Characteristics of Bone Turnover in the Long Bone Metaphysis Fractured Patients with Normal or Low Bone Mineral Density (BMD)

Abstract

The incidence of osteoporotic fractures increases as our population ages. Until now, the exact biochemical processes that occur during the healing of metaphyseal fractures remain unclear. Diagnostic instruments that allow a dynamic insight into the fracture healing process are as yet unavailable. In the present matched pair analysis, we study the time course of the osteoanabolic markers bone specific alkaline phosphatase (BAP) and transforming growth factor β1 (TGFβ1), as well as the osteocatabolic markers crosslinked C-telopeptide of type-I-collagen (β-CTX) and serum band 5 tartrate-resistant acid phosphatase (TRAP5b), during the healing of fractures that have a low level of bone mineral density (BMD) compared with fractures that have a normal BMD. Between March 2007 and February 2009, 30 patients aged older than 50 years who suffered a metaphyseal fracture were included in our study. BMDs were verified by dual energy Xray absorptiometry (DXEA) scans. The levels of BTMs were examined over an 8-week period. Osteoanabolic BAP levels in those with low levels of BMD were significantly different from the BAP levels in those with normal BMD. BAP levels in the former group increased constantly, whereas the latter group showed an initial strong decrease in BAP followed by slowly rising values. Osteocatabolic β-CTX increased in the bone of the normal BMD group constantly, whereas these levels decreased significantly in the bone of the group with low BMD from the first week. TRAP5b was significantly reduced in the low level BMD group. With this work, we conduct first insights into the molecular biology of the fracture healing process in patients with low levels of BMD that explains the mechanism of its fracture healing. The results may be one reason for the reduced healing qualities in bones with low BMD.

Age‐related bone loss is associated with FGF21 but not IGFBP1 in healthy adults

“…These results suggest that the FGF21‐associated decline in BMD during ageing might be attributable to a negative balance in bone turnover despite the increase in overall bone remodelling (Demontiero et al., 2012). Our findings are consistent with the increase in both BAP and TRAP5b concentrations, despite a decrease in BMD, in elderly men and women after hip replacement (Habermann, Eberhardt, Feld, Zichner, & Kurth, 2007), implying that bone remodelling and concentrations of bone turnover markers are likely to increase as a compensatory response to the declining BMD in older people (Wölfl et al., 2014).…”

Serum leptin, bone mineral density and the healing of long bone fractures in men with spinal cord injury

“…In addition, the osteoinductive potential of serum leptin showed possible activity in the SCI group and the control group at 16 weeks, which suggested that the positive eff ect of serum leptin on bone formation was related to the level of weight-bearing activities and normal adipose metabolism during fracture healing. Previous studies demonstrated that low BMD bone could be caused by disturbed metabolism of bone remodeling and led to a qualitatively reduced healing process [41]. Here, the same result was found in both control and SCI groups: higher BMD was correlated with better fracture formation.…”

Influence of Ibuprofen on Bone Healing After Colles' Fracture: A Randomized Controlled Clinical Trial

“…Mallmin et al enrolled 16 patients with Colles' fracture and found a minor constant increase of osteocalcin of 1 ng/ml during the 16‐week follow‐up, comparable with our results during 3‐month follow‐up. Wolfl et al included 30 patients with metaphyseal fracture, 14 of them with Colles' fracture. They found CrossLaps increased in the bone of the normal BMD group constantly, whereas these levels decreased significantly in the bone of the group with low BMD from the first week.…”