Department of Orthopedics, The General Hospital of Western Theater Command, Rongdu Avenue No. 270, Chengdu, 610083, China.
Department of Critical Care Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, 570311, China.
BMC Musculoskelet Disord. 2022 May 21;23(1):482. doi: 10.1186/s12891-022-05427-1.
Femoral neck fractures are the worst consequence of osteoporosis (OP), and its early prevention and treatment have become a public health problem. This study aims to investigate the relationship of bone-related biomarkers, femoral neck bone mineral density (BMD) and maximum load (L), selecting the indicator which can reflect femoral neck bone loss and reduced bone strength.
A total of 108 patients were recruited from January 2017 to December 2019. Venous blood samples were collected from patients before total hip replacement, and femoral neck samples were collected during the surgery. Femoral neck BMD, femoral neck L, bone-related markers (serum levels of bone turnover markers, protein expression of type I collagen (COL-I) and osteopontin (OPN) in femoral neck) were all measured and analyzed.
The expression of COL-I in femoral neck were significantly decreased, whereas other markers were all significantly increased with the decreasing of femoral neck BMD and L (P < 0.05). Among them, serum C-terminal telopeptide of type I collagen (CTX) levels and OPN expression of femoral neck were increased in osteopenia. In multiple linear regression analysis, CTX and OPN were both negatively correlated with femoral neck BMD and L, and they were independent factors of femoral neck BMD and L, whereas COL-I was independent factor affecting L (P < 0.05). Besides, CTX was negatively correlated with COL-I (β = -0.275, P = 0.012) and positively correlated with OPN (β = 0.295, P = 0.003).
Compared with other indicators, serum CTX was more sensitive to differences in bone mass and bone strength of femoral neck, and could be considered as surrogate marker for OPN and COL-I.Early measurement of CTX could facilitate the diagnosis of osteopenia and provide a theoretical basis for delaying the occurrence of femoral neck OP and fragility fractures.
股骨颈骨折是骨质疏松症（OP）最严重的后果，其早期预防和治疗已成为公共卫生问题。本研究旨在探讨骨相关生物标志物、股骨颈骨密度（BMD）和最大负荷（L）与股骨颈骨丢失和骨强度降低的关系，选择能反映股骨颈骨丢失和骨强度降低的指标。
本研究共纳入 2017 年 1 月至 2019 年 12 月期间的 108 例患者。患者在全髋关节置换术前采集静脉血样本，术中采集股骨颈样本。测量并分析股骨颈 BMD、股骨颈 L、骨相关标志物（血清骨转换标志物水平、股骨颈Ⅰ型胶原（COL-I）和骨桥蛋白（OPN）的蛋白表达）。
随着股骨颈 BMD 和 L 的降低，COL-I 在股骨颈中的表达显著降低，而其他标志物均显著升高（P<0.05）。其中，在骨质疏松症患者中，血清Ⅰ型胶原 C 端肽（CTX）水平和股骨颈 OPN 表达均升高。多元线性回归分析显示，CTX 和 OPN 均与股骨颈 BMD 和 L 呈负相关，是股骨颈 BMD 和 L 的独立影响因素，而 COL-I 是影响 L 的独立因素（P<0.05）。此外，CTX 与 COL-I 呈负相关（β=-0.275，P=0.012），与 OPN 呈正相关（β=0.295，P=0.003）。
与其他指标相比，血清 CTX 对股骨颈骨量和骨强度的差异更为敏感，可作为 OPN 和 COL-I 的替代标志物。早期测量 CTX 有助于骨质疏松症的诊断，并为延迟股骨颈 OP 和脆性骨折的发生提供理论依据。
