Stewart Christopher C, O'Hara Nathan N, Bzovsky Sofia, Bahney Chelsea S, Sprague Sheila, Slobogean Gerard P
Department of Orthopaedic Surgery, University of California, San Francisco, California, USA.
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Bone Joint Res. 2022 Apr;11(4):239-250. doi: 10.1302/2046-3758.114.BJR-2021-0226.R1.
Bone turnover markers (BTMs) follow distinct trends after fractures and limited evidence suggests differential levels in BTMs in patients with delayed healing. The effect of vitamin D, and other factors that influence BTMs and fracture healing, is important to elucidate the use of BTMs as surrogates of fracture healing. We sought to determine whether BTMs can be used as early markers of delayed fracture healing, and the effect of vitamin D on BTM response after fracture.
A total of 102 participants aged 18 to 50 years (median 28 years (interquartile range 23 to 35)), receiving an intramedullary nail for a tibial or femoral shaft fracture, were enrolled in a randomized controlled trial comparing vitamin D supplementation to placebo. Serum C-terminal telopeptide of type I collagen (CTX; bone resorption marker) and N-terminal propeptide of type I procollagen (P1NP; bone formation marker) were measured at baseline, six weeks, and 12 weeks post-injury. Clinical and radiological fracture healing was assessed at three months.
CTX and P1NP concentrations peaked at six weeks in all groups. Elevated six-week CTX and P1NP were associated with radiological healing at 12 weeks post-injury (odds ratio (OR) 10.5; 95% confidence interval 2.71 to 53.5, p = 0.002). We found no association between CTX or P1NP and functional healing. Baseline serum 25(OH)D showed a weak inverse relationship with P1NP (p = 0.036) and CTX (p = 0.221) at 12 weeks, but we observed no association between vitamin D supplementation and either BTM.
Given the association between six-week BTM concentrations and three-month radiological fracture healing, CTX and P1NP appear to be potential surrogate markers of fracture healing. Cite this article: 2022;11(4):239-250.
骨折后骨转换标志物（BTMs）呈现出不同的变化趋势，仅有有限的证据表明愈合延迟患者的BTMs水平存在差异。维生素D以及其他影响BTMs和骨折愈合的因素的作用，对于阐明BTMs作为骨折愈合替代指标的用途至关重要。我们试图确定BTMs是否可作为骨折愈合延迟的早期标志物，以及维生素D对骨折后BTMs反应的影响。
共有102名年龄在18至50岁（中位数28岁（四分位间距23至35岁））的参与者，因胫骨干或股骨干骨折接受髓内钉治疗，他们被纳入一项随机对照试验，该试验比较了维生素D补充剂与安慰剂的效果。在基线、伤后6周和12周时测量血清I型胶原C端肽（CTX；骨吸收标志物）和I型前胶原N端前肽（P1NP；骨形成标志物）。在三个月时评估临床和放射学骨折愈合情况。
所有组的CTX和P1NP浓度在6周时达到峰值。伤后12周时，6周时升高的CTX和P1NP与放射学愈合相关（比值比（OR）10.5；95%置信区间2.71至53.5，p = 0.002）。我们发现CTX或P1NP与功能愈合之间没有关联。基线血清25(OH)D在12周时与P1NP（p = 0.036）和CTX（p = 0.221）呈弱负相关，但我们未观察到维生素D补充剂与任何一种BTM之间存在关联。
鉴于6周时BTM浓度与三个月时放射学骨折愈合之间的关联，CTX和P1NP似乎是骨折愈合的潜在替代标志物。引用本文：2022；11(4)：239 - 250。
