Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients

Shota Ikegami, Mikio Kamimura, Hiroyuki Nakagawa, Kenji Takahara, Hiroyuki Hashidate, Shigeharu Uchiyama, Hiroyuki Kato, Shota Ikegami, Mikio Kamimura, Hiroyuki Nakagawa, Kenji Takahara, Hiroyuki Hashidate, Shigeharu Uchiyama, Hiroyuki Kato

Abstract

Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men) with femoral neck fracture and 21 patients (17 women and 4 men) with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP) was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX), as well as urine levels of C-terminal telopeptide of type I collagen (CTX) and deoxypyridinoline (DPD), were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX), five weeks (serum NTX and DPD), and 2-3 weeks (CTX) after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

Keywords: bone turnover marker; osteoporosis.; proximal femoral fracture.

Conflict of interest statement

Conflicts of interest: we declare that we have no conflict of interest or disclosures.

Figures

Figure 1
Figure 1
Time course of the serum levels of bone-specific alkaline phosphatase (BAP) in femoral neck fracture patients and trochanteric fracture patients.
Figure 2
Figure 2
Time course of the urine levels of N-terminal telopeptide of type I collagen (NTX) in femoral neck fracture patients and trochanteric fracture patients.
Figure 3
Figure 3
Time course of the serum levels of NTX in femoral neck fracture patients and trochanteric fracture patients.
Figure 4
Figure 4
Time course of the urine levels of deoxypyridinoline (DPD) in femoral neck fracture patients and trochanteric fracture patients.
Figure 5
Figure 5
Time course of the urine levels of C-terminal telopeptide of type I collagen (CTX) in femoral neck fracture patients and trochanteric fracture patients.
Figure 6
Figure 6
The difference in callus formation between trochanteric fracture and femoral neck fracture during each healing process in radiographs. In trochanteric fracture, increased radiodensity along the fracture line, which is regarded as callus formation, is observed at three months after surgery (shown by arrows). By contrast, the finding is inconspicuous in femoral neck fracture (shown by an arrow).

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