Bone turnover markers as surrogates of fracture healing after intramedullary fixation of tibia and femur fractures

Bone & Joint Research

article

Christopher C. Stewart¹  Nathan N. O’Hara²  Sofia Bzovsky³  Chelsea S. Bahney⁴  Sheila Sprague³  Gerard P. Slobogean² 

[1] Department of Orthopaedic Surgery, University of California;Department of Orthopaedics, University of Maryland School of Medicine;Division of Orthopaedic Surgery, Department of Surgery, McMaster University;Steadman Philippon Research Institute, Center for Regenerative & Personalized Medicine

关键词: Fracture;    Bone turnover marker;    Vitamin D;    CTX;    P1NP;    fracture healing;    femur fractures;    tibia;    Bone turnover markers;    Serum;    femoral shaft fractures;    type I collagen;    randomized controlled trial;   

DOI  :  10.1302/2046-3758.114.BJR-2021-0226.R1

学科分类：骨科学

来源: British Editorial Society Of Bone And Joint Surgery

【 摘 要 】

AimsBone turnover markers (BTMs) follow distinct trends after fractures and limited evidence suggests differential levels in BTMs in patients with delayed healing. The effect of vitamin D, and other factors that influence BTMs and fracture healing, is important to elucidate the use of BTMs as surrogates of fracture healing. We sought to determine whether BTMs can be used as early markers of delayed fracture healing, and the effect of vitamin D on BTM response after fracture.MethodsA total of 102 participants aged 18 to 50 years (median 28 years (interquartile range 23 to 35)), receiving an intramedullary nail for a tibial or femoral shaft fracture, were enrolled in a randomized controlled trial comparing vitamin D3 supplementation to placebo. Serum C-terminal telopeptide of type I collagen (CTX; bone resorption marker) and N-terminal propeptide of type I procollagen (P1NP; bone formation marker) were measured at baseline, six weeks, and 12 weeks post-injury. Clinical and radiological fracture healing was assessed at three months.ResultsCTX and P1NP concentrations peaked at six weeks in all groups. Elevated six-week CTX and P1NP were associated with radiological healing at 12 weeks post-injury (odds ratio (OR) 10.5; 95% confidence interval 2.71 to 53.5, p = 0.002). We found no association between CTX or P1NP and functional healing. Baseline serum 25(OH)D showed a weak inverse relationship with P1NP (p = 0.036) and CTX (p = 0.221) at 12 weeks, but we observed no association between vitamin D supplementation and either BTM.ConclusionGiven the association between six-week BTM concentrations and three-month radiological fracture healing, CTX and P1NP appear to be potential surrogate markers of fracture healing.

【 授权许可】

CC BY-NC