Institute of Cellular Medicine, Newcastle University, Newcastle, Upon Tyne, UK.
James Cook University Hospital, Middlesbrough, UK.
Osteoporos Int. 2021 Nov;32(11):2267-2277. doi: 10.1007/s00198-021-06001-6. Epub 2021 May 15.
The pathogenesis for low-trauma wrist fractures in men is not fully understood. This study found that these men had evidence of significantly higher bone turnover compared with control subjects. Bone turnover markers were negative predictors of bone mineral density and were a predictor of fracture.
Men with distal forearm fractures have reduced bone density, an increased risk of osteoporosis and of further fractures. The aim of this study was to investigate whether or not men with distal forearm fractures had evidence of altered bone turnover activity.
Fifty eight men with low-trauma distal forearm fracture and 58 age-matched healthy control subjects were recruited. All subjects underwent a DXA scan of the forearm, both hips, and lumbar spine, biochemical investigations, and health questionnaires. Measurements of beta crosslaps (βCTX), procollagen type I N-terminal propeptide (PINP), sclerostin, Dickkopf-1 (Dkk1), and fibroblast growth factor 23 (FGF 23) were made.
Men with fracture had significantly higher PINP than controls at 39.2 ng/ml (SD 19.5) versus 33.4 ng/ml (SD13.1) (p<0.001). They also had significantly higher βCTX at 0.45 ng/ml (SD 0.21) versus 0.37 ng/ml (SD 0.17) (p= 0.037). Fracture subjects had significantly lower aBMD and PINP was a negative predictor of aBMD at the total hip and βCTX a negative predictor of forearm aBMD. Sclerostin was a positive predictor of aBMD at the lumbar spine and hip sites. Sex hormone binding globulin (SHBG) at 37nmol/L (SD 15.0) was lower in fracture cohort compared to 47.9 nmol/L (SD 19.2) (p=0.001) in control. Multiple regression revealed that the best model for prediction of fracture included SHBG, P1NP, and ultra-distal forearm aBMD. The likelihood of distal forearm fracture was decreased by 5.1% for each nmol/L increase in SHBH and by 1.4% for every mg/cm increase in ultra-distal forearm aBMD, but increased by 6.1 % for every ng/ml increase in P1NP. Men in the highest quartile of PINP had a significantly greater likelihood of distal forearm fracture than those in the lowest quartile.
The fracture group had significantly higher PINP and βCTX compared with the control group, and these markers were negative predictors of aBMD at the total hip and forearm sites, respectively. Sclerostin was a positive predictor of the variance of spinal and hip aBMD. Likelihood of forearm fracture was best predicted by a combination of SHBG, PINP, and ultra-distal forearm aBMD. Findings of such cross-sectional data should be treated with caution, as longitudinal studies would be required to confirm or refute them.
研究人员旨在探讨前臂远端骨折男性是否存在骨转换活动改变的证据。
研究共纳入 58 名低创伤性前臂远端骨折男性患者和 58 名年龄匹配的健康对照组。所有受试者均进行了前臂、双侧髋部和腰椎的双能 X 线吸收法骨密度扫描、生化检查和健康问卷调查。检测β胶原交联 C 端肽（βCTX）、I 型前胶原氨基端前肽（PINP）、骨硬化蛋白（Sclerostin）、Dickkopf-1（Dkk1）和成纤维细胞生长因子 23（FGF 23）。
与对照组相比，骨折组的 PINP 显著升高，为 39.2ng/ml（SD 19.5）比 33.4ng/ml（SD 13.1）（p<0.001）。骨折组的 βCTX 也显著升高，为 0.45ng/ml（SD 0.21）比 0.37ng/ml（SD 0.17）（p=0.037）。骨折组的总体髋部和前臂骨密度显著降低，PINP 为骨密度的负预测因子，βCTX 为前臂骨密度的负预测因子。骨硬化蛋白为腰椎和髋部骨密度的正预测因子。与对照组相比，骨折组的性激素结合球蛋白（SHBG）为 37nmol/L（SD 15.0），明显更低，而对照组为 47.9nmol/L（SD 19.2）（p=0.001）。多元回归显示，预测骨折的最佳模型包括 SHBG、P1NP 和超远端前臂骨密度。SHBG 每增加 1nmol/L，骨折风险降低 5.1%，超远端前臂骨密度每增加 1mg/cm，骨折风险降低 1.4%，而 P1NP 每增加 1ng/ml，骨折风险增加 6.1%。PINP 最高四分位数的男性发生远端前臂骨折的可能性明显高于最低四分位数的男性。
与对照组相比，骨折组的 PINP 和 βCTX 明显升高，分别为骨密度的总髋部和前臂部位的负预测因子。骨硬化蛋白为脊柱和髋部骨密度变异的正预测因子。前臂骨折的可能性最好由 SHBG、PINP 和超远端前臂骨密度的组合来预测。这种横断面数据的结果应该谨慎对待，因为需要进行纵向研究来证实或反驳这些结果。
