Article
Investigations on the correlation between different parameters of bone metabolism in serum samples from a larger cohort of orthopedic patients
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Published: | October 23, 2017 |
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Objectives: Bone diseases such as osteoporosis or coxarthrosis play an important role especially in the elderly. Given the continuing high prevalence despite modern prophylaxis and treatment options, basic research efforts are still necessary to better understand the complexity of these pathologies and to improve and to expand the existing prevention and treatment approaches. Thus, the aim of the present study was to prospectively assess a panel of different serum parameters of bone metabolism in a larger patient population in order to evaluate possible relationships between these parameters and to correlate them with clinical data.
Methods: Overall, 216 samples both from the caput and collum femoris from 108 patients, which had to undergo a hip replacement operation due to degenerative or dysplastic coxarthrosis, hip fracture or osteonecrosis, were fixed in formalin, decalcified and embedded in paraffin. From these paraffin blocks sections were prepared and evaluated by means of hematoxylin/eosin staining for the proportion of trabecular bone. Additionally, serum levels of parathyroid hormone (PTH), osteoprotegerin (OPG) and soluble receptor activator of nuclear factor kappa B ligand (sRANKL), as well as the bone formation markers alkaline phosphatase (AP), osteocalcin (OC), total procollagen type 1 intact N-terminal propeptide (TP1NP) and tartrate-resistant acid phosphatase type 5b (TRAP5b) and the bone resorption markers sclerostin and C-telopeptide of type 1 collagen (ICTP) were determined.
Results and Conclusion: A significant relationship was seen between the PTH, OPG and AP values. OPG additionally positively correlated with the sclerostin and TP1NP and inversely with the sRANKL levels. A positive interconnection was also seen between the AP, TRAP5b and OC and between the sclerostin and the ICTP values. Besides, a significant positive correlation was noticed between bone trabecular mass and the ICTP levels and a negative association with the TRAP5b values. In female patients, the OC and TRAPb5 values were significantly higher and the sclerostin and ICTP values as well as the bone trabecular mass significantly lower as compared to the male patients. There was a significant correlation between patient age and the serum PTH, OPG and sclerostin levels and a negative interrelationship with the sRANKL values and bone trabecular mass. Impaired kidney function was associated with higher PTH, OPG, AP, sclerostin and ICTP values. As compared to patients with an osteonecrosis of the hip or with a dysplastic coxarthrosis, patients with an osteoporotic hip fracture displayed significantly higher OPG and distinctly lower sRANKL values.
It could be shown, that gender, age and kidney or respective bone disease are associated with specific changes both in bone mass and in serum parameters of bone metabolism. The study also contributes to a further elucidation of the relationships between the different parameters involved in and reflecting bone metabolism.