The Role of Bone Metabolism in the Pathogenesis of Gonarthrosis
The topicality of the problems of the knee joints osteoarthritis (gonarthrosis) is caused by its wide spreading and high risk of the restriction of joint function with the further disability and reduced quality of patients’ life. The goal and the objectives of this study were to evaluate the role of the bone metabolism with different variants of the clinical course of gonarthrosis, the links with the development of osteoporosis, bone destructive changes in the knee joints according to the findings of X-ray, sonography, magnetic imaging, X-ray densitometry. Material and methods. We observed 104 patients with osteoarthrosis (47 % men and 53 % women) aged from 32 to 76 years old. Gonarthrosis is revealed in 96 % of the cases. Overt reactive synovitis was diagnosed in 62 % of the cases by the results of the clinical and sonographic study, polyarthrosis in 55 %, systemic osteoporosis in 14 %, osteocystosis in 91 %, spondylopathy as osteochondrosis and athrosis of facet joints was detected in 72 %. Results. Significant changes in the blood markers of bone metabolism in the patients with gonarthrosis are observed, at the same time it reveals itself in the imbalance of osteoassociated macroelements (calcium, magnesium, phosphorus) with the development of hypocalcemia, which was detected in 98 %, high activity of alkaline phosphatase (47 % of the cases), signs of hyperparathyroidism and hyperosteocalcaemia. Bone metabolic disturbances in the knee joints osteoarthritis are associated with the rates of the progression of the disease and the spreading of the articular syndrome, and the indices of blood markers of bone metabolism can have a prognostic value. Markers of bone metabolism (osteoassociated macroelements, hormones parathyrin, calcitonin, osteocalcin, and alkaline phosphatase enzyme) are involved in the pathogenetic construction of gonarthrosis and they determine the development of individual radiographic, sonographic and magnetic imaging articular and periarticular signs of the pathology of the knee joints (the degree of narrowing of the articular slits, epiphyseal osteoporosis, trabecular oedema in the condyles of the femur (thigh-bone) and tibia (shinbone), the changes of the horns of meniscus, the formation of Baker cysts, intraarticular cartilage flaps and Hoffa bodies). Conclusion. The bone metabolic disturbances have clinical and pathogenetic significance in gonarthrosis that requires the development of specific medical technologies for treatment and rehabilitation of such patients.
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