Departments of Trauma Surgery, Leiden University Medical Center, postzone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Internal Medicine, Center for Bone Quality Leiden, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Eur J Trauma Emerg Surg. 2022 Dec;48(6):4857-4865. doi: 10.1007/s00068-022-02017-7. Epub 2022 Jun 16.
Sclerostin inhibits bone formation and stimulates bone resorption. Previous studies found a positive association between bone density and serum sclerostin, but literature on sclerostin levels in osteoporotic fracture patients is scarce. The aim of the present study was to compare the serum sclerostin levels in osteoporotic and non-osteoporotic fracture patients and to assess the correlation of the sclerostin levels with bone mineral density and vitamin D status.
In this cross-sectional study, we included patients over 50 years, with an extremity fracture after low-energy trauma treated between 2012 and 2018, with biobank samples and available bone density measurements by Dual X-ray Absorption. Osteoporosis was diagnosed according the World Health Organisation criteria. Vitamin D deficiency was defined as a 25(OH)D concentration < 30 nmol/L. After defrosting biobank samples, serum sclerostin was measured using the human SOST (sclerostin) enzyme-linked immunosorbent assay kit. We prespecified a subgroup analysis including only female patients.
179 patients were included of whom 139(78%) were female. In 46 patients (25.7%), osteoporosis was diagnosed. Bone mineral density was positively associated with sclerostin levels (r = 0.17, p = 0.026) and patients with osteoporosis had a significantly lower serum sclerostin compared to non-osteoporotic fracture patients (mean 41.9 pmol/L vs 48.1 pmol/L; p = 0.03). This difference remained significant after correction for potential confounders. Similar results were found in the subgroup of female patients. No association between serum sclerostin and vitamin D deficiency was found.
Osteoporotic fracture patients had lower levels of sclerostin than non-osteoporotic fracture patients. Future research should focus on the use of sclerostin as biomarker for osteoporosis in fracture patients.
骨硬化蛋白抑制骨形成并刺激骨吸收。先前的研究发现骨密度与血清骨硬化蛋白之间存在正相关，但关于骨质疏松性骨折患者骨硬化蛋白水平的文献却很少。本研究旨在比较骨质疏松性和非骨质疏松性骨折患者的血清骨硬化蛋白水平，并评估骨硬化蛋白水平与骨密度和维生素 D 状态的相关性。
在这项横断面研究中，我们纳入了 2012 年至 2018 年间因低能量创伤而接受治疗的 50 岁以上四肢骨折患者，这些患者具有生物库样本且可进行双能 X 线吸收法骨密度测量。骨质疏松症根据世界卫生组织标准进行诊断。维生素 D 缺乏定义为 25(OH)D 浓度<30nmol/L。解冻生物库样本后，使用人 SOST（骨硬化蛋白）酶联免疫吸附试剂盒测量血清骨硬化蛋白。我们预先指定了一项仅包括女性患者的亚组分析。
共纳入 179 例患者，其中 139 例（78%）为女性。在 46 例患者（25.7%）中诊断为骨质疏松症。骨密度与骨硬化蛋白水平呈正相关（r=0.17，p=0.026），且骨质疏松性骨折患者的血清骨硬化蛋白水平明显低于非骨质疏松性骨折患者（平均 41.9pmol/L 比 48.1pmol/L；p=0.03）。在校正潜在混杂因素后，这种差异仍然显著。在女性患者的亚组中也发现了类似的结果。血清骨硬化蛋白与维生素 D 缺乏之间无相关性。
骨质疏松性骨折患者的血清骨硬化蛋白水平低于非骨质疏松性骨折患者。未来的研究应集中在将骨硬化蛋白作为骨折患者骨质疏松症的生物标志物上。
