Iizuka Yoichi, Iizuka Haku, Kaneko Tetsuya, Mieda Tokue, Takechi Rumi, Suzuki Hideki, Sorimachi Yasunori, Suto Takahito, Tachibana Masahiro, Yoneyama Tomotaka, Omodaka Takuya, Hashimoto Shogo, Hamano Noritaka, Sakane Hideo, Shimoyama Daisuke, Kohama Isaku, Ohshima Atsufumi, Nozaki Tatsuya, Kamiyama Masataka, Moteki Tomohiko, Ohshima Asuka, Takamine Shuhei, Honda Akira, Ueno Akira, Tajika Tsuyoshi, Okamura Koichi, Warita Toshiro, Yonemoto Yukio, Shitara Hitoshi, Ohsawa Takashi, Takagishi Kenji
Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan.
Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan.
Injury. 2016 Nov;47(11):2484-2489. doi: 10.1016/j.injury.2016.09.031. Epub 2016 Sep 20.
Many previous reports have indicated that atypical femur fractures (AFFs) are associated with the administration of bisphosphonates (BPs). A number of risk factors and hypotheses regarding the pathogenesis of AFFs have been reported to date. The purpose of the present study was to identify the factors associated with AFFs in Japanese individuals and to elucidate the association between bone metabolism and AFFs by evaluating bone turnover markers (BTMs). We prospectively reviewed all patients with femur fractures and identified the patients with AFFs and typical femur fractures (TFFs). We collected the demographic and clinical data that were relevant to the present study, namely age, gender, affected side, affected site, concomitant medical history, and comorbid conditions, and measured the levels of BTMs within 24h after trauma. Welch's test and Fisher's exact probability test were used for the statistical analyses. A total of 338 patients, including 10 patients with AFFs and 328 patients with TFFs, were analyzed under the inclusion criteria. The use of BPs (p<0.001) and collagen disease and chronic granulomatous disease (CD/CGD) (p=0.025) were more frequently observed in patients with AFFs than in patients with TFFs, while the levels of BTMs, including N-terminal propeptides of type 1 procollagen (P1NP), isoform 5b of tartrate-resistant acid phosphatase (TRACP-5b) and undercarboxylated osteocalcin (ucOC) were significantly lower in patients with AFFs than in patients with TFFs. Furthermore, the level of TRACP-5b was found to be significantly lower in patients with atypical subtrochanteric fractures than in atypical diaphyseal fractures (p=0.025). Moreover, the levels of P1NP (p=0.016) and TRACP-5b (p=0.015) were found to be significantly lower in patients with AFFs than in patients with TFFs in a subgroup analysis of BPs users. The use of BPs was considered to be a factor associated with AFFs. Our comparison of the BTMs in patients with AFFs and TFFs indicated that the severe suppression of bone turnover was associated with the pathogenesis of AFFs. The extent of the influence of suppressed turnover on the pathogenesis of AFFs may differ depending on the fracture site.
许多既往报告表明，非典型股骨骨折（AFFs）与双膦酸盐（BPs）的使用有关。迄今为止，已经报道了一些关于AFFs发病机制的危险因素和假说。本研究的目的是确定日本人群中与AFFs相关的因素，并通过评估骨转换标志物（BTMs）来阐明骨代谢与AFFs之间的关联。我们前瞻性地回顾了所有股骨骨折患者，确定了AFFs患者和典型股骨骨折（TFFs）患者。我们收集了与本研究相关的人口统计学和临床数据，即年龄、性别、患侧、患部、伴随病史和合并症，并在创伤后24小时内测量了BTMs水平。采用Welch检验和Fisher精确概率检验进行统计分析。共有338例患者纳入分析，其中AFFs患者10例，TFFs患者328例。与TFFs患者相比，AFFs患者更常使用BPs（p<0.001）以及患有胶原病和慢性肉芽肿病（CD/CGD）（p=0.025），而AFFs患者的BTMs水平，包括I型前胶原N端前肽（P1NP）、抗酒石酸酸性磷酸酶同工型5b（TRACP-5b）和未羧化骨钙素（ucOC），显著低于TFFs患者。此外，发现非典型转子下骨折患者的TRACP-5b水平显著低于非典型骨干骨折患者（p=0.025）。此外，在BPs使用者的亚组分析中，AFFs患者的P1NP（p=0.016）和TRACP-5b（p=0.015）水平显著低于TFFs患者。使用BPs被认为是与AFFs相关的一个因素。我们对AFFs患者和TFFs患者的BTMs比较表明，骨转换的严重抑制与AFFs的发病机制有关。骨转换抑制对AFFs发病机制的影响程度可能因骨折部位而异。
