Instrumental and biochemical indicators of the bone tissue state in osteomalacia and osteoporosis
Keywords:postmenopausal, osteoporosis, osteomalacia, diagnosis
Background. A decrease in bone mineral density (BMD), which occurs in osteomalacia (OM) and osteoporosis (OP), is accompanied by a decrease in the strength properties of bone structures and an increase in the risk of fractures. Despite the same clinical outcome (fractures), the morphostructural, etiological, and pathogenetic characteristics of OP and OM differ qualitatively. The purpose of our work was to study the diagnostic criteria for osteomalacia and osteoporosis in postmenopausal women. Materials and methods. We examined 157 postmenopausal (PM) women aged 57.5 ± 1.2 years, of which 103 women were diagnosed with OP (group I) and 24 were morphometrically diagnosed with osteomalacia (group II), control group (III) included 30 apparently healthy women. X-ray densitometry was performed (osteodensitometer Hologic Discovery (USA)). The blood serum level of 25(OH)D was determined by the enzyme immunoassay on a EUROIMMUN analyzer (Germany). Bone resorption marker C-terminal telopeptide of collagen type 1 (CTx), osteocalcin (OC), and parathyroid hormone (PTH) were assessed by the immunochemiluminescent assay, phosphorus level — by spectrophotometric method using a Cobas 6000 analyzer (Roche Diagnostics, Switzerland). The level of osteoprotegerin (OPG) was determined by enzyme-linked immunosorbent assay on an Axsym analyzer (Abbot, Germany). Statistical processing was performed using Microsoft Office Excel and Statistica 10.0 software. Student’s t-test was used for mathematical processing. When assessing the strength of the correlation coefficients, the Chaddock scale was used. Results. The analysis of the data obtained showed a decrease in BMD (p <0.05) in groups I and II. However, BMD neck, T-test neck, Z-test neck in the group of women with OM were significantly reduced (p < 0.05) in comparison with the group with OP. The levels of 25(OH)D, OC, OPG were also reduced (p < 0.05) in the second group of women compared with the first group. We obtained higher (p < 0.05) indices of PTH and CTx in the group of patients with OM in comparison with the group with OP. The correlation analysis of the obtained results showed a relationship between the level of 25(OH)D and indicators of structural and functional changes in BMD: 25(OH)D and CTx (r = –0.669; p = 0.001), 25(OH)D and BMD neck (r = 0.736; p = 0.002). There was also a direct relationship between BMD neck and CTx (r = –0.463; p = 0.002). Conclusions. The PM women with OM, in comparison with the PM women with OP, developed significantly larger (p < 0.05) changes in the structural and functional state of bone tissue, biochemical markers of bone tissue resorption and remodeling, as well as lower (p < 0.05) level of 25(OH)D. The 25(OH)D level is highly informative in terms of predicting and diagnosing a decrease in BMD and the risk of fractures. The biochemical marker of CTx resorption has a high informative value in terms of predicting, timely diagnosis, and the effectiveness of the treatment.
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