Department of Geriatric Medicine, The Canberra Hospital, ACT, Australia.
Bone. 2010 Aug;47(2):400-7. doi: 10.1016/j.bone.2010.04.610. Epub 2010 May 6.
To investigate whether clinical and laboratory characteristics, including serum 25-hydroxyvitamin D (25(OH) D), PTH and parameters of mineral and bone metabolism, differ by hip fracture (HF) type.
We studied prospectively 761 consecutively admitted older patients (mean age 82.3+8.8(SD) years; 74.9% women) with low trauma non-pathological HF. A detailed clinical examination was performed, haematologic, renal, liver and thyroid function tests, serum 25(OH)D, PTH, calcium, phosphate, magnesium, C-reactive protein (CRP) and cardiac troponin I (cTnI) measured. In a subset of 294 patients' markers of bone formation (serum osteocalcin, OC; bone specific alkaline phosphatase, BAP) and bone resorption (urinary deoxypyridinoline, DPD/Cr; N-terminal cross-linked telopeptide of type 1 collagen, NTx/Cr; both corrected to urinary creatinine, Cr) were also measured.
In the trochanteric compared to the cervical group, females were older than males and the prevalence of Parkinson's disease, mean haemoglobin and albumin levels were lower. Incidence and degree of myocardial injury (cTnl rise) and inflammatory reaction (CRP elevation) as well as length of hospital stay, need of institutionalisation or in-hospital mortality were similar in both groups. Hypovitaminosis D (25(OH)D <50 mmol/L) was present in 77.8% of patients with cervical and in 82.1% with trochanteric HF, elevated PTH (>6.8 pmol/L) in 30.2% and 41.3%, respectively. The associations between 25(OH)D, PTH, and parameters of mineral metabolism and bone turnover were site-specific. In multivariate analyses, PTH (both as a continuous or categorical variable) response to hypovitaminosis D was a strong independent predictor of HF type. Coexistence of vitamin D deficiency (25(OH) D< 25 nmol/L) and elevated PTH predicts trochanteric HF while blunted PTH response predicts cervical HF (OR=3.5; 95% CI 1.5-80; p=0.005). PTH response and phosphate status (above or below median level) correctly discriminated HF type in 73.8% of patients with vitamin D deficiency.
HF type is significantly associated with PTH response to hypovitaminosis D and impaired phosphate homeostasis. We detected only minor differences between two main HF types with regard to a wide range of clinical and routine laboratory variables as well as short-term outcomes.
研究髋部骨折（HF）类型是否与临床和实验室特征有关，包括血清 25-羟维生素 D（25（OH）D）、甲状旁腺素（PTH）和矿物质及骨代谢参数。
我们前瞻性研究了 761 例连续入院的老年低创伤非病理性 HF 患者（平均年龄 82.3+8.8（SD）岁，74.9%为女性）。进行了详细的临床检查，检测了血液学、肾功能、肝功能和甲状腺功能，测量了血清 25（OH）D、PTH、钙、磷、镁、C 反应蛋白（CRP）和心肌肌钙蛋白 I（cTnI）。在 294 例患者的亚组中，还测量了骨形成标志物（血清骨钙素、OC；骨特异性碱性磷酸酶、BAP）和骨吸收标志物（尿脱氧吡啶啉、DPD/Cr；I 型胶原 N 端交联肽、NTx/Cr；均校正至尿肌酐、Cr）。
与股骨颈组相比，转子间组女性年龄大于男性，帕金森病患病率、平均血红蛋白和白蛋白水平较低。两组心肌损伤（cTnl 升高）和炎症反应（CRP 升高）的发生率和程度，以及住院时间、需要住院或院内死亡率均相似。77.8%的股骨颈组和 82.1%的转子间组患者存在维生素 D 缺乏（25（OH）D<50 mmol/L），30.2%和 41.3%的患者甲状旁腺素（PTH）升高（>6.8 pmol/L）。25（OH）D、PTH 和矿物质代谢及骨转换参数之间存在部位特异性的关联。多变量分析显示，PTH（连续或分类变量）对维生素 D 缺乏的反应是 HF 类型的独立强预测因子。维生素 D 缺乏（25（OH）D<25 nmol/L）和 PTH 升高的共存预测转子间 HF，而 PTH 反应减弱预测股骨颈 HF（OR=3.5；95%CI 1.5-80；p=0.005）。在维生素 D 缺乏的 73.8%的患者中，PTH 反应和磷酸盐状态（高于或低于中位数水平）可正确区分 HF 类型。
HF 类型与 PTH 对维生素 D 缺乏的反应和磷酸盐稳态受损显著相关。我们在广泛的临床和常规实验室参数以及短期预后方面，仅检测到两种主要 HF 类型之间存在较小差异。
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