Hashidate Hiroyuki, Kamimura Mikio, Nakagawa Hiroyuki, Takahara Kenji, Ikegami Shota, Uchiyama Shigeharu, Kato Hiroyuki
Department of Orthopedic Surgery, Shinshu University, Japan.
Open Orthop J. 2011 Jan 14;5:32-6. doi: 10.2174/1874325001105010032.
The present study measured longitudinal changes in bone turnover markers in elderly patients with vertebral fracture and investigated the relationship among bone turnover markers, duration of bed rest and bone mineral density (BMD).
Criteria for patient selection were 50 years in age and older, and presence of VF. Serum bone-specific alkaline phosphatase (BAP) was measured as a marker of bone formation. Urinary crosslinked N-terminal telopeptides of type I collagen (NTX) was measured as a marker of bone resorption. In principle, samples were collected just after injury, within 24 h, and 1, 2, 3, 5 and 8 weeks after. We also measured duration of bed rest and BMD.
The study population consisted of 42 cases. The average BMD of the lumbar vertebrae was 0.670 ± 0.174 g/cm2. Bed rest period was 17.9 ± 8.8 days. BAP showed significantly higher values at 2 and 3 weeks compared with the baseline value. Thereafter, BAP progressively decreased until 8 weeks. Urinary NTX was increased soon after the onset of pain with the same patterns in BAP. Urinary NTX values reached a peak at 3 weeks, and then they kept significantly higher values until 8 weeks. The peak value of serum BAP was affected by the duration of bed rest, although that of the urinary NTX was not. The peak values of serum BAP and urinary NTX showed negative correlations with the initial BMD values.
Bone turnover markers remained higher at 8 weeks, even patients symptom was healed after VF. Bone turnover markers were affected on physical activity and BMD.
本研究测量了老年椎体骨折患者骨转换标志物的纵向变化，并研究了骨转换标志物、卧床休息时间和骨密度（BMD）之间的关系。
入选患者的标准为年龄50岁及以上且存在椎体骨折。测量血清骨特异性碱性磷酸酶（BAP）作为骨形成的标志物。测量尿I型胶原交联N末端肽（NTX）作为骨吸收的标志物。原则上，在受伤后即刻、24小时内以及伤后1、2、3、5和8周采集样本。我们还测量了卧床休息时间和骨密度。
研究人群包括42例患者。腰椎的平均骨密度为0.670±0.174g/cm²。卧床休息时间为17.9±8.8天。与基线值相比，BAP在第2周和第3周时显著升高。此后，BAP逐渐下降直至8周。疼痛发作后不久尿NTX升高，其变化模式与BAP相同。尿NTX值在第3周达到峰值，然后直到8周一直保持显著较高水平。血清BAP的峰值受卧床休息时间的影响，而尿NTX的峰值不受影响。血清BAP和尿NTX的峰值与初始骨密度值呈负相关。
即使椎体骨折患者症状已愈合，骨转换标志物在8周时仍保持较高水平。骨转换标志物受身体活动和骨密度的影响。
