Ting Beverlie L, Walley Kempland C, Travison Thomas G, Rozental Tamara D
Seattle Hand Surgery Group, Seattle, WA.
Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
J Hand Surg Am. 2017 Feb;42(2):71-77. doi: 10.1016/j.jhsa.2016.12.003.
To examine whether premenopausal women with distal radius fractures (DRF) have lower levels of 25-hydroxyvitamin D (25[OH]D) and increased levels of serum bone turnover markers (BTM) compared with control subjects without fracture.
Premenopausal women with DRF (n = 20) were prospectively enrolled and compared with age-matched individuals without a fracture (n = 20). Outcome measures included serum levels of 25(OH)D, parathyroid hormone (PTH), markers of bone formation (osteocalcin [OC], N-terminal extension propeptide of type I collagen [P1NP], and bone-specific alkaline phosphatase [BSAP]), and markers of bone resorption (C-terminal telopeptide of type I collagen [CTX]). We assessed associations between BTM and DRF with conditional logistic regression and the utility of markers for fracture prediction with a receiver operator characteristic analysis.
The fracture group and control group were comparable in terms of age at menarche and BMI. Patients who had fractures had significantly greater levels of OC and P1NP, and demonstrated a nonsignificant increase in CTX. Levels of 25(OH)D, PTH, and BSAP were similar between groups. Conditional logistic regression revealed independent associations between DRF and increased levels of OC and CTX. Levels of 25(OH)D and PTH were not associated with DRF. Receiver operator characteristic analyses demonstrated moderate performance for OC, P1NP, BSAP, and CTX in predicting DRF.
Levels of 25(OH)D were not associated with DRF in premenopausal women. However, patients with DRF had increased levels of BTM of formation and resorption. Bone turnover markers may be helpful in predicting future fragility fractures in premenopausal women.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
探讨绝经前桡骨远端骨折（DRF）女性与未骨折的对照受试者相比，其25-羟基维生素D（25[OH]D）水平是否较低，血清骨转换标志物（BTM）水平是否升高。
前瞻性纳入绝经前DRF女性（n = 20），并与年龄匹配的未骨折个体（n = 20）进行比较。观察指标包括血清25(OH)D、甲状旁腺激素（PTH）、骨形成标志物（骨钙素[OC]、I型胶原N端前肽[P1NP]和骨特异性碱性磷酸酶[BSAP]）以及骨吸收标志物（I型胶原C端肽[CTX]）。我们采用条件逻辑回归评估BTM与DRF之间的关联，并通过受试者工作特征分析评估标志物对骨折预测的效用。
骨折组和对照组在初潮年龄和体重指数方面具有可比性。骨折患者的OC和P1NP水平显著更高，CTX水平有非显著性升高。两组间25(OH)D、PTH和BSAP水平相似。条件逻辑回归显示DRF与OC和CTX水平升高之间存在独立关联。25(OH)D和PTH水平与DRF无关。受试者工作特征分析表明，OC、P1NP、BSAP和CTX在预测DRF方面表现中等。
绝经前女性中，25(OH)D水平与DRF无关。然而，DRF患者的骨形成和骨吸收BTM水平升高。骨转换标志物可能有助于预测绝经前女性未来的脆性骨折。
研究类型/证据水平：预后II级
