Time course of 25(OH)D3 vitamin D3 as well as PTH (parathyroid hormone) during fracture healing of patients with normal and low bone mineral density (BMD)

Abstract

BackgroundUntil now the exact biochemical processes during healing of metaphyseal fractures of healthy and osteoporotic bone remain unclear. Especially the physiological time courses of 25(OH)D3 (Vitamin D) as well as PTH (Parathyroid Hormone) the most important modulators of calcium and bone homeostasis are not yet examined sufficiently. The purpose of this study was to focus on the time course of these parameters during fracture healing.MethodsIn the presented study, we analyse the time course of 25(OH)D3 and PTH during fracture healing of low BMD level fractures versus normal BMD level fractures in a matched pair analysis. Between March 2007 and February 2009 30 patients older than 50 years of age who had suffered a metaphyseal fracture of the proximal humerus, the distal radius or the proximal femur were included in our study. Osteoporosis was verified by DEXA measuring. The time courses of 25(OH)D3 and PTH were examined over an eight week period. Friedmann test, the Wilcoxon signed rank test and the Mann-Withney U test were used as post-hoc tests. A p-value ≤ 0.05 was considered significant.ResultsSerum levels of 25(OH)D3 showed no differences in both groups. In the first phase of fracture healing PTH levels in the low BMD level group remained below those of the normal BMD group in absolute figures. Over all no significant differences between low BMD level bone and normal BMD level bone could be detected in our study.ConclusionsThe time course of 25(OH)D3 and PTH during fracture healing of patients with normal and low bone mineral density were examined for the first time in humans in this setting and allowing molecular biological insights into fracture healing in metaphyseal bones on a molecural level. There were no significant differences between patients with normal and low BMD levels. Hence further studies will be necessary to obtain more detailed insight into fracture healing in order to provide reliable decision criteria for therapy and the monitoring of fracture healing.

Vitamin D and the Athlete: Current Perspectives and New Challenges

“…Vitamin D status is indicative of calcium absorption and bone mineralization [ 80 ], and a considerable expanse of knowledge describes the relationship between vitamin D deficiency and bone health [ 80 – 87 ]. Genetic, environmental, and cultural factors associated with 25[OH]D deficiency [ 88 ] increase the risk of osteoporosis [ 89 ] and are a major contributor to fracture risk [ 90 ].…”

Vitamin D and Fracture Healing: An Ongoing Puzzle

“…Clearly, given the multitude of physiological actions that require or involve vitamin D, including calcium and phosphate metabolism, osteoblast and osteoclast functions [58,115] bone collagen synthesis, and resorption [22] , the role of vitamin D in influencing bone metabolism in health and injury situations is surely a topic of considerable import and one that merits more comprehensive study, before discarding it out of hand. In particular, controlled prospective studies of well-defined samples that consider the state of prevailing calcium metabolism, as well as vitamin D serum and intraosseus levels over carefully considered time frames along with careful monitoring of the fracture healing process [76] may be helpful in efforts to examine any specific role vitamin D may have in optimizing fracture repair, as well as in preventing adverse fracture outcomes. In addition, use of carefully construed fracture and bone repair models that emulate human physiological processes quite closely, plus efforts to examine the role of vitamin D at all stages of the fracture healing process using advanced technologies [86] , plus attempts to discriminate the impact of vitamin D2 measures and supplements from D3 measures and supplements, which are three times more effective [102] may help to advance this present body of contention and ambiguity.…”

“…This latter argument seems reasonable, in light of similar conclusions by Fischer et al [1] , Fentaw et al [6] , and Gomberg et al [75] . However, given that Wolfl et al [76] who examined the time course of vitamin D levels during fracture healing in persons with fractures of healthy bone versus osteoporotic bone over an eight-week period found no intergroup differences, caution is advised in arriving at any conclusion as to whether vitamin D status at the time of fracture can affect fracture healing, or whether vitamin D supplementation is desirable. Although Degli Espositi et al [77] found osteoporosis drug treatment, especially when consistently applied in combination with calcium/vitamin D correlated with a lower risk of both re-fracture and all-cause mortality they do not definitively support a role for vitamin D supplementation in the fracture healing processes [1,67] .…”

Influence of extracorporeal shock wave therapy (ESWT) on bone turnover markers in organisms with normal and low bone mineral density during fracture healing: a randomized clinical trial

“…We found partly significantly different time courses of up-regulation of specific alkaline phosphatase (BAP) and transforming growth factor β1 (TGF-β1), as well as the bone resorption markers crosslinked C-telopeptide of type-I-collagen (β-CTX) and serum band 5 tartrate-resistant acid phosphate (TRAP5b). In addition, the time courses of vitamin D3 and parathyroid hormone (iPTH) have been examined because both parameters are important modulators of calcium and bone homeostasis, but no significant differences could be seen between the groups of normal and low BMD [ 12 ], [ 13 ]. Vitamin D3 and iPTH are affected of other metabolic pathways, thus it is not surprising that an influence of ESWT could not be shown here.…”

“…The time course of bone turnover markers, such as bone alkaline phosphatase (BAP), transforming growth factor β1 (TGF-β1), c-telopeptide of type-I-collagen (β-CTX), serum band 5 tartrate-resistant acid phosphate (TRAP5b), during fracture healing is a diagnostic method, which allows insight into ongoing processes and gives the possibility to recognize early an impaired healing course. A change of time courses of these turnover markers during fracture healing of bones with low BMD has already been observed [ 12 ], [ 13 ], [ 14 ]. In the present study, we want to evaluate whether external stimulation with ESWT has an impact on the healing process in bone with normal and low BMD.…”