Department of Orthopedic Surgery, Armed Forces Trauma Center, Armed Forces Capital Hospital, Seongnam, Republic of Korea.
Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, 88 Olympicro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
Sci Rep. 2024 Aug 28;14(1):19974. doi: 10.1038/s41598-024-71024-y.
We aimed to compare the extent of bone turnover suppression between patients with atypical femoral fractures (AFFs) and osteoporotic hip fractures (typical femur fractures, TFFs) using a one-to-one matching strategy. A single-center retrospective comparison of females aged ≥ 60 years who underwent operative treatment for AFFs and TFFs between January 2010 and March 2021 was conducted. Demographic characteristics and clinical data including fracture site, past medical history, bone mineral density (BMD), bisphosphonate (BP) medication history, and serum bone turnover marker (BTM) levels were examined. Moreover, we performed a logistic regression analysis to determine the risk factors for AFFs and a one-to-one matched-pair analysis to compare various BTMs. Overall, 336 consecutive females were included: 113 with AFFs and 213 with TFFs. The mean age, BMI, and lowest BMD T-score were 78.6 years, 22.8 kg/m, and -3.3, respectively. Patients with AFF were younger, had lower BMD, higher BMI, higher prevalence of rheumatoid arthritis, a greater proportion with previous steroid or BP use, and a longer history of BP use than patients with TFF. The 48:48 matched-pair analysis revealed higher serum 25(OH) vitamin-D (30.5 vs 18.2 ng/mL, P < 0.001) and calcium levels (8.8 vs 8.3 ng/dL, P = 0.009) and lower serum CTX levels (0.33 vs 0.54 ng/mL, P = 0.010) in the AFF group than in the TFF group, suggesting a more suppressed bone remodeling. No differences in the other BTM levels were found. Despite identical histories and durations of BP use, the AFF group exhibited lower CTX levels, suggesting more suppressed bone remodeling. This observation leads us to infer that more suppressed bone remodeling, indicated by lower CTX levels, could be linked to the occurrence of AFFs.
我们旨在通过一对一匹配策略比较非典型股骨骨折（AFFs）和骨质疏松性髋部骨折（典型股骨骨折，TFFs）患者的骨转换抑制程度。对 2010 年 1 月至 2021 年 3 月期间因 AFFs 和 TFFs 接受手术治疗的≥60 岁女性进行了单中心回顾性比较。检查了人口统计学特征和临床数据，包括骨折部位、既往病史、骨密度（BMD）、双膦酸盐（BP）用药史和血清骨转换标志物（BTM）水平。此外，我们进行了逻辑回归分析以确定 AFF 的危险因素，并进行了一对一匹配对分析以比较各种 BTM。总共纳入了 336 名连续女性：113 名 AFF 患者和 213 名 TFF 患者。平均年龄、BMI 和最低 BMD T 评分分别为 78.6 岁、22.8kg/m 和-3.3。与 TFF 患者相比，AFF 患者更年轻，BMD 更低，BMI 更高，类风湿性关节炎的患病率更高，以前使用过类固醇或 BP 的比例更高，使用 BP 的时间更长。48:48 配对分析显示，AFF 组的血清 25(OH)维生素-D（30.5 vs 18.2ng/mL，P<0.001）和钙水平（8.8 vs 8.3ng/dL，P=0.009）更高，CTX 水平（0.33 vs 0.54ng/mL，P=0.010）更低，提示骨重塑抑制更明显。其他 BTM 水平无差异。尽管有相同的 BP 使用史和使用时间，但 AFF 组的 CTX 水平较低，提示骨重塑抑制更明显。这一观察结果使我们推断，CTX 水平较低，表明骨重塑抑制更明显，可能与 AFF 的发生有关。
