LEADING FACTORS IN THE DEVELOPMENT OF COXARTHROSIS IN COMBINATION WITH OSTEOPENIA IN WOMEN

Abstract

The aim of the study. Conduct research to determine the leading factors in the development of coxarthrosis in combination with osteopenia in women.
Materials and methods. The study involved 40 women aged 50 to 70 years, patients with coxarthrosis stage I- II according to Kellgren-Lowrence in combination with osteopenia. Women with stage II coxarthrosis predominated among the patients.
The history, clinical picture, functional disorders of the hip joint, trophological status, examination, palpation of the joints, joint mobility (goniometry), assessment of the condition of the cancellous bone tissue were performed by ultrasound densitometry of the calcaneus and statistical studies.
Results. The study of medical history showed that the duration of CA in 95.0% of patients ranged from 1 to 5 years, which was (3.85±0.36) years. The number of exacerbations per year was 1.9±0.17. The duration of remission periods, respectively, was (7.2±0.5) months. When analyzing the results of ultrasonic densitometric examination, bone mineralization disorders were found in all patients. The degree of osteopenia increased with the age of patients, as well as with the stage of coxarthrosis and its duration. Along with this, there was a decrease in the quality parameters of the bone: elasticity, density, and bone strength. The predominant risk factor for coxarthrosis is overweight, as half of patients have a BMI (27.2±0.6). With increasing BMI, bone mineral density changed significantly. To a lesser extent, the risk factors for the disease were influenced by hard physical labor, hypodynamics, obesity and scoliotic posture. The degree of damage to the hip joint was directly correlated with the rate of trauma to patients. In the analysis of clinical symptoms, it was found that the WOMAC-A index was dominated by pain of moderate intensity, which increased with decreasing T-index (r = -0.63; p = 0.003), elasticity (r = – 0.67; p = 0.001) , density (r = – 0.56; p = 0.01) and bone strength (r = – 0.64; p = 0.002). More than half of the patients had morning and initial pain. Potential conditions for the intensification of the pain syndrome were: walking on uneven terrain – in 50.0% of patients, climbing stairs – in 45.0%, descending stairs – in 35.0%. In 55.0% of women, the pain worsened during prolonged standing. Excess body weight affected the pain during the ascent and descent of the stairs. The stiffness of the joint according to the WOMAC-B index was also mostly moderate. But its level increased with decreasing elasticity (r = -0.54; p = 0.01) and density (r = -0.50; p = 0.03) of bone tissue.
Conclusions: the multifactorial etiology of coxarthrosis and osteodeficiency was revealed, which consists of constitutional factors, environmental factors, genetic susceptibility, mechanical and traumatic injuries, as well as endocrine and metabolic changes in the body that disrupt the processes of subchondral remodeling. The mechanisms of development of spacecraft and OP show both differences and similarities between these states. The close relationship between the clinical manifestations of CA and the functional state of the hip joints of women was due on the one hand to risk factors, on the other, the degree of osteopenia and elasticity, the density of the trabecular layer of bone tissue and its strength. This allows us to assert the causal relationship between the development of spacecraft in combination with osteopenia.