Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA.
Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Eur Spine J. 2023 May;32(5):1678-1687. doi: 10.1007/s00586-023-07589-5. Epub 2023 Mar 16.
The sole determination of volumetric bone mineral density (vBMD) is insufficient to evaluate overall bone integrity. The accumulation of advanced glycation endproducts (AGEs) stiffens and embrittles collagen fibers. Despite the important role of AGEs in bone aging, the relationship between AGEs and vBMD is poorly understood. We hypothesized that an accumulation of AGEs, a marker of impaired bone quality, is related to decreased vBMD.
Prospectively collected data of 127 patients undergoing lumbar fusion were analyzed. Quantitative computed tomography (QCT) measurements were performed at the lumbar spine. Intraoperative bone biopsies were obtained and analyzed with confocal fluorescence microscopy for fluorescent AGEs, both trabecular and cortical. Spearman's correlation coefficients were calculated to examine relationships between vBMD and fAGEs, stratified by sex. Multivariable linear regression analysis with adjustments for age, sex, body mass index (BMI), race, diabetes mellitus and HbA1c was used to investigate associations between vBMD and fAGEs.
One-hundred and twenty-seven patients (51.2% female, 61.2 years, BMI of 28.7 kg/m) with 107 bone biopsies were included in the final analysis, excluding patients on anti-osteoporotic drug therapy. In the univariate analysis, cortical fAGEs increased with decreasing vBMD at (r = -0.301; p = 0.030), but only in men. In the multivariable analysis, trabecular fAGEs increased with decreasing vBMD after adjusting for age, sex, BMI, race, diabetes mellitus and HbA1c (β = 0.99;95%CI=(0.994,1.000); p = 0.04).
QCT-derived vBMD measurements were found to be inversely associated with trabecular fAGEs. Our results enhance the understanding of bone integrity by suggesting that spine surgery patients with decreased bone quantity may also have poorer bone quality.
仅测定体积骨矿物质密度（vBMD）不足以评估整体骨完整性。晚期糖基化终产物（AGEs）的积累会使胶原蛋白纤维变硬变脆。尽管 AGEs 在骨骼老化中起重要作用，但它们与 vBMD 之间的关系尚不清楚。我们假设，一种骨质量受损的标志物，即 AGEs 的积累，与 vBMD 降低有关。
分析了 127 例行腰椎融合术患者的前瞻性数据。在腰椎进行定量计算机断层扫描（QCT）测量。术中获取骨活检，并使用共聚焦荧光显微镜分析荧光 AGEs，包括小梁和皮质。通过 Spearman 相关系数计算，以检查 vBMD 与 fAGEs 之间的关系，按性别分层。采用多元线性回归分析，调整年龄、性别、体重指数（BMI）、种族、糖尿病和 HbA1c，以探讨 vBMD 与 fAGEs 之间的关系。
最终分析包括 127 名患者（51.2%为女性，61.2 岁，BMI 为 28.7kg/m）的 107 个骨活检，排除了接受抗骨质疏松药物治疗的患者。在单变量分析中，皮质 fAGEs 随 vBMD 降低而增加（r=−0.301；p=0.030），但仅在男性中。在多变量分析中，在调整年龄、性别、BMI、种族、糖尿病和 HbA1c 后，小梁 fAGEs 随 vBMD 降低而增加（β=0.99；95%CI=(0.994,1.000)；p=0.04）。
QCT 衍生的 vBMD 测量值与小梁 fAGEs 呈负相关。我们的结果通过表明骨量减少的脊柱手术患者可能也具有较差的骨质量，从而增强了对骨完整性的理解。
