2) Structural radiographic changes as subchondral cysts, local osteoporosis in women with osteartrosis is detected more near the articular surface — against the backdrop of the epiphysis bones of the knee joint.
3) The height of the epiphysis of the bone of the knee in osteoarthritis of third and fourth stages is reduced, which is more met on in the tibia.
4) Structural changes of epimetaphysis in the bones of the knee joint were better identified on digital radiographs than analog, and were more common in patients older than 60 years.
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