Bone turnover markers as surrogates of fracture healing after intramedullary fixation of tibia and femur fractures
Aims: Bone turnover markers (BTMs) follow distinct trends after fractures and limited evidence suggests differential levels in BTMs in patients with delayed healing. The effect of vitamin D, and other factors that influence BTMs and fracture healing, is important to elucidate the use of BTMs as surr...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2022-04-01
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| Series: | Bone & Joint Research |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.114.BJR-2021-0226.R1 |
| _version_ | 1811218858512482304 |
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| author | Christopher C. Stewart Nathan N. O’Hara Sofia Bzovsky Chelsea S. Bahney Sheila Sprague Gerard P. Slobogean On behalf of Vita-Shock Investigators |
| author_facet | Christopher C. Stewart Nathan N. O’Hara Sofia Bzovsky Chelsea S. Bahney Sheila Sprague Gerard P. Slobogean On behalf of Vita-Shock Investigators |
| author_sort | Christopher C. Stewart |
| collection | DOAJ |
| description | Aims: Bone turnover markers (BTMs) follow distinct trends after fractures and limited evidence suggests differential levels in BTMs in patients with delayed healing. The effect of vitamin D, and other factors that influence BTMs and fracture healing, is important to elucidate the use of BTMs as surrogates of fracture healing. We sought to determine whether BTMs can be used as early markers of delayed fracture healing, and the effect of vitamin D on BTM response after fracture. Methods: A total of 102 participants aged 18 to 50 years (median 28 years (interquartile range 23 to 35)), receiving an intramedullary nail for a tibial or femoral shaft fracture, were enrolled in a randomized controlled trial comparing vitamin D3 supplementation to placebo. Serum C-terminal telopeptide of type I collagen (CTX; bone resorption marker) and N-terminal propeptide of type I procollagen (P1NP; bone formation marker) were measured at baseline, six weeks, and 12 weeks post-injury. Clinical and radiological fracture healing was assessed at three months. Results: CTX and P1NP concentrations peaked at six weeks in all groups. Elevated six-week CTX and P1NP were associated with radiological healing at 12 weeks post-injury (odds ratio (OR) 10.5; 95% confidence interval 2.71 to 53.5, p = 0.002). We found no association between CTX or P1NP and functional healing. Baseline serum 25(OH)D showed a weak inverse relationship with P1NP (p = 0.036) and CTX (p = 0.221) at 12 weeks, but we observed no association between vitamin D supplementation and either BTM. Conclusion: Given the association between six-week BTM concentrations and three-month radiological fracture healing, CTX and P1NP appear to be potential surrogate markers of fracture healing. Cite this article: Bone Joint Res 2022;11(4):239–250. |
| first_indexed | 2024-04-12T07:16:29Z |
| format | Article |
| id | doaj.art-d975f7ee3e8547d9bda31156de960202 |
| institution | Directory Open Access Journal |
| issn | 2046-3758 |
| language | English |
| last_indexed | 2024-04-12T07:16:29Z |
| publishDate | 2022-04-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Research |
| spelling | doaj.art-d975f7ee3e8547d9bda31156de9602022022-12-22T03:42:27ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Research2046-37582022-04-0111423925010.1302/2046-3758.114.BJR-2021-0226.R1Bone turnover markers as surrogates of fracture healing after intramedullary fixation of tibia and femur fracturesChristopher C. Stewart0Nathan N. O’Hara1Sofia Bzovsky2Chelsea S. Bahney3Sheila Sprague4Gerard P. Slobogean5On behalf of Vita-Shock InvestigatorsDepartment of Orthopaedic Surgery, University of California, San Francisco, California, USADepartment of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USADivision of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, CanadaSteadman Philippon Research Institute, Center for Regenerative & Personalized Medicine, Vail, Colorado, USADivision of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, CanadaDepartment of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USAAims: Bone turnover markers (BTMs) follow distinct trends after fractures and limited evidence suggests differential levels in BTMs in patients with delayed healing. The effect of vitamin D, and other factors that influence BTMs and fracture healing, is important to elucidate the use of BTMs as surrogates of fracture healing. We sought to determine whether BTMs can be used as early markers of delayed fracture healing, and the effect of vitamin D on BTM response after fracture. Methods: A total of 102 participants aged 18 to 50 years (median 28 years (interquartile range 23 to 35)), receiving an intramedullary nail for a tibial or femoral shaft fracture, were enrolled in a randomized controlled trial comparing vitamin D3 supplementation to placebo. Serum C-terminal telopeptide of type I collagen (CTX; bone resorption marker) and N-terminal propeptide of type I procollagen (P1NP; bone formation marker) were measured at baseline, six weeks, and 12 weeks post-injury. Clinical and radiological fracture healing was assessed at three months. Results: CTX and P1NP concentrations peaked at six weeks in all groups. Elevated six-week CTX and P1NP were associated with radiological healing at 12 weeks post-injury (odds ratio (OR) 10.5; 95% confidence interval 2.71 to 53.5, p = 0.002). We found no association between CTX or P1NP and functional healing. Baseline serum 25(OH)D showed a weak inverse relationship with P1NP (p = 0.036) and CTX (p = 0.221) at 12 weeks, but we observed no association between vitamin D supplementation and either BTM. Conclusion: Given the association between six-week BTM concentrations and three-month radiological fracture healing, CTX and P1NP appear to be potential surrogate markers of fracture healing. Cite this article: Bone Joint Res 2022;11(4):239–250.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.114.BJR-2021-0226.R1fracturebone turnover markervitamin dctxp1npfracture healingfemur fracturestibiabone turnover markersserumfemoral shaft fracturestype i collagenrandomized controlled trial |
| spellingShingle | Christopher C. Stewart Nathan N. O’Hara Sofia Bzovsky Chelsea S. Bahney Sheila Sprague Gerard P. Slobogean On behalf of Vita-Shock Investigators Bone turnover markers as surrogates of fracture healing after intramedullary fixation of tibia and femur fractures Bone & Joint Research fracture bone turnover marker vitamin d ctx p1np fracture healing femur fractures tibia bone turnover markers serum femoral shaft fractures type i collagen randomized controlled trial |
| title | Bone turnover markers as surrogates of fracture healing after intramedullary fixation of tibia and femur fractures |
| title_full | Bone turnover markers as surrogates of fracture healing after intramedullary fixation of tibia and femur fractures |
| title_fullStr | Bone turnover markers as surrogates of fracture healing after intramedullary fixation of tibia and femur fractures |
| title_full_unstemmed | Bone turnover markers as surrogates of fracture healing after intramedullary fixation of tibia and femur fractures |
| title_short | Bone turnover markers as surrogates of fracture healing after intramedullary fixation of tibia and femur fractures |
| title_sort | bone turnover markers as surrogates of fracture healing after intramedullary fixation of tibia and femur fractures |
| topic | fracture bone turnover marker vitamin d ctx p1np fracture healing femur fractures tibia bone turnover markers serum femoral shaft fractures type i collagen randomized controlled trial |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.114.BJR-2021-0226.R1 |
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