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International Orthopaedics

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01-07-2018 | Original Paper

Imbalanced bone turnover markers and low bone mineral density in patients with osteonecrosis of the femoral head

Authors: Lulu Tian, Seung-Hoon Baek, JinAn Jang, Shin-Yoon Kim

Published in: International Orthopaedics | Issue 7/2018

Abstract

Purpose

There have been few studies investigating the cumulative effect of individual factors related to bone metabolism on the systemic balance between bone formation and resorption in patients with osteonecrosis of the femoral head (ONFH). We investigated bone mineral density (BMD) of lumbar spine and bone turnover markers that reflect systemic bone metabolism.

Methods

Two-hundred twenty patients with ONFH were matched to 220 healthy subjects according to age, gender, and body mass index. ONFH patients were divided into steroid-induced (18%), alcoholic (21%), and idiopathic ONFH (61%) and subgroup analysis was performed to exclude the effect of steroid and malnutrition on bone metabolism. We compared lumbar spine bone mineral density (BMD) between groups and measured serum bone-specific alkaline phosphatase (BALP) and urinary deoxypyridinoline/creatinine (Dpd/Cr) ratio.

Results

Logistic regression analysis revealed low spine BMD was significantly associated with each subgroup of ONFH when compared with that of the control group (odds ratio of 2.27, 4.24, and 1.86 in alcoholic, steroid, and idiopathic ONFH, respectively). The mean value of serum BALP (27.02 U/L) was within the normal reference range while average urine Dpd/Cr ratio (6.24 nM/mM) increased in ONFH group when compared with respective reference range.

Conclusion

Spine BMD decreased and urinary Dpd/Cr ratio increased in patients with non-traumatic ONFH. Further studies will be necessary to identify whether non-traumatic ONFH is merely a regional disease confined to the femoral head or may affect systemic bone metabolism.

Sohn WY, Lee SH, Min KK, Nam HW, Kim HJ (1999) Lipid profile in patients with osteonecrosis of the femoral head. J Korean Orthop Assoc 34:1059–1065

Ha YC, Koo KH, Hwang SC, Kim JR, Park HB, Kim SR, Kim KM (2002) Thrombotic and fibrinolytic abnormality in nontraumatic osteonecrosis of the femoral head. J Korean Orthop Assoc 37:31–35CrossRef

Jones JP Jr (1985) Fat embolism and osteonecrosis. Orthop Clin North Am 16:595–633PubMed

Mont MA, Jones LC, Einhorn TA, Hungerford DS, Reddi AH (1998) Osteonecrosis of the femoral head. Potential treatment with growth and differentiation factors. Clin Orthop Relat Res:S314–335

Radke S, Battmann A, Jatzke S, Eulert J, Jakob F, Schutze N (2006) Expression of the angiomatrix and angiogenic proteins CYR61, CTGF, and VEGF in osteonecrosis of the femoral head. J Orthop Res 24:945–952. https://doi.org/10.1002/jor.20097 CrossRefPubMed

Karsenty G (2000) How many factors are required to remodel bone? Nat Med 6:970–971. https://doi.org/10.1038/79655 CrossRefPubMed

Hernigou P, Beaujean F, Lambotte JC (1999) Decrease in the mesenchymal stem-cell pool in the proximal femur in corticosteroid-induced osteonecrosis. J Bone Joint Surg Br 81:349–355CrossRefPubMed

Hernigou P, Beaujean F (1997) Abnormalities in the bone marrow of the iliac crest in patients who have osteonecrosis secondary to corticosteroid therapy or alcohol abuse. J Bone Joint Surg Am 79:1047–1053CrossRefPubMed

Yeh CH, Chang JK, Ho ML, Chen CH, Wang GJ (2009) Different differentiation of stroma cells from patients with osteonecrosis: a pilot study. Clin Orthop Relat Res 467:2159–2167. https://doi.org/10.1007/s11999-009-0803-0 CrossRefPubMedPubMedCentral

10.

Chang JK, Ho ML, Yeh CH, Chen CH, Wang GJ (2006) Osteogenic gene expression decreases in stromal cells of patients with osteonecrosis. Clin Orthop Relat Res 453:286–292. https://doi.org/10.1097/01.blo.0000238869.99980.b2 CrossRefPubMed

11.

Tingart M, Beckmann J, Opolka A, Matsuura M, Wiech O, Grifka J, Grassel S (2008) Influence of factors regulating bone formation and remodeling on bone quality in osteonecrosis of the femoral head. Calcif Tissue Int 82:300–308. https://doi.org/10.1007/s00223-008-9111-z CrossRefPubMed

12.

Yoo JJ, Song WS, Koo KH, Yoon KS, Kim HJ (2009) Osteogenic abilities of bone marrow stromal cells are not defective in patients with osteonecrosis. Int Orthop 33:867–872. https://doi.org/10.1007/s00264-008-0524-0 CrossRefPubMed

13.

Koo KH, Kim R, Kim YS, Ahn IO, Cho SH, Song HR, Park YS, Kim H, Wang GJ (2002) Risk period for developing osteonecrosis of the femoral head in patients on steroid treatment. Clin Rheumatol 21:299–303. https://doi.org/10.1007/s100670200078 CrossRefPubMed

14.

Matsuo K, Hirohata T, Sugioka Y, Ikeda M, Fukuda A (1988) Influence of alcohol intake, cigarette smoking, and occupational status on idiopathic osteonecrosis of the femoral head. Clin Orthop Relat Res:115–123

15.

World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group. World Health Organ Tech Rep Ser 843:1–129

16.

Kanis JA, Gluer CC (2000) An update on the diagnosis and assessment of osteoporosis with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation. Osteoporos Int 11:192–202CrossRefPubMed

17.

Civitelli R, Armamento-Villareal R, Napoli N (2009) Bone turnover markers: understanding their value in clinical trials and clinical practice. Osteoporos Int 20:843–851. https://doi.org/10.1007/s00198-009-0838-9 CrossRefPubMed

18.

Terreni A, Pezzati P (2012) Biochemical markers in the follow-up of the osteoporotic patients. Clin Cases Miner Bone Metab 9:80–84PubMedPubMedCentral

19.

Lukert BP, Raisz LG (1990) Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 112:352–364CrossRefPubMed

20.

Maurel DB, Boisseau N, Benhamou CL, Jaffre C (2012) Alcohol and bone: review of dose effects and mechanisms. Osteoporos Int 23:1–16. https://doi.org/10.1007/s00198-011-1787-7 CrossRefPubMed

21.

Hofstaetter JG, Wang J, Yan J, Glimcher MJ (2009) The effects of alendronate in the treatment of experimental osteonecrosis of the hip in adult rabbits. Osteoarthr Cartil 17:362–370. https://doi.org/10.1016/j.joca.2008.07.013 CrossRefPubMed

22.

Chen CH, Chang JK, Lai KA, Hou SM, Chang CH, Wang GJ (2012) Alendronate in the prevention of collapse of the femoral head in nontraumatic osteonecrosis: a two-year multicenter, prospective, randomized, double-blind, placebo-controlled study. Arthritis Rheum 64:1572–1578. https://doi.org/10.1002/art.33498 CrossRefPubMed

23.

Agarwala S, Shah S, Joshi VR (2009) The use of alendronate in the treatment of avascular necrosis of the femoral head: follow-up to eight years. J Bone Joint Surg Br 91:1013–1018. https://doi.org/10.1302/0301-620X.91B8.21518 CrossRefPubMed

24.

Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RM (2005) The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am 87:2155–2159. https://doi.org/10.2106/jbjs.d.02959 CrossRefPubMed

25.

Lin T, Yan SG, Cai XZ, Ying ZM (2012) Bisphosphonates for periprosthetic bone loss after joint arthroplasty: a meta-analysis of 14 randomized controlled trials. Osteoporos Int 23:1823–1834. https://doi.org/10.1007/s00198-011-1797-5 CrossRefPubMed

Title: Imbalanced bone turnover markers and low bone mineral density in patients with osteonecrosis of the femoral head
Authors: Lulu Tian
Seung-Hoon Baek
JinAn Jang
Shin-Yoon Kim
Publication date: 01-07-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 7/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-3902-2

At a glance: The STEP trials

Springer Medicine

Imbalanced bone turnover markers and low bone mineral density in patients with osteonecrosis of the femoral head

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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