Łapiński Marcin, Żarnovsky Krystian, Czarzasta Katarzyna, Maciąg Bartosz, Maciąg Grzegorz, Adamska Olga, Mamcarz Artur, Stolarczyk Artur
Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Poland.
Department of Experimental and Clinical Physiology, Medical University of Warsaw, Poland.
Reumatologia. 2024;62(2):121-127. doi: 10.5114/reum/187096. Epub 2024 May 10.
Fracture of the proximal femur is common in elderly patients, in fact threatening their lives. Age-related sarcopenia may be involved in the imbalance resulting in the injury. Handy and readily accessible biochemical tests would be useful to assess the musculoskeletal system condition in daily practice. The aim of the study was to determine whether there is any relation between muscle decay and fracture of the proximal femur and to assess bone quality in elderly patients.
In the study 22 patients who represented the treatment group were hospitalized due to proximal femur fracture. Eighteen patients from the control group with no fracture in their history were admitted to the Internal Medicine Department. Anyone treated for osteoporosis, immune disease affecting protein balance, neoplasm, mental illness, heart failure, or myocardial infarction was excluded from the study. In every case a blood sample from an elbow vein was drawn, collected in EDTA-K2 tubes, and then centrifuged to separate plasma from the whole blood. Subsequently, the concentrations of C-terminal cross-linked telopeptide of type I collagen (CTX-I), sex hormone binding globulin (SHBG) and creatine kinase (CK) in plasma were determined using commercial enzyme-linked immunosorbent assays.
The CK plasma concentration differed between the patient groups ( = 0.011). The SHBG plasma concentration was significantly higher in the treatment group ( = 0.006), whereas a slight difference in CTX-I plasma concentration between the groups was found ( = 0.038). No significant correlations between plasma CK, SHBG or CTX-I were found ( > 0.05).
Creatine kinase is actually not an appropriate marker for the clinical assessment of muscle tissue quality in patients with or at risk of proximal femur fracture. Analyzing the quality of bone tissue, we can conclude it was poorer in patients with proximal femur fracture than in the control group.
股骨近端骨折在老年患者中很常见，实际上会威胁到他们的生命。与年龄相关的肌肉减少症可能参与了导致损伤的失衡过程。简便易用的生化检测方法在日常实践中对于评估肌肉骨骼系统状况会很有用。本研究的目的是确定肌肉衰退与股骨近端骨折之间是否存在任何关联，并评估老年患者的骨质。
在本研究中，22名代表治疗组的患者因股骨近端骨折住院。18名无骨折病史的对照组患者入住内科。任何接受过骨质疏松症、影响蛋白质平衡的免疫疾病、肿瘤、精神疾病、心力衰竭或心肌梗死治疗的患者均被排除在研究之外。在每种情况下，均从肘静脉抽取血样，收集于乙二胺四乙酸二钾（EDTA-K2）管中，然后离心以从全血中分离出血浆。随后，使用商业酶联免疫吸附测定法测定血浆中I型胶原C末端交联肽（CTX-I）、性激素结合球蛋白（SHBG）和肌酸激酶（CK）的浓度。
患者组之间的血浆CK浓度存在差异（P = 0.011）。治疗组的血浆SHBG浓度显著更高（P = 0.006），而两组之间的血浆CTX-I浓度存在轻微差异（P = 0.038）。未发现血浆CK、SHBG或CTX-I之间存在显著相关性（P > 0.05）。
肌酸激酶实际上并非股骨近端骨折患者或有股骨近端骨折风险患者肌肉组织质量临床评估的合适标志物。分析骨组织质量，我们可以得出结论，股骨近端骨折患者的骨组织质量比对照组差。
