Characteristics of bone turnover in the long bone metaphysis fractured patients with normal or low Bone Mineral Density (BMD)

Abstract

The incidence of osteoporotic fractures increases as our population ages. Until now, the exact biochemical processes that occur during the healing of metaphyseal fractures remain unclear. Diagnostic instruments that allow a dynamic insight into the fracture healing process are as yet unavailable. In the present matched pair analysis, we study the time course of the osteoanabolic markers bone specific alkaline phosphatase (BAP) and transforming growth factor β1 (TGFβ1), as well as the osteocatabolic markers crosslinked C-telopeptide of type-I-collagen (β-CTX) and serum band 5 tartrate-resistant acid phosphatase (TRAP5b), during the healing of fractures that have a low level of bone mineral density (BMD) compared with fractures that have a normal BMD. Between March 2007 and February 2009, 30 patients aged older than 50 years who suffered a metaphyseal fracture were included in our study. BMDs were verified by dual energy Xray absorptiometry (DXEA) scans. The levels of BTMs were examined over an 8-week period. Osteoanabolic BAP levels in those with low levels of BMD were significantly different from the BAP levels in those with normal BMD. BAP levels in the former group increased constantly, whereas the latter group showed an initial strong decrease in BAP followed by slowly rising values. Osteocatabolic β-CTX increased in the bone of the normal BMD group constantly, whereas these levels decreased significantly in the bone of the group with low BMD from the first week. TRAP5b was significantly reduced in the low level BMD group. With this work, we conduct first insights into the molecular biology of the fracture healing process in patients with low levels of BMD that explains the mechanism of its fracture healing. The results may be one reason for the reduced healing qualities in bones with low BMD.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Course of BAP serum concentration during fracture healing of eight weeks in low BMD versus normal BMD patients.

Statistics were performed using the software SPSS 11.0.0 (IBM Germany, Munich, Germany), P≤0.05 was considered to be significant, p≤0.01 as very significant, and p≤0.001 as highly significant. Different levels of significance are marked by one to three stars.

Figure 2. Course of TGFβ1 serum concentration during fracture healing of eight weeks in low BMD versus normal BMD patients.

Statistics were performed using the software SPSS 11.0.0 (IBM Germany, Munich, Germany), P≤0.05 was considered to be significant, p≤0.01 as very significant, and p≤0.001 as highly significant. Different levels of significance are marked by one to three stars.

Figure 3. Course of CTX serum concentration during fracture healing of eight weeks in low BMD versus normal BMD patients.

Statistics were performed using the software SPSS 11.0.0 (IBM Germany, Munich, Germany), P≤0.05 was considered to be significant, p≤0.01 as very significant, and p≤0.001 as highly significant. Different levels of significance are marked by one to three stars.

Figure 4. Course of TRAP5b serum concentration during fracture healing of eight weeks in low BMD versus normal BMD patients.

Statistics were performed using the software SPSS 11.0.0 (IBM Germany, Munich, Germany), P≤0.05 was considered to be significant, p≤0.01 as very significant, and p≤0.001 as highly significant. Different levels of significance are marked by one to three stars.

Figure 5. Consolidation of the fractures following the Lane-Shandu-scoring after 4 and 8 weeks, assessed by two independent examiners.